bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Clinical Depression, Anxiety, and Chronic Pain in the Active Duty Army Personnel
Authors: Ee Juliana S , Hing Matthew S , Dogbey Godwin Y , Cook Marc A , Agnello Robert N , Skelly Stephanie K , Frost Landon S
Published: November 2023

Introduction

Chronic pain is highly prevalent among soldiers leading to costly impacts on disability and readiness. Depression and anxiety (D&A) are frequently comorbid with chronic pain, but previous studies tend to focus on reporting the odds of co-occurrence. The aim of this study was to examine the association of properly diagnosed D&A disorders on chronic pain indicators among active duty soldiers.

Materials and Methods

Data were drawn from the intake assessments of 203 soldiers seen at an Interdisciplinary Pain Management Center. The Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria and the D&A subscales of the Patient Health Questionnaire were used to identify patients who met criteria for clinical depression or anxiety. Of the 203 patients, 129 met neither depression nor anxiety criteria (No D&A), 12 met clinical depression criteria only, 16 met clinical anxiety only, and 46 showed coexisting D&A disorders. The D&A and No D&A groups were compared using validated measures to assess the pain intensity rating and pain effect on well-being, physical functioning, and catastrophizing tendency. Data were analyzed using descriptive statistics and independent samples t-test analyses.

Results

Significant differences were found between the D&A and No D&A groups on all pain-related measures (all Ps < .001). Patients in the D&A group reported higher average intensity of pain (6.11 versus 5.05) and greater effect of pain on activity (6.91 versus 5.37), sleep (7.20 versus 4.90), emotional state (7.74 versus 4.47), and stress (8.13 versus 4.78). Depression and anxiety patients also reported higher pain-catastrophizing tendency (38.56 versus 18.50) and greater physical disability (18.20 versus 12.22).

Conclusions

Soldiers who have chronic pain with coexisting D&A disorders experience a greater degree of perceived negative impacts. Consequently, attentiveness to proper diagnosis and treatment of coexisting clinical mood disorders is an essential step in fully addressing chronic pain management.
Preliminary Head-Supported Mass Performance Guidance for Dismounted Soldier Environments
Authors: Madison Adrienne M , Holderfield M Reid , Olszko Ardyn V , Novotny Brian , McGovern Shannon M , Brozoski Frederick T , Shivers Bethany L , Chancey Valeta Carol
Published: November 2023

Introduction

The helmet is an ideal platform to mount technology that gives U.S. Soldiers an advantage over the enemy; the total system is recognized quantitatively as head-supported mass (HSM). The stress placed on the head and neck is magnified by adding mass and increasing the center of mass offset away from the atlanto-occipital complex, the head’s pivot point on the spine. Previous research has focused on HSM-related spinal degeneration and performance decrement in mounted environments. The increased capabilities and protection provided by helmet systems for dismounted Soldiers have made it necessary to determine the boundaries of HSM and center of mass offset unique to dismounted operations.

Materials and Methods

A human subject volunteer study was conducted to characterize the head and neck exposures and assess the impact of HSM on performance in a simulated field-dismounted operating environment. Data were analyzed from 21 subjects who completed the Load Effects Assessment Program-Army obstacle course at Fort Benning, GA, while wearing three different experimental HSM configurations. Four variable groups (physiologic/biomechanical, performance, kinematic, and subjective) were evaluated as performance assessments. Weight moments (WMs) corresponding to specific performance decrement levels were calculated using the quantitative relationships developed between each metric and the study HSM configurations. Data collected were used to develop the performance decrement HSM threshold criteria based on an average of 10% total performance decrement of dismounted Soldier performance responses.

Results

A WM of 134 N-cm about the atlanto-occipital complex was determined as the preliminary threshold criteria for an average of 10% total performance decrement. A WM of 164 N-cm was calculated for a corresponding 25% average total performance decrement.

Conclusions

The presented work is the first of its kind specifically for dismounted Soldiers. Research is underway to validate these limits and develop dismounted injury risk guidance.
Revisiting the classics: on the evolutionary origin of the ‘Fe ii’ and ‘He/N’ spectral classes of novae
Authors: Aydi E , Chomiuk L , Strader J , Sokolovsky K V , Williams R E , Buckley D A H , Ederoclite A , Izzo L , Kyer R , Linford J D , Kniazev A , Metzger B D , Mikołajewska J , Molaro P , Molina I , Mukai K , Munari U , Orio M , Panurach T , Shappee B J , Shen K J , Sokoloski J L , Urquhart R , Walter F M
Published: November 2023

The optical spectra of novae are characterized by emission lines from the hydrogen Balmer series and either Fe ii or He/N, leading to their traditional classification into two spectral classes: ‘Fe ii’ and ‘He/N’. For decades, the origins of these spectral features were discussed in the literature in the contexts of different bodies of gas or changes in the opacity of the ejecta, particularly associated with studies by R. E. Williams and S. N. Shore. Here, we revisit these major studies with dedicated, modern data sets, covering the evolution of several novae from early rise to peak all the way to the nebular phase. Our data confirm previous suggestions in the literature that the ‘Fe ii’ and ‘He/N’ spectral classes are phases in the spectroscopic evolution of novae driven primarily by changes in the opacity, ionization, and density of the ejecta, and most if not all novae go through at least three spectroscopic phases as their eruptions evolve: an early He/N (phase 1; observed during the early rise to visible peak and characterized by P Cygni lines of He i and N ii/iii), then an Fe ii (phase 2; observed near visible peak and characterized by P Cygni lines of Fe ii and O i), and then a later He/N (phase 3; observed during the decline and characterized by emission lines of He i/ii, N ii/iii), before entering the nebular phase. This spectral evolution seems to be ubiquitous across novae, regardless of their speed class; however the duration of each of these phases differs based on the speed class of the nova.
Searching for the spectral depolarization of ASKAP one-off FRB sources
Authors: Uttarkar Pavan A , Shannon R M , Gourdji K , Deller A T , Day C K , Bhandari S
Published: November 2023

