bluuebunny/crossref_metadata_2025 huggingface dataset:
BT41 Piloting a hospital-based teledermatology and artificial intelligence service for urgent suspected skin cancer alongside an established community-based teledermatology advice and guidance service
Authors: Frow Helen , Brown Alistair , Waqas Muhammad , Skittrall Zachary , Charman Carolyn
Published: June 2024

The aim of this pilot was to assess the value of a hospital-based teledermatology hub for urgent suspected skin cancer referrals in a semirural integrated care system. The hub uses a new medical photography-led teledermoscopy service to assess both teledermatology and artificial intelligence (AI) compared with face-to-face outpatient review in clinic. The deployment and this work were funded as part of the National Health Service AI in Health and Care Award. In parallel, the existing advice and guidance (A&G) service using images taken by general practice teams was promoted for all referrals other than urgent suspected skin cancer, including low-risk basal cell carcinomas and precancerous lesions. Analysis of the first 100 patients through the teledermoscopy–AI service showed that 18% of patients were diagnosed with benign lesions using the AI (and second-read dermatologist), 25% of patients required face-to-face review for diagnosis, 45% were triaged directly for a surgical procedure with a preoperative telephone call, 6% were prescribed topical therapy virtually, and 6% were discharged using images and telephone consultation without requiring treatment. Subsequent expansion of the dermatology medical photography team using both medical photographers and a trained healthcare assistant has supported extension of the teledermoscopy–AI service, with the pilot running to August 2024. Expansion to community hospital teledermoscopy hubs and extension of the urgent skin cancer service to the community diagnostic centre are changes supported by the pilot, to develop more streamlined pathways for patients with urgent suspected skin cancer. Through 2023 the community A&G service also expanded from around 250 requests per month to over 400 requests per month, with maintenance of conversion rates to referral of 30%, and redirection of patients with low-risk basal cell carcinomas to community skin surgery services. Development of the new urgent suspected skin cancer virtual teledermatology–AI pathway has required administrative adaptations within the hospital electronic patient record to support patient tracking, resourcing and job planning for image review. Training of photographers has been supported by online teledermoscopy resources developed by the Institute of Medical Illustrators. Selection of appropriate patients for the teledermoscopy–AI pathway while maintaining patient choice and safety has remained central to the teledermoscopy–AI pilot.
Ageing, Poverty and Agency: Reconceptualising Resistance to Poverty among Older Adults
Authors: Weiss-Dagan Shlomit , Timor-Shlevin Shachar
Published: June 2024

The experiences and daily lives of older adults living in poverty are underexplored topics in the literature. Specifically, the question of agency and how older people cope with poverty and resist it requires further investigation. Ruth Lister’s model is the theoretical foundation of this study, which emphasises individuals’ ability to be active agents in shaping their life stories. Lister’s renowned model of agency in poverty focuses on working-age people and is widely used by scholars. The current qualitative study expands on Lister’s theoretical articulation of agency by presenting the stories of twenty-seven older people living in poverty in Israel. The findings demonstrate how, under the social constraints of ageing, people tend to focus on the personal and local agency of survival because strategic and more political forms of agency are structurally inaccessible. These findings have practical implications. Social workers can play a crucial role in recognising older adults’ agency, standing with them in their struggles, advocating for them by addressing structural barriers and facilitating their access to resources. We also employ these findings to develop an expanded theoretical articulation of agency that incorporates agents and their respective social circles.
On the Morality of Reallocating Life-Sustaining Interventions in Times of Scarcity
Authors: Leever Martin G
Published: June 2024

As coronavirus disease 2019 made its way across the world in 2019, health systems began to develop guidelines to allocate what was expected to be a scarcity of medical resources. Considerable attention was given to triaging intensive care resources such as ventilators. While there was general agreement among bioethicists and policymakers that it may be permissible to withhold life-sustaining interventions from patients with poor prognoses in order to make them available to patients with better prognoses, there was disagreement about the permissibility of withdrawing such interventions for this purpose. Some maintained that the doctrine of double effect (DDE) revealed the intrinsic wrongness of such acts of reallocation. This article argues that so long as there is transparency and effective ongoing communication, the DDE may permit the discontinuation of life-sustaining interventions from patients who may still benefit from them in order to make them available to patients with more favorable prognoses.
Religious Freedom “with Chinese Characteristics”
Authors: Earley Brady
Published: June 2024

China’s approach to religious freedom is unique. Heavy State regulation and the involvement of the Chinese Communist Party often invite external critique of Chinese religious freedom based on legal commitments outside of China. However, China’s rich legal tradition and textual commitments to religious freedom suggest there is more to learn. Analyzing religious freedom in legal texts and in practice from Chairman Mao Zedong to President Xi Jinping, this article offers a dialectic account of religious freedom with Chinese characteristics. Chinese text and practice regarding religious freedom suggest three enduring constitutional commitments: non-discrimination in religious belief, normalization of religious practices, and resistance to foreign religious influence. Each of these textual commitments correspond to the values found in Daoism, Legalism, and Confucianism—the pillars of traditional Chinese culture. With this understanding of China’s religious freedom approach, the article then offers three implications for strengthening China’s commitment to its own theory of religious freedom by (1) separating State and Party policy on religious registration, (2) removing cult designations from criminal law, and (3) accommodating non-traditional religious organizations to help address social issues.
Romosozumab versus parathyroid hormone receptor agonists: which osteoanabolic to choose and when?
Authors: Anastasilakis Athanasios D , Yavropoulou Maria P , Palermo Andrea , Makras Polyzois , Paccou Julien , Tabacco Gaia , Naciu Anda Mihaela , Tsourdi Elena
Published: June 2024

