bluuebunny/crossref_metadata_2025 huggingface dataset:
Content Hubs, Information Flows, And Reactions for Pesticide-Related Discussions On Twitter
Authors: Zhou Tiancheng , Huang Yu , Avanasi Raghavendhran , Brain Richard A , Prosperi Mattia , Bian Jiang
Published: February 2025

Pesticides are essential in modern agriculture for controlling pests and enhancing food production. However, concerns about their human and environmental health impacts have broadened discussions on their use, regulation, ethics, and sustainability. Scientific research, media coverage, input from corporations, governments, and non-governmental organizations (NGOs) shape public opinions and potentially influence regulatory decisions. This project analyzed pesticide-related discussions on Twitter/X from 2013 to 2022, focusing on information influence and propagation among individuals and organizations, advancing over prior research that looked at topic frequency, trends, and geography. Using a validated snowball sampling method, we collected over 3 million tweets from 1 million users and identified key network influencers, ie, information hubs, analyzing their content, popularity, and characteristics. Machine learning and a tailored information flow score were used to explore the dynamics of information flow and sentiment across hubs. Our analysis revealed that organizational hubs, particularly NGOs and media, were more active and had higher follower-to-following ratios than individual influencers. NGOs and media also dominated the pesticide-related discourse, while individual influencers had a lesser role. Information sources were unevenly distributed, with a dominance of retweets, news, and media posts, and a low prevalence of scientific sources. Information flow was high through NGOs, academia, and individuals, but poor from government accounts. Pesticide-focused hubs were more active and targeted in their information dissemination, with public sentiment largely negative. By delving deeper into the dynamics of information dissemination and influence networks, this study provides insights that emphasize 1) the need for better communication strategies to integrate diverse stakeholder perceptions and values, and 2) prioritizing the dissemination of credible scientific information, while also addressing sectoral disparities. Together, they can help policymakers and industry stakeholders build trust, promote transparency, and advance sustainable pesticide regulation.
Bioavailability and risk assessment of metals in freshwaters: is global regulatory implementation keeping pace with scientific developments?
Authors: Merrington Graham , Gensemer Robert W , Gilron Guy , Wilson Iain , Peters Adam , Van Dam Rick , Golding Lisa A , Stauber Jenny , Gadd Jennifer , Smith Ross , DeForest David , Garman Emily , Middleton Ellizabeth , Ryan Adam , Cooper Christopher A , Smith Erin , Baken Stijn
Published: February 2025

The scientific knowledge that enables the prediction of potential aquatic ecological risks due to exposure of metals based on freshwater chemistry data have been available for several decades. As a result, ecosystems can be protected, using frameworks and procedures incorporated into regulatory approaches. Yet, when evaluating how freshwater risks from metals are assessed globally, it is apparent that regulatory jurisdictions differ in their progress, and approaches, when accounting for bioavailability. It is entirely reasonable and appropriate for there to be a lag in time between the development of the science and its incorporation into routine regulatory environmental protection. We openly acknowledge that this is not just a regulatory challenge and take a more holistic view of the implementation of the science that informs metal bioavailability. Implementation comprises the steps required to utilize science and knowledge to enable its practical, beneficial, and routine application in regulatory decision making. Different regulatory jurisdictions have taken varied approaches to account for metal bioavailability. We have made specific use of frameworks that utilize limit values, such as water quality guidelines, criteria and quality standards, to illustrate the similarities and differences in the implementation of bioavailability. Approaches taken in Europe, Canada, Australia and New Zealand, and the United States were reviewed and evaluated. While some of these approaches, or parts thereof, have been successful, other aspects have been less so. In this evaluation, we have identified key commonly encountered obstacles and challenges in these approaches to the implementation of metal bioavailability. Finally, we provide an evidence-driven ‘road map’ to the successful regulatory implementation of metal bioavailability in risk assessment, drawn from successful components of the approaches reviewed. The application of this framework will enable regulatory jurisdictions to readily keep pace with the science pertaining to metal bioavailability and avoid the challenges experienced by others.
Investigating metrics of discrete-individual repeatability of the stress response
Authors: Beattie Ursula K , Romero L Michael , Reed J Michael
Published: February 2025

There is currently no consensus on the most biologically meaningful way to calculate discrete-individual repeatability of stress response curves. In the current study, we compared three metrics of discrete-individual repeatability that incorporate the whole stress response curve: profile repeatability, Kullback-Leibler (KL) divergence, and hypothalamic-pituitary-adrenal (HPA) flexibility. As part of this work, we present a new R package for computing profile repeatability, “profrep”. Using three datasets (one synthetic and two corticosterone datasets from live birds), our objectives were (1) to compare how these metrics correlate with one another and (2) to determine how representative repeatability scores of fewer replicates were to the “consensus” score (i.e., the score of the full dataset). We found that (1) these three discrete-individual repeatability metrics do not consistently correlate with one another; (2) KL divergence and HPA flexibility are poor at distinguishing individuals from each other, i.e., they give similar scores for each individual regardless of perceived repeatability; and (3) that profile repeatability tends to overestimate repeatability when fewer replicates are available, and the consensus score is low. Despite this drawback of profile repeatability, we suggest that it may be the most well-suited metric for assessing discrete-individual repeatability.
Valuable predictive power of prognostic nutritional index in metastatic breast cancer patients treated with CDK4/6 inhibitors
Authors: Önder Tuğba , Öner İrem , Karaçin Cengiz , Ateş Öztürk
Published: February 2025

Aims and Objectives

The prognostic value of nutritional status in HR+/HER2- metastatic breast cancer (mBC) patients treated with CDK4/6 inhibitors (CDK4/6is) and endocrine therapy (ET) is unclear.

