bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambient air pollution associated with lower academic achievement among US children
Authors: Lu Wenxin , Hackman Daniel A. , Schwartz Joel 
Published: November 2021

Background:
Ambient air pollution is an important environmental exposure and has been linked with impaired cognitive function. Few studies have investigated its impact on children’s academic performance on a nationwide level. We hypothesize that higher ambient air pollution concentrations will be associated with lower average academic test scores.

Methods:
We investigated three prevalent ambient air pollutants: PM2.5, NO2 and ozone, and their associations with the average academic test scores, at the Geographic School District (GSD) level, of the third to eighth grade students in the United States from 2010 to 2016. We applied multivariate linear regression and controlled for urbanicity, socioeconomic status, student racial/ethnic compositions, and individual intercepts for each district-grade level and each year.

Results:
We found that an interquartile range increase in PM2.5 concentrations was associated with a 0.007 (95% confidence interval: 0.005, 0.009) SD lower average math test scores, and a 0.004 (95% confidence interval: 0.002, 0.005) SD lower average English language/arts test scores. Similar associations were observed for NO2 and ozone on math, and for NO2 on English language/arts. The magnitudes of these associations are equivalent to the effects of short-term reductions of thousands of dollars in district median household income. The reductions in test scores were larger for GSDs with higher socioeconomic status, though most associations remained negative at all socioeconomic levels.

Conclusions:
Our results show that ambient air pollution within a GSD is associated with lower academic performance among children. Further improving air quality may benefit children’s overall academic achievement and socioeconomic attainment across the lifespan.
Urinary lead level and colonization by antibiotic resistant bacteria
Authors: Eggers Shoshannah , Safdar Nasia , Kates Ashley , Sethi Ajay K. , Peppard Paul E. , Kanarek Marty S. , Malecki Kristen M. C. 
Published: November 2021

Background:
Infection by antibiotic resistant bacteria (ARB) is a global health crisis and asymptomatic colonization increases risk of infection. Nonhuman studies have linked heavy metal exposure to the selection of ARB; however, few epidemiologic studies have examined this relationship. This study analyzes the association between urinary lead level and colonization by ARB in a nonclinical human population.

Methods:
Data came from the Survey of the Health of Wisconsin 2016–2017, and its ancillary Wisconsin Microbiome Study. Urinary lead levels, adjusted for creatinine, were used to assess exposure. ARB included methicillin resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), fluoroquinolone resistant Gram-negative bacilli (RGNB), and Clostridium difficile (C. diff), from skin, nose, and mouth swabs, and saliva and stool samples. Logistic regression, adjusted for covariates, was used to evaluate associations between Pb and ARB. Secondary analysis investigated Pb resistance from ARB isolates.

Results:
Among 695 participants, 239 (34%) tested positive for ARB. Geometric mean urinary Pb (unadjusted) was 0.286 µg/L (95% confidence intervals [CI] = 0.263, 0.312) for ARB negative participants and 0.323 µg/L (95% CI = 0.287, 0.363) for ARB positive participants. Models adjusted for demographics, diet, and antibiotic use showed elevated odds of positive colonization for those in the 95th percentile (vs. below) of Pb exposure (odds ratio [OR] = 2.05, 95% CI = 0.95, 4.44), and associations were highest in urban residents (OR = 2.85, 95% CI = 1.07, 7.59). RGNB isolates were most resistant to Pb.

Discussion:
These novel results suggest that Pb exposure is associated with increased colonization by ARB, and that RGNB are particularly resistant to Pb.
CHANGES IN SYSTEMIC LEVELS OF VASCULAR ENDOTHELIAL GROWTH FACTOR AFTER INTRAVITREAL INJECTION OF AFLIBERCEPT OR BROLUCIZUMAB FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Angermann Reinhard , Huber Anna Lena , Nowosielski Yvonne , Salcher Stefan , Gasser Thomas , Seifarth Christof , Kralinger Martina T. , Zehetner Claus 
Published: November 2021

Purpose:
To analyze and compare the effects of intravitreal brolucizumab versus aflibercept on systemic vascular endothelial growth factor (VEGF)-A levels in patients with neovascular age-related macular degeneration.

