bluuebunny/crossref_metadata_2025 huggingface dataset:
James Thomson (B.V.)
Authors: Huseby Amy
Published: July 2023

James Thomson (B. V.) (b. 1834–d. 1882), who frequently published under the pseudonym Bysshe Vanolis, is a notable figure of fin-de-siécle poetry and the freethought movements in 19th-century England. Thomson wrote more than a dozen books of poetry, satire, biography, and essays, but he is best known for his poem The City of Dreadful Night (1874, 1880). As for his pseudonym, Bysshe he took from the poet Shelley, and Vanolis is an anagram of the German novalis, meaning “new ground.” Born in Port Glasgow, Scotland, he was orphaned by the age of eight, suffering the loss of both parents, a sister, and his sweetheart all in his early life. Thomson trained as an army schoolmaster and served in Ireland until almost the age of thirty, after which he moved to London and became a clerk. He struggled with chronic alcoholism (he was jailed several times and hospitalized repeatedly), depression, hypochondria, and insomnia, often relying on friends for housing, food, and legal assistance. Ultimately, he suffered a painful, lonely, likely alcoholism-related death. Despite such miseries, Thomson managed to establish a reputation as a poet, literary critic, and radical prose author of some merit, garnering the admiration of literati including George Eliot, William Michael Rossetti, George Meredith, and Amy Levy. His childhood at the Royal Caledonian Asylum was an experience that would shape references in City. Specifically, his early religious education from the Rev. John Cumming (b. 1807–d. 1881), a member of the asylum court (akin to a board of directors) who, in 1849, became the minister of the Caledonian Church associated with the asylum, made a distinct and lasting impression. Cumming formed in the young Thomson a lifelong distrust and animosity toward organized religion. It is little surprise, then, that when Thomson met the well-known freethinker and publisher Charles Bradlaugh (b. 1833–d. 1891), the two formed a friendship. Thomson also befriended the Holyoake brothers, Austin and George Jacob—printers, publishers, editors, freethinkers. During Thomson’s final days, Austin’s son, Percy Holyoake, together with the poet Bertram Dobell, worked to remove Thomson’s liquor stashes, get him out of jail, find him housing, and retrieve him repeatedly from the hospital. Both men corresponded regularly about the author’s whereabouts and condition. Thomson was so close to Austin Holyoake that he would eventually be buried in the same grave at Highgate Cemetery.
The Insanity Defense
Authors: Vitacco Michael J.
Published: July 2023

The insanity defense is a legal standard that deals with determining culpability for criminal acts. When met, it absolves the individual of a criminal act they committed, although they are typically mandated to a secure hospital for treatment. As defined in federal jurisdictions under 18 U.S.C. §17(a), insanity “is an affirmative defense under any Federal Statute that, at the time of the commission of the acts constituting the offense, the defendant as a result of severe mental disease or defect, was unable to appreciate the nature and quality or the wrongfulness of his acts.” The presence of a mental disease or defect is considered a threshold condition, meaning it first must be determined if a mental disease or defect exists, and then determined if that condition was severe enough to cause the individual to be unable to appreciate the wrongfulness of their acts. Some states have added a volitional component to their insanity defense. This prong deals with if an individual, as the result of a threshold condition, lacks the substantial capacity to conform their conduct to the law. However, it must be noted that the insanity defense is unpopular with many state legislatures. Four states (Idaho, Kansas, Montana, and Utah) have abolished the insanity defense. Forensic psychiatrists and psychologists are often tasked with conducting these retrospective evaluations. This is a difficult task, as it requires the forensic practitioner to reconstruct an individual’s mental state as it relates to the alleged criminal act days, months, or even years after the event. To conduct these evaluations properly often requires a substantial amount of collateral information, including previous mental health records, academic records, employment records, and, most recently, information gleaned from social media, that can assist the evaluator in the reconstruction of an individual’s mental state. This bibliography emphasizes the complexity of the insanity defense and its complicated and lengthy history. However, readers are encouraged to further explore articles and books to elucidate the lengthy legal history of the insanity defense and complexities in conducting insanity evaluations.
Judaism and Buddhism
Authors: Musch Sebastian
Published: July 2023

Until recently, the field of Jewish-Buddhist studies had been neglected. The dearth of proper academic literature on the relationship between Judaism and Buddhism remains a problem, and despite many meritorious and pioneering studies in recent years, many aspects—historic especially—remain insufficiently researched. Scholarship on Judaism and Buddhism can be divided into three waves. The first wave proliferated from the mid-nineteenth century with speculation on links between Judaism and Buddhism in antiquity, especially regarding the influence of Buddhist ideas on the Hebrew Bible. However, this line of research subsequently lost some amount of clout among scholars during the twentieth century, and its publications are of limited value today. Comparative approaches gained popularity in a second wave during the 1960s and 1970s with the growing interest in Buddhism and Buddhist-inspired meditation during the counterculture movement, when North American Jews in particular developed a strong affinity to Buddhism that persists today. This has been widely known as the JuBu (or JewBu) phenomenon since Rodger Kamenetz’s classic The Jew in the Lotus (1994), which gave birth to a generation of scholars of Jewish-Buddhist studies who were part of this trend as much as they shaped it. Since the 1990s, the current and third wave of scholarship has used sociological, ethnographic, and historical approaches around three main foci: the so-called JuBu phenomenon remains of paramount interest, the first and second waves of Jewish-Buddhist Studies have begun to be historicized by scholars as a research subject in itself, and Jewish-Buddhist interactions not only in North America but also in Europe and Israel have garnered increasing attention. All this has recently brought new methodological qualities previously missing in Jewish-Buddhist studies to the forefront. Future tasks for the field include the study of syncretistic practices that blend Buddhism and Judaism; the exploration of Jews in Buddhist contexts in South and East Asia, a focus that has been lacking most often due to linguistic and disciplinary limitations; and developing all these geographical aspects into a global history of Judaism and Buddhism.
Economic Justice in the Talmud
Authors: Cohen Aryeh
Published: July 2023

