bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tropical forest lianas have greater non-structural carbohydrate concentrations in the stem xylem than trees
Authors: Signori-Müller Caroline , Galbraith David , Tavares Julia V , Reis Simone M , Diniz Francisco C , Gilpin Martin , Marimon Beatriz S , van der Heijden Geertje M F , Borges Camila , Cintra Bruno B L , Mião Sarah , Morandi Paulo S , Nina Alex , Salas Yupayccana Carlos A , Marca Zevallos Manuel J , Cosio Eric G , Junior Ben H Marimon , Mendoza Abel M , Phillips Oliver , Salinas Norma , Vasquez Rodolfo , Mencuccini Maurizio , Oliveira Rafael S 
Published: August 2023

Abstract
Lianas (woody vines) are important components of tropical forests and are known to compete with host trees for resources, decrease tree growth and increase tree mortality. Given the observed increases in liana abundance in some forests and their impacts on forest function, an integrated understanding of carbon dynamics of lianas and liana-infested trees is critical for improved prediction of tropical forest responses to climate change. Non-structural carbohydrates (NSC) are the main substrate for plant metabolism (e.g. growth, respiration), and have been implicated in enabling tree survival under environmental stress, but little is known of how they vary among life-forms or of how liana infestation impacts host tree NSC. We quantified stem xylem total NSC concentrations and its fractions (starch and soluble sugars) in trees without liana infestation, trees with ˃50% of the canopy covered by lianas, and the lianas infesting those trees. We hypothesized that (i) liana infestation depletes NSC storage in host trees by reducing carbon assimilation due to competition for resources; (ii) trees and lianas, which greatly differ in functional traits related to water transport and carbon uptake, would also have large differences in NSC storage. As water availability has a significant role in NSC dynamics of Amazonian tree species, we tested these hypotheses within a moist site in western Amazonia and a drier site in southern Amazonia. We did not find any difference in NSC, starch or soluble sugar concentrations between infested and non-infested trees, in either site. This result suggests that negative liana impact on trees may be mediated through mechanisms other than depletion of host tree NSC concentrations. We found lianas have higher stem NSC and starch than trees in both sites. The consistent differences in starch concentrations, a long-term NSC reserve, between life forms across sites reflect differences in lianas and trees carbon gain and use. Soluble sugar concentrations were higher in lianas than in trees in the moist site but indistinguishable between life forms in the dry site. The lack of difference in soluble sugars between trees and lianas in the dry site emphasizes the importance of this NSC fraction for the metabolism of plants occurring in water limited environments.
Abstracts in Portuguese and Spanish are available in the supplementary material.
Trauma systems in Canada: striving for quality across an expansive landmass
Authors: Caminsky Natasha G. , Wong Evan G. 
Published: August 2023

Abstract
Although Canada has a universal health care program that provides free in-hospital services to all citizens, its vast landmass and nonstandardized prehospital and posthospital systems make delivering quality trauma care challenging, particularly to resource-limited rural regions. This article summarizes the strengths of the prehospital system, facility-based care, trauma network, trauma registry, rehabilitation, and governance/financing/quality assurance components of Canada’s trauma system. Future directions, including the use of telemedicine, standardization of practices, and resource optimization, are also explored. Canada’s trauma system is well developed, yet geography impedes equitable access. More standardization and resource optimization are needed.
Nasopharyngeal Swabs in Pediatric Patients With Thrombocytopenia and Anticoagulant Use
Authors: Greenmyer Jacob R. , Kohorst Mira A. , Thompson Whitney S. , Kaczor Mark , Alajbegovic Katarina , Kranz Lincoln A. , Cain Meghan , Ristagno Elizabeth H. 
Published: August 2023

Background:
Nasopharyngeal (NP) swabbing is a technique that is commonly used to test pediatric patients for viral infections with increased use during the coronavirus disease 2019 pandemic. Complications from NP swabbing are rare and seem to occur more frequently in patients at risk of bleeding. Little is known about institutional or individual practices and experiences with NP swab testing in pediatric patients with risk factors for bleeding.

Methods:
We conducted a survey study of pediatric hematology/oncology (PHO) attending physicians to assess practices and experiences with NP swab testing in pediatric patients with thrombocytopenia and/or on anticoagulation.

