bluuebunny/crossref_metadata_2025 huggingface dataset:
EP537 - Revolutionizing informed consent: A quantum leap in precision for chronic pain awareness in inguinal hernia operations through electronic consent
Authors: Ahmad Shakil , Kirmani Naveed
Published: September 2024

Aim

The study aimed to assess the extent to which clinicians provide information to patients about the occurrence of chronic pain during consultations, recognizing it's significance as a prevalent postoperative complication following inguinal hernia repair.

Methods

Data were gathered by two teams at distinct time periods within the same trust. One team utilized the standard paper-based consenting method, while the other employed a recently introduced electronic consenting process. A comparison of these approaches was undertaken to derive the study's results, making it a retrospective and comparative analysis.

Results

An investigation on this subject conducted initially uncovered that 84% of patients were not informed about the risk of chronic pain and did not provide consent for this common occurrence via standard paper based method. Consequently, the study recommended the implementation of an e-consent facility in the Trust. This facility would feature a template encompassing all pertinent risks associated with inguinal hernia surgery.

Following the introduction of e-consent later, we conducted a subsequent analysis on patients who underwent inguinal hernia surgery. The findings indicated a notable improvement, with 98% of patients having given their consent for chronic pain.Manner of consentingPatient who was informed about chronic pain during consentingPatient who wasn't informed about chronic pain during consentingPaper consent16%84%e-Consent982%

Conclusion

The incorporation of chronic pain as a potential complication in the consenting process for inguinal hernia surgery has seen improvement since the introduction of the e-consent software. However, to achieve full compliance, there is a need for further enhancement and increased utilization of the e-consent software.
EP588 - Review of the need for Immediate Nasogastric Tube Insertion in patients with Small Bowel Obstruction: Single Centre Quality Improvement Project
Authors: Wuheb Ali , Varghese Merene , Sabahat Maria , Abdalla Hashim , Liu Bin
Published: September 2024

Aim

This QIP was conducted in a busy UK hospital. It aims to review, improve, and stress the importance of early insertion of an NG tube in patients who have clinically suspected or radiologically confirmed small bowel obstruction.

Method

Retrospective data collection involving 72 patients, in a period from Jan to April 2023 (50 patients) and from May to July 2023 (22 patients)Inclusion criteria: adult patients with SBO (clinically suspected or radiologically confirmed) and NGT insertion advised by the surgical teamExclusion criteria: paediatric patients, LBO, and patients not advised NGT in ED

Results

In the first cycle, we found that NG insertion is delayed 84% > 7 hrs. With associated morbidity of pneumonia, including aspiration in 20% of patients, ileus and sepsis in 8%, and re-admission and mortality in 6%, respectively.

The following interventions were carried out.

Broad communication with the ED team to highlight the importance of NG insertion for suspected patients.

Provide NGT training for ED nursing staff

The surgical team and admission nurses should inquire about NGT insertion before accepting patients' admission to surgical emergency wards.

Circulating the QIPS recommendation Trust-wide as sharing learning point

Post-intervention, we noticed a 50% delay in NGT insertion, which is a huge improvement compared to the 84% delay

Conclusion

Early insertion of NG for decompression in both pre and post-op periods is known to decrease associated complications, including bowel oedema, perforation, aspiration pneumonia, and post-ileus, leading to better outcomes and a significant decrease in hospital stay length.
EP624 - Clavien Dindo system in general surgical patients at a district hospital in NHS
Authors: Arifuzaman Mohammed
Published: September 2024

Aims

To try and use the Clavien-Dindo system of grading of surgical complications to General Surgical patients at NMGH. To understand the predictors of grades of surgical complications. Propose the use of the CD system in regular mortality and morbidity meetings.

Methods

Retrospective cohort study. Total patients studied were 104. List of all elective and emergency general surgical patients at NMGH from 1st Feb to 2nd March 2023 collected from HIVE. Data collected included MRN, age, sex, BMI, ASA category, surgical time, blood loss, type of surgery, complication and CD grade. CD grade was calculated from the patient notes. Statistical analysis was performed on StatsDirect3 from MFT.

Results

26.9 % (n = 28) of the patients developed CD grades complications overall. Mild complications (grade 1 and 2) were 18.2 %. Serious complications (grade 3 and 4) were 7.7 %. CD 5 was 0.96 % 51 % of emergency cases develop complications (Mild 29%, serious 20%, death 2 %) 11 % of elective cases develop mild complications and no serious complications. Age and ASA grade have no statistically significant relationship in the present study. Higher BMI is associated with lower grades of complications in this study.

Conclusion

Female patients in an emergency setting with a blood loss of greater than 100 ml and a surgical time of 150 minutes or greater developing grade 2 complications. Emergency cases carry 4.6 times more complication rates than elective cases. Blood loss of 50 ml or greater would give rise to CD 1 or greater. Surgical time of lesser than 125 minutes gives CD 1. Surgical time 125 to 200 minutes gives CD 2.
EP625 - Perioperative complications in general surgical patients at a district hospital in NHS
Authors: Arifuzaman Mohammed
Published: September 2024

Aims

To try and use the Clavien-Dindo system of grading of surgical complications to General Surgical patients at NMGH. To understand the predictors of grades of surgical complications. Propose the use of the CD system in regular mortality and morbidity meetings.

