bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex moderates the relationship between social support and cardiovascular prevention behaviors in middle-aged and older adults
Authors: Blakoe M , Petrova D , Garcia-Retamero R , Goncalves K , Catena A , Hernandez J A R , Sanchez M J
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Most risk factors for cardiovascular disease (CVD) are modifiable, suggesting that the burden of CVD could be substantially reduced through cardiovascular screening and healthier lifestyle. People who have social support are found to be more likely to adhere to cardiovascular prevention recommendations, but it is not clear whether the benefit of social support is equal for men and women.

Purpose

To investigate whether sex moderates the relationship between social support and adherence to cardiovascular prevention recommendations in a nationally representative sample.

Method

Participants were 17,287 adults (n=10,264 middle-aged adults 40-64 years old and n=7,023 older adults ≥ 65 years old) who participated in the National Health Survey of Spain in 2017. Social support was measured with the Functional Social Support Questionnaire of Duke-UNC. Adherence to cardiovascular screening recommendations was assessed based on self-reported testing of cholesterol, blood pressure, and blood sugar by a health professional in the past 12 months. Adherence to recommended health-related behaviors was assessed based on the guidelines of the European Society of Cardiology regarding diet, alcohol consumption, smoking, and physical activity.

Results

Multiple regression models adjusted for socio-demographic and cardiovascular history and risk variables showed that social support was more strongly associated with adherence to cardiovascular prevention recommendations in men than in women. In particular, low social support levels were especially detrimental for both middle-aged (screening: B=0.13, 95% CI [0.06-0.20], p<0.001; behaviors: B=0.33 [0.26-0.41], p<0.001) and older men (screening: B=0.10 [0.04-0.17], p = 0.001; behaviors: B=0.16 [0.08-0.25], p<0.001), whereas older women had comparatively high adherence which was unrelated to social support (screening: B=0.02 [-0.03-0.08], p = 0.433; behaviors: B=0.03 [-0.03-0.10], p = 0.342).

Conclusions

Social support is more strongly associated with cardiovascular prevention in men than in women, such that men who lack social support have the lowest adherence to cardiovascular screening and lifestyle recommendations.
Factors affecting the occurrence of postoperative atrial fibrillation in cardiac surgery patients
Authors: Lomper K , Karbowska A , Lisiak M , Uchmanowicz I , Wleklik M
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Intorduction. Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery and is a serious clinical problem. POAF refers to new-onset atrial fibrillation developing immediately after surgery. Despite advances in surgical and perioperative techniques, it remains the most common adverse event in cardiac surgery. Many studies are being conducted to obtain detailed information on the mechanisms underlying POAF, its course and effective treatment methods. Despite a significant improvement in treatment outcomes after cardiac surgery, the incidence of POAF did not change. It continues to be a major burden for patients, physicians and healthcare systems increasing hospitalization and healthcare costs as reflected in longer hospital stays, increased post-operative complications and increased mortality.

Purpose

Identification of factors determining the occurrence of POAF in patients after cardiac surgery.

Material and Methods

125 patients (53 women, 72 men, mean age 68.68 ± 7.11) qualified for elective cardiac surgery were included in the study. Patients with persistent or paroxysmal atrial fibrillation diagnosed before the procedure were excluded from the study. The study took into account a number of sociodemographic and clinical data, which were collected on the basis of patients' medical records from the course of hospitalization (sex, age, weight, height, BMI, place of residence, type of surgery, duration of surgery, perioperative risk according to EuroScore II, results of laboratory tests before and after surgery, the presence of comorbidities and multi-morbidity, hospitalization time). In addition, the score obtained in the CHA2DS2–VASc scale was taken into account in the analysis. The assumed significance level was p < 0.05.

Results

POAF was identified in 41% of patients. The average perioperative risk in the study group was M± SD = 2.05 ± 1.61. It was noted that POAF is significantly more common in women than in men (21.6% vs. 19.2%; p = 0.048). Patients with POAF had a significantly higher BMI than patients without POAF (29.20±3.81 vs. 27.89±4.14, p = 0.38). In patients with POAF, a statistically significant correlation was found between the loss of platelets during the procedure and the length of hospitalization (r = -0.387, p<0.005). In the study group, there was no relationship between the occurrence of POAF and the type of surgery, duration of surgery, loss of hemoglobin, total protein, decrease in potassium levels, the presence of comorbidities, multimorbidity, CHA2DS-VAc score).

Conclusions

1. Female sex is an unmodifiable factor determining the occurrence of POAF in cardiac surgery. 2. Overweight is a modifiable factor determining the occurrence of POAF in cardiac surgery. 3. Perioperative platelet loss in patients with POAF results in longer hospital stay after cardiac surgery.
Women achieve equivalent health-related quality of life benefits to men from attending cardiac rehabilitation: a matched case-control study
Authors: Candelaria D , Chung S , Gallagher R
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): SOLVE-CHD NHMRC Synergy Grant

Background/Introduction

Coronary heart disease (CHD) is the leading cause of death in women globally; and women have worse health outcomes from CHD than men, including poorer health-related quality of life (HRQL). Comprehensive cardiac rehabilitation (EBCR) has well-established benefit for patients with CHD in improving HRQL. These benefits have rarely been distinguished separately for women despite known differences to men.

