bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of ultrasonic treatment on heat transfer in the heat exchanger
Authors: Kamar Nihad , Le Page Mostefa Marie , Muhr Hervé , Jost Pierre-Olivier
Published: September 2022

This paper deals with the influence of guided ultrasonic waves on heat transfer. Two piezoelectric transducers, whose structure can be vibrated at different powers and at their resonant frequency in the ultrasonic range of 27–45 kHz, were placed on the plates of a heat exchanger to inhibit the formation of a mineral deposit. These waves were set to diffuse only into the metal plates of the exchanger. During these tests, an increase in the heat transfer between the two fluids was directly observed on the continuous recording of the outlet temperature, on the calculations of the global exchange coefficient, and on the flow exchanged between the two fluids in the laminar regime. Tests are presented in this article, tests in the presence of the 45 kHz transducer, another with a 27 kHz transducer, and which combines the two have a different positioning on the exchanger. The results obtained from the ultrasonic guided waves are similar to the classical ultrasonic waves.
From the elastocaloric effect towards an efficient thermodynamic cycle
Authors: Kabirifar Parham , Trojer Jonas , Brojan Miha , Tušek Jaka
Published: September 2022

In recent years, elastocaloric cooling technology has been considered as one of the most promising alternatives to vapor compression technology. Given that elastocaloric technology is only in the early stages of development, a uniform method for evaluating the elastocaloric effect has not yet been established, and the thermodynamics of different elastocaloric cooling cycles have not yet been studied in detail. Therefore, the main goal of this work is to investigate these two important areas. Here, multiple thermodynamic cycles were studied, focusing on the parameters of the holding period of the cycle, which is essential for heat transfer between the elastocaloric material and the heat sink/source. The cycles were applied to commercially available superelastic thin-walled NiTi tubes under compressive loading and a thin NiTi wire under tensile loading. Isostress cycles with constant stress throughout the holding period, isostrain cycles with constant strain throughout the holding period and no-hold cycles (without a holding period) were studied across multiple stress/strain ranges. Based on the experimental results, a previously developed phenomenological model was applied to better understand and further evaluate the different cycles. The results revealed that the applied thermodynamic cycle significantly affects the thermomechanical response and thus the cooling/heating efficiency of the elastocaloric material. We show that by using isostress cycles and partial transformations, a Carnot-like thermodynamic cycle with improved heating/cooling efficiency can be generated. By applying the isostress cycles, an adiabatic temperature change of 30.2 K was measured, which is among the largest directly measured reproducible adiabatic temperature changes reported for any caloric material to date. Ultimately, this study intends to serve as a basis for establishing a uniform method for evaluating the elastocaloric effect in different materials that would allow for reliable and accurate one-to-one comparison of the reported results in the rapidly growing field of elastocalorics.
A Causal Mediation Analysis for Investigating the Effect of a Randomized Cash-Transfer Program in Nicaragua
Authors: Charters Thomas J , Kaufman Jay S , Nandi Arijit
Published: September 2022

Mediation analysis can be applied to data from randomized trials of health and social interventions to draw causal inference concerning their mechanisms. We used data from a cluster-randomized trial in Nicaragua, fielded between 2000 and 2002, to investigate whether the impact of providing access to a conditional cash-transfer program on child nutritional outcomes was mediated by child health check-ups and household dietary diversity. In a sample of 443 children 6–35 months old, we estimated the controlled direct (CDE) effect of random assignment on measured height-for-age z scores had we intervened so that all children received a health check-up and had the same level of household dietary diversity, using inverse-probability weighted marginal structural models to account for mediator-outcome confounding. Sensitivity analyses corrected the CDE for potential nondifferential error in the measurement of dietary diversity. Treatment assignment increased height-for-age z score by 0.37 (95% CI: 0.05, 0.69) standard deviations. The CDE was 0.20 (95% CI: −0.17, 0.57) standard deviations, suggesting nearly one-half of the program’s impact on child nutrition would be eliminated had we intervened on these factors, although estimates were relatively imprecise. This study provides an illustration of how causal mediation analysis can be applied to examine the mechanisms of multifaceted interventions.
Probable drug-induced clitoral priapism due to potentiating effects of pregabalin and duloxetine
Authors: Nguyen Joanne , Chin Justin J , Blalock Meredith
Published: September 2022

Purpose

The following case report discusses probable clitoral priapism secondary to duloxetine and pregabalin. While this is a rare adverse effect, it is possible given the mechanism of action and potentiating effects of the combined therapy. This adverse drug reaction was reported to MedWatch and shows that additional research into the physiology of clitoral erection is warranted given the scarcity of information on how drugs influence this reaction.

A 53-year-old African American female with uncontrolled anxiety was started on duloxetine. Pregabalin was added 1 month later due to continued feelings of anxiety. Three weeks later, the patient reported symptoms of clitoral pain, as well as a swollen, tender, and erect clitoris. These adverse effects remained for 4 days, prompting the patient to present to the emergency department where a physical exam was completed with no significant finding except as noted above. Pregabalin was immediately discontinued by the attending physician based on the probability that the swelling was likely drug-induced clitoral priapism. During follow-up, the patient continued to note clitoral erection and pain. The psychiatric pharmacist tapered off duloxetine over 2 weeks with resolution of symptoms. In an examination of the mechanism of action of both drugs, pregabalin can amplify duloxetine’s inhibitory effects on voltage-dependent calcium channels. It is likely this mechanism that causes smooth muscle relaxation and led to clitoral priapism.

