bluuebunny/crossref_metadata_2025 huggingface dataset:
How is digital technology used to facilitate shared decision-making between healthcare professionals and patients in cardiovascular care? A scoping review
Authors: Leysen D , Propst E , Mcgowan H , Pfannerstill F , Crutzen R , Kulnik S
Published: July 2024

Introduction

Shared decision-making (SDM) is a patient-centred approach in healthcare that emphasizes patient involvement in the decision-making process.

Digital technologies (DTs), like Mobile apps and website tools, are on the rise in cardiovascular care (CVC) and healthcare in general. But DTs can play a role in facilitating SDM, for example, with tools such as decision aids (DAs) for patients and quality check frameworks for Health care professionals (HCPs).

The aim of this scoping review (ScR) was to identify the types of DTs used to facilitate SDM within the field of CVC and the analysis of how support for SDM is implemented in these technologies; to examine the conceptualizations of SDM utilized in DTs and determine the theories underlying these conceptualizations within the field of CVC; and to present designs, methods, and outcomes of published evaluation studies concerning DTs for SDM within the field of CVC.

Methods

For this scoping review (ScR), ten databases were searched: eight biomedical and two technical databases between January 2022 and March 2022. After deduplicating the literature, the screening was conducted by the author and was independently double-screened by one of the four contributors. The selected articles were then analysed by the author on SDM and DT.

Results

From the initial 5719 search results, finished on the 6th of March 2023. 48 articles were included in this ScR. The PRISMA flow diagram is presented in Figure 1.

All 48 articles were included after the screening report on one of the 31 applications selected in this ScR. The characteristics of the DTs of the applications were analysed as presented in Table 1.

The SDM was all about treatment options, except only one application was on screening tests. Only one application made a direct reference to an SDM model, all the others hat references to literature Defining and explaining SDM.

There is an ambiguous outcome of significance in the reported evaluative studies of these applications. making it important to evaluate which characteristics of DTs are efficacious in the variability of the clinical setting.

Conclusion

There has been an increase in DTs to facilitate SDM in CVC over the past years. Within the scientific literature, there is recognition of a variety of DT characteristics and outcomes of the evaluative studies. It is important to reflect users' needs to choose the right application. It is valuable for developers to see which characteristics of DTs add value to applications.Table 1.Characteristics of DTs
The primary nursing model of remote monitoring in patients with implantable cardiac devices (CIED)
Authors: Faraci A , Coppola G , Corrado E , Novo G
Published: July 2024

Introduction

The treatment of cardiac pathologies with devices has led to an exponential increase in patients with CIED, who need more frequent, more careful check-ups, with a consequent increase in the number and clinical complexity of patients who refer to cardiac stimulation centers.

Aim

The use of remote monitoring makes it possible to have a continuous flow of information relating not only to the performance of the device but also to clinical events such as arrhythmias and heart failure without the need for direct contact, drastically reducing hospital accesses and at the same time promptly detecting any critical issues that require intervention in a more or less short time. The benefits of remote monitoring, as we have seen over the years, intervene at multiple levels, economic, social and clinical.

Materials and methods

Numerous studies have shown how remote monitoring can replace outpatient check-ups without compromising patient safety, reducing resource consumption, while scheduling at least one outpatient follow-up per year as recommended by international guidelines. With the introduction of telecardiology and remote monitoring in clinical practice, new organizational models have been implemented, which harmonize and codify the activity of the various professionals involved in the diagnostic and therapeutic process. This model must guarantee a precise definition of roles and responsibilities, traceability of actions, continuity of care, low consumption of resources, patient satisfaction and acceptance, integration with traditional hospital and out-of-hospital diagnosis and treatment pathways. A model that encompasses all these peculiar features is the PRIMARY NURSE MODEL. Primary nursing is a relationship based and resource driven system of care delivery, the building blocks are: attribution and acceptance by each individual of personal responsibility in making decisions; assignment of day to day care according to the case method; direct person to person communication; a person operationally responsible for the quality of care provided to patients. The decentralised decision making approach is based on three basic concepts: the nurse's decision making authority, responsibility and accountability.

Results and conclusions

The real CORE of this model is represented by the responsibility for the decisions made by a single nurse. Then each patient is assigned to a nurse responsible for continuity of care, whose duties include patient and caregiver education and training, website data entry, review of critical case transmissions and assessments, and submission of critical cases to the physician.
Patients' experiences of a digital group education targeting kinesiophobia after myocardial infarction or atrial fibrillation - a qualitative pilot study
Authors: Karner Kohler A M C , Hyback C , Andreae C , Lans C , Back M , Wijkman M , Johansson P , Mourad G
Published: July 2024

Background

Fear of movement (kinesiophobia) is common among patients after a myocardial infarction or atrial fibrillation. The kinesiophobia is developed due to the patients’ beliefs that physical activity may cause re-injury. This negatively affects their ability to perform physical activity which is stated as the first line treatment in present guidelines.

Purpose

To explore how patients with myocardial infarction and/or atrial fibrillation experience participation in a digital group education targeting kinesiophobia and physical activity.

