bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dexmedetomidine in the emergency department: A prospective observational cohort study
Authors: Baumgartner Kevin , Joseph Matt , Lothet Emilie , Fuller Brian M. 
Published: December 2023

AbstractBackgroundDexmedetomidine (DEX) is a centrally acting sympatholytic sedative. Abundant evidence from the intensive care unit and other settings demonstrates that the use of DEX is associated with improved sedation‐related outcomes. There is a paucity of data on the use and efficacy of DEX in the emergency department (ED).MethodsWe performed a prospective single‐center observational cohort study of patients treated with intravenous DEX for any indication in the ED. We performed serial bedside evaluations of sedation depth and delirium and administered standardized questionnaires to ED physicians about their use of DEX. We assessed the incidence of hemodynamic adverse events (HAEs; bradycardia or hypotension), clinically significant HAEs (HAEs accompanied by clinical intervention or discontinuation of DEX), sedation‐related ED outcomes, and clinician perception of DEX effectiveness.ResultsWe enrolled 75 patients treated with DEX in the ED during our study period. The most common indication for DEX was noninvasive positive pressure ventilation (32 patients, 43%). DEX was administered in the ED for a median of 2.6 h (interquartile range [IQR] 1.6–4.9 h), with a median infusion rate of 0.3 μg/kg/h (IQR 0.2–0.4 μg/kg/h). Clinically significant HAE occurred in nine patients (12%, 95% CI 6%–22%). Other sedative or analgesic infusions were administered in the ED to 21 patients (28%). Clinicians felt DEX was highly effective (median [IQR] effectiveness score of 5 [3–5] on a 5‐point Likert scale). The median (IQR) ED Richmond Agitation Sedation Scale post‐DEX was −1 (−4 to 0).ConclusionsDEX is used in the ED for diverse indications. Additional data from larger cohorts and comparative studies are required to determine the precise incidence of clinically significant HAE associated with DEX use in the ED. ED clinicians have a positive perception of the effectiveness of DEX.
Overcoming stagnant flow: A scoping review of vertical movement in the emergency department
Authors: Lowie Bobbi‐Jo , Hicks Courtney , Falat Cheyenne , Hydorn Stacey Chaney , Windsor T. Andrew , Smedley Angela , Fu Yunting , Gatz J. David 
Published: December 2023

AbstractObjectivesImproving emergency department (ED) patient flow has plagued many hospitals worldwide. “Vertical” flow improves throughput by maximizing use of chairs and waiting areas instead of beds. This process, however, is inconsistently described in the literature. The objective of this study was to collate existing evidence of successful vertical care programs.MethodA scoping review was conducted within several databases utilizing key search terms to capture relevant traditional and gray literature. All articles were uploaded into Covidence (n = 1000). After duplicates were removed, remaining abstracts were initially screened by two reviewers (n = 731). Records identified by at least one reviewer subsequently underwent a two‐reviewer full‐text screening for inclusion (n = 46). This process yielded 36 articles. Finally, each record underwent data extraction by two independent study members and any inconsistencies were resolved by a third study member. Extracted data included 21 predetermined variables. Descriptive statistics were used to summarize results.ResultsOf the 36 included articles, most were published from the United States (91.7%), after 2014 (55.6%), and as a peer‐reviewed article or abstract/conference proceeding (86.1%). While every article discussed some aspect of vertical flow, most (77.8%) were observational studies. Only half of the studies reported details of staffing and/or physical resources. A variety of challenges and success strategies were described, with several themes identified. Positive outcomes were reported by most articles (86%), although measurement of outcomes varied with the two most common being length of stay (69.4%) and arrival‐to‐provider time (55.6%).ConclusionsThe findings of this scoping review provide the first summative report of existing literature on vertical flow processes within the ED setting. Despite different measurable outcomes and varied processes, most articles support the use of vertical flow to improve throughput.
Don't take my trees: Re‐evaluating the importance of trees when it comes to managing green and golden bell frog, Litoria aurea, habitat
Authors: Gould John , Callen Alex , Matthews Lynne , Beranek Chad , McHenry Colin 
Published: December 2023