Methods:
In this prospective interventional case series study, brolucizumab (6.0 mg/50 µL) or aflibercept (2.0 mg/50 µL) was injected intravitreally in 30 patients each. Blood samples were drawn at baseline and 7 days and 28 days after the first injection. Systemic VEGF-A levels were measured using enzyme-linked immunosorbent assay. Thirty healthy individuals served as controls.

Results:
The median baseline systemic VEGF-A levels in the brolucizumab, aflibercept, and control groups were 10.8 (8.0–13.2), 12.0 (8.0–18.5), and 10.0 (8.0–15.1) pg/mL, respectively (P = 0.315). In the brolucizumab group, VEGF-A levels significantly decreased to 8.0 (8.0–11.5) pg/mL on Day 7 (P = 0.0254) and to 8.0 (8.0–8.0) pg/mL on Day 28 (P < 0.001). In the aflibercept group, VEGF-A levels significantly decreased to 8.0 (8.0–8.0) pg/mL on Day 7 (P < 0.001) but returned to the baseline level, 12.5 (8.5–14.6) pg/mL, on Day 28 (P = 0.120). Vascular endothelial growth factor–A levels were significantly different between the treatment groups after 28 days (P < 0.001).

Conclusion:
Intravitreal brolucizumab resulted in a sustained reduction of systemic VEGF-A levels until 28 days posttreatment, which raises concerns regarding its safety and long-term effects.
Infective Necrotizing Scleritis After XEN Gel Stent With Mitomycin-C
Authors: Kingston Ezekiel J. , Zagora Sophia L. , Symes Richard J. , Raman Pushpa , McCluskey Peter J. , Lusthaus Jed A. 
Published: November 2021

Purpose:
The purpose of this study was to report a case of infective necrotizing scleritis following XEN Gel Stent with mitomycin-C.

Methods:
Case report. This is a case report of a 68-year-old woman.

Results:
XEN Gel Stent glaucoma surgery enhanced with mitomycin-C 0.04% and combined with cataract surgery was performed at a regional center to manage the patient’s primary open-angle glaucoma. Past medical history was significant for rheumatoid arthritis requiring treatment with methotrexate and adalimumab. Periocular pain and swelling developed 14 months after the initial operation, followed by a rapid deterioration of visual acuity to 20/60, intraocular pressure of 4 mm Hg, and worsening pain 5 months later. On initial presentation to Sydney Eye Hospital, 180 degrees of scleral necrosis was evident with a moderate anterior segment inflammatory reaction and a large temporal choroidal effusion due to hypotony. Empirical hourly topical ofloxacin and cephalothin 5% drops, with oral moxifloxacin, were initiated. Conjunctival swab grew Staphylococcus aureus and Staphylococcus lugdunensis. Significant clinical improvement occurred, but the XEN Gel Stent became exposed after 9 days of treatment with worsening hypotony. Urgent surgical revision was performed to remove the XEN Gel Stent and apply a tutoplast plug with overlying amniotic membrane graft. Intraocular pressure gradually improved over 6 weeks to 15 mm Hg with reversal of hypotonous changes, and visual acuity stabilized at 20/40.

Conclusions:
To our knowledge, this is the first reported case of necrotizing scleritis following XEN Gel Stent insertion. It is a reminder that infection should always be the primary differential diagnosis in patients with surgical-induced necrotizing scleritis.
Interrupted femtosecond laser delivery secondary to face mask–related fogging
Authors: Sachdev Mahipal S. , Malik Raghav , Sachdev Gitansha Shreyas , Heroor Anagha , Thoumungkan Bharat R. 
Published: November 2021

Introduction:
An increase in face mask utilization has been noted during the COVID-19 pandemic. A rare complication of keratorefractive surgery where interruption of femtosecond-laser delivery was noted secondary to face-mask related fogging of the patient interface is reported.