Methods

Seven women (55-81 years) with myocardial infarction and/or atrial fibrillation that had occurred at least 6 months earlier, and kinesiophobia, i.e., score of ≥ 37 on the Tampa Scale of Kinesiophobia Swedish Version for the Heart, were included. They took part in a digital program that was based on problem-based learning and cognitive behavioural therapy and delivered via a video conferencing platform over 8 weeks and supervised by a nurse or physiotherapist. The program covered topics such as myocardial infarction, atrial fibrillation, kinesiophobia, physical activity, and exposure. A digital platform with two-factor authentication for login was developed to provide educational materials, including tutorial group scenarios, streamed lectures, factual texts, and homework assignments.

Individual semi-structured interviews were conducted with the women via a video conferencing platform after the 8-week program and transcripts were analysed using conventional qualitative content analysis.

Preliminary results

The women felt empowered after the digital encounters and joyful discussions with the group members. The educational materials and their own search for information, which was discussed in the group made them feel enlightened. The kinesiophobia was relieved or gone according to their experiences. This promoted the women to be physically active based on their own preferences. Initially, experiences of stress due to technical problems were felt. The tutor was attentive and enabling in guiding the women during the meetings on the video conferencing platform.

Conclusions

A digital group education targeting kinesiophobia after myocardial infarction and/or atrial fibrillation was experienced as feasible, enlightening, and empowering in a small group of women. The kinesiophobia was relieved or gone. This promoted them to perform physical activity as they preferred, and which is important for their recovery. More and larger studies are needed to show if a digital group educational program via a video conferencing platform can reduce kinesiophobia and promote physical activity after myocardial infarction or atrial fibrillation.
Endoscopic Balloon Dilatation of Ileal Pouch-Anal Anastomosis Strictures in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Authors: Dahiya Dushyant Singh , Jena Anuraag , Bapaye Jay , Mohan Babu P , Kassab Lena L , Facciorusso Antonio , Chandan Saurabh , Kochhar Gursimran S
Published: July 2024

Background

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for medically refractory inflammatory bowel disease (IBD). In this systematic review and meta-analysis, we assess outcomes and safety of endoscopic balloon dilatation (EBD) for IPAA strictures.

Methods

A systematic search of numerous databases was performed through June 2023 to identify studies reporting on the outcomes of EBD in pouch-related strictures. Outcomes included technical success, clinical success at index dilation and in pouch retention, recurrence of symptoms post-EBD, and adverse events of EBD. Meta-analysis was performed using a random-effects model, and results were expressed in terms of pooled rates along with relevant 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran Q statistical test with I2 statistics.

Results

Seven studies with 504 patients were included. The pooled rate of technical success and clinical success of index dilatation was 98.9% (95% CI, 94.8-99.8%; I20%) and 30.2% (95% CI, 7.1-71%; I20%), respectively. The pooled rate of clinical success in pouch retention without the need for additional surgery was 81.4% (95% CI, 69.6-89.3%; I272%). The pooled failure rate of EBD was 18.6% (95% CI, 10.7-30.4%, I272%). The pooled rate of recurrence of symptoms after index dilatation was 58.9% (95% CI, 33.3-80.5%; I213%). The pooled rate of serious adverse events was 1.8% (95% CI, 1-3.5%, I20%). No deaths related to EBD were reported.

Conclusions

Endoscopic balloon dilatation is safe and highly effective for management of IPAA strictures. Additional studies are needed to compare its efficacy with surgical interventions.
Infection spreading in tissue as a reaction-diffusion wave
Authors: Hussain Saddam , Sen Moitri , Volpert Vitaly
Published: July 2024

Viral infection develops in the organism due to virus replication inside infected cells and its transmission from infected to uninfected cells through the extracellular matrix or cell junctions. In this work, we model infection spreading in tissue with a delay reaction-diffusion system of equations for the concentrations of uninfected cells, infected cells and virus. We prove the wave existence, determine its speed of propagation and introduce a simplified one-equation model obtained from the complete model using a quasi-stationary approximation.
Finite Total Curvature and Soap Bubbles With Almost Constant Higher-Order Mean Curvature
Authors: Santilli Mario
Published: July 2024

Given $ n \geq 2 $ and $ k \in \{2, \ldots , n\} $, we study the asymptotic behaviour of sequences of bounded $C^{2}$-domains, whose $ k $-th mean curvature functions converge in $ L^{1} $-norm to a constant. Under certain curvature assumptions, we prove that finite unions of mutually tangent balls are the only possible limits with respect to convergence in volume and perimeter. The key novelty of our statement lies in the fact that we do not assume bounds on the exterior or interior touching balls.
On the Generalized Numerical Criterion
Authors: Paul Sean Timothy , Sun Song , Zhang Junsheng
Published: July 2024

In this note, we give examples that demonstrate a negative answer to the generalized numerical criterion problem for pairs.
Effect of collectors of the puerulus of the southern rock lobster Jasus edwardsii (Hutton, 1875) (Decapoda: Achelata: Palinuridae) on lobster catch rates in Tasmania, Australia
Authors: Jayanti Anes D , Gardner Caleb , León Rafael , Ogier Emily , van Putten Ingrid
Published: July 2024

