bluuebunny/crossref_metadata_2025 huggingface dataset:
Existence and analyticity of the Lei-Lin solution of the Navier-Stokes equations on the torus
Authors: Ambrose David , Lopes Filho Milton , Nussenzveig Lopes Helena
Published: August 2023

Lei and Lin [Comm. Pure Appl. Math. 64 (2011), pp. 1297–1304] have recently given a proof of a global mild solution of the three-dimensional Navier-Stokes equations in function spaces based on the Wiener algebra. An alternative proof of existence of these solutions was then developed by Bae [Proc. Amer. Math. Soc. 143 (2015), pp. 2887–2892], and this new proof allowed for an estimate of the radius of analyticity of the solutions at positive times. We adapt the Bae proof to prove existence of the Lei-Lin solution in the spatially periodic setting, finding an improved bound for the radius of analyticity in this case.
Genes That Extend Lifespan May Do So by Mitigating the Increased Risk of Death Posed by Having Hypertension
Authors: Morris Brian J , Donlon Timothy A
Published: August 2023

BACKGROUND

Genetic factors influence lifespan. In humans, there appears to be a particularly strong genetic effect in those aged ≥ 90 years. An important contribution is nutrient sensing genes which confer cell resilience.

METHODS

Our research has been investigating the genetic factors by longitudinal studies of American men of Japanese descent living on the island of Oahu in Hawaii. This cohort began as the Honolulu Heart Program in the mid-1960s and most subjects are now deceased.

RESULTS

We previously discovered various genes containing polymorphisms associated with longevity. In recent investigations of the mechanism involved we found that the longevity genotypes ameliorated the risk of mortality posed by having a cardiometabolic disease (CMD)—most prominently hypertension. For the gene FOXO3 the protective alleles mitigated the risk of hypertension, coronary heart disease (CHD) and diabetes. For the kinase MAP3K5 it was hypertension, CHD and diabetes, for the kinase receptor PIK3R1 hypertension, CHD and stroke, and for the growth hormone receptor gene (GHR) and vascular endothelial growth factor receptor 1 gene (FLT1), it was nullifying the higher mortality risk posed by hypertension. Subjects with a CMD who had a longevity genotype had similar survival as men without CMD. No variant protected against risk of death from cancer. We have postulated that the longevity-associated genotypes reduced mortality risk by effects on intracellular resilience mechanisms. In a proteomics study, 43 “stress” proteins and associated biological pathways were found to influence the association of FOXO3 genotype with reduced mortality.

CONCLUSIONS

Our landmark findings indicate how heritable genetic components affect longevity.
Validating the Reliability and Clinical Relevance of an Infraorbital Hollow Photonumeric Scale
Authors: Lorenc Z Paul , Smith Stacy , Bass Lawrence S , Bank David , Weiss Robert , Canfield Doug , D’Alessandro Brian M , Cramer Lisa M
Published: August 2023

Background

Infraorbital hollowing is a facial aesthetic issue for which a broad age range of patients seek treatment. Expanding treatment options for this region warrants the development of validated tools to objectively assess infraorbital hollow (IOH) severity before and after treatment.

Objectives

To validate a 4-point rating scale to assess depression of IOH, depression relative to the mid-pupillary line, and visibility of the lateral orbital rim.

Methods

The IOH scale described herein was developed and subjected to live validation with a total of 73 patients representing the full range of IOH severities. Scale validation was performed by board-certified plastic surgeons and dermatologists (3 raters) over 2 rounds, 2 weeks apart. Intrarater and interrater reliabilities were used to demonstrate test–retest reliability as quantitated with percentage of agreement, weighted kappa statistic with 95% confidence interval (CI), and intraclass correlation coefficient with 95% CI. The clinical relevance of a 1-grade difference was evaluated by comparing rater assessments of 77 photo pairs with their previously determined designation as “clinically different” or “not clinically different.”

Results

The IOH scale demonstrated substantial to near-perfect intrarater and interrater reliabilities when utilized by trained raters to assess a diverse group of live patients. Furthermore, clinically relevant differences between grades were established, and detection of a 1-point difference could be achieved by trained evaluators using the IOH scale.

Conclusions

This highly reliable, clinically relevant, and validated IOH scale provides a user-friendly, standardized grading system to objectively evaluate and track changes in infraorbital hollowing in clinical practice and research.

Level of Evidence: 3
The language network is not engaged in object categorization
Authors: Benn Yael , Ivanova Anna A , Clark Oliver , Mineroff Zachary , Seikus Chloe , Silva Jack Santos , Varley Rosemary , Fedorenko Evelina
Published: August 2023

The relationship between language and thought is the subject of long-standing debate. One claim states that language facilitates categorization of objects based on a certain feature (e.g. color) through the use of category labels that reduce interference from other, irrelevant features. Therefore, language impairment is expected to affect categorization of items grouped by a single feature (low-dimensional categories, e.g. “Yellow Things”) more than categorization of items that share many features (high-dimensional categories, e.g. “Animals”). To test this account, we conducted two behavioral studies with individuals with aphasia and an fMRI experiment with healthy adults. The aphasia studies showed that selective low-dimensional categorization impairment was present in some, but not all, individuals with severe anomia and was not characteristic of aphasia in general. fMRI results revealed little activity in language-responsive brain regions during both low- and high-dimensional categorization; instead, categorization recruited the domain-general multiple-demand network (involved in wide-ranging cognitive tasks). Combined, results demonstrate that the language system is not implicated in object categorization. Instead, selective low-dimensional categorization impairment might be caused by damage to brain regions responsible for cognitive control. Our work adds to the growing evidence of the dissociation between the language system and many cognitive tasks in adults.
First Known Human Death After Infection With the Avian Influenza A/H3N8 Virus: Guangdong Province, China, March 2023
Authors: Zhuang Yali , Wang Man , Liang Lijun , Mao Yunxia , Wang Kaibin , Yang Shuhuan , Deng Aiping , Zeng Kewen , Zhang Yingtao , Zhang Guanting , Kang Min , Li Baisheng , Zhang Meng , Ye Shinan
Published: August 2023

