bluuebunny/crossref_metadata_2025 huggingface dataset:
Insight into the Eyring–Powell fluid flow model using degenerate operator: geometric perturbation
Authors: ur Rahman Saeed , Luis Díaz Palencia José
Published: October 2023

This work provides a formulation of a fluid flow under a nonlinear diffusion based on a viscosity of Eyring–Powell type along with a degenerate semi-parabolic operator. The introduction of such a degenerate operator is significant as it allows us to explore a further general model not previously considered in the literature. Our aims are hence to provide analytical insights and numerical assessments to the mentioned flow model: firstly, some results are provided in connection with the regularity and uniqueness of weak solutions. The problem is converted into the travelling wave domain where solutions are obtained within an asymptotic expansion supported by the geometric perturbation theory. Finally, a numerical process is considered as the basis to ensure the validity of the analytical assessments presented. Such numerical process is performed for low Reynolds numbers given in classical porous media. As a main finding to highlight: we show that there exist exponential profiles of solutions for the velocity component. This result is not trivial for the non-linear viscosity terms considered.
Effect of sintering conditions on colossal dielectric properties of (Tb1/2Nb1/2)0.01Ti0.99O2ceramics
Authors: Thanamoon Noppakorn , Thongbai Prasit
Published: October 2023

In this study, we investigated various sintering temperatures (1200 °C−1450 °C) and durations (2–6 h) conditions for preparing (Tb1/2Nb1/2)0.01Ti0.99O2(TNTO) ceramics. By employing high sintering temperatures (≥1350 °C) and extended sintering durations (≥4 h), we successfully achieved ultra–high dielectric permittivity values (ε′ ∼ 2.2 − 4.1 × 104) and remarkably low loss tangent values (∼0.025−0.079). Remarkably, the temperature coefficient of the TNTO ceramic, sintered at 1350 °C, exhibited exceptional stability, maintaining a value of approximately 15% even at 200 °C. Additionally, we examined the phase structure and microstructure of the TNTO ceramics to gain insights into their colossal permittivity (CP) behavior. The analysis revealed the presence of rutile TiO2and TbNbTiO6phases, and the ceramics exhibited a high–density microstructure under high–temperature sintering conditions. The impedance spectroscopy analysis revealed that the primary contributor to the observed CP behavior was the interfacial polarization mechanism. The observed increase in theε′ value, correlated with the enlargement of the average grain size, can be attributed to the effect of the internal barrier layer capacitor. However, when the sintering time ≥4 h, the grain size did not significantly affect theε′ value, possibly due to reaching the maximum capacity of electron production for the interfacial polarization process (i.e., the maximum intensity of polarizability). This study provides valuable insights into optimizing the sintering conditions for TNTO ceramics and related compounds, laying the groundwork for the development of a new CP oxide suitable for practical applications.
Specialization of integral closure of ideals by general elements
Authors: Hill Lindsey , Lynn Rachel
Published: October 2023

In this paper, we prove a result similar to results of Itoh [J. Algebra 150 (1992), pp. 101–117] and Hong-Ulrich [J. Lond. Math. Soc. (2) 90 (2014), pp. 861–878], proving that integral closure of an ideal is compatible with specialization by a general element of that ideal for ideals of height at least two in a large class of rings. Moreover, we show integral closure of sufficiently large powers of the ideal is compatible with specialization by a general element of the original ideal. In a polynomial ring over an infinite field, we give a class of squarefree monomial ideals for which the integral closure is compatible with specialization by a general linear form.
Automated prediction of acute promyelocytic leukemia from flow cytometry data using a graph neural network pipeline
Authors: Cox Andrew M , Kim Daehwan , García Rolando , Fuda Franklin S , Weinberg Olga K , Chen Weina
Published: October 2023

Objectives

Our study aimed to develop a machine learning (ML) model to accurately classify acute promyelocytic leukemia (APL) from other types of acute myeloid leukemia (other AML) using multicolor flow cytometry (MFC) data. Multicolor flow cytometry is used to determine immunophenotypes that serve as disease signatures for diagnosis.

Methods

We used a data set of MFC files from 27 patients with APL and 41 patients with other AML, including those with uncommon immunophenotypes. Our ML pipeline involved training a graph neural network (GNN) to output graph-level labels and identifying the most crucial MFC parameters and cells for predictions using an input perturbation method.

Results

The top-performing GNN achieved 100% accuracy on the training/validation and test sets on classifying APL from other AML and used MFC parameters similarly to expert pathologists. Pipeline performance is amenable to use in a clinical decision support system, and our deep learning architecture readily enables prediction explanations.

