bluuebunny/crossref_metadata_2025 huggingface dataset:
Part 2. Payment for Clinical Education Experiences in Physical Therapy: Perspectives From Stakeholders
Authors: Wilkinson Tawna , Manella Kathleen , Myers Katherine , Alhajeri Sara , Konecne Janet , Lewis Michele , Dunn Jessica , Legar Tara , Fenwick Derek , Bzdweka Todd , Chleboun Gary , Gleeson Peggy Blake
Published: September 2021

Introduction/Review of the Literature:

Payment for clinical education (CE) experiences is a current topic of discussion within health care professions wherein incidence of payment is described as rare but growing. The American Council of Academic Physical Therapy (ACAPT) Board charged the National Consortium of Clinical Educators (NCCE) to investigate payment for physical therapist (PT) CE experiences. The ACAPT NCCE Task Force (TF) on Payment for Clinical Experience surveyed academic, clinical, and student CE stakeholders to explore perspectives on the current landscape for payment of PT CE experience.

Methods:

Two surveys were constructed using an exploratory research design: an academic and clinical stakeholder survey and a student survey. For the academic and clinical survey, the TF used member content expertise and literature review to draft questions. Final questions were crafted after conducting 2 validation rounds by an expert panel. For the student survey, student focus groups created and validated final survey questions. Snowball sampling was employed for survey dissemination through ACAPT and NCCE networks. Descriptive statistics were examined and significant differences (P < .05) between stakeholder groups were analyzed. Analysis of open-text responses was conducted to categorize and identify common concepts. There were 1,883 academic and clinical stakeholder survey respondents, with 84.3% identifying as a clinical-only role; all NCCE regions and practice settings were represented. First-, second-, and third-year doctor of physical therapy student survey respondents (2,815) represented both private and public academic programs.

Results:

Less than 5% of academic institutions reported paying any portion of full-time CE experiences. A majority of respondents (1,153, 71.9%) were neutral or disagreed that clinical instructors (CIs) should receive direct payment for supervising students and 76.9% indicated that students should not be required to pay for CE experiences. Both intrinsic and extrinsic factors were cited as reasons not to seek payment and as benefits for providing CE experiences. Supervision restrictions and productivity expectations were identified as key barriers to providing CE experiences. Students indicated that prior knowledge of site and CI qualifications would be expected should students be required to pay for CE experiences.

Discussion and Conclusion:

Most academic, clinical, and student CE stakeholders did not support payment for CE experiences. The stakeholder-identified motivators and nonmonetary incentives to provide CE experiences present an opportunity to explore initiatives that will enhance availability of PT CE experiences aligned with an ACAPT strategic plan on a national level.
Tracking of the beat-to-beat blood pressure changes by the Caretaker physiological monitor against invasive central aortic measurement
Authors: Kwon Younghoon , Stafford Patrick L. , Baruch Martin C. , Kim Sung-Hoon , Cho Yeilim , Mazimba Sula , Gimple Lawrence W.
Published: September 2021

Objective

There is an unmet need for noninvasive continuous blood pressure (BP) monitoring technologies in various clinical settings. Continuous and noninvasive central aortic BP monitoring is technically not feasible currently, but if realized, would provide more accurate and real-time global hemodynamic information than any form of peripheral arterial BP monitoring in an acute care setting. As part of our efforts to develop such, herein we examined the tracking correlation between noninvasively-derived peripheral arterial BP by Caretaker device against invasively measured central aortic BP.

Methods

Beat-to-beat BP by Caretaker was recorded simultaneously with central aortic BP measured in patients undergoing cardiac catheterization. Pearson’s correlation was also derived for SBP and DBP. A trend comparison analysis of the beat-to-beat BP change was performed using a four-quadrant plot analysis with the exclusion zones of 0.5 mmHg/s to determine concordance, (i.e. the direction of beat-to-beat changes in SBP and DBP).

Results

A total of 47 patients were included in the study. A total of 31 369 beats representing an average of 17.3 min of recording were used for analysis. The trend analysis yielded concordances of 84.4 and 83.5% for SBP and DBP, respectively. Respective correlations (Pearson’s r) for SBP and DBP trends were 0.87 and 0.86 (P < 0.01). Tracking of beat-to-beat BP by Caretaker showed excellent concordance and correlation in the direction and the degree of BP change with central aortic BP, respectively.

Conclusion

This study supports the satisfactory performance of the Caretaker device in continuous tracking of central aortic BP beat-to-beat BP and provides a basis to develop an algorithm for absolute central aortic BP estimation in the future.
Blood purification in sepsis and systemic inflammation
Authors: Feng Ying , Peng Jin-Yu , Peng Zhiyong
Published: September 2021

Purpose of review

Sepsis and septic shock are life-threatening diseases with high mortality. Although efforts have made to improve the survivals, the outcomes are still frustrating. Blood purification was thought to be a promising adjunctive therapy to regulate the excessive cytokine storm or to reduce the endotoxin activity caused by sepsis. Critically ill COVID-19 characterized with the similar disease to sepsis may also benefit from blood purification.

Recent findings

The recent studies mainly focused on hemadsorption materials. The results of the clinical trials showed a tendency in decrease of cytokine levels and endotoxin activity and improvement in haemodynamics. However, the results were controversial. More evidence about blood purification in sepsis and COVID-19 are needed from currently ongoing trials and future well designed trials.

