bluuebunny/crossref_metadata_2025 huggingface dataset:
N09 Exploration of medication adherence interventions in Inflammatory Bowel Disease, Multiple Sclerosis and Rheumatoid Arthritis: A Scoping Review of Randomised Controlled Trials
Authors: King K , McGuinness S , Watson N , Norton C , Chalder T , Czuber-Dochan W ,   Bowel Research in Nursing Group
Published: January 2023

Background

The inflammatory diseases of inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) have recognised medications to maintain remission.Yet between 53–75% of people with IBD, 30-80% with RA and up to 50% with MS do not take medications as prescribed.

Recognising and improving adherence in IBD, MS and RA is a primary treatment goal to keep symptoms quiescent.

This scoping review aims to identify effective adherence interventions for IBD, MS and RA. As there were few studies in IBD, MS and RA were included to learn lessons from other conditions.

Methods

Randomised controlled trial (RCT) medication adherence interventions for IBD, MS or RA conducted between 2012-2021, were identified in six electronic databases.

Critical Appraisal Skills Programme assessed study quality.

Results

3024 participants were included across 24 RCTs; 8(33.3%) investigating IBD, 12(50%) RA and 4(16.7%) MS.

Nine RCTs (37.5%) significantly improved medication adherence; all were rated high quality with five being delivered face to face and 1:1; all involving tailored education, advice or counselling by trained health professionals (HPs).

IBD interventions were varied; the two significantly effective were web-based; one offering education modules and “red flag” monitoring, with follow up testing versus telephone education. The other used text message reminders with tailored feedback.

Four of five effective RA interventions used psychological, behaviour change approaches.

Three integrated educational and artificial intelligence-based methods through telephone-education, viewing disease progression on a computer system or text messages.

Of the four MS interventions, only a Bluetooth bottle cap with mobile phone reminders and MI based telephone counselling led to significant adherence improvements.

Interventions using artificial intelligence were most significantly effective (see Table 1). Tools such as diaries, calendars and advice sheets were also effective in increasing adherence.

Only 10 interventions were theory based.

Conclusion

Tailored, face to face, 1:1 interaction with HPs can provide personalised, adherence support.

Integration of several therapeutic approaches can be effective, but it can be difficult to identify cause of any impact.

To improve adherence in inflammatory conditions, theoretically informed interventions should be developed and evaluated.

Online routes of intervention delivery must be accessible, user-friendly, and functional to promote self-management.

However, an adherence intervention which minimises costs, provides patient-centred, value-based care through implementation of evidence-based strategies will no doubt be welcomed by patients, HPs and services alike.
N11 Adherence, self-care and illness perception in patients with Inflammatory Bowel Disease – a qualitative study
Authors: Ljungström E , Eberhardson M , Hjortswang H , Pihl Lesnovska K
Published: January 2023

Background

Medical treatment (MT) is key in the management of Inflammatory Bowel Disease (IBD, ulcerative colitis [UC] and Crohn’s disease [CD]) and non-adherence is a barrier to treatment efficacy. Approximately 30 % of patients with IBD is non-adherent to MT. Self-care is defined as; the process of maintaining health through health-promoting practices and managing illness. Adherence is an important part of self-care in IBD. Illness perception relates to understanding disease and potential consequences.

The aim of this study is to add deeper understanding of adherence and non-adherence as part of self-care and explore the links to illness perception and self-efficacy in patients with IBD.

Methods

Semi-structured interviews were conducted face-to-face with 15 IBD patients (5 CD, 9 UC, 1 IBD-U, Table 1) at a university IBD-clinic in Sweden. Patients were invited to ensure richness of data and maximum variation of disease duration, age, and sex. Interviews were recorded, transcribed verbally, and analysed with inductive, latent content analysis.

Results

Analysis resulted in three main categories and ten subcategories. The first category, Disease Perception, included the observation that a majority of the informants monitors disease through bowel symptoms. However, perception of severe illness was linked to low daily function. Most informants used stress reduction and diet to reduce symptoms. Some informants struggled with acceptance of disease while others seem to have reached higher acceptance. Fear related to disease was expressed, e.g., colonoscopies, cancer and progress of disease. The second category, Health Care Perception, showed that informants highly desired a personal connection with the doctor. Some informants expressed trust issues due to delayed diagnosis, kindreds’ bad experiences from health care or emotional trauma related to disease onset or care. Unmet need of information mainly concerned the health care system, the diagnosis and MT. The third category, Treatment Perception, included the informants’ ambivalence towards MT, where worries of potential harm from MT was central. Preferences on administration of MT was a factor that influenced adherence. Many informants perceived that non-medical strategies are more or equally important as MT to decrease symptom burden.

