bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterizing multimorbidity in ALIVE: comparing single and ensemble clustering methods
Authors: Rudolph Jacqueline E , Lau Bryan , Genberg Becky L , Sun Jing , Kirk Gregory D , Mehta Shruti H
Published: April 2024

Multimorbidity, defined as having 2 or more chronic conditions, is a growing public health concern, but research in this area is complicated by the fact that multimorbidity is a highly heterogenous outcome. Individuals in a sample may have a differing number and varied combinations of conditions. Clustering methods, such as unsupervised machine learning algorithms, may allow us to tease out the unique multimorbidity phenotypes. However, many clustering methods exist, and choosing which to use is challenging because we do not know the true underlying clusters. Here, we demonstrate the use of 3 individual algorithms (partition around medoids, hierarchical clustering, and probabilistic clustering) and a clustering ensemble approach (which pools different clustering approaches) to identify multimorbidity clusters in the AIDS Linked to the Intravenous Experience cohort study. We show how the clusters can be compared based on cluster quality, interpretability, and predictive ability. In practice, it is critical to compare the clustering results from multiple algorithms and to choose the approach that performs best in the domain(s) that aligns with plans to use the clusters in future analyses.
Aesthetic Potential and Safety Profile of Nanotextured Breast Implants in 1000 Cases of Breast Augmentation: Evaluation of a Single-Center Experience
Authors: Szychta Pawel
Published: April 2024

Background

Nanotextured implants, an innovation in implant technology, are designed to enhance tissue interaction, reduce inflammation, and mitigate complications of traditional implants.

Objectives

The aim of the study was to evaluate the aesthetic potential and safety profile of nanotextured breast implants in breast augmentation from a single-surgeon experience.

Methods

This prospective cohort study included 1000 patients who underwent breast augmentation with nanotextured implants. Aesthetic outcomes were assessed with direct measurements and BCCT.core software, focusing on breast projection, symmetry, and upper pole fullness. Patient satisfaction was measured with BREAST-Q and overall satisfaction surveys. Safety profiles were evaluated based on the incidence of complications such as infection, hematoma, capsular contracture, and implant rupture. Statistical analyses were conducted to assess the outcomes.

Results

The study found significant improvements in aesthetic outcomes, with 92.8% of cases achieving substantial aesthetic enhancements. Patient satisfaction was high, with 96.4% of patients reporting enhanced self-esteem and contentment. The safety profile was favorable, with a low incidence of complications (0.7% requiring revisional surgery) and no major complications reported. Long-term follow-up data indicated sustained aesthetic outcomes and a stable safety profile.

Conclusions

The synergistic quality of nanotextured implants in relation to the natural breast gland tissue is defined by a significantly wider range of aesthetic options. The findings of this study underscore the positive impact of nanotextured breast implants on enhancing the aesthetic potential of breast augmentation and their contribution to a low incidence of complications.

Level of Evidence: 3
ExplaineR: an R package to explain machine learning models
Authors: Zargari Marandi Ramtin
Published: April 2024

SHapley Additive exPlanations (SHAP) is a widely used method for model interpretation. However, its full potential often remains untapped due to the absence of dedicated software tools. In response, ExplaineR, an R package to facilitate interpretation of binary classification and regression models based on clustering functionality for SHAP analysis is introduced here. It additionally offers user-interactive elements in visualizations for evaluating model performance, fairness analysis, decision-curve analysis, and a diverse range of SHAP plots. It facilitates in-depth post-prediction analysis of models, enabling users to pinpoint potentially significant patterns in SHAP plots and subsequently trace them back to instances through SHAP clustering. This functionality is particularly valuable for identifying patient subgroups in clinical cohorts, thus enhancing its role as a robust profiling tool. ExplaineR empowers users to generate comprehensive reports on machine learning outcomes, ensuring consistent and thorough documentation of model performance and interpretations.

Availability and implementation

ExplaineR 1.0.0 is available on GitHub (https://persimune.github.io/explainer/) and CRAN (https://cran.r-project.org/web/packages/explainer/index.html).
When Social Workers Are Given Dual Mandates: Child Maintenance and the Complexities of Family Situations in the Ghanaian Child Protection System
Authors: Abdullah Alhassan , Frimpong-Manso Kwabena , Cudjoe Ebenezer , Agbadi Pascal
Published: April 2024

Custodial parents, often single mothers, face challenges regarding child maintenance, including a lack of financial commitments from non-custodial parents for their children’s welfare. The evidence suggests that there is a strong link between child maintenance and poverty as well as other family violence issues. In addition to their primary child and family protection duties, child protection practitioners in Ghana have a mandate to assess child maintenance concerns. This dual responsibility may have the advantage of promoting holistic child and family practices, but it could also negatively impact families when practitioners overly focus on one responsibility at the expense of the other. We sought to understand and show whether families who reported child maintenance concerns to the Department of Social Welfare and Community Development in Ghana experienced challenges beyond child maintenance and whether practitioners identified these primary protection concerns in their assessments. Findings from qualitative in-depth interviews with seventeen parents show that these families experienced domestic violence, marital conflict and child abuse and neglect beyond the scope of a standard child maintenance case. The findings highlight the importance of child protection workers conducting comprehensive family assessments to resolve ‘hidden’ family difficulties when establishing child maintenance arrangements.
Low-Risk Staphylococcus aureus Bacteremia Patients Do Not Require Routine Diagnostic Imaging: A Multicenter, Retrospective, Cohort Study
Authors: Hendriks Marianne M C , Schweren Kris S A , Kleij Ayden , Berrevoets Marvin A H , de Jong Emma , van Wijngaarden Peter , Ammerlaan Heidi S M , Vos Anja , van Assen Sander , Slieker Kitty , Gisolf Jet H , Netea Mihai G , ten Oever Jaap , Kouijzer Ilse J E
Published: April 2024

