bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical resident operative autonomy on nights and weekends: What happens to surgical education during off-hours?
Authors: Anjaria Devashish J. , Oliver Joseph B. , Yu Yasong , Tsui Grace , Kunac Anastasia , Livingston David H. 
Published: February 2023

BACKGROUND
Surgical resident operative autonomy is critical for trainee maturation to independence. Acute care surgery (ACS) cases commonly occur off-hours and tension between operating room availability and on-call staff can affect resident operative autonomy. We examined operative resident autonomy for general, vascular, and thoracic (GVT) surgery during nights and weekends. We hypothesized that residents would be afforded less operative autonomy during off-hours than weekdays.

METHODS
This retrospective cohort study uses the Veterans Affairs Surgical Quality Improvement Program database, we examined all GVT cases at Veterans Affairs teaching hospitals from 2004 to 2019. All cases are coded for the level of supervision at the time of surgery: AP, attending primary surgeon; AR, attending and resident operating together; and RP, resident primary (attending supervising but not scrubbed). Cases starting between 6 pm to 7 am Monday through Friday were considered nights, cases on Saturday/Sunday were considered weekends, and collectively considered “off-hours.” Resident primary case rates were compared by start time and type.

RESULTS
Over the 15-year study period, there were 666,421 GVT cases performed with 38,097 cases (6%) performed off-hours. During off-hours, 31,396 (83%) were ACS compared with 5% of daytime cases. Overall, off-hours cases have higher RP rate than daytime cases (6.8% vs. 5.8%, p < 0.001). Daytime ACS cases have higher rates of RP than nights/weekends (7.6% vs. 6.8%, p < 0.001). Conversely, daytime elective cases have lower RP than nights (5.7% vs. 7.9%, p < 0.001). During off-hours, there are more RP cases on nights compared with weekends (7.1% vs. 6.5%, p = 0.02).

CONCLUSION
Overall, residents were afforded more operative autonomy during off-hours, with nights having greater RP than weekends. In contrast, ACS cases have more autonomy during weekdays. These data have potentially significant implications for ACS service staffing, night float rotations, and overall resident operative experience on ACS services.

LEVEL OF EVIDENCE/STUDY TYPE
Prognostic and Epidemiological; Level III.
Influence of Tricuspid Regurgitation After Heart Transplantation: A Single-center Experience
Authors: Krey Rebecca , Sommer Wiebke , Meyer Anna , Rivinius Rasmus , Schlegel Philipp , Frey Norbert , Karck Matthias , Warnecke Gregor , Arif Rawa 
Published: February 2023

Background.
Tricuspid valve regurgitation (TVR) is often observed after orthotopic heart transplantation. However, there is a scarcity of data regarding long-term outcomes of patients with TVR.

Methods.
Between January 2008 and December 2015, 169 patients underwent orthotopic heart transplantation at our center and were included in this study. TVR trends and associated clinical parameters were retrospectively analyzed. TVR was assessed after 30 d, 1 y, 3 y, and 5 y, and groups were defined according to changes in TVR grade: constant (group 1; n = 100), improvement (group 2; n = 26), and deterioration (group 3; n = 43). Survival, outcome with regard to operative technique, and long-term kidney and liver function during follow-up were assessed.

Results.
Mean follow-up time was 7.67 ± 4.17 y (median 8.62, Q1 5.06, Q3 11.16). Overall mortality was 42.0%, with differences between the groups (P < 0.01). Cox regression analysis revealed improvement of TVR as a significant predictor for survival (hazard ratio 0.23; 95% confidence interval, 0.08-0.63, P < 0.01). After 1 y 2.7%, after 3 y 3.7%, and after 5 y 3.9% of the patients showed persistent severe TVR. Creatinine levels after 30 d and 1, 3, and 5 y showed significant differences between the groups (P = 0.02, P < 0.01, P < 0.01, and P = 0.01), deterioration of TVR being associated with higher creatinine levels during follow-up.

