bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and assessment of an abbreviated medication regimen complexity index (the A-MRCI)
Authors: Scrivens Rebekah P , Liu Ina , Niznik Joshua D , Colmenares Evan W , Vest Mary-Haston , Jacobson Jennifer , Deyo Zachariah M
Published: July 2024

Purpose

Adaptation of the Medication Regimen Complexity Index (MRCI) for automation in an electronic medical record has the potential to improve medication optimization and patient outcomes. The purpose of this study was to develop and evaluate an abbreviated medication regimen complexity index (A-MRCI) and compare its associations with patient-level factors to those of the MRCI.

Methods

The MRCI was modified via several rounds of review with an expert panel of clinical pharmacists and outcomes researchers. Medication data from 138 electronic health records were abstracted to calculate MRCI and A-MRCI scores for dosage form, dosing frequency, and additional directions. Comparison between indices was performed using inferential statistics for a 1-month sample of patients admitted to a cardiology or advanced heart failure service in 2017.

Results

A-MRCI scores were higher than MRCI scores (mean difference of 3.97, P < 0.0005; 95% CI, 2.21-5.71). A significant association was observed between the A-MRCI score and both length of stay (P = 0.0005) and polypharmacy (P < 0.0005), whereas an association between MRCI score and the patient-level factors examined was not demonstrated.

Conclusion

On average, A-MRCI scores were higher and more likely to be associated with several patient-level factors. Internal analyses show the potential for integration into an electronic health record for automation. However, further exploration of the A-MRCI in a larger external validation sample is warranted.
Re-evaluating Methods for Assessing Differences in Response in Ileal vs Colonic Crohn’s Disease: A Post-hoc Analysis of the FITZROY Trial
Authors: Ma Christopher , Feagan Brian G , Wang Zhongya , Zou Guangyong , Smith Michelle I , Shackelton Lisa M , Sands Bruce E , Panaccione Remo , D’Haens Geert R , Vermeire Séverine , Jairath Vipul
Published: July 2024

Background and Aims

The ileum is the most commonly affected segment of the gastrointestinal tract in Crohn’s disease [CD]. We aimed to determine whether disease location affects response to filgotinib, a Janus kinase [JAK] inhibitor, in patients with moderately-to-severely active Crohn’s disease [CD] and applying appropriate methods to account for differences in measuring disease activity in the ileum compared with the colon.

Methods

This post-hoc analysis of data from the FITZROY phase 2 trial [NCT02048618] compared changes in the Crohn’s Disease Activity Index [CDAI] and Simple Endoscopic Score for Crohn’s Disease [SES-CD] among patients with ileal-dominant and isolated colonic CD treated with 10 weeks of filgotinib 200 mg daily or placebo. A mixed effects model for repeated measures was used to test whether ileal disease responded differently when compared with colonic disease, by evaluating for effect modification using the interaction term of treatment assignment-by-disease location.

Results

Numerically greater proportions of patients with isolated colonic disease compared to ileal-dominant CD achieved clinical remission [CDAI < 150, 75.9% vs 41.6%] and endoscopic response [SES-CD reduction by 50%, 52.5% vs 15.5%] at Week 10. However, after adjusting for baseline disease activity by disease location and within-patient clustering effects, there was no significant difference in treatment response by disease location [mean difference in ΔCDAI between ileal-dominant vs isolated colonic disease + 9.24 [95% CI: -87.19, +105.67], p = 0.85; mean difference in ΔSES-CD -1.93 [95% CI: -7.03, +3.44], p = 0.48.

Conclusions

Filgotinib demonstrated similar efficacy in ileal-dominant and isolated colonic CD when controlling for baseline disease activity and clustering effects.
The Natural History of Crohn’s Disease Leading to Intestinal Failure: A Longitudinal Cohort Study from 1973 to 2018
Authors: Wu Tian Hong , Brandt Christopher Filtenborg , Scheike Thomas , Burisch Johan , Jeppesen Palle Bekker
Published: July 2024

Background and Aims

The natural history of Crohn’s disease leading to intestinal failure is not well characterised. This study aims to describe the clinical course of Crohn’s disease preceding intestinal failure and to compare disease course and burden between Crohn’s disease patients with and without intestinal failure.

Methods

Patients with Crohn’s disease complicated by intestinal failure from Rigshospitalet, Copenhagen [n = 182] and a nationwide Danish Crohn’s disease cohort without intestinal failure [n = 22,845] were included. Using nationwide registries in Denmark, disease course was determined from hospitalisations, surgeries, and outpatient medications, and disease burden was determined from employment and mortality data.

Results

The 10-year cumulative incidence of intestinal failure following Crohn’s disease diagnosis declined from 2.7% prior to 1980 to 0.2% after 2000. Compared with Crohn’s disease patients without intestinal failure, those with intestinal failure experienced significantly longer duration of severe disease [50 vs 19 years per 100 patient-years, p < 0.01], secondary to greater corticosteroid use [71% vs 60%, p = 0.02], inpatient contacts [98% vs 55%, p < 0.01], and abdominal surgeries [99% vs 48%, p < 0.01]. However, exposure to biologics was not different between the two groups [20.4% vs 21%, p = 0.95], and duration on biologics was shorter in Crohn’s disease patients with intestinal failure [2068 vs 4126 days per 100 patient-years, p = 0.02]. Standard mortality ratio in Crohn’s disease patients with intestinal failure was 3.66 (97.5% confidence interval [CI] 2.79, 4.72].

