bluuebunny/crossref_metadata_2025 huggingface dataset:
Epitope-dependent effect of long-term cART on maintenance and recovery of HIV-1-specific CD8
+
T cells
Authors: Kuse Nozomi , Gatanaga Hiroyuki , Zhang Yu , Chikata Takayuki , Oka Shinichi , Takiguchi Masafumi
Published: October 2023

The frequency of HIV-1-specific T cells is reduced and their functional ability remains impaired in people living with HIV-1 (PLWH) under combined antiretroviral therapy (cART). However, no studies have yet reported on T-cell responses to large numbers of well-characterized HIV-1 epitopes before and under cART within the same individuals. Therefore, how cART affects the maintenance of HIV-1-specific CD8
+
T cells and which HIV-1-specific CD8
+
T cells would be useful for curative treatment remain unclear. We investigated T-cell responses to 63 HIV-1 epitopes at pre-cART and under cART in 90 PLWH who received long-term cART. The frequency of T-cell responses to HIV-1 epitopes under long-term cART varied from 0% to 100%, indicating an epitope-dependent effect of long-term cART on HIV-1-specific CD8
+
T cells. The magnitude of the responses under cART was 26.2% of that at pre-cART. The frequency of T-cell responses to protective epitopes under cART was higher than that to non-protective ones. T-cell responses to HIV-1 epitopes were detected at pre-cART in most non-AIDS HIV patients, whereas they were not detectable at pre-cART in half of the AIDS patients. Long-term cART enhanced the ability of HIV-1-specific T cells to proliferate
in vitro
in non-AIDS HIV patients, while it restored this ability of the T cells in AIDS patients. This study demonstrated that CD8
+
T cells specific for large numbers of HIV-1 epitopes were maintained in an epitope-dependent fashion under long-term cART and implied that some HIV-1-specific T cells are still candidates as effector cells for curative treatment.

IMPORTANCE

HIV-1-specific CD8
+
T cells are anticipated to become effector cells for curative treatment using the “shock and kill” approach in people living with HIV-1 (PLWH) under combined antiretroviral therapy (cART). Previous studies demonstrated that the frequency of HIV-1-specific CD8
+
T cells is reduced under cART and their functional ability remains impaired. These studies analyzed T-cell responses to a small number of HIV-1 epitopes or overlapping HIV-1 peptides. Therefore, the features of CD8
+
T cells specific for HIV-1 epitopes under cART remain only partially clarified. Here, we analyzed CD8
+
T cells specific for 63 well-characterized epitopes in 90 PLWH. We demonstrated that CD8
+
T cells specific for large numbers of HIV-1 epitopes were maintained in an epitope-dependent fashion under long-term cART and that long-term cART enhanced or restored the ability of HIV-1-specific T cells to proliferate
in vitro
. This study implies that some HIV-1-specific T cells would be useful as effector cells for curative treatment.
Global distribution, receptor binding, and cross-species transmission of H6 influenza viruses: risks and implications for humans
Authors: Yan Zhanfei , Li You , Huang Shujian , Wen Feng
Published: October 2023

The H6 subtype of avian influenza virus (AIV) is a pervasive subtype that is ubiquitously found in both wild bird and poultry populations across the globe. Recent investigations have unveiled its capacity to infect mammals, thereby expanding its host range beyond that of other subtypes and potentially facilitating its global transmission. This heightened breadth also endows H6 AIVs with the potential to serve as a genetic reservoir for the emergence of highly pathogenic avian influenza strains through genetic reassortment and adaptive mutations. Furthermore, alterations in key amino acid loci within the H6 AIV genome foster the evolution of viral infection mechanisms, which may enable the virus to surmount interspecies barriers and infect mammals, including humans, thus posing a potential threat to human well-being. In this review, we summarize the origins, dissemination patterns, geographical distribution, cross-species transmission dynamics, and genetic attributes of H6 influenza viruses. This study holds implications for the timely detection and surveillance of H6 AIVs.
High prevalence of lipopolysaccharide mutants and R2-pyocin susceptible variants in
Pseudomonas aeruginosa
populations sourced from cystic fibrosis lung infections
Authors: Mei Madeline , Pheng Preston , Kurzeja-Edwards Detriana , Diggle Stephen P.
Published: October 2023

Chronic, highly antibiotic-resistant infections in cystic fibrosis (CF) lungs contribute to increasing morbidity and mortality.
Pseudomonas aeruginosa
, a common CF pathogen, exhibits resistance to multiple antibiotics, contributing to antimicrobial resistance (AMR). These bacterial populations display genetic and phenotypic diversity, but it is unclear how this diversity affects susceptibility to bacteriocins. R-pyocins, i.e., bacteriocins produced by
P. aeruginosa
, are phage-tail-like antimicrobials. R-pyocins have potential as antimicrobials, however, recent research suggests the diversity of
P. aeruginosa
variants within CF lung infections leads to varying susceptibility to R-pyocins. This variation may be linked to changes in lipopolysaccharide (LPS), acting as the R-pyocin receptor. Currently, it is unknown how frequently R-pyocin-susceptible strains are in chronic CF lung infection, particularly when considering the heterogeneity within these strains. In this study, we tested the R2-pyocin susceptibility of 139
P
.
aeruginosa
variants from 17 sputum samples of 7 CF patients and analyzed LPS phenotypes. We found that 83% of sputum samples did not have R2-pyocin-resistant variants, while nearly all samples contained susceptible variants. There was no correlation between LPS phenotype and R2-pyocin susceptibility, though we estimate that about 76% of sputum-derived variants lack an O-specific antigen, 40% lack a common antigen, and 24% have altered LPS cores. The absence of a correlation between LPS phenotype and R-pyocin susceptibility suggests that LPS packing density may play a significant role in R-pyocin susceptibility among CF variants. Our research supports the potential of R-pyocins as therapeutic agents, as many infectious CF variants are susceptible to R2-pyocins, even within diverse bacterial populations.