Osteoanabolic agents are used as a first line treatment in patients at high fracture risk. The PTH receptor 1 (PTH1R) agonists teriparatide (TPTD) and abaloparatide (ABL) increase bone formation, bone mineral density (BMD), and bone strength by activating PTH receptors on osteoblasts. Romosozumab (ROMO), a humanized monoclonal antibody against sclerostin, dramatically but transiently stimulates bone formation and persistently reduces bone resorption. Osteoanabolic agents increase BMD and bone strength while being more effective than antiresorptives in reducing fracture risk in postmenopausal women. However, direct comparisons of the antifracture benefits of osteoanabolic therapies are limited. In a direct comparison of TPTD and ABL, the latter resulted in greater BMD increases at the hip. While no differences in vertebral or non-vertebral fracture risk were observed between the two drugs, ABL led to a greater reduction of major osteoporotic fractures. Adverse event profiles were similar between the two agents except for hypercalcemia, which occurred more often with TPTD. No direct comparisons of fracture risk reduction between ROMO and the PTH1R agonists exist. Individual studies have shown greater increases in BMD and bone strength with ROMO compared with TPTD in treatment-naive women and in women previously treated with bisphosphonates. Some safety aspects, such as a history of tumor precluding the use of PTH1R agonists, and a history of major cardiovascular events precluding the use of ROMO, should also be considered when choosing between these agents. Finally, convenience of administration, reimbursement by national health systems and length of clinical experience may influence patient choice.
Contextualizing Individual Attitudes on Economic Statecraft
Authors: Peterson Timothy M , Miller Susan M
Published: June 2024

When do US citizens express greater support for economic intervention abroad in response to violations of international norms? Under what conditions do they express greater support for punitive sanctions or positive inducements? We know little about whether and to what extent citizens offer greater support for sanctions compared to positive inducements and how contextual factors might alter support for each. We design a conjoint survey experiment to gauge support for an intervention—i.e., sanctions or inducements—using comparable counterfactuals. We compare long-enduring bad behavior to recent shocks, differently framed consequences of inaction, as well as varying expertise levels among policy proposal authors. We also consider preexisting attitudes about the target country. In a US sample, we find that policy proposals are supported to a greater extent when they involve sanctions as opposed to inducements, but that preexisting affinity toward the country has a strong conditioning impact.
HLA-DQA1*05 Allele Carriage and Anti-TNF Therapy Persistence in Inflammatory Bowel Disease
Authors: Doherty Jayne , Ryan Anthony W , Quinn Emma , Conroy Judith , Dolan Jackie , Corcoran Roisin , Hara Fintan O , Cullen Garret , Sheridan Juliette , Bailey Yvonne , Dunne Cara , Hartery Karen , McNamara Deirdre , Doherty Glen A , Kevans David
Published: June 2024

Introduction

Carriage of the HLA-DQA1*05 allele is associated with development of antidrug antibodies (ADAs) to antitumor necrosis factor (anti-TNF) therapy in patients with Crohn’s disease. However, ADA is not uniformly associated with treatment failure. We aimed to determine the impact of carriage of HLA-DQA1*05 allele on outcome of biologic therapy evaluated by drug persistence.

Methods

A multicenter, retrospective study of 877 patients with inflammatory bowel disease (IBD) treated with anti-TNF therapy with HLA-DQA1*05 genotypes were generated by imputation from whole genome sequence using the HIBAG package, in R. Primary end point was anti-TNF therapy persistence, (time to therapy failure), segregated by HLA-DQA1*05 allele genotype and development of a risk score to predict anti-TNF therapy failure, incorporating HLA-DQA1*05 allele genotype status (LORisk score).

Results

In all, 877 patients receiving anti-TNF therapy were included in our study; 543 (62%) had no copy, 281 (32%) one copy, and 53 (6%) 2 copies of HLA-DQA1*05 allele. Mean time to anti-TNF therapy failure in patients with 2 copies of HLA-DQA1*05 allele was significantly shorter compared with patients with 0 or 1 copy at 700 days’ follow-up: 418 vs 541 vs 513 days, respectively (P = .012). Factors independently associated with time to anti-TNF therapy failure included carriage of HLA-DQA1*05 allele (hazard ratio [HR], 1.2, P = .02; female gender HR, 1.6, P < .001; UC phenotype HR, 1.4, P = .009; and anti-TNF therapy type [infliximab], HR, 1.5, P = .002). The LORisk score was significantly associated with shorter time to anti-TNF therapy failure (P < .001).

Conclusions

Carriage of 2 HLA-DQA1*05 alleles is associated with less favorable outcomes for patients receiving anti-TNF therapy with shorter time to therapy failure. HLA-DQA1*05 genotype status in conjunction with clinical factors may aid in therapy selection in patients with IBD.
Digital Transformation in Thoracic Surgery: a survey among the European Society of Thoracic Surgeons
Authors: Mayer Nora , Sotiropoulos George , Novoa Nuria , Daddi Niccolo , Batirel Hasan , Asadi Nizar
Published: June 2024

OBJECTIVES

Digital transformation has drastically changed the surgical sector, but few is known about its impact on thoracic surgical practice. The aim of this paper is to report the European Society of Thoracic Surgeons (ESTS) survey results, assessing the impact of and the need for Digital Transformation in Thoracic Surgery.

