bluuebunny/crossref_metadata_2025 huggingface dataset:
The colonisation of Madagascar by land‐bound vertebrates
Authors: Ali Jason R. , Hedges S. Blair
Published: May 2023

Despite discussions extending back almost 160 years, the means by which Madagascar's iconic land vertebrates arrived on the island remains the focus of active debate. Three options have been considered: vicariance, range expansion across land bridges, and dispersal over water. The first assumes that a group (clade/lineage) occupied the island when it was connected with the other Gondwana landmasses in the Mesozoic. Causeways to Africa do not exist today, but have been proposed by some researchers for various times in the Cenozoic. Over‐water dispersal could be from rafting on floating vegetation (flotsam) or by swimming/drifting. A recent appraisal of the geological data supported the idea of vicariance, but found nothing to justify the notion of past causeways. Here we review the biological evidence for the mechanisms that explain the origins of 28 of Madagascar's land vertebrate clades [two other lineages (the geckosGeckolepisandParagehyra) could not be included in the analysis due to phylogenetic uncertainties]. The podocnemid turtles and typhlopoid snakes are conspicuous for they appear to have arisen through a deep‐time vicariance event. The two options for the remaining 26 (16 reptile, five land‐bound‐mammal, and five amphibian), which arrived between the latest Cretaceous and the present, are dispersal across land bridges or over water. As these would produce very different temporal influx patterns, we assembled and analysed published arrival times for each of the groups. For all, a ‘colonisation interval’ was generated that was bracketed by its ‘stem‐old’ and ‘crown‐young’ tree‐node ages; in two instances, the ranges were refined using palaeontological data. The synthesis of these intervals for all clades, which we term a colonisation profile, has a distinctive shape that can be compared, statistically, to various models, including those that assume the arrivals were focused in time. The analysis leads us to reject the various land bridge models (which would show temporal concentrations) and instead supports the idea of dispersal over water (temporally random). Therefore, the biological evidence is now in agreement with the geological evidence, as well as the filtered taxonomic composition of the fauna, in supporting over‐water dispersal as the mechanism that explains all but two of Madagascar's land‐vertebrate groups.
Ecological inferences about marine mammals from passive acoustic data
Authors: Fleishman Erica , Cholewiak Danielle , Gillespie Douglas , Helble Tyler , Klinck Holger , Nosal Eva‐Marie , Roch Marie A.
Published: May 2023

Monitoring on the basis of sound recordings, or passive acoustic monitoring, can complement or serve as an alternative to real‐time visual or aural monitoring of marine mammals and other animals by human observers. Passive acoustic data can support the estimation of common, individual‐level ecological metrics, such as presence, detection‐weighted occupancy, abundance and density, population viability and structure, and behaviour. Passive acoustic data also can support estimation of some community‐level metrics, such as species richness and composition. The feasibility of estimation and certainty of estimates is highly context dependent, and understanding the factors that affect the reliability of measurements is useful for those considering whether to use passive acoustic data. Here, we review basic concepts and methods of passive acoustic sampling in marine systems that often are applicable to marine mammal research and conservation. Our ultimate aim is to facilitate collaboration among ecologists, bioacousticians, and data analysts.

Ecological applications of passive acoustics require one to make decisions about sampling design, which in turn requires consideration of sound propagation, sampling of signals, and data storage. One also must make decisions about signal detection and classification and evaluation of the performance of algorithms for these tasks. Investment in the research and development of systems that automate detection and classification, including machine learning, are increasing.

Passive acoustic monitoring is more reliable for detection of species presence than for estimation of other species‐level metrics. Use of passive acoustic monitoring to distinguish among individual animals remains difficult. However, information about detection probability, vocalisation or cue rate, and relations between vocalisations and the number and behaviour of animals increases the feasibility of estimating abundance or density. Most sensor deployments are fixed in space or are sporadic, making temporal turnover in species composition more tractable to estimate than spatial turnover. Collaborations between acousticians and ecologists are most likely to be successful and rewarding when all partners critically examine and share a fundamental understanding of the target variables, sampling process, and analytical methods.
Early changes of fecal short‐chain fatty acid levels in patients with mild cognitive impairments
Authors: Gao Chao , Li Binyin , He Yixi , Huang Pai , Du Juanjuan , He Guiying , Zhang Pingchen , Tang Huidong , Chen Shengdi
Published: May 2023

Aims

To compare the fecal levels of short‐chain fatty acids (SCFAs) in patients with mild cognitive impairment (MCI) and normal controls (NCs) and to examine whether fecal SCFAs could be used as the biomarker for the identification of patients with MCI. To examine the relationship between fecal SCFAs and amyloid‐β (Aβ) deposition in the brain.

Methods

A cohort of 32 MCI patients, 23 Parkinson's disease (PD) patients, and 27 NC were recruited in our study. Fecal levels of SCFAs were measured using chromatography and mass spectrometry. Disease duration, ApoE genotype, body mass index, constipation, and diabetes were evaluated. To assess cognitive impairment, we used the Mini‐Mental Status Examination (MMSE). To assess brain atrophy, the degree of medial temporal atrophy (MTA score, Grade 0–4) was measured by structural MRI. Aβ positron emission tomography with 18F‐florbetapir (FBP) was performed in seven MCI patients at the time of stool sampling and in 28 MCI patients at an average of 12.3 ± 0.4 months from the time of stool sampling to detect and quantify Aβ deposition in the brain.

