bluuebunny/crossref_metadata_2025 huggingface dataset:
The Vienna Prediction Model for identifying patients at low risk of recurrent venous thromboembolism: a prospective cohort study
Authors: Kyrle Paul A , Eischer Lisbeth , Šinkovec Hana , Gressenberger Paul , Gary Thomas , Brodmann Marianne , Heinze Georg , Eichinger Sabine
Published: September 2023

Background and Aims

Patients with unprovoked venous thromboembolism (VTE) have a high recurrence risk, and guidelines suggest extended-phase anticoagulation. Many patients never experience recurrence but are exposed to bleeding. The aim of this study was to assess the performance of the Vienna Prediction Model (VPM) and to evaluate if the VPM accurately identifies these patients.

Methods

In patients with unprovoked VTE, the VPM was performed 3 weeks after anticoagulation withdrawal. Those with a predicted 1-year recurrence risk of ≤5.5% were prospectively followed. Study endpoint was recurrent VTE over 2 years.

Results

A total of 818 patients received anticoagulation for a median of 3.9 months. 520 patients (65%) had a predicted annual recurrence risk of ≤5.5%. During a median time of 23.9 months, 52 patients had non-fatal recurrence. The recurrence risk was 5.2% [95% confidence interval (CI) 3.2–7.2] at 1 year and 11.2% (95% CI 8.3–14) at 2 years. Model calibration was adequate after 1 year. The VPM underestimated the recurrence risk of patients with a 2-year recurrence rate of >5%. In a post-hoc analysis, the VPM’s baseline hazard was recalibrated. Bootstrap validation confirmed an ideal ratio of observed and expected recurrence events. The recurrence risk was highest in men with proximal deep-vein thrombosis or pulmonary embolism and lower in women regardless of the site of incident VTE.

Conclusions

In this prospective evaluation of the performance of the VPM, the 1-year rate of recurrence in patients with unprovoked VTE was 5.2%. Recalibration improved identification of patients at low recurrence risk and stratification into distinct low-risk categories.
Time-trend treatment effect of cardiac resynchronization therapy with or without defibrillator on mortality: a systematic review and meta-analysis
Authors: Veres Boglárka , Fehérvári Péter , Engh Marie Anne , Hegyi Péter , Gharehdaghi Sara , Zima Endre , Duray Gábor , Merkely Béla , Kosztin Annamária
Published: September 2023

Aims

This study aimed to investigate the impact of cardiac resynchronization therapy with a defibrillator (CRT-D) on mortality, comparing it with CRT with a pacemaker (CRT-P). Additionally, the study sought to identify subgroups, evaluate the time trend in treatment effects, and analyze patient characteristics, considering the changing indications over the past decades.

Methods and results

PubMed, CENTRAL, and Embase up to October 2021 were screened for studies comparing CRT-P and CRT-D, focusing on mortality. Altogether 26 observational studies were selected comprising 128 030 CRT patients, including 55 469 with CRT-P and 72 561 with CRT-D device. Cardiac resynchronization therapy with defibrillator was able to reduce all-cause mortality by almost 20% over CRT-P [adjusted hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.76–0.94; P < 0.01] even in propensity-matched studies (HR: 0.83; 95% CI: 0.80–0.87; P < 0.001) but not in those with non-ischaemic aetiology (HR: 0.95; 95% CI: 0.79–1.15; P = 0.19) or over 75 years (HR: 1.08; 95% CI 0.96–1.21; P = 0.17). When treatment effect on mortality was investigated by the median year of inclusion, there was a difference between studies released before 2015 and those thereafter. Time-trend effects could be also observed in patients’ characteristics: CRT-P candidates were getting older and the prevalence of ischaemic aetiology was increasing over time.

Conclusion

The results of this systematic review of observational studies, mostly retrospective with meta-analysis, suggest that patients with CRT-D had a lower risk of mortality compared with CRT-P. However, subgroups could be identified, where CRT-D was not superior such as non-ischaemic and older patients. An improved treatment effect of CRT-D on mortality could be observed between the early and late studies partly related to the changed characteristics of CRT candidates.
Hyaluronan synthases; mechanisms, myths, & mysteries of three types of unique bifunctional glycosyltransferases
Authors: DeAngelis Paul L , Zimmer Jochen
Published: September 2023

Hyaluronan (HA), the essential [-3-GlcNAc-1-β-4-GlcA-1-β-]n matrix polysaccharide in vertebrates and molecular camouflage coating in select pathogens, is polymerized by “HA synthase” (HAS) enzymes. The first HAS identified three decades ago opened the window for new insights and biotechnological tools. This review discusses current understanding of HA biosynthesis, its biotechnological utility, and addresses some misconceptions in the literature.

