bluuebunny/crossref_metadata_2025 huggingface dataset:
Bio-robotics research for non-invasive myoelectric neural interfaces for upper-limb prosthetic control: a 10-year perspective review
Authors: Jiang Ning , Chen Chen , He Jiayuan , Meng Jianjun , Pan Lizhi , Su Shiyong , Zhu Xiangyang
Published: February 2023

A decade ago, a group of researchers from academia and industry identified a dichotomy between the industrial and academic state-of-the-art in upper-limb prosthesis control, a widely used bio-robotics application. They proposed that four key technical challenges, if addressed, could bridge this gap and translate academic research into clinically and commercially viable products. These challenges are unintuitive control schemes, lack of sensory feedback, poor robustness and single sensor modality. Here, we provide a perspective review on the research effort that occurred in the last decade, aiming at addressing these challenges. In addition, we discuss three research areas essential to the recent development in upper-limb prosthetic control research but were not envisioned in the review 10 years ago: deep learning methods, surface electromyogram decomposition and open-source databases. To conclude the review, we provide an outlook into the near future of the research and development in upper-limb prosthetic control and beyond.
Affective Polarization in Comparative and Longitudinal Perspective
Authors: Garzia Diego , Ferreira da Silva Frederico , Maye Simon
Published: February 2023

Existent research shows that affective polarization has been intensifying in some publics, diminishing in others, and remaining stable in most. We contribute to this debate by providing the most encompassing comparative and longitudinal account of affective polarization so far. We resort to a newly assembled dataset able to track partisan affect, with varying time series, in eighteen democracies over the last six decades. We present results based on two different operational measures of affective polarization: Reiljan's Affective Polarization Index, based on reported partisans only, and Wagner's weighted distance from the most liked party, based on the whole electorate. Our reassessment of affective polarization among partisans confirms that an intensifying trend is observable in a number of countries but it is, by no means, generalizable to all established democracies. Regarding the longitudinal assessment of affective polarization among the electorate, we confirm that US citizens have become more affectively polarized over time.
How patient autonomy drives the legal liabilities of medical practitioners and the practical ways to mitigate and resolve them
Authors: Kim Hwan , Lee Albert
Published: February 2023

This paper discusses the rapidly evolving healthcare risk landscape and considers how emerging trends—such as advancement of medical technology, cyber security, pandemic risks, increasing prevalence of noncommunicable health conditions, and the shift towards patient autonomy—are shaping the nature of liabilities faced by doctors and healthcare professionals. Then it discusses practical ways to mitigate clinical risks and resolve the medico-legal claims or inquiries that arise while addressing the role that indemnity providers should play.
Exact renormalization group for wave functionals
Authors: Kuwahara Takaaki , Tanaka Gota , Tsuchiya Asato , Yamashiro Kazushi
Published: February 2023

Motivated by the construction of continuum tensor networks for interacting field theories, which are relevant in understanding the emergence of space-time in the gauge/gravity correspondence, we derive a non-perturbative functional differential equation for wave functionals in scalar field theories from the exact renormalization group equation. We check the validity of the equation using the perturbation theory. We calculate the wave functional up to the first-order perturbation and verify that it satisfies the equation.
Letters, Poems, Flowers, and Bluestocking Friendship: Mary Hamilton’s Collage–Biography of Mary Delany
Authors: Voloshkova Nataliia
Published: February 2023

This article explores a friendship between two major figures in the Bluestocking network: the courtier and diarist Mary Hamilton (1756–1816) and the artist Mary Delany (1700–1788). Drawing on the Mary Hamilton Papers and the Dickenson Family Papers, it sheds new light on the ways in which their relationship ensured continuity of female experience, solidarity, knowledge channelling, and skills transfer across generations. The article investigates these women’s collaborative activities and discusses Hamilton’s engagement with Delany’s famous paper flower collages. It also explores Hamilton’s volume of excerpts from Delany’s letters and transcriptions of poems penned by and dedicated to Delany. When read together, Hamilton’s various biographical materials related to Delany form the first contemporary collage–biography of her brilliant precursor.
Ancient Rapid Radiation Explains Most Conflicts Among Gene Trees and Well-Supported Phylogenomic Trees of Nostocalean Cyanobacteria
Authors: Pardo-De la Hoz Carlos J , Magain Nicolas , Piatkowski Bryan , Cornet Luc , Dal Forno Manuela , Carbone Ignazio , Miadlikowska Jolanta , Lutzoni François
Published: February 2023

