bluuebunny/crossref_metadata_2025 huggingface dataset:
Interplay between the non-resonant streaming instability and self-generated pressure anisotropies
Authors: Marret A , Ciardi A , Smets R
Published: July 2024

The non-thermal particles escaping from collision-less shocks into the surrounding medium can trigger a non-resonant streaming instability that converts parts of their drift kinetic energy into large amplitude magnetic field perturbations, and promote the confinement and acceleration of high energy cosmic rays. We present simulations of the instability using an hybrid-Particle-in-Cell approach including Monte Carlo collisions, and demonstrate that the development of the non-resonant mode is associated with important ion pressure anisotropies in the background plasma. Depending on the initial conditions, the anisotropies may act on the instability by lowering its growth and trigger secondary micro-instabilities. Introducing collisions with neutrals yield a strong reduction of the magnetic field amplification as predicted by linear fluid theory. In contrast, Coulomb collisions in fully ionized plasmas are found to mitigate the self-generated pressure anisotropies and promote the growth of the magnetic field.
Cluster population demographics in NGC 628 derived from stochastic population synthesis models
Authors: Tang Jianling , Grasha Kathryn , Krumholz Mark R
Published: July 2024

The physical properties of star cluster populations offer valuable insights into their birth, evolution, and disruption. However, individual stars in clusters beyond the nearest neighbours of the Milky Way are unresolved, forcing analyses of star cluster demographics to rely on integrated light, a process fraught with uncertainty. Here, we infer the demographics of the cluster population in the benchmark galaxy NGC 628 using data from the Legacy Extra-galactic UV Survey (LEGUS) coupled to a novel Bayesian forward-modelling technique. Our method analyses all 1178 clusters in the LEGUS catalogue, $\sim 4$ times more than prior studies severely affected by completeness cuts. Our results indicate that the cluster mass function is either significantly steeper than the commonly observed slope of $-2$ or is truncated at $\approx 10^{4.5}$ M$_\odot$; the latter possibility is consistent with proposed relations between truncation mass and star formation surface density. We find that cluster disruption is relatively mild for the first $\approx 200$  Myr of cluster evolution; no evidence for mass-dependent disruption is found. We find suggestive but not incontrovertible evidence that inner galaxy clusters may be more prone to disruption and outer galaxy clusters have a more truncated mass function, but confirming or refuting these findings will require larger samples from future observations of outer galaxy clusters. Finally, we find that current stellar track and atmosphere models, along with common forms for cluster mass and age distributions, cannot fully capture all features in the multidimensional photometric distribution of star clusters. While our forward-modelling approach outperforms earlier backward-modelling approaches, some systematic differences persist between observed and modelled photometric distributions.
Efficacy and Safety of Exogenous Ketones in People with Mild Neurocognitive Disorder and Alzheimer’s Disease: A Systematic Literature Review
Authors: Krolak-Salmon Pierre , Swerdlow Russell H , Mastain Thibault , Dive-Pouletty Catherine , Pooley Nick , Kisomi Masoumeh
Published: July 2024

Context

Mild neurocognitive disorder (NCD), formally known as mild cognitive impairment, is usually the clinical stage preceding the development of Alzheimer’s disease (AD), the most prevalent major NCD, and other causes of dementia. Glucose is a major source of energy for human brain metabolism and the uptake of glucose is reduced in patients with mild NCD, AD, and other NCDs. Unlike glucose, the uptake of ketones remains normal in people with mild NCD and AD, suggesting that the use of ketone bodies may compensate for glucose energy deficiency in patients with mild NCD and AD.

Objective

The aim of this systematic review was to summarize the efficacy and safety of exogenic ketones, including medium chain triglycerides (MCTs), on cognitive function in patients with mild NCD and AD.

Data Sources

The Embase, MEDLINE, MEDLINE In-Process, PubMed Ahead-of-Print, Cochrane Central Register of Controlled Trials, Europe PMC databases were searched from inception to April 2022. Studies reporting cognitive function efficacy and safety outcomes from randomized controlled trials of exogenic ketones in patients with mild NCD and AD were included.

Data Extraction

Data were extracted by 1 reviewer and checked by a second reviewer. Risk of bias was assessed using the Cochrane risk of bias tool, version 2.

Data Analysis

This review identified 13 individual trials investigating the efficacy and safety of MCT or coconut oil for patients with mild NCD or with AD. Because of the heterogeneity of the studies, a narrative synthesis was used.

Conclusion

Overall, improvements associated with exogenic ketones were observed in multiple aspects of cognitive abilities, although the large heterogeneity between the included studies makes it difficult to draw firm conclusions from the current literature. Although some studies investigated the impact of the apolipoprotein E ε4 allele status on treatment efficacy, the current data are insufficient to conclude whether such an effect is present.

