bluuebunny/crossref_metadata_2025 huggingface dataset:
Esophagogastroduodenoscopy findings that do no not explain dysphagia are associated with underutilization of high-resolution manometry
Authors: Pomenti Sydney , Nathanson John , Phipps Meaghan , Aneke-Nash Chino , Katzka David , Freedberg Daniel , Jodorkovsky Daniela
Published: April 2024

In patients with dysphagia that is not explained by upper endoscopy, high-resolution esophageal manometry (HRM) is the next logical step in diagnostic testing. This study investigated predictors of failure to refer for HRM after an upper endoscopy that was performed for but did not explain dysphagia. This was a retrospective cohort study of patients >18 years of age who underwent esophagogastroduodenoscopy (EGD) for dysphagia from 2015 to 2021. Patients with EGD findings that explained dysphagia (e.g. esophageal mass, eosinophilic esophagitis, Schatzki ring, etc.) were excluded from the main analyses. The primary outcome was failure to refer for HRM within 1 year of the index non-diagnostic EGD. We also investigated delayed referral for HRM, defined as HRM performed after the median. Multivariable logistic regression modeling was used to identify risk factors that independently predicted failure to refer for HRM, conditioned on the providing endoscopist. Among 2132 patients who underwent EGD for dysphagia, 1240 (58.2%) did not have findings to explain dysphagia on the index EGD. Of these 1240 patients, 148 (11.9%) underwent HRM within 1 year of index EGD. Endoscopic findings (e.g. hiatal hernia, tortuous esophagus, Barrett’s esophagus, surgically altered anatomy not involving the gastroesophageal junction, and esophageal varices) perceived to explain dysphagia were independently associated with failure to refer for HRM (adjusted odds ratio 0.45, 95% confidence interval 0.25–0.80). Of the 148 patients who underwent HRM within 1 year of index EGD, 29.7% were diagnosed with a disorder of esophagogastric junction outflow, 17.6% with a disorder of peristalsis, and 2.0% with both disorders of esophagogastric outflow and peristalsis. The diagnosis made by HRM was similar among those who had incidental EGD findings that were non-diagnostic for dysphagia compared with those who had completely normal EGD findings. Demographic factors including race/ethnicity, insurance type, and income were not associated with failure to refer for HRM or delayed HRM. Patients with dysphagia and endoscopic findings unrelated to dysphagia have a similar prevalence of esophageal motility disorders to those with normal endoscopic examinations, yet these patients are less likely to undergo HRM. Provider education is indicated to increase HRM referral in these patients.
Coronary bypass surgery guided by computed tomography in a low-risk population
Authors: Serruys Patrick W , Kageyama Shigetaka , Pompilio Giulio , Andreini Daniele , Pontone Gianluca , Mushtaq Saima , La Meir Mark , De Mey Johan , Tanaka Kaoru , Doenst Torsten , Teichgräber Ulf , Schneider Ulrich , Puskas John D , Narula Jagat , Gupta Himanshu , Agarwal Vikram , Leipsic Jonathon , Masuda Shinichiro , Kotoku Nozomi , Tsai Tsung-Ying , Garg Scot , Morel Marie-Angele , Onuma Yoshinobu
Published: April 2024

Background and Aims

In patients with three-vessel disease and/or left main disease, selecting revascularization strategy based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography (ICA).

Methods

In this study, coronary artery bypass grafting (CABG) procedures were planned based on CCTA without knowledge of ICA. The CABG strategy was recommended by a central core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals (CI) for feasibility was ≥75% (NCT04142021).

Results

The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Unblinding ICA was required in one case yielding a feasibility of 99.1% (95% CI 95.2%–100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Teams was 82.9% with a moderate kappa of 0.58 (95% CI 0.50–0.66) and between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95% CI 0.53–0.68). The 30-day follow-up CCTA in 102 patients (91.9%) showed an anastomosis patency rate of 92.6%, whilst MACCE was 7.2% and major bleeding 2.7%.

Conclusions

CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.
Cryocure-VT: the safety and effectiveness of ultra-low-temperature cryoablation of monomorphic ventricular tachycardia in patients with ischaemic and non-ischaemic cardiomyopathies
Authors: Verma Atul , Essebag Vidal , Neuzil Petr , Dyrda Katia , Balt Jippe , Dinov Borislav , Darma Angeliki , Arya Arash , Sacher Frederic , Reddy Vivek Y , Boersma Lucas , Grigorov Ilya , De Potter Tom
Published: April 2024

Aims

The ultra-low-temperature cryoablation (ULTC) ablation system using −196°C N2 cryogen has been reported to create lesions with freeze duration–dependent depth titratable to over 10 mm with minimum attenuation by scar. Cryocure-VT (NCT04893317) was a first-in-human clinical trial evaluating the safety and efficacy of a novel, purpose-built ULTC catheter in endocardial ablation of scar-dependent ventricular tachycardias (VTs).

