bluuebunny/crossref_metadata_2025 huggingface dataset:
The psychosocial impact of haemophilia from patients’ and caregivers’ point of view: The results of an Italian survey
Authors: Fornari Arianna , Antonazzo Ippazio Cosimo , Rocino Angiola , Preti Daniele , Fragomeno Anna , Cucuzza Francesco , Ceresi Nicola , Santoro Cristina , Ferretti Antonietta , Facchetti Rita , Cozzolino Paolo , Biasoli Chiara , Cassone Cristina , Coppola Antonio , Cortesi Paolo Angelo , Mantovani Lorenzo Giovanni
Published: December 2023

Backgroud

A huge amount of data about psychosocial issues of people with haemophilia (PwH) are available; however, these materials are fragmentary and largely outdated, failing to reflect the impact of current treatment strategies.

Aim

Describing the influence of illness on psychosocial aspects of adult PwH (≥18 years) and caregivers of children with haemophilia (CPwH) without inhibitors, in Italy.

Methods

Surveys (for adult PwH, CPwH and haemophilia specialists) were developed by a multidisciplinary working group and conducted from November 2019 to June 2020.

Results

A total of 120 PwH without inhibitors and 79 CPwH completed the survey. Adult patients reported a significant impairment in many psychosocial aspects, including working activities, relations with family members and social relations. Caregivers generally reported better scores in all aspects of the survey. Mobility, Pain and Mental health domains of EQ‐5D were the most frequently impaired in both patients and caregivers, reducing the perceived quality of life. Genetic counselling was an important issue, 53% of CPwH declaring unawareness of their carrier status, as well as the psychological support offered by the reference center, 67.0% of respondents reporting that no psychological support was provided at the time of diagnosis communication.

Conclusion

This study provides information about PwH's and CPwH's point of view in the current scenario of continuous innovations in haemophilia treatment and management furthermore, updated insights on psychosocial problems faced by patients and caregivers are reported.
New concept in fatty liver diseases
Authors: Tokushige Katsutoshi
Published: December 2023

In 2023, the nonalcoholic fatty liver disease (NAFLD) Nomenclature Consensus group proposed a new name and concept for NAFLD/nonalcoholic steatohepatitis. The Japanese Society of Gastroenterology and the Japanese Society of Hepatology have accepted these new names and concepts. It was reported that the terms “nonalcoholic” and “fatty” are misleading and inappropriate, because NAFLD does not reflect the etiology. Thus, appropriate disease names are discussed, and new concepts are published. First, the concept of steatotic liver disease (SLD) was proposed to encompass fatty liver diseases of various etiologies, which are classified into five categories. The diagnostic criteria for metabolic dysfunction‐associated steatotic liver disease (MASLD) included fatty liver with at least one of the five cardiometabolic risk factors (body mass index or waist diameter, blood glucose or glycated hemoglobin, blood pressure, triglycerides, and high‐density lipoprotein cholesterol) and the same restriction of alcohol consumption as NAFLD. A new fatty liver category was described, MetALD, to represent the intermediate drinker group (patients with MASLD with high weekly alcohol intake [140–350 g/week in women and 210–420 g/week in men]). The other five categories are alcohol‐associated liver disease, fatty liver with an identifiable specific cause, and other fatty livers of unknown cause. Nonalcoholic steatohepatitis is an important pathological concept (metabolic dysfunction‐associated steatohepatitis); however, its definition, including hepatocellular balloon‐like degeneration, needs to be reassessed. In Japan, we should use these names and criteria to manage SLD, including hepatocellular carcinoma, which is markedly increasing.
Asian participants' experience in phase 3/3b studies of long‐acting cabotegravir and rilpivirine: Efficacy, safety, pharmacokinetic, and virological outcomes through week 96
Authors: Oka Shinichi , Holohan Vicki , Shirasaka Takuma , Choi Jun Yong , Kim Yeon‐Sook , Chamay Nadine , Patel Parul , Polli Joseph W. , Ford Susan L. , Crauwels Herta , Garside Louise , D'Amico Ronald , Latham Christine , van Solingen‐Ristea Rodica , Baugh Bryan , van Wyk Jean
Published: December 2023

Objectives

Cabotegravir + rilpivirine (CAB + RPV) dosed monthly or every 2 months is the first complete long‐acting (LA) regimen recommended by treatment guidelines for the maintenance of HIV‐1 virological suppression. This post hoc analysis summarizes outcomes for Asian participants through week 96.

Methods

Data from Asian participants naive to CAB + RPV randomized to receive dosing every 4 weeks (Q4W) or every 8 weeks (Q8W) in the FLAIR (NCT02938520) and ATLAS‐2M (NCT03299049) phase 3/3b studies were pooled. The proportion of participants with plasma HIV‐1 RNA ≥50 and <50 copies/mL (per FDA Snapshot algorithm), incidence of confirmed virological failure (CVF; two consecutive HIV‐1 RNA ≥200 copies/mL), pharmacokinetics, safety, and tolerability through week 96 were assessed.