HASs are fascinating enzymes that polymerize two different UDP-activated sugars via different glycosidic linkages. Therefore, these catalysts were the first examples to break the “one enzyme/one sugar transferred” dogma. Three distinct types of these bifunctional glycosyltransferases (GTs) with disparate architectures and reaction modes are known. Based on biochemical and structural work, we present an updated classification system. Class I membrane-integrated HASs employ a processive chain elongation mechanism and secrete HA across the plasma membrane. This complex operation is accomplished by functionally integrating a cytosolic catalytic domain with a channel-forming transmembrane region. Class I enzymes, containing a single GT family-2 (GT-2) module that adds both monosaccharide units to the nascent chain, are further subdivided into two groups that construct the polymer with opposite molecular directionalities: Class I-R and I-NR elongate the HA polysaccharide at either the reducing or the non-reducing end, respectively. In contrast, Class II HASs are membrane-associated peripheral synthases with a non-processive, non-reducing end elongation mechanism using two independent GT-2 modules (one for each type of monosaccharide) and require a separate secretion system for HA export. We discuss recent mechanistic insights into HA biosynthesis that promise biotechnological benefits and exciting engineering approaches.
Effects of vertical integration on the healthcare system in China: a systematic review and meta-analysis
Authors: Wang Xin , Yang Enming , Zheng Caiyun , Yuan Shasha
Published: September 2023

Vertical integration is one possible way to improve the performance of a healthcare system; however, its effects are inconsistent, and there is a lack of evidence from undeveloped nations. This study aims to systematically review the evidence regarding effects of vertical integration on healthcare systems in China. We searched PubMed, Embase, Cochrane Library, Web of Science, ProQuest Health & Medicine Collection, China Knowledge Resource Integrated Database and Wanfang databases from April 2009 (initiation of new healthcare reform) to May 2021 for randomized controlled trials (RCTs), controlled before and after (CBA) trials, cohort studies and interrupted time series (ITS) trials. Vertical integration in the included studies must involve both primary health institutions and secondary or tertiary hospitals. After screening 3109 records, we ultimately analysed 47 studies, including 27 CBA trials, 18 RCTs and 2 ITS trials. The narrative synthesis shows that all but three studies indicated that vertical integration improved efficiency (utilization and cost of health services), quality of public health services and medical services, health provider-centred outcomes (knowledge and skill) and patient-centred outcomes (patients’ clinical outcomes, behaviour and satisfaction). Despite the heterogeneity of vertical integration interventions across different studies, the meta-analysis reveals that it lowered diastolic blood pressure (mean difference (MD) −8.41, 95% confidence interval (CI) −15.18 to −1.65) and systolic blood pressure (MD-5.83, 95% CI −9.25 to −2.40) among hypertension patients, and it lowered HbA1c levels (MD −1.95, 95% CI −2.69 to −1.21), fasting blood glucose levels (MD −1.02, 95% CI −1.53 to −0.50) and 2-hour postprandial blood glucose levels (MD −1.78, 95% CI −2.67 to −0.89). The treatment compliance behaviour was improved for hypertension participants (risk ratio (RR) 1.08, 95% CI 1.04–1.13) and for diabetes patients (RR 1.32, 95% CI 1.08–1.61). Vertical integration in China can improve efficiency, quality of care, health provider-centred outcomes and patient-centred outcomes, but high-quality original studies are highly needed.
Translation reinitiation in c.453delC frameshift mutation of KCNH2 producing functional hERG K+ channels with mild dominant negative effect in the heterozygote patient-derived iPSC cardiomyocytes
Authors: Park Na Kyeong , Park Soon-Jung , Park Yun-Gwi , Moon Sung-Hwan , Woo JooHan , Kim Hyun Jong , Kim Sung Joon , Choi Seong Woo
Published: September 2023

The c.453delC (p.Thr152Profs*14) frameshift mutation in KCNH2 is associated with an elevated risk of Long QT syndrome (LQTS) and fatal arrhythmia. Nevertheless, the loss-of-function mechanism underlying this mutation remains unexplored and necessitates an understanding of electrophysiology. To gain insight into the mechanism of the LQT phenotype, we conducted whole-cell patch-clamp and immunoblot assays, utilizing both a heterologous expression system and patient-derived induced pluripotent stem cell-cardiomyocytes (iPSC-CMs) with 453delC-KCNH2. We also explored the site of translational reinitiation by employing LC/MS mass spectrometry. Contrary to the previous assumption of early termination of translation, the findings of this study indicate that the 453delC-KCNH2 leads to an N-terminally truncated hERG channel, a potential from a non-canonical start codon, with diminished expression and reduced current (IhERG). The co-expression with wildtype KCNH2 produced heteromeric hERG channel with mild dominant-negative effect. Additionally, the heterozygote patient-derived iPSC-CMs exhibited prolonged action potential duration and reduced IhERG, which was ameliorated with the use of a hERG activator, PD-118057. The results of our study offer novel insights into the mechanisms involved in congenital LQTS associated with the 453delC mutation of KCNH2. The mutant results in the formation of less functional N-terminal-truncated channels with reduced amount of membrane expression. A hERG activator is capable of correcting abnormalities in both the heterologous expression system and patient-derived iPSC-CMs.
Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcomes
Authors: Selvaratnam Roshan J , Sovio Ulla , Cook Emma , Gaccioli Francesca , Charnock-Jones D Stephen , Smith Gordon C S
Published: September 2023

Background

In pregnancy, women are encouraged to cease smoking and limit caffeine intake. We employed objective definitions of smoking and caffeine exposure to assess their association with adverse outcomes.

