bluuebunny/crossref_metadata_2025_split huggingface dataset:
Driving pressure monitoring during acute respiratory failure in 2020
Authors: Chen Lu , Jonkman Annemijn , Pereira Sérgio M. , Lu Cong , Brochard Laurent 
Published: April 2021

Purpose of review
Assess the most recent studies using driving pressure (DP) as a monitoring technique under mechanical ventilation and describe the technical challenges associated with its measurement.

Recent findings
DP is consistently associated with survival in acute respiratory failure and acute respiratory distress syndrome (ARDS) and can detect patients at higher risk of ventilator-induced lung injury. Its measurement can be challenged by leaks and ventilator dyssynchrony, but is also feasible under pressure support ventilation. Interestingly, an aggregated summary of published results suggests that its level is on average slightly lower in patients with coronavirus disease-19 induced ARDS than in classical ARDS.

Summary
The DP is easy to obtain and should be incorporated as a minimal monitoring technique under mechanical ventilation.
How to monitor cardiovascular function in critical illness in resource-limited settings
Authors: Sivakorn Chaisith , Schultz Marcus J. , Dondorp Arjen M. 
Published: April 2021

Purpose of review
Hemodynamic monitoring is an essential component in the care for critically ill patients. A range of tools are available and new approaches have been developed. This review summarizes their availability, affordability and feasibility for hospital settings in resource-limited settings.

Recent findings
Evidence for the performance of specific hemodynamic monitoring tools or strategies in low-income and middle-income countries (LMICs) is limited. Repeated physical examination and basic observations remain a cornerstone for patient monitoring and have a high sensitivity for detecting organ hypoperfusion, but with a low specificity. Additional feasible approaches for hemodynamic monitoring in LMICs include: for tissue perfusion monitoring: urine output, skin mottling score, capillary refill time, skin temperature gradients, and blood lactate measurements; for cardiovascular monitoring: echocardiography and noninvasive or minimally invasive cardiac output measurements; and for fluid status monitoring: inferior vena cava distensibility index, mini-fluid challenge test, passive leg raising test, end-expiratory occlusion test and lung ultrasound. Tools with currently limited applicability in LMICs include microcirculatory monitoring devices and pulmonary artery catheterization, because of costs and limited added value. Especially ultrasound is a promising and affordable monitoring device for LMICs, and is increasingly available.

Summary
A set of basic tools and approaches is available for adequate hemodynamic monitoring in resource-limited settings. Future research should focus on the development and trialing of robust and context-appropriate monitoring technologies.
The association of body temperature with antibiotic therapy and mortality in patients attending the emergency department with suspected infection
Authors: Schuttevaer Romy , Brink Anniek , Alsma Jelmer , de Steenwinkel Jurriaan E.M. , Verbon Annelies , Schuit Stephanie C.E. , Lingsma Hester F. 
Published: April 2021

Background and importance
Previous studies found that septic patients with normothermia have higher mortality than patients with fever. We hypothesize that antibiotic therapy is less frequently initiated if infectious patients present with normothermia to the emergency department (ED).

Objectives
To examine the association of body temperature with the initiation of antibiotic therapy in patients attending the ED with suspected and proven infection. Additionally, the association of temperature with 30-day mortality was assessed.

Design, settings and participants
We conducted a retrospective cohort study between 2012 and 2016 at a tertiary university hospital. Adult patients attending the ED with a blood culture taken (i.e. suspected infection) and a positive blood culture (i.e. proven bacteremia) were included.

Exposure
Tympanic temperature at arrival was categorized as hypothermia (<36.1°C), normothermia (36.1–38.0°C) or hyperthermia (>38.0°C).

Outcome measures and analysis
Primary outcome was the initiation of antibiotic therapy. A secondary outcome was 30-day mortality. Multivariable logistic regression was used to control for covariates.

Main results
Of 5997 patients with a suspected infection, 45.8% had normothermia, 44.6% hyperthermia and 5.6% hypothermia. Patients with hyperthermia received more often antibiotic therapy (53.5%) compared to normothermic patients (27.6%, adjusted odds ratio [95% confidence interval], 2.59 [2.27–2.95]). Patients with hyperthermia had lower mortality (4.7%) than those with normothermia (7.4%, adjusted odds ratio [95% confidence interval], 0.50 [0.39–0.64]). Sensitivity analyses in patients with proven bacteremia (n = 934) showed similar results.

