bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-Utility Analysis of Bilateral Cochlear Implants for Children With Severe-to-Profound Sensorineural Hearing Loss in Taiwan
Authors: Lin Ting-Hsuen , Lin Pei-Hsuan , Fang Te-Yung , Wu Chen-Chi , Wang Pa-Chun , Ko Yu
Published: July 2024

Objectives:

Cochlear implants are an option for children with sensorineural hearing loss who do not benefit from hearing aids. Although bilateral cochlear implantation (CI) has been shown to enhance hearing performance and quality of life, its cost-effectiveness remains unclear. This study aimed to evaluate the cost-effectiveness of bilateral CI compared with bimodal hearing for children with sensorineural hearing loss in Taiwan from both the perspectives of patients and Taiwan’s National Health Insurance Administration (TNHIA).

Design:

A four-state Markov model was utilized in the study, including “use the first internal device,” “use the second internal device,” “use the third internal device,” and “death.” Health utility values were obtained from a local survey of health professionals and then adjusted by a scale to reflect both the negative impact of aging on hearing and the time needed to develop the full benefit of treatment in the earliest years of life. The cost data were derived from a caregiver survey, hospital databases, clinical experts, and the TNHIA. The incremental cost-effectiveness ratio (ICER) was calculated over the lifetime horizon and presented as cost per quality-adjusted life year (QALY) to evaluate the cost-effectiveness of simultaneous bilateral CI, sequential bilateral CI, and bimodal hearing. In addition, one-way sensitivity analyses and probabilistic sensitivity analyses were conducted to investigate the impact of uncertainty and the robustness of the model.

Results:

The base-case analysis showed that children with bilateral CI gained more QALYs while incurring more costs when compared with those with bimodal hearing. From the TNHIA perspective, compared with bimodal hearing, the ICER of simultaneous bilateral CI was New Taiwan Dollars 232,662 per QALY whereas from the patient perspective, the ICER was New Taiwan Dollars 1,006,965 per QALY. Moreover, simultaneous bilateral CI dominated sequential bilateral CI from both perspectives. Compared with bimodal hearing, the ICER of sequential bilateral CI did not exceed twice the gross domestic product per capita in Taiwan from either perspective. One-way sensitivity analysis demonstrated that the utility gain of bilateral CI compared with bimodal hearing was the most impactful parameter from both perspectives. Probabilistic sensitivity analysis confirmed the robustness of the base-case analysis results.

Conclusions:

Our findings reveal that bilateral CI was cost-effective when using the threshold of one to three times the 2022 gross domestic product per capita in Taiwan from both the TNHIA and patient perspectives. Future research incorporating cost and effectiveness data from other dimensions is needed to help decision-makers assess the cost-effectiveness of bilateral CI more comprehensively.
Evaluating Changes in Adult Cochlear Implant Users’ Brain and Behavior Following Auditory Training
Authors: Jeon Eun Kyung , Driscoll Virginia , Mussoi Bruna S. , Scheperle Rachel , Guthe Emily , Gfeller Kate , Abbas Paul J. , Brown Carolyn J.
Published: July 2024

Objectives:

To describe the effects of two types of auditory training on both behavioral and physiological measures of auditory function in cochlear implant (CI) users, and to examine whether a relationship exists between the behavioral and objective outcome measures.

Design:

This study involved two experiments, both of which used a within-subject design. Outcome measures included behavioral and cortical electrophysiological measures of auditory processing. In Experiment I, 8 CI users participated in a music-based auditory training. The training program included both short training sessions completed in the laboratory as well as a set of 12 training sessions that participants completed at home over the course of a month. As part of the training program, study participants listened to a range of different musical stimuli and were asked to discriminate stimuli that differed in pitch or timbre and to identify melodic changes. Performance was assessed before training and at three intervals during and after training was completed. In Experiment II, 20 CI users participated in a more focused auditory training task: the detection of spectral ripple modulation depth. Training consisted of a single 40-minute session that took place in the laboratory under the supervision of the investigators. Behavioral and physiologic measures of spectral ripple modulation depth detection were obtained immediately pre- and post-training. Data from both experiments were analyzed using mixed linear regressions, paired t tests, correlations, and descriptive statistics.

Results:

In Experiment I, there was a significant improvement in behavioral measures of pitch discrimination after the study participants completed the laboratory and home-based training sessions. There was no significant effect of training on electrophysiologic measures of the auditory N1-P2 onset response and acoustic change complex (ACC). There were no significant relationships between electrophysiologic measures and behavioral outcomes after the month-long training. In Experiment II, there was no significant effect of training on the ACC, although there was a small but significant improvement in behavioral spectral ripple modulation depth thresholds after the short-term training.

Conclusions:

This study demonstrates that auditory training improves spectral cue perception in CI users, with significant perceptual gains observed despite cortical electrophysiological responses like the ACC not reliably predicting training benefits across short- and long-term interventions. Future research should further explore individual factors that may lead to greater benefit from auditory training, in addition to optimization of training protocols and outcome measures, as well as demonstrate the generalizability of these findings.
Autoantibodies as putative biomarkers and triggers of cell dysfunctions in systemic sclerosis
Authors: Rosa Irene , Romano Eloisa , Fioretto Bianca Saveria , Manetti Mirko
Published: July 2024

Purpose of review

Antinuclear autoantibodies represent a serological hallmark of systemic sclerosis (SSc), with anticentromere, antitopoisomerase-I, and anti-RNA polymerase III antibodies routinely assessed for diagnosis, clinical subset classification, and prognosis. In addition, an increasing number of autoantibodies have been demonstrated to play a pathogenic role by mediating different SSc manifestations. This review aims to give an overview on autoantibodies as putative biomarkers in SSc and discuss their possible pathogenic role as triggers of cell dysfunctions.

