bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-Week Versus 4-Week Schedule of nab-Paclitaxel in Patients With Metastatic Breast Cancer: A Randomized Phase II Study
Authors: Liu Yaxin , Song Guohong , Di Lijun , Jiang Hanfang , Ran Ran , Zhang Ruyan , Zhang Yan , Li Huiping
Published: October 2023

Background

This head-to-head study compared a 3-week versus 4-week schedule of nab-paclitaxel in patients with metastatic breast cancer (mBC).

Methods

Patients with HER2-negative mBC were enrolled and randomly assigned (1:1) to receive nab-paclitaxel for a 3-week schedule (125 mg/m2 on days 1 and 8) or a 4-week schedule (same dose on days 1, 8, and 15) until disease progression or treatment intolerance. Patients with intolerable toxicities were allowed to receive a maintenance regimen after benefiting from nab-paclitaxel. The primary endpoint was progression-free survival (PFS).

Results

Ninety-four patients were included in the analysis (n = 47 in each arm). A longer median PFS (mPFS) was observed in the 3-week versus the 4-week schedule in the overall population (not reached vs. 6.8 months; hazard ratio [HR] = 0.44; P = .029). Patients in the 2 arms had a similar overall survival (28.0 vs. 25.8 months), objective response rate (51.1% vs. 48.9%), and disease control rate (93.6% vs. 80.9%). The 3-week schedule was associated with a lower rate of toxicity-related treatment discontinuation (8.5% vs. 29.8%) and dose delays (6.4% vs. 23.4%).

Conclusion

This study demonstrated the better antitumor activity and safety profile of a 3-week over 4-week nab-paclitaxel schedule in HER2-negative mBC, suggesting that a 3-week schedule may be a better treatment regimen in clinical practice (ClinicalTrials.gov Identifier: NCT04192331).
National campaigns
Authors: Wright Clive
Published: October 2023

Where the prevention or early cure of a health disorder is facilitated by voluntary changes in behaviour, population based campaigns are often used to heighten public awareness and stimulate health action (Schou 1987). Oral health campaigns focus public attention on specific oral conditions and promote the contact of message recipient with health agent. National campaigns form one aspect of strategies aimed at information dissemination and raising the level of awareness of disease and its prevention and are most effectively employed as part of a multi-faceted approached to changing life-styles and health behaviour (McAlister et al. 1982).
Oral health promotion with children and adolescents
Authors: Honkala Erno
Published: October 2023

This chapter emphasizes the population strategy planning in oral health promotion programmes for children and adolescents. The developmental framework of a child and the socialization process should be considered as a basis for all behavioural enterprises targeted towards children. Empowerment of a child for adopting favourable dental health habits demands a practical and educational approach. The concepts proposed by Sheiham (1990) could form the general guidelines for programme planning. Oral health for children and adolescents cannot be reached without the efforts for healthy environment, which would support healthy choices and healthy behaviour of the individuals.
Oral health promotion in the workplace
Authors: Schou Lone
Published: October 2023

It has long been recognized that using the dental surgery as the only way to promote oral health among children is insufficient. The regular or irregular visit to the dentist has only a minor influence on children’s dental health and dental health behaviour. Therefore, most dental health education efforts have concentrated on reaching children where they spend most time — in the family, at schools, or in nurseries or playgroups. However, when it comes to adults, the situation is quite different. Most oral health promotion efforts are concentrated on trying to get people to visit a dentist regularly. For many reasons, the payment system being the major one, these activities at the dentist’s office are mainly orientated towards treatment of oral diseases rather than prevention of diseases or promotion of oral health. It thus seems appropriate to try to get out of the dental office and reach people where they are.
Flavor physics beyond the Standard Model and the Kobayashi–Maskawa legacy
Authors: Isidori Gino
Published: October 2023

The Kobayashi–Maskawa (KM) hypothesis about the existence of a third generation of quarks represents a cornerstone of the Standard Model (SM). Fifty years after this seminal paper [M. Kobayashi and T. Maskawa, Prog. Theor. Phys. 49, 652 (1973)], flavor physics continues to represent a privileged observatory on physics occurring at high energy scales. In this paper I first review this statement using general effective-theory arguments, highlighting some interesting modern lessons from the KM paper. I then discuss some novel extensions of the SM based on the concept of flavor deconstruction: the hypothesis that gauge interactions are manifestly flavor-non-universal in the ultraviolet. The phenomenological consequences of this class of models are also briefly illustrated.
Is Firm-Level Political Risk Priced in the Equity Option Market?
Authors: Ho Thang , Kagkadis Anastasios , Wang George
Published: October 2023

We find a negative relation between firm-level political risk and future delta-hedged equity option returns. A quasi-natural experiment based on Brexit corroborates this finding since after the referendum there is a decrease in the option returns of the positive-Brexit exposure firms. The predictability is driven by the jump risk component of political uncertainty, is more pronounced in periods of high intermediary constraints, and is stronger among high-demand pressure options but weaker among politically active firms. Finally, consistent with a risk-based explanation, investors of options on politically risky firms are compensated with high returns when major unexpected political shocks happen. (JEL G13, G18)
Australia, Indonesia, and East Timorese Family Reunions
Authors: Schwirtlich Nicole
Published: October 2023

