bluuebunny/crossref_metadata_2025 huggingface dataset:
Intrathecal Drug Delivery
Authors: Weisbein Jacqueline , Ghosh Priyanka
Published: September 2024

Intrathecal drug delivery systems allow for more potent medication at a lower dose to be delivered directly to the intrathecal space, thus directly acting on opiate receptors in the dorsal horn. The result is better analgesia with fewer systemic side effects.
Alzheimer’s Disease
Authors: Jennette Kyle J. , Soble Jason R.
Published: September 2024

Alzheimer’s disease (AD) is the most common form of dementia, accounting for 60%–80% of all diagnoses. The risk of developing AD roughly doubles every decade after age 65, increasing to 30%–50% by age 85. The pathognomonic hallmark is the accumulation of neurotoxic extracellular beta-amyloid plaques and intracellular hyperphosphorylated tau neurofibrillary tangles that lead to neuronal degeneration/death. Neuroimaging plays a key role in diagnosis, when incorporated with appropriate clinical data, and often shows progressive atrophy in the entorhinal cortex, temporal lobes, and hippocampal formation and broader limbic system, before advancing into the frontal, temporal, and parietal cortices. Clinically, AD is characterized by prominent, amnestic memory impairment (“rapid forgetting”) that progresses to more global cognitive deterioration and neuropsychiatric symptoms (e.g., loss of awareness, apathy, sundowning). Comprehensive neuropsychological evaluation is important in assisting with diagnosis in milder disease states, as well as monitoring cognitive/functional change over time and assisting with long-term care planning.
Frontotemporal Lobar Degeneration
Authors: Polsinelli Angelina J. , Korinek Dale , Vernon Elizabeth K. , Wang Sophia
Published: September 2024

Frontotemporal lobar degeneration (FTLD) refers to the diverse neuropathologies that are the primary causes of frontotemporal dementias (FTD). FTD refers to a spectrum of progressive dementia syndromes that can be broadly grouped into behavioral (behavioral variant FTD), language (primary progressive aphasias), and motor (FTD-motor neuron disease, corticobasal syndrome, progressive supranuclear palsy syndrome) variants. This chapter covers the pathological and genetic basis of FTD, provides an overview of the epidemiology, and reviews the clinical syndrome of each FTD. Case examples are provided, and details of the diagnostic workup—particularly differential diagnosis—are reviewed. Finally, the authors discuss interventions for FTD. Currently, nonpharmacological interventions—including psychoeducation for families, behavioral modification, and environmental management—are first-line treatments. Off-label use of psychotropics may be appropriate in some cases but should be used with caution.
Rare and Rapidly Progressive Dementias
Authors: Kamper Joel E. , VanDerBleek Emily N. , Bailey Erin K.
Published: September 2024