“Economic justice” is a relatively modern term which is not internal to Talmud. This does not mean that the ideas and concepts that are usually categorized under economic justice—labor relations, fairness in wages, homelessness, markets—are not found in Talmud. The opposite is true. One implication of this is that there are broadly two approaches to economic justice in Talmud. The first is analytical, or a history of ideas approach, which answers the question: What did the sages represented in Talmud, or the anonymous editor(s) of the Talmud, think about (for example) poverty and poverty relief? This approach is descriptive and not prescriptive, which is at odds with the phrase “economic justice,” which implies that there are more and less just economic arrangements. On the other hand, there is the prescriptive approach, which, at its best, analyzes the Talmudic texts using the available scholarly tools and then draws ethical conclusions to contemporary problems from the Talmudic texts. Oftentimes these works start with the Talmud and then incorporate medieval and modern Jewish and non-Jewish sources in their discussions. A classic of the first type is Urbach 1969 (cited under Overviews and Introductions), which is an overview of the conceptual and religious world of the sages. Urbach discusses justice issues within this broader context. A classic of the latter type is Dorff 2002 (cited under Overviews and Introductions), whose goal is to articulate a Jewish approach to social ethics using, amongst other sources, the Talmud. I have also included two traditional legal responses (“responsa”) about labor issues since they cover much of the same ground in terms of Talmudic texts, but have a distinct normative goal (Uzziel 1938; Jacobs 2008, both cited under Labor). Many of the contemporary works cited here also cite responsa as primary texts when discussing issues of economic justice.
Late Maoist Economic Policies
Authors: Chu Yin-Wah
Published: July 2023

This entry adopts the year 1955 as the beginning of the late Maoist period. The decision is made upon a review of several studies of Maoist China. Having done this, this entry proceeds to discuss the economic policies introduced between 1955 and 1976, highlighting the drive to collectivization and communization, adjustments in the early 1960s subsequent to the Great Leap disaster, reform and reassertion of communization since the mid-1960s, as well as Third Front industrialization introduced around 1964. A few words will also be said in relation to specific topics related to the economic policies. Outcomes in terms of growth, structural transformation, distributive equality, and social well-being are then discussed with an effort to bring out the divergent assessments. To make sense of the formulation and implementation of the policies, this entry goes on to examine the ideational foundation in terms of Maoist thought and Chinese culture, social-structural factors pertaining to world capitalism, China’s position as a developing country, and the class struggles that attended the country’s pursuit of socialism, as well as political institutions, especially Mao’s relations to the civil bureaucracy and the issue of factionalism. The last section of this entry will highlight the lived experience of the Chinese during the late Maoist era and the people’s resistance, if any.
Projected Benefits of Long-Acting Antiretroviral Therapy in Nonsuppressed People With Human Immunodeficiency Virus Experiencing Adherence Barriers
Authors: Chen Wanyi , Gandhi Monica , Sax Paul E , Neilan Anne M , Garland Wendy H , Wilkin Timothy , Cohen Rebecca , Ciaranello Andrea L , Kulkarni Sonali P , Eron Joseph , Freedberg Kenneth A , Hyle Emily P
Published: July 2023

Background

In a demonstration project, long-acting, injectable cabotegravir-rilpivirine (CAB-RPV) achieved viral suppression in a high proportion of people with HIV (PWH) who were virologically nonsuppressed with adherence barriers. We projected the long-term impact of CAB-RPV for nonsuppressed PWH experiencing adherence barriers.

Methods

Using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model, we compared 3 strategies: (1) standard of care oral integrase inhibitor–based ART (INSTI); (2) INSTI-based ART with supportive social services (“wraparound services” [WS]) (INSTI/WS); and (3) CAB-RPV with WS (CAB-RPV/WS). Model outcomes included viral suppression (%) and engagement in care (%) at 3 years, and life expectancy (life-years [LYs]). Base case cohort characteristics included mean age of 47y (standard deviation [SD], 10y), 90% male at birth, and baseline mean CD4 count 150/µL (SD, 75/µL). Viral suppression at 3 months was 13% (INSTI), 28% (INSTI/WS), and 60% (CAB-RPV/WS). Mean loss to follow-up was 28/100 person-years (PY) (SD, 2/100 PY) without WS and 16/100 PY (SD, 1/100 PY) with WS.

Results

Projected viral suppression at 3 years would vary widely: 16% (INSTI), 38% (INSTI/WS), and 44% (CAB-RPV/WS). Life expectancy would be 7.4 LY (INSTI), 9.0 LY (INSTI/WS), and 9.4 LY (CAB-RPV/WS). Projected benefits over oral ART would be greater for PWH initiating CAB-RPV/WS at lower CD4 counts. Across plausible key parameter ranges, CAB-RPV/WS would improve viral suppression and life expectancy compared with oral INSTI strategies.

