bluuebunny/crossref_metadata_2025 huggingface dataset:
Aortic valve repair in adults: long-term clinical outcomes and echocardiographic evolution in different valve repair techniques
Authors: Zito Francesco , Veen Kevin M , Melina Giovanni , Lansac Emmanuel , Schäfers Hans-Joachim , de Kerchove Laurent , Takkenberg Johanna J M , Kluin Jolanda , Mokhles M Mostafa
Published: January 2025

Objective

Aortic valve repair/sparing have been established as effective treatments for aortic regurgitation and/or aortic aneurysms. However, concerns remain regarding long-term durability, reproducibility, and patient selection. This study aims to asses long-term clinical and echocardiographic outcomes, with a focus on aortic regurgitation grade and left ventricular ejection fraction evolution, in adults undergoing these procedures.

Methods

Adult patients in the Heart Valve Society Aortic Valve Database, undergoing any aortic valve repair/sparing technique were included. Time-to-event analyses were used for clinical outcomes and mixed-effects-models for left ventricular ejection fraction and aortic regurgitation evolution. Techniques: isolated valve repair (GROUP-1), ascending aortic replacement +valve repair (GROUP-2), partial-root replacement +/-valve repair (GROUP-3), and valve-sparing root replacement +/-valve repair (GROUP-4).

Results

Survival at 10-years was comparable to the general population in each group. The 10-year cumulative incidence of reintervention was 19.5%(95%CI:16.70-22.40%) in GROUP-1 [Including only double external annuloplasty in GROUP-1, reintervention was not significantly different between techniques (p = 0.112)], 13.8% (95%CI: 10.10-18.10%) in GROUP-2, 12.7%(95%CI:5.50-22.90%) in GROUP-3, and 8.5%(95%CI:7.00-10.10%) in GROUP-4 (p < 0.001). Severe preoperative aortic regurgitation grade [HR: 1.95(95%CI:1.19–3.21),p<0.001] and left ventricular end-diastolic diameter [HR:1.03(95%CI:1.00–1.05),p<0.001] were predictive of reintervention in GROUP-4, patch use was a predictor in all groups. Predicted left ventricular ejection fraction (%) initially increased(p < 0.001) and then stabilized.

Conclusion

This study found that aortic valve repair/sparing techniques provide a viable and effective treatment option that should be considered for all eligible patients with aortic regurgitation and/or aortic root/ascending aortic aneurysms, given their potential to restore life expectancy and provide good hemodynamic outcomes with an acceptable hazard of reintervention.
Ross procedure for aortic regurgitation versus stenosis in adults with and without autograft support
Authors: Abeln Karen B , Froede Lennart , Ehrlich Tristan , Souko Idriss , Schäfers Hans-Joachim
Published: January 2025

OBJECTIVES

The Ross procedure for aortic regurgitation (AR) and abnormal aortic valve morphologies is associated with an increased risk of autograft dilatation. Autograft support may ameliorate this problem. We analyzed the results for all haemodynamic lesions and the effect of autograft support.

METHODS

A retrospective analysis was conducted of patients who underwent a Ross procedure at Saarland University Medical Center between December 1995 and December 2023. (315 patients undergoing full-root replacement with or without autograft support). Twenty-three (7%) were younger than 18 years and were excluded. The cohort was divided into 3 groups: Patients with aortic stenosis (AS), AR, and combined disease (CD). Endpoints included survival, freedom from reoperation and AR, and aortic root dimensions; these were compared between the three groups. Median follow-up was 3.6[range 0.01–26.6] and 95% complete.

RESULTS

Overall, 292 adult patients (male 74%; mean age 39 years(SD : 10) were analyzed with (n = 209) or without autograft support (n = 83). Patients with AS (n = 79; 28%) were compared to those with AR (n = 77; 25%) and those with CD (n = 136; 50%). Valve morphology was unicuspid (n = 141; 48%), bicuspid (n = 109; 38%), or tricuspid (n = 42; 14%). Survival at 15 years was similar across the groups (AR 86%; AS 93%; CD 94%; p = 0.123). Freedom from autograft reoperation was 90% at 10 years (AR 80%; AS 95%; CD 92%; p = 0.009). With autograft support, it was 93% at 10 years (AR 90%; AS 93%; CD 95%; p = 0.179). Neither UAV (HR 1.072; 95% CI 0.34–3.43; p = 0.907) nor BAV (HR 0.102; 95% CI 0.08–1.26; p = 0.102) were associated with reoperation.

CONCLUSIONS

Patients with AR and an unsupported root replacement do have an increased risk of reintervention, irrespective of aortic valve morphology. With autograft support, however, autograft stability is excellent, irrespective of the underlying lesion. Thus, the Ross procedure in its supported version can be offered to all haemodynamic types and valve morphologies.
Oedema index trajectories at heart failure nurse clinics over 6 months after acute heart failure predict patient outcomes: a retrospective cohort study
Authors: Liu Min-Hui , Wang Chao-Hung , Ye Shu-Ling , Lin Mei-Hui , Wang Cai-Ping , Yang Ning-I
Published: January 2025

Aims

Fluid accumulation is associated with poor outcomes in patients with heart failure (HF). After acute HF, HF nurses provide home care suggestions based on oedema status assessed at outpatient clinics. However, the pattern of serial oedema changes and their associations with patient outcomes are unknown. We investigated the trajectories of bioimpedance analysis (BIA)–derived oedema index (EI) changes following acute HF and their prognostic value.

