bluuebunny/crossref_metadata_2025 huggingface dataset:
MONFIT: multi-omics factorization-based integration of time-series data sheds light on Parkinson’s disease
Authors: Mihajlović Katarina , Malod-Dognin Noël , Ameli Corrado , Skupin Alexander , Pržulj Nataša
Published: September 2024

Parkinson’s disease (PD) is a severe and complex multifactorial neurodegenerative disease with still elusive pathophysiology preventing the development of curative treatments. Molecular deep phenotyping by longitudinal multi-omics is a promising approach to identify mechanisms of PD aetiology and its progression. However, the heterogeneous data require new analysis frameworks to understand disease progression across biological entities and processes. Here, we present MONFIT, a holistic analysis pipeline that integrates and mines time-series single-cell RNA-sequencing data with bulk proteomics and metabolomics data by non-negative matrix tri-factorization, enabling prior knowledge incorporation from molecular networks. First, MONIFT integrates time-point-specific data and then holistically mines the integrated data across time points. By applying MONFIT to longitudinal multi-omics data of differentiation of PD and control patient-derived induced pluripotent stem cells into dopaminergic neurons, we identify novel PD-associated genes, emphasize molecular pathways that play important roles in PD pathology and suggest new intervention opportunities using drug-repurposing. MONFIT is fully adaptable to other multi-omics data sets.
Upcoming drug targets for kidney protective effects in chronic kidney disease
Authors: Nardone Massimo , Yau Kevin , Kugathasan Luxcia , Odutayo Ayodele , Mohsen Mai , Ouimet Jean-Philippe , Sridhar Vikas S , Cherney David Z I
Published: September 2024

PLAIN ENGLISH SUMMARY

 

People with chronic kidney disease (CKD) are at a high risk of heart disease and end-stage kidney disease. This review describes how new medications, such as glucagon-like peptide-1 receptor agonists (GLP1RA), aldosterone synthase inhibitors (ASi), soluble guanylate cyclase (sGC) and endothelin receptor antagonists (ERA), can lower heart–kidney risk in people with CKD. GLP1RA are already recommended for managing blood sugar in people with CKD and type 2 diabetes and have been shown to lower the risk of developing end-stage kidney disease. GLP1RA will likely soon be included in clinical guidelines, but further research is needed to understand how these medications protect the kidneys. ASi are another new medication that lower the protein found in urine. Larger trials are being done to see how well these medications work in slowing CKD. Lastly, both sGC agonists and ERAs have been shown to relax blood vessels to improve blood flow in the kidney, and reduce the amount of protein found in urine, both of which are critical to protecting kidneys. Larger clinical trials are being done to see if these medications prevent CKD from getting worse. In summary, this review describes the new and promising treatments for CKD. These therapies hold the potential to slow kidney disease and improve the wellbeing of patients. Further research of these new treatments is important for improving CKD care.

Despite recent advancements in the treatment of chronic kidney disease (CKD), identifying novel therapies beyond guideline-directed therapies that reduce residual cardiorenal risk remains imperative. In this review, we highlight the clinical evidence supporting emerging therapies for CKD, including glucagon-like peptide-1 receptor agonists (GLP1RA) and other incretin-based therapies, aldosterone synthase inhibitors (ASI), endothelin receptor antagonists (ERA), soluble guanylate cyclase (sGC) agonists and anti-inflammatory drugs. Long-acting GLP1RA are already recommended for glycemic control in patients with CKD and type 2 diabetes and the large, dedicated kidney outcome trial FLOW was recently stopped early for efficacy. Emerging clinical trial evidence supports the concept that ASI also provide additional benefit on top of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, which remain a cornerstone of CKD treatment. Next, we consider the use of sGC agonists, which target nitric oxide bioavailability and thereby reduce albuminuria. Finally, we explore the therapeutic potential of ERA, which act through hemodynamic and anti-fibrotic mechanisms, thereby addressing a common final pathway in the development of CKD. Accordingly, our review highlights the changing therapeutic landscape for CKD with promising agents to further prevent the progression of kidney disease.
Land and the Economy in Zambia
Authors: Ngoma Hambulo , Kabinga Moonde , Nsama Priscilla , Manda Simon
Published: September 2024

Zambia has undergone major reforms in land administration and governance from the pre-independence times to date. These reforms have altered access to land, land tenure, and governance. More recently, the country has witnessed a surge in medium- and large-scale land acquisitions. Given the centrality of land to Zambia’s economy, it is important to understand what these changes imply for socioeconomic development. This chapter contributes towards these efforts. We use Zambia’s agricultural sector as a case study for assessing trends and consequences of the surge in medium- and large-scale land acquisitions and land tenure in the post 2000s. The chapter concludes with some reflections on the consequences of the conversion of tenure from customary to leasehold and the surge in medium- and large-scale land acquisitions on land inequality, governance, and the economy.
The Livestock Sector in Zambia
Authors: Volk John , Walubita Kingsley M.
Published: September 2024

