bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Review of the Diagnosis and Management of Malignant Extradural Spinal Cord Compression: The Cancer Care Ontario Practice Guidelines Initiative‘s Neuro-Oncology Disease Site Group
Authors: Loblaw D. Andrew , Perry James , Chambers Alexandra , Laperriere Normand J.
Published: March 2005

Purpose

This systematic review describes the diagnosis and management of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MSCC).

Methods

MEDLINE, CANCERLIT, and the Cochrane Library databases were searched to January 2004 using the following terms: spinal cord compression, nerve compression syndromes, spinal cord neoplasms, clinical trial, meta-analysis, and systematic review.

Results

Symptoms for MSCC include sensory changes, autonomic dysfunction, and back pain; however, back pain was not predictive of MSCC. The sensitivity and specificity for magnetic resonance imaging (MRI) range from 0.44 to 0.93 and 0.90 to 0.98, respectively, in the diagnosis of MSCC. The sensitivity and specificity for myelography range from 0.71 to 0.97 and 0.88 to 1.00, respectively. A randomized study detected higher ambulation rates in patients with MSCC who received high-dose dexamethasone before radiotherapy (RT) compared with patients who did not receive corticosteroids before RT (81% v 63% at 3 months, respectively; P = .046). There is no direct evidence that supports or refutes the type of surgery patients should have for the treatment of MSCC, whether surgical salvage should be attempted if patient is progressing on or shortly after RT, and whether patients with spinal instability should be treated with surgery.

Conclusion

Patients with symptoms of MSCC should be managed to minimize treatment delay. MRI is the preferred imaging technique. Treatment for patients with MSCC should consider pretreatment ambulatory status, comorbidities, technical surgical factors, the presence of bony compression and spinal instability, potential surgical complications, potential RT reactions, and patient preferences.
Clinical Trial Designs for Predictive Marker Validation in Cancer Treatment Trials
Authors: Sargent Daniel J. , Conley Barbara A. , Allegra Carmen , Collette Laurence
Published: March 2005

Current staging and risk-stratification methods in oncology, while helpful, fail to adequately predict malignancy aggressiveness and/or response to specific treatment. Increased knowledge of cancer biology is generating promising marker candidates for more accurate diagnosis, prognosis assessment, and therapeutic targeting. To apply these exciting results to maximize patient benefit, a disciplined application of well-designed clinical trials for assessing the utility of markers should be used. In this article, we first review the major issues to consider when designing a clinical trial assessing the usefulness of a predictive marker. We then present two classes of clinical trial designs: the Marker by Treatment Interaction Design and the Marker-Based Strategy Design. In the first design, we assume that the marker splits the population into groups in which the efficacy of a particular treatment will differ. This design can be viewed as a classical randomized clinical trial with upfront stratification for the marker. In the second design, after the marker status is known, each patient is randomly assigned either to have therapy determined by their marker status or to receive therapy independent of marker status. The predictive value of the marker is assessed by comparing the outcome of all patients in the marker-based arm to that of all of the patients in the non–marker-based arm. We present detailed sample size calculations for a specific clinical scenario. We discuss the advantages and disadvantages of the two trial designs and their appropriateness to specific clinical situations to assist investigators seeking to design rigorous, marker-based clinical trials.
Expression of the Caudal-Type Homeodomain Transcription Factors CDX 1/2 and Outcome in Carcinomas of the Ampulla of Vater
Authors: Hansel Donna E. , Maitra Anirban , Lin John W. , Goggins Michael , Argani Pedram , Yeo Charles J. , Piantadosi Steven , Leach Steven D. , Biankin Andrew V.
Published: March 2005

Purpose

Adenocarcinomas of the ampulla of Vater demonstrate a characteristic histology but vary significantly in outcome. As a consequence, prognostic factors for these cancers are poorly defined. The caudal-type homeodomain transcription factors 1 (CDX1) and 2 (CDX2) regulate axial development and intestinal differentiation. We assessed the expression of these putative intestinal epithelial-specific transcription factors and their influence on patient outcome.

Patients and Methods

Fifty-three resected carcinomas of the ampulla of Vater, 31 pancreatic ductal adenocarcinomas, and 15 extrahepatic biliary carcinomas were analyzed for CDX1 and CDX2 expression using immunohistochemistry.

Results

Forty percent of carcinomas of the ampulla of Vater but less than 5% of pancreatic and biliary adenocarcinomas expressed CDX. Expression of CDX was associated with a better prognosis (P = .0009). Individually, both CDX1 (P = .02) and CDX2 (P = .02) expression were associated with a survival advantage on univariate analysis. Advanced T stage (P = .02), lymph node metastases (P = .004), and vascular space invasion (P = .0009) were associated with a poor prognosis. Multivariate analysis revealed vascular space invasion (P = .01) and CDX expression (P = .01) to be independent prognostic factors.

Conclusion

Expression of CDX was an independent marker of outcome in patients with resected adenocarcinoma of the ampulla of Vater. Expression of CDX may distinguish good prognosis intestinal-like tumors, which potentially arise within intestinal epithelium, from poorer prognosis pancreatobiliary tumors, which arise in adjacent pancreatic and/or biliary ductal epithelium.
Graft-Versus-Tumor Effects After Allogeneic Hematopoietic Cell Transplantation With Nonmyeloablative Conditioning
Authors: Baron Frédéric , Maris Michael B. , Sandmaier Brenda M. , Storer Barry E. , Sorror Mohamed , Diaconescu Razvan , Woolfrey Ann E. , Chauncey Thomas R. , Flowers Mary E.D. , Mielcarek Marco , Maloney David G. , Storb Rainer
Published: March 2005

Purpose

We have used a nonmyeloablative conditioning regimen consisting of total-body irradiation (2 Gy) with or without fludarabine (30 mg/m2/d for 3 days) for related and unrelated hematopoietic cell transplantation (HCT) in patients with hematologic malignancies who were not candidates for conventional HCT because of age, medical comorbidities, or preceding high-dose HCT. This approach relied on graft-versus-tumor (GVT) effects for control of malignancy.