AbstractIt is vital to identify habitats used by each life stage of a species to formulate effective conservation management and restoration guidelines. For the threatened green and golden bell frog, Litoria aurea, it is currently recommended that, to prevent waterbody shading, managed or constructed habitat for the species should not include trees. Shading has been reported to prevent adults from sun basking, reduce breeding activity, and lower water temperatures, which may impede tadpole growth and development and provide optimum conditions for the amphibian chytrid pathogen, Batrachochytrium dendrobatidis. However, the complete exclusion of trees, which are naturally present in L. aurea habitat, warrants evidence that supports this recommendation. In the present study, we used a multi‐year dataset on an L. aurea population on Kooragang Island, NSW, Australia to determine the occurrence of tree use by post‐metamorphic individuals. These data included information on nearly 12 500 individuals captured from 86 waterbodies across 8 consecutive breeding seasons. We found that tree use by juveniles, adult males, and adult females was widespread and common, occurring both during the day and night, with more than one out of every 20 individuals captured in trees. Our findings suggest that trees are a potentially important attribute of the terrestrial component of wetland habitats occupied by L. aurea. We hypothesize that trees may (i) create microhabitat for foraging and/or increased diversity of prey species, (ii) provide refuge from predators, and (iii) allow sun basking off the ground, thereby offering protection against the chytrid fungus while removing them from chytrid‐prevalent environments such as water and moist soils. We call for the careful reconsideration of tree exclusion within L. aurea habitat and further research into the benefits of allowing trees to grow near waterbodies to accommodate the ecological needs of this threatened species.
Microanatomical, histochemical and morphometric features of the major and selected minor salivary glands in laboratory Wistar rat
Authors: Adrian Florin Gal , Maria‐Catalina Matei‐Latiu , Viorel Miclaus , Vasile Rus , Calin Latiu , Adela Ratiu Ioana 
Published: December 2023

AbstractThe major and minor salivary glands are responsible for saliva production, a fluid drained in the oral cavity that will be involved in several functions at this level. The present study aimed to compare the microanatomy of the major (parotid, mandibular, sublingual) and minor salivary glands (von Ebner's and Weber's) of the Wistar rat, from a histological, histochemical and morphometrically point of view. Predominantly serous glands (parotid, mandibular and von Ebner's) showed differences in the secretion composition on both PAS and alcian blue reactions. The same observations were identified also for the mostly mucous salivary glands (sublingual and Weber). In terms of surface dimensions, the measurements suggested that the mucous acini have a greater surface compared with the serous ones, and, at the same time, a better‐represented polymorphism. In conclusion, the major and minor salivary glands in Wistar rats, a commonly used species in experimental procedures, showed similarities with other species including humans, but some structural traits are breed‐specific, this finding is very important for an extensive understanding of the morphophysiology of the salivary glands.
Differences in shift and work‐related patterns between metropolitan and regional/rural healthcare shift workers and the occupational health and safety risks
Authors: Booker Lauren A. , Spong Jo , Hodge Brad , Deacon‐Crouch Melissa , Bish Melanie , Mills Jane , Skinner Timothy C. 
Published: December 2023

AbstractObjectivesTo explore if there are differences in shift patterns and work‐related factors between metropolitan and regional/rural healthcare shift workers and their risk of poor sleep and mental health. Furthermore, explore whether these factors impact on medical errors, workplace and car/near car accidents.DesignA cross‐sectional study.SettingAn anonymous online survey of healthcare shift workers in Australia.ParticipantsA total of 403 nurses, midwives and paramedics completed the survey.Main outcome measuresSample characteristics, employment location, shift work‐related features, sleep and mental health measurements, workplace accidents, medical errors and car/near car accident post shift.ResultsRegional/rural healthcare shift workers were significantly older, had more years' experience, worked more nights, on‐call and hours per week. Those in metropolitan areas took significantly longer (minutes) to travel to work, had higher levels of anxiety, increased risk of shift work disorder, reported significantly more workplace accidents and were more likely to have a car/near car accident when commuting home post shift. Both groups reported ~25% having a medical error in the past year. Workplace accidents were related to more on‐call shifts and poor sleep quality. Medical errors were associated with fewer years' experience, more evening shifts and increased stress. Car accidents were associated with metropolitan location and increased depression.ConclusionDifferences in work‐related factors between metropolitan and regional/rural healthcare shift workers were observed. Some of these factors contributed to occupational health and safety risks. Further exploration is needed to understand how to reduce occupational health and safety risks, and improve employee and patient safety both in both regional/rural and metropolitan areas.
Effects of cost and praise‐seeking need on motive inference for those who engage in helping behaviours
Authors: Yamamoto Keisuke , Ikegami Tomoko , Yama Hiroshi 
Published: December 2023