Conclusion
Normothermia in patients presenting with infection was associated with receiving less antibiotic therapy in the ED compared to presentations with hyperthermia. Moreover, normothermia was associated with a higher mortality risk than hyperthermia.
Impact of Obstetric Emergency High-Fidelity Simulation on Maternity Nurses' Self-Efficacy in the Rural Hospital Setting
Authors: Ehmke Sabrina , Swan Marilyn , Van Gelderen Stacey , Bourdeanu Laura 
Published: April 2021

Abstract

Purpose:
The purpose of this study was to explore the impact of an obstetric emergency high-fidelity simulation on maternity nurses' perceived self-efficacy levels at three different time points.

Study Design:
We used a quasi-experimental, repeated measures design.

Methods:
A convenience sample of maternity nurses recruited from three institutions within a single rural health care system participated in simulation exercises at an academic high-fidelity simulation center. They completed the Obstetric Nursing Self Efficacy survey before, immediately after, and 2 months following the simulation.

Results:
Twenty-nine nurses were included in the analysis. All were women and Caucasian. Most (72.4%) had a baccalaureate nursing degree, with an average nursing experience of 11 years (range 1 to 44 years), and <5 years of OB experience (55.1%). Self-efficacy scores were 55.62 (SD = 9.8), 58.93 (SD = 8.9), and 61.86 (SD = 9.5) for pre-, post-, and 2 months postsimulation, respectively. There were significant changes from self-efficacy scores before the simulation when compared with scores 2 months after the simulation (p < 0.001), with a medium effect size of .45.

Clinical Implications:
High-fidelity simulation can improve maternity nurses' perceived self-efficacy in managing emergency obstetric clinical situations. Health care institutions should consider investing in high-fidelity simulation education or partnering with academic institutions that have simulation centers to promote maternity nurses' self-efficacy that can potentially translate into improved clinical skills and improved patient outcomes.
Resilience and Burnout in Pediatric Nurses in a Tertiary Children's Hospital
Authors: Waterworth Susan , Grace Anna-Marie 
Published: April 2021

Abstract

Purpose:
To identify levels of burnout and resilience in pediatric nurses in a tertiary children's hospital in New Zealand.

Methods:
Registered nurses providing pediatric care participated in a survey that included the Connor-Davison resilience scale and Maslach burnout scale. Nurses identified specific factors related to workload stress and strategies for enhancing resilience.

Results:
Participants were 197 nurses. We found low levels of resilience and high levels of burnout, although personal accomplishment scores were high. Nurses with <10 years of experience who worked >40 hours per week had significantly higher levels of emotional exhaustion compared with those who had >10 or more years of experience or worked <40 hours per week. There were differences in resilience levels based on years of practice and hours worked. Levels of depersonalisation were higher in different ethnic groups.

Clinical Implications:
Burnout remains a significant problem for pediatric nurses. Job demands are likely to rise with the increased complexity of children with long-term conditions and families requiring support. Developing supportive plans to strengthen resilience and limit burnout are required. Further research is needed on how organizations can foster resilience practices and limit burnout, nurses feeling emotionally exhausted, reducing depersonalisation, and enhancing feelings of personal accomplishment. Nurse leaders can role-model positive resilience practices when engaging their teams in open conversations about preventing or reducing burnout.
Pan-TRK Immunohistochemistry Is Highly Correlated With NTRK3 Gene Rearrangements in Salivary Gland Tumors
Authors: Csanyi-Bastien Marie , Lanic Marie-Delphine , Beaussire Ludivine , Ferric Sandra , François Arnaud , Meseure Didier , Jardin Fabrice , Wassef Michel , Ruminy Philippe , Laé Marick 
Published: April 2021