Recent findings

Over the years, different autoantibodies have been proposed as biomarkers aiding in diagnosis, disease subtype classification, disease progression prediction, organ involvement, as well as in understanding treatment response. Increasing literature also indicates functional autoantibodies as direct contributors to SSc pathogenesis by exerting agonistic or antagonistic activities on their specific cognate targets.

In SSc, search and validation of novel autoantibodies with higher diagnostic specificity and more accurate predictive values are increasingly needed for early diagnosis and specific follow-up, and to define the best therapeutic option according to different disease subsets. Moreover, since autoantibodies are also emerging as functional pathogenic players, a better unraveling of their possible pathomechanisms becomes essential to identify new targets and develop promising therapeutic agents able to neutralize their effects.
Limited Sampling Strategies Fail to Accurately Predict Mycophenolic Acid Area Under the Curve in Kidney Transplant Recipients and the Impact of Enterohepatic Recirculation
Authors: Mohamed Moataz E. , Saqr Abdelrahman , Al-Kofahi Mahmoud , Onyeaghala Guillaume , Remmel Rory P. , Staley Christopher , Dorr Casey R. , Teigen Levi , Guan Weihua , Madden Henry , Munoz Julia , Vo Duy , Sanchez Bryan , El-Rifai Rasha , Oetting William S. , Matas Arthur J. , Israni Ajay K. , Jacobson Pamala A.
Published: July 2024

Background:

Therapeutic drug monitoring for mycophenolic acid (MPA) is challenging due to difficulties in measuring the area under the curve (AUC). Limited sampling strategies (LSSs) have been developed for MPA therapeutic drug monitoring but come with risk of unacceptable performance. The authors hypothesized that the poor predictive performance of LSSs were due to the variability in MPA enterohepatic recirculation (EHR). This study is the first to evaluate LSSs models performance in the context of EHR.

Methods:

Adult kidney transplant recipients (n = 84) receiving oral mycophenolate mofetil underwent intensive MPA pharmacokinetic sampling. MPA AUC0–12hr and EHR were determined. Published MPA LSSs in kidney transplant recipients receiving tacrolimus were evaluated for their predictive performance in estimating AUC0–12hr in our full cohort and separately in individuals with high and low EHR.

Results:

None of the evaluated LSS models (n = 12) showed good precision or accuracy in predicting MPA AUC0–12hr in the full cohort. In the high EHR group, models with late timepoints had better accuracy but low precision, except for 1 model with late timepoints at 6 and 10 hours postdose, which had marginally acceptable precision. For all models, the good guess of predicted AUC0–12hr (±15% of observed AUC0–12hr) was highly variable (range, full cohort = 19%–61.9%; high EHR = 4.5%–65.9%; low EHR = 27.5%–62.5%).

Conclusions:

The predictive performance of the LSS models varied according to EHR status. Timepoints ≥5 hours postdose in LSS models are essential to capture EHR. Models and strategies that incorporate EHR during development are required to accurately ascertain MPA exposure.
Analysis of 4725 Cases of Gluteal Augmentation with Intramuscular Fillers: A Clinical Cohort Study
Authors: Alves Danuza D. , Chacur Roberto , Menezes Honório S. , Mafaldo Rodrigo C. , Chacur Nivea Maria B.S. , Gomes Leandro D. , Vargas Vicenzo S. , Barros Manoela F. , Matzembacher Gina , Castro Gabriella Andressa M.
Published: July 2024

Background:

In recent years, the aesthetic market has become more prominent for being not only a tool to correct unwanted features but also a social means for improving quality of life. The use of 30% polymethylmethacrylate (PMMA) as a gluteal filler has grown in popularity all over the world, being sought after by men and women for body remodeling because it provides a natural look as well as significant long-lasting results.

Methods:

A retrospective, multicenter study analyzed the medical records of 2801 patients who underwent a total of 4725 gluteal filler procedures between January 2009 and December 2021 at the different locations of Clínica Leger. The study protocol was approved by the Brazilian National Research Ethics Commission.

Results:

The medical records of 2801 patients (2666 women and 135 men) who underwent 4725 gluteal filler injections were retrospectively analyzed. A total of 922,776 mL of PMMA was used (average = 329 mL/patient). The occurrence of 101 adverse events (2.1%) was observed, and no statistically significant relationship between the mean injected volume and the incidence of complications could be found.

