bluuebunny/crossref_metadata_2025 huggingface dataset:
High Cost and Resource Utilization of Frostbite Readmissions in the United States
Authors: Endorf Frederick W , Nygaard Rachel M
Published: May 2021

Frostbite is a high morbidity, high-cost injury that can lead to digit or limb necrosis requiring amputation. Our primary aim is to describe the rate of readmission following frostbite injury. Our secondary aims are to describe the overall burden of care, cost, and characteristics of repeat hospitalizations of frostbite-injured people. Hospitalizations following frostbite injury (index and readmissions) were identified in the 2016 and 2017 Nationwide Readmission Database. Multivariable logistic regression was clustered by hospital and additionally adjusted for severe frostbite injury, gender, year, payor group, severity, and comorbidity index. Population estimates were calculated and adjusted for by using survey weight, sampling clusters, and stratum. In the 2-year cohort, 1065 index hospitalizations resulted in 1907 total hospitalizations following frostbite injury. Most patients were male (80.3%), lived in metropolitan/urban areas (82.3%), and nearly half were insured with Medicaid (46.4%). Of the 842 readmissions, 53.7% were associated with complications typically associated with frostbite injury. Overall, 29% of frostbite injuries resulted in at least one amputation. The average total cost and total length of stay of readmissions were $236,872 and 34.7 days. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge against medical advice (AMA) were independent predictors of unplanned readmission. Factors associated with multiple readmissions include discharge AMA and Medicare insurance, but not drug or alcohol abuse or homelessness. The population-based estimated unplanned readmission rate following frostbite injury was 35.4% (95% confidence interval 32.2%–38.6%). This is the first study examining readmissions following frostbite injury on a national level. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission, while only AMA discharge and Medicare insurance were associated with multiple readmissions. Supportive resources (community and hospital-based) may reduce unplanned readmissions of frostbite-injured patients with those additional risk factors.
Social Class Shapes Donation Allocation Preferences
Authors: Vieites Yan , Goldszmidt Rafael , Andrade Eduardo B
Published: May 2021

When considering a charitable act, consumers must often decide on how to allocate their resources across a multitude of possible causes. This article assesses how the relative “urgency” of the causes under consideration (i.e., how critical to human survival the causes are) shapes preferences for specific causes among higher and lower social class consumers. Across a series of studies in a highly unequal socioeconomic environment (Rio de Janeiro, Brazil), we demonstrate that lower-class consumers prefer to donate to urgent causes (e.g., alleviating hunger) compared to non-urgent causes (e.g., encouraging cultural activities), whereas the effect reverses among higher-class consumers. Contrasting experiences with scarcity across social classes vary the consumers’ intrinsic sympathy toward people’s unmet basic needs, which in turn shapes donation allocation preferences. Consistent with this theoretical rationale, class differences in charitable allocations decrease when (a) vivid contextual cues induce sympathy among both higher- and lower-class consumers or (b) the experience with scarcity is similar across social classes. Thus, although class differences in preferences for specific causes can be shifted with relative ease, our findings suggest that those who have the most to give do not spontaneously prioritize what is most urgently needed in society.
Incentives to Discover Talent
Authors: Brünner Tobias , Friebel Guido , Holden Richard , Prasad Suraj
Published: May 2021

We study an agent’s incentives to discover where her talents lie before putting them to productive use. In our setting, an agent can specialize and learn about the same type of talent repeatedly, or experiment and learn about different types of talent. While experimentation is efficient for a range of distributions of talent and initial signals, labor-market institutions play a crucial role for individual incentives to experiment. Institutions that give the agent sufficiently large bargaining power, provide incentives for experimentation, but for weak bargaining power, agents specialize. We also look at how competition in the labor market, human capital accumulation, and correlation across talents affect incentives to experiment. (JEL codes: D83; J24; J42)
Parenting and Psychological Health in Youth with Type 1 Diabetes: Systematic Review
Authors: Trojanowski Paige J , Niehaus Claire E , Fischer Sarah , Mehlenbeck Robyn
Published: May 2021

Objective

Type 1 diabetes (T1D) is a demanding chronic illness that may result in poorer psychological health in youth. Fortunately, certain parenting practices may be protective against adverse outcomes. However, a systematic review of these relationships in youth with T1D is lacking. Thus, the current systematic review examined the literature on parenting and child psychological health outcomes (both internalizing and externalizing symptoms) in youth with T1D. Particular attention is paid to how demographic factors are associated with these relationships.

Methods

PRISMA guidelines for systematic reviews were followed, and a literature search (PubMed, PsycINFO, and CINAHL) was conducted for studies of youth with T1D that examined the relationship between specific parenting practices or characteristics of the parent–child relationship and youth (<19 years old) internalizing or externalizing symptoms. Forty studies met inclusion criteria. Studies were examined for risk of bias.

Results

Results support that family conflict, critical parenting, support, involvement, and relationship quality are associated with psychological health outcomes in youth with T1D, with some associations varying by parent gender, child age, demographic factors, and internalizing versus externalizing outcomes.