Conclusions

These model-based results support that long-acting injectable CAB-RPV with extensive support services for nonsuppressed PWH experiencing adherence barriers is likely to increase viral suppression and improve survival. A prospective study to provide further evidence is needed.
Supporting meaningful research partnerships: an interview study applying behavior change theory to develop relevant recommendations for researchers
Authors: Shwed Alanna , Giroux Emily E , Hoekstra Femke , McKay Rhyann C , Schaefer Lee , West Christopher R , McPhail Lowell T , Sibley Kathryn M , McBride Christopher B , Munro Barry , Kaiser Anita ,   SCI Guiding Principles Consensus Panel, Gainforth Heather L
Published: July 2023

Research partnerships, while promising for ensuring translation of relevant and useable findings, are challenging and need support. This study aimed to apply behavior change theory to understand and support researchers’ adoption of a research partnership approach and the Integrated Knowledge Translation (IKT) Guiding Principles for conducting and disseminating spinal cord injury (SCI) research in partnership. Using an IKT approach, SCI researchers across Canada and the USA completed a survey (n = 22) and were interviewed (n = 13) to discuss barriers and facilitators to deciding to partner and follow the IKT Guiding Principles. The Behaviour Change Wheel, Theoretical Domains Framework (TDF), and Mode of Delivery Ontology were used to develop the survey, interview questions, and guided analyses of interview data. COM-B and TDF factors were examined using descriptive statistics and abductive analyses of barriers and facilitators of decisions to partner and/or use the IKT Guiding Principles. TDF domains from the interview transcripts were then used to identify intervention, content, and implementation options. 142 factors (79 barriers, 63 facilitators) related to deciding to partner, and 292 factors (187 barriers, 105 facilitators) related to deciding to follow the IKT Guiding Principles were identified. Barriers to partnering or use the IKT Guiding Principles were primarily related to capability and opportunity and relevant intervention options were recommended. Interventions must support researchers in understanding how to partner and use the IKT Guiding Principles while navigating a research system, which is not always supportive of the necessary time and costs required for meaningful research partnerships.
Composition and structural organization of tardigrades feeding apparatus focusing on chitin and other autofluorescent molecules
Authors: Massa Edoardo , Rebecchi Lorena , Guidetti Roberto
Published: July 2023

Chitin is a structural sugar broadly distributed among all kingdoms, and it is present in Tardigrada as α-chitin. Its presence in the buccopharyngeal apparatus of tardigrades was confirmed in previous studies and associated with autofluorescence emission, and within this emission three components were identified. This study aimed to localize the chitin in the buccopharyngeal apparatus and to understand the nature of the other autofluorescent components. Calcofluor white staining of three tardigrade species (Echiniscus sp., Milnesium sp., Macrobiotus sp.) allowed the chitin localization in the feeding structures and the separation of its signal from the whole autofluorescence emission via confocal laser scanning microscopy. Comparing different fluorochromes found in tardigrades and in the nematode Panagrellus pycnus, lambda and square lambda analyses showed that part of the autofluorescent signal is imputable to a collagen-like compound. The images acquired were analysed for morphological, functional, and evolutionary purposes. Chitin and the other autofluorescent compound were localized in the structures of the buccopharyngeal apparatus. Their distribution highlighted the presence of different levels of ‘flexibility/strength’ of the structures providing better understanding of their mechanical properties and relating them to the characteristics of the three major limnoterrestrial clades of the phylum Tardigrada.
Elevated serum levels of T-cell immunoglobulin and mucin-domain containing molecule 3 in patients with systemic inflammation following COVID-19 vaccination
Authors: Hsieh Ming-Chieh , Yu Wen-Chung , Weng Chang-Chi , Chen Wei-Jen , Chen Chun-Ku , Lee Ying-Chi , Chen Ming-Han
Published: July 2023

Background:

ChAdOx1 nCoV-19 vaccine has been widely used. Some unexpected adverse effects such as the development of systemic hyper inflammation with multiorgan involvement after vaccination, in rare cases, have been reported. However, its pathogenesis remains unclear.

Methods:

This study recruited two cases who suffered from systemic inflammation following ChAdOx1 nCoV-19 vaccine and two 30-year-old male volunteers without underlying disease who have received ChAdOx1 nCoV-19 vaccine as control group. Blood samples were collected from our patients and healthy subjects before and after treatment with anti-inflammatory agent such as glucocorticoid and tocilizumab. The immune profile from our patients and healthy controls were measured using a human XL cytokine Proteome Profiler array (ARY022b, R&D Systems).

Results:

Biochemical parameters revealed leukocytosis with segmented neutrophil dominance and elevated serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate, and ferritin in these two patients. The cytokine array revealed that mean levels of T cell immunoglobulin and mucin-domain containing-3 (TIM-3) (3640.3 vs 1580.5 pixels per inch [ppi]), B-cell activating factor (BAFF) (3036.8 vs 1471.0 ppi), urokinase plasminogen activator surface receptor (uPAR) (1043.1 vs 516.8 ppi), Resistin (1783.7 vs 711.3 ppi), platelet-derived growth factor (PDGF)-AB/BB (1980.7 vs 939.7 ppi), macrophage inflammatory protein-3-beta (MIP-3β) (911.9 vs 346.2 ppi), and interferon-inducible T-cell alpha chemoattractant (I-TAC) (1026.3 vs 419.7 ppi) were 2-fold higher in the patients than in normal subjects who received ChAdOx1 nCoV-19 vaccine.

