bluuebunny/crossref_metadata_2025 huggingface dataset:
O.6.2-2 Building momentum: lessons learned in the promotion of physical activity in primary healthcare settings
Authors: Chow Kendra , Cooper Katy , Taylor Rebecca , Oldridge-Turner Kate , Wetzel Magdelena , Allen Kate
Published: September 2023

Purpose

Physical activity plays a vital role in promoting and maintaining good physical and mental health, but too many individuals are not meeting recommendations. Policies that support physical activity prescription (PAP) within primary healthcare (PHC) settings are a key tenet of a comprehensive, systems-wide approach to increase physical activity and help prevent and manage many non-communicable diseases, including cancers. The fourth Building Momentum report sets out the emerging evidence for the benefits of promoting physical activity in PHC, and explains why designing and enacting such policies is good for individual health and economies. This is the first known report of its kind, offering a global policy perspective on developments and progress, as well as guidance on foundational policy processes and components.

Description

Physical activity is a WCRF International policy priority, directly related to our cancer prevention recommendations and MOVING framework and policy database.

Research, writing and publication were managed by WCRF International. The current state of evidence and policies were evaluated through a literature review, and interviews conducted with subject-matter experts selected for their knowledge and experience.

The report was evaluated through two rounds of review, including by interviewees, physical activity experts, and individuals from the WCRF Network, Policy Advisory Group, and the WHO.

The report will be disseminated through an initial online launch event that will showcase the main findings, country reflections and guidance. Further dissemination will be through WCRF International’s health professional and policy networks, social media, and potentially conferences like HEPA.

Conclusions

The fourth Building Momentum report provides guidance on how to establish successful policies for PAP in PHC. It addresses key issues and potential barriers to adoption, as well as identifying foundational policy processes, including: using the evidence, building shared policy objectives, the importance of local contexts and equity underpinning all policy elements. It also identifies components for designing effective policies, including: PHC professional training, health systems capacity, incentivizing structures, the importance of communication and collaboration, and creating supportive patient environments.

Engaging with these findings, as well as examples of national programmes, will enable governments and health systems to enact well-designed policy on physical activity promotion in PHC.
Reverse genetic screening during L1 arrest reveals a role of the diacylglycerol kinase 1 gene dgk-1 and sphingolipid metabolism genes in sleep regulation
Authors: Koutsoumparis Anastasios , Busack Inka , Chen Chung-Kuan , Hayashi Yu , Braeckman Bart P , Meierhofer David , Bringmann Henrik
Published: September 2023

Sleep is a fundamental state of behavioral quiescence and physiological restoration. Sleep is controlled by environmental conditions, indicating a complex regulation of sleep by multiple processes. Our knowledge of the genes and mechanisms that control sleep during various conditions is, however, still incomplete. In Caenorhabditis elegans, sleep is increased when development is arrested upon starvation. Here, we performed a reverse genetic sleep screen in arrested L1 larvae for genes that are associated with metabolism. We found over 100 genes that are associated with a reduced sleep phenotype. Enrichment analysis revealed sphingolipid metabolism as a key pathway that controls sleep. A strong sleep loss was caused by the loss of function of the diacylglycerol kinase 1 gene, dgk-1, a negative regulator of synaptic transmission. Rescue experiments indicated that dgk-1 is required for sleep in cholinergic and tyraminergic neurons. The Ring Interneuron S (RIS) neuron is crucial for sleep in C. elegans and activates to induce sleep. RIS activation transients were abolished in dgk-1 mutant animals. Calcium transients were partially rescued by a reduction-of-function mutation of unc-13, suggesting that dgk-1 might be required for RIS activation by limiting synaptic vesicle release. dgk-1 mutant animals had impaired L1 arrest survival and dampened expression of the protective heat shock factor gene hsp-12.6. These data suggest that dgk-1 impairment causes broad physiological deficits. Microcalorimetry and metabolomic analyses of larvae with impaired RIS showed that RIS is broadly required for energy conservation and metabolic control, including for the presence of sphingolipids. Our data support the notion that metabolism broadly influences sleep and that sleep is associated with profound metabolic changes. We thus provide novel insights into the interplay of lipids and sleep and provide a rich resource of mutants and metabolic pathways for future sleep studies.
Impulse controllability for degenerate singular parabolic equations via logarithmic convexity method
Authors: Maarouf Hamid , Maniar Lahcen , Ouelddris Ilham , Salhi Jawad
Published: September 2023

In this paper, we study null approximate controllability of degenerate singular parabolic equations under the action of an impulsive control. To this aim, we prove an observation estimate at one point in time for the problems associated to the operators: $$ \begin{align*}& u_{t} -(x^{\alpha} u_{x})_{x} - \dfrac{\mu}{x^{\beta}} u = 0, \qquad x \in \left(0, 1\right), \end{align*} $$ where the parameters $\alpha \geq 0$, $\beta , \mu \in \mathbb{R}$ satisfy suitable assumptions. The method of proof combines both the logarithmic convexity and the Carleman commutator.
Artificial intelligence in railway infrastructure: current research, challenges, and future opportunities
Authors: Phusakulkajorn Wassamon , Núñez Alfredo , Wang Hongrui , Jamshidi Ali , Zoeteman Arjen , Ripke Burchard , Dollevoet Rolf , De Schutter Bart , Li Zili
Published: September 2023

