bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial intelligence-enabled electrocardiogram screens low left ventricular ejection fraction with a degree of confidence
Authors: Lee Chun-Ho , Liu Wei-Ting , Lou Yu-Sheng , Lin Chin-Sheng , Fang Wen-Hui , Lee Chia-Cheng , Ho Ching-Liang , Wang Chih-Hung , Lin Chin
Published: December 2022

Background

Artificial intelligence-enabled electrocardiogram has become a substitute tool for echocardiography in left ventricular ejection fraction estimation. However, the direct use of artificial intelligence-enabled electrocardiogram may be not trustable due to the uncertainty of the prediction.

Objective

The study aimed to establish an artificial intelligence-enabled electrocardiogram with a degree of confidence to identify left ventricular dysfunction.

Methods

The study collected 76,081 and 11,771 electrocardiograms from an academic medical center and a community hospital to establish and validate the deep learning model, respectively. The proposed deep learning model provided the point estimation of the actual ejection fraction and its standard deviation derived from the maximum probability density function of a normal distribution. The primary analysis focused on the accuracy of identifying patients with left ventricular dysfunction (ejection fraction ≤ 40%). Since the standard deviation was an uncertainty indicator in a normal distribution, we used it as a degree of confidence in the artificial intelligence-enabled electrocardiogram. We further explored the clinical application of estimated standard deviation and followed up on the new-onset left ventricular dysfunction in patients with initially normal ejection fraction.

Results

The area under receiver operating characteristic curves (AUC) of detecting left ventricular dysfunction were 0.9549 and 0.9365 in internal and external validation sets. After excluding the cases with a lower degree of confidence, the artificial intelligence-enabled electrocardiogram performed better in the remaining cases in internal (AUC = 0.9759) and external (AUC = 0.9653) validation sets. For the application of future left ventricular dysfunction risk stratification in patients with initially normal ejection fraction, a 4.57-fold risk of future left ventricular dysfunction when the artificial intelligence-enabled electrocardiogram is positive in the internal validation set. The hazard ratio was increased to 8.67 after excluding the cases with a lower degree of confidence. This trend was also validated in the external validation set.

Conclusion

The deep learning model with a degree of confidence can provide advanced improvements in identifying left ventricular dysfunction and serve as a decision support and management-guided screening tool for prognosis.
“I think it's something that we should lean in to”: The use of OpenNotes in Canadian psychiatric care contexts by clinicians
Authors: Kassam Iman , Shin Hwayeon Danielle , Durocher Keri , Lo Brian , Shen Nelson , Mehta Rohan , Sockalingam Sanjeev , Wiljer David , Gratzer David , Sequeira Lydia , Strudwick Gillian
Published: December 2022

Background

OpenNotes is the concept of patients having access to their health records and clinical notes in a digital form. In psychiatric settings, clinicians often feel uncomfortable with this concept, and require support during implementation.

Objective

This study utilizes an implementation science lens to explore clinicians’ perceptions about using OpenNotes in Canadian psychiatric care contexts. The findings are intended to inform the co-design of implementation strategies to support the implementation of OpenNotes in Canadian contexts.

Method

This qualitative descriptive study employed semi-structured interviews which were completed among health professionals of varying disciplines working in direct care psychiatric roles. Data analysis consisted of a qualitative directed content analysis using themes outlined from an international Delphi study of mental health clinicians and experts. Ethical approval was obtained from the Centre for Addiction and Mental Health and the University of Toronto.

Results

In total, 23 clinicians from psychiatric settings participated in the interviews. Many of the themes outlined within the Delphi study were voiced. Benefits included enhancements to patient recall, and empowerment, improvements to care quality, strengthened relational effects and effects on professional autonomy and efficiencies. Despite the anticipated benefits of OpenNotes, identified challenges pertained to clarity surrounding exemption policies, training on patient facing notes, managing disagreements, and educating patients on reading clinical notes.

Conclusion

Many benefits and challenges were identified for adopting OpenNotes in Canadian psychiatric settings. Future work should focus on applying implementation frameworks to develop interventions that address the identified challenges.
Consumer Perceived Service Quality and Purchase Intention: Two Moderated Mediation Models Investigation
Authors: Liao Shu-Hsien , Hu Da-Chian , Chou Huan-Lun
Published: December 2022

This study aims to investigate the relationships of perceived service quality, brand image, customer satisfaction, and purchase intention. The moderated mediating role of brand love is examined on 522 mobile phone consumers in Taiwan. This study found a positive relationship between perceived service quality and purchase intention. Brand image and customer satisfaction play a fully mediated role between perceived service quality and purchase intention. Moderated mediation model one and two found that brand love plays a moderated mediating role on perceived service quality through brand image and customer satisfaction to purchase intention respectively. The results indicate that when the degree of brand love is high, the indirect effect of brand image on the perceived service quality of the purchase intention is strong; on the contrary, when the degree of brand love is low, the indirect effect of brand love on the perceived service quality and purchase intention is weak.
The Impact of Sustainable Energy on Liquidity and Financial Performance of the Textile Industry
Authors: Asif Rabia , Fiaz Muhammad , Zulfiqar Zunaina
Published: December 2022

