bluuebunny/crossref_metadata_2025 huggingface dataset:
Dermatofibrosarcoma Protuberans Recurrence After Wide Local Excision Versus Mohs Micrographic Surgery: A Systematic Review and Meta-Analysis
Authors: Martin Emma C. St. , Vyas Krishna S. , Batbold Sarah , Erwin Patricia J. , Brewer Jerry D.
Published: March 2022

BACKGROUND

Local recurrence (LR) rates of dermatofibrosarcoma protuberans (DFSP) treated with different surgical modalities are unknown.

OBJECTIVE

To evaluate the differences in LR rates of DFSP treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS).

MATERIALS AND METHODS

Pertinent studies of DFSP treated with either WLE or MMS were identified through a search of multiple databases, including Ovid MEDLINE (1946–2018), Embase (1988–2018), Web of Science (1975–2018), and Scopus (1970–2018). Comparative 2-arm and noncomparative single-arm studies were assessed through meta-analyses.

RESULTS

Of the 517 studies identified, 88 met inclusion criteria (12 comparative studies; 76 single-arm studies). In the 12 comparative studies, 352 patients with DFSP underwent MMS and 777 patients with DFSP underwent WLE. The LR rate was 1.7% after MMS and 3.7% after WLE (odds ratio, 1.549; 95% CI, 0.710–3.381; p = .27). In the 76 noncomparative studies, 980 patients underwent MMS (LR rate, 1.5%; 95% CI, 0.9%–2.1%; p < .001), and 2,215 patients underwent WLE (LR rate, 9.4%; 95% CI, 7.5%–11.3%; p < .001).

CONCLUSION

The LR rate of DFSP in patients treated with MMS is lower than in patients treated with WLE. Because of high rates of postoperative DFSP LR, MMS should be strongly considered when available.
Safety of Botulinum Toxin A Injections for Facial Rejuvenation: A Meta-Analysis of 9,669 Patients
Authors: Gostimir Mišo , Liou Victor , Yoon Michael K.
Published: March 2022

Purpose:

To quantitatively evaluate safety profile for botulinum toxin A (BTX-A) injections among patients undergoing treatment for cosmetic indications is produced, with special attention to clinically relevant covariates and their relative impact on safety.

Methods:

A systematic literature search was performed using PubMed (1996-January 2020) and Embase (1947-January 2020) to identify all randomized controlled trials (RCTs) that reported safety data for patients receiving BTX-A for cosmetic indications compared to placebo. A meta-analysis was performed to determine pooled risk ratios (RR) for treatment-related adverse events (TRAEs) and for specific adverse events. Meta-regression and additional analyses were performed for significant and/or clinically relevant covariates.

Results:

Following the review of 8,690 studies, 32 RCTs involving 9,669 patients were included. The pooled RR of any TRAE occurring after BTX-A injection compared to placebo injection was 1.53 (95% CI, 1.33–1.77; p < 0.001). Statistically significant covariates included individual injection volume and total injection volume. The type of BTX-A formulation, treatment site, total BTX-A units, and BTX-A units per injection were not significant. Specific adverse events more likely to occur following BTX-A injection rather than placebo injection included eyelid/eyebrow malposition (RR 3.55; p < 0.001), facial paresis (RR 2.42; p = 0.316), and headache (RR 1.45; p = 0.003). Injection site reactions and injection site bruising occurred at similar rates in both groups.

Conclusions:

The overall safety profile of BTX-A is acceptable and consistent with previous publications. The authors’ additional analyses provide a relative comparison of the impact of various treatment parameters on safety.
Recurrent Retrobulbar Hemorrhage Associated With CPAP Use After Orbital Fracture Repair
Authors: Ryu Christine , Geelan-Hansen Katie , Chundury Rao V.
Published: March 2022

We present a patient who underwent orbital fracture repair complicated by retrobulbar hemorrhages twice within the first postoperative week. The suspected cause is continuous positive airway pressure (CPAP) use with inappropriate patient-modified settings. The most likely mechanism of action was venous congestion from the extrinsic positive pressure, similar to Valsalva maneuvers increasing orbital vasculature pressure. In our patient, because his orbital blood vessels had recently been cauterized, they were too fragile to handle the engorgement and bled, leading to a retrobulbar hemorrhage. It is possible that at a lower CPAP setting, the vascular congestion would not have been as severe and caused bleeding. We recommend routinely asking patients about CPAP use before orbital surgeries and instructing patients to stop CPAP usage for 1 week after any orbital surgeries if medically cleared.
Blue Rubber Bleb Nevus Syndrome Manifesting as an Isolated Congenital Orbital Mass in a Neonate
Authors: Lee Irene T. , Nerad Jeffrey A. , Mawn Louise A.
Published: March 2022