METHODS

A 23-item survey was designed by the ESTS Digital Transformation Working Group to assess the impact of and the need for Digital Transformation in Thoracic Surgery. All ESTS members (1668) were invited to complete the survey between 13 March and 21 May 2022 anonymously. Data analysis was descriptive calculating frequencies and percentages. Group comparison was done using chi-square test.

RESULTS

The response rate was 6.3%. Surgeons from 26 European countries participated of which more than 80% were based in academic hospitals. The impact of digital transformation was rated very important (43.8%) and fundamental (22.7%) in more than two-thirds of the cases, regardless of surgeons’ age. None of the participants felt that digital transformation was of no importance and more than 85% had implemented digital platforms in their direct patient care. Almost 90% of the surgeons, currently not using digital platforms for training and education, would consider introducing them. About 70% were at least ‘somewhat satisfied’ with their current engagement in Digital Transformation in Thoracic Surgery.

CONCLUSIONS

Digital transformation seems to play a major role across European Thoracic Surgery departments in direct patient care, professional networking and surgical training. However, overall satisfaction with the current status of Digital Transformation in Thoracic Surgery was rather reserved, implying the need to increase the implementation of digital solutions in the latter.
The Use of Breast-specific Gamma Imaging as a Low-Cost Problem-Solving Strategy for Avoiding Biopsies in Patients With Inconclusive Imaging Findings on Mammography and Ultrasonography
Authors: Ko Andrew , Vo Alexander M , Miller Nathaniel , Liang Annie , Baumbach Maia , Riley Argue Jay , Manche Nathaniel , Gonzalez Luis , Austin Nicholas , Carver Philip , Procell Joseph , Elzein Hassan , Pan Margaret , Zeidan Nadine , Kasper William , Speer Samuel , Liang Yizhi , Pettus Benjamin J
Published: June 2024

Objective

To evaluate the clinical performance and financial costs of breast-specific gamma imaging (BSGI) as a biopsy-reducing problem-solving strategy in patients with inconclusive diagnostic imaging findings.

Methods

A retrospective analysis of all patients for whom BSGI was utilized for inconclusive imaging findings following complete diagnostic mammographic and sonographic evaluation between January 2013 and December 2018 was performed. Positive BSGI findings were correlated and biopsied with either US or stereotactic technique with confirmation by clip location and pathology. After a negative BSGI result, patients were followed for a minimum of 24 months or considered lost to follow-up and excluded (22 patients). Results of further imaging studies, biopsies, and pathology results were analyzed. Net savings of avoided biopsies were calculated based on average Medicare charges.

Results

Four hundred and forty female patients from 30 to 95 years (mean 55 years) of age were included in our study. BSGI demonstrated a negative predictive value (NPV) of 98.4% (314/319) and a positive predictive value for biopsy of 35.5% (43/121). The overall sensitivity was 89.6% (43/48), and the specificity was 80.1% (314/392). In total, 78 false positive but only 5 false negative BSGI findings were identified. Six hundred and twenty-one inconclusive imaging findings were analyzed with BSGI and a total of 309 biopsies were avoided. Estimated net financial savings from avoided biopsies were $646 897.

Conclusion

In the management of patients with inconclusive imaging findings on mammography or ultrasonography, BSGI is a problem-solving imaging modality with high NPV that helps avoid costs of image-guided biopsies.
Efficacy of 2 botanical aphicides, chicoric and 3,5-dicaffeoylquinic acids, on aphids susceptible and resistant to synthetic insecticides
Authors: Siegwart Myriam , Gauffre Bertrand , Lecerf Elodie , Poëssel Jean-Luc
Published: June 2024

Dicaffeoyltartaric acid (diCT) and 3,5-dicaffeoylquinic acid (3,5-diCQ) are described for their aphicidal properties on several aphid species. Intending to valorize diCT and 3,5-diCQ as biocontrol products and because of the high adaptive capacities of aphids to xenobiotics, we sought to determine the existence of adaptation first in Myzus persicae (Sulzer) (Hemiptera: Aphididae) and then other aphids. Resistance of aphids to these biopesticides could be promoted by (i) the existence of resistance to synthetic insecticides that may confer cross-resistance and (ii) the presence of these compounds in wild plants likely which may have led to pre-existing adaptation in aphids. We assessed the resistance levels to diCT and 3,5-diCQ in 7 lab strains (including some resistant to synthetic aphicides) and 7 wild populations of M. persicae using biotests. The activities of detoxification enzymes contributing to insecticide resistance were also measured. Additionally, we followed the same method to characterize susceptibility to these caffeic derivatives in wild populations of Nasonovia ribisnigri (Mosley) (Hemiptera: Aphididae), Brevicoryne brassicae(Linnaeus) (Hemiptera: Aphididae) and, Aphis craccivora(Koch) (Hemiptera: Aphididae). Our results show variability in susceptibility to diCT between populations of M. persicae, but resistance ratios (RR) were low (RR = 3.59). We found no cross-resistance between synthetic insecticides and diCT. Carboxylesterase and glutathione-S-transferase did not seem to be involved in its detoxification. A clone of A. craccivora collected from peanut, a species rich in diCT, was not susceptible to either diCT or 3,5-diCQ, suggesting a common molecular target for these 2 molecules and the existence of a high-effect resistance mechanism. These active botanical substances remain good candidates for M. persicae biocontrol in agriculture.
Exploring xylose metabolism in non-conventional yeasts: kinetic characterization and product accumulation under different aeration conditions
Authors: Bolzico Bruna C , Racca Sofia , Khawam Jorge N , Leonardi Rodrigo J , Tomassi Ariel H , Benzzo Maria T , Comelli Raul N
Published: June 2024