Results

Overall, 41 Asian participants received CAB + RPV (Q8W, n = 17; Q4W, n = 24). At week 96, 83% (n = 34/41) of participants maintained HIV‐1 RNA <50 copies/mL, none had HIV‐1 RNA ≥50 copies/mL, and 17% (n = 7/41) had no virological data. No Asian participant met the CVF criterion. Drug‐related adverse events occurred in 44% (n = 18/41) of participants; none were Grade ≥3. All injection site reactions were Grade 1 or 2; median duration was 2 days and most resolved within 7 days (90%, n = 390/435). CAB and RPV trough concentrations remained well above their respective protein‐adjusted 90% inhibitory concentrations (CAB, 0.166 μg/mL; RPV, 12 ng/mL) through week 96.

Conclusions

CAB + RPV LA demonstrated high efficacy, with no participants having CVF, and an acceptable safety profile in Asian participants through week 96. These data support CAB + RPV LA as a complete regimen for the maintenance of HIV‐1 virological suppression in Asian individuals.
Development of an explainable artificial intelligence model for Asian vascular wound images
Authors: Lo Zhiwen Joseph , Mak Malcolm Han Wen , Liang Shanying , Chan Yam Meng , Goh Cheng Cheng , Lai Tina , Tan Audrey , Thng Patrick , Rodriguez Jorge , Weyde Tillman , Smit Sylvia
Published: December 2023

Chronic wounds contribute to significant healthcare and economic burden worldwide. Wound assessment remains challenging given its complex and dynamic nature. The use of artificial intelligence (AI) and machine learning methods in wound analysis is promising. Explainable modelling can help its integration and acceptance in healthcare systems. We aim to develop an explainable AI model for analysing vascular wound images among an Asian population. Two thousand nine hundred and fifty‐seven wound images from a vascular wound image registry from a tertiary institution in Singapore were utilized. The dataset was split into training, validation and test sets. Wound images were classified into four types (neuroischaemic ulcer [NIU], surgical site infections [SSI], venous leg ulcers [VLU], pressure ulcer [PU]), measured with automatic estimation of width, length and depth and segmented into 18 wound and peri‐wound features. Data pre‐processing was performed using oversampling and augmentation techniques. Convolutional and deep learning models were utilized for model development. The model was evaluated with accuracy, F1 score and receiver operating characteristic (ROC) curves. Explainability methods were used to interpret AI decision reasoning. A web browser application was developed to demonstrate results of the wound AI model with explainability. After development, the model was tested on additional 15 476 unlabelled images to evaluate effectiveness. After the development on the training and validation dataset, the model performance on unseen labelled images in the test set achieved an AUROC of 0.99 for wound classification with mean accuracy of 95.9%. For wound measurements, the model achieved AUROC of 0.97 with mean accuracy of 85.0% for depth classification, and AUROC of 0.92 with mean accuracy of 87.1% for width and length determination. For wound segmentation, an AUROC of 0.95 and mean accuracy of 87.8% was achieved. Testing on unlabelled images, the model confidence score for wound classification was 82.8% with an explainability score of 60.6%. Confidence score was 87.6% for depth classification with 68.0% explainability score, while width and length measurement obtained 93.0% accuracy score with 76.6% explainability. Confidence score for wound segmentation was 83.9%, while explainability was 72.1%. Using explainable AI models, we have developed an algorithm and application for analysis of vascular wound images from an Asian population with accuracy and explainability. With further development, it can be utilized as a clinical decision support system and integrated into existing healthcare electronic systems.
Algorithm for accurate shear relaxation modulus analysis in glass viscoelasticity characterization
Authors: Zhou Tianfeng , Zhou Zhikang , Gao Liheng , Xie Jiaqing , Liu Peng , Wang Xibin
Published: December 2023

Numerical simulation of the glass molding process and analysis of material viscoelasticity are growing increasingly significant as the research on optical‐device glass molding intensifies. An accurate and efficient analytical algorithm for the shear relaxation modulus in the viscoelasticity characterization of glass was developed in this study. We measured the high‐temperature creep curve, friction coefficient, and elastic modulus of glass (D‐LaF50) according to the requirements for viscoelasticity characterization. The viscoelastic behavior of glass was characterized based on the analytical algorithm and test results. A finite element analysis model was developed to verify the accuracy of the analytical algorithm. The results show that the error of the proposed algorithm's numerical simulation compared to the test results is within 5%.
A review of the role of transcription factors in regulating adipogenesis and lipogenesis in beef cattle
Authors: Abebe Belete Kuraz , Wang Hongbao , Li Anning , Zan Linsen
Published: December 2023

