bluuebunny/crossref_metadata_2025 huggingface dataset:
P097 The Fate of Obstructive Sleep Apnea in Long-term
Authors: Jang H , Lee J , Ryu U , Park D , Mun S
Published: October 2023

Objective

This study aims to investigate the relationships of the severity of OSA and the long-term results of OSA in untreated patients and to compare them with the results of OSA patients who were operated.

Materials and Methods

The study retrospectively analyzed medical records of 79 individuals who were diagnosed with OSA, who either underwent surgical treatment or received no treatment from 2009 to 2022. Among the patients who underwent polysomnography (PSG) twice, the patients were subdivided by mild, moderate, severe groups according to apnea-hypopnea index (AHI) and the changes in OSA severity over time were compared.

Results

This study included 43 patients (54%) who received no treatment and 36 patients (46%) who had undergone surgery including tonsillectomy with or without uvula or palatopharyngeal procedures. Among the untreated patients, there was no significant changes in AHI values over time for the overall group, the mild and severe subgroups, but the moderate group showed a significant increase in AHI values (p=0.017). Surgical treatment, specifically tonsillectomy, resulted in a significant decrease in AHI values compared to untreated patients, particularly within 36 months after the procedure (p=0.000). However, for patients with a follow-up period of more than 36 months, the difference in AHI values was not statistically significant between those who underwent tonsillectomy and those who did not.

Conclusions

Untreated moderate OSA patients show worsening of AHI values over time, highlighting the need for proactive treatment. Surgical intervention can reduce AHI values within 36 months but may lead to worsening of symptoms afterwards.
P101 Brain Amyloid Burden and Autobiographical Memory in Obstructive Sleep Apnoea: A Cross-sectional Study.
Authors: Rawson G , Cavuoto M , Tolson J , O'Donoghue F , Barnes M , Howard M , Rowe C , Robinson S , Jackson M
Published: October 2023

Introduction

Emerging literature reports an increased risk of Alzheimer’s disease in individuals with obstructive sleep apnoea (OSA). Established characteristics of Alzheimer’s disease include increased brain amyloid burden and impairment to episodic and autobiographical memory. Investigating these constructs in individuals with clinically confirmed OSA will contribute to understanding of OSA and neuronal implications.

Aim

The aim of the study was to explore the relationship between brain amyloid burden and autobiographical memory in cognitively-healthy individuals with OSA.

Methods

Thirty-four participants with OSA (mean age=57.7, SD=8.5, 19 males), and 12 controls (mean age=57.1, SD=8.1, 6 males) participated in the study. Participants underwent a 11C-PiB positron emission tomography (PET) scan to quantify amyloid burden, and an assessment of autobiographical memory. Brain amyloid burden was quantified using the standardised uptake value ratio (SUVR), and the Autobiographical Memory Test (AMT) was used to assess the ability of participants to recall specific memories from their life.

Results

Individuals with OSA recalled significantly fewer specific autobiographical memories (M=6.66, SD=2.91) compared to controls (M=10.25, SD=2.09, t(45)=-3.930, p<.001). There was no significant difference in SUVR between groups, t(44)=1.465, p=.150. Recall of non-specific memories was significantly positively correlated with SUVR, r=.331, p=.026.

Discussion

Levels of brain amyloid burden did not differ significantly between groups however the results support existing literature suggesting amyloid burden is associated with autobiographical memory in individuals with OSA. Longitudinal studies investigating the trajectory of these constructs in the context of disease development should be conducted to further explore the impacts of OSA.
P103 Utility of Capillary Blood Gases (CBGs) for measuring gas exchange in the Sleep Laboratory.
Authors: Slater D , Veldre T , Urban M , Figurski D , Huang H
Published: October 2023

Introduction

Arterial Blood Gases (ABGs) are used for assessing respiratory failure in clinical practice. ABGs also provide a useful verification tool for nocturnal Transcutaneous Carbon Dioxide (TcCO2) measurements. However, there are known complications to collecting ABGs. Conversely, CBG is less invasive and more accessible to clinical practice. We assessed CBGs as an alternative to ABGs to measure pCO2 and pO2, and its suitability for verifying TcCO2. We hypothesised that CBG sampling would be suitable for TcCO2 verification and would be a suitable ABG surrogate.

Methods

ABGs were sampled by Resident Medical Officers (RMOs) and CBGs were sampled by Sleep Scientists to validate TcCO2 at awake. Correlation between measures was assessed via Pearson and Spearman coefficients. ρ > 0.6 demonstrate a moderate positive correlation, with strengthening correlation as ρ approaches 1. Agreement between measurements was assessed via Bland-Altman plots.

Results

There was a moderately strong correlation between CBG vs TcCO2 (n=125) (ρ = 0.694, p < 0.001) and CBG vs ABG (pCO2) (n=29) (ρ = 0.725, p < 0.001), with a strong correlation for ABG vs TcCO2 (n=81) (ρ = 0.847, p < 0.001). Bland-Altman plots showed agreement between CBG, ABG and TcCO2.