A male neonate presented with an isolated congenital right orbital vascular malformation without other mucocutaneous lesions or signs/symptoms of systemic disease. The orbital mass was progressive, causing amblyogenic ptosis by 6 months of age. Over 11 years, the patient underwent 4 orbital mass resections, 3 embolizations, and even a craniotomy with mass resection for an intraorbital meningoencephalocele secondary to orbital bony erosion. A diagnosis of blue rubber bleb nevus syndrome was made at age 7 when the patient developed a tender vascular lesion on his foot and was found to have other mucocutaneous lesions of the extremities and gastrointestinal tract. This is the first pediatric case of such an aggressive orbital vascular malformation from blue rubber bleb nevus syndrome causing neonatal amblyogenic ptosis and intraorbital meningoencephalocele in childhood. It is the second report of a patient presenting with an isolated orbital vascular malformation without other manifestations of blue rubber bleb nevus syndrome, leading to his delayed diagnosis.
Dorsal horn volume loss and pain pathway changes in Cavalier King Charles Spaniels with syringomyelia, signs of pain, and phantom scratching
Authors: Mortensen Danny , Thoefner Maria Soendergaard , Agerholm Joergen Steen , Slumstrup Lasse , Jensen Troels Staehelin , Bjerrum Ole Jannik , Berendt Mette , Nyengaard Jens Randel
Published: March 2022

Central neuropathic pain is a core clinical sign of syringomyelia in humans and Cavalier King Charles Spaniel (CKCS) dogs. This histopathological study used spinal cords from CKCS dogs with syringomyelia to investigate the following conditions: (1) whether specific structural cervical spinal cord entities involved in nociception were affected by loss of neuroparenchyma or other pathological changes in CKCS dogs with pain-related behaviour and phantom scratching, (2) whether pain-related behaviour or phantom scratching correlated with loss of a specific anatomical entity or upregulation of glia cells, and (3) whether syringomyelia-related lesions affected specific functional spinal cord units of nociception. Spinal cord segments C1-C8 from CKCS dogs with magnetic resonance imaging–confirmed syringomyelia and clinical signs of pain and phantom scratching (n = 8) were compared with those from CKCS dogs without syringomyelia (n = 4). Dogs with unilateral scratching (n = 7) had a volume loss (P = 0.043) of the dorsal horn laminae I-III in the ipsilateral side compared with the contralateral dorsal horn. A clear pattern of ipsilateral changes in the dorsal root entry zone characterised by deafferentation and reorganization of first-order axons into deeper laminae was found in cases with lateralised scratching. Significant changes in cell number density were not found for astrocytes or microglia, suggesting that the dogs represented cases of end-stage syringomyelia and thus could not reveal astrogliosis and microgliosis, which may be involved in the early phases of syrinx development and phantom scratching. The present relationship between clinical findings and dorsal horn and pain pathway pathology in CKCS dogs suggests that these dogs may be of interest as a supplement to experimental model pain research.
Systematic review and meta-analysis of studies in which burrowing behaviour was assessed in rodent models of disease-associated persistent pain
Authors: Zhang Xue Ying , Barakat Ahmed , Diaz-delCastillo Marta , Vollert Jan , Sena Emily S. , Heegaard Anne-Marie , Rice Andrew S.C. , Soliman Nadia
Published: March 2022

Burrowing behaviour is used to assess pain-associated behaviour in laboratory rodents. To gain insight into how models of disease-associated persistent pain and analgesics affect burrowing behaviour, we performed a systematic review and meta-analysis of studies that assessed burrowing behaviour. A systematic search in March 2020 and update in September 2020 was conducted in 4 databases. Study design characteristics and experimental data were extracted, followed by a random-effects meta-analysis. We explored the association between burrowing and monofilament-induced limb withdrawal. Dose response relationship was investigated for some analgesics. Forty-five studies were included in the meta-analysis, in which 16 model types and 14 drug classes were used. Most experiments used rat (79%) and male (72%) animals. Somatic inflammation and trauma-induced neuropathy models were associated with reduced burrowing behaviour. Analgesics (nonsteroidal anti-inflammatory drug and gabapentinoids) attenuated burrowing deficits in these models. Reporting of measures to reduce risk of bias was unclear except for randomisation which was high. There was not a correlation (R
2 = 0.1421) between burrowing and monofilament-induced limb withdrawal. Opioids, gabapentin, and naproxen showed reduced burrowing behaviour at high doses, whereas ibuprofen and celecoxib showed opposite trend. The findings indicate that burrowing could be used to assess pain-associated behaviour. We support the use of a portfolio of composite measures including spontaneous and stimulus-evoked tests. The information collected here could help in designing experiments involving burrowing assessment in models of disease-associated pain.
Resistance training protects against muscle pain through activation of androgen receptors in male and female mice
Authors: Lesnak Joseph B. , Fahrion Alexis , Helton Amber , Rasmussen Lynn , Andrew Megan , Cunard Stefanie , Huey Michaela , Kreber Austin , Landon Joseph , Siwiec Travis , Todd Kenan , Frey-Law Laura A. , Sluka Kathleen A.
Published: March 2022

Resistance training–based exercise is commonly prescribed in the clinic for the treatment of chronic pain. Mechanisms of aerobic exercise for analgesia are frequently studied, while little is known regarding resistance training mechanisms. We developed a resistance training model in mice and hypothesized resistance training would protect against development of muscle pain, mediated through the activation of androgen receptors. Activity-induced muscle hyperalgesia was produced by 2 injections of pH 5.0 stimuli with fatiguing muscle contractions. Resistance training was performed by having mice climb a ladder with attached weights, 3 times per week. Resistance training acutely increased blood lactate and prolonged training increased strength measured via forepaw grip strength and 1 repetition maximum, validating the exercise program as a resistance training model. Eight weeks of resistance training prior to induction of the pain model blocked the development of muscle hyperalgesia in both sexes. Resistance training initiated after induction of the pain model reversed muscle hyperalgesia in male mice only. A single resistance training bout acutely increased testosterone in male but not female mice. Administration of the androgen receptor antagonist flutamide (200 mg pellets) throughout the 8-week training program blocked the exercise-induced protection against muscle pain in both sexes. However, single administration of flutamide (1, 3, 10 mg/kg) in resistance-trained animals had no effect on existing exercise-induced protection against muscle pain. Therefore, resistance training acutely increases lactate and testosterone and strength overtime. Eight weeks of resistance training prevents the development of hyperalgesia through the activation of androgen receptors in an animal model of muscle pain.
Initial Specimen Diversion Device Utilization Mitigates Blood Culture Contamination Across Regional Community Hospital and Acute Care Facility
Authors: Povroznik Mark D.
Published: March 2022

