bluuebunny/crossref_metadata_2025 huggingface dataset:
An Improved Reptile Search Algorithm with Ghost Opposition-based Learning for Global Optimization Problems
Authors: Jia Heming , Lu Chenghao , Wu Di , Wen Changsheng , Rao Honghua , Abualigah Laith
Published: June 2023

In 2021, a meta-heuristic algorithm, Reptile Search Algorithm (RSA), was proposed. RSA mainly simulates the cooperative predatory behavior of crocodiles. Although RSA has a fast convergence speed, due to the influence of the crocodile predation mechanism, if the algorithm falls into the local optimum in the early stage, RSA will probably be unable to jump out of the local optimum, resulting in a poor comprehensive performance. Because of the shortcomings of RSA, introducing the local escape operator can effectively improve crocodiles' ability to explore space and generate new crocodiles to replace poor crocodiles. Benefiting from adding a restart strategy, when the optimal solution of RSA is no longer updated, the algorithm’s ability to jump out of the local optimum is effectively improved by randomly initializing the crocodile. Then joining Ghost opposition-based learning to balance the IRSA’s exploitation and exploration, the Improved RSA with Ghost Opposition-based Learning for the Global Optimization Problem (IRSA) is proposed. To verify the performance of IRSA, we used nine famous optimization algorithms to compare with IRSA in 23 standard benchmark functions and CEC2020 test functions. The experiments show that IRSA has good optimization performance and robustness, and can effectively solve six classical engineering problems, thus proving its effectiveness in solving practical problems.
Hyperparameters optimization of convolutional neural network based on local autonomous competition harmony search algorithm
Authors: Liu Dongmei , Ouyang Haibin , Li Steven , Zhang Chunliang , Zhan Zhi-Hui
Published: June 2023

Because of the good performance of convolutional neural network (CNN), it has been extensively used in many fields, such as image, speech, text, etc. However, it is easily affected by hyperparameters. How to effectively configure hyperparameters at a reasonable time to improve the performance of CNNs has always been a complex problem. To solve this problem, this paper proposes a method to automatically optimize CNN hyperparameters based on the local autonomous competitive harmony search (LACHS) algorithm. To avoid the influence of complicated parameter adjustment of LACHS algorithm on its performance, a parameter dynamic adjustment strategy is adopted, which makes the pitch adjustment probability PAR and step factor BW dynamically adjust according to the actual situation. To strengthen the fine search of neighborhood space and reduce the possibility of falling into local optima for a long time, an autonomous decision-making search strategy based on the optimal state is designed. To help the algorithm jump out of the local fitting situation, this paper proposes a local competition mechanism to make the new sound competes with the worst harmonic progression of local selection. In addition, an evaluation function is proposed, which integrates the training times and recognition accuracy. To achieve the purpose of saving the calculation cost without affecting the search result, it makes the training time for each model depending on the learning rate and batch size. In order to prove the feasibility of LACHS algorithm in configuring CNN superparameters, the classification of the Fashion-MNIST dataset and CIFAR10 dataset is tested. The comparison is made between CNN based on empirical configuration and CNN based on classical algorithms to optimize hyperparameters automatically. The results show that the performance of CNN based on the LACHS algorithm has been improved effectively, so this algorithm has certain advantages in hyperparametric optimization. In addition, this paper applies the LACHS algorithm to expression recognition. Experiments show that the performance of CNN optimized based on the LACHS algorithm is better than that of the same type of artificially designed CNN. Therefore, the method proposed in this paper is feasible in practical application.
Three-dimensional P-wave model of the shallow crustal structure, a complementary method for detecting a trapped hydrocarbon: a case study in the DehDasht region, SW Iran
Authors: Shirzad Taghi , Shakeri Nastaran , Kakhki Mohsen Kazemnia , Norouzi Siavash , AbdollahieFard Iraj
Published: June 2023

Local P-wave tomography is an efficient method to study geologically complex areas where the seismic exploration methods are not ideal for unraveling the shallow crustal heterogeneity due to the great thickness of evaporitic deposits. Despite the complex geological features in the salt-rich DehDasht region, SW Iran, we used >11 000 micro-earthquake events, which have been recorded by a temporary seismic network (deployed between 18 October 2016 and 1 July 2017), to derive the three-dimensional velocity structure based on the first arrival time. We selected a subset of events (1571 micro-earthquakes) by various strict criteria for our processing, and then the 1D velocity model was calculated by the computer program VELEST. Afterward, the 3D initial model of the inversion procedure with 1.5-km horizontal and 1-km deep intervals was parametrized using the calculated 1D model. Finally, the observed data (first arrival P-wave traveltimes and events locations) was inverted with an optimum regularization parameter and iteration using the computer program SIMULPS14. Our tomographic results indicate the DehDasht Basin as a relatively low-velocity zone filled out dominantly by the Gachsaran Formation and surrounded by the high-velocity Asmari-Pabdeh-Sarvak Formations. The basin has a bowl shape that is elongated in the NW–SE direction or an oval on a horizontal view. The depth of the basin varies between 3 and 5 km and contains many folding-faulting systems, which lead to locally low-velocity patches. Moreover, some evaporate deposits, which are overlying the Gachsaran Formation, emerge as a thin low-velocity layer (e.g. Aghajari, etc.).
Comprehensive review of undifferentiated carcinoma of the pancreas: from epidemiology to treatment
Authors: Imaoka Hiroshi , Ikeda Masafumi , Umemoto Kumiko , Sunakawa Yu , Ueno Makoto , Ueno Hideki , Ozaka Masato , Kuwahara Takamichi , Okano Naohiro , Kanai Masashi , Hisano Terumasa , Suzuki Yuko , Asagi Akinori , Shioji Kazuhiko , Todaka Akiko , Tsuji Kunihiro , Ikezawa Kenji , Miki Ikuya , Komatsu Yoshito , Akutsu Noriyuki , Yamashita Tatsuya , Okuyama Hiroyuki , Furuse Junji , Nagano Hiroaki
Published: June 2023