Methods and results

This prospective, multi-centre study enrolled patients referred for de novo or second ablations of recurrent monomorphic VT of both ischaemic and non-ischaemic aetiologies. Primary safety and efficacy endpoints of the study were freedom from device- or procedure-related major adverse events (MAEs) up to 30 days post-ablation, acute non-inducibility of clinical VTs at the end of the procedure, and freedom from sustained VT or implantable defibrillator intervention at 6 months. Ultra-low-temperature cryoablation was performed in 64 patients (age 67 ± 11 years, 78% ischaemic, ejection fraction = 35 ± 10%) at 9 centres. The primary acute effectiveness endpoint was achieved in 94% (51/54) of patients in whom post-ablation induction was attempted. There were no protocol-defined MAEs; four procedure-related serious adverse events resolved without clinical sequelae. At 6-month follow-up, 38 patients (60.3%) remained VT-free, and freedom from defibrillator shock was 81.0%, with no significant difference between ischaemic and non-ischaemic cohorts. In 47 patients with defibrillator for at least 6 months prior to the ablation, the VT burden was reduced from median of 4, inter-quartile range (IQR, 1–9) to 0, IQR (0–2).

Conclusion

In this first-in-human multi-centre experience, endocardial ULTC ablation of monomorphic VT appears safe and effective in patients with both ischaemic-cardiomyopathy and non-ischaemic-cardiomyopathy.

Clinical Trial Registration

NCT04893317.
Health policy developments in the Western Balkan Countries 2000–19: towards European Health and Health Care Policies
Authors: Arenliu Qosaj Fatime , Bourdeaux Margaret
Published: April 2024

Background

Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia have committed to becoming European Union (EU) member states. This, among others, implies that candidate/potential candidate states adopt legally authorized EU policies, including health. The study aims to identify the main country-specific health policy areas critical to the EU accession health policy dimension and present the change in associated selected health indicators from 2000 to 2019.

Methods

The study draws on published reports and analyses of official statistics over time and cross-country. Health care policy adherence to the European Commission’s recommended country-specific health actions was classified into five health policy areas: financing, payment, organization, regulation and persuasion. Key health policy areas for Western Balkan countries (WBCs) were identified. Health progress or lack thereof in catching up to the EU15 population health, health expenditure and the number of health professionals are measured.

Results

The European Commission prioritized financing and regulation for all WBCs in the five policy areas. Nine of the 18 analyzed selected health indicators showed divergence, and the other nine converged towards the EU15 averages. WBCs continue to face diverse public health challenges in improving life expectancy at birth, death rates caused by circulatory system diseases, malignant neoplasms, traffic accidents, psychoactive substance use, tuberculosis incidence, tobacco smoking prevalence and public-sector health expenditure.

Conclusions

By 2019, there is limited evidence of WBCs catching up to the average EU15 health levels and health care policies. Closer attention towards EU health and health care policies would be favourable.
Regional differences in stem form between southern and northern red spruce (Picea rubens Sarg.) populations
Authors: Morrone Steven , Green Patrick Corey
Published: April 2024

Red spruce (Picea rubens Sarg.) is a commercially and ecologically important conifer species that primarily exists at northern latitudes of eastern North America and extends southward following the Appalachian Mountains into North Carolina and Tennessee. Due to a warming climate and human-caused disturbances, only fragmented, sky-island populations remain at the highest peaks of the southern Appalachians where their habitat continues to be threatened. While they have been recognized for the rare wildlife habitat they provide in the region, these populations remain understudied. This work aimed to examine differences in stem form between the northern and southern populations of red spruce and to provide additional quantitative methods for managing red spruce stands through providing regionally fitted stem taper models. First, we examined differences in stem form using two methods: a sectional rate of change in diameter and a region variable added to the Kozak (2004) Model 02 taper model. The sectional taper comparison showed significant differences (P < .05) in taper rate throughout the stem that were most pronounced below breast height and above the midpoint. The nested model comparison also showed a significant difference after performing a likelihood ratio test. These results agreed that significant differences in stem form between the two populations exist and supported the idea that localized taper models would provide the best results. Next, we evaluated four stem taper models for their ability to predict upper stem diameters and total volume in southern Appalachian red spruce: a quadratic polynomial, a segmented, a variable exponent, and a geometric model. Fitting data came from a 1992 study across three southern Appalachian spruce-fir sites. Validation data came from a new dataset collected in 2022 at Unaka Mountain, Tennessee. Based on past studies and our results, we found that the Kozak (My last words on taper equations. For Chron 2004;80:507–15. https://doi.org/10.5558/tfc80507-4.) Model 02 variable exponent and the Max and Burkhart (Segmented polynomial regression applied to taper equations. For Sci 1976;22:283–9.) segmented polynomial models performed equally well. The choice of the final model should depend on the users’ objectives and practical limitations (i.e. programming ability, availability of fitting data, error tolerance).
Comprehensive elucidation on the genetic profile of the Hezhou Han population via an efficient InDel panel
Authors: Mei Shuyan , Cui Wei , Chen Man , Cai Meiming , Lei Fanzhang , Wang Xi , Yang Shangwu , Zhu Bofeng
Published: April 2024