IMPORTANCE

Cystic fibrosis (CF) patients often experience chronic, debilitating lung infections caused by antibiotic-resistant
Pseudomonas aeruginosa
, contributing to antimicrobial resistance (AMR). The genetic and phenotypic diversity of
P. aeruginosa
populations in CF lungs raises questions about their susceptibility to non-traditional antimicrobials, like bacteriocins. In this study, we focused on R-pyocins, a type of bacteriocin with high potency and a narrow killing spectrum. Our findings indicate that a large number of infectious CF variants are susceptible to R2-pyocins, even within diverse bacterial populations, supporting their potential use as therapeutic agents. The absence of a clear correlation between lipopolysaccharide (LPS) phenotypes and R-pyocin susceptibility suggests that LPS packing density may play a significant role in R-pyocin susceptibility among CF variants. Understanding the relationship between LPS phenotypes and R-pyocin susceptibility is crucial for developing effective treatments for these chronic infections.
Theoretical and Methodological Approaches to the Analysis of the Spatial Distribution of Endemic Diseases of Geochemical Nature
Authors: Korobova E. M. , Baranchukov V. S. , Kolmykova L. I.
Published: October 2023

Abstract—

Throughout millions of years of geological history (in the Phanerozoic), the coevolution of all living organisms took place in a fierce competition for resources and opportunities for the maximum reproduction. Due to the geochemical heterogeneity of the primary (pre-Quaternary) biosphere, this resulted in a self-regulating system of ecological niches, within which all local biocenoses and their animal and plant species were maximally adapted to the parameters of the habitat. However, with the emergence of reason, the situation changed fundamentally. Human beings became the dominant species and began the conscious development of new territories, including geochemically unfavorable ones, which led to the formation of zones of stable endemic diseases. Based on this premise, for all existing species, there should be areas with physiologically optimal habitat conditions, i.e., those under which the species has evolved to its present state. It follows that, by being able to record the geochemical parameters of the undisturbed biosphere, it is possible to obtain characteristics that are ecologically ideal for local animal and plant species. In theoretical terms, this allowed us to put forward the hypothesis that by fixing the difference between observed and ideal geochemical conditions, it is possible to build maps of risk of diseases of geochemical nature, including in areas subjected to anthropogenic pollution. The paper outlines the methodology and gives examples of construction of such maps. The obtained results can have an important practical value in organizing the system of sanitary–epidemiological service, in solving the problems of liquidation of the consequences of anthropogenic pollution, and in carrying out preventive measures to minimize the risk of diseases of geochemical nature.
Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative
Authors: Puligandla Pramod , Skarsgard Erik , Baird Robert , Guadagno Elena , Dimmer Alexandra , Ganescu Olivia , Abbasi Nimrah , Altit Gabriel , Brindle Mary , Fernandes Sairvan , Dakshinamurti Shyamala , Flageole Helene , Hebert Audrey , Keijzer Richard , Offringa Martin , Patel Dylan , Ryan Greg , Traynor Michael , Zani Augusto , Chiu Priscilla
Published: October 2023

Objective

The Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative sought to make its existing clinical practice guideline, published in 2018, into a ‘living document’.

Design and main outcome measures

Critical appraisal of CDH literature adhering to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Evidence accumulated between 1 January 2017 and 30 August 2022 was analysed to inform changes to existing or the development of new CDH care recommendations. Strength of consensus was also determined using a modified Delphi process among national experts in the field.

Results

Of the 3868 articles retrieved in our search that covered the 15 areas of CDH care, 459 underwent full-text review. Ultimately, 103 articles were used to inform 20 changes to existing recommendations, which included aspects related to prenatal diagnosis, echocardiographic evaluation, pulmonary hypertension management, surgical readiness criteria, the type of surgical repair and long-term health surveillance. Fifteen new CDH care recommendations were also created using this evidence, with most related to the management of pain and the provision of analgesia and neuromuscular blockade for patients with CDH.

Conclusions

The 2023 Canadian CDH Collaborative’s clinical practice guideline update provides a management framework for infants and children with CDH based on the best available evidence and expert consensus.
Two-year recall for people with no diabetic retinopathy: a multi-ethnic population-based retrospective cohort study using real-world data to quantify the effect
Authors: Olvera-Barrios Abraham , Rudnicka Alicja R , Anderson John , Bolter Louis , Chambers Ryan , Warwick Alasdair N , Welikala Roshan , Fajtl Jiri , Barman Sarah , Remagnino Paolo , Wu Yue , Lee Aaron Y , Chew Emily Y , Ferris Frederick L , Hingorani Aroon , Sofat Reecha , A. Egan Catherine , Tufail Adnan , Owen Christopher G
Published: October 2023

Background/aims

The English Diabetic Eye Screening Programme (DESP) offers people living with diabetes (PLD) annual screening. Less frequent screening has been advocated among PLD without diabetic retinopathy (DR), but evidence for each ethnic group is limited. We examined the potential effect of biennial versus annual screening on the detection of sight-threatening diabetic retinopathy (STDR) and proliferative diabetic retinopathy (PDR) among PLD without DR from a large urban multi-ethnic English DESP.