In 2002 East Timor, following over 20 years of Indonesian occupation, became the world’s youngest sovereign state. The violent nature of Indonesian occupation between 1975 and 1999 led to the displacement of many East Timorese who sought asylum in countries such as Australia and Portugal. This article argues that by trying to seek asylum in Australia, East Timorese refugees complicated Australia’s bipartisan desire to pursue strong diplomatic relations with Indonesia. A hesitancy to recognise East Timorese arrivals as refugees, as a result of these priorities, was reflected through immigration schemes operating in the 1970s and 1980s such as the Family Reunion Program and Special Humanitarian Program. This impacted Australia’s ability to balance its national interests in the Indo-Pacific and its humanitarian obligations, outlined in international legislation such as the 1951 Refugee Convention and 1967 Refugee Protocol. It also reflected broader diplomatic challenges Australia faced when addressing the situation in East Timor. Exploring this turbulent period in Australian foreign policy through the lens of immigration, this article contributes to research examining the role Australia played in the occupation of East Timor. It also investigates the meanings of dual representations of refugees as both victims and agents within migrant-centered historical accounts.
Pediatric growth faltering
Authors: Gallagher Heather
Published: October 2023

Pediatric growth faltering (GF), previously known as failure to thrive and now also called pediatric malnutrition and weight faltering, is a common clinical finding in primary care. Most pediatric GF cases are caused by inadequate caloric intake, not organic disease states. Evaluation requires clinicians to obtain detailed nutritional, medical, psychosocial, and family histories; take accurate anthropometric measurements; and perform a careful physical examination. Evaluation findings should be analyzed to determine whether targeted diagnostic workup, specialty referral, or a trial of nutritional counseling is indicated. Management includes caregiver education about childhood nutrition and frequent monitoring of growth parameters. A multidisciplinary approach that includes nutritionist, developmental therapist, and other specialty team member involvement is desirable.
The Importance of Compassionate Feedback
Authors: Moffa Christine
Published: October 2023

Fostering growth and improvement to keep patients and nurses safe
Original Research: What Health Care Staff Who Experienced Assisted Patient Falls Can Teach Us: Implications for Fall and Fall Injury Risk
Authors: Chavez Margeaux , Bradley Sarah E. , Lind Jason , Broderick Vianna , Barrett Blake , Cowan Linda , Arriola Nora B. , Friedman Yvonne , Bulat Tatjana
Published: October 2023

Purpose:

This quality improvement project had three aims: to identify common assisted falls scenarios, describe staff members' experiences with and risk perceptions of such falls, and explore factors that influenced their perceptions. The overarching goal was to gain useful insight for the development of assisted fall–related strategies and policies.

Methods:

In the fall of 2020, 16 staff members from 13 health care facilities were purposively recruited and interviewed. Transcript summaries of these interviews, along with secondary narrative data from employee and patient injury databases, were analyzed using thematic content analysis.

Results:

According to staff members' accounts, assisted falls most commonly took place in patient rooms or bathrooms when patients were ambulating or transferring. The interviewees described assisting falls by grabbing or holding the patient or by using their own body to brace or steady the patient. Interview and secondary narrative data noted various injuries that occurred during assisted fall events. These injuries most often involved the lower back (among staff) and the legs (among patients). Most interviewees perceived that using proper body mechanics would prevent injury.

Conclusions:

Interviewees' experiences with assisted falls indicate areas of improvement for fall prevention. The perception that using proper body mechanics will protect staff from injury may be a misconception. Although the literature reports mixed findings concerning whether staff should assist patient falls, this project's results led us to conclude that there is no safe way to physically assist a falling patient without risk of staff injury.
CE: Recognizing Transfusion-Associated Circulatory Overload
Authors: Smith Christy M.
Published: October 2023

Transfusion-associated circulatory overload (TACO) is the leading cause of transfusion-related deaths in the United States, accounting for more than 30% of fatalities reported to the Food and Drug Administration between 2016 and 2020. However, TACO is widely considered to be an underdiagnosed and underreported complication of blood transfusions, and its exact incidence is unknown. One of the reasons for this is a lack of recognition of TACO and its signs and symptoms, especially as the definition of TACO has been updated twice since 2018 without full dissemination to nurses, who are responsible for bedside care of patients during and following blood transfusions. This article seeks to bridge this gap by discussing the updated definitions and signs and symptoms of TACO, as well as the management of this treatable blood transfusion reaction.
Physical Activity Programs Improve Outcomes in Hospitalized Adults
Authors: Rosenberg Karen
Published: October 2023

According to this study:
Ethical and Legal Considerations for Sterilization Refusal in Nulliparous Women
Authors: Izatt Alyssa , Greenberg Rebecca A. , Thorne Julie , Erdman Joanna , Chauhan Nipa
Published: October 2023

We address the ethical and legal considerations for elective tubal sterilization in young, nulliparous women in Canada, with comparison with the United States and the United Kingdom. Professional guidelines recommend that age and parity should not be obstacles for receiving elective permanent contraception; however, many physicians hesitate to provide this procedure to young women because of the permanence of the procedure and the speculative possibility of regret. At the practice level, this means that there are barriers for young women to access elective sterilization; they are questioned or not taken seriously, or their desire for sterilization is more generally belittled by health care professionals. This article argues for further consideration of these requests and considers the ethical and legal issues that arise when preventing regret is prioritized over autonomy in medical practice. In Canada, there is a paucity of professional guidelines and articles offering practical considerations for handling such requests. Compared with the U.S. and U.K. policy contexts, we propose a patient-centered approach for practice to address requests for tubal sterilization that prioritizes informed consent and respect for patient autonomy. We ultimately aim to assure physicians that when the conditions of informed consent are met and documented, they practice within the limits of the law and in line with best ethical practice by respecting their patients' choice of contraceptive interventions and by ensuring their access to care.
Incidence of Recurrent Uterine Rupture
Authors: Sugai Shunya , Yamawaki Kaoru , Haino Kazufumi , Yoshihara Kosuke , Nishijima Koji
Published: October 2023

OBJECTIVE:

We aimed to quantify the incidence of recurrent uterine rupture in pregnant women.

