bluuebunny/crossref_metadata_2025 huggingface dataset:
Shrinkage-based Random Local Clocks with Scalable Inference
Authors: Fisher Alexander A , Ji Xiang , Nishimura Akihiko , Baele Guy , Lemey Philippe , Suchard Marc A
Published: November 2023

Molecular clock models undergird modern methods of divergence-time estimation. Local clock models propose that the rate of molecular evolution is constant within phylogenetic subtrees. Current local clock inference procedures exhibit one or more weaknesses, namely they achieve limited scalability to trees with large numbers of taxa, impose model misspecification, or require a priori knowledge of the existence and location of clocks. To overcome these challenges, we present an autocorrelated, Bayesian model of heritable clock rate evolution that leverages heavy-tailed priors with mean zero to shrink increments of change between branch-specific clocks. We further develop an efficient Hamiltonian Monte Carlo sampler that exploits closed form gradient computations to scale our model to large trees. Inference under our shrinkage clock exhibits a speed-up compared to the popular random local clock when estimating branch-specific clock rates on a variety of simulated datasets. This speed-up increases with the size of the problem. We further show our shrinkage clock recovers known local clocks within a rodent and mammalian phylogeny. Finally, in a problem that once appeared computationally impractical, we investigate the heritable clock structure of various surface glycoproteins of influenza A virus in the absence of prior knowledge about clock placement. We implement our shrinkage clock and make it publicly available in the BEAST software package.
Coping and Perception of Prognosis in Patients With Indolent Non-Hodgkin’s Lymphoma
Authors: Newcomb Richard A , Johnson P Connor , Yang Daniel , Holmbeck Katherine , Choe Joanna , Nabily Anisa , Lark Porsha , Dhawale Tejaswini , Amonoo Hermioni L , El-Jawahri Areej
Published: November 2023

Background

Indolent non-Hodgkin’s lymphomas (iNHL) are a heterogenous group of mostly incurable diseases with prolonged illness courses and prognostic uncertainty. Yet, studies evaluating coping and perception of prognosis are limited.

Methods

We conducted a cross-sectional study of adults newly diagnosed with iNHL in the past 3 months at a single academic center. We assessed quality of life (QOL: Functional Assessment of Cancer Therapy—General), psychological symptoms (Hospital Anxiety and Depression Scale), coping (Brief-COPE), and perception of prognosis (Prognosis Awareness Impact Scale).

Results

We enrolled 70.6% (48/68) of eligible patients. Patients had older age (mean = 66.9,sd = 10.5), were female (60.4%), predominantly identified as White (85.4%), and had at least received a college degree (75%). Chronic lymphocytic leukemia (39.6%) and follicular lymphoma (33.3%) were the most common diagnoses. Overall, 27.1% and 14.6% of patients reported clinically significant anxiety and PTSD symptoms, respectively. Patients highly utilized acceptance (56.2%), seeking emotional support (47.9%), and denial (47.9%) as coping strategies at diagnosis. While 66.7% of patients recalled their oncologist assessment of illness as incurable, only 35.4% reported that the illness is unlikely to be cured. Overall, 45.8% indicated that they were worried about prognosis and 31.2% reported perseverating on their prognosis. Higher emotional coping with prognosis was associated with fewer anxiety (B = −0.6, SE = 0.2, P < .001), depression (B = −0.3, SE = .1, P = .005), and PTSD (B = −1.3, SE = 0.4, P < .001) symptoms and better QOL (B = 1.7, SE = 0.4, P < .001).

Discussion

Patients with iNHL report substantial psychological distress, a diversity of coping strategies, and complex cognitive understanding of their prognosis. Interventions, which address prognostic uncertainty and promote positive emotional coping with prognosis, may ameliorate psychological distress in this population.
Lipid metabolites index habitat quality for Canvasbacks on stopover areas during spring migration
Authors: Bouton Andrew F , Anteau Michael J , Smith Eric J , Hagy Heath M , Lancaster Joseph D , Jacques Christopher N
Published: November 2023

Nutrients acquired by ducks on spring migratory stopover areas influence survival and subsequent reproduction. Accordingly, wetland loss and degradation on stopover areas can lead to reduced refueling efficiency and have demographic consequences. Lipid metabolite concentrations in blood provide a useful index of daily mass change in wild birds and can be used to make inferences about quality of stopover areas for refueling. We experimentally validated a model that uses lipid metabolites to predict daily mass change, and then we used those predictions to make inferences about foraging habitat quality for Canvasbacks (Aythya valisineria) at important stopover sites of the upper Mississippi and Illinois Rivers, USA. We measured plasma lipid metabolites and daily mass change of 60 wild Canvasbacks held in short-term captivity and subjected to feeding and fasting treatments. Respectively, triglyceride and β-hydroxybutyrate concentrations were positively and negatively related to mass change (R2 = 0.58). On average, Canvasbacks collected experimentally across our study area had positive index values indicating sufficient forage resources to allow energy acquisition. However, predicted daily mass increases were greater at more northerly pools of the Mississippi River (Pools 7–8 and 13) compared to more southerly locations (Pool 19 of the Mississippi River and the Illinois River Valley), which was likely due, in part, to more abundant submerged aquatic vegetation at more northerly pools. Our results affirm that lipid metabolites are useful predictors of daily mass change that in turn can provide inferences about habitat quality. Lower daily mass increases of Canvasbacks at Pool 19 are concerning because that area is considered a critically important spring stopover area for migratory diving ducks. Considering the challenges of managing large rivers for multiple uses, targeting restoration of wetlands isolated or isolatable from river systems could provide stopover areas with necessary forage for optimal mass gain.
Collaborative gatekeeping: Consensus-seeking practices among emergency call-takers
Authors: Gillooly Jessica W
Published: November 2023