Methods and results

This was a retrospective cohort study. We recruited 761 patients hospitalized for HF. Multisegmented and multifrequency BIA-derived EIs were measured at HF nurse outpatient clinics after discharge for 6 months. We explored the trajectories of EIs and their associations with all-cause rehospitalization and death within 2 years. Four EI trajectories were identified: trajectory 1 [T1, no oedema, n = 181 (23.8%)], T2 [transient, n = 341 (44.8%)], T3 [fluctuation, n = 195 (25.6%)], and T4 [worsening, n = 44 (5.8%)]. Compared with the T1 group, the T3 and T4 groups included more females; were older; had higher natriuretic peptide and glycohaemoglobin levels; and had higher incidences of comorbidities but lower albumin and cholesterol and worse kidney function (all P < 0.05). The Kaplan–Meier survival curves showed that T2, T3, and T4 patients had lower event-free survival rates than did T1 patients (all P < 0.01). Multivariable analysis demonstrated that T3 and T4 were independently associated with an increased risk for events (P < 0.001).

Conclusion

During the 6-month outpatient period after hospitalization, the EI trajectory of fluctuation or worsening was associated with poor outcomes. In the post-acute phase, monitoring the EI trajectory helps identify high-risk patients for optimizing HF management.
The influence of temperature on courtship and mate choice in a wolf spider: implications for mating success in variable environments
Authors: Rosenthal Malcolm F , Elias Damian O
Published: January 2025

The selection of animal signal form often changes significantly with the environment, yet signal form may be environment-dependent. Little is known about how variation in individual responses to changing environments affects the relationship between selection and the subsequent evolution of signal traits. To address this question, we assess the effects of variation in temperature on individual signaling and mating behavior responses across temperatures in the wolf spider Schizocosa floridana. By running repeated-measures trials, we find that temperature has predictable effects on signal form, but that the performance of individual courters is not consistent across temperatures. Traits associated with courtship rate generally increase at higher temperatures but inter-individual consistency in response to temperature change is low, despite consistent female preferences for increased courtship rate at all temperatures. Interestingly, the production of the likely most recently evolved signal component, the chirp, is consistent within signalers and predicts male performance across temperatures. Despite this, female preferences for chirp duration appear only at higher temperatures. Taken together, our results suggest that individual courter responses to changing temperatures have the potential to dampen or eliminate patterns of selection that are evident across temperatures. We discuss these results in light of current research on mating behavior and sexual selection.
A TTPA deletion is associated with retinopathy with vitamin E deficiency in the English Cocker Spaniel dog
Authors: Oliver James A C , Stanbury Katherine , Schofield Ellen , McLaughlin Bryan , Mellersh Cathryn S
Published: January 2025

Retinopathy with vitamin E deficiency is a familial disease in the English Cocker Spaniel dog breed. Ophthalmic abnormalities observed in retinopathy with vitamin E deficiency-affected English Cocker Spaniel include lipofuscin granule deposition within the tapetal fundus and subsequent retinal degeneration resulting in visual deficits. Affected dogs may also exhibit neurological signs that include ataxia and hindlimb proprioceptive deficits. In all cases, circulating plasma concentrations of α-tocopherol are low. This study sought to investigate the genetic basis of retinopathy with vitamin E deficiency in the English Cocker Spaniel breed. We undertook a genome-wide association study comprising 30 English Cocker Spaniels with normal fundic examinations aged 6 years or older (controls) and 20 diagnosed with retinopathy with vitamin E deficiency (cases) and identified a statistically associated signal on chromosome 29 (Praw = 1.909 × 10−17). Whole genome sequencing of 2 cases identified a 102 bp deletion in exon 1 of the alpha-tocopherol transfer protein gene (TTPA), truncating the protein by 34 amino acids. The c.23_124del variant segregated with retinopathy with vitamin E deficiency in a total of 30 cases and 43 controls. Variants in TTPA are causal for ataxia with vitamin E deficiency in humans which is a phenotypically similar disease to retinopathy with vitamin E deficiency. The identification of the canine variant is extremely significant as the availability of a DNA test will allow for identification of presymptomatic dogs and early therapeutic intervention which may prevent development of retinopathy and improve neurological signs. Breeders can also use the DNA test to efficiently eradicate the disease from this breed.
Within- and Between-Person Differences in Activity Factor Structure: Results from an Ecological Momentary Assessment Study
Authors: Bielak Allison A M , Mogle Jacqueline A , Sliwinski Martin J
Published: January 2025

Objective

Studies using ecological momentary assessment (EMA) of activity participation rely on items tapping domains informed by factor analyses based on single time points. Analyses from a single time point focus on differences between participants and provide little insight into how activities cluster together within a person across moments or days. The present study compared the factor structure in activity participation between- and within-persons using an expanded set of momentary activity items in middle and older adulthood.

Methods

Using tablets, 81 adults aged 41 to 94 years reported activities completed in the past 3-4 hours five times per day for 14 days.