Conclusions.
Deterioration of TVR is associated with higher mortality and renal dysfunction. Improvement of TVR may function as a positive predictor for long-term survival after heart transplantation. Improvement of TVR should be a therapeutic goal offering a prognostic value for long-term survival.
Efficacy of Behavioral Interventions for Urinary Incontinence Among Women Residing in Nursing Homes
Authors: Allen Lindsay M. , Nalley Chelsea , Devries Alison R. , Fisher Steve R. 
Published: February 2023

PURPOSE:
The purpose of this systematic review was to summarize recent evidence on the efficacy of behavioral interventions for the management of urinary incontinence (UI) among women in nursing homes.

METHODS:
Systematic review of the literature. For this review, behavioral interventions were defined as those that included some form of physical exercise or behavior modification such as scheduled toileting.

SEARCH STRATEGY:
A search of MEDLINE/PubMed, CINAHL, Scopus, and Cochrane Library electronic databases was conducted seeking randomized controlled trials published since 2010 in female participants residing in long-term care facilities (nursing homes, skilled nursing facilities) and diagnosed with UI. Inclusion criteria were studies that addressed the effects of voiding regimens, lower extremity strengthening, functional training, food and fluid management, and pelvic floor muscle training. Independent reviewers extracted relevant data and assessed methodological quality using the PEDro scale.

FINDINGS:
Five studies (pooled sample, N = 399) met inclusion criteria; mean age of participants was 81.1 ± 6.8 years; 85% were female. The PEDro scores ranged from 6 to 9; only 2 studies included residents with cognitive impairment. Interventions included voiding strategies, increasing physical activity, functional mobility training, pelvic floor muscle training, fluid management, and multicomponent combinations of approaches. Three of the 5 studies were multicomponent interventions and 2 focused on a single intervention. Outcomes included objective measures of incontinent episodes and subjective assessments of UI severity.

CONCLUSIONS:
Behaviorally based interventions can be successful in improving UI among nursing residents with and with no cognitive impairment.

IMPLICATIONS:
Future studies should examine logistic and labor costs associated with sustaining behavioral interventions using nursing home staff and investigate the effects of these therapies using appropriate quality-of-life metrics for this population.
Prospective, Case-Control Study Evaluating Effects of No-Sting Liquid Barrier Film on Skin Condition and Maturation of Stratum Corneum in Premature Neonates
Authors: Boyar Vita , Desai Tuisha 
Published: February 2023

PURPOSE:
To assess effects of a no-sting liquid barrier film (NSLBF) on the skin condition and maturation of the stratum corneum in premature neonates.

DESIGN:
This was a prospective, case-control study with each subject serving as their own control.

SUBJECTS AND SETTING:
The sample comprised 33 neonates, between 23 and 32 weeks of gestational age (GA). Participants received care in a level 4 neonatal intensive care unit in the northeastern United States. Data were collected between May 2018 and May 2019.

METHODS:
All participants had NSLBF applied to their left chest, left abdomen, and left anterior and posterior upper thigh. The right side was left untreated and served as self-control. Measurements of skin pH, hydration, transepidermal water loss (TEWL) and Neonatal Skin Condition Scores were obtained on both the untreated right and treated left sides of the body over a 14-day period on days 1, 3, 7, and 14.

RESULTS:
Worsening skin condition scores were observed on the treated side on days 7 and 14. There was an improvement in TEWL on the treated side, manifested as decrease in TEWL values. There was no difference in pH. At all points in time hydration was lower on the treated side.

CONCLUSIONS:
Worsening skin condition scores and hydration status on the treated side indicate an altered or delayed process of skin maturation. These findings suggest that no-sting liquid barrier (NSLB) application should be limited to skin under medical devices, dressings, tapes, and affected areas. In addition, we recommend allowing adequate intervals to allow physiologic stratum corneum maturation between applications of NSLB.
The Impact of Diabetic Foot Ulcer on Individuals' Lives and Daily Routine
Authors: Costa Idevania G. , Camargo-Plazas Pilar 
Published: February 2023

PURPOSE:
The purpose of this study was to explore the impact of diabetic foot ulcer (DFU) on individuals' lives and daily routines.

DESIGN:
Qualitative design informed by social constructivism and symbolic interactionism frameworks.

SUBJECTS AND SETTING:
The sample comprised 30 individuals attending a wound care clinic in Southeast Ontario, Canada. Most participants (n = 17) were between the ages of 65 and 92 years, were male (n = 20), married (n = 21), living with their family (n = 23), and had completed high school (n = 26).

