bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive value of laboratory indicators for in-hospital death in children with community-onset sepsis: a prospective observational study of 266 patients
Authors: Liu jing , Hui Qin , Lu Xiuxiu , Li Wei , Li Ning , Chen Yuanmei , Zhang Qi
Published: May 2024

Background and objectives

This study aimed to identify predictors of sepsis-associated in-hospital mortality from readily available laboratory biomarkers at onset of illness that include haematological, coagulation, liver and kidney function, blood lipid, cardiac enzymes and arterial blood gas.

Methods

Children with sepsis were enrolled consecutively in a prospective observational study involving paediatric intensive care units (PICUs) of two hospitals in Beijing, between November 2016 and January 2020. The data on demographics, laboratory examinations during the first 24 hours after PICU admission, complications and outcomes were collected. We screened baseline laboratory indicators using the Least Absolute Shrinkage and Selection Operator (LASSO) analysis, then we constructed a mortality risk model using Cox proportional hazards regression analysis. The ability of risk factors to predict in-hospital mortality was evaluated by receiver operating characteristic (ROC) curves.

Results

A total of 266 subjects were enrolled including 44 (16.5%) deaths and 222 (83.5%) survivors. Those who died showed a shorter length of hospitalisation, and a higher proportion of mechanical ventilation, complications and organ failure (p<0.05). LASSO analysis identified 13 clinical parameters related to prognosis, which were included in the final Cox model. An elevated triglyceride (TG) remained the most significant risk factor of death (HR=1.469, 95% CI: 1.010 to 2.136, p=0.044), followed by base excess (BE) (HR=1.131, 95% CI: 1.046 to 1.223, p=0.002) and pH (HR=0.95, 95% CI: 0.93 to 0.97, p<0.001). The results of the ROC curve showed that combined diagnosis of the three indicators—TG+BE+pH—has the best area under the curve (AUC) (AUC=0.77, 95% CI: 0.69 to 0.85, p<0.001), with a 68% sensitivity and 80% specificity.

Conclusion

Laboratory factors of TG, BE and pH during the first 24 hours after intensive care unit admission are associated with in-hospital mortality in PICU patients with sepsis. The combination of the three indices has high diagnostic value.
12 Exploring experiences of compassion, resilience and self-care in clinical psychologists working in palliative care
Authors: Cramond Laura , Fletcher Ian , Rehan Claire
Published: May 2024

Introduction

Compassion fatigue refers to the emotional and physical exhaustion that can be felt by professionals in caring roles, whereas compassion satisfaction encompasses the positive aspects of helping others. Levels of compassion satisfaction and fatigue have been found to be inconsistent in palliative care professionals. This could have serious implications for patients, professionals, and organisations.

Aim

This study explored the experiences of 12 clinical psychologists working in palliative care to learn more about the impact that supporting people at the end of life has on compassion and the support that professionals may require to remain resilient and practice self-care.

Method

A qualitative approach was taken, using semi-structured interviews and interpretative phenomenological analysis.

Results

Six overarching themes were identified: Being Part of Something Special, The Therapeutic Relationship at The End of Life, Pressure to do More With Less, The Change in Self as a Result of Involvement, The Idea of the Consummate Professional, and Practicing What you Preach. The professionals’ experiences were characterised by the relationship between them and patients at the end of life, the lasting impact of the work on professionals, and the effects of recent organisational change in healthcare.

Conclusions

Professionals working in palliative care should be supported to reflect on their experiences of compassion fatigue and satisfaction, and encouraged to consider how to practice good self-care to protect their well-being, build resilience and ensure the quality of patient care.
15 A model for practice implementation of a person-centred approach to carer assessment and support within palliative care (plan, pilot, train, sustain)
Authors: Diffin Janet , Ewing Gail , Rowland Christine , Grande Gunn
Published: May 2024

Introduction

The Carer Support Needs Assessment Tool (CSNAT) intervention ensures a person-centred approach to carer assessment and support within palliative care.1–3An online toolkit has been developed to prepare and support organisations with implementation of the CSNAT intervention in palliative care practice.

Aims

To test the feasibility of an online toolkit to assist organisations with implementation of a person-centred approach to carer assessment and support within palliative care.

Methods

The Plan, Pilot, Train, Sustain model has been developed from the on-going CSNAT research programme; based on feedback from 89 organisations supporting carers using the CSNAT intervention. This model underpins the online toolkit which consists of two learning components: (i) to provide practitioners with the knowledge to use the CSNAT intervention, (ii) to assist organisations to plan, pilot and sustain the use of the CSNAT intervention. Seven organisations have been recruited to a feasibility study (due to conclude June 2017). Up to 20 practitioners will provide feedback on toolkit content and online user experience via a survey and qualitative interview.

Results

Feasibility results will be reported: how informative and useful the content is, and how suitable it is for use within existing resources of palliative care services (e.g. time to complete, IT resources). This will enable refinements to toolkit content and instructions.

Conclusions

This online toolkit will assist services to respond to the increasing pressures to assess and address the support needs of family carers by providing accessible and structured guidance on how to implement the CSNAT intervention, and help ensure embedding into practice.

References

. Ewing G, Grande G. Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: A qualitative study. Palliative Medicine2013;27(3):244–256.