Conclusion

Patients with Crohn’s disease complicated by intestinal failure experienced a more persistently severe preceding course of Crohn’s disease but were not more likely to be treated with biological therapy.
Radiofrequency ablation in obstructive hypertrophic cardiomyopathy: a case report
Authors: Büchel Jasmin , Leibundgut Gregor , Badertscher Patrick , Kühne Michael , Krisai Philipp
Published: July 2024

Background

We report endocardial radiofrequency (RF) ablation as an alternative treatment approach for a symptomatic patient with obstructive hypertrophic cardiomyopathy (oHCM), who is not suitable for surgical septal myectomy or alcohol septal ablation. Endocardial RF ablation, with detailed 3D mapping of the intrinsic conducting system, offers the possibility of reducing the risk of complete heart block rates and of effectively relieving symptoms.

Case summary

We present a symptomatic 51-year-old female patient with oHCM and a maximum left ventricular outflow tract (LVOT) gradient of 148 mmHg. Because of alcohol septal ablation failure, endocardial RF ablation in combination with detailed mapping of the intrinsic conduction system and intraprocedural imaging was performed. The 6-month follow-up showed a significant improvement in exercise tolerance, no relevant dynamic LVOT obstruction with a gradient of 22 mmHg under Valsalva.

Discussion

In the current case report, endocardial RF ablation persistently reduced LVOT gradients in a patient with oHCM. Pre-interventional imaging, detailed 3D mapping of the conduction system, and correlation to intracardiac and transthoracic echocardiography were key for an effective and safe ablation of a small target zone.
Utilizing left atrial venoarterial extracorporeal membrane oxygenation to unload the left ventricle prior to angioplasty in acute myocardial infarction: a case series
Authors: Jong Hung-Chang , Ngoh Kexuan , Lin Yu-Kai , Tu Hsu-Ting , Wang Ta-jung
Published: July 2024

Background

Left ventricular (LV) unloading prior to primary angioplasty in patients experiencing acute myocardial infarction holds promise for mitigating reperfusion injury and minimizing infarct size.

Case summary

This report delves into the utilization of left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) as a pre-percutaneous transluminal coronary angioplasty (PTCA) intervention strategy aimed at augmenting circulatory support while unloading the LV. Three cases of patients with ST elevation myocardial infarction involving the left ascending coronary artery who underwent LAVA-ECMO before primary PTCA are presented. Each patient maintained robust LV systolic function following weaning from ECMO support.

Discussion

These cases underscore the potential benefits of mechanical LV unloading prior to revascularization in reducing infarct size and mitigating the risk of post-myocardial infarction heart failure.
‘What happened?’: perceptions of patients with hypertension of conflicting results between self-reported medication adherence and chemical adherence testing: a qualitative study
Authors: Soldan Sara , Flint Corien , Jaarsma Tiny , Westland Heleen
Published: July 2024

Aims

To explore the perceptions of outpatients with hypertension regarding the conflicting results between their self-reported medication adherence and chemical adherence testing.

Methods and results

An exploratory generic qualitative study design with semi-structured interviews was conducted. Thirteen adult patients being treated with antihypertensives were interviewed. Patients had a negative chemical adherence test for at least one prescribed antihypertensive, while they reported adhering to their medication. Audio-recorded interviews were thematically analysed. Six themes emerged: (1) becoming frustrated with medication intake, (2) being uncomfortable with addressing medication nonadherence, (3) feeling ashamed and angry about their nonadherence, (4) feeling falsely accused of nonadherence, (5) experiencing results as a wake-up call, and (6) wanting to be heard and listened to. Participants reacted differently to the adherence test results. Two distinct groups were identified among the participants: the first group felt shameful, disappointed, and angry at themselves for being nonadherent; the second group felt falsely accused and rejected the adherence test results. No differences between both groups were found in their reasons for becoming frustrated with medication intake and their behaviour after the adherence test results. Patients felt that communication with clinicians is key in the treatment support of patients with hypertension.

Conclusion

Clinicians need to consider the reasons for nonadherence and the different responses of patients to the chemical adherence test results in their support to optimize treatment for patients with hypertension.
Sphingosine kills intracellular Pseudomonas aeruginosa and Staphylococcus aureus
Authors: May Helene , Liu Yongjie , Kadow Stephanie , Edwards Michael J , Keitsch Simone , Wilker Barbara , Kamler Markus , Grassmé Heike , Wu Yuqing , Gulbins Erich
Published: July 2024

Sphingosine has been previously shown to kill many strains of pathogenic bacteria including Pseudomonas aeruginosa, Staphyloccus aureus, Acinetobacter, and atypical mycobacteria. However, these studies were performed on isolated or extracellular bacteria and it is unknown whether sphingosine also targets intracellular bacteria. Here, we demonstrate that exogenously-added sphingosine directly binds to extracellular P. aeruginosa and S. aureus, but also targets and binds to intracellular bacteria. Intracellular sphingosine and bacteria were identified by sequential immunostainings. We further show that exogenously-added sphingosine also kills intracellular P. aeruginosa and S. aureus using modified gentamycin assays. Intracellular killing of P. aeruginosa and S. aureus by sphingosine is not mediated by improved phagosomal-lysosomal fusion. In summary, our data indicate that sphingosine binds to and most likely also directly kills extra- and intracellular P. aeruginosa and S. aureus.
Identification investigations: a collaborative approach to the resolution of long-term unidentified persons cases at the NYC Office of Chief Medical Examiner
Authors: Soler Angela , Goldstein Justin Z , Naka Aden , Santiago Stephanie
Published: July 2024

