bluuebunny/crossref_metadata_2025 huggingface dataset:
Inertial aftermaths on peristaltic drive of MHD micropolar fluid in a two-dimensional asymmetric inclined porous soaked channel independent of wavelength: Galerkin finite element simulation
Authors: Ahmed Bilal , Anwar Fizza
Published: December 2024

This manuscript presents a detailed investigation of the peristaltic propulsion of a micropolar fluid in an inclined asymmetric channel, which is also subjected to a magnetic field applied in the normal direction. The medium is considered to be a porous, saturated environment. Unlike traditional lubrication theory, which often assumes long wavelengths and negligible Reynolds numbers, our analysis does not adhere to these constraints. This approach introduces nonlinearity into the modeled equations and allows for significant Reynolds numbers, thereby enhancing our understanding of the peristaltic phenomenon. Numerical solution of coupled partial differential equations is gained by employing a novel Galerkin built finite element method and is presented through graphs of velocity and pressure distributions in accordance with variation in several flow parameters. Streamlines’ gyration, microrotation, and vorticity for different configurations that emerged with varying phase transitions are displayed in this regard as well. It is confessed that peristaltic mixing diminishes for all values of phase differences as the permeability parameter increases, while a rising Hartmann number significantly exacerbates this effect. In addition, the microrotation of micropolar particles is observed to become increasingly distorted with higher Reynolds numbers. Furthermore, the pressure rise throughout both pumping and co-pumping regions is enhanced when the inclined channel is subjected to a greater angle of inclination.
Variational approach to atom-membrane dynamics
Authors: Clougherty Dennis P.
Published: December 2024

Using the Dirac–Frenkel variational principle, a time-dependent description of the dynamics of a two-level system coupled to a bosonic bath is formulated. The method is applied to the case of a gas of cold atoms adsorbing to an elastic membrane at a finite temperature via phonon creation. The time-dependence of the system state is analytically calculated using Laplace transform methods, and a closed-form expression for the transition rate is obtained. Atoms in the gas transition to the adsorbed state through a resonance that has contributions from a distribution of vibrational modes of the membrane. The resonance can decay with the creation of a phonon to complete the adsorption process. The adsorption rate at low membrane temperatures agrees with the golden rule estimate to the lowest order in the coupling constant for values greater than a critical coupling strength. Below this critical coupling strength, the adsorption rate is exponentially suppressed by a phonon reduction factor whose exponent diverges with increasing adsorbent size. The rate changes discontinuously with coupling strength for low temperature membranes, and the magnitude of the discontinuity decreases with increasing temperature. These variational results suggest the quantum adsorption model may contain a first-order quantum phase transition.
Nb-doping in (Mn,Fe)2(P,Ge) giant magnetocaloric materials
Authors: Li Yuliang , Ou Zhiqiang , Yibole Hargen , Li Yingjie , Jiang Ning , Gegen Bao , Xing Shouyuan , Sumen Haramtan , Tegus Ojiyed
Published: December 2024

The influence of Nb substitutions on the structure, magnetoelastic transition, and magnetocaloric properties is investigated in MnFe1−xNbxP0.76Ge0.24 (x = 0, 0.02, 0.04, 0.6) compounds. Powder XRD show that the compounds crystallize in the hexagonal Fe2P-type crystal structure (space group P6̄2 m) and contain minor amount of MnO impurity phase. At a low applied magnetic field (<1.6 T), the isothermal entropy change of the Nb-substituted MnFe0.98Nb0.02P0.76Ge0.24 sample is higher than that of the parent or more substituted samples, reaching a maximum of 14.0 J kg−1 K−1. Nb substitutions are found to efficiently reduce the thermal hysteresis in Ge-based Fe2P magnetocaloric materials; for instance, only 6 at. % of Nb for Fe substitution reduces the thermal hysteresis from 7.6 to 2.6 K while preserving giant magnetocaloric effect. Direct ΔTad measurements confirm the cyclic character of the giant magnetocaloric effect for x = 0.02.
A corollary discharge circuit in human speech
Authors: Khalilian-Gourtani Amirhossein , Wang Ran , Chen Xupeng , Yu Leyao , Dugan Patricia , Friedman Daniel , Doyle Werner , Devinsky Orrin , Wang Yao , Flinker Adeen
Published: December 2024

When we vocalize, our brain distinguishes self-generated sounds from external ones. A corollary discharge signal supports this function in animals; however, in humans, its exact origin and temporal dynamics remain unknown. We report electrocorticographic recordings in neurosurgical patients and a connectivity analysis framework based on Granger causality that reveals major neural communications. We find a reproducible source for corollary discharge across multiple speech production paradigms localized to the ventral speech motor cortex before speech articulation. The uncovered discharge predicts the degree of auditory cortex suppression during speech, its well-documented consequence. These results reveal the human corollary discharge source and timing with far-reaching implication for speech motor-control as well as auditory hallucinations in human psychosis.
Navigated range expansion promotes migratory culling
Authors: Zhang Yi , Hu Qingjuan , Su Yingtong , Chu Pan , Wei Ting , Li Xuefei , Liu Chenli , Fu Xiongfei
Published: December 2024

