bluuebunny/crossref_metadata_2025 huggingface dataset:
The Expanding Role of the U.S. Army Paramedic
Authors: Greener Robert K , Morgenweck Garrick W , Lopienski Jonathan J , Howell Chad J , Kim Jinsol , Smith Marcus F
Published: December 2024

The combat medic (68W) will play a critical role in medical operations in the event of future large-scale combat operations (LSCOs). However, the combat medic is largely not prepared for LSCOs. The revised Medical Education and Demonstration of Individual Competence (TC 8-800) state 68Ws much be able to provide advanced airway and trauma management, medication administration, and advanced casualty movement. To meet the increased prehospital medical demands under LSCOs, the U.S. Army should require the Battalion, Brigade, and Division Medical Readiness Noncommisioned Officers (NCOs) to be Nationally Registered Paramedics (who are identified with the 3P Additional Skill Identifier [ASI]). They should have the responsibility to oversee the wartime medical skills sustainment of Combat Medic Specialists (68W) within their organization. These paramedics should drive medical simulation training events and improve current operation medical skills training. These medical readiness NCOs should attend the Medic Master Training Course and serve as advisors to commanders on the status of medic skill readiness within their organization. Commanders will be able to utilize these paramedics to augment the ongoing medical training of their medics to ensure they are operating at the fullest extent of their scope of practice.
Association between osteoarthritis-related serum biochemical markers over 10–13 years and knee symptoms in middle-aged adults
Authors: Singh Ambrish , Venn Alison , Blizzard Leigh , Fraser Brooklyn J , Jones Graeme , Burgess John , Parameswaran Venkat , March Lyn , Cicuttini Flavia , Ding Changhai , Antony Benny
Published: December 2024

Objectives

To examine associations between osteoarthritis (OA)-related biochemical markers and knee symptoms in middle-aged adults over 10–13 year follow-up.

Methods

Blood samples were collected during the Childhood Determinants of Adult Health (CDAH)-1 study (2004–06) and follow-up at CDAH-3. Serum samples from baseline (n=156) and follow-up (n=167) were analyzed for cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA) using enzyme-linked immunosorbent assays. Knee symptoms were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale at follow-up. Zero-inflated Poisson regression models adjusted for age, sex, and body mass index were used for analysis.

Results

Significant associations were observed between COMP, MMP-3, and HA with knee pain and WOMAC-total score at follow-up. Baseline MMP-3 [ratio of means (RoM): 1.013; 95% CI: 1.006, 1.020], cumulative COMP (baseline + follow-up) [RoM: 1.022; 95% CI: 1.011, 1.033], and increased HA levels over time [RoM: 1.014; 95% CI: 1.007, 1.020] were positively associated with knee pain after 10–13 years.

Conclusion

Cumulative COMP, baseline MMP-3, and changes in HA were associated with knee pain over a a 10–13 year follow-up. These markers may help predict future knee symptoms in middle-aged adults.
A case of glucocorticoid-refractory IgA vasculitis with diffuse alveolar haemorrhage: A therapeutic strategy for aberrant immunoglobulin depletion
Authors: Hirokawa Kazuhiko , Sato Shunichi , Hiraoka Eiji , Iwanami Keiichi
Published: December 2024

Diffuse alveolar haemorrhage (DAH) is a rare and severe complication of IgA vasculitis (IgAV). Although glucocorticoids and immunosuppressive agents are used for its treatment, there is no consensus on the optimal form of treatment. We herein report the case of a 53-year-old, female patient with IgAV. She was initially resistant to glucocorticoid therapy and experienced acute respiratory failure due to DAH but responded well to rituximab (RTX) and plasma exchange (PLEX). While some previous case reports have suggested that RTX or PLEX can be effective for severe IgAV, there are no reports of a combination of RTX and PLEX being used successfully to treat IgAV-associated DAH. In the model of IgAV pathogenesis proposed herein, aberrant IgA1 and IgA-specific IgG autoantibodies play a pivotal role. PLEX may facilitate the prompt removal of these circulating, aberrant immunoglobulins while RTX inhibits their further production. Consequently, a combination of RTX and PLEX may represent an effective treatment approach for severe glucocorticoid-refractory cases of IgAV.
SARS-CoV-2 Illumina GeNome Assembly Line (SIGNAL), a Snakemate workflow for rapid and bulk analysis of Illumina sequencing of SARS-CoV-2 genomes
Authors: Nasir Jalees A , Maguire Finlay , Smith Kendrick M , Panousis Emily M , Baker Sheridan J C , Aftanas Patryk , Raphenya Amogelang R , Alcock Brian P , Maan Hassaan , Knox Natalie C , Banerjee Arinjay , Mossman Karen , Wang Bo , Simpson Jared T , Kozak Robert A , Mubareka Samira , McArthur Andrew G
Published: December 2024

