bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental sustainability in dermatological surgery. Part 2: reducing activity and future ecological strategies
Authors: Ali Fatima ,   BSDS Sustainability Subgroup Collaborative, Ali Fatima , Abbott Rachel , Wernham Aaron , Nikookam Yasmin , Hunt William , Holloran Sophie , Chaolin Catriona , Ang Eshen , Charalambides Maria , Lowe Ashima , Brindley Luke , Bower Christopher , Varma Sandeep , Lam Minh , Veitch David , Recica Hilmi , Ai Woo Wen , Tso Simon , Doyle Claire , Wernham Aaron , Abbott Rachel
Published: November 2024

This two-part review addresses the pressing need for environmental sustainability in dermatological surgery, driven by the National Health Service’s commitment to net-zero emissions. Part 2 of this review extends the discussion of sustainability in dermatological surgery by focusing on system-wide changes in service delivery and identifying future opportunities for reducing environmental impact. Building on the strategies outlined in Part 1, which explored low-carbon alternatives and operational resource optimization, Part 2 advocates for a comprehensive shift in the skin surgery service. Key strategies include reducing overall surgical activity, advancing research and innovation, and enhancing management practices to align with sustainability goals. Reducing surgical activity mainly involves the prevention of skin cancers, in addition to optimizing current patient pathways and empowering patients to take ownership of their follow-up. Outside of immediate clinical decision making at the individual level, the review highlights the importance of managerial policy, procurement practices and supply chain factors in driving broader national and international sustainability efforts. Advancing the sustainability agenda will also require targeted research and innovation, particularly in digital health solutions using evidence-based practices. By integrating these strategies, this review aims to provide a framework for reducing the environmental footprint of dermatological surgery and advancing towards a more sustainable healthcare system.
Risankizumab Is Associated With Normalization of Biomarkers in Patients With Crohn’s Disease: Results From the Phase 3 ADVANCE, MOTIVATE, and FORTIFY Studies
Authors: Atreya Raja , Ferrante Marc , Panaccione Remo , Feagan Brian , Shchukina Oksana , Jairath Vipul , Rieder Florian , Hisamatsu Tadakazu , Siegmund Britta , Kligys Kristina , Song Alexandra , Zambrano Javier , Mallick Madhuja , Zhang Yafei , Armuzzi Alessandro , D’Haens Geert
Published: November 2024

Background and Aims

Normalization of high-sensitivity C-reactive protein (hs-CRP) and fecal calprotectin (FCP) are suggested as intermediate treatment targets for Crohn’s disease (CD). This analysis evaluates achievement of biomarker normalization and the relationship between improvements in biomarker concentrations and clinical and endoscopic outcomes among patients treated with risankizumab.

Methods

This post hoc analysis included patients with moderately to severely active CD and elevated baseline hs-CRP (>5 mg/L) or FCP (>250 µg/g) concentrations from the 12-week ADVANCE and MOTIVATE induction studies, and the 52-week FORTIFY maintenance study. We assessed the proportion of patients achieving biomarker normalization, defined as hs-CRP ≤5 mg/L and FCP ≤250 µg/g, and the association between achieving biomarker normalization and improved clinical and endoscopic outcomes.

Results

Among 748 patients with elevated baseline hs-CRP or FCP concentrations, higher proportions of patients treated with risankizumab vs placebo achieved normalization of hs-CRP (Week 12: placebo, 17.5%; risankizumab 600 mg, 48.5%; Week 52: placebo, 29.5%; risankizumab 180 mg, 45.2%; risankizumab 360 mg, 40.8%) and FCP (Week 12: placebo, 9.1%; risankizumab 600 mg, 26.0%; Week 52: placebo, 28.0%; risankizumab 180 mg, 43.0%; risankizumab 360 mg, 44.0%; nominal p < 0.05 vs placebo for all comparisons). Achievement of both clinical or endoscopic outcomes and improvement of biomarker concentrations occurred at higher rates among patients treated with risankizumab vs placebo, regardless of prior exposure to biologic therapies.

Conclusions

Risankizumab treatment led to sustained normalization of inflammatory biomarkers with improved clinical and endoscopic results.

Clinical Trial Registration Number

ADVANCE, NCT03105128; MOTIVATE, NCT03104413; FORTIFY, NCT03105102.
Arrhythmic risk stratification in patients with left ventricular ring-like scar
Authors: Parisi Vanda , Graziosi Maddalena , Lopes Luis R , De Luca Antonio , Pasquale Ferdinando , Tini Giacomo , Targetti Mattia , Cueto Maria R , Moura Ana R , Ditaranto Raffaello , Torlasco Camilla , Taglieri Nevio , Nardi Elena , Lovato Luigi , Augusto João B , Galiè Nazzareno , Crotti Lia , Gasperetti Alessio , Biffi Mauro , Autore Camillo , Merlo Marco , Olivotto Iacopo , Sinagra Gianfranco , Elliott Perry M , Biagini Elena
Published: November 2024

Aims

Left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) has been linked to malignant arrhythmias in patients with non-ischaemic cardiomyopathy. This study aimed to perform a comprehensive evaluation of this phenotype and to identify risk factors for life-threatening arrhythmic events (LAEs), a composite of sudden cardiac death (SCD), aborted SCD, and sustained ventricular tachycardia.