Conclusion

This case suggests that pharmacological agents affecting vasoconstriction through serotonergic receptors or calcium-dependent channels can also influence clitoral erection.
StrainDesign: a comprehensive Python package for computational design of metabolic networks
Authors: Schneider Philipp , Bekiaris Pavlos Stephanos , von Kamp Axel , Klamt Steffen
Published: September 2022

Various constraint-based optimization approaches have been developed for the computational analysis and design of metabolic networks. Herein, we present StrainDesign, a comprehensive Python package that builds upon the COBRApy toolbox and integrates the most popular metabolic design algorithms, including nested strain optimization methods such as OptKnock, RobustKnock and OptCouple as well as the more general minimal cut sets approach. The optimization approaches are embedded in individual modules, which can also be combined for setting up more elaborate strain design problems. Advanced features, such as the efficient integration of GPR rules and the possibility to consider gene and reaction additions or regulatory interventions, have been generalized and are available for all modules. The package uses state-of-the-art preprocessing methods, supports multiple solvers and provides a number of enhanced tools for analyzing computed intervention strategies including 2D and 3D plots of user-selected metabolic fluxes or yields. Furthermore, a user-friendly interface for the StrainDesign package has been implemented in the GUI-based metabolic modeling software CNApy. StrainDesign provides thus a unique and rich framework for computational strain design in Python, uniting many algorithmic developments in the field and allowing modular extension in the future.

Availability and implementation

The StrainDesign package can be retrieved from PyPi, Anaconda and GitHub (https://github.com/klamt-lab/straindesign) and is also part of the latest CNApy package.
Practicing Lived Experience Leadership with Love: Photovoice Reflections of a Community-Led Crime Prevention Project
Authors: Buck Gillian , Ryan Kemi , Ryan Natasha
Published: September 2022

Lived experience leadership is part of a broader international trend towards service user involvement in public services yet little is known about services developed and delivered by people with lived experience of the criminal justice system. Our innovative study, coproduced by two formerly imprisoned community practitioners and an academic researcher, aims to amplify the voices of people delivering and using a lived experience-led crime prevention project. Using photovoice methods, in which people use cameras to document their realities and advocate for change, we explore the potential of lived experience leadership to drive individual and social change. Some of the compelling images produced by the group are showcased, revealing how in contexts of suffering, social exclusion and negative expectations, forms of inclusive, loving, hopeful community praxis can be impactful. We conclude that allegiances between community practitioners and social workers could begin to disrupt harmful and oppressive structures and create locally led, hope-filled service provision. To broker such allied practices, we include a self-audit for social and community workers, inviting reflections focused on this ambitious goal.
Impact of segmentectomy and lobectomy on non-lung cancer death in early-stage lung cancer patients
Authors: Isaka Tetsuya , Ito Hiroyuki , Yokose Tomoyuki , Saito Haruhiro , Adachi Hiroyuki , Miura Jun , Murakami Kotaro , Rino Yasushi
Published: September 2022

OBJECTIVES

This study aimed to analyse the risk of death from non-lung cancer after segmentectomy or lobectomy for early-stage lung cancer.

METHODS

A total of 1385 patients underwent lobectomy or segmentectomy for clinical stage 0–I primary lung cancer, with no evidence of recurrence after surgery, between January 2008 and December 2018. Risk factors for non-lung cancer deaths (NLCD) were analysed using multivariable logistic regression analysis. The overall survival (OS) of patients with low and high comorbidities who underwent lobectomy and segmentectomy was compared using a log-rank test.

RESULTS

Patients with NLCD (n = 126) were more likely to have undergone lobectomy than patients with non-recurrence survival (n = 1259). Multivariable analysis revealed that age (≥65 years), smoking index (≥600), body mass index (≤18.5 kg/m2), interstitial pneumonia, values for percentage of predicted vital capacity (≤9.4%) and lobectomy were risk factors for NLCD. Patients who underwent segmentectomy had significantly better 5-year OS than those who underwent lobectomy, after propensity score matching (94.6% vs 90.4%, P = 0.027). Patients with high comorbidities (patients with ≥2 of the following risks: age ≥65 years, smoking index ≥600, body mass index ≤18.5 kg/m2, Charlson Comorbidity Index ≥1, values for percentage of predicted vital capacity ≤96.4%) who underwent segmentectomy had a better 5-year OS than those who underwent lobectomy (92.8% vs 87.8%, P = 0.016). However, there was no difference in 5-year OS between segmentectomy and lobectomy in patients with low comorbidities (98.5% vs 97.4%, P = 0.867).

