bluuebunny/crossref_metadata_2025 huggingface dataset:
Secondary prevention in young patients after acute ST segment elevation myocardial infarction: missing the goals and suffering the penalties
Authors: Abrantes A , Ana Beatriz Garcia A B G , Ana Margarida Martins A M M , Catarina Gregorio C G , Miguel Raposo M R , Joao Fonseca J F , Joao Cravo J C , Alda Jordao A J , Silvia Fiuza S F , Edite Caldeira E C , Nelson Cunha N C , Ines Aguiar-Ricardo I A R , Fausto J Pinto F J P , Ana Abreu A A
Published: June 2024

Introduction

Young patients that suffer an acute ST segment elevation myocardial infarction (STEMI) are an especially vulnerable population that requires close monitoring. Therefore, secondary prevention in these pts is key to prevent event recurrence during their lifetime.

Purpose

To evaluate efficacy of risk factor control in a population of young pts with STEMI.

Methods

Retrospective, single-center study of consecutive pts, aged below 50 years, admitted with STEMI between 2017 and 2021. Demographics, clinical characteristics and outcomes were analyzed. Parametric and non-parametric tests were performed as appropriate.

Results

We included 306 pts, 81.7% were men, mean age of 43.9 ± 5.1 years, the majority was admitted with anterior followed by inferior STEMI. Only 26pts were previously under statin therapy, median cLDL at admission was 105±47. At discharge all pts were under statins however only 63% received high intensity statin and 4% ezetimibe. Only 20% of pts completed a cardiac rehabilitation program.

During a mean follow-up (FUP) of 3.8 ± 1.7 years, 52.3% of pts had less than optimal controlled hypertension, 20.7% had diabetes, 53% still smoked, cLDL was significantly lower, (mean of 86 ± 39, p<0.001), with a mean reduction of 26.8% ± 46.6. High intensity statin was prescribed to 54% of pts, ezetimibe to 33%, the combination of high intensity statin and ezetimibe to 22%, no one was under iPCSK9 or bempedoic acid.

However, only 16.8% of pts met guideline-oriented goal of cLDL<55mg/dl, and only 26.9% presented a 50% reduction from baseline cLDL. In pts with cLDL>55mg/dl only 47.7% were under high intensity statin, 33% under ezetimibe and 30.4% under high intensity statin plus ezetimibe, up titration occurred in about 30% of these pts. When considering pts under high intensity statin and ezetimibe only 23.7% met cLDL goal.

During FUP, 19 pts had reinfarction and of these only 5.3% of pts met target cLDL and half were under therapy with high intensity statin and ezetimibe. When considering the 25 pts who died, no one had cLDL<55 nor anyone was under high intensity statin plus ezetimibe.

Conclusion

Secondary prevention in coronary patients, namely young ones, must be strengthened; cardiac rehabilitation referral and completion of programs has to be optimized and special focus on cardiovascular risk factors control must be made in order to achieve guideline recommended targets and reduce adverse events during follow-up.
Cardiopulmonary fitness and personalized exercise prescription in patients with hypertrophic cardiomyopathy
Authors: Cavigli L , Olivotto I , Ragazzoni G L , Boncompagni A , Targetti M , Focardi M , Cameli M , Vannuccini F , Valente S , D'ascenzi F
Published: June 2024

Introduction

Most patients with hypertrophic cardiomyopathy (HCM) are restricted to competitive sports due to early evidence that exercise increases their risk of sudden cardiac death and malignant arrhythmias. As a result, they become inactive and experience the negative consequences of a sedentary lifestyle. Hence, the need arises to strike the right balance between these two extremes through personalized exercise prescription. The aims of this study were: 1) to assess the characteristics of HCM patients who practised regular aerobic physical activity compared to HCM sedentary patients; 2) to perform a personalized moderate-intensity exercise prescription and evaluate its effects.

Methods

HCM patients were evaluated through clinical evaluation, ECG, ambulatory ECG monitoring, echocardiography, and CPET. In selected patients, a personalized moderate-intensity exercise prescription was performed. Subsequently, patients were reevaluated with the same investigations.

Results

Physically active HCM patients demonstrated better cardiopulmonary functional capacity than sedentary patients (p≤0.0001), without significant differences regarding ventricular arrhythmias (p=0.43); moderate intensity exercise prescription led to improved cardiopulmonary fitness without occurrence of adverse events. The sedentary subjects showed a greater BMI, a higher prevalence of obesity (p=0.07), and a deterioration of their cardiopulmonary fitness due to the maintenance of a sedentary lifestyle.

Conclusions

A sedentary lifestyle led to a deterioration of cardiopulmonary functional capacity and fitness. The tailored moderate-intensity personalized exercise prescription appears to be a feasible approach in carefully selected HCM patients to counterbalance the negative effects of sedentary behaviour without significant major events.
Is the Risk of Alzheimer’s Disease and Related Dementias Among U.S. Veterans Influenced by the Intersectionality of Housing Status, HIV/AIDS, Hepatitis C, and Psychiatric Disorders?
Authors: Beydoun Hind A , Szymkowiak Dorota , Kinney Rebecca , Beydoun May A , Zonderman Alan B , Tsai Jack
Published: June 2024

Background

Homelessness and housing instability disproportionately affect U.S. veterans with psychiatric disorders, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C, and Alzheimer’s disease and related disorders (ADRD). We examined housing status and/or HIV/AIDS in relation to ADRD risk and evaluated hepatitis C, substance use, and mental health disorders as mediators and/or moderators of hypothesized relationships, among U.S. veterans ≥50 years of age seeking Department of Veterans Affairs (VA) healthcare services.