Conclusions

There were strong positive correlations observed, with agreement seen across all measures of pCO2. This analysis demonstrates both the accuracy of nocturnal TcCO2 and the utility of CBG to verify TcCO2. Surrogate CO2 measures support positive patient outcomes and verification of gas exchange.
Hypoxemia Trajectory of Non-COVID-19 Acute Respiratory Distress Syndrome Patients. An Observational Study Focusing on Hypoxemia Resolver Status
Authors: Toal Connor M. , Fowler Alexander J. , Patel Brijesh V. , Puthucheary Zudin , Prowle John R.
Published: October 2023

IMPORTANCE:

Most studies on acute respiratory distress syndrome (ARDS) group patients by severity based on their initial degree of hypoxemia. However, this grouping has limitations, including inconsistent hypoxemia trajectories and outcomes.

OBJECTIVES:

This study explores the benefits of grouping patients by resolver status based on their hypoxemia progression over the first 7 days.

DESIGN, SETTING, AND PARTICIPANTS:

This is an observational study from a large single-center database. Medical Information Mart for Intensive Care (MIMIC)-IV and MIMIC Chest X-ray JPEG databases were used. Mechanically ventilated patients that met the Berlin ARDS criteria were included.

MAIN OUTCOMES AND MEASURES:

The primary outcome was the proportion of hypoxemia resolvers vs. nonresolvers in non-COVID-19 ARDS patients. Nonresolvers were defined as those whose hypoxemia worsened or remained moderate or severe over the first 7 days. Secondary outcomes included baseline admission characteristics, initial blood gases and ventilation settings, length of invasive mechanical ventilation, length of ICU stay, and ICU survival rates across resolver groups.

RESULTS:

A total of 894 ICU admissions were included in the study. Of these, 33.9% were hypoxemia nonresolvers. The resolver groups showed no significant difference in age, body mass index, comorbidities, or Charlson score. There was no significant difference in the percentage of those with initial severe hypoxemia between the two groups (8.1% vs. 9.2%; p = 0.126). The initial Pao
2/Fio
2 ratio did not significantly increase the odds ratio (OR) of being a nonresolver (OR, 0.84; 95% CI, 0.65–1.10). Nonresolver mortality was 61.4%, comparable to the survival rates seen in nonresolvers in a previous large COVID-19 ARDS study.

CONCLUSIONS AND RELEVANCE:

Our study shows that resolver status is a valuable grouping in ARDS. It has significant advantages over grouping by initial degree of hypoxemia, including better mapping of trajectory and comparable outcomes across other studies. While it may offer insights into disease-specific associations, future studies should include resolver status analysis for more definitive conclusions.
Association of hepatitis delta virus with liver morbidity and mortality: A systematic literature review and meta-analysis
Authors: Gish Robert G. , Wong Robert J. , Di Tanna Gian Luca , Kaushik Ankita , Kim Chong , Smith Nathaniel J. , Kennedy Patrick T.F.
Published: October 2023

Background and Aims:

Studies have suggested that patients with chronic hepatitis B, either co- or superinfected, have more aggressive liver disease progression than those with the HDV. This systematic literature review and meta-analysis examined whether HDV RNA status is associated with increased risk of advanced liver disease events in patients who are HBsAg and HDV antibody positive.

Approach and Results:

A total of 12 publications were included. Relative rates of progression to advanced liver disease event for HDV RNA+/detectable versus HDV RNA−/undetectable were extracted for analysis. Reported OR and HRs with 95% CI were pooled using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. The presence of HDV RNA+ was associated with an increased risk of any advanced liver disease event [random effect (95% CI): risk ratio: 1.48 (0.93, 2.33); HR: 2.62 (1.55, 4.44)]. When compared to the patients with HDV RNA− status, HDV RNA+ was associated with a significantly higher risk of progressing to compensated cirrhosis [risk ratio: 1.74 (1.24, 2.45)] decompensated cirrhosis [HR: 3.82 (1.60, 9.10)], HCC [HR: 2.97 (1.87, 4.70)], liver transplantation [HR: 7.07 (1.61, 30.99)], and liver-related mortality [HR: 3.78 (2.18, 6.56)].

Conclusions:

The patients with HDV RNA+ status have a significantly greater risk of liver disease progression than the patients who are HDV RNA−. These findings highlight the need for improved HDV screening and linkage to treatment to reduce the risk of liver-related morbidity and mortality.
Central corneal distortion after small-incision lenticule extraction
Authors: Moshirfar Majid , Zhang Stephanie , Pandya Shreya , Murri Michael , Hura Arjan , Zhu Dagny , Mehta Jod S. , Liu Yu Chi , Ganesh Sri , Kim Gene
Published: October 2023

A 33-year-old woman with a prior history of small-incision lenticule extraction (SMILE) presented with gradual deterioration of vision in her right eye since the surgery. She had undergone bilateral SMILE for myopic correction (−7.00 diopters [D] in the right eye and −6.00 D in the left eye) 3 weeks prior. SMILE was performed with a Zeiss VisuMax femtosecond laser system, with a cap thickness of 120 µm, a cap diameter of 7.50 mm, and a lenticule diameter of 6.50 mm. At the completion of the surgery, loose epithelium was noted at the SMILE incision bilaterally, and bandage contact lenses were placed in both eyes.

