bluuebunny/crossref_metadata_2025 huggingface dataset:
VATS-Lobektomie: Die bekannten Risikofaktoren für postoperative pulmonale Komplikationen ändern sich im Alter nicht
Authors: Lesser Thomas
Published: September 2024

Background: The objective of this study is to identify and evaluate the risk factors associated with the development of postoperative pulmonary complications (PPCs) in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia. Methods: The retrospective study consecutively included elderly patients (≥ 70 years old) who underwent thoracoscopic lobectomy at Xuanwu Hospital of Capital Medical University from January 1, 2018 to August 31, 2023. The demographic characteristics, the preoperative, intraoperative and postoperative parameters were collected and analyzed using multivariate logistic regression to identify the prediction of risk factors for PPCs. Results: 322 patients were included for analysis, and 115 patients (35.7%) developed PPCs. Multifactorial regression analysis showed that ASA ≥ III (P = 0.006, 95% CI: 1.230 ∼ 3.532), duration of one-lung ventilation (P = 0.033, 95% CI: 1.069 ∼ 4.867), smoking (P = 0.027, 95% CI: 1.072 ∼ 3.194) and COPD (P = 0.015, 95% CI: 1.332 ∼ 13.716) are independent risk factors for PPCs after thoracoscopic lobectomy in elderly patients. Risk factors for PPCs are ASA ≥ III, duration of one-lung ventilation, smoking and COPD in elderly patients over 70 years old undergoing thoracoscopic lobectomy. It is necessary to pay special attention to these patients to help optimize the allocation of resources and enhance preventive efforts.
Disparities in Emergency Medical Services Use, Prehospital Notification, and Symptom Onset to Arrival in Patients With Acute Stroke
Authors: Royan Regina , Stamm Brian , Lin Timmy , Baird Janette , Becker Christopher J. , Karb Rebecca , Burton Tina M. , Kleindorfer Dawn O. , Prabhakaran Shyam , Madsen Tracy E.
Published: September 2024

BACKGROUND:

Disparities in time to hospital presentation and prehospital stroke care may be important drivers in inequities in acute stroke treatment rates, functional outcomes, and mortality. It is unknown how patient-level factors, such as race and ethnicity and county-level socioeconomic status, affect these aspects of prehospital stroke care.

METHODS:

Cross-sectional study of patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage in the Get With the Guidelines-Stroke registry, presenting from July 2015 to December 2019, with symptom onset ≤24 hours. Multivariable logistic regression and quantile regression were used to investigate the outcomes of interest: emergency medical services (EMS) transport (versus private vehicle), EMS prehospital notification (versus no prehospital notification), and stroke symptom onset to time of arrival at the emergency department. Prespecified covariates included patient-level, hospital-level, and county-level characteristics.

RESULTS:

The inclusion criteria was met by the 606 369 patients. Of the patients, 51.2% were men and 69.9% White, with a median National Institutes of Health Stroke Severity of 4 (IQR, 2–10), and median social deprivation index (SDI) of 51 (IQR, 27–75). Median symptom onset to arrival time was 176 minutes (IQR, 64–565). Black race was significantly associated with prolonged symptom onset to emergency department arrival time (+28.21 minutes [95% CI, 25.59–30.84]), and decreased odds of EMS prehospital notification (OR, 0.80 [95% CI, 0.78–0.82]). SDI was not associated with differences in EMS use but was associated with lower odds of EMS prehospital notification (upper SDI tercile versus lowest, OR, 0.79 [95% CI, 0.78–0.81]). SDI was also significantly associated with stroke symptom onset to emergency department arrival time (upper SDI tercile versus lowest +2.56 minutes [95% CI, 0.58–4.53]).

CONCLUSIONS:

In this national cross-sectional study, Black race was associated with prolonged symptom onset to time of arrival intervals and significantly decreased odds of EMS prehospital notification, despite similar use of EMS transport. Greater county-level deprivation was also associated with reduced odds of EMS prehospital notification and slightly prolonged stroke symptom onset to emergency department arrival time. Efforts to reduce place-based disparities in stroke care must address significant inequities in prehospital care of acute stroke and continue to address health inequities associated with race and ethnicity.
Associations of Rest‐Activity Rhythm Disturbances With Stroke Risk and Poststroke Adverse Outcomes
Authors: Gao Lei , Zheng Xi , Baker Sarah N. , Li Peng , Scheer Frank A. J. L. , Nogueira Ricardo C. , Hu Kun
Published: September 2024

Background

Many disease processes are influenced by circadian clocks and display ~24‐hour rhythms. Whether disruptions to these rhythms increase stroke risk is unclear. We evaluated the association between 24‐hour rest‐activity rhythms, stroke risk, and major poststroke adverse outcomes.

