bluuebunny/crossref_metadata_2025 huggingface dataset:
HDV RNA assays: Performance characteristics, clinical utility, and challenges
Authors: Wedemeyer Heiner , Leus Mitchell , Battersby Thomas R. , Glenn Jeffrey , Gordien Emmanuel , Kamili Saleem , Kapoor Hema , Kessler Harald H. , Lenz Oliver , Lütgehetmann Marc , Mixson-Hayden Tonya , Simon Christian O. , Thomson Michael , Westman Gabriel , Miller Veronica , Terrault Norah , Lampertico Pietro ,   On behalf of the HDV RNA Assays Writing Group at the HBV Forum
Published: August 2023

Coinfection with HBV and HDV results in hepatitis D, the most severe form of chronic viral hepatitis, frequently leading to liver decompensation and HCC. Pegylated interferon alpha, the only treatment option for chronic hepatitis D for many years, has limited efficacy. New treatments are in advanced clinical development, with one recent approval. Diagnosis and antiviral treatment response monitoring are based on detection and quantification of HDV RNA. However, the development of reliable HDV RNA assays is challenged by viral heterogeneity (at least 8 different genotypes and several subgenotypes), intrahost viral diversity, rapid viral evolution, and distinct secondary structure features of HDV RNA. Different RNA extraction methodologies, primer/probe design for nucleic acid tests, lack of automation, and overall dearth of standardization across testing laboratories contribute to substantial variability in performance characteristics of research-based and commercial HDV RNA assays. A World Health Organization (WHO) standard for HDV RNA, available for about 10 years, has been used by many laboratories to determine the limit of detection of their assays and facilitates comparisons of RNA levels across study centers. Here we review challenges for robust pan genotype HDV RNA quantification, discuss particular clinical needs and the importance of reliable HDV RNA quantification in the context of drug development and patient monitoring. We summarize distinct technical features and performance characteristics of available HDV RNA assays. Finally, we provide considerations for the use of HDV RNA assays in the context of drug development and patient monitoring.
Invasive pulmonary aspergillosis in the ICU: tale of a broadening risk profile
Authors: Koulenti Despoina , Papathanakos Georgios , Blot Stijn
Published: August 2023

Purpose of review

In the absence of histopathological proof, the diagnosis of invasive pulmonary aspergillosis (IPA) is usually based on mycology (not on tissue), medical imaging, and the patient's risk profile for acquiring invasive fungal disease. Here, we review the changes in risk profile for IPA that took place over the past decades.

Recent findings

In the early 2000s IPA was considered exclusively a disease of immunocompromised patients. Particularly in the context of critical illness, the risk profile has been broadened steadily. Acute viral infection by influenza or SARS-Cov-2 are now well recognized risk factors for IPA.

The classic risk profile (‘host factors’) reflecting an immunocompromised status was first enlarged by a spectrum of chronic conditions such as AIDS, cirrhosis, and chronic obstructive pulmonary disease. In the presence of critical illness, especially characterized by sepsis and/or severe respiratory distress, any chronic condition could add to the risk profile. Recently, acute viral infections have been associated with IPA leading to the concepts of influenza-associated IPA and COVID-19-associated IPA. These viral infections may affect patients without underlying disease. Hence, the risk for IPA is now a reality for ICU patients, even in the absence of any chronic conditions.
Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?
Authors: Lyons Patrick G. , McEvoy Colleen A. , Hayes-Lattin Brandon
Published: August 2023

Purpose of review

Care and outcomes of critically ill patients with cancer have improved over the past decade. This selective review will discuss recent updates in sepsis and acute respiratory failure among patients with cancer, with particular focus on important opportunities to improve outcomes further through attention to phenotyping, predictive analytics, and improved outcome measures.

Recent findings

The prevalence of cancer diagnoses in intensive care units (ICUs) is nontrivial and increasing. Sepsis and acute respiratory failure remain the most common critical illness syndromes affecting these patients, although other complications are also frequent. Recent research in oncologic sepsis has described outcome variation – including ICU, hospital, and 28-day mortality – across different types of cancer (e.g., solid vs. hematologic malignancies) and different sepsis definitions (e.g., Sepsis-3 vs. prior definitions). Research in acute respiratory failure in oncology patients has highlighted continued uncertainty in the value of diagnostic bronchoscopy for some patients and in the optimal respiratory support strategy. For both of these syndromes, specific challenges include multifactorial heterogeneity (e.g. in etiology and/or underlying cancer), delayed recognition of clinical deterioration, and complex outcomes measurement.

Improving outcomes in oncologic critical care requires attention to the heterogeneity of cancer diagnoses, timely recognition and management of critical illness, and defining appropriate ICU outcomes.
Central line associated and primary bloodstream infections
Authors: Stewart Adam G. , Laupland Kevin B. , Tabah Alexis
Published: August 2023

Purpose of review

Primary and intravascular catheter-associated bloodstream infections (CA-BSIs) represent an important clinical entity in the intensive care unit (ICU) being associated with significant morbidity and mortality. The purpose of this review was to examine the recently published data on epidemiology and management of CA-BSI and other primary BSIs specifically within the context of the ICU.

