bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary expanded polytetrafluoroethylene conduits with a hand-sewn tricuspid valve
Authors: Matsushima Shunsuke , Takahashi Ryota , Kubo Sara , Higashida Akihiko , Oshima Yoshihiro , Matsuhisa Hironori
Published: February 2025

OBJECTIVES

The biocompatibility of expanded polytetrafluoroethylene in the pulmonary position seems better than allogenic or xenogeneic reactivity. This study reviewed the application of pulmonary expanded polytetrafluoroethylene conduits having a hand-sewn tricuspid valve with diameters of 18–24 mm.

METHODS

All patients receiving this conduit between 2010 and 2022 were evaluated. A 0.1-mm-thick membrane and a standard-wall tube of expanded polytetrafluoroethylene were used for cusp and conduit material, respectively.

RESULTS

Eighty-four consecutive patients were included. The median operative age and weight were 12 (range, 1.2–40) years and 34 (range, 9.1–82) kg, respectively. Eighteen-, 20-, 22- and 24-mm conduits were used in 19, 5, 3 and 57 patients, respectively. The overall survival was 94% at 5 and 10 years with four non-valve-related deaths. There were five conduit replacements, all for 18-mm conduit stenosis. Freedom from conduit replacement was 98% and 83% at 5 and 10 years, respectively. Freedom from conduit stenosis ≥ moderate was 83% and 54% at 5 and 10 years, respectively. Freedom from pulmonary regurgitation ≥ moderate was 98% at 5 and 10 years. Linear mixed-effects models with echocardiographic data implied that 24-mm conduits functioned with a peak velocity <3.0 m/s and without moderate/severe regurgitation in patients with a body weight of up to 75 kg and a body surface area of up to 2.0 m2 for >12 years postoperatively.

CONCLUSIONS

This conduit has shown favourable clinical outcomes and is a valid alternative, especially in young patients with increased risk for early failure of the existing products.
Durability of doravirine/dolutegravir dual combination in a multicentre cohort of elderly people with HIV
Authors: Mazzitelli Maria , Cozzolino Claudia , Gervasoni Cristina , Pagano Simone , Reato Serena , Ripamonti Diego , Comi Laura , Scaglione Vincenzo , Mengato Daniele , Formica Giuseppe , Lagi Filippo , Cascio Antonio , Trizzino Marcello , Iannone Valentina , Farinacci Damiano , Cattelan Annamaria
Published: February 2025

Background

Even though the doravirine/dolutegravir combination is not mentioned by guidelines, real-life data has begun to emerge on its use. We aimed to describe the durability of doravirine/dolutegravir in a multicentre Italian cohort of elderly people with HIV (EPWH).

Methods

We included all EPWH who ever started the doravirine/dolutegravir combination in six Italian centres and were followed up until treatment discontinuation (TD) for any reason (virological failure, death, treatment interruption for other reasons) on 31 March 2024. Descriptive statistics were used to describe the study population; Kaplan–Meier curves and Cox regression analyses were used to estimate incidence and associated predictors of time to TD.

Results

We included 157 people; 61.1% were male, the median age was 59 years (IQR: 55–64), 75.2% had multimorbidity, 38.9% were on polypharmacy, and 91.1% had HIV-RNA of <50 copies/mL. No genotype resistance test was available for 19.4% of people who started doravirine/dolutegravir. The main reasons for starting doravirine/dolutegravir were high cardiovascular risk (51.6%), simplification (52.9%) and drug–drug interactions (25.5%). During a median follow-up of 27.85 (IQR: 22.92–31.79) months, 8 (5.1%) participants experienced TD (2 toxicities, 2 virological failures, 2 switches to long-acting drugs, 1 death and 1 transferred). The incidence of TD was 2.27 per 100 person-years of follow-up. Multivariable Cox regression analyses did not show any factors as predictors of TD.

Conclusions

In this multicentre cohort of EPWH with clinical complexity, the doravirine/dolutegravir combination showed good durability over time. TD probability was very low, and no significant factors seem to predict it, likely due to the limited number and heterogeneity of cases of TD.
Using bacterial and mitochondrial DNA markers to assess fecal pollution sources in stream water and sediments of a mixed land-use watershed
Authors: Ren Wenjing , Brantley Eve F , Wang Xu , Rose Joan B , Feng Yucheng
Published: February 2025

Aims

Although stream bed sediment can be an important reservoir of fecal bacteria and pathogens, it is rarely analyzed when assessing microbial water quality. This study aims to identify fecal contamination sources in stream water and sediment and evaluates the impact of rainfall events on microbial water quality in a mixed land-use watershed.

Methods and Results

Quantitative polymerase chain reaction was employed to quantify human-, cattle-, and chicken-associated genetic markers during dry and wet periods in the Middle Tallapoosa watershed in Alabama, USA. Human- and cattle-associated markers were consistently detected in water samples, irrespective of precipitation, whereas chicken-associated markers were predominantly found following significant rainfall events. In the sediment, all markers were detected at higher concentrations but with a lower frequency than in the water. Escherichia coli concentrations in water samples correlated significantly with 2-day antecedent rainfall and streamflow and were substantially lower than in the sediment.

