bluuebunny/crossref_metadata_2025 huggingface dataset:
The productivity effects of labor market deregulation: evidence from German firms during 2010–2019
Authors: Sobota Vladimir C M , Storm Servaas , van Beers Cees
Published: May 2024

In the early 2000s, the German government introduced the Hartz reforms, which deregulated German labor markets. These reforms were praised internationally as striking a balance between job growth and productivity growth. While macroeconomic research has shown that the reforms have indeed lowered German unemployment, their effects on labor productivity need to be better understood. This paper addresses the impact of temporary agency work (TAW) on German labor productivity during 2010–2019, based on data from a firm-level panel of the German Institute for Employment Research (IAB). It contributes to the rising number of firm-level studies by extending their results in a broader temporal perspective, during which TAW intensities have increased substantially, especially in TAW-using firms. The system generalized method of moment (GMM) estimations based on a firm-level data set with 13,197 observations for the period 2010–2019 show that a robust hump-shaped relationship exists between the extent of TAW and the firms’ labor productivity. We find that the increase in the use of TAWs following the Hartz reforms has, on average, positively contributed to labor productivity growth in German firms. However, the findings also show that if numerical flexibility is increased too much, productivity growth in Germany will suffer. This is particularly the case for several industrial sectors that are important in the German economy. These results are important given recent calls for more labor market flexibility to help firms grow in an increasingly turbulent global economy.
Snapshots of Ghana’s Contested Restorative Justice Programme
Authors: Afari Frank
Published: May 2024

ABSTRACT∞

Ghana’s National Reconciliation Commission (NRC) was established under the administration of President John Agyekum Kufuor (2000–2008) to provide a forum for victims and perpetrators of past human rights violations to testify about their experiences. Despite increasing scholarly interest in the Commission’s work, a set of reparations that the government implemented as a preamble to the hearings remains understudied. Drawing on multi-archival sources, this article examines them, teasing out their social and cultural significance. Further, this article examines a set of witness protection provisions that the government carved out to encourage witnesses to testify, showing their impact on witnesses. This article concludes with an analysis of some coup perpetrators’ perceptions of their own blamelessness, arguing that such sentiments tend to provide the moorings for their proclivity to contest impunity, which is a challenge that truth commissions tend to face, requiring innovative approaches to public truth-telling exercises.
Fecal Microbiota and Volatile Metabolome Pattern Alterations Precede Late-Onset Meningitis in Preterm Neonates
Authors: Frerichs Nina M , Deianova Nancy , el Manouni el Hassani Sofia , Acharjee Animesh , Quraishi Mohammed Nabil , de Boode Willem P , Cossey Veerle , Hulzebos Christian V , van Kaam Anton H , Kramer Boris W , d’Haens Esther , de Jonge Wouter J , Vijlbrief Daniel C , van Weissenbruch Mirjam M , Daulton Emma , Wicaksono Alfian N , Covington James A , Benninga Marc A , de Boer Nanne K H , van Goudoever Johannes B , Niemarkt Hendrik J , de Meij Tim G J
Published: May 2024

Background

The fecal microbiota and metabolome are hypothesized to be altered before late-onset neonatal meningitis (LOM), analogous to late-onset sepsis (LOS). The present study aimed to identify fecal microbiota composition and volatile metabolomics preceding LOM.

Methods

Cases and gestational age-matched controls were selected from a prospective, longitudinal preterm cohort study (born <30 weeks’ gestation) at 9 neonatal intensive care units. The microbial composition (16S rRNA sequencing) and volatile metabolome (gas chromatography-ion mobility spectrometry [GC-IMS] and GC-time-of-flight-mass spectrometry [GC-TOF-MS]) were analyzed in fecal samples 1–10 days pre-LOM.

Results

Of 1397 included infants, 21 were diagnosed with LOM (1.5%), and 19 with concomitant LOS (90%). Random forest classification and MaAsLin2 analysis found similar microbiota features contribute to the discrimination of fecal pre-LOM samples versus controls. A random forest model based on 6 microbiota features accurately predicted LOM 1–3 days before diagnosis with an area under the curve (AUC) of 0.88 (n = 147). Pattern recognition analysis by GC-IMS revealed an AUC of 0.70–0.76 (P < .05) in the 3 days pre-LOM (n = 92). No single discriminative metabolites were identified by GC-TOF-MS (n = 66).

Conclusions

Infants with LOM could be accurately discriminated from controls based on preclinical microbiota composition, while alterations in the volatile metabolome were moderately associated with preclinical LOM.
Microheterogeneity of Transmission Shapes Submicroscopic Malaria Carriage in Coastal Tanzania
Authors: Rapp Tyler , Amagai Kano , Sinai Cyrus , Basham Christopher , Loya Mwajabu , Ngasala Sifa , Said Hamza , Muller Meredith S , Chhetri Srijana B , Yang Guozheng , François Ruthly , Odas Melic , Mathias Derrick , Juliano Jonathan J , Lin Feng-Chang , Ngasala Billy , Lin Jessica T
Published: May 2024

Background

Asymptomatic carriage of malaria parasites persists even as malaria transmission declines. Low-density infections are often submicroscopic, not detected with rapid diagnostic tests (RDTs) or microscopy but detectable by polymerase chain reaction (PCR).

