bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Incident Cardiovascular Disease Lead to Greater Odds of Functional and Cognitive Impairment? Insights From the Health and Retirement Study
Authors: Stone Katherine L , Zhong Judy , Lyu Chen , Chodosh Joshua , Blachman Nina L , Dodson John A
Published: March 2023

Background

Although studies to date have broadly shown that cardiovascular disease (CVD) increases cognitive and physical impairment risk, there is still limited understanding of the magnitude of this risk among relevant CVD subtypes or age cohorts.

Methods

We analyzed longitudinal data from 16 679 U.S. Health and Retirement Study participants who were aged ≥65 years at study entry. Primary endpoints were physical impairment (activities of daily living impairment) or cognitive impairment (Langa–Weir Classification of dementia). We compared these endpoints among participants who developed incident CVD versus those who were CVD free, both in the short term (<2-year postdiagnosis) and long term (>5 years), controlling for sociodemographic and health characteristics. We then analyzed the effects by CVD subtype (atrial fibrillation, congestive heart failure, ischemic heart disease, and stroke) and age-at-diagnosis (65–74, 75–84, and ≥85).

Results

Over a median follow-up of 10 years, 8 750 participants (52%) developed incident CVD. Incident CVD was associated with significantly higher adjusted odds (aOR) of short-term and long-term physical and cognitive impairment. The oldest (≥85) age-at-diagnosis subgroup had the highest risk of short-term physical (aOR 3.01, 95% confidence interval [CI]: 2.40–3.77) and cognitive impairment (aOR 1.96, 95% CI: 1.55–2.48), as well as long-term impairment. All CVD subtypes were associated with higher odds of physical and cognitive impairment, with the highest risk for patients with incident stroke.

Conclusions

Incident CVD was associated with an increased risk of physical and cognitive impairment across CVD subtypes. Impairment risk after CVD was highest among the oldest patients (≥85 years) who should therefore remain a target for prevention efforts.
Person–Environment Exchange Processes in Transition into Dementia: A Scoping Review
Authors: Niedoba Simone , Oswald Frank
Published: March 2023

Background and Objectives

The important role that the environment plays in the lives of older people is widely acknowledged. To date, little is known about person–environment processes during the early stages of dementia. This scoping review aims to provide an overview of the processes involved during early dementia and the relationship to different dimensions of their life space.

Research Design and Methods

A scoping review was conducted according to the Johanna Briggs Institute Manual, which involved searching for research on early dementia and the environment across 3 databases.

Results

A total of 1,358 records were screened, with 284 sources included in the first categorization of the diverse relationships that exist between the environment and the person living with early dementia. Finally, 102 sources were selected that describe person–environment exchange processes of agency, belonging, or stress. People living with dementia actively shape, use, seek out, and avoid their environment as a reaction to both declining abilities and environmental barriers. Specifically, feelings of connectedness and familiarity are important.

Discussion and Implications

Taking both an environmental gerontology perspective and a processual, that is, transition perspective broadens the understanding of the experience and behavior of people living with early dementia. They constantly interact with and shape their environment and desire a sense of belonging. This sense of belonging might be threatened by dementia but can be actively reinforced by people living with dementia. These person–environment processes and their dynamics over time should be further investigated. Especially, quantitative data and data on socioeconomic environments are lacking.
When to conduct, and when not to conduct, management strategy evaluations
Authors: Walter III J F , Peterson C D , Marshall K , Deroba J J , Gaichas S , Williams B C , Stohs S , Tommasi D , Ahrens R
Published: March 2023

The basis of natural resource management is decision making under uncertainty while balancing competing objectives. Within fisheries management, a process described as management strategy evaluation (MSE) is becoming increasingly requested globally to develop and test management procedures. In a fisheries or other natural resource context, a management procedure is a rule that predetermines the management response given feedback from the resource and is simulation tested to be robust to multiple uncertainties. MSEs are distinguished from other risk or simulation analyses by the explicit testing of the feedback mechanism that applies decision rule-based management advice back to the simulated population or ecosystem. Stakeholder input is frequently cited as a best practice in the MSE process, since it fosters communication and facilitates buy-in to the process. Nevertheless, due to the substantial additional cost, time requirement, and necessary scientific personnel, full stakeholder MSEs remain relatively uncommon. With this communication, we provide guidance on what constitutes an MSE, when MSEs should be undertaken or where simpler approaches may suffice, and how to prioritize the degree of stakeholder participation.
How Worried Should We Be? The Implications of Fabricated Survey Data for Political Science
Authors: Castorena Oscar , Cohen Mollie J , Lupu Noam , Zechmeister Elizabeth J
Published: March 2023

Surveys are ubiquitous in the study of politics, making enumerator fabrication a critical issue. A prevailing view is that faked interviews affect inferences drawn from compromised datasets. Researchers have generated theories about how fabrication might affect inferences. Yet, speculation has outpaced systematic testing. We leverage a rare dataset to address this gap: a national face-to-face survey in Venezuela in which a uniquely high volume of falsified interviews was detected, canceled, and replaced. Comparing the verified and fraudulent datasets, we find that descriptive inference is sometimes affected, but correlational results hold, even in a dataset with an unusually high-fabrication rate. Enumerators largely fabricate plausible data. Though still egregious, enumerator fabrication may not constitute a grave threat to political science research.
Making Experts of Ourselves: Laura Puffer Morgan, Pacifism, and the Logics of the Security Sector
Authors: Turkington Rebecca
Published: March 2023

