bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Importance of Contact Zones for Distinguishing Interspecific from Intraspecific Geographic Variation
Authors: Chambers E Anne , Marshall Thomas L , Hillis David M 
Published: August 2022

Abstract
With limited sampling, geographic variation within a single species can be difficult to distinguish from interspecific variation, confounding our ability to draw accurate species boundaries. We argue that thorough sampling and analysis of contact zones between putative taxa can determine if assortative mating or selection against hybrids exists (supporting the presence of two distinct species), or alternatively if mating is random among genotypes and admixture among adjacent populations is gradual and continuous (supporting geographic variation within a single species). Here, we test two alternative hypotheses for two pairs of named taxa at contact zones within the American milksnake (Lampropeltis triangulum) complex. A prior morphological analysis found areas of gradual intergradation among named taxa, and concluded that the taxa represented geographical races of a single polytypic species. In contrast, a subsequent analysis of gene sequence data, but with limited sampling near the contact zones, hypothesized distinct boundaries between species at the contact zones. At the contact zone between proposed species L. triangulum and Lampropeltis gentilis, we examined a $\sim$700 km-wide transect across the states of Kansas and Missouri, with thorough sampling and reduced-representation genomic-level sequencing, to test the two opposing taxonomic hypotheses. Our transect analyses included examinations of population structure, fixed differences, cline-fitting, and an admixture index analysis. These analyses all supported a gradual and continuous geographic cline across a broad intergrade zone between two geographic forms of L. triangulum, thus providing strong support for a single species in this region (and no support for the recognition of L. gentilis as a distinct species). At a second contact zone between proposed species L. triangulum and Lampropeltis elapsoides (but variously treated as species or subspecies by different researchers) in Kentucky and Tennessee, we re-evaluated morphological data. In this case, the contact zone analysis indicated sympatry and reproductive isolation of the two taxa, and thus strongly supported L. triangulum and L. elapsoides as distinct species. We conclude that detailed studies of contact zones, based on either genetic or morphological data, are essential for distinguishing intraspecific from interspecific variation in the case of widely and continuously distributed taxa. [Contact zones; speciation; species concepts; species delimitation; taxonomy.]
Validation of Risk-Stratification Method for the Chronic Atrioventricular Block Cynomolgus Monkey Model and Its Mechanistic Interpretation Using 6 Drugs With Pharmacologically Distinct Profile
Authors: Goto Ai , Sakamoto Kengo , Kambayashi Ryuichi , Izumi-Nakaseko Hiroko , Kawai Shinichi , Takei Yoshinori , Matsumoto Akio , Kanda Yasunari , Sugiyama Atsushi 
Published: August 2022

Abstract
Validation of risk-stratification method for the chronic atrioventricular block cynomolgus monkey model and its mechanistic interpretation was performed using 6 pharmacologically distinct drugs. The following drugs were orally administered in conscious state, astemizole: 1, 5, and 10 mg/kg (n = 6); haloperidol: 1, 10, and 30 mg/kg (n = 5); amiodarone: 30 mg/kg (n = 4); famotidine: 10 mg/kg (n = 4); levofloxacin: 100 mg/kg (n = 4); and tolterodine: 0.2, 1, and 4.5 mg/kg (n = 4). Astemizole of 5 and 10 mg/kg significantly prolonged ΔΔQTcF, whereas no significant change was observed by the others. Torsade de pointes (TdP) was induced by astemizole of 5 and 10 mg/kg in 3/6 and 6/6, and by haloperidol of 10 and 30 mg/kg in 1/5 and 1/5, respectively, which was not observed in the others. Torsadogenic risk of the drugs was quantified using the criteria for the monkey model specified in our previous study. Namely, high-risk drugs induced TdP at ≤ 3 times of their maximum clinical daily dose. Intermediate-risk drugs did not induce TdP at this dose range, but induced it at higher doses. Low/no-risk drugs never induced TdP at any dose tested. The magnitude of risk was intermediate for astemizole and haloperidol, and low/no risk for the others. The prespecified, risk-stratification method for the monkey model may solve the issue existing between nonclinical models and patients with labile repolarization, which can reinforce the regulatory decision-making and labeling at time of marketing application of nondouble-negative drug candidate (hERG assay positive and/or in vivo QT study positive).
The Clinical Significance of Vitamin D and Zinc Levels with Respect to Immune Response in COVID-19 Positive Children
Authors: Doğan Ahmet , Dumanoğlu Doğan İmran , Uyanık Metin , Köle Mehmet Tolga , Pişmişoğlu Kemal 
Published: August 2022

Abstract

Aim
In this study, we aimed to evaluate serum vitamin D and zinc levels in children diagnosed with coronavirus disease 2019 (COVID-19).

