bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of meat composition, tenderness and the fatty acid profile of three muscles from Holstein-Friesian bulls from production system resulting in final ages of either <16 or 19 months
Authors: Nian Y. , Moloney A. P. , Li C. , Allen P. , Harrison S. M. , Prendiville R. , Kerry J. P. , Zhou G.
Published: December 2021

Context The increased number of male dairy origin calves in Ireland due to the abolition of European Union milk quotas is a potential resource for the beef industry. Rearing these animals as bulls rather than steers is more efficient from a production perspective. Ensuring satisfactory quality of bull beef from dairy origin is essential. Aim To determine the effect of two production systems and three muscle types on physico-chemical characteristics and fatty acid (FA) profile of beef from Holstein-Friesian (HF) bulls. Methods Thirty HF bulls were equally assigned to two production systems, namely, slaughter at under 16 months of age or slaughter at 19 months of age. Longissimus thoracis (LT), Semitendinosus (ST) and Gluteus medius (GM) muscles were excised post-slaughter for determination of pH, colour, Warner–Bratzler (WB) variables, cook loss, chemical composition [intramuscular fat (IMF), moisture, protein, ash], collagen characteristics and FA profile. Results WB variables and cook loss after 14 days postmortem ageing, and insoluble and total collagen contents were higher, while IMF content, redness and saturation at 24 h post-blooming were lower for muscles from the 19-month production system. Muscles from the under 16-month production system had a higher saturated fatty acid (SFA) proportion and n-6:n-3 polyunsaturated fatty acid (PUFA) ratio, while muscle from the 19-month production system had a higher PUFA proportion, n-3 PUFA proportion and PUFA:SFA ratio. The GM muscle had the lowest L* value, followed by LT and ST. Yellowness, saturation and hue angle were greater in ST. LT had lower WB variables, cook loss, moisture, and a higher IMF content than ST and GM. The PUFA proportion and PUFA:SFA ratio were highest in ST, followed by GM and LT. IMF, total FA, SFA and monounsaturated fatty acid (MUFA) concentrations were higher in LT from the under 16-month production system bulls (the interaction). Conclusions Beef from the under 16-month production system compared with beef from the 19-month production system, and LT compared with ST and GM muscles had better quality characteristics. Implications Dairy bulls can produce beef of acceptable quality. The findings will guide selection of the combination of production system and muscle type most appropriate to specific market requirements.
Discrimination and Sleep Impairment in American Indians and Alaska Natives
Authors: Danyluck Chad , Blair Irene V , Manson Spero M , Laudenslager Mark L , Daugherty Stacie L , Brondolo Elizabeth
Published: December 2021

Background

Sleep impairment may be a key pathway through which discrimination undermines health. Links between discrimination and sleep in American Indians and Alaska Natives (AI/AN) have not been established. Further, it is unclear if such links might depend on the timing of discrimination or if socioeconomic status (SES) might buffer the impact of discrimination.

Purpose

To investigate associations between interpersonal discrimination and sleep impairment in urban AI/AN, for both lifetime and recent discrimination, and controlling for other life stressors. Education and income, indices of SES, were tested as potential moderators.

Methods

A community sample of urban AI/AN (N = 303, 18–78 years old, 63% female) completed self-report measures of sleep impairment, lifetime and recent discrimination, depressive symptoms, perceived stress, other life stressors (childhood adversity and past year major events), and socio-demographic characteristics.

Results

Lifetime discrimination was associated with impaired sleep in AI/AN after adjustment for socio-demographic characteristics, recent depressive symptoms, perceived stress, and other life stressors. Past-week discrimination was associated with sleep in unadjusted but not adjusted models. Education, but not income, was found to buffer the effects of both lifetime and past-week discrimination on sleep in adjusted models.

Conclusion

Lifetime discrimination uniquely accounts for sleep impairment and may be especially harmful in those with less education. These findings suggest targeting interventions to those most in need. Limitations include the cross-sectional nature of the data. Longitudinal and qualitative work is needed to understand how education may buffer the effects of discrimination on sleep and perhaps other health problems in AI/AN.
Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants: a meta-analysis and systematic review
Authors: Xie Xiaoping , Liu Yumeng , Li Jiangbi , Gu Feng , Zhang Ke , Sui Zhenjiang , Zhang Jiting , Yu Tiecheng
Published: December 2021

Aims

evidence on the difference in fracture risks for patients with atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) versus warfarin remains controversial. We aim to compare the fracture risks between the DOAC and warfarin prescriptions among the AF patients.

Methods and Results

we systematically searched PubMed, EMBASE, the Cochrane Library and Web of Science up to 19 April 2021 for relevant studies. And the observational studies regarding the relationship between the DAOC versus warfarin prescriptions and fracture risks among the patients with AF were included in this meta-analysis. Two investigators independently screened the articles and extracted the relevant data. A random- or fixed-effect model was applied to calculate the pooled hazard ratio/relative ratios with 95% confidence intervals of fracture risks associated with the DOAC and warfarin prescriptions. Six studies comprising 351,208 patients and 9,424 fractures were included in this meta-analysis. Overall, the AF patients treated with DOACs tend to present a lower risk of any fracture compared with those treated with warfarin (relative ratio: 0.82, 95% confidence interval (CI): 0.74–0.91). Sub-analyses for each individual DOAC indicate that apixaban and rivaroxan are associated with lower risk of any fracture compared with warfarin (HR: 0.75, 95% CI: 0.60–0.92, and HR: 0.79, 95% CI: 0.71–0.88, respectively).

