bluuebunny/crossref_metadata_2025 huggingface dataset:
Is it time to abandon the theory of Democracy? The problem with the people: Afterword to the Foreword by Sergio Verdugo
Authors: Alterio Ana Micaela
Published: November 2023

Sergio Verdugo’s provocative Foreword challenges us to think about whether the concepts we inherited from classical constitutionalism are still useful for understanding our current reality. Verdugo refutes any attempt to defend what he calls “the conventional approach to constituent power.” The objective of this article is to contradict Verdugo’s assertions which, the Foreword claims, are based on an incorrect notion of the people as a unified body, or as a social consensus. The article argues, instead, for the plausibility of defending the popular notion of constituent power by anchoring it in a historical and dynamic concept of democratic legitimacy. It concludes that, although legitimizing deviations from the established channels for political transformation entails risks, we must assume them for the sake of the emancipatory potential of constituent power.
Saudi Arabia and the International Refugee Regime
Authors: Janmyr Maja , Lysa Charlotte
Published: November 2023

As a non-signatory to the 1951 Refugee Convention and its 1967 Protocol, Saudi Arabia is often portrayed as a State that refuses engagement with the global legal norms and supporting institutions focused on the protection of refugees. This article contends that this is not the case, and closely examines Saudi Arabia’s relationship with the international refugee regime by asking what was Saudi Arabia’s role in the drafting of the main refugee protection instruments, and what is its approach – past and present – to acceding to the 1951 Convention? How does Saudi Arabia engage with the United Nations High Commissioner for Refugees (UNHCR) – on the global plane but also through UNHCR’s activities in the country?

Drawing on hitherto unresearched material from the UNHCR archives pertaining to the years 1962–94, as well as interviews with key government and UNHCR actors, this article argues that Saudi Arabia engages substantively with the international refugee regime. It discusses how Saudi Arabia participated in the drafting processes of the main refugee protection instruments and shows that accession to the 1951 Convention appears to have been seriously considered at certain junctures.

The article also explores Saudi Arabia’s relationship with UNHCR. In addition to focusing on Saudi Arabia’s role in the UNHCR Executive Committee, it looks more closely at UNHCR’s activities in the country, identifying three phases of UNHCR involvement – establishment (1987–97), expansion (1998–2005), and consolidation (2005–). It finds that UNHCR’s approach to Saudi Arabia is characterized by pragmatism rather than by principle, and that Saudi Arabia has been able to influence the way UNHCR implements its mandate in the country, as well as beyond. Importantly, Saudi Arabia is a gatekeeper for UNHCR operations in the Gulf region and in Muslim-majority countries more generally. Similarly, UNHCR is an important vessel for Saudi Arabian humanitarianism.
Domination for the Rest? Creating and Contesting Secondary State-Led International Hierarchies
Authors: Hynd Alexander M , Connolly Daniel
Published: November 2023

Existing literature on international hierarchies has focused on great powers, hitherto overlooking those hierarchies led by secondary states. Secondary states lack the capabilities and geostrategic reach of their great power counterparts but nevertheless seek to create subordinate relationships in their immediate regions. We argue that in doing so secondary states draw on strategic toolkits that involve the creation of shared communities and the intensification of material dependencies between superordinate and subordinate. However, more so than great powers, secondary states do not get things all their own way. Recognizing the agency of even the weakest of states, we further contend that potential subordinates employ a range of resistance techniques—which we call firewalls and dissonance strategies. We elaborate on these strategies, and conclude our argument, by applying the theoretical model presented here to the novel case of the Sunshine Policy—a decade of inter-Korean hierarchy formation, contestation, and resistance from 1998 to 2008 in which we claim that South Korea attempted, and ultimately stalled, in its efforts to establish itself in a hierarchical relationship with North Korea.
On the Category ofReligion: A Taxonomic Analysis of a Large-Scale Database
Authors: Monroe M Willis
Published: November 2023

The Database of Religious History is a large-scale digital humanities project dedicated to capturing scholarly perspectives on the history of religious groups across the globe. Analysis of the current state of the data shows a remarkable consistency between a taxonomic tree generated from the entries submitted by our expert contributors and larger assumptions within religious studies as they pertain to the similarities and differences between religious groups. Additionally, there is broad agreement between how experts answer questions and the tags they use to categorize their own entries, demonstrating a consistency between top-down and bottom-up approaches to describing religious groups. We see both of these results as affirming a commensurable understanding of the category of religion while demonstrating the value of these types of large-scale quantitative analyses for answering larger questions within the field.
ABA signaling branches out: emerging ABA-related signaling functions inSolanum tuberosum
Authors: Abelenda José A , Barrero-Gil Javier
Published: November 2023

This article comments on:

Liu T, Dong L, Wang E, Liu S, Cheng Y, Zhao J, Xu S, Liang Z, Ma H, Nie B, Song B. 2023. StHAB1, a negative regulatory factor in abscisic acid signaling, plays crucial roles in potato drought tolerance and shoot branching. Journal of Experimental Botany 74, 6708–6721.
Insertion of a miniature inverted-repeat transposable element into the promoter of OsTCP4 results in more tillers and a lower grain size in rice
Authors: Zhang Hui , Zhang Juncheng , Xu Pengkun , Li Ming , Li Yibo
Published: November 2023