In the past few decades, genomic selection and other refined strategies have been used to increase the growth rate and lean meat production of beef cattle. Nevertheless, the fast growth rates of cattle breeds are often accompanied by a reduction in intramuscular fat (IMF) deposition, impairing meat quality. Transcription factors play vital roles in regulating adipogenesis and lipogenesis in beef cattle. Meanwhile, understanding the role of transcription factors in regulating adipogenesis and lipogenesis in beef cattle has gained significant attention to increase IMF deposition and meat quality. Therefore, the aim of this paper was to provide a comprehensive summary and valuable insight into the complex role of transcription factors in adipogenesis and lipogenesis in beef cattle. This review summarizes the contemporary studies in transcription factors in adipogenesis and lipogenesis, genome‐wide analysis of transcription factors, epigenetic regulation of transcription factors, nutritional regulation of transcription factors, metabolic signalling pathways, functional genomics methods, transcriptomic profiling of adipose tissues, transcription factors and meat quality and comparative genomics with other livestock species. In conclusion, transcription factors play a crucial role in promoting adipocyte development and fatty acid biosynthesis in beef cattle. They control adipose tissue formation and metabolism, thereby improving meat quality and maintaining metabolic balance. Understanding the processes by which these transcription factors regulate adipose tissue deposition and lipid metabolism will simplify the development of marbling or IMF composition in beef cattle.
Orismilast for the treatment of mild to severe hidradenitis suppurativa: Week 16 data from OSIRIS, a Phase 2a, open‐label, single‐centre, single‐arm, dose‐finding clinical trial
Authors: Frederiksen C. G. , Sedeh F. B. , Taudorf E. H. , Saunte D. M. , Jemec G. B. E.
Published: December 2023

Background

Hidradenitis suppurativa (HS) is a disease with an unmet need for treatment.

Objective

To examine tolerability, safety and efficacy of oral phosphodiesterase‐4 (PDE4) inhibitior orismilast 10–40 mg twice daily (BID) in HS.

Methods

A Phase 2a, single‐arm, single‐centre, open‐label, 16‐week trial in HS patients. Adjustments in maximal dose and titration were allowed, to improve tolerability, dividing the study population in two groups who completed and discontinued 16 weeks of treatment.

Descriptive statistics were applied to efficacy data from patients who completed treatment and patients who discontinued treatment prematurely. A last‐observation‐carried‐forward (LOCF) approach was used for patients who discontinued treatment.

The primary endpoint was percent change in the total number of abscesses and nodules (AN‐count) at Week 16, with the HS Clinical Response with a 50% reduction in the AN‐count (HiSCR50) as key secondary endpoint.

Results

Of the 20 patients included, 9 completed 16 weeks of treatment and 11 discontinued treatment prematurely. The mean AN‐count was reduced with 33.1% in patients who completed treatment and with 12.0% in patients who discontinued. HiSCR50 was achieved by 67.0% and 27.0% of patients who completed and discontinued treatment, respectively. Most adverse events were mild to moderate.

Conclusions

Oral orismilast demonstrated a dose‐dependent tolerability, with mild to moderate adverse effects. Further, the results of this exploratory trial indicate that orismilast may lead to clinical improvements in HS. However, larger trials with tolerable dose ranges are warranted.

The Trial is registered at Clinicaltrials.gov (UNI50007201) and EudraCT.ema.europa.eu (2021‐000049‐42).
Addressing the need for Indigenous‐specific PROMs and PREMS: A focus on methodology
Authors: d'Agincourt‐Canning Lori , Ziabakhsh Shabnam , Morgan Jenny , Jinkerson‐Brass Elder Sharon , Joolaee Soudabeh , Smith Tonya , Loft Shelby , Rosalie Darci
Published: December 2023

Purpose

Differences in Indigenous worldviews, practices and values highlight the need for Indigenous‐specific health quality indicators, such as patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs). The purpose of this paper is to present our methodology, as part of a larger study that sought to develop a framework for creating Indigenous‐specific PROMs and PREMs.

Methods

The research design was informed by Indigenous research methodology and a community‐based participatory approach. It had three core components: (1) a literature exploration of existing Indigenous‐specific PROMs and PREMs; (2) interviews with researchers with expertise in PROMs and PREMs developed for Indigenous populations and community leaders interested in using these Indigenous‐informed evaluation tools; and (3) conversations with Indigenous community members about their experiences with health surveys. Interviews were audio‐recorded and transcribed verbatim; transcripts were analyzed qualitatively using an inductive and deductive approach. Themes and sub‐themes were identified to build a framework that honours Indigenous knowledges and ways of knowing. Results were validated with select research participants and the Project Advisory Committee.

Results

Findings demonstrate how relationship building is the necessary starting point for engagement when developing survey instruments with Indigenous peoples. Engagement requires respectful collaboration through all stages of the project from determining what questions are asked to how the information will be collected, interpreted, and managed. A relational stance requires responsibility to Indigenous communities and peoples that goes beyond research carried out using a western scientific lens. It means ensuring that the project is beneficial to the community and framing questions based on Indigenous knowledge, worldviews, and community involvement.

Conclusions

This study employed a collaborative, participatory qualitative approach to develop a framework for creating PROMs and PREMs with Indigenous peoples. The methods described offer concrete examples of strategies that can be employed to support relationship‐building and collaboration when developing Indigenous‐specific survey instruments.
Disease latency and new‐user versus prevalent‐user cohort designs: Implications for pharmacoepidemiology in dementia
Authors: Wu Che‐Yuan , Swardfager Walter
Published: December 2023

See the Reply by Lee et al. in this issue.
Evaluation of a benzodiazepine deprescribing quality improvement initiative for older adults in primary care
Authors: Chae Sulgi , Lee Emma , Lindenberg Julia , Shen Kaden , Anderson Timothy S.
Published: December 2023

Background

Older adults are commonly prescribed long‐term benzodiazepines for anxiety and insomnia despite evidence of risks and limited evidence of long‐term benefits. Recent quality measures and guidelines have recommended benzodiazepine deprescribing, yet there is little real‐world data on clinic‐based deprescribing programs.