For more than a century, gendered divisions between “insider” experts and “outsider” activists kept women at the margins of arms control policy, despite their long-standing disarmament advocacy. In the interwar period, when opportunities for women to influence security thinking from the inside were essentially nonexistent, lobbyist and analyst Laura Puffer Morgan educated herself in the technical knowledge of weaponry, the economics of military spending, and the bureaucratic processes that governed both. Unlike many of her colleagues in the broader peace movement, Puffer Morgan was “equipped to ‘talk army’ with generals or analyze tonnages with admirals.” She believed that women could and should become security experts who would “meet the militarists on their own ground”—a goal she advanced in her own career through voluminous written analysis and through public education about the concrete details of arms reduction. By turning to technical expertise over moral appeal, she was able to act as an advisor to civil society coalitions and delegates alike during the disarmament conferences of the 1920s and 1930s, and advance a peace agenda in quarters where many of her peers were seen as radical interlopers. She was one of a small group of women able to claim the mantle of “expert” and her career illustrates an alternative way women participated in disarmament thinking.
Effect of ethanol preservation on prosomal length of the calanoid copepodParvocalanus crassirostris(Dahl, 1894)
Authors: La Rosa-Izquierdo Yadian Israel , Hernández-Trujillo Sergio , Amador-Marrero Ulises
Published: March 2023

Although there are quantitative studies of the effect of formalin storage on copepod body size, no comparable data exist concerning storage in ethanol. We determined the degree of shrinkage of adult specimens of Parvocalanus crassirostris (Dahl, 1894) preserved in 96% ethanol for different periods of time. Measurements of the prosome of 50 females and 50 males were undertaken in fresh specimens and 7, 15, 30, and 60 days after initial preservation in ethanol. Despite variation among specimens, no significant shrinkage (P > 0.05) was detected on average males. For females, significant shrinkage (mean –4.2%; P < 0.05) was observed after seven days, with no further significant change thereafter.
Autism Spectrum Disorders
Authors: Volkmar Fred R. , Pelphrey Kevin
Published: March 2023

Significant advances in understanding the nature of autism have been made over the past several decades and the pace of research has considerably quickened in recent years. An increased understanding of the social basis of autism (at both the psychological and neurobiological levels) may offer an opportunity to connect basic research in these areas to a growing understanding of possible genetic mechanisms. Early false theoretical leads (e.g., psychogenic models of etiology) have given way to much more sophisticated psychological approaches. The increased research focus on at risk groups (e.g., siblings) and the very earliest psychological and neurobiological manifestation will be critically important in the attempt to more fully understand the complex unfolding of autism as it first develops early in life. Clearly the marriage of these approaches with findings from neuroimaging, neurophysiology, and, ultimately, genetics will offer the prospect of better understanding its pathogenesis and hopefully treatment.
Narcissistic Personality Disorder and Pathological Narcissism
Authors: Pincus Aaron L.
Published: March 2023

The two main perspectives on narcissistic personality pathology are reviewed. First, narcissistic personality disorder (NPD), which is characterized by extreme or excessive grandiosity, is described. Research on its prevalence, stability, and comorbidity is highlighted, followed by a review of substantive research in diagnosed clinical samples. Next, the broader clinical conceptualization of pathological narcissism, which is characterized by grandiosity and vulnerability, is described. Research on pathological narcissism in clinical and nonclinical samples is highlighted. Case examples of NPD and pathological narcissism are provided. Next, the associated clinical features of NPD and pathological narcissism including suicidality, depressed mood, and aggression are discussed. Empirically supported advances in conceptualization, diagnosis, and treatment of narcissistic psychopathology are now emerging. Future research should take advantage of developments in methods, analytics, and technology allowing for novel empirical investigations of temporally dynamic contextualized narcissistic processes.
Anatomical and Histological Structures of Male Reproductive System in Long-Horned Beetle Isotomus speciosus (Schneider, 1787) (Coleoptera: Cerambycidae): Light and Scanning Electron Microscopic Study
Authors: Özyurt Koçakoğlu Nurcan , Candan Selami , Çağlar Üzeyir
Published: March 2023

Isotomus speciosus is a polyphagous insect that damages coniferous and deciduous trees. There is no study on the male reproductive system of I. speciosus although it is an important pest. For this purpose, the male reproductive system anatomy and histology of I. speciosus were investigated using light and scanning electron microscopy. According to the results obtained, the male reproductive system of I. speciosus consists of a pair of testes (each with a pair of separate testis lobes), two pairs of vasa efferentia, a pair of vasa deferentia, an ejaculatory duct, an aedeagus, and three pairs of accessory glands. Each testis lobe has about 65 testis follicles. Testis lobe has sperm development stages (growth, maturation, and differentiation). Each testis lobe is connected to the vas deferens via the vas efferens. There are masses of mature sperm that completely fill lumen of the vas deferens. The vas efferens has cylindrical epithelium, and the vas deferens has cubic epithelium. The vas deferens then opens into the aedeagus by an ejaculatory duct. The ejaculatory duct has an intima layer with spines, monolayer of epithelium, and muscle layer. In this study, similarities and differences in anatomy and histology of male reproductive organs of I. speciosus with other coleopteran species were revealed.
Increased Metabolic Demand During Outside Walking in Darkness With No Vision or With Visual Aid
Authors: Norrbrand Lena , Grönkvist Mikael , Johannesson Björn , Rappe Annika , Sjölin Johan , Eiken Ola
Published: March 2023

Introduction

For tactical reasons, the foot-borne soldiers sometimes undertake nighttime operations. However, the metabolic demand during walking in complete darkness may be markedly increased. The purpose of this study was to investigate if metabolic demand and kinematics would change while walking on a gravel road and a slightly hilly trail in darkness with or without visual aid.

