bluuebunny/crossref_metadata_2025 huggingface dataset:
Dielectric response in relation to other ablation parameters
Authors: Abeln B G S , Van Dijk V F , Balt J C , Wijffels M C E F , Boersma L V A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Dielectric imaging is used by the KODEX-EPD system to provide information that can be used to guide catheter ablation of cardiac arrhythmia. This includes assessment of catheter-tissue contact (No touch, Touch, or High touch) and local atrial wall thickness (mm). Additionally, the system can detect changes in local dielectric tissue properties to assess the effect of a radiofrequency energy application. This assessment is used to classify ablation points into low or high dielectric response (LDR or HDR), which was designed to indicate the extent of lesion transmurality.

Objectives

To evaluate the relation between dielectric response and other ablation parameters.

Methods

The KODEX-EPD system was used to guide ablation in patients with prior pulmonary vein isolation. Ablation included re-isolation of the pulmonary veins and isolation of the superior vena cava if deemed necessary. We downloaded system data from all procedures that were performed with software that provided dielectric response (version 1.5.0, 1.5.0a, 1.5.1 and 1.5.1a) and analyzed the parameters of all individual ablation points.

Results

The cohort includes 55 patients, in which 135 pulmonary veins and 19 superior venae cavae were targeted. A total of 860 energy applications were applied, resulting in 1458 ablation points. The system classified 31% of ablation points as HDR and 19% as LDR. The system did not provide a dielectric response in 49%. The system’s ability to determine dielectric response was related to the software version(oldest version 71% no DR, newest version 18%) and duration of ablation. High dielectric response (versus LDR or no DR) was multivariably associated with longer energy applications, higher mean ablation power and lower local wall thickness (Table). Mean ablation temperature and impedance drop were not multivariably associated with dielectric response.

Conclusion

Dielectric response is independently associated with local wall thickness, ablation power and duration, but not with ablation temperature and impedance drop. Newer software versions have reduced the proportion of ablation points for which no dielectric response was provided.
Retrograde access of the left atrium for catheter ablation using robotic magnetic navigation in atrial fibrillation: a case series
Authors: Tijskens M , Wolf M , De Greef Y , Schwagten B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation for which the left atrium (LA) is usually accessed by the antegrade femoral venous route and transseptal puncture. However, in rare cases, alternative routes must be used to overcome anatomical challenges. A retrograde approach via the femoral artery and by subsequently passing the aortic and mitral valve is virtually impossible using conventional catheters.

Purpose

To investigate the feasibility of a retrograde approach for AF ablation by robotic magnetic navigation (RMN) using floppy radiofrequency ablation catheters.

Methods

Between June 2014 and December 2021, a total of 6 consecutive patients underwent a total of 8 ablation procedures for AF by retrograde approach using a RMN at tour center. A magnetic catheter was introduced through the right femoral artery and manually advanced retrogradely to the aortic arch. Thereafter, it was further advanced to the LA using RMN by switching the magnets to navigation mode, passing through both aortic and mitral valve (Figure 1). Circumferential PVI was performed by antral point-by-point radiofrequency ablation and additional atrial lines were targeted when deemed necessary. Bidirectional conduction block was proven by loss of pulmonary vein potentials on the ablation catheter which automatically moved in a radial manner collecting 16 mapping points.

Results

The patient group (Figure 2) consisted of 4 females and 2 males with a mean age of 58,0±10,8years. 4 patients (67%) presented with persistent AF. The mean time between diagnosis and catheter ablation was 5,3±3,5 years. 2 patients (33%) had an acquired mechanical obstruction of the conventional transseptal route. The other 4 patients (67%) had an anatomical abnormality precluding conventional access to the LA. These 4 patients all underwent an unsuccessful ablation attempt via conventional approach elsewhere, before referral to our center. Patients 3 and 4 also underwent an epicardial ablation for AF respectively 1,3 and 6,2 years before catheter ablation using RMN. Patient 3 also underwent a failed attempt on manual catheter ablation using the retrograde route in another center. AF catheter ablation via retrograde access using RMN was possible in all patients and no complications occurred. The mean follow-up was 3,4±3,3 years.

Conclusion

Our findings indicate that a retrograde transaortic approach for catheter ablation in AF using magnetic navigation system and electroanatomical mapping is technically feasible and safe in patients with anatomical challenges precluding the use of a conventional antegrade transseptal approach. This technique may serve as an indispensable component of the management of this subgroup of patients in experienced centers.
Addition of dissolved inorganic carbon stimulates snow algae primary productivity on glacially eroded carbonate bedrock in the Medicine Bow Mountains, WY, USA
Authors: Hamilton Trinity L , Havig Jeff R
Published: May 2023