Results

The most common activities during the day involved social interactions, reading, and computer work. Watching TV or videos was the most common evening activity. Multilevel factor analysis simultaneously computed both intra-individual factors (within-person) and inter-individual factors (between-person). Four within-person and 4 between-person factors provided the best model fit, with three common factors: cognitive (read, computer); social (events, mentoring, providing care); and passive (TV, games) factors. There were notable differences in the fourth factor.

Discussion

Although three common activity factors were found between individuals and within persons from day to day, the divergence between the fourth intra- and inter-individual factors provides insight into how activity engagement operates at different timescales and likely reflect daily demands versus long-term goals. EMA provides a window into engagement throughout and across days, but researchers who commonly use retrospective reports of between-person activity engagement may find distinctly different results from factor analyses.
What Is the State of the Literature About Refugees Aged 45 and Older from Burma in Third-Country Resettlement Contexts?: A Scoping Review
Authors: Kitchens Katherine , Sesay Benjamin J , Fields Noelle L , Stringfellow Mary Kris , Mitschke Diane B
Published: January 2025

Background and Objective

Older adult refugees from Burma face unique challenges in third-country resettlement, yet their experiences are often overlooked in research and policy. This scoping review aims to examine the literature on refugees aged 45 and older from Burma in third-country resettlement contexts, identify factors contributing to successful integration, and elucidate the unique challenges they encounter.

Research Design and Methods

We systematically searched seven databases using Arksey and O’Malley’s framework. Studies were selected if they included refugees from Burma aged 45 and older in third-country resettlement contexts. Data were analyzed using Ager and Strang’s conceptual framework of refugee integration.

Results

Six studies met the inclusion criteria. Key findings highlighted disparities in health outcomes based on pre-resettlement environments, the interplay between chronic health issues and employment challenges, the importance of family bonds and institutional support, language proficiency barriers, and the impact of citizenship on self-perception. Instances of resilience and post-traumatic growth were noted, alongside lower reported well-being among older refugees compared to younger counterparts.

Discussion and Implications

The review revealed complex interactions between health, employment, social connections, language proficiency, safety, and citizenship in the integration experiences of older refugees from Burma. Findings underscore the need for integrated support systems addressing health and employment, flexible family reunification policies, tailored language acquisition programs, and clear pathways to citizenship. Future research should focus on longitudinal studies, specific employment support strategies, and the long-term impacts of institutional support on integration.
Daily Cognition in the Family Context: The Complex Associations between Memory Lapses, Family Relationships, and Affect in Middle-Aged and Older Adults
Authors: Jang Heejung , Hill Nikki L , Turner Jennifer R , Almeida David M , Jeong Mijin , Mogle Jacqueline
Published: January 2025

Background and Objectives

The analysis of daily memory lapses is an underutilized approach to understanding daily experiences of cognitive functioning. The present study adopts this approach, with the goals of exploring how the quality of family relationships predicts the frequency of daily memory lapses and moderates the link between daily memory lapses and daily affect.

Research Design and Methods

We used longitudinal data from the third wave of Midlife in the United States and the National Study of Daily Experiences to assess our research goals. Participants (N = 1,236; Mage= 62.48 years, SD= 10.21, range 43-91; 57% female) completed eight nightly telephone interviews that included reports of prospective and retrospective memory lapses as well as daily positive and negative affect.

Results

During a separate baseline interview, participants reported the emotional support they received from their family. Latent profile analysis models identified four family relationship types: pleasant, ambivalent, neutral, and unpleasant. Compared to pleasant relationships, ambivalent (b=.23, p<.05) and neutral (b=.35, p<.01) relationships significantly predicted a higher frequency of prospective memory lapses; this effect was not found among retrospective lapses. In addition, relative to pleasant relationships, ambivalent (b=.02, p<.05), neutral (b=.02, p<.05), and unpleasant (b=.07, p<.001) relationships were associated with increased negative affect on days with a retrospective lapse, but not prospective lapse.

Discussion and Implications

This study contributes to the literature by revealing that family relationships are related to the memory lapses individuals experience in their daily lives, and identifies how lapses might contribute to affective symptom load over time.
Current tectonic deformation of the Sulaiman Range (Pakistan) with InSAR
Authors: Jouanne François , Pousse-Beltran Lea , Doin Marie-Pierre , Bascou Pascale , Thollard Franck , Ahmed Awais
Published: January 2025

In Pakistan, the relative displacement between the Indian and Eurasian plates is accommodated by a left-lateral transpression zone comprising the Chaman and Ghazaband faults and the Sulaiman Range. The current tectonic deformation of the Sulaiman Range is known only from some focal mechanisms and a few neotectonic studies. In this study, we propose an Interferometric Synthetic-Aperture Radar (InSAR) quantification of current tectonic deformation using the Sentinel 1 satellite. Velocity maps for the ascending and descending tracks enabled us to locate active faults affected by creep: the Harnaï and Kingri strike-slip faults, and the Gwal–Bagh thrust. We propose a numerical simulation that considers these faults as well as the level of detachment fold-and-thrust belt. Our results suggest the existence of out-of-sequence deformation along the Gwal–Bagh thrust, creep along the Harnaï and Kingri strike-slip faults, and slip along the décollement of the Sulaiman Range. The eastern part of the Sulaiman Range is characterized by a partitioning of the deformation with a left-lateral strike-slip along the N170° Kingri fault and an eastward thrust. In contrast, the western part is characterized by north–south compressive deformation associated with right lateral strike-slip on the Harnaï N120° fault. Modelling of the coseismic deformation of the 2021 October 21 earthquake shows that this earthquake occurred on a fault with a ramp geometry, but affected by a strike-slip motion.
Importance sampling of seismic tsunami sources with near-field emphasis for inundation PTHA: benchmarking with complete ensembles
Authors: Abbate A , Davies G , Lorito S , Kalligeris N , Romano F , Tonini R , Volpe M
Published: January 2025

