bluuebunny/crossref_metadata_2025 huggingface dataset:
Deaf Identity Under Pressure: Experiences of Deaf Persons in Iceland
Authors: Diego Kristinn Arnar , Hardonk Stefan C
Published: January 2023

Over the past decades, changes in technology and policy have made developing and maintaining identity and community increasingly challenging for Deaf individuals. This is particularly obvious in Iceland, where the Deaf community is threatened in its existence. This paper reports on an empirical study that explores how Deaf individuals experience developing and maintaining a positive identity in various areas, including family life, working life, and social life. The study approaches deaf identities as multifaceted and dynamic, and particular emphasis is placed on the role of social interactions in identity-related processes. Qualitative interviews were conducted among members of the Icelandic Deaf community and analyzed using a phenomenological approach. The results indicate that social interactions within the Deaf community are a key factor in developing and maintaining Deaf identity. However, decreasing numbers in the Deaf community make its members explore other opportunities, and they experience being Deaf in Iceland as an insecure identity.
Sexual selection and the evolution of condition-dependence: an experimental test at two resource levels
Authors: Bath Eleanor , Rostant Wayne , Ostridge Harrison J , Smith Sophie , Mason Janet S , Rafaluk-Mohr Timm , Mank Judith E , Chapman Tracey , Perry Jennifer C
Published: January 2023

Stronger condition-dependence in sexually selected traits is well-documented, but how this relationship is established remains unknown. Moreover, resource availability can shape responses to sexual selection, but resource effects on the relationship between sexual selection and condition-dependence are also unknown. In this study, we directly test the hypotheses that sexual selection drives the evolution of stronger-condition-dependence and that resource availability affects the outcome, by evolving fruit flies (Drosophila melanogaster) under relatively strong or weak sexual selection (through varied sex ratios) and at resource-poor or resource-rich adult diets. We then experimentally manipulated condition via developmental diet and assessed condition-dependence in adult morphology, behavior, and reproduction. We observed stronger condition-dependence in female size in male-biased populations and in female ovariole production in resource-limited populations. However, we found no evidence that male condition-dependence increased in response to sexual selection, or that responses depended on resource levels. These results offer no support for the hypotheses that sexual selection increases male condition-dependence or that sexual selection’s influence on condition-dependence is influenced by resource availability. Our study is, to our knowledge, the first experimental test of these hypotheses. If the results we report are general, then sexual selection’s influence on the evolution of condition-dependence may be less important than predicted.
Growth and drought resilience of four native tree species suitable for reforestation of Brazil’s Atlantic Forest
Authors: Yaakobi Assaf , Livne-Luzon Stav , Marques Felipe , Mariani Bruno , Stern Rafael , Klein Tamir
Published: January 2023

Deforestation of tropical forests has been a critical issue affecting climate change mitigation and biodiversity conservation. Reforestation strives to remedy this situation, yet it is futile as long as deforestation of primary forests continues. Since deforestation is partly motivated by the demand for valuable tropical wood, reforestation should focus not only on planting native tree species, but specifically on a high diversity of native tree species with high-quality wood. However, the eco-physiological information required for growing such species is limited, and their resilience to drought events is unknown.

Here, we focused on four native tropical wood tree species identified as suitable for Brazil’s Atlantic Forest reforestation. Growth, carbon assimilation, water-use and xylem hydraulics were studied in seedlings of the two legume species Dalbergia nigra and Plathymenia foliolosa and the two non-legume species Cariniana legalis and Zeyheria tuberculosa. Seedlings were monitored weekly for 9 consecutive weeks, three to five weeks of which under induced drought.

Growth and carbon assimilation were 25–65 per cent higher in the legume vs. non-legume species. In turn, non-legume species mostly avoided the drought by stomatal closure, producing a 50 per cent higher water-use efficiency (WUE) compared with the legume species. The average water potential at 50 per cent stomatal conductivity (Ψgs50) for legume species was −2.6 MPa, whereas for non-legume species it was −0.85 MPa. Still, each species showed a unique set of responses, indicating different growth strategies under mesic and xeric conditions.

Our results indicate a divergence among legume and non-legume species, driven by a trade-off between plant productivity (carbon assimilation and growth) and plant safety (stomatal regulation and WUE). All in all, the four species of juvenile potted plants demonstrated a high capacity for recovery from drought, which supports their potential role in future reforestation under climate change.
Influence of dosing pattern of antipsychotics on treatment outcome of delirium in patients with advanced cancer
Authors: Abe Akiko , Fujisawa Daisuke , Miyajima Kaya , Takeuchi Emi , Takeuchi Mari , Mimura Masaru , Imai Kengo , Uemura Keiichi , Watanabe Hiroaki , Matsuo Naoki , Matsuda Yoshinobu , Maeda Isseki , Ogawa Asao , Yoshiuchi Kazuhiro , Iwase Satoru
Published: January 2023

Background

Clinical guidelines recommend antipsychotics for the treatment of delirium; however, there has been no confirmed recommendation regarding their administrating patterns. This study aims to investigate whether different dosing patterns of antipsychotics (single or multiple administrations) influence the outcomes of delirium treatment.

Methods

This is a secondary analysis of a prospective observational study involving patients with advanced cancer and delirium receiving antipsychotics. The Delirium Rating Scale Revised-98 was administered at baseline and after 72 h of starting pharmacotherapy. Patients were classified into single administration group (received a single dosage within 24 h before the assessment) and multiple administration group (received more than one dosage).

