bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Ambient Air Pollution on Office, Home, and 24-Hour Ambulatory Blood Pressure Measurements
Authors: Ulusoy Şükrü , Özkan Gülsüm , Varol Gamze , Erdem Yunus , Derici Ülver , Yılmaz Rahmi , Müge Değer Serpil , Arınsoy Turgay , Akpolat T
Published: April 2023

Background

Air pollution has recently been linked to a number of cardiovascular diseases, particularly hypertension (HT). In our study, we aimed to evaluate the association between air pollution and blood pressure (BP) and compare the relationship of BP measurement results obtained using different methods (office, home, and 24-hour ambulatory BP monitoring [ABPM]).

Methods

This retrospective nested panel study performed with prospective Cappadocia cohort data investigated the relationships between particulate matter (PM) 10 and sulfur dioxide (SO2) and concurrent home, office, and 24-hour ABPM data at each control performed over a 2-year period.

Results

A total of 327 patients in the Cappadocia cohort were included in this study. On the day of office blood pressure measurement, there was an increase of 1.36 mm Hg in systolic BP and 1.18 mm Hg in diastolic BP for every 10 µm/m3 rise in SO2 values. A mean 3-day 10 µm/m3 increase in SO2 was linked to an increase of 1.60 mm Hg in systolic BP and 1.33 mm Hg in diastolic BP. A 10 µm/m3 rise in mean SO2 on the day of 24-hour ABPM measurement was found to be associated with an increase of 1.3 mm Hg in systolic BP and 0.8 mm Hg in diastolic BP. SO2 and PM 10 had no effect on home measurements.

Conclusion

In conclusion, increased SO2 levels, during winter months in particular, can be associated with an elevation in office BP values. Our study findings show that air pollution in the setting in which BP is measured may be associated with the results.
The Rising Trend of the Reverse BBL and the Implications for Aesthetic Surgeons: A Google Trends Analysis
Authors: Safeek Rachel , Dang Jonathan , Mast Bruce
Published: April 2023

Goals/Purpose

Aesthetic surgery trends continue to evolve and are often popularized by social media, particularly with celebrity influence, as exemplified by gluteal fat grafting or Brazilian Butt Lift (BBL). There appears to be a trend for reversal of this procedure, but there is a paucity of research describing associated operative techniques and precautions, with most discussion limited to media publications. The aim of this study was to evaluate public interest in reverse BBL surgery over a 5-year period using Google Trends and bring attention to this emerging trend in aesthetic surgery.

Methods/Technique

A Google Trends analysis was completed using the term “reverse BBL”. Trends were analyzed over a 5-year time period and included an assessment of regional searches by state. Changes in search frequency were further analyzed based on media articles describing reverse BBL trends, with the first mention being in August 2021, followed by another series of publications from November-December 2021, and June 2022.

Results/Complications

There was a steady increase in the relative search value (normalized search volume in comparison to total search volume over 5 years) for “reverse BBL” beginning in January 2020, with a peak in December 2021 and June 2022 (Figure 1). The states associated with the most search interest in BBL reversal were: Florida, New York, California, Texas, and Illinois (Figure 2). Average relative search volume significantly increased with media publication of reverse BBL procedures among celebrities, corresponding with August 2021, November- December 2021 and mid-2022 (p<0.05) (Figure 3).

Conclusion

These data indicate there is increasing public interest in reversal of gluteal fat grafting, which appears to correlate with social media trends. As patient’s remorse trends surrounding reverse BBL’s rise, aesthetic surgeons should counsel patients accordingly prior to gluteal augmentation surgery. Furthermore, for patients having undergone gluteal augmentation seeking reversals, pre-operative consultation of risks associated with reverse BBL procedures should be discussed. More research is needed regarding best operative approach for BBL reversal, including approaches with liposuction and additional revision surgeries, and strategies to mitigate postoperative complications, while enhancing cosmetic outcomes.
excluderanges: exclusion sets for T2T-CHM13, GRCm39, and other genome assemblies
Authors: Ogata Jonathan D , Mu Wancen , Davis Eric S , Xue Bingjie , Harrell J Chuck , Sheffield Nathan C , Phanstiel Douglas H , Love Michael I , Dozmorov Mikhail G
Published: April 2023

Exclusion regions are sections of reference genomes with abnormal pileups of short sequencing reads. Removing reads overlapping them improves biological signal, and these benefits are most pronounced in differential analysis settings. Several labs created exclusion region sets, available primarily through ENCODE and Github. However, the variety of exclusion sets creates uncertainty which sets to use. Furthermore, gap regions (e.g. centromeres, telomeres, short arms) create additional considerations in generating exclusion sets. We generated exclusion sets for the latest human T2T-CHM13 and mouse GRCm39 genomes and systematically assembled and annotated these and other sets in the excluderanges R/Bioconductor data package, also accessible via the BEDbase.org API. The package provides unified access to 82 GenomicRanges objects covering six organisms, multiple genome assemblies, and types of exclusion regions. For human hg38 genome assembly, we recommend hg38.Kundaje.GRCh38_unified_blacklist as the most well-curated and annotated, and sets generated by the Blacklist tool for other organisms.