METHODS:
One-to-one semistructured interviews were conducted by the first author until saturation of each emerging theme was achieved. Interviews were audio-recorded and lasted from 45 to 90 minutes. Data collection and analysis occurred simultaneously and included intensive semistructured interviews, field notes, and researcher's journal.

RESULTS:
Participants with DFUs were found to perceive a “sense of life change,” impacting their lives across physical, psychological, and social spheres. They reported 4 key themes indicating that DFUs were (1) limiting their outings; (2) restricting leisure activities; (3) impacting personal and social life; and (4) contributing to emotional fluctuations.

CONCLUSION:
Sense of life changes resulting from DFUs were associated with participant reporting loss of freedom and enjoyment. These findings underscore the need for holistic support for patients with DFUs that simultaneously address physical, psychological, and social needs and areas of impact.
Effect of a Hospital-Acquired Pressure Injury (HAPI) Risk Score on HAPI Rates in Patients With Vascular Diseases
Authors: Moyse Tonya , Bates Jacqueline , Bena James F. , Morrison Shannon L. , Albert Nancy M. 
Published: February 2023

PURPOSE:
The purpose of this study was to assess whether a validated hospital-acquired pressure injury (HAPI) risk scale and best practice interventions were associated with lower HAPI rates compared with previous care. We also sought to identify a cut score of HAPI risk when using the instrument.

DESIGN:
Nonequivalent 2-group pre- and postintervention comparative study.

SUBJECTS AND SETTING:
The sample comprised 2871 patients treated for vascular diseases; data were collected on 2674 patients before the intervention and 197 patients postintervention. Their mean (SD) age was 69.3 (12.4) years; 29.3% (n = 842) had a history of diabetes mellitus. Based on discharge status, more patients received home health care after discharge in the postintervention group, 34% (n = 67/197) versus 16.2% (n = 430/2662), P = .001. The study setting was a quaternary care hospital in the Midwestern United States.

METHODS:
Patients who were at high risk for HAPI, based on a nomogram score, received a mobility and ambulation program intervention. Pre- and postintervention cohorts were compared using analysis of variance, χ2 test, and Fisher exact test. A receiver operating characteristic curve plot was generated to determine the ability of the risk score tool to identify HAPI risk at all possible cut points.

RESULTS:
Despite differences in patient characteristics, primary medical diagnosis, and postdischarge health care needs, the HAPI rate decreased postintervention from 13.8% (n = 370/2674) to 1.5% (n = 3/197), P = .001. A HAPI risk-predicted value cut score of 18 had strong sensitivity (0.81) and specificity (0.81), and positive and negative predictive values of 0.42 and 0.96, respectively.

CONCLUSION:
Despite higher patient acuity during the intervention period, HAPI rate decreased after HAPI nomogram and nurse-led mobility intervention implementation.
A pillar/perfusion plate enhances cell growth, reproducibility, throughput, and user friendliness in dynamic 3D cell culture
Authors: Lekkala Vinod Kumar Reddy , Kang Soo-Yeon , Liu Jiafeng , Shrestha Sunil , Acharya Prabha , Joshi Pranav , Zolfaghar Mona , Lee Minseong , Jamdagneya Paarth , Pagnis Sohan , Kundi Arham , Kabbur Samarth , Kim Ung Tae , Yang Yong , Lee Moo-Yeal 
Published: February 2023

AbstractStatic three-dimensional (3D) cell culture has been demonstrated in ultralow attachment well plates, hanging droplet plates, and microtiter well plates with hydrogels or magnetic nanoparticles. Although it is simple, reproducible, and relatively inexpensive, thus potentially used for high-throughput screening, statically cultured 3D cells often suffer from the necrotic core due to limited nutrient and oxygen diffusion and waste removal and have limitedin vivo-like tissue structure. Here, we overcome these challenges by developing a pillar/perfusion plate platform and demonstrating high-throughput, dynamic 3D cell culture. Cell spheroids have been loaded on the pillar plate with hydrogel by simple sandwiching and encapsulation and cultured dynamically in the perfusion plate on a digital rocker. Unlike traditional microfluidic devices, fast flow rates were maintained within perfusion wells, and the pillar plate could be separated from the perfusion plate for cell-based assays. It was compatible with common lab equipment and allowed cell culture, testing, staining, and imagingin situ.The pillar/perfusion plate enhanced cell growth by rapid diffusion, reproducibility, assay throughput, and user friendliness in dynamic 3D cell culture.
The drivers of dark diversity in the Scandinavian tundra are metric-dependent
Authors: Hostens Lore , Van Meerbeek Koenraad , Wiegmans Dymphna , Larson Keith , Lenoir Jonathan , Clavel Jan , Wedegärtner Ronja , Pirée Amber , Nijs Ivan , Jonas J. Lembrechts 
Published: February 2023