CONCLUSIONS

The impact of lobectomy and segmentectomy on NLCD depends on the extent of the patients’ comorbidities.
Regimen of Coronavirus Disease 2019 Vaccination Influences Extent and Kinetics of Antibody Avidity
Authors: Rössler Annika , Kimpel Janine , Fleischer Verena , Huber Silke , von Laer Dorothee , Borena Wegene , Würzner Reinhard ,   the HEVACC Study Group, Bante David , Falkensammer Barbara , Schäfer Helena , Krammer Florian , Pichler Peter , Wiedermann Ursula , Rainer Daniel , Trips Tobias , Zabernigg August
Published: September 2022

We investigated antibody titers and avidity after heterologous versus homologous coronavirus disease 2019 vaccination over 6 months after the second dose. We found a significantly higher avidity in regimens including at least 1 dose of the adenoviral vector vaccine ChAdOx1-S compared with 2 doses of the mRNA vaccine BNT162b2.
Abdominal Movements in Insect Flight Reshape the Role of Non-Aerodynamic Structures for Flight Maneuverability I: Model Predictive Control for Flower Tracking
Authors: Bustamante Jorge , Ahmed Mahad , Deora Tanvi , Fabien Brian , Daniel Thomas L
Published: September 2022

Synopsis

Research on insect flight control has focused primarily on the role of wings. Yet abdominal deflections during flight can potentially influence the dynamics of flight. This paper assesses the role of airframe deformations in flight, and asks to what extent the abdomen contributes to flight maneuverability. To address this, we use a combination of both a Model Predictive Control (MPC)-inspired computational inertial dynamics model, and free flight experiments in the hawkmoth, Manduca sexta. We explored both underactuated (i.e., number of outputs are greater than the number of inputs) and fully actuated (equal number of outputs and inputs) systems. Using metrics such as the non-dimensionalized tracking error and cost of transport to evaluate flight performance of the inertial dynamics model, we show that fully actuated simulations minimized the tracking error and cost of transport. Additionally, we tested the effect of restricted abdomen movement on free flight in live hawkmoths by fixing a carbon fiber rod over the thoracic-abdomen joint. Moths with a restricted abdomen performed worse than sham treatment moths. This study finds that abdominal motions contribute to flight control and maneuverability. Such motions of non-aerodynamic structures, found in all flying taxa, can inform the development of multi-actuated micro air vehicles.
On the Aesthetic Appreciation of Damaged Environments
Authors: Alcaraz León María José
Published: September 2022

As aesthetic appreciators of the environment, we often encounter cases where our environmental commitments and our aesthetic responses do not seem to match. Some highly altered or contaminated environments may occasion powerful and insightful aesthetic experiences. In this article, I discuss some arguments that have been offered in favor of the view that this mismatch is not possible when we appreciate a particular environment with full awareness of its damaged or altered condition. I show that these arguments are not conclusive and that there is room for valuable experiences of damaged or highly altered environments. Our knowledge of the damaged condition of an environment, while perceptually significant, does not necessarily make the resulting aesthetic experience to be negative. Finally, I show that these cases do not necessarily diminish the role that aesthetics can play in shaping our environmental sensibility and commitments.
Status of Onchocerca volvulus (Spirurida: Onchocercidae) Transmission and Effect of Climatic Variables on the Vector Population Dynamics After Two Decades of Ivermectin-based Preventive Chemotherapy in the Mbam Valley (Centre Region, Cameroon)
Authors: Domche André , Nwane Philippe B , Nana Djeunga Hugues C , Njitchouang Guy R , Pion Sébastien D , Boussinesq Michel , Njiokou Flobert , Kamgno Joseph
Published: September 2022

Entomological indicators of onchocerciasis transmission and the effect of climatic variables on the vector population dynamics were investigated in two first-line villages after more than two decades of mass drug administration with ivermectin. Female blackflies were collected in two villages (Bayomen and Biatsota) using human landing method for a period of 12 months. Blackflies were dissected and entomological indices were computed. Monthly temperature, precipitation, and humidity were collected and the Spearman correlation rank test was used to assess the relationship between biting rates and climatic variables. The highest biting rates (62,280 bites/human/month in Bayomen and 42,090 bites/human/month in Biatsota) were recorded during the long rainy season (November). The Onchocerca volvulus transmission was greater during the long dry season in both villages, with a peak at the beginning of the long dry season in Biatsota (100 infective larvae/human/month), and at the middle of the long dry season in Bayomen (92 infective larvae/human/month). No correlation was found between biting rates and selected climatic variables in the two villages. This study revealed that onchocerciasis transmission is ongoing in the study area despite almost 25 years of Community-Directed Treatment with Ivermectin. In accordance with WHO recommendations, vector control should be used in combination with mass drug administration to accelerate transmission interruption of onchocerciasis. To be optimal, this vector control should be implemented during the long dry season (November to March) when water volumes are low and transmission potentials are high.
PNV J00444033+4113068: Early superhumps with 0.7 mag amplitude and non-red color
Authors: Tampo Yusuke , Isogai Keisuke , Kojiguchi Naoto , Uemura Makoto , Kato Taichi , Tordai Tamás , Vanmunster Tonny , Itoh Hiroshi , Dubovsky Pavol A , Medulka Tomáš , Sano Yasuo , Hambsch Franz-Josef , Taguchi Kenta , Maehara Hiroyuki , Ito Junpei , Nogami Daisaku
Published: September 2022