This chapter analyses the contribution of the livestock sector to the economy of Zambia. The methodology used includes analysis of relevant literature, policy documents, and secondary data. Agriculture contributes 2.7% of the gross domestic product with livestock accounting for 33% of agricultural exports. Livestock production is practised by 72% of agricultural households. Benefits of livestock are sales of meat, eggs, and milk, hides, skins, manure, and draft power for traction and ploughing. The sector consists of smallholder and commercial production whose contributions are 80 and 20%, respectively. The sector faces numerous challenges that include weak livestock extension and advisory services, lack of commercialization of production, low investment in nonconventional livestock, poor manufacturing practices, weak grading systems for live animals and products, inadequate systems for product quality control and standards, nonoperationalization of animal identification, and traceability system. The domestic market is small and underdeveloped but demand for livestock products is rapidly growing with increasing population, urbanization, and incomes.
The Forestry Sector
Authors: Mfune Orleans , Ikachana Benious , Nsonga Albert
Published: September 2024

This chapter provides an overview of the forest sector in Zambia and highlights the contribution of the sector to national development, rural livelihoods and ecological integrity. While noting the importance of the sector to the welfare of both urban and ruler dwellers, the chapter raises a number of concerns that are central to sustaining the role of forests and woodlands. Among these concerns include declining forest cover driven by a combination of factors that include dysfunctional forest management systems, underestimation of the value of forests in economic development, and natural and anthropogenic drivers of forest change. Based on materials derived from policy documents, archival data, and forest statistical data, it argues that although the sector has huge potential to spur national development and sustain local livelihoods, this cannot be fully realized without addressing these concerns.
Resentment and Grievance
Authors: Subotic Jelena
Published: September 2024

This chapter brings together the research on emotions and national identity to examine the role of two specific emotions—resentment and grievance. The surge in global populism is evidence that much of contemporary politics is guided by various resentments and grievances, slights real or imagined. This chapter goes beyond this statement to explore ways in which resentment and grievance are not only used for specific partisan gains but in fact foundational to constructions of national identity for many states. When a state’s identity is built on resentment and grievance, this creates a hegemonic national worldview of permanent victimhood that interprets international relations not as a competition or cooperation but as a perpetual struggle to right historical wrongs and punish those international actors who are perceived to have caused the injustice in the first place. These theoretical insights are illustrated with research on resentment politics in Serbia and Russia.
Specific retinal neurons regulate context-dependent defensive responses to visual threat
Authors: Lee Tracy , Weinberg-Wolf Hannah , Zapadka Thomas E , Rudenko Andrii , Demb Jonathan B , Kim In-Jung
Published: September 2024

While encountering a visual threat, an animal assesses multiple factors to choose an appropriate defensive strategy. For example, when a rodent detects a looming aerial predator, its behavioral response can be influenced by a specific environmental context, such as the availability of a shelter. Indeed, rodents typically escape from a looming stimulus when a shelter is present; otherwise, they typically freeze. Here we report that context-dependent behavioral responses can be initiated at the earliest stage of the visual system by distinct types of retinal ganglion cells (RGCs), the retina's output neurons. Using genetically defined cell ablation in mature mice, we discovered that some RGC types were necessary for either escaping (alpha RGCs) or freezing (intrinsically photosensitive RGCs) in response to a looming stimulus but not for both behaviors; whereas other RGC types were not required for either behavior (direction-selective RGCs preferring vertical motion). Altogether, our results suggest that specific RGC types regulate distinct behavioral responses elicited by the same threatening stimulus depending on contextual signals in the environment. These findings emphasize the unique contribution of early visual pathways to evolutionally conserved behavioral reactions.
Empirical determinants of momentum: a perspective using international data
Authors: Goyal Amit , Jegadeesh Narasimhan , Subrahmanyam Avanidhar
Published: September 2024

Although momentum exists in many markets throughout the world, explanations for momentum have largely been tested using US data. We investigate the extent to which US-based momentum explanations extend to the international context, using regression-based and portfolio approaches. Among the several hypotheses we consider, we find reliable support for the hypothesis that due to limited attention, investors underreact to information arriving in small bits rather than in large chunks, which results in momentum. We also find secondary support for the overconfidence hypothesis for momentum. Finally, we find that momentum is stronger in up-markets and less-volatile markets in the international context just as in the USA. This finding also accords with the investor overconfidence hypothesis, under the proviso that investors are more confident in rising, low-volatility markets.
Stepping Back: How Should Pass/Fail Scoring Influence Step 1 Timing?
Authors: Toonkel Rebecca L. , Pock Arnyce R. , Hauer Karen E. , Kogan Jennifer R. , Seibert Christine S. , Swan Sein Aubrie , Monrad Seetha U. , Gordon David , Daniel Michelle , Ryan Michael S. , Ismail Nadia , Fazio Sara B. , Santen Sally A.
Published: September 2024