Recent findings

In critically ill patients, the pooled prevalence of primary and CA-BSI from contemporary studies was 19.7–40.7% and 26.4–37.3% of all BSIs, respectively. Failure to achieve source control (i.e., removal of catheter in CA-BSI) is associated with higher mortality. Higher severity scores and durations of ICU stay and catheter insertion are well established risk factors for CA-BSI. The use of prevention bundles when inserting a central venous line is able to reduce CA-BSI incidence from 4 to 1.6 episodes per 1000 central venous catheter days. Differential time-to-positivity of paired blood cultures may assist in the diagnosis of CA-BSI.

Primary BSI is frequently observed in ICU cohorts and has a poor effect on outcome. Surveillance for BSI among patients admitted to ICUs is fundamental to inform healthcare service delivery, design preventive approaches, to track resistance, and detect emerging pathogens.
Breath of fresh insight: unraveling the evolution of our understanding of cystic fibrosis pulmonary exacerbations
Authors: Somayaji Ranjani , Quon Bradley S.
Published: August 2023

Purpose of review

Pulmonary exacerbations are critical events with significant negative impacts in persons with cystic fibrosis, but their diagnosis and management are highly variable. Highly effective modulator therapies have greatly improved health and reduced exacerbation events, but have also reshaped how they present. This review discusses the complexities of the diagnosis and management of pulmonary exacerbations as well as the emerging work and evidence in this area.

Recent findings

The shifting epidemiology and our understanding of risk factors for pulmonary exacerbations are discussed. As symptoms may be more subtle in the modulator context, novel technologies including studies of remote monitoring are presented. The continued relevance of pulmonary exacerbations, the heterogeneity in their management, as well as current and forthcoming clinical trials to optimize treatment approaches are detailed.

In spite of the dramatic reductions in pulmonary exacerbations, airway infections persist, a proportion of persons with cystic fibrosis either on or off modulator therapies continue to experience exacerbation events, and long-term data is lacking. Innovative approaches and studies will be crucial to enable standardized and generalizable strategies to improve outcomes in persons with cystic fibrosis.
External validation of the FAMISH predicting score for early gastric cancer with endoscopic submucosal dissection
Authors: Niu Zhennan , Liang Donghong , Guan Chaoyong , Zheng Yang , Meng Changjuan , Sun Xiaofang , Liu Zhuang
Published: August 2023

Objective

To externally validate the robustness of the FAMISH predicting score designed to estimate the risk of metachronous gastric lesions (MGLs) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).

Methods

This multicenter, retrospective study included 618 patients with EGC who underwent curative ESD at two tertiary referral teaching hospitals between January 2014 and December 2019. FAMISH score was a composite indicator of age, sex, family history, corpus intestinal metaplasia, synchronous lesions, and H. pylori infection. Discrimination, calibration, and risk stratification of these scores were assessed. Associations between MGL characteristics and FAMISH scores were also explored.

Results

After a median follow-up period of 60 months, 83 of 618 patients (13.4%) developed MGL. The discrimination ability according to the area under the curve was 0.708 (95% CI, 0.645–0.772) for predicting the 5-year MGL. The calibration results showed good consistency between the predicted and actual MGL (Hosmer-Lemeshow, P > 0.05). In terms of risk stratification, the 5-year MGL rates were 4.1% (95% CI, 1.6%–6.5%), 10.8% (95% CI, 7.2%–14.3%), and 32.1% (95% CI, 20.9%–41.7%) in the low-, intermediate-, and high-risk groups, respectively (P < 0.001). For patients with MGL, the curative resection rate of ESD was significantly higher in the low- and intermediate-risk groups than in the high-risk group (100% vs. 80%, P = 0.037).

Conclusion

The FAMISH predicting score was externally validated and can be generalized to an independent patient population. This adjuvant tool can assist in individual clinical decision-making.
Granulocyte-colony stimulating factor in decompensated liver cirrhosis: a meta-analysis of four randomized controlled trials
Authors: Dimachkie Reem , Hamadi Rachelle , Alameddine Zakaria , Aridi Hussam , Sakr Fouad , Asmar Samer , Deeb Liliane
Published: August 2023

Background

Decompensated liver cirrhosis (DC) has high mortality, but liver transplantation is limited due to organ scarcity and contraindications for transplantation. Granulocyte-colony stimulating factor (GCSF) shows potential for liver disease treatment with its regenerative and immunomodulatory properties. To assess the controversial use of GCSF in DC, a meta-analysis of randomized controlled trials (RCTs) compared survival benefits in patients receiving GCSF plus standard medical therapy (SMT) versus SMT alone.

Methods

A literature search was performed in four databases from data inception up to December 2022, and all registered randomized controlled (RCTs) evaluating GCSF-based therapies for cirrhotic patients were included.

Results

A study combining four RCTs assessed the impact of GCSF with SMT in 595 patients with decompensated cirrhosis. The results indicated that GCSF + SMT led to higher odds of survival compared to SMT alone [risk ratio 1.28, 95% CI (1.08–1.5)]. Heterogeneity existed among the studies, but overall, GCSF showed potential in improving survival. The intervention group exhibited improved Child-Pugh-Turcotte scores [−2.51, CI (−4.33 to −0.70)], and increased CD34 levels, but no significant improvement in MELD scores. These findings suggest GCSF may benefit patients with decompensated cirrhosis in terms of survival and liver function.

