bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood Feeding Sources of Nyssomyia antunesi (Diptera: Psychodidae): A Suspected Vector of Leishmania (Kinetoplastida: Trypanosomatidae) in the Brazilian Amazon
Authors: Pimentel Amanda Costa , Sánchez Uzcátegui Yetsenia del Valle , de Lima Ana Carolina Stocco , Silveira Fernando Tobias , Vasconcelos dos Santos Thiago , Ishikawa Edna Aoba Yassui
Published: July 2022

Present work aimed to identify blood feeding sources and attempt to detect Leishmania DNA in Nyssomyia antunesi, suspected vector of Leishmania sp., from a park in the urban center of Belém, the capital of Pará State, in the Brazilian Amazon. Entire bodies and gut contents of Ny. antunesi engorged females, previously captured in the urban park with Centers for Disease Control (CDC) light traps and aspiration on tree bases, were subjected to Leishmania and vertebrate DNA detection through amplification of the Leishmania mini-exon and vertebrate cytochrome b (cyt b) gene regions, respectively. The quality of DNA extraction from entire bodies was ensured through amplification of the dipteran cyt b region. The vertebrate cyt b amplicons were sequenced and compared with those available on GenBank. A maximum likelihood phylogenetic tree was constructed to assess the clustering patterns of these sequences. Leishmania DNA was not detected. The sequences of 13 vertebrate cyt b amplicons were considered informative, exhibiting similarity and clustering with the following six vertebrate species: Dasyprocta leporina (1), Cuniculus paca (1), Tamandua tetradactyla (4), Choloepus didactylus (4), Pteroglossus aracari aracari (2), Homo sapiens (1). The samples of D. leporina and C. paca were obtained from the CDC canopy, whereas the others were by aspiration from tree bases. The present results revealed the eclectic and opportunist blood-feeding behavior of Ny. antunesi, with birds and mammals, these last ones acting as potential reservoirs for Leishmania species, distributed throughout the vertical forest strata.
Acute and Chronic Effects of Adjuvant Therapy on Inflammatory Markers in Breast Cancer Patients
Authors: Bower Julienne E , Ganz Patricia A , Irwin Michael R , Cole Steve W , Carroll Judith , Kuhlman Kate R , Petersen Laura , Garet Deborah , Asher Arash , Hurvitz Sara A , Crespi Catherine M
Published: July 2022

Background

Inflammation contributes to poor behavioral, functional, and clinical outcomes in cancer survivors. We examined whether standard cancer treatments—radiation and chemotherapy—led to acute and persistent changes in circulating markers of inflammation in breast cancer patients.

Methods

A total of 192 women diagnosed with early stage breast cancer provided blood samples before and after completion of radiation and/or chemotherapy and at 6-, 12-, and 18-month posttreatment follow-ups. Samples were assayed for circulating inflammatory markers, including tumor necrosis factor-α (TNF-α) and interleukin (IL)–6, downstream markers of their activity (soluble TNF receptor type II [sTNF-RII], C reactive protein), and other inflammatory mediators (IL-8, interferon-γ [IFN-γ]). Analyses evaluated within-group changes in inflammatory markers in 4 treatment groups: no radiation or chemotherapy (n = 39), radiation only (n = 77), chemotherapy only (n = 18), and chemotherapy with radiation (n = 58).

Results

Patients treated with chemotherapy showed statistically significant increases in circulating concentrations of TNF-α, sTNF-RII, IL-6, and IFN-γ from pre- to posttreatment, with parameter estimates in standard deviation units ranging from 0.55 to 1.20. Those who received chemotherapy with radiation also showed statistically significant increases in IL-8 over this period. Statistically significant increases in TNF-α, sTNF-RII, IL-6, IFN-γ, and IL-8 persisted at 6, 12, and 18 months posttreatment among patients treated with chemotherapy and radiation (all P < .05). Patients treated with radiation only showed a statistically significant increase in IL-8 at 18 months posttreatment; no increases in any markers were observed in patients treated with surgery only.

Conclusions

Chemotherapy is associated with acute increases in systemic inflammation that persist for months after treatment completion in patients who also receive radiation therapy. These increases may contribute to common behavioral symptoms and other comorbidities in cancer survivors.
HPV Vaccination Uptake, Hesitancy, and Refusal: Observations of Health-Care Professionals During the COVID-19 Pandemic
Authors: Chido-Amajuoyi Onyema Greg , Pande Mala , Agbajogu Constance , Yu Robert K , Cunningham Sonia , Shete Sanjay
Published: July 2022

HPV vaccination is highly effective at preventing several types of cancer; however, vaccine uptake is suboptimal. The COVID-19 pandemic has affected participation in cancer prevention measures such as HPV vaccination. To assess changes and barriers to HPV vaccination during the COVID-19 pandemic, we conducted a statewide cross-sectional survey of health-care professionals (HCPs) in Texas. Specifically, we evaluated changes observed by HCPs regarding HPV vaccination during the COVID-19 pandemic: 1) hesitancy, 2) refusal, and 3) uptake. Decreased HPV vaccination uptake were reported by 19.3% of HCPs, whereas increased HPV vaccination hesitancy and refusal were reported by 17.1% and 14.8% of HCPs in Texas, respectively. The COVID-19 pandemic had a negative impact on HPV vaccination. Our study identified barriers to HPV vaccination that are unique to the COVID-19 pandemic.
Advising travellers beyond infectious diseases: Can we learn from our forebears?
Authors: Kupper Thomas , Zafren Ken , Visser Jenny
Published: July 2022

