bluuebunny/crossref_metadata_2025 huggingface dataset:
A Meta-Review to Guide Military Screening and Treatment of Gambling Problems
Authors: Segura Anna , Heyman Richard E , Ochshorn Jennie , Slep Amy M Smith
Published: November 2023

Introduction

Excessive gambling can cause substantial biopsychosocial problems (e.g., difficulties with finances, relationships, mental, and physical health). For military Service Members, it can also result in security clearance denial or revocation, failure to achieve promotions, and premature career termination. Recent congressional mandates have obligated the U.S. Department of Defense to screen for problematic gambling, the predictive values of which are a function of (i) problem prevalence and (ii) tool sensitivity and specificity. This meta-review (i.e., systematic review of systematic reviews) on the screening properties of gambling assessment tools and the effectiveness of treatments for gambling disorder is to inform military services on responding to Service Members’ gambling problems.

Materials and Methods

EBSCO Discovery Service, PubMed, PsycINFO, Ovid Medline, Social Care Online, Epistemonikos, International Health Technology Assessment, and the Cochrane Central Register of Controlled Trials electronic databases were searched up to December 2022 for systematic reviews and meta-analyses on measurements of adult subclinical or gambling, and interventions targeting individuals with GD. Three and four studies were included in each section of the current meta-review (i.e., assessment tools and treatment). For review 1, the estimated risk of bias was assessed using the Risk of Bias in Systematic Reviews.

Results

Thirty-one tools were identified through the three systematic reviews. All had modest sensitivities and specificities; combined with low prevalences in the general SM population, positive results would be incorrect 64-99% of the time. However, if screening were conducted with SMs referred for alcohol problems, a positive result on the best screening tools would be correct 76% of the time. Several commonly used treatment approaches had demonstrated efficacy for GD.

Conclusions

The combination of low prevalence of GD and subclinical gambling problems in the general population, coupled with modest sensitivity and specificity, makes screening unfeasible in the general SM population. However, dual-phase screening in higher-prevalence subpopulations (i.e., SMs already identified with substance-abuse or mental-health problems) would be viable. Regarding treatment, several interventions—already used in military healthcare—with extensive empirical track records have been successfully used to treat adults with GD.
Efficacy of a Novel Telehealth Application in Health Behavior Modification and Symptomology in Military Service Members at Risk for Post-traumatic Osteoarthritis
Authors: Martin Chelsea Leonard , Nocera Maryalice , Mercer Jeremy , Marshall Stephen W , Davi Steven M , Curtin Jessica J , Cameron Kenneth L
Published: November 2023

Introduction

Mobile applications (apps) may be beneficial to promote self-management strategies to mitigate the risk of developing post-traumatic osteoarthritis in military members following a traumatic knee injury. This study investigated the efficacy of a mobile app in facilitating behavior modification to improve function and symptomology among military members.

Materials and Methods

This is a preliminary pre and post hoc analysis of a randomized control trial. The MARX scale, Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, and the Knee Injury and Osteoarthritic Outcome Score Readiness to Manage Osteoarthritis Questionnaire were completed at baseline, 6-week, 6-month, and 12-month follow-up. Participants in the treatment arm completed the System Usability Scale. Data were analyzed using descriptive statistics, the Wilcoxon sum of ranks test, the Wilcoxon signed-rank test, and Cohen’s d effect size.

Results

A total of 28 participants were included. Between-group differences for baseline and 6-week follow-up were significantly improved in the injured knee ICOAP constant pain score for the treatment group (treatment: −4.2 ± 12, 95% CI: −11.5, 3.1; control: 5.5 ± 9.9, 95% CI: 0.9, 10.1; P = .035, effect size = 0.905). Within-group differences for baseline and 6-week follow-up demonstrated a significant decline in the injured knee ICOAP constant pain score among the control group (signed-rank: 16.0, P = .031, Cohen’s d = 0.339). No other significant differences were observed. A good System Usability Scale score for usability was found (76.6 ± 8.8).

Conclusions

These results indicate that the mobile app is easy to use and may contribute to improved constant pain symptomology for patients at risk for post-traumatic osteoarthritis.
Etiology of Acute Lower Respiratory Illness Hospitalizations Among Infants in 4 Countries
Authors: Kubale John , Kujawski Stephanie , Chen Irena , Wu Zhenke , Khader Ilham Abu , Hasibra Iris , Whitaker Brett , Gresh Lionel , Simaku Artan , Simões Eric A F , Al-Gazo Mahmoud , Rogers Shannon , Gerber Susan I , Balmaseda Angel , Tallo Veronica L , Al-Sanouri Tareq M , Porter Rachael , Bino Silvia , Azziz-Baumgartner Eduardo , McMorrow Meredith , Hunt Danielle , Thompson Mark , Biggs Holly M , Gordon Aubree
Published: November 2023

Background

Recent studies explored which pathogens drive the global burden of pneumonia hospitalizations among young children. However, the etiology of broader acute lower respiratory tract infections (ALRIs) remains unclear.

Methods

Using a multicountry study (Albania, Jordan, Nicaragua, and the Philippines) of hospitalized infants and non-ill community controls between 2015 and 2017, we assessed the prevalence and severity of viral infections and coinfections. We also estimated the proportion of ALRI hospitalizations caused by 21 respiratory pathogens identified via multiplex real-time reverse transcription polymerase chain reaction with bayesian nested partially latent class models.