Methods and Results

We examined ~100 000 participants from the UK Biobank (aged 44–79 years; ~57% women) assessed with actigraphy (6–7 days) and 5‐year median follow‐up. We derived (1) most active 10‐hour activity counts across the 24‐hour cycle and the timing of its midpoint timing; (2) the least active 5‐hour count and its midpoint; (3) relative amplitude; (4) interdaily stability; and (5) intradaily variability, for stability and fragmentation of the rhythm. Cox proportional hazard models were constructed for time to (1) incident stroke (n=1652) and (2) poststroke adverse outcomes (dementia, depression, disability, or death). Suppressed relative amplitude (lowest quartile [quartile 1] versus the top quartile [quartile 4]) was associated with stroke risk (hazard ratio [HR], 1.61 [95% CI, 1.35–1.92];
P
<0.001) after adjusting for demographics. Later most active 10‐hour activity count midpoint timing (14:00–15:26; HR, 1.26 [95% CI, 1.07–1.49];
P
=0.007) also had higher stroke risk than earlier (12:17–13:10) participants. A fragmented rhythm (intradaily variability) was also associated with higher stroke risk (quartile 4 versus quartile 1; HR, 1.26 [95% CI, 1.06–1.49];
P
=0.008). Suppressed relative amplitude was associated with risk for poststroke adverse outcomes (quartile 1 versus quartile 4; HR, 2.02 [95% CI, 1.46–2.48];
P
<0.001). All associations were independent of age, sex, race, obesity, sleep disorders, cardiovascular diseases or risks, and other comorbidity burdens.

Conclusions

Suppressed 24‐hour rest‐activity rhythm may be a risk factor for stroke and an early indicator of major poststroke adverse outcomes.
A Hybrid Simulation‐Based Workshop Improves Knowledge and Confidence in the Management of Hemorrhagic Conversion of Stroke Among Interventional Neurology Trainees
Authors: Pergakis Melissa B. , Misra Asit , Al‐Mufti Fawaz , Motola Ivette , Morris Nicholas A.
Published: September 2024

Background

Mechanical thrombectomy is the standard of care in acute ischemic stroke with anterior large vessel occlusion presenting within 6 hours of symptom onset, but complications do exist. We assessed the feasibility of a hybrid simulation‐based workshop at a national meeting for interventional neurology trainees focused on the management of acute ischemic stroke and tissue‐plasminogen activator‐related hemorrhage.

Methods

In this prospective, observational, hybrid simulation‐based study at a fellows’ workshop at a national conference, participants were asked to manage a patient with acute ischemic stroke in the neurointerventional suite followed by thrombolytic‐related hemorrhage leading to cerebral herniation during mechanical thrombectomy. We evaluated the participants’ ability to complete critical actions that were developed based on best practices and relevant American Heart Association guidelines and the Neurocritical Care Society's Emergency Neurological Life Support protocols. The primary outcome was the improvement in knowledge from a precourse to postcourse test. Secondary outcomes included participant reactions.

Results

Sixty trainees completed the simulation session in 8 groups. The mean sum of critical actions completed by trainees was 9.75/14 (70%). There was a moderate effect of the intervention on trainees’ knowledge from pretest (mean 3.8, SD = 0.3) to posttest (mean 4.3, SD = 0.3). The simulation scenario was described as moderately realistic, very engaging, and extremely satisfactory. Following the workshop, all fellows endorsed an increase in proficiency and confidence in neurological emergency management.

Conclusion

Simulation‐based workshops at national conferences are feasible and a potentially useful tool for safely educating a large audience of trainees who may not have access to high‐fidelity simulation platforms at their institutions.
The Distinctio divisionis terrae et paradisi deliciarum
Authors: Sorokina Maria
Published: September 2024

The Distinctio divisionis terrae et paradisi deliciarum (Città del Vaticano, Biblioteca Apostolica Vaticana, ms Barb. lat. 2687, ff. 12v–16v) is an anonymous treatise on the place of the earthly Paradise. An unknown author asks whether the earthly Paradise could be located in the land of the Antipodes and rejects this hypothesis. This article demonstrates two points. First, it attributes the Distinctio to the Franciscan friar Gerard Odonis (d. 1349). In fact, this text is a distinction of his commentary on the Sentences (book ii, d. 20, qq. 1–2). Second, the article argues that Odonis’s opinion on the location of Paradise is quite unusual, since he reverses the Aristotelian order of elementary spheres. Odonis places the earthly Paradise so high on a mountain that it is necessary to deny the existence of the sphere of fire. While explaining how the Flood did not inundate Paradise, he asserts that water is naturally lower than earth. The article provides the first critical edition of the Distinctio.
Future scenarios of the sector of insect as food and feed in Europe
Authors: Gambelli D. , Vairo D. , Zanoli R. , Alleweldt F.
Published: September 2024

The study aims to analyse through scenario analysis the future market opportunities for products derived from insects for food and feed (IFF) in Europe. The embryonic state of the IFF industry and the lack of sufficient and detailed quantitative information did not allow the adoption of more quantitative models. Compared to standard statistical forecasting techniques, scenario analysis allows for considering the impact of future exogenous shocks and significant structural changes in the system under investigation. Organisational learning is best performed collectively. Scenario analysis is a very relevant part of this process and can lead to better strategy and action planning. The scenario time horizon was fixed to 2035, while the spatial framework was the European Union. The analysis involved a selected group of experts and stakeholders of the IFF sector to provide a shared knowledge basis that was exploited to define eight different scenarios. Two of the eight resulting scenarios are favourable for the IFF sector, and two outline adverse outcomes for the industry. The remaining four scenarios refer to contrasting situations for the IFF sector. Some implications emerge for the future development of the IFF industry: the embryonic state of the IFF business in the EU makes it very vulnerable to shocks; the crucial role of policy and regulatory framework in the insect sector, together with the different degrees of societal concerns for sustainability may strongly affect the development of IFF. Relevant aspects that emerge in some scenarios are the cooperation and industrial ecosystems with open innovation and collective IPR protection; the importance of dedicated credit; improvement of the knowledge system, and the circular economy potential of IFF for treating waste, especially in the feed sector.
Showcasing, Contextualizing, and Explaining the Diversity of Human Experiences in Combat Using gis: The Battle of Hong Kong in 1941 as an Example
Authors: Chi Man Kwong , Lai Wallace W. L. , Rivera Michael B. C.
Published: September 2024