The railway industry has the potential to make a strong contribution to the achievement of various sustainable development goals, by an expansion of its role in the transportation system of different countries. To realize this, complex technological and societal challenges are to be addressed, along with the development of suitable state-of-the-art methodologies fully tailored to the particular needs of the wide variety of railway infrastructure types and conditions. Artificial intelligence (AI) methods have been increasingly and successfully applied to solve practical problems in the railway infrastructure domain for over two decades. This paper proposes a review of the development of AI methods in railway infrastructure. First, we present a survey limited to selected journal papers published between 2010 and 2022. Bibliographical statistics are obtained, showing the increasing number of contributions in this field. Then, we select key AI methodologies and discuss their applications in the railway infrastructure. Next, AI methods for key railway components are analyzed. Finally, current challenges and future opportunities are discussed.
Genetic parameters for pulmonary arterial pressure, yearling performance, and carcass ultrasound traits in Angus cattle
Authors: Pauling Rachel C , Speidel Scott E , Thomas Milton G , Holt Timothy N , Enns R Mark
Published: September 2023

Pulmonary arterial pressure (PAP) can be used as an indicator of susceptibility to pulmonary hypertension and subsequent potential to develop right-sided heart failure (RHF). Previously reported heritability estimates of PAP have been moderate to high. Based on these estimates, selection for the indicator trait, PAP, could reduce the incidence of RHF due to hypoxia. Previous studies have also speculated that increased growth rates and body fat accumulation contribute to increased PAP and RHF. Research evaluating the genetic relationships between PAP and performance traits (e.g., yearling weight and postweaning gain) has yielded conflicting results, leading to ambiguity and uncertainty regarding the underlying genetic relationships. Additionally, no previous research has evaluated the relationship between PAP and ultrasound carcass traits. Therefore, the objective of this study was to estimate trait heritabilities and genetic correlations between PAP, post-weaning growth traits, and ultrasound carcass traits in Angus cattle, using data (n = 4,511) from the American Angus Association. We hypothesized that traits associated with increased growth and muscle would have a positive genetic (i.e., unfavorable) relationship with PAP. Estimates for heritability and genetic correlations were obtained using a multi-trait animal model. Heritability estimates for PAP (0.21 ± 0.04), post-weaning gain (PWG; 0.31 ± 0.04), and yearling weight (YWT; 0.37 ± 0.04) were within the range of estimates previously reported. Genetic correlations were weak (< 0.20) between PAP, PWG, and YWT. A low-to-moderate genetic correlation between PAP and ultrasound ribeye area (UREA) was found (0.25 ± 0.12). Genetic correlations between PAP, ultrasound back fat (UBF), ultrasound intramuscular fat (IMF), and ultrasound rump fat (RUMP) were weak (ranging in magnitude from −0.05 to 0.10) and therefore, do not provide strong support for the hypothesis of an antagonistic relationship between PAP and carcass ultrasound traits, while heritability estimates for UBF (0.43 ± 0.05), UREA (0.31 ± 0.04), IMF (0.35 ± 0.04), and RUMP (0.47 ± 0.05) were in the range of previously reported values.
Ending of the HIV Epidemic
Authors: Sokoloff Benjamin
Published: September 2023

Ending the HIV epidemic in the United States is possible. This chapter identifies the goals of the current nationwide initiative to eliminate new HIV infections in the United States and describes the pillars upon which the initiative was designed to achieve these goals. These goals include reducing the number of new infections by 75% by 2025 and 90% by 2030 by increasing the diagnosis, treatment, and prevention of HIV infection and rapid response to new clusters of HIV transmission. The chapter describes the pillars upon which the Ending the HIV Epidemic Initiative was designed to achieve these goals. The four pillars of the initiative are to increase the diagnosis, treatment, and prevention of HIV infection and the rapid response to new clusters of HIV transmissions. These pillars are based on the most robust evidence-based science, medicine, and public health principles derived from randomized controlled clinical trials.
Transmission Prevention Strategies
Authors: Chu Carolyn , Baumgartner Katrina , Bositis Christopher M.
Published: September 2023

HIV prevention encompasses a vast range of approaches and tools across biomedical, behavioral, social, and structural dimensions. Additionally, several structural factors have been identified as areas of opportunity for HIV prevention. Multiple medication options are now approved for use as pre-exposure prophylaxis, or PrEP, including long-acting antiretroviral therapy agents. Newer single-tablet regimens used as postexposure prophylaxis appear to be acceptable and well tolerated. HIV vaccine research continues to be an active area of scientific inquiry and public health interest. The chapter provides a brief overview of behavioral factors and opportunities surrounding HIV prevention, including considerations for unique circumstances and populations.
Immunology
Authors: Hartigan-O’Connor Dennis J. , Brander Christian
Published: September 2023

