bluuebunny/crossref_metadata_2025 huggingface dataset:
The Visual Listening Guide
Authors: Chan-Hartley Hannah
Published: December 2021

This chapter is a systematic examination of the Visual Listening Guide, a new type of printed graphic guide to facilitate active listening and understanding of orchestral works. Created by musicologist Hannah Chan-Hartley, the Visual Listening Guide is the first of its kind to appear in a concert program book, for use during a live performance. This chapter describes the development and creation of the Guide’s distinctive design. An analysis of its elements reveals how the Guide aims to show the structure of a symphonic work, acting like a map to it, indicating important sonic landmarks and other features. It also reviews the reception of the Visual Listening Guide following its first phase of use by concert-goers from 2015 to 2020, and considers the efficacy and potential of graphic guides to communicate about Western classical music to the broad public, helping organizations foster audience engagement and appreciation.
Friendship Online
Authors: Cocking Dean
Published: December 2021

The online social revolution has seen the pursuit of friendship online become core business of the internet and part of the friendships and social lives of most of us. This chapter provides an overview of the burgeoning contemporary research concerning online friendship and of the main themes, since Aristotle, on the nature and value of friendship. It also aims to provide some substantial fresh research for future analyses. It argues that the pursuit of friendship relies heavily upon the rich, face-to-face dynamic of plural modes of self-expression and communication that we have engaged in for thousands of years. Our social media platforms, such as Facebook, Instagram, and Twitter, flatline much of this territory, and as a result much of the moral universe that we have built upon it is lost or distorted online. The chapter concludes by suggesting that we need to better understand this social dependence of our values and valuing, both to improve the value-sensitive design of life online, and, where this social dependence cannot be well captured, to also improve our engagement in our traditional worlds and so help get us offline.
A Normative Framework for Sharing Information Online
Authors: Sullivan Emily , Alfano Mark
Published: December 2021

People have always shared information through chains and networks of testimony. It is arguably part of what makes us human and enables us to live in cooperative communities with populations greater than 150 or so. The invention of the internet and the rise of social media have turbocharged our ability to share information. This chapter develops a normative epistemic framework for sharing information online. This framework takes into account both ethical and epistemic considerations that are intertwined in typical cases of online testimony. The authors argue that, while the current state of affairs is not entirely novel, recent technological developments call for a rethinking of the norms of testimony, as well as the articulation of a set of virtuous dispositions that people would do well to cultivate in their capacity as conduits (not just sources or receivers) of information.
Crime and Presidential Accountability
Authors: Noble Benjamin S , Reeves Andrew , Webster Steven W
Published: December 2021

Americans are anxious about crime regardless of their actual exposure or risk. Given this pervasive concern, US presidents frequently talk about crime, take actions to address it, and list crime prevention efforts among their top accomplishments. We argue that presidents act this way, in part, because fear of crime translates into lowered presidential approval. However, this penalty is not applied evenly. Given the parties' stances toward crime and the criminal justice system, White Americans punish Democratic presidents (i.e., Clinton and Obama) more severely when they are anxious about crime, while Black Americans are more punitive toward Republican presidents (i.e., Bush and Trump). We examine twenty years of survey data and find evidence consistent with our theory. Our results suggest that the relationship between fear of crime and presidential accountability is conditioned by an individual’s race and the president’s party.
Patterns of total root and shoot carbon dioxide fluxes and their impact on daily tree carbon budget in large tropical tree saplings
Authors: Oren Israel , Mannerheim Neringa , Fangmeier Andreas , Buchmann Nina , Grünzweig José M
Published: December 2021

A significant amount of the carbon (C) assimilated in photosynthesis by trees is re-emitted to the atmosphere via the respiratory CO2 flux of roots. Because of technical constraints, we have little understanding of the extent and dynamics of the respiratory CO2 flux of roots at the total root system scale (RCF). This study aimed to fill this gap and to quantify the daily C budget of entire trees. We used aeroponics as a novel approach to measure directly and simultaneously RCF and the net CO2 flux of the entire shoot (SCF), to estimate their night- and day-time contributions to daily tree CO2 budget and to estimate the relative contribution of different root categories to RCF in large saplings of the tropical tree species Ceiba pentandra (L.) Gaertn. By maintaining root temperature within a narrow range (24–27.5 °C), we controlled for its effect on RCF, thus allowing the potential relationship between RCF and SCF to be tested. The carbon gain of the fast-growing saplings was 0.79 ± 0.10 g C sapling−1 day−1, with day-time shoot CO2 uptake outweighing night-time shoot and day- and night-time root CO2 losses by a factor of two. Other than a slight rise in the morning hours, RCF was relatively stable and not coupled to the daily dynamics of SCF. Albeit having lower specific respiration rates compared with fine-roots, the relative contributions of coarse-roots (diameter >2 mm) to RCF were substantial because of their large biomass and were estimated to range from 43 to 63% of RCF at midday of different days during the growing season. The results of this study suggest that (i) the entire root system needs to be monitored for its impact on the tree CO2 budget, (ii) RCF cannot be derived from SCF and (iii) the importance of coarse-root respiration to RCF may be greater than appreciated.
Physical and economic impacts of studded tyre use on pavement structures in cold climates
Authors: Abaza Osama A , Arafat Mahmoud , Uddin Muhammad Saif
Published: December 2021