Here, we report on a case of human infection with the H3N8 avian influenza virus. The patient had multiple myeloma and died of severe infection. Genome analysis showed multiple gene mutations and reassortments without mammalian-adaptive mutations. This suggests that avian influenza (A/H3N8) virus infection could be lethal for immunocompromised persons.
The prevalence ofTrichomonas vaginalisinfection among the female population of Iran: a systematic review and meta-analysis
Authors: Moghadamizad Zeinab , Khalili Javad Yazdizadeh , Olfatifar Meysam , Badri Milad , Khazaei Sasan
Published: August 2023

Trichomonas vaginalis is a protozoan parasite and probably one of the main causes of adverse birth outcomes. Still, there is a paucity of information regarding the burden of T. vaginalis infection in Iranian women. To address this gap, we conducted a systematic review and meta-analysis of studies on trichomoniasis among females in Iran from January 2000 to January 2023. We searched multiple electronic databases (PubMed, Science Direct, Scopus, ProQuest, Web of Science, Google Scholar, Scientific Information Database, Iran Medex, Magiran and Iran Doc) and identified 108 articles with a total of 200 728 women. Using a random effects model, we found a pooled prevalence of 4.30% (95% CI 3.23 to 5.52%). Subgroup analysis, also, demonstrated a statistically significant association between the T. vaginalis prevalence in Iranian women, and the age range, city, sample type, being in prison, sex working and symptomatic infections. Our findings provide important information for healthcare authorities and can inform prevention strategies against trichomoniasis in Iran.
Recurrence of tuberculous tenosynovitis in wrist tendon of a butcher: rare case report
Authors: Abdulrahman Binar Burhan , Aziz Jeza Muhamad Abdul , Salih Mohammed Kak Bra , Rashid Muhammad Jabar , Ahmed Mohammed Latif , Awl Ramyar Hersh , Rauf Shanga Baram , Ali Harem Habil Hama , Huy Nguyen Tien , Rasheed Mariwan Kadir
Published: August 2023

Diagnosing of tuberculous arthritis can be challenging due to its insidious onset and non-specific clinical presentation. A high index of suspicion is required for early diagnosis. A 54-year-old butcher was admitted to an orthopedic clinic with complaints of pain, paresthesia and an enlarging mass in the left wrist, which limited finger flexion. Initially the patient was diagnosed with carpal tunnel syndrome (CTS); the patient had no history of tuberculosis (TB), but had direct contact with animals. On clinical examination, a small mass was found in the distal volar region of the forearm and no lymphadenopathy was observed. Despite the diagnosis the patient refused to receive TB treatment. After a period of 4 months, the patient once again exhibited symptoms of CTS. This case highlights the importance of considering TB as a potential etiology for persistent symptoms of carpal tunnel surgery. Early diagnosis and prompt initiation of TB treatment can result in favorable outcomes and can prevent future recurrence.
Bivalent mRNA-1273.214 vaccine effectiveness against SARS-CoV-2 omicron XBB* infections
Authors: Chemaitelly Hiam , Ayoub Houssein H , AlMukdad Sawsan , Faust Jeremy S , Tang Patrick , Coyle Peter , Yassine Hadi M , Al Thani Asmaa A , Al-Khatib Hebah A , Hasan Mohammad R , Al-Kanaani Zaina , Al-Kuwari Einas , Jeremijenko Andrew , Kaleeckal Anvar H , Latif Ali N , Shaik Riyazuddin M , Abdul-Rahim Hanan F , Nasrallah Gheyath K , Al-Kuwari Mohamed G , Butt Adeel A , Al-Romaihi Hamad E , Al-Thani Mohamed H , Al-Khal Abdullatif , Bertollini Roberto , Abu-Raddad Laith J
Published: August 2023

Effectiveness of the 50-μg mRNA-1273.214 bivalent vaccine against SARS-CoV-2 infection was modest at 25% in a matched, retrospective, cohort study in Qatar comparing infection incidence in the bivalent cohort to that in the national no-recent-vaccination resident cohort. XBB* immune evasion, immune imprinting effects, or both, may explain findings.
Experimental validation of the mechanism of stomatal development diversification
Authors: Doll Yuki , Koga Hiroyuki , Tsukaya Hirokazu
Published: August 2023

Stomata are the structures responsible for gas exchange in plants. The established framework for stomatal development is based on the model plant Arabidopsis, but diverse patterns of stomatal development have been observed in other plant lineages and species. The molecular mechanisms behind these diversified patterns are still poorly understood. We recently proposed a model for the molecular mechanisms of the diversification of stomatal development based on the genus Callitriche (Plantaginaceae), according to which a temporal shift in the expression of key stomatal transcription factors SPEECHLESS and MUTE leads to changes in the behavior of meristemoids (stomatal precursor cells). In the present study, we genetically manipulated Arabidopsis to test this model. By altering the timing of MUTE expression, we successfully generated Arabidopsis plants with early differentiation or prolonged divisions of meristemoids, as predicted by the model. The epidermal morphology of the generated lines resembled that of species with prolonged or no meristemoid divisions. Thus, the evolutionary process can be reproduced by varying the SPEECHLESS to MUTE transition. We also observed unexpected phenotypes, which indicated the participation of additional factors in the evolution of the patterns observed in nature. This study provides novel experimental insights into the diversification of meristemoid behaviors.
TESS photometry of the pulsating hot subdwarf star V585 Peg
Authors: Reed M D , Baran A S , Telting J H , Østensen R H
Published: August 2023

