bluuebunny/crossref_metadata_2025 huggingface dataset:
Victims of Physical and Sexual Violence
Authors: Ladegard Kristie , Tse Jessica
Published: May 2023

As experts who understand the biological aspects of violence as well as the societal, environmental, and economic conditions that affect health, psychiatrists are uniquely positioned to help prevent violence. This chapter reviews the most current literature regarding the different types of violence that an emergency psychiatric provider may encounter. It suggests clinical recommendations for approaching patients suspected of experiencing interpersonal violence, and it provides guidance in assessment, treatment, and reporting guidelines. In addition, current definitions, statistical data, identification, approach recommendations, and reporting considerations are summarized. Specific types of interpersonal violence discussed include homicide, sexual violence, intimate partner violence, child abuse, human trafficking, and elder abuse.
Documenting Risk Assessments and High-Acuity Discharge Presentations
Authors: Lodhi Shafi
Published: May 2023

Psychiatrists receive substantial training in the assessment of suicidal and homicidal ideation but minimal training in documentation of these assessments. Research has demonstrated that a significant portion of patients seen in a psychiatric emergency room do not have a proper risk assessment documented. There is a gap in the literature in regard to guidelines or practical advice that can help a psychiatrist learn how to document risk assessment in a proper manner. This chapter comprehensively discusses the documentation of risk assessments in the emergency psychiatry setting, with particular emphasis on high-acuity discharge presentations. The chapter first discusses the relevant legal background, the importance of documentation, and the purpose of a risk assessment. Next, it focuses on the practical aspects of documentation, with a discussion of key elements of a risk assessment to document, general guidelines, and specific examples of “do’s and do not’s” of documentation. Finally, the chapter presents a practical guide to quickly documenting a risk assessment. A step-by-step guide is provided, as well as boilerplate text that can serve to help the reader create their own “dot phrase” in order to aid in documentation.
Taking the Pulse
Authors: Feingold Jordyn , Kaplan Carly
Published: May 2023

Burnout, a work-related phenomenon of emotional exhaustion, depersonalization, and low sense of personal accomplishment that interferes with one’s relationship to work, is highly prevalent among medical students in undergraduate medical education (UME) and residents and clinical fellows during graduate medical education (GME). This chapter provides an overview of burnout prevalence, consequences, and correlates in premedical students, medical students, residents, and clinical fellows, both in the United States and globally. While a lack of standardization in measurement poses challenges to accurate and reliable prevalence data across diverse populations, most studies report an approximately 50% prevalence of burnout among medical students, residents, and clinical fellows globally. More robust, systematic, and standardized methodology is needed to enable meaningful comparisons of burnout prevalence by populations across studies.
Components of a Comprehensive Well-Being Program
Authors: Duncan Jennifer G. , Maguire Michael , Slavin Stuart J.
Published: May 2023

A comprehensive well-being program should include multiple components in order to address the multifaceted nature of well-being. Medical students and GME trainees are a heterogenous group with numerous personal factors that impact their well-being while functioning within the larger culture of an institution, which also has a significant influence. As such, well-being initiatives should address both individual-level factors, such as physical and mental health, resilience, and professional growth, as well as institutional or systems factors, such as the learning environment, workload, and culture within teams. This chapter provides for consideration an overview of the component parts of a well-being program with attention to each of these areas of focus.
System-Level Interventions
Authors: Quinn Mariah A. , Banaszak Lauren , McFadden Kathleen , McGrath Kerri Palamara
Published: May 2023

Interventions that address systems of learning and work have the potential to impact learners broadly rather than only at an individual level. Systems-level interventions are essential—on aggregate they have greater impact on burnout than do individual-level interventions. These interventions in general target the learning environment, workplace culture, and workload demands. This chapter provides an overview of types of system-level interventions that are known to be effective for medical students and residents and fellows, as well as areas in which evidence is emerging, including for critical topics such as diversity, equity, and inclusion; learner mistreatment; evaluation and assessment; efficiency and workload; and the learning environment. Specific recommendations for each of these areas are provided.
Diagnosing Your Institution’s Readiness to Address Trainee Well-Being
Authors: Thomas Larissa R. , Kryzhanovskaya Irina , Akhtar Saadia
Published: May 2023

A number of theories regarding change management exist that can help leaders and their institutions thrive amid change by using practical strategies to solve common problems related to clinician well-being. This chapter reviews some theories of change management and describes a practical approach for assessing an organization’s readiness for change to improve well-being. In complex adaptive systems, controlled interventions are rarely feasible, and the dynamic environment means that unintended impacts should be expected and examined. Considerations for successful change management in dynamic systems include identifying stakeholders, building alliances, anticipating roadblocks, and reflecting on progress. While change management is a daunting part of any well-being leader’s job, using a strategic approach to plan, implement, and reflect on change can help an organization successfully progress along a continuum of organizational change for well-being.
Preparing Your Pitch
Authors: Chelminski Paul , Panda Mukta
Published: May 2023

