bluuebunny/crossref_metadata_2025 huggingface dataset:
Does lung procurement and exposure to Perfadex impact heart transplantation outcomes
Authors: Blitzer David , Baran David A. , Lirette Seth , Copeland Hannah
Published: March 2024

Introduction

Some studies have shown increased incidence of Primary Graft Dysfunction (PGD) after heart and lung procurement for heart transplant recipients. There have been limited investigations of the impact of lung procurement on heart procurement and the potential effects of the exposure to the type of lung preservation solution, the volume of the lung preservation solution and adequacy of decompression of the heart during heart and lung procurement and the impact on heart transplant outcomes.

Methods

Adult heart transplant recipients in the UNOS database recorded from January 1, 2000 to June 30, 2022 formed the study cohort. Any heart that was procured with a lung team that utilized Perfadex preservation solution (XVIVO, Gothenburg, Sweden) was classified as exposed to Perfadex and otherwise classified as not exposed to Perfadex. Lung procurements performed with a preservation solution other than Perfadex or unknown were excluded (n = 2486). Simple comparisons were made with t‐tests or chi‐squared tests. Logistic regression models were used to predict 30 day and 1 year survival. Accelerated failure time models were employed to analyze time to death and time to rejection.

Results

The cohort consisted of 34 192 heart transplants, of which 21 928 donors were not exposed to Perfadex (64.1%). There were statistically, but not clinically, significant differences in donor characteristics for these groups including in donor age (33.34 ± 11.01 not exposed vs. 30.70 ± 10.69 exposed; p < .001), diabetic donor (4% not exposed vs. 3% exposed; p = .004), and ischemic time (3.28 ± 1.09 h not exposed vs. 3.24 ± 1.05 h exposed; p = .002). In adjusted models, for all included donors, Perfadex exposure was associated with increased short term mortality, but no long term difference (1 year mortality OR 1.10, p = .014).

Conclusion

Perfadex exposure was associated with increased short‐term mortality for heart transplant recipients. Mechanistic investigation is warranted.
Judicial approaches to science and the procedural legitimacy of climate rulings: Comparative insights from the Netherlands and Germany
Authors: de Augustinis Juliana
Published: March 2024

This article explores how judicial approaches to science relate to the procedural legitimacy of rulings in cases where the plaintiffs seek a change in a government's overall climate policy. It reviews challenges in court interaction with climate science and compares two prominent cases: Urgenda v. The State of the Netherlands and Neubauer et al. v. Germany. The selected lawsuits yield comparative interest in aiming for changes in national climate policies and emission mitigation targets, involving the same kind of evidence (Assessment Reports by the Intergovernmental Panel on Climate Change) but resulting in partially opposing decisions. The analysis reveals that scientific inputs informed courts about climate change risks and mitigation measures. It also suggests that differing approaches to scientific reports influenced contrasting decisions regarding mitigation targets. Finally, it provides insights into how engagement with evidence might impact judgments' legitimacy from a procedural perspective.
CEO overcaution and capital structure choices
Authors: Rocciolo Francesco , Gheno Andrea , Brooks Chris
Published: March 2024

This paper develops and empirically tests a new version of the trade‐off theory of corporate capital structure choices that accounts for CEOs' biased beliefs, with a focus on overcaution. We characterize the bias as a distortion of expected rates of return on equity and debt that, for Overcautious CEOs, are overestimated compared to a rational CEO. The theory shows that if CEOs have higher bias in equity, than in debt‐value estimation, overcautious CEOs will choose lower levels of debt compared to rational CEOs, and, if the degree of overcaution is sufficiently high, they will adopt a zero‐leverage policy.
The impact of grip strength, waist circumference, and body mass index on Hemoglobin A1c value: Cross‐sectional study using outpatient clinical data in Japanese elderly patients with type 2 diabetes mellitus
Authors: Nakanishi Shuhei , Shimoda Masashi , Kimura Tomohiko , Katakura Yukino , Sanada Junpei , Fushimi Yoshiro , Iwamoto Yuichiro , Iwamoto Hideyuki , Mune Tomoatsu , Kaku Kohei , Kaneto Hideaki
Published: March 2024

Aim

Grip strength (GS) as a surrogate for muscular strength, waist circumference (WC) as a surrogate marker of visceral fat, and body mass index (BMI) as a surrogate marker of obesity should also be considered markers for the management of risks associated with type 2 diabetes mellitus (T2DM). However, in terms of the management of T2DM in elderly patients, the accentuated heterogeneity of sarcopenic change might modify the associations between those factors and glycemic control. In this cross‐sectional study, we aimed to clarify the impact of GS, WC, and BMI on hemoglobin A1c (HbA1c) in elderly Japanese patients with T2DM.

Methods

GS, WC, and BMI were measured in 327 patients. Odds ratios (ORs) and 95% confidence intervals (CIs) for good glycemic control (HbA1c < 7.0%) were investigated to analyze the three variables as numerical values by dividing them into tertiles. All results were expressed after adjustment was made for the confounders of age, sex, and number of diabetes medications being used by the study participants.

Results

The ORs of GS, WC, and BMI for well‐controlled HbA1c were 1.056 (95% CI, 1.016–1.098), 0.986 (95% CI, 0.960–1.013), and 1.032 (95% CI, 0.959–1.111), respectively. The OR of 3.726 (95% CI, 1.831–7.581) in the high tertile for GS was significantly higher than the OR in the low tertile, and no differences were observed among the tertiles for WC and BMI.

