bluuebunny/crossref_metadata_2025 huggingface dataset:
Report on the European Copyright Society’s Conference of 2024
Authors: Gurlitt David , Yaghubi Parand
Published: November 2024

This report provides an overview of the annual European Copyright Society (ECS) conference, which was held at Goethe University Frankfurt am Main on 24 May 2024. The conference, titled ‘Conflict and Trust in the European Copyright System’, featured 12 speakers from across Europe who discussed various copyright-related topics, including lawful access, the platform economy, copyright in the context of the data economy, data access, author remuneration, and artificial intelligence. The event highlighted current and emerging challenges, particularly with regard to new technologies, and explored potential solutions to address them. Although the conference was primarily focused on juridical aspects, the discussions also considered European copyright law from perspectives beyond the legal, such as sustainability and its role in the digital environment. The conference unified around the tense interplay between trust and conflict within the European copyright system, with the speakers and contributors to subsequent discussions suggesting that increasing trust could help resolve ongoing conflicts in copyright law effectively.
Squaring the circle of judicial protection for collective member state action: The Economic and Monetary Union and beyond
Authors: Iglesias Sara
Published: November 2024

Member state collective action closely connected with EU law can easily fall through the cracks of the EU system of remedies, since such action cannot be attributed to an EU institution. Setting aside the problematic issue of judicial review—excluded in various recent Court of Justice of the European Union (CJEU) rulings—this article explores the additional (or alternative) possibility of EU damages actions in such situations. Taking as the starting point the ruling on the liability of the Euro Group in Chrysostomides, the discussion that follows centers around the question of whether, in specific situations, member states should be regarded as “EU actors” liable to trigger the liability of the Union. The article argues that there is a solid ground for seriously considering the possibility of EU damages in specific situations where member states have acted collectively.
The use of continuous action representations to scale deep reinforcement learning for inventory control
Authors: Vanvuchelen Nathalie , De Moor Bram J , Boute Robert N
Published: November 2024

Accepted by: M. Zied Babai

Deep reinforcement learning (DRL) can solve complex inventory problems with a multi-dimensional state space. However, most approaches use a discrete action representation and do not scale well to problems with multi-dimensional action spaces. We use DRL with a continuous action representation for inventory problems with a large (multi-dimensional) discrete action space. To obtain feasible discrete actions from a continuous action representation, we add a tailored mapping function to the policy network that maps the continuous outputs of the policy network to a feasible integer solution. We demonstrate our approach to multi-product inventory control. We show how a continuous action representation solves larger problem instances and requires much less training time than a discrete action representation. Moreover, we show its performance matches state-of-the-art heuristic replenishment policies. This promising research avenue might pave the way for applying DRL in inventory control at scale and in practice.
Toric Vector Bundles, Non-abelianization, and Spectral Networks
Authors: Suen Yat-Hin
Published: November 2024

Spectral networks and non-abelianization were introduced by Gaiotto–Moore–Neitzke and they have many applications in mathematics and physics. In a recent work by Nho, he proved that the non-abelianization of an almost flat local system over the spectral curve of a meromorphic quadratic differential is the same as the family Floer construction. Based on the mirror symmetry philosophy, it is then natural to ask how holomorphic vector bundles arise from spectral networks and non-abelianization. In this paper, we construct toric vector bundles on complete toric surfaces via spectral networks and non-abelianization arising from Lagrangian multi-sections. As an application, we deduce that the moduli space of rank 2 toric vector bundles over toric surfaces admit an $A$-type $\mathcal{X}$-cluster structure.
Assessing the prevalence of trachoma in the East, North, Far North and Adamaoua regions of Cameroon, 2016–2022
Authors: Epee Emilienne , Tagne Carine Fokam , Bakhtiari Ana , Boyd Sarah , Willis Rebecca , Harte Anna J , Jimenez Cristina , Burgert-Brucker Clara , Goldman Whitney , Kello Amir B , Palmer Stephanie , Houck Patricia , Reid Steven , Toubali Emily , Zhang Yaobi , Cohn Daniel A , Gueye Fatou , Ngondi Jeremiah M , Teta Ismael , Harding-Esch Emma M , Solomon Anthony W , Coulibaly Sidi M , Noah Noah Jean Claude , Nko'ayissi Georges , Etoundi Mballa Alain Georges , Eballé André Omgbwa , Bella Assumpta
Published: November 2024

Background

Baseline prevalence surveys in Cameroon in 2010–2012 showed that trachoma was endemic primarily in the north of the country, with 23 evaluation units (EUs) requiring interventions against active (inflammatory) trachoma. This study presents data from prevalence surveys conducted in 2016–2022 following interventions against trachoma in the East, North, Far North and Adamaoua regions of Cameroon.

Methods

EUs were created based on health district boundaries. Within each EU, clusters were selected using probability of selection proportional to population size. Participants were examined for trachomatous inflammation—follicular (TF) and trachomatous trichiasis (TT).

Results

A total of 151 800 people were examined in 45 surveys across 35 EUs. Based on the most recent survey results, TF prevalence was greater than the 5% TF elimination threshold in two EUs. Ten EUs had TT prevalence estimates greater than the 0.2% elimination threshold.