Conclusions

Our ML pipeline shows robust performance on predicting APL and could be used to screen for APL using MFC data. It also allowed for intuitive interrogation of the model’s predictions by clinicians.
Understanding clinical implementation coordinators’ experiences in deploying evidence-based interventions
Authors: Hernandez Sara E , Solomon Demetrius , Moon Jukrin , Parmasad Vishala , Wiegmann Douglas , Bennett Nick T , Ferren Ryan S , Fitzsimmons Alec J , Lepak Alexander J , O’Horo John C , Pop-Vicas Aurora E , Schulz Lucas T , Safdar Nasia
Published: October 2023

Purpose

The fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial is a multisite clinical study in which sites carry out a preauthorization process via electronic health record–based best-practice alert (BPA) to optimize the use of fluoroquinolone antibiotics in acute care settings. Our research team worked closely with clinical implementation coordinators to facilitate the dissemination and implementation of this evidence-based intervention. Clinical implementation coordinators within the antibiotic stewardship team (AST) played a pivotal role in the implementation process; however, considerable research is needed to further understand their role. In this study, we aimed to (1) describe the roles and responsibilities of clinical implementation coordinators within ASTs and (2) identify facilitators and barriers coordinators experienced within the implementation process.

Methods

We conducted a directed content analysis of semistructured interviews, implementation diaries, and check-in meetings utilizing the conceptual framework of middle managers’ roles in innovation implementation in healthcare from Urquhart et al.

Results

Clinical implementation coordinators performed a variety of roles vital to the implementation’s success, including gathering and compiling information for BPA design, preparing staff, organizing meetings, connecting relevant stakeholders, evaluating clinical efficacy, and participating in the innovation as clinicians. Coordinators identified organizational staffing models and COVID-19 interruptions as the main barriers. Facilitators included AST empowerment, positive relationships with staff and oversight/governance committees, and using diverse implementation strategies.

Conclusion

When implementing healthcare innovations, clinical implementation coordinators facilitated the implementation process through their roles and responsibilities and acted as strategic partners in improving the adoption and sustainability of a fluoroquinolone preauthorization protocol.
Using Laser-Assisted Indocyanine Green Angiography to Assess Nipple-Areolar Complex Survival During Reduction Mammoplasty
Authors: Li Haoran , Zhang Xiaoyu , Li Zhengyao , Lin Yan , Mu Dali
Published: October 2023

Background

In reduction mammoplasty, preserving an appropriate skin flap is crucial to achieve a favorable postoperative appearance and prevent blood supply disorders in the nipple-areolar complex (NAC). Previous studies have indicated that a thinner or narrower flap is more favorable for breast shaping, but also increases the risk of blood supply disorders. Accessing the blood perfusion of the NAC and determining the critical threshold for NAC viability are essential aspects of reduction mammoplasty.

Objectives

The aim of this study was to utilize indocyanine green (ICG) angiography to assess NAC perfusion during reduction mammoplasty. It also sought to identify critical thresholds of various indicators affecting NAC survival and provide guidance for skin flap trimming.

Methods

Thirty-eight patients who underwent reduction mammoplasty were included. Each patient received ICG angiography before and after skin flap trimming. Data on NAC perfusion, skin flap length, width, thickness, and other relevant indicators were collected.

Results

Among the patients, 5 experienced NAC blood supply disorders. Multiple linear regression analysis demonstrated that the NAC blood supply had a significant correlation with the tissue thickness at the pedicle base (P < .001) and with the length-to-width ratio across the nipple (P < .05). To optimize NAC survival and achieve favorable breast shaping, cutoff points for the thickness at the pedicle base and the length-to-width ratio across the nipple of 1.15 cm and 1.71, respectively, were established.

Conclusions

ICG angiography provides an effective means to assess NAC blood supply and postoperative survival. The cutoff points established in this study help to predict the survival of the NAC and guide flap trimming.

Level of Evidence: 3
GNorm2: an improved gene name recognition and normalization system
Authors: Wei Chih-Hsuan , Luo Ling , Islamaj Rezarta , Lai Po-Ting , Lu Zhiyong
Published: October 2023

Motivation

Gene name normalization is an important yet highly complex task in biomedical text mining research, as gene names can be highly ambiguous and may refer to different genes in different species or share similar names with other bioconcepts. This poses a challenge for accurately identifying and linking gene mentions to their corresponding entries in databases such as NCBI Gene or UniProt. While there has been a body of literature on the gene normalization task, few have addressed all of these challenges or make their solutions publicly available to the scientific community.

Results

Building on the success of GNormPlus, we have created GNorm2: a more advanced tool with optimized functions and improved performance. GNorm2 integrates a range of advanced deep learning-based methods, resulting in the highest levels of accuracy and efficiency for gene recognition and normalization to date. Our tool is freely available for download.

Availability and implementation

https://github.com/ncbi/GNorm2.
Hunting down zinc(II)-binding sites in proteins with distance matrices
Authors: Laveglia Vincenzo , Bazayeva Milana , Andreini Claudia , Rosato Antonio
Published: October 2023

Motivation

In recent years, high-throughput sequencing technologies have made available the genome sequences of a huge variety of organisms. However, the functional annotation of the encoded proteins often still relies on low-throughput and costly experimental studies. Bioinformatics approaches offer a promising alternative to accelerate this process. In this work, we focus on the binding of zinc(II) ions, which is needed for 5%–10% of any organism’s proteins to achieve their physiologically relevant form.