Patients and Methods

We analyzed GVT effects in 322 patients given grafts from HLA-matched related (n = 192) or unrelated donors (n = 130).

Results

Of the 221 patients with measurable disease at HCT, 126 (57%) achieved complete (n = 98) or partial (n = 28) remissions. In multivariate analysis, there was a higher probability trend of achieving complete remissions in patients with chronic extensive graft-versus-host disease (GVHD; P = .07). One hundred eight patients (34%) relapsed or progressed. In multivariate analysis, achievement of full donor chimerism was associated with a decreased risk of relapse or progression (P = .002). Grade 2 to 4 acute GVHD had no significant impact on the risk of relapse or progression but was associated with increased risk of nonrelapse mortality and decreased probability of progression-free survival (PFS). Conversely, extensive chronic GVHD was associated with decreased risk of relapse or progression (P = .006) and increased probability of PFS (P = .003).

Conclusion

New approaches aimed at reducing the incidence of grade 2 to 4 acute GVHD might improve survival after allogeneic HCT after nonmyeloablative conditioning.
It's still bending: Verbal suggestion and alleged psychokinetic ability
Authors: Wiseman Richard , Greening Emma
Published: March 2005

Some alleged psychics appear to be able to deform metallic objects, such as keys and cutlery, by thought alone. This paper describes two studies that examined whether one aspect of these demonstrations could be created by verbal suggestion. In the first study, participants were shown a videotape in which a fake psychic placed a bent key on a table. Participants in one condition heard the fake psychic suggest that the key was continuing to bend, whilst those in the other condition did not. Participants in the suggestion condition were significantly more likely to report that the key continued to bend. These findings were replicated in the second study. In addition, participants who reported that the key continued to bend displayed a significantly higher level of confidence in their testimony than others, and were significantly less likely to recall that the fake psychic had suggested the continued bending of the key. Neither experiment revealed any differences between participants who expressed a prior belief in the paranormal compared with those who did not. The paper discusses the implications of these results for the psychology of suggestion and the assessment of eyewitness testimony for anomalous events.
Early separation anxiety and adult attachment style in women with eating disorders
Authors: Troisi Alfonso , Massaroni Paola , Cuzzolaro Massimo
Published: March 2005

Objective. To ascertain whether women with eating disorders have a higher frequency of separation anxiety symptoms in childhood, and a higher prevalence of insecure styles of adult attachment, compared with healthy women.

Methods. The Separation Anxiety Symptom Inventory (SASI) and the Attachment Style Questionnaire (ASQ) were administered to 78 women with eating disorders and 64 healthy women.

Results. Compared with control women, women with eating disorders reported more severe symptoms of separation anxiety during childhood, and scored higher on the ASQ scales, reflecting insecure styles of adult attachment. Early separation anxiety and insecure attachment were not correlated with age of onset or illness duration. The diagnostic subgroup was not associated with a specific style of insecure attachment: compared with control women, both anorexic and bulimic women scored higher on the ASQ scales reflecting anxious attachment, but not on the scales reflecting avoidant attachment.

Conclusions. The results confirm the link between eating disorders and insecure attachment that has been found in previous studies, and extend it to childhood symptoms of separation anxiety.
Autobiographical memory specificity and emotional abuse
Authors: Raes Filip , Hermans Dirk , Williams J. Mark G. , Eelen Paul
Published: March 2005

Objective. Examined the relationship between trauma and memory specificity and the importance in this of level of support received.

Method. Fifty‐two female undergraduates completed the Autobiographical Memory Test (AMT; Williams & Broadbent, 1986), assessing memory specificity and the Traumatic Experiences Checklist (TEC; Nijenhuis, Van der Hart, & Vanderlinden, 1999), assessing qualitative aspects of trauma.

Results. In low‐specific students, those who reported emotional abuse were less specific in their memory. The scores of students who had not received any support for the abuse showed a trend towards retrieval of less specific memories, as compared with those who had received support.

Conclusion. Results provide evidence for an association between trauma (emotional abuse) and reduced memory specificity, and suggest that receiving support following the abuse might protect individuals from developing over‐general memory.
The nature of imagery processes underlying food cravings
Authors: Harvey Kirsty , Kemps Eva , Tiggemann Marika
Published: March 2005

Objective. The study used a working memory approach to examine the nature of the imagery processes underlying food cravings.

Design and method. A sample of 60 dieters and 60 non‐dieters were asked to imagine either a food induction or a holiday induction scenario. Participants then performed 18 trials of either a visual imagery task (loading the visuo‐spatial sketch pad) or auditory imagery task (loading the phonological loop). Food craving was measured before and after the induction scenario, and then after every 6 trials of the imagery task.

Results. Craving intensity increased following instructions to imagine the food (but not holiday) induction scenario, especially for dieters. As predicted, the visual imagery task was superior to the auditory imagery task in reducing the level of food craving.