Conclusions

Findings highlight the importance of bolstering supportive parenting and decreasing family conflict to improve psychological health in this population. Gaps in the literature related to the dearth of father and secondary caregiver report, lack of sample diversity and attention to the influence of demographic factors, and a limited number of studies examining anxiety were identified. Directions for future research and clinical implications are discussed.
A C-terminal encoded peptide, ZmCEP1, is essential for kernel development in maize
Authors: Xu Ruibin , Li Yufeng , Sui Zhipeng , Lan Tianyu , Song Wanjun , Zhang Ming , Zhang Yirong , Xing Jiewen
Published: May 2021

C-terminal encoded peptides (CEPs) are peptide hormones which act as mobile signals coordinating important developmental programs. Previous studies have unraveled that CEPs are able to regulate plant growth and abiotic stress via cell-to-cell communication in Arabidopsis and rice; however, little is known about their roles in maize. Here, we examined the spatiotemporal expression pattern of ZmCEP1 and showed that ZmCEP1 is highly expressed in young ears and tassels of maize, particularly in the vascular bundles of ears. Heterologous expression of ZmCEP1 in Arabidopsis results in smaller plants and seed size. Similarly, overexpression of ZmCEP1 in maize decreased the plant and ear height, ear length, kernel size, and 100-kernel weight. Consistently, exogenous application of the synthesized ZmCEP1 peptide to the roots of Arabidopsis and maize inhibited root elongation. Knock-out of ZmCEP1 through CRISPR/Cas9 significantly increased plant and ear height, kernel size and 100-kernel weight. Transcriptome analysis revealed that knock-out of ZmCEP1 up-regulated a subset of genes involved in nitrogen metabolism, nitrate transport, sugar transport and auxin response. Thus, these results provide new insights into the genetic and molecular function of ZmCEP1 in regulating kernel development and plant growth, providing novel opportunities for maize breeding.
Prevalence of Musculoskeletal Injuries in New Zealand Army Recruits as Defined by Physical Therapy Service Presentations
Authors: Hall Narelle , Constantinou Maria , Brown Mark , Beck Belinda , Kuys Suzanne
Published: May 2021

Introduction

Army recruit injuries occurring during basic training can lead to high personal and organizational burdens potentially threatening deployment capability. Previous military surveillance describing recruit injury as defined by physical therapy presentations is limited to 1-year duration or includes only male infantry recruits or trained personnel. Research describing injury incidence and trends specific to New Zealand Army basic training recruits over a longer period will better inform future injury prevention programs.

Aims

To identify the incidence and patterns of injuries reported from physical therapy presentations for New Zealand Army recruits undertaking basic training over a 4-year period.

Materials and Methods

This retrospective observational study identified injuries from physical therapy service presentations in New Zealand Army recruits from 2008 to 2011. All male and female New Zealand Army recruits who presented to physical therapy, following medical triage, were included. Recruit physical therapy presentations for injury and respiratory and other conditions were collated. Injury incidence was grouped by body region (upper limbs, lower limbs, and combined spinal regions) and site (joint or segment), and cumulative and injury incidence rates were calculated.

Results

One thousand eight hundred and ninety-six (1,697 males and 199 females) New Zealand Army recruits commenced basic training between 2008 and 2011. One thousand six hundred and eighty-three physical therapy presentations occurred for recruit injury during New Zealand Army basic training over 4 years. Lower limb injuries accounted for over 75% (n = 1,285) of the overall demand for physical therapy service during recruit basic training. Injuries sustained at the knee and below accounted for 67% of all reported injury presentations.

Conclusion

Four years of injury surveillance using physical therapy presentations identified the lower limb, with the knee and below as the most commonly injured regions in New Zealand Army recruits. Injury prevention interventions for New Zealand Army recruits should aim to reduce lower limb injuries. Future research on injury surveillance would benefit from incorporating clear injury and severity definitions, established injury classification systems, and standardized incidence calculations.
The fidelity of DNA replication, particularly on GC-rich templates, is reduced by defects of the Fe–S cluster in DNA polymerase δ
Authors: Kiktev Denis A , Dominska Margaret , Zhang Tony , Dahl Joseph , Stepchenkova Elena I , Mieczkowski Piotr , Burgers Peter M , Lujan Scott , Burkholder Adam , Kunkel Thomas A , Petes Thomas D
Published: May 2021

Iron-sulfur clusters (4Fe–4S) exist in many enzymes concerned with DNA replication and repair. The contribution of these clusters to enzymatic activity is not fully understood. We identified the MET18 (MMS19) gene of Saccharomyces cerevisiae as a strong mutator on GC-rich genes. Met18p is required for the efficient insertion of iron-sulfur clusters into various proteins. met18 mutants have an elevated rate of deletions between short flanking repeats, consistent with increased DNA polymerase slippage. This phenotype is very similar to that observed in mutants of POL3 (encoding the catalytic subunit of Pol δ) that weaken binding of the iron-sulfur cluster. Comparable mutants of POL2 (Pol ϵ) do not elevate deletions. Further support for the conclusion that met18 strains result in impaired DNA synthesis by Pol δ are the observations that Pol δ isolated from met18 strains has less bound iron and is less processive in vitro than the wild-type holoenzyme.
Brief trauma therapy for occupational trauma-related PTSD/CPTSD in UK police
Authors: Biggs C , Tehrani N , Billings J
Published: May 2021

