bluuebunny/crossref_metadata_2025 huggingface dataset:
Earliest Prepared core technology in Eurasia from Nihewan (China): Implications for early human abilities and dispersals in East Asia
Authors: Ma Dong-Dong , Pei Shu-Wen , Xie Fei , Ye Zhi , Wang Fa-Gang , Xu Jing-Yue , Deng Cheng-Long , de la Torre Ignacio
Published: March 2024

Organized flaking techniques to obtain predetermined stone tools have been traced back to the early Acheulean (also known as mode 2) in Africa and are seen as indicative of the emergence of advanced technical abilities and in-depth planning skills among early humans. Here, we report one of the earliest known examples of prepared core technology in the archaeological record, at the Cenjiawan (CJW) site in the Nihewan basin of China, dated 1.1 Mya. The operational schemes reconstructed from the CJW refit sets, together with shaping patterns observed in the retouched tools, suggest that Nihewan basin toolmakers had the technical abilities of mode 2 hominins, and developed different survival strategies to adapt to local raw materials and environments. This finding predates the previously earliest known prepared core technology from Eurasia by 0.3 My, and the earliest known mode 2 sites in East Asia by a similar amount of time, thus suggesting that hominins with advanced technologies may have migrated into high latitude East Asia as early as 1.1 Mya.
Context-dependent design of induced-fit enzymes using deep learning generates well-expressed, thermally stable and active enzymes
Authors: Zimmerman Lior , Alon Noga , Levin Itay , Koganitsky Anna , Shpigel Nufar , Brestel Chen , Lapidoth Gideon D.
Published: March 2024

The potential of engineered enzymes in industrial applications is often limited by their expression levels, thermal stability, and catalytic diversity. De novo enzyme design faces challenges due to the complexity of enzymatic catalysis. An alternative approach involves expanding natural enzyme capabilities for new substrates and parameters. Here, we introduce CoSaNN (Conformation Sampling using Neural Network), an enzyme design strategy using deep learning for structure prediction and sequence optimization. CoSaNN controls enzyme conformations to expand chemical space beyond simple mutagenesis. It employs a context-dependent approach for generating enzyme designs, considering non-linear relationships in sequence and structure space. We also developed SolvIT, a graph NN predicting protein solubility in
Escherichia coli
, optimizing enzyme expression selection from larger design sets. Using this method, we engineered enzymes with superior expression levels, with 54% expressed in
E. coli
, and increased thermal stability, with over 30% having higher Tm than the template, with no high-throughput screening. Our research underscores AI’s transformative role in protein design, capturing high-order interactions and preserving allosteric mechanisms in extensively modified enzymes, and notably enhancing expression success rates. This method’s ease of use and efficiency streamlines enzyme design, opening broad avenues for biotechnological applications and broadening field accessibility.
Why the lower stratosphere cools when the troposphere warms
Authors: Lin Jonathan , Emanuel Kerry
Published: March 2024

Observational data have long suggested that in the tropics, when the troposphere locally warms, the lower stratosphere locally cools. Here, the observed anti-correlation between tropospheric and lower stratospheric temperature is confirmed—the lower stratosphere cools by approximately 2 degrees per degree of warming in the mid-troposphere. This anti-correlation is explained through a recently proposed theory holding that there is a quasi-balanced response of the stratosphere to tropospheric heating [J. Lin, K. Emanuel, Tropospheric thermal forcing of the stratosphere through quasi-balanced dynamics.
J. Atmos. Sci.
(2024).]. The local-scale anti-correlation between tropospheric and lower stratospheric temperature also holds when considering climate change—where the troposphere has been anomalously warming relative to the zonal mean, the lower stratosphere has been anomalously cooling, and vice versa. This suggests that zonally asymmetries in tropospheric temperature trends will be reflected in that of the lower stratospheric temperature trends. The zonally asymmetric trends are also found to be comparable in magnitude to the mean temperature trends in the lower stratosphere, highlighting the importance of the pattern of warming. The results and proposed theory suggest that in addition to forcing via wave-dissipation, the lower stratosphere can also be subject to direct forcing by the troposphere, through quasi-steady, quasi-balanced dynamics.
Chelation-directed interface engineering of in-place self-cleaning membranes
Authors: Yang Xiaobin , Li Yangxue , Wu Dan , Yan Linlin , Guan Jingzhu , Wen Yajie , Bai Yongping , Mamba Bhekie B. , Darling Seth B. , Shao Lu
Published: March 2024

Water–energy sustainability will depend upon the rapid development of advanced pressure-driven separation membranes. Although energy-efficient, water-treatment membranes are constrained by ubiquitous fouling, which may be alleviated by engineering self-cleaning membrane interfaces. In this study, a metal-polyphenol network was designed to direct the armorization of catalytic nanofilms (ca. 18 nm) on inert polymeric membranes. The chelation-directed mineralized coating exhibits high polarity, superhydrophilicity, and ultralow adhesion to crude oil, enabling cyclable crude oil-in-water emulsion separation. The in-place flux recovery rate exceeded 99.9%, alleviating the need for traditional ex situ cleaning. The chelation-directed nanoarmored membrane exhibited 48-fold and 6.8-fold figures of merit for in-place self-cleaning regeneration compared to the control membrane and simple hydraulic cleaning, respectively. Precursor interaction mechanisms were identified by density functional theory calculations. Chelation-directed armorization offers promise for sustainable applications in catalysis, biomedicine, environmental remediation, and beyond.
A numerical study of rigidity of hyperbolic splittings in simple two-dimensional maps
Authors: Bandtlow Oscar F , Just Wolfram , Slipantschuk Julia
Published: March 2024