The incorporation of sequencing technologies in frontline and public health healthcare settings was vital in developing virus surveillance programs during the Coronavirus Disease 2019 (COVID-19) pandemic caused by transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, increased data acquisition poses challenges for both rapid and accurate analyses. To overcome these hurdles, we developed the SARS-CoV-2 Illumina GeNome Assembly Line (SIGNAL) for quick bulk analyses of Illumina short-read sequencing data. SIGNAL is a Snakemake workflow that seamlessly manages parallel tasks to process large volumes of sequencing data. A series of outputs are generated, including consensus genomes, variant calls, lineage assessments and identified variants of concern (VOCs). Compared to other existing SARS-CoV-2 sequencing workflows, SIGNAL is one of the fastest-performing analysis tools while maintaining high accuracy. The source code is publicly available (github.com/jaleezyy/covid-19-signal) and is optimized to run on various systems, with software compatibility and resource management all handled within the workflow. Overall, SIGNAL illustrated its capacity for high-volume analyses through several contributions to publicly funded government public health surveillance programs and can be a valuable tool for continuing SARS-CoV-2 Illumina sequencing efforts and will inform the development of similar strategies for rapid viral sequence assessment.
HiCrayon reveals distinct layers of multi-state 3D chromatin organization
Authors: Nolan Ben , Harris Hannah L , Kalluchi Achyuth , Reznicek Timothy E , Cummings Christopher T , Rowley M Jordan
Published: December 2024

Chromatin contact maps are often shown as 2D heatmaps and visually compared to 1D genomic data by simple juxtaposition. While common, this strategy is imprecise, placing the onus on the reader to align features with each other. To remedy this, we developed HiCrayon, an interactive tool that facilitates the integration of 3D chromatin organization maps and 1D datasets. This visualization method integrates data from genomic assays directly into the chromatin contact map by coloring interactions according to 1D signal. HiCrayon is implemented using R shiny and python to create a graphical user interface application, available in both web and containerized format to promote accessibility. We demonstrate the utility of HiCrayon in visualizing the effectiveness of compartment calling and the relationship between ChIP-seq and various features of chromatin organization. We also demonstrate the improved visualization of other 3D genomic phenomena, such as differences between loops associated with CTCF/cohesin versus those associated with H3K27ac. We then demonstrate HiCrayon’s visualization of organizational changes that occur during differentiation and use HiCrayon to detect compartment patterns that cannot be assigned to either A or B compartments, revealing a distinct third chromatin compartment.
Initial Effectiveness of mRNA-1273 Against SARS-CoV-2 Infection and Hospitalization in Young Children
Authors: Aglipay Mary , Maguire Jonathon L , Swayze Sarah , Tuite Ashleigh , Mamdani Muhammad , Keown-Stoneman Charles , Birken Catherine S , Kwong Jeffrey C
Published: December 2024

Background

Data on mRNA-1273 (Moderna) vaccine effectiveness (VE) in children aged 6 months to 5 years are limited. The objectives of this study were to assess mRNA-1273 vaccine effectiveness against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19)–related hospitalization among children aged 6 months to 5 years during the initial 5 months of the vaccination campaign rollout, as well as to determine whether VE varied by age group (6 months to <2 years vs 2 to 5 years).

Methods

We used a test-negative study with linked health administrative data in Ontario, Canada, to evaluate vaccine effectiveness of mRNA-1273 against symptomatic SARS-CoV-2 infection and COVID-19-related hospitalization from July 28 to December 31, 2022. Participants included symptomatic children aged 6 months to 5 years who were tested by real-time polymerase chain reaction. The primary outcome was symptomatic infection, and the secondary outcome was COVID-19-related hospitalization.

Results

We included 572 test-positive cases and 3467 test-negative controls. Receipt of mRNA-1273 was associated with reduced symptomatic SARS-CoV-2 infection (VE, 90%; 95% CI, 53%–99%) and COVID-19-related hospitalization (VE, 82%; 95% CI, 4%–99%) ≥7 days after the second dose. We were unable to detect heterogeneity in VE across age groups.

Conclusions

Our findings suggest that mRNA-1273 vaccine effectiveness was initially strong against symptomatic SARS-CoV-2 infection and hospitalization in children aged 6 months to 5 years. Further research is needed to understand long-term effectiveness.
Sourcing
Authors: Dorsey David , Allen Matt
Published: December 2024

This chapter describes what sourcing is, why it is done, and how to do it efficiently and effectively. The authors highlight proven tactics and strategies cited by top field recruiters, organizational researchers, and recruiting analytic specialists. The authors describe how sourcing serves as the essential first step in building a talent pipeline and how core elements such as the employee value proposition and the workforce plan serve as a foundation for sourcing. Intelligent resource allocation for sourcing and related cost drivers are reviewed and tied to key components of an effective sourcing strategy such as referrals, realistic job previews, and emerging technology. The chapter concludes with a big-picture discussion of elements that will likely impact sourcing in the future. Examples are shown of effective practices and lessons of implementing them. A practical, user-friendly checklist is provided to aid in building a sourcing plan and system.
Job Postings, Ads, and the Age of the Aggregator
Authors: Streets Valerie N.
Published: December 2024

The first point of contact most organizations have with a potential candidate is through a job advertisement. Job ads have long created the first impression in job seekers’ eyes and thus play a crucial role in attracting or deterring individuals from the broader recruitment and selection process. While job ads have long been used, the current trend is for ads to become more interactive, customized, and engaging. Along with those changes comes a host of new issues for practitioners and researchers alike. The chapter presents an overview of the evolution of job advertisements along with some guiding principles and best practices on recruiting via job ads. In addition, the author introduces some emerging topics and issues such as integration with employee value propositions, realistic job previews, and elements of company culture.
Onboarding During Transformational Times
Authors: Ford Deborah K. , Bauer Talya N.
Published: December 2024

