bluuebunny/crossref_metadata_2025 huggingface dataset:
LISA Galactic binaries in the Roman Galactic Bulge Time-Domain Survey
Authors: Digman Matthew C , Hirata Christopher M
Published: August 2023

Short-period Galactic white dwarf binaries detectable by Laser Interferometer Space Antenna are the only guaranteed persistent sources for multimessenger gravitational-wave astronomy. Large-scale surveys in the 2020s present an opportunity to conduct preparatory science campaigns to maximize the science yield from future multimessenger targets. The Nancy Grace Roman Space Telescope Galactic Bulge Time-Domain Survey will (in its Reference Survey design) image seven fields in the Galactic Bulge approximately 40 000 times each. Although the Reference Survey cadence is optimized for detecting exoplanets via microlensing, it is also capable of detecting short-period white dwarf binaries. In this paper, we present forecasts for the number of detached short-period binaries the Roman Galactic Bulge Time-Domain Survey will discover and the implications for the design of electromagnetic surveys. Although population models are highly uncertain, we find a high probability that the baseline survey will detect of the order of ∼5 detached white dwarf binaries. The Reference Survey would also have a ${\gtrsim} 20\,{\rm per\,cent}$ chance of detecting several known benchmark white dwarf binaries at the distance of the Galactic Bulge.
Constraining accuracy of the pairwise velocities in N-body simulations using scale-free models
Authors: Maleubre Sara , Eisenstein Daniel J , Garrison Lehman H , Joyce Michael
Published: August 2023

We present a continuation of an analysis that aims to quantify resolution of N-body simulations by exploiting large (up to N = 40963) simulations of scale-free cosmologies run using abacus. Here, we focus on radial pairwise velocities of the matter field, both by direct estimation and through the cumulative two-point correlation function (using the pair conservation equation). We find that convergence at the 1 per cent level of the mean relative pairwise velocity can be demonstrated over a range of scales, evolving from a few times the grid spacing at early times to slightly below this scale at late times. We show the analysis of two different box sizes as well as from averaging results from the smaller boxes, and compare the power of the two aforementioned estimators in constraining accuracy at each scale. Down to scales of the order of the smoothing parameter, convergence is obtained at ∼$5~{{\rm per\, cent}}$ precision, and shows a behaviour indicating asymptotic stable clustering. We also infer for LCDM simulations conservative estimates on the evolution of the lower cut-off to resolution (at 1 and 5 per cent precision) as a function of redshift.
Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case–Control Study
Authors: Miller Aaron C , Arakkal Alan T , Sewell Daniel K , Segre Alberto M , Tholany Joseph , Polgreen Philip M ,   CDC MInD-Healthcare Group
Published: August 2023

Background

Antibiotics are the greatest risk factor for Clostridioides difficile infection (CDI). Risk for CDI varies across antibiotic types and classes. Optimal prescribing and stewardship recommendations require comparisons of risk across antibiotics. However, many prior studies rely on aggregated antibiotic categories or are underpowered to detect significant differences across antibiotic types. Using a large database of real-world data, we evaluate community-associated CDI risk across individual antibiotic types.

Methods

We conducted a matched case–control study using a large database of insurance claims capturing longitudinal health care encounters and medications. Case patients with community-associated CDI were matched to 5 control patients by age, sex, and enrollment period. Antibiotics prescribed within 30 days before the CDI diagnosis along with other risk factors, including comorbidities, health care exposures, and gastric acid suppression were considered. Conditional logistic regression and a Bayesian analysis were used to compare risk across individual antibiotics. A sensitivity analysis of antibiotic exposure windows between 30 and 180 days was conducted.

Results

We identified 159 404 cases and 797 020 controls. Antibiotics with the greatest risk for CDI included clindamycin and later-generation cephalosporins, and those with the lowest risk included minocycline and doxycycline. We were able to differentiate and order individual antibiotics in terms of their relative level of associated risk for CDI. Risk estimates varied considerably with different exposure windows considered.

Conclusions

We found wide variation in CDI risk within and between classes of antibiotics. These findings ordering the level of associated risk across antibiotics can help inform tradeoffs in antibiotic prescribing decisions and stewardship efforts.
Climate change outpaces adaptive potential via hybridization in nesting female Saltmarsh and Nelson’s Sparrows
Authors: Maxwell Logan M , Walsh Jennifer , Olsen Brian J , Kovach Adrienne I
Published: August 2023