Results

Compared with NC, MCI patients had significantly lower fecal levels of acetic acid, butyric acid, and caproic acid. Among fecal SCFAs, acetic acid performed the best in discriminating MCI from NC, achieved an AUC of 0.752 (p = 0.001, 95% CI: 0.628–0.876), specificity of 66.7%, and sensitivity of 75%. By combining fecal levels of acetic acid, butyric acid, and caproic acid, the diagnostic specificity was significantly improved, reaching 88.9%. To better verify the diagnostic performance of SCFAs, we randomly assigned 60% of participants into training dataset and 40% into testing dataset. Only acetic acid showed significantly difference between these two groups in the training dataset. Based on the fecal levels of acetic acid, we achieved the ROC curve. Next, the ROC curve was evaluated in the independent test data and 61.5% (8 in 13) of patients with MCI, and 72.7% (8 in 11) of NC could be identified correctly. Subgroup analysis showed that reduced fecal SCFAs in MCI group were negatively associated with Aβ deposition in cognition‐related brain regions.

Conclusion

Reductions in fecal SCFAs were observed in patients with MCI compared with NC. Reduced fecal SCFAs were negatively associated with Aβ deposition in cognition‐related brain regions in MCI group. Our findings suggest that gut metabolite SCFAs have the potential to serve as early diagnostic biomarkers for distinguishing patients with MCI from NC and could serve as potential targets for preventing AD.
BCL2 is a major regulator of haploidy maintenance in murine embryonic stem cells
Authors: Sun Shengyi , Zhao Qin , Zhao Yiding , Geng Mengyang , Wang Qing , Gao Qian , Zhang Xiao‐Ou , Zhang Wenhao , Shuai Ling
Published: May 2023

Mammalian haploid cells are important resources for forward genetic screening and are important in genetic medicine and drug development. However, the self‐diploidization of murine haploid embryonic stem cells (haESCs) during daily culture or differentiation jeopardizes their use in genetic approaches. Here, we show that overexpression (OE) of an antiapoptosis gene, BCL2, in haESCs robustly ensures their haploidy maintenance in various situations, even under strict differentiation in vivo (embryonic 10.5 chimeric fetus or 21‐day teratoma). Haploid cell lines of many lineages, including epiblasts, trophectodermal lineages, and neuroectodermal lineages, can be easily derived by the differentiation of BCL2‐OE haESCs in vitro. Transcriptome analysis revealed that BCL2‐OE activates another regulatory gene, Has2, which is also sufficient for haploidy maintenance. Together, our findings provide an effective and secure strategy to reduce diploidization during differentiation, which will contribute to the generation of haploid cell lines of the desired lineage and related genetic screening.
Clinical characteristics and serum inflammatory markers of community‐acquired mycoplasma pneumonia in children
Authors: Fan Fei , Lv Jun , Yang Qianyuan , Jiang Fei
Published: May 2023

Background

To compare the demographic and clinical features, laboratory and imaging findings in mycoplasma pneumoniae pneumonia (MPP) children with non‐MPP (NMPP) children and general MPP (GMPP) children with refractory MPP (RMPP) children and analysis the relationship with the severity of disease.

Methods

The study included 265 children with MPP and 230 children with NMPP in the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from 2020 to 2021. The children with MPP included RMPP (n = 85) and GMPP (n = 180). Demographic and clinical characteristics, laboratory and imaging findings of all children were measured as baseline data within 24 h after admission and the differences between MPP and NMPP, RMPP and GMPP patients were compared. ROC curves were used to evaluate the diagnostic and predictive value of different indicators for RMPP.

Results

Fever duration and hospital stay in children with MPP were longer than those with NMPP. The number of patients with imaging features of pleural effusion, lung consolidation and bronchopneumonia in MPP group was significantly higher than that in NMPP group. Compared with NMPP group, the levels of C‐reactive protein (CRP), procalcitonin (PCT), serum amyloid A (SAA), erythrocyte sedimentation rate (ESR), lactic dehydrogenase (LDH), prothrombin time (PT), fibrinogen (FIB) and D‐dimer and inflammatory cytokines (interleukin [IL]‐6, IL‐8, IL‐10 and IL‐1β) in MPP group were significantly higher (P < 0.05). The clinical symptoms and pulmonary imaging findings were more severe in RMPP group. The levels of white blood cell (WBC), CRP, PCT, SAA, ESR, alanine aminotransferase (ALT), LDH, ferritin, PT, FIB, D‐dimer and inflammatory cytokines in RMPP group were higher than those in GMPP group. There was no significant difference in the level of lymphocyte subsets between the RMPP and GMPP group. IL‐6, IL‐10, LDH, PT, D‐dimer and lung consolidation were independent risk factors for RMPP. IL‐6 levels and LDH activity were good predictors of RMPP.

