bluuebunny/crossref_metadata_2025 huggingface dataset:
The Stanford Medicine data science ecosystem for clinical and translational research
Authors: Callahan Alison , Ashley Euan , Datta Somalee , Desai Priyamvada , Ferris Todd A , Fries Jason A , Halaas Michael , Langlotz Curtis P , Mackey Sean , Posada José D , Pfeffer Michael A , Shah Nigam H
Published: August 2023

Objective

To describe the infrastructure, tools, and services developed at Stanford Medicine to maintain its data science ecosystem and research patient data repository for clinical and translational research.

Materials and Methods

The data science ecosystem, dubbed the Stanford Data Science Resources (SDSR), includes infrastructure and tools to create, search, retrieve, and analyze patient data, as well as services for data deidentification, linkage, and processing to extract high-value information from healthcare IT systems. Data are made available via self-service and concierge access, on HIPAA compliant secure computing infrastructure supported by in-depth user training.

Results

The Stanford Medicine Research Data Repository (STARR) functions as the SDSR data integration point, and includes electronic medical records, clinical images, text, bedside monitoring data and HL7 messages. SDSR tools include tools for electronic phenotyping, cohort building, and a search engine for patient timelines. The SDSR supports patient data collection, reproducible research, and teaching using healthcare data, and facilitates industry collaborations and large-scale observational studies.

Discussion

Research patient data repositories and their underlying data science infrastructure are essential to realizing a learning health system and advancing the mission of academic medical centers. Challenges to maintaining the SDSR include ensuring sufficient financial support while providing researchers and clinicians with maximal access to data and digital infrastructure, balancing tool development with user training, and supporting the diverse needs of users.

Conclusion

Our experience maintaining the SDSR offers a case study for academic medical centers developing data science and research informatics infrastructure.
Functional characterization of Bombyx mori (Lepidoptera: Bombycidae) C-type lectin 5
Authors: Sun Yan-Xia , Zhang Bang-Xian , Liu Fang-Fang , Rao Xiang-Jun
Published: August 2023

C-type lectins (CTLs) are an important family of pattern recognition receptors (PRRs) that regulate immune responses. The CTL5 gene of the silkworm Bombyx mori L. (Lepidoptera: Bombycidae) encodes a protein comprised of 223 amino acids, containing a signal peptide and a carbohydrate recognition domain (CRD). Our previous study showed that CTL5 can facilitate the clearance of bacteria from larval hemocoel but the underlying mechanisms are unclear. In this study, we found that CTL5 was mainly expressed in fourth-instar larvae, adult moths, and the larval epidermis. CTL5 expression showed differential responses to both pathogenic stimuli and the molting hormone 20-hydroxyecdysone. The full-length (FL) and truncated (ΔN/ΔC/ΔNC) CTL5 recombinant proteins can bind to hemocytes, polysaccharides, bacteria, and spores of the entomopathogenic fungus Beauveria bassiana. Yeast 2-hybrid assays showed that the recombinant proteins can interact with integrin β2–β5 subunits. Recombinant proteins increased the phagocytic rate of hemocytes. Injection of recombinant CTL5 stimulated the expression of many immune genes in hemocytes, mainly antimicrobial peptides and immune signaling molecules. Additionally, transcriptomic sequencing of CTL5-stimulated hemocytes revealed 265 upregulated and 580 downregulated genes. Functional enrichment and the gene set enrichment analyses showed that differentially expressed genes were mainly enriched in innate immune responses and signaling. Our study suggests that CTL5 may act as an opsonin to enhance the clearance of pathogens by regulating both humoral and cellular responses.
Rights-Based Climate Litigation in Brazil: An Assessment of Constitutional Cases Before the Brazilian Supreme Court
Authors: de Andrade Moreira Danielle , Nina Ana Lucia B , de Figueiredo Garrido Carolina , Neves Maria Eduarda Segovia Barbosa
Published: August 2023

This article presents a systematic analysis of climate litigation in the Brazilian Supreme Court. It argues that climate litigation in Brazil is centred on the protection of human rights and the court is ready (and eager) to draw a closer connection between climate and human rights. The climate litigation movement in Brazil follows in the wake of more than 40 years of a rich environmental legal framework and jurisprudence. This long trajectory includes adopting a chapter in the 1988 Brazilian Constitution dedicated to the right to an ecologically balanced environment. The Constitution determines this is a fundamental human right, encompassing the present and future generations. Building on this context, recent climate litigation cases question how climate stability fits within this constitutional framework. As the country’s constitutional tribunal, the Supreme Court recently received important climate cases addressing Brazil’s climate policy implementation. This article proceeds in three parts. First, the article contextualizes the climate litigation movement in Brazil’s broader environmental legal framework. Second, the article describes the Supreme Court climate docket of concentrated control cases. It focuses on the human right to an ecologically balanced environment and its connections with other constitutionally protected human rights. Third, the article examines the cases’ judicial reasoning, considering how the Supreme Court addressed climate change in the decisions (interlocutory or on the merits) available thus far. The ultimate goal of this article is to deepen the understanding of how the Supreme Court approaches climate as a human right through the methodical examination of the court’s pronouncements.
Consulting a neurosurgeon upon initial medical assessment reduces the time to the first surgery and potentially contributes to improved prognosis for glioblastoma patients
Authors: Kawauchi Daisuke , Ohno Makoto , Miyakita Yasuji , Takahashi Masamichi , Yanagisawa Shunsuke , Omura Takaki , Yoshida Akihiko , Kubo Yuko , Igaki Hiroshi , Ichimura Koichi , Narita Yoshitaka
Published: August 2023

Background

The neurological status of glioblastoma patients rapidly deteriorates. We recently demonstrated that early diagnosis and surgery within 3 weeks from the initial symptoms are associated with improved survival. While glioblastoma is a semi-urgent disease, the prehospital behaviors and clinical outcomes of glioblastoma patients are poorly understood. We aimed to disclose how prehospital patient behavior influences the clinical outcomes of glioblastoma patients.