Systematic Review Registration

PROSPERO registration No. CRD42022336664.
Clinical ethics consultation services: public-facing information on NCI-designated cancer center websites
Authors: Koranteng Erica , Cernik Colin , Gallagher Erin , Hantel Andrew , Marron Jonathan , Abel Gregory
Published: July 2024

Clinical ethics consultation services (CECS) can be particularly complex in oncology, and widespread misconceptions exist about their nature. As a result, visibility and accessibility of information regarding CECS is critical. We investigated the availability and content of information regarding CECS on websites of NCI-designated comprehensive cancer centers and cancer centers (CCs). Each website was reviewed for information on CECS and reviewed for benchmarks partially derived from the American Society of Bioethics and Humanities recommendations for CECS. Our analysis revealed that of 70 NCI-designated center websites, 38 had information on CECS, and 17 were found directly on these sites. When CECS information was available, most websites provided a mission statement (71%) and an explanation of what constitutes an ethics consult (74%). Few provided a description of the consult process (45%) or service membership (39%). Our findings reveal a significant gap in CECS visibility on the websites of NCI-designated CCs.
Outcomes in older adults with metastatic esophageal and gastric carcinoma treated with palliative chemotherapy
Authors: Wang Xin , Allen Michael J , Espin-Garcia Osvaldo , Suzuiki Chihiro , Bach Yvonne , Panov Elan , Ma Lucy X , Jang Raymond W , Chen Eric X , Darling Gail E , Yeung Jonathan , Swallow Carol J , Brar Savtaj Singh , Kalimuthu Sangeetha , Wong Rebecca , Veit-Haibach Patrick , Elimova Elena
Published: July 2024

Background

The incidence of esophageal and gastric carcinoma (GEC) in elderly patients is increasing, yet patients ≥75 years have historically been underrepresented in clinical trials. We sought to investigate palliative chemotherapy administration patterns and survival outcomes in older adults.

Materials and Methods

A retrospective analysis identified patients aged 65-74 (young-old) and ≥75 years (older-old) diagnosed with advanced GEC. Patient and tumor characteristics were recorded, with descriptive analysis, time-to-event data analysis using Kaplan-Meier curves and multivariate Cox proportional hazards regression analysis performed.

Results

One hundred and ninety-eight “young-old” and 109 ‘older-old’ patients were identified. Patient characteristics were similar between groups except for Charlson Co-morbidity Index (CCI), with lower co-morbidities in the “young-old” compared to “older-old” cohort (P < .001; CCI = 0 in 103 (52%) “young-old” vs 31 (28%) “older-old”). The primary diagnosis in both groups was adenocarcinoma. 119 (60%) “young-old” and 25 (23%) “older-old” patients received chemotherapy (P < .001). Performance status was the primary explanation for chemotherapy non-receipt in both cohorts; age was the explanation in 21 (25%) “older-old” patients and none in the “young-old” patients. PFS for first-line systemic therapy in “young-old” patients was 6.4 (95% CI 5.9-7.6) versus 7.5 months (95% CI 5.1-11.3) in “older-old” patients (P = .69) whilst respective OS was 12.3 (95% CI 10.1-15.5) and 10.4 months (95% CI 9.0-14.6) (P = .0816). Toxicity prompted chemotherapy cessation in 17 (15%) “young-old” and 3 (13%) “older-old” patients (P = .97). Multivariate analysis identified CCI and ECOG performance status as predictive for PFS and OS, respectively. No causative relationship was identified with other variables.

Conclusion

Our study of real-world older-adults show that significant number of “older-old” patients with GEC do not receive chemotherapy. Among “older-old” adults who do receive systemic therapy, outcomes are comparable; this underscores the importance of geriatric assessment-guided care and suggests that age alone should not be a barrier to receipt of chemotherapy in patients with advanced GEC.
Computational insights into CRISP3 downregulation in cervical cancer and its cervical lineages pattern
Authors: Cintra Ricardo Cesar , Céspedes Andrés Galindo , Conceição Mércia Patrícia Ferreira , Oliveira Maiza Vitoria Aguiar Silva , Buron Alessandro , Rodrigues das Neves Deisiane , Moraes Fabio Alves , Gamarra Olinda Maria , Rodrigues de Bastos Daniel
Published: July 2024

Background

Cysteine-rich secretory protein 3 (CRISP3) emerges as a potential biomarker in the study of many cancers, including cervical cancer (CC). This study aimed to analyze the expression pattern of CRISP3 in CC patients and CC cell lineages, following treatment with the epigenetic drugs: trichostatin A (TSA) and 5-aza-2'-deoxycytidine (5-aza).

Methods

The differentially expressed genes identified in GSE63514 were used to construct a protein–protein interaction network. CRISP3 was selected for subsequent analyses. We utilized data from the TCGA and GENT2 projects to evaluate the expression profile and clinical behavior of CRISP3. Additionally, we conducted cell culture experiments to analyze the expression profile of CRISP3 in cells.

Results

Low levels of CRISP3 were observed in squamous cell carcinoma (SCC) and human papillomavirus (HPV)16+, along with being associated with worse overall survival (OS). MIR-1229–3p was analyzed, and its high expression was associated with worse prognostic outcomes. In CC-derived cell lines, we observed low levels of CRISP3 in SiHa, followed by SW756, C33A, HeLa, and higher levels in CaSki. All cells were treated with TSA, 5-aza, or both. In all cell lines, treatment with TSA resulted in increased transcription of CRISP3.