Although most students complete Step 1 before clerkships, some institutions delay the exam until after clerkships. The change to pass/fail grading adds additional complexity that should be considered when deciding about exam timing. Both early and late administration may affect learning outcomes, learner behavior, student well-being, and residency match success. Step 1 completion before clerkships promotes learning outcomes (e.g., integration and mastery of foundational material), may encourage students to focus on the curriculum, and may better prepare students for clinical science exams (CSEs). However, delaying the exam ensures that students maintain foundational knowledge and may encourage clinical educators to demonstrate basic science illustrations. An early Step 1 may affect learner behavior by allowing clerkship students to focus on clinical learning. The associated National Board of Medical Examiners performance report may also be used for Step 2 and CSE preparation. However, delaying Step 1 allows greater scheduling flexibility based on developmental milestones. Administration of Step 1 before clerkships removes a significant stressor from the clinical year and decompresses the residency application period. However, a delayed Step 1 reduces the pressure on students to engage in numerous extracurricular and research activities to distinguish themselves due to the pass/fail change. An early Step 1 exam may also lead to improved CSE performance, which is often linked to clerkship honors criteria, an increasingly valuable distinction for residency match success after the change to pass/fail. In contrast, delaying Step 1 is associated with higher first-time pass rates, which may be especially important for students at risk for failure. Medical educators and students should collaboratively approach the question of Step 1 timing, considering these factors within the context of the medical school program, curricular constraints and priorities, and students’ individual needs and goals.
Transition From Graduate Medical Education to Independent Practice: A Scoping Review
Authors: Zavodnick Jillian , Adamczyk Abby , Diemer Gretchen , Kuchera Timothy , Leonard Nia , Jaffe Rebecca
Published: September 2024

Purpose

This study examines the gaps in early career physician readiness for independent practice after graduating from their final graduate medical education (GME) program.

Method

The authors conducted a literature search of 4 online databases (PubMed, Scopus, Health Business Elite, and Education Resources Information Center) using the following terms: population terms (GME, fellow, resident, and others), early career terms (onboarding, hiring, early career, ready, and others), readiness terms (readiness, preparedness, knowledge, skills, competence), and independence terms (attending, physician, independent practice). The databases were searched on March 12, 2024, for articles that explored GME graduate gaps in readiness for independent practice; assessment tools, curricula, or curricular need aimed at gaps in early career physician readiness; or an area where GME graduates need more knowledge and skills. They extracted specific gaps in preparedness and categorized them using existing competency frameworks.

Results

The search returned 116 articles addressing gaps in preparedness for independent practice among recent GME graduates. Surgery yielded more articles than any other specialty (43 [37%]). Overall, 192 individual gaps were extracted; the greatest number of gaps came from patient care (75 [39%]) followed by personal and professional development (44 [23%]). The most frequently identified gaps were procedural independence (10 occurrences), practice management (9 occurrences), and billing (7 occurrences).

Conclusions

Despite advances in GME, learners still struggle when transitioning to independent practice. Personal and professional development is a useful categorization for many gaps and should be considered for inclusion as a GME competency. Systematic assessment of new-to-practice attendings could help stakeholders better understand the true outcomes of GME programs. Concerted investment by specialty societies may drive greater understanding and innovative solutions. Additional study could help address the challenges in the GME-to-practice transition.
Lateral Open Wedge Osteotomy and Lateral Condyle Fusion In Situ for Children With Condyle Nonunion and Cubitus Valgus Deformity
Authors: Lu Yunan , Pan Yuchen , Canavese Federico , Lin Ran , Lai Jinglin , Chen Shunyou
Published: September 2024

Purpose:

Long-term nonunion of the lateral humeral condyle (LHC) can result in progressive cubitus valgus, elbow pain, instability, and delayed ulnar nerve palsy. Various techniques have been proposed for correction, each with its own advantages and disadvantages. The purpose of this study was to introduce a lateral open wedge osteotomy (LOWO) procedure combined with in situ osteosynthesis of nonunited LHC for the treatment of long-term LHC nonunion with cubitus valgus deformity.

Methods:

We evaluated 18 pediatric patients who had a cubitus valgus deformity greater than 10 degrees after nonunion of the LHC for more than 2 years. The LHC was fixed in situ with 1 or 2 cancellous screws, and the LOWO was fixed with a locking plate. All patients underwent clinical and radiologic evaluation, and the pre- and postoperative carrying angle (CA), range of motion (ROM), and Mayo elbow performance score (MEPS) were analyzed.

Results:

Eighteen patients, with a mean age of 9.9 ± 3.9 years, underwent treatment for LHC nonunion and cubitus valgus deformity after a mean interval of 61.6 ± 24.1 months from the initial injury. The mean follow-up period was 57.6 ± 22.8 months. Union of the LHC and LOWO was achieved in all patients. The mean CA decreased significantly from 31.6 ± 4.8 degrees before surgery to 10.4 ± 2.2 degrees after surgery (P<0.001). Surgery did not decrease elbow range of motion (P=0.202). The mean MEPS increased significantly from a preoperative value of 55 ± 4.9 to a postoperative value of 91.1 ± 5.6 (P<0.001). No significant complications were observed.

Conclusions:

LOWO combined with in situ fixation of nonunited LHC is an effective approach for treating long-term LHC nonunion associated with cubitus valgus deformity.
Rates of Visual Field Progression Before and After the Onset of Atrial Fibrillation
Authors: Nishida Takashi , Moghimi Sasan , Jin Wang , Zangwill Linda M. , Weinreb Robert N.
Published: September 2024

Précis:

This case-control study investigated the effect of atrial fibrillation (AF) on the progression of glaucoma. The presence of AF and related microvascular damage was associated with a slightly faster visual field loss in glaucoma patients.

Purpose:

To investigate the effect of atrial fibrillation (AF) on glaucoma progression.