The harvesting of the puerulus of rock, or spiny, lobsters for seed for aquaculture is a large industry throughout the Indo-Pacific region, and an increasing number of puerulus collectors are deployed. Little is known about the ‘crowding effect’ of the collectors and how catch might be influenced by their placement relative to each other owing to a lack of aggregate statistics for puerulus collectors in this region. The rock lobsters puerulus is also collected for fisheries research, as an index of puerulus catches on collectors can provide an indicator of recruitment strength. Both as a management tool and for commercial purposes, the collectors should act independently, not reducing or influencing catch rates on adjacent or other collectors in the area. We explored the independence of collectors of the puerulus of the southern rock lobster (Jasus edwardsii (Hutton, 1875)) using a long-term-data series from four sites on the east coast of Tasmania, Australia. Arrays of collectors were in grid and cross-shaped configurations, with individual collectors spaced three metres apart. Patterns in catches were examined using generalised least squares (GLS) modelling to determine if collectors filter pueruli as they swim shoreward, testing directional, neighbour, edge, and radial effects. The results revealed that there were no significant differences in puerulus settlement among collectors at this scale of spacing, meaning that arrays with collectors even as close as 3 m apart did not interfere with each other. This finding also suggests that collectors at this spacing only capture a small proportion of the available pueruli, allowing a significant number to pass through collector grids, with no significant reduction in catch of collectors further inshore. Such a result implies that it cannot be assumed that recruitment to a natural reef will be reduced by harvesting of pueruli with this type of collector and configuration.
Accumulative cartography: a visual semiotic analysis of online mobile maps
Authors: Baum Igal , Ribak Rivka
Published: July 2024

Dynamic maps featured in navigation applications draw on conventional cartographic practices for representing the urban environment, engaging drivers and users of public transportation in their efforts to reach their destinations. However, since these maps are produced within an economy of data accumulation, their construction of territory and user-friendly interface are designed to generate value. In this article, we explore what we define as accumulative cartography—mapping designed for the accumulation of data and capital—by developing a semiotic walk-through method for analyzing dynamic maps. Our visual semiotic analysis of Waze, Moovit, and Gett reveals that their maps are personalized, centering on the user; they commodify space, aiming to promote their specific business models; and they are preoccupied with time. We suggest that in contrast to printed maps, dynamic maps don’t provide users with the information required for navigation but instead navigate algorithmically for them, while accumulating their information.
Death and the artificial placenta
Authors: Nelson Anna , Romanis Elizabeth Chloe , Adkins Victoria , Weis Christina , Kuberska Karolina
Published: July 2024

Artificial Amnion and Placenta Technology (AAPT)—sometimes referred to as ‘Artificial Womb Technology’—could provide an extracorporeal alternative to bodily gestations, allowing a fetus delivered prematurely from the human uterus to continue development while maintaining fetal physiology. As AAPT moves nearer to being used in humans, important ethical and legal questions remain unanswered. In this paper, we explore how the death of the entity sustained by AAPT would be characterized in law. This question matters, as legal ambiguity in this area has the potential to compound uncertainty and the suffering of newly bereaved parent(s). We first identify the existing criteria used to delineate the legal characterization of death, which occurs before birth or during the immediate neonatal period in England and Wales. We then demonstrate that attempting to apply these in the context of AAPT gives rise to a number of challenges, which make it impossible to reach a definitive conclusion as to the nature of death in AAPT using the current legal framework. In doing so, we demonstrate that the current legal framework in England and Wales may be unable to adequately capture the situation of an entity being sustained by AAPT.
Stochastic prior for non-parametric star-formation histories
Authors: Wan Jenny T , Tacchella Sandro , Johnson Benjamin D , Iyer Kartheik G , Speagle Joshua S , Maiolino Roberto
Published: July 2024

The amount of power contained in the variations in galaxy star-formation histories (SFHs) across a range of time-scales encodes key information about the physical processes which modulate star formation. Modelling the SFHs of galaxies as stochastic processes allows the relative importance of different time-scales to be quantified via the power spectral density (PSD). In this paper, we build upon the PSD framework and develop a physically motivated, ‘stochastic’ prior for non-parametric SFHs in the spectral energy distribution (SED)-modelling code prospector. We test this prior in two different regimes: (1) massive, $z = 0.7$ galaxies with both photometry and spectra, analogous to those observed with the LEGA-C survey, and (2) $z = 8$ galaxies with photometry only, analogous to those observed with NIRCam on JWST. We find that it is able to recover key galaxy parameters (e.g. stellar mass, stellar metallicity) to the same level of fidelity as the commonly used continuity prior. Furthermore, the realistic variability information incorporated by the stochastic SFH model allows it to fit the SFHs of galaxies more accurately and precisely than traditional non-parametric models. In fact, the stochastic prior is $\gtrsim 2\times$ more accurate than the continuity prior in measuring the recent star-formation rates (log SFR$_{100}$ and log SFR$_{10}$) of both the $z = 0.7$ and $z = 8$ mock systems. While the PSD parameters of individual galaxies are difficult to constrain, the stochastic prior implementation presented in this work allows for the development of hierarchical models in the future, i.e. simultaneous SED-modelling of an ensemble of galaxies to measure their underlying PSD.
Non-monotonic relations of galaxy star formation, radius, and structure at fixed stellar mass
Authors: Stephenson Jimena , Rodríguez-Puebla Aldo , Faber S M , Primack Joel R , Avila-Reese Vladimir , Calette A R , Cannarozzo Carlo , Kakos James , Cano-Díaz Mariana , Koo David C , Shankar Francesco , Morell D F
Published: July 2024