Purpose

The aim of this study was to compare women and men’s HRQL outcomes after accounting for differences in age, partnership status and diagnosis.

Methods

A secondary analysis of a larger prospective observational study of CR outcomes using a matched case-control study of women and men. The sample included patients enrolled in four CR programs following admission for CHD (myocardial infarction [MI], percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]). Women were matched to men based on age (within 0-2 years), marital status (single, or partnered), and diagnosis (MI, PCI, or CABG). Sociodemographic data were collected from the participants and clinical information (diagnosis, comorbidities) from the medical record. HRQL was measured using the Short Form-12 Health Survey (SF-12).

Results

Thirty-seven matched women and men were included in this study at baseline, of whom 27 completed the study (72.9%). There were no significance differences in sociodemographic and clinical characteristics between men and women at baseline.

Both women and men improved HRQL substantially from pre-post CR, with no significant differences in change scores in any domain between the sexes despite women having worse scores at baseline in Physical Functioning (mean score 41.59 vs 44.15), Bodily Pain (mean score 47.78 vs 48.71) and overall physical summary score (mean score 44.14 vs 45.29).

Women had clinically meaningful improvements in Physical Functioning (MD 6.51, 95% CI 2.59-10.44) and Role Physical (MD 6.42, 95% CI 2.81-10.03), Mental Health (MD 4.35, 95% CI 2.05-6.66) and Bodily Pain (MD 4.97, 95% CI 1.36-8.60) and in the overall physical summary score (MD 5.67, 95% CI 1.98-9.38). Men achieved clinically meaningful improvements in the same domains as women plus Vitality (MD 5.11, 95% CI 0.87-9.36) and Social Function (MD 8.54, 95% CI 3.98-13.09).

Conclusion(s)

When matched to men for age, partnership status, and diagnosis, women achieve clinically meaningful and equivalent HRQL outcomes following CR. Women significantly improved in overall physical and mental health HRQL, as well as in the majority of HRQL domains. These findings could be used to strengthen advocacy in supporting women with CHD to participate and complete CR programs.
Review on clinical strategies for managing patients with elevated Lp(a): Cost-effectiveness of Lp(a) testing and awareness of lifestyle changes via Public Health Policy in absence of targeted therapy
Authors: Orfanos P , Hu X , Montgomery G , Abbas C , Lymperopoulou L , Bennett N , Zabiby A , Richardson S , Trueman D , Kaur J , Saxena N
Published: July 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Novartis Pharma AG, Basel, Switzerland

Introduction

Elevated lipoprotein(a) [Lp(a)] is an inherited, independent, and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Approximately, 20%-30% of global population has elevated Lp(a), however, Lp(a) measurement is not performed routinely in clinical practice.

Purpose

This review aimed to identify treatment patterns for patients with elevated Lp(a). In addition, a cost-effectiveness analysis (CEA) was performed to hypothesize that in the absence of Lp(a)-targeting therapy, broader Lp(a) testing, awareness of its additional risk and assertive management of other CV risk factors (e.g., LDL levels, BMI, Pulse pressure), may clinically and economically benefit patients and the healthcare system.

Methods

A systematic literature review was conducted using Embase®, MEDLINE® and MEDLINE®-In Process databases to identify the existing approaches for managing patients with ASCVD having elevated Lp(a). In addition, using a decision tree economic model and predictive risk equations from UK Biobank data, the cost effectiveness of Lp(a) screening and public policy awareness impact on other CV risk factors via lifestyle changes (e.g., diet, exercise, smoking) was assessed from a healthcare system perspective.

Results

Out of 6,387 retrieved publications, 45 studies were included. An average of 72%, 72%, 48% and 22% patients received lipid lowering therapies (LLTs), anti-clotting agents, anti-hypertensives and anti-diabetics, respectively. In the absence of Lp(a)-targeting therapy, the economic evaluation demonstrated dominance of the benefits of Lp(a) testing, awareness of its additional risk and resulting lifestyle modifications outweighing the costs incurred due to Lp(a) testing, for both primary and secondary prevention of ASCVD.

Conclusions

In the absence of a targeted therapy, investing in Lp(a) testing, awareness about elevated Lp(a) levels and optimization of modifiable risk factors via lifestyle modifications will lead to significant benefits for the healthcare system. However, this will not mitigate the Lp(a) associated CV risk, hence, there is still an unmet need for Lp(a) targeting therapies.
Developing a brief intervention to communicate cardiovascular risk to patients presenting to the emergency department with chest pain: a co-production approach
Authors: Schulberg S , Ferry A , Neubeck L , Mills N
Published: July 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Brittish Heart Foundation

Background

The majority of patients who present to the Emergency Department with suspected acute coronary syndrome (ACS) will be discharged once ACS has been ruled out. High-sensitivity cardiac troponin (hs-cTn) is a highly specific biomarker for myocardial injury and is the biomarker of choice for the diagnosis of ACS. However, our previous research on hs-cTn has demonstrated that patients with elevated levels that do not meet the diagnostic threshold for ACS are at increased risk of future cardiac events. These patients are often discharged with no further investigation or understanding of their risk of future cardiac events, despite the potential benefits of preventative strategies.