Fast Radio Bursts (FRBs) are extragalactic transients of (sub-)millisecond duration that show wide-ranging spectral, temporal, and polarimetric properties. The polarimetric analysis of FRBs can be used to probe intervening media, study the emission mechanism, and test possible progenitor models. In particular, low-frequency depolarization of FRBs can identify dense, turbulent, magnetized, ionized plasma thought to be near the FRB progenitor. An ensemble of repeating FRBs has shown low-frequency depolarization. The depolarization is quantified by the parameter $\sigma _{\rm RM}\,$, which correlates with proxies for both the turbulence and mean magnetic field strength of the putative plasma. However, while many non-repeating FRBs show comparable scattering (and hence inferred turbulence) to repeating FRBs, it is unclear whether their surrounding environments are comparable to those of repeating FRBs. To test this, we analyse the spectro-polarimetric properties of five one-off FRBs and one repeating FRB, detected and localized by the Australian Square Kilometer Array Pathfinder. We search for evidence of depolarization due to $\sigma _{\rm RM}\,$ and consider models where the depolarization is intrinsic to the source. We find no evidence (for or against) the sample showing spectral depolarization. Under the assumption that FRBs have multipath propagation-induced depolarization, the correlation between our constraint on $\sigma _{\rm RM}\,$ and RM is consistent with repeating FRBs only if the values of $\sigma _{\rm RM}\,$ are much smaller than our upper limits. Additionally, the correlation between the constraints on $\sigma _{\rm RM}\,$ and τs is inconsistent with repeating FRBs. The observations provide further evidence for differences in the typical environments and sources of one-off and repeating FRBs.
Inefficient acceleration of electrons in the shocked wind of the massive star Θ1 Ori C within the Trapezium Cluster
Authors: Bednarek W
Published: November 2023

Shocked winds of massive stars in young stellar clusters have been proposed as possible sites in which relativistic particles are accelerated. Electrons, accelerated in such an environment, are expected to efficiently Comptonize optical radiation (from massive stars) and the infrared radiation (rescattered by the dust within the cluster) producing GeV–TeV γ-rays. We investigate the time-dependent process of acceleration, propagation, and radiation of electrons in the stellar wind of the massive star Θ1 Ori C within the Trapezium Cluster. This cluster is located within the nearby Orion Nebula (M42). We show that the γ-ray emission expected from the Trapezium Cluster is consistent with the present observations of the Orion molecular cloud by the Fermi-Large Area Telescope provided that the efficiency of energy conversion from the stellar wind to relativistic electrons is very low, i.e. χ < 10−4. For such low efficiencies, the γ-ray emission from electrons accelerated in the stellar wind of Θ1 Ori C can be only barely observed by the future Cherenkov telescopes, e.g. the Cherenkov Telescope Array.
Masses, revised radii, and a third planet candidate in the ‘Inverted’ planetary system around TOI-1266
Authors: Cloutier Ryan , Greklek-McKeon Michael , Wurmser Serena , Cherubim Collin , Gillis Erik , Vanderburg Andrew , Hadden Sam , Cadieux Charles , Artigau Étienne , Vissapragada Shreyas , Mortier Annelies , López-Morales Mercedes , Latham David W , Knutson Heather , Haywood Raphaëlle D , Pallé Enric , Doyon René , Cook Neil , Andreuzzi Gloria , Cecconi Massimo , Cosentino Rosario , Ghedina Adriano , Harutyunyan Avet , Pinamonti Matteo , Stalport Manu , Damasso Mario , Rescigno Federica , Wilson Thomas G , Buchhave Lars A , Charbonneau David , Cameron Andrew Collier , Dumusque Xavier , Lovis Christophe , Mayor Michel , Molinari Emilio , Pepe Francesco , Piotto Giampaolo , Rice Ken , Sasselov Dimitar , Ségransan Damien , Sozzetti Alessandro , Udry Stéphane , Watson Chris A
Published: November 2023

Is the population of close-in planets orbiting M dwarfs sculpted by thermally driven escape or is it a direct outcome of the planet formation process? A number of recent empirical results strongly suggest the latter. However, the unique architecture of the TOI-1266 system presents a challenge to models of planet formation and atmospheric escape given its seemingly ‘inverted’ architecture of a large sub-Neptune (Pb = 10.9 d, $R_{p,b}=2.62\pm 0.11\, \mathrm{R}_{\oplus }$) orbiting interior to that of the system’s smaller planet (Pc = 18.8 d, $R_{p,c}=2.13\pm 0.12\, \mathrm{R}_{\oplus }$). Here, we present revised planetary radii based on new TESS and diffuser-assisted ground-based transit observations, and characterize both planetary masses using a set of 145 radial velocity measurements from HARPS-N ($M_{p,b}=4.23\pm 0.69\, \mathrm{M}_{\oplus }, M_{p,c}=2.88\pm 0.80\, \mathrm{M}_{\oplus }$). Our analysis also reveals a third planet candidate (Pd = 32.3 d, $M_{p,d}\sin {i} = 4.59^{+0.96}_{-0.94}\, \mathrm{M}_{\oplus }$), which if real, would form a chain of near 5:3 period ratios, although the system is likely not in a mean motion resonance. Our results indicate that TOI-1266 b and c are among the lowest density sub-Neptunes around M dwarfs and likely exhibit distinct bulk compositions of a gas-enveloped terrestrial (Xenv,b = 5.5 ± 0.7 per cent) and a water-rich world (WMFc = 59 ± 14 per cent), which is supported by hydrodynamic escape models. If distinct bulk compositions are confirmed through atmospheric characterization, the system’s unique architecture would represent an interesting test case of inside-out sub-Neptune formation at pebble traps.
Characterizing cool, neutral gas, and ionized metals in the outskirts of low-z galaxy clusters
Authors: Mishra Sapna , Muzahid Sowgat , Dutta Sayak , Srianand Raghunathan , Charlton Jane
Published: November 2023

