bluuebunny/crossref_metadata_2025 huggingface dataset:
Work fluctuations for a confined Brownian particle: the role of initial conditions
Authors: Carollo Giovanni Battista , Semeraro Massimiliano , Gonnella Giuseppe , Zamparo Marco
Published: September 2023

We study the large fluctuations of the work injected by the random force into a Brownian particle under the action of a confining harmonic potential. In particular, we compute analytically the rate function for generic uncorrelated initial conditions, showing that, depending on the initial spread, it can exhibit no, one, or two singularities associated to the onset of linear tails. A dependence on the potential strength is observed for large initial spreads (entailing two singularities), which is lost for stationary initial conditions (giving one singularity) and concentrated initial values (no singularity). We discuss the mechanism responsible for the singularities of the rate function, identifying it as a big jump in the initial values. Analytical results are corroborated by numerical simulations.
A new type of superorthogonality
Authors: Gressman Philip , Pierce Lillian , Roos Joris , Yung Po-Lam
Published: September 2023

We provide a simple criterion on a family of functions that implies a square function estimate on

L
p

L^p

for every even integer

p
≥
2

p \geq 2

. This defines a new type of superorthogonality that is verified by checking a less restrictive criterion than any other type of superorthogonality that is currently known.
Existence of convex hypersurfaces with prescribed centroaffine curvature
Authors: Guang Qiang , Li Qi-Rui , Wang Xu-Jia
Published: September 2023

In this paper, we study the existence of solutions to the centroaffine Minkowski problem, namely the existence of closed convex hypersurfaces in the Euclidean space

R

n
+
1

\mathbb {R}^{n+1}

with prescribed centroaffine curvature. This problem can be described as a variational problem with a functional resembling Kantorovich’s dual functional in optimal transportation. By using the Gauss curvature flow, we obtain new conditions for the existence of solutions to the problem.
Dihedral rigidity in hyperbolic 3-space
Authors: Chai Xiaoxiang , Wang Gaoming
Published: September 2023

We prove a comparison theorem for certain types of polyhedra in a 3-manifold with its scalar curvature bounded below by

−
6

-6

. The result confirms in some cases the Gromov dihedral rigidity conjecture in hyperbolic

3
3

-space.
Brain MRI research in neurodegenerative dementia: time to deliver on promises
Authors: Ducharme Simon
Published: September 2023

This scientific commentary refers to ‘Atrophy in behavioural variant frontotemporal dementia spans multiple large-scale prefrontal and temporal networks’ by Eldaief et al. (https://doi.org/10.1093/brain/awad167).
Revised gas-phase formation network of methyl cyanide: the origin of methyl cyanide and methanol abundance correlation in hot corinos
Authors: Giani Lisa , Ceccarelli Cecilia , Mancini Luca , Bianchi Eleonora , Pirani Fernando , Rosi Marzio , Balucani Nadia
Published: September 2023

Methyl cyanide (CH3CN) is one of the most abundant and widely spread interstellar complex organic molecules (iCOMs). Several studies found that, in hot corinos, methyl cyanide and methanol abundances are correlated suggesting a chemical link, often interpreted as a synthesis of them on the interstellar grain surfaces. In this article, we present a revised network of the reactions forming methyl cyanide in the gas phase. We carried out an exhaustive review of the gas-phase CH3CN formation routes, propose two new reactions, and performed new quantum mechanics calculations of several reactions. We found that 13 of the 15 reactions reported in the databases KIDA and UDfA have incorrect products and/or rate constants. The new corrected reaction network contains 10 reactions leading to methyl cyanide. We tested the relative importance of those reactions in forming CH3CN using our astrochemical model. We confirm that the radiative association of CH3+ and HCN, forming CH3CNH+, followed by the electron recombination of CH3CNH+, is the most important CH3CN formation route in both cold and warm environments, notwithstanding that we significantly corrected the rate constants and products of both reactions. The two newly proposed reactions play an important role in warm environments. Finally, we found a very good agreement between the CH3CN predicted abundances with those measured in cold (∼10 K) and warm (∼90 K) objects. Unexpectedly, we also found a chemical link between methanol and methyl cyanide via the CH$_{3}^{+}$ ion, which can explain the observed correlation between the CH3OH and CH3CN abundances measured in hot corinos.
Partner-Involved Financial Incentives for Smoking Cessation in Dual-Smoker Couples: A Randomized Pilot Trial
Authors: vanDellen Michelle R , Wright Julian W C , Zhao Bokai , Cullinan Caleigh , Beach Steven R H , Shen Ye , Haskins LeeAnn B , Schiavone William M , MacKillop James M
Published: September 2023