Methods

Isocitrate dehydrogenase-wildtype glioblastoma patients treated at our institution between January 2010 and December 2019 were reviewed. Patients were divided into two groups, neurosurgeon and non-neurosurgeon groups, based on the primary doctor whom patients sought for an initial evaluation. Patient demographics and prognoses were examined.

Results

Of 170 patients, 109 and 61 were classified into the neurosurgeon and non-neurosurgeon groups, respectively. The median age of neurosurgeon group was significantly younger than the non-neurosurgeon group (61 vs. 69 years old, P = 0.019) and in better performance status (preoperative Karnofsky performance status scores $\ge$80: 72.5 vs. 55.7%, P = 0.027). The neurosurgeon group exhibited a significantly shorter duration from the first hospital visit to the first surgery than the non-neurosurgeon group (18 vs. 29 days, P < 0.0001). Furthermore, the overall survival of the neurosurgeon group was significantly more prolonged than that of the non-neurosurgeon group (22.9 vs. 14.0 months, P = 0.038).

Conclusion

Seeking an initial evaluation by a neurosurgeon was potentially associated with prolonged survival in glioblastoma patients. A short duration from the first hospital visit to the first surgery is essential in enhancing glioblastoma patient prognosis.
Time to deterioration of patient-reported outcomes as a surrogate of overall survival: a meta-analysis
Authors: Shahnam Adel , Nindra Udit , Desai Jayesh , Hui Rina , Buyse Marc , Hopkins Ashley M , Sorich Michael J
Published: August 2023

Background

Overall survival is the optimal marker of treatment efficacy in randomized clinical trials (RCTs) but can take considerable time to mature. Progression-free survival (PFS) has served as an early surrogate of overall survival but is imperfect. Time to deterioration in quality of life (QOL) measures could be a surrogate for overall survival.

Methods

Phase 3 RCTs in solid malignancies that reported overall survival, PFS, and time to deterioration in QOL or physical function published between January 1, 2010, and June 30, 2022, were evaluated. Weighted regression analysis was used to assess the relationship between PFS, time to deterioration in QOL, and time to deterioration in physical function with overall survival. The coefficient of determination (R2) was used to quantify surrogacy.

Results

In total, 138 phase 3 RCTs were included. Of these, 47 trials evaluated immune checkpoint inhibitors and 91 investigated non–immune checkpoint inhibitor agents. Time to deterioration in QOL (137 RCTs) and time to deterioration in physical function (75 RCTs) performed similarly to PFS as surrogates for overall survival (R2 = 0.18 vs R2 = 0.19 and R2 = 0.10 vs R2 = 0.09, respectively). For immune checkpoint inhibitor studies, time to deterioration in physical function had a higher association with overall survival than with PFS (R2 = 0.38 vs R2 = 0.19), and PFS and time to deterioration in physical function did not correlate with each other (R2 = 0). When time to deterioration in physical function and PFS are used together, the coefficient of determination increased (R2 = 0.57).

Conclusions

Time to deterioration in physical function appears to be an overall survival surrogate measure of particular importance for immune checkpoint inhibitor treatment efficacy. The combination of time to deterioration in physical function with PFS may enable better prediction of overall survival treatment benefit in RCTs of immune checkpoint inhibitors than either PFS or time to deterioration in physical function alone.
Extreme mass ratios and fast rotation in three massive binaries
Authors: Nazé Yaël , Britavskiy Nikolay , Rauw Gregor , Labadie-Bartz Jonathan , Simón-Díaz Sergio
Published: August 2023

The origin of rapid rotation in massive stars remains debated, although binary interactions are now often advocated as a cause. However, the broad and shallow lines in the spectra of fast rotators make direct detection of binarity difficult. In this paper, we report on the discovery and analysis of multiplicity for three fast-rotating massive stars: HD 25631 (B3V), HD 191495 (B0V), and HD 46485 (O7V). They display strikingly similar TESS light curves, with two narrow eclipses superimposed on a sinusoidal variation due to reflection effects. We complement these photometric data by spectroscopy from various instruments (X-Shooter, Espadons, FUSE...), to further constrain the nature of these systems. The detailed analyses of these data demonstrates that the companions of the massive OB stars have low masses (∼1 M⊙) with rather large radii (2–4 R⊙) and low temperatures (<15 kK). These companions display no UV signature, which would exclude a hot subdwarf nature, but disentangling of the large set of X-Shooter spectra of HD 25631 revealed the typical signature of chromospheric activity in the companion’s spectrum. In addition, despite the short orbital periods (P = 3−7 d), the fast-rotating OB-stars still display non-synchronized rotation and all systems appear young (<20 Myr). This suggests that, as in a few other cases, these massive stars are paired in those systems with non-degenerate, low-mass PMS companions, implying that fast rotation would not be a consequence of a past binary interactions in their case.
The 2175 Å interstellar extinction bump: is the wavelength variable?
Authors: Wang Qian , Yang X J , Li Aigen
Published: August 2023

