bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospital nurses’ management of agitation in older cognitively impaired patients: do they recognise pain-related agitation?
Authors: Graham Frederick , Beattie Elizabeth , Fielding Elaine
Published: July 2022

Background

cognitively impaired hospital patients often experience agitation and aggression due to pain. Agitation complicates care, increasing the risk of adverse outcomes and patient-to-nurse violence. Managing agitation is challenging for nurses. Literature suggests they may rely on antipsychotics while missing other more appropriately targeted treatments. However, nurses’ management of agitation remains unclear and under-researched.

Objective

the aim of this study was to investigate hospital nurses’ management of agitation in older cognitively impaired patients with pain.

Design

this was a descriptive correlational study using virtual simulation.

Setting and participants

a total of 274 registered medical and surgical nurses from 10 public hospitals in Queensland, Australia participated in the study.

Methods

nurses undertook a virtual simulation requiring them to manage agitation in a patient with dementia and an injury. Nurses also completed a post-simulation questionnaire. Their simulation performances were correlated with demographics such as seniority, workplace, training, experience and gerontology-specific knowledge. Constructed from an original, validated vignette, the simulation included branching pathways, video scenarios and an avatar that could converse with participants.

Results

thirteen nurses (4.7%) recognised and treated the virtual patient’s agitation as pain-related. Most nurses (89%) gave antipsychotics of which 207 (78%) gave these first-line and 102 (38%) used them twice. Independent of other variables, nurses most likely to diagnose pain were dementia-unit nurses (OR = 8.7), surgical-unit nurses (OR = 7.3) and senior nurses (OR = 5).

Conclusions

hospital nurses predominately managed agitation with antipsychotics, a decision that most made after undertaking inadequate patient assessments. This confirmed a common gap in practice that may lead to the missing of pain in the clinical care of agitated patients with dementia and/or delirium.
Overall lifestyles and socioeconomic inequity in mortality and life expectancy in China: the China health and nutrition survey
Authors: Zhang Yan-Bo , Li Yue , Geng Ting-Ting , Pan Xiong-Fei , Zhou Yan-Feng , Liu Gang , Pan An
Published: July 2022

Background

socioeconomic inequity in mortality and life expectancy remains inconclusive in low- and middle-income countries, and to what extent the associations are mediated or modified by lifestyles remains debatable.

Methods

we included 21,133 adults from China Health and Nutrition Survey (1991–2011) and constructed three parameters to reflect participants’ overall individual- (synthesising income, education and occupation) and area-level (urbanisation index) socioeconomic status (SES) and lifestyles (counting the number of smoking, physical inactivity and unhealthy diet and bodyweight). HRs for mortality and life expectancy were estimated by time-dependent Cox model and life table method, respectively.

Results

during a median follow-up of 15.2 years, 1,352 deaths were recorded. HRs (95% CIs) for mortality comparing low versus high individual- and area-level SES were 2.38 (1.75–3.24) and 1.84 (1.51–2.24), respectively, corresponding to 5.7 (2.7–8.6) and 5.0 (3.6–6.3) life-year lost at age 50. Lifestyles explained ≤11.5% of socioeconomic disparity in mortality. Higher lifestyle risk scores were associated with higher mortality across all socioeconomic groups. HR (95% CI) for mortality comparing adults with low individual-level SES and 3–4 lifestyle risk factors versus those with high SES and 0–1 lifestyle risk factors was 7.06 (3.47–14.36), corresponding to 19.1 (2.6–35.7) life-year lost at age 50.

Conclusion

this is the first nationwide cohort study reporting that disadvantaged SES was associated with higher mortality and shorter life expectancy in China, which was slightly mediated by lifestyles. Risk lifestyles were related to higher mortality across all socioeconomic groups, and those with risk lifestyles and disadvantaged SES had much higher mortality risks.
Policing the Sublime: The Metaphysical Harms of Irreligious Clinical Ethics
Authors: Kornu Kimbell
Published: July 2022

Janet Malek has recently argued that the religious worldview of the clinical ethics consultant should play no normative role in clinical ethics consultation. What are the theological implications of a normatively secular clinical ethics? I argue that Malek’s proposal constitutes an irreligious clinical ethics, which commits multiple metaphysical harms. First, I summarize Malek’s key claims for a secular clinical ethics. Second, I explicate both John Milbank’s notion of ontological violence and Timothy Murphy’s irreligious bioethics to show how they apply to Malek’s secular clinical ethics, resulting in an irreligious clinical ethics. Third, I then show how an irreligious clinical ethics commits metaphysical harms to patients, clinical ethics consultants, and the institution of clinical ethics consultation. I conclude that Malek’s proposal for an irreligious clinical ethics must be rejected to maintain the metaphysical integrity of clinical ethics consultants, patients, and the institution of clinical ethics consultation.
Optimal scheduling of wind–photovoltaic power-generation system based on a copula-based conditional value-at-risk model
Authors: Ju Xin , Liu Xiaomin , Liu Shangke , Xiao Yangli
Published: July 2022