Chaotic hyperbolic dynamical systems enjoy a surprising degree of rigidity, a fact which is well known in the mathematics community but perhaps less so in theoretical physics circles. Low-dimensional hyperbolic systems are either conjugate to linear automorphisms, that is, dynamically equivalent to the Arnold cat map and its variants, or their hyperbolic structure is not smooth. We illustrate this dichotomy using a family of analytic maps, for which we show by means of numerical simulations that the corresponding hyperbolic structure is not smooth, thereby providing an example for a global mechanism which produces non-smooth phase space structures in an otherwise smooth dynamical system.
Tailored mesoscopic plasma accelerates electrons exploiting parametric instability
Authors: Kumar Rakesh Y , Sabui Ratul , Gopal R , Li Feiyu , Sarkar Soubhik , Trickey William , Anand M , Pasley John , Sheng Z-M , Trines R M G M , Scott R H H , Robinson A P L , Sharma V , Krishnamurthy M
Published: March 2024

Laser plasma electron acceleration from the interaction of an intense femtosecond laser pulse with an isolated microparticle surrounded by a low-density gas is studied here. Experiments presented here show that optimized plasma tailoring by introducing a pre-pulse boosts parametric instabilities to produce MeV electron energies and generates electron temperatures as large as 200 keV with the total charge being as high as 350 fC/shot/sr, even at a laser intensity of a few times 1016 Wcm−2. Corroborated by particle-in-cell simulations, these measurements reveal that two plasmon decay in the vicinity of the microparticle is the main contributor to hot electron generation.
Investigating the impact of polarization on surface plasmon polariton characteristics in plasmonic waveguides under periodic driving fields
Authors: Herath Kosala , Gunapala Sarath D , Premaratne Malin
Published: March 2024

This study examines the impact of polarization in the driving field on the surface plasmon polariton (SPP) modes within plasmonic waveguides under the influence of a periodic driving field. Addressing a significant knowledge gap in the existing literature, we present a comprehensive investigation employing Floquet engineering techniques, with a specific emphasis on elliptically polarized fields as the dressing field. Our analysis reveals that the use of generalized Floquet states allows us to derive Floquet states for specific polarized dressing fields, such as linear, left-handed circular, and right-handed circular polarization. Remarkably, we demonstrate that Floquet states depend on the chirality of the dressing field’s polarization. Employing the Floquet-Fermi golden rule, we assess electron transport under various polarization types and find that the specific polarization type influence electron transport properties. However, we establish that the chirality of the polarization of the dressing field does not impact the transport properties. During our numerical analysis, we assess the alterations in SPP characteristics arising from two distinct types of polarization in dressing fields: linear polarization and circular polarization. Our results underscore the potential of employing a dressing field to effectively mitigate the propagation losses of SPPs in plasmonic metals, with the extent of improvement contingent on the specific polarization type. To quantify the performance enhancements of commonly used plasmonic metals under linearly and circularly polarized dressing fields, we employ a figure of merit (FoM). This study offers insights into the practical utilization of periodic driving fields as a powerful tool in advancing plasmonic communication within chip-scale environments.
Evolution and performance analysis of quantum well FinFET for 3 nm technology node with type-II strained tri-layered hetero-channel system
Authors: Nanda Swagat , Dhar Rudra Sankar
Published: March 2024

3D FinFETs are meticulously scaled down to sub-14 nm leading to reemerging undesirable characteristics namely increased Drain Induced Barrier Leakage (DIBL), higher subthreshold swing and excessive leakage currents. This inhibits the scaling of FinFETs and research suggests probable utilization of strained silicon technology in FinFETs to improve the on currents and transconductance of the nano devices. The emergence of quantum effects including velocity overshoot and carrier confinement severely affects the electrical characteristics at sub-10 nm channel length devices. Therefore, amalgamation of strained silicon prove to be a boon in FinFETs while being at par with the proposed 3 nm technology node of IRDS 2018, and designing to develop reliable devices at 08 nm gate length is the requisite. Thus, exploring the design and performance investigation of novel 08 nm Quantum Well FinFETs (QW-FinFETs) incorporating a tri-layered strained silicon Heterostructure-On-Insulator (HOI)are proposed with distinct channel dimensions which are analyzed and compared with existing devices. The optimum QW-FinFET device developed for 3 nm technology node of IRDS 2018 achieved a ∼25% enhancement in drain currents with Device D2 portraying almost ∼103% escalations in electron mobility on account of ballistic transport of charge carriers without scattering and enriching the performance for the future generation of device resulting in faster switching operation in sub-nano regime.
Influence of silicon nitride (Si3N4) reinforcement on mechanical properties and wear behaviour of AZ31–Nano alumina (Al2O3) composites developed through the stir casting route
Authors: Veera Ajay C , Manisekar K , Thoufiq Mohammed K
Published: March 2024