Methods

PLD in North-East London DESP (January 2012 to December 2021) with no DR on two prior consecutive screening visits with up to 8 years of follow-up were examined. Annual STDR and PDR incidence rates, overall and by ethnicity, were quantified. Delays in identification of STDR and PDR events had 2-year screening intervals been used were determined.

Findings

Among 82 782 PLD (37% white, 36% South Asian, and 16% black people), there were 1788 incident STDR cases over mean (SD) 4.3 (2.4) years (STDR rate 0.51, 95% CI 0.47 to 0.55 per 100-person-years). STDR incidence rates per 100-person-years by ethnicity were 0.55 (95% CI 0.48 to 0.62) for South Asian, 0.34 (95% CI 0.29 to 0.40) for white, and 0.77 (95% CI 0.65 to 0.90) for black people. Biennial screening would have delayed diagnosis by 1 year for 56.3% (1007/1788) with STDR and 43.6% (45/103) with PDR. Standardised cumulative rates of delayed STDR per 100 000 persons for each ethnic group were 1904 (95% CI 1683 to 2154) for black people, 1276 (95% CI 1153 to 1412) for South Asian people, and 844 (95% CI 745 to 955) for white people.

Interpretation

Biennial screening would have delayed detection of some STDR and PDR by 1 year, especially among those of black ethnic origin, leading to healthcare inequalities.
Two-year MRI-defined structural damage and patient-reported outcomes following surgery or exercise for meniscal tears in young adults
Authors: Clausen Stine Haugaard , Skou Søren T , Boesen Mikael Ploug , Radev Dimitar Ivanon , Kurt Engin Yeter , Damsted Camma , Hölmich Per , Lind Martin , Tørring Sofus , Isaksen Christin , Varnum Claus , Englund Martin , Thorlund Jonas Bloch
Published: October 2023

Objective

To investigate potential differences in structural knee joint damage assessed by MRI and patient-reported outcomes (PROMs) at 2-year follow-up between young adults randomised to early surgery or exercise and education with optional delayed surgery for a meniscal tear.

Methods

A secondary analysis of a multicentre randomised controlled trial including 121 patients (18–40 years) with an MRI-verified meniscal tear. For this study, only patients with 2-year follow-up were included. The main outcomes were the difference in worsening of structural knee damage, assessed by MRI using the Anterior Cruciate Ligament OsteoArthrits Score, and the difference in change in the mean score of four Knee Injury and Osteoarthritis Outcome Score (KOOS4) subscales covering pain, symptoms, function in sport and recreation, and quality of life, from baseline to 2 years.

Results

In total, 82/121 (68%) patients completed the 2-year follow-up (39 from the surgical group and 43 from the exercise group). MRI-defined cartilage damage had developed or progressed in seven (9.1%) patients and osteophytes developed in two (2.6%) patients. The worsening of structural damage from baseline to 2-year follow-up was similar between groups. The mean (95% CI) adjusted differences in change in KOOS4between intervention groups from baseline to 2 years was −1.4 (−9.1, 6.2) points. The mean improvement in KOOS4was 16.4 (10.4, 22.4) in the surgical group and 21.5 (15.0, 28.0) in the exercise group. No between group differences in improvement were found in the KOOS subscales.

Conclusions

The 2-year worsening of MRI-defined structural damage was limited and similar in young adult patients with a meniscal tear treated with surgery or exercise with optional delayed surgery. Both groups had similar clinically relevant improvements in KOOS4, suggesting the choice of treatment strategy does not impact 2-year structural knee damage or PROMs.

Trial registration number

NCT02995551.
Does the format of result presentation and type of conclusion in Cochrane plain language summaries matter? A randomised controlled trial
Authors: Prakash V , Gore Kirti , Shukla Gunjan , Tapiawala Priyanshi , Thakkar Smit
Published: October 2023

Objectives

This study aimed to investigate whether the format and type of conclusion in Cochrane plain language summaries (PLSs) influence readers’ perception of treatment benefit and decision-making.

Design

An online parallel group, three-arm randomised controlled trial was conducted.

Setting

The study was conducted online.

Participants

The participants were physiotherapy students.

Interventions

The participants read two Cochrane PLSs, one with a positive conclusion (strong evidence of benefit) and another with a negative conclusion (strong evidence of non-benefit). Each participant read the results of both reviews presented in one of three formats: (1) numerical, (2) textual or (3) numerical and textual.

Main outcome measures

The primary outcome measure was the participants’ perception of treatment benefit.

Results

All three groups of participants perceived the treatment to have positive effects when the Cochrane PLS had a positive conclusion, regardless of the format of presentation (mean perception of treatment benefit score: textual 7.7 (SD 2.3), numerical 7.9 (SD 1.8), numerical and textual 7.7 (SD 1.7), p=0.362). However, when the Cochrane PLS had a negative conclusion, all three groups of participants failed to perceive a negative effect (mean perception of treatment benefit score: textual 5.5 (SD 3.3), numerical 5.6 (SD 2.7), numerical and textual 5.9 (SD 2.8), p=0.019).