Materials and Methods

Fourteen cadets (11 men and 3 women, age: 25 ± 7 years, height: 178 ± 8 cm, and weight: 78 ± 13 kg) walked at 4 km/h on a straight gravel road and on a slightly hilly forest trail (n = 9). Both trials were performed at nighttime under four different conditions, wearing a headlamp (Light), blindfold (Dark), monocular (Mono), or binocular (Bino) night vision goggles. During the 10-minute walks, oxygen uptake, heart rate, and kinematic data were assessed. Ratings of perceived exertion, discomfort, and mental stress were evaluated after each condition using a category ratio scale. Physiologic and kinematic variables were evaluated using repeated-measures analysis of variance, whereas ratings were evaluated using non-parametric Friedman analysis of variance.

Results

Oxygen uptake was higher in all three conditions with no or limited vision (Dark, Mono, and Bino) than in the Light condition (P ≤ 0.02) when walking on both the gravel road (+5–8%) and the forest trail (+6–14%). Heart rate was higher during the Dark than during the Light condition when walking on the forest trail, whereas there was no difference between conditions on the gravel road. During both trials, gait frequency was higher during the Dark than during the Light, Mono, and Bino conditions. Ratings were generally low during all conditions.

Conclusions

Walking on a gravel road or a forest trail wearing a blindfold or visual aid increased the metabolic demand. Thus, it appears that the metabolic demand is higher during overground walking with night vision goggles than with full vision, which may influence the performance of nighttime operations.
Predictors of damage accrual in patients with antineutrophil cytoplasmic antibody–associated vasculitis: A nationwide prospective study
Authors: Hara Akinori , Sada Ken-ei , Wada Takashi , Amano Koichi , Dobashi Hiroaki , Atsumi Tatsuya , Sugihara Takahiko , Hirayama Kouichi , Banno Shogo , Murakawa Yohko , Hasegawa Midori , Yamagata Kunihiro , Arimura Yoshihiro , Makino Hirofumi , Harigai Masayoshi
Published: March 2023

Objectives

This study elucidated the prognosis and risk factors associated with damage accrual during long-term remission maintenance therapy for patients with antineutrophil cytoplasmic antibody–associated vasculitis (AAV).

Methods

We obtained data from 120 patients registered in a nationwide prospective cohort study on remission induction therapy in Japanese patients with AAV and rapidly progressive glomerulonephritis (RemIT-JAV-RPGN), who achieved remission at 24 months after treatment initiation and were followed up for additional 24 months. The primary outcome was the vasculitis damage index (VDI) score at Month 48, and the secondary outcome included risk factors associated with increased total VDI at Month 48.

Results

The understudied patients comprised 52 men and 68 women aged 68 ± 13 years. Between Months 25 and 48, the patients’ survival rate was 95% (114/120). End-stage renal disease developed in seven patients by Month 48, and 64 cases had increased VDI. The multivariable analysis results revealed that oral prednisolone (PSL) doses at Month 24 were associated with damage accrual between Months 24 and 48.

Conclusions

VDI accrual was observed in more than half of patients with AAV during maintenance therapy, and increased VDI scores were associated with oral PSL doses 24 months after initiating remission induction therapy in Japan.
Transfer learning identifies sequence determinants of cell-type specific regulatory element accessibility
Authors: Salvatore Marco , Horlacher Marc , Marsico Annalisa , Winther Ole , Andersson Robin
Published: March 2023

Dysfunction of regulatory elements through genetic variants is a central mechanism in the pathogenesis of disease. To better understand disease etiology, there is consequently a need to understand how DNA encodes regulatory activity. Deep learning methods show great promise for modeling of biomolecular data from DNA sequence but are limited to large input data for training. Here, we develop ChromTransfer, a transfer learning method that uses a pre-trained, cell-type agnostic model of open chromatin regions as a basis for fine-tuning on regulatory sequences. We demonstrate superior performances with ChromTransfer for learning cell-type specific chromatin accessibility from sequence compared to models not informed by a pre-trained model. Importantly, ChromTransfer enables fine-tuning on small input data with minimal decrease in accuracy. We show that ChromTransfer uses sequence features matching binding site sequences of key transcription factors for prediction. Together, these results demonstrate ChromTransfer as a promising tool for learning the regulatory code.
Surveillance and Stewardship: Where Infection Prevention and Antimicrobial Stewardship Intersect
Authors: Tenover Fred C , Goff Debra A
Published: March 2023