Purpose

The aim of this study was to co-design a brief intervention with patients and healthcare professionals to promote cardiovascular health in patients where the diagnoses of ACS has been ruled out but hs-cTn concentrations indicate higher risk of future cardiac events.

Methods

Patients who presented to the Emergency Department with symptoms suggestive of ACS and a maximum high-sensitivity troponin between 5 ng/L and the 99th centile were invited to attend a focus group or participate in one-to one interviews. We also interviewed healthcare professionals involved in the care of this group. Patients were recruited using electronic medical records and staff were recruited through social media and posters. Recruitment continued until data saturation was reached. The data was analyzed using thematic analysis. We created protypes based upon the initial data which we presented back to patients and staff for feedback to help refine our brief intervention.

Results

We identified several themes from the data which included; experience of the Emergency Department, previous experience of cardiovascular risk communication, desired information, format of intervention, delivery mode of intervention, timing of delivery, language used and potential barriers. The patients did not have strong preferences on what information should be included in the intervention, however, most patients were receptive to receiving information about their cardiovascular risk guided by hs-cTn. Patients voiced that the intervention should not contain any medical terminology and information should be understood by a lay audience. Many patients and staff felt that the pressures currently faced in the Emergency Department may act as a barrier in delivering the cardiovascular brief intervention.

Conclusion

We have co-produced a cardiovascular brief intervention in collaboration with patients and healthcare professionals. The effect of this brief intervention on cardiovascular outcomes will be tested in a future randomised controlled trial.
Different kinetics of NT-proBNP and sST2 highlight different therapeutic pathways of sacubitril/valsartan
Authors: Mattavelli I , Mapelli M , Salvioni E , Bonomi A , Palermo P , Banfi C , Paolillo S , Biondi M L , Agostoni P
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

N-terminal pro-B-type natriuretic peptide (NT-proBNP) and soluble interleukin 1 receptor-like 1 ST2 (sST2) are biomarkers used to grade heart failure with reduced ejection fraction (HFrEF) severity. Both are potential targets of HFrEF treatment, but the first is associated with the patient’s hemodynamic status, while the second is more indicative of the inflammatory status and of myocardial fibrosis.

Purpose

The aim of this study was to assess the kinetics of these biomarkers after treatment with sacubitril/valsartan in HFrEF.

Methods

We analyzed blood samples of HFrEF patients at baseline (before sacubitril/valsartan treatment), after 1, 2, 3 months (respectively after a month taking the 24/26 – 49/51 – 97/103mg b.i.d. doses), and 6 months after the maximum tolerated dose was reached (end-study).

Results

We obtained samples from 72 HFrEF patients (age 64.0±10.5, 83% males) (Table 1). NT-proBNP and sST2 values progressively and significantly reduced up to 37% and 16%, respectively, with a greater reduction for NT-proBNP (p<0.001). Specifically, NT-proBNP reduced from 1144 [593-2586] to 743 [358-1524] pg/mL and sST2 from 27.3 [20.5-35.0] to 23.1 [15.9-30.7] ng/mL, p for trend <0.001 in both cases). The reduction of the two biomarkers over time occurred with statistically significant different kinetics: deferred for sST2 and faster for NT-proBNP (Figure 1). No significant changes in renal function and potassium levels were recorded.

Conclusions

These findings suggest that, in HF patients, sacubitril/valsartan effects on the cardiovascular system share a double pathway: a first, hemodynamic, faster pathway and a second, non-hemodynamic anti-inflammatory, delayed one. Both likely contribute to the sacubitril/valsartan benefits in HFrEF.Table 1Figure 1
Smoke-free home restrictions in Armenia and Georgia: motives, barriers and secondhand smoke reduction behaviors
Authors: Berg Carla J , Dekanosidze Ana , Hayrumyan Varduhi , LoParco Cassidy R , Torosyan Arevik , Grigoryan Lilit , Bazarchyan Alexander , Haardörfer Regine , Kegler Michelle C
Published: July 2023

Background

Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months.

Methods

Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home.

Results

In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers’ resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers.