Introduction

Members of dual-smoker couples (in which both partners smoke) are unlikely to try to quit smoking and are likely to relapse if they do make an attempt. The purpose of this study was to investigate the feasibility, tolerability, and preliminary outcomes of dyadic adaptations of financial incentive treatments (FITs) to promote smoking cessation in dual-smoker couples.

Aims and Methods

We enrolled 95 dual-smoker couples (N = 190) in a three-arm feasibility RCT comparing two partner-involved FITs (single vs. dual incentives) against a no-treatment control condition. Participants in all conditions were offered nicotine replacement and psychoeducation. A 3-month follow-up provided information about retention, tolerability (ie, self-reported benefits and costs of the study), and preliminary efficacy (ie, program completion, quit attempts, point-prevalent abstinence, and joint quitting).

Results

Results suggest dyadic adaptations were feasible to implement (89% retention rate) and highly tolerable for participants (p < .001). Neither feasibility nor tolerability varied across the treatment arm. Preliminary efficacy outcomes indicated partner-involved FITs have promise for increasing smoking cessation in dual-smoker couples (OR = 2.36–13.06).

Conclusions

Dyadic implementations of FITs are feasible to implement and tolerable to participants.

Implications

The evidence that dyadic adaptations of FITs were feasible and tolerable, and the positive preliminary efficacy outcomes suggest that adequately powered RCTs formally evaluating the efficacy of dyadic adaptations of FITs for dual-smoker couples are warranted.
The impact of MIF deficiency on alterations of fecal microbiota in C57BL/6 mice induced by Trichinella spiralis infection
Authors: Xie Yiting , Xu Daoxiu , Yan Siyi , Hu Xinyi , Chen Sirui , Guo Kun , Wang Jue , Chen Qinghai , Guan Wei
Published: September 2023

Trichinellosis caused by Trichinella spiralis (T. spiralis) is a major food‐borne parasitic zoonosis worldwide. Prevention of trichinellosis is an effective strategy to improve patient quality of life. Macrophage migration inhibitory factor (MIF) is closely related to the occurrence and development of several parasitic diseases. Studying the impact of MIF deficiency (Mif−/−) on the alterations in host fecal microbiota due to T. spiralis infection may contribute to proposing a novel dual therapeutic approach for trichinellosis. To reveal the diversity and differences in fecal microbial composition, feces were collected from T. spiralis‐uninfected and T. spiralis‐infected wild‐type (WT) and MIF knockout (KO) C57BL/6 mice at 0, 7, 14, and 35 days post‐infection (dpi), and the samples were sent for 16S rRNA amplicon sequencing on the Illumina NovaSeq platform. Flow cytometry was used to determine the expression levels of IFN‐γ and IL‐4 in the CD4+/CD8+ T‐cell sets of mouse spleens. The results showed that operational taxonomic unit (OTU) clustering, relative abundance of microbial composition, alpha diversity, and beta diversity exhibited significant changes among the eight groups. The LEfSe analysis selected several potential biomarkers at the genus or species level, including Akkermansia muciniphila, Lactobacillus murinus, Coprococcus catus, Firmicutes bacterium M10_2, Parabacteroides sp. CT06, and Bacteroides between the KTs and WTs groups. The predicted bacterial functions of the fecal microbiota were mainly involved in metabolism, such as the metabolism of carbohydrates, amino acids, energy, cofactors, vitamins, nucleotides, glycans, and lipids. Flow cytometry revealed an increased CD3+CD8−/CD3+CD8+ T‐cell ratio and increased IFN‐γ and IL‐4 levels in CD3+CD8− T‐cell sets from WT and MIF KO mice at 7 dpi. The results indicated that both MIF KO and infection time have a significant influence on the CD3+CD8−IFN‐γ+ and CD3+CD8−IL‐4+ response in mice after T. spiralis. In conclusion, this research showed alterations of the fecal microbiota and immune response in both WT and MIF KO mice before and after T. spiralis infection. These results revealed a potential role of MIF in regulating the pathogenesis of trichinellosis related to the intestinal microbiota. Importantly, the selected potential biomarkers combined with MIF will also offer a novel therapeutic approach to treat trichinellosis in the future.
Existential Care in Daily Nursing Practice
Authors: Tarbi Elise C. , Broden Elizabeth G. , Rosa William E. , Hayden Adam , Morgan Brianna E.
Published: September 2023