We report on the first space-based observations of the bright, high-amplitude hybrid pulsator V585 Peg (Balloon 090100001). TESS observed V585 Peg for 28 d during Sector 56 from which we detect 14 g-mode pulsations, 20 p-mode pulsations, and 26 combination frequencies. These pulsations are unusual and interesting in a number of ways; V585 Peg is a rare hybrid pulsator where both regions have many (>10) pulsations, the p-mode pulsations have clear frequency multiplets and overtone spacings while the g-mode pulsations do not, its multiplets have shown changes in splittings between years, and it appears to have two stochastic pulsations while most are stable. From p-mode multiplets, we find an average rotation period of 6.91 ± 0.83 d in which the different ℓ and m indices indicate latitudinal differential rotation. Unresolved g-mode multiplets limit rotation periods to be longer then 9.3 d for dipole modes, indicating V585 Peg to also be a radially differential rotator. We detect one secure p-mode overtone of 950 $\mu$Hz and four less sure ones of 314, 410, 440, and 554 $\mu$Hz. Two frequencies show stochastic properties indicating mode lifetimes of 3.5 and 6.2 h, which would be the shortest yet discovered.
SIMBA-C: an updated chemical enrichment model for galactic chemical evolution in the SIMBA simulation
Authors: Hough Renier T , Rennehan Douglas , Kobayashi Chiaki , Loubser S Ilani , Davé Romeel , Babul Arif , Cui Weiguang
Published: August 2023

We introduce a new chemical enrichment and stellar feedback model into GIZMO, using the SIMBA sub-grid models as a base. Based on the state-of-the-art chemical evolution model of Kobayashi et al., SIMBA-C tracks 34 elements from H→Ge and removes SIMBA’s instantaneous recycling approximation. Furthermore, we make some minor improvements to SIMBA’s base feedback models. SIMBA-C provides significant improvements on key diagnostics such as the knee of the z = 0 galaxy stellar mass function, the faint end of the main sequence, and the ability to track black holes in dwarf galaxies. SIMBA-C also matches better with recent observations of the mass–metallicity relation at z = 0, 2. By not assuming instantaneous recycling, SIMBA-C provides a much better match to galactic abundance ratio measures such as [O/Fe] and [N/O]. SIMBA-C thus opens up new avenues to constrain feedback models using detailed chemical abundance measures across cosmic time.
Contrast-enhanced ultrasonography reveals a lower cortical perfusion and a decreased renal flow reserve in hypertensive patients
Authors: Damianaki Aikaterini , Hendriks-Balk Mariëlle , Brito Wendy , Polychronopoulou Erietta , Theiler Kenji , Maillard Marc , Maurer Jonathan , Eugster Philippe , Pruijm Menno , Wuerzner Grégoire
Published: August 2023

Background

Microvascular structural alteration and dysfunction is a hallmark of arterial hypertension. So far, the visualization and the quantification of renal microcirculation in humans has been hampered by the lack of non-nephrotoxic and non-invasive radiologic techniques. Contrast-enhanced ultrasonography (CEUS) is an appealing method to investigate renal microcirculation and has not been investigated in this setting. We aimed to compare renal microcirculation in normotensive (NT) and hypertensive (HT) participants using CEUS at rest and during a sympathetic stress test.

Methods

We measured the renal perfusion index (PI, primary outcome), the renal resistive index (RRI), beat-to-beat systemic hemodynamics and plasma catecholamines before and during a 2-min cold pressor test (CPT) in NT and HT participants. Linear mixed model analysis was used to compare the effect of the CPT on the variables of interest.

Results

Seventy-three participants (32 HT) with normal kidney function were included. HT participants had a lower baseline PI compared with NT participants [median (interquartile range) 1476 (959–2155) arbitrary units (a.u.) vs 2062 (1438–3318) a.u., P < .001]. The CPT increased blood pressure, heart rate and catecholamines in all participants. The increase in PI observed in NT during the CPT was blunted in HT [+504 (117–920) a.u. vs +1159 (678–2352) a.u in NT, interaction P = .013]. Age, sex and body mass index did not modify these results.

Conclusions

HT patients had a lower basal renal cortical perfusion. During the cold pressor test, HT participants had a smaller increase in the PI, suggesting that renal cortical flow reserve is impaired.
Additional Burden Averted in the United States From Use of MF59-Adjuvanted Seasonal Influenza Vaccine Compared With Standard Seasonal Influenza Vaccine Among Adults ≥65 Years
Authors: McGovern Ian , Sardesai Aditya , Taylor Alexandra , Toro-Diaz Hector , Haag Mendel
Published: August 2023

Background

The MF59-adjuvanted trivalent inactivated influenza vaccine (aIIV3) is designed to overcome immunosenescence and enhance vaccine responses in older adults. We expanded on the Centers for Disease Control and Prevention (CDC) modeling method to estimate the number of additional influenza-related outcomes averted with aIIV3 versus generic quadrivalent inactivated influenza vaccine (IIV4) in adults ≥65 years over 3 influenza seasons (2017–2018 to 2019–2020) in the United States.

