bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Support as a Protective Factor for Alcohol Use Disorders: Results from a Nationally Representative Family History Study
Authors: Jodis Christopher A , Schwartz Joseph A , Everett Dallin C
Published: November 2022

Aims

The current study examined the buffering effect of social support on the relationship between family history and alcohol use disorder symptoms (AUDsx).

Methods

The current study analyzes data from Waves 1 and 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (N = 34,653). Count of AUDsx were measured using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version, the independent variable was a weighted density measure of family history of AUDsx and the moderating variable was social support measured using the 12-item Interpersonal Support Evaluation List (ISEL-12). Negative binomial regression models were used to estimate the association between (1) family history and AUDsx and (2) social support and AUDsx. Average marginal effects were estimated to explore the buffering effect of social support on the association between family history and AUDsx.

Results

Family history was positively associated with AUDsx (incidence rate ratio (IRR) = 1.46, 95% CI = 1.39–1.54) and social support was negatively associated with AUDsx (IRR = 0.80, 95% CI = 0.74–0.86). The marginal effects of family history decreased at higher levels of social support, indicating a buffering influence of social support on the association between family history and AUDsx.

Conclusions

Results reveal a buffering effect of social support, where greater levels of social support reduce the association between family history and AUDsx. These results indicate that the social context, and social support specifically, may be important for diminishing the risk of AUDsx.
Reproductive characteristics, use of exogenous hormones and Parkinson disease in women from the E3N study
Authors: Pesce Giancarlo , Artaud Fanny , Roze Emmanuel , Degaey Isabelle , Portugal Berta , Nguyen Thi Thu Ha , Fournier Agnès , Boutron-Ruault Marie-Christine , Severi Gianluca , Elbaz Alexis , Canonico Marianne
Published: November 2022

Despite experimental studies suggesting a disease-modifying role of oestrogens, results from epidemiological studies on the relation of reproductive characteristics and hormonal exposures with Parkinson disease in women are conflicting.

We used the data from the E3N cohort study including 98 068 women aged 40–65 years in 1990 followed until 2018. Parkinson disease was ascertained using a validation process based on drug claim databases and medical records. Reproductive characteristics and hormonal exposures were self-reported (11 questionnaires). Associations of exposures with Parkinson disease incidence were investigated using time-varying Cox proportional hazards regression with a 5-year exposure lag and age as the timescale adjusted for confounders. We identified 1165 incident Parkinson disease cases during a mean follow-up of 22.0 years (incidence rate = 54.7 per 100 000 person-years). Parkinson disease incidence was higher in women with early (<12 years, HR = 1.21, 95% CI = 1.04–1.40) or late age at menarche (≥14 years, HR = 1.18, 95% CI = 1.03–1.35) than in women with menarche at 12–13 years. Nulliparity was not associated with Parkinson disease, but Parkinson disease incidence increased with the number of children in parous women (P-trend = 0.009). Women with artificial (surgical, iatrogenic) menopause were at greater risk than women with natural menopause (HR = 1.28, 95% CI = 1.09–1.47), especially when artificial menopause occurred at an early age (≤45.0 years). Postmenopausal hormone therapy tended to mitigate greater risk associated with artificial or early menopause (≤45.0 years). While fertility treatments were not associated with Parkinson disease overall, ever users of clomiphene were at greater Parkinson disease risk than never users (HR = 1.81, 95% CI = 1.14–2.88). Other exposures (breastfeeding, oral contraceptives) were not associated with Parkinson disease. Our findings suggest that early and late age at menarche, higher parity, and artificial menopause, in particular at an early age, are associated with increased Parkinson disease incidence in women. In addition, there was some evidence that use of exogenous hormones may increase (fertility treatments) or decrease (postmenopausal hormone therapy) Parkinson disease incidence. These findings support the hypothesis that hormonal exposures play a role in the susceptibility to neurodegenerative diseases. If confirmed, they could help to identify subgroups at high risk for Parkinson disease.
COVID-19 vaccines: a geographic, social and policy view of vaccination efforts in Ontario, Canada
Authors: Bogoch Isaac I , Halani Sheliza
Published: November 2022

In recent months, more studies are emerging regarding how various nations and regions fared during the initial two years of the COVID-19 pandemic. Canada is cited as an example of a country that had performed reasonably well versus other countries with comparable infrastructures and health care systems (Razek et al., 2022). The reason is largely attributed to a combination of several public health measures coupled with widespread vaccination uptake, as a result of a country-wide vaccination campaign. This paper is based on a keynote talk given at the Autumn 2021 CJRES Annual Conference, by Dr. Isaac I. Bogoch. Dr Bogoch is an Associate Professor in the Department of Medicine at the University of Toronto, and an Infectious Diseases Consultant in the Division of Infectious Diseases at the Toronto General Hospital. Dr. Bogoch was a member of Ontario’s Vaccine Distribution Taskforce, which helped guide vaccine policy during the initial rollout of COVID-19 vaccines between December 2020 through August 2021. Dr. Bogoch explains the unique vaccine policy in the Province of Ontario and in particular the social innovation around prioritising the most vulnerable and disadvantaged neighbourhoods first, thus leading to an important intra-regional social policy view of vaccine efforts on the path beyond the ‘emergency phase’ of the COVID-19 pandemic. What is clearly obvious from his presentation is the heightened role of urban geography tools and techniques and intra-regional policy in vaccine equity efforts. Policy lessons learned in Ontario may help us sort out future urban, social, economic, epidemiologic and public health challenges and their sometimes-complex intersections in regions, economy and society. The following is an edited transcript from Dr. Bogoch’s talk.
Applying an Ecological Systems Framework: How a Historically Black University, a Predominately White Institution, and a Public School System Created a Collaborative Undergraduate Research Experience
Authors: Watkins Charity S , Cason Xavier , Greenwald Alec David , Dunston Yolanda L , Vo Quynh-Chi
Published: November 2022