The police are involved in many aspects of social life in the US, and much of their involvement stems from the emergency call-for-service system. Emergency call-takers play a crucial role in this system by filtering out inappropriate caller requests, but prior policing scholarship has overlooked the dynamic, interactional, and improvisational aspects of this work. This article illuminates these elements of gatekeeping by uncovering a set of consensus-seeking practices call-takers deploy over the telephone to collaboratively reframe callers’ problems as policeable or not. These findings help reconceptualize gatekeeping as a more fluid concept than prior scholarship has understood it to be. They also offer new avenues for organizational reform that include the study and dissemination of practices that call-takers use to process calls. Furthermore, these findings encourage agencies to move beyond exclusively rule-bound forms of guidance and pursue a practice-based reform agenda to help redefine the limits of the police role.
A survey of Kansas beef producers and consumers who participate in business-to-consumer marketing of beef
Authors: O’Quinn Travis G , Lybarger Katie R , Ibendahl Gregory A , Vaughan Yue Teng , Kwon Junehee
Published: November 2023

Following the coronavirus disease 2019 (COVID-19) pandemic, producer and consumer interest in business-to-consumer (B2C) beef sales increased. The objective of the current study was to assess current B2C beef producer and consumer attitudes and understandings of the B2C beef marketing process in order to identify knowledge gaps and strategies to improve producer/consumer interactions. Both producers and customers of local beef were recruited using a large online platform (https://shopkansasfarms.com), and descriptive statistics were used to summarize the data. In total, 41 B2C beef producers and 174 consumers who had either previously participated in B2C marketing or intended to participate were surveyed. Most producers (69.8%) only produced beef and produced only a small number (1 to 20 head) of animals per year. Many (43.9%) reported selling 100% of beef directly to consumers, while 29.3% reported selling less than 20% through this channel. Almost all (97.3%) of the producers indicated that increased sales directly to consumers would be desirable, with most (87.1%) considering this marketing channel as the most profitable. Marketing beef in smaller portions, including portioned cuts, was popular, reported by more than 62% of producers, while whole carcass sales were lower. Word-of-mouth (91.3%) and social media (65.8%) were the most popular forms of advertisement used by producers and more than one-third of producers (38.9%) reported having trouble with customers regarding a sale. Over 60% of consumers indicated they had purchased B2C beef less than 5 times, with more than 73% indicating that more than 75% of their beef purchased was local. Low take-home weights, portion sizes, and quality were among consumers’ most cited troubles. Lack of freezer space (25%), price (24.9%), and quantity of product (41.7%) were reported as the largest barriers to consumer participation in B2C marketing. Both consumers and producers indicated that consumer testimonials would be the most beneficial in improving producer/consumer interactions, with educational materials from government sources viewed as the least beneficial. These results provide a baseline for B2C beef marketing and provide insight into impactful strategies to use to assist in this process.
Identification of a Locus for High-Temperature Adult-Plant Resistance to Stripe Rust in the Wheat Yr8 Near-Isogenic Line Through Mutagenesis and Molecular Mapping
Authors: Li Yuxiang , Wang Meinan , Hu Xiaoping , Chen Xianming
Published: November 2023

Aegilops species are wheat relatives that harbor valuable disease resistance genes for wheat breeding. The wheat Yr8 near-isogenic line AvSYr8NIL has long been believed to carry only Yr8 for race-specific all-stage resistance to stripe rust, caused by Puccinia striiformis f. sp. tritici, derived from Aegilops comosa. However, AvSYr8NIL has been found to have high-temperature adult-plant (HTAP) resistance in our field and greenhouse tests. To confirm both HTAP and Yr8 resistance, seeds from AvSYr8NIL were treated with ethyl methanesulfonate to generate mutant lines. The mutant lines with only Yr8 (M641) and only HTAP resistance (M488) were crossed with the susceptible recurrent parent Avocet S (AvS). The F1 and F4 lines of AvS/M641 were phenotyped with Yr8-avirulent races in the seedling stage at the low-temperature (4 to 20°C) profile, while the F1, F2, F4, and F5 lines of AvS/M488 were phenotyped with Yr8-virulent races in the adult-plant stage at the high-temperature (10 to 30°C) profile. Both Yr8 and the HTAP resistance gene (YrM488) were recessive. The F4 populations of AvS/M641 and AvS/M488 were genotyped using polymorphic Kompetitive allele-specific PCR markers converted from single-nucleotide polymorphisms. Yr8 was mapped to a 0.66-cM fragment, and YrM488 was mapped to a 1.22-cM interval on chromosome 2D. The physical distance between the two resistance genes was estimated to be more than 500 Mb, indicating their distinct loci. The mutant lines with separated resistance genes would be useful in enhancing our understanding of different types of resistance and in further studying the interactions between wheat and the stripe rust pathogen.
Emotional Intelligence in Intensive Clinical Experiences for Nursing Students
Authors: Zoromski Lorraine
Published: November 2023