Conclusions

Based on that result, GS was found to have more potential as an effective marker of glycemic control than WC or BMI among elderly Japanese patients with T2DM. Geriatr Gerontol Int 2024; 24: 410–414.
Evaluation of the efficacy of inter‐dental brush and dental floss for peri‐implant mucositis: A crossover randomized clinical trial
Authors: Bevilacqua Lorenzo , Lorenzon Maria Giulia , Bjedov Marianna , Costantinides Fulvia , Angerame Daniele , Maglione Michele
Published: March 2024

Objectives

To evaluate the most effective method for mechanical inter‐dental plaque removal between inter‐dental brushes (IDB) and dental floss (DF), in addition to toothbrushing in patients affected by peri‐implant mucositis (PIM); to identify possible factors related to the patient or to the single implant‐supported element that could influence plaque accumulation and inflammation of peri‐implant tissues.

Methods

Forty patients with PIM were recruited. They were randomly assigned to two different groups depending on inter‐dental device used (IDB or DF).

At baseline (T0), interproximal area (IA), interproximal emergence angle of the implant crown (A°) and manual dexterity (evaluated with Purdue Pegboard) have been recorded. At 14 days (T1), the inter‐dental cleaning devices have been inverted between groups. After 14 days (T2), the Plaque Index (PI) and Gingival Index (GI) have been recorded. A questionnaire has been submitted to a patient for the analysis of preferences at T0, T1 and T2.

Results

Both inter‐dental cleaning devices were effective in reducing PI and GI in the inter‐dental area after 14 days of use. GI reduction was influenced by manual dexterity of the dominant hand. No significant differences were found for PI and GI at the variation of IA and A°.

Conclusion

IDB was the most effective method for inter‐dental plaque removal in all subjects regardless of their manual dexterity. DF seems to be more effective than IDB only in subjects with good dexterity.
Oral health with focus on dental fear and dental caries in Swedish preschool child populations attending public dental health care: Trends over 30 years
Authors: Nydell Helkimo Anna , Rolander Bo , Koch Göran
Published: March 2024

Objectives

To study changes in oral health with focus on reported dental fear prevalence and interrelationships between dental fear and prevalence of dental caries and performed restorative dental treatment in preschool child populations attending regular public dental health care between 1983 and 2013.

Methods

Every 10 years, random samples of about 100 children aged 3 and 5 years, respectively, took part in cross‐sectional studies based on oral examination and a questionnaire. One question, put to the child and answered by the parent, mirrored dental fear: “What do you feel at the prospect of an appointment with a dentist?”. Agreement to at least one of three alternatives, ill at ease, frightened and sick, indicated dental fear. Frightened and/or sick mirrored severe dental fear. 79%–94% of the samples answered the question and constituted the study group. Prevalence of caries and number of filled tooth surfaces were recorded. Dental parameters were presented in mean values.

Results

During the 30 years, dental fear prevalence was fairly constant. 21% of 3‐year‐olds and 15% of 5‐year‐olds reported dental fear in 2013. Positive relationships between dental fear prevalence and caries prevalence and number of filled tooth surfaces were found. Dental caries was reduced during the study time, but to a lesser degree in children with dental fear compared to children without dental fear.

Conclusions

Although children were offered public dental health care, the prevalence of dental fear remained high. Children with dental fear are caries risk individuals.
Perceived burdens of interacting with public authorities: How does it influence citizens' state‐encounter behavior?
Authors: Nielsen Vibeke Lehmann , Nielsen Helle Ørsted
Published: March 2024

Much research has shown that implementation behavior of frontline workers and the outcomes of public policies depend on encounters between frontline workers and citizens. However, relatively little is known about the agency of citizens in these encounters. This paper focuses on administrative burdens and psychological responses to stress as possible determinants of citizens' encounter behavior—defined as “behavioral efforts citizens employ during and in preparing for interaction with public authorities in order to master the demands of the public encounter.” Combining a framework categorizing citizens' state‐encounter behavior and theory about administrative burdens, we ask whether citizens' behavior reflects their perceptions of administrative burdens, and whether learning, psychological and compliance burdens prompt different encounter behaviors? We use data from surveys among a representative sample of 1460 Danish citizens regarding encounters with tax and home care authorities. We find that perceived administrative burdens affect citizens' behavior, but contrary to expectations, we do not find that burdens discourage citizens from engaging with authorities. Higher perceived burdens tend to prompt activist behavior. Moreover, different types of burdens affect behaviors differently.
Effects of implant placement timing and type of soft‐tissue grafting on histological and histomorphometric outcomes in a preclinical canine model
Authors: Lim Hyun‐Chang , Lee Kwang‐Seok , Shin Seung‐Yun , Jung Ronald E. , Jung Ui‐Won , Thoma Daniel S.
Published: March 2024

Aim

To determine the effects of implant timing and type of soft‐tissue grafting on histological and histomorphometric outcomes in a preclinical model.