On the first postoperative day, the patient's uncorrected distance visual acuity (UDVA) was 20/40 in both eyes. The bandage lenses were removed from both eyes, with the epithelium intact. At the first-week postoperative visit, her visual acuity was recorded as 20/30 in the right eye and 20/20 in the left eye. She noticed her vision in the right eye was not as sharp as that in her left eye. She denied experiencing any pain, redness, or ocular surface irritations. She was advised to return to the clinic for a 1-month postoperative visit and continue with aggressive lubrication in both eyes.

However, a week later, the patient returned for an emergency visit, citing significant central visual distortion in the right eye and difficulty working on the computer. At this visit, her UDVA and corrected distance visual acuity (CDVA) was 20/50 in the right eye and 20/15 in the left eye at both near and far distances. A slitlamp examination revealed mild central changes in the right eye. She once again denied any pain, redness, or irritation. She was advised to continue with artificial tears and return to the office in 1 week for further observation of the central distortion in her right eye.

Upon returning to the clinic at the third postoperative week, the patient still complained of central visual changes in the right eye, with a visual acuity of 20/70. Further slitlamp examination revealed a nonspecific central haze in the same eye, but there was no corneal staining or signs of epithelial defects. Anterior segment ocular coherence tomography (AS-OCT) and NIDEK topography were performed, showing the same central distortion in the right eye (Figures 1 and 2

JOURNAL/jcrs/04.03/02158034-202311000-00016/figure1/v/2023-11-02T191830Z/r/image-tiff

JOURNAL/jcrs/04.03/02158034-202311000-00016/figure2/v/2023-11-02T191830Z/r/image-tiff

).

Based on the examination and images provided, what is your working medical diagnosis? What other medical conditions are in your differential diagnosis? What medical and/or surgical interventions would you recommend, if any?
A systematic review of self and observer assessment of pain and related functioning in youth with brain-based developmental disabilities
Authors: Noyek Samantha , Jessa Jenna S. , Faulkner Violeta , Boerner Katelynn E. , Dewan Tammie , Doyle Dacey , Genik Lara , Grainger-Schatz Stacy , McMorris Carly , McMurtry C. Meghan , Nania Cara G. , Oberlander Tim , Lorenzetti Diane , Turner Kailyn , Birnie Kathryn A.
Published: October 2023

Pain experiences of youth with brain-based developmental disabilities are often overlooked and/or misinterpreted, increasing the risk for poor or inadequate pain assessment and management. Ample measures exist to assess acute and chronic pain, yet their utility and frequency of use in youth with brain-based developmental disabilities is unclear and available measures do not have strong measurement properties for this diverse group. This systematic review identified the scope of self-reported and observer-reported pain assessment in studies of youth (aged 3-24 years) with brain-based developmental disabilities (phase 1) and summarized other measures of pain-related functioning for acute and chronic pain (ie, physical, emotional, social, sleep, and quality of life, within the subset of quantitative studies focused primarily on pain, phase 2). A comprehensive search for English-language studies was conducted in August 2022 in Web of Science, CINAHL, MEDLINE, Cochrane CENTRAL, EMBASE, and APA PsychINFO (PROSPERO registration: CRD42021237444). A total of 17,029 unique records were screened. Of the 707 articles included in phase 1, most assessed chronic pain (n = 314; 62.0%) and primarily used observer-report (n = 155; 31%) over self-report (n = 67; 13%). Of the 137 articles included in phase 2, other outcomes assessed alongside pain intensity included motor ability (16.8%), adaptive functioning (11%), quality of life (8%), pain interference (6.6%), mental health (5.8%), and communication ability (2.9%). Cerebral palsy was the most common population in both phase 1 (n = 343; 48.5%) and phase 2 (n = 83; 59.7%). This review provides a foundational understanding of pain assessment in brain-based developmental disabilities and highlights continued inequities in holistic pain assessment for this population.
Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis
Authors: Lascurain-Aguirrebeña Ion , Dominguez Laura , Villanueva-Ruiz Iker , Ballesteros Javier , Rueda-Etxeberria Mikel , Rueda Jose-Ramón , Casado-Zumeta Xabat , Araolaza-Arrieta Maialen , Arbillaga-Etxarri Ane , Tampin Brigitte
Published: October 2023

Neural mobilisations (NM) have been advocated for the treatment of nerve-related cervicobrachial pain; however, it is unclear what types of patients with nerve-related cervicobrachial pain (if any) may benefit. Medline, Web of Science, Scopus, PeDro, Cinahl, and Cochrane databases were searched from inception until December 2022. Randomised controlled trials were included if they assessed the effectiveness of NM in nerve-related cervicobrachial pain, and outcome measures were pain intensity and/or disability. Studies were classified according to their inclusion/exclusion criteria asradiculopathy,Wainner cluster,Hall,and Elvey clusterorother. Meta-analyses with subgroup analyses were performed. Risk of bias was assessed using Cochrane Rob2 tool. Twenty-seven studies were included. For pain and disability reduction, NM was found to be more effective than no treatment (pooled pain mean difference [MD] = −2.81, 95% confidence interval [CI] = −3.81 to −1.81; pooled disability standardized mean difference = −1.55, 95% CI = −2.72 to −0.37), increased the effectiveness of standard physiotherapy as an adjuvant when compared with standard physiotherapy alone (pooled pain MD = −1.44, 95% CI = −1.98 to −0.89; pooled disability MD = −11.07, 95% CI = −16.38 to −5.75) but was no more effective than cervical traction (pooled pain MD = −0.33, 95% CI = −1.35 to 0.68; pooled disability MD = −10.09, 95% CI = −21.89 to 1.81). For disability reduction, NM was found to be more effective than exercise (pooled MD = −18.27, 95% CI = −20.29 to −17.44). In most comparisons, there were significant differences in the effectiveness of NM between the subgroups. Neural mobilisations was consistently more effective than all alternative interventions (no treatment, traction, exercise, and standard physiotherapy alone) in 13 studies classified asWainner cluster. PROSPERO registration: CRD42022376087.
Surge of Midazolam Use in the Midst of Lorazepam Shortage
Authors: Liu Tonia T. , Frost Emma D. , Donlon Jack , Gandhi Roshni M. , Mohammadi Tarannum , Murray Briana P. , Shad Mujeeb U. , Koola Maju Mathew
Published: October 2023

