bluuebunny/crossref_metadata_2025 huggingface dataset:
Apixaban in a porcine model of mechanical valve thrombosis in pulmonary position—a pilot study
Authors: Van Hoof Lucas , Truyers Isabelle , Van Hauwermeiren Hadewych , Nachtergaele Bram , Langenaeken Tom , Jacquemin Marc , Rega Filip , Verhamme Peter , Meuris Bart
Published: March 2022

OBJECTIVES

The newest mechanical valves have low thrombogenicity, making them candidates for anticoagulation with a direct oral anticoagulant. While these drugs hold great promise to replace warfarin, clinical trials have been disappointing so far. We aimed to evaluate apixaban in a porcine model of mechanical valve thrombosis with On-X® (CryoLife) aortic valves implanted in pulmonary position.

METHODS

On-X® valves were implanted in pulmonary valve position in 9 Yucatan pigs. Animals received prophylactic enoxaparin 40 mg for 1 week. Pigs in the low-dose group received 5 mg apixaban twice daily for 10 weeks. The intermediary-dose group received 5 mg twice daily for 6 weeks and then 10 mg twice daily afterwards. The high-dose group received 15 mg twice daily for 10 weeks. After sacrifice, valves were macroscopically evaluated and thrombus weight was documented.

RESULTS

The median weight of the 9 animals was 64.3 kg, range 52.5–70.9. In the low-dose group (2 animals), both valves showed manifest, chronic thrombosis with blocked hinges. In the intermediary-dose group, a normal functioning valve without thrombosis was seen in 2/4 animals. In the high-dose group (3 pigs), there was no valve thrombosis. No bleeding events occurred. In all animals, apixaban plasma levels were low compared to clinical target levels.

CONCLUSIONS

The pulmonary position seems to be an aggressive model for mechanical valve thrombosis in pigs. Apixaban has the potential to prevent valve thrombosis, even in these thrombogenic conditions. Detailed pharmacokinetic studies are needed to determine the ideal apixaban dosage for future experiments and to enable extrapolation to the clinical situation.
Measuring Political Knowledge and Not Search Proficiency in Online Surveys
Authors: DeBell Matthew
Published: March 2022

Most online survey questions testing political knowledge are susceptible to measurement error when participants look up the answers. This article reports five studies of methods to detect and prevent this common source of error. To detect lookups, “catch questions” are more reliable than self-reports, because many participants lie rather than admit looking up answers. Strongly worded instructions reduced lookups by about two-thirds, while the triple combination of instructions, requesting a promise not to look up answers, and adaptive feedback (asking participants who look up an answer to stop doing so) reduced the percentage of respondents looking up an answer by a further half, to 3%. For office recall knowledge items, photo-based open-ended questions eliminated lookups and had similar validity to traditional text-based versions, making them a good choice when a visual format is viable.
Gastrointestinal Microbiome Disruption and Antibiotic-Associated Diarrhea in Children Receiving Antibiotic Therapy for Community-Acquired Pneumonia
Authors: Kwon Jiye , Kong Yong , Wade Martina , Williams Derek J , Creech Clarence Buddy , Evans Scott , Walter Emmanuel B , Martin Judy M , Gerber Jeffrey S , Newland Jason G , Hofto Meghan E , Staat Mary Allen , Chambers Henry F , Fowler Vance G , Huskins W Charles , Pettigrew Melinda M
Published: March 2022

Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotics. We examined the gastrointestinal microbiota in children treated with β-lactams for community-acquired pneumonia. Data were from 66 children (n = 198 samples), aged 6–71 months, enrolled in the SCOUT-CAP trial (NCT02891915). AAD was defined as ≥1 day of diarrhea. Stool samples were collected on study days 1, 6–10, and 19–25. Samples were analyzed using 16S ribosomal RNA gene sequencing to identify associations between patient characteristics, microbiota characteristics, and AAD (yes/no). Nineteen (29%) children developed AAD. Microbiota compositional profiles differed between AAD groups (permutational multivariate analysis of variance, P < .03) and across visits (P < .001). Children with higher baseline relative abundances of 2 Bacteroides species were less likely to experience AAD. Higher baseline abundance of Lachnospiraceae and amino acid biosynthesis pathways were associated with AAD. Children in the AAD group experienced prolonged dysbiosis (P < .05). Specific gastrointestinal microbiota profiles are associated with AAD in children.
“As Expected”: Theoretical Implications for Racialized Administrative Power as the Status Quo
Authors: Blume Grant H
Published: March 2022

This article posits that racialized administrative power is the status quo in the United States and results from a wicked problem broadly construed as institutional racism. Acknowledging a baseline reality of racialized administrative power in the United States allows public administration theory to more directly grapple with the institutional racism that paradoxically may seem too big and complex to empirically study yet simultaneously too important and urgent to ignore. This article offers three contributions to the development of public administration theory from this conceptual frame of racialized administrative power as the status quo. First, by conceptualizing institutional racism as a wicked problem, a case is outlined to replace an assumption of neutral administrative power with a baseline assumption of racialized administrative power in the United States. Second, the article explores two prominent areas of theory in public administration—representative bureaucracy and administrative burden—to demonstrate how a baseline assumption of racialized administrative power can reorient and expand theoretical questions and research. Third, the article discusses the epistemological implications for public administration theory and research based on an assumption that racialized administrative power is the status quo. These contributions offer a step forward in addressing the need for public administration theory to better account for the institutional racism that pervades the management and performance of public organizations in the United States.
Cytokinin oxidase/dehydrogenase family genes exhibit functional divergence and overlap in rice growth and development, especially in control of tillering
Authors: Rong Chenyu , Liu Yuexin , Chang Zhongyuan , Liu Ziyu , Ding Yanfeng , Ding Chengqiang
Published: March 2022