Materials and methods
In this study, 88 children with COVID-19 disease and 88 healthy children aged 1–18 years were enrolled between 01 July 2021 and 30 October 2021 in the Pediatrics Clinic of Tekirdağ Çorlu State Hospital. Serum vitamin D and zinc levels have been measured and NCSS (Number Cruncher Statistical System) program has been utilized for statistical analysis.

Results
We included 88 COVID-19 positive pediatric patients [50% (n = 44) female] and 88 healthy children [48.86% (n = 43) female] in this study. The mean serum vitamin D levels of COVID-19 positive patients were statistically significantly lower than the control group (p = 0.0001). The zinc mean values of the study group were found to be statistically significantly lower than the control group (p = 0.0001). There was a statistically significant correlation between serum vitamin D and zinc values in all patient groups (r = 0.245, p = 0.001).

Conclusion
As a result, zinc and vitamin D levels were observed lower in COVID-19 patients than in healthy individuals. Since there is no defined treatment protocol for COVID-19 infection on children yet, zinc and vitamin D supplementation can be used as a supportive treatment in COVID-19 infection.
A Patient Navigation Model to Improve Complex Wound Care Outcomes
Authors: Arputhanathan Helen , Hyde Jane , Atilola Temidayo , Queen Douglas , Elliott James , Sibbald R. Gary 
Published: August 2022

ABSTRACT

OBJECTIVE
To create a blended format model to navigate interprofessional team assessments of patients with complex wounds during COVID-19 as a quality improvement process.

METHODS
During clinical assessments, patients were interviewed in their homes with representation from their circle of care and primary nurse on site linked to a live virtual interprofessional blended remote team model (wound care nurse specialist, advanced wound care doctor). Eligible patients had completed a wound care clinical pathway without wound closure. Palliative patients with complex wounds and patients without precise/accurate diagnoses were also included. This process addressed the components of Wound Bed Preparation 2021: manage the cause, address patient-centered concerns, determine the ability to heal, optimize local wound care, and evaluate outcomes on an ongoing basis.

RESULTS
Since April 2020, 48 patients were referred to the Home and Community Care Support Services patient navigation interprofessional team. Patients’ home-care services were initiated between 2012 and 2021. The team provided closure in 29% of patients and the wound surface area reduced in 66%. Pain was reduced in 73% of patients and appropriate infection management was implemented in 79%. In addition, nursing visits were reduced by 73% and there was a 77% decrease in supply usage.

CONCLUSIONS
This project validated the Wound Bed Preparation Paradigm 2021 as a process for assessing patients with complex wounds using a blended virtual and home-based assessment. Patient navigation with this blended model benefited patients and improved healthcare system utilization with projected cost savings.
Anesthesia and the neurobiology of fear and posttraumatic stress disorder
Authors: Vogt Keith M. , Pryor Kane O. 
Published: August 2022

Purpose of review
Dysfunction of fear memory systems underlie a cluster of clinically important and highly prevalent psychological morbidities seen in perioperative and critical care patients, most archetypally posttraumatic stress disorder (PTSD). Several sedative-hypnotics and analgesics are known to modulate fear systems, and it is theoretically plausible that clinical decisions of the anesthesiologist could impact psychological outcomes. This review aims to provide a focused synthesis of relevant literature from multiple fields of research.

Recent findings
There is evidence in some contexts that unconscious fear memory systems are less sensitive to anesthetics than are conscious memory systems. Opiates may suppress the activation of fear systems and have benefit in the prevention of PTSD following trauma. There is inconsistent evidence that the use of propofol and benzodiazepines for sedation following trauma may potentiate the development of PTSD relative to other drugs. The benefits of ketamine seen in the treatment of major depression are not clearly replicated in PTSD-cluster psychopathologies, and its effects on fear processes are complex.