Conclusions:

According to the data presented in this study, the use of PMMA injections with the appropriate volumes for aesthetic treatments and corrections is safe and effective.
Bypassing Striatal Learning Mechanisms Using Delayed Feedback to Circumvent Learning Deficits in Traumatic Brain Injury
Authors: Dobryakova Ekaterina , Tong Tien T. , Iosipchuk Olesya , Lequerica Anthony , Schneider Veronica , Chiaravalloti Nancy , Sandry Joshua
Published: July 2024

Objective: Feedback facilitates learning by guiding and modifying behaviors through an action-outcome contingency. As the majority of existing studies have focused on the immediate presentation of feedback, the impact of delayed feedback on learning is understudied. Prior work demonstrated that learning from immediate and delayed feedback employed distinct brain regions in healthy individuals, and compared to healthy individuals, individuals with traumatic brain injury (TBI) are impaired in learning from immediate feedback. The goal of the current investigation was to assess the effects of delayed vs immediate feedback on learning in individuals with TBI and examine brain networks associated with delayed and immediate feedback processing. Setting: Nonprofit research organization. Participants: Twenty-eight individuals with moderate-to-severe TBI. Design: Participants completed a paired-associate word learning task while undergoing magnetic resonance imaging. During the task, feedback was presented either immediately, after a delay, or not at all (control condition). Main Measures: Learning performance accuracy, confidence ratings, post-task questionnaire, and blood oxygen level–dependent signal. Results: Behavioral data showed that delayed feedback resulted in better learning performance than immediate feedback and no feedback. In addition, participants reported higher confidence in their performance during delayed feedback trials. During delayed vs immediate feedback processing, greater activation was observed in the superior parietal and angular gyrus. Activation in these areas has been previously associated with successful retrieval and greater memory confidence. Conclusion: The observed results might be explained by delayed feedback processing circumventing the striatal dopaminergic regions responsible for learning from immediate feedback that are impaired in TBI. In addition, delayed feedback evokes less of an affective reaction than immediate feedback, which likely benefited memory performance. Indeed, compared to delayed feedback, positive or negative immediate feedback was more likely to be rated as rewarding or punishing, respectively. The findings have significant implications for TBI rehabilitation and suggest that delaying feedback during rehabilitation might recruit brain regions that lead to better functional outcomes.
Reimagining Faculty Development: A 5-Year Journey of Outcomes and Lessons Learned of a Physician Assistant Faculty Fellowship
Authors: Gordes Karen L. , Cawley James F. , Kulo Violet , Fleming Shani , Kayingo Gerald
Published: July 2024

Introduction

Faculty sufficiency remains one of the major bottlenecks in health workforce development. There is a need for effective models for practicing clinicians to successfully transition to academic teaching roles. This article describes outcomes and lessons learned at the 5-year mark for a statewide faculty development workforce initiative for the physician assistant (PA) profession at the PA Leadership and Learning Academy (PALLA) in Maryland.

Methods

The PALLA PA faculty fellowship is a state-funded workforce initiative that consists of a 10-month training program that includes synchronous workshops, asynchronous learning modules, experiential teaching opportunities, and completion of an individual project in the realm of scholarship/service under longitudinal mentorship. Programmatic outcomes were longitudinally tracked using the Kirkpatrick model of training evaluation to evaluate the faculty training program at 4 levels of criteria: reaction (level 1), learning (level 2), behavior (level 3), and results (level 4). Key performance indicators for the fellowship include the ability for fellow graduates to provide educational support to Maryland PA programs, engage in, and promote scholarship in the PA profession and build an academic portfolio.

Results

To date, 4 cohorts of PAs (23 individuals) have completed the fellowship. Learner reaction (level 1) evaluated through surveys, and interviews reveal a positive fellowship experience, with fellows noting benefits of the longitudinal nature of the experience and individualized mentorship and fellows self-report high level of achievement of fellowship learning goals (level 2). Local and national PA review of fellow curricular and scholarly products has been positive (level 3). After graduation, 9 fellows are engaged in faculty roles, providing academic support to local PA programs; 11 fellows have had scholarly products accepted; all fellow graduates have generated an academic portfolio; and 2 fellows have provided new service to PA organizations (level 4).

Discussion

Four years of fellowship data demonstrate positive impact across Kirkpatrick 4 levels of training evaluation. Nearly, all participants have new contributions in teaching, scholarship, or service roles because of the fellowship. Key lessons learned were the benefits of the longitudinal nature of the experience for scaffolding of learning and ongoing, individualized mentorship.
Mock Board Exam Writing Groups in Physician Assistant Education: A Method to Enhance Curriculum and Mentor Junior Faculty
Authors: Loyd India , Moon Mary B. , Braun Tim , Boyett Jennifer , Foster Kenneth , Duniphin Darlla , Douglas Chad , Miller Frederick C.
Published: July 2024

Ensuring students are prepared for the Physician Assistant National Certification Exam (PANCE) is an institutional priority for all physician assistant programs. While many factors predicting PANCE performance have been investigated, exploration and discussions of interventions to improve PANCE performance are limited. Repeated exposure to board-style questions has been shown to improve board scores in similar populations. Currently, existing question banks cannot be used to generate secure summative examinations, and commercial question banks may perpetuate inequitable access among physician assistant (PA) students. To address this issue, the University of Oklahoma Physician Assistant program used a community of practice model to create a mock board exam writing group. The group was created to facilitate the development of 9 PANCE-style exams to bolster students' clinical preparedness and PANCE performance. These writing groups also provided a platform for junior faculty to receive feedback and guidance from senior colleagues, thus facilitating and promoting mentorship. This article highlights the potential benefits of mock board exam writing groups in PA education and provides insight into their development and implementation.
Comparison of Pain With Ultrasound-Guided Intra-Articular Hip Injections With and Without Prior Subcutaneous Local Anesthesia
Authors: Lazaro Rondy Michael , Smith Joshua M. , Bender Nicholas , Punreddy Ankit , Barford Nathan , Paul Jennifer H.
Published: July 2024

Objective:

To compare pain levels of intra-articular hip steroid injections performed with and without prior subcutaneous local anesthesia (LA) injection.