Prokaryotic genomes are often considered to be mosaics of genes that do not necessarily share the same evolutionary history due to widespread horizontal gene transfers (HGTs). Consequently, representing evolutionary relationships of prokaryotes as bifurcating trees has long been controversial. However, studies reporting conflicts among gene trees derived from phylogenomic data sets have shown that these conflicts can be the result of artifacts or evolutionary processes other than HGT, such as incomplete lineage sorting, low phylogenetic signal, and systematic errors due to substitution model misspecification. Here, we present the results of an extensive exploration of phylogenetic conflicts in the cyanobacterial order Nostocales, for which previous studies have inferred strongly supported conflicting relationships when using different concatenated phylogenomic data sets. We found that most of these conflicts are concentrated in deep clusters of short internodes of the Nostocales phylogeny, where the great majority of individual genes have low resolving power. We then inferred phylogenetic networks to detect HGT events while also accounting for incomplete lineage sorting. Our results indicate that most conflicts among gene trees are likely due to incomplete lineage sorting linked to an ancient rapid radiation, rather than to HGTs. Moreover, the short internodes of this radiation fit the expectations of the anomaly zone, i.e., a region of the tree parameter space where a species tree is discordant with its most likely gene tree. We demonstrated that concatenation of different sets of loci can recover up to 17 distinct and well-supported relationships within the putative anomaly zone of Nostocales, corresponding to the observed conflicts among well-supported trees based on concatenated data sets from previous studies. Our findings highlight the important role of rapid radiations as a potential cause of strongly conflicting phylogenetic relationships when using phylogenomic data sets of bacteria. We propose that polytomies may be the most appropriate phylogenetic representation of these rapid radiations that are part of anomaly zones, especially when all possible genomic markers have been considered to infer these phylogenies. [Anomaly zone; bacteria; horizontal gene transfer; incomplete lineage sorting; Nostocales; phylogenomic conflict; rapid radiation; Rhizonema.]
Transcriptional reprogramming during recovery from drought stress in Eucalyptus grandis
Authors: Teshome Demissew Tesfaye , Zharare Godfrey Elijah , Ployet Raphael , Naidoo Sanushka
Published: February 2023

The importance of drought as a constraint to agriculture and forestry is increasing with climate change. Genetic improvement of plants’ resilience is one of the mitigation strategies to curb this threat. Although recovery from drought stress is important to long-term drought adaptation and has been considered as an indicator of dehydration tolerance in annual crops, this has not been well explored in forest trees. Thus, we aimed to investigate the physiological and transcriptional changes during drought stress and rewatering in Eucalyptus grandis W. Hill ex Maiden. We set up a greenhouse experiment where we imposed drought stress on 2-year-old seedlings and rewatered the recovery group after 17 days of drought. Our measurement of leaf stomatal conductance (gs) showed that, while gs was reduced by drought stress, it fully recovered after 5 days of rewatering. The RNA-seq analysis from stem samples revealed that genes related to known stress responses such as phytohormone and reactive oxygen species signaling were upregulated, while genes involved in metabolism and growth were downregulated due to drought stress. We observed reprogramming of signal transduction pathways and metabolic processes at 1 day of rewatering, indicating a quick response to rewatering. Our results suggest that recovery from drought stress may entail alterations in the jasmonic acid, salicylic acid, ethylene and brassinosteroid signaling pathways. Using co-expression network analysis, we identified hub genes, including the putative orthologs of ABI1, ABF2, ABF3, HAI2, BAM1, GolS2 and SIP1 during drought and CAT2, G6PD1, ADG1 and FD-1 during recovery. Taken together, by highlighting the molecular processes and identifying key genes, this study gives an overview of the mechanisms underlying the response of E. grandis to drought stress and recovery that trees may face repeatedly throughout their long life cycle. This provides a useful reference to the identification and further investigation of signaling pathways and target genes for future tree improvement.
Analysis of Cotton Leafroll Dwarf Virus P0 Gene Sequences from South Carolina Reveals Low Variability Among Isolates
Authors: Spivey William W. , Williamson Zachary , Seiter Jacob , Abrahamian Peter , Wang Hehe , Greene Jeremy , Cieniewicz Elizabeth
Published: February 2023

Cotton leafroll dwarf virus (CLRDV) is emerging across the major cotton-producing states of the southern United States. Because it was detected in nearly all cotton-producing states within a few years of its initial detection in the United States, the spread of the virus has apparently occurred rapidly. In this study spanning three growing seasons in South Carolina, we collected CLRDV isolates from symptomatic and asymptomatic cotton plants in 10 counties. The genomic region encoding P0, the viral suppressor of RNA silencing, was sequenced and compared among CLRDV isolates. Low variability among CLRDV P0 sequences from South Carolina isolates with similarities to other United States isolates was revealed by amino acid sequence alignment and phylogenetic analysis. Low variability among South Carolina isolates was also confirmed by sequencing a subset of eight near-complete genomes of CLRDV isolates. Although sequence variability was low among South Carolina isolates, this data should be taken in the context of all United States isolates, for which diversity may be higher than initially expected. Sequences gathered in this study add to the body of knowledge on CLRDV diversity in the United States.
Neofusicoccum actinidiae and Neofusicoccum guttata, Two New Species Causing Kiwifruit Rot in China
Authors: Feng Lu , Liu Juan , Li Chao , Lin Yang , Cheng Jiasen , Xie Jiatao , Li Bo , Zeng Yunliu , Fu Yanping
Published: February 2023

Kiwi is a popular fruit consumed worldwide. A number of fungal pathogens have been reported to cause postharvest rot of kiwifruit, and Botryosphaeriaceae species are the major causal agents of the disease. In this study, 18 isolates belonging to the genus Neofusicoccum (family Botryosphaeriaceae) were isolated from 247 symptomatic kiwifruits of the cultivars Jinyan, Jintao, and Jinkui collected from orchards in Hubei and Jiangxi provinces, China. Among the isolates, three grouped with various known Neofusicoccum parvum isolates, whereas the remaining 15 formed two independent clades. On the basis of further phylogenetic analyses with concatenated sequences of ITS and three genes encoding translation elongation factor 1-alpha (TEF), β-tubulin (TUB), and DNA-dependent RNA polymerase II subunit (RPB2), as well as morphological characteristics, two new species, N. actinidiae and N. guttata, were proposed. Their pathogenicity to kiwi, apple, and citrus fruits was also confirmed.
Biomechanical Analysis of Multilevel Posterior Cervical Spinal Fusion Constructs
Authors: Murphy Timothy P. , Colantonio Donald F. , Le Anthony H. , Fredericks Donald R. , Schlaff Cody D. , Holm Erik B. , Sebastian Arjun S. , Pisano Alfred J. , Helgeson Melvin D. , Wagner Scott C.
Published: February 2023

Study Design:

Controlled Laboratory Study

Objective:

To compare multilevel posterior cervical fusion (PCF) constructs stopping at C7, T1, and T2 under cyclic load to determine the range of motion (ROM) between the lowest instrumented level and lowest instrumented-adjacent level (LIV-1).