The most striking characteristics of the mysterious 2175$\mathring{\rm A}$ extinction bump, the strongest spectroscopic absorption feature seen on the interstellar extinction curve, are the invariant central wavelength and variable bandwidth: its peak position at 2175$\mathring{\rm A}$ is remarkably constant, while its bandwidth varies from one line of sight to another. However, recent studies of the lines of sight towards a number of Herbig Ae/Be stars have revealed that the extinction bump exhibits substantial shifts from the canonical wavelength of 2175$\mathring{\rm A}$. In this work, we revisit these lines of sight and take a physical approach to determine the ultraviolet (UV) extinction curve for each line of sight. It is found that the wavelengths of the derived UV extinction bumps are around 2200$\mathring{\rm A}$ and the scatters are considerably smaller than those of the previous study based on the same set of Herbig Ae/Be stars, consistent with the conventional wisdom of a stable bump position. Nevertheless, the scatters are still appreciably larger than those associated with the nominal bump position of 2175$\mathring{\rm A}$. This is discussed in the context that Herbig Ae/Be stars are not well suited for interstellar extinction studies.
NuSTAR and AstroSat observations of GX 9+1: spectral and temporal studies
Authors: Thomas Neal Titus , Gudennavar S B , Bubbly S G
Published: August 2023

We have studied the spectro-temporal properties of the neutron star low-mass X-ray binary GX 9+1 using data from NuSTAR/Focal Plane Module and AstroSat/Soft X-ray Telescope and Large Area X-ray Proportional Counter (LAXPC). The hardness–intensity diagram of the source showed it to be in the soft spectral state (banana branch) during both observations. NuSTAR spectral analysis yielded an inclination angle (θ) = 29${^{+3}_{-4}}^{\circ }$ and inner disc radius (Rin) ≤ 19 km. Assuming that the accretion disc was truncated at the Alfvén radius during the observation, the upper limits of the magnetic dipole moment (μ) and the magnetic field strength (B) at the poles of the neutron star in GX 9+1 were calculated to be 1.5 × 10 26 G cm3 and 2.1 × 10 8 G, respectively (for kA = 1). Furthermore, the thickness of the boundary layer was found to be ≃7.5 km, which yielded the radius of the neutron star to be ≤11.5 km. Flux-resolved spectral analysis with AstroSat data showed the source to be disc dominated (Fdisc/Ftotal ∼ 0.9) with a monotonic increase in mass accretion rate ($\dot{m}$) along the banana branch. The analysis also showed the presence of absorption edges at ∼1.9 and ∼2.4 keV, likely due to Si xiii and S xv, respectively. Temporal analysis with LAXPC-20 data in the 0.02–100 Hz range revealed the presence of noise components, which could be characterized by broad Lorentzian components.
Contextual Characterisation Study of Chandrayaan-3 Primary Landing Site
Authors: Karanam Durga Prasad , Bhatt Megha , A Amitabh , G Ambily , Sathyan Sachana , Misra Dibyendu , Srivastava Neeraj , Bhardwaj Anil
Published: August 2023

Chandrayaan-3 is an upcoming lunar mission of India aimed at soft-landing and carrying out first-ever in situ investigations at a high-latitude location on the Moon. Chandrayaan-3 consists of a propulsion module, a lander and a rover, that carry a set of payloads for conducting in-situ science experiments. In this work, contextual characterization of the primary landing site(PLS) located at 69.367621˚S, 32.348126 ̊E is carried out in terms of identification, geomorphology, composition and thermophysical context using the best-ever high-resolution datasets. Our geomorphological study indicates that the PLS is safe for landing with slope less than 4˚ in about 78% of landing area and an average elevation variation of about 169m. The spectral analysis suggests that the region must have experienced extensive space weathering. Compositional analysis indicate that the landing region has a typical highland type of soil characteristics with Mg(4.3 to 5.2 wt.%), Fe(4.2 to 4.9 wt.%), Ca(10-11 wt.%), and Ti(0.25-0.35wt.%). Thermophysical analyses show ∼30K and ∼175K variability in spatial and diurnal temperatures at the PLS- an indicative of a local terrain of distinctive thermophysical characteristics. With important science instruments onboard, Chandrayaan-3 will provide a unique opportunity towards looking at localised variations leading to an improved understanding of the lunar surface.
LMAP-06 VOLUMETRIC MODULATED ARC THERAPY CRANIOSPINAL IRRADIATION UTILIZING A VERTEBRAL BODY SPARING APPROACH: AN ALTERNATIVE APPROACH TO IMPROVE ACCESS AND MINIMIZE TOXICITY
Authors: Perlow Haley K , Matsui Jennifer K , Ewing Ashlee , Cadieux Catherine , Blakaj Dukagjin M , Beyer Sasha J , Thomas Evan M , Grecula John C , Raval Raju R , Palmer Joshua D
Published: August 2023