Aging is a risk factor for acquired neurocognitive dysfunction, with older adults at a relatively higher risk of developing delirium, dementia, and other common syndromes. While knowledge of high-base rate etiologies like Alzheimer’s disease is certainly critical, practitioners working with older adults should also have familiarity with a number of rare and rapidly progressing neurobehavioral syndromes. This chapter highlights the clinical presentation, management, and prognosis of several of these disease processes. These include prion diseases, neuroinvasive infections and their sequalae, paraneoplastic and autoimmune neuropsychiatric syndromes, neurocognitive disorders associated with substance use, and genetic disorders. While uncommon, working knowledge of these syndromes is crucial for robust differential diagnosis of cognitive and behavioral changes in older adults.
The Belmont Report—Abridged
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: Principlism is an ethical framework used in healthcare decision-making based on four principles: autonomy (informed consent), beneficence (do good), nonmaleficence (do no harm), and justice (be fair). These principles are widely accepted as common ground for moral decision-making and are reflected in federal law for human subjects research (45 Code of Federal Regulations 46). The Belmont Report outlines the differences between healthcare practice and research and the application of these principles, such as the importance of informed consent, favorable risk–benefit assessment, and fair selection of research subjects. By adhering to these principles, healthcare professionals can ensure ethical conduct, protect patient rights, and promote a morally sound healthcare environment.
The Hippocratic Oath
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: The Hippocratic Oath is an early statement on bioethics believed to have originated and developed between the sixth century bce and the first century ce. It emphasizes the responsibilities of a practitioner, including respect for professional boundaries, confidentiality, and moral principles. The Oath requires practitioners to prioritize their patients’ well-being and maintain their knowledge and skills throughout their careers. It also calls for the practitioner to uphold certain ethical standards, such as avoiding harm, injustice, and impropriety, and to keep patient information confidential. The original Oath is not widely used today because it is considered outdated and controversial, but it remains an important historical document and symbol of traditional bioethics.
Assisted Suicide
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: Practitioner-assisted death is legal in 11 U.S. jurisdictions but prohibited by state law in 48 states and the District of Columbia. There is a distinction between practitioner-assisted death and assisted suicide, but the healthcare profession views both as fundamentally incompatible with the practitioner’s role as a healer and that both pose serious societal risks. The American Medical Association and the American College of Physicians do not support the legalization of practitioner-assisted suicide. The healthcare profession defines itself as a healing art and prohibits any healthcare options that violate this definition, such as a practitioner’s participation in assisted suicide, which goes against the principles of doing good and not causing harm. Public trust is essential for a patient-centered profession, and assisted suicide is not a standard of care, regardless of whether it is legally permissible.
Death with Dignity and Assisted Dying
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract:“Death with dignity” laws are legal in 11 jurisdictions in the United States and allow individuals to make end-of-life decisions. The central issue surrounding these laws is whether or not practitioner participation in assisted dying is compatible with the healthcare profession’s code of ethics, core tenets, and patient trust. The American College of Physicians considers euthanasia, which is the direct causation of death by a practitioner, to be fundamentally incompatible with the practitioner’s role as a healer. However, death with dignity, which involves the patient self-administering lethal medication with a prescription, is argued to be different. The question is raised about whether medicine should only be a healing art or whether the art of dying should also be part of healthcare practice.
The Doctrine of Double Effect
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: The doctrine of double effect is a medieval natural law tradition in Catholic moral theology which states that an action is morally permissible if a good outcome is intended and a harmful effect is foreseen but unintended. The moral permissibility of an action is determined by the intention of the agent rather than the consequences. The doctrine was created to justify certain actions within Catholic theology, but it precedes moral recognition of patient autonomy and only focuses on the practitioner’s intention. In modern bioethics, the four principles of bioethics—autonomy (informed consent), beneficence (do good), nonmaleficence (do no harm), and justice (be fair)—are used instead of the doctrine of double effect. The four principles are specified and balanced to determine accepted moral actions and hold practitioners legally, professionally, and morally accountable for the consequences of the action performed with the patient’s informed consent, independent of the practitioner’s intentions.
Email and Electronic Communication
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: Integrating electronic communication, such as email and text messaging, into the healthcare system is an important contemporary reality. Although these forms of communication have advantages, such as convenience and speed, they also come with increased responsibilities to protect patient confidentiality. Patients must be informed of the risks and limitations of electronic communications, and practitioners must get written consent before using these forms of communication. It is imperative to use encryption in all electronic communications to ensure the privacy and security of protected health information, avoid any Health Insurance Portability and Accountability Act privacy violations, and maintain professional boundaries.
Futile Treatment
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: The concept of futile treatment refers to treatments that lack evidence of benefiting the patient or achieving desired healthcare outcomes. Patient autonomy is a crucial aspect of informed consent based on a shared decision-making process between the patient and practitioner. The practitioner is responsible for informing the patient of the diagnosis, prognosis, treatment options, benefits, and risks and answering any questions. The practitioner is expected to provide treatment options that comply with standards of care, and futile treatments should not be part of the patient’s decision-making options. If a patient chooses a futile treatment, the practitioner should discuss the reasons for making this choice and correct any misinformation that the patient may have. The practitioner has a professional obligation of beneficence (do good) and nonmaleficence (do no harm) to only provide treatment options that will benefit the patient and minimize harm.
Lifelong Learning
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract:To act in the patient’s best interest and reduce the risk of harm, practitioners must engage in lifelong learning. States require practitioners to earn a minimum of lifelong learning and continuing professional development credits per year. This includes, but is not limited to, continuing healthcare education credits, continuing nursing education credits, continuing pharmacy education credits, continuing dental education credits, continuing education units, maintenance of certification points, performance improvement continuing healthcare education, continuing professional development points, and quality improvement points. Lifelong learning is a healthcare and legal requirement; failure to comply can result in losing a healthcare license. Practitioners must embrace continuous learning to fulfill their responsibilities as educators, learners, and quality healthcare providers.
Malpractice
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: Healthcare malpractice occurs when a practitioner’s actions or omissions deviate from standards of care to the point of being considered negligent, causing injury to the patient. Negligent acts or omissions occur when there is a breach of standards of care based on the hypothetical practice of a reasonably competent practitioner in the same community. Healthcare malpractice injuries can include physical harm, pain, and financial burden. The intention of the practitioner is not relevant in a healthcare malpractice case. Healthcare malpractice compensation is awarded to the patient as a matter of justice (be fair) to balance the unfair social distribution of burdens caused by injury and to motivate the healthcare profession and institutions to perform a root cause analysis to identify what, how, and why a negligent adverse event occurred and implement proactive measures to avert any potential future negligence.
Minor Patients
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: The healthcare treatment for minors involves a complex three-way relationship encompassing the minors, their parents or legal guardians, and healthcare practitioners. This relationship navigates the minor’s autonomy (informed consent), the right to informed assent (informed agreement), and the practitioner’s responsibility to ensure confidentiality and privacy. Guided by beneficence (do good) and nonmaleficence (do no harm), practitioners must explore minors’ reluctance to disclose information to parents, providing guidance toward appropriate social resources. Conflicts may necessitate institutional ethics consultation, although decisions ultimately rest with the parties involved. Legal protections override parental autonomy in cases of healthcare neglect. The practitioner’s professional and social obligations extend to providing essential healthcare for minors, including emergencies, treatment for sexually transmitted infections, access to contraception, prenatal care, and substance abuse treatment.
Patient–Practitioner Relationship
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract:The patient–practitioner relationship is a critical component in creating a patient-centered approach that prioritizes the patient’s best interests in accordance with the patient’s reasonable goals, values, and priorities. Autonomy is fundamental to this relationship because the patient should be empowered to make informed treatment decisions. Trust and reflective understanding in the practitioner are crucial for building this relationship, and ethical principles of beneficence and nonmaleficence guide the practitioner’s actions to maximize the patient’s best interests. Public policy of justice also plays a role because patient abandonment is considered a form of healthcare malpractice and can result in legal consequences. To maintain the trust of the healthcare community and ensure patient well-being, proper instructions and healthcare records information must be transferred if the patient–practitioner relationship is terminated. Understanding the importance of this relationship is essential for all healthcare providers.
Practitioner Disagreements
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract:The attending practitioner holds ultimate responsibility and is legally liable for the patient’s care, whereas the resident is part of the interprofessional healthcare team under the attending’s supervision. The resident must follow institutional policies and procedures for dealing with disagreements and bring any disputes to the attending’s attention. The healthcare record is not for debating disagreements but, rather, for documenting patient management. If harm or error occurs, the resident must learn how to analyze and report it while being honest and open with the patient to maximize the patient’s best interests. Legal liability laws strengthen the healthcare profession and the patient–practitioner relationship. Following the proper process for dealing with disagreements is a professional obligation based on standards of care.
Referrals and Fee Splitting
Authors: Bulger Jeffrey W.
Published: September 2024