Summary of Background Data:

PCF is a mainstay of treatment for various cervical spine conditions. The transition between the flexible cervical spine and rigid thoracic spine can lead to construct failure at the cervicothoracic junction. There is little evidence to determine the most appropriate level at which to stop a multilevel PCF.

Methods:

Fifteen human cadaveric cervicothoracic spines were randomly assigned to 1 of 3 treatment groups: PCF stopping at C7, T1, or T2. Specimens were tested in their native state, following a simulated PCF, and after cyclic loading. Specimens were loaded in flexion-extension), lateral bending, and axial rotation. Three-dimensional kinematics were recorded to evaluate ROM.

Results:

The C7 group had greater flexion-extension motion than the T1 and T2 groups following instrumentation (10.17±0.83 degree vs. 2.77±1.66 degree and 1.06±0.55 degree, P <0.001), and after cyclic loading (10.42±2.30 degree vs. 2.47±0.64 degree and 1.99±1.23 degree, P<0.001). There was no significant difference between the T1 and T2 groups. The C7 group had greater lateral bending ROM than both thoracic groups after instrumentation (8.81±3.44 degree vs. 3.51±2.52 degree, P=0.013 and 1.99±1.99 degree, P=0.003) and after cyclic loading. The C7 group had greater axial rotation motion than the thoracic groups (4.46±2.27 degree vs. 1.26±0.69 degree, P=0.010; and 0.73±0.74 degree, P=0.003) following cyclic loading.

Conclusion:

Motion at the cervicothoracic junction is significantly greater when a multilevel PCF stops at C7 rather than T1 or T2. This is likely attributable to the transition from a flexible cervical spine to a rigid thoracic spine. Although this does not account for in vivo fusion, surgeons should consider extending multilevel PCF constructs to T1 when feasible.

Level of Evidence:

Not applicable.
Clinical Significance of Lateral Pedicle Screw Malposition in Lumbar Spine Fusion
Authors: LeRoy Taryn E. , Smith Isabel C. , Kim David H. , Golenbock Samuel W. , Baker Kevin C. , Arnold Paul M. , Sasso Rick C. , Park Daniel K. , Fischgrund Jeffrey S. , Zaidi Qasim H. , Hwang Raymond W.
Published: February 2023

Study Design:

Retrospective cohort study.

Objective:

Our objective was to determine whether lateral pedicle screw breach affects fusion rates and patient-reported outcomes in lumbar fusion surgery.

Summary of Background Data:

Although lateral pedicle screw malposition is considered relatively benign, few studies have focused specifically on clinical outcomes or fusion rates associated with lateral screw malposition.

Methods:

Twelve-month postoperative computed tomography scans were reviewed for lateral breach, severity of breach, and fusion status. Patients with lateral breach were compared with patients with no breach. Outcome measures included Numerical Pain Rating Scale for back and leg pain, Oswestry Disability Index, and SF-36 physical function (SF-36 PF). Multivariable linear and logistic regression and were adjusted for age, procedure, level, and/or baseline pain score.

Results:

Forty-five patients (31%) demonstrated 1 or more lateral breaches as compared with 99 patients without breach. After adjusting for baseline scores and fusion level, patients with 2 or more screw breaches experienced SF-36 PF score improvements that were 3.43 points less (P=0.016) than patients with no lateral breach. After adjusting for baseline Numerical Pain Rating Scale, there was also a significant decrease in the odds of achieving minimally clinical important difference in back pain relief in these patients. There was no observed effect of lateral breach on the odds of successful fusion.

Conclusions:

The current study did not observe an association between laterally malpositioned pedicle screws and nonunion. However, results are consistent with a negative effect on SF-36 PF scores and self-reported back pain at 12 months.
Cervical Disk Arthroplasty and Range of Motion at 7 Years
Authors: Satin Alexander M. , Rogers-LaVanne Mary P. , Derman Peter B.
Published: February 2023

Study Design:

Secondary analysis of data collected in a prospective, randomized, noninferiority Food and Drug Administration (FDA) Investigational Device Exemption (IDE) clinical trial.

Objective:

The objective of this study was to evaluate the impact of range of motion (ROM) following single-level cervical disk arthroplasty (CDA) on the development of radiographic adjacent level degeneration (ALD).

Summary of Background Data:

The rationale for CDA is that maintenance of index-level ROM will decrease adjacent level stresses and ultimately reduce the development of ALD compared with anterior cervical discectomy and fusion. However, little information is available on the impact of hypermobility on the development of ALD after CDA.

Materials and Methods:

Radiographic assessments were evaluated for index-level flexion-extension ROM and ALD. Continuous data was assessed using 1-way analysis of variance. The relationship between ALD progression and ROM was evaluated using χ2 tests. The α was set at 0.05.