The blood purification therapy demonstrated the tendency in decrease of cytokines and endotoxin activity in different degree according to the current studies. However, the effect on mortality and haemodynamics is still in controversy. Further well designed, large sample sized studies should focus on the timing of initiating blood purification, the appropriate indications and the optimal type of blood purification membrane or cartridge to provide more evidence for clinical practice.
Acceptability of Texting 4 Relapse Prevention, Text Messaging-Based Relapse Prevention Program for People With Schizophrenia and Schizoaffective Disorder
Authors: Ybarra Michele L. , Rodriguez Katrina M. , Fehmie Desirée A. , Mojtabai Ramin , Cullen Bernadette
Published: September 2021

We report process outcomes of the pilot randomized controlled trial of Texting 4 Relapse Prevention (T4RP), a text messaging-based relapse prevention program for people with schizophrenia or schizoaffective disorder (SAD). Forty people were randomized to either the intervention or treatment as usual control group at a 2:1 ratio. Process indicators were collected at 6 months post enrollment.

Over 90% of patients agreed or strongly agreed that the text messages were easy to understand, easy to answer, positive, and helped them feel supported. Patient acceptability was positively associated with recovery (β = 0.29, p = <0.001) and patient-provider communication scores (β = 1.04, p < 0.001), and negatively associated with symptoms of the disorder (β = −0.27, p = 0.07). Acceptability was similar by diagnosis (β, SAD diagnosis = 0.40, p = 0.90) and age (β = 0.05, p = 0.67). Findings suggest that a text messaging intervention aimed at preventing relapse is feasible and perceived as beneficial in individuals with schizophrenia and SAD. Future research might include a targeted study of T4RP within the context of hospital discharge when people with schizophrenia/SAD are at highest risk of relapse.
An Exploration of Emergency Department Visits for Home Unintentional Injuries Among Children With Autism Spectrum Disorder for Evidence to Modify Injury Prevention Guidelines
Authors: Jones Vanya , Ryan Leticia , Rooker Griffin , Debinski Beata , Parnham Taylor , Mahoney Patricia , Shields Wendy
Published: September 2021

Objectives

Current childhood injury prevention guidance is anchored by a child's age. For example, children are considered at high risk for falls at ages 4 years and less, and guidance for prevention focuses on these ages. However, these guidelines may not be adequate for children with autism spectrum disorders (ASD).

Methods

This retrospective chart review examined injury characteristics for children with ASD receiving treatment in a pediatric emergency department between 2014 and 2016. Bivariate statistics determined injury demographic correlates. Chart narratives were also coded using traditional content analysis to determine the mechanism that caused the home injury.

Results

The sample (27 cases) was mostly male (89%), Black (48%), with a mean age of 7.8 (SD, 4.9) years. The most common mechanism was a fall (44%), followed by self-injurious behavior (33%), and then burns (22%). All cases identified at least 1 mechanism contributing to the injury, in 2 cases, 2 items were mentioned. Of the 29 items identified, most involved a house feature that was not stairs (24%); some included stairs, furniture, or a combination of foreign object and grill (21%); and few identified food/beverage/liquid (11%).

Conclusions

Analyses suggest that unintentional home injury prevention for children with ASD may require prevention guidance extended through older ages.
Incidence of Neck Pain in Patients With Concussion in a Pediatric Emergency Department
Authors: King Jeffrey A. , Rodriquez Brieana , Kim Irene , Nimmer Mark , Nelson Lindsay D. , Szabo Aniko , Dong Huaying , Thomas Danny
Published: September 2021

Objectives

The aims of the study were (1) to determine the frequency of neck pain in patients diagnosed with mild traumatic brain injury (mTBI) or concussion in a pediatric level 1 trauma center emergency department (ED), (2) to identify variables associated with neck pain in this population, and (3) to report on aspects of care received in the ED including imaging and medication use.

Methods

This is a retrospective chart review of 652 patients presenting to a pediatric ED with diagnosis of concussion/mTBI. Charts were reviewed for the following information: baseline demographic information, mechanism of injury, cause of mTBI, presence or absence of neck pain, point tenderness in the neck on physical examination, and whether the patient followed up within our health system in the 6 months after injury. Charts were also reviewed for other concussion-related symptoms, medication given in the ED, imaging performed in the ED, cervical spine clearance in the ED, and referrals made. For those patients who did have follow-up appointments within our system, additional chart review was performed to determine whether they sought follow-up treatment for symptoms related to concussion/neck pain and the duration of follow-up. Statistical analyses focused on the prevalence of neck pain in the sample. We subsequently explored the degree to which neck pain was associated with other collected variables.

Results

Of 652 patients, 90 (13.8%) reported neck pain. Acceleration/deceleration injury and motor vehicle accident were predictive of neck pain. Neck pain was less common in those reporting nausea and vomiting. Direct impact of the head against an object was associated with reduced odds of neck pain, but after adjusting for other variables, this was no longer statistically significant. Patients with neck pain were older than those without neck pain. Patients with neck pain were more likely to receive ibuprofen or morphine and undergo imaging of the spine. They were also more likely to receive a referral and follow-up with neurosurgery. There was no significant difference between groups with respect to concussion-related follow-up visits or follow-up visits to a dedicated concussion clinic.

Conclusions

Neck pain is a common symptom in pediatric patients with mTBI, although it was more likely in older patients and those presenting with acceleration/deceleration mechanisms. Although patients with neck pain were more likely to receive a referral and follow-up with neurosurgery, they were not more likely to have concussion-related follow-up visits. Indeed, most patients had no follow-up visits related to their concussion, which supports the notion that concussion is a self-limiting condition.
Acute Hydroxychloroquine Overdose
Authors: Pejčić Ana V.
Published: September 2021

Objectives

This review aimed to explore and summarize information from available cases of pediatric acute hydroxychloroquine overdose with confirmed hydroxychloroquine exposure to give the clinicians a helpful perspective for its better recognition and management.