Conclusions

SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.
Extraction, purification and characterization of collagen peptide prepared from skin hydrolysate of sturgeon fish
Authors: Hou Nian-Ting , Chen Bing-Huei
Published: July 2023

Collagen peptides from marine organisms have drawn great attention in food, cosmetics and medicine owing to their multiple functions including antioxidant, anticancer, cardioprotection, skin protection, and wound healing effects. Recent reports have revealed that a large amount of solid waste is discarded from fisheries that could be used for producing high value-added products. This study aims to extract and purify collagens and peptides from sturgeon fish skin, a by-product obtained during the processing of sturgeon fish. A high yield of acid-soluble collagen was obtained by using acetic acid for extraction followed by sonication, while a high yield of pepsin-soluble collagen (PSC) was shown by acetic acid and sonication followed by adding acetic acid and pepsin to the residue for extraction and then sonication. Two-stage hydrolysis with pepsin first followed by flavourzyme was necessary to produce high yield of PSC peptide. Sodium dodecyl sulfate–polyacrylamide gel electrophoresis analysis revealed the presence of type I collagen and the structural integrity was confirmed by Fourier transform infrared spectroscopy analysis. Flavourzyme was more effective in hydrolyzing PSC into peptides with low molecular weight (MW) than pepsin, papain, alcalase, and trypsin. Purification of PSC hydrolysate with a Sephadex G-10 column to exclude peptide with MW>700 Da or ultrafiltration with a dialysis membrane with MW cutoff of 500 Da produced PSC peptides with MW<700 Da and MW<728 Da accounting, respectively, accounting for 40% or 52% of all the fragments based on low resolution-matrix assisted laser desorption/ionization-mass spectrometry (LR-MALDI-MS). In conclusion, with sturgeon fish skin as raw material and flavourzyme level of 5%, the highest degree of hydrolysis and yield of PSC peptides with low MW was obtained by controlling the pH at 8, temperature at 50 °C, ratio of PSC to deionized water at 1:40 (mass concentration), hydrolysis time at 4 h, and ultrafiltration with dialyzing membrane MW cutoff of 500 Da.
The Silences of International Human Rights Law: The Need for a UN Treaty on Violence Against Women
Authors: Ada Tchoukou Julie
Published: July 2023

In the face of women’s disproportionate experience of violence and the growing scholarly literature and advocacy on this issue, there is no international treaty recognising violence against women (VAW) as a human rights violation in and of itself. The Convention on the Elimination of Discrimination against Women (CEDAW) does not include a definition of gender-based violence, violence against women or even domestic violence. Many soft law documents address VAW, including the CEDAW committee’s general recommendations. However, even though soft laws are persuasive in developing norms, their non-binding character effectively means that States cannot be held responsible for violations. Currently, to accommodate VAW within various treaties, certain ‘jurisdictional gymnastics’ must be done. This article argues that a critical re-characterization is necessary. The reality of women’s lives in many parts of the world necessitates an effective international legal framework that explicitly defines VAW, in all its forms, as a human rights violation.
Longfin squid reproductive behaviours and spawning withstand wind farm pile driving noise
Authors: Jones Ian T , Schumm Madison , Stanley Jenni A , Hanlon Roger T , Mooney T Aran
Published: July 2023

Pile driving noise is an intense, repetitive, far-reaching sound that is increasing in many coastal habitats as the offshore wind energy industry expands globally. There is concern for its impacts on keystone species and vital fisheries taxa such as squids. In controlled laboratory conditions, we investigated whether exposure to pile driving noise from offshore wind farm construction altered reproductive behaviours in the short-lived semelparous species Doryteuthis pealeii. Pile driving noise had no significant effects on the occurrence rates of agonistic behaviours, mate guarding, mating, and egg laying, compared with silent control trials. The results contrast starkly with behavioural response rates of the same squid species during feeding and shoaling. The data suggest that squid reproductive behaviours may be resilient to this increasingly pervasive environmental stressor, and that behavioural context guides responses to windfarm noise for this invertebrate taxon. While some non-reproductive behaviours can clearly be disturbed, the results show that species with limited opportunity to reproduce can tolerate intense stressors to secure reproductive success.
Mid-term outcomes of patients with subclinical hypothyroidism after coronary bypass surgery
Authors: Zhao Dong , Zhao Wei , Wang Chuangshi , Xu Fei , Zhao Wei , Tiemuerniyazi Xieraili , Ma Hao , Feng Wei
Published: July 2023

OBJECTIVES

Subclinical hypothyroidism (SCH) is characterized by an elevated thyroid-stimulating hormone and normal free thyroxine. This study aimed to evaluate the influence of SCH on mid-term outcomes of patients after coronary artery bypass grafting (CABG).

METHODS

From January 2015 to December 2018, 548 SCH patients and 6718 euthyroid patients who underwent CABG were identified. Propensity score matching was used to create 2 cohorts with similar baseline characteristics (n = 544 in each group). The mid-term follow-up outcomes were compared. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models.

RESULTS

The mean follow-up for all patients was 39.7 ± 17.3 months. The unadjusted Kaplan–Meier estimate for mortality at 5-year follow-up was higher in patients with SCH compared with euthyroid patients (5.3% vs 1.6%, log-rank P = 0.03). After adjusting for covariates, the risk of mortality was higher in patients with SCH compared with euthyroid patients [HR, 2.40; 95% confidence interval (CI), 1.03–5.58; P = 0.04]. The adjusted risk of major adverse cardiovascular and cerebral event (HR, 2.16; 95% CI, 1.51–3.08; P < 0.001) and angina (HR, 2.44; 95% CI, 1.41–4.24; P = 0.001) was higher in patients with SCH compared with euthyroid patients.