Methods:

In this longitudinal case-control study, a total of 144 eyes from 105 patients with primary open angle glaucoma were included. Forty-eight eyes of case developed AF during the follow-up followed for 15.6 years. Ninety-six eyes of control that did not have AF at baseline or during follow-up matched for age, baseline glaucoma severity, and follow-up period were followed for an average of 14.7 years. Mixed-effects linear models were used to calculate the difference in the VF MD slopes before and after the AF. CHADS2 and CHA2DS2−VASc scores were used to evaluate the risk of thrombosis event, and related microvascular damage was assessed based on these scores.

Results:

The rate of VF MD change was −0.20 (−0.42 to 0.02) dB/y before AF and −0.28 (−0.47 to −0.09) dB/y after AF for the patients with AF, and −0.21 (−0.25 to −0.17) dB/y for the control. In the multivariable models, the VF slope difference before and after the onset of AF [−0.10 (−0.14 to −0.05) dB/y, P<0.001], higher CHADS2 score [−0.07 (−0.13 to 0.00) dB/y per 1 unit, P=0.040], and higher CHA2DS2-VASc score [−0.05 (−0.10 to 0.00) dB/y per 1 unit, P=0.039] were associated with faster VF MD loss.

Conclusions:

The presence of atrial fibrillation and related microvascular damage might accelerate visual field loss. This underscores the need for a comprehensive medical history and management of cardiovascular risk factors to mitigate increased VF loss in glaucoma.
Development of a staging system for hepatoid adenocarcinoma of the stomach based on multicenter data: a retrospective cohort study
Authors: Huang Ying-Qi , Huang Ze-Ning , Hong Qing-Qi , Zhang Peng , Zhang Zi-Zhen , He Liang , Shang Liang , Wang Lin-Jun , Sun Ya-Feng , Li Zhi-Xiong , Liu Jun-Jie , Ding Fang-Hui , Lin En-De , Fu Yong-An , Lin Shuang-Ming , Chen Qi-Yue , Zheng Chao-Hui , Huang Chang-Ming , Li Ping
Published: September 2024

Background:

Hepatoid adenocarcinoma of the stomach (HAS) is a rare subtype of gastric cancer (GC) with a poor prognosis. Furthermore, the current pathological staging system for HAS does not distinguish it from that for common gastric cancer (CGC).

Methods:

The clinicopathological data of 251 patients with primary HAS who underwent radical surgery at 14 centers in China from April 2004 to December 2019 and 5082 patients with primary CGC who underwent radical surgery at two centers during the same period were retrospectively analyzed. A modified staging system was established based on the differences in survival.

Results:

After 1:4 propensity score matching (PSM), 228 patients with HAS and 828 patients with CGC were analyzed. Kaplan–Meier (K–M) analysis showed patients with HAS had a poorer prognosis compared with CGC. Multivariate analysis identified pN stage, CEA level, and perineural invasion (PNI) as independent prognostic factors in patients with HAS. A modified pT (mpT) staging was derived using recursive partitioning analysis (RPA) incorporating PNI and pT staging. The modified pathological staging system (mpTNM) integrated the mpT and the eighth American Joint Committee on Cancer (AJCC) pN definitions. Multivariate analysis showed that the mpTNM stage outperformed other pathological variables as independent predictors of OS and RFS in patients with HAS. The mpTNM staging system exhibited significantly higher predictive accuracy for 3-year OS in patients with HAS (0.707, 95% CI: 0.650–0.763) compared to that of the eighth AJCC staging system (0.667, 95% CI: 0.610–0.723, P<0.05). Analysis using the Akaike information criterion favored the mpTNM staging system over the eighth AJCC staging system (824.69 vs. 835.94) regarding the goodness of fit. The mpTNM stages showed improved homogeneity in survival prediction (likelihood ratio: 41.51 vs. 27.10). Comparatively, the mpTNM staging system outperformed the eighth AJCC staging system in survival prediction, supported by improvements in the net reclassification index (NRI: 47.7%) and integrated discrimination improvement (IDI: 0.083, P<0.05). The time-dependent ROC curve showed that the mpTNM staging system consistently outperformed the eighth AJCC staging system with increasing observation time.

Conclusion:

The mpTNM staging system exhibited superior postoperative prognostic accuracy for patients with HAS compared to the eighth AJCC staging system.
Point-of-care ultrasonography in pediatric intensive care units
Authors: Fuhrman Dana Y. , Shaik Mohammed
Published: September 2024

Bedside ultrasonography, or point-of-care ultrasonography (POCUS), is increasingly becoming widely adopted in pediatric intensive care units (ICU) for procedural interventions and diagnostics. Although vascular access remains one of the primary applications of POCUS in the pediatric ICU, its use for assessing fluid status and responsiveness is growing. POCUS helps identify reversible causes of cardiac arrest, such as pericardial effusion and pneumothorax, although its impact on outcomes is still under investigation. Here, we will review the applications of POCUS in the pediatric ICU, including the general pediatric and cardiac ICUs. We will discuss the up-to-date evidence guiding its use and adoption for critically ill children.
Effect of Mechanical Circulatory Support on Mortality After Transcatheter Aortic Valve Replacement: An Analysis
Authors: Yang Chen , Liu Yang , Mao Yu , Shang Xiaoke , Qiao Fan , Liu Jian , Zhou Yenong , Zhai Mengen , Yu Shiqiang , Chen Tao , Yang Jian , Jin Zhenxiao
Published: September 2024

