bluuebunny/crossref_metadata_2025 huggingface dataset:
Illumination Fading
Authors: Martin M G F
Published: July 2024

Bertrand Russell abandoned the notion of acquaintance in July 1918. What changes does this force in his account of the mind? This paper focuses on one puzzle of interpretation about this. In 1913, Russell offered an account of ‘egocentric particulars’, his term for indexicals and demonstratives. He argued that the fundamental objection to neutral monism was that it could not provide an adequate theory of these terms. In 1918, Russell now embraces a form of neutral monism, but he does not return to the problem of indexicals until 1940 in his William James lectures. Is the account given in 1940 significantly different from the one given in 1913? What was the argument against neutral monism in 1913? Does Russell offer a new solution in 1940 or reject his earlier view as mistaken? The answers offered here are used to draw more general morals about the current debate concerning relational theories of sense perception.
Liberation Philosophy
Authors: Cassam Quassim
Published: July 2024

Liberation philosophy seeks to contribute to the liberation of the oppressed and to the creation of a more just society. A meliorative philosophy is one that improves human lives. A liberation philosophy can be regarded as meliorative only if it has a compelling theory of change. A theory of change for philosophical interventions should explain how they can contribute to social, political or economic change. The main components of such a theory are identified and shown to be present in the work of the best liberation philosophers, such as Martin Luther King Jr. A meliorative philosophy improves human lives by, among other things, providing the kind of guidance that leads to better decision-making and improved conduct. Philosophy should conceive of the guidance it offers as co-created and reflect on the conditions for effective co-creation. The distinctive virtues of meliorative philosophy, including liberation philosophy, are personal qualities that enable co-creation. These include humility, practicality, an openness to diverse perspectives, and an instinct for lived complexity. There are philosophical purists who reject the demand that philosophy should answer to practical needs. We should be sceptical about some of the claims made by philosophical purists.
Current wig prescribing practices and financial evaluation in a National Health Service Foundation Trust: lessons learnt and future challenges
Authors: Ross Hannah E , Ong Xian Hue , Wilks Lynn , Schilling Sue , Harries Matthew , Asfour Leila
Published: July 2024

Alopecia has been associated with a significant psychological burden and the use of wigs can have a positive impact on patients’ wellbeing. Research has highlighted unequal NHS wig provision, which has led to the recommended ‘Charter for Best Practice for NHS wig provision’ by Alopecia UK and the British Association of Dermatologists/British Hair and Nail Society, published in June 2022. This single-centre review evaluated wig prescribing practices over a 12-month period, noting the prescribing department, patient demographics, diagnosis, number and type of wigs per year, and cost per prescription. Our results demonstrate the level of demand across all alopecia diagnoses and age groups. Thus, access to wigs remains vital in hair loss management. Further work is required to ensure equitable NHS wig prescribing across all regions.
A novel copy number variant in the murine Cdh23 gene gives rise to profound deafness and vestibular dysfunction
Authors: Boehler Nicholas A , Seheult Shane D I , Wahid Muhammad , Hase Kazuma , D’Amico Sierra F , Saini Shakshi , Mascarenhas Brittany , Bergman Matthew E , Phillips Michael A , Faure Paul A , Cheng Hai-Ying Mary
Published: July 2024

Hearing loss is the most common congenital sensory deficit worldwide and exhibits high genetic heterogeneity, making molecular diagnoses elusive for most individuals. Detecting novel mutations that contribute to hearing loss is crucial to providing accurate personalized diagnoses, tailored interventions, and improving prognosis. Copy number variants (CNVs) are structural mutations that are understudied, potential contributors to hearing loss. Here, we present the Abnormal Wobbly Gait (AWG) mouse, the first documented mutant exhibiting waltzer-like locomotor dysfunction, hyperactivity, circling behaviour, and profound deafness caused by a spontaneous CNV deletion in cadherin 23 (Cdh23). We were unable to identify the causative mutation through a conventional whole-genome sequencing (WGS) and variant detection pipeline, but instead found a linked variant in hexokinase 1 (Hk1) that was insufficient to recapitulate the AWG phenotype when introduced into C57BL/6J mice using CRISPR-Cas9. Investigating nearby deafness-associated genes revealed a pronounced downregulation of Cdh23 mRNA and a complete absence of full-length CDH23 protein, which is critical for the development and maintenance of inner ear hair cells, in whole head extracts from AWG neonates. Manual inspection of WGS read depth plots of the Cdh23 locus revealed a putative 10.4 kb genomic deletion of exons 11 and 12 that was validated by PCR and Sanger sequencing. This study underscores the imperative to refine variant detection strategies to permit identification of pathogenic CNVs easily missed by conventional variant calling to enhance diagnostic precision and ultimately improve clinical outcomes for individuals with genetically heterogenous disorders such as hearing loss.
Neurodevelopmental disorder-associated CYFIP2 regulates membraneless organelles and eIF2α phosphorylation via protein interactors and actin cytoskeleton
Authors: Zhang Yinhua , Kang Hyae Rim , Jun Yukyung , Kang Hyojin , Bang Geul , Ma Ruiying , Ju Sungjin , Yoon Da Eun , Kim Yoonhee , Kim Kyoungmi , Kim Jin Young , Han Kihoon
Published: July 2024