CONCLUSIONS

SCH is associated with an increased risk of mortality, major adverse cardiovascular and cerebral event and angina compared with euthyroidism in patients undergoing CABG.
A BIM-based framework for automatic numerical modelling and geotechnical analysis of a large-scale deep excavation for transportation infrastructures
Authors: Shi Chao , Jin Yunfei , Lu Hu , Shi Jiangwei
Published: July 2023

Employing emerging information and communication technologies such as building information modelling (BIM) to streamline engineering design and analysis has been mainstream over the past several years. Although BIM models are well established for aboveground infrastructures, underground BIM is still in its infancy. On one hand, valuable subsurface ground models are missing in current BIM applications as site-specific geotechnical data are often sparse and limited. On the other hand, BIM has been mainly used as a visualization tool for concise representation of design and construction data, and it has not been integrated and utilized to assess geotechnical risks associated with underground infrastructures. This paper proposes a BIM-based approach for automatic numerical modelling and geotechnical analysis. Structural information (e.g. geometries) of different project BIMs are grouped, exported, and saved, which provides a unified interface for automatic information extraction using computer codes (e.g. Python). Subsequently, subsurface ground models generated from sparse data are integrated with extracted basic geometric properties for automatic geotechnical model setup and finite element analysis. The performance of the proposed framework is illustrated using a real deep excavation project. It is revealed that BIM, as a data repository, enables timely and accurate information exchange between structural and geotechnical models in an automatic manner, which emphasizes the need of a BIM-based approach for assessing and managing geotechnical risks associated with deep excavations for underground transportation infrastructures, especially in the urban context.
Long-term alliance for pathology equipment and technology acquisition: a paradigm shift for improved quality and efficiency
Authors: Singh Gurmukh , Vinson Kellie A , Jones Kari , Gunsolus Brandy , Keever Jeremy , Keel Brooks A
Published: July 2023

Objective

Personnel costs are the largest single budget item in the clinical laboratory, other major expenses being equipment, analyzers, blood and blood components, and cost of day-to-day consumables. This report describes our experience with developing a long-term relationship with a single major vendor as a paradigm shift from the traditional multiple vendors, multiple contracts, and recurrent extended negotiations. Our objective was to develop a long-term approach for replacement of effete equipment and upgrades to operations in a pathology and laboratory medicine department in collaboration with vendors providing equipment and services.

Methods

Major vendors were invited to visit the department to analyze the workload and workflow and suggest integrated solutions to meet the goals of the department. Multiple iterations of the proposals were evaluated, and a recommendation made to the medical center leadership. The vendor, the medical center, and the department jointly developed a 15-year partnership plan to improve the operations of pathology services. The agreement encompasses a range of management and performance criteria for both sides. The salient items discussed were laboratory staffing, turnaround time, workload change, test insourcing, reference laboratory costs, and scholarly productivity and teaching.

Results

The agreement reduced laboratory staffing by 21%, eliminated stat tests by reducing the turnaround time for routine tests to less than 45 minutes for 90% of tests, with an increase of 9.1% in the number of tests, Cost avoidance in salary and reference laboratory costs was $3,424,136/year against an expected target of $2 million in total savings, despite not including cost avoidance from promoting appropriate use of laboratory testing for inpatients and increase in revenue from increase in ambulatory testing. Vizient score in laboratory utilization improved from the 94th to 76th percentile. Scholarly output increased by more than 100%.

Conclusion

This model of a long-term alliance with a chosen vendor led to improvements in quality and efficiency.
The ubiquity of carbon dredge-up in hydrogen-deficient white dwarfs as revealed by GALEX
Authors: Blouin Simon , Kilic Mukremin , Bédard Antoine , Tremblay Pier-Emmanuel
Published: July 2023

The convective dredge-up of carbon from the interiors of hydrogen-deficient white dwarfs has long been invoked to explain the presence of carbon absorption features in the spectra of cool DQ stars ($T_{\rm eff} \lt 10\,000\,$K). It has been hypothesized that this transport process is not limited to DQ white dwarfs and also operates, albeit less efficiently, in non-DQ hydrogen-deficient white dwarfs within the same temperature range. This non-DQ population is predominantly composed of DC white dwarfs, which exhibit featureless optical spectra. However, no direct observational evidence of ubiquitous carbon pollution in DC stars has thus far been uncovered. In this Letter, we analyse data from the Galaxy Evolution Explorer to reveal the photometric signature of ultraviolet carbon lines in most DC white dwarfs in the $8500\, {\rm K} \le T_{\rm eff} \le 10\,500\,$K temperature range. Our results show that the vast majority of hydrogen-deficient white dwarfs experience carbon dredge-up at some point in their evolution.
Real-world efficacy of belimumab in achieving remission or low-disease activity in systemic lupus erythematosus: A retrospective study
Authors: Hasegawa Yasuhiro , Arinuma Yoshiyuki , Asakura Hirotomo , Shindo Risa , Ino Kazuma , Kanayama Yoshiro , Tanaka Tomoki , Matsueda Yu , Wada Tatsuhiko , Oku Kenji , Yamaoka Kunihiro
Published: July 2023

Objectives

We investigated the effect of belimumab (BEL) on achieving low disease activity (LDA) and remission as an additive molecular-targeting agent to standard of care (SoC) in patients with systemic lupus erythematosus (SLE).