Colonization with multidrug-resistant organisms (MDROs) is a risk factor for subsequent infection. Surveillance for MDROs, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Enterobacterales, and carbapenemase-producing organisms, is commonly conducted in hospitals to prevent spread of MDROs, in part to reduce the potential for additional infections. Although colonization is a risk factor for infection, data on colonization with various MDROs are often not considered when selecting anti-infective therapy. There are conflicting data on the strength of the positive and negative predictive values of the colonization test results to guide therapeutic strategies. Defining therapeutic strategies for patients with complicated or drug-resistant infections or to select antimicrobial prophylaxis before performing prostate biopsies often falls under the purview of the antimicrobial stewardship team. Should colonization data, which are often present in the patient's medical record from routine infection prevention measures, be reviewed before selecting therapy for infections or for prophylaxis? In this perspective, we will explore the intersection of infection control and antimicrobial stewardship activities.
A Two-Step Diagnostic Approach for NTRK Gene Fusion Detection in Biliary Tract and Pancreatic Adenocarcinomas
Authors: Demols Anne , Rocq Laureen , Perez-Casanova Luis , Charry Manon , De Nève Nancy , Ramadhan Ali , Van Campenhout Claude , De Clercq Sarah , Maris Calliope , Closset Jean , Lucidi Valerio , Salmon Isabelle , D’Haene Nicky
Published: March 2023

Background

It is of interest to determine the incidence and molecular characteristics of NTRK gene fusions in patients with bilio-pancreatic cancers, because of possible treatment with TRK inhibitors for advanced tumors. The aim of the present study was to apply the guidelines for NTRK testing algorithm to a series of patients with bilio-pancreatic cancers.

Methods

Immunohistochemistry screening was applied on formalin-fixed paraffin-embedded archival blocks from surgical resections, biopsies, or cytological samples of biliary tract and pancreatic adenocarcinomas. The presence of at least a weak staining in rare tumor cells led to testing by 2 RNA-based NGS panels.

Results

For biliary tract tumors, 153 samples have been selected. A total of 140 samples were suitable to perform IHC, and 17 samples were IHC positive. RNA NGS testing of the 17 IHC-positive samples revealed a single NTRK3 gene fusion (ETV6(4)-NTRK3(14)) that was detected by both NGS panels. In this perihilar cholangiocarcinoma, IHC performed on a biopsy showed a weak focal cytoplasmic and nuclear staining. No other NTRK fusion was detected on the 16 other samples with both panels. Overall in the patients screened by IHC and confirmed by NGS, the percentage of NTRK fusions was 0.7%. For pancreatic cancers, 319 samples have been selected and 297 were suitable to perform IHC. Nineteen samples were IHC positive. No fusion was detected by NGS.

Conclusion

NTRK gene fusions are rare in bilio-pancreatic cancers but testing is of high interest due to possible treatment with specific TRK inhibitors.
Rethinking diagnosis-based service models for childhood neurodevelopmental disabilities in Canada: a question of equity
Authors: Ip Angie , Poon Brenda T , Oberlander Tim F
Published: March 2023

Neurodevelopmental disability in children covers a vast array of congenital and acquired long-term conditions associated with brain or neuromuscular impairments that impact function. While some presentations of neurodevelopmental disability align with diagnostic labels, many do not, leaving children whose conditions don’t fit neatly under diagnostic labels struggling to access services or families and professionals feeling pressured to assign a diagnostic label in order to access services. In this paper, we (1) discuss the evidence showing that there is often a mismatch between a child’s neurodevelopmental diagnosis, or lack of diagnosis, and function, (2) comment on the inequities exacerbated by diagnosis-based approaches for services, and (3) highlight the potential benefits of using a function and participation-based approach for providing services to children with neurodevelopmental disabilities. We close with three calls to action for function and participation-based approaches that could better support equitable services for children with neurodevelopmental disabilities.
Intermediate levels of asymptomatic transmission can lead to the highest epidemic fatalities
Authors: Park Sang Woo , Dushoff Jonathan , Grenfell Bryan T , Weitz Joshua S
Published: March 2023

Asymptomatic infections have hampered the ability to characterize and prevent the transmission of SARS-CoV-2 throughout the pandemic. Although asymptomatic infections reduce severity at the individual level, they can make population-level outcomes worse if asymptomatic individuals—unaware they are infected—transmit more than symptomatic individuals. Using an epidemic model, we show that intermediate levels of asymptomatic infection lead to the highest levels of epidemic fatalities when the decrease in symptomatic transmission, due either to individual behavior or mitigation efforts, is strong. We generalize this result to include presymptomatic transmission, showing that intermediate levels of nonsymptomatic transmission lead to the highest levels of fatalities. Finally, we extend our framework to illustrate how the intersection of asymptomatic spread and immunity profiles determine epidemic trajectories, including population-level severity, of future variants. In particular, when immunity provides protection against symptoms, but not against infections or deaths, epidemic trajectories can have faster growth rates and higher peaks, leading to more total deaths. Conversely, even modest levels of protection against infection can mitigate the population-level effects of asymptomatic spread.
Dual leucine zipper kinase is necessary for retinal ganglion cell axonal regeneration in Xenopus laevis
Authors: Fague Lindsay , Marsh-Armstrong Nicholas
Published: March 2023