Methods

A static compartmental model was developed based on an existing CDC model with 2 previously recommended calculation methods that increased the accuracy of the model in providing estimates of burden averted. Model inputs included vaccine effectiveness, vaccine coverage, population counts, and disease burden estimates. Additional burden averted (symptomatic cases, outpatient visits, hospitalizations, intensive care unit [ICU] admissions, and deaths) was expressed as total incremental cases averted between the vaccines. Sensitivity analyses tested the resilience of the model results to uncertainties in model inputs.

Results

The model estimated that vaccination with aIIV3 versus IIV4 would avert 2.24 times as many symptomatic cases, outpatient visits, hospitalizations, ICU stays, and deaths during 2017–2018; the burden averted in 2018–2019 and 2019–2020 with aIIV3 would be 3.44 and 1.72 times that averted with IIV4, respectively. Disease burden estimates and relative vaccine effectiveness of aIIV3 had the greatest impact on model estimates.

Conclusions

Over 3 influenza seasons, the model estimated that aIIV3 was more effective than IIV4 in averting influenza-related outcomes, preventing 1.72 to 3.44 times as many influenza illnesses with proportionate decreases in related healthcare use and complications.
Muslim Women, Nikah Marriages, Domestic Abuse and Religious Arbitration in England
Authors: Uddin Islam
Published: August 2023

This article explores the underlying causes and motivations surrounding non-legally binding Islamic marriages or nikah-only marriages, and their impact on dispute resolution and the process of obtaining a religious divorce, with a special focus on women experiencing domestic abuse. It draws on empirical data from a study of Islamic divorce in the UK. Inspired by phenomenological approaches, the research involved in-depth interviews with British-Muslim women to gain a well-grounded understanding of the problems associated with Muslim marriage, domestic abuse, and divorce from their lived experiences. Furthermore, the study involved interviews with experts associated with providing informal mediation and religious arbitration ranging from imams to Sharia council judges, as well as professionals such as solicitors and counsellors. Sharia council hearings were also observed and their procedural documents were analysed. The data collected were analysed using a thematic approach, and the emergent themes from the rich data provide a detailed insight into the research problem, firmly embedded in the lived experience of British Muslims.
The Netherlands
Authors: Ryngaert Cedric
Published: August 2023

The Netherlands is one of the cradles of modern international law. This is not just because its capital, The Hague is dubbed the ‘legal capital of the world’, but also because it has put a high premium on international law in its foreign policy. Initially, it saw international law as an insurance policy against the scheming of the larger European powers. Especially since the 1970s, however, it has staked out a more universalist position, particularly by actively promoting human rights in its foreign policy. The Dutch self-image of a champion of international law is not free of contradictions, however. The Netherlands is only slowly coming to terms with its colonial past and legacy. Also, its reliance on international law is at times selective and self-serving. Its independent courts, advisory bodies, vibrant media, and academic institutions may however prevent its international law confidence from turning into smugness.
Eukaryote-specific assembly factor DEAP2 mediates an early step of photosystem II assembly in Arabidopsis
Authors: Keller Jakob-Maximilian , Frieboes Maureen Julia , Jödecke Ludwig , Kappel Sandrine , Wulff Natalia , Rindfleisch Tobias , Sandoval-Ibanez Omar , Gerlach Ines , Thiele Wolfram , Bock Ralph , Eirich Jürgen , Finkemeier Iris , Schünemann Danja , Zoschke Reimo , Schöttler Mark Aurel , Armbruster Ute
Published: August 2023

The initial step of oxygenic photosynthesis is the thermodynamically challenging extraction of electrons from water and the release of molecular oxygen. This light-driven process, which is the basis for most life on Earth, is catalyzed by photosystem II (PSII) within the thylakoid membrane of photosynthetic organisms. The biogenesis of PSII requires a controlled step-wise assembly process of which the early steps are considered to be highly conserved between plants and their cyanobacterial progenitors. This assembly process involves auxiliary proteins, which are likewise conserved. In the present work, we used Arabidopsis (Arabidopsis thaliana) as a model to show that in plants, a eukaryote-exclusive assembly factor facilitates the early assembly step, during which the intrinsic antenna protein CP47 becomes associated with the PSII reaction center (RC) to form the RC47 intermediate. This factor, which we named DECREASED ELECTRON TRANSPORT AT PSII (DEAP2), works in concert with the conserved PHOTOSYNTHESIS AFFECTED MUTANT 68 (PAM68) assembly factor. The deap2 and pam68 mutants showed similar defects in PSII accumulation and assembly of the RC47 intermediate. The combined lack of both proteins resulted in a loss of functional PSII and the inability of plants to grow photoautotrophically on the soil. While overexpression of DEAP2 partially rescued the pam68 PSII accumulation phenotype, this effect was not reciprocal. DEAP2 accumulated at 20-fold higher levels than PAM68, together suggesting that both proteins have distinct functions. In summary, our results uncover eukaryotic adjustments to the PSII assembly process, which involve the addition of DEAP2 for the rapid progression from RC to RC47.
Compartmentation of photosynthesis gene expression in C4 maize depends on time of day
Authors: Borba Ana Rita , Reyna-Llorens Ivan , Dickinson Patrick J , Steed Gareth , Gouveia Paulo , Górska Alicja M , Gomes Celia , Kromdijk Johannes , Webb Alex A R , Saibo Nelson J M , Hibberd Julian M
Published: August 2023