The pre-travel consultation is usually dominated by discussion and advice on preventing infectious diseases. Yet, they account for only a few percent of deaths during travel. It is important the Travel Medicine practitioner looks beyond infectious diseases and advises on environmental harms, including the importance of road traffic incidents.
Double flows anchored in a Kerr black hole horizon – I. Meridionally self-similar MHD models with loading terms
Authors: Chantry L , Cayatte V , Sauty C , Vlahakis N , Tsinganos K
Published: July 2022

Recent observations of supermassive black holes have brought us new information on their magnetospheres. In this study, we attempt a theoretical modelling of the coupling of black holes with their jets and discs, via three innovations. First, we propose a semi-analytical MHD description of a steady relativistic inflow–outflow structure characteristic to the extraction of the hole rotational energy. The mass-loading is ensured in a thin layer, the stagnation surface, by a two-photon pair production originating to a gamma-ray emission from the surrounding disc. The double flow is described near the polar axis by an axisymmetric meridionally self-similar MHD model. Secondly, the inflow and outflow solutions are crossing the MHD critical points and are matched at the stagnation surface. Knowledge of the MHD field on the horizon gives us the angular momentum and energy extracted from the black hole. Finally, we illustrate the model with three specific examples of double-flow solutions by varying the energetic interaction between the MHD field and the rotating black hole. When the isorotation frequency is half of the black hole one, the extracted Poynting flux is comparable to the one obtained using the force-free assumption. In two of the presented solutions, the Penrose process dominates at large colatitudes, while the third is Poynting flux dominated at mid-colatitudes. Mass injection rate estimations, from disc luminosity and inner radius, give an upper limit just above the values obtained for two solutions. This model is pertinent to describe the flows near the polar axis, where pair production is more efficient.
On improving the performance of glitch classification for gravitational wave detection by using Generative Adversarial Networks
Authors: Yan Jianqi , Leung Alex P , Hui C Y
Published: July 2022

Spectrogram classification plays an important role in analysing gravitational wave data. In this paper, we propose a framework to improve the classification performance by using Generative Adversarial Networks (GANs). As substantial efforts and expertise are required to annotate spectrograms, the number of training examples is very limited. However, it is well known that deep networks can perform well only when the sample size of the training set is sufficiently large. Furthermore, the imbalanced sample sizes in different classes can also hamper the performance. In order to tackle these problems, we propose a GAN-based data augmentation framework. While standard data augmentation methods for conventional images cannot be applied on spectrograms, we found that a variant of GANs, ProGAN, is capable of generating high-resolution spectrograms which are consistent with the quality of the high-resolution original images and provide a desirable diversity. We have validated our framework by classifying glitches in the Gravity Spy data set with the GAN-generated spectrograms for training. We show that the proposed method can provide an alternative to transfer learning for the classification of spectrograms using deep networks, i.e. using a high-resolution GAN for data augmentation instead. Furthermore, fluctuations in classification performance with small sample sizes for training and evaluation can be greatly reduced. Using the trained network in our framework, we have also examined the spectrograms with label anomalies in Gravity Spy.
The moving mirror model for fast radio bursts
Authors: Yalinewich Almog , Pen Ue-Li
Published: July 2022

Recent observations of coherent radiation from the Crab pulsar suggest the emission is driven by an ultrarelativistic (γ ∼ 104), cold plasma flow. A relativistically expanding plasma shell can compress the ambient magnetic field, like a moving mirror, and thus produce coherent radiation whose wavelength is shorter than that of the ambient medium by γ2. This mechanism has been previously studied in the context of radio loud supernova explosions. In this work, we propose that a similar mechanism drives the coherent emission in fast radio bursts. The high Lorenz factors dramatically lower the implied energy and magnetic field requirements, allowing the spin-down energy of regular (or even recycled), fast spinning pulsars, rather than slow spinning magnetars, to explain FRBs. We show that this model can explain the frequency and the time evolution of observed FRBs, as well as their duration, energetics, and absence of panchromatic counterparts. We also predict that the peak frequency of subpulses decline with observation time as $\omega _{\rm obs} \propto t_{\rm obs}^{-1/2}$. Unfortunately, with current capabilities it is not possible to constrain the shape of the curve ωobs(tobs). Finally, we find that a variation of this model can explain weaker radio transients, such as the one observed from a galactic magnetar. In this variant, the shock wave produces low-frequency photons that are then Compton scattered to the GHz range.
Care Navigation Increases Initiation of Hepatitis C Treatment After Release From Prison in a Prospective Randomized Controlled Trial: The C-LINK Study
Authors: Papaluca Timothy , Craigie Anne , McDonald Lucy , Edwards Amy , Winter Rebecca , Hoang Annabelle , Pappas Alex , Waldron Aoife , McCoy Kelsey , Stoove Mark , Doyle Joseph , Hellard Margaret , Holmes Jacinta , MacIsaac Michael , Desmond Paul , Iser David , Thompson Alexander J
Published: July 2022

Background

Prison-based hepatitis C treatment is safe and effective; however, many individuals are released untreated due to time or resource constraints. On community re-entry, individuals face a number of immediate competing priorities, and in this context, linkage to hepatitis C care is low. Interventions targeted at improving healthcare continuity after prison release have yielded positive outcomes for other health diagnoses; however, data regarding hepatitis C transitional care are limited.