Methods

We conducted a case cohort study within the Pregnancy Outcome Prediction study to analyse maternal serum metabolomics in samples from 12, 20, 28 and 36 weeks of gestational age. Objective smoking status was defined based on detectable cotinine levels at each time point and objective caffeine exposure was based on tertiles of paraxanthine levels at each time point. We used logistic and linear regression to examine the association between cotinine, paraxanthine and the risk of pre-eclampsia, spontaneous pre-term birth (sPTB), fetal growth restriction (FGR), gestational diabetes mellitus and birthweight.

Results

There were 914 and 915 women in the smoking and caffeine analyses, respectively. Compared with no exposure to smoking, consistent exposure to smoking was associated with an increased risk of sPTB [adjusted odds ratio (aOR) = 2.58, 95% CI: 1.14 to 5.85)] and FGR (aOR = 4.07, 95% CI: 2.14 to 7.74) and lower birthweight (β = –387 g, 95% CI: –622 g to –153 g). On univariate analysis, consistently high levels of paraxanthine were associated with an increased risk of FGR but that association attenuated when adjusting for maternal characteristics and objective—but not self-reported—smoking status.

Conclusions

Based on objective data, consistent exposure to smoking throughout pregnancy was strongly associated with sPTB and FGR. High levels of paraxanthine were not independently associated with any of the studied outcomes and were confounded by smoking.
Risk of diabetes and cardiovascular diseases in women with vaginal bleeding before 20 gestational weeks: Danish population-based cohort study
Authors: Dudukina Elena , Horváth-Puhó Erzsébet , Sørensen Henrik Toft , Ehrenstein Vera
Published: September 2023

Background

Women’s reproductive health is associated with cardiovascular morbidity. However, an association of vaginal bleeding (VB) in pregnancy with diabetes and cardiovascular outcomes has scarcely been investigated.

Methods

We conducted a population-based cohort study in Denmark (1994–2018). Using nationwide registries, among 903 327 women we identified 1 901 725 pregnancies: 39 265 ended in childbirth and were affected by VB; 1 389 285 ended in childbirth and were unaffected by VB; 333 785 ended in a termination, and 139 390 ended in a miscarriage. The outcomes were diabetes types 1 and 2, hypertension, ischaemic heart disease including myocardial infarction, atrial fibrillation or flutter, heart failure and ischaemic and haemorrhagic stroke. We computed incidence rates and hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, calendar year of pregnancy end, morbidities and reproductive and socioeconomic factors, using inverse probability of treatment-weighted Cox proportional hazards regression.

Results

In analyses of VB-affected vs VB-unaffected pregnancies, aHRs were 1.15 (1.03–1.28) for diabetes type 1, 1.19 (1.13–1.26) for diabetes type 2, 1.19 (1.14–1.25) for hypertension, 1.26 (1.16–1.37) for ischaemic heart disease, 1.21 (1.03–1.42) for myocardial infarction, 1.32 (1.14–1.51) for atrial fibrillation or flutter and 1.23 (0.99–1.52) for heart failure. aHRs were 1.41 (1.26–1.57) and 1.46 (1.23–1.72) for ischaemic and haemorrhagic stroke, respectively. When contrasting VB-affected pregnancies with terminations, aHRs were up to 1.3-fold increased for diabetes and hypertension; however, when contrasting VB-affected pregnancies with miscarriages, estimates were below or close to the null value.

Conclusions

Women’s risks of diabetes and cardiovascular outcomes later in life were increased following VB-affected vs VB-unaffected pregnancy or termination, but not following VB-affected pregnancy vs miscarriage.
Deep sequential neural network models improve stratification of suicide attempt risk among US veterans
Authors: Martinez Carianne , Levin Drew , Jones Jessica , Finley Patrick D , McMahon Benjamin , Dhaubhadel Sayera , Cohn Judith ,   Million Veteran Program,   MVP Suicide Exemplar Workgroup, Oslin David W , Kimbrel Nathan A , Beckham Jean C
Published: September 2023

Objective

To apply deep neural networks (DNNs) to longitudinal EHR data in order to predict suicide attempt risk among veterans. Local explainability techniques were used to provide explanations for each prediction with the goal of ultimately improving outreach and intervention efforts.

Materials and methods

The DNNs fused demographic information with diagnostic, prescription, and procedure codes. Models were trained and tested on EHR data of approximately 500 000 US veterans: all veterans with recorded suicide attempts from April 1, 2005, through January 1, 2016, each paired with 5 veterans of the same age who did not attempt suicide. Shapley Additive Explanation (SHAP) values were calculated to provide explanations of DNN predictions.

Results

The DNNs outperformed logistic and linear regression models in predicting suicide attempts. After adjusting for the sampling technique, the convolutional neural network (CNN) model achieved a positive predictive value (PPV) of 0.54 for suicide attempts within 12 months by veterans in the top 0.1% risk tier. Explainability methods identified meaningful subgroups of high-risk veterans as well as key determinants of suicide attempt risk at both the group and individual level.