Results

An overall 3632 hospitalized infants and 1068 non-ill community controls participated in the study and had specimens tested. Among hospitalized infants, 1743 (48.0%) met the ALRI case definition for the etiology analysis. After accounting for the prevalence in non-ill controls, respiratory syncytial virus (RSV) was responsible for the largest proportion of ALRI hospitalizations, although the magnitude varied across sites—ranging from 65.2% (95% credible interval, 46.3%–79.6%) in Albania to 34.9% (95% credible interval, 20.0%–49.0%) in the Philippines. While the fraction of ALRI hospitalizations caused by RSV decreased as age increased, it remained the greatest driver. After RSV, rhinovirus/enterovirus (range, 13.4%–27.1%) and human metapneumovirus (range, 6.3%–12.0%) were the next-highest contributors to ALRI hospitalizations.

Conclusions

We observed substantial numbers of ALRI hospitalizations, with RSV as the largest source, particularly in infants aged <3 months. This underscores the potential for vaccines and long-lasting monoclonal antibodies on the horizon to reduce the burden of ALRI in infants worldwide.
Clinical Outcomes After Viremia Among People Receiving Dolutegravir vs Efavirenz-Based First-line Antiretroviral Therapy in South Africa
Authors: Asare Kwabena , Lewis Lara , van der Molen Johan , Sookrajh Yukteshwar , Khubone Thokozani , Moodley Pravikrishnen , Lessells Richard J , Naidoo Kogieleum , Sosibo Phelelani , Garrett Nigel , Dorward Jienchi
Published: November 2023

Background

We aimed to compare clinical outcomes after viremia between dolutegravir vs efavirenz-based first-line antiretroviral therapy (ART) as evidence is lacking outside clinical trials in resource-limited settings.

Methods

We conducted a retrospective cohort analysis with routine data from 59 South African clinics. We included people with HIV aged ≥15 years receiving first-line tenofovir disoproxil fumarate, lamivudine, dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, efavirenz (TEE) and with first viremia (≥50 copies/mL) between June and November 2020. We used multivariable modified Poisson regression models to compare retention in care and viral suppression (<50 copies/mL) after 12 months between participants on TLD vs TEE.

Results

At first viremia, among 9657 participants, 6457 (66.9%) were female, and the median age (interquartile range [IQR]) was 37 (31–44) years; 7598 (78.7%) were receiving TEE and 2059 (21.3%) TLD. Retention in care was slightly higher in the TLD group (84.9%) than TEE (80.8%; adjusted risk ratio [aRR], 1.03; 95% CI, 1.00–1.06). Of 6569 participants retained in care with a 12-month viral load, viral suppression was similar between the TLD (78.9%) and TEE (78.8%) groups (aRR, 1.02; 95% CI, 0.98–1.05). However, 3368 participants changed ART during follow-up: the majority from TEE to first-line TLD (89.1%) or second-line (TLD 3.4%, zidovudine/emtricitabine/lopinavir-ritonavir 2.1%). In a sensitivity analysis among the remaining 3980 participants who did not change ART during follow-up and had a 12-month viral load, viral suppression was higher in the TLD (78.9%) than TEE (74.9%) group (aRR, 1.07; 95% CI, 1.03–1.12).

Conclusions

Among people with viremia on first-line ART, dolutegravir was associated with slightly better retention in care and similar or better viral suppression than efavirenz.
The predictive accuracy of cardiovascular disease risk prediction tools in inflammatory arthritis and psoriasis: an observational validation study using the Clinical Practice Research Datalink
Authors: Hughes David M , Coronado Jose Ignacio Cuitun , Schofield Pieta , Yiu Zenas Z N , Zhao Sizheng Steven
Published: November 2023

Objectives

Cardiovascular risk prediction tools developed for the general population often underperform for individuals with RA, and their predictive accuracy are unclear for other inflammatory conditions that also have increased cardiovascular risk. We investigated the performance of QRISK-3, the Framingham Risk Score (FRS) and the Reynolds Risk Score (RRS) in RA, psoriatic disease (PsA and psoriasis) and AS. We considered OA as a non-inflammatory comparator.

Methods

We utilized primary care records from the Clinical Practice Research Datalink (CPRD) Aurum database to identify individuals with each condition and calculated 10-year cardiovascular risk using each prediction tool. The discrimination and calibration of each tool was assessed for each disease.

Results

The time-dependent area under the curve (AUC) for QRISK3 was 0.752 for RA (95% CI 0.734–0.777), 0.794 for AS (95% CI 0.764–0.812), 0.764 for PsA (95% CI 0.741–0.791), 0.815 for psoriasis (95% CI 0.789–0.835) and 0.698 for OA (95% CI 0.670–0.717), indicating reasonably good predictive performance. The AUCs for the FRS were similar, and slightly lower for the RRS. The FRS was reasonably well calibrated for each condition but underpredicted risk for patients with RA. The RRS tended to underpredict CVD risk, while QRISK3 overpredicted CVD risk, especially for the most high-risk individuals.