Undifferentiated carcinoma (UC) of the pancreas is a rare subtype of pancreatic cancer displaying no definitive direction of differentiation. UC has been reported as a highly aggressive malignant neoplasm, with a median overall survival of <1 year, except for several surgical series. On the other hand, UC tissue sometimes contains non-neoplastic osteoclast-like giant cells (OGCs), and such cases have been reported to have relatively longer survival. Thus, the World Health Organization (WHO) classification histologically distinguishes UC with OGCs (UCOGCs) from UC, and UCs were subclassified into three subtypes: anaplastic UC, sarcomatoid UC and carcinosarcoma. However, still less is known about UC due to its rarity, and such situations lead to further difficulties in treatment for UC. To date, only surgical resection can offer curative treatment for patients with UC, and no clear evidence for chemotherapy exists for them. However, a retrospective cohort study and case reports showed that relatively promising results paclitaxel-containing regimens for treatment of patients with unresectable UC. Furthermore, high programmed cell death protein 1 expression has been reported in sarcomatoid UCs and UCOGCs, and promising responses to anti-programmed death-ligand 1 therapy have been described in case reports of UCOGCs. Recent advances in chemotherapeutic agents and molecular technologies are opening up the possibilities for expanded treatments.
Targeted gene panel provides advantages over whole-exome sequencing for diagnosing obesity and diabetes mellitus
Authors: Yu Hairong , Yu Haoyong , Zhang Rong , Peng Danfeng , Yan Dandan , Gu Yunjuan , Bao Yuqian , Jia Weiping , Zhang Hong , Hu Cheng
Published: June 2023

A small fraction of patients diagnosed with obesity or diabetes mellitus has an underlying monogenic cause. Here, we constructed a targeted gene panel consisting of 83 genes reported to be causative for monogenic obesity or diabetes. We performed this panel in 481 patients to detect causative variants and compared these results with whole-exome sequencing (WES) data available for 146 of these patients. The coverage of targeted gene panel sequencing was significantly higher than that of WES. The diagnostic yield in patients sequenced by the panel was 32.9% with subsequent WES leading to three additional diagnoses with two novel genes. In total, 178 variants in 83 genes were detected in 146 patients by targeted sequencing. Three of the 178 variants were missed by WES, although the WES-only approach had a similar diagnostic yield. For the 335 samples only receiving targeted sequencing, the diagnostic yield was 32.2%. In conclusion, taking into account the lower costs, shorter turnaround time, and higher quality of data, targeted sequencing is a more effective screening method for monogenic obesity and diabetes compared to WES. Therefore, this approach could be routinely established and used as a first-tier test in clinical practice for specific patients.
Career disruption and limitation of financial earnings due to cancer
Authors: Mudaranthakam Dinesh Pal , Hughes Dorothy , Johnson Peggy , Mason Tracy , Nollen Nicole , Wick Jo , Welch Danny R , Calhoun Elizabeth
Published: June 2023

Purpose

This study investigated how cancer diagnosis and treatment lead to career disruption and, consequently, loss of income and depletion of savings.

Design

This study followed a qualitative descriptive design that allowed us to understand the characteristics and trends of the participants.

Method

Patients recruited (n = 20) for this study were part of the University of Kansas Cancer Center patient advocacy research group (Patient and Investigator Voices Organizing Together). The inclusion criteria were that participants must be cancer survivors or co-survivors, be aged 18 years or older, be either employed or a student at the time of cancer diagnosis, have completed their cancer treatment, and be in remission. The responses were transcribed and coded inductively to identify themes. A thematic network was constructed based on those themes, allowing us to explore and describe the intricacies of the various themes and their impacts.

Results

Most patients had to quit their jobs or take extended absences from work to handle treatment challenges. Patients employed by the same employer for longer durations had the most flexibility to balance their time between cancer treatment and work. Essential, actionable items suggested by the cancer survivors included disseminating information about coping with financial burdens and ensuring that a nurse and financial navigator were assigned to every cancer patient.

