bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of return migration of Estonian young adults in transnational mobility
Authors: Toomistu Terje , Lauren Ave , Annist Aet , Murakas Rein
Published: December 2023

Since Estonia joined the European Union in 2004, there has been a steady growth in transnational mobility for work or study among Estonian young adults, a phenomenon further boosted by the economic recession of 2008–09. This article analyses the factors that have influenced or would potentially influence their return to Estonia, following an online survey of over 2,000 participants from Estonia aged 20–35 years with a recent experience of living abroad. By deploying an analysis of logistic regression, we developed two models concerning the ‘actual return factors’ (comparing the stayers with those who have returned) and the ‘aspirational return factors’ (how the migrants imagine their future location). Some of the highlights of our results demonstrate that the likelihood of return migration is significantly lower for those whose prime reasons for leaving Estonia were related to living conditions and salary abroad. The extent of people’s ties and connections to Estonia does not play a significant role in actually returning to Estonia. However, these connections do play a role, albeit limited, in envisioning one’s future in Estonia. The outcomes of our analysis suggest that diaspora policies cannot be implemented without addressing the sending country’s internal sociopolitical situation, which influences the living conditions and economic opportunities of its citizens, scrutinized particularly carefully by those who have left the country before deciding whether or not to return.
Tube Thoracostomy Complications in Patients With ARDS Requiring ECMO: Worse in COVID-19 Patients?
Authors: Laverty Robert B , Ivins-O’Keefe Kelly M , Adams Alexandra M , Flatley Meaghan J , Sobieszczyk Michal J , Mason Phillip E , Sams Valerie G
Published: December 2023

Introduction

The incidence and management outcomes of COVID-19 patients with acute respiratory distress syndrome (ARDS) on veno-venous extracorporeal membrane oxygenation (V-V ECMO) requiring chest tubes are not well-described. This study sought to explore differences in tube thoracostomy rates and subsequent complications between patients with and without COVID-19 ARDS on V-V ECMO.

Materials and Methods

This study is a single institution, retrospective cohort study of patients with COVID-19 ARDS requiring V-V ECMO. The control cohort consisted of patients who required V-V ECMO for ARDS-related diagnoses from January 2018 to January 2021. The primary outcome was any complication following initial tube thoracostomy placement. Study approval was obtained from the Brooke Army Medical Center Institutional Review Board (C.2017.152d).

Results

Twenty-five COVID-19 patients and 38 controls were included. Demographic parameters did not differ between the groups. The incidence of pneumothorax was not significantly different between the two groups (44% COVID-19 vs. 22% control, OR 2.8, 95% CI 0.95–7.9, P = 0.09). Patients with COVID-19 were as likely to receive tube thoracostomy as controls (36% vs. 24%, OR 1.8, 95% CI 0.55–5.7). Complications, however, were more likely to occur in the COVID-19 group (89% vs. 33%, OR 16, 95% CI, 1.6–201, P = 0.0498).

Conclusions

Tube thoracostomy placement in COVID-19 patients with ARDS requiring V-V ECMO is common, as are complications following initial placement. Clinicians should anticipate the need for re-intervention in this patient population. Small-bore (14Fr and smaller) pigtail catheters appeared to be safe and efficacious in this setting, but further study on tube thoracostomy management in ECMO patients is needed.
Comparing Capabilities of Simulation Modalities for Training Combat Casualty Care: Perspectives of Combat Medics
Authors: Bailey Shannon K T , Brannick Michael T , Bowling F , Reiner Colleen C , Lyons Dennis , Llerena Luis E , Okuda Yasuharu
Published: December 2023

Introduction

Combat casualty care requires learning a complex set of skills to treat patients in challenging situations, including resource scarce environments, multiple casualty incidents, and care under fire. To train the skills needed to respond efficiently and appropriately to these diverse conditions, instructors employ a wide array of simulation modalities. Simulation modalities for medical training include manikins, task trainers, standardized patient actors (i.e., role players), computer or extended reality simulations (e.g., virtual reality, augmented reality), cadavers, and live tissue training. Simulation modalities differ from one another in multiple attributes (e.g., realism, availability). The purpose of this study was to compare capabilities across simulation modalities for combat casualty care from the perspective of experienced military medics.

Materials and Methods

To provide a more complete understanding of the relative merits and limitations of modalities, military combat medics (N = 33) were surveyed on the capabilities of simulation modalities during a 5-day technical experimentation event where they observed medical simulations from industry developers. The survey asked them to rate each of eleven modalities on each of seven attributes. To elicit additional context for the strengths, limitations, and unique considerations of using each modality, we also collected open-ended comments to provide further insight on when and how to use specific simulation modalities.

Results

Results showed differences among the simulation modalities by attribute. Cadavers, role play, moulage, and live tissue all received high ratings on two or more attributes. However, there was no modality that was rated uniformly superior to the others. Instead, modalities appear to have unique strengths and limitations depending on the training context and objectives. For example, cadavers were seen as highly realistic, but not very reusable.