Compared with the ancestral C3 state, C4 photosynthesis occurs at higher rates with improved water and nitrogen use efficiencies. In both C3 and C4 plants, rates of photosynthesis increase with light intensity and are maximal around midday. We determined that in the absence of light or temperature fluctuations, photosynthesis in maize (Zea mays) peaks in the middle of the subjective photoperiod. To investigate the molecular processes associated with these temporal changes, we performed RNA sequencing of maize mesophyll and bundle sheath strands over a 24-h time course. Preferential expression of C4 cycle genes in these cell types was strongest between 6 and 10 h after dawn when rates of photosynthesis were highest. For the bundle sheath, DNA motif enrichment and gene coexpression analyses suggested members of the DNA binding with one finger (DOF) and MADS (MINICHROMOSOME MAINTENANCE FACTOR 1/AGAMOUS/DEFICIENS/Serum Response Factor)-domain transcription factor families mediate diurnal fluctuations in C4 gene expression, while trans-activation assays in planta confirmed their ability to activate promoter fragments from bundle sheath expressed genes. The work thus identifies transcriptional regulators and peaks in cell-specific C4 gene expression coincident with maximum rates of photosynthesis in the maize leaf at midday.
Income Source Confusion Using the SILC
Authors: Bollinger Christopher Robert , Tasseva Iva Valentinova
Published: August 2023

We use a unique panel of household survey data—the Austrian version of the European Union Statistics on Income and Living Conditions (SILC) for 2008–2011—which have been linked to individual administrative records on both state unemployment benefits and earnings. We assess the extent and structure of misreporting across similar benefits and between benefits and earnings. We document that many respondents fail to report participation in one or more of the unemployment programs. Moreover, they inflate earnings for periods when they are unemployed but receiving unemployment compensation. To demonstrate the impact of income source confusion on estimators, we estimate standard Mincer wage equations. Since unemployment is associated with lower education, the reports of unemployment benefits as earnings bias downward the returns to education. Failure to report unemployment benefits also leads to substantial sample bias when selecting on these benefits, as one might in estimating the returns to job training.
Privacy Attitudes toward Mouse-Tracking Paradata Collection
Authors: Henninger Felix , Kieslich Pascal J , Fernández-Fontelo Amanda , Greven Sonja , Kreuter Frauke
Published: August 2023

Survey participants’ mouse movements provide a rich, unobtrusive source of paradata, offering insight into the response process beyond the observed answers. However, the use of mouse tracking may require participants’ explicit consent for their movements to be recorded and analyzed. Thus, the question arises of how its presence affects the willingness of participants to take part in a survey at all—if prospective respondents are reluctant to complete a survey if additional measures are recorded, collecting paradata may do more harm than good. Previous research has found that other paradata collection modes reduce the willingness to participate, and that this decrease may be influenced by the specific motivation provided to participants for collecting the data. However, the effects of mouse movement collection on survey consent and participation have not been addressed so far. In a vignette experiment, we show that reported willingness to participate in a survey decreased when mouse tracking was part of the overall consent. However, a larger proportion of the sample indicated willingness to both take part and provide mouse-tracking data when these decisions were combined, compared to an independent opt-in to paradata collection, separated from the decision to complete the study. This suggests that survey practitioners may face a trade-off between maximizing their overall participation rate and maximizing the number of participants who also provide mouse-tracking data. Explaining motivations for paradata collection did not have a positive effect and, in some cases, even reduced participants’ reported willingness to take part in the survey.
Comparison of two frailty definitions in women with systemic lupus erythematosus
Authors: Lieber Sarah B , Nahid Musarrat , Legge Alexandra , Rajan Mangala , Lipschultz Robyn A , Lin Myriam , Reid M Carrington , Mandl Lisa A
Published: August 2023

Objectives

Frailty is a risk factor for adverse health in SLE. The Fried phenotype (FP) and the SLICC Frailty Index (SLICC-FI) are common frailty metrics reflecting distinct approaches to frailty assessment. We aimed to (1) compare frailty prevalence according to both metrics in women with SLE and describe differences between frail and non-frail participants using each method and (2) evaluate for cross-sectional associations between each metric and self-reported disability.

Methods

Women aged 18–70 years with SLE were enrolled. FP and SLICC-FI were measured, and agreement calculated using a kappa statistic. Physician-reported disease activity and damage, Patient Reported Outcome Measurement Information System (PROMIS) computerized adaptive tests, and Valued Life Activities (VLA) self-reported disability were assessed. Differences between frail and non-frail participants were evaluated cross-sectionally, and the association of frailty with disability was determined for both metrics.

Results

Of 67 participants, 17.9% (FP) and 26.9% (SLICC-FI) were frail according to each metric (kappa = 0.41, P < 0.01). Compared with non-frail women, frail women had greater disease damage, worse PROMIS scores, and greater disability (all P < 0.01 for FP and SLICC-FI). After age adjustment, frailty remained associated with a greater odds of disability [FP: odds ratio (OR) 4.7, 95% CI 1.2, 18.8; SLICC-FI: OR 4.6, 95% CI 1.3, 15.8].

Conclusion

Frailty is present in 17.9–26.9% of women with SLE. These metrics identified a similar, but non-identical group of women as frail. Further studies are needed to explore which metric is most informative in this population.
Professional Identity Formation of Basic Science Medical Educators: A Qualitative Study of Identity Supports and Threats
Authors: Brooks Joanna Veazey , Dickinson Bonny L. , Quesnelle Kelly M. , Bonaminio Giulia A. , Chalk-Wilayto Janine , Dahlman Kimberly Brown , Fulton Tracy B. , Hyland Katherine M. , Kruidering Marieke , Osheroff Neil , Tuan Rupa Lalchandani , Ho Ming-Jung
Published: August 2023

Purpose

Basic science medical educators (BSME) play a vital role in the training of medical students, yet little is known about the factors that shape their professional identities. This multi-institutional qualitative study investigated factors that support and threaten the professional identity formation (PIF) of these medical educators.