Results:

More ALD progression was observed after anterior cervical discectomy and fusion than CDA (P=0.002 at the superior and P=0.049 at the inferior level). Furthermore, there was an association between ALD progression and ROM (P=0.014 at the superior level and P=0.050 at the inferior level) where patients with mid-ROM after CDA experienced the lowest frequency of ALD progression at the superior and inferior levels. Patients with the lowest and highest ROM after CDA experienced a greater increase in ALD score at the inferior level (P=0.046). Sex and age were associated with ROM groups (P=0.001 and 0.023, respectively).

Conclusions:

While maintenance of index-level ROM is protective after CDA, patients with the highest ROM after CDA have similar rates of ALD progression to the lowest ROM and greater increases in ALD compared with mid-ROM after CDA. High ROM after CDA may contribute to ALD progression.
Determinants of Mortality for Ventilated Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia
Authors: Motowski Hayley , Ilges Daniel , Hampton Nicholas , Kollef Marin H. , Micek Scott T.
Published: February 2023

IMPORTANCE:

Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection, accounting for 22% of all nosocomial infections. The available studies to date have not attempted to assess whether confounding factors may account for the observed difference in mortality for the two forms of nosocomial pneumonia associated with mechanical ventilation, namely ventilated HAP (vHAP) and ventilator-associated pneumonia (VAP).

OBJECTIVES:

To determine if vHAP is an independent predictor of mortality among patients with nosocomial pneumonia.

DESIGN, SETTING, AND PARTICIPANTS:

Single-center retrospective cohort study conducted at Barnes-Jewish Hospital, St. Louis, MO, between 2016 and 2019. Adult patients with a pneumonia discharge diagnosis were screened and patients diagnosed with vHAP and VAP were included. All patient data was extracted from the electronic health record.

MAIN OUTCOMES AND MEASURES:

The primary outcome was 30-day all-cause mortality (ACM).

RESULTS:

One thousand one-hundred twenty unique patient admissions were included (410 vHAP, 710 VAP). Thirty-day ACM was greater for patients with vHAP compared with VAP (37.1% vs 28.5%; p = 0.003). Logistic regression analysis identified vHAP (adjusted odds ratio [AOR], 1.77; 95% CI, 1.51–2.07), vasopressor use (AOR, 2.34; 95% CI, 1.94–2.82), Charlson Comorbidity Index (1-point increments) (AOR, 1.21; 95% CI, 1.18–1.24), total antibiotic treatment days (1-d increments) (AOR, 1.13; 95% CI, 1.11–1.14), and Acute Physiology and Chronic Health Evaluation II score (1-point increments) (AOR, 1.04; 95% CI, 1.03–1.06) as independent predictors of 30-day ACM. The most common bacterial pathogens identified as causes of vHAP and VAP were Staphylococcus aureus, Enterobacterales species, and Pseudomonas aeruginosa.

CONCLUSIONS AND RELEVANCE:

In this single-center cohort study with low rates of initial inappropriate antibiotic therapy, vHAP had greater 30-day ACM compared with VAP after adjusting for potential confounding variables including disease severity and comorbidities. This finding suggests that clinical trials enrolling patients with vHAP need to account for this outcome difference in their trial design and data interpretation.
Enhancing Efficacy of TCR-engineered CD4+ T Cells Via Coexpression of CD8α
Authors: Anderson Victoria E. , Brilha Sara S. , Weber Anika M. , Pachnio Annette , Wiedermann Guy E. , Dauleh Sumaya , Ahmed Tina , Pope George R. , Quinn Laura L. , Docta Roslin Y. , Quattrini Adriano , Masters Siobhan , Cartwright Neil , Viswanathan Preetha , Melchiori Luca , Rice Louise V. , Sevko Alexandra , Gueguen Claire , Saini Manoj , Tavano Barbara , Abbott Rachel J.M. , Silk Jonathan D. , Laugel Bruno , Sanderson Joseph P. , Gerry Andrew B.
Published: February 2023

Adoptive cell therapy with T cells expressing affinity-enhanced T-cell receptors (TCRs) is a promising treatment for solid tumors. Efforts are ongoing to further engineer these T cells to increase the depth and durability of clinical responses and broaden efficacy toward additional indications. In the present study, we investigated one such approach: T cells were transduced with a lentiviral vector to coexpress an affinity-enhanced HLA class I–restricted TCR directed against MAGE-A4 alongside a CD8α coreceptor. We hypothesized that this approach would enhance CD4+ T-cell helper and effector functions, possibly leading to a more potent antitumor response. Activation of transduced CD4+ T cells was measured by detecting CD40 ligand expression on the surface and cytokine and chemokine secretion from CD4+ T cells and dendritic cells cultured with melanoma-associated antigen A4+ tumor cells. In addition, T-cell cytotoxic activity against 3-dimensional tumor spheroids was measured. Our data demonstrated that CD4+ T cells coexpressing the TCR and CD8α coreceptor displayed enhanced responses, including CD40 ligand expression, interferon-gamma secretion, and cytotoxic activity, along with improved dendritic cell activation. Therefore, our study supports the addition of the CD8α coreceptor to HLA class I–restricted TCR-engineered T cells to enhance CD4+ T-cell functions, which may potentially improve the depth and durability of antitumor responses in patients.
The Impact of Training Program on Nurse's Knowledge and Skills of Myocardial Infarction Screening by Using Electrocardiogram
Authors: Fadlalmola Hammad , Tubaishat Ahmad , Habiballa Mohammed
Published: February 2023