Motile organisms can expand into new territories and increase their fitness, while nonmotile viruses usually depend on host migration to spread across long distances. In general, faster host motility facilitates virus transmission. However, recent ecological studies have also shown that animal host migration can reduce viral prevalence by removing infected individuals from the migratory group. Here, we use a bacteria-bacteriophage copropagation system to investigate how host motility affects viral spread during range expansion. We find that phage spread during chemotaxis-driven navigated range expansion decreases as bacterial migration speed increases. Theoretical and experimental analyses show that the navigated migration leads to a spatial sorting of infected and uninfected hosts in the copropagating front of bacteria-bacteriophage, with implications for the number of cells left behind. The preferential loss of infected cells in the copropagating front inhibits viral spread. Further increase in host migration speed leads to a phase transition that eliminates the phage completely. These results illustrate that navigated range expansion of the host can promote the migratory culling of infectious diseases in the migration group.
Sculpting new visual categories into the human brain
Authors: Iordan Coraline Rinn , Ritvo Victoria J. H. , Norman Kenneth A. , Turk-Browne Nicholas B. , Cohen Jonathan D.
Published: December 2024

Learning requires changing the brain. This typically occurs through experience, study, or instruction. We report an alternate route for humans to acquire visual knowledge, through the direct sculpting of activity patterns in the human brain that mirror those expected to arise through learning. We used neurofeedback from closed-loop real-time functional MRI to create new categories of visual objects in the brain, without the participants’ explicit awareness. After neural sculpting, participants exhibited behavioral and neural biases for the learned, but not for the control categories. The ability to sculpt new perceptual distinctions into the human brain offers a noninvasive research paradigm for causal testing of the link between neural representations and behavior. As such, beyond its current application to perception, our work potentially has broad relevance for advancing understanding in other domains of cognition such as decision-making, memory, and motor control.
Motion-related image schemas in Serbian journalistic articles
Authors: Pavlović Vladan , Janić Mitić Aleksandra , Mitić Ivana
Published: December 2024

The paper explores various aspects of conceptualization based on motion-related image schemas and their
combinations. It does so based on a custom-made and self-annotated linguistic corpus belonging to the journalistic register in
Serbian, used for obtaining various descriptive and inferential statistical data interpreted qualitatively. It demonstrates that
image schemas exhibit a marked clustering tendency and that they appear to interact with one another and with the categorical
variables (newspaper, topic) in non-trivial ways. It reinterprets scale as a higher order principle (rather than an image
schema per se) specifying the intensity with which other schemas occur. This, in turn, has enabled formalization of intensities of
individual image schemas participating in the established image schema complexes, with important consequences for further
research, including the exploration of the dynamic nature of schema interaction and meaning construction not only in language but
also other semiotic domains.
Anisotropic quark stars in
gravity*
Authors: Tangphati Takol , Sakallı İzzet , Banerjee Ayan , Pradhan Anirudh
Published: December 2024

We investigated the impact of

gravity on the internal structure of compact stars, expecting this theory to manifest prominently in the high-density cores of such stars. We considered the algebraic function

, where α represents the matter-geometry coupling constant. We specifically chose the matter Lagrangian density

to explore compact stars with anisotropic pressure. To this end, we employed the MIT bag model as an equation of state. Subsequently, we numerically solved the hydrostatic equilibrium equations to obtain mass-radius relations for quark stars (QSs), examining static stability criteria, adiabatic index, and speed of sound. Finally, we used recent astrophysical data to constrain the coupling parameter α, which may lead to either larger or smaller masses for QSs, compared to their counterparts in general relativity.
Sympathetic Solar Eruption on 2024 February 9
Authors: Li Shu-Yue , Zhang Qing-Min , Ying Bei-Li , Feng Li , Su Ying-Na , Lin Mu-Sheng , Zhang Yan-Jie
Published: December 2024

In this paper, we perform a follow-up investigation of the solar eruption originating from active region 13575 on 2024 February 9. The primary eruption of a hot channel generates an X3.4 class flare, a full-halo coronal mass ejection (CME), and an extreme-ultraviolet (EUV) wave. Interaction between the wave and a quiescent prominence (QP) leads to a large-amplitude, transverse oscillation of QP. After the transverse oscillation, QP loses equilibrium and rises up. The ascending motion of the prominence is coherently detected and tracked up to  ∼1.68 R
⊙ by the Solar UltraViolet Imager onboard the GOES-16 spacecraft and up to  ∼2.2 R
⊙ by the Solar Corona Imager (SCI_UV) of the Lyα Solar Telescope onboard the ASO-S spacecraft. The velocity increases linearly from 12.3 to 68.5 km s−1 at 18:30 UT. The sympathetic eruption of QP drives the second CME with a typical three-part structure. The bright core comes from the eruptive prominence, which could be further observed up to  ∼3.3 R
⊙ by the Large Angle Spectroscopic Coronagraph onboard the Solar and Heliospheric Observatory mission. The leading edge of the second CME accelerates continuously from  ∼120 to  ∼277 km s−1. The EUV wave plays an important role in linking the primary eruption with the sympathetic eruption.
Nanoarchitectonics in immobilization of DNT/TNT specific binding peptides on laser-induced graphene
Authors: Kol Seda , Kocaman Kabil Fatmanur , Aydemir Nihan , Oral Ahmet Yavuz
Published: December 2024