Relationship-centered palliative nursing during serious illness requires existential care. Yet, multilevel systemic barriers hinder nurses' ability to provide this care. The authors suggest ways to navigate these barriers, highlighting existential care priorities that nurses can attend to in their daily practice. These include 1) maintaining a strengths-based orientation, 2) taking a life course perspective, 3) grounding care firmly in relationships, and 4) responding moment to moment. They propose that by emphasizing existential care in palliative nursing, we can create a more compassionate and human-centered health system.
The Eat, Sleep, Console Approach Appears to Be Safe for Infants with Opioid Withdrawal
Authors: Rosenberg Karen
Published: September 2023

According to this study:
Breaking the Silence: A Workshop for Medical Students on Dealing With Failure in Medicine
Authors: Klasen Jennifer M. , Germann Nicolas , Lutz Sandra , Beck Jimmy , Fourie Lana
Published: September 2023

Problem

Failure is a powerful teacher but an emotionally stressful experience. Before residency, when failure in clinical training is inevitable, medical students should learn to talk about and cope with failure. However, medical school curricula rarely include this topic, and physicians seldom share their mistakes and failures with trainees. This report describes and evaluates a workshop on dealing with failure in medicine.

Approach

Two attending surgical consultants and a life coach facilitated the workshop between February 2021 and February 2022, which consisted of different educational approaches, such as presentations, small group discussions, and journal clubs. The sessions aimed to enable medical learners to identify and analyze actual and potential failure events in everyday clinical practice and learn from them, disclose and communicate medical failures and “speak up,” reflect on failure and develop coping strategies, and understand the moderating role of fear of failure.

Outcomes

Thirty medical students participated in the workshop. Dealing with failure in a productive manner was the medical learners' key learning objective and anticipated takeaway from the workshop. After the workshop, 19 of the 30 participants anonymously completed the standard university evaluation form. The medical students gave the workshop a mean (SD) rating of 8.59 (0.98) on a Likert scale ranging from 1 to 10. They felt better prepared to approach future challenges in a constructive manner after being equipped with strategies to deal with failure. Listening to the failure experiences of faculty and peers in a safe environment helped them accept that failure is inevitable.

Next Steps

The findings suggest that medical students appreciated a safe environment to discuss failure. By promoting a safe learning environment early in the medical career, medical schools could make an important contribution to reducing the stigma of failure and eliminating the shame and blame culture, thus contributing to students' well-being.
Safety and Efficacy of Oral Nalbuphine on Postoperative Pain in Hemorrhoidectomy Patients
Authors: Jao Shu-Wen , Hsiao Koung-Hung , Lin Hua-Ching , Lee Chia-Cheng , Lin Tzu-Chen , Chen Wei-Shone , Lin Chun-Chi , Lee Tsai-Yu , Jiang Jeng-Kai , Wu Chang-Chieh , Hu Oliver Yoa-Pu
Published: September 2023

Objectives:

Severe postoperative pain requiring opioid treatment has been reported in 20–40% of hemorrhoidectomy patients. Compared to morphine, nalbuphine offers better hemodynamic stability, a lower risk of respiratory depression, and a lower potential for addiction. Nalbuphine was developed from intravenous form into an oral form (PHN131) to alleviate moderate-to-severe pain.

Methods:

A randomized, double-blind, placebo-controlled, multiple-dose, parallel-design trial was conducted to evaluate the safety and efficacy of PHN131 in patients undergoing hemorrhoidectomy. Eligible patients were randomly assigned to receive either PHN131 soft capsules containing nalbuphine hydrochloride 60 mg or placebo capsules. Intramuscular diclofenac was the rescue analgesic. Pain was measured by the area under the curve of mean Visual Analog Scale (VAS) pain intensity scores.

