bluuebunny/crossref_metadata_2025 huggingface dataset:
Placebo effects in sports performance and exercise outcomes
Authors: Lindheimer Jacob B. , Beedie Chris , Raglin John S.
Published: October 2023

This chapter provides an overview of research into the placebo effect in sports and exercise. In doing so, it treats placebo effect research in Sports and equivalent research in Exercise as two distinct areas, each characterized by differing underlying assumptions: the improved understanding of psychological factors leading to enhanced performance in sports and the improved understanding of psychological and affective responses to exercise. It summarizes recent advances in understanding and knowledge, drawing attention to potential applications such as the reduction of drug use by athletes in sports and the enhancement of mental health in exercisers. We provide updated definitions and models of the placebo effect derived from Sports and Exercise research and propose future directions to better understanding and apply the placebo effect in both domains.
Expectations and placebo effects in the context of cognitive training
Authors: Parong Jocelyn , Jaeggi Susanne , Seitz Aaron , Shawn Green C.
Published: October 2023

While there is growing evidence that cognitive training improves cognition, researchers have proposed an alternative explanation that such improvements are driven, at least in part, by participants’ expectations or placebo effects. Indeed, studies have shown that people’s expectations about their cognitive performance are related to their actual performance. Because participants either bring existing positive expectations of cognitive training or have different experiences between a cognitive training intervention and control intervention (or lack thereof), it is possible that they form different expectations during the interventions, in turn affecting performance on postintervention assessments. However, the current literature is mixed regarding the extent to which these expectations explain positive findings in cognitive training. This chapter explores the role of participant expectations in cognitive training, the extent that they truly affect the results of cognitive training interventions, and strategies of how they could be minimized or alternatively harnessed to maximize the effect of interventions.
Placebo responses and effects
Authors: Boris Kohls Nikola , Leyva Monica A. , Giordano James
Published: October 2023

When addressing mechanisms by which consciousness, and the subjective experiences of “wellness,” or “illness” and suffering evoked by injury or disease are correlated, it becomes apparent that all engage pathways that can affect a variety of physiological, salutogenic, and/or maladogenic processes. This chapter addresses the concept of the placebo as both a set of putative physiological responses and biopsychosocial effects that are apparently supportive of healing and health. Although detailed elsewhere in this volume, an overview of neural mechanisms and processes are provided as relevant to an evidence-based approach to the potential utility and value of engaging such responses in particular clinical situations. Ethical issues and considerations of employing placebo responses and effects are addressed as relevant to preserving the moral integrity of the clinical encounter and act of Medicine.
Placebo effects and research quality
Authors: Jonas Wayne B. , Goldman David , Muhammed Salim , Daniel Mullins C. , Colloca Luana
Published: October 2023

Currently, most pharmacological and nonpharmacological treatments require a demonstration that their beneficial effects are superior to those seen in a placebo control group. However, determining whether treatments are effective can be difficult. The nuances of social-cultural and personal-historical contexts can affect therapeutic outcomes and need to be considered in the research designs of studies using placebo control groups. Additionally, the research design of such studies should consider what is useful from a person-centered perspective, not just a regulatory perspective. In this chapter, we explore the implications of the placebo effect for the interpretation of results from randomized placebo-controlled clinical trials. We also discuss what clinical approaches and tools should be considered “good evidence” of a therapeutic effect that should move forward to clinical practice.
beagle-agn I: simultaneous constraints on the properties of gas in star-forming and AGN narrow-line regions in galaxies
Authors: Vidal-García A , Plat A , Curtis-Lake E , Feltre A , Hirschmann M , Chevallard J , Charlot S
Published: October 2023

We present the addition of nebular emission from the narrow-line regions (NLR) surrounding active galactic nuclei (AGNs) to beagle (BayEsian Analysis of GaLaxy sEds). Using a set of idealized spectra, we fit to a set of observables (emission-line ratios and fluxes) and test the retrieval of different physical parameters. We find that fitting to standard diagnostic-line ratios plus [O ii] λ3726, λ3729/[O iii] λ5007, H β/H α, [O i] λ6300/[O ii] λ3726, λ3729, and H α flux, degeneracies remain between dust-to-metal mass ratio ($\xi _\rm {d}^{\small NLR}$) and ionization parameter ($U_\rm {s}^{\small NLR}$) in the NLR gas, and between slope of the ionizing radiation ($\alpha _{\small PL}$, characterizing the emission from the accretion disc around the central black hole) and total accretion-disc luminosity ($L_\rm {acc}$). Since these degeneracies bias the retrieval of other parameters even at maximal signal-to-noise ratio (S/N), without additional observables, we suggest fixing $\alpha _{\small PL}$ and dust-to-metal mass ratios in both NLR and H ii regions. We explore the S/N in H β required for un-biased estimates of physical parameters, finding that S/N(H β) ∼ 10 is sufficient to identify an NLR contribution, but that higher S/N is required for un-biased parameter retrieval (∼20 for NLR-dominated systems, ∼30 for objects with approximately equal H β contributions from NLR and H ii regions). We also compare the predictions of our models for different line ratios to previously published models and data. By adding [He ii] λ4686-line measurements to a set of published line fluxes for a sample of 463 AGN NLR, we show that our models with $-4\lt \hbox{$\log U_{\small S}^{\small NLR}$}\lt -1.5$ can account for the full range of observed AGN properties in the local Universe.
Probing the roles of orientation and multiscale gas distributions in shaping the obscuration of active galactic nuclei through cosmic time
Authors: Alonso-Tetilla Alba V , Shankar Francesco , Fontanot Fabio , Menci Nicola , Valentini Milena , Buchner Johannes , Laloux Brivael , Lapi Andrea , Puglisi Annagrazia , Alexander David M , Allevato Viola , Andonie Carolina , Bonoli Silvia , Hirschmann Michaela , López Iván E , Raimundo Sandra I , Ramos Almeida Cristina
Published: October 2023