Bio/chemical sensors require high selectivity for specific targets. Carbon nanomaterials, especially graphene-based materials, are preferred in sensors due to their high surface area, superior electrical conductivity, mechanical strength, and flexibility. In this study, DNT-bp (Dinitrotoluene binding peptide) and TNT-bp (Trinitrotoluene binding peptide) were immobilized on LIG (Laser-induced graphene) films through covalent and non-covalent interactions. EDC (1-ethyl-3-3-dimethylaminopropyl carbodiimide hydrochloride) is used to activate carboxylic acid groups, which then react with NHS (N-hydroxysuccinimide) to form NHS esters, facilitating the binding of amine-containing peptides to the LIG surface. XPS analysis of LIG films functionalized with EDC+NHS shows a decrease in COOH (carboxyl) and an increase in C–N/C=N/C–O groups. N1s peak at high-resolution XPS spectrum indicates that DNT-bp immobilization leads to higher elimination of NHS-esters, resulting in fewer N-C=O (amide) functional groups and more protonated nitrogen, which suggests that DNT-bp immobilization is more effective than TNT-bp immobilization. The findings suggest that LIG-based sensors provide a cost-effective platform for the detection of DNT (2,4-dinitrotoluene) and 2,4,6-trinitrotoluene (TNT). Further advancements in LIG-based biosensors may enable their broader application in security, environmental monitoring, and health diagnostics.
Electrical diagnostics of dielectric barrier discharge for optimal power determination
Authors: Singh Akhilesh Kumar , Guragain Rajesh Prakash , Shrestha Asmita , Chhetri Ganesh Kuwar , Dhungana Santosh , Baniya Hom Bahadur , Subedi Deepak Prasad , Joshi Ujjwal Man
Published: December 2024

This study presents a comprehensive theoretical and experimental analysis to determine the optimum power for a Cold Atmospheric Pressure Plasma (CAPP) system using a Dielectric Barrier Discharge (DBD) reactor. The investigation reveals that maximum power is consumed at a specific discharge gap within the DBD reactor. Power was computed across varying discharge widths, ranging from 1.0 mm to 5.0 mm, for a fixed input sinusoidal voltage with a frequency of 50 Hz. Additionally, power was calculated for different input voltages at a constant discharge width. The power consumption of the reactor was determined using the Lissajous figure method and voltage-current characteristics. Both experimental and theoretical studies identified that a discharge width of 3.0 mm is optimal for minimizing power consumption in the reactor. The theoretical predictions, based on an electrical circuit model, aligned well with experimental findings using Lissajous figures and current–voltage measurements. Moreover, the study examined the variation in the number of discharge filaments per cycle at different input voltages and discharge widths, demonstrating that an increase in discharge width results in a linear decrease in the number of filaments, while higher input voltage increases filament density. These findings highlight the importance of optimizing both discharge width and input voltage to achieve efficient power usage in plasma systems. This research contributes to the development of energy-efficient plasma technologies by providing critical insights into the power optimization of CAPP in DBD reactors, with potential applications in various industrial and agricultural processes.
Transport signatures of phase fluctuations in superconducting qubits
Authors: Wisne M , Deng Y , Cansizoglu H , Kopas C , Mutus J Y , Chandrasekhar V
Published: December 2024

Josephson junctions supply the nonlinear inductance element in superconducting qubits. In the widely used transmon configuration, where the junction is shunted by a large capacitor, the low charging energy minimizes the sensitivity of the qubit to charge noise while maintaining the necessary anharmonicity to qubit states. We report here low-frequency transport measurements on small standalone junctions and identically fabricated capacitively-shunted junctions that show two distinct features normally attributed to small capacitance junctions near zero bias: reduced switching currents and prominent finite resistance associated with phase diffusion in the current–voltage characteristic. Our transport data reveals the existence of phase fluctuations in transmons arising from intrinsic junction capacitance.
On the sign changes of 𝜓(𝑥)-𝑥
Authors: Grześkowiak Maciej , Kaczorowski Jerzy , Pańkowski Łukasz , Radziejewski Maciej
Published: December 2024

We improve the lower bound for

V
(
T
)

V(T)

, the number of sign changes of the error term

ψ
(
x
)
−
x

\psi (x)-x

in the Prime Number Theorem in the interval

[
1
,
T
]

[1,T]

for large

T
T

. We show that
\[

lim inf

T
→
∞

V
(
T
)

log
⁡
T

≥

γ

0

π

+

1
60

,

\liminf _{T\to \infty }\frac {V(T)}{\log T}\geq \frac {\gamma _{0}}{\pi }+\frac {1}{60},

\]
where

γ

0

=
14.13
…

\gamma _{0}=14.13\ldots

is the imaginary part of the lowest-lying non-trivial zero of the Riemann zeta-function. The result is based on a new density estimate for zeros of the associated

k
k

-function, over

4
⋅

10

21

4\cdot 10^{21}

times better than previously known estimates of this type.
The lowest discriminant ideal of a Cayley–Hamilton Hopf algebra
Authors: Mi Zhongkai , Wu Quanshui , Yakimov Milen
Published: December 2024