Method

A qualitative descriptive study was conducted with a purposive sample of 58 BSME from 7 allopathic medical schools in the U.S. In-depth semi-structured interviews of individual BSME were conducted between December 2020 and February 2021 to explore the facilitators and barriers shaping the PIF of BSME. Thematic analysis was conducted.

Results

Factors shaping PIF were grouped into 3 broad domains: personal, social, and structural. Interrelated themes described a combination of factors that pushed BSME into teaching (early or positive teaching experiences) and kept them there (satisfaction and rewards of teaching, communities of like-minded people), as well as factors that challenged their PIF (misunderstanding from medical students, clinical, and research faculty, lack of formal training programs, and lack of tenure-track educator positions). The structural environment was reported to be crucial for PIF and determined whether BSME felt that they belonged and were valued.

Conclusions

This study shows that although most BSME derive a sense of fulfillment and meaning from their role as medical educators, they face considerable obstacles during their PIF. Structural change and support are needed to increase recognition, value, promotion, and belonging for BSME to improve the satisfaction and retention of this important group of faculty.
Automated Patient Note Grading: Examining Scoring Reliability and Feasibility
Authors: Bond William F. , Zhou Jianing , Bhat Suma , Park Yoon Soo , Ebert-Allen Rebecca A. , Ruger Rebecca L. , Yudkowsky Rachel
Published: August 2023

Purpose

Scoring postencounter patient notes (PNs) yields significant insights into student performance, but the resource intensity of scoring limits its use. Recent advances in natural language processing (NLP) and machine learning allow application of automated short answer grading (ASAG) for this task. This retrospective study evaluated psychometric characteristics and reliability of an ASAG system for PNs and factors contributing to implementation, including feasibility and case-specific phrase annotation required to tune the system for a new case.

Method

PNs from standardized patient (SP) cases within a graduation competency exam were used to train the ASAG system, applying a feed-forward neural networks algorithm for scoring. Using faculty phrase-level annotation, 10 PNs per case were required to tune the ASAG system. After tuning, ASAG item-level ratings for 20 notes were compared across ASAG-faculty (4 cases, 80 pairings) and ASAG-nonfaculty (2 cases, 40 pairings). Psychometric characteristics were examined using item analysis and Cronbach’s alpha. Inter-rater reliability (IRR) was examined using kappa.

Results

ASAG scores demonstrated sufficient variability in differentiating learner PN performance and high IRR between machine and human ratings. Across all items the ASAG-faculty scoring mean kappa was .83 (SE ± .02). The ASAG-nonfaculty pairings kappa was .83 (SE ± .02). The ASAG scoring demonstrated high item discrimination. Internal consistency reliability values at the case level ranged from a Cronbach’s alpha of .65 to .77. Faculty time cost to train and supervise nonfaculty raters for 4 cases was approximately $1,856. Faculty cost to tune the ASAG system was approximately $928.

Conclusions

NLP-based automated scoring of PNs demonstrated a high degree of reliability and psychometric confidence for use as learner feedback. The small number of phrase-level annotations required to tune the system to a new case enhances feasibility. ASAG-enabled PN scoring has broad implications for improving feedback in case-based learning contexts in medical education.
Hsa_circ_0001946 Ameliorates Mechanical Stress-induced Intervertebral Disk Degeneration Via Targeting miR-432-5p and SOX9
Authors: Xiang Qian , Wang Juntan , Cheng Zhangrong , Zhao Kangcheng , Gan Weikang , Chen Yuhang , Zhang Yukun
Published: August 2023

Study Design.

Experimental analysis of circular RNA in intervertebral disk degeneration (IDD).

Objective.

This study aimed to explore the roles of hsa_circ_0001946 (circ-CDR1as) in mechanical stress-induced nucleus pulposus cell injury in IDD.

Summary of Background Data.

Mechanical stress is an important pathogenic factor for IDD. Excessive compression stress leads to nucleus pulposus (NP) cell apoptosis and extracellular matrix (ECM) degradation and accelerated IDD. Circ-CDR1as is associated with various degenerative conditions, but its role in IDD is not clear. Herein, we explored the roles and mechanisms of circ-CDR1as in IDD in vitro.

Materials and Methods.

An in vitro model of IDD was constructed by treating NP cells with 1.0 MPa compression stress. Quantitative real-time polymerase chain reaction assay was used for detecting the expression of circ-CDR1as and miR-432-5p. Immunofluorescent analysis was performed for MMP13 detection. Western blot assay was performed for detecting apoptosis and ECM-related protein expression. Flow cytometry analysis was used for cell apoptosis analysis. The dual-luciferase reporter was used to analyze the interaction between miR-432-5p and circ-CDR1as or SOX9. Differences in means between groups were evaluated using the Student t test or one-way analysis of variance.

Results.

In compression-treated human NP cells, we found that circ-CDR1as was significantly downregulated. Functional experiments showed that circ-CDR1as overexpression reduced the compression-induced apoptosis and ECM degradation in NP cells. Further research indicated that circ-CDR1as could act as a molecular sponge for miR-432-5p, a miRNA that enhanced compression-induced damage of NP cells by inhibiting the expression of SOX9. The luciferase reporter experiments also showed that the mutual dialogue between circ-CDR1as and miR-432-5p regulated the expression of SOX9.

Conclusions.