DATA SOURCES:

A literature search of PubMed, Web of Science, Cochrane Central, and ClinicalTrials.gov for observational studies was performed from 2000 to 2023.

METHODS OF STUDY SELECTION:

Of the 7,440 articles screened, 13 studies were included in the final review. We included studies of previous uterine ruptures that were complete uterine ruptures, defined as destruction of all uterine layers, including the serosa. The primary outcome was the pooled incidence of recurrent uterine rupture. Between-study heterogeneity was assessed with the I
2 value. Subgroup analyses were conducted in terms of the country development status, year of publication, and study size (single center vs national study). The secondary outcomes comprised the following: 1) mean gestational age at which recurrent rupture occurred, 2) mean gestational age at which delivery occurred without recurrent rupture, and 3) perinatal complications (blood loss, transfusion, maternal mortality, and neonatal mortality).

TABULATION, INTEGRATION, AND RESULTS:

A random-effects model was used to pool the incidence or mean value and the corresponding 95% CI with R software. The pooled incidence of recurrent uterine rupture was 10% (95% CI 6–17%). Developed countries had a significantly lower uterine rupture recurrence rate than less developed countries (6% vs 15%, P=.04). Year of publication and study size were not significantly associated with recurrent uterine rupture. The mean number of gestational weeks at the time of recurrent uterine rupture was 32.49 (95% CI 29.90–35.08). The mean number of gestational weeks at the time of delivery without recurrent uterine rupture was 35.77 (95% CI 34.95–36.60). The maternal mortality rate was 5% (95% CI 2–11%), and the neonatal mortality rate was 5% (95% CI 3–10%). Morbidity from hemorrhage, such as bleeding and transfusion, was not reported in any study and could not be evaluated.

CONCLUSION:

This systematic review estimated a 10% incidence of recurrent uterine rupture. This finding will enable appropriate risk counseling in patients with prior uterine rupture.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42023395010.
Cryocompression to Reduce Peripheral Neuropathy in Gynecologic Cancer
Authors: Anastasio Mary Katherine , Unnithan Shakthi , Scott Amelia , Hayes Taylor , Shah Suma , Moss Haley A. , Erkanli Alaattin , Havrilesky Laura J.
Published: October 2023

OBJECTIVE:

To investigate the efficacy of cryocompression therapy to prevent chemotherapy-induced peripheral neuropathy.

METHODS:

This single-institution, randomized, self-controlled trial of cryocompression enrolled gynecologic cancer patients planned for five to six cycles neurotoxic chemotherapy. Exclusion criteria were prior neurotoxic chemotherapy or baseline peripheral neuropathy. Participants were randomized to cryocompression on dominant versus non-dominant hand and foot (treatment), with no intervention on the opposite side (control). Compression socks and gloves and ice bags were applied 15 minutes before, during, and 15 minutes after infusion. Primary outcome measures included the PNQ (Patient Neurotoxicity Questionnaire) and the Semmes-Weinstein monofilament test; secondary outcomes included the FACT/GOG-NTX (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group – Neurotoxicity) and patient acceptability and tolerability. Sixty patients completing the study were necessary to detect a 70% reduction in the odds of PNQ grade C or higher peripheral sensory neuropathy with 80% power.

RESULTS:

Ninety-one patients were enrolled from January 2021 to October 2022; 69 were eligible for final analysis. Of the 91 patients, 64.8% were White, 30.8% were Black, and 1.1% were Hispanic or Latina. With successive cycles, more patients had sensory PNQ grade C or higher neuropathy on the control side compared with the cryocompression side. Cryocompression decreased the odds of sensory neuropathy (PNQ grade C or higher) by 46% at final visit (odds ratio 0.54, 95% CI 0.31–0.94; P=.03). There was no difference in tactile sensitivity based on the monofilament test between sides at the final visit. At the final visit, average FACT/GOG-NTX-11 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group – Neurotoxicity 11 Item Version) scores were significantly lower on the cryocompression than the control side (estimate −0.97, 95% CI −1.89 to −0.06; P=.04), as were FACT/GOG-NTX-4 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group – Neurotoxicity 4 Item Version) scores (estimate −0.35, 95% CI −0.64 to −0.05; P=.02). More than 85% of patients assessed the intervention as acceptable and tolerable.

CONCLUSIONS:

Cryocompression therapy reduces subjective chemotherapy-induced peripheral sensory neuropathy in patients who are receiving paclitaxel or cisplatin for gynecologic cancer.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04563130.
Contraceptive Provision to Women With Intellectual and Developmental Disabilities Enrolled in Medicaid
Authors: Mitchell Lauren , Vellanki Bhamini , Tang Linda , Hunter Kelly , Finnegan Amy , Swartz Jonas J. , Huchko Megan
Published: October 2023

OBJECTIVE:

To compare contraceptive provision to women with and without intellectual and developmental disabilities enrolled in North Carolina Medicaid.