The Han nationality is widely distributed in different regions, and it is one of the most populous nationalities in China. Compared with the ethnic minorities in Guangxi Zhuang Autonomous Region, there is relatively less research on Han individuals dwelled in Guangxi as a part of Chinese Han population. In this study, the genetic polymorphisms of 57 autosomal insertion/deletion (InDel) loci were explored in Hezhou Han (HZH) population. Forensic-related parameters revealed that these 57 InDel loci had high forensic validity and could be used in forensic practice application. In addition, the genetic relationships between the HZH population and 30 worldwide reference populations were explored using a variety of analytical methods, such as phylogenetic tree, principal component analysis, and genetic structure analysis. These results demonstrated that there were closer genetic relationships between the HZH and nine populations from East Asia (EAS). The prediction accuracy rates of five inter-continental cross-validation analyses for individuals from EAS was >0.9, and the prediction accuracy rates of three inter-continental cross-validation analyses for individuals from EAS, Europe, and Africa were all >0.95. In addition, 24 of the 57 InDel loci could be served as ancestral information inference loci, which could effectively distinguish individuals of EAS, Europe, and Africa. In conclusion, these InDel loci could be used not only as a good tool for individual identification and paternity testing in HZH population, but also as an auxiliary tool for ancestry information inference research.
Silicon applications in rice plants alter the stylet probing behaviors of Glyphepomis spinosa (Hemiptera: Pentatomidae)
Authors: Coutinho Walter Baida Garcia , da Silva Franciele Cristina , Barrigossi José Alexandre Freitas , de Sousa Almeida André Cirilo , Gonçalves de Jesus Flávio
Published: April 2024

The stink bug Glyphepomis spinosa Campos & Grazia (Hemiptera: Pentatomidae) is a potential rice pest in Brazil. This study evaluates the interaction between silicon sources and 3 rice cultivars (BRS Esmeralda, Canela de Ferro, and IRGA 417) and examines how increasing silicon levels affect the stylet probing behavior of G. spinosa. The experiment was set up in a completely randomized design with a 3 × 3 factorial scheme (silicon sources: calcium silicate, potassium silicate, a control, and 3 rice cultivars). Fertilizing rice plants with Si altered the probing behavior of the stink bug G. spinosa. The cultivar interaction by Si source was significant in a few variables. This was evidenced by longer periods without ingestion, prolonged time to the first stylet probe (initial probing), and less time spent in cellular maceration. This result supports the use of electropenetrography as a tool to evaluate resistance inducers in plants.
Conditional Rebates and Intel: A Step Backwards by any Standard?
Authors: Cole Matthew
Published: April 2024

This paper considers the law on conditional rebates. It sets out the changes introduced by the Court of Justice of the European Union (CJEU) Intel decision and how these have been applied in the General Court Intel Renv case. It is explained that the changes are part of a broader move to bring EU competition law in line with a Consumer Welfare Standard (CWS). An analysis of the new test then reveals that it is flawed for five reasons: the new test ignores the fact that low prices and exclusion are separable. The test incorporates the As-Efficient Competitor test, which only protects firms with low costs, not those that are more competitive as a whole. The test introduces a new standard of harm, which means that the law no longer prevents the restriction of competition, but rather prevents making it impossible for a firm with the same costs as the dominant undertaking to compete, which is a different standard. The new standard diminishes the deterrent effect of the law. Finally, compared with the original test, the CJEU test fails to maximize consumer surplus (despite that being the aim of the CWS). Therefore, there is no reason to retain the test and it is recommended that it is reversed.
School-Based Mobile Clinics to Improve Vaccine Access: A Cross-sectional Study of COVID-19 Vaccination
Authors: Mohareb Amir M , Deukmejian Miriam , Guerra Castillo Cesar , Brown Tyler S , LaRocque Regina , Taveras Elsie , Sarin Gupta Priya
Published: April 2024

School-based COVID-19 vaccine clinics were more likely to vaccinate children who identified as a racial minority, who lacked a regular source of primary care, and who lacked private insurance compared to those vaccinated in non-school-based community locations.
Medical statisticians: Always on tap but never on top?
Authors: Bunce Catey , Price Gill , Day Simon , Kanaan Mona
Published: April 2024

Working life for some medical statisticians can be dissatisfying, with a sense of playing second fiddle, according to research described here by Catey Bunce, Gill Price, Simon Day and Mona Kanaan on behalf of the Royal Statistical Society Medical Section
The story of the R number: How an obscure epidemiological figure took over our lives. Part 2: Modelling
Authors: Freeguard Gavin
Published: April 2024

How do you build a complex epidemiological model in record time with little or no reliable data? In the second instalment of his six-part series, Gavin Freeguard describes how different modelling groups in the UK used different data sources and assumptions to try to understand Covid-19 infection rates, and how this diversity proved to be a strength rather than a weakness
Show and tell: Stats communicators share their stories
Authors: Bennett Hayley , Chivers Tom
Published: April 2024

One of the biggest challenges facing any statistician is communicating their work to people who don’t eat, sleep and breathe data to the extent they do. Even the most thorough courses in statistics can leave students – be they undergraduates or PhD candidates – at a loss as to how to share their knowledge effectively and persuasively, be it via a work presentation or TED talk, personal blog or magazine article, newsletter, X thread, or even just a conversation with a boss or friend.