Conclusion

this meta-analysis suggests that DOAC users have a lower risk of fractures than the warfarin users. The results of this study may provide optimal anticoagulation opportunities for AF patients with high fracture risk factors.
The Factors Correlated With the Blood Pressure Control Among the Elderly Hypertension in Hangzhou
Authors: Liu Shi-jun , Liu Qing-min , Ding Hua , Luo Jun , Qiu Xin
Published: December 2021

Background

To evaluate the effectiveness of community health management of elderly hypertension, and to describe the status and related risk factors of blood pressure control.

Methods

This was a cross-sectional study. Hypertensive patients aged 60 years and above who took part in community health management in Hangzhou were selected. Data on lifestyle, obesity, blood lipids, fasting plasma glucose, and blood pressure were collected. Systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 mm Hg were used to calculate the blood pressure control rate.

Results

There were 209,768 subjects with mean age (70.7 ± 7.1) years in the present study. The mean value of systolic and diastolic blood pressures was (141.4 ± 16.9) and (80.2 ± 10.0) mm Hg, respectively. The blood pressure control rate was 48.39%. The rate of the subjects with unhealthy lifestyles, obesity (or central obesity), dyslipidemia, and abnormal fasting plasma glucose was 86.27%, 38.20%, 58.16%, and 14.72%, respectively. The unhealthy lifestyle, obesity, abnormal fasting plasma glucose, and dyslipidemia, affected blood pressure control rate, with an odds ratio (95% confidence interval) of 1.18 (1.15–1.21), 1.23 (1.21–1.25), 1.44 (1.40–1.48), and 1.10 (1.09–1.11), respectively. When 4 risk factors were combined, odds ratio (95% confidence interval) was 1.96 (95% confidence interval 1.83–2.09) for poor blood pressure control. Overall, the percentage of isolated systolic hypertension was 34.87% and increased with age.

Conclusions

The blood pressure control rate of the elderly hypertension patients in the community health management by national essential public health service was 48.39%. Obesity, unhealthy lifestyle, abnormal fasting blood glucose, and dyslipidemia are risk factors of poor blood pressure control and have cumulative effects.
Key articles and guidelines for the pediatric clinical pharmacist from 2019 and 2020
Authors: Bobo Kelly S , Cober M Petrea , Eiland Lea S , Heigham Melissa , King Morgan , Johnson Peter N , Miller Jamie L , Sierra Caroline M
Published: December 2021

Purpose

To summarize recently published research reports and practice guidelines deemed to be significantly impactful for pediatric pharmacy practice.

Our author group was composed of 8 board-certified pediatric pharmacists. Eight major themes were identified: critical care, hematology/oncology, medication safety, general pediatrics, infectious diseases, neurology/psychiatry, gastrointestinal/nutrition, and neonatology. The author group was assigned a specific theme(s) based on their practice expertise and were asked to identify articles using MEDLINE and/or searches of relevant journal articles pertaining to each theme that were published from January 2019 through December 2020 that they felt were “significant” for pediatric pharmacy practice. A final list of compiled articles was distributed to the authors, and an article was considered significant if it received a vote from 5 of the 8 authors. Thirty-two articles, including 16 clinical practice guidelines or position statements and 16 review or primary literature articles, were included in this review. For each of these articles, a narrative regarding its implications for pediatric pharmacy practice is provided.

Conclusion

Given the heterogeneity of pediatric patients, it is difficult for pediatric pharmacists to stay up to date with the most recent literature, especially in practice areas outside their main expertise. Over the last few years, there has been a significant number of publications impacting the practice of pediatric pharmacists. This review of articles that have significantly affected pediatric pharmacy practice may be helpful in staying up to date on key articles in the literature.
Development of a specialty medication clinical dashboard to improve tumor necrosis factor-α inhibitor safety and adherence monitoring
Authors: Hu Anna M , Pepin Marc J , Hashem Mohamed G , Britt Rachel B , Britnell Sara R , Bryan William E , Brown Jamie N
Published: December 2021

Purpose

To describe the development of a pilot specialty medication clinical dashboard targeting tumor necrosis factor (TNF)-α inhibitor therapy.

