bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extraordinary long-stem confers resistance of intrinsic terminators to processive antitermination
Authors: Miguel-Arribas Andrés , Martín-María Ana , Alaerds Eef C W , Val-Calvo Jorge , Yuste Luis , Rojo Fernando , Abia David , Wu Ling Juan , Meijer Wilfried J J 
Published: May 2023

Abstract
Many prokaryotic operons encode a processive antitermination (P-AT) system. Transcription complexes associated with an antitermination factor can bypass multiple transcription termination signals regardless of their sequences. However, to avoid compromising transcriptional regulation of downstream regions, the terminator at the end of the operon needs to be resistant to antitermination. So far, no studies on the mechanism of resistance to antitermination have been reported. The recently discovered conAn P-AT system is composed of two components that are encoded at the start of many conjugation operons on plasmids of Gram-positive bacteria. Here we report the identification of a conAn-resistant terminator, named TerR, in the conjugation operon of the Bacillus subtilis plasmid pLS20, re-defining the end of the conjugation operon. We investigated the various characteristics of TerR and show that its extraordinary long stem is the determining feature for resistance to antitermination. This is the first P-AT resistance mechanism to be reported.
Career Intention of Baccalaureate Student Nurses
Authors: Docherty Angie , Franklin Heather , Voss Heather , Dieckmann Nathan 
Published: May 2023

Abstract

AIM
This study had two aims: to determine initial career intention of nursing students and to assess whether nursing education variables predict career intentions toward public health/community health nursing.

BACKGROUND
Nursing graduates are expected to be prepared to work in community settings. However, there is uncertainty in whether students are attracted to these settings and whether nursing education is impactful in shaping career intention.

METHOD
A cross-sectional survey targeted baccalaureate and accelerated students across Oregon. Analyses utilized descriptive statistics and multiple regression.

RESULTS
Students reported most interest in acute care. Didactic and clinical learning were not related to intention to pursue a public health/community health career. The strongest predictor was career intention when starting nursing school.

CONCLUSION
Students enter nursing school with largely fixed intentions. Educators need to develop greater prenursing outreach and understanding of the drivers toward public and community health to build curricula and passion for this area of nursing.
International and Interprofessional Collaboration: An Innovative Week of Learning Across Three Professions, Three Universities, and One Ocean
Authors: Kazley Abby Swanson , Creed Joan M. , Grotenhuis Connie , Boissonneault Gilbert , Springer Hans , Alpay Laurence , Doms Rob 
Published: May 2023

Abstract
As the COVID-19 pandemic prevented planned international travel opportunities for students and faculty, faculty at three universities from three professions created a four-day innovative, online learning experience. Each session included presentations from each country, small-group discussions, and evaluation. The topics appealed to students regardless of profession or nationality. Daily evaluations showed attendees valued the experience. The benefits of international and interprofessional learning were evident; students gained better understanding of other professions and health care systems through sessions that expanded their thinking. International appreciation and learning can be prioritized without physical travel.
Early Empiric Antibiotic Use in Patients Hospitalized With COVID-19: A Retrospective Cohort Study*
Authors: Widere J. Christian , Davis Claire Leilani , Loomba Johanna Jean , Bell Taison D. , Enfield Kyle B. , Barros Andrew Julio ,   on behalf of the N3C Consortium
Published: May 2023

OBJECTIVE:
To investigate temporal trends and outcomes associated with early antibiotic prescribing in patients hospitalized with COVID-19.

DESIGN:
Retrospective propensity-matched cohort study using the National COVID Cohort Collaborative (N3C) database.

SETTING:
Sixty-six health systems throughout the United States that were contributing to the N3C database. Centers that had fewer than 500 admissions in their dataset were excluded.

