bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond the Medication Pass: Attitudes, Ethics, Agency, and Antipsychotic Medications in Assisted Living/Residential Care
Authors: Dys Sarah , Carder Paula
Published: August 2022

Background and Objectives

As-needed (PRN) antipsychotic medication use (APU) among assisted living/residential care (AL/RC) residents is a controversial health policy issue. AL/RC care staff, families, clinicians, researchers, and policymakers disagree about PRN APU to manage behavioral expressions associated with residents’ dementia or cognitive impairment.

Research Design and Methods

Semistructured interviews among eleven direct care staff (n = 3), licensed nurses (n = 2), administrators/executive directors (n = 4), and consultant pharmacists (n = 2) currently working in Oregon AL/RC. Using situational analysis, we identify, describe, and visualize positions and ideologies by job role to theorize PRN APU decision-making.

Results

Three broad processes underlie APU to manage residents’ behavioral expressions: justifying PRN APU, moralizing APU, and balancing local practices (eg, managing behavioral expressions, respecting individuals) with nonlocal practices (eg, professional authority). People involved in the situation of APU in AL/RC describe positive and negative justifications, and personal moral positions that frame PRN antipsychotics or nonpharmaceutical interventions as “right” or “wrong,” driving various approaches to behavior management. Participants described a converse orientation between perceived level of agency within and proximity to the situation of APU. Those most closely involved, or local, to the situation of passing medications (eg, direct care staff and nurses) expressed less agency compared with nonlocal physicians and policymakers, who are not involved in the day-to-day practices within AL/RC.

Discussion and Implications

This study raises practice and policy implications regarding APU in AL/RC settings. Care staff roles, ethical considerations, and perceived agency inform decision-making on whether to use antipsychotic medications. Participants described costs and benefits associated with both PRN APU and nonpharmaceutical interventions when responding to AL/RC residents’ behavioral expressions. Participants’ experiences emphasize the interactions across multiple levels of care. Balancing regulatory goals with resident-centered practices underscores the need for a system-level perspective, extending beyond direct care staff passing antipsychotic medications to residents.
Effects of public and external health spending on out-of-pocket payments for healthcare in sub-Saharan Africa
Authors: Frimpong Albert Opoku , Amporfu Eugenia , Arthur Eric
Published: August 2022

Financing healthcare in sub-Saharan Africa (SSA) is characterized by high levels of out-of-pocket (OOP) payments for healthcare. This renders many individuals vulnerable to poverty and deviates from the Universal Health Coverage (UHC) goal of providing financial protection for healthcare. We examined the relative effects of public and external health spending on OOP healthcare payments in SSA. We used the system generalized method of moments (GMM) estimator and data from the World Bank’s World Development Indicators for 43 SSA countries from 2000 to 2017. The results show that reductions in OOP payments are higher with increases in public spending than external spending. This means increases in public health spending, compared with external health spending, will increase the pace towards achieving the financial protection goal of UHC in SSA. But since government spending is limited by fiscal space and parliamentary approval, public health spending through social health insurance might provide a regular means of financing healthcare to speed up achieving the financial protection goal in SSA countries.
Lifting Methods in Mass Partition Problems
Authors: Soberón Pablo , Takahashi Yuki
Published: August 2022

Many results about mass partitions are proved by lifting $\mathds {R}^d$ to a higher-dimensional space and dividing the higher-dimensional space into pieces. We extend such methods to use lifting arguments to polyhedral surfaces. Among other results, we prove the existence of equipartitions of $d+1$ measures in $\mathds {R}^d$ by parallel hyperplanes and of $d+2$ measures in $\mathds {R}^d$ by concentric spheres. For measures whose supports are sufficiently well separated, we prove results where one can cut a fixed (possibly different) fraction of each measure either by parallel hyperplanes, concentric spheres, convex polyhedral surfaces of few facets, or convex polytopes with few vertices.
Development of a usability checklist for public health dashboards to identify violations of usability principles
Authors: Ansari Bahareh , Martin Erika G
Published: August 2022

Objective

To develop a usability checklist for public health dashboards.

Materials and methods

This study systematically evaluated all publicly available dashboards for sexually transmitted infections on state health department websites in the United States (N = 13). A set of 11 principles derived from the information visualization literature were used to identify usability problems that violate critical usability principles: spatial organization, information coding, consistency, removal of extraneous ink, recognition rather than recall, minimal action, dataset reduction, flexibility to user experience, understandability of contents, scientific integrity, and readability. Three user groups were considered for public health dashboards: public health practitioners, academic researchers, and the general public. Six reviewers with usability knowledge and diverse domain expertise examined the dashboards using a rubric based on the 11 principles. Data analysis included quantitative analysis of experts’ usability scores and qualitative synthesis of their textual comments.

Results

The dashboards had varying levels of complexity, and the usability scores were dependent on the dashboards’ complexity. Overall, understandability of contents, flexibility, and scientific integrity were the areas with the most major usability problems. The usability problems informed a checklist to improve performance in the 11 areas.

Discussion

The varying complexity of the dashboards suggests a diversity of target audiences. However, the identified usability problems suggest that dashboards’ effectiveness for different groups of users was limited.