Conclusions

Trachoma remains a public health problem in Cameroon. Continued interventions are needed in EUs with prevalence estimates greater than elimination thresholds, including antibiotic mass drug administration and improved access to TT surgery. Future surveys will be needed to determine when national elimination of trachoma as a public health problem has been achieved.
Topiary and false jewels: Adam Smith on magnificence, aesthetic value, and market value
Authors: Zuckert Rachel
Published: November 2024

In his essay, “Of the Nature of That Imitation Which Takes Place in What Are Called the Imitative Arts,” Adam Smith discusses two examples, topiary and false jewels, apparently coming to opposed conclusions: that aesthetic value is, and that it is not, independent of market value. I unpack the reasoning behind these conclusions, arguing that Smith’s position is consistent: he recognizes that aesthetic value can be occluded by market prices—as when one dismisses the beauty of something cheap out of snobbery—or heightened by them, as in the case of the aesthetic value of magnificence. Because aesthetic value can thus be heightened or corrupted by market value on Smith’s analysis, I suggest, speculatively, that for Smith the bad influence of economic considerations in aesthetic matters (faulty snobbery or an economically-derived corruption of taste) is identified by reference to moral, not purely aesthetic criteria.
A single upstream mutation of whiB7 underlies amikacin and clarithromycin resistance in Mycobacterium abscessus
Authors: De Boeck Nathan , Villellas Cristina , Crespo-Yuste Estefanía , Gonzalo-Asensio Jesús , Buckley Peter T , Thys Kim , Vuong Cuong , Lounis Nacer , Verstraeten Natalie , Michiels Jan
Published: November 2024

Aims

We aimed to investigate the molecular mechanisms underlying the survival of Mycobacterium abscessus when faced with antibiotic combination therapy. By conducting evolution experiments and whole-genome sequencing (WGS), we sought to identify genetic variants associated with stress response mechanisms, with a particular focus on drug survival and resistance.

Methods and results

We conducted evolution experiments on M. abscessus, exposing the bacteria to a combination therapy of amikacin and rifabutin. Genetic mutations associated with increased antibiotic survival and altered susceptibility were subsequently identified by WGS. We focused on mutations that contribute to stress response mechanisms and tolerance. Of particular interest was a novel frameshift mutation in MAB_3509c, a gene of unknown function within the upstream open reading frame of whiB7. A MAB_3509c knockout mutant was constructed, and expression of downstream drug resistance genes was assessed by RT-qPCR. Mutation of MAB_3509c results in increased RNA levels of whiB7 and downstream stress response genes such as eis2, which is responsible for aminoglycoside resistance.

Conclusion

Our findings demonstrate the importance of whiB7 in the adaptive stress response in M. abscessus. Moreover, our results highlight the complexity of M. abscessus adapting to drug stress and underscore the need for further research.
Predictors of nodal upstaging in clinical N1 nonsmall cell lung cancer
Authors: Kayawake Hidenao , Okami Jiro , Shintani Yasushi , Ito Hiroyuki , Ohtsuka Takashi , Toyooka Shinichi , Mori Takeshi , Watanabe Shun-ichi , Asamura Hisao , Chida Masayuki , Endo Shunsuke , Kadokura Mitsutaka , Nakanishi Ryoichi , Miyaoka Etsuo , Yoshino Ichiro , Date Hiroshi ,   the Japanese Joint Committee of Lung Cancer Registry
Published: November 2024

Background

Surgical resection followed by adjuvant chemotherapy is currently the first choice for the treatment of clinical N1 (cN1) non-small cell lung cancer (NSCLC). However, diagnosing cN1 correctly can be difficult, even with current imaging diagnostic technologies. We aimed to analyze the diagnostic accuracy of preoperative nodal status and the predictive factors for nodal upstaging of cN1-NSCLC.

Methods

Patients receiving surgery for cN1-NSCLC in 2010 (n = 1040) were enrolled in the Japanese Joint Committee of Lung Cancer Registry Database. We investigated the diagnostic accuracy of cN1, predictive factors for nodal upstaging, and prognostic factors for overall survival (OS) and recurrence-free survival (RFS).

Results

The 5-year OS and RFS for all patients were 58.2% and 42.7%, respectively. The postoperative pathological nodal status included N0 (36.6%), N1 (39.7%), N2 (23.6%), and N3 (0.1%). In multivariate analysis, younger age (P = .005), no history of smoking (P = .006), and adenocarcinoma (P < .001) were significant predictive factors for nodal upstaging. Older age (P < .001) and higher clinical T (cT) factor (P < .001) were significant indicators for worse OS, while older age (P = .02), higher cT factor (P = .019), high carcinoembryonic antigen value (P = .002), and adenocarcinoma (P = .008) were significant indicators for worse RFS.

Conclusions

The diagnostic accuracy of cN1 in this study was ~40%. No history of smoking and adenocarcinoma were significant predictors for nodal upstaging. Although younger age was a significant predictor for nodal upstaging, it was a significant factor for better prognosis.
The challenges of imported rabid animals to rabies-free and rabies-eliminating countries
Authors: Acharya Krishna Prasad , Phuyal Sarita
Published: November 2024

This manuscript discusses the challenges encountered by rabies-free and rabies-eliminating countries due to imported rabid animals and proposes practical strategies to prevent the reintroduction of the rabies virus in these countries.
High histoplasmosis incidence in kidney transplant recipients in Santa Fe city, Argentina
Authors: Loaiza-Oliva Manuela , Gamarra Soledad , Agusti Joaquín , Gaite Luis , Paladini José Hugo , Martínez Valeria , Arriola Mariano , Gaite Judith Ana , Garcia-Effron Guillermo
Published: November 2024