Conclusion:

We demonstrated that systemic inflammation may occur in subjects who have received the ChAdOx1 nCoV-19 vaccination. Moreover, we proposed immune markers, which may be implicated in the pathogenesis of systemic inflammation following COVID-19 vaccination as potential diagnostic biomarkers.
Serum VEGF Levels on Admission in COVID-19 Patients Correlate with SP-D and Neutrophils, Reflecting Disease Severity: A Prospective Study
Authors: Tsuji Mayoko , Kondo Mitsuko , Sato Yasuto , Miyoshi Azusa , Kobayashi Fumi , Arimura Ken , Yamashita Kaoru , Morimoto Satoshi , Yanagisawa Naoko , Ichihara Atsuhiro , Tagaya Etsuko
Published: July 2023

Background and objective

The COVID-19 pandemic caused by SARS-CoV-2 has resulted in significant global morbidity and mortality. This study aimed to investigate the clinical significance of serum vascular endothelial growth factor (VEGF) in COVID-19 patients and its association with disease severity and pulmonary injury.

Methods

We prospectively collected data from 71 hospitalized COVID-19 patients between June 2020 and January 2021. Patients were classified as either mild or severe based on their oxygen requirements during hospitalization. Serum VEGF levels were measured using an ELISA kit.

Results

In comparison to mild cases, significantly elevated serum VEGF levels were observed in severe COVID-19 patients. Furthermore, VEGF levels exhibited a positive correlation with white blood cell count, neutrophil count, and lymphocyte count. Notably, serum surfactant protein-D (SP-D), an indicator of alveolar epithelial cell damage, was significantly higher in patients with elevated VEGF levels.

Conclusion

These results suggest that elevated serum VEGF levels could serve as a prognostic biomarker for COVID-19 as it is indicative of alveolar epithelial cell injury caused by SARS-CoV-2 infection. Additionally, we observed a correlation between VEGF and neutrophil activation, which plays a role in the immune response during endothelial cell injury, indicating a potential involvement of angiogenesis in disease progression. Further research is needed to elucidate the underlying mechanisms of VEGF elevation in COVID-19.
Using an Anomaly Detection Approach for the Segmentation of Colorectal Cancer Tumors in Whole Slide Images
Authors: Gu Qiangqiang , Meroueh Chady , Levernier Jacob , Kroneman Trynda , Flotte Thomas , Hart Steven
Published: July 2023

Colorectal cancer (CRC) is the 2ndmost commonly diagnosed cancer in the United States. Genetic testing is critical in assisting in the early detection of CRC and selection of individualized treatment plans, which have shown to improve the survival rate of CRC patients. The tissue slides review (TSR), a tumor tissue macro-dissection procedure, is a required pre-analytical step to perform genetic testing. Due to the subjective nature of the process, major discrepancies in CRC diagnostics by pathologists are reported, and metrics for quality are often only qualitative. Progressive context encoder anomaly detection (P-CEAD) is an anomaly detection approach to detect tumor tissue from Whole Slide Images (WSIs), since tumor tissue is by its nature, an anomaly. P-CEAD-based CRC tumor segmentation achieves a 71% ±26% sensitivity, 92% ±7% specificity, and 63% ±23% F1 score. The proposed approach provides an automated CRC tumor segmentation pipeline with a quantitatively reproducible quality compared with the conventional manual tumor segmentation procedure.
A multidisciplinary assessment of ChatGPT’s knowledge of amyloidosis
Authors: King Ryan C. , Samaan Jamil S. , Yeo Yee Hui , Kunkel David C. , Habib Ali A. , Ghashghaei Roxana
Published: July 2023

Amyloidosis is a rare, multisystem disease with several subtypes including AA (secondary), AL (amyloid light chain), and ATTR (transthyretin amyloidosis). In addition to variable symptoms and multidisciplinary management, amyloidosis being a rare disease further contributes to patients being at risk for decreased health literacy regarding their condition. Increased access to education materials containing simple, plain language may bridge literacy gaps and improve outcomes for patients with rare diseases such as amyloidosis. The large language model (LLM), Chat Generative Pre-Trained Transformer (ChatGPT), may be a powerful tool for improving the availability of accurate and easy to understand education materials. Amyloidosis-related questions from cardiology, gastroenterology, and neurology were sourced from esteemed medical societies and institutions along with amyloidosis Facebook support groups and inputted into ChatGPT-3.5 and GPT-4. Answers were graded on 4-point scale with both models responding to the majority of questions with either “comprehensive” or “correct but inadequate” answers with only 1 (1.2%) answer by GPT-3.5 graded as “completely inaccurate”. When assessing reproducibility, GPT-3.5 scored reliably on more than 83.3% of responses, while GPT-4 produced above 98.2% consistent answers. Our findings show that ChatGPT can potentially serve as a supplemental tool in disseminating vital health education to patients living with amyloidosis.
Allelic strengths of encephalopathy-associatedUBA5variants correlate betweenin vivoandin vitroassays
Authors: Pan Xueyang , Alvarez Albert N. , Ma Mengqi , Lu Shenzhao , Crawford Michael W. , Briere Lauren C. , Kanca Oguz , Yamamoto Shinya , Sweetser David A. , Wilson Jenny L. , Napier Ruth J. , Pruneda Jonathan N. , Bellen Hugo J.
Published: July 2023

