bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac and kidney benefits of empagliflozin in heart failure across the spectrum of kidney function: Insights from the EMPEROR‐Preserved trial
Authors: Sharma Abhinav , Ferreira João Pedro , Zannad Faiez , Pocock Stuart J. , Filippatos Gerasimos , Pfarr Egon , Petrini Michaela , Kraus Bettina J. , Wanner Christoph , Packer Milton , Butler Javed , Anker Stefan D.
Published: April 2023

Aim

In the EMPEROR‐Preserved trial, empagliflozin improved clinical outcomes of patients with heart failure (HF) with preserved ejection fraction. In this pre‐specified analysis, we aim to study the effect of empagliflozin on cardiovascular and kidney outcomes across the spectrum of kidney function.

Methods and results

Patients were categorized by the presence or absence of chronic kidney disease (CKD) at baseline (CKD defined by an estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2 or urine albumin to creatinine ratio >300 mg/g). The primary and key secondary outcomes were (i) a composite of cardiovascular death or first HF hospitalization (primary outcome); (ii) total number of HF hospitalization, (iii) eGFR slope; and a pre‐specified exploratory composite kidney outcome including a sustained ≥40% decline in eGFR, chronic dialysis or renal transplant. The median follow‐up was 26.2 months. A total of 5988 patients were randomized to empagliflozin or placebo, of whom 3198 (53.5%) had CKD. Irrespective of CKD status, empagliflozin reduced the primary outcome (with CKD: hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.69–0.94; without CKD: HR 0.75, 95% CI 0.60–0.95; interaction p = 0.67) and total (first and recurrent) hospitalizations for HF (with CKD: HR 0.68, 95% CI 0.54–0.86; without CKD: HR 0.89, 95% CI 0.66–1.21; interaction p = 0.17). Empagliflozin slowed the slope of eGFR decline by 1.43 (1.01–1.85) ml/min/1.73 m2/year in patients with CKD and 1.31 (0.88–1.74) ml/min/1.73 m2/year in patients without CKD (interaction p = 0.70). Empagliflozin did not reduce the pre‐specified kidney outcome in patients with or without CKD (with CKD: HR 0.97, 95% CI 0.71–1.34; without CKD: HR 0.92, 95% CI 0.58–1.48; interaction p = 0.86) but slowed progression to macroalbuminuria and reduced the risk of acute kidney injury. The effect of empagliflozin on the primary composite outcome and the key secondary outcomes was consistent across five baseline eGFR categories (all interaction p >0.05). Empagliflozin was well tolerated independent of CKD status.

Conclusions

In EMPEROR‐Preserved, empagliflozin had a beneficial effect on the key efficacy outcomes in patients with and without CKD. Overall, the benefit and safety of empagliflozin was consistent across a wide range of kidney function spectrum, down to a baseline eGFR of 20 ml/min/1.73 m2.
Decreased serum concentrations of antiseizure medications in children with drug resistant epilepsy following treatment with ketogenic diet
Authors: Pedersen Sigrid , Kverneland Magnhild , Rudi Knut , Gervin Kristina , Landmark Cecilie Johannessen , Iversen Per Ole , Selmer Kaja Kristine
Published: April 2023

Objective

To examine the potential influence of a ketogenic diet on serum concentrations of antiseizure medications (ASMs) in children with drug resistant epilepsy.

Methods

We investigated the serum concentrations of ASMs in 25 children with drug resistant epilepsy, 2–13 years of age, treated with a classical ketogenic diet for 12 weeks. The patients were recruited from the National Centre for Epilepsy from August 15th, 2017, to January 24th, 2022. Changes in ASM serum concentrations were analyzed using a mixed effect model analysis. Significance level was set at P < 0.05 for all comparisons.

Results

The participants used 12 different ASMs during the study. The mean number of ASMs was 2.4 (±SD 0.7). None of the participants changed the type or dose of the ASMs during the intervention period. The serum concentrations of clobazam (n = 9, P = 0.002), desmethylclobazam (n = 9, P = 0.010), and lamotrigine (n = 6, P = 0.016) decreased significantly during the dietary treatment. The analytes with the largest reduction in serum concentration after 12 weeks of dietary treatment were clobazam (mean change −38%) and desmethylclobazam (mean change −37%). We found no significant change in the serum concentrations of levetiracetam, topiramate, and valproic acid.

Significance

We identified a significant decrease in the serum concentrations of clobazam, desmethylclobazam, and lamotrigine following a 12‐week ketogenic diet intervention in children with drug resistant epilepsy. An unintended decrease in the serum concentrations of ASMs may render the patient prone to seizures. Measurements of ASM serum concentrations might be useful in patients on a ketogenic diet, especially in patients with lack of efficacy of the dietary treatment.
Mycoprotein as chicken meat substitute in nugget formulation: Physicochemical and sensorial characterization
Authors: Hashempour‐Baltork Fataneh , Jannat Behrooz , Dadgarnejad Manouchehr , Mirza Alizadeh Adel , Khosravi‐Darani Kianoush , Hosseini Hedayat
Published: April 2023