In cold regions like Alaska of USA, Canada and the northern parts of Europe, using studded tyres is common among the public when driving in icy and snowy conditions. However, studded tyres cause extensive wear to asphalt pavement, reducing pavement life. This study addresses the physical and economic impacts of winter studded tyres on the roadway system to better inform decision makers as they develop alternative solutions and future polices. The approach is applied in a case study from a sample of Alaska statewide road segments. Surveys were employed to examine the extent of the use of studded tyres and cost-effective alternatives. A pavement life-cycle cost review was established considering several variables to discover a realistic cost of roadway resurfacing and rehabilitation. Wear rates due to studded tyres and rut rates due to wheel loads were found for different highway classes. The results indicate higher average wear rates due to studded passenger vehicles on freeways than average rut rates due to heavy wheel loads. The results also indicate lower average wear rates on arterial and collector roads. The estimates show that studded tyre use reduced asphalt surface life by about 7 years on the selected freeway sample in the case study, which is about 47% loss in pavement life based on the initial design life of 15 years. Other road classes experienced lower reductions in service life. Finally, cost analysis was provided to reflect the impact of studded tyres on the state's budget. Countermeasures were suggested, which in turn may help other cold regions develop strategies on the use of new winter tyre technology.
PA licensure questions, the Americans with Disabilities Act, and seeking medical care
Authors: Roman Christopher , Neary Stephanie , Nettesheim Emily , Zorn Jennifer
Published: December 2021

Objective:

This study built on a recent publication to explore physician assistant (PA) licensure renewal applications, as well as PA likelihood to seek help for physical or mental health conditions.

Methods:

We were able to obtain licensure renewal applications from 47 states. A national survey was then conducted to explore the connection between licensure questions and help-seeking behavior.

Results:

Only 18 states were consistent with the Americans with Disabilities Act (ADA) in their approach to initial and renewal applications. Thirty-five percent of PAs expressed reluctance to seek help for a mental health issue due to concerns about licensure repercussions. States with applications that were inconsistent with the ADA were significantly more likely to express these concerns.

Conclusions:

Considerable stigma exists among PAs regarding seeking help for mental health issues. Problematic licensure questions increase this reluctance. Advocacy is needed to reduce stigma of mental health and substance use, and to modernize licensure applications.
Moving Beyond Implicit Bias in Antiracist Academic Medicine Initiatives
Authors: Calhoun Amanda , Genao Inginia , Martin Andrés , Windish Donna
Published: December 2021

The concept of implicit bias has arguably laid the groundwork for uncomfortable discussions surrounding race in academic medicine, but its effectiveness in changing racist behavior and systems remains unclear. Terms like implicit bias, while perhaps more palatable than other concepts to some, may result in confusion and divert time from meaningful reconceptualization and creation of effective antiracism initiatives. This Invited Commentary contends that the term implicit bias is inadequate for addressing racism because it is too broad; does not necessarily lead to a change in racist behaviors; assumes that racism is unconscious, aggressor-centered, and individual-focused; and implies that everyone suffers equally in a racist system. The authors illustrate why terms like implicit bias are inadequate in combatting racism in medicine and suggest alternate terminology to use while engaging in antiracism work in academic medicine.
Diagnosis and treatment of focal fibrocartilaginous dysplasia of the distal ulna
Authors: Zhou Da-fei , Zhou Yuan , Lou Lu-xin , Fu Gang , Yang Zheng
Published: December 2021

Focal fibrocartilaginous dysplasia (FFCD) of the distal ulna is a rare benign lesion resulting in progressive radiocapitellar dislocation, limb deformity and limitation in function. This study reported our experience with 10 cases and it aimed to determine a reasonable strategy for diagnosis and treatment. Ten cases treated from 2010 to 2018 in our department were retrospectively reviewed. The diagnosis was based on imaging features. All patients underwent lesion excision in the early stage and five patients required ulna lengthening in the second stage. The radiographic and functional outcomes were analyzed and reported. The median age at diagnosis was 32 months (range, 6-36 months). The median age at the time of surgery was 34 months (range, 10-40 months). The median clinical and radiographic follow-up period was 37 months (range, 24-50 months). The ulna was shortened by an average of 31 mm (range, 27–35 mm). There was no new radial head dislocation after lesion excision. For five cases of radial head dislocation, the median elbow varus angle before ulnar lengthening was 20° and it decreased to 5° after ulnar lengthening. Supination and pronation of the elbow increased from 50°-10° to 70°-30°. We believe that early excision of the lesion can prevent radiocapitellar joint dislocation in patients with FFCD of the ulna. Ulna lengthening can correct limb deformity and improve the range of motion.
The readability of online patient education materials for slipped capital femoral epiphysis
Authors: Pruneski James A. , Kiapour Ata M.
Published: December 2021

