bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnicity and New Issues
Authors: Rovny Jan
Published: June 2024

This empirical chapter investigates how ethnicity influences responses to new political issues. Using diverse quantitative data, the chapter explores the significant impact of ethnic minority views on shaping general ideological tendencies for both minorities and majorities, influencing individual and political parties’ stances on related issues, such as immigration and European integration. By analyzing individual and party perspectives, the chapter shows that attitudes toward immigration and European integration are closely linked with views of ‘otherness,’ generally developed in the context of how one sees ethnic minorities. The chapter further delves into how ethnic heterogeneity shapes the formation of political preferences of majority populations, showcasing the influence of ethnic minority presence on individual-level political views across ethnically homogenous and heterogeneous countries in the region.
Ethnicity and Democratic Resilience
Authors: Rovny Jan
Published: June 2024

The chapter investigates the role of ethnic politics in shaping the democratic outcomes of eastern European countries, both in the context of democratic transition in the 1990s, and amidst recent challenges to liberal democratic norms and democratic backsliding. It demonstrates how politically mobilized ethnic minorities contribute to democratic outcomes, with their presence shaping the resilience of democratic institutions and practices. Using experimental as well as observational quantitative evidence, the chapter shows how ethnic minorities and their representatives reinforce the liberal side of politics, countering the influence of illiberal parties that typically spearhead democratic regression. A survey experiment among ethnic minority respondents in Estonia and Slovakia demonstrates the causal effect of ethnic minority status on democratic preferences. Observational evidence underlines the role of ethnic representation in democratic politics. In heterogeneous societies where ethnic minorities are politically relevant, their involvement impedes the monopolistic dominance of illiberal forces, safeguarding democratic institutions. Ultimately, the chapter demonstrates that the electoral success and government participation of ethnic minority parties contribute to reinforcing liberal democracy in the region.
Permanent or Provisional? The Sudeten Germans
Authors: Rovny Jan
Published: June 2024

This chapter provides a case study of the German minority in interwar Czechoslovakia, studying the positions of German political representatives from 1920 to 1938. Using historical sources as well as quantitative analyses of all parliamentary speeches of German representatives, the chapter highlights two central arguments. First, it emphasizes the significance of the Germans’ status as a provisional versus permanent ethnic minority. In doing so, the chapter underscores the circumstantial nature of ethnic minority liberalism. It shows the centrality of perceived permanence of ethnic minority status, which determines political strategies. Second, the chapter underscores the role of interethnic cooperation. It demonstrates the systemic benefits of cooperative endeavors between moderate minority and majority representatives as a driving force for ethnic liberalism, particularly in the pursuit of shared non-ethnic political goals, promoting democratic cooperation in the face of extremist threats. The chapter reveals how, during the early days of the Czechoslovak state, the Sudeten German minority hesitated as a provisional minority, inclined toward association with Austria. However, as the state solidified and their minority status became permanent, their pursuit shifted toward establishing peaceful relations with the ethnic majority. Despite the onset of the Great Depression, cooperation between Czechs and Germans thrived, but collapsed with the rise of Nazism, leading to the breakdown of Czech-German collaboration due to Hitler’s policy of offering Sudeten Germans an exit from minority status. The chapter maintains a nuanced perspective on the Sudeten Germans, acknowledging the diversity among their elites’ affiliations, encompassing both committed Nazis and dedicated anti-Nazi activists.
Major Minority: The Estonian Russians
Authors: Rovny Jan
Published: June 2024

This chapter studies the important Russian-speaking minority in Estonia. Using an original individual-level survey that over-samples the Russian-speaking minority, as well as a large number of interviews with key politicians, civil servants, and academics, the chapter explores how ethnic identity influences the political preferences of Estonian Russian speakers, and examines the representation of this group in Estonian politics. Tracing the emergence of political elites among the Russian-speaking community, the chapter assesses their views and actions, and the formation of their political strategies. The chapter highlights the specific views of Estonian Russian speakers, and how they are influenced by generational and other factors. Furthermore, the chapter sheds light on the translation of these preferences into the political sphere by partisan actors, addressing the strategic cooptation of ethnic minority elites into majority parties. The chapter illuminates the delicate balance between preserving Russian language and culture while fostering constructive cooperation with Estonian peers. The chapter offers insights into the historical context of Estonian–Russian relations, and the re-establishment of Estonian independence. It highlights the role of ethnic minority politics in shaping political preferences, representation, and democracy in the Baltic country.
Comparison between computer recognition and manual measurement methods for the estimation of leaf area
Authors: Mu Youying , He Ke , Shi Peijian , Wang Lin , Deng Linli , Shi Zhuyue , Liu Mengdi , Niklas Karl J
Published: June 2024

Background and Aims

Leaf area (A) is a crucial indicator of the photosynthetic capacity of plants. The Montgomery equation (ME), which hypothesizes that A is proportional to the product of leaf length (L) and width (W), is a valid tool for non-destructively measuring A for many broadleaved plants. At present, the methods used to compute L and W for the ME can be broadly divided into two kinds: using computer recognition and measuring manually. However, the potential difference in the prediction accuracy using either method has not been thoroughly examined in previous studies.