Background

Police are frequently exposed to occupational trauma, making them vulnerable to post-traumatic stress disorder (PTSD) and other mental health conditions. Through personal and occupational trauma police are also at risk of developing Complex PTSD (CPTSD), associated with prolonged and repetitive trauma. Police Occupational Health Services require effective interventions to treat officers experiencing mental health conditions, including CPTSD. However, there is a lack of guidance for the treatment of occupational trauma.

Aims

To explore differences in demographics and trauma exposure between police with CPTSD and PTSD and compare the effectiveness of brief trauma-focused therapy between these diagnostic groups.

Methods

Observational cohort study using clinical data from the Trauma Support Service, providing brief trauma-focused therapy for PTSD (cognitive behavioural therapy/eye movement desensitization and reprocessing) to UK police officers. Demographics, trauma exposure, baseline symptom severity and treatment effectiveness were compared between police with PTSD and CPTSD. Changes in PTSD, depression and anxiety symptoms were used to measure treatment effectiveness.

Results

Brief trauma therapy reduced symptoms of PTSD, depression and anxiety. Treatment effectiveness did not differ between CPTSD and PTSD groups. Police with CPTSD exposed to both primary and secondary occupational trauma had poorer treatment outcomes than those exposed to a single occupational trauma type.

Conclusions

Brief trauma-focused interventions are potentially effective in reducing symptoms of PTSD, depression and anxiety in police with CPTSD and PTSD. Further research is needed to establish whether additional CPTSD symptoms (affect dysregulation, self-perception and relational difficulties) are also reduced.
Evidence of False Positivity forVibrioSpecies Tested by Gastrointestinal Multiplex PCR Panels, Minnesota, 2016–2018
Authors: Decuir Marijke , Fowler Randal C , Cebelinski Elizabeth , Smith Kirk , Boxrud David , Medus Carlota
Published: May 2021

Background

Syndromic gastrointestinal multiplex polymerase chain reaction (PCR) panels (GMPPs) are used by an increasing number of clinical laboratories to identify enteric pathogens. Vibrio species are included on GMPPs, but because of the low prevalence of vibriosis, performance characteristics for these panels have been difficult to measure.

Methods

All Vibrio spp. cases identified by GMPPs in Minnesota during 2016–2018 (n = 100) were assessed to identify differences between culture-confirmed cases and those that were PCR-positive only.

Results

Overall, 47% of cases had Vibrio species recovered by culture. Two GMPPs were used in Minnesota, Verigene EPT and FilmArray GIP, and the recovery rate of Vibrio spp. was significantly different between these platforms (Verigene EPT 63%, compared with FilmArray GIP 28%). No distinct seasonality was identified among GMPP-positive, culture-negative cases, whereas culture-confirmed case incidence peaked during July and August. Among cases with no other pathogen detected by the GMPP, confirmed cases reported a lower rate of bloody diarrhea (odds ratio [OR], 0.7; P = .004) and were less likely to have a symptom duration >14 days (OR, 0.3; P = .04). Confirmed cases were also more likely to include reports of consuming food items typically associated with Vibrio spp. infection or to have another likely source of infection (eg, international travel or contact with an untreated body of fresh or salt water or marine life; OR, 9.6; P = .001).

Conclusions

The combined findings indicate that cases identified by GMPP that did not have culture confirmation were less likely to include symptoms or exposures consistent with vibriosis. These findings emphasize the need for improvements to testing platform specificity and the importance of combining clinical and exposure information when diagnosing an infection. This study underscores the importance of maintaining the ability to culture Vibrio species to aid in accurate diagnoses.
A Prospective Study of Cytomegalovirus-Specific Cell-Mediated Immune Monitoring and Cytomegalovirus Infection in Patients With Active Systemic Lupus Erythematosus Receiving Immunosuppressants
Authors: Bruminhent Jackrapong , Autto Suphanan , Rotjanapan Porpon , Ngarmjanyaporn Pintip , Bushyakanist Asalaysa , Kirdlarp Suppachok , O-charoen Pichaya , Setthaudom Chavachol , Pisitkun Prapaporn
Published: May 2021

Background

The effects of cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) on CMV infection in patients with autoimmune diseases receiving immunosuppressants have not been explored.

Methods

Patients with active systemic lupus erythematosus (SLE) were preemptively monitored for clinically significant CMV infection (CsCMVI; defined as plasma CMV DNA loads >3 log10 IU/mL). CMV-specific CMI was assessed using an enzyme-linked immunosorbent assay (QuantiFERON-CMV [QF]) before as well as 1 and 3 months after intense immunosuppressive therapy.