So how do we help the non-expert get their head around complex statistics, and at the same time find our voices as messengers? In this special feature, we ask three of the best stats communicators working today to tell us what they do, and how and why they do it. Because rarely does the data speak for itself.

What happens when you combine creativity with data nous? Daniel Parris tells Hayley Bennett about his unorthodox journey into the statistics world, and why he started his must-read newsletter for numerate culture-vultures

Want to create more memorable data viz? Take your time, go for a walk and remember it’s OK to suck at the start, Alli Torban tells Hayley Bennett

As a science writer for British newspapers, author of popular books on statistical matters and twice winner of the Royal Statistical Society’s award for statistical excellence in journalism, Tom Chivers is versed in demystifying complex concepts for mainstream readers. His latest book explains Bayes’ theorem to the non-statistician.
Household Costs Indices: The new inflation measure
Authors: Leyland Jill
Published: April 2024

Inflation does not affect every household the same way. In addition, how it is measured can vary, sometimes giving noticeably different results. Jill Leyland describes the Household Costs Indices, a new way to measure and understand people’s experiences of inflation, now being published by the UK’s Office for National Statistics
Why do buildings skip the thirteenth floor?
Authors: Hardesty Madison , Auerbach Jonathan
Published: April 2024

Superstition, tradition or a money-making sleight of hand? Either way, New York City apartment blocks tend to avoid having a thirteenth floor. Madison Hardesty and Jonathan Auerbach find out how much New Yorkers are prepared to pay not to live on the “unlucky” floor
The philosophy of statistics
Authors: Pawitan Yudi , Lee Youngjo
Published: April 2024

When we interpret statistics, we inevitably incorporate our personal knowledge and philosophical preferences. All statisticians therefore need to understand the philosophical foundation of probability and statistics, say Yudi Pawitan and Youngjo Lee – and puzzles and paradoxes can help
Bad stats: A regular series exploring slip-ups, snafus and salutary lessons from the world of statistics: The Wakefield Study and the autism debate
Authors: Samaranayake V A
Published: April 2024

A regular series exploring slip-ups, snafus and salutary lessons from the world of statistics
Similarity to earthquakes again: periodic radio pulses of the magnetar SGR 1935+2154 are accompanied by aftershocks like fast radio bursts
Authors: Tsuzuki Yuya , Totani Tomonori , Hu Chin-Ping , Enoto Teruaki
Published: April 2024

It was recently discovered that the time correlations of repeating fast radio bursts (FRBs) are similar to earthquake aftershocks. Motivated by the association between FRBs and magnetars, here we report correlation function analyses in the time-energy space for the 563 periodic radio pulses and the 579 X-ray short bursts from the magnetar SGR 1935+2154, which is known to have generated FRBs. Although radio pulses are concentrated near the fixed phase of the rotational cycle, we find that when multiple pulses occur within a single cycle, their correlation properties (aftershock production probability, aftershock rate decaying in power of time, and more) are similar to those of extragalactic FRBs and earthquakes. A possible interpretation is that the radio pulses are produced by rupture of the neutron star crust, and the first pulse within one cycle is triggered by external force periodically exerted on the crust. The periodic external force may be from the interaction of the magnetosphere with material ejected in an outburst. For X-ray bursts, we found no significant correlation signal, though correlation on the same time-scale as radio pulses may be hidden due to the long event duration. The aftershock similarity between the periodic radio pulsation and FRBs is surprising, given that the two are energetically very different, and therefore the energy sources would be different. This suggests that the essence of FRB-like phenomena is starquakes, regardless of the energy source, and it is important to search for FRB-like bursts from neutron stars with various properties or environments.
Liquid biopsy for improving diagnosis and monitoring of CNS lymphomas: A RANO review
Authors: Nayak Lakshmi , Bettegowda Chetan , Scherer Florian , Galldiks Norbert , Ahluwalia Manmeet , Baraniskin Alexander , von Baumgarten Louisa , Bromberg Jacoline E C , Ferreri Andrés J M , Grommes Christian , Hoang-Xuan Khê , Kühn Julia , Rubenstein James L , Rudà Roberta , Weller Michael , Chang Susan M , van den Bent Martin J , Wen Patrick Y , Soffietti Riccardo
Published: April 2024

Background

The utility of liquid biopsies is well documented in several extracranial and intracranial (brain/leptomeningeal metastases, gliomas) tumors.

Methods

The RANO (Response Assessment in Neuro-Oncology) group has set up a multidisciplinary Task Force to critically review the role of blood and cerebrospinal fluid (CSF)–liquid biopsy in CNS lymphomas, with a main focus on primary central nervous system lymphomas (PCNSL).

Results

Several clinical applications are suggested: diagnosis of PCNSL in critical settings (elderly or frail patients, deep locations, and steroid responsiveness), definition of minimal residual disease, early indication of tumor response or relapse following treatments, and prediction of outcome.