A nurse is usually the one who faces electrocardiogram (ECG) interpretation; thus, there is a need to increase knowledge and skills of nurses on doing and interpreting the electrocardiogram. The objective of the study was to assess the effectiveness of training program on the knowledge and skills of nursing staff regarding screening of myocardial infarction by using 12-lead ECG. A descriptive case-control study design with comparison groups (intervention and control) was performed in 4 hospitals at Sudan. Two hospitals were selected randomly as intervention group, and the another 2 was the control group. Data collection was taken pre- and posttraining program for both groups, followed by posttest evaluation (late posttest) after 3 months for intervention group only, using same structured knowledge questionnaire and direct observation checklist to assess the nurse's skills. The baseline scores at the pretest revealed that there was no significant difference between intervention and control groups. After the training program, the score increased for the intervention group 22.94 compared with the control group 12.64 (P < .001). The same reported for the skill scores, where it was 25.52 for the intervention group and 16.12 for the control group (P < .001). Three months later, the second posttest showed as well significant differences from the baseline for the intervention group in the knowledge score (M = 20.42, P < .001) and the skills score (M = 24.64, P < .001). The study showed poor knowledge and skills among nurses regarding screening of myocardial infarction by using electrocardiogram at the pretest. The training program was effective in improving their knowledge and skills.
Needs of Family Members of Intensive Care Patients
Authors: Jafarpoor Hasanali , Manoochehri Houman , Vasli Parvaneh
Published: February 2023

This article reports the results of a research project designed to identify the needs of family members and others who are coping with hospitalization of loved one in the intensive care unit, thus alleviating stress. The health care provider's viewpoints were also considered. Study participants were 9 family members of intensive care unit patients and 24 health care providers working in intensive care units. Data were collected and analyzed from 24 individual interviews (average of 35 minutes per interview) and 1 focus group interview (1 hour). The findings revealed 2 basic needs: (1) reducing concerns and (2) being supported. The first need could be addressed by open visitation, access to information, assurance of quality of care, and empowerment via education and involvement. The second need could be met by emotional support, access to facilities, and postdischarge support. Health care providers and decision makers can use these results to respond to these needs and increase people's satisfaction of intensive care unit services.
Striving to Keep a Clear Conscience by Going Above and Beyond
Authors: Jodaki Kurosh , Esmaeili Maryam , Cheraghi Mohammad Ali , Mazaheri Monir
Published: February 2023

Working as a nurse in the critical care unit may involve ethical challenges including conflict of conscience. Literature provides very limited knowledge about intensive care unit (ICU) nurses' perception of conscience. Considering the influence of culture on the perception of conscience, it is important to study it in diverse contexts. This study aims were to explore the meaning of conscience and the impact of conscience on nurses' practice in the ICU. A qualitative research approach was used to answer the research question, and qualitative content analysis guided the study. A total of 17 interviews were conducted with ICU nurses. Data were collected through semistructured tools by using videoconferencing and face-to-face interviews. Data analysis resulted in the formation of 2 main categories and 7 subcategories. The main categories included understanding the conscience and unlimited efforts in caretaking as the path to a clear conscience. The category of understanding the conscience includes 3 subcategories of conscience as an intrinsic asset and internal observer, dynamicity of conscience, and conscience as the cornerstone of morality. Also, the category of unlimited efforts in caretaking as the path to a clear conscience consists of 4 subcategories including giving full attention to the patient, putting oneself in another's shoes, taking responsibility, and working beyond the job description. Conscience plays an essential role in providing the ethical care among ICU nurses. The ICU nurses felt that they need to go above and beyond to keep their conscience clear. Nurses expressed the importance of following the call of conscience at their workplace, which demanded unlimited efforts to achieve a clear conscience.
Development and Validation of a Red Flag Prediction Model for Admission of COVID-19 Patients to the Intensive Care Unit
Authors: Mahran Ghada S. K. , Gadallah Marzoka A. , Mekkawy Mimi M. , Ahmed Sanaa M. , Sayed Magdy M. M. , Obiedallah Ahmed A. , Abbas Mostafa S. , Mohamed Sherif A. A.
Published: February 2023

We aimed to develop and validate a model for the criteria for admission of COVID-19 patients to the intensive care unit (ICU). A Delphi design study was conducted. The content validity index (CVI) was used to determine the degree of agreement among the experts to validate the content of the admission criteria tool. Eleven experts determined the validity. The evaluation was conducted using a 4-point rating scale. The accepted CVI value was 0.50 and more. The model was validated with 31 items in the 5 dimensions, with the item-CVI of 1, a face validity index of 1, and a scale-level content validity index (S-CVI) value of 1. We have developed and validated a red flag prediction model for ICU admission of COVID-19 patients. The accurate implementation of this model could improve the outcomes of those patients and possibly decrease mortality.
Development of a Discharge Criteria Checklist for COVID-19 Patients From the Intensive Care Unit
Authors: Mahran Ghada S. K. , Gadallah Marzoka A. , Ahmed Awatef E. , Abouzied Warda R. , Obiedallah Ahmed A. , Sayed Magdy M. M. , Abbas Mostafa S. , Mohamed Sherif A. A.
Published: February 2023