Chronic inflammation in human immunodeficiency virus (HIV) disease may have its origins in translocation of microbial products across a Th17 cell-deficient mucosal barrier. Collagen deposition in lymph nodes contributes to T-cell loss by interrupting homeostasis. Sensing of intracellular pathogens, including HIV in abortively infected cells, contributes to progressive CD4 + T-cell loss in chronic HIV infection. This chapter on immunology chapter covers how HIV effects the immune system as whole. Mechanisms of chronic inflammation in HIV as well as pathogenesis of immune reconstitution inflammatory syndromes are discussed. Immunologic effects of antiretroviral therapy and the role of persistent immune dysfunction during therapy on clinical outcomes is examined in this chapter. Many promising immune-based therapeutics are now being tested in small clinical trials. The chapter concludes with a review of the future of immune-based therapeutics in HIV disease.
HIV Testing and Counseling
Authors: Delgado Alejandro
Published: September 2023

The chapter HIV Testing and Counseling lists and describes the various types of HIV testing available. The chapter also presents an overview of HIV counseling, as well as how to adapt counseling to the variety of situations or environments in which these conversations can take place. HIV testing terminology and algorithms are presented to the reader along with descriptive figures. Laboratory markers for HIV are reviewed. The chapter describes who should be tested, as well as pre- and posttest counseling elements. A section of the chapter is dedicated to special populations and environments, including blood supply screening, prenatal screening, and testing settings. Strategies to improve uptake of HIV testing are discussed.
Health Maintenance
Authors: Kseri Ramiz
Published: September 2023

This chapter presents a detailed outline of tuberculosis (TB) screening and assessment methods and discusses testing frequency. The importance of routine dental care for people with HIV and immunization schedules for people with HIV is highlighted. The chapter describes screening indications (including exposure history) and assessment methods (including selection, interpretation, and limitations of screening tests in people with HIV (PWH); the importance of routine dental care for PWH and the essential information to be included in the treating physician’s written referral; the prevention of cardiovascular disease before clinical presentation among PWH; the immunization schedule for PWH; family planning and preconception care considerations in serodiscordant and seroconcordant couples living with HIV; and the recommended frequency and specimen collection technique for cervical Pap smears in female PWH, the role of human papillomavirus (HPV) testing, and indications for specialist referral for colposcopy.
Diversity Awareness
Authors: Spinner Gary F.
Published: September 2023

This chapter will help the learner to understand how concepts of social determinants of health and racial and ethnic disparities impact the care of people with HIV. The chapter discusses the meaning of systemic racism, and how it has contributed to, or failed to rectify, the health disparities among many persons with HIV. It provides an understanding of the diversity of persons with HIV, the complexity of their unique cultures that are shaped by a multitude of factors, and the importance of becoming competent in developing a clinician–patient relationship across cultural differences. It discusses the impact of stigma on healthcare-seeking behavior, treatment adherence, and safe practices among populations experiencing disproportionate access to healthcare including, adolescents, transgender persons, homeless or displaced individuals, incarcerated individuals, patients in rural settings, immigrants, and migrant workers.
The Pharmacist’s Role in HIV Care
Authors: Cocohoba Jennifer
Published: September 2023

Medications are essential tools used for prevention, treatment, and the management of co-occurring conditions in persons at risk for HIV and in persons living with HIV (PWH). A multidisciplinary approach to HIV care should consider the inclusion of a pharmacist because of pharmacists’ broad expertise on medication therapy. Pharmacists play an important role across the spectrum of HIV care: they facilitate access to medications, ensure accurate dispensing, and provide patients with education on their medications. This chapter provides an overview of the vital role HIV-experienced clinical pharmacists play as members of an ambulatory or hospital-based care settings, as they are able to help facilitate access to medications, ensure appropriate prescribing and dispensing practices, prevent and recognize medication errors including important drug–drug interactions, and share information with patients and caregivers on medication self-management and adherence. Collaborative drug therapy management agreements and statewide protocols achieved through legislative efforts can also help further the potential role and impact that pharmacists can play in ending the HIV epidemic.
Virology and Natural History of HIV
Authors: Mathur Poonam
Published: September 2023

Human immunodeficiency virus (HIV) is a member of the lentivirus subfamily of retroviruses. The HIV life cycle can be divided into two phases: virus entry, reverse transcription, entry into the nucleus, and integration of double-stranded DNA (the provirus) and regulation of production of viral proteins and new infectious virions. HIV enters the human cell via the CD4 receptor and chemokine coreceptors, primarily CCR5 and CXCR4. The viral genome is transcribed from RNA to DNA by reverse transcriptase and integrated into the host genome by integrase. The HIV genome encodes 15 proteins comprising three categories: structural, regulatory, and accessory. After budding from the host cell, the virus matures into its infectious form through cleavage of viral precursor proteins by protease. HIV structure and life cycle are highlighted in this chapter. The reader is provided information regarding how virology informs treatment aimed at various stages of the viral life cycle and virology in relation to current and potential drug targets. The chapter goes on to discuss viral classification, viral structure, and viral entry. Reverse transcription and integration are reviewed, and the chapter concludes with an overview of HIV natural history.
Scientific Basis of Antiretroviral Therapy
Authors: Koren David E. , Pandit Neha Sheth , Heil Emily
Published: September 2023

