bluuebunny/crossref_metadata_2025 huggingface dataset:
The Chlamydomonas Genome Project, version 6: Reference assemblies for mating-type plus and minus strains reveal extensive structural mutation in the laboratory
Authors: Craig Rory J , Gallaher Sean D , Shu Shengqiang , Salomé Patrice A , Jenkins Jerry W , Blaby-Haas Crysten E , Purvine Samuel O , O’Donnell Samuel , Barry Kerrie , Grimwood Jane , Strenkert Daniela , Kropat Janette , Daum Chris , Yoshinaga Yuko , Goodstein David M , Vallon Olivier , Schmutz Jeremy , Merchant Sabeeha S
Published: December 2022

Five versions of the Chlamydomonas reinhardtii reference genome have been produced over the last two decades. Here we present version 6, bringing significant advances in assembly quality and structural annotations. PacBio-based chromosome-level assemblies for two laboratory strains, CC-503 and CC-4532, provide resources for the plus and minus mating-type alleles. We corrected major misassemblies in previous versions and validated our assemblies via linkage analyses. Contiguity increased over ten-fold and >80% of filled gaps are within genes. We used Iso-Seq and deep RNA-seq datasets to improve structural annotations, and updated gene symbols and textual annotation of functionally characterized genes via extensive manual curation. We discovered that the cell wall-less classical reference strain CC-503 exhibits genomic instability potentially caused by deletion of the helicase RECQ3, with major structural mutations identified that affect >100 genes. We therefore present the CC-4532 assembly as the primary reference, although this strain also carries unique structural mutations and is experiencing rapid proliferation of a Gypsy retrotransposon. We expect all laboratory strains to harbor gene-disrupting mutations, which should be considered when interpreting and comparing experimental results. Collectively, the resources presented here herald a new era of Chlamydomonas genomics and will provide the foundation for continued research in this important reference organism.
Delphinieae flowers originated from the rewiring of interactions between duplicated and diversified floral organ identity and symmetry genes
Authors: Zhao Huiqi , Liao Hong , Li Shuixian , Zhang Rui , Dai Jing , Ma Pengrui , Wang Tianpeng , Wang Meimei , Yuan Yi , Fu Xuehao , Cheng Jie , Duan Xiaoshan , Xie Yanru , Zhang Peng , Kong Hongzhi , Shan Hongyan
Published: December 2022

Species of the tribe Delphinieae (Ranunculaceae) have long been the focus of morphological, ecological, and evolutionary studies due to their highly specialized, nearly zygomorphic (bilaterally symmetrical) spiral flowers with nested petal and sepal spurs and reduced petals. The mechanisms underlying the development and evolution of Delphinieae flowers, however, remain unclear. Here, by conducting extensive phylogenetic, comparative transcriptomic, expression, and functional studies, we clarified the evolutionary histories, expression patterns, and functions of floral organ identity and symmetry genes in Delphinieae. We found that duplication and/or diversification of APETALA3-3 (AP3-3), AGAMOUS-LIKE6 (AGL6), CYCLOIDEA (CYC), and DIVARICATA (DIV) lineage genes was tightly associated with the origination of Delphinieae flowers. Specifically, an AGL6-lineage member (such as the Delphinium ajacis AGL6-1a) represses sepal spur formation and petal development in the lateral and ventral parts of the flower while determining petal identity redundantly with AGL6-1b. By contrast, two CYC2-like genes, CYC2b and CYC2a, define the dorsal and lateral-ventral identities of the flower, respectively, and form complex regulatory links with AP3-3, AGL6-1a, and DIV1. Therefore, duplication and diversification of floral symmetry genes, as well as co-option of the duplicated copies into the preexisting floral regulatory network, have been key for the origin of Delphinieae flowers.
Collaborative Architecture: Components, Relationships, and Implications for Partner Influence
Authors: Page Stephen B , Stone Melissa M
Published: December 2022

This article provides a detailed exploration of the collaborative architecture concept and its ability to deepen research on interorganizational collaborative arrangements. After introducing four components of collaborative architecture (goals, arenas, membership, and mechanisms), the article uses the components to compare two cases of public education reform collaborations. We investigate methodological challenges in coding and data analysis and evaluate the conceptual strengths and weaknesses of collaborative architecture, including the extent to which it lends specificity to existing frameworks for studying collaboration and collaborative governance. The article demonstrates that the collaborative architecture concept enables researchers to probe and assess important characteristics and relationships among goals, boundaries, structures, and processes of interorganizational collaboration as well as the exercise and embeddedness of partner influence.
Capital Regulations and the Management of Credit Commitments during Crisis Times
Authors: Pelzl Paul , Valderrama María Teresa
Published: December 2022

Borrower drawdowns on credit commitments reduce a bank’s capital buffer. Using Austrian credit register data and exploiting the 2008–09 financial crisis as an exogenous shock to bank health, we provide novel evidence that capital-constrained banks manage this risk by cutting credit commitments that are not fully used. Controlling for their capital position, we find that banks also respond to liquidity problems by cutting such commitments. However, banks manage the capital and liquidity risk posed by undrawn credit in a way that limits negative macroeconomic implications: credit cuts are targeted at financially less constrained firms, and we show that borrowers of more-affected banks can substitute lost credit with credit from other banks and do not suffer real effects. Additional findings suggest that voluntary agreements between constrained banks and strong firms to reduce spare borrowing capacity can explain why strong firms experience larger credit cuts.
CONVERSANT WIRELESS LICENSING SARL v HUAWEI TECHNOLOGIES CO, LTD
Authors:   Court of Appeal
Published: December 2022