Conclusions

The study furthers our understanding of simulation modalities for medical training by providing insight from combat medics on the benefits, limitations, and considerations for implementing different modalities depending on the training context. These results may be helpful to instructors in selecting modalities for their programs.
Dose–response association between animal protein sources and risk of gestational diabetes mellitus: a systematic review and meta-analysis
Authors: Talebi Sepide , Ghoreishy Seyed Mojtaba , Ghavami Abed , Sikaroudi Masoumeh Khalighi , Nielsen Sabrina Mai , Talebi Ali , Mohammadi Hamed
Published: December 2023

Context

There are contradictory findings about the relationship between various animal protein sources and the risk of gestational diabetes mellitus (GDM).

Objective

The purpose of our study was to understand better the associations between total protein, animal protein, and animal protein sources and the risk of developing GDM.

Data Sources

A systematic literature search was conducted in PubMed, Scopus, and Web of Science encompassing the literature up until August 2022. A random-effects model was used to combine the data. For estimating the dose–response curves, a one-stage linear mixed-effects meta-analysis was conducted.

Data Extraction

Data related to the association between animal protein consumption and the risk of GDM in the general population was extracted from prospective cohort studies.

Data Analysis

It was determined that 17 prospective cohort studies with a total of 49 120 participants met the eligibility criteria. It was concluded with high certainty of evidence that there was a significant association between dietary animal protein intake and GDM risk (1.94, 95% CI 1.42 to 2.65, n = 6). Moreover, a higher intake of total protein, total meat, and red meat was positively and significantly associated with an increased risk of GDM. The pooled relative risks of GDM were 1.50 (95% CI: 1.16, 1.94; n = 3) for a 30 g/d increment in processed meat, 1.68 (95% CI: 1.25, 2.24; n = 2) and 1.94 (95% CI: 1.41, 2.67; n = 4) for a 100 g/d increment in total and red meat, and 1.21 (95% CI: 1.10, 1.33; n = 4) and 1.32 (95% CI: 1.15, 1.52; n = 3) for a 5% increment in total protein and animal protein, respectively. GDM had a positive linear association with total protein, animal protein, total meat consumption, and red meat consumption, based on non-linear dose–response analysis.

Conclusion

Overall, consuming more animal protein–rich foods can increase the risk of GDM. The results from the current study need to be validated by other, well-designed prospective studies.

Systematic Review Registration

PROSPERO registration no. CRD42022352303.
Effects of carnosine and histidine-containing dipeptides on biomarkers of inflammation and oxidative stress: a systematic review and meta-analysis
Authors: Saadati Saeede , Kabthymer Robel Hussen , Aldini Giancarlo , Mousa Aya , Feehan Jack , de Courten Barbora
Published: December 2023

Context

Carnosine and histidine-containing dipeptides (HCDs) are suggested to have anti-inflammatory and antioxidative benefits, but their effects on circulating adipokines and inflammatory and oxidative stress biomarkers remain unclear.

Objectives

The aim of the present systematic review and meta-analysis was to determine the impact of HCD supplementation on inflammatory and oxidative stress biomarkers.

Data Sources

A systematic search was performed on Medline via Ovid, Scopus, Embase, ISI Web of Science, and the Cochrane Library databases from inception to 25 January 2023.

Data Extraction

Using relevant key words, trials investigating the effects of carnosine/HCD supplementation on markers of inflammation and oxidative stress, including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), adiponectin, malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), total antioxidant capacity (TAC), and catalase (CAT) were identified. Meta-analyses were conducted using random-effects models to calculate the weighted mean differences (WMDs) and 95% confidence intervals (CIs).

Data Analysis

A total of 9 trials comprising 350 participants were included in the present meta-analysis. Carnosine/HCD supplementation led to a significant reduction in CRP (WMD: –0.97 mg/L; 95% CI: –1.59, –0.36), TNF-α (WMD: –3.60 pg/mL; 95% CI: –7.03, –0.18), and MDA (WMD: –0.34 μmol/L; 95% CI: –0.56, –0.12) and an elevation in CAT (WMD: 4.48 U/mL; 95% CI: 2.43, 6.53) compared with placebo. In contrast, carnosine/HCD supplementation had no effect on IL-6, adiponectin, GSH, SOD, and TAC levels.

Conclusion

Carnosine/HCD supplementation may reduce inflammatory and oxidative stress biomarkers, and potentially modulate the cardiometabolic risks associated with chronic low-grade inflammation and lipid peroxidation.

Systematic Review Registration

PROSPERO registration no. CRD42017075354.
Incidence of Respiratory Syncytial Virus–Associated Lower Respiratory Tract Illness in Infants in Low- and Middle-Income Regions During the Coronavirus Disease 2019 Pandemic
Authors: Fry Samantha , Chokephaibulkit Kulkanya , Pallem Sridevi , Henry Ouzama , Pu Yongjia , Akawung Agnes , Kim Joon Hyung , Yanni Emad , Tullio Antonella Nadia , Aurpibul Linda , Lee Christine Mui Fong , Ceballos Ana , Zaman Khalequ , Abadía de Regalado Ivonne , Ahmed Khatija , Arias Fernandez Diana Andrea , Taher Sri Wahyu , Caccavo Juliana , Coutinho Conrado Milani , D’Andrea Nores Ulises , De León Tirza , D’Silva Emily Christine , De Bernardi Mara , Dieser Pablo , Falaschi Andrea , Flores Acosta Clara del Carmen , Gentile Angela , Teo Ik Hui , Kotze Sheena , López-Medina Eduardo , Luca Ruben , Lucion Maria Florencia , Mantaring Jacinto Blas III V , Marín Bladimir , Moelo Malahleha , Mussi-Pinhata Marisa Márcia , Pinto Jorge , Puthanakit Thanyawee , Reyes Osvaldo , Roa Maria Fernanda , Rodriguez Brieschke María Teresa , Rodriguez Camilo Enrique , Rodriguez Niño Juan Nicolas , Schwarzbold Alexandre Vargas , Sierra Garcia Alexandra , Sivapatham Lavitha , Soon Ruey , Tinoco Juan Carlos , Velásquez Penagos Jesús Arnulfo , Dos Santos Gaël
Published: December 2023