Methods

We developed a benzodiazepine deprescribing quality improvement program for older adults at a large US academic medical center. The program targeted adults aged 65 years and older who were prescribed chronic benzodiazepines by their primary care physician (PCP). PCPs were contacted to opt‐out patients not suitable for deprescribing; then eligible patients were mailed a letter discussing patient‐specific risks and advising them to discuss deprescribing with their PCP or a pharmacist who was available to support tapering. The primary outcomes were the number of patients who discussed deprescribing and who initiated a taper within 90 days of outreach.

Results

Of 504 older adults prescribed benzodiazepines, 133 (26%) were opted out by their PCPs leaving a cohort of 371 (median age 71 years [IQR 68–75], 58% female, 82% White). The median daily diazepam milligram equivalent was 5 mg (IQR 3–6 mg) and 30% were prescribed long‐acting benzodiazepines. Three months following patient outreach, 97 patients (26%) had a documented discussion of benzodiazepines with their PCP or clinic pharmacist. Of these patients, 35 (36%) had documentation of a deprescribing discussion and 25 (26%) initiated a taper. At 12 months, 16 patients (64%) were tapered successfully, with nine (36%) patients taking a lower benzodiazepine dose and seven (28%) discontinuing benzodiazepines completely.

Conclusions

A low‐intensity benzodiazepine deprescribing outreach program led to deprescribing conversations for a minority of patients, but one‐quarter of older adults who engaged in a conversation chose to taper and nearly two‐thirds sustained reduced use. Incorporating benzodiazepine deprescribing into routine care may require more intensive population‐health efforts to engage patients and clinicians.
Antagonistic MADS‐box transcription factors SEEDSTICK and SEPALLATA3 form a transcriptional regulatory network that regulates seed oil accumulation
Authors: He Shuangcheng , Min Yuanchang , Liu Zijin , Zhi Fang , Ma Rong , Ge Ankang , Wang Shixiang , Zhao Yu , Peng Danshuai , Zhang Da , Jin Minshan , Song Bo , Wang Jianjun , Guo Yuan , Chen Mingxun
Published: December 2023

Transcriptional regulation is essential for balancing multiple metabolic pathways that influence oil accumulation in seeds. Thus far, the transcriptional regulatory mechanisms that govern seed oil accumulation remain largely unknown. Here, we identified the transcriptional regulatory network composed of MADS‐box transcription factors SEEDSTICK (STK) and SEPALLATA3 (SEP3), which bridges several key genes to regulate oil accumulation in seeds. We found that STK, highly expressed in the developing embryo, positively regulates seed oil accumulation in Arabidopsis (Arabidopsis thaliana). Furthermore, we discovered that SEP3 physically interacts with STK in vivo and in vitro. Seed oil content is increased by the SEP3 mutation, while it is decreased by SEP3 overexpression. The chromatin immunoprecipitation, electrophoretic mobility shift assay, and transient dual‐luciferase reporter assays showed that STK positively regulates seed oil accumulation by directly repressing the expression of MYB5, SEP3, and SEED FATTY ACID REDUCER 4 (SFAR4). Moreover, genetic and molecular analyses demonstrated that STK and SEP3 antagonistically regulate seed oil production and that SEP3 weakens the binding ability of STK to MYB5, SEP3, and SFAR4. Additionally, we demonstrated that TRANSPARENT TESTA 8 (TT8) and ACYL‐ACYL CARRIER PROTEIN DESATURASE 3 (AAD3) are direct targets of MYB5 during seed oil accumulation in Arabidopsis. Together, our findings provide the transcriptional regulatory network antagonistically orchestrated by STK and SEP3, which fine tunes oil accumulation in seeds.
Certified Nurse‐Midwives as Teachers: Expanding Interprofessional Collaboration Learning Opportunities for Medical Students on the Obstetrics and Gynecology Clerkship
Authors: Liang Angela C. , Malone Anita , Kobernik Emily K. , Holman Elizabeth , Hammoud Maya M. , Majszak Christina , Kempner Samantha , Morgan Helen K.
Published: December 2023

Introduction

Interprofessional experiences provide critical exposure to collaborative health care teams, yet medical students often lack this experience during clinical clerkships. We created a labor and delivery triage rotation exclusively staffed by certified nurse‐midwives in the obstetrics and gynecology clerkship to address this gap. We sought to evaluate the clinical learning experiences of medical students rotating on this midwife‐supervised collaborative team.

Methods

Between 2018 and 2020, we electronically sent all medical students an evaluation after each required clerkship. Our primary outcome was the quality of teaching score, as defined by level of agreement on a 5‐point Likert scale with a statement regarding teaching quality. A secondary outcome evaluated scores from the National Board of Medical Examiners (NBME) Obstetrics and Gynecology subject examination taken by all students at the end of the rotation. Evaluations and assessments were compared between students rotating on labor and delivery triage and those who did not. Evaluation comments from students rotating on labor and delivery triage were collated to identify common themes.