H1 Patents—European patents—Telecommunications—Standards essential patents—Construction—Validity—Claim amendments—Added matter—Appeal to Court of Appeal—Whether to permit new arguments on appeal
THALER v COMPTROLLER GENERAL OF PATENTS
Authors:   Court of Appeal
Published: December 2022

H1 Patents — Patent applications — Identification of inventor — Artificial intelligence — Whether the inventor could be a machine — Entitlement to apply — Entitlement to grant — Appeal to Court of Appeal
Mitochondrial transplantation in cardiac surgical patients: optimism, caveats, and outstanding questions
Authors: Cherry Anne D.
Published: December 2022

Purpose of review

Mitochondria satisfy the high metabolic demand of the heart, and also play major roles in reactive oxygen species signaling, calcium buffering, and regulation of cell death. Mitochondrial damage or dysfunction can drive diseases seen in cardiac surgical patients, including heart failure and ischemia/reperfusion injury. Exogenous transplantation of isolated mitochondria has been proposed as one way to augment mitochondrial function and mitigate a number of pathologic processes, with a heavy focus on ischemia/reperfusion injury.

Recent findings

Animal models of cardiac ischemia/reperfusion injury have shown functional benefits after mitochondrial transplantation. Many of the mechanisms underlying this therapy's effect; optimal dosing, delivery, and timing; and how it will translate to cardiac surgical patients are yet unknown.

Mitochondrial transplantation is a potential therapeutic strategy for cardiac ischemia/reperfusion injury. Effective application to selected cardiac surgical patients can be informed by further mechanistic investigations.
Cardiovascular disease, surgery and outcomes in women: are they any different
Authors: Klein Katherine M.
Published: December 2022

Purpose of review

Cardiovascular disease is a leading cause of death for women worldwide and continues to be a major determinant of significant morbidity. Several studies have investigated the marked differences in diagnosis, treatment and etiology in cardiovascular disease and how it relates to gender. In this review, several key studies highlight the stark differences and bring light to the disparity and potential opportunities for further research.

Recent findings

One noted area of gender disparity is ischemic cardiac disease as it relates to surgical management. Women have historically had delays in diagnosis, inferior surgical revascularization techniques, and inadequate postoperative care when compared to men.

By highlighting the disparities in cardiovascular ischemic care, the hope is to bring attention and future research to a population group that is currently undertreated for their ischemic disease and suffering high mortality rates.
Is venoarterial extracorporeal membrane oxygenation an option for managing septic shock
Authors: Helwani Mohammad A. , Lim Aaron
Published: December 2022

Purpose of review

To describe sepsis-induced cardiomyopathy. Discuss indications and current evidence of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) in setting of sepsis-induced cardiomyopathy.

Recent findings

Recent data suggests a survival benefit with the use of VA-ECMO in patients with septic shock complicated by septic-induced cardiomyopathy with severe left ventricular systolic dysfunction. VA-ECMO was associated with poor outcomes in adults with septic shock without severe systolic dysfunction. The evidence is generated from retrospective and meta-analysis of observational studies.

Sepsis-induced cardiomyopathy is an increasingly recognized entity characterized by reversible ventricular dysfunction in the setting of sepsis. When hypotension persists despite standard management of septic shock (e.g. adequate fluid resuscitation, vasopressors, inotropes) and there is evidence of severe cardiac systolic dysfunction and end-organ hypoperfusion, VA-ECMO should be considered as a bridge therapy to recovery. VA-ECMO should not be used for isolated vasodilatory septic shock without significant myocardial dysfunction.
Surgical left atrial appendage occlusion with concomitant cardiac surgical procedures: exacerbating heart failure or preventing stroke
Authors: Mandell Daniel R. , Boisen Michael L.
Published: December 2022

Purpose of review

The left atrial appendage (LAA) is a common source of thromboembolic stroke in patients with atrial fibrillation. Current guidelines recommend consideration of surgical LAA occlusion concomitant with other cardiac surgical procedures based mostly on observational data and a few small trials. Recently published results of several large retrospective studies and one prospective trial are reviewed herein.

Recent findings

Large retrospective studies using quality and administrative databases show mixed results with regard to efficacy of surgical LAA occlusion in preventing stroke, although most showed stroke reduction in patients with a history of atrial fibrillation (AF). Safety concerns have been raised based on nonrandomized data suggesting increased complications. A recent large, multicenter international randomized study with 3-year follow-up demonstrated significant reduction in stroke following LAA occlusion with no differences in death or heart failure exacerbations.

Most patients with AF undergoing another cardiac surgical procedure should be considered for concomitant LAA occlusion as part of a heart team discussion. The choice of surgical closure technique is critical. There is insufficient data to recommend LAA occlusion as an alternative to anticoagulation.
Multimodal prehabilitation program valuation for thoracic surgical patients
Authors: Solow Maxamillian , Perry Tjorvi E.
Published: December 2022

Purpose of review

Modifiable patient-related risk factors, such as physical, emotional, and cognitive frailty, poor nutritional status, sleep hygiene, anemia, alcohol abuse, and smoking reduce a patient's ability to effectively recover from the insult of surgery. Herein, we review the value of implementing a comprehensive prehabilitation program for patients undergoing thoracic surgery.