Aims:
Secretory carcinoma (SC) is characterized by ETV6 rearrangements, most often ETV6-NTRK3 fusion. Given its histologic overlap with other salivary gland tumors (SGTs), SCs can be difficult to diagnose without genetic confirmation. A recently developed pan‐TRK (tropomyosin receptor kinase) antibody shows promise for identifying tumors with NTRK (neurotrophic tyrosine kinase receptor 3) fusions. The aim of this study was to evaluate the utility of pan‐TRK immunohistochemistry in distinguishing SCs from mimics and selecting patients eligible for TRK inhibitor clinical trials. We examined whole‐tissue sections from 111 SGTs with molecular characterization, including 26 SCs (23 with ETV6-NTRK3 fusion and 3 with ETV6-RET fusion detected by ligation-dependent reverse transcription-polymerase chain reaction, next-generation sequencing and 85 non-SC SGTs (no ETV6-NTRK3 fusion). Immunohistochemistry was performed with a pan‐TRK rabbit monoclonal antibody. When any pan‐TRK staining (nuclear or cytoplasmic with any staining intensity) was considered to indicate positivity, 22 of 23 SCs with ETV6-NTRK3 fusion (95.7%) and 33 of 85 non‐SC (38.8%) salivary neoplasms were positive, mainly basal cell adenoma, pleomorphic adenomas, adenoid cystic carcinomas, and epithelial-myoepithelial carcinomas. All SCs with ETV6-RET fusion were entirely negative. When only nuclear pan-TRK staining with any staining intensity was considered positive, 18 of 23 SCs with ETV6-NTRK3 fusion (78.3%) were positive, 11 among them with diffuse staining (>30% of cells). All non-SCs and SCs with ETV6-RET fusion were entirely negative. In comparison to molecular analysis (ligation-dependent reverse transcription-polymerase chain reaction, next-generation sequencing), nuclear pan-TRK IHC has a sensitivity of 78.3% and a specificity of 100% for diagnosing SCs with ETV6-NTRK3 fusion, 69% and 100% for SCs (all fusions). Pan-TRK is a reasonable screening test for diagnosing SCs among SGTs when taking only nuclear staining into account. Although pan-TRK expression is not entirely sensitive for SCs, nuclear staining is highly specific for SCs with ETV6-NTRK3 fusion. The lack of pan-TRK immunoreactivity in a subset of SCs is suggestive of atypical exons 4 to 14 or exons 5 to 14 ETV6-NTRK3 fusion or non-NTRK alternative fusion partners such as ETV6-RET. Pan-TRK staining can serve as a strong diagnostic marker to distinguish SC from it mimics and to select patients eligible for TRK inhibitor clinical trials.
Realistic Kidney Tissue Surrogates for Multienergy Computed Tomography—Feasibility and Estimation of Energy-Dependent Attenuation Thresholds for Renal Lesion Enhancement in Low-kV and Virtual Monoenergetic Imaging
Authors: Euler André , Zadory Matthias , Breiding Philipe Sebastian , Sartoretti Thomas , Ghafoor Soleen , Froehlich Johannes Malta , Donati Olivio Fabrizio 
Published: April 2021

Purpose
The aims of this study were to assess if kidney tissue surrogates (KTSs) are superior to distilled water-iodine solutions in the emulation of energy-dependent computed tomography (CT) attenuation characteristics of renal parenchyma and to estimate attenuation thresholds for definite lesion enhancement for low-kV single-energy and low-keV dual-energy virtual monoenergetic imaging.

Methods
A water-filled phantom (diameter, 30 cm) with multiple vials was imaged on a dual-source dual-energy CT (DS-DE) and a single-source split-filter dual-energy CT (SF-DE), both in single-energy mode at 80, 100, 120, 140 kVp and in dual-energy mode at 80/Sn150, 90/Sn150, and 100/Sn150 kVp for DS-DE and AuSn120 kVp for SF-DE. Single-energy images, linear-blended dual-energy images, and virtual monoenergetic imaging at energy levels from 40 to 190 keV were reconstructed. First, attenuation characteristics of KTS in solid and liquid consistencies were compared. Second, solid KTSs were developed to match the CT attenuation of unenhanced renal parenchyma at 120 kVp as retrospectively measured in 100 patients. Third, CT attenuation of KTS-iodine and water-iodine solutions at 8 different iodine concentrations (0–10 mg I/mL) were compared as a function of tube voltage and of keV level using multiple linear regression models. Energy-dependent attenuation thresholds for definite lesion enhancement were calculated.