A proportion of patients still need mechanical circulatory support (MCS) during the transcatheter aortic valve replacement (TAVR) because of intraoperative hemodynamic instability. However, the outcomes of patients with different MCS type during TAVR are still controversial. A total of 538 patients who underwent TAVR procedure in four centers were included. The time-related outcomes and their predictors of patients who did not have MCS (MCS−, n = 498) were compared with those who underwent emergency MCS (eMCS+, n = 18) and prophylactic MCS (pMCS+, n = 22). We evaluated the association between different MCS groups and all-cause mortality using conditional landmark analysis with Cox regression. There was a significant increase in 30-day mortality in the eMCS+ group (p
log-rank < 0.001) and no significant difference in 31-day to 1-year mortality among the groups (p
log-rank = 0.789). A significant improvement in the left ventricular ejection fraction was observed in the pMCS+ group at 1 year after TAVR. Emergency MCS was independently associated with 30-day mortality, as well as 1-year mortality. Prophylactic MCS showed good clinical outcomes and might be considered for high-risk patients. Further studies are needed to investigate the predictors that lead to MCS usage and long-term mortality in TAVR patients with MCS.
Resuscitative endovascular balloon occlusion of the aorta for trauma patients with uncontrolled hemorrhage: a retrospective target trial emulation (the AT-REBOA target trial)
Authors: Hallmann Barbara , Honnef Gabriel , Eibinger Nicolas , Eichlseder Michael , Posch Martin , Puchwein Paul , Zoidl Philipp , Zajic Paul
Published: September 2024

Background

Noncompressible truncal hemorrhage is a major contributor to preventable deaths in trauma patients and, despite advances in emergency care, still poses a big challenge.

Objectives

This study aimed to assess the clinical efficacy of trauma resuscitation care incorporating Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) compared to standard care for managing uncontrolled torso or lower body hemorrhage.

Methods

This study utilized a target trial design with a matched case–control methodology, emulating randomized 1 : 1 allocation for patients receiving trauma resuscitation care with or without the use of REBOA. The study was conducted at a high-volume trauma center in Southern Austria, including trauma patients treated between January 2019 and October 2023, aged 16 and above, with suspected severe non-compressible torso hemorrhage. The primary outcome was 30-day in-hospital mortality. Secondary outcomes were in-hospital mortality rates at 3, 6, 24 h, and 90 days, need for damage control procedures, time to these procedures, computed tomography (CT) scan rates during resuscitation, complications, length of intensive care and in-hospital stay, and causes of death.

Results

Median age was 55 [interquartile range (IQR) 42–64] years. Median total injury severity, assessed by Injury Severity Score, was 46.5 (IQR: 43–57). There was no significant difference in 30-day in-hospital mortality between groups [9/11 (41%) vs. 9/11 (41%), odds ratio: 1.00, 95% confidence interval (CI): 0.3–3.36, P > 0.999]. Lower mortality rates within 3, 6, and 24 h were observed in the REBOA group; in a Cox proportional hazards model, hazard ratio (95% CI) for mortality in the REBOA group was 0.87 (0.35–2.15). Timing to damage control procedures did not significantly differ between groups, although patients in the REBOA group underwent significantly more CT scans. Bleeding was cited as the main cause of death less frequently in the REBOA group.

Conclusion

In severely injured patients presenting with possible major non-compressible torso hemorrhage, a systematically implemented resuscitation strategy including REBOA during the initial hospital phase, is not associated with significant changes in mortality.
Acceptability of Doxycycline Prophylaxis, Prior Antibiotic Use, and Knowledge of Antimicrobial Resistance Among Australian Gay and Bisexual Men and Nonbinary People
Authors: Holt Martin , Bavinton Benjamin R. , Calabrese Sarah K. , Broady Timothy R. , Clackett Shawn , Cornelisse Vincent J. , Yu Simin , Gordon Tina , Heath-Paynter Dash , de Wit John B. F. , MacGibbon James
Published: September 2024

Background

There is growing interest in novel sexually transmissible infection (STI) prevention strategies, including doxycycline postexposure prophylaxis (doxy-PEP). We assessed interest in doxy-PEP and other STI prevention strategies among gay and bisexual men and nonbinary people in Australia, as well as prior antibiotic use for STI prevention, and knowledge of antimicrobial resistance (AMR).

Methods

We conducted a national, online survey in June to July 2023. Multivariable logistic regression was used to identify factors associated with the acceptability of doxy-PEP.

Results

Of 2046 participants, 26.9% had been diagnosed with an STI in the previous year. Condoms were rated as an acceptable STI prevention strategy by 45.1% of the sample, STI preexposure prophylaxis by 54.0%, and doxy-PEP by 75.8%. Previous antibiotic use for STI prevention was reported by 7.5% of the sample, and 2.6% were currently using antibiotics for STI prevention. Over half the sample (62.1%) had some knowledge of AMR. Of those who knew something about AMR, 76.2% were concerned about it. Interest in using doxy-PEP was independently associated with previous use of antibiotics for STI prevention (adjusted odds ratio, 3.09; 95% confidence interval, 1.78–5.35; P < 0.001), whereas those who were concerned about AMR were less interested in it (adjusted odds ratio, 0.51; 95% confidence interval, 0.36–0.72; P < 0.001).