Conclusions

Humans and cattle were the primary contamination sources in the study area, and runoff from storms and sediment contributed to fecal contamination in the streams.
OpenAI’s patent pledge: a post-Moderna analysis
Authors: Lenarczyk Gabriela , Aboy Mateo
Published: February 2025

Patent pledges have increasingly been used as private ordering mechanisms to facilitate innovation and collaboration while balancing the proprietary interests of patent holders. The Moderna v Pfizer/BioNTech decision by the UK High Court marked the first judicial analysis of the enforceability and interpretation of such pledges. OpenAI’s patent pledge, committing to defensive patent use subject to specific behavioural conditions, raises novel interpretative issues. Their pledge diverges from traditional pledges by focusing on defensive use, conditioned upon specific behavioural triggers such as avoiding harm or legal actions against OpenAI. This article examines the pledge through the lens of the Moderna framework, analysing its scope, revocability and operational limits. The pledge’s reliance on broad behavioural conditions and lack of explicit temporal markers introduce noteworthy legal and practical complexities. These elements affect its enforceability and create challenges for third-party reliance. Our analysis highlights the balance between strategic flexibility for patent holders and the need for clarity to foster trust among implementers. The findings underscore the balance between fostering innovation and protecting proprietary interests.
The conserved IR75 subfamily mediates carboxylic acid detection in insects of public health and agricultural importance
Authors: Cooke Matthew , Chembars Michael S , Pitts Ronald Jason
Published: February 2025

Insects perceive and respond to carboxylic acids (CAs), amines, and aldehydes primarily via conserved ionotropic receptors (IRs). These receptors form the basis for a second olfactory system distinct from the well-characterized odorant receptors. Neurons expressing IRs are housed in dedicated sensilla and innervate glomeruli, separate from those innervated by odorant receptor neurons. The IR8a co-receptor is highly conserved across insect orders and, together with ionotropic receptor tuning receptors, primarily detects CAs. The conservation of genes and the anatomical separation of neural pathways underscore the importance of these compound classes and CAs, specifically in insect chemical ecology. We provide a summary of carboxylic acid detection in insects, focusing on dipteran and lepidopteran species of significance to public health and agriculture. An overview of insect behavior toward CAs is provided, as well as a comprehensive update on carboxylic acid receptor function in insects. Phylogenetic analysis of publicly available genome databases reveals several species that encode and express homologs of previously deorphanized carboxylic acid receptors, highlighting avenues for future research.
Structural Volatility Impulse Response Analysis
Authors: Fengler Matthias R , Polivka Jeannine
Published: February 2025

We make three contributions to the volatility impulse response function (VIRF) developed by Hafner and Herwartz (2006). First, we derive its law for multivariate GARCH models of the BEKK type. Second, we present a structural embedding of the VIRF, leveraging recent advancements in the identification of multivariate generalized autoregressive conditional heteroskedasticity models. Third, we show how to endow the VIRF with a causal interpretation. We illustrate the merits of a structural VIRF analysis by investigating the impacts of historical and out-of-sample shock scenarios on the U.S. equity, government bond, and foreign exchange markets.
Changing the Paradigm: Practical Wisdom as True North in Medical Education
Authors: Plews-Ogan Margaret L
Published: February 2025

The practice of medicine is a complex endeavor requiring high levels of knowledge and technical capability, and the capacity to apply the skills and knowledge to do the right thing in the right way, for the right reason, in a particular context. The orchestration of the virtues, managing uncertainty, applying knowledge and technical skills to a particular individual in a particular circumstance, and exercising the virtues in challenging circumstances, are the tasks of practical wisdom. Centuries ago, Aristotle suggested that capacities for wise action are developed through practice, experience, and reflection. Neuroscience and cognitive psychology are now beginning to contribute to our understanding of the complex interplay between emotion, cognition, and behavior that is necessary for wise action, and how this capacity for wise action can be developed. In this paper, I propose that wisdom offers an appropriate true north for medical education. Wisdom shifts the focus beyond the simple acquisition of knowledge and technical skills and integrates essential virtues like compassion, trustworthiness, humility, and the balancing of the virtues, into the professional formation for medical students. Informed by the humanities, the neurosciences, and the social sciences, we must now integrate the skills and practices necessary to the development of practical wisdom into medical education at all levels.
Response to Oleribe
Authors: Riviere Paul , Murphy James D , Vitzthum Lucas K
Published: February 2025

We would like to thank Dr Oleribe for their interest in the study, “Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors”. In the critical appraisal, the author concludes that there is an increased rate of persistent opioid use among Black veterans because the proportion of veterans with persistent opioid use who were Black was higher than the proportion of African American veterans on a census bureau report of veterans. While we appreciate the author’s investigation into potential racial disparities in adverse opioid outcomes, we do not agree with their methodology and do not believe the data supports their conclusion.
Free metatarsophalangeal joint to metacarpophalangeal joint transfer – a unique surgical technique
Authors: Asghar Zoha , Sheikh Zubaid Moazzam , Asif Muhammad
Published: February 2025