Discussion and conclusion

The deep learning methods employed in the present study have the potential to significantly enhance existing suicide risk models for veterans. These methods can also provide important clues to explore the relative value of long-term and short-term intervention strategies. Furthermore, the explainability methods utilized here could also be used to communicate to clinicians the key features which increase specific veterans’ risk for attempting suicide.
Domestication is associated with increased interspecific hybrid compatibility in landfowl (order: Galliformes)
Authors: Alfieri James M , Hingoranee Reina , Athrey Giridhar N , Blackmon Heath
Published: September 2023

Some species are able to hybridize despite being exceptionally diverged. The causes of this variation in accumulation of reproductive isolation remain poorly understood, and domestication as an impetus or hindrance to reproductive isolation remains to be characterized. In this study, we investigated the role of divergence time, domestication, and mismatches in morphology, habitat, and clutch size among hybridizing species on reproductive isolation in the bird order Galliformes. We compiled and analyzed hybridization occurrences from literature and recorded measures of postzygotic reproductive isolation. We used a text-mining approach leveraging a historical aviculture magazine to quantify the degree of domestication across species. We obtained divergence time, morphology, habitat, and clutch size data from open sources. We found 123 species pairs (involving 77 species) with known offspring fertility (sterile, only males fertile, or both sexes fertile). We found that divergence time and clutch size were significant predictors of reproductive isolation (McFadden’s Pseudo-R2 = 0.59), but not habitat or morphological mismatch. Perhaps most interesting, we found a significant relationship between domestication and reproductive compatibility after correcting for phylogeny, removing extreme values, and addressing potential biases (F1,74 = 5.43, R2 = 0.06, P-value = 0.02). We speculate that the genetic architecture and disruption in selective reproductive regimes associated with domestication may impact reproductive isolation, causing domesticated species to be more reproductively labile.
Lysosomal control of dendritic cell function
Authors: Yang Jia , Rong Shan-Jie , Zhou Hai-Feng , Yang Chao , Sun Fei , Li Jun-Yi
Published: September 2023

Lysosomal compartments undergo extensive remodeling during dendritic cell (DC) activation to meet the dynamic functional requirements of DCs. Instead of being regarded as stationary and digestive organelles, recent studies have increasingly appreciated the versatile roles of lysosomes in regulating key aspects of DC biology. Lysosomes actively control DC motility by linking calcium efflux to the actomyosin contraction, while enhanced DC lysosomal membrane permeability contributes to the inflammasome activation. Besides, lysosomes provide a platform for the transduction of innate immune signaling and the intricate host-pathogen interplay. Lysosomes and lysosome-associated structures are also critically engaged in antigen presentation and cross-presentation processes, which are pivotal for the induction of antigen-specific adaptive immune response. Through the current review, we emphasize that lysosome targeting strategies serve as vital DC-based immunotherapies in fighting against tumor, infectious diseases, and autoinflammatory disorders.
Artificial intelligence–based image analysis in clinical testing: lessons from cervical cancer screening
Authors: Egemen Didem , Perkins Rebecca B , Cheung Li C , Befano Brian , Rodriguez Ana Cecilia , Desai Kanan , Lemay Andreanne , Ahmed Syed Rakin , Antani Sameer , Jeronimo Jose , Wentzensen Nicolas , Kalpathy-Cramer Jayashree , De Sanjose Silvia , Schiffman Mark
Published: September 2023

Novel screening and diagnostic tests based on artificial intelligence (AI) image recognition algorithms are proliferating. Some initial reports claim outstanding accuracy followed by disappointing lack of confirmation, including our own early work on cervical screening. This is a presentation of lessons learned, organized as a conceptual step-by-step approach to bridge the gap between the creation of an AI algorithm and clinical efficacy. The first fundamental principle is specifying rigorously what the algorithm is designed to identify and what the test is intended to measure (eg, screening, diagnostic, or prognostic). Second, designing the AI algorithm to minimize the most clinically important errors. For example, many equivocal cervical images cannot yet be labeled because the borderline between cases and controls is blurred. To avoid a misclassified case-control dichotomy, we have isolated the equivocal cases and formally included an intermediate, indeterminate class (severity order of classes: case>indeterminate>control). The third principle is evaluating AI algorithms like any other test, using clinical epidemiologic criteria. Repeatability of the algorithm at the borderline, for indeterminate images, has proven extremely informative. Distinguishing between internal and external validation is also essential. Linking the AI algorithm results to clinical risk estimation is the fourth principle. Absolute risk (not relative) is the critical metric for translating a test result into clinical use. Finally, generating risk-based guidelines for clinical use that match local resources and priorities is the last principle in our approach. We are particularly interested in applications to lower-resource settings to address health disparities. We note that similar principles apply to other domains of AI-based image analysis for medical diagnostic testing.
Specific antioxidant enzymes are involved in the freeze-thawing response of industrial baker’s yeasts
Authors: Kronberg María F , Terlizzi Natalia L , Galvagno Miguel A
Published: September 2023

In this study, the biochemical basis of resistance to slow freezing and thawing (F-T) stress was explored in two baker yeast industrial strains of Saccharomyces cerevisiae that presented differential tolerance to freezing in order to be in the frozen bakery industry. Strain Y8, used commercially in sweet baking doughs, exhibited greater stress tolerance than Y9, a strain employed in regular doughs. Survival of Y8 was higher than that of Y9 (30% vs 12%) after F-T or other reactive oxygen species (ROS) inducing stresses compared to their non-stressed controls. The superior F-T tolerance of Y8 was related to its lower ROS accumulation capacity, determined by fluorometry in cell-free extracts and in vivo, by fluorescence microscopy upon F-T, being Y8 ROS accumulation 2-fold lower than that of Y9. That, in turn, could be positively associated with Y8’s higher constitutive activities of cytosolic catalase (CAT) and superoxide dismutase by a significant activation (25%) of Y8 CAT after F-T. That would complement the protective effects of other protectant molecules like trehalose, present at high concentration in this strain.
Myocardial Ischemia
Authors: Bursian Alberto , Mohamed Basma
Published: September 2023