This study looked for associations between measures of emotional intelligence in an intensive clinical experience for nursing students in their final semester of an associate degree program. Twenty nursing students from a technical college in the Midwest volunteered to complete the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) before and after an intensive clinical experience. The results were mixed with a significant decrease in several specific scores within the MSCEIT on the Time Point 2 test. Stress levels or fatigue could have impacted participants’ decreased performance on the MSCEIT.
Effect of Extracerebral Contamination on Near-infrared Spectroscopy as Revealed during Organ Donation: A Prospective Observational Study in Brain-dead Organ Donors
Authors: Soehle Martin , Langer Juliane , Schindler Ehrenfried , Manekeller Steffen , Coburn Mark , Thudium Marcus
Published: November 2023

Background

Near-infrared spectroscopy (NIRS) has been utilized widely in anesthesia and intensive care to monitor regional cerebral oxygen saturation (rScO2). A normal oxygenation of extracerebral tissues may overlay and thereby mask cerebral desaturations, a phenomenon known as extracerebral contamination. The authors investigated the effect of a cessation of extracerebral tissue perfusion on rScO2 in patients with anoxic brains.

Methods

In a single-center, prospective, observational study, brain-dead adults undergoing organ donation were investigated. rScO2 was measured bifrontally using the INVOS 5100C/7100 as well as the ForeSight Elite system. To achieve an efficient conservation of organs and to prevent a redistribution of the perfusion fluid to other tissues, the aorta was clamped before organ perfusion. rScO2 was monitored until at least 40 min after aortic clamping. The primary outcome was the amount of extracerebral contamination as quantified by the absolute decrease in rScO2 after aortic clamping. Secondary outcomes were the absolute rScO2 values obtained before and after clamping.

Results

Twelve organ donors were included. Aortic clamping resulted in a significantly (P < 0.001) greater absolute decrease in rScO2 when comparing the INVOS (43.0 ± 9.5%) to the ForeSight (27.8 ± 7.1%) monitor. Before aortic clamping, near-normal rScO2 values were obtained by the INVOS (63.8 ± 6.2%) and the ForeSight monitor (67.7 ± 6.5%). The rScO2 significantly (P < 0.001) dropped to 20.8 ± 7.8% (INVOS) and 39.9 ± 8.1% (ForeSight) 30 min after clamping, i.e., a condition of a desaturation of both extracerebral and cerebral tissues.

Conclusions

The abrupt end of extracerebral contamination, caused by aortic clamping, affected both NIRS monitors to a considerable extent. Both the INVOS and the ForeSight monitor were unable to detect severe cerebral hypoxia or anoxia under conditions of normal extracerebral oxygenation. While both NIRS monitors may guide measures to optimize arterial oxygen supply to the head, they should not be used with the intention to detect isolated cerebral desaturations.

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Comparison of the Odontoid and Orbital–Coronal Vertical Axis Lines in Evaluating Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery
Authors: Shen Yong , Sardar Zeeshan M. , Katiyar Prerana , Malka Matan , Greisberg Gabriella , Hassan Fthimnir , Reyes Justin L. , Zuckerman Scott L. , Lombardi Joseph M. , Lehman Ronald A. , Lenke Lawrence G. ,   Multi-Ethnic Alignment Normative Study Group
Published: November 2023

Study Design.

Asymptomatic Multi-Ethnic Alignment Normative Study (MEANS) cohort: cross-sectional, multicenter. Symptomatic cohort: retrospective, multisurgeon, single-center.

Objective.

To assess the association of odontoid–coronal vertical axis (OD-CVA) and orbital–coronal vertical axis (ORB-CVA) with radiographic parameters, patient-reported outcomes, and clinical outcomes.

Summary of Background Data.

Previous literature studied the OD-CVA in an asymptomatic cohort and ORB-CVA in a symptomatic cohort, demonstrating their correlations with radiographic parameters and ORB-CVA with outcomes.

Materials and Methods.

A total of 468 asymptomatic adult participants were prospectively enrolled in the MEANS cohort. 174 symptomatic patients with adult spinal deformity with ≥6 fused levels and 2-year follow-ups were retrospectively enrolled in the symptomatic cohort. The association between OD-CVA and ORB-CVA, and radiographic parameters, perioperative variables, PROs, and outcomes were analyzed. Pearson correlation was used to assess correlation and logistic regression odds of outcomes.

Results.

In the MEANS cohort, the ORB-CVA correlated with C7-CVA (r = 0.58) and OD-CVA (r= 0.74). In the symptomatic cohort, preoperative ORB-CVA correlated better with leg length discrepancy; r = 0.17, P= 0.029), whereas preoperative OD-CVA correlated better with C7-CVA (r = 0.90, P< 0.001). Postoperative ORB-CVA correlated with postoperative C7-CVA (r = 0.66, P< 0.001), and postoperative OD-CVA correlated strongly with postoperative C7-CVA (r= 0.81, P< 0.001). Both preoperative OD-CVA (r= 0.199) and ORB-CVA (r = 0.208) correlated with the preoperative Oswestry Disability Index. ORB-CVA correlated better than OD-CVA in the preoperative Scoliosis Research Society-22r pain category but worse in total and other subcategories. Preoperative ORB-CVA was associated with increased odds of intraoperative complication (odds ratio = 1.28, 1.01–1.22), like OD-CVA (odds ratio = 1.30, 1.12–1.53). Neither preoperative ORB-CVA nor OD-CVA was associated with reoperations and readmissions after multivariate analysis. Preoperative OD-ORB mismatch >1.5 cm was not associated with increased odds of intraoperative and postoperative complications, reoperations, or readmissions.

Conclusion.