Methods

Retrospective cohort study. Total patients studied were 104. List of all elective and emergency general surgical patients at NMGH from 1st Feb to 2nd March 2023 collected from HIVE. Data collected included MRN, age, sex, BMI, ASA category, surgical time, blood loss, type of surgery, complication and CD grade. CD grade was calculated from the patient notes. Statistical analysis was performed on StatsDirect3 from MFT.

Results

26.9 % (n = 28) of the patients developed CD grades complications overall. Mild complications (grade 1 and 2) were 18.2 %. Serious complications (grade 3 and 4) were 7.7 %. CD 5 was 0.96 %. 51 % of emergency cases develop complications (Mild 29%, serious 20%, death 2 %). 11 % of elective cases develop mild complications and no serious complications. Age and ASA grade have no statistically significant relationship in the present study. Higher BMI is associated with lower grades of complications in this study.

Conclusion

Female patients in an emergency setting with a blood loss of greater than 100 ml and a surgical time of 150 minutes or greater developing grade 2 complications. Emergency cases carry 4.6 times more complication rates than elective cases. Blood loss of 50 ml or greater would give rise to CD 1 or greater. Surgical time of lesser than 125 minutes gives CD 1. Surgical time 125 to 200 minutes gives CD 2.
Redundant role of PAD2 and PAD4 in the development of cardiovascular lesions in a mouse model of Kawasaki disease vasculitis
Authors: Domiciano Talita P , Lee Youngho , Carvalho Thacyana T , Wakita Daiko , Martinon Daisy , Jena Prasant K , Fert-Bober Justyna , Borges Vanessa , Crother Timothy R , Chen Shuang , Moreira Debbie , Van Eyk Jennifer E , Noval Rivas Magali , Arditi Moshe , Shimada Kenichi
Published: September 2024

Kawasaki disease (KD) is the leading cause of acquired heart disease in children. While circulating neutrophils are increased and activated during acute KD, it is unclear whether neutrophils and neutrophil extracellular traps (NETs) contribute to the pathogenesis of KD. Peptidylarginine deiminase 4 (PAD4), an enzyme involved in protein citrullination and essential for NETs formation, is implicated in the pathogenesis of various diseases. Here, we used the Lactobacillus casei cell wall extract (LCWE)-induced mouse model of KD vasculitis to determine the contribution of PAD4 in KD vasculitis. We found that the pan-PADs inhibitor, Cl-amidine, significantly reduced LCWE-induced cardiovascular lesions, but neutrophil-specific Padi4 KO mice did not impact the development of KD vasculitis. While in vitro treatment of macrophages, which highly express Padi4, with Cl-amidine inhibited IL-1β secretion, macrophage-specific Padi4 KO mice did not reduce the lesions. Padi4−/− mice also developed KD vasculitis, AFM30a, a PAD2 inhibitor, significantly reduced KD vasculitis in Padi4−/− mice, indicating a compensatory role of PAD2 in PAD4 deficiency. We also identified several citrullinated proteins in macrophages with constitutively active NLRP3 inflammasome that were inhibited by Cl-amidine treatment, suggesting that protein citrullination participates in NLRP3 inflammasome activation. These data indicate a dispensable role for PAD4-dependent NETs formation, and a redundant role of PAD2 and PAD4 in this murine KD vasculitis. The cardioprotective effects of Cl-amidine to reduce the severity of murine KD vasculitis are not limited to PAD4 inhibition and may include decreased citrullination in the inflammasome pathway.
Influence of sea ice concentration, sex and chick age on foraging flexibility and success in an Arctic seabird
Authors: Eby Alyssa , Patterson Allison , Whelan Shannon , Elliott Kyle H , Gilchrist H Grant , Love Oliver P
Published: September 2024

Declining sea ice and increased variability in sea ice dynamics are altering Arctic marine food webs. Changes in sea ice dynamics and prey availability are likely to impact pagophilic (ice-dependent and ice-associated) species, such as thick-billed murres (Uria lomvia), through changes in foraging behaviour and foraging success. At the same time, extrinsic factors, such as chick demand, and intrinsic factors, such as sex, are also likely to influence foraging behaviour and foraging success of adult murres. Here, we use 3 years of data (2017–2019) to examine the impacts of environmental conditions (sea ice concentration and sea surface temperature), sex and chick age (as a proxy for chick demand) on foraging and diving behaviour (measured via biologgers), energy expenditure (estimated from activity budgets) and foraging success (measured via nutritional biomarkers) of thick-billed murres during the incubation and chick-rearing stages at Coats Island, Nunavut. Murres only exhibited foraging flexibility to environmental conditions during incubation, which is also the only stage when ice was present. When more ice was present, foraging effort increased, murres foraged farther and made deeper dives, where murres making deeper dives had higher foraging success (greater relative change in mass). During incubation, murre behaviour was also influenced by sex of the individual, where males made more and shorter trips and more dives. During chick-rearing, murre behaviour was influenced primarily by the sex of the individual and chick age. Males made shallower dives and fewer dive bouts per day, and more dives. Birds made longer, deeper dives as chicks aged, likely representing increased intra-specific competition for prey throughout the season. Our results suggest variation in sea ice concentration does impact foraging success of murres; however, sex-specific foraging strategies may help buffer colony breeding success from variability in sea ice concentration.
IL23R-Specific CAR Tregs for the Treatment of Crohn’s Disease
Authors: Cui Yue , David Marion , Bouchareychas Laura , Rouquier Sandrine , Sajuthi Satria , Ayrault Marion , Navarin Candice , Lara Gregory , Lafon Audrey , Saviane Gaëlle , Boulakirba Sonia , Menardi Alexandra , Demory Alexandra , Frikeche Jihane , de la Forest Divonne Beghelli Stephanie , Lu Hsiaomei Heidi , Dumont Celine , Abel Tobias , Fenard David , de la Rosa Maurus , Gertner-Dardenne Julie
Published: September 2024