Change in health care organizations requires multiple skills: sophisticated communication, systematic planning, and implementation expertise. Such skills for achieving change are often based on relationships rather than transactions. This chapter outlines the communication skills and organizational approaches needed to prepare an institution for positive change in an environment where health care professionals are the leaders in fulfilling missions of patient care, education, and research. The chapter describes a creative approach to fostering organizational change. The chapter presents tools such as the elevator speech (or pitch) and the Logic Model which, respectively, create institutional awareness and a systematic framework for implementing change. The chapter also reviews developments in communications and psychological sciences from the past 50 years that can catalyze the respectful, inclusive, and productive conversations that motivate teams and drive change.
Initial Steps in Program Development
Authors: Akhtar Saadia , Dua Sakshi , Rosenfield Paul , Ripp Jonathan A.
Published: May 2023

This chapter outlines a stepwise approach to forming an institutional well-being program. It discusses the importance of establishing support and engaging stakeholders, and it highlights the importance of data gathering and conducting a needs assessment. The chapter presents a process for prioritizing efforts and generating a proposal to establish a well-being program. It reviews the development of a mission, vision, purpose, and model for well-being. It examines the governance, organizational, and reporting structure for a comprehensive well-being program. The roles of constituent-based well-being leaders such as undergraduate medical education (UME) well-being champions/directors and graduate medical education (GME) well-being champions/directors are also discussed. The chapter also describes well-being committee structures that provide an opportunity for members to share perspectives and solutions for well-being matters. The chapter also includes the process of instituting policies and guidelines that advance well-being.
Novel Technology and Discoveries: The Future of Physician Well-Being
Authors: Horvath Keith A. , Berry Anne J.
Published: May 2023

Advancements in technology change the way that clinicians practice medicine. The field is ever evolving, and clinicians must learn and implement new approaches to treatment and care delivery. This chapter explores three examples of how new technologies have transformed health care: the transition to electronic health records, adoption of telehealth, and introduction of artificial intelligence. These cases highlight the tension between embracing novel innovations with the need to guard against unintended consequences that result from their adoption. There is also recognition of the need to effectively teach innovation as well as consideration for ways to support clinician well-being when introducing new technologies.
Attending to Medical Student and GME Trainee Well-Being in the Midst of Crisis
Authors: DePierro Jonathan , Peccoralo Lauren , Hurtado Alicia , Akhtar Saadia , Ripp Jonathan A.
Published: May 2023

A major crisis such as a natural disaster, pandemic, or man-made attack can have a major impact on medical student and physician trainee well-being. This chapter details a number of efforts to preserve and promote trainee well-being, including meeting basic needs and safety, robust and supportive communications, psychosocial and mental health support, “on the ground” resources, and support from and for leadership. Basic needs of medical students and trainees during a crisis include housing, transportation, childcare, and resources to maintain physical health and personal safety. Robust and supportive communication includes attention to the purpose of communication, anticipation of needs, addressing of concerns, and sharing of mental health and well-being related resources. Psychosocial and mental health support may include group discussions, one-on-one support, psychiatric care, and spiritual care support. Finally, support for leaders can involve leadership trainings and resources. Strategically supporting medical student and GME trainee needs during a crisis can maintain and enhance their well-being.
The period–luminosity relation for Mira variables in the Milky Way using Gaia DR3: a further distance anchor for H0
Authors: Sanders Jason L
Published: May 2023

Gaia DR3 parallaxes are used to calibrate preliminary period–luminosity relations of O-rich Mira variables in the 2MASS J, H, and Ks bands using a probabilistic model accounting for variations in the parallax zero-point and underestimation of the parallax uncertainties. The derived relations are compared to those measured for the Large and Small Magellanic Clouds, the Sagittarius dwarf spheroidal galaxy, globular cluster members, and the subset of Milky Way Mira variables with VLBI parallaxes. The Milky Way linear JHKs relations are slightly steeper and thus fainter at short period than the corresponding LMC relations, suggesting population effects in the near-infrared are perhaps larger than previous observational works have claimed. Models of the Gaia astrometry for the Mira variables suggest that, despite the intrinsic photocentre wobble and use of mean photometry in the astrometric solution of the current data reduction, the recovered parallaxes should be on average unbiased but with underestimated uncertainties for the nearest stars. The recommended Gaia EDR3 parallax zero-point corrections evaluated at $\nu _\mathrm{eff}=1.25\, \mu \mathrm{m}^{-1}$ require minimal ($\lesssim 5\, \mu \mathrm{as}$) corrections for redder five-parameter sources, but overcorrect the parallaxes for redder six-parameter sources, and the parallax uncertainties are underestimated at most by a factor ∼1.6 at $G\approx 12.5\, \mathrm{mag}$. The derived period–luminosity relations are used as anchors for the Mira variables in the Type Ia host galaxy NGC 1559 to find $H_0=(73.7\pm 4.4)\, \mathrm{km\, s}^{-1}\, \mathrm{Mpc}^{-1}$.
Galaxy morphology classification using multiscale convolution capsule network
Authors: Li Guangping , Xu Tingting , Li Liping , Gao Xianjun , Liu Zhijing , Cao Jie , Yang Mingcun , Zhou Weihong
Published: May 2023