Conclusion

The findings add understanding of reasons for adherence and non-adherence to MT and demonstrates the complex mechanisms behind this phenomenon. The informants’ evaluation of risk and benefit with MT covers considerations that are not entirely medically established. This highlights the importance of a trustful dialogue and shared decision making between patient and health care provider in order to increase adherence.
N13 Low compliance with remote monitoring of patient-reported outcomes via digital application in patients with inflammatory bowel disease
Authors: Haj Natour O , Ben Horin S , Lipkin M , Galper A , kopylov U
Published: January 2023

Background

Remote management through online web-based services can reduce healthcare utilization and improve the quality of life and treatment adherence of IBD patients compared to standard care.However, the actual compliance and durability of remote follow-up protocols in IBD have not been well studied.

Aim

To describe the compliance with mobile-app patient-reported outcomes (PRO) questionnaires in a long-term monitoring program for IBD patients

Methods

Retrospective cohort study that included patients with Crohn’s Disease (CD) or ulcerative colitis (UC) treated at a tertiary center. Patients received questionnaires via the specialized smartphone app Datos Health™.The follow-up program included the following questionnaires: IBD-control,Patient-Reported Outcomes Measurement Information System (PROMIS-10), Short IBD Questionnaire (S-IBDQ), and Patient Reported Outcome-2 (PRO 2).

Results

402 IBD patients were enrolled in the program; 299 (74.4%) had CD and 103 UC (25.6%). 187 of the study patients (46.5%) male, 16(0.04%) were naive to biological therapy, 189 (47%) received their first biological therapy. Median age as 35.68 (interquartile ratio (IQR)- 35.68-43.31) and mean disease duration 9.8 years (7-14).

SIBDQ was sent for 515 (398-577) days,20 (15-23) questionnaires were sent, response rate was 23%. After 30 days -62(15.4%) of patients were still responding, 100 days- 36(9%), 1 year- 40(11.3%).

PROMIS-10 was sent for a median of 482(365-574) days; 17(13-20) questionnaires were sent, response rate was 13%. After 30 days -27(6.7%) of patients were still responding, after 100 days- 21(5.2%) and after 1 year- 34 (8.5%).

IBD-control was sent for a median of 515(397-584) days; 21(15-23) questionnaires were sent ,response rate was 22%. After 30 days -63 (15.7%) of patients were still responding, after 100 days- 37 (9.2%) and after 1 year- 40 (10%).

PRO 2 was sent for a median of 361(144-447) days;107(47-140) questionnaires were sent, response rate-11% After 30 days-47(11.7%), after 100 days -23(5.7%) and after 1 year -36(9%) were still responding

Figure 1: The response rate of filled questionnaires over time

SIBDQ; Short IBD Questionnaire. PRO-2; Patient-Reported Outcomes 2. Promis-global 10; Patient-Reported Outcomes Measurement Information System . IBD-control.

Conclusion

Long-term follow-up of IBD patients with remote PRO is associated with low compliance and high withdrawal rates.Future design of such programs should accommodate patients' needs, incorporatE rapid rule-based feedback and devise a smart adaptive frequency strategy to avoid alert fatigue and increase compliance.
N15 Influence of abundant nurse staffing on patient-reported outcomes among patients with inflammatory bowel disease in clinical remission
Authors: Tanaka M , Kawakami A , Sakagami K , Terai T , Ito H
Published: January 2023

Background

There is evidence that a higher number of nurses is associated with better patient outcomes in acute care settings, but little is known in outpatient settings. Patients with inflammatory bowel disease (IBD) are largely treated in outpatient settings and sometimes face difficulties due to their disease or treatment. Through the experience of living with their disease and managing it well, their self-efficacy related to IBD management would improve. Health professionals play important roles in empowering patients and supporting them to be able to manage their disease conditions well. The aim of this study is to explore the impact of adequate support with abundant nurse staffing on self-efficacy and difficulties of life among patients with IBD in clinical remission.

Methods

This is a cross-sectional questionnaire survey, using secondary analysis of a previously reported larger study. Data of a total of 499 patients with IBD in clinical remission, 318 from a specialized IBD clinic (UC: 83, CD: 235) and 181 online (UC: 109, CD: 72), was used for this study. The clinic has 10 full-time staffs (2 physicians, 7 nurses, 1 pharmacist) and 3 part-time staffs (2 doctors, 1 counselor) for approximately 30 outpatients visiting the clinic per day. This number shows the clinic is considerably abundant in nurse staffing compared to the Japanese standard of 1 nurse per 30 outpatients set by the Medical Care Law. The IBD-Self-Efficacy Scale (IBD-SES) and difficulty of life scale (DLS) were used as disease specific patient reported outcome measures. Multiple regression analysis was conducted in order to assess the extent of influence by the difference of facility after adjusting potential effects of confounders.

Results

All multi regression models included following confounders; age, sex, disease, job status, use of biologic, and disease duration. In IBD-SES, the subscales except for the subscale “managing medical care” showed significantly higher self-efficacy scores in patients who were recruited from the specialized clinic than those from online. As for DLS, all subscales and the total score showed significantly lower difficulty scores in patients who were recruited from the clinic.