Discussion. The results confirmed the imaginal basis of food cravings. Specifically, they demonstrated that the imagery processes involved in food cravings are predominantly visual in nature. Hence concurrent tasks that load the visuospatial sketch pad of working memory can be used to reduce food cravings. The findings have potential application in the treatment of craving episodes in clinical populations.
Complement Factor H as a Marker for Detection of Bladder Cancer
Authors: Cheng Zhu-Zhu , Corey Michael J , Pärepalo Maria , Majno Sandra , Hellwage Jens , Zipfel Peter F , Kinders Robert J , Raitanen Mika , Meri Seppo , Jokiranta T Sakari
Published: March 2005

Background: The BTA TRAK™ and BTA stat™ tests for bladder cancer use monoclonal antibodies (mAbs) X13.2 and X52.1 to detect factor H (FH)-related material in urine. The exact ligands remain unknown.

Methods: Western blot analyses of purified FH, recombinant factor H-related protein 1 (FHR-1), and serum and urine samples were used to identify the ligands of X13.2 and X52.1. Recombinant FH constructs were used to identify the target sites of X13.2 and X52.1. To analyze whether natural ligands of FH could compete with its recognition by the capture mAb X52.1, we used surface plasmon resonance analysis. The role of the ligands of X52.1 in the BTA TRAK assay was tested with use of purified proteins and FH-depleted samples.

Results: X13.2 bound to domain 3 of FH and FH-like protein 1, whereas X52.1 bound to domain 18 of FH and to FHR-1. Using specific FH depletion from a bladder cancer patient’s urine and purified FH, we demonstrated that FH is the ligand recognized by the BTA TRAK test. By contrast, FHR-1 in urine reduced the FH-dependent test signal.

Conclusions: FH is a tumor marker for bladder cancer. To reveal the presence of bladder cancer, the BTA TRAK assay detects FH, whereas FHR-1 is able to partly inhibit this detection. This indicates a special mechanism for a diagnostic immunoassay based on the combined effect of simultaneous positive and negative signals in a single sample.
Retracted: Effects of Vitamin K2 on Osteoporosis
Authors: Iwamoto Jun , Takeda Tsuyoshi , Sato Yoshihiro
Published: March 2005

Vitamin K2 is a cofactor of γ-carboxylase, which converts the glutamic acid (Glu) residue in osteocalcin molecules to γ-carboxyglutamic acid (Gla), and is, therefore, essential for γ-carboxylation of osteocalcin. Available evidence suggests that vitamin K2 also enhances osteocalcin accumulation in the extracellular matrix of osteoblasts in vitro. Osteocalcin-knockout mice develop hyperostosis, suggesting that the Gla-containing osteocalcin promotes normal bone mineralization. Although the precise role of osteocalcin in bone mineralization remains obscure, it probably regulates the growth of hydroxyapatite crystals. Furthermore, vitamin K2 also inhibits the expression of the osteoclast differentiation factor (ODF) / RANK ligand, tartrate-resistant acid phosphatase activity, and mononuclear cell formation, and induces osteoclast apoptosis in vitro. There is some evidence indicating that vitamin K2 prevents bone resorption in ovariectomized rats, retards the increase in bone turnover in orchidectomized rats, ameliorates the increase in bone resorption and decrease in bone formation in sciatic neurectomized rats, and prevents the decrease in bone formation in glucocorticoid-treated rats. These findings suggest that vitamin K2 may not only stimulate bone formation but also suppress bone resorption in vivo. Clinically, vitamin K2 sustains the lumbar bone mineral density (BMD) and prevents osteoporotic fractures in patients with age-related osteoporosis, prevents vertebral fractures in patients with glucocorticoid-induced osteoporosis, increases the metacarpal BMD in the paralytic upper extremities of patients with cerebrovascular disease, and sustains the lumbar BMD in patients with liver-dysfunction-induced osteoporosis. Vitamin K deficiency, as indicated by an increased circulating level of undercarboxylated osteocalcin, may contribute to osteoporotic fractures. Even though the effect of vitamin K2 on the BMD is quite modest, this vitamin may have the potential to regulate bone metabolism and play a role in reducing the risk of osteoporotic fractures. No randomized well-controlled prospective studies conducted on a sufficiently large number of patients have been reported yet, therefore, further studies are needed to confirm the efficacy of vitamin K2 in the treatment of osteoporosis.
Collapse and Self-Reconstruction of Mesoscopic Architectures of Supramolecular J Aggregates in Solution: From Strings to Tubular Rods
Authors: Yao Hiroshi , Michaels Chris , Stranick Stephan , Isohashi Takeshi , Kimura Keisaku
Published: March 2005

:

This Letter reports the collapse and subsequent self-reassembly of mesoscopic architectures of supramolecular J aggregates in solution. Ultrasonication of the string-like 5,5-dichloro-3,3-disulfopropyl thiacyanine (TC) J aggregates caused fragmentation (collapse) of the initial morphology, followed by a prompt self-reconstruction into mesoscopic rod-like architectures. Fluorescence microscopy, polarized light microscopy, atomic force microscopy and near-field scanning optical microscopy revealed that the apparent rod-like morphology was a tubular architecture with a monomolecular wall (single-wall) and open ends.
Lipoprotein(a), C-Reactive Protein, and Cardiovascular Risk in Primary and Secondary Prevention Populations
Authors: Small Aeron M. , Pournamdari Ashley , Melloni Giorgio E.M. , Scirica Benjamin M. , Bhatt Deepak L. , Raz Itamar , Braunwald Eugene , Giugliano Robert P. , Sabatine Marc S. , Peloso Gina M. , Marston Nicholas A. , Natarajan Pradeep
Published: February 2024

Importance

Elevated lipoprotein(a) (Lp[a]) is a putative causal risk factor for atherosclerotic cardiovascular disease (ASCVD). There are conflicting data as to whether Lp(a) may increase cardiovascular risk only in the presence of concomitant inflammation.