Cytokinins play key roles in plant growth and development, and hence their biosynthesis and degradation have been extensively studied. Cytokinin oxidase/dehydrogenases (CKXs) are a group of enzymes that regulate oxidative cleavage to maintain cytokinin homeostasis. In rice, 11 CKX genes have been identified to date; however, most of their functions remain unknown. In this study, we comprehensively examined the expression patterns and functions of the CKXs in rice by using CRISPR/Cas9 technology to construct mutants of all 11 genes. The results revealed that the ckx single-mutants and higher-order ckx4 ckx9 mutant lines showed functional overlaps and sub-functionalization. Notably, the ckx1 ckx2 and ckx4 ckx9 double-mutants displayed contrasting phenotypic changes in tiller number and panicle size compared to the wild-type. In addition, we identified several genes with significantly altered expression in both the ckx4 and ckx9 single-mutant and double-mutant plants. Many of the differentially expressed genes were found to be associated with auxin and cytokinin pathways, and cytokinins in the ckx4 ckx9 double-mutant were increased compared to the wild-type. Taken together, our findings provide new insights into the functions of CKX genes in rice growth and may provide the foundations for future studies aimed at improving rice yield.
The resolved chemical abundance properties within the interstellar medium of star-forming galaxies at z≈ 1.5
Authors: Gillman S , Puglisi A , Dudzevičiūtė U , Swinbank A M , Tiley A L , Harrison C M , Molina J , Sharples R M , Bower R G , Cirasuolo M , Ibar Edo , Obreschkow D
Published: March 2022

We exploit the unprecedented depth of integral field data from the KMOS Ultra-deep Rotational Velocity Survey (KURVS) to analyse the strong (Hα) and forbidden ([N ii], [S ii]) emission line ratios in 22 main-sequence galaxies at $z\, \approx \, 1.5$. Using the [N ii]/Hα emission-line ratio, we confirm the presence of the stellar mass – gas-phase metallicity relation at this epoch, with galaxies exhibiting on average 0.13 ± 0.04 dex lower gas-phase metallicity (12 + log(O/H)M13  =  8.40 ± 0.03) for a given stellar mass (log10(M*[M⊙]  =  10.1 ± 0.1) .than local main-sequence galaxies. We determine the galaxy-integrated [S ii] doublet ratio, with a median value of [S ii]λ6716/λ6731  =  1.26 ± 0.14 equivalent to an electron density of log10(ne[cm−3])  =  1.95 ± 0.12. Utilising CANDELS HST multi-band imaging we define the pixel surface-mass and star-formation rate density in each galaxy and spatially resolve the fundamental metallicity relation at $z\, \approx \, 1.5$, finding an evolution of 0.05 ± 0.01 dex compared to the local relation. We quantify the intrinsic gas-phase metallicity gradient within the galaxies using the [N ii]/Hα calibration, finding a median annuli-based gradient of ΔZ/ΔR  =  −0.015 ± 0.005 dex kpc−1. Finally, we examine the azimuthal variations in gas-phase metallicity, which show a negative correlation with the galaxy integrated star-formation rate surface density ($r_{\rm s}\,$  =  −0.40, ps  =  0.07) but no connection to the galaxies kinematic or morphological properties nor radial variations in stellar mass surface density or star formation rate surface density. This suggests both the radial and azimuthal variations in interstellar medium properties are connected to the galaxy integrated density of recent star formation.
Homogeneous transit timing analyses of 10 exoplanet systems
Authors: Baştürk Ö , Esmer E M , Yalçınkaya S , Torun Ş , Mancini L , Helweh F , Karamanlı E , Southworth J , Aliş S , Wünsche A , Tezcan F , Aladağ Y , Aksaker N , Tunç E , Davoudi F , Fişek S , Bretton M , Evans D F , Yeşilyaprak C , Yılmaz M , Tezcan C T , Yelkenci K
Published: March 2022

We study the transit timings of 10 exoplanets in order to investigate potential transit timing variations in them. We model their available ground-based light curves, some presented here and others taken from the literature, and homogeneously measure the mid-transit times. We statistically compare our results with published values and find that the measurement errors agree. However, in terms of recovering the possible frequencies, homogeneous sets can be found to be more useful, of which no statistically relevant example has been found for the planets in our study. We corrected the ephemeris information of all 10 planets we studied and provide these most precise light elements as references for future transit observations with space-borne and ground-based instruments. We found no evidence for secular or periodic changes in the orbital periods of the planets in our sample, including the ultra-short period WASP-103 b, whose orbit is expected to decay on an observable time-scale. Therefore, we derive the lower limits for the reduced tidal quality factors (Q$^{\prime }_{\star }$) for the host stars based on best-fitting quadratic functions to their timing data. We also present a global model of all available data for WASP-74 b, which has a Gaia parallax-based distance value ∼25 per cent larger than the published value.
Detecting the periodicity of highly irregularly sampled light curves with Gaussian processes: the case of SDSS J025214.67−002813.7
Authors: Covino Stefano , Tobar Felipe , Treves Aldo
Published: March 2022