METHODS:

Our retrospective cohort study used 2019 North Carolina Medicaid claims to identify women aged 15–44 years with and without intellectual and developmental disabilities at risk for pregnancy who were continuously enrolled during 2019 or had Family Planning Medicaid with at least one claim. We calculated the proportion in each cohort who received 1) most or moderately effective contraception, 2) long-acting reversible contraception, 3) short-acting contraception, and 4) individual methods. We classified contraceptive receipt by procedure type and disaggregated across sociodemographic characteristics. Adjusting for age, race, ethnicity, and urban or rural setting, we constructed logistic regression models to estimate most or moderately effective contraceptive provision odds by intellectual and developmental disability status and by level or type of intellectual and developmental disability. We performed subanalyses to estimate co-occurrence of provision and menstrual disorders.

RESULTS:

Among 9,508 women with intellectual and developmental disabilities and 299,978 without, a significantly smaller proportion with intellectual and developmental disabilities received most or moderately effective contraception (30.1% vs 36.3%, P<.001). With the exception of injectable contraception, this trend was consistent across all measures and remained statistically significant after controlling for race, ethnicity, age, and urban or rural status (adjusted odds ratio 0.75, 95% CI 0.72–0.79; P<.001). Among those who received most or moderately effective contraception, a significantly greater proportion of women with intellectual and developmental disabilities had co-occurring menstrual disorders (31.3% vs 24.3%, P<.001).

CONCLUSION:

These findings suggest disparities in contraceptive provision and potential differences in clinical indication by intellectual and developmental disability status. Future studies should investigate reasons for and barriers to contraceptive use among women with intellectual and developmental disabilities.
Incidence and factors associated with hepatitis B surface antigen seroclearance in patients co-infected with HBV/HIV during antiretroviral therapy in Guangdong, China
Authors: He Yaozu , Lin Weiyin , Li Hong , Gu Fei , Zhong Huolin , Lan Yun , Li Yonghong , Guo Pengle , Hu Fengyu , Cai Weiping , Tang Xiaoping , Li Linghua
Published: October 2023

Background:

Hepatitis B surface antigen (HBsAg) clearance is vital for a functional cure of hepatitis B virus (HBV) infection. However, the incidence and predictors of HBsAg seroclearance in patients co-infected with HBV and human immunodeficiency virus (HIV) remain largely unknown in Guangdong, China.

Methods:

Between 2009 and 2019, patients co-infected with HBV/HIV undergoing antiretroviral therapy (ART) in Guangzhou Eighth People's Hospital affiliated to Guangzhou Medical University were retrospectively reviewed with the endpoint on December 31, 2020. The incidence and risk factors for HBsAg seroclearance were evaluated using Kaplan–Meier and multivariate Cox regression analyses.

Results:

A total of 1550 HBV/HIV co-infected patients were included in the study, with the median age of 42 years and 86.0% (1333/1550) males. Further, 98.3% (1524/1550) received ART containing tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC). HBV DNA was examined in 1283 cases at the last follow-up. Over the median 4.7 years of follow-up, 8.1% (126/1550) patients achieved HBsAg seroclearance, among whom 50.8% (64/126) obtained hepatitis B surface antibody, 28.1% (137/488) acquired hepatitis B e antigen seroconversion, and 95.9% (1231/1283) undetectable HBV DNA. Compared with patients who maintained HBsAg positive, cases achieving HBsAg seroclearance showed no differences in age, gender, CD4+ T cell count, alanine aminotransferase (ALT) level, or fibrosis status; however, they presented lower HBV DNA levels, lower HBsAg levels, and higher rates of HBV genotype B at the baseline. Multivariate analysis showed that baseline HBsAg <1500 cutoff index (COI) (adjusted hazard ratio [aHR], 2.74, 95% confidence interval [95% CI]: 1.48–5.09), ALT elevation >2 × upper limit of normal during the first six months after receiving ART (aHR, 2.96, 95% CI: 1.53–5.77), and HBV genotype B (aHR, 3.73, 95% CI: 1.46–9.59) were independent predictors for HBsAg seroclearance (all P <0.01).

Conclusions:

Long-term TDF-containing ART has high anti-HBV efficacy including relatively high overall HBsAg seroclearance in HBV/HIV co-infected patients. Lower baseline HBsAg levels, HBV genotype B, and elevated ALT levels during the first six months of ART are potential predictors of HBsAg seroclearance.
Preordering Periodic Acid–Schiff Staining: A Quality Improvement Study
Authors: Wolner Zachary J. , Mustin Danielle E. , Stoff Benjamin K.
Published: October 2023