Snow is a critical component of the Earth system. High-elevation snow can persist into the spring, summer, and early fall and hosts a diverse array of life, including snow algae. Due in part to the presence of pigments, snow algae lower albedo and accelerate snow melt, which has led to increasing interest in identifying and quantifying the environmental factors that constrain their distribution. Dissolved inorganic carbon (DIC) concentration is low in supraglacial snow on Cascade stratovolcanoes, and snow algae primary productivity can be stimulated through DIC addition. Here we asked if inorganic carbon would be a limiting nutrient for snow hosted on glacially eroded carbonate bedrock, which could provide an additional source of DIC. We assayed snow algae communities for nutrient and DIC limitation on two seasonal snowfields on glacially eroded carbonate bedrock in the Snowy Range of the Medicine Bow Mountains, Wyoming, United States. DIC stimulated snow algae primary productivity in snow with lower DIC concentration despite the presence of carbonate bedrock. Our results support the hypothesis that increased atmospheric CO2 concentrations may lead to larger and more robust snow algae blooms globally, even for sites with carbonate bedrock.
The First Genome of the Cold-Water Octocoral, the Pink Sea Fan, Eunicella verrucosa
Authors: Macleod Kirsty L , Paris Josephine R , Jenkins Tom L , Stevens Jamie R
Published: May 2023

Cold-water corals form an important part of temperate benthic ecosystems by increasing three-dimensionality and providing an important ecological substrate for other benthic fauna. However, the fragile three-dimensional structure and life-history characteristics of cold-water corals can leave populations vulnerable to anthropogenic disturbance. Meanwhile, the ability of temperate octocorals, particularly shallow-water species, to respond to adjustments in their environment linked to climate change has not been studied. This study reports the first genome assembly of the pink sea fan (Eunicella verrucosa), a temperate shallow-water octocoral species. We produced an assembly of 467 Mb, comprising 4,277 contigs and an N50 of 250,417 bp. In total, 213 Mb (45.96% of the genome) comprised repetitive sequences. Annotation of the genome using RNA-seq data derived from polyp tissue and gorgonin skeleton resulted in 36,099 protein-coding genes after 90% similarity clustering, capturing 92.2% of the complete Benchmarking Universal Single-Copy Orthologs (BUSCO) ortholog benchmark genes. Functional annotation of the proteome using orthology inference identified 25,419 annotated genes. This genome adds to the very few genomic resources currently available in the octocoral community and represents a key step in allowing scientists to investigate the genomic and transcriptomic responses of octocorals to climate change.
Sensitized piRNA reporter identifies multiple RNA processing factors involved in piRNA-mediated gene silencing
Authors: Brown Jordan S , Zhang Donglei , Gaylord Olivia , Chen Wenjun , Lee Heng-Chi
Published: May 2023

Metazoans guard their germlines against transposons and other foreign transcripts with PIWI-interacting RNAs (piRNAs). Due to the robust heritability of the silencing initiated by piRNAs in Caenorhabditis elegans (C. elegans), previous screens using C. elegans were strongly biased to uncover members of this pathway in the maintenance process but not in the initiation process. To identify novel piRNA pathway members, we have utilized a sensitized reporter strain which detects defects in initiation, amplification, or regulation of piRNA silencing. Using our reporter, we have identified Integrator complex subunits, nuclear pore components, protein import components, and pre-mRNA splicing factors as essential for piRNA-mediated gene silencing. We found the small nuclear processing cellular machine termed the Integrator complex is required for both type I and type II piRNA production. Notably, we identified a role for nuclear pore and nucleolar components NPP-1/Nup54, NPP-6/Nup160, NPP-7/Nup153, and FIB-1 in promoting the perinuclear localization of anti-silencing CSR-1 Argonaute, as well as a role for Importin factor IMA-3 in nuclear localization of silencing Argonaute HRDE-1. Together, we have shown that piRNA silencing in C. elegans is dependent on evolutionarily ancient RNA processing machinery that has been co-opted to function in the piRNA-mediated genome surveillance pathway.
Alterations in the Fungal Microbiome in Ulcerative Colitis
Authors: Hsia Katie , Zhao Naisi , Chung Mei , Algarrahi Khalid , Montaser Kouhsari Laleh , Fu May , Chen Hannah , Singh Siddharth , Michaud Dominique S , Jangi Sushrut
Published: May 2023

Background

Although gut fungi have been implicated in the immunopathogenesis of inflammatory bowel disease, the fungal microbiome has not been deeply explored across endohistologic activity and treatment exposure in ulcerative colitis.

Methods

We analyzed data from the SPARC IBD (Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease) registry. We evaluated the fungal composition of fecal samples from 98 patients with ulcerative colitis across endoscopic activity (n = 43), endohistologic activity (n = 41), and biologic exposure (n = 82). Across all subgroups, we assessed fungal diversity and differential abundance of taxonomic groups.

Results

We identified 500 unique fungal amplicon sequence variants across the cohort of 82 patients, dominated by phylum Ascomycota. Compared with endoscopic remission, patients with endoscopic activity had increased Saccharomyces (log2 fold change = 4.54; adjusted P < 5 × 10-5) and increased Candida (log2 fold change = 2.56; adjusted P < .03). After adjusting for age, sex, and biologic exposure among patients with endoscopic activity, Saccharomyces (log2 fold change = 7.76; adjusted P < 1 × 10-15) and Candida (log2 fold change = 7.28; adjusted P< 1 × 10-8) remained enriched during endoscopic activity compared with quiescence.