Conflicts of interest in healthcare practice, such as self-referral and fee splitting, have far-reaching effects on patients, practitioners, and public policy. At the core of healthcare ethics, the practitioner’s main priority must be to act in the patient’s best interest, guided by the patient’s reasonable goals, values, and priorities. Referrals to other healthcare services should be based on evidence-based reasoning, and practitioners must comply with Health Insurance Portability and Accountability Act laws. Conflicts of interest are incompatible with essential ethical principles, undermining patient autonomy through informed consent and violating the principles of beneficence (do good) and nonmaleficence (do no harm) for the practitioner. Through mechanisms such as the federal Stark law, public policy is critical in ensuring justice by prohibiting self-referral, protecting individual rights, implementing fair procedures, and distributing social goods equitably.
Structural Injustice
Authors: Bulger Jeffrey W.
Published: September 2024

Structural injustice has significant effects on healthcare disparities. Structural injustice refers to social, political, and institutional practices that result in unequal effects on individuals due to their membership in a certain social group. It is strongly linked to group identity and can manifest in inequalities in education, opportunity, wealth, political representation, and access to healthcare. It is imperative that society and healthcare practitioners recognize the unity of humanity in combating structural injustice. The patient–practitioner relationship is also impacted by structural injustice, which can affect informed consent and the principles of beneficence and nonmaleficence in healthcare practice. The importance of the principle of justice and the role of a democratic constitutional republic in promoting fairness and structural alignment in government cannot be overstressed. The principles of biomedical ethics, like a democratic constitutional republic, require structural checks and balances to ensure ethical practice.
Testimonials and Quackery
Authors: Bulger Jeffrey W.
Published: September 2024

The use of patient testimonials in healthcare marketing can have both positive and negative effects. Testimonials can provide social proof of a practitioner’s skills and services, but they can also be deceptive and unprofessional. Quackery, the act of making exaggerated claims for financial gain, is a concern, and patients are vulnerable to its seduction, especially in times of stress and pain. Requesting a testimonial from a vulnerable patient may not be a violation of the Health Insurance Portability and Accountability Act, but it is considered a form of coercion and violates the patient-centered nature of the patient–practitioner relationship. The practitioner’s obligation is to provide patient-centered care and never compromise the relationship for financial gain. Making exaggerated claims is unprofessional and illegal, and asking for a testimonial from a vulnerable patient is unethical. Practitioners must maintain focus on patient-centered care and not engage in deceptive practices.
Torture
Authors: Bulger Jeffrey W.
Published: September 2024

The healthcare profession prohibits any association with torture or enhanced interrogation techniques. Practitioners have a professional, legal, and moral obligation to oppose, expose, and report these practices, and practitioners must never cross the boundary of participating in torture or enhanced interrogation. When practitioners treat those injured by torture, they must not do so for the purpose of further torture. The healthcare profession holds practitioners accountable for reporting abuse, including in legal war zones or under the orders of superiors. Practitioners have a legal obligation to report possible torture as a violation of human rights. Failure to report abuse is considered the same as failure to report child or elder abuse and can result in legal liability. The healthcare profession will never deviate from its stance against torture or enhanced interrogation techniques.
Cultural factors in suicide
Authors: Watson Cameron , Bhugra Dinesh , Ventriglio Antonio
Published: September 2024