Conclusion

We identified a significant downregulation of CRISP3 in CC, particularly in cases with HPV16 infection and SCC, which was associated with poorer OS. Preliminary findings suggest that epigenetic treatments with TSA and 5-aza may modulate CRISP3 expression, warranting further research to elucidate its regulatory mechanisms and potential as a prognostic biomarker.
Roles of three cytochrome P450 monooxygenases in triterpene biosynthesis and their potential impact on growth and development
Authors: Yang Caiqiong , Halitschke Rayko , O’Connor Sarah E , Baldwin Ian T
Published: July 2024

Pentacyclic triterpenoids, recognized for their natural bioactivity, display complex spatiotemporal accumulation patterns within the ecological model plant Nicotiana attenuata. Despite their ecological importance, the underlying biosynthetic enzymes and functional attributes of triterpenoid synthesis in N. attenuata remain unexplored. Here, we show that 3 cytochrome P450 monooxygenases (NaCYP716A419, NaCYP716C87, and NaCYP716E107) from N. attenuata oxidize the pentacyclic triterpene skeleton, as evidenced by heterologous expression in Nicotiana benthamiana. NaCYP716A419 catalyzed a consecutive 3-step oxidation reaction at the C28 position of β-amyrin/lupeol/lupanediol, yielding the corresponding alcohol, aldehyde, and carboxylic acid. NaCYP716C87 hydroxylated the C2α position of β-amyrin/lupeol/lupanediol/erythrodiol/oleanolic acid/betulinic acid, while NaCYP716E107 hydroxylated the C6β position of β-amyrin/oleanolic acid. The genes encoding these 3 CYP716 enzymes are highly expressed in flowers and respond to induction by ABA, MeJA, SA, GA3, and abiotic stress treatments. Using VIGS technology, we revealed that silencing of NaCYP716A419 affects the growth and reproduction of N. attenuata, suggesting the ecological significance of these specialized metabolite biosynthetic steps.
The Global Crisis of Trust in Elections
Authors: Kerr Nicholas , King Bridgett A , Wahman Michael
Published: July 2024

This article introduces a special issue on trust in elections. While the number of electoral democracies has grown globally, we are currently experiencing a crisis of electoral trust. Political polarization, social divisions, and the rapid spread of misinformation have all been related to enhanced widespread skepticism about the quality of national elections. The special issue is focused on two central questions: How can we explain variations in trust in elections at the individual and country levels? How does trust in elections shape political behavior? In the introduction essay, we frame the contributions of the special issue, provide descriptive statistics about trust in elections globally, summarize the current state of the literature, and point to avenues for future research.
Restoring Trust in US Elections through Effective Election Administrator Messaging
Authors: Brown Mitchell , Hale Kathleen , Jordan Soren , Williamson Ryan D
Published: July 2024

During the 2020 election cycle, numerous national, state, and local organizations mounted campaigns designed to counter mis- and disinformation about election activities and to foster public trust in election processes. Local and state election offices focused intently on creating and disseminating accurate messages about when, where, and how to vote. Despite these efforts, trust in the 2020 election remained confoundingly low. This research analyzes this disconnect between messages from election offices and public trust by testing messages collected from election officials around the country using focus groups and a national panel survey experiment. We find that in focus groups, neutral messages that evoke local connections tested better than other types of messages. Further, messenger characteristics influenced whether participants trusted the messages. Using messages based on these findings, we fielded a survey experiment during the 2022 midterm election cycle, finding that the interaction between baseline trust, racial identification, and identification with the messenger moves trust.
Prognostic value of first 24-hour urine output in patients with acute myocardial infarction in intensive care units: a retrospective study based on the MIMIC-IV database
Authors: Bao Lilian , Ge Junbo
Published: July 2024

Purpose

To investigate the effect of first 24-hour (24-h) urine output (UO) on in-hospital and 1-year mortality in patients admitted to intensive care units due to acute myocardial infarction.

Methods

This was a retrospective cohort study based on the medical information mart for intensive care IV database involving patients admitted to intensive care units due to acute myocardial infarction. Patients were classified as low UO (LUO), high UO (HUO), and middle UO with a first 24-h UO below 800 ml, over 2500 ml, or in between, respectively. The primary outcome was in-hospital mortality and the secondary outcome was 1-year mortality.

Results

A total of 4337 patients were involved. Taking middle UO group as reference, after adjusting for confounders including age, gender, height, weight, comorbidity, occurrence of cardiogenic shock, revascularization, blood pressure, creatinine, N-terminal pro-brain natriuretic peptide, and use of loop diuretics, LUO was independently associated with higher in-hospital mortality [odds ratio 4.05, 95% confidence interval (CI): 3.12–5.26], while HUO was an independent protective factor (odds ratio 0.52, 95% CI: 0.35–0.77). In the multivariant Cox regression model, LUO was an independent risk factor for 1-year mortality (hazard ratio 2.65, 95% CI: 2.16–3.26), while HUO did not show significant association.

Conclusion

In patients admitted to intensive care units due to acute myocardial infarction, first 24-h UO <800 ml was a strong predictor for higher in-hospital and 1-year mortality, while first 24-h UO over 2500 ml was associated with lower in-hospital mortality but not long-term mortality.
Should we hate hate speech regulation? The argument from viewpoint discrimination
Authors: Bishop Sebastien
Published: July 2024