This was a quality improvement project conducted between August 2019 and April 2020. The dashboard was designed with collaboration between clinical pharmacists and specialty providers in rheumatology, gastroenterology, and dermatology. Data was queried from the Veterans Affairs Corporate Data Warehouse. Patients with an active prescription or intravenous order for a TNF-α inhibitor were included. Dashboard flag criteria focused on TNF-α inhibitor safety and adherence monitoring. Flag results from the dashboard were characterized from data captured at a single time point. For 431 patients on TNF-α inhibitor treatment at the institution, 304 flags corresponding to 223 unique patients (51.7%) were identified on the dashboard: 3% of patients had a new infection, 9% had overdue monitoring laboratory tests, 5% had a critical laboratory result, 2% were on 2 biologic agents, 27% were overdue for a refill, 6% had an emergency department visit, and 2% had an inpatient admission. No patients were flagged for heart failure exacerbation or new malignancy. Seventeen percent of patients were prescribed high-dose etanercept or adalimumab, representing a potential annual cost savings of $302,497 if 50% of these patients had their dose successfully reduced to labeled dosing. Opportunities for pharmacist intervention utilizing the dashboard were identified and characterized through chart review of flagged patients.

Conclusion

Pharmacists have the opportunity to improve safety and adherence for TNF-α inhibitor therapy through use of a specialty medication clinical dashboard. The dashboard should be used in conjunction with collaborative practice protocols.
Medication regimen complexity vs patient acuity for predicting critical care pharmacist interventions
Authors: Smith Susan E , Shelley Rachel , Sikora Andrea
Published: December 2021

Purpose

Quantifying and predicting critical care pharmacist (CCP) workload has significant ramifications for expanding CCP services that improve patient outcomes. Medication regimen complexity has been proposed as an objective, pharmacist-oriented metric that demonstrates relationships to patient outcomes and pharmacist interventions. The purpose of this evaluation was to compare the relationship of medication regimen complexity versus a traditional patient acuity metric for evaluating pharmacist interventions.

This was a post hoc analysis of a previously completed prospective, observational study. Pharmacist interventions were prospectively collected and tabulated at 24 hours, 48 hours, and intensive care unit (ICU) discharge, and the electronic medical record was reviewed to collect patient demographics, medication data, and outcomes. The primary outcome was the relationship between medication regimen complexity–intensive care unit (MRC-ICU) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and pharmacist interventions at 24 hours, 48 hours, and ICU discharge. These relationships were determined by Spearman rank-order correlation (rS) and confirmed by calculating the beta coefficient (β) via multiple linear regression adjusting for patient age, gender, and admission type. Data on 100 patients admitted to a mixed medical/surgical ICU were retrospectively evaluated. Both MRC-ICU and APACHE II scores were correlated with ICU interventions at all 3 time points (at 24 hours, rS = 0.370 [P < 0.001] for MRC-ICU score and rS = 0.283 [P = 0.004] for APACHE II score); however, this relationship was not sustained for APACHE II in the adjusted analysis (at 24 hours, β = 0.099 [P = 0.001] for MRC-ICU and β = 0.031 [P = 0.085] for APACHE II score).

Conclusion

A pharmacist-oriented score had a stronger relationship with pharmacist interventions as compared to patient acuity. As pharmacists have demonstrated value across the continuum of patient care, these findings support that pharmacist-oriented workload predictions require tailored metrics, beyond that of patient acuity.
Evaluating the effects of a mindfulness mobile application on student pharmacists’ stress, burnout, and mindfulness
Authors: Chu Angela , Rose Tyler M , Gundrum Danielle A , McMorris Tressa E , Klausner Eytan A , Lang Lynn A , Shan Guogen
Published: December 2021

Purpose

Pharmacists report high levels of burnout. Mindfulness approaches have been demonstrated to have positive results in the general population and in other healthcare professions. However, limited studies have been performed evaluating mindfulness approaches in student pharmacists. The aim of this study was to evaluate the effectiveness of daily use of a mindfulness mobile application in improving student pharmacists’ perceived stress, burnout, and mindfulness.

Methods

This study was a randomized, longitudinal, waitlist-controlled trial. The intervention group was asked to meditate using the mindfulness application Headspace daily for at least 6 weeks. The waitlist control group was asked to abstain from using the application for the entire study. Stress, burnout, and mindfulness were assessed using validated survey instruments at baseline, 6 weeks, and 10 weeks. A secondary outcome was to assess the persistence of application use after the intervention period.

Results

Fifty-six participants completed the study. The intervention group reported significantly lower scores on stress and burnout at 6 weeks compared to the control group. The intervention group also reported significantly higher scores on mindfulness. The differences in stress, burnout, and mindfulness persisted at follow-up. The mean percentage of students in the intervention group who used the application each day was 90% over the intervention period and 62% over the follow-up period.

Conclusion

A mindfulness mobile application significantly improved student pharmacists’ stress, burnout, and mindfulness with daily use. Most participants continued to use the application for 4 weeks after the end of the intervention. Positive effects on stress and mindfulness persisted even with decreased use.
Utilization of apixaban anti-Xa levels in transition from apixaban to warfarin in a patient with chronic renal dysfunction
Authors: Elgersma Brittany , Zochert Sara
Published: December 2021

Purpose

The effect of apixaban on anti–factor Xa (anti-Xa) assays and international normalized ratio (INR) complicates transitions between anticoagulant agents. When switching from apixaban to warfarin, the recommendation is to begin both a parenteral anticoagulant and warfarin at the time of the next apixaban dose and to discontinue the parenteral agent when the INR is in an acceptable range. This proves challenging in renal dysfunction, as continued presence of apixaban contributes to both a prolonged effect on the INR and continued therapeutic levels of anticoagulation.