Site-specific Probabilistic Tsunami Hazard Assessment (PTHA) is a powerful tool for coastal planning against tsunami risk. However, its typically high computational demands led to the introduction of a Monte Carlo Stratified Importance Sampling (SIS) approach, which selects a representative subset of scenarios for numerical inundation simulations. We here empirically validate this sampling approach, for the first time to our knowledge, using an existing extensive data set of numerical inundation simulations for two coastal sites in the Mediterranean Sea (Catania and Siracusa, both located in Sicily, Italy). Moreover, we propose a modified importance sampling function to prioritize seismic tsunami scenarios based on their arrival time at an offshore point near the target site, in addition to their wave amplitude and occurrence rate as leveraged in the previous work. This sampling function is applied separately in each earthquake magnitude bin, and allows denser sampling of near-field earthquakes to whose variations tsunamis are very sensitive. We compare the confidence intervals of the offshore PTHA estimates obtained with the new and the original importance sampling functions. Then, we benchmark our onshore PTHA estimates obtained with both functions against the inundation PTHA calculated using the full set of scenarios. We also test the assumption that onshore random errors follow a normal distribution, as found previously for the offshore case. As a result of the benchmarks, we find that the SIS approach works satisfactorily. Introducing the arrival time as an additional sampling factor enhances the precision of the estimates of both the mean and the percentiles for the two coastal sites considered. With this modification it is possible to deal efficiently with heterogeneous near-field earthquake sources involving coastal deformation at Catania and Siracusa, in addition to regional crustal and subduction sources. By comparing the sampling errors with the model (epistemic) uncertainty, an optimal trade-off between the number of simulations employed and the uncertainty of the PTHA model can be found, even for such a complex situation. A relatively small number of scenarios, on the order of a few thousand, is sufficient to perform site-specific PTHA for practical applications. These numbers correspond to 4–8 per cent of the already reduced ensembles used in previous assessments at the same sites.
Balancing the right to health and commercial speech: the approach of Argentina’s Supreme Court
Authors: Cerra Berenice
Published: January 2025

Noncommunicable diseases (NCDs) cause significant human and economic costs globally. Each year, 17 million people die from an NCD before age 70. The burden of NCDs is associated with socioenvironmental, cultural factors and social behavior, including modifiable risk factors like tobacco use, unhealthy diets, physical inactivity and alcohol consumption. NCDs can be prevented if healthy environments are guaranteed by the promotion of effective public policies that control the behavior of the tobacco, food and alcohol industries. The regulation of marketing strategies of unhealthy products, and even its ban, has been demonstrated as an effective measure to protect the right to health and promote human rights. However, companies that produce and commercialize these ultra-processed food products argue that protecting measures restricting marketing violate their constitutional right to freedom of speech, among others. Regarding tobacco product marketing activities, the Supreme Court of Justice of Argentina has ruled that it is afforded less constitutional protection than political speech and could be restricted to protect public health and human rights. This article examines the tobacco marketing case and, using an analytical framework argues that the proportionality test used by the Supreme Court could indeed be applied to ultra-processed food products. It is concluded that a complete ban on ultra-processed food product marketing would be constitutionally valid.
In situ zooplankton density estimates at a foraging site in the Canadian Arctic are below minimum prey thresholds for adult bowhead whales (Balaena mysticetus)
Authors: McLennan Hayley , Fortune Sarah , den Haan Manon , Bazinet Alexis , Cox Martin J , Proud Roland , Mackie Connor , Kilabuk Ricky , Brierley Andrew S
Published: January 2025

Bowhead whales (Balaena mysticetus) are an iconic Arctic species with a critical ecological role as a top predator. Bowheads can reach up to 80 tonnes and 20 m, yet feed on zooplankton four orders of magnitude smaller. Arctic zooplankton community composition and distribution are changing, which may have direct impacts on bowhead foraging. Data on the threshold prey density for successful bowhead feeding are needed to predict these impacts. However, zooplankton densities are patchy temporally and spatially, influenced by oceanographic conditions that alter the location of energetically profitable patches. We assessed spatio-temporal patterns in zooplankton abundance and distribution using a multi-frequency echosounder following a systematic and opportunistic survey near feeding whales in Iqalujjuaq Fjord, Cumberland Sound, Nunavut (65.66°N, 65.20°W) during August 2023. Zooplankton net samples were used to validate the acoustic data. There was a strong link between copepod distribution and environmental variables (e.g. water depth and tidal cycle) (generalized additive models, P < .001). Copepods were present in 49.8% of the fjord, with a median density of 3240 copepods m−3 and 0.26 g C m−3. Based on published prey density requirements, this site provides feeding opportunities for juveniles but is insufficient for the needs of adults (>0.44 g C m−3).
Moduli Spaces of Nilpotent Displays
Authors: Bartling Sebastian , Hoff Manuel
Published: January 2025