Methods

Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, EBSCO and Serbian Citation Index. The abstracts from 2 toxicology conferences were manually checked for additional relevant publications, as well as reference lists of the retrieved publications. Descriptive statistics, narrative summation, and tabulation of the extracted data were made.

Results

Nine publications and a total of 9 patients were included in the review. Reported age of the patients varied from 2.5 to 16 years (median, 16 years). There were more female patients (77.8%). Estimated total ingested hydroxychloroquine dose was reported in 7 cases (77.8%), and it ranged from 4.0 to 20.0 g (median: 12.0 g). Four patients (44.4%) ingested hydroxychloroquine with a coingestant. Altered mental status (100.0%), cardiotoxicity (88.9%), hypotension (77.8%), and hypokalemia (55.6%) were the most commonly reported clinical manifestations. The majority of the patients were hospitalized (88.9%). More than half of the patients (55.6%) were reported to be treated in the intensive care unit. Most frequently reported therapeutic measures were the following: administration of intravenous fluids/infusions (77.8%), vasopressors (77.8%), bicarbonate therapy—sodium bicarbonate (66.7%), potassium replacement (55.6%), and intubation/ventilation (55.6%). Three patients (33.3%) died.

Conclusions

Management of acute hydroxychloroquine overdose in children should be symptomatic and tailored to observed clinical manifestations. There is a need for additional investigations to better understand the impact and effectiveness of various treatment options.
Description of a Novel ERBB4-rearranged Uterine Sarcoma
Authors: Lim Shu Hui , Mansor Sorsiah B. , Kathirvel Rajeswari , Kuick Chik Hong , Lim-Tan Soo Kim , McCluggage W. Glenn
Published: September 2021

High-grade endometrial stromal sarcoma (HGESS) is an uncommon tumor accounting for <1% of all uterine malignancies. Currently this designation is largely reserved for neoplasms harboring YWHAE-NUTM2A/B and ZC3H7B-BCOR translocations. Here, we report a novel CIQTNF1-ERBB4 translocation in a uterine neoplasm arising in a 49-yr-old woman with morphology suggestive of HGESS. Histologic examination of the 5 cm polypoid uterine corpus mass showed a neoplasm composed of a monotonous population of cells with moderately atypical ovoid to spindle shaped nuclei with easily identifiable mitotic activity and prominent vasculature with focal intravascular extension. Immunohistochemistry showed variable positivity with desmin, estrogen receptor, progesterone receptor, AE1/3 and cyclin D1, and molecular testing showed a translocation between CIQTNF1 on chromosome 17 and ERBB4 on chromosome 2. This represents the first report of this translocation in a uterine neoplasm and adds to the growing list of translocations identified in uterine sarcomas. Although the morphology is suggestive of HGESS, this neoplasm is currently best termed an ERBB4-rearranged uterine sarcoma until additional cases are reported to more fully characterize these neoplasms.
“Neuroendocrine Tumor Grade 3 (NET G3)” of the Uterine Cervix: A Report of 2 Cases
Authors: Katafuchi Tatsuya , Kawakami Fumi , Iwagoi Yutaka , Saito Fumitaka , Mikami Yoshiki
Published: September 2021

In the fifth edition of the World Health Organization classification of female genital tumors, neuroendocrine neoplasms are subcategorized as neuroendocrine tumors (NETs) of grade 1 (G1) and G2, and neuroendocrine carcinoma. NET G3 is not included, as it is for classification of pancreas tumors. Herein, we report 2 cases of “NET G3” of the uterine cervix with long-term follow-up. The patients are 40- and 36-yr-old women who presented with polypoid masses on the uterine cervix. Microscopic examination of hysterectomy specimens revealed tumor features similar to those of pancreatic NET G3 and intestinal type mucinous carcinoma cells invading the cervical stroma. In both cases, the NET component was positive for synaptophysin and chromogranin A, and negative for TTF-1. Mitotic counts were <1/2 mm2 and 5/2 mm2, and the Ki-67 labeling indexes were 57% and 39%, respectively. Pathologic stage classifications (AJCC, version 9) were pT1b1, pN0, and cM0 (FIGO stage IB1), and both patients received adjuvant therapy. One patient had lung and pancreas metastases 4 to 8 yr after initial surgery, which were surgically removed. Both patients remain alive without evidence of recurrent disease 6 and 16 yr after initial surgery. The indolent clinical courses of these cases appear to indicate that cervical “NET G3” is biologically closer to NET than neuroendocrine carcinoma; thus, including uterine cervical “NET G3” in the classification may be justified. However, the optimal management for this tumor type remains undetermined.
The Evolving Molecular Landscape of High-Grade Gliomas
Authors: Pinarbasi Emile , Pratt Drew
Published: September 2021

The classification, diagnosis, and biological understanding of high-grade gliomas has been transformed by an evolving understanding of glioma biology. High-grade gliomas, in particular, have exemplified the impact of molecular alterations in pathology. The discovery of mutations in a key metabolic enzyme (IDH), histone genes (H3-3A), and large-scale chromosome changes (+7/−10, 1p/19q) are examples of specific alterations that now supplant traditional histologic interpretation. Here, we review established and recently defined types of adult and pediatric high-grade gliomas with discussion of key molecular alterations that have been leveraged for subclassification, grading, or prognosis.
Precision Radiotherapy for Gliomas
Authors: Connor Michael , Kim Michelle M. , Cao Yue , Hattangadi-Gluth Jona
Published: September 2021