Methods

We conducted a prospective randomized controlled trial comparing a hepatitis C care navigator intervention with standard of care for individuals released from prison with untreated hepatitis C infection. The primary outcome was prescription of hepatitis C direct-acting antivirals (DAA) within 6 months of release.

Results

Forty-six participants were randomized. The median age was 36 years and 59% were male. Ninety percent (n = 36 of 40) had injected drugs within 6 months before incarceration. Twenty-two were randomized to care navigation and 24 were randomized to standard of care. Individuals randomized to the intervention were more likely to commence hepatitis C DAAs within 6 months of release (73%, n = 16 of 22 vs 33% n = 8 of 24, P < .01), and the median time between re-entry and DAA prescription was significantly shorter (21 days [interquartile range {IQR}, 11–42] vs 82 days [IQR, 44–99], P = .049).

Conclusions

Care navigation increased hepatitis C treatment uptake among untreated individuals released from prison. Public policy should support similar models of care to promote treatment in this high-risk population. Such an approach will help achieve hepatitis C elimination as a public health threat.
P–T–t Path of Unusual Garnet–Kyanite–Staurolite– Amphibole Schists, Ellesmere Island, Canada—Quartz Inclusion in Garnet Barometry and Monazite Petrochronology
Authors: Kośmińska Karolina , Gilotti Jane A , McClelland William C , Coble Matthew A , Thomas Jay B
Published: July 2022

Garnet–kyanite–staurolite assemblages with large, late porphyroblasts of amphibole form garbenschists in Ordovician volcaniclastic rocks lying immediately south of the Pearya terrane on northernmost Ellesmere Island, Canada. The schist, which together with carbonate olistoliths makes up the Petersen Bay Assemblage (PBA), displays a series of parallel isograds that mark an increase in metamorphic grade over a distance of 10 km towards the contact with Pearya; however, a steep, brittle Cenozoic strike-slip fault with an unknown amount displacement disturbs the earlier accretionary relationship. The late amphibole growth, probably due to fluid ingress, is clear evidence of disequilibrium conditions in the garbenschist. In order to recover the P–T history of the schists, we construct isochemical phase equilibrium models for a nearby garnet–mica schist that escaped the fluid event and compare the results to quartz inclusion in garnet (QuiG) barometry for a garbenschist and the metapelitic garnet schist. Quartz inclusions are confined to garnet cores and the QuiG results, combined with Ti-in-biotite and garnet–biotite thermometry, delineate a prograde path from 480 to 600°C and 0.7 to 0.9 GPa. This path agrees with growth zoning in garnet deduced from X-ray maps of the spessartine component in garnet. The peak conditions obtained from pseudosection modelling using effective bulk composition and the intersection of garnet rim with matrix biotite and white mica isopleths in the metapelite are 665°C at ≤0.85 GPa. Three generations of monazite (I, II and III) were identified by textural characterization, geochemical composition (REE and Y concentrations) and U–Pb ages measured by ion microprobe. Monazite I occurs in the matrix and as inclusions in garnet rims and grew at peak P–T conditions at 397 ± 2 Ma (2σ) from the breakdown of allanite. Monazite II forms overgrowths on matrix Monazite I grains that are oriented parallel to the main schistosity and yield ages of 385 ± 2 Ma. Monazite III, found only in the garbenschist, is 374 ± 6 Ma, which is interpreted as the time of amphibole growth during fluid infiltration at lower temperature and pressure on a clockwise P–T path that remained in the kyanite stability field. These results point to a relatively short (≈12 Myr) Barrovian metamorphic event that affected the schists of the PBA. An obvious heat source is lacking in the adjacent Pearya terrane, but we speculate it was large Devonian plutons—similar to the 390 ± 10 Ma Cape Woods granite located 40 km across strike from the fault—that have been excised by strike-slip. Arc fragments that are correlative to the PBA are low grade; they never saw the heat and were not directly involved in Pearya accretion.
An Updated View of the Roles of p53 in Embryonic Stem Cells
Authors: Ayaz Gamze , Yan Hualong , Malik Navdeep , Huang Jing
Published: July 2022

The TP53 gene is unarguably one of the most studied human genes. Its encoded protein, p53, is a tumor suppressor and is often called the “guardian of the genome” due to its pivotal role in maintaining genome stability. Historically, most studies of p53 have focused on its roles in somatic cells and tissues, but in the last 2 decades, its functions in embryonic stem cells (ESCs) and induced pluripotent stem cells have attracted increasing attention. Recent studies have identified p53 as a critical regulator of pluripotency, self-renewal, differentiation, proliferation, and genome stability in mouse and human embryonic stem cells. In this article, we systematically review the studies on the functions of p53 in ESCs, provide an updated overview, attempt to reconcile controversial results described in the literature, and discuss the relevance of these cellular functions of p53 to its roles in tumor suppression.
The Paraguayan experience in modernizing its secured transactions legal framework
Authors: Moreno Rodríguez José A , Cazal Zaldivar Lucía E
Published: July 2022