Increasing the application of renewable energy in the power system is an effective way to achieve the goal of ‘Dual Carbon’. At the same time, the high proportion of renewable energy connected to the grid endangers the safe operation of the power system. To solve this problem, this paper proposes the application of a copula function to describe the correlation between wind power and photovoltaic power, and reduce the uncertainty of power-system operation with a high proportion of renewable energy. In order to increase the robustness of the model, this paper proposes the application of the conditional value-at-risk theory to construct the objective function of the model and effectively control the tail risk of power-system operation costs. Through case analysis, it is found that the model proposed in this paper has strong practicality and economy.
Wind energy conversion system using perturb & observe-based maximum power point approach interfaced with T-type three-level inverter connected to grid
Authors: S Pranupa , Sriram A T , Nagaraja Rao S
Published: July 2022

In this paper, the performance of a permanent magnet synchronous generator (PMSG)-based wind energy conversion system (WECS) supplied to an uncontrolled rectifier-fed boost converter (BC) interfaced with a three-phase T-type three-level inverter (TLI) has been analysed. The proposed WECS involves three converters, namely an uncontrolled rectifier that is used for conversion from AC to DC; a BC supplied by a PMSG-fed rectifier used to enhance the voltage gain; and a grid-connected three-phase T-type TLI is proposed to eliminate power-quality issues with synchronization of grid voltage and current. The main goal of this research is to model and control the grid-connected T-type TLI using a d–q synchronous frame for wind energy for regulating the DC-link voltage and transferring the generated wind power from the BC to the grid. Furthermore, the perturb & observe (P&O)-based maximum power point (MPP) approach is recommended to keep track of the MPP for a BC that is supplied from a PMSG-based WECS under constant and variable wind speeds. The proposed PMSG-based WECS interfaced with grid-connected T-type TLI using d–q control has been computationally modelled, simulated and validated with constant and variable speeds using MATLAB® and Simulink®. It is confirmed that the P&O-based MPP approach ensures maximum power for varying wind speeds, and the total harmonic distortion of the T-type TLI grid current value is 3.18%, which is within IEEE-519 limits. Furthermore, with grid synchronization, the power factor of the T-type TLI is maintained at unity to avoid power-quality issues.
Racialised Threat Perception within International Society: From Japan to China
Authors: Han Enze
Published: July 2022

This article takes a comparative approach that looks at the rise of Japan and China during their ascendency and challenge to the hegemonic state within the international system, and the subsequent racial threat perception that both countries experienced. Engaging the English School of International Relations, it focuses particularly on the legacies of differentiation within international society. It contends that, given the English School’s emphasis on the concept of international society that likens that relationship among states to a social one, it is fruitful to examine how social differentiation occurs within a domestic setting and to use that finding as analogous to international society. The article argues that racialised threat perception towards Japan and China heightened in tandem with their successive rises due to the challenges the two countries posed to the status and privileges of the dominant country—the USA—and which coincided with a US economic downturn and domestic crisis. This racially sensitive approach can provide at least one lens through which to understand the racial threat perception and contemporary relational dynamics between the two great powers: the USA versus the People’s Republic of China.
Repellent effect of synanthropic house mouse urine odor on small forest mammals
Authors: Zhigarev Igor A , Alpatov Vasiliy V , Shitikov Dmitry A , Nekrasova Maria V , Alekseeva Olga G , Kotenkova Elena V
Published: July 2022

In this study, we examined the effect of synanthropic house mouse (Mus musculus) urine odor on catching probability of small mammals to live traps. We conducted a series of field experiments in August 2016 and 2017 in a natural forests of the northwestern Moscow Region (Russia). Small mammals were trapped at two 4-ha fields using capture-mark-recapture technique by setting 200 live traps (100 points, 2 traps per point) within each field. One trap in each pair was odorless (control) with bait only, whereas the other one was odor-baited with 20 μL of the urine of a synanthropic house mouse. Further analysis was based on the data collected from 2 rodent species (bank vole Myodes glareolus, herb field mouse Apodemus uralensis) and 3 shrew species (common shrew Sorex araneus, Laxmann’s shrew Sorex caecutiens, and Eurasian pygmy shrew Sorex minutus). As a result, only bank voles significantly avoided odor-baited live traps. Using generalized linear mixed models, we showed that the choice of a trap by bank voles depended on their age, whereas the probability of repeated capture to a certain live trap was related to their prior experience. We discuss the possible role of components of synanthropic house mouse urine in the population management of exoanthropic small mammals.
Training College Students with Hearing Loss in Theory of Mind
Authors: Wu Yang , Liu Xiping , Zhang Shengnan , Zhong Rubo
Published: July 2022

This paper explored training methods to improve the Theory of Mind levels of Chinese college students with hearing loss and investigated the transfer effect of training. Ninety Chinese college students with hearing loss were randomly divided into two groups: the ToM training group and the physical-conversation training group. The ToM training group received ToM training, and the physical-conversation training group as the control group received physical-conversation training. All the participants attended four separate 60-min lectures. The ToM Story Task and the False Belief Task were used to assess the training’s effect, and the ToM animation task was adopted to investigate the transfer effect. Before training, the level of ToM of the two participant groups was similar. After training, the ToM level of Chinese college students with hearing loss who participated in ToM training was significantly higher than the students who underwent physical-conversation training. Moreover, the findings revealed that ToM training has long-term transfer effects. This study thus showed that ToM training can effectively improve the ToM level of Chinese college students with hearing loss.
Transcatheter closure of residual Gerbode defect after aortic valve replacement surgery
Authors: Slim Mehdi , Mekki Nouha , Ouannes Sami , Neffati Elies
Published: July 2022