Based on a 20-yr-long multiband observation of its light curve, it was conjectured that the quasar SDSS J025214.67−002813.7 has a periodicity of ∼4.4 yr. These observations were acquired at a highly irregular sampling rate and feature long intervals of missing data. In this setting, the inference over the light curve’s spectral content requires, in addition to classic Fourier methods, a proper model of the probability distribution of the missing observations. In this article, we address the detection of the periodicity of a light curve from partial and irregularly sampled observations using Gaussian processes, a Bayesian non-parametric model for time series. This methodology allows us to evaluate the veracity of the claimed periodicity of the above-mentioned quasar and also to estimate its power spectral density. Our main contribution is the confirmation that considering periodic component definitely improves the modelling of the data, although being the source originally selected by a large sample of objects, the possibility that this is a chance result cannot be ruled out.
Synthetic solar cycle for active regions violating the Hale’s polarity law
Authors: Zhukova A , Khlystova A , Abramenko V , Sokoloff D
Published: March 2022

Long observational series for bipolar active regions (ARs) provide significant information about the mutual transformation of the poloidal and toroidal components of the global solar magnetic field. The direction of the toroidal field determines the polarity of leading sunspots in ARs in accordance with the Hale’s polarity law. The vast majority of bipolar ARs obey this regularity, whereas a few per cent of ARs have the opposite sense of polarity (anti-Hale ARs). However, the study of these ARs is hampered by their poor statistics. The data for five 11-yr cycles (16–18 and 23, 24) were combined here to compile a synthetic cycle of unique time length and latitudinal width. The synthetic cycle comprises data for 14838 ARs and 367 of them are the anti-Hale ARs. A specific routine to compile the synthetic cycle was demonstrated. We found that, in general, anti-Hale ARs follow the solar cycle and are spread throughout the time-latitude diagram evenly, which implies their fundamental connection with the global dynamo mechanism and the toroidal flux system. The increase in their number and percentage occurs in the second part of the cycle, which is in favour of their contribution to the polar field reversal. The excess in the anti-Hale ARs percentage at the edges of the butterfly diagram and near an oncoming solar minimum (where the toroidal field weakens) might be associated with the strengthening of the influence of turbulent convection and magnetic field fluctuations on the arising flux tubes. The evidence of the misalignment between the magnetic and heliographic equators is also found.
Bending waves excited by irregular gas inflow along warps
Authors: Khachaturyants Tigran , Beraldo e Silva Leandro , Debattista Victor P , Daniel Kathryne J
Published: March 2022

Gaia has revealed clear evidence of bending waves in the vertical kinematics of stars in the solar neighbourhood. We study bending waves in two simulations, one warped, with the warp due to misaligned gas inflow, and the other unwarped. We find slow, retrograde bending waves in both models, with the ones in the warped model having larger amplitudes. We also find fast, prograde bending waves. Prograde bending waves in the unwarped model are very weak, in agreement with the expectation that these waves should decay on short, approximately crossing, time-scales, due to strong winding. However, prograde bending waves are much stronger for the duration of the warped model, pointing to irregular gas inflow along the warp as a continuous source of excitation. We demonstrate that large-amplitude bending waves that propagate through the solar neighbourhood give rise to a correlation between the mean vertical velocity and the angular momentum, with a slope consistent with that found by Gaia. The bending waves affect populations of all ages, but the sharpest features are found in the young populations, hinting that short-wavelength waves are not supported by the older, kinematically hotter, populations. Our results demonstrate the importance of misaligned gas accretion as a recurrent source of vertical perturbations of disc galaxies, including in the Milky Way.
RNA polymerase pausing, stalling and bypass during transcription of damaged DNA: from molecular basis to functional consequences
Authors: Agapov Aleksei , Olina Anna , Kulbachinskiy Andrey
Published: March 2022

Cellular DNA is continuously transcribed into RNA by multisubunit RNA polymerases (RNAPs). The continuity of transcription can be disrupted by DNA lesions that arise from the activities of cellular enzymes, reactions with endogenous and exogenous chemicals or irradiation. Here, we review available data on translesion RNA synthesis by multisubunit RNAPs from various domains of life, define common principles and variations in DNA damage sensing by RNAP, and consider existing controversies in the field of translesion transcription. Depending on the type of DNA lesion, it may be correctly bypassed by RNAP, or lead to transcriptional mutagenesis, or result in transcription stalling. Various lesions can affect the loading of the templating base into the active site of RNAP, or interfere with nucleotide binding and incorporation into RNA, or impair RNAP translocation. Stalled RNAP acts as a sensor of DNA damage during transcription-coupled repair. The outcome of DNA lesion recognition by RNAP depends on the interplay between multiple transcription and repair factors, which can stimulate RNAP bypass or increase RNAP stalling, and plays the central role in maintaining the DNA integrity. Unveiling the mechanisms of translesion transcription in various systems is thus instrumental for understanding molecular pathways underlying gene regulation and genome stability.
Structural Determinants of Sugar Alcohol Biosynthesis in Plants: The Crystal Structures of Mannose-6-Phosphate and Aldose-6-Phosphate Reductases
Authors: Minen Romina I , Bhayani Jaina A , Hartman Matías D , Cereijo Antonela E , Zheng Yuanzhang , Ballicora Miguel A , Iglesias Alberto A , Liu Dali , Figueroa Carlos M
Published: March 2022