Conclusions

Doxycycline postexposure prophylaxis was highly acceptable to gay and bisexual men and nonbinary people in Australia, and few factors distinguished between interest in using it or not. We recommend community and professional discussion and education about the effective use of doxy-PEP, AMR, and who would most benefit from doxy-PEP.
Anal Cancer Screening Practices Among Higher-Risk Populations in an Academic Medical System
Authors: Gore Daniel , O'Donoghue Ashley , Dechen Tenzin , Zerillo Jessica , Multani Ami , Krakower Douglas
Published: September 2024

Background

Although some experts recommend anal cancer screening for disproportionally affected populations including people living with HIV (PWH), condyloma acuminata, human papillomavirus–associated gynecologic dysplasia and cancers, and solid organ transplants, actual screening practices remain understudied. Our objective was to characterize anal cancer screening practices among higher-risk populations in an academic medical system with access to high-resolution anoscopy.

Methods

We extracted outpatient clinical data for the aforementioned populations from January 1, 2015, to August 1, 2022, at 3 sites of an academic medical system. Data included patients' demographics, medical comorbidities, and anal cytology and human papillomavirus testing results. We used χ
2 tests and logistic regression to assess for associations between patient characteristics and anal cancer screening.

Results

Of 7654 patients, 6.3% received anal cytology screening at least once including 21.7% of PWH, 13.8% of people with condyloma acuminata, 1.1% of people with gynecologic cancers, and 0.5% of people with solid organ transplants. In multivariable analysis, Black patients were 46% less likely to receive screening than White patients (95% confidence interval [CI], 0.40–0.71), and cisgender women were 73% less likely to receive screening than cisgender men (95% confidence interval, 0.20–0.38). Of 485 individuals who received anal cytology screening, 37.5% were only screened once and 70.5% had abnormal cytology on one or more screenings.

Conclusion

Only one-fifth of PWH received anal cancer screening, and other higher-risk populations had even lower screening rates. Black patients and women were also less likely to be screened. Strategies to improve equitable screening practices for anal cancer are needed.
Efficacy of Doxycycline as Preexposure and/or Postexposure Prophylaxis to Prevent Sexually Transmitted Diseases: A Systematic Review and Meta-Analysis
Authors: Boschiero Matheus Negri , Sansone Nathália Mariana Santos , Matos Laura Ribeiro , Marson Fernando Augusto Lima
Published: September 2024

Introduction

Bacterial sexually transmitted infections (STIs), specifically infection by Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, have an important burden worldwide. The use of doxycycline as preexposure prophylaxis (PREP or doxy-PREP) or postexposure prophylaxis (PEP or doxy-PEP) might be effective as prophylaxis because it is effective against C. trachomatis and T. pallidum.

Aims

Our objective was to evaluate the efficacy of doxycycline as PREP or PEP against bacterial STIs (C. trachomatis, N. gonorrhoeae, and T. pallidum).

Methods

A systematic review and meta-analysis of randomized clinical trials of a high-risk group of individuals was conducted to evaluate whether doxycycline is as effective as PREP or PEP in preventing bacterial STIs. The PubMed-MEDLINE (MEDlars online), Cohrane, Scientific Electronic Library Online (SciELO), and Latin America and the Caribbean Literature on Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde -LILACS) databases were searched for randomized clinical trials published up to March 2024. Data were extracted from published reports. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence interval (CI) were pooled across trials.

Main Outcome Measure

The primary end points were any incidence of bacterial STIs and individual STI infections.

Results

A total of 4 studies were included in the analysis, 3 of which evaluated doxy-PEP and 1 evaluated doxy-PREP. In the doxy-PEP group, a total of 1182 participants were evaluated. In the pooled analysis of doxy-PEP studies, the incidence of the first STI was lower in the doxy-PEP group (HR, 0.538 [95% CI, 0.337–0.859]; I
2 = 77%; P < 0.05). Regarding individual infections, only 2 studies were included. In the doxy-PEP group, the incidence of individual infection of C. trachomatis was lower compared with controls (RR, 0.291 [95% CI, 0.093–0.911]) (I
2 = 89%; P < 0.05). Because only one study evaluated doxy-PREP, it was not possible to calculate a meta-analysis index; however, the use of doxycycline as PREP was associated with a decrease in the rate of any STI.

Conclusions

The use of doxy-PEP might reduce the first STI, mainly C. trachomatis, if used within 72 hours after condomless sex. The use of doxy-PREP might also decrease the chance of any STI; however, only 1 study was evaluated.
Assessing Attitudes and Knowledge of Mpox Vaccine Among Unvaccinated Men Who Have Sex With Men
Authors: Green Caitlin J. , (Chela) Hall Grace , Kachur Rachel , Finley Elizabeth , Furness Bruce W. , Merritt Matthew , Lewis Felicia M. T.
Published: September 2024

Background

The 2022 mpox outbreak disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Mpox cases continue to be reported nationally. Vaccination is a tool to prevent the spread of and serious disease from mpox. To understand mpox vaccine uptake and hesitancy, a virtual focus group with unvaccinated GBMSM was conducted.