Conclusion

These results suggest that the combination of GCSF and SMT may have a positive impact on the survival rate and improvement in CPT score in patients with DC. Further RCTs are needed to shed more light on this promising modality in end-stage liver disease.
Clinicopathological profile of mastalgia in females: incidence, types, and pathological correlations. a cross-Sectional study
Authors: Ali Aqeed Abid , Faraj Faruk Hasan
Published: August 2023

Introduction:

Mastalgia was the most common symptom in patients attending a breast clinic. The two most common types of mastalgia were (cyclical and non-cyclical). The common cause of cyclical was Physiological changes due to premenstrual tension syndrome fibrocystic changes or fibroadenosis and (Aberrations in the Normal Development and Involution of the breast ). Non-cyclical diseases are mainly benign rather than malignant. Solid masses (fibroadenomas), cysts, infections, abscesses, trauma, and nipple discharge (hormones) are rare diseases associated with breast cancer. The aim of this study is to study the incidence of mastalgia, types (cyclical and non-cyclical) and pathological types of mastalgia (benign and malignant pathologies)

Material and methods:

A cross-sectional descriptive study of mastalgia was carried out at the Breast Center Department of Maternity Teaching Hospital located in Erbil, from January 2014 to September 2015. A total of 150 breast pain cases (available clinical data) were studied in detail.

Results:

There are two types of mastalgia based on triple assessments, these are as follows, cyclical 90 cases (60%) and non-cyclical 60 cases (40%). Fibrocystic breast changes or fibroadenosis 35 cases (23.3%) and thirdly nipple discharges as part of fibrocystic (fibroadenosis) five cases (3.3%). Non-cyclical mastalgia was subdivided into benign breast pathologies, fibroadenoma 30 cases (20%), breast cyst 10 cases (6.7%), nipple discharge (hormonal) five cases (3.3%), mastitis three cases (2%) abscess two cases (1.3%), fat necrosis one case (0.7%), and malignant breast pathologies, cancer three cases (2%). Clinicopathological correlations in the current study were highly significant (P<0.005).

Conclusion:

Not all discomfort or pain can be diagnosed as mastalgia; occasionally, chest wall, referral pain, and systemic causes can mimic mastalgia. These results highlight the importance of differentiating between cyclical and non-cyclical mastalgia using clinical assessment, sonography, mammography, and blood investigations. Most mastalgia cases are benign, with cyclical mastalgia primarily related to hormonal changes during the menstrual cycle.
Briumvi: a breakthrough in the treatment of relapsing multiple sclerosis: a review
Authors: Azhar Ayesha , Taimuri Muskan Asim , Shamat Shamat Fathi , Ikram Areeba , Ali Sajjad , Ali Tehreem , Khabir Yumna
Published: August 2023

Multiple sclerosis (MS) is a chronic systemic autoimmune disorder characterized by plaques of demyelination, autoimmune inflammation, and astrocytic gliosis. The primary cells involved in the pathophysiology of MS are T cells. However, B cells have recently been implicated in the pathophysiology of the disease. Therefore, researchers have been exploring B cell therapy as an alternative treatment option for MS. B cell therapy is based on the targeted depletion of CD20-positive B cells. Rituximab, ocrelizumab, and ofatumumab are anti-CD20 antibodies already approved. Briumvi, the fourth type of anti-CD20 antibody was approved by FDA in December 2022, for the treatment of relapsing types of MS, including relapsing-remitting multiple sclerosis, active secondary progressive multiple sclerosis, and clinically isolated syndromes after the drug was tested in two randomized, double-blind, phase III, ULTIMATE I, and II trials which compared Briumvi (ublituximab) with Aubiago (teriflunomide). Ublituximab was found to have a much lower annual relapse rate in the ULTIMATE II trials than teriflunomide. Briumvi is a chimeric recombinant IgG1 monoclonal antibody directed against human CD20 with potential antineoplastic activity. Its mechanism of action involves several distinct processes that collectively lead to the depletion of B cells and suppression of the immune response. The primary mode of action of Briumvi is its high-affinity binding to CD20. Infusion-related reactions are the most common side effects encountered following intravenous administration of ublituximab.
Lung cancer presenting with neurocognitive decline: a compelling case report highlighting healthcare seeking behavior in rural Nepal
Authors: Katwal Shailendra , Ghimire Aastha , Bhattarai Bharosha , Joshi Nishant
Published: August 2023

Introduction:

Lung cancer is a major contributor of burden of disease globally. Early diagnosis plays a crucial role in determining the patient’s prognosis. However, diagnostic constraints and healthcare-seeking behavior in rural areas contribute to the increased mortality and morbidity associated with this disease.

Case presentation:

The authors present a case that came in with mood and personality changes who was diagnosed with lung cancer with metastasis in the brain and did not seek health care services despite a prolonged duration of her neurocognitive symptoms.

Clinical discussion:

Rural communities face multiple barriers to early diagnosis and treatment, including healthcare-seeking behavior. It is crucial to develop policies aimed at addressing these barriers in order to enhance the health status of rural Nepal.