Conclusions

Career disruption is common among cancer patients, and the financial burden due to their career trajectory is irreparable. The financial burden is more prominent in younger cancer patients and creates a cascading effect that financially affects close family members.
Intensity-modulated radiation therapy with the central shielding technique for patients with uterine cervical cancer
Authors: Torii Akira , Tomita Natsuo , Kuno Mayu , Nishio Masahiro , Yamada Yuki , Takaoka Taiki , Okazaki Dai , Niwa Masanari , Kita Nozomi , Takano Seiya , Murao Takayuki , Ogawa Yasutaka , Hiwatashi Akio
Published: June 2023

We aimed to examine outcomes and toxicities of intensity-modulated radiation therapy (IMRT) with the central shielding (CS) technique for patients with uterine cervical cancer. This retrospective study included 54 patients with International Federation of Gynecology and Obstetrics IB-IVA cancer. Whole pelvic radiotherapy or extended-field radiotherapy were performed at the dose of 50.4 Gy in 28 fractions with helical tomotherapy (HT). Six patients had para-aortic lymph node metastases. The CS technique with HT was utilized after a total dose of 28.8–41.4 Gy to reduce doses to the rectum and bladder. The prescribed dose of intracavitary brachytherapy was mainly 18–24 Gy in three or four fractions at point A. Concurrent chemotherapy was used for 47 patients (87%). Median follow-up time was 56 months. Seventeen patients (31%) developed recurrence. The recurrence of the cervix was observed in two patients (4%). The 5-year rates of the locoregional control, progression-free survival (PFS) and overall survival were 79, 66 and 82%, respectively. Among several factors evaluated, histological type of adenocarcinoma was only a significantly worse prognostic factor for PFS by multivariate analysis (hazard ratio, 4.9 [95% confidence interval, 1.3–18], P = 0.018). Grade 2 or higher late toxicities were observed in nine patients (17%). Two patients (4%) each had grade 3 proctitis and grade 3 ileus, respectively. No grade 4 toxicity or treatment-related death was observed. The results suggest that IMRT with the CS technique allows a high local control without increasing the risk of complications for cervical cancer patients.
‘On the Border, I Learned How to Advocate’: Borderlands as Political Spaces for Burmese Women’s Activism
Authors: Olivius Elisabeth , Hedström Jenny
Published: June 2023

This article explores the political space of the border through the experiences of women activists from Myanmar, for whom the borderlands in Thailand have provided refuge as well as a conducive environment for political mobilization. At the same time, the border renders refugee activists insecure and precarious. Drawing on life history interviews, our analysis expands conceptualizations of the border as a dynamic political space by illustrating its dual capacity to both facilitate and constrain the political agency of refugee women from Myanmar. In particular, the spatial and temporal fluidity and in-betweenness of the border is shown to foster both repression and resistance. Exploring the character and salience of the border as a space for activism over time, we demonstrate how the political space of the border is relational, constituted in interaction with other political spaces, such as politics and governance in Myanmar, transnational activist networks, and the politics of international aid.
Creating Educational Borderlands: Civic Learning in a Syrian School in Lebanon
Authors: Chopra Vidur , Talhouk Joumana , Dryden-Peterson Sarah , Geha Carmen
Published: June 2023

Limitations on membership and participation in host societies sharply constrain refugee young people’s civic development. Especially when refugees attend national schools, they find themselves submerged in civic learning that does not include them or represent their experiences and realities. To explore possibilities for civic learning among refugees, we examine the education created by a Syrian community inside the structures of a Lebanese private school in Beirut. We conceive of this school as a ‘borderlands’ and find that it supports civic membership and participation in three ways: through adaptations to the Lebanese structures, curricula, and languages of schooling; through pedagogies focused on pragmatism; and through opening limited spaces for students to practice civic skills. We argue that the borderlands space created by this school holds lessons for both refugee and national teachers and school systems seeking to foster civic learning among refugees.
Rectal prolapse associated with intussusception and malignancy
Authors: Sseruwagi Timon Mac , Lewis Catherine R
Published: June 2023

Rectal prolapse associated with intussusception is when the intestine slides into the adjacent part causing a protrusion through the anus. It is also referred to as recto-anal intussusception or trans-anal protrusion of intussusception. Pre-operative diagnosis of the associated intussusception is usually hard to make. We present a case of a patient who presented with a rectal prolapse. Surgical exploration also noted an intussusception and rectal malignancy. We demonstrate the importance of surgical management in patients with rectal prolapse to avoid progression of a malignancy or intussusception.
The role of catalytic and regulatory domains of human PrimPol in DNA binding and synthesis
Authors: Boldinova Elizaveta O , Baranovskiy Andrey G , Gagarinskaya Diana I , Manukyan Anna A , Makarova Alena V , Tahirov Tahir H
Published: June 2023

Human PrimPol possesses DNA primase and DNA polymerase activities and restarts stalled replication forks protecting cells against DNA damage in nuclei and mitochondria. The zinc-binding motif (ZnFn) of the C-terminal domain (CTD) of PrimPol is required for DNA primase activity but the mechanism is not clear. In this work, we biochemically demonstrate that PrimPol initiates de novo DNA synthesis in cis-orientation, when the N-terminal catalytic domain (NTD) and the CTD of the same molecule cooperate for substrates binding and catalysis. The modeling studies revealed that PrimPol uses a similar mode of initiating NTP coordination as the human primase. The ZnFn motif residue Arg417 is required for binding the 5′-triphosphate group that stabilizes the PrimPol complex with a DNA template-primer. We found that the NTD alone is able to initiate DNA synthesis, and the CTD stimulates the primase activity of NTD. The regulatory role of the RPA-binding motif in the modulation of PrimPol binding to DNA is also demonstrated.
Prediction-oriented prognostic biomarker discovery with survival machine learning methods
Authors: Yao Sijie , Cao Biwei , Li Tingyi , Kalos Denise , Yuan Yading , Wang Xuefeng
Published: June 2023