. Ewing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for Use in Palliative and End-of-life Care at Home: A Validation Study. Journal of Pain and Symptom Management2013;46(3):395–405.

. Ewing G, Austin L, Diffin J, Grande G. Developing a person-centred approach to carer assessment and support. British Journal of Community Nursing2015;20(12): 580–584.
17 Improving care and support in advanced copd: six recommendations of the population-based living with breathlessness study
Authors: Farquhar Morag , Ewing Gail , White Patrick , Burge Peter , Mahadeva Ravi , Gardener A Carole , Moore Caroline , Butcher Hanne Holt , Howson Sophie , Booth Sara , Ling Tom
Published: May 2024

Introduction

Chronic obstructive pulmonary disease (COPD) is a chronic progressive condition with high symptom-burden. National guidance calls for quality end-of-life care for patients with any condition, yet we rely on frameworks developed for cancer with its largely predictable trajectory.

Aim

To inform a new framework to improve care and support in advanced COPD.

Methods

The Living with Breathlessness Study was a multiple-component, population-based, mixed-method longitudinal, multiple-perspective programme to identify new evidence on health and social care needs and preferences of patients with advanced COPD and their carers. It followed more than 500 patients and carers for up to 18 months through interview and survey methods. Qualitative data on barriers and facilitators to meeting needs were collected from clinicians. Programme-wide evidence was synthesised to identify recommendations. Stakeholder views were then collected through a workshop and online survey.

Results

Six inter-related recommendations emerged, linked by the concept of proactive person-centred care, supported by action points to enable delivery. In brief: (1) stop focusing on the challenge of prognostication as a barrier to meeting need, (2) change targets to incentivise person-centred care, (3) enable identification of patient support needs, (4) identify and support carers, (5) identify and respond to psychological morbidity, (6) change societal understandings. The recommendations garnered significant support from stakeholders, with caution regarding ease of implementation.

Conclusion

These recommendations could inform a new framework for care and support in advanced COPD likely to have resonance for those living with other advanced non-malignant long term conditions, and clinicians striving to support them.
23 Talking about the future with homeless people with ill health: the need for a different conversation
Authors: Hudson Briony F , Shulman Caroline , Low Joseph , Hewett Nigel , Daley Julian , Davis Sarah , Brophy Niamh , Howard Diana , Vivat Bella , Kennedy Peter , Stone Patrick
Published: May 2024

Introduction

Homelessness is associated with death at a young age, frequently related to physical and mental health problems complicated by drug or alcohol dependence (Stringfellow et al., 2015). Homeless people experience high symptom burden at the end-of-life (Tobey et al., 2016), yet access to palliative care services is limited (Shulman et al., In press). Conversations around future wishes and preferences with homeless people rarely take place.

Aim

To explore the barriers to conversations about the future with unwell homeless people and alternative approaches to these difficult conversations.

Methods

Focus groups and interviews were used to explore views and experiences around palliative care with currently and formerly homeless people (n=38), healthcare professionals (n=32), hostel and outreach staff (n=39) and drug and alcohol workers (n=4), from three London boroughs. Verbatim transcripts were analysed using thematic analysis.

Results

Three themes were identified relating to the challenges of discussing future care preferences: the recovery focused nature of services; uncertainty around when and how to have conversations; fear of negative impact on the homeless person and staff.

Conclusions

There is little acknowledgement, discussion or planning around the health needs of unwell homeless people who are at risk of dying, reducing opportunities for person-centred care. An approach that considers current and continuing care needs that accommodates potential improvements and deterioration is needed. Identifying those whose health is a concern, rather than those thought to be imminently dying may help to ensure the wishes and choices of homeless people are respected, if their health deteriorates.

References

. Shulman C, Hudson BF, Low J, Hewett N, Daley J, Kennedy P, Davis S, Brophy N, Howard D, Vivat B, Stone P, (In press). Homelessness at the end of life: A qualitative analysis of the barriers in providing palliative care for people who are homeless. Palliative Medicine.

. Stringfellow EJ, Kim TW, Pollio DE, Kertesz SG. Primary care provider experience and social support among homeless-experienced persons with tri-morbidity. Addiction science & clinical practice2015;10:A64–A64.

. Tobey M, Manasson J, Decarlo K, Ciraldo-maryniuk K, Gaeta JM, Wilson E. Homeless Individuals Approaching the End of Life: Symptoms and Attitudes. Journal of Pain and Symptom Management2016; In press.
38 Understanding learning needs and ways of engaging with web apps: the development of an innovative educational web-based application for the respect process
Authors: Soosaipillai Gehan , Stables Tom , Pfeifer Nadine , Mooney Jenny , Archer Stephanie , Darzi Ara , Stirling Lucy Caroline
Published: May 2024

Introduction

Optimal care of patients who are at risk of acute deterioration requires compassionate and competent communication and shared decision making (Department of Health 2008). ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a new national process that creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices (ReSPECT Steering Group 2017).

The ReSPECT Educational Material Project Operations Group at UCLPartners is creating an innovative web-app to support health and care staff of all disciplines, in all settings, in the ReSPECT process.

Aims

Understand user learning needs and utilise their experience and knowledge to inform the content of the web-app.

Methods

We conducted interviews and focus groups with 31 health and care staff from a range of settings, in the NHS, third and private sectors, including a NHS trust that has implemented ReSPECT. We explored the pedagogy of online learning and the reality of engaging in such conversations.