d-Xylose is a metabolizable carbon source for several non-Saccharomyces species, but not for native strains of S. cerevisiae. For the potential application of xylose-assimilating yeasts in biotechnological processes, a deeper understanding of pentose catabolism is needed. This work aimed to investigate the traits behind xylose utilization in diverse yeast species. The performance of 9 selected xylose-metabolizing yeast strains was evaluated and compared across 3 oxygenation conditions. Oxygenation diversely impacted growth, xylose consumption, and product accumulation. Xylose utilization by ethanol-producing species such as Spathaspora passalidarum and Scheffersomyces stipitis was less affected by oxygen restriction compared with other xylitol-accumulating species such as Meyerozyma guilliermondii, Naganishia liquefaciens, and Yamadazyma sp., for which increased aeration stimulated xylose assimilation considerably. Spathaspora passalidarum exhibited superior conversion of xylose to ethanol and showed the fastest growth and xylose consumption in all 3 conditions. By performing assays under identical conditions for all selected yeasts, we minimize bias in comparisons, providing valuable insight into xylose metabolism and facilitating the development of robust bioprocesses.

One-Sentence Summary

This work aims to expand the knowledge of xylose utilization in different yeast species, with a focus on how oxygenation impacts xylose assimilation.
Too amused to stop? Self-control and the disengagement process on Netflix
Authors: Gilbert Alicia , Reinecke Leonard , Meier Adrian , Baumgartner Susanne E , Dietrich Felix
Published: June 2024

Consuming media entertainment often challenges recipients’ self-control. While past research related self-control almost exclusively to whether individuals engage in media use, it might be equally relevant for the disengagement from media use. Testing core assumptions of the Appraisal of Media Use, Self-Control, and Entertainment (AMUSE) model, the present study investigates the situational interplay of self-control and affective appraisals in predicting disengagement from Netflix use. Preregistered hypotheses were tested based on an event-contingent experience sampling design, in which 205 adult Netflix users in the Netherlands and Germany were tracked and surveyed for two weeks. Results demonstrate that disengagement is contingent upon enjoyment and appreciation and that enjoyment, in turn, can be “spoiled” by feeling guilty. Self-control influenced goal conflict and enjoyment throughout the reception process. We discuss opportunities for modeling disengagement from media use with situational research approaches.
Strawberry phenotypic plasticity in flowering time is driven by the interaction between genetic loci and temperature
Authors: Prohaska Alexandre , Petit Aurélie , Lesemann Silke , Rey-Serra Pol , Mazzoni Luca , Masny Agnieszka , Sánchez-Sevilla José F , Potier Aline , Gaston Amèlia , Klamkowski Krzysztof , Rothan Christophe , Mezzetti Bruno , Amaya Iraida , Olbricht Klaus , Denoyes Béatrice
Published: June 2024

Flowering time (FT), which determines when fruits or seeds can be harvested, is subject to phenotypic plasticity, that is, the ability of a genotype to display different phenotypes in response to environmental variation. Here, we investigated how the environment affects the genetic architecture of FT in cultivated strawberry (Fragaria × ananassa) and modifies its quantitative trait locus (QTL) effects. To this end, we used a bi-parental segregating population grown for 2 years at widely divergent latitudes (five European countries) and combined climatic variables with genomic data (Affymetrix SNP array). Examination, using different phenological models, of the response of FT to photoperiod, temperature, and global radiation indicated that temperature is the main driver of FT in strawberry. We next characterized in the segregating population the phenotypic plasticity of FT by using three statistical approaches that generated plasticity parameters including reaction norm parameters. We detected 25 FT QTLs summarized as 10 unique QTLs. Mean values and plasticity parameter QTLs were co-localized in three of them, including the major 6D_M QTL whose effect is strongly modulated by temperature. The design and validation of a genetic marker for the 6D_M QTL offers great potential for breeding programs, for example selecting early-flowering strawberry varieties well adapted to different environmental conditions.
Raffinose catabolism enhances maize waterlogging tolerance by stimulating adventitious root growth and development
Authors: Yan Dong , Gao Yu , Zhang Yumin , Li Dan , Dirk Lynnette M A , Downie A Bruce , Zhao Tianyong
Published: June 2024