PATIENTS:
Patients hospitalized with COVID-19 were included. Patients were defined to have early antibiotic use if they received at least 3 calendar days of intravenous antibiotics within the first 5 days of admission.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Of 322,867 qualifying first hospitalizations, 43,089 patients received early empiric antibiotics. Antibiotic use declined across all centers in the data collection period, from March 2020 (23%) to June 2022 (9.6%). Average rates of early empiric antibiotic use (EEAU) also varied significantly between centers (deviance explained 7.33% vs 20.0%, p < 0.001). Antibiotic use decreased slightly by day 2 of hospitalization and was significantly reduced by day 5. Mechanical ventilation before day 2 (odds ratio [OR] 3.57; 95% CI, 3.42–3.72), extracorporeal membrane oxygenation before day 2 (OR 2.14; 95% CI, 1.75–2.61), and early vasopressor use (OR 1.85; 95% CI, 1.78–1.93) but not region of residence was associated with EEAU. After propensity matching, EEAU was associated with an increased risk for in-hospital mortality (OR 1.27; 95% CI, 1.23–1.33), prolonged mechanical ventilation (OR 1.65; 95% CI, 1.50–1.82), late broad-spectrum antibiotic exposure (OR 3.24; 95% CI, 2.99–3.52), and late Clostridium difficile infection (OR 1.60; 95% CI, 1.37–1.87).

CONCLUSIONS:
Although treatment of COVID-19 patients with empiric antibiotics has declined during the pandemic, the frequency of use remains high. There is significant inter-center variation in antibiotic prescribing practices and evidence of potential harm. Our findings are hypothesis-generating and future work should prospectively compare outcomes and adverse events.
Prevalence of Mental Health Diagnoses Among Early Adolescents Before and During Foster Care
Authors: Herd Toria , Palmer Lindsey , Font Sarah 
Published: May 2023

Abstract:

Objective:
This study aimed to characterize the rates and types of diagnosed mental health (MH) disorders among children and adolescents before and during foster care (FC) overall and by race and ethnicity.

Methods:
We used population-based linked administrative data of medical assistance (public insurance) claims records and child protective services data from a cohort of early adolescents who entered FC at 10 to 14 years old. MH diagnoses were coded according to the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9 and ICD-10) and included adjustment disorders, disruptive disorders, attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, mood disorders, attachment disorders, autism, and other disorders.

Results:
Before FC entry, 41% of children and adolescents had at least 1 MH diagnosis. Attention-deficit/hyperactivity disorder (25%), mood disorders (18%), and disruptive disorders (15%) were the most common pre-entry diagnoses. Among early adolescents entering FC with no previous diagnosis, 52% were later diagnosed with adjustment disorder (accounting for 73% of all youth with a new diagnosis during FC). White early adolescents had higher rates of diagnosed MH disorders before FC, whereas racial/ethnic minority early adolescents were more likely to receive a MH diagnosis during FC. Black early adolescents were more likely than White and Hispanic early adolescents to be diagnosed with disruptive disorders and less likely to be diagnosed with anxiety or adjustment disorders during FC.

Conclusion:
Results highlight the high rates of MH needs among early adolescents before entry into FC, whether detected before or during FC. Results also illustrate disparities in pre-entry MH care between racial/ethnic minority and White early adolescents, with minority youth less likely to be receiving services before entry.
The Effect of Health Literacy on Health-Related Quality of Life Among Saudi Women With Chronic Diseases
Authors: ALHALAL Eman , HADIDI Bayan , SAAD Abeer Fouad , HADIDI Jahra Ali 
Published: May 2023

ABSTRACT

Background
Women have unique health concerns in the context of chronic illness. Although health literacy has been linked to health-related quality of life, the pathway by which some factors mediate this relationship has not been well examined among Saudi women with chronic disease.

Purpose
This study was designed to examine the relationship between health literacy and health-related quality of life and determine the mediating roles of healthy lifestyle and patient-centered care in explaining this relationship.

Methods
A cross-sectional study was used. A random sample of 20 primary healthcare centers in Saudi Arabia was selected. A convenience sample of 300 women diagnosed with a chronic illness was recruited from these centers. Structural equation modeling was used to test the proposed relationships.

Results
Controlling for women's age and education, the hypothesized model adequately fit the data. Health literacy and its dimensions were found to positively and directly affect both patient-centered care (β = 0.614, B = 0.189, p < .001) and healthy lifestyle behaviors (β = 0.550, B = 1.211, p < .001). Furthermore, both patient-centered care (β = 0.390, B = 1.301, p < .001) and healthy lifestyle behaviors (β = 0.322, B = 0.150, p < .001) were found to positively and directly affect health-related quality of life, whereas health literacy had significant, direct (β = 0.285, B = 0.292, p < .001) and indirect (β = 0.417, B = 0.428, p < .001) effects on health-related quality of life through patient-centered care and healthy lifestyle behaviors.