Giant cell tumors of metacarpal bones is a rare occurrence. The tumor particularly exhibits an aggressive behavior in small bones of the extremities. Different techniques such as curettage with or without bone grafting, en bloc resection (more commonly preferred) and reconstruction have been discussed but a unique way of reconstruction is using the metatarsal for substitution. Other options include the fibular graft or using a portion of the iliac crest. We report the case of a young female with a giant cell tumor of the fourth metacarpal bone where we reconstructed the diseased joint with the metatarsal bone while achieving good local control, preserving lower limb and hand function along with cosmesis. The transfer of osteoarticular ligamentous complexes of the metatarsal bone for reconstruction of metacarpal bone defects is a technique that provides good cosmetic outcomes, excellent function with minimum effects to the donor site function.
A rare case of nephroblastoma arising in a multicystic dysplastic kidney: a case report and review of the literature
Authors: Youssef Sabrine Ben , Dghaies Rim , Toumi Afef , Njima Manel , Salem Randa , Fredj Myriam Ben , Ammar Nouha , Chabchoub Imene , Ksia Amine , Sahnoun Lassaad
Published: February 2025

The simultaneous occurrence of Wilms tumor (WT) and multicystic kidney disease (MCKD) is extremely uncommon. Diagnosing WT in pediatric patients with multicystic dysplastic kidney (MCDK) substantially impacts management strategies, especially in surgical interventions and long-term outcomes. In summary, while the exact prevalence of WT in children with MCKD is not well-defined, children with MCDK are followed up throughout childhood by ultrasound because of the perceived risk of developing WT, although this risk is poorly defined and somewhat controversial. Herein, we present the case of an 8-year-old child diagnosed with WT arising in a clearly defined MCDK, discovered incidentally through histological analysis. This case contributes to the ongoing discussion by adding to the existing reports in the literature.
Mitral autograft for partial tricuspid valve replacement: a case report
Authors: El Mourabit Yassin , Tribak Mohammed , El Bakkali Abderahmane , Mermade Lahcen , Moughil Said
Published: February 2025

Surgical management of tricuspid valve infective endocarditis is controversial. We report a case of infective endocarditis of the mitral and tricuspid valves which was treated by partial replacement of the tricuspid valve with a mitral autograft and replacement of the mitral valve with a mechanical prosthesis. Indication for surgical treatment was persistent tricuspid valve vegetations >20 mm after recurrent pulmonary emboli. After an 18-month postoperative follow-up, the patient was in good clinical condition with no residual tricuspid regurgitation. Mitral autograft replacement of the tricuspid valve expands the possibilities for tricuspid valve repair in the context of infective endocarditis.
Sensitivity of Coccidioides serologic tests among culture-proven coccidioidomycosis patients with hematological malignancy compared to a matched immunocompetent cohort
Authors: Al-Obaidi Mohanad M , Rao Amith , Marco Tom , Srivastava Rishab , Kuzmin Paulina , Nematollahi Saman , Zangeneh Tirdad T
Published: February 2025

Coccidioidomycosis is associated with an increased risk of mortality and morbidity among immunosuppressed patients. The sensitivity of current commercial Coccidioides serologic tests is not well evaluated in patients with hematological malignancy. We conducted a retrospective study, including patients with culture-proven coccidioidomycosis, from October 1, 2017, to December 12, 2023. Cases with hematological malignancy and hematopoietic stem cell transplant (HM) were matched with an immunocompetent cohort (1:2) to compare the sensitivity of serology (enzyme immunoassay IgG/IgM or complement fixation) tests—matched by age, gender, and race. We matched 43 HM patients with 86 controls. The median age of the HM/hematopoietic stem cell transplant cohort was 67 (Interquartile Range [IQR], 52–75), 65% male, and 86% White. Most HM had lymphoma (37%), followed by leukemia (35%). Most cases had pulmonary infection (74%) versus controls (84%), P-value = .2, and 12% had a prior history of coccidioidomycosis compared to controls (17%), P-value = .4. Positive Coccidioides serology test results among HM were statistically significantly lower than controls (37% versus 72%), P-value ≤ .001. Multivariate conditional logistic regression identified HM and a history of coccidioidomycosis as statistically significantly associated with positive serologic testing, with Odds Ratio (OR) 0.27 (95% Confidence Interval [CI] 0.12–0.62, P-value = .002) and OR 6.07 (95% CI 1.25–29.4, P-value = .025), respectively.Coccidioides serology tests in HM patients with culture-proven coccidioidomycosis had low sensitivity. Given the increased risk of complications in this group, future studies are needed to evaluate more sensitive diagnostic tests.
Aspergillus spp., aspergillosis and azole usage in animal species in Europe: Results from a multisectoral survey and review of recent literature
Authors: de Jong Judith E , Heuvelink Annet E , Dieste Pérez Lucía , Holstege Manon M C
Published: February 2025