Results

Of 374 students, 370 (98.9%) completed the end‐of‐clerkship course evaluation and 312 (83.4%) completed teaching evaluations. Sixty‐seven students (17.9%) rotated in labor and delivery triage; of these, 52 (77.6%) completed both the course and triage rotation evaluations. There were no differences in the mean quality of teaching scores (3.9 ± 1.2 versus 3.8 ± 1.2, p = 0.54) or in NBME Obstetrics and Gynecology subject examination scores between students rotating in labor and delivery triage compared to all other rotations (79.9% ± 7.2% vs 80.2% ± 7.8%, P = 0.436). Comments from teaching evaluations highlighted student exposure to the midwifery philosophy of care model.

Discussion

This work demonstrates the feasibility and benefits of this midwife‐led authentic interprofessional collaborative experience for medical students. This model can serve as an example of how to implement and evaluate interprofessional collaboration experiences in the clinical setting.
Using experiments to study families and intimate relationships
Authors: Doan Long , Quadlin Natasha , Khanna Katharine
Published: December 2023

Social scientists increasingly are using experiments to examine causal processes and mechanisms in their research. Yet, experiments work much better for some research aims than others. Some goals that are of great interest to family scholars, such as testing theoretical arguments, are well‐suited to experimental approaches; other goals, such as documenting real‐world experiences, may be best served by another research design. Our aim in this article is to discuss the power and limits of experimental methods for the study of family, with an emphasis on describing the types of topics and approaches that work best in an experimental framework. We begin by briefly reviewing the current state of the literature and the types of experiments that are commonly used to study families and intimate relationships. We discuss recent examples and “best practices” to illustrate the potential strengths of experiments for the study of family. After walking through an in‐depth example of an experimental research design, we describe some unresolved theoretical puzzles in the family literature from the previous mid‐decade review that seem ripe for experimental study. In doing so, we demonstrate that experiments, when used appropriately, can provide powerful evidence of causal mechanisms that resonate with scholarly audiences and the public.
Redefining CT perfusion‐based ischemic core estimates for the ghost core in early time window stroke
Authors: Koneru Manisha , Hoseinyazdi Meisam , Lakhani Dhairya A. , Greene Cynthia , Copeland Karen , Wang Richard , Xu Risheng , Luna Licia , Caplan Justin M. , Dmytriw Adam A. , Guenego Adrien , Heit Jeremy J. , Albers Gregory W. , Wintermark Max , Gonzalez Luis F. , Urrutia Victor C. , Huang Judy , Nael Kambiz , Leigh Richard , Marsh Elisabeth B. , Hillis Argye E. , Llinas Rafael H. , Yedavalli Vivek S.
Published: December 2023

Background and Purpose

In large vessel occlusion (LVO) stroke patients, relative cerebral blood flow (rCBF)<30% volume thresholds are commonly used in treatment decisions. In the early time window, nearly infarcted but salvageable tissue volumes may lead to pretreatment overestimates of infarct volume, and thus potentially exclude patients who may otherwise benefit from intervention. Our multisite analysis aims to explore the strength of relationships between widely used pretreatment CT parameters and clinical outcomes for early window stroke patients.

Methods

Patients from two sites in a prospective registry were analyzed. Patients with LVOs, presenting within 3 hours of last known well, and who were successfully reperfused were included. Primary short‐term neurological outcome was percent National Institutes of Health Stroke Scale (NIHSS) change from admission to discharge. Secondary long‐term outcome was 90‐day modified Rankin score. Spearman's correlations were performed. Significance was attributed to p‐value ≤.05.

Results

Among 73 patients, median age was 66 (interquartile range 54‐76) years. Among all pretreatment imaging parameters, rCBF<30%, rCBF<34%, and rCBF<38% volumes were significantly, inversely correlated with percentage NIHSS change (p<.048). No other parameters significantly correlated with outcomes.

Conclusions

Our multisite analysis shows that favorable short‐term neurological recovery was significantly correlated with rCBF volumes in the early time window. However, modest strength of correlations provides supportive evidence that the applicability of general ischemic core estimate thresholds in this subpopulation is limited. Our results support future larger‐scale efforts to liberalize or reevaluate current rCBF parameter thresholds guiding treatment decisions for early time window stroke patients.
Melatonin facts: Lack of evidence that melatonin is a radical scavenger in living systems
Authors: Boutin Jean A. , Liberelle Maxime , Yous Saïd , Ferry Gilles , Nepveu Françoise
Published: December 2023