Guided by the National Association of Social Workers’ Code of Ethics and measures of competence provided by the Council on Social Work Education, the social work field serves as a model for strategies that promote collaboration across difference, strengths-based advocacy with communities, and education through engagement. These values and perspectives are relevant beyond social work, as they are applied in various disciplines and settings including educational systems. In academic environments, social workers and educators work together to facilitate the development of knowledge, attitudes, skills, and interactions that are individualized, empowering, equitable, strengths-focused, and culturally responsive among all individuals serving children in the school setting, including volunteers from the surrounding community. Using an ecological systems framework to explore the bidirectional relationships between individual student experiences, peer interactions, university–community connections, and collaboration with a local public school district, this article identifies how an interinstitutional student-engaged research partnership between a historically Black university, a predominately White institution, and a local school district models the power of a diverse and equitable collaboration with each subsystem positively contributing to the realization of social work values and ethics. Implications for public school students, staff, and surrounding communities are discussed.
Promoting Deaf-Adults’ Participation in Early Care and Education of Deaf Children
Authors: Fobi Daniel , Swanwick Ruth , Asomaning Derrick , Doku Richard
Published: November 2022

Few studies exist on the early care and education (ECE) of children who are deaf in low-to-middle-income countries, and none examine the roles of deaf adults in such provision. A research base is needed to inform contextually sensitive “deaf-infused” models of ECE in such contexts that build on indigenous deaf community experience, knowledge, and local expertise. This paper discusses the development of ECE in Ghana in sub-Saharan Africa focusing specifically on the perspectives of deaf adults on their roles in ECE support and leadership. Seventeen deaf adults with different leadership and advocacy roles in Ghana were interviewed about their perceptions of ECE priorities in this context, and the role of deaf adults in the development and delivery of early support. The participants expressed diverse views on ECE for the children and their families and suggested ways of building capacity and leadership among deaf adults to support ECE for the children and their families.
Reservations to the Istanbul Convention and the Role of GREVIO: A Call for New Approach
Authors: Burek Wojciech
Published: November 2022

The question of whether the monitoring bodies have competence concerning reservations is at the centre of the discussion of reservations to human rights treaties that has occupied many international legal scholars over the last few decades. The Istanbul Convention’s treaty monitoring body, GREVIO, is the only human rights treaty monitoring body with a direct competence concerning reservations. However, as practice to date shows, it does not make much use of this power. This is a big disappointment considering all the efforts of other bodies in the past and the doctrinal positions of various scholars. The main aims of this article are threefold to: present GREVIO’s practice to date concerning reservations, provide a brief historical overview of how other human rights treaty bodies have approached their role concerning reservations, and finally, attempt to explain why GREVIO has abandoned a more proactive position on reservations.
Analysis of pollutant emission reduction in a coal power plant using renewable energy
Authors: Smaisim Ghassan Fadhil , Abed Azher M , Alavi Hosein
Published: November 2022

The major and challengeable restriction facing coal power plants (CPPs) is the emission of polluting gases caused by burning coal. Therefore, adopting the reasonable and practical solutions toward mitigate the emission of pollutants is needful. The integration of renewable technologies and energies with such plants can be possible in achieving higher efficiency and mitigating emissions. In the current research, the thermodynamic assessment and analysis of pollutant emission reduction in a CPP using renewables is developed. In this regard, a molten carbonate fuel cell (MCFC) and a solar farm (based on parabolic dish collectors, PDCs) are integrated with CPP. Developed CPP can generate electric power and domestic hot water (DHW). In addition to MCFC, two gas and steam turbines have been installed in CPP to generate electricity. The planned CPP is primarily coal-driven; however, it has been integrated with renewables units to reduce the environmental hazards caused by burning coal. According to the findings yielded from the simulation, the planned CPP has energy and exergy efficiencies equal to 72.5% and 43.85%, respectively. It was also estimated that CPP could generate around 205.5 MW of electricity and 1027.5 kg of DHW per second. Additionally, the amount of gases released from CPP was estimated approximately equal to 0.116 t/s. On average, the required number of collectors in solar units A and B should be almost 89.9 and 25.4, respectively. The performance of CPP when using Powder River Basin coal (PRBC) has been also compared with the performance of the plant when using petcoke.
Protection of Two and Three mRNA Vaccine Doses Against Severe Outcomes Among Adults Hospitalized With COVID-19—VISION Network, August 2021 to March 2022
Authors: DeSilva Malini B , Mitchell Patrick K , Klein Nicola P , Dixon Brian E , Tenforde Mark W , Thompson Mark G , Naleway Allison L , Grannis Shaun J , Ong Toan C , Natarajan Karthik , Reese Sarah E , Zerbo Ousseny , Kharbanda Anupam B , Patel Palak , Stenehjem Edward , Raiyani Chandni , Irving Stephanie A , Fadel William F , Rao Suchitra , Han Jungmi , Reynolds Sue , Davis Jonathan M , Lewis Ned , McEvoy Charlene , Dickerson Monica , Dascomb Kristin , Valvi Nimish R , Barron Michelle A , Goddard Kristin , Vazquez-Benitez Gabriela , Grisel Nancy , Mamawala Mufaddal , Embi Peter J , Fireman Bruce , Essien Inih J , Griggs Eric P , Arndorfer Julie , Gaglani Manjusha
Published: November 2022