A West Virginia regional community hospital incorporated an initial specimen diversion device (ISDD) into conventional blood culture protocol with the objective to bring the hospital-wide blood culture contamination (BCC) rate from a 3.06% preintervention rate to a target performance level below 1%. Emergency department staff, laboratory phlebotomists, and nursing staff on acute-critical care floors were trained on ISDD (Steripath Gen2, Magnolia Medical Technologies, Inc., Seattle, WA) operating procedure and utilized the device for blood culture sample collection with adult patients from September 2020 through April 2021. Of 5642 blood culture sets collected hospital-wide, 4631 were collected with the ISDD, whereas the remaining sets were collected via the conventional method. The ISDD BCC rate of 0.78% differed from the conventional method BCC rate of 4.06% observed during the intervention period (chi-squared test P < 0.00001). The ISDD group attained a sub-1% BCC rate to satisfy the intervention objective.
Practice scholarship satisfaction and impact as perceived by DNP-prepared nurses
Authors: Kesten Karen , Moran Katherine , Beebe Sarah L. , Conrad Dianne , Burson Rosanne , Corrigan Catherine , Manderscheid Amy , Pohl Elizabeth
Published: March 2022

Background:

Today's health systems are complex and are challenged to strive for high-quality care that leads to optimal health outcomes. Doctor of Nursing Practice (DNP)-prepared nurses have the necessary competencies to influence health systems and delivery, that lead to safe and effective practice, by implementing practice scholarship, the translation of science to transform health care delivery, and clinical inquiry to improve practice.

Purpose:

The purpose of this study was to determine DNP-prepared nurses' satisfaction with their frequency of engagement in practice scholarship, and the relationship between the satisfaction and perceived impact of practice scholarship.

Methods:

In this cross-sectional study, DNP-prepared nurses (n = 309) were recruited from a U.S. national membership organization and were asked to complete an online survey.

Results:

Usable data findings (n = 269) revealed that 81% of participants reported feeling very, or moderately, satisfied with time spent engaging in practice scholarship or clinical inquiry in the areas of quality improvement, translation of research, and evidence-based practice; however, 19% expressed minimal satisfaction or dissatisfaction. There was a significant, moderate positive correlation between impact and satisfaction with time spent engaging in practice scholarship.

Conclusions:

Unclear roles and the lack of objective data measurement of practice scholarship are hindering the ability of DNP-prepared nurses to work to the full extent of their education and scope of practice.

Implications:

Further studies to develop processes and tools to measure the value and impact of DNP-prepared nurses on quality and safety, health care policies, systems, and population health are recommended.
Measuring the impact of a COVID-19 continuing education program
Authors: Roberts Eve N. , Smithing Robert T. , Tucker Paula
Published: March 2022

The COVID-19 pandemic has led to a rapidly shifting health care environment, with frequent changes to best practices, which can lead to knowledge and practice gaps among health care providers, including nurse practitioners (NPs). The purpose of this paper was to describe a continuing education (CE) program developed to address COVID-19 knowledge gaps and to report on the changes in knowledge, competence, and confidence following program completion. The CE program was a 2.5 to 2.67 contact hour webinar delivered in July 2020, October 2020, and February 2021. Content included COVID-19 prevention, diagnosis, and management and was updated before the second and third webinars. Changes in content and webinar audience participation in the question and answer portion were reflected in the CE credit awarded. Preactivity and postactivity knowledge, competence, and confidence levels were assessed among activity completers. Changes between the preactivity and postactivity evaluation were compared. A total of 2,901 learners were included in the analysis, of whom 91.6% were NPs. Overall, baseline knowledge of COVID-19 transmission, diagnosis, and treatment was low. Substantial improvements in knowledge, competence, and confidence were reported from baseline to postactivity evaluation, with increases of 47–73% overall. Furthermore, learner confidence in identifying patients at risk for severe COVID-19 and counseling patients on prevention and transmission significantly increased. Despite plans to implement strategies to improve COVID-19 management, several barriers to uptake were identified. The rapid development of a COVID-19 CE program resulted in substantial gains in NP knowledge related to prevention, diagnosis, and management, with possible implications for nearly 68,000 patient encounters per month.
Nonalcoholic fatty liver disease: opinions, population served, and management from a sample of French hepato(gastroentero)logists (PERSEPT study)
Authors: Pariente Alexandre , Rosa Isabelle , Dharancy Sébastien , Hanslik Bertrand ,   for the Investigators of PERSEPT Study
Published: March 2022

Objective

The three-fold objective of this study was to describe the opinions, the population served, and tools used for the management of nonalcoholic fatty liver disease (NAFLD) by French hepato(gastro)enterologists (HGEs).