Conclusion

CVD risk for individuals with RA, AS and psoriatic disease was generally less accurately predicted using each of the three CVD risk prediction tools than the reported accuracies in the original publications. Individuals with OA also had less accurate predictions, suggesting inflammation is not the sole reason for underperformance. Disease-specific risk prediction tools may be required.
The Sigatoka Disease Complex Caused by Pseudocercospora spp. and Other Fungal Pathogens Associated with Musa spp. in Puerto Rico
Authors: Aviles-Noriega Ashley , Serrato-Diaz Luz M. , Giraldo-Zapata Martha C. , Cuevas Hugo E. , Rivera-Vargas Lydia I.
Published: November 2023

Bananas (Musa spp.) are among the world’s most economically important staple food crops. The most important fungal leaf diseases of Musa spp. worldwide are caused by the Sigatoka disease complex, which comprises black Sigatoka (Pseudocercospora fijiensis), yellow Sigatoka (P. musae), and Eumusae leaf spot (P. eumusae). Considering the rapid spreading rate of black Sigatoka in Puerto Rico since its first observation in 2004, a disease survey was conducted from 2018 to 2020 to evaluate the Sigatoka disease complex on the island. Sixty-one leaf samples showing Sigatoka-like symptoms were collected throughout the island for diagnosis by molecular approaches and fungal isolation. Molecular analysis using species-specific primers for P. fijiensis, P. musae, and P. eumusae detected the presence of P. fijiensis in 50 leaf samples. Thirty-eight fungal isolates were collected and identified by morphology and genomic sequencing from various nuclear genes. The analysis identified 24 isolates as P. fijiensis, while the rest of the isolates belonged to the genus Cladosporium spp. and Cladosporium-like spp. (n = 5), Neocordana musae (n = 2), Zasmidium spp. (n = 6), and Z. musigenum (n = 1). The high frequency of P. fijiensis found in leaf samples and collected isolates suggests that black Sigatoka has displaced the yellow Sigatoka (P. musae) in Puerto Rico. Accurate identification of fungal species causing foliar diseases in Musa spp. will allow the establishment of quarantine regulations and specific management approaches in Puerto Rico.
Association of Early Dexmedetomidine Utilization With Clinical and Functional Outcomes Following Moderate-Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study*
Authors: Liu Sunny Yang , Kelly-Hedrick Margot , Temkin Nancy , Barber Jason , Komisarow Jordan , Hatfield Jordan , Ohnuma Tetsu , Manley Geoffrey , Treggiari Miriam M. , Colton Katharine , Vavilala Monica S. , Grandhi Ramesh , Laskowitz Daniel T. , Mathew Joseph P. , Hernandez Adrian , James Michael L. , Raghunathan Karthik , Goldstein Ben , Markowitz Amy , Krishnamoorthy Vijay ,   The Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) Investigators
Published: November 2023

OBJECTIVE:

To examine early sedation patterns, as well as the association of dexmedetomidine exposure, with clinical and functional outcomes among mechanically ventilated patients with moderate-severe traumatic brain injury (msTBI).

DESIGN:

Retrospective cohort study with prospectively collected data.

SETTING:

Eighteen Level-1 Trauma Centers, United States.

PATIENTS:

Adult (age > 17) patients with msTBI (as defined by Glasgow Coma Scale < 13) who required mechanical ventilation from the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Using propensity-weighted models, we examined the association of early dexmedetomidine exposure (within the first 5 d of ICU admission) with the primary outcome of 6-month Glasgow Outcomes Scale Extended (GOS-E) and the following secondary outcomes: length of hospital stay, hospital mortality, 6-month Disability Rating Scale (DRS), and 6-month mortality. The study population included 352 subjects who required mechanical ventilation within 24 hours of admission. The initial sedative medication was propofol for 240 patients (68%), midazolam for 59 patients (17%), ketamine for 6 patients (2%), dexmedetomidine for 3 patients (1%), and 43 patients (12%) never received continuous sedation. Early dexmedetomidine was administered in 77 of the patients (22%), usually as a second-line agent. Compared with unexposed patients, early dexmedetomidine exposure was not associated with better 6-month GOS-E (weighted odds ratio [OR] = 1.48; 95% CI, 0.98–2.25). Early dexmedetomidine exposure was associated with lower DRS (weighted OR = –3.04; 95% CI, –5.88 to –0.21). In patients requiring ICP monitoring within the first 24 hours of admission, early dexmedetomidine exposure was associated with higher 6-month GOS-E score (OR 2.17; 95% CI, 1.24–3.80), lower DRS score (adjusted mean difference, –5.81; 95% CI, –9.38 to 2.25), and reduced length of hospital stay (hazard ratio = 1.50; 95% CI, 1.02–2.20).

CONCLUSION:

Variation exists in early sedation choice among mechanically ventilated patients with msTBI. Early dexmedetomidine exposure was not associated with improved 6-month functional outcomes in the entire population, although may have clinical benefit in patients with indications for ICP monitoring.
Manmade earthquakes and healthcare visits for anxiety disorders in Oklahoma, 2010–2019
Authors: Elser Holly , Kempinsky Arielle , Goldman-Mellor Sidra , Li Maggie , Catalano Ralph , Rehkopf David H. , Casey Joan A.
Published: November 2023

Background:

Since 2010, seismicity in Oklahoma has increased from wastewater injection. It remains unknown if these earthquakes have resulted in increased treatment seeking for mental healthcare services.

Methods:

Using data from a nationwide United States patient-level commercial and Medicare Advantage claims database from 2010 to 2019, we identified healthcare encounters for anxiety disorders using diagnostic codes and subclassified them as adjustment reaction; anxiety-related disorders; physical symptoms of anxiety; and stress disorders. With U.S. Geological Survey Advanced National Seismic System data, we generated county-level 6-month rolling counts of felt earthquakes (≥M 4) and linked them to patient residential county at the time of the healthcare visit. In this repeated measures, individual-level analysis we used generalized estimating equations to estimate the odds of monthly anxiety-related healthcare visits as a function of the frequency of ≥M 4 earthquakes in the previous 6 months.