A class I PCF type protein, TCP4, was identified as a transcription factor associated with both grain size and tillering through a DNA pull-down-MS assay combined with a genome-wide association study. This transcription factor was found to have a significant role in the variations among the 533 rice accessions, dividing them into two main subspecies. A Tourist-like miniature inverted-repeat transposable element (MITE) was discovered in the promoter of TCP4 in japonica/geng accessions (TCP4M+), which was found to suppress the expression of TCP4 at the transcriptional level. The MITE-deleted haplotype (TCP4M-) was mainly found in indica/xian accessions. ChIP-qPCR and EMSA demonstrated the binding of TCP4 to promoters of grain reservoir genes such as SSIIa and Amy3D in vivo and in vitro, respectively. The introduction of the genomic sequence of TCP4M+ into different TCP4M- cultivars was found to affect the expression of TCP4 in the transgenic rice, resulting in decreased expression of its downstream target gene SSIIa, increased tiller number, and decreased seed length. This study revealed that a Tourist-like MITE contributes to subspecies divergence by regulating the expression of TCP4 in response to environmental pressure, thus influencing source-sink balance by regulating starch biosynthesis in rice.
Statistical analysis of the gravitational anomaly in Gaia wide binaries
Authors: Hernandez X , Verteletskyi V , Nasser L , Aguayo-Ortiz A
Published: November 2023

The exploration of the low acceleration a < a0 regime, where a0 = 1.2 × 10−10 m s−2 is the acceleration scale of MOND around which gravitational anomalies at galactic scale appear, has recently been extended to the much smaller mass and length scales of local wide binaries thanks to the availability of the Gaia catalogue. Statistical methods to test the underlying structure of gravity using large samples of such binary stars and dealing with the necessary presence of kinematic contaminants in such samples have also been presented. However, an alternative approach using binary samples carefully selected to avoid any such contaminants, and consequently much smaller samples, has been lacking a formal statistical development. In the interest of having independent high-quality checks on the results of wide binary gravity tests, we here develop a formal statistical framework for treating small, clean, wide binary samples in the context of testing modifications to gravity of the form G → γG. The method is validated through extensive tests with synthetic data samples, and applied to recent Gaia DR3 binary star observational samples of relative velocities and internal separations on the plane of the sky, v2D and r2D, respectively. Our final results for a high acceleration r2D < 0.01 pc region are of γ = 1.000 ± 0.096, in full accordance with Newtonian expectations. For a low acceleration r2D > 0.01 pc region, however, we obtain γ = 1.5 ± 0.2, inconsistent with the Newtonian value of γ = 1 at a 2.6σ level, and much more indicative of MOND AQUAL predictions of close to γ = 1.4.
ExoMol line lists – LVI. The SO line list, MARVEL analysis of experimental transition data and refinement of the spectroscopic model
Authors: Brady Ryan P , Yurchenko Sergei N , Tennyson Jonathan , Kim Gap-Sue
Published: November 2023

A semi-empirical IR/Vis line list, SOLIS, for the sulphur monoxide molecule 32S16O is presented. SOLIS includes accurate empirical rovibrational energy levels, uncertainties, lifetimes, quantum number assignments, and transition probabilities in the form of Einstein A coefficients covering the $X\, {}^{3}\Sigma ^{-}$$, a\, {}^{1}\Delta , b\, {}^{1}\Sigma ^{+}, A\, {}^{3}\Pi , B\, {}^{3}\Sigma ^{-}, A^{\prime \prime }\, {}^{3}\Sigma ^{+}, A^{\prime }\, {}^{3}\Delta$, and $e\, {}^{1}\Pi$ systems and wavenumber range up to 43 303.5 cm−1 (≥230.93 nm) with J ≤ 69. SOLIS has been computed by solving the rovibronic Schrödinger equation for diatomics using the general purpose variational code Duo and starting from a published ab initio spectroscopic model of SO (including potential energy curves, coupling curves, (transition) dipole moment curves) which is refined to experimental data. To this end, a database of 50 106 experimental transitions, 48 972 being non-redundant, has been compiled through the analysis of 29 experimental sources, and a self-consistent network of 8558 rovibronic energy levels for the X, a, b, A, B, and C electronic states has been generated with the marvel algorithm covering rotational and vibrational quantum numbers J ≤ 69 and v ≤ 30 and energies up to 52 350.40 cm−1. No observed transitions connect to the $B\, {}^{3}\Sigma ^{-}$(v = 0) state which is required to model perturbations correctly, so we leave fitting the $B\, {}^3\Sigma ^-$ and $C\, {}^3\Pi$ state UV model to a future project. The SO line list is available at ExoMol from www.exomol.com.
Role of magnetic pressure forces in fluctuation dynamo saturation
Authors: Sur Sharanya , Subramanian Kandaswamy
Published: November 2023

Using magnetohydrodynamic simulations of fluctuation dynamos in turbulent flows with rms Mach numbers $\mathcal {M}_{\rm rms}= 0.2, 1.1$, and 3, we show that magnetic pressure forces play a crucial role in dynamo saturation in supersonic flows. First, as expected when pressure forces oppose compression, an increase in anticorrelation between density and magnetic field strengths obtains even in subsonic flows with the anticorrelation arising from the intense but rarer magnetic structures. In supersonic flows, due to stronger compressive motions density and magnetic field strength continue to maintain a positive correlation. However, the degree of positive correlation decreases as the dynamo saturates. Secondly, we find that the unit vectors of ∇ρ and ∇B2 are preferentially antiparallel to each other in subsonic flows. This is indicative of magnetic pressure opposing compression. This antiparallel alignment persists in transonic and supersonic flows at dynamo saturation. However, compressive motions also lead to the emergence of a parallel alignment in these flows. Finally, we consider the work done against the components of the Lorentz force and the different sources of magnetic energy growth and dissipation. We show that while in subsonic flows, suppression of field line stretching is dominant in saturating the dynamo, the picture is different in supersonic flows. Both field line stretching and compression initially amplifies the field. However, growing magnetic pressure opposes further compression of magnetic flux which tends to reduce the compressive motions. Simultaneously, field line stretching also reduces. But, suppression of compressive amplification dominates the saturation of the dynamo.
An analytical late–Universe approach to the weaving of modern cosmology
Authors: Cogato Fabrizio , Moresco Michele , Amati Lorenzo , Cimatti Andrea
Published: November 2023