Retinal ganglion cell (RGC) axons of the African clawed frog, Xenopus laevis, unlike those of mammals, are capable of regeneration and functional reinnervation of central brain targets following injury. Here, we describe a tadpole optic nerve crush (ONC) procedure and assessments of brain reinnervation based on live imaging of RGC-specific transgenes which, when paired with CRISPR/Cas9 injections at the one-cell stage, can be used to assess the function of regeneration-associated genes in vivo in F0 animals. Using this assay, we find that map3k12, also known as dual leucine zipper kinase (Dlk), is necessary for RGC axonal regeneration and acts in a dose-dependent manner. Loss of Dlk does not affect RGC innervation of the brain during development or visually driven behavior but does block both axonal regeneration and functional vision restoration after ONC. Dlk loss does not alter the acute changes in mitochondrial movement that occur within RGC axons hours after ONC but does completely block the phosphorylation and nuclear translocation of the transcription factor Jun within RGCs days after ONC; yet, Jun is dispensable for reinnervation. These results demonstrate that in a species fully capable of regenerating its RGC axons, Dlk is essential for the axonal injury signal to reach the nucleus but may affect regeneration through a different pathway than by which it signals in mammalian RGCs.
2B-AlertApp 2.0: personalized caffeine recommendations for optimal alertness
Authors: Vital-Lopez Francisco G , Doty Tracy J , Anlap Ian , Killgore William D S , Reifman Jaques
Published: March 2023

Study Objectives

If properly consumed, caffeine can safely and effectively mitigate the effects of sleep loss on alertness. However, there are no tools to determine the amount and time to consume caffeine to maximize its effectiveness. Here, we extended the capabilities of the 2B-Alert app, a unique smartphone application that learns an individual’s trait-like response to sleep loss, to provide personalized caffeine recommendations to optimize alertness.

Methods

We prospectively validated 2B-Alert’s capabilities in a 62-hour total sleep deprivation study in which 21 participants used the app to measure their alertness throughout the study via the psychomotor vigilance test (PVT). Using PVT data collected during the first 36 hours of the sleep challenge, the app learned the participant’s sleep-loss response and provided personalized caffeine recommendations so that each participant would sustain alertness at a pre-specified target level (mean response time of 270 milliseconds) during a 6-hour period starting at 44 hours of wakefulness, using the least amount of caffeine possible. Starting at 42 hours, participants consumed 0 to 800 mg of caffeine, per the app recommendation.

Results

2B-Alert recommended no caffeine to five participants, 100–400 mg to 11 participants, and 500–800 mg to five participants. Regardless of the consumed amount, participants sustained the target alertness level ~80% of the time.

Conclusions

2B-Alert automatically learns an individual’s phenotype and provides personalized caffeine recommendations in real time so that individuals achieve a desired alertness level regardless of their sleep-loss susceptibility.
Rapid and Live-Cell Detection of Senescence in Mesenchymal Stem Cells by Micro Magnetic Resonance Relaxometry
Authors: Thamarath Smitha Surendran , Tee Ching Ann , Neo Shu Hui , Yang Dahou , Othman Rashidah , Boyer Laurie A , Han Jongyoon
Published: March 2023

Detection of cellular senescence is important quality analytics of cell therapy products, including mesenchymal stromal cells (MSCs). However, its detection is critically limited by the lack of specific markers and the destructive assays used to read out these markers. Here, we establish a rapid, live-cell assay for detecting senescent cells in heterogeneous mesenchymal stromal cell (MSC) cultures. We report that the T2 relaxation time measured by microscale Magnetic Resonance Relaxometry, which is related to intracellular iron accumulation, correlates strongly with senescence markers in MSC cultures under diverse conditions, including different passages and donors, size-sorted MSCs by inertial spiral microfluidic device, and drug-induced senescence. In addition, the live-cell and non-destructive method presented here has general applicability to other cells and tissues and can critically advance our understanding of cellular senescence.
Quasi-Experimental Evidence on Carbon Pricing
Authors: Vrolijk Kasper , Sato Misato
Published: March 2023

A growing literature suggests that carbon emissions are most efficiently reduced by carbon pricing. The evidence base on the effectiveness of market-based mechanisms, however, faces three key limitations: studies often (a) predict, rather than evaluate effects, (b) show large difference in findings, and (c) cannot always infer causal relations. Quasi-experimental studies can address these challenges by using variation in policies over time, space, or entities. This paper systematically reviews this new literature, outlines the benefits and caveats of quasi-experimental methodologies, and verifies the reliability and value of quasi-experimental estimates. The overall evidence base documents a causal effect between carbon pricing and emission reductions, with ambiguous effects on economic outcomes, and there are important gaps and inconsistencies. This review underscores that estimates should be interpreted with care because of: (a) inappropriate choice of method, (b) incorrect implementation of empirical analysis (e.g., violate identifying assumptions), and (c) data limitations. More cross-learning across studies and use of novel empirical strategies is needed to improve the empirical evidence base going forward.
Implementing a Rapid Response Team
Authors: Jamous Sabat El , Kouatly Iman , Irani Joanna , Badr Lina Kurdahi
Published: March 2023

Background

The benefits of rapid response teams (RRTs) have been controversial with few studies conducted in low- to middle-income countries.

Objective

The aim of this study was to investigate the effectiveness of implementing an RRT on 4 patient outcomes.