Methods

Seventy-five French HGEs working in hospitals or in private practice, who regularly managed patients with NAFLD, completed three questionnaires: one about their opinions about disease management, one on the 10 first patients with NAFLD they saw in February 2020, and the third about the first five patients meeting the 2016 European Association for the Study of the Liver criteria for specialist referral.

Results

Management of NAFLD was seen as challenging, complex, time-consuming, and frustrating. Available treatments were considered to be unsatisfactory by most participants. In the whole population studied (671 patients), 41% were obese, 50% overweight, 49% had type 2 diabetes, 61% dyslipidemia, 51% arterial hypertension, 57% nonalcoholic steato-hepatitis (NASH), 37% advanced fibrosis, and 19% cirrhosis. In the subgroup of 313 patients needing specialist referral, the use of liver biopsy was low (30%) and decreasing, whereas vibration-controlled transient elastometry was high (66%) and increasing; blood fibrosis tests were rarely used. NASH was usually diagnosed without liver biopsy. Nutritional counseling was provided to 3/4 patients, physical activity counseling in 1/5. A personalized therapeutic project was defined in less than one-third of patients. Ursodeoxycholic acid and vitamin E were used in a minority of patients.

Conclusion

The management of NAFLD is not considered satisfactory by French HGE who care for a relatively severe population. Noninvasive assessment of fibrosis and multidisciplinary management should be improved.
Predictor of primary response to antitumor necrosis factor-α therapy for inflammatory bowel disease: a single-center observational study
Authors: Yoshida Atsushi , Kimura Koji , Morizane Toshio , Ueno Fumiaki
Published: March 2022

Background

It is necessary to find reliable and appropriate predictors of primary response to anti-TNFα therapy (infliximab and adalimumab) in inflammatory bowel disease (IBD) so as to avoid treatment failure and select optimal treatment. The aim of this study is to reveal useful predictors of the response to anti-TNFα treatment from baseline to 2 months after initial administration of anti-TNFα for individual IBD patients using our pharmacokinetic and pharmacodynamic (PK/PD) model at the time of second administration.

Methods

We retrospectively analyzed 26 IBD patients who received anti-TNFα. In the PK/PD model, inflammation was assumed to be suppressed based on the action of anti-TNFα at the rate constant of K
anti-TNFα (day−1). K
anti-TNFα
0 (day−1) is K
anti-TNFα in the absence of anti-TNFα. We expressed inflammation caused by factors not affected by the action of anti-TNFα using the rate constant K
else (day−1). Using univariate and multivariate linear regressions, we statistically analyzed factors related to the improvement of disease activity index.

Results

The significant correlation between K
anti-TNFα
0/K
else and the improvement of disease activity index was shown in Crohn’s disease patients (univariate: estimated value 2.4; P = 0.003; and multivariate: 1.8; P = 0.012) and ulcerative colitis patients (univariate: 0.12; P = 0.011), and no other factors were significant.

Conclusion

This is the first study to present a useful predictor of primary response to anti-TNFα of individual IBD patients at second administration. The K
anti-TNFα
0/K
else ratio may help to select the optimal therapeutic drug and avoid the improper continuous administration of anti-TNFα in the induction phase.
Relationship with the Father of the Baby and Pregnancy-Related Anxiety among Pregnant Black Women
Authors: Hyer Suzanne , Hu Wenfang , Hu Mengtong , Davis Jean W. , Xie Rui , Giurgescu Carmen
Published: March 2022

Purpose:

Pregnancy-related anxiety may increase the risk of preterm birth. Effective coping strategies and social support may help minimize pregnancy-related anxiety.

Study Design:

Secondary analysis of cross-sectional data.

Methods:

A sample of 408 pregnant non-Hispanic Black women completed questionnaires between 19 and 31 weeks gestation. Mediation analysis with structural equation modeling was used to explore effects of the relationship with the father of the baby on pregnancy-related anxiety.

Results:

Support from the father of the baby was negatively associated with avoidance coping (r = -.22, p < .001) and pregnancy-related anxiety (r = - .17, p < .001), whereas conflict with the father of the baby was positively associated with avoidance coping (r = .37, p < .001) and pregnancy-related anxiety (r = .29, p < .001). Avoidance coping was positively associated with pregnancy-related anxiety (r = .34, p < .001). After adjustment, avoidance coping partially mediated the effect of conflict with the father of the baby on pregnancy-related anxiety.

Clinical Implications:

Discussions with women about management of pregnancy-related anxiety should consider her current social support and coping mechanisms. Providers should offer support and resources on adaptive coping strategies.
Supraventricular Tachycardia in Infants With Congenital Diaphragmatic Hernia: Prevalence, Associations, and Outcomes
Authors: Tella Joseph B. , Dao Duy T. , Alexander Mark E. , Geva Alon , Vitali Sally H. , Zalieckas Jill M. , Mehta Nilesh M. , McManus Michael L. , Buchmiller Terry L. , Mullen Mary P.
Published: March 2022

OBJECTIVES:

To characterize the prevalence, associations, management, and outcomes of supraventricular tachycardia (SVT) in neonates with congenital diaphragmatic hernia (CDH).

DESIGN:

Retrospective chart and cardiology code review within a cohort of patients with CDH was used to define a subpopulation with atrial arrhythmia. SVT mechanisms were confirmed by electrocardiogram analysis. Cox proportional hazard regression identified risk factors for SVT and association with clinical outcomes.