Materials and Methods

Four implant placement protocols were randomly applied at the mesial root sites of the third and fourth mandibular premolars in 10 mongrel dogs: immediate placement (group IP), early placement (group EP), delayed placement with/without alveolar ridge preservation (groups ARP and DP, respectively). A connective‐tissue graft (CTG) or porcine‐derived volume‐stable collagen matrix (VCMX) was applied to enhance the ridge profile (simultaneously with implant placement in group IP and staged for others), resulting in five sites for each combination. All dogs were sacrificed 3 months after soft‐tissue grafting. Histological and histomorphometric analyses were performed, and the data were analysed descriptively.

Results

CTG and VCMX were difficult to differentiate from the augmented area. The median total tissue thickness on the buccal aspect of the implant was largest in group IP/CTG (between 2.78 and 3.87 mm). The soft‐tissue thickness was generally favourable with CTG at all implant placement timings. Within the DP groups, CTG yielded statistically significantly larger total and soft‐tissue thickness than VCMX (p < .05). Among the groups with VCMX, group EP/VCMX showed the largest soft‐tissue thickness at apical levels to the implant shoulder.

Conclusions

CTG generally led to greater tissue thickness than VCMX.
Community paramedicine in dementia care
Authors: Parsons Colby , Escobar Christian , Jasani Amy , Zhao Duzhi , Gliatto Peter , Blutinger Erik , Ornstein Katherine A.
Published: March 2024

Background

Novel hospital diversion strategies are needed to support a growing number of patients with dementia living in the community. One promising model is community paramedicine (CP), which deploys paramedics to the home, who consult with a physician to coordinate treatment and assess disposition. While evidence suggests CP can manage many patients without escalation to the emergency department (ED), no studies have evaluated optimal CP utilization for patients with dementia. Therefore, we compare the use and outcomes of CP for homebound patients with and without dementia.

Methods

This retrospective cohort study examines 251 homebound patients receiving home‐based primary care, who utilized a physician‐led CP service between March 2017 and May 2022. Linked electronic health record data included patient demographics, clinical characteristics, and CP encounter details. Dementia status and CP outcomes, including rates of ED transport, over‐transport (i.e., transported, but not hospitalized), and under‐transport (i.e., not transported, but ED visit within 3 days), were determined via chart review. Using logistic regression, we modeled the association of dementia status with over‐ and under‐transport, adjusting for age, sex, and chief complaint.

Results

Fifty‐three percent of CP patients had dementia. Their most common chief complaints were dyspnea (24.3%), altered mental status (17.9%), and generalized weakness (9.8%). We found no significant difference in ED transport rates by dementia status (25.4 vs. 22.8%, p = 0.54). Dementia diagnosis was associated with lower rates of over‐transport (OR = 0.21, p = 0.03, CI [0.05, 0.85]) and comparable rates of under‐transport (OR = 0.70, p = 0.47, CI [0.27, 1.83]) in adjusted models.

Conclusions

CP has effectively managed a diverse population of homebound patients with dementia cared for via home‐based primary care. Future work should examine potential cost savings and use of CP in dementia care across geographic and healthcare settings.
Microscopic investigation of the optical and morphological properties of iPP/TiO2 nanocomposite fibres using computed tomography technique
Authors: El‐Bakary Mohammed A. , Sokkar Taha Z. N. , Al‐Kalali Naef. A. , Raslan Mohammed I.
Published: March 2024

In this article, the optical and structural properties of iPP/TiO2 nanocomposite fibres, considering three distinct extrusion speeds (25, 50 and 78 m/min) in addition to blank isotactic polypropylene samples were determined. Employing computed tomographic scans, localised optical defects in the nanocomposite fibres are unveiled, while refractive indices are examined by analysing transmitted intensity with incident light vibrating parallel and perpendicular to the fibre axis. The internal structure is further characterised through birefringence and density calculations. Mechanical properties, specifically stiffness, are probed by measuring elastic modulus values along the fibre. The investigation extends to the presence of TiO2 nanoparticles in the isotactic polypropylene matrix, inspecting their influence on the uniform morphology along and across the fibre. While the addition of TiO2 nanoparticles has many advantages, including enhanced properties, the study shows adverse effects on the morphological integrity of the fibres, particularly at higher extrusion rates. Micrographs are included to visually illustrate these findings, providing a comprehensive understanding of the complex interaction between extrusion rates, TiO2 nanoparticle incorporation, and the resulting optical and structural properties in iPP fibres.
A Modified Arthroscopic Triple‐row Repair Technique for L‐shaped Delaminated Rotator Cuff Tears
Authors: Fang Yushun , Zhang Shaohua , Xiong Jun , Zhang Qingsong
Published: March 2024

Objective

To compare the clinical outcomes of a modified arthroscopic triple‐row (TR) repair technique with the suture bridge (SB) repair technique in treating L‐shaped delaminated rotator cuff tears. Various surgical techniques for L‐shaped delaminated rotator cuff tears have been reported, many of which aid in increasing the contact area and pressure of the rotator cuff. However, there is still debate over which technique yields superior results.

Methods

From January 2017 to March 2020, 61 cases of L‐shaped delaminated rotator cuff tears were included in this study. Of these, 34 cases underwent the modified arthroscopic triple‐row repair technique, while 27 cases were addressed with the suture bridge repair technique. Functional assessment was conducted using the American Shoulder and Elbow Surgeons (ASES) score, the University of California Los Angeles (UCLA) shoulder score, the Constant score (CS), and the visual analogue scale (VAS) score. Magnetic Resonance Imaging (MRI) assessments for rotator cuff healing were performed at the 24‐month postoperative mark. Statistical evaluations were conducted using SPSS for Windows (Version 25.0, IBM, Armonk, NY, USA), employing the Wilcoxon signed‐rank test to compare preoperative and postoperative data and ROM differences, and the Mann–WhitneyUtest for statistical differences in clinical outcome scores between the two groups. Ap‐value of less than 0.05 was considered statistically significant.