Methods and results

One hundred and fifteen patients [median age 39 (interquartile range, IQR, 28–52), 42% females] were identified at 6 referral centres. Inclusion criteria were ring-like LV scar [≥3 contiguous segments with sub-epicardial/midwall late gadolinium enhancement (LGE) in the same slice] and one among: pathogenic/likely pathogenic genetic variant, family history for cardiomyopathy, or arrhythmogenic cardiomyopathy diagnosis. During the study follow-up, survival free from LAEs was 60% (3.8 events/100 patients/year); at a median follow-up of 4.6 years (IQR 1.7–8.4) it was 84%. On multivariable analysis, anterior Q waves [hazard ratio (HR): 1.030, 95% confidence intervals (CI): 1.014–1.046, P < 0.001], QRS width (HR: 4.642, 95% CI: 1.296–16.628, P = 0.018), and LV end-diastolic volume index (LVEDVi; HR: 1.011, 95% CI: 1.001–1.021, per mL/m2 increase, P = 0.040) were independently associated with LAEs; with good discrimination power (Harrell’s C-index = 0.796). Three risk categories were identified: normal electrocardiogram (ECG), abnormal ECG and no LAEs predictive variables, abnormal ECG and ≥1 LAEs predictive variables, with a decreasing survival from 100 to 65% and 49%, respectively (Log-rank test = 0.015).

Conclusion

In this study, the LV ring-like scar phenotype was associated with a high rate of malignant arrhythmias in presence of anterior Q waves, QRS prolongation, and increased LVEDVi. A normal ECG identified a lower risk sub-group.
Precommercial Thinning but Not Commercial Thinning Increases the Merchantable and Large Sawlog Volume Production of Lodgepole Pine on Fair Sites
Authors: Ara Mostarin , Pinno Bradley D , Scaria Francis , Froese Robert E
Published: November 2024

The effect of thinning on stand structure and volume production is well studied. However, the effect of combinations of precommercial (PCT) and commercial thinning (CT) on the production of different log grades and differential growth responses is less understood, although it is crucial for forest managers to choose an optimal management regime. Starting with actual operational field data from a lodgepole pine (Pinus contorta var.latifolia) PCT trial on fair quality sites (site index: 16–18 m at 50 years), we used an individual tree growth model to forecast development over the entire rotation. We found thinning changed the structure (density, quadratic mean diameter) of the stands but not the total volume production. However, in terms of merchantable volume and large sawlog volume, stands with only PCT provided the largest volume, more than either CT or a combination of PCT and CT, or the unthinned control. Moreover, our study findings also showed that, by doing only PCT, stands reached maximum merchantable or large sawlog mean annual increment earlier than other thinned or unthinned stands. This indicates that PCT might shorten the rotation length and contribute to an enhanced supply of timber.

Study Implications: The effect of commercial thinning (CT) on stand structure and volume production is well studied. However, the effect of combinations of precommercial (PCT) and commercial thinning (CT) on the production of different log grades and differential growth responses is less studied, although it is crucial for forest managers to choose a management option. Starting with actual operational field data from a lodgepole pine (Pinus contorta var.latifolia) PCT trial in a fair-quality site (site index [SI]: 16–18), we used an individual tree growth model to develop the stands over the entire rotation. We found thinning changed the structure (density, quadratic mean diameter) of the stands but not the total volume production. However, in terms of merchantable volume and large sawlog volume, stands with only PCT provided the largest volume, more than either CT or a combination of PCT and CT, or the unthinned control. Moreover, our study findings also showed that, by doing only PCT, stands reached maximum merchantable or large sawlog MAI earlier than other thinned or unthinned stands. This indicates that PCT might shorten the rotation length and contribute to the continuous supply of timber production.
Protein–protein and protein–nucleic acid binding site prediction via interpretable hierarchical geometric deep learning
Authors: Zhang Shizhuo , Han Jiyun , Liu Juntao
Published: November 2024

Identification of protein–protein and protein–nucleic acid binding sites provides insights into biological processes related to protein functions and technical guidance for disease diagnosis and drug design. However, accurate predictions by computational approaches remain highly challenging due to the limited knowledge of residue binding patterns. The binding pattern of a residue should be characterized by the spatial distribution of its neighboring residues combined with their physicochemical information interaction, which yet cannot be achieved by previous methods. Here, we design GraphRBF, a hierarchical geometric deep learning model to learn residue binding patterns from big data. To achieve it, GraphRBF describes physicochemical information interactions by designing an enhanced graph neural network and characterizes residue spatial distributions by introducing a prioritized radial basis function neural network. After training and testing, GraphRBF shows great improvements over existing state-of-the-art methods and strong interpretability of its learned representations. Applying GraphRBF to the SARS-CoV-2 omicron spike protein, it successfully identifies known epitopes of the protein. Moreover, it predicts multiple potential binding regions for new nanobodies or even new drugs with strong evidence. A user-friendly online server for GraphRBF is freely available at http://liulab.top/GraphRBF/server.
Association between discontinuity in clinicians and outcomes of nursing home residents
Authors: Yun Hyunkyung , Unruh Mark Aaron , Ryskina Kira L , Jung Hye-Young
Published: November 2024