A 42-year-old man with a history of surgically repaired coarctation of the aorta presented with a refractory right heart failure. Echocardiography revealed a calcified bicuspid aortic valve both regurgitant and stenotic and a defect within the membranous septum with left to right shunt from the left ventricle (LV) to the right atrium. The patient was referred to surgery for an aortic valve replacement and closure with patch repair of the Gerbode type defect. Post-operative course was complicated by refractory heart failure with a persistent left to right shunt through the defect due to loose sutures. Taking into account the high surgical risk, percutaneous closure of the defect was decided. An Amplatzer Duct Occluder (St Jude Medical, USA) I device was successfully released within the defect. The patient was completely asymptomatic on follow-up.
Genetic Association Between Epigenetic Aging-Acceleration and the Progression of Mild Cognitive Impairment to Alzheimer’s Disease
Authors: Liu Hongliang , Lutz Michael , Luo Sheng ,   Alzheimer’s Disease Neuroimaging Initiative
Published: July 2022

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder, and previous studies have shown its association with accelerated aging. In this study, we hypothesized that single nucleotide polymorphisms (SNPs) that contributed to aging acceleration are also associated with the progression from mild cognitive impairment (MCI) to AD. By applying genetic correlation analysis and single-locus survival analysis, we investigated the associations between intrinsic- and extrinsic-epigenetic-age-acceleration (IEAA and EEAA) related SNPs and the progression time from MCI to AD dementia using the data of 767 MCI participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) study and 1 373 MCI patients from the National Alzheimer’s Coordinating Center (NACC) study. Genetic correlations were found between IEAA/EEAA and AD (positive for IEAA-AD and negative for EEAA-AD). We revealed that 70 IEAA and 81 EEAA SNPs had associations with the progression time from MCI to AD with Bayesian false-discovery probability ≤ 0.8 in the ADNI study, with 22 IEAA SNPs and 16 EEAA SNPs being replicated in the NACC study (p < .05). Polygenic risk score (PRS) analysis showed that EEAA PRS but not IEAA PRS was associated with AD progression and the trend of decreasing fusiform gyrus volume in 2 data sets. Risk models incorporating both EAA PRSs did not show any significant improvement in predictive accuracy. Our results revealed multiple genetic variants with pleiotropic effects on both EAA and AD, which suggested shared genetic architecture between epigenetic age acceleration and AD progression.
On computing viscoelastic Love numbers for general planetary models: the ALMA3 code
Authors: Melini D , Saliby C , Spada G
Published: July 2022

The computation of the Love numbers (LNs) for a spherically symmetric self-gravitating viscoelastic Earth is a classical problem in global geodynamics. Here we revisit the problem of the numerical evaluation of loading and tidal LNs in the static limit for an incompressible planetary body, adopting a Laplace inversion scheme based upon the Post-Widder formula as an alternative to the traditional viscoelastic normal modes method. We also consider, within the same framework, complex-valued, frequency-dependent LNs that describe the response to a periodic forcing, which are paramount in the study of the tidal deformation of planets. Furthermore, we numerically obtain the time-derivatives of LNs, suitable for modelling geodetic signals in response to surface loads variations. A number of examples are shown, in which time and frequency-dependent LNs are evaluated for the Earth and planets adopting realistic rheological profiles. The numerical solution scheme is implemented in ALMA3 (the plAnetary Love nuMbers cAlculator, version 3), an upgraded open-source Fortran 90 program that computes the LNs for radially layered planetary bodies with a wide range of rheologies, including transient laws like Andrade or Burgers.
Double synonymous mutations in exon 9 of the Cullin3 gene restore exon inclusion by abolishing hnRNPs inhibition
Authors: Liu Zhiying , Sui Aihua , Wang Sai , Cui Li , Xin Qing , Zhang Ruixiao , Han Yue , Shao Leping , Zhao Xiangzhong
Published: July 2022

All mutations in exon 9 of the Cullin3 gene associated with pseudohypoaldosteronism type II (PHA II) contribute to exon skipping to different degrees, but the specific molecular mechanism of this aberrant splicing is still unclear. The aims of this study were to investigate the regulatory mechanism underlying two synonymous splicing events, c.1221A > G (p. Glu407Glu) and c.1236G > A (p. Leu412Leu), and to discover a therapeutic strategy for correcting this aberrant splicing by targeting potential regulatory sites. Through a series of RNA pulldown, silver staining, western blotting, small interfering RNA knockdown, in vitro overexpression and single or double site-directed mutagenesis experiments, we first explored the pathogenesis of exon 9 skipping caused by mutations in the CUL3 gene and verified that the main splicing regulators associated with the synonymous c.1221A > G and c.1236G > A mutations were heterogeneous nuclear ribonucleoproteins. In addition, we verified that introducing another synonymous mutation, c.1224A > G (A18G), significantly rescued the abnormal splicing caused by c.1221A > G and c.1236G > A, highlighting the therapeutic potential for the treatment of PHA II.
Air Breathing and Suction Feeding Kinematics in the West African Lungfish,Protopterus annectens
Authors: Kaczmarek Elska B , Gartner Samantha M , Westneat Mark W , Brainerd Elizabeth L
Published: July 2022