Background and Aims

Regulatory T cells (Tregs) are key regulators in maintaining tissue homeostasis. Disrupted immune homeostasis is associated with Crohn’s disease (CD) pathogenesis. Thus, Treg therapy represents a promising long-acting treatment to restore immune balance in the diseased intestine. Chimeric antigen receptor (CAR) T-cell therapy has revolutionized cancer treatment. This innovative approach also provides the opportunity to improve therapy for CD. By targeting a disease-relevant protein, interleukin-23 receptor (IL23R), we engineered Tregs expressing IL23R-CAR for treating active CD.

Methods

Intestinal IL23R expression from active CD was verified by immunohistochemical analysis. Phenotypic and functional characteristics of IL23R-CAR Tregs were assessed using in vitro assays and their migration capacity was monitored in a xenograft tumor model. Transcriptomic and proteomic analyses were performed to associate molecular profiles with IL23R-CAR Treg activation against colon biopsy-derived cells from active CD patients.

Results

Our study showed that IL23R-CAR displayed negligible tonic signaling and a strong signal-to-noise ratio. IL23R-CAR Tregs maintained regulatory phenotype during in vitro expansion, even when chronically exposed to proinflammatory cytokines and target antigen. IL23R engagement on IL23R-CAR Tregs triggered CAR-specific activation and significantly enhanced their suppressive activity. Also, IL23R-CAR Tregs migrated to IL23R-expressing tissue in humanized mice. Finally, IL23R-CAR Tregs elicited a specific activation against colon biopsy-derived cells from active CD, suggesting an efficient CAR engagement in active CD. Molecular profiling of CD patient biopsies also revealed transcriptomic and proteomic patterns associated with IL23R-CAR activation.

Conclusions

Overall, our results demonstrate that IL23R-CAR Tregs represent a promising therapy for active CD.
Clinical course of pregnancy-associated spontaneous coronary artery dissection: a case series
Authors: Würdinger Michael , Schweiger Victor , Rajman Katja , Di Vece Davide , Gilhofer Thomas , Ghadri Jelena R , Templin Christian
Published: September 2024

Background

Spontaneous coronary artery dissection (SCAD) is the most important cause of acute coronary syndromes during pregnancy and in the post-partum period and involves a spontaneous intimal tear or intramural haematoma of a coronary artery. Pregnancy-associated SCAD accounts for a minority of SCAD cases but is associated with a high rate of adverse events.

Case summary

We present a series of three cases with pregnancy-associated SCAD. All patients presented with acute coronary syndromes in the post-partum period, between 12 days and 5 months after delivery. They all had additional conditions that are associated with SCAD, such as fibromuscular dysplasia and migraine. The management of one patient was uncomplicated, however, the courses of the other two were characterized by adverse events. One presented after an out-of-hospital cardiac arrest, the other presented with multivessel SCAD and developed progression and recurrence of SCAD during follow-up. In conclusion, the patients could be successfully treated conservatively and were in good condition at their latest follow-ups.

Discussion

This case series highlights the wide range of clinical courses that could exist in pregnancy-associated SCAD, from a benign manifestation to a life-threatening condition. Importantly, those patients are at an increased risk for acute and late adverse events.
A case report describing myocardial ischaemia as a side effect of carbamazepine overdose
Authors: Skiba Małgorzata M , Szymański Mateusz , Piasecka Małgorzata
Published: September 2024

Background

Overdoses of carbamazepine may occur due to various reasons. The summary of product characteristics of carbamazepine includes information about the possibility of side effects after taking this drug. However, the symptoms described do not include coronary vasospasm, which occurred in the case described. Making such a diagnosis is a key element in therapeutic management, as it changes further clinical decisions.

Case summary

A 46-year-old patient was admitted to the hospital for disorders of consciousness following an overdose of carbamazepine. On the second day, the patient exhibited respiratory distress. Subsequently, the patient was transferred to the intensive care unit, intubated, and placed on mechanical ventilation. On the same day, the patient experienced recurrent cardiac arrhythmias in the form of pulseless ventricular tachycardia and ventricular fibrillation; the patient was resuscitated and defibrillated eight times. Due to a rapid decline in cardiac output coupled with persistent electrocardiographic changes and haemodynamic instability, the patient underwent urgent coronary angiography. The procedure revealed a spasm in the initial segment of the circumflex branch of the left coronary artery, which subsequently resolved following nitroglycerin administration. Subsequent to the implementation of this therapeutic approach, a reduction in the demand for norepinephrine and dobutamine was achieved. In the following days, the patient's general condition improved. The patient was discharged home while maintaining full cognitive capacity and cardiovascular and respiratory fitness.