Combining cosmological probes has consolidated the standard cosmological model with per cent precision, but some tensions have recently emerged when certain parameters are estimated from the local or primordial Universe. The origin of this behaviour is still under debate; however, it is crucial to study as many probes as possible to cross-check the results with independent methods and provide additional pieces of information to the cosmological puzzle. In this work, by combining several late-Universe probes (0 < z < 10), namely, Type Ia supernovae, baryon acoustic oscillations, cosmic chronometers, and gamma-ray bursts, we aim to derive cosmological constraints independently of local or early-Universe anchors. To test the standard cosmological model and its various extensions, considering an evolving dark energy equation of state and the curvature as a free parameter, we analyse each probe individually and all their possible permutations. Assuming a flat Lambda cold dark matter (ΛCDM) model, the full combination of probes provides $H_0=67.2^{+3.4}_{-3.2}$ km s−1 Mpc−1 and Ωm = 0.325 ± 0.015 [68 per cent confidence level (C.L.)]. Considering a flat wCDM model, we measure $w_0=-0.91^{+0.07}_{-0.08}$ (68 per cent C.L.), while by relaxing the flatness assumption (ΛCDM model, 95 per cent C.L.) we obtain $\Omega _k=0.125^{+0.167}_{-0.165}$. Finally, we analytically characterize the degeneracy directions and the relative orientation of the probes’ contours. By calculating the figure-of-merit, we quantify the synergies among independent methods, estimate the constraining power of each probe, and identify which provides the best contribution to the inference process. Pending the new cosmological surveys, this study confirms the exigency for new emerging probes in the landscape of modern cosmology.
A targeted search for FRB counterparts with Konus-Wind
Authors: Ridnaia A , Frederiks D , Svinkin D
Published: November 2023

We present results of the search for hard X-ray/soft gamma-ray emission in coincidence with publicly reported (via Transient Name Server, TNS1) fast radio bursts (FRBs). The search was carried out using continuous Konus-Wind data with 2.944 s time resolution. We perform a targeted search for each individual burst from 581 FRBs, along with a stacking analysis of the bursts from eight repeating sources in our sample and a separate stacking analysis of the bursts from the non-repeating FRBs. We find no significant associations in either case. We report upper bounds on the hard X-ray (20–1500 keV) flux assuming four spectral models, which generally describe spectra of short and long gamma-ray bursts (GRBs), magnetar giant flares, and the short burst, coincident with FRB 200428 from a Galactic magnetar. Depending on the spectral model, our upper bounds are in the range of (0.1–2) × 10−6 erg cm−2. For 18 FRBs with known distances, we present upper bounds on the isotropic equivalent energy release and peak luminosity. For the nearest FRB 200120E, we derive the most stringent upper bounds of Eiso ≤ 2.0 × 1044 erg and Liso ≤ 1.2 × 1044 erg s−1. Furthermore, we report lower bounds on radio-to-gamma-ray fluence ratio Eradio/Eiso ≥ 10−11–10−9 and compare our results with previously reported searches and theoretical predictions for high-energy counterparts to FRBs.
Seven white dwarfs with circumstellar gas discs I: white dwarf parameters and accreted planetary abundances
Authors: Rogers L K , Bonsor A , Xu S , Dufour P , Klein B L , Buchan A , Hodgkin S , Hardy F , Kissler-Patig M , Melis C , Weinberger A J , Zuckerman B
Published: November 2023

Observations of planetary material polluting the atmospheres of white dwarfs are an important probe of the bulk composition of exoplanetary material. Medium- and high-resolution optical and ultraviolet spectroscopy of seven white dwarfs with known circumstellar dust and gas emission are presented. Detections or meaningful upper limits for photospheric absorption lines are measured for: C, O, Na, S, P, Mg, Al, Si, Ca, Ti, Cr, Fe, and Ni. For 16 white dwarfs with known observable gaseous emission discs (and measured photospheric abundances), there is no evidence that their accretion rates differ, on average, from those without detectable gaseous emission. This suggests that, typically, accretion is not enhanced by gas drag. At the effective temperature range of the white dwarfs in this sample (16 000–25 000 K) the abundance ratios of elements are more consistent than absolute abundances when comparing abundances derived from spectroscopic white dwarf parameters versus photometric white dwarf parameters. Crucially, this highlights that the uncertainties on white dwarf parameters do not prevent white dwarfs from being utilized to study planetary composition. The abundances of oxygen and silicon for the three hydrogen-dominated white dwarfs in the sample with both optical and ultraviolet spectra differ by 0.62 dex depending on if they are derived from the optical or ultraviolet spectra. This optical/ultraviolet discrepancy may be related to differences in the atmospheric depth of line formation; further investigations into the white dwarf atmospheric modelling are needed to understand this discrepancy.
Constraining the long-lived supramassive neutron stars by magnetar boosted kilonovae
Authors: Wang Hao , Beniamini Paz , Giannios Dimitrios
Published: November 2023