Suicide, as a phenomenon, is ubiquitous across all cultures. The reported rates of suicide are often an underestimate, as in many societies, the act of suicide is still illegal and punishable by law. Cultural factors such as gender roles, religion, sexual orientation, poverty, unemployment, economic downturn, and other factors can play a significant role in contributing to the incidence rates of suicide. The form of society and its impact on the rates of suicide were first described by Durkheim in the nineteenth century. Social determinants do influence the rates of psychiatric disorders and suicide. Different cultures have different patterns and types of suicide, as seen in Japan and India. Cultural values and mores can contribute to suicidal ideation and acts of deliberate self-harm across cultures. In clinical assessments and management, it is critical to be cognizant of cultural factors and the role that culture can play in suicide.
Genetic aspects of suicide
Authors: Giegling Ina , Maul Stephan , Hartmann Annette M. , Rujescu Dan
Published: September 2024

Suicidal behaviour is a major health risk responsible for more than 1 million deaths per year worldwide. The risk of suicide-related behaviour is presumed to be the result of a complex interplay between sociocultural factors, psychiatric history, personality traits (impulsivity, anger, aggression, and neuroticism), and genetic, as well as neurobiological, vulnerability. Suicidal behaviour, associated personality-derived endophenotypes, and accompanying mental illness show intrinsic heritability. Genes implicated in suicidal behaviour and partially overlapping genetic backgrounds are beginning to emerge, as sample sizes increase in candidate gene and genome-wide association studies, and polygenic risk score predictions are conducted, although no conclusive results can be given at present. Sample sizes of all ethnicities, harmonization of phenotypes and their assessment, and consideration of environmental influences on gene expression and interaction need to be improved in further studies.
Suicide among Asian migrants in Hong Kong: A case study
Authors: Wong Anna , Yip Paul
Published: September 2024

Migration is linked directly or indirectly to the quest for decent work opportunities and Asia plays a major role in global migration patterns. Yet, despite research and theory development on migrants’ well-being, there is still a lack of understanding about suicide prevalence and risk and protective factors among Asian migrants. Using Hong Kong as a case study, this chapter examines the hypothesis that Asians who migrate and subsequently identify as ethnic minorities or migrants are at increased risk of suicide. The underlying assumption is that the challenges often experienced by ethnic minorities and migrants in the migration destination, together with the stigma rooted in the culture of their original country, make them more vulnerable to the risk of suicide. Coroner suicide records and relevant data on four major migrant groups were examined to determine whether or not Asians who migrate and subsequently identify as ethnic minorities or migrants are at increased risk of suicide, and why.
Suicidality in Black and further non-white communities
Authors: Lazaridou Felicia Boma , Schouler-Ocak Meryam
Published: September 2024

This chapter provides a theoretical and conceptual overview of suicidality in Black and further non-white communities, a hitherto rather neglected vulnerable group that suffers particularly from racism and other forms of discrimination—interpersonally, institutionally, and structurally. Therefore, social justice approaches are urgently needed to address inequities in complex social meta-problems such as suicidality. Furthermore, the cumulativeness and complexity of social stress as a risk factor for suicidality are highlighted. The association with centring the thwarted social belongingness of racism’s structural exclusion as suicide risk factor is also discussed. Prevention programmes tailored to Black and further non-white communities are discussed.
The influence of religion on euthanasia and physician-assisted suicide
Authors: Savani Shahnaz , Arora Anil , Brown Marcus , Ma Ying , Gearing Robin Edward
Published: September 2024

The increasing relevance of research on euthanasia and physician-assisted suicide (PAS) in the context of terminal illnesses, unresolved pain, palliative care, and significant deterioration in quality of life has emerged in the recent literature. The importance of patient autonomy, the right to die with dignity, self-determination, and the right to end pain and suffering have gained traction among patients and professionals in the medical community. The purpose of this chapter is to investigate the association and influence of religion on the perspectives on, and attitudes towards, euthanasia and PAS across five of the dominant world religions, specifically Buddhism, Christianity, Hinduism, Islam, and Judaism.
Suicide during the global COVID-19 pandemic
Authors: Wasserman Danuta , Iosue Miriam , Carli Vladimir
Published: September 2024

This chapter on suicide during the coronavirus disease 2019 (COVID-19) pandemic in the world discusses the impact of COVID-19 pandemic on suicidal thoughts and behaviour in different countries and regions of the world. It reviews trends in suicide rates during the different phases of the pandemic in four World Health Organization regions. It also examines variations in suicide-related emergency department visits and data on self-reported suicidal thoughts and behaviour. Trends in suicide rates during previous epidemics and outbreaks are also discussed, as well as findings on risk and protective factors. Finally, it considers the impact of the COVID-19 pandemic on mental health and suicidality among migrants and indigenous people.
Structures
Authors: Cyna Allan M. , Andrew Marion I. , Tan Suyin G.M.
Published: September 2024