Methods

Clinical information was retrospectively collected from patients with SLE who received BEL additive to SoC (BEL + SoC), and from patients treated with SoC alone as a control arm. Disease activity was measured by SLE-disease activity score (SLE-DAS). The proportion of patients in LDA and remission at 12 months was compared after propensity score matching. The factors contributing to LDA and remission achievement were identified by Cox proportional hazard model.

Results

BEL + SoC significantly reduced SLE-DAS at 6 months, with a significantly higher proportion of patients achieving LDA and remission at 12 months compared to SoC alone. The presence of arthritis at baseline was significantly associated with achieving LDA and remission. Additionally, both treatment groups experienced a significant reduction in daily glucocorticoid dose.

Conclusions

Adding BEL to SoC was beneficial for patients with arthritis, leading to higher proportion of achieving LDA and remission, while also reducing their glucocorticoid dose. Our results indicate the utility of BEL in a treat-to-target approach for SLE patients in a real-world setting.
Finite-range effect in the two-dimensional density-induced BCS–BEC crossover
Authors: Sakakibara Hikaru , Tajima Hiroyuki , Liang Haozhao
Published: July 2023

We theoretically investigate the Bardeen–Cooper–Schrieffer (BCS) to Bose–Einstein condensation (BEC) crossover in a two-dimensional Fermi gas with the finite-range interaction by using the Hartree–Fock–Bogoliubov theory. Expanding the scattering phase shift in terms of the scattering length and effective range, we discuss the effect of the finite-range interaction on the pairing and thermodynamic properties. By solving the gap equation and the number equation self-consistently, we numerically calculate the effective-range dependence of the pairing gap, chemical potential, and pair size throughout the BCS–BEC crossover. Our results would be useful for further understanding of low-dimensional many-body problems.
A multimodal celestial object classification network based on 2D spectrum and photometric image
Authors: Zhang Mingru , Gao Junping , Luo A-Li , Jiang Xia , Zhang Liwen , Wu Kuang , Qiu Bo
Published: July 2023

In astronomy, classifying celestial objects based on the spectral data observed by astronomical telescopes is a basic task. So far, most of the work of spectral classification is based on 1D spectral data. However, 2D spectral data, which is the predecessor of 1D spectral data, is rarely used for research. This paper proposes a multimodal celestial classification network (MAC-Net) based on 2D spectra and photometric images that introduces an attention mechanism. In this work, all 2D spectral data and photometric data were obtained from LAMOST (the Large Sky Area Multi-Object Fiber Spectroscopic Telescope) DR6 and SDSS (Sloan Digital Sky Survey), respectively. The model extracts the features of the blue arm, red arm, and photometric images through three input branches, merges the features at the feature level and sends them to its classifiers for classification. The 2D spectral data set used in this experiment includes 1223 galaxy spectra, 466 quasar spectra, and 1202 star spectra. The same number of photometric images constitute the photometric image data set. Experimental results show that MAC-Net can classify galaxies, quasars, and stars with a classification precision of 99.2 per cent, 100 per cent, and 97.6 per cent, respectively. And the accuracy reached 98.6 per cent, it means that the similarity between this result and the results obtained by the LAMOST template matching method is 98.6 per cent. The results exceed the performance of the 1D spectrum classification network. At the same time, it also proves the feasibility and effectiveness of directly using 2D spectra to classify celestial bodies by using MAC-Net.
When the brain turns on with sexual desire: fMRI findings, issues, and future directions
Authors: Bittoni Celeste , Kiesner Jeff
Published: July 2023

Introduction

More than 2 decades of neuroimaging research has sought to uncover the neurologic basis of sexual desire. However, the lack of a clear conceptual distinction between sexual desire and sexual arousal or even a broadly accepted definition of sexual desire has led to confusion in the literature regarding brain areas uniquely associated with sexual desire.

Objectives

(1) To critically review the neuroimaging literature that seeks to identify brain areas and networks involved in sexual desire; (2) to identify and discuss those brain areas and potential networks that are most promising for providing insights to sexual desire; and (3) to offer recommendations for future studies.

Methods

Existing meta-analyses were used as a starting point to identify relevant neuroimaging studies on sexual desire, arousal, and love. This base was then expanded via Google Scholar and forward citation tracking of already identified studies.