Methods

To characterize submicroscopic Plasmodium falciparum carriage in an area of declining malaria transmission, asymptomatic persons >5 years of age in rural Bagamoyo District, Tanzania, were screened using RDT, microscopy, and PCR. We investigated the size of the submicroscopic reservoir of infection across villages, determined factors associated with submicroscopic carriage, and assessed the natural history of submicroscopic malaria over 4 weeks.

Results

Among 6076 participants, P. falciparum prevalences by RDT, microscopy, and PCR were 9%, 9%, and 28%, respectively, with roughly two-thirds of PCR-positive individuals harboring submicroscopic infection. Adult status, female sex, dry season months, screened windows, and bed net use were associated with submicroscopic carriage. Among 15 villages encompassing 80% of participants, the proportion of submicroscopic carriers increased with decreasing village-level malaria prevalence. Over 4 weeks, 23% of submicroscopic carriers (61 of 266) became RDT positive, with half exhibiting symptoms, while half (133 of 266) were no longer parasitemic at the end of 4 weeks. Progression to RDT-positive patent malaria occurred more frequently in villages with higher malaria prevalence.

Conclusions

Microheterogeneity in transmission observed at the village level appears to affect both the size of the submicroscopic reservoir and the likelihood of submicroscopic carriers developing patent malaria in coastal Tanzania.
Are medical history data fit for risk stratification of patients with chest pain in emergency care? Comparing data collected from patients using computerized history taking with data documented by physicians in the electronic health record in the CLEOS-CPDS prospective cohort study
Authors: Brandberg Helge , Sundberg Carl Johan , Spaak Jonas , Koch Sabine , Kahan Thomas
Published: May 2024

Objective

In acute chest pain management, risk stratification tools, including medical history, are recommended. We compared the fraction of patients with sufficient clinical data obtained using computerized history taking software (CHT) versus physician-acquired medical history to calculate established risk scores and assessed the patient-by-patient agreement between these 2 ways of obtaining medical history information.

Materials and methods

This was a prospective cohort study of clinically stable patients aged ≥ 18 years presenting to the emergency department (ED) at Danderyd University Hospital (Stockholm, Sweden) in 2017-2019 with acute chest pain and non-diagnostic ECG and serum markers. Medical histories were self-reported using CHT on a tablet. Observations on discrete variables in the risk scores were extracted from electronic health records (EHR) and the CHT database. The patient-by-patient agreement was described by Cohen’s kappa statistics.

Results

Of the total 1000 patients included (mean age 55.3 ± 17.4 years; 46% women), HEART score, EDACS, and T-MACS could be calculated in 75%, 74%, and 83% by CHT and in 31%, 10%, and 25% by EHR, respectively. The agreement between CHT and EHR was slight to moderate (kappa 0.19-0.70) for chest pain characteristics and moderate to almost perfect (kappa 0.55-0.91) for risk factors.

Conclusions

CHT can acquire and document data for chest pain risk stratification in most ED patients using established risk scores, achieving this goal for a substantially larger number of patients, as compared to EHR data. The agreement between CHT and physician-acquired history taking is high for traditional risk factors and lower for chest pain characteristics.

Clinical trial registration

ClinicalTrials.gov NCT03439449
The Discomfort of Things! Tidying-up and Decluttering in Consumers’ Homes
Authors: Gollnhofer Johanna F , Bhatnagar Kushagra , Manke Birte
Published: May 2024

Most relatively affluent consumers are fighting a losing battle with material disorder in their homes. No matter how hard they try to rein it in, material disorder always comes out on top. We argue that part of the continued obduracy of material disorder is because of its messy understanding. We clarify material disorder’s muddled conceptual boundaries by theorizing from an ethnographic investigation of consumers who recently dealt with material disorder through decluttering their homes. Leveraging twin analytical lenses that we label the possessive materialist and post-materialist lenses, we surface two distinct yet inter-dependent forms of disorder (disorder-as-untidiness and disorder-as-clutteredness) that together plague consumers’ homes. We contribute a pluralized understanding of material disorder, that is, disorders not disorder. We also offer novel insight into agentic struggles between consumers and home possessions over material dis/orders.
Evaluation of insecticide residues against spotted lanternfly (Hemiptera: Fulgoridae)
Authors: Nixon Laura J , Leskey Tracy C
Published: May 2024