Conclusions

The usability of public health data dashboards can be improved to accommodate different user groups. This checklist can guide the development of future public health dashboards to engage diverse audiences.
Serum Leukocyte Cell-Derived Chemotaxin 2 (LECT2) Level Is Associated with Osteoporosis
Authors: Wang Qiang , Xu Feng , Chen Jiong , Xie Yan-Qing , Xu Su-Ling , He Wen-Ming
Published: August 2022

Objective

The aim of this study was to examine serum leukocyte cell-derived chemotaxin 2 (LECT2) levels in osteoporosis subjects to confirm its association with osteoporosis.

Methods

A total of 204 adult subjects were recruited. Bone mineral densities (BMD) were assessed and blood samples were collected for measurements of biomedical parameters and the bone turnover markers. Serum LECT2 levels were measured by enzyme-linked immunosorbent assay. The relationships between serum LECT2 levels and other parameters were analyzed using the Spearman correlation coefficient.

Results

Serum LECT2 levels were significantly increased in osteoporosis subjects over controls. We found a significantly negative correlation of serum LECT2 with BMD, 25-hydroxy-vitamin D, and creatinine and a significantly positive correlation with C-terminal telopeptide of type 1 collagen and total cholesterol.

Conclusion

Serum LECT2 levels were significantly upregulated in osteoporosis subjects and correlated with the severity of bone loss. Serum LECT2 could be a potential biomarker to assess the risk of bone loss.
ULX pulsar Swift J0243.6+6124 observations with NuSTAR: dominance of reflected emission in the super-Eddington state
Authors: Bykov S D , Gilfanov M R , Tsygankov S S , Filippova E V
Published: August 2022

We report the discovery of the bright reflected emission component in the super-Eddington state of the ultraluminous X-ray pulsar Swift J0243.6+6124, based on the NuSTAR observations of the source during its 2017 outburst. The flux of the reflected emission is weakly variable over the pulsar phase while the direct emission shows significantly larger pulsation amplitude. We propose that in this system the neutron star finds itself in the centre of the well formed by the inner edge of the geometrically thick super-Eddington accretion disc truncated by the magnetic field of the pulsar. The aspect ratio of the well is H/R ∼ 1. The inner edge of the truncated disc is continuously illuminated by the emission of the accretion column giving rise to the weakly variable reflected emission. As the neutron star rotates, its emission sweeps through the line of sight, giving rise to the pulsating direct emission. From Doppler broadening of the iron line, we measure the truncation radius of the accretion disc ∼50 Rg. The inferred dipole component of the magnetic field is consistent with previous estimates favouring a not very strong field. The uniqueness of this system is determined by its moderately super-Eddington accretion rate and the moderate magnetic field so that the inner edge of the truncated geometrically thick accretion disc is seen from the neutron star at a large solid angle.
Probing the link between quenching and morphological evolution
Authors: Koutsouridou I , Cattaneo A
Published: August 2022

We use a semi-analytic model of galaxy formation to compare the predictions of two quenching scenarios: halo quenching and black hole (BH) quenching. After calibrating both models so that they fit the mass function of galaxies, BH quenching is in better agreement with the fraction of passive galaxies as a function of stellar mass M* and with the galaxy morphological distribution on a star formation rate versus M* diagram. Besides this main finding, there are two other results from this research. First, a successful BH-quenching model requires that minor mergers contribute to the growth of supermassive BHs. If galaxies that reach high M* through repeated minor mergers are not quenched, there are too many blue galaxies at high masses. Second, the growth of BHs in mergers must become less efficient at low masses in order to reproduce the MBH–M* relation and the passive fraction as a function of M*, in agreement with the idea that supernovae prevent efficient BH growth in systems with low escape speeds. Our findings are consistent with a quasar-feedback scenario in which BHs grow until they are massive enough to blow away the cold gas in their host galaxies and to heat the hot circumgalactic medium to such high entropy that its cooling time becomes long. They also support the notion that quenching and maintenance correspond to different feedback regimes.
Kinematics of the H α and H β broad-line region in an SDSS sample of type-1 AGNs
Authors: Rakić N
Published: August 2022

Here, we investigate the kinematics of the part of the broad-line region (BLR) in active galactic nuclei (AGNs) emitting H β and H α emission lines. We explore the widths and asymmetries of the broad H β and H α emission lines in a sample of high-quality (i.e. high signal-to-noise ratio) spectra of type-1 AGN taken from the Data Release 16 of the Sloan Digital Sky Survey in order to explore possible deviation from the gravitationally bound motion. To find only the broad component of H β and H α, we use the fantasy (Fully Automated pythoN Tool for AGN Spectra analYsis) code for the multicomponent modelling of the AGN spectra and for careful extraction of the broad emission-line parameters. We show that based on the broad-line profiles widths and asymmetries, the BLR gas emitting H β and H α lines follows similar kinematics, and seems to be virialized in our sample of type-1 AGN.
On the thermal structure of the proto-super star cluster 13 in NGC 253
Authors: Rico-Villas F , González-Alfonso E , Martín-Pintado J , Rivilla V M , Martín S
Published: August 2022

