bluuebunny/crossref_metadata_2025 huggingface dataset:
Scalable and accurate variational Bayes for high-dimensional binary regression models
Authors: Fasano Augusto , Durante Daniele , Zanella Giacomo
Published: May 2022

Modern methods for Bayesian regression beyond the Gaussian response setting are often computationally impractical or inaccurate in high dimensions. In fact, as discussed in recent literature, bypassing such a trade-off is still an open problem even in routine binary regression models, and there is limited theory on the quality of variational approximations in high-dimensional settings. To address this gap, we study the approximation accuracy of routinely used mean-field variational Bayes solutions in high-dimensional probit regression with Gaussian priors, obtaining novel and practically relevant results on the pathological behaviour of such strategies in uncertainty quantification, point estimation and prediction. Motivated by these results, we further develop a new partially factorized variational approximation for the posterior distribution of the probit coefficients that leverages a representation with global and local variables but, unlike for classical mean-field assumptions, it avoids a fully factorized approximation, and instead assumes a factorization only for the local variables. We prove that the resulting approximation belongs to a tractable class of unified skew-normal densities that crucially incorporates skewness and, unlike for state-of-the-art mean-field solutions, converges to the exact posterior density as $p \rightarrow \infty$. To solve the variational optimization problem, we derive a tractable coordinate ascent variational inference algorithm that easily scales to $p$ in the tens of thousands, and provably requires a number of iterations converging to $1$ as $p \rightarrow \infty$. Such findings are also illustrated in extensive empirical studies where our novel solution is shown to improve the approximation accuracy of mean-field variational Bayes for any $n$ and $p$, with the magnitude of these gains being remarkable in those high-dimensional $p>n$ settings where state-of-the-art methods are computationally impractical.
Policing, punishment and comparative penality
Authors: Newburn Tim , Jones Trevor
Published: May 2022

Apparently growing punitiveness in many countries toward the end of the twentieth century prompted considerable criminological activity which focused on attempting to understand trends and contrasts in systems and patterns of punishment. Although to date this literature has tended to treat policing and punishment as being largely separate spheres of activity this paper advances two reasons for paying greater attention to policing in this context. First, and briefly, to reflect the fact that the police are the ‘gatekeepers’ to the penal system, and therefore in some senses inseparable from other penal practices. Second, and more centrally, that in various forms policing both involves, and is often experienced as, punishment. Attempts to understand the nature of and differences between penal states will be enhanced by the inclusion of policing within its ambit.
A Precision Adjuvant Approach to Enhance Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccines Optimized for Immunologically Distinct Vulnerable Populations
Authors: Dowling David J , Levy Ofer
Published: May 2022

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused significant mortality, especially among older adults whose distinct immune system reflects immunosenescence. Multiple SARS-CoV-2 vaccines have received emergency use authorization and/or licensure from the US Food and Drug Administration and throughout the world. However, their deployment has heighted significant limitations, such by age-dependent immunogenicity, requirements for multiple vaccine doses, refrigeration infrastructure that is not universally available, as well as waning immunity. Thus, there was, and continues to be a need for continued innovation during the pandemic given the desire for dose-sparing, formulations stable at more readily achievable temperatures, need for robust immunogenicity in vulnerable populations, and development of safe and effective pediatric vaccines. In this context, optimal SARS-CoV-2 vaccines may ultimately rely on inclusion of adjuvants as they can potentially enhance protection of vulnerable populations and provide dose-sparing effects enabling single shot protection.
Kidney involvement in hereditary transthyretin amyloidosis: a cohort study of 103 patients
Authors: Solignac Justine , Delmont Emilien , Fortanier Etienne , Attarian Shahram , Mancini Julien , Daniel Laurent , Ion Ioana , Ricci Jean-Etienne , Robert Thomas , Habib Gilbert , Moranne Olivier , Jourde-Chiche Noémie
Published: May 2022

Background

Hereditary transthyretin amyloidosis (ATTRv) is a disabling and life-threatening disease that primarily affects the nervous system and heart. Its kidney involvement has not been systematically studied, particularly in non-V30M mutations, and is not well known to nephrologists.

Methods

We conducted a retrospective study describing the kidney phenotype of all prevalent patients with ATTR mutations, with neurological or cardiac involvement or presymptomatic carriers, followed up in two university hospitals from the South of France between June 2011 and June 2021.

Results

A total of 103 patients were included, among whom 79 were symptomatic and 24 were presymptomatic carriers. Patients carried 21 different ATTR mutations and 54% carried the V30M mutation. After a mean follow-up of 7.9 ± 25.7 years, 30.4% of the symptomatic patients had developed chronic kidney disease (CKD) and 20.3% had a urinary protein:creatinine ratio ≥0.5 g/g. None of the presymptomatic carriers had CKD or proteinuria. In a multivariate analysis, late onset of symptoms (after 60 years), the V122I mutation and proteinuria were significantly associated with CKD. The median CKD-free survival in symptomatic patients was estimated at 81.0 years (interquartile range 77.1–84.9). It did not differ between V30M and non-V30M patients, but was lower in patients with the V122I mutation. The average age of the onset of CKD was 69.3 ± 13.0 years. In one 38-year-old V30M female who presented a kidney-predominant phenotype, treatment with patisiran resulted in remission of the nephrotic syndrome.