Results

A total of 555 patients (single administration 492 (88.6%); multiple administration 63 (11.4%)) were subjected to analyses. The patients in the multiple administration group were more likely to be male, in psycho-oncology consulting settings, with lower performance status, with hyperactive delirium and with severer delirium symptoms. In the multivariate analysis, single administration was significantly associated with better improvement of delirium (p < 0.01, 95% confidence interval: 1.83–5.87) even after controlling covariates. There were no significant differences in the mean dosages of antipsychotics per day in chlorpromazine equivalent (single administration 116.8 mg/day, multiple administration 123.5 mg/day) and the incidence of adverse events between the two groups.

Conclusions

In this observational study sample, Delirium Rating Scale severity score improvement in single administration was higher than that seen in multiple administration. There was no difference in adverse events between the two groups.
Safety and efficacy of tumour-treating fields (TTFields) therapy for newly diagnosed glioblastoma in Japanese patients using the Novo-TTF System: a prospective post-approval study
Authors: Nishikawa Ryo , Yamasaki Fumiyuki , Arakawa Yoshiki , Muragaki Yoshihiro , Narita Yoshitaka , Tanaka Shota , Yamaguchi Shigeru , Mukasa Akitake , Kanamori Masayuki
Published: January 2023

Background

Tumour-treating fields therapy is a locoregional, anti-cancer treatment. Efficacy and safety of tumour-treating fields therapy in adults with newly diagnosed glioblastoma were demonstrated in the pivotal phase 3 EF-14 study (NCT00916409). Here, we report post-approval data of tumour-treating fields therapy in Japanese patients with newly diagnosed glioblastoma.

Methods

Unsolicited post-marketing surveillance data from Japanese patients with newly diagnosed glioblastoma treated with tumour-treating fields therapy (December 2016–June 2020) were retrospectively analysed. The primary endpoints were skin, neurological and psychiatric adverse events. The secondary endpoints were 1- and 2-year overall survival rates, and the 6-month progression-free survival. adverse events were analysed using MedDRA v24.0. The overall survival and progression-free survival were assessed using the Kaplan–Meier survival analysis (log-rank testing). The Cox proportional hazard regression analyses were also performed.

Results

Forty patients with newly diagnosed glioblastoma were enrolled (62.5% male; median age 59 years; median baseline Karnofsky Performance Scale score 90). The most common tumour-treating-fields-therapy-related adverse event was beneath-array local skin reaction (60% of patients). The adverse events were mostly mild to moderate in severity. Neurological disorders were observed in 2.5% patients (one patient reported dysesthesia). No psychiatric disorders were reported. The 1- and 2-year overall survival rates were 77.9% (95% CI 60.6–88.3) and 53.6% (35.5–68.7%), respectively. The 6-month progression-free survival was 77.5% (61.2–87.6%). These survival rates compare favourably with those in the EF-14 trial (1- and 2-year overall survival rates: 73% [69–77%] and 43% [39–48%], respectively; 6-month progression-free survival rate: 56% (51–61%).

Conclusion

This post-approval, real-world evidence study revealed no new safety signals and suggests the safety and efficacy of tumour-treating fields therapy in Japanese patients with newly diagnosed glioblastoma.
A novel salivary effector, BtE3, is essential for whitefly performance on host plants
Authors: Peng Zhengke , Su Qi , Ren Jun , Tian Lixia , Zeng Yang , Yang Yuting , Wang Shaoli , Xie Wen , Wu Qingjun , Li Zhenyu , Zhang Youjun
Published: January 2023

The whitefly Bemisia tabaci is a piercing-sucking herbivore that reduces the yields of crops both by feeding on plants and transmitting plant viruses. Like most plant feeders, B. tabaci has evolved ways to avoid plant defence responses. For example, B. tabaci is known to secrete salivary effectors to suppress host defences. However, the nature of B. tabaci effectors is not completely understood. In this study, we used B. tabaci genomic and salivary gland transcriptomic data and an overexpression system to identify a previously unknown B. tabaci salivary effector, BtE3. BtE3 is specifically expressed in the head (containing primary salivary glands) and is secreted into hosts during B. tabaci feeding. In planta overexpression of BtE3 blocked Burkholderia glumae-induced hypersensitive response (HR) in both Nicotiana benthamiana and Solanum lycopersicum. Silencing of BtE3 by plant-mediated RNAi prevented B. tabaci from continuously ingesting phloem sap, and reduced B. tabaci survival and fecundity. Moreover, overexpression of BtE3 in planta up-regulated the salicylic acid- (SA-) signalling pathway, but suppressed the downstream jasmonic acid- (JA-) mediated defences. Taken together, these results indicate that BtE3 is a B. tabaci-specific novel effector involved in B. tabaci-plant interactions. These findings increase our understanding of B. tabaci effectors and suggest novel strategies for B. tabaci pest management.
eRASSt J074426.3 + 291606: prompt accretion disc formation in a ‘faint and slow’ tidal disruption event
Authors: Malyali A , Liu Z , Merloni A , Rau A , Buchner J , Ciroi S , Di Mille F , Grotova I , Dwelly T , Nandra K , Salvato M , Homan D , Krumpe M
Published: January 2023