Gliomas are the most common primary brain cancer, yet are extraordinarily challenging to treat because they can be aggressive and infiltrative, locally recurrent, and resistant to standard treatments. Furthermore, the treatments themselves, including radiation therapy, can affect patients' neurocognitive function and quality of life. Noninvasive imaging is the standard of care for primary brain tumors, including diagnosis, treatment planning, and monitoring for treatment response. This article explores the ways in which advanced imaging has and will continue to transform radiation treatment for patients with gliomas, with a focus on cognitive preservation and novel biomarkers, as well as precision radiotherapy and treatment adaptation. Advances in novel imaging techniques continue to push the field forward, to more precisely guided treatment planning, radiation dose escalation, measurement of therapeutic response, and understanding of radiation-associated injury.
The Effect of Bright Light Therapy on Sleep and Quality of Life in Patients With Poststroke Insomnia
Authors: Kim Won-Hyoung , Joa Kyung-Lim , Kim Chang-Beom , Lee Hyun-Sung , Kang Sang-Gu , Jung Han-Young , Bae Jae Nam
Published: September 2021

Objective

Poststroke insomnia is common and negatively affects stroke recovery. The objective of this study was to determine the effectiveness of bright light therapy for mild-to-moderate stroke patients with insomnia.

Methods

This study was randomized, double blind, and placebo controlled. A 2-week trial was conducted on patients with mild-to-moderate stroke who had poststroke insomnia. Only patients who had experienced a first episode of stroke were enrolled in this study. Sleep parameters were measured using the Actiwatch Spectrum Pro for 7 days before and after light therapy. The instrument specifically collected data concerning sleep, mood state, fatigue, and subjective quality of life. Participants with poststroke insomnia received bright light therapy (10,000 lux) or placebo therapy for 30 minutes in the early morning. A total of 112 eligible participants entered the study, but only 56 patients were randomized to treatment (27 to bright light therapy and 29 to placebo therapy).

Results

Results from analysis of variance showed that the mean change of sleep latency (F(1,55) =4.793, p = .033) and sleep efficiency (F(1,55) = 5.625, p = .022) were significantly superior in bright light therapy over placebo. Bright light therapy resulted in significant improvements in daytime sleepiness, fatigue, mood, and quality of life in study participants (p < .05).

Conclusions

Bright light therapy is a nonpharmacological treatment of early, poststroke insomnia in patients who had a mild to moderate stroke. In addition, bright light therapy is effective for the treatment of daytime sleepiness, fatigue, and depression and for improving quality of life in patients with poststroke insomnia.

Trial registration

ClinicalTrials.gov Identifier: NCT04721574.
Impact of Image Reconstruction Parameters on Abdominal Aortic Calcification Measurement Using Abdominal Computed Tomography
Authors: Abdelganne Layal , Song Fiona , Oliver Joseph , Galea Michael , Chen Xiao , McGill Jeannette , Spelman Tim , Lim Ruth P. , Kutaiba Numan
Published: September 2021

Background and Aims

Abdominal aortic calcification (AAC) is correlated with cardiovascular outcomes independent of traditional risk factors. Quantification of AAC on computed tomography (CT) has not been standardized. Reconstruction parameters have been shown to impact coronary calcium scores. The aim of our study was to assess the impact of abdominal CT reconstruction parameters, slice thickness (ST), and display field of view (DFOV) on AAC quantitative scoring on abdominal CT examinations.

Methods

We retrospectively measured AAC on noncontrast CT of 46 patients (mean age, 64.1 years; 35 males) using 5 different reconstruction protocols with a range of ST and DFOV: protocol A, 2.5 mm ST, 35 cm DFOV; protocol B, 2.5 mm ST, 50 cm DFOV; protocol C, 2.5 mm ST, 25 cm DFOV; protocol D, 5 mm ST, 35 cm DFOV; and protocol E: 0.625 mm ST, 35 cm DFOV. The AAC scores from each protocol were compared using concordance correlation coefficient and Bland-Altman agreement analyses.

Results

The AAC mean (SD) scores for each protocol were as follows: A, 2022 (2418); B, 2022 (2412); C, 1939 (2310); D, 2220 (2695); and E, 1862 (2234). The AAC mean score differences between protocols and reference protocol A were −0.47, 82.01, −198.94, and 160 for protocols B, C, D, and E, respectively, with differences between protocols C to E statistically significantly different (P < 0.05). The different protocols showed overall excellent correlation (concordance correlation coefficient, >0.9) between AAC scores.

Conclusions

Slice thickness and DFOV can impact AAC score measurement. A description of reconstruction parameters is important to allow comparisons across different cohorts.
Prognostic Values of the Timing of Antibiotic Administration and the Sepsis Bundle Component in Elderly Patients With Septic Shock: A Retrospective Study
Authors: Liang Chih-Yu , Yang Yong-Ye , Hung Chi-Chieh , Wang Tsung-Han , Hsu Yin-Chou
Published: September 2021

Introduction:

Elderly patients are more susceptible to sepsis and septic shock. Early administration of broad-spectrum antibiotics is a key element of the sepsis management of bundle. Our study aimed to investigate the association between the timing of antibiotics administration and the risk of adverse outcomes in elderly patients with septic shock, and to examine the prognostic value of other bundle elements.