Results

Comparative analysis of the preoperative and final follow‐up scores revealed a substantial enhancement in shoulder function, as indicated by the ASES, UCLA, CS, and VAS scores, with statistical significance (p < 0.001). At both the preoperative stage and final follow‐up, no notable differences were observed in ASES, UCLA, CS, and VAS scores between the two groups. However, the TR repair group exhibited lower VAS scores than the SB group at 1 and 3 months postoperatively. Active range of motion (ROM) showed significant improvement in both groups. No significant differences in ROM were noted between the two groups either before the surgery or at the final follow‐up.

Conclusion

The study demonstrates that both the modified arthroscopic TR and SB techniques for L‐shaped delaminated cuff tears yield satisfactory outcomes, with no significant differences in overall clinical performance. Notably, early postoperative pain management appears more effective with the modified TR technique, suggesting its potential for enhanced early recovery experiences. This technique's design, promoting securer fixation and optimal contact conditions, is implied to facilitate superior long‐term healing, warranting further investigation into its long‐term benefits.
Whole‐body and targeted narrowband ultraviolet B phototherapy effectively stabilize acral vitiligo with negligible repigmentation beyond wrists and ankles: Results from a split‐body randomized controlled trial
Authors: Thind Anish , Vinay Keshavamurthy , Mehta Hitaishi , Bishnoi Anuradha , Kumaran Muthu Sendhil , Parsad Davinder
Published: March 2024

Background

Narrowband ultraviolet B (NB‐UVB) phototherapy promotes stability and repigmentation in vitiligo. No studies have compared targeted NB‐UVB with whole‐body NB‐UVB in treatment of acral vitiligo.

Objectives

This randomized split‐body study compared whole‐body NB‐UVB with targeted NB‐UVB in inducing stability and repigmentation in acral vitiligo.

Methods

Thirty‐two patients with bilaterally symmetrical acral vitiligo lesions (distal to elbows and knees) were recruited. Patients received whole‐body NB‐UVB treatment, with one hand and one foot shielded until elbow and knee, followed by targeted NB‐UVB treatment on the shielded side. Patients were assessed at 4‐week intervals for 24 weeks using Vitiligo Disease Activity (VIDA) score, Vitiligo Skin Activity Score (VSAS), Vitiligo Area Scoring Index (determined through fingertip method, using the method to calculate facial‐VASI) and degree of repigmentation.

Results

After 12 weeks, 87.5% of patients achieved a VIDA score of 3, with none having active disease at 24 weeks. Over 50% repigmentation was observed in 42.2% and 37.5% of limbs in whole‐body and targeted groups, respectively (p = .95). No improvement in F‐VASI scores of hands and feet (distal to wrist and ankles) was noted with either modality over the 24‐week period.

Conclusion

Our study showed comparable repigmentation rates between whole‐body and targeted NB‐UVB groups. Limited effectiveness of phototherapy in repigmentation of hands and feet underscores an important therapeutic gap.
Current state of gene therapy in sickle cell disease
Authors: Tang Mei San , Shan Hua
Published: March 2024

Sickle cell disease (SCD) is a type of hemoglobinopathy due to an autosomal recessive genetic defect, causing significant red cell sickling, multi‐organ damage and long‐term severe morbidities. Due to its complicated care and the impact on quality of life, a curative treatment for SCD is highly desirable. In recent years, gene therapy is emerging as a curative option for SCD, where autologous haematopoietic stem cells are collected from SCD patients and genetically modified ex vivo to reduce its sickling tendency before reinfusion. Although still largely investigational, a limited number of gene therapy options have been recently granted approval for SCD patients. Published data are still currently limited, but early studies have so far demonstrated the intended outcomes of less vaso‐occlusive crisis and haemolysis. Nonetheless, despite its curative potential, larger clinical trials and longer follow‐up period are still necessary to evaluate the safety of this treatment option, especially the risk of unintended genetic modifications. Furthermore, SCD patients frequently have limited access to specialty care; hence, the issues of affordability and accessibility to SCD gene therapy must also be addressed for it to benefit the appropriate patient population.
Comparison of Participation in Strength Activity Among People With and Without Disabilities: 2013–2017 Behavioral Risk Factor Surveillance System
Authors: Leung Willie , Sung Ming-Chih , Lee Jinhyun , Jung Jaehun , Fiscella Nicole , Shi Lu
Published: March 2024