Protein UFMylation downstream of the E1 enzyme UBA5 plays essential roles in development and ER stress. Variants in theUBA5gene are associated with developmental and epileptic encephalopathy 44 (DEE44), an autosomal recessive disorder characterized by early-onset encephalopathy, movement abnormalities, global developmental delay, intellectual disability, and seizures. DEE44 is caused by at least twelve different missense variants described as loss of function (LoF), but the relationships between genotypes and molecular or clinical phenotypes remains to be established. We developed a humanizedUBA5fly model and biochemical activity assays in order to describein vivoandin vitrogenotype-phenotype relationships across theUBA5allelic series.In vivo, we observed a broad spectrum of phenotypes in viability, developmental timing, lifespan, locomotor activity, and bang sensitivity. A range of functional effects was also observedin vitroacross comprehensive biochemical assays for protein stability, ATP binding, UFM1 activation, and UFM1 transthiolation. Importantly, there is a strong correlation betweenin vivoandin vitrophenotypes, establishing a classification of LoF variants into mild, intermediate, and severe allelic strengths. By systemically evaluatingUBA5variants acrossin vivoandin vitroplatforms, this study provides a foundation for more basic and translational UBA5 research, as well as a basis for evaluating current and future individuals afflicted with this rare disease.
Exploring COVID-19 vaccine uptake among healthcare workers in Zimbabwe: A mixed methods study
Authors: Taruvinga Tinotenda , Chingono Rudo S. , Marambire Edson , Larsson Leyla , Olaru Ioana D. , Sibanda Sibusisiwe , Nzvere Farirayi , Redzo Nicole , Ndhlovu Chiratidzo E. , Rusakaniko Simbarashe , Mujuru Hilda , Sibanda Edwin , Chonzi Prosper , Siamuchembu Maphios , Chikodzore Rudo , Mahomva Agnes , Ferrand Rashida A. , Dixon Justin , Kranzer Katharina
Published: July 2023

With COVID-19 no longer categorized as a public health emergency of international concern, vaccination strategies and priority groups for vaccination have evolved. Africa Centers for Diseases Prevention and Control proposed the ‘100-100-70%’ strategy which aims to vaccinate all healthcare workers, all vulnerable groups, and 70% of the general population. Understanding whether healthcare workers were reached during previous vaccination campaigns and what can be done to address concerns, anxieties, and other influences on vaccine uptake, will be important to optimally plan how to achieve these ambitious targets. In this mixed-methods study, between June 2021 and July 2022 a quantitative survey was conducted with healthcare workers accessing a comprehensive health check in Zimbabwe to determine whether and, if so, when they had received a COVID-19 vaccine. Healthcare workers were categorized as those who had received the vaccine ‘early’ (before 30.06.2021) and those who had received it ‘late’ (after 30.06.2021). In addition, 17 in-depth interviews were conducted to understand perceptions and beliefs about COVID-19 vaccines. Of the 2905 healthcare workers employed at 37 facilities who participated in the study, 2818 (97%, 95% CI [92%-102%]) reported that they had received at least one vaccine dose. Geographical location, older age, higher educational attainment and having a chronic condition was associated with receiving the vaccine early. Qualitatively, (mis)information, infection risk perception, quasi-mandatory vaccination requirements, and legitimate concerns such as safety and efficacy influenced vaccine uptake. Meeting the proposed 100-100-70 target entails continued emphasis on strong communication while engaging meaningfully with healthcare workers’ concerns. Mandatory vaccination may undermine trust and should not be a substitute for sustained engagement.
Health-seeking behaviour and beliefs around sore throat in The Gambia: a qualitative study
Authors: Sans Maria Suau , Manneh Muhammed , Ceesay Isatou , Bittaye Amat , de Crombrugghe Gabrielle , Keeley Alexander J , de Silva Thushan I. , Palmer Jennifer , Armitage Edwin P. , Marks Michael
Published: July 2023

Group AStreptococcus(StrepA) bacteria causes a broad spectrum of diseases. The most common manifestations of StrepA infection are sore throat and pus-producing skin infections such as impetigo. Complications of StrepA infection lead to inflammation in the bones, muscles, joints, and internal organs causing acute rheumatic fever and rheumatic heart disease (RHD). In The Gambia, the RHD burden is thought to be very high. However, epidemiological data is minimal, and StrepA control programmes do not exist. This study aims to explore common beliefs and practices related to sore throats among primary caregivers of children, and healthcare providers in a community with a high StrepA disease burden. This will inform the design of preventative strategies for StrepA-related sequelae.

Four informal conversations with providers and fifteen semi-structured interviews with caregivers were conducted in the peri-urban area of Sukuta, The Gambia. Sampling was purposive and gradual, beginning from households identified to have recently experienced sore throat through a parallel cohort study. Themes explored in qualitative analysis included: sore throat causal attributions and diagnoses, care practises, health-seeking behaviour, and perceived barriers to using the biomedical sector.