Results:

VAS results in patients receiving PHN131 were significantly lower than placebo group scores through 48 hours postoperatively (149.2±75.52 vs. 179.6±65.97; P=0.0301). According to Brief Pain Inventory Short Form scores, the impact of pain on quality of life was significantly smaller for the PHN131 group than for the placebo group. Time to the first use of diclofenac postoperatively was significantly longer in the PHN131 group than in the placebo group. The cumulative dosage of diclofenac in the PHN131 group was only around half of that in the placebo group (P<0.0001). Drug-related adverse events were mild-to-moderate and resolved by treatment end. No drug-related severe adverse events were observed.

Discussion:

Our findings demonstrate that PHN131 is effective and well-tolerated in the treatment of moderate-to-severe pain and may provide another option for patients to control their pain.
Reproductive Justice in the U.S. Immigration Detention System
Authors: Pepe Claudia S. , Saadi Altaf , Molina Rose L.
Published: September 2023

Reproductive coercion extends from a historical context in which the obstetrics and gynecology profession has interfered with the reproductive and bodily autonomy of immigrants. We provide illustrative examples of historical and contemporary immigration policies that allow mechanisms of reproductive control to persist within the immigration detention system. We end by compelling obstetrician–gynecologists to act as agents of change by leveraging their social, economic, and political power to resist and eliminate structures and norms that enable reproductive oppression of immigrant groups in detention.
Association of Neighborhood Economic Status and Race With Developing Pelvic Inflammatory Disease After Sexually Transmitted Infections
Authors: Wang Runzhi , Carson Kathryn A. , Sao Saumya S. , Coleman Jenell S.
Published: September 2023

OBJECTIVE:

To explore the association of neighborhood-level socioeconomic status (SES) and race with developing pelvic inflammatory disease (PID) after sexually transmitted infection (STI) among female adolescents and young adults in Maryland.

METHODS:

We used Maryland statewide hospital claims data (outpatient and inpatient visits) for this retrospective cohort study. Female adolescents and young adults aged 15–24 years who had at least one STI from July 1, 2013, to March 31, 2015, were included. A participant entered the cohort on the date of the first STI diagnosis and was followed up until PID occurrence or 3 years after the first STI. Median household income of the participant’s residential ZIP code tabulation area was used as the neighborhood-level SES. Discrete-time hazard models were used to estimate the hazard of PID.

RESULTS:

Of the 2,873 participants, 88.5% were of Black race, and 67.2% were aged 20–24 years. The hazard of PID after an STI among Black women was 1.40 times that of White women (95% CI 1.06–1.85). After adjustment for age, insurance type, and number of STI events, the hazard ratio (HR) did not change. However, adding neighborhood-level SES to the model attenuated the disparity in PID after STI between Black and White women (HR 1.25, 95% CI 0.94–1.67).

CONCLUSION:

Racial disparities in PID diagnosis are mitigated by neighborhood-level SES.
Census Tracts Are Not Neighborhoods: Addressing Spatial Misalignment in Studies Examining the Impact of Historical Redlining on Present-day Health Outcomes
Authors: Maliniak Maret L. , Moubadder Leah , Nash Rebecca , Lash Timothy L. , Kramer Michael R. , McCullough Lauren E.
Published: September 2023

Background:

Research examining the effects of historical redlining on present-day health outcomes is often complicated by the misalignment of contemporary census boundaries with the neighborhood boundaries drawn by the US Home Owners’ Loan Corporation (HOLC) in the 1930s. Previous studies have used different approaches to assign historical HOLC grades to contemporary geographies, but how well they capture redlining exposure is unknown.

Methods:

Our analysis included 7711 residences identified in the Multiple Listing Service database in Atlanta, Georgia (2017–2022). We evaluated the classification of HOLC grade assignment (A, B, C, D, or ungraded) when assigning exposure under four area-level approaches (centroid, majority land area, weighted score, and highest HOLC) compared with using complete address data (gold standard). We additionally compared approaches across three 2020 census geographies (tract, block group, and block).

Results:

When comparing the use of census tracts to complete address data, sensitivity was highest for the weighted score approach, which correctly identified 77% of residences in truly A–D graded neighborhoods as compared with the majority land area (44%), centroid (54%), and highest HOLC (59%) approaches. Regarding specificity, the majority land area approach best-classified residences in truly ungraded neighborhoods (93%) as compared with the weighted score (65%), centroid (81%), and highest HOLC (54%) approaches. Classification improved regardless of approach when using census block compared with the census tract.