Background

Stratification to categorize patients with Staphylococcus aureus bacteremia (SAB) as low or high risk for metastatic infection may direct diagnostic evaluation and enable personalized management. We investigated the frequency of metastatic infections in low-risk SAB patients, their clinical relevance, and whether omission of routine imaging is associated with worse outcomes.

Methods

We performed a retrospective cohort study at 7 Dutch hospitals among adult patients with low-risk SAB, defined as hospital-acquired infection without treatment delay, absence of prosthetic material, short duration of bacteremia, and rapid defervescence. Primary outcome was the proportion of patients whose treatment plan changed due to detected metastatic infections, as evaluated by both actual therapy administered and by linking a adjudicated diagnosis to guideline-recommended treatment. Secondary outcomes were 90-day relapse-free survival and factors associated with the performance of diagnostic imaging.

Results

Of 377 patients included, 298 (79%) underwent diagnostic imaging. In 15 of these 298 patients (5.0%), imaging findings during patient admission had been interpreted as metastatic infections that should extend treatment. Using the final adjudicated diagnosis, 4 patients (1.3%) had clinically relevant metastatic infection. In a multilevel multivariable logistic regression analysis, 90-day relapse-free survival was similar between patients without imaging and those who underwent imaging (81.0% versus 83.6%; adjusted odds ratio, 0.749; 95% confidence interval, .373–1.504).

Conclusions

Our study advocates risk stratification for the management of SAB patients. Prerequisites are follow-up blood cultures, bedside infectious diseases consultation, and a critical review of disease evolution. Using this approach, routine imaging could be omitted in low-risk patients.
Acute aortic catastrophe caused by cardiovascular oncological manipulation by tyrosine kinase inhibitors with immune checkpoint blockades: a case report and literature review
Authors: Sultan Sherif , Acharya Yogesh , Donnellan Paul , Hynes Niamh , Kerin Michael , Soliman Osama
Published: April 2024

Background

Tyrosine kinase inhibitors targeting the vascular endothelial growth factor (VEGF) inhibitor pathway with immune checkpoint blockade have shown promising outcomes in managing metastatic renal cancer. However, they increase the risk of a person developing high blood pressure and cardiovascular complications.

Case summary

In this study, we report the case of a 73-year-old woman on axitinib and pembrolizumab for her Stage 4 renal cell carcinoma. She presented with intractable chest pain and high systolic blood pressure, not responding to opiates. Her computed tomography angiography results showed an acute intra-mural haematoma with a rupture in the descending thoracic aorta. She underwent emergency thoracic endovascular aortic repair. Post-operatively, she recovered fully without any neurological or cardiovascular issues.

Discussion

The severity of cardiovascular haemodynamic complications arising from the consumption of VEGF inhibitors and from immunotherapy and the lack of anti-hypertensive strategies to adequately manage such events require an unequivocal and urgent assessment of their cardiovascular safety. This case highlights the crucial role of cardiovascular oncology in managing such acute aortic catastrophes.
Early outcomes after post-cardiotomy extracorporeal membrane oxygenation in paediatric patients: a contemporary, binational cohort study
Authors: Crawford Lachlan , Marathe Supreet P , Betts Kim S , Karl Tom R , Mattke Adrian , Rahiman Sarfaraz , Campbell Isobella , Inoue Takamichi , Nair Harikrishnan , Iyengar Ajay , Konstantinov Igor E ,   ANZCORS Collaborative, Andrews David , Artrip John , Brink Johann , Brizard Christian , Davies Ben , Finucane Kirsten , Johnson Janelle , Liava'a Matt , Nicholson Ian , Patukale Aditya , Venugopal Prem , Alphonso Nelson
Published: April 2024

OBJECTIVES

The aim of this study was to assess the early outcomes and risk factors of paediatric patients requiring extracorporeal membrane oxygenation after cardiac surgery (post-cardiotomy).

METHODS

Retrospective binational cohort study from the Australia and New Zealand Congenital Outcomes Registry for Surgery database. All patients younger than 18 years of age who underwent a paediatric cardiac surgical procedure from 1 January 2013 to 31 December 2021 and required post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) in the same hospital admission were included in the study.

RESULTS

Of the 12 290 patients included in the study, 376 patients required post-cardiotomy ECMO (3%). Amongst these patients, hospital mortality was 35.6% and two-thirds of patients experienced a major complication. Hypoplastic left heart syndrome was the most common diagnosis (17%). The Norwood procedure and modified Blalock–Taussig shunts had the highest incidence of requiring PC-ECMO (odds ratio of 10 and 6.8 respectively). Predictors of hospital mortality after PC-ECMO included single-ventricle physiology, intracranial haemorrhage and chylothorax.