As anaesthetists, we encounter patients at their most vulnerable and stressed, with some resigned to whatever is required and others not so ready to hand over control of their most vital functions. Dealing with this spectrum of reactions presents challenges, particularly if patients hold different, and sometimes, seemingly illogical realities. Consideration of language structure offers insights into the important role conscious and subconscious communication has in influencing patients’ perceptions, experience, and behaviour. This chapter introduces the ‘LAURS’ and ‘GREAT’ structures which feature as the recurring communication frameworks in the multiple contexts explored in this book. With this understanding and using these structures we begin to see how we can work with different realities to build previously elusive rapport and stronger therapeutic relationships.
How words hurt
Authors: Lang Elvira V. , Burgoyne Laura L. , Cyna Allan M.
Published: September 2024

Negative suggestions are ubiquitous in hospital practice. Clear evidence from both observational and randomized controlled trials shows that negative suggestions increase pain and anxiety, a phenomenon termed the nocebo effect. For example, asking about pain scores may increase requests for analgesia postoperatively and warning patients about pain can reverse the analgesic effect of local anaesthetic cream. Likewise, the side effects of propofol may be exaggerated if patients are advised that propofol ‘will sting’ or ‘hurt’ during injection. Alternative communications could be that propofol, ‘is a powerful and effective anaesthetic’ during its administration. Anaesthetists need to be mindful that their communications may have nocebo effects when negative perceptual language is used. Providing meaningful information such as, ‘the local anaesthetic will numb the skin to allow us to finish positioning your drip more comfortably’, rather than ‘Sting coming!’ can help generate positive outcomes such as decreased pain and anxiety.
Language and the subconscious
Authors: Cyna Allan M. , Andrew Marion I. , Tan Suyin G.M.
Published: September 2024

As anaesthetists we pride ourselves on our cognitive capabilities with information and reasoning at the core of our practice. Much of our discussion with patients about anaesthesia is conscious. Yet it is the subconscious mind that drives much of what humans do, especially when stressed. Patient anxiety, fear, suffering, and even anger often fail to respond to logical explanations alone since these emotional subconscious responses arise from hidden knowledge and prior experiences. In this chapter we invite a shift in thinking and focus on the subconscious, its functions, and its influence on our perceptions and behaviour. The chapter explores learnable techniques and language structures including imagery, double binds, ‘Yes sets’, and time distortion, that act as gateways to access helpful non-volitional responses. Incorporation of these ‘below the radar’ communication techniques into anaesthetic practice offers a skillset that supports patient and anaesthetist in achieving their goals.
Aneurysms
Authors: Davies Robert , Russell Terri-Ann
Published: September 2024

An arterial aneurysm is defined as a 50% or greater increase in the diameter of a vessel. The infrarenal aorta and popliteal artery are the commonest locations for arterial aneurysms. The longevity of the benefits of endovascular aneurysm repair (EVAR) does not seem to endure, as the initial mortality advantage observed in the EVAR-1 trial is not sustained in long-term studies. Despite the increasing use of EVAR in the treatment of ruptured abdominal aortic aneurysms, meta-analyses of trials on aortic aneurysm rupture fail to demonstrate a mortality benefit of EVAR over open repair. The majority of arterial aneurysms are asymptomatic at the time of presentation having been identified incidentally during routine health checks or investigations for other pathologies.
Periodicity significance testing with null-signal templates: reassessment of PTF’s SMBH binary candidates
Authors: Robnik Jakob , Bayer Adrian E , Charisi Maria , Haiman Zoltán , Lin Allison , Seljak Uroš
Published: September 2024

Periodograms are widely employed for identifying periodicity in time series data, yet they often struggle to accurately quantify the statistical significance of detected periodic signals when the data complexity precludes reliable simulations. We develop a data-driven approach to address this challenge by introducing a null-signal template (NST). The NST is created by carefully randomizing the period of each cycle in the periodogram template, rendering it non-periodic. It has the same frequentist properties as a periodic signal template, and we show with simulations that the distribution of false positives is the same as with the original periodic template, regardless of the underlying data. Thus, performing a periodicity search with the NST acts as an effective simulation of the null (no-signal) hypothesis, without having to simulate the noise properties of the data. We apply the NST method to the supermassive black hole binaries (SMBHB) search in the Palomar Transient Factory (PTF), where Charisi et al. had previously proposed 33 high signal-to-noise candidates utilizing simulations to quantify their significance. Our approach reveals that these simulations do not capture the complexity of the real data. There are no statistically significant periodic signal detections above the non-periodic background. To improve the search sensitivity, we introduce a Gaussian quadrature based algorithm for the Bayes Factor with correlated noise as a test statistic. We show with simulations that this improves sensitivity to true signals by more than an order of magnitude. However, the Bayes Factor approach also results in no statistically significant detections in the PTF data.
Radial velocity analysis of stars with debris discs
Authors: Bisht Deepak , Jones Hugh R A
Published: September 2024