Recent findings

Although prehabilitation is not a novel concept, recent evidence suggest that 4–6 weeks of prehabilitation prior to surgery is likely to increase a patient's preoperative functional status allowing patients to return to independence earlier after surgery. The value of a prehabilitation program can be determined using cost effectiveness analysis, cost-benefit analysis (CBA), cost-utility analysis (CUA), and cost-consequence analysis (CCA).

It stands to reason that well designed prehabilitation programs can add value by improving quality metrics at a lower cost to our healthcare system. Definitive randomized trials are needed to confirm this notion.
Current concepts in evaluation and management of preoperative anaemia in patients undergoing thoracic surgery
Authors: Lanigan Megan , Wilkey Andrew
Published: December 2022

Purpose of review

The purpose of this review is to evaluate the current recommendations for management of perioperative anaemia in patients undergoing thoracic surgery, present the impact of anaemia on outcomes in this patient population and suggest an algorithm for evaluating and treating anaemia preoperatively.

Recent findings

Anaemia is a common medical issue noted preoperatively in patients presenting for thoracic surgery and carries significant morbidity. Preoperative anaemia increases the likelihood of receiving a perioperative transfusion, which represents a significant risk factor for morbidity and reduced disease-free survival in lung cancer patients presenting for thoracic surgery. It is also associated with longer hospital lengths of stay and increased risk for reoperation following lung transplantation. An algorithm-based approach to management of anaemia is beneficial and treatment with iron has been shown to reduce transfusions.

Patients undergoing thoracic surgery have a high incidence of preoperative anaemia that increases the risk of transfusion and postoperative morbidity. Preoperative evaluation and tailored treatment based on the underlying cause of anaemia reduces the incidence of anaemia prior to surgery and decreases transfusion rates.
Pulmonary prehabilitation and smoking cessation
Authors: Ibekwe Stephanie Opusunju , Mondal Samhati , Faloye Abimbola O.
Published: December 2022

Purpose of review

This review aims to summarize the current literature on pulmonary prehabilitation programs, their effects on postoperative pulmonary complications, and the financial implications of implementing these programs. Additionally, this review has discussed the current trends in pulmonary prehabilitation programs, techniques for improving rates of perioperative smoking cessation, and the optimal timing of these interventions.

Recent findings

Prehabilitation is a series of personalized multimodal interventions tailored to individual needs, including lifestyle and behavioral measures. Pulmonary prehabilitation has shown to reduce postoperative pulmonary complications (PPCs).

The implications of clinical practice and research findings regarding PPCs are an increased burden of postoperative complications and financial cost to both patients and hospital systems. There is convincing evidence that pulmonary prehabilitation based on endurance training should be started 8–12 weeks prior to major surgery; however, similar rates of improved postoperative outcomes are observed with high-intensity interval training (HIIT) for 1–2 weeks. This shorter interval of prehabilitation may be more appropriate for patients awaiting thoracic surgery, especially for cancer resection. Additionally, costs associated with creating and maintaining a prehabilitation program are mitigated by shortened lengths of stay and reduced PPCs. Please see Video Abstract, http://links.lww.com/COAN/A90.
Postoperative nausea and vomiting: risk factors, prediction tools, and algorithms
Authors: Schlesinger Tobias , Meybohm Patrick , Kranke Peter
Published: December 2022

Purpose of review

Postoperative/postdischarge nausea and vomiting (PONV/PDNV) remain relevant issues in perioperative care. Especially in ambulatory surgery, PONV can prevent discharge or lead to unplanned readmission.

Recent findings

The evidence for the management of PONV is now quite good but is still inadequately implemented. A universal, multimodal rather than risk-adapted approach for PONV prophylaxis is now recommended. The evidence on PDNV is insufficient.

PDNV management is based primarily on consequent prophylaxis and therapy of PONV.
Current status of point of care ultrasonography for the perioperative care of trauma patients
Authors: Heinz Eric R. , Keneally Ryan , d’Empaire Pablo Perez , Vincent Anita
Published: December 2022

Purpose of review

The incorporation of point of care ultrasound into the field of anesthesiology and perioperative medicine is growing at rapid pace. The benefits of this modality align with the acuity of patient care and decision-making in anesthetic care of a trauma patient.

Recent findings

Cardiac ultrasound can be used to diagnose cardiac tamponade or investigate the inferior vena cava to assess volume status in patients who may suffer from hemorrhagic shock. Thoracic ultrasound may be used to rapidly identify pneumothorax or hemothorax in a patient suffering chest wall trauma. In addition, investigators are exploring the utility of ultrasonography in traumatic airway management and elevated intracranial pressure. In addition, the utility of gastric ultrasound on trauma patients is briefly discussed.