In today’s competitive climate, industry leaders must battle for top talent. Onboarding has emerged as a critical differentiator for reinforcing the employer value proposition, instilling commitment in new hires, and accelerating time to productivity. A rigorous and intimate onboarding program that reinforces interpersonal connection became critical during COVID-19 isolation, and high-touch elements add value for remote work. This chapter offers guidelines to enable speed and ease in the onboarding process by leveraging technological advances. Recommendations are made for employee-centric design decisions, and a proposed methodology is offered to create thoughtful experiences for those “moments that matter” in the employee journey.
The Geography of Taste
Authors: 9780197509081
Published: December 2024

Aesthetic and artistic preferences and practices vary widely between individuals and between cultures. To enjoy flamenco, for example, requires an entirely different cognitive approach and emotional attitude than that required to appreciate Bharatanatyam. In this collaborative work, four philosophers reconceive the philosophy of art and aesthetics by taking aesthetic diversity and cultural specificity, rather than universality, as the starting points of inquiry. Why are aesthetic and artistic responses so diverse? To what extent might they originate in universal human capacities? Can members of one culture enjoy and understand the artistic products of another? Or do they do each other injustice in the attempt? Is diversity a valuable feature of aesthetic and artistic engagement? To model what the turn toward diversity might look like in aesthetic inquiry, each author defends a different account of aesthetic diversity, and all engage in a collective dialogue about these issues.
Cultures and Values
Authors: McIver Lopes Dominic
Published: December 2024

Working with a minimal theory of culture, according to which cultures are group-level patterns of specific types of activities, together with a modest theory of values as features that figure in reasons to promote or inhibit, this chapter provides constitutive accounts of hedonic, aesthetic, and artistic cultures, each organized around values in different ways. Hedonic cultures generate hedonic payoffs. Aesthetic cultures coordinate sundry activities around distinctive vocabularies of aesthetic value. Artistic cultures are ones where media of making are leveraged in order to generate any of a range of different varieties of value. The argument for this three-way division of the geography of taste is that it provides an effective framework for empirical investigations of the striking degree of variation within each of the three cultures of taste.
The Great Curse
Authors: Berry Albert
Published: December 2024

Land is the key input for economies in the earliest stages of development, when seventy-five percent to ninety percent of the labor force is engaged in agriculture. Concentration of land ownership has been a common, and usually quite damaging, feature of most societies throughout history as both the cause and the result of access to power. Highly unequal control of land typically implies severe inequality of income and welfare, as well. Landlessness has been at the root of many of the world’s most serious and persistent problems, including severe exploitation and the deprivation of political rights and basic human needs. Historically, the motivation for many revolutions has been access to land. This volume reviews the land reform experiences of multiple countries during the twentieth century. The experiences l covered illustrate the widespread need for reform, the great difficulties facing major changes, and the extreme cost of failure in delicate political moments. Looking ahead, the biggest challenge will be to avoid the injustices and inequality that have accompanied land concentration in the past.
Assessing the Success of Agrarian Reforms and Other Policies to Deal with Land Concentration
Authors: Berry Albert
Published: December 2024

Agrarian reform varies in goals and coverage, as well as in what triggers it—sometimes revolutions and sometimes other paths. In more feudal societies, the main objectives have been to raise the incomes of beneficiaries and to curtail the abuses associated with serfdom or extreme societal inequality. Under communist regimes, land is taken from former landholders by force and provided to families that have been organized into cooperatives or state farms. In more capitalistic societies, the main objective is to raise the income and economic security of farm families by providing them with more land and more secure title to it. Land passed to beneficiaries may come from large landowners or from the state. Land expropriation usually involves partial payment to the landlord. The process may be market-based in the sense that (1) it involves a voluntary sale by the former owners, and (2) the new operator’s purchase is partially subsidized. Some implementing governments have been autocratic (e.g., military), while others have not. Often ethnicity is related to position on the socio-economic hierarchy and plays a role in revolutions or protests. Putting an end to slavery/serfdom has the most widely achieved benefit. Fast equitable growth has been achieved in a few cases; however, many others have fallen short on this front, usually as a result of strong opposition from vested interests, but frequently also from a lack of understanding and competence by those implementing the reform.
Land Reform under Capitalist Regimes in Twentieth-Century Latin America: Varying Degrees of Failure
Authors: Berry Albert
Published: December 2024

Nearly all the countries of Latin America have experienced high or extreme levels of land concentration and most have, at some point or points, undertaken land reforms. Although most such reforms have fallen far short of the hopes of their supporters in terms of scope and degree of economic gains to former tenants and landless workers, some have brought enormous welfare gains to large groups taken out of some form of serfdom. Loss of life related to reform attempts has been large in Mexico (at the time of the Revolution), Colombia (over most of the twentieth century), and Guatemala (through a 1980s ethnic genocide carried out by the military). Even when it did improve income distribution in the short term, no major land reform left a long-term legacy of significantly lower inequality.
Strand Three and the British–Irish Intergovernmental Relationship
Authors: Tannam Etain
Published: December 2024