The New York City Office of Chief Medical Examiner (NYC OCME) investigates approximately 9 000–10 000 deaths every year, each of which necessitates a formal identification. Although standard identification protocols resolve the majority of these cases, there are still a substantial number of long-term unidentified persons cases that require a targeted investigation. This process involves not only the comprehensive review of all available postmortem data (e.g. scene findings, personal effects, autopsy findings, toxicology results, forensic anthropology reports, dental findings, fingerprints, forensic biology), but also the collection of antemortem data through focused informant interviews, analyzing casefiles and/or archival records, reviewing public missing person postings (e.g. National Missing and Unidentified Persons System (NamUs)), and collaborating with law enforcement and other agencies. This holistic approach to identification investigations is systematic yet flexible, allowing for the needs of each unidentified person and/or missing person case to be thoroughly assessed and efficiently addressed. These efforts have proven successful at NYC OCME, resulting in over 80 long-term unidentified persons identifications confirmed in the last 7 years, dating as far back as 1969. This paper provides a detailed breakdown of the NYC OCME framework for long-term unidentified persons investigations, citing multiple case studies to underscore how investigators utilize multiple lines of evidence to generate potential leads. Although each jurisdiction faces a unique set of demands and limitations, sharing these investigative strategies and perspectives may benefit practitioners contending with long-term unidentified persons cases and their inherent complexities.

Key points
Deploying deep Solanaceae domestication and virus biotechnology knowledge to enhance food system performance and diversity
Authors: Pasin Fabio , Uranga Mireia , Charudattan Raghavan , Kwon Choon-Tak
Published: July 2024

Our knowledge of crop domestication, genomics, and of the plant virosphere unevenly represents the taxonomic distribution of the global biodiversity, and, as we show here, is significantly enriched for the Solanaceae. Within the family, potato, tomato, eggplant, pepper, and over 100 lesser-known edible species play important nutrition and cultural roles in global and local food systems. Technologies using engineered viruses are transitioning from proof-of-concept applications in model plants to the precise trait breeding of Solanaceae crops. Leveraging this accumulated knowledge, we highlight the potential of virus-based biotechnologies for fast-track improvement of Solanaceae crop production systems, contributing to enhanced global and local human nutrition and food security.
Acquired Human Immunodeficiency Virus Type 1 Drug Resistance in Rhode Island, USA, 2004–2021
Authors: Aung Su , Novitsky Vlad , Steingrimsson Jon , Gillani Fizza S , Howison Mark , Nagel Katherine , Solomon Matthew , Bertrand Thomas , Bhattarai Lila , Fulton John , Bandy Utpala , Kantor Rami
Published: July 2024

Background

Human immunodeficiency virus type 1 (HIV-1) acquired drug resistance (ADR) compromises antiretroviral therapy (ART).

Methods

We aggregated all HIV-1 protease–reverse transcriptase–integrase sequences over 2004–2021 at the largest HIV center in Rhode Island and evaluated ADR extent, trends, and impact using Stanford Database tools. Trends were measured with Mann-Kendall statistic, and multivariable regressions evaluated resistance predictors.

Results

Sequences were available for 914 ART-experienced persons. Overall ADR to any drug decreased from 77% to 49% (−0.66 Mann-Kendall statistic); nucleoside reverse transcriptase inhibitors 65% to 32%, nonnucleoside reverse transcriptase inhibitors 53% to 43%, and protease inhibitors 28% to 7% (2004–2021), and integrase strand transfer inhibitors 16% to 13% (2017–2021). Multiclass resistance decreased from 44% to 12% (2-class) and 12% to 6% (3-class). In 2021, 94% had at least one 3-drug or 2-drug one-pill-once-daily (OPOD) option. Males and those exposed to more ART regimens were more likely to have ≥2-class resistance, and higher regimen exposure was also associated with fewer OPOD options.

Conclusions

Comprehensive analyses within a densely-sampled HIV epidemic over 2004–2021 demonstrated decreasing ADR. Continued ADR monitoring is important to maintain ART success, particularly with rising INSTI use in all lines of therapy and 2-drug and long-acting formulations.
c-di-GMP and AHL signals-triggered chemical communication under electrical signaling disruption restores Geobacter sulfurreducens biofilm formation
Authors: Zhu Qian , Zheng Yanyan , Zhou Xingwang , Wang Dunjia , Yuan Mengjiao , Qian Dingkang , Liang Sha , Yu Wenbo , Yang Jiakuan , Hou Huijie , Hu Jingping
Published: July 2024