Conclusions

Endoscopic inflammation in ulcerative colitis is associated with an expansion of Saccharomyces and Candida compared with remission. The role of these fungal taxa as potential biomarkers and targets for personalized approaches to therapeutics in ulcerative colitis should be evaluated.
From the simplex to the sphere: faster constrained optimization using the Hadamard parametrization
Authors: Li Qiuwei , McKenzie Daniel , Yin Wotao
Published: May 2023

The standard simplex in $\mathbb{R}^{n}$, also known as the probability simplex, is the set of nonnegative vectors whose entries sum up to 1. It frequently appears as a constraint in optimization problems that arise in machine learning, statistics, data science, operations research and beyond. We convert the standard simplex to the unit sphere and thus transform the corresponding constrained optimization problem into an optimization problem on a simple, smooth manifold. We show that Karush-Kuhn-Tucker points and strict-saddle points of the minimization problem on the standard simplex all correspond to those of the transformed problem, and vice versa. So, solving one problem is equivalent to solving the other problem. Then, we propose several simple, efficient and projection-free algorithms using the manifold structure. The equivalence and the proposed algorithm can be extended to optimization problems with unit simplex, weighted probability simplex or $\ell _{1}$-norm sphere constraints. Numerical experiments between the new algorithms and existing ones show the advantages of the new approach. Open source code is available at https://github.com/DanielMckenzie/HadRGD.
Global exponential stabilization of the linearized Korteweg-de Vries equation with a state delay
Authors: Ayadi Habib , Jlassi Mariem
Published: May 2023

In this paper, well-posedness and global boundary exponential stabilization problems are studied for the one-dimensional linearized Korteweg-de Vries equation (KdV) with state delay, which is posed in bounded interval $[0,2\pi ]$ and actuated at the left boundary by Dirichlet condition. Based on the infinite-dimensional backstepping method for the delay-free case, a linear Volterra-type integral transformation maps the system into another homogeneous target system, and an explicit feedback control law is obtained. Under this feedback, we prove the well-posedness of the considered system in an appropriate Banach space and its exponential stabilization in the topology of $L^{2}(0,2\pi )$-norm by the use of an appropriate Lyapunov–Razumikhin functional. Moreover, under the same feedback law, we get the local exponential stability for the non-linear KdV equation. A numerical example is provided to illustrate the result.
Higher order time discretization for the stochastic semilinear wave equation with multiplicative noise
Authors: Feng Xiaobing , Ashirbad Panda Akash , Prohl Andreas
Published: May 2023

In this paper, a higher order time-discretization scheme is proposed, where the iterates approximate the solution of the stochastic semilinear wave equation driven by multiplicative noise with general drift and diffusion. We employ variational method for its error analysis and prove an improved convergence order of $\frac 32$ for the approximates of the solution. The core of the analysis is Hölder continuity in time and moment bounds for the solutions of the continuous and the discrete problem. Computational experiments are also presented.
Strong Comic Immoralism
Authors: Kianpour Connor K
Published: May 2023

Strong comic immoralism maintains that every time a humorous demonstration (for example, a joke) involves a moral defect, it is enhanced aesthetically in virtue of having this moral defect. I want to show that strong comic immoralism is a coherent position, that it is possible to defend, and that there is, in fact, some reason to defend it. By doing this, my hope is that, moving forward, those who are interested in questions about the relationship between immorality and the aesthetic value of jokes will take more seriously the objections that may be presented against their views by the strong comic immoralist, rather than claiming that “no one on this side of Satan” would be one.
The use of a genomic relationship matrix for breed assignment of cattle breeds: comparison and combination with a machine learning method
Authors: Wilmot Hélène , Niehoff Tobias , Soyeurt Hélène , Gengler Nicolas , Calus Mario P L
Published: May 2023