We report on multiwavelength observations of the tidal disruption event (TDE) candidate eRASSt J074426.3 + 291606 (J0744), located in the nucleus of a previously quiescent galaxy at z = 0.0396. J0744 was first detected as a new, ultra-soft X-ray source (photon index ∼4) during the second SRG/eROSITA All-Sky Survey (eRASS2), where it had brightened in the 0.3–2 keV band by a factor of more than ∼160 relative to an archival 3σ upper limit inferred from a serendipitous Chandra pointing in 2011. The transient was also independently found in the optical by the Zwicky Transient Facility (ZTF), with the eRASS2 detection occurring only ∼20 d after the peak optical brightness, suggesting that the accretion disc formed promptly in this TDE. Continued X-ray monitoring over the following ∼400 d by eROSITA, NICER XTI and Swift XRT showed a net decline by a factor of ∼100, albeit with large amplitude X-ray variability where the system fades, and then rebrightens, in the 0.3–2 keV band by a factor ∼50 during an 80-d period. Contemporaneous Swift UVOT observations during this extreme X-ray variability reveal a relatively smooth decline, which persists over ∼400 d post-optical peak. The peak observed optical luminosity (absolute g-band magnitude ∼−16.8 mag) from this transient makes J0744 the faintest optically detected TDE observed to date. However, contrasting the known set of ‘faint and fast’ TDEs, the optical emission from J0744 decays slowly (exponential decay time-scale ∼120 d), making J0744 the first member of a potential new class of ‘faint and slow’ TDEs.
Reverberation of pulsar wind nebulae – II. Anatomy of the ‘thin-shell’ evolution
Authors: Bandiera R , Bucciantini N , Martín J , Olmi B , Torres D F
Published: January 2023

During its early evolution, a pulsar wind nebula (PWN) sweeps the inner part of the supernova ejecta and forms a thin massive shell. Later on, when the shell has been reached by the reverse shock of the supernova remnant, the evolution becomes more complex, in most cases reverting the expansion into a compression: this later phase is called ‘reverberation’. Computations done so far to understand this phase have been mostly performed in the thin-shell approximation, where the evolution of the PWN radius is assimilated to that of the swept-up shell under the effect of both the inner pressure from the PWN, and the outer pressure from the supernova remnant. Despite the thin-shell approach seems rather justifiable, its implementations have so far been inaccurate, and its correctness, never tested. The outer pressure was naively assumed to be scaled according to the Sedov solution (or a constant fraction of it) along the entire evolution. The thin-shell assumption itself fails along the process, being the shell no longer thin in comparison with the size of the PWN. Here, through a combination of numerical models, dimensional arguments, and analytical approximations, we present a detailed analysis of the interaction of the PWN with the supernova remnant. We provide a new analytical approximation of the outer pressure, beyond the Sedov solution, and a revised ‘thin-shell’ able to reproduce results from numerical simulations. Finally, we compute the efficiency by which the PWN is compressed during reverberation over a wide population of sources.
Automated classification of eclipsing binary systems in the VVV Survey
Authors: Daza-Perilla I V , Gramajo L V , Lares M , Palma T , Ferreira Lopes C E , Minniti D , Clariá J J
Published: January 2023

With the advent of large-scale photometric surveys of the sky, modern science witnesses the dawn of big data astronomy, where automatic handling and discovery are paramount. In this context, classification tasks are among the key capabilities a data reduction pipeline must possess in order to compile reliable data sets, to accomplish data processing with an efficiency level impossible to achieve by means of detailed processing and human intervention. The VISTA Variables of the Vía Láctea Survey, in the southern part of the Galactic disc, comprises multiepoch photometric data necessary for the potential discovery of variable objects, including eclipsing binary systems (EBs). In this study, we use a recently published catalogue of one hundred EBs, classified by fine-tuning theoretical models according to contact, detached, or semidetached classes belonging to the tile d040 of the VVV. We describe the method implemented to obtain a supervised machine-learning model, capable of classifying EBs using information extracted from the light curves of variable object candidates in the phase space from tile d078. We also discuss the efficiency of the models, the relative importance of the features and the future prospects to construct an extensive data base of EBs in the VVV survey.
Quantifying the global ‘CMB tension’ between the Atacama Cosmology Telescope and the Planck satellite in extended models of cosmology
Authors: Di Valentino Eleonora , Giarè William , Melchiorri Alessandro , Silk Joseph
Published: January 2023

We study the global agreement between the most recent observations of the cosmic microwave background (CMB) temperature and polarization anisotropies angular power spectra released by the Atacama Cosmology Telescope and the Planck satellite in various cosmological models that differ by the inclusion of different combinations of additional parameters. By using the Suspiciousness statistic, we show that the global ‘CMB tension’ between the two experiments, quantified at the Gaussian equivalent level of $\sim 2.5\, \sigma$ within the baseline Lambda cold dark matter, is reduced at the level of 1.8σ when the effective number of relativistic particles (Neff) is significantly less than the standard value, while it ranges between $2.3\, \sigma$ and $3.5\, \sigma$ in all the other extended models.
Faraday rotation measure variations of repeating fast radio burst sources
Authors: Yang Yuan-Pei , Xu Siyao , Zhang Bing
Published: January 2023