Raffinose mitigates plant heat, drought, and cold stresses; however, whether raffinose contributes to plant waterlogging tolerance is unknown. The maize raffinose synthase mutant zmrafs-1 had seedlings that lack raffinose, generated fewer and shorter adventitious roots, and were more sensitive to waterlogging stress, while overexpression of the raffinose synthase gene, ZmRAFS, increased raffinose content, stimulated adventitious root formation, and enhanced waterlogging tolerance of maize seedlings. Transcriptome analysis of null segregant seedlings compared with zmrafs-1, particularly when waterlogged, revealed that the expression of genes related to galactose metabolism and the auxin biosynthetic pathway were up-regulated by raffinose. Additionally, indole-3-acetic acid content was significantly decreased in zmrafs-1 seedlings and increased in ZmRAFS-overexpressing seedlings. Inhibition of the hydrolysis of raffinose by 1-deoxygalactonojirimycin decreased the waterlogging tolerance of maize seedlings, the expression of genes encoding proteins related to auxin transport-related genes, and the indole-3-acetic acid level in the seedlings, indicating that the hydrolysis of raffinose is necessary for maize waterlogging tolerance. These data demonstrate that raffinose catabolism stimulates adventitious root formation via the auxin signaling pathway to enhance maize waterlogging tolerance.
A Multicenter Retrospective Study Evaluating Intravenous to Oral Antibiotic Stepdown for Uncomplicated Streptococcal Bacteremia
Authors: Lew Alison K , Salam Madison E , Gross Alan E , Wang Sheila K , McGuire Erin , Pettit Natasha N , Pisano Jennifer , Nguyen Cynthia T
Published: June 2024

Background

The purpose of this study was to compare the efficacy and safety of intravenous (IV) versus oral (PO) stepdown therapy for uncomplicated streptococcal bacteremia.

Methods

This multicenter, retrospective study included adult patients with uncomplicated streptococcal bacteremia between 1 July 2019 and 1 July 2022. Patients who received IV therapy for the full treatment course were compared to patients who transitioned to PO therapy after initial IV therapy. The primary outcome was clinical success, defined as absence of infection recurrence, infection-related readmission, and infection-related mortality at 90 days. Secondary outcomes included microbiological success, length of stay (LOS), and IV line–associated complications.

Results

Of 238 patients included, 47.1% received PO stepdown therapy. Clinical success occurred in 94.4% and 94.6% in the IV only and PO stepdown groups, respectively (P = .946). Patients who transitioned to PO therapy received a median duration of IV therapy of 3.9 days (interquartile range, 2.9–7.3 days). Line complications were more frequent in the IV only group, primarily driven by catheter-related infections (7.2% vs 0%, P = .002). LOS was significantly shorter in the PO stepdown group (5.5 vs 9.2 days, P < .001).

Conclusions

Patients transitioned to PO antibiotics for uncomplicated streptococcal bacteremia had similar rates of clinical success compared to patients who received only IV therapy. With consideration of infectious source, severity of illness, and comorbidities, PO stepdown following initial IV antibiotics for uncomplicated streptococcal bacteremia in select patients is a reasonable approach that may result in decreased LOS and line-related complications.
The tensor as an informational resource
Authors: Christandl Matthias
Published: June 2024

A tensor is a multidimensional array of numbers that can be used to store data, encode a computational relation, and represent quantum entanglement. In this sense, a tensor can be viewed as valuable resource whose transformation can lead to an understanding of structure in data, computational complexity, and quantum information. In order to facilitate the understanding of this resource, we propose a family of information-theoretically constructed preorders on tensors, which can be used to compare tensors with each other and to assess the existence of transformations between them. The construction places copies of a given tensor at the edges of a hypergraph and allows transformations at the vertices. A preorder is then induced by the transformations possible in a given growing sequence of hypergraphs. The new family of preorders generalizes the asymptotic restriction preorder which Strassen defined in order to study the computational complexity of matrix multiplication. We derive general properties of the preorders and their associated asymptotic notions of tensor rank and view recent results on tensor rank nonadditivity, tensor networks, and algebraic complexity in this unifying frame. We hope that this work will provide a useful vantage point for exploring tensors in applied mathematics, physics, and computer science but also from a purely mathematical point of view.
National Institute of Mental Health Support for Cognitive Treatment Development in Schizophrenia: A Narrative Review
Authors: Heinssen Robert K , Morris Sarah E , Sherrill Joel T
Published: June 2024

For several decades the National Institute of Mental Health (NIMH) has supported basic and translational research into cognitive impairment in schizophrenia. This article describes the Institute’s ongoing commitment to cognitive assessment and intervention research, as reflected by three signature initiatives—Measurement and Treatment Research to Improve Cognition in Schizophrenia; Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia; and Research Domain Criteria—and related funding announcements that span basic experimental studies, efficacy and comparative effectiveness trials, and implementation research designed to promote cognitive healthcare in real-world treatment settings. We discuss how trends in science and public health policy since the early 2000s have influenced NIMH treatment development activities, resulting in greater attention to (1) inclusive teams that reflect end-user perspectives on the utility of proposed studies; (2) measurement of discrete neurocognitive processes to inform targeted interventions; (3) clinical trials that produce useful information about putative illness mechanisms, promising treatment targets, and downstream clinical effects; and (4) “productive urgency” in pursuing feasible and effective cognitive interventions for psychosis. Programs employing these principles have catalyzed cognitive measurement, drug development, and behavioral intervention approaches that aim to improve neurocognition and community functioning among persons with schizophrenia. NIMH will maintain support for innovative and impactful investigator-initiated research that advances patient-centered, clinically effective, and continuously improving cognitive health care for persons with psychotic disorders.
Bidirectional associations between the duration and timing of nocturnal sleep and daytime naps in adolescents differ from weekdays to weekends
Authors: Leong Ruth L F , Tian Liang , Yu Nicole , Teo Teck Boon , Ong Ju Lynn , Chee Michael W L
Published: June 2024

Study Objectives

Previous studies examining bidirectional relationships between nocturnal sleep and napping have focused on sleep duration, leaving a gap in our understanding of how sleep timing contributes. Here, we assessed the duration and timing for night sleep and daytime naps, to evaluate how the previous night’s sleep influences the next day's napping, and how napping influences same-night nocturnal sleep.