Given the long-term complications of undiagnosed slipped capital femoral epiphysis (SCFE) and the importance of readable health information materials on positive, equitable health outcomes, the objective of this study was to determine if the online patient education materials regarding SCFE are written at or below accepted recommendations. The secondary objective was to determine whether the readability of these materials varied when stratified by the type of website. ‘Slipped capital femoral epiphysis’, ‘SCFE’, and ‘slipped femoral head’ were used as search queries in three common search engines. The readability of each website was evaluated using five established metrics, and the scores were compared by website type and by the complexity of the search query. In this study of 53 unique websites about SCFE, we demonstrated that only one of the web pages was written at the recommended sixth-grade level, and the mean reading level of the online material was above the 10th-grade level. Post hoc testing showed that only websites associated with pediatric academic institutions were written at a significantly lower grade level than general health websites [P < 0.05 for all, range (0.003, 0.04)]. The materials about SCFE that are available to patients and their families continue to be written at an inappropriate level. To increase accessibility and allow for equitable long-term health outcomes, physicians, universities, hospitals and medical societies must ensure that they produce readable education to increase patients’ understanding of SCFE, its symptoms and available treatment options. Future studies evaluating progress regarding these metrics are warranted.
A Cluster-based Method to Quantify Individual Heterogeneity in Tuberculosis Transmission
Authors: Smith Jonathan P. , Gandhi Neel R. , Silk Benjamin J. , Cohen Ted , Lopman Benjamin , Raz Kala , Winglee Kathryn , Kammerer Steve , Benkeser David , Kramer Michael R. , Hill Andrew N.
Published: December 2021

Background:

Recent evidence suggests transmission of Mycobacterium tuberculosis (Mtb) may be characterized by extreme individual heterogeneity in secondary cases (i.e., few cases account for the majority of transmission). Such heterogeneity implies outbreaks are rarer but more extensive and has profound implications in infectious disease control. However, discrete person-to-person transmission events in tuberculosis (TB) are often unobserved, precluding our ability to directly quantify individual heterogeneity in TB epidemiology.

Methods:

We used a modified negative binomial branching process model to quantify the extent of individual heterogeneity using only observed transmission cluster size distribution data (i.e., the simple sum of all cases in a transmission chain) without knowledge of individual-level transmission events. The negative binomial parameter k quantifies the extent of individual heterogeneity (generally,

indicates extensive heterogeneity, and as

transmission becomes more homogenous). We validated the robustness of the inference procedure considering common limitations affecting cluster size data. Finally, we demonstrate the epidemiologic utility of this method by applying it to aggregate US molecular surveillance data from the US Centers for Disease Control and Prevention.

Results:

The cluster-based method reliably inferred k using TB transmission cluster data despite a high degree of bias introduced into the model. We found that the TB transmission in the United States was characterized by a high propensity for extensive outbreaks (

; 95% confidence interval = 0.09, 0.10).

Conclusions:

The proposed method can accurately quantify critical parameters that govern TB transmission using simple, more easily obtainable cluster data to improve our understanding of TB epidemiology.
Decidualization and Related Pregnancy Complications
Authors: Tong Jing , Lv Shijian , Yang Jieqiong , Li Hongwanyu , Li Weiya , Zhang Cong
Published: December 2021

Decidualization is the differentiation of endometrial stromal cells into secretory decidual stromal cells. Human decidualization involves some amount of signaling molecules and pathways as well as genetic reprogramming, which is driven by the postovulatory rise in progesterone levels and local cyclic adenosine monophosphate production. Decidualization extends from the primary decidual zone to the secondary decidual zone, and then exits through apoptosis. Evidences support that decidual fibroblasts function as the pool of decidual stromal cells during pregnancy. Decidualization undergoes an acute inflammatory phase, an anti-inflammatory secretory phase to the final recession phase. The decidualization of the inner layer of endometrium, termed decidua, is the most critical determinant of pregnancy success, which can promote placenta formation, modulate immune tolerance, foster resistance to oxidative stress, sense embryo quality, and control labor. Failure to adequate decidualization in terms of hormones, biochemistry, and immunology leads to adverse pregnancy outcomes, including diseases such as preeclampsia, miscarriage, premature labor, repeated implantation failures, and some age-related decline in reproductive capacity. The development of animal models and in vitro culture systems combined with emerging technologies provides a powerful system to explore the mechanism of decidualization. However, decidualization is a dynamic, multi-step process, and translating of current research progress into disease predictions and interventions for pregnancy complications remains to be achieved. The study of periodic regeneration and spontaneous decidualization of the endometrium will be beneficial to the diagnosis and treatment of pregnancy diseases.
Outcomes, Temporal Trends, and Resource Utilization in Ischemic versus Nonischemic Cardiogenic Shock
Authors: Lemor Alejandro , Hosseini Dehkordi Seyed Hamed , Alrayes Hussayn , Cowger Jennifer , Naidu Srihari S. , Villablanca Pedro A. , Basir Mir B , O’Neill William
Published: December 2021