Kilonovae are optical transients following the merger of neutron star binaries, which are powered by the r-process heating of merger ejecta. However, if a merger remnant is a long-lived supramassive neutron star supported by its uniform rotation, it will inject energy into the ejecta through spin-down power. The energy injection can boost the peak luminosity of a kilonova by many orders of magnitudes, thus significantly increasing the detectable volume. Therefore, even if such events are only a small fraction of the kilonova population, they could dominate the detection rates. However, after many years of optical sky surveys, no such event has been confirmed. In this work, we build a boosted kilonova model with rich physical details, including the description of the evolution and stability of a proto neutron star, and the energy absorption through X-ray photoionization. We simulate the observation prospects and find the only way to match the absence of detection is to limit the energy injection by the newly born magnetar to only a small fraction of the neutron star rotational energy, thus they should collapse soon after the merger. Our result indicates that most supramassive neutron stars resulting from binary neutron star mergers are short lived and they are likely to be rare in the Universe.
Increasing planet-stirring efficiency of debris discs by ‘projectile stirring’ and ‘resonant stirring’
Authors: Costa Tyson , Pearce Tim D , Krivov Alexander V
Published: November 2023

Extrasolar debris discs are detected by observing dust, which is thought to be released during planetesimal collisions. This implies that planetesimals are dynamically excited (‘stirred’), such that collisions are sufficiently common and violent. The most frequently considered stirring mechanisms are self-stirring by disc self-gravity, and planet-stirring via secular interactions. However, these models face problems when considering disc mass, self-gravity, and planet eccentricity, leading to the possibility that other, unexplored mechanisms instead stir debris. We hypothesize that planet-stirring could be more efficient than the traditional secular model implies, due to two additional mechanisms. First, a planet at the inner edge of a debris disc can scatter massive bodies on to eccentric, disc-crossing orbits, which then excite debris (‘projectile stirring’). Second, a planet can stir debris over a wide region via broad mean-motion resonances, both at and between nominal resonance locations (‘resonant stirring’). Both mechanisms can be effective even for low-eccentricity planets, unlike secular-planet-stirring. We run N-body simulations across a broad parameter space, to determine the viability of these new stirring mechanisms. We quantify stirring levels using a bespoke program for assessing rebound debris simulations, which we make publicly available. We find that even low-mass projectiles can stir discs, and verify this with a simple analytic criterion. We also show that resonant stirring is effective for planets above ${\sim 0.5\, {\rm M_{Jup}}}$. By proving that these mechanisms can increase planet-stirring efficiency, we demonstrate that planets could still be stirring debris discs even in cases where conventional (secular) planet-stirring is insufficient.
Phosphate Limitation Responses in Marine Green Algae Are Linked to Reprogramming of the tRNA Epitranscriptome and Codon Usage Bias
Authors: Hehenberger Elisabeth , Guo Jian , Wilken Susanne , Hoadley Kenneth , Sudek Lisa , Poirier Camille , Dannebaum Richard , Susko Edward , Worden Alexandra Z
Published: November 2023

Marine algae are central to global carbon fixation, and their productivity is dictated largely by resource availability. Reduced nutrient availability is predicted for vast oceanic regions as an outcome of climate change; however, there is much to learn regarding response mechanisms of the tiny picoplankton that thrive in these environments, especially eukaryotic phytoplankton. Here, we investigate responses of the picoeukaryote Micromonas commoda, a green alga found throughout subtropical and tropical oceans. Under shifting phosphate availability scenarios, transcriptomic analyses revealed altered expression of transfer RNA modification enzymes and biased codon usage of transcripts more abundant during phosphate-limiting versus phosphate-replete conditions, consistent with the role of transfer RNA modifications in regulating codon recognition. To associate the observed shift in the expression of the transfer RNA modification enzyme complement with the transfer RNAs encoded by M. commoda, we also determined the transfer RNA repertoire of this alga revealing potential targets of the modification enzymes. Codon usage bias was particularly pronounced in transcripts encoding proteins with direct roles in managing phosphate limitation and photosystem-associated proteins that have ill-characterized putative functions in “light stress.” The observed codon usage bias corresponds to a proposed stress response mechanism in which the interplay between stress-induced changes in transfer RNA modifications and skewed codon usage in certain essential response genes drives preferential translation of the encoded proteins. Collectively, we expose a potential underlying mechanism for achieving growth under enhanced nutrient limitation that extends beyond the catalog of up- or downregulated protein-encoding genes to the cell biological controls that underpin acclimation to changing environmental conditions.
Kidney phosphate wasting predicts poor outcome in polycystic kidney disease
Authors: Xue Laixi , Geurts Frank , Meijer Esther , de Borst Martin H , Gansevoort Ron T , Zietse Robert , Hoorn Ewout J , Salih Mahdi ,   the DIPAK Consortium, Drenth Joost P H , de Fijter Johannes W , Losekoot Monique , Peters Dorien J M , Wetzels Jack F , Nijenhuis Tom
Published: November 2023

Background

Patients with autosomal dominant polycystic kidney disease (ADPKD) have disproportionately high levels of fibroblast growth factor 23 (FGF-23) for their chronic kidney disease stage, however only a subgroup develops kidney phosphate wasting. We assessed factors associated with phosphate wasting and hypothesize that it identifies patients with more severe disease and predicts disease progression.