Craniospinal irradiation (CSI) is indicated for adult patients diagnosed with leptomeningeal disease (LMD). Proton-based vertebral-body-sparing (VBS) CSI has been explored with pediatric patients to minimize hematologic toxicity; however, utilization of VBS in an adult population is limited. A recent phase II trial has shown efficacy of proton-based CSI to treat non-small cell lung and breast cancer with LMD. We hypothesize that VBS-CSI utilizing volumetric modulated arc therapy (VMAT) could also effectively reduce dose to vertebral bodies and surrounding organs-at-risk (OARs), minimizing toxicity for adult patients with LMD and comparing favorably to proton-based CSI. Consecutive patients with leptomeningeal disease received VMAT VBS-CSI, 30 Gy in 10 fractions, as a part of a prospective registry. Full VMAT arcs for the brain fields matched to two spine isocenters for the upper and lower spine were created utilizing limited posterior arcs. To further decrease the vertebral body dose, an avoid entry and exit contour was created. Acute toxicity data were collected using Common Terminology Criteria for Adverse Events (CTCAE) v5. Ten adult patients were treated in this cohort. One patient experienced Grade 2 neutropenia with the remaining nine experiencing Grade 1 hematologic toxicity. Three patients experienced Grade 2 gastrointestinal toxicity. with the remaining seven experiencing Grade 1 nausea. No patient experienced Grade 3+ toxicities in this cohort. One patient experienced a 5-day delay in systemic therapy initiation due to neutropenia; otherwise, all patients planned for systemic therapy started without delay. VMAT VBS-CSI is an effective technique to reduce dose to surrounding OARs and vertebral bodies. In this study, VMAT VBS-CSI led to acceptable toxicity compared to patients treated with proton CSI on a phase 2 clinical trial. Given its promising early results, future prospective evaluation of the technique is warranted.
SDPS-11 IMPACT OF MOLECULAR MARKERS USING FISH TECHNIQUE ON GOS/SURVIVAL IN HIGH GRADE GLIOMAS IN INDIAN SCENARIO
Authors: Pathak Ashis , Brar Harman , Puri Abhishek
Published: August 2023

Aims

Molecular markers (MGMT, IDH and 1p/19q, MIB-1 index, TP53) are used for present day diagnosis of high-grade glial tumours. This study evaluates outcome parameters [e.g., GOS, progression free (PFS) and overall survival(OS)] in treated high grade gliomas in Indian context using FISH technique for molecular characterisation.

MATERIALS AND METHODS

This study used FISH techniques for IDH, MGMT and other IHC markers prospectively on 10 patients with high-grade gliomas, after safe maximal resection. Outcomes were noted for PFS and OS. A GOS of 1-3 (considered unfavourable); 4-5 (favourable), was documented at every 3-monthly follow-up for 2 years. The standardised detection of IDH (by FISH) and methylation profiles of tumours is the strength of the study.

RESULTS

Most (80%) patients had a GOS > 13 post operatively, and none were less than 9. There was no statistically significant effect of gender, extent of resection or tumour location. IDH-1 positivity was recorded in 10%, MGMT methylation in 40%, intermediate to low MIB-1 index in 83.3%. TP53 mutations were noted in 30% cohort who had adverse outcome. The median PFS was 8.60 months. Mean survival was 12.70 months, with no molecular marker having statistically significant effects on PFS or OS. GOS of 13-15 conferred the best OS in contrast to GOS of 9-12 (16.2 months versus 7.5 months); (p = 0.001).

CONCLUSION

GOS is an easy-to-use, validated scoring system with broad applicability and high reproducibility as a quantitative benchmark for clinical assessment. Since IHC lacks standardisation, FISH, despite being costlier, was used as a diagnostic benchmark. Further research on the impact of genomic profiling, extent of resection, especially in geriatric age groups is needed, to formulate an algorithm for optimal management.
Immune-Inflammatory Response And Compensatory Immune-Regulatory Reflex Systems And White Matter Integrity in Schizophrenia
Authors: Gou Mengzhuang , Chen Wenjin , Li Yanli , Chen Song , Feng Wei , Pan Shujuan , Luo Xingguang , Tan Shuping , Tian Baopeng , Li Wei , Tong Jinghui , Zhou Yanfang , Li Hongna , Yu Ting , Wang Zhiren , Zhang Ping , Huang Junchao , Kochunov Peter , Tian Li , Li Chiang-Shan R , Hong L Elliot , Tan Yunlong
Published: August 2023

Background and Hypothesis

Low-grade neural and peripheral inflammation are among the proposed pathophysiological mechanisms of schizophrenia. White matter impairment is one of the more consistent findings in schizophrenia but the underlying mechanism remains obscure. Many cerebral white matter components are sensitive to neuroinflammatory conditions that can result in demyelination, altered oligodendrocyte differentiation, and other changes. We tested the hypothesis that altered immune-inflammatory response system (IRS) and compensatory immune-regulatory reflex system (IRS/CIRS) dynamics are associated with reduced white matter integrity in patients with schizophrenia.