Lycorma delicatula White (Hemiptera: Fulgoridae), spotted lanternfly, is a univoltine, phloem-feeding, polyphagous and invasive insect in the United States. Although a primary host for this species is Ailanthus altissima (Mill.) Swingle, tree of heaven, L. delicatula also feeds on many other plant species, including cultivated grapevines. As this species continues to spread, it is important to develop effective management tools. Here, we evaluated the residual efficacy of 4 insecticides commonly used in tree fruit management programs: dinotefuran, bifenthrin, carbaryl, and thiamethoxam. First, all mobile life stages (early instars, late instars, and adults) of L. delicatula were exposed for 1 h to dry insecticide residues (18 h old) applied to glass or A. altissima bark surfaces. While some mortality was detected immediately following the 1 h exposure period, 100% mortality occurred within 24 h for all materials and life stages exposed on both glass and bark surfaces. To evaluate longer residual activity of these materials, groups of adult L. delicatula were introduced into cages containing A. altissima trees treated with the same individual insecticides and exposed 6 h to residues that were 18 h or 7 days old. Paired, untreated A. altissima served as controls. In these bioassays, 48 h mortality for 18 h old residue reached 95% for thiamethoxam and 100% for bifenthrin and dinotefuran. Seven-day-old bifenthrin and dinotefuran residues again yielded 100% mortality, while thiamethoxam resulted in 58% mortality, and carbaryl yielded only 13.3% and was not significantly different from the control. These results clearly document the efficacy of specific insecticide applications as management tools against L. delicatula.
Sand Fly larvae are capable of positive chemotaxis: a proof of concept study using Phlebotomus papatasi (Diptera: Psychodidae) as a model species
Authors: Tsikolia Maia , Tsafrakidou Panagiota , Gkektsian Arsen , Miaoulis Michael , Rowland Tobin E , Chaskopoulou Alexandra
Published: May 2024

Phlebotomine sand flies are important vectors of medical and veterinary importance, transmitting pathogens, such as the Leishmania parasites, responsible for 700,000 to 1 million new cases of leishmaniasis every year. The vast majority of the current sand fly surveillance and control tools are tailored against the adult stages, due to the limited knowledge on the ecology of the larval stages. Since vector control is primarily an ecological problem, an in-depth understanding of the behavior of the target insect pests across all the different life stages of their development is required prior to the development of effective control strategies. It is well known that chemical cues play an important role in insect behavior. While there are numerous studies investigating the behavior of adult sand flies in response to chemical sources, there is currently no information available on the response of their larval stages. In this study, novel bioassays were constructed to investigate the effect of chemical cues (gustatory and olfactory) on the behavior of Phlebotomus papatasi (Scopoli) sand fly larvae. The larvae exhibited a clear food preference within a few hours of exposure in a 2-choice bioassay, while, also, demonstrated positive chemotaxis in response to volatile stimuli emitted from their preferred food source. Identification of the specific chemical compounds (or the combination thereof) eliciting attractance response to sand fly immature stages could lead to the development of innovative, and targeted (larval-specific) tools for the surveillance, and management of these important public health pests.
Interventions for insomnia in cancer patients and survivors—a comprehensive systematic review and meta-analysis
Authors: Nissen Eva Rames , Neumann Henrike , Knutzen Sofie Møgelberg , Henriksen Emilie Nørholm , Amidi Ali , Johansen Christoffer , von Heymann Annika , Christiansen Peer , Zachariae Robert
Published: May 2024

Background

Considering the persistent nature and higher prevalence of insomnia in cancer patients and survivors compared with the general population, there is a need for effective management strategies. This systematic review and meta-analysis aimed to comprehensively evaluate the available evidence for the efficacy of pharmacological and nonpharmacological interventions for insomnia in adult cancer patients and survivors.

Methods

Following the PRISMA guidelines, we analyzed data from 61 randomized controlled trials involving 6528 participants. Interventions included pharmacological, physical, and psychological treatments, with a focus on insomnia severity and secondary sleep and non-sleep outcomes. Frequentist and Bayesian analytical strategies were employed for data synthesis and interpretation.

Results

Cognitive-Behavioral Therapy for Insomnia (CBT-I) emerged as the most efficacious intervention for reducing insomnia severity in cancer survivors and further demonstrated significant improvements in fatigue, depressive symptoms, and anxiety. CBT-I showed a large postintervention effect (g = 0.86; 95% confidence interval [CI] = 0.57 to 1.15) and a medium effect at follow-up (g = 0.55; 95% CI = 0.18 to 0.92). Other interventions such as bright white light therapy, sleep medication, melatonin, exercise, mind-body therapies, and mindfulness-based therapies showed benefits, but the evidence for their efficacy was less convincing compared with CBT-I. Brief Behavioral Therapy for Insomnia showed promise as a less burdensome alternative for patients in active cancer treatment.

Conclusions

CBT-I is supported as a first-line treatment for insomnia in cancer survivors, with significant benefits observed across sleep and non-sleep outcomes. The findings also highlight the potential of less intensive alternatives. The research contributes valuable insights for clinical practice and underscores the need for further exploration into the complexities of sleep disturbances in cancer patients and survivors.
E-cadherin expression and gene expression profiles in corticotroph pituitary neuroendocrine tumor subtypes
Authors: Kiseljak-Vassiliades Katja , Lipe Kristin , Turin Christie G , Fishbein Lauren , Costello James C , Kerr Janice M , Holmstoen Tessa B , Youssef A Samy , Lillehei Kevin O , Kleinschmidt-DeMasters Bette K , Wierman Margaret E
Published: May 2024