Methods

In the present study, we measured 540 Alangium chinense leaves, 489 Liquidambar formosana leaves and 215 Liriodendron × sinoamericanum leaves, utilizing computer recognition and manual measurement methods to determine L and W. The ME was used to fit the data determined by the two methods, and the goodness of fits were compared. The prediction errors of A were analysed by examining the correlations with two leaf symmetry indices (areal ratio of the left side to the right side, and standardized index for bilateral asymmetry), as well as the leaf shape complexity index (the leaf dissection index).

Key Results

The results indicate that there is a neglectable difference in the estimation of A between the two methods. This further validates that the ME is an effective method for estimating A in broadleaved tree species, including those with lobes. Additionally, leaf shape complexity significantly influenced the estimation of A.

Conclusions

These results show that the use of computer recognition and manual measurement in the field are both effective and feasible, although the influence of leaf shape complexity should be considered when applying the ME to estimate A in the future.
Effect of 4 hydroxy fatty acids on lipid accumulation in the 3T3-L1 cells: a comparative study
Authors: Kaji Nanaka , Omae Tsubasa , Matsuzaki Hidenori , Yamamoto Yukihiro
Published: June 2024

Notwithstanding the several investigations of the hydroxy fatty acids (hFAs)’ physiological functions, studies focusing on their anti-obesity effects are limited. This study investigated the anti-obesity effects of 4 hFAs—10-hydroxy stearic acid (10-hSA), 12-hydroxy stearic acid (12-hSA), 9,12-hydroxy stearic acid (9,12-dhSA), and 12-hydroxy oleic acid (12-hOA)—on the 3T3-L1 cells. All hFAs suppressed lipid accumulation, with 10-hSA and 12-hOA exhibiting the strongest suppression, followed by 12-hSA and 9,12-hSA. This trend was similar to that observed for the glycerol-3-phosphate dehydrogenase (GPDH) activity level. Contrastingly, only 9,12-dhSA suppressed cell viability. The mRNA levels of HK1 and Aldoa were markedly suppressed by 10-hSA and 12-hSA compared to the control. Additionally, mRNA expression of Gyk was considerably suppressed by 12-hSA. Thus, all hFAs suppressed lipid accumulation by suppressing GPDH activity, although their molecular mechanisms were different. These findings will aid the application of hFAs in the food and medical industries.
Exposure to humans and task difficulty levels affect wild raccoons (Procyon lotor) learning
Authors: Lazure Louis , Weladji Robert B
Published: June 2024

Cognition helps wildlife exploit novel resources and environments. Raccoons (Procyon lotor) have successfully adapted to human presence, in part due to their cognitive abilities. However, interactions between humans and wildlife can create conflict. A better understanding of the raccoon’s behavioral flexibility and learning ability could mitigate some conflicts. Our objective was to evaluate wild raccoons learning in contexts varying in terms of exposure to humans (recreational and preservation zoning within protected areas) and task difficulty. Learning can be evaluated over multiple exposures to a cognitive task. Across three years of experiment, we employed 2 food extraction tasks to gauge the change in problem-solving performance over trials. This assessment considered the success probability (the number of successful trials divided by the total number of trials) and the time taken to solve the puzzles. We also looked at the effects of 2 behavioral traits, exploratory diversity and persistence. We found strong evidence for learning over consecutive trials in terms of improved success probability. Improvement in terms of success probability and solving time was more pronounced with the initially easier task. We detected an increase in success probability over trials only in the recreation zones, and there was no evidence of an effect of behavioral traits. The improved performance attributed to learning was also maintained over consecutive years. We provide additional evidence that raccoons can learn how to solve a problem, resulting in a more effective solution in consecutive trials. Finally, we consider the management implications of dealing with raccoons accessing anthropogenic resources.
Effect of synthetic CT on dose-derived toxicity predictors for MR-only prostate radiotherapy
Authors: Thomas Christopher , Dregely Isabel , Oksuz Ilkay , Guerrero Urbano Teresa , Greener Tony , King Andrew P , Barrington Sally F
Published: June 2024

Objectives

Toxicity-driven adaptive radiotherapy (RT) is enhanced by the superior soft tissue contrast of magnetic resonance (MR) imaging compared with conventional computed tomography (CT). However, in an MR-only RT pathway synthetic CTs (sCT) are required for dose calculation. This study evaluates 3 sCT approaches for accurate rectal toxicity prediction in prostate RT.

Methods

Thirty-six patients had MR (T2-weighted acquisition optimized for anatomical delineation, and T1-Dixon) with same day standard-of-care planning CT for prostate RT. Multiple sCT were created per patient using bulk density (BD), tissue stratification (TS, from T1-Dixon) and deep-learning (DL) artificial intelligence (AI) (from T2-weighted) approaches for dose distribution calculation and creation of rectal dose volume histograms (DVH) and dose surface maps (DSM) to assess grade-2 (G2) rectal bleeding risk.

Results

Maximum absolute errors using sCT for DVH-based G2 rectal bleeding risk (risk range 1.6% to 6.1%) were 0.6% (BD), 0.3% (TS) and 0.1% (DL). DSM-derived risk prediction errors followed a similar pattern. DL sCT has voxel-wise density generated from T2-weighted MR and improved accuracy for both risk-prediction methods.