Study Design

Patients with schizophrenia (SCZ, 70M/50F, age = 40.76 ± 13.10) and healthy controls (HCs, 38M/27F, age = 37.48 ± 12.31) underwent neuroimaging and plasma collection. A panel of cytokines were assessed using enzyme-linked immunosorbent assay. White matter integrity was measured by fractional anisotropy (FA) from diffusion tensor imaging using a 3-T Prisma MRI scanner. The cytokines were used to generate 3 composite scores: IRS, CIRS, and IRS/CIRS ratio.

Study Results

The IRS/CIRS ratio in SCZ was significantly higher than that in HCs (P = .009). SCZ had a significantly lower whole-brain white matter average FA (P < .001), and genu of corpus callosum (GCC) was the most affected white matter tract and its FA was significantly associated with IRS/CIRS (r = 0.29, P = .002). FA of GCC was negatively associated with negative symptom scores in SCZ (r = −0.23, P = .016). There was no mediation effect taking FA of GCC as mediator, for that IRS/CIRS was not associated with negative symptom score significantly (P = .217) in SCZ.

Conclusions

Elevated IRS/CIRS might partly account for the severity of negative symptoms through targeting the integrity of GCC.
College Choices, Choice Dilemmas: Black Advantaged Parents’ Views of Their Children’s College Options
Authors: Faulk Deborwah
Published: August 2023

Studies investigating college views largely neglect the Black advantaged and specifically the role of parents in the college search process. Drawing on interviews with upper, upper-middle-, and middle-class parents, this paper investigates how Black advantaged parents view their children’s college options. In an anti-black and credentialed society, parents contend with the consequences of where their children enroll in college and the names their degrees bear. Black advantaged parents’ views of their children’s college options reflect a set of dilemmas relative to college choices. As college graduates, parents recognize that degrees from HBCUs are weighed down by racial stigma and institutional anti-blackness. Fears about anti-black perceptions of HBCUs fuel parental concerns about racial discrimination post-graduation. Yet, parents also recognize that as students on historically white campuses their children are at risk of experiences with anti-black racism while enrolled in college. This article describes the challenge of antiblackness as multi-dimensional, impacting parents’ attention both to their children’s experiences as graduates and as students. This paper offers implications for black parenting, decision-making, and higher education.
Maternal Employment and Childcare Use from an Intersectional Perspective: Stratification along Class, Contractual and Gender Lines in Denmark, France, Germany, Italy, Sweden and the UK
Authors: Ferragina Emanuele , Magalini Edoardo
Published: August 2023

Connecting streams of feminist and comparative social policy literature, this article investigates stratification in maternal employment and childcare use along class, contractual, and gender lines across six countries (Denmark, France, Germany, Italy, Sweden, and the United Kingdom) and five family policy models. Detailing the different stratifying factors that intervene in the relation between maternal employment and childcare use offers a concrete analysis of the complex link between social reproduction and work. Employing multivariate regressions and EU-SILC (2007–2018) data, it provides an intersectional perspective to the literature. First, we observe a process of formalization in childcare use with a parallel reduction of nonformal care for couples; this process is slower for single mothers. Second, we document a paradox in relation to the social investment approach: the relation between childcare use and maternal employment is stronger in countries that recently expanded childcare to modify their male-breadwinner orientation, but in these countries childcare use is more stratified along class/contract types, a concern for the outcomes of social investment strategies outside of Scandinavia. Being out of work, being in a lower social class, fulfilling domestic tasks and/or care activities, and having an atypical contract negatively correlates with childcare use in most countries. Third, households where partners have more similar earning levels use childcare to a greater extent. The article also provides models employing different dependent and independent variables, alternative family structures, full and part-time work, formal and nonformal childcare, and rich country details.
A Hydroponic-Based Bioassay to Facilitate Plasmodiophora brassicae Phenotyping
Authors: Salih Rasha , Brochu Anne-Sophie , Labbé Caroline , Strelkov Stephen E. , Franke Coreen , Bélanger Richard , Pérez-López Edel
Published: August 2023

Clubroot, caused by the obligate parasite Plasmodiophora brassicae, is one of the most devastating diseases affecting the canola/oilseed rape (Brassica napus) industry worldwide. Currently, the planting of clubroot-resistant (CR) cultivars is the most effective strategy used to restrict the spread and the economic losses linked to the disease. However, virulent P. brassicae isolates have been able to infect many of the currently available CR cultivars, and the options to manage the disease are becoming limited. Another challenge has been achieving consistency in evaluating host reactions to P. brassicae infection, with most bioassays conducted in soil and/or potting medium, which requires significant space and can be labor intensive. Visual scoring of clubroot symptom development can also be influenced by user bias. Here, we have developed a hydroponic bioassay using well-characterized P. brassicae single-spore isolates representative of clubroot virulence in Canada, as well as field isolates from three Canadian provinces in combination with canola inbred homozygous lines carrying resistance genetics representative of CR cultivars available to growers in Canada. To improve the efficiency and consistency of disease assessment, symptom severity scores were compared with clubroot evaluations based on the scanned root area. According to the results, this bioassay offers a reliable, less expensive, and reproducible option to evaluate P. brassicae virulence, as well as to identify which canola resistance profile(s) may be effective against particular isolates. This bioassay will contribute to the breeding of new CR canola cultivars and the identification of virulence genes in P. brassicae that could trigger resistance and that have been very elusive to this day.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Risk of Miscarriage in Relation to Seasonal Influenza Vaccination Before or During Pregnancy
Authors: Regan Annette K. , Wesselink Amelia K. , Wang Tanran R. , Savitz David A. , Yland Jennifer J. , Rothman Kenneth J. , Hatch Elizabeth E. , Wise Lauren A.
Published: August 2023

OBJECTIVE:

To evaluate the association between seasonal influenza vaccination and miscarriage using data from an ongoing, prospective cohort study.