In the past decades, numerous countries of the five continents have been substantively modernizing their private law legal framework in topics related to commercial law, including secured transactions. Paraguay has not been an alien to this phenomenon and has adopted numerous harmonizing instruments developed by international organizations such as UNCITRAL, Unidroit, and the Hague Conference on Private International Law in commercial arbitration, international contracts, and the sale of goods, among others. This brief contribution describes the Paraguayan situation of access to secured credit with particular emphasis on small- and medium-sized enterprises and the legal shortcomings that obstruct financing backed by movable assets. Further, the article also discusses the road travelled to modernize the Paraguayan legal framework on secured transactions and makes recommendations for the future based on the lessons learned from the process.
Identification of a Small Translocation from 6R Possessing Stripe Rust Resistance to Wheat
Authors: Ashraf Rimsha , Johansson Eva , Vallenback Pernilla , Steffenson Brian J. , Bajgain Prabin , Rahmatov Mahbubjon
Published: July 2022

Wheat stripe rust, caused by Puccinia striiformis f. sp. tritici Eriks. & E. Henn, is the most devastating fungal disease of bread wheat. Here, a wheat-rye multiple disomic substitution line, SLU126 4R (4D), 5R (5D), and 6R (7D), possessing resistance against 25 races of P. striiformis f. sp. tritici, was used and crossed with Chinese Spring ph1b to induce homeologous recombination to produce introgressions with a reduced rye chromosome segment. Seedling assays confirmed that the stripe rust resistance from SLU126 was retained over multiple generations. Through genotyping-by-sequencing (GBS) platforms and aligning the putative GBS-single-nucleotide polymorphism (SNPs) to the full-length annotated rye nucleotide-binding leucine-rich repeat (NLR) genes in the parental lines (CS ph1b, SLU126, CSA, and SLU820), we identified the physical position of 26, 13, and 9 NLR genes on chromosomes 6R, 4R, and 5R, respectively. The physical positions of 25 NLR genes on chromosome 6R were identified from 568,460,437 bp to 879,958,268 bp in the 6RL chromosome segment. Based on these NLR positions on the 6RL chromosome segment, the three linked SNPs (868,123,650 to 873,285,112 bp) were validated through kompetitive allele-specific PCR (KASP) assays in SLU126 and resistance plants in the family 29-N3-5. Using these KASP markers, we identified a small piece of the rye translocation (i.e., as a possible 6DS.6DL.6RL.6DL) containing the stripe resistance gene, temporary designated YrSLU, within the 6RL segment. This new stripe rust resistance gene provides an additional asset for wheat improvement to mitigate yield losses caused by stripe rust.
Formal Caregiver Experiences of Caring for Individuals at Risk for or with a Pressure Injury: A Metasynthesis
Authors: Heerschap Corey , Woo Kevin Y.
Published: July 2022

OBJECTIVE

To explore formal caregiver experiences caring for patients with a pressure injury (PI) or who are at risk of developing a PI.

DATA SOURCES

In November 2019, the researchers searched CINAHL (Cumulative Index to Nursing and Allied Health Literature) and MEDLINE databases for articles related to caregivers and their experiences with PI prevention and care.

STUDY SELECTION

Twenty-eight qualitative studies were included in this review.

DATA EXTRACTION

Literature was graded and critiqued with regard to design and research quality and then synthesized utilizing a narrative approach.

DATA SYNTHESIS

Four themes were found within the literature: knowledge and education, environment and resources, collaboration and role clarity, and risk assessment.

CONCLUSIONS

Across healthcare settings, formal caregivers noted the importance of effective PI knowledge and education. Recognizing both barriers and facilitators to PI prevention and management within the healthcare environment can help decision-makers make informed choices to improve PI management within their settings. In addition, developing interprofessional team skills and relationships, rather than practicing in silos, may have an impact on PI management. Although there are many interventions that reduce PI risk and assist in the management of PIs, not every intervention is appropriate for every healthcare setting. Clinician education on PIs, along with new interventions, could significantly impact the effectiveness of patient care.
Histopathology of Pouch and Para-Pouch Inflammatory and Neoplastic Disorders
Authors: Ballentine Samuel , Lee Hwajeong , Liu Xiuli
Published: July 2022

BACKGROUND:

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is used to treat patients with ulcerative colitis or familial adenomatous polyposis who need colectomy. While this procedure substantially improves patient’s quality of life and reduces cancer risk, it is associated with a variety of sequelae‚ including surgical complications, inflammatory disorders, and neoplasia. Pouchitis, cuffitis, and Crohn’s disease of the pouch are the most common inflammatory disorders of the pouch and para-pouch.

OBJECTIVE:

This study aimed to elaborate on the histopathology of common inflammatory and neoplastic disorders of the pouch and para-pouch.