To develop a breed assignment model, three main steps are generally followed: 1) The selection of breed informative single nucleotide polymorphism (SNP); 2) The training of a model, based on a reference population, that allows to classify animals to their breed of origin; and 3) The validation of the developed model on external animals i.e., that were not used in previous steps. However, there is no consensus in the literature about which methodology to follow for the first step, nor about the number of SNP to be selected. This can raise many questions when developing the model and lead to the use of sophisticated methodologies for selecting SNP (e.g., with iterative algorithms, partitions of SNP, or combination of several methods). Therefore, it may be of interest to avoid the first step by the use of all the available SNP. For this purpose, we propose the use of a genomic relationship matrix (GRM), combined or not with a machine learning method, for breed assignment. We compared it with a previously developed model based on selected informative SNP. Four methodologies were investigated: 1) The PLS_NSC methodology: selection of SNP based on a partial least square-discriminant analysis (PLS-DA) and breed assignment by classification based on the nearest shrunken centroids (NSC) method; 2) Breed assignment based on the highest mean relatedness of an animal to the reference populations of each breed (referred to mean_GRM); 3) Breed assignment based on the highest SD of the relatedness of an animal to the reference populations of each breed (referred to SD_GRM) and 4) The GRM_SVM methodology: the use of means and SD of the relatedness defined in mean_GRM and SD_GRM methodologies combined with the linear support vector machine (SVM), a machine learning method used for classification. Regarding mean global accuracies, results showed that the use of mean_GRM or GRM_SVM was not significantly different (Bonferroni corrected P > 0.0083) than the model based on a reduced SNP panel (PLS_NSC). Moreover, the mean_GRM and GRM_SVM methodology were more efficient than PLS_NSC as it was faster to compute. Therefore, it is possible to bypass the selection of SNP and, by the use of a GRM, to develop an efficient breed assignment model. In routine, we recommend the use of GRM_SVM over mean_GRM as it gave a slightly increased global accuracy, which can help endangered breeds to be maintained. The script to execute the different methodologies can be accessed on: https://github.com/hwilmot675/Breed_assignment.
Multitrophic biodiversity enhances ecosystem functions, services and ecological intensification in agriculture
Authors: Buzhdygan Oksana Y , Petermann Jana S
Published: May 2023

One central challenge for humanity is to mitigate and adapt to an ongoing climate and biodiversity crisis while providing resources to a growing human population. Ecological intensification (EI) aims to maximize crop productivity while minimizing impacts on the environment, especially by using biodiversity to improve ecosystem functions and services. Many EI measures are based on trophic interactions between organisms (e.g. pollination, biocontrol). Here, we investigate how research on multitrophic effects of biodiversity on ecosystem functioning could advance the application of EI measures in agriculture and forestry. We review previous studies and use qualitative analyses of the literature to test how important variables such as land-use parameters or habitat complexity affect multitrophic diversity, ecosystem functions and multitrophic biodiversity–ecosystem functioning relationships. We found that positive effects of biodiversity on ecosystem functions are prevalent in production systems, largely across ecosystem function dimensions, trophic levels, study methodologies and different ecosystem functions, however, with certain context dependencies. We also found strong impacts of land use and management on multitrophic biodiversity and ecosystem functions. We detected knowledge gaps in terms of data from underrepresented geographical areas, production systems, organism groups and functional diversity measurements. Additionally, we identified several aspects that require more attention in the future, such as trade-offs between multiple functions, temporal dynamics, effects of climate change, the spatial scale of the measures and their implementation. This information will be vital to ensure that agricultural and forest landscapes produce resources for humanity sustainably within the environmental limits of the planet.
National Inclusion Policy Openings/Barriers for Refugee Teachers: Critical Reflections from Kenya
Authors: Mendenhall Mary , Falk Danielle
Published: May 2023

Many refugee teachers toil for years with little support, inadequate working conditions, and unliveable wages, all while facing ‘unknowable futures’ (Dryden-Peterson 2017) about their ability to continue working as teachers. The current push for inclusion of refugees into national education systems has created policy openings for the inclusion of refugee teachers. Drawing on interviews with refugee teachers in Kakuma refugee camp and critical policy analysis of refugee education policies across global, regional, and national levels, our study examines what refugee teachers identify as policy barriers influencing their work and how policies that purport to include refugees into national systems address the needs of refugee teachers. We argue that policies that recognize refugee teachers either fail to address their specific professional needs for recognized teaching certification, adequate teacher compensation, and future career pathways or are inadequately implemented, leaving teachers and the countries hosting them without adequate support to improve teacher management.
Castleman disease: a case report of an unusual adrenal incidentaloma and literature review
Authors: Aldosari Sarah , Altalhi Bassam , Albisher Nesreen , Mohammed Shamayel , Alhazmi Alaa , Alsobhi Saif
Published: May 2023

Adrenal incidentaloma (AI) is an incidental detection of an adrenal mass on an image not performed for a suspected adrenal problem. AI has become a commonly encountered lesion that requires further investigations for evidence of hormonal hypersecretion or malignancy potential. According to guidelines, surgical intervention is the standard of care for unilateral AI. We report on a case of a 64-year-old female who presented with a nonfunctional adrenal mass associated with compressive symptoms, which was revealed to be a mixed hyaline vascular and plasma cell variant Castleman disease (CD) after surgical resection. Although hyaline vascular variant and plasma cell variant of CD has been identified in adrenal glands, this is the first report of a mixed hyaline vascular and plasma cell variant in an adrenal mass.
A unique case of inverted Meckel’s diverticulum presented as an adult intussusception: a case report
Authors: Lahham Elias E , Iwaiwi Bashaer I , Halteh Silvia , Khaled Hala , AlQadi Mohammad
Published: May 2023