Results:
There were 130 total respondents (5.6%, n = 130/2327) from 6 countries. Relatively few respondents (n = 17/130, 13.1%) reported that their institution had a policy specifying a lower-level platelet cutoff for patients undergoing NP swabbing. The median platelet cutoff below which NP swabs are not performed according to existing policies is 30,000×10(9)/L (interquartile range: 20,000 to 40,000). The median cutoff based on the opinion of the respondents was 10,000 (interquartile range: 10,000 to 20,000). There were 24 episodes of epistaxis among PHO patients that were NP swabbed; many adverse events (56.5%, n = 13/23) were described as persistent, severe, and/or required intervention. Three reported cases of epistaxis with anticoagulation or antiplatelet therapy occurred in patients with concomitant thrombocytopenia. Only 1 respondent (n = 1/130, 0.7%) reported an institutional policy for limiting NP swabs in patients on anticoagulant therapy. NP (66.9%) and nares (33.1%) were the most common sources of coronavirus disease 2019 testing that were reported.

Conclusion:
A small percentage of institutions in this survey have a policy restricting NP swabs in PHO patients. The discrepancy between lower platelet cutoffs proposed by experts and institutional policy suggests that existing policies may be too conservative. Expert guidelines are needed on this topic. Other bleeding risk factors (eg, aspirin use and von Willebrand disease) should be considered in policies and guidelines.
A Study of Medical Surgical Nurses Leaders' Evidence-Based Practice Attributes
Authors: Gallagher-Ford Lynn , Hinkley Teresa-Lynn (Terri) , Thomas Bindu , Hertel Robin , Messinger Jeff D. , Cengiz Adem , Yoder Linda H. 
Published: August 2023

OBJECTIVE
The purpose of this study was to determine medical-surgical nurse leaders' evidence-based practice (EBP) attributes, perceived barriers to EBP, and whether there were differences in leaders' EBP competencies and EBP implementation by demographic and organizational factors.

BACKGROUND
Leaders are crucial to the development of cultures that support EBP implementation, but little is known about medical-surgical nurse leaders' capacity to perform this aspect of their role.

METHODS
A cross-sectional design using survey methodology was used. The survey contained demographic/work setting questions and 3 instruments to measure EBP beliefs, implementation, and competencies.

RESULTS
Senior leaders self-reported higher EBP attributes compared with nurses in other roles; nurses with an MSN or higher reported greater frequency of EBP implementation. A regression revealed that EBP competencies, EBP beliefs, having a DNP degree, and working in an Academy of Medical-Surgical Nurses Premier Recognition In the Specialty of Med-surg unit or a Pathway to Excellence® organization had significant, positive effects on EBP implementation scores (R
2 = 0.37).

CONCLUSIONS
Findings demonstrate there is a range of EBP beliefs and competencies, and barriers to EBP among medical-surgical nurse leaders. Because medical-surgical nursing is the largest acute care practice specialty in the United States and many other countries, leaders fully integrating EBP into their practice would be a substantial contribution to advancing EBP in healthcare.
Recurrent Tumefactive Central Nervous System Lesions Due to BRIP1-Related Fanconi Anemia
Authors: Nathoo Nabeela , Gavrilova Ralitza H. , Trejo-Lopez Jorge A. , McGarrah Patrick W. , Go Ronald S. , Alqallaf Abdulradha , Tobin W. Oliver 
Published: August 2023

Introduction:
Fanconi anemia (FA) is an inherited condition associated with genetic mutations that affect DNA repair proteins. More than 20 genes involved in the FA/BRCA pathway have been implicated in FA, including BRIP1. Tumefactive brain lesions are rare in FA.

Case Report:
We describe a patient with FA and recurrent tumefactive brain lesions preceded by calcifications on head computed tomography. A biopsy revealed white-matter gliosis with severe vasculopathy. Whole-genome sequencing demonstrated a BRIP1 homozygous variant with a final diagnosis of recurrent tumefactive brain lesions due to BRIP1-associated CNS vasculopathy. Immunosuppressive treatment was ineffective in the present case.