Results

The study included 55 patients with active SLE; patients were a mean age (SD) of 34 (13) years and had a median SLE Disease Activity Index 2000 score (SD) of 14 (8), and 93% were female. Most patients had renal involvement (67%), received methylprednisolone (93%), and were CMV-seropositive (95%). Thirteen (23.6%) patients developed CsCMVI. Among patients with active SLE who were QF-negative (QF–) and QF-positive (QF+) before receiving immunosuppressive therapy, 28.6% and 25% developed CsCMVI, respectively (P = .69). However, 1 month postimmunosuppression, more QF– than QF+ patients developed CsCMVI (44.4% vs 11.8%; P = .03; adjusted hazard ratio, 4.97; 95% CI, 1.07–23.10; P = .04).

Conclusions

Patients with active SLE and low CMV-specific T-cell responses could develop CMV infection after receiving immunosuppressants. Further studies should focus on CMV-specific CMI among patients with autoimmune diseases.
Gastrointestinal Histoplasmosis Mimicking Crohn’s Disease
Authors: Shojaei Esfandiar , Walsh Joanna C , Sangle Nikhil , Yan Brian , Silverman Michael S , Hosseini-Moghaddam Seyed M
Published: May 2021

Disseminated histoplasmosis is a life-threatening disease usually seen in immunocompromised patients living in endemic areas. We present an apparently immunocompetent patient with gastrointestinal histoplasmosis who was initially diagnosed with biopsy-proven Crohn’s disease. Following discontinuation of anti-inflammatory drugs and institution of antifungal therapy, his gastrointestinal illness completely improved. Specific fungal staining should be routinely included in histopathologic assessment of tissue specimens diagnosed as Crohn’s disease.
Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies
Authors: Moreno-García E , Puerta-Alcalde P , Gariup G , Fernández-Ruiz M , López Cortés L E , Cuervo G , Salavert M , Merino P , Machado M , Guinea J , García-Rodríguez J , Garnacho-Montero J , Cardozo C , Peman J , Montejo M , Fortún J , Almirante B , Castro C , Rodríguez-Baño J , Aguado J M , Martínez J A , Carratalà J , Soriano A , Garcia-Vidal C
Published: May 2021

Background

There are no clear criteria for antifungal de-escalation after initial empirical treatments. We hypothesized that early de-escalation (ED) (within 5 days) to fluconazole is safe in fluconazole-susceptible candidemia with controlled source of infection.

Methods

This is a multicenter post hoc study that included consecutive patients from 3 prospective candidemia cohorts (2007–2016). The impact of ED and factors associated with mortality were assessed.

Results

Of 1023 candidemia episodes, 235 met inclusion criteria. Of these, 54 (23%) were classified as the ED group and 181 (77%) were classified as the non-ED group. ED was more common in catheter-related candidemia (51.9% vs 31.5%; P = .006) and episodes caused by Candida parapsilosis, yet it was less frequent in patients in the intensive care unit (24.1% vs 39.2%; P = .043), infections caused by Nakaseomyces glabrata (0% vs 9.9%; P = .016), and candidemia from an unknown source (24.1% vs 47%; P = .003). In the ED and non-ED groups, 30-day mortality was 11.1% and 29.8% (P = .006), respectively. Chronic obstructive pulmonary disease (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.48–10.61), Pitt score > 2 (OR, 4.39; 95% CI, 1.94–9.20), unknown source of candidemia (OR, 2.59; 95% CI, 1.14–5.86), candidemia caused by Candida albicans (OR, 3.92; 95% CI, 1.48–10.61), and prior surgery (OR, 0.29; 95% CI, 0.08–0.97) were independent predictors of mortality. Similar results were found when a propensity score for receiving ED was incorporated into the model. ED had no significant impact on mortality (OR, 0.50; 95% CI, 0.16–1.53).

Conclusions

Early de-escalation is a safe strategy in patients with candidemia caused by fluconazole-susceptible strains with controlled source of bloodstream infection and hemodynamic stability. These results are important to apply antifungal stewardship strategies.
LARP6C orchestrates posttranscriptional reprogramming of gene expression during hydration to promote pollen tube guidance
Authors: Billey Elodie , Hafidh Said , Cruz-Gallardo Isabel , Litholdo Celso G. , Jean Viviane , Carpentier Marie-Christine , Picart Claire , Kumar Vinod , Kulichova Katarina , Maréchal Eric , Honys David , Conte Maria R. , Deragon Jean-Marc , Bousquet-Antonelli Cécile
Published: May 2021