Conclusion

In conclusion, there were differences in clinical characteristics and serum inflammatory markers between MPP group and NMPP group, RMPP group and GMPP group. IL‐6, IL‐10, LDH, PT and D‐dimer can be used as predictive indicators for RMPP.
Atrial fibrillation and QT corrected. What is the best formula to use?
Authors: Luzza Francesco , De Sarro Rosalba , Licordari Roberto , Crea Pasquale , Pugliatti Pietro , Certo Giuseppe , Pistelli Lorenzo , Campanella Francesca , Lo Nigro Maria Claudia , Casale Matteo , Correale Michele , Dattilo Giuseppe
Published: May 2023

Background

QT interval varies with the heart rate (HR), so a correction in QT calculation is needed (QTc). Atrial fibrillation (AF) is associated with elevated HR and beat‐to‐beat variation.

Aim

To find best correlation between QTc in atrial fibrillation (AF) versus restored sinus rhytm (SR) after electrical cardioversion (ECV) (primary end point) and to determine which correction formula and method are the best to determine QTc in AF (secondary end point).

Methods

During a 3‐month period, we considered patients who underwent 12‐lead ECG recording and received an AF diagnosis with indication for ECV. Exclusion criteria were as follows: QRS duration >120 ms, therapy with QT‐prolonging drugs, a rate control strategy and a nonelectrical cardioversion. The QT interval was corrected using Bazzett's, Framingham, Fridericia and Hodges formulas during the last ECG during AF and the first one immediately after ECV. QTc mean was calculated as mQTc (average of 10 QTc calculated beat per beat) and as QTcM (QTc calculated from the average of 10 raw QT and RR for each beat).

Results

Fifty consecutive patients were enrolled in the study. Bazett's formula showed a significant change in mean QTc value between the two rhythms (421.5 ± 33.9 vs. 446.1 ± 31.9; p < 0.001 for mQTc and 420.9 ± 34.1 vs. 441.8 ± 30.9; p = 0.003 for QTcM). On the contrary, in patients with SR, QTc assessed by the Framingham, Fridericia, and Hodges formulas was similar to that in AF. Furthermore, good correlations between mQTc and QTcM are present for each formula, even in AF or SR.

Conclusions

During AF, Bazzett's formula, seems to be the most imprecise in QTc estimation.
Policies for inclusive education practices in teacher education in the United Kingdom and France
Authors: Malet Régis
Published: May 2023

Implementation of any inclusive policy is dependent on longstanding conceptions, beliefs, and public discourses on schooling, learning, and including children in mainstream schooling. The adoption of inclusive education in education policies in France and the United Kingdom requires discursive support to reshape the meaning and content of teachers' work, duties and practices. Although inclusive education is widely debated, analyses of the variations in policy narratives promoting inclusive teaching in Europe are lacking. This article reports on comparative and international analysis of discourses and policies for empowering teachers for continuous professional development and inclusive school practices. The analysis focuses on an exploration of varieties of articulations, resources, and conceptual dynamics in the UK and France. These elements are discussed within the broader scheme of the teaching profession, with reference to the inclusive education paradigm.
Policing is more effective against eggs of non‐natal versus natal workers at early colony stages in a bumblebee
Authors: Holland Jacob G. , Zanette Lorenzo R. S. , Nunes Tulio , Bourke Andrew F. G.
Published: May 2023

Eusocial insect colonies are vulnerable to exploitation by egg‐laying workers arising either as natal reproductive workers or as non‐natal reproductive ‘drifting’ workers (intraspecific social parasites). Worker egg‐laying is potentially costly to the colony, but queens and workers can counter its costs via egg eating (queen or worker policing). Bumblebee colonies exhibit egg laying by both natal and non‐natal workers: natal workers collectively lay more eggs but do so only after a specific point in the colony cycle, the ‘competition point’, whereas non‐natal workers potentially lay eggs throughout the colony cycle. These features create a special opportunity to investigate whether policing of worker‐laid eggs is context‐dependent (i.e. depends on worker origin of eggs and/or colony stage). We introduced artificial egg cells containing eggs laid by either natal or non‐natal workers into colonies of the bumblebee Bombus terrestris both before and after their competition points and observed the fate of introduced egg cells and eggs. In both colony stages, the majority of introduced egg cells and eggs were policed, demonstrating that policing was not activated only after the competition point. However, in the pre‐competition point stage alone, a smaller proportion of non‐natal workers' eggs (15%) remained after 20 h compared to the proportion of natal workers' eggs remaining (24%). More effective policing of non‐natal workers' eggs early in the colony cycle potentially represents an adaptive, context‐dependent response to the stage in the cycle when all worker‐laid eggs are normally unrelated to the natal colony.
Global patterns and drivers of genetic diversity among marine habitat‐forming species
Authors: Figuerola‐Ferrando Laura , Barreiro Aldo , Montero‐Serra Ignasi , Pagès‐Escolà Marta , Garrabou Joaquim , Linares Cristina , Ledoux Jean‐Baptiste
Published: May 2023

Aim

Intraspecific genetic diversity is one of the pillars of biodiversity, supporting the resilience and evolutionary potential of populations. Yet, our knowledge regarding the patterns of genetic diversity at macroecological scales, so‐called macrogenetic patterns, remains scarce, particularly in marine species. Marine habitat‐forming (MHF) species are key species in some of the most diverse but also most impacted marine ecosystems, such as coral reefs and marine forests. We characterize the patterns and drivers of genetic diversity in MHF species and provide a macrogenetic baseline, which can be used for conservation planning and for future genetic monitoring programmes.