Histoplasmosis is endemic in the central/northeast region of Argentina. It is estimated that the incidence of this mycosis is low in solid organ transplant recipients. This work aims to describe the epidemiology, clinical forms, and evolution of kidney transplant recipients diagnosed with histoplasmosis in Santa Fe city, Argentina. A retrospective study was carried out between 2015 and 2020 on kidney transplant patients with symptoms associated with histoplasmosis in Santa Fe. Histoplasmosis diagnosis was performed through histopathology, recovery of Histoplasma spp., by culture, and/or positive nested Polimerase Chain Reaction (PCR) specific for the Histoplasma Hc100 gene. During the study period, 360 kidney transplantations were performed. Of these patients, 12 were diagnosed with histoplasmosis (3.3%). The patients' median age was 51 years, and 75% were male. Eleven patients (92%) presented the disseminated form of the disease. Thirty-three percent were diagnosed with histoplasmosis in their first year post-transplantation (mostly 6–12 months), while 42% received their diagnosis 3 years after transplantation. Laboratory diagnosis was performed by histopathology, culture, and PCR in four cases (33%), by culture and PCR in three cases (25%), and by PCR alone in three cases (25%). Thus, all 12 patients showed positive nested PCR results. All patients received amphotericin B as initial treatment. A good response was observed in 83% of patients. We found a high incidence of histoplasmosis in kidney transplant recipients (up to 10 times higher than reports from other endemic areas). Diagnosis by histopathology/culture showed 75% sensitivity, while nested PCR showed better sensitivity and diagnostic speed.
Viscous heating and instabilities in the partially ionized solar atmosphere
Authors: Pandey B P , Wardle Mark
Published: November 2024

In weak magnetic fields ($\lesssim 50 \, \mbox{G}$), parallel and perpendicular viscosities, mainly from neutrals, may exceed magnetic diffusivities (Ohm, Hall, and ambipolar) in the middle and upper chromospheres. Ion-driven gyroviscosity may dominate in the upper chromosphere and transition region. In strong fields ($\gtrsim 100\, \mbox{G}$), viscosities primarily exceed diffusivities in the upper chromosphere and transition region. Parallel and perpendicular viscosities, being similar in magnitude, dampen waves and potentially compete with ambipolar diffusion in plasma heating, potentially inhibiting Hall and ambipolar instabilities when equal. The perpendicular viscosity tensor has two components, $\nu _1$ and $\nu _2$, which differ slightly and show weak dependence on ion magnetization. Their differences, combined with shear, may destabilize waves, though magnetic diffusion introduces a cut-off for this instability. In configurations with a magnetic field ${\boldsymbol B}$ having vertical ($b_z=B_z/|{\boldsymbol B}|$) and azimuthal ($b_y=B_y/|{\boldsymbol B}|$) components, and a wavevector ${\boldsymbol k}$ with radial ($\hat{k}_x=k_x/|{\boldsymbol k}|$) and vertical ($\hat{k}_z=k_z/|{\boldsymbol k}|$) components, parallel viscosity, and Hall diffusion can generate the viscous-Hall instability. Gyroviscosity further destabilizes waves in the upper regions. These findings indicate that the solar atmosphere may experience various viscous instabilities, revealing complex interactions between viscosity, magnetic fields, and plasma dynamics across different atmospheric regions.
X-ray AGN in Boötes: the lack of growth of the most massive black holes since z = 4
Authors: Guetzoyan Paloma , Aird James , Georgakakis Antonis , Coil Alison L , Barlow-Hall Cassandra , Hickox Ryan C , Rankine Amy L , Terrazas Bryan A
Published: November 2024

Supermassive black holes (BHs) are known to efficiently grow through gas accretion, but even sustained and intense mass build-up through this mechanism struggles to explain the assembly of the most massive BHs observed in the local Universe. Using the Chandra Deep-Wide Field Survey (CDFWS) in the Boötes field, we measure BH–galaxy assembly in massive galaxies ($M_\star \gtrsim 10^{10}\,\rm M_\odot$) through the active galactic nucleus (AGN) fraction and specific black hole accretion rate (sBHAR) distribution as a function of redshift and stellar mass. We determine stellar masses and star formation rates for a parent sample of optically selected galaxies as well as those with X-ray detections indicating the presence of an AGN through spectral energy distribution (SED) fitting. We derive a redshift-dependent mass completeness limit and extract X-ray information for every galaxy as to provide a comprehensive picture of the AGN population in massive galaxies. While X-ray AGN samples are dominated by moderately massive host galaxies of $M_{\star } \geqslant 10^{10}\rm {\rm M}_{\odot }$, we do not find a strong stellar mass dependence in AGN fraction (to limits in sBHAR), indicating a bias towards massive galaxies in the observed samples. We derive BH–galaxy growth tracks over time, which reveal that while most BH mass has been accumulated since $z=4$ for lower mass BHs, the assembly of the most massive BHs is more complex, with little to no relative mass gain since $z=4$, implying that rapid and intense growth episodes prior to $z=4$ were necessary to form these massive BHs.
Attempt to re-estimate organ doses of victims in non-homogeneous exposure accident by means of the state-of-the-art Mesh-type Reference Computational Phantom—a case study of an IR-192 source accident
Authors: Kowatari Munehiko , Yoshitomi Hiroshi , Tani Kotaro , Tanimura Yoshihiko , Kurihara Osamu
Published: November 2024