Summary
There are multiple theoretical mechanisms by which anesthetic drugs can modulate fear systems and clinically important fear-based psychopathologies. The current state of research provides some evidence to support further hypothesis investigation. However, the absence of effectiveness studies and the inconsistent signals from smaller studies provide insufficient evidence to currently offer firm clinical guidance.
Children’s Hip Predictive (CHiP) Score: A Triage Tool for Hip Dislocation in Children Referred With Suspected Hip Dysplasia
Authors: Murphy Evelyn P. , Howells Catherine , Gallagher Olga , Kelly Paula M. , O’Kelly Patrick , Noel Jacques , Moore David , O’Toole Patrick J. , Kennedy Jim 
Published: August 2022

Background:
A fundamental tenent of treating developmental dysplasia of the hip is to identify patients with dislocated hips early so as to avoid the long-term sequelae of late diagnosis. The aim of this study was to develop a readily useable triage tool for patients with suspected hip dislocation, based on the clinical history and examination findings of the referring practitioner.

Methods:
All primary care referrals (n=934) over a 3-year period for suspected developmental dysplasia of the hip to a tertiary pediatric center were evaluated. Defined parameters with respect to history and clinical examination were evaluated. Multivariable logistic regression was used to establish predictors of hip dislocation, and from this a predictive model was derived which incorporated significant predictors of dislocation. An illustrative nomogram translated this predictive model into a usable numerical scoring system called the Children’s Hip Prediction score, which estimates probability of hip dislocation.

Results:
There were 97 dislocated hips in 85 patients. The final predictive model included age, sex, family history, breech, gait concerns, decreased abduction, leg length discrepancy, and medical/neurological syndrome. The area under receiver operating curve for the model is 0.761. A Children’s Hip Prediction score of≥5 corresponds to a sensitivity of 76.3% and a score of≥15 has a specificity of 97.8%, corresponding to an odds ratio of 27.3 for increased risk of dislocation.

Conclusion:
We found that a novel clinical prediction score, based on readily available history and examination parameters strongly predicted risk of dislocations in hip dysplasia referral. It is hoped that this tool could be utilized to optimize resource allocation and may be of particular benefit in less well-resourced health care systems.

Level of Evidence:
Level II.
Titanium-coated PEEK Versus Uncoated PEEK Cages in Lumbar Interbody Fusion
Authors: Lv Zheng-tao , Xu Yong , Cao Bin , Dai Jun , Zhang Si-yuan , Huang Jun-ming , Liang Shuang , Jiang Feng-xian 
Published: August 2022

Study Design:
Systematic review and meta-analysis.

Objective:
This study was performed to compare the fusion and subsidence rate of titanium-coated polyetheretherketone (Ti-PEEK) versus polyetheretherketone (PEEK) cages after lumbar fusion and to investigate the clinical effect on patient-reported outcomes (PROMs).

Summary of Background Data:
Ti-PEEK cages have been developed to combine the advantages of both titanium alloy and PEEK, but whether they are superior to uncoated PEEK cages in bone fusion is still inconclusive.

Methods:
PubMed, EMBASE, ISI Web of Science, CENTRAL, and CNKI were searched to identify randomized controlled trials that compared the efficacy of Ti-PEEK and PEEK cages in lumbar fusion. Difference in fusion rate and subsidence rate was indicated by risk ratio and its associated 95% confidence interval (95% confidence interval). Mean difference was calculated for Oswestry Disability Index and visual analogue scale for low back pain. Subgroup analysis was performed by time course after the surgery. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to evaluate the certainty of evidence.

Results:
Four randomized controlled trials involving 325 patients (160 patients in Ti-PEEK group and 165 patients in PEEK group) that underwent lumbar fusion were included by our current study. Low to moderate evidence suggested that Ti-PEEK and PEEK cages exhibited equivalent fusion rate and subsidence rate at any follow-up time. Low to moderate evidence suggested that there was no difference in PROMs except for visual analogue scale measured at 6 months (mean difference: −0.57, 95% confidence interval −0.94, −0.21; P=0.002) but the difference was not clinically relevant according to the minimal clinically important difference.

Conclusion:
Low to moderate evidence showed that Ti-PEEK and PEEK had equivalent effect in bone fusion and cages subsidence at any follow-up time after lumbar fusion surgeries. Low to moderate evidence showed no clinically important difference in PROMs.
Bebtelovimab-Induced Bradycardia Leading to Cardiac Arrest
Authors: Gearges Christina , Haider Hibah , Rana Vishal , Asghar Zahra , Kewalramani Anjali , Kuschner Zachary 
Published: August 2022

BACKGROUND:
Bebtelovimab is a monoclonal antibody used to prevent progression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Complications of SARS-CoV-2 infection can include cardiac effects including sinus bradycardia.

