bluuebunny/crossref_metadata_2025 huggingface dataset:
Radon level in groundwater in Kwara State, Nigeria, and the potential radiation dose due to intake
Authors: Jimoh Kabir O , Ademola Janet A
Published: August 2023

Radon in groundwater for domestic purposes contributes to indoor radon and at high concentration levels could be hazardous to inhabitants. Rn-222 concentrations in 101 groundwater samples from some Local Government Areas (LGAs) of Kwara State, Nigeria, were determined by AlphaGUARD portable radon monitor. The mean activity concentrations for the LGAs varied from 4.28 ± 2.29 to 14.59 ± 8.92 Bq.l−1. Radon concentrations were <100 Bq.l−1 guidance level recommended by CEC and WHO. Eighteen percent exceeded the recommended 11.1 Bq.l−1 by the United States Environmental Protection Agency. All the samples exceeded the 0.1 Bq.l−1 Maximum Permitted Level of the Standard Organization of Nigeria for radionuclide contaminant. Mean effective dose from ingestion was estimated for adults, children and infants. Inhalation dose was also estimated. The mean annual effective doses in five LGAs were higher than the 0.1 mSv reference dose level of committed effective dose from the intake of drinking water for 1 y as recommended by the ICRP.

Highlights
Comparison of sensitivity characteristics between GAFCHROMIC LD-V1 and GAFCHROMIC XR-QA2 in mammographic dosimetry
Authors: Gotanda Tatsuhiro , Kawaji Yasuyuki , Yatake Hidetoshi , Imai Shinya , Akagawa Takuya , Gotanda Rumi , Katsuda Toshizo
Published: August 2023

In recent years, radiochromic films have begun to be used for dosimetry in mammography; however, the most sensitive GAFCHROMIC XR-QA2 (XR-QA2) film is no longer available owing to its discontinuation. In this study, we evaluated the sensitivity characteristics of GAFCHROMIC LD-V1 (LD-V1) as an alternative to XR-QA2 in the field of mammography, at a low dose and low energy. Our results show that the average ratio of the concentration change of LD-V1 divided by the concentration change of XR-QA2 at each absorbed dose was 53.7%, indicating the sensitivity of LD-V1 to be approximately half of XR-QA2. In addition, the linearity of the concentration change is sufficient even within a dose range of 0.59–14.52 mGy, which is lower than the manufacturer's recommended dose range. Therefore, the LD-V1 is capable of accurate dose assessment even with a low dose and the low level of energy used in mammography.
Perioperative Team-Based Morbidity and Mortality Conferences: A Systematic Review of the Literature
Authors: Samost-Williams Aubrey , Rosen Roni , Hannenberg Alexander , Lydston Melis , Nash Garrett M. , Brindle Mary
Published: August 2023

Objective:

This systematic review aimed to identify key elements of perioperative team-based morbidity and mortality conferences (TBMMs) and their impact on patient safety, education, and quality improvement outcomes.

Background:

Patient safety in the perioperative period is influenced by system, team, and individual behaviors. However, despite this recognition, single-discipline morbidity and mortality conferences remain a mainstay of educational and quality improvement efforts.

Methods:

A structured search was conducted in MEDLINE Complete, Embase, Web of Science, ClinicalTrials.gov, Cochrane CENTRAL, and ProQuest Dissertations and Theses Global in July 2022. Search results were screened, and the articles meeting inclusion criteria were abstracted.

Results:

Seven studies were identified. Key TBMM elements were identified, including activities done before the conference—case selection and case investigation; during the conference—standardized presentation formats and formal moderators; and after the conference—follow-up emails and quality improvement projects. The impacts of TBMMs on educational, safety, and quality improvement outcomes were heterogeneous, and no meta-analysis could be conducted; however, improvement was typically shown in each of these domains where comparisons were made.

Conclusions:

Recommendations for key TBMM elements can be drawn from the reports of successful perioperative TBMMs. Possible benefits of structured TBMMs over single-discipline conferences were identified for further exploration, including opportunities for rich educational contributions for trainees, improved patient safety, and the potential for system-wide quality improvement. Design and implementation of TBMM should address meticulous preparation of cases, standardized presentation format, and effective facilitation to increase the likelihood of realizing the potential benefits.
Completion Total Mesorectal Excision: A Case-Matched Comparison With Primary Resection
Authors: Burghgraef Thijs A. , Rutgers Marieke L. , Leijtens Jeroen W. A. , Tuyman Jurriaan B. , Consten Esther C. J. , Hompes Roel ,   on behalf of the MIRECA working group.
Published: August 2023

Objectives:

The aim of this study was to compare the perioperative and oncological results of completion total mesorectal excision (cTME) versus primary total mesorectal excision (pTME).

Background:

Early-stage rectal cancer can be treated by local excision alone, which is associated with less surgical morbidity and improved functional outcomes compared with radical surgery. When high-risk histological features are present, cTME is indicated, with possible worse clinical and oncological outcomes compared to pTME.

Methods:

This retrospective cohort study included all patients that underwent TME surgery for rectal cancer performed in 11 centers in the Netherlands between 2015 and 2017. After case-matching, we compared cTME with pTME. The primary outcome was major postoperative morbidity. Secondary outcomes included the rate of restorative procedures and 3-year oncological outcomes.