Conclusions:

Misclassification of historical redlining exposure is inevitable when using contemporary census geographies rather than complete address data. This study provides a framework for assessing spatial misalignment and selecting an approach for classification.
Improving Visualization of Intramuscular Perforator Course: Augmented Reality Headsets for DIEP Flap Breast Reconstruction
Authors: Seth Ishith , Lindhardt Joakim , Jakobsen Anders , Bo Thomsen Jørn , Kiil Birgitte Jul , Rozen Warren Matthew , Kenney Peter Sinkjaer
Published: September 2023

Background:

Augmented reality (AR) technology, exemplified by devices such as the Microsoft HoloLens 2, has gained interest for its potential applications in preoperative guidance. This study explores the use of AR technology for perforator identification during deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.

Methods:

A case series of five patients where an AR device was used to identify perforators during DIEP flap breast reconstruction is presented. The device was utilized to recognize preoperative perforators and map their extra- and intramuscular routes. Sound and/or color Doppler confirmation was used to verify the findings.

Results:

In all five cases, the AR device successfully identified preoperative perforators and delineated their extra- and intramuscular routes. AR technology in perioperative visualization of vasculature offers the potential to enhance surgical precision and reduce operative times. By providing an augmented three-dimensional overlay of patients’ vascular structures, AR can facilitate a more comprehensive understanding of individual anatomy, ultimately improving surgical outcomes.

Conclusions:

AR technology shows promise in enhancing perforator identification efficiency and deepening understanding of perforator trajectories during preoperative planning. Nonetheless, additional research is needed to establish whether the advantages of AR technology warrant its widespread adoption for perforator identification.
Association of subendocardial viability ratio and mortality in the elderly population: results from the CARdiovascular disease, Living and Ageing in Halle study
Authors: Schott Artjom , Kluttig Alexander , Mikolajczyk Rafael , Großkopf Anne , Greiser Karin Halina , Werdan Karl , Sedding Daniel , Nuding Sebastian
Published: September 2023

Objectives:

The subendocardial viability ratio (SEVR) reflects the balance of myocardial oxygen supply and demand. Low SEVR indicates a reduced subendocardial perfusion and has been shown to predict mortality in patients with kidney disease and diabetes. The aim of this study is to investigate the association of SEVR and mortality in the elderly population.

Methods:

We analysed data from the CARdiovascular disease, Living and Ageing in Halle (CARLA) study. SEVR was estimated noninvasively by radial artery tonometry and brachial blood pressure measurement. The study population was divided into a low (SEVR ≤130%) and normal (SEVR >130%) SEVR group. Cox-regression was used for survival analysis.

Results:

In total, 1414 participants (635 women, 779 men) aged from 50 to 87 years (mean age 67.3 years) were included in the analysis. The all-cause mortality was 22.7% during a median follow-up of 10.5 years. The unadjusted association of SEVR with all-cause mortality decreased from 3.52 (1.31–9.46) [hazard ratio (95% confidence interval) for low SEVR ≤ 130% versus normal SEVR > 130%] among those younger than 60 years to 0.86 (0.50–1.48) among those older than 80 years and from 1.81 (0.22–14.70) to 0.75 (0.30–1.91) for cardiovascular mortality. Sex-specific unadjusted analyses demonstrated an association of SEVR with all-cause and cardiovascular mortality in men [2.32 (1.61–3.34) and 2.24 (1.18–4.24)], but not in women [1.53 (0.87–2.72) and 1.14 (0.34–3.82)].

Conclusion:

Our data suggests that SEVR is an age dependent predictor for all-cause mortality, predominantly in men younger than 60 years.
A Comprehensive Wavefront Assessment of Keratoconus Using an Integrated Scheimpflug Corneal Tomographer/Hartmann–Shack Wavefront Aberrometer
Authors: Koh Shizuka , Matsuo Risako , Inoue Ryota , Miyazato Aoi , Asonuma Sanae , Maeno Sayo , Mihashi Toshifumi , Maeda Naoyuki , Nishida Kohji
Published: September 2023

Objectives:

To characterize higher-order aberrations (HOAs) in different severities of keratoconus (KC) from the anterior and posterior corneal surfaces and whole eye using an integrated Scheimpflug corneal tomographer/Hartmann–Shack wavefront aberrometer.