Results:

We identified 4,594 individuals in Oklahoma observed from 2010 to 2019. For every additional five ≥M 4 earthquakes in the preceding 6 months, the odds of healthcare visits for stress disorders increased (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.03, 1.57). We found no evidence of an association with adjustment reaction (OR = 1.05; 95% CI = 0.89, 1.23), anxiety-related disorders (OR = 0.96; 95% CI = 0.90, 1.03), or physical symptoms of anxiety (OR = 1.03; 95% CI = 0.98, 1.09).

Conclusions:

We report an association between increased frequency of felt earthquakes and treatment seeking for stress disorders. This finding should motivate ongoing study of the potential consequences of the oil and gas industry for mental health outcomes including anxiety disorders.
Trametinib Inhibits Lymphatic Vessel Invasion of Bone in a Mouse Model of Gorham-Stout Disease
Authors: McCarter Anna L. , Dellinger Michael T.
Published: November 2023

Objective:

Gorham-Stout disease (GSD) is a rare lymphatic anomaly that can be caused by somatic activating mutations in KRAS. This discovery has led investigators to suggest that MEK inhibitors could be a novel treatment for GSD. However, the effect of MEK inhibitors on bone disease in animal models of GSD has not been investigated. We recently reported that Osx-tTA;TetO-Vegfc mice exhibit a phenotype that resembles GSD. Osx-tTA;TetO-Vegfc mice overexpress vascular endothelial growth factor-C (VEGF-C) in bone, which stimulates the development of lymphatic vessels in bone and the gradual loss of cortical bone. The objective of this study was to characterize the effect of trametinib, an FDA-approved MEK1/2 inhibitor, on lymphangiogenesis and osteolysis in Osx-tTA;TetO-Vegfc mice.

Methods:

Immunoblotting was performed to assess the effect of trametinib on VEGF-C-induced phosphorylation of ERK1/2, AKT, and S6 in primary human lymphatic endothelial cells. Prevention and intervention experiments were performed to determine the effect of trametinib on lymphangiogenesis and osteolysis in Osx-tTA;TetO-Vegfc mice.

Results:

We found that trametinib blocked VEGF-C-induced phosphorylation of ERK1/2 in primary human lymphatic endothelial cells. We also found that trametinib prevented VEGF-C-induced lymphatic invasion of bone and cortical bone loss in Osx-tTA;TetO-Vegfc mice. Additionally, trametinib slowed the progression of disease in Osx-tTA;TetO-Vegfc mice with established disease. However, it did not reverse disease in Osx-tTA;TetO-Vegfc mice.

Conclusion:

Our results show trametinib impacts bone disease in Osx-tTA;TetO-Vegfc mice. These findings further support the testing of MEK inhibitors in patients with GSD and other RAS pathway-driven complex lymphatic anomalies with bone involvement.
A Qualitative Study of Parents' Experiences of Bonding in End-of-Life Care in a Neonatal Intensive Care Unit
Authors: Funkquist Eva-Lotta , Lindquist Alva , Edner Ann
Published: November 2023

Aim:

To examine the parent's experiences of bonding in the care of newborns who were seriously ill during the neonatal period and did not survive.

Design:

Data were collected through 7 interviews with 10 parents whose infants were cared for and died in a neonatal intensive care unit.

Methods:

The interviews were pilot processed using inductive content analysis and then processed again using deductive content analysis with the attachment theory applied as a theoretical frame.

Results:

Three main themes emerged from the parents' descriptions: 1. The parents' relationship with the healthcare provider: an alliance between the parent and the healthcare provider can facilitate communication, for example, the use of proposals to promote parents' role in the care; 2. The parents' relationship with the infant: parents' wish to fulfill the role of a protective parent, and it is of importance for the parents' future well-being to take part in care and decision making; and 3. The parents' relationship with the own self: in this unknown situation, parents' expectations of parenthood are broken, and they experience feelings of shame and powerlessness.

Conclusion:

The relationship between the parent and the healthcare provider affects how the parents bond with their child and their experiences of the healthcare.
Efficacy οf Wet Age-related Macular Degeneration Treatment οn Reading: A Pilot Study Using Eye-movement Analysis
Authors: Ktistakis Emmanouil , Simos Panagiotis , Tsilimbaris Miltiadis K. , Plainis Sotiris
Published: November 2023

SIGNIFICANCE

Functional vision, as evaluated with silent passage reading speed, improves after anti–vascular endothelial growth factor (anti-VEGF) treatment in patients with wet age-related macular antidegeneration (wAMD), reflecting primarily a concomitant reduction in the number of fixations. Implementing eye movement analysis when reading may better characterize the effectiveness of therapeutic approaches in wAMD.

PURPOSE

This study aimed to evaluate silent reading performance by means of eye fixation analysis before and after anti-VEGF treatment in wAMD patients.

METHODS

Sixteen wAMD patients who underwent anti-VEGF treatment in one eye and visual acuity (VA) better than 0.5 logMAR served as the AMD group. Twenty adults without ocular pathology served as the control group. Central retinal thickness and near VA were assessed at baseline and 3 to 4 months after their first visit. Reading performance was evaluated using short passages of 0.4-logMAR print size. Eye movements were recorded using EyeLink II video eye tracker. Data analysis included computation of reading speed, fixation duration, number of fixations, and percentage of regressions. Frequency distributions of fixation durations were analyzed with ex-Gaussian fittings.

RESULTS

In the AMD group, silent reading speed in the treated eye correlated well with central retinal thickness reduction and improved significantly by an average of 15.9 ± 28.5 words per minute (P = .04). This improvement was accompanied by an average reduction of 0.24 ± 0.38 in fixations per word (P = .03). The corresponding improvement in monocular VA was not statistically significant. Other eye fixation parameters did not change significantly after treatment. No statistically significant differences were found in the control group.