Electrogenic biofilms, which have attracted considerable attention in simultaneous wastewater treatment and energy recovery in bioelectrochemical systems, are regulated by chemical communication and potassium channel-mediated electrical signaling. However, how these two communication pathways interact with each other has not been thoroughly investigated. This study first explored the roles of chemical communication, including intracellular bis-(3′-5′)-cyclic dimeric guanosine monophosphate (c-di-GMP) and extracellular N-acyl-homoserine lactone (AHL)-mediated quorum sensing, in electrogenic biofilm formation through an integrated analysis of transcriptomics and metabolomics. Electrical signaling disruption inhibited the formation and electroactivity of Geobacter sulfurreducens biofilm, which was mainly ascribed to the reduction in biofilm viability and extracellular protein/polysaccharide ratio. The upregulation of expression levels of genes encoding c-di-GMP and AHL synthesis by transcriptomic analysis, and the increased secretion of N-butanoyl-L-homoserine lactone by metabolomic analysis confirmed the enhancement of chemical communication under electrical signaling disruption, thus indicating a compensatory mechanism among different signaling pathways. Furthermore, protein–protein interaction network showed the convergence of different signaling pathways, with c-di-GMP-related genes acting as central bridges. This study highlights the interaction of different signaling pathways, especially the resilience of c-di-GMP signaling to adverse external stresses, thereby laying the foundation for facilitating electrogenic biofilm formation under adverse conditions in practical applications.
Globally distributed bacteriophage genomes reveal mechanisms of tripartite phage–bacteria–coral interactions
Authors: Wallace Bailey A , Varona Natascha S , Hesketh-Best Poppy J , Stiffler Alexandra K , Silveira Cynthia B
Published: July 2024

Reef-building corals depend on an intricate community of microorganisms for functioning and resilience. The infection of coral-associated bacteria by bacteriophages can modify bacterial ecological interactions, yet very little is known about phage functions in the holobiont. This gap stems from methodological limitations that have prevented the recovery of high-quality viral genomes and bacterial host assignment from coral samples. Here, we introduce a size fractionation approach that increased bacterial and viral recovery in coral metagenomes by 9-fold and 2-fold, respectively, and enabled the assembly and binning of bacterial and viral genomes at relatively low sequencing coverage. We combined these viral genomes with those derived from 677 publicly available metagenomes, viromes, and bacterial isolates from stony corals to build a global coral virus database of over 20,000 viral genomic sequences spanning four viral realms. The tailed bacteriophage families Kyanoviridae and Autographiviridae were the most abundant, replacing groups formerly referred to as Myoviridae and Podoviridae, respectively. Prophage and CRISPR spacer linkages between these viruses and 626 bacterial metagenome-assembled genomes and bacterial isolates showed that most viruses infected Alphaproteobacteria, the most abundant class, and less abundant taxa like Halanaerobiia and Bacteroidia. A host–phage–gene network identified keystone viruses with the genomic capacity to modulate bacterial metabolic pathways and direct molecular interactions with eukaryotic cells. This study reveals the genomic basis of nested symbioses between bacteriophage, bacteria, and the coral host and its endosymbiotic algae.
Pharmacokinetic/pharmacodynamic model-based optimization of temocillin dosing strategies for the treatment of systemic infections
Authors: van Os Wisse , Nussbaumer-Pröll Alina , Pham Anh Duc , Wijnant Gert-Jan , Ngougni Pokem Perrin , Van Bambeke Françoise , van Hasselt J G Coen , Zeitlinger Markus
Published: July 2024

Background

Temocillin is increasingly considered as an alternative to carbapenems. However, there is no consensus on optimal dosing strategies and limited data on temocillin efficacy in systemic infections.

Objectives

We compared temocillin dosing strategies using pharmacokinetic/pharmacodynamic (PK/PD) modelling and simulation based on plasma exposure and in vitro time–kill data.

Methods

Temocillin effects on four Escherichia coli strains were evaluated using static time–kill experiments and the hollow-fibre infection model, in which unbound plasma concentrations following intermittent and continuous infusion regimens of 4 and 6 g daily were replicated over 72 h. A PK/PD model was developed to describe the time–kill data. The PK/PD model was coupled to a population PK model of temocillin in critically ill patients to predict bacterial killing and resistance development following various dosing regimens.

Results

Amplification of resistant subpopulations was observed within 24 h for all strains. The PK/PD model described the observed bacterial kill kinetics and resistance development from both experimental systems well. Simulations indicated dose-dependent bacterial killing within and beyond the currently used daily dose range, and a superiority of continuous compared with intermittent infusions. However, regrowth of resistant subpopulations was frequently observed. For two strains, bacteriostasis over 72 h was predicted only with doses that are higher than those currently licensed.

Conclusions

Continuous infusions and 6 g daily doses of temocillin kill E. coli more effectively than 4 g daily doses and intermittent infusions, and may increase efficacy in the treatment of systemic infections. However, higher daily doses may be required to suppress resistance development.
Impact of the SIK3 pathway inhibition on osteoclast differentiation via oxidative phosphorylation
Authors: Kamei Katsuhiko , Yahara Yasuhito , Kim Jun-Dal , Tsuji Mamiko , Iwasaki Mami , Takemori Hiroshi , Seki Shoji , Makino Hiroto , Futakawa Hayato , Hirokawa Tatsuro , Nguyen Tran Canh Tung , Nakagawa Takashi , Kawaguchi Yoshiharu
Published: July 2024