Methods:

This study included eyes with clinical KC, topographic KC (no clinical signs), fellow eyes with very asymmetric ectasia with normal topography and no clinical signs (VAE-NT), and control eyes. Corneal and ocular wavefront aberrations were obtained using an integrated Scheimpflug tomographer/Hartmann–Shack wavefront aberrometer. The diagnostic capability of distinguishing VAE-NT from the control was also tested.

Results:

This study included 68 eyes with clinical KC, 44 with topographic KC, 26 with VAE-NT, and 45 controls. Clinical KC had significantly greater total HOAs and coma from the anterior and posterior corneal surfaces and whole eye than the other groups (P<0.05). Although topographic KC had significantly greater values in all wavefront parameters than the control (P<0.05), ocular and corneal HOAs did not differ between the VAE-NT and control groups. The coma from the anterior cornea in topographic KC was significantly greater than that in VAE-NT (P<0.05); the coma from the posterior cornea and whole eye did not differ. Total HOAs from the anterior corneal surface exhibited the highest area under the receiver operating characteristic curve value of 0.774 (sensitivity, 73%; specificity, 78%).

Conclusion:

A comprehensive wavefront assessment can be used to quantitatively evaluate corneal and ocular HOAs across various severity of KC. Total HOAs from the anterior corneal surface exhibited the potential ability in distinguishing VAE-NT from the control eyes.
A Qualitative Study Exploring White-Collar Employee/Manager Experiences of Mental Health and Well-being Initiatives in Corporate Environments
Authors: Young Paul , Chow Vivien , Haslam Cheryl , Barker Jamie
Published: September 2023

Objective

The aim of the study is to explore white-collar corporate employee/manager experiences of current employer-led mental health and well-being initiatives.

Methods

Twenty-five participants took part in semistructured interviews yielding over 19 hours of data. Thematic analysis of the interview transcripts was undertaken. Participants worked for organizations including investment banks, insurers, asset managers, consultants, public relations, marketing, and legal firms.

Results

Many participants were skeptical of the effectiveness of current company-led mental health and well-being initiatives against a backdrop of high job demands and unsupportive cultures. A commonly expressed view was that organizations were paying lip service to the issue. Participants communicated that more leadership role modeling on mental health and well-being, supportive job designs, and accessible skills-focused psychological support would be beneficial.

Conclusions

Corporate white-collar employees/managers welcome mental health and well-being initiatives but are skeptical about their current effectiveness.
Discrepancies Between Expected and Actual Cochlear Implant–Related Functional Outcomes
Authors: Fabie Joshua E. , Shannon Christian M. , Schvartz-Leyzac Kara , Dubno Judy R. , McRackan Theodore R.
Published: September 2023

Objective

Previous research has demonstrated that realistic patient expectations are a critical factor in determining cochlear implant (CI) candidacy. The current study uses the validated Cochlear Implant Quality of Life–Expectations (CIQOL-Expectations) instrument to determine expectations of potential CI users and the degree to which their pre-CI expectations are met after implantation.

Study Design

Prospective cohort study.

Setting

Tertiary medical center.

Patients

Sixty adult CI patients.

Interventions/Main Outcome Measures

Pre-CI aided and post-CI consonant-nucleus-consonant word and AzBio sentence scores, pre-CI CIQOL-Expectations, and pre-CI and 3/6/12-month post-CI CIQOL-35 Profile scores.

Results

Mean pre-CI CIQOL-Expectations exceeded 12-month mean CIQOL-35 Profile scores for the global measure and the communication, environment, and listening effort domains (d = 0.65–0.97). The communication and listening effort domain scores had the largest discrepancy between expected and actual post-CI improvement (actual scores, 15.1 and 16.3 points lower than expected [d = 0.93–0.97], respectively). For 42% of patients, pre-CI global expectations exceeded 12-month post-CI CIQOL-35 Profile global scores, 49% met their expectations, and actual scores exceeded expectations for only 10% of patients. Similar patterns were seen for all CIQOL domains except emotional.