Aspergillosis in humans and animals is caused by certain Aspergillus spp. and can be treated with fungicide azoles. Treatment in animals is often long and complicated by the lack of registered products, species-specific pharmacodynamics, side effects, and withdrawal periods for animal products. The emergence of azole resistance in Aspergillus spp. isolates from human, environmental, and avian samples is alarming, requiring multisectoral attention and a One Health approach. Recent information on the prevalence and impact of aspergillosis in animals, and the use of fungicide azoles in their treatment is however lacking. In this study, we collected and analysed data on the occurrence of aspergillosis and/or presence of Aspergillus spp., and the use of fungicide azoles in animal categories in Europe over the last decade, by means of an international survey and literature review. Thirty-three survey responses were included, from respondents with various professional backgrounds. Fifty-eight articles were included for literature review, of which 90% contained information on the presence of Aspergillus spp. in diseased or healthy animals and 38% on the veterinary use of azoles. Results were consistent: the presence of Aspergillus spp. and related disease, and the use of fungicide azoles were most frequently reported in ‘companion animals’ and ‘zoo animals and wildlife’. Considering the limitations in interpreting the obtained results and the lack of available data, more consistent data collection is necessary to accurately estimate the importance of Aspergillus spp. and related diseases, the use of azoles in veterinary medicine, and its relevance in public health.
The Quark-Nova model for FRBs: model comparison with observational data
Authors: Ouyed Rachid , Leahy Denis , Koning Nico
Published: February 2025

We utilize the Quark-Novae (QN) model for fast radio bursts (FRBs) to evaluate its performance in reproducing the distribution and statistical properties of key observations. These include frequency, duration, fluence, dispersion measure (DM), and other relevant features such as repetition, periodic activity window, and the sad trombone effect. In our model, FRBs are attributed to coherent synchrotron emission originating from collisionless QN chunks that traverse ionized media both within and outside their host galaxies. By considering burst repetition from a single chunk and accounting for the intrinsic DM of the chunks, we find agreement between our model and the observed properties of FRBs. This agreement enhances our confidence in the model’s effectiveness for interpreting FRB observations. Our model generates testable predictions, allowing for future experiments and observations to validate and further refine our understanding of FRBs.
A case of newly onset rheumatoid arthritis successfully treated with methotrexate under the antiretrovirus therapy against HIV infection
Authors: Miyagawa Ippei , Nakayamada Shingo , Saito Kazuyoshi , Shimizu Shoichi , Hanami Kentaro , Ueno Masanobu , Tanaka Yoshiya
Published: February 2025

The patient was a 70-year-old woman. In July 2018, she developed pneumocystis pneumonia and was diagnosed with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome. Antiretroviral therapy was continued, the HIV-RNA load was suppressed, and the CD4+cells count was maintained. In 2024, the polyarticular pain and swelling persisted. HIV-associated arthropathy, reactive arthritis, and other diseases were excluded. The patient was diagnosed with rheumatoid arthritis (RA) according to the ACR/EULAR 2010 Rheumatoid Arthritis Classification Criteria. Joint radiography revealed narrowing of the wrist joint, and joint ultrasonography showed synovial thickening and power Doppler signals, supporting the diagnosis of RA. Methotrexate was initiated, and remission was achieved and maintained. After starting methotrexate, HIV-RNA load increased transiently but rapidly decreased after that. CD4+cells count was maintained. Patients with HIV have underlying immune dysfunction, and RA requires treatment with immunosuppressants, which makes treatment challenging. Recently, HIV infection has been considered a factor that makes the diagnosis of RA difficult. When symptoms suggestive of RA are observed in HIV-infected patients, it is important to make a thorough differential diagnosis and determine a treatment plan based on the characteristics of RA complicated by HIV infection.
Granitoid Metasomatism and Giant Quartz Vein Formation by Mineral Replacement: Insights from the Canigó Massif, Eastern Pyrenees
Authors: González-Esvertit Eloi , Canals Àngels , Prieto-Torrell Claudia , Bons Paul D , Llorens Maria-Gema , Casas Josep Maria , Aguilar Carmen , Neilson Joyce , Elburg Marlina A , Gomez-Rivas Enrique
Published: February 2025

Metasomatism is a ubiquitous process in the Earth’s crust, exerting major controls on fluid, heat and mass transfer and rock deformation, and is commonly constituted by mineral replacement reactions. Different types of metasomatism may coexist and/or successively conceal each other in a given area. Deciphering the geochemical behaviour, regional extent and mineralogical changes of multi-stage metasomatism can be difficult because of the overprinting of successive events and their frequent relationship with deformation. Here, we investigate granitoid metasomatism, namely silicification, feldspathisation and sericitisation, in the Variscan basement rocks of the Canigó Massif (Eastern Pyrenees, SW Europe), which is spatially related to Giant Quartz Veins (GQVs) tens of metres wide and several kilometres long. Unaltered and altered granitic orthogneisses derived from Ordovician intrusives and late-Variscan granitoids, as well as GQV occurrences, are studied across scales through structural and textural characterisation, whole-rock geochemistry and Electron Backscatter Diffraction (EBSD). Geochemical analyses are further compared with a new database including more than 600 unaltered granite and orthogneiss samples from the Pyrenees and the Catalan Coastal Ranges (SW European Variscan Belt). Results show that silicification, the dominant metasomatic process, was related to regional-scale shear zones and contributed to form GQVs through mineral replacement. This is confirmed at the macro- (km), meso- (m–cm) and micro-scale (μm) by relict fabrics, mineral phases and structural features of the precursor rocks within veins, by a progressive depletion of all major and trace elements, except silica, in rocks sampled along decreasing distances from GQV outcrops, and by the localisation of mylonitic deformation along GQVs. Feldspathisation and sericitisation are, in contrast, restricted to specific sectors and exposed as albitite, trondhjemite and pale green mica-rich outcrops. It is suggested that most of the exposed areas of the studied GQVs are, accordingly, not veins sensu stricto but metasomatic products where the original fabrics and features of precursor rocks were overprinted during coupled deformation and Si-metasomatism. Results presented here have major implications for the scale and geochemical behaviour of multi-metasomatic events, as well as on the kinetics of mineral replacement processes leading to changes in the physicochemical properties of crustal rocks.
Examining the effect of warrior and guardian mindsets on attitudes toward use of force: an analysis of US police recruits
Authors: Donner Christopher M , Maskály Jon
Published: February 2025