Perioperative myocardial ischemia or myocardial injury is the most common cause of perioperative cardiac complications in patients undergoing noncardiac surgery. Perioperative cardiac complications include cardiac death, heart failure, ventricular tachycardia, and nonfatal myocardial infarction. These complications occur in up to 5% of noncardiac surgery patients. Also, there is a larger group of patients who have a rise in troponin, a biomarker of cardiac injury, but no symptoms and no evidence of myocardial ischemia on electrocardiogram. In this chapter, we will focus on the evaluation and management of perioperative myocardial ischemia or infarction in patients undergoing noncardiac surgery. The etiology of perioperative myocardial ischemia can be plaque rupture versus supply-demand mismatch as a result of different factors including the stress of surgery and hemodynamic changes. Plaque rupture as a result may present as ST-elevation myocardial infarction, and this would warrant urgent involvement of the cardiologists for a possible intervention. Perioperative non-ST-elevation myocardial infarction may result from supply-demand mismatch. This would need modification of risk factors perioperatively and can extend to postoperative care that includes observation and possible intervention. As a result of the high risk of perioperative cardiac morbidity, patients are better screened using different risk assessment tools and referred to preoperative assessment based on their risk factors and the risk of surgery. It is advised to be proactive in the management of patients at high risk of perioperative major adverse cardiac events.
Crisis Resource Management
Authors: Berkow Lauren C. , Ruskin Keith
Published: September 2023

Anesthesia was the first medical specialty to recognize the role of human factors and crisis resource management (CRM) in improving patient safety. This chapter will review the basics of CRM, including teamwork, communication, shared mental models, and situation awareness. Lack of good communication is one of the most common causes of adverse events and medical errors. Good communication fosters clear team roles and collective decision-making. Strategies that improve communication, foster teamwork, and anticipate and plan for emergencies can have a significant impact on outcome. The chapter will also review the role of cognitive aids and checklists in managing off-nominal and critical events. The use of checklists and cognitive aids can help standardize patient care as well as ensure that vital steps are not skipped in the emergent setting. The use of simulation and team training can improve communication in the operating room.
Ambivalence, Decisional Balance, and Equipoise
Authors: D’Alesio Mark , Kelly Thomas M. , Douaihy Antoine
Published: September 2023

This chapter reviews the concepts and interaction of ambivalence, decisional balance, and equipoise. Ambivalence is the classic “push-pull” of the competing thoughts and feelings patients experience in relation to an issue they feel the need to confront. Decisional balance has been described as a technical tool to measure the relative weight of pros and cons and of the benefits and costs of change. Equipoise is defined as a conscious decision to remain neutral and not intentionally steer a patient toward making a specific choice, direction, or change. The authors discuss recognizing ambivalence as a normal process of behavior change and the importance of accepting each patient’s thoughts and feelings in a nonjudgmental, nondictatorial atmosphere. This results in a method for self-determination of patient goals and the means of achieving them. A personal reflection is offered by one of the authors regarding his use of Motivational Interviewing in helping a man resolve his ambivalence regarding whether or not to adhere to medication.
Motivational Interviewing in Primary Care Settings
Authors: Windler Carolyn , Rossiter Brianna
Published: September 2023

This chapter reviews the application of Motivational Interviewing (MI) in primary care (PC) settings, and it focuses on some of the most common chronic health behavior problems encountered by primary care practitioners. MI has a crucial role in healthcare generally, and in the individual treatment of people with common, yet often chronic, and even fatal, conditions. We describe MI in the context of medication adherence, chronic pain management, and tobacco cessation, as well as health maintenance screenings. The goal is to increase the broad utility of MI throughout PC medicine, to maximize positive healthcare outcomes, and strengthen practitioner confidence with this widely effective clinical approach.
Motivational Interviewing and Obesity
Authors: Leikam Lindsay , Rofey Dana , Gold Melanie A.
Published: September 2023

Obesity is an increasingly common and serious health problem in the United States, and it leads to physical health risks such as cardiovascular and metabolic abnormalities. Further, obesity increases risk for psychosocial stressors in childhood and adolescence, including increased bullying by peers and being subject to negative bias by peers, teachers, and family members. This chapter reviews the evidence for the effectiveness of Motivational Interviewing (MI) with obese adults and adolescents and presents the application of MI, showing the use of open-ended questions, affirmations, reflective listening, and summaries in clinical encounters. An important element of the chapter is the presentation on combining therapies such as MI and cognitive restructuring. Several clinical vignettes demonstrate the value of this treatment for improving health-related clinical outcomes for patients struggling with obesity.
Healing Justice Frameworks and Motivational Interviewing
Authors: Auster Lauren , Chang Judy , Miller Elizabeth
Published: September 2023