Location

Global.

Time period

Contemporary.

Major taxa studied

Bryozoans, hexacorals, hydrozoans, octocorals, seagrasses, seaweeds, sponges.

Methods

We analysed a database including genetic diversity estimates based on microsatellites in more than 9,000 georeferenced populations from 140 species, which belong to seven animal and plant taxa. Focusing on expected heterozygosity, we used generalized additive models to test the effect of latitude, taxon, and conservation status. We tested the correlation between the species richness and the genetic diversity.

Results

We reveal a significant but complex biogeographic pattern characterized by a bimodal latitudinal trend influenced by taxonomy. We also report a positive species genetic diversity correlation at the scale of the ecoregions. The difference in genetic diversity between protected and unprotected areas was not significant.

Main conclusions

The contrasting results between MHF animals and plants suggest that the latitudinal genetic diversity patterns observed in MHF species are idiosyncratic, as reported in terrestrial species. Our results support the existence of shared drivers between genetic and species diversities, which remain to be formally identified. Concerning, these macrogenetic patterns are not aligned from the existing network of marine protected areas. Providing the first macrogenetic baseline in MHF species, this study echoes the call regarding the need to consider genetic diversity in biodiversity assessments and management.
Latitudinal patterns of aquatic insect emergence driven by climate
Authors: Nash Liam N. , Zorzetti Lucas W. , Antiqueira Pablo A. P. , Carbone Chris , Romero Gustavo Q. , Kratina Pavel
Published: May 2023

Aim

Emerging aquatic insects link aquatic and terrestrial ecosystems across the Earth. Their diversity, abundance and functional importance means their emergence is an important phenological event. Nevertheless, aquatic insect emergence is understudied at a global scale compared to other phenological events, despite changing phenology being one of the most significant ecological responses to climate change. Here, we quantitatively describe the global patterns, and key proposed drivers, of seasonal aquatic insect emergence, to further understand how these patterns might change in the future.

Location

Global.

Time Period

1950–2018.

Major Taxa Studied

Emerging aquatic insects.

Methods

We extracted monthly emergence data from 86 studies across 163 sites to construct 1053 annual emergence curves. We parameterized the curves using two complementary metrics of seasonality, which were modelled against geographical and climatic variables to determine the direct and indirect relationships between them.

Results

We found clear global trends in aquatic insect emergence patterns across latitude and underlying climates. Between‐month variation and temporal restriction of emergence increased from the equator to the poles, going from small, aseasonal fluctuations in the warm, thermally stable tropics to large, seasonal peaks at cooler, thermally unstable higher latitudes. While emergence trends were associated with gradients of precipitation, temperature was the dominant climatic driver of the latitudinal trend.

Main Conclusions

These findings suggest that with climate warming, aquatic insects will emerge over longer periods, diluted in abundances and displaying less seasonal emergence patterns with smaller between‐month fluctuations. This may result in disruption of ecosystem functions seasonally dependent on aquatic insects, such as riparian predation, pollination and disease transmission. The cross‐ecosystem life cycle of aquatic insects means changes to their seasonal patterns of emergence will have impacts in both aquatic and terrestrial ecosystems.
Microbiologic outcomes of ceftazidime‐avibactam dosing in patients with sepsis utilizing renal replacement therapies
Authors: El Nekidy Wasim S. , Al Ali Mooza , Abidi Emna , Ghazi Islam M. , Attallah Nizar , El Lababidi Rania , Mooty Mohamad , Ghosn Muriel , Mallat Jihad
Published: May 2023

Introduction

The suggested dose of ceftazidime‐avibactam (CEF/AVI) in patient with multidrug resistant organisms and utilizing renal replacement therapies (RRTs) is not validated in clinical studies. The objective of this study was to evaluate the microbiologic cure of bacteremia and pneumonia using the recommended CEF/AVI dosing in patients utilizing RRT.

Methods

A retrospective observational study conducted at our institution between September 15, 2018 and March 15, 2022. The primary end point was to determine the microbiologic cure. The secondary end points were the clinical cure, 30‐day recurrence, 30‐day all cause mortality.

Results

Fifty‐six patients met the inclusion criteria, 36 (64.3%) were males, the median age was 69 (59.5–79.3) years, and the median weight was 69 (60–83.8) kg. Pneumonia represented 34 (60.7%) of infections. Microbiologic cure was achieved in 32 (57%) subjects. However, clinical cure was achieved in 23 (71.9%) patients in the microbiologic cure group versus 12 (50%) in the microbiologic failure group (p = 0.094). The 30‐day recurrence occurred in 2 (6.3%) patients in the microbiologic cure group versus 3 (12.5%) in the microbiologic failure group (p = 0.673). Further, the 30‐day all‐cause mortality was 18 (56.3%) versus 10 (41.7%) in both groups respectively (p = 0.28). The most used dose in patients utilizing continuous veno‐venous hemofiltration (CVVH) was 1.25 g q8h, while the dose was 1.25 g q24h in those who utilized intermittent hemodialysis (IHD). The multivariate logistic regression indicated that bacteremia (OR 41.5 [3.77–46]), Enterobacterales (OR 5.4 [1.04–27.9]), and the drug daily dose (OR 2.33 [1.15–4.72]) were independently associated with microbiologic cure.