Research on the water-to-land transition tends to focus on the locomotor changes necessary for terrestriality. However, the evolution from water breathing to air breathing was also a necessary precursor to the invasion of land. Air is approximately 1000 times less dense and 50 times less viscous, and contains hundreds of times more oxygen than water. However, unlike the transition to terrestrial locomotion, breathing air does not require body weight support, so the evolution of air breathing may have necessitated smaller changes to morphology and function. We used X-ray reconstruction of moving morphology to compare the cranial kinematics of aquatic buccal pumping, such as that seen in suction feeding, with the aerial buccal pumping required for lung ventilation in the West African lungfish (Protopterus annectens). During buccal pumping behaviors, the cranial bones and associated soft tissues act as valves and pumps, and the sequence of their motions controls the pattern of fluid flow. Both behaviors are characterized by an anterior-to-posterior wave of expansion and an anterior-to-posterior wave of compression. We found that the pectoral girdle and cranial rib rotate consistently during air breathing and suction feeding, and that the muscle between them shortens during buccal expansion. Overall, we conclude that the major cranial bones maintain the same basic functions (i.e., acting as valves or pumps, or transmitting power) across aquatic and aerial buccal pumping. The cranial morphology that enables aquatic buccal pumping is well suited to perform air breathing and accommodates the physical differences between air and water.
Gross Capital Flows by Banks, Corporates, and Sovereigns
Authors: Avdjiev Stefan , Hardy Bryan , Kalemli-Özcan Şebnem , Servén Luis
Published: July 2022

We construct a new quarterly data set of international capital flows broken down by sector—banks, corporates, and sovereigns—and demonstrate the importance of distinguishing capital flows by the sector of domestic borrowers and lenders. We document four new sets of facts. First, banks account for the largest part of the external debt (stocks and flows) in advanced economies, whereas in emerging markets, banks, corporates, and sovereigns have roughly equal shares. Second, the high correlation between total capital inflows and outflows documented in the literature is driven by banking sector flows; that is, domestic banks’ borrowing from foreigners is highly correlated with domestic banks’ lending to foreigners. Third, sovereign flows behave very differently from and often act as a countervailing force to private sector (banking and corporate) flows, especially in emerging markets. Fourth, different shocks (global financial cycles versus domestic business cycles; banking versus currency versus sovereign crises) generate very distinct patterns of capital inflows and outflows by sector. The stylized facts we document deepen our understanding of the dynamics and behavior of capital flows and have important implications for open economy models.
A. W. Franks, William Ridgeway and collections of Irish antiquities
Authors: McEvansoneya Philip
Published: July 2022

The visit by A. W. Franks of the British Museum to the Irish Industrial Exhibition in Dublin in 1853 gave him the opportunity to assess the holdings of Irish antiquarian material displayed there. This soon led to purchases for the museum. The collections that most interested him are discussed here, along with another, long known to William Ridgeway, who eventually bought it on behalf of the Cambridge Antiquarian Society.
Larval Mortality and Ovipositional Preference in Aedes albopictus (Diptera: Culicidae) Induced by the Entomopathogenic Fungus Beauveria bassiana (Hypocreales: Cordycipitaceae)
Authors: Kirsch John M , Tay Jia-Wei
Published: July 2022

Entomopathogenic fungi allow chemical-free and environmentally safe vector management. Beauveria bassiana (Balsamo-Crivelli) Vuillemin is a promising biological control agent and an important component of integrated vector management. We investigated the mortality of Aedes albopictus (Skuse) larvae exposed to five concentrations of B. bassiana using Mycotrol ESO and adult oviposition behavior to analyze the egg-laying preferences of wild Ae. albopictus in response to different fungal concentrations. We examined the mortality of mid-instars exposed to B. bassiana concentrations of 1 × 104, 1 × 105, 1 × 106, 1 × 107, and 1 × 108 conidia/ml every 24 h for 12 d. In the oviposition behavior study, the fungus was applied to wooden paddles at 1 × 105, 1 × 107, and 1 × 109 conidia/ml, and the paddles were individually placed into quad-ovitraps. Both experiments contained control groups without B. bassiana. Kaplan–Meier survival analysis revealed that larval mortality was concentration dependent. The median lethal concentration was 2.43 × 105 conidia/ml on d 12. The median lethal time was 3.68 d at 1 × 106 conidia/ml. Oviposition monitoring revealed no significant difference in egg count between the control and treatment paddles. We observed an inverse relationship between the concentration of B. bassiana and the percentage of paddles with eggs. We concluded that concentrations above 1 × 106 conidia/ml are larvicidal, and Ae. albopictus laid similar numbers of eggs on fungus-impregnated and control wooden substrates; however, they were more likely to oviposit on substrates without B. bassiana. With these findings, we suggest that B. bassiana-infused ovitraps can be used for mosquito population monitoring while also delivering mycopesticides to adult mosquitoes.
Jewish difference and recovering ‘commedia’: erich w. korngold’s ‘die tote stadt’ in post-first world war austria
Authors: Hsieh Amanda
Published: July 2022