Recently, some fast radio burst (FRB) repeaters were reported to exhibit complex, diverse variations of Faraday rotation measures (RMs), which implies that they are surrounded by an inhomogeneous, dynamically evolving, magnetized environment. We systematically investigate some possible astrophysical processes that may cause RM variations of an FRB repeater. The processes include (1) a supernova remnant (SNR) with a fluctuating medium; (2) a binary system with stellar winds from a massive/giant star companion or stellar flares from a low-mass star companion; (3) a pair plasma medium from a neutron star (including pulsar winds, pulsar wind nebulae, and magnetar flares); (4) outflows from a massive black hole. For the SNR scenario, a large relative RM variation within a few years requires that the SNR is young with a thin and local anisotropic shell, or the size of dense gas clouds in interstellar/circumstellar medium around the SNR is extremely small. If the RM variation is caused by the companion medium in a binary system, it is more likely from the stellar winds of a massive/giant star companion. The RM variation contributed by stellar flares from a low-mass star is disfavored, because this scenario predicts an extremely large relative RM variation during a short period of time. The scenarios invoking a pair plasma from a neutron star can be ruled out due to their extremely low RM contributions. Outflows from a massive black hole could provide a large RM variation if the FRB source is in the vicinity of the black hole.
The Epiphany of Saudi Law
Authors: Mallat Chibli
Published: January 2023

The chapter starts with the difficulty for a Saudi citizen, up until the early 21st century, to find what law is. It underlines the acceleration of statutory enactment circa 2000, and the publication of case law starting in 2007. It notes the absence of legislation in the classical age and provides some possible explanations both in the larger Islamic context and in the specific Saudi case. It then describes the accelerated enactment of laws and the systematic publication of collections of case law: the Mudawwana in 2007, the two Ahkam series of 2013–15, together with the extensive discussion by the respective Ministers of justice overseeing their publication; the Diwan al-mazalem separate jurisdiction, the commercial courts and the Supreme court; as well as special committees and boards.
The First Principle
Authors: Magri Tito
Published: January 2023

The First Principle individuates the conditions and limits of object representation, as realized in human cognitive nature. The principle depends on the ontology of perceptions, impressions, and ideas, as qualitatively individuated mental particulars. Perceptions figure in Hume’s philosophy both for their mental existence and for their contents. The different conceptual roles and the naturally necessary joint instantiation of these two aspects are crucial for Hume’s explanations. Mental existence is contingent, consisting in causal relations among perceptions. Content individuates impressions as equivalent to sensible objects. By the First Principle, object representation is only by ideas caused by impressions of sensation and exactly resembling them. The actuality of objects is represented not by an element of content but by a mode of conception. The First Principle is also the basis for Hume’s views about reference and truth. Hume uses it is a critical tool but aiming to taxonomy rather than exclusion.
A Botched-Up Succession Plan
Authors: Palekar Srilatha , Pardhi Arun , Jindal Sunanda
Published: January 2023

When transfer of managerial authority is not accompanied by ownership change, the predecessor continues to call the shots. In all the excitement generated by the recent events in the Tata group, where the chairman was replaced by his predecessor—albeit as an interim measure—the real issue has gone into hiding. A substantial focus of the discussions and comments from the press, observers, and experts has been on procedures and personalities. Whether the incumbent chairman was given adequate notice about his removal and whether he was given a chance to argue his case is no doubt relevant questions to assess the fairness of the decision. But these questions speak to the procedural issues surrounding corporate governance. The other widely discussed question is about the differing perspectives and the positions taken by the incumbent and the predecessor. But if one were to seriously search for the root cause of this issue, it is possible to recognize the elephant in the room—ineffective succession planning and implementation. Succession planning is one issue that not many business organizations have handled well. While it can be quite challenging and tricky in family—owned and managed companies, we also have examples of other companies promoted by professionals struggling in this area. What comes in the way of highly reputed and sensible business leaders delivering on this inevitable but crucial mandate given to them in their role as business leaders and owners?
Spatiotemporal formation of the large vacuole regulated by the BIN2-VLG module is required for female gametophyte development in Arabidopsis
Authors: Hu Li-Qin , Yu Shi-Xia , Xu Wan-Yue , Zu Song-Hao , Jiang Yu-Tong , Shi Hao-Tian , Zhang Yan-Jie , Xue Hong-Wei , Wang Ying-Xiang , Lin Wen-Hui
Published: January 2023

In Arabidopsis thaliana, female gametophyte (FG) development is accompanied by the formation and expansion of the large vacuole in the FG; this is essential for FG expansion, nuclear polar localization, and cell fate determination. Arabidopsis VACUOLELESS GAMETOPHYTES (VLG) facilitates vesicular fusion to form large vacuole in the FG, but the regulation of VLG remains largely unknown. Here, we found that gain-of-function mutation of BRASSINOSTEROID INSENSITIVE2 (BIN2) (bin2-1) increases VLG abundance to induce the vacuole formation at stage FG1, and leads to abortion of FG. Loss-of-function mutation of BIN2 and its homologs (bin2-3 bil1 bil2) reduced VLG abundance and mimicked vlg/VLG phenotypes. Knocking down VLG in bin2-1 decreased the ratio of aberrant vacuole formation at stage FG1, whereas FG1-specific overexpression of VLG mimicked the bin2-1 phenotype. VLG partially rescued the bin2-3 bil1 bil2 phenotype, demonstrating that VLG acts downstream of BIN2. Mutation of VLG residues that are phosphorylated by BIN2 altered VLG stability and a phosphorylation mimic of VLG causes similar defects as did bin2-1. Therefore, BIN2 may function by interacting with and phosphorylating VLG in the FG to enhance its stability and abundance, thus facilitating vacuole formation. Our findings provide mechanistic insight into how the BIN2-VLG module regulates the spatiotemporal formation of the large vacuole in FG development.
Does Scientific Evidence Support the Widespread Use of SQFs as a Proactive Policing Strategy?
Authors: Weisburd David , Petersen Kevin , Fay Sydney
Published: January 2023