Discussion

In the case described, the expeditious performance of a cardiological diagnostic evaluation played a pivotal role in achieving therapeutic success, enabling the prompt initiation of appropriate treatment.
The Progressive Development of International Law on the Return of Stolen Assets: Mapping the Paths Forward
Authors: Rose Cecily
Published: September 2024

The return of stolen assets represents a ‘fundamental principle’ of the United Nations Convention against Corruption (UNCAC). The convention’s inclusion of a chapter on asset recovery was considered a groundbreaking achievement at the time of the treaty’s conclusion in 2003. The treaty negotiations concerning these provisions, however, were highly controversial, and the discussions did not benefit from a substantial body of practical experience concerning the return of stolen assets. In the 20 years since the treaty’s conclusion, states have acquired some experience with asset return, and the gaps and limitations in UNCAC’s regime governing asset recovery have become apparent. Article 57 of UNCAC, concerning asset return and disposal, exemplifies the need for progressive development of international asset recovery laws. Article 57 requires ‘updating’ or supplementation because the provision does not adequately address major recurrent issues, such as the recipients, use and monitoring of returned assets; the transparency of the asset return process; and the participation of civil society in the process. Normative development could involve formal law reform, within the UNCAC legal framework, but it could also involve more informal legal change, outside of the UNCAC regime. The Global Forum on Asset Recovery represents an important example of legal change that raises issues of both accountability and effectiveness.
The NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial: rationale and design of a randomized controlled trial
Authors: Boskovic Miroslav , Jortveit Jarle , Haraldsen Marius Blørstad , Berge Trygve , Engdahl Johan , Løchen Maja-Lisa , Schuster Peter , Sandberg Edvard Liljedahl , Grimsmo Jostein , Atar Dan , Anfinsen Ole-Gunnar , Pripp Are Hugo , Grenne Bjørnar Leangen , Halvorsen Sigrun
Published: September 2024

Aims

Atrial fibrillation (AF) is a common arrhythmia, and many cases of AF may be undiagnosed. Whether screening for AF and subsequent treatment if AF is detected can improve long-term outcome remains an unsettled question. The primary aim of the NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial is to assess whether self-screening for AF with continuous electrocardiogram (ECG) for 3–7 days in individuals aged 65 years or older with at least one additional risk factor for stroke, and initiation of guideline-recommended therapy in patients with detected AF, will reduce the occurrence of stroke.

Methods and results

This study is a nationwide open, siteless, randomized, controlled trial. Individuals ≥65 years of age are randomly identified from the National Population Register of Norway and are invited to take a digital inclusion/exclusion test. Individuals passing the inclusion/exclusion test are randomized to either the intervention group or the control group. A total of 35 000 participants will be enrolled. In the intervention group, self-screening is performed continuously over 3–7 days at home with a patch ECG device (ECG247) at inclusion and after 12–18 months. If AF is detected, guideline-recommended therapy will be initiated. Patients will be followed up for 5 years through national health registries. The primary outcome is time to a first stroke (ischaemic or haemorrhagic stroke). The first participant in the NORSCREEN trial was enrolled on 1 September 2023.

Conclusion

The results from the NORSCREEN trial will provide new insights regarding the efficacy of digital siteless self-screening for AF with respect to stroke prevention in individuals at an increased risk of stroke.

Trial registration

Clinical trials: NCT05914883.
Sub-sampling graph neural networks for genomic prediction of quantitative phenotypes
Authors: Kihlman Ragini , Launonen Ilkka , Sillanpää Mikko J , Waldmann Patrik
Published: September 2024

In genomics, use of deep learning (DL) is rapidly growing and DL has successfully demonstrated its ability to uncover complex relationships in large biological and biomedical data sets. With the development of high-throughput sequencing techniques, genomic markers can now be allocated to large sections of a genome. By analyzing allele sharing between individuals, one may calculate realized genomic relationships from single-nucleotide polymorphisms (SNPs) data rather than relying on known pedigree relationships under polygenic model. The traditional approaches in genome-wide prediction (GWP) of quantitative phenotypes utilize genomic relationships in fixed global covariance modeling, possibly with some nonlinear kernel mapping (for example Gaussian processes). On the other hand, the DL approaches proposed so far for GWP fail to take into account the non-Euclidean graph structure of relationships between individuals over several generations. In this paper, we propose one global convolutional neural network (GCN) and one local sub-sampling architecture (GCN-RS) that are specifically designed to perform regression analysis based on genomic relationship information. A GCN is tailored to non-Euclidean spaces and consists of several layers of graph convolutions. The GCN-RS architecture is designed to further improve the GCN’s performance by sub-sampling the graph to reduce the dimensionality of the input data. Through these graph convolutional layers, the GCN maps input genomic markers to their quantitative phenotype values. The graphs are constructed using an iterative nearest neighbor approach. Comparisons show that the GCN-RS outperforms the popular Genomic Best Linear Unbiased Predictor method on one simulated and three real datasets from wheat, mice and pig with a predictive improvement of 4.4% to 49.4% in terms of test mean squared error. This indicates that GCN-RS is a promising tool for genomic predictions in plants and animals. Furthermore, GCN-RS is computationally efficient, making it a viable option for large-scale applications.
Automatic relocation of intermediate-depth earthquakes using adaptive teleseismic arrays
Authors: Blackwell Alice , Craig Timothy , Rost Sebastian
Published: September 2024