Periodic acid–Schiff (PAS) stain is a commonly used ancillary test for inflammatory and infectious dermatoses, yet infrequently changes the diagnosis. Previous studies have shown that clinical suspicion and histopathologic features are poor predictors of PAS positivity. Current appropriate use criteria from the American Society of Dermatopathology supports PAS staining when histopathologic features could be consistent with a dermatophyte infection. At the authors' institution, PAS stains are preordered on biopsies of inflammatory and infectious diagnoses to aid in a timelier sign out. Our aim was to reduce the percentage of PAS stains preordered on all dermatology specimens over a 6-month period without reducing the percentage of fungal infections identified. Review of a 12-month preintervention period found that our laboratory received 6104 biopsies for which PAS stain was preordered on 616 (10.1%). Based on a review of the preintervention period, preordering PAS on cases with clinical suspicion for cutaneous T-cell lymphoma was stopped unless there was clinical suspicion for eczematous dermatitis, vesiculobullous disorders, or fungal infection. The proposed intervention resulted in a 3.7% reduction in the number of PAS stains ordered while PAS-positivity rate remained unchanged. The described quality improvement process may be used as a model for other laboratories.
Malignant Melanoacanthoma
Authors: Ticknor Iesha L. , Cassarino David S.
Published: October 2023

Melanoacanthomas are benign variations of seborrheic keratosis that have been known to mimic other common benign and malignant skin lesions. Therefore, the diagnosis typically requires biopsy and careful histologic examination. Here, we present the case of a 25-year-old woman initially diagnosed clinically with an epidermal inclusion cyst, but, on biopsy and further evaluation, was found to have histological features of an atypical or malignant melanoacanthoma. Contrary to typical cases of melanoacanthoma, histologic evaluation revealed atypical findings consistent with malignancy, such as tumor necrosis, marked cytologic atypia and pleomorphism, and numerous mitoses, including atypical forms, features consistent with malignancy (ie, similar to a squamous cell carcinoma in these areas). This report highlights the importance of histological evaluation in diagnosis and treatment of skin lesions because atypical presentations often occur and can delay correct diagnosis and appropriate treatment.
Type 2 Leprosy Reaction Mimicking Leukocytoclastic Vasculitis in a Postpartum Patient
Authors: Schaffenburg William , Royer Michael , Scorza Melissa
Published: October 2023

Leprosy is a disease caused by Mycobacterium leprae that, depending on a patient's baseline susceptibility and immune system function, can present in a wide variety of ways. The host's immune system response to the infection can be cell-mediated or humoral and can be further altered by changes in immune function or treatment. Depending on the time at which a skin biopsy is taken from affected areas, different inflammatory cell types are present, and the histopathology can mimic that of other infectious, autoimmune, or malignant entities, especially when the clinical information provided is vague. We present a case of a 24-year-old Micronesian woman who initially presented immediately postpartum with clinical and histopathological findings suggestive of urticarial vasculitis, but a subsequent biopsy resulted in a diagnosis of erythema nodosum leprosum reaction and borderline multibacillary leprosy. This case illustrates an unusual clinical and histological presentation of M. leprae and highlights the importance of clinical history.
BASELINE SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHIC RETINAL LAYER FEATURES IDENTIFIED BY ARTIFICIAL INTELLIGENCE PREDICT THE COURSE OF CENTRAL SEROUS CHORIORETINOPATHY
Authors: Desideri Lorenzo Ferro , Anguita Rodrigo , Berger Lieselotte E , Feenstra Helena M A , Scandella Davide , Sznitman Raphael , Boon Camiel J F , van Dijk Elon H C , Zinkernagel Martin S
Published: October 2023

Purpose

To identify optical coherence tomography (OCT) features to predict the course of central serous chorioretinopathy (CSC) with an artificial intelligence (AI) based program

Methods

Multicenter, observational study with a retrospective design. Treatment-naïve patients with acute CSC and chronic CSC were enrolled. Baseline OCTs were examined by an AI-developed platform (Discovery® OCT Fluid and Biomarker Detector, RetinAI AG, Switzerland). Through this platform, automated retinal layers thicknesses and volumes, including intaretinal and subretinal fluid (IRF, SRF) and pigment epithelium detachment (PED) were measured. Baseline OCT features were compared between acute CSC and chronic CSC patients

Results

160 eyes of 144 patients with CSC were enrolled, of which 100 had chronic CSC and 60 acute CSC. Retinal layer analysis of baseline OCT scans showed that the inner nuclear layer, the outer nuclear layer and the photoreceptor-RPE complex were significantly thicker at baseline in eyes with acute CSC in comparison with those with chronic CSC (p<0.001). Similarly, choriocapillaris and choroidal stroma and retinal thickness (RT) were thicker in acute CSC than chronic CSC eyes (p=0.001). Volume analysis revealed average greater SRF volumes in the aCSC group in comparison with cCSC (p=0.041)

Conclusion

OCT features may be helpful to predict the clinical course of CSC. The baseline presence of an increased thickness in the outer retinal layers, choriocapillaris and choroidal stroma, and SRF volume seems to be associated with acute course of the disease
Analysis of Prosthetic Replacement of the Ocular Surface Ecosystem Anterior Surface Condition Using Noninvasive Keratograph Break-Up Time
Authors: Nodecker Kayla , Madabhushi Sankirth , Brocks Daniel
Published: October 2023

Objectives:

Noninvasive keratograph break-up time (NIKBUT) was developed as an alternative to fluorescein-based measurements of tear break-up time and may have utility not only for the objective evaluation of tear film stability on the corneal surface but also on the surface of scleral and contacts lenses. We report on two cases that highlight the potential use of NIKBUT to provide objective prelens tear film stability data to evaluate the anterior surface of a customized ocular surface prosthetic devices (PD; PROSE, BostonSight, Needham, MA).

Methods:

Case report and literature review.