Using high angular resolution ALMA observations (0.02 arcsec ≈ 0.34 pc), we study the thermal structure and kinematics of the proto-super star cluster 13 in the central region of NGC 253 through their continuum and vibrationally excited HC3N emission from J = 24−23 and J = 26−25 lines arising from vibrational states up to v4 = 1. We have carried 2D-LTE and non-local radiative transfer modelling of the radial profile of the HC3N and continuum emission in concentric rings of 0.1 pc width. From the 2D-LTE analysis, we found a Super Hot Core (SHC) of 1.5 pc with very high vibrational temperatures (>500 K), and a jump in the radial velocity (21 km s−1) in the SE-NW direction. From the non-local models, we derive the HC3N column density, H2 density, and dust temperature (Tdust) profiles. Our results show that the thermal structure of the SHC is dominated by the greenhouse effect due to the high dust opacity in the IR, leading to an overestimation of the LTE Tdust and its derived luminosity. The kinematics and Tdust profile of the SHC suggest that star formation was likely triggered by a cloud–cloud collision. We compare proto-SSC 13 to other deeply embedded star-forming regions, and discuss the origin of the $L_\text{IR}/M_{\text{H}_2}$ excess above ∼100 L⊙ M$_\odot ^{-1}$ observed in (U)LIRGs.
Fitness Landscape Analysis of a tRNA Gene Reveals that the Wild Type Allele is Sub-optimal, Yet Mutationally Robust
Authors: Gabzi Tzahi , Pilpel Yitzhak , Friedlander Tamar
Published: August 2022

Fitness landscape mapping and the prediction of evolutionary trajectories on these landscapes are major tasks in evolutionary biology research. Evolutionary dynamics is tightly linked to the landscape topography, but this relation is not straightforward. Here, we analyze a fitness landscape of a yeast tRNA gene, previously measured under four different conditions. We find that the wild type allele is sub-optimal, and 8–10% of its variants are fitter. We rule out the possibilities that the wild type is fittest on average on these four conditions or located on a local fitness maximum. Notwithstanding, we cannot exclude the possibility that the wild type might be fittest in some of the many conditions in the complex ecology that yeast lives at. Instead, we find that the wild type is mutationally robust (“flat”), while more fit variants are typically mutationally fragile. Similar observations of mutational robustness or flatness have been so far made in very few cases, predominantly in viral genomes.
Black-hole-inspired thermal trapping with graded heat-conduction metadevices
Authors: Xu Liujun , Liu Jinrong , Jin Peng , Xu Guoqiang , Li Jiaxin , Ouyang Xiaoping , Li Ying , Qiu Cheng-Wei , Huang Jiping
Published: August 2022

The curved space-time produced by black holes leads to the intriguing trapping effect. So far, metadevices have enabled analogous black holes to trap light or sound in laboratory spacetime. However, trapping heat in a conductive environment is still challenging because diffusive behaviors are directionless. Inspired by black holes, we construct graded heat-conduction metadevices to achieve thermal trapping, resorting to the imitated advection produced by graded thermal conductivities rather than the trivial solution of using insulation materials to confine thermal diffusion. We experimentally demonstrate thermal trapping for guiding hot spots to diffuse towards the center. Graded heat-conduction metadevices have advantages in energy-efficient thermal regulation because the imitated advection has a similar temperature field effect to the realistic advection that is usually driven by external energy sources. These results also provide an insight into correlating transformation thermotics with other disciplines, such as cosmology, for emerging heat control schemes.
JAM-A facilitates hair follicle regeneration in alopecia areata through functioning as ceRNA to protect VCAN expression in dermal papilla cells
Authors: Wu Minjuan , Xu Chen , Jiang Junfeng , Xu Sha , Xiong Jun , Fan Xiaoming , Ji Kaihong , Zhao Yunpeng , Ni Haitao , Wang Yue , Liu Houqi , Xia Zhaofan
Published: August 2022

The dermal papilla cells in hair follicles function as critical regulators of hair growth. In particular, alopecia areata (AA) is closely related to the malfunctioning of the human dermal papilla cells (hDPCs). Thus, identifying the regulatory mechanism of hDPCs is important in inducing hair follicle (HF) regeneration in AA patients. Recently, growing evidence has indicated that 3′ untranslated regions (3′ UTR) of key genes may participate in the regulatory circuitry underlying cell differentiation and diseases through a so-called competing endogenous mechanism, but none have been reported in HF regeneration. Here, we demonstrate that the 3′ UTR of junctional adhesion molecule A (JAM-A) could act as an essential competing endogenous RNA to maintain hDPCs function and promote HF regeneration in AA. We showed that the 3′ UTR of JAM-A shares many microRNA (miRNA) response elements, especially miR-221–3p, with versican (VCAN) mRNA, and JAM-A 3′ UTR could directly modulate the miRNA-mediated suppression of VCAN in self-renewing hDPCs. Furthermore, upregulated VCAN can in turn promote the expression level of JAM-A. Overall, we propose that JAM-A 3′ UTR forms a feedback loop with VCAN and miR-221–3p to regulate hDPC maintenance, proliferation, and differentiation, which may lead to developing new therapies for hair loss.
The photosynthesis apparatus of European mistletoe (Viscum album)
Authors: Schröder Lucie , Hegermann Jan , Pille Patrick , Braun Hans-Peter
Published: August 2022