Background: The current physical activity guidelines recommend engagement in strength activities at least 2 days per week. Currently, there is a lack of literature examining strength activities among people with disabilities. The purpose of this study is to estimate and compare the prevalence of engagement in strength activities and adherence to strength activity guidelines among adults with and without disabilities in the United States. Methods: A total of 1,005,644 adults (18–80 y old) with and without disabilities from the 2013 to 2017 Behavioral Risk Factor Surveillance System were included in this secondary data analysis. Descriptive analyses were performed to describe the prevalence of strength activity behaviors of adults with and without disabilities. Logistic and Poisson regression models were performed to evaluate the relative contribution of disability status on strength activity behaviors. Results: A higher proportion of participants without disabilities (46.42%, 95% CI, 46.18–46.65) reported engaging in strength activities compared with participants with disabilities (30.68%, 95% CI, 30.29–31.08; P < .01). Participants with disabilities were less likely to engage in strength activities (odds ratio = 0.51, 95% CI, 0.50–0.52; adjusted odds ratio = 0.75, 95% CI, 0.73–0.77) and meet strength activity guidelines (odds ratio = 0.56, 95% CI, 0.54–0.57; adjusted odds ratio = 0.75, 95% CI, 0.73–0.77) than participants without disabilities. Conclusion: Experiencing a disability is associated with lower engagement in strength activities; thus, it is important to identify effective and efficient approaches to promoting strength activities among people with disabilities.
S
-nitrosylation of a receptor-like cytoplasmic kinase regulates plant immunity
Authors: Cui Beimi , Pan Qiaona , Cui Wenqiang , Wang Yiqin , Loake Verity I. P. , Yuan Shuguang , Liu Fengquan , Loake Gary J.
Published: March 2024

Perception of pathogen/microbial-associated molecular patterns (P/MAMPs) by plant cell surface receptors leads to a sustained burst of reactive oxygen species (ROS), a key feature of P/MAMP-triggered immunity (PTI). Here we report that P/MAMP recognition leads to a rapid nitrosative burst, initiating the accumulation of nitric oxide (NO), subsequently leading to
S
-nitrosylation of the receptor-like cytoplasmic kinase (RLCK), botrytis-induced kinase 1 (BIK1), at Cys
80
. This redox-based, posttranslational modification, promotes the phosphorylation of BIK1, subsequently resulting in BIK1 activation and stabilization. Further, BIK1
S
-nitrosylation increases its physical interaction with RBOHD, the source of the apoplastic oxidative burst, promoting ROS formation. Our data identify mechanistic links between rapid NO accumulation and the expression of PTI, providing insights into plant immunity.
Field-free deterministic switching of all–van der Waals spin-orbit torque system above room temperature
Authors: Kajale Shivam N. , Nguyen Thanh , Hung Nguyen Tuan , Li Mingda , Sarkar Deblina
Published: March 2024

Two-dimensional van der Waals (vdW) magnetic materials hold promise for the development of high-density, energy-efficient spintronic devices for memory and computation. Recent breakthroughs in material discoveries and spin-orbit torque control of vdW ferromagnets have opened a path for integration of vdW magnets in commercial spintronic devices. However, a solution for field-free electric control of perpendicular magnetic anisotropy (PMA) vdW magnets at room temperatures, essential for building compact and thermally stable spintronic devices, is still missing. Here, we report a solution for the field-free, deterministic, and nonvolatile switching of a PMA vdW ferromagnet, Fe
3
GaTe
2
, above room temperature (up to 320 K). We use the unconventional out-of-plane anti-damping torque from an adjacent WTe
2
layer to enable such switching with a low current density of 2.23 × 10
6
A cm
−2
. This study exemplifies the efficacy of low-symmetry vdW materials for spin-orbit torque control of vdW ferromagnets and provides an all-vdW solution for the next generation of scalable and energy-efficient spintronic devices.
Efficient learning of mixed-state tomography for photonic quantum walk
Authors: Wang Qin-Qin , Dong Shaojun , Li Xiao-Wei , Xu Xiao-Ye , Wang Chao , Han Shuai , Yung Man-Hong , Han Yong-Jian , Li Chuan-Feng , Guo Guang-Can
Published: March 2024

Noise-enhanced applications in open quantum walk (QW) has recently seen a surge due to their ability to improve performance. However, verifying the success of open QW is challenging, as mixed-state tomography is a resource-intensive process, and implementing all required measurements is almost impossible due to various physical constraints. To address this challenge, we present a neural-network–based method for reconstructing mixed states with a high fidelity (∼97.5%) while costing only 50% of the number of measurements typically required for open discrete-time QW in one dimension. Our method uses a neural density operator that models the system and environment, followed by a generalized natural gradient descent procedure that significantly speeds up the training process. Moreover, we introduce a compact interferometric measurement device, improving the scalability of our photonic QW setup that enables experimental learning of mixed states. Our results demonstrate that highly expressive neural networks can serve as powerful alternatives to traditional state tomography.
New legal aid fund for sleuths
Authors: Else Holly
Published: March 2024

Investor pledges $1 million for science whistleblowers
Is Arctic melt driving European heat waves?
Authors: Kintisch Eli
Published: March 2024

“Cold blob” from increased meltwater alters key weather patterns, study suggests
Spatial ecology of
Haemophilus and Aggregatibacter
in the human oral cavity
Authors: Giacomini Jonathan J. , Torres-Morales Julian , Tang Jonathan , Dewhirst Floyd E. , Borisy Gary G. , Mark Welch Jessica L.
Published: March 2024