This chapter provides an overview of intergovernmental cooperation under Strand Three of the 1998 Agreement particularly the role of the standing British–Irish Intergovernmental Conference, that subsumed both the Anglo-Irish Council and the Intergovernmental Conference established under the 1985 Agreement. It also examines the impact of Brexit on the British–Irish intergovernmentalism, It highlights the neglect of Strand Three of the Agreement, by both governments, from 2007 to 2018 and how weak implementation of Strand Three’s undermined Strands One and Two of the Agreement even before Brexit.
A data-integrative modeling approach accurately characterizes the effects of mutations on Arabidopsis lipid metabolism
Authors: Correa Córdoba Sandra , Burgos Asdrúbal , Cuadros-Inostroza Álvaro , Xu Ke , Brotman Yariv , Nikoloski Zoran
Published: December 2024

Collections of insertional mutants have been instrumental for characterizing the functional relevance of genes in different model organisms, including Arabidopsis (Arabidopsis thaliana). However, mutations may often result in subtle phenotypes, rendering it difficult to pinpoint the function of a knocked-out gene. Here, we present a data-integrative modeling approach that enables predicting the effects of mutations on metabolic traits and plant growth. To test the approach, we gathered lipidomics data and physiological read-outs for a set of 64 Arabidopsis lines with mutations in lipid metabolism. Use of flux sums as a proxy for metabolite concentrations allowed us to integrate the relative abundance of lipids and facilitated accurate predictions of growth and biochemical phenotype in approximately 73% and 76% of the mutants, respectively, for which phenotypic data were available. Likewise, we showed that this approach can pinpoint alterations in metabolic pathways related to silent mutations. Therefore, our study paves the way for coupling model-driven characterization of mutant lines from different mutagenesis approaches with metabolomic technologies, as well as for validating knowledge structured in large-scale metabolic networks of plants and other species.
The calcium-dependent protein kinase CmaCPK4 regulates sex determination in pumpkin (Cucurbita maxima D.)
Authors: Wang Chaojie , Wang Yunli , Wang Guichao , Zhang Ke , Liu Zhe , Li Xiaopeng , Xu Wenlong , Li Zheng , Qu Shuping
Published: December 2024

Pumpkin (Cucurbita maxima D.) is typically monoecious with individual male and female flowers, and its yield is associated with the degree of femaleness, i.e. the ratio of female to male flowers produced by the plant. Subgynoecy represents a sex form with a high degree of femaleness, but the regulatory mechanisms in pumpkin remain poorly understood. In this study, using the F2 population crossed from the subgynoecious line 2013-12 and the monoecious line 9-6, we initially identified a recessive locus to control the subgynoecious trait and named it sg1. After bulked segregant analysis with whole-genome resequencing and molecular marker linkage analysis, the sg1 locus was mapped to pumpkin Chromosome 2. Genetic sequence analysis found a pumpkin calcium-dependent protein kinase (CPK) gene, CmaCPK4, in the mapping interval as the candidate gene. A retrotransposon insertion identified within the promoter elevated CmaCPK4 expression in 2013-12. Morphological characterization of near-isogenic lines containing the sg1 allele showed increases in the ratio of female flowers and high ethylene contents in terminal buds compared with the receptor parent. Heterologous overexpression of CmaCPK4 significantly increased the ratio of female flowers in cucumber (Cucumis sativus). Furthermore, CmaCPK4 directly interacts with and phosphorylates 1-aminocyclopropane-1-carboxylate synthase 5 (CmaACS5) and 1-aminocyclopropane-1-carboxylate synthase 7 (CmaACS7), resulting in increased ethylene content in 2013-12, which affected pumpkin sex determination. These findings provide insights into the role of the CmaCPK4–CmaACS5/CmaACS7 module in ethylene-induced sex determination in pumpkin.
OP02 Bridging the Gap: Reducing Delays in Axial Spondyloarthritis Diagnosis through Innovative Public Health Campaigning
Authors: Eddison Joe , Kennedy N , Heron N , Pendleton Adrian , Webb Dale
Published: December 2024

Background and aims

The Act on Axial SpA campaign is dedicated to minimising the lengthy 8.5-year delay in diagnosing axial spondyloarthritis (axial SpA) by implementing a pioneering Gold Standard diagnosis time of just one year. Collaborating with the Belfast Health & Social Care Trust, our initiative aims to streamline the patient journey from symptom onset to diagnosis through a comprehensive, integrated intervention package. By enhancing awareness of Axial SpA and optimising diagnostic procedures alongside specialist care pathways, our pilot project endeavours to abbreviate the time to diagnosis, thereby serving as a blueprint for broader implementation across healthcare systems.

Methods

In partnership with a specialist Belfast-based creative agency, we devised a geo-targeted, multi-channel media campaign to bolster public awareness. Our strategy encompassed out-of-home advertising, radio promotions, and targeted social media adverts. The campaign featured 85 out-of-home advertising panels across 85 locations, radio slots on Cool FM, and geographically tailored social media adverts on Facebook and Instagram. Spanning six weeks during January and February 2024, we meticulously tracked the campaign's performance through standard social media and digital analytics platforms.