The origin of obscuration in active galactic nuclei (AGNs) is still an open debate. In particular, it is unclear what drives the relative contributions to the line-of-sight column densities from galaxy-scale and torus-linked obscuration. The latter source is expected to play a significant role in Unification Models, while the former is thought to be relevant in both Unification and Evolutionary models. In this work, we make use of a combination of cosmological semi-analytic models and semi-empirical prescriptions for the properties of galaxies and AGN, to study AGN obscuration. We consider a detailed object-by-object modelling of AGN evolution, including different AGN light curves (LCs), gas density profiles, and also AGN feedback-induced gas cavities. Irrespective of our assumptions on specific AGN LC or galaxy gas fractions, we find that, on the strict assumption of an exponential profile for the gas component, galaxy-scale obscuration alone can hardly reproduce the fraction of log (NH/cm−2) ≥ 24 sources at least at z ≲ 3. This requires an additional torus component with a thickness that decreases with luminosity to match the data. The torus should be present in all evolutionary stages of a visible AGN to be effective, although galaxy-scale gas obscuration may be sufficient to reproduce the obscured fraction with 22 < log (NH/cm−2) < 24 (Compton-thin, CTN) if we assume extremely compact gas disc components. The claimed drop of CTN fractions with increasing luminosity does not appear to be a consequence of AGN feedback, but rather of gas reservoirs becoming more compact with decreasing stellar mass.
The global burden of antimicrobial resistance – urinary tract infections
Authors: Von Vietinghoff Sibylle , Shevchuk Olga , Dobrindt Ulrich , Engel Daniel Robert , Jorch Selina K , Kurts Christian , Miethke Thomas , Wagenlehner Florian
Published: October 2023

Antimicrobial resistance (AMR) has emerged as a significant global healthcare problem. Antibiotic use has accelerated the physiologic process of AMR, particularly in Gram-negative pathogens. Urinary tract infections (UTIs) are predominantly of a Gram-negative nature. Uropathogens are evolutionarily highly adapted and selected strains with specific virulence factors, suggesting common mechanisms in how bacterial cells acquire virulence and AMR factors. The simultaneous increase in resistance and virulence is a complex and context-dependent phenomenon. Among known AMR mechanisms, the plenitude of different β-lactamases is especially prominent. The risk for AMR in UTIs varies in different patient populations. A history of antibiotic consumption and the physiology of urinary flow are major factors that shape AMR prevalence. The urinary tract is in close crosstalk with the microbiome of other compartments, including the gut and genital tracts. In addition, pharmacokinetic properties and the physiochemical composition of urinary compartments can contribute to the emergence of AMR. Alternatives to antibiotic treatment and a broader approach to address bacterial infections are needed. Among the various alternatives studied, antimicrobial peptides and bacteriophage treatment appear to be highly promising approaches. We herein summarize the present knowledge of clinical and microbiological AMR in UTIs and discuss innovative approaches, namely new risk prediction tools and the use of non-antibiotic approaches to defend against uropathogenic microbes.
Spin-based magnetic random-access memory for high-performance computing
Authors: Cai Kaiming , Jin Tianli , Lew Wen Siang
Published: October 2023

Spin-based memory technology is now available as embedded magnetic random access memory (eMRAM) for fast, high-density and non-volatile memory products, which can significantly boost computing performance and ignite the development of new computing architectures.
Outcomes and Predictors of Rapid Antiretroviral Therapy Initiation for People With Newly Diagnosed HIV in an Integrated Health Care System
Authors: Dalal Avani , Clark Earl , Samiezade-Yazd Zahra , Lee-Rodriguez Christian , Lam Jennifer O , Luu Mitchell N
Published: October 2023

Background

Rapid antiretroviral therapy (ART) is the recommended treatment strategy for patients newly diagnosed with HIV, but the literature supporting this strategy has focused on short-term outcomes. We examined both long-term outcomes and predictors of rapid ART among patients newly diagnosed with HIV within an integrated health care system in Northern California.

Methods

This observational cohort study included adults newly diagnosed with HIV between January 2015 and December 2020 at Kaiser Permanente Northern California. Rapid ART was defined as ART initiation within 7 days of HIV diagnosis. We collected demographic and clinical data to determine short-term and long-term outcomes, including viral suppression, care retention, medication adherence, and cumulative viral burden. Logistic regression models were used to identify predictors of rapid ART initiation.