Availability and implementation

https://bioconductor.org/packages/excluderanges/. Package website: https://dozmorovlab.github.io/excluderanges/.
Visualizing reactive astrocyte-neuron interaction in Alzheimer’s disease using 11C-acetate and 18F-FDG
Authors: Nam Min-Ho , Ko Hae Young , Kim Dongwoo , Lee Sangwon , Park Yongmin Mason , Hyeon Seung Jae , Won Woojin , Chung Jee-In , Kim Seon Yoo , Jo Han Hee , Oh Kyeong Taek , Han Young-Eun , Lee Gwan-Ho , Ju Yeon Ha , Lee Hyowon , Kim Hyunjin , Heo Jaejun , Bhalla Mridula , Kim Ki Jung , Kwon Jea , Stein Thor D , Kong Mingyu , Lee Hyunbeom , Lee Seung Eun , Oh Soo-Jin , Chun Joong-Hyun , Park Mi-Ae , Park Ki Duk , Ryu Hoon , Yun Mijin , Lee C Justin
Published: April 2023

Reactive astrogliosis is a hallmark of Alzheimer’s disease (AD). However, a clinically validated neuroimaging probe to visualize the reactive astrogliosis is yet to be discovered. Here, we show that PET imaging with 11C-acetate and 18F-fluorodeoxyglucose (18F-FDG) functionally visualizes the reactive astrocyte-mediated neuronal hypometabolism in the brains with neuroinflammation and AD.

To investigate the alterations of acetate and glucose metabolism in the diseased brains and their impact on the AD pathology, we adopted multifaceted approaches including microPET imaging, autoradiography, immunohistochemistry, metabolomics, and electrophysiology. Two AD rodent models, APP/PS1 and 5xFAD transgenic mice, one adenovirus-induced rat model of reactive astrogliosis, and post-mortem human brain tissues were used in this study. We further curated a proof-of-concept human study that included 11C-acetate and 18F-FDG PET imaging analyses along with neuropsychological assessments from 11 AD patients and 10 healthy control subjects.

We demonstrate that reactive astrocytes excessively absorb acetate through elevated monocarboxylate transporter-1 (MCT1) in rodent models of both reactive astrogliosis and AD. The elevated acetate uptake is associated with reactive astrogliosis and boosts the aberrant astrocytic GABA synthesis when amyloid-β is present. The excessive astrocytic GABA subsequently suppresses neuronal activity, which could lead to glucose uptake through decreased glucose transporter-3 in the diseased brains. We further demonstrate that 11C-acetate uptake was significantly increased in the entorhinal cortex, hippocampus and temporo-parietal neocortex of the AD patients compared to the healthy controls, while 18F-FDG uptake was significantly reduced in the same regions. Additionally, we discover a strong correlation between the patients’ cognitive function and the PET signals of both 11C-acetate and 18F-FDG.

We demonstrate the potential value of PET imaging with 11C-acetate and 18F-FDG by visualizing reactive astrogliosis and the associated neuronal glucose hypometablosim for AD patients. Our findings further suggest that the acetate-boosted reactive astrocyte-neuron interaction could contribute to the cognitive decline in AD.
Lesion effects in terms of local impedance variations after pulsed-field ablation during pulmonary vein isolation: a case report
Authors: Iacopino Saverio , Fabiano Gennaro , Malacrida Maurizio , Petretta Andrea
Published: April 2023

Background

To date, no information is available on highly localized impedance (LI) measurements during the ablation of pulmonary veins (PVs) via a new form of energy such as electroporation by means of pulsed-field ablation (PFA).

Case summary

A 55-year-old man with a history of paroxysmal atrial fibrillation was admitted to our hospital for PV isolation (PVI). The procedure was performed with the new multi-electrode PFA catheter (FARAWAVE™). Before energy delivery, a high-density map of the left atrium was constructed with the Rhythmia™ system, while the IntellaNAV Mifi™ OI catheter was used to assess the baseline LI values of the four PVs. A manual tag was used to record the exact position where the IntellaNAV™ catheter measured the LI values for each segment of the vein before and after PVI. The LI values displayed a significant variation after PFA delivery (124.3 ± 5 Ω for baseline LI vs. 96.8 ± 6 Ω after PFA, P < 0.0001) with a mean absolute LI variation of 27.5 ± 7Ω and a mean percentage LI variation of 25.8 ± 8%. The differences between the average LI values pre- and post-PFA were 28.0 ± 5, 26.5 ± 9, 26.8 ± 3, and 28.8 ± 10 Ω for the superior, anterior, posterior, and inferior portions of the PV.

Discussion

This is the first instance of the acute characterization, in terms of LI drop, of antral lesions created by a new PFA system. Local impedance variations at ablation sites seem to be larger than those recorded at successful ablation spots obtained by means of thermal energy sources.
Caring for a Relative With Dementia in Long-Term Care During the COVID-19 Pandemic: A Prospective Longitudinal Study
Authors: Mitchell Lauren L , Horn Brenna , Stabler Henry , Birkeland Robyn W , Peterson Colleen M , Albers Elle A , Gaugler Joseph E
Published: April 2023

Background and Objectives

The coronavirus disease 2019 (COVID-19) pandemic introduced unprecedented threats and disruptions for caregivers of people with dementia living in residential long-term care (LTC) facilities. Qualitative and cross-sectional studies have reported substantial negative effects of the pandemic on dementia caregivers’ well-being, but little to no prospective research has examined the impact of COVID-19 on caregiver well-being using pre-pandemic assessments. The present study used longitudinal data from an ongoing randomized controlled trial of a psychosocial intervention to support family caregivers whose relatives had entered LTC.