Results

To implement a predictor of zinc(II)-binding sites in the 3D structures of proteins, we used a neural network, followed by a filter of the network output against the local structure of all known sites. The latter was implemented as a function comparing the distance matrices of the Cα and Cβ atoms of the sites. We called the resulting tool Master of Metals (MOM). The structural models for the entire proteome of an organism generated by AlphaFold can be used as input to our tool in order to achieve annotation at the whole organism level within a few hours. To demonstrate this, we applied MOM to the yeast proteome, obtaining a precision of about 76%, based on data for homologous proteins.

Availability and implementation

Master of Metals has been implemented in Python and is available at https://github.com/cerm-cirmmp/Master-of-metals.
Metformin in elderly type 2 diabetes mellitus: dose-dependent dementia risk reduction
Authors: Sun Mingyang , Chen Wan-Ming , Wu Szu-Yuan , Zhang Jiaqiang
Published: October 2023

This study aimed to investigate the controversial association between metformin use and diabetes-associated dementia in elderly patients with type 2 diabetes mellitus (T2DM) and evaluate the potential protective effects of metformin, as well as its intensity of use and dose-dependency, against dementia in this population.

The study used a time-dependent Cox hazards model to evaluate the effect of metformin use on the incidence of dementia. The case group included elderly patients with T2DM (≥60 years old) who received metformin, while the control group consisted of elderly patients with T2DM who did not receive metformin during the follow-up period.

Our analysis revealed a significant reduction in the risk of dementia among elderly individuals using metformin, with an adjusted hazard ratio of 0.34 (95% confidence interval: 0.33 to 0.36). Notably, metformin users with a daily intensity of 1 defined daily dose (DDD) or higher had a lower risk of dementia, with an adjusted hazard ratio (95% confidence interval) of 0.46 (0.22 to 0.6), compared to those with a daily intensity of <1 DDD. Additionally, the analysis of cumulative DDDs of metformin showed a dose-response relationship, with progressively lower adjusted hazard ratio across quartiles (0.15, 0.21, 0.28, and 0.53 for quartiles 4, 3, 2 and 1, respectively), compared to never metformin users (P for trend < 0.0001).

Metformin use in elderly patients with T2DM is significantly associated with a substantial reduction in the risk of dementia. Notably, the protective effect of metformin demonstrates a dose-dependent relationship, with higher daily and cumulative dosages of metformin showing a greater risk reduction.
“But I Am Afflicted” Attending to Persons in Pain and Modern Health Care
Authors: Barton Sarah Jean , McCarty Brett
Published: October 2023

Over one in five adults in the United States and around the world are estimated to live with chronic pain. How are we to attend well to persons living with pain? This is a difficult, pressing question for both healthcare institutions and Christian communities, and it is only made more complex both by the contemporary opioid crisis and by how experiences of pain and addiction are shaped in the American context by race, gender, and class. Attending faithfully to persons in pain demands thoughtful, creative resources on both practical and conceptual levels. In this special issue of Christian Bioethics, eight scholars from different disciplines—Sarah Barton, Farr Curlin, Jaime Konerman-Sease, Brett McCarty, Joel Shuman, Devan Stahl, John Swinton, and Emmy Yang—engage the meaning of attending to persons in pain for Christian bioethics and for faithful Christian practice.
Olfaction and declarative memory in aging: a meta-analysis
Authors: Jobin Benoît , Roy-Côté Frédérique , Frasnelli Johannes , Boller Benjamin
Published: October 2023

Olfactory and declarative memory performances are associated, as both functions are processed by overlapping medial-temporal and prefrontal structures and decline in older adults. While a decline in olfactory identification may be related to a decline in declarative memory, the relationship between olfactory detection threshold and declarative memory remains unclear. In this meta-analysis, we assessed (i) the relationship between olfactory identification/detection threshold and verbal declarative memory in cognitively normal older adults, and (ii) the effect of age on these relationships. We included articles from PsychNet, PubMed, and Academic Search Complete according to the following criteria: (i) inclusion of cognitively normal older adults; (ii) assessment of episodic or semantic memory; and (iii) assessment of olfactory identification or detection threshold. Seventeen studies and 22 effect sizes were eligible and included in this meta-analysis. Olfactory identification was associated with episodic (small effect size: r = 0.19; k = 22) and semantic memory (small effect size: r = 0.16; k = 23). Similarly, the olfactory detection threshold was associated with both episodic (small to medium effect size: r = 0.25; k = 5) and semantic memory (small effect size: r = 0.17; k = 7). Age was found to moderate the relationship between olfactory detection threshold and memory performance. Both olfactory identification and detection threshold performances are associated with declarative memory in older adults, and age only moderates the relationship between olfactory detection threshold and declarative memory performances.
US Guidelines Fall Short on Short-Course Tuberculosis-Preventive Therapy
Authors: Krishnan Sonya , Chaisson Richard E
Published: October 2023

The provision of tuberculosis-preventive therapy (TPT) to vulnerable populations is critical for global control. Shorter-course TPT regimens are highly effective and improve completion rates. Despite incorporation of 1 month of rifapentine and isoniazid into global guidelines, current US TPT guidelines do not include this as a recommended regimen, but should.
Outcomes of SARS-CoV-2 Omicron Variant Infections Compared With Seasonal Influenza and Respiratory Syncytial Virus Infections in Adults Attending the Emergency Department: A Multicenter Cohort Study
Authors: Hedberg Pontus , Karlsson Valik John , Abdel-Halim Lina , Alfvén Tobias , Nauclér Pontus
Published: October 2023

Background

There is a controversy over the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in an era of less virulent variants and an increasing population immunity. We compared outcomes in adults attending the emergency department (ED) with an Omicron, influenza, or respiratory syncytial virus (RSV) infection.