DATA SOURCES:

A Medline search for English language studies published between 1981 and 2021 using the PubMed search engine. The terms “ileal pouch-anal anastomosis,” “pouchitis,” “pouchitis activity score,” “secondary pouchitis,” “Crohn’s disease of the pouch,” “Crohn’s-like conditions of the pouch,” “pre-pouch ileitis,” “cuffitis,” “pouch adenocarcinoma,” and “pouch neoplasia” were used.

STUDY SELECTION:

The published human studies that reported histopathology of common inflammatory and neoplastic disorders of the ileal pouch were selected and reviewed.

CONCLUSIONS:

Histologic examination plays an essential role in confirming inflammation in pouchitis, identifying etiology and clues for secondary pouchitis, and diagnosing neoplasia. A standardized, simple, and reproducible histologic grading system for pouchitis is needed. Pouch and para-pouch glandular dysplasia diagnosis is challenging and should always be reviewed by at least one gastrointestinal pathologist.
Construction of J-Pouch and S-Pouch
Authors: Justiniano Carla F. , Hull Tracy L.
Published: July 2022

BACKGROUND:

Pelvic pouch surgery evolved under the late Dr. Victor Fazio’s influence.

OBJECTIVE:

To describe construction of J- and S-pouches according to Fazio’s teachings.

TECHNICAL POINTS:

There are several key points to consider for pelvic pouch construction, starting with the decision of performing a 2- or 3-stage procedure and handling of the rectal stump. At time of pouch construction, ileal reach must be assessed early in the operative course and mesenteric lengthening maneuvers are deployed as warranted. If these maneuvers still do not allow sufficient length, alternatives include an S-pouch, longer rectal stump/anal transition zone, or returning to the operating room at a later date. The rectum is then mobilized sufficiently to allow a straight stapler firing to avoid outlet obstruction from impinged nearby tissues. The 15-20-cm pouch is constructed ensuring its staple lines are straight, staple line bleeding is addressed, the tip of the J is closed to be as short as possible, and a leak test is performed. At the time of the anastomosis, it is crucial to keep the mesentery and pouch straight, ensure no bowel is trapped below the mesentery, confirm that anterior structures are not being incorporated into the anastomosis, and perform a leak test, adding transanal sutures as needed to repair any defects. An ileostomy is then created.

CONCLUSION:

Pouch construction is challenging. At each stage, consider the patient, who carries the ultimate risk. The end goal is a functional, long-lasting pouch.
Surgical Techniques Following Free Cartilage Grafting
Authors: Hill Sheena T. , Delost Rachel L. , Wee Corinne E. , Long Tobias C. , Bordeaux Jeremy S. , Scott Jeffrey F.
Published: July 2022

BACKGROUND

Reconstruction of surgical defects with free cartilage grafts poses unique challenges.

OBJECTIVES

To characterize surgical techniques following free cartilage grafting.

MATERIALS AND METHODS

A literature review was performed using the Embase, PubMed Medline, Cochrane Library, ClinicalTrials.gov, and Web of Science databases from inception to May 21, 2021. Studies describing free cartilage grafts harvested from the ear or nose under local anesthesia, specifically for reconstruction of facial surgical defects, were selected for inclusion. Only surgical defects resulting from tumor resection were included.

RESULTS

In total, 34 studies involving 713 patients with 723 surgical defects met inclusion criteria. The mean age of patients was 63.3 ± 10.4 years. Free cartilage grafts were most commonly harvested from the ear (93.1%). The most common recipient site was the nose (90.3%), followed by the lower eyelid (6.7%) and ear (3.0%).

CONCLUSION

Free cartilage grafts are an effective reconstructive option for patients with deep or cartilaginous defects that have compromised structural support on the nose, ear, or eyelid.
Negative Control Exposures: Causal Effect Identifiability and Use in Probabilistic-bias and Bayesian Analyses With Unmeasured Confounders
Authors: Flanders W. Dana , Waller Lance A. , Zhang Qi , Getahun Darios , Silverberg Michael , Goodman Michael
Published: July 2022

Background:

Probabilistic bias and Bayesian analyses are important tools for bias correction, particularly when required parameters are nonidentifiable. Negative controls are another tool; they can be used to detect and correct for confounding. Our goals are to present conditions that assure identifiability of certain causal effects and to describe and illustrate a probabilistic bias analysis and related Bayesian analysis that use a negative control exposure.

Methods:

Using potential-outcome models, we characterized assumptions needed for identification of causal effects using a dichotomous, negative control exposure when residual confounding exists. We defined bias parameters, characterized their relationships with the negative control and with specified causal effects, and described the corresponding probabilistic-bias and Bayesian analyses. We present analytic examples using data on hormone therapy and suicide attempts among transgender people. To address possible confounding by healthcare utilization, we used prior tetanus–diphtheria–pertussis (TdaP) vaccination as a negative control exposure.

Results:

Hormone therapy was weakly associated with risk (risk ratio [RR] = 0.9). The negative control exposure was associated with risk (RR = 1.7), suggesting confounding. Based on an assumed prior distribution for the bias parameter, the 95% simulation interval for the distribution of confounding-adjusted RR was (0.17, 1.6), with median 0.5; the 95% credibility interval was similar.