Design:

Randomized prospective study.

Setting:

University-based musculoskeletal clinic.

Participants:

Forty-one adult patients undergoing a first-time ultrasound-guided unilateral intra-articular hip steroid injection.

Interventions:

Subjects were randomized into 1 of 2 groups: intra-articular hip injection with prior subcutaneous LA with 2 mL of lidocaine 1% (With LA) or hip injection without prior subcutaneous LA (Without LA). Visual analog scale (VAS) pain scores (0–100) were collected before and after each injection.

Main Outcome Measures:

Visual analog scale pain score for the intra-articular hip injection.

Results:

Of the 41 total subjects, 18 were randomized to the Without LA group and 23 to the With LA group. There was no significant difference in baseline (preprocedure) VAS scores between the Without LA (mean ± SD = 39.2 ± 27.2) and With LA (41.2 ± 24.0) groups (P = 0.864). The mean ± SD VAS score for the subcutaneous LA injection in the With LA group was 20.4 ± 16.1. There was no significant difference in VAS scores for the intra-articular hip injection between the Without LA (48.5 ± 27.7) and With LA (39.5 ± 25.7) groups (P = 0.232).

Conclusions:

Subcutaneous injection of lidocaine before an intra-articular hip injection did not significantly decrease pain from the intra-articular hip injection. Providers may perform intra-articular hip injections with a 22-gauge 3.5-inch spinal needle without the need for an extra subcutaneous LA injection.
Impact of Gender and Marital Status on Door-to-Treatment (DTT) Time and Acute Stroke Outcome
Authors: Karim Nurose , Tumin Dmitry , Karim Sehrish
Published: July 2024

Objectives:

Delays in acute stroke treatment lead to poor outcomes. Women can present with atypical stroke symptoms, are older at the time of stroke, and tend to be living alone, causing delays in pre-hospital diagnosis and seeking care. It is unclear if gender disparities in ED arrival and stroke assessment are compounded by gender differences after ED arrival. Therefore, we sought to identify if gender and marital status were associated with faster door-to-treatment (DTT) time.

Methods:

Our single-center stroke database was queried for adults presenting to ED with acute stroke between January 1, 2018 and January 30, 2023 treated with IV thrombolytics (IVT)+/− endovascular thrombectomy (EVT) and a known DTT time. The primary outcome was DTT (door-to-needle+door-to-puncture) time. Data collected includes the National Institutes of Health Stroke Scale (NIHSS) at presentation and discharge, gender, marital status, age, and intervention (IVT alone or IVT+/− EVT).

Results:

Among 674 patients identified, 35 patients were excluded due to missing data. Of 639 patients (median age 66 y), 25%/18% of patients were married men/women, respectively, and 22%/35% were single men/women. Median DTN time, DTP time, and discharge NIHSS score were 36, 79, and 4 mins, respectively. On multivariable analysis, neither DTT time nor NIHSS score at discharge improved among married men relative to any other combination of gender and marital status.

Conclusions:

Gender differences in the knowledge of stroke warning signs and gender disparities in ED assessment did not translate into faster DTT time. More work is needed to find ways to accelerate stroke care after ED arrival.
Knowledge on Sexually Transmitted Infections and Dedicated Health Care Centers Among Italian Adults: Insights From a Nationwide Cross-Sectional Study
Authors: Lo Moro Giuseppina , Scaioli Giacomo , Paladini Giovanni , Martinelli Alessia , Zanaga Giulia , Bert Fabrizio , Siliquini Roberta
Published: July 2024

Background

Sexually transmitted infections (STI) are a global concern. In Italy, despite the presence of publicly funded STI diagnostic centers, limited attention has been given to the knowledge of these services among the adult population. This study primarily aimed to evaluate Italian adults' knowledge about STI and dedicated health care centers. Secondarily, it explored condom usage behaviors.

Methods

Conducted nationwide, this cross-sectional study used an online questionnaire. The primary outcomes included knowledge of dedicated STI centers and scores on the Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ); secondary outcomes included inconsistent condom usage rates during various forms of intercourse.

Results

With a participant count of 1036, results indicated that only 36% were aware of dedicated STI centers. The median STD-KQ score was 11 (interquartile range, 6–15). Multivariable regression models unveiled factors significantly associated with knowledge. Lesbian, gay, bisexual, transsexual, and queer (LGBTQ) individuals, health care workers, and those with higher STD-KQ scores exhibited greater STI centers' awareness. Better STD-KQ scores correlated with higher education levels, substance use, past STI diagnosis, and health care employment. Around 80% of the sample reported inconsistent condom use during different forms of intercourse. Although enhanced knowledge correlated with increased condom use, certain groups exhibited discrepancies between knowledge of STI and actual condom use.