Classification of galaxy morphology is a hot issue in astronomical research. Although significant progress has been made in the last decade in classifying galaxy morphology using deep learning technology, there are still some deficiencies in spatial feature representation and classification accuracy. In this study, we present a multiscale convolutional capsule network (MSCCN) model for the classification of galaxy morphology. First, this model improves the convolutional layers using a multibranch structure to extract the multiscale hidden features of galaxy images. In order to further explore the hidden information in the features, the multiscale features are encapsulated and fed into the capsule layer. Second, we use a sigmoid function to replace the softmax function in dynamic routing, which can enhance the robustness of MSCCN. Finally, the classification model achieves 97 per cent accuracy, 96 per cent precision, 98 per cent recall, and 97 per cent F1-score under macroscopic averaging. In addition, a more comprehensive model evaluation was accomplished in this study. We visualized the morphological features for the part of sample set that used the t-distributed stochastic neighbour embedding (t-SNE) algorithm. The results show that the model has a better generalization ability and robustness, and it can be effectively used in the galaxy morphological classification.
Job exposure matrices for occupational respiratory disease: a narrative review
Authors: Huntley C C , Bhomra P , Walters G I
Published: May 2023

Background

Job exposure matrices (JEMs) are epidemiological tools used to provide estimations of occupational exposures when it is not feasible to complete detailed individual occupational histories.

Aims

To identify and summarize the characteristics of published general population JEMs (GPJEM) of inhalable occupational exposures applied in studies of respiratory disease.

Methods

MEDLINE and EMBASE databases were searched using pre-defined search terms, with screening performed by two independent reviewers to identify studies reporting the use of a GPJEM. JEM creation papers were subsequently identified and reviewed for each individual GPJEM, noting its characteristics in terms of occupational classification system and exposure estimates.

Results

From 728 studies identified in initial searches, 33 GPJEMs of inhalable occupational exposures were identified. Versions of the International Standards Classification of Occupations were the most used occupational classification system. Binary, probability and intensity-based exposure estimates were most frequently reported in GPJEMs.

Conclusions

Selection of a GPJEM to apply in epidemiological research should be based on the exposure(s) of interest, time period of occupations under review, geographical region for intended use, occupation classification system used and the exposure estimate outcome.
Targeting of plasmodesmal proteins requires unconventional signals
Authors: Luna Gabriel Robles , Li Jiefu , Wang Xu , Liao Li , Lee Jung-Youn
Published: May 2023

Effective cellular signaling relies on precise spatial localization and dynamic interactions among proteins in specific subcellular compartments or niches, such as cell-to-cell contact sites and junctions. In plants, endogenous and pathogenic proteins gained the ability to target plasmodesmata, membrane-lined cytoplasmic connections, through evolution to regulate or exploit cellular signaling across cell wall boundaries. For example, the receptor-like membrane protein PLASMODESMATA-LOCATED PROTEIN 5 (PDLP5), a potent regulator of plasmodesmal permeability, generates feed-forward or feed-back signals important for plant immunity and root development. However, the molecular features that determine the plasmodesmal association of PDLP5 or other proteins remain largely unknown, and no protein motifs have been identified as plasmodesmal targeting signals. Here, we developed an approach combining custom-built machine-learning algorithms and targeted mutagenesis to examine PDLP5 in Arabidopsis thaliana and Nicotiana benthamiana. We report that PDLP5 and its closely related proteins carry unconventional targeting signals consisting of short stretches of amino acids. PDLP5 contains 2 divergent, tandemly arranged signals, either of which is sufficient for localization and biological function in regulating viral movement through plasmodesmata. Notably, plasmodesmal targeting signals exhibit little sequence conservation but are located similarly proximal to the membrane. These features appear to be a common theme in plasmodesmal targeting.
The longitudinal study of muscle changes with ultrasound: differential changes in idiopathic inflammatory myopathy subgroups
Authors: Paramalingam Shereen , Needham Merrilee , Bulsara Max , Mastaglia Frank L , Keen Helen I
Published: May 2023

Objectives

We investigated shear wave elastography (SWE), B mode US and power Doppler (PDUS) as imaging biomarkers for longitudinal follow-up in idiopathic inflammatory myopathy (IIM), with a particular focus on immune-mediated necrotizing myopathy (IMNM) and DM.

Methods

Participants had serial SWE, PDUS on the deltoid (D) and vastus lateralis (VL) muscles on four occasions at intervals of 3–6 months. Clinical assessments included manual muscle testing, and patient- and physician-reported outcome scales.

Results

Thirty-three participants were included: IMNM = 17, DM = 12, overlap myositis = 3, PM = 1. Twenty were in a prevalent clinic group, and 13 were recently treated cases in an incident group. Differential changes in SWS and US domains occurred with time in both the prevalent and incident groups. In the VL-prevalent subgroup, echogenicity increased over time (P = 0.040), while in the incident cases there was a trend for reduction to normal over time (P = 0.097) with treatment. Muscle bulk reduced in the D-prevalent subgroup over time (P = 0.096), suggesting atrophy. SWS also reduced in the VL-incident subgroup over time (P = 0.096), suggesting a trend towards improvement in muscle stiffness with treatment.