Conclusions

Post-CI functional abilities seem to fall short of pre-CI expectations for a substantial percentage of CI users, which was most apparent for the communication and listening effort CIQOL domains. These results may help clinicians direct personalized counseling toward common misconceptions, which can aid shared decision making and potentially minimize the mismatch between expected and realized outcomes.

Level of Evidence: III.

IRB Pro00073019, approved December 20, 2017 (Medical University of South Carolina).
Evaluating Telehealth Uptake Among North Carolina Medicaid Beneficiaries With Musculoskeletal Conditions
Authors: Freed Salama S. , Jones Kelley A. , Whitaker Rebecca G. , Norman Katherine , Carvalho Marissa , Giri Abhigya , Lake Ashley , Tchuisseu Yolande Pokam , Repka Samantha , Vasudeva Karina , Bey Nadia , Bettger Janet Prvu
Published: September 2023

Background:

The shift from in-person to virtual visits, known as telehealth (TH), during the COVID-19 pandemic was a significant change for North Carolina (NC) Medicaid beneficiaries seeking treatment for musculoskeletal (MSK) conditions, as remote care for these conditions was previously unavailable. We used this policy change to investigate factors associated with TH uptake and whether TH availability mitigated disparities in access to care or affected emergency department (ED) visits among these beneficiaries.

Research Design:

Using 2019–2021 NC Medicaid claims, we identified beneficiaries receiving treatment for MSK conditions before COVID-19 (March 2019–February 2020) and analyzed uptake of newly available TH during COVID-19 (April 2020–March 2021). We used descriptive analysis and Poisson generalized estimating equations to quantify TH uptake, factors associated with TH uptake, and the association with ED visits during COVID-19.

Results:

Black and Hispanic beneficiaries were less likely to use TH compared with White and non-Hispanic counterparts (10%, P<0.001 and 20%, P=0.03, respectively). Adults eligible for Tailored Plans, specialized NC Medicaid plans for those with significant behavioral health needs or intellectual/developmental disabilities, were less likely to use TH [adjusted risk ratio (ARR):0.83, 95% CI (0.78, 0.87)]; youth eligible for Tailored Plans were more likely to use TH [ARR:1.28, 95% CI (1.16, 1.42)]. Lower county-level internet access was associated with lower TH use [ARR: 0.85, 95% CI (0.82, 0.99)]. No statistical difference in ED utilization was observed between TH users and non-users.

Conclusions:

TH has the potential to deliver convenient care to beneficiaries with MSK conditions who can access it. Further research and policy changes should explore and address underlying factors driving disparities and improve equitable access to care for this population.
Effects of a Rehabilitation-at-Home Program Compared to Post-acute Skilled Nursing Facility Care on Safety, Readmission, and Community Dwelling Status
Authors: Augustine Matthew R. , Intrator Orna , Li Jiejin , Lubetsky Sara , Ornstein Katherine A. , DeCherrie Linda V. , Leff Bruce , Siu Albert L.
Published: September 2023

Objectives:

To evaluate the effectiveness and safety of Rehabilitation-at-Home (RaH), which provides high-frequency, multidisciplinary post-acute rehabilitative services in patients’ homes.

Design:

Comparative effectiveness analysis.

Setting and Participants:

Medicare Fee-For-Service patients who received RaH in a Center for Medicare and Medicaid Innovation Center Demonstration during 2016–2017 (N=173) or who received Medicare Skilled Nursing Facility (SNF) care in 2016–2017 within the same geographic service area with similar inclusion and exclusion criteria (N=5535).

Methods:

We propensity-matched RaH participants to a cohort of SNF patients using clinical and demographic characteristics with exact match on surgical and non-surgical hospitalizations. Outcomes included hospitalization within 30 days of post-acute admission, death within 30 days of post-acute discharge, length of stay, falls, use of antipsychotic medication, and discharge to community.

Results:

The majority of RaH participants were older than or equal to 85 years (57.8%) and non-Hispanic white (72.2%) with mean hospital length of stay of 8.1 (SD 7.6) days. In propensity-matched analyses, 10.1% (95% CI: 0.5%, 19.8) and 4.2% (95% CI: 0.1%, 8.5%) fewer RaH participants experienced hospital readmission and death, respectively. RaH participants had, on average, 2.8 fewer days (95% CI 1.4, 4.3) of post-acute care; 11.4% (95% CI: 5.2%, 17.7%) fewer RaH participants experienced fall; and 25.8% (95% CI: 17.8%, 33.9%) more were discharged to the community. Use of antipsychotic medications was no different.