Identifying novel and reliable prognostic biomarkers for predicting patient survival outcomes is essential for deciding personalized treatment strategies for diseases such as cancer. Numerous feature selection techniques have been proposed to address the high-dimensional problem in constructing prediction models. Not only does feature selection lower the data dimension, but it also improves the prediction accuracy of the resulted models by mitigating overfitting. The performances of these feature selection methods when applied to survival models, on the other hand, deserve further investigation. In this paper, we construct and compare a series of prediction-oriented biomarker selection frameworks by leveraging recent machine learning algorithms, including random survival forests, extreme gradient boosting, light gradient boosting and deep learning-based survival models. Additionally, we adapt the recently proposed prediction-oriented marker selection (PROMISE) to a survival model (PROMISE-Cox) as a benchmark approach. Our simulation studies indicate that boosting-based approaches tend to provide superior accuracy with better true positive rate and false positive rate in more complicated scenarios. For demonstration purpose, we applied the proposed biomarker selection strategies to identify prognostic biomarkers in different modalities of head and neck cancer data.
The Damages and Distortions from Discrimination in the Rental Housing Market
Authors: Christensen Peter , Timmins Christopher
Published: June 2023

By constraining an individual’s choice during a search, housing discrimination distorts sorting decisions away from true preferences and results in a ceteris paribus reduction in welfare. This study combines a large-scale field experiment with a residential sorting model to derive utility-theoretic measures of renter welfare loss associated with the constraints imposed by discrimination in the rental housing market. Results from experiments conducted in five cities show that key neighborhood amenities are associated with higher levels of discrimination. Counterfactual simulations based on the sorting model suggest that discrimination imposes damages equivalent to 4.4% and 3.5% of the annual incomes for African American and Hispanic/Latinx renters, respectively. Damages are increasing in income for African American renters, such that effects become stronger for economically mobile households. Renters of color must make substantial investments in additional search to mitigate the costs of these constraints. We find that a naive model ignoring discrimination constraints yields biased estimates of willingness to pay for key neighborhood amenities.
Committee-Based Blockchains as Games between Opportunistic Players and Adversaries
Authors: Amoussou-Guenou Yackolley , Biais Bruno , Potop-Butucaru Maria , Tucci-Piergiovanni Sara
Published: June 2023

We study consensus in a protocol capturing in a simplified manner the major features of the majority of Proof of Stake blockchains. A committee is formed; one member proposes a block; and the others can check its validity and vote for it. Blocks with a majority of votes are produced. When an invalid block is produced, the stakes of the members who voted for it are “slashed.” Profit-maximizing members interact with adversaries seeking to disrupt consensus. When slashing is limited, free-riding and moral-hazard lead to invalid blocks in equilibrium. We propose a protocol modification producing only valid blocks in equilibrium.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Belimumab treatment of adult idiopathic inflammatory myopathy
Authors: Marder Galina , Quach Tam , Chadha Priyal , Nandkumar Preeya , Tsang Jimmy , Levine Todd , Schiopu Elena , Furie Richard , Davidson Anne , Narain Sonali
Published: June 2023

Objective

To evaluate belimumab addition to the standard of care in patents with refractory idiopathic inflammatory myopathy (IIM).

Methods

We conducted a 40-week multicentre, randomized, double-blind, placebo-controlled trial with 1:1 IV belimumab 10 mg/kg or placebo randomization and a 24-week open-label extension. Clinical responses were measured by the definition of improvement (DOI) and total improvement score (TIS). Flow cytometry analyses were performed on available samples before randomization, at 24 and 60–64 weeks. Descriptive statistics, t-test, Fisher’s exact test and analysis of variance tests were used.

Results

A total of 17 patients were randomized, 15 received five or more doses of belimumab or placebo and were included in the intention-to-treat analysis. More belimumab patients vs placebo attained a TIS ≥40 [55.5% vs 33.3%; P = non-significant (NS)] and achieved the DOI (33.3% vs 16.7%; P = NS) at weeks 40 and 64; the mean TIS was similar among groups. Two patients achieved major responses (TIS = 72.5) after week 40 in the belimumab arm and none in the placebo arm. No improvement in the placebo arm after switching to the open-label phase was observed. There was no steroid-sparing effect. No new safety signals were detected. Although total B cells were not reduced, belimumab induced naïve B cell depletion while enhancing the number and frequency memory B cells.

Conclusion

The study did not meet the primary endpoint and no statistically significant differences were observed in clinical responses between arms. More patients achieved sustained TIS ≥40 and reached the DOI. Most patients who received belimumab for >40 weeks had clinical improvement. Phenotypic changes in B cell populations were not associated with clinical responses.