CASE SUMMARY:
We describe the case of an 86-year-old male infected with SARS-CoV-2 who experienced bradycardia with cardiac arrest immediately following infusion of Bebtelovimab with return of spontaneous circulation obtained following 1 minute of chest compressions and administration of atropine. His bradycardia resolved, and he was extubated on hospital day 1, found to be neurologically intact, and discharged on hospital day 9.

CONCLUSIONS:
Due to the time course of the patient’s symptomatology, we attribute the bradycardic arrest to the Bebtelovimab infusion. This case illustrates the need for further research into the etiology of bradycardia due to SARS-CoV-2 infection and to examine potential links to monoclonal antibody infusion. It also serves as important caution to maintain close cardiac monitoring while administering monoclonal antibodies for SARS-CoV-2.
No Reduction in Revision Risk Associated With Highly Cross-linked Polyethylene With or Without Antioxidants Over Conventional Polyetheylene in TKA: An Analysis From the American Joint Replacement Registry
Authors: Kendall Jamil , Pelt Christopher E. , Imlay Benjamin , Yep Patrick , Mullen Kyle , Kagan Ryland 
Published: August 2022

Abstract

Background
Highly cross-linked polyethylene (HXLPE) can improve wear properties in TKA, but it can also lead to decreased mechanical properties. Antioxidants were added to HXLPE to improve its mechanical properties while retaining the improved wear characteristics. However, it remains unclear whether these modifications to conventional polytheylene used in TKA have resulted in a change in the revision risk.

Questions/purposes
We used American Joint Replacement Registry data to ask: (1) Is there a difference in all-cause revision in patients who underwent TKA using HXLPE with or without an antioxidant doping compared with conventional polyethylene? (2) Is there a difference in revision for aseptic failure in patients who underwent TKA using HXLPE with or without an antioxidant doping compared with conventional polyethylene?

Methods
We analyzed American Joint Replacement Registry data from 2012 to 2019. We identified 339,366 primary TKAs over the study period in patients older than 65 years and linked procedures to supplemental Centers for Medicare & Medicaid data where available. Patient total number of reported comorbidities, gender, age, region, polyethylene characteristics, procedure dates, and indication for revision were recorded. Median follow-up was 34 months. We compared HXLPE with or without antioxidants to conventional polyethylene. Event-free percent survival curves and Cox proportional hazard regression modeling was used for all-cause revision and revision for aseptic failure.

Results
Compared with conventional polyethylene, there was no difference in all-cause revision with HXLPE with an antioxidant (HR 1.06 [95% CI 0.98 to 1.14]; p = 0.13) or HXLPE without an antioxidant (HR 1.04 [95% CI 0.97 to 1.11]; p = 0.28). Compared with conventional polyethylene, there was no difference in revision for aseptic failure with HXLPE with an antioxidant (HR 1.07 [95% CI 0.99 to 1.14]; p = 0.08) or HXLPE without an antioxidant (HR 1.03 [95% CI 0.97 to 1.01]; p = 0.30).

Conclusion
We found no difference in revision risk between HXLPE with or without an antioxidant and conventional polyethylene during this time frame. HXLPE polyethylene, with or without an antioxidant, should not be widely adopted until or unless it is shown to be superior to conventional polyethylene in TKA.

Level of Evidence
Level III, therapeutic study.
Differences in rates of pelvic lymph node dissection in National Comprehensive Cancer Network favorable, unfavorable intermediate and high-risk prostate cancer across United States SEER registries
Authors: Flammia Rocco Simone , Hoeh Benedikt , Chierigo Francesco , Hohenhorst Lukas , Sorce Gabriele , Tian Zhen , Leonardo Costantino , Graefen Markus , Terrone Carlo , Saad Fred , Shariat Shahrokh F. , Briganti Alberto , Montorsi Francesco , Chun Felix K. H. , Gallucci Michele , Karakiewicz Pierre I. 
Published: August 2022

Abstract

Background
The National Comprehensive Cancer Network (NCCN) guidelines recommend pelvic lymph node dissection (PLND) in NCCN high- and intermediate-risk prostate cancer patients. We tested for PLND nonadherence (no-PLND) rates within the Surveillance Epidemiology and End Results (2010–2015).

Materials and methods
We identified all radical prostatectomy patients who fulfilled the NCCN PLND guideline criteria (N = 23,495). No-PLND rates were tabulated and further stratified according to NCCN risk subgroups, race/ethnicity, geographic distribution, and year of diagnosis.