AbstractThis study revealed determinants that influence motive inference toward helpers who engage in lifesaving. The costly signalling theory contends that higher costs associated with helping behaviour will promote one's inference of altruistic motives toward a helper. We examined how costs affect third parties' motive inference when controlling for benefits to recipients. In addition, in terms of projection theory, we predicted that the stronger the third parties' praise‐seeking need, the more likely it is they will infer self‐presentational motives toward a helper. We also examined if the praise‐seeking need would moderate the effect of cost on motive inference. Two vignette studies using hypothetical scenarios were conducted. In Study 1 (N = 140) and Study 2 (N = 100), the main effect of costs was found to be significant, indicating that the larger the cost, the more likely it is that a third party inferred altruistic motives toward a helper. Moreover, the main effect (but not the moderation effect) of the praise‐seeking need was also significant, as predicted above. This study provides stronger support for the costly signalling theory and reveals an individual‐difference factor that determines motive inference toward a helper.
Quantifying hospital environmental ventilation using carbon dioxide monitoring – a multicentre study
Authors: Wilson N. M. , Calabria C. , Warren A. , Finlay A. , O'Donovan A. , Passerello G. L. , Ribaric N. L. , Ward P. , Gillespie R. , Farrel R. , McNarry A. F. , Pan D. 
Published: December 2023

SummaryThe COVID‐19 pandemic has highlighted the importance of environmental ventilation in reducing airborne pathogen transmission. Carbon dioxide monitoring is recommended in the community to ensure adequate ventilation. Dynamic measurements of ventilation quantifying human exhaled waste gas accumulation are not conducted routinely in hospitals. Instead, environmental ventilation is allocated using static hourly air change rates. These vary according to the degree of perceived hazard, with the highest change rates reserved for locations where aerosol‐generating procedures are performed, where medical/anaesthetic gases are used and where a small number of high‐risk infective or immunocompromised patients may be isolated to reduce cross‐infection. We aimed to quantify the quality and distribution of ventilation in hospital by measuring carbon dioxide levels in a two‐phased prospective observational study. First, under controlled conditions, we validated our method and the relationship between human occupancy, ventilation and carbon dioxide levels using non‐dispersive infrared carbon dioxide monitors. We then assessed ventilation quality in patient‐occupied (clinical) and staff break and office (non‐clinical) areas across two hospitals in Scotland. We selected acute medical and respiratory wards in which patients with COVID‐19 are cared for routinely, as well as ICUs and operating theatres where aerosol‐generating procedures are performed routinely. Between November and December 2022, 127,680 carbon dioxide measurements were obtained across 32 areas over 8 weeks. Carbon dioxide levels breached the 800 ppm threshold for 14% of the time in non‐clinical areas vs. 7% in clinical areas (p < 0.001). In non‐clinical areas, carbon dioxide levels were > 800 ppm for 20% of the time in both ICUs and wards, vs. 1% in operating theatres (p < 0.001). In clinical areas, carbon dioxide was > 800 ppm for 16% of the time in wards, vs. 0% in ICUs and operating theatres (p < 0.001). We conclude that staff break, office and clinical areas on acute medical and respiratory wards frequently had inadequate ventilation, potentially increasing the risks of airborne pathogen transmission to staff and patients. Conversely, ventilation was consistently high in the ICU and operating theatre clinical environments. Carbon dioxide monitoring could be used to measure and guide improvements in hospital ventilation.
Integrative NGS testing reveals clonal dynamics of adverse genomic defects contributing to a natural progression in treatment‐naïve CLL patients
Authors: Navrkalova Veronika , Plevova Karla , Radova Lenka , Porc Jakub , Pal Karol , Malcikova Jitka , Pavlova Sarka , Doubek Michael , Panovska Anna , Kotaskova Jana , Pospisilova Sarka 
Published: December 2023