Intermediate-depth earthquakes, accommodating intraslab deformation, typically occur within subduction zone settings at depths between 60–300 km. These events are in a unique position to inform us about the geodynamics of the subducting slab, specifically the geometry of the slab and the stress state of the host material. Improvements in the density and quality of recorded seismic data enhance our ability to determine precise locations of intermediate-depth earthquakes, in order to establish connections between event nucleation and the tectonic setting. Depth phases (near-source surface reflections, e.g. pP and sP) are crucial for the accurate determination of earthquake source depth using global seismic data. However, they suffer from poor signal-to-noise ratios in the P wave coda. This reduces the ability to systematically measure differential traveltimes to the direct P arrival, particularly for the frequent lower magnitude seismicity which highlights considerable seismogenic regions of the subducted slabs. To address this limitation, we have developed an automated approach to group globally distributed stations at teleseismic distances into ad-hoc arrays with apertures of 2.5$^\circ$, before optimizing and applying phase-weighted beamforming techniques to each array. Resultant vespagrams allow automated picking algorithms to determine differential arrival times between the depth phases and their corresponding direct P arrival. Using these differential times we can then determine the depths of earthquakes, which in turn can be used to create a catalogue of relocated events. This will allow new comparisons and insights into the governing controls on the distribution of earthquakes in subducted slabs. We demonstrate this method by relocating intermediate-depth events associated with northern Chile and the Peruvian flat slab regions of the subducting Nazca plate. The relocated Chilean catalogue contains comparable event depths to an established catalogue, calculated using a semi-automated global methodology, which serves to validate our fully automatic methodology. The new Peruvian catalogue we generate indicates three broad zones of seismicity approximately between latitudes 1–7$^\circ$S, 7–13$^\circ$S and 13–19$^\circ$S. These align with flat to steep slab dip transitions and the previously identified Pucallpa Nest. We also find a regionally deeper slab top than indicated by recent slab models, with intraslab events concentrated at points where the slab bends, suggesting a link between slab flexure and intermediate-depth earthquake nucleation.
Insurance acceptance and cash pay rates for psychotherapy in the US
Authors: Zhu Jane M , Huntington Aine , Haeder Simon , Wolk Courtney , McConnell K John
Published: September 2024

Cost and insurance coverage remain important barriers to mental health care, including psychotherapy and mental health counseling services (“psychotherapy”). While data are scant, psychotherapy services are often delivered in private practice settings, where providers frequently do not take insurance and instead rely on direct pay. In this cross-sectional analysis, we use a large national online directory of 175 083 psychotherapy providers to describe characteristics of private practice psychotherapy providers who accept and do not accept insurance, and assess self-reported private pay rates. Overall, about one-third of private practice psychotherapists did not accept insurance, with insurance acceptance varying substantially across states. We also found significant session rate differentials, with Medicaid rates being on average 40% lower than reported cash pay rates, which averaged $143.26 a session. Taken together, low insurance acceptance across a broad swath of mental health provider types means that access to care is disproportionately reliant on patients’ ability to afford out-of-pocket payments—even when covered by insurance. While our findings are descriptive and may not be representative of all US psychotherapists, they add to scant existing knowledge about the cash pay market for an important mental health service that has experienced increased use and demand over time.
Community design of the Brooklyn Health Equity Index
Authors: Afable Aimee , Salisu Margaret , Blackwell Tenya , Divittis Anthony , Hoglund Mark , Lewis Gwendolyn , Boutin-Foster Carla , Douglas Montgomery
Published: September 2024

Health equity drives quality care. Few reliable metrics that capture patients’ perceptions of health equity exist. We report on the development of a patient-centered metric for health systems change in central Brooklyn, which stands out as an outlier in New York City with a disproportionate burden of poverty, disease, and death. A community-engaged, sequential, mixed-methods research design was used. Qualitative interviews were conducted with 80 community and health care stakeholders across central Brooklyn. Candidate items were derived from qualitative themes and examined for face, interpretive validity, and language. Interitem reliability and confirmatory factor analysis was assessed using data collected via text and automated discharge calls among 368 patients from a local hospital. Qualitative data analysis informed the content of 11 draft questions covering 3 broad domains: trust-building, provider appreciation of social determinants of health, and experiences of discrimination. Psychometric testing resulted in a Cronbach's alpha of 0.774 and led to deletion of 1 item, resulting in a 10-item Brooklyn Health Equity Index (BKHI). The 10-item BKHI is a novel, brief, and reliable measure that captures patients’ perceptions of inequities and offers a real-time measure for health systems and payors to monitor progress toward advancing health equity.
Potassium stimulates fruit sugar accumulation by increasing carbon flow in Citrus sinensis
Authors: Wu Kongjie , Hu Chengxiao , Liao Peiyu , Hu Yinlong , Sun Xuecheng , Tan Qiling , Pan Zhiyong , Xu Shoujun , Dong Zhihao , Wu Songwei
Published: September 2024

Soluble sugars contribute to the taste and flavor of citrus fruit. Potassium (K), known as a quality element, plays key roles in improving sugar accumulation and fruit quality, but the mechanism is largely unknown. This study aims to elucidate how K improves sugar accumulation by regulating carbon flow from source leaves to fruit in Newhall navel orange. We found that optimal fruit K concentrations around 1.5% improved sugar accumulation and fruit quality in citrus. K application increased the strength of both sink and source, as indicated by the increased fruit growth rate, enzyme activities and expression levels of key genes involved in sucrose (Suc) metabolism in fruit and leaf. K application also facilitated Suc transport from source leaves to fruit, as confirmed by the enhanced 13C-Suc level in fruit. Furthermore, we found that navel orange used the symplastic pathway for transporting Suc from source leaves to fruit, and K application enhanced symplastic loading, as demonstrated by the intensified carboxyfluorescein signal and increased plasmodesmata density in leaves. The findings reveal that K stimulates fruit sugar accumulation by increasing carbon flow from source leaves to fruit in Newhall navel orange.
Do populists escalate international disputes?
Authors: Destradi Sandra , Plagemann Johannes
Published: September 2024