Sustainable energy is considered to be the most important input for any organization owing to its noteworthy impact on the liquidity and performance of the firms. Hence, it is imperative to evidence the impact of sustainable energy on a firm’s liquidity and performance. As the disruptions in sustainable energy adversely impact the performance of manufacturing firms by reducing production directly and amplifying operational leverage, it is significant to investigate the impact the sustainable energy on a firm’s liquidity and performance. Further, the impact of disruptions in sustainable energy is size specific, therefore, the study also assumes the moderating role of firm size in shaping the stated relation. So, the aim of the current research is to investigate the impact of sustainable energy supply on liquidity and performance of the firms keeping in view the moderation effect of firm size. Using financial data of 120 textile firms from the year 2010 to 2022, the current investigation has employed a panel data methodology to quantify the impact of the sustainable energy disruption on a firm’s liquidity and performance. The results revealed that the sustainable supply of energy sources significantly impacts liquidity and working capital management as well as the performance of the textile sector in Pakistan. Further, firm size tends to moderate the relation between sustainable energy supply and performance. Although the effect is found to be partially moderated. It is recommended that in the long run, the firms might opt for alternate energy sources resulting in savings from huge performance losses. Encouraged by the inadequacy of empirical evidence in developing economies like Pakistan and keeping in view the importance of working capital management and performance efﬁciency, the current work is the need of the day. The impact of sustainable energy sources must be researched to gauge the impact on the manufacturing industry’s performance.
Customer-Defined Market Orientation, Brand Image and Customer Satisfaction: A Mediation Approach
Authors: Khan Mustafa Rehman , Khan Naveed R. , Kumar V V Ravi , Bhatt Vimal Kamleshkumar , Malik Falak
Published: December 2022

Over the past two decades, marketing literature has classified market orientation’s nature, antecedents, and consequences as intra-organizational phenomena. Most studies focus on market orientation at the organizational level, concentrating on managers’ views of their companies. Another school of thought contends that customer perception of company offerings is critical. This research provides empirical data on the effect of a customer-defined market orientation on consumer satisfaction, with brand image functioning as a mediator. The study focused on South Asian ethnic restaurants in Malaysia. Data was collected from 301 respondents and analyzed using the PLS-SEM technique. Results reveal that customer-defined market orientation has a positive impact on consumer satisfaction. Furthermore, brand image mediated the link between customer-defined market orientation and customer satisfaction to a lesser extent. Finally, researchers addressed managerial implications, limitations, and future directions.
Pedicle Screw-Associated Violation of the Adjacent Unfused Facet Joint: Clinical Outcomes and Fusion Rates
Authors: Sinz Nathan J. , Hwang Raymond W. , Lee Gyu-Ho , Baker Kevin C. , Arnold Paul , Sasso Rick , Park Daniel , Fischgrund Jeffrey , Niu Ruijia , Kim David H.
Published: December 2022

Study Design

Retrospective review of a prospective randomized trial.

Objectives

To compare outcome scores and fusion rates in patients with and without pedicle screw-associated facet joint violation (FJV) after a single-level lumbar fusion.

Methods

Clinical outcomes data and computed tomography (CT) imaging were reviewed for 157 patients participating in a multicenter prospective trial. Post-operative CT scans at 12-months follow-up were examined for fusion status and FJV. Patient-reported outcomes (PROs) included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for leg and low back pain. Chi-square test of independence was used to compare proportions between groups on categorical measures. Two-sample t-test was used to identify differences in mean patient outcome scores. Logistic regression models were performed to determine association between FJV and fusion rates.

Results

Of the 157 patients included, there were 18 (11.5%) with FJV (Group A) and 139 (88.5%) without FJV (Group B). Patients with FJV experienced less improvement in ODI (P = .004) and VAS back pain scores (P = .04) vs patients without FJV. There was no difference in mean VAS leg pain (P = .4997). The rate of fusion at 12-months for patients with FJV (27.8%) was lower compared to those without FJV (71.2%) (P = .0002). Patients with FJV were 76% less likely to have a successful fusion at 12-months.

Conclusion

Pedicle screw-associated violation of the adjacent unfused facet joint during single-level lumbar fusion is associated with less improvement in back pain, back pain-associated disability, and a lower fusion rate at 1-year after surgery.
Native Land Right System About Tribal Women in Jharkhand: An Interpretative Analysis
Authors: Gautam Ambrish
Published: December 2022

Pre-colonial equitable gender relations in the forested upland of Jharkhand plateau have been waning over the last 200 years on a spiraling pace. The rudimentary patriarchy of the indigenous communities of the hoary past received a great fillip during the early phase of ‘feudalism from bellow’ by the primary states. It grew at a faster pace in the colonial period, as a result of the privatization of land and religio-cultural impact of the Zamindari system. Presently, the complete exposure to the dominant society of the plains has triggered of a process of complete demolition of the indigenous institutions that upheld women’s economic rights and social status at a much higher level than that of the peasant society of the plains. The government policfy of economic reform and structural change, since the 90s accelerated the process of masculisation of social institutions further. Through this article I had tried to highlight the situation of tribal women in context with economic rights and social status in the society.
Assessment of the Ulnar Collateral Ligament of the Elbow Using Ultrasonic Shear Wave Elastography in Professional Baseball Players
Authors: Yoshikawa Tomoya , Inui Atsuyuki , Mifune Yutaka , Nishimoto Hanako , Yamaura Kohei , Mukohara Shintaro , Shinohara Issei , Hoshino Yuichi , Matsuishita Takehiko , Kuroda Ryosuke
Published: December 2022