Sugar alcohols are major photosynthetic products in plant species from the Apiaceae and Plantaginaceae families. Mannose-6-phosphate reductase (Man6PRase) and aldose-6-phosphate reductase (Ald6PRase) are key enzymes for synthesizing mannitol and glucitol in celery (Apium graveolens) and peach (Prunus persica), respectively. In this work, we report the first crystal structures of dimeric plant aldo/keto reductases (AKRs), celery Man6PRase (solved in the presence of mannonic acid and NADP+) and peach Ald6PRase (obtained in the apo form). Both structures displayed the typical TIM barrel folding commonly observed in proteins from the AKR superfamily. Analysis of the Man6PRase holo form showed that residues putatively involved in the catalytic mechanism are located close to the nicotinamide ring of NADP+, where the hydride transfer to the sugar phosphate should take place. Additionally, we found that Lys48 is important for the binding of the sugar phosphate. Interestingly, the Man6PRase K48A mutant had a lower catalytic efficiency with mannose-6-phosphate but a higher catalytic efficiency with mannose than the wild type. Overall, our work sheds light on the structure–function relationships of important enzymes to synthesize sugar alcohols in plants.
Transitioning Opinion?
Authors: Lewis Daniel C , Flores Andrew R , Haider-Markel Donald P , Miller Patrick R , Taylor Jami K
Published: March 2022

Few public opinion surveys addressed transgender rights prior to 2015, but scholarly attention to these issues began to proliferate with a series of surveys from 2015 and 2016 that identified a number of important variables shaping attitudes toward transgender people and policies. Yet, the political environment surrounding transgender rights has changed significantly since 2015, with increasing public attention to these issues, more prominent position taking by partisan political figures, and substantial shifts in public policy on a wide variety of transgender issues. We examine a wide range of survey items throughout this period to explore how public opinion has evolved over time. Further, using national surveys from 2015 and 2020, we explore whether and how the structure of public opinion may have changed. Our analyses reveal growing support for transgender rights, the increasing importance of political orientations and elite cues in shaping opinion, and substantial variation in attitudes across issues.
Rotating particles in AdS: Holography at weak gauge coupling and without conformal symmetry
Authors: Kitamura Tomotaka , Miyashita Shoichiro , Sekino Yasuhiro
Published: March 2022

We consider the gauge/gravity correspondence between maximally supersymmetric Yang–Mills theory in (p + 1) dimensions and superstring theory on the near-horizon limit of the Dp-brane solution. The string-frame metric is AdSp + 2 × S8 − p times a Weyl factor, and there is no conformal symmetry except for p = 3. In a previous paper by one of the present authors, the free-field result of gauge theory has been reproduced from string theory for a particular operator that has angular momentum along S8 − p. In this paper, we extend this result to operators that have angular momenta along AdSp + 2. Our approach is based on a Euclidean formulation proposed by Dobashi et al. [Nucl. Phys. B 665, 94 (2003)] and on the “string bit” picture. We first show that the spinning string solution in Lorentzian AdS, found by Gubser et al. [Nucl. Phys. B 636, 99 (2002)], can be recast in a form that connects two points on the boundary of Euclidean AdS. The transition amplitudes of such strings can be interpreted as gauge theory correlators. We study the case of zero gauge coupling by ignoring interactions among string bits (massless particles in 10D spacetime that constitute a string), and show that the free-field results of gauge theory are reproduced.
Center vortex and confinement in Yang–Mills theory and QCD with anomaly-preserving compactifications
Authors: Tanizaki Yuya , Ünsal Mithat
Published: March 2022

We construct an anomaly-preserving compactification of 4D gauge theories, including SU(N) Yang–Mills theory, $\mathcal {N}=1$ supersymmetric Yang–Mills theory, and quantum chromodynamics (QCD), down to 2D by turning on the ’t Hooft flux through T2. This provides a new framework to analytically calculate nonperturbative properties such as confinement, chiral symmetry breaking, and the multi-branch structure of vacua. We give a semiclassical description of these phenomena based on the center vortex and show that it enjoys the same anomaly-matching condition as the original 4D gauge theory. We conjecture that the weak-coupling vacuum structure on small $T^2 \times \mathbb {R}^2$ is adiabatically connected to the strong-coupling regime on $\mathbb {R}^4$ without any phase transitions. In QCD with fundamental quarks as well, we can turn on the ’t Hooft flux either by activating the SU(Nf)V symmetry twist for Nf = N flavors or by introducing a magnetic flux of baryon number U(1)B for arbitrary Nf flavors. In both cases, the weak-coupling center-vortex theory gives a prediction consistent with the chiral Lagrangian of 4D QCD.
How Intersectional Threat Shapes Views of Gun Policy: The John Wayne Solution
Authors: Drakulich Kevin , Craig Brandon M
Published: March 2022