Conclusion

Microbiologic cure of ceftazidime‐avibactam in patient utilizing CVVH and IHD is dependent on bacteremia diagnosis, the drug daily dose, and bacterial species. These findings need to be replicated in a larger prospective study, with no recommendations in those utilizing RRT.
Satisfaction or gratitude? Exploring the disparate effects of physicians' knowledge sharing on patients' service evaluation in online medical consultations
Authors: Tan Hongying , Zhang Xiaofei , Yang Yefei
Published: May 2023

The influence of physicians' knowledge sharing on patient satisfaction in online medical consultations (OMCs) has received extensive attention in recent years. However, patient gratitude in OMCs, another crucial outcome for physicians' knowledge sharing, has largely been overlooked. To address this gap, this study attempts to distinguish patient satisfaction from gratitude in OMCs and elucidate the relationship between the sharing process and outcomes. Drawing on the affect theory of social exchange, this study proposes a model that investigates the relative effects of physicians' informational and emotional support during the knowledge‐sharing process on patient satisfaction and gratitude, as well as the contingent roles of physicians' professional seniority and patients' disease severity. The research model is tested by using data from a well‐known online health platform in China. The results indicate that patient gratitude is associated with a more favourable service evaluation than satisfaction in OMCs. Physicians' informational support has a greater effect on patient satisfaction than emotional support, while emotional support has a greater effect on patient gratitude than informational support. Moreover, professional seniority and disease severity positively and negatively moderate the relationship between emotional support and patient gratitude, respectively. A survey‐based experiment is also adopted to validate the research model with self‐reported perceptual measures. This study contributes to the literature on patient gratitude, online healthcare service evaluation, knowledge sharing, and the affect theory of social exchange.
Weaving Evidence into Action for Veterans with dementia (WEAVE): Codesigning the implementation of nonpharmacological interventions for programme fidelity and sustainability
Authors: Meyer Claudia , Golenko Xanthe , Cyarto Elizabeth V. , O'Keefe Fleur , Cooley Josh , Bonney Gwen , Min Mina , Lowthian Judy
Published: May 2023

Rationale

Challenges associated with translating evidence into practice are well recognised and calls for effective strategies to reduce the time lag and successfully embed evidence‐based practices into usual care are loud and clear. While a plethora of nonpharmacological interventions for people with dementia exist; few are based on strong evidence and there is little consideration for programme operationalisation in the complex environment of long‐term care.

Aims and Objectives

This paper describes the preparation for the implementation of the Weaving Evidence into Action for Veterans with dementia project, incorporating the codesign of delivery of four evidence‐based, nonpharmacological interventions.

Method

Implementation preparation for this type 2 hybrid effectiveness‐implementation project was underpinned by the Implementation Framework for Aged Care (IFAC). A sociocultural–political contextual scan was undertaken, and reflection on the IFAC question ‘why change?’ with key stakeholders. Delivery of the four interventions of music therapy, exercise, reminiscence therapy and sensory modulation was explored using codesign methodology. Preparation of both intervention delivery personnel and recipients was via training, establishment of a change team and promotional/awareness‐raising strategies.

Results

The contextual scan revealed Australian government reforms and organisational imperatives facing long‐term care services, while reflections on ‘why change’ flagged best practice dementia care at the local care home level. Several codesign sessions involved veterans with dementia, family members, care home staff members and volunteers to ensure programme alignment with needs and preferences, accounting for existing activities. Training was designed and delivered before programme commencement. A change team was established and strategies to support behaviour change instigated. Implementation evaluation is reported elsewhere.

Conclusion

The extended preparatory period for implementation, afforded by the COVID‐19 pandemic on programme commencement, enabled time for widespread understanding of the programme and necessary upskill of staff. Comprehensive codesign with all stakeholders of programme components identified core and flexible elements necessary for fidelity of implementation.
Decision‐To‐Scope Score: A novel tool with excellent accuracy in predicting foreign bodies in the esophagus
Authors: Macedo Silva Vítor , Lima Capela Tiago , Freitas Marta , Cúrdia Gonçalves Tiago , Boal Carvalho Pedro , Rosa Bruno , Cotter José
Published: May 2023

Introduction

Foreign body (FB) ingestion is a common indication for urgent esophagogastroduodenoscopy (EGD). Nevertheless, most pass spontaneously through the gastrointestinal (GI) tract. Differently from GI bleeding, there is no validated score aiming to identify “low‐risk” patients in suspected FB ingestion. We aimed to create a score able to discriminate patients who are candidates to emergent EGD in this scenario.

Methods

Retrospective study of consecutive patients admitted for suspected FB in the upper GI tract between 2016 and 2021. The evaluated outcome was endoscopic confirmation of FB in the esophagus. Variables significantly associated with the outcome on multivariate analysis were computed into a score predicting endoscopic confirmation.