Conclusion

SWE and US appear promising as imaging biomarkers for patient follow-up in IIM and indicate changes over time, especially with echogenicity, muscle bulk and SWS in the VL. Due to the limitations of the participant numbers, additional studies with a larger cohort are needed to help evaluate these US domains further and outline specific characteristics within the IIM subgroups.
A teaching concept for school experiments on radioactivity using augmented reality methods
Authors: Schuette Charlotte , Streuber Marcus , Pottgiesser Vivien , Preim Bernhard , Saalfeld Patrick , Vahlbruch Jan-Willem , Walther Clemens
Published: May 2023

Digital media are becoming increasingly influential in society, especially among the younger generation. Therefore, an augmented reality (AR) app was developed that simulates experiments with radioactive sources. The app runs experiments on the range and penetration power of alpha, beta and gamma radiation. It assigns virtual radiation sources, shielding materials or a detector to printed image markers, and superimposes their 3D images on the camera image. Alpha, beta and gamma radiation are clearly distinguishable by choosing different visualizations. The detector displays the measured count rates. At school, the app can be used in different ways. A concept for a teaching unit in Grade 10 was developed and tested in several classes based on a prototype of the app. The learning progress from the AR experiments was examined. Furthermore, an evaluation of the app was carried out. The most recent version of the app can be found here: https://seafile.projekt.uni-hannover.de/d/dd033aaaf5df4ec18362/
Experiences with accreditation for radon measurement laboratories
Authors: Wiedner Hannah , Rupp Christian
Published: May 2023

The adoption of the Council Directive 2013/59/EURATOM into Austrian national law generated new challenges for businesses, authorities and measurement services. The law defines radon priority regions in which all employers are obliged to hire an authorised radon-monitoring service to determine radon activity concentration at workplaces in basements and on ground floors. In this paper, an overview of our experiences with the process of becoming an accredited and authorised radon-monitoring body using integrating and time-resolved radon measurement equipment is given. The main challenges to overcome, such as determination of measurement uncertainty, conducting metrologically traceable calibration of the track-etch detector system, information not covered by ISO 11665-1, ISO 11665-4 and ISO 11665-5, availability of proficiency tests, etc., are described. This paper aims to be a guideline for laboratories seeking accreditation in the field of radon activity concentration measurements.
Information on cosmic radiation received by Belgian aircrew: a survey
Authors: Pepin Stéphane , Fremout An , Leonard Sophie , Radulovic Sarah , Vanaudenhove Thibault
Published: May 2023

Exposure of aircrew to cosmic radiation had already been identified as an issue of concern in the European BSS of 1996 which requested airlines to assess the exposure of the crew and to inform their workers of the health risks their work involves. These requirements have been implemented in Belgian regulations in 2001 and updated with the transposition of the 2013/59/Euratom directive. Dosimetry data show that aircrew is the group of workers, which contributes the most to the collective dose of occupationally exposed workers in Belgium. In order to verify the extent of the information received by Belgian aircrew regarding their exposure to cosmic radiation, FANC, the Belgian radiation protection authority, launched in 2019 a large survey in collaboration with the Belgian Cockpit Association (BeCA), the professional association representing airline pilots in Belgium. The survey included 8 questions regarding the information of aircrew on cosmic radiation in general, on the individual dose level and on the risk related to exposure during pregnancy. A total of about 400 responses to the survey were received. Overall, the survey reveals that aircrew members in Belgium receive too little information about the potential risks, that they are not sufficiently informed about their own exposure and that female staff members are insufficiently informed about the hazards for the unborn child in case of pregnancy, and 66% of the respondents answered that their employer has never informed them about their exposure to cosmic radiation. However, most are aware of this phenomenon, either because they have looked up information or because they have discussed the topic with colleagues and professional associations. The results also showed that 17% of female crew continued to fly while being pregnant. Finally, the survey also allowed to identify differences and similarities between different groups of workers: cockpit and cabin crew, men and women. For instance, cabin crew was even less informed about their individual exposure than cockpit crew.
Simple one-parameter function to retrieve the correct exposure value from CR-39 radon detectors in high-saturation regime. Checks on two kinds of analysis systems
Authors: Marchese Rocco , Nicolino Antonella , Palma Achille , Procopio Salvatore
Published: May 2023

Radon activity concentration measurements in air can be easily performed by using CR-39 detectors whose response is almost linear in the range of medium–low exposures. However, when the exposure values grow too much, a saturation phenomenon becomes relevant and some corrections have to be adopted even if they cannot always be very accurate and easy to apply. Therefore, a simple alternative method for determining the correct response curve of the CR-39 detectors, from low up to very high radon exposures, is showed. To verify its robustness and the general applicability, several certified measurements were carried out in a radon chamber at different levels of exposure. Moreover, two different types of commercially available radon analysis systems were used.
Public exposure to artificial optical radiation in the aesthetics and the entertainment sector in Greece. Risk management actions
Authors: Petri Aspasia , Karabetsos Efthymios
Published: May 2023