European mistletoe (Viscum album) is known for its special mode of cellular respiration. It lacks the mitochondrial NADH dehydrogenase complex (Complex I of the respiratory chain) and has restricted capacities to generate mitochondrial adenosine triphosphate (ATP). Here, we present an investigation of the V. album energy metabolism taking place in chloroplasts. Thylakoids were purified from young V. album leaves, and membrane-bound protein complexes were characterized by Blue native polyacrylamide gel electrophoresis as well as by the complexome profiling approach. Proteins were systematically identified by label-free quantitative shotgun proteomics. We identified >1,800 distinct proteins (accessible at https://complexomemap.de/va_leaves), including nearly 100 proteins forming part of the protein complexes involved in the light-dependent part of photosynthesis. The photosynthesis apparatus of V. album has distinct features: (1) comparatively low amounts of Photosystem I; (2) absence of the NDH complex (the chloroplast pendant of mitochondrial Complex I involved in cyclic electron transport (CET) around Photosystem I); (3) reduced levels of the proton gradient regulation 5 (PGR5) and proton gradient regulation 5-like 1 (PGRL1) proteins, which offer an alternative route for CET around Photosystem I; (4) comparable amounts of Photosystem II and the chloroplast ATP synthase complex to other seed plants. Our data suggest a restricted capacity for chloroplast ATP biosynthesis by the photophosphorylation process. This is in addition to the limited ATP supply by the mitochondria. We propose a view on mistletoe’s mode of life, according to which its metabolism relies to a greater extent on energy-rich compounds provided by the host trees.
Does periodontal treatment improve rheumatoid arthritis disease activity? A systematic review
Authors: Mustufvi Zhain , Twigg Joshua , Kerry Joel , Chesterman James , Pavitt Sue , Tugnait Aradhna , Mankia Kulveer
Published: August 2022

Objectives

The association of periodontal disease in people diagnosed with RA is emerging as an important driver of the RA autoimmune response. Screening for and treating periodontal disease might benefit people with RA. We performed a systematic literature review to investigate the effect of periodontal treatment on RA disease activity.

Methods

Medline/PubMed, Embase and Cochrane databases were searched. Studies investigating the effect of periodontal treatment on various RA disease activity measures were included. The quality of included studies was assessed. Data were grouped and analysed according to RA disease outcome measures, and a narrative synthesis was performed.

Results

We identified a total of 21 studies, of which 11 were of non-randomized experimental design trials and 10 were randomized controlled trials. The quality of the studies ranged from low to serious/critical levels of bias. RA DAS-28 was the primary outcome for most studies. A total of 9 out of 17 studies reported a significant intra-group change in DAS-28. Three studies demonstrated a significant intra-group improvement in ACPA level after non-surgical periodontal treatment. Other RA biomarkers showed high levels of variability at baseline and after periodontal treatment.

Conclusion

There is some evidence to suggest that periodontal treatment improves RA disease activity in the short term, as measured by DAS-28. Further high-quality studies with longer durations of follow-up are needed. The selection of the study population, periodontal interventions, biomarkers and outcome measures should all be considered when designing future studies. There is a need for well-balanced subject groups with prespecified disease characteristics.
Successful integration of an automated patient-reported outcome measure within a hospital electronic patient record
Authors: Neame Matthew T , Reilly David , Puthiyaveetil Ajmal , McCann Liza , Mahmood Kamran , Almeida Beverley , Pain Clare E , Furfie Victoria , Cleary Andrew G
Published: August 2022

Objectives

The objective of this evaluation was to assess the feasibility of implementing a fully integrated, automated, electronic patient-reported outcome measures (ePROM) system into a hospital electronic patient record (EPR; hospital-based clinical record). Additional objectives included evaluating the effect of the system on patient-reported outcome measures (PROM) completion rates and investigating the acceptability of the ePROM.

Methods

The evaluation was conducted in a rheumatology clinic in a specialist children’s hospital in the UK. Paper-based childhood HAQ PROMs were already used in the clinic, and an EPR was the main hospital information system. The technical feasibility of introducing the ePROM technology was assessed using a case study approach; the effect of the system on PROM completion rates was investigated using a before–after design; and acceptability was assessed using semi-structured questionnaires and a focus group.

Results

An automated and integrated ePROM system was implemented successfully in April 2021. After implementation, ∼500 automated SMS text messaging invitations to complete ePROMs were sent to care-givers each month. PROM completion rates increased from 33 of 100 (33%) to 47 of 65 (72%) after the introduction of the ePROM system (χ2 = 11.51; P < 0.05). The ePROM system was highly acceptable to patients and clinical staff. Some clinical staff expressed a concern that an electronic system might represent a barrier to care for families with more limited resources.

Conclusion

High levels of automation and integration with existing technology systems seemed to be key contextual factors associated with the successful implementation and adoption of the ePROM intervention in a paediatric rheumatology clinic.
Rituximab as maintenance therapy following remission induction in relapsing or refractory systemic lupus erythematosus
Authors: Chen Xiaochan , Shi Xiaowei , Xue Han , Lv Honghua , Yu Lishi , Wu Xiudi , Wang Qiaohong , Wu Huaxiang , Han Fei , Xue Jing
Published: August 2022

Objective

To investigate the efficacy and safety of rituximab (RTX) maintenance therapy compared with traditional immunosuppressive agent (ISA) maintenance therapy in patients with relapsing or refractory SLE.

Methods

It is a prospective observational non-randomized cohort study. The study enrolled SLE patients in four centres who had received at least one course of RTX induction treatment. Patients with a clinical response to RTX were divided into two groups based on their maintenance therapy in the first 12 months: the RTX group and the ISA group. The relapse-free survival times were compared between the two groups. Univariate and multivariate analyses were conducted to identify predictive factors for disease relapse.