Results
Unenhanced renal parenchyma at 120 kVp measured on average 30 HU on both scanners in the patient cohort. Solid KTS with a water content of 80% emulated the attenuation of unenhanced renal parenchyma (30 HU) more accurately compared with water-iodine solutions (0 HU). Attenuation difference between KTS-iodine and water-iodine solutions converged with increasing iodine concentration and decreasing x-ray energy due to beam-hardening effects. A slight attenuation difference of approximately 2 HU was found between the 2 CT scanners. Attenuation thresholds for definite lesion enhancement were dependent on tube voltage and keV level and ranged from 16.6 to 33.2 HU and 3.2 to 68.3 HU for single-energy and dual-energy CT scan modes for DS-DE and from 16.1 to 34.3 HU and 3.3 to 92.2 HU for SF-DE.

Conclusions
Kidney tissue surrogates more accurately emulate the energy-dependent CT attenuation characteristics of renal parenchyma for multienergy CT compared with conventional water-iodine approaches. Energy-dependent thresholds for definite lesion enhancement could facilitate lesion characterization when imaging at different energies than the traditional 120 kVp.
Robotic Distal Gastrectomy With a Novel “Preemptive Retropancreatic Approach” During Dissection of Suprapancreatic Lymph Nodes for Gastric Cancer
Authors: Ebihara Yuma , Kurashima Yo , Murakami Soichi , Shichinohe Toshiaki , Hirano Satoshi 
Published: April 2021

Introduction:
Abrogating contact with the pancreas in suprapancreatic lymph nodes dissection for gastric cancer can prevent pancreatic fistula because of postoperative pancreatic damage. Our novel “Preemptive retropancreatic approach” is a useful technique that minimizes pancreatic compression during robotic distal gastrectomy (RDG) with multijointed forceps. Here, we report the usefulness of RDG for gastric cancer surgery using our novel “Preemptive retropancreatic approach”.

Materials:
“Preemptive retropancreatic approach”: initial dissection of the bilateral retropancreatic space, the adherence between the retroperitoneum surface and the pancreas (fusion fascia) is released, providing a good operative field and hindering contact with the pancreas in suprapancreatic lymph nodes dissection during RDG. We herein reported consecutive 30 patients with gastric cancer who underwent RDG at Hokkaido University from September 2014 to March 2020.

Results:
All operations were performed by a single surgeon (Y.E.). The median operating time was 281 minutes (132 to 415). The median intraoperative bleeding was 0 ml of blood (0 to 255). There were 2 incidences of postoperative complications (≥Clavien-Dindo classification II), and there were no cases of postoperative pancreas-related complications. The median length of hospital stay after the surgery was 10 days (6 to 33).

Conclusion:
As RDG for gastric cancer is still in its early introductory phase, its superiority has yet to be definitively established. However, we believe that “Preemptive retropancreatic approach” may reduce postoperative pancreatic-related complications in suprapancreatic lymph nodes dissection.
Whole genome sequencing as an investigational device for return of hereditary disease risk and pharmacogenomic results as part of the All of Us Research Program
Authors: Venner E , Muzny D , Smith JD , Walker K , Neben CL , Lockwood CM , Empey PE , Metcalf GA ,   The All of Us Research Program Regulatory Working Group, Mian S , Musick A , Rehm H , Harrison S , Gabriel S , Gibbs R , Nickerson D , Zhou AY , Doheny K , Ozenberger B , Topper SE , Lennon NJ 
Published: April 2021

AbstractThe All of Us Research Program (AoURP, ‘the program’) is an initiative, sponsored by the National Institutes of Health (NIH), that aims to enroll one million people (or more) across the United States. Through repeated engagement of participants, a research resource is being created to enable a variety of future observational and interventional studies. The program has also committed to genomic data generation and returning important health-related information to participants. To do so, whole genome sequencing (WGS), variant calling processes, data interpretation, and return-of-results procedures had to be created and receive an Investigational Device Exemption (IDE) from the United States Food and Drug Administration (FDA). The performance of the entire workflow was assessed through the largest known cross-center, WGS-based, validation activity that was refined iteratively through interactions with the FDA over many months. The accuracy and precision of the WGS process as a device for the return of certain health-related genomic results was determined to be sufficient, and an IDE was granted. We present here both the process of navigating the IDE application process with the FDA and the results of the validation study as a guide to future projects which may need to follow a similar path. Future supplements to the IDE will be submitted to support additional variant classes, sample types, and any expansion to the reportable regions.
Longitudinal changes in physical activity during and after the first national lockdown due to the COVID-19 pandemic in England
Authors: Bu Feifei , Bone Jessica K , Mitchell John J , Steptoe Andrew , Fancourt Daisy 
Published: April 2021