Methods/Materials

The effect of PNI values before starting CDK 4/6i on patient prognosis was retrospectively analyzed.

Results

A total of 431 patients were evaluated. After 35.7 months of follow-up, the median overall survival (mOS) was 46.3 months (95% CI, 29.7–62.8). The PNI-low group had decreased progression-free survival compared to the PNI-high group [16.6 vs. 30.5 months; univariate HR = 1.640, 95% confidence interval (CI): 1.281–2.099, P < .001]. The PNI-low group's mOS was noticeably shorter than the PNI-high group (35.0 months vs. not reached; multivariate-adjusted HR: 2.082, 95% CI: 1.398–3.102, P < .001). When stratified by CDK4/6i line: In patients using CDK4/6i as the first line, mPFS for the PNI-low and PNI-high group was 24.6 vs. 35.6 months (P = .026), and survival probabilities at 24, 36, and 48 months in the PNI-low and PNI-high groups were 75%, 62%, 57%, and 88%, 80%, and 72%, respectively (P = .002). In patients using CDK4/6i as the second line and after, mPFS was 8.2 vs.12.0 months (P = .014), and mOS was 18.6 vs. 39.6 months (P = .001) for the PNI-low and PNI-high group, respectively. The ORR and DCR were significantly lower in the low-PNI group than in the high-PNI group (P = .018 and P = .017, respectively). The incidence of grade 3–4 side effects due to CDK4/6is (39.8% vs. 30.7%, P = .046) was significantly greater in the PNI-low group than in the PNI-high group.

Conclusions

This study's results suggest that PNI is an easily measured and reliable indicator of prognosis in mBC patients treated with CDK4/6i and ET.
Critical Thinking: Stress-testing Competing Reasons in the Practical Domain
Authors: Dunne Gerry
Published: February 2025

Harvey Siegel has argued that successful critical thinking requires both a critical mindset and expertise in evaluating reasons. In this paper, I focus on the latter, the business of accurately appraising competing reasons in the practical domain. More specifically, I critically examine the limitations inherent in two commonly used epistemic frameworks: the balance account and reasons-for-and-against. I argue neither is suitable for scenarios requiring especially nuanced appraisals or complex metrics. This is because they primarily deal with somewhat crude approximations and/or binary choices. I will propose a new framework to address this concern. I dub this the stress-testing-critique-support-explanationist account (STCSEA). STCSEA is engineered to handle complex practical epistemic situations, ones where determining what to do is not straightforward or immediately calculable. To fully understand the accurate and reliable determination of competing reasons’ strengths and weaknesses, educators require sophisticated tools. Such tools can help us fully to grasp the concept and mechanics of rational defeat—that being figuring out the strength of competing reasons. To do so, we must also formulate and continuously refine an operationalized defeasibility taxonomy.

I proceed as follows. In Section 1, I provide a brief overview of the critical thinking debate. I then survey John Pollock’s work on defeaters. This work is germane to the conversation yet remains something of a lacuna in the contemporary philosophy of education literature. In Section II, I discuss the balance account and reasons-for-and-against, specifically their evident limitations. In Section III, I make a case for the superiority of STCSEA when it comes to handling ‘hard cases’. These are cases where what we should, must, or may do, involves a complex computation. Such computations often exceed the mathematical or epistemic resources associated with ‘balancing metaphors’ and ‘for and against’ determinations.
Legal framework for hydrogen production in Austria using the specific example of a company site in Tyrol
Authors: Monsberger Carolin , Thaler Bernhard , Steinlechner Sebastian , Fina Bernadette
Published: February 2025

This article examines the legal framework for hydrogen production in Austria within the broader context of European Union (EU) regulations, focusing on a company site in Tyrol. At the EU level, the Industrial Emissions Directive, the EU Hydrogen Strategy, the REPower EU Plan, and the Delegated Acts to the Renewable Directive are addressed. For the national regulation in Austria, regulations for electrolyzers (e.g. licensing and safety regulations) as well as the regulation of hydrogen networks—or the absence thereof—are examined. The study assesses the impact of these regulations on an operating location in Tyrol. This analysis reveals the intricate legal landscape shaping hydrogen production in the EU and, specifically, in Austria, highlighting challenges for project development and compliance. The study underscores the need for clarity and harmonization in regulations to support the growth of a sustainable hydrogen economy.
Bioremediation potential of Pseudomonas aeruginosa to counteract Arsenite-induced phytotoxicity in Solanum lycopersicum cultivated within a contaminated agroecosystem
Authors: Patel Vivek , Supriya G Naga Rathna
Published: February 2025