Corticotroph adenomas/pituitary neuroendocrine tumors (PitNETs) are associated with significant morbidity and mortality. Predictors of tumor behavior have not shown high prognostic accuracy. For somatotroph adenomas/PitNETs, E-cadherin expression correlates strongly with prognosis. E-cadherin expression has not been investigated in other PitNETs. A retrospective chart review of adults with corticotroph adenomas/PitNETs was conducted to assess correlation between E-cadherin expression and tumor characteristics. In addition, gene expression microarray was performed in subset of tumors (n = 16). Seventy-seven patients were identified; 71% were female, with median age of cohort 45.2 years. Seventy-five percent had macroadenomas, of which 22% were hormonally active. Ninety-five percent of microadenomas were hormonally active. Adrenocorticotropic hormone granulation pattern by IHC identified 63% as densely granulated (DG) and 34% as sparsely granulated (SG). All microadenomas were DG (p < .001); 50% of macroadenomas were DG associated with increased tumor invasion compared to SG. E-cadherin IHC was positive in 80%, diminished in 17%, and absent in 20% and did not correlate with corticotroph PitNETs subtype, size, or prognosis. In contrast to the distinct transcriptomes of corticotroph PitNETs and normal pituitaries, a comparison of clinically active and silent corticotroph PitNETs demonstrated similar molecular signatures indicating their common origin, but with unique differences related to their secretory status.
A case of reverse amblyopia in a myopic anisometropic patient: an atypical presentation
Authors: AlTurki Hissah , Amir Amaar , AlShamlan Fatima , Emara Khalid , AlSahaf Esraa , Altaf Huda
Published: May 2024

We herein report a case of a 4-year-old female patient who presented with anisometropic amblyopia with initial visual acuity recorded at 20/400 OD and 20/100 OS. The patient was recommended for patching. Eighteen months later, the patient presented with visual acuity of 20/60 OD and 20/80 and reverse amblyopia was noted. In settings of amblyopia, where alternate patching may be used, it is most likely that reverse amblyopia, if present, will affect the more myopic eye. However, unexpectedly, in this case, reverse amblyopia occurred in the less myopic eye. With discontinuation of occlusion therapy and continued use of optical correction, the patients reverse amblyopia resolved and the visual equity equalized. To our knowledge, this is the first case described in the literature demonstrating such an occurrence. Awareness of this rare presentation by clinicians is of great importance to aid in correctly diagnosing and treating such patients.
Immigrants’ negotiation of the homeland and the hostland: Transnational transformation of perception and usage of Korean hagwons
Authors: Baik Eun Se
Published: May 2024

Focusing on Korean and Korean American usage of hagwons, popular private supplementary educational institutions native to Korea and transmitted to the USA, this article explores the transnational transformation of students’ and parents’ perception and experiences surrounding institutions transmitted from the migrant-sending society to the receiving society. While previous studies of immigrant-led ethnic institutions in the USA focus on these institutions as local institutions developed in the migrant-receiving society and operating in the receiving society contexts, immigrant-led institutions also include transnationally transmitted institutions originating from migrants’ ethnic homelands. Contextualizing immigrant-led ethnic institutions in a transnational framework, this study (1) traces how nonmigrant Koreans perceive and use hagwons in their origin society and (2) examines how (im)migrant Koreans negotiate homeland and hostland norms in navigating the transnationally transmitted institutions. In-depth interviews with nonmigrant and (im)migrant Korean students and parents in Seoul Metropolitan Area, Korea, and Greater Boston, the USA, reveal that immigrants integrate transnational and assimilative strategies in utilizing the transnationally transmitted institutions. Specifically, while deciding to use the tried-and-tested educational institutions transmitted from Korea to educate their second-generation children, immigrant Koreans utilize hagwons in ways that respond to the assimilative needs and constraints of the host society. While hagwons are uniquely Korean and Korean American institutions, their transnational transmission and transformation have implications for better understanding how immigrant experiences—in this case, education of immigrants and their children—are shaped at the intersection of the sending society and the receiving society influences.
Priority Competencies for Designated Education Officers in the Veterans Health Administration
Authors: Bidwell Duane R , Samuel Anita , Cervero Ronald M , Durning Steven J , Stephan Sherri L , Patel Erin L , Bowman Marjorie A , Meyer Holly S
Published: May 2024

Introduction

Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance.

Materials and Methods

Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that operationalizes competencies for more than 200 federal jobs.

Results

The research identified 25 primary competencies within 6 leadership domains. Five of the primary competencies cut across all leadership domains.

Conclusions

Veteran Health Administration subject-matter experts in educational leadership say the identified competencies are urgently needed, critical for effective leadership, and valuable for distinguishing superior DEO performance. The competencies are relevant to VHA and perhaps other senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. In military training facilities, attending to these competencies can help Designated Institutional Officials responsible for graduate medical education become more credible partners to other hospital leaders and contribute to becoming a high reliability organization. Executives identifying, recruiting, and appointing VHA DEOs and Designated Institutional Officials at military training facilities should consider these competencies when assessing candidates.
Emerging Trends in the Prevalence of Military Medicine Interest Groups and Specialty Tracks at U.S. Medical Schools
Authors: Keating III Donald P , Unrath Megan A , Steffes Rachel M , Guenther Timothy M , Beutel Bryan G
Published: May 2024

Introduction

A challenge confronting health care is the national physician shortage, notably impacting the DoD’s recruitment of military physicians. To address this, the Health Professions Scholarship Program is annually awarded to medical students to facilitate their transition into the U.S. Armed Forces. There is a glaring absence of military medical education in civilian schools to accommodate the unique interests of these students. While medical schools have adapted with interest groups and specialty tracks, the current presence of military medicine interest groups (MMIGs) and military medicine specialty tracks (MMSTs) remains under-explored. This study aimed to (1) update the prevalence of MMIGs in U.S. medical institutions, (2) identify the presence of MMSTs, and (3) compare military medicine involvement between allopathic and osteopathic programs.