Conclusion

CKD affects almost one-third of patients with symptomatic ATTRv. The role of ATTRv per se in the development of CKD in this population remains to be determined, but some patients may benefit from specific therapies.
Practical ethical concerns in allocation of pig kidneys to humans
Authors: Bayliss George
Published: May 2022

The fundamental ethical question of whether pig organs should be transplanted into humans has been settled, as recent surgeries demonstrating proof of concept demonstrate. Other issues need to be considered and reconciled before xenotransplantation of pig kidneys becomes a solution to the organ shortage for people waiting for a kidney transplant or as a viable alternative to the deceased donor or living donor human kidneys. Human trials will be needed beyond brain-dead individuals to show that xenotransplantation is safe from immunologic and infectious standpoints. Transplant centers will need to show that xenotransplantation provides a long-term benefit to recipients and is financially viable. If trials are successful and receive regulatory approval, pig xenotransplants may become another option for people waiting for a kidney. Before patients are discharged with a functioning xenograft, practical issues with ethical implications remain.
Optimized Droplet Digital PCR Assay on Cell-Free DNA Samples for Non-Invasive Prenatal Diagnosis: Application to Beta-Thalassemia
Authors: Constantinou Constantina G , Karitzi Eleni , Byrou Stefania , Stephanou Coralea , Michailidou Kyriaki , Makariou Christiana , Hadjilambi Georgia , Christofides Agathoklis , Kleanthous Marina , Papasavva Thessalia
Published: May 2022

Background

Thalassemias are inherited blood disorders and by far one of the most common monogenic diseases globally. Beta-thalassemia has a particularly high prevalence in Cyprus, with the IVSI-110 G>A (HBB:c.93-21G>A) pathogenic variation representing almost 79% of the total carriers. The discovery that 3% to 20% of cell-free fetal DNA (cffDNA) is present in the maternal plasma allowed the development of non-invasive prenatal diagnosis (NIPD) of monogenic diseases, like beta-thalassemia, avoiding the risks of invasive procedures. However, the development of NIPD holds major technical challenges and has not yet reached the clinical setting.

Methods

In this study, we apply droplet digital PCR (ddPCR) coupled with the relative variant dosage approach to develop a NIPD assay for IVSI-110 G>A beta-thalassemia. We have implemented an optimization process for ddPCR to address the challenges of ddPCR assays such as inconclusive rain droplets and thus increase the sensitivity and specificity of the assay. The established protocol was evaluated on 40 maternal plasma samples with a median gestational age of 10 weeks where both parents carried the same pathogenic variation.

Results

Thirty-three samples were correctly classified, 6 remained inconclusive, and 1 was misclassified. Our assay exhibited 97.06% accuracy (95% CI, 82.46–99.68), 100% sensitivity (95% CI, 76.84–100), and 95% specificity (95% CI, 75.13–99.87), demonstrating its efficiency for the non-invasive detection of both maternal and paternal alleles.

Conclusions

We have developed an efficient, simple, and cost-effective ddPCR assay for the non-invasive determination of fetal genotype in couples at risk of IVSI-110 G>A beta-thalassemia, bringing NIPD of monogenic diseases closer to the diagnostic setting.
Development and pilot evaluation of an educational session to support sparing opioid prescriptions to opioid naïve patients in a Canadian primary care setting
Authors: Narayan Shawna , Rizzardo Stefania , Hamilton Michee-Ana , Cooper Ian , Maclure Malcolm , McCracken Rita K , Klimas Jan
Published: May 2022

Background

Prescribing rates of some analgesics decreased during the public health crisis. Yet, up to a quarter of opioid-naïve persons prescribed opioids for noncancer pain develop prescription opioid use disorder. We, therefore, sought to evaluate a pilot educational session to support primary care-based sparing of opioid analgesics for noncancer pain among opioid-naïve patients in British Columbia (BC).

Methods

Therapeutics Initiative in BC has launched an audit and feedback intervention. Individual prescribing portraits were mailed to opioid prescribers, followed by academic detailing webinars. The webinars’ learning outcomes included defining the terms opioid naïve and opioid sparing, and educating attendees on the (lack of) evidence for opioid analgesics to treat noncancer pain. The primary outcome was change in knowledge measured by four multiple-choice questions at the outset and conclusion of the webinar.

Results

Two hundred participants attended four webinars; 124 (62%) responded to the knowledge questions. Community-based primary care professionals (80/65%) from mostly urban settings (77/62%) self-identified as family physicians (46/37%), residents (22/18%), nurse practitioners (24/19%), and others (32/26%). Twelve participants (10%) recalled receiving the individualized portraits. While the correct identification of opioid naïve definitions increased by 23%, the correct identification of opioid sparing declined by 7%. Knowledge of the gaps in high-quality evidence supporting opioid analgesics and risk tools increased by 26% and 35%, respectively.