This case describes the transition of apixaban to warfarin in a patient with acute on chronic kidney disease and recent deep vein thrombosis, utilizing chromogenic apixaban anti-Xa assays to assess the level of anticoagulation and avoid unnecessary parenteral anticoagulation.

Conclusion

Utilization of apixaban anti-Xa levels aided in the transition from apixaban to warfarin in a patient with chronic renal failure and avoided need for parenteral bridging therapy.
Spreader Graft vs Spreader Flap in Rhinoplasty: A Systematic Review and Meta-Analysis of Aesthetic and Functional Outcomes
Authors: Keyhan Seied Omid , Fallahi Hamid Reza , Cheshmi Behzad , Jafari Modrek Mahdi , Ramezanzade Shaqayeq , Sadeghi Erfan
Published: December 2021

Background

Insufficient support of the nasal mid-vault during rhinoplasty can cause significant complications. Accordingly, surgeons have recently paid much more attention to the preservation of nasal patency. The spreader graft is the gold standard technique for the reconstruction of nasal mid-vault.

Objectives

The objective of this study was to compare the spreader graft and spreader flap in terms of aesthetic and functional outcomes.

Methods

An inclusive search was performed with PubMed/Medline, Google Scholar, and Cochrane Library databases up to April 2021. Multiple aesthetic and functional factors, including dorsal aesthetic lines restoration, satisfaction rate, internal nasal valve angle improvement, nasal obstruction symptom evaluation scale, and active anterior rhinomanometry were evaluated. Also, a meta-analysis was performed on the included articles that provided adequate data for mentioned factors.

Results

After excluding papers that did not conform with the selection criteria, 10 articles with a total sample size of 567 cases with a mean age of 27.7 years (range, 18-65 years) were finally included. Analysis of the data revealed no statistically significant difference between the spreader graft and spreader flap techniques in terms of dorsal aesthetic lines restoration, internal nasal valve angle improvement, nasal obstruction symptom evaluation scale, and anterior rhinomanometry.

Conclusions

However, in terms of satisfaction rate, the analyzes indicated that spreader graft has significantly superior aesthetic outcomes. Generally, in case of appropriately selected patients, there is no statistically significant difference between spreader graft and spreader flap techniques in terms of aesthetic and functional outcomes.
Effect of Throat Pack Placement on the Incidence of Sore Throat and Postoperative Nausea and Vomiting in Septorhinoplasty Patients: A Randomized Controlled Trial
Authors: Borna Reza , McCleary Sean , Wang Libing , Lee Albert , Saadat Sean , Grogan Tristan , Partownavid Parisa , Roostaeian Jason
Published: December 2021

Background

Advances in surgical and anesthetic techniques have led to a growing interest in performing procedures at ambulatory surgery centers. However, procedures involving the oropharyngeal or nasopharyngeal region may lead to the ingestion of blood, which can lead to postoperative nausea and vomiting (PONV). To date, limited studies have largely failed to demonstrate the benefits of oropharyngeal throat packing.

Objectives

The authors aimed to investigate whether throat packing during elective septorhinoplasty increases the incidence of postoperative throat pain and assess its effects on PONV.

Methods

A randomized, prospective, single-blinded study was performed on 101 patients undergoing elective septorhinoplasty who received oropharyngeal throat packing vs no packing to compare the incidence of PONV and throat pain in the immediate postoperative period in addition to postoperative day (POD) 1 and 2.

Results

The incidence and severity of postoperative throat pain were significantly greater in patients receiving throat packs in the immediate postoperative period and on POD 1. Significant differences in throat pain and incidence between the 2 groups diminished by POD 2. Patients having received throat packs also demonstrated a higher utilization of opioids in postanesthesia care unit. The incidence of PONV did not significantly differ between the 2 cohorts at any point of observations.

Conclusions

The results of this study largely agree with previous data that throat packs may contribute to postoperative throat pain while not significantly altering the incidence of PONV. Considering these data, we do not recommend routine utilization of throat packing during elective septorhinoplasty.