Recently, several highly publicized and troubling police-citizen encounters around the USA have led many to question not only police tactics but also, more broadly, police legitimacy. These events, among others, led President Obama to create a Task Force on 21st Century Policing. Part of its focus was on fostering legitimacy through community policing and a service-oriented approach to policing practices, and one of its recommendations to enhance legitimacy in the eyes of the public was to call upon the police to embrace a guardian mindset. Part of their reasoning was that officers who adopt a guardian mindset should be less likely to have an ‘us versus them’ worldview and less likely to overly use aggressive, coercive, and physical tactics (i.e. use of force) against the public. To test this assertion, attitudinal survey data are analyzed using a multi-agency sample of police recruits from the USA. Structural equation modeling results demonstrate that recruits with a warrior mindset have more favorable views toward using force. In contrast, recruits who embody a guardian mindset have less favorable views toward the use of force. Specific findings, study limitations, and implications for reform are discussed.
Emotional characteristics and intrinsic brain network functional connectivity among adults aged 75+
Authors: Pruitt Patrick J , Yu Kexin , Lahna David , Schwartz Daniel , Peltier Scott , Silbert Lisa , Dodge Hiroko
Published: February 2025

Despite having a meaningful impact on the quality of life, emotional well-being is often understudied in older adults in favor of cognitive performance, particularly when examining its association with neurobiological function. Socially isolated older adults have poorer emotional health than their non-isolated peers and are at increased risk of dementia. Characterizing neurobiological correlates of emotional characteristics in this population may help elucidate pathways that link social isolation and dementia risk. In a sample of 50 socially isolated older adults aged 75+ years (“older-old”; 30 with mild cognitive impairment; 20 with unimpaired cognition), we use the National Institutes of Health Toolbox—Emotion Battery to examine associations between emotional characteristics and functional magnetic resonance imaging (fMRI)-derived intrinsic brain network functional connectivity. We found a positive association between the default mode network connectivity and negative affect. Amygdala–ventromedial prefrontal cortex (vmPFC) connectivity was negatively associated with psychological well-being and positively associated with negative affect. These results did not survive correction for multiple comparisons. These findings replicate, in a sample of socially isolated older-old adults, the previous work highlighting the relationship between amygdala–vmPFC connectivity and individual differences in emotional health, with more inverse connectivity associated with better emotional characteristics.
Integrating Well-Being Into a Health Systems Science Curriculum
Authors: Smeraglio Andrea , Schnure Nilan , DiVeronica Matthew , McGhee Bryn , Terndrup Christopher , Domingo Michelle Santo , Tuepker Anaïs , Carney Patricia A. , Prasad Ramya , Bonura Erin
Published: February 2025

Purpose

The Quadruple Aim identified improving provider well-being as an extension of the Triple Aim (enhance patient experience, improve population health, and reduce costs). Despite this expansion, health system science (HSS) and well-being training in graduate medical education remain taught as parallel rather than interconnected topics, as suggested by the Quadruple Aim. To address this gap, the authors integrated well-being into an HSS curriculum and evaluated the effect on trainee HSS knowledge and attitudes, well-being, and learning pedagogy.

Method

In this mixed-methods study, quantitative survey data (QI proficiency self-assessment, Mini-Z burnout assessment) and qualitative interview data were collected at Oregon Health & Science University between October and November 2021 for curriculum graduates, approximately 18 or 6 months after course completion for interns in academic years 2019 to 2020 and 2020 to 2021, respectively, to evaluate general experiences, satisfaction, skills and attitudes, and behaviors.

Results

A total of 68 residents completed the course. Improvement was noted in all 9 variables of self-assessed QI proficiency (lowest mean [SD] score of 2.07 [1.03] in month 1 and highest mean [SD] score of 3.98 [0.67] in month 11 [3.98]; P < .001 for all variables). Qualitative interviews with 25 residents (35.2%) 6 to 18 months after course completion demonstrated longitudinal retention of systems thinking principles and improved empathy for multidisciplinary colleagues. Participants perceived the well-being curricular component as having created a tone of programmatic support, being deisolating, and assisting trainees in recognizing system effects on well-being. Residents perceived burnout, however, as unchanged and caused by factors unmodifiable by HSS. Contextualization, conversations, reflection, and actualization with projects were key elements of learning.