Hybridization and introgression can promote adaptive potential and evolutionary resilience in response to increased pressures of climate change; they can also disrupt local adaptation and lead to outbreeding depression. We investigated female fitness consequences of hybridization in two sister species that are endemic to a threatened tidal marsh ecosystem: Saltmarsh (Ammospiza caudacutus) and Nelson’s (Ammospiza nelsoni) sparrows. We found increasing nest flooding rates due to rising sea levels are outpacing potential adaptive benefits of hybridization due to very low overall nesting success in both the Nelson’s and Saltmarsh sparrows. In the center of the hybrid zone across two years, we determined the success of 201 nests of 104 pure and admixed Saltmarsh and Nelson’s Sparrow females, genotyped using a panel of single nucleotide polymorphisms (SNPs) from double digest restriction-site associated DNA (ddRAD) sequencing. We evaluated 5 metrics of female fitness and modeled nesting success in relation to genotypic, environmental, and nesting characteristics. We found differential fitness among Saltmarsh, Nelson’s, and hybrid females, such that birds with predominantly Saltmarsh Sparrow alleles had higher reproductive success than birds with predominantly Nelson’s Sparrows alleles, and hybrids were intermediate. Fledging success increased with two known tidal marsh nesting adaptations: nest height and nesting synchrony with tidal cycles. We found a positive relationship between hybrid index and fitness in daily nest survival in 2016, but not in 2017, likely due to differing levels of precipitation and nest flooding between years. The strongest and most consistent predictors of daily nest survival were nesting synchrony with lunar tidal flooding cycles and daily maximum tide height. Fitness patterns suggest that there may be an adaptive benefit of interspecific geneflow for the Nelson’s Sparrow at the detriment of the Saltmarsh Sparrow; however, flooding rates are so high in many years they mask any fitness differences between the species, and all females had poor nesting success, regardless of genetic makeup.
The transcription factor ERF108 interacts with AUXIN RESPONSE FACTORs to mediate cotton fiber secondary cell wall biosynthesis
Authors: Wang Yao , Li Yang , He Shao-Ping , Xu Shang-Wei , Li Li , Zheng Yong , Li Xue-Bao
Published: August 2023

Phytohormones play indispensable roles in plant growth and development. However, the molecular mechanisms underlying phytohormone-mediated regulation of fiber secondary cell wall (SCW) formation in cotton (Gossypium hirsutum) remain largely underexplored. Here, we provide mechanistic evidence for functional interplay between the APETALA2/ethylene response factor (AP2/ERF) transcription factor GhERF108 and auxin response factors GhARF7-1 and GhARF7-2 in dictating the ethylene–auxin signaling crosstalk that regulates fiber SCW biosynthesis. Specifically, in vitro cotton ovule culture revealed that ethylene and auxin promote fiber SCW deposition. GhERF108 RNA interference (RNAi) cotton displayed remarkably reduced cell wall thickness compared with controls. GhERF108 interacted with GhARF7-1 and GhARF7-2 to enhance the activation of the MYB transcription factor gene GhMYBL1 (MYB domain-like protein 1) in fibers. GhARF7-1 and GhARF7-2 respond to auxin signals that promote fiber SCW thickening. GhMYBL1 RNAi and GhARF7-1 and GhARF7-2 virus-induced gene silencing (VIGS) cotton displayed similar defects in fiber SCW formation as GhERF108 RNAi cotton. Moreover, the ethylene and auxin responses were reduced in GhMYBL1 RNAi plants. GhMYBL1 directly binds to the promoters of GhCesA4-1, GhCesA4-2, and GhCesA8-1 and activates their expression to promote cellulose biosynthesis, thereby boosting fiber SCW formation. Collectively, our findings demonstrate that the collaboration between GhERF108 and GhARF7-1 or GhARF7-2 establishes ethylene–auxin signaling crosstalk to activate GhMYBL1, ultimately leading to the activation of fiber SCW biosynthesis.
The transcription factors ZmNAC128 and ZmNAC130 coordinate with Opaque2 to promote endosperm filling in maize
Authors: Chen Erwang , Yu Huiqin , He Juan , Peng Di , Zhu Panpan , Pan Shuxing , Wu Xu , Wang Jincang , Ji Chen , Chao Zhenfei , Xu Zhuopin , Wu Yuejin , Chao Daiyin , Wu Yongrui , Zhang Zhiyong
Published: August 2023

Endosperm filling in maize (Zea mays), which involves nutrient uptake and biosynthesis of storage reserves, largely determines grain yield and quality. However, much remains unclear about the synchronization of these processes. Here, we comprehensively investigated the functions of duplicate NAM, ATAF1/2, and CUC2 (NAC)-type transcription factors, namely, ZmNAC128 and ZmNAC130, in endosperm filling. The gene-edited double mutant zmnac128 zmnac130 exhibits a poorly filled kernel phenotype such that the kernels have an inner cavity. RNA sequencing and protein abundance analysis revealed that the expression of many genes involved in the biosynthesis of zein and starch is reduced in the filling endosperm of zmnac128 zmnac130. Further, DNA affinity purification and sequencing combined with chromatin-immunoprecipitation quantitative PCR and promoter transactivation assays demonstrated that ZmNAC128 and ZmNAC130 are direct regulators of 3 (16-, 27-, and 50-kD) γ-zein genes and 6 important starch metabolism genes (Brittle2 [Bt2], pullulanase-type starch debranching enzyme [Zpu1], granule-bound starch synthase 1 [GBSS1], starch synthase 1 [SS1], starch synthase IIa [SSIIa], and sucrose synthase 1 [Sus1]). ZmNAC128 and ZmNAC130 recognize an additional cis-element in the Opaque2 (O2) promoter to regulate its expression. The triple mutant zmnac128 zmnac130 o2 exhibits extremely poor endosperm filling, which results in more than 70% of kernel weight loss. ZmNAC128 and ZmNAC130 regulate the expression of the transporter genes sugars that will eventually be exported transporter 4c (ZmSWEET4c), sucrose and glucose carrier 1 (ZmSUGCAR1), and yellow stripe-like2 (ZmYSL2) and in turn facilitate nutrient uptake, while O2 plays a supporting role. In conclusion, ZmNAC128 and ZmNAC130 cooperate with O2 to facilitate endosperm filling, which involves nutrient uptake in the basal endosperm transfer layer (BETL) and the synthesis of zeins and starch in the starchy endosperm (SE).
Hydrogen Sulfide Attenuates Mesenchymal Stem Cell Aging Progress via the Calcineurin-NFAT Signaling Pathway
Authors: Yang Shan , Su Yingying , Li Xiaoyan , Wang Hao , Du Juan , Feng Jie , Xie Yongmei , Luo Zhenhua , Xu Junji , Guo Lijia , Liu Yi
Published: August 2023