Results

We included 228 patients. From these, 97 (42.5%) had a confirmed FB in EGD. Time since ingestion <6 h (OR = 4.0; P = 0.042), absence of any meal after FB ingestion (OR = 7.1; P = 0.005), dysphagia (OR = 11.8; P < 0.001), odynophagia (OR = 4.6; P = 0.004), and drooling (OR = 15.1; P < 0.001) were independent predictors of confirmed FB. These variables were used to compute a FB predicting score—the Decision‐To‐Scope (DTS) Score: time since ingestion <6 h (+1 point), absence of meals (+2 points), dysphagia (+3 points), odynophagia (+1 point), and drooling (+4 points). DTS‐Score had excellent accuracy to predict the outcome (AUC = 0.953; 95%CI = 0.928–0.977; P < 0.001). The optimal cutoff to identify low‐risk patients was a score ≤5 (sensitivity 85.0% and specificity 94.7%).

Conclusions

More than half of the suspected FB were not confirmed by EGD. The DTS‐Score presented excellent accuracy at stratifying patients' risk and may contribute to the decision to perform emergent EGD in suspected FB ingestion.
Determinants of access of frail, community‐residing older adults to geriatricians in Ontario
Authors: Hogeveen Sophie , Hirdes John P. , Heckman George , Keller Heather
Published: May 2023

Objectives

Little is known about determinants of access to community‐based geriatricians. The Geriatric 5Ms™ describe geriatricians' core competencies and inform referrals to specialists for older adults with complex needs. We explored the association of the Geriatric 5Ms™ and other characteristics with outpatient access to geriatricians by home care (HC) clients.

Methods

This was a population‐based, retrospective cohort study of frail community‐dwelling HC clients (≥60 years) with complex needs (n = 196,444). Health assessment information was linked to health services data in Ontario, Canada, 2012–2015. Multivariable generalized estimating equations were used to identify characteristics associated with geriatrician contact (≥1 visit in 90 days post‐HC admission), including derived Geriatric 5Ms™ score, and predisposing, enabling, and need factors obtained from clinical assessments.

Results

Only 5.2% of the cohort had outpatient geriatrician contact in Ontario, Canada. Derived Geriatric 5Ms™ score was associated with higher odds of contact, but the model had modest discriminatory power (c‐statistic = 0.67). In the broader multivariable model, based on empirically included factors and adjusted for regional differences, age, worsening of decision‐making, dementia, hallucinations, Parkinsonism, osteoporosis, and caregiver distress/institutionalization risk were associated with higher odds of geriatrician contact. Female sex, difficulties accessing home, impaired locomotion, recovery potential, hemiplegia/hemiparesis, and cancer, were associated with lower odds of contact. This model had good discriminatory power (c‐statistic = 0.77).

Conclusions

Few frail, community‐dwelling older adults receiving HC had any outpatient geriatrician contact. While the derived Geriatric 5Ms™ score was associated with contact, a broader empirical model performed better than the Geriatric 5Ms™ in predicting contact with an outpatient geriatrician. Contact was mainly driven by conditions common in older adults, but evidence suggests that geriatricians are not evaluating the most medically complex and unstable older adults in the community. These findings suggest a need to re‐examine the referral process for geriatricians and the allocation of limited specialized resources.
Q‐switched ruby laser is safe and effective in treating primary gingival hyperpigmentation
Authors: Noyman Yehonatan , Kornowski Yoram , Slodownik Dan , Lapidoth Moshe , Levi Assi
Published: May 2023

Background

Physiologic gingival hyperpigmentation (PGH) is a benign condition that results from increased melanin production and is prevalent among darker skin individuals. Although the use of lasers for PGH has gained popularity in recent years, the lasers being used are mostly ablative, and act through a non‐selective tissue damage mechanism.

Aims

The objective of this study was to evaluate the use of a non‐ablative 694‐nm Q‐switched ruby laser (QSRL) for the depigmentation of PGH.

Methods

A retrospective single‐center study of patients diagnosed with PGH and treated with a QSRL Between March 2019 and November 2020.

Results

Four patients were treated with QSRL for 1–3 sessions, until complete depigmentation was achieved. The average follow‐up was 11 months (range 7–18 months) with no patient exhibiting re‐pigmentation. Adverse events included mild local tenderness and transient erosions in two patients.

Conclusion

The 694‐nm QSRL is a novel and promising safe and effective method for treating PGH with the advantages of being a non‐ablative modality that minimizes tissue damage and optimizes the outcome.
Possible heterogeneity of initial pancreatic islet beta‐cell autoimmunity heralding type 1 diabetes
Authors: Lernmark Åke , Akolkar Beena , Hagopian William , Krischer Jeffrey , McIndoe Richard , Rewers Marian , Toppari Jorma , Vehik Kendra , Ziegler Anette‐G. ,   The TEDDY Study Group
Published: May 2023