Conclusion

The educational session outlined in this pilot yielded mixed results but appeared acceptable to learners and may need further refinement to become a feasible way to train professionals to help tackle the current toxic drugs crisis.
Effects of crystalloid and colloid priming strategies for cardiopulmonary bypass on colloid oncotic pressure and haemostasis: a meta-analysis
Authors: Beukers Anne Maria , de Ruijter Jamy Adriana Catharina , Loer Stephan Alexander , Vonk Alexander , Bulte Carolien Suzanna Enna
Published: May 2022

OBJECTIVES

Colloid oncotic pressure (COP) is an important factor in cardiac surgery, owing to its role in haemodilution. The effect of cardiopulmonary bypass prime fluids on the COP is unknown. In this study, the effect of crystalloid and colloid prime fluids, with or without retrograde autologous priming (RAP), on the COP during elective cardiac surgery was evaluated.

METHODS

Randomized controlled trials and prospective clinical trials comparing crystalloid and colloid priming fluids or with RAP were selected. The primary outcome was the COP; secondary outcomes were fluid balance, fluid requirements, weight gain, blood loss, platelet count and transfusion requirements.

RESULTS

From 1582 records, 29 eligible studies were identified. COPs were comparable between gelofusine and hydroxyethyl starch (HES) during bypass [mean difference (MD): 0.69; 95% confidence interval (CI): −2.05, 3.43; P = 0.621], after bypass (MD: −0.11; 95% CI: −2.54, 2.32; P = 0.930) and postoperative (MD: −0.61; 95% CI: −1.60, 0.38; P = 0.228). Fluid balance was lower with HES than with crystalloids. RAP reduced transfusion requirements compared with crystalloids. Blood loss was comparable between groups.

CONCLUSIONS

COPs did not differ between crystalloids and colloids. As a result of increased transcapillary fluid movement, fluid balance was lower with HES than with crystalloids. Haematocrit and transfusion requirements were comparable between groups. However, the latter was lower when RAP was applied to crystalloid priming compared with crystalloids alone. Finally, no differences in blood loss were observed between the groups.
Longer Gaps Between Values of Binary Quadratic Forms
Authors: Dietmann Rainer , Elsholtz Christian , Kalmynin Alexander , Konyagin Sergei , Maynard James
Published: May 2022

We prove new lower bounds on large gaps between integers that are sums of two squares or are represented by any binary quadratic form of discriminant $D$, improving the results of Richards. Let $s_1, s_2, \ldots $ be the sequence of positive integers, arranged in increasing order, that are representable by any binary quadratic form of fixed discriminant $D$, then $$ \begin{align*} & \limsup_{n \rightarrow \infty} \frac{s_{n+1}-s_n}{\log s_n} \gg \frac{|D|}{\varphi(|D|)\log |D|}, \end{align*}$$improving a lower bound of $\frac {1}{|D|}$ of Richards. In the special case of sums of two squares, we improve Richards’s bound of $1/4$ to $\frac {390}{449}=0.868\ldots $. We also generalize Richards’s result in another direction: if $d$ is composite we show that there exist constants $C_d$ such that for all integer values of $x$ none of the values $p_d(x)=C_d+x^d$ is a sum of two squares. Let $d$ be a prime. For all $k\in {\mathbb {N}}$, there exists a smallest positive integer $y_k$ such that none of the integers $y_k+j^d, 1\leq j \leq k$, is a sum of two squares. Moreover, $$ \begin{align*} & \limsup_{k \rightarrow \infty} \frac{k}{\log y_k} \gg \frac{1}{ \sqrt{\log d}}. \end{align*}$$
Pharmacogenetics of Dolutegravir Plasma Exposure Among Southern Africans With Human Immunodeficiency Virus
Authors: Cindi Zinhle , Kawuma Aida N , Maartens Gary , Bradford Yuki , Venter Francois , Sokhela Simiso , Chandiwana Nomathemba , Wasmann Roeland E , Denti Paolo , Wiesner Lubbe , Ritchie Marylyn D , Haas David W , Sinxadi Phumla
Published: May 2022

Background

Dolutegravir is a component of preferred antiretroviral therapy (ART) regimens. We characterized the pharmacogenetics of dolutegravir exposure after ART initiation in the ADVANCE trial in South Africa.

Methods

Genome-wide genotyping followed by imputation was performed. We developed a population pharmacokinetic model for dolutegravir using nonlinear mixed-effects modeling. Linear regression models examined associations with unexplained variability in dolutegravir area under the concentration-time curve (AUCVAR).

Results

Genetic associations were evaluable in 284 individuals. Of 9 polymorphisms previously associated with dolutegravir pharmacokinetics, the lowest P value with AUCVAR was UGT1A1 rs887829 (P = 1.8 × 10−4), which was also associated with log10 bilirubin (P = 8.6 × 10−13). After adjusting for rs887829, AUCVAR was independently associated with rs28899168 in the UGT1A locus (P = .02), as were bilirubin concentrations (P = 7.7 × 10−8). In the population pharmacokinetic model, rs887829 T/T and C/T were associated with 25.9% and 10.8% decreases in dolutegravir clearance, respectively, compared with C/C. The lowest P value for AUCVAR genome-wide was CAMKMT rs343942 (P = 2.4 × 10−7).