De novo variants in the Cytoplasmic FMR1-interacting protein 2 (CYFIP2) have been repeatedly associated with neurodevelopmental disorders and epilepsy, underscoring its critical role in brain development and function. While CYFIP2’s role in regulating actin polymerization as part of the WAVE regulatory complex (WRC) is well-established, its additional molecular functions remain relatively unexplored. In this study, we performed unbiased quantitative proteomic analysis, revealing 278 differentially expressed proteins (DEPs) in the forebrain of Cyfip2 knock-out embryonic mice compared to wild-type mice. Unexpectedly, these DEPs, in conjunction with previously identified CYFIP2 brain interactors, included not only other WRC components but also numerous proteins associated with membraneless organelles (MLOs) involved in mRNA processing and translation within cells, including the nucleolus, stress granules, and processing bodies. Additionally, single-cell transcriptomic analysis of the Cyfip2 knock-out forebrain revealed gene expression changes linked to cellular stress responses and MLOs. We also observed morphological changes in MLOs in Cyfip2 knock-out brains and CYFIP2 knock-down cells under basal and stress conditions. Lastly, we demonstrated that CYFIP2 knock-down in cells, potentially through WRC-dependent actin regulation, suppressed the phosphorylation levels of the alpha subunit of eukaryotic translation initiation factor 2 (eIF2α), thereby enhancing protein synthesis. These results suggest a physical and functional connection between CYFIP2 and various MLO proteins and also extend CYFIP2’s role within the WRC from actin regulation to influencing eIF2α phosphorylation and protein synthesis. With these dual functions, CYFIP2 may fine-tune the balance between MLO formation/dynamics and protein synthesis, a crucial aspect of proper mRNA processing and translation.
Small molecules, enormous functions: potential approach for overcoming bottlenecks in embryogenic tissue induction and maintenance in conifers
Authors: Guo Tao , Bao Fen , Fan Yingming , Zhang Jinfeng , Zhao Jian
Published: July 2024

Somatic embryogenesis (SE) is not only the most effective method among various strategies for the asexual propagation of forest trees but also a basis for genetic improvement. However, some bottlenecks, such as the recalcitrance of initiation, the maintenance of embryogenic potential during proliferation and the low efficiency of maturation as well as high rate of abnormal embryo development remain unresolved. These bottlenecks refer to complex mechanisms, including transcriptional regulatory networks, epigenetic modifications and physiological conditions. In recent years, several small molecules utilized in animal stem cell research have exhibited positive effects on plant regeneration, including conifer species, which offers a potential novel approach to overcome the challenges associated with SE in conifers. In this review, we summarize the small molecules used in conifers, including redox substances, epigenetic regulatory inhibitors and other metabolism-related molecules, which overcome these difficulties without the use of genetic engineering. Moreover, this approach also has the advantages of dynamic reversibility, simple operation, and simultaneous regulation of multiple targets, which might be one of the best choices for optimizing plant regeneration systems including SE.
Grapevine gray mold disease: infection, defense and management
Authors: Rahman Mati Ur , Liu Xia , Wang Xiping , Fan Ben
Published: July 2024

Grapevine (Vitis vinifera L.,) is among the world’s leading fruit crops. The production of grapes is severely affected by many diseases including gray mold, caused by the necrotrophic fungus Botrytis cinerea. Although all Vitis species can be hosts for B. cinerea, V. vinifera are particularly susceptible. Accordingly, this disease poses a significant threat to the grape industry and causes substantial economic losses. Development of resistant V. vinifera cultivars has progressed from incidental selection by farmers, to targeted selection through the use of statistics and experimental design, to the employment of genetic and genomic data. Emerging technologies such as marker-assisted selection and genetic engineering have facilitated the development of cultivars that possess resistance to B. cinerea. A promising method involves using the CRISPR/Cas9 system to induce targeted mutagenesis and develop genetically modified non-transgenic crops. Hence, scientists are now engaged in the active pursuit of identifying genes associated with susceptibility and resistance. This review focuses on the known mechanisms of interaction between the B. cinerea pathogen and its grapevine host. It also explores innate immune systems that have evolved in V. vinifera, with the objective of facilitating the rapid development of resistant grapevine cultivars.
The crisis in the palm of our hand
Authors: Norman Jethro , Ford Matthew , Cold-Ravnkilde Signe Marie
Published: July 2024