METHODS:

We analyzed 2013–2022 data from PRESTO (Pregnancy Study Online), a prospective prepregnancy cohort study of female pregnancy planners and their male partners in the United States and Canada. Female participants completed a baseline questionnaire and then follow-up questionnaires every 8 weeks until pregnancy, during early and late pregnancy, and during the postpartum period. Vaccine information was self-reported on all questionnaires. Miscarriage was identified from self-reported information during follow-up. Male partners were invited to complete a baseline questionnaire only. We used Cox proportional hazard models to estimate the hazard ratio (HR) and 95% CI for the association between vaccination less than 3 months before pregnancy detection through the 19th week of pregnancy and miscarriage, with gestational weeks as the time scale. We modeled vaccination as a time-varying exposure and used propensity-score fine stratification to control for confounding from seasonal and female partner factors.

RESULTS:

Of 6,946 pregnancies, 23.3% of female partners reported exposure to influenza vaccine before or during pregnancy: 3.2% during pregnancy (gestational age 4–19 weeks) and 20.1% during the 3 months before pregnancy detection. The miscarriage rate was 16.2% in unvaccinated and 17.0% among vaccinated participants. Compared with no vaccine exposure, influenza vaccination was not associated with increased rate of miscarriage when administered before (HR 0.99, 95% CI 0.81–1.20) or during (HR 0.83, 95% CI 0.47–1.47) pregnancy. Of the 1,135 couples with male partner vaccination data available, 10.8% reported vaccination less than 3 months before pregnancy. The HR for the association between male partner vaccination and miscarriage was 1.17 (95% CI 0.73–1.90).

CONCLUSION:

Influenza vaccination before or during pregnancy was not associated with miscarriage.
Practical Review of the Cost of Diagnosis and Management of Positional Plagiocephaly
Authors: Watt Ayden , Alabdulkarim Abdulaziz , Lee James , Gilardino Mirko
Published: August 2023

Background:

Positional plagiocephaly has garnered increased research interest since the introduction of the Back to Sleep campaign in the 1990s, and the subsequent increase in infants with cranial deformity. Research has focused on treatment outcomes and developing new modalities to address asymmetric heads. Little attention has been given to the cost of treatment and diagnosis. This study aimed to summarize the literature and provide an overview of the costs associated with a diagnosis of positional plagiocephaly.

Methods:

A literature review was performed by searching PubMed and Ovid Embase to identify studies pertaining to the “cost” of plagiocephaly diagnosis or treatment through direct financial factors, disturbance to daily routines (ie, through treatment prolongation), or related stress.

Results:

Twenty-nine peer-reviewed studies were included. Treatment options for plagiocephaly are stratified by severity and age of diagnosis, with different pathways available to treat different stages of asymmetry. The common factor across all treatment modalities is that earlier diagnosis unequivocally leads to better aesthetic outcomes and shorter treatment times. This leads to lower costs for treatment, a lower stress burden for parents, and lower costs for the healthcare system in the future through reduction of long-term effects. Our theoretical cost model suggests that early diagnosis at 4 months can lead to a treatment cost of $1495, when compared with $5195 for detection of deformity at or after 6 months.

Conclusion:

The dramatic cost disparity between early and late diagnosis highlights the need for reliable methods to accurately detect cranial deformity early in an infant’s life.
Consecutive Liver and Bone Marrow Transplantation for Erythropoietic Protoporphyria: Case Report and Literature Review
Authors: Portich Júlia Plentz , Ribeiro Aline Sinhorelo , Rodrigues Taniguchi Adriano Nori , Backes Ariane , de Souza Carolina Fischinger Moura , Kieling Carlos Oscar , Scherer Fernanda Fetter , de Oliveira Poswar Fabiano , Leipnitz Ian , Doederlein Schwartz Ida Vanessa , Sekine Leo , Rigoni Lisandra Della Costa , Marquardt da Silveira Luciana , de Almeida Furlanetto Marina , Adami Marina Rossato , Breunig Raquel Cristine , Guedes Renata Rostirola , do Amaral Sheila Nogueira , Gonçalves Vieira Sandra Maria , de Brum Soares Tahiane , Silva Thiago Oliveira , da Rocha Silla Lúcia Mariano , Astigarraga Claudia Caceres , Paz Alessandra Aparecida , Daudt Liane Esteves
Published: August 2023

Background:

Erythropoietic protoporphyria (EPP) is a rare inherited disease of heme biosynthesis resulting in the accumulation of protoporphyrin, characterized by liver failure in a minority of cases. Although liver transplant (LT) is the therapeutic strategy for advanced hepatic disease, it does not correct the primary defect, which leads to recurrence in liver graft. Thus, hematopoietic stem cell transplantation (HSCT) is an approach for treating EPP.

Methods:

We aim to describe the first sequential LT and HSCT for EPP performed in Latin America, besides reviewing the present-day literature.