In the first days of WZ Sge-type dwarf nova (DN) outbursts, the 2 : 1 resonance induces a spiral arm structure in the accretion disk, which is observed as early superhumps in optical light curves. We reports on our optical observations of an eclipsing WZ Sge-type DN PNV J00444033+4113068 during its 2021 superoutburst using the 3.8 m Seimei telescope and through the Variable Star Network collaboration. The eclipse analysis showed that its orbital period was 0.055425534(1) d. Our observations confirmed early superhumps with an amplitude of 0.7 mag, the largest amplitude among known WZ Sge-type DNe. More interestingly, its early superhumps became the reddest around their secondary minimum, whereas other WZ Sge-type DNe show the reddest color around the early superhump maximum. The spectrum around the peak of the outburst showed two double-peaked emission lines of He ii 4686 Å and Hα with a peak separation of ≥700 km s−1, supporting a very high-inclination system. With the early superhump mapping, the unique profile and color of the early superhump are successfully reproduced by an accretion disk with a vertically extended double arm structure. Therefore, a large amplitude and a unique color behavior of the early superhumps in PNV J00444033+4113068 can be explained by the 2 : 1 resonance model along with other WZ Sge-type DNe.
Down-regulated FcγRII expression on plasma cells is associated with the disease activity of ANCA-associated vasculitis
Authors: Wang Chen , Gong Yan , You Ran , Li Zhi-Ying , Zhao Ming-Hui , Chen Min
Published: September 2022

Objectives

Inhibitory FcγRIIB/CD32B on B cells are critical for immunity regulation to help maintain peripheral tolerance. Altered FcγRIIB expression on B cells has been observed in several autoimmune diseases, and animal studies have suggested that FcγRIIB on B cells participates in the pathogenesis of ANCA-associated vasculitis (AAV). Here, we investigated the expression of FcγRII (FcγRIIB) on various B cell subsets and the correlation of FcγRII/CD32 expression with disease activity in AAV patients.

Material and methods

Blood samples of patients with AAV in active stage and in remission were collected. FcγRII/CD32 expressions on various B cell subsets of the whole blood were detected by flow cytometry, and their correlation with clinical and pathological data was analysed.

Results

The expression of FcγRII/CD32 on plasma cells was significantly lower in AAV patients in active stage than those in both AAV patients in remission and healthy donors. Furthermore, the expression of FcγRII/CD32 on plasma cells negatively correlated with BVAS and percentages of cellular crescents in renal biopsies.

Conclusions

There is a down-regulation of FcγRIIB/CD32B expression on B cells in patients with AAV, which is associated with the disease activity of AAV.
Host prediction for disease-associated gastrointestinal cressdnaviruses
Authors: Kinsella Cormac M , Deijs Martin , Becker Christin , Broekhuizen Patricia , van Gool Tom , Bart Aldert , Schaefer Arne S , van der Hoek Lia
Published: September 2022

Metagenomic techniques have facilitated the discovery of thousands of viruses, yet because samples are often highly biodiverse, fundamental data on the specific cellular hosts are usually missing. Numerous gastrointestinal viruses linked to human or animal diseases are affected by this, preventing research into their medical or veterinary importance. Here, we developed a computational workflow for the prediction of viral hosts from complex metagenomic datasets. We applied it to seven lineages of gastrointestinal cressdnaviruses using 1,124 metagenomic datasets, predicting hosts of four lineages. The Redondoviridae, strongly associated to human gum disease (periodontitis), were predicted to infect Entamoeba gingivalis, an oral pathogen itself involved in periodontitis. The Kirkoviridae, originally linked to fatal equine disease, were predicted to infect a variety of parabasalid protists, including Dientamoeba fragilis in humans. Two viral lineages observed in human diarrhoeal disease (CRESSV1 and CRESSV19, i.e. pecoviruses and hudisaviruses) were predicted to infect Blastocystis spp. and Endolimax nana respectively, protists responsible for millions of annual human infections. Our prediction approach is adaptable to any virus lineage and requires neither training datasets nor host genome assemblies. Two host predictions (for the Kirkoviridae and CRESSV1 lineages) could be independently confirmed as virus–host relationships using endogenous viral elements identified inside host genomes, while a further prediction (for the Redondoviridae) was strongly supported as a virus–host relationship using a case–control screening experiment of human oral plaques.
Anxiety in heart failure patients and its association with socio-demographic and clinical characteristics: a cross-sectional study
Authors: Costa Filipa M. D. , Martins Sónia P. V. , Moreira Emilia C. T. D. , Cardoso José C. M. S. , Fernandes Lia P. N. S.
Published: September 2022

Background:

Anxiety is one of the most frequent psychiatric disorders in heart failure (HF) patients. However, it is often neglected in clinical practice and studies about the particular relationship with the New York Heart Association (NYHA) classes for HF are scarce. In this context, this study aims to analyze the presence of anxiety symptoms in HF outpatients and also its association with sociodemographic and clinical characteristics of these patients.

Methods:

This cross-sectional study is part of the longitudinal Deus Ex-Machina project (NORTE-01-0145-FEDER-000026). HF patients were recruited at an outpatient clinic at a University Hospital. Patients with inability to communicate, severe visual/hearing impairment, or NYHA class IV were excluded. Sociodemographic data and NYHA class were registered. Anxiety was assessed with the 7-item Generalized Anxiety Disorders Scale (with a score ≥10 clinically relevant anxiety). Patients with and without anxiety were compared regarding socio-demographic and clinical variables.

Results:

The sample (n = 136) had a median age of 59years (Q1: 49; Q3: 68), 66.2% were male and 31.6% presented clinically relevant anxiety. A higher percentage of HF patients with anxiety had psychiatric disorders (58.1% vs 26.9%; P = .001), psychotropic medication (62.8% vs 30.1%; P = .001), and depression (60.5% vs 9.7%; P< .001). No significant differences were found regarding the remaining variables, including NYHA classes.