This chapter opens with a discussion about classes and mechanisms of antiretroviral agents. The mechanisms of action of the traditional versus newer antiretroviral classes is reviewed as well as the five major categories of antiretroviral agents. Key characteristics and findings of recent clinical trials from the US Department of Health and Human Services recommended regimens are reported. The topics of pharmacokinetics, pharmacodynamics, and pharmacogenomics are reviewed for the reader. Long-acting intramuscular (LAI) cabotegravir and rilpivirine are a novel, two-drug regimen containing an integrase strand transfer inhibitor and nonnucleoside reverse transcriptase inhibitor (NNRTI), respectively, that can be administered to PWH virologically suppressed on an oral ARV regimen. The combination of these LAI ARVs is approved to be administered every month or every two months. The chapter concludes with the topics of ARV dosing, coformulations, clinical trial design, and access programs to medicines in clinical trial development.
Prescribing Antiretroviral Therapy
Authors: Mathur Poonam , Mudroch Steven , Ajmal Saira , Temesgen Zelalem , Koren David E.
Published: September 2023

Uncontrolled HIV replication is associated with inflammation, accelerated aging, and a higher rate of comorbid illnesses, effects which have been shown to be reduced by earlier initiation of antiretroviral therapy (ART). Treatment of HIV with ART is highly effective at preventing HIV-1 transmission. This chapter provides an overview of what ART is and the current treatment guidelines according to the US Department of Health and Human Services and the International Antiviral Society-USA. The chapter enumerates the goals of ART and the rationale for treatment as soon as possible of all persons with HIV. Important criteria in selecting an initial treatment regimen is discussed as well as when to switch or simplify ART. Factors for consideration in ART regimen selection and other information involving ART are presented to the reader via tables.
Antiretroviral Treatment and Stewardship in Hospital Settings
Authors: Koren David E.
Published: September 2023

This chapter discusses the issues determining the relative priority of initiating and/or maintaining antiretroviral therapy in the context of hospitalized people with HIV with significant comorbid conditions as well as the continuity of care after discharge from the impatient setting. The chapter defines the antiretroviral stewardship and allows the learner to understand its potential benefit in implementation. It describes important consideration in the preoperative, perioperative, and postoperative care of people with HIV. An updated link to a reference table of available antiretroviral therapy (ART) formulations is provided. New ART agents since the last publication are incorporated in the chapter, and an additional resource regarding known absorption sites of ARVs, as well as pharmacokinetic effects of bariatric surgery on ARV, is provided. Lastly, the chapter describes the pharmacologic complications that may result from bariatric surgery.
Solid Organ Transplantation in Persons with HIV
Authors: Durand Christine M.
Published: September 2023

Until recently, people living with HIV were largely excluded from consideration of solid organ transplantation because of concerns regarding limited life expectancy and less favorable survival and graft outcomes. The HIV Organ Policy Equity Act allows use of organs from donors with HIV to be used for transplant for recipients with HIV under research protocols. Significant progress has been made in HIV D+/R + transplantation such that data demonstrate patient and graft survival rates in kidney transplant recipients with HIV are equivalent to that of seronegative kidney recipients, and liver transplant outcomes are improving over time and with use of highly effective hepatitis C treatment for people with HIV-hepatitis C virus (HCV) coinfection. Careful management of drug–drug interactions is crucial, and pretransplant evaluation includes comprehensive infection screening and vaccination.
Select Topics in the Care of Cis-Gender Women with HIV
Authors: Baron Jillian T. , Maguire Christina E. , Short William R.
Published: September 2023

Healthcare providers need to be proactive in addressing issues related to prepregancy care and contraception among individuals living with HIV who are of childbearing age and potential. While this is a chapter focused on the care of cis-gender women and family planning and prepregancy care considerations in serodifferent couples living with HIV, many of these topics including contraception and prepregnancy care relate to transgender and gender-diverse individuals. Cervical HPV infection and guideline recommendations for cervical Pap smears are reviewed. Considerations for gender-diverse patients are discussed. The chapter concludes with an overview of the clinical management of HIV-positive pregnant individuals, including recommendations for the use of antiretroviral therapy (ART) and drug disposition.
Endocrine and Metabolic Disorders
Authors: Sekhar Rajagopal V.
Published: September 2023

With the advent of effective antiretroviral therapeutic regimens, HIV infection has become a chronic disease. People living with HIV have a longer life expectancy, and we are now able to see the emergence of disorders in such people who live longer, and these include an increasing prevalence of endocrine and metabolic abnormalities. The underlying etiology of these disorders can be attributed to multiple factors, including the effects of HIV itself, antiretroviral therapies, inflammation, endothelial and immune dysfunction, and mitochondrial dysfunction. Since endocrine disorders are often insidious in their development, clinical suspicion and appropriate dynamic testing are necessary for accurate diagnosis and management and should include the participation of an endocrinologist where possible. This chapter helps identify the spectrum of endocrine and metabolic complications affecting people with HIV and the mechanisms and clinical management of endocrine and metabolic diseases associated with HIV and antiretroviral use. Specifically, certain protease inhibitors, nonnucleoside reverse transcriptase inhibitors, and integrase inhibitors are linked to changes in body morphology, lipohypertrophy, lipoatrophy, dyslipidemia, and weight gain. These manifest in multiple conditions including diabetes mellitus, adrenal disorders, thyroid abnormalities, gonadal dysfunction, metabolic disorders, nonalcoholic fatty liver disease, and premature aging. An overview of these manifesting conditions and treatment options are discussed.
Non-Opportunistic Infections
Authors: Chakrabarti Priyanka
Published: September 2023