Methods

A retrospective cohort study was conducted using linked VA Homeless Operations Management and Evaluation System and Corporate Data Warehouse databases (2017–2023) on 3 275 098 eligible veterans yielding 133 388 ADRD cases over 5 years of follow-up. Multivariable regression and causal mediation analyses were performed, controlling for demographic and clinical characteristics.

Results

Taking stably housed veterans without HIV/AIDS as referent, ADRD risk was higher among veterans with homelessness/housing instability alone (adjusted hazard ratio [aHR] = 1.67, 95% confidence interval [CI]: 1.63,1.72), lower among veterans with HIV/AIDS alone (aHR = 0.65, 95% CI: 0.58,0.73), but similar to veterans with homelessness/housing instability and HIV/AIDS (aHR = 1.01, 95% CI: 0.79,1.29). In adjusted models, hepatitis C and psychiatric disorders were positively related to homelessness/housing instability and ADRD risk, but negatively related to HIV/AIDS. Statistically significant mediation and/or moderation of hepatitis C and psychiatric disorders were observed, although <10% of total effects were explained by these characteristics, controlling for confounders.

Conclusions

Among older veterans, ADRD diagnoses over 5 years were less among those with HIV/AIDS, but more among those with homelessness/housing instability, and these relationships were partly explained by hepatitis C and psychiatric disorders.
Ageism and (Successful) Digital Engagement: A Proposed Theoretical Model
Authors: Mannheim Ittay , Köttl Hanna
Published: June 2024

Recently, scholars have highlighted the detrimental consequences of technology-based ageism. Digital technology (DT) is commonly discoursed as an opportunity to promote Successful Aging. Nevertheless, the theoretical implications of ageism, DT, and Successful Aging are underexplored. This paper presents a new theoretical model of Digital Engagement and Ageism (D-EngAge), which elaborates on the potential impacts of ageism on digital engagement and participation in later life and explains how ageism may pose a threat to realizing the potential of DT to promote Successful Aging. The D-EngAge model was developed based on a synthesis of findings from 12 recent studies we conducted on the intersection of ageism and DT. Findings were synthesized through Iversen’s clasification of four dimensions of ageism, demonstrating how ageism as a multifaceted construct has a reciprocal relationship with digital engagement on the micro- (individual), meso- (social interaction), and macro-levels (discourses and societal practices). Consequently, digital engagement on these levels may exacerbate or reduce technology-based ageism. This forum paper identifies ageism as a barrier to utilizing DT, critically discusses power imbalances, and deconstructs Successful Aging discourses regarding digital engagement. Theoretical implications and recommendations for future interventions and policy measures to mitigate ageism and promote digital engagement and participation in later life are presented.
Understanding Trophic Interactions in a Warming World by Bridging Foraging Ecology and Biomechanics with Network Science
Authors: Cuff Jordan P , Labonte David , Windsor Fredric M
Published: June 2024

Synopsis

Climate change will disrupt biological processes at every scale. Ecosystem functions and services vital to ecological resilience are set to shift, with consequences for how we manage land, natural resources, and food systems. Increasing temperatures cause morphological shifts, with concomitant implications for biomechanical performance metrics crucial to trophic interactions. Biomechanical performance, such as maximum bite force or running speed, determines the breadth of resources accessible to consumers, the outcome of interspecific interactions, and thus the structure of ecological networks. Climate change-induced impacts to ecosystem services and resilience are therefore on the horizon, mediated by disruptions of biomechanical performance and, consequently, trophic interactions across whole ecosystems. Here, we argue that there is an urgent need to investigate the complex interactions between climate change, biomechanical traits, and foraging ecology to help predict changes to ecological networks and ecosystem functioning. We discuss how these seemingly disparate disciplines can be connected through network science. Using an ant-plant network as an example, we illustrate how different data types could be integrated to investigate the interaction between warming, bite force, and trophic interactions, and discuss what such an integration will achieve. It is our hope that this integrative framework will help to identify a viable means to elucidate previously intractable impacts of climate change, with effective predictive potential to guide management and mitigation.
Green and Versatile High-Throughput Microwell Oxidation-Based Spectrophotometric Methods for Determination of Galidesivir in Capsules
Authors: Darwish Ibrahim A , Alzoman Nourah Z
Published: June 2024

Background

Galidesivir (GDV) is a promising new antiviral drug for the potent and safe treatment of a broad spectrum of viral diseases, including COVID-19. In the literature, no analytical method exists for the determination of GDV in bulk and dosage form.

Objective

The aim of this study was the development of versatile green and simple microwell spectrophotometric methods (MW-SPMs) for the determination of GDV in its bulk form and capsules.

Methods

Three MW-SPMs were developed involving the oxidation of GDV by ammonium metavanadate (AMV), chromium trioxide (CTO), and potassium iodate (PIO) in an acid medium. The reactions were carried out in 96-well plates at room temperature and the absorbances of chromogenic reaction products were measured by an absorbance microplate reader at 780, 595, and 475 nm for AMV, CTO, and PIO, respectively. Variables influencing the reactions were carefully investigated and optimized.