ORB-CVA and OD-CVA correlated with radiographic parameters, patient-reported outcomes, and intraoperative complications. ORB-CVA and OD-CVA can be used interchangeably as cranial coronal parameters in adult spinal deformity surgery.
Anti-Factor-Xa and Activated Partial Thromboplastin Time Concordance and Outcomes in Adults Undergoing Extracorporeal Membrane Oxygenation: A Secondary Analysis of the Pilot Low-Dose Heparin in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation Randomized Trial
Authors: Aubron Cécile , Chapalain Xavier , Bailey Michael , Board Jasmin , Buhr Heidi , Cartwright Bruce , Dennis Mark , Hodgson Carol , Forrest Paul , McIlroy David , Murphy Deirdre , Murray Lynne , Pellegrino Vincent , Pilcher David , Sheldrake Jayne , Tran Huyen , Vallance Shirley , Cooper D. James , McQuilten Zoe
Published: November 2023

OBJECTIVES:

To determine the concordance between activated partial thromboplastin time (aPTT) and anti-factor-Xa (anti-Xa) in adults undergoing extracorporeal membrane oxygenation (ECMO) and to identify the factors associated with discordant paired aPTT/anti-Xa.

DESIGN:

Pre-planned secondary analysis of the Low-Dose Heparin in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation pilot randomized unblinded, parallel-group controlled trial.

SETTING:

Two ICUs in two university hospitals.

PATIENTS:

Thirty-two critically ill patients who underwent ECMO and who had at least one paired aPTT and anti-Xa assay performed at the same time.

INTERVENTIONS:

We analyzed the concordance between aPTT and anti-Xa and identified factors associated with discordant paired aPTT/anti-Xa based on their respective therapeutic ranges. We also compared biological parameters between heparin resistance episode and no heparin resistance.

MEASUREMENTS AND MAIN RESULTS:

Of the 32 patients who were included in this study, 24 (75%) had at least one discordant paired aPTT/anti-Xa. Of the 581 paired aPTT/anti-Xa that were analyzed, 202 were discordant. The aPTT was relatively lower than anti-Xa in 66 cases (32.7%) or relatively higher than anti-Xa in 136 cases (67.3%). Thirty-three heparin resistance episodes were identified in six patients (19%).

CONCLUSIONS:

In these critically ill patients undergoing ECMO, one third of paired aPTT/anti-Xa measures was discordant. Coagulopathy and heparin resistance might be the reasons for discordance. Our results support the potential importance of routinely monitoring both tests in this setting.
Higher Survival With the Use of Extracorporeal Cardiopulmonary Resuscitation Compared With Conventional Cardiopulmonary Resuscitation in Children Following Cardiac Surgery: Results of an Analysis of the Get With The Guidelines-Resuscitation Registry*
Authors: Kobayashi Ryan L. , Gauvreau Kimberlee , Alexander Peta M. A. , Teele Sarah A. , Fynn-Thompson Francis , Lasa Javier J. , Bembea Melania , Thiagarajan Ravi R. ,   for the American Heart Association’s (AHA) Get With The Guidelines-Resuscitation (GWTG-R) Investigators
Published: November 2023

OBJECTIVES:

Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation (CPR) is increasingly used in children suffering cardiac arrest after cardiac surgery. However, its efficacy in promoting survival has not been evaluated. We compared survival of pediatric cardiac surgery patients suffering in-hospital cardiac arrest who were resuscitated with extracorporeal CPR (E-CPR) to those resuscitated with conventional CPR (C-CPR) using propensity matching.

DESIGN:

Retrospective study using multicenter data from the American Heart Association Get With The Guidelines-Resuscitation registry (2008–2020).

SETTING:

Multicenter cardiac arrest database containing cardiac arrest and CPR data from U.S. hospitals.

PATIENTS:

Cardiac surgical patients younger than 18 years old who suffered in-hospital cardiac arrest and received greater than or equal to 10 minutes of CPR.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among 1223 patients, 741 (60.6%) received C-CPR and 482 (39.4%) received E-CPR. E-CPR utilization increased over the study period (p < 0.001). Duration of CPR was longer in E-CPR compared with C-CPR recipients (42 vs. 26 min; p < 0.001). In a propensity score matched cohort (382 E-CPR recipients, 382 C-CPR recipients), E-CPR recipients had survival to discharge (odds ratio [OR], 2.22; 95% CI, 1.7–2.9; p < 0.001). E-CPR survival was only higher when CPR duration was greater than 18 minutes. Propensity matched analysis using patients from institutions contributing at least one E-CPR case (n = 35 centers; 353 E-CPR recipients, 353 C-CPR recipients) similarly demonstrated improved survival in E-CPR recipients compared with those who received C-CPR alone (OR, 2.08; 95% CI, 1.6–2.8; p < 0.001).

CONCLUSIONS:

E-CPR compared with C-CPR improved survival in children suffering cardiac arrest after cardiac surgery requiring CPR greater than or equal to 10 minutes.
Effectiveness and Safety of Immune Checkpoint Inhibitors in Cancer Patients With Autoimmune Disease: A Retrospective Cohort Study
Authors: Raghavan Arjun A. , Goutam Sid , Musto Grace , Geirnaert Marc , Ye Carrie , O’Neil Liam J. , Graham Jeffrey
Published: November 2023