Conclusions:
Mechanistically, the specific role of BRIP1 mutation in CNS inflammation and vasculopathy is unclear. However, immunodeficiency disorders can lead to autoimmunity and/or immune dysregulation due to the possible loss or gain of function of components of the immune system.
Effects of Prostaglandin E1 on Mastectomy Flap Necrosis in Immediate Implant-Based Breast Reconstruction
Authors: Hwang Ji Won , Lim Woo Sung , Kim Hyun Goo , Park Jin-Woo , Bae Juyoung , Park Seyeon , Jeon Byung-Joon , Woo Kyong-Je 
Published: August 2023

Background:
Necrosis of a cutaneous flap including the nipple-areola complex is a common complication in immediate implant-based breast reconstruction following nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM). This study aimed to evaluate the efficacy of prostaglandin E1 (PGE1) in reducing such complications.

Methods:
A retrospective analysis of prospectively collected data was conducted at two centers, and the cohort consisted of patients undergoing NSM/SSM followed by immediate reconstruction with a prosthesis. Patients who were randomly allocated to the treatment group were administered daily intravenous PGE1 (10 μg/2 mL) beginning intraoperatively through postoperative day 6. Skin flap complications including nipple/skin necrosis, delayed wound healing, and postoperative wound revision were recorded. Complication rates were compared between the PGE1 and control groups.

Results:
A total of 276 breasts in 259 patients were included for analysis (139 breasts in the treatment group and 137 breasts in the control group). There was no difference in patient demographics between the control and treatment groups. Reconstructed breasts receiving PGE1 had significantly lower rates of overall skin complications (21.6% versus 34.3%; P = 0.022) and wound revision (2.9% versus 9.5%; P = 0.025). Among NSM cases, the PGE1 group showed a significantly lower rate of nipple necrosis (15.5% versus 29.4%; P = 0.027). In the multivariate analysis, the use of PGE1 significantly reduced the risk of overall skin flap complications (OR, 0.491; P = 0.018) and wound revision (OR, 0.213; P = 0.018) in NSM/SSM cases, and nipple necrosis (OR, 0.357; P = 0.008) in NSM cases.

Conclusion:
PGE1 can be effective in reducing risk of mastectomy flap complications in immediate implant-based breast reconstructions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Fracture Patterns, Associated Injuries, Management, and Treatment Outcomes of 530 Pediatric Mandibular Fractures
Authors: Irgebay Zhazira , Glenney Anne E. , Cheng Lucille , Li Runjia , Mocharnuk Joseph W. , Smetona John , Balasubramani G. K. , Losee Joseph E. , Goldstein Jesse A. 
Published: August 2023

Background:
Mandibular fractures account for up to 48.8% of pediatric facial fractures; however, there are a wide range of available treatment modalities, and few studies describe trends in adverse outcomes of these injuries. This study describes fracture cause, pattern, management, and treatment outcomes in pediatric mandibular fracture patients.

Methods:
A retrospective review was performed of patients younger than 18 years who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, cause, medical history, associated facial fractures, other associated injuries, treatments, and outcomes.

Results:
A total of 530 pediatric patients with 829 mandibular fractures were included in the analysis. Most isolated mandibular fractures were treated with physical therapy and rest (n = 253 [47.7%]). Patients with combination fractures, specifically those involving the parasymphysis and angle, were 2.63 times more likely to undergo surgical management compared with patients with a single facial fracture (P < 0.0001). Older age (P < 0.001), sex (P = 0.042), mechanism (P = 0.008) and cause of injury (P = 0.002), and specific fractures (eg, isolated angle [P = 0.001]) were more associated with adverse outcomes. The odds of adverse outcomes were higher for patients treated with closed reduction and external fixation or open reduction and internal fixation compared with conservative management (OR, 1.8, 95% CI, 1.0 to 3.2; and OR, 2.1, 95% CI, 1.2 to 3.5, respectively).

Conclusions:
Fracture type, mechanism of injury, and treatment modality in pediatric mandibular fractures are associated with distinct rates and types of adverse outcomes. Large-scale studies characterizing these injuries are critical for guiding physicians in the management of these patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Prevalence of Retinal Venous Malformations in Patients With Cerebral Cavernous or Arteriovenous Malformations
Authors: Chan Kyle S. , Daulton Melanie R. , Reddy Vishruth D. , McComb Erin N. , Lavine Jeremy A. 
Published: August 2023

Background:
Cerebral vascular malformations (CVMs) may result in hemorrhage, seizure, neurologic dysfunction, and death. CVMs include capillary telangiectasias, venous malformations, cavernous malformations, and arteriovenous malformations. Cavernous and arteriovenous malformations carry the highest risk of complications. Retinal venous malformations (RVMs) have been proposed as an associated finding. Our objective was to determine the prevalence of RVMs in patients with high-risk CVMs.