Background

We assessed coronavirus disease 2019 (COVID-19) vaccination impact on illness severity among adults hospitalized with COVID-19, August 2021–March 2022.

Methods

We evaluated differences in intensive care unit (ICU) admission, in-hospital death, and length of stay among vaccinated (2 or 3 mRNA vaccine doses) versus unvaccinated patients aged ≥18 years hospitalized for ≥24 hours with COVID-19–like illness and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) molecular testing. We calculated odds ratios (ORs) for ICU admission and death and subdistribution hazard ratios (SHR) for time to hospital discharge adjusted for age, geographic region, calendar time, and local virus circulation.

Results

We included 27 149 SARS-CoV-2–positive hospitalizations. During both Delta- and Omicron-predominant periods, protection against ICU admission was strongest among 3-dose vaccinees compared with unvaccinated patients (Delta OR, 0.52 [95% CI, .28–.96]; Omicron OR, 0.69 [95% CI, .54–.87]). During both periods, risk of in-hospital death was lower among vaccinated compared with unvaccinated patients but ORs overlapped across vaccination strata. We observed SHR >1 across all vaccination strata in both periods indicating faster discharge for vaccinated patients.

Conclusions

COVID-19 vaccination was associated with lower rates of ICU admission and in-hospital death in both Delta and Omicron periods compared with being unvaccinated.
Deployment of a Reservoir-Targeted Vaccine Against Borrelia burgdorferi Reduces the Prevalence of Babesia microti Coinfection in Ixodes scapularis Ticks
Authors: Vannier Edouard , Richer Luciana M , Dinh Duy M , Brisson Dustin , Ostfeld Richard S , Gomes-Solecki Maria
Published: November 2022

In the Northeast and upper Midwest of the United States, Babesia microti and Borrelia burgdorferi use Ixodes scapularis ticks as vector and Peromyscus leucopus mice as major reservoir host. We previously established, in a 5-year field trial, that a reservoir-targeted outer surface protein A vaccine reduces the prevalence of B. burgdorferi-infected ticks. We accessed ticks and mouse blood samples collected during the trial, extracted total DNA, and amplified the B. microti 18S rRNA gene. Vaccine deployment reduced the prevalence of ticks coinfected with B. microti and that of mice infected with B. microti. Breaking the enzootic cycle of B. burgdorferi may reduce the incidence of babesiosis.
Simultaneous screening of zebrafish larvae cardiac and respiratory functions: a microfluidic multi-phenotypic approach
Authors: Khalili Arezoo , van Wijngaarden Ellen , Zoidl Georg R , Rezai Pouya
Published: November 2022

Multi-phenotypic screening of multiple zebrafish larvae plays an important role in enhancing the quality and speed of biological assays. Many microfluidic platforms have been presented for zebrafish phenotypic assays, but multi-organ screening of multiple larvae, from different needed orientations, in a single device that can enable rapid and large-sample testing is yet to be achieved. Here, we propose a multi-phenotypic quadruple-fish microfluidic chip for simultaneous monitoring of heart activity and fin movement of 5–7-day postfertilization zebrafish larvae trapped in the chip. In each experiment, fin movements of four larvae were quantified in the dorsal view in terms of fin beat frequency (FBF). Positioning of four optical prisms next to the traps provided the lateral views of the four larvae and enabled heart rate (HR) monitoring. The device’s functionality in chemical testing was validated by assessing the impacts of ethanol on heart and fin activities. Larvae treated with 3% ethanol displayed a significant drop of 13.2 and 35.8% in HR and FBF, respectively. Subsequent tests with cadmium chloride highlighted the novel application of our device for screening the effect of heavy metals on cardiac and respiratory function at the same time. Exposure to 5 $\mu$g/l cadmium chloride revealed a significant increase of 8.2% and 39.2% in HR and FBF, respectively. The device can be employed to monitor multi-phenotypic behavioral responses of zebrafish larvae induced by chemical stimuli in various chemical screening assays, in applications such as ecotoxicology and drug discovery.
Implementation of antibiotic stewardship programmes in paediatric patients in regional referral hospitals in Tanzania: experience from prescribers and dispensers
Authors: Nkinda Lilian , Mwakawanga Dorkasi L , Kibwana Upendo O , Mikomangwa Wigilya P , Myemba David T , Sirili Nathanael , Mwakalukwa Rodgers , Kilonzi Manase , Sambayi Godfrey , Maganda Betty A , Njiro Belinda J , Ndumwa Harrieth P , Mutagonda Ritah , Marealle Alphonce I , Felix Fatuma F , Mlyuka Hamu J , Makuka Gerald , Kubigwa Samson W , Kunambi Peter P , Mfaume Rashid , Nshau Arapha Bashir , Bwire George M , Scherpbier Robert , Nyankesha Elevanie
Published: November 2022

Background

In 2017, Tanzania launched the National Action Plan for Antimicrobial Resistance (NAPAR), 2017–2022 and implementation of antibiotic stewardship programmes (ASPs) was one of the agendas. Since the launch of the National Action Plan, no study has been done to assess its implementation.