Results

Linear relations with excellent correlation coefficients (0.9991–0.9997) were found between the absorbances and GDV concentrations in the range of 25–500 µg/mL. The LODs were ≥8.3 µg/mL. The accuracy and precision of the three MW-SPMs were confirmed by recovery and replicate analysis, respectively. The recovery values were 98.6–101.2% and the RSDs were ≤1.02%. The proposed MW-SPMs were successfully applied to the analysis of GDV in bulk drug and capsules with high accuracy and precision. The greenness of the MW-SPMs was confirmed by three comprehensive metric tools.

Conclusion

The proposed MW-SPMs combined the inherent advantages of microwell-based analysis and the use of common laboratory reagents for the reactions involved. These advantages include high-throughput, ready automation, reduced sample/reagent volume, precise measurements, and versatility. The advantages of the use of common laboratory reagents include availability, consistency, compatibility, safety, and cost-effectiveness.

Highlights

Overall, the proposed MW-SPMs are versatile valuable tools for the quantitation of GDV during its pharmaceutical manufacturing.
Effect of feeding calf starter with calcium salts of medium-chain fatty acids on the growth and metabolic hormones in calves
Authors: Masuda Y , Fukumori R , Tomoshige M , Sarentonglaga B , Sugino T , Nagao Y
Published: June 2024

We investigated the effects of a calf starter supplemented with calcium salts of medium-chain fatty acids (MCFA-Ca) on growth and plasma hormone concentration in calves. Twelve Holstein calves were randomly assigned to two dietary groups (without supplementation [CON] and supplemented with MCFA-Ca [MCFA]) from 4 d of age. Calves were fed 1.0 kg/d of milk replacer until 5 wk of age and were completely weaned at 7 wk of age. Calves in the MCFA group received a calf starter containing 1% MCFA-Ca. dry matter intake (DMI) was measured daily, and body weight was measured weekly. Rumen fluid was collected at 13 wk of age to measure pH and volatile fatty acid concentration. Preprandial blood samples were collected weekly to measure the basal plasma hormone and metabolite concentrations. At 4, 8, and 13 wk of age, peri-prandial blood samples were collected every 30 min, from 60 min before feeding to 120 min after feeding, to observe metabolic responses to feeding. In addition, insulin sensitivity was assessed using euglycemic-hyperinsulinemic clamps at 4, 8, and 13 wk of age in three calves from each treatment. There were no differences in starter and hay DMI between the treatments. However, the average daily gain (ADG) after weaning was higher in the MCFA group than in the CON group. Weekly changes in plasma parameters did not differ between the treatments. Plasma concentrations of preprandial ghrelin and postprandial total ketone bodies at 13 wk of age were higher in the MCFA group than in the CON group. At 8 wk of age, peri-prandial plasma insulin concentrations were lower in the MCFA group than in the CON group. There were no differences between the treatments in terms of insulin sensitivity. The present study suggested that feeding weaning calves MCFA-Ca increases the ADG during the postweaning period, which may be mediated by endocrine signals, such as enhanced ghrelin secretion and decreased insulin secretion, without altering insulin sensitivity.
Scrutinizing evidence for the triggering of active galactic nuclei in the outskirts of massive galaxy clusters at z ≈ 1
Authors: Muñoz Rodríguez Iván , Georgakakis Antonis , Shankar Francesco , Ruiz Ángel , Bonoli Silvia , Comparat Johan , Fu Hao , Koulouridis Elias , Lapi Andrea , Almeida Cristina Ramos
Published: June 2024

Environmental effects are believed to play an important yet poorly understood role in triggering accretion events onto the supermassive black holes (SMBHs) of galaxies (active galactic nuclei; AGNs). Massive clusters, which represent the densest structures in the Universe, provide an excellent laboratory to isolate environmental effects and study their impact on black hole growth. In this work, we critically review observational evidence for the preferential activation of SMBHs in the outskirts of galaxy clusters. We develop a semi-empirical model under the assumption that the incidence of AGN in galaxies is independent of environment. We demonstrate that the model is broadly consistent with recent observations on the AGN halo occupation at z =

0.2, although it may overpredict satellite AGN in massive haloes at that low redshift. We then use this model to interpret the projected radial distribution of X-ray sources around high redshift (z ≈ 1) massive ($\gt 5 \times 10^{14} \, M_\odot$) clusters, which show excess counts outside their virial radius. Such an excess naturally arises in our model as a result of sample variance. Up to 20  per cent of the simulated projected radial distributions show excess counts similar to the observations, which are however, because of background/foreground AGN and hence, not physically associated with the cluster. Our analysis emphasizes the importance of projection effects and shows that current observations of z ≈ 1 clusters remain inconclusive on the activation of SMBHs during infall.
Measuring glitch recoveries and braking indices with Bayesian model selection
Authors: Liu Y , Keith M J , Antonopoulou D , Weltevrede P , Shaw B , Stappers B W , Lyne A G , Mickaliger M B , Basu A
Published: June 2024