Background

Incidence data of respiratory syncytial virus–associated lower respiratory tract illness (RSV-LRTI) are sparse in low- and middle-income countries (LMICs). We estimated RSV-LRTI incidence rates (IRs) in infants in LMICs using World Health Organization case definitions.

Methods

This prospective cohort study, conducted in 10 LMICs from May 2019 to October 2021 (largely overlapping with the coronavirus disease 2019 [COVID-19] pandemic), followed infants born to women with low-risk pregnancies for 1 year from birth using active and passive surveillance to detect potential LRTIs, and quantitative reverse-transcription polymerase chain reaction on nasal swabs to detect RSV.

Results

Among 2094 infants, 32 (1.5%) experienced an RSV-LRTI (8 during their first 6 months of life, 24 thereafter). Seventeen (0.8%) infants had severe RSV-LRTI and 168 (8.0%) had all-cause LRTI. IRs (95% confidence intervals [CIs]) of first RSV-LRTI episode were 1.0 (.3–2.3), 0.8 (.3–1.5), and 1.6 (1.1–2.2) per 100 person-years for infants aged 0–2, 0–5, and 0–11 months, respectively. IRs (95% CIs) of the first all-cause LRTI episode were 10.7 (8.1–14.0), 11.7 (9.6–14.0), and 8.7 (7.5–10.2) per 100 person-years, respectively. IRs varied by country (RSV-LRTI: 0.0–8.3, all-cause LRTI: 0.0–49.6 per 100 person-years for 0- to 11-month-olds).

Conclusions

RSV-LRTI IRs in infants in this study were relatively low, likely due to reduced viral circulation caused by COVID-19–related nonpharmaceutical interventions.

Clinical Trials Registration

NCT03614676.
Preswitch Regimens Influence the Rate of Weight Gain After Switch to Tenofovir Disoproxil Fumarate, Lamivudine, and Dolutegravir (TLD): Study From an East African Cohort
Authors: Bourgi Kassem , Ofner Susan , Musick Beverly , Wools-Kaloustian Kara , Humphrey John M , Diero Lameck , Yiannoutsos Constantin T , Gupta Samir K
Published: December 2023

Background

Switching from non-nucleoside reverse transcriptase inhibitor (NNRTI)–based regimens to dolutegravir (DTG) has been associated with greater weight gain.

Methods

We conducted our analysis using a longitudinal cohort of people with HIV (PWH) in Western Kenya. We evaluated changes in the rate of weight gain among treatment-experienced, virally suppressed PWH who switched from NNRTI to tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD). We modeled the weights pre- and postswitch using a 2-phase model with linear trend preswitch and an inverted exponential function postswitch. We estimated an 18-month excess weight gain by comparing the projected weight with that expected using the preswitch rate.

Results

A total of 18 662 individuals were included in our analysis, with 55% switching from efavirenz (EFV) and 45% from nevirapine (NVP). Of the studied individuals, 51% were female, and the median age and body mass index (BMI) were 51 years and 22 kg/m2, respectively. For the overall population, the rate of weight gain increased from 0.47 kg/year preswitch to 0.77 kg/year, with higher increases for females (0.57 kg/year to 0.96 kg/year) than males (0.34 kg/year to 0.62 kg/year). The rate of weight gain for individuals switching from EFV-based regimens significantly increased from 0.57 kg/year preswitch to 1.11 kg/year postswitch but remained stable at 0.35 kg/year preswitch vs 0.32 kg/year postswitch for individuals switching from NVP-based regimens.

Conclusions

Switching from NNRTI-based regimens to TLD is associated with a modest increase in the rate of weight gain, with the preswitch NNRTI being the key determinant of the amount of weight gain experienced postswitch.
Diagnostic Accuracy of Clinical Diagnostic Scoring Systems for Childhood Tuberculosis: A Systematic Review and Meta-analysis
Authors: Kakinda Michael , Olum Ronald , Baluku Joseph Baruch , Bongomin Felix
Published: December 2023

Background

Diagnosis of childhood tuberculosis (TB) poses several challenges. Therefore, point-based scoring systems and diagnostic algorithms have been developed to improve the diagnostic yields in this population. However, there are no updated systematic reviews of the existing childhood TB scoring systems and algorithms. Hence, we systematically reviewed the diagnostic accuracy of the childhood TB diagnostic scoring systems and algorithms.

Methods

We systematically searched PubMed, CINAHL, Embase, Scopus, and Google Scholar databases for relevant articles published until 30 March 2023. QUADAS-2 was used to assess their study quality. Diagnostic accuracy measures (ie, sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios) were pooled using a random-effects model.