Although immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, patients with pre-existing autoimmune diseases (PADs) have largely been excluded from clinical trials evaluating this drug class. This study evaluates the effectiveness and safety of ICI therapy in individuals with PAD in a real-world setting. A retrospective study of patients exposed to ICI therapy between 2012 and 2019 was conducted. Patients with PAD were identified and matched to an ICI-exposed group without PAD based on age, sex, and cancer type. Primary outcomes included toxicity, time to treatment failure, overall survival, and objective response rate. The association between PAD status and outcomes was determined using Cox and logistic regression modeling. A total of 813 patients exposed to ICI therapy were identified, of which 8.2% (N=67) had a PAD. When compared with a matched cohort without PAD (N=132), there was no significant difference in the rates of new immune-related adverse events (irAEs, 42.4% in the non-PAD group vs. 47.8% in the PAD group, P=0.474). After controlling for the type of ICI, there was no significant association between PAD status and irAE (odds ratio 1.67, 95% CI: 0.9–3.21 P=0.1). There was no significant association between overall survival and PAD status (hazard ratio 1.12, 95% CI: 0.76–1.66. P=0.56) or between time to treatment failure and PAD status (hazard ratio 0.82, 95% CI: 0.6–1.12, P=0.22). There was an association between PAD status and objective response rate (odds ratio 3.28, 95% CI: 1.28–8.38, P=0.013). In summary, PAD status was not associated with enhanced toxicity when compared with patients without PAD, with similar oncologic effectiveness between these 2 groups.
Management of metastatic bone disease of melanoma
Authors: Chen Wenyan , Yang Chen , Chen Biqi , Xi Mian , Chen Baoqing , Li Qiaoqiao
Published: November 2023

One of the most aggressive tumors arising from the skin, mucosa, and uvea is malignant melanoma, which easily metastasizes. Bone tissue is one of the most typical locations for distant metastasis, and around 5%-20% of patients eventually acquired skeletal metastases. For decades, the incidence of bone metastases was higher, bringing greater burden on the family, society, and healthcare system owing to the progress of targeted therapy and immunotherapy, which prolonging the survival time substantially. Moreover, bone metastases result in skeletal-related events, which influence the quality of life, obviously. Appropriate intervention is therefore crucial. To obtain the optimum cost-effectiveness, existing treatment algorithm must be integrated, which is still controversial. We have aimed to throw light on current views concerning the formation, biological and clinical features, and treatment protocol of melanoma bone metastases to guide the decision-making process.
Bone marrow metastases: a systematic review of a neglected involvement in malignant melanoma
Authors: Paolino Giovanni , Carugno Andrea , Rongioletti Franco , Ponzoni Maurilio , Russo Vincenzo , Sena Paolo , Ardigò Marco , Costanzo Antonio , Mercuri Santo Raffaele , Valenti Mario
Published: November 2023

The occurrence of bone marrow metastases (BMM) in melanoma patients is often underestimated, with only 7% detected during in-vivo staging procedures but rising to 45% in autopsy cases. This systematic review aims to shed light on the clinical and laboratory features of BMM in melanoma by analyzing 73 studies selected from 2 482 initially retrieved from PubMed, Embase, and Cochrane CENTRAL databases. Our findings reveal a slight male predominance, with a median age at BMM diagnosis of 56 years. Primary melanoma sites included the skin (52%), mucosa (8.8%), uvea (20.5%) and unidentified (19%). BMM was preceded by lymph node involvement in 36.5% of cases, whereas 63% showed no nodal metastases, with direct BMM occurring in 22.5% and metastases to other sites in 41%. Common BMM symptoms included pain (60.7%), anemia (80%), thrombocytopenia, leukoerythroblastosis, pancytopenia and leukopenia, while disseminated intravascular coagulation was detected in 11% of cases. In 23.6% of cases, BMM was amelanotic. The prognosis for BMM is grim, with a median survival of only 2 months. Conventional therapies for BMM remain largely ineffective, emphasizing the importance of considering bone marrow as a potential metastatic site in melanoma patients.
Epidemic of HIV in Pakistan: an emerging health issue threatening to derail progress toward the SDGs
Authors: Baloch Rabia , Muzzamil Muhammad , Raza Shaeroz , Naz Simra , Butt Shahiqa , Malikzai Abdullah
Published: November 2023

To give a broad overview of the ways in which inconsistent record-keeping and reporting have exacerbated the HIV epidemic in Pakistan. And how they are affecting our capacity to achieve the Sustainable Development Goals (SDGs). It is crucial to shed light on the efforts and challenges in this area because HIV is taboo in Pakistan. As the HIV rate rises and healthcare reporting in Pakistan weakens, evidence-based solutions must be developed and implemented. Disease reporting and epidemiological patterns are shifting quickly, and innovative approaches are needed to keep up. Although Pakistan is a low- and middle-income country, the SDGs would be difficult to achieve because of its financial woes and dysfunctional healthcare system. This has an overall negative impact on health care as a whole. In low- and middle-income nations like Pakistan, where there is a significant lack of data on the individuals impacted by the disease, attempting and sustaining HIV surveillance efforts requires the government’s and other donors’ engagement. Removing roadblocks to an evidence-based approach to HIV, measuring progress toward eradicating the virus, and allocating resources in light of this is an immediate necessity.
Rate and durability of the clearance of HBsAg in Alaska Native persons with long-term HBV infection: 1982–2019
Authors: Bruden Dana , McMahon Brian J. , Snowball Mary , Towshend-Bulson Lisa , Homan Chriss , Johnston Janet M. , Simons Brenna C. , Bruce Michael G. , Cooley Laura , Spradling Philip R. , Harris Aaron M.
Published: November 2023

Background and Aims:

A functional cure and therapeutic end point of chronic HBV infection is defined as the clearance of HBsAg from serum. Little is known about the long-term durability of HBsAg loss in the Alaskan Native population.