Methods

The study was approved for exempt status from the Kansas City University Institutional Review Board (study number 20,211,568-1). In a cross-sectional analysis, surveys were sent to 208 U.S. medical schools, with responses from student services or available public data from 200 institutions included in the final analysis. A secondary survey was sent to respondents who provided MMIG or MMST contacts.

Results

Results indicated that 62% (n = 124/200) of schools currently have an established MMIG, a modest growth from 56% (n = 70/125) in 2015 (p = .14). MMST prevalence, however, is minimal at 2.5% (5/200). Osteopathic institutions demonstrated a significantly greater engagement in military medicine education (88.7%) compared to allopathic schools (52.4%) (p < .001).

Conclusion

This research underscores the need for comprehensive military medical training in medical schools to meet the interests and career aspirations of their students. Future studies should also evaluate the efficacy of MMIGs and MMSTs in preparing students for military medical roles.
Detection and characterization of icy cavities on the nucleus of comet 67P/Churyumov–Gerasimenko
Authors: Lamy Philippe , Faury Guillaume , Romeuf David , Groussin Olivier
Published: May 2024

We report on the detection of three icy cavities on the nucleus of comet 67P/Churyumov–Gerasimenko. They were identified on high-resolution anaglyphs built from images acquired by the Optical, Spectroscopic, and Infrared Remote Imaging System instrument aboard the Rosetta spacecraft on 2016 April 9 and 10. Visually, they appear as bright patches of typically 15 to 30 m across whose large reflectances and spectral slopes in the visible substantiate the presence of sub-surface water ice. Using a new high-resolution photogrammetric shape model, we determined the three-dimensional shape of these cavities whose depth ranges from 20 to 47 m. Spectral slopes were interpreted with models combining water ice and refractory dark material and the water ice abundances in the cavities were found to amount to a few per cent. The determination of the lifetime of the icy cavities was strongly biased by the availability of appropriate and favourable observations, but we found evidence of values of up to 2 yr. The icy cavities were found to be connected to jets well documented in past studies. A thermal model allowed us to track their solar insolation over a large part of the orbit of the comet and a transitory bright jet on 2015 July 18 was unambiguously linked to the brief illumination of the icy bottom of one of the cavities. These cavities are likely to be the first potential subsurface access points detected on a cometary nucleus and their lifetimes suggest that they reveal pristine sub-surface icy layers or pockets rather than recently recondensed water vapour.
Absence of nebular He ii λ4686 constrains the UV emission from the ultraluminous X-ray pulsar NGC 1313 X-2
Authors: Gúrpide A , Castro Segura N , Soria R , Middleton M
Published: May 2024

While much has been learned in recent decades about the X-ray emission of the extragalactic ultraluminous X-ray sources (ULXs), their radiative output in the ultraviolet (UV) band remains poorly constrained. Understanding of the full ULX spectral energy distribution (SED) is imperative to constrain the accretion flow geometry powering them, as well as their radiative power. Here we present constraints on the UV emission of the pulsating ULX (PULX) NGC 1313 X-2 based on the absence of nebular He ii λ4686 emission in its immediate environment. To this end, we first perform multiband spectroscopy of the ULX to derive three realistic extrapolations of the SED into the inaccessible UV, each predicting varying levels of UV luminosity. We then perform photoionization modelling of the bubble nebula and predict the He ii λ4686 fluxes that should have been observed based on each of the derived SEDs. We then compare these predictions with the derived upper limit on He ii λ4686 from the Multi-Unit Spectroscopic Explorer data, which allows us to infer a UV luminosity LUV ≲ 1 × 1039 erg s−1 in the PULX NGC 1313 X-2. Comparing the UV luminosity inferred with other ULXs, our work suggests there may be an intrinsic difference between hard and soft ULXs, either related to different mass-transfer rates and/or the nature of the accretor. However, a statistical sample of ULXs with inferred UV luminosities is needed to fully determine the distinguishing features between hard and soft ULXs. Finally, we discuss ULXs ionizing role in the context of the nebular He ii λ4686 line observed in star-forming metal-poor galaxies.
Numerical study on the interaction of AGN winds and interstellar medium
Authors: Zhu Yi , Yang Bo , He Guansheng , Jiang Chunhua , Lin Wenbin
Published: May 2024

Accretion disc winds can leave active galactic nuclei (AGNs) and interact with the interstellar medium (ISM) of their host galaxies. We perform two-dimensional numerical simulations to investigate the interaction of AGN winds and ISM. We study the properties of outflows in the 1–1000 pc region under different gravitational potentials and ISM gas densities, and compare these ionized outflows with the observed warm absorbers (WAs). We find that AGN winds drag the ISM and transfer their momentum/energy to the ISM. The properties of winds depend on the gas density of the initial ISM. The higher the initial ISM density, the lower the wind speed, and the narrower the opening angle of the winds. For the case of ρ0 = 10−25 g cm−3, the winds have the strongest intensity at the outer boundary. They can blow the ISM gas, giving feedback on star formation and galaxy evolution. We also find that the interaction of AGN winds and ISM can generate WAs in certain conditions and AGN winds play some roles in generating WAs.
Scattering model of scintillation arcs in pulsar secondary spectra
Authors: Kramer Tobias , Waltner Daniel , Heller Eric J , Stinebring Dan R
Published: May 2024