Among the potentially most consequential effects of populism is its impact on countries' international conflict behaviour. However, empirical evidence about populists' approach to international disputes is inconclusive. We develop a theoretical framework focused on mobilization and personalization, which we argue are particularly relevant characteristics of populist foreign policy-making. We hypothesize that, on a conflict–cooperation continuum, a country's approach to a bilateral dispute will become more conflictive under a populist government if that dispute is strongly used for domestic political mobilization, and if decision-making on that issue is highly personalized. Conversely, foreign policy will not become more conflictive in cases of weak mobilization and personalization. We carry out in-depth qualitative within-case comparisons of non-populist and populist governments' policies in Bolivia (2002–2019), India (2004–2022), and the Philippines (2010–2022), focusing on two selected bilateral disputes per country. Drawing on a broad range of sources, including 71 expert interviews conducted in the three countries, we find that populists in power escalate international disputes if they strongly use foreign policy issues for domestic mobilization and, at the same time, strongly personalize decision-making. This finding nuances existing assessments about the effect of populism on foreign policy change.
Populist international (dis)order? Lessons from world-order visions in Latin American populism
Authors: Farias Deborah Barros Leal , Casarões Guilherme , WAJNER Daniel F
Published: September 2024

The study of populism's international links has grown significantly. Yet, there are gaps in conceptualizing potential implications for the international order. Our study contributes to filling this gap by asking: if a ‘populist international order’ (PIO) were to emerge, and populists could envision the world close(r) to their liking, what would this order look like? We pursue answers through a plausibility probe of three deductively-derived normative pillars: 1) cooperation under a PIO is characterized by more fractured, mostly symbolic, small-scale multilateralism; 2) a PIO relies on a narrow, selective embrace of the rule of law, to be respected only when seen as representing the wishes of the ‘real people’; and 3) the commitment to pluralism in ‘international society’ is replaced by an anti-pluralist, monolithic notion of popular sovereignty as the primary behavioural driver. Our analysis is based on contemporary populist leadership from Latin America: Brazil's Jair Bolsonaro, Venezuela's Nicolás Maduro and Mexico's Andrés Manuel López Obrador. We examine how these populists have addressed our proposed PIO pillars in different ways and shaped their world-order visions in relation to them. The lessons derived from this study can contribute to bridging gaps regarding the effects of global populism in International Relations, including prospects of mitigating the systemic impact of populism on the international order.
Beyond exit: how populist governments disengage from international institutions
Authors: Pacciardi Agnese , Spandler Kilian , Söderbaum Fredrik
Published: September 2024

There is a widespread belief among scholars and policy-makers that populism has fuelled a unilateralist backlash because of its emphasis on nationalism, popular sovereignty and identity politics. Although a few populist governments have indeed withdrawn from some international institutions, this ‘disengagement hypothesis’ needs to be scrutinized and unpacked. In this article, we develop a framework that distinguishes between four types of institutional disengagement—criticism, obstruction, extortion and exit—and show that populist governments use them in a fluid and tactical way to navigate between the radical and pragmatic imperatives of populist politics. Our comparative case-study of the Hungarian executive under Viktor Orbán (since 2010) and the Trump administration in the US (2017–2021) demonstrates that both governments have frequently used criticism, obstruction and extortion to disengage from international institutions but have only rarely exited from them. The article thus deepens our understanding of the impact of populism on both individual institutions and the multilateral order more broadly, and helps policy-makers develop strategies to counter the adverse effects of populism.
Association Between Maternal Infections in Pregnancy and the Risk of Inflammatory Bowel Disease in the Offspring: Findings From Two Scandinavian Birth Cohorts
Authors: Guo Annie , Ludvigsson Johnny , Lerchova Tereza , Imberg Henrik , Størdal Ketil , Mårild Karl
Published: September 2024

Background

The association of infections and antibiotic use in pregnancy and the risk of inflammatory bowel disease (IBD) development in the offspring have been scarcely investigated. We examined infection and antibiotic use in pregnancy and the risk of IBD in offspring.

Methods

We followed participants from the All Babies in Southeast Sweden (ABIS) and the Norwegian mother father and child cohort (MoBa) from birth (1997-2009) until 2020-2021. IBD diagnosis was classified as ≥2 records in national registers. Information on infections (any, gastrointestinal, and respiratory), their timing (early or late in pregnancy), and antibiotic use in pregnancy were collected from questionnaires. Cox proportional-hazard regression and meta-analytic methods were used to estimate pooled adjusted hazard ratios (aHRs) for IBD and its subtypes, adjusted for parental IBD, maternal smoking, and education. Sensitivity analyses accounted for exposure to antibiotics and infections 0-12 months of age.