According to philosophers like James Weinstein, our democratic values give us a compelling reason to tolerate hate speech. In fact, they argue that even if hate speech causes significant harms, our democratic values nonetheless sometimes call for a hands-off approach. In particular, they evoke the democratic value of citizens being free to criticize and voice dissent towards the laws that bind them. This paper seeks to establish two key points. First, that upon closer examination, the kind of arguments that Weinstein presents against hate speech regulation is less than convincing. Secondly, that by building on Weinstein's discussion of the concept of viewpoint discrimination, we can construct a more convincing objection to hate speech regulation. That said, this more convincing objection falls short of calling for the abolition of all hate speech regulation, instead highlighting the need for transparency and consistency in the way governments regulate harmful speech.
Do Cognitive Subtypes Exist in People at Clinical High Risk for Psychosis? Results From the EU-GEI Study
Authors: Gifford George , Avila Alessia , Kempton Matthew J , Fusar-Poli Paolo , McCutcheon Robert A , Coutts Fiona , Tognin Stefania , Valmaggia Lucia , de Haan Lieuwe , van der Gaag Mark , Nelson Barnaby , Pantelis Christos , Riecher-Rössler Anita , Bressan Rodrigo , Barrantes-Vidal Neus , Krebs Marie-Odile , Glenthøj Birte , Ruhrmann Stephan , Sachs Gabriele , Rutten Bart P F , van Os Jim , EU-GEI High Risk Study  , McGuire Philip
Published: July 2024

Background and Hypothesis

Cognition has been associated with socio-occupational functioning in individuals at Clinical High Risk for Psychosis (CHR-P). The present study hypothesized that clustering CHR-P participants based on cognitive data could reveal clinically meaningful subtypes.

Study Design

A cohort of 291 CHR-P subjects was recruited through the multicentre EU-GEI high-risk study. We explored whether an underlying cluster structure was present in the cognition data. Clustering of cognition data was performed using k-means clustering and density-based spatial clustering of applications with noise. Cognitive subtypes were validated by comparing differences in functioning, psychosis symptoms, transition outcome, and grey matter volume between clusters. Network analysis was used to further examine relationships between cognition scores and clinical symptoms.

Study Results

No underlying cluster structure was found in the cognitive data. K-means clustering produced “spared” and “impaired” cognition clusters similar to those reported in previous studies. However, these clusters were not associated with differences in functioning, symptomatology, outcome, or grey matter volume. Network analysis identified cognition and symptoms/functioning measures that formed separate subnetworks of associations.

Conclusions

Stratifying patients according to cognitive performance has the potential to inform clinical care. However, we did not find evidence of cognitive clusters in this CHR-P sample. We suggest that care needs to be taken in inferring the existence of distinct cognitive subtypes from unsupervised learning studies. Future research in CHR-P samples could explore the existence of cognitive subtypes across a wider range of cognitive domains.
Blouch: Bayesian Linear Ornstein-Uhlenbeck Models for Comparative Hypotheses
Authors: Grabowski Mark
Published: July 2024

Relationships among species in the tree of life can complicate comparative methods and testing adaptive hypotheses. Models based on the Ornstein-Uhlenbeck process permit hypotheses about adaptation to be tested by allowing traits to either evolve toward fixed adaptive optima (e.g., regimes or niches) or track continuously changing optima that can be influenced by other traits. These models allow estimation of the effects of both adaptation and phylogenetic inertia—resistance to adaptation due to any source—on trait evolution, an approach known as the “adaptation-inertia” framework. However, previous applications of this framework, and most approaches suggested to deal with the issue of species non-independence, are based on a maximum likelihood approach, and thus it is difficult to include information based on prior biological knowledge in the analysis, which can affect resulting inferences. Here, I present Blouch, (Bayesian Linear Ornstein-Uhlenbeck Models for Comparative Hypotheses), which fits allometric and adaptive models of continuous trait evolution in a Bayesian framework based on fixed or continuous predictors and incorporates measurement error. I first briefly discuss the models implemented in Blouch, and then the new applications for these models provided by a Bayesian framework. This includes the advantages of assigning biologically meaningful priors when compared to non-Bayesian approaches, allowing for varying effects (intercepts and slopes), and multilevel modeling. Validations on simulated data show good performance in recovering the true evolutionary parameters for all models. To demonstrate the workflow of Blouch on an empirical dataset, I test the hypothesis that the relatively larger antlers of larger-bodied deer are the result of more intense sexual selection that comes along with their tendency to live in larger breeding groups. While results show that larger-bodied deer that live in larger breeding groups have relatively larger antlers, deer living in the smallest groups appear to have a different and steeper scaling pattern of antler size to body size than other groups. These results are contrary to previous findings and may argue that a different type of sexual selection or other selective pressures govern optimum antler size in the smallest breeding groups.
Efficacy of intrauterine device procedural analgesics
Authors: Grossman Kara , McKown Erin , Cushing Rachel
Published: July 2024

Nearly half of all pregnancies worldwide are unintended. Intrauterine devices are an effective, long-acting form of pregnancy prevention that require minimal maintenance, and also can be used in patients with menorrhagia. However, they are underused because of pain associated with their insertion. Topical and local anesthesia are good options for reducing procedural pain in select patients. IUD placement falls within the scope of practice for physician associates/assistants (PAs) practicing in family medicine, internal medicine, and women's health. PAs should be aware of these additional analgesia options available to patients in order to increase use of effective contraception.
Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity
Authors: Bullard Kimberley A. , Ramanadhan Shaalini , Caughey Aaron B. , Rodriguez Maria I.
Published: July 2024

OBJECTIVE:

To estimate the cost effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce future short interpregnancy interval (IPI), severe maternal morbidity (SMM), and preterm birth.