Results

Among the 82 patients included in the cohort, 67 (81.7%) patients had a clinical response at 6 months. RTX maintenance therapy was applied in 34 (50.7%) patients and ISA maintenance therapy was applied in the remaining 33 (49.3%) patients. After a median follow-up of 24 months, a total of 13 (19.4%) patients had experienced disease relapse, comprising three in the RTX group and 10 in the ISA group. Patients in the RTX group had a higher relapse-free survival rate than patients in the ISA group. Multivariate analysis identified hydroxychloroquine use, RTX maintenance therapy and haematological system involvement as independent predictors for sustained remission.

Conclusion

This multicentre prospective cohort study demonstrated that long-term RTX maintenance therapy has high efficacy and acceptable safety in relapsing or refractory SLE patients who had a clinical response to RTX induction therapy.
The transcription activator AtxA from Bacillus anthracis was employed for developing a tight-control, high-level, modulable and stationary-phase-specific transcription activity in Escherichia coli
Authors: Liu Ying-Xing , Zhuo Xiao-Zhen , Li Si-Yu
Published: August 2022

The strong transcriptional activity of the virulent gene pagA in Bacillus anthracis has been proven to be anthrax toxin activator (AtxA)-regulated. However, the obscure pagA transcription mechanism hinders practical applications of this strong promoter. In this study, a 509-bp DNA fragment [termed 509sequence, (−508)-(+1) relative to the P2 transcription start site] was cloned upstream of rbs-GFPuv as pTOL02B to elucidate the AtxA-regulated transcription. The 509sequence was dissected into the −10 sequence, −35 sequence, ATrich tract, SLI/SLII and upstream site. In conjunction with the heterologous co-expression of AtxA (under the control of the T7 promoter), the −10 sequence (TATACT) was sufficient for the AtxA-regulated transcription. Integration of pTOL02F + pTOLAtxA as pTOL03F showed that the AtxA-regulated transcription exhibited a strong specific fluorescence intensity/common analytical chemistry term (OD600) of 40 597 ± 446 and an induction/repression ratio of 122. An improved induction/repression ratio of 276 was achieved by cultivating Escherichia coli/pTOL03F in M9 minimal medium. The newly developed promoter system termed PAtxA consists of AtxA, the −10 sequence and Escherichia RNA polymerase. These three elements synergistically and cooperatively formed a previously undiscovered transcription system, which exhibited a tight-control, high-level, modulable and stationary-phase-specific transcription. The PAtxA was used for phaCAB expression for the stationary-phase polyhydroxybutyrate production, and the results showed that a PHB yield, content and titer of 0.20 ± 0.27 g/g-glucose, 68 ± 11% and 1.5 ± 0.4 g/l can be obtained. The positive inducible PAtxA, in contrast to negative inducible, should be a useful tool to diversify the gene information flow in synthetic biology.

Graphical Abstract
Evaluation of the acid-binding capacity of ingredients and complete diets commonly used for weanling pigs
Authors: Stas Ethan B , Tokach Mike D , DeRouchey Joel M , Goodband Robert D , Woodworth Jason C , Gebhardt Jordan T
Published: August 2022

Some ingredients bind more acid in the stomach than others which can increase gastric pH in weaned pigs causing decreased protein digestion and allow pathogenic micro-organisms to proliferate. Our objective was to measure acid-binding capacity at a pH of 4 (ABC-4) of common nursery ingredients and determine additivity in diets. Ingredient categories included: cereal grains, vegetable proteins, animal proteins and milk, vitamin premixes and minerals, amino acids, and fiber sources. A 0.5-g sample of each ingredient was suspended in 50 mL of distilled deionized water and titrated with 0.1-N hydrochloric acid. Sample ABC-4 was calculated as the amount of acid in milliequivalents (meq) required to lower 1 kg to a pH of 4. Cereal grains were found to have lower ABC-4 compared to other ingredients. Vegetable proteins had higher ABC-4 with more variation than cereal grains. Soybean meal (SBM) had an ABC-4 of 602 ± 28.2 meq. Soy protein concentrate and enzymatically treated soybean meal (ESBM) had higher ABC-4 compared to SBM while fermented soybean meal (FSBM) was lower. Zinc oxide (ZnO) and calcium carbonate (CaCO3) had the highest ABC-4 among all ingredients with values of 21,863 ± 598.7 and 18,384 ± 769.7 meq, respectively. Following ingredient analysis, a series of diets were analyzed to determine additivity by comparing the differences between calculated and analyzed ABC-4 value. All diets analyzed had lower ABC-4 than calculated values; however, analyzed ABC-4 increased along with calculated values across diets. The first series of diets were arranged in a 2 × 5 factorial consisting of increasing CaCO3 with or without ZnO. There was a ZnO × CaCO3 interaction (P = 0.020) for difference between calculated and analyzed ABC-4. Within the interaction, differences between calculated and analyzed ABC-4 increased (linear, P < 0.001) as CaCO3 increased in diets without ZnO, but not in diets with ZnO. The second series of diets analyzed consisted of different levels of SBM with either FSBM or ESBM included at 5% of the diet. Differences between calculated and analyzed values were not different between treatments (P = 0.640). In conclusion, perfect ABC-4 additivity in diets was not found due to lower analyzed than calculated values; however, analyzed ABC-4 still increased as calculated values increased. This data suggests diet ABC-4 can be adjusted through selection of ingredients but more feeding trials are needed to determine its impact on pig performance.
Utility of Xpert MTB/RIF Ultra and digital chest radiography for the diagnosis and treatment of TB in people living with HIV: a randomised controlled trial (XACT-TB)
Authors: Mukoka Madalo , Twabi Hussein H , Msefula Chisomo , Semphere Robina , Ndhlovu Gabriel , Lipenga Trancizeo , Sikwese Tionge Daston , Malisita Kenneth , Choko Augustine , Corbett Elizabeth L , MacPherson Peter , Nliwasa Marriott
Published: August 2022