Conclusion

Our results suggest that abundant nurse staffing influences favorably on self-efficacy and difficulties of life among patients with IBD in clinical remission.
N16 Exploring the factors that influence adjustment to and acceptance of an intestinal stoma for IBD: preliminary findings
Authors: Essex R , Burch J , Kemp K , Duncan J , Monks C , Dibley L ,   PRESTO PPI team
Published: January 2023

Background

Adjusting to a stoma can be difficult. During development of a new Patient-Reported Outcome Measure, peoples’ perceptions of factors influencing acceptance of a stoma were explored.

Methods

Participants aged 18 years+ (confirmed IBD diagnosis, current or prior stoma) were recruited via Crohn’s & Colitis UK. Semi-structured interviews (online/phone January–April 2022) were audio-recorded, transcribed professionally, and analysed thematically.

Results

Of 29 participants, 16 (55%) were female, 13 (45% male, or non-binary); mean age 53 years (range 22-77 years); with Crohn’s disease (n=11), ulcerative colitis (n=15) and IBD-unclassified (n=3). Mean time from diagnosis to first stoma: 9.3 years; 27 (93%) had a permanent stoma. Four early themes emerged:

Diagnosis and treatment: Clinical history before stoma surgery affected peoples’ responses afterwards. Delayed diagnosis, medication, and a declining health trajectory led to ‘no other option’ making it easier to consent to and accept stoma-forming surgery. Relief and control came once practical stoma care was mastered. Those who reported delayed diagnosis and/or not being believed about being seriously unwell, carried that experience forward with them.

Challenges of living with a stoma: No-one was ‘pleased’ that they had a stoma, but all (bar one) felt that life was better with, than without one. The stoma was harder to accept when not preceded by extended illness, or when temporary. Challenges included poor facilities for managing the stoma away from home and finding the right appliance to suit. The time needed per day to care for the stoma was burdensome. It took about two years to reach acceptance after stoma surgery.

Personality and coping: Participants viewed their stoma in the same way they addressed other challenges: there was no choice but to ‘get on with it’. Problem-solving skills had often been learnt in childhood. Recalling the stark health contrast between life without and with a stoma was helpful in accepting the stoma as part of their identity.

Social impacts and influences: Family, intimate partner, and social support were crucial. There is inadequate support for ostomates’ family members, especially children. Partners were accepting of the stoma, but women worried about body image and remaining attractive. People described anticipated and perceived stigma; whilst concerned that the stoma might be ‘obvious’ to others, they also endured negative comments because it was invisible.

Conclusion

Adjustment to living well with a stoma is influenced by personality, coping style, and social support, informed by prior personal, social and clinical experiences. Public ignorance about stomas and others' stigmatising attitudes often cause the most distress.
N17 Azathioprine - Is it really a dirty drug? IBD nurse's experience at Our Lady of Lourdes Hospital
Authors: Anderson E , McMahon S
Published: January 2023

Background

Azathioprine is commonly used in the treatment of inflammatory bowel disease (IBD) either as monotherapy or in combination with anti-TNF agents. Azathioprine has numerous side-effects (SA) including leukopenia, pancreatitis and drug-induced liver injury (DILI). At our centre, dedicated IBD nurses play a central role in educating patients regarding potential SA and the importance of blood test monitoring. Suboptimal compliance with regard to blood test monitoring is a significant issue, particularly given that some SE are likely to be asymptomatic, and only apparent on blood tests; eg. neutropenia, leukopenia, DILI. Our aim was to capture real world data regarding the true burden of SE experienced by IBD patients taking azathioprine.

Methods

We conducted a single-centre study within a dedicated gastroenterology unit served by two full-time dedicated specialist IBD nurses. Our unit serves over 1000 IBD patients. Currently approximately 22% of our patient cohort are taking azathiopriine. A prospectively maintained excel database was initiated in 2014 by the IBD nurses in order to capture data regarding SE experienced by IBD patients taking azathioprine. Data was recorded by the IBD nurses each time a patient experienced a SE secondary to azathioprine. The nature of the SE was recorded. Of note, checking of TPMT levels prior to initiation of azathioprine is standard practice in our centre.

Results

During the eight year study period (2014-2022), 91 patients were recorded as having experienced SE to azathioprine. The most common SE (n=43%) was a general intolerance to the drug which included short periods of nausea or flu-like symptoms; followed by muscle/joint pain (n=17%); pancreatitis (n=14%); abnormal lfts (n=12%); hair loss (n=10%); low wcc (n=4%).

Conclusion

Our prospectively collected real-world data shows that SE from azathioprine are common amongst IBD patients. This emphasises the importance of patient counselling prior to initiation of this drug. Whilst leukopenia is a particular concern amongst IBD services who prescribe azathioprine, our data show that this accounts for a very small percentage of SE that our patients experience while taking azathioprine.
N18 Exploring the experiences of UK-dwelling Bangladeshi native language-speaking patients with Inflammatory Bowel Disease: preliminary findings from a qualitative study
Authors: Ahmed S , Singh H , Newton P , Ojo O , Dibley L
Published: January 2023

Background

Native language-speaking patients with IBD may be underserved by an Anglo-centric delivery of healthcare in multicultural communities. We explored experiences of IBD Bangladeshi patients living in the UK whose preferred languages were Bengali or Sylheti.