Method:

This is a single-center, retrospective, case-control study including elderly patients (aged ≥ 65 years) diagnosed with septic shock in the emergency department between October 1, 2018, and December 31, 2019. Eligible patients were divided into early (within 1 h) and late (beyond 1 h) groups according to the time interval between septic shock recognition and initial antibiotic administration. The characteristics, sepsis-related severity scores, management strategy, and outcomes were recorded. A multivariate logistic regression model was used to identify the independent prognostic factors.

Results:

A total of 331 patients were included in the study. The overall 90-day mortality rate was 43.8% (145/331). There were no significant differences in baseline characteristics, sepsis-related severity scores, and management strategy between the two groups. There was no significant difference between the early and late groups in the rate of intensive care unit transfer (46.4% vs. 46.6%, P = 0.96), endotracheal intubation (28.3% vs. 27.5%, P = 0.87), renal replacement therapy (21.7% vs. 21.8%, P = 1.00), or 90-day mortality (44.2% vs. 43.5%, P = 0.90). Serum lactate level (hazard ratio [HR] = 1.15, P < 0.01) and source control (HR = 0.56, P = 0.03) were identified as independent factors associated with 90-day mortality.

Conclusion:

The timing of antibiotic administration was not associated with adverse outcomes in elderly patients with septic shock. Serum lactate level and source control implementation were independent prognostic factors in these patients.
Neuregulin-1β Alleviates Sepsis-Induced Skeletal Muscle Atrophy by Inhibiting Autophagy via AKT/mTOR Signaling Pathway in Rats
Authors: Yin Dandan , Lin Dawei , Xie Yunbin , Gong Aihua , Jiang Peng , Wu Jin
Published: September 2021

Background:

Several studies have shown that excessive protein degradation is a major cause of skeletal muscle atrophy induced by sepsis, and autophagy is the main pathway participating in protein degradation. However, the role of autophagy in sepsis is still controversial. Previously, we found that neuregulin-1β (NRG-1β) alleviated sepsis-induced diaphragm atrophy through the phosphatidylinositol-3 kinase signaling pathway. Akt/mechanistic target of rapamycin (mTOR) is a classic signaling pathway to regulate autophagy, which maintains intracellular homeostasis. This study aimed to investigate whether NRG-1β could alleviate sepsis-induced skeletal muscle atrophy by regulating autophagy.

Methods:

L6 rat myoblast cells were differentiated using 2% fetal bovine serum into myotubes, which were divided into four groups: Con group treated with normal serum; Sep group treated with septic serum to form a sepsis cell model; septic serum + NRG-1β (SN) group treated with septic serum for 24 h followed by injection with NRG-1β and incubation for another 48 h; and serum+NRG-1β+LY294002 group, in which the PI3K inhibitor LY294002 was added 30 min before NRG-1β, and other treatments were similar to those in SN group. Effects of NRG-1β were also evaluated in vivo using Sprague–Dawley (SD) rats, in which sepsis was induced by cecal ligation and puncture (CLP).

Results:

In L6 myotubes treated with septic serum, the expression of autophagy-related proteins UNC-51 like kinase 1, p-Beclin-1, and Beclin-1, and the ratio of LC3B II/I were highly increased, while protein p62 expression was decreased, indicating that autophagy was excessively activated. Moreover, NRG-1 expression was decreased, as detected by confocal immunofluorescence and western blotting. Upon exogenous addition of NRG-1β, autophagy was inhibited by the activation of Akt/mTOR signaling pathway, and cell viability was also increased. These effects disappeared in the presence of LY294002. In SD rats, sepsis was induced by CLP. NRG-1β was shown to inhibit autophagy in these rats via the Akt/mTOR pathway, leading to increased body weight of the septic SD rats and alleviation of atrophy of the tibialis anterior muscle.

Conclusion:

NRG-1β could alleviate sepsis-induced skeletal muscle atrophy by inhibiting autophagy via the AKT/mTOR signaling pathway.
Hydroxyl Ethyl Starch (HES) Preserves Intrarenal Microcirculatory Perfusion Shown by Contrast-Enhanced Ultrasound (Ceus), and Renal Function in a Severe Hemodilution Model in Pigs
Authors: Ergin Bülent , van Rooij Tom , Lima Alexandre , Ince Yasin , Specht Patricia A.C. , Mik Egbert G. , Kooiman Klazina , de Jong Nico , Ince Can
Published: September 2021

Acute normovolemic hemodilution (ANH) is associated with low oxygen carrying capacity of blood and purposed to cause renal injury in perioperative setting. It is best accomplished in a perioperative setting by a colloid such as hydroxyl ethyl starch (HES) due its capacity to fill the vascular compartment and maintain colloidal pressure. However, alterations of intra renal microvascular perfusion, flow and its effects on renal function and damage during ANH has not been sufficiently clarified. Based on the extensive use of HES in the perioperative setting we tested the hypothesis that the use of HES during ANH is able to perfuse the kidney microcirculation adequately without causing renal dysfunction and injury in pigs. Hemodilution (n = 8) was performed by stepwise replacing blood with HES to hematocrit (Hct) levels of 20% (T1), 15% (T2), and 10% (T3). Seven control animals were investigated. Systemic and renal hemodynamics were monitored. Renal microcirculatory perfusion was visualized and quantified using contrast-enhanced ultrasound (CEUS) and laser speckle imaging (LSI). In addition, sublingual microcirculation was measured by handheld vital microscopy (HVM). Intrarenal mean transit time of ultrasound contrast agent (IRMTT-CEUS) was reduced in the renal cortex at Hct 10% in comparison to control at T3 (1.4 ± 0.6 vs. 2.2 ± 0.7 seconds, respectively, P < 0.05). Although renal function was preserved, the serum neutrophil gelatinase-associated lipocalin (NGAL) levels was higher at Hct 10% (0.033 ± 0.004 pg/μg protein) in comparison to control at T3 (0.021 ± 0.002 pg/μg protein. A mild correlation between CO and IRMTT (renal RBC velocity) (r −0.53; P = 0.001) and CO and NGAL levels (r 0.66; P = 0.001) was also found. Our results show that HES induced ANH is associated with a preserved intra renal blood volume, perfusion, and function in the clinical range of Hct (<15%). However, at severely low Hct (10%) ANH was associated with renal injury as indicated by increased NGAL levels. Changes in renal microcirculatory flow (CEUS and LSI) followed those seen in the sublingual microcirculation measured with HVM.
A Decade Later—Progress and Next Steps for Pediatric Simulation Research
Authors: Mallory Leah A. , Doughty Cara B. , Davis Kasey I. , Cheng Adam , Calhoun Aaron W. , Auerbach Marc A. , Duff Jonathan P. , Kessler David O.
Published: September 2021