This article discusses the application of gis in the study of military history, particularly for campaigns in modern Asian history (1800s-1950s), citing the Battle of Hong Kong 1941 Spatial History Project as an example. gis allows researchers to move beyond text-based narratives by visualizing, contextualizing, and explaining the diversity of human experiences that are often overshadowed by frontline actions. This article assesses the use of gis-based interactive maps in visualizing the flow of the battle, reconstructing the battlefield, examining the diverse human experience, and integrating disparate historical data. Reflecting on the research team’s interdisciplinary experience in creating a gis-based interactive map, this article argues that such a method is suitable for military campaigns that took place in a rapidly changing urban environment. It also discusses the limitations of this method and the need to remain critical towards the visualization of data, the use of sources, and interpretation.
ʿAlāʾ al-Dīn al-Samarqandī’s Non-Realist Approach to Good (Ḥasan) and Bad (Qabīḥ): Moral Ontology in Sixth/Twelfth-Century Māturīdī Theology and Legal Theory
Authors: Obuchi Hisashi
Published: September 2024

The Māturīdīs think that, without revealed law, human beings can grasp through speculative reasoning that some actions are good (ḥasan) and some are bad (qabīḥ). This article addresses the ontological aspect of such ethical rationalism. An analysis of the texts of legal theory shows that the sixth/twelfth-century Māturīdīs approached moral values in a non-realist way. Specifically, ʿAlāʾ al-Dīn al-Samarqandī (d. 539/1144?), who identifies himself as a true successor of Abū Manṣūr al-Māturīdī (d. 333/944), demonstrates that goodness (ḥusn) and badness (qubḥ) are neither real accidents nor divine command and prohibition; rather, “good” and “bad” just express one’s natural or rational approval and disapproval of objects and actions, and Prophetic law shapes some of the natural likes and dislikes. On this account, I conclude that al-Samarqandī’s view, shared by his contemporaneous fellow Māturīdīs such as Abū l-Thanāʾ al-Lāmishī (d. after 539/1144) and Najm al-Dīn al-Nasafī (d. 537/1142), challenges the current standard interpretations of the Māturīdī ethics as realism or divine command theory.
Parapaulipalpina lobata, new species, the first species of Parapaulipalpina Gnaspini, 1996 (Coleoptera: Leiodidae: Cholevinae: Ptomaphagini) from Brazil
Authors: GNASPINI PEDRO , MORAES GABRIELLA M. , GOMYDE EDUARDO C.
Published: September 2024

Parapaulipalpina lobata Gnaspini, Moraes & Gomyde, new species (Coleoptera: Leiodidae: Cholevinae: Ptomaphagini) is described from Pará State, Northern Brazil. This is the first record of the genus from Brazil. The genus otherwise includes four species described from Northern South America (Colombia, Ecuador, Peru, Venezuela). The apex of the male metatibia of P. lobata sp. nov. is widened and flattened, which is unique in the tribe as a whole, and diagnostic for the species. A key for all known species is provided.
Integrating Laser-Induced Breakdown Spectroscopy and Ensemble Learning as Minimally Invasive Optical Screening for Diabetes
Authors: Rehan Imran , Khan Saranjam , Ullah Rahat
Published: September 2024

Diabetes mellitus is a prevalent chronic disease necessitating timely identification for effective management. This paper introduces a reliable, straightforward, and efficient method for the minimally invasive identification of diabetes mellitus through nanosecond pulsed laser-induced breakdown spectroscopy (LIBS) by integrating a state-of-the-art machine learning approach. LIBS spectra were collected from urine samples of diabetic and healthy individuals. Principal component analysis and an ensemble learning classification model were used to identify significant changes in LIBS peak intensity between the diseased and normal urine samples. The model, integrating six distinct classifiers and cross-validation techniques, exhibited high accuracy (96.5%) in predicting diabetes mellitus. Our findings emphasize the potential of LIBS for diabetes mellitus identification in urine samples. This technique may hold potential for future applications in diagnosing other health conditions.
The Relationships Between Alcohol Drinking and Risky Sexual Behavior Among Korean Adolescents: Focusing on Heterosexual Adolescents
Authors: Her Wonbin , Oh Young Sam
Published: September 2024