Conclusions

These findings emphasize the need for targeted awareness campaigns to enhance accessibility to STI centers, underscoring the necessity for multifaceted interventions beyond information dissemination to address suboptimal condom usage. In providing insights into STI knowledge and behaviors among Italian adults, this research informs interventions and policy adjustments to combat STI.
Subcutaneous and Visceral Adipose Tissue Reference Values From the Framingham Heart Study Thoracic and Abdominal CT
Authors: Marquardt J. Peter , Tonnesen P. Erik , Mercaldo Nathaniel D. , Graur Alexander , Allaire Brett , Bouxsein Mary L. , Samelson Elizabeth J. , Kiel Douglas P. , Fintelmann Florian J.
Published: July 2024

Background

Computed tomography (CT) captures the quantity, density, and distribution of subcutaneous and visceral (SAT and VAT) adipose tissue compartments. These metrics may change with age and sex.

Objective

The study aims to provide age-, sex-, and vertebral level–specific reference values for SAT on chest CT and for SAT and VAT on abdomen CT.

Materials and Methods

This secondary analysis of an observational study describes SAT and VAT measurements in participants of the Framingham Heart Study without known cancer diagnosis who underwent at least 1 of 2 CT examinations between 2002 and 2011. We used a previously validated machine learning–assisted pipeline and rigorous quality assurance to segment SAT at the fifth, eighth, and tenth thoracic vertebra (T5, T8, T10) and SAT and VAT at the third lumbar vertebra (L3). For each metric, we measured cross-sectional area (cm2) and mean attenuation (Hounsfield units [HU]) and calculated index (area/height2) (cm2/m2) and gauge (attenuation × index) (HU × cm2/m2). We summarized body composition metrics by age and sex and modeled sex-, age-, and vertebral level–specific reference curves.

Results

We included 14,898 single-level measurements from up to 4 vertebral levels of 3797 scans of 3730 Framingham Heart Study participants (1889 [51%] male with a mean [standard deviation] age of 55.6 ± 10.6 years; range, 38–81 years). The mean VAT index increased with age from 65 (cm2/m2) in males and 29 (cm2/m2) in females in the <45-year-old age group to 99 (cm2/m2) in males and 60 (cm2/m2) in females in >75-year-old age group. The increase of SAT with age was less pronounced, resulting in the VAT/SAT ratio increasing with age. A free R package and online interactive visual web interface allow access to reference values.

Conclusions

This study establishes age-, sex-, and vertebral level–specific reference values for CT-assessed SAT at vertebral levels T5, T8, T10, and L3 and VAT at vertebral level L3.
Diagnosis of Extraosseous Lesions Overlapping the Bones on Bone Scintigraphy
Authors: Bi Bing , Zhu Jing , Li Na , Hu Hangzhi , Shao Fuqiang
Published: July 2024

Extraosseous MDP uptake was not uncommon on the bone scintigraphy. When the extraosseous activity is overlapping the bones, it might cause difficulty in interpreting the result when only static images were acquired. Here we report 2 cases that abnormal MDP activity overlapping the bones on planar images, which were confirmed as soft tissue lesions by SPECT/CT or CT imaging.
Surgeon Gender and Early Complications in Elective Surgery
Authors: Caturegli Ilaria , Pachano Bravo Ana Maria , Abdellah Israa , Fatima Moomtahina , Bafford Andrea Chao , Widyaningsih Suci Ardini , Kaabia Ons
Published: July 2024

Objective:

To examine the association between surgeon gender and early postoperative complications, including 30-day death and readmission, in elective surgery.

Background:

Variations between male and female surgeon practice patterns may be a source of bias and gender inequality in the surgical field, perhaps impacting the quality of care. However, there are limited and conflicting studies regarding the association between surgeon gender and postoperative outcomes.

Methods:

MEDLINE and Embase were searched in October 2023 for observational studies, including patients who underwent elective surgery requiring general or regional anesthesia across multiple surgical specialties. Multiple independent blinded reviewers oversaw the data selection, extraction, and quality assessment according to the PRISMA, MOOSE, and Newcastle Ottawa Scale guidelines. Data were pooled as odds ratios, using a generic inverse-variance random-effects model.

Results:

Of 944 abstracts screened, 11 studies were included in this systematic review and meta-analysis. A total of 4,440,740 postoperative patients were assessed for a composite primary outcome of mortality, readmission, and other complications within 30 days of elective surgery, with a total of 325,712 (7.3%) surgeries performed by 7072 (10.9%) female surgeons. There was no association between surgeon gender and the composite of mortality, readmission, and/or complications (odds ratio=0.97, 95% CI 0.95–1.00; I
2=64.9%; P=0.001).

Conclusions:

These results support that surgeon gender is not associated with early postoperative outcomes, including mortality, readmission, or other complications in elective surgery. These findings encourage patients, health care providers, and stakeholders not to consider surgeon gender as a risk factor for postoperative complications.
Screening and early detection of post-extubation oropharyngeal dysphagia: a best practice implementation project
Authors: Garcia Paulo Carlos , Sichieri Karina , Martins de Matos Tatiane , Malissani Martins Daniel , Peres Emília Cristina , Vaz Bonini Milena , Cardoso Franco Ortiz Diley , Alves de Araújo Püschel Vilanice , Cruz Diná de Almeida Lopes Monteiro da
Published: July 2024

Introduction:

Patients undergoing intubation and mechanical ventilation in an intensive care unit risk developing post-extubation oropharyngeal dysphagia (PED). PED can lead to aspiration complications, aspiration pneumonia, and prolonged hospitalization, as well as increased repeat intubation and in-hospital morbidity and mortality.