Results:

Case 1 demonstrates improvement in prelens tear film stability with NIKBUT increasing from 4.59 to 11.47 sec after the addition of a polyethylene glycol–based polymer coating to the PD surface. In case 2, when a NIKBUT value could not be obtained, keratograph infrared images were used to evaluate improved anterior lens surface wetting.

Conclusion:

Noninvasive keratograph break-up time may provide an objective modality to evaluate prelens tear film stability and PD wettability. Such measurements may allow for a better understanding of visual degradation related to PD lens condition and the appropriate timing of lens recoating, reconditioning, and replacement.
How Many Lives Will You Save? A Mixed Methods Evaluation of a Novel, Online Game for Patient Safety and Quality Improvement Education
Authors: Ruiz Colón Gabriela , Evans Kambria , Kanzawa Mia , Phadke Anuradha , Katznelson Laurence , Shieh Lisa
Published: October 2023

Medical trainees have limited knowledge of quality improvement and patient safety concepts. The authors developed a free quality improvement/patient safety educational game entitled Safety Quest (SQ). However, 1803 undergraduate medical trainees, graduate medical trainees, and continuing medical education learners globally completed at least 1 level of SQ. Pre- and post-SQ knowledge and satisfaction were assessed among continuing medical education learners. Thematic analysis of feedback given by trainees was conducted. Among graduate medical trainees, SQ outranked other learning modalities. Three content areas emerged from feedback: engagement, ease of use, and effectiveness; 87% of comments addressing engagement were positive. After completing SQ, 98.6% of learners passed the post-test, versus 59.2% for the pretest (P < 0.0001). Ninety-three percent of learners agreed that SQ was engaging and interactive, and 92% believed it contributed to their professional growth. With an increased need for educational curricula to be delivered virtually, gamification emerges as a unique strategy that learners praise as engaging and effective.
Application of interventional therapy via hepatic artery in pancreatic neuroendocrine neoplasms liver metastases
Authors: Liu Haikuan , Yu Hang , Yang Dequan , Yao Wang , Wang Yu
Published: October 2023

Pancreatic neuroendocrine neoplasm (PNEN) is the second most common malignant tumor of the pancreas. It has the characteristic of high metastases rate, and the liver is the most common site for metastasis. Metastasis affects prognosis and survival seriously. A number of earlier studies have shown that the interventional therapy via hepatic artery could reduce hepatic tumor burden and hormone secretion safely and rapidly, significantly improve objective response rate (ORR), and enhance the efficacy and prolong the survival time when combined with system therapy. The interventional therapy via hepatic artery plays an important role in the treatment of PNEN liver metastases. Interventional therapy via hepatic artery could possibly increase ORR, prolong progression-free survival, and even overall survival for appropriate patients.
American Academy of Nurse Practitioners Certification Board announces changes in the recertification program
Authors: Tyler Diane , Schumann Lorna
Published: October 2023

The vision of the American Academy of Nurse Practitioners Certification Board (AANPCB) is that nurse practitioners (NPs) meet the highest standards of excellence and competence to support quality care and optimal health outcomes. The highest standards of excellence require monitoring and improving our certification and recertification programs. After conducting a thorough review of the relevant literature and a series of surveys of our certificants, changes were made to the AANPCB recertification requirements that are consistent with continued competency. These changes are (1) maintaining a minimum of 1,000 advanced practice hours as an NP in the role of clinician, educator, administrator, and/or researcher plus obtaining 100 contact hours of qualified professional development credits; (2) allowing completion of the renewal criteria after the certification end date for individuals who have allowed their certification to expire; and (3) retiring the COVID temporary certification extension policy.
Primary care nurse practitioners' perceptions and experiences communicating with adults about adverse childhood experiences
Authors: Strauch Kimberly A.
Published: October 2023

Background:

Clinical communication focused on childhood adversity has not been well described in the extant literature. There is a wealth of knowledge about patient-centered communication, including patient-centered communication techniques involving the discussion of health risks in primary care. However, there remain gaps in our understanding of the role that communication plays in exploring adverse childhood experience (ACE) exposure among adults in the clinical context.

Purpose:

To better understand factors that influence how nurse practitioners (NPs) communicate with adults about ACEs in the context of primary care while simultaneously exploring NPs' perceptions and experiences of their ability to communicate with adults about ACE exposure.

Methodology:

Guided by the Patient-to-Provider Communication of Adverse Childhood Experiences in Primary Care (PPC-ACE) Model, an exploratory, qualitative, descriptive study was conducted among 15 US-based primary care NPs. Nurse practitioner's participated in semistructured interviews, which were recorded and transcribed. Transcripts were analyzed using inductive thematic analysis. Atlas.ti provided supplemental data visualization. Demographic data, practice characteristics, and baseline ACEs knowledge were collected by means of Qualtrics.

Results:

Key themes described communication approaches and perceived barriers and facilitators to ACE-related conversations. Scope of practice, provider biases, diversity in practice models, and secondary trauma were factors NPs' perceived as positively or negatively influencing ACE-related communication in primary care.

Conclusions:

Outcomes from this study provided deeper insights into the various influencers of NP-perceived, ACE-related, patient-centered communication among adults in primary care.