The aim of this study was to replace chicken breast by mycoprotein in nuggets and optimizing the sensory and technological properties. In the first step of the study, 14 formulations were prepared by mixture design to evaluate the impact of three binding agents (as independent variables): soy protein isolate, phosphate, and carrageenan on sensory properties. Then, the optimized formulation of mycoprotein nugget (with higher acceptability) was characterized and compared to chicken nugget (control) from texture, color, and physicochemical aspects. The texture attributes including hardness, springiness, cohesiveness, and chewiness of the optimized sample (1.37 kg, 0.70 mm, 0.56, and 0.53 kg.mm) had no significant difference (p > .05) compared to control. Based on the results, optimized sample had a lower lightness and yellowness (a*, b*, and L* were 3.06, 18.62, and 59.23, respectively) rather than the similar value of the control (2.20, 21.27, and 79.10, respectively), which indicated carrageenan did not lead to any significant impact (p > .05) on the color. Also, mycoprotein nugget showed 33% lower cooking loss in comparison to control. Moisture, protein, lipid, and ash in optimized sample were 57.9 ± 1.9, 24.1 ± 1.0, 13.2 ± 1.2, and 2.1 ± 0.5, respectively. Investigation on physicochemical properties shows an acceptable characterization in optimized sample in comparison to control. The results of this study present an opportunity to produce nonmeat nuggets with similar texture and acceptable sensory and technological characteristics by using mycoprotein as meat alternative. The production of mycoprotein is eco‐friendly, not dependent on climate (flood and drought) and landscape limitation, which is an important aspect in meat alternatives in the near future.
Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey
Authors: Shokri Azad , Bolbanabad Amjad Mohamadi , Rezaei Satar , Moradi Ghobad , Piroozi Bakhtiar
Published: April 2023

Background and Aims

One of the goals of the Islamic Republic of Iran is to reduce the prevalence of catastrophic health expenditures among Iranian households to 1% by the end of the sixth 5‐year development plan (2016−2021). This study was conducted to evaluate the level of access to this goal in the final year of this program.

Methods

A national cross‐sectional study was conducted on 2000 Iranian households in five provinces of Iran in 2021. Data were collected through interviews using the World Health Survey questionnaire. Data from households whose health care costs were more than 40% of their capacity to pay were included in the group of households with catastrophic health expanditure (CHE). Determinants of CHE were identified using univariate and multivariate regression analysis.

Results

8.3% of households had experienced CHE. The variables of being a female head of household (odd ratio [OR] = 2.7), use of inpatient (OR = 1.82), dental (OR = 3.09), and rehabilitation services (OR = 6.12), families with disabled members (OR = 2.03) and low economic status of the households (OR = 10.73) were significantly associated with increased odds of facing CHE (p < 0.05).

Conclusion

In the final year of the sixth 5‐year development plan, Iran has not yet achieved its goal of “reducing the percentage of households exposed to CHE to 1%.” Policymakers should pay attention to factors increasing the odds of facing CHE in designing interventions.
Public health concerns about Tuberculosis caused by Russia/Ukraine conflict
Authors: Paul Innocent K. , Nchasi Goodluck , Bulimbe Deusdedith B. , Mollel Meshack K. , Msafiri George G. , Mbogo Alex , Mswanzari Mayunga B. , Joseph Msengi , Mahmoud Ashraf , Volkova Anastasiia
Published: April 2023

According to WHO, Ukraine has the fourth‐highest Tuberculosis (TB) incidence in the WHO European region while globally has the fifth‐highest number of confirmed cases of extensively drug‐resistant TB. Before the Russian invasion in Ukraine several interventions have been employed to mitigate the TB epidemic in the country. However, the ongoing war has demolished meticulous efforts and subsequently worsen the situation. WHO in collaboration with the Ukraine government and other organizations such as EU and UK are required to take up arms against the situation. In this work, implications brought up from the war, efforts, and recommendations to battling TB epidemic due to the war are highlighted.
Technical computations for dependent shear rate effect on magnetized peristaltic transport of synovia with two fluid viscosity models: Arthritis treatments
Authors: Ibrahim M. G. , Brini S. , Sfina N. , Briki K.
Published: April 2023

Synovitis studies are the key to the treatment of most arthritis diseases in a human physique. So this study visualizes the effects of two dependent fluid viscosity models on magnet nano peristaltic transport of synovial fluid in nonuniform channel walls. Two fluid models are constructed, the first model considered that the Shear rate is dependent on fluid concentration (model‐I), and the exponentially dependent viscosity on the fluid concentration is proposed as a second model (model‐II). The fluid models are represented by a highly nonlinear system of partial differential equations. Joule heat, thermal radiation, and Arrhenius energy are studied as external effects. Those models are offered in a gradient mechanism, then simplified using droppings bars and using the fact of long wavelength, and low Reynolds. Pressure gradient and trapped bolus profiles and shear stress distribution as well as fluid temperature, velocity, and concentration performance are scrutinized. Analytical results are obtained in appropriate/chosen boundary conditions depending on the walls of the channel. Attracted/signified results are compared with the nearest trusted results by Khan et al. Solution intervals are sub‐divided and analytically treated at each of them by multi‐stage differential transform algorithms. Outcomes gratify that, joints are provided by more cushion and lubrication at high fluid temperatures. Magnetic effects are advised in rheumatoid arthritis treatments, increasing the synovial fluid temperature and allowing fluid particles to move freely inside joints.
Role of lncRNA MAGI2‐AS3 in lipopolysaccharide‐induced nucleus pulposus cells injury by regulating miR‐374b‐5p/interleukin‐10 axis
Authors: Yu Jiang , Li Chengjin
Published: April 2023

Background

Intervertebral disc degeneration (IDD) is a pathological process that occurs during the natural aging of intervertebral discs. Accumulating evidence suggests that noncoding RNAs (ncRNAs), including microRNAs and long ncRNAs (lncRNAs), participate in the pathogenesis and development of IDD. Herein, we examined the role of lncRNA MAGI2‐AS3 in the pathogenic mechanism of IDD.