Objective:

This evidence implementation project aimed to promote evidence-based screening and early detection of PED in an adult intensive care unit in a secondary public hospital in Brazil.

Method:

The project followed the seven-phase JBI Evidence Implementation Framework to promote changes at the study site. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) approach were also used. The project was developed considering the main barriers to best practices, which were identified through a baseline audit. An educational program was designed to address the identified barriers. Two follow-up audits were then conducted to assess the changes in compliance with the evidence-based practices.

Results:

The baseline audit showed deficits in current practices. The first follow-up audit indicated improved compliance with best practices, with five of the seven audit criteria showing 100% compliance. The second follow-up audit indicated that compliance remained at 100% for those five criteria and increased for the other two after an additional intervention to address poor results in nursing care documentation.

Conclusion:

The first follow-up audit showed good adherence to the educational program for the screening and detection of PED by nurses. The second follow-up audit, in line with the new strategies, showed improvement in nursing documentation.

Spanish abstract:

http://links.lww.com/IJEBH/A241
Symptom propagation in respiratory pathogens of public health concern: a review of the evidence
Authors: Asplin Phoebe , Mancy Rebecca , Finnie Thomas , Cumming Fergus , Keeling Matt J. , Hill Edward M.
Published: July 2024

Symptom propagation occurs when the symptom set an individual experiences is correlated with the symptom set of the individual who infected them. Symptom propagation may dramatically affect epidemiological outcomes, potentially causing clusters of severe disease. Conversely, it could result in chains of mild infection, generating widespread immunity with minimal cost to public health. Despite accumulating evidence that symptom propagation occurs for many respiratory pathogens, the underlying mechanisms are not well understood. Here, we conducted a scoping literature review for 14 respiratory pathogens to ascertain the extent of evidence for symptom propagation by two mechanisms: dose–severity relationships and route–severity relationships. We identify considerable heterogeneity between pathogens in the relative importance of the two mechanisms, highlighting the importance of pathogen-specific investigations. For almost all pathogens, including influenza and SARS-CoV-2, we found support for at least one of the two mechanisms. For some pathogens, including influenza, we found convincing evidence that both mechanisms contribute to symptom propagation. Furthermore, infectious disease models traditionally do not include symptom propagation. We summarize the present state of modelling advancements to address the methodological gap. We then investigate a simplified disease outbreak scenario, finding that under strong symptom propagation, isolating mildly infected individuals can have negative epidemiological implications.
Modelling Lassa virus dynamics in West African
Mastomys natalensis
and the impact of human activities
Authors: John Reju Sam , Fatoyinbo Hammed Olawale , Hayman David T. S.
Published: July 2024

Lassa fever is a West African rodent-borne viral haemorrhagic fever that kills thousands of people a year, with 100 000 to 300 000 people a year probably infected by Lassa virus (LASV). The main reservoir of LASV is the Natal multimammate mouse,
Mastomys natalensis
. There is reported asynchrony between peak infection in the rodent population and peak Lassa fever risk among people, probably owing to differing seasonal contact rates. Here, we developed a susceptible-infected-recovered (

S
I
R

)-based model of LASV dynamics in its rodent host,
M. natalensis
, with a persistently infected class and seasonal birthing to test the impact of changes to seasonal birthing in the future owing to climate and land use change. Our simulations suggest shifting rodent birthing timing and synchrony will alter the peak of viral prevalence, changing risk to people, with viral dynamics mainly stable in adults and varying in the young, but with more infected individuals. We calculate the time-average basic reproductive number,

R
~

p

, for this infectious disease system with periodic changes to population sizes owing to birthing using a time-average method and with a sensitivity analysis show four key parameters: carrying capacity, adult mortality, the transmission parameter among adults and additional disease-induced mortality impact the maintenance of LASV in
M. natalensis
most, with carrying capacity and adult mortality potentially changeable owing to human activities and interventions.
Recent progress in dendritic pruning of
Drosophila
C4da sensory neurons
Authors: Rui Menglong
Published: July 2024

The brain can adapt to changes in the environment through alterations in the number and structure of synapses. During embryonic and early postnatal stages, the synapses in the brain undergo rapid expansion and interconnections to form circuits. However, many of these synaptic connections are redundant or incorrect. Neurite pruning is a conserved process that occurs during both vertebrate and invertebrate development. It requires precise spatiotemporal control of local degradation of cellular components, comprising cytoskeletons and membranes, refines neuronal circuits, and ensures the precise connectivity required for proper function. The
Drosophila
’s class IV dendritic arborization (C4da) sensory neuron has a well-characterized architecture and undergoes dendrite-specific sculpting, making it a valuable model for unravelling the intricate regulatory mechanisms underlie dendritic pruning. In this review, I attempt to provide an overview of the present state of research on dendritic pruning in C4da sensory neurons, as well as potential functional mechanisms in neurodevelopmental disorders.
Telerehabilitation services have declined post-COVID-19
Authors: May Anthony K , Holland Anne E , Alison Jennifer A , Herrmann Kelcie , Cox Narelle S
Published: July 2024

Objective

To characterize Pulmonary rehabilitation (PR) service delivery, investigate the impact of the pandemic on PR services, and describe centre-based PR (CBPR) and telerehabilitation with reference to PR essential components.