Summary Statement

A decade ago, at the time of formation of the International Network for Pediatric Simulation-based Innovation, Research, and Education, the group embarked on a consensus building exercise. The goal was to forecast the facilitators and barriers to growth and maturity of science in the field of pediatric simulation-based research. This exercise produced 6 domains critical to progress in the field: (1) prioritization, (2) research methodology and outcomes, (3) academic collaboration, (4) integration/implementation/sustainability, (5) technology, and (6) resources/support/advocacy. This article reflects on and summarizes a decade of progress in the field of pediatric simulation research and suggests next steps in each domain as we look forward, including lessons learned by our collaborative grass roots network that can be used to accelerate research efforts in other domains within healthcare simulation science.
Success of Concomitant Versus Interval Slings for Prevention and Treatment of Bothersome de Novo Stress Urinary Incontinence
Authors: Fitzgerald Jocelyn J. , Soriano Alex , Panza Joseph , Hoke Tanya P. , Desai Shweta P. , Artsen Amanda M. , Andiman Sarah E. , Antosh Danielle D. , Gutman Robert E.
Published: September 2021

Background

Despite large trials designed to guide management on whether to perform a prophylactic continence procedure at the time of pelvic organ prolapse (POP) repair, it remains unclear if a staged or interval approach confers advantages in treatment of bothersome stress urinary incontinence (SUI) in women without bothersome SUI before their POP repair.

Objective

The objective of this study was to compare success of concomitant versus interval slings for the prevention/treatment of de novo bothersome SUI after POP repair.

Study Design

This multicenter retrospective cohort with prospective follow-up enrolled women with minimal or no SUI symptoms who underwent minimally invasive apical surgery for stage 2 or higher POP between 2011 and 2018 and had a concomitant sling placed at the time of POP surgery or an interval sling placed. Prospectively, all patients were administered the Urogenital Distress Inventory Short-Form 6, the Patient Global Impression of Improvement, and questions on reoperation/retreatment and complications.

Results

A total of 120 patients had concomitant slings, and 60 had interval slings. There were no differences in the proportion of patients who had intrinsic sphincter deficiency (22% vs 20%), although the concomitant sling group was more likely to have a positive cough stress test result (30% vs 8%, P = 0.006). The interval sling group was more likely to report “yes” to SUI symptoms on Urogenital Distress Inventory Short-Form 6 (3% vs 30%, P = 0.0006) and during their postoperative visit (0% vs 24%, P < 0.0001). There were no differences in surgical complications.

Conclusions

Among women with minimal or no SUI symptoms undergoing prolapse repair, concomitant slings resulted in lower rates of bothersome SUI compared with similar women undergoing interval sling placement.
Effect of Enhanced Recovery Protocol on Opioid Use in Pelvic Organ Prolapse Surgery
Authors: Mehr Allen A. , Elmer-Lyon Caroline , Maetzold Erin , Bradley Catherine S. , Kowalski Joseph T.
Published: September 2021

Objectives

Our primary objective was to compare the total opioid use by patients undergoing apical pelvic organ prolapse surgery before and after implementation of an enhanced recovery protocol (ERP).

Methods

Participants of this ambispective cohort study included a “pre-ERP” retrospective cohort and an “ERP” cohort of patients prospectively enrolled after the full implementation of the ERP in January 2019. Demographic and clinical data were collected from the electronic record. Descriptive statistics were used for demographic variables. Total opioid use was calculated for each participant using morphine milligram equivalents (MMEs) and compared between cohorts using the Student t test.

Results

Study participants (n = 65) were similar between cohorts and had a mean (SD) age of 62.4 (9.7) years and body mass index of 28.9 (4.8), and had a median parity of 3 (interquartile range, 2–4). Comorbid conditions, assessed with the Charlson Comorbidity Index, were also similar, with a mean (SD) of 2 (2.9). Hysterectomy approach and apical procedures did not differ between groups. After ERP implementation, mean (SD) intraoperative and postoperative MMEs decreased significantly (59.4 [31.6] vs 36.9 [20.5], P < 0.01). Total MMEs prescribed at discharge also decreased (392.3 [88.4] vs 94.6 [61.3], P < 0.01). Total anesthesia time and surgical time were similar, whereas mean total admission time decreased (27.3 [10.8] vs 18 [8.6] hours, P < 0.01). Telephone calls within 30 days increased from mean 1 (1.0) to 2.2 (1.9) (P < 0.01), whereas clinic visits and 30-day readmissions did not differ.