Conclusions

An integrated HSS and well-being curriculum allowed trainees to see the role systems play in multiple domains, including their well-being. Trainees developed longitudinal systems, teamwork, error-reporting skills, systems thinking, and well-being skills.
Empowering Stigmatized Voices: Cocreating a Curriculum on Pain and Opioid Use Disorder With Patient Partners
Authors: Graves Lisa , Turnnidge Jennifer , Mulder Jeanne , Akberzai Samsoor , Chen Kuan-chin Jean , Jackson Mathieu , Dalgarno Nancy , Descoteaux Annie , MacLeod Bryan , Van Hoorn Rob , Soleas Eleftherios K. , Karazivan Philippe
Published: February 2025

Purpose

This study explores the partnership experiences of patient and health care professional (HCP) subject matter experts (SMEs) in cocreating educational content and examines their reflections on how to better support educational partnerships in future initiatives.

Method

In this qualitative, exploratory study, semistructured interviews of patient and HCP SMEs were conducted between February and August 2022. Interviews were conducted with videoconferencing software, audio recorded, and transcribed verbatim. Interviews were analyzed using an iterative, inductive approach informed by reflexive thematic analysis.

Results

Eight patient SMEs and 6 HCP SMEs were interviewed. Three themes and 8 subthemes were developed to represent SMEs’ experiences. The overarching themes included (1) building authentic partnerships, (2) developing equitable partnership processes, and (3) setting the stage for successful cocreation. Authentic partnerships were conceptualized as relationships that foster meaningful engagement, provide opportunities for learning and growing together, and require navigation of tensions and constraints. Equitable partnership processes included creating shared expectations and facilitating open and clear communication among partners. Participants discussed how future partnerships can benefit by embracing diversity and innovation, encouraging sustained engagement, and facilitating high-quality processes and products.

Conclusions

The findings of this study highlight that positive cocreation experiences are characterized by building authentic partnerships, developing equitable partnership processes, and setting the stage for successful cocreation. Future work can build on these findings to further explore how to best foster cocreation within educational partnerships.
Objectivity of the relative power and covariance of the Clausius-Duhem inequality in fracture dynamics
Authors: Mariano Paolo Maria
Published: February 2025

We prove that balance laws at a crack tip, including those of configurational actions, all derive from a requirement of objectivity for the power of actions performed relatively to a virtually-varying reference configuration. The procedure maintains distinction between balance laws and constitutive structures but avoids postulating balance laws in strong, integral or weak forms. We thus generalize the results to cracks evolving into bodies with active microstructure by exploiting a covariance argument for a version of the Clausius-Duhem inequality. Here, covariance is intended as structure invariance of the inequality under diffeomorphism-based observer changes. The results are independent of specific microstructures.
A Bioelectric Router for Adaptive Isochronous Neurostimulation
Authors: Sahai Eashan , Hickman Jordan , Denman Daniel J
Published: February 2025

Objective

Multipolar intracranial electrical brain stimulation (iEBS) is a method that has potential to improve clinical applications of mono- and bipolar iEBS. Current tools for researching multipolar iEBS are proprietary, can have high entry costs, lack flexibility in managing different stimulation parameters and electrodes, and can include clinical features unnecessary for the requisite exploratory research. This is a factor limiting the progress in understanding and applying multipolar iEBS effectively. To address these challenges, we developed the Bioelectric Router for Adaptive Isochronous Neuro stimulation (BRAINS) board.

Approach

The BRAINS board is a cost-effective and customizable device designed to facilitate multipolar stimulation experiments across a 16-channel electrode array using common research electrode setups. The BRAINS board interfaces with a microcontroller, allowing users to configure each channel for cathodal or anodal input, establish a grounded connection, or maintain a floating state. The design prioritizes ease of integration by leveraging standard tools like a microcontroller and an analog signal isolators while providing options to customize setups according to experimental conditions. It also ensures output isolation, reduces noise, and supports remote configuration changes for rapid switching of electrode states. To test the efficacy of the board, we performed bench-top validation of monopolar, bipolar, and multipolar stimulation regimes. The same regimes were testedin vivoin mouse primary visual cortex and measured using Neuropixel recordings.

Main Results

The BRAINS board demonstrates no meaningful differences in Root Mean Square Error (RMSE) noise or signal-to-noise ratio compared to the baseline performance of the isolated stimulator alone. The board supports configuration changes at a rate of up to 600 Hz without introducing residual noise, enabling high-frequency switching necessary for temporally multiplexed multipolar stimulation.