Results

We enrolled 1409 adults; 34.1% initiated rapid ART. The rapid ART group achieved viral suppression faster (48 vs 77 days; P < .001) and experienced lower cumulative viral burden (log10 viremia copy-years, 3.63 vs 3.82; P < .01) but had slightly reduced medication adherence (74.8% vs 75.2%; P < .01). There was no improvement in long-term viral suppression and care retention in the rapid group during follow-up. Patients were more likely to initiate rapid ART after 2017 and were less likely if they required an interpreter.

Conclusions

Patients who received rapid ART had an improved cumulative HIV burden but no long-term improvement in care retention and viral suppression. Our findings suggest that rapid ART should be offered but additional interventions may be needed for patients newly diagnosed with HIV.
The history of dental health education: a case study of Britain
Authors: Towner Elizabeth M L
Published: October 2023

An understanding of the history of dental health education in any one country or area comes from an appreciation of the interplay of the particular social, political, economic, and technological forces over a period of time. Britain has been selected to illustrate this history because there is a particularly rich variety of primary and secondary source material which can be drawn upon in order to explore these various themes. Some of the primary sources include contemporary books, journals, and other literature, annual reports of local school medical officers and the Chief Medical Officer, government reports, and company records.
Oral health promotion in developing countries
Authors: Dickson Murray
Published: October 2023

Many people associate oral health promotion with health talks and posters, but to others it is more encompassing, as in the words of the World Health Organization: ‘health promotion is the process of enabling people to increase control over, and to improve, their health’ (Epp 1986). In the application of health promotion to oral health, one must come to consider an expanded sphere of determinants that influence oral disease in order to develop interventions that are effective, acceptable, and sustainable.
Evaluation and planning of oral health promotion programmes
Authors: Blinkhorn Anthony S
Published: October 2023

Oral health promotion has as its central theme the improvement and maintenance of the oral health of the general population. This, together with the necessity of updating the knowledge of all health and allied professionals about relevant aspects of preventive dentistry, constitutes the main everyday activities of those involved in oral health promotion and education.

In all dental health care systems health promotion is a minor budgetary item, but by the very nature of its public profile it is open to more scrutiny than many other branches of dentistry. Indeed, health promotion as a whole attracts more criticism than money, and investigations into its potential value are the source of much debate.
Blockade of Syk modulates neutrophil immune-responses via the mTOR/RUBCNL-dependent autophagy pathway to alleviate intestinal inflammation in ulcerative colitis
Authors: Zhu Fengqin , Jing Dehuai , Zhou Huihui , Hu Zongjing , Wang Yan , Jin Guiyuan , Yang Yonghong , Zhou Guangxi
Published: October 2023

Background

Ulcerative colitis (UC) is a progressive chronic inflammatory disorder. Neutrophils play a critical role in regulating intestinal mucosal homeostasis in UC. Spleen tyrosine kinase (Syk) is involved in several inflammatory diseases. Here, we evaluated the effects and underlying mechanisms of Syk on neutrophil immune-responses in UC.

Methods

Syk expression in the colonic tissues of patients with UC was determined using quantitative reverse transcription-polymerase chain reaction (qRT-PCR), western blotting, and immunohistochemistry. Colonic biopsies from patients with UC were obtained for single-cell RNA-sequencing. Neutrophils isolated from peripheral blood were pre-treated with R788 (a Syk inhibitor) and gene differences were determined using RNA sequencing. Neutrophil functions were analyzed using qRT-PCR, flow cytometry, and Transwell assay. R788 was administered daily to mice with dextran sulfate sodium (DSS)-induced colitis to verify the effects of Syk on intestinal inflammation.

Results

Syk expression was increased in inflamed mucosa and neutrophils of patients with UC and positively correlated with disease activity. Pharmacological inhibition of Syk in neutrophils decreased the production of pro-inflammatory cytokines, chemokines, neutrophil extracellular traps, reactive oxygen species, and myeloperoxidase. Apoptosis and migration of neutrophils were suppressed by Syk blockade. Syk blockade ameliorated mucosal inflammation in DSS-induced murine colitis by inhibiting neutrophil-associated immune responses. Mechanistically, Syk regulated neutrophil immune-responses via the mammalian target of rapamycin kinase/rubicon-like autophagy enhancer-dependent autophagy pathway.