Aging is a gradual process that is coupled with a decline in the regenerative capacity of stem cells and a subsequent reduction in tissue function and repair. Hydrogen sulfide (H2S) plays an important role in maintaining the function of stem cells. The present study aimed to investigate the role of H2S in mesenchymal stem cell aging and the underlying mechanism and to provide novel insights into stem cell therapies in elderly people. Bone marrow mesenchymal stem cells (BMMSCs) were isolated from young mice (2 months) and from old mice (12 months). Senescence-associated β-galactosidase (SA-β-Gal) activity, reactive oxygen species (ROS) production, ROS scavenging enzymes, and the expression of cell-cycle-related genes were compared between those young and old BMMSCs. The expression of H2S-producing enzymes and the production of H2S in BMMSCs were examined. In vitro osteogenic differentiation and cell senescence were analyzed in young and old BMMSCs before and after H2S treatment. The underlying mechanism was investigated using calcineurin and NFAT1 inhibitors or a Foxp3 siRNA. Bone volume/tissue volume (BV/TV) of femurs in mice was examined using micro-CT with or without systemic injection of an H2S donor. Here, we found that H2S levels in BMMSCs declined with age. When the generation of H2S was blocked with the CBS inhibitor hydroxylamine and the CSE inhibitor dl-propargylglycine, BMMSCs underwent senescence. The elevation of H2S levels rescued BMMSC function in vitro and prevented bone loss in vivo. Mechanistically, H2S represses cell aging via the calcineurin-NFAT1 signaling pathway.
Leveraging an implementation science partnership network to understand how Federally Qualified Health Centers operationalize and address health equity
Authors: Aschbrenner Kelly A , Cruz Jennifer L , Kruse Gina R , Nguyen Huy , Huebner Torres Cristina , Celli Maria , Sarcione Carrie , Singh Deepinder , Emmons Karen M
Published: August 2023

Health equity-focused implementation research requires using definitions and approaches that are relevant and meaningful to implementation partners. We examined how health equity was operationalized and addressed at Federally Qualified Health Centers (FQHCs). We conducted semi-structured interviews with leadership (n = 19) and staff (n = 12) at 10 FQHCs in an implementation science partnership network for cancer control equity to understand how they operationalized and addressed health equity. We performed rapid qualitative analysis and shared findings with a larger group of 13 community health centers (including the 10 FQHCs) at an Implementation Learning Community (ILC) to identify action areas for research and practice, followed by a second phase of synthesizing qualitative codes into themes and mapping themes onto a framework for advancing health equity in healthcare organizations. Participants defined health equity as central to the mission of FQHCs, and identified barriers (e.g. financing models) and facilitators (e.g. interpreter services) to advancing health equity at FQHCs. These findings resonated with ILC participants who emphasized the challenge of addressing root cause social determinants of inequities using limited available resources in FQHCs and the importance of developing meaningful collaboration with communities for data collection, data interpretation, data use, and data ownership. Themes captured recommendations to advance health equity in daily work at FQHCs, including investments in staffing, training, and resources. Mapping qualitative themes from health equity-centered interviews with FQHC partners onto a framework for advancing health equity in healthcare organizations can provide clear, context-specific direction for actions aimed at improving health and healthcare equity.
Predicting Potato Diseases in Smallholder Agricultural Areas of Nigeria Using Machine Learning and Remote Sensing-Based Climate Data
Authors: Ibrahim Esther S. , Nendel Claas , Kamali Bahareh , Gajere Efron N. , Hostert Patrick
Published: August 2023

Crop disease management is crucial for sustainable food production. Although farmers in Nigeria continue to apply broad-spectrum fungicides to potato, potato diseases are still on the rise. Machine-learning methods have recently become more common as part of epidemiological early warning systems. They provide vital information on data–disease relations that may be useful for predisease management. In this study, we build on machine-learning methods to develop spatial early warning tools for Nigeria, using the Jos Plateau as a test case. Both remote sensing meteorological and field data were used to (i) predict disease incidence using field reference data and a random forest (RF) classifier and to (ii) identify local conditions conducive to potato diseases using multi-criteria classification (MCC) based on machine-learning results. The results of the RF for 2019, 2020, and 2021 showed similar spatial characteristics, whereas the MCC varied significantly. Both models predicted that between 72 and 96% of potato fields would be infested. The MCC model further revealed that spatiotemporal frequencies of vulnerability in June can serve as the indicator that informs degrees of infestation. A 5-day vulnerability window used in the context of the MCC proved to be the most useful tool for developing an efficient spraying regime, based on a combination of temperature, rainfall, and relative humidity thresholds. As a result, we were able to develop an operational early-warning system for potato disease in the tropical highlands of Africa. In particular, we introduced spatial risks, creating a more sustainable early-warning approach.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Do We Need Support in Prepectoral Breast Reconstruction? Comparing Outcomes with and without ADM
Authors: Salibian Ara A. , Bekisz Jonathan M. , Kussie Hudson C. , Thanik Vishal D. , Levine Jamie P. , Choi Mihye , Karp Nolan S.
Published: August 2023

Background:

The majority of two-stage prepectoral breast reconstruction has been described utilizing acellular dermal matrix (ADM). Although reports of prepectoral breast reconstruction without ADM exist, there is a paucity of comparative studies.