Methods

In November 2022, a 60-minute, virtual focus group was conducted within an artificial intelligence (AI) platform that engages participants in chat-based conversation. The AI system uses machine learning and natural language processing to analyze and provide results immediately to the moderator. Descriptive frequencies, cross-tabulations, and qualitative themes were analyzed.

Results

Fifty-one GBMSM aged 18 to 55 years participated, of whom 12 had attempted to get the mpox vaccine. The top barriers in accessing the vaccine included challenges in scheduling appointments (4 of 12), available vaccine locations (3 of 12), and transportation (2 of 12). Nine participants reported not wanting the vaccine, and 22 were undecided; of these, 15 (4 of 9 and 11 of 22, respectively) said they did not think they needed the vaccine due to low perceived risk or monogamy. Among the undecided, after receiving health messaging about mpox, 12 of 22 said the messaging made them reconsider getting the vaccine.

Conclusion

During an outbreak, many unvaccinated GBMSM who may be at increased risk for mpox either wanted the vaccine or, with appropriate health messaging, may be open to getting the vaccine. Messaging about mpox vaccine efficacy, potential side effects, and how to access the vaccine may improve vaccine uptake especially as cases continue to occur.
Engagement and Factors Associated With Annual Anal Human Papillomavirus Screening Among Sexual and Gender Minority Individuals
Authors: Nitkowski Jenna , Ridolfi Timothy J. , Lundeen Sarah J. , Giuliano Anna R. , Chiao Elizabeth , Fernandez Maria E. , Schick Vanessa , Smith Jennifer S. , Bruggink Paige , Brzezinski Bridgett , Nyitray Alan G.
Published: September 2024

Background

Although self-sampling could help address anal cancer screening barriers, no studies have investigated annual engagement with this method or compared it with annual screening with a provider. Building on our baseline article, we compared annual anal screening engagement between home-based self-sampling and clinic-based clinician sampling.

Methods

The Prevent Anal Cancer Self-Swab Study recruited and randomized sexual and gender minority individuals 25 years and older who have sex with men to a home or clinic arm. Home-based participants were mailed an anal human papillomavirus self-sampling kit at baseline and 12 months, whereas clinic-based participants were asked to schedule and attend 1 of 5 participating clinics at baseline and 12 months. Using Poisson regression, we conducted an intention-to-treat analysis of 240 randomized participants who were invited to screen at both timepoints.

Results

More than half (58.8%) of participants completed annual (median = 370 days) anal screening. In the home arm, 65.0% of participants engaged in annual screening compared with 52.5% of clinic-based participants (P = 0.049). When stratified by HIV status, persons living with HIV had a higher proportion of home (71.1%) versus clinic (22.2%) annual screening (P < 0.001). Non-Hispanic Black participants participated more in home-based annual anal screening (73.1%) than annual clinic screening (31.6%; P = 0.01). Overall, annual screening engagement was significantly higher among participants who had heard of anal cancer from an LGBTQ organization, reported “some” prior anal cancer knowledge, preferred an insertive anal sex position, and reported any prior cancer diagnosis.

Conclusions

Annual screening engagement among those at disproportionate anal cancer risk was higher in the home arm.
Long-Term Outcomes of 1989 Immediate Implant-Based Breast Reconstructions: An Analysis of Risk Factors for Failure and Revision Surgery
Authors: Kooijman Merel M. L. , van Bommel Annelotte C. M. , van Duijnhoven Frederieke H. , Scholten Astrid N. , Smorenburg Carolien H. , Woerdeman Leonie A. E. , Breugem Corstiaan C.
Published: September 2024

Background:

Nipple- or skin-sparing mastectomy and immediate implant-based breast reconstruction (IBR) is potentially associated with long-term unfavorable outcomes, such as revision surgery and reconstruction failure. This large patient cohort study aimed to provide long-term data on the incidence of these outcomes and to identify predictive risk factors.

Methods:

Between 2012 and 2019, 1989 mastectomies with IBR were performed in 1512 women in the authors’ institute. A direct-to-implant method was used in 93% and a 2-staged method with tissue expander in 7%. Logistic regression analysis was used to identify patient- and treatment-related risk factors associated with revision surgery or reconstructive failure.

Results:

The mean follow-up was 62.2 months. IBR failed in 6.7% of all breasts; thus, a breast was present in 93.3%. Age older than 44 years yielded a 2.6-fold, and radiotherapy, a 1.7-fold increased risk for reconstruction failure. Revision surgery was performed in 60% of all breasts. The mean number of revisions of all IBRs was 1.2 (range, 0 to 8; SD, 1.37). Factors associated with significantly higher rates of revision surgery were age older than 44 years (OR, 1.23), smoking (OR, 1.53), specimen weight greater than 492 g (OR, 1.39), implant volume greater than 422 g (OR, 1.95), and radiotherapy (OR, 1.51). Nipple preservation was protective for both outcomes (OR, 0.71 and 0.42, respectively). Direct-to-implant procedures did not require any surgical revision in 43% of these patients.