We present the first detection of cool, neutral gas in the outskirts of low-z galaxy clusters using a statistically significant sample of 3191 z ≈ 0.2 background quasar-foreground cluster pairs by cross-matching the Hubble Spectroscopic Legacy Archive quasar catalogue with optically- and SZ-selected cluster catalogues. The median cluster mass of our sample is ≈1014.2 $\rm {\rm M}_{\odot }$ with a median impact parameter (ρcl) of ≈5 Mpc. We detect significant Lyα, marginal C iv, but no O vi absorption in the signal-to-noise ratio weighted mean stacked spectra with rest-frame equivalent widths of 0.096 ± 0.011, 0.032 ± 0.015, and <0.009 Å (3σ) for our sample. The Lyα REW shows a declining trend with increasing ρcl (ρcl/R500), which is well explained by a power-law with a slope of −0.79 (−0.70). The covering fractions (CFs) measured for Lyα (21 per cent), C iv (10 per cent), and O vi (10 per cent) in cluster outskirts are significantly lower than in the circumgalatic medium (CGM). We also find that the CGM of galaxies that are closer to cluster centres or that are in massive clusters is considerably deficient in neutral gas. The low CF of the Lyα along with the non-detection of Lyα signal when the strong absorbers ($N(\rm{H\,{\small I}}) > 10^{13}$ cm−2) are excluded, indicate the patchy distribution of cool gas in the outskirts. We argue that the cool gas in cluster outskirts in combination arises from the circumgalactic gas stripped from cluster galaxies and to large-scale filaments feeding the clusters with cool gas.
The effect of sculpting planets on the steepness of debris-disc inner edges
Authors: Pearce Tim D , Krivov Alexander V , Sefilian Antranik A , Jankovic Marija R , Löhne Torsten , Morgner Tobias , Wyatt Mark C , Booth Mark , Marino Sebastian
Published: November 2023

Debris discs are our best means to probe the outer regions of planetary systems. Many studies assume that planets lie at the inner edges of debris discs, akin to Neptune and the Kuiper Belt, and use the disc morphologies to constrain those otherwise-undetectable planets. However, this produces a degeneracy in planet mass and semimajor axis. We investigate the effect of a sculpting planet on the radial surface-density profile at the disc inner edge, and show that this degeneracy can be broken by considering the steepness of the edge profile. Like previous studies, we show that a planet on a circular orbit ejects unstable debris and excites surviving material through mean-motion resonances. For a non-migrating, circular-orbit planet, in the case where collisions are negligible, the steepness of the disc inner edge depends on the planet-to-star mass ratio and the initial-disc excitation level. We provide a simple analytic model to infer planet properties from the steepness of ALMA-resolved disc edges. We also perform a collisional analysis, showing that a purely planet-sculpted disc would be distinguishable from a purely collisional disc and that, whilst collisions flatten planet-sculpted edges, they are unlikely to fully erase a planet’s signature. Finally, we apply our results to ALMA-resolved debris discs and show that, whilst many inner edges are too steep to be explained by collisions alone, they are too flat to arise through completed sculpting by non-migrating, circular-orbit planets. We discuss implications of this for the architectures, histories, and dynamics in the outer regions of planetary systems.
Scalable Surveillance of E-Cigarette Products on Instagram and TikTok Using Computer Vision
Authors: Vassey Julia , Kennedy Chris J , Herbert Chang Ho-Chun , Smith Ashley S , Unger Jennifer B
Published: November 2023

Introduction

Instagram and TikTok, video-based social media platforms popular among adolescents, contain tobacco-related content despite the platforms’ policies prohibiting substance-related posts. Prior research identified themes in e-cigarette-related social media posts using qualitative or text-based machine learning methods. We developed an image-based computer vision model to identify e-cigarette products in social media images and videos.

Aims and Methods

We created a data set of 6999 Instagram images labeled for 8 object classes: mod or pod devices, e-juice containers, packaging boxes, nicotine warning labels, e-juice flavors, e-cigarette brand names, and smoke clouds. We trained a DyHead object detection model using a Swin-Large backbone, evaluated the model’s performance on 20 Instagram and TikTok videos, and applied the model to 14 072 e-cigarette-related promotional TikTok videos (2019–2022; 10 276 485 frames).

Results

The model achieved the following mean average precision scores on the image test set: e-juice container: 0.89; pod device: 0.67; mod device: 0.54; packaging box: 0.84; nicotine warning label: 0.86; e-cigarette brand name: 0.71; e-juice flavor name: 0.89; and smoke cloud: 0.46. The prevalence of pod devices in promotional TikTok videos increased by 15% from 2019 to 2022. The prevalence of e-juices increased by 33% from 2021 to 2022. The prevalence of e-juice flavor names and e-cigarette brand names increased by about 100% from 2019 to 2022.