Conclusions

The format of Cochrane PLSs does not appear to significantly impact physiotherapy students’ perception of treatment benefit, understanding of evidence, persuasiveness or confidence in their decision. However, participants’ perception of treatment benefit does not align with the conclusion when the Cochrane PLS indicates strong evidence of non-benefit from the intervention.

Trial registration number

CTRI/2022/10/046476.
Effectiveness of return-of-service schemes for human resources for health retention: a retrospective cohort study of four Southern African countries
Authors: Mabunda Sikhumbuzo A , Durbach Andrea , Chitha Wezile W , Phiri Hawor , Phalane Mahlane , Moaletsane Oduetse , Angell Blake , Joshi Rohina
Published: October 2023

Background

Governments use return-of-service (RoS) schemes to train, employ and retain health professionals in the public sector. We determined the effectiveness of RoS schemes in four Southern African countries.

Methods

This retrospective cohort study used databases of RoS beneficiaries from South Africa, Botswana, Eswatini and Lesotho. We ascertained the period of funding for beneficiaries between 2000 and 2010, study programme, selection criteria, study country and if they completed their studies. Records were sought to track beneficiaries’ service and fulfilment of their RoS obligations. Data were sought at the provincial level in South Africa and nationally for the other three countries. Binomial logistics regression and Kaplan-Meier survival estimates were used to determine risk factors and predictors of defaulting.

Results

Most beneficiary enrolment (eg, decision on why they were funded, socioeconomic status, disability status, high school results) and service data (eg, health facilities where they worked, how long they worked at each health facility, movement between health facilities) were not available. A total of 5616 beneficiaries were drawn from the four countries’ databases. Of those with full data available, 21.7% (229/1056) were retained/served beyond their obligatory period and 20.2% (213/1056) were still serving. A total of 24.3% (95% CI: 21.7% to 26.9%; n=257/1056) of beneficiaries in the final subanalysis of two South African provinces fulfilled their contractual obligations. Only 32.2% (277/861) of beneficiaries undertook internship within their funding provinces. Governments needed to fund six beneficiaries to have one beneficiary complete their contractual obligation if they undertook internship outside their province.

Conclusion

Record keeping in all countries was poor, hampering the effectiveness of RoS schemes. Of the units with full data available, the retention rate was below 25%, and internship being undertaken outside the funding province was associated with higher defaulter rates, calling for a policy overhaul.
Evaluation of the efficacy and safety of MRI-guided focused ultrasound (MRgFUS) for focal hand dystonia: study protocol for an open-label non-randomised clinical trial
Authors: Maamary Joel , Peters James , Kyle Kain , Ruge Diane , Jonker Benjamin , Barnett Yael , Tisch Stephen
Published: October 2023

Introduction

MRI-guided focused ultrasound (MRgFUS) thalamotomy provides an exciting development in the field of minimally invasive stereotactic neurosurgery. Current treatment options for focal hand dystonia are limited, with potentially more effective invasive stereotactic interventions, such as deep brain stimulation or lesional therapies, rarely used. The advent of minimally invasive brain lesioning provides a potentially safe and effective treatment approach with a recent pilot study establishing MRgFUS Vo-complex thalamotomy as an effective treatment option for focal hand dystonia. In this study, we undertake an open-label clinical trial to further establish MRgFUS Vo-complex thalamotomy as an effective treatment for focal hand dystonia with greater attention paid to potential motor costs associated with this treatment. To elucidate pathophysiology of dystonia and treatment mechanisms, neurophysiological and MRI analysis will be performed longitudinally to explore the hypothesis that neuroplastic and structural changes that may underlie this treatment benefit.

Methods and analysis

A total of 10 participants will be recruited into this open-label clinical trial. All participants will undergo clinical, kinemetric, neurophysiological and radiological testing at baseline, followed by repeated measures at predesignated time points post MRgFUS Vo-complex thalamotomy. Further, to identify any underlying structural or neurophysiological abnormalities present in individuals with focal hand dystonia, 10 age and gender matched control participants will be recruited to undergo comparative investigation. These results will be compared with the intervention participants both at baseline and at 12 months to assess for normalisation of these abnormalities, if present.

Ethics and dissemination

This trial was reviewed and approved by the St Vincent’s Health Network Sydney Human Research Ethics Committee (2022/ETH00778). Study results will be published in peer-reviewed journals and presented at both national and international conferences.

Trial registration number

CTRN12622000775718.
Simple signage and targeted education can lead to process improvement in acute appendicitis care
Authors: Atwood Rex , Benoit Patrick , Hennrikus William , Kraemer Laura , Gunasingha Rathnayaka Mudiyanselage , Kindvall Angela , Jessie Elliot , Gosztyla Carolyn , Bradley Matthew
Published: October 2023

Introduction

An institution-wide protocol for uncomplicated acute appendicitis was created to improve compliance with best practices between the emergency department (ED), radiology and surgery. Awareness of the protocol was spread with the publication of a smartphone application and communication to clinical leadership. On interim review of quality metrics, poor protocol adherence in diagnostic imaging and antimicrobial stewardship was observed. The authors hypothesised that two further simple interventions would result in more efficient radiographic diagnosis and antimicrobial administration.