Intimate partner violence (IPV) is defined as physical and sexual violence, emotional abuse, and stalking by an intimate partner. This chapter reviews the research on IPV and discusses how Motivational Interviewing (MI) provides patients experiencing IPV a supportive, empathic approach. The authors indicate that MI is such an approach as patients do not want to feel pressured but want health trainees and practitioners to talk to them about the violence in a safe and private setting, without pushing for disclosure. IPV patients primarily need an offer of tangible medical and social resources for support. Application of one framework for treatment called CUES (confidentiality, universal education, empowerment, and support) is described. Three scenarios with patients are presented, demonstrating the use of MI in treatment with patients experiencing IPV.
Motivational Interviewing in e-Health and Telehealth
Authors: Hovis Elizabeth , Latronica James
Published: September 2023

Considering the mass expansion of telehealth, or remote medical care services, rolled out during the COVID-19 pandemic, it is important to touch on the history, benefits, challenges, and implementation of Motivational Interviewing (MI) in clinical encounters through the framework of remote engagement. This chapter reviews the history and research evidence for the use of telehealth in general, and the integration of MI into telehealth services specifically. Best practice evidence is presented, and additional foci are the technological challenges of delivering telehealth and issues related to billing for telehealth services. Personal reflections are offered on cases where patients request telehealth services because telehealth appointments: (1) ease the burden of travel to appointments, (2) help patients save money, and (3) reduce the risk of contracting communicable diseases.
Learning and Experiencing Motivational Interviewing
Authors: Boness Cassandra , Douaihy Antoine
Published: September 2023

Learning Motivational Interviewing (MI) is much more than learning and strengthening new clinical strategies for facilitating behavior change. In this chapter we argue that learning MI is more about how we approach the task of learning than the task itself. In this context, Miller and Moyers’s (2007) roughly additive developmental stages are reviewed. Each stage is intended to build the foundation for the next. This eight-stage framework can be useful for understanding the training sequence and for identifying stages where trainees may get stuck when learning MI. Case examples are offered describing how open-ended questions, affirmations, reflective listening, and summaries can be used to increase change talk and help patients develop change plans. Varying methods for learning MI, such as deliberate practice and coaching and modeling are presented.
WALLABY pre-pilot survey: ultra-diffuse galaxies in the Eridanus supergroup
Authors: For B-Q , Spekkens K , Staveley-Smith L , Bekki K , Karunakaran A , Catinella B , Koribalski B S , Lee-Waddell K , Madrid J P , Murugeshan C , Rhee J , Westmeier T , Wong O I , Zaritsky D , Donnerstein R
Published: September 2023

We present a pilot study of the atomic neutral hydrogen gas (H i) content of ultra-diffuse galaxy (UDG) candidates. In this paper, we use the pre-pilot Eridanus field data from the Widefield ASKAP L-band Legacy All-sky Blind Survey to search for H i in UDG candidates found in the Systematically Measuring Ultra-diffuse Galaxies survey (SMUDGes). We narrow down to 78 SMUDGes UDG candidates within the maximum radial extents of the Eridanus subgroups for this study. Most SMUDGes UDGs candidates in this study have effective radii smaller than 1.5 kpc and thus fail to meet the defining size threshold. We only find one H i detection, which we classify as a low-surface-brightness dwarf. Six putative UDGs are H i-free. We show the overall distribution of SMUDGes UDG candidates on the size–luminosity relation and compare them with low-mass dwarfs on the atomic gas fraction versus stellar mass scaling relation. There is no correlation between gas-richness and colour indicating that colour is not the sole parameter determining their H i content. The evolutionary paths that drive galaxy morphological changes and UDG formation channels are likely the additional factors to affect the H i content of putative UDGs. The actual numbers of UDGs for the Eridanus and NGC 1332 subgroups are consistent with the predicted abundance of UDGs and the halo virial mass relation, except for the NGC 1407 subgroup, which has a smaller number of UDGs than the predicted number. Different group environments suggest that these putative UDGs are likely formed via the satellite accretion scenario.
101 eclipsing quadruple star candidates discovered in TESS full frame images
Authors: Kostov Veselin B , Powell Brian P , Rappaport Saul A , Borkovits Tamás , Gagliano Robert , Jacobsy Thomas L , Jayaraman Rahul , Kristiansen Martti H , LaCourse Daryll M , Mitnyan Tibor , Omohundro Mark , Orosz Jerome , Pál András , Schmitt Allan R , Schwengeler Hans M , Terentev Ivan A , Torres Guillermo , Barclay Thomas , Vanderburg Andrew , Welsh William
Published: September 2023

We present our second catalogue of quadruple star candidates, containing 101 systems discovered in TESS Full-Frame Image data. The targets were initially detected as eclipsing binary stars with the help of supervised machine learning methods applied to sectors (Sectors 1 through 54). A dedicated team of citizen scientists subsequently identified through visual inspection two sets of eclipses following two different periods. All 101 systems presented here pass comprehensive photocenter motion tests confirming that both sets of eclipses originate from the target star. Some of the systems exhibit prominent eclipse time variations suggesting dynamical interactions between the two component binary stars. One target is an eclipsing quintuple candidate with a (2 + 1) + 2 hierarchical configuration, such that the (2 + 1) subsystem produces eclipses on the triple orbit as well. Another has recently been confirmed as the second shortest period quadruple reported to date. This catalogue provides ephemerides, eclipse depths and durations, sample statistics, and highlights potentially interesting targets for future studies.
Hyperfine collisional excitation of ammonia by molecular hydrogen
Authors: Loreau J , Faure A , Lique F , Demes S , Dagdigian P J
Published: September 2023