Conclusions

Deep learning-based object detection technology enables automated analysis of visual posts on social media. Our computer vision model can detect the presence of e-cigarettes products in images and videos, providing valuable surveillance data for tobacco regulatory science (TRS).

Implications

Prior research identified themes in e-cigarette-related social media posts using qualitative or text-based machine learning methods. We developed an image-based computer vision model to identify e-cigarette products in social media images and videos. We trained a DyHead object detection model using a Swin-Large backbone, evaluated the model’s performance on 20 Instagram and TikTok videos featuring at least two e-cigarette objects, and applied the model to 14 072 e-cigarette-related promotional TikTok videos (2019–2022; 10 276 485 frames). The deep learning model can be used for automated, scalable surveillance of image- and video-based e-cigarette-related promotional content on social media, providing valuable data for TRS. Social media platforms could use computer vision to identify tobacco-related imagery and remove it promptly, which could reduce adolescents’ exposure to tobacco content online.
Hydrogen cyanamide exposure: a case series from Pavia Poison Control Centre
Authors: Bernasconi L , Carnovale M , Lonati D , Petrolini V M , Schicchi A , Brolli B , Negrini V M , Grazioli C , Maystrova O , Buscaglia E , Scaravaggi Giulia , Crema F , Locatelli C A
Published: November 2023

Background

Hydrogen cyanamide is a plant growth regulator introduced in Italy as Dormex in 2000, but recalled from the market in 2008. It’s currently not authorized in Europe. Inhalation/dermal contact may cause irritation/caustic burns, ingestion of severe organ damage and concomitant alcohol consumption disulfiram-like reaction due to aldehyde-dehydrogenase inhibition by hydrogen cyanamide.

Aims

To study all exposure cases referred to our centre, evaluating temporal and geographic distribution and analysing clinical manifestations, including the ones after alcohol consumption.

Methods

We retrospectively evaluated all hydrogen cyanamide exposures referred to our Poison Control Centre (January 2007–December 2021). For each case, age, sex, exposure route/year, geographical location, intent of exposure, alcohol co-ingestion, emergency department-admission Poison Severity Score, signs/symptoms and treatment were analysed.

Results

Thirty subjects were included. Median case/year was 1 [1; 2]: 79% occurred after market withdrawal, 92% in Sicily. All exposures were unintentional and work related; 41% of patients also co-ingested alcohol. Mean poison severity score at emergency department admission was 1.54, more severe when ingestion occurred. The most common signs/symptoms were flushing, secondary to peripheral vasodilation (41%), hyperaemia/erythema (29%), dyspnoea (25%), nausea (20%), vomiting (12%), oedema (12%), II–III degrees burns (12%) and pharyngodynia (12%). All patients were treated symptomatically and fully recovered.

Conclusions

Hydrogen cyanamide exposure can lead to severe clinical manifestations. Despite its withdrawal from the Italian market, hydrogen cyanamide is still used: through PCC’s crucial role in monitoring exposure to agricultural products efforts should be made to contrast illegal trade and increase awareness of its potential toxicity in those countries in which it’s still legal.
Bayesian model comparison for simulation-based inference
Authors: Spurio Mancini A , Docherty M M , Price M A , McEwen J D
Published: November 2023

Comparison of appropriate models to describe observational data is a fundamental task of science. The Bayesian model evidence, or marginal likelihood, is a computationally challenging, yet crucial, quantity to estimate to perform Bayesian model comparison. We introduce a methodology to compute the Bayesian model evidence in simulation-based inference (SBI) scenarios (often called likelihood-free inference). In particular, we leverage the recently proposed learned harmonic mean estimator and exploit the fact that it is decoupled from the method used to generate posterior samples, i.e. it requires posterior samples only, which may be generated by any approach. This flexibility, which is lacking in many alternative methods for computing the model evidence, allows us to develop SBI model comparison techniques for the three main neural density estimation approaches, including neural posterior estimation, neural likelihood estimation, and neural ratio estimation. We demonstrate and validate our SBI evidence calculation techniques on a range of inference problems, including a gravitational wave example. Moreover, we further validate the accuracy of the learned harmonic mean estimator, implemented in the harmonic software, in likelihood-based settings. These results highlight the potential of harmonic as a sampler-agnostic method to estimate the model evidence in both likelihood-based and simulation-based scenarios.
Dysregulation of neutrophil oxidant production and interleukin-1–related cytokines in granulomatosis with polyangiitis
Authors: Amsler Jennifer , Everts-Graber Judith , Martin Katherine R , Roccabianca Arnaud , Lopes Chloé , Tourneur Léa , Mocek Julie , Karras Alexandre , Naccache Jean-Marc , Bonnotte Bernard , Samson Maxime , Hanslik Thomas , Puéchal Xavier , Terrier Benjamin , Guillevin Loïc , Néel Antoine , Mouthon Luc , Witko-Sarsat Véronique
Published: November 2023

Objectives

Neutrophils play a key role in ANCA-associated vasculitis, both as targets of autoimmunity and as facilitators of vascular damage. In granulomatosis with polyangiitis (GPA), the data regarding the production of reactive oxygen species (ROS) in neutrophils are unclear. Further, recent data suggests that ROS production could have an anti-inflammatory effect through the regulation of inflammasomes and IL-1–related cytokines. We aimed to analyse ROS production in neutrophils from patients with GPA and investigate its association with IL-1–related cytokines and the autoantigen PR3.