Results

Brain areas that are commonly associated with sexual desire and arousal include the amygdala, hypothalamus, dorsal and ventral striatum, anterior cingulate, insula, and prefrontal and orbitofrontal cortex. However, because the same basic paradigm has been used to study sexual desire and arousal, unambiguous conclusions regarding areas uniquely involved in sexual desire cannot be drawn. Moreover, the lack of connectivity analyses and a failure to acknowledge negative BOLD (blood-oxygen level dependent) significantly limit conclusions on the neural basis of sexual desire.

Conclusion

Five recommendations are made. First, stimulus types (ie, erotic vs sexually explicit) should be selected by the meaningful theoretical conceptualization of the constructs of interest. Second, participants should be provided with definitions of sexual desire, mental sexual arousal, and perceived genital sexual arousal, so they can choose which terms best describe their experience. Third, event-related designs should be used with caution when investigating sexual desire. Fourth, time series analyses should be used to identify both positive and negative BOLD. Fifth, connectivity analyses should be performed to identify brain networks.
Spatial Dependency in Stubble-Borne Pyrenophora teres f. teres and Influence of Sample Support Size on DNA Concentration and Fungicide Resistance Frequency
Authors: Hodgson Leon M. , Rakshit Suman , Lopez-Ruiz Francisco J. , Gibberd Mark R. , Thomas Geoff J. , Zerihun Ayalsew
Published: July 2023

Fungicide resistance in foliar fungal pathogens is an increasing challenge to crop production. Yield impacts due to loss of fungicide efficacy may be reduced through effective surveillance and appropriate management intervention. For stubble-borne pathogens, off-season crop residues may be used to monitor fungicide resistance to inform pre-planting decisions; however, appropriate sampling strategies and support sizes for crop residues have not previously been considered. Here, we used Pyrenophora teres f. teres ( Ptt) with resistance to demethylase inhibitor fungicides as a model system to assess spatial dependency and to compare the effects of different sampling strategies and support sizes on pathogen density ( Ptt DNA concentration) and the frequency of fungicide resistance mutation. The results showed that sampling strategies (hand-picked versus raked) did not affect estimates of pathogen density or fungicide resistance frequency; however, sample variances were lower from raked samples. The effects of differing sample support size, as the size of the collection area (1.2, 8.6, or 60 m2), on fungicide resistance frequency were not evident ( P > 0.05). However, measures of pathogen density increased with area size ( P < 0.05); the 60 m2 area yielded the highest Ptt DNA concentration and produced the lowest number of pathogen-absent samples. Sample variances for pathogen density and fungicide resistance frequency were generally homogeneous between area sizes. The pattern of pathogen density was spatially independent; however, spatial dependency was identified for fungicide resistance frequency, with a range of 110 m, in one of the two fields surveyed. Collectively, the results inform designs for monitoring of fungicide resistance in stubble-borne pathogens.
Current Situation of Fire Blight in China
Authors: Sun Weibo , Gong Peijie , Zhao Yancun , Ming Liang , Zeng Quan , Liu Fengquan
Published: July 2023

Fire blight, caused by the plant-pathogenic bacterium Erwinia amylovora, is a devastating disease that occurs on rosaceous plants, including pears and apples. E. amylovora is indigenous to North America and was spread to the Eurasian continent in the second half of the 20th century through contaminated plant materials. In 2016, fire blight was first observed in Yili, Xinjiang Province, in Northwestern China. Since then, it has spread to most pear-producing regions in Xinjiang Province and parts of Gansu Province. The disease has caused severe damage to China's pear and apple industries, including the 2017 disease epidemic in Korla, Xinjiang, which caused an overall yield reduction of 30 to about 50% in Korla and the destruction of over 1 million pear trees. Over the past few years, a combined effort of research, extension, and education by the Chinese government, scientists, and fruit growers has greatly alleviated outbreaks and epidemics in affected regions while successfully limiting the further spread of fire blight to new geographical regions. Here, we review the occurrence, spread, and damage of this disease to the Chinese fruit industry, as well as the management options used in China and their outcomes. We also discuss future perspectives for restraining the spread and alleviating the damage of fire blight in China.
Using Natural Language Processing and Machine Learning to Identify Internal Medicine–Pediatrics Residency Values in Applications
Authors: Drum Benjamin , Shi Jianlin , Peterson Bennet , Lamb Sara , Hurdle John F. , Gradick Casey
Published: July 2023

Problem

Although holistic review has been used successfully in some residency programs to decrease bias, such review is time-consuming and unsustainable for many programs without initial prescreening. The unstructured qualitative data in residency applications, including notable experiences, letters of recommendation, personal statement, and medical student performance evaluations, require extensive time, resources, and metrics to evaluate; therefore, previous applicant screening relied heavily on quantitative metrics, which can be socioeconomically and racially biased.