Results:

In total 1069 patients were included, of which 35 underwent cTME. After matching (1:2 ratio), 29 cTME and 58 pTME were analyzed. No differences were found for major morbidity (27.6% vs 19.0%; P = 0.28) and abdominoperineal excision rate (31.0% vs 32.8%; P = 0.85) between cTME and pTME, respectively. Local recurrence (3.4% vs 8.6%; P = 0.43), systemic recurrence (3.4% vs 12.1%; P = 0.25), overall survival (93.1% vs 94.8%; P = 0.71), and disease-free survival (89.7% vs 81.0%; P = 0.43) were comparable between cTME and pTME.

Conclusions:

cTME is not associated with higher major morbidity, whereas the abdominoperineal excision rate and 3-year oncological outcomes are similar compared to pTME. Local excision as a diagnostic tool followed by completion surgery for early rectal cancer does not compromise outcomes and should still be considered as the treatment of early-stage rectal cancer.
Electrode Montage Induced Changes in Air-Conducted Ocular Vestibular-Evoked Myogenic Potential
Authors: Raveendran Rajesh Kumar , Singh Niraj Kumar
Published: August 2023

Objectives:

Stimulus and recording parameters are pivotal for shaping the ocular vestibular-evoked myogenic potential (oVEMP). In the last decade, several attempts were made to identify the optimum electrode placement site to improve the oVEMP responses. A vast majority of these found larger response amplitudes for alternate electrode montages like belly-tendon (BT), chin-referenced (CR), and/or sternum-referenced montages than the clinically used infra-orbital montage. However, no study has yet compared all alternate electrode montages in a simultaneous recording paradigm to eliminate other confounding factors. Also, no study has compared all of them for their test–retest reliability, waveform morphology, and signal-to-noise ratio. Therefore, the decision on which among these electrode montages is best suited for oVEMP acquisition remains opaque. The present study aimed to investigate the effects of various electrode montages on oVEMP’s response parameters and to determine the test–retest reliability of each of these in clinically healthy individuals using a simultaneous recording paradigm.

Design:

This study had a within-subject experimental design. Fifty-five young healthy adults (age range: 20–30 years) underwent contralateral oVEMP recording using infra-orbital, BT, chin-referenced, and sternum-referenced electrode montages simultaneously using a four-channel evoked potential system.

Results:

BT montage had a significantly shorter latency, larger amplitude, higher signal-to-noise ratio, and better morphology than other alternate montages (p < 0.008). Further, all electrode montages of the current study showed fair/moderate to excellent test–retest reliability.

Conclusions:

By virtue of producing significantly better response parameters than the other electrode montages, BT montage seems better suited to the recording of oVEMP than the known electrode montages thus far.
An Analysis of Scoliosis in Autism Spectrum Disorder
Authors: Orland Keith , Harvey Kaela , Klinkerman Lydia N. , Corrales Arturo , Jamnik Adam , Zale Connor , Jo Chan-Hee , Rathjen Karl , McIntosh Amy , Petrasic Jason , Sucato Daniel J. , Ramo Brandon , Johnson Megan , Brooks Jaysson T.
Published: August 2023

Background:

Children with autism/Asperger are grouped into the diagnosis of autism spectrum disorder (ASD). It remains uncertain whether children with ASD and scoliosis have radiographic and clinical outcomes similar to idiopathic scoliosis (IS) patients.

Methods:

A single-center, retrospective review of a prospective scoliosis registry evaluated patients who had a posterior spinal fusion±Anterior Spinal Fusion and an underlying diagnosis of ASD between 1990 and 2021. A 2:1 match with AIS patients by age and sex was compared using demographic, radiographic, intraoperative, and SRS-22/30 variables.

Results:

Thirty patients with ASD (63% male, mean age at surgery 14.6±2.5 y) met inclusion criteria, with a follow-up of 2.46±1.00 years. Despite no differences in curve magnitude preoperatively, patients with ASD had a higher percent correction at 2-year follow-up (66% vs. 57%, P=0.01) and improved mean curve magnitude (20±10 degrees) at 2-year follow-up compared with IS patients (27±11 degrees, P<0.01). ASD patients had less lumbar lordosis preoperatively (40±12 vs. 53±14, P<0.01), but there were no significant differences in sagittal parameters at 2-year follow-up. There were no significant differences in the rate of complications at 2-year follow-up between ASD and AIS cohorts.

Conclusions:

Although patients with ASD exhibited decreased lordosis compared with IS patients preoperatively, their radiographic outcomes at 2-year follow-up were the same. In addition, ASD patients maintained greater curve correction than IS patients at 2 years follow-up.

Level of Evidence:

Prognostic retrospective study.
Taking Action Against Clinician Burnout Through Reducing the Documentation Burden With an Operating Room Supply Scanning Approach
Authors: Abda Robert , Pietrzyk Gail , Scott Paul Wesley , Fennimore Laura
Published: August 2023

Documenting surgical supply items in the operating room can be a burdensome task for circulating nurses because of manual input within the electronic medical record. This can lead to documentation fatigue and contribute to nursing burnout. The aim of this quality improvement project was to design and implement a supply item scanning process and evaluate the effect on intraoperative documentation completion time, room turnover time, picklist documentation accuracy, nurse satisfaction, and burnout. The sample included nine acute care hospitals throughout the United States, with 189 total circulating nurses and 31 718 procedures occurring during the study timeframe of 8 months. Results indicated that nurses were able to complete documentation on average 37.33 minutes sooner, and the operating room turnover time decreased by 1.88 minutes. Although nurses reported that their perceived picklist documentation accuracy did not improve, and the presence of new scanning technology did not influence their hospital employment decision, subjective feedback was mostly positive, with most responses citing the helpfulness of scanning for documentation. This study shows that an interdisciplinary team can effectively work to optimize documentation efficiency and performance improvement using a scanning intervention. Lessons learned through this process can translate into optimizations elsewhere in the electronic medical record.
Creating Subsets of International Classification for Nursing Practice Precoordinated Concepts
Authors: Björvell Catrin , Jansson Inger , Busck-Håkans Viveca , Karlsson Ingela
Published: August 2023