Methods

We analyzed sleep diary and actigraphy data from 153 teens (males = 43.8%, mean age = 16.6 years). Participants who never napped were excluded. Nocturnal sleep-nap relationships were investigated using logistic and linear regression models separately for weekdays and weekends.

Results

Participants napped an average of 2.3 times a week. 167 school day naps and 107 weekends were recorded. Naps were on average 82.12 ± 53.34 minutes and the average nap onset was 14:58 ± 3.78 hours. Their duration, start and end times did not significantly differ between weekdays and weekends. Nocturnal sleep duration did not predict next-day nap occurrence or duration. However, on school days, earlier wake times significantly increased the likelihood of napping that day, and advanced nap timing. On weekends, later bedtimes and wake times delayed nap timing. On school days, napping longer than one’s average shortened nocturnal sleep whereas on weekends, waking from a nap later than one’s average delayed bedtimes.

Conclusions

Early wake times increase the likelihood of napping and advance the time of a nap that day. Naps may be detrimental to the same night’s sleep only if they are long and occur late, as these can delay bedtimes and shorten nocturnal sleep duration, especially on school days.

Clinical trials

The Cognitive and Metabolic Effects of Sleep Restriction in Adolescents (NFS4), https://clinicaltrials.gov/study/NCT03333512, ID: NCT03333512. Investigating Preferred Nap Schedules for Adolescents (NFS5), https://clinicaltrials.gov/study/NCT04044885, ID: NCT04044885.
Low Risk of Cardiac Complications During Long-Term Follow-Up of Opioid Dependence
Authors: Tremonti Chris , Celemajer David S. , Marel Christina , Mills Katherine , Foo Shawn , Wilson Jack , Slade Tim , Teesson Maree , Haber Paul
Published: June 2024

Objectives

To prospectively assess rates of QT prolongation, arrhythmia, syncope, and sudden cardiac death (SCD) in a cohort of people with heroin dependence.

Methods

To estimate rates of QT prolongation, arrhythmia, and syncope, a subcohort (n = 130) from the Australian Treatment Outcomes Study, a prospective longitudinal cohort study of 615 people with heroin dependence, underwent medical history, venepuncture, and ECG at the 18- to 20-year follow-up.

To estimate rates of SCD, probabilistic matching for the entire cohort was undertaken with the Australian Institute of Health and Welfare National Death Index. Deaths were classified into suicide, accidental overdose, trauma, unknown, and disease, which were then further subclassified by probability of SCD. SCD rate was the number of possible or probable SCDs divided by total patient years from the cohort.

Results

From the subcohort, 4 participants (3%) met the criteria for QT prolongation; 3 were prescribed methadone. Seven participants (5%) reported history of arrhythmia, including 2 transferred from methadone to buprenorphine. Thirty participants (23%) reported a previous syncopal event—14 diagnosed as nonarrhythmic syncope and 13 not investigated. In the previous 12 months, 66 participants (51%) reported heroin use; 55 participants (42%) were prescribed methadone. No participant had QTc greater than 500 milliseconds.

There were 3 possible SCDs, translating to an estimated SCD rate of 0.29 (CI: 0.05, 0.8) events per 1000 patient years. More cohort members died of overdose (n = 50), suicide (n = 11), and hepatitis C (n = 4).

Conclusions

Low rates of QT prolongation, arrhythmia, syncope, and SCD in the cohort despite high rates of heroin use and methadone treatment.
Worse Preoperative 12-Item Veterans Rand Physical Component Scores Prognosticate Inferior Outcomes Following Outpatient Lumbar Decompression
Authors: Anwar Fatima N. , Roca Andrea M. , Loya Alexandra C. , Medakkar Srinath S. , Kaul Aayush , Wolf Jacob C. , Federico Vincent P. , Sayari Arash J. , Lopez Gregory D. , Singh Kern
Published: June 2024

Study Design:

Retrospective Review.

Objective:

Evaluate the influence of the 12-Item veterans Rand (VR-12) physical component score (PCS) on patient-reported outcome measures (PROMs) in an outpatient lumbar decompression (LD) cohort.

Summary of Background Data:

The influence of baseline VR-12 PCS on postoperative clinical outcomes has not been evaluated in patients undergoing outpatient LD.

