bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetocardiograph as a noninvasive and radiation-free diagnostic device for myocardial infarction: a systematic review and meta-analysis
Authors: Xu Yansong , Han Xiaole , Guo Mingyue , Li Ruochuan , Dong Yiming , Fan Jiaxin , Yin Xiaofei , Xie Fei , Pang Jiaojiao , Chen Yuguo
Published: March 2023

Background

This study aimed to evaluate the diagnostic accuracy of magnetocardiograph, a relatively new noninvasive device, in patients with myocardial infarction (MI).

Methods

To identify studies assessing the diagnostic accuracy of magnetocardiography for MI, we searched four databases on November 7, 2022, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science, plus ClinicalTrials.gov. Three reviewers screened the studies independently and emailed the authors for more precise data when necessary. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to evaluate the quality of the included studies. STATA (version 17; Stata Corporation, College Station, TX, USA) was used for meta-analysis of 2 × 2 contingency table data.

Results

A total of 6 articles were included in this study. The diagnostic parameters of all included studies were summarized as follows: the pooled sensitivity was 0.91 (95% confidence intervals [95% CIs]: 0.81–0.96; I
2 = 88.54); specificity was 0.83 (95% CI: 0.75–0.89; I
2 = 83); positive likelihood ratio was 5.3 (95% CI: 3.5–8.2); negative likelihood ratio was 0.1 (95% CI: 0.04–0.24); and diagnostic odds ratio was 51 (95% CI: 16–161). The area under the curve for the receiver operating characteristic curve was 0.92 (95% CI: 0.89–0.94). After metaregression analysis, we found that the number of channels and the way of environmental magnetic noise elimination were heterogeneous sources.

Conclusion

In summary, our meta-analysis shows that magnetocardiography holds a high accuracy in diagnosing MI and takes the advantages of noninvasive, radiation-free, and noncontact. However, further high-quality studies to confirm its usefulness in diagnosing MI are warranted.
Propensity Scores in Health Disparities Research: The Example of Cognitive Aging and the Hispanic Paradox
Authors: Kezios Katrina L. , Zimmerman Scott C. , Zhang Adina , Calonico Sebastian , Jawadekar Neal , Glymour M. Maria , Zeki Al Hazzouri Adina
Published: March 2023

Background:

Individuals of Mexican ancestry in the United States experience substantial socioeconomic disadvantages compared with non-Hispanic white individuals; however, some studies show these groups have similar dementia risk. Evaluating whether migration selection factors (e.g., education) associated with risk of Alzheimer disease and related dementia (ADRD) explain this paradoxical finding presents statistical challenges. Intercorrelation of risk factors, common with social determinants, could make certain covariate patterns very likely or unlikely to occur for particular groups, which complicates their comparison. Propensity score (PS) methods could be leveraged here to diagnose nonoverlap and help balance exposure groups.

Methods:

We compare conventional and PS-based methods to examine differences in cognitive trajectories between foreign-born Mexican American, US-born Mexican American, and US-born non-Hispanic white individuals in the Health and Retirement Study (1994–2018). We examined cognition using a global measure. We estimated trajectories of cognitive decline from linear mixed models adjusted for migration selection factors also associated with ADRD risk conventionally or with inverse probability weighting. We also employed PS trimming and match weighting.

Results:

In the full sample, where PS overlap was poor, unadjusted analyses showed both Mexican ancestry groups had worse baseline cognitive scores but similar or slower rates of decline compared with non-Hispanic white adults; adjusted findings were similar, regardless of method. Focusing analyses on populations where PS overlap was improved (PS trimming and match weighting) did not alter conclusions.

Conclusions:

Attempting to equalize groups on migration selection and ADRD risk factors did not explain paradoxical findings for Mexican ancestry groups in our study.
Neighborhood-level Socioeconomic Position During Early Pregnancy and Risk of Gastroschisis
Authors: Neo Dayna T. , Desrosiers Tania A. , Martin Chantel L. , Carmichael Suzan L. , Gucsavas-Calikoglu Muge , Conway Kristin M. , Evans Shannon Pruitt , Feldkamp Marcia L. , Gilboa Suzanne M. , Insaf Tabassum Z. , Musfee Fadi I. , Shaw Gary M. , Shumate Charles J. , Werler Martha M. , Olshan Andrew F. ,   the National Birth Defects Prevention Study
Published: March 2023

Background:

Neighborhood-level socioeconomic position has been shown to influence birth outcomes, including selected birth defects. This study examines the un derstudied association between neighborhood-level socioeconomic position during early pregnancy and the risk of gastroschisis, an abdominal birth defect of increasing prevalence.

Methods:

We conducted a case–control study of 1,269 gastroschisis cases and 10,217 controls using data from the National Birth Defects Prevention Study (1997–2011). To characterize neighborhood-level socioeconomic position, we conducted a principal component analysis to construct two indices—Neighborhood Deprivation Index (NDI) and Neighborhood Socioeconomic Position Index (nSEPI). We created neighborhood-level indices using census socioeconomic indicators corresponding to census tracts associated with addresses where mothers lived the longest during the periconceptional period. We used generalized estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with multiple imputations for missing data and adjustment for maternal race–ethnicity, household income, education, birth year, and duration of residence.