Conclusions

Women undergoing apical pelvic organ prolapse surgery at an academic medical center received significantly fewer opioids after implementation of an ERP without a change in postoperative pain scores.
Value in acute care surgery, Part 1: Methods of quantifying cost
Authors: Martin R. Shayn , Lester Erica L.W. , Ross Samuel W. , Davis Kimberly A. , Tres Scherer L.R. , Minei Joseph P. , Staudenmayer Kristan L.
Published: September 2021

BACKGROUND

With health care expenditures continuing to increase rapidly, the need to understand and provide value has become more important than ever. In order to determine the value of care, the ability to accurately measure cost is essential. The acute care surgeon leader is an integral part of driving improvement by engaging in value increasing discussions. Different approaches to quantifying cost exist depending on the purpose of the analysis and available resources. Cost analysis methods range from detailed microcosting and time-driven activity-based costing to less complex gross and expenditure-based approaches. An overview of these methods and a practical approach to costing based on the needs of the acute care surgeon leader is presented.
Eastern Association for the Surgery of Trauma Multicenter Trial: Comparison of pre-injury antithrombotic use and reversal strategies among severe traumatic brain injury patients
Authors: Yorkgitis Brian K. , Tatum Danielle M. , Taghavi Sharven , Schroeppel Thomas J. , Noorbakhsh Matthew R. , Philps Frances Hite , Bugaev Nikolay , Mukherjee Kaushik , Bellora Mellody , Ong Adrian W. , Ratnasekera Asanthi , Nordham Kristen D. , Carrick Matthew M. , Haan James M. , Lightwine Kelly L. , Lottenberg Lawrence , Borrego Robert , Cullinane Daniel C. , Berne John D. , Rodriguez Mederos Dalier , Hayward Thomas Z. , Kerwin Andy J. , Crandall Marie
Published: September 2021

BACKGROUND

Trauma teams are often faced with patients on antithrombotic (AT) drugs, which is challenging when bleeding occurs. We sought to compare the effects of different AT medications on head injury severity and hypothesized that AT reversal would not improve mortality in severe traumatic brain injury (TBI) patients.

METHODS

An Eastern Association for the Surgery of Trauma–sponsored prospective, multicentered, observational study of 15 trauma centers was performed. Patient demographics, injury burden, comorbidities, AT agents, and reversal attempts were collected. Outcomes of interest were head injury severity and in-hospital mortality.

RESULTS

Analysis was performed on 2,793 patients. The majority of patients were on aspirin (acetylsalicylic acid [ASA], 46.1%). Patients on a platelet chemoreceptor blocker (P2Y12) had the highest mean Injury Severity Score (9.1 ± 8.1). Patients taking P2Y12 inhibitors ± ASA, and ASA-warfarin had the highest head Abbreviated Injury Scale (AIS) mean (1.2 ± 1.6). On risk-adjusted analysis, warfarin-ASA was associated with a higher head AIS (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.34–4.42) after controlling for Injury Severity Score, Charlson Comorbidity Index, initial Glasgow Coma Scale score, and initial systolic blood pressure. Among patients with severe TBI (head AIS score, ≥3) on antiplatelet therapy, reversal with desmopressin (DDAVP) and/or platelet transfusion did not improve survival (82.9% reversal vs. 90.4% none, p = 0.30). In severe TBI patients taking Xa inhibitors who received prothrombin complex concentrate, survival was not improved (84.6% reversal vs. 84.6% none, p = 0.68). With risk adjustment as described previously, mortality was not improved with reversal attempts (antiplatelet agents: OR 0.83; 85% CI, 0.12–5.9 [p = 0.85]; Xa inhibitors: OR, 0.76; 95% CI, 0.12–4.64; p = 0.77).

CONCLUSION

Reversal attempts appear to confer no mortality benefit in severe TBI patients on antiplatelet agents or Xa inhibitors. Combination therapy was associated with severity of head injury among patients taking preinjury AT therapy, with ASA-warfarin possessing the greatest risk.

LEVEL OF EVIDENCE

Prognostic, level II.
Chryseobacterium potabilaquae sp. nov., Chryseobacterium aquaeductus sp. nov. and Chryseobacterium fistulae sp. nov., from drinking water systems
Authors: Lucena Teresa , Ruvira María A. , Macián M. Carmen , Arahal David R. , Aznar Rosa , Pujalte María J.
Published: September 2021

A polyphasic taxonomic study was conducted on three strains isolated from drinking water systems that had previously been deposited as

Chryseobacterium

species at the Spanish Type Culture Collection in order to complete their classification. Strains CECT 9293T, CECT 9390T and CECT 9393T were isolated from sites in Barcelona, Spain, in the framework of a project aimed at generating the first MALDI-TOF database specific for bacteria present in water for human consumption. Their partial 16S rRNA sequences showed that their closest relatives among the type strains of

Chryseobacterium

exhibited 98 % similarity or less, supporting their taxonomic novelty. At the same time, comparison between them revealed that strains CECT 9293T and CECT 9393T could perhaps be related at the species level as they shared 99.5 % similarity. However, whole genome sequencing was performed and the subsequent calculation of relatedness indices, average nucleotide identity and estimated DNA–DNA hybridization, ruled out that possibility and confirmed instead that each of the strains should be considered a separate species in the genus