Methods

We conducted a quality improvement pre-and-post design using the Plan-Do-Study-Act model in a tertiary hospital in a low- to middle-income country. We collected data before and after implementing the RRT in 4 phases and over 4 years.

Results

Survival to discharge after cardiac arrest was 25.0% per 1000 discharges in 2016 and increased to 50% in 2019, a 50% increase. The rate of activations per 1000 discharges was 20.45% for the code team in 2016 and 33.6% for the RRT team in 2019. Thirty-one patients who arrested were transferred to a critical care unit before implementing the RRT, and 33% of such patients were transferred after. The time it took the code team to arrive at the bedside was 3.1 minutes in 2016 and decreased to 1.7 minutes for the RRT team to arrive in 2019, a 46% decrease.

Discussion and Clinical Implications

Implementing an RTT led by nurses in a low- to middle-income country increased the survival rate of patients who had a cardiac arrest by 50%. The role of nurses in improving patient outcomes and saving lives is substantial and empowers nurses to call for assistance to save patient lives who show early signs of a cardiac arrest. Hospital administrators should continue to use strategies to improve nurses' timely response to the clinical deterioration of patients and to continue to collect data to assess the effect of the RRT over time.
Machine learning algorithm improves the detection of NASH (NAS-based) and at-risk NASH: A development and validation study
Authors: Lee Jenny , Westphal Max , Vali Yasaman , Boursier Jerome , Petta Salvatorre , Ostroff Rachel , Alexander Leigh , Chen Yu , Fournier Celine , Geier Andreas , Francque Sven , Wonders Kristy , Tiniakos Dina , Bedossa Pierre , Allison Mike , Papatheodoridis Georgios , Cortez-Pinto Helena , Pais Raluca , Dufour Jean-Francois , Leeming Diana Julie , Harrison Stephen , Cobbold Jeremy , Holleboom Adriaan G. , Yki-Järvinen Hannele , Crespo Javier , Ekstedt Mattias , Aithal Guruprasad P. , Bugianesi Elisabetta , Romero-Gomez Manuel , Torstenson Richard , Karsdal Morten , Yunis Carla , Schattenberg Jörn M. , Schuppan Detlef , Ratziu Vlad , Brass Clifford , Duffin Kevin , Zwinderman Koos , Pavlides Michael , Anstee Quentin M. , Bossuyt Patrick M. ,   on behalf of the LITMUS investigators
Published: March 2023

Background and Aims:

Detecting NASH remains challenging, while at-risk NASH (steatohepatitis and F≥ 2) tends to progress and is of interest for drug development and clinical application. We developed prediction models by supervised machine learning techniques, with clinical data and biomarkers to stage and grade patients with NAFLD.

Approach and Results:

Learning data were collected in the Liver Investigation: Testing Marker Utility in Steatohepatitis metacohort (966 biopsy-proven NAFLD adults), staged and graded according to NASH CRN. Conditions of interest were the clinical trial definition of NASH (NAS ≥ 4;53%), at-risk NASH (NASH with F ≥ 2;35%), significant (F ≥ 2;47%), and advanced fibrosis (F ≥ 3;28%). Thirty-five predictors were included. Missing data were handled by multiple imputations. Data were randomly split into training/validation (75/25) sets. A gradient boosting machine was applied to develop 2 models for each condition: clinical versus extended (clinical and biomarkers). Two variants of the NASH and at-risk NASH models were constructed: direct and composite models.

Clinical gradient boosting machine models for steatosis/inflammation/ballooning had AUCs of 0.94/0.79/0.72. There were no improvements when biomarkers were included. The direct NASH model produced AUCs (clinical/extended) of 0.61/0.65. The composite NASH model performed significantly better (0.71) for both variants. The composite at-risk NASH model had an AUC of 0.83 (clinical and extended), an improvement over the direct model. Significant fibrosis models had AUCs (clinical/extended) of 0.76/0.78. The extended advanced fibrosis model (0.86) performed significantly better than the clinical version (0.82).

Conclusions:

Detection of NASH and at-risk NASH can be improved by constructing independent machine learning models for each component, using only clinical predictors. Adding biomarkers only improved the accuracy of fibrosis.
Pentosan polysulfate sodium (Elmiron) maculopathy: a genetic perspective
Authors: Kalaw Fritz Gerald P. , Ignacio John Carlos I. , Wu Chris Y. , Ferreyra Henry , Nudleman Eric , Baxter Sally L. , Freeman William R. , Borooah Shyamanga
Published: March 2023

Purpose:

To assess genetic associations for pentosan polysufate sodium maculopathy.

Methods:

Genetic testing for inherited retinal dystrophy (IRD) genes using exome testing and for 14 age-related macular degeneration (AMD) associated single nucleotide polymorphisms (SNP) using panel testing were performed. Additionally, full-field electroretinograms (ffERG) were obtained to identify any cone-rod dystrophy.

Results:

Eleven out of fifteen patients were female, with a mean age of 69 (range 46-85). IRD exome testing in five patients revealed six pathogenic variants but failed to confirm IRD in any patient genetically. FfERG performed in 12 patients demonstrated only non-specific a- and b-wave abnormalities in 11 cases and was normal in one case. For AMD SNPs, CFH rs3766405 (p=0.003) and CETP (p=0.027) were found to be statistically significantly associated with pentosan polysulfate maculopathy phenotype compared to the control population.