CONCLUSIONS

In the current era, one-third of patients who required PC-ECMO after paediatric cardiac surgery in Australia and New Zealand did not survive to hospital discharge. The Norwood procedure and isolated modified Blalock–Taussig shunt had the highest incidence of requiring PC-ECMO. Patients undergoing the Norwood procedure had the highest mortality (48%). Two-thirds of patients on PC-ECMO developed a major complication.
Financial inclusion and nutrition among rural households in Rwanda
Authors: Bali Swain Ranjula , Nsabimana Aimable
Published: April 2024

Using Rwandan Integrated Household Living Conditions surveys (2013/2014 and 2016/17), we investigate whether financial inclusion leads to improved nutrition in rural Rwanda. Our empirical evidence shows a robust positive impact of financial inclusion by formal financial institutions, although informal institutions like tontines were ineffective in improving food expenditure or nutrition. Furthermore, the heterogeneous marginal effects of financial inclusion reduce the gender gap between the food expenditure and nutrition of female- and male-headed households. The results, hence, suggest that the country should promote formal financial inclusion to provide wide-ranging welfare effects by improving food security, nutrition and food expenditure in its rural communities.
Combination of the CRAC Channel Inhibitor CM4620 and Galactose as a Potential Therapy for Acute Pancreatitis
Authors: Lewis Siân , Evans David L , Tsugorka Tetyana T , Peng Shuang , Stauderman Ken , Gerasimenko Oleg , Gerasimenko Julia
Published: April 2024

Acute pancreatitis (AP) is a life-threatening inflammatory disease with no specific therapy. Excessive cytoplasmic Ca2+ elevation and intracellular ATP depletion are responsible for the initiation of AP. Inhibition of Ca2+ release–activated Ca2+ (CRAC) channels has been proposed as a potential treatment, and currently, a novel selective CRAC channel inhibitor CM4620 (Auxora, CalciMedica) is in Phase 2b human trials. While CM4620 is on track to become the first effective treatment for AP, it does not produce complete protection in animal models. Recently, an alternative approach has suggested reducing ATP depletion with a natural carbohydrate galactose. Here, we have investigated the possibility of using the smallest effective concentration of CM4620 in combination with galactose. Protective effects of CM4620, in the range of 1-100 n m, have been studied against necrosis induced by bile acids, palmitoleic acid, or l-asparaginase. CM4620 markedly protected against necrosis induced by bile acids or asparaginase starting from 50 n m and palmitoleic acid starting from 1 n m. Combining CM4620 and galactose (1 m m) significantly reduced the extent of necrosis to near-control levels. In the palmitoleic acid-alcohol–induced experimental mouse model of AP, CM4620 at a concentration of 0.1 mg/kg alone significantly reduced edema, necrosis, inflammation, and the total histopathological score. A combination of 0.1 mg/kg CM4620 with galactose (100 m m) significantly reduced further necrosis, inflammation, and histopathological score. Our data show that CM4620 can be used at much lower concentrations than reported previously, reducing potential side effects. The novel combination of CM4620 with galactose synergistically targets complementary pathological mechanisms of AP.
Addressing Cognitive Assessment Disparities Among Hispanic Adults: Adapting the MoCA-SA for Improved Accuracy and Accessibility Among Spanish Speakers
Authors: Piedra Lissette M , Iveniuk James , Howe Melissa J K , Pudelek Kelly , Marquez David X
Published: April 2024

Objectives

Hispanic adults display a higher likelihood of early-stage cognitive decline than their White counterparts yet receive fewer clinical diagnoses. This troubling trend highlights the significance of longitudinal surveys like the National Social Life, Health, and Aging Project (NSHAP) in monitoring cognitive changes in aging Hispanics. Using NSHAP’s Rounds 2 and 3, we observed notable cognitive score differences between English and Spanish speakers, as assessed by the survey-adapted version of the Montreal Cognitive Assessment (MoCA-SA). Our study aims to discern if statistical adjustments can reduce measurement variance in global cognition scores between these language groups.

Methods

We applied modification indexes, 2-parameter item response theory models, and split-sample testing to pinpoint items that exhibit resilience to language-related bias among our Hispanic sample. From this analysis, an abbreviated version of the MoCA-SA, termed MoCA-SAA, was introduced. Subsequently, we juxtaposed the performance and predictive validity of both MoCA versions against four consequential outcomes indicative of cognitive decline.

Results

Our refined methodologies enabled the identification of consistent items across both language cohorts. The MoCA-SAA demonstrated performance and predictive validity in line with the original MoCA-SA concerning outcomes linked to cognitive deterioration.