This study aims to develop and validate a checklist of discharge readiness criteria for COVID-19 patients from the intensive care unit (ICU). We conducted a Delphi design study. The degree of agreement among 7 experts had been evaluated using the content validity index (CVI) through a 4-point Likert scale. The instrument was validated with 17 items. All the experts rated all items as very relevant which scored the item-CVI 1, which validates all checklist items. Using the mean of all items, the scale-CVI was calculated, and it was 1. This meant validation of the checklist as a whole. With regard to the overall checklist evaluation, the mean expert proportion of the instrument was 1, and the S-CVI/UA was 1. This discharge criteria checklist improves transition of care for COVID-19 patients and can help nurses, doctors, and academics to discharge COVID-19 patients from the ICU safely.
Safety and Efficacy of a Thermomechanical Fractional Injury Device for Periorbital Rhytides
Authors: Wang Jordan V. , Bajaj Shirin , Orbuch David , Lapidoth Moshe , Klein Ifat , Gerstein Yael Agmon , Geronemus Roy G. , Levi Assi
Published: February 2023

BACKGROUND

Periorbital rejuvenation is a common cosmetic concern. A fractional thermomechanical skin rejuvenation system was developed to offer clinical improvements from direct heat transfer.

OBJECTIVE

A prospective study evaluated the efficacy and safety of the device for periorbital fine lines and wrinkles.

MATERIALS AND METHODS

Subjects with moderate-to-severe periorbital rhytides were enrolled and underwent 4 monthly treatments with a novel device using thermomechanical fractional injury (Tixel 2; Novoxel, Netanya, Israel).

RESULTS

Fifty-one subjects were enrolled. Mean age was 56.8 years, and 88.2% were women. Fitzpatrick skin Types I to IV were included. For Fitzpatrick Wrinkle Classification System (FWCS), mean baseline score was 5.7. Per investigator, there was a mean 2.0-grade improvement in FWCS at 3-month follow-up (p < .0001). Per 3 blinded physician raters, there was a mean improvement of 2.2 (p < .0001), 2.0 (p < .0001), and 1.2 (p < .0001) in FWCS at 3-month follow-up. Each of the raters correctly identified posttreatment images for 87.5%, 77.1%, and 75.0% of subjects. At least 2 raters agreed on grading 83.3% of subjects as responders. There were no severe adverse events. Subjects experienced minimal pain and downtime.

CONCLUSION

A novel device using thermomechanical fractional injury was demonstrated to be safe and effective in the treatment of periorbital rhytides.
Treatment for Myocardial Infarction: In Vivo Evaluation of Curcumin-Loaded PEGylated-GQD Nanoparticles
Authors: Rostamzadeh Farzaneh , Jafarinejad-Farsangi Saeideh , Ansari-Asl Zeinab , Farrokhi Mitra Shadkam , Jafari Elham
Published: February 2023

Curcumin (Cur) has been suggested as a complementary treatment for cardiovascular diseases. Its efficiency, however, is modest due to poor biocompatibility. This study examined the effects of curcumin loaded on polyethylene glycol–graphene quantum dots (Cur-PEG-GQDs) on hemodynamic and cardiac function in rats with myocardial infarction (MI). The study groups included control, MI, MI+Cur-3, MI + Cur-7, MI + Cur-15, MI + PEG-GQDs-5, MI + PEG-GQDs-10, MI + Cur-PEG-GQDs-5, and MI + Cur-PEG-GQDs-10. MI was established by left anterior descending artery ligation. Two weeks after intraperitoneal administration of vehicle, Cur, PEG-GQDs, and Cur-PEG-GQDs, blood pressure and heart contractility indices were measured. Triphenyl tetrazolium chloride, colorimetry, and clinical laboratory methods were used to measure the infarct size, the oxidant and antioxidant content, and the kidney and liver function parameters, respectively. In the MI animals, Cur-7, PEG-GQDs-10, Cur-PEG-GQDs-5, and Cur-PEG-GQDs-10 recovered systolic blood pressure, diastolic blood pressure, left ventricular systolic pressure, and ±dp/dt max disturbances and reduced myocardial infarct size, fibrosis, and left ventricular end-diastolic pressure. Curcumin lowered antioxidant markers and elevated 1 oxidant marker in the heart in a dose-dependent manner. Although Cur-PEG-GQDs-5 and Cur-PEG-GQDs-10 reduced curcumin's oxidative stress effects, the superoxide dismutase, glutathione peroxidase, and total antioxidant capacity levels were significantly lower in Cur-PEG-GQDs-5 and Cur-PEG-GQDs-10 groups compared with the MI group. Malondialdehyde levels were lower in Cur-PEG-GQDs-5 and -10 groups compared with the Cur-3, Cur-7, and Cur-15 groups. The glutathione/glutathione disulfide ratio improved in the groups treated by Cur-7, PEG-GQDs-10, Cur-PEG-GQDs-5, and Cur-PEG-GQDs-10. The findings indicated that Cur-PEG-GQDs mitigated MI-induced cardiac dysfunction. However, because of the increase in oxidative stress in the heart, nonclassic mechanisms may be involved in the beneficial effect of Cur-PEG-GQDs on MI-induced cardiac dysfunction.
A Retrospective Review of Cardiogenic Shock Development in Patients With ST-Elevation Myocardial Infarction and Percutaneous Coronary Intervention Receiving Early Beta-Blockers
Authors: Lacoursiere Lauren , Woodruff Ashley E. , Mills Kevin , Chilbert Maya R.
Published: February 2023