Increasing evidence suggests that posttranscriptional regulation is a key player in the transition between mature pollen and the progamic phase (from pollination to fertilization). Nonetheless, the actors in this messenger RNA (mRNA)-based gene expression reprogramming are poorly understood. We demonstrate that the evolutionarily conserved RNA-binding protein LARP6C is necessary for the transition from dry pollen to pollen tubes and the guided growth of pollen tubes towards the ovule in Arabidopsis thaliana. In dry pollen, LARP6C binds to transcripts encoding proteins that function in lipid synthesis and homeostasis, vesicular trafficking, and polarized cell growth. LARP6C also forms cytoplasmic granules that contain the poly(A) binding protein and possibly represent storage sites for translationally silent mRNAs. In pollen tubes, the loss of LARP6C negatively affects the quantities and distribution of storage lipids, as well as vesicular trafficking. In Nicotiana benthamiana leaf cells and in planta, analysis of reporter mRNAs designed from the LARP6C target MGD2 provided evidence that LARP6C can shift from a repressor to an activator of translation when the pollen grain enters the progamic phase. We propose that LARP6C orchestrates the timely posttranscriptional regulation of a subset of mRNAs in pollen during the transition from the quiescent to active state and along the progamic phase to promote male fertilization in plants.
Fatty acid export protein BnFAX6 functions in lipid synthesis and axillary bud growth in Brassica napus
Authors: Huang Ke-Lin , Tian Jing , Wang Huan , Fu Yi-Fan , Li Yang , Zheng Yong , Li Xue-Bao
Published: May 2021

Sugar is considered as the primary regulator of plant apical dominance, whereby the outgrowth of axillary buds is inhibited by the shoot tip. However, there are some deficiencies in this theory. Here, we reveal that Fatty Acid Export 6 (BnFAX6) functions in FA transport, and linoleic acid or its derivatives acts as a signaling molecule in regulating apical dominance of Brassica napus. BnFAX6 is responsible for mediating FA export from plastids. Overexpression of BnFAX6 in B. napus heightened the expression of genes involved in glycolysis and lipid biosynthesis, promoting the flow of photosynthetic products to the biosynthesis of FAs (including linoleic acid and its derivatives). Enhancing expression of BnFAX6 increased oil content in seeds and leaves and resulted in semi-dwarf and increased branching phenotypes with more siliques, contributing to increased yield per plant relative to wild-type. Furthermore, decapitation led to the rapid flow of the carbon from photosynthetic products to FA biosynthesis in axillary buds, consistent with the overexpression of BnFAX6 in B. napus. In addition, free FAs, especially linoleic acid, were rapidly transported from leaves to axillary buds. Increasing linoleic acid in axillary buds repressed expression of a key transcriptional regulator responsible for maintaining bud dormancy, resulting in bud outgrowth. Taken together, we uncovered that BnFAX6 mediating FA export from plastids functions in lipid biosynthesis and in axillary bud dormancy release, possibly through enhancing linoleic acid level in axillary buds of B. napus.
Motor adaptation and internal model formation in a robot-mediated forcefield
Authors: Taga Myriam , Curci Annacarmen , Pizzamigglio Sara , Lacal Irene , Turner Duncan L , Fu Cynthia H Y
Published: May 2021

Background

Motor adaptation relies on error-based learning for accurate movements in changing environments. However, the neurophysiological mechanisms driving individual differences in performance are unclear. Transcranial magnetic stimulation (TMS)-evoked potential can provide a direct measure of cortical excitability.

Objective

To investigate cortical excitability as a predictor of motor learning and motor adaptation in a robot-mediated forcefield.

Methods

A group of 15 right-handed healthy participants (mean age 23 years) performed a robot-mediated forcefield perturbation task. There were two conditions: unperturbed non-adaptation and perturbed adaptation. TMS was applied in the resting state at baseline and following motor adaptation over the contralateral primary motor cortex (left M1). Electroencephalographic (EEG) activity was continuously recorded, and cortical excitability was measured by TMS-evoked potential (TEP). Motor learning was quantified by the motor learning index.

Results

Larger error-related negativity (ERN) in fronto-central regions was associated with improved motor performance as measured by a reduction in trajectory errors. Baseline TEP N100 peak amplitude predicted motor learning (P = 0.005), which was significantly attenuated relative to baseline (P = 0.0018) following motor adaptation.

Conclusions

ERN reflected the formation of a predictive internal model adapted to the forcefield perturbation. Attenuation in TEP N100 amplitude reflected an increase in cortical excitability with motor adaptation reflecting neuroplastic changes in the sensorimotor cortex. TEP N100 is a potential biomarker for predicting the outcome in robot-mediated therapy and a mechanism to investigate psychomotor abnormalities in depression.
When Shareholders Disagree: Trading after Shareholder Meetings
Authors: Li Sophia Zhengzi , Maug Ernst , Schwartz-Ziv Miriam
Published: May 2021

This paper analyzes how trading after shareholder meetings changes the composition of the shareholder base. Analyzing daily trades, we find that mutual funds reduce their holdings if their votes are opposed to the voting outcome. Trading volume is high even when stock prices do not change, peaks on the meeting date, and remains high up to four weeks after shareholder meetings. The results support models based on differences of opinion that predict that shareholders’ beliefs may diverge more after observing voting outcomes. Hence, trading after meetings creates a more homogeneous shareholder base, which has important implications for corporate governance.
Sleep and interrogation: does losing sleep impact criminal history disclosure?
Authors: Krizan Zlatan , Miller Anthony J , Meissner Christian A
Published: May 2021

Study Objectives

Despite centuries of using sleep deprivation to interrogate, there is virtually no scientific evidence on how sleep shapes behavior within interrogation settings. To evaluate the impact of sleeplessness on participants’ behavior during investigative interviews, an experimental study examined the impact of sleep restriction on disclosure of past illegal behavior.