Circ-CDR1as binds to miR-432-5p and plays a protective role in mitigating compression-induced NP cell apoptosis and ECM degradation by targeting SOX9. Circ-CDR1as may provide a novel therapeutic target for the clinical management of IDD in the future.
Achilles Tendon Ruptures: Anatomy and Physiology
Authors: Greisberg Justin K. , Arciero Emily
Published: August 2023

Together, the muscle bellies of the medial and lateral gastrocnemius along with the soleus conjoin to make the Achilles tendon. The Achilles tendon is the most commonly ruptured tendon. It is important to take into account the length-tension relationship of muscle and anatomic positioning of the Achilles when treating Achilles tendon ruptures.

Level of Evidence: Level V, expert opinion.
A Comparison of Multimodal Analgesic Regimens for Opioid Reduction in Elective Plastic Surgery: A Randomized Study
Authors: Long-Lijoi Katherine L. , Mukherjee Hrijeeta , Pinell Ximena A. , Grimmer Karl , Davison Steven P.
Published: August 2023

Background:

This trial aimed to compare the efficacy of a multimodal analgesic regimen with gabapentin to a multimodal nonsteroidal anti-inflammatory drug (NSAID) regimen following cosmetic surgery. This was a prospective randomized study of 106 patients undergoing elective outpatient cosmetic surgery.

Methods:

Patients were randomly assigned to a multimodal regimen of postoperative acetaminophen, gabapentin, and oxycodone with an acetaminophen and gabapentin preload or postoperative ibuprofen and oxycodone-acetaminophen protocol without a preload. Data on compliance, number of narcotic pills consumed, duration of analgesic use, pain levels, patient satisfaction, time from incision close to postanesthesia care unit (PACU) admission, and incidence of bleeding-related complications were collected and analyzed.

Results:

Patients from both regimens reported equivalent postoperative pain control with the exception of pain in PACU. NSAID patients exhibited a 9.3% higher rate of compliance (P = 0.01), a 6.0% higher rate of satisfaction with pain control (P = 0.04), a 25.2% shorter interval between closure and PACU (=0.01), and an 8.2% lower rate of bleeding-related complications, all of which were statistically significant (P < 0.05).

Conclusions:

Both regimens are viable tools in combating opioid overprescription as they both effectively reduce postoperative pain. However, the NSAID protocol resulted in greater satisfaction related to pain management and was more cost-effective by reducing emergence time from anesthesia. As there were no hematomas associated with the use of NSAIDs and a significantly higher rate of compliance, the use of NSAIDs in enhanced recovery after surgery protocols is supported.
Pneumosepsis survival in the setting of obesity leads to persistent steatohepatitis and metabolic dysfunction
Authors: Kumar Avnee J. , Parthasarathy Chitra , Prescott Hallie C. , Denstaedt Scott J. , Newstead Michael W. , Bridges Dave , Bustamante Angela , Singer Kanakadurga , Singer Benjamin H.
Published: August 2023

Background:

As critical care practice evolves, the sepsis survivor population continues to expand, often with lingering inflammation in many organs, including the liver. Given the concurrently increasing population of patients with NAFLD, in this study, we aimed to understand the long-term effect of sepsis on pre-existing NAFLD and hyperglycemia.

Methods:

Male mice were randomized to a high-fat diet or a control diet (CD). After 24 weeks on diet, mice were inoculated with Klebsiella pneumoniae (Kpa). Serial glucose tolerance tests, and insulin and pyruvate challenge tests were performed 1 week before infection and at 2 and 6 weeks after infection. Whole tissue RNA sequencing and histological evaluation of the liver were performed. To test whether persistent inflammation could be reproduced in other abnormal liver environments, mice were also challenged with Kpa after exposure to a methionine-choline–deficient high-fat diet. Finally, a retrospective cohort of 65,139 patients was analyzed to evaluate whether obesity was associated with liver injury after sepsis.

Results:

After Kpa inoculation, high-fat diet mice had normalized fasting blood glucose without a change in insulin sensitivity but with a notable decrease in pyruvate utilization. Liver examination revealed focal macrophage collections and a unique inflammatory gene signature on RNA analysis. In the clinical cohort, preobesity, and class 1 and class 2 obesity were associated with increased odds of elevated aminotransferase levels 1–2 years after sepsis.

Conclusions:

The combination of diet-induced obesity and pneumosepsis survival in a murine model resulted in unique changes in gluconeogenesis and liver inflammation, consistent with the progression of benign steatosis to steatohepatitis. In a cohort study, obese patients had an increased risk of elevated aminotransferase levels 1–2 years following sepsis.
Posterior segment manifestations of ocular metastasis
Authors: Kongwattananon Wijak , Pothikamjorn Thananop , Somkijrungroj Thanapong
Published: August 2023

Purpose of review

This article reviewed and summarized recent published data on ocular imaging findings and treatment of posterior segment manifestations of ocular metastasis.

Recent findings

Advanced ocular imaging can help differentiate ocular metastases from other mimicking lesions, including primary intraocular tumors or infections. Recently, case reports have demonstrated the successful use of targeted systemic therapy to achieve local control of vitreous and choroidal metastases.