In this study, hybrid composites consisting of AZ31 alloy matrix reinforced with 2 wt% aluminum oxide nanoparticles (Al2O3) and 2, 4, or 6 wt% silicon nitride microparticles (Si3N4) have been prepared using the stir casting route. The mechanical properties, such as hardness, tensile strength, compression strength, impact strength, and sliding wear performance, were evaluated for the fabricated hybrid composites. The mechanical properties improve significantly with the inclusion of reinforcement content. The hybrid composite having 4 wt% Si3N4 reinforcement exhibits higher mechanical properties like micro-hardness (68.8 HV), tensile strength (172 MPa), percentage of elongation (11.9%), compression strength (278 MPa), and impact strength (6.4 J). The wear rate and coefficient of friction tend to reduce with the inclusion of Si3N4 reinforcement content under dry sliding wear conditions. Worn-out surface micrograph investigation displays wear mechanisms such as abrasive wear and plastic deformation with micro–ploughing and micro-cutting.
Study the effect of generating randomly rough interfaces on electron transport properties across the heterostructures
Authors: Abubaker Ali Hazim , Ebrahiminejad Zhaleh , Tehrani-Nasab Said
Published: March 2024

In the present paper, generating randomly rough interfaces -with two different types of correlation functions and dissimilar characteristics and morphologies- have been considered. The correlation functions of generated interfaces have Gaussian and exponential forms and they have been used in heterostructures as the rough interfaces. The main purpose of the present research is to study the effect of interfaces roughness types on the coherent electron transport through heterostructures. In order to better evaluation, the transport properties of heterostructures have been obtained for both planar and rough interfaces. The results show that the transmission probability and current density have the lower values with considering the rough interfaces, in comparison with the planar ones. Moreover, it is found that the generated interfaces by exponential correlation function were rougher than that Gaussian ones.
A novel finite difference scheme for numerical solution of fractional order population growth model
Authors: Rahrovi Yahya , Mahmoudi Yaghoub , Salimi Shamloo Ali , Jahangirirad Mohammad , Fathizadeh Einollah
Published: March 2024

In this paper, we propose a new scheme based on the implicit finite difference method for solving the fractional population growth model (FPGM). We use the well-known L1 finite difference method to approximate the Caputo fractional derivative of order 0 < α ≤ 1, and the linear interpolation to approximate the integral part. We provide a study on the stability and convergence of the scheme. We present the numerical solution of the proposed method and compare it with three other methods to demonstrate its validity and efficiency.
Studies on the impacts of the pore size and shape on deuterium retention in tungsten fuzzy nanostructures
Authors: Chen J.Y. , Dai S.Y. , Yang K.R. , Zu C.R. , Liu D.P. , Ni W.Y. , Liu S.G.
Published: March 2024

Tritium retention in plasma-facing materials is a critical issue that can significantly impact the long-term and steady-state operation of fusion devices. The experiments conducted in the laboratory device MIES have confirmed that the presence of the tungsten (W) nanostructure (called ‘fuzz’) leads to a substantial retention of hydrogen isotopes within W fuzz layer. This observation motivates us to conduct dedicated modeling to investigate the influence of W nanostructures on deuterium (D) retention using the three-dimensional kinetic Monte Carlo code SURO-FUZZ. The SURO-FUZZ code offers a great flexibility in generating diverse microscopic structures of the W fuzzy surface through the quartet structure generation set (QSGS) approach, which allows us to explore the effects of the pore size and shape on D retention. In this study, several different W nanostructures generated by QSGS approach are utilized to conduct a comprehensive comparison between MIES experiments and SURO-FUZZ simulations. It is demonstrated that the simulated D retention can be brought into a reasonable agreement with the experimental data. On this basis, predictive estimations of D retention on EAST and ITER have been performed with SURO-FUZZ modeling. The simulation results indicate that the total D retention induced by W fuzz remains well below the administrative limit of 700 g.
Template free synthesis of vacancy tailored, highly mesoporous one-dimensional δ-MnO2 for energy storage applications
Authors: Ramakrishnan Aswini , Swaminathan Sindhu , Mayandi Jeyanthinath , K G Deepa
Published: March 2024

This work involves the synthesis of highly conducting, ultra-thin, mesoporous manganese dioxide, nanotubes and nanowires, using a sol–gel technique. This is a template-free method for preparing mesoporous (3.3 to 5.4 nm) nanotubes and nanowires of 10–15 nm radius with surface area (221.19 m2/g-102.09 m2/g). In the MnO2 lattice, oxygen and cationic vacancies are tailored by changing the reducing agent for improved energy storage. X-ray photoelectron spectroscopic studies are conducted to quantify the oxygen and cationic vacancies. The tailored one-dimensional δ-MnO2 is used as an electrode material for symmetric and asymmetric supercapacitor designs. A non-toxic, less volatile aqueous neutral electrolyte is used for the supercapacitive measurement, giving a specific capacitance of 460.75 F g−1 at 2 mV s−1 with symmetric mode at 1 V. With activated carbon, this material can also produce asymmetric supercapacitors with a specific capacitance of 107.38 F g−1 at 10 mV s−1 at 1.7 V.
Real-World Impact of Blood Pressure Control in Patients With Apparent Treatment-Resistant or Difficult-to-Control Hypertension and Stages 3 and 4 Chronic Kidney Disease
Authors: Bakris George , Chen Cindy , Campbell Alicia K , Ashton Veronica , Haskell Lloyd , Singhal Mukul
Published: March 2024

BACKGROUND

Chronic kidney disease (CKD) is a common comorbidity in patients with apparent treatment-resistant hypertension (aTRH). We assessed clinical outcomes, healthcare resource utilization events, and costs in patients with aTRH or difficult-to-control hypertension and stage 3–4 CKD with uncontrolled vs. controlled BP.