Haemophilus
and
Aggregatibacter
are two of the most common bacterial genera in the human oral cavity, encompassing both commensals and pathogens of substantial ecological and medical significance. In this study, we conducted a metapangenomic analysis of oral
Haemophilus
and
Aggregatibacter
species to uncover genomic diversity, phylogenetic relationships, and habitat specialization within the human oral cavity. Using three metrics—pangenomic gene content, phylogenomics, and average nucleotide identity (ANI)—we first identified distinct species and sub-species groups among these genera. Mapping of metagenomic reads then revealed clear patterns of habitat specialization, such as
Aggregatibacter
species predominantly in dental plaque, a distinctive
Haemophilus parainfluenzae
sub-species group on the tongue dorsum, and
H
. sp. HMT-036 predominantly in keratinized gingiva and buccal mucosa. In addition, we found that supragingival plaque samples contained predominantly only one out of the three taxa,
H. parainfluenzae
,
Aggregatibacter aphrophilus
, and
A
. sp. HMT-458, suggesting independent niches or a competitive relationship. Functional analyses revealed the presence of key metabolic genes, such as oxaloacetate decarboxylase, correlated with habitat specialization, suggesting metabolic versatility as a driving force. Additionally, heme synthesis distinguishes
H
. sp. HMT-036 from closely related
Haemophilus haemolyticus
, suggesting that the availability of micronutrients, particularly iron, was important in the evolutionary ecology of these species. Overall, our study exemplifies the power of metapangenomics to identify factors that may affect ecological interactions within microbial communities, including genomic diversity, habitat specialization, and metabolic versatility.

IMPORTANCE

Understanding the microbial ecology of the mouth is essential for comprehending human physiology. This study employs metapangenomics to reveal that various
Haemophilus
and
Aggregatibacter
species exhibit distinct ecological preferences within the oral cavity of healthy individuals, thereby supporting the site-specialist hypothesis. Additionally, it was observed that the gene pool of different
Haemophilus
species correlates with their ecological niches. These findings shed light on the significance of key metabolic functions in shaping microbial distribution patterns and interspecies interactions in the oral ecosystem.
Even short periods of diabetes remission are linked to lower risk of heart attack and stroke
Authors: Saul Helen , Deeney Brendan , Swaithes Laura , Hounkpatin Hilda , Dambha-Miller Hajira
Published: March 2024

The study

Dambha-Miller H, Hounkpatin HO, Stuart B, Farmer A, Griffin S. Type 2 diabetes remission trajectories and variation in risk of diabetes complications: a population-based cohort study.
PLoS ONE
2023;18. doi:
10.1371/journal.pone.0290791
.

To read the full NIHR Alert, go to:
https://evidence.nihr.ac.uk/alert/even-short-periods-of-diabetes-remission-are-linked-to-lower-risk-of-heart-attack-and-stroke/
Comparison of the effects of different functional exercise sequences on lymphedema in breast cancer: protocol for an exploratory randomised controlled cross-over trial
Authors: Qiu Lin , Wu Jing , Huang Yingying , Ye Maodie , Song Lifang , Huang Haihong , Jin Yongmei
Published: March 2024

Introduction

Breast cancer-related lymphedema (BCRL) is a common postoperative complication of breast cancer. It develops in a chronic and vicious cycle. Once lymphedema occurs, it cannot be cured and bring serious physiological, psychological, social and economic burden to patients. Upper limb functional exercises are an effective and convenient intervention for managing lymphedema. However, the optimal exercise sequence remains unclear. Therefore, we aim to compare the effects of exercise sequences under the guidance of commonly used exercise sequences and lymphatic flow theory.

Methods

An exploratory randomised controlled cross-over trial will be conducted. 32 patients with BCRL are randomly allocated into two groups (group A and group B). Group A patients will perform functional exercise from wrist joint to shoulder joint, and the exercise direction of group B is opposite to that of group A, that is, from shoulder joint to wrist joint end. Exercise time is once a day, each 20–30 min, for 2 weeks. After 2 weeks of washout period, A and B groups of exchange exercise sequences (exercise frequency and duration unchanged). The primary outcome is upper limb circumference, and secondary outcomes are upper limb function and lymphedema symptoms.

Ethics and dissemination

This study protocol is presented in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines. All participants will sign a written informed consent. The research ethics regional committee of Shanghai Seventh People’s Hospital has approved the study. Regardless of the outcome of this study, the results will be published in open-access journals to ensure public access.

Trial registration number

ChiCTR2200066463.
Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic’s and referring provider’s perspectives
Authors: Mamataz Taslima , Virani Sean A , McDonald Michael , Edgell Heather , Grace Sherry L
Published: March 2024

Objectives

There are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This study investigated actual versus ideal HF clinic inclusion or exclusion criteria and how that related to referring providers' perspectives of ideal criteria.

Design, setting and participants

Two cross-sectional surveys were administered via research electronic data capture to clinic providers and referrers (eg, cardiologists, family physicians and nurse practitioners) across Canada.

Measures

Twenty-seven criteria selected based on the literature and HF guidelines were tested. Respondents were asked to list any additional criteria. The degree of agreement was assessed (eg, Kappa).

Results

Responses were received from providers at 48 clinics (37.5% response rate). The most common actual inclusion criteria were newly diagnosed HF with reduced or preserved ejection fraction, New York Heart Association class IIIB/IV and recent hospitalisation (each endorsed by >74% of respondents). Exclusion criteria included congenital aetiology, intravenous inotropes, a lack of specialists, some non-cardiac comorbidities and logistical factors (eg, rurality and technology access). There was the greatest discordance between actual and ideal criteria for the following: inpatient at the same institution (κ=0.14), congenital heart disease, pulmonary hypertension or genetic cardiomyopathies (all κ=0.36). One-third (n=16) of clinics had changed criteria, often for non-clinical reasons. Seventy-three referring providers completed the survey. Criteria endorsed more by referrers than clinics included low blood pressure with a high heart rate, recurrent defibrillator shocks and intravenous inotropes—criteria also consistent with guidelines.