Beta-blockers (BBs) have proven to improve morbidity and mortality in patients after an ST elevation myocardial infarction (STEMI). Guidelines suggest initiating a BB within 24 hours, except in those with risk factors for developing cardiogenic shock, although published literature is conflicting regarding the true association of these risk factors with shock. This retrospective cohort study aimed to assess whether the presence of defined risk factors was associated with cardiogenic shock after early BB administration in patients with a STEMI and percutaneous coronary intervention. The primary outcome determined the rate of cardiogenic shock development and secondarily determined any characteristics associated with cardiogenic shock in patients who received beta blockers. The population included 299 patients and cardiogenic shock occurred in 8 patients (2.7%). There were no median (interquartile range) differences in age [63 years (60–71) versus 62 years (52–71); P = 0.4965], systolic blood pressure [110 mm Hg (105–115) versus 109 mm Hg (103–114); P = 0.6027], or heart rate [90 (78–104) versus 76 (64–90); P = 0.0697] before BB administration in patients who developed shock versus those who did not, respectively. Hours to BB administration from arrival [15.6 (6.0–54.8) versus 21.9 (10.6–42; P = 0.6968] and the number (%) with anterior infarction [3 (37.5%) versus 107 (36.8%); P = 1.000] were similar between groups. There was a statistically significant higher median (interquartile range) peak troponin [140 ng/mL (54–304) versus 49 ng/mL (16–132); P = 0.0354] in patients who developed shock. Early initiation of a BB in patients with STEMI and percutaneous coronary intervention with risk factors for cardiogenic shock does not seem to be associated with shock in most patients.
Exploring a Framework for Early Childhood Systems Maturity
Authors: Swanson Loraine , Menon Meera , Minogue Amber , Russell Rebecca , Berns Scott
Published: February 2023

Given the proportion of young children experiencing disadvantages in achieving optimal health due to inequities related to race, place, and income, there is increasing attention to developing effective early childhood (EC) systems. As EC leaders embrace methods such as collective impact in driving systems change, there is a growing recognition that a one-size-fits-all approach to developing integrated EC systems may be inappropriate as systems-building efforts may differ in their “maturity.” Systems maturity, as we define, refers to the ability of child-focused organizations, across disciplines and sectors, to successfully collaborate toward continuous improvement in supporting optimal child well-being. A flexible, developmental framework of systems building accounting for maturity better articulates the nuances of EC systems-building work. This article describes an emergent framework of EC systems development observed from states and communities participating in the Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN) and aiming to build systems for increased developmental promotion and screening. The framework depicted both acknowledges the complexity of systems building while providing a simplified frame for assessing the status of a system to drive further system development. This framework can be utilized to guide effective implementation and evaluation of EC systems-building initiatives.
Project ECHO
Authors: Bateman Katherine J. , Schwartz Ilene S. , Grimm Ryan P.
Published: February 2023

Children with intellectual and developmental disabilities engage in higher rates of challenging behavior (CB) than their typically developing peers. Effective and sustainable intervention and supports designed to reduce CB, as well as promote the development of positive, prosocial behavior, are urgently needed. One approach to targeting CB is providing parents with education and support to serve as the agents of behavior change. The purpose of this study was to examine the effectiveness of a parent education (PE) program focused on the principles of applied behavior analysis delivered using the Project ECHO service delivery model. Results demonstrate positive outcomes in parents' senses of competency and empowerment. In addition, parents identified the intervention as acceptable, suggesting this model as a highly effective and sustainable PE model for this population.
Building Better Bridges
Authors: Chang Ya-Chih , Hunt Nancy , Dodds Robin
Published: February 2023

Infants and toddlers with disabilities (ages birth to 2 years) and their families receive services under IDEA Part C, and children and youth with disabilities (ages 3–21 years) receive special education and related services under IDEA Part B. IDEA mandates the provision of opportunities for parent involvement in early intervention (Part C), preschool special education (Part B), and transition between the two (Individuals with Disabilities Education Act [IDEA], 2004). Despite the emphasis in federal law on collaboration with families and communicating information to them, parents do not feel well supported during the transition period (Douglas, Meadan, & Schultheiss, 2022). The limited research on this transition shows that primary caregivers lack understanding of how their roles change during this transition period. The authors of the current study conducted four focus groups to evaluate the perceptions of parents, early interventionists, and preschool special educators, all from predominantly minority populations, regarding the transition process for early intervention to preschool for young children with disabilities. Primary themes were identified: (1) lost in transition, (2) restricted choices lead to restrictive placements, and (3) discontinuity. These challenges are discussed and recommendations are provided.
Risk of Major Malformations Following First-Trimester Exposure to Olanzapine
Authors: Viguera Adele C. , Freeman Marlene P. , Kobylski Lauren A. , Rossa Ella T. , Gaccione Peter , Chitayat David , Hernández-Díaz Sonia , Cohen Lee S.
Published: February 2023

Purpose/Background

Since its US Food and Drug Administration approval in 1996, olanzapine has been one of the most commonly prescribed atypical antipsychotics, making a better understanding of its reproductive safety profile critical. The goal of the current analysis was to determine the risk of major malformations among infants exposed to olanzapine during pregnancy compared with a group of nonexposed infants.

Methods/Procedures

The National Pregnancy Registry for Psychiatric Medications is a prospective pharmacovigilance program in which pregnant women are enrolled and interviewed during pregnancy and the postpartum period. Labor and delivery and pediatric medical records were screened for evidence of major malformations followed by adjudication by a dysmorphologist blinded to medication exposure. Infants with first-trimester exposure to olanzapine were compared with controls without second-generation antipsychotic exposure.