Ammonia is one of the most widely observed molecules in space, and many observations are able to resolve the hyperfine structure due to the electric quadrupole moment of the nitrogen nucleus. The observed spectra often display anomalies in the satellite components of the lines, which indicate substantial deviations from the local thermodynamic equilibrium. The interpretation of the spectra thus requires the knowledge of the rate coefficients for the hyperfine excitation of NH3 induced by collisions with H2 molecules, the dominant collider in the cold interstellar medium. In this paper, we present the first such calculations using a recoupling approach. The rate coefficients are obtained for all hyperfine levels within rotation–inversion levels up to j = 4 and temperatures up to 100 K by means of quantum scattering close-coupling calculations on an accurate, five-dimensional, potential energy surface. We show that the rate coefficients depart significantly from those obtained with the statistical approach and that they do not conform to any simple propensity rules. Finally, we perform radiative transfer calculations to illustrate the impact of our new rate coefficients by modelling the hyperfine line intensities of the inversion transition in ground-state para-NH3 (jk = 11) and of the rotational transition 10 → 00 in ortho-NH3.
Upregulated TIMP1 facilitates and coordinates myometrial contraction by decreasing collagens and cell adhesive capacity during human labor
Authors: Bao Junjie , Wang Xiaodi , Chen Lina , Wen Bolun , Gao Qiu , Pan Xiuyu , Chen Yunshan , Ji Kaiyuan , Liu Huishu
Published: September 2023

Myometrial contraction is one of the key events involved in parturition. Increasing evidence suggests the importance of the extracellular matrix (ECM) in this process, in addition to the functional role of myometrial smooth muscle cells, and our previous study identified an upregulated tissue inhibitor of metalloproteinase 1 (TIMP1) in human laboring myometrium compared to nonlabor samples. This study aimed to further explore the potential role of TIMP1 in myometrial contraction. First, we confirmed increased myometrial TIMP1 levels in labor and during labor with cervical dilation using transcriptomic and proteomic analyses, followed by real-time PCR, western blotting, and immunohistochemistry. Then, a cell contraction assay was performed to verify the decreased contractility after TIMP1 knockdown in vitro. To further understand the underlying mechanism, we used RNA-sequencing analysis to reveal the upregulated genes after TIMP1 knockdown; these genes were enriched in collagen fibril organization, cell adhesion, and ECM organization. Subsequently, a human matrix metalloproteinase (MMP) array and collagen staining were performed to determine the TIMPs, MMPs and collagens in laboring and nonlabor myometrium. A real-time cell adhesion assay was used to detect cell adhesive capacity. The results showed upregulated MMP8 and MMP9, downregulated collagens, and attenuated cell adhesive capacity in laboring myometrium, while lower MMP levels and higher collagen levels and cell adhesive capacity were observed in nonlabor. Moreover, TIMP1 knockdown led to restoration of cell adhesive capacity. Together, these results indicate that upregulated TIMP1 during labor facilitates and coordinates myometrial contraction by decreasing collagen and cell adhesive capacity, which may provide effective strategies for the regulation of myometrial contraction.
In vitro chemopreventive and cytotoxic effects of Amazon mosses Leucobryum martianum (Hornsch.) and Leucobryum laevifolium (Broth) extracts
Authors: Fernandes Andreia da Silva , de Oliveira Carine Gonçalves , Evangelista Heitor , Sulamita D.S. Maria , Araujo-Lima Carlos Fernando , Felzenszwalb Israel
Published: September 2023

Several bioactive compounds, such as polyphenols, demonstrate low toxicity and prominent effects on cancer cells with antioxidant, anti-inflammatory, and antitumor activities. Such compounds can be found in Amazon mosses Leucobryum martianum (Hornsch.) Hampe ex Müll. Hal. (Hornsch.) and Leucobryum laevifolium (Broth). Antimutagenic assay with Salmonella enterica serovar Typhimurium and cytotoxicity with different eukaryotic cell lines were carried out to screen aqueous, hydroalcoholic, and ethanolic extracts of those Amazon mosses for anticancer potential. The results indicate the capacity of all extracts of both mosses to exert chemopreventive effects against 4-nitroquinoline-N-oxide (4NQO) and 2-aminoanthracene (2-AA), which are direct or indirect mutagens. In particular, the ethanolic and aqueous extract from L. martianum. The ethanolic extract from L. martianum induces significant cytotoxicity by mitochondrial metabolism and cell membrane disruption pathways to tumor or non-tumor cells. The aqueous extract from L. martianum showed a mainly cytotoxic response in the HepG2 cells, a human liver carcinoma, reaching ~90% cytotoxicity. The same extract did not induce significant damage to normal liver cells (F C3H cells) by membrane interaction pathway. The selective cytotoxicity in the aqueous extract of L. martianum makes it a candidate against liver cancer. Further studies, including in vivo models, are necessary to validate the efficacy and safety of the aqueous extract of L. martianum.
Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: a systematic review
Authors: Wagnew Fasil , Gray Darren , Tsheten Tsheten , Kelly Matthew , Clements Archie C A , Alene Kefyalew Addis
Published: September 2023

Context

Nutritional interventions substantially improve tuberculosis (TB) treatment outcomes and prevent complications. However, there is limited evidence about the connections between having nutritional support and TB treatment adherence.