METHODS

This retrospective cohort study used linked IQVIA Ambulatory EMR–US and IQVIA PharMetrics Plus claims databases. Adult patients had claims for ≥3 antihypertensive medication classes within 30 days between 01/01/2015 and 06/30/2021, 2 office BP measures recorded 1–90 days apart, ≥1 claim with ICD-9/10-CM diagnosis codes for CKD 3/4, and ≥1 year of continuous enrollment. Baseline BP was defined as uncontrolled (≥130/80 mm Hg) or controlled (<130/80 mm Hg) BP. Outcomes included risk of major adverse cardiovascular events plus (MACE+; stroke, myocardial infarction, heart failure hospitalization), end-stage renal disease (ESRD), healthcare resource utilization events, and costs during follow-up.

RESULTS

Of 3,966 patients with stage 3–4 CKD using ≥3 antihypertensive medications, 2,479 had uncontrolled BP and 1,487 had controlled BP. After adjusting for baseline differences, patients with uncontrolled vs. controlled BP had a higher risk of MACE+ (HR [95% CI]: 1.18 [1.03–1.36]), ESRD (1.85 [1.44–2.39]), inpatient hospitalization (rate ratio [95% CI]: 1.35 [1.28–1.43]), and outpatient visits (1.12 [1.11–1.12]) and incurred higher total medical and pharmacy costs (mean difference [95% CI]: $10,055 [$6,741–$13,646] per patient per year).

CONCLUSIONS

Patients with aTRH and stage 3–4 CKD and uncontrolled BP despite treatment with ≥3 antihypertensive classes had an increased risk of MACE+ and ESRD and incurred greater healthcare resource utilization and medical expenditures compared with patients taking ≥3 antihypertensive classes with controlled BP.
Comparing Antoine parameter sources for accurate vapor pressure prediction across a range of temperatures
Authors: Moshele Puleng , Stenzel Mark R , Drolet Daniel , Arnold Susan F
Published: March 2024

Determining the vapor pressure of a substance at the relevant process temperature is a key component in conducting an exposure assessment to ascertain worker exposure. However, vapor pressure data at various temperatures relevant to the work environment is not readily available for many chemicals. The Antoine equation is a mathematical expression that relates temperature and vapor pressure. The objective of this analysis was to compare Antoine parameter data from 3 independent data sources; Hansen, Yaws, and Custom data and identify the source that generates the most accurate vapor pressure values with the least bias, relative to the referent data set from the CRC Handbook of Chemistry and Physics. Temperatures predicted from 3 different Antoine sources across a range of vapor pressures for 59 chemicals are compared to the reference source. The results show that temperatures predicted using Antoine parameters from the 3 sources are not statistically significantly different, indicating that all 3 sources could be useful. However, the Yaws dataset will be used in the SDM 2.0 because the data is readily available and robust.
Electronic cigarette social norms among adolescents in New South Wales, Australia
Authors: Yazidjoglou Amelia , Watts Christina , Joshy Grace , Banks Emily , Freeman Becky
Published: March 2024

The use of electronic cigarettes (e-cigarettes) is common and increasing, especially among youth. In 2022/2023, 30% of 12- to 17-year-olds reported ever using e-cigarettes in Australia—a >50% increase from 2017 (14%). Several adverse e-cigarette health effects have been identified and most effects remain unknown. Social norms, rules that govern social behaviours, are associated with current and future adolescent e-cigarette use. Understanding social norms in Australian adolescents is critical to the development of targeted and effective e-cigarette prevention activities. This study aims to explore e-cigarette social norms among adolescents living in New South Wales, Australia. A total of 32 online single or paired semi-structured qualitative interviews were conducted involving 46 participants aged 14–17 years, as part of the Generation Vape project. Reflexive thematic analysis was applied within a constructivist perceptive. Adolescents perceived e-cigarettes use as prolific among their peers, with use considered common, acceptable and normal. Fuelled by social exposure to e-cigarettes, ‘everyone’ was generally thought to be using them (descriptive norms). E-cigarette use was considered so entrenched that it was part of adolescent identity, with abstinence regarded as atypical. Use was driven by an internalised desire to fit it (injunctive norm), rather than being attributed to overt/external ‘peer-pressure’. Positive e-cigarette norms exist among Australian adolescents with norm formation strongly influenced by social exposure, including e-cigarette promotion. Prevention efforts should include limiting adolescent exposure to e-cigarette marketing to help redefine existing pro-e-cigarette social norms and protect health.
Women, Peace and Security as deterrence? NATO and Russia's war against Ukraine
Authors: O'Sullivan Míla
Published: March 2024

NATO's security turn following Russia's 2014 invasion of Ukraine opened new prospects for adopting the Women, Peace and Security (WPS) agenda from external operations to all tasks of the alliance. Drawing on feminist institutionalism and feminist pragmatist approach to security, this article interrogates NATO's WPS localization in deterrence and territorial defence. I demonstrate that NATO has in the past decade been unable to operationalize WPS in deterrence and defence. I identify following obstacles to NATO's post-2014 WPS considerations: first, implementing WPS pragmatically as an external, depoliticized and low-priority military agenda pushed primarily by femocrats; second, taking WPS to the strategic level while omitting practical localization in deterrence and defence; and third, approaching WPS partnership with Ukraine as a unidirectional transfer of NATO's WPS knowledge to Ukraine rather than a mutual learning. I argue that these institutional factors made NATO's WPS implementation only reactive and ultimately ill-prepared for such gendered security crisis as the one caused by Russia's full-out war against Ukraine in 2022. The article makes the case for rethinking feminist conceptualization of deterrence through the convergence of WPS and resilience agendas. This concerns going beyond military deterrence and centring social and political practices which are linked to societal resilience.
NATO and the global colour line
Authors: Sen Somdeep
Published: March 2024