This study aims to identify potential exoplanet signals from nearby stars with resolved debris discs. However, the high activity of many stars with debris discs limits the detection of periodic signals. Our study is constrained to a sample of 29 stars that have appropriate radial velocity data and debris disc measurements sufficient to resolve their inclination. Our results confirm and update previous findings for exoplanets around HD 10647, HD 115617, HD 69830, GJ 581, HD 22049, and HD 142091, and we identify long-term activity signals around HD 207129 and HD 202628. We utilize the inclination angles of the debris discs, assuming co-planarity between debris disc and exoplanet orbit, to determine the ‘disc-aligned’ masses of radial velocity exoplanets in this study. The ‘disc-aligned’ masses of HD 69830 b, HD 69830 c, and 61 Vir b suggests that they may be classified as ‘hot’ or ‘warm’ Jupiters and so might be nearby examples of planets that have undergone recent type-II disc migration.
Widespread Adaptive Introgression of Major Histocompatibility Complex Genes across Vertebrate Hybrid Zones
Authors: Gaczorek T , Dudek K , Fritz U , Bahri-Sfar L , Baird S J E , Bonhomme F , Dufresnes C , Gvoždík V , Irwin D , Kotlík P , Marková S , McGinnity P , Migalska M , Moravec J , Natola L , Pabijan M , Phillips K P , Schöneberg Y , Souissi A , Radwan J , Babik W
Published: September 2024

Interspecific introgression is a potentially important source of novel variation of adaptive significance. Although multiple cases of adaptive introgression are well documented, broader generalizations about its targets and mechanisms are lacking. Multiallelic balancing selection, particularly when acting through rare allele advantage, is an evolutionary mechanism expected to favor adaptive introgression. This is because introgressed alleles are likely to confer an immediate selective advantage, facilitating their establishment in the recipient species even in the face of strong genomic barriers to introgression. Vertebrate major histocompatibility complex genes are well-established targets of long-term multiallelic balancing selection, so widespread adaptive major histocompatibility complex introgression is expected. Here, we evaluate this hypothesis using data from 29 hybrid zones formed by fish, amphibians, squamates, turtles, birds, and mammals at advanced stages of speciation. The key prediction of more extensive major histocompatibility complex introgression compared to genome-wide introgression was tested with three complementary statistical approaches. We found evidence for widespread adaptive introgression of major histocompatibility complex genes, providing a link between the process of adaptive introgression and an underlying mechanism. Our work identifies major histocompatibility complex introgression as a general mechanism by which species can acquire novel, and possibly regain previously lost, variation that may enhance defense against pathogens and increase adaptive potential.
Mobile Phone-Based Smoking-Cessation Intervention in Patients With Chronic Diseases in China: A Sequential Multiple Assignment Randomized Trial
Authors: Weng Xue , Song Chuyu , Liu Kefeng , Zhao Shengzhi , Yang Hongcui , Wang Man Ping
Published: September 2024

Introduction

Mobile phone-based interventions show promise for smoking cessation but often face low engagement. This study assessed the feasibility and preliminary effectiveness of a 2-phase, multi-component mobile phone-based smoking-cessation intervention for patients with chronic diseases.

Aims and Methods

This Sequential Multiple Assignment Randomized Trial recruited smokers with chronic diseases from hospitals in Zhuhai, China. Participants received brief cessation advice and were randomized to personalized chat support (PCS, n = 64) or group chat support (GCS, n = 64) for 1 month. At 1-month, PCS nonresponders (continuing smokers) were re-randomized to receive either multi-component optional support (MOS) or continued PCS for 2 months. GCS nonresponders were re-randomized to receive PCS or continued GCS. Responders continued with their initial intervention for 2 months. Feasibility outcomes included eligibility, participation, retention, intervention engagement, and satisfaction. Preliminary effectiveness was assessed by abstinence rates among nonresponders.

Results

Of 160 screened, 128 (all male, 46.1% aged ≤39 years) participated. At 1 month, 51 and 53 nonresponded to PCS and GCS, respectively. Of them, 26 were re-randomized to receive PCS-MOS and 26 to receive GCS-PCS. At 6 months, PCS-MOS showed a nonsignificant higher validated abstinence rate compared to PCS alone (11.5% vs. 4.2%, odds ratio [OR] 3.13, 95% CI: 0.30 to 32.31, p = .34), GCS-PCS showed a nonsignificant lower validated abstinence rate compared to GCS (0% vs. 11.1%, OR 0.50, 95% CI: 0.15 to 1.67, p = .26).

Conclusions

This trial showed the feasibility of leveraging hospital visits as teachable opportunities and integrating mobile phone-based smoking-cessation support into chronic disease management in China. Optional treatments alongside mobile support showed preliminary effectiveness.