Results:

Mothers residing in moderate (NDI Tertile 2 aOR = 1.23; 95% CI = 1.03, 1.48 and nSEPI Tertile 2 aOR = 1.24; 95% CI = 1.04, 1.49) or low socioeconomic neighborhoods (NDI Tertile 3 aOR = 1.28; 95% CI = 1.05, 1.55 and nSEPI Tertile 3 aOR = 1.32, 95% CI = 1.09, 1.61) were more likely to deliver an infant with gastroschisis compared with mothers residing in high socioeconomic neighborhoods.

Conclusions:

Our findings suggest that lower neighborhood-level socioeconomic position during early pregnancy is associated with elevated odds of gastroschisis. Additional epidemiologic studies may aid in confirming this finding and evaluating potential mechanisms linking neighborhood-level socioeconomic factors and gastroschisis.
Strategies Addressing Barriers to the Implementation of a Pediatric Hand Fracture Care Pathway
Authors: Baykan Altay , Lafreniere Ann-Sophie , Fraulin Frankie O.G. , Hartley Rebecca , Harrop Alan Robertson , Love Shannan , Ronksley Paul , Donald Maoliosa
Published: March 2023

Background:

We recently highlighted shortcomings in the care of pediatric hand fractures in our local context. The Calgary Kids’ Hand Rule (CKHR) was developed to predict hand fractures that require referral to a hand surgeon. The aims of this study were to identify barriers to a new care pathway for pediatric hand fractures, based on the CKHR and to generate tailored strategies to support its implementation.

Methods:

We performed a conventional content analysis of transcripts from four focus groups (parents, emergency/urgent care physicians, plastic surgeons, and hand therapists) to identify relevant concepts (facilitators and barriers). These concepts were mapped to two frameworks. Generic strategies to address the barriers were identified, and further discussions with key stakeholders resulted in tailored strategies for implementation.

Results:

Five facilitators to implementation of a CKHR-based hand fracture care pathway included established rapport between hand therapists and surgeons, potential for more streamlined care, agreement on identifying another care provider, positive perceptions of hand therapist expertise, and opportunity for patient education. Two individual barriers were concern for poor outcomes and trust. Three systemic barriers were awareness and usability, referral process, and cost and resources. Strategies to address these barriers include pilot-testing of the new care pathway, ensuring closed loop communication, multiple knowledge translation activities, integration of CKHR into the clinical information system, coordinating care and development of parent handouts.

Conclusion:

Mapping barriers to established implementation frameworks has informed tailored implementation strategies, bringing us one step closer to successfully implementing a new pediatric hand fracture pathway.
Customized Bowman-Stromal Inlay: An Attempt to Change the Topography of the Keratoconus Cornea
Authors: Mittal Vikas , Jain Neha , Pandya Yatri , Chatterjee Debapriya
Published: March 2023

Purpose:

The objective of this report is to describe a modification of a previously reported technique with an aim of improving the corneal topography and visual outcomes in progressive keratoconus along with stabilization of ectasia.

Method:

In a 26-year-old man with progressive keratoconus, corneal collagen cross-linking was performed in one eye. The other eye had a keratometry of 69.6 D and thinnest pachymetry of 397 µm for which a customized Bowman-stromal inlay surgery was performed. The technique involved the harvesting of Bowman-stromal inlay (anterior 180-μm human donor cornea having the Bowman's layer and anterior stroma) using the femtosecond laser and central ablation of this inlay was done on the stromal side using an excimer laser. This customized inlay was placed in the anterior stromal pocket of the patient's cornea using a regular intraocular lens injector.

Results:

Stabilization of keratoconus could be achieved in the present case along with improvement in the corrected distance visual acuity and pachymetry. Maximum keratometry decreased from 69.6 D to 57.3 D.

Conclusions:

Customized Bowman-stromal inlay technique appears to be a step towards creating an ideal inlay for the keratoconus cornea.
Monocyte, Lymphocyte and Neutrophil Ratios – Easy-to-Use Biomarkers for the Diagnosis of Pediatric Tuberculosis
Authors: Kissling Mirjam , Fritschi Nora , Baumann Philipp , Buettcher Michael , Bonhoeffer Jan , Naranbhai Vivek , Ritz Nicole
Published: March 2023

Background:

The neutrophil-to-lymphocyte-ratio (NLR), neutrophil-to-monocyte-plus-lymphocyte-ratio (NMLR) and monocyte-to-lymphocyte-ratio (MLR) may have diagnostic potential for tuberculosis (TB).

Methods:

Data of two prospective multicenter studies in Switzerland were used, which included children <18 years with TB exposure, infection or disease or with febrile non-TB lower-respiratory-tract infection (nTB-LRTI).

Results:

Of the 389 children included 25 (6.4%) had TB disease, 12 (3.1%) TB infection, 28 (7.2%) were healthy TB exposed and 324 (83.3%) nTB-LRTI. Median (IQR) NLR was highest with 2.0 (1.2, 2.2) in children with TB disease compared to TB exposed [0.8 (0.6, 1.3); P = 0.002] and nTB-LRTI [0.3 (0.1, 1.0); P < 0.001]. Median (IQR) NMLR was highest with 1.4 (1.2, 1.7) in children with TB disease compared to healthy exposed [0.7 (0.6, 1.1); P = 0.003] and children with nTB-LRTI [0.2 (0.1, 0.6); P < 0.001). Receiver operating characteristic curves to detect TB disease compared to nTB-LRTI for NLR and NMLR had an area under the curve of 0.82 and 0.86, the sensitivity of 88% and 88%, and specificity of 71% and 76%, respectively.