Conclusion:

The presentation of lung cancer with atypical symptoms can contribute to delays in diagnosis and treatment, ultimately impacting the overall prognosis of the patient. Late presentation to healthcare centers further exacerbates the burden of the disease, emphasizing the critical importance of proper healthcare-seeking behavior.
Nursing 2023
Authors: Sanford Kathleen
Published: August 2023

The COVID-19 pandemic has been blamed for multiple health system problems. Many of the current issues, including staffing shortages, while exacerbated by the epidemic, have plagued us for decades. Various reactionary solutions to nursing shortages have been implemented during periods of crises, only to be abandoned when shortages have become less acute. Root causes for the resulting chronic shortages of nursing care team members have not been widely addressed. Nurse leaders have a responsibility to current and future patients, communities, and caregivers to mitigate these while implementing solutions to the current acute crisis in staffing. This requires an organization's nursing enterprise to define a vision for a preferred future, a strategic plan, and specific tactics to address the current crisis while ensuring sustainability of solutions. This article shares a high-level example from one of the country's largest health care systems.
Transition to Perioperative Specialty Practice
Authors: Knighten Mary Lynne , Yvanovich Miriam
Published: August 2023

Frontline nurses are exiting the workforce, fueling a crisis in health care. Years of chronic staffing shortages, trauma experienced during the COVID-19 pandemic, and faculty shortages resulting in lessened ability to produce new nurses are complicating the ability of hospitals and health systems to provide high-quality care at a time when hundreds of thousands of nurses are predicted to leave the profession. A solution to this problem, which may produce internal “churn,” can also create the opportunity for an internal pipeline of transition to specialty practice—recovering nurses who otherwise might be lost. An influx of experienced nurses to the perioperative setting from medical/surgical, telemetry, emergency departments, and intensive care units provides a unique opportunity to fill critical vacancies for a department that traditionally hires less experienced nurses and has expected vacancies due to nurses of retirement age leaving. Key components of a transition to practice arising from the desire to leave stressful, traumatic bedside roles and seek “safer” and perceived less stressful clinical positions involve assessing and promoting resilience and demonstrating self-efficacy. Creating the right environment and offering an evidence-based training opportunity for experienced nurses in a specialty transition to practice can leverage years of experience and skill, support new skill acquisition, stem outward migration of nurses, and potentially salvage the careers of nurses who have contributed to the profession.
Radiation Oncologist Shortage Creates Opportunity for NPs
Authors: Swanson Susan L. , Swanson John W. , Cavanaugh Sean X. , Wright Phyllis P. , Simpson Roy L.
Published: August 2023

A 50% estimated increase in new cancer cases over the next few decades will significantly challenge health care systems already strained by a shortage of oncology providers. Radiation oncology (RO), 1 of 3 three primary pillars of oncology care, treats half of all new cancer cases. Workforce shortages, reimbursement changes, delays in patient treatment, and the lack of follow-up care all continue to increase pressure on RO centers to boost efficiency, improve patient and staff retention, and strive for service satisfaction. Nurse practitioners (NPs) can bring greater capacity, expertise, and profitability to RO, especially in light of the fact that demand is predicted to outstrip supply by as much as 10 times. It is critical, however, that NPs receive specialized training in RO's clinical, technological, and operational processes before assuming patient-facing roles.
Nursing Faculty Workforce Development Project
Authors: Welch Susan , Acker Kristi , Burton Wanda , Cheshire Michelle , Sartain Andrea , Wedgeworth Monika , Welch Teresa
Published: August 2023

A proposed nursing faculty workforce development project by a college of nursing within a research-intensive institution will increase the number of nurse faculty from the current population of BSN-prepared nurses from underserved communities in a state to earn a master of science in nursing (MSN) degree with a nursing education specialty. This project will be accomplished through partnerships between a college of nursing and academic institutions with large nursing student populations from underserved communities. In addition, the project will incorporate the employment of MSN students at academic partner institutions within a clinical nurse faculty role. The proposed project will continue after an initial federally funded grant to continue the project and address the nurse faculty shortage from diverse populations and advance health equity and culturally congruent health care in the state. The project will also enhance partnership building with stakeholders, such as statewide academic institutions, to impact underserved communities.
A review of the safety of linezolid during pregnancy, a potential alternative syphilis treatment
Authors: Navarro Sabrina , Keith Kori , Stafylis Chrysovalantis , Konda Kelika , Klausner Jeffrey
Published: August 2023

With growing maternal and congenital syphilis epidemics and shortages of benzathine penicillin, alternative syphilis treatments are needed. Linezolid has shown efficacy against syphilis in animal models. This review found no teratogenic effects. Some adverse effects were seen in animals, but none were reported in a small number of human studies.
Adenovirus-Associated Urethritis, a Not So Uncommon Entity. A Review of 91 Cases
Authors: Idigoras Pedro , Montes Milagrosa , López-Olaizola Maddi , de la Caba Idoia , Grandioso David , Cilla Gustavo
Published: August 2023

Background

Human adenovirus (HAdV) is likely an underdiagnosed cause of urethritis, although it was already associated with urethritis in descriptions published more than 40 years ago. Differential clinical features of this entity, such as meatitis, conjunctivitis, and a predominance of mononuclear white blood cells in first-void urine and/or urethral smear, can be useful to increase diagnostic suspicion.