Trivalent arsenic (AsIII) is the most toxic form of arsenic, accumulates in plant systems through aquaporins, and inhibiting plant growth. This study focuses on mitigating the bioavailability of arsenite (AsIII) in agricultural soils through biological approaches. A potential AsIII tolerant bacterium Pseudomonas aeruginosa VS3 was isolated from contaminated soil. Subsequent analysis revealed that this strain can produce EPS and biofilms. Additionally, the strain exhibited production of plant growth promoting traits (IAA, gibberellins, and solubilisation of Si). Biotransformation assay demonstrated that strain can oxidize AsIII to the less toxic arsenate (AsV) with conversion efficiency of 51%. Findings from the field trial proven that P. aeruginosa significantly reduced AsIII toxicity in S. lycopersicum and boosted plant growth under AsIII stress conditions. Additionally, inoculation with P. aeruginosa enhanced the activities of antioxidant enzymes (40% increase in peroxidase and a 17% increase in PAL) compared to untreated controls under AsIII stress. The bacterial treatment reduced arsenic accumulation in root tissues, demonstrating P. aeruginosa VS3’s potential as a bioremediation agent to alleviate arsenite stress and enhance plant growth.
RTFAST-Spectra: Emulation of X-ray reverberation mapping for active galactic nuclei
Authors: Ricketts Benjamin J , Huppenkothen Daniela , Lucchini Matteo , Ingram Adam , Mastroserio Guglielmo , Ho Matthew , Wandelt Benjamin
Published: February 2025

Bayesian analysis has begun to be more widely adopted in X-ray spectroscopy, but it has largely been constrained to relatively simple physical models due to limitations in X-ray modelling software and computation time. As a result, Bayesian analysis of numerical models with high physics complexity have remained out of reach. This is a challenge, for example when modelling the X-ray emission of accreting black hole X-ray binaries, where the slow model computations severely limit explorations of parameter space and may bias the inference of astrophysical parameters. Here, we present RTFAST-Spectra: a neural network emulator that acts as a drop in replacement for the spectral portion of the black hole X-ray reverberation model RTDIST. This is the first emulator for the reltrans model suite and the first emulator for a state-of-the-art x-ray reflection model incorporating relativistic effects with 17 physically meaningful model parameters. We use Principal Component Analysis to create a light-weight neural network that is able to preserve correlations between complex atomic lines and simple continuum, enabling consistent modelling of key parameters of scientific interest. We achieve a $\mathcal {O}(10^2)$ times speed up over the original model in the most conservative conditions with $\mathcal {O}(1\%)$ precision over all 17 free parameters in the original numerical model, taking full posterior fits from months to hours. We employ Markov Chain Monte Carlo sampling to show how we can better explore the posteriors of model parameters in simulated data and discuss the complexities in interpreting the model when fitting real data.
A Novel Giant Magnetoresistance–Enabled Multiplex Polymerase Chain Reaction Assay for the Diagnosis of Invasive Fungal Infection
Authors: Vergidis Paschalis , Ordaya Eloy E , Porter Emma , Sweet Hannah , Wang Wei , Evans Anton F , Zhang Chi , Young Jo-Anne H , Liu Xiaoying
Published: February 2025

Background

Despite advances in clinical microbiology, the diagnosis of invasive fungal infections remains challenging. Giant magnetoresistance (GMR) is a novel technology that enables the detection of trace amounts of cell-free DNA (cfDNA). We evaluated a high-multiplex molecular diagnostic assay coupled with GMR-enabled lab-on-a-chip technology that can detect 18 different fungal species.

Methods

Analytical performance was evaluated in spiked plasma samples. After amplification, cfDNA was digested. Residual single-stranded DNA was flowed over a GMR sensor that was surface-coated with probes specific to different fungal species. After hybridization, magnetic beads bound to the probe complexes produced a GMR signal that was detected by the sensors. Clinical performance was determined using residual serum samples collected before the initiation of antifungal treatment from 20 patients with infection.

Results

The limit of detection of the assay ranged from 5 to 50 copies per polymerase chain reaction (PCR) reaction. Nonspecific signals were not observed in the spiked samples. Fungal cfDNA was detected in 80% of patients with invasive candidiasis (3/4 with candidemia, 5/6 with invasive candidiasis without candidemia), all 3 cases of invasive pulmonary aspergillosis, and all 3 cases of disseminated histoplasmosis. cfDNA was not detected in 2 patients with cryptococcosis (both had negative blood cultures) and 2 patients with Pneumocystis pneumonia.

Conclusions

We developed a novel GMR-enabled multiplex PCR assay detecting fungal pathogens that have been prioritized for public health action. Clinical sensitivity was highest in cases of presumed angioinvasion and dissemination. This technology has the potential for use in the clinical microbiology laboratory setting.
Plasma ctDNA kinetics as a predictor of systemic therapy response for advanced non-small cell lung cancer: a systematic review and meta-analysis
Authors: Leite da Silva Luís F , Saldanha Erick F , de Menezes Júnior Samuel Alonso , Halamy Pereira Leonardo , de Bragança dos Santos João Alexandre R , Buonopane Isabella Romagnoli , de Souza Erito M , de Menezes Caio Ulysses Galvani , Lopes Gilberto
Published: February 2025

Background

Predicting early treatment response in advanced non-small cell lung cancer (NSCLC) is challenging. Longitudinal monitoring of circulating tumor DNA (ctDNA) can track tumor response to treatments like immune checkpoint blockade (ICB) and correlate with outcomes. This meta-analysis evaluated whether ctDNA clearance or decrease is associated with improved survival across various settings in NSCLC.