Background

TB is a leading cause of morbidity among HIV positive individuals. Accurate algorithms are needed to achieve early TB diagnosis and treatment. We investigated the use of Xpert MTB/RIF Ultra in combination with chest radiography for TB diagnosis in ambulatory HIV positive individuals.

Methods

This was a randomised controlled trial with a 2-by-2 factorial design. Outpatient HIV clinic attendees with cough were randomised to four arms: Arm 1—Standard Xpert/no chest radiography (CXR); Arm 2—Standard Xpert/CXR; Arm 3—Xpert Ultra/no CXR; and Arm 4—Xpert Ultra/CXR. Participants were followed up at days 28 and 56 to assess for TB treatment initiation.

Results

We randomised 640 participants. Bacteriologically confirmed TB treatment initiation at day 28 were: Arm 1 (8.4% [14/162]), Arm 2 (6.9% [11/159]), Arm 3 (8.2% [13/159]) and Arm 4 (5.6% [9/160]) and between Xpert Ultra group (Arms 3 and 4) (6.9% [22/319]) vs Standard Xpert group (Arms 1 and 2) (7.8% [25/321]), risk ratio 0.89 (95% CI 0.51 to 1.54). By day 56, there were also similar all-TB treatment initiations in the x-ray group (Arms 2 and 4) (16.0% [51/319]) compared with the no x-ray group (Arms 1 and 3) (13.1% [42/321]), risk ratio 1.22 (95% CI 0.84 to 1.78); however, the contribution of clinically diagnosed treatment initiations were higher in x-ray groups (50.9% vs 19.0%).

Conclusions

Xpert Ultra performed similarly to Xpert MTB/RIF. X-rays are useful for TB screening but further research should investigate how to mitigate false-positive treatment initiations.
Medical School Without Walls: 50 Years of Regional Campuses at Indiana University School of Medicine
Authors: Wallach Paul M. , Birnbaum Deborah R. , Ryan Elizabeth R. , Pieczko Brandon T. , Hess Jay L.
Published: August 2022

The history of Indiana University School of Medicine (IUSM) dates to 1871, when Indiana Medical College entered into an affiliation with Indiana University in Bloomington to offer medical education. In 1971, the Indiana General Assembly passed a bill to create and fund a distributed model for medical education for which IUSM was responsible, an innovative approach to implementing a statewide medical education program. IUSM became one of the first U.S. medical schools to implement what is today known as a regional medical campus model. This regional medical campus system has permitted IUSM to expand enrollment based on national and local concerns about physician shortages, increase access to care locally, support expansion of graduate medical education, and provide opportunities for research and scholarship by faculty and students statewide. This effort was made possible by partnerships with other universities and health care systems across the state and the support of local community and state leaders. The model is a forward-thinking and cost-effective way to educate physicians for service in the state of Indiana and is applicable to others. This article highlights milestones in IUSM’s 50-year history of regional medical education, describes the development of the regional medical campus model, recognizes significant achievements over the years, shares lessons learned, and discusses considerations for the future of medical education.
Cardiac Safety of Imatinib for the Treatment of COVID-19: A Secondary Analysis of a Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Duijvelaar Erik , Vanhove Arthur , Schippers Job R. , Smeele Patrick J. , de Man Frances S. , Pinto Yigal , Aman Jurjan , Bogaard Harm Jan ,   CounterCOVID Collaborative Group
Published: August 2022

Although previous studies support the clinical benefit of imatinib regarding respiratory status in hospitalized patients with COVID-19, potential cardiotoxicity may limit its clinical application. This study aimed to investigate the cardiac safety of imatinib in COVID-19. In the CounterCOVID study, 385 hospitalized hypoxemic patients with COVID-19 were randomly assigned to receive 10 days of oral imatinib or placebo in a 1:1 ratio. Patients with a corrected QT interval (QTc) >500 ms or left ventricular ejection fraction <40% were excluded. Severe cardiac adverse events were monitored for 28 days or until death occurred. Electrocardiogram measurements and cardiac biomarkers were assessed repeatedly during the first 10 days. A total of 36 severe cardiac events occurred, with a similar incidence in both treatment groups. No differences were observed in the computer-generated Bazett, manually interpreted Bazett, or Fridericia-interpreted QTcs. No clinically relevant alterations in other electrocardiogram parameters or plasma high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations were observed. Similar findings were observed in a subgroup of 72 patients admitted to the intensive care unit. In the univariate and multivariable linear mixed models, treatment with imatinib was not significantly associated with QT interval duration, hs-cTnT, or NT-proBNP levels. In conclusion, imatinib treatment did not result in more cardiac events, QT interval prolongation, or altered hs-cTnT or NT-proBNP levels. This suggests that treatment with imatinib is safe in hospitalized patients with COVID-19 with a QTc duration of less than 500 ms and left ventricular ejection fraction >40%.
Extending the benefit of nutrition intervention beyond the operative setting
Authors: Nogueira Paulo L. Batista , Dock-Nascimento Diana B. , de Aguilar-Nascimento José E.
Published: August 2022

Purpose of review

To provide an update of the recent evidence on the potential of perioperative nutritional interventions to benefit adult patients undergoing head and neck and digestive procedures.