Conclusions

Our findings indicate that Syk facilitates specific neutrophil functional responses to mucosal inflammation in UC, and its inhibition ameliorates mucosal inflammation in DSS-induced murine colitis, suggesting its potential as a novel therapeutic target for UC treatment.
Emerging roles of activating transcription factor 2 in the development of breast cancer: a comprehensive review
Authors: Amarah Ahmed , Elsabagh Ahmed Adel , Ouda Amr , Karen Omar , Ferih Khaled , Elmakaty Ibrahim , Malki Mohammed Imad
Published: October 2023

Activating transcription factor 2 (ATF2) is a member of the leucine zipper family of DNA binding proteins that are responsible for regulating various genes that play an essential role in major biological and cellular functions. Since ATF2 plays a vital role in cellular proliferation and apoptosis, it is believed that it greatly affects the development of breast cancers. However, its exact role in breast cancer is incompletely understood. It remains a subject of debate, ambiguity, and continuous research. Several studies have suggested the role of ATF2 as an oncogene, promoting cellular proliferation and worsening the outcome of cancers. In contrast, other studies have postulated that ATF2 plays a tumor suppressive role in estrogen receptor-positive breast cancer. The ambiguity surrounding its role in breast cancer is the reason why there is an influx of recent studies and research in this area. In this narrative review, we investigate several studies that have been published about the role of ATF2 in breast cancer. We also explore studies that have examined the association between ATF2 and endocrine therapy resistance. ATF2 has been suggested to modulate estrogen receptor (ER) expression and activity, potentially affecting tamoxifen sensitivity in breast cancer cells. Therefore, the role of ATF2 in DNA repair mechanisms and drug resistance has been deeply explored in this review. Additionally, there are numerous ongoing clinical trials exploring the effect of targeting ATF2 pathways and mechanisms on the outcome of breast cancers, some of which we have discussed. The studies and clinical trials that are being conducted to understand the multifaceted role of ATF2 and its signaling pathways may provide valuable insight for developing efficient targeted therapeutic solutions to enhance the outcomes of breast cancer and overcome endocrine resistance. We suggest further research to elucidate the dual roles of ATF2 in breast cancer and potential therapeutic therapies for its treatment.
Masked inverse folding with sequence transfer for protein representation learning
Authors: Yang Kevin K , Zanichelli Niccolò , Yeh Hugh
Published: October 2023

Self-supervised pretraining on protein sequences has led to state-of-the art performance on protein function and fitness prediction. However, sequence-only methods ignore the rich information contained in experimental and predicted protein structures. Meanwhile, inverse folding methods reconstruct a protein’s amino-acid sequence given its structure, but do not take advantage of sequences that do not have known structures. In this study, we train a masked inverse folding protein masked language model parameterized as a structured graph neural network. During pretraining, this model learns to reconstruct corrupted sequences conditioned on the backbone structure. We then show that using the outputs from a pretrained sequence-only protein masked language model as input to the inverse folding model further improves pretraining perplexity. We evaluate both of these models on downstream protein engineering tasks and analyze the effect of using information from experimental or predicted structures on performance.
Attitudes towards technology supported rheumatoid arthritis care: investigating patient- and clinician-perceived opportunities and barriers
Authors: MacBrayne Amy , Curzon Paul , Soyel Hamit , Marsh William , Fenton Norman , Pitzalis Costantino , Humby Frances
Published: October 2023

Objectives

Globally, demand outstrips capacity in rheumatology services, making Mobile Health (mHealth) attractive, with the potential to improve access, empower patient self-management and save costs. Existing mHealth interventions have poor uptake by end users. This study was designed to understand existing challenges, opportunities and barriers for computer technology in the RA care pathway.

Methods

People with RA were recruited from Barts Health NHS Trust rheumatology clinics to complete paper questionnaires and clinicians were recruited from a variety of centres in the UK to complete an online questionnaire. Data collected included demographics, current technology use, challenges managing RA, RA medications and monitoring, clinic appointments, opportunities for technology and barriers to technology.

Results

A total of 109 patient and 41 clinician questionnaires were completed. A total of 83.5% of patients and 93.5% of clinicians use smartphones daily. However, only 25% had ever used an arthritis app and only 5% had persisted with one. Both groups identified managing pain, flares and RA medications as areas of existing need. Access to care, medication support and disease education were mutually agreeable opportunities; however, discrepancies existed between groups with clinicians prioritizing education over access, likely due to concerns of data overwhelm (80.6% considered this a barrier).

Conclusions

In spite of high technology use and willingness from both sides, our cohort did not utilize technology to support care, suggesting inadequacies in the existing software. The lack of an objective biomarker for RA disease activity, existing challenges in the healthcare system and the need for integration with existing technical systems were identified as the greatest barriers.

Trial registration

Registered on the Clinical Research Network registry (IRAS ID: 264690).
Self-reported diagnostic confidence predicts diagnostic accuracy in axial spondyloarthritis imaging
Authors: Ulas Sevtap Tugce , Radny Felix , Ziegeler Katharina , Eshed Iris , Greese Juliane , Deppe Dominik , Stelbrink Carsten , Biesen Robert , Haibel Hildrun , Rios Rodriguez Valeria , Rademacher Judith , Protopopov Mikhail , Proft Fabian , Poddubnyy Denis , Diekhoff Torsten
Published: October 2023

Objectives

Reporting diagnostic confidence (DC) in axial spondyloarthritis (axSpA) imaging is recommended by the ASAS guidelines. Our aim was to investigate whether self-reported DC predicts diagnostic accuracy in axSpA imaging using X-ray (XR), computed tomography (CT) and magnetic resonance imaging (MRI).