Methods

A systematic review of MEDLINE, EMBASE, and Cochrane databases (up to April 2024) identified studies evaluating the impact of ctDNA kinetics on survival outcomes in non-curative NSCLC settings. Pooled hazard ratios (HR) for progression-free survival (PFS) and overall survival (OS) were calculated using a random effects model.

Results

We included 32 studies with 3047 NSCLC patients receiving systemic therapies such as targeted therapy (TT), ICB, and chemotherapy. Meta-analysis of 31 studies showed that ctDNA decrease/clearance was linked to improved PFS (HR: 0.32 [0.26, 0.40], I² = 63%, P < .01). Subgroup analysis indicated strong PFS benefits from ctDNA clearance (HR: 0.27 [0.20, 0.36]). Similar improvements were seen across patients undergoing targeted therapy (HR: 0.34) and ICB (HR: 0.33). Analysis of 25 studies revealed a significant association between ctDNA reduction and better OS (HR: 0.31 [0.23, 0.42], I² = 47%, P < .01). Subgroup findings were consistent for both TT (HR: 0.41) and ICB (HR: 0.32). Sensitivity analysis demonstrated that ctDNA clearance/decrease was consistently associated with improved PFS across study designs and ctDNA analysis methods. There was no significant variation in hazard ratios for PFS based on NSCLC subtypes, smoking status, or sex.

Conclusion

Plasma ctDNA kinetics was associated with improved survival outcomes in patients diagnosed with advanced NSCLC undergoing treatment with TT and ICB.
NuSTAR detection of a hot stellar superflare with a temperature of 95 MK in hard X-rays
Authors: Hakamata Tomohiro , Matsumoto Hironori , Odaka Hirokazu , Takasao Shinsuke
Published: February 2025

A search of the hard X-ray archive data of the Nuclear Spectroscopic Telescope Array (NuSTAR) found a transient source, NuSTAR J230059+5857.4, during an observation of 1E 2259+586 on 2013 April 25. A multi-wavelength analysis using X-ray, optical, and infrared data, mostly taken in its quiescent phase, was conducted to identify the origin of NuSTAR J230059+5857.4 and elucidate the phenomena associated with the flare activity. The results indicated that NuSTAR J230059+5857.4 was a stellar flare that occurred on a single M-dwarf, M-dwarf binary, or pre-main-sequence star. NuSTAR J230059+5857.4 exhibited a higher emission measure and higher temperature, $8.60^{+2.15}_{-1.73} \times 10^{54}\:$cm$^{-3}$ and $8.21^{+2.71}_{-1.86}\:$keV, respectively, on average than the nominal values of stellar flares reported in the past. The flare loop size estimated on the basis of the model to balance the plasma and magnetic pressures was larger than the stellar radius by a factor of several. Because, based on solar flare loops, this flare loop scale is excessively large, we conjecture that the observed large emission measure could be attributed to the observation of mutually associated multiple flares simultaneously occurring on the stellar surface, known as sympathetic flares. Thanks to the large effective area of NuSTAR in the hard X-ray band, we are able to conduct a detailed discussion about a temperature variation associated with the flare. Investigation of the temperature variation during the flare revealed that the temperature remained significantly higher than during the quiescent phase even after the count rate dropped to around $5\%$ of the peak. The sustained high temperature over the long duration is consistent with the idea of sympathetic flares. We found that it is essential to use theoretical models to evaluate loops and assess temporal changes in temperature, as done in this study, to determine whether there are multiple flares or not when analyzing flare observation data.
Neuroforecasting reveals generalizable components of choice
Authors: Genevsky Alexander , Tong Lester C , Knutson Brian
Published: February 2025

Accurate forecasts of population-level behavior critically inform institutional choices and public policy. While neuroforecasting research suggests that measurements of group brain activity can improve forecasting accuracy relative to behavior, less is known about how and when brain activity can effectively improve out-of-sample forecasts. We analyzed neural and behavioral data collected in two experiments to forecast choice in more vs. less demographically representative aggregate internet markets in order to test when forecasts based on brain activity generalize better than behavior. In both experiments, while the accuracy of market forecasts based on behavior varied as a function of sample representativeness, market forecasts based on brain activity remained significant regardless of sample representativeness. These findings are consistent with the notion that brain activity associated with early affective responses can generalize across individuals to index aggregate choice more broadly than downstream behavior. Thus, brain activity from limited samples may reveal generalizable components of choice that can improve market forecasts. These findings inform theory regarding which components of individual choice generalize to improve market forecasts and provide insights into mechanisms that underlie the effective application of neuroforecasting.
Exploring the Virome of Blackberry and Wild Rubus spp. in South Carolina
Authors: Schnabel Elise , Xavier Cesar , Whitfield Anna E. , Dubrow Zoe , Pham Gina , Cieniewicz Elizabeth
Published: February 2025