Conclusions:

A substantial proportion of HF patients present clinically relevant anxiety, particularly those with psychiatric history, depressive symptoms, or under psychotropic medication. Therefore, integrating routine screening and treatment of this comorbidity in clinical practice is of utmost importance. Further studies are needed to clarify the association of anxiety with HF.
Transfusion-Associated Adverse Events
Authors: Lea Nicole C. , Gibbs Karen , Johnson Chantay , Lam Anne , Wuestner Elizabeth , Hui Shiu-Ki Rocky
Published: September 2022

Although blood transfusions are considered a potentially life-saving therapy, noninfectious and infectious adverse events can lead to significant morbidities and even mortality. Vital signs and visual observation of patients during blood transfusions are thoroughly taught in nursing school. Updated terms of hemovigilance and transfusion-associated adverse events (TAAEs) are presented through this case study. A patient with factor V deficiency, which requires chronic plasma transfusions, experienced 2 types of TAAEs, anaphylaxis and transfusion-associated circulatory overload. The patient's history and TAAEs are presented and discussed to provide evidence for the importance of vigilant bedside surveillance. Early identification of TAAEs may prevent unnecessary morbidity and/or mortality. The primary nursing functions and responsibilities are presented with algorithmic supplementation to facilitate better understanding of best practice. Ongoing assessment of hemovigilance practices is indicated to ascertain which monitoring tools can lead to optimal patient care.
Acuity Tools for the Antepartum and Neonatal Intensive Care Units
Authors: Roth Cheryl , Dent Sarah A. , Luster Mary H. , Hering Sandra L. , Bay R. Curtis
Published: September 2022

Purpose:

To evaluate content validity and interrater reliability for acuity tools developed for the antepartum and neonatal intensive care unit (NICU) patient population.

Study Design and Methods:

Antepartum and NICU acuity tools were developed to better evaluate nurse staffing assignment equity and patient needs. Following several iterations with staff nurses and nurse leaders, content validity of the acuity tools was established via a panel of experts in each substantive area using the Content Validity Index. The final tools were then evaluated for interrater reliability using Intraclass Correlation.

Results:

Content validity for the Antepartum Acuity Tool was S-CVI/Ave = 0.87 and for the NICU Acuity Tool was S-CVI/Ave = 0.98. Interrater Reliability for the Antepartum Acuity tool was ICC = 0.88, and the NICU Acuity Tool was ICC = 0.95.

Clinical Implications:

These tools have established content validity and interrater reliability and are appropriate for use in the antepartum and NICU settings to determine patient acuity and promote appropriate nurse-to-patient assignments.
Transgender and Nonbinary Deaths Investigated by the State Medical Examiner in the Portland, Oregon, Metro Area and Their Concordance With Vital Records, 2011-2021
Authors: Walters Jaime K. , Mew Molly C. , Repp Kimberly K.
Published: September 2022

Objectives:

To illustrate possible improvements in recording of gender identity, we investigated discrepancies between gender identity from medical examiner (ME) death investigations and sex as recorded in the final death record.

Design:

Evaluation of a database used to record information related to medicolegal death investigation with matching to state vital records. Kappa analysis was used to measure concordance between both systems.

Setting:

The Portland, Oregon, metro area (Clackamas, Multnomah, and Washington Counties) and deaths investigated by the Offices of each County Medical Examiner between January 2011 and September 2020.

Intervention:

Epidemiologists identified incongruous data that have significant negative implications for transgender populations. Epidemiologists identified key actions that, if taken by death investigators, death record software, and the federal death certificate form, will rectify harmful data discrepancies.

Main Outcome Measure:

Concordance of gender identity and sex in ME data and death record, respectively.

Results:

We identified 51 deaths in transgender persons; the majority were classified as transgender female (71%). The κ statistic was −0.0657, indicating poor concordance between the gender identity in ME investigation and the death certificate in vital records.

Conclusions:

Information gathered via medicolegal death investigations is foundational to effective public health/public safety response; MEs and coroners are often the first to document emerging health threats. Discrepancies in official death records impede accurate surveillance of a population disproportionately at risk of violent death.
The global burden of cognitive impairment in people with HIV
Authors: Keng Lea D. , Winston Alan , Sabin Caroline A.
Published: September 2022

Objective:

While life expectancies of people with HIV (PWH) have increased through the successes of antiretroviral treatment, cognitive impairment remains a pressing concern. Prevalence estimates vary worldwide as different definitions for cognitive impairment are used and resource availability differs across geographical settings. We aim to explore this heterogeneity and estimate the global cognitive impairment burden in PWH.

Design:

Systematic literature review and meta-analysis.

Methods:

We searched PubMed, Embase, SCOPUS, and Web of Science for studies reporting on cognitive impairment prevalence in PWH. Nine factors were investigated for their potential association with the prevalence using a univariate meta-analysis and a meta-regression: assessment method, geographical region, country income, exclusion criteria, study quality, age, sex, publication year, and sample size.

Results:

The literature search identified 8539 records, of which 225 were included. The adjusted prevalence was significantly lower in males than females. Across 44 countries, 12 assessment methods were used; the HIV-associated neurocognitive disorder/Frascati criteria, known for high false-positive rates, was employed in 44.4% of studies. The pooled cognitive impairment prevalence estimate in PWH, including asymptomatic cases, was 39.6% (95% confidence interval: 37.2–42.1%; range: 7–87%). The meta-regression explained 13.3% of between-study variation, with substantial residual heterogeneity (I
2 = 97.7%).