Materials and methods

Surgery residents received targeted in-person education on the appropriate antibiotic choices and diagnostic imaging in the protocol. Signs were placed in the emergency and radiology work areas, immediately adjacent to provider workstations highlighting the preferred imaging for patients with suspected appendicitis and the preferred antibiotic choices for those with proven appendicitis. Protocol adherence was compared before and after each intervention.

Results

Targeted education was associated with improved antibiotic stewardship within the surgical department from 30% to 91% protocol adherence before/after intervention (p<0.005). Visible signs in the ED were associated with expedited antimicrobial administration from 50% to 90% of patients receiving antibiotics in the ED prior to being brought to the operating room before/after intervention (p<0.005). Diagnostic imaging after the placement of signs showed improved protocol adherence from 35% to 75% (p<0.005).

Conclusion

This study demonstrates that smartphone-based applications and communication among clinical leadership achieved suboptimal adherence to an institutional protocol. Targeted in-person education reinforcement and visible signage immediately adjacent to provider workstations were associated with significantly increased adherence. This type of initiative can be used in other aspects of acute care general surgery to further improve quality of care and hospital efficiency.
Effect of physical activity counselling on the number of contacts in primary healthcare, specialised healthcare and the related healthcare costs among patients with type 2 diabetes: a register-based evaluation study
Authors: Martiskainen Tuula , Lamidi Marja-Leena , Linna Miika , Venojärvi Mika , Tikkanen Heikki , Laatikainen Tiina
Published: October 2023

Introduction

This study evaluated the effect of physical activity (PA) counselling on the number of contacts and related costs in primary healthcare (PHC) and specialised healthcare (SHC) among patients with type 2 diabetes (T2D).

Methods

The study was carried out in North Karelia, Finland, among PHC clients with T2D in 2016–2018. Altogether, 521 patients participated in the counselling. In total, 1382 sex, age, time of diagnosis and intervention time-matched controls were used to assess the effect of the intervention. Information on outpatient nurse and physician appointments in PHC and SHC was collected from October 2016 to December 2019. The reason for the visit was identified with the recorded main diagnosis using both International Classification of Diseases-10 and International Standard Classification of Primary Care-2 diagnoses. Unit costs of SHC visits were based on average diagnosis-related group costs and for PHC unit costs for appointments for physicians, nurses and physiotherapists on the national price list.

Results

The number of physician and nurse appointments in the PHC related to T2D decreased in the intervention group and increased in the control group with statistically significant differences in mean annual changes between groups (p=0.010 and p<0.001, respectively). In PHC, the number of physician appointments related to musculoskeletal disorders decreased in the intervention group and increased in the control group with a statistically significant difference between groups (p<0.001). In the intervention group, T2D-related costs of appointments per person-year in PHC decreased, while an increase was observed in the control group (p<0.001).

Conclusions

This study shows that PA counselling in PHC offers significant benefits in the treatment of patients with T2D by also improving the use of the resources in healthcare. The PA counselling reduced the number of other appointments and costs of appointments per person-year.
Prevalence of developmental dysplasia of the hip (DDH) in infants: a systematic review and meta-analysis
Authors: Tao Zhongbin , Wang Jie , Li Yanming , Zhou Yongkang , Yan Xiaoli , Yang Junqiang , Liu Huili , Li Bowen , Ling Jizu , Pei Yijie , Zhang Jianglin , Li Yuanyuan
Published: October 2023

Objective

To estimate the prevalence of developmental dysplasia of the hip (DDH) in infants with a systematic review and meta-analysis.

Method

A literature search was conducted in April 2023, using databases such as Cochrane Library, PubMed, MEDLINE, CNKI, and SinoMed, without language restrictions. Eligible studies included cross-sectional studies reporting the prevalence of DDH among infants aged 0–12 months. Two independent reviewers manually selected and coded the studies, with any disagreements resolved by a third reviewer. Meta-analysis was performed using a random-effects model to calculate the prevalence of DDH. Regression analysis examined the trend of DDH prevalence, and stratification analysis explored heterogeneity between studies.

Results

A total of 65 studies involving 3 451 682 infants were included in the meta-analysis. None of the studies were classified as high quality, four were medium-to-high quality, 50 were low-to-medium quality, and eight were low quality. The pooled prevalence of DDH was 1.40% (95% CI: 0.86 to 2.28, I2=100%), and prevalence of dysplasia, subluxation, and dislocation was 1.45% (95% CI: 0.93 to 2.24, I2=97%), 0.37% (95% CI: 0.22 to 0.60, I2=94%), and 0.21% (95% CI: 0.13 to 0.34, I2=92%), respectively. Notably, the overall prevalence has a slight upward trend in the last three decades (β=0.24, p=0.35), but the dysplasia was downward trend (β=−0.48, p<0.01). Girls have higher risk of DDH than boys (1.46% vs 0.66%; Q=5.83, df=1, p=0.02). There were no significant differences based on gender, country, setting, or screening technique.