Methods

Seventy-two GPA patients with disease flare were included in the NEUTROVASC prospective cohort study. ROS production in whole blood of patients with active GPA was evaluated and compared with that in the same patients in remission or healthy controls. Associations between ROS production, PR3 membrane expression on neutrophils, serum levels of IL-1–related cytokines as well as inflammasome-related proteins were analysed.

Results

We observed a robust defect in ROS production by neutrophils from patients with active GPA compared with healthy controls, independent of glucocorticoid treatment. Serum levels of IL-1–related cytokines were significantly increased in GPA patients, particularly in patients with kidney involvement, and levels of these cytokines returned to normal after patients achieved remission. Further, inflammasome-related proteins were significantly dysregulated in the cytosol of neutrophils as well as the serum from GPA patients.

Conclusion

Our data suggests that ROS production and regulation of inflammasomes in neutrophils from patients with GPA are disturbed and may be a potential therapeutic target.

Trial registration

ClinicalTrials.gov, https://www.clinicaltrials.gov, NCT01862068.
Fathers, daughters, and matters of trust
Authors: Morrison David
Published: November 2023

This article arises from a complex family dispute and some difficulty in determining the full facts underpinning the complaint. Information given by the parties grudgingly, partially, and in very poor order, caused the primary judge in the penultimate case considered herein to no doubt reluctantly prefer the daughter’s version of events over that of her father. The primary concern is whether or not the father loaned money to his daughter in the purchase of a house in her own name, giving rise to a concomitant responsibility on her part to repay the said loan, or whether, because of the nature of the arrangement, monies advanced by the father might instead be interpreted consistent with an intention on his part to have a beneficial interest in the property.
Contributors to Second-Degree Accelerated Student Success During the COVID-19 Pandemic as Perceived by Administrators, Directors, and Faculty
Authors: Fellows Bonnie J.
Published: November 2023

AIM

This qualitative descriptive study explored the contributors to second-degree accelerated program (SDAP) student success during COVID-19 as described by SDAP administrators, directors, and faculty.

BACKGROUND

SDAPs are fast, rigorous, and stressful. Understanding how SDAP students remain successful, despite their challenges and stressors, during the disorder of a global pandemic could provide insight for administrators, directors, and faculty on how to facilitate success in SDAP students in the future.

METHOD

A qualitative descriptive approach was used in this study. Personal interviews and a demographic survey were used for data collection.

RESULTS

Fourteen SDAP administrators, directors, and faculty participated. Six themes emerged: engagement, clinical experiences, student characteristics, relationships, flexibility, and faculty concerns.

CONCLUSION

Participants shared several recommendations to guide other SDAP administrators, directors, and faculty in developing robust SDAPs and successful students.
A Brief Online Training to Address Pharmacists' Willingness to Dispense Buprenorphine
Authors: Carpenter Delesha , Mashburn Patricia , Viracola Cheryl , Marley Grace , Ostrach Bayla
Published: November 2023

Background

The recent passage of the Mainstreaming Addiction Treatment (MAT) Act could increase the number of patients seeking to fill buprenorphine prescriptions at community pharmacies; however, multiple barriers limit community pharmacists' ability and willingness to dispense buprenorphine. We assess whether a brief online buprenorphine training program (Buprenorphine Understanding in the Pharmacy Environment) improves community pharmacists' outcomes, including willingness to dispense buprenorphine.

Methods

A convenience sample of practicing community pharmacists participated in a 30-minute buprenorphine training. The training was codeveloped with pharmacy advisors and presented solutions to common buprenorphine dispensing barriers. Participants completed a pretest and posttest that assessed their buprenorphine knowledge (5 multiple-choice items based on training content), self-efficacy to engage in various buprenorphine-related behaviors (7 items), buprenorphine attitudes (8 items), and willingness to dispense buprenorphine to 4 different types of customers. Descriptive statistics were calculated, and paired-samples t tests were used to evaluate the impact of the training on pharmacist outcomes.

Results

Of 266 individuals who accessed the pretest, 104 responses were included in the analysis (response rate, 39%). Buprenorphine Understanding in the Pharmacy Environment improved pharmacists' mean buprenorphine knowledge scores (pretest, 2.2; posttest, 3.5; P < 0.001), all 7 self-efficacy items (all P < 0.001), mean buprenorphine attitudes (pretest, 3.1; posttest, 3.4; P < 0.001), and willingness to dispense to all four types of buprenorphine customers (all P < 0.01).

Conclusions

A brief buprenorphine training increased pharmacists' willingness to dispense buprenorphine. Although generalizability of the results may be limited by use of a convenience sample, our pharmacist-oriented training showed promising results and may be an important step in increasing availability of buprenorphine in community pharmacies.
Feel, move, or walk? Which has a greater contribution to functioning in total knee arthroplasty? A comparative study between two instrumentations based on a classification and regression tree
Authors: Fontes Ana Paula , Cintra Rui Miguel , Gomes Luís Filipe , Sousa João Paulo
Published: November 2023

Background:

This study aimed to know which variables most contribute to the functioning acquired in the third month using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and a multivariate analysis through classification and regression tree (CRT), comparing the conventional instrumentation (CI), and patient-specific instrumentation (PSI).

Methods:

This is an observational and retrospective study. The sample consisted of 252 patients, 68 receiving CI (27.0%) and 184 receiving PSI (73.0%). The functional variables of the study were: knee pain, passive flexion and extension, gait distance and the domains of the WOMAC index.