Background

Lorazepam is a widely prescribed benzodiazepine that is used to manage anxiety, insomnia, and status epilepticus and is used for pre-anesthetic care as well as several off-label indications including aggression, alcohol withdrawal, panic disorder, chemotherapy-associated anticipatory nausea, and catatonia. Recent increases in demand, manufacturing changes, and quality control issues have resulted in a shortage of injectable and oral lorazepam, prompting clinicians to use alternatives. One such alternative is midazolam, a drug that has been used primarily in the intensive care unit and anesthesia settings.

Procedures

This article examines the significant pharmacologic differences between lorazepam and midazolam. In addition, this article provides dosage guidelines based on the current scientific knowledge and recommendations for conversion equivalencies.

Results

The clinical preference for lorazepam can be attributed to its simpler metabolism with no active metabolites, better suitability for patients with less severe hepatic and renal impairment, less risk of adverse reactions, fewer drug-drug interactions, and greater desirability for special populations. In periods of shortages, midazolam has been shown to be effective for a number of off-label uses. To manage conditions that have not been extensively studied, clinicians may opt to use conversion equivalencies, with the caveat that guidelines may vary greatly between institutions and online sources; therefore, it would be best to start low and titrate slowly.

Conclusions

Our goal is to aid clinicians in safely and effectively prescribing midazolam during the shortage of injectable lorazepam so that patients are provided the same effects and benefits.
Occupational Health Providers’ Perceptions of Employee Vaccine Hesitancy
Authors: Dooley Cara E. , Saif Nadia T. , Hodorowicz Mary T. , Doyle Mary L. , Gucer Patricia W. , Edwards Lori A. , Cloeren Marianne
Published: October 2023

Objective

This study examined the perspectives of occupational health providers (OHPs) on the most frequently encountered clinically relevant reasons for employee vaccine hesitancy.

Methods

We conducted an anonymous, online, cross-sectional survey of US OHPs (N = 217). The survey asked OHPs about the major reasons that employees cite for being unwilling to receive the following three categories of vaccines: COVID-19, annual influenza, and others relevant to the workplace.

Results

Concern about adverse effects was the most frequently reported reason for employee vaccine hesitancy for each vaccine category. Mistrust was reported more frequently for COVID-19 than for the influenza vaccine or other vaccines (χ2
P < 0.05). Targets of employee mistrust included government and researchers or scientists, but mistrust of healthcare providers was uncommon.

Conclusions

These results can be used to inform interventions to address vaccine hesitancy in the occupational health setting.
Management of Patients Receiving Antiplatelet Therapy During Gastroenterological Surgery
Authors: Fujikawa Takahisa , Hasegawa Suguru , Takahashi Ryo , Naito Shigetoshi , Kaihara Satoshi , Uryuhara Kenji , Hirata Keiji , Tamura Toshihisa , Terajima Hiroaki , Kawai Takayuki , Okabe Hiroshi , Machimoto Takafumi , Tanaka Hirokazu , Honma Shusaku , Furumoto Katsuyoshi , Honda Goro , Uemura Shuichiro , Nishitai Ryuta , Hida Koya , Aoyama Ryuhei , Wada Seidai , Hirose Tetsuro , Obama Kazutaka
Published: October 2023

Objective:

This study aimed to evaluate the effect of continuing preoperative aspirin monotherapy on surgical outcomes in patients receiving antiplatelet therapy (APT).

Summary Background Data:

The effectiveness of continuing preoperative aspirin monotherapy in patients undergoing APT in preventing thromboembolic consequences is mostly unknown.

Methods:

This prospective multicenter cohort study on the Safety and Feasibility of Gastroenterological Surgery in Patients Undergoing Antithrombotic Therapy (GSATT study) conducted at 14 clinical centers enrolled and screened patients between October 2019 and December 2021. The participants (n=1,170) were assigned to the continued APT group, discontinued APT group, or non-APT group, and the surgical outcomes of each group were compared. Propensity score matching was performed between the continued and discontinued APT groups to investigate the effect of continuing preoperative aspirin therapy on thromboembolic complications.

Results:

The rate of thromboembolic complications in the continued APT group was substantially lower than that in the non-APT or discontinued APT groups (0.5% vs. 2.6% vs. 2.9%; P=0.027). Multivariate investigation of the entire cohort revealed that discontinuation of APT (P<0.001) and chronic anticoagulant use (P<0.001) were independent risk factors for postoperative thromboembolism. The post-matching evaluation demonstrated that the rates of thromboembolic complications were significantly different between the continued and discontinued APT groups (0.6% vs. 3.3%; P=0.012).