This chapter demonstrates the diagnosis and treatment of respiratory complications in people with HIV. These complications include nonspecific interstitial pneumonitis (NSIP), HIV lymphocytic interstitial pneumonitis (LIP), diffuse infiltrative CD8+ lymphocyte syndrome, and pulmonary arterial hypertension (PAH). While the prevalence and etiology of NSIP are unknown, evidence suggests immune dysregulation plays a part. Thus, prevalence is declining with the use of newer antiretroviral regimens. LIP is a common respiratory infection in children with HIV however is a rare complication in adults with HIV. While the clinical presentation of PAH is similar in PWH as the general population, the prevalence is higher. After reviewing this module, learners will be able to diagnose, differentiate, and treat respiratory complications associated with HIV and antiretroviral use.
HIV and Hepatitis Coinfection
Authors: Vigil Karen J.
Published: September 2023

This chapter discusses the epidemiology, clinical presentation, diagnosis, treatment, and complications of hepatitis B and hepatitis C in people with HIV. The learner will gain an understanding that all people with HIV should have a complete evaluation for hepatitis B, which patients are candidates for hepatitis B vaccinations, and appropriate treatments for hepatitis B among patients living with HIV. The learner will also understand that patients with HIV who develop acute hepatitis C should be treated immediately, and rescreened for potential reinfection, which direct acting agents work best for patients with HIV and how to modify antiretroviral therapy to reduce drug–drug interactions, disease severity, and cost considerations.
The COVID-19 Pandemic and HIV
Authors: Prokesch Richard C.
Published: September 2023

SARS-CoV-2 infection has been rampant around the world and especially the United States; the pandemic has impacted activities of daily living and stressed health care systems. HIV does not appear to be an independent risk factor for developing COVID-19, and people living with HIV (PWH) on effective antiretroviral therapy (ART) have no greater risk of contracting or developing severe COVID-19 compared to individuals without HIV. However, approximately half of the US population of PWH is aged 50 years or older (with many experiencing multiple comorbidities), and older PWH are at increased risk of serious COVID-19 disease. Available therapies for COVID-19 are safe and relatively well-tolerated among PWH; special attention should be paid to drug–drug interactions between antivirals and ART. Similarly, vaccines for COVID-19 are safe and effective for PWH. This chapter provides a summary overview of the COVID-19 pandemic and how it impacts people with HIV and special considerations for healthcare providers. It summarizes the findings of investigations aimed to determine if PWH are more susceptible to COVID-19 compared to non-HIV infected populations. Lastly, it provides guidance and best practices on healthcare delivery during a pandemic.
HIV and Bone Health
Authors: Bedimo Roger
Published: September 2023

With improved long-term survival among persons living with HIV (PWH), age-related comorbidities, including osteoporosis and fragility fractures, have become more prevalent. There are limited HIV-specific evidence-based recommendations regarding screening for bone disease, although extrapolation of screening recommendations from the general population is reasonable. This chapter delineates the prevalence of low bone mineral density and fractures in PWH and helps the learner to become familiar with the concept that metabolic bone disease is a common manifestation of HI infection with an increased risk of fracture. The learner will be able to discuss risk factors associate with diminished bone mineral density and fractures for PWH, understand screening indications and diagnostic tests used to identify bone disease among PWH, and identify current strategies for PWH who have low one-mineral density or have sustained bond fractures.
Recurring outbursts of the supernova impostor AT 2016blu in NGC 4559
Authors: Aghakhanloo Mojgan , Smith Nathan , Milne Peter , Andrews Jennifer E , Van Dyk Schuyler D , Filippenko Alexei V , Jencson Jacob E , Lau Ryan M , Sand David J , Wyatt Samuel , Zheng WeiKang
Published: September 2023

We present the first photometric analysis of the supernova (SN) impostor AT 2016blu in NGC 4559. This transient was discovered by the Lick Observatory Supernova Search in 2012 and has continued its outbursts since then. Optical and infrared photometry of AT 2016blu reveals at least 19 outbursts in 2012–2022. Similar photometry from 1999 to 2009 shows no outbursts, indicating that the star was relatively stable in the decade before discovery. Archival Hubble Space Telescope observations suggest that the progenitor had a minimum initial mass of $M \gtrsim 33$ M⊙ and a luminosity of $L \gtrsim 10^{5.7}$ L⊙. AT 2016blu’s outbursts show irregular variability with multiple closely spaced peaks having typical amplitudes of 1–2 mag and durations of 1–4 weeks. While individual outbursts have irregular light curves, concentrations of these peaks recur with a period of ∼113 ± 2 d. Based on this period, we predict upcoming outbursts in 2023 and 2024. AT 2016blu shares similarities with SN 2000ch in NGC 3432, where outbursts may arise from periastron encounters in an eccentric binary containing a luminous blue variable (LBV). We propose that AT 2016blu’s outbursts are also driven by interactions that intensify around periastron in an eccentric system. Intrinsic variability of the LBV-like primary star may cause different intensity and duration of binary interaction at each periastron passage. AT 2016blu also resembles the periastron encounters of η Carinae prior to its Great Eruption and the erratic pre-SN eruptions of SN 2009ip. This similarity and the onset of eruptions in the past decade hint that AT 2016blu may also be headed for a catastrophe, making it a target of great interest.
Spectral investigation of the interstellar cloud towards a runaway star AE Aur
Authors: Bondar A , Krełowski J
Published: September 2023