Conclusions

DL improves dosimetric and predicted risk calculation accuracy. Both TS and DL methods are clinically suitable for sCT generation in toxicity-guided RT, however, DL offers increased accuracy and offers efficiencies by removing the need for T1-Dixon MR.

Advances in knowledge

This study demonstrates novel insights regarding the effect of sCT on predictive toxicity metrics, demonstrating clear accuracy improvement with increased sCT resolution. Accuracy of toxicity calculation in MR-only RT should be assessed for all treatment sites where dose to critical structures will guide adaptive-RT strategies.

Clinical trial registration number

Patient data were taken from an ethically approved (UK Health Research Authority) clinical trial run at Guy’s and St Thomas’ NHS Foundation Trust. Study Name: MR-simulation in Radiotherapy for Prostate Cancer. ClinicalTrials.gov Identifier: NCT03238170.
Statin use and risk of Parkinson’s disease among older adults in Japan: a nested case–control study using the Longevity Improvement and Fair Evidence study
Authors: Ge Sanyu , Zha Ling , Kimura Yasuyoshi , Shimomura Yoshimitsu , Komatsu Masayo , Gon Yasufumi , Komukai Sho , Murata Fumiko , Maeda Megumi , Kiyohara Kosuke , Sobue Tomotaka , Kitamura Tetsuhisa , Fukuda Haruhisa
Published: June 2024

The association between statin use and the risk of Parkinson’s disease remains inconclusive, particularly in Japan’s super-ageing society. This study aimed to investigate the potential association between statin use and the risk of Parkinson’s disease among Japanese participants aged ≥65 years. We used data from the Longevity Improvement and Fair Evidence Study, which included medical and long-term care claim data from April 2014 to December 2020 across 17 municipalities. Using a nested case–control design, we matched one case to five controls based on age, sex, municipality and cohort entry year. A conditional logistic regression model was used to estimate the odds ratios with 95% confidence intervals. Among the 56 186 participants (9397 cases and 46 789 controls), 53.6% were women. The inverse association between statin use and Parkinson’s disease risk was significant after adjusting for multiple variables (odds ratio: 0.61; 95% confidence interval: 0.56–0.66). Compared with non-users, the dose analysis revealed varying odds ratios: 1.30 (1.12–1.52) for 1–30 total standard daily doses, 0.77 (0.64–0.92) for 31–90 total standard daily doses, 0.62 (0.52–0.75) for 91–180 total standard daily doses and 0.30 (0.25–0.35) for >180 total standard daily doses. Statin use among older Japanese adults was associated with a decreased risk of Parkinson’s disease. Notably, lower cumulative statin doses were associated with an elevated risk of Parkinson’s disease, whereas higher cumulative doses exhibited protective effects against Parkinson’s disease development.
Post-synthetic modification of near-infrared absorbing cyclodextrin-encapsulated cyanine dyes for controlling absorption wavelength, stability, and singlet oxygen generation
Authors: Zhang Huimin , Masui Yoichi , Masai Hiroshi , Terao Jun
Published: June 2024

In this study, near-infrared absorbing rotaxane-type cyanine dyes exhibit high tolerance to various chemical reactions, which is attributed to the encapsulation effect of their cyclic molecules. As a result, rotaxane dyes can be post-modified on the host α-cyclodextrin or guest cyanine skeleton to adjust their solubility, absorption wavelength, stability, and singlet oxygen generation ability. The guest modification product obtained via the Heck reaction demonstrates a red shift of its absorption wavelength owing to the extended conjugation system. Moreover, the products of host modification through the methylation and benzylation of all cyclodextrin hydroxyl groups not only become lipophilic and show extended absorption, but also exhibit higher photooxidation tolerance, lower singlet oxygen generation rate, and increased singlet oxygen tolerance, indicating their potential applicability as highly durable dyes. Furthermore, the outstanding singlet oxygen tolerance of these dyes enables their use in long-life singlet oxygen generators, in which the total amount of singlet oxygen increases. This work demonstrates that an intrinsically unstable near-infrared cyanine dye can be used as a synthetic intermediate by stabilizing it via α-cyclodextrin encapsulation, allowing the post-modification of various properties of cyanine dyes toward the higher-order near-infrared-absorbing materials with complex functionalities and diverse utilities.
Distinguishing the transitions of fluorescence spectra of tryptophan-134 and 213 in BSA induced by bindings of UV filters, oxybenzone-3, and avobenzone
Authors: Minamide Megumi , Tsurushima Minori , Koga Ryotaro , Hasegawa Kanji , Kurosawa Yuya , Tsuchida Tomohiro , Goto Satoru
Published: June 2024