Melatonin is a small natural compound, so called a neuro‐hormone that is synthesized mainly in pineal gland in animals. Its main role is to master the clock of the body, under the surveillance of light. In other words, it transfers the information concerning night and day to the peripheral organs which, without it, could not “know” which part of the circadian rhythm the body is in. Besides its main circadian and circannual rhythms mastering, melatonin is reported to be a radical scavenger and/or an antioxidant. Because radical scavengers are chemical species able to neutralize highly reactive and toxic species such as reactive oxygen species, one would like to transfer this property to living system, despite impossibilities already largely reported in the literature. In the present commentary, we refresh the memory of the readers with this notion of radical scavenger, and review the possible evidence that melatonin could be an in vivo radical scavenger, while we only marginally discuss here the fact that melatonin is a molecular antioxidant, a feature that merits a review on its own. We conclude four things: (i) the evidence that melatonin is a scavenger in acellular systems is overwhelming and could not be doubted; (ii) the transposition of this property in living (animal) systems is (a) theoretically impossible and (b) not proven in any system reported in the literature where most of the time, the delay of the action of melatonin is over several hours, thus signing a probable induction of cellular enzymatic antioxidant defenses; (iii) this last fact needs a confirmation through the discovery of a nuclear factor—a key relay in induction processes—that binds melatonin and is activated by it and (iv) we also gather the very important description of the radical scavenging capacity of melatonin in acellular systems that is now proven and shared by many other double bond‐bearing molecules. We finally discussed briefly on the reason—scientific or else—that led this description, and the consequences of this claim, in research, in physiology, in pathology, but most disturbingly in therapeutics where a vast amount of money, hope, and patient bien‐être are at stake.
Kelp and sea urchin settlement mediated by biotic interactions with benthic coralline algal species
Authors: Twist Brenton A. , Mazel Florent , Zaklan Duff Stefanie , Lemay Matthew A. , Pearce Christopher M. , Martone Patrick T.
Published: December 2023

Species interactions can influence key ecological processes that support community assembly and composition. For example, coralline algae encompass extensive diversity and may play a major role in regime shifts from kelp forests to urchin‐dominated barrens through their role in inducing invertebrate larval metamorphosis and influencing kelp spore settlement. In a series of laboratory experiments, we tested the hypothesis that different coralline communities facilitate the maintenance of either ecosystem state by either promoting or inhibiting early recruitment of kelps or urchins. Coralline algae significantly increased red urchin metamorphosis compared with a control, while they had varying effects on kelp settlement. Urchin metamorphosis and density of juvenile canopy kelps did not differ significantly across coralline species abundant in both kelp forests and urchin barrens, suggesting that recruitment of urchin and canopy kelps does not depend on specific corallines. Non‐calcified fleshy red algal crusts promoted the highest mean urchin metamorphosis percentage and showed some of the lowest canopy kelp settlement. In contrast, settlement of one subcanopy kelp species was reduced on crustose corallines, but elevated on articulated corallines, suggesting that articulated corallines, typically absent in urchin barrens, may need to recover before this subcanopy kelp could return. Coralline species differed in surface bacterial microbiome composition; however, urchin metamorphosis was not significantly different when microbiomes were removed with antibiotics. Our results clarify the role played by coralline algal species in kelp forest community assembly and could have important implications for kelp forest recovery.
A novel for an ageing population? Masculinity and demographic shift in David Lodge'sDeaf Sentence(2008)
Authors: Rossoni Stefano
Published: December 2023

This article examines David Lodge's novelDeaf Sentence(2008), which focuses on the life of Desmond, a retired professor of linguistics. I argue that this text offers a standpoint through which readers can visualise the global phenomenon of population ageing and address the question of global responsibility. I look atDeaf Sentencewithin the tradition of the Bakhtinian polyphonic novel and through the lens of the campus novel that Lodge discusses in his critical writing. The analysis of dialogism and self‐reflexivity illuminates the reverberations of global ageing on the life of Desmond, situating questions of wellbeing and demography within a narrative perspective. Detailing their struggles with isolation, incontinence and erectile dysfunction, the narration of Desmond and his father growing older sheds light on the limitations of biomedical scripts for older men based on bodily control and sexual performativity. Considering the tension of biomedical discourses and gender expectations informing the cultural construction of ageing in the global North, I contend that Lodge's writing exposes the limits of the neoliberal ideals of self‐sufficiency and individual responsibility at the heart of the notion of successful ageing. Echoing Desmond's self‐reflection,Deaf Sentenceoffers its reader a standpoint through which to reflect on his problematic participation in the neoliberal, patriarchal regimes that marginalise him. Interpreting the novel as a space for deconstructing the ideal of an autonomous and independent subject postulated by neoliberal discourses, I readDeaf Sentenceas an invitation to its readers to embrace their own vulnerability, fostering ethics of care towards themselves and the other.
Circadian clock‐ and temperature‐associated genes contribute to overall genomic differentiation along elevation in lichenized fungi
Authors: Valim Henrique F. , Grande Francesco Dal , Wong Edgar L. Y. , Schmitt Imke
Published: December 2023

Circadian regulation is linked to local environmental adaptation, and many species with broad climatic niches display variation in circadian genes. Here, we hypothesize that lichenizing fungi occupying different climate zones tune their metabolism to local environmental conditions with the help of their circadian systems. We study two species of the genus Umbilicaria occupying similar climatic niches (Mediterranean and the cold temperate) in different continents. Using homology to Neurospora crassa genes, we identify gene sets associated with circadian rhythms (11 core, 39 peripheral genes) as well as temperature response (37 genes). Nucleotide diversity of these genes is significantly correlated with mean annual temperature, minimum temperature of the coldest month and mean temperature of the coldest quarter. Furthermore, we identify altitudinal clines in allele frequencies in several non‐synonymous substitutions in core clock components, for example, white collar‐like, frh‐like and various ccg‐like genes. A dN/dS approach revealed a few significant peripheral clock‐ and temperature‐associated genes (e.g. ras‐1‐like, gna‐1‐like) that may play a role in fine‐tuning the circadian clock and temperature‐response machinery. An analysis of allele frequency changes demonstrated the strongest evidence for differentiation above the genomic background in the clock‐associated genes in U. pustulata. These results highlight the likely relevance of the circadian clock in environmental adaptation, particularly frost tolerance, of lichens. Whether or not the fungal clock modulates the symbiotic interaction within the lichen consortium remains to be investigated. We corroborate the finding of genetic variation in clock components along altitude—not only latitude—as has been reported in other species.
Environmental change unlinks a gene from its trait
Authors: Wellenreuther Maren
Published: December 2023