The use of pedestrian stops, commonly known as SQFs (Stop, Question, and Frisk), has been one of the most common yet controversial proactive strategies in modern policing. In this paper, we report on a recently completed Campbell Collaboration Systematic Review that allows us to answer key policy questions about the use of SQFs in policing. Is there convincing evidence that pedestrian stops reduce crime? Are claims of negative impacts on individuals confirmed by research? And if there is evidence both of crime reductions and harmful effects, how do such costs and benefits weigh against each other? And finally, how do the impacts of pedestrian stops compare with other proactive policing strategies? Based on our review of findings, we conclude that existing scientific evidence does not support the widespread use of SQFs as a proactive policing strategy.
The nexus between research impact and sustainability assessment: From stakeholders’ perspective
Authors: Chams Nour , Guesmi Bouali , Gil José María
Published: January 2023

A multi-criteria decision-making system based on stakeholder evaluation is performed to investigate the nexus between research impact and sustainability performance in the agro-food sector, in Spain. This study attempts to go a step further beyond the scientific assessment of research by examining its societal contribution. The empirical application is built upon the ELECTRE III methodology. Combining Evaluation theory and Stakeholder theory, the analysis facilitates the assessment of research impact with the inclusion of stakeholders’ knowledge. Four research programmes are selected from different agro-food industries representing the case studies addressed in this study. Each stakeholder performs an evaluation of the research programmes based on indicators and sub-indicators of sustainability performance. The findings reveal ranking matrices of research impact and demonstrate its implicit contribution to the Sustainable Development Goals. This study provides insights to policy-makers and practitioners and sheds light on how research evaluation accentuates the transition to sustainable agro-food sector.
Electroacupuncture Ameliorates Depression-Like Behaviors Comorbid to Chronic Neuropathic Pain via Tet1-Mediated Restoration of Adult Neurogenesis
Authors: Li Yunyun , Liu Xiaodie , Fu Qianqian , Fan Wenxiang , Shao Xiaomei , Fang Jianqiao , Liu Jing-Gen , Xu Chi
Published: January 2023

Although electroacupuncture (EA) stimulation is a widely used therapy for chronic pain and comorbid psychiatric disorders, its long-term effects on chronic neuropathic pain-induced depression and the underlying mechanisms remain elusive. In the present study, we found that EA stimulation was able to restore adult neurogenesis in the ventral dentate gyrus (DG), by both increasing neuronal differentiation and restoring the normal morphology of newborn dendrites, in mice with spared nerve injury surgery. By ablating the Nestin+ neural stem cells (NSCs) via diphtheria toxin fragment A expression, we further proved that neurogenesis in the ventral DG was crucial to the long-term, but not the immediate antidepressant effect of EA, nor was it associated with nociception. Furthermore, we found that the restoration of neurogenesis was dependent on Tet1-mediated epigenetic modification upon EA treatment. Tet1 could bind to the promoter of the Prox1 gene, thus catalyzing its demethylation and facilitating its expression, which finally contributed to the restoration of neurogenesis and amelioration of depression-like behaviors induced by chronic neuropathic pain. Thus, we conclude that EA stimulation restores inhibited Tet1 expression in hippocampal NSCs of mice with chronic neuropathic pain, and increased Tet1 expression ameliorates hypermethylation of Prox1 and restores normal adult neurogenesis in the ventral DG, which contributes to the long-term antidepressant effect of EA.
Everything old is new again: a case series of pediatric cutaneous leishmaniasis in Portland, Maine
Authors: Jubulis Jennifer , Goddard Amanda , Seiverling Elizabeth , Kimball Marc , McCarthy Carol
Published: January 2023

Leishmaniasis has varying clinical manifestations and treatment regimens, dependent on species and host. Old world leishmaniasis, found primarily in Africa and Asia, may be associated with visceral disease, while new world disease, primarily in Latin America, may be associated with mucocutaneous disease. We present a case series of pediatric African patients with New World cutaneous leishmaniasis. Data extraction was performed via chart review, of children with cutaneous leishmaniasis presenting to the pediatric infectious diseases clinic in Portland, ME. Biopsy specimens were sent to the federal center for disease control (CDC) for identification via polymerase chain reaction (PCR) and culture. Five cases of cutaneous leishmaniasis were diagnosed in pediatric patients (ages 1–17 years) in Maine during the study period. Leishmaniasis was not initially suspected; thus, time to diagnosis was 1–4 months, Two patients were diagnosed with Leishmania panamensis, one with Leishmania brasiliensis, one with Leishmania sp. and one with mixed infection (L. panamensis and Leishmania mexicana). One patient was managed with surgical excision only, one was observed off therapy, and three were treated with ketoconazole. This case series highlights the importance of a high index of suspicion in migrant patients. Detailed travel history and epidemiologic knowledge is essential to diagnosis, as patients may present with forms of illness not congruent with their country of origin.
Characterization of a Host-Specific Toxic Activity Produced byBipolaris cookei, Causal Agent of Target Leaf Spot of Sorghum
Authors: Samira Rozalynne , Lopez Luis Fernando Samayoa , Holland James , Balint-Kurti Peter J.
Published: January 2023