Background:

Injury to the ulnar collateral ligament (UCL) of the elbow can cause chronic pain and loss of throwing ability. Ultrasonic shear wave elastography (SWE) is a new imaging method that can be used for quantitative assessment of tissue elasticity.

Purpose:

To evaluate the properties of the UCL in professional baseball players using SWE.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

This study included 35 professional baseball players (mean age, 23.0 years) without elbow injuries. Both elbows of each player were examined using ultrasound, and comparisons between the dominant and nondominant arms were conducted. The thickness of the anterior bundle of the UCL at its midportion was measured in the resting position on ultrasound. We also measured the difference in the ulnohumeral joint space with and without gravity stress on the forearm. Tissue elasticity was evaluated using a built-in software program. The relationship between UCL elasticity and ultrasound findings was analyzed using the Pearson correlation coefficient.

Results:

The mean ± SD thickness of the UCL was significantly greater in the dominant arm versus the nondominant arm (6.0 ± 1.4 vs 5.3 ± 1.3 mm; P = .004). The mean joint space difference was significantly wider in the dominant arm as compared with the nondominant arm (0.81 ± 0.42 vs 0.52 ± 0.31 mm; P = .002), and the mean UCL elasticity was lower in the dominant arm than in the nondominant arm (34.9 ± 11.6 vs 43.3 ± 10.6 kPa; P = .002). UCL elasticity was negatively correlated with UCL thickness ( r = –0.27; P = .02) and joint space difference ( r = –0.34; P = .003).

Conclusion:

In professional baseball players, the elbow UCL of the dominant arm demonstrated increased thickness, with a larger joint space gap on gravity stress and lower elasticity in SWE as compared with the nondominant arm. Greater medial joint laxity can be predicted by assessing the elasticity of the UCL using SWE.
Osteointegration of PLLA/β-TCP Biocomposite Anchors Used in Coracoid Transfer Procedures for Shoulder Instability: Quantitative Computed Tomography With a Minimum 2-Year Follow-up
Authors: Shen Guangsi , Ma Yinguang , Zhang Shuhan , Song Qingfa , Tang Chengyang , Zhang Yaxuan , Liu Guihu , Liu Qiang , Shao Zhenxing , Cui Guoqing
Published: December 2022

Background:

Biocomposite anchors have been a popular choice for use in coracoid transfer procedures for shoulder instability and are hypothesized to allow bone ingrowth.

Purpose:

To quantitatively evaluate the osteointegration of 85% PLLA/15% β-TCP biocomposite anchors used in the coracoid transfer procedure for shoulder instability.

Study Design:

Case series; Level of evidence, 4.

Methods:

We performed a retrospective case series of abstracted data from the records of 74 patients who underwent coracoid transfer procedures with biocomposite anchors. Computed tomography was performed at 24 months postoperatively. A total of 4 researchers independently reviewed the computed tomography images. The density (in Hounsfield unit [HU] values) of the anchor tunnels, glenoid, and subscapularis was assessed, and osteointegration of the anchor tunnels was evaluated with HU values, the quantitative ossification quality score (QOQS), and tunnel widening.

Results:

Included were 74 patients (58 male, 16 female), involving 76 shoulders and 124 biocomposite anchors. At ≥24-month follow-up, 72 of 124 (58.06%) anchor tunnels were classified as QOQS type 1, including 12 completely ossified tunnels and 60 almost completely ossified tunnels. Some degree of ossification (QOQS types 1-3) was observed in 118 (95.16%) anchor tunnels. Overall, 3 anchor tunnels were enlarged (QOQS type 5). The mean HU value of the anchor tunnels was 339.75, which was significantly higher than the preoperative HU value of the glenoid vault (262.19). Among the 124 anchor tunnels, 79 had HU values higher than their glenoid HU values, and 45 had lower HU values than their glenoid HU values. In the comparison of tunnel HU values at 12 versus ≥24 months, the HU value at ≥24 months was significantly higher. A total of 20 anchor tunnels widened.