In Atlantic salmon (Salmo salar), sea age is a major life history trait governed by a sex‐specific trade‐off between reproductive success and survival. In this issue of Molecular Ecology, Besnier et al. (Molecular Ecology, 2023) found evidence to suggest that the disassociation between sea age and major effect loci, including the previously identified candidate genes vgll3 and six6, may be related to the recently observed trend towards slower growth and later maturation. These results are of importance because they challenge the prevailing view that evolution moves in a slow shuffle, and they provide a pertinent example of how an optimal phenotype can change due to growth‐driven plasticity and lead to contemporary molecular and phenotypic evolution.
Barriers and facilitators to offering post‐intensive care follow‐up services from the perspective of critical care professionals: A qualitative study
Authors: Zhang Feng , Chen Zhen , Xue Dan‐dan , Zhang Rui , Cheng Yun
Published: December 2023

Background

Various programmes and models for post‐intensive care unit (ICU) follow‐up services have been developed worldwide. In China, post‐ICU follow‐up remains in the exploratory stage and little is known regarding the appropriate form and challenges of implementation, which need to be further explored.

Aim

This study aimed to explore and describe the barriers to and facilitators of post‐ICU follow‐up services from the perspective of critical care professionals.

Design

This was a descriptive qualitative study. Semi‐structured interviews were conducted with 21 health care workers whose units had offered ICU survivors different forms of follow‐up services; the data were analysed by qualitative content analysis during August 2022 and December 2022.

Setting

The study was conducted at 14 ICUs in 11 tertiary hospitals in Shanghai, China.

Findings

Seventeen subthemes were extracted as barriers and facilitators in the follow‐up of ICU survivors. In the initiating process, the barriers included the restriction of decision‐making rights and scope of practice, indifferent attitude towards survivors and repeated work. The facilitators included admitted significance, the needs of ICU survivors, the conscientiousness of professionals and the pioneers and leadership support. In the implementation process, lack of confidence, lack of cooperation in medical consortium, distrusted relationships, restrictions of medical insurance, ageing problems and insufficient human resources acted as barriers, whereas lessons learned, positive feedback and digital support served as facilitators. Furthermore, recommendations and tips were identified for offering follow‐up services.

Conclusion

Medical personnel can better utilize available resources and develop strategies to overcome constraints by gaining insights into the abovementioned barriers and facilitators. The findings of this study can provide a useful reference for structured and systematic follow‐ups to ameliorate post‐intensive care syndrome in low‐ and middle‐income countries.

Relevance to Clinical Practice

Publicity and educational measures play a crucial role in enhancing the awareness of survivors and the consensus of health care professionals from medical consortium regarding impairments after critical care. Leadership and policy support can address numerous obstacles to guiding follow‐up services.
Tracheostomy tube changes in patients with tracheostomy: A quality improvement project
Authors: Liu Yu , Zhou Chunlan , Wu Yanni , Deng Shuijuan , Chen Ying , Zhou Jungui
Published: December 2023

Background

Tracheostomy tube changes are a considerable part of the management of patients with tracheostomy and are necessary for preventing aspiration pneumonia, especially in patients with long‐term tracheostomy. The process of tracheostomy tube changes in many patients may not be timely, safe or efficient.

Aim

The objectives were to implement a quality improvement intervention that reduces the incidence of aspiration pneumonia in patients with tracheostomy, improve staff knowledge about tracheostomy tube changes and improve staff adherence to documentation.

Methods

A pre‐post intervention design was used in this quality improvement project. We created a change strategy bundle that included identification of the need for and observation determination of the timing of tube changes timing, change assessments, identification of the person and location, preparation, co‐operation and maintenance. A tracheostomy tube change workflow was also created. Then, the intervention was implemented in the clinic after staff training. The incidence of aspiration pneumonia, staff knowledge and staff adherence were compared before and after the intervention.

Results

Two hundred and 20 patients were enrolled (105 in the preintervention group; 115 in the postintervention group) with 88 tracheostomy tube change episodes (23 in the preintervention group; 65 in the postintervention group). Thirty‐five staff members completed the training and surveys. The incidence of pneumonia decreased from 43.8% to 27.8% after the intervention (p = .013). The knowledge score of staff increased from 46.57 ± 11.10 to 88.14 ± 6.76, and the implementation rate of the audit increased to 67.32%–100%.

Conclusions

This quality improvement project regarding tracheostomy changes reduced the incidence of pneumonia, increased staff knowledge about tracheostomy tube changes and improved staff adherence.