An attempt was made to estimate organ doses of a victim in a high-dose non-homogeneous exposure accident caused by a sealed 192Ir gamma-ray source. The Gilan accident was selected as a case study. Organ doses including testis, red bone marrow and so on were properly estimated by applying the Monte Carlo calculation with the state-of-the-art adult male Mesh type Reference Computational Phantom. By introducing a complicated exposure scenario, the dose distribution on the right chest of the victim in the Gilan accident could be reproduced to a certain extent.
Changes in morphological and physiological traits of urban trees in response to elevated temperatures within an Urban Heat Island
Authors: Martínez-Villa Johanna Andrea , Paquette Alain , Feeley Kenneth J , Morales-Morales Paula Andrea , Messier Christian , Durán Sandra M
Published: November 2024

Urban heat islands (UHIs) are a common phenomenon in metropolitan areas worldwide where the air temperature is significantly higher in urban areas than in surrounding suburban, rural or natural areas. Mitigation strategies to counteract UHI effects include increasing tree cover and green spaces to reduce heat. The successful application of these approaches necessitates a deep understanding of the thermal tolerances in urban trees and their susceptibility to elevated urban temperatures. We evaluated how the photosynthetic thermal optimum (Topt), photosynthetic heat tolerance (T50) and key leaf thermoregulatory morphological traits (leaf area [LA], specific leaf area, leaf width, thickness and leaf dry matter content) differ between conspecific trees growing in ‘hot’ (UHI) vs ‘cool’ parts of Montreal, Canada (with a difference of 3.4 °C in air temperature), to assess the ability of seven common tree species to acclimation to higher temperatures. We hypothesized that individuals with hotter growing temperatures would exhibit higher Topt and T50, as well as leaf thermoregulatory morphological traits aligned with conservative strategies (e.g., reduced LA and increased leaf mass) compared with their counterparts in the cooler parts of the city. Contrary to our a priori hypotheses, LA increased with growing temperatures and only four of the seven species had higher T50 and only three had higher Topt values in the hotter area. These results suggest that many tree species cannot acclimate to elevated temperatures and that the important services they provide, such as carbon capture, can be negatively affected by high temperatures caused by climate change and/or the UHI effect. The ability vs inability of tree species to acclimate to high temperatures should be considered when implementing long term tree planting programs in urban areas.
Effect of an Intensive Nurse Home Visiting Program on Postpartum Contraceptive Use and Birth Spacing
Authors: Steenland Maria W. , Oviedo Dea , Bates Mary Ann , Zhou Annetta , Zera Chloe , Baicker Katherine , McConnell Margaret A.
Published: November 2024

OBJECTIVE:

To evaluate the effect of an intensive nurse home visiting program on postpartum contraceptive use and birth spacing among individuals with a first pregnancy who were eligible for Medicaid insurance in South Carolina.

METHODS:

We conducted a nonblinded, randomized controlled trial of the Nurse-Family Partnership (NFP), an established intensive home visiting program that provides prenatal and postpartum home visits through 2 years after childbirth. The trial included patients who were eligible for Medicaid insurance with a first pregnancy at less than 28 weeks of gestation between April 1, 2016, and March 17, 2020, who were followed up through 2 years after childbirth. Participants were randomized 2:1 to NFP compared with standard of care treatment. The primary outcome was a birth interval of less than 21 months between the index pregnancy and a subsequent birth. The secondary outcomes were birth intervals of less than 15 and 24 months, receipt of a contraceptive implant or intrauterine device (IUD) immediately postpartum, any contraceptive use and receipt of a family planning visit (at both 6 weeks and 1 year postpartum), and IUD receipt at 1 year postpartum. We assessed outcomes using linked birth certificate records and Medicaid claims data.

RESULTS:

A total of 4,932 trial participants (3,295 in the intervention group and 1,637 in the control group) were included in the study analysis. Within 21 months of the study index birth, 11.0% of individuals in the NFP group and 12.2% of the usual care group had a subsequent birth. The NFP did not have a statistically significant effect on birth intervals of less than 21 months (adjusted coefficient −1.1, 95% CI, −2.9 to 0.8). There were no statistically significant differences between the NFP and control groups for any of the study's eight secondary outcomes related to birth spacing and postpartum contraceptive use.

CONCLUSION:

Home visits with a registered nurse did not affect postpartum contraceptive use or birth spacing.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03360539.
Infertility amid the COVID-19 pandemic: Emotion rules
Authors: Carneiro Márcia M. , Bossi Renata , Xavier Ana C. , Hurtado Rodrigo , Mattos Tatiana , Alvarenga Debora , Sampaio Marcos
Published: November 2024

Introduction:

People struggling with infertility are increasingly turning to social media for infertility-related content and support. The COVID-19 pandemic fuelled interest on social media as fertility treatments were canceled worldwide. Instagram became a source of information and support but data on the topic are scarce.

Objective:

Identify the topics of greatest interest in the posts of a reproductive medicine clinic (ORIGEN) during the pandemic by evaluating engagement measured through Instagram metrics: number of likes, comments, and other interactions.

Methods:

This study involved publicly available posts in the Instagram ORIGEN account published between March 16, 2020, and December 31, 2020. Posts were categorized according to content into educational/scientific, informative (about the clinic and staff), and emotional (“cute post,” maternity/pregnancy, patient testimonials, tips, and motivational). For each category, the 5 most frequent in terms of likes, reach (number of Instagram accounts that saw the posts), and interaction (amount of comments, likes, and saves) were included in the analysis. The study involved only publicly available data, so there was no need for ethical approval. The Mann-Whitney test was used to compare scientific and emotional posts, and P<0.05 was considered significant.