Metastasis can lead to a wide variety of posterior segment ocular manifestations. The choroid is the most common metastatic site, whereas tumor metastasizing to the retina and optic disc are rare. Patients with possible metastatic eye disease are recommended to undergo extensive investigation to determine the underlying primary cancer and ongoing systemic metastases. Currently, there is no consensus on the treatment strategy. Treatment generally includes systemic chemotherapy in combination with local treatment, such as radiotherapy, laser therapy, or anti-vascular endothelial growth factor (anti-VEGF) treatment.
Predictors of Colonoscopy Use Among Asian Indians in New York City, 2003 to 2016
Authors: Nagpal Neha , McCready Taylor M. , Xia Yuhe , Lin Kevin , Glenn Matthew , Ng Sandy , Trinh-Shevrin Chau , Troxel Andrea B. , Kwon Simona C. , Liang Peter S.
Published: August 2023

Background:

Asian Americans have the lowest colorectal cancer screening uptake of any racial and ethnic group in the United States. Asian Indians are among the most under-screened Asian American subgroups, but there is limited data for this population. We sought to characterize predictors of colonoscopy use among Asian Indians in New York City.

Methods:

Using 2003 to 2016 data from the New York City Community Health Survey, we identified all Asian Indian participants aged 50 years or older. We examined the association between sociodemographic and medical factors and up-to-date colonoscopy use (defined as colonoscopy within the last 10 y) using logistic regression over 4 time periods: 2003 to 2008, 2009 to 2012, 2013 to 2014, 2015 to 2016.

Results:

On multivariable analysis, language, age, income, recent exercise, body mass index, and influenza vaccination were associated with colonoscopy uptake in 1 time period. Compared with participants who preferred English, those who preferred an Indian language were less likely to have been up-to-date in 2013 to 2014 (odds ratio 0.12, 95% CI 0.02-0.66). Individuals older than 65 years were more likely than those aged 50 to 64 years to have received a colonoscopy in 2009 to 2012 (odds ratio 3.91, 95% CI 1.49-10.24), although the risk estimates were also consistently positive in the other 3 time periods.

Conclusions:

Among Asian Indians living in New York City, several demographic, socioeconomic, and health-related characteristics predict colonoscopy use. These findings highlight the importance of examining determinants of colonoscopy uptake in this understudied population to inform future public health interventions.
Chronically misdiagnosed Eagle’s syndrome, treated through transoral styloidectomy: a rare case report
Authors: Hamamin Omed Shafiq , Arif Ali Talib , Razha Ayoub Baqr , Abdul Aziz Jeza Muhamad , Rashid Muhammad Jabar , Rasheed Mariwan kadir , Abdullah Lanya Latif , Abdulrahman Mustafa Shakhawan , Ghafoor Raz Abdulkarim , Qutbadeen Nuha , Hamasharif Pshko Ahmad
Published: August 2023

Introduction:

The stylohyoid ligament begins when the styloid process extends from the petrous temporal bone in a thin bony protrusion. Eagle’s syndrome (ES) is a condition related to either calcification of the calcifying the stylohyoid ligament or elongating styloid process The incidence of symptomatic ES is 0.16%, and it is more common in women. The reported study diagnosed ES and treated it surgically through transoral approach styloidectomy.

Case presentation:

A 39-year-old man who is a farmer and a driver was presented with complaints of ongoing, excruciating discomfort in the back of his left ear. Before the exam, he took a variety of drugs, various drugs 2 years without receiving a definitive diagnosis. Axial, coronal, and sagittal computed tomography scans of both petrous bones were analyzed, and the results showed aberrant styloid process elongation and calcification of the stylohyoid ligament

Discussion:

ES, shares many symptoms with other regional illnesses. Physicians frequently misdiagnose cases of ES and treat them without providing a conclusive diagnosis or treatment.

Conclusion:

ES diagnosis can be difficult for otolaryngologists and primary care providers due to its similarity with other regional illnesses. However, surgical intervention can result in consistent and significant symptomatic improvement when correctly diagnosed. The case presented in the report was successfully diagnosed as ES and treated surgically through transoral approach styloidectomy.
Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis
Authors: Shah Bidhan Bikram , Shankar Abhirami , Kumar Vinesh , Kumar Sumeet , Malik Umair Arshad , Majeed Abdul , Kumar Vijay , Berkha  , Suman  , Kumar Sumeet , Netha Aadarsh , Subedi Sonika , Ahmed Shoaib
Published: August 2023

Background:

Optimal treatment regimen for patients with antiphospholipid syndrome (APS) remain unclear. Therefore, the authors sought to compare the outcomes of vitamin K antagonists (VKAs) vs. direct oral anticoagulants (DOACs) in patients with APS.

Methods:

MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials comparing efficacy and safety of VKAs and DOACs inhibitors in patients with APS. Recurrent thrombosis, all-cause mortality, stroke, adverse reactions, and bleeding were among outcomes of interest. Mantel–Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs.

Results:

The analysis included 625 patients from four randomized controlled trials and one post hoc analysis. Meta-analysis showed statistically non-significant difference between DOACs inhibitors and VKAs in the recurrent thrombosis risk (arterial or venous) [RR 2.77 (95%, CI 0.79, 9.65); P=0.11, I2=50%]. Consistent results were revealed among patients with the previous history of arterial thrombosis [RR 2.76 (95% CI 0.93, 8.16); P=0.75, I2=0%], venous thrombosis [RR 1.71 (95% CI 0.60, 4.84); P=0.31, I2=15%] and patients who were triple antiphospholipid positive [RR 4.12 (95% CI 0.46, 37.10); P=0.21, I2=58%]. DOACs inhibitors were significantly associated with increased risk of stroke [RR 8.51 (95% CI 2.35, 3.82); P=0.47, I2=0%].

Conclusion:

DOACs exhibited increased risk of stroke among patients with APS. In addition, although not significant, the higher RRs among patients on DOACs may indicate higher risk of thrombotic events associated with DOACs.