Results

• Users need to see representations of themselves to learn from and connect with the material.

• Apprenticeship learning models that encourage reflection are the most effective for the difficult conversations.

• Length and credibility of information are key factors in engaging with learning materials.

• Online learning is often rushed through to get to the evaluation part.

Conclusion

These insights are guiding the development of the web-app. We will use iterative-design to test the content and improve usability. The educational impact of the web-app and impact on patient outcomes will be evaluated in future studies.

References

. Department of Health, 2008.End of Life Care Strategy – promoting high quality care for all adults at the end of life,

. ReSPECT Steering Group, 2017. ReSPECT (Recommended Summary Plan for Emergency Care and Treatment). Available at: http://www.respectprocess.org.uk.
41 Solstice: sancuso in supportive and palliative care; a feasibility study in patients with cancer and refractory nausea and vomiting
Authors: Villa Shaun , Berman Richard , Dean Emma , Carter Louise
Published: May 2024

Background

Nausea and vomiting (N and V) are common, debilitating symptoms in patients with cancer, often precipitating inpatient admission for subcutaneous/intravenous antiemetics and re-hydration. Currently, there are no evidence-based solutions and treatment algorithms differ across clinical practice. Some of these patients will experience difficulty swallowing tablets and/or are unable to keep oral medications down. Treatments for patients with cancer may also reduce the ability of the intestines to absorb medicines within a tablet.

SANCUSO (Granisetron Transdermal System [transdermal skin patch]) is indicated for the prevention of (N and V) in patients receiving moderately and/or highly emetogenic chemotherapy regimens. The SANCUSO patch delivers consistent, predictable levels of granisetron throughout five days with smoother daily pharmacokinetics compared to daily dosing. The role of Sancuso in patients with cancer and refractory N and V which is unrelated to chemotherapy has not yet been explored.

Methods

An open-label, randomised feasibility study comparing SANCUSO with ‘physician’s choice’ of antiemetic in patients with cancer and refractory N and V. A feasibility study is required at this juncture as standard antiemetic treatment in this patient population is undefined, and the therapeutic efficacy of SANCUSO requires appraisal before embarking on a larger randomised trial. To assess feasibility, we have categorised objectives into four domains; (i) Recruitment - assess the number of patients approached, consent rate, number of eligible patients and explore the methods used to identify potential patients (ii) Patients - willingness to participate and acceptability of the intervention (iii) Clinicians’ - ability to recruit, which physician’s choice is selected, experience including monitoring of prescribing practice in the control arm (iv) Trial procedures - determine the appropriate primary outcome, adherence/compliance rates.

Implications

We aim to determine whether this approach is feasible and warrants further investigation in a larger randomised Phase II trial leading to a confirmatory multi-centre randomised Phase III trial to include a cost-effectiveness appraisal.
56 Educational interventions for improving knowledge of dementia progression and the mental health of family carers: a systematic review
Authors: Lee Cheuk Yan , Moore Kirsten , Candy Bridget , Sampson Liz
Published: May 2024

Aim

Dementia is one of the common causes of death worldwide. The progressive nature of dementia can cause chronic grief among caregivers, increasing the risk of developing persistent complex bereavement disorder (DSM 5, 2013). According to the European Association of Palliative Care (EAPC) white paper (2014), education on the progression of dementia should be provided to the family of an individual with dementia. This systematic review aims to examine the effect of educational interventions focusing on providing information regarding the progression of dementia to informal caregivers.

Method

MEDLINE, PsycINFO and CINAHL were searched in March 2017. Randomised controlled trials (RCTs) with samples of informal carers who are providing day-to-day caring for an individual with dementia living in the community were eligible. Included interventions were educational programmes that involve a component aimed to increase carer’s understanding of the progression of dementia. Two authors independently assessed studies for eligibility. Risk of bias of included studies will be assessed independently by two authors.

Results

We screened 2781 citations and 16 studies were included. Preliminary results suggest that educational interventions may improve knowledge of dementia among carers, and may reduce depression. Reduction in carer burden and stress was also reported in some studies.

Conclusion

This is the first systematic review to consider the potential benefit of recommendations in the EAPC white paper. Based on these preliminary results, prior to full critique and review analysis, there is some evidence from individual studies to support the effectiveness of educational intervention in improving carers’ knowledge in dementia.

References

. Van der Steen, J. T., Radbruch, L., Hertogh, C. M., de Boer, M. E., Hughes, J. C., Larkin, P., & Koopmans, R. T. (2014). White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliative medicine, 28(3), 197–209.

. American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Positive psychosocial factors may protect against perceived stress in people with systemic lupus erythematosus with and without trauma history
Authors: DeQuattro Kimberly , Trupin Laura , Patterson Sarah , Rush Stephanie , Gordon Caroline , Greenlund Kurt J , Barbour Kamil E , Lanata Cristina , Criswell Lindsey A , Dall'Era Maria , Yazdany Jinoos , Katz Patricia P
Published: May 2024

Objective

Trauma history is associated with SLE onset and worse patient-reported outcomes; perceived stress is associated with greater SLE disease activity. Stress perceptions vary in response to life events and may be influenced by psychosocial factors. In an SLE cohort, we examined whether stressful events associated with perceived stress, whether psychosocial factors affected perceived stress, and whether these relationships varied by prior trauma exposure.