Results:

The CRT method identified that the only explanatory variable that contributed to the highest functioning in the CI group (13.2 in the WOMAC) was pain in the third month with a value ≤2.5 in the visual analog scale (VAS). In the PSI group, the variable that best explained functioning was pain in the first postoperative month (VAS ≤4.5), with the best functional result (2.8 in WOMAC) referring to the patients who walked >320.5 m in the 6-minute walk test in the first month and who had flexion of >112.5 in the third month.

Conclusions:

Feeling pain is the variable with the most significant explanatory power for the results achieved in functioning at the third month, regardless of the arthroplasty instrumentation employed. Moving the knee in higher flexion ranges and obtaining higher mean values of gait speed also positively influences functioning in patients subjected to PSI.
Clinical Outcomes and Associated Pathologies Following Pediatric Traumatic Hip Dislocations: A Systematic Review of the Literature
Authors: Baumann Anthony N. , Ndjonko Laura C.M. , Schoenecker Jonathan G. , Baldwin Keith D.
Published: November 2023

Introduction:

Pediatric traumatic hip dislocations are a rare condition that can have devastating short and/or long-term outcomes and associated pathologies (APs), including associated injuries (AIs) and long-term adverse events (LTAEs), with negative long-term sequelae. Currently, there are little data that exist on the rate of APs, with the most notable being avascular necrosis (AVN), for pediatric traumatic hip dislocations. The purpose of this systematic review is to evaluate the outcome relative frequency of dislocation direction, reduction type, and rate of APs for traumatic hip dislocations in the pediatric population.

Methods:

A systematic review on the topic of traumatic hip dislocations in the pediatric population was performed using PubMed, ScienceDirect, Web of Science, CINAHL, and MEDLINE databases from database inception to March 30, 2023. Inclusion criteria was full-text English articles, addressed traumatic hip dislocations, and pediatric patients (<18 y old).

Results:

A total of 24 articles (n=575 patients) met final inclusion criteria from a total of 219 articles retrieved from the initial search. For the average age of the included patients with reported age (n=433 patients), the frequency weighted mean was 9.50 years±1.75 years with a frequency weighted mean follow-up time of 74.05 months ±45.97 months (n=399 patients). The most common dislocation direction was posterior (86.4%), the most common treatment type was closed reduction (84.5%), AVN was the most common type of LTAEs (15.5% of APs), and labral/capsular injuries and acetabular fractures were the most common type of AIs (14.0% and 9.4% of APs, respectively). There were a combined total of 414 APs (72%) out of 575 total patients.

Conclusion:

Pediatric traumatic hip dislocations are associated with a high rate of AIs and LTAEs (72%, 414 APs out of 575 patients). AVN, labral/capsular injuries, and acetabular fractures are the most common APs after pediatric traumatic hip dislocations. Pediatric hip dislocations are usually posterior and commonly managed through closed reduction.

Level of Evidence:

III, Systematic Review.
Enhancing Precision in L-band Electron Paramagnetic Resonance Tooth Dosimetry: Incorporating Digital Image Processing and Radiation Therapy Plans for Geometric Correction
Authors: Park Jong In , Koo Chang Uk , Oh Jeonghun , Kim In Jung , Choi Kwon , Ye Sung-Joon
Published: November 2023

Following unforeseen exposure to radiation, quick dose determination is essential to prioritize potential patients that require immediate medical care. L-band electron paramagnetic resonance tooth dosimetry can be efficiently used for rapid triage as this poses no harm to the human incisor, although geometric variations among human teeth may hinder accurate dose estimation. Consequently, we propose a practical geometric correction method using a mobile phone camera. Donated human incisors were irradiated with calibrated 6-MV photon beam irradiation, and dose-response curves were developed by irradiation with a predetermined dose using custom-made poly(methyl methacrylate) slab phantoms. Three radiation treatment plans for incisors were selected and altered to suit the head phantom. The mean doses on tooth structures were calculated using a commercial treatment planning system, and the electron paramagnetic resonance signals of the incisors were measured. The enamel area was computed from camera-acquired tooth images. The relative standard uncertainty was rigorously estimated both with and without geometric correction. The effects on the electron paramagnetic resonance signal caused by axial and rotational movements of tooth samples were evaluated through finite element analysis. The mean absolute deviations of mean doses both with and without geometric correction showed marginal improvement. The average relative differences without and with geometric correction significantly decreased from 21.0% to 16.8% (p = 0.01). The geometric correction method shows potential in improving dose precision measurement with minimal delay. Furthermore, our findings demonstrated the viability of using treatment planning system doses in dose estimation for L-band electron paramagnetic resonance tooth dosimetry.
Origins and Popularization of Traditional Chinese Therapies in Argentina at the End of 20th Century: the Case of Daniel Alegre
Authors: Viotti Nicolás
Published: November 2023

Various resources of the so-called traditional Chinese medicine, such as taijiquan, massage, diets, or acupuncture, have become widely available in the everyday therapeutic culture of contemporary Argentina. While these resources can be found in the first half of the 20th century, it is evident that from the 1960s onward their presence is more evident, with a strong emphasis from the 1980s on. This article aims to describe the reception and popularization of body and therapeutic techniques of traditional Chinese medicine in Argentina in the 1980s through the case of Daniel Alegre, a key figure in the dissemination of Chinese therapeutic techniques. To do so, it focuses on certain key mediators in the popularization of techniques such as taijiquan and Chinese massage: teachers, promoters, and specialized magazines. All these mediators are key artifacts in the processes of massification and dissemination of traditional Chinese medicine in a broader emerging horizon associated with two simultaneous processes, the Chinese cultural transnationalization and the boom of new forms of holistic management of personal well-being.
Risk factors for rehospitalization within 90 days in patients with total joint replacement: A meta-analysis
Authors: Zeng Liping , Cai Hua , Qiu Aling , Zhang Dongfu , Lin Lingying , Lian Xirong , Chen Manli
Published: November 2023

Background:

The risk factors influencing the readmission within 90 days following total joint replacement (TJR) are complex and heterogeneous, and few systematic reviews to date have focused on this issue.