Methods

Retrospective multicenter cohort study including adults attending the ED in 6 acute care hospitals in Stockholm County, Sweden, with an Omicron, influenza, or RSV infection during 2021–2022 and 2015–2019. During 2021–2022, patients were tested for all 3 viruses by multiplex polymerase chain reaction (PCR) testing. The primary outcome was 30-day all-cause mortality. Secondary outcomes were 90-day all-cause mortality, hospitalization, and intensive care unit (ICU) admission.

Results

A total of 6385 patients from 2021–2022 were included in the main analyses: 4833 Omicron, 1099 influenza, and 453 RSV. The 30-day mortality was 7.9% (n = 381) in the Omicron, 2.5% (n = 28) in the influenza, and 6.0% (n = 27) in the RSV cohort. Patients with Omicron had an adjusted 30-day mortality odds ratio (OR) of 2.36 (95% confidence interval [CI] 1.60–3.62) compared with influenza and 1.42 (95% CI .94–2.21) compared with RSV. Among unvaccinated Omicron patients, stronger associations were observed compared with both influenza (OR 5.51 [95% CI 3.41–9.18]) and RSV (OR 3.29 [95% CI 2.01–5.56]). Similar trends were observed for secondary outcomes. Findings were consistent in comparisons with 5709 pre-pandemic influenza 995 RSV patients.

Conclusions

In patients attending the ED, infections with Omicron were both more common and associated with more severe outcomes compared with influenza and RSV, in particular among unvaccinated patients.
Efficacy of pharmacological and interventional treatment for resistant hypertension: a network meta-analysis
Authors: Tian Zhejia , Vollmer Barbosa Clara , Lang Hannah , Bauersachs Johann , Melk Anette , Schmidt Bernhard M W
Published: October 2023

Aims

Resistant hypertension is associated with a high risk of cardiovascular disease, chronic kidney disease, and mortality. Yet, its management is challenging. This study aims to establish the comparative effectiveness of pharmacologic and interventional treatments by conducting a network meta-analysis.

Methods and results

MEDLINE, Cochrane Register of Controlled Trials, and Web of Science Core Collection were systematically searched in March 2022. Randomized controlled trials comparing treatment options for management of resistant hypertension were included. Outcomes were blood pressure (BP) changes, measured in the office and in 24 h ambulatory BP measurement. We applied a frequentist random effects model to perform a network meta-analysis combining placebo medication and sham procedure as the reference comparator. From 4771 records, 24 studies met the inclusion criteria with 3458 included patients in total. Twelve active treatment alternatives [spironolactone, doxazosin, β-blocker, clonidine, darusentan, guanfacine, various types of renal sympathetic denervation, lifestyle intervention, continuous positive airway pressure, and baroreflex activation therapy (BAT)] were analysed. Among all comparators, spironolactone had the highest ranking probability and was considered the most effective treatment to reduce office systolic blood pressure (sBP) [−13.30 mmHg (−17.89; −8.72); P < 0.0001] and 24 h sBP [−8.46 mmHg (−12.54; −4.38); P < 0.0001] in patients with resistant hypertension. Lifestyle interventions were the most effective non-pharmacological treatment, lowering office sBP by −7.26 mmHg (−13.73; −0.8), whereas BAT lowered office sBP by −7.0 (−18.59; 4.59). Renal denervation lowered office sBP by −5.64 mmHg (−12.95; 1.66) and −3.79 mmHg (−11.39; 3.8) depending on the type of the procedure.

Conclusion

Among all pharmacologic and interventional treatments, spironolactone is the most effective treatment in reducing BP in patients with resistant hypertension. More comparative trials and especially trials with long-term follow-up are needed. In the meanwhile, we have to conclude that a combination of spironolactone and lifestyle modification are the most effective treatments in resistant hypertension.
Ozanimod-exposed Patients with Ulcerative Colitis Undergoing Total Colectomy Exhibit Unique Lymph Node Histological Changes
Authors: Cohen Nathaniel A , Weber Christopher R , Cheng Jason X , Choi David , Garcia Nicole M , Choi Natalie K , Rubin David T
Published: October 2023

Introduction

Ozanimod regulates lymphocyte egress from the spleen and lymph nodes into the systemic circulation. The histological changes which occur in the lymph nodes of patients on ozanimod is unknown.

Materials and Methods

This retrospective study included patients with ulcerative colitis [UC] undergoing total colectomy for treatment-refractory disease who received ozanimod, and a cohort of patients with UC undergoing colectomy who did not have ozanimod exposure. Histology of the lymph nodes from the mesentery of colectomy specimens was reviewed and multiple features were scored by experienced pathologists.