The dynamic spectra of pulsars frequently exhibit diverse interference patterns, often associated with parabolic arcs in the Fourier-transformed (secondary) spectra. Our approach differs from previous ones in two ways: first, we extend beyond the traditional Fresnel–Kirchhoff method by using the Green’s function of the Helmholtz equation, i.e. we consider spherical waves originating from three-dimensional space, not from a two-dimensional screen. Secondly, the discrete structures observed in the secondary spectrum result from discrete scatterer configurations, namely plasma concentrations in the interstellar medium, and not from the selection of points by the stationary phase approximation. Through advanced numerical techniques, we model both the dynamic and secondary spectra, providing a comprehensive framework that describes all components of the latter spectra in terms of physical quantities. Additionally, we provide a thorough analytical explanation of the secondary spectrum.
#1704 GLP-1RA versus DPP-4 inhibitors and rates of hyperkalemia and discontinuation of renin-angiotensin system (RAS) blockade in Swedish routine care
Authors: Xu Yang , Huang Tao , Bosi Alessandro , Faucon Anne-Laure , Fu Edouard , Carrero Juan-Jesus
Published: May 2024

Background and Aims

Emerging evidence suggest that glucagon-like peptide-1 receptor agonists (GLP-1RA) influence tubular handling of electrolytes and increase potassium excretion, which may translate into reduced risk of hyperkalemia. Hyperkalemia is a common complication that limits persistence on guideline-recommended RAS inhibitors (RASi). Here, we quantified and compared rates of hyperkalemia and RASi discontinuation among users of GLP-1RA versus dipeptidyl peptidase-4 inhibitors (DPP-4i) in a large healthcare system.

Method

We used data from the SCREAM project (Jan 2008-Dec 2021) to conduct a population-based active-comparator, new-user cohort study of adults with type-2 diabetes who started GLP-1RA or DPP-4i. The primary outcome was hyperkalemia occurrence, overall (plasma potassium>5.0 mmol/L) and by severity (mild -potassium >5-≤5.5 mmol/L- and moderate-severe -potassium >5.5 mmol/L- hyperkalemia). Among ongoing RASi users, we assessed time to RASi discontinuation through evaluation of subsequent RASi dispensations. Cox regression with inverse probability of treatment weighting (IPTW) was used to estimate pooled hazard ratios (HRs) and rate differences. Major cardiovascular events (MACEs) served as positive control outcome to evaluate unmeasured confounding bias.

Results

During a median follow-up of 3.0 (Interquartile range [IQR] 1.2-5.6) years, we identified 33 280 eligible participants, of which 13 633 started GLP-1RA and 19 647 DPP-4i. Mean age was 64 years and 40% were women. Compared with DPP-4i, starting GLP-1RA was associated with a lower rate of hyperkalemia (Hazard ratio [HR] 0.91; 95% CI: 0.84-0.99, Fig. 1), with no suggestion of effect modification by baseline eGFR strata (HR 0.91 (0.78-1.07) for eGFR ≥60 and HR 0.92 (0.83-1.01) for eGFR <60 ml/min/1.73 m2, P for interaction >0.05). Similar findings were observed for mild (HR 0.90; 0.83-0.98) and moderate-severe (HR 0.92; 0.80-1.06) hyperkalemia. Out of 21 751 participants that were using RASi, 8 463 discontinued this therapy during median 2.0 (0.7, 4.1) years of follow-up. Initiation of GLP-1RA vs. DPP-4i was associated with lower rate of RASi discontinuation (HR: 0.93; 0.87-0.98), with no interaction across strata of baseline eGFR (HR 0.97 (0.83-1.12) for eGFR ≥60 and HR 0.93 (0.87-0.99) for <60 ml/min/1.73 m2, P for interaction >0.05). Consistent with trial evidence, we observed a lower rate of MACE for GLP-1RA vs DPP-4i (HR 0.87; 0.78-0.98).

Conclusion

In patients with diabetes managed in routine care, the use of GLP-1RA was associated with lower rates of hyperkalemia and discontinuation of RASi compared with DPP-4i, providing further observational evidence in support of the use of these medications.
#1398 Linezolid adsorption during in vitro model of hemoadsorption with mini-module of HA380 cartridge
Authors: Perin Natascha , Lorenzin Anna , de Cal Massimo , Ronco Claudio , Zanella Monica
Published: May 2024

Background and Aims

Septic shock is one of the most frequent causes in Intensive Care Unit (ICU) admission and is related to a very high risk of mortality. About one third of patients with sepsis develops acute kidney injury (AKI) which contributes to a worsening prognosis. AKI due to sepsis is the result of a dysregulated host immune response to infection, with the production of inflammatory mediators and cytokines that cause hemodynamic alterations, endothelial damage, apoptosis and, finally, immunoparalysis. The Jafron HA380 cartridge has been specifically designed for use in clinical conditions characterized by cytokine storm such as sepsis. Given the growing application of these hemoadsorption device in cases of septic AKI in ICU, an unsolved problem is whether these polymers adsorb drugs, including antibiotics. In vitro experiments were conducted to determine its adsorption capacity towards Linezolid (LZD) antibiotic.