Cardiogenic shock (CS) is associated with significant morbidity and mortality. Differentiating the etiologic factors driving CS has epidemiological significance and aids in optimization of therapeutic strategies, prognostication, and resource utilization. The aim herein is to investigate the epidemiology and clinical outcomes of CS in those with ischemic and nonischemic CS etiologies. Using International Classification of Diseases codes, we queried the national inpatient sample for CS hospitalization from 2007 to 2018 and divided the study sample into cohorts of ischemic (I-CS) and nonischemic cardiogenic shock (NI-CS). We then compared the primary outcome of in-hospital mortality between these 2 cohorts. Two groups of secondary outcomes (clinical and procedural) were also assessed between the 2 cohorts. CS was present in 557,860 hospitalizations; 84% of these were I-CS and 15.8% NI-CS. Patients with I-CS were older, more commonly males, with more risk factors for coronary artery disease (P < 0.05). NI-CS had higher prevalence of preexisting systolic heart failure and atrial fibrillation. The in-hospital mortality was significantly higher in patients with I-CS (32.2% vs. 29.5%, adjusted odds ratio 1.10, P < 0.001). Frequencies of acute ischemic stroke, mechanical ventilation, ventricular arrhythmias, and vascular complications were higher in I-CS versus NI-CS, while acute kidney injury and acute liver failure were more common in NI-CS (P < 0.05). The use of mechanical circulatory support devices was higher in the I-CS group. In conclusion, patients with I-CS comprise the vast majority of CS and are associated with higher mortality and higher resource utilization. Conversely, patients with NI-CS appear to have higher survival but with a higher prevalence of end-organ dysfunction.
Corneal Graft Rejection After Inactivated SARS-CoV-2 Vaccine: Case Report
Authors: Simão Mariana Fernandez , Kwitko Sérgio
Published: December 2021

Purpose:

Our aim was to report the case of endothelial corneal allograft rejection after inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine with an atypical presentation.

Methods:

This was a case report.

Results:

A 63-year-old woman with previous penetrating keratoplasty and laser in situ keratomileusis presented with clinical signs of endothelial corneal graft rejection 24 hours after CoronaVac (SinoVac Biotech, Beijing/China) vaccine. Slitlamp examination showed corneal edema and interface fluid accumulation. It was partially resolved after treatment with topical corticosteroids and polydimethylsiloxane.

Conclusions:

Corneal allograft rejection was already reported after another SARS-CoV-2 vaccine. This is the first report in the literature describing a possible association with inactivated SARS-CoV-2 vaccine and corneal allograft rejection, especially with laser in situ keratomileusis interface fluid accumulation presentation. Ophthalmologists should be aware of this potential complication.
Value of Conventional Ultrasound-based Scoring System in Distinguishing Adenomatous Polyps From Cholesterol Polyps
Authors: Zhu Lianhua , Han Peng , Jiang Bo , Li Nan , Jiao Ziyu , Zhu Yaqiong , Tang Wenbo , Fei Xiang
Published: December 2021

Background and Aim:

Ultrasound has increased the detection of gallbladder polyps, but it has limitations in evaluating the nature of gallbladder polyps, especially the maximum size of 1.0 to 1.5 cm. We assessed the value of ultrasound scoring system based on independent predictive parameters in distinguishing adenomatous polyps from cholesterol polyps with the maximum size of 1.0 to 1.5 cm.

Materials and Methods:

We enrolled 163 patients with gallbladder polyps (1.0 to 1.5 cm) who underwent ultrasonography and cholecystectomy. Ultrasound image characteristics were compared between cholesterol polyps and adenomatous polyps in the training cohort from April 2018 to January 2020. An ultrasound scoring system was constructed in the training cohort, and its diagnostic performance was evaluated in the validation cohort from February 2020 to February 2021.

Results:

Maximum size, height/width ratio, stone or sludge, vascularity, and hyperechoic spot were significantly different between cholesterol polyps and adenomatous polyps in the training cohort (P<0.05). The independent predictive parameters for adenomatous polyps were lower height/width ratio, presence of vascularity and absence of hyperechoic spot. The total score was as follows: (height/width ratio, <0.9=4, ≥0.9=0) + (vascularity, present=3, absent=0) + (hyperechoic spot, absent=2, present=0). The sensitivity, specificity and accuracy of ultrasound scoring system ≥5 for diagnosis of adenomatous polyps in the validation cohort were 73.33%, 80.49%, and 78.57%, respectively.

Conclusions:

The ultrasound scoring system aids in distinguishing adenomatous polyps from cholesterol polyps, and effectively decreasing unnecessary cholecystectomy.
Submucosal tunnelling techniques for Zenker’s diverticulum: a systematic review of early outcomes with pooled analysis
Authors: Spadaccini Marco , Maselli Roberta , Chandrasekar Viveksandeep Thoguluva , Patel Harsh K. , Fugazza Alessandro , Galtieri Piera Alessia , Pellegatta Gaia , Attardo Simona , Carrara Silvia , Anderloni Andrea , Desai Pankaj , Alkandari Asma , Sharma Prateek , Khashab Mouen A , Repici Alessandro
Published: December 2021