Methods:

Patients undergoing primary, elective, 1/2-level outpatient LD with baseline VR-12 PCS scores were retrospectively identified from a prospectively maintained single-surgeon database. Cohorts were preoperative VR-12 PCS<30 and VR-12 PCS≥30. Patient/perioperative characteristics and preoperative/postoperative 6-week/final follow-up (FF) PROMs were collected. Physical health PROMs included the VR-12 PCS, 12-Item Short Form (SF-12) PCS, patient-reported outcome measure information system-physical function (PROMIS-PF), visual analog scale (VAS)-back/leg, and Oswestry disability index (ODI). Mental health PROMs included the VR-12/SF-12 mental component score (MCS) and the patient-health questionnaire-9 (PHQ-9). Average FF was 13.8±8.9 months postoperatively. PROM improvements at 6 weeks/FF and minimal clinically important difference (MCID) achievement rates were determined. χ2 analysis and the Student’s t tests compared demographics, perioperative data, and preoperative PROMs. Multivariate linear/logistic regression compared postoperative PROMs, PROM improvements, and MCID achievement rates.

Results:

Six weeks postoperatively, VR-12 PCS<30 reported worse baseline PROMs (P≤0.042, all) and worse scores except VR-12/SF-12 MCS (P≤0.043, all). Compared with VR-12 PCS≥30, VR-12 PCS<30 had worse FF VR-12 PCS, SF-12 PCS/MCS, PROMIS-PF, PHQ-9, and VAS-Back (P≤0.033, all). VR-12 PCS<30 experienced greater 6-week improvements in VR-12/SF-12 PCS, PHQ-9, VAS-Back, and ODI (P≤0.039, all). VR-12 PCS<30 had greater FF improvements in VR-12/SF-12 PCS, PHQ-9, and ODI (P≤0.001, all) and greater overall MCID achievement in VR-12 PCS/MCS, SF-12 PCS, PHQ-9, and ODI (P≤0.033, all).

Conclusions:

VR-12 PCS<30 patients-reported worse baseline/postoperative mental/physical health scores. However, they reported greater improvements in physical function, depressive burden, back pain, and disability by 6 weeks and FF and experienced greater MCID achievement for physical functioning, mental health, and disability scores.
Long-term clinical outcomes in elderly patients with chronic total occlusion and type 2 diabetes: the impact of coronary collateralization following successful recanalization
Authors: Wang Ming , Zhang Shuyi , Zhai Xinrong , Guan Shaofeng , Gan Qian , Han Wenzheng , Qu Xinkai
Published: June 2024

Background and purpose:

Chronic total occlusion (CTO) lesions commonly affect elderly patients, especially those with type 2 diabetes mellitus (T2DM), often associated with coronary collaterals (CC). However, it remains unclear whether CC influences the prognosis of CTO. This retrospective single-center study aimed to evaluate the prognostic relevance of CC in elderly patients with T2DM after successful revascularization for CTO.

Methods:

We analyzed data from 416 patients diagnosed with CTO who underwent successful revascularization between January 2013 and January 2017. Patients were categorized into two groups: the Non-T2DM group and T2DM group. Subgroup analyses were performed based on the status of CC. The primary outcome was the occurrence of major adverse cardiac events (MACE) during the follow-up period, with the secondary outcomes including all-cause mortality, cardiac death, and repeat revascularization.

Results:

CC did not significantly impact clinical endpoints in the overall elderly patient population. However, we observed a lower incidence of MACE, cardiac death, all-cause mortality, and repeat revascularization in the Non-T2DM group compared to the T2DM group. In patients without T2DM, poor-CC was associated with higher rates of all-cause mortality (9% vs. 18%, P = 0.041), an increased risk of cardiac death (5% vs. 12%, P = 0.042), and a greater incidence of MACE (15% vs. 28%, P = 0.031), whereas no such associations were observed in T2DM patients. Furthermore, in multivariate Cox analysis, T2DM emerged as an independent factor influencing the time to MACE (adjusted hazard ratio [HR]:1.847, 95% confidence interval [95% CI]: 1.215–2.810, P = 0.004) and repeat revascularization (adjusted HR: 2.093, 95% CI: 1.310–3.344, P = 0.002) in elderly CTO patients, rather than coronary collateralization. Notably, regardless of the quality of CC, elderly patients with T2DM exhibited a poorer prognosis.

Conclusions:

Elderly patients without T2DM derived greater long-term survival benefits from successful revascularization of CTO compared to those with T2DM. Additionally, good collateralization was associated with a decreased risk of adverse clinical outcomes specifically in Non-T2DM patients.
Diffuse Dermal Angiomatosis in a Patient With Rheumatoid Arthritis: Case Report
Authors: Faria Jessia Pagan , Seko Gabriele Harumi , Mioto Eldis , Gubert Marina , Collete Mariana , Siqueira Icaro Allysson , Malia Alisson Rombi , Finatti Izabela
Published: June 2024

Diffuse dermal angiomatosis is a rare vascular disorder of skin tissue in the spectrum of cutaneous reactive angiomatosis. Clinically, it presents as violaceous plaques that may ulcerate and is characterized by endothelial proliferation within the dermis on microscopic examination. It is mainly located in the breasts and extremities.

Case Presentation:

We report a case of erythematoviolaceous cutaneous plaques in an uncommon location (abdomen and dorsum) in a patient with rheumatoid arthritis and without other disorders such as atherosclerotic disease, macromastia and smoking.