Guns are highly visible in the news, in politics, and in American culture more broadly. While most Americans support some gun control, a significant and vocal minority of Americans are firmly opposed. Drawing on work from the recently developing sociology of modern gun culture, we propose an intersectional threat model—wherein perceived threats to multiple privileged identities provoke a distinct response—for understanding the positions Americans take on gun policies. Using data from a 2018 national survey conducted by the American National Election Survey, we find a robust role for perceived threats along gender, race, and citizenship lines in opposition to background checks for private sales and an assault weapons ban as well as support for arming teachers. Interactions reveal multiplicative effects: that gender threats matter more when racial and immigrant threats are also felt. We discuss implications for the prospect of policy and for understanding the pro-gun alt-right movement and other potential applications of intersectional threat.
Sonography of the Floor of the Mouth: Anatomic Highlights, Pitfalls, and Normal Variants
Authors: Dawkins Adrian , Sobieh Ahmed , Nair Rashmi , Ganesh Halemane
Published: March 2022

Neck sonography is well-established as a primary imaging tool for the evaluation of the thyroid gland and thyroid-related pathologies. However, there are other structures within the head and neck that may be thoroughly evaluated sonographically, avoiding the need for more costly and time-consuming imaging modalities. The authors seek to tout the prowess of ultrasound beyond the typical confines of the thyroid, focusing on the sonography of the floor of the mouth.
Estimands and Estimation of COVID-19 Vaccine Effectiveness Under the Test-Negative Design
Authors: Schnitzer Mireille E.
Published: March 2022

The test-negative design is routinely used for the monitoring of seasonal flu vaccine effectiveness. More recently, it has become integral to the estimation of COVID-19 vaccine effectiveness, in particular for more severe disease outcomes. Because the design has many important advantages and is becoming a mainstay for monitoring postlicensure vaccine effectiveness, epidemiologists and biostatisticians may be interested in further understanding the effect measures being estimated in these studies and connections to causal effects. Logistic regression is typically applied to estimate the conditional risk ratio but relies on correct outcome model specification and may be biased in the presence of effect modification by a confounder. We give and justify an inverse probability of treatment weighting (IPTW) estimator for the marginal risk ratio, which is valid under effect modification. We use causal directed acyclic graphs, and counterfactual arguments under assumptions about no interference and partial interference to illustrate the connection between these statistical estimands and causal quantities. We conduct a simulation study to illustrate and confirm our derivations and to evaluate the performance of the estimators. We find that if the effectiveness of the vaccine varies across patient subgroups, the logistic regression can lead to misleading estimates, but the IPTW estimator can produce unbiased estimates. We also find that in the presence of partial interference both estimators can produce misleading estimates.
Cesarean section delivery rates, determinants, and indications: a retrospective study in Dekemhare Hospital
Authors: Idris Idris M. , Menghisteab Selam
Published: March 2022

Objectives:

Cesarean section delivery is at increasing rate worldwide. The present study was designed to explore the cesarean section delivery rate, and its common indications along with their socio-demographic determinants in Dekemhare Hospital, Southern region of Eritrea.

Methods and Materials:

A retrospective study was utilized to retrieve data of all women who delivered in Dekemhare Hospital during 2019. Using a structured questionnaire, all information required was recorded using data files such as birth (vaginal and cesarean) files, pregnancy registration file, and neonatal data. All women who delivered by cesarean section, their indications were collected reviewing registration records of the operating theater where the procedure was conducted. To describe the results, both descriptive and analytical analysis were conducted using SPSS version 25. χ2 test and multivariate logistic regression analysis were done to identify determinants of cesarean section. A significance level of 0.05 was used as a cut point of statistical significance.

Main Findings:

The rate of cesarean section delivery was 10.1%. The top 6 indications of cesarean section were: malposition (26.3%), prolonged and obstructed labor (21.2%), mal-presentation (14.4%), previous/repeat cesarean section (10.2%), amniotic fluid disorders (9.3%), and fetal distress (5.9%). Mothers who were nulliparous [odds ratio (OR): 9.2; 95% confidence interval (CI): 1.8–14.3; P-value: 0.007], referral from other health facility (OR: 7.8, 95% CI: 3.7–16.5, P-value <0.0001), and who had delivered stillbirths (OR: 8.2; 95% CI: 1.7–38.9; P-value: 0.008) were more likely to deliver through cesarean section.

Conclusion:

The rate of cesarean section in Dekemhare hospital is fairly optimal (10.1%). Prolonged and obstructed labor, mal-presentation and malposition were the most common indications. Nulliparous and referral mothers had higher risk of cesarean section. Decision-making for cesarean section should outweigh the benefits and risks of the intervention within the context of women’s entire reproductive life-cycle.
Impact of estimated pulse wave velocity and socioeconomic status on the risk of stroke in men: a prospective cohort study
Authors: Jae Sae Young , Heffernan Kevin S. , Kim Hyun Jeong , Kunutsor Setor K. , Fernhall Bo , Kurl Sudhir , Laukkanen Jari A.
Published: March 2022

Objective:

High pulse wave velocity (PWV) and low socioeconomic status (SES) are each associated with increased risk of stroke, but clarification of the interplay between PWV, SES and the risk of stroke appears to be warranted to identify vulnerable populations at high risk of stroke. We conducted a prospective study that examined the independent and joint associations of PWV and SES with the risk of stroke in the general population.