CONCLUSIONS

Visual acuity tests may underestimate the potential therapeutic effects after anti-VEGF treatment in patients with relatively good acuity who are being treated for wAMD. Evaluating silent reading performance and eye fixation parameters may better characterize the effectiveness of therapeutic approaches in wAMD patients.
Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013–2021
Authors: Vo Luan Thanh , Nguyen Dat Tat , Tran Thinh Ngoc , Tran Hang Hoang-Thanh , Đoan Trang Thi-Hoai , Pham Tram Ngoc , Mai Thanh Thi-Hoai , Nguyen Quynh Xuan-Thuy , Nguyen Thuan Khac , Nguyen Thuong Thi-Kim , Burza Sakib , Nguyen Thanh Tat
Published: November 2023

OBJECTIVES:

Profound dengue shock syndrome (DSS) complicated by severe respiratory failure necessitating mechanical ventilation (MV) accounts for high case fatality rates among PICU-admitted patients. A major challenge to management is the assessment of intravascular volume, which can be hampered by severe plasma leakage and the use of MV.

DESIGN:

Retrospective cohort, from 2013 to 2021.

PATIENTS:

Sixty-seven children with profound DSS supported by MV, some of whom underwent bedside point-of-care ultrasound (POCUS) for assessment and monitoring of hemodynamics and fluid administration.

SETTING:

PICU of the tertiary Children’s Hospital No. 2 in Vietnam.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We analyzed data clinical and laboratory data during PICU stay. In particular, during use of MV (i.e., at times 0-, 6-, and 24-hr after commencement) and fluid resuscitation. The primary study outcome was 28-day in-hospital mortality, and the secondary outcomes were associations with changes in hemodynamics, blood lactate, and vasoactive-inotrope score (VIS). Patients had a median age of 7 years (interquartile range, 4–9). Use of POCUS during fluid management (39/67), as opposed to not using (28/67), was associated with lower mortality (6/39 [15%] vs. 18/28 [64%]; difference 49 % [95% CI, 28–70%],p< 0.001). Use of POCUS was associated with lower odds of death (adjusted odds ratio 0.17 [95% CI, 0.04–0.76],p= 0.02). The utilization of POCUS, versus not, was associated with greater use of resuscitation fluid, and reductions in VIS and pediatric logistic organ dysfunction (PELOD-2) score at 24 hours after MV and PICU discharge.

CONCLUSIONS:

In our experience of pediatric patients with profound DSS and undergoing MV (2013–2021), POCUS use was associated with lower odds of death, a higher volume of resuscitation fluid, and improvements in the blood lactate levels, VIS, and PELOD-2 score.
Achieving Equity in Childhood Vaccination: A Mixed-Methods Study of Immunization Programs, Policies, and Coverage in 3 US States
Authors: Brumbaugh Kaitlin (Quirk) , Ornelas India J. , Casas Francisco Rios , Mokdad Ali H.
Published: November 2023

Objective:

In this study, we sought to understand patterns of childhood vaccinations in the United States across socioeconomic and racial/ethnic groups over a 12-year period to identify interventions that improve immunization equity and inform public health practice.

Design:

We conducted an explanatory, sequential, mixed-methods study. US state- and county-level immunization data were analyzed to understand trends in immunization coverage among racial/ethnic groups. Qualitative interviews with public health and community leaders were used to explain trends, gain insight into routine childhood immunization interventions, and understand local contexts and data limitations.

Participants and Setting:

Secondary data were used from the National Immunization Survey—Child (NIS) public use data sets (2007 and 2019). Eligible participants for qualitative interviews were routine childhood immunization stakeholders from selected counties in North Carolina, Washington, and Arizona.

Main Outcome Measure:

Our integrated findings report trends and probability of children aged 19 months to 3 years being fully vaccinated (measles-mumps-rubella [MMR], diphtheria and tetanus toxoids and acellular pertussis [DTaP], hepatitis B [Hep B]), interventions, and recommendations to improve routine childhood immunization coverage and equity.

Results:

Vaccination coverage remained high and relatively stable between 2007 and 2019; however, there were differences across racial/ethnic groups. Public health leaders identified key interventions that effectively improved vaccine equity and coverage, including data quality improvement, tailored interventions for specific populations, multisector partnerships, addressing common barriers, and data limitations. Participants also identified the critical role of state policies, public health funding, and community vaccine norms.

Conclusions:

Variability persists in vaccination coverage and equity across states, race/ethnicity, and socioeconomic status despite decades of interventions. Vaccine stakeholders should use our findings to improve coverage and reduce disparities. Equitable improvements can be realized through policy change, data tracking/infrastructure improvements, and tailored interventions. Furthermore, local partners are critical in improving vaccine coverage and equitable interventions to disrupt disparities that long hold true for vaccine-preventable diseases.
The Relationship Between Conventionally Obtained Serum-Based Liver Function Indices and Intravoxel Incoherent Motion Diffusion-Weighted Imaging and Magnetic Resonance Elastography in Patients With Hepatocellular Carcinoma
Authors: Yamakuni Ryo , Ishikawa Hironobu , Ishii Shiro , Kakamu Takeyasu , Hara Junko , Sugawara Shigeyasu , Sekino Hirofumi , Seino Shinya , Fukushima Kenji , Ito Hiroshi
Published: November 2023

Objectives

To investigate the relationship between conventionally obtained serum-based biochemical indices and intravoxel incoherent motion imaging (IVIM) parameters compared with magnetic resonance elastography (MRE).