The rapid global proliferation of smartphones and their associated information infrastructures has been a defining feature of the past decade's global crises. Yet, while the digital is now a topic of keen interest for scholars working on virtually everything that constitutes the international, the smartphone as an object of study in and of itself has been largely elusive. Moreover, emerging studies of contemporary crisis, such as ‘polycrisis’, often downplay the role of the digital. How can we conceptualize the ambiguity and ubiquity of the smartphone, as it impacts diverse fields of human action, from war to humanitarianism to democracy? And how can we empirically study this phenomenon and its distributed effects? We contend that smartphones are both embedded in and embed global crises. We conceptualize this as ‘global crisis ecologies’: new spaces that are not simply geographical, or easily framed in terms of North/South divisions, and that include the informational infrastructures that mediate the way crisis is apprehended. This framing helps us understand how multiple civilian, state and non-state actors at different societal levels participate in crises through everyday smartphone use. It foregrounds how the speed, audio-visual capabilities and inherent scalability of smartphones shape how crises are perceived and managed.
Platform kinship and the reshaping of political order in the Somali territories
Authors: Norman Jethro
Published: July 2024

Numerous studies show that digital technologies facilitate diaspora engagement in homeland affairs. However, communities in home countries also adapt digital platforms to harness diasporic support and drive socio-political change. Despite a rich literature on ‘digital kinship’, there remains a limited understanding of kinship's broader political and developmental impact, especially in (post)conflict regions. This article draws on fieldwork in the Somali territories to argue that a distinctive model of governance, platform kinship, is emerging as an alternative to existing state and international development programmes. Focusing on WhatsApp, it highlights how the platform's specific features are adapted to Somali segmentary clan structures, enabling kinship groups to bridge digital divides, preserve oral traditions and uphold egalitarian principles. Platform kinship has state-like effects. Through an ecosystem of WhatsApp groups, geographically dispersed kin mediate disputes, coordinate development projects, fund political campaigns, and respond to conflicts and crises. However, it also empowers new actors, including youth, politicians and business elites, while marginalizing elders. Furthermore, because platform kinship strengthens the clan as the central political unit, it can deepen divisions between kinship groups and undermine state-building projects and conceptions of national identity. This has important implications for policy-makers and academics working on digital governance, development and peacebuilding.
The political economy of connectivity in the Somali Horn of Africa
Authors: Iazzolino Gianluca , Musa Ahmed M
Published: July 2024

This article focuses on the political economy of connectivity in the Somali Horn of Africa (HoA). On the one hand, it charts the emergence of firms in Somalia and Somaliland at the intersection of telecommunication and finance, eventually controlling logistics through digital platforms that enable the circulation of people, goods and value across the region. On the other, it examines the historical and political elements that have shaped a peculiar instance of digital capitalism against a backdrop of protracted insecurity and state fragility. It uses the specific case-study of digital platforms in the Somali HoA to provide insights into the multiple shapes that digital capitalism can take. To advance the authors' analysis, the article links the notions of digital infrastructural power and ‘extrastatecraft’. Empirically, it delves into the case of digital platforms in the Somali HoA to illustrate how the unique digital landscape of the region has evolved over fifty years of political instability and economic volatility. Theoretically, the article navigates the implications of the state's heavy reliance on privately owned and managed platforms amid the backdrop of variegated digital capitalism narratives, which have predominantly centred on the global North.
Piracy and the broader ‘gun business’ in the Niger Delta
Authors: Jacobsen Katja Lindskov , Rasmussen Amanda Møller
Published: July 2024

Piracy cannot be understood in isolation from other (criminal) engagements, but how can we explore such linkages and why is it relevant to understand their implications, both for piracy and counterpiracy? Appreciating that Niger Delta-based piracy has dropped to historically low levels, this article explores what pirates do when they do not sustain themselves by engaging in piracy. As such, the article offers novel empirical insights into underexplored dimensions of piracy. Moreover, we use this case-study to demonstrate the relevance of an infrastructure-inspired conceptualization much beyond analyses of piracy and counterpiracy. Showing how piracy is linked to broader and often violent infrastructures that interventions leave unaddressed, and stressing key implications of the continuity and change in such linkages, is a first step towards appreciating the centrality of a broader dilemma that intervention actors confront: how to conceptualize the necessity to delimit a problem, while appreciating the significance of problem-dimensions left unaddressed? Our suggestion is that an infrastructure-inspired approach offers a helpful starting-point, a suggestion that we demonstrate in an analysis of how Niger Delta-based piracy forms part of a broader ‘gun business’ landscape, which does not only entail different types of crime but also various types of victims.
From Individual Calcifiers to Ecosystem Dynamics: Ocean Acidification Effects on Urchins and Abalone
Authors: deVries Maya S , Ly Nhi , Ebner Chase , Hallisey Ryan
Published: July 2024