Material and Methods

To develop an IDD in vitro model, we treated human nucleus pulposus (NP) cells with lipopolysaccharide (LPS). Aberrant levels of lncRNA MAGI2‐AS3, miR‐374b‐5p, interleukin (IL)‐10 and extracellular matrix (ECM)‐related proteins in NP cells were examined using reverse transcription‐quantitative PCR and western blot analysis. LPS‐induced NP cell injury and inflammatory response were confirmed using the MTT assay, flow cytometry, Caspase3 activity, and enzyme‐linked immunosorbent assay. Dual‐luciferase reporter assay and rescue experiments were performed to confirm targets between lncRNA MAGI2‐AS3 and miR‐374b‐5p or miR‐374b‐5p and IL‐10.

Results

LPS‐induced NP cells exhibited low levels of lncRNA MAGI2‐AS3 and IL‐10 expression, along with high miR‐374b‐5p expression. miR‐374b‐5p was a target of lncRNA MAGI2‐AS3 and IL‐10. LncRNA MAGI2‐AS3 ameliorated injury, inflammatory response, and ECM degradation in LPS‐treated NP cells by downregulating miR‐374b‐5p to upregulate IL‐10 expression.

Conclusions

LncRNA MAGI2‐AS3 increased IL‐10 expression levels by sponging miR‐374b‐5p, which, in turn, alleviated LPS‐triggered decreased NP cell proliferation and increased apoptosis, inflammatory response, and ECM degradation. Therefore, lncRNA MAGI2‐AS3 may be a potential therapeutic target for IDD.
CHARACTERIZATION OF THE CLASS I HLA 9.2‐kb PVU II RESTRICTION FRAGMENT LENGTH POLYMORPHISM: Linkage to HLA‐A and Lack of Disease Association
Authors: Ahearn Joseph M. , Calomiris Jon J. , Wigley Fredrick M. , Jabs Douglas A. , Bias Wilma B. , Hochberg Marc C.
Published: April 2023

The strongest reported association between a class I HLA allele and disease is that of HLA–B27 with ankylosing spondylitis (AS). However, it has not been shown whether B27 is the gene that predisposes to the development of AS or if it is merely linked with the disease‐susceptibility locus. Furthermore, if B27 itself is the disease‐susceptibility gene, there may be epistatic loci that also contribute to the development of AS or modify its clinical manifestation. A class I HLA 9.2‐kb Pvu II restriction fragment was recently identified, which, when present in a B27‐positive individual, further increased the relative risk for developing AS (from 119 to 297). This study was therefore designed to confirm the association between AS and this restriction fragment length polymorphism (RFLP) and to map the location of this fragment in the genome. The data presented here suggest that the class I HLA 9.2‐kb Pvu II RFLP represents a Pvu II polymorphism at the 5' end of the HLA–A locus that is tightly linked with both HLA–A3 and A9 alleles. However, there is no association between this RFLP and AS in a population of patients living in Baltimore.
SUCCESSFUL PLASMA INFUSION TREATMENT OF A PATIENT WITH C2 DEFICIENCY AND SYSTEMIC LUPUS ERYTHEMATOSUS: CLINICAL EXPERIENCE OVER FORTY‐FIVE MONTHS
Authors: Steinsson Kristján , Erlendsson Kristján , Valdimarsson Helgi
Published: April 2023

We describe a patient with C2 deficiency and severe systemic lupus erythematosus (SLE) that did not respond to conventional therapy. Over a period of 45 months, she was given 22 cycles of plasma therapy. For 6–8 weeks after each plasma infusion, there was a full clinical remission of the SLE, and a brief restoration of hemolytic complement activity. However, there were more prolonged increases in the activities of the complement components that are believed to be more directly involved in the clearance of immune complexes. Because of the theoretical risk that the infused complement might enhance inflammatory tissue damage, there has been some reluctance to try plasma replacement therapy in SLE patients with complement deficiency. We have not observed any adverse effects with the long‐term use of this treatment, and our experience indicates that this therapeutic approach can be beneficial.
MX HOMOLOGOUS PROTEIN IN MONONUCLEAR CELLS FROM PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: von Wussow Peter , Jakschies Detlef , Hochkeppel Heinz , Horisberger Michel , Hartung Klaus , Deicher Helmuth
Published: April 2023

The 76‐kd human interferon (IFN)–induced MX protein is the homolog to the murine protein, which is necessary and sufficient to provide adequate resistance to influenza virus infection in murine cells and in mice. Fifty‐one patients with systemic lupus erythematosus (SLE) were screened for the presence of the MX homolog in mononuclear cells and for IFN and anti‐IFN antibodies in serum. In 47 of 51 patients, significant levels of the MX homolog were found, while only 15 of 51 patients had measurable α‐IFN in their serum. The IFN activity found in these sera was characterized as a partially acid‐labile α‐IFN, by means of acid‐stability cross‐reactivity on heterologous cells, trypsin sensitivity, and neutralization by homologous or heterologous anti‐sera. Four of the patients had no detectable MX homolog in their leukocytes; 3 of these 4 possessed an anti–α‐IFN antibody that was able to neutralize both a natural α‐IFN preparation and the acid‐labile IFN in SLE sera. Also, acid‐labile α‐IFN–containing SLE sera induced the MX homolog in vitro in mononuclear cells from healthy donors. These observations suggest that endogenously produced α‐IFN is responsible for the observed induction of the MX homolog in SLE and that the IFN system is activated in more than 90% of SLE patients.
Magnetized vermiculite as a tool for the treatment of produced water generated by oil companies: Effects on aquatic organisms before and after treatment
Authors: Viana Tais S. , Campos Diana , Bartilotti Mariana , Leite Fernanda G. , Zanoni Maria Valnice Boldrin , Dorta Daniel J. , Oliveira Danielle P. , Pestana João L. T.
Published: April 2023