Conclusion:

Lack of data from more than 70% of the world's countries, cohorts being unselected for symptoms in most research studies, and limitations of the HIV-associated neurocognitive disorder/Frascati criteria restrict the ability to accurately determine the global burden of cognitive impairment in PWH. More studies in low-resource settings and a standardized approach to assessing cognitive impairment, bridging research and clinical realms, are needed.
Modelling the impact of HIV and hepatitis C virus prevention and treatment interventions among people who inject drugs in Kenya
Authors: Stone Jack , Fraser Hannah , Walker Josephine G. , Mafirakureva Nyashadzaishe , Mundia Bernard , Cleland Charles , Bartilol Kigen , Musyoki Helgar , Waruiru Wanjiru , Ragi Allan , Bhattacharjee Parinita , Chhun Nok , Lizcano John , Akiyama Matthew J. , Cherutich Peter , Wisse Ernst , Kurth Ann , Luhmann Niklas , Vickerman Peter
Published: September 2022

Objectives:

People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14–26%) and hepatitis C virus (HCV; 11–36%) prevalence. We evaluated the impact of existing and scaled-up interventions on HIV and HCV incidence among PWID in Kenya.

Design:

HIV and HCV transmission model among PWID, calibrated to Nairobi and Kenya's Coastal region.

Methods:

For each setting, we projected the impact (percent of HIV/HCV infections averted in 2020) of existing coverages of antiretroviral therapy (ART; 63–79%), opioid agonist therapy (OAT; 8–13%) and needle and syringe programmes (NSP; 45–61%). We then projected the impact (reduction in HIV/HCV incidence over 2021–2030), of scaling-up harm reduction [Full harm reduction (‘Full HR’): 50% OAT, 75% NSP] and/or HIV (UNAIDS 90–90–90) and HCV treatment (1000 PWID over 2021–2025) and reducing sexual risk (by 25/50/75%). We estimated HCV treatment levels needed to reduce HCV incidence by 90% by 2030.

Results:

In 2020, OAT and NSP averted 46.0–50.8% (range of medians) of HIV infections and 50.0–66.1% of HCV infections, mostly because of NSP. ART only averted 12.9–39.8% of HIV infections because of suboptimal viral suppression (28–48%). Full HR and ART could reduce HIV incidence by 51.5–64% and HCV incidence by 84.6–86.6% by 2030. Also halving sexual risk could reduce HIV incidence by 68.0–74.1%. Alongside full HR, treating 2244 PWID over 2021–2025 could reduce HCV incidence by 90% by 2030.

Conclusion:

Existing interventions are having substantial impact on HIV and HCV transmission in Kenya. However, to eliminate HIV and HCV, further scale-up is needed with reductions in sexual risk and HCV treatment.
Improved virologic outcomes in postpartum women living with HIV referred to differentiated models of care
Authors: Myer Landon , Odayar Jasantha , Malaba Thokozile R. , Allerton Joanna , Kabanda Siti , Hu Nai-Chung , Kalombo Cathy , Hsiao Nei-Yuan , Jacobs Shahieda , Nofemela Andile , Lesosky Maia
Published: September 2022

Objectives:

Differentiated service delivery (DSD) models are used to deliver antiretroviral therapy (ART) but data are limited in postpartum women, who are at high risk of non-adherence and elevated viral load (VL) over the extended postpartum period.

Design:

Randomized controlled trial.

Methods:

We enrolled consecutive postpartum women who initiated ART during pregnancy and met local DSD eligibility (clinically stable, VL less than 400 copies/ml) at a large primary healthcare (PHC) clinic. Women were randomized to a community-based ‘adherence club’ (AC, the local DSD model: community health worker-led groups of 20–30 patients with ART dispensing at a community venue) or routine PHC clinics (local standard of care with nurse/doctor-led services). Follow-up visits with VL separate from routine care took place at 3, 6, 12, 18 and 24 months postpartum. Endpoints were time to VL of at least 1000 copies/ml (primary) and VL of at least 50 copies/ml (secondary) by intention-to-treat.

Results:

At enrolment (n = 409), the median duration postpartum was 10 days, all women had a VL less than 1000 copies/ml and 88% had a VL less than 50 copies/ml; baseline characteristics did not differ by arm. Twenty-four-month retention was 89%. Sixteen and 29% of women in AC experienced a VL of at least 1000 copies/ml by 12 and 24 months, compared to 23 and 37% in PHC, respectively (hazard ratio [HR] = 0.71; 95% confidence interval [CI] = 0.50–1.01). Thirty-two and 44% of women in ACs had a VL of at least 50 copies/ml by 12 and 24 months, compared to 42 and 56% in PHC, respectively (HR = 0.68; 95% CI = 0.51–0.91).