Sore throats were typically perceived to affect one child in a family, disproportionately or exclusively. Sore throats are rarely perceived as life-threatening, and awareness of links between sore throat and ARF or RHD was not reported among caregivers or providers in this study population. Most cases of sore throat are initially managed at home using traditional medicine which delays resort to antibiotics, though in two instances of severe pain with the presence of exudate, fear that the child’s life was at risk prompted care-seeking through the formal health system.

Our findings can inform the development of tailored strategies to increase community knowledge of the potential long-term consequences of sore throats and appropriate care-seeking, alongside improvements in the health system, to prevent StrepA sequelae effectively.
Application of 4D flow MRI for exploring the anatomical and haemodynamic characteristics of pelvic veins and their correlations
Authors: Nie Chengli , Tao Li , Chen Jiangwei , Yang Jianghu , Huang Wen
Published: July 2023

Objective

There is currently a lack of studies evaluating the anatomy and haemodynamics of the pelvic veins in clinical practice. Four-dimensional flow magnetic resonance imaging (4D flow MRI) can simultaneously obtain information on vascular anatomy and haemodynamics. The goal of this study was to use 4D flow MRI to explore the anatomical and haemodynamic characteristics of pelvic veins and their correlations in an asymptomatic population.

Methods

Four-dimensional flow MRI was used to measure anatomical parameters, including the pelvic vein area, common iliac vein-inferior vena cava angle, iliac vein tortuosity, and common iliac vein stenosis rate, and haemodynamic parameters, including the pelvic venous blood flow, average blood flow velocity, and external iliac vein-inferior vena cava pressure difference, in 30 asymptomatic volunteers. The correlation between iliac vein anatomy and haemodynamics was analysed.

Results

There were correlations between the anatomical parameters of the iliac vein and the haemodynamic parameters. A larger iliac vein area was correlated with a higher blood flow. A greater iliac vein stenosis rate was correlated with a lower blood flow, lower mean velocity of the external iliac vein, and higher external iliac vein-inferior vena cava pressure difference. A greater common iliac vein-inferior vena cava angle was associated with a lower iliac vein flow velocity and a higher external iliac vein-inferior vena cava pressure difference. Finally, a greater the iliac vein tortuosity was correlated with a lower iliac vein velocity and higher external iliac vein-inferior vena cava pressure difference. There were differences in the anatomical and haemodynamic parameters of the bilateral common iliac vein and external iliac vein. The left pelvic vein common iliac-inferior vena cava angle, iliac vein tortuosity and iliac vein stenosis rate were higher than those of the right side. The flow and average velocity of the left common iliac vein and the left external iliac vein were lower than those of the right, and the pressure of the left external iliac vein was higher than that of the right.

Conclusion

The anatomical structure of the pelvic vein, including the iliac vein area, common iliac vein-inferior vena cava angle, iliac vein tortuosity, and iliac vein stenosis rate, are important factors that affect haemodynamic changes in the pelvic vein. There are correlations between parameters related to the anatomical structures and haemodynamic changes of the pelvic veins. Differences in the anatomy and haemodynamics of the bilateral pelvic veins may be one reason why the left extremity is more prone to chronic venous disease (CVD)-related symptoms.
Aneurysmal versus “Benign” Perimesencephalic Subarachnoid Hemorrhage
Authors: Alrohimi Anas , Davison Mark A , Pandhi Abhi , Abdulrazzak Mohammad A , Wadden Daniel , Bain Mark , Moore Nina , Hussain M. Shazam , Toth Gabor
Published: July 2023

Introduction

The rate of underlying ruptured aneurysm, complications, and outcomes in “benign” perimesencephalic subarachnoid hemorrhage (PMSAH) are not well known and underreported.

Methods

Retrospective analysis of patients with PMSAH from a large tertiary care center (2007-2023). Clinical and imaging data were studied.

Results

Eighty-one patients were included with mean age of 55.5 ± 10.3 years. Median (IQR) Hunt and Hess grade was 2 (1-2), and modified Fisher grade was 3 (1-3). An underlying ruptured aneurysm was diagnosed in 5 patients (6.2%). The most common complication was vasospasm in 25 patients (31%) with a significantly higher rate of symptomatic vasospasm among patients with underlying aneurysm (40% vs 2.6%; P=0.01). The median (IQR) time of vasospasm detection was 7 (8-9) days. The majority of vasospasm cases (84%) were asymptomatic, which was not associated with poor outcomes (OR= 0.95, [0.22–4.1],P=0.9) compared to the asymptomatic vasospasm (OR= 8.6, [1.06-69.88],P= 0.04). Hydrocephalus occurred in 10% of patients within one day, at higher rate in the aneurysmal group (40% vs 8%; P=0.07). A total of 88% of patients had a favorable functional outcome (mRS 0-2) at discharge, but at a significantly higher rate in non-aneurysmal patients (91% vs 40%; P=0.01). An underlying aneurysm and hydrocephalus were associated with poor functional status (OR= 14.7, [2.1–104],P=0.007, and OR= 22.6, [4.2–123.5],P<0.001), respectively.