Although Meckel’s diverticulum (MD) is a relatively common asymptomatic gastrointestinal anomaly, an inverted MD is a rare entity that is challenging to diagnose prior to surgery and presents usually in the pediatric population with bleeding, anemia and abdominal pain. The most frequent adult presentation in non-inverted MD is intestinal obstruction, whereas bleeding and anemia are the most typical presenting complaints in inverted MD. Here, we report our experience with an adult female patient, who presented with 5 days duration of abdominal pain, nausea and vomiting. Imaging revealed signs of small bowel obstruction with bowel wall thickening in the terminal ileum and a double target appearance. This case describes a rare cause of adult intestinal intussusception because of inverted MD, which was successfully managed with surgery. The final pathology report confirms the diagnosis.
(002) Transfeminine Genital Reconstructive Surgery Complications Based on Insurance Claims Data
Authors: Schardein J , Snyder L , Jimbo M , Hebert K , Horns J J , Driggs N , Das R , Myers J , Hotaling J M
Published: May 2023

Introduction

Transfeminine genital reconstructive surgery is an important part of gender affirmation for many transgender women. Currently, various vaginoplasty techniques are performed by different surgeons across the United States. Surgical outcomes of individual surgeons and groups have been published in the literature, however complications using an insurance claims database have yet to be reported.

Objective

Our objective is to present post-vaginoplasty complication rates among surgeons in the United States using a large claims database.

Methods

A retrospective review was conducted of all transgender women who underwent vaginoplasty using IBM MarketScan insurance claims database between 2011-2020. Baseline patient characteristics, including age, obesity, smoking status, Charlson Comorbidity Index (CCI) and the region the surgery was performed were obtained. Patients were followed after surgery to identify complications. Common surgical complications, such as bleeding/hematoma, wound dehiscence, postsurgical infection, DVT, PE, and MI, and complications specific to gender affirming surgery, such as pelvic pain, dyspareunia, rectal injury, urinary issues, urethral stricture, loss of neovaginal depth, and prolapse, were investigated using ICD-9/ICD-10 and CPT codes. Hazard ratios (HRs) were calculated to determine how baseline factors influenced complications.

Results

A total of 1588 privately insured patients who underwent vaginoplasty for gender affirmation with 414 different surgeons were identified. The mean age was 34 years (22-53 years), 16% were obese and 8% were smokers. The majority (70%) of patients had a CCI of 0. Overall, at a mean follow-up of 14 months (5-28 months), 66% of patients had a complication. A common surgical complication occurred in 19% of patients and a gender affirming surgery complication occurred in 61% of patients. Among those with a gender affirming surgery complication, 17% had pelvic pain, 3% had dyspareunia, <1% had a rectal injury, 21% had urinary issues, 19% had a urethral stricture, 16% had loss of neovaginal depth and 15% had prolapse. A CCI of 2 had a HR of 1.82 (p=0.004) for a common complication and age had a HR of 1.01 (p<0.001) for a gender affirming complication. Smoking was associated with a statistically significant HR for both common complications and gender affirming complications (1.48 and 1.26, respectively; P<0.05).

Conclusions

Post-vaginoplasty, the majority of patients have at least one complication based on insurance claims data. All patients should be counseled on smoking cessation prior to surgery to potentially decrease the risk of complications.

Disclosure

No
(009) Comparing the Sexual Lives of Adolescents and Young Adults (AYA) With and Without a History of Cancer
Authors: Carpenter K , Conroy K , Dallal D , Black L
Published: May 2023

Introduction

Studies have consistently described poor sexual outcomes for AYA cancer survivors – nearly half of which report some level of negative subjective impact of cancer on their sexual lives (Wettergren et al., 2016, Geue et al., 2015). Available data typically comes from long-term survivors, indicating a chronicity of sexual problems that persist long after treatment and recovery. Among AYA survivors, there remains a major unmet need for sexuality-based supportive care, which will likely have to be tailored to the social/developmental needs of a younger population.

Objective

1) Compare a sample of AYA survivors to age- and partner-matched peers across a wide variety of sexual outcomes, including behavior, function, affect, and cognition. 2) Explore variables associated with maintenance of sexual problems within the AYA survivor population, i.e., potential intervention targets.

Methods

Women ages 18-39 with a history of cancer (31% hematologic, 18% breast, 16% gynecologic, 14% thyroid, 20% other) were matched with healthy controls based on age (within 5 years) and partner status (single vs. partnered) (total N=272). Survivors were diagnosed at age 26 (SD=7.88, range 2 to 39 years). 71% of survivors who reported knowing stage at diagnosis (stage 0-2, 54%). At the time of survey, 79% were partnered. We conducted independent samples t-tests to compare scores on sexual behavior (PROMIS), function (PROMIS), distress (Female Sexual Distress Scale [FSDS]), self-efficacy (Sexual Self-Efficacy Scale for Females), and sexual self schema (SSS), hypothesizing that survivors would have poorer sexual outcomes.