We investigate the relation between galaxy structure and star formation rate (SFR) in a sample of $\sim 2.9\times 10^{4}$ central galaxies with $z\lt 0.0674$ and axial ratios $b/a\gt 0.5$. The star-forming main sequence (SFMS) shows a bend around the stellar mass of $M_\ast \le {}M_c=2\times 10^{10}{}{\rm M}_{\odot }$. At $M_\ast \le {}M_c$, the SFMS follows a power-law $\text{SFR}\propto {}M_\ast ^{0.85}$, while at higher masses it flattens. $M_c$ corresponds to a dark matter halo mass of $M_\text{vir}\sim {}10^{11.8}{\rm M}_{\odot }$ where virial shocks occurs. Some galaxy structure (e.g. half-light radius, $R_e$) exhibits a non-monotonic dependence across the SFMS at a fixed $M_\ast$. We find $\text{SFR}\propto {R_e^{-0.28}}$ at fixed $M_\ast$, consistent with the global Kennicutt–Schmidt (KS) law. This finding suggests that galaxy sizes contribute to the scatter of the SFMS. However, at $M_\ast \gt M_c$ the relationship between SFR and $R_e$ diminishes. Low-mass galaxies above the mean of the SFMS have smaller radii, exhibit compact and centrally concentrated profiles resembling green valley (GV) and quiescent galaxies at the same mass, and have higher $M_{\text{H}_2}{/}M_\rm{H\,{\small I}}$. Conversely, those below the SFMS exhibit larger radii, lower densities, have no GV or quiescent counterparts at their mass and have lower $M_{\text{H}_2}/M_\rm{H\,{\small I}}$. The above data suggest two pathways for quenching low-mass galaxies, $M_\ast \le {}M_c$: a fast one that changes the morphology on the SFMS and a slow one that does not. Above $M_c$, galaxies below the SFMS resemble GV and quiescent galaxies structurally, implying that they undergo a structural transformation already within the SFMS. For these massive galaxies, CG are strongly bimodal, with SFMS galaxies exhibiting negative colour gradients, suggesting most star formation occurs in their outskirts, maintaining them within the SFMS.
An ALMA CO(1-0) survey of the 2Jy sample: large and massive molecular discs in radio AGN host galaxies
Authors: Tadhunter C , Oosterloo T , Morganti R , Almeida C Ramos , Martín M Villar , Emonts B , Dicken D
Published: July 2024

The jets of radio AGN provide one of the most important forms of active galactic nuclei (AGN) feedback, yet considerable uncertainties remain about how they are triggered. Since the molecular gas reservoirs of the host galaxies can supply key information about the dominant triggering mechanism(s), here we present Atacama Large Millimeter/sub-millimeter Array CO(1-0) observations of a complete sample of 29 powerful radio AGN ($P_{1.4\,{\rm GHz}} \gt 10^{25}$ W Hz$^{-1}$ and $0.05 \lt z \lt 0.3$) with an angular resolution of about 2–3 arcsec (corresponding to 2–8 kpc). We detect molecular gas with masses in the range $10^{8.9} \lt M_{{\rm H}_2} \lt 10^{10.2}$ M$_\odot$ in the early-type host galaxies of ten targets, while for the other 19 sources, we derive upper limits. The detection rate of objects with such large molecular masses – $34\pm 9$ per cent – is higher than in the general population of non-active early-type galaxies (ETGs: $\lt $10 per cent). The kinematics of the molecular gas are dominated in most cases by rotating disc-like structures, with diameters up to 25 kpc. Compared with the results for samples of quiescent ETG in the literature, we find a larger fraction of more massive, more extended and less settled molecular gas structures. In most of the CO-detected sources, the results are consistent with triggering of the AGN as the gas settles following a merger or close encounter with a gas-rich companion. However, in a minority of objects at the centres of rich clusters of galaxies, the accretion of gas cooling from the hot X-ray haloes is a plausible alternative to galaxy interactions as a triggering mechanism.
The Evolution of Ultraconserved Elements in Vertebrates
Authors: Cummins Mitchell , Watson Cadel , Edwards Richard J , Mattick John S
Published: July 2024

Ultraconserved elements were discovered two decades ago, arbitrarily defined as sequences that are identical over a length ≥ 200 bp in the human, mouse, and rat genomes. The definition was subsequently extended to sequences ≥ 100 bp identical in at least three of five mammalian genomes (including dog and cow), and shown to have undergone rapid expansion from ancestors in fish and strong negative selection in birds and mammals. Since then, many more genomes have become available, allowing better definition and more thorough examination of ultraconserved element distribution and evolutionary history. We developed a fast and flexible analytical pipeline for identifying ultraconserved elements in multiple genomes, dedUCE, which allows manipulation of minimum length, sequence identity, and number of species with a detectable ultraconserved element according to specified parameters. We suggest an updated definition of ultraconserved elements as sequences ≥ 100 bp and ≥97% sequence identity in ≥50% of placental mammal orders (12,813 ultraconserved elements). By mapping ultraconserved elements to ∼200 species, we find that placental ultraconserved elements appeared early in vertebrate evolution, well before land colonization, suggesting that the evolutionary pressures driving ultraconserved element selection were present in aquatic environments in the Cambrian–Devonian periods. Most (>90%) ultraconserved elements likely appeared after the divergence of gnathostomes from jawless predecessors, were largely established in sequence identity by early Sarcopterygii evolution—before the divergence of lobe-finned fishes from tetrapods—and became near fixed in the amniotes. Ultraconserved elements are mainly located in the introns of protein-coding and noncoding genes involved in neurological and skeletomuscular development, enriched in regulatory elements, and dynamically expressed throughout embryonic development.
Inhibition of PERK-mediated unfolded protein response acts as a switch for reversal of residual senescence and as senolytic therapy in glioblastoma
Authors: Ketkar Madhura , Desai Sanket , Rana Pranav , Thorat Rahul , Epari Sridhar , Dutt Amit , Dutt Shilpee
Published: July 2024