Conclusions

Thus far, no clinically validated circulating biomarkers for managing both primary and secondary CNS lymphomas exist. There is need of standardization of biofluid collection, choice of analytes, and type of technique to perform the molecular analysis. The various assays should be evaluated through well-organized central testing within clinical trials.
Intrinsically topological second Chern insulator via synthetic dimensions
Authors: Kim Seokwoo , Rho Junsuk
Published: April 2024

Exploring Hidden Dimensions: Unveiling Topological Crystals in a 4D Space.
Managing gender-inclusive, just energy transitions in South Asia
Authors: Mohideen Reihana , Kolantharaj Jaimes
Published: April 2024

The demand for a Just Transition (JT) is gaining momentum internationally and has important implications for the energy and power sectors. This paper draws on >10 years of practice integrating gender equality and social inclusion considerations in the energy and power sectors in low- and middle-income countries in South Asia and examines JTs in the energy and power sectors with a focus on gender equality. It includes a brief history of JT frameworks. The paper outlines the energy transition in South Asia, including progress towards net zero based on countries’ Nationally Determined Contributions and some country strategies for integrating gender elements. It includes a brief energy audit that examines trends towards the incorporation of greater shares of renewables over the past two decades, the gender-related implications of distributed generation and demand-side participation, and the gender-related impacts on employment. Drawing on this landscape, the paper goes on to examine the transformation of the energy sector in the Maldives as a case study, with a focus on gender considerations, and draws out some key lessons for a gender-inclusive just energy transition (JET). The paper then proposes a gender and socially inclusive domains framework to guide policy and planning.
Novel Surface Topographic Assessment of Lung Volume and Pulmonary Function Tests in Idiopathic Scoliosis: A Preliminary Study
Authors: Heyer Jessica H. , Wisch Jenna L. , Nagra Kiran K. , Thakur Ankush , Hillstrom Howard J. , Groisser Benjamin N. , Zucker Colson P. , Cunningham Matthew E. , Hresko M. Timothy , Haddas Ram , Blanco John S. , Di Maio Mary F. , Widmann Roger F.
Published: April 2024

Objective:

Severe spinal deformity results in restrictive pulmonary disease from thoracic distortions and lung-volume limitations. Though spirometry and body plethysmography are widely accepted tests for pulmonary function tests (PFTs), they are time-consuming and require patient compliance. This study investigates whether surface topographic [surface topography (ST)] measurements of body volume difference (BVD) and torso volume difference between maximum inhale and exhale correlate to values determined on PFTs.

Methods:

This study included patients with idiopathic scoliosis and thoracic/thoracolumbar curves ≥40 degrees. Patients received ST scans, clinical examinations, and EOS biplanar radiographs on the same day. PFTs were performed within 3 months of ST/radiographic analysis. Univariate linear regression analysis was used to examine relationships between BVD, PFT values, and mean curves.

Results:

Sixteen patients (14.6 ± 2.2 y, 69% females) with idiopathic scoliosis and mean thoracic/thoracolumbar curves of 62 degrees ± 15˚ degrees (45 degrees to 93 degrees) were assessed. BVD displayed statistically high-positive positive correlations with forced vital capacity (R = 0.863, P < 0.0001), forced expiratory volume in 1 second (R = 0.870, P < 0.001), vital capacity (R = 0.802, P < 0.0001), and TLC (R = 0.831, P < 0.0001. Torso volume difference showed similarly high positive correlations to forced vital capacity, forced expiratory volume in 1 second, vital capacity, and TLC, but not residual volume. No correlations emerged between the mean thoracic/thoracolumbar curve and BVD or PFT values.

Conclusion:

This study strongly endorses further investigation into ST scanning as an alternative to traditional PFTs for assessing pulmonary volumes. The noncontact and noninvasive nature of ST scanning presents a valuable alternative method for analyzing thoracic volume, particularly beneficial for patients unable to cooperate with standard PFTs.

Level of Evidence:

Level II—prognostic.
Are Generative Pretrained Transformer 4 Responses to Developmental Dysplasia of the Hip Clinical Scenarios Universal? An International Review
Authors: Luo Shaoting , Canavese Federico , Aroojis Alaric , Andreacchio Antonio , Anticevic Darko , Bouchard Maryse , Castaneda Pablo , De Rosa Vincenzo , Fiogbe Michel Armand , Frick Steven L. , Hui James H. , Johari Ashok N. , Loro Antonio , Lyu Xuemin , Matsushita Masaki , Omeroglu Hakan , Roye David P. , Shah Maulin M. , Yong Bicheng , Li Lianyong
Published: April 2024

Objective:

There is increasing interest in applying artificial intelligence chatbots like generative pretrained transformer 4 (GPT-4) in the medical field. This study aimed to explore the universality of GPT-4 responses to simulated clinical scenarios of developmental dysplasia of the hip (DDH) across diverse global settings.