Objective

To investigate whether Lp(a) is associated with cardiovascular risk independent of high-sensitivity C-reactive protein (hs-CRP) in both primary and secondary prevention populations.

Design, Setting, and Participants

This cohort study uses data from 3 distinct cohorts, 1 population-based cohort and 2 randomized clinical trials. Participants included individuals from the UK Biobank (data from 2006-2010) without prevalent ASCVD, participants in the FOURIER (TIMI 59) trial (data from 2013-2017) who had baseline Lp(a) and hs-CRP data, and participants in the SAVOR-TIMI 53 trial (data from 2010-2013) who had prevalent ASCVD and baseline values for Lp(a) and hs-CRP. The data analysis took place from November 2022 to November 2023.

Exposure

Baseline plasma Lp(a), considered either as a continuous variable or dichotomized at 125 nmol/L.

Main Outcomes and Measures

Risk of major adverse cardiovascular events (MACE) (composite of cardiovascular death, myocardial infarction [MI], or ischemic stroke), the individual MACE components, and peripheral artery disease (PAD).

Results

Among 357 220 individuals in the UK Biobank without prevalent ASCVD, 232 699 (65%) had low hs-CRP (<2 mg/L), and 124 521 (35%) had high hs-CRP (≥2 mg/L) values. In a Cox proportional hazard model adjusted for ASCVD risk factors, higher Lp(a) was associated with increased cardiovascular risk regardless of baseline hs-CRP value for MACE (hs-CRP ≥2 mg/L: hazard ratio [HR] per 50-nmol/L higher Lp[a], 1.05; 95% CI, 1.04-1.07; P < .001; for hs-CRP <2 mg/L: HR, 1.05; 95% CI, 1.04-1.07; P < .001; P = .80 for interaction), as well as MI, ischemic stroke, and PAD individually. Among 34 020 individuals in the FOURIER and SAVOR trials with baseline cardiometabolic disease, there were 17 643 (52%) with low and 16 377 (48%) with high baseline hs-CRP values. In Cox proportional hazard models using aggregated data from FOURIER and SAVOR, higher baseline Lp(a) was associated with increased cardiovascular risk regardless of baseline hs-CRP for MACE (hs-CRP ≥2 mg/L: HR per 50-nmol/L higher Lp[a], 1.02; 95% CI, 1.00-1.05; P = .04; hs-CRP <2 mg/L: HR, 1.05; 95% CI, 1.02-1.08; P < .001; P = .16 for interaction), MI, and PAD.

Conclusions and Relevance

In this study, higher levels of Lp(a) were associated with MACE, MI, and PAD in both primary and secondary prevention populations regardless of baseline hs-CRP value.
Macrocheilia as an Atypical Clinical Presentation of Capillary Malformation–Arteriovenous Malformation Type 2
Authors: Rovira-López Roger , Pérez-Jurado Luis A. , Pujol Ramon M.
Published: February 2024

This case report describes a 53-year-old man with multiple erythematous macules and papules diffusely distributed on the frontal area, cheeks, eyelids, nose, and supralabial skin.
Unmet Social Needs and Breast Cancer Screening Utilization and Stage at Presentation
Authors: Goel Neha , Lubarsky Maya , Hernandez Alexandra E. , Benck Kelley , Lee Emma , Kesmodel Susan , Knaul Felicia , Kobetz Erin , Anderson Benjamin O.
Published: February 2024

Importance

Unmet social needs in local populations may hinder the development of targeted cancer control interventions aimed at improving screening utilization and early-stage breast cancer diagnosis to ultimately improve breast cancer survival disparities.

Objective

To evaluate if (1) city-funded screening mammography is associated with utilization of screening mammography, (2) unmet social needs are associated with utilization of screening mammography, and (3) unmet social needs are associated with later-stage disease at diagnosis.

Design, Setting, and Participants

This cohort study included patients with stages I-IV invasive ductal or lobular carcinoma treated at an academic medical center (including both an underserved safety-net hospital [SNH] and a National Cancer Institute–designated academic cancer center [ACC]) from 2020 to 2023. Eligible patients were aged 18 years or older and able to consent. Data were analyzed between July 2023 and September 2023.

Exposure

The Health Leads Social Needs Screening Toolkit, a screening tool that gathers information on the most common social need domains affecting patient health.

Main Outcomes and Measures

Univariable and multivariable logistic regression was utilized to evaluate the following primary outcomes: (1) routine screening mammography and (2) American Joint Committee on Cancer 8th edition clinical stage at presentation.

Results

Of the 322 women who completed the Health Leads Social Needs Screening Toolkit, 201 (62%) self-identified as Hispanic, 63 (19%) as non-Hispanic Black, and 63 (19%) as non-Hispanic White. Two hundred fifty-five (76%) patients with access to city-funded screening mammography completed a screening mammogram. Patients who presented to the SNH were more likely to present with late-stage disease compared with early-stage disease (15 of 48 [31%] vs 50 of 274 [18%]; P = .04). On multivariable logistic regression, not completing a screening mammography was associated with having an increasing number of unmet social needs (OR, 0.74; 95% CI, 0.55-0.99; P = .047) and an increasing age at diagnosis (OR, 0.92; 95% CI, 0.89-0.96; P < .001). Moreover, increasing unmet social needs was significantly associated with late-stage diagnosis above and beyond screening mammography (OR, 1.38; 95% CI, 1.01-1.89; P = .04).