Methods

Healthy participants from a university community (N = 143) either maintained or curbed their sleep (up to 4 h a night) across 2 days with sleep monitored via actigraphy. They were then asked to disclose past illegal acts and interviewed about them. Next, they were reinterviewed following an example of a detailed memory account (model statement). Disclosures were blindly coded for quantity and quality by two independent raters.

Results

Sleep-restricted individuals reported similar offenses, but less information during their disclosure with slightly less precision. Model statement increased disclosure but did not reduce the inhibiting impact of sleep loss. Mediation analysis confirmed the causal role of sleep as responsible for experimental differences in amount of information, and participants’ reports suggested impaired motivation to recall information played a role.

Conclusions

The findings suggest that even moderate sleep loss can inhibit criminal disclosure during interviews, point to motivational factors as responsible, and suggest investigators should be cautious when interrogating sleepy participants.
Supplementation of protease to low amino acid diets containing superdose level of phytase for wean-to-finish pigs: effects on performance, postweaning intestinal health and carcass characteristics
Authors: Perez-Palencia J Y , Samuel R S , Levesque C L
Published: May 2021

This experiment investigated the effects of protease supplementation to low amino acid (AA) diets containing phytase on pig growth performance, postweaning intestinal health and carcass characteristics. A total of 936 weaned pigs (21 d of age, initial BW 5.87 ± 0.31 kg) were used in a 2 × 2 factorial design comparing the main effects of AA supply [standard feeding program: balanced for all nutrients with adjustment of Ca and P due to inclusion of phytase (2,500 FTU/kg in Phase 1 to 4; 500 FTU/kg in Phase 5 to 9) vs. low AA feeding program: 15% lower standardized ileal digestible lysine with relative reduction of all other essential AA] and protease level (0 vs. 0.0125%). Pens were assigned to dietary treatment according to a randomized complete block design with 26 pigs per pen and nine replicates per dietary treatment. Feed and water were provided on an ad libitum basis for all phases throughout the wean-to-finish period. Feed intake and body weight were determined every 2 wk during nursery period and monthly in the grow-finish period. Intestinal health in the first 17 d was assessed based on lactulose:mannitol ratio (L:M), serum IgA, and pen diarrhea assessment. Overall, pigs fed standard wean-to-finish diets had greater (P < 0.05) ADG and G:F than pigs fed low AA diets. Pig growth performance was not different throughout the wean-to-finish period with or without protease supplementation and with no interaction between AA supply and protease supplementation. There were no differences among dietary treatments for carcass characteristics. No difference was observed for urinary L:M and serum IgA; however, the L:M ratio was approximately 32% lower in pigs fed low AA diets + protease compared with pigs fed standard and low AA diets at d 5 and d 17 postweaning. Pigs fed protease supplemented diets had lower incidence of diarrhea (χ2 < 0.05) compared with pigs fed diets without protease. Results of the experiment indicate that dietary protease supplementation benefits intestinal health of nursery pigs.
Comparison of monensin sodium sources for finishing beef cattle
Authors: Husz Taylor C , Smith Wyatt N , Lockard Caleb G , Homolka Megan N , Anderson Peter T , Gentry Wes W , Sugg Joel D , Casey Kenneth D , Jennings Jenny S
Published: May 2021

The objective of this study was to evaluate the ruminal fermentation characteristics of ruminally fistulated beef steers consuming a steam-flaked corn (SFC) or dry-rolled corn (DRC) based diet containing either Rumensin 90 (RUM; Elanco, Greenfield, IN), or Monovet 90 (MV; Huvepharma, Peachtree City, GA). Six ruminally fistulated steers (657.7 kg ± 72.6) housed individually were used in a 6 × 6 Latin square design with 2 × 3 factorial treatment arrangement. Each of the 6 periods were 15 d with 14 d for diet adaptation and 1 d of rumen fluid collections. Dietary treatments were DRC without monensin sodium (DRC-C), SFC without monensin sodium (SFC-C), DRC with Rumensin 90 (DRC-R), DRC with Monovet 90 (DRC-MV), SFC with Rumensin 90 (SFC-R), and SFC with Monovet 90 (SFC-MV). Rumen contents and fluid were collected through the fistula of each animal at 0, 3, 6, 12, and 24 h on d 15 of each period. Rumen fluid collected at 6 h post-feeding each period was used for in vitro analyses. Steer was the experimental unit and the model included fixed effects of grain processing, additive, and grain processing × additive. Total gas produced was composited from each in vitro bottle into a gas collection bag for the 48-h determination of methane concentration. No differences were detected for DMI (P = 0.81). Ruminal pH did not differ for the control or additive treatments (P = 0.33). However, ruminal pH was lower (P < 0.01) with SFC compared to DRC. There was a significant difference in acetate to propionate ratio for grain type (P = 0.01) and a tendency for additive inclusion (P = 0.06). Additive inclusion reduced methane proportion of total gas compared to control treatments (P ≤ 0.01). Overall, monensin sodium reduced methane concentration though source had no effect on DMI or ruminal pH.
Retrospective hospital-based study on snakebite envenomation in Sudan
Authors: Khalid Huda , Azrag Rasha S
Published: May 2021