This article explores the role of NATO in the upkeep of what W. E. B. Du Bois termed the global ‘colour line’—namely a racialized division of the world. Formally, the organization views itself as a defensive alliance, focused on safeguarding the freedom and security of its member states. However, building on works that reveal the racialized founding and workings of international relations, I argue that this seemingly defensive aspiration is premised on an antagonistic, racialized conception of the global order that is tantamount to what Du Bois conceived as the ‘colour line’. For one thing, it is premised on the metropolitan notion that values such as freedom, security, stability, human rights, democracy and rule of law are endogenous to transatlantic alliance and, by extension, the global North. Furthermore, by positioning itself as a line of defence against threats to these values also presumes that such ‘good values’ are lacking beyond the geographical limits of this alliance. Empirically, this article will focus on NATO's policy engagement in the Middle East and its strategic concerns with ‘threats’ of terrorism, conflict, fragility and instability emanating from the region that undermine the freedom and security of the NATO states.
Strategic clarity or calamity? Competing logics of deterrence in the Taiwan Strait
Authors: Harris Peter , McKinney Jared M
Published: March 2024

What is the best way to restore or uphold deterrence when an existing deterrent is perceived to have decayed? One common answer is that deterrers should simply add more of the ingredients that generally make for strong deterrents: more certainty that threats will be carried out, more capabilities to inflict severe punishments upon an adversary, and greater capacity to carry out threats with celerity (speed). This answer draws upon an intuitive quantitative logic that more is always better when it comes to dissuading an adversary from taking unwanted actions. In this article, however, we explain how following this quantitative logic can have the unintended consequence of worsening security relations and provoking war, especially under conditions of shifting power. Using proposals for the United States to provide ‘strategic clarity’ regarding its intentions to defend Taiwan against Chinese aggression as a case-study, we show how efforts to maximize the certainty, severity and celerity of threats can backfire in practice. In general terms, our conclusion is that scholars and policy practitioners must assess the viability of deterrents from a qualitative perspective. With specific reference to Taiwan, we find that strategic clarity would be unlikely to strengthen deterrence in the Taiwan Strait.
Bargaining with Patriarchy in Peacemaking: The Failure of Women, Peace, and Security in Afghanistan
Authors: Akbari Farkhondeh , True Jacqui
Published: March 2024

After two decades of effort to embed Women, Peace, and Security (WPS), why and how did the agenda fail to transform patriarchal gendered structures and prevent the regression of women’s rights and security in Afghanistan? To address this question, the paper investigates how the WPS agenda was conceptualized and operationalized in Afghanistan. We apply Kandiyoti’s concept of patriarchal bargains to analyze multi-level power dynamics across four peace and conflict phases between 2001 and 2022, drawing from primary and secondary sources, including interviews with women leaders and key experts. While 20 years of engagement could not be expected to transform the country’s conservative gender order, we argue that WPS efforts lacked a grounded understanding of the gendered constraints in a conflict transition as well as a political strategy for achieving its goals. While the case of Afghanistan is unique, it is nonetheless highly relevant to other settings making significant investments in WPS. For advancing WPS, the paper suggests that the international normative framework must be connected to local voices that understand the context-specific, patriarchal power dynamics and how to bargain with them to achieve outcomes and gains for women’s security and rights.
An unusual anterior mitral leaflet perforation in a patient with no infective endocarditis: a case report
Authors: Wei Kaiming , Yao Yu , Liu Chuanzhen , Cao Yuan
Published: March 2024

Background

Mitral valve perforation refers to the occurrence of cracks or openings in the structure of the mitral valve, allowing blood to escape through these gaps. Typically, this is caused by infective endocarditis and the most common site is the anterior leaflet. However, it is crucial to explore other potential causes of valve damage, particularly when conventional risk factors are not apparent.

Case presentation

We present a case of a middle-aged male patient who developed mitral valve perforation because of aortic valve regurgitation in the absence of infective endocarditis.

Conclusion

Exploring such rare cases contributes to a deeper understanding of valvular diseases and enhances clinical decision making for effective management.
Final 1-Year Results of the TUTOR Randomized Trial Comparing Carpal Tunnel Release with Ultrasound Guidance to Mini-open Technique
Authors: Eberlin Kyle R. , Amis Benjamin P. , Berkbigler Thomas P. , Dy Christopher J. , Fischer Mark D. , Gluck James L. , Kaplan F. Thomas D. , McDonald Thomas J. , Miller Larry E. , Palmer Alexander , Perry Paul E. , Walker Marc E. , Watt James F.
Published: March 2024

Background:

Studies comparing carpal tunnel release with ultrasound guidance (CTR-US) to mini-open CTR (mOCTR) are limited. This randomized trial compared the efficacy and safety of these techniques.

Methods:

In this multicenter randomized trial, patients were randomized (2:1) to unilateral CTR-US or mOCTR. Outcomes included Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), numeric pain scale (0–10), EuroQoL-5 Dimension 5-Level (EQ-5D-5L), scar outcomes, and complications over 1 year.