In the last decade, flexible endoscopic septotomy has been reported as a well-tolerated and effective treatment for Zenker’s diverticulum. More recently, novel endoscopic submucosal tunneling techniques, namely Zenker-PerOral Endoscopic Myotomy (Z-POEM) and PerOral Endoscopic Septotomy (POES) have been proposed to obtain complete muscular septum exposure and deeper myotomy. The aim of this study is to provide a systematic review with a meta-analysis of the first experiences of third space approaches for Zenker’s diverticulum. Electronic databases (Medline, Scopus, EMBASE) were searched up to October 2020. Studies including patients with symptomatic Zenker’s diverticulum who underwent endoscopic treatment by submucosal tunneling technique were eligible. Procedural, clinical and safety outcomes were assessed by pooling data with a random-effect model to obtain a proportion with a 95% confidence interval. Nine retrospective studies were eligible for inclusion (196 patients). Five studies were performed in the USA, two in Europe and two in Asia. Endoscopic treatment was feasible in 96.9% (I
2 = 0%) of patients. The mean procedure duration was 36.4 ± 14.3 minutes. Clinical success was achieved after 93.4% (I
2 = 0%) of procedures. The overall adverse events rate was 4.9% (I
2 = 0%). No differences between the two approaches (Z-POEM vs POES) have been shown in terms of both efficacy and safety. Submucosal tunneling techniques appear to be feasible for symptomatic Zenker’s diverticulum, with promising results in terms of efficacy and safety outcomes.
The promising role of CCL2 as a noninvasive marker for nonalcoholic steatohepatitis diagnosis in Egyptian populations
Authors: Ali Ahmed Amin , Fouda Aya , Abdelaziz El sayed , Abdelkawy Khaled , Ahmed Mohammed Hussien
Published: December 2021

Background

Nonalcoholic fatty liver disease (NAFLD) is a common liver problem, including both nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). In this study, we investigated the role of CCL2 and IL6 as a noninvasive tool for the diagnosis of NASH in clinical practice and to establish criteria for discrimination NASH from NAFL in Egyptian populations with NAFLD.

Method

In addition to 30 healthy controls, serum samples from 66 NAFLD patients histologically diagnosed by biopsy (32 NAFL and 34 NASH) were analyzed for serum IL6, CCL2, liver biomarkers, complete blood count and lipid profile. Serum IL6 or CCL2 levels were tested for correlation with the NASH activity score (NAS score).

Result

Both IL6 and CCL2 were significantly upregulated in NASH patients compared with NAFL patients or control. Serum CCL2 was significantly correlated with the degree of hepatocytes ballooning (the diagnostic endpoint for NASH) without any significant correlation with steatosis or lobular inflammation. Serum IL6 was not correlated with the NAS score. The ROC curve analysis of CCL2 for NASH diagnosis revealed an area under curve (AUROC) of 0.959 at cutoff ≥227 pg/ml. While IL6 revealed an (AUROC) of 0.790.

Conclusion

Serum CCL2 but not IL6 is a promising noninvasive tool for NASH diagnosis and CCL2 can provide a reliable, validated scoring system to discriminate NAFL from NASH in the Egyptian population confirming the role of CCL2 in NASH pathogenesis. These findings will aid in the development of innovative NASH treatment strategies in Egypt and improve the quality of clinical care.
Re‐evaluation of King Wilson Index in Children With Acutely Decompensated Hepatic Wilson Disease
Authors: Chanpong Atchariya , Dhawan Anil
Published: December 2021

Objectives:

Liver transplantation (LT) in Wilson disease (WD) is a life‐saving option for patients presenting with liver failure and encephalopathy. Patients without encephalopathy can avoid LT and treated successfully with chelation therapy. It is essential to predict the risk of fatal outcomes where LT is required. We aim to critically analyse the validity of the WD Index prospectively from a cohort of WD patients managed at our institution.

Methods:

WD Index and other clinical data from 2005 to 2018, recorded prospectively as part of clinical management, were analysed.

Results:

Over 13‐year period, 52 children with WD (29 boys) with median age at diagnosis of 11.69 (range 3.92–17.26) years were studied. Of these, 17 were diagnosed as part of family screening, 17 presented with abnormal liver enzyme, and 18 with acute hepatic decompensation (AHD) as per PALF definition. Patients presented with abnormal liver enzyme and in the pre‐symptomatic group had WD Index <11, and none of them required LT. WD Index is still a good predictor for LT in WD patients with AHD, providing a sensitivity of 80%, specificity of 100%, positive‐predictive, and negative‐predictive value of 100% and 80%, respectively. Patients presented with an index of 8–10 also required LT at median duration of 58 days (IQR 48–135 days).

Conclusions:

WD patients presenting with AHD who had an index of ≥11 do require LT. Children with a WD Index of 8 to 10 within the first 2 months of admission require close monitoring as LT may become necessary.
The Role of Participation in and Effectiveness of Shared Governance Councils in the Nurses' Perception of a Professional Practice Work Environment
Authors: Al-Ruzzieh Majeda A. , Ayaad Omar , Hess Robert G.
Published: December 2021

OBJECTIVES

The aims of this study were to identify the differences in nurses' perceptions of their professional practice work environment (PPWE) related to their participation in shared governance (SG) councils and to examine the perception of effectiveness of SG councils among nurses who participate in them.