Conclusion:

NLR and NMLR are promising, easy-to-obtain diagnostic biomarkers to differentiate children with TB disease from other lower respiratory tract infections. These results require validation in a larger study and in settings with high and low TB endemicity.
Determination of weight loss effectiveness evaluation indexes and establishment of a nomogram for forecasting the probability of effectiveness of weight loss in bariatric surgery: a retrospective cohort
Authors: Lu Guanhua , Dong Zhiyong , Huang Biao , Hu Songhao , Cai Shenhua , Hu Min , Hu Ruixiang , Wang Cunchuan
Published: March 2023

Background:

The purpose of this research was to determine the index that contributes the most to assessing the effectiveness of weight loss 1 year following bariatric surgery and to implement it as the clinical outcome to develop and confirm a nomogram to predict whether bariatric surgery would be effective.

Methods:

Patient information was extracted from the Chinese Obesity and Metabolic Surgery Database for this retrospective study. The most contributing weight loss effectiveness evaluation index was created using canonical correlation analysis (CCA), and the predictors were screened using logistic regression analysis. A nomogram for estimating the likelihood of effectiveness of weight loss was constructed, and its performance was further verified.

Results:

Information was obtained for 540 patients, including 30 variables. According to the CCA, ≥25 percentage total weight loss was found to be the most correlated with patient information and contribute the most as a weight loss effectiveness evaluation index. Logistic regression analysis and nomogram scores identified age, surgical strategy, abdominal circumference, weight loss history, and hyperlipidemia as predictors of effectiveness in weight loss. The prediction model’s discrimination, accuracy, and clinical benefit were demonstrated by the consistency index, calibration curve, and decision curve analysis.

Conclusions:

The authors determined a 25 percentage total weight loss as an index for weight loss effectiveness assessment by CCA and next established and validated a nomogram, which demonstrated promising performance in predicting the probability of effectiveness of weight loss in bariatric surgery. The nomogram might be a valuable tool in clinical practice.
Novel Polymerized Human Serum Albumin For Ex Vivo Lung Perfusion
Authors: Eren Emre , Black Sylvester M. , Reader Brenda F. , Beal Eliza , Cuddington Clayton , Belcher Donald A. , Palmer Andre F. , Whitson Bryan A.
Published: March 2023

Ex vivo lung perfusion (EVLP) is a method of organ preservation to expand the donor pool by allowing organ assessment and repair. Perfusion solution composition is crucial to maintaining and improving organ function during EVLP. EVLP compared perfusates supplemented with either polymeric human serum albumin (PolyHSA) or standard human serum albumin (HSA). Rat heart-lung blocks underwent normothermic EVLP (37°C) for 120 minutes using perfusate with 4% HSA or 4% PolyHSA synthesized at a 50:1 or 60:1 molar ratio of glutaraldehyde to PolyHSA. Oxygen delivery, lung compliance, pulmonary vascular resistance (PVR), wet-to-dry ratio, and lung weight were measured. Perfusion solution type (HSA or PolyHSA) significantly impacted end-organ metrics. Oxygen delivery, lung compliance, and PVR were comparable among groups (P > 0.05). Wet-to-dry ratio increased in the HSA group compared to the PolyHSA groups (both P < 0.05) suggesting edema formation. Wet-to-dry ratio was most favorable in the 60:1 PolyHSA-treated lungs compared to HSA (P < 0.05). Compared to using HSA, PolyHSA significantly lessened lung edema. Our data confirm that the physical properties of perfusate plasma substitutes significantly impact oncotic pressure and the development of tissue injury and edema. Our findings demonstrate the importance of perfusion solutions and PolyHSA is an excellent candidate macromolecule to limit pulmonary edema.

http://links.lww.com/ASAIO/A980
An Innovative Approach to Minimizing Downtime in Continuous Kidney Replacement Therapy
Authors: Treu Denny , Ashenuga Michael , Massingham Kara , Brugger James , Medina Luis , Ficociello Linda H. , Thompson David
Published: March 2023

Continuous kidney replacement therapy (CKRT) is often utilized to stabilize patients with severe acute kidney injury associated with significant electrolyte abnormalities and/or oliguria and concomitant fluid accumulation. Circuit downtime may reduce daily treatment time and affect delivered doses of CKRT. Studies have found clotting to be the leading cause of downtime and underdosing, which are associated with negative treatment outcomes. The NxStage Cartridge Express with Speedswap (NxStage Medical, Inc.) was designed to minimize downtime by allowing filter priming to occur in parallel with ongoing CKRT and by permitting filter exchanges without the need to replace the entire cartridge. Data from pilot studies suggest that filter exchanges using this system interrupt treatment by an average of 4 minutes per exchange—a considerable reduction from traditional systems that require treatment to be discontinued while the filter is primed, which can take 30 minutes or more. In addition to increasing patient time on therapy, this system has the potential to reduce costs for patients who require a high number of filter changes, and reduce nursing labor and environmental impact (reduced plastic waste). Future studies should confirm whether patients at higher risk of clotted/clogged filters benefit from CKRT with a system designed for rapid filter changes.
Small bowel obstruction: what a gastroenterologist needs to know
Authors: Tai Foong Way David , Sidhu Reena
Published: March 2023

Purpose of review

Intrabdominal adhesions and intestinal hernias are the commonest cause of small bowel obstruction. Small bowel diseases, which cause small bowel obstruction, are rarer and often poses a challenge to gastroenterologists to diagnose and treat. In this review, small bowel diseases, which predispose to small bowel obstruction, are focused on, and their challenges in diagnosis and treatment.