Research Design and Methods

Data collection began in 2016 and continued through 2021. Caregivers (N = 132) completed up to 7 assessments measuring their depressive symptoms, self-efficacy, and burden.

Results

Latent growth curve models testing preregistered hypotheses revealed no significant effects of the pandemic on caregiver outcomes on average, though caregivers varied in terms of individual intercepts and slopes. Furthermore, factors such as caregiver–care recipient relationship closeness, care recipient’s COVID-19 infection status, and caregivers’ ratings of LTC facilities’ COVID-19 policies did not significantly moderate trajectories of well-being.

Discussion and Implications

Findings highlight the heterogeneity of caregivers’ experiences during the pandemic, and suggest caution when interpreting cross-sectional findings on the impacts of the COVID-19 pandemic on caregiver well-being and distress.
Salutogenic nursing home care: Antonovsky’s salutogenic health theory as a guide to wellbeing
Authors: Drageset Sigrunn , Ellingsen Sidsel , Haugan Gørill
Published: April 2023

The nursing home (NH) population is characterized by a high symptom burden resulting from chronic illnesses and functional impairments that cannot be cured. Most long-term NH residents are in the last phase of life and in need of palliative care. Hence, health and wellbeing are important aims of salutogenic NH care, which includes more than the treatment of residents’ diseases and symptoms. Research shows that cognitively intact long-term NH residents with a high score on sense of coherence (SOC) experience better wellbeing. Therefore, NH care should be developed in a salutogenic direction, promoting residents’ health and wellbeing by identifying general and specific resistant resources and facilitating residents’ perceived SOC. Based on Antonovsky’s salutogenic health theory and focusing on SOC comprising comprehensibility, manageability and meaningfulness along with resistance resources, this article discusses how nurses can apply salutogenic knowledge as a guide to promote wellbeing among long-term NH residents.
Supporting reorientation of health services in Indigenous Australian communities: the health promotion systems assessment tool
Authors: Percival Nikki , Feeney Lynette , Laycock Alison , Bailie Ross
Published: April 2023

Few tools and mechanisms exist to assist the reorientation of health services, especially in the Indigenous Australian health context; where improving health status and life expectancy is a priority. We developed a health promotion systems assessment tool (HPSAT) to provide health services with the information and support they need to drive health system change. Tool development occurred using a participatory, iterative approach that included a literature review, expert input by Indigenous and non-Indigenous stakeholders and annual group workshops in four Indigenous Australian primary health care (PHC) services. Four health system components: (i) organizational environment; (ii) service delivery systems; (iii) information systems and decision support; and (iv) adaptability and integration, form the framework of the tool. A scoring system monitors system change over time. The HPSAT provides a constructive framework to support health services to collectively assess and support reorientation in Indigenous Australian PHC services. Participation of key stakeholders with an intimate knowledge about the local context was pivotal in developing a user-friendly and fit-for-purpose tool. Maximum benefits of the tool are likely to be gained when used as part of a continuous quality improvement intervention.
Developing culturally-responsive health promotion: insights from cultural experts
Authors: Look Mele A , Maskarinec Gregory G , de Silva Māpuana , Werner Kamuela , Mabellos Tricia , Palakiko Donna-Marie , Haumea Stacy L , Gonsalves Joseph , Seabury Aukahi A , Vegas Jetney Kahaulahilahi , Solatorio Cappy , Kaholokula Joseph Keaweʻaimoku
Published: April 2023

Culturally-responsive health promotion initiatives are important to the creation of health equity for Indigenous and minority populations and these initiatives are complex and time-intensive to establish. The knowledge and resources of cultural experts are often pivotal in programs, yet there is minimal research on effective collaborations. The KāHOLO Project demonstrated strong success in the management of uncontrolled hypertension in the high-risk Indigenous population through a 6-month program based on the Hawaiian cultural dance of hula. This program was developed utilizing a community-based participatory research approach and implemented by cultural experts. To better understand the effectiveness of the research endeavor and program, six experienced hula experts and educators who delivered the community-based program were interviewed. As skilled and trusted cultural experts they set a safe supportive learning environment that promoted health and cultural goals. They articulated it was important that the program maintained cultural priorities and integrity. Through the methodical establishment of mutual respect, cooperation on research protocols and requirements was achieved. The development of cultural experts as health allies offers important inroads to the inclusion of minority and Indigenous cultures in health programming.
African Hut model of health: a framework for improving African migrant health in Aotearoa/New Zealand
Authors: Badu Emmanuel , Mpofu Charles , Came Heather
Published: April 2023