Conclusions

In South Africa, rs887829 and rs28899168 in the UGT1A locus were independently associated with dolutegravir AUCVAR. The novel rs28899168 association warrants replication. This study enhances understanding of dolutegravir pharmacogenetics in Africa.
A New Detection of the Invasive Mexican Rice Borer (Lepidoptera: Crambidae) From Georgia in the United States Based on Morphological and Molecular Data
Authors: Kang Ilgoo , Wilson Blake , Carter Blake , Diaz Rodrigo
Published: May 2022

The Mexican rice borer, Eoreuma loftini (Dyar), is an invasive herbivore that attacks many gramineous host plants. The species is an economic pest of several grass crops in North America including sugarcane (Saccharum spp.), rice (Oryza sativa), corn (Zea mays), and sorghum (Sorghum bicolor). The species was first detected in the United States in 1980 and has since expanded its range eastward along the Gulf Coast reaching Louisiana in 2008. A disjointed introduction was detected in Florida in 2012, though range expansion of this population within the state has been limited. Most recently, a separate introduction was detected along the Atlantic coast of Georgia near the South Carolina border (32.19884° N, 81.35894° W). Larvae were collected from sugarcane in 2020 and 2021 and identified as E. loftini. The identification was confirmed with genetic analysis showing >99% similarity with most mitochondrial cytochrome c oxidase subunit 1 (COI) sequences of known E. loftini. This is the furthest north and east of any established population in North America. Potential routes of introduction and impacts to crop production along the U.S. Atlantic Coast are discussed.
A new method in establishing quantitative relationships between manuscripts of the New Testament
Authors: Hyytiäinen Pasi
Published: May 2022

New Testament textual critics have for decades calculated the similarities between the manuscripts in a similar manner, using collations and variation units. This conventional methodology requires enormous amounts of time and manual work. Here is proposed a new method that does not require these preprocessing steps, enabling the establishment of quantitative relationships using manuscript transcriptions only. This is achieved by applying a technique called shingling, where the manuscript transcriptions are turned in a computerized manner into smaller pieces called tokens or k-grams. Then, a string metric is used to calculate the similarities between the tokenized strings. This method is efficient, meaning that it allows critics to consider all textual evidence in each manuscript tradition. At the same time, it returns similarity values that are compatible with those of conventional approaches.
Dual AGN in the Horizon-AGN simulation and their link to galaxy and massive black hole mergers, with an excursus on multiple AGN
Authors: Volonteri Marta , Pfister Hugo , Beckmann Ricarda , Dotti Massimo , Dubois Yohan , Massonneau Warren , Musoke Gibwa , Tremmel Michael
Published: May 2022

The occurrence of dual active galactic nuclei (AGN) on scales of a few tens of kpc can be used to study merger-induced accretion on massive black holes (MBHs) and to derive clues on MBH mergers, using dual AGN as a parent population of precursors. We investigate the properties of dual AGN in the cosmological simulation Horizon-AGN. We create catalogs of dual AGN selected with distance and luminosity criteria, plus sub-catalogs where further mass cuts are applied. We divide the sample into dual AGN hosted in different galaxies, on the way to a merger, and into those hosted in one galaxy, after the galaxy merger has happened. We find that the relation between MBH and galaxy mass is similar to that of general AGN population and we compare the properties of dual AGN also with a control sample, discussing differences and similarities in masses and Eddington ratios. The typical mass ratio of galaxy mergers associated to dual AGN is 0.2, with mass loss in the smaller galaxy decreasing the mass ratio as the merger progresses. Between 30 and 80 per cent of dual AGN with separations between 4 and 30 kpc can be matched to an ensuing MBH merger. The dual AGN fraction increases with redshift and with separation threshold, although above 50 kpc the increase of multiple AGN limits that of duals. Multiple AGN are generally associated with massive haloes, and mass loss of satellites shapes the galaxy–halo relation.
AliSim: A Fast and Versatile Phylogenetic Sequence Simulator for the Genomic Era
Authors: Ly-Trong Nhan , Naser-Khdour Suha , Lanfear Robert , Minh Bui Quang
Published: May 2022

Sequence simulators play an important role in phylogenetics. Simulated data has many applications, such as evaluating the performance of different methods, hypothesis testing with parametric bootstraps, and, more recently, generating data for training machine-learning applications. Many sequence simulation programmes exist, but the most feature-rich programmes tend to be rather slow, and the fastest programmes tend to be feature-poor. Here, we introduce AliSim, a new tool that can efficiently simulate biologically realistic alignments under a large range of complex evolutionary models. To achieve high performance across a wide range of simulation conditions, AliSim implements an adaptive approach that combines the commonly used rate matrix and probability matrix approaches. AliSim takes 1.4 h and 1.3 GB RAM to simulate alignments with one million sequences or sites, whereas popular software Seq-Gen, Dawg, and INDELible require 2–5 h and 50–500 GB of RAM. We provide AliSim as an extension of the IQ-TREE software version 2.2, freely available at www.iqtree.org, and a comprehensive user tutorial at http://www.iqtree.org/doc/AliSim.
Measuring Nicotine Dependence Among Adolescent and Young Adult Cigarillo Users
Authors: Flocke Susan A , Ishler Karen , Albert Elizabeth , Cavallo David , Lim Rock , Trapl Erika
Published: May 2022

Introduction

Current measures of nicotine dependence (ND) were developed and validated for cigarette smokers only, limiting their utility for other combustible tobacco users. This study evaluates the psychometric properties of a pool of new and adapted items to measure ND among cigarillo and multiple tobacco product users.