Recent findings

Diagnosis of causes of partial small bowel obstruction is improved with computed tomography (CT) and magnetic resonance (MR) enterography. In fibrostenotic Crohn's strictures and NSAID diaphragm disease, endoscopic balloon dilatation can delay the need for surgery if the lesion is short and accessible; however, many may still inevitably require surgery. Biologic therapy may reduce the need for surgery in symptomatic small bowel Crohn's disease wherein the strictures are predominantly inflammatory. In chronic radiation enteropathy, only refractory small bowel obstruction and those with nutritional difficulties warrant surgery.

Small bowel diseases causing bowel obstruction are often challenging to diagnose and require numerous investigations over a period of time, which often culminate with surgery. Use of biologics and endoscopic balloon dilatation can help to delay and prevent surgery in some instances.
Bridging the gaps: recent advances in diagnosis, care, and outcomes in congenital hyperinsulinism
Authors: Rosenfeld Elizabeth , De León Diva D.
Published: March 2023

Purpose of review

To highlight advances in congenital hyperinsulinism (HI), including newly described molecular mechanisms of disease, novel therapeutic interventions, and improved understanding of long-term outcomes.

Recent findings

Important advances have been made elucidating the molecular mechanisms responsible for HI. Non-coding variants in HK1 have been found to cause aberrant hexokinase expression. Inactivating mutations in SLC25A36 have been identified in children with features of the hyperinsulinism hyperammonemia syndrome. Low-level mosaic mutations in known HI genes have been detected in cases of ‘genetic testing negative’ HI. Identification and localization of focal HI lesions remains a priority, since focal HI can be cured with surgery. Use of 68Ga-NODAGA-exendin-4 PET has been proposed to localize focal lesions. Additional studies are needed before this technique replaces 18F-DOPA PET as standard of care. Treatment options for children with diffuse HI remain limited. The long-acting somatostatin analog, lanreotide, was shown to significantly improve glycemic control in a large series of children with HI. New therapies are under development, with promising preliminary results. Long-term quality of life and neurodevelopmental outcomes remain suboptimal.

Advanced genetic and epigenomic analytic techniques have uncovered novel molecular mechanisms of HI. Development of new drugs holds promise to improve long-term outcomes for individuals with HI.
Updates in pediatric ultrasound
Authors: Ruscica Alice , Chen Christie , Ng Lorraine
Published: March 2023

Purpose of review

Point-of-care ultrasound (POCUS) has various diagnostic and therapeutic applications in the pediatric acute care setting that have an impact on clinical outcomes.

Recent findings

POCUS can improve diagnostic efficiency and expedite management in pediatric patients who present to the emergency department with common complaints such as respiratory distress, abdominal pain, shock, and pain.

Rapid advancements in POCUS have allowed it to become a powerful tool in pediatric care. As the clinical applications of ultrasound diversify, research is needed to evaluate impacts on healthcare outcomes, delivery, and costs.
Managing periprosthetic fractures: perspectives on periprosthetic pelvic fractures
Authors: de Ridder Victor A. , Pape Hans-Christoph , Chana-Rodríguez Francisco , Boudissa Mehdi , Glowalla Claudio , Stuby Fabian , Herath Steven , Histing Tina , Tilkeridis Konstantinos , Dailiana Zoe
Published: March 2023

Periacetabular periprosthetic fractures are rare but potentially disastrous for the longevity of the adjacent implants, leading to multiple revision surgeries. It is of paramount importance to identify and treat intraoperative fractures, which will lead to satisfactory results. Postoperative fractures may be managed operatively or nonoperatively depending on the patient's pain and function, the fracture pattern, and the stability of the acetabular component.
Impact of COVID-19 on Mental Health of Oncology Health Care Workers and Interdisciplinary Collaboration: Results of Surveys in 2021 and 2022
Authors: Bienert Agnieszka , Meier Klaus , Kokisheva Antonina , Gama Brambila Rodrigo A. , Veraldi Marianna , de Lima Vilaca Marques Nuno Carlos Rosa , Kuzmanović Maja , Andreianu Dan Paul , Badibouidi Ferdinand , Vallespin Romina Morales
Published: March 2023

Introduction:

The 2019 coronavirus pandemic has caused serious health crises around the world such as psychological reactions of health workers. The way we work (stress, anxiety, and psychological problems) and the activities assigned to pharmacists, such as vaccination, have changed. So, we conducted a survey to investigate their psychophysical well-being and the influence of vaccination on the daily work of pharmacists.

Methods:

The survey (translated into 9 languages and distributed online) on mental health was sent to all ESOP members in March 2021 and February 2022 and on vaccination in December 2020, March 2021, and February 2022. The data were analyzed using Excel (Microsoft Office 2016, Microsoft, Redmond, WA) and basic descriptive statistics.

Results:

Over 800 colleagues from different health areas and 62 countries took part in the survey. As a result of poor mental health and increased workload as a consequence of the pandemic, it was observed in 30% (2021) and 15% (2022) of respondents, while increased cooperation among healthcare workers was observed in 65% of responders. In the vaccination survey, less than half of the professionals surveyed were directly involved in the vaccination process, conducted mainly in hospitals at first and then in other centers to increase coverage, such as “Community Pharmacy.” For the first time, there have been reports of pharmacists authorized to administer vaccines in some countries.