Methods

This is a cross-sectional analysis of data from the California Lupus Epidemiology Study, an adult SLE cohort. Multivariable linear regression analyses controlling for age, gender, educational attainment, income, SLE damage, comorbid conditions, glucocorticoids ≥7.5 mg/day and depression examined associations of recent stressful events (Life Events Inventory) and positive (resilience, self-efficacy, emotional support) and negative (social isolation) psychosocial factors with perceived stress. Analyses were stratified by lifetime trauma history (Brief Trauma Questionnaire (BTQ)) and by adverse childhood experiences (ACEs) in a subset.

Results

Among 242 individuals with SLE, a greater number of recent stressful events was associated with greater perceived stress (beta (95% CI)=0.20 (0.07 to 0.33), p=0.003). Positive psychosocial factor score representing resilience, self-efficacy and emotional support was associated with lower perceived stress when accounting for number of stressful events (−0.67 (−0.94 to –0.40), p<0.0001); social isolation was associated with higher stress (0.20 (0.14 to 0.25), p<0.0001). In analyses stratified by BTQ trauma and ACEs, associations of psychosocial factors and perceived stress were similar between groups. However, the number of recent stressful events was significantly associated with perceived stress only for people with BTQ trauma (0.17 (0.05 to 0.29), p=0.0077) and ACEs (0.37 (0.15 to 0.58), p=0.0011).

Conclusion

Enhancing positive and lessening negative psychosocial factors may mitigate deleterious perceived stress, which may improve outcomes in SLE, even among individuals with a history of prior trauma who may be more vulnerable to recent stressful events.
Six-minute walk test in healthy British service personnel
Authors: O'Sullivan Oliver , Felton J , Mclean S , Bennett A N
Published: May 2024

Introduction

The 6 min walk test (6MWT) is a widely used, safe and effective submaximal exercise test. The primary outcome is the distance walked, but additional physiological and patient-reported metrics can be recorded. It is used to assess function and is commonly used within UK Defence Rehabilitation. However, there are no published British military 6MWT data in a non-injured population. This study reports the 6MWT procedure and results from healthy British service personnel.

Methods

A convenience sample of 46 individuals (male n=40) undertook 95 6MWTs over three study visits throughout a year. They were performed on a 20 m straight-line route, administered by an exercise rehabilitation instructor and preceded by anthropometric measurements (height, weight). Physiological measures (HR, oxygen saturations (SpO2)) and patient-reported measures (Borg shortness of breath (SoB), rate of perceived exertion (RPE) and fatigue) were taken before and after the assessment. Statistical tests were performed between pre-test and post-test measures, and sex and body mass, and concurrent cardiopulmonary exercise tests (CPET) with 6MWT distance.

Results

The mean 6MWT distance was 705.5±86 m; males 709.4±86.9 m and females 685.9±81.9 m (p=0.32), with a median Borg SoB of 1 (IQR: 0–2) and RPE 9 (IQR: 7–11), and a negative correlation between body mass index and 6MWT distance, p=0.007. There were no significant differences between pre-test and post-test measures. Peak workload and VO2Max correlated weakly with 6MWT distance (0.336, p=0.01 and 0.375, p=0.09, respectively), but submaximal CPET measures did not.

Conclusion

These results provide a benchmark for British military 6MWT data to guide clinical and research use. However, a larger dataset is required for validation and normative values.
Constraint on boric acid resistance and tolerance evolvability in Candida albicans
Authors: Syvolos Yana , Salama Ola E. , Gerstein Aleeza C.
Published: May 2024

Boric acid is a broad-spectrum antimicrobial used to treat vulvovaginal candidiasis when patients relapse on the primary azole drug fluconazole. Candida albicans is the most common cause of vulvovaginal candidiasis, colloquially referred to as a “vaginal yeast infection”. Little is known about the propensity of C. albicans to develop BA resistance or tolerance (the ability of a subpopulation to grow slowly in high levels of drug). We evolved 96 replicates from eight diverse C. albicans strains to increasing BA concentrations to test the evolvability of BA resistance and tolerance. Replicate growth was individually assessed daily, with replicates passaged when they had reached an optical density consistent with exponential growth. Many replicates went extinct quickly. Although some replicates could grow in much higher levels of BA than the ancestral strains, evolved populations isolated from the highest terminal BA levels (after 11 weeks of passages) surprisingly showed only modest growth improvements and only at low levels of BA. No large increases in resistance or tolerance were observed in the evolved replicates. Overall, our findings illustrate that there may be evolutionary constraints limiting the emergence of BA resistance and tolerance, which could explain why it remains an effective treatment for recurrent yeast infections.
Rutaecarpine Alleviates Early Brain Injury-Induced Inflammatory Response Following Subarachnoid Hemorrhage via SIRT6/NF-κB Pathway
Authors: Xu Min , Qian Li-Hui , Wang Jun-Xiang , He Zi-Yang , Ling Xiao-Yang , Wang Wen-Hua , Wang Jin-Wen , Hu Yue , Gong Ming-Jie
Published: May 2024