Incorporation of point of care ultrasound techniques into the practice of trauma anesthesiology is important for noninvasive, mobile and expeditious assessment of trauma patients. In addition, further large-scale studies are needed to investigate how point of care ultrasound impacts outcomes in trauma patients.
Liver Injury in Patients With Distal Esophageal Carcinoma After Precision Radiation Therapy
Authors: Betancourt Cuellar Sonia L. , Benveniste Marcelo F. , Truong Mylene , Nguyen Quynh-Nhu , Atiyah Afaf , Hofstetter Wayne L. , Erasmus Jeremy J.
Published: December 2022

Objective:

To determine the incidence and various patterns of radiation-induced liver injury (RILI) and its temporal evolution on fluorodeoxiglucose-positron emission tomography/computed tomography (FDG-PET/CT) after neoadjuvant chemoradiation using precision radiation in patients with esophageal carcinoma.

Material and Methods:

We evaluated 639 patients with locally advanced esophageal carcinoma who had serial FDG-PET/CTs after neoadjuvant chemoradiation. Two readers reviewed the imaging studies in consensus and recorded the cases where new foci of increased FDG uptake were identified within the radiated liver parenchyma. RILI was confirmed by follow-up imaging or percutaneous biopsy.

Results:

FDG-avid RILI developed in 39/639 (6%) of patients. The caudate and left hepatic lobe were involved in all cases. There were various patterns of increased FDG uptake: 38% of patients had a single focus of increased FDG uptake and 62% had 2 regions of increased FDG uptake, which were focal nodular or diffuse or a combination of focal nodular and diffuse FDG uptake. On CT, 72% of patients had a poorly-marginated region of low attenuation and 28% had a well-defined region of low attenuation with sharp, well-defined linear borders in the location of the radiation, as confirmed by the treatment plan.

Conclusion:

The caudate and left hepatic lobes were involved in all cases of RILI. The various imaging patterns of RILI on FDG-PET/CT include 1 or 2 regions of increased FDG uptake with a nodular, diffuse, or combined appearance. Awareness of this potential complication of radiation therapy and knowledge of the imaging manifestations of RILI is important to avoid misinterpretation as a metastasis.
The Role of the Quality of Relationship in Couples Facing Treatment for Breast Cancer
Authors: Valente Marco , Chirico Ilaria , Girotti Chiara , Ottoboni Giovanni , Chattat Rabih
Published: December 2022

Introduction:

Breast cancer is the leading cause of cancer death in women worldwide. Recently, the focus of research has shifted from psychiatric, psychological, and social consequences on the woman who gets sick from breast cancer to the impact on the couple. Indeed, the psychosocial perspective has developed the construct of the Quality of Relationship (QoR) that affects the quality of life of both members of the dyad.

Objective:

The aim of this study was to extend knowledge in this field by identifying and analyzing what dimensions of QoR may impact couples’ psychosocial adjustment to breast cancer and related treatments.

Patients and Methods:

Semistructured interviews explored couples’ experiences of breast cancer diagnosis and treatment. Transcripts were analyzed using inductive thematic analysis.

Results:

Twelve couples were interviewed. Results showed how the dimensions of psychosocial support, dyadic coping, communication, and intimacy are associated and define the construct of QoR, thus affecting the couples’ adjustment to breast cancer diagnosis and to the disease pathway.

Conclusion:

Assessment procedures of couple functioning since and after diagnosis could increase the appropriateness and benefits of integrating existing clinical practice in oncological settings.
Addressing Suicide Risk in Primary Care: Cost Savings Associated with Diverting Patients From Emergency Departments
Authors: Mancini Kathryn , Myers Brittany R. , Pajek Julie , Ramirez Lisa , Stancin Terry
Published: December 2022

Introduction:

Integrating behavioral health into primary care ambulatory clinics can improve management of patients presenting with suicidality in medical practices. To date, financial outcomes associated with managing suicidality in integrated care have not been documented.

Objective:

This study sought to evaluate both course of treatment (e.g., the patient is discharged home and referred to emergency departments [EDs]) and financial outcomes (e.g., cost to medical center) for patients presenting with suicidality in integrated pediatric primary care.

Methods:

Medical record review was conducted across a 6-month period. Demographics, course of treatment, and financial data were collected. Financial data were extracted using EPSi software using a cost accounting model. We documented the amount in dollars billed to the patient/insurance company and the amount reimbursed to the medical center and then calculated net margins associated with each course of treatment.

Results:

Participants were 103 youth (aged 7–24 years). The results demonstrate that the integrated model of care diverted 93% of participants from the ED and that the highlighted model of care yielded cost savings for the medical center. After reimbursement, patients seen in the ED for suicide evaluations cost the medical center an average of 16 times more than patients who were managed in the primary care setting.

Conclusion:

The results document the magnitude of cost savings associated with an integrated care model for treating high-risk youth.
Improving Developmental Screening and Supporting Families with Paid Parent Partners
Authors: Badawi Debbie G. , Thomas Josie , Archuleta Pattie , Taylor Stacy , Pyle Meredith
Published: December 2022

Objective:

The primary goals of the project were to improve rates of developmental screening and appropriate referral for atypical screens for children from birth to 3 years in participating practices and to integrate parent partners (PPs) into primary care.

Method:

Parents' Place of Maryland, in collaboration with the Maryland Department of Health, developed a quality improvement project to improve rates of developmental screening, referral, and follow-up. Nine practices from across the state completed the project. Participating practices received training and technical assistance for screening, referral, and data collection as well as a paid part-time PP to assist with care coordination. Families of children with atypical developmental screening results were offered a referral to receive support in following through with referrals, including needed social services to address health care barriers.