Aims and Methods

Items were drawn from the PROMIS Nicotine Dependence Item Bank which were adapted to be product neutral and new items were developed from a qualitative study of 60 adolescent and young adult cigarillo smokers. A total of 42 ND items were included in a web-based survey. Eligible participants were 14–28 year olds who smoked a minimum of 2 cigarillos per week. Analyses included confirmatory factor analysis, item response theory analysis, analysis of differential item functioning, and reliability. Ordinary least square regression was used to test the association of ND score with deciles of nicotine consumption.

Results

Among the 1089 participants, the median number of cigarillos smoked per week was 20; 54% of participants also smoked cigarettes. All PROMIS items and 8 of 10 new items met the item response theory fit criteria. Two PROMIS items had nonignorable differential item functioning. The pool of 40 items had good score reliability for a range of 2 SDs. Twenty-, eight-, and four-item short forms showed similarly good measurement properties; each was positively associated with decile of nicotine consumption, p < .001; R2 = 0.33.

Conclusions

This adapted bank of ND items is psychometrically sound and includes items that are product neutral, making it suitable for assessing ND among cigarillo and polytobacco users.

Implications

This study rigorously evaluates adapted items to measure ND among cigarillo and polytobacco users and reports the reliability initial evidence of validity of short form scores.
Climate and Environmental Justice Policies in the First Year of the Biden Administration
Authors: Cha J Mijin , Farrell Caroline , Stevis Dimitris
Published: May 2022

When President Biden took office in January 2021, it was widely expected that he would reverse Trump-era policies and take steps to address climate change, racial justice, and rising inequality. Then-candidate Biden made strong commitments to addressing the climate crisis, including stating that “the Green New Deal is a crucial framework for meeting the climate challenges we face.” But with the parties evenly split in the Senate, this meant legislating ambitious climate policy would be difficult. This article analyzes the Biden Administration’s climate and environmental justice initiatives in its first year. The Biden administration successfully advanced some environmental policy through legislation but relied primarily on ambitious executive orders and with a particular focus on integrating equity and justice considerations into climate and environmental policy, while encountering challenges from Republican state officials.
Innovation and Strategic Network Formation
Authors: Dasaratha Krishna
Published: May 2022

We study a model of innovation with a large number of firms that create new technologies by combining several discrete ideas. These ideas are created via private investment and spread between firms. Firms face a choice between secrecy, which protects existing intellectual property, and openness, which facilitates learning from others. Their decisions determine interaction rates between firms, and these interaction rates enter our model as link probabilities in a learning network. Higher interaction rates impose both positive and negative externalities, as there is more learning but also more competition. We show that the equilibrium learning network is at a critical threshold between sparse and dense networks. At equilibrium, the positive externality from interaction dominates: the innovation rate and welfare would be dramatically higher if the network were denser. So there are large returns to increasing interaction rates above the critical threshold. Nevertheless, several natural types of interventions fail to move the equilibrium away from criticality. One effective policy solution is to introduce informational intermediaries, such as public innovators who do not have incentives to be secretive. These intermediaries can facilitate a high-innovation equilibrium by transmitting ideas from one private firm to another.
Diversity and Pathogenicity of Pythium Species Associated with Reduced Yields of Processing Tomatoes (Solanum lycopersicum) in Victoria, Australia
Authors: Callaghan Sophia Eleanor , Burgess Lester William , Ades Peter , Tesoriero Len Anthony , Taylor Paul William James
Published: May 2022

Yield decline associated with poor crop establishment, stunting, wilting, and diminished root systems was reported in processing tomato crops in Victoria, Australia. During surveys between 2016 and 2018 Pythium species were isolated by soil baiting and by culturing from the diseased roots and collars of plants exhibiting these symptoms. Eleven species of Pythium were identified based on cultural characteristics and phylogenetic analysis with ITS, Cox-1, and Cox-2 gene sequences. None of the 11 Pythium species had been reported previously from processing or fresh tomatoes in Australia. Pythium dissotocum was the most abundant and widespread species isolated during surveys in each of two growing seasons. In pathogenicity tests, these Pythium species ranged from nonpathogenic to highly aggressive. P. aphanidermatum, P. ultimum, and P. irregulare were consistently the most aggressive species, causing serious damage or death at the pregermination, postgermination, and later stages of plant growth. Five processing tomato cultivars varied significantly in their susceptibility to Pythium disease. These results suggest that Pythium species could be contributing to yield loss in processing tomatoes in Victoria both in the crop establishment phase and through the season.
Psychometric Evaluation of the Clinical and Simulation General Self-Efficacy Scale
Authors: Brennan Brittany A.
Published: May 2022

Clinical education and simulation can influence nursing students’ self-efficacy, but there is a lack of reliable and valid instruments to measure self-efficacy in these areas. The aim of this study was to psychometrically evaluate the Clinical and Simulation General Self-Efficacy Scale (CSGSES) in a sample of 125 nursing students. The scale content validity index was .94. Exploratory factor analysis revealed a three-factor model with 16 items. Concurrent validity showed a positive association; Cronbach’s alpha was .875; test-retest reliability was significant. The revised CSGSES shows evidence of validity and reliability to measure nursing student self-efficacy concerning clinical and simulation.
The Safety Profile of Hepatectomy Following Preoperative Systemic Therapy with Lenvatinib Plus Anti-PD-1 Antibodies Versus Hepatectomy Alone in Patients With Hepatocellular Carcinoma
Authors: Shen Ying-Hao , Huang Cheng , Zhu Xiao-Dong , Xu Ming-Hao , Chen Zhao-Shuo , Tan Chang-Jun , Zhou Jian , Fan Jia , Sun Hui-Chuan
Published: May 2022

Objective:

To determine the safety of hepatectomy after combined lenvatinib and anti-PD-1 preoperative systemic therapy (PST) in patients with marginally resectable hepatocellular carcinoma (HCC).