Maintenance of bone homeostasis and the balance between bone resorption and formation are crucial for maintaining skeletal integrity. This study sought to investigate the role of salt-inducible kinase 3 (SIK3), a key regulator in cellular energy metabolism, during the differentiation of osteoclasts. Despite osteoclasts being high energy-consuming cells essential for breaking down mineralized bone tissue, the specific function of SIK3 in this process remains unclear. To address this issue, we generated osteoclast-specific SIK3 conditional knockout mice and assessed the impact of SIK3 deletion on bone homeostasis. Our findings revealed that SIK3 conditional knockout mice exhibited increased bone mass and an osteopetrosis phenotype, suggesting a pivotal role for SIK3 in bone resorption. Moreover, we assessed the impact of pterosin B, a SIK3 inhibitor, on osteoclast differentiation. The treatment with pterosin B inhibited osteoclast differentiation, reduced the numbers of multinucleated osteoclasts, and suppressed resorption activity in vitro. Gene expression analysis demonstrated that SIK3 deletion and pterosin B treatment influence a common set of genes involved in osteoclast differentiation and bone resorption. Furthermore, pterosin B treatment altered intracellular metabolism, particularly affecting key metabolic pathways, such as the tricarboxylic acid cycle and oxidative phosphorylation. These results provide valuable insights into the involvement of SIK3 in osteoclast differentiation and the molecular mechanisms underlying osteoclast function and bone diseases.
Non-dominated sorting simplified swarm optimization for multi-objective omni-channel of pollution-routing problem
Authors: Zhu Wenbo , Liang Tzu-Ching , Yeh Wei-Chang , Yang Guangyi , Tan Shi-Yi , Liu Zhenyao , Huang Chia-Ling
Published: July 2024

The activities of the traffic department mainly contribute to the generation of greenhouse gas (GHG) emissions. The swift expansion of the traffic department results in a significant increase in global pollution levels, adversely affecting human health. To address GHG emissions and propose impactful solutions for reducing fuel consumption in vehicles, environmental considerations are integrated with the core principles of the vehicle routing problem. This integration gives rise to the pollution-routing problem (PRP), which aims to optimize routing decisions with a focus on minimizing environmental impact. At the same time, the retail distribution system explores the use of an omni-channel approach as a transportation mode adopted in this study. The objectives of this research include minimizing total travel costs and fuel consumption while aiming to reduce GHG emissions, promoting environmental sustainability, and enhancing the convenience of shopping and pickup for customers through the integration of online and offline modes. This problem is NP-hard; therefore, the Non-dominated Sorting Simplified Swarm Optimization (NSSO) algorithm is employed. NSSO combines the non-dominated technique of Non-dominated Sorting Genetic Algorithm II (NSGA-II) with the update mechanism of Simplified Swarm Optimization to obtain a set of Pareto-optimal solutions. Moreover, the NSSO, a multi-objective evolutionary algorithm, is adopted to address multi-objective problems. The PRP benchmark dataset is utilized, and the results are compared with two other multi-objective evolutionary algorithms: NSGA-II and Non-dominated Sorting Particle Swarm Optimization (NSPSO). The findings of the study confirm that NSSO exhibits feasibility, provides good solutions, and achieves faster convergence compared with the other two algorithms, NSGA-II and NSPSO.
Low evolutionary potential for blue-green egg colouration in a wild bird population
Authors: D’Arpa Stefania R , Gil Diego , Muriel Jaime , Monclús Raquel , Pérez-Rodríguez Lorenzo , Martinez-Padilla Jesús
Published: July 2024

Exploring the evolutionary architecture of female sexual traits and their potential evolvability is important to understand their possible role as postmating sexual signals. Egg colouration has been proposed to be one of these postmating sexual signals, honestly advertising female quality in birds, especially in blue-green laying species. In this study, we used an animal model in a Bayesian framework to estimate the evolvability of multiple descriptors of blue-green egg colouration and egg size in a wild long-term monitored population of spotless starlings (Sturnus unicolor). Our results show low to moderate heritability (h2 = 0.31–0.44) for 3 egg colour descriptors (blue-green chroma, chroma, and lightness) and egg size. Using the coefficient of additive genetic variance (CVA) and the evolvability (IA) as proxies of evolutionary potential of all components of this trait, we found low values of CVA for all these variables, suggesting a small evolutionary potential of these phenotypic traits, contrasting to previous results reported in another blue-green egg laying species. Our results indicate a modest raw genetic material of this trait on which sexual selection can act upon and, therefore, a small probability for these traits to respond easily to selection.
Auxetic metamaterial inspired by the seesaw motion
Authors: Lim Teik-Cheng
Published: July 2024

A mechanical metamaterial has been constructed using a network of interconnected isosceles triangles and right triangles by inspiration from the seesaw motion. The connections are defined as hinges with rotationally elastic restraints wherein each isosceles triangle is connected to three neighboring rotating units, while each right triangle is connected to four neighboring rotating units. The effective Poisson's ratio under on-axes loading were established using geometrical approach, while the on-axes Young's moduli were developed by matching the spring rotational energy at the hinges of the metamaterial during relative rotation of the rigid units with the strain energy of deformation of the homogenized continuum. Results reveal that by adjusting the geometrical parameters, the Poisson's ratio can range from positive to negative values. The results also show that both the Poisson's ratio and Young's moduli have a wide range of geometrical parameters for fine-tuning at low mechanical properties and well as a narrow range of geometrical parameters for coarse tuning at high mechanical properties. These observations suggest that the metamaterial has a wide range of applications from soft robotics to structural applications by adjustment of its geometrical parameters.
Evaluation of a structured pharmacist-led intervention on glycemic control in underprivileged diabetic patients: a randomized open-label trial
Authors: Abdul-Latif Maha , Nagib Reem , Amin Mohamed , El-Yazbi Ahmed F
Published: July 2024

Objective

This study assesses the impact of a structured clinical pharmacist intervention on glycemic control in diabetic patients maintained on intensive insulin therapy attending the internal medicine clinic in a hospital with limited financial resources.