Results:

Developmental screening rates across practices increased from 65% to 95% during the 9-month project, and autism-specific screening increased from 75% to 94%. Appropriate referral rates tripled from 6% to 20% of children. After an initial learning curve, practices gradually increased referrals to PPs, and they served 292 individual families (total of 544 contacts) over 9 months. PPs helped families identify a variety of community services to meet their needs.

Conclusion:

While developmental screening rates can be improved using quality improvement processes, supporting families to connect to services requires additional resources. Integrating trained PPs into pediatric practices improves access to community-based services in a cost-efficient manner. More research is needed to identify the most efficient models for providing this service on a broader scale.
What Factors Are Associated With Willingness to Use HIV Pre-exposure Prophylaxis (PrEP) Among U.S. Men Who Have Sex With Men Not on PrEP? A Systematic Review and Meta-analysis
Authors: Kamitani Emiko , Wichser Megan E. , Mizuno Yuko , DeLuca Julia B. , Higa Darrel H.
Published: December 2022

Pre-exposure prophylaxis (PrEP), an antiretroviral medication to prevent HIV, is becoming more widely available in the United States since the Federal Drug Administration approved it in 2012. However, PrEP use among men who have sex with men (MSM) is still limited and many MSM who are willing to take PrEP are not on PrEP. We performed a systematic review to identify factors associated with willingness to use PrEP among MSM who are not on PrEP. The majority of the 23 relevant studies had low risk of bias and used a cross-sectional design. Willingness was associated with being Hispanic/Latino (odds ratio [OR] = 1.68, 95% confidence interval [CI] [1.01-2.78]), Black (OR = 1.41, 95% CI [1.02-1.95]), younger (OR = 1.08, 95% CI [1.02-1.15]), having no college degree (OR = 1.37, 95% CI [1.12-1.59]), or low income (OR = 1.21, 95% CI [1.12-1.32]). A higher proportion of MSM who had recent condomless anal sex (OR = 1.85, 95% CI [1.49-2.29]) were diagnosed with sexually transmitted infection (OR = 1.60, 95% CI [1.27-2.01]), or MSM who had multiple sex partners (OR = 1.58, 95% CI [1.07-2.32]) were more willing to use PrEP compared with their respective counterparts. Findings suggest that MSM with racial/ethnic minority status, low-socioeconomic status, younger age, and engagement in HIV risk behaviors are willing to take PrEP but may lack access. Study limitations include the inability to conduct meta-analyses on certain predictor variables due to a small number of studies. This review identified MSM subpopulations who may benefit from interventions increasing PrEP access.
The Role of the Hand Surgery Consultant in the Care of the Amateur and Professional Golfer
Authors: Graham Thomas J. , Polatsch Daniel B. , Thomas Bruce J.
Published: December 2022

Golf is unique in this compendium of sports-related hand and wrist injury management. It is the only sport where the ball is stationary and there is no opponent against whom the player is defending. This distinctive sport dates to the 15th century in Scotland and is one of the oldest sports, but it is one where technology has changed many of the fundamental elements—from the “playing field (through advanced in agronomy) and the equipment (club and ball technology).
The Role of the Hand Surgery Consultant in the Management of the High School and Collegiate Athlete
Authors: Harman Timothy W. , Barry Annabeth P. , Bamberger H. Brent , Graham Thomas J.
Published: December 2022

For the purpose of this article, we will not use individual sports as the primary delineator; however, the two different levels of play: High School and Collegiate. We plan to share insight that we have gained through decades of practice treating High School sports and collegiate athletes. This article offers readers reliable guidance on not only treating the athlete’s hand but understanding the person as a whole and the struggles at each level of play.
Predictors of Mediastinal Exploration While on Extracorporeal Membrane Oxygenation After Pediatric Cardiac Surgery
Authors: Kerstein Jason S. , Adams Phillip S. , Maul Timothy M. , Stebler Jamie , Baust Tracy , Saenz Lucas , Albert Oluchi , Palmer David , Morell Victor O. , Domnina Yuliya
Published: December 2022

Cardiac surgical patients requiring extracorporeal membrane oxygenation (ECMO) are at increased risk for hemorrhage due to necessary anticoagulation, in-situ cannulas, and disturbed hemostasis. We performed a retrospective, cross-sectional study of patients 0–18 years old in our cardiac intensive care unit (CICU) cannulated to ECMO within 48 h of cardiopulmonary bypass. The 69 patients included in the study were divided into three analysis groups based on serial chest tube output per hour: no bleeding (NB) on admission to the CICU (21/69, 30%), bleeding stopped (BS) with medical management (26/69, 38%), bleeding requiring emergent mediastinal exploration (BME) (22/69, 32%). The NB group had a more favorable coagulation profile upon admission to the CICU (PTT 53 s NB, 105 s BS, 83 s BME p < 0.001, ACT 169 s NB, 225 s BS, 211 s BME, p =0.013). Only chest tube output during the first three postcannulation hours remained associated with the need for mediastinal exploration by multivariable analysis. An average chest-tube output of 11.6 mL/kg/h during the first three hours had the highest percentage of patients classified correctly (84%) for requiring mediastinal exploration during their ECMO run (sensitivity 91%, specificity 81%).
Eicosapentaenoic acid vs. docosahexaenoic acid for the prevention of cardiovascular disease
Authors: Sweeney Ty E. , Gaine Sean P. , Michos Erin D.
Published: December 2022

Purpose of review

Populations with greater fatty fish intake have lower risk of coronary heart disease. However, trials testing omega-3 fatty acids (FA) on cardiovascular outcomes have yielded inconsistent results. In this review, we summarize the major cardiovascular trials examining omega-3 FA supplementation, and compare differences with eicosapentaenoic acid (EPA) alone vs. docosahexaenoic acid (DHA) combined with EPA.