SETTING:

Medical Surgical ICU in a single, tertiary center, Boston Children’s Hospital.

PATIENTS:

Eligible patients included neonates presenting with classic Bochdalek posterolateral CDH between 2005 and 2017, excluding newborns with Morgagni hernia or late diagnoses of CDH (>28 d).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

SVT arose in 25 of 232 neonates with CDH, (11%); 14 of 25 infants (56%) had recurrent SVT; atrioventricular node-dependent tachycardia was the most frequent mechanism (32%). The majority (71%) of SVT episodes received intervention. Nine patients (36%) received preventative antiarrhythmic medications. SVT was associated with lower Apgar score at 1 min, structural heart disease, larger defect size, extracorporeal membrane oxygenation (ECMO) support, and prostaglandin therapy for ductal patency as well as hospital stay greater than or equal to 8 weeks and use of supplemental oxygen at discharge.

CONCLUSIONS:

SVT can occur in neonates with CDH and frequently requires treatment. Odds of occurrence are increased with greater CDH disease severity, ECMO, and prostaglandin use. In unadjusted logistic regression analysis, SVT was associated with adverse hospital outcomes, underscoring the importance of recognition and management in this vulnerable population.
The Cost of a Learner in the Pediatric Emergency Department
Authors: Corey Patrick , Jadhav Nagesh , Grams Keith , Sigal Adam , Babineau Ryan , Alweis Richard
Published: March 2022

Objectives

Experimental learning is a foundation of medical education, but a learner in the pediatric emergency department impacts utilization, time and disposition metrics. Our study sought to compare the effect of a resident learner on metrics between 2 pediatric emergency departments.

Methods

This retrospective study was conducted in 2019 in 2 pediatric emergency departments of tertiary care hospitals. We compared various time, utilization, and disposition metrics between resident-covered and nonresident-covered patients.

Results

A total of 62,548 patient encounters were included in our analysis, with 8102 (13%) encounters were resident-managed. Residents were consistently found to see higher-acuity patients, which led to increased relative value unit generation. Residents used more diagnostic testing consistently across both sites. However, we found significant differences between time and disposition metrics between the 2 sites.

Conclusions

Residents see sicker patients and tend to order more ancillary tests, which ultimately leads to increased relative value unit generation. We hypothesize that the difference in metrics seen could be explained by the training background of residents, as well as efficiencies of the department as a whole.
A Standardized Diagnostic Pathway for Suspected Appendicitis in Children Reduces Unnecessary Imaging
Authors: D’Cruz Roshan J. , Linden Allison F. , Devin Courtney L. , Savage Jillian , Zomorrodi Arezoo , Reichard Kirk W. , Choudhary Arabinda , Berman Loren
Published: March 2022

Introduction:

Ultrasound (US) for the diagnosis of acute appendicitis is often nondiagnostic, and additional imaging is required. A standardized approach may reduce unnecessary imaging.

Methods:

We retrospectively analyzed all patients who had imaging for appendicitis in our emergency department in 2017 and evaluated patient characteristics associated with nondiagnostic US. Using these results, we developed a pediatric appendicitis score (PAS)-based imaging pathway and compared imaging trends prepathway and postpathway implementation.

Results:

A total of 971 patients received imaging for suspected appendicitis prepathway in 2017. Female sex, obesity, and low/intermediate PAS were significantly associated with nondiagnostic US, but not magnetic resonance imaging (MRI) (P < 0.0001). Nearly one-third of patients received multiple imaging studies (US followed by MRI/computed tomography). As low/intermediate PAS was most strongly associated with a nondiagnostic US on multivariate analysis, we developed a PAS-based imaging stewardship pathway to eliminate imaging in low-PAS patients and reduce the number of patients with an intermediate PAS who received multiple imaging studies by obtaining an MRI as the first-line study. After implementation, only 22 low-PAS patients received imaging (compared with 238 preimplementation), and the proportion of intermediate-PAS patients receiving multiple imaging studies decreased from 31.4% to 13% (P < 0.0001). The cost of imaging per 100 patients increased from $24,255 to $31,082.

Conclusion:

A PAS-based imaging stewardship pathway reduces unnecessary imaging for suspected appendicitis.
Factors Influencing Health Equity of Influenza Vaccination in Pediatric Patients
Authors: Donnelly Lane F. , Wood Matthew , Chantra Jean , Loh Ling , Burkart Brendan , Lee Grace M.
Published: March 2022

Introduction:

Social factors can be a determinate for multiple health outcomes. We evaluated the association of numerous social factors on rates of influenza nonvaccination in a large pediatric primary and subspecialty care system.

Methods:

During the 2019–2020 influenza vaccination season, we calculated the nonvaccination rate for a pediatric healthcare system with both subspecialty and primary care practices. We compared influenza vaccination rates for factors that might affect health equity (patient gender, language preference, health insurance payer category, race and ethnicity, and estimated median household income based on zip code analysis) by creating simultaneous 95% confidence intervals using the Wilson method with continuity correction and a Bonferroni adjustment for the number of categories compared.