Conclusions:

APT discontinuation following elective gastroenterological surgery increases the risk of thromboembolic consequences, whereas continuing preoperative aspirin greatly reduces this risk. The continuation of preoperative aspirin therapy in APT-received patients is considered one of the best alternatives for preventing thromboembolism during elective gastroenterological surgery.
Why some Patients Benefit from Participating in a Sham Surgery Trial
Authors: Abbasi Ali , Cifu Adam S.
Published: October 2023

Objective:

We analyze the ethics of sham surgical trials from a utilitarian perspective and explore whether patients can benefit from participating in these trials.

Summary Background Data:

Sham-controlled randomized trials are an essential tool to evaluate the risks and benefits of some surgical procedures. However, sham trials are controversial because they expose patients to the harms of a sham procedure without the possibility of benefit. We argue that ethical analyses of sham trials have focused only on the harms of sham surgery, and neglected to account for the harms of the procedure being studied.

Methods:

We develop a theoretical model to estimate the harms and benefits experienced by patients who enter a sham surgery trial, taking into accounts the harms and benefits of the sham and intervention.

Results:

When the procedure in question is found to be ineffective, sham trials typically result in net benefit to participants because some participants are only exposed to the harms of the sham procedure, which are much lower than the harms of the full procedure. When the procedure is found to be beneficial, the primary harm to patients who underwent the sham is not due to the sham itself, but because they suffer a delay in receiving an effective intervention.

Conclusions:

Patients often benefit from participating in sham surgery trials, because the harms of the sham procedure are lower than the harms of the full procedure, which may turn out to be ineffective. Our results call for re-thinking the ethics of sham surgery trials.
CHALF Score: A Novel Tool to Rapidly Risk Stratify Children in Need of Liver Transplant Evaluation During Acute Liver Failure
Authors: Ascher-Bartlett Johanna M. , Bangerth Sarah , Jordan Shannon , Weaver Carly , Barhouma Sarah , Etesami Kambiz , Kohli Rohit , Emamaullee Juliet
Published: October 2023

Background.

Pediatric acute liver failure (PALF) can require emergent liver transplantation (LT, >25%) or lead to death (~15%). Existing models cannot predict clinical trajectory or survival with native liver (SNL). We aimed to create a predictive model for PALF clinical outcomes based on admission variables.

Methods.

A retrospective, single-center PALF cohort (April 2003 to January 2022) was identified using International Classification of Disease codes, selected using National Institutes of Health PALF Study Group (PALFSG) criteria, and grouped by clinical outcome (SNL, LT, or death). Significant admission variables were advanced for feature selection using least absolute shrinkage and selection operator regression with bootstrapping (5000×). A predictive model of SNL versus LT or death was created using logistic regression and validated using PALFSG data.

Results.

Our single-center cohort included 147 patients (58% SNL, 32% LT, 10% expired), while the PALFSG validation cohort included 492 patients (50% SNL, 35% LT, 15% expired). Admission variables associated with SNL included albumin (odds ratio [OR], 16; P < 0.01), ammonia (OR, 2.37; P < 0.01), and total bilirubin (OR, 2.25; P < 0.001). A model using these variables predicted SNL versus LT or death with high accuracy (accuracy [0.75 training, 0.70 validation], area under the curve [0.83 training, 0.78 validation]). A scaled score (CHLA-acute liver failure score) was created that predicted SNL versus LT or death with greater accuracy (C statistic 0.83) than Pediatric End-Stage Liver Disease (C statistic 0.76) and admission liver injury unit (C statistic 0.76) scores.

Conclusions.

The CHLA-acute liver failure score predicts SNL versus LT or mortality in PALF using admission laboratories with high accuracy. This novel, externally validated model offers an objective guide for urgent referral to a pediatric LT center.
Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation
Authors: Igra Noah M , Schmulevich Daniela , Geng Zhi , Guzman Jessica , Biddinger Paul D , Gates Jonathan D , Spinella Philip C , Yazer Mark H , Cannon Jeremy W ,   the THOR-AABB Workgroup
Published: October 2023

BACKGROUND:

Urban areas in the US are increasingly focused on mass casualty incident (MCI) response. We simulated prehospital triage scenarios and hypothesized that using hospital-based blood product inventories for on-scene triage decisions would minimize time to treatment.

STUDY DESIGN:

Discrete event simulations modeled MCI casualty injury and patient flow after a simulated blast event in Boston, MA. Casualties were divided into moderate (Injury Severity Score 9 to 15) and severe (Injury Severity Score >15) based on injury patterns. Blood product inventories were collected from all hospitals (n = 6). The primary endpoint was the proportion of casualties managed with 1:1:1 balanced resuscitation in a target timeframe (moderate, 3.5 U red blood cells in 6 hours; severe, 10 U red blood cells in 1 hour). Three triage scenarios were compared, including unimpeded casualty movement to proximate hospitals (Nearest), equal distribution among hospitals (Equal), and blood product inventory–based triage (Supply-Guided).