Results

Six [13%] ozanimod-treated patients with UC required surgery for treatment-refractory disease. Colectomy specimen data were available for five patients [one patient had surgery at an outside centre]. Lymph node specimens from six control patients with UC who had colectomy were examined. Histological examination of lymph nodes showed that patients treated with ozanimod had significantly greater extent of dilated sinuses [p = 0.03] and greater degrees of sinus histiocytosis [p = 0.03] compared with control patients. In addition, there was a trend towards more Castleman-like angiotrophic hyperplasia, plasma cell infiltration, and subcortical interfollicular expansion in ozanimod-treated patients.

Conclusion

This study identifies unique histological changes in the lymph nodes of patients with UC treated with ozanimod. The presence of sinus histiocytosis and dilated sinuses is in keeping with the known mechanism of action of ozanimod, and suggests that blocking lymphocyte egression from lymph nodes was insufficient to ameliorate disease severity in these patients. The possibility of Castleman-like features, identified in several of the cases, needs to be further investigated.
The ISCHEMIA trial revisited: setting the record straight on the benefits of coronary bypass surgery and the misinterpretation of a landmark trial
Authors: Gomes Walter J , Marin-Cuartas Mateo , Bakaeen Faisal , Sádaba J Rafael , Dayan Victor , Almeida Rui , Parolari Alessandro , Myers Patrick O , Borger Michael A
Published: October 2023

OBJECTIVES

The ISCHEMIA trial is a landmark study that has been the subject of heated debate within the cardiovascular community. In this analysis of the ISCHEMIA trial, we aim to set the record straight on the benefits of coronary artery bypass grafting (CABG) and the misinterpretation of this landmark trial. We sought to clarify and reorient this misinterpretation.

METHODS

We herein analyse the ISCHEMIA trial in detail and describe how its misinterpretation has led to an erroneous guideline recommendation downgrading for prognosis-altering surgical therapy in these at-risk patients.

RESULTS

The interim ISCHEMIA trial findings align with previous evidence where CABG reduces the long-term risks of myocardial infarction and mortality in advanced coronary artery disease. The trial outcomes of a significantly lower rate of cardiovascular mortality and a higher rate of non-cardiovascular mortality with the invasive strategy are explained according to landmark evidence.

CONCLUSIONS

The ISCHEMIA trial findings are aligned with previous evidence and should not be used to downgrade recommendations in recent guidelines for the indisputable benefits of CABG.
Cultural capital, network resources, and occupational attainment: a panel study on the intragenerational conversion of cultural resources
Authors: Meuleman Roza , Kraaykamp Gerbert
Published: October 2023

Adding to a growing body of research, this study examines the intragenerational conversion of cultural capital into occupational attainment. More specifically, we argue that cultural and economic network resources constitute an important—yet understudied—explanation for why individuals’ cultural capital yields returns in the labour market. To test our expectations, we collected unique panel data in the Netherlands with information on individuals’ cultural capital (i.e. highbrow participation), offline core, and extended networks, and occupational outcomes. In line with theoretical notions of communicating cultural match, signalling competencies, and enhancing emotional returns, our results show that cultural capital is positively associated with a higher overall occupational position. Besides, individuals’ access to network resources largely explains the association between cultural capital and a higher occupational position. Interestingly, cultural resources in the extended network play a more important role than economic network resources in the conversion of cultural capital into a higher cultural occupational position. Conversely, economic core network resources are more important than cultural core network resources in the conversion of cultural capital into a higher economic occupational position. Our study thus provides strong support for the idea that the conversion of cultural capital into occupational returns, via social capital, is field-specific.
Estimated number of reported vaccine-preventable disease cases averted following the introduction of routine vaccination programs in Sweden, 1910–2019
Authors: Martin Leah J , Galanis Ilias , Lepp Tiia , Lindstrand Ann
Published: October 2023

Background

Routine childhood vaccination programs have had enormous positive public health impacts worldwide. However, in some areas, these benefits may be impeded by vaccine hesitancy and undervaccination. We estimated the number of reported cases of measles, pertussis, mumps and poliomyelitis averted in Sweden after the introduction of routine childhood vaccination programs.

Methods

We used annual national data on population size and the number of reported cases of measles (1911–2019), pertussis (1911–2019), mumps (1914–2019) and poliomyelitis (1910–2019) for Sweden. For each disease, we calculated the median and 95% confidence interval of the annual pre-vaccination incidence to estimate the number of counterfactual cases; that is, the estimated number of cases that would have been observed in the post-vaccination period had no vaccine been introduced (median incidence × average annual population). For the post-vaccination periods, we calculated reported cases averted and assumed all decreases were due to vaccines.

Results

In total, for all four diseases combined, over 2.1 million cases were reported over the respective surveillance periods. Since the introduction of vaccinations, we estimate that over 1.5 million reported cases of these four diseases combined have been averted: measles (633 091), pertussis (608 670), mumps (262 951) and poliomyelitis (58 240). However, due to underreporting, especially during pre-vaccination years, these are likely underestimates.