Methods

Bangladeshi patients aged 18 years+, with confirmed diagnosis of Crohn’s disease, or ulcerative colitis, who fully or mostly spoke Bengali or Sylheti, were recruited from IBD infusion clinics. Semi-structured individual phone interviews with a bilingual researcher (captured February-May 2021) were audio-recorded, translated and transcribed professionally, and analysed thematically.

Results

The eight participants were aged 34-52 years; 4 (50%) females; with Crohn’s disease (n=3), ulcerative colitis (n=5). They spoke no English (n=2), Standard Bengali (n=8), and/or Sylheti (n=6); they could read Bengali and some English (n=5), Bengali only (n=2), or neither (n=1). Four early themes emerged:

The impact of socioeconomic factors: Health inequalities pervaded participants’ experiences. They lived in a deprived London borough in multiple occupancy and/or multi-generational households, often with just one toilet. Those on low incomes had limited access to health-maintaining resources such as diet and medications.

The importance of understanding and being understood in their native language: Issues with translation of health information and interpretation in health settings were reported. Participants struggled to explain their experiences of and concerns about IBD to clinicians; having a clinician who understood their position enabled needs and concerns to be better addressed.

Understanding the condition and its chronic nature: Few participants had a good lay understanding of IBD and did not comprehend why it was only ‘being managed rather than cured’ by clinicians. Some distrusted Western medicine, believing that treatment would be better, and curative, in their native country. Family, friends, and the wider Bangladeshi community did not understand IBD and its effects.

Day-to-day self-management experienced as a burden: Self-management tasks impinged on day-to-day activities, disrupting cultural and religious pursuits. Toileting, food practices and medication management all impacted negatively on personal and family social relationships and events, and on the ability to work.

Conclusion

Wider socioeconomic factors preceded and affected participant’s resources and ability to self-manage their condition. Language barriers fostered poor understanding of IBD and its chronic nature. Improved translation and interpretation assistance, alongside community-based initiatives to ameliorate health inequalities and improve access to health resources, would benefit this community.
N23 Burnout among European IBD specialists – a survey supported by ECCO
Authors: Sánta A , Volosin M , Farkas K , Keresztes C , Rafael B , Molnár T
Published: January 2023

Background

The aim of the study was to measure the level of burnout and the factors influencing it, as well as to analyse the personal and professional risk factors among European IBD professionals.

Methods

102 respondents (56.9% male, average age 48 (SD:10.6)) completed the questionnaire, which consisted of four different psychological constructs (burnout, depression, somatization and well-being), as well as sociodemographic, health-related and work-related factors.

Results

In our study, 47.1% of IBD professionals showed burnout. For all three factors of burnout combined, 17.6% of participants scored at least in the moderate range. The highest rate of burnout factors was depersonalization (medium 48%; high 47.1%). 33.3% of the respondents reported decreased personal performance and 5.9% showed moderate emotional exhaustion. Depression, somatization and well-being correlated with emotional exhaustion and depersonalization, but only depression correlated with personal accomplishment. Emotional exhaustion correlated with age, physical activity and time spent in health care as an IBD specialists. Regression analysis showed that depression is the most important factor explaining both personal accomplishment (β=0.4599; p=0.006) and depersonalization (β=0.5692; p<.001). Among the work factors, endoscopic access and dedicated IBD outpatient unit had a negative effect on burnout. The opportunity to participate in multidisciplinary meetings was proved to be a clear anti-burnout factor.

Conclusion

The pilot study tends to draw the attention to the importance of burnout among IBD professionals in Europe, particularly in relation to depersonalization. Further studies may help uncover the role of underlying factors and provide a basis for international support and prevention programs.
N28 Satisfaction with telemedicine programs in inflammatory bowel disease: a natiowise multicenter study
Authors: Cano Sanz N , Serrano Redondo M , Jurado Monroy R M , Suárez Álvarez P , García Prada M , Latras Cortés I , Sierra Ausín M
Published: January 2023

Background

The novelty of using telemedicine systems with inflammatory bowel disease (IBD) patients represents a new point of view of care delivery. However, different factors such as the acceptance and access to telematic means, the digital literacy of the population and health professionals, as well as other objective and subjective factors in their use must be weighed in order to implement this type of programs. Thus, we propose a multicenter study in different IBD units of Spanish centers with availability of telemedicine programs for clinical follow-up and/or determination of fecal calprotectin at home.

Methods

Cross-sectional observational study. IBD monographic units around national territory with available telemedicine programs were contacted. They were requested to answer to specific questionnaires by professionals (10 questions) and by patients (18 questions), all of them compound by closed-ended questions with a 5-item Likert scale and short answer questions. The closed-ended questions underwent quantitative analysis, while the short answer questions underwent qualitative analysis using the SWOT method.