Methods

Patients with hepatocellular carcinoma who underwent ≥2 liver magnetic resonance imaging (MRI) scan, including IVIM and MRE, between 2017 and 2020 and biochemical testing within 1 week before or after MRI were included in this study. Biochemical tests were performed to determine the albumin-bilirubin (ALBI) score and modified ALBI (mALBI) grade, aspartate aminotransferase to platelet ratio index (APRI), and fibrosis-4 index (FIB-4). The diffusion coefficient (D), pseudo-diffusion coefficient (D*), fractional volume occupied by flowing spins (f), and apparent diffusion coefficient were calculated for IVIM. The correlations between (1) the imaging parameters and biochemical indices and (2) the changes in mALBI grades and imaging parameters were evaluated.

Results

This study included 98 scans of 40 patients (31 men; mean age, 67.7 years). The correlation analysis between the biochemical and IVIM parameters showed that ALBI score and D* had the best correlation (r = −0.3731, P < 0.001), and the correlation was higher than that with MRE (r = 0.3289, P < 0.001). However, among FIB-4, APRI, and MRI parameters, MRE outperformed IVIM parameters (MRE and FIB-4, r = 0.3775, P < 0.001; MRE and APRI, r = 0.4687, P < 0.001). There were significant differences in the changes in MRE among the 3 groups (improved, deteriorated, and unchanged mALBI groups) in the analysis of covariance (P = 0.0434). There were no significant changes in IVIM.

Conclusions

Intravoxel incoherent motion imaging has the potential to develop into a more readily obtainable method of liver function assessment.
A 10-Year Retrospective Review on the Use of Prophylactic Spinal Reconstruction in Spinal Surgery Involving High-Risk Patients
Authors: Choudhry Salman , Er Seray , Ha Michael , Brown Madeline , Karwoski Allison , Ludwig Steven C. , Cavanaugh Daniel L. , Sansur Charles A. , Crandall Kenneth M. , Rasko Yvonne M.
Published: November 2023

Background

Spinal surgeries are being offered to a broader patient population who are both medically and surgically complex. History of prior spinal surgery, advanced age, and presence of comorbidities, such as obesity, malnutrition, steroid use, and tobacco use, are risk factors for postoperative complications. Prophylactic spinal reconstruction at the time of spinal surgery has been shown to have improved outcomes and decreased wound complications; however, outcomes focusing specifically on complex patients with a history of previous spinal surgery (or surgeries) have not been well described.

Methods

This is a retrospective study performed at the University of Maryland Medical Center (Baltimore, MD) of high-risk patients who underwent complex spinal surgery with prophylactic spinal reconstruction from 2011 to 2022. One hundred forty-three consecutive surgeries from 136 patients were included in the study. Patients younger than 17 years or who had an incomplete medical record were excluded.

Results

Most patients were female (63.6%) versus male (31.5%). The average American Society of Anesthesiologists score was 3. All but 6 patients (11%) had a history of at least 1 spinal surgery, with nearly half of patients having had between 2 and 5 spinal surgeries. Reconstruction was performed with paraspinous flaps in most cases (n = 133 [93%]). The overall complication rate was 10.5%, with surgical site infection being the most common complication. Seventeen patients (12.5%) underwent reoperation within 90 days of initial surgery. Average length of follow-up was 4.18 months (range, 0.03–40.53 months).

Conclusions

In appropriately selected patients, prophylactic spinal reconstruction offers improved outcomes with decreased wound complications compared with salvage. For large defects, paraspinous flaps are recommended over other reconstructive options. Prolonged drain placement is felt to be protective against complications.
Interleukin-6 Levels During Normothermic Machine Perfusion Impact Postreperfusion Hemodynamics of Liver Graft Recipients: A Prospective Single-center Observational Study
Authors: Mathis Simon , Weissenbacher Annemarie , Putzer Gabriel , Gasteiger Lukas , Cardini Benno , Hell Tobias , Schlosser Lisa , Oberhuber Rupert , Schneeberger Stefan , Martini Judith
Published: November 2023

Background.

Hemodynamic instability after liver graft reperfusion increases recipient morbidity after liver transplantation. The etiologies of hemodynamic disturbances appear to be multifactorial and are poorly understood. Normothermic machine perfusion (NMP) provides an opportunity to analyze graft quality prior to transplantation. In the present study, we aim to investigate the influence of interleukin-6 (IL-6) levels during NMP on postreperfusion hemodynamics of the recipient.

Methods.

Consecutive NMP-liver transplants at a single-center were prospectively analyzed. Perfusate samples were collected at the beginning, after 6 h, and at the end of perfusion and analyzed for IL-6 levels. Mean arterial pressure (MAP) and catecholamine consumption during surgery were recorded. IL-6 levels at the end of NMP were correlated to donor and perfusion characteristics as well as changes in MAP and catecholamine requirements during the anhepatic and reperfusion phase.

Results.

IL-6 perfusate measurements were assessed in 77 livers undergoing NMP and transplantation. Donor age, sex, cold ischemic time, and NMP time did not correlate with IL-6 levels. Perfusates of donation after circulatory death grafts showed higher IL-6 levels at the end of NMP than donation after brain death grafts. However, IL-6 levels at the end of NMP correlated with catecholamine requirements and MAP in the reperfusion phase. Per log10 increase in IL-6 levels, an increase of 42% points in administered catecholamine dose was observed, despite MAP being decreased by 3.6% points compared to baseline values.