AbstractAimDark diversity refers to the set of species that are not observed in an area but could potentially occur based on suitable local environmental conditions. In this paper, we applied both niche-based and co-occurrence-based methods to estimate the dark diversity of vascular plant species in the subarctic tundra. We then aimed to unravel the drivers explaining (1) why some locations were missing relatively more suitable species than others, and (2) why certain plant species were more often absent from suitable locations than others.LocationThe Scandinavian tundra around Abisko, northern Sweden.MethodsWe calculated the dark diversity in 107 plots spread out across four mountain trails using four different methods. Two niche-based (Beals’ index and hypergeometric method) and two co-occurrences-based (climatic niche model and climatic niche model followed by species-specific threshold) methods. This was then followed by multiple generalized linear mixed models and general linear models to determine which habitat characteristics and species traits contributed most to the dark diversity.ResultsThe study showed a notable divergence in the predicted drivers of dark diversity depending on the method used. Nevertheless, we can conclude that plot-level dark diversity was generally 18% higher in areas at low elevations and 30% and 10% higher in areas with a low species richness or low levels of habitat disturbance, respectively.ConclusionOur findings call for caution when interpreting statistical findings of dark diversity estimates. Even so, all analyses point towards an important role for natural processes such as competitive dominance as main driver of the spatial patterns found in dark diversity in the northern Scandes.
Delayed development of basal spikelets in wheat explains their increased floret abortion and rudimentary nature
Authors: Backhaus Anna Elisabeth , Griffiths Cara , Vergara-Cruces Angel , Simmonds James , Lee Rebecca , Morris Richard J. , Uauy Cristobal 
Published: February 2023

AbstractWheat (Triticum aestivum L.) breeding efforts have increased grain yield predominantly by raising grain numbers per spikelet, rather than grain weight or spikelet number. However, across a single spike large differences exist in the number of grains per spikelet. The central spikelets produce the highest number of grains in any given genotype while apical and basal spikelets are less productive. Basal spikelets are delayed in development just after initiation and are smaller and less advanced than central spikelets already by the glume primordium stage. However, basal spikelets continue to develop and produce florets until much later in the wheat growth cycle. The precise timings or the cause of their growth cessation, and subsequent abortion, is largely unknown. In this study we investigated the underlying causes of rudimentary basal spikelet abortion. We investigated basal spikelet development in four UK winter wheat varieties as well as a set of near-isogenic lines forVRT-A2(VEGETATIVE TO REPRODUCTIVE TRANSITION 2) using shading applications in the field. We propose that basal spikelet abortion is likely the consequence of complete floret abortion as both occur at the same time and have the same response to shading treatments. Furthermore, we found that the developmental age of florets pre-abortion is an important factor for their likelihood to survive and develop viable seed. Previously, it had been proposed that reduced assimilate availability in the base of the spike leads to increased abortion. Re-analysis of published data alongside data presented here, however, does not support this model. We found that rather than assimilate availability, it is the reduced developmental age of basal florets before abortion that correlates with increased abortion. Using the floret Waddington developmental stage pre-abortion, we were able to predict final grain set per spikelet across the spike, alongside the characteristic gradient in number of grains from basal to central spikelets. We found that advancing past Waddington stage 5.5 seems to be important for floret survival and that most florets in basal spikelets had not reached this stage at the onset of floret abortion. The abortion of all florets could therefore be the reason for their rudimentary appearance in the mature spike, suggesting that basal spikelet abortion is simply the consequence of all florets inside the spikelet being aborted and thus all other spikelet structures (e.g., lemma, rachilla, glume) also ceasing to develop. Future efforts to improve spikelet homogeneity across the spike could thus focus on improving basal spikelet establishment and increasing floret development rates pre-abortion.
Conformational analysis of chromosome structures reveals vital role of chromosome morphology in gene function
Authors: Zhan Yuxiang , Yildirim Asli , Boninsegna Lorenzo , Alber Frank 
Published: February 2023