Conclusions:

We used dichotomous negative control exposure to identify causal effects when a confounder was unmeasured under strong assumptions. It may be possible to relax assumptions and the negative control exposure could prove helpful for probabilistic bias analyses and Bayesian analyses.
The role of telemedicine in minimally invasive gynecologic surgery
Authors: Siedhoff Matthew T. , Truong Mireille D. , Wright Kelly N.
Published: July 2022

Purpose of review

Telemedicine has been available for decades but has had minimal use in the USA prior to the COVID-19 pandemic. We aim to educate readers on the benefits of telemedicine and provide insight from our experience to optimize care in this setting.

Recent findings

The COVID-19 pandemic ushered in a massive increase in use of telemedicine, offering several advantages with comparable clinical outcomes.

This review summarizes the recent vast expansion of telemedicine, describes the benefits specific to minimally invasive gynecologic surgery, and offers practical suggestions for maintaining a successful practice that incorporates both in-person and virtual experiences for patients, anticipating continued use of telemedicine beyond the end of the current public health emergency.
Prevention and management of vaginal cuff dehiscence: an updated review
Authors: Pinho Gabriella , Liu Ying Xin , Kim Sara , Lian Xun
Published: July 2022

Purpose of review

Minimally invasive hysterectomy has gained popularity because of its many benefits. However, laparoscopic and robotic assisted hysterectomy have been associated with increased risk of vaginal cuff dehiscence. This review is meant to address risk management and prevention of vaginal cuff dehiscence in patients undergoing minimally invasive hysterectomy.

Recent findings

Recent findings in the literature focus on addressing modifiable risk factors in patients and on using good surgical technique to help minimize the risk of vaginal cuff dehiscence.

The focus of this review is to help surgeons identify patient risk factors and address them preoperatively and to review surgical techniques that can minimize the risk of vaginal cuff dehiscence.
Current trends in artificial intelligence in reproductive endocrinology
Authors: Bhaskar Dhananjay , Chang T. Arthur , Wang Shunping
Published: July 2022

Purpose of review

Artificial Intelligence, a tool that integrates computer science and machine learning to mimic human decision-making processes, is transforming the world and changing the way we live. Recently, the healthcare industry has gradually adopted artificial intelligence in many applications and obtained some degree of success. In this review, we summarize the current applications of artificial intelligence in Reproductive Endocrinology, in both laboratory and clinical settings.

Recent findings

Artificial Intelligence has been used to select the embryos with high implantation potential, proper ploidy status, to predict later embryo development, and to increase pregnancy and live birth rates. Some studies also suggested that artificial intelligence can help improve infertility diagnosis and patient management. Recently, it has been demonstrated that artificial intelligence also plays a role in effective laboratory quality control and performance.

In this review, we discuss various applications of artificial intelligence in different areas of reproductive medicine. We summarize the current findings with their potentials and limitations, and also discuss the future direction for research and clinical applications.
Clinical Utility of Bronchoalveolar Lavage in Pediatric Oncology Patients
Authors: Shanthikumar Shivanthan , Colenutt Samuel , Cole Theresa , Conyers Rachel , Rozen Tom , Harrison Jo , Robinson Philip , Haeusler Gabrielle M.
Published: July 2022

Background:

Lower airway sampling is important in the assessment of lower respiratory tract infection in children with cancer or posthematopoietic stem cell transplant and can be done via bronchoalveolar lavage (BAL). Clinicians can struggle with balancing the benefits of BAL against the risks. This study aimed to define the diagnostic and clinical utility of BAL in this population.

Methods:

A single-center retrospective review of BAL performed in children with cancer or posthematopoietic stem cell transplant. Data extracted included demographics, BAL method and results and antimicrobial treatment. Variables significantly associated with diagnostic yield, diagnostic impact (confirmation or exclusion of infection), and clinical impact (any change in antimicrobial or nonantimicrobial therapy) were assessed in both univariate and multivariate analysis.

Results:

Seventy-three BAL episodes were included. In 26 (35.6%) episodes, a pathogen was identified on BAL. Forty-nine (67%) BAL episodes had a diagnostic impact and 15 (21%) had a clinical impact. Late BAL (>72 hours) compared with early BAL (odds ratio 3.27; 95% CI: 1.03–10.86), and flexible bronchoscopy compared with nonbronchoscopic lavage (odds ratio 6.10; 95% CI: 1.90–24.0), were more likely to have a diagnostic impact on multivariate analysis. No associations were found for clinical impact.

Conclusions:

One-third of BAL episodes identified a pathogen, two-thirds had a diagnostic impact, and almost a quarter of episodes impacted antimicrobial prescribing. The method and timing of BAL may be important, with flexible bronchoscopy 6-fold more likely and late BAL 3-fold more likely to have a diagnostic impact.
Impact of COVID-19 Containment Strategies and Meningococcal Conjugate ACWY Vaccination on Meningococcal Carriage in Adolescents
Authors: McMillan Mark , Bednarz Jana , Leong Lex E.X. , Lawrence Andrew , Marshall Helen S.
Published: July 2022

Objectives:

To examine if COVID-19 containment strategies were associated with reduced pharyngeal carriage of meningococci in adolescents. Also, to observe if carriage prevalence of meningococcal A, C, W and Y differed in meningococcal conjugate ACWY vaccinated and unvaccinated adolescents.