Produced water (PW) generated by oil companies is a highly impacting waste that contains chemicals such as metals and organic and inorganic compounds. Given its polluting potential, PW requires effective treatment before being discharged into the environment. Conventional treatments have limited efficiency in removing PW toxicity, so alternative approaches must be developed and standardized. In this context, treatment with adsorbent materials like magnetized vermiculite (VMT‐mag) is highlighted. This work aimed to evaluate the efficiency of treatment with VMT‐mag in reducing PW toxicity to aquatic biota. For this purpose, three aquatic species (the midge Chironomus riparius, the planarian Girardia tigrina, and the crustacean Daphnia magna) were exposed to untreated PW and to PW treated with VMT‐mag at laboratory conditions. The assessed endpoints included mortality, growth, emergence, and developmental time of C. riparius; mortality, locomotion, feeding, and head regeneration of G. tigrina; and intrinsic population growth rate (r) and reproductive output of D. magna. The results showed that all the species exposed to raw PW were impaired: C. riparius had delayed development, G. tigrina had reduced locomotor activity and delayed head regeneration, and D. magna had reduced reproduction and delayed intrinsic population growth rate (r). Most of the analyzed parameters showed that treatment with VMT‐mag diminished PW toxicity. Therefore, using VMT‐mag to treat PW may be the key to reducing the PW effects on aquatic organisms.
Trauma‐focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy
Authors: De Jongh A. , Hafkemeijer L. C. S.
Published: April 2023

Objective

Complex post‐traumatic stress disorder (CPTSD) is a classification within the International Classification of Diseases, 11th Revision (ICD‐11) that, besides the DSM‐5 symptom clusters of post‐post‐traumatic stress disorder (PTSD), includes the presence of negative self‐concept, difficulties in regulating emotions and relationship skills. The purpose of the present study was to provide guidance on how to deliver Eye Movement Desensitization and Reprocessing (EMDR) therapy in the context of CPTSD, based on current clinical knowledge and the latest scientific research findings.

Method

This paper describes the treatment of a 52‐year‐old woman with CPTSD and borderline personality disorder for which immediate trauma‐focused EMDR therapy was used.

Results

First, a description of what EMDR therapy entails and some important treatment strategies that the therapist may employ to assist in trauma‐focused treatment of clients with CPTSD using EMDR therapy are outlined.

Conclusion

The treatment results are in line with mounting evidence supporting the notion that EMDR therapy is a safe and potentially effective treatment alternative for individuals with CPTSD or personality problems.
Utilization of three‐dimensional framework theory in identifying the motivational factors for selecting a postgraduate dental specialty–A pilot study
Authors: Zulfiqar Kanwal , Farid Huma , Luqman Uzair , Ilyas Kausar , Bashir Ulfat
Published: April 2023

Objectives

Three‐dimensional framework theory classifies factors influencing career selection into intrinsic, extrinsic, and interpersonal dimensions. The objectives of this pilot research were to assess the psychometric properties of a scale encompassing factors affecting post‐graduation specialty selection according to three‐dimensional framework theory and identify motivational factors that affect dental students’ and interns’ choice of post‐graduation specialty.

Methodology

A closed‐ended self‐structured research instrument consisting of a list of 19 factors was presented to dental students and dental interns at Margalla Dental College, Rawalpindi, Pakistan, and Islamic International Dental College, Islamabad, Pakistan (n = 235). Exploratory factor analysis and Cronbach‐alpha (α) were used to assess the construct validity and reliability (internal consistency) of the scale respectively. Descriptive analysis and non‐parametric tests were used for data analysis with a level of significance at ≤0.05.

Results

A 3‐factor solution with 11 items was stabilized. Cronbach‐alpha of the pilot study turned out to be 0.72. With a response rate of 92.15%, the most common motivational factor affecting post‐graduation specialty selection was the Intrinsic factor “personnel joy and motivation to work hard.” Dental interns and male participants were more likely to select the post‐graduation specialty due to intrinsic motivational factors (p < 0.05). Inspiration from the family member and supporting the family also influenced male participants and interns respectively (p < 0.05). Female participants preferred to choose a less saturated field (p < 0.05). A medium positive statistically significant correlation was observed between the interpersonal motivational factor “inspiration by a teacher” and the choice of “basic sciences” as a post‐graduation specialty (p < 0.01).