Recent findings

Perioperative nutrition within multimodal prehabilitation programs improve postoperative outcomes. Perioperative fasting time can be reduced with beverages containing carbohydrate alone or blended with a nitrogenous source such as whey protein; this approach seems to be safe and improve outcome. The choice of protein-containing formula, as well as diet composition to be recommended early during the postoperative refeeding, can be optimized to reduce complications. Sarcopenia is an important risk factor for surgical patients, as such, prehabilitation along with preoperative nutrition is strongly advised. Perioperative supplementation with β-hydroxy β-methylbutyrate to mitigate sarcopenia requires further investigation. Although perioperative nutritional interventions reduce healthcare costs, recent data suggest it has been scarcely prescribed.

Nutritional intervention is key in multimodal programs of enhanced recovery after surgery to ensure better outcomes. Perioperative fasting should be shortened, and include clear fluids containing carbohydrates and protein, especially in the early postoperative period. Multimodal prehabilitation is key to mitigate sarcopenia. Action to improve knowledge on the cost-effectiveness of nutritional interventions in the perioperative setting are needed.
Analysis of INSPPIRE‐2 Cohort
Authors: Uc Aliye , Cress Gretchen A. , Wang Fuchenchu , Abu‐El‐Haija Maisam , Ellery Kate M. , Fishman Douglas S. , Gariepy Cheryl E. , Gonska Tanja , Lin Tom K. , Liu Quin Y. , Mehta Megha , Maqbool Asim , McFerron Brian A. , Morinville Veronique D. , Ooi Chee Y. , Perito Emily R. , Schwarzenberg Sarah Jane , Sellers Zachary M. , Serrano Jose , Shah Uzma , Troendle David M. , Wilschanski Michael , Zheng Yuhua , Yuan Ying , Lowe Mark E. ,   Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer
Published: August 2022

Objectives:

The objective of this study is to investigate risk factors and disease burden in pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP).

Methods:

Data were obtained from INternational Study group of Pediatric Pancreatitis: In search for a cuRE‐2 (INSPPIRE‐2), the largest multi‐center prospective cohort study in pediatric patients with ARP or CP.

Results:

Of 689 children, 365 had ARP (53%), 324 had CP (47%). CP was more commonly associated with female sex, younger age at first acute pancreatitis (AP) attack, Asian race, family history of CP, lower BMI%, genetic and obstructive factors, PRSS1 mutations and pancreas divisum. CFTR mutations, toxic‐metabolic factors, medication use, hypertriglyceridemia, Crohn disease were more common in children with ARP. Constant or frequent abdominal pain, emergency room (ER) visits, hospitalizations, medical, endoscopic or surgical therapies were significantly more common in CP, episodic pain in ARP. A total of 33.1% of children with CP had exocrine pancreatic insufficiency (EPI), 8.7% had diabetes mellitus. Compared to boys, girls were more likely to report pain impacting socialization and school, medical therapies, cholecystectomy, but no increased opioid use. There was no difference in race, ethnicity, age at first AP episode, age at CP diagnosis, duration of disease, risk factors, prevalence of EPI or diabetes between boys and girls. Multivariate analysis revealed that family history of CP, constant pain, obstructive risk factors were predictors of CP.

Conclusions:

Children with family history of CP, constant pain, or obstructive risk factors should raise suspicion for CP.
Controversy Over Liver Transplantation or Resection for Neuroendocrine Liver Metastasis
Authors: Eshmuminov Dilmurodjon , Studer Debora J. , Lopez Lopez Victor , Schneider Marcel A. , Lerut Jan , Lo Mary , Sher Linda , Musholt Thomas J. , Lozan Oana , Bouzakri Nabila , Sposito Carlo , Miceli Rosalba , Barat Shoma , Morris David , Oehler Helga , Schreckenbach Teresa , Husen Peri , Rosen Charles B. , Gores Gregory J. , Masui Toshihiko , Cheung Tan-To , Kim-Fuchs Corina , Perren Aurel , Dutkowski Philipp , Petrowsky Henrik , Thiis-Evensen Espen , Line Pål-Dag , Grat Michal , Partelli Stefano , Falconi Massimo , Tanno Lulu , Robles-Campos Ricardo , Mazzaferro Vincenzo , Clavien Pierre-Alain , Lehmann Kuno
Published: August 2022

Background:

In patients with neuroendocrine liver metastasis (NELM), liver transplantation (LT) is an alternative to liver resection (LR), although the choice of therapy remains controversial. In this multicenter study, we aim to provide novel insight in this dispute.

Methods:

Following a systematic literature search, 15 large international centers were contacted to provide comprehensive data on their patients after LR or LT for NELM. Survival analyses were performed with the Kaplan-Meier method, while multivariable Cox regression served to identify factors influencing survival after either transplantation or resection. Inverse probability weighting and propensity score matching was used for analyses with balanced and equalized baseline characteristics.