Clinical trial registration number

Clinicaltrials.gov (https://clinicaltrials.gov/), NCT02347891
Making sense of the financialization of households: state of the art and beyond
Authors: Bobek Alicja , Mikuš Marek , Sokol Martin
Published: June 2023

Building on, and going beyond, the state-of-the-art literature, this article aims to advance the analysis and conceptualization of the financialization of households. It argues that there is a need to better conceptualize the household and that the relations between households and other actors in financialized capitalism require further elaboration. Its contribution rests on providing a high-level review of literature and on proposing a relational and activity-orientated approach to the household as a micro-level social institution performing its activities through a web of relationships. Furthermore, it builds on the concept of ‘financial chains’ to draw attention to power relations and transfers of value between households and other economic actors. In doing so, the article also highlights the uneven ways through which households are inserted into such ‘financial chains’ and explores social, spatial and temporal dimensions of household financialization. Finally, it suggests avenues for further research.
Disseminating sleep education to graduate psychology programs online: a knowledge translation study to improve the management of insomnia
Authors: Meaklim Hailey , Meltzer Lisa J , Rehm Imogen C , Junge Moira F , Monfries Melissa , Kennedy Gerard A , Bucks Romola S , Graco Marnie , Jackson Melinda L
Published: June 2023

Study Objectives

Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework.

Methods

Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months.

Results

Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students’ sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency.

Conclusions

Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.
Prevalence and Correlates of Past Year Ecstasy/MDMA Use in the United States
Authors: Yang Kevin H. , Kepner Wayne , Nijum Anamika , Han Benjamin H. , Palamar Joseph J.
Published: June 2023

Objectives

3,4-Methylenedioxymethamphetamine (MDMA) (also known as “ecstasy” or “Molly”) has regained attention in recent years for its efficacy in treating posttraumatic stress disorder, and the drug was granted breakthrough therapy designation for such use by the US Food and Drug Administration in 2017. However, little is known about the current epidemiology of recreational ecstasy/MDMA use.

Methods

We estimated past-year prevalence and correlates of ecstasy/MDMA use based on a representative sample of noninstitutionalized US individuals 12 years or older from the 2015–2020 National Survey on Drug Use and Health (N = 315,661).

Results

An estimated 0.9% (95% confidence interval [CI] = 0.9–1.0) of individuals used ecstasy/MDMA in the past year. Compared with those ages 35–49 years, all younger age groups were at increased odds for use, while those older than 50 years (adjusted odds ratio [aOR] = 0.14, 95% CI = 0.08–0.23) were at low odds for use. Compared with heterosexual men, those identifying as bisexual women (aOR = 1.32, 95% CI = 1.02–1.72) were at increased odds for use, and compared with White individuals, those identifying as Asian (aOR = 1.92, 95% CI = 1.42–2.59), Black (aOR = 1.70, 95% CI = 1.41–2.06), or multiracial (aOR = 1.61, 95% CI = 1.19–2.16) were at increased odds for use. Past-year use of other drugs (e.g., cannabis, ketamine), prescription drug misuse (e.g., pain relievers, stimulants), nicotine dependence (aOR = 1.21, 95% CI = 1.00–1.45), and alcohol use disorder (aOR = 1.41, 95% CI = 1.25–1.58) were also associated with increased odds for use.

Conclusions

While use of ecstasy/MDMA continues to be relatively rare, findings from this study can help inform prevention and harm reduction strategies, especially among certain subpopulations that are at high risk for use.
Facilitation and Preferred Models for Delivering Substance Use Disorder Treatment in HIV Clinics: Results From a Multisite Randomized Trial
Authors: Muvvala Srinivas B. , Gan Geliang , Morford Kenneth L. , Dziura James , Esserman Denise , Porter Elizabeth , Chan Philip A. , Cornman Deborah H. , Reynolds Jesse , Yager Jessica E. , Fiellin David A. , Edelman E. Jennifer
Published: June 2023

Background

Integrated addiction treatment in HIV clinics is associated with improved outcomes, yet it is offered inconsistently and with variable models of care. We sought to evaluate the impact of Implementation Facilitation (“Facilitation”) on clinician and staff preference for provision of addiction treatment in HIV clinics with on-site resources (all trained or designated on-site specialist) versus outside resources (outside specialist or refer out).

Methods

From July 2017 to July 2020, surveys assessed clinician and staff preferences for addiction treatment models during control (ie, baseline), intervention, evaluation, and maintenance phases in 4 HIV clinics in the Northeast United States.

Results

During the control phase, among 76 respondents (response rate, 58%), the proportions who preferred treatment with on-site resources for opioid use disorder (OUD), alcohol use disorder (AUD), and tobacco use disorder (TUD) were 63%, 55%, and 63%, respectively. Compared with control, there were no significant differences in preferred model during the intervention and evaluation phases except for AUD where there was an increased preference for treatment with on-site resources in the intervention versus control phase. Compared with control, during the maintenance phase, a higher proportion of clinicians and staff preferred providing addiction treatment with on-site resources versus outside resources: OUD, 75% (odds ratio [OR; 95% confidence interval {CI}], 1.79 [1.06–3.03]); AUD, 73% (OR [95% CI], 2.23 [1.36–3.65]), and TUD, 76% (OR [95% CI], 1.88 [1.11–3.18]).