Methods:

A single-institution retrospective review was performed of consecutive patients undergoing immediate prepectoral two-stage breast reconstruction with tissue expanders from 2017 to 2019. Short-term reconstructive and aesthetic complications were compared between cases that utilized ADM for support and those that did not.

Results:

In total, 76 cases (51 patients) were identified, of which 35 cases utilized ADM and 41 did not. Risk factors and demographics were similar between the two cohorts with the exception of body mass index, which was higher in the ADM cohort (29.3 versus 25.4, P = 0.011). Average follow-up length was also longer in patients who received ADM (20.3 versus 12.3 months, P < 0.001). Intraoperative expander fill was higher in patients who did not receive ADM (296.8 cm3 versus 151.4 cm3, P < 0.001) though final implant size was comparable in both cohorts (P = 0.584). There was no significant difference in the rate of any complication between the ADM and no ADM cohorts (25.7% versus 17.1%, respectively P = 0.357), including major mastectomy flap necrosis (P = 0.245), major infection (P = 1.000), seroma (P = 0.620), expander explantation (P = 1.000), capsular contracture (P = 1.000), implant dystopia (P = 1.000), and rippling (P = 0.362).

Conclusions:

Immediate two-stage prepectoral breast reconstruction with tissue expanders has comparable rates of short-term complications with or without ADM support. Safety of prepectoral expander placement without ADM may warrant more selective ADM use in these cases.
Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients
Authors: Katsnelson Jacob Y. , Spaniol Joseph R. , Buinewicz Joshua C. , Ramsey Frederick V. , Buinewicz Brian R.
Published: August 2023

Background:

Breast implant illness (BII) is a term popularized by social media to describe systemic symptoms that patients ascribe to their breast implants. Though the concept of implants as an underlying cause for a systemic illness remains controversial, few studies have delineated the implant characteristics, capsular histology, and outcomes of patients who undergo explantation for BII.

Methods:

We retrospectively reviewed the demographics, presenting symptoms, outcomes, capsular histology, and culture results of all women who presented to the senior author with symptoms attributed to BII and underwent breast implant removal with capsulectomy from August 2016 to February 2020. Chi-square and logistic regression analyses were performed to evaluate association between implant type, composition, and findings of inflammation on capsule pathology.

Results:

Among 248 patients, 111 (23%) capsules demonstrated inflammatory changes on permanent pathology. Capsular inflammation was independently associated with silicone versus saline (right odds ratio [OR] = 2.18 [1.16–4.11], P = 0.016, left OR = 2.35 [1.08–5.12], P = 0.03) and textured versus smooth implants (right OR = 2.18 [1.16–4.11], P = 0.016, left OR = 2.25 [1.17–4.31], P = 0.01). Silicone material was present in the capsules of 12 patients (4.8%). Fourteen patients had positive cultures. There was one pneumothorax (0.4%), three hematomas requiring evacuation (1%), and two DVTs (0.8%). Of 228 patients, 206 (90.4%) reported high satisfaction with the outcome of the procedure.

Conclusions:

In a large cohort of BII patients, we found that capsular inflammation is significantly associated with silicone and textured implants. Implant removal with capsulectomy can be safely performed in patients with BII with a low complication rate and high patient satisfaction.
A fearful adult attachment style is associated with double the prevalence of chronic pain compared to secure attachment: A national survey of a South African population
Authors: Stamp Gabriella Elisabeth , Iacovides Stella , Wadley Antonia Louise
Published: August 2023

Our response to threats, including pain, are believed to be learnt during our early interpersonal relationships, and can be measured through attachment style. Preliminary epidemiological evidence suggests that insecure attachment styles are more prevalent in those with chronic pain. Our aim was to determine the association between adult attachment style and chronic pain prevalence and burden in a South African population. A nationwide online survey determined adult attachment style (using The Experience in Close Relationships - Relationship Structures (ECR-RS) Questionnaire), prevalence of chronic pain and typically-associated psychological factors. In those with chronic pain, the association with attachment style and pain burden (pain sites, severity and interference, using the Brief Pain Inventory) was further determined. Results of the 2371 individuals were analyzed using multivariate generalized linear models. In our young (median age 23 years; IQR 20-28), well-educated and primarily female (74%) cohort with predominantly a middle-to-high socioeconomic status, we found a high prevalence of chronic pain (27%). All three insecure attachment styles were associated with increased chronic pain prevalence when compared to the secure attachment style (Dismissing: 31%, Odds ratio [95%CI] = 1.38 [1.02-1.85], p=0.037; Preoccupied: 42%, Odds ratio [95%CI] = 2.26 [1.62-3.13], p<0.001; Fearful: 49%, Odds ratio [95%CI] = 2.95 [2.03-4.29], p<0.001). Adult attachment style was not directly associated with the burden of chronic pain, because pain catastrophizing mediated this relationship. Adult attachment style was, however, directly associated with chronic pain prevalence, with more than double the chronic pain prevalence in the fearfully, compared to securely, attached individuals.
Cytokines as Potential Novel Therapeutic Targets in Severe Inflammatory Cardiomyopathy
Authors: Suwalski Phillip , Golpour Ainoosh , Weiner January , Musigk Nicolas , Balzer Felix , Giesa Niklas , Amr Ali , Trebing Johannes , Sedaghat-Hamedani Farbod , Meder Benjamin , Beule Dieter , Landmesser Ulf , Heidecker Bettina
Published: August 2023