Objectives

To explore the experiences of prescribers and dispensers on implementing ASPs among paediatric patients attending Regional Referral Hospitals (RRHs) in Tanzania.

Methods

An exploratory qualitative study was conducted among key informants, in 14 RRHs in Tanzania between July and August 2020. A total of 28 key informants, 14 dispensers in charge of pharmacies and 14 medical doctors in charge of paediatric departments (prescribers), were interviewed. A hybrid thematic analysis was conducted on the gathered information.

Results

Most of the study participants were not conversant with the term ‘antibiotic stewardship’. Some had heard about the programmes but were not aware of the activities involved in the programme. Those who were knowledgeable on ASPs mentioned the lack of existence of such programmes in their settings. They further added that absence or limited knowledge of the stewardship concepts may have influenced the current poor practices. Barriers to the implementation of ASPs mentioned were lack of laboratory facilities to support culture and susceptibility tests, lack of materials and reagents, management pressure to prevent loss or to generate income, patients’ influence and limited training opportunities.

Conclusions

Despite launching the NAPAR in 2017, we found limited implementation of ASPs in the management of paediatric patients. This study highlighted some barriers and identified possible intervention points.
Corporatization, Administrative Intensity, and the Performance of Public Sector Organizations
Authors: Veronesi Gianluca , Kirkpatrick Ian , Altanlar Ali , Sarto Fabrizia
Published: November 2022

The process of corporatization in public services has led to the emergence of new, more autonomous organizational forms. However, while these reforms have been centrally about the development of management capabilities in public sector organizations, we know surprisingly little about what this process involves. To address this concern, we draw on the literature on administrative intensity (AI) to frame hypotheses about the likely relationship between corporatization and investments in management and administration, and the consequences of these investments for performance. As an empirical case, we then focus on the effects of Foundation Trust status on AI and efficiency, effectiveness, and responsiveness in the acute care hospital sector in the English NHS. Based on a database of nine years (2008/09–2016/17) and dynamic panel data regressions, the results show that corporatization leads to a leaner administration and improved organizational efficiency, effectiveness, and responsiveness. In addition, the analysis reveals that lower levels of AI positively mediate the relationship between corporatization and performance, although only in relation to the efficiency dimension. These findings highlight the crucial, but previously misunderstood, importance of lean administration as part of the corporatization reform package, with implications for theory, research, and policy.
External exposure assessment in the Fukushima accident area for governmental policy planning in Japan: part 1. Methodologies for personal dosimetry applied after the accident
Authors: Sanada Yukihisa , Yoshimura Kazuya , Sato Rina , Nakayama Mariko , Tsubokura Masaharu
Published: November 2022

The evacuation order areas established due to the accident at the Tokyo Electric Power Company Holdings’ (TEPCO) Fukushima Daiichi Nuclear Power Plant (FDNPP) have been reorganized according to the decrease in ambient dose rates and the decontamination progress. The Japanese government decided to decontaminate the difficult-to-return areas and lift the evacuation order by 2030. This radiation protection strategy can be optimized by examining emergency exposure situations to date and the existing exposure after the accident. This article reviews the methods that can determine the individual radiation doses of residents who should return to their homes when the evacuation order is lifted in the specific reconstruction reproduction base area and the difficult-to-return areas outside this base area and summarizes the points to be considered when implementing these methods. In Part 1 of this article, we review the efforts made by the Japanese government and research institutes to assess radiation doses to residents after the FDNPP accident.
Presumptive treatment or serological screening for schistosomiasis in migrants from Sub-Saharan Africa could save both lives and money for the Italian National Health System: results of an economic evaluation
Authors: Zammarchi Lorenzo , Botta Annarita , Tilli Marta , Gobbi Federico , Bartoloni Alessandro , Boccalini Sara
Published: November 2022

Background

Schistosomiasis can lead to severe irreversible complications and death if left untreated. Italian and European guidelines recommend serological screening for this infection in migrants from Sub-Saharan Africa (SSA). However, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking. This study aims to compare benefits and costs of different strategies to manage schistosomiasis in migrants from SSA to Italy.

Methods

A decision tree and a Markov model were developed to assess the health and economic impacts of three interventions: (i) passive diagnosis for symptomatic patients (current practice in Italy); (ii) serological screening of all migrants and treating those found positive and (iii) presumptive treatment for all migrants with praziquantel in a single dose. The time horizon of analysis was one year to determine the exact expenses, and 28 years to consider possible sequelae, in the Italian health-care perspective. Data input was derived from available literature; costs were taken from the price list of Careggi University Hospital, Florence, and from National Hospitals Records.