Methods

We retrospectively studied 91 episodes of HAdV-associated urethritis diagnosed for 9 years and 6 months after optimizing efforts to detect the pathogen mainly in patients with features suggestive of this condition.

Results

Dysuria was the main symptom (84%), whereas meatitis was observed in 34% of cases. Furthermore, 40% of patients had conjunctivitis. Human adenovirus type D was the most prevalent HAdV (56%), although HAdV-C6, a type not previously associated with urethritis, was observed in 12 patients (13%).

Conclusions

Urethritis due to HAdV is not uncommon, and it is important to screen for it to avoid unnecessary treatments, contact tracing studies, and checkups. The use of multiplex polymerase chain reaction assays that include HAdV, for the diagnosis of urethritis, would raise awareness of its role in this entity.
Facilitated Asynchronous Online Learning to Build Public Health Strategic Skills
Authors: Meredith Genevive R. , Leong Donna , Frost Cheyanna , Travis Alexander J.
Published: August 2023

Context:

The COVID-19 pandemic spurred significant government investments for hiring public health workers. There are clear opportunities to help build capacities among both current and incoming public health workers, closing well-elucidated skill gaps.

Objective:

To report on the development process, methods used, and outcomes seen from a point-in-time public health workforce capacity-building initiative, Public Health Essentials (PHE).

Design:

Capacity-building outcomes evaluation using pre/postintervention measures.

Setting:

The United States.

Participants:

A total of 512 learners working in roles (government or adjacent to) that support public health.

Intervention:

PHE, a cohort-based facilitated asynchronous online course comprising 5 units, 18 modules, 54 learning outcomes, and 266 teaching and applied assessment elements designed to build public health strategic skills.

Main Outcome Measure(s):

Two outputs and 3 outcomes were used to assess and improve progress in achieving our goal of building generalizable and transferrable public health ability and confidence among diverse public health workers: Use of PHE, PHE completion rate, Learner competence, Change in self-assessed ability, and Benefits of PHE.

Results:

From September 2021 to December 2022, 4 agencies used PHE for fellowship training or employee capacity building. Some 79% (n = 512) of learners completed the training, demonstrating competence in all 54 areas assessed by expert course facilitators. Of those, 79% (n = 321) completed both optional pre- and post-PHE surveys, reporting statistically significant gains in all strategic skill domains assessed (n = 9), regardless of demographics and public health experience. Learners gained new skills and knowledge (92%), developed a better understanding of public health (86%), and broadened their public health skill base (84%). A majority can apply the knowledge and skills gained directly to their work (94%), which benefits their team (92%), and have increased their confidence as public health practitioners (49%).

Conclusions:

PHE can significantly improve learners' ability across 9 strategic skill areas in as few as 15 weeks, regardless of their demographics, training, or experience.
Cervical Cancer Screening Positivity Among Women Living With HIV in CDC-PEPFAR Programs 2018–2022
Authors: McCormick Laura J. , Gutreuter Steve , Adeoye Oluwatosin , Alger Sarah X. , Amado Celeste , Bay Zurnaid , Chirwa Catherine Motswere , Chituwo Omega , Correia Della , Deus Maria , Dirlikov Emilio , Efuntoye Tim , Gunde Laurence , Kabaghe Alinune , Kalamya Julius N. , Lorenzoni Cesaltina , Magesa Daniel , Mate Celina , Mulokoshi Theopolina , Ninsiima Josephine Connie , Nyangasi Mary , Nyika Ponesai , Pasipamire Munyaradzi , Ssali Mina , Tefera Fana , Torre Lindsey A. , Urso Marilena , Wandira Ronald , Zemburuka Brigitte , Montandon Michele
Published: August 2023

Background:

The US President's Emergency Plan for AIDS Relief aims to address the higher risk of cervical cancer among women living with HIV by offering high-quality screening services in the highest burden regions of the world.

Methods:

We analyzed the US President's Emergency Plan for AIDS Relief Monitoring, Evaluation, and Reporting data from Centers for Disease Control and Prevention–supported sites in 13 countries in sub-Saharan Africa for women living with HIV aged older than 15 years who accessed cervical cancer screening services (mostly visual inspection, with ablative or excisional treatment offered for precancerous lesions), April 2018–March 2022. We calculated the positivity by age, country, and clinical visit type (first lifetime screen or routine rescreening). We fitted negative binomial random coefficient models of log-linear trends in time to estimate the probabilities of testing positive and any temporal trends in positivity.

Results:

Among the 2.8 million completed cancer screens, 5.4% identified precancerous lesions, and 0.8% were positive for suspected invasive cervical cancers (6.1% overall). The positivity rates declined over the study period among those women screening for cervical cancer for the first time and among those women presenting to antiretroviral therapy clinics for routine rescreening.