Significance

The BRAINS board represents a significant advancement in exploratory brain stimulation research by providing a user-friendly, customizable, open source, and cost-effective tool capable of conducting sophisticated, reproducible, and finely controlled stimulation experiments. With a capacity for effectively real-time information processing and efficient parameter exploration the BRAINS board can enhance both exploratory research on iEBS and enable improved clinical use of multipolar and closed-loop iEBS.
Impact of sucrose sinks on phloem transport
Authors: Nakad Mazen , Weng Ensheng , Gentine Pierre
Published: February 2025

The movement of photosynthates within plants is a focus in plant physiology, ecohydrology, and earth systems modeling. The phloem, one of the plant’s hydraulic systems, facilitates this transport. It is believed to be optimized for efficient photosynthates transport, notably sucrose. This has implications ranging from local impacts on plant survival during drought to ecosystem-scale effects on carbon and water cycling. Most models for phloem transport rely on the pressure-flow hypothesis, where sucrose is loaded in leaves, drawing water from the xylem through osmosis, generating pressure gradients for transport. Experimental challenges in measuring sugar fluxes have led to reliance on theoretical models, though discrepancies exist, especially for long-distance transport. Criticism of the pressure-flow hypothesis notes low hydraulic conductance in sieve tubes, possibly hindering sucrose transport in taller plants. This research explores osmotically driven flows through the development of a new one-dimensional numerical model that includes sources from photosynthesis and sinks towards the stem and roots. The model also incorporates a concentration-dependent viscosity and the xylem water potential. It shows that different allocation schemes of sucrose sinks towards the stem of the plant influence the speed at which sucrose is transported. These findings provide insight into how carbon allocation along the phloem may have evolved to enhance the efficiency of transporting soluble compounds in the phloem.

Highlights

Sucrose sinks along the phloem influence mass flux beyond simple reaction-like consumption dynamics

Mass flux is modulated by the sucrose allocation profile along the tree stem

Observations of xylem-phloem water exchange can provide insights into the physical sucrose sink profile
Multi-tissue transcriptomic aging atlas reveals predictive aging biomarkers in the killifish
Authors: Costa Emma K. , Chen Jingxun , Guldner Ian H. , Mboning Lajoyce , Schmahl Natalie , Tsenter Aleksandra , Wu Man-Ru , Moran-Losada Patricia , Bouchard Louis S. , Wang Sui , Singh Param Priya , Pellegrini Matteo , Brunet Anne , Wyss-Coray Tony
Published: February 2025

Aging is associated with progressive tissue dysfunction, leading to frailty and mortality. Characterizing aging features, such as changes in gene expression and dynamics, shared across tissues or specific to each tissue, is crucial for understanding systemic and local factors contributing to the aging process. We performed RNA-sequencing on 13 tissues at 6 different ages in the African turquoise killifish, the shortest-lived vertebrate that can be raised in captivity. This comprehensive, sex-balanced ‘atlas’ dataset reveals the varying strength of sex-age interactions across killifish tissues and identifies age-altered biological pathways that are evolutionarily conserved. Demonstrating the utility of this resource, we discovered that the killifish head kidney exhibits a myeloid bias during aging, a phenomenon more pronounced in females than in males. In addition, we developed tissue-specific ‘transcriptomic clocks’ and identified biomarkers predictive of chronological age. We show the importance of sex-specific clocks for selected tissues and use the tissue clocks to evaluate a dietary intervention in the killifish. Our work provides a comprehensive resource for studying aging dynamics across tissues in the killifish, a powerful vertebrate aging model.
Gestational diabetes mellitus and vascular malperfusion lesions in the placenta: a systematic review and meta-analysis
Authors: Arcot Amrita , Walker Rachel E. , Gallagher Kelly , Goldstein Jeffery A. , Gernand Alison D.
Published: February 2025

Background

Gestational diabetes mellitus (GDM) can result in increased placental lesions related to high maternal blood glucose, but these relationships are not well understood.

Objective

To examine the relationship between GDM and placental vascular malperfusion lesions: accelerated villous maturation, increased syncytial knots, delayed villous maturation, and increased fibrin deposition.

Search strategy

PubMed, BIOSIS, and Web of Science databases were systematically searched for full-text articles in English from inception until August 21, 2024.

Selection criteria

Our inclusion criteria were randomized controlled trials, case-control, cohort, and cross-sectional studies that examined the relationship between GDM and selected placental vascular malperfusion lesions. The outcome must have been reported as a total proportion.

Data collection and analysis

We included all eligible studies in narrative synthesis. If an outcome of interest was in at least three studies, we calculated the odds ratios (OR) by GDM diagnosis, with 95% confidence intervals, using mixed-effects logistic regression with random study effects. We evaluated the risk of bias with the Newcastle-Ottawa Scale.

Main results

We screened 151 studies, of which eight were included (n=1,291), and six met the criteria for meta-analysis (n=561). Unadjusted odds (95% confidence interval) of delayed villous maturation were six-fold higher (OR: 6.37 [3.28, 12.37]) in pregnancies with GDM compared to those without GDM. The narrative synthesis of the literature found higher proportions of increased syncytial knots, delayed villous maturation, and increased fibrin deposition, but not accelerated villous maturation, in pregnancies with versus without GDM.

Conclusions

GDM was associated with increased risk of three placental malperfusion lesions, although there is a small number of studies in this area. Future investigations should examine if these vascular malperfusions are associated with adverse pregnancy outcomes often linked with GDM.

Synopsis

GDM is associated with increased syncytial knots, delayed villous maturation, and increased fibrin deposition, but not accelerated villous maturation.