Results

Assuming a population of 100 000 migrants with schistosomiasis prevalence of 21·2%, the presumptive treatment has a greater clinical impact with 86.3% of the affected being cured (75.2% in screening programme and 44.9% in a passive diagnosis strategy). In the first year, the presumptive treatment and the screening strategy compared with passive diagnosis prove cost-effective (299 and 595 cost/QALY, respectively). In the 28-year horizon, the two strategies (screening and presumptive treatment) compared with passive diagnosis become dominant (less expensive with more QALYs) and cost-saving.

Conclusion

The results of the model suggest that presumptive treatment and screening strategies are more favourable than the current passive diagnosis in the public health management of schistosomiasis in SSA migrants, especially in a longer period analysis.
Mitigating the risk of disputes in the renewable energy sector in North Africa: Lessons learned from solar energy claims brought against European States
Authors: Abdel-Hakam Ahmed
Published: November 2022

Over the past 20 years, in an effort to reduce reliance on fossil fuel generated power, States have been trying to shift to renewable energy by devising attractive and favourable regulations in order to attract foreign investment in a sector that requires significant amounts of capital that usually needs to be frontloaded. This article aims to provide an overview of claims brought against a number of European States who adopted ambitious and investor-friendly legislations, and as a result of a subsequent change to these regulations, were subject to a large number of arbitration claims in relation to the extent of these States’ right to amend (with a retrospective effect) the incentives that they granted to foreign investors in the renewable energy sector.
Impact of maximal extent of resection on postoperative deficits, patient functioning, and survival within clinically important glioblastoma subgroups
Authors: Gerritsen Jasper K W , Zwarthoed Rosa H , Kilgallon John L , Nawabi Noah Lee , Versyck Georges , Jessurun Charissa A C , Pruijn Koen P , Fisher Fleur L , Larivière Emma , Solie Lien , Mekary Rania A , Satoer Djaina D , Schouten Joost W , Bos Eelke M , Kloet Alfred , Tewarie Rishi Nandoe , Smith Timothy R , Dirven Clemens M F , De Vleeschouwer Steven , Vincent Arnaud J P E , Broekman Marike L D
Published: November 2022

Background

The impact of extent of resection (EOR), residual tumor volume (RTV), and gross-total resection (GTR) in glioblastoma subgroups is currently unknown. This study aimed to analyze their impact on patient subgroups in relation to neurological and functional outcomes.

Methods

Patients with tumor resection for eloquent glioblastoma between 2010 and 2020 at 4 tertiary centers were recruited from a cohort of 3919 patients.

Results

One thousand and forty-seven (1047) patients were included. Higher EOR and lower RTV were significantly associated with improved overall survival (OS) and progression-free survival (PFS) across all subgroups, but RTV was a stronger prognostic factor. GTR based on RTV improved median OS in the overall cohort (19.0 months, P < .0001), and in the subgroups with IDH wildtype tumors (18.5 months, P = .00055), MGMT methylated tumors (35.0 months, P < .0001), aged <70 (20.0 months, P < .0001), NIHSS 0–1 (19.0 months, P = .0038), KPS 90–100 (19.5 months, P = .0012), and KPS ≤80 (17.0 months, P = .036). GTR was significantly associated with improved OS in the overall cohort (HR 0.58, P = .0070) and improved PFS in the NIHSS 0–1 subgroup (HR 0.47, P = .012). GTR combined with preservation of neurological function (OFO 1 grade) yielded the longest survival times (median OS 22.0 months, P < .0001), which was significantly more frequently achieved in the awake mapping group (50.0%) than in the asleep group (21.8%) (P < .0001).

Conclusions

Maximum resection was especially beneficial in the subgroups aged <70, NIHSS 0–1, and KPS 90–100 without increasing the risk of postoperative NIHSS or KPS worsening. These findings may assist surgical decision making in individual glioblastoma patients.
Cost-effectiveness analysis of 3 radiation treatment strategies for patients with multiple brain metastases
Authors: Chen Victor Eric , Kim Minchul , Nelson Nicolas , Kim Inkyu Kevin , Shi Wenyin
Published: November 2022

Background

Patients diagnosed with multiple brain metastases often survive for less than 2 years, and clinicians must carefully evaluate the impact of interventions on quality of life. Three types of radiation treatment are widely accepted for patients with multiple brain metastases: Whole brain radiation therapy (WBRT), hippocampal avoidance whole-brain radiation therapy (HA-WBRT), and stereotactic radiosurgery (SRS). WBRT, the standard option, is less costly than its newer alternatives but causes more severe adverse effects such as memory loss. To determine whether the cost-effectiveness ratio of HA-WBRT and SRS are superior to WBRT, we used published data to simulate cases of multiple brain metastases.

Methods

We designed a Markov model using data from previously published studies to simulate the disease course of patients with 5 to 15 brain metastases and determine the cost-effectiveness of HA-WBRT and SRS relative to WBRT. Incremental cost-effectiveness ratios (ICERs) were calculated and compared against a willingness-to-pay threshold of $100 000 per quality-adjusted life year.

Results

SRS met the threshold for cost-effectiveness, with ICERs ranging $41 198–$54 852 for patients with 5 to 15 brain metastases; however, HA-WBRT was not cost-effective, with an ICER of $163 915 for all simulated patients. Model results were robust to sensitivity analyses.