Implications:

Findings will inform future research focused on ACE-related communication in primary care in the domains of NP education, practice, and health policy.
Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015–2019)*
Authors: Van Damme Danielle M. , McRae Emily M. , Irving Sharon Y. , Kelly Serena P. , Tarquinio Keiko M. , Giuliano John S. , Ruppe Michael D. , Kierys Krista L. , Breuer Ryan K. , Parsons Simon J. , Mallory Palen P. , Shenoi Asha N. , Swain Kelly A. , Polikoff Lee A. , Lee Anthony , Adu-Darko Michelle A. , Napolitano Natalie , Shults Justine , Nishisaki Akira , Berkenbosch John W. ,   for the National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)
Published: October 2023

OBJECTIVES:

To describe tracheal intubation (TI) practice by Advanced Practice Registered Nurses (APRNs) in North American PICUs, including rates of TI-associated events (TIAEs) from 2015 to 2019.

DESIGN/SETTING:

Retrospective study using the National Emergency Airway Registry for Children with all TIs performed in PICU and pediatric cardiac ICU between January 2015 and December 2019. The primary outcome was first attempt TI success rate. Secondary outcomes were TIAEs, severe TIAEs, and hypoxemia.

SUBJECTS:

Critically ill children requiring TI in a PICU or pediatric cardiac ICU.

INTERVENTIONS:

None

MEASUREMENTS AND MAIN RESULTS:

Among 11,012 TIs, APRNs performed 1,626 (14.7%). Overall, TI by APRNs, compared with other clinicians, occurred less frequently in patients with known difficult airway (11.1% vs. 14.3%; p < 0.001), but more frequently in infants younger than 1 year old (55.9% vs. 44.4%; p < 0.0001), and in patients with cardiac disease (26.3% vs. 15.9%; p < 0.0001).There was lower odds of success in first attempt TI for APRNs vs. other clinicians (adjusted odds ratio, 0.70; 95% CI, 0.62–0.79). We failed to identify a difference in rates of TIAE, severe TIAE, and oxygen desaturation events for TIs by APRNs compared with other clinicians. The TI first attempt success rate improved with APRN experience (< 1 yr: 54.2%, 1–5 yr: 59.4%, 6–10 yr: 67.6%, > 10 yr: 63.1%; p = 0.021).

CONCLUSIONS:

TI performed by APRNs was associated with lower odds of first attempt success when compared with other ICU clinicians although there was no appreciable difference in procedural adverse events. There appears to be a positive relationship between experience and success rates. These data suggest there is an ongoing need for opportunities to build on TI competency with APRNs.
Menstruation Confounding the Correct Interpretation of 99mTc-RBC Bleeding Scan
Authors: Wang Guanyun , Lu Xia , Wang Wei , Yang Jigang
Published: October 2023

99mTc-RBC bleeding scan in a 17-year-old adolescent girl showed an increased focal activity in the pelvis. However, SPECT/CT showed that this activity was located in the uterus, which was considered a normal variant considering that the patient was in her fourth day of the menstrual period. Subsequent99mTcO4−Meckel scan showed the typical characteristic of ectopic gastric mucosa in the small bowel. Postsurgical pathology confirmed the diagnosis of ectopic gastric mucosa. This case suggested the menstrual period uterus should be included as differential diagnosis of99mTc-RBC scan.
177Lu-DOTATATE (Lutathera) Therapy in 68Ga-DOTATATE PET/CT-Negative Liver Metastases of a Neuroendocrine Tumor
Authors: Ventura David , Roll Wolfgang , Kasper Hans-Udo , Rahbar Kambiz , Stegger Lars
Published: October 2023

A 73-year-old man with metastatic pancreatic neuroendocrine tumor was evaluated with 68Ga-DOTATATE PET/CT for peptide receptor radionuclide therapy. Both PET-positive and negative lesions were seen in the liver, along with extrahepatic metastases. Histopathology was obtained from one of the PET-negative liver lesions to exclude secondary malignancy. Histology confirmed a well-differentiated (G2) metastasis of pNET with high somatostatin receptor expression. We initiated peptide receptor radionuclide therapy with close monitoring of the PET-negative liver metastases. We present a rare case, where posttherapeutic scintigraphy revealed vigorous uptake of 177Lu-DOTATATE even in the 68Ga-DOTATATE PET-negative liver metastases. Follow-up PET/CT showed a partial response to therapy.
At the Scrub Sink: Uterosacral Ligament Suspension
Authors: Meriwether Kate V.
Published: October 2023

Uterosacral ligament suspension for repair of prolapse has some challenges, such as visualization in the vagina, choice of suture, and avoidance of dangers such as ureteral kinking. This editorial offers some tips for performing a uterosacral suspension that are commonly discussed “at the scrub sink” before a case.
Coccidioidomycosis in Africa: Mini Review
Authors: Jayte Mohamed
Published: October 2023

Background

Coccidioidomycosis, also known as San Joaquin valley fever, is a disease caused by inhalation of spores from Coccidioides fungi that are endemic to certain parts of the Americas. However, cases have increasingly been reported in other parts of the world including Africa.

Methods

A systematic search of PubMed, Google Scholar and Web of Science databases was conducted in June 2022 using terms: “Coccidioidomycosis”,“Coccidioides”,“San Joaquin Valley fever” in combination with “Africa”. Studies were screened and included if they reported original clinical cases of human coccidioidomycosis originating from Africa. Data extraction focused on demographics, clinical characteristics, diagnosis and exposure links.