Discussion

The translated measures ensure the inclusion of Hispanic Spanish speakers in NSHAP, who might otherwise be overlooked. The statistical adjustment outlined in this study offers a means to mitigate potential measurement disparities when assessing overall cognition. Despite these advancements, we acknowledge persistent issues related to the translation of the MoCA-SA into Spanish that warrant further attention.
Joint data and model-driven simultaneous inversion of velocity and density
Authors: Chen Guoxin , Chen Jinxin , Jensen Kristian , Li Chunfeng , Chen Shengchang , Wang Hanchuang , Li Jun , Qi Yuli , Huang Xingguo
Published: April 2024

Density is an important parameter for both geological research and geophysical exploration. However, for model-driven seismic inversion methods, high-fidelity density inversion is challenging due to seismic wave traveltime insensitivity to density and crosstalk that density has with velocity. To circumvent the challenge of density inversion, some inversion methods treat density as a constant value or derive density from velocity through empirical equation. On the other hand, deep learning approaches are completely driven by data and have strong target-oriented characteristics, offering a new way to solve multiparameter coupling problems. Nevertheless, the accuracy of the inversion results of data-driven algorithms is directly related to the amount and diversity of the training data, and thus, they lack the universality of model-driven algorithms. To achieve accurate density inversion, we propose a simultaneous inversion algorithm for velocity and density that combines the advantages of data- and model- driven approaches: A neural network model (U-T), combining the U-net and Transformer architectures, is proposed to construct non-linear mappings between seismic data as inputs and the velocity and density as predictions. Next, the model-driven inversion algorithm uses the U-T prediction as the initial model to obtain the final accurate solution. In the model-driven module, envelope-based sparse constrained deconvolution is used to obtain full-band seismic data, while a variable dominant frequency full waveform inversion algorithm is used to perform multiscale inversion, ultimately leading to accurate inversion results of velocity and density. The performance of the algorithm on the Sigsbee2A and Marmousi models demonstrates its effectiveness.
Print Dictionaries Are Still in Use: A Survey of Source Preferences by Polish Translators
Authors: Sycz-Opoń Joanna
Published: April 2024

The study aimed to investigate the sources used by modern translators, specifically whether they use traditional lexicographic tools or diverted their preferences to newer sources of information. Data was collected via an online survey. The sample consisted of 229 mainly Polish translators of various languages and specialisations. It was found that the most frequently used source was the search engine, followed by Wikipedia/similar and online parallel texts. Officially published dictionaries are used often. Moreover, dictionaries were most often cited as the sources that translators could not imagine working without (34% of the total responses); 8% of the responses mentioned printed dictionaries as indispensable in translators’ work and these are used by 87% of the translators who took part in the study. Online dictionaries without a specified author are used by 83% of respondents, but 99% of them verify the content either regularly (50%) or occasionally (49%).
Evaluation of the stability of ceftazidime/avibactam in elastomeric infusion devices used for outpatient parenteral antimicrobial therapy utilizing a national stability protocol framework
Authors: Naicker Saiyuri , Roberts Jason A , Won Hayoung , Wallis Steven C , Unwin Sean , Jamieson Conor , Hills Tim , Gilchrist Mark , Santillo Mark , Seaton R Andrew , Drummond Felicity , Sime Fekade B
Published: April 2024

Objectives

To evaluate the stability of ceftazidime/avibactam in elastomeric infusers, utilizing the UK’s Yellow Cover Document (YCD) stability testing framework, in conditions representative of OPAT practice.

Methods

Ceftazidime/avibactam was reconstituted with sodium chloride 0.9% (w/v) in two elastomeric infusers at concentrations (dose) levels of 1500/375, 3000/750 and 6000 mg/1500 mg in 240 mL. The infusers were exposed to a fridge storage (2°C–8°C) for 14 days followed by 24 h in-use temperature (32°C).

Results

After 14 days of fridge storage and subsequent 24 h exposure to 32°C, mean ± SD of ceftazidime percent remaining was 75.5% ± 1.8%, 79.9% ± 1.1%, 82.4% ± 0.6%, for Easypump, and 81.7% ± 1.2%, 82.5% ± 0.5%, 85.4% ± 1.1% for Dosi-Fuser devices at the high, intermediate and low doses tested, respectively. For avibactam, mean ± SD percent remaining was 83.2% ± 1.8%, 87.4% ± 2.0%, 93.1% ± 0.9% for Easypump, and 85.1% ± 2.0%, 86.7% ± 0.1%, 92.5% ± 0.1% for Dosi-Fuser devices. The cumulative amount of pyridine generated in the devices ranged from 10.4 mg at low dose to 76.9 mg at high dose. Regression-based simulation showed that the degradation of both ceftazidime and avibactam was <10% for at least 12 h of the running phase, if stored in a fridge for not more than 72 h prior to in-use temperature exposure.

Conclusions

Whilst not meeting the strict UK YCD criteria for ≤5% degradation, ceftazidime/avibactam may be acceptable to administer as a continuous 12 hourly infusion in those territories where degradation of ≤10% is deemed acceptable.
Coffee berry borer (Coleoptera: Scolytidae) population dynamics across Hawaii Island’s diverse coffee-growing landscape: optimizing location-specific pesticide applications
Authors: Johnson Melissa A , Manoukis Nicholas C
Published: April 2024