Background

Snakebite statistics are lacking in Sudan despite the high estimated burden. In this study we aimed to describe the incidence of snakebite envenomation and death in Sudan and to show the state-wise distribution of snakebite episode.

Methods

We retrospectively analyzed hospital-based data on snakebite for 2014–2018. Data were obtained from the annual health statistical reports of the Ministry of Health. Descriptive statistics were used to illustrate the results.

Results

A total of 63 160 people were envenomed during 2014–2018 with an average of 12 632 cases/year. The death rate between inpatient cases was 2.5%. The annual incidence was 18– 47 cases/100 000 population. Gadarif state recorded the highest incidence (132/100 000 population) of snakebite envenomation in Sudan whereas Northern state had the least incidence (5/100 000 population). The 15–24 y age group experienced the highest risk of snakebite and males were more exposed to snakebites than females.

Conclusions

Although hospital-based records underestimate the burden of snakebite, they can still provide an insight regarding the actual numbers. Here, we highlight the at-risk states in Sudan to be targeted for further questionnaire-based epidemiological studies and to guide health authorities to reduce the burden of snakebite envenomation by insuring proper antivenom distribution to the highly affected areas.
Original Research: Oral Care as Prevention for Nonventilator Hospital-Acquired Pneumonia
Authors: Giuliano Karen K. , Penoyer Daleen , Middleton Aurea , Baker Dian
Published: May 2021

Background:

Nonventilator hospital-acquired pneumonia (NV-HAP) presents a serious and largely preventable threat to patient safety in U.S. hospitals. There is an emerging body of evidence on the effectiveness of oral care in preventing NV-HAP.

Purpose:

The primary aim of this study was to determine the effectiveness of a universal, standardized oral care protocol in preventing NV-HAP in the acute care setting. The primary outcome measure was NV-HAP incidence per 1,000 patient-days.

Methods:

This 12-month study was conducted on four units at an 800-bed tertiary medical center. Patients on one medical and one surgical unit were randomly assigned to receive enhanced oral care (intervention units); patients on another medical and another surgical unit received usual oral care (control units).

Results:

Total enrollment was 8,709. For the medical control versus intervention units, oral care frequency increased from a mean of 0.95 to 2.25 times per day, and there was a significant 85% reduction in the NV-HAP incidence rate. The odds of developing NV-HAP were 7.1 times higher on the medical control versus intervention units, a significant finding. For the surgical control versus intervention units, oral care frequency increased from a mean of 1.18 to 2.02 times per day, with a 56% reduction in the NV-HAP incidence rate. The odds of developing NV-HAP were 1.6 times higher on the surgical control versus intervention units, although this result did not reach significance.

Conclusions:

These findings add to the growing body of evidence that daily oral care as a means of primary source control may have a role in NV-HAP prevention. The implementation of effective strategies to ensure that such care is consistently provided warrants further study. It's not yet known what degree and frequency of oral care are required to effect favorable changes in the oral microbiome during acute care hospitalization.
Exanthematous reactions to drugs in children
Authors: Atanaskovic-Markovic Marina , Tsabouri Sophia
Published: May 2021

Purpose of review

The true exanthematous reactions to drugs in children are rare and overdiagnosed. Drugs may cause exanthema either due to inducing an immune response or because of their interaction with viruses, if drugs are taken in the course of a viral infection. Also, viral infections are very often in children and they can provoke an exanthema which is difficult to differentiate from exanthematous reactions to drugs. Consequently, the majority of children are incorrectly labeled as ‘allergic’.

Recent findings

The correct diagnosis of exanthematous drug reactions in children is still an important and hot topic. Most information about the approach and management of drug hypersensitivity in children is applied from available guidelines and consensus statement for adults. Recently, a systematic clinical approach for timely differential diagnosis and management of rashes in children who present a cutaneous exanthema while receiving a drug, is proposed.

It is important to consider the detailed clinical history of appearing and developing exanthematous drug reaction, as well as physical examination which includes the description and the distribution of exanthema and at the end making the appropriate diagnosis. Thus, it could reduce overdiagnosis and promote appropriate procedures, that will prevent the overlabeling of drug hypersensitivity in children.
Evidence-based management of eczema: five things that should be done more and five things that should be dropped
Authors: Olabi Bayanne , Williams Hywel C.
Published: May 2021

Purpose of review

We provide readers with an evidence-informed opinion on current treatments for eczema (atopic dermatitis) with the intention of improving patient care. We suggest five treatment aspects that should be promoted and five that should be demoted. Evidence sources include key randomized controlled trials and systematic reviews.