METHODS:

We built a decision analytic model using TreeAge software to compare maternal health and cost outcomes in two settings, one in which immediate postpartum LARC is a covered option and the other where it is not, among a theoretical cohort of 100,000 people with Medicaid insurance who were immediately postpartum and did not have permanent contraception. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost increase per an incremental quality-adjusted life-years (QALY) gained from one health intervention compared with another. Secondary outcomes included subsequent short IPI, defined as time between last delivery and conception of less than 18 months, as well as SMM, preterm birth, overall costs, and QALYs. We performed sensitivity analyses on all costs, probabilities, and utilities.

RESULTS:

Use of immediate postpartum LARC was the cost-effective strategy, with an ICER of −11,880,220,102. Use of immediate postpartum LARC resulted in 299 fewer repeat births overall, 178 fewer births with short IPI, two fewer cases of SMM, and 34 fewer preterm births. Coverage of immediate postpartum LARC resulted in 25 additional QALYs and saved $2,968,796.

CONCLUSION:

Coverage of immediate postpartum LARC at the time of index delivery can improve quality of life and reduce health care costs for Medicaid programs. Expanding coverage to include immediate postpartum LARC can help to achieve optimal IPI and decrease SMM and preterm birth.
Erythroferrone in focus: emerging perspectives in iron metabolism and hematopathologies
Authors: Babar Sadia , Saboor Muhammad
Published: July 2024

Beyond its core role in iron metabolism, erythroferrone (ERFE) has emerged as a key player with far-reaching implications in various hematologic disorders. Its regulatory effect on hepcidin underlines its significance in conditions characterized by disrupted iron homeostasis. In β-thalassemia and myelodysplastic syndromes, its dysregulation intricately contributes to the clinical challenges of anemia and iron overload which highlights its potential as a therapeutic target. In anemia of chronic disease and iron deficiency anemia, ERFE presents a unique profile. In chronic kidney disease (CKD), the intricate interplay between ERFE, erythropoietin, and hepcidin undergoes dysregulation, contributing to the complex iron imbalance characteristic of this condition. Recent research suggests that ERFE plays a multifaceted role in restoring iron balance in CKD, beyond simply suppressing hepcidin production. The potential to modulate ERFE activity offers a novel approach to treating a spectrum of disorders associated with iron dysregulation. As our understanding of ERFE continues to evolve, it is poised to become a key focus in the development of targeted treatments, making it an exciting and dynamic area of ongoing research. Modulating ERFE activity presents a groundbreaking approach to treat iron dysregulation in conditions like iron deficiency anemia, thalassemia, and hemochromatosis. As new research unveils its intricate roles, ERFE has rapidly emerged as a key target for developing targeted therapies like ERFE agonists and antagonists. With promising studies underway, this dynamic field holds immense potential to improve patient outcomes, reduce complications, and offer personalized treatment options in hematology research. This comprehensive overview of ERFE’s role across various conditions underscores its pivotal function in iron metabolism and associated pathologies.
Clinical effect of individualized 3D printing guide assisted placement of upper cervical pedicle screw
Authors: Niu Guoqi , Li Chao , Zhou Gong , Chen Hui , Nie Hu , Liu Tao , Jiang Weili , Cheng Jiawei , Liu Lutan , Zhu Jun , Yu Ruochen , Yang Yi , Mo Tiande , Bai Jianzhong
Published: July 2024

Background:

The upper cervical vertebrae are adjacent to important anatomical structures, with high variability and thin pedicle, leading to difficulties in screw placement. We investigate the clinical effect of individualized 3D printing guide assisted upper cervical pedicle screw placement.

Methods:

Eighteen patients with upper cervical spine injury requiring surgical treatment were included in our hospital from May 2010 to May 2020. These patients were divided into the guide plate assisted screw implantation group ([guide plate assisted screw implantation group] Group A, N = 10) and the traditional operation group (traditional operation group [Group B], N = 8). All patients were followed up for more than 2 years. Screw implant accuracy, cervical spine Japanese orthopaedic association (JOA) score, Ameri can Spinal Injury Association (ASIA) score, visual analogue scale (VAS) score, operation time, and intraoperative blood loss were compared between the two groups.

Results:

A total of 72 atlantoaxial pedicle screws were implanted, 40 in group A and 32 in group B. The accuracy rate of screw implantation was 97.50% in group A and 81.25% in group B (P < 0.05). The operation time in group A (189.7 ± 16.1 mins) and group B (242.1 ± 23.2 mins), P < 0.05. The intraoperative blood loss in group A (216.0 ± 49.7 mL) and group B (385.0 ± 23.5 mL), P < 0.05. The intraoperative fluoroscopic times were 8.7 ± 1.1 in group A and 30.0 ± 3.3 in group B (P < 0.05). One week after operation, the JOA, Asia and VAS scores of group A were significantly better than those of group B, but there was no significant difference between the two groups at the last follow-up.