Results:

The overall influenza nonvaccination rate was 58.0% (59,375 not vaccinated of 102,377). Statistically significant differences in nonvaccination rate were present for the following health equity indicators: Spanish (75.6%) and Chinese Dialects (78.0%) > English (55.9%) speaking; Hispanic (70.1%) > many other race and ethnicities; Asian (51%) < many other race and ethnicities; Commercial (53.5%) < Public (71.2%) or Self (81.4%) pay; and lower (67.6%–79.1%) > higher median household income (52.9%–56.4%).

Conclusions:

Non-English language preference, Hispanic ethnicity, public insurance, and lower median household income are associated with a decreased likelihood of influenza vaccination. We are using these data to inform our key drivers to improve influenza vaccination in our system.
Improving Primary Care Adolescent Depression Screening and Initial Management: A Quality Improvement Study
Authors: Beck Kristen E. , Snyder Dane , Toth Christina , Hostutler Cody A. , Tinto Jennifer , Letostak Tiasha Barik , Chandawarkar Aarti , Kemper Alex R.
Published: March 2022

Introduction:

Although recommended, adolescent depression screening with appropriate initial management is challenging. This project aimed to improve adolescent depression screening rates during preventive care visits in 12 primary care clinics from 65.4% to 80%, increase the proportion of documented initial management for those with a positive screen from 69.5% to 85%, then sustain improvements for 12 months.

Methods:

This quality improvement project involved 12 urban primary care clinics serving >120,000 mostly Medicaid-enrolled patients and targeted adolescents 12–17 years. Interventions included standardized depression screening using tablets with electronic health record (EHR) capture and automated scoring, embedding screening results and initial management actions into the EHR, provider education, and individual clinician and clinic performance feedback.

Results:

After standardizing the approach to screening, the process mean depression screening rate was 91.9%. However, after adopting tablets into the clinic flow, there was an unexpected initial decrease in proportion with appropriately documented initial management plans, from 89.7% to 67.6%. In response to this special cause variation, there was additional provider feedback and education, and a redesign of the EHR flow related to the presentation of results and prompts for action after a positive screen. As a result, the proportion with appropriately documented initial management was 87.3% by project completion.

Conclusions:

Tablet-based screening with EHR scoring capture effectively increased depression screening rates but required significant additional work to improve initial management after a positive screen. A full system approach, including EHR modification, clinician education, and performance feedback, is needed to make meaningful, sustained improvements in comprehensive adolescent depression screening.
177Lu-DOTATATE PRRT for Multiple Unusual Metastatic Sites in Neuroendocrine Tumor
Authors: Parghane Rahul V. , Basu Sandip
Published: March 2022

Thyroid gland and orbit are rare sites of metastases in neuroendocrine tumors. We present an extremely rare case of rectal neuroendocrine tumor with metastases to thyroid gland and intra-orbital regions that demonstrated significant reduction in size and uptake of the lesions on somatostatin receptor based 68Ga-DOTATATE PET/CT, following 177Lu-DOTATATE peptide receptor radionuclide therapy. The case illustrates the efficacy of 177Lu-DOTATATE peptide receptor radionuclide therapy for tumor cytoreduction, which can be considered as a promising treatment modality for somatostatin receptor expressing and tracer-avid metastatic lesions at multiple rare locations.
Delayed Nephrotoxicity After 225Ac-PSMA-617 Radioligand Therapy
Authors: Satapathy Swayamjeet , Sharma Amit , Sood Ashwani , Maheshwari Pooja , Gill Harinder Jit Singh
Published: March 2022

177Lu-PSMA-617 radioligand therapy (RLT) has evolved as a suitable alternative to existing therapeutic options in patients with metastatic castration-resistant prostate cancer. With the emergence of α-emitters such as 225Ac, the efficacy of PSMA-RLT has further improved. Xerostomia and myelosuppression are common early treatment-emergent adverse events in patients receiving this therapy; however, data on long-term toxicity are relatively scarce. In this report, we describe a 76-year-old man with metastatic castration-resistant prostate cancer, who after having an initial excellent response to 2 cycles of 225Ac-PSMA-617 RLT, developed delayed nephrotoxicity in the form of tubulointerstitial nephritis.
Adult Tiger Man
Authors: Aksu Ayşegül , Şin Cihan , Yilmaz Burçak
Published: March 2022

The scan demonstrated multiple linear and patchy hypermetabolic lesions in skeletal muscles, mimicking the coat of a tiger, and was referred to as “a tiger man” sign. A 38-year-old man was admitted to our hospital with weakness, shortness of breath, and muscle pain. A CT scan showed a mass in the anterior mediastinum. 18F-FDG PET/CT was performed to evaluate the mass with a preliminary diagnosis of thymoma; heterogeneous 18F-FDG uptake in the mediastinal mass and tiger man findings in skeletal muscles were observed in PET/CT images.
Imaging Characteristics of Coexisting Metastatic Papillary Thyroid Cancer and Prostate Cancer on 18F-Fluciclovine and 68Ga-PSMA-11 PET/CT
Authors: Lu Yang
Published: March 2022

A 76-year-old man with biopsy-proven metastatic papillary thyroid cancer in a mediastinal nodule status post total thyroidectomy is on surveillance. The patient also had prostate cancer and received prostatectomy and androgen deprivation treatment. An 18F-fluciclovine PET revealed avid lesions in the mediastinal nodule and a sclerotic focus at L5 with concurrent prostate-specific antigen level of 0.4 ng/mL. The L5 lesion was later biopsied and confirmed as metastasis from prostate cancer. A 68Ga-PSMA-11 PET 2 months later showed avid radiotracer uptake within L5 metastasis but not the mediastinal nodule. The patient received radiation therapy to the L5 lesion and responded well.
Liver Ultrasound Attenuation
Authors: Gatos Ilias , Drazinos Petros , Yarmenitis Spyros , Theotokas Ioannis , Koskinas John , Koullias Emmanouil , Mitranou Asimina , Manesis Emmanuel , Zoumpoulis Pavlos S.
Published: March 2022