Results:

Patients received CTR-US (n = 94) via wrist incision (mean 6 mm) or mOCTR (n = 28) via palmar incision (mean 22 mm). Comparing CTR-US with mOCTR, the mean changes in BCTQ-SSS (−1.8 versus -1.8; P = 0.96), BCTQ-FSS (−1.0 versus −1.0; P = 0.75), numeric pain scale (−3.9 versus −3.8; P = 0.74), and EQ-5D-5L (0.13 versus 0.12; P = 0.79) over 1 year were comparable between groups. Freedom from scar sensitivity or pain favored CTR-US (95% versus 74%; P = 0.005). Complications occurred in 2.1% versus 3.6% of patients (P = 0.55), all within 3 weeks postprocedure. There was one revision surgery in the CTR-US group, and no revisions for persistent or recurrent symptoms in either group.

Conclusions:

CTR-US and mOCTR demonstrated similar improvement in carpal tunnel syndrome symptoms and quality of life with comparable low complication rates over 1 year of follow-up. CTR-US was performed with a smaller incision and associated with less scar discomfort.
Usage of Dermal Regeneration Templates (Pelnac) for Coverage of Exposed Hand Tendons in Acute Setting
Authors: Ali Rama Ahmed , Hemidan Ahmed Gamal , Kadry Hamed Mohamed , Saad Ahmed Samy
Published: March 2024

Background:

The loss of soft tissue coverage of tendons is a challenging reconstructive problem after acute hand trauma. Subsequent tendon adhesions and the loss of range of movement in addition to the poor aesthetic outcome and donor site scarring should be avoided when deciding the plan of management. Pelnac is one of the commonly used skin substitutes in reconstructive surgery that can be used for coverage of exposed tendons, but the postoperative functional outcome needs to be addressed in detail.

Methods:

Twenty-six patients with acute isolated tendon injuries distal to the wrist joint were included. Two-stage reconstructive procedures were performed; the first one was the application of Pelnac. The second stage was carried out after the complete integration of Pelnac via the application of a split-thickness graft. The function outcome assesses the return of the normal range of motion to the affected hand and the QuickDASH score questionnaire. The aesthetic outcome was assessed using the Vancouver scar scale.

Results:

The Pelnac was integrated in 100% of cases, with complete grafts taken in 22 of 26 patients. The mean QuickDASH score was 20.5 ± 15.7, and mean Vancouver scar scale was 3.53 ± 3.2. The full range of motion returned in 22 of 26 patients.

Conclusions:

Using Pelnac to cover the exposed hand tendons in an acute setting is a convenient and efficient procedure with minimal morbidity. It can offer a good option for their coverage with preservation of hand function and acceptable aesthetic outcome.
Risk Evaluation in Occupational Safety and Health Research
Authors: Felknor Sarah A. , Streit Jessica M.K. , Morley Angela M. , Piacentino John D.
Published: March 2024

Objective

Research involving working populations can pose unique ethical and risk evaluation challenges. The purpose of this benchmarking project was to assess how federal agencies and academic institutions approach the interpretation and application of key risk evaluation concepts in research involving workers in their places of employment.

Methods

Key informant interviews were conducted to ascertain current practices related to assessing soundness of research design, determining risk reasonableness and research relatedness of risks, and evaluating the risk of noninvasive clinical tests in occupational settings.

Results

There were noteworthy commonalities among the approaches described to review and address critical aspects of risk evaluation for occupational safety and health research involving human participants.

Conclusions

The insights gleaned may help guide institutional review boards and Human Research Protection Programs as they consider the ethical issues of human subjects research in occupational settings.
Non-invasive vascular measures as prognostic predictors for older patients with non-ST elevation acute coronary syndrome
Authors: Dirjayanto Valerie J. , Pompei Graziella , Rubino Francesca , Biscaglia Simone , Campo Gianluca , Mihailidou A.S. , den Ruijter Hester , Kunadian Vijay
Published: March 2024

Background

Adverse cardiac events are common in older patients with non-ST elevation acute coronary syndrome (NSTEACS), yet prognostic predictors are still lacking. This study investigated the long-term prognostic significance of non-invasive measures including endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness in older NSTEACS patients referred for invasive treatment.

Methods

NSTEACS patients aged 75 years and older recruited to a multicentre cohort study (NCT01933581) were assessed for baseline endothelial function using endoPAT logarithm of reactive hyperemia index (LnRHI), CIMT using B-mode ultrasound, and vascular stiffness using carotid-femoral pulse wave velocity (cfPWV). Long-term outcomes included major adverse cardiovascular events (MACE), a composite of death, reinfarction, urgent revascularization, stroke/transient ischemic attack, and significant bleeding.

Results

Recruitment resulted in 214 patients assessed for LnRHI, 190 patients assessed for CIMT and 245 patients assessed for cfPWV. For LnRHI group (median follow-up 4.73 years [IQR: 1.41–5.00]), Cox regression analysis revealed a trend towards increased risk of MACE (HR: 1.24 [95% CI: 0.80–1.93]; P = 0.328) and mortality (HR: 1.49 [95% CI: 0.86–2.59]; P = 0.157), but no significance was reached. No difference for other components of MACE was found. For CIMT group (median follow up 4.74 years [IQR: 1.55–5.00]), no statistically significant difference in MACE was found (HR: 0.92 [95% CI: 0.53–1.59]; P = 0.754). Similarly, for cfPWV group (median follow-up 4.96 years [IQR: 1.55–5.00]), results did not support prognostic significance (for MACE, HR: 0.95 [95% CI: 0.65–1.39]; P = 0.794).

Conclusion

Endothelial function, CIMT and vascular stiffness were proven unsuitable as strong prognostic predictors in older patients with NSTEACS.