Design:

Repeat cross-sectional study of pharyngeal carriage.

Setting:

In 2020, recruitment commenced from February to March (pre-COVID-19) and recommenced from August to September (during COVID-19 measures) in South Australia.

Participants:

Eligible participants were between 17 and 25 years of age and completed secondary school in South Australia in 2019.

Results:

A total of 1338 school leavers were enrolled in 2020, with a mean age of 18.6 years (standard deviation 0.6). Pharyngeal carriage of disease-associated meningococci was higher during the COVID-19 period compared with the pre-COVID-19 period (41/600 [6.83%] vs. 27/738 [3.66%]; adjusted odds ratio [aOR], 2.03; 95% CI: 1.22–3.39; P = 0.01). Nongroupable carriage decreased during COVID period (1.67% vs. 3.79%; aOR, 0.45; 95% CI: 0.22–0.95). Pharyngeal carriage of groups A, C, W and Y was similar among school leavers vaccinated with meningococcal conjugate ACWY (7/257 [2.72%]) compared with those unvaccinated (29/1081 [2.68%]; aOR, 0.86; 95% CI: 0.37–2.02; P = 0.73). Clonal complex 41/44 predominated in both periods.

Conclusions:

Meningococcal carriage prevalence was not impacted by public health strategies to reduce severe acute respiratory syndrome coronavirus 2 transmission and is unlikely to be the mechanism for lower meningococcal disease incidence. As international travel resumes and influenza recirculates, clinicians must remain vigilant for signs and symptoms of meningococcal disease. Vaccinating people at the highest risk of invasive meningococcal disease remains crucial despite containment strategies.
Suppressed serological vitamin A in patients with liver cirrhosis is associated with impaired liver function and clinical detoriation
Authors: Nagel Michael , Labenz Christian , Dobbermann Henrike , Czauderna Carolin , Wallscheid Nina Cabezas , Schattenberg Jörn M. , Wörns Marcus A. , Galle Peter R. , Marquardt Jens U.
Published: July 2022

Background

The liver is of critical importance for the homeostasis of metabolic and immunomodulatory properties as well as the storage of vitamins, especially vitamin A. In this prospective analysis, the incidence of serological vitamin A deficiency and the association with disease severity as well as clinical complications in patients with liver cirrhosis were investigated.

Method

From May 2017 to May 2018, 159 patients with primarily alcohol-associated and non-alcoholic steatohepatitis (NASH)-associated preexisting liver cirrhosis were prospectively enrolled and vitamin A status was collected. Clinical complications and infections were followed and recorded over a period of 1-year follow-up. Selected findings were validated in an independent cohort of 44 patients.

Results

At study inclusion, 77% of patients showed decreased serological vitamin A. Suppressed vitamin A was more common in alcoholic (52 vs. 8%) and NASH-associated liver cirrhosis (16 vs. 9%) than in viral-associated liver cirrhosis. MELD score as well as Child-Pugh score were significantly associated with suppressed vitamin A (P < 0.001). The association between the degree of vitamin A suppression and liver function was confirmed in univariate and multivariate regression analysis. After 1 year of follow-up, 57 patients died and 21 patients received a liver transplant. In addition, low vitamin A levels were more commonly observed in patients with severe ascites (P = 0.001), hepatic encephalopathy (P = 0.002) and hepatorenal syndromes (P = 0.008). In addition, patients with reduced vitamin A showed an increased incidence of infections (P = 0.02), especially respiratory infections (P = 0.04).

Conclusion:

Suppressed serological Vitamin A is common in patients with liver cirrhosis and is associated with liver function. Clinical complications and infections are more frequent in patients with liver cirrhosis and vitamin A suppression.
Diverting Ileostomy in Children With Functional Constipation
Authors: Rodriguez Leonel , Colliard Kitzia , Nurko Samuel , Flores Alejandro , Buchmiller Terry L.
Published: July 2022

Objectives:

Pediatric functional constipation (FC) may require invasive evaluations [like colon manometry (CM)] and surgical interventions [including diverting ostomy (DO)]. We evaluated the utility of CM in guiding surgery after DO.

Methods:

Children with medically refractory FC undergoing an ostomy were included. Institutional Review Board approval was obtained for this retrospective study. Demographics and CM variables [high amplitude propagating contractions (HAPCs)] were recorded. Outcome measures: response to ostomy closure defined as successful if no need for further surgery after ostomy closure, and improvement on baseline CM after ostomy. A CM‐guided ostomy closure algorithm was developed based on previous studies. We evaluated the association between response to ostomy closure and demographics, ostomy indication and CM improvement, and evaluated the role of CM predicting response using algorithm.