Conclusions

Since the introduction of these routine childhood vaccination programs in Sweden, a substantial number of reported cases of vaccine-preventable diseases have been averted. Vigilance against both failure to vaccinate and undervaccination is necessary to prevent future increases of these vaccine-preventable diseases.
Social inequalities in the risk of giving birth to a small for gestational age child in Sweden 2010–16: a cross-sectional study adopting an intersectional approach
Authors: Axelsson Fisk Sten , Alex-Petersen Jesper , Rostila Mikael , Liu Can , Juárez Sol Pia
Published: October 2023

Background

Well-established associations exist between the risk of small for gestational age (SGA) and unidimensional sociodemographic factors. We investigated social inequalities in SGA risk and adopted an intersectional approach that simultaneously considers different social categories. By doing so, we could assess heterogeneities in SGA risk within unidimensional sociodemographic categories.

Methods

We included all live 679 694 singleton births in Sweden between 2010 and 2016. The outcome was SGA, and the exposures were age, maternal educational level, dichotomous migration status and civil status. Thirty-six possible combinations of these factors constituted the exposure in an intersectional model. We present odds ratios (ORs) with 95% confidence intervals (95% CIs) and the area under the receiver operating characteristic curve (AUC)—a measurement of discriminatory accuracy (i.e. the ability to discriminate the babies born SGA from those who are not).

Results

Women with low education and women born outside Sweden had ORs of 1.46 (95% CI 1.38–1.54) and 1.50 (95% CI 1.43–1.56) in unidimensional analyses, respectively. Among women aged under 25 with low education who were born outside Sweden and unmarried, the highest OR was 3.06 (2.59–3.63). The discriminatory accuracy was low for both the unidimensional model that included all sociodemographic factors (AUC 0. 563) and the intersectional model (AUC 0.571).

Conclusions

The intersectional approach revealed a complex sociodemographic pattern of SGA risk. Sociodemographic factors have a low accuracy in identifying SGA at the individual level, even when quantifying their multi-dimensional intersections. This cautions against interventions targeted to individuals belonging to socially defined groups to reduce social inequalities in SGA risk.
Measurement of treatment burden in patients with multimorbidity in the Netherlands: translation and validation of the Multimorbidity Treatment Burden Questionnaire (NL-MTBQ)
Authors: Engels Loes W S , van Merode Tiny , Heijmans Monique , Menting Juliane , Duncan Polly , Rademakers Jany
Published: October 2023

Background

Multimorbidity is a growing problem. The number and complexity of (non-)pharmaceutical treatments create a great burden for patients. Treatment burden refers to the perception of the weight of these treatments, and is associated with multimorbidity. Measurement of treatment burden is of great value for optimizing treatment and health-related outcomes.

Objective

We aim to translate and validate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for use in the Dutch population with multimorbidity and explore the level of treatment burden.

Methods

Translating the MTBQ into Dutch included forward–backward translation, piloting, and cognitive interviewing (n = 8). Psychometric properties of the questionnaire were assessed in a cross-sectional study of patients with multimorbidity recruited from a panel in the Netherlands (n = 959). We examined item properties, dimensionality, internal consistency reliability, and construct validity. The level of treatment burden in the population was assessed.

Results

The mean age among 959 participants with multimorbidity was 69.9 (17–96) years. Median global NL-MTBQ score was 3.85 (interquartile range 0–9.62), representing low treatment burden. Significant floor effects were found for all 13 items of the instrument. Factor analysis supported a single-factor structure. The NL-MTBQ had high internal consistency (α = 0.845), and provided good evidence on the construct validity of the scale.

Conclusion

The Dutch version of the 13-item MTBQ is a single-structured, valid, and compact patient-reported outcome measure to assess treatment burden in primary care patients with multimorbidity. It could identify patients experiencing high treatment burden, with great potential to enhance shared decision-making and offer additional support.
Aeromonas hydrophila infection in tilapia triggers changes in the microbiota composition of fish internal organs
Authors: Ofek Tamir , Izhaki Ido , Halpern Malka
Published: October 2023

Aeromonas hydrophila is a major pathogenic species that causes mass mortality in various freshwater fish species including hybrid tilapia, the main fish species in Israeli aquaculture. Our hypothesis was that A. hydrophila infection may cause changes in the microbiota composition of fish internal organs, and therefore we aimed to study the effect of A. hydrophila infection by injection or by net handling on the microbiota compositions of fish intestine, spleen, and liver. Significant differences in the microbiota composition were found between the internal organs of the diseased and the healthy fish in both experimental setups. Fusobacteriota was the most dominant phylum in the microbiota of healthy fish (∼70%, liver). Cetobacterium was the most abundant genus and relatively more abundant in healthy, compared to diseased fish. When A. hydrophila was inoculated by injection, it was the only pathogenic genus in the spleen and liver of the diseased fish. However, in the handling experiment, Vibrio was also detected in the diseased fish, demonstrating coinfection interactions. Based on these experiments, we conclude that indeed, A. hydrophila infection in tilapia causes changes in the microbiota composition of fish internal organs, and that fish net handling may trigger bacterial infection in freshwater aquaculture.
Associations Between Blood Nutritional Biomarkers and Cerebral Amyloid-β: Insights From the COGFRAIL Cohort Study
Authors: Grande de França Natasha A , Díaz Gustavo , Lengelé Laetitia , Soriano Gaëlle , Caspar-Bauguil Sylvie , Saint-Aubert Laure , Payoux Pierre , Rouch Laure , Vellas Bruno , de Souto Barreto Philipe , Sourdet Sandrine
Published: October 2023