Conclusions/Implications for Practice
Special consideration should be given to health literacy, patient-centered care, and healthy lifestyle behaviors to enhance health-related quality of life in women with chronic illness. Gender-specific health services and interventions are needed to improve women's health literacy.
Prognostic Factors in Alcohol-associated Liver Disease Patients Presenting With First Evidence of Ascites
Authors: Fahoum Khalid , Shen Nicole T. , Basu Elora , Lee Jihui , Kaplan Alyson , Salajegheh Annaheta , Rosenblatt Russell , Jesudian Arun , Lucero Catherine , Fortune Brett , Safford Monika , Brown Robert S. 
Published: May 2023

Goals:
To identify factors associated with transplantation and death in alcohol-associated liver disease (ALD) patients presenting with first evidence of ascites.

Background:
Ascites development is a poor prognostic sign for patients with cirrhosis. Among ALD patients, the baseline factors at time of ascites development that are associated with eventual transplantation or death are currently unknown.

Study:
Adult patients with ascites in the “Evaluating Alcohol Use in Alcohol-related Liver Disease Prospective Cohort Study” (NCT03267069 clinicaltrials.gov) were identified from 2016 to 2020. Demographic, clinical, and laboratory factors at initial ascites presentation were identified as potential predictors of transplant and death as competing risks.

Results:
A total of 96 patients were identified. Median (interquartile range) follow-up time was 2.00 years (0.87 to 3.85). By last follow-up, 34/96 patients had been transplanted (35.4%) and 11/96 had died (11.4%). Prognostic factors for transplant included age per decade [hazard ratio (HR): 0.52 (95% CI, 0.33 to 0.83)], employed status [HR: 0.35 (95% CI, 0.14 to 0.90)], and sodium [HR: 0.94 (95% CI, 0.90 to 0.99)], whereas prognostic factors for death were body mass index [HR: 1.11 (95% CI, 1.00 to 1.22)], Charlson index [HR: 2.14 [95% CI, 1.13 to 4.08]), Maddrey Discriminant Function >32 (HR: 5.88 (95% CI, 1.18, 29.39)], aspartate aminotransferase [HR: 0.99 (95% CI, 0.98 to 0.997)], and a prior 12-month abstinence period [HR: 5.53 (95% CI, 1.10 to 27.83)], adjusted for age, sex, and ALD subcategory.

Conclusions:
Several factors at initial ascites presentation are associated with increased risk of transplantation or death and validation in larger cohorts will allow for improved risk stratification for ALD patients.
Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review
Authors: McLeish Shian F. , Murchison Amanda B. , Smith Dora M. , Ghahremani Taylor , Johnson Isaiah M. , Magann Everett F. 
Published: May 2023

Importance
Uterine rupture during labor is a calamitous event that can result in maternal/neonatal morbidity/mortality. Lower uterine segment (LUS) thickness measurement is a proposed method to determine the risk factor of uterine rupture in women undergoing trial of labor after cesarean. Does this measurement predict uterine rupture risk?

Objectives
This review examines current evidence to determine if a thin LUS ultrasound diagnosis during pregnancy with prior cesarean delivery(s) can reliably predict uterine rupture risk while attempting vaginal birth after cesarean (VBAC).

Evidence Acquisition
Electronic databases (PubMed and CINAHL) were searched with one limitation of abstracts in English. Search terms used were “lower uterine segment” AND “risk(s)” AND “rupture” OR “dehiscence.

Results
After reviewing 164 identified articles, 15 were used in this review. Of the studies including LUS thickness measurement, notable differences were found: gestational age at time of measurement, full thickness measurement versus myometrial thickness, number of sonographers involved, ultrasound technique (transabdominal vs transvaginal), and blinding. Other factors influencing LUS thickness include fetal weight, amniotic fluid volume, and gestational age. The most recent systematic review and meta-analysis suggests that an LUS > 3.65 mm should be safe for a VBAC, 2–3.65 mm is probably safe, and <2 mm identifies a patient at higher risk for uterine rupture/dehiscence.