Conclusion:

Among 124 anchor tunnels, 95.16% showed ossification, 58.06% were completely or nearly completely ossified, and 3 were enlarged. The HU value of the anchor tunnel increased over time.
Opportunities for Antimicrobial Stewardship in Caring for Febrile Pediatric Inpatients in Abu Dhabi
Authors: Abass Maha Khalil , Khan Junaid , Nsutebu Emmanuel Fru , Fischer Philip R.
Published: December 2022

Antimicrobial stewardship programs seek to improve patient outcomes, reduce cost, and hinder development of antimicrobial resistance. Collection of inpatient antimicrobial use data is foundational to these programs, and decisions to initiate and discontinue antibiotics are potentially amenable to improvement. In order to better understand our current practices and with a view toward improved antimicrobial stewardship, we reviewed charts of previously healthy children to age 16 years hospitalized with fever (without an evident localized source) and/or other findings suggestive of serious bacterial infection. Of 105 patients (18% 0-2 months of age, 42% 3-12 months, 25% 2-5 years), 100 (95%) received antibiotics, 72% for more than 2 days. Of 98 patients with negative body fluid cultures, 23 received antibiotics for 2 days or less, and 70 received antimicrobial therapy for more than 2 days. Focusing on selective initiation and earlier discontinuation of antimicrobial therapy in hospitalized children might reduce unnecessary antibiotic use.
Increased Incidence of Precocious Puberty in Girls During COVID-19 Pandemic: Early Indicator of the Upcoming Childhood Metabolic Syndrome Pandemic?
Authors: Itani Alaa , Abou Hamdan Aya , Zgheib Hawraa , Ghandour Zeina , Costanian Christy , Azar Ahlam
Published: December 2022

To evaluate retrospectively the incidence of central precocious puberty (CPP) during the COVID 19 lockdown and comparing the data with the corresponding data from the previous 2 years. The study included 23 girls with CPP and 14 patients with early puberty. Nineteen patients were newly diagnosed with CPP compared to 4 patients diagnosed with CPP during the previous 2 years. The number of new patients diagnosed with CPP was significantly higher than the mean during the previous 2 years ( P < .001). There were more overweight patients with CPP during and after the lockdown ( P < .05). These patients had also increased uterus length ( P < .05) and more advanced bone age ( P < .05). The increase in the incidence of central precocious puberty during and after the lockdown due to COVID 19 can be considered a serious consequence of the increased fat mass and an early indicator of the worsening of childhood obesity.
Cross-sectional Survey Examining Patient Attitudes and Preferences for Rescheduling Screening Colonoscopies Canceled due to the COVID-19 Pandemic
Authors: Valentine K. D. , Leavitt Lauren , Atlas Steven J. , Chen Emily , Ha Jasmine , Percac-Lima Sanja , Fairfield Kathleen M. , Korsen Neil , Han Paul K. J. , Richter James M. , Simmons Leigh , Sepucha Karen R.
Published: December 2022

Background. Early in the COVID-19 pandemic colonoscopies for colorectal cancer (CRC) screening were canceled. Patient perceptions of the benefits and risks of routine screening relative to health concerns associated with the COVID-19 pandemic were unknown. Purpose. Assess patient anxiety, worry, and interest in CRC screening during the COVID-19 pandemic. Methods. A random sample of 200 patients aged 45 to 75 y with colonoscopy cancellation due to COVID-19 in March to May 2020 were surveyed. Anxiety, COVID-19 and CRC risk perceptions, COVID-19 and CRC worry, likelihood of following through with colonoscopy in the next month, and interest in alternatives to colonoscopy were assessed. Subsequent screening was tracked for 12 mo. Results. Respondents ( N = 127/200, 63.5%) were on average 60 y old, female (59%), college educated (62% college degree or more), and White (91%). A substantial portion of patients (46%) stated they may not follow through with a colonoscopy in the next month. There was greater interest in stool-based testing than in delaying screening (48% v. 26%). Women, older patients, and patients indicating tolerance of uncertainty due to complexity reported they were less likely to follow through with colonoscopy in the next month. Greater interest in stool-based testing was related to lower perceptions of CRC risk. Greater interest in delaying screening was related to less worry about CRC and less tolerance of risk. Over 12 mo, 60% of participants completed screening. Patients who stated they were more likely to screen in the next month were more likely to complete CRC screening ( P = 0.01). Conclusions. Respondents who had a colonoscopy canceled during the COVID-19 pandemic varied in interest in rescheduling the procedure. A shared decision-making approach may help patients address varying concerns and select the best approach to screening for them.

Highlights

In the wake of the first wave of the COVID-19 pandemic, almost half of patients stated they were not likely to follow through with a colonoscopy in the short term, about half were interested in screening with a stool-based test, and only one-quarter were interested in delaying screening until next year. Patients who perceived themselves at higher risk of colorectal cancer were less interested in stool-based testing, and patients who were more worried about colorectal cancer were less interested in delaying screening. A shared decision-making approach may be necessary to tailor screening discussions for patients during subsequent waves of the pandemic, other occasions where resources are limited and patient preferences vary, or where patients hold conflicting views of screening.
A Corpus-based Study on Selected Dalit Autobiographies
Authors: Mohammadi Mandana Kolahdouz , khan Mainul Hasan
Published: December 2022