Little is known about the impact of clinician discontinuity on quality of care for nursing home residents. We examined the association between clinician discontinuity and outcomes of residents with long-term care stays up to 3 years using claims for a national 20% sample of Medicare fee-for-service beneficiaries from 2014 through 2019. We used an event study analysis that accounted for staggered treatment timing. Estimates were adjusted for resident, clinician, and nursing home characteristics. Three sensitivity analyses were conducted. The first excluded small nursing homes, which were in the lowest quartile based on the number of beds. The second attributed residents to clinician practices rather than individual clinicians. The third removed the 3-year long-term care stay restriction. We found that, compared to residents who did not experience a clinician change, those with a clinician change had a 0.7 percentage point higher likelihood of an ambulatory care sensitive hospitalization in a given quarter (a 36.8% relative increase). Clinician discontinuity was not associated with ambulatory care sensitive emergency department visits. Results from our 3 sensitivity analyses were consistent with those from the primary analysis. Policymakers may consider using continuity in clinicians as a marker of nursing home quality.
Obesity Uncovers the Presence of Inflammatory Lung Macrophage Subsets With an Adipose Tissue Transcriptomic Signature in Influenza Virus Infection
Authors: Alarcon Pablo C , Ulanowicz Cassidy J , Damen Michelle S M A , Eom John , Sawada Keisuke , Chung Hak , Alahakoon Tara , Oates Jarren R , Wayland Jennifer L , Stankiewicz Traci E , Moreno-Fernandez Maria E , Zacharias William J , Salomonis Nathan , Divanovic Senad
Published: November 2024

Obesity is an independent risk factor for increased disease severity during influenza A virus (IAV) infection. White adipose tissue (WAT) inflammation promotes disease pathogenesis in obesity. Whether obesity modifies lung and WAT immune cells to amplify influenza severity is unknown. We show that obesity establishes a proinflammatory transcriptome in lung immune cells that is augmented during IAV infection and that IAV infection changes WAT immune cell milieu in obesity. Notably, a decrease in WAT macrophages (ATM) inversely correlates with an increase in infiltrating lung macrophages in obese IAV-infected mice. Further analyses of lung immune cell uncovered a macrophage subset that shares a transcriptomic signature with inflammatory ATMs. Importantly, adoptive transfer of ATMs from obese mice into lean IAV infected mice promotes host immune cell infiltration to the lungs. These findings suggest that, in an obese state, ATMs may exacerbate the inflammatory milieu important in pathologic responses to IAV infection.
Postearthquake train operation safety assessment model based on machine learning
Authors: Mao Yong-heng , He Chang , Jiang Lizhong
Published: November 2024

Assessing the seismic risk to high-speed rail systems with limited structural damage data is a challenging task. This study employs machine learning algorithms to predict the wheel–rail forces of high-speed trains operating under postearthquake conditions, particularly when infrastructure along the railway is damaged. By developing a postearthquake train operation safety assessment model, this article effectively predicts the impact of track irregularities induced by different earthquake intensities on wheel–rail interactions. The results obtained through feature selection and regression analysis using the Random Forest algorithm provide valuable insights into key safety indicators for postearthquake train operations. Compared to traditional multibody dynamic models, this approach significantly improves the efficiency of analysis and computation. An analysis of the results across multiple speed levels reveals that trains operating at 250 km/h face derailment risks when subjected to high-intensity earthquakes (PGA > 0.6 g). The proposed predictive safety assessment model demonstrates that adjusting train speeds according to seismic intensity can effectively enhance operational safety, offering critical support for postearthquake emergency recovery efforts.
Ethanol stability from 9 years of a blind quality control program in blood alcohol analysis
Authors: Phung Erika , Rodgers Corissa , Gooden Andrea , Stout Peter , Lee Dayong
Published: November 2024

A blind quality control (BQC) program in blood alcohol analysis was implemented at the Houston Forensic Science Center (HFSC) in September 2015. By mimicking authentic toxicology blood evidence, the laboratory can perform a concurrent evaluation of their technical and administrative casework procedures and test the accuracy and reliability of their volatile analysis method in a format that is blinded to the analyst. From September 2015 to November 2023, HFSC’s Quality Division submitted 1228 antemortem whole-blood samples: 292 ethanol-negative samples and 936 ethanol-positive samples at 16 target concentrations (0.051, 0.080, 0.100, 0.110, 0.120, 0.130, 0.150, 0.160, 0.170, 0.180, 0.190, 0.200, 0.230, 0.240, 0.250, and 0.260 g/dL). A second, unopened blood tube in 168 of the 1228 BQCs was also analyzed after 721–1140 days: 24 ethanol-negative samples and 144 ethanol-positive samples at 5 target concentrations (0.080, 0.100, 0.130, 0.180, and 0.240 g/dL).