Conclusions:

These positivity rates are lower than expectations set by the published literature. Further research is needed to determine whether these lower rates are attributable to the high level of consistent antiretroviral therapy use among these populations, and systematic program monitoring and quality assurance activities are essential to ensure women living with HIV have access to the highest possible quality prevention services.
The Capacity of HIV Care Facilities to Implement Strategies Recommended by the Ending the HIV Epidemic Initiative: The Medical Monitoring Project Facility Survey
Authors: Beer Linda , Williams Dustin , Tie Yunfeng , McManus Timothy , Yuan Anne (Xin) , Crim Stacy M. , Demeke Hanna B. , Creel Darryl , Blackwell Angela D. , Craw Jason A. , Weiser John
Published: August 2023

Background:

Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic activities.

Setting:

US HIV care facilities.

Methods:

We analyzed 2021 survey data from 514 facilities that were recruited from a census of facilities providing care to a national probability sample of US adults with HIV. We present weighted estimates of facility characteristics, services, and policies and estimates of the proportion of all US HIV patients attending these facilities.

Results:

Among HIV care facilities, 37% were private practices, 72% were in areas with population >1 million, and 21% had more than 1000 HIV patients. Most provided preexposure prophylaxis (83%) and postexposure prophylaxis (84%). More than 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/sexually transmitted infection (STI) transmission risk reduction counseling (89%); fewer had on-site access to treatment for substance use disorders (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups.

Conclusion:

Results indicate some strengths that support Ending the HIV Epidemic–recommended strategies among HIV care facilities, such as high availability of preexposure prophylaxis/postexposure prophylaxis, as well as areas for improvement, such as provision of staff antistigma trainings and adherence supports.
IgG4 Positivity in Chronic Tonsillitis: A New Component of IgG4-Related Disease?
Authors: Sahin Murat S. , Gundogdu Baris , Vural Gurcan , Dogantekin Betul
Published: August 2023

Objective:

Immunoglobulin G4-related disease (IgG4-RD) and chronic tonsillitis are both chronic fibroinflammatory diseases in which tissue atrophy is sometimes observed. In this study, the authors aimed to investigate the pathologic IgG4 positivity in tonsillectomy specimens and hypothesized to name it as a new clinical component of IgG4-RD if there is significant IgG4 positivity in chronic tonsillitis.

Methods:

A total of 73 patients who underwent tonsillectomy for chronic tonsillitis were included in this study. Of these, 31 patients had atrophic form chronic tonsillitis. Pathologic examinations and specific IgG4 immunohistochemical staining were performed by the same experienced pathologist in terms of IgG4-RD.

Results:

Sixty-three percent (n=46) of the cases were male, 37% (n=27) were female, their ages ranged from 3 to 51, and the mean age was 19.11±14.82. It was determined that 23.3% (n=17) of the cases participating in the study were IgG4-positive. When the pathologic grades of the cases were examined; it was observed that 13.7% (n=10) were Grade I, 65.8% (n=48) were Grade II, and 20.5% (n=15) were Grade III. A statistically significant difference was found between the pathology degrees of the cases according to the IgG4 groups (P=0.001; P<0.01).

Conclusion:

The authors concluded that as the histopathologic grades of chronic lymphoplasmacytic inflammation in tonsils specimen increase, IgG4 positivity rates also increase. Therefore, this clinical entity may be a new IgG4-related disease state in cases with chronic tonsillitis.

Level of Evidence:

Level II.
Quality of Life and Real-Time Patient Experience During Neoadjuvant Therapy
Authors: Shannon Alexander H , Sarna Angela , Bressler Luke , Monsour Christina , Palettas Marilly , Huang Emily , D’Souza Desmond M , Kneuertz Peter J , Ejaz Aslam , Pawlik Timothy M , Santry Heena , Cloyd Jordan M
Published: August 2023

Background:

Neoadjuvant therapy (NT) is increasingly used for patients with localized gastrointestinal (GI) cancers. There is little data assessing patient experience and quality of life (QOL) during NT for GI cancers.

Objective:

To use a customized smartphone application to prospectively measure QOL and the real-time patient experience during NT.

Methods:

Patients with GI cancers receiving NT were instructed on using a customized smartphone application through which the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, a validated measure of health-related (HR) QOL, was administered at baseline, every 30 days, and at completion of NT. Participants also tracked their mood, symptoms, and used free-text journaling functionalities in the application. Mean overall and sub-section HRQOL scores were calculated during NT.

Results:

Among 104 enrolled patients, mean age was 60.5±11.5 years and 55% were male. Common cancer diagnoses were colorectal (40%), pancreatic (37%), and esophageal (15%). Mean overall FACT-G scores did not change during NT (P=0.987). While functional wellbeing scores were consistently the lowest and social wellbeing scores the highest, FACT subscores similarly did not change during NT (all P>0.01). The most common symptoms reported during NT were fatigue, insomnia, and anxiety (39.3%, 34.5%, and 28.3% of patient entries, respectively). Qualitative analysis of free-text journaling entries identified anxiety, fear, and frustration as the most common themes, but also the importance of social support systems and confidence in health care providers.