Synopsis

A central question in ecology is to what extent do trophic interactions govern the structure and function of communities? This question is becoming more pressing as trophic interactions shift with rapid climate change. Sea urchins and abalone are key invertebrates in the habitats where they reside. Sea urchins are critical members of exemplar trophic cascades in kelp forests due to their impact on kelp establishment and maintenance; yet their populations are controlled by predators, such as sea otters and sunflower sea stars. Abalone compete with urchins for macroalgal food resources and therefore can help regulate urchin populations in kelp forests. Given that both urchin tests and abalone shells used for predator defense are comprised of calcium carbonate, much research has been conducted on the impacts of ocean acidification (OA) on these calcified structures. A growing body of literature has shown that urchin tests are less calcified and break with less force under OA conditions. Less is known about abalone, but their shells also appear to respond negatively to OA. Using kelp forest communities as exemplar ecosystems, we discuss the morphological, biomechanical, and physiological responses to OA in urchins and abalone and consider how these individual level responses scale to trophic interactions and ultimately whole ecosystem processes. Although the impacts of OA on the calcified structures used for defense have been well studied, calcified mechanisms for food consumption, such as the Aristotle's lantern of urchins, are much less understood. Thus, examining both the feeding and defense sides of trophic interactions would greatly improve our understanding of OA responses across individual to ecosystem scales. More generally, measurements of morphological, biomechanical, and physiological responses to OA can be made in individuals to help predict higher level ecological responses, which would greatly contribute to broader predictions of whole ecosystem responses to OA.
Pharmacokinetics and pharmacological target attainment of standard temocillin dosing in non-critically ill patients with complicated urinary tract infections
Authors: Wijnant Gert-Jan , Ngougni Pokem Perrin , Coessens Marie , Cottone Eleonora , Ermtraud Julian , Goeman Lieven , Vervaeke Steven , Wicha Sebastian G , Van Bambeke Françoise
Published: July 2024

Objectives

Temocillin, a carbapenem-sparing β-lactam antibiotic, is commonly used at the standard 4 g/day dosage for treating complicated urinary tract infections (cUTIs). However, pharmacokinetic/pharmacodynamic (PK/PD) data supporting this regimen is limited. This study evaluated the plasma pharmacokinetics (PK) and PTA of temocillin in non-critically ill cUTI patients with varying degrees of renal insufficiency (RI).

Methods

In this single-centre clinical study, 22 cUTI patients received a fixed 4 g/day (2 g q12h, intravenously) temocillin dose, irrespective of renal function (no RI: n = 5, mild RI: n = 8, moderate RI: n = 9). Plasma samples were collected post-dosing for LC-MS analysis of total and unbound temocillin levels. Monte Carlo simulations were performed based on the established PK/PD target of ≥35% fT > MIC (minimal inhibitory concentration).

Results

Among patients, the highest plasma drug exposure and PK/PD target attainment were observed in those with moderate RI (median AUC0–12h = 1143 h.mg/L and %fT > MIC = 68%), followed by mild RI patients (median AUC0–12h = 918 h.mg/L and %fT > MIC = 34%), and the lowest in those with healthy kidney function (median AUC0–12h = 692 h.mg/L and %fT > MIC = 26%). Simulations indicated that the 4 g/day temocillin dose achieves 90% PTA only for glomerular filtration rate < 60 mL/min and MIC ≤ 8 mg/L.

Conclusion

The standard temocillin dose may need to be increased from 4 to 6 g/day to treat non-critically ill cUTI patients, in line with recent EUCAST recommendations. For patients with moderate RI, who experience higher exposure due to reduced renal drug clearance, 4 g/day temocillin remains appropriate.
Less water in agriculture? Potential and challenges in optimizing water use efficiency
Authors: Wientjes Emilie , Seijger Chris
Published: July 2024

This article comments on:

Turc B, Sahay S, Haupt J, de Oliveira Santos T, Bai G, Glowacka K. 2024. Up-regulation of non-photochemical quenching improves water use efficiency and reduces whole-plant water consumption under drought in Nicotianatabacum. Journal of Experimental Botany 75, 3959–3972.
Using a new spectral disentangling approach to ascertain whether the massive binary HDE 228766 contains a Wolf–Rayet star
Authors: Quintero Edwin A , Eenens Philippe
Published: July 2024

The massive binary HDE 228766 is composed of an O type primary and an evolved secondary. However, previous qualitative analyses of the composite spectrum have led to a wide discussion about whether the secondary is an Of or a Wolf–Rayet star. We use new observations and our novel QER20 package to disentangle for the first time the spectra of the two stellar components and obtain artefact$-$free reconstructed spectra, yielding the more accurate and reliable spectral classifications of O7.5 V((f))z for the primary and O6 Iaf for the secondary. The emission features of the P$-$Cygni profiles of the H $\beta$ and He i 5876 Å lines, present in the reconstructed spectrum of the secondary, show that this star is at an initial phase of its transition to the WN evolutionary stage. A previously unobserved variable emission, composed of at least four independent features, is seen since 2014 superposed to the H $\gamma$ absorption line. Our analysis reveals that these emission features originate from a physically extended region. This could be explained by an episode of enhanced mass-loss in the scenario of a non$-$conservative evolution of the binary.
Viscous circumbinary protoplanetary discs – I. Structure of the inner cavity
Authors: Penzlin Anna B T , Booth Richard A , Nelson Richard P , Schäfer Christoph M , Kley Wilhelm
Published: July 2024