This study aims to examine the relationship between alcohol consumption and risky sexual behavior among Korean adolescents. Data from the 16th Korea Youth Risk Behavior Survey were utilized. Logistic regression analyses were conducted to test the effects of alcohol use on the probability of sex without contraception. The study matched 547 drinkers with 547 non-drinkers based on propensity score matching. In this study, the higher the alcohol consumption among adolescents, the more likely they are to engage in sex without contraception. Also, female adolescents’ alcohol consumption was found to be positively associated with risky sexual behaviors. This study highlights that the relationship between alcohol consumption and risky sexual behavior varied by gender. This suggests that adolescents’ risky sexual behaviors are influenced not only by drinking-related factors but also by personal characteristics.
Animal models for preventing seroma after surgery: a systematic review and meta-analysis
Authors: Poos Steven E.M. , Hermans Bob P. , van Goor Harry , ten Broek Richard P.G.
Published: September 2024

Novel interventions for seroma prevention are urgently needed in clinical practice. Animal models are pivotal tools for testing these interventions; however, a significant translational gap persists between clinical and animal model outcomes. This systematic review aims to assess the methodological characteristics and quality of animal models utilized for seroma prevention. A meta-analysis was performed to estimate the expected seroma incidence rate for control groups and determine the effect size of typical interventions. We systematically retrieved all studies describing animal models in which seroma formation was induced. Methodological characteristics, risks of bias, and study quality were assessed. Seroma volume and -incidence data were used for the meta-analysis. In total, 55 studies were included, with 42 eligible for meta-analysis. Rats (69%) were the most frequently used species, with mastectomy (50%) being the predominant surgical procedure in these models. Despite significant risks of bias across all studies, an improving trend in reporting quality per decade was observed. The meta-analysis revealed an average seroma incidence of 90% in typical control groups. The average intervention halved the seroma incidence (RR = 0.49; CI 0.35, 0.70) and significantly reduced seroma volume (SMD = −3.31; CI −4.21, −2.41), although notable heterogeneity was present. In conclusion, animal models for seroma prevention exhibit methodological flaws and multiple risks of bias. Implementing sufficiently powered positive and negative control groups could improve the internal validity of these models. More research is needed for further development of animal seroma models.
Getting to the root of root–microbe interactions
Authors: King William L , Hayward Regan J , Goebel Marc , Fleishman Suzanne M , Bauerle Taryn L , Bell Terrence H
Published: September 2024

Microbial relationships with roots influence many ecosystem functions and nutrient fluxes, including their sometimes-profound effects on plant health and productivity. Fine roots were often classified with a diameter less than 2 mm, but fine roots under that size perform distinct functional roles in the environment. Importantly, two broad functional categories of fine roots are absorptive and transportive, with absorptive fine roots acting as metabolic hotspots for root activity. In two of our recent studies, we have shown that several microbial community characteristics differ between absorptive and transportive fine roots, including composition, abundance, and function, as well as the root metabolome. This highlights a growing recognition within microbial ecology that we must consider fine-scale environmental variability, such as root physiology and morphology, when interpreting microbial patterns. In this commentary, we summarize the findings of our latest article, further speculate on some of these patterns, and suggest future studies for examining decomposition and applying cutting-edge single-cell sequencing techniques.
The relationship between the food intake frequency, weight status and intelligence in school children
Authors: Hsu Wen-Yu , Hu Suh-Woan , Yen Chin-En
Published: September 2024

This study aimed to explore the relationship between food intake frequency, weight status, and intelligence among school children. A cross-sectional study involved 562 children (aged 6.3–12.7 years) randomly selected from five elementary schools in Taichung City, Taiwan. Demographic information was collected, and the children's body weight and height were measured to calculate their body mass index. A food frequency questionnaire assessed the participating children's dietary habits. Intelligence quotient scores were evaluated using Raven's colored progress matrices for first and second graders, and Raven's standard progressive matrices for third to sixth graders. This study found that there was no significant relationship in intelligence quotient scores between gender, birth order groups, and weight status. The higher consumption of pork liver, hamburgers, fruit juices, and the Taiwanese snack “Science Noodles” was associated with lower intelligence quotient scores among school children.
Production Structures and Fluctuations in the Money Supply: An Analysis Based on Marx’s Concept of Set-Free Money Capital
Authors: Liang Junshang , Tang Chengwei
Published: September 2024

In chapter 15 of volume 2 of Capital, Marx introduced the concept of set-free money capital during the turnover process of industrial capital, positing its role in the credit system. Saros further formalized this process, suggesting that set-free money capital could serve as loanable funds, impacting the credit system. This article advances this research by making three significant contributions. Firstly, it offers a more succinct formalization of the turnover process, improving pedagogical clarity. Secondly, it reinterprets the significance of set-free money capital within the modern credit money system using post-Keynesian endogenous money theory, linking production directly to the money supply. Lastly, it demonstrates through simulations that production structure influences the periodic fluctuations of set-free money capital at the macro level, affecting the money supply.