Discriminant ideals of noncommutative algebras

A
A

, which are module finite over a central subalgebra

C
C

, are key invariants that carry important information about

A
A

, such as the sum of the squares of the dimensions of its irreducible modules with a given central character. There has been substantial research on the computation of discriminants, but very little is known about the computation of discriminant ideals. In this paper we carry out a detailed investigation of the lowest discriminant ideals of Cayley–Hamilton Hopf algebras in the sense of De Concini, Reshetikhin, Rosso and Procesi, whose identity fiber algebras are basic. The lowest discriminant ideals are the most complicated ones, because they capture the most degenerate behaviour of the fibers in the exact opposite spectrum of the picture from the Azumaya locus. We provide a description of the zero sets of the lowest discriminant ideals of Cayley–Hamilton Hopf algebras in terms of maximally stable modules of Hopf algebras, irreducible modules that are stable under tensoring with the maximal possible number of irreducible modules with trivial central character. In important situations, this is shown to be governed by the actions of the winding automorphism groups. The results are illustrated with applications to the group algebras of central extensions of abelian groups, big quantum Borel subalgebras at roots of unity and quantum coordinate rings at roots of unity.
Lasers, Light, and Energy-Based Devices in Plastic Surgery: A 3-Year Review of a Resident Cosmetic Clinic Experience
Authors: Nadarajan Vidhya , Thota Bhavana , Dogaroiu Anca , Kim Lauren , Niksic Amor , Barillas Jennifer , Hoopman John , Amirlak Bardia , Kenkel Jeffrey M
Published: December 2024

Background

The increasing utilization of laser and light-based technologies in plastic surgery has heightened the need for comprehensive training programs within residency programs, allowing trainees to remain competitive in the cosmetic medicine field.

Objectives

This review intends to describe our trainees’ experience with lasers in their last 2 years of training while participating in their resident cosmetic clinic.

Methods

This retrospective chart review examines laser procedures conducted from 2021 to 2023 within the Resident Cosmetic Clinic at the study institution. Data were gathered from internal records and patient charts, focusing on demographics, procedure types, complication rates, and training structures.

Results

This study analyzed 162 resident cosmetic laser, light-based device, and radiofrequency cases between 2021 and 2023. There were 90 patients with an average age of 46.8 years with the majority being females (95.6%). Intense pulsed light was the most frequently used modality used in 46.01% of procedures. The overall complication rate was 6.17%.

Conclusions

The findings suggest that resident laser clinics, under proper supervision, provide a safe and effective training ground for future plastic surgeons. This study underscores the need for standardized and comprehensive education to enhance resident knowledge and skills in laser and other energy-based devices.

Level of Evidence: 3 (Therapeutic)
Partially factorized variational inference for high-dimensional mixed models
Authors: Goplerud M , Papaspiliopoulos O , Zanella G
Published: December 2024

While generalized linear mixed models are a fundamental tool in applied statistics, many specifications, such as those involving categorical factors with many levels or interaction terms, can be computationally challenging to estimate due to the need to compute or approximate high-dimensional integrals. Variational inference is a popular way to perform such computations, especially in the Bayesian context. However, naive use of such methods can provide unreliable uncertainty quantification. We show that this is indeed the case for mixed models, proving that standard mean-field variational inference dramatically underestimates posterior uncertainty in high-dimensions. We then show how appropriately relaxing the mean-field assumption leads to methods whose uncertainty quantification does not deteriorate in high-dimensions, and whose total computational cost scales linearly with the number of parameters and observations. Our theoretical and numerical results focus on mixed models with Gaussian or binomial likelihoods, and rely on connections to random graph theory to obtain sharp high-dimensional asymptotic analysis. We also provide generic results, which are of independent interest, relating the accuracy of variational inference to the convergence rate of the corresponding coordinate ascent algorithm that is used to find it. Our proposed methodology is implemented in the R package vglmer. Numerical results with simulated and real data examples illustrate the favourable computation cost versus accuracy trade-off of our approach compared to various alternatives.
Association Between Serum Ustekinumab Concentrations and Endoscopic Disease Activity in Moderate-to-Severe Crohn’s Disease Patients
Authors: Di Fonzo David M P , Alabdulkarim Balqis , Yanofsky Russell , Abduallah Yaqeen , Golovics Petra , Lakatos Peter L , Bitton Alain , Wild Gary , Afif Waqqas , Bessissow Talat
Published: December 2024

Background/Aims

The role of ustekinumab therapeutic drug monitoring in patients with Crohn’s disease (CD) remains ambiguous. Examination of the association serum ustekinumab concentrations and endoscopic outcomes has yielded inconsistent results. Our study examined whether serum ustekinumab concentrations were associated with endoscopic healing in patients with moderate-to-severe CD.

Methods

This was a cross-sectional study of adult patients with CD on maintenance ustekinumab. Patients were included if they had serum ustekinumab concentrations and endoscopic evaluation taken within 4 months of each other. Endoscopic healing was defined as absence of ulceration on endoscopy or Simplified Endoscopic Score for Crohn’s disease (SES-CD) < 3. Quartile analysis of drug levels was performed, and receiver operating characteristic curve was calculated. Multivariate logistic regression assessed for the probability of endoscopic healing based on serum ustekinumab concentration.

Results

Seventy-four patients were included in the final analysis. The mean serum ustekinumab concentration of the population was 6.10 mcg/mL. Serum ustekinumab concentration did not predict endoscopic remission based on either the absence of ulceration or SES-CD < 3. There was no difference in the frequency of ulceration at increasing serum ustekinumab concentrations. There was no threshold serum ustekinumab concentration associated with the absence of ulceration (area under the curve [AUC] = 0.50) or SES-CD < 3 (AUC = 0.49).