Results

Our campaign resonated strongly with individuals experiencing low back pain, prompting them to take action by utilising the NASS symptom checker. Over the six-week period, our social media outreach amassed an impressive 995,399 impressions and reached 831,390 individuals. Out-of-home advertising achieved an 81% reach among 18–40-year-olds in Belfast, engaging over 88,000 individuals. Additionally, radio partnership adverts reached more than 565,000 adults across Northern Ireland.

This extensive reach translated into robust engagement metrics:

• Social media ads garnered 16,799 clicks and 227,158 engagements.

• Radio advertising led to 2,390 readership engagements on Cool FM.

• The Act on Axial SpA website witnessed a surge in traffic, with 2,976 users from Belfast visiting during the campaign, compared to 285 in the entirety of 2023.

• Remarkably, the NASS symptom checker experienced a staggering 4,389% increase in average daily completions during the campaign. (Figure 1) OP02 Figure 1.Number of people completing the NASS symptom checker in Belfast. (Source: Google Analytics).

Conclusions

Our findings demonstrate the efficacy of engaging individuals with longstanding low back pain through innovative, visually compelling marketing materials infused with public health messaging. Moreover, early clinical data suggests that heightened public awareness can be achieved without overwhelming the healthcare system, while expediting patients' journeys towards diagnosis. By continuing to monitor referrals and diagnoses, we aim to assess the long-term impact of our campaign on addressing delays in axial SpA diagnosis.
aPKC/Par3/Par6 polarity complexes regulate podocyte motility and crescent formation in the progression of ANCA-associated vasculitis
Authors: Zou Rong , Wang Chen , Geng Wei , Little Mark A , Chen Min
Published: December 2024

Objectives

Podocyte bridging may be a key initial event occurring early in crescent formation. This study aims to probe the underlying mechanism of atypical protein kinase C (aPKC)/protease-activated receptor 3(Par3)/Par6 polarity complexes on podocyte motility and crescent formation during the progression of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

Methods

The effects of anti-TNF-α monoclonal antibody (mAb) on the crescent formation, localization and expression of aPKC/Par3/Par6 polarity complexes, and activities of small GTPases (Rho/Rac1/Cdc42) were explored in an AAV mouse model. Podocytes were stimulated in vitro by TNF-α and myeloperoxidase (MPO)-ANCA positive serum collected from patients with microscopic polyangiitis (MPA). Then, podocyte motility, aPKC/Par3/Par6 polarity protein expression and small GTPases activity were measured. The impacts of heat shock protein 70 (HSP70), a type of molecular chaperone, on the phosphorylation of aPKC was evaluated.

Results

Anti-TNF-α mAb inhibited crescent formation and restored the localization of aPKC/Par3/Par6 polarity complexes in the glomerulus of the AAV mouse model. Both MPO-ANCA-positive serum and TNF-α stimulation significantly induced podocyte motility by inhibiting of aPKC phosphorylation and detachment of aPKC/Par3/Par6 polarity complexes. Overexpression of HSP70 increased p-aPKC level and inhibited podocyte motility stimulated by either MPO-ANCA-positive serum or TNF-α.

Conclusion

The podocyte polarity preserved by aPKC/Par3/Par6 polarity complexes, especially the phosphorylation status of aPKC, may play an important role in the crescent formation of AAV. The inhibition of TNF-α prevents the crescent formation in AAV via, at least partly, inhibiting podocyte polarity loss and motility.
Assessing mold growth severity on various textiles: comparative analysis of inoculum densities and fungal strains
Authors: Hammad Ann , Beaugrand Kendall , Ross Joseph A , Allan Nick , Berman Martin
Published: December 2024

Mold growth on textiles during overseas shipping poses significant economic and health risks, necessitating a comprehensive understanding of fungal contamination dynamics. This study evaluated textile susceptibility to fungal contamination during transit by examining growth patterns, onset times, and determining minimum fungal densities for visible mold growth. Inoculations of six fungal strains (individual and pooled) were conducted at inoculum densities ranging from 102 to 106 spores/ml on various textile materials. The study comprised two phases: pilot growth (PG, with glucose) and Simulated Shipping Conditions (SSC, without glucose). PG yielded mycelial mats on textiles for all fungal strains except Penicillium citrinum and Stachybotrys chartarum. SSC exhibited variable susceptibilities, with cotton and suede highly susceptible and polyester, imitation suede, and polyurethane notably resistant to mycelial growth. Minimum fungal densities for visible mold growth were established for each textile based on SSC. The findings reveal distinct fungal susceptibilities among textiles, influenced by material composition and structure. Consistent growth on certain textiles at lower fungal densities highlights the need for targeted preventive measures. This research provides crucial insights for the manufacturing and shipping industries, guiding the development of effective mold prevention strategies and establishment of contamination limits during overseas transport.
DeSUMOylating isopeptidase 1 participates in the faithful chromosome segregation and vincristine sensitivity
Authors: Ikeda Yuki , Yuki Ryuzaburo , Saito Youhei , Nakayama Yuji
Published: December 2024