Dalit literature represents consciousness about human rights. Autobiographies written by Dalit authors are based on real-life experiences. Based on the conducted studies regarding Dalit autobiographies, women are the ones who suffer oppression and violence to a great extent (Simon, 2021) since they are the backbone of the family. Therefore, how Dalit autobiographies draw their reader’s attention is essential and makes these autobiographies unique. In recent years, text analysis tools have been introduced to facilitate information extraction from a collection of texts and compare two or more texts. So, this article using text mining tools aims to analyze three selected Dalit autobiographies of women writers. The central hypothesis of this study is that sufferers, their families and society have higher frequency in Dalit autobiographies and semantic relations between these elements at the lexical level are available. Based on the findings of this study, only in Dutt’s work, keyword in contexts (KWICs) such as “Dalit, caste, India” had higher frequencies than two other works. In Halder’s work, the frequency of these KWICs was zero. Accordingly, it can be said that in recent years, authors are explicitly willing to attract their readers’ attention toward Dalits and their problems.
From the Social to the Clinical: Towards a Psychopathology of Everyday Casteism
Authors: Mandal Mahitosh
Published: December 2022

Caste has predominantly been understood as a social problem. It is understood as a form of discrimination embedded in the Hindu society that promotes Brahmanical supremacy which, in turn, is founded on the ostracization and dehumanization of the Dalit subject. The great bulk of the existing scholarship on caste has been dedicated to exploring the history, politics, religiosity, anti-sociality and illegality of caste. This article is an emphatic attempt to redirect the field of Dalit studies from considering caste—casteism, to be more precise—as a social problem to defining it as a medical or clinical or psychological problem. It introduces the reader to the neglected trend of research on the interface between caste and mental health and advances the radical possibility of understanding caste as a form of psychopathology. It makes use of the relevant psychological and psychoanalytic concepts from Sigmund Freud, Carl Gustav Jung and Jacques Lacan and proposes to define casteism in conjunction with the psychology of racism as theorized by Franz Fanon and David Livingstone Smith.
Boosa Movement: A Prologue to the Birth of New Kannada Intellectualism
Authors: Mohankumar B. S.  , Jyothi N.
Published: December 2022

The Boosa movement was one of the most controversial incidents in the history of Post-Independence literary as well as political discourse in Karnataka. B Basavalingappa, the cynosure of the movement, made a controversial statement on Kannada literature. He commented that most Kannada literature was filled with Boosa (cattle fodder). His statement created an uproar across Karnataka. In this context, this article aims to present how yellow journalism portrayed Basavalingappa and his comments, which eventually made him lose his political position. The hypothesis presents how Basavalingappa was a victim of caste-based politics coupled with yellow journalism. On the other hand, it also presents that despite the political assassination of Basavalingappa from power, how the Boosa incident gave rise to Dalit consciousness and acted as a prologue to the birth of new Kannada intellectuality.
Invention or Inversion? Revisiting the Question of Caste Tradition
Authors: Ghosh Aryama , Mondal Subhadeep
Published: December 2022

The main theme of this paper is to revisit the question of caste and the politics of/on traditions. We have explored the questions of mythology; how ‘we’, the lower caste people associate and (re)interpret the mythical characters as a process of social upward mobility. So, is it the invention of tradition or is it the inversion of tradition or both? Interestingly, we could be able to locate a distinct regional pattern in this case. Thus, we argue that in the Northern part of India, specifically in Uttar Pradesh, though it is the process called the invention of tradition, it can be framed as a little tradition under the grand Hindu tradition. On the other hand, in the Southern part of the country specifically in Tamil Nadu, it is rather the process called the inversion of tradition which is much more radically grounded in sub-national ethos. Based on these premises, this article further argues that Uttar Pradesh’s caste politics is based on the invention of a tradition model which can incorporate the lower castes’ little traditions within the larger ambit of the Hindu grand narratives. Thus, new Hindutva politics has easily appropriated them within their polemic. On the contrary, in the South, due to the inversion of the tradition model embedded in a pre-existing political tradition and sub-national ethos, Hindutva failed to get a proper hold in recent times.
Technique for Reconstruction of the Proximal Tibiofibular Joint Using Biceps Femoris and Iliotibial Band Autograft With Suture Tape Augmentation
Authors: Burger Joseph M. , Sarac Nikolas , Miller Timothy
Published: December 2022

Background:

Proximal tibiofibular joint instability is an uncommon condition that can occur in acute traumatic dislocations, chronic or recurrent dislocations, and atraumatic dislocations. A variety of procedures have been described for treatment of this condition including fibular head resection, arthrodesis, suture button stabilization, and soft tissue reconstruction.

Indications:

The initial management consists of conservative measures such as activity modification, use of a supportive strap, and physical therapy. When nonoperative management fails, surgical management is indicated.

Technique Description:

To optimize surgical technique and patient outcomes, a previously described reconstruction technique was modified with reinforcement of suture tape augmentation and decreased invasiveness.

Results:

This technique has several advantages including a smaller incision with shorter iliotibial band (ITB) and biceps femoris tendon (BFT) grafts and safer posterior to anterior drilling as opposed to anterior to posterior directed drilling.