Clinical trial registration:

NCT01933581.
Non-insulin Medications for the Management of Type 2 Diabetes
Authors: Hayes Marla J.
Published: March 2024

Type 2 diabetes (T2D) is predicted to affect 366 million people over the age of 65 years by the year 2030. As the understanding of the core defects associated with T2D advanced, researchers recognized management should target multiple defects in glucose metabolism. As a result, efforts to manage T2D focus on developing new drug therapies aimed at addressing each of the identified metabolic defects. Optimal treatment of T2D is necessary to decrease the risk for coronary heart disease, stroke, and vascular diseases. This article discusses non-insulin pharmacologic treatments for T2D that are guided by glycemic efficacy, safety profiles, effects on weight and hypoglycemia risk, tolerability, patient comorbidities, route of administration, patient preference, and cost.
Premature Classification of Early-stage Endometrioid Ovarian Carcinoma With Mesonephric-like Differentiation as Mesonephric-like Adenocarcinoma
Authors: Miyama Yu , Ogasawara Aiko , Hasegawa Kosei , Yasuda Masanori
Published: March 2024

Ovarian mesonephric-like adenocarcinoma (MLA) is a rare tumor with potential origins in endometriosis and Müllerian-type epithelial tumors. The morphologic patterns of MLA overlap with those of endometrioid ovarian carcinoma (EnOC). We speculated that a subset of MLAs would be classified as EnOCs. In this study, we attempted to identify MLAs from malignant endometrioid tumors. Given that the study patients with MLAs had both endometrioid-like and mesonephric-like morphologies, we defined mesonephric-like differentiation (MLD) as an endometrioid tumor with focal or diffuse MLA morphology and immunophenotype. Twelve patients exhibited mesonephric-like morphologic patterns. Immunohistochemistry analysis for CD10, TTF-1, estrogen receptor (ER), GATA3, calretinin, and PAX8 expression was done using whole-section slides. Two patients without the MLA immunophenotype were excluded. Ten patients with EnOCs with MLD (8.3%) were identified from a cohort of 121 patients with malignant endometrioid tumors. All 10 patients were positive for TTF-1 and/or GATA3. Most patients were ER-negative. Morphologically, MLD was associated with papillary thyroid carcinoma-like nuclei, flattened cells, tubular, nested, reticular, or glomeruloid architecture, and infiltrative growth. All 10 patients had pre-existing endometriosis and/or adenofibromas. Among the EnOCs with MLD, 5 had coexisting components such as EnOC grade 1 [(G1), cases 4, 7, and 9], mucinous borderline tumor (case 1), and dedifferentiated carcinoma (case 10), with distinct borders between EnOC with MLD and the other components. Nine of the 10 MLA patients (90%) harbored KRAS hotspot mutations. In addition, 4 patients harboring other components shared common KRAS hotspot mutations. No significant prognostic differences were observed between patients with and without MLD. Based on our findings, we suggest that EnOC with MLD, especially in the early stages and without high-grade components, should be considered a subtype of EnOC. Overtreatment should be avoided in such patients, particularly in the early stages. In this study, as the characteristics between EnOC with MLD and MLA were not distinguishable, we considered both conditions to be on the same spectrum. EnOCs with MLD exhibit the MLA phenotype during disease progression and are prematurely classified as MLA. Nevertheless, more patients with EnOC who have MLD/MLA are required for a more robust comparison between conventional EnOC according to staging and grading.
Ten-Year Stability of an Insomnia Sleeper Phenotype and Its Association With Chronic Conditions
Authors: Lee Soomi , Smith Claire E. , Wallace Meredith L. , Buxton Orfeu M. , Almeida David M. , Patel Sanjay R. , Andel Ross
Published: March 2024

Objective

To identify distinct sleep health phenotypes in adults, examine transitions in sleep health phenotypes over time, and subsequently relate these to the risk of chronic conditions.

Methods

A national sample of adults from the Midlife in the United States study (N = 3683) provided longitudinal data with two time points (T1: 2004–2006, T2: 2013–2017). Participants self-reported on sleep health (regularity, satisfaction, alertness, efficiency, duration) and the number and type of chronic conditions. Covariates included age, sex, race, education, education, partnered status, number of children, work status, smoking, alcohol, and physical activity.

Results

Latent transition analysis identified four sleep health phenotypes across both time points: good sleepers, insomnia sleepers, weekend catch-up sleepers, and nappers. Between T1 and T2, the majority (77%) maintained their phenotype, with the nappers and insomnia sleepers being the most stable. In fully adjusted models with good sleepers at both time points as the reference, being an insomnia sleeper at either time point was related to having an increased number of total chronic conditions by 28%–81% at T2, adjusting for T1 conditions. Insomnia sleepers at both time points were at 72%–188% higher risk for cardiovascular disease, diabetes, depression, and frailty. Being a napper at any time point related to increased risks for diabetes, cancer, and frailty. Being a weekend catch-up sleeper was not associated with chronic conditions. Those with lower education and unemployed were more likely to be insomnia sleepers; older adults and retirees were more likely to be nappers.