Results:

A total of 60 children underwent ostomy for FC (median age: 7.1 years, range 0.15–23.6 years, 50% female). Ostomy was closed in 30 patients and deemed successful in 23 of 30. CM was performed in 42 of 60 patients before ostomy and in 29 of 30 before ostomy closure. We found no association between ostomy outcome and age, gender, weight, imaging studies, follow‐up time, time with ostomy, HAPCs, and CM improvement. We found an association between failed response and ostomy indication of antegrade colonic enemas (ACE) failure (P = 0.026) and successful response when ostomy closure was guided by algorithm (P = 0.03).

Conclusions:

DO is a useful intervention in selected children with medically refractory FC, improving colon motility in most. CM can successfully guide the timing and type of ostomy closure. Larger studies are needed to further validate our findings.
Subtyping of Eosinophilic Esophagitis Based on Disease Presentation in a pediatric Cohort
Authors: Sessions Julia , Purington Natasha , McGhee Sean , Bass Dorsey , Wang Yiwen , Goyal Alka , Khavari Nasim
Published: July 2022

Objective:

Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory disease characterized by eosinophilic infiltration of esophageal tissue. Subtyping of EoE patients could be useful in predicting therapeutic response. We propose clinical subtypes, apply them to our pediatric EoE population retrospectively, and assess therapy choices and remission at one year.

Methods:

A retrospective chart review of pediatric patients diagnosed with EoE was conducted. Patients were grouped into proposed subtypes (severe, allergic, fibrostenotic, inflammatory, unclassified) based on presenting characteristics. The primary outcome was histologic remission, which was defined <15 eosinophils/high-powered-field (hpf) at the closest visit 1 year postdiagnosis.

Results:

Subtyping was possible in 242 of 256 patients and follow-up histological data were available in 75 subjects. The majority had an overlap in phenotype with 17% severe, 77% allergic, 15% fibrostenotic, 60% inflammatory, and 5% unclassified, whereas 45% of the cohort were assigned to a unique subtype. At 1 year, 43/75 (57%) of patients achieved histologic remission, with an overall average decrease of 33 (IQR −47, −12) eosinophils/hpf across the entire cohort. There was no difference in remission rates among subtypes. First-line therapy review revealed higher rates of proton pump inhibitor (PPI) ± topical steroids utilization in severe patients, while topical steroids were prescribed preferentially over dietary therapy in the fibrostenotic subtype.

Conclusion:

There were no observed differences in remission rates at 1 year among clinically defined subtypes of EoE, although this could be attributed to overlapping subtypes. Most patients responded well to medical therapy. Larger scale prospective studies designed to subtype patients and protocolize treatment may help personalize the approach to EoE management.
Functional Nasal Surgery
Authors: Avashia Yash J. , Glener Adam D. , Marcus Jeffrey R.
Published: July 2022

Learning Objectives:

After studying this article, the participant should be able to: (1) understand the functional significance of nasal anatomy as it relates to rhinoplasty and perform a comprehensive functional nasal assessment. (2) Identify the anatomical level of obstruction based on the authors’ algorithmic approach and understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, external nasal valve collapse. (3) Understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, and external nasal valve collapse. (4) Appreciate the objective assessment tools for functional nasal surgery from a clinical and research perspective.

The intent of functional rhinoplasty is to improve nasal airflow (and the perception thereof) by surgically correcting the anatomical sources of obstruction in the nasal airway. Cosmetic and functional rhinoplasty are not mutually exclusive entities, and the techniques that address one area, inevitably may affect the another. The rate of functional problems after cosmetic rhinoplasty range from 15 to 68 percent with nasal airway obstruction found to be the most common indication for secondary surgery. The objective of this CME article is to provide readers with an understanding of the (1) functional components of nasal anatomy, (2) clinical functional assessment, and (3) the current evidence supporting corrective maneuvers for each component.
Human-environment feedback and the consistency of proenvironmental behavior
Authors: Ecotière Claire , Billiard Sylvain , André Jean-Baptiste , Collet Pierre , Ferrière Régis , Méléard Sylvie
Published: July 2022

Addressing global environmental crises such as anthropogenic climate change requires the consistent adoption of proenvironmental behavior by a large part of a population. Here, we develop a mathematical model of a simple behavior-environment feedback loop to ask how the individual assessment of the environmental state combines with social interactions to influence the consistent adoption of proenvironmental behavior, and how this feeds back to the perceived environmental state. In this stochastic individual-based model, individuals can switch between two behaviors, ’active’ (or actively proenvironmental) and ’baseline’, differing in their perceived cost (higher for the active behavior) and environmental impact (lower for the active behavior). We show that the deterministic dynamics and the stochastic fluctuations of the system can be approximated by ordinary differential equations and a Ornstein-Uhlenbeck type process. By definition, the proenvironmental behavior is adopted consistently when, at population stationary state, its frequency is high and random fluctuations in frequency are small. We find that the combination of social and environmental feedbacks can promote the spread of costly proenvironmental behavior when neither, operating in isolation, would. To be adopted consistently, strong social pressure for proenvironmental action is necessary but not sufficient – social interactions must occur on a faster timescale compared to individual assessment, and the difference in perceived environmental impact must be small. This simple model suggests a scenario to achieve large reductions in environmental impact, which involves incrementally more active and potentially more costly behavior being consistently adopted under increasing social pressure for proenvironmentalism.