Funding

Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of the Maternal Child Health Bureau Nutrition Training Grant, The TRANSCEND Program in Maternal Child Health Nutrition (T7949101).

Registration

Registered in PROSPERO under protocol number CRD42023449651
Clinical determinants and outcomes associated with the development of acute kidney injury in critically ill patients: a Brazilian retrospective cohort study
Authors: Menezes Rodrigo C. , Meira-Teles Rodrigo S.F. , Moura Lucas G. , Ferreira Isabella B. B. , Filgueiras Filho Nivaldo M. , Andrade Bruno B.
Published: February 2025

Background

Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients and associates with significant morbidity and mortality. Understanding region-specific risk factors is crucial for early identification and management, especially in resource-limited settings. This study aimed to identify characteristics, risk factors, and outcomes related to AKI in critically ill patients from a center in Northeast Brazil.

Methods

Retrospective cohort study that used secondary data of adult ICU patients admitted to a medium-sized hospital in Brazil between August 2015 and April 2024. Patients with pre-existing chronic kidney disease or AKI at admission were excluded. Demographic and clinical variables, documented comorbidities, clinical and laboratory data in the first 6 hours of admission, and adverse events during hospitalization were collected. To evaluate risk factors, the variables were included in a multivariable Cox regression model, while to assess complications, a univariable model was employed. Bayesian network modeling was applied to infer causal relations between the presence of AKI and the statistically significant risk factors. Kaplan-Meier curves were used to evaluate survival and length of stay.

Results

Of 5,416 patients analyzed, 369 (6.81%) developed AKI during their ICU stay. Independent risk factors for AKI included advanced age (adjusted Hazard Ratio [aHR] 1.01 per increase in 1 year of age; 95% CI: 1.00–1.02; p=0.008), chronic liver failure (aHR 10.02; 95% CI: 4.91–20.41; p<0.001), arterial hypertension (aHR 1.29; 95% CI: 1.00–1.66; p=0.048), higher heart rate at admission (aHR 1.01 per bpm; 95% CI: 1.00–1.01; p=0.004), and reduced level of consciousness (aHR 1.67 per point decrease in Glasgow Coma Scale; 95% CI: 1.34–2.07; p<0.001). Underweight patients had a lower risk of AKI compared to those with normal weight (aHR 0.59; 95% CI: 0.38–0.91; p=0.017). AKI was associated with higher mortality (37.13% vs. 10.54%; p<0.001) and longer hospital stay (median 16 vs. 10 days; p<0.001).

Conclusions

Age, chronic liver failure, arterial hypertension, higher heart rate, and reduced level of consciousness at admission are independent risk factors for AKI development. AKI was associated with poorer outcomes, highlighting the need for early identification and targeted interventions in this population.
Childhood Nutrition and Service Delivery Indicators across and between two Epidemics (Ebola and COVID-19) in Sierra Leone: A Descriptive Study using Serial Cross-Sectional Surveys
Authors: Bangura Kadiatu , Koroma Aminata Shamit , Pyne-Bailey Solade , Koroma Manso M , Lakoh Sulaiman , Sevalie Stephen , Molleh Bailah , Mekonnen Zeleke Abebaw , Chan Adrienne , Mishra Sharmistha , N’jai Alhaji U.
Published: February 2025

Introduction

Sierra Leone is one of the worst affected by hunger and food insecurity, but data to understand the impact of public health emergencies on nutrition indicators is limited. In this study, we sought to describe nutrition service delivery and nutritional health among children under age five before and during the Ebola epidemic, the inter-epidemic period, and during the COVID-19 pandemic (2021) in Sierra Leone.

Methods

We conducted a descriptive study using secondary data from five serial cross-sectional surveys conducted using representative sampling as part of programmatic monitoring and evaluation: 2010 (N=14027, before Ebola); 2014 (N=10,975, during Ebola); 2017 and 2019 (N=9059, N=4,870, respectively, inter-pandemic period); 2021 (N=10,165, during COVID-19). We described and compared the prevalence of each of the following indicator at each time-point: shunting, global acute malnutrition, breastfeeding and underweight.

Results

The prevalence of stunting was 34.1% before the Ebola epidemic, 28.8% during the Ebola epidemic, 31.3% after the Ebola epidemic, 25.9% before the COVID-19 epidemic, and 26.2% during the COVID-19 epidemic. The prevalence of global acute malnutrition was: 6.9% before the Ebola epidemic, 4.7% during the Ebola epidemic, 5.1% after the Ebola epidemic, 5.0% before the COVID-19 epidemic, and 5.2% during the COVID-19 epidemic. Finally, the report showed that the proportion of breastfeeding for up to 23 months was 84.0% (before the Ebola epidemic), 86.0% (during the Ebola epidemic), 85.0% (after the Ebola epidemic), 61.8% (before the COVID-19 epidemic), and 53.1% (during the COVID-19 epidemic).

Conclusion

We found a variable effect of the Ebola epidemic and COVID-19 on nutrition health and nutrition indicators. Findings highlight the importance of continuing to strengthen the implementation of nutrition programs during and after public health emergencies.