The International Classification for Nursing Practice is a comprehensive terminology representing the domain of nursing practice. A categorization of the diagnoses/outcomes and interventions may further increase the usefulness of the terminology in clinical practice. The aim of this study was to categorize the precoordinated concepts of the International Classification for Nursing Practice into subsets for nursing diagnoses/outcomes and interventions using the structure of an established documentation model. The aim was also to investigate the distribution of the precoordinated concepts of the International Classification for Nursing Practice across the different areas of nursing practice. The method was a descriptive content analysis using a deductive approach. The VIPS model was used as a theoretical framework for categorization. The results showed that all the precoordinated concepts of the International Classification for Nursing Practice could be categorized according to the keywords in the VIPS model. It also revealed the parts of nursing practice covered by the concepts of the International Classification for Nursing Practice as well as the parts that needed to be added to the International Classification for Nursing Practice. This has not been identified in earlier subsets as they covered only one specific area of nursing.
Mobile programs in family planning
Authors: Kaur Simranvir , Lathrop Eva
Published: August 2023

Purpose of review

Mobile health outreach programs are an alternative way to provide family planning services for rural populations or populations affected by conflict, outbreaks, or humanitarian crises. Here, we review the current literature about mobile health outreach programs in family planning.

Recent findings

Mobile health outreach programs are effective in delivering family planning services by increasing access to family planning services including expanding method choice, contributing to resilient healthcare models, and advancing reproductive justice.

Mobile health outreach programs may be a reasonable, cost saving, person-centered alternative to delivering healthcare particularly when traditional systems are strained.

Mobile health outreach programs in family planning exist in the United States and globally. Current literature suggests that mobile and outreach programs are effective in increasing knowledge and access to family planning in part by expanding method choice. A mobile health outreach approach is a resilient model that is person-centered and lends itself well to empower patients to practice self-care. The findings and lessons learned may be helpful in guiding future mobile health outreach programs in family planning and other services conducive to an out of clinic model, particularly as a response to overburdened health systems.
Management of missing intrauterine device strings and migrated intrauterine devices
Authors: Amaya Stephanie I. , Blumenthal Paul D.
Published: August 2023

Purpose of review

The purpose of this review is to review the recent literature with respect to the management of missing intrauterine device (IUD) strings. As IUD use has increased over time, it is important to review management options for this uncommon but possible complication.

Recent findings

This article will cover stepwise approaches to management of missing IUD strings based on the most recent literature. Initial steps include obtaining history and using in office tools to reveal IUD strings. Subsequent steps focus on imaging guidelines including obtaining transvaginal ultrasound when available. Finally, IUD removal with tools for uterine instrumentation are discussed, focusing on using tools that do not require cervical dilation and allow for grasping of the device.

This paper details a stepwise approach to the management of missing IUD strings which, as discussed in the article, may become more frequent given the rise of IUD use in general and postpartum placement in specific.
Telerehabilitation Technology Used for Remote Wrist/Finger Range of Motion Evaluation: A Scoping Review
Authors: Kuchtaruk Adrian , Yu Sammie Sam Yee , Iansavichene Alla , Davidson Jacob , Wilson Claire A. , Symonette Caitlin
Published: August 2023

Background:

Monitoring finger/wrist range of motion (ROM) is an important component of routine hand therapy after surgery. Telerehabilitation is a field that may potentially address various barriers of in-person hand therapy appointments. Therefore, the purpose of this scoping review is to identify telerehabilitation technologies that can be feasibly used in a patient’s home to objectively measure finger/wrist ROM.

Methods:

Following PRISMA-ScR guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases using alternative word spellings for the following core concepts: “wrist/hand,” “rehabilitation,” and “telemedicine.” Studies were imported into Covidence, and systematic two-level screening was done by two independent reviewers. Patient demographics and telerehabilitation information were extracted from the selected articles, and a narrative synthesis of the findings was done.

Results:

There were 28 studies included in this review, of which the telerehabilitation strategies included smartphone angle measurement applications, smartphone photography, videoconference, and wearable or external sensors. Most studies measured wrist ROM with the most accurate technologies being wearable and external sensors. For finger ROM, the smartphone angle application and photography had higher accuracy than sensor systems. The telerehabilitation strategies that had the highest level of usability in a remote setting were smartphone photographs and estimation during virtual appointments.

Conclusions:

Telerehabilitation can be used as a reliable substitute to in-person goniometer measurements, particularly the smartphone photography and motion sensor ROM measurement technologies. Future research should investigate how to improve the accuracy of motion sensor applications that are available on easy-to-access devices.
The Preferred Design of the Profunda Artery Perforator Flap for Autologous Breast Reconstruction: Transverse or Diagonal?
Authors: Cohen Zack , Azoury Saïd C. , Nelson Jonas A. , Haglich Kathryn , Dayan Joseph H. , Matros Evan , Allen Robert J.
Published: August 2023

Background:

Since its introduction for autologous breast reconstruction in 2010, the profunda artery perforator (PAP) flap has emerged as a preferred choice when an abdominal flap is suboptimal. The traditional transverse design (tPAP) was popularized, given the inconspicuous donor scar. A diagonal design (dPAP) has since evolved to address some of the shortcomings of the tPAP. The authors aimed to compare outcomes of tPAP/dPAP flaps harvested for breast reconstruction by a single surgeon.