Relevance to Clinical Practice

A standardized tracheostomy tube change bundle, education, interprofessional collaboration and culture changes were important to ensure the best outcomes in this quality improvement project. These factors improved the timeliness, efficiency and safety of tracheostomy tube changes.
Second infant spinal anesthetic: Incidence, dose modification, and adverse events after initial failure
Authors: Frawley Geoff
Published: December 2023

Introduction

Infant spinal anesthesia is an important technique in premature and ex‐premature infants undergoing lower abdominal surgery. Previous studies of infant spinal anesthesia report high failure rates, but fail to adequately identify contributing factors. The aim of this study is to retrospectively review spinal anesthetics from a quaternary anesthetic centre to determine overall spinal failure rate, incidence of second spinal attempts and adverse events associated with a second spinal anesthetic.

Methods

A retrospective review of infant spinal anesthetics performed between May 2016 and June 2023.

Results

Five hundred and fifty‐one infants (mean postmenstrual age 42.9 weeks and weight 3873 g) were included. The overall success rate on first attempt was 86.5% with a further 5.1% requiring a successful second spinal anesthetic after initial failure. Spinal anesthetic failure requiring conversion to general anesthesia occurred in 9.4% of cases The causes of failed spinal anesthetic were inability to access the subdural space (dry tap 4.2%), inadequate motor blockade (2.9%), and repeated bloody taps (2.2%). Spinal anesthetic failure was significantly increased in cases where the anesthetist was routinely performing less than 5 spinal anesthetics per year [OR 2.21 (95% CI 1.28, 3.83, p = .004)] but only weakly associated with years of pediatric anesthetic experience. Failure rates were 21.4% with styletted spinal needles and 9.2% for non styletted [OR 2.68 (95% CI 1.23–5.86, p = .012)]. The incidence of perioperative apnoea was 6.7% with the highest rate in infants in which failed spinal anesthesia required conversion to general anesthesia (25%). There were 28 cases where initial spinal anesthetic failed to produce adequate anesthesia and a repeat spinal anesthetic was performed. Repeat spinal anesthesia was successful in 92.8% of cases with awake caudal anesthesia successful in 7.2% of cases. In three cases high spinal blockade occurred, one after a single spinal and two after a repeat spinal. Both repeat spinal high block cases required intubation and brief resuscitation.

Conclusion

Infant spinal anesthesia is associated with high success rates if experienced anesthetists are present or performing the block. Repeat spinal anesthesia may be associated with an increased incidence of high spinal block. Greater awareness of the slow onset of high block should promote techniques aimed at minimizing cephalad spread of local anesthetic including slight head up positioning during surgery.
Linear target change detection from a single image based on three‐dimensional real scene
Authors: Liu Yang , Ji Zheng , Chen Lingfeng , Liu Yuchen
Published: December 2023

Change detection is a critical component in the field of remote sensing, with significant implications for resource management and land monitoring. Currently, most conventional methods for remote sensing change detection often rely on qualitative monitoring, which usually requires data collection from the entire scene over multiple time periods. In this paper, we propose a method that can be computationally intensive and lacks reusability, especially when dealing with large datasets. We use a novel methodology that leverages the texture features and geometric structure information derived from three‐dimensional (3D) real scenes. By establishing a two‐dimensional (2D)–3D geometric relationship between a single observational image and the corresponding 3D scene, we can obtain more accurate positional information for the image. This relationship allows us to transfer the depth information from the 3D model to the observational image, thereby facilitating precise geometric change measurements for specific planar targets. Experimental results indicate that our approach enables millimetre‐level change detection of minuscule targets based on a single image. Compared with conventional methods, our technique offers enhanced efficiency and reusability, making it a valuable tool for the fine‐grained change detection of small targets based on 3D real scene.
Maternal body mass index and cerebral palsy in children: A systematic review and dose–response meta‐analysis
Authors: Hu Guomin , Zhao Yang , Fu Xueru , Hu Dongsheng , Liang Xin
Published: December 2023

Background

Accumulating studies indicate that maternal obesity is associated with the risk of cerebral palsy (CP); however, their conclusions have been inconsistent.

Objectives

To quantitatively estimate the association between maternal body mass index (BMI) and CP in offspring.

Data Sources

PubMed, Embase and Web of Science.

Study Selection and Data Extraction

Articles published up to 18 September 2022 were searched that reported the correlation between maternal BMI and CP in children. Two reviewers independently extracted data and critically assessed articles.

Synthesis

Pooled relative risks (RR) and 95% confidence intervals (CI) were estimated by the random‐effects model. Subgroup analysis and meta‐regression were performed to explore sources of heterogeneity.

Results

In total, 11 articles (8,407,668 participants) were identified for inclusion in our meta‐analysis. For maternal underweight, no significant association was found with CP risk (RR 1.11, 95% CI 0.90, 1.38). The risk of CP was increased by 25% (RR 1.25, 95% CI 1.06, 1.47), 38% (RR 1.38, 95% CI 1.18, 1.61) and 127% (RR 2.27, 95% CI 1.82, 2.83) for maternal overweight, obesity and obesity grade 3, respectively. In addition, we observed a positive linear dose‐response relationship, with the pooled risk of cerebral palsy in offspring increasing by 3% with each unit increase in maternal BMI.

Conclusion

This meta‐analysis indicates that the risk of CP in offspring grew with maternal overweight or obesity grades increasing, and was positively correlated with maternal BMI.