Results

The patient, a 13-year-old female with a history of photosensitivity, presented with symptoms of cholestatic and hepatopulmonary syndrome and was diagnosed with EPP. Liver biopsy demonstrated cirrhosis. She was submitted to a successful LT and showed improvement of respiratory symptoms. However, she had disease recurrence on the liver graft. She underwent a myeloablative HSCT using a matched unrelated donor, conditioning with BuCy (busulfan and cyclophosphamide), and GvHD (graft vs. host disease) prophylaxis with ATG (thymoglobulin), tacrolimus and methotrexate. Neutrophil engraftment occurred on D+18. She has presented mixed chimerism, but normalization of PP levels, being 300 days after HSCT, in good state of health and normal liver function.

Conclusions:

Consecutive LT and HSCT for EPP is a procedure that has been described in 10 cases in the literature and, even though these patients are a highly diversified population, studies have shown favorable results. This concept of treatment should be considered in patients with established liver disease.
Baseline Quality of Life in Pediatric Patients With Low-flow Vascular Malformations
Authors: Arleo Timothy L. , Swerdlin Rachel F. , Gill Anne E. , Goudy Steven L. , Meisel Jonathan A. , Briones Michael A. , Shah Jay H. , Wright Allyson , Hawkins Clifford Matthew
Published: August 2023

Objective:

The aim of this study was to quantify and describe baseline patient and parent-proxy health-related quality of life scores in patients with low-flow vascular malformations at a single, tertiary-care vascular anomalies clinic.

Study design:

This is a retrospective study of data collected on patients with low-flow vascular malformations between the ages of 2 to 25 who were seen at a single, tertiary-care center vascular anomalies clinic. A total of 266 patients are included in this study.

Results:

Patients with lymphatic malformations report decreased quality of life scores as compared with venous malformations in the emotional, psychological, school, and social domains. Patients with lower extremity malformation report decreased quality of life scores as compared with head/neck, trunk, upper extremity, and multifocal malformations; most notably in the physical domain.

Conclusions:

Treatment of low-flow vascular malformations should aim to improve patient quality of life. The use of standardized health-related quality of life measures in this study quantifies baseline quality of life scores among patients with low-flow vascular malformations.
Strategies for Teaching Diversity, Equity, and Inclusion in Principles of Nursing
Authors: Victor Joyce , Gangaware Ashley , Siek Jacob
Published: August 2023

Background:

Nursing programs need to identify creative teaching strategies, guiding students to reflect on individual value systems and consider the values of others as they apply diversity, equity, and inclusion (DEI) in the provision of individualized nursing care.

Purpose:

The purpose of this project was to develop teaching strategies related to DEI content and examine how first clinical semester, prelicensure baccalaureate nursing students perceived these strategies.

Methods:

Participants engaged in self-reflection on topics related to DEI, using guided questions in discussion boards, a written paper, and a simulation-based experience. Thirteen students completed an anonymous survey with consideration of these activities and their perceived impact on DEI in their personal nursing practice.

Outcomes:

Three investigators analyzed survey responses by employing Word Clouds, word counts, and interdependent content analysis and found that using the existing syllabi for the Principles of Nursing course and modifying it to address DEI concepts resulted in perceived increases in awareness, sensitivity, knowledge, competence, and holism.
Peripheral T-cell activation, Th17 cells, regulatory T-cells, and aortic aneurysm in people with HIV
Authors: Hove-Skovsgaard Malene , Høgh Julie , Pham Michael Huy Cuong , Knudsen Andreas Dehlbæk , Gerstoft Jan , Ostrowski Sisse Rye , Køber Lars , Benfield Thomas , Kofoed Klaus Fuglsang , Nielsen Susanne Dam
Published: August 2023

Here, we investigate if peripheral T-cell activation and proportion of Th17 and T-regulatory cells (Tregs) are associated with aortic aneurysm or aortic diameter in people with HIV. Aorta was examined by computed tomography scans and T-cells by flow cytometry in 428 participants, and aortic aneurysm was found in 32 participants. None of the T-cell subsets were associated with aortic aneurysm, but activated T-cells and Tregs had opposite association to aorta diameter indicating an inverse impact.
Clinical Characterization of Congenital Anophthalmic and Microphthalmic Cavities in Inidviduals With Craniofacial Anomalies
Authors: Parizotto Paula Isabella , Gonçalves Paula Raul , Kokitsu Nancy Mizue , Alonso Nivaldo , Tonello Cristiano
Published: August 2023

Objective:

Measure the frequency of anophthalmic and microphthalmic patients with craniofacial anomalies (FCAs).

Design:

Descriptive, cross-sectional, retrospective study.

Setting:

Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo (HRAC-USP). The medical records of patients treated at HRAC from 2000 to 2012 with a diagnosis of congenital anophthalmia or microphthalmia were examined. Patients were excluded for secondary anophthalmia, incomplete medical records, or information that could not be accessed.

Outcome Measures:

Frequency of anophthalmia and microphthalmia; the proportions and diagnoses of associated FCAs; impairment of ocular appendages; extracranial or facial anomalies; genetic alterations; and surgical approach.