Results

We followed 117 493 children for 2 024 299 person-years (follow-up 22.3 years in ABIS and 16.4 years in MoBa), including 451 IBD cases. The aHRs for any infection and respiratory infections in pregnancy and offspring IBD were close to one (aHR = 0.99 [95% CI = 0.73-1.33] and aHR = 1.00 [95% CI = 0.81-1.23], respectively). However, any versus no infection in early pregnancy was associated with IBD development (aHR = 1.26 [95% CI = 1.02-1.55]), particularly Crohn’s disease (CD; aHR = 1.40 [95% CI = 1.01-1.93]). Any versus no gastrointestinal infection in late pregnancy was associated with offspring CD (aHR = 1.95 [95% CI = 1.34-2.84]). Antibiotic use in pregnancy was not associated with IBD in the child (aHR = 1.15 [95% CI = 0.93-1.44]).

Conclusions

In this binational birth cohort study, the risk of offspring IBD varied by infection type and timing but not with maternal antibiotic use in pregnancy.
Taxonomic and functional characterization of biofilms from a photovoltaic panel reveals high genetic and metabolic complexity of the communities
Authors: Jotta Viviane Faria Morais , García Glen Jasper Yupanqui , Fonseca Paula Luize Camargos , de Mello Ferreira Angela , Azevedo Vasco , Brenig Bertram , Góes-Neto Aristóteles , Badotti Fernanda
Published: September 2024

Aims

Biofilms are complex microbial cell aggregates that attach to different surfaces in nature, industrial environments, or hospital settings. In photovoltaic panels (PVs), biofilms are related to significant energy conversion losses. In this study, our aim was to characterize the communities of microorganisms and the genes involved in biofilm formation.

Methods and results

In this study, biofilm samples collected from a PV system installed in southeastern Brazil were analyzed through shotgun metagenomics, and the microbial communities and genes involved in biofilm formation were investigated. A total of 2030 different genera were identified in the samples, many of which were classified as extremophiles or producers of exopolysaccharides. Bacteria prevailed in the samples (89%), mainly the genera Mucilaginibacter, Microbacterium, Pedobacter, Massilia, and Hymenobacter. The functional annotation revealed >12 000 genes related to biofilm formation and stress response. Genes involved in the iron transport and synthesis of c-di-GMP and c-AMP second messengers were abundant in the samples. The pathways related to these components play a crucial role in biofilm formation and could be promising targets for preventing biofilm formation in the PV. In addition, Raman spectroscopy analysis indicated the presence of hematite, goethite, and ferrite, consistent with the mineralogical composition of the regional soil and metal-resistant bacteria.

Conclusions

Taken together, our findings reveal that PV biofilms are a promising source of microorganisms of industrial interest and genes of central importance in regulating biofilm formation and persistence.
Dominant strain shift in the invasive fall armyworm (Lepidoptera: Noctuidae) populations in Thailand as inferred from mitochondrial COI and nuclear Tpi genes
Authors: Phanthian Chitsanuphong , Tandavanitj Nontivich , Chaisuekul Chatchawan
Published: September 2024

The fall armyworm, Spodoptera frugiperda (J. E. Smith, 1797) (Lepidoptera: Noctuidae), is a significant global pest, that exhibits 2 discernible strains, corn strain (CS) and rice strain (RS). After initial detection in the eastern hemisphere in 2016, the dominant strain was identified as RS based only on cytochrome C oxidase subunit I (COI) mitochondrial gene from limited samples from various countries, including Thailand. This study aimed to assess strain and haplotype variation in the S. frugiperda populations in Thailand using both mitochondrial COI and nuclear triosephosphate isomerase (Tpi) genes. Analyses of COI sequences (n = 105) revealed 2 predominant haplotypes, COICSh4 (82.86%) and COIRSh1 (17.14%), and the analyses of Tpi sequences (n = 99) revealed 6 haplotypes, with TpiCa1a (53.53%) being the most prevalent. Of the 98 caterpillar samples, the majority exhibited true CS (83.67%) for both genes. Meanwhile, interstrain hybrids, indicated by gene discordance, accounted for the minority (16.33%). Interestingly, despite the initial dominance of RS during the 2018 outbreak, the current study identified CS as the prevalent strain across all localities in Thailand. These findings suggested a shift in S. frugiperda dynamics in Thailand that was possibly influenced by factors, such as competitive exclusion principle, pesticide usage in rice cultivation, and preferences for corn over rice. Our study suggests a need to reexamine the previous reports of rice-strain dominance in various countries in the eastern hemisphere after the initial invasion.
A rare presentation of hematosalpinx with torsion in a thirteen year-old virgin: a case report
Authors: Raju Shivani , Kashyap Shravya , Jobran Afnan W M , K Shrivarshini , N Shravya
Published: September 2024

A medical condition called hematosalpinx causes an accumulation of blood within the fallopian tube. It is usually seen in patients with ectopic pregnancy. Inflammatory disease of the pelvis, tubal cancer, pelvic trauma, and endometriosis are further causes. Here, we report a unique case of hematosalpinx with associated tubal torsion in a 13-year-old female lacking any previously reported contributing causes. She is celibate and presented with abdominal pain and fever. Beta-hcg was not present, and her menstrual cycle was regular. Pelvic ultrasound sonography revealed a large cyst and was suggestive of a right paraovarian cyst. An exploratory laparotomy was performed and a giant hematosalpinx was observed in an otherwise normal ovary. In conclusion, although very rare in adolescence, hematosalpinx must be considered in the differential diagnosis. This unusual instance highlights new concerns regarding the pathogenesis of hematosalpinx.
An Ambivalent Turn: The Changing Image of the Talmud Among Twentieth-Century German-Jewish Intellectuals
Authors: Maor Zohar
Published: September 2024