Background:

PST followed by hepatectomy (PSTH) is an emerging treatment for HCC. However, the impact of PST with lenvatinib plus anti-PD-1 antibodies on surgical safety is unknown.

Methods:

Medical records from consecutive patients with marginally resectable advanced HCC who underwent hepatectomy after PST with lenvatinib and anti-PD-1 antibodies between January 2018 and August 2021 were retrieved from a prospectively designed database. Propensity score matching (1:2) was performed with a further 2318 HCC patients who underwent upfront hepatectomy (UH) without initial antitumor treatment during the same period.

Results:

In total, 49 and 98 matched patients were included in the PSTH and UH groups, respectively. Compared to the UH group, individuals in the PSTH group experienced more intraoperative blood loss, blood transfusions, and longer postoperative hospital stays. Moreover, posthepatectomy liver failure was more common in the PSTH group, who also had worse albumin-bilirubin (ALBI) scores on postoperative days 1–7. A significantly greater amount of drainage was also required in the PSTH group. However, the 30-day morbidity and 90-day mortality were similar among the two groups. Additionally, the duration of surgery, use of hepatic inflow occlusion during surgery, and the levels of postoperative inflammation-based markers were not statistically different between the two groups.

Conclusions:

Despite more intraoperative and postoperative adverse events, PSTH had comparable 30-day morbidity and 90-day mortality as UH. Thus, PSTH appears to be a viable treatment option for marginally resectable HCC patients with careful preoperative evaluation.
Moisturization of the Surgical Field during Cancer Resection Reduces Perioperative Complications in Reconstruction Surgery
Authors: Ishii Megumi , Tashima Hiroki , Tomita Koichi , Kurita Tomoyuki , Kubo Tateki
Published: May 2022

Background:

Intraoperative tissue desiccation is a risk factor for infection and wound necrosis. We hypothesized that maintaining a moist environment in the surgical field would reduce perioperative complications in free flap reconstruction for head and neck cancer surgery.

Methods:

A total of 331 patients who underwent free flap reconstruction after head and neck cancer surgery from January 2013 to December 2017 at Osaka International Cancer Institute were included in the study. We classified patients into two groups: those in whom saline was sprayed only during reconstruction (control group: 162 patients) and those in whom saline was sprayed in the surgical field intermittently during cancer resection and reconstruction (moisturized group: 169 patients). We compared perioperative complications, including intraoperative arterial anastomotic thrombosis, between the two groups. Other candidate risk factors for intraoperative arterial thrombosis that were assessed included a history of preoperative irradiation, history of neck surgery, advanced age, and flap type.

Results:

Rates of abscess formation and intraoperative arterial thrombosis were significantly lower in the moisturized group than in the control group (6.5% versus 12.7%, P < 0.05 and 3.0% versus 11.1%, P < 0.01, respectively). Binomial logistic regression analysis revealed that, in addition to no moisturization during cancer resection, advanced age and jejunal flap use were significant risk factors for intraoperative arterial thrombosis.

Conclusions:

Moisturization of the surgical field during cancer resection reduced the rate of perioperative complications in free flap reconstruction. Although simple, preventing desiccation of the surgical field by spraying saline solution intermittently had significant benefits on postoperative complications.
Maddalena Opioid Switching Score in patients with cancer pain
Authors: Mercadante Sebastiano , Lo Cascio Alessio , Adile Claudio , Ferrera Patrizia , Casuccio Alessandra
Published: May 2022

Evaluation of opioid switching (OS) for cancer pain has not been properly assessed. The aim of this study was to assess an integrated score (Maddalena Opioid Switching Score) as a simple and repeatable tool to evaluate the outcomes of OS, facilitating the interpretation and comparison of studies, and information exchange among researchers. The integrated score took into account pain intensity, intensity of opioid-related symptoms, and cognitive function by using an author's formula. Physical and psychological symptoms were evaluated by the Edmonton Symptom Assessment Scale and Patient Global Impression (PGI) by the minimal clinically important difference. One hundred six patients were analyzed. Ninety-five patients were switched successfully, and 11 patients underwent a further OS and/or an alternative procedure. The Maddalena Opioid Switching Score significantly decreased after OS and was highly correlated to PGI of improvement (P < 0.0005). In patients with unsuccessful OS, no significant changes in the Maddalena Opioid Switching Score and PGI were observed. A significant reduction in Edmonton Symptom Assessment Scale items intensity was observed after OS. The Maddalena Opioid Switching Score resulted to be a sensitive instrument for measuring the clinical improvement produced by OS.
Air versus Saline: The Effect of Tissue Expander Fill on Outcomes of Prepectoral Breast Reconstruction
Authors: Yesantharao Pooja S. , Rizk Nada , Martin Shanique A. , Tevlin Ruth , Lee Gordon K. , Nazerali Rahim S.
Published: May 2022

Background:

Traditionally, saline is used for intraoperative/postoperative expansion in two-stage alloplastic breast reconstruction. Recently, intraoperative expansion with air has been proposed, to reduce pressure on the mastectomy skin flap in the immediate postoperative setting. The authors examined whether the intraoperative tissue expansion medium (i.e., air versus saline) affected postmastectomy complications in two-stage prepectoral reconstruction.