Approach and Results:

We performed a retrospective cohort study of Alaska Native patients with chronic HBV-monoinfection from January 1982 through December 2019. The original group in this cohort was identified during a 1982 to 1987 population-based screening for 3 HBV serologic markers in 53,000 Alaska Native persons. With close to 32,000 years of follow-up, we assessed the frequency and duration of HBsAg seroclearance (HBsAg-negative for > 6 mo). We examined factors associated with HBsAg clearance and followed persons for a median of 13.1 years afterward to assess the durability of HBsAg clearance. Among 1079 persons with an average length of follow-up of 33 years, 260 (24%) cleared HBsAg at a constant rate of 0.82% per person/per year. Of the 260 persons who cleared, 249 (96%) remained HBsAg-negative, while 11 persons had ≥ 2 transient HBsAg-positive results in subsequent follow-up.

Conclusions:

Of the patients with chronic HBV monoinfection, 0.82% of people per year achieved a functional cure. HBsAg seroclearance was durable for treated and nontreated patients and lasted, on average, over 13 years without seroreversion.
From Genotype to Phenotype: How Enhancers Control Gene Expression and Cell Identity in Hematopoiesis
Authors: Mulet-Lazaro Roger , Delwel Ruud
Published: November 2023

Blood comprises a wide array of specialized cells, all of which share the same genetic information and ultimately derive from the same precursor, the hematopoietic stem cell (HSC). This diversity of phenotypes is underpinned by unique transcriptional programs gradually acquired in the process known as hematopoiesis. Spatiotemporal regulation of gene expression depends on many factors, but critical among them are enhancers—sequences of DNA that bind transcription factors and increase transcription of genes under their control. Thus, hematopoiesis involves the activation of specific enhancer repertoires in HSCs and their progeny, driving the expression of sets of genes that collectively determine morphology and function. Disruption of this tightly regulated process can have catastrophic consequences: in hematopoietic malignancies, dysregulation of transcriptional control by enhancers leads to misexpression of oncogenes that ultimately drive transformation. This review attempts to provide a basic understanding of enhancers and their role in transcriptional regulation, with a focus on normal and malignant hematopoiesis. We present examples of enhancers controlling master regulators of hematopoiesis and discuss the main mechanisms leading to enhancer dysregulation in leukemia and lymphoma.
Does liraglutide alleviate inflammation in brain-dead donors? A randomized clinical trial
Authors: Custódio Geisiane , Massutti Andrew Maykon , da Igreja Mauro Rafael , Lemos Natália Emerim , Crispim Daisy , Visioli Fernanda , Palma Victor de Mello , Leitão Cristiane Bauermann , Rech Tatiana Helena
Published: November 2023

Brain death triggers an inflammatory cascade that damages organs before procurement, adversely affecting the quality of grafts. This randomized clinical trial aimed to compare the efficacy of liraglutide compared to placebo in attenuating brain death-induced inflammation, endoplasmic reticulum stress, and oxidative stress. We conducted a double-blinded, placebo-controlled, randomized clinical trial with brain-dead donors. Fifty brain-dead donors were randomized to receive subcutaneous liraglutide or placebo. The primary outcome was the reduction in IL-6 plasma levels. Secondary outcomes were changes in other plasma pro-inflammatory (IL-1β, interferon-γ, TNF) and anti-inflammatory cytokines (IL-10), expression of antiapoptotic (BCL2), endoplasmic reticulum stress markers (DDIT3/CHOP, HSPA5/BIP), and antioxidant (superoxide dismutase 2, uncoupling protein 2) genes, and expression TNF, DDIT3, and superoxide dismutase 2 proteins in liver biopsies. The liraglutide group showed lower cytokine levels compared to the placebo group during follow-up: Δ IL-6 (−28 [−182, 135] vs. 32 [−10.6, 70.7] pg/mL; p = 0.041) and Δ IL-10 (−0.01 [−2.2, 1.5] vs. 1.9 [−0.2, 6.1] pg/mL; p = 0.042), respectively. The administration of liraglutide did not significantly alter the expression of inflammatory, antiapoptotic, endoplasmic reticulum stress, or antioxidant genes in the liver tissue. Similar to gene expression, expressions of proteins in the liver were not affected by the administration of liraglutide. Treatment with liraglutide did not increase the organ recovery rate [OR = 1.2 (95% CI: 0.2–8.6), p = 0.82]. Liraglutide administration reduced IL-6 and prevented the increase of IL-10 plasma levels in brain-dead donors without affecting the expression of genes and proteins related to inflammation, apoptosis, endoplasmic reticulum stress, or oxidative stress.
Prosthetic Stimulation of the Vestibular Nerve Can Evoke Robust Eye and Head Movements Despite Prior Labyrinthectomy
Authors: Wiboonsaksakul Kantapon Pum , Della Santina Charles C. , Cullen Kathleen E.
Published: November 2023

Hypothesis

Prosthetic electrical stimulation can evoke compensatory eye and head movement despite vestibular implant electrode insertion occurring years after prior labyrinthectomy.

Background

Vestibular implants sense head rotation and directly stimulate the vestibular nerve, bypassing damaged end organs. Animal research and current clinical trials have demonstrated the efficacy of this approach. However, candidacy criteria for vestibular implants currently require presence of a patent labyrinth in the candidate ear and at least aidable hearing in the opposite ear, thus excluding patients who have undergone prior labyrinthectomy for unilateral Menière's disease that later progressed to bilateral vestibular hypofunction.