Conclusions

We propose that SRS, but not HA-WBRT, should be offered to patients with multiple brain metastases as a treatment alternative to standard WBRT. Incorporating these findings into clinical practice will help promote patient-centered care and decrease national healthcare expenditures, thereby addressing issues around health equity and access to care.
Isolation of single cells from human uterus in the third trimester of pregnancy: myometrium, decidua, amnion and chorion
Authors: Cocker Alexander T H , Whettlock Emily M , Browne Brendan , Lai Pei F , Li Jonathan K H , Sivarajasingam Sivatharjini P , Imami Nesrina , Johnson Mark R , Male Victoria
Published: November 2022

During pregnancy, interactions between uterine immune cells and cells of the surrounding reproductive tissues are thought to be vital for regulating labour. The mechanism that specifically initiates spontaneous labour has not been determined, but distinct changes in uterine immune cell populations and their activation status have been observed during labour at term gestation. To understand the regulation of human labour by the immune system, the ability to isolate both immune cells and non-immune cells from the uterus is required. Here, we describe protocols developed in our laboratory to isolate single cells from uterine tissues, which preserve both immune and non-immune cell populations for further analysis. We provide detailed methods for isolating immune and non-immune cells from human myometrium, chorion, amnion and decidua, together with representative flow cytometry analysis of isolated cell populations present. The protocols can be completed in tandem and take approximately 4–5 h, resulting in single-cell suspensions that contain viable leucocytes, and non-immune cells in sufficient numbers for single-cell analysis approaches such as flow cytometry and single cell RNA sequencing (scRNAseq).
Multi-omics analysis reveals the mechanism of bHLH130 responding to low-nitrogen stress of apple rootstock
Authors: Wang Xiaona , Chai Xiaofen , Gao Beibei , Deng Cecilia , Günther Catrin S , Wu Ting , Zhang Xinzhong , Xu Xuefeng , Han Zhenhai , Wang Yi
Published: November 2022

Nitrogen is critical for plant growth and development. With the increase of nitrogen fertilizer application, nitrogen use efficiency decreases, resulting in wasted resources. In apple (Malus domestica) rootstocks, the potential molecular mechanism for improving nitrogen uptake efficiency to alleviate low-nitrogen stress remains unclear. We utilized multi-omics approaches to investigate the mechanism of nitrogen uptake in two apple rootstocks with different responses to nitrogen stress, Malus hupehensis and Malus sieversii. Under low-nitrogen stress, Malus sieversii showed higher efficiency in nitrogen uptake. Multi-omics analysis revealed substantial differences in the expression of genes involved in flavonoid and lignin synthesis pathways between the two materials, which were related to the corresponding metabolites. We discovered that basic helix–loop–helix 130 (bHLH130) transcription factor was highly negatively associated with the flavonoid biosynthetic pathway. bHLH130 may directly bind to the chalcone synthase gene (CHS) promoter and inhibit its expression. Overexpressing CHS increased flavonoid accumulation and nitrogen uptake. Inhibiting bHLH130 increased flavonoid biosynthesis while decreasing lignin accumulation, thus improving nitrogen uptake efficiency. These findings revealed the molecular mechanism by which bHLH130 regulates flavonoid and lignin biosyntheses in apple rootstocks under low-nitrogen stress.
Lessons to learn from the analysis of routine health data from Moria Refugee Camp on Lesvos, Greece
Authors: Hart Paul L , Zahos Helen , Salt Nicola , Schofield Roger , Mahroof-Shaffi Siyana , Simonek Tomas , Harkensee Christian
Published: November 2022

Background

Refugees in humanitarian settings commonly experience many health needs and barriers to access healthcare; health data from these settings are infrequently reported, preventing effective healthcare provision. This report describes health needs of refugees in Moria Camp on Lesvos, Greece—Europe’s largest refugee camp.

Methods

A set of routinely collected service data of 18 131 consultations of 11 938 patients, attending a primary care clinic in the camp over 6 months in 2019–20, was analysed retrospectively, focusing on chronic health conditions.

Results

The most frequent chronic conditions were musculoskeletal pain (25.1%), mental health (15.9%), cardiac (12.7%) and endocrine conditions (8.9%). In all, 70.4% of consultations were for acute health problems, with high rates of injuries and wounds (20.8%), respiratory infections (12.5%), gastroenteritis (10.7%) and skin problems (9.7%), particularly scabies.

Conclusions

The prevalence of acute and chronic health problems is high in this setting, with some likely attributable to the deplorable living conditions in the camp. Despite its magnitude, the interpretability of routine health data is limited. A research agenda is identified, and a framework for chronic disease management in refugee camps is proposed.
Controllability of Functional Brain Networks and Its Clinical Significance in First-Episode Schizophrenia
Authors: Li Qian , Yao Li , You Wanfang , Liu Jiang , Deng Shikuang , Li Bin , Luo Lekai , Zhao Youjin , Wang Yuxia , Wang Yaxuan , Zhang Qian , Long Fenghua , Sweeney John A , Gu Shi , Li Fei , Gong Qiyong
Published: November 2022

Background and Hypothesis

Disrupted control of brain state transitions may contribute to the diverse dysfunctions of cognition, emotion, and behavior that are fundamental to schizophrenia. Control theory provides the rationale for evaluating brain state transitions from a controllability perspective, which may help reveal the brain mechanism for clinical features such as cognitive control deficits associated with schizophrenia. We hypothesized that brain controllability would be altered in patients with schizophrenia, and that controllability of brain networks would be related to clinical symptomatology.