Results:

A total of 56 patients had anophthalmia (52.3%), 35 had microphthalmia (32.7%), and 16 patients had both (15%). Individuals with FCAs associated with microphthalmia, anophthalmia, or both totaled 74, corresponding to 69.2%. Anophthalmia was more likely than microphthalmia to be accompanied by FCAs, at 76.4% of patients (P < 0.05). Cleft lip and palate were the main malformations associated with anophthalmia (23.64%), with microphthalmia (45%), and with both (44.44%). Reconstructive surgery was done in 63.6% of cases. The ocular attachments were compromised in 71% of cases. Extracraniofacial malformations were found in 9.3% of patients. Only 7 records contained karyotypes, and no changes directly related to anophthalmia or microphthalmia were found.

Conclusion:

Anophthalmia is more frequent than microphthalmia and is more often accompanied by FCA. Cleft lip and cleft palate are the most frequent concomitant malformations.
Impact of Pregnancy on Papilledema and Vision Loss in Idiopathic Intracranial Hypertension Patients: A Chart Review and Case Series of 13 Patients
Authors: Lambert-Cheatham Nathan A. , Nagia Lina , Pasmanter Nathaniel R. , Pellizzari Richard , Lee Beom , Miller Neysa J. , Kaufman David I.
Published: August 2023

Background:

Studies suggest that weight gain is a prominent risk factor for recurrence of papilledema in idiopathic intracranial hypertension (IIH). Given this information, the significant weight gain that occurs during pregnancy, and the fact that pharmacologic therapy is many times discontinued, raises concerns for worsening edema and vision loss. To examine the impact of pregnancy weight gain on IIH, a retrospective chart review of patients with IIH and pregnancy was performed. Compared with previous studies, we 1) quantified findings with optical coherence tomography (OCT) and Humphrey visual field (HVF) data, 2) Included baseline data before pregnancy, 3) determined excess pregnancy weight gain using body mass index-adjusted weight gain goals, and 4) correlated worsening in IIH symptoms with changes in papilledema.

Methods:

Charts were reviewed for patients with diagnoses of IIH who had at least 2 visits with neuro-ophthalmology during pregnancy. Thirteen patients met inclusion criteria. Data were compared from baseline visits before pregnancy, pregnancy visits, and postpregnancy visits.

Results:

Comparisons of HVF mean deviation (MD), OCT retinal nerve fiber layer (RNFL), and Max OCT RNFL during pregnancy were not significant compared with baseline (P = 0.51, 0.41, and 0.25). Three patients were found to have increased papilledema during pregnancy (Max Avg OCT RNFL of 152.5, 129, and 123.5 μm) of which 2 developed new reproducible mild visual field defects (HVF ∆MD −1.78 and −4.49). All patients showed more than the 6% weight gain, typically observed in recurrent IIH. Eleven patients gained more than their weight from initial diagnosis. Eight patients had excess pregnancy weight gain. Six patients discontinued pharmacologic therapy for IIH.

Conclusions:

Weight gain seems to carry a lower risk in IIH patients when associated with pregnancy. This is suggested by the high rate of stable or even decreased disc edema in patients despite medication discontinuation and excess pregnancy weight gain. We postulate these findings may be related to changes in weight distribution or endocrine changes during pregnancy.
Study on Good Clinical Practices among Researchers in a Tertiary Healthcare Institute in India
Authors: Harshita  , Panda Prasan Kumar
Published: August 2023

BACKGROUND

Good Clinical Practice (GCP) is put in place to protect human participants in clinical trials as well as to ensure the quality of research. Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community. Therefore, it must be ensured that researchers are well-versed in the GCP. But not much is known about the knowledge and practices of the GCP in the medical colleges of North India.

AIM

To assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants.

METHODS

This is a cross-sectional study. A self-structured questionnaire about GCP, after expert validations, was circulated among researchers, at a tertiary healthcare institute, All India Institute of Medical Sciences (AIIMS), Rishikesh. A total of 59 individuals, who were selected by universal sampling, participated in the study. All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects, except residents and faculty, and are still a part of the institute have been included in the study. The study was approved by the Institutional Ethics Committee of AIIMS, Rishikesh. We used descriptive analysis and the Chi-squared test to analyze data. P-value < 0.05 was considered significant.

RESULTS

Out of 59 participants, only 11 (18.6%) were certified for GCP. Most of the participants (64.4%) had “Average” knowledge, 33.9% had “Good” knowledge and 1.7% had “Poor” knowledge. Only 49% of participants had satisfactory practices related to GCP. There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board (P=0.010), confidentiality & privacy (P=0.011), and participant safety & adverse events (P<0.001). There was also a significant difference in knowledge of research misconduct (P=0.024) and participant safety & adverse events (P=0.011) based on certification of GCP. There was a notable difference in the practices related to recruitment & retention on the basis of current academic position (P<0.001) and certification of GCP (P=0.023). We also observed a considerable difference between the knowledge and practices of GCP among the participants (P=0.013).

CONCLUSION

Participants have basic knowledge of GCP but show a lack thereof in certain domains of GCP. This can be addressed by holding training sessions focusing on these particular domains.

Core tip

There is a lack of knowledge about the Good Clinical Practices in the researchers of medical colleges. In order to improve the quality of research, as well as, make research a better experience for the participants of research, we must work on improving awarenss of the GCP among researchers. This can be done by organising training sessions or workshops which throw light on the principles of GCP.