Conclusions:

Despite the necessity of revision surgery in the majority of IBRs, nearly half of the breasts did not require any revision surgery, and long-term reconstruction failure rates are extremely low. Therefore, IBR should be offered to all eligible women undergoing mastectomy, while understanding the risks.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Brief Report: Internalized Poverty-Related Stigma and Interpersonal Violence Among Women Living With HIV in the United States
Authors: Maya Sigal , Sheira Lila A. , Frongillo Edward A. , Pala Andrea Norcini , Kempf Mirjam-Colette , Konkle-Parker Deborah , Wilson Tracey E. , Tien Phyllis C. , Wingood Gina , Topper Elizabeth F. , Neilands Torsten B. , Johnson Mallory O. , Logie Carmen H. , Weiser Sheri D. , Turan Janet M. , Turan Bulent
Published: September 2024

Background:

Interpersonal violence (IPV) affects half of women living with HIV (WLHIV) in the United States and has important consequences for mental health and HIV outcomes. Although different types of stigmas (eg, HIV- or sexual identity-related) are associated with increased risk of IPV, the relationship between poverty-related stigma and IPV is unclear, even though poverty frequently co-occurs with IPV.

Methods:

Data from up to 4 annual visits (2016–2020) were collected from 374 WLHIV enrolled in a substudy of the Women's Interagency HIV Study (now known as Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study) at 4 sites across the United States. A validated measure of the perceived stigma of poverty was used, along with questions on recent experiences of IPV. We used a mixed-effects model to assess the association between internalized poverty stigma and IPV.

Results:

The unadjusted model with internalized poverty stigma and recent IPV as independent and dependent variables, respectively, suggested that the 2 were associated (prevalence ratio 1.29 [95% CI: 1.02 to 1.62, P = 0.033]). After adjusting for income and education, we found an independent association between internalized poverty-related stigma and recent IPV, with a prevalence ratio of 1.35 (95% CI: 1.07 to 1.71, P = 0.011).

Conclusion:

Our findings suggest that reducing the psychologic consequences of poverty may better situate WLHIV to escape or avoid IPV. The usefulness of screening WLHIV who may be experiencing poverty-related stigma for IPV should be investigated. Interventions that address internalized poverty-related stigma may provide an avenue for reducing the harms caused by IPV in addition to interventions aiming to reduce violence itself.
Assessing and Managing Medical Adhesive-Related Skin Injury in Patients with a Peripherally Inserted Central Catheter
Authors: Ratliff Catherine , Barton Andrew , Hitchcock Jan , Gray Mikel
Published: September 2024

BACKGROUND:

Medical adhesive-related skin injuries (MARSIs) are prevalent adverse effects associated with use of medical devices and increasingly recognized as potentially avoidable. Despite advances in preventive measures, MARSI events still occur, and individualized care must be designed to meet patient needs.

CASES:

This article describes three cases where skin injuries occurred because of application, removal, and ongoing use of a medical adhesive device; all three cases occurred underneath dressings used to secure and protect the skin adjacent to a peripherally inserted central catheter (PICC). The first case describes evaluation and management of a skin tear in an elderly female with multiple comorbid conditions, and Case 2 describes assessment and care of contact irritant dermatitis occurring under a PICC dressing. In both cases, specialist nurses with knowledge of MARSI assessed and managed the skin underneath the medical adhesive device in a manner that allowed maintenance of the PICC and continuation of therapy. In contrast, Case 3 describes a female with irritant contact dermatitis underneath a PICC dressing that was responding to care by the nurse specialists of a vascular access team. In this case, the patient presented to their facility’s emergency department with severe itching. The vascular access team initially was not consulted, and the PICC line was removed, although inspection revealed dry skin without signs of infection.

CONCLUSIONS:

Medical adhesive-related skin injury is a clinically relevant and useful construct that identifies a variety of prevalent conditions associated with the use of medical adhesive device such as tapes and PICC dressings. These cases, in particular Cases 1 and 2, illustrate that the MARSI construct provides a framework for assessing and managing medical skin injuries with the possibility of preserving the PICC and the ongoing therapy these patients were receiving.
Highly virulent avian brood-parasitic species show elevated embryonic metabolic rates at specific incubation stages compared to less virulent and non-parasitic species
Authors: McClelland Stephanie C. , Lund Jess , Dixit Tanmay , Hamama Silky , McClean Luke A. , Spottiswoode Claire N. , White Craig R. , Louder Matthew I. M. , Hauber Mark E. , Honza Marcel , Portugal Steven J.
Published: September 2024

As the avian embryo grows and develops within the egg, its metabolic rate gradually increases. Obligate avian brood-parasitic birds lay their eggs in the nests of other species to avoid the costs of parental care, and all but one of these brood-parasitic species are altricial at hatching. Yet the chicks of some altricial brood-parasitic species perform the physically demanding task of evicting, stabbing or otherwise killing host progeny within days of hatching. This implies a need for high metabolic rates in the embryo, just as precocial species require. Using flow-through respirometry
in situ
, we investigated embryonic metabolic rates in diverse avian brood parasite lineages which either kill host offspring (high virulence) or share the nest with host young (low virulence). High-virulence brood parasite embryos exhibited higher overall metabolic rates than both non-parasitic (parental) species and low-virulence parasites. This was driven by significantly elevated metabolic rates around the halfway point of incubation. Additionally, a fine-scale analysis of the embryos of a host–parasitic pair showed faster increases in metabolic rates in the parasite. Together these results suggest that the metabolic patterns of the embryos of high-virulence parasites facilitate their early-life demands.