Implications

(1) This study showed the feasibility and potential effectiveness of using a SMART design to personalize and adapt mobile phone-based smoking cessation interventions for patients with chronic diseases in China. (2) By leveraging teachable moments during hospital visits, the findings suggest that adaptive, personalized mHealth support can enhance smoking cessation outcomes, although not statistically significant. (3) The integration of mobile phone-based interventions into chronic disease management showed promise. (4) These findings support the need for broader implementation and optimization of mHealth interventions in clinical settings in China.

Trial registration

ClinicalTrials.gov, NCT06187142.
m5C and m6A modifications regulate the mobility of pumpkin CHOLINE KINASE 1 mRNA under chilling stress
Authors: Li Xiaojun , Wang Cuicui , Chen Ying , Liu Wenqian , Zhang Miao , Wang Naonao , Xiang Chenggang , Gao Lihong , Dong Yihan , Zhang Wenna
Published: September 2024

Mobile messenger RNAs (mRNAs) serve as crucial long-distance signaling molecules, responding to environmental stimuli in plants. Although many mobile transcripts have been identified, only a limited subset has been characterized as functional long-distance signals within specific plant species, raising an intriguing question about whether the prevalence of species specificity in mobile transcripts implies a divergence in the mechanisms governing mRNA mobility across distinct plant species. Our study delved into the notable case of CHOLINE KINASE 1 (CK1), an extensively studied instance of mobile mRNAs regulated by a transfer RNA–like sequence (TLS) in Arabidopsis (Arabidopsis thaliana). We established an association between mRNA mobility and length, independent of TLS numbers. Notably, neither the mobile mRNAs nor the mechanisms underpinning their mobility proved to be conserved across different plant species. The exclusive mobility of pumpkin CK1 mRNA under chilling stress was pivotal in enhancing the chilling tolerance of cucumber/pumpkin heterografts. Distinct from the TLS-mediated mobility of AtCK1 mRNA, the mobility of CmoCK1 mRNA is orchestrated by both m5C and m6A modifications, adding dimensions to our understanding of mRNA transport mechanisms.
CARDIA sleep ancillary study: study design and methods
Authors: Knutson Kristen L , Reid Kathryn J , Karanth Sunaina , Kim Nathan , Abbott Sabra M , Alexandria Shaina J , Harrington Katharine , Thomas S Justin , Lewis Cora E , Schreiner Pamela J , Carnethon Mercedes R
Published: September 2024

Sleep and circadian disturbances are common and are experienced more often by Black compared to White individuals. We conducted an observational study of sleep that was ancillary to an ongoing cohort study, Coronary Artery Disease in Young Adults (CARDIA). The goal of the ancillary study will be to examine potential determinants of sleep/circadian disparities between Black and White adults in future analyses. Herein we describe the study design and methodology. Our ancillary study coincided with the Year 35 examination of the CARDIA study and was conducted in two phases (due to the SARS-COV-2 pandemic). Phase 1 involved only questionnaires to assess chronotype, restless legs syndrome, and the household sleep environment. Phase 2 involved three additional questionnaires to assess sleep quality, daytime sleepiness and insomnia symptoms, as well as two sleep devices. Participants wore a wrist activity monitor to assess sleep–wake patterns and light levels for 7 days and a home sleep apnea test for 1 night. A subset also had devices objectively record light, temperature, and sound levels in their bedrooms for 7 days. Sample sizes ranged based on assessment from 2200 to 2400, completing Phase 1 questionnaires, 899 with valid wrist actigraphy data, and 619 with a valid sleep apnea test. The data will be part of the full CARDIA dataset, which is available to researchers.
Reducing the excessive inflammation after burn injury in aged mice by maintaining a healthier intestinal microbiome
Authors: Walrath Travis , Najarro Kevin M. , Giesy Lauren E. , Khair Shanawaj , Orlicky David J. , McMahan Rachel H. , Kovacs Elizabeth J.
Published: September 2024

One in six people are projected to be 65 years or older by 2050. As the population ages, better treatments for injuries that disproportionately impact the aged population will be needed. Clinical studies show that people aged 65 and older experience higher rates of morbidity and mortality after burn injury, including a greater incidence of pulmonary complications when compared to younger burn injured adults, which we and others believe is mediated, in part, by inflammation originating in the intestines. Herein, we use our clinically relevant model of scald burn injury in young and aged mice to determine whether cohousing aged mice with young mice or giving aged mice oral gavage of fecal material from young mice is sufficient to alter the microbiome of the aged mice and protect them from inflammation in the ileum and the lungs. Aged burn injured mice have less DNA expression of Bacteroidetes in the feces and an unhealthy Firmicutes/Bacteroidetes ratio. Both Bacteroidetes and the ratio of these two phyla are restored in aged burn injured by prior cohousing for a month with younger mice but not fecal transfer from young mice. This shift in the microbiome coincides with heightened expression of danger‐associated molecular patterns (DAMP), and pro‐inflammatory cytokine interleukin‐6 (il6) in the ileum and lung of aged, burn injured mice, and heightened antimicrobial peptide camp in the lung. Cohousing reverses DAMP expression in the ileum and lung, and cathelicidin‐related antimicrobial peptide protein (camp) in the lung, while fecal transfer heightened DAMPs while reducing camp in the lung, and also increased IL‐6 protein in the lungs. These results highlight the importance of the intestinal microbiome in mediating inflammation within the gut–lung axis, giving insights into potential future treatments in the clinic.
Why Voting and Voter Disenfranchisement Matter to Health
Authors: Batiste-Brown Quanna , Katz Janet R. , Canty Lucinda , Coleman Christopher Lance , Wallace LeShonda , Moore Angelo D. , Bartlett Robin , Gomes Melissa
Published: September 2024