Subarachnoid hemorrhage (SAH), a specific subtype of cerebrovascular accident, is characterized by the extravasation of blood into the interstice between the brain and its enveloping delicate tissues. This pathophysiological phenomenon can precipitate an early brain injury (EBI), which is characterized by inflammation and neuronal death. Rutaecarpine (Rut), a flavonoid compound discovered in various plants, has been shown to have protective effects against SAH-induced cerebral insult in rodent models. In our study, we used a rodent SAH model to evaluate the effect of Rut on EBI and investigated the effect of Rut on the inflammatory response and its regulation of SIRT6 expression in vitro. We found that Rut exerts a protective effect on EBI in SAH rats, which is partly due to its ability to inhibit the inflammatory response. Notably, Rut up-regulated Sirtuin 6 (SIRT6) expression, leading to an increase in H3K9 deacetylation and inhibition of nuclear factor-kappa B (NF-[Formula: see text]B) transcriptional activation, thereby mediating the inflammatory response. In addition, further data showed that SIRT6 was proven to mediate the regulation of Rut on the microglial inflammatory response. These findings highlight the importance of SIRT6 in the regulation of inflammation and suggest a potential mechanism for the protective effect of Rut on EBI. In summary, Rut may have the potential to prevent and treat SAH-induced brain injury by interacting with SIRT6. Our findings may provide a new therapeutic strategy for the treatment of SAH-induced EBI.
Opinion Change or Differential Turnout: Changing Opinions on the Austin Police Department in a Budget Feedback Process
Authors: Gelauff Lodewijk , Goel Ashish
Published: May 2024

In 2020 the tragic murder of George Floyd at the hands of law enforcement ignited and intensified nationwide protests, demanding changes in police funding and allocation. This happened during a budgeting feedback exercise where residents of Austin, Texas were invited to share opinions on the budgets of various city service areas, including the Police Department, on an online platform designed by our team. Daily responses increased by a hundredfold and responses registered after the “exogenous shock” overwhelmingly advocated for reducing police funding.

This opinion shift far exceeded what we observed in 14 other Participatory Budgeting elections on our Participatory Budgeting Platform, and can’t be explained by shifts in the respondent demographics. Analysis of the results from an Austin budgetary feedback exercise in 2021 and a follow-up survey indicates that the opinion shift from 2020 persisted, with the opinion gap on police funding widening. We conclude that there was an actual change of opinion regarding police funding.

This study not only sheds light on the enduring impact of the 2020 events and protests on public opinion, but also showcases the value of analysis of clustered opinions as a tool in the evaluation toolkit of survey organizers.
CHUNAV: Analyzing Hindi Hate Speech and Targeted Groups in Indian Election Discourse
Authors: Jafri Farhan Ahmad , Rauniyar Kritesh , Thapa Surendrabikram , Siddiqui Mohammad Aman , Khushi Matloob , Naseem Usman
Published: May 2024

In the ever-evolving landscape of online discourse and political dialogue, the rise of hate speech poses a significant challenge to maintaining a respectful and inclusive digital environment. The context becomes particularly complex when considering the Hindi language—a low-resource language with limited available data. To address this pressing concern, we introduce the
CHUNAV
dataset—a collection of 11,457 Hindi tweets gathered during assembly elections in various states.
CHUNAV
is purpose-built for hate speech categorization and the identification of target groups. The dataset is a valuable resource for exploring hate speech within the distinctive socio-political context of Indian elections. The tweets within
CHUNAV
have been meticulously categorized into “Hate” and “Non-Hate” labels, and further subdivided to pinpoint the specific targets of hate speech, including “Individual”, “Organization”, and “Community” labels (as shown in Figure 1). Furthermore, this paper presents multiple benchmark models for hate speech detection, along with an innovative ensemble and oversampling-based method. The paper also delves into the results of topic modeling, all aimed at effectively addressing hate speech and target identification in the Hindi language. This contribution seeks to advance the field of hate speech analysis and foster a safer and more inclusive online space within the distinctive realm of Indian Assembly Elections.
MERA: Meta-Learning Based Runtime Adaptation for Industrial Wireless Sensor-Actuator Networks
Authors: Cheng Xia , Sha Mo
Published: May 2024

IEEE 802.15.4-based industrial wireless sensor-actuator networks (WSANs) have been widely deployed to connect sensors, actuators, and controllers in industrial facilities. Configuring an industrial WSAN to meet the application-specified quality of service (QoS) requirements is a complex process, which involves theoretical computation, simulation, and field testing, among other tasks. Since industrial wireless networks become increasingly hierarchical, heterogeneous, and complex, many research efforts have been made to apply wireless simulations and advanced machine learning techniques for network configuration. Unfortunately, our study shows that the network configuration model generated by the state-of-the-art method decays quickly over time. To address this issue, we develop a
ME
ta-learning based
R
untime
A
daptation (MERA) method that efficiently adapts network configuration models for industrial WSANs at runtime. Under MERA, the parameters of the network configuration model are explicitly trained such that a small number of optimization steps with only a few new measurements will produce good generalization performance after the network condition changes. We also develop a data sampling method to reduce the measurements required by MERA at runtime without sacrificing its performance. Experimental results show that MERA achieves higher prediction accuracy with less physical measurements, less computation time, and longer adaptation intervals compared to a state-of-the-art baseline.
Transcriptomic Profiling in Low-Risk Thyroid Cancer Induced by Microwave Ablation
Authors: Li Huarong , Liang Lei , Li Jianming
Published: May 2024