All 316 ethanol-negative samples remained negative. After 42–758 days, the average (median, range) change in ethanol concentration of the 936 positive samples was −1.4% (−1.3%, −12.0% to +8.4%) with a statistically significant difference (P < .001) observed for the gradual decline in blood alcohol concentration (BAC) over time. The average BAC percentage differences per target concentration, ranged from −6.4% (−0.008 g/dL) to +5.7% (+0.011 g/dL), were within HFSC’s current measurement uncertainty (9.4% at k = 3), showing no apparent correlation between the change in ethanol and the theoretical target concentration. As the analysis time between the two blood specimens from the same evidence kit extended, the loss in ethanol significantly increased (P < .001).
Risk Factors for ARDS in Hospitalized Burn Patients: An Analysis of the National Trauma Data Bank
Authors: Sim Danielle , Subramanian Madhu , Caffrey Julie
Published: November 2024

Acute respiratory distress syndrome (ARDS) is a common complication among mechanically ventilated adult patients with burns; however, the risk factors associated with its development are not well understood. Conflicting evidence also exists regarding ARDS as an independent predictor of poor hospital outcomes. The purpose of this study is to identify risk factors for ARDS in mechanically ventilated adult patients with burns and characterize the impact of ARDS on hospital course. The National Trauma Data Bank was queried for patients ≥ 18 years with International Classification of Diseases (ICD) codes corresponding to burn injury from 2007 to 2016. Hospitalized patients with at least 48 h of mechanical ventilation were included. Multivariate logistic regression was used to identify risk factors for ARDS. Propensity score-matched analysis at a 1:3 ratio was used to determine the impact of ARDS on hospital course. This sample included 13,928 patients, of which 1437 (10.3%) developed ARDS. Hypotension in the emergency department, alcohol use disorder, total body surface area, injury severity score (ISS), and inhalation injury were independently associated with ARDS. In the propensity score-matched cohort, patients with ARDS had a significantly longer median (interquartile range) length of stay (31 [15-54] vs. 22 [9-43], P < .001). In-hospital mortality was also significantly higher in the ARDS cohort (203 [35%] vs. 325 [24%], P < .001). These findings highlight the impact of patient and injury characteristics on developing ARDS and support the consideration of ARDS when estimating mortality risk in patients with burns.
Altered post-fracture systemic bone loss in a mouse model of osteocyte dysfunction
Authors: Osipov Benjamin , Emami Armaun J , Cunningham Hailey C , Orr Sophie , Lin Yu-Yang , Jbeily Elias H , Punati Ritvik S , Murugesh Deepa K , Zukowski Hannah M , Loots Gabriela G , Carney Randy , Vargas Diego , Ferguson Virginia L , Christiansen Blaine A
Published: November 2024

Femur fracture leads to loss of bone at uninjured skeletal sites, which may increase risk of subsequent fracture. Osteocytes, the most abundant bone cells, can directly resorb bone matrix and regulate osteoclast and osteoblast activity, but their role in systemic bone loss after fracture remains poorly understood. In this study we used a transgenic (TG+) mouse model that overexpresses human B-cell lymphoma 2 (BCL-2) in osteoblasts and osteocytes. This causes enhanced osteoblast proliferation, followed by disruption in lacunar-canalicular connectivity and massive osteocyte death by 10 wk of age. We hypothesized that reduced viable osteocyte density would decrease the magnitude of systemic bone loss after femur fracture, reduce perilacunar remodeling, and alter callus formation. Bone remodeling was assessed using serum biomarkers of bone formation and resorption at 5 d post-fracture. We used micro-computed tomography, high resolution x-ray microscopy, mechanical testing, and Raman spectroscopy to quantify the magnitude of systemic bone loss, as well as changes in osteocyte lacunar volume, bone strength, and bone composition 2 wk post-fracture. Fracture was associated with a reduction in circulating markers of bone resorption in non-transgenic (TG-) animals. TG+ mice exhibited high bone mass in the limbs, greater cortical elastic modulus and reduced post-yield displacement. After fracture, TG+ mice lost less trabecular bone than TG- mice, but conversely TG+ mice exhibited trends toward a lower yield point and reduced femoral cortical thickness after fracture, though these were not statistically significant. Lacunar density was greater in TG+ mice, but fracture did not alter lacunar volume in TG+ or TG- mice. These findings suggest that osteocytes potentially play a significant role in the post-traumatic systemic response to fracture, though the effects differ between trabecular and cortical bone.
Vulnerability assessment for naval ships against air-explosive impulses: modified damage-extent method incorporating structural capacity
Authors: Kim Kwang Sik , Yoon Joon Young , Lee Jang Hyun
Published: November 2024

Traditionally, vulnerability assessments for naval ships have relied on empirical calculations to estimate the extent of damage without taking into account the structural capacity of the ship. This study introduces an enhanced damage-extent method that incorporates the structural load-bearing capacity of the hull to assess the vulnerability of naval ships to explosive loads. This vulnerability assessment predicts the area of damage to the hull structure and calculates the probability of onboard equipment experiencing functional losses due to the explosive load, thus allowing various design alternatives to be evaluated. The proposed methodology improves upon traditional damage-volume-based approaches, such as damage-radius and ellipsoid methods, by considering the hull’s structural stiffness and intrinsic damage resistance. It integrates the hull’s structural resistance to the load, enhancing the damage assessment process for both the hull and equipment. This approach facilitates damage prediction for different hull designs by comparing the allowable impulse with the explosive pressure. In assessing the functionality loss and vulnerability of the equipment within the damaged hull, the network of equipment functions is considered. An anti-ship cruise missile with a sea-skimming trajectory is investigated as the explosive charge, with procedures established to simulate its trajectory and impact location on the hull. Hundreds of potential internal and external explosion points are generated, predicting the explosive pressure at each location. The shock wave, including incident overpressure, reflection pressure, and quasi-static gas pressure, is converted into impulses, taking into account the configuration of hull compartments to accurately predict these pressures and equivalent impulse. The resulting impulse is compared with the intrinsic damage capacity of each compartment’s structure to assess potential damage. System network and fault tree analysis evaluate the loss of function and vulnerability of equipment within the damaged hull. Finally, the proposed capacity-based damage extent method demonstrates more accurate damage assessment compared to traditional methods, overcoming the limitations of damage-radius and ellipsoid approaches by considering hull strength.
An elastohydrodynamic model of the slot-die coating process
Authors: Lemarchand Fabian , Rivas Alejandro , Pradera-Mallabiabarrena Ainara , Salterain Alaine
Published: November 2024