Discussion/Conclusion:

The authors believe there is increased stability with this reconstruction technique due to the added suture tape augmentation in addition to the biologic healing potential provided by the ITB and BFT autografts. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Diagnosis and management of pulmonary arterial hypertension
Authors: Cullivan Sarah , Higgins Margaret , Gaine Sean
Published: December 2022

Pulmonary arterial hypertension (PAH) is a progressive disease of the pulmonary vasculature that is characterised by elevated pressures within the pulmonary vascular tree. Recent decades have witnessed a dramatic expansion in our understanding of the pathobiology and the epidemiology of PAH, and improvements in treatment options and outcomes. The prevalence of PAH is estimated to be between 48 and 55 cases per million adults. The definition was recently amended and a diagnosis of PAH now requires evidence of a mean pulmonary artery pressure >20 mmHg, a pulmonary vascular resistance >2 Wood units and a pulmonary artery wedge pressure ≤15 mmHg at right heart catheterisation. Detailed clinical assessment and a number of additional diagnostic tests are required to assign a clinical group. Biochemistry, echocardiography, lung imaging and pulmonary function tests provide valuable information to assist in the assignment of a clinical group. Risk assessment tools have been refined, and these greatly facilitate risk stratification and enhance treatment decisions and prognostication. Current therapies target three therapeutic pathways: the nitric oxide, prostacyclin and endothelin pathways. While lung transplantation remains the only curative intervention for PAH, there are a number of promising therapies under investigation which may further reduce morbidity and improve outcomes.

This review describes the epidemiology, pathology and pathobiology of PAH and introduces important concepts regarding the diagnosis and risk stratification of PAH. The management of PAH is also discussed, with a special focus on PAH specific therapy and key supportive measures.
Vertical niche differentiation of comammox Nitrospira in water-level fluctuation zone of the Three Gorges Reservoir, China
Authors: Ding Hang , Zhou Mingzhi , Wang Yuchun , Hu Mingming , Wen Jie , Li Shanze , Bao Yufei , Zhao Jianwei
Published: December 2022

Comammox (CMX) Nitrospira bacteria (NB) can accomplish ammonia oxidation independently, and their niche differentiation holds promise for their ecological and survival functions. In this work, the vertical niche differentiation of CMX NB was investigated in the soils of 6 water-level fluctuation (WLF) zones (both natural and artificial) in the Three Gorges Reservoir (TGR) region. The results demonstrated that the level of clade A amoA was obviously reduced with increasing soil depth in the natural WLF zones and one of the artificial WLF zones. However, in the other two artificial WLF zones, the abundance of this gene was not dramatically reduced with depth. The level of clade B amoA did not markedly decrease with increasing soil depth in most WLF zones and remained stable in the three WLF zones. Total nitrogen (TN) had the most significant effect on the abundance of CMX NB. Clade A.1, clade A.2.1, clade A.2.2, clade A.3, and clade B of CMX NB co-occurred simultaneously in all WLF zones. The number of operational taxonomic units (OTUs) of clade A in the two types of WLF zones first increased and then decreased with increasing depth, whereas the number of OTUs of clade B continuously increased with depth in the artificial WLF zone. Total carbon (TC) and pH, as environmental factors, affected the community structure of CMX NB. This study confirmed the vertical differentiation of the abundance and diversity of CMX NB in the WLF zones of the TGR region, and the artificial restoration of the WLF zones affected the niche differentiation of CMX NB to a certain degree.
Performance of several types of beta-binomial models in comparison to standard approaches for meta-analyses with very few studies
Authors: Felsch Moritz , Beckmann Lars , Bender Ralf , Kuss Oliver , Skipka Guido , Mathes Tim
Published: December 2022

Background

Meta-analyses are used to summarise the results of several studies on a specific research question. Standard methods for meta-analyses, namely inverse variance random effects models, have unfavourable properties if only very few (2 – 4) studies are available. Therefore, alternative meta-analytic methods are needed. In the case of binary data, the “common-rho” beta-binomial model has shown good results in situations with sparse data or few studies. The major concern of this model is that it ignores the fact that each treatment arm is paired with a respective control arm from the same study. Thus, the randomisation to a study arm of a specific study is disrespected, which may lead to compromised estimates of the treatment effect. Therefore, we extended this model to a version that respects randomisation.

The aim of this simulation study was to compare the “common-rho” beta-binomial model and several other beta-binomial models with standard meta-analyses models, including generalised linear mixed models and several inverse variance random effects models.

Methods

We conducted a simulation study comparing beta-binomial models and various standard meta-analysis methods. The design of the simulation aimed to consider meta-analytic situations occurring in practice.

Results

No method performed well in scenarios with only 2 studies in the random effects scenario. In this situation, a fixed effect model or a qualitative summary of the study results may be preferable. In scenarios with 3 or 4 studies, most methods satisfied the nominal coverage probability. The “common-rho” beta-binomial model showed the highest power under the alternative hypothesis. The beta-binomial model respecting randomisation did not improve performance.