Results:

Three hundred forty-seven posts were published: 155 emotional, 189 scientific, and 3 informative. The most frequent topics were commemorative days (n=66), fertility/infertility (n=36), good news about the pandemic (n=22), maternity/pregnancy (n=20), tips (n=19), “cute post” (n=15), motivational message (n=13), egg freezing (n=13), and endometriosis (n=9). During the study period, there was a 13% increase in followers. Brazilians aged 35–44 comprised the majority of followers (46% women; 41.3% men). Posts with emotional content had significantly more likes (P<0.05), reach (P<0.05), and interactions (P<0.05).

Conclusions:

Public interest in infertility-related themes grew during the pandemic with a 13% increase in ORIGEN account followers, consisting mainly of Brazilian reproductive-age women. Although scientific posts were the majority, emotional posts attracted significantly more attention in terms of the main Instagram metrics: likes, reach, and interactions.
Activation of the kynurenine pathway identified in individuals with covert hepatic encephalopathy
Authors: Zeng Georgia , Krishnamurthy Shivani , Staats Pires Ananda , Guller Anna , Chaganti Joga , Tun Nway , Lockart Ian , Montagnese Sara , Brew Bruce , Guillemin Gilles J , Danta Mark , Heng Benjamin
Published: November 2024

Background:

HE is a neuropsychiatric complication of liver disease characterized by systemic elevation in ammonia and proinflammatory cytokines. These neurotoxins cross the blood-brain barrier and cause neuroinflammation, which can activate the kynurenine pathway (KP). This results in dysregulated production of neuroactive KP metabolites, such as quinolinic acid, which is known to cause astrocyte and neuronal death. Our aim was to compare KP activity between patients with covert HE (CHE), patients without encephalopathic cirrhosis (NHE), and healthy controls (HCs).

Methods:

This was a single-center prospective cohort study conducted between 2018 and 2021 at St Vincent’s Hospital, Sydney. Overall, 13 patients with CHE, 10 patients with NHE, and 12 with HC were recruited. Patients with cirrhosis were diagnosed with CHE if they scored ≤−4 on the Psychometric Hepatic Encephalopathy Score. KP metabolite levels were quantified on plasma samples via HPLC and gas chromatography/mass spectrometry. One-way Kruskal-Wallis test was used to compare the expression levels of KP enzymes.

Results:

KP was highly activated in patients with cirrhosis, demonstrated by higher levels of activity in the rate-limiting enzymes, indoleamine 2,3-dioxygenase, and tryptophan-2,3-dioxygenase in both CHE (65.04±20.72, p=0.003) and patients with NHE (64.85±22.10, p=0.015) compared to HC (40.95±7.301). Higher quinolinic acid concentrations were demonstrated in CHE (3726 nM±3385, p<0.001) and patients with NHE (1788 nM±632.3, p=0.032) compared to HC (624 nM±457). KP activation was positively correlated with inflammatory marker C-reactive protein in patients with CHE (Rs=0.721, p≤0.01).

Conclusions:

KP is highly activated in patients with CHE, resulting in heightened production of neurotoxic metabolites. Dysregulation of the pathway is demonstrable in patients who do not yet show clinical signs of neurocognitive impairment. Therapeutic agents that modulate KP activity may be able to alleviate symptoms of patients with CHE.
Clinical predictors and noninvasive imaging in Fontan-associated liver disease: A systematic review and meta-analysis
Authors: Seol Jae Hee , Song Jinyoung , Kim Soo Jin , Ko Hoon , Na Jae Yoon , Cho Min Jung , Choi Hee Joung , Lee Jue Seong , Oh Kyung Jin , Jung Jo Won , Jung Se Yong
Published: November 2024

Background:

Despite the development of several imaging modalities for diagnosing Fontan-associated liver disease (FALD), there is no optimal protocol for the follow-up of FALD. We conducted a systematic review and meta-analysis to identify factors related to liver fibrosis using biopsy reports and to identify alternative noninvasive modalities that could better reflect liver histological changes in FALD.

Methods:

A systematic review and meta-analysis were conducted following the PRISMA guidelines Table S2. We searched Embase, PubMed, and Cochrane databases for studies on FALD, focusing on those assessing clinical factors associated with liver fibrosis severity through liver biopsy and noninvasive imaging techniques.

Results:

A total of 42 studies were identified, of which 12 conducted meta-analyses and subgroup analyses of the severity of liver fibrosis using liver biopsies. Liver biopsy results showed a weak positive correlation between Fontan duration and fibrosis severity (R = 0.36). Subgroup analyses revealed significant differences in hemodynamic parameters, such as Fontan pressure, between patients with mild and severe fibrosis. Platelet count, aspartate aminotransferase to platelet ratio index, and fibrosis-4 index were significantly associated with fibrosis severity, with severe fibrosis showing lower platelet counts and higher aspartate aminotransferase to platelet ratio index and fibrosis-4 index levels. Noninvasive imaging modalities, particularly magnetic resonance elastography and shear wave elastography, demonstrated strong correlations with biopsy-confirmed fibrosis severity.

Conclusions:

This study identifies key clinical factors, and noninvasive modalities accurately reflect liver fibrosis severity in patients with FALD. Clinical factors such as platelet count, aspartate aminotransferase to platelet ratio index, and fibrosis-4 index may aid in identifying patients at risk for severe fibrosis. In addition, magnetic resonance elastography and shear wave elastography are promising tools for noninvasive assessment in our study. Further research is needed to refine these diagnostic approaches and improve patient management.
Long-Term Impact of an Online Physician Group-Coaching Program to Improve Burnout and Self-Compassion in Trainees
Authors: Fainstad Tyra , Syed Adnan , Thibodeau Pari Shah , Vinaithirthan Vall , Jones Christine D. , Mann Adrienne
Published: November 2024

Goal

To evaluate long-term outcomes of Better Together Physician Coaching, a digital life-coaching program to improve resident well-being.