Background

Glioblastoma due to recurrence is clinically challenging with 10–15 months overall survival. Previously we showed that therapy-induced senescence (TIS) in glioblastoma reverses causing recurrence. Here, we aim to delineate the TIS reversal mechanism for potential therapeutic intervention to prevent glioblastoma (GBM) recurrence.

Methods

Residual senescent (RS) and end of residual senescence (ERS) cells were captured from GBM patient-derived primary-cultures and cell lines mimicking clinical scenarios. RNA-sequencing, transcript/protein validations, knock-down/inhibitor studies, ChIP RT-PCR, biochemical assays, and IHCs were performed for the mechanistics of TIS reversal. In vivo validations were conducted in GBM orthotopic mouse model.

Results

Transcriptome analysis showed co-expression of endoplasmic reticulum (ER) stress-unfolded protein response (UPR) and senescence-associated secretory phenotype (SASP) with TIS induction and reversal. Robust SASP production and secretion by RS cells could induce senescence, Reactive oxygen specis (ROS), DNA damage, and ER stress in paracrine fashion independent of radiation. Neutralization of most significantly enriched cytokine from RS-secretome IL1β, suppressed SASP, and delayed senescence reversal. Mechanistically, with SASP and massive protein accumulation in ER, RS cells displayed stressed ER morphology, upregulated ER stress markers, and PERK pathway activation via peIF2α-ATF4-CHOP which was spontaneously resolved in ERS. ChIP RT-PCR showed CHOP occupancy at CXCL8/IL8, CDKN1A/p21, and BCL2L1/BCLXL aiding survival. PERK knockdown/inhibition with GSK2606414 in combination with radiation led to sustained ER stress and senescence without SASP. PERKi in RS functioned as senolytic via apoptosis and prevented recurrence in vitro and in vivo ameliorating overall survival.

Conclusion

We demonstrate that PERK-mediated UPR regulates senescence reversal and its inhibition can be exploited as a potential seno-therapeutic option in glioblastoma.
Oral Preexposure Prophylaxis Uptake and Discontinuation in the HIV Vaccine Trials Network 704/HIV Prevention Trials Network 085 Study: Implications for Biomedical Human Immunodeficiency Virus Prevention Trials
Authors: Cantos Valeria D , Neradilek Moni , Huang Yunda , Roxby Alison C , Gillespie Kevin , deCamp Allan C , Karuna Shelly T , Edupuganti Srilatha , Gallardo-Cartagena Jorge , Sanchez Jorge , del Rio Carlos , Veloso Valdilea , Cohen Myron S , Donnell Deborah J , Corey Lawrence , Kelley Colleen F
Published: July 2024

Background

HIV Vaccine Trials Network (HVTN) 704/085, a placebo-controlled clinical trial assessing the efficacy of VRC01 broadly neutralizing antibody infusion for HIV prevention, offered oral preexposure prophylaxis (PrEP) as the standard of prevention at no cost to participants.

Methods

We characterized features of- identified factors associated with- PrEP initiation and discontinuation, and the effects of PrEP initiation on HIV incidence.

Results

Of 2221 participants, 31.8% initiated oral PrEP during study follow-up, with the highest proportion of PrEP initiations in Brazil (83.2%) and the United States (US) (54.2%). Prior PrEP use was associated with PrEP initiation (hazard ratio [HR], 2.22 [95% confidence interval {CI}, 1.25–3.95]). Participants from Switzerland (HR, 0.5 [95% CI, .3–1.0]) and Peru (HR, 0.08 [95% CI, .06–.1]) had lower likelihood of PrEP initiation compared to the US, while participants from Brazil had higher likelihood (HR, 2.6 [95% CI, 2.0–3.3]). In the US, PrEP initiation was lower in areas with higher unmet need for PrEP (HR, 0.9 per 5 units [95% CI, 0.8–1.0]). PrEP initiators had 58% less risk of acquiring HIV than PrEP noninitiators. Among PrEP initiators, 34.4% discontinued PrEP during study follow-up. Brazil had 63% less likelihood of PrEP discontinuation than the US (HR, 0.37 [95% CI, .22–.60]).