The goal of this study is tracking of possible changes in the spectrum of the interstellar cloud seen along the sightline towards a runaway star AE Aur. The study considers variations in the radial velocities of the interstellar molecules and atoms, dwelling in the cloud, for the period ≈17 yr. The most recent results of 6 yr monitoring of equivalent widths variability for the CH and CH+ absorption lines are also presented. The study was done using the CH B-X(0,0) 3886 Å, A-X (0,0) 4300 Å and the CH+ A-X (1-0) 3958 Å, A-X (0,0) 4232 Å lines as well as the interstellar potassium K i 7699 Å line. Moreover, a short discussion concerning the distance to the star is included. The present study is a continuation of our previous works and works of other researchers dedicated to the problem of small-scale structure in diffuse interstellar clouds. High resolution optical spectra from different spectrographs have been used in this work. The results of the study do not demonstrate significant changes in the radial velocities of the spectral features mentioned. The intensities of the CH and CH+ lines show slight tendency to vary at 1–3  per cent level.
On the triple pulsar profiles generated by ordinary mode
Authors: Beskin V S , Istomin A Yu , Mikhaylenko A G
Published: September 2023

A detailed study of the refraction of an ordinary wave in the magnetosphere of radio pulsars was carried out. For this, a consistent theory of the generation of secondary particles was constructed, which essentially takes into account the dependence of the number density and the energy spectrum of secondary particles on the distance from the magnetic axis. This made it possible to determine with high accuracy the refraction of the ordinary O-mode in the central region of the outflowing plasma, which makes it possible to explain the central peak of three-humped mean radio profiles. As shown by detailed numerical calculations, in most cases it is possible to reproduce quite well the observed mean profiles of radio pulsars.
P11.06.B PERFUSION MRI IMPACTS MANAGEMENT IN PATIENTS WITH TREATED GLIOMA: FIRST RESULTS FROM THE PERISCOPE PROJECT
Authors: Teunissen W , Derks S , Labrecque J , Lam C , Hunink M , Dirven L , van der Hoorn A , Smits M ,   PERISCOPE consortium
Published: September 2023

BACKGROUND

Perfusion MRI (pMRI) is widely used for differentiation between progressive disease and pseudoprogression in patients with treated glioma. Although pMRI has long been available, its clinical relevance and utilization are not well known. We investigate the role of pMRI in clinical management decisions and its association with overall survival (OS) in patients with glioma under surveillance after focal radiotherapy.

MATERIALS AND METHODS

We performed a retrospective multicenter cohort study of patients treated for glioma between 2008 and 2021. At the moment of first substantial abnormalities on follow-up MRI, both with or without pMRI, we collected the management decisions, information about the (p)MRI and clinical parameters from the patient records. Causal inference methods were used to design a model predicting the probability of a management change with or without pMRI at first scan after radiotherapy (baseline), during chemotherapy (on-treatment) and after treatment. A multivariable Cox-proportional hazards model was used for OS analysis (adjusted for age, clinical performance, surgery type, histopathological diagnosis). Subgroup analyses were performed for patients with glioblastoma only.

RESULTS

976 patients (mean age 57.2 ±12.4 years; 649 men) were included in 7 neuro-oncological referral centers (4 academic), 548 with and 428 without pMRI. Eighty percent of pMRI scans were of sufficient quality. Eighty percent of patients had glioblastoma and in this group, during the “on-treatment” phase, there was a 16% lower probability of change in clinical management in patients with pMRI, which was more pronounced (37%) in academic hospitals. OS was longer in patients with versus without pMRI with a hazard ratio of 0.77 (95%CI: 0.67,0.89, p<0.001). These findings were similar when only considering patients with glioblastoma.

CONCLUSION

pMRI was associated with fewer management changes while patients were on treatment, and with longer OS. This latter result must be interpreted with caution due to possible confounding.:
Breeders’ age, nest-site characteristics and climatic conditions but not density-dependent effects determine Bonelli’s Eagle breeding performance: A long-term study (2002–2021)
Authors: López-Peinado Andrés , López-López Pascual
Published: September 2023

The conservation of endangered species is a crucial topic in conservation biology due to the important ecological roles these species play in their respective ecosystems. Top predators are particularly vulnerable to the variation in environmental conditions. The Bonelli’s Eagle (Aquila fasciata) is a long-lived bird of prey that fulfills its role as a top predator in Mediterranean ecosystems, but its overall population has declined in the Iberian Peninsula in recent decades. As with other long-lived species, the Bonelli’s Eagle reaches its maximum fitness at maturity, highlighting the importance of assessing how intrinsic and extrinsic factors affect population dynamics over time. In this study, we conducted annual surveys of a Bonelli’s Eagle subpopulation in the eastern Iberian Peninsula from 2002 to 2021. Our results indicate that the large decline observed in the number of occupied territories, fledged chicks, and successful pairs is not due to negative density-dependent effects but rather influenced by various environmental and demographic factors. These factors include breeders’ age, nest-site characteristics, climatic conditions, and previous breeding costs. We found that productivity was higher in territories with high winter precipitation and temperatures, as well as in coastal areas, leading to earlier laying dates. Additionally, the presence of subadult individuals in the breeding pair decreased breeding performance. Interestingly, the variability in the number of fledglings in each territory was driven by previous breeding costs. Prioritizing efforts to mitigate adult mortality and conserve suitable habitats becomes imperative to halt the ongoing decline of this population and also to enhance productivity, ultimately facilitating the restoration of the species to previous population levels.
Adverse Selection and Climate Risk: A Response to
Authors: LaCour-Little Michael , Pavlov Andrey , Wachter Susan
Published: September 2023