Methods:
We retrospectively reviewed patients diagnosed with cerebral cavernous or arteriovenous malformations (high-risk CVMs) who were evaluated by the ophthalmology service at Northwestern University between 2017 and 2020. Patients were stratified into 3 cohorts based on level of certainty: dilated funduscopic examination (DFE), DFE with any form of ocular imaging, and DFE with complete imaging of the macula. We recorded ophthalmic examination abnormalities, ocular imaging findings, and major CVM complications.

Results:
We evaluated 156 patients with high-risk CVMs who had undergone DFE. Ocular imaging of any type was performed in 56 patients, of whom 46 had complete imaging of the macula. Zero RVMs were identified in any cohort (95% confidence interval: 0%–1.9% for the entire cohort, 0%–5.4% for any ocular imaging cohort, and 0%–6.5% for the complete macular imaging cohort). Cerebral hemorrhage or seizure occurred in 15%–33% of patients. Associated visual field defects or cranial nerve palsies were found in 14%–20% of patients.

Conclusions:
Zero RVMs were identified in patients with high-risk CVMs. However, neuro-ophthalmic findings were common. Therefore, we recommend neuroimaging for patients with RVMs and neuro-ophthalmic signs or symptoms. In asymptomatic patients with RVMs, a potential algorithm for neuroimaging is proposed.
Advanced Hemodynamic and Cluster Analysis for Identifying Novel RV function subphenotypes in Patients with Pulmonary Hypertension
Authors: Janowski Alexandra M , Ravellette Keeley S , Insel Michael , Garcia Joe G , Rischard Franz P , Vanderpool Rebecca R 
Published: August 2023

AbstractBackgroundQuantifying right ventricular (RV) function is important to describe the pathophysiology of in pulmonary hypertension (PH). Current phenotyping strategies in PH rely on few invasive hemodynamic parameters to quantify RV dysfunction severity. The aim of this study was to identify novel RV phenotypes using unsupervised clustering methods on advanced hemodynamic features of RV function.MethodsParticipants were identified from the University of Arizona Pulmonary Hypertension Registry (n=190). RV-pulmonary artery coupling (Ees/Ea), RV systolic (Ees) and diastolic function (Eed) was quantified from stored RV pressure waveforms. Consensus clustering analysis with bootstrapping was used to identify the optimal clustering method. Pearson correlation analysis was used to reduce collinearity between variables. RV cluster subphenotypes were characterized using clinical data and compared to pulmonary vascular resistance (PVR) quintiles.ResultsFive distinct RV clusters (C1-C5) with distinct RV subphenotypes were identified using k-medoids with a Pearson distance matrix. Clusters 1 and 2 both have low diastolic stiffness (Eed) and afterload (Ea) but RV-PA coupling (Ees/Ea) is decreased in C2. Intermediate cluster (C3) has a similar Ees/Ea as C2 but with higher PA pressure and afterload. Clusters C4 and C5 have increased Eed and Ea but C5 has a significant decrease in Ees/Ea. Cardiac output was high in C3 distinct from the other clusters. In the PVR quintiles, contractility increased and stroke volume decreased as a function of increased afterload. World Symposium PH classifications were distributed across clusters and PVR quintiles.ConclusionsRV-centric phenotyping offers an opportunity for a more precise-medicine based management approach.
Design and Validation of a Low-Cost, Open-Source, 3D-Printed Otoscope
Authors: Lowe Joshua , Bagha Hamza , Inayat Hamza , Eid Anas , Talarico Frankie , Ni Tiffany , Loubani Tarek 
Published: August 2023