Oxybenzone-3 (OBZ) and avobenzone (ABZ), commercially available ultraviolet-light filters for sunscreens, are known to induce photosensitizing allergy as an adverse effect, similar to an analgesic ketoprofen (KTP) due to their benzophenone moiety. The present study focused on OBZ and ABZ's protein binding compared to the related analgesics, KTP, diclofenac (DCF), and ibuprofen (IBP). The bovine serum albumin (BSA) was used as a protein model, measuring the fluorescent spectral peak shifts (i) and Stern–Volmer analysis (i) of its intrinsic tryptophans. Moreover, their adsorption types (iii) were verified using the singular value decomposition (SVD) computation of fluorescence spectra. For (i), (ii), and (iii), KTP and DCF caused a no-shift peak, an ordinary dynamic quenching, and a simple Langmuir adsorption. We found OBZ exhibiting (i) red-shift and (ii) including static quenching, ABZ suggesting (i) blue-shift and (iii) binding to multiple bind sites, and IBP indicating (i) blue-shift and (iii) multivalent bindings. Integrating the results, it can be understood that OBZ interacts with subdomain IA (around W134) in BSA, while ABZ interacts with subdomain IIA (around W213) in BSA. Moreover, IBP is bound to BSA with a cooperative effect, certified by Hill's plot. OBZ and ABZ had their individual binding sites on a protein, suggesting the exchange between OBZ and ABZ might reduce their own adverse effect. The present study verified the effectiveness of the SVD computation in distinguishing the details of the adsorption manner of ligands around the intrinsic fluorescent probes.
Photocatalytic water splitting over K6M10.8O30 (M = Ta, Nb) with a partially filled tetragonal tungsten bronze structure
Authors: Moriya Misa , Kato Hideki , Iwase Akihide
Published: June 2024

K6M10.8O30 (M = Ta, Nb) with partially filled C sites in a tetragonal tungsten bronze structure represented as the general formula (A1)4(A2)2C4M10O30 shows photocatalytic activity for water splitting under UV light irradiation upon loading with suitable cocatalysts. An apparent quantum yield of the optimized NiO(0.2 wt%)-loaded K6Ta10.8O30 for water splitting is 13% at 248 nm.
Prognostic value of aortic valve calcification in non-severe aortic stenosis with preserved ejection fraction
Authors: Ye Zi , Scott Christopher G , Gajjar Rohan A , Foley Thomas , Clavel Marie-Annick , Nkomo Vuyisile T , Luis S Allen , Miranda William R , Padang Ratnasari , Pislaru Sorin V , Enriquez-Sarano Maurice , Michelena Hector I
Published: June 2024

Aims

Aortic valve calcification (AVC) is prognostic in patients with aortic stenosis (AS). We assessed the AVC prognostic value in non-severe AS patients.

Methods and results

We conducted a retrospective study of 395 patients with non-severe AS, LVEF ≥ 50%. The Agatston method was used for CT AVC assessment. The log-rank test determined the best AVC cut-offs for survival under medical surveillance: 1185  arbitrary unit (AU) in men and 850 AU in women, lower than the established cut-offs for severe AS (2064 AU in men and 1274 AU in women). Patients were divided into 3 AVC groups based on these cut-offs: low (<1185 AU in men and <850 AU in women), sub-severe (1185–2064 AU in men and 850–1274 AU in women), and severe (>2064 AU in men and >1274 AU in women). Of 395 patients (mean age 73 ± 12 years, 60.5% men, aortic valve area 1.23 ± 0.30 cm2, mean pressure gradient 28 ± 8 mmHg), 218 underwent aortic valve intervention (AVI) and 158 deaths occurred during follow-up, 82 before AVI. Median survival time under medical surveillance was 2.1 (0.7–4.9) years. Compared with the low AVC group, both sub-severe and severe AVC groups had higher risk for all-cause death under medical surveillance after comprehensive adjustment including echocardiographic AS severity and coronary artery calcium score (all P ≤ 0.006); while mortality risk was similar between sub-severe and severe AVC groups (all P ≥ 0.2). This mortality risk pattern persisted in the overall survival analysis after adjustment for AVI. AVI was protective of all-cause death in the sub-severe and severe AVC (all P ≤ 0.01), but not in the low AVC groups.

Conclusion

Sub-severe AVC is a robust risk stratification parameter in patients with non-severe AS and may inform AVI timing.
Standardized assessment of evidence supporting the adoption of mobile health solutions: A Clinical Consensus Statement of the ESC Regulatory Affairs Committee
Authors: Caiani Enrico G , Kemps Hareld , Hoogendoorn Petra , Asteggiano Riccardo , Böhm Allan , Borregaard Britt , Boriani Giuseppe , Brunner La Rocca Hans-Peter , Casado-Arroyo Ruben , Castelletti Silvia , Christodorescu Ruxandra Maria , Cowie Martin R , Dendale Paul , Dunn Fiona , Fraser Alan G , Lane Deirdre A , Locati Emanuela T , Małaczyńska-Rajpold Katarzyna , Merșa Caius O , Neubeck Lis , Parati Gianfranco , Plummer Chris , Rosano Giuseppe , Scherrenberg Martijn , Smirthwaite Amie , Szymanski Piotr
Published: June 2024