We show that the moduli problem of deformations of nilpotent displays by quasi-isogenies is representable, without using $p$-divisible groups. The main ingredients are Artin’s criterion and the theory of truncated displays. This gives in particular a new proof for the representability of Rapoport–Zink spaces.
Surveillance of antimicrobial resistance in hospitalized companion animals in China in 2022–23
Authors: Liu Yang , Zhai Yimeng , Jiang Chenwei , Liu Huan , Li Zhenyu , Yuan Yafang , Song Jinfeng , Yuan Shuai
Published: January 2025

Objectives

In this study, bacteria isolated from companion animals in China were taxonomically identified and assessed for antimicrobial susceptibility to evaluate the prevalence of antimicrobial resistance (AMR) in pets.

Methods

From October 2022 to October 2023, 5468 samples were collected from pets, predominantly from cats and dogs, in China, of which 5253 bacterial strains were identified (>98%). Antimicrobial susceptibility was assessed using the VITEK 2 COMPACT system and the Kirby–Bauer disc diffusion method.

Results

The most common bacterial species were Escherichia coli (14.5%) and Staphylococcus pseudintermedius (13.6%). E. coli exhibited high resistance to ampicillin and cefpodoxime (56.8%–73.2%) but moderate resistance to doxycycline, trimethoprim-sulfamethoxazole, enrofloxacin, gentamicin, and amoxicillin-clavulanate (18.1%–38.5%). Klebsiella spp. and Enterobacter spp. were resistance to several antimicrobials (32.2%–57.7%). High susceptibility to imipenem was noted in Proteus spp., Pseudomonas spp., and Acinetobacter spp. (91.7%–94.1%). Coagulase-positive Staphylococcus spp. demonstrated higher resistance than coagulase-negative strains. Enterococcus faecium showed greater resistance to some antimicrobials compared with E. faecalis. Streptococcus spp. exhibited low resistance to enrofloxacin (1.6%) and penicillin (1.1%).

Conclusions

The study demonstrates that AMR is widespread in companion animals in China, emphasizing the need for continuous surveillance. The accumulation of commercial antimicrobial susceptibility data can improve understanding of AMR and promote more effective antimicrobial stewardship and clinical practices in veterinary medicine.
Evaluating robustly standardized explainable anomaly detection of implausible variables in cancer data
Authors: Röchner Philipp , Rothlauf Franz
Published: January 2025

Objectives

Explanations help to understand why anomaly detection algorithms identify data as anomalous. This study evaluates whether robustly standardized explanation scores correctly identify the implausible variables that make cancer data anomalous.

Materials and Methods

The dataset analyzed consists of 18 587 truncated real-world cancer registry records containing 8 categorical variables describing patients diagnosed with bladder and lung tumors. We identified 800 anomalous records using an autoencoder’s per-record reconstruction error, which is a common neural network-based anomaly detection approach. For each variable of a record, we determined a robust explanation score, which indicates how anomalous the variable is. A variable’s robust explanation score is the autoencoder’s per-variable reconstruction error measured by cross-entropy and robustly standardized across records; that is, large reconstruction errors have a small effect on standardization. To evaluate the explanation scores, medical coders identified the implausible variables of the anomalous records. We then compare the explanation scores to the medical coders’ validation in a classification and ranking setting. As baselines, we identified anomalous variables using the raw autoencoder’s per-variable reconstruction error, the non-robustly standardized per-variable reconstruction error, the empirical frequency of implausible variables according to the medical coders’ validation, and random selection or ranking of variables.

Results

When we sort the variables by their robust explanation scores, on average, the 2.37 highest-ranked variables contain all implausible variables. For the baselines, on average, the 2.84, 2.98, 3.27, and 4.91 highest-ranked variables contain all the variables that made a record implausible.

Discussion

We found that explanations based on robust explanation scores were better than or as good as the baseline explanations examined in the classification and ranking settings. Due to the international standardization of cancer data coding, we expect our results to generalize to other cancer types and registries. As we anticipate different magnitudes of per-variable autoencoder reconstruction errors in data from other medical registries and domains, these may also benefit from robustly standardizing the reconstruction errors per variable. Future work could explore methods to identify subsets of anomalous variables, addressing whether individual variables or their combinations contribute to anomalies. This direction aims to improve the interpretability and utility of anomaly detection systems.

Conclusions

Robust explanation scores can improve explanations for identifying implausible variables in cancer data.
Building an allergy reconciliation module to eliminate allergy discrepancies in electronic health records
Authors: Blackley Suzanne V , Lo Ying-Chih , Varghese Sheril , Chang Frank Y , James Oliver D , Seger Diane L , Blumenthal Kimberly G , Goss Foster R , Zhou Li
Published: January 2025

Objective

Accurate, complete allergy histories are critical for decision-making and medication prescription. However, allergy information is often spread across the electronic health record (EHR); thus, allergy lists are often inaccurate or incomplete. Discrepant allergy information can lead to suboptimal or unsafe clinical care and contribute to alert fatigue. We developed an allergy reconciliation module within Mass General Brigham (MGB)’s EHR to support accurate and intuitive reconciliation of discrepancies in the allergy list, thereby enhancing patient safety.