Method

In vitro circulation was performed using a dedicated testing platform Galileo. A customized cartridge was built assembling mini-module components scaled in dimension towards HA380 and filled with 75 g of HA380 beads (25% of the regular size cartridge). Peristaltic pump was set at 250 mL/min. Four circulations were performed varying the initial mass of Linezolid in the tested solution (200, 400, 600, 1200 mg). Samples were collected after the first passage (FP) through the cartridge and every 5 or 10 minutes and Linezolid concentrations were measured. Adsorption was assessed considering the Removal Ratio (RR) and its kinetics.

Results

In vitro circulation confirms the affinity of beads material in binding Linezolid molecules. The kinetics shows an instantaneous and rapid adsorption in the very first part of the experiments. After that the adsorption rate decreases due to the decrease of antibiotic available in the solution. Among all the experiments, after the first passage of the solution through the cartridge, a RR higher than 70% has been achieved. After 100 passages of the solution into the cartridge, the adsorption reached about the 100% of RR. None of the amounts of Linezolid tested led to the cartridge saturation. A linear behavior between the mass injected in the solution and the mass adsorbed can be ascribable to the linear phase of Langmuir isotherm (see Fig.).

Conclusion

HA380 adsorbs significant amounts of Linezolid. The linear trend of the isotherm reveals a direct proportionality between binding sites of the sorbent material and the Linezolid tested. Further investigation using a higher quantity of Linezolid is necessary to reach the saturation of the cartridge and to understand the sorbent material capacity. These preliminary results highlight that there is an interaction that could affect the clinical outcome.
#699 Diagnostic accuracy of the Modified Renal Angina Index (mRAI) for predicting acute kidney injury among critically ill Filipino adults
Authors: Alas Karla Patricia , Pasilan Renz Michael
Published: May 2024

Background and Aims

The proposed mRAI (modified renal angina index) (Fig. 1) predicts moderate to severe AKI within the first 7 days of ICU stay which outperforms serum creatinine and urine output. The use of the mRAI in AKI may be warranted to improve predicted performance of AKI biomarkers. The study aims to evaluate the diagnostic accuracy of modified renal angina index in predicting Acute Kidney Injury (AKI) among Critically ill Adult Filipino patient in a Tertiary Institution and its association with in hospital MAKE (Major Adverse Kidney Events).

Method

A retrospective cohort study including all adult critically ill patients, they were dichotomized into “low” (<10) or “high risk” (>10) based on the mRAI score upon the 1st ICU admission (Day 0-24 hr) during the hospital stay. Inclusion criteria: age >18 years old, ICU patients between 2019-2022. Exclusion criteria: Chronic Kidney Disease (Egfr <30 ml/min), Transplant recipients, HIV/Cancer, <48 hrs ICU stay, little changes in creatinine (<2x from baseline between Day 0-24 hr ICU admission). The composite outcome is achieved if at least one is met during the index of hospitalization: All-cause mortality prior to discharge or after ICU admission, New onset of renal replacement therapy (RRT), persistent renal dysfunction.

The sensitivity, specificity, predictive values and area under the curve is used to determine diagnostic accuracy of the mRAI Scoring and its association with in Hospital MAKE. Simple and multiple logistic regression analysis is used to control the effect of confounders in determining the association of mRAI to AKI. SPSS version 20 will be used in the analysis.

Results

Using a cut off score of 10, the mRAI show 84.29% sensitivity, 76.06% specificity, 77.63%, PPV 83.08% NPV 80.14% and AUC 80.14% in predicting moderate to severe AKI (Fig. 2). A mRAI of >10 is associated with in hospital MAKE showing a 97.14% sensitivity, 67.61% specificity, 74.73% PPV, 96.0% NPV, and AUC 82.27% (Fig. 3). Among the high risk group there were 68 (97.1%) who had MAKE, 62 (88.6%) new onset RRT, 12% (17.1%) died within 7 days of ICU admission, 64 (91.4%) persistent renal dysfunction (Fig. 4).

Conclusion

The proposed score can be applied among critically ill adult Filipino patients which is an easy bedside tool for identification of moderate to severe AKI. mRAI constitutes a sensitive test with a high negative predictive, affirming its capability being a screening test, complementary to laboratory parameters and clinical judgement. We also found out that a mRAI score of >10 is associated with In-Hospital Major Adverse Kidney Events.
#2668 New treatments, new challenges: nephrotoxicity associated to naxitamab in patients with high-risk neuroblastoma
Authors: Sancho Pedro Arango , Rodríguez Ana Cristina Aguilar , Espinoza Yarima López , Marín Emma Fortes , Pérez Juan Pablo Muñoz , Obanos Maite Gorostegui , Baños Yolanda Calzada , Báez Víctor Alfonso López , Moreno Marta Jiménez , Sampera Elena Codina , Aris Álvaro Madrid , Mora Jaume
Published: May 2024

Background and Aims

Neuroblastoma is the most common extracranial solid tumor in children, harboring a poor survival for those with high-risk (HR) tumors. Naxitamab (hu3F8) is a humanized monoclonal anti-disialoganglioside (GD2) antibody approved for the treatment of patients older than 1-year with refractory/relapsed HR-neuroblastoma limited to bone and/or bone marrow. First naxitamab (DanyelzaR) infusion was in 2017 in our institution and since then a large experience has been acquired with its use through several clinical trials as well as an expanded named patient access program. The objective is to describe the renal toxicity profile associated to naxitamab in patients with HR-neuroblastoma.