Methods:

A retrospective review was conducted from 2017 to 2022 of patients undergoing tPAP versus dPAP-based breast reconstruction by a single surgeon at a tertiary cancer center. Patient variables and operative variables were assessed. Need for additional symmetrizing breast procedures were compared. Complications and BREAST-Q patient-reported outcome measures were analyzed.

Results:

Thirty-nine flaps were used to reconstruct 35 breasts in 24 patients. Average follow-up for the group was 1.8 years. The groups were similar with respect to demographics. The majority of dPAP flaps had two perforators, whereas most tPAP flaps had one perforator. The dPAP flaps had greater average weights, width, and overall surface area. There were no cases of partial/total flap loss. Complications and PROM results were similar between the two groups.

Conclusions:

The dPAP design allows for a larger skin paddle and greater tissue harvest and capture of cutaneous perforators, without increasing the risk of complications or compromising satisfaction. It should be considered as a viable option in patients unable to undergo abdominal-based reconstruction. Additional patients and multi-institutional efforts are necessary to better compare advantages of either design.
The evolving role of cardiopulmonary exercise testing in ischemic heart disease – state of the art review
Authors: Chaudhry Sundeep , Kumar Naresh , Arena Ross , Verma Subodh
Published: August 2023

Purpose of review

Cardiopulmonary exercise testing (CPET) is the gold standard for directly assessing cardiorespiratory fitness (CRF) and has a relatively new and evolving role in evaluating atherosclerotic heart disease, particularly in detecting cardiac dysfunction caused by ischemic heart disease. The purpose of this review is to assess the current literature on the link between cardiovascular (CV) risk factors, cardiac dysfunction and CRF assessed by CPET.

Recent findings

We summarize the basics of exercise physiology and the key determinants of CRF. Prognostically, several studies have been published relating directly measured CRF by CPET and outcomes allowing for more precise risk assessment. Diagnostically, this review describes in detail what is considered healthy and abnormal cardiac function assessed by CPET. New studies demonstrate that cardiac dysfunction on CPET is a common finding in asymptomatic individuals and is associated with CV risk factors and lower CRF. This review covers how key CPET parameters change as individuals transition from the asymptomatic to the symptomatic stage with progressively decreasing CRF. Finally, a supplement with case studies with long-term longitudinal data demonstrating how CPET can be used in daily clinical decision making is presented.

In summary, CPET is a powerful tool to provide individualized CV risk assessment, monitor the effectiveness of therapeutic interventions, and provide meaningful feedback to help patients guide their path to improve CRF when routinely used in the outpatient setting.
Geospatial analysis of cyanobacterial exposure and liver cancer in the contiguous United States
Authors: Ledenko Matthew , Antwi Samuel O. , Patel Tushar
Published: August 2023

Background and Aims:

Cyanobacteria are commonly found in water bodies and their production of hepatotoxins can contribute to liver damage. However, the population health effects of cyanobacteria exposure (CE) are unknown. Our objectives were to determine the effect of chronic exposure to cyanobacteria through proximity to water bodies with high cyanobacteria counts on the incidence and mortality of liver cancers, as well as to identify location-based risk factors.

Approach and Results:

Across the contiguous United States, regions with high cyanobacteria counts in water bodies were identified using satellite remote sensing data. The data were geospatially mapped to county boundaries, and disease mortality and incidence rates were analyzed. Distinctive spatial clusters of CE and mortality related to liver diseases or cancer were identified. There was a highly significant spatial association between CE, liver disease, and liver cancer but not between CE and all cancers. Hot spots of CE and mortality were identified along the Gulf of Mexico, eastern Texas, Louisiana, and Florida, and cold spots across the Appalachians. The social vulnerability index was identified as a major location-based determinant by logistic regression, with counties in the fourth or fifth quintiles having the highest prevalence of hot spots of CE and mortality from liver cancer.

Conclusions:

These findings emphasize the importance of environmental exposure to cyanobacteria as a location-based determinant of mortality from liver cancer. Public health initiatives addressing CE may be considered to reduce mortality, particularly in areas of high social vulnerability.
Duet: An Exploratory Language Intervention for Toddlers in Low-Income Households
Authors: Alper Rebecca M. , Luo Rufan , Mogul Marjie , Bakeman Roger , Masek Lillian , Chen Yu , Paterson Sarah , Pace Amy , Golinkoff Roberta M. , Owen Margaret Tresch , Hirsh-Pasek Kathy
Published: August 2023

Preventative parent-coaching programs can improve early interaction quality, language skills, and academic outcomes for children experiencing economic adversity. Using a community-based participatory research framework, we piloted Duet, a preventative, parent-implemented, early language intervention. We assigned home visitors to provide Duet or standard-of-care services to 23 children (aged 1; 0–2; 3; 9 Duet, 14 control) and their parents. We used odds ratios to describe the likelihood of improvement. The Duet group had greater odds of improvement than the control group for parent developmental knowledge (moderate effect size), self-efficacy (moderate effect size), parent–child interaction (moderate effect size), and child's language (weak effect size). The preliminary Duet data are promising. Limitations included recruitment and retention in the community setting. Future research will explore Duet's efficacy, effectiveness, and scalability.
Predicting Insulin Resistance in a Pediatric Population With Obesity
Authors: Araújo Daniela , Morgado Carla , Correia-Pinto Jorge , Antunes Henedina
Published: August 2023

Objectives:

Insulin resistance (IR) affects children and adolescents with obesity and early diagnosis is crucial to prevent long-term consequences. Our aim was to identify predictors of IR and develop a multivariate model to accurately predict IR.