Conclusions

The findings from this study lend support for “Facilitation” as a strategy to enhance clinician and staff preference for integrated addiction treatment in HIV clinics with on-site resources.
Maternal serum per- and polyfluoroalkyl substances during pregnancy and breastfeeding duration
Authors: Friedman Chloe , Dabelea Dana , Keil Alexander P. , Adgate John L. , Glueck Deborah H. , Calafat Antonia M. , Starling Anne P.
Published: June 2023

Background/objectives:

Per- and polyfluoroalkyl substances (PFAS) are endocrine-disrupting chemicals that may affect breastfeeding duration. We examined associations between maternal PFAS concentrations during pregnancy and breastfeeding cessation. We investigated potential effect modification by parity status.

Methods:

Among 555 women enrolled in the Healthy Start study (2009–2014), we quantified maternal serum concentrations of 5 PFAS during mid- to late-pregnancy (mean 27 weeks of gestation). Participants self-reported their breastfeeding practices through 18–24 months postnatally. Among all participants and stratified by parity, we estimated associations between maternal PFAS concentrations and breastfeeding discontinuation by 3 and 6 months, using Poisson regression, and breastfeeding duration, using Cox regression.

Results:

Median PFAS concentrations were similar to those in the general US population. Associations between PFAS and breastfeeding duration differed by parity status. After adjusting for covariates, among primiparous women, associations between PFAS and breastfeeding cessation by 3 and 6 months were generally null, with some inverse associations. Among multiparous women, there were positive associations between perfluorohexane sulfonate, perfluorooctane sulfonate, perfluorooctanoate (PFOA), and perfluorononanoate and breastfeeding cessation by 3 and 6 months. For example, per ln-ng/mL increase in PFOA, the risk ratio for breastfeeding discontinuation by 6 months was 1.45 (95% confidence interval, 1.18, 1.78). Hazard ratios reflected similar patterns between PFAS and breastfeeding duration.

Conclusions:

Among primiparous women, we did not find evidence for associations between PFAS concentrations and breastfeeding duration. In contrast, among multiparous women, PFAS serum concentrations were generally inversely associated with breastfeeding duration, though estimates may be biased due to confounding by unmeasured previous breastfeeding.
Management of Radiation-induced Tissue Injuries: A Review of Current Treatment Strategies
Authors: Simman Richard , Bach Karen , Abbas Fuad , Klomparens Kara , Brickman Bradley Joseph
Published: June 2023

Background:

Although radiation therapy remains an integral component in cancer treatment, the sequela of tissue damage can result in long-term morbidity and mortality for patients. This article aimed to perform a comprehensive review of the current literature for both nonsurgical and surgical management strategies for radiation-induced injuries.

Methods:

A literature search was performed on PubMed to review the current described management and treatment options for radiation-induced injuries. Patient demographics, medical diagnoses, complications, strategies of management care, and outcomes were reviewed.

Results:

The most commonly described management options and reconstructive techniques of radiation wounds were analyzed and reported.

Conclusions:

Consideration of current techniques and outcomes in the management of radiation-induced wounds demonstrates that impaired wound healing remains a major problem. This literature review provides a detailed overview of the most frequently used therapies with recommendations for surgeons.
Supraclavicular Artery Island Flap for Head and Neck Oncologic Reconstruction: 15-year Experience, Past, Present, Future
Authors: Nasr Hani Y. , Friedlander Paul , Chiu Ernest S.
Published: June 2023

Background:

Head and neck reconstruction poses unique challenges due to the complex structure of the region. Primary goals include soft-tissue coverage, adequate color and texture match, and minimal donor-site morbidity. Local and musculocutaneous regional flaps have largely been replaced with fasciocutaneous free flaps (FFF) over recent years. The supraclavicular artery island flap (SCAIF), a locoregional, fasciocutaneous, axially-based flap, has been shown to produce similar outcomes to FFF. We present our 15-year experience using the SCAIF for head and neck reconstruction, discuss its evolution, and provide case examples for its range of indications.

Methods:

Retrospective chart review identified 128 patients who underwent reconstruction of the head and neck with the SCAIF between the years 2006-2021 at Tulane University Medical Center. Patient demographics, lengths of stay, operative times, surgical indications, and complications were recorded.

Results:

The cohort mean age was 66.9 years. Mean lengths of stay and follow-up times were 6.9 days and 9.1 months, respectively. The most common indications for SCAIF reconstruction were recurrent radiated neck disease (n=27, 21.1%), pharyngeal wall defects (n=23, 18.0%), and parotidectomy defects (n=21, 16.4%). Overall complication rate was 17.2%. Partial thickness flap loss (5.5%), contained pharyngeal leak (3.2%), and distal tip necrosis (2.4%) were the most common complications. No functional donor site morbidity was encountered.