Target leaf spot (TLS) of sorghum, caused by the necrotrophic fungus Bipolaris cookei, can cause severe yield loss in many parts of the world. We grew B. cookei in liquid culture and observed that the resulting culture filtrate (CF) was differentially toxic when infiltrated into the leaves of a population of 288 diverse sorghum lines. In this population, we found a significant correlation between high CF sensitivity and susceptibility to TLS. This suggests that the toxin produced in culture may play a role in the pathogenicity of B. cookei in the field. We demonstrated that the toxic activity is light sensitive and, surprisingly, insensitive to pronase, suggesting that it is not proteinaceous. We identified the two sorghum genetic loci most associated with the response to CF in this population. Screening seedlings with B. cookei CF could be a useful approach for prescreening germplasm for TLS resistance.
Permanent Compared With Absorbable Suture in Apical Prolapse Surgery
Authors: Pollack Bracha L. , Popiel Patrick , Toaff Miriam C. , Drugge Elizabeth , Bielawski Adrienne , Sacks Ashley , Bibi Moses , Friedman-Ciment Rebecca , LeBron Kira , Alishahian Leael , Phillips Dena , Rubino Sara R. , Pollack Sela , Khan Rida S. , Khan Eesha S. , Pape Dominique Malacarne , Grimes Cara L.
Published: January 2023

OBJECTIVE:

To explore how permanent compared with absorbable suture affects anatomic success in native tissue vaginal suspension (uterosacral ligament suspension and sacrospinous ligament suspension) and sacrocolpopexy with mesh.

DATA SOURCES:

MEDLINE, EMBASE, and ClinicalTrials.gov were searched through March 29, 2022.

METHODS OF STUDY SELECTION:

Our population included women undergoing apical prolapse surgery (uterosacral ligament suspension and sacrospinous ligament suspension and abdominal sacrocolpopexy). Our intervention was permanent suture for apical prolapse surgery, and our comparator was absorbable suture. We determined a single anatomic success proportion per study. Adverse events collected included suture and mesh exposure, surgery for suture and mesh complication, dyspareunia, and granulation tissue. Abstracts were doubly screened, full-text articles were doubly screened, and accepted articles were doubly extracted. Quality of studies was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. In single-arm studies using either permanent or absorbable suture, random effects meta-analyses of pooled proportions were used to assess anatomic success. In comparative studies investigating both suture types, random effects meta-analyses of pooled risk ratios were used.

TABULATION, INTEGRATION, AND RESULTS:

Of 4,658 abstracts screened, 398 full-text articles were assessed and 63 studies were included (24 vaginal suspension [13 uterosacral ligament suspension and 11 sacrospinous ligament suspension] and 39 sacrocolpopexy). At 2-year follow-up, there was no difference in permanent compared with absorbable suture in uterosacral ligament suspension and sacrospinous ligament suspension (proportional anatomic success rate 88% [95% CI 0.81–0.93] vs 88% [95% CI 0.82–0.92]). Similarly, at 18-month follow-up, there was no difference in permanent compared with absorbable suture in sacrocolpopexy (proportional anatomic success rate 92% [95% CI 0.88–0.95] vs 96% [95% CI 0.92–0.99]). On meta-analysis, there was no difference in relative risk (RR) of success for permanent compared with absorbable suture for uterosacral ligament suspension and sacrospinous ligament suspension (RR 1.11, 95% CI 0.93–1.33) or sacrocolpopexy (RR 1.00, 95% CI0.98–1.03).

CONCLUSION:

Success rates were similarly high for absorbable and permanent suture after uterosacral ligament suspension, sacrospinous ligament suspension, and sacrocolpopexy, with medium-term follow-up.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42021265848.
Maximum Dose Rate of Intrapartum Oxytocin Infusion and Associated Obstetric and Perinatal Outcomes
Authors: Son Moeun , Roy Archana , Grobman William A. , Miller Emily S. , Dude Annie , Peaceman Alan M. , Stetson Bethany
Published: January 2023

OBJECTIVE:

Despite lack of evidence for a safety threshold for oxytocin dose rate, many hospital protocols specify a maximum rate. We investigated whether exceeding 20 milliunits/min of oxytocin was associated with adverse outcomes.

METHODS:

This is a secondary analysis of a double-blind, single-center, randomized controlled trial of nulliparous patients with singleton gestations at 36 weeks of gestation or later who presented in spontaneous labor randomized 1:1 to either a high-dose oxytocin titration regimen (initial-incremental rate of 6 milliunits/min) or standard-dose titration regimen (initial-incremental rate of 2 milliunits/min) for labor augmentation. A maximum oxytocin dose rate limit was not specified in the study protocol. For this secondary analysis, outcomes of participants who received oxytocin and exceeded a dose rate of 20 milliunits/min at any point in labor were compared with those whose rate remained at 20 milliunits/min or less. In addition, the cumulative proportions of labor and birth outcomes were calculated for each maximum dose rate of oxytocin reached among this study cohort.