Methods:

The current study included 2666 men aged 42–61 years, who were enrolled in the Kuopio Ischaemic Heart Disease Study cohort. Estimated PWV (ePWV), a proxy of carotid-femoral PWV, was calculated from an equation based on age and mean blood pressure. SES was assessed using self-reported questionnaires and classified as tertiles, whereas ePWV was categorized as high (≥10m/s) and low (<10m/s).

Results:

Individuals with high ePWV had a 48% higher risk of stroke after adjusting for confounding factors, whereas individuals with low SES had a similar 35% increased risk of stroke, compared with those high SES. Results of the joint associations of ePWV and SES with stroke showed high ePWV-high SES and high ePWV-low SES to be each associated with an increased risk of stroke: hazard ratios 1.53, 95% confidence intervals (CIs) (1.12–2.08) and hazard ratio 1.63, 95% CI (1.21–2.20), respectively, but low ePWV-low SES was not associated with a heightened risk of stroke (hazard ratio 1.12, 95% CI 0.87–1.44) compared with the low ePWV-high SES group.

Conclusion:

ePWV and SES are each independently associated with stroke risk. The association between elevated ePWV and the heightened risk of stroke is regardless of low or high SES.
High Prevalence of Tuberculosis Infection and Disease in Child Household Contacts of Adults With Rifampin-resistant Tuberculosis
Authors: Kim Soyeon , Wu Xingye , Hughes Michael D. , Upton Caryn , Narunsky Kim , Mendoza-Ticona Alberto , Khajenoori Saltnat , Gonzales Pedro , Badal-Faesen Sharlaa , Shenje Justin , Omoz-Oarhe Ayotunde , Rouzier Vanessa , Garcia-Prats Anthony J. , Demers Anne-Marie , Naini Linda , Smith Elizabeth , Churchyard Gavin , Swindells Susan , Shah N. Sarita , Gupta Amita , Hesseling Anneke C. ,   for the ACTG A5300/IMPAACT 2003/PHOENix Feasibility Study Team
Published: March 2022

Background:

Household contact (HHC) investigation is an important strategy to identify individuals with tuberculosis (TB) exposure, infection and disease, including those who may benefit from tuberculosis preventive therapy (TPT). Data in children exposed to rifampin-resistant TB are limited.

Methods:

In preparation for and to inform the feasibility of an interventional trial, HHC of adults with pulmonary rifampin-resistant TB from high TB-burden countries were evaluated in a cross-sectional study. Using interferon-gamma release assay and study-specific and 2015 international consensus definitions of intrathoracic TB in children, we evaluated the prevalence and predictors of TB infection and disease in child (<15 years) HHCs.

Results:

Of 303 child HHCs, median age (range) 7 years (0−14), 57% [95% confidence interval (CI): 50%–64%] had a positive interferon-gamma release assay result (TB infected). TB infection was associated with the index case smoking (P = 0.034), being the parent or sleeping in the same room (P = 0.002) and the child HHC being age ≥5 years and having attended school (P = 0.013). Four had study-defined confirmed TB and 9 had probable TB, a prevalence of 4.3% (95% CI: 2.6%−7.1%). Using the international consensus definitions, 4 had confirmed TB and 49 had unconfirmed TB, a prevalence of 17.2% (95% CI: 12.9%–22.4%). Twenty (7%) children had received TPT.

Conclusions:

The prevalence of TB infection and disease was high in child HHC exposed to rifampin-resistant TB. Few children had routinely received TPT. High-quality evidence is needed to inform strong recommendations for and access to TPT in children exposed to TB resistant to rifampin.
Neuroscientific evidence for pain being a classically conditioned response to trauma- and pain-related cues in humans
Authors: Franke Laila K. , Miedl Stephan F. , Danböck Sarah K. , Grill Markus , Liedlgruber Michael , Kronbichler Martin , Flor Herta , Wilhelm Frank H.
Published: March 2022

Psychological trauma is typically accompanied by physical pain, and posttraumatic stress disorder (PTSD) often cooccurs with chronic pain. Clinical reports suggest that pain after trauma may be part of re-experiencing symptomatology. Classical conditioning can underlie visual re-experiencing because intrusions can occur as conditioned responses (CRs) to trauma-related cues. If individuals also experience pain to cues previously paired with, but not inflicting nociceptive stimulation anymore (ie, conditioned stimuli, CS), conditioning could also explain re-experiencing of pain. Sixty-five participants underwent classical conditioning, where painful electrocutaneous stimulation and aversive film clips served as unconditioned stimuli (US) in a 2 (pain/no pain) × 2 (aversive/neutral film) design. Conditioned stimuli were neutral pictures depicting contextual details from the films. One day later, participants were re-exposed to CS during a memory-triggering task (MTT). We assessed pain-CRs by self-report and an fMRI-based marker of nociceptive pain, the neurological pain signature (NPS), and recorded spontaneous daily-life pain intrusions with an e-diary. During conditioning, pain-signaling CS elicited more self-reported pain and NPS responses than no-pain–signaling CS. Possibly because the aversive film masked differences in participants' responses to pain-signaling CS vs no pain–signaling CS, pain-CRs during acquisition were most evident within the neutral film condition. When participants were re-exposed to CS during MTT, self-reported pain-CRs during the neutral film condition and, although more uncertain, NPS-CRs during the aversive film condition persisted. Of importance, participants with stronger pain-CRs showed a greater probability and severity of experiencing spontaneous pain intrusions during daily life. Our data support that spatiotemporally associating innocuous cues with pain (CS) endows these cues to elicit conditioned pain responses in the absence of noxious stimulation. In this way pain can emerge as a CR with emotional and sensory components. Classical conditioning presents a possible mechanism explaining pain intrusions and, more broadly, pain experienced without a nociceptive input.
Spotlighting the Zebras: A Role for Medical Students in Shaping Rare Disease Care
Authors: Ayyappan Vinay , Gonzalez Elizabeth , Pichette Émilie , Spahic Harisa , Guzman Stacy
Published: March 2022