Safety issues are raised from the use of low- and high-power optical radiation sources, both laser and non-laser, by non-experts for aesthetic and entertainment purposes. The Greek Atomic Energy Commission relied on the ISO 31000:2018 framework to manage the public exposure risk to such cases. Risk was evaluated as (1) intolerable for lasers and intense pulsed light sources at aesthetic procedures and in the case of laser pointers, (2) severe for lasers at laser shows and (3) moderate for light-emitting diodes (LEDs) at aesthetic procedures, home-use intense pulsed light sources/LEDs and laser/LED projectors. Operators’ training, public awareness campaigns, intensive market surveillance actions and the enhancement of the regulatory framework have been proposed as risk treatment/control measures and have been prioritised in this order, according to their effectiveness in reducing the exposure risk and their urgency of implementation. The Greek Atomic Energy Commission developed public awareness campaigns regarding exposure safety to laser and non-laser light sources at aesthetic procedures and the use of laser pointers.
Operational radiation protection challenges for the LHC experiments
Authors: Bozzato Davide , Froeschl Robert , Kouskoura Vasiliki
Published: May 2023

Radiation protection physicists at CERN are often required to assess residual activation for the Large Hadron Collider (LHC) experiments during stop periods in order to ensure adequate optimization during planned exposure situations and to establish proper procedures for the radiological control of materials. Given the complexity of the facilities and of the high-energy and mixed fields inducing the activation, Monte Carlo transport codes are an essential tool to simulate both prompt and residual radiation. The present work highlights the challenges of assessing residual dose rates for the LHC experiments in shutdown configurations and of establishing residual activation zonings. For the latter, a method based on fluence conversion coefficients was developed and is efficiently employed. The practical example of the assessment of the activation of the 600 tons of austenitic stainless steel in the future Compact Muon Solenoid (CMS) High Granularity Calorimeter will be used to demonstrate how these challenges are dealt with and the capabilities of the method developed.
The European NORM Association (ENA)—promoting radiation protection in the field of norm in Europe
Authors: Gellermann Rainer , Ahrens Christian , Friedreich Susanne , Kunze Christian , Pepin Stéphane , Van Bochove Lonneke , Wiegers Rob
Published: May 2023

The European NORM Association (ENA) was founded in 2017, merging previously informal European networks. It has the statute of an International Non-profit Organization established under Belgian Law. The objective of ENA is to promote and advance radiation protection in the context of exposure to NORM. It operates as a European platform and forum for discussion, dissemination and exchange of information, training and education and by supporting scientific knowledge and new directions of research related to NORM issues. A key activity of ENA is to share practical solutions. To this end, ENA gathers radiation protection practitioners, regulators, scientists and industry representatives in order to support the management of NORM in compliance with European standards and according to best practices. Since its foundation, ENA has organized three workshops where topical issues on NORM have been discussed. It has established close working relationships and links with IAEA, HERCA, IRPA and other international initiatives—getting a recognition at international level. ENA has set up working groups on NORM in the industry, in the environment, in building materials and, as recently as in 2021, a working group on decommissioning of NORM facilities. A series of webinars have been organized to present case studies on NORM decommissioning and discuss associated challenges and practical solutions.
The Kids Are Still Not Alright
Authors: Kirton Carl A.
Published: May 2023

We have a crisis in child and adolescent health in this country.
New Delivery Route for Furosemide in Heart Failure
Authors: Aschenbrenner Diane S.
Published: May 2023

A new delivery mechanism provides subcutaneous infusion of furosemide to treat fluid overload in adults with heart failure.
Web-Guided Self-Treatment of Benign Paroxysmal Positional Vertigo
Authors: Rosenberg Karen
Published: May 2023

According to this study:

A randomized clinical trial demonstrated the efficacy of a web-guided self-treatment system for recurrent benign paroxysmal positional vertigo.

This system can play an important role in telemedicine for vestibular disorders.
Telemonitoring, Nurse Telephone Coaching Helpful in Post discharge Management of Patients with Heart Failure
Authors: Rosenberg Karen
Published: May 2023

According to this study:

Noninvasive telemonitoring and nurse telephone coaching improved survival and days out of the hospital in patients who had heart failure and a high comorbidity burden.

Patients with multiple other health problems may be the most likely to benefit from this approach.
Aspirin Noninferior to Low-Molecular-Weight Heparin for Thromboprophylaxis After Fracture
Authors: Rosenberg Karen
Published: May 2023

According to this study:

Thromboprophylaxis with aspirin was noninferior to low-molecular-weight heparin for preventing fatal events in patients with orthopedic trauma.

The incidence of deep vein thrombosis, pulmonary embolism, and death at 90 days was low in both groups.
Direct oral anticoagulant drugs for the management of venous thromboembolism
Authors: Thanavaro Joanne L.
Published: May 2023

Direct oral anticoagulants (DOACs) are effective for both prevention and treatment of venous thromboembolism (VTE) and have favorable safety in comparison with warfarin. Although drug-drug interactions with DOACs are not as frequent as with warfarin, certain drugs can interfere with DOAC metabolism, affect DOAC efficacy, and potentially cause adverse reactions when used in combination with DOACs. The NP must determine which agent is most beneficial for the individual patient with VTE based on a number of factors. A knowledge of periprocedural management of DOACs will assist the NP in providing a smooth transition for patients undergoing minor and major procedures and surgeries.
Implementing Effective Interventions Against Workplace Violence
Authors: Shane Escue Jennifer , Gutierrez Felipe , Rebecca Batts Jenny , Lumagui Melvin , Oloan Virtud
Published: May 2023