SUMOylation, the modification of proteins with a small ubiquitin‐like modifier (SUMO), is known to regulate various cellular events, including cell division. This process is dynamic, with its status depending on the balance between SUMOylation and deSUMOylation. While the regulation of cell division by sentrin‐specific protease (SENP) family proteins through deSUMOylation has been investigated, the role of another deSUMOylase, deSUMOylating isopeptidase 1 (DESI1), remains unknown. In this study, we explored DESI1's role in cell division. Knockdown of DESI1 accelerated cell division progression, leading to a significant increase in abnormal chromosome segregation. These phenotypes were rescued by re‐expression of wild‐type DESI1, but not catalytically inactive DESI1. DESI1 knockdown reduced the mitotic arrest caused by nocodazole, suggesting DESI1's involvement in the spindle assembly checkpoint (SAC). Localization of Aurora B, a key SAC regulator, at the metaphase chromosomes was reduced due to decreased Aurora B expression upon DESI1 knockdown. Consistently, DESI1 knockdown reduced transcription of FoxM1 target genes, such as Aurora B, cyclin B1, and CENP‐F. The TCGA database showed that both decreased and increased DESI1 expression levels are associated with poor prognosis in patients with certain cancer types. Importantly, we found that DESI1 knockdown reduced sensitivity to vincristine by inducing mitotic slippage. These results suggest that DESI1 is required for faithful chromosome segregation via regulating FoxM1 transcriptional activity and thereby SAC activity in an isopeptidase activity‐dependent manner. Our findings identified DESI1 as a novel regulator of cell division and a factor affecting cancer chemotherapy.
Precision Education: The Future of Lifelong Learning in Medicine
Authors: Desai Sanjay V. , Burk-Rafel Jesse , Lomis Kimberly D. , Caverzagie Kelly , Richardson Judee , O’Brien Celia Laird , Andrews John , Heckman Kevin , Henderson David , Prober Charles G. , Pugh Carla M. , Stern Scott D. , Triola Marc M. , Santen Sally A.
Published: December 2024

The goal of medical education is to produce a physician workforce capable of delivering high-quality equitable care to diverse patient populations and communities. To achieve this aim amidst explosive growth in medical knowledge and increasingly complex medical care, a system of personalized and continuous learning, assessment, and feedback for trainees and practicing physicians is urgently needed. In this perspective, the authors build on prior work to advance a conceptual framework for such a system: precision education (PE).

PE is a system that uses data and technology to transform lifelong learning by improving personalization, efficiency, and agency at the individual, program, and organization levels. PE “cycles” start with data inputs proactively gathered from new and existing sources, including assessments, educational activities, electronic medical records, patient care outcomes, and clinical practice patterns. Through technology-enabled analytics, insights are generated to drive precision interventions. At the individual level, such interventions include personalized just-in-time educational programming. Coaching is essential to provide feedback and increase learner participation and personalization. Outcomes are measured using assessment and evaluation of interventions at the individual, program, and organizational levels, with ongoing adjustment for repeated cycles of improvement. PE is rooted in patient, health system, and population data; promotes value-based care and health equity; and generates an adaptive learning culture.

The authors suggest fundamental principles for PE, including promoting equity in structures and processes, learner agency, and integration with workflow (harmonization). Finally, the authors explore the immediate need to develop consensus-driven standards: rules of engagement between people, products, and entities that interact in these systems to ensure interoperability, data sharing, replicability, and scale of PE innovations.
Trainees’ Perspectives on the Next Era of Assessment and Precision Education
Authors: Marcotte Kayla , Negrete Manriquez Jose A. , Hunt Maya , Spadafore Maxwell , Perrone Kenneth H. , Zhou Christine Yang
Published: December 2024

The next era of assessment in medical education promises new assessment systems, increased focus on ensuring high-quality equitable patient care, and precision education to drive learning and improvement. The potential benefits of using learning analytics and technology to augment medical training abound. To ensure that the ideals of this future for medical education are realized, educators should partner with trainees to build and implement new assessment systems. Coproduction of assessment systems by educators and trainees will help to ensure that new educational interventions are feasible and sustainable. In this paper, the authors provide a trainee perspective on 5 key areas that affect trainees in the next era of assessment: (1) precision education, (2) assessor education, (3) transparency in assessment development and implementation, (4) ongoing evaluation of the consequences of assessment, and (5) patient care data as sources of education outcomes.

As precision education is developed, it is critical that trainees understand how their educational data are collected, stored, and ultimately utilized for educational outcomes. Since assessors play a key role in generating assessment data, it is important that they are prepared to give high-quality assessments and are continuously evaluated on their abilities. Transparency in the development and implementation of assessments requires communicating how assessments are created, the evidence behind them, and their intended uses. Furthermore, ongoing evaluation of the intended and unintended consequences that new assessments have on trainees should be conducted and communicated to trainees. Finally, trainees should participate in determining what patient care data are used to inform educational outcomes. The authors believe that trainee coproduction is critical to building stronger assessment systems that utilize evidence-based educational theories for improved learning and ultimately better patient care.
Considering the Secondary Use of Clinical and Educational Data to Facilitate the Development of Artificial Intelligence Models
Authors: Thoma Brent , Spadafore Maxwell , Sebok-Syer Stefanie S. , George Brian C. , Chan Teresa M. , Krumm Andrew E.
Published: December 2024