Conclusion

The prevalence of DDH among infants is approximately one in a 100, with girls being at higher risk. Though the prevalence of dysplasia has decreased, there is a slight upward trend in overall DDH. Therefore, routine screening for DDH in infants is recommended to prevent more serious developmental problems.
Body dissatisfaction, disordered eating and exercise behaviours: associations with symptoms of REDs in male and female athletes
Authors: Vardardottir Birna , Olafsdottir Anna Sigridur , Gudmundsdottir Sigridur Lara
Published: October 2023

Objectives

Disordered eating and compulsive exercise behaviours are common among athletes and can increase the risk of relative energy deficiency in sport (REDs). Contrarily, the prevalence of muscle dysmorphia and its relationship with REDs are unknown. This cross-sectional study aimed to evaluate associations of all three with REDs symptoms.

Methods

Elite and subelite Icelandic athletes (n=83, 67.5% females) answered the Low Energy Availability in Females/Males Questionnaires (LEAF-Q/LEAM-Q), Eating Disorder Examination–Questionnaire Short (EDE-QS), Exercise Addiction Inventory (EAI) and Muscle Dysmorphic Disorder Inventory (MDDI). Body composition was assessed via dual-energy X-ray absorptiometry; resting metabolic rate via indirect calorimetry; and blood samples were drawn for analysis of nutrition and hormonal status. Females were compared based on LEAF-Q total score (≥8 (at risk) vs <8). Simple linear regression was applied to evaluate associations of (a) testosterone with other objective measures and LEAM-Q scores in males; and (b) LEAF-Q/LEAM-Q scores with EDE-QS, EAI and MDDI scores.

Results

In total, 8.4% of participants scored above cut-off on EDE-QS, 19.3% on EAI and 13.3% on MDDI. Females with LEAF-Q total score ≥8 had higher median scores on EDE-QS, EAI and MDDI compared with those scoring <8. Testosterone was positively associated with iron and inversely with total iron-binding capacity but was not associated with scoring on any of the administered questionnaires.

Conclusion

Drive for muscularity and aesthetic physique may play a role in the complex presentation of REDs. Screening for muscle dysmorphia, in addition to disordered eating and compulsive exercise, could therefore facilitate early detection of REDs.
X as a proxy for tackle safety culture? Sentiment analysis of social media posts on red-carded and yellow-carded tackles during the 2019 Rugby World Cup
Authors: Alexander Firdows , Tucker Ross , Jones Ben , Hendricks Sharief
Published: October 2023

Objectives

This study analysed the overall sentiment of attitudes, opinions, views and emotions expressed in posts on X related to red-carded and yellow-carded tackles during the 2019 Rugby World Cup (RWC).

Methods

Sentiment analysis was conducted on posts on X about red or yellow cards issued at the 2019 RWC. Posts were classified as ‘agree’, ‘disagree’ and ‘neutral’. The frequency of posts, red cards, yellow cards, all injuries, tackle injuries and total number of tackles per match were also synced to the 45-match playing schedule.

Results

Five tackle-related red cards were issued during the 2019 RWC, and 15 tackle-related yellow cards, with 337 and 302 posts identified for each card decision, respectively. For red cards, 42% of posts (n=158/377) agreed with the referee’s decision, 19% (n=71/377) disagreed and 40% were neutral. For yellow cards, 24% (n=73/302) agreed with the referee’s decision, 33% (n=99/302) disagreed and 43% were neutral.

Conclusions

For red cards, posts were 2.2 times more likely to agree with the referee’s decision than disagree. Posts that agreed with a red card decision were also more likely to be shared (reposted) than posts that disagreed with a red card decision. In contrast, sentiments expressed for yellow card decisions were mixed. This may be related to interpreting the degree of danger and whether mitigation is applied. Within the ecosystem of rugby, sharing sentiments on social media plays a powerful role in creating a positive player welfare narrative.
Reduction of moderate to severe tricuspid regurgitation after catheter ablation for atrial fibrillation
Authors: Cha Myung-Jin , Lee Seung-Ah , Cho Min Soo , Nam Gi-Byoung , Choi Kee-Joon , Kim Jun
Published: October 2023

Objective

Tricuspid regurgitation (TR) is a progressive disease with high mortality and limited medical treatment options, and its association with atrial fibrillation (AF) has been documented. This study aimed to investigate whether successful rhythm control through catheter ablation for AF could reduce TR severity.

Methods

A total of 106 patients with drug-refractory AF with moderate to severe secondary TR who underwent AF ablation were screened from a single-centre ablation registry. Echocardiographic parameter changes (pre-procedure vs 1 day/1 year post-procedure) were analysed. Holter monitoring was performed at 3/6/12 months to assess AF recurrence. The primary outcome was at least one grade TR reduction with its main determinants evaluated.

Results

After excluding 36 patients (prior tricuspid valve surgery, intracardiac devices or insufficient data), 70 patients (aged 63.8±9.7 years, 50% female) were analysed. Of these, 17 (24.3%) had severe TR, 55 (78.6%) persistent AF and all restored sinus rhythm with catheter ablation. The primary outcome was achieved in 53 (75.7%) at 1-year assessment (73.6% of moderate and 82.4% of severe TR). There were significant decreases of vena contracta (6.1→3.2 mm) and tricuspid annular diameter (37.3→32.6 mm) at 1 year. Although 25 patients experienced AF recurrence within 1 year, 56 (80%) patients finally maintained sinus rhythm with medical treatment (87% in patients with TR reduction and 59% without). From the multivariate analysis, sinus rhythm maintenance was the most significant determinant of TR reduction (OR 8.3, 95% CI 1.8 to 37.4).