Methods

We performed a secondary analysis of survey data from the pilot program implementation between January 2021 and June 2022. An intention-to-treat analysis was completed for baseline versus post-6 months and baseline versus post-12 months for all outcome measures.

Principal Findings

Of 101 participants, 95 completed a baseline survey (94%), 66 completed a 6-month survey (65%) and 36 completed a 12-month survey (35%). There were no significant differences in burnout scale scores between baseline to 6 or 12 months. Self-compassion scores (i.e., means) improved after 6 months, from 33.2 to 38.2 (p < .001) and remained improved after 12 months at 36.7 (p = .020). Impostor syndrome score means decreased after 6 months, from 5.41 to 4.38 (p = .005) but were not sustained after 12 months (4.66, p = .081). Moral injury score means decreased from baseline to 6 months from 41.2 to 37.0 (p = .018), but reductions were not sustained at 12 months (38.1, p = .166).

Practical Applications

This study showed significant, sustained improvement in self-compassion for coaching program participants.
Beyond the Bottom Line: Assessing Charity Care, Community Benefits, and Tax Exemptions in Nonprofit Hospitals
Authors: Zare Hossein , Anderson Gerard
Published: November 2024

Goal

This study aimed to compare the value of tax exemptions and community benefits across various nonprofit hospitals and show how hospital and geographical characteristics can explain the values.

Methods

Data from 2017 to 2021 Internal Revenue Service Form 990s were used to evaluate 17 types of community benefits in nonprofit hospitals and assess six categories of tax benefits. Descriptive analyses compared charity care, community benefits, and estimated tax exemptions among nonprofit hospitals while considering variations in teaching status, location (rurality), and US region. Additionally, random effect regression analyses, both unadjusted and adjusted, explored the connection between the community benefit-to-expense ratio and a range of hospital and geographical features.

Principal Findings

Between 2017 and 2021, nonprofit hospitals allocated, on average, 8.8% of their total expenses to 17 types of community benefits, with 1.8% of their expenses dedicated to charity care; 5.2% benefited from tax exemptions. There were significant disparities among nonprofit hospitals, as 24.0% received more tax benefits than they spent on community benefits, and 81.0% received more than their charity care expenditures. The characteristics and location of nonprofit hospitals influenced the provision and composition of community benefits. Teaching hospitals allocated a higher percentage of total community benefits compared to nonteaching hospitals (9.2% vs. 8.6%). The top three categories in teaching hospitals were Medicaid shortfall, charity care, and unreimbursed education, whereas nonteaching hospitals focused more on charity care and subsidized health services, in addition to Medicaid shortfall. Furthermore, the location of a nonprofit hospital impacted the distribution of community benefits. Rural hospitals prioritized Medicaid shortfall, subsidized health services, and charity care, while urban hospitals concentrated more on Medicaid shortfall, charity care, and subsidized health service (in that order). The regression results showed that system affiliation and location in the Southern region of the United States were positive predictors of charity care spending at nonprofits.

Practical Applications

Lack of transparency and explicit requirements from federal agencies and states for what is necessary to receive tax benefits results in wide variations in community benefits spending by nonprofit hospitals. Some receive more in tax benefits than they provide in community benefits, and three-quarters of all nonprofit hospitals receive more in tax benefits than they provide in charity care. Developing a more explicit definition of community benefits can make all nonprofit hospitals more accountable.
Vitamin D and immune response against severe acute respiratory syndrome coronavirus 2 in older adults: does it really work?
Authors: Pedreáñez Adriana B. , Mosquera-Sulbarán Jesús A. , Muñáz Nelson E. , Tene Diego M. , Robalino Jorge G.
Published: November 2024

Coronavirus disease 2019 was announced as a pandemic by the WHO on 11 February 2020. Since that time, challenges have arisen regarding the use of supplements to optimally support the immune system in the general population, and especially in older adults. The severity of severe acute respiratory syndrome coronavirus 2 infection varies significantly with age, being generally more severe in geriatric patients. There is evidence supporting the involvement of vitamin D in different processes related to the immune response. Some observational studies have related the decrease in vitamin D levels to the severity of coronavirus disease 2019, suggesting a protective role of vitamin D in this disease. In this narrative review, we analyze the possible role of vitamin D in modulating the immune mechanisms that are activated during severe acute respiratory syndrome coronavirus 2 infection, with special emphasis on older adults.
Knowledge, attitude and practice towards coronavirus disease 2019 among Indian residents – an online cross-sectional survey
Authors: Manokaran Kalaivani , U. Saritha Kamath , Varghese Aneena , N. Ravi Shankar , Kaushik Siddharth , Ahmed Shiek Fareeth , Selvam Robert , Paramasivam Prabu , M. Anju
Published: November 2024

Introduction:

Coronavirus disease 2019 (COVID-19) pandemic is posing challenge to the public health sector. The present study assessed knowledge, attitude, and practice (KAP) towards this COVID-19 among Indian population.

Methods:

The online cross-sectional survey for evaluating KAP towards COVID-19 was conducted (n = 2059) among Indian residents. Choropleth maps analysis was carried out to present the state-wise distribution, and Moran's I tool to assess KAP's overall spatial autocorrelation.