Conclusions.

IL-6 levels may be a predictor for recipient hemodynamic instability during liver reperfusion. Larger studies are needed to confirm this finding.
Visual Snow Syndrome Improves With Modulation of Resting-State Functional MRI Connectivity After Mindfulness-Based Cognitive Therapy: An Open-Label Feasibility Study
Authors: Wong Sui H. , Pontillo Giuseppe , Kanber Baris , Prados Ferran , Wingrove Janet , Yiannakas Marios , Davagnanam Indran , Gandini Wheeler-Kingshott Claudia A. M. , Toosy Ahmed T.
Published: November 2023

Background:

Visual snow syndrome (VSS) is associated with functional connectivity (FC) dysregulation of visual networks (VNs). We hypothesized that mindfulness-based cognitive therapy, customized for visual symptoms (MBCT-vision), can treat VSS and modulate dysfunctional VNs.

Methods:

An open-label feasibility study for an 8-week MBCT-vision treatment program was conducted. Primary (symptom severity; impact on daily life) and secondary (WHO-5; CORE-10) outcomes at Week 9 and Week 20 were compared with baseline. Secondary MRI outcomes in a subcohort compared resting-state functional and diffusion MRI between baseline and Week 20.

Results:

Twenty-one participants (14 male participants, median 30 years, range 22–56 years) recruited from January 2020 to October 2021. Two (9.5%) dropped out. Self-rated symptom severity (0–10) improved: baseline (median [interquartile range (IQR)] 7 [6–8]) vs Week 9 (5.5 [3–7], P = 0.015) and Week 20 (4 [3–6], P < 0.001), respectively. Self-rated impact of symptoms on daily life (0–10) improved: baseline (6 [5–8]) vs Week 9 (4 [2–5], P = 0.003) and Week 20 (2 [1–3], P < 0.001), respectively. WHO-5 Wellbeing (0–100) improved: baseline (median [IQR] 52 [36–56]) vs Week 9 (median 64 [47–80], P = 0.001) and Week 20 (68 [48–76], P < 0.001), respectively. CORE-10 Distress (0–40) improved: baseline (15 [12–20]) vs Week 9 (12.5 [11–16.5], P = 0.003) and Week 20 (11 [10–14], P = 0.003), respectively. Within-subject fMRI analysis found reductions between baseline and Week 20, within VN-related FC in the i) left lateral occipital cortex (size = 82 mL, familywise error [FWE]-corrected P value = 0.006) and ii) left cerebellar lobules VIIb/VIII (size = 65 mL, FWE-corrected P value = 0.02), and increases within VN-related FC in the precuneus/posterior cingulate cortex (size = 69 mL, cluster-level FWE-corrected P value = 0.02).

Conclusions:

MBCT-vision was a feasible treatment for VSS, improved symptoms and modulated FC of VNs. This study also showed proof-of-concept for intensive mindfulness interventions in the treatment of neurological conditions.
Metamagnetism in a coordination polymer built of trimeric cobalt units and melamine
Authors: Bernabé Vírseda Ignacio , Mantel Arthur , Prado-Roller Alexander , Eisterer Michael , Shiozawa Hidetsugu
Published: November 2023

A coordination polymer of linear trimeric cobalt units and melamine has been synthesized. The magnetic isotherms of violet coloured crystals as long as 400 μm show a field-induced transition in an external field of about 2 T at temperatures approximately below 2 K. It is addressed that by assuming the coexistent positive and negative exchange between the nearest-neighbour spins in the linear trimer, this metamagnetism can be interpreted as a transition from antiferromagnetic to ferromagnetic exchange within each trimeric spin cluster. Although weak inter-cluster or inter-chain exchange to yield a long-range magnetic order is another possible and often attributed origin of metamagnetism in low-dimensional spin systems, this study demonstrates the significance of the exchange flip within each cluster in clustered spin networks.
Targeted genome sequencing for tuberculosis drug susceptibility testing in South Africa: A proposed diagnostic pipeline
Authors: Bagratee Tayarv , Studholme David
Published: November 2023

In July 2023, the World Health Organization (WHO) began recommending targeted next-generation sequencing (tNGS), due to its ability to detect resistance to many drugs with a single test. In March 2023, South Africa further adopted the GeneXpert® XDR cartridge, which detects mutations associated with resistance to second-line injectable drugs. Here, we consider the feasibility for implementing tNGS in South Africa, what such a facility might look like and the specific context of this upper-middle-income country. Whilst the WHO now recommends tNGS for TB diagnostics and DST, there are many economic and infrastructural challenges opposing its deployment. In lieu of this, we instead recommend a stratified diagnostic pipeline that utilises South Africa's existing GeneXpert technologies, in an attempt to reduce the costs associated with implementation of tNGS.
Urinary tract infections: a review of the current diagnostics landscape
Authors: Grey Braith , Upton Mathew , Joshi Lovleen Tina
Published: November 2023

Urinary tract infections are the most common bacterial infections worldwide. Infections can range from mild, recurrent (rUTI) to complicated (cUTIs), and are predominantly caused by uropathogenic