Patient and clinical findings:
Young patients with stable tear film and healthy ocular surface were advised femtosecond laser assisted laser in situ keratomileusis (3 eyes) and small-incision lenticule extraction (1 eye) for refractive errors. Intraoperative interruption of laser delivery was noted secondary to droplet condensation or fogging of the patient interface. The fogging developed secondary to the escape of humid exhaled breath.

Diagnosis, intervention, and outcomes:
Incomplete delivery of the laser required aborting the procedure with retreatment at a later date. In eyes where partial laser delivery was obtained, the flap was manually dissected from the underlying stroma and the procedure was completed in the same sitting. All eyes achieved a final uncorrected distance visual acuity of 20/20 with no long-term sequelae.

Conclusions:
Fogging of the patient interface is a rare complication secondary to face mask use. Sealing the top of the face mask with well-adhering micropore, readjustment of face masks, removing the mask prior to draping, and checking for droplet condensates on the interface prior to laser delivery may minimize the incidence.
Nutritional screening and nutritional interventions in patients following gastrointestinal surgery in a general surgical ward: a best practice implementation project
Authors: Zhang Qi , Yu Zhenghong , Qi Birong , Ni Xiaohong , Moola Sandeep 
Published: November 2021

ABSTRACT

Objectives:
The aim of this implementation project was to improve nutritional screening and nutritional interventions for patients scheduled for gastrointestinal surgery in a general surgical ward.

Introduction:
Malnutrition is common in hospitalized surgical patients and has many adverse outcomes affecting the patients’ quality of life. Improving nutritional risk screening and nutritional support could reduce the incidence of malnutrition and its adverse outcomes.

Methods:
The project used the JBI audit and feedback method to implement evidence into practice. JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used for promoting change in general surgical wards. Six audit criteria were created based on an evidence summary, including using screening tool, patients’ and caregivers’ education, nurses’ education on nutritional screening and support, preoperative nutrition support and postoperative early food intake. A baseline audit was conducted, followed by nursing information system improvement, education, multidisciplinary meetings targeted at clinicians and two cycles of follow-up audits.

Results:
Results from the baseline and follow-up audits showed improvement for all the criteria. Compliance for criteria 1–3 increased from 0 to 100%, and that for criterion 4 increased from 32 to 100%. These four criteria sustained 100% in follow-up cycle 2. Compliance for criterion 5 increased from 8 to 50% in follow-up cycle 1 audit, but decreased to 0% in follow-up cycle 2 audit, and similarly for criterion 6, compliance increased from 45 to 56% in follow-up cycle 1 audit, but decreased to 48% in follow-up cycle 2 audit.

Conclusion:
The objectives related to nutritional risk screening, nurse knowledge, patients and families were successfully realized and sustained positive results. This project demonstrated that a nursing information system and long-term patient education are essential strategies to achieve and sustain positive results. The objectives related to preoperative nutritional support and postoperative early enteral food intake were challenges and represented barriers. In future, a multiple-pronged strategy will be implemented to achieve overall success and change according to best practice.
Perioperative diabetes management of adult patients with diabetes: a best practice implementation project
Authors: Chen Tanghua , Kumaran Suji , Vigh Gia , Astorga Cecilia , Beehan Sean , Burrell Maria , Deakin Gail , Kernahan Carmen , Lambrakis Paul , Loader Joanne , Ly Nakim , Nguyen Mark , Pasco Kristofer , Perry Mary , Richter Matthew , Russell Hamish , Smith Frances , Venzon Raquel , Vernon Amanda 
Published: November 2021

ABSTRACT

Objectives:
The objectives of this project were to conduct a retrospective healthcare records audit to determine the current compliance with evidence-based criteria regarding perioperative management of patients with diabetes; to identify barriers and facilitators to achieve compliance and develop strategies to address areas of non-compliance, and to implement evidence-based best practice recommendations for perioperative diabetic management and to assess the effectiveness of these strategies in improving compliance of perioperative diabetic management across five participating clinical areas in a large tertiary referral hospital.