Methods:

We conducted a cross-sectional analysis of demographical, clinical, and biochemical data from a cohort of patients attending a specialized Paediatric Nutrition Unit in Portugal over a 20-year period. We developed multivariate regression models to predict IR. The participants were randomly divided into 2 groups: a model group for developing the predictive models and a validation group for cross-validation of the study.

Results:

Our study included 1423 participants, aged 3–17 years old, randomly divided in the model (n = 879) and validation groups (n = 544). The predictive models, including uniquely demographic and clinical variables, demonstrated good discriminative ability [area under the curve (AUC): 0.834–0.868; sensitivity: 77.0%–83.7%; specificity: 77.0%–78.7%] and high negative predictive values (88.9%–91.6%). While the diagnostic ability of adding fasting glucose or triglycerides/high density lipoprotein cholesterol index to the models based on clinical parameters did not show significant improvement, fasting insulin appeared to enhance the discriminative power of the model (AUC: 0.996). During the validation, the model considering demographic and clinical variables along with insulin showed excellent IR discrimination (AUC: 0.978) and maintained high negative predictive values (90%–96.3%) for all models.

Conclusion:

Models based on demographic and clinical variables can be advantageously used to identify children and adolescents at moderate/high risk of IR, who would benefit from fasting insulin evaluation.
Risk Factors for Coated Midline Catheter-Related Thrombosis
Authors: Bahl Amit , Johnson Steven , Mielke Nicholas , Chen Nai-Wei
Published: August 2023

Midline catheter-related thrombosis (MCRT) is a high-stakes complication. The authors aimed to explore risk factors for the development of symptomatic MCRT, including patient, procedure, catheter, and vein characteristics. This study performed an analysis of existing trial data that compared MCRT in 2 MCs with differing antithrombotic properties. Cox regression was used for univariable and multivariable analyses to evaluate the primary outcome of MCRT. Among 191 patients in this analysis, the average age was 60.2 years (standard deviation = 16.7 years), and 59.7% were female (114/191). Clinical indications for MC placement included antibiotics (60.7%), difficult venous access (32.5%), or both (6.8%). Body temperature ≥38°C (adjusted hazard ratio [aHR] = 6.26; 95% CI, 1.24−20.29; P = .03), catheter-to-vein ratio >0.40 (aHR = 2.65; 95% CI, 0.99−6.74; P = .05), and MC distance from antecubital fossa >7.0 cm (aHR = 2.82; 95% CI, 1.10–7.90; P = .03), were each significantly associated with the higher risk of the occurrence of symptomatic MCRT. This study found that catheter-to-vein ratio >0.40, distance from the antecubital fossa >7 cm, and body temperature ≥38°C were each associated with higher risk of MCRT. Current practices should be modified to include a minimum vein size to avoid MC insertions that occupy >40% of a given vein. Further research is needed to explain the impact of the catheter tip position and fever in relation to MCRT.
The Distribution of the Nerves and Arteries of the Platysma for Clinical Applications
Authors: Kim Ye-Gyung , Jeon Anna , Hwang Kun , Chung Yoon-Hee , Han Seung-Ho
Published: August 2023

This study aimed to provide anatomical data on the platysma for clinical procedures. The authors obtained 25 specimens from 15 adult Korean cadavers (9 men, 6 women; mean age, 72 years; range, 61–85 years). Lines connecting the gonion with the gnathion (G-GN) and the acromial end (acromial end of the clavicle) with the sternal end (sternal end of the clavicle) were used as references. Modified Sihler staining was used to trace the nerves distributed in the platysma. The superior border values of the platysma were 12.1 ± 2.7 mm, 31.5 ± 5.3 mm, 42.4 ± 5.6 mm, and 61.7 ± 6.4 mm, respectively, for sections 2 through 5 on the G-GN line. The inferior border values of the platysma were 83.6 ± 19.1 mm, 80.1 ± 14.0 mm, 74.8 ± 14.5 mm, 67.2 ± 13.7 mm, and 54.6 ± 7.1 mm, respectively, for the 5 sections on the acromial end of the clavicle-sternal end of the clavicle line. In the hyoid bone, cricoid cartilage, and jugular notch, the mean distance between the bilateral platysma was 14.4 ± 2.2 mm, 22.6 ± 10.6 mm, and 51.1 ± 15.7 mm, respectively. The mean angle at the cervical branch of the facial nerve and the anterior border of the sternocleidomastoid muscle sternal head was 28.7 ± 2.6 degrees and 53.4 ± 7.7 degrees from the G-GN line, respectively. The upper third of the platysma was supplied by branches of the facial artery and submental artery. The middle third was supplied by branches of the occipital artery and received its direct blood supply from branches of the external carotid artery. The lower third was supplied by branches of the transverse cervical artery. The authors hope that the results of this study will be helpful for rejuvenation procedures of the neck.
Zigzag persistence for coral reef resilience using a stochastic spatial model
Authors: McDonald R. A. , Neuhausler R. , Robinson M. , Larsen L. G. , Harrington H. A. , Bruna M.
Published: August 2023