Conclusion

This pilot study resulted in the development of a scale with a 3‐factor solution stabilized at 11 items. The internal consistency of the scale turned out to be 0.72. Oral and maxillofacial surgery was the first choice of post‐graduation chosen by 35.5% of the respondents. Fellowship was chosen as the preferred type of post‐graduation by 46% of the respondents. Irrespective of gender and designation, the top most influential factor, chosen by 88.5% of the respondents, was the intrinsic motivational factor “personal joy and motivation to work hard.”
Referral networks for pediatric patients with genetic conditions: The perspective of occupational therapists
Authors: Henly Megan , Phillips Kimberly G. , Smith Sarah L. , Kloza Edward M. , Brucker Debra L.
Published: April 2023

Families of children with developmental delays but no diagnosed genetic condition may benefit from connection to genetic systems of care. This work examines the role of occupational therapy as a space for families of pediatric patients to gain access to genetic services. Between September 2021 and February 2022, we interviewed 20 occupational therapists in New England who work primarily with pediatric patients. We transcribed the interviews and used a grounded theory approach to identify and code recurring themes. The data reveal several barriers to linking pediatric patients to genetic systems of care, including lack of insurance coverage, wait times for appointments and test results, hesitant primary care providers, and familial and cultural stigma of disability. We discuss the unique role of occupational therapists as professionals who spend substantial time with patients, often in their everyday environments, to bridge these barriers. We also address challenges associated with occupational therapists facilitating connections to genetics services, including their lack of specialized knowledge of genetics and barriers fully integrating with others on the medical team.
Intraoperative Bleeding Control with Terlipressin in Functional Endoscopic Sinus Surgery
Authors: Pavlov Vladimir E. , Polushin Yury S. , Kolotilov Leonid V. , Karpishchenko Sergey A.
Published: April 2023

Objective

To evaluate the use of terlipressin for intraoperative bleeding reduction in functional endoscopic sinus surgery (FESS).

Methods

This prospective, randomized, single‐center, single‐blinded cohort study included 74 cases of FESS performed under general anesthesia (GA). The patients were randomized into two groups: WT (without terlipressin, n = 39) and T (with 200 μg terlipressin, n = 35). Bleeding intensity (BI) was assessed using a 6‐point scale. Heart rate (HR), mean blood pressure (MBP), perfusion index (PI), and BI were recorded at 10, 30, and 60 min after surgery. A BI score ≥2 qualified as significant.

Results

The T group had significantly higher MBP compared with the WT group, but HR values did not differ significantly. PI and BI scores were significantly reduced in the T group compared with the WT group. The risk of significant bleeding in the treatment group was 35.5 times lower (odds ratio [OR], 0.028; 95% confidence interval [CI], 0.006–0.138) at 30 min and 7.1 times lower (OR, 0.140; 95% CI, 0.049–0.402) at 60 min. The prognostic model for significant bleeding at 60 min showed that only terlipressin played a significant role in bleeding control (p < 0.05). The model predicted a 13.9‐fold decrease in significant bleeding risk in the T group.

Conclusion

Low doses (200 μg) of terlipressin reduced intraoperative bleeding without decreasing blood pressure during FESS under GA.

Level of Evidence

2 Laryngoscope, 133:3313–3318, 2023
The impact of distance traveled and rurality on the clinical course of head and neck cancer
Authors: Debick Nadia , Gemmiti Amanda , Ryan Jesse
Published: April 2023

Objective

To explore the relationship between distance traveled and rurality to clinical timepoints and 2‐year disease free survival (DFS) in newly diagnosed HNC patients.

Methods

This study was conducted through retrospective analysis, with key independent variables including distance to academic medical center and rurality score. To better understand delays in care, the sample was divided into two groups based on an optimal treatment timeline. We then assessed for the impact of distance traveled.

Results

A higher proportion of patients in the optimal treatment timeline group resided in metropolitan areas, which also had a lower mean index of medically underserviced score. Patients in this group had a shorter duration from first presentation for HNC to presentation to an academic medical center and a shorter duration from referral to presentation. However, there was no significant difference in 2‐year DFS between the groups. Those who lived closest to Upstate were more likely to identify as Black. Those who live in suburban communities around Upstate were most likely to initiate treatment within 1 month of presentation. Those who live farthest from Upstate were the least likely to have an HPV‐negative cancer of the head and neck, and more likely to receive surgery as part of treatment and to receive a biopsy prior to presenting to Upstate.

Conclusions

Despite differences in distance traveled and rurality between communities, there was no impact on 2‐year DFS. Together, we suggest that these findings support that socioeconomic and patient factors, instead of travel distance alone, impact HNC workup patterns.

Level of Evidence

Level III.
Production of phytodetritus by a coral reef sponge increases from shallow to mesophotic depths
Authors: Lesser Michael P. , Macartney Keir J. , Slattery Marc
Published: April 2023

On Caribbean coral reefs, sponges are important members of the benthic community and have an important role in consuming particulate organic matter (POM) and dissolved organic matter (DOM), with the subsequent production of detritus that is then shunted into a process now referred to as the “sponge‐loop.” An emergent species of sponge commonly found on Caribbean coral reefs, Agelas tubulata, increases in size and growth rate from shallow (< 30 m) to mesophotic depths (30–150 m) on Grand Cayman Island. A. tubulata depends largely on heterotrophy across shallow to mesophotic depths and has been shown to utilize detritus on shallow reefs. However, detritus production by A. tubulata on shallow and mesophotic coral reefs has not been previously reported. Here we show, using flow cytometry, that sponge detritus includes a previously unquantified component, phytodetritus. Sponge phytodetritus production was shown experimentally to be greater in sponges from mesophotic depths compared to sponges from shallow coral reefs. Additionally, the size range of this phytodetritus corresponds to the size range of autotrophic picoplankton, primarily prochlorophytes, known to be an important food source for filter‐feeding sponges. Given the known lability of phytodetritus, compared to other more recalcitrant components of the detrital pool, its role in the food web of mesophotic communities combined with the increased availability of live POM, may be an underappreciated component of mesophotic community carbon and nitrogen flow.
Advances in Intelligent Stimuli‐Responsive Microneedle for Biomedical Applications
Authors: Xu Kai , Weng Jie , Li Jianshu , Chen Xingyu
Published: April 2023