The slot-die coating process plays an important role in the industry, as it is employed in many different fields. The characteristics of the final application are determined by the flow between the die and the roller. This research paper aims to develop a mathematical model of such flow that takes into account the roller deformations caused by high pressure values reached by the coating fluid. This elastohydrodynamic model is made up of a coupling between the mathematical model of the flow and the mathematical model of the roller deformations. Model resolution is undertaken numerically by deforming the flow domain according to the roller deformations using computational fluid dynamics and computational solid mechanics techniques. For its part, the finite volume method is used to perform the flow model analysis and the finite element method is employed to deal with roller deformations. The results obtained from this model give information on the flow pressure distribution, coating gaps, meniscus position, extent of roller deformations in the coating flow, and the influence of different operating conditions. The information obtained from this study is valuable for industrial applications, as it gives insights into the coating process that can help manufacturers to define a suitable combination of operating parameters in order to obtain coating applications that meet quality and performance requirements.
Monitoring and management of the Nearctic leafhopper Scaphoideus titanus (Hemiptera: Cicadellidae) in Italian vineyards
Authors: Bagnoli Bruno , Ricciardi Renato , De Fazi Livia , D’Anna Giordana , Braccini Piero , Benelli Giovanni , Lucchi Andrea
Published: November 2024

The Nearctic leafhopper Scaphoideus titanus Ball (Hemiptera: Cicadellidae) is the main vector of the grapevine flavescence dorée (FD) phytoplasmas in Europe. To limit the impact of pest control activities on human health and the environment, EU legislation is withdrawing a growing number of active ingredients (a.i.), highlighting the need to evaluate alternative S. titanus management tools. In this context, we carried out a three-year (2021–2023) study in Italian vineyards characterized by high S. titanus populations. We compared the effectiveness of different insecticide-based strategies, i.e., targeting only nymphs (2021) or nymphs and adults (2022–2023), by spraying some of the currently allowed products (i.e., flupyradifurone, acetamiprid, sulfoxaflor, etofenprox, deltamethrin, and pyrethrins). The effectiveness of insecticide-based treatments was evaluated in terms of adult catches on yellow sticky traps. Furthermore, to achieve useful insights for optimizing current monitoring tools, we compared S. titanus catches on sticky traps of five different colors (i.e., yellow, green, blue, black, and white), as well as those achieved with two types of currently marketed yellow sticky traps. Results showed that etofenprox, deltamethrin, and sulfoxaflor were the most effective products for reducing S. titanus adult populations (33.64%, 30.30%, and 31.26%, respectively). Yellow and green sticky traps were more attractive to S. titanus adults than white, blue, and black ones. Moreover, a significant difference in capture efficiency was observed between two commercial yellow devices (i.e., tenfold higher catches using Glutor over Super color). Practical implications of our results are discussed in the context of current IPM against this key leafhopper vector of FD.
Large cell neuroendocrine carcinoma in pancreatoblastoma with TP53 and SMAD4 mutations: a clinicopathologic study of a rare entity
Authors: Nwosu Ifeomachukwu E , Zhang Jenny , Elliott Alexis S , De La Maza Michelina , Sun Belinda L
Published: November 2024

Pancreatoblastoma, a rare pancreatic tumor, exhibits diverse differentiation pathways, including acinar, ductal, and neuroendocrine lineages, often with distinct squamoid nests [3]. We present a notable case of pancreatoblastoma coexisting with large cell neuroendocrine carcinoma in a 10-year-old boy, presenting with abdominal discomfort, weight loss, and lesions in the pancreas, spleen, and liver visible on imaging. A liver biopsy revealed a poorly differentiated carcinoma with neuroendocrine features, while a splenic biopsy showed acinar cell differentiation, raising possible diagnoses of pancreatoblastoma or acinar cell carcinoma. Subsequent surgical resection after chemotherapy revealed diverse components within the pancreatoblastoma, including well-differentiated acinar and neuroendocrine cells, squamoid nests, and a high-grade neuroendocrine carcinoma. Genetic analysis detected pathogenic variants in TP53 and SMAD4, rarely found in pancreatoblastomas. This juxtaposition of large cell neuroendocrine carcinoma and pancreatoblastoma suggests a potential evolution from well-differentiated neuroendocrine tumors to poorly-differentiated carcinomas within pancreatoblastomas.
Multiple lung nodules revealing chronic pulmonary schistosomiasis
Authors: Gerber Victor , Biry Morgane , Sohler Sophie , Labani Aissam , Le Hyaric Coralie , Koebel Christelle , Lemmet Thomas , Hoellinger Baptiste , Danion François , Lefebvre Nicolas , Hansmann Yves , Kassegne Loïc , Ruch Yvon
Published: November 2024