Methods

We included 604 patients with ADPKD from a multicenter prospective observational cohort (DIPAK; Developing Intervention Strategies to Halt Progression of Autosomal Dominant Polycystic Kidney Disease) in four university medical centers in the Netherlands. We measured parathyroid hormone (PTH) and total plasma FGF-23 levels, and calculated the ratio of tubular maximum reabsorption rate of phosphate to glomerular filtration rate (TmP/GFR) with <0.8 mmol/L defined as kidney phosphate wasting. We analysed the association of TmP/GFR with estimated GFR (eGFR) decline over time and the risk for a composite kidney outcome (≥30% eGFR decline, kidney failure or kidney replacement therapy).

Results

In our cohort (age 48 ± 12 years, 39% male, eGFR 63 ± 28 mL/min/1.73 m2), 59% of patients had phosphate wasting. Male sex [coefficient –0.2, 95% confidence interval (CI) –0.2; –0.1], eGFR (0.002, 95% CI 0.001; 0.004), FGF-23 (0.1, 95% CI 0.03; 0.2), PTH (–0.2, 95% CI –0.3; –0.06) and copeptin (–0.08, 95% CI –0.1; –0.08) were associated with TmP/GFR. Corrected for PTH, FGF-23 and eGFR, every 0.1 mmol/L decrease in TmP/GFR was associated with a greater eGFR decline of 0.2 mL/min/1.73 m2/year (95% CI 0.01; 0.3) and an increased hazard ratio of 1.09 (95% CI 1.01; 1.18) of the composite kidney outcome.

Conclusion

Our study shows that in patients with ADPKD, phosphate wasting is prevalent and associated with more rapid disease progression. Phosphate wasting may be a consequence of early proximal tubular dysfunction and insufficient suppression of PTH.
n-Alkane 13C/12C indicates differential metabolic controls of fatty lipid chain extension in C3 and C4 grasses
Authors: Zhao Yu , Yang Hubiao , Yan Qiulin , Zhu Zhenyu , Wang Bo , Song Zhiguang , Hou Shengwei , Zhou Youping
Published: November 2023

Fundamental differences in metabolic control of fatty acids chain extension are reflected in the contrasting carbon isotopic composition profiles of C3 and C4 grasses.
Mating system is associated with seed phenotypes upon loss of RNA-directed DNA methylation in Brassicaceae
Authors: Dew-Budd Kelly J , Chow Hiu Tung , Kendall Timmy , David Brandon C , Rozelle James A , Mosher Rebecca A , Beilstein Mark A
Published: November 2023

In plants, de novo DNA methylation is guided by 24-nt short interfering (si)RNAs in a process called RNA-directed DNA methylation (RdDM). Primarily targeted at transposons, RdDM causes transcriptional silencing and can indirectly influence expression of neighboring genes. During reproduction, a small number of siRNA loci are dramatically upregulated in the maternally derived seed coat, suggesting that RdDM might have a special function during reproduction. However, the developmental consequence of RdDM has been difficult to dissect because disruption of RdDM does not result in overt phenotypes in Arabidopsis (Arabidopsis thaliana), where the pathway has been most thoroughly studied. In contrast, Brassica rapa mutants lacking RdDM have a severe seed production defect, which is determined by the maternal sporophytic genotype. To explore the factors that underlie the different phenotypes of these species, we produced RdDM mutations in 3 additional members of the Brassicaceae family: Camelina sativa, Capsella rubella, and Capsella grandiflora. Among these 3 species, only mutations in the obligate outcrosser, C. grandiflora, displayed a seed production defect similar to Brassica rapa mutants, suggesting that mating system is a key determinant for reproductive phenotypes in RdDM mutants.
Racial, socioeconomic, and neighborhood characteristics in relation to COVID-19 severity of illness for adolescents and young adults
Authors: Dahleh Ayaat , Bean Andrew J , Johnson Tricia J
Published: November 2023

This study tests the hypotheses that insurance status, race and ethnicity, and neighborhood characteristics are associated with hospital admission and severe health outcomes (Intensive Care Unit [ICU] admission and oxygen assistance) for youth and young adults who present to the emergency department (ED) with COVID-19 in a single, academic health system in Illinois, Rush University System for Health (RUSH). Demographic and clinical data from the electronic health record were collected for all 13- to 24-y-old patients seen at RUSH who tested positive for COVID-19 between March 2020 and 2021. Individual-level and neighborhood characteristics were analyzed to determine their association with hospital admission and severe health outcomes through generalized estimating equations. As of March 2021, 1,057 patients were seen in the ED within RUSH in which non-Hispanic White (odds ratio [OR], 2.96; 95% CI, 1.61–5.46; P = 0.001) and Hispanic (OR, 3.34; 95% CI, 1.84–6.10; P < 0.001) adolescents and youth were more likely to be admitted to the hospital compared with non-Hispanic Black/other adolescents and youth. Patients with public insurance or who were uninsured were less likely to be admitted to the ICU compared with those with private insurance (OR, 0.24; 95% CI, 0.09–0.64; P = 0.004). None of the neighborhood characteristics were significantly associated with hospital admission or severe health outcomes after adjusting for covariates. Our findings demonstrated that race and ethnicity were related to hospitalization, while insurance was associated with presentation severity due to COVID-19 for adolescents and young adults. These findings can aid public health investigators in understanding COVID-19 disparities among adolescents and young adults.
Taking pluralism seriously: a new perspective on evidence-based policy
Authors: Bschir Karim , Lohse Simon
Published: November 2023