Methods

A randomized parallel open-label clinical trial design was employed. Ethical approval was obtained from the Egyptian Ministry of Health (MOH) ethics committee. Adult diabetic patients, on intensive insulin therapy, were recruited from an internal medicine clinic at an MOH hospital. Patients were randomly allocated into two groups; control, on premixed insulin twice daily, and intervention, receiving a structured pharmacist intervention including the addition of regular insulin doses as needed. Patients were followed up for three months. A 1% reduction of HbA1c level at the conclusion was considered the primary outcome.

Key findings

One hundred and twenty-five patients (62 control and 63 intervention) consented to participate in the study, of whom 98 (46 control and 52 intervention) completed the follow-up period. At three months, the odds ratio for HbA1c reduction by at least by 1% in the intervention group was 3.2 (95% CI 1.45–7.08). Very few cases of hypoglycemia were reported in either group. The HbA1c reduction was not affected by age, weight, or literacy status of the patients.

Conclusions

Clinical pharmacist interventions, even in environments with scarce resources and socioeconomic challenges, remain effective in achieving better glycemic control. This trial has been registered in the Pan-African Clinical Trial Registry (PACTR201610001812290, https://pactr.samrc.ac.za/).
Bouveret syndrome preceding classical gallstone ileus: a rare presentation of a cholecystoduodenal fistula
Authors: Qian William , Soares Jewel , Jayewardene Ishanth Devinda , Peck Nigel
Published: July 2024

Bouveret syndrome is the rarest variant of gallstone ileus characterized by the passage and impaction of a gallstone through a bilioenteric fistula leading to gastric outlet obstruction. The documented movement of an impacted gallstone in Bouveret syndrome through the gastrointestinal tract has not been previously discussed in the literature. A 64-year-old man presented with acute on chronic epigastric pain, fevers, and vomiting. Abdominal computed tomography established a diagnosis of Bouveret syndrome. A trial of endoscopic gallstone extraction was unsuccessful. Laparoscopic gastrotomy and stone removal were later attempted, however, intraoperatively it was noted that the stone had migrated and was now impacted in the jejunum causing a small bowel obstruction. The clinical picture was now that of gallstone ileus. Laparoscopic enterolithotomy was performed successfully. This article discusses the radiological, endoscopic, and intraoperative findings in this rare case of Bouveret syndrome that had evolved into classical gallstone ileus following stone migration.
Primary diffuse large B-cell lymphoma of the lacrimal sac with involvement of maxillary sinus: a case report and review of literature
Authors: Sadhar Birkaran , Slupek David , Steehler Andrew , Denne Carter , Steehler Kirk
Published: July 2024

Primary lacrimal sac lymphoma is a rare condition, often presenting with nasolacrimal duct obstruction. Herein, we present a unique case of diffuse large B-cell lymphoma (DLBCL) involving the lacrimal sac, maxillary sinus, and infraorbital nerve. Prompt diagnosis via biopsy is essential for timely treatment and the prevention of tumor progression. A 66-year-old female presented with intractable epiphora, infraorbital nerve hypesthesia, and medial canthal swelling. Imaging revealed a soft tissue mass in the right maxillary sinus extending into the right inferior orbit and nasal cavity. A biopsy confirmed DLBCL, prompting systemic chemotherapy. Residual disease prompted high-dose involved-site radiation, resulting in tumor regression. To our knowledge, this is the first case of primary DLBCL of the lacrimal sac with concurrent involvement of the maxillary sinus and infraorbital nerve. This case underscores the significance of lacrimal sac biopsy in refractory dacryocystitis or unilateral sinus disease and the effectiveness of multimodal treatment approaches in managing DLBCL.
Robotic-assisted repair of an anterior diaphragmatic hernia secondary to Xiphoidectomy
Authors: Skogsberg Amanda , Porter Allison
Published: July 2024

Anterior diaphragmatic hernias manifest when a diaphragmatic defect permits abdominal contents to enter the thoracic cavity. They may be congenital or acquired; when acquired, the typical etiology is traumatic injury. Without treatment, they risk incarceration or strangulation. A 55-year-old male with a history of xiphoidectomy during sternotomy for cardiac disease was incidentally found to have an anterior diaphragmatic hernia on a screening chest CT (computed tomography) scan. He developed gastric obstruction shortly after an outpatient surgical consultation. He was admitted to the hospital, and further workup revealed a right-sided type-4 diaphragmatic hernia with an incarcerated colon, antrum, and pylorus. Nasogastric decompression was performed, followed by robotic-assisted transabdominal preperitoneal (r-TAPP) repair with mesh. He recovered without complications. There are currently no reports in the literature of an anterior diaphragmatic hernia secondary to a xiphoidectomy. This case demonstrates the successful use of r-TAPP for this rare presentation of an anterior diaphragmatic hernia.
Evaluating Item Response Format and Content Using Partial Credit Trees in Scale Development
Authors: Asamoah Nana Amma Berko , Turner Ronna C , Lo Wen-Juo , Crawford Brandon L , McClelland Sara , Jozkowski Kristen N
Published: July 2024