Conclusion

In patients with AF with moderate to severe TR, more than two-thirds of patients experienced reduced TR severity, with notable improvements in echocardiographic parameters. Sinus rhythm maintenance was associated with significant TR reduction.
Physicians’ duty to climate protection as an expression of their professional identity: a defence from Korsgaard’s neo-Kantian moral framework
Authors: van Gils-Schmidt Henk Jasper , Salloch Sabine
Published: October 2023

The medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians’ normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard’s neo-Kantian moral account of practical identities. We begin by showing the case of physicians’ duty to climate protection, before we succinctly introduce Korsgaard’s account. We subsequently show how the duty to climate protection can follow from physicians’ identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians’ professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively.
Further characterisation ofARX-related disorders in females due to inherited or de novo variants
Authors: Gras Mathilde , Heide Solveig , Keren Boris , Valence Stéphanie , Garel Catherine , Whalen Sandra , Jansen Anna C , Keymolen Kathelijn , Stouffs Katrien , Jennesson Mélanie , Poirsier Céline , Lesca Gaetan , Depienne Christel , Nava Caroline , Rastetter Agnès , Curie Aurore , Cuisset Laurence , Des Portes Vincent , Milh Mathieu , Charles Perrine , Mignot Cyril , Héron Delphine
Published: October 2023

The Aristaless-related homeobox (ARX) gene is located on the X chromosome and encodes a transcription factor that is essential for brain development. While the clinical spectrum ofARX-related disorders is well described in males, from X linked lissencephaly with abnormal genitalia syndrome to syndromic and non-syndromic intellectual disability (ID), its phenotypic delineation in females is incomplete. Carrier females inARXfamilies are usually asymptomatic, but ID has been reported in some of them, as well as in others with de novo variants. In this study, we collected the clinical and molecular data of 10 unpublished female patients with de novoARXpathogenic variants and reviewed the data of 63 females from the literature with either de novo variants (n=10), inherited variants (n=33) or variants of unknown inheritance (n=20). Altogether, the clinical spectrum of females with heterozygous pathogenicARXvariants is broad: 42.5% are asymptomatic, 16.4% have isolated agenesis of the corpus callosum (ACC) or mild symptoms (learning disabilities, autism spectrum disorder, drug-responsive epilepsy) without ID, whereas 41% present with a severe phenotype (ie, ID or developmental and epileptic encephalopathy (DEE)). The ID/DEE phenotype was significantly more prevalent in females carrying de novo variants (75%, n=15/20) versus in those carrying inherited variants (27.3%, n=9/33). ACC was observed in 66.7% (n=24/36) of females who underwent a brain MRI. By refining the clinical spectrum of females carryingARXpathogenic variants, we show that ID is a frequent sign in females with this X linked condition.
Interest and competence in leadership and management among newly qualified specialists in Finland
Authors: Parviainen Heli , Kärki Juulia , Kosonen Hanna , Halava Heli
Published: October 2023

Background

Medical faculties in Finland are responsible for the quality and content of continuous medical education programmes that also includes compulsory management studies (10 European Credit Transfer and Accumulation System). The aim of this study is to evaluate medical specialists’ experiences of the compulsory management studies and their attitudes towards leaders and managers.

Methods

The Universities of Turku and Tampere conducted a survey among doctors who completed their specialist training between 1 January 2016 and 1 January 2019. Of these doctors, 83 completed the survey (response rate 25%). The analysis was carried out using a cross-table, and in the visual analysis, a box plot has been used.

Results

Of the respondents, 38% were content with management and leadership studies, and they reported a particular need for improving skills in human resources management, healthcare economy, legislation, organisational management, and social and healthcare systems. Most respondents (83%) showed interest in future leadership roles.

Conclusions

The findings of this study show that newly qualified doctors do wish for added education and training in management and leadership.
Personalised medicine: a healing application within comorbid PTSD and mTBI military patient sample with a particular focus on special operators
Authors: Moret Nicole E , Bennion L D
Published: October 2023

Personalised medicine is replacing prototypical medical care. Personalised medicine focuses on enhancing patients� functioning and preventing future negative impacts of both medical disease and psychological disorders, and unfolds uniquely for each individual. The military special forces community is a group at higher risk for physical trauma, for example, traumatic brain injuries, as well as psychosocial stressors and traumas associated with combat, high operational tempos and sleep deprivation. From a system�s cost�benefit perspective and resonating with community norms of resiliency, personalised medicine offers unique innovative treatments for special operators. In this article, we outline the successful applications of personalised medicine via the multidisciplinary treatment of special operators with comorbid conditions (primarily mild traumatic brain injury and post-traumatic stress disorder).
Are multidisciplinary consultation meetings for prenatal diagnosis achievable in a low-income country? A descriptive cross-sectional survey in Benin
Authors: Yassegoungbe Monsoia Gildas , Assan Beaudelaire Romulus , Houegban Amoussou Sedjro Clotaire Romeo , Metchihoungbe Codjo Serge , Lecompte Jean-Francois , Aguemon Christine Tschabu , Gbetey Sidoine Bitho , Breaud Jean , Gbenou Antoine Seraphin
Published: October 2023

Objective

The multidisciplinary antenatal diagnosis staff bring together practitioners who are involved in the management of the antenatal period at birth. This project was designed following the French experience to institute multidisciplinary consultation meetings for prenatal diagnosis (MCMPD) in Benin.