Numerous viruses infect blackberry, and they are associated with virus disease complexes with complicated etiologies. Blackberry virus diseases limit the lifespan of blackberry production in the southeastern United States. Although some previous research has been done to understand which viruses are prevalent in South Carolina, a comprehensive study on the virome of blackberry has not been done in this region. Additionally, the role of wild Rubus as sources of virus inoculum is likely under-appreciated and represents a potential opportunity for disease management. We took a comprehensive approach to characterize viral genome sequences from known and novel viruses using metatranscriptomic sequencing of blackberry and wild Rubus spp. leaf samples collected in 2021 from eight sites across South Carolina. We detected 17 known and 6 novel plant viruses and describe relevant genome sequence information. Although the etiologies of these novel viruses are yet to be elucidated, they should be considered part of the blackberry/wild Rubus virome and further studied. We describe instances of potential connectivity of virus populations between cultivated blackberry and wild Rubus for several viruses at several sites. In addition to plant viruses, we also describe numerous viruses likely associated with foliar fungi, referred to as Rubus leaf-associated viruses. This study revealed a diverse landscape of both known and novel viruses in blackberry and wild Rubus in South Carolina and has stimulated topics for future research, such as temporal analyses of virus spread at the landscape scale and investigating potential vectors and biological relevance of novel viruses.
Retroperitoneal dedifferentiated liposarcoma – diagnostic and surgical challenges: a case report
Authors: Saha Akash , Habibullah Quazi , Rahman Mohammad Mashiur , Bandha Biplob Chandra , Islam Sajib Monirul , Islam Saiful , Das Sagor Kumar , Tonny Jabin Sultana , Rahman Abidur
Published: February 2025

Introduction:

Primary retroperitoneal liposarcoma is a rare variety of tumors accounting for 0.07%–0.2% of all malignancies. This type of sarcoma often causes diagnostic and therapeutic challenges due to its delayed presentation and anatomical location. Though there are some oncological measures like chemotherapy and radiotherapy still persist, complete surgical resection is the mainstay of treatment. However, the recurrence rate is very high in the case of retroperitoneal sarcomas.

Case presentation:

A 34-year-old male patient presented to our surgery department with abdominal distension, a lumpy feeling in his upper abdomen, and a significant weight loss over the past 3 months. On examination, there was a large intraabdominal mass measuring about 20 × 15 cm in the epigastric, left hypochondriac, umbilical, and left lumber region, which was partially mobile, partly hard, and partly cystic in consistency; the surface was smooth, and the margin was regular. After diagnostic and radiological workup, our primary suspicion was, it might be a case of retroperitoneal liposarcoma. Computed tomography (CT) guided fine needle aspiration tomography (FNAC) reveals, it was a spindle cell sarcoma. However, after six cycles neoadjuvant chemotherapy, resection was performed. Complete resection (R0) was done with extraction of a soft tissue mass of 12.5 kg, followed by adjuvant chemotherapy for three cycles. No recurrence is found after 3-month follow-up.

Conclusion:

Though retroperitoneal sarcoma may challenge the surgeon’s skill, complete marginal clearance along with oncological consultation may delay the recurrence and improve the quality of life of the patients. However, careful and long-term follow-up is required to detect early recurrence and increase the life expectancy of the patients.
Hypertension in chronic kidney disease and future heart failure
Authors: Burnier Michel
Published: February 2025

Purpose of review

Hypertension and chronic kidney diseases (CKDs) are known risk factors for the development or worsening of heart failure. In last years, several new therapeutic approaches for the management of people with diabetic and nondiabetic CKD and hypertension have been investigated. In this brief review, the most recent findings regarding the ability of SGLT-2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists (nsMRA) and GLP-1 receptor agonists to prevent heart failure in patients with hypertension and CKD will be discussed.

Recent findings

In the last 3 years, several large clinical trials involving very large numbers of CKD patients have been published showing that these new therapeutic approaches significantly reduce the risk of heart failure events and hospitalizations in patients with diabetic and nondiabetic nephropathies and hypertension as well as in patients with heart failure without nephropathy. Moreover, these drugs retard the progression of CKD towards end-stage kidney disease.

These observations already have a major impact on the management of people with hypertension and CKD. SGLT-2 inhibitors are now recommended as first-line therapy in people with diabetes, CKD and heart failure. The use of nsMRA is increasing and could replace spironolactone over time in heart failure as well as in early CKD stages.
RNA therapeutics in cardiovascular medicine
Authors: Damase Tulsi Ram , Cooke John P.
Published: February 2025

Purpose of review

RNA therapeutics came to global attention when mRNA-based vaccines provided an answer to the SARS-CoV-2 pandemic. The immense significance of this development notwithstanding, it is important to note that almost a decade prior to the pandemic, RNA drugs had made important inroads toward the amelioration of disease. The first class of RNA therapies to be introduced into clinical use were the antisense oligomers and siRNA drugs which generally induce a therapeutic effect by acting to brake or to modulate mRNA expression. RNA therapeutics is quickly becoming the fourth pillar of pharmacotherapy, and will have broad applications, including for the treatment of cardiovascular disease.