SummaryLarge‐scale next‐generation sequencing (NGS) studies revealed extensive genetic heterogeneity, driving a highly variable clinical course of chronic lymphocytic leukaemia (CLL). The evolution of subclonal populations contributes to diverse therapy responses and disease refractoriness. Besides, the dynamics and impact of subpopulations before therapy initiation are not well understood. We examined changes in genomic defects in serial samples of 100 untreated CLL patients, spanning from indolent to aggressive disease. A comprehensive NGS panel LYNX, which provides targeted mutational analysis and genome‐wide chromosomal defect assessment, was employed. We observed dynamic changes in the composition and/or proportion of genomic aberrations in most patients (62%). Clonal evolution of gene variants prevailed over the chromosomal alterations. Unsupervised clustering based on aberration dynamics revealed four groups of patients with different clinical behaviour. An adverse cluster was associated with fast progression and early therapy need, characterized by the expansion of TP53 defects, ATM mutations, and 18p− alongside dynamic SF3B1 mutations. Our results show that clonal evolution is active even without therapy pressure and that repeated genetic testing can be clinically relevant during long‐term patient monitoring. Moreover, integrative NGS testing contributes to the consolidated evaluation of results and accurate assessment of individual patient prognosis.
SARAF overexpression impairs thrombin‐induced Ca2+ homeostasis in neonatal platelets
Authors: Berna‐Erro Alejandro , Granados Maria P. , Teruel‐Montoya Raul , Ferrer‐Marin Francisca , Delgado Elena , Corbacho Antonio J. , Fenández Esperanza , Vazquez‐Godoy Maria T. , Tapia Jose A. , Redondo Pedro Cosme 
Published: December 2023

SummaryNeonatal platelets present a reduced response to the platelet agonist, thrombin (Thr), thus resulting in a deficient Thr‐induced aggregation. These alterations are more pronounced in premature newborns. Here, our aim was to uncover the causes underneath the impaired Ca2+ homeostasis described in neonatal platelets. Both Ca2+ mobilization and Ca2+ influx in response to Thr are decreased in neonatal platelets compared to maternal and control woman platelets. In neonatal platelets, we observed impaired Ca2+ mobilization in response to the PAR‐1 agonist (SFLLRN) or by blocking SERCA3 function with tert‐butylhydroquinone. Regarding SOCE, the STIM1 regulatory protein, SARAF, was found overexpressed in neonatal platelets, promoting an increase in STIM1/SARAF interaction even under resting conditions. Additionally, higher interaction between SARAF and PDCD61/ALG2 was also observed, reducing SARAF ubiquitination and prolonging its half‐life. These results were reproduced by overexpressing SARAF in MEG01 and DAMI cells. Finally, we also observed that pannexin 1 permeability is enhanced in response to Thr in control woman and maternal platelets, but not in neonatal platelets, hence, leading to the deregulation of the Ca2+ entry found in neonatal platelets. Summarizing, we show that in neonatal platelets both Ca2+ accumulation in the intracellular stores and Thr‐evoked Ca2+ entry through either capacitative channels or non‐selective channels are altered in neonatal platelets, contributing to deregulated Ca2+ homeostasis in neonatal platelets and leading to the altered aggregation observed in these subjects.
Patterns of liana diversity and host interaction networks in selectively logged and unlogged forests of Uppangala, Western Ghats, India
Authors: Wilson Vincy K. , Ayyappan Narayanan , Parthasarathy Narayanaswamy , Menon Devika , Behera Debabrata 
Published: December 2023