Recent findings

Under-treatment of eczema can be countered by more aggressive use of topical therapies including the ‘get control then keep control’ regimen, and systemics for severe disease, supplemented with good patient education. Topical corticosteroids should be used once daily rather than twice daily. Topical calcineurin inhibitors are useful for sensitive sites. There is little evidence to support the continued use of oral antihistamines, oral or topical antistaphylococcal treatments for infected eczema or probiotics for treating eczema. Nonpharmacological treatments including silk clothing, ion-exchange water softeners and emollient bath additives have not been shown to benefit eczema patients. Despite promising pilot studies, large trials suggest that emollients from birth do not prevent eczema and may result in harms such as increased skin infections and food allergy.

New evidence-based insights on existing and newer treatments allow clinicians the opportunity to change their practice in a way that enhances patients’ quality of life.
Improving Family-Centered Care for Infants in Neonatal Intensive Care Units
Authors: Franck Linda S. , Bisgaard Robin , Cormier Diana M. , Hutchison Jennifer , Moore Dishon , Gay Caryl , Christensen Holly , Kriz Rebecca M. , Mora Jennifer , Ekno Mary , Hackett Heather , Lare Natasha
Published: May 2021

Background:

Family-centered care is a philosophy and healthcare delivery model adopted by many neonatal intensive care units (NICUs) worldwide, yet practice varies widely.

Purpose:

The aim of this study was to synthesize recommendations from frontline NICU healthcare professionals regarding family-centered care.

Methods:

Data were obtained from the baseline phase of a multicenter quasi-experimental study comparing usual family-centered NICU care (baseline) with mobile-enhanced family integrated care (intervention). Members of the NICU clinical care team completed a family-centered care survey and provided free-text comments regarding practice of family-centered care in their NICU and recommendations for improvement. The comments were analyzed using a directed content analysis approach by a research team that included NICU nurses and parents.

Results:

Of the 382 NICU healthcare providers from 6 NICUs who completed the survey, 68 (18%) provided 89 free-text comments/recommendations about family-centered care. Almost all comments were provided by nurses (91%). Six main themes were identified: language translation; communication between staff and families; staffing and workflow; team culture and leadership; education; and NICU environment. The need for greater resources for staffing, education, and environmental supports was prominent among the comments, as was team culture and staff–parent communications.

Implications for Practice:

The NICU healthcare professionals identified a range of issues that support or impede delivery of family-centered care and provided actionable recommendations for improvement.

Implications for Research:

Future research should include economic analyses that will enable determination of the return on investment so that NICUs can better justify the human and capital resources needed to implement high-quality family-centered care.
Term Newborn Care Recommendations Provided in a Kenyan Postnatal Ward
Authors: Reid Davika D. , García Alexandra A. , Zuñiga Julie A. , Mercer Tim , Gulbas Lauren , Walker Lorraine O. , Chelagat Dinah
Published: May 2021

Background:

Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited.

Purpose:

To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school.

Methods:

A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis.

Results:

Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care.

Implications for Practice:

There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality.

Implications for Research:

Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.
Reconstruction of Septic Tibial Bone Defects With the Masquelet Technique and External Ring Fixation—A Low Healing Rate and High Complication and Revision Rates
Authors: Lotzien Sebastian , Rosteius Thomas , Reinke Charlotte , Behr Björn , Lehnhardt Marcus , Schildhauer Thomas Armin , Gessmann Jan
Published: May 2021

Objectives:

To evaluate the results of a series of septic tibial bone defects treated with the Masquelet technique and external ring fixation as a standardized treatment procedure.

Design:

Retrospective study.

Setting:

Level one trauma center.

Patients/Participants:

All patients 18 years of age or older with septic diaphyseal bone defects of the tibia who underwent induced membrane treatment with ring fixation at our institution between June 1, 2012, and November 31, 2017.

Intervention:

Staged management as described by Masquelet using an external ring fixator for definitive fixation.

Main Outcome Measurements:

Bony healing at the last follow-up and the time to healing in months. Functional results were assessed according to the scoring system of the Association for the Study and Application of Methods of Ilizarov. The secondary outcome measures were treatment failure and complications.

Results:

Thirty-one patients were treated, with a mean follow-up period of 33 months (range, 13–69 months). Overall, among 14 patients assessed as having achieved bone healing, an average of 3.7 surgical revisions were required. The mean healing time was 15.5 months (range, 6–49 months). According to the Association for the Study and Application of Methods of Ilizarov criteria, 7 patients were rated as “excellent” and 6 patients were rated as “good”; one patient showed “poor” functional results. A total of 17 cases of treatment failure and 36 complications were detected.

Conclusions:

The combination of the Masquelet technique and external fixation yielded a low healing rate and was associated with a significant number of cases of treatment failure.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.