RESULTS:

Simulated MCIs generated a mean ± SD of 302 ± 7 casualties, including 57 ± 2 moderate and 15 ± 2 severe casualties. Nearest triage resulted in significantly fewer overall casualties treated in the target time (55% vs Equal 86% vs Supply-Guided 91%, p < 0.001). These differences were principally due to fewer moderate casualties treated, but there was no difference among strategies for severe casualties.

CONCLUSIONS:

In this simulation study comparing different triage strategies, including one based on actual blood product inventories, nearest hospital triage was inferior to equal distribution or a Supply-Guided strategy. Disaster response leaders in US urban areas should consider modeling different MCI scenarios and casualty numbers to determine optimal triage strategies for their area given hospital numbers and blood product availability.
Deciphering the tissue-specific functional effect of Alzheimer risk SNPs with deep genome annotation
Authors: Varathan Pradeep , Xie Linhui , He Bing , Saykin Andrew J. , Nho Kwangsik , Yan Jingwen
Published: October 2023

Alzheimer’s disease (AD) is a highly heritable brain dementia, along with substantial failure of cognitive function. Large-scale genome-wide association studies (GWAS) have led to a significant set of SNPs associated with AD and related traits. GWAS hits usually emerge as clusters where a lead SNP with the highest significance is surrounded by other less significant neighboring SNPs. Although functionality is not guaranteed with even the strongest associations in the GWAS, the lead SNPs have been historically the focus of the field, with the remaining associations inferred as redundant. Recent deep genome annotation tools enable the prediction of function from a segment of DNA sequence with significantly improved precision, which allows in-silico mutagenesis to interrogate the functional effect of SNP alleles. In this project, we explored the impact of top AD GWAS hits on the chromatin functions, and whether it will be altered by the genomic context (i.e., alleles of neighborhood SNPs). Our results showed that highly correlated SNPs in the same LD block could have distinct impact on the downstream functions. Although some GWAS lead SNPs showed dominating functional effect regardless of the neighborhood SNP alleles, several other ones do get enhanced loss or gain of function under certain genomic context, suggesting potential extra information hidden in the LD blocks.
Systematic Review of risk score prediction models using maternal characteristics with and without biomarkers for the prediction of GDM
Authors: Parkhi Durga , Sampathkumar Swetha , Weldeselassie Yonas , Sukumar Nithya , Saravanan Ponnusamy
Published: October 2023

Background

GDM is associated with adverse maternal and fetal complications. By the time GDM is diagnosed, continuous exposure to the hyperglycaemic intrauterine environment can adversely affect the fetus. Hence, early pregnancy prediction of GDM is important.

Aim

To systematically evaluate whether composite risk score prediction models can accurately predict GDM in early pregnancy.

Method

Systematic review of observational studies involving pregnant women of <20 weeks of gestation was carried out. The search involved various databases, grey literature, and reference lists till August 2022. The primary outcome was the predictive performance of the models in terms of the AUC, for <14 weeks and 14-20 weeks of gestation.

Results

Sixty-seven articles for <14 weeks and 22 for 14-20 weeks of gestation were included (initial search - 4542). The sample size ranged from 42 to 1,160,933. The studies were from Canada, USA, UK, Europe, Israel, Iran, China, Taiwan, South Korea, South Africa, Australia, Singapore, and Thailand. For <14 weeks, the AUC ranges were 0.59-0.88 and 0.53-0.95, respectively for models that used only maternal characteristics and for those that included biomarkers. For 14-20 weeks these AUCs were 0.68-0.71 and 0.65-0.92. Age, ethnicity, BMI, family history of diabetes, and prior GDM were the 5 most commonly used risk factors. The addition of systolic BP improved performance in some models. Triglycerides, PAPP-A, and lipocalin- 2, combined with maternal characteristics, have the highest predictive performance. AUC varied according to the population studied. Pooled analyses were not done due to high heterogeneity.

Conclusion

Accurate GDM risk prediction may be possible if common risk factors are combined with biomarkers. However, more research is needed in populations of high GDM risk. Artificial Intelligence-based risk prediction models that incorporate fetal biometry data may improve accuracy.
Analysis of rare coding variants in 470,000 exome-sequenced subjects characterises contributions to risk of type 2 diabetes
Authors: Curtis David
Published: October 2023

Aims

To follow up results from an earlier study using an extended sample of 470,000 exome-sequenced subjects to identify genes associated with type 2 diabetes (T2D) and to characterise the distribution of rare variants in these genes.

Materials and methods

Exome sequence data for 470,000 UK Biobank participants was analysed using a combined phenotype for T2D obtained from diagnostic and prescription data. Gene-wise weighted burden analysis of rare coding variants in the new cohort of 270,000 samples was carried out for the 32 genes previously significant with uncorrected p < 0.001 along with 7 other genes previously implicated in T2D. Follow-up studies ofGCK, GIGYF1, HNF1AandHNF4Aused the full sample of 470,000 to investigate the effects of different categories of variant.

Results

No novel genes were identified as exome wide significant. Rare loss of function (LOF) variants inGCKexerted a very large effect on T2D risk but more common (though still very rare) nonsynonymous variants classified as probably damaging by PolyPhen on average approximately doubled risk. Rare variants in the other three genes also had large effects on risk.

Conclusions

In spite of the very large sample size, no novel genes are implicated. Coding variants with an identifiable effect are collectively too rare be generally useful for guiding treatment choices for most patients. The finding that some nonsynonymous variants inGCKaffect T2D risk is novel but not unexpected and does not have obvious practical implications.