Results

To abstract date, 18 IBD units joined to the study, including 21 health professionals and 44 patients. The mean score for the closed-ended questions was 26.45 ± 7.32 out of 40 points for health professionals (6.6/10) and 52.67 ± 23.54 out of 72 points for patients (7.3/10). The SWOT analysis identified as weaknesses: lack of integration with the computer system of the centers; threats: low perceived usefulness, flaws in the design of the application; and strengths: free telematic system and fecal calprotectin collection kits, reduction of visits to the healthcare center, simple collection method and analysis of fecal calprotectin at home.

Conclusion

The development of telemedicine systems in IBD units in our country is still limited. Users, patients and professionals, perceive some problems in its use that lead to its underuse and abandonment. Implementing improvement measures represents an opportunity to increase their acceptance and to incorporate this kind of programs into daily practice.
Severing the Belt and Road: Overseas Chinese Networks and COVID-19 Travel Restrictions
Authors: Kim Sung Eun , Shin Adrian J , Yang Yujeong
Published: January 2023

In response to the COVID-19 pandemic, governments around the world have imposed a wide variety of entry restrictions on international travel. Historical cases illustrate that public health concerns based on entrenched prejudices toward immigrant communities have led to restrictive measures against migration from foreign countries. Using our new dataset, COVID-19 Travel Restrictions and Categories, we examine whether Chinese migrant networks around the world have driven government decisions to bar the entry of Chinese nationals and travelers from China in the early months of the COVID-19 pandemic. Our survival analysis of China-specific travel restrictions from January to March 2020 shows that not all Chinese migrant networks were important determinants. We find that entry bans on travel from China emerged more quickly in countries where a large number of temporary Chinese migrants work in clustered sites of Chinese contracted projects.
Foreign Policy Alignment and Russia's Energy Weapon
Authors: Stoelzel Chadwick Christina M , Long Andrew G
Published: January 2023

Scholars of international relations disagree whether trade in natural gas between Europe and Russia provides the latter with a source of foreign policy power. Because a reduction in trade of natural gas is costly for importers, the potential economic power of Russia's energy weapon could alter strategic calculations about diplomatic conflict with Russia. Consequently, we hypothesize that increases in dependence on Russian natural gas will lead to more foreign policy convergence with Russia. Using a panel of European states from 1995 to 2013 and a time series of Germany from 1979 to 2013, we find support for our argument that greater dependence on Russian natural gas correlates with more similarity in voting patterns at the United Nations General Assembly. Our research suggests that Russian natural gas imports to Europe shape broader political alignments, adding to the growing body of research on the potential ramifications of Russia's energy weapon.
Assessing Healthy Aging Score and Its Association With All-Cause Mortality: Findings From the China Health and Retirement Longitudinal Study
Authors: Zeng Zihang , Li Xuerui , Yang Wenzhe , Wang Jiao , Zhu Yun , Qi Xiuying , Xu Weili
Published: January 2023

Background and Objectives

To construct a comprehensive healthy aging score (HAS) and explore its association with all-cause mortality and its potential interactions with other demographics on mortality.

Research Design and Methods

This study included 5,409 participants aged ≥60 years from the China Health and Retirement Longitudinal Study. An HAS was constructed based on three dimensions of healthy aging including intrinsic capacity (IC), environmental support (ES), and chronic disease (CD), which were assessed at baseline, and categorized by tertiles (poor, moderate, and high). Participants were followed up biennially for all-cause mortality through the death registration or family interview from 2011 to 2018. Data were analyzed using Cox regression, Laplace regression, and receiver-operating characteristic analysis.

Results

During 7 years of follow-up, 877 (16.21%) participants died. An HAS was constructed based on the cognition, mobility, and instrumental activity of daily living in the IC dimension; housing in the ES dimension; and hypertension, diabetes, chronic lung disease, stroke, and cancer in the CD dimension, which was associated with death. HAS seems a good predictor of all-cause mortality, with an area under the curve of 0.749. The hazard ratios and 95% confidence intervals for all-cause mortality related to moderate and poor HAS (vs high HAS) were 1.26 (1.01–1.56) and 2.38 (1.94–2.91), respectively. The median survival time was 2.46 years shorter in participants with poor HAS than those with high HAS. There were significant additive interactions of HAS with age, sex, and marital status on death.

Discussion and Implications

Poor HAS may increase mortality and shorten survival, especially among older, male, and single adults.
Gravity degree–depth relationship using point mass spherical harmonics
Authors: Goossens Sander , Smith David E
Published: January 2023