JEL Classification: B51, E32, E51
Anti-CD20 Therapy in Children With Severe Epstein-Barr Virus–Associated Meningoencephalitis
Authors: Ahsan Sana , Jafarpour Saba , Khoshnood Mellad M. , Nagesh Deepti , Ho Eugenia , Ahsan Nusrat , Santoro Jonathan D.
Published: September 2024

Epstein-Barr virus meningoencephalitis is a rare central nervous system infection that lacks standardized treatment. Immunocompetent and immunosuppressed individuals with this condition frequently have poor prognostic outcomes, making the need to identify therapeutic interventions high. Here, we report 2 pediatric cases of severe Epstein-Barr virus meningoencephalitis, both unresponsive to immunoglobulin and corticosteroid therapy, who demonstrated rapid clinical recovery following rituximab administration. Prognostic outcomes revealed marked improvements in symptoms, neurologic function, and quality of life. Rituximab may offer therapeutic potential in severe and refractory Epstein-Barr virus meningoencephalitis through the medication's target of Epstein-Barr virus harboring B cells. This report emphasizes the need for timely evaluation and consideration of rituximab therapy in immunocompetent pediatric patients with Epstein-Barr virus meningoencephalitis.
Evaluation of Sepsis-Related Medical Emergency Team (MET) Calls with Pharmacist Involvement and Time to Antimicrobial Administration
Authors: Du Li Xian Simon , Edwards Gail Emily , Rashidzada Zohal , Newnham Harvey , McGloughlin Steve , Orosz Judit , Tong Erica Y.
Published: September 2024

Objective: To evaluate the difference in proportion of patients receiving antimicrobials within one hour of sepsis recognition at sepsis-related Medical Emergency Team (MET) calls, without or with a sepsis-credentialed pharmacist. Design: Retrospective pre and post-intervention study. Setting: Single centre tertiary referral hospital. Participants: Patients admitted to the General Medicine Unit who had a sepsis-related MET call 24 hrs per day, and all other units from 17:00-08:00 hrs from August 2019 to Jan 2020 in the pre-intervention cohort and Aug 2020 to Jan 2021 for the post-intervention cohort. Interventions: Pharmacists attended MET calls to assist selection of antimicrobials, collaboratively prescribe with the medical officers, ensure supply, provide advice on dosing calculations, reconstitution, and administration. The pre-intervention cohort (Aug 2019-Jan 2020) did not have credentialed pharmacists’ involvement at MET calls. Outcome Measures: Proportion of patients who received antimicrobials within one hours of MET call. Results: There were 97 sepsis-related MET calls in the pre-intervention cohort and 110 sepsis-related MET calls in the post-intervention cohort. A significantly higher proportion of patients received antimicrobials within one hour with pharmacist involvement, compared to control (81.3% vs 59.7%, P = .0006). A reduction in median time to antimicrobial administration (43 min vs 54 min, P = .017) was observed. Conclusion: Sepsis-related MET calls with pharmacist involvement experienced a greater proportion of patients receiving antimicrobials within one hour of sepsis recognition, and a reduction in median time to antimicrobial administration. These results provide support for routine pharmacist involvement at MET calls to assist patients receiving medications in a timely and efficient manner.
Examination of adhesive force and the model’s dimension in continuous and conventional printing using the oxygen inhibition effect
Authors: Manzour Amir Hasan , Zamani Jamal
Published: September 2024

In constrained surface vat photopolymerization, the adhesive force between the formed layer of the model and the bottom of the resin container restricts the printing capability. This research investigates the adhesive forces in digital light processing (DLP) and continuous digital light processing (CDLP), focusing on how the oxygen inhibition effect, resin container membrane, and model geometries affect these forces. This study tested four distinct resin vats, with particular attention given to oxygen-permeable vats, to evaluate their role in reducing adhesive forces. A permeable vat that reduced the separation force by 52% using the oxygen inhibition layer was assessed for continuous printing. The influence of model geometry on the adhesive force in DLP and CDLP was evaluated using a permeable vat. Moreover, an inverse relationship was identified between resin absorbance and both curing depth and printing speed. It was observed that as the model’s cross-sectional area increased, so did the adhesion force in continuous printing. These findings prove that continuous printing can achieve faster build times in CDLP than in DLP, with a maximum speed of 288 mm/h.
Trends in Medicaid Take-Up Among Eligible Adults After the Affordable Care Act Medicaid Expansions: 2014–2019
Authors: Abdus Salam
Published: September 2024

Little is known about how take-up of Medicaid among eligible adults has changed since 2014. This study used data from the Medical Expenditure Panel Survey to examine changes in Medicaid enrollment among Medicaid-eligible adults between 2014 and 2019. Eligibility for Medicaid was simulated using state- and year-specific eligibility rules. Among all Medicaid-eligible citizen adults aged 19–64 years, the proportion enrolled in Medicaid increased from 55.5% in 2014–2015 to 61.9% in 2016–2017, and then remained approximately at the same level in 2018–2019 (61.5%). Among adults who became eligible because of the Medicaid expansions, the proportion enrolled in Medicaid increased from 44.1% in 2014–2015 to 53.8% in 2016–2017. Among pre-Affordable Care Act (ACA)-eligible adults, there was no statistically significant change in the proportion enrolled in Medicaid between 2014–2015 and 2016–2017 (66.8% and 69.7%, respectively). There were significant differences in changes in take-up rates across population subgroups.
Carbon-Storing Structural Material Based on Wastewater-Cultivated Chlorella Sorokiniana
Authors: Yi Haozhe , Oh Kiwon , Kang Ravinder K. , Yothers Cody W. , Franz Annaliese K. , Qiao Yu
Published: September 2024