This research has been conducted using the UK Biobank Resource.
Going around the Kok cycle of the water oxidation reaction with femtosecond X-ray crystallography
Authors: Bhowmick Asmit , Simon Philipp S. , Bogacz Isabel , Hussein Rana , Zhang Miao , Makita Hiroki , Ibrahim Mohamed , Chatterjee Ruchira , Doyle Margaret D. , Cheah Mun Hon , Chernev Petko , Fuller Franklin D. , Fransson Thomas , Alonso-Mori Roberto , Brewster Aaron S. , Sauter Nicholas K. , Bergmann Uwe , Dobbek Holger , Zouni Athina , Messinger Johannes , Kern Jan , Yachandra Vittal K. , Yano Junko
Published: October 2023

The water oxidation reaction in photosystem II (PS II) produces most of the molecular oxygen in the atmosphere, which sustains life on Earth, and in this process releases four electrons and four protons that drive the downstream process of CO2 fixation in the photosynthetic apparatus. The catalytic center of PS II is an oxygen-bridged Mn4Ca complex (Mn4CaO5) which is progressively oxidized upon the absorption of light by the chlorophyll of the PS II reaction center, and the accumulation of four oxidative equivalents in the catalytic center results in the oxidation of two waters to dioxygen in the last step. The recent emergence of X-ray free-electron lasers (XFELs) with intense femtosecond X-ray pulses has opened up opportunities to visualize this reaction in PS II as it proceeds through the catalytic cycle. In this review, we summarize our recent studies of the catalytic reaction in PS II by following the structural changes along the reaction pathway via room-temperature X-ray crystallography using XFELs. The evolution of the electron density changes at the Mn complex reveals notable structural changes, including the insertion of OX from a new water molecule, which disappears on completion of the reaction, implicating it in the O—O bond formation reaction. We were also able to follow the structural dynamics of the protein coordinating with the catalytic complex and of channels within the protein that are important for substrate and product transport, revealing well orchestrated conformational changes in response to the electronic changes at the Mn4Ca cluster.
Investor attention during soccer World Cups
Authors: Lobato Manuel , Maura Mario Jordi , Rodriguez Javier , Romero-Perez Herminio
Published: October 2023

Purpose

This study aims to examine investor attention by exploring the trading behavior of investors in US-based exchange traded funds (ETFs) of countries active in the Federation Internationale de Football Association (FIFA) World Cups.

Design/methodology/approach

The present study employs event study methodology to measure abnormal returns and excess trading volume of country-specific ETFs during six FIFA World Cups. The sample of ETFs includes 19 participating countries.

Findings

Consistent with investor behavior that might be explained by attention effect, the study finds that country-specific ETFs from participating countries do indeed behave differently during FIFA World Cups events. The authors find significant evidence of abnormal trading volume and, albeit weaker, abnormal returns during cups.

Originality/value

This study contributes to the literature on investor behavior, linking investor attention with salient sports events.
The mediation role of perceived brand trustworthiness in brand social responsibility and brand positioning: evidence from the Tanzanian beverage industry
Authors: Amani David
Published: October 2023

Purpose

The current study was developed in response to the profound impact of ethical practices on the beverage industry. It aims to examine the mediating role of perceived brand trustworthiness in the relationship between brand social responsibility and brand positioning in the Tanzanian beverage industry.

Design/methodology/approach

The study adopted a post-positivist approach, as it encompasses a deterministic perspective where causes are believed to determine outcomes or effects. The study focused on customers of two major beverage companies in Tanzania, namely Coca-Cola and Pepsi. Data were collected from 458 customers and analyzed using structural equation modeling.

Findings

The findings indicate that brand social responsibility serves as a valuable intangible asset, capable of establishing a competitive edge when integrated into the value proposition. Additionally, the results reveal that brand trustworthiness plays a mediating role in the connection between brand social responsibility and brand positioning.

Research limitations/implications

The study employed a convenience sampling technique; hence, generalization of the findings should be approached with caution.

Originality/value

This study represents one of the few scholarly endeavors that explore the role of social responsibility at the product brand level in establishing brand positioning. By doing so, it contributes to the advancement of knowledge concerning the impact of brand social responsibility on building competitiveness within the context of today's competitive business environment.
Rebel group legitimacy, ideology and durable peace
Authors: Druckman Daniel , Vuković Siniša , Verbeek Nicolas
Published: October 2023

Purpose

This study aims to explore the role of rebel group legitimacy and ideology in durable peace (DP) following peace agreements to end civil wars. It builds on earlier research showing that justice and civil society involvement are critical in achieving DP. This study adds the impacts of rebel group activities and support on DP. Activities include service delivery and mobilization. Support is gauged with outcomes of presidential and parliamentary elections held following peace agreements.

Design/methodology/approach

Five data sets were used to measure the key variables: DP, inclusive commissions (IC), legitimacy symmetry (electoral outcomes), service delivery and ideological mobilization. A measure of rebel group integration in the political system was also constructed. Impacts of the integration, legitimacy and ideology variables were assessed with a hierarchical regression model (HRM). This study begins with a base model drawn from earlier research showing the key predictors were procedural justice (PJ) and IC. The authors ask about the extent to which the rebel group variables contribute additional variance to the prediction of DP.