Many of the most intriguing features, including spirals and cavities, in the current disc observations are found in binary systems like GG Tau, HD 142527, or HD 100453. Such features are evidence of the dynamic interactions between binary stars and the viscous disc. Understanding these dynamic interactions and how they result in the structure and growth of asymmetric circumbinary discs is a difficult problem, for which there is no complete analytical solution, that predicts the shape of the observed disc accurately. We use numerical simulations to evolve circumbinary discs with varying disc viscosities and investigate the size and shape of the inner cavities in such protoplanetary discs. We have simulated over 140 locally isothermal 2D grid-based disc models for $\ge$3 × 104 binary orbits each and mapped out the parameter space relevant for protoplanetary discs. With this, it becomes possible to create parametrized profiles for individual discs to compare to observations and find limits to their binary eccentricity or internal viscosity from the simulation data. In the long-term simulations, larger cavity sizes than previously considered are possible within the parameter space ($\le$6 binary separations). As an example, we find that the eccentricity of the disc around HD 142527 suggests the impact of the binary dynamics on the disc. However, even considering the larger cavity sizes, the large size of the cavity in HD 142527 remains unexplained by the simulations considering the most recent orbital constraints.
Heart failure events in randomized controlled trials for adults receiving maintenance dialysis: a meta-epidemiologic study
Authors: Collister David , Pyne Lonnie , Bhasin Arrti A , Smyth Brendan , Herrington William , Jardine Meg , Mark Patrick B , Badve Sunil , Rossignol Patrick , Dember Laura M , Wanner Christoph , Ezekowitz Justin , Devereaux P J , Parfrey Patrick , Gansevoort Ron , Walsh Michael
Published: July 2024

Background and hypothesis

Heart failure is characterized as cardiac dysfunction resulting in elevated cardiac filling pressures with symptoms and signs of congestion. Distinguishing heart failure from other causes of similar presentations in patients with kidney failure is challenging but necessary, and is needed in randomized controlled trials (RCTs) to accurately estimate treatment effects. The objective of this study was to review heart failure events, their diagnostic criteria, and adjudication in RCTs of patients with kidney failure treated with dialysis. We hypothesized that heart failure events, diagnostic criteria, and adjudication were infrequently reported in RCTs in dialysis.

Methods

We conducted a meta-epidemiologic systematic review of RCTs from high-impact medical, nephrology, and cardiology journals from 2000 to 2020. RCTs were eligible if they enrolled adults receiving maintenance dialysis for kidney failure and evaluated any intervention.

Results

Of 561 RCTs in patients receiving dialysis, 36 (6.4%) reported heart failure events as primary (10, 27.8%) or secondary (31, 86.1%) outcomes. Ten of the 36 (27.8%) RCTs provided heart failure event diagnostic criteria and five of these (50%) adjudicated heart failure events. These 10 RCTs included event diagnostic criteria for heart failure or heart failure hospitalizations, and their criteria included dyspnoea (5/10), oedema (2/10), rales/crackles (4/10), chest X-ray pulmonary oedema or vascular redistribution (4/10), treatment in an acute setting (6/10), and ultrafiltration or dialysis (4/10). No study explicitly distinguished heart failure from volume overload secondary to non-adherence or underdialysis.

Conclusion

Overall, we found that heart failure events are infrequently reported in RCTs in dialysis and are heterogeneously defined. Further research is required to develop standardized diagnostic criteria that are practical and meaningful to patients and clinicians.
Development of Tools to Detect and Identify Strains Belonging to the Pseudomonas syringae Species Complex Responsible for Vein Clearing of Zucchini
Authors: Lacault Caroline , Briand Martial , Jacques Marie-Agnès , Darrasse Armelle
Published: July 2024

Vein clearing of zucchini (VCZ) is a disease caused by seedborne bacteria that affects young plants of Cucurbita pepo subsp. pepo. VCZ agents are distributed into four phylogenetic clusters within clades 2a and 2ba of phylogroup 2 of the Pseudomonas syringae species complex. All these strains are pathogenic to squash, but only certain strains can also attack melon and cucumber. Strains belonging to clades 2b and 2d are sometimes isolated from zucchini seeds but have not been associated with VCZ epidemics. Identification tools for VCZ agents are required to improve disease control. Primers were designed to implement a seven-gene multilocus sequence analysis (MLSA) scheme for a collection of 60 strains isolated from zucchini seeds. The MLSA showed a clear predominance of strains of cluster 2ba-A and the presence of VCZ strains in a fifth cluster (2ba-C). PCR tests were designed to characterize strains in the VCZ clusters, and a multiplex qPCR test was proposed to distinguish strains with a cucurbit host range extended to melon and cucumber, harboring hopZ5 and sylC, from other strains harboring avrRpt2 and sylC. Additional qPCR tests were also designed to gain insights into clade-2b and -2d strains that can be isolated from cucurbits. These tools evaluated in silico with the NCBI database and experimentally with a collection of 112 strains detected all target strains, except for the test dedicated to clade-2b strains, and excluded 96.7 to 100% of nontarget strains. These tools are intended to serve phylogenetic studies, epidemiological monitoring, and seed testing.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Exclusive Human Milk Diets and the Reduction of Necrotizing Enterocolitis
Authors: Harris Lydia , Lewis Stephanie , Vardaman Shellye
Published: July 2024

Background:

Necrotizing enterocolitis (NEC) is common in preterm infants, especially infants less than 32 weeks gestation. Mortality from NEC is 7% and occurs in 1 out of 1000 preterm infants. Studies have shown the efficacy of an exclusive milk from mother diet in decreasing rates of NEC and associated mortality.