Microalgae cultivation is a promising technology for carbon sequestration and wastewater remediation. It is economically and logistically critical to find viable applications for the large quantities of produced biomass. In current research, a structural material is developed by using nearly 100% Chlorella sorokiniana. The otherwise non-cohesive microalgae cells are first surface-activated and then compacted under a relatively high pressure. The resulting material is a dense solid, stronger than typical steel-reinforced concrete in flexural tests. The processing procedure is simple and fast, and the setup is scalable. This technique may be useful for next-generation green construction and provide a use-case for sustainable microalgae biomass.
Surgical Repair of Tetralogy of Fallot Using Autologous Right Atrial Appendage to Reconstruct the Right Ventricular Outflow Tract: A Case Series With Four-Year Follow-up
Authors: Egunov Oleg Anatolyevich , Kozhanov Roman Sergeevich , Cetta Frank , Krivoshchekov Evgeny Vladimirovich
Published: September 2024

This clinical case series describes the surgical management of tetralogy of Fallot in five children using autologous right atrial appendage to reconstruct the right ventricular outflow tract. Transthoracic echocardiography performed at four-year follow-up showed a mild residual gradient and moderate regurgitation of the neopulmonary valve in all cases.
Camino de la Muerte: Crossing the Darién Gap and Migration in the Americas
Authors: Obinna Denise N.
Published: September 2024

As the only land bridge connecting South and North America, the Darién Gap has become one of the most widely used migration paths in the Americas. It is also one of the deadliest. Fleeing poverty, economic, political and social instability, migrants on this trek come from different countries around the world. Venturing through over 60 miles of dense rainforest, steep mountains and swamps, this manuscript examines the growing importance of the Darién Gap as a strategic transit point for migrants in Latin America. Examining the dynamics of forced migration, this work also evaluates the complex confluence of factors driving migration on the Pan-American highway. Facing immense harms to personal safety and autonomy, this manuscript underscores how factors such as human rights violations, gender-based violence (GBV) and climate change have affected forced migration streams through the Darién Gap.
Core Health and Living Stress Among Older People
Authors: Garg Neha , Singh Ajit
Published: September 2024

Maintaining core health and managing living stress among older individuals are crucial for their overall well-being. As people age, various factors impact their physical and mental health, making it essential to address these concerns comprehensively. In this discussion, we will explore the significance of core health, the challenges older people face and strategies to alleviate living stress, covering various aspects such as physical activity, nutrition, social connections and mental health support.
Using Dungeons and Dragons to Creatively Evaluate What It Takes to Be a Successful Entrepreneur: A Role-Playing Exercise
Authors: Swab R. Gabrielle , Mercer Ian S. , Harris John N.
Published: September 2024

In this manuscript, we introduce the creation of content-specific fictional characters as a role-playing activity where students build and creatively write about their own character—their ‘Ideal Entrepreneur’. The exercise allows students to meaningfully engage with course material and consider their preconceived notions of what an entrepreneur needs to “be” to be successful. Using the character creation outline from the role-playing game Dungeons and Dragons, students role-play their created entrepreneur as a character with chosen attributes through storytelling. This encourages outside-the-box thinking and the allowance for creativity in a novel and interesting way, all while engaging with the course content. We highlight not only the activity but also how this is a useful exercise for students in practicing entrepreneurial scenarios and considering the relationship between entrepreneurial attributes and outcomes. We additionally provide student feedback regarding the benefits they received by participating.
When Alternative Analyses of the Same Data Come to Different Conclusions: A Tutorial Using DeclareDesign With a Worked Real-World Example
Authors: Bishop Dorothy V. M. , Hulme Charles
Published: September 2024

Recent studies in psychology have documented how analytic flexibility can result in different results from the same data set. Here, we demonstrate a package in the R programming language, DeclareDesign, that uses simulated data to diagnose the ways in which different analytic designs can give different outcomes. To illustrate features of the package, we contrast two analyses of a randomized controlled trial (RCT) of GraphoGame, an intervention to help children learn to read. The initial analysis found no evidence that the intervention was effective, but a subsequent reanalysis concluded that GraphoGame significantly improved children’s reading. With DeclareDesign, we can simulate data in which the truth is known and thus can identify which analysis is optimal for estimating the intervention effect using “diagnosands,” including bias, precision, and power. The simulations showed that the original analysis accurately estimated intervention effects, whereas selection of a subset of data in the reanalysis introduced substantial bias, overestimating the effect sizes. This problem was exacerbated by inclusion of multiple outcome measures in the reanalysis. Much has been written about the dangers of performing reanalyses of data from RCTs that violate the random assignment of participants to conditions; simulated data make this message clear and quantify the extent to which such practices introduce bias. The simulations confirm the original conclusion that the intervention has no benefit over “business as usual.” In this tutorial, we demonstrate several features of DeclareDesign, which can simulate observational and experimental research designs, allowing researchers to make principled decisions about which analysis to prefer.
Pediatric Chronic Recurrent Multifocal Osteomyelitis—The Great Mimic: Diagnostic and Management Considerations for the Craniofacial Surgeon
Authors: Kong Bo Hyun , Williams Joseph K. , Soldanska Magdalena , Brady Colin M.
Published: September 2024