Commedia dell’arte re-emerged in the early twentieth century to become a means for Europe’s assimilated Jews to process the conditions of modernity by non-serious means. Yet, existing scholarship on Erich W. Korngold’s Die tote Stadt tends to focus on the protagonist Paul with respect to the doppelgängers Marie/Marietta, spotlighting the psychodrama of Acts I and III but overlooking the overtly theatrical episodes of Act II’s extended commedia dell’arte sequence. The opera’s ‘Schlager’ (hit songs) offered old-world comfort to its post-First World War Viennese audience. Nevertheless, the commedia dell’arte scenes were significant in terms of advancing an affirmative politics for war-torn Vienna’s assimilated Jews, precisely because of how deliberately noisy they appeared in opposition to the world of Catholic harmony. Placing side by side Wagnerian symbolism and commedia dell’arte—that is, ingredients from Christianity and contemporary popular Jewish theatre—Korngold’s opera asked timely questions of the Jewish citizenry in Austria’s First Republic.
Gene regulatory network study of rheumatoid arthritis in single-cell chromatin landscapes of peripheral blood mononuclear cells
Authors: Zhang Cantong , Hong Xiaoping , Yu Haiyan , Xu Huixuan , Qiu Xiaofen , Cai Wanxia , Hocher Berthold , Dai Weier , Tang Donge , Liu Dongzhou , Dai Yong
Published: July 2022

Objectives

Assays for transposase-accessible chromatin with single-cell sequencing (scATAC-seq) contribute to the progress in epigenetic studies. The purpose of our project was to discover the transcription factors (TFs) that were involved in the pathogenesis of rheumatoid arthritis (RA) at a single-cell resolution using epigenetic technology.

Methods

Peripheral blood mononuclear cells of seven RA patients and seven natural controls were extracted nuclei suspensions for library construction. Subsequently, scATAC-seq was performed to generate a high-resolution map of active regulatory DNA for bioinformatics analysis.

Results

We obtained 22 accessible chromatin patterns. Then, 10 key TFs were involved in RA pathogenesis by regulating the activity of mitogen-activated protein kinase. Consequently, two genes (PTPRC and SPAG9) regulated by 10 key TFs were found, which may be associated with RA disease pathogenesis, and these TFs were obviously enriched in RA patients (P < .05, fold change value > 1.2). With further quantitative polymerase chain reaction validation on PTPRC and SPAG9 in monocytes, we found differential expression of these two genes, which were regulated by eight TFs [ZNF384, HNF1B, DMRTA2, MEF2A, NFE2L1, CREB3L4 (var. 2), FOSL2::JUNB (var. 2), and MEF2B], showing highly accessible binding sites in RA patients.

Conclusions

These findings demonstrate the value of using scATAC-seq to reveal transcriptional regulatory variation in RA-derived peripheral blood mononuclear cells, providing insights into therapy from an epigenetic perspective.
Associations of levetiracetam use with the safety and tolerability profile of chemoradiotherapy for patients with newly diagnosed glioblastoma
Authors: Seystahl Katharina , Oppong Felix Boakye , Le Rhun Emilie , Hertler Caroline , Stupp Roger , Nabors Burt , Chinot Olivier , Preusser Matthias , Gorlia Thierry , Weller Michael
Published: July 2022

Background

Levetiracetam (LEV) is one of the most frequently used antiepileptic drugs (AED) for brain tumor patients with seizures. We hypothesized that toxicity of LEV and temozolomide-based chemoradiotherapy may overlap.

Methods

Using a pooled cohort of patients with newly diagnosed glioblastoma included in clinical trials prior to chemoradiotherapy (CENTRIC, CORE, AVAglio) or prior to maintenance therapy (ACT-IV), we tested associations of hematologic toxicity, nausea or emesis, fatigue, and psychiatric adverse events during concomitant and maintenance treatment with the use of LEV alone or with other AED versus other AED alone or in combination versus no AED use at the start of chemoradiotherapy and of maintenance treatment.

Results

Of 1681 and 2020 patients who started concomitant chemoradiotherapy and maintenance temozolomide, respectively, 473 and 714 patients (28.1% and 35.3%) were treated with a LEV-containing regimen, 538 and 475 patients (32.0% and 23.5%) with other AED, and 670 and 831 patients (39.9% and 41.1%) had no AED. LEV was associated with higher risk of psychiatric adverse events during concomitant treatment in univariable and multivariable analyses (RR 1.86 and 1.88, P < .001) while there were no associations with hematologic toxicity, nausea or emesis, or fatigue. LEV was associated with reduced risk of nausea or emesis during maintenance treatment in multivariable analysis (HR = 0.80, P = .017) while there were no associations with hematologic toxicity, fatigue, or psychiatric adverse events.

Conclusions

LEV is not associated with reduced tolerability of chemoradiotherapy in patients with glioblastoma regarding hematologic toxicity and fatigue. Antiemetic properties of LEV may be beneficial during maintenance temozolomide.
Reducing Misperceptions About Very Low Nicotine Content Cigarettes: Insights From Adults Who Smoke
Authors: Ranney Leah M , Jarman Kristen L , Clark Sonia A , Baler G , Gourlay Margaret , Brewer Noel T , Goldstein Adam O , Byron M Justin
Published: July 2022

Introduction

Many people incorrectly think that very low nicotine content (VLNC) cigarettes are less carcinogenic than current cigarettes. This risk misperception by people who smoke could reduce motivation to quit under a nicotine reduction policy. We qualitatively examined perspectives on campaign messages designed to reduce misperceptions.