For a selection of 35 pulsars with large spin-up glitches ($\Delta {\nu }/\nu \ge 10^{-6}$), which are monitored by the Jodrell Bank Observatory, we analyse 157 glitches and their recoveries. All parameters are measured consistently and we choose the best model to describe the post-glitch recovery based on Bayesian evidence. We present updated glitch epochs, sizes, changes of spin down rate, exponentially recovering components (amplitude and corresponding time-scale) when present, as well as pulsars’ second frequency derivatives and their glitch-associated changes if detected. We discuss the different observed styles of post-glitch recovery as well as some particularly interesting sources. Several correlations are revealed between glitch parameters and pulsar spin parameters, including a very strong correlation between a pulsar’s interglitch $|\ddot{\nu }|$ and $\dot{\nu }$, as well as between the glitch-induced spin-down rate change $\Delta \dot{\nu }_{\rm p}$ that does not relax exponentially and $\dot{\nu }$. We find that the ratio $\left|\Delta \dot{\nu }_{\mathrm{p}}/\ddot{\nu }\right|$ can be used as an estimate of glitch recurrence times, especially for those pulsars for which there are indications of a characteristic glitch size and interglitch waiting time. We calculate the interglitch braking index n and find that pulsars with large glitches typically have n greater than 3, suggesting that internal torques dominate the rotational evolution between glitches. The external torque, for example, from electromagnetic dipole radiation, could dominate the observed $\ddot{\nu }$ for the youngest pulsars ($\lesssim 10^{4}\,\,\mathrm{yr}$), which may be expected to display $n\sim 3$.
Spontaneous grain refinement effect of rare earth zinc alloy anodes enables stable zinc batteries
Authors: Chen Manjing , Gong Yuxiang , Zhao Yunxiang , Song Yexin , Tang Yan , Zeng Zhiyuan , Liang Shuquan , Zhou Peng , Lu Bingan , Zhang Xiaotan , Zhou Jiang
Published: June 2024

Irreversible interfacial reactions at the anodes pose a significant challenge to the long-term stability and lifespan of zinc (Zn) metal batteries, impeding their practical application as energy storage devices. The plating and stripping behavior of Zn ions on polycrystalline surfaces is inherently influenced by the microscopic structure of Zn anodes, a comprehensive understanding of which is crucial but often overlooked. Herein, commercial Zn foils were remodeled through the incorporation of cerium (Ce) elements via the ‘pinning effect’ during the electrodeposition process. By leveraging the electron-donating effect of Ce atoms segregated at grain boundaries (GBs), the electronic configuration of Zn is restructured to increase active sites for Zn nucleation. This facilitates continuous nucleation throughout the growth stage, leading to a high-rate instantaneous-progressive composite nucleation model that achieves a spatially uniform distribution of Zn nuclei and induces spontaneous grain refinement. Moreover, the incorporation of Ce elements elevates the site energy of GBs, mitigating detrimental parasitic reactions by enhancing the GB stability. Consequently, the remodeled ZnCe electrode exhibits highly reversible Zn plating/stripping with an accumulated capacity of up to 4.0 Ah cm−2 in a Zn symmetric cell over 4000 h without short-circuit behavior. Notably, a ∼0.4 Ah Zn||NH4V4O10 pouch cell runs over 110 cycles with 83% capacity retention with the high-areal-loading cathode (≈20 mg cm−2). This refining-grains strategy offers new insights into designing dendrite-free metal anodes in rechargeable batteries.
Discrimination of the Veterans Aging Cohort Study Index 2.0 for Predicting Cause-specific Mortality Among Persons With HIV in Europe and North America
Authors: Ambia Julie , Ingle Suzanne M , McGinnis Kathleen , Pantazis Nikos , Silverberg Michael J , Wittkop Linda , Kusejko Katharina , Crane Heidi , van Sighem Ard , Sarcletti Mario , Cozzi-Lepri Alessandro , Domingo Pere , Jarrin Inma , Wyen Christoph , Hessamfar Mojgan , Zhang Lei , Cavassini Matthias , Berenguer Juan , Sterling Timothy R , Reiss Peter , Abgrall Sophie , Gill M John , Justice Amy , Sterne Jonathan A C , Trickey Adam
Published: June 2024

Background

Predicting cause-specific mortality among people with HIV (PWH) could facilitate targeted care to improve survival. We assessed discrimination of the Veterans Aging Cohort Study (VACS) Index 2.0 in predicting cause-specific mortality among PWH on antiretroviral therapy (ART).

Methods

Using Antiretroviral Therapy Cohort Collaboration data for PWH who initiated ART between 2000 and 2018, VACS Index 2.0 scores (higher scores indicate worse prognosis) were calculated around a randomly selected visit date at least 1 year after ART initiation. Missingness in VACS Index 2.0 variables was addressed through multiple imputation. Cox models estimated associations between VACS Index 2.0 and causes of death, with discrimination evaluated using Harrell's C-statistic. Absolute mortality risk was modelled using flexible parametric survival models.

Results

Of 59 741 PWH (mean age: 43 years; 80% male), the mean VACS Index 2.0 at baseline was 41 (range: 0–129). For 2425 deaths over 168 162 person-years follow-up (median: 2.6 years/person), AIDS (n = 455) and non–AIDS-defining cancers (n = 452) were the most common causes. Predicted 5-year mortality for PWH with a mean VACS Index 2.0 score of 38 at baseline was 1% and approximately doubled for every 10-unit increase. The 5-year all-cause mortality C-statistic was .83. Discrimination with the VACS Index 2.0 was highest for deaths resulting from AIDS (0.91), liver-related (0.91), respiratory-related (0.89), non-AIDS infections (0.87), and non–AIDS-defining cancers (0.83), and lowest for suicides/accidental deaths (0.65).