The diagnosis of CRMO of the craniomaxillofacial skeleton is often delayed due to shared clinical features with a range of alternate diagnoses. We present our recent CRMO case series and resulting review of the literature in an effort to re-emphasize CRMO to surgical providers as a diagnostic consideration in inflammatory pathologies of the craniomaxillofacial skeleton. The series elucidates the diagnostic criteria, work-up, and management of this pathology to promote more efficient multidisciplinary communication and coordination highlighting that earlier treatment portends a more favorable prognosis.
Telemedicine’s Impact on Patient Satisfaction and Efficiency in a Pediatric Plastic Surgery Practice
Authors: LaValley Myles N. , Wright Matthew A. , Nelson Ronald , Kreber Lily , Bogue Jarrod T. , Imahiyerobo Thomas A.
Published: September 2024

Background: For decades, clinicians have cited telemedicine as a useful and effective tool for delivering care in surgical specialties. This study aims to investigate the direct impact of telemedicine on a pediatric plastic surgery practice, examining patient satisfaction and visit efficiency. Methods: Between March 2020 and May 2021, patient families were surveyed online regarding their visit, with questions surrounding convenience, ease of communication, ability to demonstrate physical exam findings, and likelihood of recommending the encounter format. Responses were compared between in-person and telemedicine visits. The duration of encounters during the study time period was also documented from the electronic medical record. Results: Ninety families (15.1%) completed the survey. Telemedicine visits were rated as more convenient than in-person visits (3.77 ± 0.51 vs 3.36 ± 0.94, P < .001). The ability to communicate in telemedicine was rated as similar to in-person ( P = .104), as was the likelihood to recommend that format ( P = .189). Quality of the physical exam was rated as worse for the telehealth visits (3.37 ± 0.89 vs 3.89 ± 0.35, P < .001). Of telemedicine participants, 7.5% also described connectivity issues and 3.8% reported audiovisual problems. Regarding visit efficiency, telehealth visits were shorter across all encounter types including follow-up (34.3 ± 81.1 vs 55.7 ± 44.1 minutes, P = .01), new patient (29.3 ± 25.5 vs 65.1 ± 43.4 minutes, P < .001), and postoperative (24.9 ± 22.9 vs 61.3 ± 48.8 minutes, P < .001) visits. Conclusion: Telemedicine provides an excellent modality for care delivery in the pediatric plastic surgery setting, minimizing time and inconveniences associated with presenting in-person. However, there remains clear concern about the efficacy of the physical examination and technological reliability from the patient’s perspective.
Incorporation of immunotherapy into frontline treatment for adults with B-cell precursor acute lymphoblastic leukemia.
Authors: Badar Talha , Luger Selina M. , Litzow Mark R
Published: September 2024

Although complete remission rates in adults with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) have improved over the last two decades, it is still inferior to that of the pediatric population and once in remission, the risk of relapse is still high. Furthermore, while pediatric-inspired chemotherapy regimens have improved long-term outcomes for adolescents and young adults, these intensive chemotherapy regimens are not well tolerated in older patients and are associated with higher morbidity and mortality. Immunotherapeutic agents offer a potential opportunity to improve response and decrease relapse without increasing toxicity. The incorporation of rituximab (anti-CD20 monoclonal antibody) into chemotherapy regimens has been shown to improve outcomes. The treatment of BCP-ALL in adults has been transformed with the approval of inotuzumab ozogamicin (anti-CD22 antibody drug conjugate), blinatumomab (CD3/CD19 bispecific antibody construct), and CAR T-cells for relapsed or refractory disease, and of blinatumomab for measurable residual disease (MRD)-positive remission. More recently, studies of inotuzumab and blinatumomab have shown promising results when used upfront either with or without multiagent chemotherapy. Blinatumomab has also been shown in a randomized trial to provide a survival benefit in patients with MRD-negative first remission when added to chemotherapy which recently led to its additional FDA approval for use in consolidation. In this review, we highlight the evolution of chemoimmunotherapy-based treatment approaches in the management of treatment-naïve BCP-ALL.
TP53-Mutated Acute Myeloid Leukemia: How Can We Improve Outcomes?
Authors: Sallman David A , Stahl Maximilian
Published: September 2024

Despite advances in the treatment paradigm of patients with acute myeloid leukemia (AML), TP53 mutated AML represents a molecular subgroup that has failed to improve with an overall survival around 6 months that is independent of age and fitness. Notably, there has been significant elucidation in understanding the biology of the disease and key advancements in the classification and prognostication of these patients. International collaborative efforts of novel clinical interventions are urgently needed to change the standard of care.
Microenvironmental acidification by pneumococcal sugar consumption fosters barrier disruption and immune suppression in the human alveolus
Authors: Fatykhova Diana , Fritsch Verena N. , Siebert Keerthana , Methling Karen , Lalk Michael , Busche Tobias , Kalinowski Jörn , Weiner January , Beule Dieter , Bertrams Wilhelm , Kohler Thomas P. , Hammerschmidt Sven , Löwa Anna , Fischer Mara , Mieth Maren , Hellwig Katharina , Frey Doris , Neudecker Jens , Rueckert Jens C. , Toennies Mario , Bauer Torsten T. , Graff Mareike , Tran Hong-Linh , Eggeling Stephan , Gruber Achim D. , Antelmann Haike , Hippenstiel Stefan , Hocke Andreas C.
Published: September 2024