Mobile health (mHealth) solutions have the potential to improve self-management and clinical care. For successful integration into routine clinical practice, healthcare professionals (HCPs) need accepted criteria helping the mHealth solutions’ selection, while patients require transparency to trust their use. Information about their evidence, safety and security may be hard to obtain and consensus is lacking on the level of required evidence. The new Medical Device Regulation is more stringent than its predecessor, yet its scope does not span all intended uses and several difficulties remain. The European Society of Cardiology Regulatory Affairs Committee set up a Task Force to explore existing assessment frameworks and clinical and cost-effectiveness evidence. This knowledge was used to propose criteria with which HCPs could evaluate mHealth solutions spanning diagnostic support, therapeutics, remote follow-up and education, specifically for cardiac rhythm management, heart failure and preventive cardiology. While curated national libraries of health apps may be helpful, their requirements and rigour in initial and follow-up assessments may vary significantly. The recently developed CEN-ISO/TS 82304-2 health app quality assessment framework has the potential to address this issue and to become a widely used and efficient tool to help drive decision-making internationally. The Task Force would like to stress the importance of co-development of solutions with relevant stakeholders, and maintenance of health information in apps to ensure these remain evidence-based and consistent with best practice. Several general and domain-specific criteria are advised to assist HCPs in their assessment of clinical evidence to provide informed advice to patients about mHealth utilization.
E-vita OPEN NEO in the treatment of acute or chronic aortic pathologies: first interim results of the NEOS study
Authors: Tsagakis Konstantinos , Kempfert Joerg , Zierer Andreas , Martens Andreas , Dohle Daniel-Sebastian , Castiglioni Alessandro , Wong Randolph Hung-Leung , Widenka Kazimierz , Liakopoulos Oliver , Borger Michael A , Oo Aung Ye , Holubec Tomas , Luehr Maximilian , Legarra Calderón Juan José , Grabenwöger Martin
Published: June 2024

OBJECTIVES

The aim of this multicentre study was to demonstrate the safety and clinical performance of E-vita OPEN NEO Stent Graft System (Artivion, Inc.) in the treatment of aneurysm or dissection, both acute and chronic, in the ascending aorta, aortic arch and descending thoracic aorta.

METHODS

In this observational study of 12 centres performed in Europe and in Asia patients were enrolled between December 2020 and March 2022. All patients underwent frozen elephant trunk using E-vita OPEN NEO Stent Graft System. Primary end point was the rate of all-cause mortality at 30 days and secondary end points included further clinical and safety data are reported up to 3–6 months postoperatively.

RESULTS

A total of 100 patients (66.7% male; mean age, 57.7 years) were enrolled at 12 sites. A total of 99 patients underwent surgery using the E-vita OPEN NEO for acute or subacute type A aortic dissection (n = 37), chronic type A aortic dissection (n = 33) or thoracic aortic aneurysm (n = 29), while 1 patient did not undergo surgery. Device technical success at 24 h was achieved in 97.0%. At discharge, new disabling stroke occurred in 4.4%, while new paraplegia and new paraparesis was reported in 2.2% and 2.2%, respectively. Renal failure requiring permanent (>90 days) dialysis or hemofiltration at discharge was observed in 3.3% of patients. Between discharge and the 3–6 months visit, no patients experienced new disabling stroke, new paraplegia or new paraparesis. The 30-day mortality was 5.1% and the estimated 6-month survival rate was 91.6% (standard deviation: 2.9).

CONCLUSIONS

Total arch replacement with the E-vita OPEN NEO can be performed with excellent results in both the acute and chronic setting. This indicates that E-vita OPEN NEO can be used safely, including in the setting of acute type A aortic dissection.
Two-year prognosis and cardiovascular disease prevention after acute coronary syndrome: the role of cardiac rehabilitation—a French nationwide study
Authors: Blacher Jacques , Olié Valérie , Gabet Amélie , Cinaud Alexandre , Tuppin Philippe , Iliou Marie-Christine , Grave Clémence
Published: June 2024

Aims

To evaluate the impact of cardiac rehabilitation (CR) on optimization of secondary prevention treatments for acute coronary syndrome (ACS), medication persistence, medical follow-up, rehospitalization, and all-cause mortality.

Methods and results

The National Health Insurance database was used to identify all patients hospitalized for ACS in France in 2019 and those among them who received CR. Patients’ characteristics and outcomes were described and compared between CR and non-CR patients. Poisson regression models were used to identify the impact of CR after adjusting for confounders. A Cox model was fitted to identify the variables related to mortality after adjustment for medication persistence and cardiologic follow-up. In 2019, 22% of 134 846 patients hospitalized for ACS in France received CR within 6 months of their discharge. After 1 year, only 60% of patients who did not receive CR were still taking BASI (combination of beta-blockers, antiplatelet agents, statins, and renin–angiotensin–aldosterone system inhibitors) drugs. This rate and the medical follow-up rate were higher in patients who received CR. Two years after the ACS event, patients who received CR had better medical follow-up and lower mortality risk, after adjusting for cofounding variables [adjusted hazard ratio all-cause mortality = 0.65 (0.61–0.69)]. After adjustment for the dispensing of cardiovascular drugs and cardiologic follow-up, the independent effect of CR was not as strong but remained significant [hazard ratio = 0.90 (95% confidence interval: 0.84–0.95)].

Conclusion

Patients who received CR after hospitalization for ACS had a better prognosis. Optimization of efficient secondary prevention strategies, improved medication persistence, and enhanced cardiologic follow-up seemed to play a major role.
Dosing of IV posaconazole to treat critically ill patients with invasive pulmonary aspergillosis: a population pharmacokinetics modelling and simulation study
Authors: Elkayal Omar , Mertens Beatrijs , Wauters Joost , Debaveye Yves , Rijnders Bart , Verweij Paul E , Brüggemann Roger J , Spriet Isabel , Dreesen Erwin
Published: June 2024

Background

Posaconazole is used for the prophylaxis and treatment of invasive fungal infections in critically ill patients. Standard dosing was shown to result in adequate attainment of the prophylaxis Cmin target (0.7 mg/L) but not of the treatment Cmin target (1.0 mg/L).