Conclusions:

With the spread of the virus, the increased workload has affected the mental health of health workers. Although a slight improvement from 2022 vs 2021 was observed, there is a need now to work on improving mental health of health care workers, to protect/care about them, and also to ensure that they will not leave the profession to ensure health care for patients with cancer and COVID-19 (and in general to all patients). Vaccination was an opportunity for the pharmacist to play a more active role that reinforces the value of pharmaceutical practice.
Development and Validation of a Mixed-Reality Simulator for Reducing Biopsy Core Deviation During Simulated Freehand Systematic Prostate Biopsy
Authors: Lampotang Samsun , Lizdas David E. , Johnson William T. , Mei Vincent , Wakim Jonathan , Lou XiangYang , DeStephens Anthony , Acar Yahya , Moy Louis , Ahmad Ardalanejaz , Brisbane Wayne , Stringer Thomas
Published: March 2023

Introduction

We describe the development and validation of a mixed-reality prostate biopsy (PBx) simulator with built-in guidance aids and real-time 3-dimensional visualization.

Methods

We evaluated our simulator during one-on-one training sessions with urology residents and attendings from 2018 to 2022. Participants performed freehand, side-fire, double-sextant transrectal ultrasound-guided systematic prostate biopsy (sPBx). After a baseline assessment (first set of 12 biopsy cores), participants trained for 25 minutes with visualization and cognitive aids activated. Training was followed by an exit set of 12 biopsy cores without visualization or cognitive aids and afterward, subjective assessment by trainees of the simulator. Deviation is the shortest distance of the center of a core from its intended template location.

Results

Baseline deviations (mean ± SD) for residents (n = 24) and attendings (n = 4) were 13.4 ± 8.9 mm and 8.5 ± 3.6 mm (P < 0.001), respectively. Posttraining deviations were 8.7 ± 6.6 mm and 7.6 ± 3.7 mm (P = 0.271), respectively. Deviations between baseline and exit were decreased significantly for residents (P < 0.001) but not for attendings (P = 0.093). Overall feedback from participants was positive. Confidence in performing a PBx increased in novices after training (P = 0.011) and did not change among attendings (P = 0.180).

Conclusions

A new PBx simulator can quantify and improve accuracy during simulated freehand sPBx while providing visualization and graphical feedback. Improved simulated sPBx accuracy could lead to more even distribution of biopsy cores within the prostate when performed in clinical settings, possibly reducing the high risk of missing an existing lesion and thus decreasing the time to initiating treatment, if indicated.
Firearm legislation: The association between neighboring states and crude death rates
Authors: Chammas Majid , Pust Gerd Daniel , Meizoso Jonathan P. , Ramsay Ian A. , Ke Hengyi , Rattan Rishi , Namias Nicholas , Crandall Marie , Yeh D. Dante
Published: March 2023

BACKGROUND

Few studies have examined the impact of interstate differences in firearm laws on state-level firearm mortality. We aim to study the association between neighboring states' firearm legislation and firearm-related crude death rate (CDR).

METHODS

The CDC Web-based Injury Statistics Query and Reporting System was queried for adult all-intent (accidental, suicide, and homicide) firearm-related CDR among the 50 states from 2012 to 2020. States were divided into five cohorts based on the Giffords Law Center Annual Gun Law Scorecard, and two groups were constructed: Strict (A, B, C) and Lenient (D, F). We examined the effect of (1) a single incongruent neighbor, defined as “Different” if the state is bordered by ≥1 state with a grade score difference >1, and (2) the average grade of all neighboring states, defined as “Different” if the average of all neighboring states resulted in a grade score difference >1.

RESULTS

Strict states with similar average neighbors had significantly lower CDR compared with Strict states with different average neighbors (2.98 [1.91–5.06] vs. 3.87 [2.37–5.94], p = 0.02), while Lenient states with similar average neighbors had significantly higher CDR compared with Lenient states with different average neighbors (6.02 [4.56–8.11] vs. 4.7 [3.95–5.35], p = 0.002). Lenient states surrounded by all similar Lenient states had the highest CDR, which was significantly higher than Lenient states with ≥1 different neighbor (6.52 [5.09–8.96] vs. 5.19 [3.85–6.61], p < 0.001). However, Strict states with ≥1 different neighbor did not have higher CDR compared with Strict states surrounded by all similar Strict states (3.39 [2.17–5.35] vs. 3.14 [1.91–5.38], p = 0.5).

CONCLUSION

We report a lopsided neighboring effect whereby Lenient states may benefit from at least one Strict neighbor, while Strict states may be adversely affected only when surrounded by mostly Lenient neighbors. These findings may assist policymakers regarding the efficacy of their own state's legislation in the context of incongruent neighboring states.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
Optimal Prehospital Crystalloid Resuscitation Volume in Trauma Patients at Risk for Hemorrhagic Shock
Authors: Deeb Andrew-Paul , Lu Liling , Guyette Frank X , Peitzman Andrew B , Daley Brian J , Miller Richard S , Harbrecht Brian G , Phelan Herb A , Sperry Jason L , Brown Joshua B
Published: March 2023

Background:

Prehospital resuscitation guidelines vary widely and blood products, although likely superior, are not available for most patients in the prehospital setting. Our objective was to determine the prehospital crystalloid volume associated with the lowest mortality among patients in hemorrhagic shock.