A major challenge to area-wide management of coffee berry borer (Hypothenemus hampei Ferrari) (Coleoptera: Scolytidae) is understanding how a heterogeneous coffee-growing landscape affects coffee berry borer population dynamics across temporal and spatial scales. We examined coffee phenology, weather, coffee berry borer flight activity, infestation, coffee berry borer position within the fruit, and management across 14 commercial coffee farms from 2016 to 2018 on Hawaii Island to characterize variation among districts and elevations. Here we aim to determine whether the timing of pesticide applications might be optimized based on specific locations. We observed larger populations of coffee berry borer at low-elevation farms and in the Kona district compared to mid- and high-elevation farms and the Ka’u district. Temperature, relative humidity, and rainfall all differed significantly across districts and elevations. We also observed a trend of higher fruit production at low-elevation farms compared to high-elevation farms, and differences in the timing of fruit development. Infestation increased with higher pest pressure and air temperatures and reduced fruit availability early and late in the season. Lastly, the timing and number of management interventions varied among districts and elevations. Combining information on trap catch, infestation, coffee berry borer position, and plant phenology, we present an optimized pesticide spray schedule for each location and find that the number of sprays could be reduced by 33–75% in comparison to the existing integrated pest management recommendations while maintaining effective control. Implementing a coordinated area-wide approach refined by small-scale optimization will lead to improved management of coffee berry borer on individual farms and a reduction in pest pressure across the coffee-growing landscape.
MALrisk: a machine-learning–based tool to predict imported malaria in returned travellers with fever
Authors: Balerdi-Sarasola Leire , Fleitas Pedro , Bottieau Emmanuel , Genton Blaise , Petrone Paula , Muñoz Jose , Camprubí-Ferrer Daniel
Published: April 2024

Background

Early diagnosis is key to reducing the morbi-mortality associated with P. falciparum malaria among international travellers. However, access to microbiological tests can be challenging for some healthcare settings. Artificial Intelligence could improve the management of febrile travellers.

Methods

Data from a multicentric prospective study of febrile travellers were obtained to build a machine-learning model to predict malaria cases among travellers presenting with fever. Demographic characteristics, clinical and laboratory variables were leveraged as features. Eleven machine-learning classification models were evaluated by 50-fold cross-validation in a Training set. Then, the model with the best performance, defined by the Area Under the Curve (AUC), was chosen for parameter optimization and evaluation in the Test set. Finally, a reduced model was elaborated with those features that contributed most to the model.

Results

Out of 11 machine-learning models, XGBoost presented the best performance (mean AUC of 0.98 and a mean F1 score of 0.78). A reduced model (MALrisk) was developed using only six features: Africa as a travel destination, platelet count, rash, respiratory symptoms, hyperbilirubinemia and chemoprophylaxis intake. MALrisk predicted malaria cases with 100% (95%CI 96–100) sensitivity and 72% (95%CI 68–75) specificity.

Conclusions

The MALrisk can aid in the timely identification of malaria in non-endemic settings, allowing the initiation of empiric antimalarials and reinforcing the need for urgent transfer in healthcare facilities with no access to malaria diagnostic tests. This resource could be easily scalable to a digital application and could reduce the morbidity associated with late diagnosis.
The European energy crisis, the Dutch TTF, and the market correction mechanism: a financial markets perspective
Authors: Rogge Ebbe
Published: April 2024

In September 2022, the Title Transfer Facility (TTF) prices spiked at unprecedented levels. For various reasons, including the Russian invasion of Ukraine, Europe was facing an energy crisis: gas supply was significantly reduced while demand remained unchanged. Policymakers responded with a variety of measures, including regulatory interventions on the TTF market. While seeking to improve the situation in the ‘real world economy’, these measures have an important financial regulatory angle. This article investigates the potential impact of these interventions, in particular of the Market Correction Mechanism, on the wholesale gas market from a financial markets perspective. Considering, amongst others, observations from the EU Agency for the Cooperation of Energy Regulators, the European Securities and Markets Authority, and the European Central Bank, it appears that these interventions may have unintended negative consequences in light of the functioning and attractiveness of the Capital Markets Union and achieving strategic autonomy.
Analyticity with extra-logical information
Authors: Piazza Mario , Tesi Matteo
Published: April 2024

In this paper, a new approach to the issue of extra-logical information within analytic (i.e. obeying the sub-formula property) sequent systems is introduced. We prove that incorporating extra-logical axioms into a purely logical system can preserve analyticity, provided these axioms belong to a suitable class of formulas that can be decomposed into a set of equivalent initial sequents and are permutable over the cut rule. Our approach is applicable not only to first-order classical and intuitionistic logics, but also to substructural logics. Furthermore, we establish a limit for the augmented systems under analysis: exceeding the boundaries of their respective classes of extra-logical axioms leads to either a loss of analyticity or a loss of structural properties.
The relationship between simulated sub-millimeter and near-infrared images of Sagittarius A* from a magnetically arrested black hole accretion flow
Authors: Grigorian A A , Dexter J
Published: April 2024