Methods:

This was a retrospective cohort study of 87 patients (144 breasts) undergoing prepectoral breast reconstruction at the authors’ institution. Patient data were abstracted from medical records. Stepwise, multivariable-adjusted logistic regression using robust variances was used to identify predictors of postmastectomy complications. Statistical and power analyses were completed.

Results:

Of the 87 study patients, 29 (33.3 percent) received intraoperative saline fill and 58 (66.7 percent) received air fill. Demographic/clinical data were well-matched between cohorts. Median follow-up was 165 days, and average patient age was 46.7 years. Initial tissue expander fill volumes were similar between study cohorts (p = 0.2). The crude association between air versus saline fill on overall complication rates suggested that air-filled tissue expanders may be protective (OR = 0.4; p = 0.03), and the suggested protective effect was maintained with borderline significance even after potential confounders (i.e., American Society of Anesthesiologists class III or higher, body mass index, diabetes, mastectomy specimen weight, smoking status) were added to the model (OR = 0.4; p = 0.05). In addition, fewer complications requiring salvage reoperation were observed with air-filled tissue expanders (adjusted OR = 0.3; p = 0.02).

Conclusions:

The medium used for immediate intraoperative tissue expansion impacted postmastectomy outcomes in patients undergoing two-stage prepectoral breast reconstruction. The results demonstrated that air-filled tissue expanders were associated with fewer postoperative complications/salvage reoperations relative to saline-filled tissue expanders.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Aquatic Therapy Intervention, Including the 4-Walls Drill, for Persons With Hoehn and Yahr Stage IV Parkinson's Disease: A Retrospective Data Analysis
Authors: Thorson Carolyn L. , Hogan Baylor Elizabeth , Brown Patricia Saccomanno
Published: May 2022

Background and Purpose:

Individuals with Parkinson's disease (PD) experience a decline in functional mobility secondary to the associated motor symptoms of festinating gait, rigidity, bradykinesia, and postural instability. The objectives of this study were to determine the feasibility of the 4-walls drill for individuals with Hoehn and Yahr stage IV (H&Y IV) PD and evaluate the effect of an aquatic therapy (AT) intervention on land-based gait speed.

Methods:

A retrospective data analysis was performed after 4 individuals completed an AT program incorporating the 4-walls drill. Primary outcome of gait speed was measured via land-based 4-m walk test (4MWT). Secondary outcome measures in the aquatic environment included 60-second sit-to-stand (STS) test, forward walking speed, and number of steps for backward and sideways walking. A Wilcoxon signed rank test was used to determine significance, with significance set at .05.

Results:

No adverse events were reported. Analysis of pre- and posttreatment scores revealed no significant difference in the 4MWT (P = .068), 60-second STS test (P = 1.0), and forward (P = .144), backward (P = .93), and sideways (P = .144) walking.

Conclusion:

The 4-walls drill is a safe and feasible intervention for persons with H&Y IV PD. The results did not show a statistically significant improvement in land-based gait speed or aquatic outcome measures. One subject continued to receive AT for an additional 5 visits and demonstrated continued improvement across all aquatic outcome measures. Future research with a larger sample size and longer intervention duration is needed.
Direct and Indirect Effects of a Project ECHO Longitudinal Clinical Tele-Mentoring Program on Viral Suppression for Persons With HIV: A Population-Based Analysis
Authors: Wood Brian R. , Bauer Karin , Lechtenberg Richard , Buskin Susan E. , Bush Lea , Capizzi Jeff , Crutsinger-Perry Beth , Erly Steven J. , Menza Timothy W. , Reuer Jennifer R. , Golden Matthew R. , Hughes James P.
Published: May 2022

Background:

Project Extension for Community Health Outcomes (ECHO) aims to connect community providers to academic specialists, deliver longitudinal clinical mentorship and case consultations, plus encourage dissemination of knowledge and resources. The impact on outcomes for persons with HIV (PWH) is uncertain.

Setting:

PWH in Washington and Oregon outside of the Seattle and Portland metro areas, January 2011 to March 2018.

Methods:

Using viral load (VL) surveillance data, we assessed difference in the percentage of PWH who were virally suppressed among PWH whose providers participated versus did not participate in Project ECHO. Analyses included multiple mixed-effects regression models, adjusting for time and for patient, provider, and clinic characteristics.

Results:

Based on 65,623 VL results, Project ECHO participation was associated with an increase in the percentage of patients with VL suppression (13.7 percentage points greater;P< 0.0001), although the effect varied by estimated provider PWH patient volume. The difference was 14.7 percentage points (P< 0.0001) among patients of providers who order <20 VL's/quarter and 2.3 and −0.6 percentage points among patients of providers who order 20–40 or >40 VL's/quarter, respectively (P> 0.5). The magnitude of difference in VL suppression was associated with the number of sessions attended. Among patients of lower-volume providers who did not participate, VL suppression was 6.2 percentage points higher if providers worked in a clinic where another provider did participate (P< 0.0001).