RESULTS:

Of the 1,003 participants in the parent trial, 955 (95.2%) received oxytocin, as planned, and were included, with 190 (19.9%) exceeding a maximum dose rate of 20 milliunits/min. Those who exceeded 20 milliunits/min were older and were more likely to have rupture of membranes as their trial entry indication, have hypertensive disorders of pregnancy, receive intrapartum magnesium sulfate infusion, and receive oxytocin for longer. Those whose maximum rates exceeded 20 milliunits/min underwent cesarean delivery more frequently, but the majority (74%) still delivered vaginally. In multivariable analyses, there were no significant associations between maximum oxytocin dose rates greater than 20 milliunits/min and cesarean delivery (adjusted odds ratio [aOR] 1.57, 95% CI 1.00–2.46), peripartum infection (aOR 0.69, 95% CI 0.41–1.19), postpartum hemorrhage (aOR 1.37, 95% CI 0.70–2.71), or neonatal intensive care unit (NICU) admission (aOR 1.72, 95% CI 0.89–3.31). Although 85% of spontaneous vaginal deliveries occurred at maximum oxytocin dose rates of 20 milliunits/min or less, vaginal deliveries continued to occur at higher maximum dose rates. The cumulative proportions of NICU admissions and composite severe neonatal morbidity and mortality cases increased with increasing oxytocin dose rates even with maximum oxytocin dose rates at 20 milliunits/min or less.

CONCLUSION:

In multivariable analyses, there are no significant differences in maternal or perinatal adverse outcomes based on exceeding 20 milliunits/min of oxytocin. These data suggest that oxytocin dosing should be individualized to each patient and not be based on arbitrary thresholds.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02487797.
Nurse Leader Perceptions of Data in the Veterans Health Administration
Authors: Wong Janine J. , SoRelle Richard P. , Yang Christine , Knox Melissa K. , Hysong Sylvia J. , Dorsey Lynette E. , O'Mahen Patrick N. , Petersen Laura A.
Published: January 2023

Healthcare systems and nursing leaders aim to make evidence-based nurse staffing decisions. Understanding how nurses use and perceive available data to support safe staffing can strengthen learning healthcare systems and support evidence-based practice, particularly given emerging data availability and specific nursing challenges in data usability. However, current literature offers sparse insight into the nature of data use and challenges in the inpatient nurse staffing management context. We aimed to investigate how nurse leaders experience using data to guide their inpatient staffing management decisions in the Veterans Health Administration, the largest integrated healthcare system in the United States. We conducted semistructured interviews with 27 Veterans Health Administration nurse leaders across five management levels, using a constant comparative approach for analysis. Participants primarily reported using data for quality improvement, organizational learning, and organizational monitoring and support. Challenges included data fragmentation, unavailability and unsuitability to user need, lack of knowledge about available data, and untimely reporting. Our findings suggest that prioritizing end-user experience and needs is necessary to better govern evidence-based data tools for improving nursing care. Continuous nurse leader involvement in data governance is integral to ensuring high-quality data for end-user nurses to guide their decisions impacting patient care.
Budesonide as first-line treatment in patients with autoimmune hepatitis seems inferior to standard predniso(lo)ne administration
Authors: Díaz-González Álvaro , Hernández-Guerra Manuel , Pérez-Medrano Indhira , Sapena Víctor , Riveiro-Barciela Mar , Barreira-Díaz Ana , Gómez Elena , Morillas Rosa M , Del Barrio María , Escudé Laia , Mateos Beatriz , Horta Diana , Gómez Judith , Conde Isabel , Ferre-Aracil Carlos , El Hajra Ismael , Arencibía Ana , Zamora Javier , Fernández Ainhoa , Salcedo Magdalena , Molina Esther , Soria Anna , Estévez Pamela , López Carmen , Álvarez-Navascúes Carmen , García-Retortillo Montserrat , Crespo Javier , Londoño María-Carlota ,   ColHai Registry
Published: January 2023

Background and Aims:

In patients with non-severe acute or chronic autoimmune hepatitis (AIH) without cirrhosis, clinical practice guidelines recommend indistinct use of prednisone or budesonide. However, budesonide is infrequently used in clinical practice. We aimed to describe its use and compare its efficacy and safety with prednisone as first-line options.

Approach and Results:

This was a retrospective, multicenter study of 105 naive AIH patients treated with budesonide as the first-line drug. The control group included 276 patients treated with prednisone. Efficacy was assessed using logistic regression and validated using inverse probability of treatment weighting propensity score. The median time to biochemical response (BR) was 3.1 months in patients treated with budesonide and 4.9 months in those with prednisone. The BR rate was significantly higher in patients treated with prednisone (87% vs. 49% of patients with budesonide, p < 0.001). The probability of achieving BR, assessed using the inverse probability of treatment weighting propensity score, was significantly lower in the budesonide group (OR = 0.20; 95% CI: 0.11–0.38) at any time during follow-up, and at 6 (OR = 0.51; 95% CI: 0.29–0.89) and 12 months after starting treatment (0.41; 95% CI: 0.23–0.73). In patients with transaminases <2 × upper limit of normal, BR was similar in both treatment groups. Prednisone treatment was significantly associated with a higher risk of adverse events (24.2% vs. 15.9%, p = 0.047).