We described the case of a Guinea-Conakry patient presented with a pulmonary Schistosoma mansoni infection. Hypereosinophilia, positive serology and multiple lung nodules led us to suspect the diagnosis. However, parasitic examination of stool and urine were negative. The diagnosis was obtained thanks to specific serum PCR.
Does pre-charge bail prevent harm? A natural experiment
Authors: Whitten Dan
Published: November 2024

In the last decade pre-charge bail (PCB) has been subject to unprecedented scrutiny. Conflicting public policy decisions have been made on the basis that PCB prevents harm. Despite this, there has to date been no empirical examination of the relationship between PCB and crime-related harm. Utilizing bail law reform in 2017 as a natural experiment, this study draws on two comparable samples (n = 746), derived from the Metropolitan Police Service. Analysis indicated no statistically significant difference between harm caused by suspects whilst under investigation before versus after the law change, despite an 85.4 per cent reduction in arrestees being subject to bail. Findings may serve to undermine oft-confident assertion in the public policy arena that it is axiomatic that bail prevents harm. Further, this constitutes a nascent empirical evidence base regarding PCB that enables further research on this under-examined subject.
Beyond symbolism: the roles of action planning and case-making in immigrant integration policymaking
Authors: Allen William L , Broadhead Jacqueline
Published: November 2024

How do city-level policymakers build support for substantive action in policy domains characterized by low levels of national salience and limited local capacity, and which evidentiary resources support as well as reflect these uses? Despite much attention to policymakers’ engagement with evidence, existing work tends to focus on domains where the issues at stake attract high levels of input and influence from central governments. This limits empirical and theoretical understanding of how local efforts to implement potentially contentious policies arise, and through which means. In response, we examine how municipal actors in 12 cities and regions across the UK have devised and communicated policies on immigrant integration—an area that lacks national policy inputs yet is locally consequential—through the mechanism of “action planning.” Drawing on 6 years’ worth of documentary evidence generated through a university-initiated collaboration with these municipalities, we show how action plans gather attention for objectives and propagate examples of practice to other cities—what we call “case-making.” This serves as a micro-foundation for the action planning mechanism, which links symbolic statements about immigrant integration with substantive intended actions.
“Mission-Aligned Funds Flow”: Effect on Clinical Departments
Authors: Lakshminrusimha Satyan , Murin Susan , Galante Joseph , Mustafa Zishan , Sousa Noel , Chen Stanley , Aizenberg Debbie A. , Morris Elizabeth , Lubarsky David A.
Published: November 2024

Problem

Academic medical centers struggle with the high cost of care, reduced reimbursement, intense competition, and low profit margins. Many factors, including a high proportion of publicly insured patients, a model rewarding procedural specialties, and research and educational support burden, led to faculty salary inequities, physician disengagement, and difficulty recruiting.

Approach

UC Davis Health implemented an aligned funds flow model in July 2021 to create a mission-aligned model in which all departments had financial margins to optimize recruitment, retention, research, and teaching.

Outcomes

The 3-year experience (academic years 2021-2024) with this model at UC Davis Health was characterized by physician compensation, physician recruitment, and profit increases. Total collections for departments increased by 4% in the first year, 0.2% in the second year, and 11.3% in the third year of funds flow. Total productivity increased by 4.9% during the first year, 3.6% during the second year, and 8.4% during the third year. Salaries increased in all departmental categories in year 3. Productivity and collections per faculty member increased during the first year and were stable during the second and third years. Parity among procedural, primary care, and hospital-based service lines was improved because departmental revenue was agnostic to payer mix and hospital agreements were more formulaic. The hospital contribution to funds flow increased from $67 million in 2022 to $101 million in 2024.

Next Steps

Regular communication and transparency are critical to ongoing trust and success with implementation of sustaining funds flow. The new model resulted in improved physician compensation and increased hiring. However, the implementation of funds flow had a negative fiscal effect on the academic medical center, and sustainability may require fine-tuning to balance affordability. The authors plan to convert outpatient primary care to productivity-based models and decrease time-limited support for new faculty from 2 years to 1 year.
Epidemiology of Acute Compartment Syndrome After Pediatric Tibial Tubercle and Tibial Shaft Fractures
Authors: Milner John D. , Bergen Michael A. , Zhang Helen , Callanan Tucker C. , Liu Jonathan , Hall Rigel P. , Daniels Alan H. , Cruz Aristides I.
Published: November 2024

Background:

While acute compartment syndrome (ACS) is a well-reported complication after pediatric tibial shaft fractures, prior literature has suggested that pediatric patients with tibial tubercle fractures may be at increased risk of ACS due to the proximity of the tibial tubercle to the anterior tibial recurrent artery. However, this theory was largely based on a series of early case reports without substantiation in larger-scale studies.

Hypothesis/Purpose:

The purpose of this study is to conduct a population-level analysis of the incidence and risk factors of acute compartment syndrome following pediatric tibial tubercle and tibial shaft fractures. We hypothesize that the rate of ACS would be lower in patients with tibial tubercle fractures when compared with those with tibial shaft fractures.