Streptococcus pneumoniaeis the most common causative agent of community-acquired pneumonia worldwide. A key pathogenic mechanism that exacerbates severity of disease is the disruption of the alveolar–capillary barrier. However, the specific virulence mechanisms responsible for this in the human lung are not yet fully understood. In this study, we infected living human lung tissue withStrep. pneumoniaeand observed a significant degradation of the central junctional proteins occludin and vascular endothelial cadherin, indicating barrier disruption. Surprisingly, neither pneumolysin, bacterial hydrogen peroxide nor pro-inflammatory activation were sufficient to cause this junctional degradation. Instead, pneumococcal infection led to a significant decrease of pH (∼6), resulting in the acidification of the alveolar microenvironment, which was linked to junctional degradation. Stabilising the pH at physiological levels during infection reversed this effect, even in a therapeutic-like approach. Further analysis of bacterial metabolites and RNA sequencing revealed that sugar consumption and subsequent lactate production were the major factors contributing to bacterially induced alveolar acidification, which also hindered the release of critical immune factors. Our findings highlight bacterial metabolite-induced acidification as an independent virulence mechanism for barrier disruption and inflammatory dysregulation in pneumonia. Thus, our data suggest that strictly monitoring and buffering alveolar pH during infections caused by fermentative bacteria could serve as an adjunctive therapeutic strategy for sustaining barrier integrity and immune response.
Exploring the role of calf circumference as a predisposing factor for intra-hospital delirium: investigating potential gender differences: revealing potential gender variances
Authors: Ceolin Chiara , Papa Mario Virgilio , Simonato Cristina , Cazzavillan Sara , Vergadoro Margherita , Trapella Giulia Salerno , Sermasi Riccardo , De Rui Marina , Noale Marianna , Zanforlini Bruno Micael , Curreri Chiara , Bertocco Anna , Devita Maria , Sergi Giuseppe , Coin Alessandra
Published: September 2024

Background

Malnutrition and sarcopenia significantly increase the risk of intra-hospital delirium, particularly among older adults. Given the potential correlation between calf circumference (CC) and these conditions, CC emerges as a promising predisposing factor for delirium. This study aims to investigate the independent association between delirium and anthropometric parameters, focusing on evaluating CC’s predictive capacity for intra-hospital delirium risk. Additionally, it aims to compare CC’s predictive performance with the widely used Mini Nutritional Assessment (MNA), while also considering potential gender disparities.

Methods

This is a retrospective study which enrolled patients aged ≥ 65 years from September 2021 to March 2022 at the Padova Hospital (Italy). Physical characteristics, intra-hospital delirium incidence, and body composition were assessed. Sarcopenia was diagnosed using the 2019 European Consensus criteria.

Results

Among 207 subjects, delirium affected 19% of patients. CC showed a significant association with intra-hospital delirium among the analyzed anthropometric parameters. ROC curves indicated that CC’s predictive capacity for delirium onset was comparable to MNA (p = 0.98), particularly in women. In a multivariable logistic regression model, female gender and higher cognitive and CC scores emerged as protective factors against delirium onset, with each unit increase in CC associated with a 24% reduction in the odds of delirium. Conversely, sarcopenia did not significantly influence delirium onset.

Conclusions

CC shows promise as a predisposing factor for intra-hospital delirium, similar to MNA, albeit with significant gender differences. CC could serve as a valuable tool for assessing delirium risk among female patients. Further validation of these findings is necessary through larger-scale studies.
Alcohol free? An analysis of UK and Scottish Government obesity policies’ engagement with alcohol 1999–2023
Authors: Young Callum , Hawkins Benjamin
Published: September 2024

Background and aims

Alcoholic beverages can be highly calorific yet remain largely absent from obesity policy debates. This article seeks to identify how Scottish and English obesity policies have engaged with the issue of alcohol consumption since devolution.

Methods

Obesity policy documents for England and Scotland from 1999 to 2023 were thematically analysed to identify their engagement with alcohol consumption. A stakeholder analysis was undertaken to identify key public health actors and commercial sector policy actors in the debate regarding the inclusion of alcohol in obesity policy. Their engagement with the issue of alcohol as an obesity policy issue was assessed through thematic analysis of consultation responses, along with documents, press releases, reports and other statements on policy (e.g. blog posts) available on stakeholder websites.

Results

While alcohol was recognised as a risk factor for obesity within obesity policy documents, no specific measures to address this issue were identified until a consultation on mandatory calorie labelling on alcoholic beverages was proposed in 2020. Engagement with alcohol in the policy documents was mainly limited to voluntary and self-regulatory measures favoured by industry actors who portrayed themselves as a key part of the policy solution. They used the policy focus on childhood obesity as a pretext to exclude alcoholic drink from fiscal and labelling measures. Public health NGOs, by contrast, argued that obesity measures such as mandatory calorie labelling and other obesity policies should be extended to alcoholic beverages.

Conclusion

There is an insufficient engagement with alcohol as an obesity policy issue within policy documents and an over-reliance on voluntary and industry-partnership approaches. Alcoholic beverages and reduced alcohol products are excluded from beverage taxes and labelling requirements in ways which are hard to justify. As with other areas of public health policy, this represents an industry-favoured policy agenda, opposed by health NGOs. Further research is needed to understand the influence of these actors on the engagement of obesity policy with alcohol.