Results

We included 15 eligible studies, with a total of 7327 study participants aged <15 years, with 10 evaluations of childhood TB diagnostic scoring systems and algorithms. Among these algorithms and scoring systems, only 3 were evaluated more than once. These were the Keith Edwards scoring system with 5 studies (sensitivity, 81.9%; specificity, 81.2%), Kenneth Jones criteria with 3 studies (sensitivity, 80.1%; specificity, 45.7%), and the Ministry of Health–Brazil algorithm with 3 studies (sensitivity, 79.9%; specificity, 73.2%).

Conclusions

We recommend using the Keith Edwards scoring system because of its high sensitivity and specificity. Further research is necessary to assess the effectiveness of scoring systems and algorithms in identifying TB in children with HIV and malnutrition.
Reflex Human Immunodeficiency Virus (HIV) Type 1 RNA Testing Enables Timely Differentiation of False-Positive Results From Acute HIV Infection
Authors: Kaperak Christopher , Eller Dylan , Devlin Samantha A , Hall André , Schmitt Jessica , Friedman Eleanor E , Beavis Kathleen G , Stanford Kimberly A , Pitrak David , McNulty Moira C
Published: December 2023

Accurate, timely human immunodeficiency virus (HIV) diagnosis is critical. Routine HIV screening program data were examined before and after reflex HIV type 1 RNA testing. Reflex testing facilitated confirmation of reactive HIV screening assays (as true or false positives) (odds ratio, 23.7 [95% confidence interval, 6.7–83.4]; P < .0001), improving detection of acute HIV and reducing unconfirmed discordant results.
A Randomized Placebo-Controlled Trial of the Anti-Nerve Growth Factor Antibody Tanezumab in Subjects With Cancer Pain Due to Bone Metastasis
Authors: Fallon Marie , Sopata Maciej , Dragon Erika , Brown Mark T , Viktrup Lars , West Christine R , Bao Weihang , Agyemang Alex
Published: December 2023

Background

This phase III, randomized, double-blind, placebo-controlled, parallel-group study assessed the efficacy and safety of tanezumab in subjects with cancer pain predominantly due to bone metastasis receiving background opioid therapy.

Methods

Subjects were randomized (stratified by (1) tumor aggressiveness and (2) presence/absence of concomitant anticancer treatment) to placebo or tanezumab 20 mg. Treatment was administered by subcutaneous injection every 8 weeks for 24 weeks (3 doses) followed by a 24-week safety follow-up period. The primary outcome was change in daily average pain in the index bone metastasis cancer pain site (from 0 = no pain to 10 = worst possible pain) from baseline to week 8.

Results

LS mean (SE) change in pain at week 8 was −1.25 (0.35) for placebo (n = 73) and –2.03 (0.35) for tanezumab 20 mg (n = 72). LS mean (SE) [95% CI] difference from placebo was –0.78 (0.37) [–1.52, –0.04]; P = .0381 with α = 0.0478. The number of subjects with a treatment-emergent adverse event during the treatment period was 50 (68.5%) for placebo and 53 (73.6%) for tanezumab 20 mg. The number of subjects with a prespecified joint safety event was 0 for placebo and 2 (2.8%) for tanezumab 20 mg (pathologic fracture; n = 2).

Conclusion

Tanezumab 20 mg met the primary efficacy endpoint at week 8. Conclusions on longer-term efficacy are limited since the study was not designed to evaluate the durability of the effect beyond 8 weeks. Safety findings were consistent with adverse events expected in subjects with cancer pain due to bone metastasis and the known safety profile of tanezumab. Clinicaltrials.gov identifier: NCT02609828.
Political science meets physical science: The shared concept of stability
Authors: Breslauer George W , Breslauer Kenneth J
Published: December 2023

A biophysical chemist and a political scientist team up to explore striking parallels between the requisites of “stability” and the causes of instability within both the cellular/molecular world of biophysical chemistry and the world of social and political organization of self-assembled, societal structures, such as sovereign states and institutions. The structure, function, and organizational similarities of such parallelisms are particularly noteworthy, given that human agency introduces greater contingency in the sociopolitical world than do the “laws of Nature” in the natural-scientific world. In this perspective piece, we critically identify and analyze these parallels between the natural and the social realms through the prism of the shared concept of stability, including causal factors that embrace the full “stability spectrum” from instability to stability. This spectrum includes the crucial bridging, time-dependent, intermediate, kinetic state of “metastability.” Our analyses reveal that, in the microscopic/molecular world of the physical sciences, the thermodynamic and kinetic characterizations of the stabilities and transformations between physiochemical “states” exhibit cognate properties and features in the macroscopic world of sociopolitical arenas in ways that reflect a greater than traditionally assumed continuity between Nature and society. Select examples from the natural and social realms are presented and elaborated on to illustrate these parallelisms, while underscoring the striking similarities in their functional consequences.
A recent surge of nitrous oxide misuse around London which merits a public health warning
Authors: Malek Naveed , Nihat Akın , Mattoscio Miriam , Simioni Valentina , Deeb Jacquie , Chawda Sanjiv , Cifelli Alberto , Krommyda Magdalini
Published: December 2023

Background

Use of nitrous oxide (N2O) gas for recreational purposes by young people is increasingly recognized as a public health hazard in the UK.