Conclusions

When included as standard of prevention in HVTN 704/085, oral PrEP utilization patterns mirrored those observed in real-life settings. Variable effects of oral PrEP on HIV outcomes in clinical trials may be expected based on regional differences in oral PrEP use.
The Custom of the Country
Authors: Wharton Edith
Published: July 2024

Edith Whartonߣs satiric anatomy of American society in the first decade of the twentieth century appeared in 1913; it both appalled and fascinated its first reviewers, and established her as a major novelist. The Saturday Review wrote that she had ߢassembled as many detestable people as it is possible to pack between the covers of a six-hundred page novelߣ, but concluded that the book was ߢbrilliantly writtenߣ, and ߢshould be read as a parableߣ.

It follows the career of Undine Spragg, recently arrived in New York from the midwest and determined to conquer high society. Glamorous, selfish, mercenary and manipulative, her principal assets are her striking beauty, her tenacity, and her fatherߣs money. With her sights set on an advantageous marriage, Undine pursues her schemes in a world of shifting values, where triumph is swiftly followed by dissullusion.

Wharton was recreating an environment she knew intimately, and Undineߣs education for social success is chronicled in meticulous detail. The novel superbly captures the world of post-Civil War America, as ruthless in its social ambitions as in its business and politics.
XV
Authors: Wharton Edith
Published: July 2024

In the Dagonet drawing-room the lamps had long been lit, and Mrs Fairford, after a last impatient turn, had put aside the curtains of worn damask to strain her eyes into the darkening square. She came back to the hearth, where Charles Bowen stood...
The Shadow-Line
Authors: Conrad Joseph
Published: July 2024

Written in 1915, The Shadow-Line is based upon events and experiences from twenty-seven years earlier to which Conrad returned obsessively in his fiction. A young sea captain’s first command brings with it a succession of crises: his sea is becalmed, the crew laid low by fever, and his deranged first mate is convinced that the ship is haunted by the malignant spirit of a previous captain.

This is indeed a work full of ‘sudden passions’, in which Conrad is able to show how the full intensity of existence can be experienced by the man who, in the words of the older Captain Giles, is prepared to ‘stand up to his bad luck, to his mistakes, to his conscience’. A subtle and penetrating analysis of the nature of manhood, The Shadow-Line investigates varieties of masculinity and desire in a subtext that counterpoints the tale’s seemingly conventional surface.
Chapter IV
Authors: London Jack
Published: July 2024

MY next bout with John Barleycorn occurred when I was seven. This time my imagination was at fault, and I was frightened into the encounter. Still farming, my family had moved to a ranch on the bleak sad coast of San Mateo County south of...
CHAPTER XXVI
Authors: Woolf Virginia
Published: July 2024

Although the old coaches, with their gay panels and the guard’s horn, and the humours of the box and the vicissitudes of the road, have long mouldered into dust so far as they were matter, and are preserved in the printed pages of our...
CHAPTER XXXII
Authors: Woolf Virginia
Published: July 2024

Nobody asked Katharine any questions next day. If cross-examined she might have said that nobody spoke to her. She worked a little, wrote a little, ordered the dinner, and sat, for longer than she knew, with her head on her hand piercing whatever lay...
Chapter VI
Authors: Conrad Joseph
Published: July 2024

A profound stillness reigned in the Casa Gould. The master of the house, walking along the corridor, opened the door of his room, and saw his wife sitting in a big armchair—his own smoking armchair—thoughtful, contemplating her little shoes. And she did not raise...
Chapter II
Authors: Conrad Joseph
Published: July 2024

Captain Mitchell, pacing the wharf, was asking himself the same question. There was always the doubt whether the warning of the Esmeralda telegraphist—a fragmentary and interrupted message—had been properly understood. However, the good man had made up his mind not to go to bed...
Chapter III
Authors: Conrad Joseph
Published: July 2024

Directly they were alone, the colonel’s severe official manner changed. He rose and approached the doctor. His eyes shone with rapacity and hope; he became confidential. “The silver might have been indeed put on board the lighter, but, it was not conceivable that it...
Women Novelists
Authors: Woolf Virginia
Published: July 2024

By rights, or, more modestly, according to a theory of ours, Mr Brimley Johnson* should have written a book amply calculated, according to the sex of the reader, to cause gratification or annoyance, but of no value from a critical point of...
Chapter 8
Authors: Lewis Wyndham
Published: July 2024

For the first time since his ‘return’ Tarr found no Kreisler at the Café Toucy. The waiter told him that Kreisler had not been there at all that evening. Tarr reconsidered his responsibilities. He could not return to Montmartre without first informing himself of...
Chapter IV
Authors: Lewis Sinclair
Published: July 2024

I

It was a morning of artistic creation. Fifteen minutes after the purple prose of Babbitt’s form-letter, Chester Kirby Laylock, the resident salesman at Glen Oriole, came in to report a sale and submit an advertisement. Babbitt disapproved of Laylock, who sang in choirs...
Chapter VI
Authors: Lewis Sinclair
Published: July 2024

I

He forgot Paul Riesling in an afternoon of not unagreeable details. After a return to his office, which seemed to have staggered on without him, he drove a “prospect” out to view a four-flat tenement in the Linton district. He was inspired by...
Chapter XXI
Authors: Lewis Sinclair
Published: July 2024

The International Organization of Boosters’ Clubs has become a world-force for optimism, manly pleasantry, and good business. Chapters are to be found now in thirty countries. Nine hundred and twenty of the thousand chapters, however, are in the United States.