BACKGROUND

Research suggests that adopting SG in nursing can lead to significant, positive outcomes, such as patient and nurse satisfaction and enhanced nurse empowerment, engagement, and a PPWE.

METHODS

The study used a cross-sectional design in a Magnet®-designated urban Jordanian cancer care hospital. A convenience sample of 580 direct care nurses was used. The data were collected using self-administered questionnaires, the Council Health (CH) instrument, and the Professional Practice Work Environment Inventory (PPWEI).

RESULTS

Results demonstrated a significant difference in the total score of PPWE between the SG council members (4.85) and nonmembers (4.68) (t = 2.906, P = 0.004). The results also indicated small to strong correlations of the total overall council health mean and all domain means of council effectiveness with total overall PPWEI mean and all domain means of PPWE (P < 0.05) among nurses who participated in SG councils.

CONCLUSION

Findings support involving more staff in SG councils and that enhancing the SG councils' effectiveness positively affects the PPWE.
Organizational Impact on Healthcare Workers' Moral Injury During COVID-19
Authors: Nelson Katie E. , Hanson Ginger C. , Boyce Danielle , Ley Cathaleen D. , Swavely Deborah , Reina Michelle , Rushton Cynda Hylton
Published: December 2021

OBJECTIVE

The aim of this study was to explore relationships between organizational factors and moral injury among healthcare workers and the impact of perceptions of their leaders and organizations during COVID-19.

BACKGROUND

COVID-19 placed healthcare workers at risk for moral injury, which often involves feeling betrayed by people with authority and can impact workplace culture.

METHODS

Secondary data from a Web-based survey of mid-Atlantic healthcare workers were analyzed using mixed methods. Data were synthesized using the Reina Trust & Betrayal Model.

RESULTS

Fifty-five percent (n = 328/595) of respondents wrote comments. Forty-one percent (n = 134/328) of commenters had moral injury scores of 36 or higher. Three themes emerged: organizational infrastructure, support from leaders, and palliative care involvement. Respondents outlined organizational remedies, which were organized into 5 domains.

CONCLUSIONS

Findings suggest healthcare workers feel trust was breached by their organizations' leaders during COVID-19. Further study is needed to understand intersections between organizational factors and moral injury to enhance trust within healthcare organizations.
Human Germinal Center–associated Lymphoma (HGAL) Is a Reliable Marker of Normal and Neoplastic Follicular Helper T Cells Including Angioimmunoblastic T-Cell Lymphoma
Authors: Koo Matthew , Zhang Jingjing , Tan Brent , Kurzer Jason , Gratzinger Dita , Zhao Shuchun , Suarez Carlos , Lossos Izidore S. , Warnke Roger A. , Natkunam Yasodha
Published: December 2021

The diagnosis of angioimmunoblastic T-cell lymphoma (AITL) is complex and requires the demonstration of a T-follicular helper (TFH) phenotype. Immunophenotypic markers that detect the TFH phenotype are highly variable, thereby necessitating the use of 3 to 5 TFH markers to substantiate a TFH phenotype. We tested the utility of germinal center markers human germinal center–associated lymphoma (HGAL) and LIM-domain only 2 (LMO2) in detecting a TFH phenotype. We compared their staining to that of 6 TFH markers in current use, PD-1, ICOS, CXCL13, SAP, CD10, and BCL6, in a cohort of 23 AITL. Our results show that although both markers can detect a TFH phenotype, HGAL was superior to LMO2 in the percent of cells stained and the intensity of staining, 2 variables used to generate H-scores. Using H-scores as the metric, HGAL was most comparable to BCL6 among the currently used TFH markers and was more sensitive than CXCL13, SAP, CD10, and LMO2. PD-1 and ICOS emerged as the most robust of the 8 markers tested in this study in detecting a TFH phenotype. We conclude that HGAL is a reliable marker of TFH cells and can aid in the diagnosis of lymphomas of TFH derivation, particularly in the recognition of early patterns of AITL.
Lessons Learned from a Quality Improvement Initiative: Adverse Childhood Experiences Screening in a Pediatric Clinic
Authors: Crenshaw Molly M. , Owens Caitlyn R. , Dow-Smith Carrie , Olm-Shipman Casey , Monroe Rasheeda T.
Published: December 2021

Introduction:

Universal screening for adverse childhood experiences (ACEs) is recommended by the American Academy of Pediatrics due to downstream health risks. However, widespread screening practices have not been adopted.

Methods:

We used quality improvement methods to establish ACEs screening in a busy pediatric clinic that serves primarily Medicaid-insured and Spanish-speaking patients. The final Plan-Do-Study-Act cycle included the screening of both the patient and his/her caregiver(s). ACEs scores were a process measure; balancing measures were the average time to screen, the number of referrals generated, and qualitative caregiver reception.

Results:

We screened 232 families, and the process maintained a ≥ 80% completion rate of ACEs screening for 1-month-old children and their caregivers during the final 10 weeks. 23% of caregivers had an ACEs score ≥ 4; overall, 6% were referred for further resources. The average time to discuss the screen was 86.78 seconds. The general caregiver reception was gratitude; 2% refused screening.