AbstractThe modern otoscope is an indispensable instrument utilized by primary care physicians as the gold standard tool to diagnose an array of otologic diseases and conditions. At present, commercially available, traditional otoscopes remain cost-prohibitive to many potential users despite limited innovation since its invention in the early 19thcentury. In this publication, the design and assembly of a low-cost, open-source, 3D-printed otoscope, the Glia Otoscope V1.0, is outlined. Subsequently, we describe the benchtop evaluation conducted, which measured several outcomes relevant to otoscopy performance against a traditional, gold standard otoscope, the Welch Allyn Rechargeable V3.5 Halogen HPX Otoscope. Measured outcomes included illuminance, correlated color temperature, color rendering index, spatial resolution, field of view, weight, battery life, and cost. Overall, the Glia Otoscope V1.0 demonstrated comparable performance across measured outcomes against the traditional otoscope. Further validation in the clinical setting is warranted as the Glia Otoscope V1.0 and its future iterations hold tremendous potential in improving access and alleviating the burden of otologic disease in lower and middle-income countries. Finally, we present a novel tool, the Otoscope Assessment Tool, which establishes a standard set of performance characteristics for benchtop evaluation of otoscope performance.
Exploring Burn First Aid Knowledge and Water Lavage Practices in Uganda: A Cross-Sectional Study
Authors: Kasagga Brian , Baluku Joseph Baruch , Bongomin Felix , Kasozi Derrick , Muwanguzi Eria , Namazzi Mercy , Sadiq Yusuf , Alenyo Rose , Kalanzi Edris Wamala , Balumuka Darius , Elobu Alex Emmanuel 
Published: August 2023

ABSTRACTBackgroundLow- and middle-income countries experience higher burn-related morbidity and mortality compared to high-income countries. Prehospital Burn First Aid (BFA) has been proven effective in reducing such outcomes. This study aimed to assess BFA knowledge and water lavage practices and their associated factors among burn victims and the general population at a tertiary health facility in Uganda.MethodsA cross-sectional study was conducted at the Burns Unit of Kiruddu National Referral Hospital in Kampala between April and November 2022. Participants included burn patients, caregivers, and visitors. Data on BFA knowledge and practices were collected using an interviewer-administered questionnaire. BFA knowledge was evaluated using 13 questions, with ≥80% score considered adequate. Logistic regression was used to analyze associations.ResultsThe study had 404 participants, comprising 68(16.8%) burn victims, 161(39.9%) primary caregivers, and 175(43.3%) visitors. Among all participants, 339(83.9%) had never received BFA information, and 392(97.0%) had no first aid training. Mean BFA knowledge score was 56% (SD 13.9), with only 5.4% demonstrating adequate knowledge. Only 26(27.7%) of current and former burn victims used water lavage as BFA. No statistically significant associations were found between BFA knowledge, water lavage usage, and demographic variables on univariate and multivariate analyses.ConclusionThis study highlights inadequate BFA knowledge and practices among participants. Addressing these deficiencies through community-based initiatives is crucial to improving burn care in Uganda.
A Single-Tube Colorimetric Loop-Mediated Isothermal Amplification for Rapid Detection of SARS-CoV-2 RNA
Authors: Hongjaisee Sayamon , Kham-Kjing Nang , Musikul Piyagorn , Daengkaokhew Wannaporn , Kongson Nuntita , Guntala Ratchadakorn , Jaiyapan Nitipoom , Kline Enos , Panpradist Nuttada , Ngo-Giang-Huong Nicole , Khamduang Woottichai 
Published: August 2023

AbstractSince SARS-CoV-2 is a highly transmissible virus, a rapid and accurate diagnostic method is necessary to prevent virus spread. We aimed to develop and evaluate a new rapid colorimetric reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay for SARS-CoV-2 detection in a single closed-tube. Nasopharyngeal and throat swabs collected from at-risk individuals testing for SARS-CoV-2 were used to assess the sensitivity and specificity of a new RT-LAMP assay against a commercial qRT-PCR assay. Total RNA extracts were submitted to the RT-LAMP reaction under optimal conditions and amplified at 65°C for 30 minutes using three sets of specific primers targeting the nucleocapsid gene. The reaction was detected using two different indicator dyes, hydroxynaphthol blue (HNB) and cresol red. A total of 82 samples were used for detection with HNB and 94 samples with cresol red, and results were compared with the qRT-PCR assay. The sensitivity of the RT-LAMP-based HNB assay was 92.1% and the specificity was 93.2%. The sensitivity of the RT-LAMP-based cresol red assay was 80.3%, and the specificity was 97%. This colorimetric feature makes this assay highly accessible, low-cost, and user-friendly, which can be deployed for massive scale-up and rapid diagnosis of SARS-CoV-2 infection, particularly in low-resource settings.