Findings/Results

As of April 18, 2022, 2619 women have enrolled in the study. At the time of data extraction, 49 olanzapine-exposed infants and 1156 infants in the comparison group were eligible for these analyses. There were no major malformations associated with olanzapine exposure in the first trimester. The absolute risk for major malformations in the exposure group was 0.00% (95% confidence interval, 0.00–7.25) for olanzapine compared with 1.64% (95% confidence interval, 0.99–2.55) in the control group.

Implications/Conclusions

In this prospective cohort, no major malformations were associated with olanzapine exposure during the first trimester. Although these data are preliminary and cannot rule out more modest effects, they are nonetheless important, adding to the growing reproductive safety data for olanzapine.
The Healthy Work Survey
Authors: Dobson Marnie , Schnall Peter , Faghri Pouran , Landsbergis Paul
Published: February 2023

Objectives

Work-related psychosocial stressors have been recognized as occupational hazards and assessed in workplaces in many countries for decades. Identifying tools to measure work-related psychosocial hazards to increase awareness in the United States about the impact on employees’ health and safety is critical (J Occup Environ Med. 2021;63:e245–e249).

Methods

We describe the development and psychometric validation of an online tool, the Healthy Work Survey, utilizing items from the National Institute for Occupational Safety and Health Quality of Work Life questionnaire.

Results

There are 55 items in the final core work section of the HWS. Factor analyses confirmed nine factors, and the subsequent multi-item scales had acceptable internal consistency. A user-friendly, online system and automated report compares individual’s and organization’s scores to distributions from a representative US working population (General Social Survey Quality of Work Life).

Discussion

The HWS is a reliable, valid tool for organizations and individuals to assess psychosocial work hazards.
Development of the Korean Firefighter Performance Battery
Authors: Kim Ji-Been , Kim Chae-Been , Xiang Ying-Ying , Dong-il Seo , Wook Song , Lee Han-Joon , Kang Hyun-Joo , Lee Chung-Gun , Ahn Yeon Soon , Park Jung-Jun
Published: February 2023

Objective

The Candidate Physical Capability Test (CPAT) has been used in many countries to assess the fitness levels of firefighters, but it requires a special facility with a space of at least 900 square m2 and expensive equipment. Because it can be difficult to have both money and space at smaller gas stations, we have developed the Korean Firefighter Performance Battery (KFPB).

Methods

To verify the validity and reliability of the developed KFPB, this study consists of three parts, a validation test, reliability test, and evaluation criterion.

Results

As a result of the analysis, the KFPB met all of the criteria as a valid evaluation. Furthermore, the KFPB seems to compensate for the shortcomings of CPAT.

Conclusions

In locations where the CPAT is difficult to administer, the KFPB is expected to be used as a firefighting job–related physical fitness evaluation.
Cancer-cell-derived sialylated IgG as a novel biomarker for predicting poor pathological response to neoadjuvant therapy and prognosis in pancreatic cancer
Authors: Cui Ming , Shoucair Sami , Liao Quan , Qiu Xiaoyan , Kinny-Köster Benedict , Habib Joseph R. , Ghabi Elie M. , Wang Junke , Shin Eun Ji , Leng Sean X. , Ali Syed Z. , Thompson Elizabeth D. , Zimmerman Jacquelyn W. , Shubert Christopher R. , Lafaro Kelly J. , Burkhart Richard A. , Burns William R. , Zheng Lei , He Jin , Zhao Yupei , Wolfgang Christopher L. , Yu Jun
Published: February 2023

Background:

Neoadjuvant therapy (NAT) is increasingly applied in pancreatic ductal adenocarcinoma (PDAC); however, accurate prediction of therapeutic response to NAT remains a pressing clinical challenge. Cancer-cell-derived sialylated immunoglobulin G (SIA-IgG) was previously identified as a prognostic biomarker in PDAC. This study aims to explore whether SIA-IgG expression in treatment-naïve fine needle aspirate (FNA) biopsy specimens could predict the pathological response (PR) to NAT for PDAC.

Methods:

Endoscopic ultrasonography-guided FNA biopsy specimens prior to NAT were prospectively obtained from 72 patients with PDAC at the Johns Hopkins Hospital. SIA-IgG expression of PDAC specimens was assessed by immunohistochemistry. Associations between SIA-IgG expression and PR, as well as patient prognosis, were analyzed. A second cohort enrolling surgically resected primary tumor specimens from 79 patients with PDAC was used to validate the prognostic value of SIA-IgG expression.

Results:

SIA-IgG was expressed in 58.3% of treatment-naïve FNA biopsies. Positive SIA-IgG expression at diagnosis was associated with unfavorable PR and can serve as an independent predictor of PR. The sensitivity and specificity of SIA-IgG expression in FNA specimens in predicting an unfavorable PR were 63.9% and 80.6%, respectively. Both positive SIA-IgG expression in treatment-naïve FNA specimens and high SIA-IgG expression in surgically resected primary tumor specimens were significantly associated with shorter survival.

Conclusions:

Assessment of SIA-IgG on FNA specimens prior to NAT may help predict PR for PDAC. Additionally, SIA-IgG expression in treatment-naïve FNA specimens and surgically resected primary tumor specimens were predictive of the prognosis for PDAC.