Methods

We looked at the hospital records of patients admitted over the last 4 years to a single neurological centre in Essex to determine the demographics, presentation, and management of patients presenting with symptoms of N2O toxicity from its recreational use.

Results

Of the 17 patients (mean age = 22.9 ± 3 years) admitted between September 2018 and October 2022, 70% were admitted between January and October 2022. All patients reported limb paraesthesiae and 16/17 reported (95%) imbalance; 11/17 (65%) showed objective limb weakness. Serum B12 concentration was low in 9/17 (53%). Plasma methylmalonic acid (n = 7) and homocysteine (n = 8) levels were elevated in all patients tested. Spinal cord Magnetic Resonance Imaging (MRI) imaging was abnormal in 10/17 (59%) patients. Nerve conduction studies were abnormal in 10/13 (77%) patients, with evidence of a symmetric, length-dependent, large fibre neuropathy.

Conclusions

There has been a recent surge of cases with neurological complications of recreational N2O abuse in the UK, with a relatively greater rate in 2022. Greater awareness of this condition amongst clinicians and health regulators is urgently required to prevent harm from N2O misuse in young people.
Identification of FOXO1 as a geroprotector in human synovium through single-nucleus transcriptomic profiling
Authors: Liu Feifei , Lu Yi , Wang Xuebao , Sun Shuhui , Pan Huize , Wang Min , Wang Zehua , Zhang Weiqi , Ma Shuai , Sun Guoqiang , Chu Qun , Wang Si , Qu Jing , Liu Guang-Hui
Published: December 2023

The synovium, a thin layer of tissue that is adjacent to the joints and secretes synovial fluid, undergoes changes in aging that contribute to intense shoulder pain and other joint diseases. However, the mechanism underlying human synovial aging remains poorly characterized. Here, we generated a comprehensive transcriptomic profile of synovial cells present in the subacromial synovium from young and aged individuals. By delineating aging-related transcriptomic changes across different cell types and their associated regulatory networks, we identified two subsets of mesenchymal stromal cells (MSCs) in human synovium, which are lining and sublining MSCs, and found that angiogenesis and fibrosis-associated genes were upregulated whereas genes associated with cell adhesion and cartilage development were downregulated in aged MSCs. Moreover, the specific cell-cell communications in aged synovium mirrors that of aging-related inflammation and tissue remodeling, including vascular hyperplasia and tissue fibrosis. In particular, we identified forkhead box O1 (FOXO1) as one of the major regulons for aging differentially expressed genes (DEGs) in synovial MSCs, and validated its downregulation in both lining and sublining MSC populations of the aged synovium. In human FOXO1-depleted MSCs derived from human embryonic stem cells, we recapitulated the senescent phenotype observed in the subacromial synovium of aged donors. These data indicate an important role of FOXO1 in the regulation of human synovial aging. Overall, our study improves our understanding of synovial aging during joint degeneration, thereby informing the development of novel intervention strategies aimed at rejuvenating the aged joint.
Non-perturbative SQED beta function using the functional renormalization group approach and the NSVZ exact beta function
Authors: Echeverria Puentes Jeremy , Schmidt Iván
Published: December 2023

The renormalization group equations of massive $\mathcal {N}=1$ supersymmetric quantum electrodynamics are studied using the functional renormalization group approach. A non-perturbative form of the beta function has been computed via a derivative expansion of the effective action. In the local potential approximation, the functional form of the non-perturbative beta function is closely related to the form of the Novikov–Shifman–Vainshtein–Zakharov (NSVZ) exact beta function; this relationship is exact if an effective fine-structure constant is defined. The non-massive limit of the same is also analyzed. Furthermore, the calculation of the beta function has been improved by incorporating the influence of momentum modes on the propagation of the superfields in the non-perturbative running of the electric charge, applying a second-order truncation for the derivative expansion, which we use to find the momentum contributions to the β function. Again, we find the NSVZ relation for an effective fine-structure constant.

It is with sadness that I say goodbye to my professor, Iván Schmidt Andrade, who left us during the course of this work. His passion for research and his special vision of physics work will remain with us. Thank you for everything.
Effects of serum proteins on corrosion rates and product bioabsorbability of biodegradable metals
Authors: Zhang Hongjie , Li Xin , Qu Zehua , Zhang Wanqian , Wang Qunsong , Cao Dinglingge , Wang Yaoben , Wang Xin , Wang Yang , Yu Lin , Ding Jiandong
Published: December 2023

Corrodible metals are the newest kind of biodegradable materials and raise a new problem of the corrosion products. However, the removal of the precipitated products has been unclear and even largely ignored in publications. Herein, we find that albumin, an abundant macromolecule in serum, enhances the solubility of corrosion products of iron in blood mimetic Hank’s solution significantly. This is universal for other main biodegradable metals such as magnesium, zinc and polyester-coated iron. Albumin also influences corrosion rates in diverse trends in Hank’s solution and normal saline. Based on quantitative study theoretically and experimentally, both the effects on corrosion rates and soluble fractions are interpreted by a unified mechanism, and the key factor leading to different corrosion behaviors in corrosion media is the interference of albumin to the Ca/P passivation layer on the metal surface. This work has illustrated that the interactions between metals and media macromolecules should be taken into consideration in the design of the next-generation metal-based biodegradable medical devices in the formulism of precision medicine. The improved Hank’s solution in the presence of albumin and with a higher content of initial calcium salt is suggested to access biodegradable metals potentially for cardiovascular medical devices, where the content of calcium salt is calculated after consideration of chelating of calcium ions by albumin, resulting in the physiological concentration of free calcium ions.
A Model of Online Misinformation
Authors: Acemoglu Daron , Ozdaglar Asuman , Siderius James
Published: December 2023