Conclusion

Findings indicate a heightened risk of chronic conditions involved in suboptimal sleep health phenotypes, mainly insomnia sleepers.
Gender Differences in the Prevalence and Clinical Correlates of Metabolic Syndrome in First-Episode and Drug-Naïve Patients With Major Depressive Disorder
Authors: Zhang Jian-Jun , Wang Jingxia , Wang Xiao-Qian , Zhang Xiang-Yang
Published: March 2024

Objective

Major depressive disorder (MDD) is a severe psychiatric symptom worldwide, and the coexistence of MDD with metabolic syndrome (MetS) is common in clinical practice. However, gender differences in comorbid MetS in first-episode and drug-naïve (FEDN) MDD patients have not been reported. Here, we explored potential gender differences in the prevalence and clinical correlates of comorbid MetS in FEDN MDD patients.

Methods

A cross-sectional study of 1718 FEDN MDD patients was conducted. Demographic and clinical data were collected. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale, and Positive and Negative Syndrome Scale positive subscale were used to evaluate depression, anxiety, and psychotic symptoms, respectively.

Results

The prevalence of MetS was 1.645-fold higher in female MDD patients (38.50%) than in male patients (26.53%). Patients with MetS had higher HAMD score, Hamilton Anxiety Scale score, and Positive and Negative Syndrome Scale positive subscale score than patients without MetS (p values < .001). Furthermore, suicide attempts (male: odds ratio [OR] = 1.706, p = .034; female: OR = 1.639, p = .004) and HAMD score (male: OR = 1.251, p < .001; female: OR = 1.148, p < .001) were independently associated with MetS in male and female patients, whereas age of onset was independently associated with MetS only in female patients (OR = 1.744, p = .047).

Conclusions

Our findings suggest significant gender differences in the prevalence and clinical correlates of comorbid MetS in FEDN MDD patients. Clinical variables (suicide attempts and HAMD scores) may be independently associated with MetS in MDD patients.
Dynamic Associations Among Sleep, Emotion Dysregulation, and Desire to Live in a Perinatal Sample
Authors: Kaliush Parisa R. , Butner Jonathan E. , Williams Paula G. , Conradt Elisabeth , Crowell Sheila E.
Published: March 2024

Objective

The present study prospectively examined dynamic associations among sleep, emotion dysregulation, and desire to live during the perinatal transition, as it was theorized that these factors may contribute to the emergence of postpartum suicide risk.

Method

Ninety-four women (M
age = 29.2 years; 23.4% Latina) wore wrist actigraphs and completed twice daily surveys for 7 days during the third trimester of pregnancy, 6 weeks postpartum, and 4 months postpartum. Multilevel, change-as-outcome models were built to examine changes in attractor dynamics among sleep, emotion dysregulation, and desire to live, as well as if sleep-emotion dysregulation dynamics differed based on participants’ desires to live.

Results

From pregnancy to 6 weeks postpartum, emotion dysregulation (B = −0.09, p = .032) and desire to live (B = −0.16, p < .001) exhibited more stable temporal patterns around higher emotion dysregulation and lower desire to live. Compared to women who reported consistently high desires to live, those who experienced fluctuations in their desires to live exhibited lower, more stable sleep efficiency during pregnancy (B = −0.90, p < .001). At 4 months postpartum, those with fluctuating desires to live exhibited a coupling dynamic whereby low sleep efficiency predicted increases in emotion dysregulation (B = −0.16, p = .020).

Conclusions

This study was the first to examine nonlinear dynamics among risk factors for postpartum suicide, which may be evident as early as pregnancy and 6 weeks postpartum. Sleep health, in particular, warrants further exploration as a key susceptibility factor in the emergence of postpartum suicide risk.

Preregistration

Open Science Framework (https://osf.io/qxb75/?view_only=799ffe5c048842dfb89d3ddfebaa420d).
Sleep Disturbance as a Mediator of Lung Cancer Stigma on Psychological Distress and Physical Symptom Burden
Authors: Williamson Timothy J. , Garon Edward B. , Irwin Michael R. , Choi Alyssa K. , Goldman Jonathan W. , Stanton Annette L.
Published: March 2024

Objective

This study tested sleep disturbance as a mediator through which stigma and discrimination predict psychological distress and physical symptom burden in adults with lung cancer.

Methods

Lung cancer patients on active oncological treatment (N = 108; 74.1% stage IV) completed questionnaires on lung cancer stigma, sleep, distress, and physical symptoms at study entry and at 6- and 12-week follow-up. Mediation analyses were conducted to investigate whether stigma and discrimination predicted distress and physical symptoms at study entry and across 12 weeks through disrupted sleep.

Results

Higher discrimination (b = 5.52, 95% confidence interval [CI] = 2.10–8.94) and constrained disclosure (b = 0.45, 95% CI = 0.05–0.85) were associated significantly with higher sleep disruption at study entry. Sleep disruption, in turn, was associated with higher distress (b = 0.19, 95% CI = 0.09–0.29) and physical symptoms (b = 0.28, 95% CI = 0.17–0.40) at study entry. Sleep disruption significantly mediated relationships between higher discrimination and the outcomes of distress (indirect effect = 1.04, 95% CI = 0.13–1.96) and physical symptoms (indirect effect = 1.58, 95% CI = 0.37–2.79) at study entry. Sleep disruption also mediated relationships between constrained disclosure and the outcomes of distress (indirect effect = 0.85, 95% CI = < 0.01–0.17) and physical symptoms (indirect effect = 0.13, 95% CI = 0.01–0.25).

Conclusions

Lung cancer patients evidenced pronounced sleep disruption, which mediated relationships between indicators of lung cancer stigma and distress and physical symptoms at study entry. Research is needed to test additional mechanisms through which lung cancer stigma predicts these outcomes longitudinally.