Results

Age at first intercourse and number of partners were comparable across groups. Survivors were more likely to report having children than controls [X2 (1, N = 192) = 5.63, p =.02]. Survivors evidenced a less varied behavioral repertoire (past 30 days) [t(262)=-2.64, p=.01] and engaged in vaginal intercourse significantly less often [t(205)=-1.97, p=.05]; this effect was more pronounced among partnered survivors. Despite lower frequency of intercourse, survivors reported using lubricant more often than the controls [t(211)=2.04, p=.04]. Survivors reported poorer sexual interest [t(281)=-4.89, p<.01], lubrication [t(281)=-4.12, p<.001], orgasm [t(279)=-2.65, p=.01], and satisfaction [t(278)=-3.07, p<.01]. Sexual affect and cognition were also poorer for survivors; they tended to have higher sexual distress [t(269)=5.05, p<.01], more embarrassed/conservative sexual self schema [t(268)=2.22, p=.03], and lower sexual self-efficacy [t(286)=-4.94, p<.01].

Conclusions

Young adult survivors of cancer experience more sexual problems than peers, including a more restricted sexual repertoire, less frequent sexual behaviors, poorer sexual function, as well as more negative emotion and cognition regarding their sexuality. There has been insufficient attention to the unique needs and experiences of younger survivors.

Disclosure

No
(023) The Acute Effect of Caffeine on Genital Arousal in Women: A Pilot Study
Authors: Mcmahon L , Meston C
Published: May 2023

Introduction

Genital sexual arousal, a process characterized by increased vaginal lubrication and vasocongestion in females, is facilitated by moderate activation of the sympathetic nervous system (SNS) (for review, see Stanton, Handy, & Meston, 2018). Among the range of factors that impede the female genital arousal response (e.g., disrupted endocrine functioning and vascular and neurological problems), antidepressants have strikingly deleterious effects on genital arousal function that hinder quality of life (Nappi et al., 2016) and jeopardize medication adherence. When patients present with antidepressant-induced sexual side effects, physicians may switch their antidepressant or tack on an additional medication (e.g., bupropion) to counter them. While sometimes effective, this increases patients’ financial burden and often introduces a host of new side effects. Moderate activation of the SNS through exercise has shown promising results for ameliorating antidepressant-induced genital arousal dysfunction (Lorenz & Meston, 2012; 2014). Given that SNS activation prior to sex counteracts the inhibitory effect of antidepressants on genital blood flow, it is feasible that caffeine – an SNS stimulant (Biaggioni et al., 1991; Zahn et al., 1987) – could improve antidepressant-induced genital arousal difficulties if ingested prior to sex. Caffeine could serve as a low-cost, widely accessible intervention with minimal side effects if efficacy is shown.

Objective

The goal of the present pilot study is to examine whether the acute administration of 300mg of caffeine increases genital arousal (i.e., vaginal pulse amplitude) in women experiencing antidepressant-induced genital arousal difficulties.

Methods

Women attended two counterbalanced in-laboratory sessions in which they ingested either 300mg caffeine or placebo. Fifteen minutes post-ingestion, they viewed an erotic film while their heart rate and genital sexual arousal were measured. Caffeine consumption was controlled for.

Results

Preliminary data analyses suggest that compared to placebo, 300mg of caffeine increases vaginal pulse amplitude fifteen minutes post-ingestion among women experiencing antidepressant-induced genital arousal difficulties. Additional pilot subjects are currently being tested; results will be updated with an addendum upon completion.

Conclusions

If efficacy is demonstrated in our sample, caffeine may serve as a low-cost, widely accessible treatment for women experiencing antidepressant-induced genital arousal dysfunction. While we aim to target genital arousal concerns with caffeine, improvements in genital arousal are likely to positively impact other stages of women’s sexual response given the high degree of overlap between these stages.

Disclosure

No
(059) Comfort With Sexual Health Literacy Assessed in Urology Resident Physicians
Authors: Horwitz R , Lewis K , Khooblall P , Haile E S , Lundy S D , Bajic P
Published: May 2023

Introduction

Despite the importance of sexual health, physicians may not be adequately equipped to diagnose and treat sexual dysfunction. Topics related to healthy sexual function (pleasure, masturbation, communication, sex toys/tools, and anal sex practices) are largely omitted from medical education. It is vital that urologists are trained to ask detailed questions about sexual health, counsel on healthy sexual habits, and identify and treat sexual dysfunction.

Objective

To determine the level of comfort among urology residents in taking a comprehensive sexual health history, identifying sexual dysfunction, and treating patients of various gender identities and sexual orientations.

Methods

An anonymous electronic survey was distributed to current urology residents in the United States. The survey contained five demographics questions and twenty-three questions tied to sexual health competencies. Participants were asked to provide their education year, current age, medical school location, residency location, and estimated hours of sexual health education during training (excluding STI/STD content). Survey questions targeted previously established sexual education competency domains.

Results

A total of 52 urology residents participated in the study. Participant post-graduate years ranged from 1-6. 61.5% of participants stated they received only 0-3 hours of formal sex education during medical school and 46.3% reported having any formal sex education during urology residency. 80% of participants felt comfortable asking patients about self-erogenous stimulation, but only 27% of responders felt comfortable answering questions about anal stimulation devices, and 35% of responders felt comfortable answering questions about vaginal stimulation devices. Greater than 94% of residents feel “very comfortable” or “somewhat comfortable” with describing male sexual dysfunction and performing physical exam for a man with sexual dysfunction, but only 59% felt the same towards female sexual dysfunction. When describing medicines used for sexual function, 100% of residents are comfortable doing so for men, but only 63% are comfortable doing the same for women. When counseling transgender males or females on sexual practice/therapies/surgeries, only 29% of residents felt comfortable.