Methods

We performed a post hoc analysis including 163 patients with low back pain (89 axSpA and 56 non-axSpA). Nine blinded readers with different experience levels [inexperienced (<1 year), semi-experienced (3–8 years) and experienced (>12 years)] scored the sacroiliac joint images for compatibility with axSpA. DC was reported on a scale from 1 (not sure) to 10 (very sure). Mean DC scores and standard deviations were calculated for correct and incorrect responses using XR, CT, MRI, XR+MRI and CT+MRI. Differences in DC were assessed using the Mann–Whitney U test.

Results

DC scores were higher for correct axSpA diagnoses and differed significantly between correct and incorrect responses for all modalities (P < 0.001), with a mean DC of 7.1 ± 2.1 and 6.3 ± 2.1 for XR, 8.3 ± 1.8 and 6.7 ± 2.0 for CT, 8.1 ± 1.9 and 6.2 ± 1.9 for MRI, 8.2 ± 1.8 and 6.7 ± 1.8 for XR+MRI and 8.4 ± 1.8 and 6.8 ± 1.8 for CT+MRI, respectively. This was also the case when looking at the results by experience group, except for XR in the inexperienced group.

Conclusion

Providing self-reported DC in radiological reports is useful information to predict diagnostic reliability in axSpA imaging.
An analysis of the risks that arise for discretionary trust settlements in the event of a divorce: to what extent does the Family Court’s asset division approach undermine discretionary trusts?
Authors: Chan Nicole
Published: October 2023

Following the House of Lords’ decision in White v White, the concept of ‘equality’ has made asset computation and division following divorce, particularly in ‘big-money’ cases, more extensive. This article examines whether discretionary trusts are vulnerable to interference by the Family Court during ancillary relief proceedings through considering three approaches. First, by varying the trust settlement under section 24(1)(c) of the Matrimonial Causes Act 1973 (‘MCA’). Second, through the ‘resource’ approach under section 25(2)(a) MCA. Third, by relying on the sham doctrine. It accordingly identifies practical considerations for trustees and settlors to ensure that their trust assets remain intact following divorce proceedings.
Validating and Optimizing a Method for Detecting Phytophthora Species by Baiting Leachate from Arrays of Container Nursery Plants
Authors: Swiecki Tedmund J. , Bernhardt Elizabeth A. , McClanahan Sean G.
Published: October 2023

In 2014, Phytophthora root rot was identified as a serious problem in nursery plants grown for habitat restoration in California. To support efforts to produce restoration nursery stock free of Phytophthora species, we developed a standardized leachate baiting method that can be conducted by nursery staff. Each plant in an array of up to 42 container-grown nursery plants is irrigated six times at 15-min intervals with a standardized water volume. Irrigation leachate is collected in a specialized vessel containing a green (unripe) pear bait. Test sensitivity was assessed using arrays of Phytophthora-free plants containing varying numbers of plants from which Phytophthora had previously been baited. The percentage of tests with Phytophthora detections increased as the proportion of infested plants in the array increased. In tests of individual inoculated plants, Phytophthora detection from a given plant varied over time, especially for less susceptible hosts. This variability likely limits test sensitivity in arrays with few infested containers. Direct probability and Monte Carlo simulation models showed that testing two to three arrays per block and 20 to 40 plants per array provided the greatest increases in detection probability for blocks of 200 to 1,000 plants in which 1 to 5% of the plants were infected. Random sampling had lower detection success than sampling biased to increase the odds of selecting infected plants. Results of extensive testing at a case study nursery were consistent with model predictions. The leachate baiting method has wide applicability for detecting and identifying Phytophthora species in nursery stock.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Development and Validation of a Real-Time PCR for the Molecular Identification of Thaumatotibia leucotreta (Lepidoptera: Tortricidae: Olethreutinae) Intercepted in Trade
Authors: van de Vossenberg Bart T. L. H. , te Braak Naomi , Timm Alicia E. , van Noort Tom H. , Gilligan Todd M.
Published: October 2023

The false codling moth, Thaumatotibia leucotreta (Meyrick), is a polyphagous pest indigenous to most of sub-Saharan Africa. This species is considered to be quarantined throughout much of the world, in part due to its extensive host range and significant damage caused by larval feeding. We developed a specific real-time PCR assay that allows for rapid and reliable identification of T. leucotreta. More than 150 target specimens were sequenced using an Illumina whole-genome shotgun approach to identify the most suitable loci for assay development. A hydrolysis probe that binds to a segment of the internal transcribed spacer 2 (ITS2) region was designed and used with a generic internal control targeting 18S rDNA. The assay was examined for cross-reactivity by testing additional Thaumatotibia species and representatives of related Olethreutine leafroller genera such as Cryptophlebia, Cydia, and Grapholita, which are often encountered in the same geographic region and on the same hosts as T. leucotreta. We compared our newly developed test to previously published TaqMan real-time PCR, SYBR Green real-time PCR, and loop-mediated isothermal amplification (LAMP) tests. Our newly developed real-time PCR assay outperformed all three tests in terms of analytical specificity, with 100% accuracy. These results will help to further improve diagnostic standards for molecular identification of T. leucotreta.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Vitamin D deficiency rickets in a toddler
Authors: Dubowy Susan Martin
Published: October 2023