Background

Despite currently available state-of-the art therapies, a substantial proportion of patients with inflammatory cardiomyopathy progresses to advanced heart failure. There is an urgent need for novel therapies to improve outcomes. We hypothesized that elevated cyto-kine levels in inflammatory cardiomyopathy may lead to cardiac injury and that specific cyto-kines are associated with severely decreased left ventricular function consequently, thereby suggesting their potential as therapeutic targets.

Methods and Results

Blood samples collected from 529 patients at 2 registries were inves-tigated. First, in a derivation cohort of inflammatory cardiomyopathy from our medical center (n=63), we discovered cytokines that correlate inversely with severely decreased left ventricu-lar ejection fraction (LVEF). We confirmed reproducibility of our results in an independent cohort from a national registry (n=425) and to some degree generalizability in a small cohort of idiopathic dilated cardiomyopathy (IDCM, n=41). In total, we identified 82 cytokines asso-ciated with severely decreased LVEF (FDR < 0.05); a small portion had been previously pro-posed as therapeutic targets, while others emerged as novel discoveries. Finally, real-world data from electronic medical records further indicated the potential of inhibitors targeting cy-tokines of interest to confer a cardioprotective effect.

Conclusions

We identified 82 cytokines associated with severe inflammatory cardiomyopa-thy. Our data were highly significant, reproducible, and generalizable to IDCM. The fact that some of the cytokines had been suggested as potential targets in prior literature supports va-lidity and plausibility of our data. Given that inhibition of cytokines is technically feasible, the identified proteins are compelling potential novel therapeutic targets.

Trial registration number:ClinicalTrials.govIdentifier:NCT04265040,NCT02187263

VISUAL ABSTRACT
Secular Trends in Airway Management of Out-of-Hospital Cardiac Arrest in the National EMS Information System (NEMSIS) Dataset
Authors: Gage Christopher B. , Powell Jonathan R. , Nassal Michelle , Wang Henry , Panchal Ashish R.
Published: August 2023

Introduction

Advanced airway management is essential in resuscitation from out-of-hospital cardiac arrest (OHCA). No longitudinal national studies have described longitudinal trends in airway device choice. We sought to evaluate secular trends of OHCA endotracheal intubation (ETI) and supraglottic airway (SGA) in the United States (US).

Methods

We evaluated ETI and SGA use for 2013-2022 in adult OHCA in the US using the National EMS Information System (NEMSIS) database. We identified OHCA events (CPR performed or defibrillation) and evaluated the proportions of ETI and SGA used during OHCA. We repeated the results stratified by urbanicity. We used descriptive statistics to describe incidence prevalence with nonparametric trend testing for proportional changes over time and a two-sample stochastic rank sum test for equivalence to evaluate airway use differences by urbanicity.

Results

During the study period, we observed 320,154,097 adult 9-1-1 events. Of 3,118,703 OHCA, there were 699,568 and 337,458 cases with reported ETI and SGA attempts. The dominant airway choice was ETI, though the trend of ETI choice decreased as SGA increased over time (p-trend <0.05). From 2013 to 2022, SGA use increased in urban settings while rural and suburban remained stable (urban 27% to 39%*; suburban 31% to 29%; rural 28% to 29%, respectively, *p<0.05).

Conclusion

Over ten years, rates of advanced airway use have increased, with ETI remaining the predominant airway for adults in OHCA. Interestingly, ETI choice decreased as SGA increased over the study period. SGA use distinctly differed in urban settings, increasing concerns for disparities in care provision among communities. With the increased use of SGA over time, further evaluation of patient outcomes is required in datasets with robust linkage to Utstein variables.
Pediatric solid pseudopapillary neoplasm of the pancreas
Authors: Samuel Ashish Sam , Boddu Deepthi , Sebastian Patricia , Thomas Alex , Sreekanth K T , Hegde Priyanka , Jehangir Susan
Published: August 2023

Background

Solid pseudopapillary neoplasm of the pancreas (SPN) in children is rare tumor with low malignant potential. Some tumors however behave aggressively. There is very little literature on the management of these variants especially in children. We share our experience of managing large and recurrent SPN and explore the clinicopathological findings correlating to the risk of recurrence.

Methods

This is a retrospective study of children who were treated for SPN between 2012 and 2022 at a tertiary care center in India. The clinicopathological features and management strategies in these children were evaluated.

Results

16 children with SPN were treated during this period (88% girls). The median age of presentation was 12 years (IQR 9-14). All children presented with abdominal pain. Computed tomography gave a definitive diagnosis in 81% of cases. The tumor predominantly involved the head of the pancreas (n=9, 56%). Eight of nine children classified as high-grade malignant had a benign course. One child had a recurrence of the tumor 4 years after the initial resection and further recurrence on chemotherapy. She required radiation therapy in addition to reoperation following which she is disease free for 77 months. The overall median follow-up was 46 months (IQR 18-72 months).