Background. Peripheral blood mononuclear cells (PBMCs) serve as the immune system’s primary transportation hub outside of the affected ablated tissue. This study aims to explore the transcriptomic profiling of the immune response in PBMCs induced by microwave ablation (MWA) in low-risk thyroid cancer. Methods. For eight patients diagnosed with low-risk thyroid cancer, 10 ml of peripheral venous blood was collected before MWA as well as one day and one month after MWA. mRNA was extracted from PBMCs for transcriptome next-generation gene sequencing and qRT-PCR analyses. The plasma samples were used for chemokine detection purposes. Results. One day and one month after MWA, there were significant changes in GSEA, particularly in the NF-kappa B-TNFα pathway, inflammatory response, and early and late estrogen response. Common changes in differently expressed genes resulted in a significant downregulation of tumor-promoting genes (BCL3, NR6A1, and PFKFB3). One day after low-risk thyroid cancer MWA, GO enrichment analysis mainly revealed processes related to oxygen transport and other pathways. One month after MWA, GO enrichment analysis mainly revealed regulation of toll-like receptor signaling and other pathways. Furthermore, inflammation-related cytokines and regulatory genes, as well as tumor-promoting cytokines and regulatory genes, were downregulated after MWA. Conclusions. This study presents a comprehensive profile of the systemic immune response induced by thermal ablation for treating low-risk thyroid cancer. More significantly, this study provides valuable insight into potential references for systemic antitumor immunity of ablation against low-risk thyroid cancer. This trial is registered with ChiCTR1900024544.
Subungual Acantholytic Dyskeratotic Acanthoma: A Case Report and Literature Review
Authors: Gupta Ankit , de Menezes Sara Lee , Howard Matthew David , O’Keefe Rod , Prakash Saurabh , Kern Johannes Steffen
Published: May 2024

Introduction: Subungual acantholytic dyskeratotic acanthoma is a rare benign tumor of epidermal keratinocytes characterized by acantholysis and dyskeratosis. Only 7 other cases have been published in the literature. Case Presentation: A 29-year-old male presented with painful erythronychia and onycholysis of the left thumbnail. He worked as an electrician and was ambidextrous. Two months prior to the onset, he reported completing a mechanical task which led to repeated and sustained pressure to his left thumb. The clinical diagnosis was onychopapilloma, and a longitudinal excision was performed to remove the tumor. However, on histopathological examination, the primary features were hyperkeratosis, acantholysis, and dyskeratosis, consistent with a final diagnosis of subungual acantholytic dyskeratotic acanthoma. Conclusion: Nail trauma was reported by our case as a preceding feature, and this has not been described previously. Pain may accompany nail changes in the presentation of this tumor. Although subungual acantholytic dyskeratotic acanthoma is a benign tumor, it caused disruption in productivity, and our case highlights the need for timely access to specialist nail services.
De Novo Elastin Assembly Alleviates Development of Supravalvular Aortic Stenosis—Brief Report
Authors: Ellis Matthew W. , Riaz Muhammad , Huang Yan , Anderson Christopher W. , Hoareau Marie , Li Xin , Luo Hangqi , Lee Seoyeon , Park Jinkyu , Luo Jiesi , Batty Luke D. , Huang Qunhua , Lopez Colleen A. , Reinhardt Dieter P. , Tellides George , Qyang Yibing
Published: May 2024

BACKGROUND:

A series of incurable cardiovascular disorders arise due to improper formation of elastin during development. Supravalvular aortic stenosis (SVAS), resulting from a haploinsufficiency of
ELN
, is caused by improper stress sensing by medial vascular smooth muscle cells, leading to progressive luminal occlusion and heart failure. SVAS remains incurable, as current therapies do not address the root issue of defective elastin.

METHODS:

We use SVAS here as a model of vascular proliferative disease using both human induced pluripotent stem cell–derived vascular smooth muscle cells and developmental
Eln
+/–
mouse models to establish de novo elastin assembly as a new therapeutic intervention.

RESULTS:

We demonstrate mitigation of vascular proliferative abnormalities following de novo extracellular elastin assembly through the addition of the polyphenol epigallocatechin gallate to SVAS human induced pluripotent stem cell–derived vascular smooth muscle cells and in utero to
Eln
+/–
mice.

CONCLUSIONS:

We demonstrate de novo elastin deposition normalizes SVAS human induced pluripotent stem cell–derived vascular smooth muscle cell hyperproliferation and rescues hypertension and aortic mechanics in
Eln
+/–
mice, providing critical preclinical findings for the future application of epigallocatechin gallate treatment in humans.
Abstract 08: Blood Pressure Percentile Charts Better Identify High Risk Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Allen Norrina B , Gauen Abigail , Wilkins John T , Cho So Mi , Falkner Bonita E , Cook Nancy R , Glynn Robert J , Lloyd-Jones Donald M , Rosner Bernard
Published: May 2024

Introduction:
Current guidelines set a static threshold for diagnosis of hypertension based on absolute blood pressure (BP) levels for all ages. However, BP generally increases with age and relative levels tend to track within individuals from young adulthood on. We aimed to determine whether BP
percentiles
, compared to the current AHA/ACC clinical thresholds for hypertension, are better able to identify young adults at higher risk for future CVD events.