Chryseobacterium

. Having clarified their status, we also performed phylogenomic analyses and searched for possible environmental or non-type material sequences that could be related to any of them at the species level. In parallel, the strains were characterized phenotypically and compared to their closest relatives to determine diagnostic traits to support their formal proposal. The proposed species are Chryseobacterium potabilaquae sp. nov. with the type strain CECT 9293T (=LMG 32084T), Chryseobacterium aquaeductus sp. nov. with the type strain CECT 9390T (=LMG 32085T) and Chryseobacterium fistulae sp. nov. with the type strain CECT 9393T (=LMG 32086T).
Clostridium chrysemydis sp. nov., isolated from the faecal material of a painted turtle
Authors: Hunter Kathryn C. , Lawson Paul A. , Dowd Scot E. , McLaughlin R. W.
Published: September 2021

A strict anaerobic, Gram-stain-positive rod-shaped bacterium, designated PTT, was isolated from the faecal material of a painted turtle (Chrysemys picta). Based on a comparative 16S rRNA gene sequence analysis, the isolate was assigned to Clostridium sensu stricto with the highest sequence similarities to

Clostridium moniliforme

(97.4 %),

Clostridium sardiniense

(97.2 %) and the misclassified organism

Eubacterium multiforme

(97.1 %). The predominant cellular fatty acids of strain PTT were C14 : 0, C16 : 0 and an unidentified product with an equivalent chain length of 14.969. The G+C content determined from the genome was 28.8 mol%. The fermentation end products from glucose were acetate and butyrate with no alcohols detected and trace amounts of CO2 and H2 also detected; no respiratory quinones were detected. Based on biochemical, phylogenetic, genotypic and chemotaxonomic criteria, the isolate represents a novel species of the genus

Clostridium

for which the name Clostridium chrysemydis sp. nov. is proposed. The type strain is strain PTT (=CCUG 74180T=ATCC TSD-219T).
Spike-independent infection of human coronavirus 229E in bat cells
Authors: Mah Marcus G , Linster Martin , Low Dolyce HW , Yan Zhuang , Jayakumar Jayanthi , Samsudin Firdaus , Wong Foong Ying , Bond Peter J , Mendenhall Ian H , Su Yvonne CF , Smith Gavin JD
Published: September 2021

Bats are the reservoir for numerous human pathogens including coronaviruses. The factors leading to the emergence and sustained transmission of coronaviruses in humans are poorly understood. An outstanding question is how coronaviruses can accomplish a host switch with a likely mismatch between the surface protein spike of a bat virus and the human cellular receptor at the time of zoonotic virus transmission. To identify potential novel evolutionary pathways for zoonotic virus emergence, we serially passaged six human 229E isolates in a newly establishedRhinolophus lepidus(horseshoe bat) kidney cells and analyzed viral genetic changes. Here we observed extensive deletions within the spike and ORF4 genes of five 229E viruses after passaging in bat cells. As a result, spike protein expression and infectivity of human cells was lost in 5 of 6 viruses but the capability to infect bat cells was maintained. Only viruses that expressed the spike protein could be neutralized by 229E spike-specific antibodies in human cells, whereas there was no neutralizing effect on viruses that do not express the spike protein inoculated on bat cells. However, one isolate acquired an early stop codon abrogating spike expression but maintaining infection in bat cells. Upon passaging this isolate in human cells, spike expression was restored due to acquisition of nucleotide insertions amongst virus subpopulations. Spike-independent infection of coronaviruses provides an alternative mechanism for viral maintenance in bats that does not rely on the compatibility of viral surface proteins and cellular entry receptors.
COVID-19 L·OVE REPOSITORY IS HIGHLY COMPREHENSIVE AND CAN BE USED AS A SINGLE SOURCE FOR COVID-19 STUDIES
Authors: Verdugo-Paiva F , Vergara C , Ávila C , Castro J , Cid J , Contreras V , Jara I , Jiménez V , Lee MH , Muñoz M , Rojas Gómez AM , Rosón-Rodríguez P , Serrano-Arévalo K , Silva-Ruz I , Vásquez-Laval J , Zambrano-Achig P , Zavadzki G , Rada G
Published: September 2021

Objective

COVID-19 Living OVerview of Evidence (COVID-19 L·OVE) is a public repository and classification platform for COVID-19 articles. The repository contains over 430,000 articles as of 20 September 2021 and intends to provide a one-stop shop for COVID-19 evidence. Considering that systematic reviews conduct high-quality searches, this study assesses the comprehensiveness and currency of the repository against the total number of studies in a representative sample of COVID-19 systematic reviews.

Methods

Our sample was generated from all the studies included in the systematic reviews of COVID-19 published during April 2021. We estimated the comprehensiveness of COVID-19 L·OVE repository by determining how many of the individual studies in the sample were included in the COVID-19 L·OVE repository. We estimated the currency as the percentage of studies that were available in the COVID-19 L·OVE repository at the time the systematic reviews conducted their own search.

Results

We identified 83 eligible systematic reviews that included 2132 studies. COVID-19 L·OVE had an overall comprehensiveness of 99.67% (2125/2132). The overall currency of the repository, that is, the proportion of articles that would have been obtained if the search of the reviews was conducted in COVID-19 L·OVE instead of searching the original sources, was 96.48% (2057/2132). Both the comprehensiveness and the currency were 100% for randomised trials (82/82).

Conclusion

The COVID-19 L·OVE repository is highly comprehensive and current. Using this repository instead of traditional manual searches in multiple databases can save a great amount of work to people conducting systematic reviews and would improve the comprehensiveness and timeliness of evidence syntheses. This tool is particularly important for supporting living evidence synthesis processes