Understanding the relationship between blood nutrients and neurodegeneration could contribute to devising strategies for preventing Alzheimer’s disease. We investigated the associations between fatty acids, vitamins D, B6, B12, folate, homocysteine, and the cerebral load of amyloid β (Aβ). This cross-sectional study included 177 older adults (70–96 years, 65% female) with objective cognitive impairment, prefrail, or frail. Cerebral Aβ load was determined using positron emission tomography Standardized Uptake Value ratios. Fatty acids were assessed in erythrocytes, vitamins D and homocysteine in serum, and the other vitamins in plasma. Linear regression models corrected for multiple comparisons evaluated the associations between each nutrient and Aβ. The principal component factor followed by linear regression grouped the fatty acids strongly correlated (factor) and associated with Aβ. Higher concentrations of polyunsaturated fatty acids (PUFAs): clupanodonic acid (22:5n-3; β: −0.13; p = .001), mead acid (20:3n-9; β: −0.07; p = .036), and adrenic acid (22:4n-6; β: −0.05; p = .031) were associated with lower global Aβ load, whereas linoleic acid (18:2n-6) was associated with higher global Aβ load (β: 0.18; p = .042). Clupanodonic acid was inversely associated with Aβ in all cerebral regions except the thalamus. The factor composed of mead, clupanodonic, and arachidonic (20:4n-6) acids was associated with a lower global Aβ load (β: −0.02; p = .002). Some erythrocyte PUFAs were inversely associated with Aβ load in the brain, and most of them were metabolites of the essential fatty acids linoleic and α-linolenic. Given the cross-sectional design, these results must be carefully interpreted, and longitudinal studies are needed.
Quality of Relationships and Caregiver Burden: A Longitudinal Study of Caregivers for Advanced Cancer Patients
Authors: Sun Rongjun , Francis Linda E
Published: October 2023

Objectives

In a longitudinal design, this study investigates the role of the quality of relationships in the well-being of caregivers for a family member with advanced cancer, specifically, the quality of relations among family members and the caregiver’s commitment to caregiving. Following the stress process model, good quality of relations and caregiver’s high commitment should be resources mitigating caregiver burden, even though overinvestment in the caregiver role may lead to the opposite outcome.

Methods

Data were drawn from a longitudinal study of 336 caregivers of advanced cancer patients in an urban community, who were interviewed shortly after patient diagnosis and again 3 months later. Caregiver burden is measured by 4 subscales (17 items) of the Caregiver Reaction Assessment. We used a random-effect model to investigate the association between caregiver burden and the 2 focused contributing factors—caregiver commitment and family relationship quality—when other covariates were controlled. A fixed-effect model then examines the association between the changes in caregiver burden and related time-varying factors, including caregiver commitment, when family relationship quality was used as a moderator.

Results

Both the random and fixed-effect models consistently show that a cancer caregiver’s positive commitment to the patient reduces caregiver burden, and family relationship quality provides an overall moderating influence that reduces the felt burden.

Discussion

The quality of relations between the caregiver and patient and with others in the family network is critical in understanding caregiver burden in advanced cancer and should be viewed as part of long-term family dynamics.
Community-Engaged Research With Latino Dementia Caregivers: Overcoming Challenges in Community Advisory Board Development
Authors: Quiñones Maria M , Sörensen Silvia , Hepburn Kenneth , Capellan Jahaira , Heffner Kathi L
Published: October 2023

Background and Objectives

Latinos caring for a person with Alzheimer’s disease and related dementias (ADRD) have the highest prevalence of caregiving. Yet, they are less likely to benefit from evidence-based interventions given their continued underrepresentation in ADRD-related research. Community advisory boards (CABs) have the potential to address barriers to research for underrepresented communities; however, there are complexities to establishing and sustaining CABs. This article describes how our work addressed challenges in CABs related to unbalanced power relations, language barriers, the value of time, and low research knowledge and health literacy.

Research Design and Methods

Nine Latino CAB members, including older Latino caregivers, were trained in a comprehensive program designed to increase knowledge about health research methods and ethics, cognitive health, and cultural adaptation methods. Members completed pre- and post-training measures of Alzheimer’s disease knowledge, attitudes, and beliefs toward research, and a satisfaction survey.

Results

Results from the satisfaction questionnaire indicated that the program was well received. CAB members increased their knowledge regarding the management of behavioral and psychological symptoms of dementia and dementia-associated risk factors and treatment. Positive changes in members’ attitudes toward research included increased willingness to participate in trials and subject protection measures.