A complex interplay between species governs the evolution of spatial patterns in ecology. An open problem in the biological sciences is characterizing spatio-temporal data and understanding how changes at the local scale affect global dynamics/behaviour. Here, we extend a well-studied temporal mathematical model of coral reef dynamics to include stochastic and spatial interactions and generate data to study different ecological scenarios. We present descriptors to characterize patterns in heterogeneous spatio-temporal data surpassing spatially averaged measures. We apply these descriptors to simulated coral data and demonstrate the utility of two topological data analysis techniques—persistent homology and zigzag persistence—for characterizing mechanisms of reef resilience. We show that the introduction of local competition between species leads to the appearance of coral clusters in the reef. We use our analyses to distinguish temporal dynamics stemming from different initial configurations of coral, showing that the neighbourhood composition of coral sites determines their long-term survival. Using zigzag persistence, we determine which spatial configurations protect coral from extinction in different environments. Finally, we apply this toolkit of multi-scale methods to empirical coral reef data, which distinguish spatio-temporal reef dynamics in different locations, and demonstrate the applicability to a range of datasets.
On the variability and dependence of human leg stiffness across strides during running and some consequences for the analysis of locomotion data
Authors: Selvitella Alessandro Maria , Foster Kathleen Lois
Published: August 2023

Typically, animal locomotion studies involve consecutive strides, which are frequently assumed to be independent with parameters that do not vary across strides. This assumption is often not tested. However, failing in particular to account for dependence across strides may cause an incorrect estimate of the uncertainty of the measurements and thereby lead to either missing (overestimating variance) or over-evaluating (underestimating variance) biological signals. In turn, this impacts replicability of the results because variability is accounted for differently across experiments. In this paper, we analyse the changes of a couple of measures of human leg stiffness across strides during running experiments, using a publicly available dataset. A major finding of this analysis is that the time series of these measurements of stiffness show autocorrelation even at large lags and so there is dependence between individual strides, even when separated by many intervening strides. Our results question the practice in biomechanics research of using each stride as an independent observation or of sub-selecting strides at small lags. Following the outcome of our analysis, we strongly recommend caution in doing so without first confirming the independence of the measurements across strides and without confirming that sub-selection does not produce spurious results.
Effectiveness of face masks for reducing transmission of SARS-CoV-2: a rapid systematic review
Authors: Boulos Leah , Curran Janet A. , Gallant Allyson , Wong Helen , Johnson Catherine , Delahunty-Pike Alannah , Saxinger Lynora , Chu Derek , Comeau Jeannette , Flynn Trudy , Clegg Julie , Dye Christopher
Published: August 2023

This rapid systematic review of evidence asks whether (i) wearing a face mask, (ii) one type of mask over another and (iii) mandatory mask policies can reduce the transmission of SARS-CoV-2 infection, either in community-based or healthcare settings. A search of studies published 1 January 2020–27 January 2023 yielded 5185 unique records. Due to a paucity of randomized controlled trials (RCTs), observational studies were included in the analysis. We analysed 35 studies in community settings (three RCTs and 32 observational) and 40 in healthcare settings (one RCT and 39 observational). Ninety-five per cent of studies included were conducted before highly transmissible Omicron variants emerged. Ninety-one per cent of observational studies were at ‘critical’ risk of bias (ROB) in at least one domain, often failing to separate the effects of masks from concurrent interventions. More studies found that masks (
n
 = 39/47; 83%) and mask mandates (
n
 = 16/18; 89%) reduced infection than found no effect (
n
 = 8/65; 12%) or favoured controls (
n
 = 1/65; 2%). Seven observational studies found that respirators were more protective than surgical masks, while five found no statistically significant difference between the two mask types. Despite the ROB, and allowing for uncertain and variable efficacy, we conclude that wearing masks, wearing higher quality masks (respirators), and mask mandates generally reduced SARS-CoV-2 transmission in these study populations.

This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.
Neisseria lisongii sp. nov. and Neisseria yangbaofengii sp. nov., isolated from the respiratory tracts of marmots
Authors: Yang Caixin , Zhao Lijun , Zhou Juan , Cheng Yanpeng , Yang Jing , Zhou Huimin , Luo Wenbo , Lu Shan , Jin Dong , Pu Ji , Zhang Sihui , Liu Liyun , Xu Jianguo
Published: August 2023

Four Gram-stain-negative, oxidase-positive, non-motile, cocci-shaped bacteria strains (ZJ106T, ZJ104, ZJ785T and ZJ930) were isolated from marmot respiratory tracts. Phylogenetic analyses based on 16S rRNA genes, 53 ribosomal protein sequences and 441 core genes supported that all four strains belonged to the genus

Neisseria

with close relatives

Neisseria weixii

10022T and

Neisseria iguanae

ATCC 51483T. Average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values were below the species-level thresholds (95–96 % for ANI, and 70 % for dDDH). The major fatty acids of all four strains were C16 : 1
 ω7c /C16 : 1
 ω6c, C16 : 0 and C18 : 1
 ω9c. Major polar lipids were composed of diphosphatidylglycerol, phosphatidylethanolamine and phosphatidylglycerol. MK-8 was the major menaquinone. Based on Virulence Factor Database analysis, the four strains were found to contain NspA and PorB H-factor binding proteins that promote evasion of host immunity. Strains ZJ106T and ZJ104 contained structures similar to the capsule synthesis manipulator of