Study Design

Controllability measurements of functional brain networks, including average controllability and modal controllability, were calculated and compared between 125 first-episode never-treated patients with schizophrenia and 133 healthy controls (HCs). Associations between controllability metrics and clinical symptoms were evaluated using sparse canonical correlation analysis.

Study Results

Compared to HCs, patients showed significantly increased average controllability (PFDR = .023) and decreased modal controllability (PFDR = .023) in dorsal anterior cingulate cortex (dACC). General psychopathology symptoms and positive symptoms were positively correlated with average controllability in regions of default mode network and negatively associated with average controllability in regions of sensorimotor, dorsal attention, and frontoparietal networks.

Conclusions

Our findings suggest that altered controllability of functional activity in dACC may play a critical role in the pathophysiology of schizophrenia, consistent with the importance of this region in cognitive and brain state control operations. The demonstration of associations of functional controllability with psychosis symptoms suggests that the identified alterations in average controllability of brain function may contribute to the severity of acute psychotic illness in schizophrenia.
Novel Harzia ixtarensis Fungus on Annona cherimola Fruit in Mexico and Its Synergistic Relationship with Colletotrichum fragariae
Authors: Villanueva-Arce Ramón , Yáñez-Morales María de Jesús , Alanís-Martínez Iobana , Silva-Rojas Hilda Victoria , Valdez-Carrasco Jorge M.
Published: November 2022

Since 2005 in Íxtaro, Michoacán, symptoms of Harzia infection have been observed on immature Annona cherimola fruit with Colletotrichum fragariae-induced anthracnose lesions and mummified fruit. This study aimed to identify the Harzia sp. and evaluate its pathogenicity. Four isolates were obtained from fruit exhibiting symptoms, cultured in four types of agar under various conditions, and characterized based on concatenated internal transcribes spacer (ITS) + large subunit and ITS + small subunit sequences. Additionally, the isolates were compared with two CBS species (two-type strains and two isolates) of Harzia patula and H. tenella under the same conditions as the Harzia isolates, and all known Harzia spp. in culture were included in two phylogenetic analyses. H. ixtarensis sp. nov. was proposed. Compared with H. patula CBS isolate 121524 which was the most closely phylogenetically related species, H. ixtarensis was characterized by slower colony growth (white to salmonish-beige), different percentages of two forms of conidia (elongated and globose; unicellular and hyaline to subhyaline), and smaller conidia. The conidia mainly germinated with two hyaline tubes without an appressorium. In situ inoculations (1 × 106 ml−1 conidia suspension) of fruit showed that fruit with wounds developed larger lesions than those without wounds. Harzia inoculation on anthracnose lesions (induced by prior inoculation with C. fragariae) produced larger anthracnose lesions than C. fragariae alone. When C. fragariae or H. ixtarensis was inoculated alone, the lesion size was 51 and 99% smaller, respectively, indicating synergy between C. fragariae and H. ixtarensis. Thus, H. ixtarensis may have a parasitic-synergistic and necrotrophic lifestyle, and exhibited symptoms on anthracnose lesions.
Validation of Standard Area Diagrams to Estimate the Severity of Septoria Leaf Spot on Stevia in Paraguay, Mexico, and the United States
Authors: Sanabria-Velazquez Andres D. , Enciso-Maldonado Guillermo A. , Maidana-Ojeda Marco , Diaz-Najera Jose F. , Thiessen Lindsey D. , Shew H. David
Published: November 2022

Septoria leaf spot (SLS) affects stevia leaves, reducing their quality. Estimates of SLS severity on different genotypes are made to identify resistance and as a basis to compare management approaches. The use of standard area diagrams (SADs) can improve the accuracy and reliability of severity estimates. In this study, we developed new SADs with six illustrations (0.5, 1, 10, 25, 40, and 75% severity). The SADs were validated by raters with and without experience in estimating SLS. Raters evaluated 40 leaf photos with SLS severities ranging from 0 to 100% without and with the SADs. Agreement (ρc), bias (Cb), precision (r), and intracluster correlation (ρ) coefficients were significantly closer to “true” severity values when the SADs was used by inexperienced (ρc = 0.89; Cb = 0.97; r = 0.90, ρ = 0.81) and experienced (ρc = 0.94; Cb = 0.99; r = 0.95, ρ = 0.91) raters. The SADs were tested under field conditions in Paraguay, Mexico, and the United States, with inexperienced raters assigned to two groups, one SADs trained and the other not trained, that estimated SLS severity three times: first, all raters without SADs and no time limit for the estimates; second, only the SADs-trained group used SADs and no time limit; and third, only the SADs-trained group used SADs, with a time limit of 10 s imposed per specimen assessment. Agreement and reliability of SLS severity estimates significantly improved when raters used the SADs without a time limit. The use of the new SADs improved the accuracy, precision, and reliability of SLS severity estimates, enhancing the uniformity in assessment across different stevia programs.
Gastrointestinal Emergencies in the ICU
Authors: Rao Sheldon , Baltaji Stephanie , Crow Kyle , DiSilvio Briana , Cheema Tariq
Published: November 2022