Aims and Methods

Adults who smoke from North Carolina participated in online interviews. After being introduced to the idea of a VLNC policy, participants were shown VLNC messages and asked about their perceptions on the clarity, understandability, persuasiveness, and meaning of the messages. We conducted a thematic content analysis of the transcripts.

Results

Thirty adults who smoke cigarettes participated (15 females, 13 males, 2 nonbinary) with a mean age of 43 years. Central themes that emerged were: (1) Confusion about the proposed VLNC cigarette policy affected how messages were interpreted; (2) Messages that promote self-efficacy for quitting rather than guilt or fear were better received; and (3) Direct and succinct messages were seen as more able to grab attention and inform people who smoke. Some participant concerns focused on whether VLNC cigarettes would relieve their nicotine cravings and whether they would need to smoke more VLNC cigarettes to feel satisfied.

Conclusion

Campaign messages to educate the public about the harmful effects of smoking VLNC cigarettes may be more effective if people who smoke are informed about the policy’s rationale to understand why nicotine is removed rather than the other harmful chemicals. Messages should also acknowledge the difficulty of quitting and be short and direct to capture attention.

Implications

Adults who smoke have some confusion about nicotine reduction in cigarettes and this affects how they perceive potential communication campaign messages about the risk of smoking VLNC cigarettes. In our qualitative research, we found that adults who smoke prefer messages about VLNC cigarettes that acknowledge the challenge of quitting and that are direct and succinct. With further development, campaign messages may be able to reduce misperceptions about VLNC cigarettes and maximize the public health benefit of a nicotine reduction policy.
Effective cerebello–cerebral connectivity during implicit and explicit social belief sequence learning using dynamic causal modeling
Authors: Ma Qianying , Pu Min , Haihambo Naem , Baetens Kris , Heleven Elien , Deroost Natacha , Baeken Chris , Van Overwalle Frank
Published: July 2022

To study social sequence learning, earlier functional magnetic resonance imaging (fMRI) studies investigated the neural correlates of a novel Belief Serial Reaction Time task in which participants learned sequences of beliefs held by protagonists. The results demonstrated the involvement of the mentalizing network in the posterior cerebellum and cerebral areas (e.g. temporoparietal junction, precuneus and temporal pole) during implicit and explicit social sequence learning. However, little is known about the neural functional interaction between these areas during this task. Dynamic causal modeling analyses for both implicit and explicit belief sequence learning revealed that the posterior cerebellar Crus I & II were effectively connected to cerebral mentalizing areas, especially the bilateral temporoparietal junction, via closed loops (i.e. bidirectional functional connections that initiate and terminate at the same cerebellar and cerebral areas). There were more closed loops during implicit than explicit learning, which may indicate that the posterior cerebellum may be more involved in implicitly learning sequential social information. Our analysis supports the general view that the posterior cerebellum receives incoming signals from critical mentalizing areas in the cerebrum to identify sequences of social actions and then sends signals back to the same cortical mentalizing areas to better prepare for others’ social actions and one’s responses to it.
The designer benzodiazepine, flubromazepam, induces reward-enhancing and cardiotoxic effects in rodents
Authors: Hong Eunchong , Gu Sun Mi , Kim Jin Mook , Yoon Kyung Sik , Lee Jin-Moo , Kim Young-Hoon , Suh Soo Kyung , Lee Dohyun , Eom Heejong , Yun Jaesuk , Cha Hye Jin
Published: July 2022

The use of many benzodiazepines is controlled worldwide due to their high likelihood of abuse and potential adverse effects. Flubromazepam—a designer benzodiazepine—is a long-acting gamma-aminobutyric acid subtype A receptor agonist. There is currently a lack of scientific evidence regarding the potential for flubromazepam dependence or other adverse effects. This study aimed to evaluate the dependence potential, and cardiotoxicity via confirmation of the QT and RR intervals which are the factors on the electrical properties of the heart of flubromazepam in rodents. Using a conditioned place preference test, we discovered that mice treated intraperitoneally with flubromazepam (0.1 mg/kg) exhibited a significant preference for the flubromazepam-paired compartment, suggesting a potential for flubromazepam dependence. In addition, we observed several cardiotoxic effects of flubromazepam; 100-μM flubromazepam reduced cell viability, increased RR intervals but not QT intervals in the electrocardiography measurements, and considerably inhibited potassium channels in a human ether-à-go-go-related gene assay. Collectively, these findings suggest that flubromazepam may have adverse effects on psychological and cardiovascular health, laying the foundation for further efforts to list flubromazepam as a controlled substance at both national and international levels.
PIN1-mediated ROS production is involved in antagonism of N-acetyl-L-cysteine against arsenic-induced hepatotoxicity
Authors: Zhang Huijie , He Zhixin , Deng Ping , Lu Muxue , Zhou Chao , Yang Lingling , Yu Zhengping
Published: July 2022