We identify two issues in the work of Ouazad and Kahn (2022). Correcting either reverses the original result. The two changes are to use the correct FHFA conforming loan limits for each county and year and to compare the individual loan amount to that limit correctly. There is no evidence that lenders transfer climate risk by altering loan origination and securitization behavior. None of our results calls into question the value and importance of the O&K model as a test for adverse selection. The question addressed and the setup of the test are important and should be replicated over time.
Trustee powers—observations from Australia
Authors: Appleby Daniel , Nathani Shruti
Published: September 2023

Much of the current and future intergenerational wealth transfers in Australia is and will be through discretionary family trust structures and testamentary trusts. The number of disputes in relation to the administration of these trusts will very likely increase. This article provides a general overview of some specific aspects of trust administration and trustee powers and obligations in Australia, including adding and removing beneficiaries, decanting trust assets, provision of information to beneficiaries, fettering of discretions and avoiding or resolving disputes in relation to the exercise of those powers.
Disparate Impact: How Does Social Deprivation Affect Patient-reported Outcomes After ACL Reconstruction in Children and Adolescents?
Authors: Kiani Sara N. , England Patrick , Gornitzky Alex L. , Renjilian Christopher B. , Williams Brendan A. , Ganley Theodore J.
Published: September 2023

Background:

Research has indicated that lower socioeconomic status is associated with delays in the treatment of anterior cruciate ligament (ACL) injuries; however, there is a paucity of literature evaluating its association with patient-reported outcomes (PROs). Using the Area Deprivation Index (ADI), a validated proxy for socioeconomic status, the study aimed to determine how relative socioeconomic disadvantage is related to PROs after primary ACL reconstruction (ACLR) in pediatric patients.

Methods:

This retrospective cohort study included all patients 18 years old or above who underwent primary ACLR at an academic institution between 2018 and 2021. Exclusion criteria included multiligament injury, congenital ACL absence, and absent outcomes data. The minimum follow-up was 6 months. A Patient-reported Outcomes Measurement Information System (PROMIS) 50 Pediatric self-report questionnaire was completed at postoperative visits, and domain scores for pain, physical function/mobility, fatigue, anxiety, depression, and peer relationships were generated. The National ADI percentile was calculated using the patients’ addresses. Patients were divided into quartiles (low, moderate, moderate-severe, and severe ADI), and comparative analyses were performed to determine the relationship between ADI and PROMIS.

Results:

A total of 413 patients were identified, including 49% (n=207), 33% (n=139), 11% (n=48), and 7% (n=30) from the low, moderate, moderate-severe, and severe deprivation areas, respectively. As compared with those in the low-deprivation quartile, patients in the severe deprivation quartile had delayed time to the first clinic visit (11 vs. 16.5 d, P=0.044) and surgery (51 vs. 80 d, P=0.004). There were no differences in the number of additional procedures required at index surgery. All quartiles had progressive improvements in physical function/mobility and pain scores throughout recovery, but at 9 months, there was significantly more pain in the severe deprivation cohort, despite no difference in self-reported physical function and mobility. Those with severe socioeconomic disadvantage had worse psychosocial outcomes, including significantly increased depression, fatigue, and anxiety and decreased peer relationship scores.

Conclusions:

Although there were no differences in preoperative PROMIS scores, pediatric patients living in areas with higher levels of socioeconomic deprivation/disadvantage had worse psychosocial PROs after ACLR.

Level of Evidence:

Level III—retrospective comparative study.
Intrarater and Interrater Reliability of Radiographic Characteristics in Skeletally Immature Patients With Anterior Cruciate Ligament Tears: A PLUTO Study Group Reliability Study
Authors: Perkins Crystal A. , Coene Ryan P. , Miller Patricia E. , Anderson Chris N. , Nunally Kianna D. , Parikh Shital N. , Busch Michael T. , Chambers Henry G. , Christino Melissa A. , Cordasco Frank A. , Edmonds Eric W. , Fabricant Peter D. , Ganley Theodore J. , Green Daniel W. , Heyworth Benton E. , Lawrence John Todd R. , Matava Matthew J. , Micheli Lyle J. , Milewski Matthew D. , Nepple Jeffrey , Pennock Andrew T. , Saluan Paul M. , Shea Kevin G. , Wall Eric J. , Willimon Samuel C. ,   PLUTO Study Group, Kocher Mininder S.
Published: September 2023

Background:

Radiographic measurements of limb alignment in skeletally immature patients with anterior cruciate ligament (ACL) tears are frequently used for surgical decision-making, preoperative planning, and postoperative monitoring of skeletal growth. However, the interrater and intrarater reliability of these radiographic characteristics in this patient population is not well documented.