Conclusions:

While patient symptom burden remains high, results of this prospective cohort study suggest QOL is maintained during NT for localized GI cancers.
Health care utilization outcomes in patients with blunt chest wall trauma following discharge from the emergency department: A retrospective, observational data-linkage study
Authors: Battle Ceri , Hutchings Hayley , Rafferty James , Toghill Hannah , Akbari Ashley , Watkins Alan
Published: August 2023

BACKGROUND

Although much is published reporting clinical outcomes in the patients with blunt chest wall trauma who are admitted to hospital from the ED, less is known about the patients’ recovery when they are discharged directly without admission. The aim of this study was to investigate the health care utilization outcomes in adult patients with blunt chest wall trauma, discharged directly from ED in a trauma unit in the United Kingdom.

METHODS

This was a longitudinal, retrospective, single-center, observational study incorporating analysis of linked datasets, using the Secure Anonymised Information Linkage databank for admissions to a trauma unit in the Wales, between January 1, 2016, and December 31, 2020. All patients 16 years or older with a primary diagnosis of blunt chest wall trauma discharged directly home were included. Data were analyzed using a negative binomial regression model.

RESULTS

There were 3,205 presentations to the ED included. Mean age was 53 years, 57% were male, with the predominant injury mechanism being a low velocity fall (50%). 93% of the cohort sustained between 0 and 3 rib fractures. Four percent of the cohort were reported to have chronic obstructive pulmonary disease, and 4% using preinjury anticoagulants. On regression analysis, inpatient admissions, outpatient appointments and primary care contacts all significantly increased in the 12-week period postinjury, compared with the 12-week period preinjury (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.33–1.99; p < 0.001; OR, 1.28; 95% CI, 1.14–1.43; p < 0.001; OR, 1.02; 95% CI, 1.01–1.02; p < 0.001, respectively). Risk of health care resource utilization increased significantly with each additional year of age, chronic obstructive pulmonary disease and preinjury anticoagulant use (all p < 0.05). Social deprivation and number of rib fracture did not impact outcomes.

CONCLUSION

The results of this study demonstrate the need for appropriate signposting and follow-up for patients with blunt chest wall trauma presenting to the ED, not requiring admission to the hospital.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
Transplant Center Attitudes Toward Early Liver Transplant for Alcohol-associated Liver Disease
Authors: Mitchell Jonathan , Herrick-Reynolds Kayleigh , Motter Jennifer D. , Teles Mayan , Kates Olivia , Sung Hannah , Chen Po-Hung , King Elizabeth , Cameron Andrew
Published: August 2023

Background.

Many centers have removed 6-mo pretransplant alcohol abstinence requirements to provide early liver transplant (ELT) for individuals with severe alcohol-associated liver disease (ALD), but the practice remains controversial. Using data collected from a nationally distributed survey, this study examines the practices and attitudes of transplant centers in the United States regarding ELT.

Methods.

A 20-item survey designed to assess center practices and provider attitudes was distributed to 225 medical and surgical directors from 143 liver transplant centers via email.

Results.

Surveys were completed by 28.9% (n = 65) of directors and 39% (n = 56) of transplant centers. All responding centers reported evaluating patients for ELT. Circumstances for considering ELT included <6 mo of survival without a transplant (96.4%) and inability to participate in alcohol addiction therapy pretransplant (75%). Most (66%) directors indicated their center had established criteria for listing candidates with severe ALD for ELT. Regarding important factors for ELT candidate listing, 57.1% indicated patient survival, 37.5% indicated graft survival, and 55.4% indicated having a low risk of relapse. Only 12.7% of directors affirmed the statement, “Six months of pretransplant abstinence decreases the risk of relapse.”

Conclusions.

More centers are providing ELT for severe ALD. Inability to participate in alcohol addiction therapy and <6 mo of survival are commonly reported circumstances for considering ELT. Continued investigation of posttransplant outcomes in patients receiving ELT is essential to establishing a national consensus for distributing this valuable resource.
Gilsonicaris
from the Lower Devonian Hunsrück slate is a eunicidan annelid and not the oldest crown anostracan crustacean
Authors: Gueriau P. , Parry L. A. , Rabet N.
Published: August 2023

The Lower Devonian (Lower Emsian, −400 Myr) roof slates of the Hunsrück in southeastern Germany have delivered a highly diverse and exceptionally preserved marine fauna that provides a unique snapshot into the anatomy and ecology of a wide range of Palaeozoic animals. Several of the described taxa, however, remain enigmatic in their affinity, at least until new pyritized features hidden under the surface of the slate are revealed using X-ray radiography or micro-computed tomography (µCT). Here, we redescribe such an enigmatic fossil, the putative anostracan crustacean
Gilsonicaris rhenanus
Van Straelen, 1943. Using µCT scanning, we unveil unprecedented details of its anatomy, including a ventral oral opening and four pairs of recalcitrant jaw elements. These jaws are morphologically consistent with the scolecodonts of eunicidan polychaetes, which along with the gross anatomy of the body and head unambiguously identifies
G. rhenanus
as a polychaete rather than an arthropod. While this discovery firmly discards the Early Devonian record of crown anostracans in the fossil record, it adds a new record of eunicidan soft tissues, which are surprisingly rare considering the abundant microfossil record of scolecodonts.
Using GPS tracking to monitor the breeding performance of a low-density raptor improves accuracy, and reduces long-term financial and carbon costs
Authors: Murgatroyd M. , Tate G. , Amar A.
Published: August 2023