Conclusions:

The SCAIF is a versatile, fasciocutaneous, axially-based flap able to produce similar outcomes to FFF in the reconstruction of the head and neck region while reducing costs, lengths of stay, operative times, and donor site morbidity.
Recent Trends and Future Directions for the Integrated Plastic Surgery Match
Authors: Fijany Arman J. , Zago Ilana , Olsson Sofia E. , Troia Thomas , Givechian Kevin Bijan , Boctor Michael J. , Pekarev Maxim
Published: June 2023

The integrated plastic surgery residency match has risen to be the most competitive specialty in the 2022 match. This reality has prompted medical students to reach a high level of personal achievements, including pursuing research fellowships to boost research productivity. The competitive nature of this specialty has highlighted several barriers for applicants, such as those from groups underrepresented in surgery, of lower socioeconomic backgrounds, or without a home program. In recent years, there have been several changes to the match that stand to attenuate disparities among applicants, such as the transition to virtual interviews and the shift of the United States Medical Licensing Examination Step 1 score to pass-fail. The introduction of the Plastic Surgery Common Application and standardized letters of recommendation has altered the application process for the plastic surgery match. Given these recent trends, evaluating the current landscape and looking toward future directions for the integrated plastic surgery match becomes necessary. Understanding these changes will not only benefit medical students by giving them a transparent look into the match process but also provide a framework for other specialties to follow to increase accessibility to their specific specialty.
Conversion to Glaucoma in Pediatric Glaucoma Suspects
Authors: Cardakli Nur , Gore Rujuta A. , Kraus Courtney L.
Published: June 2023

Précis:

In this retrospective review of pediatric glaucoma suspects, 11.5% of eyes progressed to glaucoma over an average of 6.5 years; eyes with ocular hypertension had an 18-fold increased risk of progression compared with eyes with suspicious disc appearance.

Purpose:

The purpose of this study was to describe the rate of progression to glaucoma of a large cohort of pediatric glaucoma suspects at a quaternary academic center.

Design:

Retrospective case series

Participants:

One thousand three hundred seventy-five eyes (824 individuals) followed as pediatric glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016.

Methods:

Retrospective study of pediatric patients monitored as glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016.

Main Outcome Measures:

Progression to glaucoma, defined according to Childhood Glaucoma Research Network criteria or by surgical intervention; initiation of intraocular pressure-lowering therapy.

Results:

One hundred fifty-eight (11.5%) eyes from 109 unique patients met the criteria for conversion to glaucoma during follow-up; rates of conversion ranged between 34.1% for eyes monitored for ocular hypertension, 16.2% for eyes with prior lensectomy, 12.1% for eyes monitored for other ocular risk factors, 2.4% for eyes with suspicious disc appearance, and 0.4% for eyes monitored for systemic risk factors. The first criterion met for conversion to glaucoma was ocular hypertension in 149 eyes (94.3%) and enlarged cup-to-disc ratio (CDR) in 9 eyes (5.7%); the most common second criterion met was the enlargement of CDR since initial presentation (45 eyes, 28.5%), surgical intervention (33 eyes, 20.9%), visual field changes (21 eyes, 13.3%), and asymmetric CDR change compared with fellow eye (20 eyes, 12.7%). The Kaplan-Meier survival curves across the different indications for being monitored as a glaucoma suspect significantly differed (P<0.0001). Eyes being monitored for ocular hypertension had an 18-fold increased risk of conversion to glaucoma than those followed for suspicious disc appearance [hazard ratio (HR) 18.33, 95% CI, 10.05–33.41). Eyes monitored for prior lensectomy and for other ocular risk factors had a 6-fold and 5-fold increased risk of conversion to glaucoma than those followed for suspicious disc appearance, respectively (HR: 6.20, 95% CI, 3.66–10.51; HR: 5.43, 95% CI, 3.00–9.84). Eyes followed for ocular hypertension were nearly 4 times more likely to convert to glaucoma than those followed for prior lensectomy (HR: 3.72, 95% CI, 2.28–6.07).

Conclusions:

Eyes being followed as pediatric glaucoma suspects for ocular hypertension had higher rates of progression to glaucoma than eyes being monitored for prior lensectomy, other ocular risk factors, suspicious disc appearance, or systemic risk factors.
Five-Year Outcomes of Graft-Free Tube Shunts and Risk Factors for Tube Exposures in Glaucoma
Authors: Youn Saerom , Yan David Benedict
Published: June 2023

Précis:

Use of a scleral tunnel technique instead of a patch graft can be considered in most cases of tube shunt implantation. Grafts may still be considered in younger (<65 y old) East Asians.

Purpose:

(1) To assess the risk factors for tube exposure with a graft-free implantation technique and (2) to examine 5-year outcomes of graft-free tube shunt insertion.

Methods:

This was a retrospective case series of 204 consecutive eyes undergoing a glaucoma tube shunt implantation with a scleral tunnel technique in lieu of a graft. Preoperative and postoperative best-corrected visual acuity, intraocular pressure, and number of glaucoma medications were compared. Failure was defined as the following: (1) intraocular pressure >21 mm Hg or ≤5 mm Hg on 2 consecutive visits after 3 mo; (2) required additional glaucoma surgery; (3) loss of light perception. Univariable and multivariable regression analyses were conducted to identify risk factors of tube exposures.