Conclusions and Relevance

In this cohort study, access to screening mammography did not translate to utilization of screening mammography, increasing unmet social needs were significantly associated with lower rates of screening mammography, and those with increasing unmet social needs were more likely to present with late-stage disease. This association transcended recruitment site (SNH vs ACC), indicating that patients in either hospital setting may benefit from unmet social needs screening to overcome access to care barriers associated with late-stage disease at diagnosis.
Effectiveness of Virtual Reality Training in Teaching Personal Protective Equipment Skills
Authors: Tsukada Keisuke , Yasui Youichi , Miyata Satoshi , Fuyumuro Junko , Kikuchi Tomomi , Mizuno Takuhiro , Nakayama Satoshi , Kawano Hirotaka , Miyamoto Wataru
Published: February 2024

Importance

Training on the proper use of personal protective equipment (PPE) is critical for infection prevention among health care workers. Traditional methods, such as face-to-face and video-based training, can strain resources and present challenges.

Objective

To determine the effectiveness of 360° virtual reality (VR) training for PPE donning and doffing compared with face-to-face and video training in enhancing the PPE use skills of prospective health care practitioners.

Design, Setting, and Participants

A blinded, prospective, and randomized noninferiority clinical trial was conducted from August to December 2021 at Teikyo University School of Medicine in Tokyo, Japan, with a mixed population of medical students. Participants were second- to fourth-year medicine, medical technology, or pharmacy students aged 20 years or older with no prior PPE training. Participants were randomized into 1 of 3 training groups (VR, face-to-face, or video) based on their enrollment order. An intention-to-treat analysis was conducted.

Intervention

A 30-minute lecture on PPE procedures was delivered to all participants before the training. After the lecture, the VR group trained with an immersive 360° VR tool, the face-to-face group trained with actual PPE, and the video group trained by watching video footage on a computer and a projector. After 3 days, a standardized practical skills test was administered.

Main Outcomes and Measures

The primary outcome was the mean score on a 20-point practical skills test, and the secondary outcome was the percentage of correct execution.

Results

A total of 91 participants were recruited and randomized into 3 groups: VR (n = 30), face-to-face (n = 30), and video (n = 31) training. After excluding 1 participant due to illness, 90 participants (mean [SD] age, 24.2 [3.15] years; 54 males [60.0%]) completed the assessment. The mean (SD) scores were 17.70 (2.10) points for the VR group, 17.57 (2.45) points for the face-to-face group, and 15.87 (2.90) points for the video group. The VR group demonstrated no significant difference in performance from the face-to-face group. However, the VR group had significantly higher effectiveness than the video group (17.70 vs 15.87 points; P = .02).

Conclusions and Relevance

Results of this trial indicate that VR training was as effective as face-to-face training in enhancing PPE donning and doffing skills and was superior to video training. The findings suggest that VR training is a viable resource-conserving training option.

Trial Registration

Japan Registry of Clinical Trials Identifier: jRCT103021029
Disparities in Enrollment in Medicare Advantage Plans With Dental Benefits
Authors: Weatherspoon Darien J. , Hutfless Susan , Manski Richard J. , Moeller John F.
Published: February 2024

This cross-sectional study evaluates the association of Medicare beneficiaries’ sociodemographic characteristics with having Medicare Advantage plans that cover oral health services.
Variations in Suicide Risk and Risk Factors After Hospitalization for Depression in Finland, 1996-2017
Authors: Aaltonen Kari , Sund Reijo , Hakulinen Christian , Pirkola Sami , Isometsä Erkki
Published: February 2024

Importance

Although incidence of suicide in depression varies remarkably temporally, risk factors have been modeled as constant and remain uncharted in the short term. How effectively factors measured at one point in time predict risk at different time points is unknown.

Objective

To examine the absolute risk and risk factors for suicide in hospitalized patients with depression starting from the first days after discharge up to 2 years and to evaluate whether the size of relative risk by factor displays temporal patterns over consecutive phases of follow-up.

Design, Setting, and Participants

This population-based study using Finnish registers (hospital discharge, population, and cause of death registers) included all hospitalizations for depression as the principal diagnosis in Finland from 1996 to 2017, with a maximum follow-up of 2 years. Data were analyzed from January 2022 to November 2023.

Main Outcomes and Measures

Incidence rate (IR), IR ratios, hazard functions, and hazard ratios for suicide by consecutive time periods (0 to 3 days, 4 to 7 days, 7 to 30 days, 31 to 90 days, 91 to 365 days, and 1 to 2 years) since discharge.