Methods:

Seventeen international experts with more than 15 years of experience in pediatric orthopaedics were selected for the evaluation panel. Eight simulated DDH clinical scenarios were created, covering 4 key areas: (1) initial evaluation and diagnosis, (2) initial examination and treatment, (3) nursing care and follow-up, and (4) prognosis and rehabilitation planning. Each scenario was completed independently in a new GPT-4 session. Interrater reliability was assessed using Fleiss kappa, and the quality, relevance, and applicability of GPT-4 responses were analyzed using median scores and interquartile ranges. Following scoring, experts met in ZOOM sessions to generate Regional Consensus Assessment Scores, which were intended to represent a consistent regional assessment of the use of the GPT-4 in pediatric orthopaedic care.

Results:

GPT-4’s responses to the 8 clinical DDH scenarios received performance scores ranging from 44.3% to 98.9% of the 88-point maximum. The Fleiss kappa statistic of 0.113 (P = 0.001) indicated low agreement among experts in their ratings. When assessing the responses’ quality, relevance, and applicability, the median scores were 3, with interquartile ranges of 3 to 4, 3 to 4, and 2 to 3, respectively. Significant differences were noted in the prognosis and rehabilitation domain scores (P < 0.05 for all). Regional consensus scores were 75 for Africa, 74 for Asia, 73 for India, 80 for Europe, and 65 for North America, with the Kruskal-Wallis test highlighting significant disparities between these regions (P = 0.034).

Conclusions:

This study demonstrates the promise of GPT-4 in pediatric orthopaedic care, particularly in supporting preliminary DDH assessments and guiding treatment strategies for specialist care. However, effective integration of GPT-4 into clinical practice will require adaptation to specific regional health care contexts, highlighting the importance of a nuanced approach to health technology adaptation.

Level of Evidence:

Level IV.
Skin–Tarsus–Skin Combined with Orbicularis–Tarsus–Orbicularis Fixation Technique Creates a Double Eyelid: A Case Series
Authors: Xiong Tingfeng , Ye Qing
Published: April 2024

Background:

The skin–tarsus–skin and orbicularis–tarsus–orbicularis fixation methods are widely used in double-eyelid surgery. Both methods have limitations. In this study, the two surgical methods were integrated and applied to form a stable double eyelid that mimics the natural physiological structure with minimal visible scarring.

Methods:

At the inner, middle, and outer sites of the double-eyelid line, 7-0 silk sutures were passed successively through the orbicularis oculi muscle at the lower edge of the incision, the tarsus/anterior tarsus tissue, and the orbicularis oculi muscle at the upper edge of the incision, and the skin was sutured with 8-0 thread. The remaining parts were fixed with 8-0 silk sutures successively passed through the skin at the lower edge of the incision, tarsus/anterior tarsus tissue, and skin at the upper edge of the incision. Scar formation, incidence of complications, and patient satisfaction were observed and recorded during follow-up.

Results:

Fifty-eight patients were included. The follow-up ranged from 3 to 24 months (mean, 8 months) with 47 patients undergoing primary and 11 secondary/revision surgery. Twelve cases showed slight linear scars and in 46 cases, surgical marks were almost invisible, and there were no dynamic depressed scars. Evaluation of patient satisfaction showed high satisfaction scores (VAS score, 8.56 ± 0.51). The main reason for dissatisfaction was asymmetry of the double eyelid. There were no significant complications.

Conclusion:

A skin–tarsus–skin combined with orbicularis–tarsus–orbicularis fixation technique can produce a long-lasting, natural-looking double eyelid.
Training in Vascular Microsurgery: The Ex Vivo Biological Model on Domestic Turkey Leg (Meleagris gallopavo)
Authors: La Torre Francesca , Manfellotto Vincenzo , Mazzarella Vincenzo , Sorbino Luigi , D’Alessio Matteo , Petroccione Carlo , Nicoletti Maria Maddalena , Ferraro Giuseppe Andrea , Pieretti Gorizio
Published: April 2024

There are various models for practicing microsurgical anastomoses, from synthetic to ex vivo and in vivo biological ones. In this study, we present the domestic turkey (Meleagris gallopavo) as an ex vivo biological model in the practice of surgical anastomoses. In our opinion, it represents a model that is very similar to a human one, low cost, and easy to find. In fact, our study shows that the diameters of the arteries and veins used for anastomoses (tibial artery diameter: 2.5 ± 0.6 mm; tibial vein diameter: 3.5 ± 1.2 mm) are similar to those of human arteries and veins most frequently used in microsurgical free flaps. So, we believe that this animal model is a great model for microsurgical training for doctors who approach this difficult and long to learn discipline.
Extending the Range of Measurement for Minimally Invasive Treatments by Adding New Concepts to FACE-Q Aesthetics Scales
Authors: Klassen Anne F. , Pusic Andrea L. , Kaur Manraj , Rae Charlene , Poulsen Lotte , Mansouri Jasmine , Tsangaris Elena , Dayan Steven , Klok Jennifer , Armstrong Kathleen , Santosa Katherine , Cano Stefan
Published: April 2024

Background:

The Satisfaction with Face Overall and Psychological Function scales are the most frequently used FACE-Q Aesthetics module scales. This study aimed to extend their range of measurement by adding and testing new concepts. We aimed to create FACE-Q Aesthetics item libraries.