Recent findings

The United States (US) Food and Drug Administration (FDA) has approved several antisense oligomers (ASOs) and siRNA-based drugs to treat disorders associated with cardiovascular disease. In addition, multiple RNA-based drugs are in clinical trials to assess their safety and efficacy in patients with cardiovascular disorders, such as Zodasiran, a siRNA therapy that targets angiopoietin-like protein 3 (ANGPTL3) to reduce LDL cholesterol.

Because of limitless sequence choice; speed of design; and relative ease of synthesis, RNA drugs will be rapidly developed, will have broad applications, and will be generated at lower cost than other drug types. This review aims to highlight RNA therapies for cardiovascular diseases that are approved, and those that are under clinical evaluation.
Assessing the Relationship Between Chronic Pain and Cognition: A NIDILRR and VA TBI Model Systems Collaborative Project
Authors: Peckham Mackenzie , Beaulieu Cynthia L , Hays Kaitlin , Lundstern Marissa , MacIntyre Bria , Osborne Candice , Rabinowitz Amanda , Service Allan L , Sevigny Mitch , Abbasi Katherine , Walker William C , Welch Abigail , Tefertiller Candace
Published: February 2025

Objective: To investigate the associations between current chronic pain and cognition and current chronic head pain and cognition in individuals with traumatic brain injury (TBI). Setting: Community. Participants: A total of 1762 participants from the TBI Model Systems who endorsed experiencing current chronic pain and who completed the Current Chronic Pain survey. Design: Secondary analysis of a subset of data collected through a multi-site, cross-sectional observational cohort study. Main Outcome Measures: Cognition as measured by the Brief Test of Adult Cognition by Telephone (BTACT). Results: Individuals with TBI who reported current chronic pain exhibited lower cognitive performance compared to those who reported no pain. Among individuals who reported pain, greater pain intensity and pain interference were negatively associated with cognition, resulting in poorer cognitive performance. The negative association was even greater for individuals acknowledging chronic head pain compared to pain from other body locations. Conclusion: The negative association between current chronic pain and cognition for individuals with TBI indicates the need to consider pain intensity and pain interference as factors possibly influencing cognitive ability.
Antimicrobials for Neonates: Practitioner Decisions and Diagnostic Certainty
Authors: Spotswood Naomi E. , Grace Erin , Dargaville Peter A. , Beeson James G. , Hickey Leah , Haeusler Gabrielle M. , Bryant Penelope A. , Cooper Celia , Keir Amy K.
Published: February 2025

Background:

Antimicrobials are frequently prescribed to neonates who require hospital care, but the influences on clinical decision-making and practice variation in this process are ill-understood. We performed a cross-sectional survey of practitioners who prescribe antimicrobials in 3 Australian neonatal units.

Methods:

During two 5-day data capture periods per center, 56 practitioners reported their general confidence in antimicrobial decision-making for neonates. Then, 4 questionnaires evaluated diagnostic certainty and influences on antimicrobial decision-making for 68 antimicrobial courses and 11 infection evaluations where antimicrobials were not prescribed.

Results:

Self-reported guideline use at antimicrobial commencement was high (26/31, 84%). Clinical risk factors, clinical signs and laboratory tests contributed variably to decisions to start and cease antimicrobials. Consultation with a colleague contributed to 14/31 (45%) decisions to commence antimicrobials and 13/34 (38%) decisions to cease them. The most frequent responses to questions regarding the likelihood of infection and the possibility of an alternative diagnosis were “some possibility” and “some likelihood.” Team concordance in responses ranged from 14% to 50%. While practitioners in roles that denoted more clinical experience had greater general confidence in antimicrobial decision-making, this difference was not observed in real-world clinical situations where infection was not microbiologically confirmed.

Conclusions:

Clinical, laboratory, practitioner, team and center-based factors each influence antimicrobial prescribing decisions. Clinical uncertainty and differing guidelines likely contribute to practice variation. Future work to inform stewardship efforts should include improved guideline consistency, roles of diagnostic aids and a better understanding of the medicocultural contributors to neonatal antimicrobial prescribing.
The Certification Ranking of Stroke Treatment Centers Is Unclear to the General Public
Authors: Preciado Michael V. , Wilson Jennifer E. , Alejandro-White Jose , Denbow Maria , Olson DaiWai M.
Published: February 2025

BACKGROUND: Certified stroke treatment centers are classified based on their available resources to treat stroke including an Acute Stroke Ready Hospital (ASRH), a primary stroke center (PSC), a Thrombectomy-Capable Stroke Center (TCSC), and comprehensive stroke centers (CSCs). These hospitals all provide varying levels of care with CSCs being the most able to treat all types and complexities of stroke. This undergraduate nursing-led study explored the public's preference for treatment at different certified stroke treatment centers. METHODS: This study was a prospective nonrandomized observational survey of English-speaking adults at a plasma donation center in the Southwest United States. Subjects completed a 2-minute survey asking whether they would drive to the hospital or call 911 during a suspected stroke, and at which type of hospital they would prefer to be treated. RESULTS: Of 249 respondents, 204 (81.9%) indicated that they would call 911 for hospital transport, and 45 (18.1%) would drive their family member to a hospital. Most respondents (95/248, 38.3%) would prefer treatment at a PSC, 90 (36.3%) preferred an ASRH, 52 (21.0%) preferred a CSC, and 11 (4.4%) preferred a TCSC. There was no association between transportation preference and hospital preference dichotomized as CSC or PSC versus ASRH or TCSC (χ2 = 0.021, P = .885), nor CSC versus other (χ2 = 0.944, P = .331). CONCLUSION: Most respondents did not select CSC as the preferred treatment site, and 1 in 5 would drive rather than call 911. This indicates a knowledge gap regarding stroke center classification that warrants increased education.
Implementation of a Low-risk Algorithm for Outpatient Management of Febrile Pediatric Patients With Sickle Cell Disease
Authors: Erno Jason , Noisette Laurence , Bergmann Shayla , Diaz Charyse , Depriest Brittany , Nietert Paul J. , Hudspeth Michelle
Published: February 2025