Materials and Methods

We combined data-driven methods and knowledge from domain experts to develop 5 mechanisms to compare allergy information across the EHR and designed a user interface to display discrepancies and suggested reconciliation actions, with links to relevant data sources. Qualitative and quantitative analyses were conducted to assess the module’s performance and measure user acceptance.

Results

We implemented and tested the proposed allergy reconciliation mechanisms and module. A comprehensive integration workflow was developed for the module, which was piloted among 111 primary care physicians at MGB. F1 scores of the reconciliation mechanisms range from 0.86 to 1.0. Qualitative analysis showed majority positive feedback from pilot users.

Discussion

Our allergy reconciliation module achieved high performance, and physicians who used it largely accepted its recommendations. However, 56% of the pilot group ultimately did not use the module. User engagement and education are likely needed to increase adoption.

Conclusion

We built a module to automatically identify discrepancies within patients’ allergy records and remind providers to reconcile and update the allergy list. Its high accuracy shows promise for enhancing patient safety and utility of drug allergy alerts.
A novel machine learning-based cancer-specific CVD risk score among patients with breast, colorectal, or lung cancer
Authors: Stabellini Nickolas , Makram Omar M , Kunhiraman Harikrishnan Hyma , Daoud Hisham , Shanahan John , Montero Alberto J , Blumenthal Roger S , Aggarwal Charu , Swami Umang , Virani Salim S , Noronha Vanita , Agarwal Neeraj , Dent Susan , Guha Avirup
Published: January 2025

Background

Cancer patients have up to a 3-fold higher risk for cardiovascular disease (CVD) than the general population. Traditional CVD risk scores may be less accurate for them. We aimed to develop cancer-specific CVD risk scores and compare them with conventional scores in predicting 10-year CVD risk for patients with breast cancer (BC), colorectal cancer (CRC), or lung cancer (LC).

Methods

We analyzed adults diagnosed with BC, CRC, or LC between 2005-2012. An ML Extreme Gradient Boosting (XGBoost) algorithm ranked 40-50 covariates for predicting CVD for each cancer type using SHapley Additive exPlanations (SHAP) values. The top 10 ML-predictors were used to create predictive equations using logistic regression and compared to ACC/AHA Pooled Cohort Equations (PCE), Predicting Risk of cardiovascular disease EVENTs (PREVENT), and Systematic COronary Risk Evaluation-2 (SCORE2) using the area under the curve (AUC).

Results

We included 10,339 patients: 55.5% had BC, 15.6% had CRC, and 29.7% had LC. The actual 10-year CVD rates were: BC 21%, CRC 10%, and LC 28%. The predictors derived from the ML algorithm included cancer-specific and socioeconomic factors. The cancer-specific predictive scores achieved AUCs of 0.84, 0.76, and 0.83 for BC, CRC, and LC, respectively, and outperformed PCE, PREVENT and SCORE2, increasing the absolute AUC values by up to 0.31 points (with AUC ranging from 0 to 1). Similar results were found when excluding patients with cardiac history or advanced cancer from the analysis.

Conclusion(s)

Cancer-specific CVD predictive scores outperform conventional scores and emphasize the importance of integrating cancer-related covariates for precise prediction.
From camp to quarter: the contention of post-disaster social housing in al-Mankubin, North Lebanon
Authors: Forster Robert
Published: January 2025

The neighbourhood of al-Mankubin was established as an encampment for the displaced of Tripoli, North Lebanon, after a disastrous flood in 1955. This article analyses the history of a lesser-known internal displacement camp in Lebanon and its urban consolidation. In contrast to narratives of Mankubin’s abandonment by the state, this article argues that actors within Lebanon’s fragmented state supported the establishment and growth of the quarter. The issue of squatting on state-owned land is interrogated through an analysis of the flood relief process in the 1950s and the subsequent derailment of the housing project for the flood-displaced. Today, al-Mankubin sits at the intersection of social housing and encampment, perpetuated over seven decades by the absence of land tenure and as a site of convergence for displaced persons and migrants from Lebanon, Palestine, and Syria.
Device-assisted versus manual circumcision: a prospective, comparative, multicenter study
Authors: García Rojo Esther , Alonso Isa Manuel , Manfredi Celeste , Lo Re Mattia , Belli Simone , García Gómez Borja , Fiorillo Alessandro , Celada Guillermo , Justo Quintas Juan , Bozzini Giorgio , Fraile Agustín , Romero-Otero Javier
Published: January 2025

Background

Circumcision is a common urological procedure performed for various medical, cultural, religious, and aesthetic reasons.

Aim

This study aimed to compare the effectiveness and safety of device-assisted (DeCi) and manual circumcision (MaCi) in adult European patients.