Scientific policy advice in the face of complex real-world problems requires a maximally pluralistic knowledge base. However, integrating different types of knowledge from a variety of sources raises a series of highly challenging epistemic as well as practical problems. We propose an integrated model of pluralistic policy advice emphasizing the appropriate constitution and structure of pluralistic expert panels. Furthermore, we suggest that normative assumptions underlying expert advice should be made explicit to policymakers. The goal should not be to avoid normative biases, but rather to create transparency with respect to the unavoidable value judgements that influence the epistemic preferences of experts and to provide policymakers with evidence-based scenarios that range over a variety of value preferences.
Lactate produced by alveolar type II cells suppresses inflammatory alveolar macrophages in acute lung injury
Authors: Roy René M. , Allawzi Ayed , Burns Nana , Sul Christina , Rubio Victoria , Graham Jessica , Stenmark Kurt , Nozik Eva S. , Tuder Rubin M. , Vohwinkel Christine U.
Published: November 2023

Alveolar inflammation is a hallmark of acute lung injury (ALI), and its clinical correlate is acute respiratory distress syndrome—and it is as a result of interactions between alveolar type II cells (ATII) and alveolar macrophages (AM). In the setting of acute injury, the microenvironment of the intra‐alveolar space is determined in part by metabolites and cytokines and is known to shape the AM phenotype. In response to ALI, increased glycolysis is observed in AT II cells, mediated by the transcription factor hypoxia‐inducible factor (HIF) 1α, which has been shown to decrease inflammation. We hypothesized that in acute lung injury, lactate, the end product of glycolysis, produced by ATII cells shifts AMs toward an anti‐inflammatory phenotype, thus mitigating ALI. We found that local intratracheal delivery of lactate improved ALI in two different mouse models. Lactate shifted cytokine expression of murine AMs toward increased IL‐10, while decreasing IL‐1 and IL‐6 expression. Mice with ATII‐specific deletion of Hif1a and mice treated with an inhibitor of lactate dehydrogenase displayed exacerbated ALI and increased inflammation with decreased levels of lactate in the bronchoalveolar lavage fluid; however, all those parameters improved with intratracheal lactate. When exposed to LPS (to recapitulate an inflammatory stimulus as it occurs in ALI), human primary AMs co‐cultured with alveolar epithelial cells had reduced inflammatory responses. Taken together, these studies reveal an innate protective pathway, in which lactate produced by ATII cells shifts AMs toward an anti‐inflammatory phenotype and dampens excessive inflammation in ALI.
How acculturation contributes to a rise of diabetes in Hmong Americans
Authors: Xiong Tou
Published: November 2023

This article explores the reasons for the high prevalence of diabetes among Hmong Americans, who are at greater risk for diabetes compared with non-Hispanic White patients and have a higher prevalence of diabetes than other Asian Americans and other races. Knowledge of this issue may allow medical practitioners to identify, screen, and treat Hmong Americans more frequently and at earlier ages. Although better integration of healthcare services, access, and education are needed, earlier screening may help start the diabetes education process sooner; reduce hospital, ED, and office visits; reduce costs; and prevent end-organ damage.
HIV Nursing
Authors: Pierce Jonah
Published: November 2023

These nurses provide compassionate care to patients with HIV and AIDS.
Implementing an Adult Extracorporeal Membrane Oxygenation Program During the COVID-19 Pandemic
Authors: Pitts Brandy , Vaughan Midge , Roney Jamie Kay
Published: November 2023

Background:

In response to the needs of patients infected with COVID-19, an interdisciplinary team was assembled to implement an adult extracorporeal membrane oxygenation (ECMO) program in the surgical ICU of a West Texas tertiary care hospital. Use of Extracorporeal Life Support Organization (ELSO) guidelines was essential to the development of this effort.

Aim:

The aim of this project was to develop, implement, and evaluate an adult ECMO program.

Methods:

A logic model was used in designing and evaluating the adult ECMO program. A 35-hour ECMO specialist training course was developed, and training began in August 2020, a month before implementation of the project began. Patient outcomes were measured between September 2020 and December 2021. Descriptive statistics were used to measure the clinical outcomes of interest.

Results:

Seventeen newly trained ECMO specialists included experienced critical care nurses and respiratory therapists. Protocols were developed for the initiation of ECMO, and tracked patient outcomes included survival off ECMO, survival to discharge, major and minor complications, and length of stay. Nine patients had COVID-19 and demonstrated an 11.11% mortality rate after adult ECMO program implementation.

Conclusions:

Use of the ELSO professional guidelines to design and develop this project led to the achievement of a sustainable ECMO program. Hospital leaders can now implement adult ECMO programs amid other demands for resources that may be created by future pandemics.
Binge-eating disorder
Authors: Scrandis Debra A. , Arnow Deborah
Published: November 2023

Binge-eating disorder (BED) has the highest prevalence of any eating disorder in the US today. However, the condition is frequently not recognized as an eating disorder by healthcare providers or patients. Patients with this diagnosis often have significant psychiatric and medical comorbidities that might respond to evidence-based treatments. NPs in primary care with awareness of the diagnostic criteria for BED and knowledge of its assessment and treatment options can coordinate care for patients experiencing this health challenge.
The Levonorgestrel-Releasing Intrauterine Device as Emergency Contraception
Authors: Ramanadhan Shaalini , Jensen Jeffrey
Published: November 2023