There is renewed international effort to improve the health and well-being of migrants. For African migrants, theoretical frameworks designed to account for and guide interventions to address the underlying mechanisms that interact to influence health and well-being remain largely underdeveloped. The aim of this study was to address this gap by providing a unique socio-ecological framework with specific entry points for targeted health promotion action aimed at improving the health and well-being of African migrants living in Aotearoa New Zealand. The African Hut model of health was developed through an inductive iterative approach informed by a review of the evidence and semi-structured interviews with key informants. The interviews were conducted in person using one-on-one format and employed to refine initial themes from the literature. A hybrid thematic analysis, involving both inductive and deductive approaches was used to analyse the interview data. The health and well-being of African migrant communities are the outcome of complex interplay of individual, economic, social and structural factors. To protect and promote the health of African communities in Aotearoa requires tailored interventions that centre culture and deliver holistically.
Income Inequality and Redistribution in Sub-Saharan Africa
Authors: Niño-Zarazúa Miguel , Scaturro Francesca , Jordá Vanesa , Tarp Finn
Published: April 2023

A strand of the political economy literature emphasizes the effect of income inequality on growth and poverty, which materialises through redistribution. The theoretical expectation postulated by standard economic theory is that high inequality would lead to higher redistribution via the collective action of the median voter. The empirical literature testing the median voter theorem has been conducted in the context of industrialised economies. In this article, we examine the median voter hypothesis with specific reference to SSA, a region characterised by high levels of income inequality and limited redistribution. We adopt an instrumental variable approach to unpack the determinants and plausible mechanisms underpinning this relationship. In the article, we account for the effect of omitted top income earners in income inequality estimates, given their weight in the shape of the income distribution and their influence in redistributive policies. Overall, we find a positive relationship between inequality and redistribution in SSA, especially among middle-income countries. Further examination reveals that the abundance of natural resource rents seems to be the driving force affecting tax policy choices, which in turn exacerbates income inequality and undermines progressive redistribution. Thus, in assessing the relationship between inequality and redistribution, our results do not provide strong evidence to support the propositions of the median voter theorem, but instead, they call for alternative interpretations that seem to align more closely to the existence of multiple steady states.
Typology Construction for Comparative Country Case Study Analysis of Patterns of Growth in Sub-Saharan Africa
Authors: Shaffer Paul
Published: April 2023

This study has been motivated by the limitations of cross-country regressions and unstructured comparative case studies in providing policy-relevant findings on the determinants of patterns of growth. It presents a methodology to improve upon existing comparative case study research by situating cases withing a typological framework and subsequently using cluster analysis to improve the matching of cases with respect to a number of ‘weakly exogenous’ variables. Such an approach performs a taxonomic function, distinguishing different types of cases and an explanatory function by facilitating the comparison of similar cases in terms of variables in the typology (‘like with like’ comparisons) or of cases with one or more known differences with respect to these variables. The approach is illustrated using data on poverty and growth in SSA and uncovers a number of good comparator cases situated within a typological framework for subsequent comparative analysis.
Missing data matter: an empirical evaluation of the impacts of missing EHR data in comparative effectiveness research
Authors: Zhou Yizhao , Shi Jiasheng , Stein Ronen , Liu Xiaokang , Baldassano Robert N , Forrest Christopher B , Chen Yong , Huang Jing
Published: April 2023

Objectives

The impacts of missing data in comparative effectiveness research (CER) using electronic health records (EHRs) may vary depending on the type and pattern of missing data. In this study, we aimed to quantify these impacts and compare the performance of different imputation methods.

Materials and Methods

We conducted an empirical (simulation) study to quantify the bias and power loss in estimating treatment effects in CER using EHR data. We considered various missing scenarios and used the propensity scores to control for confounding. We compared the performance of the multiple imputation and spline smoothing methods to handle missing data.

Results

When missing data depended on the stochastic progression of disease and medical practice patterns, the spline smoothing method produced results that were close to those obtained when there were no missing data. Compared to multiple imputation, the spline smoothing generally performed similarly or better, with smaller estimation bias and less power loss. The multiple imputation can still reduce study bias and power loss in some restrictive scenarios, eg, when missing data did not depend on the stochastic process of disease progression.

Discussion and Conclusion

Missing data in EHRs could lead to biased estimates of treatment effects and false negative findings in CER even after missing data were imputed. It is important to leverage the temporal information of disease trajectory to impute missing values when using EHRs as a data resource for CER and to consider the missing rate and the effect size when choosing an imputation method.
Left-behind versus unequal places: interpersonal inequality, economic decline and the rise of populism in the USA and Europe
Authors: Rodríguez-Pose Andrés , Terrero-Dávila Javier , Lee Neil
Published: April 2023

Economic change over the past 20 years has rendered many individuals and territories vulnerable, leading to greater interpersonal and interterritorial inequality. This rising inequality is seen as a root cause of populism. Yet, there is no comparative evidence as to whether this discontent is the consequence of localised interpersonal inequality or stagnant growth in ‘left-behind’ places. This article assesses the association between levels and changes in local GDP per capita and interpersonal inequality, and the rise of far-right populism in Europe and in the USA. The analysis—conducted at small region level for Europe and county level for the USA—shows that there are both similarities and differences in the factors connected to populist voting on both sides of the Atlantic. In the USA, neither interpersonal inequality nor economic decline can explain populist support on their own. However, these factors gain significance when considered together with the racial composition of the area. Counties with a large share of white population where economic growth has been stagnant and where inequalities have increased supported Donald Trump. Meanwhile, counties with a similar economic trajectory but with a higher share of minorities shunned populism. In Europe, the most significant factor behind the rise of far-right populism is economic decline. This effect is particularly large in areas with a high share of immigration.
Activity of plant essential oils against clinically and environmentally isolatedSalmonella entericaserotypes:in vitroassays and molecular docking
Authors: Rochín-Medina Jesús J , Mendoza-López Ilianne A , Castro-del Campo Nohelia , Bastidas-Bastidas Pedro J , Ramírez Karina
Published: April 2023