Conclusions
Study heterogeneity, absence of an agreed upon thickness threshold, poor correlation between ultrasound and MRI measurements, or physical cesarean measurements currently make VBAC uterine rupture risk prediction uncertain.

Relevance
Our aim is to analyze existing literature to determine if evidence supports LUS measurement in women undergoing VBAC after cesarean to determine risk of uterine rupture.

Target Audience
Obstetricians and gynecologist, family physicians

Learning Objectives
After completing this learning activity, the participant should be able to identify the differences and how they occur between studies evaluating the thinness of the LUS in women undergoing a trial of labor after cesarean delivery; compare the accuracy of LUS measurement between ultrasound, MRI, and physical measurement at cesarean delivery; and describe the factors that influence the thinness of the LUS.
A Novel Comprehensive Algorithm for Evaluation of PICU Patients With New Fever or Instability*
Authors: Sick-Samuels Anna C. , Booth Lauren D. , Milstone Aaron M. , Schumacher Christina , Bergmann Jules , Stockwell David C. 
Published: May 2023

OBJECTIVES:
There is variation in microbiology testing among PICU patients with fever offering opportunities to reduce avoidable testing and treatment. Our objective is to describe the development and assess the impact of a novel comprehensive testing algorithm to support judicious testing practices and expanded diagnostic differentials for PICU patients with new fever or instability.

DESIGN:
A mixed-methods quality improvement study.

SETTING:
Single-center academic PICU and pediatric cardiac ICU.

SUBJECTS:
Admitted PICU patients and physicians.

INTERVENTIONS:
A multidisciplinary team developed a clinical decision-support algorithm.

MEASUREMENTS AND MAIN RESULTS:
We evaluated blood, endotracheal, and urine cultures, urinalyses, and broad-spectrum antibiotic use per 1,000 ICU patient-days using statistical process control charts and incident rate ratios (IRRs) and assessed clinical outcomes 24 months pre- and 18 months postimplementation. We surveyed physicians weekly for 12 months postimplementation. Blood cultures declined by 17% (IRR, 0.83; 95% CI, 0.77–0.89), endotracheal cultures by 26% (IRR, 0.74; 95% CI, 0.63–0.86), and urine cultures by 36% (IRR, 0.64; 95% CI, 0.56–0.73). There was an anticipated rise in urinalysis testing by 23% (IRR, 1.23; 95% CI, 1.14–1.33). Despite higher acuity and fewer brief hospitalizations, mortality, hospital, and PICU readmissions were stable, and PICU length of stay declined. Of the 108 physician surveys, 46 replied (43%), and 39 (85%) recently used the algorithm; 0 reported patient safety concerns, two (4%) provided constructive feedback, and 28 (61%) reported the algorithm improved patient care.

CONCLUSIONS:
A comprehensive fever algorithm was associated with reductions in blood, endotracheal, and urine cultures and anticipated increase in urinalyses. We detected no patient harm, and physicians reported improved patient care.
Measuring Energy Requirements of Traumatic Brain Injury Patients in Pediatric Intensive Care With Indirect Calorimetry: A Comparison With Empiric Methods*
Authors: Beggs Megan R. , Ashkin Allison , Larsen Bodil M. K. , Garros Daniel 
Published: May 2023

OBJECTIVES:
Energy requirements following moderate or severe pediatric traumatic brain injury (TBI) have not been fully elucidated. Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure (MREE) in PICU. However, technical complexity limits its use. We aimed to determine whether MREE differs from standard of care energy estimation and delivery in a cohort of pediatric patients following moderate to severe TBI during PICU admission.

DESIGN:
Retrospective case series study.

SETTING:
Single-center, 16-bed general PICU in Canada between May 2011 and January 2019.