Methods:
Among 5,115 CARDIA participants (ppts; mean age 25 yrs; 54% female; 51% Black), we used baseline BP level and over 35 years of follow-up for fatal and non-fatal CVD events. We calculated normative BP percentiles for adults aged 18 and older using NHANES by estimating underlying BP among treated individuals combined with observed BP for untreated individuals (Figure). Using these BP Percentile Charts, we calculated the baseline BP percentile for each ppt. Adjusted survival analyses examined the association between BP percentile (in deciles) and incident CVD events over 30 years. C statistics for models using BP percentiles vs those using current guideline-recommended thresholds were compared to determine relative accuracy.

Results:
At baseline, mean S/DBP was 112/70 mmHg and <1% were on antihypertensive medications. Adjusted HRs for BP percentile decile demonstrated a dose-response effect with increasing risk associated with higher deciles of SBP. Compared to the 5
th
decile young adults with SBPs in the highest decile 90-100% (SBP ≥127 for men and ≥120 for women) had a HR of 1.76 (95% CI 1.10-2.83). C statistics for models using BP percentiles were higher than for models using guideline-recommended thresholds (0.724 vs 0.713). No significant association was seen with DBP deciles.

Conclusion:
BP percentiles are better able to predict future CVD risk in young adults as compared to current age-invariant thresholds. These methods may help to risk stratify young adults and more accurately identify higher risk individuals for early prevention efforts.
Abstract 12: Blood Pressure Phenotypes, Subclinical Cerebrovascular Diseases and Coronary Artery Calcification in Japanese Men
Authors: Bayaraa Nomin , Yano Yuichiro , Mohd Azahar Nazar , Tran Ngoc Hoang Phap , Hisamatsu Takashi , Kondo Keiko , Torii Sayuki , Kadota Aya , Fujiyoshi Akira , Ohkubo Takayoshi , Shiino Akihiko , Nozaki Kazuhiko , Ueshima Hirotsugu , Miura Katsuyuki
Published: May 2024

Introduction:
Hypertension, with its various phenotypes including white-coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT), is a known risk factor for cardiovascular diseases (CVDs). Yet, it remains unclear whether the association between subclinical CVD and hypertension varies based on its phenotype, and if this relationship differs depending on the location of atherosclerosis.

Hypothesis:
We hypothesized that MHT, WCHT, and SHT are associated with greater subclinical cerebrovascular diseases and coronary artery calcification (CAC) compared to normotension.

Methods:
In this community-based observational study of Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA), a total of 740 male participants underwent brain magnetic resonance imaging (MRI) to assess the presence of lacunar infarction, white-matter hyperintensities (WMHs), microbleed, and intracranial artery stenosis (ICAS) between 2012 and 2015. They also underwent office blood pressure (BP) measurements, home BP monitoring for at least 5 consecutive days, and CAC assessments between 2010-2014. The final analysis included 686 participants without a history of CVDs.

Results:
Of the 686 participants, the mean age was 68.0 years (SD±8.3) and 39.3% were receiving antihypertensive medicine. Using a multivariable logistic regression analysis, WCHT, MHT, and SHT each were significantly associated with higher risk for microbleeds compared to the normotensive group (see Table). However, the association of WCHT with microbleeds was evident in participants on antihypertensive medication (Odds ratios 7.98, 95% confidence interval 2.10-30.24), but was absent in those not taking such medication (Odds ratios 1.23, 95% confidence interval 0.31-4.83). SHT was associated with lacunar infarction, ICAS and CAC compared to the normotensive group (see Table).

Conclusions:
In Japanese men, WCHT, MHT, and SHT were associated with subclinical cerebrovascular diseases, whereas only SHT was associated to CAC.
Abstract 15: Associations of Physical Activity and Sedentary Behavior With Clinical Cardiovascular Health 2-7 Year After Pregnancy: The nuMoM2b Heart Health Study (HHS)
Authors: Barone Gibbs Bethany , Modlin Sarah , Bairey C Noel N , Haas David , Khan Sadiya S , Lane Abbi D , McNeil Rebecca , Varagic Jasmina , Vasquez-Huot Ligia , Catov Janet M
Published: May 2024

Introduction:
The reproductive years are a critical period when clinical cardiovascular health (CVH) often declines. Though lifestyle behaviors such as increasing physical activity (PA) are recommended, limited longitudinal data supports these strategies following delivery.

Hypothesis:
We posited that higher moderate-vigorous intensity PA (MVPA) and lower sedentary behavior (SB) would be associated with more favorable changes in CVH in the years after delivery.

Methods:
We conducted a prospective analysis in the nuMoM2b Heart Health Study (HHS). nuMoM2b followed primiparas from 8 clinical centers from the 1
st
trimester through delivery. The HHS followed a subset of these participants 2-7 years later. Self-reported leisure MVPA from an adapted Modifiable Activity Questionnaire and leisure SB duration were measured only at the HHS follow-up. Clinical components of ideal CVH (BMI, blood pressure [BP], glucose, and lipids) were assessed in the 1
st
trimester and the HHS follow-up. CVH components were scored by Life’s Essential 8, where 0 = poorest and 100 = ideal, to calculate component-specific and an average clinical ideal CVH score. Linear regression evaluated associations of MVPA guideline categories and SB quartiles with changes in ideal CVH scores (from 1st trimester to HHS visit), adjusting for baseline and confounders.