Conclusions

For deaths among PWH, discrimination with the VACS Index 2.0 was highest for deaths with measurable physiological causes and was lowest for suicide/accidental deaths.
Household Transmission of Tinea Infections: Analysis of a Large Commercial Health Insurance Claims Database, United States, 2021
Authors: Benedict Kaitlin , Lipner Shari R , Caplan Avrom S , Gold Jeremy A W
Published: June 2024

Among 207 914 multimember households with a tinea case, a secondary case was diagnosed in another household member in 8.5%. Excluding same-day diagnoses (20%), the median time from index case to first secondary case was 138 days. To prevent household tinea transmission, appropriate treatment and strategies to reduce environmental contamination are needed.
Impact of Catheter-Drawn Blood Cultures on Patient Management: A Multicenter, Retrospective Cohort Study
Authors: Wales Rebecca , McCormick Winston , Matteo Andrés Blanco-Di , Del Pozo José L , Has Phinnara , Mermel Leonard A
Published: June 2024

Background

Nosocomial bloodstream infections associated with intravascular catheters pose significant financial burden, morbidity, and mortality. There is much debate about whether or not blood cultures should be drawn through central venous catheters, and while guidelines advocate for catheter-drawn cultures when catheter infection is suspected, there is variable practice in this regard.

Methods

We performed a retrospective cohort study assessing episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures in tertiary care hospitals in the United States and Spain.

Results

We identified 143 episodes in 122 patients meeting inclusion criteria. Thirty percent of such episodes revealed growth of potential pathogens such as Staphylococcus aureus. Overall, 21% of follow-up percutaneously-drawn blood cultures obtained within 48 hours revealed growth of the same microbe after an episode of positive catheter-drawn blood cultures with negative concomitant percutaneously-drawn cultures (33% when potential pathogens were isolated; 16% when common skin contaminants were isolated). Patients with cultures growing pathogenic organisms were more likely to receive targeted antimicrobial therapy and have their catheters removed sooner.

Conclusions

Many episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures lead to growth from percutaneously-drawn follow-up blood cultures. Thus, such initial discordant results should not be disregarded. Our findings advocate for a nuanced approach to blood culture interpretation, emphasizing the value of catheter-drawn blood cultures in clinical decision making and management.
When do trademarks improve the measurement of innovation? An analysis of innovations from Dutch SMEs
Authors: Morales Pablo , Flikkema Meindert , Castaldi Carolina , de Man Ard-Pieter
Published: June 2024

Effective innovation policymaking critically relies on monitoring innovation. An emerging literature suggests that trademarks could help measure a larger share of innovations than when only utilizing patents, particularly for small- and medium-sized enterprises (SMEs). This study establishes when trademarks improve the measurement of innovation compared to solely relying on patents as innovation metrics, by examining the propensity to use trademarks for non-patented innovations from SMEs. We collected multiple original samples of innovations from Dutch SMEs and assessed the extent to which trademarks and/or patents were filed for those innovations. Our results show that trademarks can improve innovation measurement for SMEs, particularly in scale-intensive and supplier-dominated industries and in some service industries—areas where patent propensities are low. Our results bear implications for monitoring innovation and evaluating science, research, and innovation policy. Overall, by combining trademark and patent data, the number of measured innovations by SMEs increases approximately by a relative of 51.8 per cent.
Enhancing care: evaluating the impact of True North Sexual Health and Rehabilitation eTraining for healthcare providers working with prostate cancer patients and partners
Authors: Matthew Andrew G , McLeod Deborah , Robinson John W , Walker Lauren , Wassersug Richard J , Elliott Stacy , Guirguis Steven , Incze Taylor , Trachtenberg Lianne
Published: June 2024

Background

Educational programs that enhance healthcare providers’ competence in managing the care of patients with sexual dysfunction following prostate cancer treatments are needed to facilitate comprehensive sexual health treatments for patients and their partners.

Aim

In this study we evaluated the impact of a real-world online sexual health educational intervention called the True North Sexual Health and Rehabilitation eTraining Program. This program is designed to increase healthcare providers’ knowledge and self-efficacy in providing sexual healthcare to prostate cancer patients and their partners.

Methods

Healthcare providers were invited to join a 12-week virtual training program. Participants completed precourse surveys (n = 89), retrospective prepost surveys (n = 58), and a 3-month follow-up survey (subset n = 18) to assess retention of relevant outcomes. Additionally, a course satisfaction survey was administered to participants (n = 57) at the end of the course.

Outcomes

The main outcomes focused on participants’ perceived knowledge and self-efficacy in conducting assessments and providing interventions for various relevant physical, functional, psychological, and relational domains of sexual dysfunction in prostate cancer patients and their partners.

Results

According to the retrospective analysis of post-then-pre–survey results, graduates perceived that their knowledge of and self-efficacy in providing sexual health counseling improved after completing the course. The 3-month follow-up survey indicated that the course graduate self-efficacy remained high 3 months after the course. Furthermore, the satisfaction survey indicated that a vast majority (98.2%) of participants were satisfied with the educational intervention.

Clinical Implications

This real-world sexual health educational intervention can increase self-efficacy and knowledge in healthcare providers who are supporting prostate cancer patients dealing with sexual dysfunction.