Method

Retrospective descriptive study including 244 patients treated with naxitamab (either on monotherapy or associated to chemotherapy) from June 2017 to December 2022 in whom renal involvement and/or hypertension (HT) was evaluated.

Results

Mean age of the cohort was 8 years (41% female -101- and 59% male -143-), presenting nephrotoxicity of some type up to 26.6% (n = 65): AHT (11.9%), acute renal damage (ARD 10.2%) and proteinuria (5.3%), developing all during the first 3 cycles. All of them were classified as mild adverse events (1-2) according to the Common Terminology Criteria for Adverse Events (CTCAE) scale, except for one patient with ARD grade 3 and two patients with HT grade 3. In the case of HT only in 6 patients an Ambulatory Blood Pressure Monitoring (ABPM) was performed, observing: 2 nocturnal-HT, 2 diurnal-HT without specific-pattern and 2 disautonomic-patterns. Among the ARD, all cases were tubular except for two patients who presented acute tubule-interstitial nephritis (AIN) (one with clinical-analytical pattern and another confirmed by biopsy). Eight of them (32%) had potential confounding factors (previous chemotherapy, ibuprofen or radiotherapy). Among patients with proteinuria (none in the nephrotic range): 38% tubular, 38% glomerular and 23% mixed. Two patients presented ARD + HT and 3 a combination of HT + ARD + proteinuria. All patients received prior chemotherapy and 2 developing chronic renal damage (CKD stage 2 and 3).

Conclusion

Short-and long-term follow-up, the systematic performance of ABPM, and the use of early markers of renal damage, could lead to a more efficient management of complications derived from this new treatment.
#2295 Can we detect the evolution of GFR with estimated GFR in patients with ADPKD?
Authors: Miquel Rosa , Luis-Lima Sergio , Mallén Patricia Isabel Delgado , Torres Sara Estupiñan , Caso Maria Angeles Cobo , Martin Laura Díaz , Rodríguez Silvana , Cruz Coriolano , Rinne Federico González , Hernández Domingo , Porrini Esteban
Published: May 2024

Background and Aims

ADPKD affects about 10% of the patients with CKD. In the disease the formation of cysts replace normal renal parenchyma leading to renal function loss. The evolution of the disease is irregular: some patients lose renal function very fast while others remain stable or have a slow loss. This may have consequences in clinical care. In day-to-day practice, GFR is evaluated by means of formulas, which are algorithms that use creatinine and others markers like age and gender to estimate GFR. However, the accuracy and precision of eGFR in reflecting real GFR in ADPKD is not clear, being this the objective of our study.

Method

To analyse the capacity of eGFR by creatinine-based formulas in predicting mGFR changes over time. We evaluated patients with ADPKD, who underwent mGFR and eGFR by a group 5 equations at baseline, month 6 and then annually. mGFR was evaluated by the clearance of iohexol using dried blood spots (iohexol-DBS) and eGFR with the following creatinine-based equations: Cockcroft-Gault, aMDRD, CKD-EPI, FAS and EKFC. We calculated renal function decline (GFR decline) using repeated measured with mGFR and eGFR. All subjects have at least 3 repeated evaluations of renal function. The agreement between mGFR and eGFR declines was analysed by the concordance correlation coefficient (CCC). Also, we evaluated the capacity of eGFR decline in detecting diverse degree of GFR decline (a) rapid progressors: mGFR of −5 ml/min/y; (b) moderate progressors: −2 to −5 ml/min/y; (c) stable: > −2 ml/min/y.

Results

We evaluated 111 (43; 37% men); age: 42 y ± 14, with a 5 ± 1 evaluations of GFR over time (mGFR and eGFR). The average GFR decline was: −2,8 ml/min/year (mGFR); −3,1 (Cockcroft-Gault), −2,9 (aMDRD), −3,0 (CKD-EPI), −2,8 (FAS) and −2,6 (EFKC) According with mGFR decline, 21 patients (19%) were rapid progressors; 46 (41%) moderate progressors and 44 (40%) stable. The agreement between eGFR decline and mGFR decline was poor, reflected by a low CCC: 0.37 (Cockcroft-Gault); 0.76 (aMDRD); 0.80 (CKD-EPI), 0.77 (FAS); 0.81 (EFKC). In general, eGFR decline failed to detect progression of renal function over time. On average, 43% of the rapid progressors, 53% of the moderate progressors and 54% of the stable patients were not detected by any formula, respectively. Finally, a total of 12% and 6% of those stable or moderate progressors were falsely classified as rapid progressors.

Conclusion

eGFR is not able to reflect properly renal function changes over time in patients with ADPKP in about half of the patients. A relevant number of cases are erroneously considered as rapid progressors or even stable patients. This may have clinical consequences. Whenever possible, mGFR could be considered in this population.