Conclusion

The “common-rho” beta-binomial appears to be a good option for meta-analyses of very few studies. As residual concerns about the consequences of disrespecting randomisation may still exist, we recommend a sensitivity analysis with a standard meta-analysis method that respects randomisation.
SCARA5 induced ferroptosis to effect ESCC proliferation and metastasis by combining with Ferritin light chain
Authors: Liu Yanqun , Xiong Rong , Xiao Ting , Xiong Li , Wu Jialin , Li Junfeng , Feng Gang , Song Guiqin , Liu Kang
Published: December 2022

Background

Esophageal squamous cell carcinoma (ESCC) remains one of the most lethal cancers worldwide accompany with an extremely poor prognosis. Therefore, this study aims to screen for new molecules affecting ESCC and explore their mechanisms of action to provide ideas for targeted therapies for ESCC.

Methods

Firstly, we screened out the membrane protein SCARA5 by high-throughput sequencing of the ESCC patient tissues, and RT-qPCR and WB were used to verify the differential expression of SCARA5 in esophageal cell lines, and IHC analyzed the expression localization of SCARA5 in ESCC tissue. Then, flow cytometry, wound healing assay, Transwell assay and CCK-8 assay were used to explore the effects of SCARA5 on cell cycle, migration and invasion as well as cell proliferation activity of esophageal squamous carcinoma cells. Meanwhile, transmission electron microscopy was used to detect changes in cellular mitochondrial morphology, and flow cytometry were used to detect changes in intracellular reactive oxygen metabolism, and immunofluorescence and flow cytometry were used to detect changes in intracellular Fe2+. Mechanistically, co-immunoprecipitation was used to detect whether SCARA5 binds to ferritin light chain, and ferroptosis-related protein expression was detected by WB. Finally, the tumor xenograft model was applied to validation the role of SCARA5 tumor growth inhibition in vivo.

Results

We found that SCARA5 was aberrantly decreased in ESCC tissues and cell lines. Furthermore, we confirmed that SCARA5 suppressed the cell cycle, metastasis and invasion of ESCC cells. Meanwhile, we also found that overexpression of SCARA5 caused changes in mitochondrial morphology, accumulation of intracellular reactive oxygen species and increased intracellular Fe2+ in ESCC cells, which induced ferroptosis in ESCC cells. Mechanically, we validated that SCARA5 combined with ferritin light chain and increased intracellular Fe2+. As well as, overexpression SCARA5 induced ferroptosis by increasing ferritin light chain in nude mice subcutaneous tumors and inhibited the growth of nude mice subcutaneous tumors.

Conclusion

Collectively, our findings demonstrated that SCARA5 suppressed the proliferation and metastasis of ESCC by triggering ferroptosis through combining with ferritin light chain.
The Mini-SIPS: development of a brief clinical structured interview guide to diagnosing DSM-5 Attenuated Psychosis Syndrome and training outcomes
Authors: Woods Scott W. , Lympus Cole , McGlashan Thomas H. , Walsh Barbara C. , Cannon Tyrone D.
Published: December 2022

Objective

The Mini-SIPS, a condensed version of the Structured Interview for Psychosis-Risk Syndromes (SIPS), is intended to efficiently identify for clinicians the minimum information needed to support a DSM-5 Attenuated Psychosis Syndrome (APS) diagnosis.

Methods

The instrument and the DSM-5 criteria are accessible through the online training program.

Results

Most individuals (67.5%) in the first 212 to complete the training program indicated an intended use of the Mini-SIPS exclusively for clinical purposes. Performance on the post-training quiz was excellent for those with and without prior training in structured diagnostic interviewing.

Conclusion

The Mini-SIPS, and accompanying training program, are offered as public-domain clinical resources to the mental health community.
Achieving the UNAIDS 90–90-90 targets: a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa
Authors: Sabapathy K. , Balzer L. , Larmarange J. , Block L. , Floyd S. , Iwuji C. , Wirth K. , Ayles H. , Fidler S. , Kamya M. , Petersen M. , Havlir D. , Dabis F. , Moore J. , Hayes R.
Published: December 2022

Background

Four large community-randomized trials examining universal testing and treatment (UTT) to reduce HIV transmission were conducted between 2012–2018 in Botswana, Kenya, Uganda, Zambia and South Africa. In 2014, the UNAIDS 90–90-90 targets were adopted as a useful metric to monitor coverage. We systematically review the approaches used by the trials to measure intervention delivery, and estimate coverage against the 90–90-90 targets. We aim to provide in-depth understanding of the background contexts and complexities that affect estimation of population-level coverage related to the 90–90-90 targets.

Methods

Estimates were based predominantly on “process” data obtained during delivery of the interventions which included a combination of home-based and community-based services. Cascade coverage data included routine electronic health records, self-reported data, survey data, and active ascertainment of HIV viral load measurements in the field.

Results

The estimated total adult populations of trial intervention communities included in this study ranged from 4,290 (TasP) to 142,250 (Zambian PopART Arm-B). The estimated total numbers of PLHIV ranged from 1,283 (TasP) to 20,541 (Zambian PopART Arm-B). By the end of intervention delivery, the first-90 target (knowledge of HIV status among all PLHIV) was met by all the trials (89.2%-94.0%). Three of the four trials also achieved the second- and third-90 targets, and viral suppression in BCPP and SEARCH exceeded the UNAIDS target of 73%, while viral suppression in the Zambian PopART Arm-A and B communities was within a small margin (~ 3%) of the target.