Strengths and Limitations

The use of a retrospective post-then-pre–survey helped to mitigate response shift bias while minimizing data gaps. However, it is important to note that this investigation was not a traditional research study and lacked a control group, thus limiting causal attributions.

Conclusion

The True North Sexual Health and Rehabilitation eTraining program acts as an accessible and effective resource for healthcare providers seeking specialized training in providing sexual healthcare for prostate cancer patients and their partners.
Oral appliance therapy and hypoglossal nerve stimulation as non-positive airway pressure treatment alternatives for obstructive sleep apnea: a narrative expert review
Authors: Parthasarathy Sairam , Ayas Najib T , Bogan Richard , Hwang Dennis , Kushida Clete , Lown Jonathan S , Ojile Joseph M , Patel Imran , Prasad Bharati , Rapoport David M , Strollo Patrick , Vanderveken Oliver M , Viviano John
Published: June 2024

This perspective on alternatives to positive airway pressure (PAP) therapy for the treatment of obstructive sleep apnea (OSA) summarizes the proceedings of a focus group that was conducted by the Sleep Research Society Foundation. This perspective is from a multidisciplinary panel of experts from sleep medicine, dental sleep medicine, and otolaryngology that aims to identify the current role of oral appliance therapy and hypoglossal nerve stimulation for the treatment of OSA with emphasis on the US practice arena. A secondary aim is to identify—from an implementation science standpoint—the various barriers and facilitators for adoption of non-PAP treatment that includes access to care, multidisciplinary expertise, reimbursement, regulatory aspects, current treatment guidelines, health policies, and other factors related to the delivery of care. The panel has contextualized the review with recent events—such as a large-scale PAP device recall compounded by supply chain woes of the pandemic—and emerging science in the field of OSA and offers solutions for multidisciplinary approaches while identifying knowledge gaps and future research opportunities.
Collusion and Violence in Underground Drug Markets
Authors: Stitt Mary Ellen , Sobering Katherine , Auyero Javier
Published: June 2024

Poor urban neighborhoods throughout the Americas are marked by high rates of interpersonal violence, much of which is associated with the underground drug trade. Scholars have examined the social dynamics that produce and shape violence among neighborhood residents and the state agents who police them. But less is known about the clandestine collaborations between residents and agents of the state and how those collaborations might contribute to violence. This study draws on ethnographic fieldwork and an original legal archive to analyze the links between police collusion with drug market groups and interpersonal violence. We find that 1) police provide their collaborators with powerful weapons and ammunition; 2) state agents become involved and help escalate violent territorial disputes between underground market groups; and 3) violence erupts between state agents colluding with civilian dealers and those attempting to disrupt the drug trade. These findings shed new light on the social and organizational factors shaping patterns of violence in poor neighborhoods, illuminating the ways that state agents contribute to that violence. In doing so, the findings advance our understanding of policing, drug markets, and the role of the state in shaping the everyday lives of the urban poor.
Analysis of Plant and Fungal Transcripts from Resistant and Susceptible Phenotypes of Leptospermum scoparium Challenged by Austropuccinia psidii
Authors: Frampton Rebekah A. , Shuey Louise S. , David Charles C. , Pringle Georgia M. , Kalamorz Falk , Pegg Geoff S. , Chagné David , Smith Grant R.
Published: June 2024

Austropuccinia psidii is the causal pathogen of myrtle rust disease of Myrtaceae. To gain understanding of the initial infection process, gene expression in germinating A. psidii urediniospores and in Leptospermum scoparium-inoculated leaves were investigated via analyses of RNA sequencing samples taken 24 and 48 h postinoculation (hpi). Principal component analyses of transformed transcript count data revealed differential gene expression between the uninoculated L. scoparium control plants that correlated with the three plant leaf resistance phenotypes (immunity, hypersensitive response, and susceptibility). Gene expression in the immune resistant plants did not significantly change in response to fungal inoculation, whereas susceptible plants showed differential expression of genes in response to fungal challenge. A putative disease resistance gene, jg24539.t1, was identified in the L. scoparium hypersensitive response phenotype family. Expression of this gene may be associated with the phenotype and could be important for further understanding the plant hypersensitive response to A. psidii challenge. Differential expression of pathogen genes was found between samples taken 24 and 48 hpi, but there were no significant differences in pathogen gene expression that were associated with the three different plant leaf resistance phenotypes. There was a significant decrease in the abundance of fungal transcripts encoding three putative effectors and a putative carbohydrate-active enzyme between 24 and 48 hpi, suggesting that the encoded proteins are important during the initial phase of infection. These transcripts, or their translated proteins, may be potential targets to impede the early phases of fungal infection by this wide-host-range obligate biotrophic basidiomycete.
Long-term outcomes and patterns of recurrence in patients with thin melanoma and a negative sentinel lymph node biopsy: a single-center experience
Authors: Shemer Maayan , Shimonovitz Michal , Furer Rozalin , Abu-Abeid Adam , Dayan Danit , Schneebaum Schlomo , Miodovnik Mor , Nizri Eran
Published: June 2024