We present a model of online content sharing where agents sequentially observe an article and decide whether to share it with others. This content may or may not contain misinformation. Each agent starts with an ideological bias and gains utility from positive social media interactions but does not want to be called out for propagating misinformation. We characterize the (Bayesian–Nash) equilibria of this social media game and establish that it exhibits strategic complementarities. Under this framework, we study how a platform interested in maximizing engagement would design its algorithm. Our main result establishes that when the relevant articles have low-reliability and are thus likely to contain misinformation, the engagement-maximizing algorithm takes the form of a “filter bubble”—creating an echo chamber of like-minded users. Moreover, filter bubbles become more likely when there is greater polarization in society and content is more divisive. Finally, we discuss various regulatory solutions to such platform-manufactured misinformation.
High levels of sleep disturbance across early childhood increases cardiometabolic disease risk index in early adolescence: longitudinal sleep analysis using the Health Outcomes and Measures of the Environment study
Authors: Duraccio Kara McRae , Xu Yingying , Beebe Dean W , Lanphear Bruce , Chen Aimin , Braun Joseph M , Kalkwarf Heidi , Cecil Kim M , Yolton Kimberly
Published: December 2023

Study Objectives

This study examines the impact of sleep duration, bedtime, and sleep disturbance during early childhood on the risk of cardiometabolic disorder (CMD) in early adolescence.

Methods

Within the Health Outcomes and Measures of Environment Study, we examined sleep patterns of 330 children from ages 2 to 8 years and the relationship of these sleep patterns with cardiometabolic risk measures at age 12 (N = 220). We used a group-based semi-parametric mixture model to identify distinct trajectories in sleep duration, bedtime timing, and sleep disturbance for the entire sample. We then examined the associations between sleep trajectories and CMD risk measures using general linear models using both an unadjusted model (no covariates) and an adjusted model (adjusting for child pubertal stage, child sex, duration of breastfeeding, household income, maternal education, and maternal serum cotinine).

Results

In the unadjusted and adjusted models, we found significant differences in CMD risk scores by trajectories of sleep disturbance. Children in the “high” disturbance trajectory had higher CMD risk scores than those in the ‘low’ disturbance trajectory (p’s = 0.002 and 0.039, respectively). No significant differences in CMD risk were observed for bedtime timing or total sleep time trajectories in the unadjusted or adjusted models.

Conclusions

In this cohort, caregiver-reported sleep disturbance in early childhood was associated with more adverse cardiometabolic profiles in early adolescence. Our findings suggest that trials to reduce CMD risk via sleep interventions—which have been conducted in adolescents and adults—may be implemented too late.
Does Workplace Discrimination Contribute to Sex Work for Trans and Nonbinary Workers?
Authors: Shircliff Jesse Ezra , Hutchinson Brook , Glass Christy , Suárez Mario , Miller Gabe H , Marquez-Velarde Guadalupe
Published: December 2023

Workplace discrimination contributes to economic precarity for trans individuals, and some evidence suggests that barriers to formal employment may contribute to engagement in sex work. This study examines whether particular types of workplace discrimination – including blocked access to jobs and termination due to trans status – represent a pathway into sex work for trans and nonbinary workers conditional upon social status, gender, and race. Our analysis relies on the 2015 U.S. Transgender Survey (USTS), where we stratify multiple logistic regression models for trans men, trans women, and nonbinary individuals and introduce an interaction term between workplace discrimination and race. We exploit two time horizons in the data for a lifetime analysis and a past-year analysis. We find strong support that trans women and nonbinary individuals are more likely to engage in sex work when they have experienced workplace discrimination compared to trans men. Predicted probabilities show that workplace discrimination amplifies the likelihood of sex work for most trans workers of color compared to those who are white. By contributing to the literature on “bad jobs” and anti-trans workplace bias from an intersectional approach, this study informs debates on anti-discrimination policies and practices that facilitate economic security for trans workers.
Spring wood phenology responds more strongly to chilling temperatures than bud phenology in European conifers
Authors: Lin Shaozhi , Wang Huanjiong , Dai Junhu , Ge Quansheng
Published: December 2023