Results:

Our results demonstrated an average KAP score of 16.9 ± 2.0 (1.0, 22.0), 9.5 ± 2.0 (0.0, 12.0) and 4.0 ± (4.0, 4.0) (0.0, 5.0). The Moran's I tool for KAP's spatial autocorrelations observed as low as −0.04, −0.06, and 0.004.

Conclusion:

The interventional programs have to be encouraged for disease spread, and improving the public's practice for a better quality of life. Adherence to precautionary measures as per the standard guidelines is essential to prevent the spread of the disease, which might be subjective to the general population's knowledge and attitudes towards COVID-19.
Pulmonary co-infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a middle-aged male, case report and literature review
Authors: Chen Hanlu , Qiu Chunning , Cen Ke , Wu Shenghai
Published: November 2024

Co-infection with Cryptococcus neoformans and Mycobacterium tuberculosis is rare, especially in people with normal immune function. We present a case of a middle-aged man with tuberculosis complicated with cryptococcal pneumonia. He was admitted for chest distress, productive cough with white sputum and fever. The diagnosis was based on the positive detection of Mycobacterium tuberculosis RNA in bronchoalveolar lavage fluid (BALF), positive T-SPOT by ESAT-6 and finding Cryptococcus neoformans in BALF culture.
Unprecedented fungal infections and systematization of superficial mycosis: the immunity paradigm
Authors: Leite Gabriel Gomes Vieira Ribeiro , Damasceno Carlos Américo Veiga
Published: November 2024

Fungal infections account for >1 million deaths per year worldwide and projections foresee continual increase. Longer lives of patients with immunity defects such as HIV due to technological and therapeutic advancements in the past few decades has made a new approach to fungal infections needed. Fungi which were previously thought as environmental and saprophytic seem to be able to infect immunocompromised patients to a deadly extent, and as the medical scientific community – and subsequently clinicians – were unaware of these organisms concerning pathological relations, it seemed crucial to organize information on the topic to better address it. In this review, we have compiled data on the basic molecular mechanisms of infection and immunity against fungi, epidemiology, diagnosis, treatment and prevention of fungal infections, as well as presented the main rising ‘new’ fungi from the immunity paradigm of last decades. In conclusion, literature data seems to attribute great importance to the observation of superficial mycosis and preventing its systematization, since treatment are not yet promising against unprecedented diseases brought up by the fungi immunity paradigm.
Prevalence of vanA, B, C and cfr resistance genes among clinical isolates of Staphylococcus aureus and their role in biofilm formation
Authors: Salman Istabreq Muhammed Ali , Khazaal Saba Saadoon , Al-Alak Shaymaa Khudhr
Published: November 2024

Background:

The increasement in the resistance to methicillin and the ineffectiveness of β-lactams among methicillin-resistant Staphylococcus aureus (MRSA) has led vancomycin and linezoli to be as selective drugs for treating Staphylococcal infections, in particular MRSA. The aim of this study was to explore the vancomycin and linezolid resistance in clinical isolates of S. aureus that produce biofilm.

Materials and methods:

Standard microbiology methods were applied to identify 270 S. aureus isolates. Both were confirmed by the femA gene. Resistance to methicillin and linezolid was investigated by disc diffusion and agar dilution methods, and it was confirmed by E-test and biofilm formation was determined. All isolates were examined for mecA gene for MRSA. Specific primers were used to detect vancomycin (vanA, B, C), and linezolid resistance (cfr gene) and next the PCR products.

Results:

One-hundred and fifty-two (56.3%) isolates were resistant to methicillin (MRSA) and 6 (1.2%) of them were nonsusceptible to vancomycin and likewise 10 (3.7%) isolates were resistant to linezolid. About 243(90%) isolates of S. aureus were positive for biofilm production. Additionally, 144 isolates (53.3%) were MRSA by mecA gene. The vanA gene was detected in two isolates (0.7%), but none of them has amplified the cfr gene.

Conclusion:

Resistance to methicillin was high and vancomycin resistance via vanA gene was detected, which enhances the risk of spreading vancomycin resistance. However, resistance to linezolid was not associated with the cfr gene. Therefore, linezolid is yet a valuable antimicrobial in the eradication of S. aureus infections. Our study showed there is an association between Staphylococcus aureus resistance and biofilm production of our isolates.
Pathogenicity and virulence genes of Pseudomonas aeruginosa
Authors: Kareem Sawsan Mohammed , Hamza Israa Hussein , Hussein Abed Walaa
Published: November 2024

The bacteria Pseudomonas aeruginosa is considered one of the bacteria that has low susceptibility to antibiotics. It is an opportunistic pathogen that causes serious infections in hospitals (hospital-acquired infections), immunocompromised patients and cystic fibrosis patients. P. aeruginosa colonizes in an ecosystem that is relevant and plays a vital role in its virulence and antibiotic resistance. So, it determines the nature of these bacteria and plays an important role in understanding the infection and the antimicrobial treatment of avoiding it.
Identification and prevalence of type II toxin–antitoxin genes in Acinetobacter baumannii isolates from clinical samples
Authors: Dashtbin Shirin , Mirkalantari Shiva
Published: November 2024

Introduction:

The toxin–antitoxin (TA) system is a prevalent genetic module found in prokaryotes and plays a significant role in their survival. Mobile genetic elements (MGEs) contribute to the dissemination of antibiotic resistance genes (ARGs), making TA systems critical in this aspect. However, the extent of diversity and abundance of TA systems in Acinetobacter baumannii, a bacterial species that harbors ARGs, remains incompletely characterized.