Conclusions

There are knowledge gaps in sexual medicine literacy confidence among urology residents surveyed. Lack of a comprehensive sexual health education curriculum during medical training may be affecting patient care. Women and sexual and gender minority (LGBTQ) patients may be at higher risk of being treated by a urologist without comfort in managing their sexual health. Sexual health education optimization during urology residency has the potential to promote improved understanding of the sexual health of women and sexual and gender minorities and improve the evaluation and management of sexual dysfunction in general.

Disclosure

No
(073) The New, Undescribed, and Lethal Components of The Genitourinary Syndrome of Menopause
Authors: Dominguez-Bali A , Dominguez-Bali C , Baqer A , Hassan Z , Sharma R , Marquez L
Published: May 2023

Introduction

Genitourinary syndrome of menopause (GSM) has been well described within medical literature and its effects have been well managed by physicians with an extensive understanding of the condition. However, the progression of medicine in each area continues to evolve. We propose new findings that are extremely important to have in consideration of GSM.

Objective

To describe new findings that are not traditionally associated with GSM, some with lethal consequences: * False abnormal pap smears * Total vulvovaginal obliteration and secondary renal damage * Undiagnosed recurrent urinary tract infections (UTI) in the geriatric population without hormone replacement therapy with secondary sepsis, pneumonia, and death.

Methods

Large review of recent literature, diagnosis, treatment and follow up of patients within our facility and nursing homes including geriatric females with and without hormone replacement therapy.

Results

`- Resolution of the abnormal pap smear with the use of local estrogens in more than 1500 cases. - Management of 6 cases of vulvovaginal obliteration with surgery, dilators, increasing penetrative sex, and local estrogens with great results. - Description of some dozens of patients seen and evaluated in home care facilities with undiagnosed UTI by the primary care, showed subsequent findings of sepsis, pneumonia, and even death.

Conclusions

Emphasize the need to inform and educate healthcare providers, especially primary care, internal medicine, OB/GYN physicians, and urologists the ample growing and potentially lethal spectrum of GSM.

Disclosure

No
Identification and analysis of a clinically isolated strain of Halomonas based on whole-genome sequencing and comparative genomics
Authors: Wang Pinjia , Xie Chengbin
Published: May 2023

Objective

The aim of this study was to identify the species of a Halomonas strain isolated from a neonatal blood sample and to understand the potential pathogenicity and characteristic genes of the strain.

Methods

The genomic DNA of strain 18071143 (identified as Halomonas by matrix-assisted laser desorption-ionization time of flight-mass spectrometry and the 16S ribosomal RNA (rRNA) gene sequence) was sequenced using Nanopore PromethION platforms. The average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) were calculated using the complete genome sequences of the strain. Comparative genomic analyses were performed on strain 18071143 and 3 strains of Halomonas (Halomonas stevensii S18214, Halomonas hamiltonii KCTC 22154, and Halomonas johnsoniae KCTC 22157) that were associated with human infections and had high genomic similarity to strain 18071143.

Results

Phylogenetic, ANI, and dDDH similarity analyses based on genome sequence indicated that strain 18071143 belonged to the species H stevensii. Similarities exist between strain 18071143 and the other 3 Halomonas strains in terms of gene structure and protein function. Nonetheless, strain 18071143 has greater potential for DNA replication, recombination, repair, and horizontal transfer.

Conclusion

Whole-genome sequencing holds great promise for accurate strain identification in clinical microbiology. In addition, the results of this study provide data for understanding Halomonas from the perspective of pathogenic bacteria.
Identification of genes essential for bile acid resistance in the probiotic Lacticaseibacillus paracasei strain Shirota
Authors: Shimizu Kensuke , Ito Masahiro , Katto Miyuki , Takada Toshihiko , Oana Kosuke , Makino Hiroshi , Okada Nobuhiko , Kurakawa Takashi , Oishi Kenji
Published: May 2023

Bile acid resistance is crucial to allow probiotic strains to survive in the gastrointestinal tract and exert health-promoting effects on their hosts. Our aim here was to determine the mechanism of this resistance via a genetic approach by identifying the genes essential for bile acid resistance in Lacticaseibacillus paracasei strain Shirota (LcS). We generated 4649 transposon-inserted lines of L. paracasei YIT 0291, which has the same genome sequence as LcS but lacks the pLY101 plasmid, and we screened them for bile-acid-sensitive mutants. The growth of 14 mutated strains was strongly inhibited by bile acid, and we identified 10 genes that could be involved in bile acid resistance. Expression of these genes was not markedly induced by bile acid, suggesting that their homeostatic expression is important for exerting bile acid resistance. Two mutants in which the transposon was independently inserted into cardiolipin synthase (cls) genes, showed strong growth inhibition. Disruption of the cls genes in LcS caused decreased cardiolipin (CL) production and the accumulation of the precursor phosphatidylglycerol in bacterial cells. These data suggest that LcS possesses several mechanisms for exerting bile acid resistance, and that homeostatic CL production is among the factors most essential for this resistance.
In Reply: Overall Survival of Resectable Metastatic Colon Cancer Treated With Neoadjuvant Chemotherapy or Adjuvant Chemotherapy in Non-academic Program
Authors: Hao Zhonglin , Chen Quan , Huang Bin
Published: May 2023