A comparative assessment of bud and wood phenology could aid a better understanding of tree growth dynamics. However, the reason for asynchronism or synchronism in leaf and cambial phenology remains unclear. To test the assumption that the temporal relationship between the budburst date and the onset date of wood formation is due to their common or different responses to environmental factors, we constructed a wood phenology dataset from previous literature, and compared it with an existing bud phenology dataset in Europe. We selected three common conifers (Larix decidua Mill., Picea abies (L.) H. Karst. and Pinus sylvestris L.) in both datasets and analyzed 909 records of the onset of wood formation at 47 sites and 238,720 records of budburst date at 3051 sites. We quantified chilling accumulation (CA) and forcing requirement (FR) of budburst and onset of wood formation based on common measures of CA and FR. We then constructed negative exponential CA–FR curves for bud and wood phenology separately. The results showed that the median, variance and probability distribution of CA–FR curves varied significantly between bud and wood phenology for three conifers. The different FR under the same chilling condition caused asynchronous bud and wood phenology. Furthermore, the CA–FR curves manifested that wood phenology was more sensitive to chilling than bud phenology. Thus, the FR of the onset of wood formation increases more than that of budburst under the same warming scenarios, explaining the stronger earlier trends in the budburst date than the onset date of woody formation simulated by the process-based model. Our work not only provides a possible explanation for asynchronous bud and wood phenology from the perspective of organ-specific responses to chilling and forcing, but also develops a phenological model for predicting both bud and wood phenology with acceptable uncertainties.
Small‐molecule CEM3 strengthens single‐cell oscillators in the suprachiasmatic nucleus
Authors: van Beurden Anouk W. , Tersteeg Mayke M. H. , Michel Stephan , van Veldhoven Jaco P. D. , IJzerman Adriaan P. , Rohling Jos H. T. , Meijer Johanna H.
Published: December 2023

A robust endogenous clock is required for proper function of many physiological processes. The suprachiasmatic nucleus (SCN) constitutes our central circadian clock and allows us to adapt to daily changes in the environment. Aging can cause a decline in the amplitude of circadian rhythms in SCN and peripheral clocks, which contributes to increased risk of several chronic diseases. Strengthening clock function would therefore be an effective strategy to improve health. A high‐throughput chemical screening has identified clock‐enhancing molecule 3 (CEM3) as small molecule that increases circadian rhythm amplitude in cell lines and SCN explants. It is, however, currently not known whether CEM3 acts by enhancing the amplitude of individual single‐cell oscillators or by enhancing synchrony among neurons. In view of CEM3's potential, it is of evident importance to clarify the mode of action of CEM3. Here, we investigated the effects of CEM3 on single‐cell PERIOD2::LUCIFERASE rhythms in mouse SCN explants. CEM3 increased the amplitude in approximately 80%–90% of the individual cells in the SCN without disrupting the phase and/or period of their rhythms. Noticeably, CEM3's effect on amplitude is independent of the cell's initial amplitude. These findings make CEM3 a potential therapeutic candidate to restore compromised amplitude in circadian rhythms and will boost the development of other molecular approaches to improve health.
Advances in the clinical use of patient-reported outcomes in thoracic surgery
Authors: Bou-Samra Patrick , Kneuertz Peter J.
Published: December 2023

Purpose of review

Patient-reported outcomes (PROs) are increasingly recognized as a clinical tool for measuring and improving patient-centric care. This review provides a summary on recent advances in the use of PROs in the field of thoracic surgery.

Recent findings

PROs have been used as primary endpoints in clinical trials and observational studies evaluating clinical care pathways and quantifying the benefits of minimally invasive surgical techniques for patients undergoing lung surgery. Qualitative and quantitative research has yielded fundamental insights into which PRO domains are meaningful and valued by patients after lung surgery. Patient experience and recovery after esophagectomy have been further characterized by using PROs. New disease-specific survey tools for patients have been developed to track long-term symptoms after esophageal reconstruction. Patient satisfaction has emerged as the key metric used to gauge the patient centeredness of hospital systems.

Advances have been made in the application of PROs in multiple areas of thoracic surgery, which include lung and esophageal surgery. The growing focus on the use of PROs in clinical pathways has led to a better understanding on how to optimize patient experience.
Update on guidelines and recommendations for enhanced recovery after thoracic surgery
Authors: Cohen Joshua B. , Smith Brad B. , Teeter Emily G.
Published: December 2023

Purpose of review

Enhanced recovery after thoracic surgery (ERATS) has continued its growth in popularity over the past few years, and evidence for its utility is catching up to other specialties. This review will present and examine some of that accumulated evidence since guidelines sponsored by the Enhanced Recovery after Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) were first published in 2019.

Recent findings

The ERAS/ESTS guidelines published in 2019 have not been updated, but new studies have been done and new data has been published regarding some of the individual components of the guidelines as they relate to thoracic and lung resection surgery. While there is still not a consensus on many of these issues, the volume of available evidence is becoming more robust, some of which will be incorporated into this review.

The continued accumulation of data and evidence for the benefits of enhanced recovery techniques in thoracic and lung resection surgery will provide the thoracic anesthesiologist with guidance on how to best care for these patients before, during, and after surgery. The data from these studies will also help to elucidate which components of ERAS protocols are the most beneficial, and which components perhaps do not provide as much benefit as previously thought.
Modern fluid management in thoracic surgery
Authors: Batchelor Timothy J.P.
Published: December 2023

Purpose of review

To provide an approach to perioperative fluid management for lung resection patients that incorporates the entire patient pathway in the context of international guidelines on enhanced recovery after surgery (ERAS).