This essay explores the attitudes of five prominent German-speaking intellectuals, active in the early twentieth century, to the Talmud: Martin Buber, Max Brod, Shmuel Hugo Bergmann, Franz Rosenzweig, and Gershom Scholem. All were central and influential figures in the turn to irrationalism that characterized this period whose discovery of Kabbalah and Hasidism is well documented. However, this essay explores their interest in the Talmud and how it was related to their take on the trend toward irrationalism. These five intellectuals renounced the critical view of the Talmud that was prevalent during the Jewish Enlightenment (Haskalah), and were inspired by the pivotal role of the Talmud in pre-modern and present East-European Jewry. Nevertheless, their turn was ambivalent, as they kept some of the Enlightened images of the Talmud, and were influenced by Buber’s disdain of the Halachic part of Judaism.
Making target sites in large structured RNAs accessible to RNA-cleaving DNAzymes through hybridization with synthetic DNA oligonucleotides
Authors: Nurmi Connor , Gu Jimmy , Mathai Amal , Brennan John D , Li Yingfu
Published: September 2024

The 10–23 DNAzyme is one of the most active DNA-based enzymes, and in theory, can be designed to target any purine-pyrimidine junction within an RNA sequence for cleavage. However, purine-pyrimidine junctions within a large, structured RNA (lsRNA) molecule of biological origin are not always accessible to 10–23, negating its general utility as an RNA-cutting molecular scissor. Herein, we report a generalizable strategy that allows 10–23 to access any purine-pyrimidine junction within an lsRNA. Using three large SARS-CoV-2 mRNA sequences of 566, 584 and 831 nucleotides in length as model systems, we show that the use of antisense DNA oligonucleotides (ASOs) that target the upstream and downstream regions flanking the cleavage site can restore the activity (kobs) of previously poorly active 10–23 DNAzyme systems by up to 2000-fold. We corroborated these findings mechanistically using in-line probing to demonstrate that ASOs reduced 10–23 DNAzyme target site structure within the lsRNA substrates. This approach represents a simple, efficient, cost-effective, and generalizable way to improve the accessibility of 10–23 to a chosen target site within an lsRNA molecule, especially where direct access to the genomic RNA target is necessary.
EGFR and EGFRvIII coopt host defense pathways promoting progression in glioblastoma
Authors: An Zhenyi , Fan Qi-Wen , Wang Linyu , Yoda Hiroyuki , Barata Megumi J , Jimenez-Morales David , Phillips Joanna J , Swaney Danielle L , Stevenson Erica , Lee Ethan , Krogan Nevan , Weiss William A
Published: September 2024

Background

Co-amplification of the epidermal growth factor receptor (EGFR) and EGFRvIII, a tumor-specific truncation mutant of EGFR, represent hallmark genetic lesions in glioblastoma.

Methods

We used phospho-proteomics, RNA-sequencing, TCGA data, glioblastoma cell culture, and mouse models to study the signal transduction mediated by EGFR and EGFRvIII.

Results

We report that EGFR and EGFRvIII stimulate the innate immune defense receptor Toll-like Receptor 2 (TLR2); and that knockout of TLR2 dramatically improved survival in orthotopic glioblastoma xenografts. EGFR and EGFRvIII activated TLR2 in a ligand-independent manner, promoting tumor growth and immune evasion. We show that EGFR and EGFRvIII cooperate to activate the Rho-associated protein kinase ROCK2, which modulated malignant progression both by activating TLR2 and WNT signaling, and through remodeling the tumor microenvironment.

Conclusions

Together, our findings show that EGFR and EGFRvIII cooperate to drive tumor progression through ROCK2 and downstream WNT-β-catenin/TLR2 signaling pathways.
Gender Disparities in Statin Prescriptions in People With HIV With Low/Moderate to High Cardiovascular Risk
Authors: Abela Irene A , Chammartin Frédérique , Amstutz Alain , Surial Bernard , Ballif Marie , Marzolini Catia , Aebi-Popp Karoline , Notter Julia , Segeral Olivier , Stoeckle Marcel , Cavassini Matthias , Bernasconi Enos , Günthard Huldrych F , Kouyos Roger D , Pasin Chloé ,   the Swiss HIV Cohort Study, Abela I , Aebi-Popp K , Anagnostopoulos A , Battegay M , Bernasconi E , Braun D L , Bucher H C , Calmy A , Cavassini M , Ciuffi A , Dollenmaier G , Egger M , Elzi L , Fehr J , Fellay J , Furrer H , Fux C A , Günthard H F , Hachfeld A , Haerry D , Hassec B , Hirsch H H , Hoffmann M , Hösli I , Huber M , Jackson-Perry D , Kahlert C R , Keiser O , Klimkait T , Kouyos R D , Kovari H , Kusejko K , Labhardt N , Leuzinger K , Martinez de Tejada B , Marzolini C , Metzner K J , Müller N , Nemeth J , Nicca D , Notter J , Paioni P , Pantaleo G , Perreau M , Rauch A , Salazar-Vizcaya L , Schmid P , Speck R , Stöckle M , Tarr P , Trkola A , Wandeler G , Weisser M , Yerly S
Published: September 2024

The REPRIEVE trial suggests that primary cardiovascular disease (CVD) prevention could be considered among people with HIV at low CVD risk. We found cisgender women with low/moderate and high CVD risk are less likely to receive statins than cisgender men. Efforts are needed to guarantee equal access to statin-based CVD prevention.