Relationships between the degree of a spherical harmonic model of the gravitational field of a body and the depth of a source expressed as a density contrast can be used to study the structure of features. Here, we show that the gravitational acceleration per spherical harmonic degree of a constant density source has an extremum that depends on the depth of the source. Using the spherical harmonics expansion for a point mass source, we use this to derive a degree–depth relationship. Our relationship resembles an earlier one derived by Bowin, with substantial differences at the lower degrees. We also find that a recent relationship derived by Deng et al. overestimates the source depth. The relationship that we derive relates spherical harmonic degree n to depth d for a planet of radius R according to $d = (1-e^{\frac{-1}{n+1}})R$, which simplifies to d = R/(n + 1) for high degrees. We support our new relationship with synthetic models of a density contrast in a planet. We also show how the differences between our relationship and that of Bowin affect band-filtered gravity, for example when inspecting the upper 100 km of the Moon. Using point masses in our modelling results in an approximate relationship where in reality sources can be deeper than estimated, since any source contributes to all spherical harmonic degrees. The use of the contribution per individual degree however provides an intuitive relationship between spherical harmonic degree and depth that can be used to place relative bounds on source depths or to determine the bounds on spherical harmonic expansions when band-filtering gravity field models.
Single-cell Expression Atlas Reveals Cell Heterogeneity in the Creeping Fat of Crohn’s Disease
Authors: Shu Weigang , Wang Yongheng , Li Chuanding , Zhang Lei , Zhuoma Deji , Yang Pengyu , Yan Guorong , Chen Chunqiu , Ba Yongbing , Du Peng , Wang Xiaolei
Published: January 2023

Background

Creeping fat (CrF) has been recognized to play a positive role in Crohn’s disease (CD) progression, yet the cellular compositions within mesenteric adipose tissue (MAT) and their potential mechanism in CrF formation are poorly understood.

Methods

Analysis of 10X single-cell RNA sequencing was performed on 67 064 cells from 3 pairs of surgically resected samples of CrF and their uninvolved MAT. The results were validated in another cohort with 6 paired MAT samples by immunofluorescence.

Results

All samples manifested excellent consistency and repeatability in our study, and 10 cell types from the transcriptome atlas, including 20 clusters, were identified. In CrF, a specific vascular endothelial cell subpopulation highly expressing lipoprotein lipase was first identified, with a significantly increased proportion. This vascular endothelial cell subpopulation manifested robust peroxisome proliferator-activated receptor γ (PPARγ) transcription activity and an upregulated PPAR signaling pathway and was involved in lipid metabolism and the antibacterial response. A novel fibroblast subpopulation (FC3) with remarkable GREM1 and RFLNB expression was identified and validated to predominantly accumulate in the CrF. The FC3 was annotated as inflammation-associated fibroblasts, which are characterized by inflammatory responses and the regulation of Smad phosphorylation related to intestinal fibrosis. The trajectory of fibroblasts revealed their pro-inflammatory and profibrotic conversion tendency during CrF formation with corresponding gene dynamics. Additionally, we unprecedently dissected the different origins and functions of 6 macrophage subclusters within the myeloid compartment.

Conclusions

Our results uncover the cellular heterogeneity in the MAT of CD and the role of these various cellular compositions in CrF development. This comprehensive understanding of CrF provides future directions for in-depth research on and potential targets for MAT-based treatment.
Delays in Therapy Associated With Current Prior Authorization Process for the Treatment of Inflammatory Bowel Disease
Authors: Choi David K , Cohen Nathaniel A , Choden Tenzin , Cohen Russell D , Rubin David T
Published: January 2023

Lay Summary

Despite a high approval rate, there were unnecessary delays in therapy due to prior authorizations. This study identified the impact of type of IBD, FDA-labeled indication, and dose escalations on approvals.
The challenges of selective fertility and carryover effects in within-sibship analyses: the effect of assisted reproductive technology on perinatal mortality as an example
Authors: Westvik-Johari Kjersti , Håberg Siri E , Lawlor Deborah A , Romundstad Liv Bente , Bergh Christina , Wennerholm Ulla-Britt , Gissler Mika , Henningsen Anna-Karina A , Tiitinen Aila , Pinborg Anja , Opdahl Signe
Published: January 2023

Background

Within-sibship analyses show lower perinatal mortality after assisted reproductive technology (ART) compared with natural conception (NC), a finding that appears biologically unlikely. We investigated whether this may be attributed to bias from selective fertility and carryover effects.

Methods

Using data from national registries in Denmark (1994–2014), Finland (1990–2014) and Norway and Sweden (1988–2015), we studied 5 722 826 singleton pregnancies, including 119 900 ART-conceived and 37 590 exposure-discordant sibships. Perinatal mortality at the population level and within sibships was compared using multilevel logistic regression with random and fixed intercepts, respectively. We estimated selective fertility as the proportion of primiparous women with and without perinatal loss who had a second delivery, and carryover effects through bidirectional and crosswise associations.

Results

Population analysis showed higher perinatal mortality among ART conception compared with NC (odds ratio 1.21, 95% CI 1.13 to 1.30), whereas within-sibship analysis showed the opposite (OR 0.36, 95% CI 0.31 to 0.43). Primiparous women with perinatal loss were more likely to give birth again (selective fertility) and to use ART in this subsequent pregnancy (carryover effects), resulting in strong selection of double-discordant sibships with death of the naturally conceived and survival of the ART-conceived sibling. After controlling for conception method and outcome in the first pregnancy, ART was not consistently associated with perinatal mortality in the second pregnancy.