Sagittarius A* (Sgr A*), the supermassive black hole at the centre of the Milky Way, undergoes large-amplitude near-infrared (NIR) flares that can coincide with the continuous rotation of the NIR emission region. One promising explanation for this observed NIR behaviour is a magnetic flux eruption, which occurs in three-dimensional General Relativistic Magneto-Hydrodynamic (3D GRMHD) simulations of magnetically arrested accretion flows. After running two-temperature 3D GRMHD simulations, where the electron temperature is evolved self-consistently along with the gas temperature, it is possible to calculate ray-traced images of the synchotron emission from thermal electrons in the accretion flow. Changes in the gas-dominated (σ = b2/2ρ < 1) regions of the accretion flow during a magnetic flux eruption reproduce the NIR flaring and NIR emission region rotation of Sgr A* with durations consistent with observation. In this paper, we demonstrate that these models also predict that large (1.5x – 2x) size increases of the sub-millimeter (sub-mm) and millimeter (mm) emission region follow most NIR flares by 20–50 min. These size increases occur across a wide parameter space of black hole spin (a = 0.3, 0.5, −0.5, and 0.9375) and initial tilt angle between the accretion flow and black hole spin axes θ0 (θ0 = 0°, 16°, and 30°). We also calculate the sub-mm polarization angle rotation and the shift of the sub-mm spectral index from zero to –0.8 during a prominent NIR flare in our high spin (a = 0.9375) simulation. We show that, during a magnetic flux eruption, a large (∼10rg), magnetically dominated (σ > 1), low-density, and high-temperature ‘bubble’ forms in the accretion flow. The drop in density inside the bubble and additional electron heating in accretion flow between 15rg and 25rg leads to a sub-mm size increase in corresponding images.
Les données probantes et les recommandations sur le cannabis à des fins médicales chez les enfants
Authors: Kelly Lauren E , Rieder Michael J , Finkelstein Yaron
Published: April 2024

L’intérêt envers l’utilisation des produits du cannabis à des fins médicales chez les enfants de moins de 18 ans augmente. De nombreux produits du cannabis à des fins médicales contiennent du cannabidiol, du delta-9-tétrahydrocannabinol ou ces deux produits. Malgré les nombreuses prétentions thérapeutiques, peu d’études rigoureuses guident la posologie, l’innocuité et l’efficacité du cannabis à des fins médicales en pédiatrie clinique. Le présent document de principes passe en revue les données probantes à jour et expose les recommandations sur l’utilisation du cannabis à des fins médicales chez les enfants. Les rapports à plus long terme (deux ans) souscrivent à la tolérabilité et à l’efficacité soutenues d’un traitement au cannabidiol chez les patients ayant le syndrome de Lennox-Gastaut ou le syndrome de Dravet. Les extraits de cannabis enrichis de cannabidiol qui renferment de petites quantités de delta-9-tétrahydrocannabinol ont été évalués auprès d’un petit nombre de patients d’âge pédiatrique, et d’autres recherches devront être réalisées pour éclairer les guides de pratique clinique. Étant donné l’utilisation répandue du cannabis à des fins médicales au Canada, les pédiatres devraient être prêts à participer à des échanges ouverts et continus avec les familles au sujet de ses avantages potentiels et de ses risques, ainsi qu’à préparer des plans individuels en vue d’en surveiller l’efficacité, de réduire les méfaits et de limiter les interactions médicamenteuses.
La prise en charge de l’asthme léger et très léger chez les enfants d’âge préscolaire, les enfants et les adolescents
Authors: Yang Connie L , Zysman-Colman Zofia , Chétrit Estelle , Hicks Anne , Reisman Joseph , Glicksman Amy
Published: April 2024

Le présent point de pratique résume la mise à jour des lignes directrices de la Société canadienne de thoracologie publiée en 2021 sur le diagnostic et la prise en charge de l’asthme chez les enfants d’âge préscolaire, les enfants et les adultes. Ces nouvelles recommandations incluent, parmi les critères de contrôle de l’asthme, une diminution de la fréquence des symptômes diurnes et de l’utilisation de médicaments pour soulager l’asthme à un maximum de deux fois par semaine. Elles comprennent également l’évaluation du risque d’exacerbation de l’asthme, la non-utilisation de bêta-agonistes à courte durée d’action seuls au besoin chez les patients à plus fort risque d’exacerbation et la possibilité d’administrer du budésonide-formotérol au besoin aux jeunes de 12 ans ou plus qui sont incapables de prendre des corticostéroïdes inhalés au quotidien malgré une éducation sur l’asthme et un soutien importants. La préférence pour la prise quotidienne de corticostéroïdes inhalés afin de traiter l’asthme léger chez les enfants et la recommandation d’éviter les courts traitements intermittents de corticostéroïdes inhalés ne changent pas.
High-throughput quantification of quasistatic, dynamic and spall strength of materials across 10 orders of strain rates
Authors: Eswarappa Prameela Suhas , Walker Christopher C , DiMarco Christopher S , Mallick Debjoy D , Sun Xingsheng , Hernandez Stephanie , Sasaki Taisuke , Wilkerson Justin W , Ramesh K T , Pharr George M , Weihs Timothy P
Published: April 2024