The type of response options selected for items on a survey, along with how many response options to include and whether to allow neutral midpoints, impacts data obtained from survey collections and the interpretations made using the results. Further, if subgroups within a population (e.g., racial/ethnic, gender, age) interpret response options differently, this variance can artificially inflate non-significant differences or mask true differences between groups. In this study, we apply two recursive partitioning procedures for investigating differential item functioning (DIF) in an experiment evaluating seven item response formats (five levels of an agree–disagree [AD] format and two levels of an item-specific [IS] format). Partial credit tree procedures allow for the evaluation of multiple covariates without prespecifying subgroups to be compared. We applied the procedures to items measuring adults’ attitudes toward legal abortion and all response formats functioned without DIF for age, gender, race, education, and religion when evaluated using global DIF screening approaches. Item-focused analyses indicated that odd-numbered response formats were less susceptible to content-based DIF. The combination of psychometric properties indicated that five-point AD and IS formats may be preferable for abortion attitude measurement based on the screening procedures conducted in this study.
Exploring the Origins and Evolution of Oxygenic and Anoxygenic Photosynthesis in Deeply Branched Cyanobacteriota
Authors: Tan Sha , Liu Lan , Jiao Jian-Yu , Li Meng-Meng , Hu Chao-Jian , Lv Ai-Ping , Qi Yan-Ling , Li Yu-Xian , Rao Yang-Zhi , Qu Yan-Ni , Jiang Hong-Chen , Soo Rochelle M , Evans Paul N , Hua Zheng-Shuang , Li Wen-Jun
Published: July 2024

Cyanobacteriota, the sole prokaryotes capable of oxygenic photosynthesis (OxyP), occupy a unique and pivotal role in Earth's history. While the notion that OxyP may have originated from Cyanobacteriota is widely accepted, its early evolution remains elusive. Here, by using both metagenomics and metatranscriptomics, we explore 36 metagenome-assembled genomes from hot spring ecosystems, belonging to two deep-branching cyanobacterial orders: Thermostichales and Gloeomargaritales. Functional investigation reveals that Thermostichales encode the crucial thylakoid membrane biogenesis protein, vesicle-inducing protein in plastids 1 (Vipp1). Based on the phylogenetic results, we infer that the evolution of the thylakoid membrane predates the divergence of Thermostichales from other cyanobacterial groups and that Thermostichales may be the most ancient lineage known to date to have inherited this feature from their common ancestor. Apart from OxyP, both lineages are potentially capable of sulfide-driven AnoxyP by linking sulfide oxidation to the photosynthetic electron transport chain. Unexpectedly, this AnoxyP capacity appears to be an acquired feature, as the key gene sqr was horizontally transferred from later-evolved cyanobacterial lineages. The presence of two D1 protein variants in Thermostichales suggests the functional flexibility of photosystems, ensuring their survival in fluctuating redox environments. Furthermore, all MAGs feature streamlined phycobilisomes with a preference for capturing longer-wavelength light, implying a unique evolutionary trajectory. Collectively, these results reveal the photosynthetic flexibility in these early-diverging cyanobacterial lineages, shedding new light on the early evolution of Cyanobacteriota and their photosynthetic processes.
Impact of an Intervention Program on Clostridioides difficile Infections: Comparison of 2 Hospital Cohorts
Authors: Kamel Sara , Corbacho-Loarte María Dolores , Escudero-Sánchez Rosa , Halperin Ana , Llorente Sergio , Quevedo Sara María , Suárez-Carantoña Cecilia , del Campo Laura , Hernández María Soledad , Guillen Santiago Moreno , Cobo Javier
Published: July 2024

Background

Clostridioides difficile infection (CDI) occurs in various contexts and care settings and is managed by multiple specialists who are not experts in its management. While there are many initiatives to improve the diagnosis and avoid overdiagnosis, there is less focus on the overall management of the infection.

Methods

We studied a cohort of patients with a positive test result for toxigenic C difficile in 2 hospitals. Hospital A has a program that provides advice from an infectious disease specialist (IDS) and promotes continuity of care by providing a phone number to contact the IDS. Hospital B does not have any specific CDI program. The evaluation assessed the proportion of patients not treated (carriers or self-limited disease), adherence to Infectious Diseases Society of America guidelines, access to novel therapies, recurrence and mortality rates, and readmission and emergency department visits due to CDI. We assessed the program's effectiveness through a logistic regression model adjusted for covariates chosen by clinical criteria.

Results

Hospital A avoided more unnecessary treatments (19.3% vs 11.5%), provided access to novel therapies more frequently (35.3% vs 13%), and adhered more closely to current guidelines (95.8% vs 71.3%). Although the mortality and recurrence rates did not differ, the absence of an intervention program was associated with greater odds of admission due to recurrence (odds ratio, 4.19; P = .037) and more visits to the emergency department due to CDI (odds ratio, 8.74; P = .001).

Conclusions

Implementation of a CDI intervention program based on recommendations from IDSs and improved access to specialized care during the follow-up is associated with enhanced quality of CDI management and potential reductions in hospital resource utilization.
Safety of Antiretroviral Exposure During Pregnancy: Opportunities to Close Data Gaps
Authors: Short William R , Miller Emily S , Simone Joanne , Statton Anne , Finocchario-Kessler Sarah , Lampe Margaret
Published: July 2024

Pregnant persons with chronic health conditions often require pharmacotherapy to remain healthy. The Antiretroviral Pregnancy Registry is a prospective, international, voluntary, and exposure registry that collects information on antiretroviral (ARV) exposure; however, a minority of providers use the registry, leaving critical gaps to guide prescribing in this population. The Task Force for the Elimination of Perinatal HIV Transmission in the United States, funded by the Centers for Disease Control and Prevention, has identified the monitoring of ARV safety as a paramount concern in the ongoing mission to eliminate perinatal human immunodeficiency virus (HIV) transmission. As active members of this task force, we urge all healthcare providers who care for pregnant individuals to prioritize reporting all ARV exposures to the registry.
Instability and inequality in the British state
Authors: Diamond Patrick , Newman Jack
Published: July 2024