The etiology of type 1 diabetes (T1D) foreshadows the pancreatic islet beta‐cell autoimmune pathogenesis that heralds the clinical onset of T1D. Standardized and harmonized tests of autoantibodies against insulin (IAA), glutamic acid decarboxylase (GADA), islet antigen‐2 (IA‐2A), and ZnT8 transporter (ZnT8A) allowed children to be followed from birth until the appearance of a first islet autoantibody. In the Environmental Determinants of Diabetes in the Young (TEDDY) study, a multicenter (Finland, Germany, Sweden, and the United States) observational study, children were identified at birth for the T1D high‐risk HLA haploid genotypes DQ2/DQ8, DQ2/DQ2, DQ8/DQ8, and DQ4/DQ8. The TEDDY study was preceded by smaller studies in Finland, Germany, Colorado, Washington, and Sweden. The aims were to follow children at increased genetic risk to identify environmental factors that trigger the first‐appearing autoantibody (etiology) and progress to T1D (pathogenesis). The larger TEDDY study found that the incidence rate of the first‐appearing autoantibody was split into two patterns. IAA first peaked already during the first year of life and tapered off by 3–4 years of age. GADA first appeared by 2–3 years of age to reach a plateau by about 4 years. Prior to the first‐appearing autoantibody, genetic variants were either common or unique to either pattern. A split was also observed in whole blood transcriptomics, metabolomics, dietary factors, and exposures such as gestational life events and early infections associated with prolonged shedding of virus. An innate immune reaction prior to the adaptive response cannot be excluded. Clarifying the mechanisms by which autoimmunity is triggered to either insulin or GAD65 is key to uncovering the etiology of autoimmune T1D.
Utility and limitations of patient‐adjusted D‐dimer cut‐off levels for diagnosis of venous thromboembolism—A systematic review and meta‐analysis
Authors: Gerber Joël L. , Messmer Anna S. , Krebs Tobias , Müller Martin , Hofer Debora M. , Pfortmueller Carmen A.
Published: May 2023

Purpose

To systematically assess test performance of patient‐adapted D‐dimer cut‐offs for the diagnosis of venous thromboembolism (VTE).

Methods

Systematic review and analysis of articles published in PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases. Investigations assessing patient‐adjusted D‐dimer thresholds for the exclusion of VTE were included. A hierarchical summary receiver operating characteristic model was used to assess diagnostic accuracy. Risk of bias was assessed by Quality Assessment of Diagnostic Accuracy Studies 2 score.

Results

A total of 68 studies involving 141,880 patients met the inclusion criteria. The standard cut‐off revealed a sensitivity of 0.99 (95% confidence interval [CI] 0.98–0.99) and specificity of 0.23 (95% CI 0.16–0.31). Sensitivity was comparable to the standard cut‐off for age‐adjustment (0.97 [95% CI 0.96–0.98]) and YEARS algorithm (0.98 [95% CI 0.91–1.00]) but lower for pretest probability (PTP)‐adjusted (0.95 [95% CI 0.89–0.98) and COVID‐19‐adapted thresholds (0.93 [95% CI 0.82–0.98]). Specificity was significantly higher across all adjustment strategies (age: 0.43 [95% CI 0.36–0.50]; PTP: 0.63 [95% CI 0.51–0.73]; YEARS algorithm: 0.65 [95% CI 0.39–0.84]; and COVID‐19: 0.51 [95% CI 0.40–0.63]). The YEARS algorithm provided the best negative likelihood ratio (0.03 [95% CI 0.01–0.15]), followed by age‐adjusted (both 0.07 [95% CI 0.05–0.09]), PTP (0.08 [95% CI 0.04–0.17), and COVID‐19‐adjusted thresholds (0.13 [95% CI 0.05–0.32]).

Conclusions

This study indicates that adjustment of D‐dimer thresholds to patient‐specific factors is safe and embodies considerable potential for reduction of imaging. However, robustness, safety, and efficiency vary considerably among different adjustment strategies with a high degree of heterogeneity.
Quality care close to home: Objectives and early outcomes of a second paediatric heart transplant service in Australia
Authors: Basu Shreerupa , Irving Claire , Roberts Philip , Orr Yishay , Reilly Catherine , Casey Charlene , Griffiths Amelia , Oake Diane , McElduff Michelle , Macdonald Peter , Nair Priya , Jansz Paul , Festa Marino
Published: May 2023

Aim

We describe the experience of a new paediatric heart transplant (HT) centre in Australia. New South Wales offers quaternary paediatric cardiac services including comprehensive care pre‐ and post‐HT; however, perioperative HT care has previously occurred at the national paediatric centre or in adult centres. Internationally, perioperative HT care is highly protocol‐driven and a majority of HT occurs in low volume centres. Establishing a low volume paediatric HT centre in New South Wales offers potential for quality HT care close to home.

Methods

Retrospective review of programme data for the first 12 months was undertaken. Patient selection was audited against the programme's intended initiation criteria. Longitudinal patient data on outcomes and complications were obtained from patient medical records.

Results

The programme's initial phase offered HT to children with non‐congenital heart disease and no requirement for durable mechanical circulatory support. Eight patients met criteria for HT referral. Three underwent interstate transfer to the national paediatric centre. Five children (13–15 years, weight 36–85 kg) underwent HT in the new programme. Individual predicted 90‐day mortality was 1.3–11.6%, with increased risk for recipients transplanted from veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) and with restrictive/hypertrophic cardiomyopathies. Survival at 90 days and for duration of follow‐up is 100%. Observed programme benefits include mitigation of family dislocation and improved continuity of care within a family‐centred programme.