Study Design:

This is a secondary analysis of the Prehospital Air Medical Plasma trial. Injured patients from the scene with hypotension and tachycardia or severe hypotension were included. Segmented regression and generalized additive models (GAM) were used to evaluate non-linear effects of prehospital crystalloid volume on 24-hour mortality. Logistic regression evaluated the association between risk-adjusted mortality and prehospital crystalloid volume ranges to identify optimal target volumes. Inverse propensity weighting was performed to account for patient heterogeneity.

Results:

There were 405 patients included. Segmented regression suggested the nadir of 24-hour mortality lay within 377-1419mL of prehospital crystalloid. GAM suggested the nadir of 24-hour mortality lay within 242-1333mL of prehospital crystalloid. A clinically operationalized range of 250-1250mL was selected based on these findings. Odds of 24-hour mortality were higher for patients receiving <250mL (aOR 2.46; 95%CI 1.31—4.83, p=0.007) and >1250mL (aOR 2.57; 95%CI 1.24—5.45, p=0.012) compared to 250-1250mL. Propensity weighted regression similarly demonstrated odds of 24-hour mortality were higher for patients receiving <250mL (aOR 2.62; 95%CI 1.34—5.12, p=0.005) and >1250mL (aOR 2.93; 95%CI 1.36—6.29, p=0.006) compared to 250-1250mL.

Conclusion:

Prehospital crystalloid volumes between 250-1250mL are associated with lower mortality compared to lower or higher volumes. Further work to validate these finding may provide practical volume targets for prehospital crystalloid resuscitation.
Sir Martin Francis Wood. 19 April 1927—23 November 2021
Authors: Williams FRS Peter
Published: March 2023

Martin Wood was much more than an engineer or entrepreneur. In co-founding with his wife, Audrey Wood, the very first spin-out company in the history of the then 900-year-old University of Oxford, he initiated a climate of innovation that, decades later, still influences the university and the city of Oxford. His hand can be traced in literally dozens of local technology enterprises, and Oxford Instruments’ central role in the development of superconducting magnets for MRI represents an historical achievement of international significance.
A phylogenomic approach to resolving interrelationships of polyclad flatworms, with implications for life-history evolution
Authors: Goodheart Jessica A. , Collins Allen G. , Cummings Michael P. , Egger Bernhard , Rawlinson Kate A.
Published: March 2023

Platyhelminthes (flatworms) are a diverse invertebrate phylum useful for exploring life-history evolution. Within Platyhelminthes, only two clades develop through a larval stage: free-living polyclads and parasitic neodermatans. Neodermatan larvae are considered evolutionarily derived, whereas polyclad larvae are hypothesized to be ancestral due to ciliary band similarities among polyclad and other spiralian larvae. However, larval evolution has been challenging to investigate within polyclads due to low support for deeper phylogenetic relationships. To investigate polyclad life-history evolution, we generated transcriptomic data for 21 species of polyclads to build a well-supported phylogeny for the group. The resulting tree provides strong support for deeper nodes, and we recover a new monophyletic clade of early branching cotyleans. We then used ancestral state reconstructions to investigate ancestral modes of development within Polycladida and more broadly within flatworms. In polyclads, we were unable to reconstruct the ancestral state of deeper nodes with significant support because early branching clades show diverse modes of development. This suggests a complex history of larval evolution in polyclads that likely includes multiple losses and/or multiple gains. However, our ancestral state reconstruction across a previously published platyhelminth phylogeny supports a direct developing prorhynchid/polyclad ancestor, which suggests that a larval stage in the life cycle evolved along the polyclad stem lineage or within polyclads.
Organic or junk food? Microplastic contamination in Antarctic krill and salps
Authors: Wilkie Johnston Laura , Bergami Elisa , Rowlands Emily , Manno Clara
Published: March 2023

Microplastics (MP) have been reported in Southern Ocean (SO), where they are likely to encounter Antarctic zooplankton and enter pelagic food webs. Here we assess the presence of MP within Antarctic krill (
Euphausia superba
) and salps (
Salpa thompsoni
) and quantify their abundance and type by micro-Fourier transform infrared microscopy. MP were found in both species, with fibres being more abundant than fragments (krill: 56.25% and salps: 22.32% of the total MP). Polymer identification indicated MP originated from both local and distant sources. Our findings prove how
in situ
MP ingestion from these organisms is a real and ongoing process in the SO. MP amount was higher in krill (2.13 ± 0.26 MP ind
−1
) than salps (1.38 ± 0.42 MP ind
−1
), while MP size extracted from krill (130 ± 30 µm) was significantly lower than MP size from salps (330 ± 50 µm). We suggest that differences between abundance and size of MP ingested by these two species may be related to their food strategies, their ability to fragment MP as well as different human pressures within the collection areas of the study region. First comparative field-based evidence of MP in both krill and salps, two emblematic zooplankton species of the SO marine ecosystems, underlines that Antarctic marine ecosystems may be particularly sensitive to plastic pollution.
Can language representation models think in bets?
Authors: Tang Zhisheng , Kejriwal Mayank
Published: March 2023