Conclusions:

Early DSD referral was associated with reduced viraemia through 24 months postpartum and may be an important strategy to improve maternal virologic outcomes.
Imaging, Clinical, and Demographic Differences in Patients With Type III Spinal Cerebrospinal Fluid Leak (Cerebrospinal Venous Fistulas) Compared With Patients With Types I and II Spinal Cerebrospinal Fluid Leak
Authors: Mehan William A. , Buch Karen
Published: September 2022

Objective

Spinal cerebrospinal fluid (CSF) leaks are an underdiagnosed cause of neurologic symptoms. The most common types of spinal CSF leaks are from dural tears (type I) and meningeal diverticula (type II). Cerebrospinal fluid–venous fistulas (type III) are less common and underrecognized. The purpose of this study was to evaluate the intracranial and spinal imaging findings in patients with types I/II versus type III leaks.

Materials and Methods

This was a retrospective, institutional review board–approved study performed on adult patients between January 2020 to September 2021 with surgically confirmed type I/II/III spinal CSF leak. Patients had preoperative brain magnetic resonance imaging (MRI) with contrast and medical records detailing symptoms and clinical diagnoses. Patients were excluded for nondiagnostic brain MRIs. Demographic and clinical information were recorded. The presence of extra-axial collections, pachymeningeal thickening, brain sagging, and decreased pontomamillary distance were evaluated on MRI.

Results

Seven patients had type III leaks, and 16 had type I/II leaks. Patients with type III leaks were older (P = 0.0003) and had higher rates of initial misdiagnosis (100% vs 31%) and longer times to correct diagnosis (P = 0.03) compared with type I/II leaks. Intracranial extra-axial collections were never seen with type III leaks but were seen in 50% of type I/II leaks. Pachymeningeal thickening and brainstem sagging occurred in nearly equal frequency between groups. Smaller pontomamillary distances were seen in type III leaks versus type I/II leaks (P = 0.047).

Conclusions

When evaluating patients with suspected spinal CSF leak, findings of older age, absence of intracranial extra-axial collections, and small pontomamillary distances may raise suspicion for type III versus type I/II leak.
Preliminary Evaluation of a Novel Neural Network-Based Hybrid Simulator for Surgical Training and Performance Assessment of Neonatal Thoracentesis
Authors: Sheth Nihar N. , Srinivasan Nishant , Patel Saurabhkumar , Luciano Cristian J.
Published: September 2022

Introduction

Tension pneumothorax is a rare and life-threatening situation in neonates requiring immediate intervention through thoracentesis. Significant complications can arise while performing thoracentesis in the case of inadequate skill level or exposure to the condition. Although simulation-based training (SBT) has proven to be effective in learning surgical skills, training sessions are long, subjective, and expensive, because of which they cannot be held regularly. This article attempts to improve traditional SBT for neonatal thoracentesis through an autonomous simulator that can provide real-time objective feedback during surgical training and assessment.

Methods

The simulator incorporates a custom manikin and virtual reality software interfaced through electromagnetic sensors that track the motion of surgical instruments. The software application reads and stores instrument motion information to replicate physical actions in the virtual environment, play back previously stored surgical performances and analyze data through a pretrained neural network. The simulator encapsulates the experience of SBT by allowing trainees to watch and replicate an ideal method of conducting the procedure, providing simplified, real-time autonomous guidance during practice and an objective taskwise assessment of the performance during testing.

Results

The preliminary trial held at the University of Illinois Hospital in the presence of 1 neonatologist and 4 fellows revealed that all the participants used the autonomous guidance more than once, and all found simulation experience to be accurate and overall effective in learning thoracentesis.

Conclusion

Although the sample size is small, the simulator shows potential in being a viable alternative approach for training and assessment for thoracentesis.
Disparity-Sensitive Measures in Surgical Care: A Delphi Panel Consensus
Authors: de Jager Elzerie , Osman Samia Y , Levine Adele A , Liu Charles , Maggard Gibbons Melinda A , Ko Clifford Y , Burstin Helen R , Haider Adil H , Hoyt David B , Schoenfeld Andrew J , Britt LD , Weissman Joel S
Published: September 2022

BACKGROUND:

In the US, disparities in surgical care impede the delivery of uniformly high-quality care to all patients. There is a lack of disparity-sensitive measures related to surgical care. The American College of Surgeons Metrics for Equitable Access and Care in Surgery group, through research and expert consensus, aimed to identify disparity-sensitive measures in surgical care.

STUDY DESIGN:

An environmental scan, systematic literature review, and subspecialty society surveys were conducted to identify potential disparity-sensitive surgical measures. A modified Delphi process was conducted where panelists rated measures on both importance and validity. In addition, a novel literature-based disparity-sensitive scoring process was used.

RESULTS:

We identified 841 potential disparity-sensitive surgical measures. From these, our Delphi and literature-based approaches yielded a consensus list of 125 candidate disparity-sensitive measures. These measures were rated as both valid and important and were supported by the existing literature.