Results:
Participants (n = 3,985) were 27 ± 6 years old, 36% from a racial/ethnic minority group, with average MVPA of 261 ± 332 min/week and SB of 3.8 ± 3.2 hr/day at follow-up. Clinical ideal CVH score declined from the 1
st
trimester (85.6 ± 14.5 pts) to follow-up (81.6 ± 16.3 pts; p<0.001). Both higher MVPA and lower SB were associated with more favorable changes in ideal CVH score and ideal BMI score (see Table). Only lower SB was associated with more favorable changes in ideal BP score; only higher MVPA was associated with more favorable changes in ideal glucose and lipid scores.

Conclusion:
Higher MVPA and lower SB each contribute to the maintenance of ideal clinical CVH in the years following pregnancy.
Abstract 33: Population Trends in Gestational Diabetes From 2000-2019: An Emerging Urban Epidemic?
Authors: McGavock Jonathan , Brunton Nicole , Prior Heather , Friesen Kevin , Burchill Charles , Yamamoto Jennifer
Published: May 2024

Introduction:
There is little information describing rates of gestational diabetes (GDM) over the last two decades among population sub-groups, particularly within an urban context.

Hypotheses:
Rates of GDM will increase over time, particularly among rural dwelling women and those living in low socio-economic neighbourhoods.

Research Design and Methods:
We performed a registry-based administrative cohort study of women that delivered a child between 2000 and-2019 (n = 293 514) in the entire province of Manitoba, Canada. GDM was defined as incident diabetes diagnosis between 21 weeks’ gestation and 6 weeks’ postpartum using ICD-10-CM codes (O24, E12-E14). Difference-in-differences analyses were used to compare incident rates of GDM during two time periods 2000-2009 (period 1) and 2010-2019 (period 2) for the entire population in Manitoba, Canada and among women in rural/urban areas, and low vs high income areas. Geospatial mapping examined changes in rates of GDM by neighbourhood-level.

Results:
Between period 1 and period 2, the number of deliveries increased from 51.3 /1000 (11,525 per year) to 53.8/1000 (12, 534 per year). During period 1 age standardized rates of GDM were 2 to 3-fold higher in women over 35 years old, compared to women 18-25 yrs (2.2 vs 4.7%). Between period 1 and period 2, incident rates of GDM in the province increased 3.5-fold (2.5 vs 8.7%), with trends more pronounced among women over 35 yrs compared to women 18-25 yrs (absolute difference-in-difference: 3.83%; 95% CI: 3.12 to 4.53%) and women living in urban areas, compared to women in rural areas (absolute difference-in-difference: 1.68%; 95% CI: 1.37 to 1.99%). Geospatial mapping suggests that the increased incidence of GDM in urban areas is occurring in neighbourhoods with a larger representation of new immigrants.

Conclusions:
Rates of GDM increased over 3-fold from 2000-2019, affecting 9% of pregnancies in 2019, particularly among women over 35 years old (14% of pregnancies) and women living in urban areas (10% of pregnancies). Geospatial mapping suggests urban trends in GDM are occurring in areas where recently immigrated women have settled.
Abstract 41: Independent Prediction of Mortality From Opportunistic Screening of Aortic Calcification
Authors: Horbal Steven R , Derstine Brian A , Leis Aleda , Ross Brian E , Brown Edward , Wang Stewart C , Holcombe Sven A
Published: May 2024

Introduction:
Abdominal aortic calcifications (AAC), often discovered during diagnostic medical imaging, have recently gained traction as valuable indicators of cardiovascular health. The morphomic aortic calcification score (MAC) uses dynamic thresholding and machine learning algorithms to automatically segment, process, and grade AAC from medical imaging. This study’s purpose was to evaluate AAC and mortality in patients over the age of 65 with previous diagnostic imaging.

Methods:
A novel community sample of 6655 participants had received an abdominal CT scan between 1999-2022 at Michigan Medicine. Participants were 65 years or older and without diagnosed cardiovascular disease at scan time. MAC threshold of 4.21% abdominal aortic wall coverage at the L3 level was used to prioritize sensitivity. Cox models were used to evaluate the associations between MAC and mortality. Model 1 was unadjusted; model 2 controlled for diabetes, subcutaneous-visceral fat ratio, and biological sex; model 3 added age. Effect modification was evaluated between MAC and age, as well as MAC and sex.

Results:
Mean follow up time was 3,916 (sd 1661) days. From the initial scan, 1306 deaths were observed at 10 years (19.62%), and 2277 deaths overall (34.21%). The proportional hazard assumption held. Models indicated significant hazard ratios for MAC and mortality: model 1 (unadjusted) HR 1.36 (95% CI 1.23, 1.50); model 2 (adjusted) HR 1.28 (1.14, 1.44); model 3 (model 2 + age) HR 1.15 (95% CI 1.03, 1.31). No effect modification was observed between MAC and age or sex.

Discussion:
MAC, a novel measure of abdominal aortic calcification, was independently associated with mortality in a hospital-based community sample of patients over the age of 65. Interestingly, the addition of age attenuated the MAC-mortality relationship, but significance remained. This work highlights the independent effects of abdominal aortic calcification and potential utility as a factor of future mortality in opportunistic screening of asymptomatic populations.