Purpose:

To evaluate the effectiveness of an existing exclusive human milk diet (EHMD) protocol on the incidence of NEC in extremely premature infants. EHMD, for the purposes of this project is defined as breast milk of mother, with or without human milk-based fortifier.

Methods:

A single-center retrospective quasi-experimental study. The sample included 201 infants born less than 32 weeks gestation, weighing less than 1250 grams, small for gestational age (SGA) and with low Apgar scores. Outcomes measured included incidences of NEC, mortality, and co-morbidities in infants pre- and postinitiation of an EHMD protocol.

Results:

Just 4.8% of the EHMD group had a NEC diagnosis compared to 10.5% of the bovine-based (BOV) group. There was a 1% mortality rate of the EHMD group as compared to 6% in the BOV group. The EHMD group had a statistically significant greater weight gain during hospitalization as compared to infants fed BOV (P = < .05).

Implications for Practice and Research:

Neonatal intensive care units should consider EHMDs for use in this infant population. Future research is needed to support dissemination of the use of EHMD as standard of practice.
Design and Content Validity of Health Games for Children With Atopic Dermatitis
Authors: Muzzolon Mariana , Morgan Mariana A. P. , Imoto Renata R. , Carvalho Vânia Oliveira
Published: July 2024

Objective:

The success of managing atopic dermatitis (AD) largely depends on patient adherence to treatment. Achieving adherence requires more than knowledge transfer; it also requires a change in patients’ health behavior. Therefore, we conducted this study to develop and validate the content of health games for the pediatric population with AD.

Methods:

The study was conducted from August 2019 to February 2024 in the Hospital Complex of the Federal University of Paraná, Curitiba, Paraná, Brazil. The content of health games about AD were the book Oli e o Grande Desafio da Coceira™ (“Oli and the Great Itching Challenge”) and the games Dermatrilha™ (“Dermatrail”) and Caixinha Surpresa da Dermatite™ (“Dermatitis Surprise Box”). The instrument development process consisted of 5 stages: planning of the instruments, development of the instruments, development of content validation questionnaires, evaluation by an expert committee comprising 5 pediatric dermatologists, 5 hospital psychologists, 5 illustrators/designers, and 5 early childhood education teachers, and a pre-test with the target audience comprising 25 children with AD aged 5 to 12 years. The content validity index was used to assess content validity.

Results:

The content validity index was 0.94 in the evaluation by the expert committee and 0.95 in the evaluation by the target audience. Among the games, the general content validity index was 0.95 among the members of the expert committee and 0.92 among the target audience, being higher than 0.80 for all items.

Conclusion:

The health games evaluated in this study are useful psychoeducational tools with high content validity for use in the therapeutic education of children with AD.
Trends in Common Ownership among Insurers in Medicare Part D
Authors: Chatterji Pinka , Ho Chun-Yu , Kamara Alyssa , Lee Jaehak
Published: July 2024

Background:

Recent studies document the rising prevalence of common ownership by institutional investors in specific industries. Those investors offer products, such as mutual and index funds, to trade securities on behalf of others and often own shares of multiple firms in the same industry to diversify portfolios. However, at present, few studies focus on common ownership trends in health care.

Objectives:

This paper examines institutional investors’ common ownership in the major insurers offering plans in the Medicare Part D stand-alone prescription drug plan (PDP) market between 2013 and 2020.

Research Design:

Using data from the Securities and Exchange Commission (SEC) database and the Center for Research in Securities Prices, we compute the percentages of outstanding shares of each insurer owned by institutional investors. Data visualization and network analysis are employed to assess the trends in common ownership among major insurers.

Results:

We document a high prevalence of and substantial increase in shared institutional investors in the PDP market. From 2013 to 2020, the degree of common ownership increased by 7% on average, and the common ownership network became more connected. Common ownership also varies across the 34 PDP regions depending on their reliance on listed insurers, that are traded in the stock exchange, offering stand-alone PDPs.

Conclusions:

High and rising common ownership in the Medicare Part D PDP market raises policy questions about potential effects on plan offerings, premiums, and quality for consumers.
Factors Associated with COVID-19 Public Health Workforce Pipeline
Authors: Macomber Kathryn , Brooks Jamie , White Heather , Chase Yvette , Thomas Carmen
Published: July 2024

Public health entities nationwide conducted historic hiring to mitigate the COVID-19 pandemic. Post-pandemic recovery has seen recognition and investment in the need for public health infrastructure including workforce. This case study presents a descriptive analysis of COVID-19 case investigators and contact tracers who were part of the COVID-19 workforce in Michigan and associated factors in their ongoing interest in the field. The majority of these respondents have continued their public health career.
Nerve Transfers in the Management of Femoral Nerve Palsy
Authors: Lee Alyssa , Robinson Larry , Baltzer Heather , Farag Jordan
Published: July 2024