Conclusion

Complete resection of the tumor provides a cure in most patients with SPN. Recurrent tumors require a multi-modality approach. Long-term survival is good. Better prognostic criteria with immunohistochemistry are required to predict the behavior of these tumors as the WHO criteria for malignancy correlate poorly with clinical outcomes in childhood SPN.
The temporal relationship between preeclampsia and heart failure
Authors: Baker Charlotte , Smits Peter D , Rodriguez Patricia , Cartwright Brianna M Goodwin , Gratzl Samuel , Brar Rajdeep , Garrett Emily , Stucky Nicholas L
Published: August 2023

Importance

Hypertensive disorders of pregnancy (e.g., preeclampsia) occur in approximately 8 to 10% of pregnancies in the US. Preeclampsia is a significant risk factor for future cardiovascular disease but in the US there is no universal long-term clinical follow up or screening for these conditions.

Objective

To determine whether having preeclampsia increases the rate of heart failure at or after delivery across demographics and obstetrics related comorbidities.

Design

Retrospective cohort study. We examined deliveries between January 1, 2018 and March 31, 2023 and assessed the time to heart failure stratified by preeclampsia status. Index event (T0) was first recorded delivery in time frame.

Setting

Population based using nationally representative data from electronic health records by Truveta

Participants

Female. 16 to 50 years of age. First recorded delivery in time frame identified using ICD-9-CM, ICD-10-CM, and SNOMED CT codes for delivery. Exclusion criteria: missing information on sex, race, ethnicity, age; if last contact with the health care system was T0; recent history of related cardiovascular conditions; or congenital heart disease.

Exposure

Preeclampsia on or before delivery.

Main Outcomes and Measures

Diagnosis of heart failure (HF) at or after T0. Other measures included were Leonard’s obstetric comorbidity score, age, race, ethnicity, and disability. We used Cox proportional hazards models to assess time till HF.

Results

718,166 individuals were included and 14,204 had preeclampsia. After adjusting for obstetric comorbidities, race, ethnicity, age and disability, Black patients had a higher hazard of HF compared to white women (HR 3.48; CI 2.97, 4.06). Black patients with preeclampsia had a higher hazard of HF than white patients without preeclampsia (HR 4.63; CI 1.65, 12.99). Black patients without preeclampsia had a risk of HF similar to other racial groups with preeclampsia.

Conclusions and Relevance

The risk for HF after preeclampsia was significant and should continue to be explored. Modifiable factors for both preeclampsia and HF which should be a focus include substance use disorder and pregestational diabetes. Regular long term clinical follow up or screening of women with preeclampsia for HF may be warranted.

Key Points

Question

Does having preeclampsia increase the rate of heart failure at or after delivery across demographics and obstetrics related comorbidities?

Findings

In this retrospective cohort study that included 718,166 deliveries, the risk of heart failure at any point after delivery was 2.82 times greater in women that had preeclampsia than those that did not, after controlling for obstetric comorbidities, race, ethnicity, and age.

Meaning

Regular long term clinical follow up or screening of women with preeclampsia for heart failure may be warranted.
Mobile instrumental assessment of swallowing in residential aged care homes
Authors: Birchall Olga , Bennett Michelle , Lawson Nadine , Richards Amanda , Cotton Susan M. , Vogel Adam P.
Published: August 2023

Purpose

Adults living in residential-aged-care-homes (RACHs) with oropharyngeal dysphagia may not have timely access to instrumental swallowing assessment due to barriers, including the need to travel off-site for assessment. This study describes the feasibility, utility, and acceptability of mobile Flexible-Endoscopic-Swallowing-Assessment (mFEES) in Australian residential-aged-care-homes (RACHs).

Method

Residents with dysphagia living in RACHs were assessed using onsite mFEES. Feasibility, utility, and acceptability were measured at institutional, resident, and implementation levels.

Result

Healthcare professionals and medical decision makers reported that mFEES facilitated a better understanding of residents’ swallowing function/dysphagia management and was beneficial over off-site services. Self-rated discomfort during mFEES was low and most residents presented with no or minimal anxiety about the procedure. Costs of mobile assessments are documented.

Conclusion

mFEES was a safe, well tolerated, and practical service that offered opportunity to enhance person-centered clinical care in older adults living with dysphagia in RACHs.
Bi-directional associations between mask usage and the associated reasons before and after the downgrading of the legal status of COVID-19 in Japan: A longitudinal study
Authors: Murakami Michio
Published: August 2023

Objectives

From a public health perspective, it is important to clarify the associations between mask usage and the associated reasons in situations when mask usage is promoted or mitigated. Therefore, I clarified the changes in mask usage and the associated reasons before and after the downgrading of the legal status of COVID-19 in Japan, and analyzed the bi-directional associations between the two.

Design

Longitudinal study.

Methods

Online surveys were conducted in two waves, between April 18–19, 2023 and June 6–15, 2023, among people aged 20–69 years living in Japan. A total of 291 participants completed both the surveys. The associations between mask usage and beliefs about the reasons for mask usage were analyzed using a cross-lagged panel model.