Conclusion

“Benign” PMSAH pattern was associated with a ruptured aneurysm in 6.2% of patients, which highlights the critical value of conventional cerebral angiogram in the workup. Expectedly, an underlying aneurysm was associated with higher rates of symptomatic vasospasm, hydrocephalus, and lower rates of good clinical outcome. Aneurysm and hydrocephalus were independently associated with poorer outcomes, however, these were detected very early during hospitalization. Vasospasm alone was not associated with poor outcomes. Our findings suggest that non-aneurysmal PMSAH patients can safely be managed with less strict monitoring and a shorter hospital stay.
Screening Implications for Distribution of Colorectal Cancer Subsite by Age
Authors: Lin Gloria , Hein David M. , Liu Po-Hong , Singal Amit G. , Sanford Nina N.
Published: July 2023

Objectives

The effectiveness of colonoscopy to reduce colorectal cancer (CRC) mortality is extrapolated from cohort studies in the absence of randomized controlled trial (RCT) data, whereas flexible sigmoidoscopy is supported by RCT data and may be easier to implement in practice. We characterized the anatomic distribution of CRC to determine the proportion that is visible with sigmoidoscopy.

Methods

Patients with a primary diagnosis of colorectal adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results program (2000-2020). Tumors from the rectum to descending colon were categorized as visible by sigmoidoscopy, whereas more proximal tumors as requiring colonoscopy. Differential prognosis between tumor locations, stratified by age groups and stage, were assessed using overall restricted mean survival time (RMST) at 2, 5, and 10 years.

Results

Among 309,466 patients, 58% had tumors visible by sigmoidoscopy, including 73% of those under age 50 (OR 2.10, 95%CI 2.03-2.16 age <45, OR 2.20, 95%CI 2.13-2.27 age 45-49 versus age>50). Male sex (OR 1.54, 95%CI 1.51-1.56) and Asian or Pacific Islander race (OR 1.60, 95%CI 1.56-1.64) were also positively associated with tumors visualizable by sigmoidoscopy. Across age groups, for local disease, RMST was comparable for tumors visible versus not visible on sigmoidoscopy. For regional and metastatic cancer, patients with tumors visible by sigmoidoscopy had improved RMST versus those with more proximal tumors.

Conclusions

Most CRC arise in locations visible by flexible sigmoidoscopy. Flexible sigmoidoscopy should be considered as a viable option for CRC screening, particularly in younger patients unwilling or unable to undergo colonoscopy.
A randomised controlled trial of preconception lifestyle intervention on maternal and offspring health in people with increased risk of gestational diabetes: study protocol for the BEFORE THE BEGINNING trial
Authors: Sujan MAJ , Skarstad HS , Rosvold G , Fougner SL , Nyrnes SA , Iversen AC , Follestad T , Salvesen KÅ , Moholdt T
Published: July 2023

Introduction

Gestational diabetes mellitus (GDM) is associated with increased risk for type 2 diabetes in the mother and cardiometabolic diseases in the child. The preconception period is an optimal window to adapt the lifestyle for improved outcomes for both mother and child. Our aim is to determine the effect of a lifestyle intervention, initiated before and continued throughout pregnancy, on maternal glucose tolerance and other maternal and infant cardiometabolic outcomes.

Methods and analysis

This ongoing randomised controlled trial has included 167 females aged 18-39 years old at increased risk for GDM who are contemplating pregnancy. The participants were randomly allocated 1:1 to an intervention or control group. The intervention consists of exercise (volume is set by a heart rate-based app and corresponds to ≥ 1 hour of weekly exercise at ≥ 80% of individual heart rate maximum), and time-restricted eating (≤ 10 hours/day window of energy intake). The primary outcome measure is glucose tolerance in gestational week 28. Maternal and offspring outcomes are measured before and during pregnancy, at delivery, and at 6-8 weeks postpartum. Primary and secondary continuous outcome measures will be compared between groups based on the “intention to treat” principle using linear mixed models.

Ethics and dissemination

The Regional Committees for Medical and Health Research Ethics in Norway has approved the study (REK 143756). The anonymised results will be submitted for publication and posted in a publicly accessible database of clinical study results.

Strengths and limitations of this study

The intervention starts before and continues throughout pregnancy to make it easier for the participants to adopt an active lifestyle before pregnancy.

This study includes individuals at high risk of GDM from multiple ethnic backgrounds, which improves the generalisability of the findings.

The effects of the intervention on the cardiac function and body composition of the offspring will be comprehensively evaluated.

Due to the difficulty of blinding investigators and participants to behavioural interventions, investigators will not be blinded for outcome assessments.

Due to the long duration of the intervention, adherence to lifestyle modifications may be difficult for some participants despite regular monitoring and motivational support.
An updated PREDICT breast cancer prognostic model including the benefits and harms of radiotherapy
Authors: Grootes Isabelle , Wishart Gordon C. , Pharoah Paul David Peter
Published: July 2023

Background

Predict Breast (www.breast.predict.nhs.uk) is an online prognostication and treatment benefit tool for early invasive breast cancer. However, the most recent version of PREDICT Breast (v2.2) was based on data for breast cancer cases diagnosed from 1999 to 2003 and did not incorporate the benefits of radiotherapy or the harms associated with theray. Since then, there has been a substantial improvement in the outcomes for breast cancer cases. The aim of this study was to update PREDICT Breast to ensure that the underlying model is appropriate for contemporary patients.