Recent findings

The JELIS and REDUCE-IT trials both demonstrated significant reduction in cardiovascular events with high dose EPA in the form of icosapent ethyl (IPE), with a similar trend seen in the RESPECT-EPA trial. In contrast, the ASCEND, VITAL, STRENGTH, and OMEMI trials examining EPA+DPA combinations failed to demonstrate benefit. Beyond the difference in omega-3 FA formulations (IPE vs. omega-3 carboxylic acid), other differences between REDUCE-IT and STRENGTH include the achieved EPA levels, differing properties that EPA and DHA have on membrane stabilization, and the comparator oils tested in the trials.

The totality of evidence suggests EPA alone, administered in a highly-purified, high-dose form, improves cardiovascular outcomes among patients with elevated triglycerides at high cardiovascular risk, but EPA and DHA together does not. Current guidelines endorse the use of IPE in statin-treated patients at high cardiovascular risk who have triglycerides >135 mg/dl.
Inflammation and kidney stones: cause and effect?
Authors: Capolongo Giovanna , Ferraro Pietro Manuel , Unwin Robert
Published: December 2022

Purpose of review

This short review is intended to highlight the potential role of inflammation as a key pathological driver, rather than a mere consequence, of nephrolithiasis. Although there is clearly a strong likelihood that the relationship is bidirectional, and that kidney stone-triggered inflammation can establish a vicious cycle of tissue injury and stone formation.

Recent findings

These consist of data from both recent preclinical and clinical studies demonstrating the importance of inflammation in models of stone disease and in kidney tissue from patients with nephrolithiasis, and as a potential driver of disease recurrence and a suitable treatment target. In particular, the role of immune cells and their relationship to the NLRP3 inflammasome is becoming clearer, as well as the potential contribution to tissue injury and stone formation of the pro-inflammatory cytokines interleukin-1β and interleukin-18.

This concept is not new and raises the possibility that targeting inflammation directly may prove to be a novel and suitable means of treatment for at least some types of kidney stone, and in certain clinical settings, both acutely and as prevention, especially in those patients experiencing recurrent stone episodes and/or who have a well defined metabolic cause such as uric acid or calcium oxalate stones.
Is There a Reduction in Chemsex Practice in Men Who Have Sex With Men During COVID-19 Lockdown? Results of the CheRRLock Study
Authors: L’Yavanc Thomas , Gosset Daniel , Plathey Marine , Jedrzejewski Thibaut , Gazalet Philippe , Lasry Stéphane , Pierre Nadège , Kachal Abdessamad , Fremondiere Marc , Ohayon Michel , Palich Romain ,   on behalf of the “190” working group
Published: December 2022

Background and aims:

Chemsex is a growing concern among men who have sex with men (MSM). COVID-19 lockdowns have had consequences on social and sexual interactions. We aimed to assess changes in chemsex practices during COVID-19 lockdown in France among MSM and factors associated with maintaining or increasing chemsex practice.

Methods:

Repeated face-to-face questionnaires were conducted at “Le 190” Sexual Health Center, Paris, France, exploring lifestyle, sexual, and chemsex practices, COVID-19 concerns and mental health before and during second lockdown in France (30/10/2020–15/12/2020). Inclusion criteria were chemsex practices at least 3 times throughout lifetime and at least once in the 3 months before second lockdown. The primary end point was the proportion of participants who declared having stopped, decreased, maintained, or increased their chemsex practice during lockdown. Univariable and multivariable logistic regressions were used to analyze factors associated with evolutions of chemsex practice.

Results:

Ninety-three MSM were included: 66% HIV-positive and 30% taking PrEP. Drugs most used were cathinones (91%) and GHB/GBL (52%). Participants reported stopping, decreasing, maintaining, and increasing chemsex drugs use in 14%, 22%, 22%, and 42% of cases, respectively. Despite this overall increase in chemsex practice, MSM decreased their number of sexual partners. Factors significantly associated with maintaining or increasing chemsex drugs use were feeling lonely (OR = 3.24), craving (OR = 4.51), and working during lockdown (OR = 3.27), contrasting with fear of COVID-19 (OR = 0.31).

Conclusion:

Restriction measures lead to changes in sexual behavior and seem to increase chemsex practice. Maintaining care for most isolated patients should be a priority in COVID-19 context.
Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho
Authors: Katende Bulemba , Bresser Moniek , Kamele Mashaete , Chere Lebohang , Tlahali Mosa , Erhardt Rahel Milena , Muhairwe Josephine , Ayakaka Irene , Glass Tracy R , Ruhwald Morten , van Ginneken Bram , Murphy Keelin , de Vos Margaretha , Amstutz Alain , Mareka Mathabo , Mooko Sekhele Matabo , Labhardt Niklaus D. , Reither Klaus , González Fernández Lucia
Published: December 2022

Introduction

The surge of the COVID-19 pandemic challenged health services globally, and in Lesotho, the HIV and tuberculosis (TB) services were similarly affected. Integrated, multi-disease diagnostic services were proposed solutions to mitigate these disruptions. We describe and evaluate the effect of an integrated, hospital-based COVID-19, TB and HIV screening and diagnostic model in two rural districts in Lesotho, during the period between December 2020 and August 2022.