Arsenic, a widely existing environmental contaminant, is recognized to be toxic to multiple organs. Exposure to arsenic results in liver damage via excessive production of reactive oxidative species (ROS). PIN1 regulates the levels of ROS. N-acetyl-L-cysteine (NAC) is an ROS scavenger that protects the hepatic functions. Whether PIN1 plays a regulatory role in NAC-mediated antagonism against arsenic hepatotoxicity remains largely unknown. In our study, the protective effects of NAC against arsenic (NaAsO2)-induced hepatotoxicity were evaluated in vitro and in vivo. Arsenic exposure induced cytotoxicity by increasing the intracellular ROS production, impairing mitochondrial function and inducing apoptosis in L02 hepatocytes. Overexpression of PIN1 markedly protected against arsenic cytotoxicity, decreased ROS levels, and mitigated mitochondrial dysfunction and apoptosis in L02 cells. However, loss of PIN1 further aggravated arsenic-induced cytotoxicity and abolished the protective effects of NAC in L02 cells. An in vivo study showed that pretreatment with NAC rescued arsenic-induced liver injury by restoring liver function and suppressing hepatic oxidative stress. Overexpression of PIN1 in mice transfected with AAV-Pin1 relieved arsenic-induced liver dysfunction and hepatic oxidative stress. Taken together, our study identified PIN1 as a novel intervention target for antagonizing arsenic-induced hepatotoxicity, highlighting a new pharmacological mechanism of NAC targeting PIN1 in antagonism against arsenic toxicity.
Deltoid-Sparing Modified Judet Approach: Technique and Clinical Series
Authors: LaRoque Michael C , Heare Austin , Cole Peter A
Published: July 2022

Posterior approaches provide the mainstay for treatment in most of the scapula body and neck fractures, even those associated with many intraarticular variants. Several posterior approach modifications for minimizing soft-tissue damage and limiting muscular detachment, have previously been described in the literature; however, little or no clinical evidence is available specifically applied to the various approaches.

In this study, we describe complete sparing of the deltoid muscle origin during the “modified Judet” approach. The modified approach as previously described detaches the deltoid origin. Deltoid sparing allows for satisfactory visualization and fixation of extra-articular scapula fractures and even some intraarticular variants. The purpose of this article was to describe the deltoid-sparing modified Judet approach and report clinical outcomes for 23 patients after surgical treatment.
Factors Causing Delay in Discharge in Patients Eligible for Ambulatory Lumbar Fusion Surgery
Authors: Shahi Pratyush , Vaishnav Avani S. , Melissaridou Dimitra , Sivaganesan Ahilan , Sarmiento J. Manuel , Urakawa Hikari , Araghi Kasra , Shinn Daniel J. , Song Junho , Dalal Sidhant , Iyer Sravisht , Sheha Evan D. , Dowdell James E. , Qureshi Sheeraz A.
Published: July 2022

Study Design.

Retrospective review of prospectively collected data

Objective.

To analyze the postoperative factors that led delayed discharge in patients who would have been eligible for ambulatory lumbar fusion (ALF).

Summary of Background Data.

Assessing postoperative inefficiencies is vital to increase the feasibility of ALF.

Methods.

Patients who underwent single-level MI-TLIF and would have met the eligibility criteria for ALF were included. Length of stay [LOS]; time in post-anesthesia recovery unit [PACU]; alertness and neurological exam, and pain scores at 3 and 6 hours; type of analgesia; time to physical therapy [PT] visit; reasons for PT non-clearance; time to per-oral [PO] intake; time to voiding; time to readiness for discharge were assessed. Time taken to meet each discharge criterion was calculated. Multiple regression analyses were performed to study the effect of variables on postoperative parameters influencing discharge.

Results.

Out of 71 patients, 4% were discharged on the same day and 69% on postoperative day one. PT clearance was the last-met discharge criterion in 93%. 66% did not get PT evaluation on the day of surgery. 76% required intravenous (IV) opioids and <60% had adequate pain control. 27% had orthostatic intolerance (OI). The median postoperative LOS was 26.9 hours, time in PACU was 4.2 hours, time to PO intake was 6.5 hours, time to 1st void was 6.3 hours, time to 1st PT visit was 17.7 hours, time to PT clearance was 21.8 hours, and time to discharge readiness was 21.9 hours. Regression analysis showed that time to PT clearance, time to PO intake, time to voiding, time in PACU, and pain score at 3 hours had a significant effect on LOS.

Conclusions.

Unavailability of PT, surgery after 1 PM, OI, inadequate pain control, prolonged PACU stay, and long feeding and voiding times were identified as modifiable factors preventing same-day discharge.

Level of Evidence.