Introduction:
Type 2 diabetes is a frequent co-morbidity among inpatients. It affects up to 20% of the general surgical population. Patients with diabetes undergoing surgery have a greater complication rate and length of hospital stay. Optimization of diabetes management of hospitalized patients will improve quality of care delivery, prevent postoperative complications and reduce length of stay and costs. However, there is limited knowledge and understanding of whether the current nursing practices concerning perioperative diabetic management meet the best practice recommendations outlined by JBI best practice criteria.

Methods:
A pre-post intervention healthcare record audit was conducted to examine compliance with nine best practice recommendations for perioperative diabetic management across five clinical areas. Following pre-intervention data analysis along with two focus group discussions, barriers to compliance with best practice criteria were identified and targeted strategies were used to address the issues. This project used the JBI Practice Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools.

Results:
Face to face education sessions and educational resources relating to perioperative diabetic management were delivered to nursing staff, which resulted in improved compliance for most of the audit criteria, with significant improvement in the areas of regular blood glucose level monitoring and nursing staff receiving education and training in the post-implementation analysis.
Maintaining oral hydration in older adults in surgical wards: a best practice implementation project
Authors: Seah Kwang Hui , Low Amanda Pei Shan , Low Jian Ying , Luk Grace Kar Sin , Chia Hui Xian , Goh Mien Li 
Published: November 2021

ABSTRACT

Introduction and aim:
Oral hydration is essential in older adults as poor hydration can complicate existing medical conditions and increase morbidity. Older adults in surgical wards are at risk of dehydration due to insufficient fluid consumption. The aim of this project is to ensure patients aged 65 years and above are adequately hydrated.

Methods:
The current project was conducted over 7 months from February to August 2019 and involved pre and postimplementation audits to ensure compliance with best practice. The Joanna Briggs Institute Practical Application of Clinical Evidence System and the Getting Research into Practice tools were used as a guide. Audits were conducted at four surgical wards with a sample of 42 patients at each audit. The measures implemented include educating nurses on the importance of oral hydration in older adult patients and labelling water jugs to encourage fluid intake among these patients.

Results:
Nurses’ compliance in monitoring older adult patients’ daily fluid intake increased from 5 to 76% at follow-up audit (P < 0.05). In addition, the average amount of fluid consumed over 3 days increased from 858.23 to 1037.50 ml.

Conclusion:
This project demonstrated a significant increase in oral fluid intake among older adult patients during hospitalization and their understanding of adequate fluid intake. Nurses play an important role in ensuring adequate amounts of daily fluid intake by these patients.
The incorporation of body composition assessments as part of routine clinical care in a tertiary hospital's dietetic department: a best practice implementation project
Authors: Wilkinson Shelley A. , Jobber Chloe J.D. , Nave Fiona , van der Meij Barbara S. 
Published: November 2021

ABSTRACT

Objectives:
Our aim was to incorporate body composition assessment (BCA) into dietetic department procedures using interventions tailored to previously identified barriers and enablers.

Introduction:
BCA is recommended as part of routine malnutrition assessment and follow-up but is not yet part of usual care.

Methods:
Evidence-informed strategies to overcome barriers and enablers were operationalized and delivered as three overarching interventions: upskilling (professional development strategy), modelling and reducing fear of change (Clinical Champion project), and embedding as usual practice (departmental integration). Process evaluation assessed intervention fidelity. A survey assessed utilization of BCA devices, (perceived) competency, and attitudes of clinical dietitians towards BCA before and after interventions.

Results:
Two of the three elements were incorporated as planned (upskilling and embedding as usual practice), with one element (modelling and reducing fear of change) modified through iterative processes. The Clinical Champion project ran for 12 rather than 6 months, and resulted in the majority of champions confident with their skills, completing BCA within their daily clinical workload and feeling BCA was useful. Pre-surveys and post-surveys within the department of 26 dietitians showed a marked reduction in most perceived barriers and improved recognition of enablers across all theoretical framework domains; with a large proportion of ‘not applicable’ responses given for many barriers at follow-up.