Workplace violence (WPV) is widespread and increasing in health care organizations. The purpose of this performance improvement (PI) project was to understand what measures could effectively be implemented to decrease the incidence of WPV events in an acute inpatient health care facility. The A3 problem-solving methodology was utilized. The current state and countermeasures to decrease gaps in the current processes were examined. The methodology engaged all stakeholders in problem-solving and continuous improvement. PI members implemented the house-wide interventions in January 2019 and in financial year 2019 assault with injuries decreased to 39. Further research is needed to support effective interventions against WPV.
Evaluation of a Nurse-Driven Fluid Management Protocol to Improve Outcomes in Critically Ill Patients
Authors: Barstow Loraine , Tola Denise H. , Smallheer Benjamin
Published: May 2023

This article reports results of a nurse-driven fluid management protocol in a medical-surgical intensive care unit (ICU). Use of static measures such as central venous pressure monitoring, heart rate, blood pressure, and urine output is poor predictors of fluid responsiveness and can result in inappropriate fluid administration. Indiscriminate administration of fluid can result in prolonged mechanical ventilation time, increased vasopressor requirements, increased length of stay, and greater costs. Use of dynamic preload parameters such as stroke volume variation (SVV), pulse pressure variation, or changes in stroke volume with a passive leg raise has been shown to be more accurate predictors of fluid responsiveness. Improved patient outcomes including decreased length of hospital stay, reduction in kidney injury, decreased mechanical ventilation time and requirements, and reduced vasopressor requirements have been demonstrated by using dynamic preload parameters. ICU nurses were educated on cardiac output and dynamic preload parameters and a nurse-driven fluid replacement protocol was established. Knowledge scores, confidence scores, and patient outcomes were measured pre- and post-implementation. The results indicated that there was no change in knowledge scores between pre- and postimplementation groups (mean = 80%). There was a statistically significant increase in nurse confidence in using SVV (P = .003); however, this change is not clinically significant. There was no statistically significant difference in other confidence categories. The study indicated that ICU nurses were resistant to adoption of a nurse-driven fluid management protocol. While anesthesia clinicians are familiar with technologies to evaluate fluid responsiveness in the perioperative setting, the new technology posed challenges to ICU confidence. This project demonstrates that traditional methods of nursing education did not provide the support needed for implementation of a novel approach to fluid management, and that there is a need for further improvement in educational strategies.
Performance of ChatGPT on the pharmacist licensing examination in Taiwan
Authors: Wang Ying-Mei , Shen Hung-Wei , Chen Tzeng-Ji
Published: May 2023

Background:

ChatGPT is an artificial intelligence model trained for conversations. ChatGPT has been widely applied in general medical education and cardiology, but its application in pharmacy has been lacking. This study examined the accuracy of ChatGPT on the Taiwanese Pharmacist Licensing Examination and investigated its potential role in pharmacy education.

Methods:

ChatGPT was used on the first Taiwanese Pharmacist Licensing Examination in 2023 in Mandarin and English. The questions were entered manually one by one. Graphical questions, chemical formulae, and tables were excluded. Textual questions were scored according to the number of correct answers. Chart question scores were determined by multiplying the number and the correct rate of text questions. This study was conducted from March 5 to March 10, 2023, by using ChatGPT 3.5.

Results:

The correct rate of ChatGPT in Chinese and English questions was 54.4% and 56.9% in the first stage, and 53.8% and 67.6% in the second stage. On the Chinese test, only pharmacology and pharmacochemistry sections received passing scores. The English test scores were higher than the Chinese test scores across all subjects and were significantly higher in dispensing pharmacy and clinical pharmacy as well as therapeutics.

Conclusion:

ChatGPT 3.5 failed the Taiwanese Pharmacist Licensing Examination. Although it is not able to pass the examination, it can be improved quickly through deep learning. It reminds us that we should not only use multiple-choice questions to assess a pharmacist’s ability, but also use more variety of evaluations in the future. Pharmacy education should be changed in line with the examination, and students must be able to use AI technology for self-learning. More importantly, we need to help students develop humanistic qualities and strengthen their ability to interact with patients, so that they can become warm-hearted healthcare professionals.
Reassessing the survival benefit of deceased donor liver transplantation – retrospective cohort study
Authors: Malamon John S. , Kaplan Bruce , Jackson Whitney E. , Saben Jessica L. , Schold Jesse D. , Pomfret Elizabeth A. , Pomposelli James J.
Published: May 2023

Introduction:

Currently in the United States, deceased donor liver transplant (DDLT) allocation priority is based on the Model for End-Stage Liver Disease including sodium (MELD-Na) score. The United Network for Organ Sharing’s “Share-15” policy states that candidates with MELD-Na scores of 15 or greater have priority to receive local organ offers compared to candidates with lower MELD-Na scores. Since the inception of this policy, major changes in the primary etiologies of end-stage liver disease have occurred and previous assumptions need to be recalibrated.