AbstractLianas shape tropical forest species composition, structure, and dynamics. Increasing climate fluctuation and anthropogenic disturbances increase liana abundance. Despite the increasing number of liana studies in India, only a few have examined the distribution and association of hosts with lianas, or liana–host interaction networks to determine their functional significance and conservational value. Therefore, our objective was to fill the knowledge gap about the diversity, abundance, and network structure of liana–host interactions in response to logging disturbance in a wet evergreen forest of Uppangala in central Western Ghats, India. We sampled lianas ≥1 cm in diameter at 1.3 m from the base and their host trees in thirty 20 m × 20 m plots in selectively logged and unlogged forest management regimes. We evaluated liana–host tree interactions in logged and unlogged forests and retrieved community‐level measures (nestedness, connectance, modularity, and network specialization index) and species‐level indicators (species specialization index). Diversity and abundance of liana species were considerably greater in the selectively logged forest site. The logged forest site had compartmentalization, anti‐nestedness, and network specialization, while unlogged forests were not showing any significant network structure. Most species of lianas and hosts were peripherals, but others were structurally important (connectors, module hubs, and network hubs) in the two forest sites. Forest management regimes had distinct structurally significant species.
Conceptualizations of health, ability to act upon those definitions and desire for supports among families from historically marginalized communities
Authors: Stransky Michelle L. , Bremer‐Kamens Miriam , Bair‐Merritt Megan , Howard Carey , Brooks Candace , Meill Augusta , Morris Anita , Sheldrick R. Christopher 
Published: December 2023

AbstractRespect for parents' values and clinician–parent collaboration is less common among families from historically marginalized communities. We investigated how parents from marginalized communities operationalize health and their preferences for paediatric primary care. We recruited families who spoke English, Haitian Creole or Spanish with at least one child younger than 6 years old. Staff queried families' values and life experiences, perspectives on health and healthcare, social supports and resources. Fourteen interviews with the parents of 26 children were thematically analysed. Interviews revealed the following four themes: (1) parents' definitions of ‘health’ extend beyond physical health; (2) families' ability to actuate health definitions is complicated by poverty's impact on agency; (3) parents engage in ongoing problem recognition and identify solutions, but enacting solutions can be derailed by barriers and (4) parents want support from professionals and peers who acknowledged the hard work of parenting. Eliciting parents' multidimensional conceptualizations of health can support families' goal achievement and concern identification in the context of isolation, limited agency and few resources. Efforts to improve family centred care and reduce disparities in paediatric primary care must be responsive to the strengths, challenges, resources and priorities of marginalized families.
Working towards convergence of the clinical management of differences of sex development/intersex conditions and the human rights framework: A case study
Authors: Cools Martine , Verhagen Emmanuelle , Hoebeke Piet , Van Hoecke Eline , Cannoot Pieter 
Published: December 2023

AbstractObjectiveMedical treatments that aim to modify the appearance of the genitals in children who are born with a difference of sex development/intersex (DSD/I*) condition are highly controversial. Human Rights bodies worldwide have argued that such treatments are conflicting with the child's right of personal autonomy and should be legally restricted to the unique situation where the child's physical health is in danger.DesignWe here review the current status of legal initiatives in Europe that have addressed the issue of medical treatments in minors who have a DSD for which they have not been able to give personal informed consent due to their young age.PatientsThe management of a 3 years old child who has congenital adrenal hyperplasia (CAH) and grows up with atypical‐looking genitals is discussed.ResultsIn spite of extensive psychosocial support to the child and family from birth onwards, and good medical control of CAH, the child develops signs of emotional distress, suspected to be attributable to the genital difference. Our discussions include perspectives from the multidisciplinary DSD team caring for the child, a human rights specialist, and an intersex activist. From our discussions, we conclude that with evolving medical care, new ethical and human rights challenges are raised. A truly holistic human rights approach should not only consider physical but also mental health and psychosocial and psychosexual adaptation of the child to the medical condition, when reflecting on the acceptability of medical treatments in minors for which no personal informed consent can be obtained due to their young age. In addition it is paramount to include the meaningful participation of the child in the clinical management at the earliest possible stage.ConclusionsContinued convergence of clinical management and the human rights framework can be realised based on constructive discussions involving all stakeholders, and with the best interest of the child – and adult that they will become ‐ as a common goal.