Objectives

To provide an optimized posaconazole dosing regimen for IV treatment of patients with invasive pulmonary aspergillosis in the ICU.

Methods

A population pharmacokinetics (popPK) model was developed using data from the POSA-FLU PK substudy (NCT03378479). Monte Carlo simulations were performed to assess treatment Cmin and AUC0–24 PTA. PTA ≥90% was deemed clinically acceptable. PopPK modelling and simulation were performed using NONMEM 7.5.

Results

Thirty-one patients with intensive PK sampling were included in the PK substudy, contributing 532 posaconazole plasma concentrations. The popPK of IV posaconazole was best described by a two-compartment model with linear elimination. Interindividual variability was estimated on clearance and volume of distribution in central and peripheral compartments. Posaconazole peripheral volume of distribution increased with bodyweight. An optimized loading regimen of 300 mg q12h and 300 mg q8h in the first two treatment days achieved acceptable PTA by Day 3 in patients <100 kg and ≥100 kg, respectively. A maintenance regimen of 400 mg q24h ensured ≥90% Cmin PTA, whereas the standard 300 mg q24h was sufficient to achieve the AUC0–24 target throughout 14 days, irrespective of bodyweight.

Conclusions

We have defined a convenient, optimized IV posaconazole dosing regimen that was predicted to attain the treatment target in critically ill patients with invasive aspergillosis.
Unusual presentation of cutaneous myiasis in the knee: case report
Authors: Dahduli Omar S , Aldeghaither Sarah A , Alhossan Abdullah M
Published: June 2024

Myiasis is infestation of live human tissue by larva. It usually involves immunocompromised people or people living in unsanitary conditions. The cutaneous myiasis is most common type and can enter the skin with a pre-existing wound. Herein we present a case of an 18-year-old girl known case of Dystrophic Epidermolysis Bullosa with cutaneous myiasis affecting the knee managed surgically with full recovery. Such case has not reported previously in the literature, and detailed management plan is described.
Eosinophilic appendicitis: an insidious and fortuitous diagnosis
Authors: Llera Brent , Hanna Iman , Jureller Michael
Published: June 2024

Eosinophilic appendicitis is a rare inflammatory condition characterized by the infiltration of eosinophils into the appendix, which is often misdiagnosed as acute appendicitis given similarities in their clinical presentation. Acute eosinophilic appendicitis: a rare cause of lower gastrointestinal hemorrhage. Within this particular report, we present a case of eosinophilic appendicitis in a 42-year-old female who underwent a laparoscopic appendectomy. The purpose of this report is to increase awareness about this unique condition and emphasize the importance of considering eosinophilic appendicitis as a differential diagnosis in patients with appendicitis-like symptoms whose clinical examination and laboratory findings may suggest otherwise.
A rare case of small cell neuroendocrine carcinoma of gallbladder origin
Authors: Dülger Uğur Can , Erdem Şahin , Cünük Emine Sena , Altıntoprak Fatih
Published: June 2024

Neuroendocrine carcinomas (NECs) of the gallbladder are very rare and aggressive tumors with poor prognosis. Most of them are poorly differentiated and belong to the small cell type. We report a case of a 59-year-old woman who presented with abdominal pain and distension. Contrast-enhanced computed tomography revealed a large heterogeneous mass in the liver, adjacent to the gallbladder, and omental nodules. CA 19-9 level was elevated and ascitic fluid cytology was suspicious for malignancy. Percutaneous biopsy of the liver mass confirmed the diagnosis of small cell NEC of the gallbladder. The patient was considered inoperable and planned for chemotherapy, but she died 20 days after admission. This case illustrates the diagnostic challenges and the dismal outcome of small cell NEC of the gallbladder. Early detection and multimodal treatment are essential for improving the survival of these patients.
Experiences of Deployed Physicians in Support of Operation Allies Refuge/Operation Allies Welcome: Lessons to Inform Improvements in Training
Authors: Kiger Michelle E , Hickey Patrick W , Hammond Caitlin E , Knickerbocker Kara J , Wolf Lauren J , Lara Sebastian
Published: June 2024

Introduction

Stability operations, including humanitarian assistance and disaster relief missions, are key functions of U.S. Military medicine and the Military Medical Humanitarian Assistance Course (MMHAC) is a 2-day course widely used to prepare military medical personnel for such missions. It focuses on caring for those most vulnerable in the wake of disasters, particularly children. The large-scale humanitarian deployment of military medical providers in support of Operation Allies Welcome/Operation Allies Refuge (OAW/OAR) presents an opportunity to evaluate the preparedness of these providers to care for the needs of the Afghan travelers, so we explored the experiences of military medical providers deployed in support of OAW/OAR to inform improvements in the MMHAC.

Materials and Methods

We conducted a qualitative study of military medical providers who were deployed in support of OAW/OAR using a series of three virtual focus groups. Focus group questions were structured around the main topics covered in the MMHAC (patient care, ethical considerations, logistical concerns, and preventive and public health) and explicitly asked about adaptive leadership challenges faced and strategies used to overcome them. We analyzed transcripts using inductive thematic analysis within a constructivist paradigm, with adaptive leadership as a sensitizing concept. The study was approved by the Institutional Review Board of Uniformed Services University.