Methods:

Web of Science, Embase, PubMed, and Chinese National Knowledge Infrastructure databases were searched from the inception dates to December 2022. Relevant, published studies were identified using the following keywords: risk factors, rehospitalization, total hip replacement, total knee replacement, total shoulder replacement, and total joint replacement. All relevant data were collected from the studies that meet the inclusion criteria. The methodological quality of the studies was assessed using the Newcastle–Ottawa Scale (NOS).

Results:

Of 68,336 patients who underwent TJR, 1,269,415 (5.4%) were readmitted within 90 days. High American Society of Anesthesiologists (ASA) class (OR, 1.502; 95%CI:1.405–1.605; P < .001), heart failure (OR,1.494; 95%CI: 1.235–1.754; P < .001), diabetes (OR, 1.246; 95%CI:1.128–1.377; P < .001), liver disease (OR, 1.339; 95%CI:1.237–1.450; P < .001), drinking (OR, 1.114; 95%CI:1.041–1.192; P = .002), depression (OR, 1.294; 95%CI:1.223–1.396; P < .001), urinary tract infection (OR, 5.879; 95%CI: 5.119–6.753; P < .001), and deep vein thrombosis (OR, 10.007; 95%CI: 8.787–11.396; P < .001) showed statistically positive correlation with increased 90-day readmissions after TJR, but high blood pressure, smoking, and pneumonia had no significant association with readmission risk.

Conclusion:

The findings of this review and meta-analysis will aid clinicians as they seek to understand the risk factors for 90-day readmission following TJR. Clinicians should consider the identified key risk factors associated with unplanned readmissions and develop strategies to risk-stratify patients and provide dedicated interventions to reduce the rates of readmission and enhance the recovery process.
The safety and efficacy of first-line atezolizumab plus bevacizumab in patients with unresectable hepatocellular carcinoma: A multicenter real-world study from Turkey
Authors: Akyildiz Arif , Guven Deniz Can , Ozluk Ahmet Anil , Ismayilov Rashad , Mutlu Emel , Unal Olcun Umit , Yildiz Ibrahim , Iriagac Yakup , Turhal Serdar , Akbas Sinem , Bayram Ertugrul , Telli Tugba Akin , Turkoz Fatma Paksoy , Ozcelik Melike , Erciyestepe Mert , Selvi Oguzhan , Gulbagci Burcu , Erturk Ismail , Isleyen Zehra Sucuoglu , Kahraman Seda , Akdag Mutianur Ozkorkmaz , Hamitoglu Buket , Unek Ilkay Tugba , Unal Caglar , Hacibekiroglu İlhan , Arslan Cagatay , Azizy Abdulmunir , Helvaci Kaan , Demirci Umut , Dizdar Omer , Basaran Mert , Goker Erdem , Sendur Mehmet Ali , Yalcin Suayib
Published: November 2023

The aim of the study was to evaluate the real-world clinical outcomes of atezolizumab and bevacizumab (Atez/Bev) as the initial therapy for advanced hepatocellular carcinoma (HCC). We retrospectively analyzed 65 patients treated with Atez/Bev for advanced HCC from 22 institutions in Turkey between September 2020 and March 2023. Responses were evaluated by RECIST v1.1 criteria. The median progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Cox regression model was employed to conduct multivariate analyses. The median age was 65 (range, 22–89) years, and 83.1% of the patients were male. A total of 1.5% achieved a complete response, 35.4% had a partial response, 36.9% had stable disease, and 26.2% had progressive disease. The disease control rate was 73.8% and associated with alpha-fetoprotein levels at diagnosis and concomitant antibiotic use. The incidence rates of any grade and grade ≥ 3 adverse events were 29.2% and 10.7%, respectively. At a median follow-up of 11.3 (3.4–33.3) months, the median PFS and OS were 5.1 (95% CI: 3–7.3) and 18.1 (95% CI: 6.2–29.9) months, respectively. In univariate analyses, ECOG-PS ≥ 1 (relative to 0), Child-Pugh class B (relative to A), neutrophil-to-lymphocyte ratio (NLR) > 2.9 (relative to ≤ 2.9), and concomitant antibiotic use significantly increased the overall risk of mortality. Multivariate analysis revealed that ECOG-PS ≥ 1 (HR: 2.69, P = .02), NLR > 2.9 (HR: 2.94, P = .017), and concomitant antibiotic use (HR: 4.18, P = .003) were independent predictors of OS. Atez/Bev is an effective and safe first-line therapy for advanced-stage HCC in a real-world setting. The survival benefit was especially promising in patients with a ECOG-PS score of 0, Child-Pugh class A, lower NLR, and patients who were not exposed to antibiotics during the treatment.
Autonomy-supportive environments for people with dementia: an evidence-based review
Authors: Li Jiajing
Published: November 2023

Objective:

As one of the core principles of person-centered care, supporting the autonomy of residents with dementia has received increasing attention worldwide. Supportive physical environments play an important role in promoting autonomy in the everyday life of residents in care facilities. However, there is no universal definition for autonomy in everyday life nor focused research on autonomy-supportive environments. Thus, this study aims to systematically review the existing evidence of autonomy-supportive design features based on a synthesized concept analysis of autonomy in everyday life.