Conclusion:

This study demonstrates the feasibility of initiating ACEs screening of 1 age group and their caregivers using quality improvement methods.
Standardized Process Measures in Radiographic Hip Surveillance for Children with Cerebral Palsy
Authors: Milks Kathryn S. , Mesi Erin L. , Whitaker Amanda T. , Ruess Lynne
Published: December 2021

Introduction:

Detection of hip migration in children with cerebral palsy (CP) through radiographic surveillance can prevent dislocations. Migration Percentage (MP) is the accepted method for quantifying hip subluxation in CP on pelvis x-ray but was not being reported at our institution. Our objective was to improve care for children with CP by standardizing radiographic techniques and reporting radiographs obtained as part of a hip surveillance program.

Methods:

A baseline retrospective review of CP surveillance pelvis x-ray reports was performed. We then educated radiologists and technologists, standardized imaging techniques, and required structured radiology reporting to include MP measurement and dislocation risk categories. We tracked compliance with the reporting template for 10 months. Images and reports were also assessed for quality and accuracy by an orthopedic surgeon.

Results:

Baseline period reports showed no consistency. In total, 449 children with CP (mean age: 7.3 years ± 4.2) had a surveillance pelvis radiograph during the postintervention study period (May 2019–February 2020). An estimated 90% reporting compliance was achieved and sustained by 5 months. Eight (89%) of the children with high-risk hips were newly diagnosed during our study period; all had a progressive increase in MP from prior examinations. All clinicians surveyed agreed that the standardized reports, including MP, were helpful to their practice.

Conclusions:

Using evidence-based process measures and quality improvement methodology, we standardized hip surveillance for children with CP. Radiology reports that include MP and risk category for hip dislocation enable clear communication for referrals across specialties and early detection and treatment for better outcomes.
Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events
Authors: Falcone Richard A. , Simmons Jeffrey , Carver Amanda M. , Mullett Brooke , Kotagal Meera , Lin Erica , Muething Stephen , von Allmen Daniel
Published: December 2021

Introduction:

The perioperative environment is one of the most complex areas within a hospital with significant safety risks. Despite a long history of safety-focused work, a recent cluster of patient safety events prompted a renewed comprehensive approach to improve safety processes and transform culture.

Methods:

Our team comprehensively approached perioperative safety through integration across traditional silos and a focus on institutional safety culture. This approach consisted of a careful review of all events, developing Perioperative Safety Coordinating and Education teams, testing and implementing new/revised safety processes, and an ongoing evaluation plan.

Results:

Updates to our Perioperative Safety Mission and Tenets and the development of an empowered Safety Culture Champion team composed of a diverse group of frontline team members addressed our safety culture. In addition, key safety processes (time-outs, intraoperative huddles, and prevention of retained foreign bodies) were revised and implemented. Observation of key safety processes demonstrates a 90% compliance, which includes all steps and team engagement. After implementation, a span of 377 days between events was accomplished, which is significantly higher than the 33 days between events during our cluster.

Conclusions:

This work builds upon prior incremental improvements through a comprehensive investment in not only improving key processes but transforming the safety culture. Acceptable deviance from the standard process is no longer the norm. Instead, an approach that emphasizes understanding, integration, engagement, and accountability for safety by each team member for every patient, every time, every day, has been implemented.
Implementation of a Nurse-Driven Asthma Pathway in the Pediatric Intensive Care Unit
Authors: Flaherty Michael R. , Whalen Kimberly , Lee Ji , Duran Carlos , Alshareef Ohood , Yager Phoebe , Cummings Brian
Published: December 2021

Background:

Asthma is one of the most common conditions requiring admission to a pediatric intensive care unit. Dosing and weaning medications, particularly bronchodilators, are highly variable, and evidence-based weaning algorithms for clinicians are lacking in this setting.

Methods:

Patients admitted to a quaternary pediatric intensive care unit diagnosed with acute severe asthma were evaluated for time spent receiving continuous albuterol therapy, the length of stay in the intensive unit care unit, and the length of stay in the hospital. We developed an asthma pathway and continuous bronchodilator weaning algorithm to be used by bedside nurses. We then implemented two major Plan-Do-Study-Act cycles to facilitate the use of the pathway. They included implementing the algorithm and then integrating it as a clinical decision support tool in the electronic medical record. We used standard statistics and quality improvement methodology to analyze results.

Results:

One-hundred twenty-six patients met inclusion criteria during the study period, with 32 during baseline collection, 60 after weaning algorithm development and implementation, and 34 after clinical decision support implementation. Using quality improvement methodology, hours spent receiving continuous albuterol decreased from a mean of 43.6 to 28.6 hours after clinical decision support development. There were no differences in length of stay using standard statistics and QI methodology.