AbstractThe 3D conformations of chromosomes are highly variant and stochastic between single cells. Recent progress in multiplexed 3D FISH imaging, single cell Hi-C and genome structure modeling allows a closer analysis of the structural variations of chromosomes between cells to infer the functional implications of structural heterogeneity. Here, we introduce a two-step dimensionality reduction method to classify a population of single cell 3D chromosome structures, either from simulation or imaging experiment, into dominant conformational clusters with distinct chromosome morphologies. We found that almost half of all structures for each chromosome can be described by 5-10 dominant chromosome morphologies, which play a fundamental role in establishing conformational variation of chromosomes. These morphologies are conserved in different cell types, but vary in their relative proportion of structures. Chromosome morphologies are distinguished by the presence or absence of characteristic chromosome territory domains, which expose some chromosomal regions to varying nuclear environments in different morphologies, such as nuclear positions and associations to nuclear speckles, lamina, and nucleoli. These observations point to distinct functional variations for the same chromosomal region in different chromosome morphologies. We validated chromosome conformational clusters and their associated subnuclear locations with data from DNA-MERFISH imaging and single cell sci-HiC data. Our method provides an important approach to assess the variation of chromosome structures between cells and link differences in conformational states with distinct gene functions.
Extruding transcription elongation loops observed in high-resolution single-cell 3D genomes
Authors: Wu Honggui , Zhang Jiankun , Tan Longzhi , Xie X. Sunney 
Published: February 2023

AbstractInside human nuclei, genes are transcribed within a highly packed genome, whose organization is facilitated by cohesin-mediated loop extrusion. However, whether cohesin-mediated loop extrusion participates in transcription is unknown. Here we report that the cohesin-mediated loop extrusion participates in transcription by forming a topoisomerases-regulated transcription elongation loop (TEL), in which cohesin is stalled at the transcription start site (TSS) and gradually extrudes loops asymmetrically until reaching the transcription termination site (TTS). By improving the spatial resolution of single-cell 3D genome mapping to 5 kb with micrococcal nuclease (MNase) in our new single-cell Micro-C (scMicro-C) method, we directly observed the loop expansion of TELs. Furthermore, TEL’s biological function is to ensure high transcriptional burst frequencies by fast re-initiation of RNA Pol II.One-Sentence SummarySingle-cell high-resolution 3D genome structures reveal that cohesin-mediated loop extrusion participates in transcription.
Machine learning inference of continuous single-cell state transitions during myoblast differentiation and fusion
Authors: Shakarchy Amit , Zarfati Giulia , Hazak Adi , Mealem Reut , Huk Karina , Ziv Tamar , Avinoam Ori , Zaritsky Assaf 
Published: February 2023

AbstractCells modifying their internal organization during continuous state-transitions, supporting functions from cell division to differentiation. However, tools to measure dynamic physiological states of individual transitioning cells are lacking. We combined live-cell imaging and machine learning to monitor ERK1/2-inhibited primary murine skeletal muscle precursor cells, that transition rapidly and robustly from proliferating myoblasts to post-mitotic myocytes and then fuse, forming multinucleated myotubes. Our model, trained using motility and actin intensity features from single cell tracking data, effectively tracked real-time continuous differentiation, revealing that differentiation occurs 7.5-14.5 hours post-induction, followed by fusion ∼3 hours later. Co-inhibition of ERK1/2 and p38 led to differentiation without fusion. Our model inferred co-inhibition leads to terminal differentiation, indicating that p38 is specifically required for transitioning from terminal differentiation to fusion. Our model also predicted that co-inhibition leads to changes in actin dynamics. Mass spectrometry supported these in silico predictions and suggested novel fusion and maturation regulators downstream of differentiation. Collectively, this approach can be adapted to various biological processes to uncover novel links between dynamic single-cell states and their functional outcomes.