Conclusion:

Pentosan polysulfate maculopathy is not associated with Mendelian IRD genes. However, several AMD risk alleles were identified to be associated with maculopathy compared to their frequency in the normal population. This suggests a role for genes in disease pathology, particularly the alternative complement pathway. These findings would benefit from further investigation to understand the risk of developing maculopathy in taking pentosan polysulfate.
Evaluation of optic disc and macular vascularity changes in CRVO using optical coherence tomography angiography
Authors: Yousif Hussein , Rashad Mohammad , Abdel Dayem Hisham Khairy , Abdellatif Mona K
Published: March 2023

Purpose:

To quantify changes in optic disc and macular vasculature in patients with central retinal vein occlusion (CRVO) using optical coherence tomography (OCT) angiography and detect its correlation with visual acuity (VA).

Methods:

The study included 20 eyes of 20 patients with treatment naïve CRVO and 20 age-matched controls. OCT and OCT angiography (OCTA) were performed on the macula and optic disc. Central 1 mm subfield foveal thickness (CSFT) was measured. Vascular densities (VD) of superficial and deep macular capillary plexuses with whole disc VD, inside disc VD and radial peripapillary capillary plexus (RPC) were analyzed. Macular ischemia was evaluated by fundus fluorescein angiography (FFA). VA was correlated with measured parameters.

Results:

All measured macular and disc VDs differed significantly between cases and controls except inside disc VD. Visual acuity showed a highly significant negative correlation with whole disc VD (P = 0.005) and RPC (P = 0.002), borderline correlation with CSFT (P=0.06), and insignificant correlation with macular VDs. RPC VD showed a significant correlation with deep parafoveal (P=0.04), and superficial and deep perifoveal VDs (P=0.01).

Conclusion:

Optic disc VD could provide more accurate indication of retinal blood supply than macular VD in cases of CRVO with severe macular edema.
Pathways of Fluid Leakage in Age Related Macular Degeneration
Authors: Fouad Yousef A. , Santina Ahmad , Bousquet Elodie , Sadda Srinivas R. , Sarraf David
Published: March 2023

Age related macular degeneration is the most common cause of blindness in the western world and the development of intravitreal pharmacotherapies for the treatment of the neovascular complications of this disorder is considered a revolution in the care of this devastating disease. Anti-vascular endothelial growth factor (VEGF) agents such as ranibizumab and aflibercept can prevent blindness by reducing or resolving fluid in AMD and therefore the detection of these biomarkers (e.g. intraretinal and subretinal fluid) with high resolution, depth resolved tools such as optical coherence tomography (OCT) is a critical process in the successful management of this condition. However, there is growing evidence to indicate that fluid is not always the result of neovascular pathways and therefore the obligatory administration of anti-VEGF therapy in response to the observation of fluid on OCT may be flawed. Non-neovascular mechanisms of fluid leakage (e.g. retinal pigment epithelium pump impairment) should also be considered and in these circumstances anti-VEGF injection should be deferred. This editorial will review the neovascular and non-neovascular pathways of fluid leakage in AMD and will provide more informed guidance for the overall evaluation and management of exudation in AMD, including an observe and extend regimen in the context of non-neovascular fluid.
Hyperreflective band in the ganglion cell layer in retinitis pigmentosa
Authors: Antropoli Alessio , Arrigo Alessandro , Bianco Lorenzo , Cavallari Elena , Berni Alessandro , Casoni Filippo , Consalez Giacomo , Bandello Francesco , Cremona Ottavio , Battaglia Parodi Maurizio
Published: March 2023

Purpose:

To describe a sign that takes the form of a continuous hyperreflective band within the thickness of the ganglion cell layer (GCL), thus dubbed the “hyperreflective ganglion cell layer band” (HGB), which we detected in a fraction of patients affected by retinitis pigmentosa (RP).

Methods:

Retrospective, cross-sectional, observational study. Optical coherence tomography (OCT) images of RP patients examined between May 2015 and June 2021 were retrospectively reviewed for the presence of HGB, epiretinal membrane (ERM), macular hole and cystoid macular edema (CME). The ellipsoid zone (EZ) width was also measured. A subgroup of patients underwent microperimetry in the central 2°,4° and 10°.

Results:

One hundred forty-four eyes from 77 subjects were included in the study. HGB was present in 39 (25.3%) RP eyes. Mean best-corrected visual acuity (BCVA) was 0.39 ± 0.05 logMAR (approximately 20/50 Snellen equivalent) and 0.18 ± 0.03 logMAR (approximately 20/32 Snellen equivalent) in eyes with and without HGB, respectively (p < 0.001). The two groups did not differ with regard to EZ width, mean 2°, 4° and 10° retinal sensitivity, and prevalence of CME, ERM and macular hole. The multivariable analysis showed the presence of HGB to be a predictor of poorer BCVA (p<0.001).

Conclusions:

HGB is an OCT finding detectable in approximately a quarter of RP eyes and is associated with a poorer visual function. In the discussion, we speculate about possible morphogenetic scenarios to explain this observation.
Future of virtual education and telementoring
Authors: Seddon Ian , Rosenberg Eric , Houston Steve K.
Published: March 2023

Purpose of review

To summarize recent technological advancements in medical and surgical education and explore what the future of medicine might be as it relates to blockchain technology, the metaverse, and web3.