In recent years, transformer-based language representation models (LRMs) have achieved state-of-the-art results on difficult natural language understanding problems, such as question answering and text summarization. As these models are integrated into real-world applications, evaluating their ability to make rational decisions is an important research agenda, with practical ramifications. This article investigates LRMs’ rational decision-making ability through a carefully designed set of decision-making benchmarks and experiments. Inspired by classic work in cognitive science, we model the decision-making problem as a bet. We then investigate an LRM’s ability to choose outcomes that have optimal, or at minimum, positive expected gain. Through a robust body of experiments on four established LRMs, we show that a model is able to ‘think in bets’ if it is first fine-tuned on bet questions with an identical structure. Modifying the bet question’s structure, while still retaining its fundamental characteristics, decreases an LRM’s performance by more than 25%, on average, although absolute performance remains well above random. LRMs are also found to be more rational when selecting outcomes with non-negative expected gain, rather than optimal or strictly positive expected gain. Our results suggest that LRMs could potentially be applied to tasks that rely on cognitive decision-making skills, but that more research is necessary before these models can robustly make rational decisions.
Highly contiguous genomes of human clinical isolates of Giardia duodenalis reveal assemblage- and sub-assemblage-specific presence–absence variation in protein-coding genes
Authors: Klotz Christian , Schmid Marc William , Winter Katja , Ignatius Ralf , Weisz Filip , Saghaug Christina Skar , Langeland Nina , Dawson Scott , Lalle Marco , Hanevik Kurt , Cacciò Simone M. , Aebischer Toni
Published: March 2023

Giardia duodenalis (syn. G. intestinalis, G. lamblia) is a widespread gastrointestinal protozoan parasite with debated taxonomic status. Currently, eight distinct genetic sub-groups, termed assemblages A–H, are defined based on a few genetic markers. Assemblages A and B may represent distinct species and are both of human public health relevance. Genomic studies are scarce and the few reference genomes available, in particular for assemblage B, are insufficient for adequate comparative genomics. Here, by combining long- and short-read sequences generated by PacBio and Illumina sequencing technologies, we provide nine annotated genome sequences for reference from new clinical isolates (four assemblage A and five assemblage B parasite isolates). Isolates chosen represent the currently accepted classification of sub-assemblages AI, AII, BIII and BIV. Synteny over the whole genome was generally high, but we report chromosome-level translocations as a feature that distinguishes assemblage A from B parasites. Orthologue gene group analysis was used to define gene content differences between assemblage A and B and to contribute a gene-set-based operational definition of respective taxonomic units. Giardia is tetraploid, and high allelic sequence heterogeneity (ASH) for assemblage B vs. assemblage A has been observed so far. Noteworthy, here we report an extremely low ASH (0.002%) for one of the assemblage B isolates (a value even lower than the reference assemblage A isolate WB-C6). This challenges the view of low ASH being a notable feature that distinguishes assemblage A from B parasites, and low ASH allowed assembly of the most contiguous assemblage B genome currently available for reference. In conclusion, the description of nine highly contiguous genome assemblies of new isolates of G. duodenalis assemblage A and B adds to our understanding of the genomics and species population structure of this widespread zoonotic parasite.
Health Circuit: a practice-proven adaptive case management approach for innovative healthcare services
Authors: Herranz Carmen , Martín Laura , Dana Fernando , Sisó-Almirall Antoni , Roca Josep , Cano Isaac
Published: March 2023

Digital health tools may facilitate care continuum. However, enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. The study presents Health Circuit, a digital health tool with an adaptive case management approach and analyses its healthcare impact, as well as its usability (SUS) and acceptability (NPS) by healthcare professionals and patients. In 2018-19, an initial prototype of Health Circuit was tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (Study I). In 2021, a pilot version of Health Circuit was evaluated in 104 high risk patients undergoing prehabilitation before major surgery (Study II). In study I, Health Circuit resulted in reduction of emergency room visits [4 (13%) vs 7 (44%)] and enhanced patients’ empowerment (p<0.0001) and showed good acceptability/usability scores (NPS 31 and SUS 54/100). In Study II, NPS scored 40 and SUS 85/100. The acceptance rate was also high (mean score of 8.4/10). Health Circuit showed potential for healthcare value generation, good both acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios.
Sterile faecal filtrate transplantation alters phage-microbe dynamics in individuals with metabolic syndrome: a double blind, randomised, placebo-controlled clinical trial assessing efficacy and safety
Authors: Wortelboer Koen , de Jonge Patrick A. , Scheithauer Torsten P.M. , Attaye Ilias , Marleen Kemper E. , Nieuwdorp Max , Herrema Hilde
Published: March 2023

Objective

Bacteriophages (phages) are viruses of bacteria and have been shown to shape microbial communities. Previous studies have shown that altering the microbiota through faecal microbiota transplantation (FMT) can improve insulin resistance in individuals with metabolic syndrome (MetSyn). Interestingly, similar effects were observed in diet-induced obese mice after a faecal virome transplantation (FVT), raising the question whether phages of a healthy donor can improve glucose metabolism in individuals with MetSyn as well.

Design

We performed a double-blind, randomised, placebo-controlled pilot study in which 24 individuals with MetSyn were randomised to receive a sterile faecal filtrate transplantation (FFT) from a lean healthy donor or a placebo. From baseline up to 28 days, we assessed safety, effects on glucose metabolism, and longitudinal changes within the bacteriome and phageome.