Background:

Splenic dysfunction in children with sickle cell disease (SCD) increases the risk of serious bacterial infections; therefore, families are instructed to seek medical care in the presence of fever. Recurrent hospital admissions of patients with SCD cause financial and resource burdens on caregivers and the health care system, contributing to a lower quality of life in this patient population. Recent studies have documented a reduction of the incidence of bacterial infections among these patients managed on an outpatient basis with no association of increased morbidity and mortality. We decided to establish a partnership between our pediatric hematology/oncology division and pediatric emergency medicine division to initiate an algorithm to identify low-risk patients eligible for outpatient management.

Procedure:

We conducted a retrospective review of patients with SCD younger than 18 years of age, followed at the Comprehensive Care Sickle Cell Center at the Medical University of South Carolina (MUSC), who presented to our Pediatric Emergency Department (ED) with a temperature ≥101°F from July 1, 2018 to June 30, 2020.

Results:

The mean length of stay and age at admission were nearly equal between pre-implementation and post-implementation of the algorithm. The admission rates from the study for were 55.2% and 43.6% pre-implementation and post-implementation, respectively. Patients revisited the ED within 72 hours in 6.7% of patients in pre-implementation and 5.9% of patients in post-implementation. There were no patient deaths.

Conclusions:

Our pathway helps standardize the treatment of febrile pediatric patients with SCD. Although the decrease in admissions did not reach statistical significance, the > 10% decrease in admissions was likely meaningful to reduce health care burdens for patients and families.
Nurses' Role in the Birth Experience
Authors: Raposo Nicholas M. , Jurgens Corrine Y.
Published: February 2025

Background:

Intrapartum nurses are integral to the birth experience, yet their unique influence on this patient-reported outcome is not clear. The purpose of this review is to synthesize and highlight characteristics and practices of intrapartum nursing care associated with the birth experience.

Methods:

A search was conducted in February and March 2024 in CINAHL, PubMed, and Scopus with keywords birth experience, birth satisfaction, and nurse. Publication date was unrestricted, as no similar review was identified. Original, peer-reviewed publications in English were included. Publications that explored mediators of the birth experience, made unclear associations, or validated instruments were excluded. The Johns Hopkins Research Evidence Appraisal Tool was used for quality assessment. Findings were presented through Maslow's hierarchy of needs.

Results:

Twenty-five publications were included. They were published between 1989 and 2021 and present national and international data on a range of birth experience outcomes. Most publications were good or high quality. Characteristics and practices of intrapartum nursing care associated with the birth experience were those that fulfilled patients' physiological, safety, love, esteem, and self-actualization needs throughout labor and birth.

Discussion:

Fulfilled needs set the stage for positive birth experiences, whereas unfulfilled needs were associated with negative birth experiences. Findings can be used to support intrapartum nurses in optimizing birth experience outcomes.
In a Flash
Authors: Beck Cheryl Tatano
Published: February 2025

Purpose:

To describe women's experiences of surviving an amniotic fluid embolism (AFE) as written in their online stories.

Study Design and Methods:

In this qualitative descriptive study, 50 stories of AFE that women posted on the AFE Foundation website were analyzed using Braun and Clarke's thematic analysis.

Results:

In this sample, 35 women had emergency cesarean births, 12 had vaginal births, and 3 did not mention the type of birth. In 35 of the stories, women's ethnicity could be determined. Thirty-three women were White and one each were Black and Asian. Twenty-eight mothers were primiparas and 22 were multiparas. Five themes were identified: In a Flash, Heartbreaking Loss of Memory, Arduous Trek Towards Physical Recovery, Struggling Mentally with the Aftermath of a Traumatic Birth, and It Takes a Village and Then Some.

Clinical Implications:

The five themes identified from survivors' stories of AFE provide a firsthand account of surviving this catastrophic complication of childbirth and its prolonged aftermath. Nursing interventions based on these findings can be designed to help women heal from AFE.
Edutech-Based Formative Assessment and Teaching Competencies in Nursing Education
Authors: Shin Sujin , Hong Eunmin , Lee Miji , Lee Minjae
Published: February 2025

Background:

The integration of education and technology (Edutech) has become significant in education.

Purpose:

To explore the current state of formative assessment in nursing education and factors influencing technological pedagogical content knowledge (TPACK) competencies.