CONCLUSION:

There are profound disparities in surgical care within the US healthcare system. A multidisciplinary Delphi panel identified 125 potential disparity-sensitive surgical measures that could be used to track health disparities, evaluate the impact of focused interventions, and reduce healthcare inequity.
The stressosome is required to transduce low pH signals leading to increased transcription of the amino acid-based acid tolerance mechanisms in Listeria monocytogenes
Authors: Guerreiro Duarte N. , Boyd Aoife , O'Byrne Conor P.
Published: September 2022

Increasing proton concentration in the environment represents a potentially lethal stress for single-celled microorganisms. To survive in an acidifying environment, the foodborne pathogen

Listeria monocytogenes

quickly activates the alternative sigma factor B (σB), resulting in upregulation of the general stress response (GSR) regulon. Activation of σB is regulated by the stressosome, a multi-protein sensory complex involved in stress detection and signal transduction. In this study, we used

L. monocytogenes

strains harbouring two stressosome mutants to investigate the role of this complex in triggering expression of known amino acid-based resistance mechanisms in response to low pH. We found that expression of glutamate decarboxylase (gadD3) and arginine and agmatine deiminases (arcA and aguA1, respectively) were upregulated upon acid shock (pH 5 for 15 min) in a stressosome-dependent manner. In contrast, transcription of the arg operons (argGH and argCJBDF), which encode enzymes for the l-arginine biosynthesis pathway, were upregulated upon acid shock in a stressosome-independent manner. Finally, we found that transcription of argR, which encodes a transcriptional regulator of the arc and arg operons, was largely unaffected by acidic shock. Thus, our findings suggest that the stressosome plays a role in activating amino acid-based pH homeostatic mechanisms in

L. monocytogenes

. Additionally, we show that genes encoding the l-arginine biosynthesis pathway are highly upregulated under acidic conditions, suggesting that intracellular arginine can help withstand environmental acidification in this pathogen.
Evaluation of long-term sequelae by cardiopulmonary exercise testing 12 months after hospitalization for critical COVID-19
Authors: Noureddine Sofia , Roux-Claudé Pauline , Laurent Lucie , Ritter Ophélie , Dolla Pauline , Karaer Sinan , Claudé Frédéric , Eberst Guillaume , Westeel Virginie , Barnig Cindy
Published: September 2022

Background

Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequalae.

Methods

In this prospective single-center study, we performed CPET in 60 patients, 12 months after a critical COVID-19 infection that required intensive care unit (ICU) treatment. Lung function at rest and chest computed tomography (CT) scan were also performed.

Results

Twelve months after severe COVID-19 pneumonia, the majority of the patients had a peak O2 uptake (V’O2) considered within normal limits. However, length of ICU stay remained an independent predictor of V’O2. Surprisingly, more than half of the patients with a normal peak predicted V’O2 showed ventilatory inefficiency during exercise (high VE/VCO2 ratio and high VE/VCO2 slope) with increased physiological dead space (VD/Vt) and low end-tidal CO2 partial pressure (PETCO2) values. This impairment was even more pronounced in patients with persistent dyspnea. Notably, peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay.

Conclusions

Even if reduced exercise capacity was rare 12 months after critical COVID-19, more than half of the patients with normal exercise capacity showed ventilatory inefficiency.
Multiomic Approach Characterises the Neuroprotective Role of Retromer in Regulating Lysosomal Health
Authors: Daly James L. , Danson Chris M. , Lewis Philip A. , Riccardo Sara , Di Filippo Lucio , Cacchiarelli Davide , Cross Stephen J. , Heesom Kate J. , Ballabio Andrea , Edgar James R. , Cullen Peter J.
Published: September 2022

Retromer controls cellular homeostasis through regulating integral membrane protein sorting and transport and by controlling late-stage maturation of the endo-lysosomal network. Retromer dysfunction, which is linked to neurodegenerative disorders including Parkinson’s and Alzheimer’s diseases, manifests in complex cellular phenotypes, though the precise nature of this dysfunction, and its relation to neurodegeneration, remain unclear. Here, we perform the first integrated multiomics approach to provide precise insight into the impact of Retromer dysfunction on endo-lysosomal health and homeostasis within a human neuroglioma cell model. We quantify profound changes to the lysosomal proteome, indicative of broad lysosomal dysfunction and inefficient autophagic lysosome reformation, coupled with a reconfigured cell surface proteome and secretome reflective of increased lysosomal exocytosis. Through this global proteomic approach and parallel transcriptomic analysis, we provide an unprecedented integrated view of Retromer function in regulating lysosomal homeostasis and emphasise its role in neuroprotection.
Regenerative hallmarks of aging: Insights through the lens ofPleurodeles waltl
Authors: Tsissios Georgios , Theodoroudis-Rapp Gabriella , Chen Weihao , Sallese Anthony , Smucker Byran , Ernst Lake , Chen Junfan , Xu Yiqi , Ratvasky Sophia , Wang Hui , Del Rio-Tsonis Katia
Published: September 2022

Background

Aging and regeneration are heavily linked processes. While it is generally accepted that regenerative capacity declines with age, some vertebrates, such as newts, can bypass the deleterious effects of aging and successfully regenerate a lens throughout their lifetime.

Results

Here, we used Optical Coherence Tomography (OCT) to monitor the lens regeneration process of larvae, juvenile, and adult newts. While all three life stages were able to regenerate a lens through transdifferentiation of the dorsal iris pigment epithelial cells (iPECs), an age-related decline in the kinetics of the regeneration process was observed. Consistent with these findings, iPECs from older animals exhibited a delay in cell cycle re-entry. Furthermore, it was observed that clearance of the extracellular matrix (ECM) was delayed in older organisms.

Conclusions

Collectively, our results suggest that although lens regeneration capacity does not decline throughout the lifespan of newts, the intrinsic and extrinsic cellular changes caused by aging alter the kinetics of this process. By understanding how aging affects lens regeneration in newts, we can gain important insights for restoring the age-related regeneration decline observed in most vertebrates.