Rare diseases are collectively common, and thus very likely to be encountered in clinical practice. However, due in large part to deficits in medical training specific to these conditions, rare disease patients all-too often find themselves facing inadequate care. We are medical students representing institutions from the United States and Canada who believe that trainees can drive change in the landscape of rare disease care. In addition to highlighting a need for medical education to inculcate the knowledge and skills to effectively care for rare disease patients, we describe our efforts including a combination of peer-assisted learning, patient-oriented outreach, and interprofessional collaboration, which are intended to improve awareness of rare disease among future medical professionals.
Respiratory ECMO Survival Prediction (RESP) Score for COVID-19 Patients Treated with ECMO
Authors: Joshi Hariom , Flanagan Mindy , Subramanian Rakeshkumar , Drouin Michelle
Published: March 2022

Veno-venous extracorporeal membrane oxygenation (VV ECMO) has been used as a life-supporting modality for patients with severe respiratory failure because of coronavirus disease 2019 (COVID-19). We aim to evaluate the performance of the RESP score in predicting the hospital survival of COVID-19 patients undergoing VV ECMO. We performed retrospective analysis of the extracorporeal life support organization (ELSO) dataset for COVID-19 patients requiring ECMO support to evaluate the performance of RESP score in predicting in hospital survival.

All adult (age ≥18) COVID-19 patients receiving VV ECMO for acute respiratory failure enrolled in the ELSO database from March to August 2020 were included in the analysis.

A total of 1985 patients from the ELSO registry were identified and analyzed based on pre-ECMO variables. Median RESP score of survivors was 3 (IQR 1–5) compared to 2 (IQR 0–4) in deceased. A logistic model including RESP score variables poorly discriminated survival and death with AUC (area under curve) 0.61 (95% confidence interval: 0.59–0.64). In-hospital survival for COVID-19 patients based on RESP score class from I to V was 69.7%, 59.3%, 45.7%, 42.5%, and 32.3%, respectively. Patients with immunosuppression (relative risk = 0.43) and pre-ECMO cardiac arrest (relative risk = 0.48) had lower survival.

RESP score is a poor predictor of survival in COVID-19 patients undergoing ECMO. Compared to the original cohort used for RESP score creation, COVID-19 patients in RESP class I–III had worse survival whereas the patients in RESP class IV–V had better survival.
Nurse Executive Experiences With COVID-19
Authors: Langan Joanne C. , Griffin Anne Reid , Shipman Sallie , Dobalian Aram
Published: March 2022

We conducted semistructured telephone interviews with 2 hospital-based nurse leaders who supervised nurses during the initial phases of the COVID-19 pandemic in northeastern region of the United States. These interviews are a subset of a larger study with 11 nurse executives who supervised nurses during both natural and human-made disasters in different regions of the United States. Qualitative data were analyzed using a grounded theory approach, followed by a content analysis of emerging themes. Participants shared several key concepts: deep commitment of nurses in an extensive range of roles and responsibilities during tragic events; an emphasis on educational needs to best prepare nurses for disaster response; the importance of organizational strategies and definitive policies for supporting nurses' response and recovery; and mental/emotional health support as essential for nurses to cope with the events. The nurse executive participants reported many opportunities to enhance nurses' knowledge and skill set to augment care in the hospital. A team-based approach that leverages the expertise of team members to strengthen the health care team is implemented and demonstrates positive patient outcomes.
Restless Legs Syndrome and the Eyes
Authors: Can Usta Nuray , Gunay Betul Onal
Published: March 2022

Background:

Restless legs syndrome (RLS) is a movement disorder thought to be caused by impaired dopamine action. This study aimed to evaluate possible changes in ocular biometric and optic coherence tomography (OCT) parameters in RLS patients.

Methods:

This is a prospective, cross-sectional comparative study. Consecutive primary and secondary (with iron-deficiency anemia) RLS patients and age-matched and sex-matched controls were enrolled in the study. All participants underwent comprehensive neurological and ophthalmological examinations. Ocular biometric and OCT parameters, such as choroidal thickness, macular thickness, macular volume, ganglion cell layer thickness, inner nuclear cell layer thickness, and retinal nerve fiber layer thickness, were compared.

Results:

Fifty-one RLS patients and 50 healthy controls were included in this study. There was no difference between the groups’ refraction status, ocular biometric data (axial length, anterior chamber depth, central corneal thickness), or OCT parameters (choroidal thickness, macular thickness, macular volume, ganglion cell layer thickness, inner nuclear cell layer thickness). Primary and secondary (with only iron-deficiency anemia) RLS patients were compared, and there was no difference in their axial length, anterior chamber depth, central corneal thickness or OCT parameters. No significant relationship was found between disease severity or duration and OCT parameters.