Methods

We conducted a prospective, comparative, non-randomized multicenter study including 200 consecutive adult males undergoing circumcision under local anesthesia. Patients were divided into two groups (MaCi or DeCi) based on patient preferences following proper counseling. Follow-up was scheduled at 1 week and 1 month post-surgery. Surgical and postoperative outcomes were recorded, with patient satisfaction with aesthetic results as the primary outcome, and procedure-related complications as secondary outcomes. Satisfaction was assessed using a 5-point Likert scale, while postoperative complications were classified using the Clavien-Dindo (CD) system.

Outcomes

A total of 200 patients (100 per group) were included. The DeCi group had a significantly shorter mean operative time than the MaCi group (11.20 ± 5.92 vs. 23.20 ± 7.93 minutes, P < .001). Patient satisfaction with aesthetic results was significantly higher in the DeCi group, with 67.4% of patients being “very satisfied” or “satisfied” compared to 36.7% in the MaCi group (P < .001). The DeCi group also reported significantly lower perceived pain during surgery (mean ± SD visual analogue scale [VAS] score: 1.54 ± 1.77 vs. 4.20 ± 2.10 points, P = .025) and at 1 month postoperatively (mean ± SD VAS score: 0.54 ± 1.03 vs. 2.35 ± 2.77, P < .001). Intraoperative and postoperative complication rates were similar between groups, with no significant differences (P > .05). Only 5% of patients in the MaCi group and 4% in the DeCi group experienced a CD Grade ≥ 3 postoperative complication.

Clinical Implications

DeCi appears to offer superior aesthetic outcomes and reduced pain compared to MaCi, making it a promising option for circumcision in adult European men.

Strengths & Limitations

This is the first study directly comparing DeCi and MaCi in a European adult population. The study's strengths include its prospective multicenter design, large sample size, and use of validated tools for outcome evaluation, which enhance the reliability and generalizability of the results. However, the non-randomized design, the age difference between groups, the testing of only one circumcision device model, and the lack of a cost-effectiveness analysis limit the generalizability of the findings.

Conclusion

In adult European men, DeCi offers superior aesthetic results and a similar safety profile compared to MaCi, though further research is needed to address the study's limitations.
X-ray surface brightness fluctuations in smooth galaxy cluster atmospheres
Authors: Li Muzi , McNamara B R , Zhuravleva Irina
Published: January 2025

We measure surface brightness fluctuations in Chandra X-ray images of the cores of the galaxy clusters Abell 2029, Abell 2151, Abell 2107, RBS0533, and RBS0540. Their relatively structureless X-ray atmospheres exhibit the thermodynamic properties of cool-cores including short central cooling times and low entropy. However, unlike typical cool-core clusters, molecular gas, star formation, and bubbles associated with radio jets are faint or absent near their central galaxies. Four clusters show typical gas density fluctuation amplitudes of $\sim~$10 per cent on the scales probed, apart from RBS0540, which exhibits lower amplitudes, suggesting that its gas is mildly disturbed. Under the assumption that gas density fluctuations are indicative of random gas velocities, we estimate scale-dependent velocity amplitudes of gas motions across all studied clusters, which range from 100 to 200 $\rm\sim~km~s^{-1}$ in Abell 2029, Abell 2151, and Abell 2107. These velocity estimates are comparable to the atmospheric velocity dispersion in the Perseus cluster measured by the Hitomi X-ray Observatory. The turbulent heating rates implied by our measurements are of the same order as the radiative cooling rates. Our results suggest that atmospheric sloshing and perhaps turbulent motion may aid radio jets in stabilizing atmospheric cooling.
GRB 220831A: a hostless, intermediate gamma-ray burst with an unusual optical afterglow
Authors: Freeburn James , O’Connor Brendan , Cooke Jeff , Dobie Dougal , Möller Anais , Tejos Nicolas , Zhang Jielai , Beniamini Paz , Auchettl Katie , DeLaunay James , Dichiara Simone , Fong Wen-fai , Goode Simon , Gordon Alexa , Kilpatrick Charles D , Lien Amy , Mihalenko Cassidy , Ryan Geoffrey , Siellez Karelle , Suhr Mark , Troja Eleonora , Van Bemmel Natasha , Webb Sara
Published: January 2025

GRB 220831A is a gamma-ray burst (GRB) with a duration and spectral peak energy that places it at the interface between the distribution of long-soft and short-hard GRBs. In this paper, we present the multiwavelength follow-up campaign to GRB 220831A and its optical, near-infrared, X-ray and radio counterparts. Our deep optical and near-infrared observations do not reveal an underlying host galaxy, and establish that GRB 220831A is observationally hostless to depth, $m_i\gtrsim 26.6$ AB mag. Based on the Amati relation and the non-detection of an accompanying supernova, we find that this GRB is most likely to have originated from a collapsar at $z\gt 2$, but it could also possibly be a compact object merger at $z\lt 0.4$ with a large separation distance from its host galaxy. Regardless of its origin, we show that its optical and near-infrared counterpart departs from the evolution expected from a dominated synchrotron afterglow, exhibiting a steep post-break temporal power-law index of $-3.83^{+0.62}_{-0.79}$, too steep to be the jet-break. By analysing a range of models, we find that the observed steep departure from forward shock closure relations is likely due to an internal process producing either a flare or a plateau.
The Autonomic Nervous System and Inflammation in Chronic Kidney Disease
Authors: Zoccali Carmine , Mallamaci Francesca , Kanbay Mehmet , Tuttle Katherine R , Kotanko Peter , De Caterina Raffaele , Grassi Guido , Mancia Giuseppe
Published: January 2025