Methods:

We retrospectively analyzed the Scientific Registry of Transplant Recipients database between 2012 and 2021 to determine life years saved by DDLT at each interval of MELD-Na score and the time-to-equal risk and time-to-equal survival versus remaining on the waitlist. We stratified our analysis by MELD exception points, primary disease etiology, and MELD score.

Results:

On aggregate, compared to remaining on the waitlist, a significant one-year survival advantage of DDLT at MELD-Na scores as low as 12 was found. The median life-years saved at this score after liver transplant was estimated to be greater than 9 years. While the total life years saved were comparable across all MELD-Na scores, the time-to-equal risk and time-to-equal survival decreased exponentially as MELD-Na scores increased.

Conclusion:

Herein we challenge the perception as to the timing of DDLT and when that benefit occurs. National liver allocation policy is transitioning to a continuous distribution framework and these data will be instrumental to defining the attributes of the continuos allocation score.
Significance of Shear Wave Dispersion Slope Values Before Versus After Biliary Drainage in Patients With Obstructive Jaundice
Authors: Sugiura Ryo , Kuwatani Masaki , Nishida Mutsumi , Satoh Megumi , Kawakubo Kazumichi , Kato Shin , Hirata Koji , Nakajima Masahito , Hirata Hajime , Takishin Yunosuke , Sakamoto Naoya
Published: May 2023

The shear wave dispersion (SWD) slope has become available in the clinical practice and is related to tissue viscosity. However, clinical evaluation using SWD was not yet performed for obstructive jaundice. We aimed to evaluate the change of SWD values between before and after biliary drainage in patients with obstructive jaundice. This prospective observational cohort study evaluated 20 patients with obstructive jaundice who underwent biliary drainage. The SWD and liver elasticity values were measured before versus after biliary drainage, comparing between days −5 and 0 (day 0), days 1 and 3 (day 2), and days 6 and 8 (day 7). The mean ± SD values of SWD measured at day 0, day 2, and day 7 were 15.3 ± 2.7, 14.2 ± 3.3, and 13.3 ± 2.4 m/s/kHz, respectively. Dispersion slope values were decreased significantly from day 0 to day 2, from day 2 to day 7, and from day 0 to day 7 (P < 0.05). Liver elasticity levels and serum hepatobiliary enzymes were additionally decreased significantly over time after biliary drainage. The correlations between SWD and liver elasticity values were strong (r = 0.91, P < 0.01). In conclusion, the SWD values decreased significantly over time after biliary drainage concomitant with liver elasticity.
Genomic epidemiology of Staphylococcus aureus isolated from bloodstream infections in South America during 2019 supports regional surveillance
Authors: Di Gregorio Sabrina , Vielma Jesús , Haim María Sol , Rago Lucía , Campos Josefina , Kekre Mihir , Abrudan Monica , Famiglietti Ángela , Canigia Liliana Fernandez , Rubinstein Gabriela , Helena von Specht Martha , Herrera Melina , Aro Carolina , Galas Marcelo , Yarhui Norah Balderrama , Figueiredo Agnes , Lincopan Nilton , Falcon Miryan , Guillén Rosa , Camou Teresa , Varela Gustavo , Aanensen David M. , Argimón Silvia , Mollerach Marta ,   on behalf of StaphNET-SA consortium
Published: May 2023

Staphylococcus aureus

remains one of the leading causes of infections worldwide and a common cause of bacteraemia. However, studies documenting the epidemiology of

S. aureus

in South America using genomics are scarce. We hereby report on the largest genomic epidemiology study to date of both methicillin-resistant

S. aureus

(MRSA) and methicillin-susceptible

S. aureus

(MSSA) in South America, conducted by the StaphNET-SA network. We characterised 404 genomes recovered from a prospective observational study of

S. aureus

bacteraemia in 58 hospitals from Argentina, Bolivia, Brazil, Paraguay and Uruguay between April and October 2019. We show that a minority of

S. aureus

isolates are phenotypically multi-drug resistant (5.2%), but more than a quarter are resistant to macrolide–lincosamide–streptogramin B (MLSb). MSSA were more genetically diverse than MRSA. Lower rates of associated antimicrobial resistance in community-associated(CA)-MRSA versus hospital-associated (HA)-MRSA were found in association with three

S. aureus

genotypes dominating the MRSA population: CC30-MRSA-IVc-t019-lukS/F-PV+, CC5-MRSA-IV-t002-lukS/F-PV- and CC8-MRSA-IVc-t008-lukS/F-PV+-COMER+. These are historically from a CA origin, carry on average fewer antimicrobial resistance determinants, and often lack key virulence genes. Surprisingly, CC398-MSSA-t1451-lukS/F-PV- related to the CC398 human-associated lineage is widely disseminated throughout the region, and is described here for the first time as the most prevalent MSSA lineage in South America. Moreover, CC398 strains carrying ermT (largely responsible for the MLSb resistance rates of MSSA strains: inducible iMLSb phenotype) and sh_fabI (related to triclosan resistance) were recovered from both CA and HA origin. The frequency of MRSA and MSSA lineages differed between countries but the most prevalent