Level of Evidence: 2
A novel enzyme synthesized by Acinetobacter sp. SM04 is responsible for zearalenone biodegradation
Authors: Tang Yuqian , Liu Chendi , Yang Jiguo , Peng Xian
Published: December 2021

Zearalenone (ZEA), a nonsteroidal estrogenic mycotoxin produced by multiple Fusarium species, contaminates cereals and threatens the health of both humans and animals by inducing hepatotoxicity, immunotoxicity, and genotoxicity. A new alkali tolerant enzyme named Ase, capable of degrading ZEA without H2O2, was derived from Acinetobacter sp. SM04 in this study. The Ase gene shares 97% sequence identity with hypothetical proteins from Acinetobacter pittii strain WCHAP 100004 and YMC 2010/8/T346 and Acinetobacter calcoaceticus PHEA-2, respectively. Based on the Acinetobacter genus database, the gene encoding Ase was cloned and extracellularly expressed in Escherichia coli BL21. After degrading 88.4% of ZEA (20 µg/mL), it was confirmed through MCF-7 cell proliferation assays that Ase can transform ZEA into a nonestrogenic toxic metabolite. Recombinant Ase (molecular weight: 28 kDa), produced by E. coli BL21/pET32a(+)-His-Ase, was identified as an oxygen-utilizing and cytochrome-related enzyme with optimal activity at 60 °C and pH 9.0.
Isopentenyl diphosphate/dimethylallyl diphosphate-specific Nudix hydrolase from the methanogenic archaeon Methanosarcina mazei
Authors: Ishibashi Yumi , Matsushima Natsumi , Ito Tomokazu , Hemmi Hisashi
Published: December 2021

Nudix hydrolases typically catalyze the hydrolysis of nucleoside diphosphate linked to moiety X and yield nucleoside monophosphate and X-phosphate, while some of them hydrolyze a terminal diphosphate group of non-nucleosidic compounds and convert it into a phosphate group. Although the number of Nudix hydrolases is usually limited in archaea comparing with those in bacteria and eukaryotes, the physiological functions of most archaeal Nudix hydrolases remain unknown. In this study, a Nudix hydrolase family protein, MM_2582, from the methanogenic archaeon Methanosarcina mazei was recombinantly expressed in Escherichia coli, purified, and characterized. This recombinant protein shows higher hydrolase activity toward isopentenyl diphosphate and short-chain prenyl diphosphates than that toward nucleosidic compounds. Kinetic studies demonstrated that the archaeal enzyme prefers isopentenyl diphosphate and dimethylallyl diphosphate, which suggests its role in the biosynthesis of prenylated flavin mononucleotide, a recently discovered coenzyme that is required, for example, in the archaea-specific modified mevalonate pathway.
Isolation and characterization of indigo-reducing bacteria and analysis of microbiota from indigo fermentation suspensions
Authors: Nakagawa Kasumi , Takeuchi Michiki , Tada Manami , Matsunaga Momoka , Kugo Masami , Kiyofuji Suzuna , Kikuchi Mayu , Yomota Kazuya , Sakamoto Takaiku , Kano Kenji , Ogawa Jun , Sakuradani Eiji
Published: December 2021

In natural indigo dyeing, the water-insoluble indigo included in the composted indigo leaves called sukumo is converted to water-soluble leuco-indigo through the reduction activities of microorganisms under alkaline conditions. To understand the relationship between indigo reduction and microorganisms in indigo-fermentation suspensions, we isolated and identified the microorganisms that reduce indigo and analyzed the microbiota in indigo-fermentation suspensions. Indigo-reducing microorganisms, which were not isolated by means of a conventional indigo carmine-reduction assay method, were isolated by using indigo as a direct substrate and further identified and characterized. We succeeded in isolating bacteria closely related to Corynebacterium glutamicum, Chryseomicrobium aureum, and Enterococcus sp. for the first time. Anthraquinone was found to be an effective mediator that facilitated the indigo-reduction activity of the isolated strains. On analysis of the microbiota in indigo-fermentation suspensions, the ratio of indigo-reducing bacteria and others was found to be important for maintaining the indigo-reduction activity.
Identification of transposon-inserted mutations including rnpB::Tn that abolished glucose induction of sigX encoding extracytoplasmic function-sigma factor in Bacillus subtilis
Authors: Ogura Mitsuo
Published: December 2021

We investigated the regulators of the glucose induction (GI) of the ECF-sigma genes sigX/M. During further screening of transposon-inserted mutants, we identified several regulators including an RNA component of RNase P (rnpB), which is required for tRNA maturation. A depletion of rnpB is known to trigger the stringent response. We showed evidence that the stringent response inhibited GI of sigX/M.
Complementation of fission yeast kinesin-5/Cut7 with human Eg5 provides a versatile platform for screening of anticancer compounds
Authors: Hwang Woosang , Toda Takashi , Yukawa Masashi
Published: December 2021

Kinesin-5 family proteins are essential for bipolar spindle assembly to ensure mitotic fidelity. Here, we demonstrate evolutionary functional conservation of kinesin-5 between human and fission yeast. Human Eg5 expressed in the nucleus replaces fission yeast counterpart Cut7. Intriguingly, Eg5 overproduction results in cytotoxicity. This phenotype provides a useful platform for the development of novel kinesin-5 inhibitors as anticancer drugs.
Practice research methods in social work: Processes, applications and implications for social service organisations
Authors: McBeath Bowen , Austin Michael J , Carnochan Sarah , Chuang Emmeline
Published: December 2021