Methods

Data from 4,644 ER-negative and 30,830 ER-positive breast cancer cases diagnosed from 2000 to 2017 in the region served by the Eastern Cancer Registry were used for model development. Multivariable fractional polynomials in a Cox proportional hazards framework were used to estimate the prognostic effects of year of diagnosis, age at diagnosis, tumour size, tumour grade and number of positive nodes and to compute the baseline hazard functions. Separate models were developed for ER-positive and ER-negative disease. Data on 32,408 breast cancer patients from the West Midlands Cancer Registry and from 100,551 breast cancer cases from the other English Cancer Registries combined were used to determine the discriminative power, calibration, and reclassification of the new version of PREDICT Breast (v3.0).

Results

The new model (v3.0) was well-calibrated; predicted numbers of 5-, 10- and 15-year breast cancer deaths were within 10 per cent of the observed number in both model development and model validation data sets. In contrast, PREDICT Breast v2.2 was found to substantially over-predict the number of deaths. Discrimination was also good: The AUC for 15-year breast cancer survival was 0. 824 in the model development data, 0.809 in the West Midlands data set and 0.846 in the data set for the other registries. There figures were slightly better than those for PREDICT Breast v2.2

Conclusion

Incorporating the prognostic effect of year of diagnosis, updating the prognostic effects of all risk factors and amending the baseline hazard functions have led to an improvement of model performance of PREDICT Breast. The new model will be implemented in the online tool which should lead to more accurate absolute treatment benefit predictions for individual patients.
Serum Autotaxin is a Prognostic Indicator of Liver-related Events in Patients with Non-alcoholic Fatty Liver Disease
Authors: Iwadare Takanobu , Kimura Takefumi , Okumura Taiki , Wakabayashi Shun-ichi , Nakajima Taro , Kondo Shohei , Kobayashi Hiroyuki , Yamashita Yuki , Sugiura Ayumi , Fujimori Naoyuki , Yamazaki Tomoo , Kunimoto Hideo , Shimamoto Satoshi , Igarashi Koji , Joshita Satoru , Tanaka Naoki , Umemura Takeji
Published: July 2023

Background

Circulating autotaxin (ATX) levels have been reported to correlate with liver inflammation activity and liver fibrosis severity in patients with non-alcoholic fatty liver disease (NAFLD). The objective of this study was to investigate whether serum ATX could predict liver-related events (LRE) in NAFLD patients.

Methods

This retrospective investigation included 309 biopsy-proven NAFLD patients registered at Shinshu University Hospital between 1998 and 2021. All patients were followed for at least 1 year, during which time the prevalence of LRE, including newly developing hepatocellular carcinoma, hepatic encephalopathy, ascites, and esophagogastric varices, was investigated in relation to ATX levels at the time of liver biopsy.

Results

During the median follow-up period of 7.0 years, LRE were observed in 20 patients (6.5%). The area under the receiver operating characteristic curve and cut-off value of serum ATX for predicting LRE were 0.81 and 1.227 mg/L, respectively. Patients with serum ATX greater than the cut-off at the time of liver biopsy had a significantly higher cumulative incidence of LRE than those without (18.4% vs. 2.7%, p < 0.00001). Multivariate Cox proportional hazards models for LRE determined fibrosis stage and ATX divided by the upper limit of normal as independently associated factors.

Conclusion

Serum ATX may serve as a predictive marker for LRE in patients with NAFLD.
Negative Symptoms and Their Associations with Other Clinical Variables and Working Memory Across the Schizophrenia Spectrum and Bipolar Disorder
Authors: De Pieri Marco , Berg Xaver , Georgiadis Foivos , Brakowski Janis , Burrer Achim , Sabe Michel , Kaliuzhna Mariia , Vetter Stefan , Seifritz Erich , Homan Philipp , Kaiser Stefan , Kirschner Matthias
Published: July 2023

Negative symptoms (NS) of schizophrenia spectrum disorders (SSD) are also prevalent in bipolar-disorder-I (BD-I) and show associations with impaired working memory (WM). However, empirical work on their relationship to other clinical factors across SSD and BD-I are sparse. Here, we characterized the associations of NS with key clinical variables and WM capacity across a combined sample of SSD and BD. We included 50 outpatients with SSD and 49 with BD-I and assessed NS domains using SANS global scores for avolition-apathy, anhedonia-asociality, alogia and blunted affect. We assessed the transdiagnostic relationship between NS and other clinical variables including positive symptoms, disorganization, depressive symptoms, antipsychotic medication using multiple regressions. The strength of these associations was further determined through dominance analyses. Lastly, we used multiple regression to assess the relationship between NS domains and WM. To assess the generalizability of transdiagnostic associations, analyses were repeated in each diagnostic group separately. Across SSD and BD-I, disorganization was associated with avolition-apathy and anhedonia-asociality and depressive symptoms additionally predicted anhedonia-asociality. Antipsychotic dose was associated with blunted affect while group differences only predicted alogia. Higher avolition-apathy was related to impaired WM transdiagnostically, partially mediated by severity of disorganization, whereas only in BD-I higher anhedonia-asociality was associated with better WM capacity. This study demonstrated transdiagnostic associations of both avolition-apathy and anhedonia-asociality with disorganization, and identified avolition-apathy as potential transdiagnostic predictor of WM impairments. Overall, our findings highlight the importance of understanding the relationship between NS domains and other clinical factors with cognitive function across SSD and BD.