Nutritional rickets is the failure of normal bone formation in children, caused by vitamin D deficiency, low calcium intake, or a combination of both. In the United States, prolonged breastfeeding without vitamin D supplementation is a major risk factor. Increasing awareness of the rationale for and importance of vitamin D supplements for all breastfed infants and children should reduce the incidence of vitamin D deficiency rickets and prevent bone deformity.
Racial disparities in pain management
Authors: Garvick Sarah J. , Banz Joe , Chin Melissa , Fesler Katie , Olson Anna M. , Wolff Emily , Gregory Tanya
Published: October 2023

Medical journals from the 1800s described differences in disease susceptibility, skin thickness, and pain tolerance among races. These misconceptions about biologic differences, the historical exploitation of minorities in research, and implicit biases among healthcare workers have all affected patient care. Discrepancies still exist in pain assessment and management for minority patients compared with their White counterparts and lead to poor health outcomes. By implementing specific changes in policy and practice, including standardization, implicit bias training, and building a diverse workforce, clinicians can begin to provide care that more equitably manages pain for all patients, regardless of race.
PAs in the Bulgarian healthcare system
Authors: Hristova Petya , Bruza-Augatis Mirela , Platikanova Magdalena
Published: October 2023

This article examines the importance of the physician associate/assistant (PA) profession in the healthcare system in Bulgaria. PAs in the country primarily work in emergency medicine and surgery, and are needed in other clinical settings, such as obstetrics and gynecology and psychiatric clinics, that are experiencing challenges because of physician shortages.
Increasing donor heart use in cardiac transplantation
Authors: DeVries Stephen A. , Smith Jason
Published: October 2023

A shortage of donor hearts remains a critical problem in cardiac transplantation, resulting in longer recipient wait times and increased wait list mortality. The disparity between available donor hearts and patients with end-stage heart failure who need transplant is expected to grow. The donor heart pool can be increased by using organs from expanded criteria, Public Health Service increased risk, hepatitis C, and donation after circulatory death donors.
Eating disorders among bariatric surgery patients
Authors: Parsons Marissa A. , Clemens Jonathan P.
Published: October 2023

Postoperative eating behaviors and unhealthy weight control measures are leading causes of bariatric surgery complications. Candidates for bariatric surgery and individuals with eating disorders may share common risk factors, such as a history of dieting, and/or being bullied or teased for their weight. Binge-eating disorder, night eating syndrome, and bulimia nervosa are the most common eating disorders among candidates for bariatric surgery before the operation. Malnutrition, stress, and intense fear of weight gain can lead to the development of an eating disorder after surgery as well. Plugging, grazing, loss of control eating, dumping, and food avoidance are specific disordered behaviors that may present after bariatric surgery. To improve physical and psychological outcomes for individuals under their care, clinicians can screen for these disordered behaviors and distinguish them from a healthy diet and the expected postsurgical course.
Treatment options for symptomatic knee osteoarthritis in adults
Authors: Clark Gregory P.
Published: October 2023

Knee osteoarthritis is a common medical condition in adults, especially among older adults. The incidence and prevalence of knee osteoarthritis are increasing, and many healthcare providers manage patients with symptomatic presentations. This article reviews the most common nonsurgical and surgical treatment options for knee osteoarthritis, emphasizing evidence-based and practical therapies.
Love in the PICU: The Hidden Language of Nurses
Authors: McCarthy Sarah Brand
Published: October 2023

A letter to my five-year-old daughter
Dyspareunia
Authors: Hrelic Debra A. , Wax Erin M. , Saccomano Scott J.
Published: October 2023

Dyspareunia in women is a recurrent pain in the genital and/or pelvic area associated with sexual intercourse. Dyspareunia is associated with increased risk of sexual dysfunction and relationship distress, and it may impact an individual's confidence, self-image, and self-esteem. Pain resulting from dyspareunia can be superficial or deep; it can range from intermittent to continuous and dull to sharp. Regardless of presentation, many women are reluctant to report symptoms to providers, making it an underreported yet common condition. The onus lies with practitioners to form trusting and safe relationships with patients in which such discussions are possible. A knowledgeable practitioner can encourage disclosure and improve outcomes for patients with dyspareunia.
The Effect of Kangaroo Care on Paternal Attachment
Authors: Yildirim Fatma , Büyükkayaci Duman Nuriye , Şahin Ebru , Vural Gülşen
Published: October 2023

Background:

During the first interaction between the father and the infant, touch can be very important especially father–infant skin-to-skin contact. Few studies have focused on the effect of kangaroo care (KC) on paternal attachment.

Purpose:

This randomized controlled study was conducted to determine the effect of KC on paternal attachment.

Methods:

A total of 90 fathers of healthy newborns, including 45 in the intervention group and 45 in the control group who met the inclusion criteria, were included randomly in the study. Data were collected using the Introductory Information Form at study admission and the Father–Infant Attachment Scale (FIAS) at 3 months of age. T test, Mann–Whitney U test, and Kruskal–Wallis test were used for statistical analysis.