This research aimed to evaluate the antimicrobial activity of essential oils (EOs) against clinically and environmentally isolated Salmonella serotypes. Oregano, thyme, and grapefruit EO compounds were identified, and the antimicrobial activity was evaluated against the S. Saintpaul, Oranienburg, and Infantis serotypes. In addition, molecular docking was performed to explore the possible mechanisms between compounds of EOs with microbial enzymes. Thymol was the main compound identified in oregano (44.0%) and thyme (31%) EOs, while d-limonene was present in a greater proportion in grapefruit EO. Oregano EO had the highest antimicrobial activity, followed by thyme and grapefruit EOs. Oregano and thyme EOs illustrated a greater inhibitory capacity to all serotypes, particularly with the environmental S. Saintpaul. Oregano EO presented values of minimum inhibitory concentration (MIC) and minimum bactericidal concentration of 0.1 μL/mL for all serotypes, while thyme and grapefruit EOs presented MIC values of 0.1 μL/mL for the clinical serotypes S. Infantis and S. Oranienburg, respectively. Molecular docking analysis showed the optimal binding free energies for thymol and carvacrol with glucokinase, ATP-dependent-6-fructokinase, outer membrane porin C, and topoisomerase IV. Our results indicate that these EOs can inhibit clinically and environmentally isolated Salmonella serotypes and can be used as alternatives for developing natural food preservatives.
Cold molecular gas outflow encasing the ionized one in the Seyfert galaxy NGC 3281
Authors: Dall’Agnol de Oliveira Bruno , Storchi-Bergmann Thaisa , Morganti Raffaella , Riffel Rogemar A , Ramakrishnan Venkatessh
Published: April 2023

We present ALMA CO (2-1) observations of the Seyfert 2 galaxy NGC 3281 at ∼100 pc spatial resolution. This galaxy was previously known to present a bi-conical ionized gas outflow extending to 2 kpc from the nucleus. The analysis of the CO moment and channel maps, as well as kinematic modelling, reveals two main components in the molecular gas: one rotating in the galaxy plane and another outflowing and extending up to ∼1.8–2.6 kpc from the nucleus, partially encasing the ionized component. The mass of the outflowing molecular gas component is Mmol, out = (2.5 ± 1.6) × 106 $\rm {{\rm M}_{\odot }}$ , representing ∼1.7–2 per cent of the total molecular gas seen in emission within the inner 2.3 kpc. The corresponding mass outflow rate and power are $\dot{M}_{\mathrm{out},\mathrm{mol}}$  = 0.12–0.72 $\rm {{\rm M}_{\odot }\, yr^{-1}}$ and $\dot{E}_{\mathrm{out},\mathrm{mol}}$  = (0.045–1.6) ${\times }\, 10^{40}$  $\rm {erg\, s^{-1}}$ , which translates to a kinetic coupling efficiency with the AGN power of only 10−4–0.02 per cent. This value reaches up to 0.1 per cent when including both the feedback in the ionized and molecular gas, as well as considering that only part of the energy couples kinetically with the gas. Some of the non-rotating CO emission can also be attributed to inflow in the galaxy plane towards the nucleus. The similarity of the CO outflow – encasing the ionized gas one and the X-ray emission – to those seen in other sources, suggests that this may be a common property of galactic outflows.
Debris rings from extrasolar irregular satellites
Authors: Hayakawa Kevin T , Hansen Bradley M S
Published: April 2023

Irregular satellites are the minor bodies found orbiting all four Solar system giant planets, with large semimajor axes, eccentricities, and inclinations. Previous studies have determined that the Solar system’s irregular satellites are extremely collisionally evolved populations today, having lost ∼99 per cent of their initial mass over the course of hundreds of Myr. Such an evolution implies that the irregular satellites must have produced a population of dusty collisional debris in the past, which is potentially observable due to the resulting reprocessing of stellar light. In this paper, we examine the signatures of the debris discs produced by extrasolar analogues of this process. Radiation pressure, quantified by the parameter β, is the driving force behind the liberation of dust grains from the planetary Hill sphere, and results in the formation of circumstellar dust rings, even in the absence of an underlying belt of asteroids in the system. Our simulated discs reproduce many of the same features seen in some classes of observed debris discs, such as thin ring morphology, a large blowout size, and azimuthal symmetry. We compare our simulated discs’ radial profiles to those of the narrow dust rings observed around Fomalhaut and HR 4796A, and show that they can broadly reproduce the observed radial distribution of dust.
Impacts of Temporary Migration on Development in Origin Countries
Authors: Bossavie Laurent , Özden Çağlar
Published: April 2023