Objective

The aim of this study was to determine the effectiveness of nutritional support in improving treatment adherence among patients with TB.

Data Sources

Databases, including PubMed, Embase (Ovid), Web of Science, and Scopus, were comprehensively reviewed to identify relevant studies reporting the impacts of nutritional support on TB treatment adherence.

Data Extraction

Two authors independently screened the title, abstracts, and full article texts to identify eligible studies and assess the risk of bias. Observational and interventional studies were included.

Data Analysis

A narrative synthesis approach was used to summarize the findings qualitatively.

Results

From the search, 3059 publications were identified; of these, 8 studies were included in this systematic review. Three types of nutritional interventions were identified: food baskets (eg, energy, micronutrient- or macronutrient-enriched food support), nutritional advice and guidance, and incentives for buying foods. Although 5 studies reported that nutritional support significantly improved treatment adherence in patients with TB, 3 studies showed that nutritional support had no effect on TB treatment adherence.

Conclusions

Providing nutritional support may improve adherence to TB treatment. However, more well-powered, high-quality trials are warranted to demonstrate the effect of nutrition support on cost-effectively improving adherence to TB treatment.

Systematic Review Registration

PROSPERO registration no. CRD42023392162.
Roles and the Moral Practice of Precedent
Authors: Van Wees Nathan
Published: September 2023

Some recent work in legal theory argues that legal questions boil down to moral questions. On this view, lawyers and judges are ultimately interested in the moral effect of things done by legal institutions. This view has been called the ‘new legal anti-positivism’. So far, it has not given a convincing account of precedent. That is, it has not explained how moral reasons can account for what judges do in practice when they follow past decisions. Any successful account must explain the central features of this practice: why lower courts follow higher courts, and not the other way around; the difference between ratio and obiter; and the situations in which judges distinguish or overrule past decisions. This article gives a non-positivist account that meets this challenge, by giving a prominent place to the moral importance of roles. The account avoids some problems faced by existing non-positivist accounts of precedent.
Surgical De-Escalation in Medullary Thyroid Cancer: A Commentary
Authors: Ginzberg Sara P , Krumeich Lauren N
Published: September 2023

This commentary remarks on the results of a recent study that investigated patterns and outcomes of recurrent medullary thyroid cancer to inform decision making on the optimal management of lateral neck lymph node compartments in medullary thyroid cancer.
Slave Soldiers, British Colonial Rule, and Armed Resistance
Authors: Roach Steven C.
Published: September 2023

This chapter traces the roots of South Sudan’s liberation movement to the rise of slave soldiers during the Turkiyyah period (1820–1885) and the efforts by the Mahdist state to end colonial oppression (1885–1899). It then examines British colonial rule and how this divided Sudan into a modernized North and undeveloped South during the first half of the twentieth century. The chapter addresses the impact of Britain’s indirect rule on tribal relations and development in the South. It then moves on to analyze the rise of armed rebellion, or the Anyanya, during Sudan’s first civil war (1955–1972), before finally turning to the new autonomous government in the South (1972–1983). It shows how Khartoum’s lack of investment in its institutions and infrastructure created tensions and problems that eventually led to the outbreak of Sudan’s second civil war.
A Transitional Government and the Prospects for Peace and National Unity
Authors: Roach Steven C.
Published: September 2023

This concluding chapter analyzes the short and long-term challenges of implementing R-ARCSS, including consensus building, intercommunal violence, party infighting, COVID-19, corruption in the oil market, and demilitarizing patronage. To meet these challenges and reduce the tensions in RTGoNU, I argue that the parties need to adopt an integrative approach to governing or implementing R-ARCSS, which links the present (government action) with past and future objectives through a concerted balance of justice, accountability, peace, and democracy. The fact that the national elite continues to repress civil society in the peace process underscores the deep-seated exclusion in the country. In addressing this underlying problem, then, I shall offer various ideas and strategies regarding what I call an integrative social contract as well as the proper alignment of regional politics with long-term peace.
Leisure in a Technological World
Authors: Elliston Clark
Published: September 2023

Twentieth-century advances in both industry and technology promised a future without toil and labor—but this future did not come to pass. Instead, Americans work longer and harder than ever before, despite enjoying more material goods than in the past. Concomitantly, leisure is now alternately suppressed under the celebration of ‘hard work’ and ‘commitment,’ on one hand, or elevated as the pre-eminent end of human life, on the other. The distortion inherent in both alternatives leads to fundamental problems, since leisure is central to genuine human flourishing. In this chapter, Elliston builds on these realities to argue that our philosophical technophilia, so integral to the diminishment of labor, leisure, and play, seriously overlooks aspects of Western modernity which threaten the foundations of human flourishing. He concludes that the very aspects of technological advance that have contributed much to the betterment of humankind also contain within them seeds of destruction if left unchallenged.