The primary objective of this systematic review is to describe the effectiveness of nerve transfers for restoring quadriceps motor function in patients with femoral nerve palsy. MEDLINE, Embase, and CENTRAL were searched from their inception to June 2023 for any English language, primary literature investigating nerve transfers for femoral nerve palsy. Data were extracted for study and intervention characteristics, as well as clinical outcomes, including preoperative and postoperative knee extension strength, electrodiagnostic studies, functional outcomes, adverse events, and donor site morbidity. The primary outcome was defined as return of knee extension equivalent to or greater than a grade 4-on the Medical Research Council scale. Eighteen studies with a total of 40 patients were included. The most common nerve donor was the obturator nerve in 17 studies with 37 patients, followed by the nerve to sartorius in two studies (10 patients). Significant variations in procedures and outcomes reported were observed. There were no studies that reported an effect on ambulation due to donor weakness. Based on the available literature, nerve transfer appears to be an effective treatment for restoring quadriceps function in this population, with 79% of patients in our study achieving at minimum 4-/5 Medical Research Council grade power.
Improving Interpreter Access in the Pediatric Emergency Department: A Quality Improvement Initiative
Authors: Douglas Katherine E. , Fox Miriam T. , Cheston Christine C. , Behara M. Laxmi , Schoppel Kyle A.
Published: July 2024

Background:

An increasing proportion of the population in the United States have limited English proficiency (LEP). Hospitals that receive federal funding must offer interpreter services. However, access is often lacking for patients. Patients with LEP are at higher risk for adverse events, and the Emergency Department is a particularly high-risk environment for these events.

Methods:

This quality improvement initiative took place from April 2021 to August 2022 in an urban, tertiary care Pediatric Emergency Department. A driver diagram informed four Plan-Do-Study-Act cycles, and data were collected through medical record review, patient surveys, and staff surveys. We tracked outcomes using run and control chart data.

Results:

During the study period, the proportion of patients with LEP reporting “always” having an interpreter was unchanged (no centerline shift—control chart rules). Documentation of interpreter use for encounters with patients with LEP improved. Preferred language documentation and documentation of the need for an interpreter in the electronic medical record showed no change. Process measure data for staff-reported use of professional interpreters significantly increased, and the use of ad hoc interpreters decreased significantly. Length of stay did not change for English or LEP patients.

Conclusions:

This quality improvement initiative improved appropriate documentation of LEP and decreased use of nonqualified interpreters, although no change occurred in the proportion of patients who reported always having an interpreter. Patient satisfaction was unaffected.
Medical Student Exposure to Plastic Surgery and the Impact of a Home Training Program
Authors: Ford Aubree , Granger Peter , Vargo James D.
Published: July 2024

Background

Contemporary medical education devotes little time to plastic surgery topics. This deficiency is potentially greater at institutions without a dedicated plastic surgery training program. Lack of exposure to plastic surgery results in many medical students developing limited awareness to the full scope of the field. As a result, these future physicians may be unaware of many conditions treated by the plastic surgeon, resulting in referrals being diverted to alternative specialist and furthering scope of practice creep. This study aims to assess medical students' exposure to plastic surgery and evaluate institutional-based differences in plastic surgery education by comparing medical schools with and without a plastic surgery training program.

Methods

Surveys were distributed to medical students at 2 institutions in the same United States city: 1 with a plastic surgery training program (TP) and 1 with no training program (NTP). Surveys assessed students' clinical experiences, exposure to plastic surgery, and understanding of the scope of plastic surgery.

Results

The response rate was 24.3% (306 of 1261). Many students reported having “little” or “no” exposure to plastic surgery during preclinical (93.5%) and clinical (77.7%) phases. NTP students were more likely to report “no” exposure to plastic surgery during both the preclinical (P = 0.0145) and clinical (P = 0.045) years. Consequently, approximately half of all students felt uncomfortable knowing when to refer a patient (46.1%) or place an inpatient consult (51.1%) to a plastic surgeon.

When presented with clinical scenarios, plastic surgery was selected by only 53.4% of students. Performance between institutions was similar (53.0% TP vs 53.5% NTP, P = 0.936), with greater accuracy on cosmetic vignettes compared with hand and peripheral nerve vignettes. There was a statistically significant difference in 4 subspecialty domains between students who had prior exposure to plastic surgery and those who did not (hand/peripheral nerve, P < 0.0001; craniofacial, P = 0.007; breast/cosmetic, P = 0.001; and reconstruction/burn, P < 0.0001).