Microneedles (MNs) are a new type of drug delivery method that can be regarded as an alternative to traditional transdermal drug delivery systems. Recently, MNs have attracted widespread attention for their advantages of effectiveness, safety, and painlessness. However, the functionality of traditional MNs is too monotonous and limits their application. To improve the efficiency of disease treatment and diagnosis by combining the advantages of MNs, the concept of intelligent stimulus‐responsive MNs is proposed. Intelligent stimuli‐responsive MNs can exhibit unique biomedical functions according to the internal and external environment changes. This review discusses the classification and principles of intelligent stimuli‐responsive MNs, such as magnet, temperature, light, electricity, reactive oxygen species, pH, glucose, and protein. This review also highlights examples of intelligent stimuli‐responsive MNs for biomedical applications, such as on‐demand drug delivery, tissue repair, bioimaging, detection and monitoring, and photothermal therapy. These intelligent stimuli‐responsive MNs offer the advantages of high biocompatibility, targeted therapy, selective detection, and precision treatment. Finally, the prospects and challenges for the application of intelligent stimuli‐responsive MNs are discussed.
Dimensions of Network Polymers: Universal Relationship for the Ratio between Mean‐Square Radius of Gyration and Graph Diameter
Authors: Tobita Hidetaka
Published: April 2023

Mean‐square radius of gyration Rg2 and the graph diameter D, which describe the dimensions of polymers, are investigated for the network polymers. Both for the random and nonrandom statistical networks whose cycle rank is r, a linear relationship Rg2 = ar D applies. The ratio ϕ of ar against the corresponding ring‐free architecture a0, ϕr = ar/a0 has a universal relationship applicable both for the random and nonrandom networks with ϕr∝r−0.25 for large r’s, and an empirical relationship, ϕr = [(1 + r)−2/3 + r/2]−0.25 is proposed. For the polymer fraction having a given number of r, the nonrandom nature of crosslinking tends to make both Rg2 and D larger compared with the corresponding random networks, except for the limited cases with small values of r’s.
Medicaid rates to psychiatrists lag, with wide variation among states
Authors: Enos Gary
Published: April 2023

Medicaid payment rates for psychiatric services continue to lag behind comparable Medicare reimbursement in most states, with wide variation in rates across the country, a newly published study reported. While low payment rates are thought to contribute to a shortage of psychiatrists treating low‐income patients, the study's researchers suggest that simply increasing reimbursement rates might not be enough to shore up the workforce.
APA poll reveals Americans' thoughts about diet, MH connection
Authors: Canady Valerie A.
Published: April 2023

Many adults say they feel knowledgeable about the relationship between diet and mental health and are willing to change their diet in a way that would positively impact their mental health, according to the American Psychiatric Association's (APA's) latest Healthy Minds Monthly poll.
Integrating Widely Targeted Lipidomics and Transcriptomics Unravels Aberrant Lipid Metabolism and Identifies Potential Biomarkers of Food Allergies in Rats
Authors: Sun Shanfeng , Li Kexin , Du Hang , Luo Jiangzuo , Jiang Yuchi , Wang Junjuan , Liu Manman , Liu Guirong , Han Shiwen , Che Huilian
Published: April 2023

Scope

Oral food challenges (OFCs) are currently the gold standard for determining the clinical reactivity of food allergy (FA) but are time‐consuming, expensive, and risky. To screen novel peripheral biomarkers of FA and characterize the aberrant lipid metabolism in serum, 24 rats are divided into four groups: peanut, milk, and shrimp allergy (PA, MA, and SA, respectively) and control groups, with six rats in each group, and used for widely targeted lipidomics and transcriptomics analysis.

Methods and results

Widely targeted lipidomics reveal 144, 162, and 206 differentially accumulated lipids in PA, MA, and SA groups, respectively. The study integrates widely targeted lipidomics and transcriptomics and identifies abnormal lipid metabolism correlated with widespread differential accumulation of diverse lipids (including triacylglycerol, diacylglycerol, sphingolipid, and glycerophospholipid) in PA, MA, and SA. Simplified random forest classifier is constructed through five repetitions of 10‐fold cross‐validation to distinguish allergy from control. A subset of 15 lipids as potential biomarkers allows for more reliable and more accurate prediction of FA. Independent replication validates the reproducibility of potential biomarkers.