Results

We constructed 4 themes from participant responses, each addressing challenges that medical providers faced during their mission: (1) Medical providers navigated tension between medical and public health priorities and military mission priorities; (2) Chronic and complex care needs posed unique challenges for medical personnel; (3) Challenges in patient care were compounded by logistical and system-based barriers; and (4) Cultural barriers led to ethical dilemmas that physicians felt inadequately prepared to handle, most notably with respect to gender-related concerns. Within each theme, participants described which aspects of MMHAC training were most helpful and which areas were inadequate.

Conclusions

Physicians found the OAR/OAW mission meaningful but also identified challenges related to medical care provision, public health, logistics, and ethical dilemmas that hindered their ability to carry out their medical mission. Lessons learned from OAW/OAR highlight several areas in which the MMHAC training could be augmented and improved to further mitigate these challenges.
Using a Fitbit-based Walking Game to Improve Physical Activity Among U.S. Veterans
Authors: Simmering Jacob E , Polgreen Linnea A , Francis Shelby L , Strom Austin J , Segre Alberto M , Polgreen Philip M
Published: June 2024

Introduction

Physical inactivity, hereafter inactivity, is a serious health problem among U.S. veterans, hereafter veterans. Inactive adults are at risk for adverse cardiac events and premature mortality. Specifically, among veterans, inactivity has been associated with a 23% increase in mortality. In order to increase physical activity among veterans, we developed Veterans Affairs (VA) MapTrek, a mobile-phone-based web app that allows users to take a virtual walk in interesting locations around the world while tracking their progress against that of others like themselves on an interactive map. Steps are counted by a commercially available Fitbit triaxial accelerometer, and users see their progress along a predefined scenic path overlaid on Google Maps. The objective of this study was to determine the effectiveness of VA MapTrek to increase physical activity in a population of veterans at risk for obesity-related morbidity.

Materials and Methods

We recruited overweight and obese veterans obtaining care at the Iowa City Veterans Affairs Health Center. Half of the veterans were assigned to participate in VA MapTrek. Each week, participants were assigned virtual walking races (Monday through Saturday), which followed a predetermined route that is displayed on Google Maps. The participant’s position on the map is automatically updated each time their Fitbit syncs to their phone. In addition, challenges were issued periodically. Veterans in the control group were only given a Fitbit. We regressed daily step counts on the days of the week, the days since the start of the intervention period, whether the user was in the VA MapTrek or Control group, and an interaction between the study group and the days since the start of the intervention period. We included subject-specific random intercepts and subject-specific random slopes. This model was estimated using Bayesian Hamiltonian Monte Carlo using Stan’s No-U-Turns sampler. We set vague, uniform priors on all the parameters.

Results

We enrolled 276 participants, but only 251 (102 in the control group and 149 in the VA MapTrek group) contributed data during the intervention period. Our analysis suggests an 86.8% likelihood that the VA MapTrek intervention led to a minimum increase of 1,000 daily steps over the 8-week period, compared to the control group. Throughout the 8-week intervention, we project that VA MapTrek participants would have taken an extra 96,627 steps, equivalent to 77.8 additional kilometers (km) (48.3 additional miles), assuming an average of 1,242 steps per km (2,000 steps per mile).

Conclusions

Our study underscores the potential of VA MapTrek as an intervention for promoting walking among veterans who face elevated risks of obesity and cardiac issues. Rural veterans are a high-risk population, and new interventions like VA MapTrek are needed to improve veterans’ health.
Balance, Landing Biomechanics, and Functional Movement Screen Characteristics With and Without Knee Exoskeleton in Military Soldiers
Authors: Nagai Takashi , Zeppetelli David J , Sarantos Lucas C , Johnson Caleb D , Borden Charles Joseph B , Dempsey Cole A , Ramirez Vanessa
Published: June 2024

Introduction

A light-weight pneumatic-powered knee exoskeleton could augment mobility and lifting capabilities for a variety of occupational settings. However, added weight/bulkiness and artificially produced knee extension torque could compromise sensorimotor characteristics.

Materials and Methods

Ten healthy participants conducted 3 visits within 10 days to the biomechanics laboratory. Participants were asked to complete the following tasks on each visit: single-leg balance, single-leg drop-landing, and select functional movement tasks. Balance characteristics (the ground reaction forces variability and center-of-pressure velocity) were derived from force plates while knee flexion angles during drop-landing and functional movement tasks were captured using a motion capture system. Descriptive statistics as well as paired t-tests or Wilcoxon signed-rank tests were used to compare between conditions. Significance was set at P < .05 a priori.

Results

During single-leg balance, the ground reaction force variabilities were significantly increased (P = .013–.019) and the center of pressure velocity was decreased (P = .001–.017) when wearing knee exoskeleton. During single-leg drop-landing, the exoskeleton condition showed lower knee flexion angles at the initial contact (P = .004–.021) and peak (P = .006–.010). Additionally, the peak vertical ground reaction force was higher in the exoskeleton condition (P = .007). During functional movement tasks, the exoskeleton condition showed less knee flexion range-of-motion during the overhead squat (P = .007–.033) and hurdle step-over (P = .004–.005).