Method:

In this cross-sectional study, a total of 70 A. baumannii isolates were collected from different clinical samples in microbiology laboratory of different hospitals of Tehran Hospital in six months. Antibacterial resistance of the isolates was determined using disk diffusion method. The prevalence of toxin-antitoxin systems in isolates was also determined by PCR method. Fischer and Chi-square statistical analysis tests were used to determine the association between the presence of these genes and the source of the isolate and antibacterial resistance, respectively.

Results and Discussion:

The results obtained from PCR analysis targeting TAs system loci revealed a high prevalence of TA genes. The gnat/XRE-like genes were detected in all isolates, while the hipA/hipB gene was present in 27.1% of them. The remaining genes, hicA/hicB, were found in 44.2% of the isolates. Significant correlations were found between the presence of hipA/hipB genes and resistance to ceftazidime, meropenem, imipenem, and cefepime (P < 0.05). Additionally, we found a significant association between the presence of the hicA/hicB genes and resistance to gentamycin, ciprofloxacin, amikacin, meropenem, imipenem, and cefepime. Due to the high prevalence of TA systems in A. baumannii, particularly the GCN5-related N-acetyltransferases/XRE-like system, we suggest that these systems may serve as promising targets for the development of antimicrobial drugs to treat infections caused by this pathogen.
Association between various antiseptics and multidrug-resistant skin microbiota and post-cesarean surgery infection
Authors: Edwar Dalia Awni , Naji Eman Natiq
Published: November 2024

Sample swabs were taken from 340 different sites, including 310 swabs from patients’ skin at the site of cesarean surgery incision from several positions before and after sterilization with 10% povidone-iodine and with 10% povidone-iodine mixed with 70% ethanol, and 30 swabs from infected surgical sites were taken from 30 patients with postoperative cesarean infection to detect the causative bacterial pathogen. The isolates were identified and diagnosed by phenotypic examination and biochemical tests, as well as Vitek-2 assay. Staphylococcus epidermidis was the prevalent bacteria isolated from all skin sample sources with high resistance to Ampicillin, Amoxicillin/Clavulanic acid, Metronidazole, and Cefixime; otherwise, all bacterial isolates were sensitive to Imipenem and Tigecycline. Staphylococcus aureus was the dominant bacteria from surgical site infection (SSI) swabs with high resistance to Ampicillin, Cefixime, Ceftriaxone, and Metronidazole, and all 23 isolates were sensitive to Imipenem, Ciprofloxacin, Cefoxitin, Vancomycin, and Tigecycline.
Phenotypic variations of staphylococcal pathogenesis: a comprehensive review
Authors: Ghazaei Ciamak , Khalid Linta
Published: November 2024

Gram positive Staphylococcus strains causes variety of infection ranging from mild skin infections to life threatening infections. Its pathogenicity is due to its ability to produce virulence factors i.e. exotoxins, enzymes and surface adhesions. 90% of staphylococcal infections are caused by strains that produces virulence factors while 40–50% are resistant to commonly available antibiotics. The emergence of resistance is often related with phenotypic variations i.e. biofilm formation and the altered membrane permeability. The review also covers mechanism of pathogenesis of staphylococcal that includes the interplay of variety of virulence factors that staphylococcal bacteria produces, i.e. protein A, FnBPs and α toxins. The FnBPs have role in colonization, promotion of antibiotic resistance, biofilm formation and invasion of immune responses. Biofilm formation has significant role as a manifestation of phenotypic variations in staphylococcal strains and in pathogenesis of various diseases i.e. osteomyelitis, endocarditis catheter related bloodstream and infections associated with medical devices. Various genetic factors are involved in biofilm formation including agr system and the aca operon. Biofilm present on the joint's replacement demonstrates increased persistence and antibiotic resistance. Phenotypic variations of Staphylococcus strains play significant role in pathogenesis of various diseases. Further research and development at molecular level is needed to better understand the mechanism of biofilm formation and identification of new therapeutic targets of biofilm. This review provides an insight into strategies for treating and preventing staphylococcal biofilm associated infections.
Gut microbiota and geriatric health
Authors: Nayak Kusumakshi , Gopan Adithya , Priyanka  , Muraleedharan Anju , Varghese Aneena , Patil Asha , Manokaran Kalaivani
Published: November 2024

Background:

Each individual has a distinct gut microbiota composition that serves a variety of important roles in the metabolism of the host's nutrients, immunomodulation, and maintains immunity and inflammatory response and influences the gut–brain axis (GBA). In addition to modulating the immune system, the hypothalamic–pituitary–adrenal (HPA) axis, and tryptophan metabolism, microorganisms can synthesize several neurotransmitters and generate metabolites, such as short-chain fatty acids (SCFAs), that have neuroactive features. The gut microbiome is highly susceptible to lifestyle modifications, diet and xenobiotics, which leads to dysbiosis. Dysbiosis in the geriatric population can cause numerous disease conditions like Alzheimer's and Parkinson's disease, cardiovascular disease, gastrointestinal disease, and cancer. Dysbiosis of the gut microbiota has been associated with behavioural and neurological disorders such as depression, Alzheimer's, Parkinson's, and autism spectrum disorder. Furthermore, SCFA administration and microbiota alteration have been suggested as therapy objectives for these illnesses. DNA-based culture-independent methods, including next-generation sequencing, which provide quantitative information on the human gut microbiota are used to define the entire gut health and its relation to various disorders. The current review aims to summarize the available literature on the role of gut microbiota in ageing and dysbiosis in disease conditions.