Design

Online national cross-sectional survey.

Setting

Australian PR services.

Participants

Representatives of PR programs listed within the Lung Foundation Australia national database (n=295).

Interventions

Not applicable.

Main Outcome Measure(s)

Availability of PR in CBPR and telerehabilitation settings.

Results

97% of Australian PR services (n=114/117) delivered CBPR, similarly to pre-COVID-19 pandemic availability (96%). 43% (n=50/116) of services delivered telerehabilitation, which was significantly less than availability during COVID-19 restrictions (74%; p<0.001). CBPR was primarily delivered in a group setting (99%; median (IQR) 7 (6-8) participants/group), and telerehabilitation primarily via individual telephone calls (94%). 39% of respondents report CBPR group size has reduced. PR essential components of initial centre-based assessments and individually prescribed/progressed endurance and resistance training were achieved by most CBPR and telerehabilitation programs. Staff training in delivery of telerehabilitation models was undertaken in 33% of services.

Conclusions

PR essential components are generally met in current Australian programs. However, telerehabilitation services and CBPR program capacity have declined indicating reduced program capacity. Sustainability of effective PR programs is required to support access for people with chronic respiratory diseases.
Convergent expansions of keystone gene families drive metabolic innovation in a major eukaryotic clade
Authors: David Kyle T , Schraiber Joshua G , Crandall Johnathan G. , LaBella Abigail Leavitt , Opulente Dana A , Harrison Marie-Claire , Wolters John F , Zhou Xiaofan , Shen Xing-Xing , Groenewald Marizeth , Hittinger Chris Todd , Pennell Matt , Rokas Antonis
Published: July 2024

Many remarkable innovations have repeatedly occurred across vast evolutionary distances. When convergent traits emerge on the tree of life, they are sometimes driven by the same underlying gene families, while other times many different gene families are involved. Conversely, a gene family may be repeatedly recruited for a single trait or many different traits. To understand the general rules governing convergence at both genomic and phenotypic levels, we systematically tested associations between 56 binary metabolic traits and gene count in 14,710 gene families from 993 species of Saccharomycotina yeasts. Using a recently developed phylogenetic approach that reduces spurious correlations, we discovered that gene family expansion and contraction was significantly linked to trait gain and loss in 45/56 (80%) of traits. While 601/746 (81%) of significant gene families were associated with only one trait, we also identified several 'keystone' gene families that were significantly associated with up to 13/56 (23%) of all traits. These results indicate that metabolic innovations in yeasts are governed by a narrow set of major genetic elements and mechanisms.
Systematic Multi-Omics Investigation of Androgen Receptor Driven Gene Expression and Epigenetics changes in Prostate Cancer
Authors: Li Lin , Cho Kyung Hyun , Yu Xiuping , Cheng Siyuan
Published: July 2024

Background:Prostate cancer, a common malignancy, is driven by androgen receptor (AR) signaling. Understanding the function of AR signaling is critical for prostate cancer research.Methods:We performed multi-omics data analysis for the AR+, androgen-sensitive LNCaP cell line, focusing on gene expression (RNAseq), chromatin accessibility (ATACseq), and transcription factor binding (ChIPseq). High-quality datasets were curated from public repositories and processed using state-of-the-art bioinformatics tools.Results:Our analysis identified 1004 up-regulated and 707 down-regulated genes in response to androgen deprivation therapy (ADT) which diminished AR signaling activity. Gene-set enrichment analysis revealed that AR signaling influences pathways related to neuron differentiation, cell adhesion, P53 signaling, and inflammation. ATACseq and ChIPseq data demonstrated that as a transcription factor, AR primarily binds to distal enhancers, influencing chromatin modifications without affecting proximal promoter regions. In addition, the AR-induced genes maintained higher active chromatin states than AR-inhibited genes, even under ADT conditions. Furthermore, ADT did not directly induce neuroendocrine differentiation in LNCaP cells, suggesting a complex mechanism behind neuroendocrine prostate cancer development. In addition, a publicly available online application LNCaP-ADT (https://pcatools.shinyapps.io/shinyADT/) was launched for users to visualize and browse data generated by this study.Conclusion:This study provides a comprehensive multi-omics dataset, elucidating the role of AR signaling in prostate cancer at the transcriptomic and epigenomic levels. The reprocessed data is publicly available, offering a valuable resource for future prostate cancer research.
Linking stomatal size and density to water use efficiency and leaf carbon isotope ratio in juvenile and mature trees
Authors: Petrík Peter , Petek-Petrík Anja , Lamarque Laurent J. , Link Roman M. , Waite Pierre-André , Ruehr Nadine K. , Schuldt Bernhard , Maire Vincent
Published: July 2024