Results

This study included 193 197 hospitalizations among 91 161 individuals, of whom 51 197 (56.2%) were female, and the mean (SD) age was 44.0 (17.3) years. Altogether, patients were followed up to 226 615 person-years. A total of 1219 men and 757 women died of suicide. Incidence of suicide was extremely high during the first days after discharge (IR of 6062 [95% CI, 4963-7404] per 100 000 on days 0 to 3; IR of 3884 [95% CI, 3119-4835] per 100 000 on days 4 to 7) and declined thereafter. Several factors were associated with risk of suicide over the first days after discharge. Current suicide attempt by hanging or firearms increased the risk of suicide most on days 0 to 3 (IR ratio, 18.9; 95% CI, 3.1-59.8) and on days 0 to 7 (IR ratio, 10.1; 95% CI, 1.7-31.5). Temporal patterns of the size of the relative risk diverged over time, being constant, declining, or increasing. Clinical factors had the strongest association immediately. Relative risk remained constant among men and even increased among those with alcohol or substance use disorder.

Conclusions and Relevance

In this study, patients hospitalized for depression had extremely high risk of suicide during the first days after discharge. Thereafter, incidence declined steeply but remained high. Within the periods of the highest risk of suicide, several factors increased overall risk manyfold. Risk factors’ observed potencies varied over time and had characteristic temporal patterns.
Academic Surgery in the Era of Large Language Models
Authors: Rengers Timothy A. , Thiels Cornelius A. , Salehinejad Hojjat
Published: February 2024

Importance

This review aims to assess the benefits and risks of implementing large language model (LLM) solutions in an academic surgical setting.

Observations

The integration of LLMs and artificial intelligence (AI) into surgical practice has generated international attention with the emergence of OpenAI’s ChatGPT and Google’s Bard. From an administrative standpoint, LLMs have the potential to revolutionize academic practices by reducing administrative burdens and improving efficiency. LLMs have the potential to facilitate surgical research by increasing writing efficiency, building predictive models, and aiding in large dataset analysis. From a clinical standpoint, LLMs can enhance efficiency by triaging patient concerns and generating automated responses. However, challenges exist, such as the need for improved LLM generalization performance, validating content, and addressing ethical concerns. In addition, patient privacy, potential bias in training, and legal responsibility are important considerations that require attention. Research and precautionary measures are necessary to ensure safe and unbiased use of LLMs in surgery.

Conclusions and Relevance

Although limitations exist, LLMs hold promise for enhancing surgical efficiency while still prioritizing patient care. The authors recommend that the academic surgical community further investigate the potential applications of LLMs while being cautious about potential harms.
Cell competition: emerging signaling and unsolved questions
Authors: Nagata Rina , Igaki Tatsushi
Published: February 2024

Multicellular communities have an intrinsic mechanism that optimizes their structure and function via cell–cell communication. One of the driving forces for such self‐organization of the multicellular system is cell competition, the elimination of viable unfit or deleterious cells via cell–cell interaction. Studies in Drosophila and mammals have identified multiple mechanisms of cell competition caused by different types of mutations or cellular changes. Intriguingly, recent studies have found that different types of “losers” of cell competition commonly show reduced protein synthesis. In Drosophila, the reduction in protein synthesis levels in loser cells is caused by phosphorylation of the translation initiation factor eIF2α via a bZip transcription factor Xrp1. Given that a variety of cellular stresses converge on eIF2α phosphorylation and thus global inhibition of protein synthesis, cell competition may be a machinery that optimizes multicellular fitness by removing stressed cells. In this review, we summarize and discuss emerging signaling mechanisms and critical unsolved questions, as well as the role of protein synthesis in cell competition.
Building trustworthy NeuroSymbolic AI Systems: Consistency, reliability, explainability, and safety
Authors: Gaur Manas , Sheth Amit
Published: February 2024

Explainability and Safety engender trust. These require a model to exhibit consistency and reliability. To achieve these, it is necessary to use and analyzedataandknowledgewith statistical and symbolic AI methods relevant to the AI application––neither alone will do. Consequently, we argue and seek to demonstrate that the NeuroSymbolic AI approach is better suited for making AI a trusted AI system. We present the CREST framework that shows howConsistency,Reliability, user‐levelExplainability, andSafety are built on NeuroSymbolic methods that use data and knowledge to support requirements for critical applications such as health and well‐being. This article focuses on Large Language Models (LLMs) as the chosen AI system within the CREST framework. LLMs have garnered substantial attention from researchers due to their versatility in handling a broad array of natural language processing (NLP) scenarios. As examples, ChatGPT and Google's MedPaLM have emerged as highly promising platforms for providing information in general and health‐related queries, respectively. Nevertheless, these models remain black boxes despite incorporating human feedback and instruction‐guided tuning. For instance, ChatGPT can generateunsafe responsesdespite instituting safety guardrails. CREST presents a plausible approach harnessing procedural and graph‐based knowledge within a NeuroSymbolic framework to shed light on the challenges associated with LLMs.
The AI Institute for Engaged Learning
Authors: Lester James , Bansal Mohit , Biswas Gautam , Hmelo‐Silver Cindy , Roschelle Jeremy , Rowe Jonathan
Published: February 2024

The EngageAI Institute focuses on AI‐driven narrative‐centered learning environments that create engaging story‐based problem‐solving experiences to support collaborative learning. The institute's research has three complementary strands. First, the institute creates narrative‐centered learning environments that generate interactive story‐based problem scenarios to elicit rich communication, encourage coordination, and spark collaborative creativity. Second, the institute creates virtual embodied conversational agent technologies with multiple modalities for communication (speech, facial expression, gesture, gaze, and posture) to support student learning. Embodied conversational agents are driven by advances in natural language understanding, natural language generation, and computer vision. Third, the institute is creating an innovative multimodal learning analytics framework that analyzes parallel streams of multimodal data derived from students’ conversations, gaze, facial expressions, gesture, and posture as they interact with each other, with teachers, and with embodied conversational agents. Woven throughout the institute's activities is a strong focus on ethics, with an emphasis on creating AI‐augmented learning that is deeply informed by considerations of fairness, accountability, transparency, trust, and privacy. The institute emphasizes broad participation and diverse perspectives to ensure that advances in AI‐augmented learning address inequities in STEM. The institute brings together a multistate network of universities, diverse K‐12 school systems, science museums, and nonprofit partners. Key to all of these endeavors is an emphasis on diversity, equity, and inclusion.
The efficacy of the Self‐Administered Interview in minimising the misinformation effect
Authors: Bird Emily , Wiener Jan , Attard‐Johnson Janice
Published: February 2024