Results:

The mean FIAS scores for the intervention group (I) were higher than for the control group (C) (I: 80.57 ± 13.70; C: 56.76 ± 13.23) (P < .05). Patience and tolerance (I: 13.70 ± 1.18; C: 11.57 ± 2.30), pleasure in interaction (I: 29.50 ± 2.86; C: 17.13 ± 5.93), and love and pride (I: 37.37 ± 2.85; C: 28.06 ± 5.82) mean scores for FIAS subdimensions in the intervention group were also higher than in the control group (P < .05).

Implications for Practice and Research:

Findings of this study demonstrate that KC has the potential to increase paternal attachment. Healthcare providers should provide discharge education for fathers on KC to increase father–infant attachment. There is a need for studies with larger samples in different cultures on the factors related to parents that affect father–infant attachment and evidence-based practices that increase attachment.
Prior Cesarean Birth and Risk of Uterine Rupture in Second-Trimester Medication Abortions Using Mifepristone and Misoprostol
Authors: Henkel Andrea , Miller Hayley E. , Zhang Jiaqi , Lyell Deirdre J. , Shaw Kate A.
Published: October 2023

OBJECTIVE:

To assess the risk difference of uterine rupture when using current mifepristone and misoprostol regimens for second-trimester abortion among individuals with prior cesarean birth compared with those without prior cesarean birth.

DATA SOURCES:

We searched the terms second trimester, induction, mifepristone, and abortion in PubMed, EMBASE, POPLINE, ClinicalTrials.gov, and Cochrane Library from inception until December 2022.

METHODS OF STUDY SELECTION:

We included randomized trials and observational studies including a mixed cohort, with and without uterine scar, of individuals at 14–28 weeks of gestation who used mifepristone and misoprostol to end a pregnancy or to manage a fetal death. We excluded case reports, narrative reviews, and studies not published in English. Two reviewers independently screened studies.

TABULATION, INTEGRATION, AND RESULTS:

Absolute risks with binomial CIs were calculated from pooled data. Using R software, we estimated total risk difference by the Mantel–Haenszel random-effects method without continuity correction. For studies with zero events, a continuity correction of 0.5 was applied for individual risk differences and plotted graphically with forest plots. Statistical heterogeneity was assessed with Higgins I
2 statistics. Funnel plot assessed for publication bias. Of 198 articles identified, 22 met the inclusion criteria: seven randomized trials (n=923) and 15 observational studies (n=6,195). Uterine rupture risk with prior cesarean birth was 1.1% (10/874) (95% CI 0.6–2.1) and without prior cesarean birth was 0.01% (2/6,244) (95% CI 0.0–0.12). The risk difference was 1.23% (95% CI 0.46–2.00, I
2=0%). Of the 12 reported uterine ruptures, three resulted in hysterectomy.

CONCLUSION:

Uterine rupture with mifepristone and misoprostol use during second-trimester induction abortion is rare, with the risk increased to 1% in individuals with prior cesarean birth.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42022302626.
Concurrent Minimally Invasive Gynecologic Procedures at the Time of Laparoscopic Cholecystectomy
Authors: Matsuo Koji , Rau Alesandra R. , Ciesielski Katharine M. , Vallejo Andrew , Mandelbaum Rachel S. , Roman Lynda D. , Klar Maximilian , Matsushima Kazuhide , Wright Jason D.
Published: October 2023

In this cross-sectional study including 1,722,479 women who underwent laparoscopic cholecystectomy between January 2016 and December 2019 identified in the Healthcare Cost and Utilization Project's Nationwide Ambulatory Surgery Sample, the prevalence rate of gynecologic diagnoses was 11.3 per 1,000. Among presumed elective laparoscopic cholecystectomy, the highest performance rate of concurrent gynecologic procedure per gynecologic diagnosis was laparoscopic adnexectomy among patients with benign ovarian tumor (652/1,000 diagnoses), followed by laparoscopic adnexectomy for endometrioma (386/1,000 diagnoses) and cervical conization for cervical carcinoma in situ (304 for 1,000 diagnoses). The measured surgical morbidity rates for patients who had concurrent gynecologic surgery and those who did not were 2.8 per 1,000 and 1.9 per 1,000, respectively (adjusted odds ratio 1.39, 95% CI 0.75–2.59). These results suggest that minimally invasive gynecologic surgeries are being performed at the time of outpatient laparoscopic cholecystectomy in the United States.
Pupil Dilation Reflects Perceptual Priorities During a Receptive Speech Task
Authors: Mechtenberg Hannah , Giorio Cristal , Myers Emily B.
Published: October 2023

Objectives:

The listening demand incurred by speech perception fluctuates in normal conversation. At the acoustic-phonetic level, natural variation in pronunciation acts as speedbumps to accurate lexical selection. Any given utterance may be more or less phonetically ambiguous—a problem that must be resolved by the listener to choose the correct word. This becomes especially apparent when considering two common speech registers—clear and casual—that have characteristically different levels of phonetic ambiguity. Clear speech prioritizes intelligibility through hyperarticulation which results in less ambiguity at the phonetic level, while casual speech tends to have a more collapsed acoustic space. We hypothesized that listeners would invest greater cognitive resources while listening to casual speech to resolve the increased amount of phonetic ambiguity, as compared with clear speech. To this end, we used pupillometry as an online measure of listening effort during perception of clear and casual continuous speech in two background conditions: quiet and noise.