S. aureus

genotypes are high-risk clones widely distributed in the South American region without a clear country-specific phylogeographical structure. Therefore, our findings underline the need for continuous genomic surveillance by regional networks such as StaphNET-SA. This article contains data hosted by Microreact.
Multi-Scale Label-free Human Brain Imaging with Integrated Serial Sectioning Polarization Sensitive Optical Coherence Tomography and Two-Photon Microscopy
Authors: Chang Shuaibin , Yang Jiarui , Novoseltseva Anna , Fu Xinlei , Li Chenglin , Chen Shih-Chi , Augustinack Jean C. , Magnain Caroline , Fischl Bruce , Mckee Ann C. , Boas David A. , Chen Ichun Anderson , Wang Hui
Published: May 2023

The study of neurodegenerative processes in the human brain requires a comprehensive understanding of cytoarchitectonic, myeloarchitectonic, and vascular structures. Recent computational advances have enabled volumetric reconstruction of the human brain using thousands of stained slices, however, tissue distortions and loss resulting from standard histological processing have hindered deformation-free reconstruction of the human brain. The development of a multi-scale and volumetric human brain imaging technique that can measure intact brain structure would be a major technical advance. Here, we describe the development of integrated serial sectioning Polarization Sensitive Optical Coherence Tomography (PSOCT) and Two Photon Microscopy (2PM) to provide label-free multi-contrast imaging, including scattering, birefringence and autofluorescence of human brain tissue. We demonstrate that high-throughput reconstruction of 4×4×2cm3sample blocks and simple registration of PSOCT and 2PM images enable comprehensive analysis of myelin content, vascular structure, and cellular information. We show that 2μmin-plane resolution 2PM images provide microscopic validation and enrichment of the cellular information provided by the PSOCT optical property maps on the same sample, revealing the sophisticated capillary networks and lipofuscin filled cell bodies across the cortical layers. Our method is applicable to the study of a variety of pathological processes, including demyelination, cell loss, and microvascular changes in neurodegenerative diseases such as Alzheimer’s disease (AD) and Chronic Traumatic Encephalopathy (CTE).
Sex and gonadectomy modify behavioral seizure susceptibility and mortality in a repeated low-dose kainic acid systemic injection paradigm in mice
Authors: Lawande Niraj V. , Conklin Elisabeth A. , Christian-Hinman Catherine A.
Published: May 2023

Objective

Sex differences in epilepsy appear driven in part due to effects of gonadal steroids, with varying results in experimental models based on species, strain, and method of seizure induction. Furthermore, removing a main source of these steroids via gonadectomy may impact seizure characteristics differently in males and females. Repeated low-dose kainic acid (RLDKA) systemic injection paradigms were recently shown to reliably induce status epilepticus (SE) and hippocampal histopathology in C57BL/6J mice. Here, we investigated whether seizure susceptibility in a RLDKA injection protocol exhibits a sex difference, and whether gonadectomy differentially influences response to this seizure induction paradigm in males and females.

Methods

Adult C57BL/6J mice were left gonad-intact as controls or gonadectomized (females: ovariectomized, OVX; males: orchidectomized, ORX). At least 2 weeks later, KA was injected i.p. every 30 minutes at 7.5 mg/kg or less until the animal reached SE, defined by at least 5 generalized seizures (GS, Racine stage 3 or higher). Parameters of susceptibility to GS induction, SE development, and mortality rates were quantified.

Results

No differences in seizure susceptibility or mortality were observed between control males and control females. ORX males exhibited increased susceptibility and reduced latency to both GS and SE, but OVX females exhibited increased susceptibility and reduced latency to SE only. However, ORX males, but not OVX females, exhibited strongly increased seizure-induced mortality.

Significance

The RLDKA protocol is notable for its efficacy in inducing SE and seizure-induced histopathology in C57BL/6J mice, the background for many transgenic strains in current use in epilepsy research. The present results indicate that this protocol may be beneficial for investigating the effects of gonadal hormone replacement on seizure susceptibility, mortality, and seizure-induced histopathology, and that gonadectomy unmasks sex differences in susceptibility to seizures and mortality not observed in gonad-intact controls.
Concurrent loss of ciliary genesWDR93andCFAP46in phylogenetically distant birds
Authors: Girish Salve Buddhabhushan , Kurian Amia Miriam , Vijay Nagarjun
Published: May 2023

The respiratory system is the primary route of infection for many contagious pathogens. Mucociliary clearance of inhaled pathogens is an important innate defense mechanism sustained by the rhythmic movement of epithelial cilia. To counter host defenses, viral pathogens target epithelial cells and cilia. For instance, the influenza virus modulates the expression ofWDR93, a central ciliary apparatus C1d projection component. Lineage-specific prevalence of such host defense genes results in differential susceptibility. Our comparative analysis of ∼500 vertebrate genomes supports the widespread conservation ofWDR93. However, we identified loss of theWDR93in landfowl, geese, and other phylogenetically-independent bird species. Notably, species withWDR93loss have concurrently lost another C1d component,CFAP46, through large segmental deletions. Understanding the consequences of such gene loss may provide insight into their role in host-pathogen interactions and benefit global pathogen surveillance efforts by prioritizing species missing host defense genes and identifying putative zoonotic reservoirs.