Methods:

A retrospective cohort analysis of the PearlDiver Mariner database was performed by querying all patients diagnosed with tibial tubercle and tibial shaft fractures between January 2010 and October 2022. Matched cohorts (n=25,483) of patients with pediatric tibial tubercle and tibial shaft fractures were captured using International Classification of Diseases, Ninth Revision (ICD-9), Tenth Revision (ICD-10) billing codes, and age as inclusion/exclusion criteria. Rates of subsequent compartment syndrome were calculated by querying for insurance claims with associated CPT codes for fasciotomy and/or ICD-9/ICD-10 billing codes for compartment syndrome. Student t test and χ2 analyses were used to compare demographics between the tibial tubercle and tibial shaft cohorts.

Results:

The rate of ACS was significantly lower in the tibial tubercle cohort (0.46%) than in the tibial shaft cohort (0.70%, P<0.001). Male sex and increased age were associated with an increased risk of developing ACS in both cohorts (P<0.001). In addition, polytrauma was found to be a risk factor for ACS among patients with tibial shaft fractures (P<0.001).

Conclusion:

We report a low rate of ACS following both pediatric tibial tubercle fractures and pediatric tibial shaft fractures. Among patients with tibial tubercle fractures, male sex, and increased age were noted to be risk factors for ACS, whereas male sex, older age, and polytrauma were risk factors for ACS among patients with tibial shaft fractures.
Spinal Injuries and Spine Care in the U.S. Military Health System (2001–Present)
Authors: Holly Kaitlyn E. , Hatton Malina O. , Bryan Matthew R. , Freedman Brett A. , Helgeson Melvin D. , Koehlmoos Tracey P. , Schoenfeld Andrew J.
Published: November 2024

Study Design.

Literature review.

Objective.

The goal of this study was to provide a comprehensive outline of spinal injuries that may transpire over the course of military service from traumatic to repetitive stress injuries and chronic sequelae. We considered studies that assessed spinal injuries in combat and non-combat settings as reported in the literature over the last 15 to 20 years.

Background.

Military service places servicemembers under substantial physical demands, while also exposing them to dangerous, unpredictable environments. As a result, servicemembers are at an increased risk of spinal injuries from combat-related trauma and other causes. They may have different care needs and recovery profiles when compared with civilians with spinal disorders.

Materials and Methods.

We performed a review of the available literature on spinal injuries and spinal care in the Military Health System from 2001 to the present.

Results.

The studies discussed in this review were primarily focused on the conflicts in both Iraq and Afghanistan from over 10 years ago and do not fully capture the present-day advancements in military technology that may have an impact on the potential for spinal injuries. The long-term effects of sustained military service and the relative influence of high demand versus sedentary military occupations on the development of spinal disorders remain poorly understood. Given the changing nature of military service, both with respect to the demographic in uniform and the ever-evolving nature of modern combat, we believe that only a long-term prospective observational study dedicated to the surveillance of spinal problems could effectively answer these questions.

Conclusion.

Further research into the present-day characterization of spinal injuries is warranted given the advancements in both military technology and spine care that have occurred over the last 10 years.
Implementing and Evaluating a Pilot Interprofessional Training Program to Engage Health Care Teams in Cost of Care Conversations
Authors: Edward Jean , Northrip Kimberly D. , Kay Rayens Mary , Costich Julia , Welker Andrea , O'Farrell Rachel , D'Orazio John
Published: November 2024

Introduction:

This study evaluated the impact of
Financial and Insurance Navigation Assistance-Training – a pilot interprofessional training program to facilitate cost of care (CoC) conversations and address health-harming social determinants of health in a pediatric hematology–oncology clinic.

Methods:

A pre–post study design was used to evaluate the impact of
Financial and Insurance Navigation Assistance-Training on an interprofessional health care team's (clinicians, social workers, financial navigator, and legal advocates) knowledge, attitudes, and behaviors related to CoC conversations and screening, referring, and collaborating with interprofessional team members. Data were collected via surveys administered at baseline/pretraining, immediate post-training, and 12-month post-training.

Results:

Most health care team members (n= 21) reported improvement in their knowledge of available financial (66.7%) and legal resources (86.7%) and ability to address social needs (93.3%), financial needs (93.3%), and facilitate CoC conversations with patients and caregivers (66.7%).

Discussion:

Improvements in attitudes and behaviors toward engaging in CoC conversations, screenings, and referrals were relatively improved as a result of the training. However, there was a lower positive rate for actual behaviors around routine screening and initiating discussions on out-of-pocket costs, suggesting a need to address barriers. Study findings highlight the importance of interprofessional education in helping health care teams address social determinants of health through effective CoC conversations.
Effect of remimazolam on intra-operative hypotension
Authors: He Ting-Yu , Zhong Rui-Peng , Zhong Wei-Bo , Huang Gui-Ming , Liu Xiao-Cheng
Published: November 2024

BACKGROUND

Hypotension is common during anaesthesia. Increasing number of studies have reported that remimazolam may be associated with lower incidence of intra-operative hypotension compared with other anaesthetics. However, the results remain controversial.

OBJECTIVE

This study aimed to evaluate the influence of remimazolam on intra-operative hypotension and its related outcomes (hypoxaemia, bradycardia and time to awake).

DESIGN

A systematic review of randomised controlled trials (RCTs) with meta-analyses

DATA SOURCES

PubMed, Cocharane and Embase databases were searched to identify eligible RCTs published up to June 2024.