Although social work research is commonly rooted within social service settings, it can be difficult for social work researchers and practitioners to develop and sustain participatory studies that specifically promote knowledge sharing and service improvement involving organisational practice. One participatory approach is practice research (PR), which involves social work researchers and practitioners collaborating to define, understand and try to improve the delivery of health and social care services and organisational structures and processes. The two goals of this commentary are to introduce essential methods and approaches to PR and to identify points of connection involving PR and social service organisational studies. Our specific focus on PR in statutory, voluntary and private social service organisations reflects efforts to connect practice, theory and qualitative and quantitative research methods to develop and share organisationally-situated knowledge.
Transformation of Sequential Hospital and Outpatient Laboratory Data into Between-Day Reference Change Values
Authors: Cembrowski George S , Lyon Andrew W , McCudden Christopher , Qiu Yuelin , Xu Qian , Mei Junyi , Tran David V , Sadrzadeh S M Hossein , Cervinski Mark A
Published: December 2021

Background

Serial differences between intrapatient consecutive measurements can be transformed into Taylor series of variation vs time with the intersection at time = 0 (y0) equal to the total variation (analytical + biological + preanalytical). With small preanalytical variation, y0, expressed as a percentage of the mean, is equal to the variable component of the reference change value (RCV) calculation: (CVA2 + CVI2)1/2.

Methods

We determined the between-day RCV of patient data for 17 analytes and compared them to healthy participants’ RCVs. We analyzed 653 consecutive days of Dartmouth-Hitchcock Roche Modular general chemistry data (4.2 million results: 60% inpatient, 40% outpatient). The serial patient values of 17 analytes were transformed into 95% 2-sided RCV (RCVAlternate), and 3 sets of RCVhealthy were calculated from 3 Roche Modular analyzers’ quality control summaries and CVI derived from biological variation (BV) studies using healthy participants.

Results

The RCVAlternate values are similar to RCVhealthy derived from known components of variation. For sodium, chloride, bicarbonate calcium, magnesium, phosphate, alanine aminotransferase, albumin, and total protein, the RCVs are equivalent. As expected, increased variation was found for glucose, aspartate aminotransferase, creatinine, and potassium. Direct bilirubin and urea demonstrated lower variation.

Conclusions

Our RCVAlternate values integrate known and unknown components of analytic, biologic, and preanalytic variation, and depict the variations observed by clinical teams that make medical decisions based on the test values. The RCVAlternate values are similar to the RCVhealthy values derived from known components of variation and suggest further studies to better understand the results being generated on actual patients tested in typical laboratory environments.
An Advanced EEG Motion Artifacts Eradication Algorithm
Authors: Shukla Piyush Kumar , Roy Vandana , Shukla Prashant Kumar , Chaturvedi Anoop Kumar , Saxena Aumreesh Kumar , Maheshwari Manish , Pal Parashu Ram
Published: December 2021

The electroencephalography (EEG) signal is corrupted with some non-cerebral activities due to patient movement during signal measurement. These non-cerebral activities are termed as artifacts, which may diminish the superiority of acquired EEG signal statistics. The state of the art artifact elimination approaches applied canonical correlation analysis (CCA) for confiscating EEG motion artifacts accompanied by ensemble empirical mode decomposition (EEMD). An improved cascaded approach based on Gaussian elimination CCA (GECCA) and EEMD is applied to suppress EEG artifacts effectively. However, in a highly noisy environment, a novel addition of median filter before the GECCA algorithm is suggested for improving the accuracy of onslaught the EEG signal. The median filter is opted due to its edge preserving nature and speed. This proposed approach is appraised using efficacy grounds for instance Del signal to noise ratio, Lambda (λ), root mean square error and receiver operating characteristic (ROC) parameters and verified contrary to presently obtainable EEG artifacts exclusion methods. The primary concern is to improve the efficacy and precision of the proposed artifact elimination technique. The elapsed time is also calculated to evaluate the computation efficiency. Results show that the proposed algorithm is appropriate to be used as an addition to existing algorithms in use.
Using dermal glucocorticoids to determine the effects of disease and environment on the critically endangered Wyoming toad
Authors: Santymire Rachel M , Sacerdote-Velat Allison B , Gygli Andrew , Keinath Douglas A , Poo Sinlan , Hinkson Kristin M , McKeag Elizabeth M
Published: December 2021