4
Immigration Transition and Symptom Distress Changes by a Technology-Based Intervention
Authors: Im Eun-Ok , Yi Jee-Seon , Chee Wonshik
Published: July 2022

Technology-based programs using computers and mobile devices are known to be effective in providing information and support to marginalized populations including immigrants. Yet, little is still known on the factors that may influence the effectiveness of technology-based programs in improving symptom experience, including immigration transition, especially among Asian American breast cancer survivors. This study aimed to identify the characteristics related to immigration transition that significantly affected the symptom distress changes by a technology-based information and coaching/support program among Asian American breast cancer survivors. This secondary analysis was conducted with the data from 102 Asian American breast cancer survivors from a randomized clinical trial in progress. Multiple instruments were used: the questions on background characteristics and immigration transition and the Memorial Symptom Assessment Scale–Short Form. The data were analyzed using repeated-measurement analyses and decision tree analyses. The mean changes in the symptoms distress scores were as follows: −0.12 (SD, 0.47) in the Global Distress Index scores; −0.08 (SD, 0.43) in the physical symptom distress scores; and −0.15 (SD, 0.65) in the psychological symptom distress scores. The characteristics with the highest impact on the symptom distress score changes included the immigration age for Global Distress Index and physical symptom distress score and the level of acculturation for psychological symptom distress score.
Interactive Nurse Scheduling
Authors: Gradišar Mirko , Turk Tomaž , Perme Hajdinjak Janja , Tomat Luka
Published: July 2022

Repeatedly solving nurse scheduling problems is one of the most difficult and time-consuming tasks for nurse managers. Although software solutions exist to solve nurse scheduling problems automatically, they are limited to cases in which scheduling rules can be easily formalized and are relatively stable. In other cases, nurse scheduling problems must be solved manually. Thus, this article proposes a new general method for solving nurse scheduling problems that overcomes the limitations of existing methods by introducing human-computer interaction. The solution is based on not only the computer's algorithmic logic but also the nurse manager's knowledge and experiences. We tested the method in a large hospital. The results show that our method also can be used for cases in which fully automated nurse scheduling is not feasible and that it performs better than manual scheduling. In addition, the time spent on scheduling decreased by 80%, and nurse satisfaction with the schedule increased.
The No Surprises Act: What Do Plastic Surgeons Need to Know?
Authors: Seitz Allison J. , Nicksic Peter J. , Rao Venkat K.
Published: July 2022

Background:

Out-of-network, or “surprise” bills, have grown common in recent years and have raised substantial concern for patients. Congress recently enacted the No Surprises Act, effective on January 1, 2022, ending the majority of out-of-network bills for privately insured patients. The aim of this review is to briefly summarize the history of surprise billing, describe the regulations of the No Surprises Act, and examine the impact this legislation will have on the field of plastic surgery.

Methods:

A PubMed and Google Scholar literature search was conducted on out-of-network billing, or surprise bills, and the No Surprises Act. Media outlets, governmental agencies, and local and national medical organizations were additionally queried for surprise billing and the No Surprises Act.

Results:

Under the No Surprises Act, privately insured patients are protected from surprise medical bills in emergency and nonemergency settings, and uninsured or self-pay patients must be provided a good faith estimate of service fees before receiving nonemergent care. Plastic surgeons may consent patients to receive out-of-network bills if consent is obtained at least 72 hours before rendering a nonemergency service. Despite these patient protections, this act may influence plastic surgeons’ reimbursement rates and incentivize surgeons to alter their network status.

Conclusions:

The No Surprises Act provides significant protections for patients. However, it may have adverse effects for plastic surgeons. Plastic surgeons will only get paid in-network fees while providing care to patients unless consent is properly obtained in a nonemergent setting.
Disentangling self from pain: mindfulness meditation–induced pain relief is driven by thalamic–default mode network decoupling
Authors: Riegner Gabriel , Posey Grace , Oliva Valeria , Jung Youngkyoo , Mobley William , Zeidan Fadel
Published: July 2022

For millenniums, mindfulness was believed to diminish pain by reducing the influence of self-appraisals of noxious sensations. Today, mindfulness meditation is a highly popular and effective pain therapy that is believed to engage multiple, nonplacebo-related mechanisms to attenuate pain. Recent evidence suggests that mindfulness meditation–induced pain relief is associated with the engagement of unique cortico-thalamo-cortical nociceptive filtering mechanisms. However, the functional neural connections supporting mindfulness meditation–based analgesia remain unknown. This mechanistically focused clinical trial combined functional magnetic resonance imaging with psychophysical pain testing (49°C stimulation and pain visual analogue scales) to identify the neural connectivity supporting the direct modulation of pain-related behavioral and neural responses by mindfulness meditation. We hypothesized that mindfulness meditation-based pain relief would be reflected by greater decoupling between brain mechanisms supporting appraisal (prefrontal) and nociceptive processing (thalamus). After baseline pain testing, 40 participants were randomized to a well-validated, 4-session mindfulness meditation or book-listening regimen. Functional magnetic resonance imaging and noxious heat (49°C; right calf) were combined during meditation to test study hypotheses. Mindfulness meditation significantly reduced behavioral and neural pain responses when compared to the controls. Preregistered (NCT03414138) whole-brain analyses revealed that mindfulness meditation–induced analgesia was moderated by greater thalamus–precuneus decoupling and ventromedial prefrontal deactivation, respectively, signifying a pain modulatory role across functionally distinct neural mechanisms supporting self-referential processing. Two separate preregistered seed-to-seed analyses found that mindfulness meditation–based pain relief was also associated with weaker contralateral thalamic connectivity with the prefrontal and primary somatosensory cortex, respectively. Thus, we propose that mindfulness meditation is associated with a novel self-referential nociceptive gating mechanism to reduce pain.