Medical training programs and health care systems collect ever-increasing amounts of educational and clinical data. These data are collected with the primary purpose of supporting either trainee learning or patient care. Well-established principles guide the secondary use of these data for program evaluation and quality improvement initiatives. More recently, however, these clinical and educational data are also increasingly being used to train artificial intelligence (AI) models. The implications of this relatively unique secondary use of data have not been well explored. These models can support the development of sophisticated AI products that can be commercialized. While these products have the potential to support and improve the educational system, there are challenges related to validity, patient and learner consent, and biased or discriminatory outputs. The authors consider the implications of developing AI models and products using educational and clinical data from learners, discuss the uses of these products within medical education, and outline considerations that should guide the appropriate use of data for this purpose. These issues are further explored by examining how they have been navigated in an educational collaborative.
Ambulatory Long Block: A Model of Precision Education and Assessment for Internal Medicine Residents
Authors: Warm Eric J. , Kinnear Benjamin , Knopp Michelle I. , Powers-Fletcher Margaret , Segev Mati , Willauer Alexandra , Schauer Daniel
Published: December 2024

High-quality precision education (PE) aims to enhance outcomes for learners and society by incorporating longitudinal data and analytics to shape personalized learning strategies. However, existing educational data collection methods often suffer from fragmentation, leading to gaps in understanding learner and program performance. In this article, the authors present a novel approach to PE at the University of Cincinnati, focusing on the Ambulatory Long Block, a year-long continuous ambulatory group-practice experience. Over the last 17 years, the Ambulatory Long Block has evolved into a sophisticated data collection and analysis system that integrates feedback from various stakeholders, as well as learner self-assessment, electronic health record utilization information, and clinical throughput metrics. The authors detail their approach to data prioritization, collection, analysis, visualization, and feedback, providing a practical example of PE in action. This model has been associated with improvements in both learner performance and patient care outcomes. The authors also highlight the potential for real-time data review through automation and emphasize the importance of collaboration in advancing PE. Generalizable principles include designing learning environments with continuity as a central feature, gathering both quantitative and qualitative performance data from interprofessional assessors, using this information to supplement traditional workplace-based assessments, and pairing it with self-assessments. The authors advocate for criterion referencing over normative comparisons, using user-friendly data visualizations, and employing tailored coaching strategies for individual learners. The Ambulatory Long Block model underscores the potential of PE to drive improvements in medical education and health care outcomes.
Mechanical Power Is Associated With Mortality in Pressure-Controlled Ventilated Patients: A Dutch, Single-Center Cohort Study
Authors: Goedegebuur Jamilla , Smits Floor E. , Snoep Jacob W. M. , Rietveld Petra J. , van der Velde Franciska , de Jonge Evert , Schoe Abraham
Published: December 2024

IMPORTANCE:

Mechanical power (MP) could serve as a valuable parameter in clinical practice to estimate the likelihood of adverse outcomes. However, the safety thresholds for MP in mechanical ventilation remain underexplored and contentious.

OBJECTIVES:

This study aims to investigate the association between MP and hospital mortality across varying degrees of lung disease severity, classified by Pao
2/Fio
2 ratios.

DESIGN, SETTING, AND PARTICIPANTS:

This is a retrospective cohort study using automatically extracted data. Patients admitted to the ICU of a tertiary referral hospital in The Netherlands between 2018 and 2024 and ventilated in pressure-controlled mode were included.

MAIN OUTCOMES AND MEASURES:

Logistic regression, adjusted for age, sex, Acute Physiology and Chronic Health Evaluation-IV score, and Pao
2/Fio
2 ratio, was used to calculate the odds ratio (OR) for all-cause in-hospital mortality.

RESULTS:

A total of 2184 patients were analyzed, with a mean age of 62.5 ± 13.8 years, of whom 1508 (70.2%) were male. The mean MP was highest in patients with the lowest Pao
2/Fio
2 ratios (21.5 ± 6.5 J/min) compared with those with the highest ratios (12.0 ± 3.8 J/min; p < 0.001). Adjusted analyses revealed that increased MP was associated with higher mortality (OR, 1.06; 95% CI, 1.03–1.09 per J/min increase). Similarly, MP normalized for body weight showed a stronger association with mortality (OR, 1.004; 95% CI, 1.002–1.006 per J/min/kg increase). An increase in mortality was seen when MP exceeded 16–18 J/min.

CONCLUSIONS AND RELEVANCE:

Our findings demonstrate a significant association between MP and hospital mortality, even after adjusting for key confounders. Mortality increases notably when MP exceeds 16–18 J/min. Normalized MP presents an even stronger association with mortality. These results underscore the need for further research into ventilation strategies that consider MP adjustments.
Prenatal Spina Bifida Repair: A Survey of Current Practice in the United States
Authors: Garg Stuti P. , Shah Krish V. , Lentskevich Marina , Yau Alice , Gosain Arun K.
Published: December 2024

Background:

Prenatal myelomeningocele (MMC) repair offers significant benefits over traditional postnatal repair, as demonstrated by the Management of Myelomeningocele Study trial. We characterize the current specialist involvement in prenatal and postnatal MMC repair.

Methods:

The top 50 US News Children’s Hospitals for Neonatology and Neurology/Neurosurgery were queried, resulting in 67 unique hospitals. Specialties involved in MMC repair were extracted via hospital websites and surveys.