Methods:

In-depth concept elicitation interviews were conducted. Concepts were formed into items and refined through multiple rounds of patient and expert input. The items were tested with people living in the United States, Canada, and the United Kingdom who had minimally invasive facial aesthetic treatments. Participants were recruited through an online platform (ie, Prolific). Psychometric properties were examined using Rasch measurement theory analysis, test–retest reliability, and construct validity.

Results:

We conducted 26 interviews. New concepts were developed into items and refined with input from 12 experts, 11 clinic patients, and 184 Prolific participants. A sample of 1369 Prolific participants completed 52 appearance and 22 psychological items. After removing 10 and 2 items respectively, the psychometric tests provided evidence of reliability with the person separation index, Cronbach alpha, and test–retest reliability values without extremes of 0.88 or more. For validity, lower scores were associated with looking older than one’s age, being more bothered by facial skin laxity, treatment wearing off, and having deeper lines on Merz Assessment scales. Short-form scales formed from the 42 appearance items provide examples of item library application.

Conclusions:

This study provides an innovative means to customize scales to measure appearance and psychological function that maximizes content validity and minimizes respondent burden in the context of minimally invasive treatments.
Association of Chronotype and Shiftwork With COVID-19 Infection
Authors: Quan Stuart F. , Weaver Matthew D. , Czeisler Mark É. , Barger Laura K. , Booker Lauren A. , Howard Mark E. , Jackson Melinda L. , Lane Rashon I. , McDonald Christine F. , Ridgers Anna , Robbins Rebecca , Varma Prerna , Rajaratnam Shantha M.W. , Czeisler Charles A.
Published: April 2024

Objective

This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. Methods: This study used a cross-sectional survey of 19,821 U.S. adults. Results: COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift/remote work, sleep duration, and comorbidities, morning chronotype was associated with a higher (adjusted odds ratio [aOR]: 1.15, 95% CI: 1.10–1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78–0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28–2.74). Conclusion: Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.
Metastatic Lung Adenocarcinoma Received Combined 177Lu-FAP-2286 Radiation Therapy and Targeted Therapy
Authors: Yang Hongyu , Liu Huipan , Zhang Yu , Zhang Yu , Chen Yue
Published: April 2024

A 56-year-old man with metastatic lung adenocarcinoma received combined 177Lu-FAP-2286 radiation therapy and targeted therapy. After 1 treatment cycle, improvement of symptoms and radiological remission was observed. Moreover, the patient did not report any adverse effects.
Navigating ecological novelty towards planetary stewardship: challenges and opportunities in biodiversity dynamics in a transforming biosphere
Authors: Svenning Jens-Christian , McGeoch Melodie A. , Normand Signe , Ordonez Alejandro , Riede Felix
Published: April 2024

Human-induced global changes, including anthropogenic climate change, biotic globalization, trophic downgrading and pervasive land-use intensification, are transforming Earth's biosphere, placing biodiversity and ecosystems at the forefront of unprecedented challenges. The Anthropocene, characterized by the importance of
Homo sapiens
in shaping the Earth system, necessitates a re-evaluation of our understanding and stewardship of ecosystems. This theme issue delves into the multifaceted challenges posed by the ongoing ecological planetary transformation and explores potential solutions across four key subthemes. Firstly, it investigates the functioning and stewardship of emerging novel ecosystems, emphasizing the urgent need to comprehend the dynamics of ecosystems under uncharted conditions. The second subtheme focuses on biodiversity projections under global change, recognizing the necessity of predicting ecological shifts in the Anthropocene. Importantly, the inherent uncertainties and the complexity of ecological responses to environmental stressors pose challenges for societal responses and for accurate projections of ecological change. The RAD framework (resist-accept-direct) is highlighted as a flexible yet nuanced decision-making tool that recognizes the need for adaptive approaches, providing insights for directing and adapting to Anthropocene dynamics while minimizing negative impacts. The imperative to extend our temporal perspective beyond 2100 is emphasized, given the irreversible changes already set in motion. Advancing methods to study ecosystem dynamics under rising biosphere novelty is the subject of the third subtheme. The fourth subtheme emphasizes the importance of integrating human perspectives into understanding, forecasting and managing novel ecosystems. Cultural diversity and biological diversity are intertwined, and the evolving relationship between humans and ecosystems offers lessons for future stewardship. Achieving planetary stewardship in the Anthropocene demands collaboration across scales and integration of ecological and societal perspectives, scalable approaches fit to changing, novel ecological conditions, as well as cultural innovation.

This article is part of the theme issue ‘Ecological novelty and planetary stewardship: biodiversity dynamics in a transforming biosphere’.
Projected future climatic forcing on the global distribution of vegetation types
Authors: Allen Bethany J. , Hill Daniel J. , Burke Ariane M. , Clark Michael , Marchant Robert , Stringer Lindsay C. , Williams David R. , Lyon Christopher
Published: April 2024

Most emissions scenarios suggest temperature and precipitation regimes will change dramatically across the globe over the next 500 years. These changes will have large impacts on the biosphere, with species forced to migrate to follow their preferred environmental conditions, therefore moving and fragmenting ecosystems. However, most projections of the impacts of climate change only reach 2100, limiting our understanding of the temporal scope of climate impacts, and potentially impeding suitable adaptive action. To address this data gap, we model future climate change every 20 years from 2000 to 2500 CE, under different CO
2
emissions scenarios, using a general circulation model. We then apply a biome model to these modelled climate futures, to investigate shifts in climatic forcing on vegetation worldwide, the feasibility of the migration required to enact these modelled vegetation changes, and potential overlap with human land use based on modern-day anthromes. Under a business-as-usual scenario, up to 40% of terrestrial area is expected to be suited to a different biome by 2500. Cold-adapted biomes, particularly boreal forest and dry tundra, are predicted to experience the greatest losses of suitable area. Without mitigation, these changes could have severe consequences both for global biodiversity and the provision of ecosystem services.