Methods

Adults and children above 5 years attending two hospitals were screened for COVID-19 and TB symptoms. After a positive screening, participants were offered to enroll in a service model that included clinical evaluation, chest radiography, SARS-CoV-2, Xpert MTB/RIF Ultra and HIV testing. Participants diagnosed with COVID-19, TB, or HIV were contacted after 28 days evaluate their health status, and linkage to HIV or TB services.

Results

Of the 179160 participants screened, 6623(37%) screened positive, and 4371(66%) were enrolled in this service model, yielding a total of 458 diagnoses. One positive rapid antigen test for SARS-CoV-2 was found per 11 participants screened, one Xpert-positive TB case was diagnosed per 85 people screened, and 1 new HIV diagnosis was done per 182 people screened. Of the 321(82.9%) participants contacted after 28 days of diagnosis, 304(94.7%) reported to be healthy. Of the individuals that were newly diagnosed with HIV or TB, 18/24(75.0%) and 46/51(90.1%) started treatment. This service showed no difference in the detection of new HIV and TB cases when compared to other hospitals, where no such integrated service model was provided.

Conclusion

This screening and diagnostic model successfully maintained same-day, integrated COVID-19, TB, and HIV testing services through different COVID-19 incidence periods in a resource-limited context. There were positive effects in avoiding diagnostic delays and ensuring linkage to services, however, efficiencies were contingent on the successful adaptation to the changing environment.
Community-based emergency transport system in Shinyanga, Tanzania: a local innovation to avert maternal and newborns deaths for a low-resource setting
Authors: Munishi Castory , Mateshi Gilbert , Mlunde Linda B. , Njiro Belinda J , Ngowi Jackline E , Kengia James T. , Kapologwe Ntuli A. , Deng Linda , Timbrell Alice , Kitinya Wilson , Pembe Andrea B. , Sunguya Bruno F.
Published: December 2022

Introduction

In achieving sustainable development goal 3.1, Tanzania needs substantial investment to address the persistent burden of maternal mortality. Efforts are needed to curtail the three delays which underlie most of the deaths. The government of Tanzania implemented a community-based emergency transport intervention to address the second delay through m-mama program to address these delays. This examined the cost-effectiveness of this intervention as compared to the use of a standard ambulance system alone.

Materials and Methods

Program data provided by the program implementers was used in this secondary data analysis. The data included costs of referral services using the Emergency Transportation System (EmTS) and comparing with the standard ambulance system. Analysis was conducted using Microsoft Excel to generate data that was fed in a TreeAge Pro Healthcare 2022 model. The cost and effectiveness data were discounted at 5% to make fair comparisons of the two systems.

Results

A total of 989 referrals were made where, 30.1% were completed using the standard referral system using ambulance, and the majority (69.9%) were completed using the EmTS. The Emergency transport system costed USD 170.4 per completed referral compared to USD 472 per referral using ambulance system alone in the six councils of Shinyanga region where the intervention was conducted.

Conclusion

The introduction of m-mama emergency transportation system has proved to be cost effective compared to the use of standard ambulance system alone in Shinyanga region. Given the high burden of maternal mortality in Tanzania, this community-based program can save implementation costs and may be more sustainable should be scaled up to other regions in Tanzania. Using implementation science methods while scaling up, lessons learned in various regions may further improve the effectiveness of the EmTS.
Deep Learning of Electrocardiograms Enables Scalable Human Disease Profiling
Authors: Venn Rachael A. , Wang Xin , Friedman Sam Freesun , Diamant Nate , Khurshid Shaan , Achille Paolo Di , Weng Lu-Chen , Choi Seung Hoan , Reeder Christopher , Pirruccello James P. , Singh Pulkit , Lau Emily S. , Philippakis Anthony , Anderson Christopher D. , Ellinor Patrick T. , Ho Jennifer E. , Batra Puneet , Lubitz Steven A.
Published: December 2022