Emergency contraception methods that also deliver ongoing contraception provide the most effective options for individuals hoping to prevent pregnancy after unprotected intercourse. Although the copper intrauterine device (IUD) provides the most effective option for emergency contraception because the device prevents pregnancy when placed before implantation and offers long-acting contraception, uptake by patients has been limited. Recently, the Society of Family Planning issued new guidance recommending the levonorgestrel IUD (LNG-IUD) as an emergency contraception option along with the copper IUD. Here, we review evidence related to this recommendation and conclude that the available data do not support use of the LNG-IUD for emergency contraception. We discuss the mechanisms of action of emergency contraception methods and how these concepts interface with the current political and social landscape of contraception and abortion care. We describe limitations of the existing evidence supporting use of the LNG-IUD as emergency contraception and highlight the critical research needed to establish the device as a highly effective method of emergency contraception.
Vaccination updates and special considerations for systemic lupus erythematosus patients
Authors: Law Jammie , Sorrento Cristina , Saxena Amit
Published: November 2023

Purpose of review

We review the latest guidelines and note special considerations for systemic lupus erythematosus (SLE) patients when approaching vaccination against SARS-CoV-2, influenza, pneumococcus, herpes zoster, and potentially respiratory syncytial virus (RSV) vaccine in the future.

Recent findings

SLE patients have unique infectious risks due to newer treatments and the nature of the disease itself. It is important to balance the benefit of additional protective immunity from updated vaccines against the possible risk of disease activity exacerbations.

It is important to continuously evaluate the safety and immunogenicity of updated vaccines specifically for SLE patients. Additionally, the newly approved RSV vaccine should be considered for this population to reduce severe respiratory illness.
How Porcine Acellular Dermal Matrix Influences the Development of the Breast Capsule 1 Year after Implantation: A Histopathological Analysis
Authors: Cazzato Vito , Renzi Nadia , Bottosso Stefano , De Grazia Alessia , Pasquali Silvia , Di Lecce Claudia , Martellani Fulvia , Zanconati Fabrizio , Ramella Vittorio , Papa Giovanni
Published: November 2023

Background:

In prepectoral breast reconstruction (PPBR) the acellular dermal matrix (ADM)’s integration capacity into the tissue is known. The aim of this study was to analyze the effect of the ADM on development and composition of the peri-implant breast capsule in a dynamic setting of breast tissue expansion during two-stage prepectoral breast reconstruction.

Methods:

This is a prospective single-center study in which 50 patients who underwent mastectomy and breast reconstruction with prepectoral tissue expander and Braxon ADM (group A) and submuscular tissue expander (group B) were enrolled. One-year post implantation hematoxylin & eosin (H&E) staining and immunohistochemistry analyses were done on capsule tissue samples.

Results:

The analysis conducted on H&E-stained samples showed a significant reduction of cellular density and a decrease of the cellular infiltration in capsules of ADM-covered expanders compared with naked expander capsules (P < 0.05). The immunohistochemical analyses showed that group A capsules presented significantly less M1 CD68+ macrophages (P < 0.05), lower alfa-SMA expression levels, and a lower number of myofibroblasts (P < 0.05) compared with group B capsules. Presence of lymphatic vessels was minimally detected in both groups.

Conclusions:

The ADM presence around the prepectoral tissue expander influences the development of the peri-implant capsule, causing a significant reduction of the number of cells and inflammatory infiltrate, especially M1 macrophages and myofibroblasts. The ADM Braxon is therefore effective in creating a noninflamed capsule around the implant and in dynamic tissue conditions, and such an environment is maintained in time.
Pediatric-acquired Idiopathic Blepharoptosis with the Eyelids Being Habitually Opened Using the Frontalis Muscle
Authors: Ishii Naohiro , Ko Takanori , Kiuchi Tomoki , Shimabukuro Makoto , Matsuzaki Kyoichi , Kishi Kazuo
Published: November 2023

Pediatric-acquired idiopathic blepharoptosis is rare, and no studies on surgery for the disease have been reported. We present a case of the disease with an atypical postoperative course. The patient initially underwent levator aponeurosis advancement. However, she cannot sufficiently open the affected eyelid without conscious effort and has developed a habit of opening the eyelids using the frontalis muscle. She underwent secondary frontalis suspension with the fascia latae, and then she was able to open her eyelids well all the time. When the disease duration in pediatric-acquired blepharoptosis is long, the habit of opening the eyelids using the frontalis muscle may be difficult to break. In such cases, we believe that frontalis suspension is the best operation.
Female Abdominal Landmarks and Their Improvements Using Polydioxanone Thread Placement for Umbilicus Elevation
Authors: Yu Arthur Y. , Tang Yuqing , Yu David E.
Published: November 2023

Background:

Different landmarks on the abdomen have been used to evaluate abdominal aesthetics. However, because researchers use different methods for landmark measurements, there is no consensus as to which landmarks to use for either assessing abdominal aesthetics or guiding surgical planning.

Methods:

Female model photographs were analyzed for abdominal aesthetics with the umbilicus as the key dividing point. Because of the limitation on the number of landmarks that could be shown with model photographs, abdominal landmarks on actual female patients were studied. The variations of landmark metrics due to positional changes and before/after our polydioxanone (PDO)–assisted high-definition liposuctions were recorded.

Results:

For model photographs, the abdominal apex to mid-umbilicus distance (AU) versus midumbilicus to lower abdominal skin crease (UC) ratio was 1.626. Almost all bony landmarks demonstrated significant caudal shift when switched from standing to supine positions. Meanwhile, other landmarks also underwent substantial changes. This provides evidence that metrics taken in different positions cannot be compared with one another. As expected, after umbilici were elevated with our special technique, the relevant metrics improved postoperatively, with results close to being ideal. However, marked deviations from the mean measured values do exist.