Water-use efficiency (WUE) is affected by multiple leaf traits, including stomatal morphology. However, the impact of stomatal morphology on WUE across different ontogenetic stages of tree species is not well-documented. Here, we investigated the relationship between stomatal morphology intrinsic water-use efficiency (iWUE=A/gs) and leaf carbon isotope ratio (δ13C). We sampled 190 individuals including juvenile and mature trees belonging to 18 temperate broadleaved tree species and 9 genera. We measured guard cell length (GCL), stomatal density (SD), specific leaf area (SLA), gas-exchange, iWUE and leaf δ13C as a proxy for long-term WUE. Leaf δ13C correlated positively with iWUE for both juvenile and mature trees. Across species, GCL showed a negative and SD a positive effect on iWUE and leaf δ13C of both juvenile and mature trees. Within species, however, only GCL was significantly associated with iWUE and leaf δ13C. Pioneer species (Populus,Prunus,Betula) showed a significantly lower leaf δ13C than climax forest species (Fagus,Quercus,Tilia), but the differentiation was not clear for iWUE. We conclude that GCL and SD can be considered as functional morphological traits impacting the iWUE and leaf δ13C of trees, highlighting their potential for rapid phenotyping approaches in ecological studies.
Aerobic methane production by methylotrophicMethylotenerain groundwater
Authors: Li Shengjie , Dong Xiaoli , Humez Pauline , Borecki Joanna , Birks Jean , McClain Cynthia , Mayer Bernhard , Strous Marc , Diao Muhe
Published: July 2024

Methyloteneraare signature denitrifiers and methylotrophs commonly found together with methanotrophic bacteria in lakes and freshwater sediments. Here we show that three distinctMethyloteneraecotypes were abundant in methane-rich, Pleistocene-aged groundwaters. Just like in surface water biomes, groundwaterMethyloteneraoften co-occurred with methane-oxidizing bacteria, even though they were generally unable to denitrify. One abundantMethyloteneraecotype expressed a pathway for aerobic methane production from methylphosphonate. This phosphate-acquisition strategy was recently found to contribute to methane production in the oligotrophic, oxic upper ocean. Gene organization, phylogeny and 3D protein structure of the key enzyme, C-P lyase subunit PhnJ were consistent with a role in phosphate uptake. We conclude that phosphate may be a limiting nutrient in productive, methane rich aquifers and that methylphosphonate degradation can contribute to groundwater methane production.
Unusual traits shape the architecture of the Ig ancestor molecule
Authors: Urdiciain Alejandro , Madej Thomas , Wang Jiyao , Song James , Erausquin Elena , Youkharibache Philippe , López-Sagaseta Jacinto
Published: July 2024

Understanding the ancestral Ig domain’s molecular structure and tracing the evolution of Ig-like proteins are fundamental components missing from our comprehension of their evolutionary trajectory and function. We have elucidated the molecular structures of two Ig-like proteins from the evolutionary most ancestralphylum, Porifera, revealing previously unidentified Ig-domain features that highlight the concomitant presence of a novel Ig “Early Variable” (EV)-set in tandem with a C1-set domain. The latter, to our knowledge, has never been reported before in non-vertebrates. The IgV and IgC1 sets and their combination into functional Ig-like receptors are part of the adaptive immune system in higher vertebrates, which allows for highly specific immune responses. These observations in the ancientPorifera phylumcould indicate the presence of primitive forms of adaptive immunity or a foundational immune strategy that has been conserved through evolution. By unveiling important clues into the molecular configuration of ancestral Ig domains, these findings challenge and expand our understanding of how immunity has evolved within its current landscape.
Arterial arcades and collaterals regress under hemodynamics-based diameter adaptation: a computational and mathematical analysis
Authors: Rottschäfer Vivi , Kuppers Willem G.N. , Chen Jiao , van Bavel Ed
Published: July 2024

Segments in the arterial network have a >1000-fold span of radii. This is believed to result from adaptation of each segment to the wall shear stress (WSS), with outward respectively inward remodeling if WSS is higher or lower than some reference value. While this seems a straightforward mechanism for arterial tree design, the arterial network is not a tree but contains numerous arcades, collaterals and other looping structures. In this theoretical study, we analyzed stability of looping structures in arterial networks under WSS control.

Simulation models were based on very simple network topologies as well as on published human coronary and mouse cerebral arterial networks. Adaptation was implemented as a rate of change of structural radius of each segment that is proportional to the deviation from its reference WSS. A more generalized model was based on adaptation to a large range of other local hemodynamic stimuli, including velocity, flow and power dissipation.

For over 12,000 tested parameter sets, the simulations invariably predicted loss of loops due to regression of one or more of the segments. In the small networks, this was the case for both the WSS and the generalized model, and for a large range of initial conditions and model parameters. Loss of loopiness also was predicted by models that included direction-dependent adaptation rates, heterogeneous reference WSS or adaptation rates among the adapting segments, and adaptation under dynamic conditions. Loss of loops was also found in the coronary and cerebral artery networks subjected to adaptation to WSS.

In a mathematical analysis we proved that loss of loops is a direct consequence of Kirchhoff’s circuit law, which for each loop leads to a positive eigenvalue in the Jacobian matrix of partial derivatives in the adaptation model, and therefore to unstable equilibria in the presence of loops.

Loss of loops is an inherent property of arterial networks that adapt to local hemodynamics. Additional mechanisms are therefore needed to explain their presence, including direct communication between connected segments.