This article is part of the theme issue ‘Ecological novelty and planetary stewardship: biodiversity dynamics in a transforming biosphere’.
Legacies of millennial-scale climate oscillations in contemporary biodiversity in eastern North America
Authors: Fastovich David , Radeloff Volker C. , Zuckerberg Benjamin , Williams John W.
Published: April 2024

The Atlantic meridional overturning circulation (AMOC) has caused significant climate changes over the past 90 000 years. Prior work has hypothesized that these millennial-scale climate variations effected past and contemporary biodiversity, but the effects are understudied. Moreover, few biogeographic models have accounted for uncertainties in palaeoclimatic simulations of millennial-scale variability. We examine whether refuges from millennial-scale climate oscillations have left detectable legacies in the patterns of contemporary species richness in eastern North America. We analyse 13 palaeoclimate estimates from climate simulations and proxy-based reconstructions as predictors for the contemporary richness of amphibians, passerine birds, mammals, reptiles and trees. Results suggest that past climate changes owing to AMOC variations have left weak but detectable imprints on the contemporary richness of mammals and trees. High temperature stability, precipitation increase, and an apparent climate fulcrum in the southeastern United States across millennial-scale climate oscillations aligns with high biodiversity in the region. These findings support the hypothesis that the southeastern United States may have acted as a biodiversity refuge. However, for some taxa, the strength and direction of palaeoclimate-richness relationships varies among different palaeoclimate estimates, pointing to the importance of palaeoclimatic ensembles and the need for caution when basing biogeographic interpretations on individual palaeoclimate simulations.

This article is part of the theme issue ‘Ecological novelty and planetary stewardship: biodiversity dynamics in a transforming biosphere’.
Range and climate niche shifts in European and North American breeding birds
Authors: Zurell Damaris , Schifferle Katrin , Herrando Sergi , Keller Verena , Lehikoinen Aleksi , Sattler Thomas , Wiedenroth Levin
Published: April 2024

Species respond dynamically to climate change and exhibit time lags. Consequently, species may not occupy their full climatic niche during range shifting. Here, we assessed climate niche tracking during recent range shifts of European and United States (US) birds. Using data from two European bird atlases and from the North American Breeding Bird Survey between the 1980s and 2010s, we analysed range overlap and climate niche overlap based on kernel density estimation. Phylogenetic multiple regression was used to assess the effect of species morphological, ecological and biogeographic traits on range and niche metrics. European birds shifted their ranges north and north-eastwards, US birds westwards. Range unfilling was lower than expected by null models, and niche expansion was more common than niche unfilling. Also, climate niche tracking was generally lower in US birds and poorly explained by species traits. Overall, our results suggest that dispersal limitations were minor in range shifting birds in Europe and the USA while delayed extinctions from unfavourable areas seem more important. Regional differences could be related to differences in land use history and monitoring schemes. Comparative analyses of range and niche shifts provide a useful screening approach for identifying the importance of transient dynamics and time-lagged responses to climate change.

This article is part of the theme issue ‘Ecological novelty and planetary stewardship: biodiversity dynamics in a transforming biosphere’.
A nature-positive future with biological invasions: theory, decision support and research needs
Authors: McGeoch Melodie A. , Clarke David A. , Mungi Ninad Avinash , Ordonez Alejandro
Published: April 2024

In 2050, most areas of biodiversity significance will be heavily influenced by multiple drivers of environmental change. This includes overlap with the introduced ranges of many alien species that negatively impact biodiversity. With the decline in biodiversity and increase in all forms of global change, the need to envision the desired qualities of natural systems in the Anthropocene is growing, as is the need to actively maintain their natural values. Here, we draw on community ecology and invasion biology to (i) better understand trajectories of change in communities with a mix of native and alien populations, and (ii) to frame approaches to the stewardship of these mixed-species communities. We provide a set of premises and actions upon which a nature-positive future with biological invasions (NPF-BI) could be based, and a decision framework for dealing with uncertain species movements under climate change. A series of alternative management approaches become apparent when framed by scale-sensitive, spatially explicit, context relevant and risk-consequence considerations. Evidence of the properties of mixed-species communities together with predictive frameworks for the relative importance of the ecological processes at play provide actionable pathways to a NPF in which the reality of mixed-species communities are accommodated and managed.

This article is part of the theme issue ‘Ecological novelty and planetary stewardship: biodiversity dynamics in a transforming biosphere’.