Design:

Forty-eight participants performed a probe detection task while listening to spoken, nonsensical sentences (masked and unmasked) while recording pupil size. Pupil size was modeled using growth curve analysis to capture the dynamics of the pupil response as the sentence unfolded.

Results:

Pupil size during listening was sensitive to the presence of noise and speech register (clear/casual). Unsurprisingly, listeners had overall larger pupil dilations during speech perception in noise, replicating earlier work. The pupil dilation pattern for clear and casual sentences was considerably more complex. Pupil dilation during clear speech trials was slightly larger than for casual speech, across quiet and noisy backgrounds.

Conclusions:

We suggest that listener motivation could explain the larger pupil dilations to clearly spoken speech. We propose that, bounded by the context of this task, listeners devoted more resources to perceiving the speech signal with the greatest acoustic/phonetic fidelity. Further, we unexpectedly found systematic differences in pupil dilation preceding the onset of the spoken sentences. Together, these data demonstrate that the pupillary system is not merely reactive but also adaptive—sensitive to both task structure and listener motivation to maximize accurate perception in a limited resource system.
Improved 30-Day Survival Estimation in ICU Patients: A Comparative Analysis of Different Approaches With Real-World Data*
Authors: Vacheron Charles-Hervé , Friggeri Arnaud , Gerbaud-Coulas Chloe , Dagonneau Tristan , Timsit Jean Francois , Allaouchiche Bernard , Wallet Florent , Bohe Julien , Piriou Vincent , Maucort-Boulch Delphine , Fauvernier Mathieu
Published: October 2023

OBJECTIVES:

The objective of this study was to compare three different approaches for estimating 30-day survival in ICU studies, considering the issue of informative censoring that occurs when patients are lost to follow-up after discharge.

DESIGN:

A comparative analysis was conducted to evaluate the effect of different approaches on the estimation of 30-day survival. Three methods were compared: the classical approach using the Kaplan-Meier (KM) estimator and Cox regression modeling, the competing risk approach using the Fine and gray model, considering censoring as a competing event, and the logistic regression approach.

SETTING:

The study was conducted in a university ICU and data from patients admitted between 2010 and 2020 were included. Patient characteristics were collected from electronic records.

PATIENTS:

A total of 10,581 patients were included in the study. The true date of death for each patient, obtained from a national registry, allowed for an absence of censoring.

INTERVENTIONS:

All patients were censored at the time of discharge from the ICU, and the three different approaches were applied to estimate the mortality rate and the effects of covariates on mortality. Regression analyses were performed using five variables known to be associated with ICU mortality.

MEASUREMENTS AND MAIN RESULTS:

The 30-day survival rate for the included patients was found to be 80.5% (95% CI, 79.7–81.2%). The KM estimator severely underestimated the 30-day survival (50.6%; 95% CI, 48.0–53.4%), while the competing risk and logistic regression approaches provided similar results, only slightly overestimating the survival rate (84.5%; 95% CI, 83.8–85.2%). Regression analyses showed that the estimates were not systematically biased, with the Cox and logistic regression models exhibiting greater bias compared with the competing risk regression method.

CONCLUSIONS:

The competing risk approach provides more accurate estimates of 30-day survival and is less biased compared with the other methods evaluated.
Five Domains of a Conceptual Framework of Continuing Professional Development
Authors: Sklar David P. , Chan Teresa , Illing Jan , Madhavpeddi Adrienne , Rayburn William F.
Published: October 2023

Continuing professional development (CPD) for health professionals involves efforts at improving health of individuals and the population through educational activities of health professionals who previously attained a recognized level of acceptable proficiency (licensure). However, those educational activities have inconsistently improved health care outcomes of patients. We suggest a conceptual change of emphasis in designing CPD to better align it with the goals of improving health care value for patients through the dynamic incorporation of five distinct domains to be included in learning activities. We identify these domains as: (1) identifying, appraising, and learning new information [New Knowledge]; (2) ongoing practicing of newly or previously acquired skills to maintain expertise [New Skills and Maintenance]; (3) sharing and transfer of new learning for the health care team which changes their practice [Teams]; (4) analyzing data to identify problems and drive change resulting in improvements in the health care system and patient outcomes [Quality Improvement]; and (5) promoting population health and prevention of disease [Prevention]. We describe how these five domains can be integrated into a comprehensive conceptual framework of CPD, supported by appropriate learning theories that align with the goals of the health care delivery system. Drawing on these distinct but interrelated areas of CPD will help organizers and directors of learning events to develop their activities to meet the goals of learners and the health care system.