Temporary migration is widespread globally. While the literature has traditionally focused on the impacts of permanent migration on destination countries, evidence on the effects of temporary migration on origin countries has grown over the past decade. This paper highlights that the economic development impacts, especially on low- and middle-income origin countries, are complex, dynamic, context-specific, and multichanneled. The paper identifies five main pathways: (a) labor supply; (b) human capital; (c) financial capital and entrepreneurship; (d) aggregate welfare and poverty; and (e) institutions and social norms. Several factors shape these pathways and their eventual impacts. These include initial economic conditions at home, the scale and double selectivity of emigration and return migration, whether migration was planned to be temporary ex ante, and employment and human capital accumulation opportunities experienced by migrants while they are overseas. Meaningful policy interventions to increase the development impacts of temporary migration require proper analysis, which, in turn, depends on high-quality data on workers’ employment trajectories, as well as their decision processes on the timing of their migration and return. These are currently the biggest research challenges to overcome to study the development impacts of temporary migration.
Elevated bile acids are associated with left ventricular structural changes in biliary atresia
Authors: Virk Manpreet K. , Mian Muhammad Umair M. , Bashir Dalia A. , Wilkes John K. , Schlingman Tobias , Flores Saul , Kennedy Curtis , Lam Fong , Arikan Ayse A. , Nguyen Trung , Mysore Krupa , Galvan Nhu Thao Nguyen , Coss-Bu Jorge , Karpen Saul J. , Harpavat Sanjiv , Desai Moreshwar S.
Published: April 2023

Background:

In children with biliary atresia (BA), pathologic structural changes within the heart, which define cirrhotic cardiomyopathy, are associated with adverse perioperative outcomes. Despite their clinical relevance, little is known about the pathogenesis and triggers of pathologic remodeling. Bile acid excess causes cardiomyopathy in experimental cirrhosis, but its role in BA is poorly understood.

Methods:

Echocardiographic parameters of left ventricular (LV) geometry [LV mass (LVM), LVM indexed to height, left atrial volume indexed to BSA (LAVI), and LV internal diameter (LVID)] were correlated with circulating serum bile acid concentrations in 40 children (52% female) with BA listed for transplantation. A receiver-operating characteristic curve was generated to determine optimal threshold values of bile acids to detect pathologic changes in LV geometry using Youden index. Paraffin-embedded human heart tissue was separately analyzed by immunohistochemistry for the presence of bile acid-sensing Takeda G-protein-coupled membrane receptor type 5.

Results:

In the cohort, 52% (21/40) of children had abnormal LV geometry; the optimal bile acid concentration to detect this abnormality with 70% sensitivity and 64% specificity was 152 µmol/L (C-statistics=0.68). Children with bile acid concentrations >152 µmol/L had ∼8-fold increased odds of detecting abnormalities in LVM, LVM index, left atrial volume index, and LV internal diameter. Serum bile acids positively correlated with LVM, LVM index, and LV internal diameter. Separately, Takeda G-protein-coupled membrane receptor type 5 protein was detected in myocardial vasculature and cardiomyocytes on immunohistochemistry.

Conclusion:

This association highlights the unique role of bile acids as one of the targetable potential triggers for myocardial structural changes in BA.
Medical malpractice claims in Hepatology: Rates, Reasons, and Results
Authors: Holman Alexis , McKeown Ellen , Quinn Moira , Parikh Neehar D. , Tapper Elliot B.
Published: April 2023

Background:

Clinicians are motivated to provide safe, high-quality care to patients with chronic liver disease. This includes the desire to avoid litigation. Data are limited regarding the actual sources of medicolegal risk in chronic liver disease.

Methods:

We conducted a review of a national liability insurer (Candello) with an additional granular analysis of our institution’s registry of liability claims. We included closed cases involving chronic liver disease-related encounters between 2012 and 2021. We determined rates of legal claims from a denominator of unique patients with cirrhosis or transplant care seen over the study period.

Results:

Local database: We retrieved 39 claims of which 15 involved patients with non-cirrhotic chronic liver disease, 13 involved cirrhosis (0.06% incidence), and 11 involved patients who underwent transplantation (0.6% incidence). Most claims involved periprocedural complications. Others included adverse reactions to prophylactic plasma transfusion, medication-induced HE, and falls/fractures.

National database:

We found 94 claims related to liver disease out of 102,575 (0.09%) total claims. Overall, 56% involved diagnosis-related issues (failure/delay in ordering a diagnostic test, failure to appreciate and reconcile a symptom/sign or result, or the misinterpretation of a diagnostic study). Miscommunication between providers and between providers and patients was implicated in 22% of cases. Patient behavior-related factors (nonadherence with scheduled appointments, treatments, or diagnostic testing) factored in 20% of cases. Selection or the management of therapy played a role in 7% of cases. Very rarely were cases associated with technical skill (4%), house staff supervision (3%), or weekend/holiday care (1%). Fifty-one (55%) claims involved HCC.