Conclusion:
This evidence-informed implementation strategy successfully integrated BCA into dietitians’ practice and departmental processes highlighting direction for future service changes. Continual assessment of barriers and success of integration into routine workloads is required to facilitate this.
Improvement in use of best practice in the care of patients with oral mucositis in a comprehensive cancer center in Iran: a best practice implementation case study
Authors: Alizadeh Mahasti , Moradi Siavash , Zaboli Ehsan , Emadian Seyedeh Fatemeh , Ghorbani Anahita , Hedayatizadeh Omran Akbar , Alizadeh Navaei Reza 
Published: November 2021

ABSTRACT

Introduction:
Oral mucositis is a common debilitating complication of cancer treatments, particularly chemotherapy and radiation.

Objectives:
The purpose of this study was to improve oral mucositis prevention and control among cancer patients through the implementation of best practice guidelines in a tertiary referral center in Northern Iran.

Methods:
A clinical audit design was utilized in this implementation project. A preimplementation audit was conducted against nine best practice criteria for the prevention and treatment of oral mucositis among new cases of cancer patients in November and December 2019. Fifty cancer patients and 20 nurses participated in this phase of the clinical audit. The next step included a facilitated multidisciplinary focus group identifying targeted strategies and implementing them, completed in late December 2019. A postimplementation audit was then conducted on another 50 cancer patients and the same 20 nurses in January and early February 2020. The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice software.

Results:
The preimplementation audit revealed gaps between the current practice and best practice across eight of the nine criteria. After implementing the targeted strategies, the outcomes improved across most of the criteria in the follow-up audit: 80% increase was observed in compliance of staff education, 100% increase in providing standard oral hygiene protocol in place, 64% increase in carrying out a dental examination and conducting initial oral cavity examination, and also 34% increase in conducting of ongoing oral cavity examination by a dentist, and finally 100% increase in providing preventive and therapeutic oral care regimens in place and oral pain assessment using a validated tool.

Conclusion:
The results of this project indicate that clinical auditing is an effective approach to the assessment of evidence-based care practices for oral mucositis among new cancer patients. Evidence-based oral mucositis management among cancer patients can be achieved by educating the patients and nursing staff using the newest guidelines and dentists’ comprehensive dental and oral hygiene examinations.
Early-Stage Identification and Avoidance of Antisense Oligonucleotides Causing Species-Specific Inflammatory Responses in Human Volunteers Peripheral Blood Mononuclear Cells
Authors: Burel Sebastien A. , Machemer Todd , Baker Brenda F. , Kwoh T. Jesse , Paz Suzanne , Younis Husam , Henry Scott P. 
Published: November 2021

AbstractA human peripheral blood mononuclear cell (PBMC)-based assay was developed to identify antisense oligonucleotide (ASO) with the potential to activate a cellular innate immune response outside of an acceptable level. The development of this assay was initiated when ISIS 353512 targeting the mRNA for human C-reactive protein was tested in a phase I clinical trial in which healthy human volunteers unexpectedly experienced increases in interleukin-6 (IL-6) and C-reactive protein. This level of immune stimulation was not anticipated following rodent and non-human primate safety studies in which no evidence of exaggerated proinflammatory effects were observed. The IL-6 increase induced by ISIS 353512 was caused by activation of B-cells. The IL-6 induction was inhibited by chloroquine pretreatment of the PBMC and the nature of the ASOs suggested that the response is mediated by a toll like receptor, in all likelihood TLR9. While assessing the inter PBMC donor variability, two class of responders to ISIS 353512 were identified (discriminator and non-discriminators). The discriminator source of PBMC was shown to produce low level of IL-6 after 24 hours in culture in absence of ASO treatment. The PBMC assay using discriminator donors was shown to be reproducible allowing to assess reliably the immune potential of ASOs via comparison to known benchmark ASO controls that were previously shown to be either safe or inflammatory in clinical trials.