Conclusions:

In the real-life setting, the use of budesonide as first-line treatment is low, and it is generally prescribed to patients with perceived less disease activity. Budesonide was inferior to prednisone as a first-line drug but was associated with fewer side effects.
Model to predict major complications following liver resection for HCC in patients with metabolic syndrome
Authors: Berardi Giammauro , Ratti Francesca , Sposito Carlo , Nebbia Martina , D’Souza Daniel M. , Pascual Franco , Dogeas Epameinondas , Tohme Samer , D’Amico Francesco E. , Alessandris Remo , Simonelli Ilaria , Del Basso Celeste , Russolillo Nadia , Moro Amika , Fiorentini Guido , Serenari Matteo , Rotellar Fernando , Zimmitti Giuseppe , Famularo Simone , Ivanics Tommy , Hoffman Daniel , Onkendi Edwin , Essaji Yasmin , Lopez Ben Santiago , Caula Celia , Rompianesi Gianluca , Chopra Asmita , Abu Hilal Mohammed , Torzilli Guido , Sapisochin Gonzalo , Corvera Carlos , Alseidi Adnan , Helton Scott , Troisi Roberto I. , Simo Kerri , Conrad Claudius , Cescon Matteo , Cleary Sean , Kwon Choon H.D. , Ferrero Alessandro , Ettorre Giuseppe M. , Cillo Umberto , Geller David , Cherqui Daniel , Serrano Pablo E. , Ferrone Cristina , Mazzaferro Vincenzo , Aldrighetti Luca , Kingham T. Peter
Published: January 2023

Background:

Metabolic syndrome (MS) is rapidly growing as risk factor for HCC. Liver resection for HCC in patients with MS is associated with increased postoperative risks. There are no data on factors associated with postoperative complications.

Aims:

The aim was to identify risk factors and develop and validate a model for postoperative major morbidity after liver resection for HCC in patients with MS, using a large multicentric Western cohort.

Materials and Methods:

The univariable logistic regression analysis was applied to select predictive factors for 90 days major morbidity. The model was built on the multivariable regression and presented as a nomogram. Performance was evaluated by internal validation through the bootstrap method. The predictive discrimination was assessed through the concordance index.

Results:

A total of 1087 patients were gathered from 24 centers between 2001 and 2021. Four hundred and eighty-four patients (45.2%) were obese. Most liver resections were performed using an open approach (59.1%), and 743 (68.3%) underwent minor hepatectomies. Three hundred and seventy-six patients (34.6%) developed postoperative complications, with 13.8% major morbidity and 2.9% mortality rates. Seven hundred and thirteen patients had complete data and were included in the prediction model. The model identified obesity, diabetes, ischemic heart disease, portal hypertension, open approach, major hepatectomy, and changes in the nontumoral parenchyma as risk factors for major morbidity. The model demonstrated an AUC of 72.8% (95% CI: 67.2%–78.2%) (https://childb.shinyapps.io/NomogramMajorMorbidity90days/).

Conclusions:

Patients undergoing liver resection for HCC and MS are at high risk of postoperative major complications and death. Careful patient selection, considering baseline characteristics, liver function, and type of surgery, is key to achieving optimal outcomes.
The Association Between Federally Qualified Health Centers' Medical Training Programs and Clinical Outcomes
Authors: Choi Seongwon , Davlyatov Ganisher , Cendoma Philip , Borkowski Nancy
Published: January 2023

This study examined whether an association exists between federally qualified health centers' (FQHCs') provision of medical training programs and clinical outcomes. Employing a cross-sectional data analysis of the sample FQHCs in the year 2019, the study found that FQHCs with medical training programs provided higher rates of immunization, screenings for cervical cancer, tobacco, statin use, and colorectal cancer. The FQHCs with medical training programs also reported a higher percentage of hypertensive patients properly managing blood pressure level. The results indicated that an FQHC providing medical training, as part of its organizational structure, may have a positive influence on patient outcomes.
Implementing an Electronic Root Cause Analysis Reporting System to Decrease Hospital-Acquired Pressure Injuries
Authors: Armstrong Amy Alvarez
Published: January 2023

Hospital-acquired pressure injuries (HAPIs) continue to increase in comparison to other hospital-acquired conditions, despite advancements in prevention and wound care practices. In 2017, an interprofessional skin team (IST) was formed at an academic medical center to improve patient care and reduce HAPIs. Intentional wound, ostomy, continence (WOC) nurse rounding coupled with IST efforts steadily decreased HAPIs in the organization by 39%. In an effort to continue to improve care, a root cause analysis (RCA) of HAPIs was initiated in two intensive care units (ICUs) in October 2019. Using the Plan-Do-Study-Act model, two WOC nurses and a nursing professional development specialist from the IST developed the HAPIs RCA process. Rapid cycle process improvement demonstrated the need to transition from a paper form to an electronic process to increase accessibility for all nursing units and patients to benefit. In May 2020, an electronic reporting system for RCAs for HAPIs began. After implementation, there has been a 53.5% reduction in HAPIs over 2 years. The standardized, electronic RCA process has resulted in improvement, dissemination of best practices, and fostering nonpunitive accountability for each unit's HAPIs.
Comparing satisfaction and outcomes in on-campus versus virtual education for nurse practitioner students
Authors: Kreider Kathryn Evans
Published: January 2023

This article highlights the development and implementation of interactive training experiences for graduate nursing students as part of specialty training in endocrinology. Emphasis was placed on accomplishing the shift from on-campus to virtual training while maintaining fidelity and student satisfaction. A total of 106 graduate nursing students from five cohorts submitted evaluations. Student satisfaction remained high regardless of whether the content was delivered in person or virtually. Most students in the virtual cohorts evaluated the online training positively. Student presentation grades were highest with on-campus delivery. Transitioning in-person training to a virtual environment can be an effective method of delivering nurse practitioner education while promoting student satisfaction. Recommendations for optimizing hybrid learning experiences are offered based on adult learning principles.