Neisseria meningitidis

. Based on phenotypic and phylogenetic evidence, we propose that strains ZJ106T and ZJ785T represent two novel species of the genus

Neisseria

, respectively, with the names Neisseria lisongii sp. nov. and Neisseria yangbaofengii sp. nov. The type strains are ZJ106T (=GDMCC 1.3111T=JCM 35323T) and ZJ785T (=GDMCC 1.1998T=KCTC 82336T)
Intraepithelial CD15 infiltration identifies high grade anal dysplasia in people with HIV
Authors: Burgos Joaquín , Mancebo Cristina , Massana Núria , Astorga-Gamaza Antonio , Castellvi Josep , Landolfi Stefania , Curran Adrià , Garcia-Perez Jorge N. , Falcó Vicenç , Buzón María J. , Genescà Meritxell
Published: August 2023

Men who have sex with men (MSM) with HIV are at high risk for squamous intraepithelial lesion (SIL) and anal cancer. The identification of local immunological mechanisms involved in the development of anal dysplasia could aid treatment and diagnostics. We performed a study of 111 anal biopsies obtained from 101 MSM with HIV, who participated in an anal screening program. In a test prospective cohort (N=54), in addition to histological examination, we assessed multiple immune subsets by flow cytometry. Selected molecules were further evaluated by immunohistochemistry in a validation retrospective cohort (N=47). Pathological samples were characterized by the presence of Resident Memory T cells with low expression of CD103 and by changes in the Natural Killer cell subsets, affecting residency and activation. Furthermore, potentially immune suppressive subsets, including CD15+CD16+mature neutrophils, gradually increased as the anal lesion progressed. Immunohistochemistry confirmed the association between the presence of CD15 in the epithelium and SIL diagnosis, with a sensitivity of 80% and specificity of 71% (AUC 0.762) for the correlation with high-grade SIL. A complex immunological environment with imbalanced proportions of resident effectors and immune suppressive subsets characterizes pathological samples. Neutrophil infiltration, determined by CD15 staining, may represent a valuable pathological marker associated with the grade of dysplasia.

Abstract Figure
Determinants of Maternal Health Service Utilization and Continuum of Care in Nepal: An Analysis from Demographic and Health Survey 2022
Authors: Pandey Achyut Raj , Adhikari Bikram , Sangroula Raj Kumar , Regmi Shophika , Sharma Shreeman , Dulal Bishnu , Lamichhane Bipul , KC Saugat Pratap , Dhakal Pratistha , Baral Sushil Chandra
Published: August 2023

Background

Continuum of care for maternal health services is essential in minimizing preventable fatalities linked to pregnancy and childbirth. The study focuses on assessing determinants of maternal health service utilization i.e., four or more antenatal care (ANC) visits, institutional delivery, and postnatal care (PNC) visit within the first 2 days of delivery and the continuum of care.

Methods

We performed weighted analysis of Nepal Demographic and Health Survey 2022 accounting for complex survey design. Categorical variables are presented using frequency, percentage, and 95% confidence intervals (CI), while numerical variables were represented as mean and a 95% CI. We performed bivariable and multivariable binary logistic regression and the results are odds ratios presented with 95%.

Results

Among total participants, 80.5% (95% CI: 77.9, 82.8) had four or more antenatal care (ANC) visits, 79.4% (95% CI: 76.8, 81.9) had institutional delivery and 70.2% (95% CI:67.5, 72.9 postnatal care (PNC) visit within 2 days of delivery. The proportion of participants having both four or more ANC visits and institutional delivery was 67.6% (95% CI: 64.7, 70.4) those completing all three components of care (4 or more ANC visits, delivering in health facility and having PNC visit for mother within 2 days of delivery) was 51.2% (95% CI: 48.3, 54.0).

Compared to participants in poorest wealth quintile, participants in wealthiest quintile had 12 folds higher odds (AOR: 11.96, 95% CI: 14.36, 32.79) of having both four or more ANC visits and institutional delivery. Residents of the Madhesh had lower odds (AOR: 0.47, 95% CI: 0.23, 0.99), Sudurpaschim had higher odds (AOR: 2.37, 95% CI: 1.17, 4.82) of having 4 or more ANC visits and institutional delivery compared to Koshi Province. Residents of Bagmati Province had lower odds (AOR:0.49, 95% CI: 0.28, 0.87) of having all three components of care: 4 or more ANC visits, institutional delivery and PNC visit within 2 days of delivery for mother.