Discussion and Conclusion:

It is believed that ischemia or inflammation creates local hypoxia, leading to an increase in pro-angiogenic cytokines with subsequent endothelial proliferation and neovascularization. We report a case of a patient with rheumatoid arthritis (autoimmune disease) who presented with an asymptomatic cutaneous violaceous and roundish lesion in the trunk that may be related to diffuse dermal angiomatosis.
Cutaneous Ciliated Cysts: 2 Case Reports and Review of Literature
Authors: Yalçın Anıl Can , Yalçın Nazlıcan , Çakmak Halil İbrahim , Bedir Recep
Published: June 2024

Cutaneous ciliated cysts are rare benign lesions most commonly seen in the lower extremities of young female patients. There is still ongoing debate about the origin of these cysts, with the most common theories being Mullerian heterotopia and eccrine gland metaplasia. To further increase the data pool, we present 2 new cutaneous ciliated cyst cases and gathered data about all 67 cases of literature. We want to highlight that immunohistochemistry and demographic information may play a key role in distinguishing between the 2 possible origins of this cyst, namely estrogen receptor, progesterone receptor, and carcinoembryonic antigen immunohistochemistry. Estrogen receptor and progesterone receptor nuclear positivity is proof of Mullerian origin, but when they are negative with a positive carcinoembryonic antigen, the most likely origin is eccrine gland metaplasia. We advocate using the terms “Cutaneous Mullerian Cyst” and “Ciliated Cutaneous Eccrine Cyst” instead of “Cutaneous Ciliated Cyst” to accurately indicate their distinct origins.
Spitz Melanoma With SLC20A1::ALK Fusion: A Novel Fusion Previously Undescribed in Spitz Melanocytic Neoplasm
Authors: Cho Woo Cheal , Prieto Victor G. , Yang Richard K.
Published: June 2024

Spitz melanocytic neoplasms exhibit frequent chromosomal rearrangements leading to recurring gene fusions, such as ALK fusions. TPM3 and DCTN1 emerge as the predominant fusion partners of ALK, although less common partners such as NPM1, TPR, CLIP1, GTF3C2, MLPH, EEF2, MYO5A, and KANK1 have also been documented. Although ALK fusions are primarily associated with Spitz nevi or atypical Spitz tumors, instances of Spitz melanoma with ALK fusions documented in the English literature are exceedingly rare. Here, we present a case of Spitz melanoma harboring SLC20A1::ALK fusion, highlighting a novel fusion transcript not previously reported in Spitz melanocytic neoplasms, including Spitz melanomas. In addition, the tumor exhibits multiple aberrant chromosomal alterations characteristic of melanoma, along with a somatic mutation in GRM3.
Pulmonary tumor thrombotic microangiopathy: Two case reports and literature review
Authors: Ma Hua , Gao Jian-Mei , Wang Jing , Huang Ling-Yan , Tian Xing-Cang , Tian Zhi-Gang , Wang Shao-Jin , Ma Gang , Tan Hai , Zhang Shu-Xiang
Published: June 2024

Rationale:

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but serious complication in patients with malignancy; its main manifestation includes acute pulmonary hypertension with severe respiratory distress. More than 200 cases have been reported since it was first identified in 1990. PTTM accounts for approximately 0.9% to 3.3% of deaths due to malignancy, but only a minority of patients are diagnosed ante-mortem, with most patients having a definitive diagnosis after autopsy.

Patient concerns:

Two middle-aged women both died within a short period of time due to progressive dyspnea and severe pulmonary hypertension.

Diagnoses:

One patient was definitively confirmed as a gastrointestinal malignant tumor by liver puncture biopsy pathology. Ultimately, the clinical diagnosis was pulmonary tumor thrombotic microangiopathy.

Interventions:

The patient was treated symptomatically with oxygen, diuresis, and anticoagulation, while a liver puncture was perfected to clarify the cause.

Outcomes:

Two cases of middle-aged female patients with rapidly progressive pulmonary hypertension and respiratory failure resulted in death with malignant neoplasm.

Lessons:

PTTM has a rapid onset and a high morbidity and mortality rate. Our clinicians need to be more aware of the need for timely diagnosis through a targeted clinical approach, leading to more targeted treatment and a better prognosis.
Effects of psychosocial characteristics on cognitive function in middle-aged and older adults: Focusing on change by year using the Korean Longitudinal Study of Aging panel data (2014–2018)
Authors: Park Ji-Young , Jung Hye-Sun
Published: June 2024

Old age is associated with a higher risk of dementia. Psychosocial characteristics frequently affect cognitive function; however, the exact mechanism underlying the effect of psychosocial factors on cognitive function is unclear. Therefore, this study aimed to investigate the effects of psychosocial characteristics on cognitive function. The participants comprised 4809 middle-aged and older (years 50+) adults. The analysis used data from the Korean Longitudinal Study of Aging from 2014 to 2018. The effects of neighborhood interaction, depression, life satisfaction, and economic activity on cognitive function were examined, and a linear mixed model analysis was performed to assess the change in cognitive function by year. A statistically significant association was found between neighborhood interaction and time. Additionally, cognitive function decreased in the presence of depression and with time. In men, significant interactions were found between depression and time and between economic activity and time. In women, significant interactions were found between life satisfaction and time. The findings indicate that since active neighborhood interaction positively affects cognitive function, it is necessary to develop various community-wide social activity programs for middle-aged and older adults. As depression is a risk factor for cognitive impairment, it is crucial to prevent cognitive decline through continuous management of depression. Given the positive effects of economic activity on cognitive function in men, it is essential to expand infrastructure to sustain economic activity by developing educational programs and creating job opportunities for middle-aged and older men.