The response of metals and their microstructures under extreme dynamic conditions can be markedly different from that under quasistatic conditions. Traditionally, high strain rates and shock stresses are achieved using cumbersome and expensive methods such as the Kolsky bar or large spall experiments. These methods are low throughput and do not facilitate high-fidelity microstructure–property linkages. In this work, we combine two powerful small-scale testing methods, custom nanoindentation, and laser-driven microflyer (LDMF) shock, to measure the dynamic and spall strength of metals. The nanoindentation system is configured to test samples from quasistatic to dynamic strain-rate regimes. The LDMF shock system can test samples through impact loading, triggering spall failure. The model material used for testing is magnesium alloys, which are lightweight, possess high-specific strengths, and have historically been challenging to design and strengthen due to their mechanical anisotropy. We adopt two distinct microstructures, solutionized (no precipitates) and peak-aged (with precipitates) to demonstrate interesting upticks in strain-rate sensitivity and evolution of dynamic strength. At high shock-loading rates, we unravel an interesting paradigm where the spall strength vs. strain rate of these materials converges, but the failure mechanisms are markedly different. Peak aging, considered to be a standard method to strengthen metallic alloys, causes catastrophic failure, faring much worse than solutionized alloys. Our high-throughput testing framework not only quantifies strength but also teases out unexplored failure mechanisms at extreme strain rates, providing valuable insights for the rapid design and improvement of materials for extreme environments.
Evaluating the effects of co-response teams in reducing subsequent hospitalization: A place-based randomized controlled trial
Authors: Yang Sue-Ming , Lu Yi-Fang
Published: April 2024

Responding to incidents involving individuals with mental illness has been a challenge for police officers. While co-response teams have been embraced as an effective police response strategy, most prior evaluation studies on co-response teams focused on outcomes that are not directly related to individuals’ subsequent mental health state. Additionally, the lack of experimental research hinders our ability to draw causal conclusions on the effects of co-response teams. To address this knowledge gap, this study evaluated the effectiveness of co-response teams on hospitalization outcomes of individuals in crisis using a place-based randomized controlled trial in southwest Virginia. Street segments with high volumes of mental health calls for service were randomly assigned to either treatment hotspots (n = 113) or control hotspots (n = 115). The results suggest that the co-response teams had a significant effect on reducing subsequent hospitalizations, with an estimated effect size of −0.22. The findings, challenges, and recommendations for future co-response team implementations were discussed.
Out of Many, One? Exploring Ethnolinguistic Identity Appeals in the Brussels Capital Region
Authors: Blanckaert Benjamin , Caluwaerts Didier
Published: April 2024

Consociationalism promises to resolve tensions among groups in deeply divided societies by constructing shared identity that transcends ethnic divisions. Yet there is no guarantee that this will happen, and empirical studies testing this claim yield inconsistent results. We examine the extent to which political parties appeal to shared identities within a consociation, focusing on the Brussels Capital Region (BCR) in Belgium. The BCR constitutes a regional consociation aimed at addressing divisions between Dutch and French speakers. Based on a quantitative analysis of party programs, and a qualitative analysis of thirty interviews with Brussels MPs, our findings indicate that parties do indeed appeal to a common sense of belonging, often on issues that have a low ethnolinguistic salience. When addressing contentious community matters, however, we observe that Dutch-speaking parties (especially ethnic outbidders) prioritize their own linguistic group identity more than Francophone parties.
Incidence and risk factors of mental illnesses among patients with systemic autoimmune rheumatic diseases: an 18-year population-based study
Authors: Chu Wei-Min , Chao Wen-Cheng , Chen Der-Yuan , Ho Wei-Li , Chen Hsin-Hua
Published: April 2024

Objective

This study aimed to assess the incidence and risk factors surrounding mental illnesses in patients diagnosed with systemic autoimmune rheumatic diseases (SARDs).

Methods

This retrospective cohort study used nationwide, population-based claim data taken from Taiwan’s National Health Insurance Research Database (NHIRD) to identify patients certified as having a catastrophic illness for systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), dermatomyositis (DM), polymyositis (PM) or Sjögren’s syndrome (SS) from the years 2002–2020. We furthermore calculated the incidence of mental illness in patients diagnosed with SARDs while exploring factors associated with the development of mental illness using multivariable Cox regression analysis shown as adjusted hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

Among the 28 588 participants, the average age was 47.4 (SD 14.9) years, with most participants being female (76.4%). When compared with patients with rheumatoid arthritis, patients with SLE (HR: 1.20, 95% CI: 1.10–1.32), SS (HR: 1.29, 95% CI: 1.19–1.39), and DM (HR: 1.28, 95% CI: 1.04–1.32) showed a significantly increased risk of developing mental illness. Additionally, when compared with patients with rheumatoid arthritis, patients with SLE (HR: 1.32, 95% CI: 1.21–1.44), SSc (HR: 1.20, 95% CI: 1.02–1.41), SS (HR: 1.17, 95% CI: 1.08–1.26), DM (HR: 1.73, 95% CI: 1.44–2.07), and PM (HR: 1.64, 95% CI: 1.32–2.03) showed a significantly increased risk of antidepressant use.

Conclusion

This population-based cohort study revealed that patients diagnosed with SLE, SS, and DM had significantly higher risks of developing mental illness when compared with patients with RA.
Proximal tubular MBD2 promotes autophagy to drive the progression of AKI caused by vancomycin via regulation of miR‐597‐5p/S1PR1 axis
Authors: Guo Yong , Wu Dengke , Li Xiaozhou , Wang Juan , Li Huiling , Li Yijian , Luo Dan , Yi Feng , Zhang Dongshan
Published: April 2024