Conclusion:

Individualized 3D printing guide assisted placement of upper cervical pedicle screws can significantly improve the accuracy of screw implantation and postoperative function of patients, and reduce the times of X-ray fluoroscopy, operation time, and intraoperative blood loss, which is a safe and effective approach and worthy of clinical promotion.
The atlas for human brain research
Authors: Liu Chengxin , Yao Yuan , Tang Yuchun
Published: July 2024

The human brain atlas has recently become an essential tool for exploring the structure and function of the human brain. It serves as the primary platform for analyzing and processing both structural and functional brain information. The atlas plays a vital role in interpreting computational results, visualizing information, and processing data. Additionally, it is a crucial component of brain research programs. This review provides a brief history of brain atlas development and an overview of the current state-of-the-art in brain atlases. The applications, principles, and benefits of brain atlases are also discussed. Brain atlases can be classified into five types, including: (1) Brain atlases based on sectional specimens. (2) Visual brain atlases based on digital human technology. (3) Probabilistic brain atlases based on in vivo imaging data. (4) Brain atlases at the histological and gene level. (5) Brainnetome atlases. In this review, future directions for the development of brain atlas in developmental neuroscience and their potential clinical applications are proposed.
Overt Scientific Bias and Clandestine Acts by Trusted Scientists: The Flawed Application of the Linear No-threshold Model
Authors: Cardarelli John J.
Published: July 2024

The Health Physics Society (HPS) released a video documentary on the history of the linear no-threshold (LNT) model in April 2022. It exposed many scientific and ethical failings of many leaders, influential scientists, and organizations that have resulted in the current system of radiological protection. Since then, the society received many comments; most were supportive, while a few criticized the video documentary as delivering an anti-LNT message. Shortly thereafter, many emails discovered via an independent Freedom of Information Act request revealed multiple layers of coordination between prominent people in the field of radiation protection to coopt the leadership within the HPS and suppress information they perceived or assumed to be contrary to a pro-LNT message. Many of these emails were published by JunkScience.com, an independent organization that exposes faulty scientific data and analyses used to advance special interests and hidden agendas. This Forum article is intended to document in the peer-reviewed literature the JunkScience.com findings of clandestine acts by trusted scientists within the radiation protection community. The emails exposed strong personal biases, actions taken by leaders within the National Commission on Radiation Protection and Measurements (NCRP) to “save the Society” from its “downward spiral,” and actions taken by NCRP and HPS members serving on a National Academies of Sciences committee to suppress scientific information relevant to the debate about health effects in low-dose environments. These anti-science actions harm our entire profession and the trust that Congress bestows on our scientific organizations expecting to receive objective recommendations based on sound science. It is important that these events are recorded in the scientific literature from a historical perspective. The radiation protection community will be judged not by what is revealed in this article but by what actions are taken from here.
Indoor Radon Concentrations in Severe Cold Area and Cold Area and Impact of Energy-saving Design on Indoor Radon in China
Authors: Wu Yunyun , Song Yanchao , Hou Changsong , Cui Hongxing , Shang Bing , Sun Haoran
Published: July 2024

This study investigated indoor radon concentrations in modern residential buildings in the Cold Area and Severe Cold Area in China. A total of 19 cities covering 16 provinces were selected with 1,610 dwellings measured for indoor radon concentration. The arithmetic mean and geometric mean of indoor radon concentration were 68 Bq m−3 and 57 Bq m−3, respectively. It was found that indoor radon concentrations were much higher in the Severe Cold Area than those in the Cold Area. The indoor radon concentrations showed an increasing trend for newly constructed buildings. It was estimated that the average effective dose from inhalation of indoor radon is 2.15 mSv and 1.60 mSv for the Severe Cold Area and Cold Area, respectively. The more and more rigid energy-saving design for residential buildings in the Severe Cold Area and Cold Area has an obvious impact on the increased trend of indoor radon due to extremely low air exchange rate in China.
Process Evaluation of a Work Stress Prevention Approach in Primary Education
Authors: Bakhuys Roozeboom Maartje C. , Niks Irene M.W. , van Zwieten Marianne H.J. , Wiezer Noortje M. , Boot Cécile R.L. , Schelvis Roosmarijn M.C.
Published: July 2024

Objective

Participatory organizational-level interventions carry a risk of implementation failure. The current study evaluates the implementation of a work stress prevention approach in primary education and reflects on the use of real-time feedback as implementation strategy to prevent this risk.

Methods

The process evaluation was conducted at four primary schools in the Netherlands. A framework for evaluating organizational-level interventions was applied using mixed methods.

Results

Results show the implementation level varied between schools and was hindered by the intervention context, school size, and planning of the approach. Management commitment and employee involvement seemed important factors for successful implementation. Real-time feedback seemed valuable to further improve implementation, but not to prevent implementation failure.

Conclusions

Collecting data on implementation factors before the active phase of the approach, may provide the possibility to anticipate on implementation problems earlier.
Outcome of treatment modalities for spontaneous esophageal rupture: a meta-analysis and case series
Authors: Pan Jiajian , Ge Yong , Feng Tianci , Zheng Chengwen , Zhang Xueqiu , Feng Shoujie , Sun Teng , Zhao Feng , Sha Zhengbu , Zhang Hao
Published: July 2024

Background:

Current treatment modalities for spontaneous esophageal perforation remain controversial because of their rarity.

Objective:

To describe our institution’s experience in managing patients with spontaneous esophageal rupture and conduct a meta-analysis of existing studies to determine the best evidence-based treatment options.

Methods:

The authors enrolled patients with spontaneous esophageal rupture who underwent their first treatment at our institution. The authors also identified studies through a systematic search of the MEDLINE, EMBASE, and Cochrane Library databases before 1 April 2024, for inclusion in the meta-analysis.