Amphibian populations are declining worldwide, and increased exposure to environmental stressors, including global climate change and pathogens like Batrachochytrium dendrobatidis (Bd), may be contributing to this decline. Our goal was to use a novel dermal swabbing method to measure glucocorticoid (GC) hormones and investigate the relationship among disease and environmental conditions in the critically endangered Wyoming toad (Anaxyrus baxteri). Our objectives were to (i) validate the use of dermal swabs to measure GCs using an adrenocorticotropic hormone (ACTH) challenge on eight captive toads (4 ACTH: 2 M, 2F and 4 saline as a control: 2 M, 2F), (ii) investigate stress physiology and disease status of toads across six reintroduction sites and (iii) compare dermal cortisol between reintroduced and captive toads. Dermal cortisol peaked immediately after the ACTH and saline injections. Faecal GC metabolites (FGMs) were significantly higher one week after the ACTH injection compared with the week before. Saline-injected toads had no change in FGM over time. Toads were only found in three reintroduction sites and dermal cortisol was similar across sites; however, reintroduced toads had higher dermal cortisol in August compared with June and compared with captive individuals. Bd status did not influence dermal cortisol concentrations. Dermal and faecal hormonal metabolite analyses can be used to study amphibian stress physiology and learn how environmental conditions are impacting population success.
ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2—care pathways, treatment, and follow-up
Authors:   The Task Force for the management of COVID-19 of the European Society of Cardiology, Baigent Colin , Windecker Stephan , Andreini Daniele , Arbelo Elena , Barbato Emanuele , Bartorelli Antonio L , Baumbach Andreas , Behr Elijah R , Berti Sergio , Bueno Héctor , Capodanno Davide , Cappato Riccardo , Chieffo Alaide , Collet Jean Philippe , Cuisset Thomas , de Simone Giovanni , Delgado Victoria , Dendale Paul , Dudek Dariusz , Edvardsen Thor , Elvan Arif , González-Juanatey José R , Gori Mauro , Grobbee Diederick , Guzik Tomasz J , Halvorsen Sigrun , Haude Michael , Heidbuchel Hein , Hindricks Gerhard , Ibanez Borja , Karam Nicole , Katus Hugo , Klok Fredrikus A , Konstantinides Stavros V , Landmesser Ulf , Leclercq Christophe , Leonardi Sergio , Lettino Maddalena , Marenzi Giancarlo , Mauri Josepa , Metra Marco , Morici Nuccia , Mueller Christian , Petronio Anna Sonia , Polovina Marija M , Potpara Tatjana , Praz Fabien , Prendergast Bernard , Prescott Eva , Price Susanna , Pruszczyk Piotr , Rodríguez-Leor Oriol , Roffi Marco , Romaguera Rafael , Rosenkranz Stephan , Sarkozy Andrea , Scherrenberg Martijn , Seferovic Petar , Senni Michele , Spera Francesco R , Stefanini Giulio , Thiele Holger , Tomasoni Daniela , Torracca Luccia , Touyz Rhian M , Wilde Arthur A , Williams Bryan
Published: December 2021

Aims

Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19.

Methods and results

A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19.

Conclusion

This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
Cooperation amidst competition: cybersecurity partnership in the US financial services sector
Authors: Atkins Sean , Lawson Chappell
Published: December 2021

The US Financial Services Sector (FSS) is commonly regarded as one of the most successful in addressing cybersecurity through public–private partnership and as a potential model for less advanced sectors. However, how well the sector has actually fared remains poorly understood. Based on publicly available material and in-depth interviews with those intimately involved in business–government collaboration on cybersecurity in the FSS, we analyze how and why collaboration evolved into its current form. We find that considerable gaps remain, which both reveal limitations in the current policy framework for the FSS and suggest lessons for other critical infrastructure sectors.
Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction?
Authors: Beveridge Claire A , Triggs Joseph R , Thanawala Shivani U , Ahuja Nitin K , Falk Gary W , Benitez Alain J , Lynch Kristle L
Published: December 2021

Background

Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment.

Methods

A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson’s chi-square tests were used to assess for associations.

Results

Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03.

Conclusion

This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.
Application of intraoperative nerve monitoring for recurrent laryngeal nerves in minimally invasive McKeown esophagectomy
Authors: Zhao Luo , He Jia , Qin Yingzhi , Liu Hongsheng , Li Shanqing , Han Zhijun , Li Li
Published: December 2021

Background

Mediastinal lymphadenectomy is of great importance during esophagectomy for esophageal squamous cell carcinoma. However, recurrent laryngeal nerve (RLN) injury is a severe complication caused by lymphadenectomy along the RLN. Intraoperative nerve monitoring (IONM) can effectively identify the RLN and reduce the incidence of postoperative vocal cord paralysis (VCP). Here, we describe the feasibility and effectiveness of IONM in minimally invasive McKeown esophagectomy.

Methods

A total of 150 patients who underwent minimally invasive McKeown esophagectomy from 2016 to 2020 were enrolled in this study. We divided the patients into two groups: a neuromonitoring group (IONM, n = 70) and a control group (control, n = 80). Clinical data, surgical variables, and postoperative complications were retrospectively analyzed and compared.

Results

There was no significant difference in baseline data between the two groups. Postoperative VCP occurred in six cases (8.6%) in the IONM group, which was lower than that in the control group (21.3%, P = 0.032). Postoperative pulmonary complications were found in five cases (7.1%) and 14 in the control group (18.8%, P = 0.037). The postoperative hospital stay in the IONM group was significantly shorter than that in the control group (8 vs. 12, median, P < 0.001). The number of RLN lymph nodes harvested in the IONM group was higher than that in the control group (13.74 ± 5.77 vs. 11.03 ± 5.78, P = 0.005). The sensitivity and specificity of IONM monitoring VCP were 83.8% and 100%, respectively. A total of 66.7% of patients with a reduction in signal showed transient VCP, whereas 100% with a loss of signal showed permanent VCP.