Methods:

A synthesized concept analysis on autonomy was conducted based on related definitions of autonomy in design guidelines and environmental assessment tools of elderly care facilities. Using keywords from the concept analysis, multiple databases including PubMed, Web of Science, CINAHL, PsycINFO, and Dementia Design Info were used to carry out a systematic review of autonomy-supportive environmental design features for people with dementia. Additional guidelines and standards were manually searched. The design features supported by empirical studies and studies based on experts’ experience were extracted from the literature. The evidence intensity of each feature was assessed according to the quality and quantity of related studies.

Results:

Four domains of autonomy, freedom, independence, control, and choice emerged based on the concept analysis. Seventy-eight autonomy-supportive design features were extracted from the literature. Features are summarized into 8 categories: building layout, circulation space, living room, dining space, bathroom, bedroom, outdoor space, and details. Of design features, 60% in the category of building layout have been cross-validated by empirical studies, whereas only 25% of the overall design features have.

Conclusions:

The results of this review show that numerous design features of the physical environment can support the autonomy of people with dementia in the 4 domains. Features of building layout are well researched and the evidence intensity for the rest of design features still needs to be improved through future empirical studies.
Psychotherapy and Artificial Intelligence
Authors: Plakun Eric M.
Published: November 2023

This column explores the challenges involved in providing psychotherapy through artificial intelligence. It reviews artificial intelligence’s capacity across schools of therapy to address relevant issues related to privacy, the use of technical interventions, and the therapeutic relationship.
Factors Associated With COVID-19 Vaccine Hesitancy in Rheumatology Outpatients in New York City
Authors: Barbhaiya Medha , Schneider Brandon , Levine Jonah M. , Bruce Omar , Do Huong , Siegel Caroline H. , Bykerk Vivian P. , Feldman Candace H. , Jannat-Khah Deanna , Mandl Lisa A.
Published: November 2023

Objective

The aim of this study was to measure COVID-19 vaccine hesitancy among rheumatology outpatients from an early COVID-19 “hotspot” during the initial period of vaccine availability.

Methods

In March 2021, a Web-based survey was sent to 7505 adults seen at a Rheumatology Division in New York City. We evaluated characteristics associated with 3 categories of COVID-19 vaccination status: declined, undecided, and willing/already received. We used multinomial logistic regression models to calculate relative risk ratios assessing predictors of vaccination status.

Results

Among 2384 (32%) respondents (80% female, 87% White, 59% with systemic rheumatic disease), 2240 (94.0%) were willing/already received COVID-19 vaccination, 88 (3.7%) were undecided, and 56 (2.3%) declined. Compared with those willing/already vaccinated, those declining or undecided were younger, more likely identified as Black or Hispanic/Latinx, and had lower household income and educational attainment. Immunosuppressive medication use did not differ among groups. After multivariable adjustment, every 1-year increase in age was associated with a 0.96 lower relative risk of declining or being undecided versus willing/already vaccinated. Respondents identifying as Black versus White had a higher relative risk ratio of being undecided (4.29 [95% confidence interval, 1.96–9.36]), as did those identifying as Hispanic/Latinx versus non-Hispanic/non-Latinx (2.81 [95% confidence interval, 1.29–6.09]). Those declining vaccination were least likely to believe in general vaccine importance or the safety and efficacy of the COVID-19 vaccine.

Conclusions

Among rheumatology patients in New York City with and without systemic rheumatic disease, COVID-19 vaccine uptake was high after its initial availability. Sociodemographic but not medication-related factors were associated with vaccine hesitancy; these findings can inform future rheumatology vaccination programs.
Association Between Herpes Simplex Virus II Infection and Rheumatoid Arthritis in US Adults
Authors: Fu Tieh-Cheng , Lin Jr-Rung , Chang Ching-Mao
Published: November 2023

Background/Objective

The potential correlation between herpes simplex virus (HSV) and human papillomavirus (HPV) infections and rheumatoid arthritis (RA) has not been definitively established. Further research is needed to determine the relationship between the development of RA and the presence of these viral infections.

Methods

A case-control study was conducted with data from the National Health and Nutrition Examination Survey between 2009 and 2014. Our analysis examined the association between HSV I, HSV II, HPV oral polymerase chain reaction (PCR), HPV vaginal PCR, and RA. We identified adults aged 20 to 49 years with a primary diagnosis of RA using the National Health and Nutrition Examination Survey database codes (MCQ191 = 1 [years 2009–2010]; MCQ195 = 2 [years 2011–2014]) and excluded patients with incomplete data on key variables and primary outcomes.

Results

The study included 8620 patients, with 150 patients diagnosed with RA and 1500 patients without RA. Patients with RA had a significantly higher prevalence of HSV II infection compared with those without RA (36.34% vs. 24.72%, p = 0.015) after propensity score matching. No significant differences were observed for HSV I, HPV oral PCR, and HPV vaginal PCR between the 2 groups. Patients with RA were older; were more likely to be female, obese, and non-Hispanic White; and had a higher prevalence of comorbidities than those without RA.

Conclusions

This population-based propensity score–matching study provides evidence of an association between HSV II infection and RA in US adults. Further research is needed to fully elucidate the relationship between viral infections and RA, with the aim of developing effective risk reduction strategies and innovative treatments for RA.