Traditionally, demographic monitoring of birds has been undertaken by intensive monitoring of nesting sites. However, this is challenging for low-density species, whereby the effort and costs involved in locating and monitoring remote sites can be prohibitive or even bias research findings. We show that Global Positioning System (GPS) tracking can overcome these challenges for a low-density raptor. Field monitoring of martial eagles
Polemaetus bellicosus
from 2013 to 2021 showed consistently poor breeding performance, with a mean productivity of 0.22 (±0.04) fledged young/pair/year. Using GPS tracking data to infer breeding performance gave a significantly higher productivity of 0.46 (±0.10) fledged young/pair/year. Breeding rate and success were also underestimated by field monitoring. These differences were likely due to logistical constraints of field monitoring, particularly relating to finding alternative nests. Comparing costs between approaches, we estimated that GPS monitoring was financially cheaper than field monitoring per sample after 10 years. Carbon costs per sample were lower for GPS-based approaches than field monitoring from the second year, and over a 10-year period GPS monitoring produced considerable savings (200% less carbon). We recommend that despite high initial costs, for long-term demographic monitoring of low-density species, or where logistical constraints make traditional field monitoring inaccurate, remote monitoring options should be considered.
Influences of dynamic load phase shifts on the energetics and biomechanics of humans
Authors: Zhang Qinhao , Chen Wenbin , Liang Jiejunyi , Cheng Longfei , Huang Bo , Xiong Caihua
Published: August 2023

Using load-suspended backpacks to reduce vertical peak dynamic load exerted on humans can reduce metabolic costs. However, is it possible to further reduce metabolic cost by modulating dynamic load phase shift? If so, is anti-phase better than the others? In this study, we investigated the biomechanics, energetics and trunk response under phase shifts. Nine subjects wearing an active backpack with 19.4 kg loads walked on a treadmill at 5 km h
−1
with four phase shift trials (T1–T4) and a load-locked trial (LK). Our results show that anti-phase trial (T3) assists ankle more and reduces the moment and gastrocnemius medialis activity, while T4 assists knee more and reduces the moment and rectus femoris activity. Due to the load injecting more mechanical energy into human in T3 and T4, the positive centre-of-mass work is significantly reduced. However, the gross metabolic rate is lowest in T4 and 4.43% lower than in T2, which may be because the activations of erector spinae and gluteus maximus are reduced in T4. In addition, T3 increases trunk extensor effort, which may weaken the metabolic advantage. This study provides guidance for improving assistance strategies and human–load interfaces and deepens the understanding of the energetics and biomechanics of human loaded walking.
Mask wearing provides psychological ease but does not affect facial expression intensity estimation
Authors: Kawagoe Toshikazu , Teramoto Wataru
Published: August 2023

During the COVID-19 pandemic, wearing a face mask became a global daily practice. Japanese people were already accustomed to wearing masks due to their collectivistic culture, which prioritizes conformity and group harmony. In such a culture, where individuals are concerned about how others perceive them and their actions, wearing masks can be a self-protective action to prevent, escape, or reduce the severity of perceived negative feelings. Previous studies indicate that people experiencing anxiety tend to have negative biases when evaluating emotional expressions on faces. Therefore, we hypothesized that wearing a mask can reduce the negative feelings caused by social pressure, emotion processing, especially intensity perception. While our findings confirmed that wearing a mask reduced negative feelings caused by social pressure, there was no significant change in emotion intensity recognition performance. This null result might be attributed to the small effect size of the association between negative bias in emotion processing and an individual's state. In future studies, it would be valuable to include participants from non-collectivistic cultures to gain a broader understanding of the impact of wearing masks on emotion processing.
Prey species and abundance affect growth and photosynthetic performance of the polyphagous sea slugElysia crispata
Authors: Cartaxana Paulo , Morelli Luca , Cassin Elena , Havurinne Vesa , Cabral Miguel , Cruz Sónia
Published: August 2023

Some sacoglossan sea slugs steal functional macroalgal chloroplasts (kleptoplasts). In this study, we investigated the effects of algal prey species and abundance on the growth and photosynthetic capacity of the tropical polyphagous sea slugElysia crispata. Recently hatched sea slugs fed and acquired chloroplasts from the macroalgaBryopsis plumosa,but not fromAcetabularia acetabulum. However, adult sea slugs were able to switch diet toA. acetabulum, rapidly replacing the great majority of the original kleptoplasts. When fed withB. plumosa, higher feeding frequency resulted in significantly higher growth and kleptoplast photosynthetic yield, as well as a slower relative decrease in these parameters upon starvation. Longevity ofA. acetabulum-derived chloroplasts inE. crispatawas over twofold that ofB. plumosa. Furthermore, significantly lower relative weight loss under starvation was observed in sea slugs previously fed onA. acetabulumthan onB. plumosa. This study shows that functionality and longevity of kleptoplasts in photosynthetic sea slugs depend on the origin of the plastids. Furthermore, we have identifiedA. acetabulumas a donor of photosynthetically efficient chloroplasts common to highly specialized monophagous and polyphagous sea slugs capable of long-term retention, which opens new experimental routes to unravel the unsolved mysteries of kleptoplasty.