Conclusion:

Protocolized asthma management in the intensive care unit setting utilizing a multidisciplinary approach and clinical decision support tools for bedside nursing can reduce time spent receiving continuous albuterol and may lead to improved patient outcomes.
Predictors of Blood Loss During Orthognathic Surgery and the Need for Pre-Deposit Autologous Blood Donation
Authors: Kim Jin-Kyu , Kim Jun-Young , Park Jin Hoo , Jung Hwi-Dong , Jung Young-Soo
Published: December 2021

The aim of this study was to identify the clinicolaboratory predictors of relative blood loss (RBL) during orthognathic surgery and determine the need for predeposit autologous blood donation (PABD) for the surgery. Using a retrospective study design, 297 patients who underwent bimaxillary orthognathic surgery between 2016 and 2020 were enrolled. To investigate patient-specific risk factors, we calculated the allowable blood loss (ABL) for each patient and RBL as the ratio of estimated intraoperative blood loss (EiBL) to ABL. The correlations between the clinico-laboratory variables and EiBL and RBL were analyzed using stepwise multivariate regression analysis, and independent t test and one-way ANOVA were performed.

There was no significant difference in transfusion rate between the PABD group (N = 202/279) and non-PABD group (N = 77/279) (P 
= 0.052). Sex (P 
< 0.001), body mass index class (P 
= 0.001), operative time (P < 0.001), and baseline hematocrit (P < 0.001) were significant predictors of EIBL and RBL. EIBL exceeded ABL in only 2 patients. The significant factors of RBL in orthognathic surgery were hematocrit, body mass index, and operative time. Clinicians should be more careful about bleeding in patients with low baseline hematocrit level or high body mass index, or those expected to undergo prolonged surgeries owing to a complicated surgical plan. The need for PABD before orthognathic surgery is low.
Performing excellence: Nobel Prize nomination networks in North America
Authors: Hansson Nils , Schlich Thomas
Published: December 2021

This paper examines how scientific excellence is performed in Nobel nominations for medical scientists. Performing excellence encompasses both conducting excellent scientific work and being recognized for it. Both dimensions are closely intertwined: doing and recognizing excellent work depend on each other. Tracing nominations from the Nobel Archives in Solna, Sweden, the paper shows that Nobel Prizes are only the tip of the iceberg of networks of scientific recognition, which belong to cultures of excellence. Approaching cultures of excellence through nominations helps to understand how scientific prizes were awarded. The nominations show that science is not just a cognitive activity but also a social endeavour, and that the decision about who is awarded the Nobel Prize is also an outcome of social processes. Analysing the nomination networks thus explains to a certain extent the predominance of researchers from the USA versus Canada (and other countries). It shows, among other things, that a proactive policy of Nobel Prize nominations is part of the culture of excellence in which American scientists often participate. The mechanisms of scientific recognition as reflected in Nobel Prize nomination networks and rhetoric give insight into the patterns and the background of awarding the prize.
Genomic comparisons of Escherichia coli ST131 from Australia
Authors: Li Dmitriy , Wyrsch Ethan R. , Elankumaran Paarthiphan , Dolejska Monika , Marenda Marc S. , Browning Glenn F. , Bushell Rhys N. , McKinnon Jessica , Chowdhury Piklu Roy , Hitchick Nola , Miller Natalie , Donner Erica , Drigo Barbara , Baker Dave , Charles Ian G. , Kudinha Timothy , Jarocki Veronica M. , Djordjevic Steven Philip
Published: December 2021

Escherichia coli

ST131 is a globally dispersed extraintestinal pathogenic

E. coli

lineage contributing significantly to hospital and community acquired urinary tract and bloodstream infections. Here we describe a detailed phylogenetic analysis of the whole genome sequences of 284 Australian ST131

E. coli

isolates from diverse sources, including clinical, food and companion animals, wildlife and the environment. Our phylogeny and the results of single nucleotide polymorphism (SNP) analysis show the typical ST131 clade distribution with clades A, B and C clearly displayed, but no niche associations were observed. Indeed, interspecies relatedness was a feature of this study. Thirty-five isolates (29 of human and six of wild bird origin) from clade A (32 fimH41, 2 fimH89, 1 fimH141) were observed to differ by an average of 76 SNPs. Forty-five isolates from clade C1 from four sources formed a cluster with an average of 46 SNPs. Within this cluster, human sourced isolates differed by approximately 37 SNPs from isolates sourced from canines, approximately 50 SNPs from isolates from wild birds, and approximately 52 SNPs from isolates from wastewater. Many ST131 carried resistance genes to multiple antibiotic classes and while 41 (14 %) contained the complete class one integron–integrase intI1, 128 (45 %) isolates harboured a truncated intI1 (462–1014 bp), highlighting the ongoing evolution of this element. The module intI1–dfrA17–aadA5–qacEΔ1–sul1–ORF–chrA–padR–IS1600–mphR–mrx–mphA, conferring resistance to trimethoprim, aminoglycosides, quaternary ammonium compounds, sulphonamides, chromate and macrolides, was the most common structure. Most (73 %) Australian ST131 isolates carry at least one extended spectrum β-lactamase gene, typically bla
CTX-M-15 and bla
CTX-M-27. Notably, dual parC-1aAB and gyrA-1AB fluoroquinolone resistant mutations, a unique feature of clade C ST131 isolates, were identified in some clade A isolates. The results of this study indicate that the the ST131 population in Australia carries diverse antimicrobial resistance genes and plasmid replicons and indicate cross-species movement of ST131 strains across diverse reservoirs.