This letter to the editor responds to the letter from Su et al, regarding concerns related to immortal time bias that may partially account for recently published study results.
Degrees of Epistemic Criticizability
Authors: Boult Cameron
Published: May 2023

We regularly make graded normative judgements in the epistemic domain. Recent work in the literature examines degrees of justification, degrees of rationality, and degrees of assertability. This paper addresses a different dimension of the gradeability of epistemic normativity, one that has been given little attention. How should we understand degrees of epistemic criticizability? In virtue of what sorts of factors can one epistemic failing be worse than another? The paper develops a dual-factor view of degrees of epistemic criticizability. According to the view, degrees of epistemic criticizability are (i) an inverse function of degrees of doxastic justification and (ii) a function of degrees of agent culpability. The paper develops an account of each factor, and explains how they should be weighted. The paper also addresses the importance of modelling degrees of epistemic criticizability in a broader context. I focus on the role that such a model can play in the ethics of epistemic criticism.
Impacts of pregnancy and menopause on COVID-19 severity: a systematic review and meta-analysis of 4.6 million women
Authors: Liu Y , Li H , Peng Y , Gao L , Liu C , Wei B , Luo Z
Published: May 2023

Background

Corona Virus Disease 2019 (COVID-19) pandemic is still a public health emergency of international concern. However, whether pregnancy and menopause impact the severity of COVID-19 remain unclear.

Aim

This study is performed to investigate the truth.

Design

Study appraisal and synthesis follows PRISMA guideline. Meta-analysis is performed in random-effects model.

Methods

PubMed, Embase, Cochrane database, Central, CINAHL, ClinicalTrials.gov, WHO COVID-19 database and WHO-ICTRP are searched until 28 March 2023.

Results

In total, 57 studies (4 640 275 COVID-19 women) were analyzed. Pregnant women were at a lower risk of severe COVID-19, intensive care unit (ICU) admission and disease mortality compared to those nonpregnant women with comparable comorbidities. In contrast, pregnant women with more prepregnancy comorbidities were at a higher risk of severe COVID-19, ICU admission and invasive mechanical ventilation (IMV). In addition, pregnant women with pregnancy complications had a significantly increased risk of severe COVID-19 and ICU admission. Menopause increased COVID-19 severity, IMV requirement and disease mortality. Hormone replacement therapy inhibited COVID-19 severity in postmenopausal women. Premenopausal and postmenopausal women had a lower chance of severe illness than age-matched men. The impact of pregnancy on COVID-19 severity was significant in Americans and Caucasians, whereas the effect of menopause on COVID-19 severity was only significant in Chinese.

Conclusions

Pregnancy and menopause are protective and risk factors for severe COVID-19, respectively. The protective role of pregnancy on COVID-19 is minimal and could be counteracted or masked by prepregnancy or pregnancy comorbidities. The administration of estrogen and progesterone may prevent severe COVID-19.
On Idle Possibilities and Missed Chances: Refugee Rights in Egypt
Authors: Habersky Elena , Hetaba-Sabry Amira , McNally Claire
Published: May 2023

This article investigates the rights of refugees in Egypt and the numerous barriers that exist that prevent their enjoyment. Specifically, the article examines the implementation of international and regional legal frameworks relating to refugees and asylum-seekers by two key stakeholders in Egypt, namely the host state and the United Nations High Commissioner for Refugees (UNHCR). In addition, the article explores the current and potential future role of international and regional law in the implementation of these rights, while investigating the national legal framework and practice on the ground in relation to four core rights: obtaining refugee status, issuing documentation, attempting to protect family unity or to reunify with family in case of separation, and accessing public healthcare. In doing this, the article investigates, first, whether the host state and/or UNHCR retains a preference for a legal framework found at one scale of analysis over the other, and second, if international law and in particular, regional law and governance frameworks could be better utilised by all key stakeholders to improve the situation for refugees on the ground. Through the collection of empirical data from interviews and focus groups, a clear picture emerges of regional legal frameworks and norms remaining on the periphery or simply being ignored by the two key stakeholders responsible for implementing protection mechanisms. Instead, the analysed core rights are understood through a complex hybrid of international norms and national policy. This appears like a missed opportunity. The article concludes by arguing that, while in practice regional legal provisions currently only have a limited effect, they have the potential to offer improved protection and rights for a wider group of asylum-seekers and refugees.