Approach

Using residency applications to the University of Utah internal medicine–pediatrics program from 2015 to 2019, the authors extracted relevant snippets of text from the narrative sections of applications. Expert reviewers annotated these snippets into specific values (academic strength; intellectual curiosity; compassion; communication; work ethic; teamwork; leadership; self-awareness; diversity, equity, and inclusion; professionalism; and adaptability) previously identified as associated with resident success. The authors prospectively applied a machine learning model (MLM) to snippets from applications from 2023, and output was compared with a manual holistic review performed without knowledge of MLM results.

Outcomes

Overall, the MLM had a sensitivity of 0.64, specificity of 0.97, positive predictive value of 0.62, negative predictive value of 0.97, and F1 score of 0.63. The mean (SD) total number of annotations per application was significantly correlated with invited for interview status (invited: 208.6 [59.1]; not invited: 145.2 [57.2]; P < .001). In addition, 8 of the 10 individual values were significantly predictive of an applicant’s invited for interview status.

Next Steps

The authors created an MLM that can identify several values important for resident success in internal medicine–pediatrics programs with moderate sensitivity and high specificity. The authors will continue to refine the MLM by increasing the number of annotations, exploring parameter tuning and feature engineering options, and identifying which application sections have the highest correlation with invited for interview status.
Exploring challenges in the management and treatment of inclusion body myositis
Authors: Skolka Michael P. , Naddaf Elie
Published: July 2023

Purpose of review

This review provides an overview of the management and treatment landscape of inclusion body myositis (IBM), while highlighting the current challenges and future directions.

Recent findings

IBM is a slowly progressive myopathy that predominantly affects patients over the age of 40, leading to increased morbidity and mortality. Unfortunately, a definitive cure for IBM remains elusive. Various clinical trials targeting inflammatory and some of the noninflammatory pathways have failed. The search for effective disease-modifying treatments faces numerous hurdles including variability in presentation, diagnostic challenges, poor understanding of pathogenesis, scarcity of disease models, a lack of validated outcome measures, and challenges related to clinical trial design. Close monitoring of swallowing and respiratory function, adapting an exercise routine, and addressing mobility issues are the mainstay of management at this time.

Addressing the obstacles encountered by patients with IBM and the medical community presents a multitude of challenges. Effectively surmounting these hurdles requires embracing cutting-edge research strategies aimed at enhancing the management and treatment of IBM, while elevating the quality of life for those affected.
Hemosiderotic Xanthelasmas. A New Clinicopathological Variant of Xanthelasma Palpebrarum or a Localized Variant of Xanthosiderohistiocytosis of the Eyelids?
Authors: Lobato-Berezo Alejandro , March-Rodríguez Álvaro , Pujol Ramon M. , Fernández-Figueras María Teresa
Published: July 2023

Xanthelasma palpebrarum represent the most common subtype of cutaneous plane xanthomas. Xanthosiderohistiocytosis is considered a rare variant of xanthoma disseminatum, with only 4 cases reported to date. We report the case of a man with progressive pigmented lesions on the 4 eyelids that could correspond to hemosiderotic xanthelasmas or a localized variant of xanthosiderohistiocytosis.
Pain management after cardiac surgery via median sternotomy
Authors: Maeßen Timo , Korir Nelson , Van de Velde Marc , Kennes Jelle , Pogatzki-Zahn Esther , Joshi Girish P.
Published: July 2023

BACKGROUND

Pain after cardiac surgery via median sternotomy can be difficult to treat, and if inadequately managed can lead to respiratory complications, prolonged hospital stays and chronic pain.

OBJECTIVES

To evaluate available literature and develop recommendations for optimal pain management after cardiac surgery via median sternotomy.

DESIGN

A systematic review using PROcedure-SPECific Pain Management (PROSPECT) methodology.

ELIGIBILITY CRITERIA

Randomised controlled trials and systematic reviews published in the English language until November 2020 assessing postoperative pain after cardiac surgery via median sternotomy using analgesic, anaesthetic or surgical interventions.

DATA SOURCES

PubMed, Embase and Cochrane Databases.

RESULTS

Of 319 eligible studies, 209 randomised controlled trials and three systematic reviews were included in the final analysis. Pre-operative, intra-operative and postoperative interventions that reduced postoperative pain included paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), intravenous magnesium, intravenous dexmedetomidine and parasternal block/infiltration.

CONCLUSIONS

The analgesic regimen for cardiac surgery via sternotomy should include paracetamol and NSAIDs, unless contraindicated, administered intra-operatively and continued postoperatively. Intra-operative magnesium and dexmedetomidine infusions may be considered as adjuncts particularly when basic analgesics are not administered. It is not clear if combining dexmedetomidine and magnesium would provide superior pain relief compared with either drug alone. Parasternal block/surgical site infiltration is also recommended. However, no basic analgesics were used in the studies assessing these interventions. Opioids should be reserved for rescue analgesia. Other interventions, including cyclo-oxygenase-2 specific inhibitors, are not recommended because there was insufficient, inconsistent or no evidence to support their use and/or due to safety concerns.