Conclusions

These findings add to the growing body of literature demonstrating that medical students have limited exposure to plastic surgery. Although limited in its scope, this study suggests that home TP status does not appear to overtly impact students' understanding. Increased exposure and overall surgical experience correlated with an increased understanding of the scope of plastic surgery.
Electroconvulsive Therapy in Forensic Psychiatry
Authors: Besse Matthias , Gather Jakov , Schiffer Boris , Zilles-Wegner David
Published: July 2024

Patients with schizophrenia are the largest population in forensic hospitals, and treatment-resistant psychosis is associated with length of stay. For patients with severe and treatment-resistant psychotic disorders, electroconvulsive therapy (ECT) is a potentially effective treatment. Data regarding the use of ECT in forensic psychiatry are scarce. This systematic review aims to provide an overview of the use of ECT in forensic psychiatry. Three databases (PubMed, Web of Science, and PsycINFO) were searched for publications since 1980. Peer-reviewed articles describing patients who underwent ECT treatment in the context of forensic psychiatry were included when a treatment outcome was reported. We identified 5 case reports and 1 case series comprising 13 patients treated with ECT in forensic settings. The quality of evidence was poor accompanied by a considerable risk of bias. Patients were diagnosed with schizophrenia spectrum disorders (n = 10) or depression with psychotic features (n = 3). Eleven patients (84.6%) were described as responders in terms of symptom improvement associated with a reduction of aggressive behavior and improved functioning. At least 3 patients were able to return to community settings. Despite the very limited evidence base, our review suggests that patients in forensic hospitals may benefit from ECT, but more systematic and higher-quality evidence is urgently needed. In addition to prospective, controlled observational studies, a qualitative view focusing on patients' perspectives in this specific setting is of particular importance.
Effect of chemotherapeutic agents on natural transformation frequency in Acinetobacter baylyi
Authors: Winter Macaulay , Vos Michiel , Buckling Angus , Johnsen Pål Jarle , Harms Klaus
Published: July 2024

Natural transformation is the ability of a bacterial cell to take up extracellular DNA which is subsequently available for recombination into the chromosome (or maintenance as an extrachromosomal element). Like other mechanisms of horizontal gene transfer, natural transformation is a significant driver for the dissemination of antimicrobial resistance. Recent studies have shown that many pharmaceutical compounds such as antidepressants and anti-inflammatory drugs can upregulate transformation frequency in the model species Acinetobacter baylyi. Chemotherapeutic compounds have been shown to increase the abundance of antimicrobial resistance genes and increase colonization rates of potentially pathogenic bacteria in patient gastrointestinal tracts, indicating an increased risk of infection and providing a pool of pathogenicity or resistance genes for transformable commensal bacteria. We here test for the effect of six cancer chemotherapeutic compounds on A. baylyi natural transformation frequency, finding two compounds, docetaxel and daunorubicin, to significantly decrease transformation frequency, and daunorubicin to also decrease growth rate significantly. Enhancing our understanding of the effect of chemotherapeutic compounds on the frequency of natural transformation could aid in preventing the horizontal spread of antimicrobial resistance genes.
A study on viruses and bacteria with particular interest on Mycoplasma pneumoniae in children with exacerbation of asthma from a tertiary care hospital in Sri Lanka
Authors: Wijesooriya Lakmini Inoka , Chalker Victoria , Perera Priyantha , Sunil-Chandra N.P.
Published: July 2024

Asthma is a significant public health concern, particularly in children with severe symptoms. Exacerbation of asthma (EOA) is life-threatening and respiratory infections (RIs) play a crucial role. Though viruses  play a significant role in EOA,  patients are empirically treated with antibiotics which contribute to the development of antibiotic resistance. Although there are widely reported association of EOA with viral or M. pneumoniae infections, there are no published data in Sri Lanka. The present study aimed to identify the association of common respiratory viruses, typical respiratory bacterial pathogens, and M. pneumoniae in children with EOA   and relate them with the compatibility of antimicrobial use.
A case-control study was conducted in the pediatric unit of North Colombo Teaching Hospital, Sri Lanka, involving two groups of children between 5-15 years of age. Group-1: children with EOA, Group-2: children with stable asthma (SA). Each group consisted of 100 children. Sputum/throat swabs were tested for common respiratory viruses using virus specific  FITC-labelled monoclonal antibodies (MAbs),  bacteria by routine culture and M. pneumoniae by RT-PCR. Macrolide-resistance in M. pneumoniae was detected using conventional PCR and sequencing specific genetic mutations in the 23S rRNA gene. M. pneumoniae was genotyped using nested multilocus sequence typing (MLST), which targeted eight housekeeping genes  (ppa, pgm, gyrB, gmk, glyA, atpA, arcC, adk).
There was no significant difference in age, gender, demographic or geographical locations   between the two groups. In children with EOA, antibiotics were used in 66% (66/100) and macrolides in 42% (42/100) in children with EOA.  Samples consisted of 78% (78/100)  sputum and 22% (22/100) throat swabs. Adenovirus   was the most common   virus identified, and it was significantly higher in children with EOA compared to those with SA, but no significant difference in typical bacteria findings between the two groups.   M. pneumoniae was detected in one patient    with EOA, with none  detected in the SA group. The  M. pneumoniae was macrolide sensitive, and   it was ST14 by Multi Locus Sequence Typing. This study showed that the empiric use of antibiotics in children with asthma may be better targeted with prior pathogen screening to inform appropriate treatment to minimize antibiotic resistance.