Results:

Overall, 455 patients were analyzed, including 230 after LR and 225 after LT, with a median follow-up of 97 months [95% confidence interval (CI): 85–110 months]. Multivariable analysis revealed G3 grading as a negative prognostic factor for LR [hazard ratio (HR)=2.22, 95% CI: 1.04–4.77, P=0.040], while G2 grading (HR=2.52, 95% CI: 1.15–5.52, P=0.021) and LT outside Milan criteria (HR=2.40, 95% CI: 1.16–4.92, P=0.018) were negative prognostic factors in transplanted patients. Inverse probability-weighted multivariate analyses revealed a distinct survival benefit after LT. Matched patients presented a median overall survival (OS) of 197 months (95% CI: 143–not reached) and a 73% 5-year OS after LT, and 119 months (95% CI: 74–133 months) and a 52.8% 5-year OS after LR (HR=0.59, 95% CI: 0.3–0.9, P=0.022). However, the survival benefit after LT was lost if patients were transplanted outside Milan criteria.

Conclusions:

This multicentric study in patients with NELM demonstrates a survival benefit of LT over LR. This benefit depends on adherence to selection criteria, in particular low-grade tumor biology and Milan criteria, and must be balanced against potential risks of LT.
Apheresis of Deceased Donors as a New Source of Mobilized Peripheral Blood Hematopoietic Stem Cells for Transplant Tolerance
Authors: Sosa Rebecca A. , Mone Thomas , Naini Bita V. , Kohn Donald B. , Reed Elaine F. , Wheeler Kristina , Campo-Fernandez Beatriz , Davila Alejandra , Chaffin Donald J. , DiNorcia Joseph , Kaldas Fady M. , Cohen Aaron , Lum Erik L. , Veale Jeffrey L. , Kogut Neil M.
Published: August 2022

Background.

Solid organ transplantation is the therapy of choice for many patients with end-stage organ failure; however, recipients must remain on lifelong immunosuppression, leaving them susceptible to infections and cancer. The study of transplant tolerance to prolong graft survival in the absence of immunosuppression has been restricted to recipients of living donor allografts; however, deceased donors significantly outnumber living donors. Mobilization of hematopoietic stem cells (HSCs) from the bone marrow to peripheral blood (PB) could allow PB-HSCs to be used to induce tolerance in deceased donor kidney recipients; however, a major concern is the well-known concomitant mobilization of immune cells into the liver.

Methods.

We mobilized HSCs to the PD using a protocol of 2 doses of granulocyte colony-stimulating factor and 1 dose of plerixafor, followed by the collection of mobilized cells via apheresis in 3 deceased donors. The physiological, laboratory, and radiographic parameters were monitored throughout the procedure. Longitudinal biopsies were performed to assess the potential for ectopic liver mobilization.

Results.

The use of both agents led to the successful mobilization of peripheral blood CD34+ cells, demonstrating the potential for use in transplant tolerance protocols. Increased immune cell trafficking into the liver was not observed, and apheresis of mobilized cells resulted in a uniform decrease in all liver leukocyte subsets.

Conclusions.

HSCs can be mobilized and collected from the PB of brain-dead donors. This new approach may facilitate the dissemination of immune tolerance trials beyond living-donor kidney transplantation to deceased-donor transplantation, without sacrificing the transplantability of the liver.
Diet variation in a critically endangered marine predator revealed with stable isotope analysis
Authors: Ogilvy Courtney , Constantine Rochelle , Bury Sarah J. , Carroll Emma L.
Published: August 2022

Understanding the foraging ecology of animals gives insights into their trophic relationships and habitat use. We used stable isotope analysis to understand the foraging ecology of a critically endangered marine predator, the Māui dolphin. We analysed carbon and nitrogen isotope ratios of skin samples (n= 101) collected from 1993 to 2021 to investigate temporal changes in diet and niche space. Genetic monitoring associated each sample with a DNA profile which allowed us to assess individual and population level changes in diet. Potential prey and trophic level indicator samples were also collected (n= 166; 15 species) and incorporated in Bayesian mixing models to estimate importance of prey types to Māui dolphin diet. We found isotopic niche space had decreased over time, particularly since the 2008 implementation of a Marine Mammal Sanctuary. We observed a decreasing trend in ∂13C and ∂15N values, but this was not linear and several fluctuations in isotope values occurred over time. The largest variation in isotope values occurred during an El Niño event, suggesting that prey is influenced by climate-driven oceanographic variables. Mixing models indicated relative importance of prey remained constant since 2008. The isotopic variability observed here is not consistent with individual specialization, rather it occurs at the population level.
Thermo-chemo-mechanically coupled cavity dynamics and the emergence of multi-phase bursts
Authors: Chockalingam S. , Lem J. , Cohen T.
Published: August 2022

Understanding the dynamics induced by confined thermo-chemical processes occurring inside a solid medium is a fundamental problem of interest in several applications, such as hotspot formation and micro-explosions in energetic materials and laser-induced cavitation for energy focusing and material characterization. In recent years, advanced experimental capabilities have uncovered elusive behaviours in such systems, including temperature spikes that emerge at short timescales, and multi-phase explosions. By coupling the mechanics of the solid, the thermodynamics, and the chemical kinetics of the decomposition reactions, the theoretical model developed here explains and demonstrates these phenomena. The dimensionless response of the system is studied numerically and analytical expressions for the mechanical response limits are derived. These results should be useful in guiding future experiments and in explaining phenomena that may emerge at various length and timescales.