Results

A total of 29 articles met the eligibility criteria and were included in the review. Most cases originated from North and East Africa with common clinical presentations including pulmonary symptoms, skin lesions and disseminated disease. Exposure links included travel to endemic areas.

Conclusion

Though traditionally considered non-endemic, Africa appears to be experiencing an increase in reported Coccidioidomycosis cases, highlighting the need for awareness and further research on disease epidemiology in the region.
Electroencephalographic insights into variant function and clinical outcomes inSCN2Aencephalopathy
Authors: Fogerson Michelle , Tsitsiklis Melina , Brimble Elise , Brünger Tobias , Arslan Alexander R. , Nerrie Jayne , Laberinto Kim P. , Lacoste Alix M.B. , Martin Richard L. , Lal Dennis , Pathmanathan Jay , Brandon Westover M. , Fitter Nasha , Donoghue Jacob
Published: October 2023

Neither phenotype nor genotype reliably predicts clinical disease severity or neurodevelopmental outcomes inSCN2Adevelopmental and epileptic encephalopathy. In this study we examined the electroencephalographic (EEG) features of children withSCN2Avariants to quantify the range of EEG abnormalities and link EEG biomarkers to developmental outcomes.

We retrospectively analyzed data from a cohort of 28 children withSCN2Avariants and employed a genetics-based consensus framework to infer the functional characterization of each subject’sSCN2Avariant. Eleven subjects were predicted to have a gain-of-function variant, and 17 subjects a loss-of-function variant. Overall, variant classifications matched subject phenotypes. 493 EEG recordings from the 28 subjects were analyzed (ages 1 day to 16 years). In addition to theSCN2Arecordings, normative data from 1230 children without an epilepsy diagnosis or epileptiform features based on neurologists’ review was analyzed (1704 EEG recordings, ages 0 days to 16 years). We detected interictal epileptiform discharges (IEDs) in theSCN2Arecordings using Beacon’s automated IED detection algorithm. We characterized background spectral features by computing relative power in four frequency bands (delta=1-4Hz, theta=4-8Hz, alpha=8-13Hz, beta=13-30Hz) in recordings from both theSCN2Aand control cohorts. Additionally, we determined whether eachSCN2Arecording was associated with a gross motor developmental delay based on reported attainment of gross motor milestones. We then used mixed effects logistic regression models to estimate the effect of EEG biomarkers on developmental delay.

We characterized EEG abnormalities in the background spectral features of theSCN2Acohort compared to the controls and identified differences in EEG signatures between the subjects with gain- and loss-of-function variants. Additionally, we showed that background spectral features are correlated with motor developmental outcome when measured relative to age-matched neurotypical children. Furthermore, we showed that interictal epileptiform activity is correlated with delayed motor development in subjects with gain-of-function variants.

Taken together, these findings suggest that EEG biomarkers can be used to identify neurological abnormalities that correlate both withSCN2Avariants and measures of development. We demonstrate the potential value of EEG as a disease biomarker, and we highlight the potential of such biomarkers to both guide future invasive genetic therapies and to be used as diagnostic tools.
Environmental detection of parasites in the marginalized Paiute reservations compared to a nearby area
Authors: McKim Shannon , Kopystynsky Kristen , Wolf Nathaniel , Akbar Fahim A. , Bottazzi Maria Elena , Hotez Peter J. , Mejia Rojelio
Published: October 2023

The amounts of parasite DNA in soil samples from different playgrounds and other public areas can help identify areas of possible microbe transmission as well as giving indications of possible occurrence of parasite infection in nearby communities. We collected 207 soil samples from parks located on Paiute indigenous tribal areas in southwest Utah and from higher income city of St. George, Utah, and tested them for the presence of 11 parasites that can cause human disease. Molecular tests revealed elevated odds ratio of detecting the helminthTrichuris trichiura3.072 (1.114 to 8.065) and any protozoa (not includingAcanthamoeba) 3.036 (1.101 to 7.966) in the tribal land playgrounds compared to St. George parks. These findings support previous studies showing that areas in lower socioeconomic communities, especially marginalized communities, tend to have higher presence of parasites in the soil that may lead to higher rates of disease prevalence.
Offline hippocampal reactivation during dentate spikes supports flexible memory
Authors: McHugh Stephen B. , Lopes-dos-Santos Vítor , Castelli Manfredi , Gava Giuseppe P. , Thompson Sophie E. , Tam Shu K.E. , Hartwich Katja , Dupret David
Published: October 2023

Stabilizing new memories requires coordinated neuronal spiking activity during sleep. Hippocampal sharp-wave ripples (SWRs) in the Cornu Ammonis (CA) region, and dentate spikes (DSs) in the dentate gyrus (DG) are prime candidate network events supporting this offline process. SWRs have been studied extensively but the contribution of DSs remains unclear. By combining triple-(DG-CA3-CA1) ensemble recordings and closed-loop optogenetics in mice we show that, like SWRs, DSs synchronize spiking across DG and CA principal cells to reactivate population-level patterns of neuronal coactivity expressed during prior waking experience. Notably, the population coactivity structure in DSs is more diverse and higher-dimensional than that seen during SWRs. Importantly, suppressing DG granule cell spiking selectively during DSs impairs subsequent flexible memory performance in a multi-object recognition task and associated hippocampal patterns of neuronal coactivity. We conclude that DSs constitute a second offline network event central to hippocampal population dynamics serving memory-guided behavior.