Objectives

Nonalcoholic fatty liver disease (NAFLD) is the most widespread chronic liver disease type in the Western countries. Ultrasound (US) is used for NAFLD and hepatic steatosis (HS) grading. The most popular US method for NAFLD assessment is the hepatorenal index (HRI), but because of its limitations, other noninvasive methods have been developed. The Resona 7 US system has recently incorporated an US attenuation–related quantitative feature, liver ultrasound attenuation (LiSA), for HS estimation. The purpose of this study is to compare LiSA’s and HRI’s performance on NAFLD assessment.

Methods

A total of 159 NAFLD patients having a magnetic resonance imaging–proton density fat fraction (MRI-PDFF) examination were examined by 2 radiologists, who performed LiSA and HRI measurements in the liver. Correlation of LiSA's and HRI's measurements with MRI-PDFF values was calculated through Pearson correlation coefficient (PCC). To further investigate the performance of LiSA and HRI, optimum cutoffs, provided by the literature, were used to correspond HS grades to MRI-PDFF results. Moreover, a receiver operating characteristic (ROC) analysis on LiSA measurements and steatosis grades was performed.

Results

Magnetic resonance imaging–PDFF was better correlated with LiSA (PCC = 0.80) than HRI (PCC = 0.67). Receiver operating characteristic analysis showed better performance range for LiSA (77.8%–91.8%) than for HRI (72.8%–85.4%) on all HS grades for all studies used for corresponding MRI-PDFF values to HS grades.

Conclusions

The results indicate that LiSA is more accurate than HRI in HS differentiation and can lead to more accurate grading of HS on NAFLD patients.
Identification of rare mutations of the vasoactive intestinal peptide receptor 2 gene in schizophrenia
Authors: Chen Chia-Hsiang , Cheng Min-Chih , Hu Tsung-Ming , Ping Lieh-Yung , Kushima Itaru , Aleksic Branko
Published: March 2022

Objective

Studies showed that rare copy number variations (CNVs) encompassing the vasoactive intestinal peptide receptor 2 gene (VIPR2) were associated with schizophrenia, indicating VIPR2 is a risk gene for schizophrenia. We hypothesized that besides CNV, rare pathogenic single-nucleotide variant (SNV) or small insertion/deletion (Indel) of VIPR2 might be present in some patients and contribute to the pathogenesis of schizophrenia.

Methods

We performed genome-wide CNV analysis to screen CNV at the VIPR2 locus and targeted sequencing of all the exons of VIPR2 to search for SNV and indel in a sample of patients with chronic schizophrenia from Taiwan.

Results

We detected a 230-kb microduplication encompassing the VIPR2 in 1 out of 200 patients. Furthermore, we identified six ultrarare SNVs, including one splicing SNV and five missense SNVs, in 516 patients. In-silico analyses showed these SNVs had a damaging effect on the function of VIPR2.

Conclusion

Our findings support the idea that besides CNV, rare pathogenic SNVs of VIPR2 might contribute to the pathogenesis of schizophrenia in some patients.
Social environment influences termination of nomadic migration
Authors: Robart Ashley R. , Zuñiga Hilary X. , Navarro Guillermo , Watts Heather E.
Published: March 2022

The final stage of migration, when animals terminate migratory movements and transition to a more sedentary state, remains the least understood phase of migration. Whereas migrants that return to the same locations each year may use mechanisms associated with locating a specific destination, migrants with low site fidelity, such as nomadic migrants, may rely on local environmental cues to determine when to cease migratory movements. Using an experiment with captive birds, we tested whether the presence of a conspecific influences the termination of migration, indicated by changes in behaviour and physiology, in a nomadic migrant (the pine siskin,
Spinus pinus
). We paired migratory birds with a non-migratory individual or left migratory and non-migratory individuals unpaired. Migratory paired birds had a significant decline in nocturnal activity immediately after pairing and activity levels remained lower two weeks later, with significant declines in energetic reserves and flight muscle size also observed. By contrast, migratory unpaired birds maintained high levels of activity and energetic reserves. These results provide evidence for a role of the social environment in migratory termination decisions. Social cues may be particularly useful in nomadic migrants, such as pine siskins, to facilitate settling in high quality, but unfamiliar, habitats.
A predictive multiscale model of in-stent restenosis in femoral arteries: linking haemodynamics and gene expression with an agent-based model of cellular dynamics
Authors: Corti Anna , Colombo Monika , Rozowsky Jared M. , Casarin Stefano , He Yong , Carbonaro Dario , Migliavacca Francesco , Rodriguez Matas Jose F. , Berceli Scott A. , Chiastra Claudio
Published: March 2022