Conclusions

There is considerable agreement on the main clinic entry criteria, but given some discordance, two levels of clinics may be warranted. Publicising evidence-based criteria and applying them systematically at referral sources could support improved HF patient care journeys and outcomes.
Adjuvant chemotherapy and survival outcomes in older women with HR+/HER2− breast cancer: a propensity score-matched retrospective cohort study using the SEER database
Authors: Ma Xindi , Wu Shang , Zhang Xiangmei , Chen Nannan , Yang Chenhui , Yang Chao , Cao Miao , Du Kaiye , Liu Yunjiang
Published: March 2024

Objectives

This study aimed to investigate the impact of adjuvant chemotherapy (ACT) on survival outcomes in older women with hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2−) breast cancer (BC).

Design

A retrospective cohort study using data from the Surveillance, Epidemiology, and End Results database, which contains publicly available information from US cancer registries.

Setting and participants

The study included 45 762 older patients with BC aged over 65 years diagnosed between 2010 and 2015.

Methods

Patients were divided into two groups based on age: 65–79 years and ≥80 years. Propensity score matching (PSM) was employed to balance clinicopathological characteristics between patients who received ACT and those who did not. Data analysis used the χ2test and Kaplan-Meier method, with a subgroup analysis conducted to identify potential beneficiaries of ACT.

Outcome measures

Overall survival (OS) and cancer-specific survival (CSS).

Results

Due to clinicopathological characteristic imbalances between patients with BC aged 65–79 years and those aged ≥80 years, PSM was used to categorise the population into two groups for analysis: the 65–79 years age group (n=38 128) and the ≥80 years age group (n=7634). Among patients aged 65–79 years, Kaplan-Meier analysis post-PSM indicated that ACT was effective in improving OS (p<0.05, HR=0.80, 95% CI 0.73 to 0.88), particularly in those with advanced disease stages, but did not show a significant benefit in CSS (p=0.09, HR=1.13, 95% CI 0.98 to 1.31). Conversely, for patients aged ≥80 years, ACT did not demonstrate any improvement in OS (p=0.79, HR=1.04, 95% CI 0.79 to 1.36) or CSS (p=0.09, HR=1.46, 95% CI 0.69 to 2.26) after matching. Subgroup analysis also revealed no positive impact on OS and CSS.

Conclusions

Patients with HR+/HER2− BC ≥80 years of age may be considered exempt from ACT because no benefits were found in terms of OS and CSS.
Experiences, prevalence and drivers of disrespect and abuse of adolescents during facility-based childbirth in sub-Saharan Africa: a scoping review protocol
Authors: Udho Samson , Clow Sheila Elizabeth
Published: March 2024

Introduction

Adolescents are more likely to experience disrespect and abuse (D&A) by skilled health personnel during facility-based childbirth. However, research evidence on the experiences, prevalence and drivers of D&A of adolescents in childbirth is limited. We aim to establish research evidence on the experiences, prevalence and drivers of D&A of adolescents during facility-based childbirth in sub-Saharan Africa and identify gaps in the literature to inform future research.

Methods and analysis

The protocol is designed using Arksey and O’Malley’s methodological framework and will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will systematically search to retrieve peer-reviewed articles published in English from 2011 to date in PubMed/Medline, EBSCOhost (Africa Wide Information, CINAHL, PsycINFO and SocINDEX), Web of Science (SciELO Citation Index and Web of Science Core Collection) and Scopus. Two independent reviewers will screen the references by titles, abstracts and full texts. Discrepancies in screening results will be resolved through discussions. Key elements of included studies will be charted using a predetermined tool. We will perform numerical analysis and synthesis of narrative accounts of the extent, nature and distribution of review studies.

Ethics and dissemination

No ethical approval is required since the scoping review will use openly available public data and information. Review findings will be disseminated at conferences and published in peer-reviewed journals. No protocol registration is required.
Defining acceptable data collection and reuse standards for queer artificial intelligence research in mental health: protocol for the online PARQAIR-MH Delphi study
Authors: Joyce Dan W , Kormilitzin Andrey , Hamer-Hunt Julia , McKee Kevin R , Tomasev Nenad
Published: March 2024

Introduction

For artificial intelligence (AI) to help improve mental healthcare, the design of data-driven technologies needs to be fair, safe, and inclusive. Participatory design can play a critical role in empowering marginalised communities to take an active role in constructing research agendas and outputs. Given the unmet needs of the LGBTQI+ (Lesbian, Gay, Bisexual, Transgender, Queer and Intersex) community in mental healthcare, there is a pressing need for participatory research to include a range of diverse queer perspectives on issues of data collection and use (in routine clinical care as well as for research) as well as AI design. Here we propose a protocol for a Delphi consensus process for the development of PARticipatory Queer AI Research for Mental Health (PARQAIR-MH) practices, aimed at informing digital health practices and policy.