Conclusion

Audit of the first 12 months' activity of a second paediatric HT centre in Australia demonstrates adherence to proposed patient selection criteria and excellent 90‐day patient outcomes. The programme demonstrates feasibility of care close to home, providing continuity for all patients including those requiring increased rehabilitation and psychosocial support post‐transplantation.
Ulva: An emerging green seaweed model for systems biology
Authors: Blomme Jonas , Wichard Thomas , Jacobs Thomas B. , De Clerck Olivier
Published: May 2023

Green seaweeds exhibit a wide range of morphologies and occupy various ecological niches, spanning from freshwater to marine and terrestrial habitats. These organisms, which predominantly belong to the class Ulvophyceae, showcase a remarkable instance of parallel evolution toward complex multicellularity and macroscopic thalli in the Viridiplantae lineage. Within the green seaweeds, several Ulva species (“sea lettuce”) are model organisms for studying carbon assimilation, interactions with bacteria, life cycle progression, and morphogenesis. Ulva species are also notorious for their fast growth and capacity to dominate nutrient‐rich, anthropogenically disturbed coastal ecosystems during “green tide” blooms. From an economic perspective, Ulva has garnered increasing attention as a promising feedstock for the production of food, feed, and biobased products, also as a means of removing excess nutrients from the environment. We propose that Ulva is poised to further develop as a model in green seaweed research. In this perspective, we focus explicitly on Ulva mutabilis/compressa as a model species and highlight the molecular data and tools that are currently available or in development. We discuss several areas that will benefit from future research or where exciting new developments have been reported in other Ulva species.
Association between defect morphology and healing of intrabony defects treated with minimally invasive non‐surgical therapy: A pilot exploratory analysis of two cohorts
Authors: Nibali Luigi , Mehta Jaimini , Al‐Shemeri Dhare , Anoixiadou Styliani , Parashis Andreas , Vouros Ioannis
Published: May 2023

Objective

The aim of this study was to explore the associations between defect morphology (defined by clinical and radiographic parameters) and the healing of periodontal intrabony defects treated with minimally invasive non‐surgical therapy (MINST).

Background Data

MINST has shown to result in favorable clinical and radiographic improvements in intrabony defects. However, it is not clear which types of intrabony defects are most suitable for this treatment.

Methods

Clinical and radiographic analyses were carried out in a total of 71 intrabony defects treated with MINST belonging to two previously published studies. Baseline defect characteristics were analyzed and related to clinical and radiographic outcomes at 12 months post‐MINST with or without adjunctive enamel matrix derivative.

Results

No associations were detected between defect depth, angle and predicted number of walls and clinical and radiographic healing 12 months post‐MINST.

Conclusions

No evidence emerged for associations between defect characteristics and healing following MINST. These data seem to suggest that factors other than defect morphology may influence treatment response to MINST.
The impact of rural structural and community health factors on postmastectomy complications among south central Appalachian breast cancer patients
Authors: Tasman Jordan , Roberson Patricia N. E. , Clegg Devin , Boukovalas Stefanos , Lloyd Jillian
Published: May 2023

Purpose

The study examined how structural and community health factors, including primary care physicians (PCP), food insecurity, diabetes, and mortality rate per county, are linked to the number and severity of postmastectomy complications among south central Appalachian breast cancer patients depending on rural status.

Methods

Data was obtained through a retrospective review of 473 breast cancer patients that underwent a mastectomy from 2017 to 2021. Patient's ZIP Code was used to determine their rural–urban community area code and their county of residence for census data. We conducted a zero inflated Poisson regression.

Findings

Results demonstrated that patients in small rural/isolated areas with low (B = −4.10, SE = 1.93, OR = 0.02, p = 0.03) to average (B = −2.67, SE = 1.32, OR = 0.07, p = 0.04) food insecurity and average (B = −2.67, SE = 1.32, OR = 0.07, p = 0.04) to high (B = −10.62, SE = 4.71, OR = 0.00, p = 0.02) PCP have significantly fewer postmastectomy complications compared to their urban counterparts. Additionally, patients residing in small rural/isolated areas with high (B = 4.47, SE = 0.49, d = 0.42, p < 0.001) diabetes and low mortality (B = 5.70, SE = 0.58, d = 0.45, p < 0.001) rates have significantly more severe postmastectomy complications.

Conclusion

These findings demonstrate that patients who reside in small/rural isolated areas may experience fewer and less severe postmastectomy when there is certain optimal structural and community health factors present compared to their urban counterparts. Oncologic care teams could utilize this information in routine consult for risk assessment and mitigation. Future research should further examine additional risks for postmastectomy complications.
Emerging Hyalomma lusitanicum: From identification to vectorial role and integrated control
Authors: Valcárcel Félix , Elhachimi L. , Vilá M. , Tomassone L. , Sánchez M. , Selles S. M. A. , Kouidri M. , González M. G. , Martín‐Hernández R. , Valcárcel Á. , Fernández N. , Tercero J. M. , Sanchis J. , Bellido‐Blasco J. , González‐Coloma A. , Olmeda A. S.
Published: May 2023

In the Mediterranean basin, the tick species Hyalomma lusitanicum Koch stands out among other species of the Hyalomma genus due to its wide distribution, and there is great concern about its potential role as a vector and/or reservoir and its continuous expansion to new areas because of climate warming and human and other animal movements. This review aims to consolidate all the information on H. lusitanicum, including taxonomy and evolution, morphological and molecular identification, life cycle, sampling methods, rearing under laboratory conditions, ecology, hosts, geographical distribution, seasonality, vector role and control methods. The availability of adequate data is extremely relevant to the development of appropriate control strategies in areas where this tick is currently distributed as well as in new areas where it could become established in the near future.