Discussion and Implications

Formalized training in research conduct and ethics and health literacy is a promising strategy to reduce challenges in establishing and maintaining CABs and can also optimize CAB impact to address gaps in older Latino ADRD caregiving research.
Are Depression and Anxiety Underdiagnosed in Socially Vulnerable Patients With Inflammatory Bowel Disease?
Authors: Sheehan Jessica L , Jordan Ariel A , Newman Kira L , Johnson Laura A , Eloubeidi Dala , Cohen-Mekelburg Shirley , Berinstein Jeffrey A , Tipirneni Renuka , Higgins Peter D R
Published: October 2023

Introduction

Depression and anxiety are highly prevalent among individuals with inflammatory bowel disease (IBD); however, little is understood about how social determinants of health (SDOH) may impact mental health diagnoses in this population. The social vulnerability index (SVI) is a publicly available tool that can be used to study SDOH in IBD patients.

Methods

Home addresses from a retrospective cohort of IBD patients at a single center were used to geocode patients to their individual census tract and corresponding SVI. We used multivariable logistic regression to examine the relationship between SVI and comorbid mental health diagnoses in patients with IBD. Secondarily, data from standardized health questionnaires were then used to determine if patients were adequately screened for depression and anxiety.

Results

In all, 9644 patients were included; 18% had a diagnosis of depression, 21% anxiety, and 32% had a composite of “any mental health diagnosis.” Depression (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.02-1.56) but not anxiety (OR, 0.87; 95% CI, 0.71-1.06) nor “any mental health diagnosis” (OR, 1.09; 95% CI, 0.92-1.30) was associated with higher levels of social vulnerability. However, overall rates of screening for depression and anxiety were low (15% and 8%, respectively), with the lowest screening rates among the most socially vulnerable (depression 8.2%, anxiety 6.3%).

Conclusions

Disparities in the diagnoses of depression and anxiety for socially vulnerable patients with IBD exist. Awareness of these inequities is the first step toward developing interventions to improve mental health screening, eliminate barriers and bias, and promote referrals for appropriate mental health management.
NLRP3 inflammasome activation in sensory neurons promotes chronic inflammatory and osteoarthritis pain
Authors: Silva Santos Ribeiro Patrícia , Willemen Hanneke L D M , Versteeg Sabine , Martin Gil Christian , Eijkelkamp Niels
Published: October 2023

Pain is one of the most debilitating symptoms in rheumatic diseases. Pain often persists after total knee replacement in osteoarthritis, or when inflammation is minimal/absent in rheumatoid arthritis. This suggests that pain transitions to a chronic state independent of the original damage/inflammation. Mitochondrial dysfunction in the nervous system promotes chronic pain and is linked to NLRP3 inflammasome activation. Therefore, we investigated the role of mitochondrial dysfunction and NLRP3 inflammasome activation in the transition from acute to persistent inflammation-induced nociplastic pain and in persistent monoiodoacetate-induced osteoarthritis pain. Intraplantar injection of carrageenan in mice induced transient inflammatory pain that resolved within 7 days. A subsequent intraplantar PGE2 injection induced persistent mechanical hypersensitivity, while in naive mice it resolved within one day. Thus, this initial transient inflammation induced maladaptive nociceptor neuroplasticity, so-called hyperalgesic priming. At Day 7, when mice were primed, expression of NLRP3 inflammasome pathway components was increased, and dorsal root ganglia (DRG) neurons displayed signs of activated NLRP3 inflammasome. Inhibition of NLRP3 inflammasome with MCC950 prevented the transition from acute to chronic pain in this hyperalgesic priming model. In mice with persistent monoiodoacetate-induced osteoarthritis pain, DRG neurons displayed signs of mitochondrial oxidative stress and NLRP3 inflammasome activation. Blocking NLRP3 inflammasome activity attenuated established osteoarthritis pain. In males, NLPR3 inhibition had longer-lasting effects than in females. Overall, these data suggest that NLRP3 inflammasome activation in sensory neurons, potentially caused by neuronal oxidative stress, promotes development of persistent inflammatory and osteoarthritis pain. Therefore, targeting NLRP3 inflammasome pathway may be a promising approach to treat chronic pain.
The Gendered Peace Premium
Authors: Blair Christopher W , Schwartz Joshua A
Published: October 2023

The adage that “only Nixon could go to China” suggests hawkish leaders face fewer domestic political barriers to pursuing conciliation with foreign adversaries. Since hawks are viewed as less ideologically predisposed to peace than doves, their efforts at rapprochement are more likely to be perceived as in the national interest. We explore how this conventional wisdom intersects with prominent gender stereotypes about women’s role in national security. Do gender stereotypes that women are inclined toward peace make it more difficult for women leaders to pursue conciliation? In a series of survey experiments, we find evidence of a gendered peace premium—a penalty women leaders face for pursuing peace. When women leaders seek rapprochement with foreign adversaries, they are perceived as acting “according to type.” Consequently, women’s conciliatory policy proposals are viewed as less likely to be in the national interest than identical policies pursued by male leaders. Partisanship dynamics significantly moderate the gendered peace premium, and policy success can attenuate women leaders’ disadvantage. While this discriminatory dynamic does not make it impossible for women leaders to seek and achieve peace, it does make it more difficult and politically costly than some perspectives assume.