The UK state has been through many periods of perceived crisis, but the instability of the last decade has shaken some of the foundational institutions of British politics. Our main argument is that the rise of political instability relates to the failure of British politics to respond to structural inequality in society and politics. This includes growing economic and geographic disparities, as well as destabilizing divisions over long-standing social injustices. The infusion of these trends into the political process is the subject of the ‘asymmetric power model (APM)’, which acts as the theoretical underpinning of this paper and the special issue it introduces. In this editorial to the Parliamentary Affairs Special Issue on ‘Instability and inequality in the British state’, we elaborate these arguments and provide a brief overview of the eight papers in the issue, which cover the APM, the constitution, the UK Union, the Conservative Party, public policymaking, gender inequalities, intersectional inequalities, and geographical inequalities. Together, the papers identify the causes and features of the UK’s troubling inequality-instability dialectic and offer various practical and theoretical ways forward.
Thermomorphogenesis of the Arabidopsis thaliana Root: Flexible Cell Division, Constrained Elongation and the Role of Cryptochrome
Authors: Zimmermann Maura J , Jathar Vikram D , Baskin Tobias I
Published: July 2024

Understanding how plants respond to temperature is relevant for agriculture in a warming world. Responses to temperature in the shoot have been characterized more fully than those in the root. Previous work on thermomorphogenesis in roots established that for Arabidopsis thaliana (Columbia) seedlings grown continuously at a given temperature, the root meristem produces cells at the same rate at 15°C as at 25°C and the root’s growth zone is the same length. To uncover the pathway(s) underlying this constancy, we screened 34 A. thaliana genotypes for parameters related to growth and division. No line failed to respond to temperature. Behavior was little affected by mutations in phytochrome or other genes that underly thermomorphogenesis in shoots. However, a mutant in cryptochrome 2 was disrupted substantially in both cell division and elongation, specifically at 15°C. Among the 34 lines, cell production rate varied extensively and was associated only weakly with root growth rate; in contrast, parameters relating to elongation were stable. Our data are consistent with models of root growth that invoke cell non-autonomous regulation for establishing boundaries between meristem, elongation zone and mature zone.
Spring resting egg production of the calanoid copepod, Eurytemora affinis, in a freshet-dominated estuary
Authors: Breckenridge Joanne , Pakhomov Evgeny
Published: July 2024

Seasonal peaks in river discharge, such as snowmelt-dominated freshets, are predictable events that can have a large effect on flushing rates and salinity in estuaries. Resting eggs, which many coastal and estuarine copepods produce for overwintering or aestivation, could also serve to bridge predictable peaks in river discharge. We assessed the timing of resting egg production of the egg-carrying estuarine copepod, Eurytemora affinis (Poppe), in relation to river discharge in the Fraser River Estuary, Canada. Approximately 30 field-collected females were individually incubated on 12 occasions over the period February 2015–May 2016. Eurytemora affinis abundance and population structure were investigated from vertical net tow samples collected twice monthly to monthly. Resting eggs occurred primarily in May 2015 and May 2016 (6.5 and 9.2 eggs day−1, respectively), a month prior to peak flows, and the proportion of offspring that were resting eggs increased with river discharge. Eurytemora affinis reached a minimum abundance in July 2015, when the population was dominated by adults (86%). Resting egg production in E. affinis is typically considered an overwintering mechanism but we suggest that the ultimate driver of resting egg production in this population is avoidance of flushing and/or low salinities.
Development of a measuring app for systemic sclerosis-related digital ulceration (SALVE: Scleroderma App for Lesion VErification)
Authors: Davison Adrian K , Krishan Ashma , New Robert P , Murray Andrea , Dinsdale Graham , Manning Joanne , Hall Frances , Pauling John D , Vail Andy , Kearney Kathryn , Patrick Helen , Hughes Michael , Dixon William , Dickinson Mark , Taylor Chris , Herrick Ariane L
Published: July 2024

Objectives

To test the hypothesis that photographs (in addition to self-reported data) can be collected daily by patients with SSc using a smartphone app designed specifically for digital lesions, and could provide an objective outcome measure for use in clinical trials.

Methods

An app was developed to collect images and patient-reported outcome measures including Pain score and the Hand Disability in Systemic Sclerosis-Digital Ulcers (HDISS-DU) questionnaire. Participants photographed their lesion(s) each day for 30 days and uploaded images to a secure repository. Lesions were analysed both manually and automatically, using a machine learning approach.

Results

Twenty-five patients with SSc-related digital lesions consented, of whom 19 completed the 30-day study, with evaluable data from 27 lesions. Mean (s.d.) baseline Pain score was 5.7 (2.4) and HDISS-DU 2.2 (0.9), indicating high lesion- and disease-related morbidity. A total of 506 images were used in the analysis [mean number of used images per lesion 18.7 (s.d. 8.3)]. Mean (s.d.) manual and automated lesion areas at day 1 were 11.6 (16.0) and 13.9 (16.7) mm2, respectively. Manual area decreased by 0.08 mm2 per day (2.4 mm2 over 30 days) and automated area by 0.1 mm2 (3.0 mm2 over 30 days). Average gradients of manual and automated measurements over 30 days correlated strongly (r = 0.81). Manual measurements were on average 40% lower than automated ones, with wide limits of agreement.

Conclusion

Even patients with significant hand disability were able to use the app. Automated measurement of finger lesions could be valuable as an outcome measure in clinical trials.