Methods:

A total of 216 novice nurse educators with <5 years of teaching experience in South Korea were surveyed online.

Results:

Among these participants, 27.3% used EFA (Edutech-based formative assessment), highlighting its benefits in providing immediate feedback and accessibility, yet faced insufficient time, technical issues and insufficient digital literacy as significant barriers. Completion of nursing education courses in a graduate program, EFA experience, and age were associated with TPACK competencies.

Conclusion:

Implementing Edutech improves assessment processes and highlights the critical need for comprehensive technological training and support to improve digital literacy and TPACK competencies. Effective educational strategies tailored to the diverse technological abilities of nurse educators are needed for enhancing overall teaching quality.
Developing Clinical Reasoning and Clinical Judgment Competency Through Collaborative Exam Generation
Authors: Von Visger Tania T. , Gill Amarjot S. , Seo Young Sik , Mann Catherine M.
Published: February 2025

Background:

The American Association of Colleges of Nursing promotes competency-based education (CBE) to foster learning, producing competent graduates. Effective CBE necessitates innovative teaching strategies to optimize academic performance.

Purpose:

The purpose of this study was to initiate early clinical reasoning and clinical judgment competency development while enhancing the academic performance and engagement of undergraduate nursing students through collaborative learning and digital engagement strategies.

Methods:

We conducted a retrospective academic records review of nursing students in the undergraduate program enrolled in fall 2023 and spring 2024 in an online statistic course.

Results:

Ninety-six student records were included in the review. Student engagement predicted academic success as measured by collaborative exam generation (r = .50, p < .001), time spent in course content (B = 5.22, SE = 1.55, t = 3.34, p = .001), and student discussion posts (B = 7.22, SE = 1.42, t = 5.11, p < .001).

Conclusions:

Active, collaborative learning approaches can be introduced in nursing prerequisite courses to develop competency in critical reasoning, clinical judgment, and respectful communication strategies to build interprofessional partnerships.
The combined strength of standardized lab sprint testing and wheelchair mobility field testing in wheelchair tennis players
Authors: Janssen Rowie J.F. , van Dijk Marit P. , Rietveld Thomas , de Groot Sonja , van der Woude Lucas H.V. , Houdijk Han , Vegter Riemer J.K.
Published: February 2025

Objective

This cross-sectional study examined associations between wheelchair sprint and anaerobic power (measured in the lab) and wheelchair mobility performance (measured in the field) among two groups of wheelchair tennis players. Additionally, construct validity was assessed for both lab and field tests.

Design

Nine amateur and nine elite wheelchair tennis players performed a Sprint and Wingate test on a wheelchair ergometer in the lab and a Sprint, Illinois and Spider test in the field, with inertial measurement units on their wheelchairs. Associations were assessed using regression analyses, and construct validity was assessed with an independent t-test (elite vs. amateur).

Results

The strongest associations were observed between lab outcomes and field sprint power (R2 > 90%), followed by peak linear velocity and test duration (R2 = 77-85%), while peak rotational velocity showed the lowest associations with lab outcomes (R2 = 69-80%). The elite group outperformed the amateur group on all test outcomes.

Conclusion

Despite differences in lab- and field-testing methodologies (e.g., trunk influence, linear/rotational components), the strong associations indicate overlap in measured constructs. Field testing offers valuable insight into practical performance, whereas lab testing enables in-depth biomechanical and physiological analyses. All tests effectively discriminate between elite and amateur wheelchair tennis players.
68Ga-DOTATOC PET/CT of Glomus Tumor of the Small Bowel
Authors: Habouzit Vincent , Perotto Ornella , Maillard Nicolas , Grange Rémi , Yvorel Violaine
Published: February 2025

A 57-year-old woman had an incidental finding of a hypervascular small bowel lesion on a contrast-enhanced CT scan performed for a suspected renal graft infection. The morphologic features of the lesion were suggestive of a neuroendocrine tumor (NET), but serum chromogranin A and urinary 5-HIAA were negative. 68Ga-DOTATOC PET/CT showed high SSTR-2 expression in the lesion, suggesting a NET. However, pathologic examination revealed diffuse alpha-smooth muscle actin positivity, consistent with a glomus tumor. This case highlights the utility of PET/CT for in vivo molecular tumor characterization and the challenge of distinguishing between different tumor types with overlapping molecular targets.
FDG-PET/CT Findings in Hemophagocytic Lymphohistiocytosis
Authors: Dawson Debra Ann , Sutherland Duncan E.K.
Published: February 2025

A 44-year-old man was admitted to the hospital with fever, pancytopenia, and a new rash. FDG-PET was ordered in light of nonspecific clinical, imaging, and biopsy findings. Findings included diffuse FDG uptake throughout the subcutaneous fat overlying fat stranding/haziness on CT. FDG uptake was associated with scattered subsolid/ground-glass lesions in the lungs. Splenomegaly and increased FDG uptake throughout the bone marrow were seen. Diagnostic considerations included infectious versus lymphomatous processes, and possible sites for biopsy were identified. Biopsy of a highly FDG-avid lung lesion led to a diagnosis of hemophagocytic lymphohistiocytosis secondary to peripheral T-cell lymphoma, not otherwise specified.