Gastrointestinal (GI) emergencies and disorders are among the most common reasons to be admitted to an intensive care unit (ICU). In addition, critically ill patients admitted to the ICU for non–GI-related diseases are frequently at risk of developing GI complications during their hospitalization. This article details the epidemiology/etiology, clinical presentation, diagnostic assessment, and management of the following GI emergencies: upper and lower GI bleed, acute pancreatitis, and ascending cholangitis.
A Conceptual Model for a Blended Intervention Approach to Support Early Language and Social-Emotional Development in Toddler Classrooms
Authors: Cunningham Jennifer E. , Chow Jason C. , Meeker Kathleen Artman , Taylor Abby , Hemmeter Mary Louise , Kaiser Ann P.
Published: November 2022

The purpose of this article is to present a theory-driven blended intervention model that integrates evidence-based interventions to support language and social development of young children. We (1) provide an overview of practices that are designed to support language and social-emotional development, (2) present a theory of change model that outlines the theoretical basis for our proposed approach, and (3) provide an example of the conceptual model via the blending of Tier 1 interventions that provide class-wide language and behavioral support for young children. We conclude by arguing for the parsimony that a proactive synergy between social and language interventions blended into a single professional development approach will provide.
Recent advances in diagnosis, treatment, and prognosis of IgG4-related autoimmune pancreatitis: a narrative review
Authors: He Xin , Sun Boyuan , Nie Yuxue , Zhang Wen
Published: November 2022

Immunoglobulin G4 (IgG4)-related autoimmune pancreatitis (AIP), also known as “type 1 AIP,” is a rare, chronic, and fibroinflammatory disease manifested as obstructive jaundice and enlargement of the pancreas, usually accompanied by extra-pancreatic organ involvement. The understanding of IgG4-related AIP is gradually deepening. In this review, we summarized the basic concepts, common clinical manifestations, and new progress of the disease including diagnostic, therapeutic strategies, and prognosis mainly based on published case reports, cohort studies, meta-analyses, and guidelines in the past 5 years. Issues such as diagnostic markers, risk factors for relapse, and more effective treatment still need to be further studied.
Sleep Loss Influences the Interconnected Brain-Body Regulation of Cardiovascular Function in Humans
Authors: Krause Adam J. , Vallat Raphael , Ben Simon Eti , Walker Matthew P.
Published: November 2022

Objective

Poor sleep is associated with hypertension, a major risk factor for cardiovascular disease. However, the mechanism(s) through which sleep loss affects cardiovascular health remain largely unknown, including the brain and body systems that regulate vascular function.

Method

Sixty-six healthy adults participated in a repeated-measures, cross-over, experimental study involving assessments of cardiovascular function and brain connectivity following a night of sleep and a night of sleep deprivation.

Results

First, sleep deprivation significantly increased blood pressure—both systolic and diastolic. Interestingly, this change was independent of any increase in heart rate, inferring a vasculature-specific rather than direct cardiac pathway. Second, sleep loss compromised functional brain connectivity within the recognized vascular control network, specifically the insula, anterior cingulate, amygdala, and ventral and medial prefrontal cortices. Third, the sleep-loss related changes in brain connectivity and vascular tone were not independent, but significantly inter-dependent, with changes in brain nodes predicting the sleep-loss shift towards hypertension.

Conclusions

These findings establish a previously unrecognized embodied framework in which sleep loss confers increased risk of cardiovascular disease through an impact upon brain control of vascular tone, rather than a direct impact on accelerated heart rate itself.
Preoperative Imaging of Costal Cartilage to Aid Reconstructive Head and Neck Surgery
Authors: Faderani Ryan , Arumugam Vinodh , Tarassoli Sam , Jovic Thomas H , Whitaker Iain S
Published: November 2022

Objective

Autologous costal cartilage is used extensively in reconstructive surgery because of its stability, durability, and biocompatibility. The current preoperative evaluation of costal cartilage often only consists of a physical examination. Several studies have highlighted the benefits of preoperative imaging as a tool to ensure optimal graft harvest. This systematic review aims to synthesize the current evidence and establish the efficacy of the various imaging modalities for the assessment of costal cartilage.

Review Methods

The data sources were explored using a search strategy based on the terms (“costal cartilage” OR “ribs” AND “imaging*”) combined with Boolean operators. The primary outcome measures were the ability to measure the dimensions of costal cartilages and to detect the presence of calcifications.

Results

A total of 28 publications were included in the final review, with 12 case series, 7 case control studies, and 9 cohort studies. Twenty-two studies used computed tomography (CT); 4 studies used x-ray and 2 studies used ultrasonography, whereas no studies used magnetic resonance imaging. Meta-analysis of the data from these studies was not deemed possible.

Conclusions

Our findings suggest that CT is the modality with the strongest evidence base that provides the greatest degree of information. The major benefits of CT are its ability to provide 3-dimensional image reconstruction for surgical planning, ability to detect synchondroses, and assess cartilage quality. Where radiation exposure is less preferable, x-ray and ultrasound (US) may play an important role. X-ray appears to be particularly useful when the main concern is the presence of calcification. The limited studies available indicate that US can provide useful and accurate information on cartilage quality and morphology. Further studies are warranted in exploring the use of US in preoperative planning, particularly in the pediatric population.