Conclusions:

Abdominal landmarks change with positional adjustment. In standing position, many landmarks can be used for assessment of abdominal aesthetics. Ideally, efforts should be made such that the final AU/UC is close to 1.618, and XU/UP and UIC close to ideal, for satisfactory surgical results. Nevertheless, in actual practice, umbilicus positions can be varied to accomplish desired goals.
Genitourinary Syndrome of Menopause: Does Everyone Have It?
Authors: Doust Jenny , Huguenin Annabelle , Hickey Martha
Published: November 2023

In 2014, the North American Menopause Society and the International Society for the Study of Women’s Sexual Health recommended using the term genitourinary syndrome of menopause (GSM) to cover a range of genital and urinary symptoms that might be experienced during and after menopause. The term as currently defined, however, includes symptoms that may not be menopausal symptoms. The term GSM also includes “objective” measures such as vaginal pH that do not relate to symptom severity and are not priorities for clinicians or patients. We question the validity of GSM as a new syndrome and recommend the definition of the syndrome be revised to ensure it more closely reflects the symptoms attributable to menopause and the experience, difficulties, and response to treatment of those affected.
Prognostic value of a serum β-human chorionic gonadotropin cutoff, twelve days after fresh embryo transfer, on predicting live birth among Ugandan women
Authors: Zaake Daniel , Lwetabe Michael Weber , Kayiira Anthony
Published: November 2023

Objective:

This study aimed to evaluate the prognostic value of a serum β-hCG level cutoff, 12 days after embryo transfer, on predicting live births among Ugandan women.

Methods:

This is a retrospective cross-sectional study. Three hundred thirty-seven fresh IVF cycles with serum β-hCG ≥5 mIU/mL, at 12 days after embryo transfer, were eligible. We abstracted participant characteristics, IVF cycle characteristics, live birth, clinical pregnancy, and ongoing pregnancy data from each eligible cycle. We utilized the Youden Index metric and the maximize_boot_metric method to link serum β-hCG levels to outcome data and determine the optimal cutoff values.

Results:

The optimal serum β-hCG cutoff value for predicting live birth was 437.42 mIU/mL with a corresponding sensitivity and false positive rate of 72% and 31%, respectively. The cutoffs for clinical and ongoing pregnancy were 239.58 mIU/mL and 353.66 mIU/mL, respectively. These corresponded with a sensitivity of 83% and 77%, respectively, and a false positive rate of 27% and 33%, respectively. The serum β-hCG cutoff had poor discriminatory performance for predicting live births but moderate performance for predicting clinical and ongoing pregnancies.

Conclusion:

A single serum β-hCG 12 days after cleavage embryo transfer has poor discriminatory performance in predicting live birth, albeit performing modestly in predicting clinical pregnancy and ongoing pregnancy among Ugandan women.
Diagnostic accuracy of AGILE 3+ score for advanced fibrosis in patients with NAFLD: A systematic review and meta-analysis
Authors: Dalbeni Andrea , Lombardi Rosa , Henrique Matteus , Zoncapè Mirko , Pennisi Grazia , Petta Salvatore , Tateishi Ryosuke , Keklikkiran Caglayan , Colecchia Antonio , Sacerdoti David , Mantovani Alessandro , Ravaioli Federico
Published: November 2023

Background and Aims:

A simple noninvasive score, the Agile 3+ score, combining liver stiffness measurement, aspartate aminotransferase/alanine aminotransferase ratio, platelet count, diabetes status, sex, and age, has been proposed for the identification of advanced fibrosis in patients with suspected NAFLD. We performed a systematic review and meta-analysis of observational studies to evaluate the diagnostic accuracy of the Agile 3+ score in identifying patients with NAFLD and advanced fibrosis. Recently, an International consensus changed the nomenclature of NAFLD into metabolic-associated steatotic liver disease, so currently, the two terms are interchangeable.

Approach and Results:

We systematically searched MEDLINE, Ovid Embase, Scopus, and Cochrane Library electronic databases for full-text published articles in any language from the inception to the April 24, 2023. We included original articles reporting data on the sensitivity and specificity of the Agile 3+ score, according to previously described rule-out (≤ 0.451) and rule-in (≥ 0.679) cutoffs. We included 6 observational studies (total of 6955 participants) with biopsy-proven NAFLD [mean age 53 (SE 4) years, mean body mass index 30.9 (SE 2.3) kg/m2, 54.0% men, prevalence of diabetes 59.6%]. The pooled prevalence of advanced fibrosis (≥ F3) was 42.1%. By the rule-out cutoff, the overall sensitivity and specificity were 88% (95% CI: 81–93%;I2= 89.2%) and 65% (95% CI: 54–75%;I2= 97.6%), respectively. By the rule-in cutoff, the overall sensitivity and specificity were 68% (95% CI: 57–78%;I2=91.1%) and 87% (95% CI: 80%–92%;I2=96.7%), respectively. Meta-regression analyses reported that the diagnostic accuracy was partly mediated by age (p< 0.01), body mass index (p< 0.01), and, although not statistically significant, sex (p= 0.06).

Conclusions:

Our systematic review and meta-analysis suggests that Agile 3+ accurately diagnoses NAFLD with advanced fibrosis and can identify patients eligible for biopsy and emerging pharmacotherapies.