None of these is more...
The Man who Disappeared (America)
Authors: Kafka Franz
Published: July 2024

Entering New York harbour, the young immigrant Karl Rossmann sees the Statue of Liberty, ‘her arm with the sword stretched upward’. This forbidding introduction sets the tone for Kafka’s narrative about an innocent European astray in an ultra-modern America that is both a fantasy and an object of social satire. Expelled by his family after seduction by a maidservant, Karl finds in America a series of surrogate families, but he continues to get into undeserved trouble and is forced to move on once again. Along the way Karl encounters extremes of wealth and poverty, experiences the cruelty of the American work ethic, and has glimpses of the criminal underworld, without losing the basic goodness and resourcefulness that enable him to survive the hazards of the New World.

Full of incident, and blackly humorous, Kafka’s first novel portrays American civilization with horrified fascination. This edition retains Kafka’s distinctive style in a sensitive and natural new translation, together with a penetrating introduction and notes.
Box 5
Authors: Leroux Gaston
Published: July 2024

Armand Moncharmin wrote such voluminous memoirs that we are perfectly entitled to ask how, especially during his lengthy term as co-Director of the Opera, he ever found time to do anything towards running the place beyond setting down everything that went on there. He...
Incorporating boron distribution variations in microdosimetric kinetic model-based relative biological effectiveness calculations for boron neutron capture therapy
Authors: Li Mingzhu , Geng Changran , Han Yang , Guan Fada , Liu Yuanhao , Shu Diyun , Tang Xiaobin
Published: July 2024

This study introduces the MKM_B model, an approach derived from the MKM model, designed to evaluate the biological effectiveness of Boron Neutron Capture Therapy (BNCT) in the face of challenges from varying microscopic boron distributions. The model introduces a boron compensation factor, allowing for the assessment of compound Biological Effectiveness (CBE) values for different boron distributions. Utilizing the TOPAS simulation platform, the lineal energy spectrum of particles in BNCT was simulated, and the sensitivity of the MKM_B model to parameter variations and the influence of cell size on the model were thoroughly investigated. The CBE values for 10B-boronphenylalanine (BPA) and 10B-sodium (BSH) were determined to be 3.70 and 1.75, respectively. These calculations were based on using the nucleus radius of 2.5 μm and the cell radius of 5 μm while considering a 50% surviving fraction. It was observed that as cell size decreased, the CBE values for both BPA and BSH increased. Additionally, the model parameter rd was identified as having the most significant impact on CBE, with other parameters showing moderate effects. The development of the MKM_B model enables the accurate prediction of CBE under different boron distributions in BNCT. This model offers a promising approach to optimize treatment planning by providing increased accuracy in biological effectiveness.
Mapping Seedling and Adult Plant Leaf Rust Resistance Genes in the Durum Wheat Cultivar Strongfield and Other Triticum turgidum Lines
Authors: Bokore Firdissa E. , Boyle Kerry , Ruan Yuefeng , McCartney Curt A. , Hiebert Colin W. , Knox Ron E. , Pei Xiangyu , Reimer Elsa , Ammar Karim , Zhang Wentao , Fobert Pierre , Cuthbert Richard D. , Berraies Samia , McCallum Brent D.
Published: July 2024

Durum wheat ( Triticum turgidum) is threatened by the appearance of new virulent races of leaf rust, caused by Puccinia triticina, in recent years. This study was conducted to determine the leaf rust resistance in a modern Canadian durum cultivar, Strongfield. Six populations derived from crosses of Strongfield with six tetraploid wheat lines, respectively, were tested at the seedling plant stage with different P. triticina races. Two of the populations were evaluated for adult plant leaf rust infection in Canada and Mexico. A stepwise regression joint linkage quantitative trait locus (QTL) mapping and analysis by MapQTL were performed. Strongfield contributed the majority of QTLs detected, contributing seven QTLs detected in field tests and eight QTLs conditioning seedling resistance. A 1B QTL, QLr-Spa-1B.1, from Strongfield had a significant effect in both Canadian and Mexican field tests and corresponded with Lr46/ Yr29. The remaining field QTLs were found in only the Canadian or the Mexican environment, not both. The QTL from Strongfield on 3A, QLr-Spa-3A, conferred seedling resistance to all races tested and had a significant effect in the field in Canada. This is the first report of QLr-Spa-3A and Lr46/ Yr29 as key components of genetic resistance in Canadian durum wheat. KASP markers were developed to detect QLr-Spa-3A for use in marker-assisted leaf rust resistance breeding. The susceptible parental lines contributed QTLs on 1A, 2B, and 5B that were effective in Mexican field tests and may be good targets to integrate into modern durum varieties to improve resistance to new durum virulent races.
Comprehensive metabolic modulations of sphingolipids are promising severity indicators in COVID‐19
Authors: Uranbileg Baasanjav , Isago Hideaki , Nakayama Hitoshi , Jubishi Daisuke , Okamoto Koh , Sakai Eri , Kubota Masayuki , Tsutsumi Takeya , Moriya Kyoji , Kurano Makoto
Published: July 2024