Results

The FFT was well-tolerated and safe and glucose variability (time between 3.9-10 mmol/L glucose) improved in the week following the FFT. Glucose excursions during oral glucose tolerance tests were comparable in both the FFT and placebo group after 28 days. The phage virion composition was significantly altered two days after FFT as compared to placebo. Moreover, we found that FFT induced more virulent phage-microbe interactions within the first two days after administration, while these interactions appeared more temperate in the placebo group.

Conclusion

We provide evidence that gut phages from a healthy donor can be safely administered to transiently alter the gut microbiota of recipients, thereby providing a critical basis for follow-up studies.

Trial registration number

Dutch Trial Registry: NL8289
Prediction of a major adverse coronary event in Women through CORSWO
Authors: Romero-Farina Guillermo , Aguadé-Bruix Santiago , Ferreira-González Ignacio
Published: March 2023

BACKGROUND

In women, risk stratification for a major adverse coronary event (MACE) is complex, and moreover women have often been underrepresented in cardiovascular studies. This study aims to establish aCOronaryRiskScore inWOmen (CORSWO) to predict MACE.

METHODS

From a cohort of 25,943 consecutive patients referred for clinical gSPECT-MPI (gated single-photon emission computed tomography myocardial perfusion imaging), 2,226 women (aged 66.7±11.6 years) were included. During the follow-up (mean 4±2.7 years) post gSPECT-MPI, MACE (unstable-angina requiring hospitalization, non-fetal myocardial infarction, coronary revascularization, cardiac death) was assessed. The patients were divided into training (n=1460) and validation (n=766) groups. To obtain the predictor model, LASSO-regression analysis with 10-fold cross-validation was used.

RESULTS

In training group, 148 women had MACE (0.026/patient/year). The best model (ROC area:0.8, Brier score:0.0777) to stratify women included: age >69 years (OR:1.6); diabetes mellitus (OR:2); angina-history (OR:1.6); nitrate (OR:1.5); left bundle branch block (OR:1.2); pharmacological test (OR:1.6); ST-segment-depression (≥1mm) (OR:2); stress angina (OR:1.3); myocardial ischemia >5% (OR:2.6); perfusion defect at rest >9% (OR:2.4); perfusion defect at stress >6% (OR:1.7); end-systolic volume index >15 ml (OR:1.6); and left ventricular ejection fraction <50% (OR:1.2). This model was validated (validation group) with a strong prediction (ROC area:0.8, Brier score:0.0747). The CORSWO obtained from these variables allows the stratification of women into five risk levels: very low (score:0,HR:1), low (score:1-2,HR:1.5), moderate (score:3-6,HR:2.7), high (score:7-10,HR:6.9) and very high (score:≥11,HR:21.7).

CONCLUSIONS

In a clinical practice setting we can obtain an excellent coronary risk stratification in women, however at the expense of multiple variables.

CLINICAL PERSPECTIVE

What Is New?

The coronary risk stratification of women depends on of the multiple clinical, exercise and imaging variables.

This new risk score allows the risk to be calculated for individual women in a simple way with a mean of a 4-year follow-up.

What Are the Clinical Implications?

CORSWO is an effective tool to stratify the risk for major adverse coronary event in 5 risk levels, very low, low, moderate, high and very high risk with a good accuracy.
Measuring extracellular human brain pH and amino acid metabolism with hyperpolarized [1-13C]pyruvate
Authors: Khan Alixander S , McLean Mary A , Kaggie Joshua D , Horvat-Menih Ines , Matys Tomasz , Schulte Rolf F , Locke Matthew J , Grimmer Ashley , Wodtke Pascal , Latimer Elizabeth , Frary Amy , Graves Martin J , Gallagher Ferdia A
Published: March 2023

Hyperpolarized carbon-13 MRI has shown promise for non-invasive assessment of the cerebral metabolism of [1-13C]pyruvate in both healthy volunteers and in patients. Exchange of pyruvate to lactate catalyzed by lactate dehydrogenase (LDH), and pyruvate flux to bicarbonate through pyruvate dehydrogenase (PDH), are the most widely studied reactionsin vivo. Here we show the potential of the technique to probe other metabolic reactions in the human brain. Approximately 50 s after intravenous injection of hyperpolarized pyruvate, high flip angle pulses were used to detect cerebral13C-labelled carbon dioxide (13CO2), in addition to the13C-bicarbonate (H13CO2-) subsequently formed by carbonic anhydrase. Brain pH weighted towards the extracellular compartment was calculated from the ratio of H13CO3-to13CO2in seven volunteers using the Henderson-Hasselbalch equation, demonstrating an average pH ± S.D. of 7.40 ± 0.02, with inter-observer reproducibility of 0.04. In addition, hyperpolarized [1-13C]aspartate was also detected in four of nine volunteers demonstrating irreversible pyruvate carboxylation to oxaloacetate by pyruvate carboxylase (PC), and subsequent transamination by aspartate aminotransferase (AST), with this flux being approximately 6% of that through PDH. Hyperpolarized [1-13C]alanine signal was also detected within the head but this was localized to muscle tissue in keeping with skeletal alanine aminotransferase (ALT) activity. The results demonstrate the potential of hyperpolarized carbon-13 MRI to assess cerebral and extracerebral [1-13C]pyruvate metabolism in addition to LDH and PDH activity. Non-invasive measurements of brain pH could be particularly important in assessing cerebral pathology given the wide range of disease processes that alter acid-base balance.