Methods and analysis

The development of PARQAIR-MH is comprised of four stages. In stage 1, a review of recent literature and fact-finding consultation with stakeholder organisations will be conducted to define a terms-of-reference for stage 2, the Delphi process. Our Delphi process consists of three rounds, where the first two rounds will iterate and identify items to be included in the final Delphi survey for consensus ratings. Stage 3 consists of consensus meetings to review and aggregate the Delphi survey responses, leading to stage 4 where we will produce a reusable toolkit to facilitate participatory development of future bespoke LGBTQI+–adapted data collection, harmonisation, and use for data-driven AI applications specifically in mental healthcare settings.

Ethics and dissemination

PARQAIR-MH aims to deliver a toolkit that will help to ensure that the specific needs of LGBTQI+ communities are accounted for in mental health applications of data-driven technologies. The study is expected to run from June 2024 through January 2025, with the final outputs delivered in mid-2025. Participants in the Delphi process will be recruited by snowball and opportunistic sampling via professional networks and social media (but not by direct approach to healthcare service users, patients, specific clinical services, or via clinicians’ caseloads). Participants will not be required to share personal narratives and experiences of healthcare or treatment for any condition. Before agreeing to participate, people will be given information about the issues considered to be in-scope for the Delphi (eg, developing best practices and methods for collecting and harmonising sensitive characteristics data; developing guidelines for data use/reuse) alongside specific risks of unintended harm from participating that can be reasonably anticipated. Outputs will be made available in open-access peer-reviewed publications, blogs, social media, and on a dedicated project website for future reuse.
Exploring Norwegian homecare healthcare professionals’ perceptions of risk and the link to high-quality care: a qualitative multiple case study
Authors: Idsøe-Jakobsen Ingvild , Dombestein Heidi , Brønnick Kolbjørn Kallesten , Wiig Siri
Published: March 2024

Objectives

Homecare is a critical component of the ongoing restructuring of healthcare worldwide, given the shift from institution- to home-based care. The homecare evidence base still contains significant gaps: There is a lack of knowledge regarding quality and safety work and interventions. This study explores how home healthcare professionals perceive and use the concept of risk to guide them in providing high-quality healthcare while maintaining resilience.

Design

The study design is a qualitative multiple case study. The phenomena explored were risk perception, sensemaking and adaptations of care delivered to patients in their homes. Inductive content analysis was conducted.

Setting

The study was conducted in three Norwegian municipalities. Each municipality was defined as a single case.

Participants

Interviews with healthcare professionals were performed both individually and in focus groups of three to five persons. 19 interviews with 35 informants were conducted: 11 individual semistructured interviews and 8 focus groups.

Results

Four themes were identified: ‘professionalism is constantly prioritising and aligning care based on here-and-now observations’ ‘teamwork feels safe and enhances quality’ ‘taking responsibility for system risk’ and ‘reluctantly accepting the extended expectations from society’.

Conclusions

To make sense of risk when aspiring for high-quality care in everyday work, the healthcare professionals in this sample mainly used their clinical gaze, gut feeling and experience to detect subtle changes in the patients’ condition. Assessing risk information, not only individually but also as a team, was reportedly crucial for high-quality care. Healthcare professionals emphasised the well-being, safety and soundness of the patients when acting on risk information. They felt obliged to act on their gut feeling, moral compass and clinical understanding of quality.
Characteristics and phenotypes of a COPD cohort from referral hospital clinics in Uganda
Authors: Alupo Patricia , Mugenyi Levicatus , Katagira Winceslaus , Kayongo Alex , Nalunjogi Joanitah , Siddharthan Trishul , Hurst John R , Kirenga Bruce , Jones Rupert
Published: March 2024

Introduction

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition with varied clinical and pathophysiological characteristics. Although there is increasing evidence that COPD in low-income and middle-income countries may have different clinical characteristics from that in high-income countries, little is known about COPD phenotypes in these settings. We describe the clinical characteristics and risk factor profile of a COPD population in Uganda.

Methods

We cross sectionally analysed the baseline clinical characteristics of 323 patients with COPD aged 30 years and above who were attending 2 national referral outpatient facilities in Kampala, Uganda between July 2019 and March 2021. Logistic regression was used to determine factors associated with spirometric disease severity.

Results

The median age was 62 years; 51.1% females; 93.5% scored COPD Assessment Test >10; 63.8% modified medical research council (mMRC) >2; 71.8% had wheezing; 16.7% HIV positive; 20.4% had a history of pulmonary tuberculosis (TB); 50% with blood eosinophilic count >3%, 51.7% had 3 or more exacerbations in the past year. Greater severity by Global initiative for Chronic Obstructive Lung Disease (GOLD) stage was inversely related to age (aOR=0.95, 95% CI 0.92 to 0.97), and obesity compared with underweight (aOR=0.25, 95% CI 0.07 to 0.82). Regarding clinical factors, more severe airflow obstruction was associated with SPO2<93% (aOR=3.79, 95% CI 2.05 to 7.00), mMRC ≥2 (aOR=2.21, 95% CI 1.08 to 4.53), and a history of severe exacerbations (aOR=2.64, 95% CI 1.32 to 5.26).

Conclusion

Patients with COPD in this population had specific characteristics and risk factor profiles including HIV and TB meriting tailored preventative approaches. Further studies are needed to better understand the pathophysiological mechanisms at play and the therapeutic implications of these findings.