Recent findings

The concern with intraoperative fluid management is that giving too little or too much fluid is associated with worse outcomes after lung resection. However, it has not emerged as a key care element in thoracic ERAS programs probably due to the influence of other ERAS elements. Carbohydrate loading 2 h before surgery and the allowance of water until just prior to induction ensures the patient is both well hydrated and metabolically normal when they enter the operating room. Consequently, maintaining a euvolemic state during anesthesia can be achieved without goal-directed fluid therapy despite the recommendations of some guidelines. Intravenous fluids can be safely stopped in the immediate postoperative period.

The goal of perioperative euvolemia can be achieved with the ongoing evolution and application of ERAS principles. A focus on the pre and postoperative phases of fluid management and a pragmatic approach to intraoperative fluid management negates the need for goal-directed fluid therapy in most cases.
Innovative designs for trials informing the care of cardiac surgical patients: part I
Authors: Anusic Nikola , Sessler Daniel I.
Published: December 2023

Purpose of review

Randomized clinical trials, now commonplace and regarded as top-tier evidence, are actually a recent development. The first randomized trial took place in 1948, just six decades ago. As anticipated from a relatively young field, rapid progress continues in response to an ever-increasing number of medical questions that demand answers. We examine evolving methodologies in cardiac anesthesia clinical trials, focusing on the transition towards larger sample sizes, increasing use of pragmatic trial designs, and the innovative adoption of real-time automated enrollment and randomization. We highlight how these changes enhance the reliability and feasibility of clinical trials.

Recent findings

Recent understanding in clinical trial methodology acknowledges the importance of large sample sizes, which increase the reliability of findings. As illustrated by P value fragility, small trials can mislead despite statistical significance. Pragmatic trials have gained prominence, offering real-world insights into the effectiveness of various treatments. Additionally, the use of real-time automated enrollment and randomization, particularly in situations where obtaining prior consent is impractical, is an important methodological advance.

The landscape of cardiac anesthesia clinical trials is rapidly evolving, with a clear trend towards large sample sizes and innovative approaches to enrollment. Recent developments enhance the quality and applicability of research findings, thus providing robust guidance to clinicians.
A decade-long analysis of gender, race, and ethnic representation of incoming cardiothoracic anesthesiology fellows
Authors: Sesi Jenna M. , Mansour Meghan R. , Soto Roy G.
Published: December 2023

Purpose of review

This study calls attention to the necessity for increasing representation of minority groups among cardiothoracic fellowship programs.

Recent findings

Demographics in medicine are changing, with more women and varying ethnicities contributing to the physician pool. Despite this change, diversity among cardiothoracic anesthesia fellows has not mirrored this trend.

In November of 2022, medical student, anesthesia resident and cardiothoracic fellow demographics were analyzed from 2011 to 2021 to assess the changes in program diversity. Although male and female individuals have relatively similar representation in medical schools, female individuals only represent 34.8% of total US anesthesia residents. Cardiothoracic anesthesia fellowship programs continue to be male-sex dominant and white racial representation has consistently made up a majority of the total trainees. Increasing diversity amongst healthcare providers increases the likelihood of providing culturally competent care, thereby decreasing the healthcare gap in minority communities.
Blood-brain Barrier Permeability May Influence Vasopressor Effects in Anesthetized Patients With Brain Tumor: An Analysis of Magnetic Resonance Imaging Data
Authors: Rasmussen Mads , Koch Klaus U. , Espelund Ulrick S. , Mohamad Niwar , Korshøj Anders R. , Juul Niels , Angleys Hugo , Meng Lingzhong , Østergaard Leif , Mikkelsen Irene K.
Published: December 2023

Objective:

This is a secondary analysis of data from a previous study of anesthetized brain tumor patients receiving ephedrine or phenylephrine infusions. 18 patients with magnetic imaging verified tumor contrast enhancement were included. We hypothesized that vasopressors induce microcirculatory flow changes, characterized by increased capillary transit time heterogeneity (CTH) and decreased mean transit time (MTT), in brain regions exhibiting BBB leakage.

Methods:

This is a secondary analysis of data from a previous study of anesthetized brain tumor patients receiving ephedrine or phenylephrine infusions. 18 patients with magnetic imaging verified tumor contrast enhancement were included. Postvasopressor to prevasopressor ratios of CTH, MTT, relative transit time heterogeneity (RTH), cerebral blood flow (CBF), cerebral blood volume, and oxygen extraction fraction (OEF) were calculated in tumor, peritumoral, hippocampal, and contralateral grey matter regions. Comparisons were made between brain regions and vasopressors.

Results:

During phenylephrine infusion, ratios of CTH, RTH, and CBF were greater, and ratios of MTT and OEF were lower, in the tumor region with contrast leakage compared with corresponding contralateral grey matter ratios. During ephedrine infusion, ratios of CTH, MTT, RTH, CBF, and cerebral blood volume were higher in the tumor region with leakage compared with contralateral grey matter ratios. In addition, the ratio of CBF was higher in all regions, the ratio of RTH was lower in the leaking tumor region, and the ratio of OEF was lower in peritumoral, hippocampal, and grey matter regions with ephedrine compared with phenylephrine.

Conclusions:

Vasopressors can induce distinct microcirculatory flow alterations in regions with compromised brain tumor barrier or BBB. Ephedrine, a combined α and β-adrenergic agonist, appears to result in fewer flow alterations and less impact on tissue oxygenation compared with phenylephrine, a pure α-adrenergic agonist.