PATIENTS:
Children (0–18 yr) admitted to a PICU for moderate (Glasgow Coma Scale [GCS] 9–12) to severe TBI (GCS < 9) and had an IC study performed while mechanically ventilated.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
During the study period, 245 patients were admitted with the diagnosis of trauma with TBI. The study includes a convenience sample of 26 patients with severe (n = 23) and moderate (n = 3) TBI who underwent a total of 34 IC measurements. MREE varied considerably from 29% to 144% of predicted energy expenditure. Using Bland-Altman comparative analysis, neither Schofield nor World Health Organization predictive equations were in agreement with MREE. Only one measurement revealed that the patient was appropriately fed (energy provided in nutrition support was within 10% of MREE); 10 (38%) measurements revealed overfeeding and 15 (58%) underfeeding at the time of testing.

CONCLUSIONS:
The present study adds to the small body of literature highlighting the limitations of predictive equations to evaluate energy requirements following moderate to severe pediatric TBI. IC, when feasible, should be used as the preferred method to orient PICU teams to feed such vulnerable patients.
Predictors of Risk for Cerebral Palsy: A Review
Authors: Mohanty Tanochni , Joseph Sibi Daniel , Gunasekaran Pradeep Kumar , Doreswamy Srinivasa Murthy , Saini Lokesh 
Published: May 2023

Purpose:
To identify the earliest predictors of risk for diagnosis of cerebral palsy (CP).

Methods:
A comprehensive literature search was conducted using various databases. The publications were reviewed to identify risk factors for CP from conception to early infancy. Studies were critically appraised with Joanna Briggs Institute guidelines for quality appraisal and evaluated for risk of bias using the Agency for Health Care Research and Quality guidelines.

Results:
The initial search yielded 129 studies and 20 studies were included. Forty-seven risk factors for CP were extracted of which several were duplicate terms. The significant risk factors found to be indicative of CP were low birth weight (<1500 g), birth at less than 28 weeks of gestational age, periventricular leukomalacia, grade 3 or 4 intraventricular hemorrhage, preeclampsia, prematurity, an Apgar score of less than 4 at the first minute, birth asphyxia, preterm premature rupture of membrane, and absent fidgety movements.

Conclusion:
Twenty-three factors were consistently reported as predictors of CP.
Early Identification of Atypical Motor Performance of Infants With Prenatal Opioid Exposure
Authors: Boynewicz Kara , Campbell Suzann K. , Chroust Alyson 
Published: May 2023

Purpose:
To investigate the association between prenatal opioid exposure (POE) and newborn infants' motor performance to aid in the early identification of developmental delays.

Methods:
Nineteen infants with POE requiring pharmacological treatment, 27 infants with POE without pharmacological treatment, and 25 infants without POE were assessed via the Test of Infant Motor Performance (TIMP).

Results:
Infants in both groups with POE had lower TIMP scores than infants without POE. There was no difference between the TIMP scores of infants with POE who required pharmacological treatment and infants with POE who did not require pharmacological treatment.

Conclusions:
The TIMP can detect differences in motor performance of infants with POE. Regardless of whether infants required pharmacological treatment, POE was associated with lower motor performance. Those working in hospital or early intervention settings can use the TIMP to identify early delays in infants with POE and refer for intervention.
Ventral Column Spinal Cord Stimulation for Post Lumbar Laminectomy Syndrome: A Case Report
Authors: Van Acker Gustaf , Kim Chong H. 
Published: May 2023

ABSTRACT
Spinal cord stimulation is an increasingly utilized treatment for a number of chronic pain states. Dorsal column stimulation is historically and currently the anatomical target of choice for most chronic pain conditions, including post-laminectomy syndrome and radicular pain. However early studies suggested that stimulation of an alternative target, the ventral columns that carry pain fibers in the anterior and lateral spinothalamic tracts, may offer comparable or superior pain relief. A patient undergoing standard-of-care spinal cord stimulation trial had an additional lead placed on the right ventrolateral aspect of the spinal cord. Following the usual 7-day trial of dorsal column stimulation, the dorsal leads were removed and ventrolateral column stimulation was applied through the retained ventral lead for a period of 3 days. The Brief Pain Index Short Form and Numeric Rating Scale were recorded for both dorsal and ventral stimulation. Ventrolateral spinal cord stimulation provided comparable outcomes compared with dorsal column stimulation using non-paresthesia-based stimulation. The results suggest further investigation into spinal cord stimulation anatomical placement and mechanism of action is warranted.