Methods

This is a descriptive cross-sectional study examining the knowledge, attitudes, and practices of Beninese practitioners in the field of MCMPD to develop the pilot phase of the project.

Results

We collected 108 participants from different specialties. Pediatricians and pediatric surgeons were in the majority at 23.9% and 16.5%, respectively. Sixty-seven percent of participants were from the public sector (n=75). One practitioner felt that it was not a good idea to implement these meetings. Almost all staff (96.2%) agreed that this meeting would have a positive impact on reducing neonatal mortality. Omphalocele (58.5%), spina bifida aperta (43.6%), and gastroschisis (34%) were the most commonly diagnosed antenatal conditions in Benin. No neonatal pathology required medical termination of the pregnancy according to 35.6% of the participants.

Conclusions

The objective of reducing infant mortality due to medical and surgical pathologies is a noble one and deserves to be supported. This innovative project, developed through this study, the first of its kind in the subregion, will contribute inexorably to the achievement of the third Goal Sustainable Development.
How do latitude and urban heat islands affect larval melanization in monarch butterflies (Danaus plexippus) ?
Authors: Batool Rohab , Jenan Juriyah , Schuster Madeline , Murray Rosalind L.
Published: October 2023

As temperatures warm in response to anthropogenic changes (climate change and urbanization), animals must respond adaptively to these changes or be displaced. Here, we use community science data (iNaturalist and BugGuide) to show that melanization in larval monarch butterflies ( Danaus plexippus (Linnaeus, 1758), an endangered species in Canada) is correlated with latitude and temperature across a latitudinal gradient, indicating likely use in thermoregulation. We also predicted that melanization would decrease in cities where temperatures are consistently higher than rural areas; however, we found that while melanization was lower in urban areas, it was not statistically significant. Our results demonstrate the importance of considering life stage when assessing capacity for adaptation to anthropogenic change in vulnerable animal populations, like monarch butterflies. We also show the value of using community science to sample species (particular those of most concern) distributions across the landscape.
Fastensor: Optimise the Tensor I/O Path from SSD to GPU for Deep Learning Training
Authors: Wei Jia , Zhang Xingjun , Wang Longxiang , Wei Zheng
Published: October 2023

In recent years, benefiting from the increase in model size and complexity, deep learning has achieved tremendous success in computer vision (CV) and (NLP). Training deep learning models using accelerators such as GPUs often requires much iterative data to be transferred from NVMe SSD to GPU memory. Much recent work has focused on data transfer during the pre-processing phase and has introduced techniques such as multiprocessing and GPU Direct Storage (GDS) to accelerate it. However, tensor data during training (such as Checkpoints, logs, and intermediate feature maps), which is also time-consuming, is often transferred using traditional serial, long-I/O-path transfer methods.

In this article, based on GDS technology, we built Fastensor, an efficient tool for tensor data transfer between the NVMe SSDs and GPUs. To achieve higher tensor data I/O throughput, we optimized the traditional data I/O process. We also proposed a data and runtime context-aware tensor I/O algorithm. Fastensor can select the most suitable data transfer tool for the current tensor from a candidate set of tools during model training. The optimal tool is derived from a dictionary generated by our adaptive exploration algorithm in the first few training iterations. We used Fastensor’s unified interface to test the read/write bandwidth and energy consumption of different transfer tools for different sizes of tensor blocks. We found that the execution efficiency of different tensor transfer tools is related to both the tensor block size and the runtime context.

We then deployed Fastensor in the widely applicable Pytorch deep learning framework. We showed that Fastensor could perform superior in typical scenarios of model parameter saving and intermediate feature map transfer with the same hardware configuration. Fastensor achieves a 5.37x read performance improvement compared to
torch.save
() when used for model parameter saving. When used for intermediate feature map transfer, Fastensor can increase the supported training batch size by 20x, while the total read and write speed is increased by 2.96x compared to the torch I/O API.
ACM SIGMM Executive Committee Newsletter - 1, 2022
Authors: Bimbo Alberto del , Chen Phoebe , Redi Miriam
Published: October 2023

The Special Interest Group in Multimedia of ACM, ACM SIGMM, provides a forum for researchers, engineers, and practitioners in all aspects of multimedia computing, communication, storage, and applications. We do this through our sponsorship and organization of conferences and workshops, supporting student travel to such events, discounted registrations, two regional chapters, recognition of excellence and achievement through an awards scheme, and we inform the Multimedia community of our activities through the SIGMM Records, social media and through mailing lists. Information on joining SIGMM can be found at https://www.acm.org/special-interest-groups/sigs/sigmm.
Two Interviews with Renown Datasets Researchers
Authors: Reimat Nacho , Martin Pierre-Etienne
Published: October 2023

This issue of the Dataset Column provides two interviews with the researchers responsible for novel datasets of recent years. In particular, we first interview Nacho Reimat (https://www.cwi.nl/people/nacho-reimat), the scientific programmer responsible for the CWIPC-SXR, one of the first datasets on dynamic, interactive volumetric media. Second, we interview Pierre-Etienne Martin (https://www.eva.mpg.de/comparative-cultural-psychology/staff/pierre-etienne-martin/), responsible for contributions to datasets in the area of sports and culture.