Methods

Eight years after right unilateral labyrinthectomy, we implanted stimulating electrodes in the previously exenterated right ear ampullae of a rhesus macaque monkey. The left labyrinth had long-standing hypofunction due to intratympanic gentamicin injection and surgical disruption. We used three-dimensional video-oculography to measure eye movement responses to prosthetic electrical stimulation. We also measured head-movement responses to prosthetic stimulation with the head unrestrained.

Results

Bilateral vestibular hypofunction was confirmed by absence of vestibuloocular reflex responses to whole-body rotation without prosthetic stimulation. For a subset of the implanted electrodes, prosthetic vestibular stimulation evoked robust compensatory eye and head movements. One electrode reliably elicited responses aligned with the implanted ear's anterior canal nerve regardless of the return electrode used. Similarly, a second electrode also elicited responses consistent with excitation of the horizontal canal nerve. Responses grew quasilinearly with stimulation rate and current amplitude.

Conclusion

Prosthetic electrical stimulation targeting the vestibular nerve can be effective years after labyrinthectomy, if at least some parts of the vestibular nerve's ampullary branches remain despite destruction or removal of the membranous labyrinth.
Exoscope-Assisted Stapedotomy: Evaluation of Safety and Efficacy
Authors: Conway Robert M. , Fan Caleb J. , Choi Jonathan S. , Babu Kavan , Mallany Hugh P. , Babu Seilesh C.
Published: November 2023

Objective

Evaluate the safety and efficacy of exoscope-assisted stapedotomy.

Study Design

Retrospective chart review.

Setting

Tertiary care neurotology clinic.

Patients

Adult patients with otosclerosis undergoing stapedotomy.

Intervention(s)

Primary stapedotomy.

Main Outcome Measure(s)

Evaluation of audiologic outcomes, including pure-tone average, bone-conduction thresholds, word recognition score, and air-bone gap. Complications, need for scutum removal, and length of surgery were also evaluated.

Results

A total of 47 patients were identified, and 24 patients underwent surgery with the microscope and 22 with the exoscope. There were significant improvements in pure-tone average, mean bone-conduction thresholds, and air-bone gap for both groups. There was no difference in preoperative or postoperative audiologic status for either group. There was no difference in rates of dysgeusia, chorda tympani nerve damage, dizziness, or facial paresis in either group.

Conclusions

This study indicates similar audiologic outcomes, complication profiles, and visualization when comparing exoscopic and microscopic stapedotomy. Demonstrated here, exoscopic stapedotomy can be safely performed in a transcanal manner.
Advancements in airway stents: a comprehensive update
Authors: Aravena Carlos , Gildea Thomas R.
Published: November 2023

Purpose of review

This review provides an overview of the evolving field of airway stenting (AS), highlighting its relevance in the management of central airway obstruction (CAO). It discusses recent advancements, including 3D-printed silicone stents (3DPSS), metallic stents, biodegradable stents (BS), and drug-eluting stents (DES), which are transforming clinical practice. The review underscores the ongoing challenges in patient selection, stent choice, and long-term management in the context of an evolving landscape.

Recent findings

Innovations, particularly 3DPSS, have shown promise in providing patient-specific solutions. These stents offer improved symptom relief, enhanced quality of life, and lower complication rates, especially for complex airway diseases. The use of BS and DES is explored, raising prospects for future applications.

The evolution of AS reflects a deepening understanding of airway obstructions. Recent innovations, such as 3DPSS, BS, and DES, show considerable promise in addressing the limitations of conventional stents. However, challenges related to complications, patient selection, and long-term management persist, demanding further research. Wide practice variations in the management of AS highlight the need for more clinical data and standardized guidelines. The search for the ideal stent continues, driven by the pursuit of better outcomes for patients with CAO.
Board Leaders' Perspectives of the Impact of Nurses on Boards
Authors: Sundean Lisa J. , Christopher Roberta , Reede Lynn , Mott Jason , Mylott Laura
Published: November 2023

OBJECTIVE

The purpose of the study was to explore the impact of nurses on boards (NOBs) from the perspectives of board leaders who are not nurses.

BACKGROUND

Research about the impact of NOBs derives from nurses' recall of board experiences. No studies explore the impact of NOBs from perspectives other than nurses.

METHODS

Researchers used an exploratory qualitative design with purposive sampling and interviewed 16 participants.

RESULTS

According to participants, NOBs impact board governance as boundary spanners within the healthcare ecosystem. The overarching pattern is supported by 6 traversing themes.

CONCLUSIONS

Board leaders' perspectives of NOBs as boundary spanners illustrate the far-reaching impact nurses have in the board role and on the direction of healthcare organizations.
Mediators of psychosocial well-being for immigrant women living with breast cancer in Canada: a critical ethnography
Authors: D'Souza Melba Sheila , Fehr Florriann Carissa , Smith Michelle Lynne , Marshall Marie-Claire
Published: November 2023

Background:

Immigrant women living with breast cancer experience a lack of psychosocial and emotional support, which adds to the complexity of navigating and using health care services in Canada.

Aim:

To explore the mediators of psychosocial well-being for immigrant women living with breast cancer in Canada.

Methods:

A critical ethnography was used. The study identified 27 immigrants living with breast cancer, who had been born in a foreign country, migrated to Canada within the past 10 years, and lived in rural communities of British Columbia between August 2021 and March 2022. Institutional research ethics board approval and informed consent were obtained.