The electrocardiogram (ECG) is an inexpensive and widely available diagnostic tool, and therefore has great potential to facilitate disease detection in large-scale populations. Both cardiac and noncardiac diseases may alter the appearance of the ECG, though the extent to which diseases across the human phenotypic landscape can be detected on the ECG remains unclear. We developed a deep learning variational autoencoder model that encodes and reconstructs ECG waveform data within a multidimensional latent space. We then systematically evaluated whether associations between ECG encodings and a broad range of disease phenotypes could be detected using the latent space model by deriving disease vectors and projecting individual ECG encodings onto the vectors. We developed models for both 12- and single-lead ECGs, akin to those used in wearable ECG technology. We leveraged phecodes to generate disease labels using International Classification of Disease (ICD) codes for about 1,600 phenotypes in three different datasets linked to electronic health record data. We tested associations between ECG encodings and disease phenotypes using a phenome-wide association study approach in each dataset, and meta-analyzed the results. We observed that the latent space ECG model identified associations for 645 (40%) diseases tested in the 12-lead model. Associations were enriched for diseases of the circulatory (n=140, 82% of category-specific diseases), respiratory (n=53, 62%), and endocrine/metabolic (n=73, 45%) systems, with additional associations evident across the human phenome; results were similar for the single-lead models. The top ECG latent space association was with hypertension in the 12-lead ECG model, and cardiomyopathy in the single-lead ECG model (p<2.2×10-308for each). The ECG latent space model demonstrated a greater number of associations than ECG models using standard ECG intervals alone, and generally resulted in improvements in discrimination of diseases compared to models comprising only age, sex, and race. We further demonstrate how a latent space model can be used to generate disease-specific ECG waveforms and facilitate disease profiling for individual patients.
Risk Factor Analysis for Extended-Spectrum Beta-Lactamase Producing Enterobacterales Colonization or Infection: Evaluation of a Novel Approach to Assess Local Prevalence as a Risk Factor
Authors: Cherian Jerald , Cosgrove Sara E. , Haghpanah Fardad , Klein Eili Y. ,   the Centers for Disease Control and Prevention’s Prevention Epicenters Program and the Modeling Infectious Diseases in Healthcare Network
Published: December 2022

Objective

To explore an approach to identify the risk of local prevalence of extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) on ESBL-E colonization or infection, and reassess known risk factors.

Design

Case-control study.

Setting

Johns Hopkins Health System emergency departments (EDs) in the Baltimore-Washington, D.C. region.

Patients

Patients aged ≥18 years with a culture growing Enterobacterales between 4/2019-12/2021. Cases had a culture growing an ESBL-E.

Methods

Addresses were linked to Census Block Groups and placed into communities using a clustering algorithm. Prevalence in each community was estimated by the proportion of ESBL-E among Enterobacterales isolates. Logistic regression was used to determine risk factors for ESBL-E colonization or infection.

Results

ESBL-E were detected in 1167 of 11,229 patients (10.4%). Risk factors included a history of ESBL-E in the prior year (OR, 15.62; 95% CI, 11.25-21.68), and exposure to a skilled nursing or long term care facility (OR, 1.66; 95% CI, 1.39-1.99), 3rd generation cephalosporin (OR, 1.83; 95% CI, 1.50-2.23), carbapenem (OR, 2.01; 95% CI, 1.46-2.78) or trimethoprim-sulfamethoxazole (OR, 1.53; 95% CI, 1.05-2.22) within the prior 6 months. Patients were at lower risk if their community had a prevalence <25thpercentile in the prior 3 months (OR, 0.84; 95% CI, 0.71-0.98), 6 months (OR, 0.84; 95% CI, 0.71-0.99) or 12 months (OR, 0.81; 95% CI, 0.69-0.96). There was no association between being in a community >75thpercentile and the outcome.

Conclusions

This method of defining the recent local prevalence of ESBL-E may partially capture differences in the likelihood of a patient having an ESBL-E.
Dynamics of Covid-19 Vaccine-Hesitancy among Primary Health Care Workers in an Urban City in India
Authors: Ali Syeda Sana , Iyer Gowri , Mahajan Hemant , Kannuri Nanda Kishore
Published: December 2022

Background

The health care workers (HCWs) were one of the vulnerable populations prioritized during the Covid-19 vaccination (COVISHIELD and COVAXIN) campaign. They are also the first point of contact for vaccine-related information and therefore, play a crucial role in shaping peoples’ vaccine seeking behaviour.

Objectives

(i) To estimate the proportion of Covid-19 vaccine hesitancy among HCWs in urban primary health care centres (UPHC) across Hyderabad; and (ii) To explore factors influencing vaccine hesitancy and vaccine acceptance in this population.

Methods

A cross-sectional study was conducted among 238 HCWs from 21 urban health centres in Hyderabad between June and July 2021. The prevalence of vaccine hesitancy was assessed using the questions adapted from ‘the UNICEF Guyana Covid-19 Vaccination Hesitancy Survey’. We used ‘the SAGE determinants of vaccine hesitancy’ to determine factors underlying vaccine hesitancy and acceptance.

Results

The prevalence of vaccine hesitancy among HCWs was 17% (12.3% - 22.2%) during the 6 months following emergency vaccine approval. ‘Self-protection’, ‘Vaccine-confidence’, and ‘Responsibility towards the general population’ were some of the reasons in favour of Covid-19 vaccination. Whereas ‘Vaccine-safety’ has emerged as the primary determinant of vaccine-hesitancy in this population. HCWs were susceptible to misinformation in the social media and in their communities, which might have shaped their opinion about the vaccines for the Covid-19.

Conclusion

Although the COVID-19 vaccines (COVISHIELD and COVAXIN) were approved for administration by the Drugs Controller General of India, one in every six HCWs working in the UPHCs in Hyderabad, India had eitherrefused or delayedvaccinations mainly due to limited information on ‘vaccine-safety’. This highlights a critical need to address the vaccine-hesitancy among HCWs (especially during the initial phases of novel vaccine introduction), as similar behaviour of the HCWs towards novel vaccines could affect the uptake of these vaccines among the general population (which they serve).