Conclusion:

We provide the rates and reasons for medical malpractice claims in hepatology.
Race-based reporting and participation of Black individuals in registered pain clinical trials, United States, 2000 to 2019
Authors: Vo Anh Khoa , Cerdeña Jessica P. , Loree Jonathan M. , Cairns Brian E. , Conklin Annalijn I. , Kaseweter Kimberley , Chondoma Lerato , Cragg Jacquelyn J. , Kramer John L.K.
Published: April 2023

There are numerous, well-established racial disparities in the management of pain. The degree to which these are evident at the stage of conducting clinical trials is unknown. To address this knowledge gap, we examined race-based reporting, participation of Black individuals, and the factors associated with reporting and participation in pain clinical trials in the United States. Data were extracted from Clinicaltrials.gov and published articles. One thousand two hundred trials met our inclusion criteria; 482 (40.2%) reported participant race. More recent, publicly funded, and larger trials were more likely to report race. Of 82,468 participants included in pain clinical trials that reported race, 15,101 were Black individuals (18.3%). Participation of Black individuals was significantly associated with pain type (ß = +27% in cardiovascular disease pain compared with acute pain, P < 0.05), study population (ß = +33% and +7% in pain in minoritized populations and women, respectively, compared with general population, P < 0.05), pain intervention (ß = +7.5% for trials of opioid interventions compared with nonopioid interventions, P < 0.05), and a diverse team of investigators (ß = +8.0% for studies incorporating a visible non-White investigator compared with those that did not, P < 0.05). Our results indicate that representation of Black participants in pain clinical trials generally aligns with national demographics in the United States. Increased representation corresponds with health conditions more prevalent among Black individuals (eg, cardiovascular disease) and with a diverse study team composition. Despite these encouraging results, less than half of pain trials reported race, which introduces potential publication bias and limits external validity.
Lessons learned from a novel 3-year longitudinal stepwise “Residents-as-Teachers” program
Authors: Liang Jen-Feng , Cheng Hao-Min , Huang Chia-Chang , Yang Ying-Ying , Chen Chen-Huan
Published: April 2023

Background:

Most residents-as-teachers (RaT) programs are delivered over days to weeks without comprehensive evaluation, and stepwise approaches have rarely been applied to RaT activities. This study aimed to depict the implementation experience and evaluate the effectiveness of a novel longitudinal 3-year, stepwise RaT program.

Methods:

The longitudinal RaT program included three once yearly face-to-face courses according to the different teaching roles of the residents. To evaluate the effectiveness of the new longitudinal program, we designed a randomized controlled study for first-year residents of all specialties in one medical center. The effectiveness was evaluated by the objective structured teaching exercise (OSTE), feedback from participants and medical students, and evaluation of clinical practice performance by program directors.

Results:

A total of 35 (37.6%) of 93 residents participated in this study, and 13 (37.1%) of all enrolled residents completed all 3-year courses, including seven for the longitudinal program and six for the traditional. The serial OSTE revealed significantly higher scores in the longitudinal group in the second and third years (13.43 vs 9.50, p = 0.001 and 14.29 vs 10.33, p = 0.015). Satisfaction was higher when advanced topics were taught in the second and third years compared with those taught in the first year (4.43 vs 3.89, p = 0.02). The feedback from medical students was similar between the two groups, and the evaluation from program directors revealed insignificantly better clinical performance among the longitudinal course participants.

Conclusion:

It is challenging to conduct a multi-year longitudinal RaT program on young residents. Nevertheless, this longitudinal program was potentially associated with better learning retention and higher satisfaction and worthy to be promoted.
Immune checkpoint inhibitor sintilimab-induced lethal myocarditis overlapping with myasthenia gravis in thymoma patient: A case report
Authors: Wang Chen , Zhong Bingdi , He Jing , Liao Xiaohong
Published: April 2023

Rationale:

Immune checkpoint inhibitors have been extensively used and significantly improved the clinical outcomes in multiple types of cancer. But the immune-related adverse events occur frequently, particularly in thymoma. The cardiac immune-related adverse, which is relatively rare but fatal, have been increasing reported.

Patient concerns:

A 45-year-old thymoma patient was admitted to our hospital after receiving anti-programmed cell death-1 treatment with sintilimab 14 days later, accompanied by abdominal pain, intermittent chest tightness and dizziness.

Diagnoses:

The laboratory tests revealed elevated serum troponin I. Electrocardiogram reported the prolongation of QTc interval. Echocardiography showed small amount of pericardial effusion, a left ventricular ejection fraction of 71%. Coronary artery computed tomography angiography revealed localized noncalcified plaque in the middle of the left anterior descending artery and mild stenosis of the lumen. Enhanced computed tomography scanning of the whole abdomen showed no abnormal signs in the parenchyma organs. Combining the results of the examinations, the Immune checkpoint inhibitor induced myocarditis was diagnosed.

Interventions:

The patient was treated with glucocorticoids (120 mg/day, IV, methylprednisolone) within 24 hours of admission. Seven days later, the patient experienced tachy ventricular arrhythmia and cardiogenic shock and was transferred to intensive care unit after electrical cardioversion, tracheal intubation and cardiopulmonary resuscitation. Intravenous immunoglobulin therapy at 25 g/day was given and methylprednisolone was reduced to 40 mg/day for the next 3 days. Intravenous esmolol and lidocaine were used for correcting arrhythmias. Ventilator positive pressure ventilation was used for respiratory support. She was administrated with plasmapheresis when the electrocardiogram monitoring showed ventricular arrhythmia storms.

Outcome:

The patient progressed to ventricular arrhythmia storms and cardiac failure, which eventually resulted in death.