The COVID‐19 pandemic, caused by SARS‐CoV‐2, has had a significant worldwide impact, affecting millions of people. COVID‐19 is characterized by a heterogenous clinical phenotype, potentially involving hyperinflammation and prolonged tissue damage, although the exact underlying mechanisms are yet to be fully understood. Sphingolipid metabolites, which govern cell survival and proliferation, have emerged as key players in inflammatory signaling and cytokine responses. Given the complex metabolic pathway of sphingolipids, this study aimed to understand their potential role in the pathogenesis of COVID‐19. We conducted a comprehensive examination of sphingolipid modulations across groups classified based on disease severity, incorporating a time‐course in serum and urine samples. Several sphingolipids, including sphingosine, lactosylceramide, and hexosylceramide, emerged as promising indicators of COVID‐19 severity, as validated by correlation analyses conducted on both serum and urine samples. Other sphingolipids, such as sphingosine 1‐phosphate, ceramides, and deoxy‐dihydroceramides, decreased in both COVID‐19 patients and individuals with non‐COVID infectious diseases. This suggests that these sphingolipids are not specifically associated with COVID‐19 but rather with pathological conditions caused by infectious diseases. Our analysis of urine samples revealed elevated levels of various sphingolipids, with changes dependent on disease severity, potentially highlighting the acute kidney injury associated with COVID‐19. This study illuminates the intricate relationship between disturbed sphingolipid metabolism, COVID‐19 severity, and clinical factors. These findings provide valuable insights into the broader landscape of inflammatory diseases.
Perioperative care of patients with recent stroke undergoing nonemergent, nonneurological, noncardiac, nonvascular surgery: a systematic review and meta-analysis
Authors: Lele Abhijit V. , Moreton Elizabeth Olive , Sundararajan Jayashree , Blacker Samuel Neal
Published: July 2024

Purpose of review

To systematically review and perform a meta-analysis of published literature regarding postoperative stroke and mortality in patients with a history of stroke and to provide a framework for preoperative, intraoperative, and postoperative care in an elective setting.

Recent findings

Patients with nonneurological, noncardiac, and nonvascular surgery within three months after stroke have a 153-fold risk, those within 6 months have a 50-fold risk, and those within 12 months have a 20-fold risk of postoperative stroke. There is a 12-fold risk of in-hospital mortality within three months and a three-to-four-fold risk of mortality for more than 12 months after stroke. The risk of stroke and mortality continues to persist years after stroke. Recurrent stroke is common in patients in whom anticoagulation/antiplatelet therapy is discontinued. Stroke and time elapsed after stroke should be included in the preoperative assessment questionnaire, and a stroke-specific risk assessment should be performed before surgical planning is pursued.

In patients with a history of a recent stroke, anesthesiology, surgery, and neurology experts should create a shared mental model in which the patient/surrogate decision-maker is informed about the risks and benefits of the proposed surgical procedure; secondary-stroke-prevention medications are reviewed; plans are made for interruptions and resumption; and intraoperative care is individualized to reduce the likelihood of postoperative stroke or death.
Harnessing artificial intelligence for predicting and managing postoperative pain: a narrative literature review
Authors: Sajdeya Ruba , Narouze Samer
Published: July 2024

Purpose of review

This review examines recent research on artificial intelligence focusing on machine learning (ML) models for predicting postoperative pain outcomes. We also identify technical, ethical, and practical hurdles that demand continued investigation and research.

Recent findings

Current ML models leverage diverse datasets, algorithmic techniques, and validation methods to identify predictive biomarkers, risk factors, and phenotypic signatures associated with increased acute and chronic postoperative pain and persistent opioid use. ML models demonstrate satisfactory performance to predict pain outcomes and their prognostic trajectories, identify modifiable risk factors and at-risk patients who benefit from targeted pain management strategies, and show promise in pain prevention applications. However, further evidence is needed to evaluate the reliability, generalizability, effectiveness, and safety of ML-driven approaches before their integration into perioperative pain management practices.

Artificial intelligence (AI) has the potential to enhance perioperative pain management by providing more accurate predictive models and personalized interventions. By leveraging ML algorithms, clinicians can better identify at-risk patients and tailor treatment strategies accordingly. However, successful implementation needs to address challenges in data quality, algorithmic complexity, and ethical and practical considerations. Future research should focus on validating AI-driven interventions in clinical practice and fostering interdisciplinary collaboration to advance perioperative care.
Kratom: a primer for pain physicians
Authors: Emerick Trent , Durbhakula Shravani , Eibel Maria R. , Kohan Lynn
Published: July 2024

Purpose of review

Kratom is used commonly in the United States, usually to mitigate pain, opioid withdrawal, or fatigue. A comprehensive discussion on kratom, tailored to pain management physicians, is needed, given its associated risks and potential interactions.

Recent findings

Kratom and its main metabolites, mitragynine and 7-OH-mitragynine, bind to a variety of receptors including mu opioid receptors. Still, kratom cannot be described as a classic opioid. Kratom has been utilized without FDA approval as an alternative to traditional medications for opioid use disorder and opioid withdrawal. Lower doses of kratom typically cause opioid-like effects while higher doses can have sedating effects. Tolerance, dependence and withdrawal still occur, although kratom withdrawal appears to be more moderate than opioid withdrawal. Contamination with heavy metals and biological toxins is concerning and there is potential for serious complications, including seizures and death.

The use of kratom as an opioid-sparing alternative as a part of a multimodal pain regimen is not without significant risks. It is of utmost importance for pain physicians to be aware of the risks and adverse effects associated with kratom use.