Conclusion

The results reveal the major abnormalities in lipid metabolism and suggest the potential role of lipids as novel molecular signatures for FA.
One‐dimensional nonlinear creep consolidation of soft soils with time‐dependent drainage boundary under construction load
Authors: Cui Penglu , Cao Wengui , Liu Yangyang , Zhang Xingyi , Li Huixin , Xu Zan
Published: April 2023

To further investigate the nonlinear creep properties of soft soils and the effect of variable loading, a one‐dimensional (1D) nonlinear creep consolidation system of soft soils under construction load is established, including time‐dependent drainage (TDD) boundary, elastic‐viscous‐plastic deformation, non‐Darcy flow (NDF), and self‐weight stress. The consolidation problem is presented by virtue of the finite volume method, and the associated calculation program is compiled. The efficiency of the numerical solutions is validated by comparing the degenerated solution against analytical, semi‐analytical, and numerical solutions. Then the influences of construction load and nonlinear creep model parameters on consolidation are studied. The results show that TDD boundary and construction load significantly affect consolidation, and the larger the loading rate and interface parameter, the faster soil's overall dissipation process of excess pore‐water pressure (EPP). Meanwhile, at the earlier consolidation stage, considering the secondary consolidation effect will cause an increase in excess pore‐water pressure (EPP). Prolonging the construction period, decreasing the interface parameter, considering the self‐weight stress, or increasing the non‐Newtonian index will all aggravate this phenomenon. Additionally, the TDD boundary, construction load, and non‐Newtonian index flow (NNIF) are not a determinant for final soil settlement.
Impact of COVID‐19 in relation to the outpatient pediatric feeding therapy experience: A speech‐language pathologist's review of literature and professional experience
Authors: Theodotou Kyrsten Leigh
Published: April 2023

It is well known in the medical and pediatric feeding community how parental stress affects outcomes of pediatric nutrition and feeding behaviors. There is growing literature suggesting the impact of the COVID‐19 pandemic in relation to caregiver and child stress. It could be suggested that this increase in stress contributed to or exacerbated pediatric feeding difficulties. In addition, the COVID‐19 pandemic resulted in pediatric rehabilitation therapists quickly transitioning from in‐person to virtual evaluation and treatment models. The purpose of this article is to review current literature regarding the definition and prevalence of pediatric feeding disorder, the impact of the COVID‐19 pandemic on parent/child stress and relationships surrounding feeding, and this speech‐language pathologist's perception of both the positive and negative aspects of providing ongoing outpatient feeding evaluations and treatments in the context of the COVID‐19 pandemic, as well as clinical considerations for ongoing feeding therapy after the COVID‐19 pandemic.
Assessing public perception and awareness of UK mandatory calorie labeling in the out‐of‐home sector: Using Twitter and Google trends data
Authors: Polden Megan , Robinson Eric , Jones Andrew
Published: April 2023

Objectives

In 2021 the UK government announced a new obesity policy requiring large out‐of‐home food outlets to provide mandatory in‐store calorie labeling on food and drink items. Public acceptability and engagement with obesity policies could influence the level of impact on wider public health particularly with population‐level policies such as calorie labeling. This study aimed to examine public responses and awareness of the policy using social media (Twitter) comments and Google trends data.

Methods

This study examined responses to social media posts on Twitter (tweets) from the UK Department of Health and Social Care detailing the policy, implementation date and post‐implementation information about the policy's enforcement. The sentiments of the tweets were coded and the number of likes and replies extracted. This study utilized google trends to examine public awareness of the policy by extracting weekly relative search volume for relevant phrases such as “calorie labeling.”

Results

From the 276 replies/quote‐tweet extracted, the majority expressed a negative sentiment toward the policy (N = 197/71.4%). There were fewer tweets expressing a positive sentiment (N = 25/8.7%) and a neutral/no sentiment (N = 54/19.6%). There was no difference in the number of “likes” or retweets between tweets expressing positive or negative sentiments. Five themes were identified expressing negative sentiments (most common being negative impacts on eating disorders). Google trends data revealed increased searches for “calorie labels/labeling” during the week of the policy enforcement compared to previous weeks in the last 5 years but no significant differences in searches for specific menu calorie labeling.

Conclusions

This analysis revealed negative sentiment toward and increased searching of calorie labeling information during the announcement and implementation of the 2021 mandatory calorie labeling policy in England. A greater understanding of public responses to calorie labeling policies may help tailor future policies and public communication strategies.
Effectiveness of the forced‐choice coin test for detecting malingering during forensic psychiatric examinations
Authors: Tsuji Keisuke
Published: April 2023

Background

In general clinical psychiatric practice, open questions are favored over closed ones because they are considered more therapeutically effective and less likely to make the patients pander to us. However, in forensic psychiatric examinations, suspects may attempt malingering.

Case Presentation

Using a simple examination based on a forced‐choice technique, the author proved that the level of intelligence of a theft suspect pretending to have an intellectual developmental disorder was not so low. The author prepared two sets consisting of a few coins each and asked the suspect to choose which set had a higher total value. The suspect was questioned repeatedly over multiple trials. He always selected the wrong set over the course of more than 10 trials.

Conclusion

If the suspect really did not know the correct answer, the probability of getting the answer right or wrong in a binary choice question is 50% for both. The probability of answering the question wrong by chance 10 times in a row is (1/2),10in other words, about 0.1%. It was evident that the suspect intentionally kept answering incorrectly. When suspects who pretend to have an intellectual developmental disorder answer only “I do not know” to all questions without actively playing out the symptoms, it is difficult to demonstrate that the symptoms are psychiatrically conflicting and prove that they are malingering. Even in such cases, this type of test based on a forced‐choice technique can be used to prove that suspects are behaving falsely.
Oral health and cystic fibrosis in pediatrics: A survey of health professionals
Authors: Chin Delia , Ramalingam Lochana , Harrison Joanne , Silva Mihiri
Published: April 2023

Background

Children with cystic fibrosis (CF) are usually managed by hospital‐based, multidisciplinary teams (MDTs). This study aimed to investigate oral health perspectives, training, and practices of health professionals working with children with CF.