Conclusion

IONM is feasible in minimally invasive McKeown esophagectomy. It showed advantages for distinguishing RLN and achieving thorough mediastinal lymphadenectomy with less RLN injury. Abnormal IONM signals can provide an accurate prediction of postoperative VCP incidence.
MitraClip repair of right-sided atrioventricular valve in a patient with congenitally corrected transposition of the great arteries: a case report
Authors: Lewis Antonio , Hakemi Emad , Lopez David , Cubeddu Robert J
Published: December 2021

Background

Patients with congenitally corrected transposition of the great arteries (ccTGA) often develop tricuspid valve (systemic atrioventricular valve) dysfunction due to right ventricular overload and dilatation, but isolated mitral valve (MV) disease is rarely found. Isolated mitral (subpulmonic atrioventricular valve) interventions, specifically catheter-directed, have not been reported up to date.

Case summary

A man with ccTGA is evaluated for dyspnoea. Multimodality imaging assessment confirmed severe right-sided MV regurgitation due to prolapse. In light of high surgical risk, a minimally invasive transcatheter MitraClip procedure was pursued.

Discussion

To our knowledge, this is the first case of successful MV repair via percutaneous approach using MitraClip in a patient with ccTGA and biventricular failure. Our case illustrates the safety and feasibility of the edge-to-edge procedure in such a rare instance, but also the importance of multimodality imaging (both invasive and non-invasive) and the Heart Team approach when caring for these complex patients.
Successful rotational atherectomy of left main stem with double kiss crush stenting using double guiding catheter: a case report
Authors: Maqableh Ghaith M , Osheiba Mohammed , Mechery Anthony , Khan Sohail Q
Published: December 2021

Background

Coronary artery bypass grafting is the preferred revascularization procedure for patients with multivessel disease, and those with complex left main disease, as it is associated with a survival advantage in this group of patients. Sometimes however surgical management is not the treatment of choice due to many factors including ongoing chest pain, haemodynamic instability, or patient preference. In these situations, percutaneous coronary intervention (PCI) offers an alternative revascularization strategy. In this case study, we present a successful PCI with rotational atherectomy (RA) for distal left main stem (LMS), left anterior descending (LAD), and circumflex artery (CX) using a double guide catheter technique in a patient with severe calcific disease.

Case summary

A 63-year-old female was diagnosed with a non-ST-elevation myocardial infarction. Coronary angiography showed significant distal LMS disease with a severe proximal/ostial calcified lesion of the LAD and a possible thrombotic lesion at the ostium of the CX. She had ongoing haemodynamic instability with chest pain however could not be offered immediate surgical revascularization. We therefore elected to proceed to complex bifurcation LMS coronary intervention using RA under intravascular ultrasound (IVUS) guidance achieving an excellent final result with TIMI III flow.

Discussion

This case demonstrates that RA using the double catheter technique (also known as Ping-Pong) can be safely performed with minimal complication rates and with very favourable angiographic and IVUS results. The clinical outcome was excellent with early discharge.
Development of severe intrapulmonary shunting in a patient with carcinoid heart disease after closure of a persistent foramen ovale: a case report
Authors: Schüttler Dominik , Mourouzis Konstantinos , Auernhammer Christoph J , Rizas Konstantinos D
Published: December 2021

Background

Neuroendocrine tumours (NETs) can affect the cardiopulmonary system causing carcinoid heart disease (CHD) and valve destruction. Persistent foramen ovale (PFO) occlusion is indicated in patients with CHD and shunt-related left heart valve involvement.

Case summary

We report the case of a 54-year-old female patient with metastatic NET originating from the small bowel. The patient was on medication with octreotide and telotristat. One year after diagnosis, cardiac involvement of carcinoid developed with regurgitation of right-sided and, due to PFO, left-sided heart valves. Closure of PFO was performed (Occlutech 16/18 mm). One year later, she presented with recurrent severe dyspnoea. The PFO occluder was in situ without residual shunt. Valvular heart disease, including left-sided disease, and metastatic spread of NET were stable. Blood gas analysis revealed arterial hypoxaemia (pO2 = 44 mmHg/5.87 kPa), which was related to extensive intrapulmonary shunting (31% shunt fraction) confirmed using contrast-enhanced echocardiography. The patient was prescribed long-term oxygen supplementation as symptomatic therapy and anti-tumoural therapy was intensified with selective internal radiotherapy (SIRT) of the liver metastases to improve biochemical control of the carcinoid syndrome. At a follow-up visit 4 months after SIRT, the patient-reported stable dyspnoea; however, magnetic resonance imaging revealed progression of osseous metastases.

Discussion

An echocardiographic assessment of the presence of a PFO is recommended in patients with NET as PFO closure minimizes the risk of left-sided carcinoid valve disease. Deterioration of symptomatic status in metastasized NET might also be due to a hepatopulmonary-like physiology with intrapulmonary shunting and arterial desaturation thought to be caused by vasoactive substances secreted by the tumour. This is a rare case describing the development of this syndrome after PFO closure.