In-stent restenosis (ISR) is a maladaptive inflammatory-driven response of femoral arteries to percutaneous transluminal angioplasty and stent deployment, leading to lumen re-narrowing as consequence of excessive cellular proliferative and synthetic activities. A thorough understanding of the underlying mechanobiological factors contributing to ISR is still lacking. Computational multiscale models integrating both continuous- and agent-based approaches have been identified as promising tools to capture key aspects of the complex network of events encompassing molecular, cellular and tissue response to the intervention. In this regard, this work presents a multiscale framework integrating the effects of local haemodynamics and monocyte gene expression data on cellular dynamics to simulate ISR mechanobiological processes in a patient-specific model of stented superficial femoral artery. The framework is based on the coupling of computational fluid dynamics simulations (haemodynamics module) with an agent-based model (ABM) of cellular activities (tissue remodelling module). Sensitivity analysis and surrogate modelling combined with genetic algorithm optimization were adopted to explore the model behaviour and calibrate the ABM parameters. The proposed framework successfully described the patient lumen area reduction from baseline to one-month follow-up, demonstrating the potential capabilities of this approach in predicting the short-term arterial response to the endovascular procedure.
Time-dependent investigation of a mechanochemical synthesis of bismuth telluride-based materials and their structural and thermoelectric properties
Authors: Groeneveld Dennis , Koenig Jan D. , Poschmann Michael , Groß Hendrik , Bensch Wolfgang , Kienle Lorenz , Wöllenstein Jürgen
Published: March 2022

Here, we report on the time dependence of a synthesis procedure for generation of both n- and p-type bismuth telluride-based materials. To initiate the reaction, the starting materials were first mechanical pre-reacted. The Rietveld refinements of X-ray diffraction (XRD) data collected after different milling times demonstrate that Bi2Te3was formed after only 10 min, and longer milling times do not alter the composition. To complete the phase formation, the powders were treated by field-assisted sintering and heat treatment afterwards. The effect of this fast procedure on the structural and thermoelectric properties was investigated. Samples were obtained with relative densities above 99%. A clear preferred orientation of the crystallites in the samples is evidenced by Rietveld refinements of XRD data. The thermoelectric characteristics demonstrate a good performance despite the short milling time. Further, it was demonstrated for this fast synthesis that the physical transport properties can be varied with well-known n- and p-type dopants like CHI3or Pb. For these non-optimized materials, aZTvalue of 0.7 (n-type) and 0.9 (p-type) between 400 and 450 K was achieved. The long-term stability is demonstrated by repeated measurements up to 523 K showing no significant alteration of the thermoelectric performance.
Phylogenetic signal and rate of evolutionary change in language structures
Authors: Hübler Nataliia
Published: March 2022

Within linguistics, there is an ongoing debate about whether some language structures remain stable over time, which structures these are and whether they can be used to uncover the relationships between languages. However, there is no consensus on the definition of the term ‘stability’. I define ‘stability’ as a high phylogenetic signal and a low rate of change. I use metric
D
to measure the phylogenetic signal and Hidden Markov Model to calculate the evolutionary rate for 171 structural features coded for 12 Japonic, 2 Koreanic, 14 Mongolic, 11 Tungusic and 21 Turkic languages. To more deeply investigate the differences in evolutionary dynamics of structural features across areas of grammar, I divide the features into 4 language domains, 13 functional categories and 9 parts of speech. My results suggest that there is a correlation between the phylogenetic signal and evolutionary rate and that, overall, two-thirds of the features have a high phylogenetic signal and over a half of the features evolve at a slow rate. Specifically, argument marking (flagging and indexing), derivation and valency appear to be the most stable functional categories, pronouns and nouns the most stable parts of speech, and phonological and morphological levels the most stable language domains.
Causal coupling between European and UK markets triggered by announcements of monetary policy decisions
Authors: Volta Vittoria , Aste Tomaso
Published: March 2022

We investigate high-frequency reactions in the Eurozone stock market and the UK stock market during the time period surrounding European Central Bank (ECB) and the Bank of England (BoE)’s interest rate decisions, assessing how these two markets react and co-move influencing each other. The effects are quantified by measuring linear and nonlinear transfer entropy combined with a bivariate empirical mode decomposition from a dataset of 1 min prices for the Euro Stoxx 50 and the FTSE 100 stock indices. We uncover that central banks’ interest rate decisions induce an upsurge in intraday volatility that is more pronounced on ECB announcement days and there is a significant information flow between the markets with prevalent direction going from the market where the announcement is made towards the other.
Leclercia pneumoniae sp. nov., a bacterium isolated from clinical specimen in Leipzig, Germany
Authors: Hönemann Mario , Viehweger Adrian , Dietze Nadine , Johnke Julia , Rodloff Arne C.
Published: March 2022

Strain 49125T was isolated from an infant with pneumonia and septicaemia at the Leipzig University Hospital. Phenotypic and genomic traits were investigated. The strain's biochemical profile and its MALDI-TOF spectrogram did not differ from comparative samples of

Leclercia adecarboxylata

, thus far the sole member of the

Leclercia

species. A circular genome with a size of 4.4 Mbp and a G+C content of 55.0 mol% was reconstructed using hybrid Illumina and Nanopore sequencing. Phylogenetic analysis was based on 172 marker genes and validated using a k-mer-based search against a large genome collection including subsequent in silico DNA–DNA hybridization. Whole genome average nucleotide identity to any described species was below 95%, suggesting that strain 49125T represents a new species, for which we propose the name Leclercia pneumoniae sp. nov. with the type strain 49125T (=LMG 32245T=DSM 112336T).