Conclusions

Participants exhibited stiffer landing technique with the exoskeleton. Given that these compromised sensorimotor characteristics have been associated with musculoskeletal injury risk, modifications to exoskeletons to promote softer landing and greater knee flexion range-of-motion during dynamic activities may be warranted.
Current Status of Cold Injuries in the South Korean Military Over the Past 5 Years: Analysis and Assessment Based on the 2023–2024 Surveillance System
Authors: Ha Beom-man , Lim Hunjong , Yu Jeong-A , Jung Jae-Hyeop
Published: June 2024

Introduction

This study aimed to examine the prevalence of cold injuries and review the cold injury monitoring system in the South Korean military.

Materials and Methods

This study conducted a retrospective and cross-sectional analysis using data from the Defense Medical Statistic Information System (DMSIS) on cold injuries among military personnel from 2018 to 2023. It incorporated findings from the Korean Armed Forces Medical Command’s cold injury surveillance system and analyzed cases from the Armed Forces Capital Hospital, covering all branches of the military by status and rank.

Results

An analysis of cold injury in the South Korean military over the past 5 years revealed varying numbers of cases treated, from 799 in 2018-2019 to 467 in 2022-2023. According to the surveillance system in 2023-2024, the Army experienced the majority of these cases, with 94.5% of the total. The incidence per 1,000 personnel was the highest in the Army at 0.98 compared to the Air Force and Navy/Marine Corps. Rank-based analysis indicated the most affected were private first-class soldiers. Frostbite was the most frequent condition, alongside chilblains, hypothermia, and immersion injuries, with no marked difference in the type of illness across branches.

Conclusions

The study underscores the need for focused prevention and treatment, particularly in the Army. By analyzing data from a newly implemented surveillance system, it revealed a higher incidence of frostbite and chilblains among lower ranks. The findings highlight the importance of targeted educational measures and enhanced response strategies to protect personnel against cold injuries.
In silico design of DNA sequences for in vivo nucleosome positioning
Authors: Routhier Etienne , Joubert Alexandra , Westbrook Alex , Pierre Edgard , Lancrey Astrid , Cariou Marie , Boulé Jean-Baptiste , Mozziconacci Julien
Published: June 2024

The computational design of synthetic DNA sequences with designer in vivo properties is gaining traction in the field of synthetic genomics. We propose here a computational method which combines a kinetic Monte Carlo framework with a deep mutational screening based on deep learning predictions. We apply our method to build regular nucleosome arrays with tailored nucleosomal repeat lengths (NRL) in yeast. Our design was validated in vivo by successfully engineering and integrating thousands of kilobases long tandem arrays of computationally optimized sequences which could accommodate NRLs much larger than the yeast natural NRL (namely 197 and 237 bp, compared to the natural NRL of ∼165 bp). RNA-seq results show that transcription of the arrays can occur but is not driven by the NRL. The computational method proposed here delineates the key sequence rules for nucleosome positioning in yeast and should be easily applicable to other sequence properties and other genomes.
Unlocking the potential of protein-derived peptides to target G-quadruplex DNA: from recognition to anticancer activity
Authors: Merlino Francesco , Marzano Simona , Zizza Pasquale , D’Aria Federica , Grasso Nicola , Carachino Alice , Iachettini Sara , Biroccio Annamaria , Fonzo Silvia Di , Grieco Paolo , Randazzo Antonio , Amato Jussara , Pagano Bruno
Published: June 2024

Noncanonical nucleic acid structures, particularly G-quadruplexes, have garnered significant attention as potential therapeutic targets in cancer treatment. Here, the recognition of G-quadruplex DNA by peptides derived from the Rap1 protein is explored, with the aim of developing novel peptide-based G-quadruplex ligands with enhanced selectivity and anticancer activity. Biophysical techniques were employed to assess the interaction of a peptide derived from the G-quadruplex-binding domain of the protein with various biologically relevant G-quadruplex structures. Through alanine scanning mutagenesis, key amino acids crucial for G-quadruplex recognition were identified, leading to the discovery of two peptides with improved G-quadruplex-binding properties. However, despite their in vitro efficacy, these peptides showed limited cell penetration and anticancer activity. To overcome this challenge, cell-penetrating peptide (CPP)-conjugated derivatives were designed, some of which exhibited significant cytotoxic effects on cancer cells. Interestingly, selected CPP-conjugated peptides exerted potent anticancer activity across various tumour types via a G-quadruplex-dependent mechanism. These findings underscore the potential of peptide-based G-quadruplex ligands in cancer therapy and pave the way for the development of novel therapeutic strategies targeting these DNA structures.
Future Deployment and Comparison to the Restructuring Plan
Authors: Clarke Ian , Mackenzie Patrick , Zeng Kai
Published: May 2024

This chapter explicates CVA's future development and its comparison to the restructuring plans under Part 26A of the Companies Act 2006. Across Europe, debtors use numerous variety of structures such as bank loans and debt securities. The chapter primarily focuses on common financing, liability structures, CVA features, a case study, and the future deployment of processes in a restructuring context. The key differences between CVAs and restructuring plans are the eligibility of companies, people bound by the agreements, voting, class composition, fairness, and process. However, CVAs are expected to continue to play an instrumental role as either standalone restructuring tools or restructuring non-financial liabilities of debtors.