Conclusions

Our study found no association between serum ustekinumab concentrations and endoscopic remission in patients with CD. Exploration of mechanisms accounting for this lack of association is warranted.
Insidious pericardial journey of an orthodontic metallic retainer wire
Authors: Grandmougin Daniel , Dan Pan , Ferraro Francesco , Maureira Juan-Pablo
Published: December 2024

Ingestion of foreign bodies may be a frequent cause of painful dysphagia. We report the case of a metallic wire impacted in the oesophagus with potentially devastating consequences.
Glucagon-like peptide-1 receptor agonists for the treatment of obstructive sleep apnea: a meta-analysis
Authors: Li Mingxia , Lin Hong , Yang Qianru , Zhang Xiaolong , Zhou Qiong , Shi Jiankuan , Ge Fangfang
Published: December 2024

Study Objectives

Obstructive sleep apnea (OSA) is characterized by disordered breathing during sleep and is associated with major cardiovascular complications. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) as an important treatment for obesity and diabetes mellitus show promising therapeutic prospects in OSA. We conducted a meta-analysis to evaluate the effect of GLP-1RA intervention in OSA individuals.

Methods

We searched the PubMed and Web of Science databases (published until July 1, 2024). The included studies evaluated the GLP-1RA in OSA individuals and the efficacy outcomes measured by the apnea-hypopnea index (AHI).

Results

Six studies with a total of 1067 participants enrolled. GLP-1RA significantly decreased AHI with an estimated treatment difference of −9.48 events per hour (95% confidence interval [CI] =  −12.56 to − 6.40, I2 = 92%). The change in weight was −10.99 kg and body mass index (BMI) was –1.60 kg/m2. The mean difference in systolic blood pressure was –4.81 mmHg and in diastolic blood pressure was –0.32 mmHg. Tirzepatide significantly reduced AHI more than liraglutide with an estimated treatment difference of –21.86 events per hour (95% CI = –25.93 to –17.79) vs –5.10 events per hour (95% CI = –6.95 to –3.26). Obese individuals experienced a more significant decrease in AHI with an estimated treatment difference of –12.93 events per hour vs –4.31 events per hour. The application of continuous positive airway pressure and the duration of follow-up did not affect the therapeutic effect.

Conclusions

GLP-1RA could significantly reduce the severity of OSA, and also lead to weight loss and lower blood pressure. Further high-quality randomized controlled trials (RCTs) are needed to explore different GLP-1RA treatments and durations in OSA and identify participant subgroups that may benefit the most.

Clinical Trial

NA.
Cover crops are unlikely to pose a risk to the management of Neopestalotiopsis sp. of strawberry in Florida
Authors: Marin Marcus Vinicius , Zuniga Pinto Adrian Israel , Baggio Juliana , Peres Natalia
Published: December 2024

An aggressive Neopestalotiopsis sp. has emerged causing leaf spot and fruit rot on strawberry. In Florida strawberry production, cover crops (CCs) are grown in the summer to maintain and enhance soil structure and properties. Although CCs can be used in integrated disease management programs, they could also serve as hosts and increase inoculum levels. Since Pestalotiopsis-like fungi are known for their endophytic ability and wide host range, we sought to determine the effect of CCs commonly used over the summer in Florida on Neopestalotiopsis sp. inoculum. Pathogenicity was tested on sunn hemp, iron clay cowpea, sorghum sudan, oats, sunflower, and ryegrass. Moreover, trials in strawberry fields with histories of disease outbreaks, were conducted using iron clay cowpea, sorghum sudan, and sunn hemp as CCs plus a fallow control. Plants were evaluated for presence of symptoms in the field or following incubation in the laboratory. Soil samples were collected from each treatment and processed using a semiselective medium. Strawberry isolates were pathogenic to all the inoculated CCs, but symptoms were subtle and did not progress over time. Symptoms were not observed on the CCs under field conditions. Neopestalotiopsis sp. was successfully isolated from a single sorghum plant at one trial site, a single clay pea plant at another site, and a single sunflower plant at a third trial site. This suggests that the risk might be more closely associated with the decomposition of strawberry plant material rather than the infection of alternate hosts. Colony-forming units per g soil varied from 0 to 125, and differences were not consistent among trials. Our data suggest that the CCs tested do not pose a risk of increasing pathogen levels on strawberry fields and should still be used to protect and enhance organic matter in the soil.
Evidence-Based Clinical Utility of Heart Rate Variability Across Populations, Including Long COVID
Authors: Steere Karin
Published: December 2024

Purpose:

Heart rate variability (HRV) has been used for decades as a tool for measuring systemic health through the autonomic nervous system (ANS). The purpose of this paper was to examine the literature on HRV and to investigate its use in the long COVID (LC) population.

Summary of Key Points:

Measurement devices vary significantly in their validity and reliability when compared with the gold standard of electrocardiogram (ECG). Wrist and hand devices typically demonstrate diminished validity for capturing HRV signal, while chest strap devices often exhibit high reliability and validity. Lack of transparency in third-party software used to clean and analyze HRV data makes assessment for accuracy problematic. This is of particular concern when single beat miscalculations can result in significantly dissimilar output. The conditions under which HRV data are collected, such as natural or paced breathing, activity intensity, and patient position, can dramatically affect HRV readings. While some individual HRV metrics have consistently been shown to reflect certain components of the ANS, such as high-frequency power as a measure of parasympathetic function, the meaning of other metrics is less clear.