Lessons:

The case aims to raise awareness of immune-mediated cardiotoxicity and bring thoughts to the prospects of immunotherapy in thymoma.
Increasing Understanding and Perceived Confidence of Nurses Working in an Emergency Department in Assessing Patients at Risk of Violent Behavior
Authors: Inuenwi Blossom , Lommel Lisa , Peter Swapna B. , Carley Annette
Published: April 2023

Purpose

The aims of this quality improvement project were to improve understanding and perceived confidence in using a tool that assesses patients at risk of violence.

Project Description

The Brøset Violence Checklist is valid at assessing patients at risk of violence. Participants were given access to an e-learning module that demonstrated how to use the tool. Improvement in understanding and perceived confidence in using the tool were assessed preintervention and postintervention via an investigator-developed survey. Analysis of the data was conducted using descriptive statistics, and open-ended survey responses were analyzed using content analysis.

Outcome

Participants did not demonstrate an increase in understanding and perceived confidence after introduction of the e-learning module. Nurses reported that the Brøset Violence Checklist was easy to use, clear, reliable, and accurate and could be used to standardize assessments of at-risk patients.

Conclusion

Emergency department nursing staff were educated in use of a risk assessment tool for identifying patients at risk of violence. This supported the implementation and integration of the tool into emergency department workflow.
Demographic and clinical characteristics of children with limb loss in Saudi Arabia: A retrospective study
Authors: Alghamdi Mohammed S. , Alenazi Aqeel M. , Alghadier Mshari , Elnaggar Ragab K. , Alshehri Mohammed M. , Alqahtani Bader A. , Al-Nowaisri Khalid , Ghazal Haitham , Alodaibi Faris , Alhowimel Ahmed S.
Published: April 2023

Purpose:

The aim of this study was to describe the demographic and clinical characteristics of children with limb loss in Saudi Arabia.

Methods:

This is a retrospective study on children attending a limb loss clinic in a tertiary hospital in Riyadh, Saudi Arabia, between July 2012 and June 2020. Descriptive statistics were computed to describe the sample characteristics. A Chi-Squared test was conducted to explore the relationship between a child's sex with the type of limb loss (congenital or acquired) and extent of limb loss (major and minor) and the association between child's age and the mechanism of injury in traumatic limb loss.

Results:

A total of 122 children aged 2–16 years were included of whom 52% were boys. Congenital limb loss represented 57% of the sample with upper extremity loss accounting for 63.7% of all limb loss in this type. Trauma-related limb loss represented the most frequent etiology (88.2%) in the acquired limb loss group. Road traffic accidents accounted for 51.7% of the mechanism of injuries in trauma-related limb loss. Child's sex was not associated with the type of limb loss nor the extent of limb loss (p > 0.05). In addition, child's age was not associated with the mechanism of injury in traumatic limb loss (p > 0.05).

Conclusion:

Child's sex was not a determinant of type nor the extent of limb loss. Most of the acquired limb loss was trauma-related with road traffic accidents as the most common mechanism of injury. The findings of this study illuminate the importance of ongoing prosthetic care for children with a limb loss because young children may require multiple prostheses as they grow in age and size.
Transcriptomic profiling of nuclei from PFA-fixed and FFPE brain tissues
Authors: Guo Yunxia , Ma Junjie , Dang Kaitong , Li Zhengyue , Ge Qinyu , Huang Yan , Wang Guangzhong , Zhao Xiangwei
Published: April 2023

Formalin-fixed and paraffin-embedded (FFPE) tissue archives are the largest repository of clinically annotated specimens, and FFPE-compatible single cell gene expression workflow had been developed and applied recently. However, for tissues where cells are hard to dissociate or brains with complex neuronal cells, nuclear transcriptomic profiling are desirable. Moreover, the effects of standard pathological practice on the transcriptome of samples obtained from such archived specimens was also largely anecdotal. Here, we performed RNA-seq of nuclei from hippocampal of mice that underwent freezing, paraformaldehyde (PFA) fixation, and paraffin embedding. Then, we comprehensively evaluated the parameters affecting mRNA quality, transcription patterns, functional level and cell states of nuclei, including PFA fixation time and storage time of FFPE tissues. The results showed that the transcriptome signatures of nuclei isolated from fresh PFA-fixed and fresh FFPE tissues were more similar to matched frozen samples. By contrast, the brain fixed for more than 3 days had prominent impacts on the sequencing data, such as the numbers and biotypes of gene, GC content and ratio of reads interval. Commensurately, prolonged fixation time will result in more differentially expressed genes, especially those enriched in spliceosome and synaptic related pathways, affecting the analysis of gene splicing and neuron cells. MuSiC deconvolution results revealed that PFA infiltrating brains for 3 days will destroy the real cell states, and the proportion of neuron, endothelial and oligodendrocytes diminished while that of microglia was reversed. Yet the effect of storage time on cell composition was more neglectable for FFPE samples. In addition, oligodendrocyte precursor cells were most affected in all fixed samples, and their destruction was independent of fixation time and preservation time. The comprehensive results highlighted that fixation time had much more influences on the nuclear transcriptomic profiles than FFPE retention time, and the cliff-like effects appeared to occur over a fixed period of 1-3 days, with no more differences from additional fixation durations.