Our recent investigation has indicated that the global deletion of MBD2 can mitigate the progression of AKI induced by VAN. Nevertheless, the role and regulatory mechanisms of proximal tubular MBD2 in this pathophysiological process have yet to be elucidated. Our preceding investigation revealed that autophagy played a crucial role in advancing AKI induced by VAN. Consequently, we postulated that MBD2 present in the proximal tubule could upregulate the autophagic process to expedite the onset of AKI. In the present study, we found for the first time that MBD2 mediated the autophagy production induced by VAN. Through the utilization of miRNA chip analysis, we have mechanistically demonstrated that MBD2 initiates the activation of miR‐597‐5p through promoter demethylation. This process leads to the suppression of S1PR1, which results in the induction of autophagy and apoptosis in renal tubular cells. Besides, PT‐MBD2‐KO reduced autophagy to attenuate VAN‐induced AKI via regulation of the miR‐597‐5p/S1PR1 axis, which was reversed by rapamycin. Finally, the overexpression of MBD2 aggravated the diminished VAN‐induced AKI in autophagy‐deficient mice (PT‐Atg7‐KO). These data demonstrate that proximal tubular MBD2 facilitated the process of autophagy via the miR‐597‐5p/S1PR1 axis and subsequently instigated VAN‐induced AKI through the induction of apoptosis. The potentiality of MBD2 being a target for AKI was established.
Dynamic Cortical Connectivity During Propofol Sedation in Glioma Patients
Authors: Yang Wanning , Jian Minyu , Wang Xinxin , Zhou Yang , Liang Yi , Chen Yiwei , Li Yang , Li Ke , Ma Bo , Liu Haiyang , Han Ruquan
Published: April 2024

Background:

The behavioral manifestations and neurophysiological responses to sedation can assist in understanding brain function after neurological damage, and can be described by cortical functional connectivity. Glioma patients may experience neurological deficits that are not clinically detectable before sedation. We hypothesized that patients with gliomas exhibit distinct cortical connectivity patterns compared to non-neurosurgical patients during sedation.

Methods:

This is a secondary analysis of a previously published prospective observational study. Patients scheduled for resection of supratentorial glioma (n=21) or a non-neurosurgical procedure (n=21) under general anesthesia were included in this study. Frontal electroencephalography (EEG) signals were recorded at different sedation levels as assessed by the Observer Assessment of Alertness/Sedation (OAA/S) score. Kernel principal component analysis and k-means clustering were used to determine possible temporal dynamics from the weighted phase lag index characteristics.

Results:

Ten EEG connectivity states were identified by clustering (76% consistency), each with unique properties. At OAA/S 3, the median (Q1, Q3) occurrence rates of state 6 (glioma group, 0.110 [0.083, 0.155] vs. control group, 0.070 [0.030, 0.110]; P=0.008) and state 7 (glioma group, 0.105 [0.083, 0.148] vs. control group: 0.065 [0.038, 0.090]; P=0.001), which are dominated by beta connectivity, were significantly different between the 2 groups, reflecting differential conversion of the beta band between the left and right brain regions. In addition, the temporal dynamics of the brain’s functional connectivity was also reflected in the transition relationships between metastable states.

Conclusions:

There were differences in EEG functional connectivity, which is dynamic, between the glioma and nonglioma groups during sedation.
The Impact of Regular Diet Recovery on Postoperative Rehabilitation After Elective Cesarean Section
Authors: Hu Caihong , Fei Kuilin , Liu Yuelan , Jiang Xiaoe , Yong Wenjing , Zhang Weishe , Li Ping
Published: April 2024

Objective

To determine the role of regular diet recovery after restoration of normal muscle strength of both lower extremities in promoting postoperative recovery in women undergoing elective cesarean section.

Methods

This was a prospective observational cohort study. Patients who underwent elective cesarean section at Xiangya Hospital, Central South University, from October 2022 to December 2022, were categorized into two groups based on the duration of postoperative fasting: the observation group resumed eating after regaining lower extremity muscle strength, while the control group adhered to traditional postoperative fasting guidelines, waiting 6 hours before eating. Primary outcomes included postoperative pain levels assessed by visual analog scale (VAS) pain scores and time to first flatus. Demographic characteristics, time to first lactation, hospital stay length, and patient satisfaction were also assessed. Statistical analysis was conducted using Student’s t test and Chi-squared test, with significance set at P < 0.05.

Results

Out of a total of 300 patients, 240 were included in the analysis, comprising 112 in the control group and 128 in the observation group. There were no significant differences in baseline demographic characteristics. The median values of the first flatus time and the first lactation time were 33.37 ± 1.22 vs. 18.06 ± 6.34 hours (P = 0.003) and 26.34 ± 8.21 vs. 7.05 ± 1.26 hours (P = 0.001) in the control and observation groups, respectively. The median hospital stay duration in the control and observation groups was 6.54 ± 0.53 vs. 4.84 ± 0.18 days (P = 0.000), respectively. Median postoperative VAS pain scores and patient satisfaction values were 8.57 ± 0.11 vs. 4.91 ± 0.27 (P = 0.000) and 9.36 ± 0.16 vs. 9.72 ± 0.08 (P = 0.005) in the control and observation groups, respectively. There were no statistically significant differences in other postoperative outcomes, such as intestinal obstruction, infection, and readmission within 42 days (P > 0.05).

Conclusion

Food intake after restoration of lower extremity muscle strength improves first flatus, relieves postoperative pain, shortens hospital stay, and enhances satisfaction after elective cesarean section, without adverse effects. It is crucial for postoperative rehabilitation and should be encouraged.