ELIGIBILITY CRITERIA

RCTs published in English were eligible for inclusion. The study patients were 18 years or older who were administered with remimazolam and other positive control agents in either the pre-operative or intra-operative period. The incidence of intra-operative hypotension was identified in these studies.

RESULTS

This study evaluated 34 trials including 4847 individuals. Basing on moderate-certainty evidence, we found that remimazolam administration reduced the incidence of intra-operative hypotension [risk ratio (RR) = 0.48, 95% confidence interval (95% CI): 0.41 to 0.57] and bradycardia (16 studies, n = 2869, RR = 0.40, 95% CI: 0.29 to 0.54). No difference was observed in the incidence of hypoxaemia (RR = 0.70, 95% CI: 0.48 to 1.01) and time to awake (MD = −0.91, 95% CI: −2.42 to 0.60). The remarkable association between remimazolam and hypotension remained robust and significant, regardless of general anaesthesia or procedural sedation (P < 0.01, I

2
 = 82%). No significant difference was found between different control drugs (P = 0.97, I

2
 = 82%).

CONCLUSION

Moderate-quality evidence shows that remimazolam administration to patients undergoing general anaesthesia or procedural sedation decreases the incidence of intra-operative hypotension and bradycardia.
Coccidioidal Endophthalmitis Secondary to Coccidoides Posadasii: A Rare Infection in Humans
Authors: Muste Justin , Baynes Kimberly , Srivastava Sunil K
Published: November 2024

Purpose:

To describe the first case of Coccidioides posadasii endophthalmitis.

Methods:

A 41-year-old man referred for acute retinal necrosis (ARN) failing 3 months of outpatient treatment was referred for further management. Three consecutive pars plana vitrectomies were required to identify C. posadasii as the source of the endophthalmitis. Two amphotericin intravitreal injections were delivered in addition to three foscarnet injections, two clindamycin, and one ceftazidime. Therapeutic intervention was complicated by patient compliance.

Results:

Despite repeated surgical and medical intervention, vision was lost. The patient later developed fungal meningitis.

Conclusions:

Given parallels between C. posadasii and C. immitis endogenous endophthalmitis, a combined medical and surgical approach can combat C. posadasii in cases of good patient compliance with therapy.
No Increased Injury Risk on Artificial Turf in Finnish Premier Division Football
Authors: Immonen Ville , Kurittu Einari , Kuitunen Ilari , Vasankari Tommi , Leppänen Mari
Published: November 2024

Objective:

To compare the injury risk between natural grass and artificial turf in the male Finnish premier division (Veikkausliiga) matches during the 2019 league season.

Design:

A retrospective reanalysis of prospectively collected season-long injury surveillance cohort study.

Setting:

Finnish elite-level male football.

Participants:

All 12 teams of Veikkausliiga participated in the study. All players were eligible to participate. Two hundred thirty-six players took part in the follow-up between February and November 2019.

Interventions:

Matches were played between April and November 2019. Injury data were collected using standard injury reports from the team medicals and weekly player questionnaires. Individual player exposure in matches was collected. Artificial turf was classified as exposure and natural grass as control in the analyses.

Main Outcome Measures:

Match-related injury incidence and incidence rate ratios (IRR) with 95% confidence intervals (CI) on natural grass and artificial turf.

Results:

A total of 113 injuries (65 on artificial turf, 48 on natural grass) in 167 matches (90 on artificial turf, 77 on natural grass) were included. Injury incidence was 27.2/1000 hours on artificial turf and 23.9/1000 hours on natural grass and (IRR, 1.1; 95% CI, 0.8–1.7). There was no difference in injury types, anatomical regions, injury recurrence, injury severity, or injury contact. Forwards may have had an increased injury incidence on artificial turf compared with natural grass (IRR, 3.4; 95% CI, 1.0–11.8).

Conclusions:

This study supports previous reports that there is no significant increase in the overall risk of injury in professional football played on artificial turf compared with that on natural grass.
Amino acids and the kidney; friends or foes?
Authors: Baiardo Redaelli Martina , Landoni Giovanni , Monti Giacomo , Bellomo Rinaldo
Published: November 2024

Purpose of review

Acute kidney injury (AKI) is common in hospitalized patients and is independently associated with morbidity and mortality. Moreover, AKI increases the risk of chronic kidney disease, which is a major healthcare problem. Currently, no single therapy has been proven to be effective in preventing AKI. The role of amino acids in the context of kidney function and AKI prevention has been controversial and most of the evidence is available from nutritional studies. However, knowledge of amino acids in recruiting renal functional reserve and their potential role to protect renal function under stress has recently expanded.

Recent findings

The nephroprotective effects of amino acids were first postulated in 1973. Recently, this strategy gained renewed interest and has been more extensively studied, reintroducing their use in clinical situations characterized by a high incidence of AKI. Intravenous amino acids administration for kidney protection is now supported by a large multinational randomized double-blind controlled trial in cardiac surgery and by experimental and observational data. All such data support the rationale for a biologically and clinically important nephroprotective effect.

The infusion of amino acids was recently found to reduce the incidence of AKI in cardiac surgery patients and surgical patients. This strategy for the protection of renal function is supported by a multicenter, international, double-blind randomized trial, with a huge potential for additional application in several clinical fields. Several mechanisms of action support the robustness of these findings and are summarized in this manuscript.