Conclusions

Whereas population estimates may be biased by residual confounding, within-sibship estimates were biased by selective fertility and carryover effects. It remains unclear whether ART conception contributes to perinatal mortality.
A modified binary version of aphid–ant mutualism for feature selection: a COVID-19 case study
Authors: Eslami N , Yazdani S , Mirzaei M , Hadavandi E
Published: January 2023

The speedy development of intelligent technologies and gadgets has led to a drastic increment of dimensions within the datasets in recent years. Dimension reduction algorithms, such as feature selection methods, are crucial to resolving this obstacle. Currently, metaheuristic algorithms have been extensively used in feature selection tasks due to their acceptable computational cost and performance. In this article, a binary-modified version of aphid–ant mutualism (AAM) called binary aphid–ant mutualism (BAAM) is introduced to solve the feature selection problems. Like AAM, in BAAM, the intensification and diversification mechanisms are modeled via the intercommunication of aphids with other colonies’ members, including aphids and ants. However, unlike AAM, the number of colonies’ members can change in each iteration based on the attraction power of their leaders. Moreover, the second- and third-best individuals can take the place of the ringleader and lead the pioneer colony. Also, to maintain the population diversity, prevent premature convergence, and facilitate information sharing between individuals of colonies including aphids and ants, a random cross-over operator is utilized in BAAM. The proposed BAAM is compared with five other feature selection algorithms using several evaluation metrics. Twelve medical and nine non-medical benchmark datasets with different numbers of features, instances, and classes from the University of California, Irvine and Arizona State University repositories are considered for all the experiments. Moreover, a coronavirus disease (COVID-19) dataset is used to validate the effectiveness of the BAAM in real-world applications. Based on the acquired outcomes, the proposed BAAM outperformed other comparative methods in terms of classification accuracy using various classifiers, including K nearest neighbor, kernel-based extreme learning machine, and multi-class support vector machine, choosing the most informative features, the best and mean fitness values and convergence speed in most cases. As an instance, in the COVID-19 dataset, BAAM achieved 96.53% average accuracy and selected the most informative feature subset.
The WTO’S Contribution to the Challenges of Global Commons
Authors: Okonjo-Iweala Ngozi
Published: January 2023

Global trade can be an important part of the solution to modern global challenges, just as the rule-based multilateral trading system played an instrumental role in fostering peace and prosperity since its creation in 1947. Trade has been a lifeline for producing and accessing critical medical supplies from face masks to vaccines almost since the beginning of the pandemic; trade is also an important means for adapting to climate change as well as cutting emissions; and trade has helped net-food-importing countries faced with food crisis. For trade to be a part of solutions to the range of modern challenges, the role of the World Trade Organization (WTO) is indispensable, and it must be updated for it to remain fit for purpose. The continuing reinvention of the WTO will not be easy, but the outcomes of the 12th Ministerial Conference (MC12) are a good start. In this special contribution to the Journal of International Economic Law, I reflect on the WTO’s role for the twenty-first century and beyond and how the MC12 outcomes will serve as a foundation and a platform for Members to build on to reinvent the WTO.
Pilot study of aerosols visualized and evaluated in a radiotherapy room
Authors: Musha Atsushi , Kubo Nobuteru , Kawamura Hidemasa , Okano Naoko , Yanagisawa Kunio , Sugawara Kazuaki , Okamoto Ryuta , Takahashi Kozo , Kawabata Hideki , Ohno Tatsuya
Published: January 2023

Health care institutions provide prevention strategies for coronavirus disease 2019 and non-infectious disease care. We investigated the characteristics of patient contamination in a radiotherapy room by examining the trajectory and number of airborne particles in the air when talking and coughing occurred and clarified the actual state of contamination in this closed space. Aerosols were visualized and evaluated in the vertical height and head-to-tail width directions when the participant was lying on the radiotherapy tabletop. Aerosol reach was significantly greater for loud voice and coughing both at vertical height and the head-to-tail width direction. The size and number of particles around the radiotherapy tabletop were also visualized and evaluated in the radiotherapy room. The radiotherapy staff who were in the presence of the participant sometimes had many particles adhering to their facial area; particle adhesion to the staff was dominated by small size particles. Particle adherence to the irradiation device surface near the ceiling had particles larger than 1 mm. Tabletop particles tended to have a wider size range, including bigger sizes and a larger count compared to the surrounding floor. The 0.7-m radius distance from the participant's mouth tended to be highly contaminated, and the smaller the particle size, the farther it reached. The capacity to estimate areas prone to contamination can be used to predict infection of other patients and medical staff in a radiotherapy room.
Argumentation Frameworks with Attack Classification
Authors: Vassiliades Alexandros , Flouris Giorgos , Patkos Theodore , Bikakis Antonis , Bassiliades Nick , Plexousakis Dimitris
Published: January 2023