The autonomic nervous system plays a crucial role in regulating physiological processes and maintaining homeostasis through its two branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system. Dysregulation of the autonomic system, characterized by increased sympathetic activity and reduced parasympathetic tone, is a common feature in chronic kidney disease (CKD) and cardiovascular disease. This imbalance contributes to a pro-inflammatory state, exacerbating disease progression and increasing the risk for cardiovascular events. The sympathetic system promotes inflammation by releasing catecholamines, which activate adrenergic receptors on immune cells. The parasympathetic system exerts anti-inflammatory effects via the cholinergic anti-inflammatory pathway mediated by the vagus nerve. Targeting the autonomic system to restore the balance between the sympathetic and the parasympathetic components offers promising approaches to reduce inflammation and improve outcomes in CKD and cardiovascular disease. Beta-blockers, angiotensin-converting enzyme inhibitors (ACEi), and angiotensin II receptor blockers (ARBs) are pharmacological agents that modulate sympathetic activity and have shown anti-inflammatory effects. Lifestyle interventions, such as a healthy diet, physical exercise, mindfulness, and meditation, enhance parasympathetic activity and improve autonomic function. Vagus nerve stimulation has emerged as a promising therapy, demonstrating significant potential in reducing inflammation and improving clinical outcomes in various conditions, including CKD, myocardial infarction and stroke. Despite mixed results in heart failure trials, vagal nerve stimulation has consistently improved quality-of-life measures. Understanding the mechanisms underlying autonomic system regulation of inflammation can inform the development of novel therapeutic strategies to restore autonomic balance and improve patient outcomes in CKD and cardiovascular disease.
Effects of the Curcuminoid and Non-Curcuminoid Compounds of Turmeric on the Gut Microbiome and Inflammation: Potential Use in the Treatment and Prevention of Disease
Authors: Kacena Claire
Published: January 2025

The gut microbiome is a complex system that directly interacts with and influences many systems in the body. This delicate balance of microbiota plays an important role in health and disease and is highly influenced by lifestyle factors and the surrounding environment. As further research emerges, understanding the full potential of the gut microbiome and the impact of using nutraceuticals to positively influence its function may open the door to greater therapeutic outcomes in the treatment and prevention of disease. Curcumin, a bioactive compound derived from the turmeric rhizome, has been studied in depth for its influence on human health as a potent anti-inflammatory and antioxidant properties. However, the therapeutic activity of curcumin is limited by its low oral bioavailability. While most available research has primarily focused on the curcuminoid compounds of turmeric, the non-curcuminoid compounds hold promise to offer therapeutic benefits while synergistically enhancing the bioavailability of curcumin and supporting the gut microbiome. This review summarizes current knowledge of the relationship between the gut and the various systems within the body, and how dysbiosis, or disruption in the gut microbial balance, leads to inflammation and increased risk of chronic disease. The review also summarizes recent research that focuses on the bioactivity of both the curcuminoid and non-curcuminoid compounds that comprise the whole turmeric root and their synergistic role in enhancing bioavailability to support a healthy gut microbiome and promising use in the treatment and prevention of disease.
Clinical Features and Outcomes of Myroides Species Infections
Authors: Alabdely Mayyadah H , Englund Kristin , Shrestha Nabin K
Published: January 2025

Background

Myroides species, Gram-negative bacilli from the Flavobacteriaceae family, are typically considered low-virulence pathogens but have previously been described as extensively drug-resistant. This study investigates the clinical features and outcomes of Myroides infections.

Methods

We conducted a retrospective cohort study of patients hospitalized at Cleveland Clinic with Myroides infection. Infections were defined as a positive Myroides culture from a sterile site that were treated with an antibiotic to which the isolate was susceptible. Controls were hospitalized patients with a positive culture for Myroides, who did not meet the definition for infection. Survival for infected patients and uninfected controls was compared using Cox proportional hazards regression.

Results

Between January 2015 and September 2023, 52 positive Myroides species cultures were identified, with 21 deemed infections. A higher proportion of Myroides-infected patients than controls had diabetes mellitus. The most common infections were skin/soft-tissue infections (42.8%), osteomyelitis (33.3%), and urinary tract infections (19%); and 28.5% were bacteremic infections. All isolates were resistant to aminoglycosides, but the majority were susceptible to trimethoprim-sulfamethoxazole (81%), ciprofloxacin (57%), and meropenem (68%). The main antimicrobial treatments provided were meropenem, ciprofloxacin, and trimethoprim-sulfamethoxazole. A significant difference in survival was not found between patients with Myroides infection and uninfected controls (hazard ratio, 3.42; 95% confidence interval, .63–18.74; P = .16).

Conclusions

All patients in this study had reasonable treatment options, belying previous reports of extensive antibiotic resistance in Myroides. Our small study did not detect a statistically significant decrease in survival among Myroides-infected patients compared to controls.