Results
Overall, the no-PLND rate was 26%; it was 41%, 25%, and 11% in the NCCN intermediate favorable, intermediate unfavorable, and high-risk prostate cancer patients, respectively (p < 0.001). Over time, the no-PLND rates declined in the overall cohort and within each NCCN risk subgroup. Georgia exhibited the highest no-PLND rate (49%), whereas New Jersey exhibited the lowest (15%). Finally, no-PLND race/ethnicity differences were recorded only in the NCCN intermediate unfavorable subgroup, where Asians exhibited the lowest no-PLND rate (20%) versus African Americans (27%) versus Whites (26%) versus Hispanic-Latinos (25%).

Conclusions
The lowest no-PLND rates were recorded in the NCCN high-risk patients followed by NCCN intermediate unfavorable and favorable risk in that order. Our findings suggest that unexpectedly elevated differences in no-PLND rates warrant further examination. In all the NCCN risk subgroups, the no-PLND rates decreased over time.
Clearance of Piperacillin–Tazobactam and Vancomycin During Continuous Renal Replacement With Regional Citrate Anticoagulation
Authors: Sharrock Lucy , Ankravs Melissa J. , Deane Adam M. , Rechnitzer Thomas , Wallis Steven C. , Roberts Jason A. , Bellomo Rinaldo 
Published: August 2022

Background:
The use of regional citrate anticoagulation during continuous venovenous hemodiafiltration (CVVHDF) has increased worldwide. However, data on its effect on the pharmacokinetics of antibiotics are limited. In this study, the authors aimed to measure the clearance of piperacillin–tazobactam and vancomycin in patients receiving CVVHDF with regional citrate anticoagulation.

Methods:
This study measured piperacillin–tazobactam and vancomycin concentrations in patients receiving CVVHDF with regional citrate anticoagulation. Dosing regimens were independently selected by intensivists. Arterial blood and effluent fluid samples were obtained over a single dosing interval and analyzed using ultra-high-performance liquid chromatography with tandem mass spectrometry.

Results:
Seventeen sampling intervals in 15 patients (9 receiving piperacillin–tazobactam only, 4 receiving vancomycin only, and 2 receiving both) were used. The median overall clearance for piperacillin was 35.2 mL/min [interquartile range (IQR): 32.2–38.6], 70 mL/min (IQR: 62.7–76.2) for tazobactam, and 29.5 mL/min (IQR: 26.2–32) for vancomycin.

Conclusions:
This is the first study to quantify the pharmacokinetics of vancomycin and piperacillin–tazobactam in patients receiving CVVHDF with regional citrate anticoagulation. These results indicate high clearance and provide key information to guide optimal dosing.
A Novel Orderset Driven Emergency Department Atrial Fibrillation Algorithm to Increase Discharge and Risk-appropriate Anticoagulation
Authors: Roumpf Steven K. , Kline Jeffrey A. , Dandamudi Gopi , Schaffer Jason T. , Flack Tara , Gallaher Wesley , Weaver Allison M. , Hunt Ina , Thinnes Erynn , Strachan Christian C. , Hall Cassandra , Pafford Carl , Hunter Benton R. 
Published: August 2022

Introduction:
Patients with atrial fibrillation (AF) are frequently admitted from the emergency department (ED), and when discharged, are not reliably prescribed indicated anticoagulation. We report the impact of a novel computerized ED AF pathway orderset on discharge rate and risk-appropriate anticoagulation in patients with primary AF.

Methods:
The orderset included options for rate and rhythm control of primary AF, structured risk assessment for thrombotic complications, recommendations for anticoagulation as appropriate, and follow up with an electrophysiologist. All patients discharged from the ED in whom the AF orderset was utilized over an 18-month period comprised the primary study population. The primary outcome was the rate of appropriate anticoagulation or not according to confirmed CHADS-VASC and HASBLED scores. Additionally, the percentage of primary AF patients discharged directly from the ED was compared in the 18-month periods before and after introduction of the orderset.

Results:
A total of 56 patients, average age 57.8 years and average initial heart rate 126 beats/minute, were included in the primary analysis. All 56 (100%; 95% confidence interval, 94-100) received guideline-concordant anticoagulation. The discharge rates in the pre- and postorderset implementation periods were 29% and 41%, respectively (95% confidence interval for 12% difference, 5-18).

Conclusions:
Our novel AF pathway orderset was associated with 100% guideline-concordant anticoagulation in patients discharged from the ED. Availability of the orderset was associated with a significant increase in the proportion of ED AF patients discharged.