Hypothesis:

Excellent reliability across 4 raters will be demonstrated for all digital measures of length, coronal plane joint orientation angles, mechanical axis, and tibial slope in skeletally immature patients with ACL tears.

Study Design:

Cohort study (diagnosis).

Methods:

Three fellowship-trained orthopaedic surgeons and 1 medical student performed 2 rounds of radiographic measurements on digital imaging (lateral knee radiographs and long-leg radiographs) of skeletally immature patients with ACL tears. Intrarater and interrater reliability for continuous radiographic measurements was assessed with intraclass correlation coefficients (ICCs) across 4 raters with 95% CIs for affected and unaffected side measurements. Interrater reliability analysis used an ICC (2, 4) structure and intrarater reliability analysis used an ICC (2, 1) structure. A weighted kappa coefficient was calculated for ordinal variables along with 95% CIs for both interrater and intrarater reliability. Agreement statistic interpretations are based on scales described by Fleiss, and Cicchetti and Sparrow: <0.40, poor; 0.40 to 0.59, fair; 0.60 to 0.74, good; and >0.74, excellent.

Results:

Radiographs from a convenience sample of 43 patients were included. Intrarater reliability was excellent for nearly all measurements and raters. Interrater reliability was also excellent for nearly all reads for all measurements.

Conclusion:

Radiographic reliability of long-leg radiographs and lateral knee x-rays in skeletally immature children with ACL tears is excellent across nearly all measures and raters and can be obtained and interpreted as reliable and reproducible means to measure limb length and alignment.

Level of Evidence:

Level III.
Laparoscopic Versus Transanal Ileal-Pouch Anal Anastomosis for Ulcerative Colitis: A Patient-Centered Treatment Trade-Off Study
Authors: Yang Mei Lucy , Brar Mantaj S. , Kennedy Erin , de Buck van Overstraeten Anthony
Published: September 2023

BACKGROUND:

Transanal ileal pouch anal anastomosis is a relatively new technique aiming to reduce surgical invasiveness while providing better access to the pelvis in patients with ulcerative colitis. Currently, patients’ preference on surgical approach has never been investigated.

OBJECTIVE:

To observe patient preference between transanal and laparoscopic ileal pouch anal anastomosis by measuring the potential risk, expressed in pouch function reduction, patients are willing to take to undergo transanal surgery.

DESIGN:

We conducted standardized interviews of patients using the threshold technique.

SETTINGS:

Patients from Mount Sinai Hospital in Toronto were included.

PATIENTS:

Fifty-two patients with ulcerative colitis participated in this study.

INTERVENTION:

Patients with ulcerative colitis, with or without previous pouch surgery were submitted to standardized interviews using the threshold technique.

MAIN OUTCOME MEASURES:

We measured the absolute increase in bowel frequency, bowel urgency, and fecal incontinence patients would accept if undergoing transanal ileal pouch anal-anastomosis.

RESULTS:

Thirty-two patients (mean age: 38.7 ± 15.3) with previous surgery and 20 patients (mean age: 39.5 ± 11.9) with no previous surgery participated in this study. Patients accepted an absolute increase of 2 bowel movements per day and one episode of fecal incontinence per month to undergo transanal ileal pouch anal anastomosis. They also accepted 10 minutes of worsening bowel urgency (ie. decrease 10 minutes of “holding time”) for transanal surgery. Younger patients aged 21-29 only accepted an absolute decrease of 5 minutes in “holding time” (P = 0.02).

LIMITATIONS:

Biases inherent to study design.

CONCLUSIONS:

Patients were willing to accept a potential reduction in pouch function to receive the less invasive method of transanal ileal pouch anal anastomosis. More studies evaluating long-term functional outcomes after transanal ileal pouch anal anastomosis are required to help patients make educated surgical decisions..
Hepatocyte transplantation: The progress and the challenges
Authors: Sun Zhen , Yuan Xiang , Wu Jingqi , Wang Chenhua , Zhang Kun , Zhang Ludi , Hui Lijian
Published: September 2023

Numerous studies have shown that hepatocyte transplantation is a promising approach for liver diseases, such as liver-based metabolic diseases and acute liver failure. However, it lacks strong evidence to support the long-term therapeutic effects of hepatocyte transplantation in clinical practice. Currently, major hurdles include availability of quality-assured hepatocytes, efficient engraftment and repopulation, and effective immunosuppressive regimens. Notably, cell sources have been advanced recently by expanding primary human hepatocytes by means of dedifferentiationin vitro. Moreover, the transplantation efficiency was remarkably improved by the established preparative hepatic irradiation in combination with hepatic mitogenic stimuli regimens. Finally, immunosuppression drugs, including glucocorticoid and inhibitors for co-stimulating signals of T cell activation, were proposed to prevent innate and adaptive immune rejection of allografted hepatocytes. Despite remarkable progress, further studies are required to improvein vitrocell expansion technology, develop clinically feasible preconditioning regimens, and further optimize immunosuppression regimens or establishex vivogene correction-based autologous hepatocyte transplantation.