Results:

Among the 58 hospitals included, only 18 (31%) offered both prenatal and postnatal MMC repair, and the remaining 40 (69%) offered postnatal repair only. Of the 40 hospitals offering postnatal repair only, neurosurgeons (n = 38), orthopedic surgeons (n = 34), and urologists (n = 33) were most often included. Of the 18 hospitals with prenatal repair, neurosurgeons (n = 18) and maternal–fetal medicine specialists (n = 14) were most commonly involved. Prenatal teams had pediatric and fetal surgeons involved more often than postnatal teams (P = 0.011 and P = 0.035, respectively). Only 7 prenatal teams included fellowship-trained fetal surgeons. Teams led by fetal surgeons always included neurosurgeons (n = 7) and maternal–fetal medicine specialists (n = 7) and were least likely to include plastic surgeons (n = 1).

Conclusions:

These data emphasize both the delayed adaptation of fetal repair of MMC by major children’s hospitals and lack of fellowship-trained specialists involved; only 31% of the major children’s hospitals offer prenatal repair of MMC, with only 39% of those hospitals being led by a fellowship-trained fetal surgeon. These data highlight the need for additional teams trained in prenatal MMC repair as well as the standardization of fetal surgery fellowships to allow for the development of prenatal repair teams.
Module Creation Within the TOPS Registry: An Opportunity for Longitudinal Collection of Procedure-specific Clinical Outcomes
Authors: Hallman Taylor G. , Qureshi Umer , Reisner Kathryn , Figueroa Ariel E. , Gosain Arun K.
Published: December 2024

The Tracking Operations and Outcomes for Plastic Surgeons (TOPS) data registry, first launched in 2002 by the American Society of Plastic Surgeons (ASPS) in collaboration with the Plastic Surgery Foundation (PSF), was designed to avoid the perceived shortcomings of other national data registries as they pertain to interests of the plastic surgery community. Given the diversity of plastic surgery practice, the ASPS and PSF sought to ensure that the TOPS registry platform would support detailed collection of data useful to plastic surgeons practicing in all subspecialties. Therefore, a key design element of the TOPS registry is its ability to incorporate custom-made modules that allow for focused collection of topic/procedure-specific information. Although the TOPS database has collected information on more than 1.6 million plastic surgery procedures and outcomes since its inception more than 20 years ago, only a handful of custom modules have been created. This article outlines the senior author’s experience collaborating with the ASPS and PSF to successfully develop and implement a custom module within the TOPS registry. This information serves to promote further awareness, usage, and creation of TOPS modules, as these modules enable assessment of complex clinical conditions by leveraging data collection efforts through the single largest national plastic surgery organization.
Does Seven Days of Postoperative Enoxaparin Increase Bleeding Risk in Abdominal Contouring Surgery? A Single-center Experience
Authors: Abushehab Abdallah , Tunaboylu Mehmet Furkan , Kuruoglu Doga , Meira Pazelli Alexandre , Hussein Sara M. , Sharaf Basel A.
Published: December 2024

Background:

Venous thromboembolism (VTE) poses a major risk after abdominal contouring surgery, impacting morbidity and mortality. Despite various preventative strategies, surgeons are cautious about using enoxaparin for extended postoperative periods. This study aims to determine if a 7-day postoperative course of enoxaparin increases bleeding risks compared with a single dose of intraoperative unfractionated heparin in patients undergoing abdominal contouring surgery.

Methods:

A retrospective cohort analysis was performed on patients who underwent abdominoplasty or panniculectomy from August 2017 to October 2023. Patients were split into 2 groups: Group 1 received 5000 units of intraoperative unfractionated heparin in addition to 7 days of postoperative enoxaparin (40 mg daily); group 2 received only the intraoperative heparin dose. Primary outcomes included bleeding events and VTE incidence. Secondary outcomes were seroma, infection, surgical site dehiscence, necrosis, drain duration, and reoperation rates.

Results:

The study included 121 patients (111 women, 10 men), with 61 patients in group 1 and 60 in group 2. The average age was 49 ± 12 years, and the average body mass index was 29.8 ± 5 kg/m². No cases of VTE were reported. Postoperative bleeding occurred in 3 patients (4.9%) in group I and 2 patients (3.3%) in group 2, showing no statistically significant difference (P = 0.66). Secondary outcomes also showed no significant differences between the groups.

Conclusions:

Our study of 121 patients undergoing either abdominoplasty or panniculectomy demonstrated that administering enoxaparin for 7 days postoperatively is safe and does not increase the risk of bleeding.
Umbilical Cord Abnormalities
Authors: Pinette Michael G. , Tropepe Maria
Published: December 2024

The umbilical cord is the connection between mother and fetus through which gases and nutrients are exchanged. It's remarkable structure allows for freedom of movement while providing a cushioned, protected conduit from mother to fetus. Fetal development and survival are dependent upon the umbilical cord. This article reviews abnormalities of the umbilical cord that can be seen with structural and chromosomal abnormalities and altered umbilical cord flow associated with fetal growth restriction and poor pregnancy outcomes.
Multiple Eyelid Apocrine Hidrocystomas in a Patient With Prolactinoma
Authors: Akgoz Eda , Derin Sengun Gozde , Dashdamirova Saida , Hacisalihoglu Uguray Payam , Kaynak Pelin
Published: December 2024

In this case report, the authors demonstrate a rare co-occurrence of multiple eyelid apocrine hidrocystomas with a prolactinoma.