Conclusions:

Disease severity and disease duration do not affect OCT parameters in primary or secondary RLS patients. OCT data do not seem to provide information about the course of this disease.
Current Understanding of the Effects and Potential Clinical Utility of Kratom: A Review
Authors: Larsen Inna , Zhang Emily , Farahmand Pantea
Published: March 2022

Objective:

The increasingly widespread use of kratom in the United States has raised concerns about its safety as well as spurring research into potential applications of its active ingredients in medical treatments.

Methods:

We reviewed the literature published over the past 20 years, including peer-reviewed publications and data released by United States government health agencies to provide an overview of this topic.

Results:

A variety of potentially beneficial and adverse effects of kratom use related to its opioid and stimulant properties have been documented, including addiction and withdrawal. Preliminary research in animals and case reports in humans have suggested medical utility for kratom in treating alcohol and opioid use disorders, pain, depression, and anxiety. However, the lack of controlled, standardized studies limits the clinical utility of this agent and is a barrier to safe consumption.

Conclusions:

Historically, kratom has been used for medical purposes and for the treatment of alcohol and substance use disorders. The currently available literature suggests a potential for similar clinical applications. However, without controlled research studies or regulation, kratom poses numerous health risks to consumers.
Electrocardiogram Monitoring Practices for Hospitalized Adults Receiving Antipsychotics: A Retrospective Cohort Study
Authors: Sinvani Liron , Afroz-Hossain Anika , Muran Andrew , Strunk Andrew , Williams Myia S. , Qiu Michael , Zeltser Roman , Makaryus Amgad N. , Wolf-Klein Gisele , Pekmezaris Renee
Published: March 2022

Objective:

Antipsychotics are frequently used for managing both acute and chronic neuropsychiatric disorders. While antipsychotics are known to be associated with increased mortality due to cardiac arrhythmia, there is a lack of consensus on the timing and frequency of electrocardiogram (ECG) monitoring.  The goal of this study was to examine current ECG monitoring practices for adults receiving antipsychotics, specifically during hospital admission.

Methods:

The study involved a multisite retrospective chart review of adults admitted across 8 hospitals between January 2010 and December 2015 who received antipsychotics during hospitalization. The primary outcome was the presence of an ECG after receiving an antipsychotic.

Results:

During the study period, there were 26,353 hospitalizations during which adults received antipsychotic medication; the average age of the patients was 61.4 years, 50.1% were female, and 64.8% were white. The average comorbidity score was 1.4 with a median length of stay of 8.3 days. Of the 26,353 patients who were hospitalized, 60.6% (n=15,977) of patients in the sample had an ECG during their hospitalization, and 41.2% (n=10,865) had the ECG following antipsychotic administration. Patients who received a follow-up ECG had a longer length of stay (median: 11.3 d) compared with those who did not receive a follow-up ECG (median: 7.0 d). Follow-up ECGs were more likely among patients who had a history of heart failure [odds ratio (OR)=1.17, 95% confidence interval (CI): 1.06-1.30, P=0.002], who were receiving multiple antipsychotics (OR=1.3, 95% CI: 1.24-1.36, P<0.001) or other QT-prolonging medications (OR=1.09, 95% CI: 1.07-1.1, P<0.001), who were receiving risperidone (OR=1.12, 95% CI: 1.004-1.25, P=0.04), and who showed an increase in QTc duration (OR per 10 ms increase=1.02, 95% CI: 1.01-1.04, P=0.003). Follow-up ECGs were less likely to be administered to patients who were receiving antipsychotics before admission (OR=0.93, 95% CI: 0.87-0.997, P=0.04).

Conclusions:

This study demonstrated that, in a large health system, ECG monitoring is not routinely practiced for hospitalized patients receiving antipsychotics. Further studies are needed to identify patients who would most benefit from ECG monitoring in the acute care setting.
Video Games as a Complementary Therapy for Schizophrenia: A Systematic Review
Authors: Molina Rosa , Díaz-Oliván Isaac , Girela Braulio , Moreno Manon , Jiménez-Muñoz Laura , Delgado-Gómez David , Peñuelas-Calvo Inmaculada , Baca-García Enrique , Porras-Segovia Alejandro
Published: March 2022

Background:

Schizophrenia is a prevalent and serious disorder. Video games have shown potential as an aid in health care for people who suffer from schizophrenia. Although video games may contribute benefit in the treatment of schizophrenia, reviews on this topic are scarce. In this article, we systematically review the evidence concerning video game-based therapeutic interventions for people diagnosed with schizophrenia.

Methods:

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was registered in the PROSPERO database. We searched 4 databases—PubMed, Web of Science, EMBASE, and clinicaltrials.gov—to identify original studies exploring video game-based therapeutic interventions for people with schizophrenia.

Results:

After initial screening, full-text review, and study selection, 11 articles were included in the review. Most studies used video consoles as the platform, with a minority using a personal computer. Video game-based therapeutic interventions were well accepted and generally effective in improving cognitive areas.

Conclusions:

Cognitive training could be one of the main mechanisms underlying the usefulness and effectiveness of video game-based therapeutic interventions. Software optimization and greater collaboration between developers and health care professionals are some of the priorities for future research in this area.