Recent findings

Through the use of digitally assisted ophthalmic surgery and high dynamic range 3D cameras, it is now possible to record and live stream 3D video content. Although the ‘metaverse’ is still in its early stages, there are a variety of proto-metaverse technologies that exist to facilitate user interactions that can mimic the real world through the use of shared digital environments and 3D spatial audio. Advanced blockchain technologies can allow for further development of interoperable virtual worlds where a user has an on-chain identity, credentials, data, assets, and much more that they can carry across platforms seamlessly.

As remote real-time communication becomes an integral part of human interaction, 3D live streaming has the potential to revolutionize ophthalmic education by removing traditional geographic and physical constraints of in-person surgical viewing. The incorporation of metaverse and web3 technologies has created new outlets for knowledge sharing that may improve how we operate, teach, learn, and transfer knowledge.
Patients’ Perceptions of Safety and Debriefing in Forensic Mental Health Care in Finland
Authors: Asikainen Jaana , Vehviläinen-Julkunen Katri , Repo-Tiihonen Eila , Louheranta Olavi
Published: March 2023

Background

Safety is of paramount importance to patients and staff in forensic mental health hospitals. Previous research has focused on organizational and nurses’ perceptions of safety and violence in psychiatric wards. However, little is known about how patients view their safety. This study aimed to describe how patient debriefing can improve safety.

Methods

Qualitative research using thematic analysis was used. Data were collected by semistructured interviews and debriefing forms. Inpatient interviews (n = 45) were conducted between June and July 2018, with debriefing forms (n = 376) collected retrospectively.

Results

Forensic inpatient responses were divided into two main categories: psychological and physical security. Psychological safety included care culture and patient-related themes. Responses on care culture highlighted weaknesses in nurse–patient communication, whereas patient-related themes related to respondents’ descriptions of the challenges posed by mental illness. Physical safety related to both the environment and patient-related themes, with various restrictions and environmental distractions seen by respondents as negatively affecting patient safety.

Conclusions

Patients who participated in the study felt that care culture, especially communication with nurses, most significantly impacted their safety. Forensic hospitals should consider patients’ perceptions of their care while systematically gathering information through debriefing, as these practices can contribute to the development of a safer care environment. The next step will be clarifying how changes in nursing practices and the care environment can be used to prevent violence in psychiatric wards.
Enhancing Hepatitis A and B Vaccinations Through Electronic Clinical Decision Support Systems and Staff Education in a Correctional Facility
Authors: Atem Jude N. , El Ghaziri Mazen
Published: March 2023

Background

Despite the prevalence and risks for hepatitis A virus (HAV) and hepatitis B virus (HBV) infection and the availability of safe and effective vaccines, HAV/HBV vaccinations are disproportionately low in jails. This quality improvement project evaluated the effectiveness of clinical decision support systems: electronic standing orders to nurses, clinical alerts to nurses and healthcare providers, and secondarily staff education in enhancing HAV and HBV vaccination and knowledge of hepatitis infection.

Methods

We distributed a validated self-report hepatitis knowledge questionnaire (α = 0.7–0.8) before and after an educational presentation to nurses, nurse practitioners, and physicians (N = 26) at a Northeastern state jail and then embedded electronic clinical alerts and standing orders in the electronic medical record. The questionnaire assessed pre- and posteducation knowledge scores. The number of vaccine status screenings and vaccinations was retrieved from the electronic medical record 3 months pre- and post-implementation. Descriptive statistics and the Wilcoxon signed-ranks test were used for data analysis.

Results

Twenty-one participants completed the pretest, 18 attended the educational intervention, and 15 completed the posttest. Vaccine status screening increased by 97.5%, and HAV and HBV vaccinations increased by 8.7%. Knowledge scores improved significantly post-intervention (p = 0.04), with an effect size of r = 0.67).

Discussion/Conclusion

Using the Donabedian quality of care model, we showed that quality initiatives are feasible in a jail setting. Implementing a clinical decision support system and education improved the vaccination rate, which may decrease HAV/HBV incidence in the jail and prevent community spread.
Sexual Assault Nurse Examiner Education Needs in Texas
Authors: Gary Jodie C. , Charles Laurie , Mitchell Stacey
Published: March 2023

Background: As with many areas of the nation, Texas lacks a robust sexual assault nurse examiner (SANE) workforce. A program in Texas offers courses to educate and expand SANE skills to better provide trauma-informed care to vulnerable populations. Methods: A survey to stakeholders of a SANE educational program, as part of a planned program evaluation, elicited not only barriers to providing care but also specific program needs to better expand access to sexual assault and domestic violence medical forensic examinations in Texas. Results: In January 2022, a total of 40 stakeholders, all registered nurses in the state of Texas, provided vital information on their current program. Analysis of written survey responses provided themes regarding barriers to providing SANE care and suggestions for expanded education. Discussion: The survey provided valuable feedback and comments on the perceptions of the current SANE program. Written responses offered direction for additional learning desires of SANEs associated with the program as well as areas for the program to expand to meet the needs of the learners. This stakeholder guidance has implications beyond this one SANE education program to enhance and expand other programs based on learner needs.