Two experiments investigated the efficacy of the Self‐Administered Interview (SAI) in immediate recall and minimising misinformation into later recall. In Experiment 1, participants (N = 114) viewed a reconstructed crime video and completed the SAI, Written Free Recall (WFR), or no recall for immediate recall, followed by a Delayed Recall questionnaire 1‐to‐2 weeks later. Experiment 2 replicated the procedure, except after the delay, participants (N = 141) were exposed to misinformation before Delayed Recall. Across both experiments, the SAI enhanced immediate memory, particularly for person details, compared to WFR. However, this initial enhancement did not lead to more correct information after the delay, although it reduced incorrect responses compared to no immediate recall. Surprisingly, neither the SAI nor the WFR reduced susceptibility to misinformation. The findings suggest completing an SAI immediately or soon after witnessing an event could enhance memory recall, reinforcing its potential utility for witnesses.
Biodegradable Near‐Infrared‐IIb Rare‐Earth Nanoprobe Enables Time‐Programmable Neuroimaging
Authors: Zheng Xue , Du Yijing , Dang Zetao , Lan Ke , Liu Guantong , Ren Jingyan , Wang Xin , Zhu Shoujun
Published: February 2024

Neural imaging plays a crucial role in understanding the structure and function of the living body. While near‐infrared‐II (NIR‐II) imaging techniques have emerged as potential tools for non‐invasive and high‐resolution imaging of neural activity, there have been rare relevant reports on in vivo neural imaging. This study presents the development of biodegradable NIR‐II rare‐earth nanoprobes as a novel contrast agent for enhanced neural imaging. The biodegradable NIR‐II rare‐earth nanoprobes exhibit excellent long wavelength emission, high quantum yield, and tunable biodegradation time in vivo. This work demonstrates the effectiveness of these nanoprobes in enhancing the imaging depth and resolution in a mouse model of neural activity, thereby facilitating a better understanding of the structure and function of the nervous system. Furthermore, their biodegradability ensures minimal long‐term toxicity and allows for repeatedly monitoring of damaged nerves during the recovery or deterioration process. The results highlight the potential of biodegradable NIR‐II rare‐earth nanoprobes for advancing neural imaging techniques and facilitating deeper insights into neuroscience research and clinical diagnostics.
Monolithic Conjugated Microporous Polymer Aerogel for Triboelectric Nanogenerator
Authors: Meng Nan , Zhang Yu , Liu Wei , Chen Qiaochu , Soykeabkaew Nattakan , Liao Yaozu
Published: February 2024

Triboelectric nanogenerator (TENG) has emerged as a novel nanotechnology for energy harvesting and self‐powered sensing via utilizing various low‐frequency mechanical energies throughout the surrounding environment. However, designing TENG with high physical robustness, flexibility, and output performance is rather challenging. This study develops monolithic conjugated microporous polymer aerogel (CMPA) with delocalized π‐conjugation to construct TENG with a robust porous structure. The as‐produced CMPA is composed of hollow intertwined nanotubes with a high degree of flexibility and high specific surface area (up to 528 m2 g−1). Due to its intrinsic nature of conjugated electron transfer and architectural characteristics, the CMPA‐based TENG (effective area: 4.9 cm2) shows a high sensitivity to mechanical force and excellent electric output (open‐circuit voltage: 72 V, short‐circuit peak current: 3.2 µA and transferred charge: 48 nC). Moreover, the CMPA‐based TENG can charge micro‐electronic devices and sense human motions. This work will inspire the design of aerogel‐based electronic devices and the management of renewable energy resources.
Encapsulation of Highly Dispersed Au NPs by Strong Metal–Support Interactions in Porous Titania Nanoplates for Efficient Electrosynthesis of H2O2
Authors: He Yilei , Wei Yanze , Wang Zumin , Xia Tian , Rao Fu , Song Zhifan , Yu Ranbo
Published: February 2024