Conclusions

All four UTT trials aimed to implement wide-scale testing and treatment for HIV prevention at population level and showed substantial increases in testing and treatment for HIV in the intervention communities. This study has not uncovered any one estimation approach which is superior, rather that several approaches are available and researchers or policy makers seeking to measure coverage should reflect on background contexts and complexities that affect estimation of population-level coverage in their specific settings.

All four trials surpassed UNAIDS targets for universal testing in their intervention communities ahead of the 2020 milestone. All but one of the trials also achieved the 90–90 targets for treatment and viral suppression. UTT is a realistic option to achieve 95–95-95 by 2030 and fast-track the end of the HIV epidemic.
Importance of the reflective logbook in improving the residents’ perception of reflective learning in the dermatology residency program in Saudi Arabia: findings from a cross-sectional study
Authors: Alotaibi Hend M. , Alharithy Ruaa , Alotaibi Hala M.
Published: December 2022

Background

Reflection is an essential feature of the learning process in all medical education and training fields. While writing the logbooks has been considered to improve learners’ reflection in several disciplines, it is unknown whether writing reflective logbooks improves the learning perception of dermatology residents. Therefore, this study was carried out to assess the role of the reflective logbook in improving the residents’ perception of reflective learning in the dermatology residency program.

Methods

This cross-sectional study was conducted on 32 dermatology residents from year two (R2) to year four (R4) enrolled in different hospitals in Riyadh, Saudi Arabia. A baseline electronic survey was emailed to all residents before and after implementing the reflective logbook for six months. The survey included 28 close-ended questions assessing their point of view on a Likert scale, and responses varied from agreeing to disagreeing strongly. Frequencies and proportions were generated for the categorical variables such as sex and level of residency. The graphs were generated to assess the proportion of residents correctly responding to the knowledge questions. The data were analyzed using SPSS version 23.

Results

Almost 80% of dermatology residents considered reflection as an important element of their learning, and 47% of the residents agreed that a reflective log book increases understanding in medical education. About 44% of the residents agreed that the reflective logbook assisted in their learning, and about 19% strongly agreed on the same. However, only 37.5% agreed that logbooks helped them acquire theoretical knowledge, and 9.4% and 18.8% agreed that they helped them acquire practical and research skills, respectively. Almost 68% of the residents had support in writing the logbook, and 34.4% agreed that logbooks helped them address their patient’s needs and enhance their diagnostic skills.

Conclusion

The study findings revealed that dermatology residents perceived reflection and writing a reflective logbook as important and potentially beneficial. However, knowing the importance of reflection and what reflection means was not optimal. Not all dermatology residents were aware of the reflection and reflective logbooks as tools for reflective learning. Thereby warranting regular workshops or fostering continuous medical education on the importance of reflection.
Pharmacokinetics and pharmacodynamics of intra-articular isoflupredone following administration to horses with lipopolysaccharide-induced synovitis
Authors: Knych Heather K. , Weiner Daniel , Harrison Linda , McKemie Daniel S.
Published: December 2022

Background

Intra-articular corticosteroids, such as isoflupredone acetate, are commonly used in the treatment of joint inflammation, especially in performance horses. Following administration in a non-inflamed joints blood concentrations of isoflupredone were low and detectable for only a short period of time post-administration compared to synovial fluid concentrations. For some drugs, inflammation can affect pharmacokinetics, therefore, the goal of the current study was to describe the pharmacokinetics of isoflupredone acetate following intra-articular administration using a model of acute synovitis. Secondarily, pharmacodynamic effects, including effects on joint circumference, joint flexion, and lameness following intra-articular administration of isoflupredone acetate in the experimental model were described.

Methods

Sixteen horses received a single intra-articular dose of 8 mg of isoflupredone acetate or saline 12 h post-administration of lipopolysaccharide. Blood and urine samples were collected up to 72 h and synovial fluid for 28 days post-administration, drug concentrations determined by liquid chromatography- mass spectrometry and pharmacokinetic analysis performed. Joint circumference, maximum angle of pain free joint flexion and lameness were evaluated prior to and post-treatment.

Results

The maximum isoflupredone plasma concentration was 2.45 ± 0.61 ng/mL at 2.5 ± 0.75 h and concentrations were less than the limit of quantitation by 72 h. Isoflupredone was below detectable concentrations in urine by 72 h post-administration in all horses and no longer detectable in synovial fluid by 96 h post-administration. Joint circumference was significantly decreased in the isoflupredone treatment group compared to the saline group at 24 and 48 h post drug administration. Pain free joint flexion was significantly different between the saline and isoflupredone treatment groups on day 4 post-treatment.

Conclusions

Synovial fluid concentrations and maximum plasma concentrations of isoflupredone differed slightly between the current study and a previous one describing administration into a non-inflamed joint, however, the detection time of isoflupredone in blood was comparable. Effects of isoflupredone on joint circumference and degree of pain free joint flexion suggest a short duration of effect with respect to alleviation of lipopolysaccharide induced synovitis, however, results of this study support future studies of the anti-inflammatory effects of intra-articular isoflupredone acetate.