Abstract argumentation frameworks (AAFs), introduced by Dung (1995, Artif. Intell., 228, 321–357), enabled a new way of reasoning with arguments, which does not take into account the internal structure of arguments but only how they are related to each other. The only form of relation considered in AAFs is a binary attack relation on the set of arguments. From the definitions of acceptability semantics of AAFs, it is obvious that attacks actually have a dual role: on the one hand, they generate conflicts; on the other hand, they can defend other arguments from attacks. In this paper, we propose a framework, where the modeller can explicitly specify the role of each attack. For this purpose, we define a set of conflict-generating attacks ${\mathcal {R}_{C}}$ and a set of defending attacks ${\mathcal {R}_{d}}$, as well as a family of semantics that considers the role of each attack while determining which arguments are attacked, which are defended and which will be included in each extension. We study the formal properties of the proposed framework and semantics, show that our framework is a generalization of AAFs and assess its semantics against a set of principles. Finally, we present a web application that provides an interface for creating custom argumentation frameworks and uses ASP to compute their extensions.
Kink oscillations of magnetic flux tubes in presence of resistivity
Authors: Ebrahimi Zanyar , Javaherian Mohsen
Published: January 2023

Kink oscillations in the solar coronal flux tubes are among the best seismological tools for estimating the unknown parameters of the solar corona. Here, we study the effect of resistivity on the linear evolution of magnetohydrodynamic (MHD) kink waves in magnetic flux tubes with transverse inhomogeneity in the plasma density. In thin tube thin boundary approximation, we obtain the well-known resistive spectrum of Alfvén continuum modes with a semi-analytical method and study the relative importance of the eigenmodes in the spectrum. As shown in previous studies, the quasi-mode solution of ideal MHD appears in the spectrum. Results show that while the internal and external homogeneous regions of the flux tube oscillate dominantly in quasi-mode in the inhomogeneous region in each magnetic surface a different combination of resistive eigenmodes contributes to the perturbations. Comparing the results obtained here with those obtained previously in the same configuration for a viscous plasma shows that resistivity is less efficient than viscosity in transforming the energy of the wave to heat.
Validation of new ACR/EULAR 2022 classification criteria for anti-neutrophil cytoplasmic antibody–associated vasculitis
Authors: Sada Ken-ei , Kaname Shinya , Higuchi Tomoaki , Furuta Shunsuke , Nagasaka Kenji , Nanki Toshihiro , Tsuboi Naotake , Amano Koichi , Dobashi Hiroaki , Hiromura Keiju , Bando Masashi , Wada Takashi , Arimura Yoshihiro , Makino Hirofumi , Harigai Masayoshi
Published: January 2023

Objective

The objective of this study was to compare the American College of Rheumatology/European Alliance of Associations for Rheumatology 2022 criteria with the previous classification algorithm for anti-neutrophil cytoplasmic antibody–associated vasculitis.

Methods

We used data from two nationwide, prospective, inception cohort studies. The enrolled patients were classified as having eosinophilic granulomatosis with polyangiitis (EGPA), granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA) according to the new criteria; these criteria were compared with Watts’ algorithm.

Results

Among 477 patients, 10.7%, 9.9%, and 75.6% were classified as having EGPA, GPA, and MPA, respectively; 6.1% were unclassifiable. Three patients met both the EGPA and MPA criteria, and eight patients met both the GPA and MPA criteria. Of 78 patients with GPA classified using Watts’ algorithm, 27 (34.6%) patients were reclassified as having MPA. Ear, nose, and throat involvement was significantly less frequent in patients reclassified as having MPA than in those reclassified as having GPA. Of 73 patients unclassifiable using Watts’ algorithm, 62 were reclassified as having MPA. All patients reclassified as having MPA were myeloperoxidase-anti-neutrophil cytoplasmic antibody positive, and 46 had interstitial lung disease.

Conclusion

Although the American College of Rheumatology/European Alliance of Associations for Rheumatology 2022 criteria cause overlapping multiple criteria fulfilments in some patients, those items contribute to classifying unclassifiable patients using Watts’ algorithm into MPA.
Fatal cerebral venous sinus thrombosis with preceding thrombocytopenia in a patient with new-onset eosinophilic granulomatosis with polyangiitis
Authors: Tanomogi Naoki , Ota Takahiro , Sato Daisuke , Itagaki Shingo , Shimada Kota
Published: January 2023

A previously healthy, 44-year-old, female patient was hospitalised for acute abdominal pain and bilateral pneumonia. Eosinophilic granulomatosis with polyangiitis (EGPA) was diagnosed on the basis of eosinophilia, eosinophilic tissue inflammation, polyneuropathy, and bilateral pneumonia. She had a fatal cerebral venous sinus thrombosis following thrombocytopenia, which was apparently caused by platelet consumption. It may have been possible to prevent the deterioration of the venous thrombosis by starting immunosuppressive or anticoagulant therapy earlier. If a patient with EGPA presents with unexplained thrombocytopenia, the physician should assess for physical findings or laboratory abnormalities suggestive of thrombosis. Additionally, if the patient complains of headache or nausea with normal head computed tomography findings, magnetic resonance imaging or magnetic resonance venography should be performed to assess for cerebral venous sinus thrombosis.