Tuning the electrocatalytic selectivity and long‐term stability for industrially significant, yet reactively unfavorable products, remains a challenge in oxygen reduction. Herein, the Au/TiO2 catalysts with strong metal–support interactions (SMSI) are designed and synthesized through an in situ auto‐reduction of Au‐modified Ti‐MOF. Highly dispersed ultra‐low loading of Au NPs strongly capsulated in porous TiO2 substrate, together with conductive carbon derivated from MOFs, enables Au/TiO2 electrocatalysts to achieve excellent H2O2 electrosynthesis through the two‐electron oxygen reduction reaction (2e ORR). Au(1.0)/TiO2 (0.52 wt% Au loading) exhibited a high selectivity of 90%, a remarkable Faradaic efficiency of 98%, and 72.2 mg L−1 h−1 H2O2 production. Highly dispersed Au NPs promote active site exposure, while the conductive carbon and the porous superstructure enhance mass diffusion. Notably, the SMSI between Au NPs and TiO2 substrate leads to superb stability (over 168 h) of the electrocatalysts, as it ensures continuous electronic interactions. Experimental characterizations and density functional theory (DFT) simulations further revealed that the SMSI effect medicates the activation of the *OOH intermediate formation and the d‐band center, which are conductive to 2e ORR. Moreover, this strategy provides a potential way toward high‐performance electrocatalysts in flow system devices for continuously purifying sewage and chemical bleaching in extreme environments.
Colossal Magnetoresistive Switching Induced by d0 Ferromagnetism of MgO in a Semiconductor Nanochannel Device with Ferromagnetic Fe/MgO Electrodes
Authors: Ohya Shinobu , Tsuruoka Shun , Kaneda Masaya , Shinya Hikari , Fukushima Tetsuya , Takeda Takahito , Tadano Yuriko , Endo Tatsuro , Anh Le Duc , Masago Akira , Katayama‐Yoshida Hiroshi , Tanaka Masaaki
Published: February 2024

Exploring potential spintronic functionalities in resistive switching (RS) devices is of great interest for creating new applications, such as multifunctional resistive random‐access memory and novel neuromorphic computing devices. In particular, the importance of the spin‐triplet state of cation vacancies in oxide materials, which is induced by localized and strong O–2p on‐site Coulomb interactions, in RS devices has been overlooked. d0 ferromagnetism sometimes appears due to the spin‐triplet state and ferromagnetic Zener's double exchange interactions between cation vacancies, which are occasionally strong enough to make nonmagnetic oxides ferromagnetic. Here, for the first time, anomalous and colossal magneto‐RS (CMRS) with very high magnetic field dependence is demonstrated by utilizing an unconventional RS device composed of a Ge nanochannel with all‐epitaxial single‐crystalline Fe/MgO electrodes. The device shows colossal and unusual behavior as the threshold voltage and ON/OFF ratio strongly depend on a magnetic field, which is controllable with an applied voltage. This new phenomenon is attributed to the formation of d0‐ferromagnetic filaments by attractive Mg vacancies due to the spin‐triplet states with ferromagnetic double exchange interactions and the ferromagnetic proximity effect of Fe on MgO. The findings will allow the development of energy‐efficient CMRS devices with multifield susceptibility.
Layered High‐Entropy Metallic Glasses for Photothermal CO2 Methanation
Authors: Yu Xiwen , Ding Xue , Yao Yingfang , Gao Wanguo , Wang Cheng , Wu Chengyang , Wu Congping , Wang Bing , Wang Lu , Zou Zhigang
Published: February 2024

High entropy alloys and metallic glasses, as two typical metastable nanomaterials, have attracted tremendous interest in energy conversion catalysis due to their high reactivity in nonequilibrium states. Herein, a novel nanomaterial, layered high entropy metallic glass (HEMG), in a higher energy state than low‐entropy alloys and its crystalline counterpart due to both the disordered elemental and structural arrangements, is synthesized. Specifically, the MnNiZrRuCe HEMG exhibits highly enhanced photothermal catalytic activity and long‐term stability. An unprecedented CO2 methanation rate of 489 mmol g−1 h−1 at 330 °C is achieved, which is, to the authors’ knowledge, the highest photothermal CO2 methanation rate in flow reactors. The remarkable activity originates from the abundant free volume and high internal energy state of HEMG, which lead to the extraordinary heterolytic H2 dissociation capacity. The high‐entropy effect also ensures the excellent stability of HEMG for up to 450 h. This work not only provides a new perspective on the catalytic mechanism of HEMG, but also sheds light on the great catalytic potential in future carbon‐negative industry.
Surface‐Enriched Single‐Bi‐Atoms Tailoring of Pt Nanorings for Direct Methanol Fuel Cells with Ultralow‐Pt‐Loading
Authors: Fan Xiaokun , Chen Wen , Xie Lei , Liu Xianglong , Ding Yutian , Zhang Long , Tang Min , Liao Yujia , Yang Qi , Fu Xian‐Zhu , Luo Shuiping , Luo Jing‐Li
Published: February 2024

Single‐atom decorating of Pt emerges as a highly effective strategy to boost catalytic properties, which can trigger the most Pt active sites while blocking the smallest number of Pt atoms. However, the rational design and creation of high‐density single‐atoms on Pt surface remain as a huge challenge. Herein, a customized synthesis of surface‐enriched single‐Bi‐atoms tailored Pt nanorings (SE‐Bi1/Pt NRs) toward methanol oxidation is reported, which is guided by the density functional theory (DFT) calculations suggesting that a relatively higher density of Bi species on Pt surface can ensure a CO‐free pathway and accelerate the kinetics of *HCOOH formation. Decorating Pt NRs with dense single‐Bi‐atoms is achieved by starting from PtBi intermetallic nanoplates (NPs) with intrinsically isolated Bi atoms and subsequent etching and annealing treatments. The SE‐Bi1/Pt NRs exhibit a mass activity of 23.77 A mg−1 Pt toward methanol oxidation in alkaline electrolyte, which is 2.2 and 12.8 times higher than those of Pt‐Bi NRs and Pt/C, respectively. This excellent activity endows the SE‐Bi1/Pt NRs with a high likelihood to be used as a practical anodic electrocatalyst for direct methanol fuel cells （DMFCs） with high power density of 85.3 mW cm−2 and ultralow Pt loading of 0.39 mg cm−2.