Results:

This case series included data from 17 patients with delayed diagnosis who were treated with esophageal stents, with an immediate mortality rate of 5.9%. In addition to the cases from our institution, the authors obtained 944 patients from 46 studies in the final analysis. The combined immediate mortality rate was 11% (95% CI: 0.08–0.15). The combined reintervention rate was 11% (95% CI: 0.05–0.19). The combined immediate mortality was 6% (95% CI: 0.04–0.09) after primary closure, 14% (95% CI: 0.02–0.32) after T-tube drain repair, 2% (95% CI: 0.00–0.15) after esophagectomy, 8% (95% CI: 0.03–0.15) after stent placement, and 22% (95% CI: 0.03–0.47) after conservative treatment. The subgroup analysis based on the timing of the intervention showed that the immediate mortality rate in patients initiating treatment within 24 h of rupture was 3% (95% CI: 0.01–0.08), whereas that in patients initiating treatment >24 h later was 12% (95% CI: 0.08–0.18).

Conclusion:

Outcomes are best after esophagectomy, and primary closure or esophageal stenting is a good option compared with other treatment modalities. Prognosis is related to the timing of intervention, and accurate diagnosis and treatment within 24 h significantly reduces the risk of death in patients. Patients with delayed diagnosis may have a better prognosis with stent placement.
Metabolic syndrome and cancer risk: a two-sample Mendelian randomization study of European ancestry
Authors: Zhou Lin , Gao Huiyu , Zhang Jiabin , Xu Qian , Wang Qiang , Wang Li , Tan Ying , Luo Ziyuan , Zhou Junjie , Shuai Hui , Cai Xiang , Zheng Yongbo , Wang Shan , Duan Xi , Wu Tao
Published: July 2024

Background:

The relationship between Metabolic Syndrome and cancer remains controversial. The authors aimed to assess the association between Metabolic Syndrome and cancer risk at different locations using a Mendelian randomization approach.

Methods:

The authors extracted single nucleotide polymorphisms (SNPs) of MetS and its components from public databases for populations of European ancestry. Causal effects were estimated using inverse variance weighting, MR-Egger, weighted median, and MR-PRESSO. Sensitivity analyses were performed using Cochran’s Q test, MR-Egger intercept test, MR-PRESSO, leave-one-out analysis, and funnel plots. In addition, the authors calculated the Statistical power. Finally, the authors applied the False Discovery Rate (FDR) to correct our results.

Results:

IVW methods showed that Genetically predicted Metabolic Syndrome may be a potential risk factor for hepatocellular carcinoma (P=0.031, P-FDR=0.093). Metabolic Syndrome was not causally associated with cancers at other sites (lung, thyroid, breast, prostate, kidney, bladder, colorectal, esophagus, and stomach). In further analyses, WC may increase the risk of lung (P=0.003, P-FDR=0.018), and esophageal (P=0.011, P-FDR=0.066) cancers and decrease the risk of prostate cancer (P=0.006, P-FDR=0.001). Furthermore, hypertension may reduce the risk of Hepatic cancer (P=0.014, P-FDR=0.084).

Conclusion:

Our study suggests that genetically predicted Metabolic Syndrome may increase the risk of some cancers. Prevention and treatment of Metabolic Syndrome may help to prevent the development of related cancers.
The use of artificial intelligence for graduate nursing education: An educational evaluation
Authors: Bumbach Michael D. , Carrington Jane M. , Love Rene , Bjarnadottir Ragnhildur , Cho Hwayoung , Keenan Gail
Published: July 2024

With artificial intelligence (AI) rapidly advancing, advanced practice nurses must understand and use it responsibly. Here, we describe an assignment in which Doctor of Nursing Practice (DNP) students learned to use generative text AI. Using our program and course outcomes, developed from the 2021 American Association of Colleges of Nursing (AACN) Essentials competency for DNP students to learn and use AI, we reviewed the literature seeking examples using ChatGPT for the DNP informatics course. No published examples existed to guide us toward infusing a ChatGPT assignment into the course. We developed a novel assignment that included a guide for students on how to use ChatGPT. Students were given time before the assignment to learn the AI/chatbot technology. They were then given the assignment and grading rubric. The assignment was to develop a tool for their current or future practice using ChatGPT. During the course faculty debrief, we learned that few students had questions and the assignment was clear. We also learned that students who sought to develop straightforward, uncomplicated patient tools succeeded with the technology. Those who sought to create something for complex patients had more challenges. Nursing education and practice will be influenced by the increasing prevalence of AI. This manuscript outlines an AI-based assignment for graduate nursing education intended for the students to become familiar with current AI and best practices for patient care. The assignment was well received by students. We plan to use it again in the next course offering.
Toward a Diagnostic Imaging Algorithm for Undifferentiated Pulsatile Tinnitus
Authors: Cavarocchi Caitlin , Wong Kevin , Cao Austin C. , Hwa Tiffany P. , Quimby Alexandra E. , Eliades Steven J. , Ruckenstein Michael J. , Bigelow Douglas C. , Choudhri Omar A. , Brant Jason A.
Published: July 2024

Objective

Decisions around the diagnostic evaluation for pulsatile tinnitus (PT) remain challenging. We describe the usage patterns and diagnostic accuracy of imaging modalities and propose an evidence-based diagnostic approach for undifferentiated PT.

Study Design

Retrospective.

Setting

Single otology/neurotology clinic.

Subjects

Patients with PT presenting between 2009 and 2020.

Main Outcome Measures

Sensitivity, specificity, diagnostic yield, and diagnostic accuracy.