AbstractBackgroundRecent studies have shown reduced physical activity at early stages of the COVID-19 pandemic. However, there is a lack of investigation on longitudinal changes in physical activity beyond lockdowns and stay at home orders. Moreover, it is unclear if there is heterogeneity in physical activity growth trajectories. This study aimed to explore longitudinal patterns of physical activity and factors associated with them.MethodsData were from the UCL COVID -19 Social Study. The analytical sample consisted of 35,915 adults in England who were followed up for 22 weeks from 24th March to 23rd August 2020. Data were analysed using growth mixture models.FindingsOur analyses identified six classes of growth trajectories, including three stable classes showing little change over time (62.4% in total), two classes showing decreasing physical activity (28.6%), and one class showing increasing physical activity over time (9%). A range of factors were found to be associated the class membership of physical activity trajectories, such as age, gender, education, income, employment status, and health.InterpretationThere is substantial heterogeneity in longitudinal changes in physical activity during the COVID-19 pandemic. However, a substantial proportion of our sample showed persistent physical inactivity or decreasing physical activity. Given the well-established linked between physical activity and health, persistent or increased physical inactivity is likely to have both immediate and long-term implications for people’s physical and mental health, as well as general wellbeing. More efforts are needed to promote physical activity during the pandemic and beyond.FundingNuffield Foundation, UK Research and Innovation, Wellcome Trust
“Immunogenetics of resistance to SARS-CoV-2 infection in discordant couples”
Authors: Castelli Erick C. , de Castro Mateus V. , Naslavsky Michel S. , Scliar Marilia O. , Silva Nayane S. B. , Andrade Heloisa S. , Souza Andreia S. , Pereira Raphaela Neto , Castro Camila F. B. , Mendes-Junior Celso T. , Meyer Diogo , Nunes Kelly , Matos Larissa R. B. , Silva Monize V. R. , Wang Jaqueline T. W. , Esposito Joyce , Coria Vivian R. , Bortolin Raul H. , Hirata Mario H. , Magawa Jhosiene Y. , Cunha-Neto Edecio , Coelho Verônica , Santos Keity S. , Marin Maria Lucia C. , Kalil Jorge , Neto Miguel Mitne , Maciel Rui M. B. , Passos-Bueno Maria Rita , Zatz Mayana 
Published: April 2021

AbstractBackgroundDespite the high number of individuals infected by SARS-CoV-2 who develop COVID-19 symptoms worldwide, many exposed individuals remain asymptomatic and/or stay uninfected. This could be explained by a combination of environmental (exposure, previous infection), epigenetic, and genetic factors. Aiming to identify genetic variants involved in SARS-CoV-2 resistance, we analyzed 86 discordant Brazilian couples where one was infected and symptomatic while the partner remained asymptomatic and seronegative despite sharing the same bedroom during the infection. The discordant partners had comparable ages, and genetic ancestry proportions.MethodsWhole-exome sequencing followed by a state-of-the-art method to call genotypes and haplotypes across the highly polymorphic MHC and LRC.ResultsWe observed a minor impact in antigen-presentation genes and KIR genes associated with resistance. Interestingly, genes related to immune modulation, mainly involved in NK cell killing activation/inhibition harbor variants potentially contributing to infection resistance. We hypothesize that individuals prone to produce higher amounts of MICA (possibly soluble), LILRB1, LILRB2, and low amounts of MICB, would be more susceptible to infection.ConclusionAccording to this hypothesis, quantitative differences in these NK activity-related molecules could contribute to resistance to COVID-19 down regulating NK cell cytotoxic activity in infected individuals but not in resistant partners.