Nurses can play a crucial role as trusted advocates.
What Nurses in Advanced Practice Know
Authors: Dupler Alice E.
Published: September 2024

Integrating valid, reliable, and applicable knowledge into care
Gender and Authorship in Annals of Surgery: A nineteen-year review including the pandemic
Authors: Liang Jane W. , Chang Marcello , Stein Sharon L. , Salles Arghavan
Published: September 2024

Objective:

We examined article submission data from the Annals of Surgery to assess gender bias in publishing.

Background:

Medicine has long been a male-dominated practice, particularly in surgical fields. A key criterion for promotion in academic medicine is the publication record. Thus, it is critical to understand the extent to which there are gendered disparities in access to publishing which may contribute to differences in career advancement, especially given the exacerbation of these disparities in the early part of the COVID-19 pandemic.

Methods:

Working with Annals of Surgery submission data (2005–2023), we assigned author genders using genderize.io. Primary outcomes were final decision on the article (acceptance or rejection) and time to decision. Differences were examined between first-author gender, last-author gender, and first-author/last-author gender pairs using regression and chi-squared analyses.

Results:

Men submit more articles than women. This gap widened until the number of submissions peaked in 2020, after which submissions from men appeared to decrease at a faster rate than those from women. Acceptance rates and time to decision have generally declined over time, but articles by women experienced, on average, higher acceptance rates and longer time to decision during recent years compared with those by men.

Conclusions:

Our data from a single journal suggest that the widening gender gap in submissions that existed before the pandemic may be narrowing, and overall research productivity of academic surgeons may be declining. Further work is needed to examine the long-term productivity and career trajectories of academic surgeons by gender accounting for the ongoing pandemic.
What About the Others? Clinical Management of Gynecologic Cancer Risk in Patients With Moderate-Risk Hereditary Cancer Genes (ATM, BRIP1, RAD51C, RAD51D, and PALB2)
Authors: Goldfeld Ester I. , Kelly Brianna E. , Ring Kari L.
Published: September 2024

Hereditary cancer syndromes associated with gynecologic malignancies account for up to 18% of all cases of ovarian, uterine, and cervical cancers, and identification of these syndromes has implications for cancer screening and risk reduction techniques in affected patients. The associated cancer risks with moderate-penetrance genes are rapidly evolving and present variable risks for the provider counseling the patient. In this review, we detail the cancer risk and management of patients with germline PV in the moderate-risk hereditary cancer genes ATM, BRIP1, RAD51C, RAD51D, and PALB2.
MACULAR HOLE SURGERY AND RETINAL TECTONICS
Authors: Pellegrini Marco , Adamo Ginevra , Vivarelli Chiara , Bizzarri Alice , Mondin Riccardo , Talli Pietro Maria , Nasini Francesco , Giannaccare Giuseppe , Mura Marco
Published: September 2024

Purpose:

To evaluate the tangential retinal displacement occurring following macular hole (MH) surgery and to assess the impact of the internal limiting membrane (ILM) peeling size on the extent of the retinal movement.

Methods:

This retrospective study included patients with full-thickness MH undergoing 25-gauge pars plana vitrectomy with ILM peeling. Patients received either a small ILM peeling with a size of two-disk diameters or a large peeling extended up to the vascular arcades. Near-infrared retinal imaging was performed with the Spectral is (Heidelberg Engineering, Carlsbad, Germany) before and 6 months after the surgery. The tangential retinal displacement was evaluated comparing the optical flow of near-infrared images with a custom digital image analysis algorithm.

Results:

Forty-four eyes of 44 patients undergoing vitrectomy with small (n = 24) or large (n = 20) ILM peeling were included. An average overall displacement of 31.3 ± 22.8 µm toward the optic disk was observed after the surgery. Large ILM peeling was associated with a significantly higher overall displacement (P = 0.009), displacement in the central 4-mm circle (P < 0.001), and displacement in outer 8-mm ring (P = 0.001). Macular holes closure was achieved in 100% and 83.3% of patients in the large and small peeling group, respectively (P = 0.055).

Conclusion:

Pars plana vitrectomy with ILM peeling for MH results in a tangential retinal displacement toward the optic disk. A larger extent of the ILM peeling leads to a greater tangential movement, possibly improving the MH closure rate.