Results

A total of 315 subjects met inclusion criteria (74% female, mean ± SD age = 52 ± 17 years). Subjects were divided into four cohorts based on exam findings: normal (n = 229), venous cohort (n = 34), arterial cohort (n = 16), and outer/middle ear pathology cohort (n = 40). In total, 53% of patients received a nonidiopathic diagnosis for PT. The most common identifiable cause was sigmoid sinus dehiscence (78%) in the venous cohort, carotid stenosis (36%) in the arterial cohort, and glomus tumor (56%) in the outer/middle ear pathology cohort. There was a higher diagnostic rate among patients with positive exam findings compared to those with unrevealing exams (p = 0.04). Imaging studies with the highest diagnostic yield were computed tomography (CT) venography (44%), formal angiography (42%), and magnetic resonance venography (40%); studies with the highest specificity were formal angiography (0.82), CT angiography (0.67), and CT venography (0.67). A diagnostic algorithm is proposed.

Conclusions

Reaching a diagnosis in patients with PT requires a systematic approach, taking into account both clinical and radiographic information. Physical examination is a key first step for differentiating patients into venous, arterial, and other cohorts to narrow down the likely pathology and determine which radiographic studies have the highest yield and accuracy.
Prevalence of HIV-related stigma among people with HIV in Switzerland: addressing the elephant in the room
Authors: Kampouri Eleftheria , Damas José , Kusejko Katharina , Ledergerber Bruno , Braun Dominique , Nawej Tshikung Olivier , Hachfeld Anna , Weisser Maja , Wissel Kerstin , Bernasconi Enos , Cobos Manuel Isabel , Jackson-Perry David , Eriksson Lars E. , Reinius Maria , Cavassini Matthias , Darling Katharine E.A. ,   and the Swiss HIV Cohort Study (SHCS)
Published: July 2024

Objectives:

We aimed to determine the prevalence of HIV-related stigma among people with HIV (PWH) in Switzerland

Design:

A cross-sectional multicenter study nested within the Swiss HIV Cohort Study (SHCS).

Methods:

We included adult PWH enrolled in the SHCS, attending follow-up between March 1, 2020, and January 31, 2021. Inability to speak English, French, German, or Italian was the only exclusion criterion. Participants were invited to complete a validated 12-item HIV-stigma questionnaire comprising four stigma subscales (negative self-image, personalized stigma, disclosure concerns, and concerns regarding public attitudes), plus two healthcare-related stigma items. Questionnaire responses were graded using a four-point Likert-type scale, higher scores indicating higher stigma. “Non-applicable,” inferring HIV-status non-disclosure, was possible for personalized stigma; stigma scores from participants answering “non-applicable” to at least one item were analyzed separately. Factors associated with HIV-stigma were identified through multivariable linear models.

Results:

Of 9643 PWH with a SHCS visit, 5563 participated in the study: 26% were female, 13% Black, and 37% heterosexual; median age was 53 years (interquartile range 44–59); 2067 participants (37%) gave at least one “non-applicable” response. Disclosure concerns had the highest stigma scores and were reported by 4656/5563 (84%). HIV-stigma was reported across all demographic groups. However, being female, Black, and heterosexual were independently associated with higher scores. Higher education and longer follow-up duration were associated with lower scores. Healthcare-related stigma was reported in 37% of participants.

Conclusion:

HIV-stigma was prevalent across all demographic groups. The association with being female and Black suggests that HIV-stigma accentuates preexisting sex and race inequalities.
A 20-year retrospective analysis of deep venous thrombosis and pulmonary embolism among combat casualties requiring damage-control laparotomy at US military Role 2 surgical units
Authors: Cobler-Lichter Michael D. , Collie Brianna L. , Delamater Jessica M. , Shagabayeva Larisa , Lyons Nicole B. , Bustillos Luciana Tito , Namias Nicholas , Stallings Jonathan D. , Gross Kirby R. , Buzzelli Mark D. , Gurney Jennifer , Proctor Kenneth G. , Wetstein Paul J.
Published: July 2024

BACKGROUND

Combat casualties receiving damage-control laparotomy at forward deployed, resource-constrained US military Role 2 (R2) surgical units require multiple evacuations, but the added risk of venous thromboembolism (VTE) in this population has not been defined. To fill this gap, we retrospectively analyzed 20 years of Department of Defense Trauma Registry data to define the VTE rate in this population.

METHODS

Department of Defense Trauma Registry from 2002 to 2023 was queried for US military combat casualties requiring damage-control laparotomy at R2. All deaths were excluded in subsequent analysis. Rates of VTE were assessed, and subgroup analysis was performed on patients requiring massive transfusion.

RESULTS

Department of Defense Trauma Registry (n = 288) patients were young (mean age, 25 years) and predominantly male (98%) with severe (mean Injury Severity Score, 26), mostly penetrating injury (76%) and high mortality. Venous thromboembolism rate was high: 15.8% (DVT, 10.3%; pulmonary embolism, 7.1%). In the massively transfused population, the VTE rate was even higher (26.7% vs. 10.2%, p < 0.001).

CONCLUSION

This is the first report that combat casualties requiring damage-control laparotomy at R2 have such high VTE rates. Therefore, for military casualties, we propose screening ultrasound upon arrival to each subsequent capable echelon of care and low threshold for initiating thromboprophylaxis.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.