Recommendations for Clinical Practice:

Heart rate variability can be an extraordinarily valuable tool to measure systemic function. However, it is recommended that clinicians be judicious in the interpretation of HRV, considering inconsistencies in presentation. This is particularly true in LC, where individual HRV varies greatly. In all populations, clinicians should consider using valid devices to assess trends in HRV values over time, along with consideration of unique physical conditions.
Suprachoroidal Space in Rhegmatogenous Retinal Detachment Assessed with Optical Coherence Tomography: Implications for Potential Future Therapeutic Interventions
Authors: Jung Katherine L. , Pecaku Aurora , Demian Sueellen , Pimentel Miguel Cruz , Melo Isabela Martins , Muni Rajeev H.
Published: December 2024

Purpose:

To comprehensively investigate the suprachoroidal space (SCS) in the context of rhegmatogenous retinal detachment (RRD) using swept-source optical coherence tomography (SS-OCT).

Methods:

We conducted a post hoc analysis of 90 consecutive patients with a primary RRD. Baseline SS-OCT scans were graded for the presence and thickness of the suprachoroidal space. Available scans of the fellow eye were graded for comparison.

Results:

The suprachoroidal space was visible in 31.6% (24/76) of gradable RRD scans, with a mean thickest location measuring 67.0µm (SD 25.9), mean thinnest location of 33.8µm (SD 11.1), and mean average thickness of 50.0µm (SD 16.8). Additionally, the SCS was detectable in 28.3% (13/46) of available fellow eye scans, with a mean thickest location measuring 47.0µm (SD 41.7), thinnest location of 25.2µm (SD 27.6) and mean average thickness of 35.8µm (SD 31.4). A statistically significant difference was found between RRD and fellow eyes in all measurements of SCS thickness.

Conclusion:

In RRD, the suprachoroidal space serves as a crucial fluid reservoir influenced by dynamic shifts in intraocular hydrostatic and oncotic pressures. We found significant SCS engorgement in RRD eyes compared to fellow eyes, which may facilitate intra-SCS therapies such as suprachoroidal viscopexy (SCVEXY) or other pharmacologic interventions.
Adrenal Cortical Carcinoma Presenting as CSCR
Authors: Gohari A. Reza , Modjtahedi Sara P. , Telander Caleb R. , Kong MaxX.
Published: December 2024

Purpose:

We describe a case of bilateral chronic central serous chorioretinopathy (CSCR) secondary to adrenal cortical carcinoma.

Methods:

Case report of a 70-year-old Hispanic man presenting with bilateral multifocal CSCR.

Results:

Clinical findings of bilateral chronic CSCR along with 160 µm of subretinal fluid (SRF) and choroidal thickness greater than 400 µm without enhanced depth optical coherence tomography was noted in a patient presenting with distortion in vision in both eyes and weight gain of 15 pounds, weakness, and fatigue starting 8 months prior. Further endocrine testing showed an elevated 24-hour urinary free cortisol level of 137 µg with no change in serum cortisol levels following low-dose dexamethasone suppression test and undetectable serum adrenocorticotropic hormone (ACTH) levels consistent with ACTH-independent Cushing’s syndrome. Imaging of the abdomen revealed heterogeneously enhancing masses, and biopsy of the adrenal tumor led to the diagnosis of adrenal cortical carcinoma. He died 3 weeks after starting hospice care, and only completed one round of chemotherapy.

Conclusion:

Adrenal tumors including adrenal cortical carcinoma may present as bilateral chronic central serous chorioretinopathy.
Differentiating Depressive Symptoms From Side Effects in Individuals With Major Depressive Disorder With Postpartum Onset
Authors: Pulido Christine M. , Walson Ifeanyi S. , Yang Amy , Stika Catherine S. , Sit Dorothy K. , Wisner Katherine L.
Published: December 2024

Purpose

Somatic symptoms are commonly seen in major depressive disorder (MDD) with postpartum onset and can be similar to side effects of antidepressant medications. The aim of this study is to determine whether the decline in depressive symptoms measured by the Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement (SIGH-ADS) is significantly associated with the decrease in somatic symptoms identified by the Asberg scale.

Methods

A secondary analysis of data from a randomized controlled trial was conducted. The original 8-week trial included 62 participants and assessed the efficacy of sertraline versus estradiol transdermal patches and their respective placebos for MDD with postpartum onset. The SIGH-ADS scale was used to assess depression severity and the Asberg scale was used to evaluate treatment emergent side effects, defined as an increase of ≥2 from baseline measures. Correlation analyses were performed between total scale scores. The scales were compared to establish symptoms, which overlapped across scales versus symptoms, which were unique to each scale.

Results

Positive correlations were observed between the SIGH-ADS and Asberg scales and across the 8-week trial in all 3 treatment groups (correlation coefficient range 0.468–0.712). Headache was the most frequent treatment emergent side effect (10 occurrences). Fourteen symptoms were found to overlap between the 2 scales.