Conclusion:

Project ECHO is associated with improvement in VL suppression for PWH whose providers participate or work in the same clinic system as a provider who participates, primarily because of benefits for patients of lower-volume providers.
Flower sharing and pollinator health: a behavioural perspective
Authors: Nicholls E. , Rands S. A. , Botías C. , Hempel de Ibarra N.
Published: May 2022

Disease is an integral part of any organisms' life, and bees have evolved immune responses and a suite of hygienic behaviours to keep them at bay in the nest. It is now evident that flowers are another transmission hub for pathogens and parasites, raising questions about adaptations that help pollinating insects stay healthy while visiting hundreds of plants over their lifetime. Drawing on recent advances in our understanding of how bees of varying size, dietary specialization and sociality differ in their foraging ranges, navigational strategies and floral resource preferences, we explore the behavioural mechanisms and strategies that may enable foraging bees to reduce disease exposure and transmission risks at flowers by partitioning overlapping resources in space and in time. By taking a novel behavioural perspective, we highlight the missing links between disease biology and the ecology of plant–pollinator relationships, critical for improving the understanding of disease transmission risks and the better design and management of habitat for pollinator conservation.

This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.
Consuming sunflower pollen reduced pathogen infection but did not alter measures of immunity in bumblebees
Authors: Fowler Alison E. , Sadd Ben M. , Bassingthwaite Toby , Irwin Rebecca E. , Adler Lynn S.
Published: May 2022

Certain diets can benefit bee health by reducing pathogens, but the mechanism(s) driving these medicinal effects are largely unexplored. Recent research found that sunflower (Helianthus annuus) pollen reduces the gut pathogenCrithidia bombiin the common eastern bumblebee (Bombus impatiens). Here, we tested the effects of sunflower pollen and infection on two bee immune metrics to determine whether sunflower pollen diet drives changes in host immunity that can explain this medicinal effect. Bees were infected withC. bombior not and given either sunflower or wildflower pollen. Subsequently, bees received a benign immune challenge or were left naive to test the induced and constitutive immune responses, respectively. We measured haemolymph phenoloxidase activity, involved in the melanization cascade, and antibacterial activity. Sunflower pollen reducedC. bombiinfection, but we found no significant pollen diet effect on either immune measure. Phenoloxidase activity was also not affected byC. bombiinfection status; however, uninfected bees were more likely to have measurable constitutive antibacterial activity, while infected bees had higher induced antibacterial activity. Overall, we found that sunflower pollen does not significantly affect the immune responses we measured, suggesting that the mechanisms underlying its medicinal effect do not involve these bee immune parameters.

This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.
Sweet solutions: nectar chemistry and quality
Authors: Nicolson Susan W.
Published: May 2022

Nectar, the main floral reward for pollinators, varies greatly in composition and concentration. The assumption that nectar quality is equivalent to its sugar (energy) concentration is too simple. Diverse non-sugar components, especially amino acids and secondary metabolites, play various roles in nutrition and health of pollinators. Many nectar compounds have indirect effects by altering the foraging behaviour of pollinators or protecting them from disease. This review also emphasizes the water component of nectar, often ignored because of evaporative losses and difficulties in sampling small nectar volumes. Nectar properties vary with environmental factors, pollinator visits and microbial contamination. Pollination mutualisms depend on the ability of insect and vertebrate pollinators to cope with and benefit from the variation and diversity in nectar chemistry.

This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.
Mutualism has its limits: consequences of asymmetric interactions between a well-defended plant and its herbivorous pollinator
Authors: Balbuena Maria Sol , Broadhead Geoffrey T. , Dahake Ajinkya , Barnett Emily , Vergara Melissa , Skogen Krissa A. , Jogesh Tania , Raguso Robert A.
Published: May 2022

Concern for pollinator health often focuses on social bees and their agricultural importance at the expense of other pollinators and their ecosystem services. When pollinating herbivores use the same plants as nectar sources and larval hosts, ecological conflicts emerge for both parties, as the pollinator's services are mitigated by herbivory and its larvae are harmed by plant defences. We tracked individual-level metrics of pollinator health—growth, survivorship, fecundity—across the life cycle of a pollinating herbivore, the common hawkmoth,
Hyles lineata
, interacting with a rare plant,
Oenothera harringtonii
, that is polymorphic for the common floral volatile (
R
)-(−)-linalool. Linalool had no impact on floral attraction, but its experimental addition suppressed oviposition on plants lacking linalool. Plants showed robust resistance against herbivory from leaf-disc to whole-plant scales, through poor larval growth and survivorship. Higher larval performance on other
Oenothera
species indicates that constitutive herbivore resistance by
O. harringtonii
is not a genus-wide trait. Leaf volatiles differed among populations of
O. harringtonii
but were not induced by larval herbivory. Similarly, elagitannins and other phenolics varied among plant tissues but were not herbivore-induced. Our findings highlight asymmetric plant–pollinator interactions and the importance of third parties, including alternative larval host plants, in maintaining pollinator health.

This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.