Escherichia coli

(UPEC). Antibiotic therapy is important to tackle infection; however, with the continued emergence of antibiotic resistance there is an urgent need to monitor the use of effective antibiotics through better stewardship measures. Currently, clinical diagnosis of UTIs relies on empiric methods supported by laboratory testing including cellular analysis (of both human and bacterial cells), dipstick analysis and phenotypic culture. Therefore, development of novel, sensitive and specific diagnostics is an important means to rationalise antibiotic therapy in patients. This review discusses the current diagnostic landscape and highlights promising novel diagnostic technologies in development that could aid in treatment and management of antibiotic-resistant UTIs.
Soil seed bank richness, abundance and density across spatial scales and global biomes
Authors: Auffret Alistair G. , Ladouceur Emma , Haussmann Natalie S. , Keil Petr , Daouti Eirini , Elumeeva Tatiana G. , Kačergytė Ineta , Knape Jonas , Kotowska Dorota , Low Matthew , Onipchenko Vladimir G. , Paquet Matthieu , Rubene Diana , Plue Jan
Published: November 2023

Soil seed banks are an important component of plant population and community dynamics. As a functional strategy that has evolved in response to abiotic disturbance regimes, they are likely to play a key role in determining biodiversity responses to global change. However, like all aspects of biodiversity, patterns in soil seed banks are likely to be scale-dependent. Here, we investigate components of diversity in the soil seed bank across global biomes, accounting for sampled soil area and geographic extent. Species richness increases with spatial scale at a similar rate across terrestrial biomes, but with differences in the slope (beta diversity). At small scales (0.01 m2), mediterranean systems exhibited the highest seed bank richness, while at larger scales (15 m2) it was tropical forests. Seed density m-2in the soil was highest in arable systems, followed by tropical and temperate grasslands. Lower densities were found in both high-diversity tropical biomes that are characterised by short-lived seeds, and low-diversity boreal/tundra biomes with more stable established vegetation. Our synthesis shows how a combination of spatial scale and the environmental conditions of different biomes shape global patterns of the multiple components of biodiversity in the soil seed bank.
Study protocol of the Hungarian Longitudinal Study of Healthy Brain Aging (HuBA)
Authors: Bankó Éva M. , Weiss Béla , Hevesi István , Manga Annamária , Vakli Pál , Havadi-Nagy Menta , Kelemen Rebeka , Somogyi Eszter , Homolya István , Bihari Adél , Simon Ádám , Nárai Ádám , Tóth Krisztina , Báthori Noémi , Tomacsek Vivien , Kamondi Anita , Racsmány Mihály , Dénes Ádám , Simor Péter , Kovács Tibor , Hermann Petra , Vidnyánszky Zoltán
Published: November 2023

Background

Neurocognitive aging and the associated brain diseases impose a major social and economic burden. Therefore, substantial efforts have been put into revealing the lifestyle, neurobiological and genetic underpinnings of healthy neurocognitive aging. However, these studies take place almost exclusively in a limited number of highly-developed countries. Thus, it is an important open question to what extent their findings may generalize to neurocognitive aging in other, not yet investigated regions.

Purpose

The purpose of the Hungarian Longitudinal Study of Healthy Brain Aging (HuBA) is to collect multi-modal longitudinal data on healthy neurocognitive aging to address the data gap in this field in Central and Eastern Europe.

Methods

We adapted the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging1study protocol to local circumstances and will collect demographic, lifestyle, mental and physical health, medication and medical history related information as well as record a series of magnetic resonance imaging (MRI) data. In addition, participants will also be offered to participate in the collection of blood samples to assess circulating inflammatory biomarkers as well as a sleep study aimed at evaluating the general sleep quality based on multi-day collection of subjective sleep questionnaires and whole-night electroencephalographic (EEG) data.

Results & Discussion

Data collection will be longitudinal with 18 months between measurements and at least three sessions are intended. The collected data might reveal specific local trends or could also indicate the generalizability of previous findings. Moreover, as the HuBA protocol also offers a sleep study designed for thorough characterization of participants’ sleep quality and related factors, our extended multi-modal dataset might provide a base for incorporating these measures into healthy and clinical aging research.

Conclusion

Besides its straightforward national benefits in terms of health expenditure, we hope that this Hungarian initiative could provide results valid for the whole Central and Eastern European region and could also promote aging and Alzheimer’s disease research in these countries.
ProkBERT Family: Genomic Language Models for Microbiome Applications
Authors: Ligeti Balázs , Szepesi-Nagy István , Bodnár Babett , Ligeti-Nagy Noémi , Juhász János
Published: November 2023

Machine learning offers transformative capabilities in microbiology and microbiome analysis, deciphering intricate microbial interactions, predicting functionalities, and unveiling novel patterns in vast datasets. This enriches our comprehension of microbial ecosystems and their influence on health and disease. However, the integration of machine learning in these fields contends with issues like the scarcity of labeled datasets, the immense volume and complexity of microbial data, and the subtle interactions within microbial communities. Addressing these challenges, we introduce the ProkBERT model family. Built on transfer learning and self-supervised methodologies, ProkBERT models capitalize on the abundant available data, demonstrating adaptability across diverse scenarios. The models’ learned representations align with established biological understanding, shedding light on phylogenetic relationships. With the novel Local Context-Aware (LCA) tokenization, the ProkBERT family overcomes the context size limitations of traditional transformer models without sacrificing performance or the information rich local context. In bioinformatics tasks like promoter prediction and phage identification, ProkBERT models excel. For promoter predictions, the best performing model achieved an MCC of 0.74 forE. coliand 0.62 in mixed-species contexts. In phage identification, they all consistently outperformed tools like VirSorter2 and DeepVirFinder, registering an MCC of 0.85. Compact yet powerful, the ProkBERT models are efficient, generalizable, and swift. They cater to both supervised and unsupervised tasks, providing an accessible tool for the community. The models are available on GitHub and HuggingFace.