Conclusions

These findings underscore the importance of reviewing somatic symptoms before administering medication to discern true treatment emergent side effects, especially in populations recovering from labor and delivery. Somatic symptoms decline in parallel with depressive symptom scores during treatment, suggesting they are indicative of underlying illness rather than side effects.
Effect of Self-efficacy, Disease Perception, Social Support, Anxiety, and Depression on Self-management in Young Patients With Stroke
Authors: Zhang Rongfang , Li Xiaojing , Luo Huanli , Niu Jiangtao , Zhang Huimin
Published: December 2024

BACKGROUND: Better self-management of chronic diseases may benefit patient functional status, medication effectiveness, lifestyle, and psychosocial health. Self-efficacy, disease perception, social support, anxiety, and depression are determinants of self-management behaviors in individuals with chronic illnesses. There remains a gap in the empirical exploration of the influence of these factors on self-management behaviors in young Chinese stroke survivors. This study examined how these factors affect specific self-management behaviors. METHODS: Validated instruments were used to evaluate patient self-efficacy, disease perception, social support, anxiety, and depression in a cross-sectional study. Structural equation modeling was used to examine the hypothesis. RESULTS: Self-efficacy and social support showed a positive correlation with self-management (0.421 and 0.446, respectively; P < .001). Disease perception, anxiety, and depression were negatively correlated with self-management (−0.158 and −0.336, respectively; P < .05). The structural equation model fit the data very well; social support had a direct positive effect on self-management (t = 3.002, P < .05) and self-efficacy (t = 5.773, P < .001). However, the presence of social support had a positive impact on reducing anxiety and depression (t = −5.046, P < .001). Furthermore, self-efficacy positively affected self-management (t = 1.226, P < .05), whereas anxiety and depression (t = −1.190, P < .05) and disease perception (t = −1.068, P < .05) had adverse effects on self-management. CONCLUSION: Medical staff and caregivers can improve patient self-management by helping them recognize the disease, reducing negative perceptions, communicating more for better understanding and care, intervening in anxiety and depression, and promoting mental health. This is especially important for young stroke patients.
Optimizing nurse practitioner productivity within the Veterans Health Administration
Authors: Peacock Michelle , Rybacki Diane , Dixon Brooke , Haslam Aaron , Wirtz Rugen Kathryn , Jensen Penny Kaye , Colandrea Maria
Published: December 2024

Background:

Nurse practitioners (NPs) provide high-quality, comprehensive health care at Veterans Health Administration (VHA) medical centers in various practice settings. Accurately determining the productivity of NPs is essential to understanding their overall contribution to veteran care. There is a lack of understanding of the contributors to the variability among VHA medical centers regarding their processes for capturing these data. Using benchmark data from the VHA Support Service Center Capital Assets application, this quality improvement (QI) initiative implemented a series of plan-do-study-act (PDSA) cycles to determine whether increased education regarding billing and coding, along with person classification and labor mapping accuracy, could increase NP productivity.

Local problem:

The problem identified through an analysis of NP productivity revealed variability across multiple VHA facilities.

Methods:

The PDSA method was employed in this QI project. The QI team compared the total workload relative value units (wRVU) for NPs in each participating facility pre and post a three-phase intervention.

Interventions:

Nurse practitioners' person classification and labor mapping accuracy was evaluated at each site. An educational program regarding billing and coding was developed and delivered to the NP frontline staff. The QI team compared the total wRVUs for the NPs at each facility pre- and postintervention.

Results:

An increase in the wRVUs was observed following the intervention across six facilities. Five of the seven facilities displayed stability in relative value unit improvement postintervention.

Conclusion:

Educating frontline NPs on billing, coding, person classification, and labor mapping can improve NP productivity.
Risk factors for early liver recurrence after pancreatic cancer resection
Authors: Shirai Yoshihiro , Kimura Nana , Tanaka Haruyoshi , Fukasawa Mina , Muranushi Ryo , Watanabe Toru , Hirano Katsuhisa , Shibuya Kazuto , Yoshioka Isaku , Fujii Tsutomu
Published: December 2024

Background

Liver recurrence after resection is one of the most common types of recurrence and is a risk factor for poor prognosis. The aim of this study was to identify risk factors for initial liver recurrence.

Methods

Total of 109 patients with resectable pancreatic ductal adenocarcinoma who underwent resection between 2015 and 2022 were included. The influence of clinicopathologic variables on liver recurrence was analyzed to create a novel scoring system to predict liver recurrence.

Results

The liver recurrence rate was 24%, with 17% recurrence within one year. Patients with liver recurrence had an extremely poor prognosis within 1 year [MST 12.4 (95% CI 5.7-19.1)]. In multivariate analysis, R-PV, large tumor diameter ≥ 45 mm and venous invasion were independent risk factors for early liver recurrence. When each of these risk factors was scored as 1 point, the 1-year liver recurrence rates by score were 0 (0%), 1 (9%), 2 (30%), and 3 (84%).

Conclusion

The risk factors for postoperative early liver recurrence were R-PV, a tumor diameter ≥ 45 mm and pathological venous invasion. Surgery for pancreatic cancer with these factors may require special treatment, such as hepatic arterial injection.
Circulating biomarkers of macrophage activation in different stages of chronic pancreatitis: A pilot study
Authors: Hagn-Meincke Rasmus , Novovic Srdan , Hadi Amer , Jensen Annette B. , Drewes Asbjørn M. , Kraup Henrik , Frøkjær Jens B. , Park Walter G. , Jørgensen Peter L. , Møller Holger Jon , Deleuran Bent W. , Olesen Søren S.
Published: December 2024

Objectives

Activation of type M2 macrophages has been implicated in the pathogenesis of chronic pancreatitis (CP). In a clinical pilot study, we investigated blood-based markers of macrophage activation at different stages of CP.