Methods

Data were collected through an online survey distributed to health professionals caring for children with CF by the CF Director in 12 Australian hospitals. The questions related to perspectives, training, and dental referral/advice relating to oral health for children with CF. The data were analyzed using descriptive statistics.

Results

Forty‐four participants (26 physicians, 8 nurses, 6 physiotherapists, 2 dieticians, 1 psychologist, and 1 pharmacist) completed the survey. Most (n = 33, 75%) indicated they rarely/never check or discuss dental health. Of those who did, most reported lacking skills to inspect teeth and discuss dental health. Frequently reported barriers were lack of skills, training, knowledge, and time. Most respondents (n = 30, 68%) indicated they rarely/never recommend patients to see the dentist. The most frequently reported barrier to referrals was not considering it part of their role (43%).

Conclusions

Closer working relations between CF units and dental teams may remove barriers that prevent non‐dental clinicians from supporting patients with CF maintain oral health. Better integration of dental care within the MDT through improved professional training, increased referral practices, and availability of digital resources may help to improve dental care for all children, including children and adolescents with CF.
Direct analysis in real‐time mass spectrometry: Observations of helium, nitrogen and argon as ionisation gas for the detection of small molecules using a single quadrupole instrument
Authors: Mathias Simone , Sears Patrick
Published: April 2023

Rationale

Direct analysis in real time is typically performed using helium as the ionisation gas for the detection of analytes by mass spectrometry (MS). Nitrogen and argon are found with abundance in the air and provide a cheaper and greener alternative to the use of helium as ionisation gas. This study explores the use of helium, nitrogen and argon as ionisation gas for the detection of organic compounds.

Methods

Four illicit drugs, two amino acids and five explosives were chosen as target analytes to understand selectivity, sensitivity and linearity when helium, nitrogen or argon was used as the ionisation gas with the direct analysis in real time (DART) source. Analysis was carried out on a Waters Acquity QDa single quadrupole mass spectrometer.

Results

Calibration curves over the range of 5–100 ng were produced for each analyte using the different ionisation gases to assess the instrument response. Nitrogen gave a higher response to concentration than helium or argon; however, the lowest limits of detection were observed when helium was used.

Conclusions

All the target analytes were detected using DART‐MS with helium, nitrogen or argon as the ionisation gas. Whereas helium provided the highest sensitivity, nitrogen produced reasonable limits of detection and had good linearity across the concentration range explored, suggesting it provides a greener and cheaper alternative to helium.
Analyzing the influence of changes in land use and management practices on the lag time of peak flows for tropical watersheds of Ethiopia
Authors: Sultan Dagnenet , Tsunekawa Atsushi , Tsubo Mitsuru , Haregeweyn Nigussie , Adgo Enyew , Meshesha Derege Tsegaye , Berihun Mulatu Liyew , Fenta Ayele Almaw , Ebabu Kindiye , Setargie Tadesual Asamin
Published: April 2023

Changes in peak flow response time governed by rainfall and physical configurations of watersheds have been the topic of many studies, but other factors are also important. We aimed to analyze the dynamics in the lag time (TL) of peak flow for a tropical watershed (Kecha) and its sub‐watersheds (Dokmit, Zenjero Maderia, and Wotit Minch) in Ethiopia, as influenced by land‐use changes from 1982 to 2017 and the implementation of soil and water conservation (SWC) practices since 2011. Layered maps of land use, soil type, and SWC practices were used to determine the curve number, and the Natural Resource Conservation Service hydrologic model was used to estimate TL. We compared the estimated values against measured median values of TL for 30 rainfall–runoff events. The estimated TL of 1982, 2005, and 2017 varied from 9 to 19 min, 8 to 18 min, and 10 to 22 min, respectively, in the Dokmit, Zenjero Maderia, and Wotit Minch sub‐watersheds. The smallest (8 min) and greatest (22 min) values of TL were observed during 2005 and 2017, respectively. These results are likely attributable to the increased amount of cultivated area at the expense of bushland and forest in 2005 as compared to 1982, and the implementation of SWC practices in 2011–2017. Dokmit had the lowest TL values of the three sub‐watersheds, most likely because of its greater coverage of grazing and cultivated lands and degraded Nitic Luvisol. The variation in TL values among the sub‐watersheds was related to changes in both land use and SWC practices but also to the presence of degraded areas inherited from past human activities. Overall, such spatiotemporal flow response time analysis can provide useful information for the proper design of sustainable development strategies for particular niches in tropical regions of Ethiopia and elsewhere.
Moderate deviations in cycle count
Authors: Neeman Joe , Radin Charles , Sadun Lorenzo
Published: April 2023

We prove moderate deviations bounds for the lower tail of the number of odd cycles in a random graph. We show that the probability of decreasing triangle density by , is whenever . These complement results of Goldschmidt, Griffiths, and Scott, who showed that for , the probability is . That is, deviations of order smaller than behave like small deviations, and deviations of order larger than behave like large deviations. We conjecture that a sharp change between the two regimes occurs for deviations of size , which we associate with a single large negative eigenvalue of the adjacency matrix becoming responsible for almost all of the cycle deficit. We give analogous results for the ‐cycle density, for all odd . Our results can be interpreted as finite size effects in phase transitions in constrained random graphs.