The majority of patients diagnosed with melanoma have thin melanomas (≤1 mm). Data on the rate and pattern of recurrence after a negative sentinel lymph node biopsy (SLNB) are sparse. We retrospectively searched our institutional database and retrieved the records of patients with thin melanomas who underwent an SLNB with negative results. We analyzed patterns of recurrence, time to recurrence, and mode of diagnosis. Thirteen of the 198 patients with thin melanomas and negative SLNB results had tumor recurrence (6.5%): two local in transit (15.4%), three regional (21.3%), and eight distant (61.5%). Distant recurrences tended to occur later than local or regional ones [median disease-free survival = 50 months (95% confidence interval: 36.1–63.9) vs. 34 and 15 months (95% confidence interval: 5.4–24.6), P = 0.005, respectively]. The percentage of patients with tumor thickness ≥0.8 mm was higher among those who sustained recurrence (84.6 vs. 64.9% for no recurrence, P = 0.04). The majority of patients with recurrence were not being followed up when diagnosed (69%), and they are presented because of clinical symptoms. Patients with recurrence had lower survival compared with those without recurrence (median: 118 months vs. ongoing survival, P < 0.001, respectively). Melanoma recurrence in patients with thin melanomas and negative SLNBs is rare, tends to be distant, and negatively affects prognosis. Recurrence tends to occur in patients with melanoma thickness ≥0.8 mm. Further studies are needed to identify patients with high recurrence risk and determine optimal follow-up protocols.
Toxin for Treating Raynaud Conditions in Hands (The TORCH Study): A Systematic Review and Meta-analysis
Authors: Geary Ellen , Wormald Justin C.R. , Cronin Kevin J. , Giele Henk P. , Durcan Laura , Kennedy Oran , O’Brien Fergal , Dolan Roisin T.
Published: June 2024

Background:

Raynaud disease of the hands is a complex disorder resulting in inappropriate constriction and/or insufficient dilation in microcirculation. There is an emerging role for botulinum toxin type A (BTX-A) in the treatment armamentarium for refractory Raynaud disease. The aim of this systematic review was to critically evaluate the management of primary and secondary Raynaud disease treated with BTX-A intervention.

Methods:

We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of clinical studies assessing treatment of primary or secondary Raynaud disease with BTX-A by searching Ovid MEDLINE and Embase databases from inception to first August 2023. The review protocol was prospectively registered on the PROSPERO database (CRD42022312253).

Results:

Our search strategy identified 288 research articles, of which 18 studies [four randomized controlled trials (RCTs), two non-RCTs, five case series, and seven retrospective cohort studies] were eligible for analysis. Meta-analysis demonstrated that the probability of pain visual analog scale score improvement with BTX-A intervention was 81.95% [95% confidence interval (74.12–87.81) P = 0.19, heterogeneity I
2 = 26%] and probability of digital ulcer healing was 79.37% [95% confidence interval (62.45–89.9) P = 0.02, heterogeneity I
2 = 56%].

Conclusions:

Delivery of BTX-A to digital vessels in the hand may be an effective management strategy for primary and secondary Raynaud disease. A definitive, appropriately-powered RCT with objective functional and patient-reported outcome measures is required to accurately assess and quantify the efficacy of BTX-A in Raynaud disease of the hands.
Prepectoral Breast Reconstruction with Prosthesis and Acellular Dermal Matrix: A New Technique of ADM Implantation and Fixation
Authors: Tettamanzi Matilde , Arrica Giovanni , Ziani Federico , Manconi Anna , Beatrici Edoardo , Trignano Claudia , Rubino Corrado , Trignano Emilio
Published: June 2024

Background:

Direct-to-implant (DTI) immediate breast reconstruction has proven to be an oncologically safe technique and linked to better overall results. The introduction of new surgical techniques has prompted us to develop an acellular dermal matrix fixation technique that reduces the rate of complications and implant loss.

Methods:

We retrospectively analyzed data from patients who underwent DTI prepectoral breast reconstruction with two different techniques of acellular dermal matrix fixation to the chest wall. Descriptive statistics were reported using frequencies and percentages for categorical variables, and means and SDs for continuous variables. Pearson chi-square test was used to compare differences in categorical variables. Univariable and multivariable logistic regression models were fitted to investigate the predictors of complications.

Results:

From October 2019 to March 2023, 90 DTI breast reconstructions were performed, 43 using the standard technique and 47 using the new technique. The new technique demonstrated a significant reduction of major complications (P = 0.010), namely seroma (13.9% versus 2.3%), skin necrosis (9.3% versus 2.3%), implant loss (7% versus 0%), wound dehiscence (9.3% versus 0%), and infection (4.7% versus 0%). Compared with the standard technique, the new one reduced the risk of complications by 76% (OR 0.24; 95% confidence interval 0.09–0.68; P = 0.007) and 73% (aOR 0.27; 95% confidence interval 0.08–0.92; P = 0.037), at univariable and multivariable regression models. No other significant predictor of complications was identified.

Conclusions:

The procedure performed with the proposed modality proved to be advantageous. Careful fixation of the prosthetic implant and the placement of two drains, were the keys to a drastic reduction in complications.
The State of Surgical Research in Sub-Saharan Africa: An Urgent Call for Surgical Research Trainers
Authors: Nthumba Peter M. , Odhiambo Moses , Pusic Andrea , Kamau Stephen , Rohde Christine , Onyango Onesmus , Gosman Amanda , Vyas Raj , Nthumba Michelle N.
Published: June 2024

Background:

Surgery in low- and middle-income countries (LMICs) is poorly developed because of years of neglect. Sustained research on global surgery led to its recognition as an indivisible and indispensable part of primary healthcare in 2015. However, this has had little visible effect on surgical ecosystems within LMICs, especially in sub-Saharan Africa (SSA). SSA surgical research systems strengthening, which includes skills transfer, with local priority setting driving the research agenda, is needed to propel global surgery into the future.