Conclusion

There are notable differences in coverage of maternal health services based on education, wealth quintile, province and place of residence. Addressing economic inequalities and provincial differences and harnessing technology to provide and equitable access to vital maternal and newborn health initiatives.
Machine Learning Reveals Synovial Fibroblast Genes Associated with Pain Affect Sensory Nerve Growth in Rheumatoid Arthritis
Authors: Bai Zilong , Bartelo Nicholas , Aslam Maryam , Hale Caryn , Blachere Nathalie E. , Parveen Salina , Spolaore Edoardo , DiCarlo Edward , Gravallese Ellen , Smith Melanie H. ,   Accelerating Medicines Partnership Program: Rheumatoid Arthritis and Systemic Lupus Erythematosus (AMP RA/SLE) Network, Frank Mayu O. , Jiang Caroline S. , Zhang Haotan , Lewis Myles J. , Sikandar Shafaq , Pitzalis Costantino , Malfait Anne-Marie , Miller Rachel E. , Zhang Fan , Goodman Susan , Darnell Robert , Wang Fei , Orange Dana E.
Published: August 2023

It has been presumed that rheumatoid arthritis (RA) joint pain is related to inflammation in the synovium; however, recent studies reveal that pain scores in patients do not correlate with synovial inflammation. We identified a module of 815 genes associated with pain, using a novel machine learning approach, Graph-based Gene expression Module Identification (GbGMI), in samples from patients with longstanding RA, but limited synovial inflammation at arthroplasty, and validated this finding in an independent cohort of synovial biopsy samples from early, untreated RA patients. Single-cell RNA-seq analyses indicated these genes were most robustly expressed by lining layer fibroblasts and receptor-ligand interaction analysis predicted robust lining layer fibroblast crosstalk with pain sensitive CGRP+ dorsal root ganglion sensory neurons. Netrin-4, which is abundantly expressed by lining fibroblasts and associated with pain, significantly increased the branching of pain-sensitive CGRP+ neuronsin vitro. We conclude GbGMI is a useful method for identifying a module of genes that associate with a clinical feature of interest. Using this approach, we find that Netrin-4 is produced by synovial fibroblasts in the absence of inflammation and can enhance the outgrowth of CGRP+ pain sensitive nerve fibers.

One Sentence Summary

Machine Learning reveals synovial fibroblast genes related to pain affect sensory nerve growth in Rheumatoid Arthritis addresses unmet clinical need.
Analytic optimization ofPlasmodium falciparummarker gene haplotype recovery from amplicon deep sequencing of complex mixtures
Authors: Lapp Zena , Freedman Elizabeth , Huang Kathie , Markwalter Christine F , Obala Andrew A , Prudhomme-O’Meara Wendy , Taylor Steve M
Published: August 2023

Molecular epidemiologic studies of malaria parasites commonly employ amplicon deep sequencing (AmpSeq) of marker genes derived from dried blood spots (DBS) to answer public health questions related to topics such as transmission and drug resistance. As these methods are increasingly employed to inform direct public health action, it is important to rigorously evaluate the risk of false positive and false negative haplotypes derived from clinically-relevant sample types. We performed a control experiment evaluating haplotype recovery from AmpSeq of 5 marker genes (ama1,csp,msp7,sera2, andtrap) from DBS containing mixtures of DNA from 1 to 10 knownP. falciparumreference strains across 3 parasite densities in triplicate (n=270 samples). While false positive haplotypes were present across all parasite densities and mixtures, we optimized censoring criteria to remove 83% (148/179) of false positives while removing only 8% (67/859) of true positives. Post-censoring, the median pairwise Jaccard distance between replicates was 0.83. We failed to recover 35% (477/1365) of haplotypes expected to be present in the sample. Haplotypes were more likely to be missed in low-density samples with <1.5 genomes/µL (OR: 3.88, CI: 1.82-8.27, vs. high-density samples with ≥75 genomes/µL) and in samples with lower read depth (OR per 10,000 reads: 0.61, CI: 0.54-0.69). Furthermore, minority haplotypes within a sample were more likely to be missed than dominant haplotypes (OR per 0.01 increase in proportion: 0.96, CI: 0.96-0.97). Finally, in clinical samples the percent concordance across markers for multiplicity of infection ranged from 40%-80%. Taken together, our observations indicate that, with sufficient read depth, haplotypes can be successfully recovered from DBS while limiting the false positive rate.
FGF23 is a potential prognostic biomarker in uterine sarcoma
Authors: Yang Ling , Cai Ying , Wang Yunjia , Huang Yue , Zhang Chi , Ma Hu , Zhou Jian-Guo
Published: August 2023

Background

Uterine sarcoma (US) is a highly malignant cancer with poor prognosis and high mortality in women. In this study, we evaluated the expression of human fibroblast growth factor 23 (FGF23) in different US subtypes and the relationship between survival and clinicopathological characteristics.

Methods

We conducted a comparative analysis of FGF23 gene expression in different pathological types of US. Utilizing a cohort from The Cancer Genome Atlas (TCGA) of 57 patients, a 50-patient microarray dataset (GSE119043) from the Gene Expression Omnibus (GEO) and a clinical cohort of 44 patients, we analyzed gene expression profiles and corresponding clinicopathological information. Immunohistochemistry (IHC) was used to examine the expression level of FGF23 in four US subtypes. Survival analysis was used to assess the relationship between FGF23 expression and prognosis in US patients.

Results

Compared with uterine normal smooth muscle (UNSM) and uterine leiomyoma (ULM), FGF23 expression was significantly upregulated in US and was differentially expressed in four US subtypes. Uterine carcinosarcoma (UCS) exhibited the highest expression of FGF23 among the subtypes. Survival analysis indicated that FGF23 expression was unrelated to overall survival and progression-free survival in US (P>0.05). Similar results were obtained from the validation cohorts. Univariate and multivariate analyses showed no significant correlation between FGF23 expression and the US prognosis. Tumor stage, CA125 and tumor recurrence were independent prognostic factors for survival of US patients.

Conclusion

FGF23 was highly expressed in uterine sarcoma and was promising as a novel potential biomarker for the diagnosis and prognosis of uterine sarcoma.