Results

Mask usage decreased slightly, but significantly, from the first to the second wave (P< 0.001, Cohen’s d = −0.23). Of the eight beliefs regarding mask usage, slight but significant decreases were observed in terms of relief and information effects (P= 0.046, Cohen’s d = −0.12;P= 0.018, Cohen’s d = −0.14). There was a significant association between socio-psychological reasons other than infection risk avoidance (such as norm and relief) during the first wave and mask usage during the second wave [standard estimates:0.25 (95% confidence interval (CI):0.06–0.44)]. Contrarily, mask usage during the first wave was significantly associated with the reasons for infection risk avoidance during the second wave [standard estimates:0.13 (0.03–0.24)].

Conclusions

The impact of downgrading the legal status of COVID-19 in Japan on mask usage and the associated reasons were found to be limited. In terms of promoting or mitigating mask usage, the significance of risk communication based on socio-psychological reasons other than infection risk avoidance, such as norms and relief, was highlighted.
Prevalence of depression and associated factors among cervical cancer patients attending tertiary center in Bhaktapur, Nepal
Authors: Dhakal Mamta , Basel Prem
Published: August 2023

Background/ Objectives

This study aimed to estimate the prevalence of depression and associated factors among cervical cancer patients attending tertiary center in Bhaktapur, Nepal.

Methods

A cross-sectional study was conducted among 140 women aged 35 years and above with cervical cancer who came for follow-up at Bhaktapur Cancer Hospital using Beck Depression Inventory (BDI). Chi-square test and multivariate logistic regression were performed to determine the association between depression and related variables at 95% confidence level.

Results

The prevalence of depression was found to be 67.9% (95% CI: 57.5%-76.4%). Age (AOR: 1.3, 95% CI: 0.2-5.1), education of participants (AOR: 1.9, 95% CI: 0.5-7.8), education of husband (AOR: 2, 95% CI: 0.6-7.1) and alcohol consumption status of husband (AOR: 3.5, 95% CI: 1.1-11.8) were found to be the associated factors of depression in women with cervical cancer.

Conclusion

Nearly seven in ten women with cervical cancer are found to be depressed.
“The Running Injury Continuum: A qualitative examination of recreational runners’ description and management of injury”
Authors: Lacey Aisling , Whyte Enda , O’Keeffe Sinéad , O’Connor Siobhán , Burke Aoife , Moran Kieran
Published: August 2023

Introduction

A critical step in understanding and preventing running-related injuries (RRIs) is appropriately defining RRIs. Current definitions of RRIs may not represent the full process of injury development, failing to capture lower levels of injury that many athletes continue to train through. Understanding runners’ description and management of the injury development process may allow for a more appropriate examination of all levels of injury. This study aimed to examine recreational runners’ description and management of the injury development process.

Methods

A qualitative focus group study was undertaken. Seven semi-structured focus groups with male (n=13) and female (n=18) recreational runners took place. Focus groups were audio and video recorded, and transcribed verbatim. Transcripts were reflexively thematically analysed. A critical friend approach was taken to data coding. Multiple methods of trustworthiness were executed.

Results

Runners describe injury on a nine-level continuum, ranging from injury-free to career-ending injury. There are lower and higher levels of injury. Each level of injury is described across four categories of descriptors; physical description, outcome (effect on running and daily life), psychological description, and management.

Conclusion

The Running Injury Continuum is a tool that can be used for injury surveillance (for healthcare professionals and researchers) and for research investigating RRI risk factors. Healthcare professionals, researchers and coaches must ensure they monitor the development of all levels of RRIs, across all categories of descriptors. Runners need to be educated regarding appropriate self-management strategies for lower level injuries, with access to evidence-based information being a critical management tool.
Predicting Wilson’s Disease Progression using Machine Learning with Real-World Electronic Health Records
Authors: Liang Caihua , Kelly Scott P. , Shen Rongjun , Li Ling , Lobello Kasia , Arkin Steven , Huang Kui , Zhou Xiaofeng
Published: August 2023

BACKGROUND & AIMS

Wilson’s disease (WD) is a rare genetic disorder causing excessive copper accumulation. Research on the natural history of WD is limited. Our objective was to identify predictors for WD progression to cirrhosis, liver failure, and death and to predict individual risk of progression to these endpoints at 1, 2, 3, and 5 years after WD diagnosis.

METHODS

A retrospective natural history cohort study of adult patients with first-recorded WD diagnosis was conducted using the US Optum EHR data between 1/1/2007 and 6/30/2020. LASSO Cox regression, Random Survival Forest (RSF), and XGBoost (XGB) models were used to identify important predictors for progression to cirrhosis, liver failure, and death. The strong predictors for each outcome identified through weighted average rankings across models and reviewed by clinical experts were used for patient-level prediction using RSF and XGB models. The resulting models were validated with an independent sample cohort. C-index and dynamic AUCs were used to evaluate model performance.

RESULTS

Over the study period, 310 out of 2,901 WD patients developed cirrhosis, 255 out of 3,251 developed liver failure, and 604 out of 3,559 died. Age at WD diagnosis, alcoholism, AST and bilirubin levels within 3 months of WD diagnosis, and neurologic and hepatic conditions were the most common predictors for progression to the study endpoints. XGB had a slight superior predictive performance compared with RSF and was then used to predict individual risks for progression to the study endpoints with the top ensemble predictors. The dynamic AUC was 0.78 at Year 1, 0.74 at Year 2, 0.72 at Year 3 and 0.72 at Year 5 for cirrhosis; 0.82 at Year 1, 0.78 at Year 2, and 0.77 at both Year 3 and Year 5 for liver failure; 0.81 at Year 1, 0.83 at Year 2, and 0.82 at both Year 3 and Year 5 for death.