Methods:

The authors performed a literature review of the state of surgical research within SSA and also report the initial efforts of two research training nonprofits to empower young African surgeons with research skills.

Results:

Surgical research in SSA is disadvantaged even before it is birthed, facing monumental challenges at every stage of development, from research agenda determination to funding, study execution, and publication. Compared with a global output of 17.49 publications per 100,000 population, SSA produces 0.9 (P < 0.0001). The Surgeons in Humanitarian Alliance for Reconstructive, Research, and Education and Enabling Africa Clinical Health Research programs are involved in the longitudinal research mentorship of surgical residents within SSA; the improved quality of research and successful publications by participants suggest nascent steps in growing young surgical scientists.

Conclusions:

In the absence of an existing surgical research infrastructure within LMICs, global surgery research trainers should link up and collaborate to help develop a surgical research community that will provide the local data required to help transform the SSA surgical ecosystem.
Primary Practice Patterns for the Initial Management of Open Angle Glaucoma
Authors: Rhee Douglas J. , Sancheti Himani , Rothman Adam L. , Herndon Leon , Brubaker Jacob W. , Patrianakos Thomas , Radcliffe Nathan , Zhang Amy D. , Szczotka-Flynn Loretta
Published: June 2024

Précis:

About one-fourth of survey respondents from an ASCRS database initiate treatment for primary open angle glaucoma (POAG) with laser trabeculoplasty. Factors impacting physicians’ choice of laser versus topical treatment for POAG were explored.

Purpose:

To characterize primary treatment preferences (topical medication versus laser trabeculoplasty or intracameral sustained release implants) in primary open angle glaucoma (POAG) patients and determine factors related to primary intervention selection.

Methods:

A 33-question survey was distributed to an American Society of Cataract and Refractive Surgery database on treatment choices made by ophthalmologists for POAG. Data collected included country of practice, years of practice, completion of glaucoma fellowship training, type of practice, and preference for the first line of treatment for POAG. Multiple logit regression was used to compare the effect of covariates on physicians’ choice of either topical medication or laser trabeculoplasty for POAG.

Results:

A total of 252 of 19,246 (1.3%) surveys were returned. Almost three-quarters of respondents used topical medication as the first line of treatment for POAG (73.6%), whereas 26.4% preferred to start with laser treatment. Significant variables associated with the selection of laser (vs. drops) are practicing in the United States (odds ratio [OR] 2.85; 95% CI, 1.33–6.10), the more recent completion of ophthalmology residency (OR 1.95; 95% CI, 1.00–3.77), the greater volume of minimally invasive glaucoma surgeries (MIGS) (OR 1.68; 95% CI, 1.18–2.40), and a glaucoma patient base greater than 25% (OR 2.21; 95% CI, 1.09–4.48).

Conclusions:

For the first-line treatment of POAG, laser trabeculoplasty is more likely to be preferred, over topical drops, by U.S. physicians who are relatively new in practice, who have a larger glaucoma patient base, and who perform more MIGS.
Diagnostic Pitfalls: Soft Tissue Lymphoma: Superficial Soft Tissue Lymphoma Mimicking a Venous Malformation
Authors: Roblot Victoire , Bousson Valérie , Bisdorff Annouk
Published: June 2024

In this case report, 3 patients addressed to our vascular anomalies reference center to manage a slow-flow vascular anomaly were reported. Our objective is to highlight that a discrepancy between clinical and radiological data should suggest a differential diagnosis and a percutaneous biopsy be considered. In our 3 patients, the biopsy provided a diagnosis of soft tissue lymphoma. Some red flags should not be overlooked to avoid missing this diagnosis, patient's past medical history of lymphoma and clinical palpation of a nondepressible hard lesion. On magnetic resonance imaging, the lesion shape and contours particularly the presence of spicules appear to be interesting features to consider lymphoma (this sign is absent in common venous malformation). Therefore, the triad past medical history and clinical and imaging data (ultrasound and MRI) are mandatory for an accurate diagnosis of vascular malformations.
Academic Service Partnerships: A 21st Century Business Strategy to Integrate Physician Assistant Learners Into a Value-Based Health Care Delivery Model
Authors: Redmond Angelique
Published: June 2024

Although there has been a surge in physician assistant (PA) programs in the United States, PA programs have concurrently experienced challenges with partnering with a sufficient pool of clinical training sites. During the long-lived fee-for-service era, many programs have relied on transactional relationships with individual clinicians, hospitals, community health centers, private practices, and other entities to provide the required clinical experiences for PA learners. These arrangements often involved bargaining a supervised clinical experience in exchange for continuing medical education credit or other incentives included in a clinician's benefits package. However, with the recent transformation of the US health care delivery system into a value-based care model, academic service partnerships have emerged as valuable solutions. Academic service partnerships uniquely integrate health professions learners into health systems by providing more sustainable, results-driven clinical experiences that benefit the program, the clinical training site, and the patients.