Results:

The findings indicated two significant themes: The immigrant women had limited knowledge, information, and communication and experienced physical, psychological, and emotional distress.

Conclusion:

There is a significant need for culturally responsive care services for immigrant women living with breast cancer in rural communities. Recommendations include the development of psychosocial oncology, such as integrated counseling and therapies, to reduce cancer-related post-traumatic stress and improve their psychosocial and emotional well-being. Interdisciplinary approaches to psychosocial oncology are particularly crucial for immigrants and rural communities, where women need access to cancer navigation and ongoing support for a better health-related quality of life.
Proximity to Swine Farming Operations as a Risk Factor for Eosinophilic Esophagitis
Authors: Cotton Cary C. , Jensen Elizabeth T. , Hoffman Kate , Green Daniel J. , Tapia Amanda L. , Turner Kevin O. , Genta Robert M. , Dellon Evan S.
Published: November 2023

We aimed to determine whether residential proximity to permitted swine facilities was associated with an increased risk of eosinophilic esophagitis (EoE) by conducting a case-control study using 2 complementary data sources: 1 from a tertiary care center (n = 401 cases and 1805 controls) and 1 from a large pathology group (n = 904 cases and 4074 controls). Addresses of the subjects and swine facilities were geocoded, and adjusted odds of EoE relative to proximity to and density of swine facilities were calculated. We observed a positive association between proximity to a permitted swine facility (<1 mile) and odds of EoE (adjusted odds ratio R, 2.56; 95% CI, 1.33–4.95) in the tertiary center data; density of farms (>10 farms/census tract) was also positively associated (adjusted odds ratio, 2.76; 95% CI, 1.30–5.84). However, this association was not observed in the pathology database. Though proximity to and density of swine operations were associated with EoE, associations were sensitive to the database used.
A Year After Implementation of the Telehealth Waiver: Being Offered and Utilizing Video-Specific Telehealth Among Dual-Eligible Medicare Recipients During the COVID-19 Pandemic
Authors: Choi Jasmin , Kim Grace , Choi Sugy , Chang Ji Eun
Published: November 2023

Objective:

Telehealth is an essential tool to provide access to care while reducing infection exposure for high-risk populations during the COVID-19 pandemic. Our study aims to examine factors associated with telehealth availability and usage among Medicare and dual-eligible recipients 1 year after implementation of the Medicare's temporary telehealth waiver.

Design, Setting, and Participant:

A cross-sectional, phone survey with a national representative sample of Medicare recipients. We obtained a final study sample from the Winter 2021 COVID-19 Supplement of Medicare Current Beneficiary Survey dataset (N = 10 586). We examined associations for being offered and having had telehealth visits or any video telehealth visits during the pandemic since November 1, 2020.

Main Outcome Measures:

Our primary outcomes were being offered any telehealth, being offered any video telehealth, having had any telehealth visit, and having had any video telehealth.

Results:

Although dual eligibility was not significantly associated with being offered or having had any telehealth services during the pandemic, those who were dual eligible were more likely to have had video telehealth visits (adjusted odds ratio = 1.39, 95% confidence interval 1.04-1.86, P = .03) compared with those with non-dual eligibility. Recipients with disability eligibility, technology access, and severe chronic conditions were more likely to have been offered or have had telehealth. At the same time, those who lived in the nonmetropolitan area were less likely to have been offered or have had telehealth, including video telehealth.

Conclusions:

Our findings suggest that the federal waivers to expand telehealth services were successful in continuing care for vulnerable Medicare recipients. The providers' specific outreach and intervention efforts to offer telehealth visits are crucial for dual-eligible recipients. To increase video telehealth uptake, technology access and services to rural areas should be prioritized.
Development and Validation of a New Score to Assess the Risk of Posttransplantation Diabetes Mellitus in Kidney Transplant Recipients
Authors: Serna-Higuita Lina Maria , Isaza-López Maria Carolina , Hernández-Herrera Gilma Norela , Serna-Campuzano Angelica Maria , Nieto-Rios John Fredy , Heyne Nils , Guthoff Martina
Published: November 2023

Background.

Posttransplantation diabetes mellitus (PTDM) is a serious complication of solid organ transplantation. It is associated with major adverse cardiovascular events, which are a leading cause of morbidity and mortality in transplant patients. This study aimed to develop and validate a score to predict the risk of PTDM in kidney transplant recipients.

Methods.

A single-center retrospective cohort study was conducted in a tertiary care hospital in Medellín, Colombia, between 2005 and 2019. Data from 727 kidney transplant recipients were used to develop a risk prediction model. Significant predictors with competing risks were identified using time-dependent Cox proportional hazard regression models. To build the prediction model, the score for each variable was weighted using calculated regression coefficients. External validation was performed using independent data, including 198 kidney transplant recipients from Tübingen, Germany.

Results.

Among the 727 kidney transplant recipients, 122 developed PTDM. The predictive model was based on 5 predictors (age, gender, body mass index, tacrolimus therapy, and transient posttransplantation hyperglycemia) and exhibited good predictive performance (C-index: 0.7 [95% confidence interval, 0.65-0.76]). The risk score, which included 33 patients with PTDM, was used as a validation data set. The results showed good discrimination (C-index: 0.72 [95% confidence interval, 0.62-0.84]). The Brier score and calibration plot demonstrated an acceptable fit capability in external validation.

Conclusions.

We proposed and validated a prognostic model to predict the risk of PTDM, which performed well in discrimination and calibration, and is a simple score for use and implementation by means of a nomogram for routine clinical application.