Methods

We performed a cross-sectional analysis of prospectively collected plasma samples from healthy controls and patients with suspected or definitive CP according to the M-ANNHEIM criteria. Plasma concentrations of soluble CD163 (sCD163), soluble CD206 (sCD206), and monocyte chemoattractant protein-1 (MCP-1) were analyzed using enzyme-linked immunosorbent assays. Group and pairwise comparisons of analytes were performed using regression models and area under the receiver operating curves (AUC-ROC).

Results

In total, 73 subjects with CP (28 suspected CP and 45 definitive CP) and 40 controls were included. Compared to controls, the median plasma concentrations of sCD163 (p = 0.019) and sCD206 (p = 0.033) were elevated in patients with definitive CP. sCD206 was also elevated in patients with definitive CP (p = 0.042). ROC analysis revealed that the optimal sCD163 cutpoint to distinguish definitive CP from controls was 1.84 mg/ml (AUC-ROC 0.65; 95 % confidence interval [CI], 0.54-0.77). The optimal sCD206 cutpoint to distinguish definitive CP from controls was 0.24 mg/ml (AUC-ROC 0.66; 95 % CI 0.54-0.78). The analytes did not significantly discriminate patients with suspected CP from controls. MCP-1 concentrations showed no differences across subgroups.

Conclusion

Our study demonstrates that subjects with definitive CP, sampled during a clinically quiescent phase, exhibited increased levels of sCD163 and sCD206. This indicates the presence of activated M2 macrophages in patients with CP at advanced, but not early, clinical stages.
The Effect of Epidural Analgesia on In-Hospital Outcomes in Patients with Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Authors: Moazzami Bobak , Mohammadpour Zinat , Zabala Zohyra E. , Chawla Saurabh
Published: December 2024

Objectives

Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may reduce AP severity and improve outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients.

Method

Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until mid-May 2024 for RCTs comparing EA with other pain management strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed a random-effects model and the Mantel-Haenszel method. Study heterogeneity was assessed using the I2 statistic.

Results

Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR = 0.69, 95% CI [0.29, 1.65], p = 0.40), mechanical ventilation (RR = 0.82, 95% CI [0.61, 1.10], p = 0.19), sepsis events (RR = 0.88, 95% CI [0.42, 1.86], p = 0.74), hospital/ICU stay (WMD = 0.49 days, 95% CI [-1.13, 2.10], p = 0.55), and pain score (WMD = 1.49, 95% CI [-0.42, 3.40], p = 0.13). However, opioid requirements were significantly lower, as reported by one study with morphine milligram equivalent of 15 mg/day compared to 52 mg/day in the control group (p = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score (I2 = 92%). The overall certainty of evidence was very low due to the small number of studies, risk of bias, and limited sample size.

Conclusions

EA did not significantly improve in-hospital outcomes in AP patients. However, findings indicated reduced opioid consumption in the EA group, suggesting potential benefits in pain management. Further high-quality, large-scale randomized trials are needed to understand the potential benefits of EA in this population.
INVESTIGATION OF GEOSPATIAL DISPARITIES IN CHRONIC PANCREATITIS OUTCOMES
Authors: Kahan Tamara F. , Noriega Marco , Liyen-Cartelle Anabel , Bocchino Rachel , Anderson Kelsey , Zuberi Shaharyar A. , Shah Ishani , Olivares Miriam , Kelly Jill , Freedman Steven D. , Rabinowitz Loren , Chhoda Ankit , Sheth Sunil G.
Published: December 2024

OBJECTIVES

Chronic pancreatitis (CP) is a fibro-inflammatory disorder characterized by abdominal pain and exocrine and endocrine pancreatic insufficiency resulting in significant morbidity. This study evaluates the impact of geospatial parameters, assessed using the Social Vulnerability Index (SVI), a tool comprising sixteen social attributes, on CP outcomes, including opioid use.

METHODS

We conducted a retrospective analysis of CP patients with available addresses followed at our pancreas center. We reviewed demographics, clinical variables including number of CP flares, local complications, pancreatic function, and healthcare-resource utilization (HRU) including imaging, endoscopic procedures, and surgeries, and outpatient opioid prescriptions measured in morphine milligram equivalents (MME). Regression analysis was performed to assess the association between outcomes and SVI [divided into 4 quartiles (I-IV; IV being most vulnerable].

RESULTS

Among 324 CP patients followed over 8 years, we noted trends of higher dependence on governmental insurance or no insurance among patients in higher SVI quartiles (III/IV vs. I/II) but no differences in demographics, comorbidities, or etiology of CP. In patients residing in more vulnerable SVI quartiles, we noted significantly higher frequency of hospitalizations for CP flares and lower daily MME. Rates of exocrine and endocrine pancreatic dysfunction and HRU were similar across all SVI quartiles.

CONCLUSIONS

Despite multidisciplinary guideline-based care, residence in the most vulnerable neighborhoods may be associated with less opioid use and more frequent CP flares, suggesting possible inadequate pain control in these patients. These findings should guide prospective investigation of the impact of geospatial social determinants of health in CP and efforts to mitigate the above disparities.