CONCLUSIONS

This study identified the most influential clinical predictors and assessed patient-level risk of WD progression using machine learning. Results from machine learning prognostic models will increase understanding of disease natural history and may help improve clinical trial design and guide individualized clinical care.
Barriers influencing implementation of patient safety incident reporting and learning guidelines in specialised care units, KwaZulu-Natal: A qualitative study
Authors: Gqaleni T.M.H , Mkhize Sipho. W.
Published: August 2023

Background

Globally, increased occurrences of Patient Safety Incidents have become a public concern. The implementation of Patient Safety Incidents incident reporting and learning guidelines is fundamental to reducing preventable patient harm. To improve the implementation of these guidelines in specialised care units in KwaZulu- Natal, the views of healthcare professionals were unearthed.

Aim

This study explores the healthcare professional views toward the implementation of Patient Safety Incidents reporting and learning Guidelines in specialised care units.

Methods

A descriptive, explorative qualitative approach, was used to collect qualitative data from healthcare professionals working in specialised care units. The study was conducted in SCUs of three purposely selected public hospitals in two districts of KwaZulu-Natal. Group discussions and semi-structured interviews were conducted from March to May 2021. Content data analysis was performed using Tesch’s method of analysis process.

Results

The main themes that emerged during data analysis were: Ineffective reporting system affecting the communication of PSI guidelines, Inadequate Institutional and management for the healthcare professionals, Insufficient education and training of healthcare professionals, and poor human resources affecting the implementation of PSI guidelines. The findings highlighted that there were more major barriers to the implementation of PSI reporting and learning guidelines.

Conclusion

This study confirmed that PSI reporting and learning guidelines are still not successfully implemented in the specialised care units and the barriers to implementation were highlighted. For rigorous implementation in South Africa, the study recommends revised PSI reporting and learning guidelines, designed in consultation with the frontline healthcare professionals, consisting of standardised, simple -user-friendly reporting process as well as a better implementation strategy to guide the healthcare professionals. Continuous professional development programmes may play an important role in the facilitation of the implementation process.
Plasmodium falciparum pfhrp2andpfhrp3gene deletions among patients enrolled at 100 health facilities throughout Tanzania: February to July 2021
Authors: Rogier Eric , Battle Nastassia , Bakari Catherine , Seth Misago D. , Nace Douglas , Herman Camelia , Madebe Rashid A. , Mandara Celine I. , Lyimo Beatus M. , Giesbrecht David J. , Popkin-Hall Zachary R. , Francis Filbert , Mbwambo Daniel , Garimo Issa , Aaron Sijenunu , Lusasi Abdallah , Molteni Fabrizio , Njau Ritha , Cunningham Jane A. , Lazaro Samwel , Mohamed Ally , Juliano Jonathan J. , Bailey Jeffrey A. , Udhayakumar Venkatachalam , Ishengoma Deus S.
Published: August 2023

Plasmodium falciparumwith the histidine rich protein 2 gene (pfhrp2) deleted from its genome can escape diagnosis by HRP2-based rapid diagnostic tests (HRP2-RDTs). The World Health Organization (WHO) recommends switching to a non-HRP2 RDT forP. falciparumclinical case diagnosis whenpfhrp2deletion prevalence causes ≥ 5% of RDTs to return false negative results. Tanzania is a country of heterogenousP. falciparumtransmission, with some regions approaching elimination and others at varying levels of control. In concordance with the current recommended WHOpfhrp2deletion surveillance strategy, 100 health facilities encompassing 10 regions of Tanzania enrolled malaria-suspected patients between February and July 2021. Of 7,863 persons of all ages enrolled and providing RDT result and blood sample, 3,777 (48.0%) were positive by the national RDT testing forPlasmodiumlactate dehydrogenase (pLDH) and/or HRP2. A second RDT testing specifically for theP. falciparumLDH (Pf-pLDH) antigen found 95 persons (2.5% of all RDT positives) were positive, though negative by the national RDT for HRP2, and were selected forpfhrp2andpfhrp3(pfhrp2/3) genotyping. Multiplex antigen detection by laboratory bead assay found 135/7,847 (1.7%) of all blood samples positive for Plasmodium antigens but very low or no HRP2, and these were selected for genotyping as well. Of the samples selected for genotyping based on RDT or laboratory multiplex result, 158 were P. falciparum DNA positive, and 140 had sufficient DNA to be genotyped for pfhrp2/3. Most of these (125/140) were found to be pfhrp2+/pfhrp3+, with smaller numbers deleted for only pfhrp2 (n=9) or only pfhrp3 (n=6). No dual pfhrp2/3 deleted parasites were observed. This survey estimated that 0.24% (95% confidence interval: 0.08% to 0.39%) of false-negative HRP2-RDTs for symptomatic persons were due to pfhrp2 deletions in this 2021 Tanzania survey. These data provide evidence for HRP2-based diagnostics as currently accurate for P. falciparum diagnosis in Tanzania.