Findings

The main contributors to the prediction of DP were PJ, IC and integration in the political system. None of the legitimacy or mobilization variables added significant variance to the prediction. Only one of the mobilization variables, forced recruitment, was significant. The decision to integrate into the political system following the agreement did not mediate the relationship between PJ in the negotiation process and DP. Results of a factor analysis showed that DP, PJ, IC and integration formed a cluster with strong loadings on the first factor.

Research limitations/implications

The negative results for the legitimacy and mobilization variables may not be the last word on rebel group influences. Lack of support for the key hypotheses spurs attempts to discover other sources that contribute to the survival of rebel group actors in the political system and, in turn, to DP.

Practical implications

The issues raised by this study contribute to debates about ways to attain peaceful relations among competing groups following a civil war. It appears that attention to factors inside and around the negotiation process (PJ, ICs and conversion) may be more important than rebel group activities outside of these processes. The results call attention, in particular, to the important role played by political integration. From a policy perspective, it would be useful to develop levers for encouraging rebel groups to emerge as political actors in the post-agreement environment.

Originality/value

Developing measures of the symmetry of rebel group legitimacy and integration in the context of a comparative case study are the primary original contributions of this study. Furthermore, the mode of analysis (HRM) is novel in this literature. This approach builds on and extends the earlier research on factors influencing DP.
Audit committee characteristics as determinants of non-audit fees in UK FTSE 350 companies
Authors: Wigglesworth Mandy Jayne , Shubita Moade , Combs Alan
Published: October 2023

Purpose

This study aims to examine trends in audit committee characteristics of companies and associates characteristics subject to major change with a fee-based proxy for audit committee effectiveness.

Design/methodology/approach

The research adopts an empirical approach. Using descriptive and inferential statistics, observations for 253 Financial Times Stock Exchange 350 companies’ audit committee characteristics gathered from annual reports at the beginning and end of a five-year period are evaluated against averaged non-audit fees (NAF) as a proportion of total audit fees.

Findings

Audit committee composition shows an increased incidence of female membership and of members with previous audit experience. The increase in members with previous audit experience is more marked where this is gained with the incumbent auditor. An increase is also shown in chief financial officers with previous audit experience. Previous audit experience is associated with reduced NAF as a proportion of total fees. This is marked where audit experience has been gained with the incumbent auditor. These results suggest that the benefits of financial expertise gained from audit experience outweigh impairments to independence due to social ties. Nevertheless, other studies indicate concerns about independence are still well-founded.

Originality/value

This paper’s original contribution is to evaluate the potential effect of previous audit experience on those involved in audit committees in light of concerns raised in the literature and by regulators that external auditor independence should be maintained. The innovative fee-based proxy for audit committee effectiveness facilitates an evaluation as to which influence prevails.
The role of attributes of cycling tourism and enduring involvement in developing tourists’ place attachment
Authors: Wang Junfeng
Published: October 2023

Purpose

This study aims to investigate the advancement of place attachment within the bicycle tourism context. Specifically, this study seeks to ascertain whether the four attributes of bicycle tourism (tourism attractions, accessibility, amenities and complementary services) and enduring involvement can serve as predictors of tourists’ place attachment. Also, the research endeavors to examine the positive effects generated by the four attributes of bicycle tourism on enduring involvement. Additionally, the mediating role that enduring involvement plays in attribute–place attachment relationships will be clarified.

Design/methodology/approach

The final 547 samples are collected from five WeChat cycling groups in Shanghai, and the partial least squares structural equation modeling approach is used to analyze the data.

Findings

The results show that each of the four attributes has a positive impact on place attachment. Moreover, tourism attractions, accessibility and amenities can be the drivers of enduring involvement. Enduring involvement mediates the tourism attractions–place attachment relationship, the accessibility–place attachment relationship, as well as the amenities–place attachment relationship.

Research limitations/implications

This paper, to the best of the author’s knowledge, pioneeringly introduces the concept of enduring involvement and place attachment into bicycle tourism research, and the findings contribute to providing practical implications for destination managers and government policymakers.

Originality/value

This is innovative work with a comprehensive and creative research framework for place attachment.
Drivers of financial stability gap: evidence from sub-Saharan Africa
Authors: Kulu Evans , Osei Bismark
Published: October 2023

Purpose

As an effort to support the quest for a stable financial sector, this study aims to determine the factors that contribute to the financial stability gap in sub-Saharan Africa (SSA).

Design/methodology/approach

The estimation techniques used include the fixed and random effect, system general methods of moments and dominance analysis. The data used is annual data for 33 SSA countries, covering the period 2007 to 2018.

Findings

Key findings from the analyses indicate that nonperforming loans increase gaps in financial stability while regulatory quality, control of corruption, political stability and appreciation of the local currency reduce the financial stability gap in SSA.

Research limitations/implications

The absence of a specific metric for measuring the financial stability gap appears to be the limitation of this study. Its existence could improve the discussion and also make replicability easier. However, this study relies on a measure introduced by Kulu et al. (2022b), which is also acceptable and quite popular in the literature.

Originality/value

To the best of the authors’ knowledge, this study is the first in the finance literature to estimate the determinants of the financial stability gap in SSA.