Results:

Intraocular pressure and the number of glaucoma medications were significantly decreased at all postoperative time points (P<0.001). Success rates were 91% at year 1, 75% at year 3, and 67% at year 5. The most common early (<3 mo) complication was tube malpositioning. The most common late (>3 mo to 5 y) complications were corneal complications and uncontrolled intraocular pressure. By year 5, 6.9% of tubes were exposed. Multivariable regression showed that age less than 65 years old (odds ratio: 3.66, P=0.04) and East Asian ethnicity (odds ratio: 3.36, P=0.04) were associated with significantly increased risk of tube exposure.

Conclusions:

Graft-free glaucoma tube implantation has comparable long-term outcomes and complication rates to shunts with a graft. Younger (<65 y old) East Asians are at greater risk of tube exposure without a graft.
Evaluation of the pharmacotherapeutic impact on contractility recovery in patients with newly diagnosed, acute onset dilated cardiomyopathy
Authors: Orszulak Michal , Baasansuren Sugarmaa , Balwierz Magdalena , Cempa Miłosz , Halfar Andrzej , Zimoląg Aneta , Męcka Klaudia , Wybraniec Maciej T. , Mizia-Stec Katarzyna
Published: June 2023

In patients with acute onset dilated cardiomyopathy (DCM) an improvement of left ventricular ejection fraction (LVEF) can occur as an effect of complex therapy. The aim of the study was to evaluate a pharmacotherapeutic impact on LVEF recovery in newly diagnosed DCM heart failure (HF) patients. A total of 2436 patients hospitalized due to acute decompensated HF were retrospectively analyzed. Finally, 24 patients with newly diagnosed DCM (51.4 ± 16.3 years, New York Heart Association 2.3 ± 0.7, LVEF 25 ± 10%) were observed (13.4 ± 16.0 months) in terms of the result of complex therapy. Patients were divided according to LVEF improvement on follow-up echocardiography: “recovery group” (LVEF improvement > 5%; n = 13) and “nonrecovery group” (∆LVEF ≤ 5%; n = 11). Evaluation of baseline parameters showed lower LVEF (19 ± 6 vs 31 ± 10%; P = .0048) and lower incidence of arterial hypertension (27% vs 73%; P = .043) in “recovery” group. After follow-up period LVEF was similar in both groups; however, significant LVEF improvement was demonstrated only in the “recovery group” (19 ± 6% to 34 ± 8%; P < .001). Only the “recovery group” showed significant HF symptoms reduction (New York Heart Association class: 2.5 ± 0.7 to 1.6 ± 0.6; P = .003). The “recovery group” had prescribed higher doses of loop diuretic (equivalent dose of furosemidum: 80 ± 38 mg vs 43 ± 24 mg; P = .025). Despite optimal therapy, significant LVEF improvement is observed only in the half of the patients with newly diagnosed DCM with HF with reduced EF. Prescription of higher doses of loop diuretics may have positive effect on the reduction of symptoms in newly diagnosed DCM HF patients. Lack of other risk factors such as arterial hypertension may increase the chance of LVEF recovery.
Clinical role of 18F-FDG PET/CT for detection of radioactive iodine refractory differentiated thyroid cancer
Authors: Tang Xiaowei , Shi Liang , Zhao Zhenyu , Wang Jun , Yang Rui , Huang Yue , Tang Jun , Chen Zhengguo , Wang Feng
Published: June 2023

In clinical settings, an estimated 10% differentiated thyroid cancer (DTC) cases become radioactive iodide refractory (RAIR), which lack a molecular marker and have fewer treatment selections. A higher uptake of 18F-fluorodeoxyglucose (18F-FDG) might indicate poor prognosis for DTC. This study aimed to evaluate the clinical value of 18F-FDG psitron emission tomography/computed tomography (PET/CT) for the early diagnosis of RAIR-DTC and high-risk DTC. A total of 68 DTC patients were enrolled and underwent 18F-FDG PET/CT for the detection of recurrence and/or metastasis. 18F-FDG uptake was evaluated in patients with different postoperative recurrence risks or TNM stages and compared between RAIR and non-RAIR-DTC based on its maximum standardized uptake value and tumor/liver (T/L) ratio. The final diagnosis was judged by histopathology and follow-up data. Of 68 DTC cases, 42 were RAIR and 24 non-RAIR, with 2 not determined. A total of 263 of 293 lesions detected on 18F-FDG PET/CT were confirmed to be locoregional or metastatic after follow-up. The T/L ratio was significantly higher for RAIR than for non-RAIR (median 5.18 vs 1.44; P < .01) and also significantly higher in postoperative patients at high-risk of recurrence than at low to medium risk (median 4.90 vs 2.16; P < .01). 18F-FDG PET/CT exhibited a sensitivity of 83.3% and specificity of 87.5% for identifying RAIR, with a cutoff T/L value of 2.98. 18F-FDG PET/CT has the potential to diagnose RAIR-DTC early and identify the high-risk DTC. The T/L ratio is a useful parameter for the detection of RAIR-DTC patients.