Conclusions and Implications:

RaH is a promising alternative to delivering SNF-level post-acute RaH. The program seems to be safe, readmissions are lower, and transition back to the community is improved.
Near-Death Experiences and Sleep Disturbance
Authors: Lindsay Nicole , O'Sullivan Laura , Gibson Rosemary , Ladyman Clare , Tassell-Matamua Natasha
Published: September 2023

Near-death experiences (NDEs) are nonordinary states of consciousness typically occurring on the brink of death. Sleep changes after NDEs have been described, including shorter sleep duration, longer sleep latency, and more sleep disturbances; however, objective verification is lacking. In this exploratory research, 57 participants took part in a 14-day actigraphy study and were assigned to three groups: those who have had an NDE (n = 26); those who experienced a near-death event but without NDE (n = 12); and those who had never come close to death (n = 19). No significant differences were found between groups for actigraphy data. Paired samples t tests indicated significant differences between subjective and objective measures of sleep onset latency, sleep duration, and sleep efficiency, notably among the NDE group. Findings are indicative of the phenomenon known as sleep state misperception (SSM), which may have clinical implications for the study of NDEs and SSM.
Breastfeeding Among Women Living With HIV in the Era of Lifelong ART: An Observational Multicountry Study in Eastern and Southern Africa
Authors: Taha Taha E. , Bandala-Jacques Antonio , Yende-Zuma Nonhlanhla , Violari Avy , Stranix-Chibanda Lynda , Atuhaire Patience , Hanley Sherika , Gadama Luis , Chinula Lameck , Dadabhai Sufia , Aizire Jim , Brummel Sean S. , Fowler Mary Glenn
Published: September 2023

Background:

Lifelong antiretroviral treatment (ART) use is recommended for pregnant and breastfeeding (BF) women living with HIV (WLWH) to prevent perinatal HIV transmission and improve maternal health. We address 2 objectives in this analysis: (1) determine timing and factors associated with BF cessation and (2) assess the impact of BF on health of WLWH on ART.

Setting:

This multicountry study included 8 sites in Uganda, Malawi, Zimbabwe, and South Africa.

Methods:

This was a prospective study of WLWH on lifelong ART. These women initially participated from 2011 to 2016 in a randomized clinical trial (PROMISE) to prevent perinatal HIV transmission and subsequently reenrolled in an observational study (PROMOTE, 2016–2021) to assess ART adherence, safety, and impact.

Results:

The PROMOTE cohort included 1987 women on ART. Of them, 752 breastfed and were included in analyses of objective 1; all women were included in analyses of objective 2. The median time to BF cessation varied by country (11.2–19.7 months). Country of residence, age, and health status of women were significantly associated with time to BF cessation (compared with Zimbabwe: Malawi, adjusted hazard ratio [aHR] 0.50, 95% confidence interval [95% CI]: 0.40 to 0.62, P < 0.001; South Africa, aHR 1.49, 95% CI: 1.11 to 2.00, P = 0.008; and Uganda, aHR 1.77, 95% CI: 1.37 to 2.29, P < 0.001). Women who breastfed had lower risk of being “unwell” compared with women who never breastfed (adjusted rate ratio 0.87, 95% CI: 0.81 to 0.95 P = 0.030).

Conclusion:

Women on lifelong ART should be encouraged to continue BF with no concern for their health. Time to BF cessation should be monitored for proper counseling in each country.
Brief Report: HIV Drug Resistance Assessment Among Women Who Seroconverted During the MTN-025/HOPE Open-Label Extension Dapivirine Vaginal Ring Trial
Authors: Parikh Urvi M. , Penrose Kerri J. , Heaps Amy L. , Sethi Rahil , Goetz B. Jay , Szydlo Daniel , Chandran Uma , Palanee-Phillips Thesla , Mgodi Nyaradzo M. , Baeten Jared M. , Mellors John W. ,   the MTN-025/HOPE Study Team
Published: September 2023

Background:

Clinical trials of dapivirine (DPV) vaginal ring have shown it is safe, effective, and desired by women as an HIV prevention option. The risk of drug resistance is a potential concern for DPV ring users who acquire HIV. We conducted a comprehensive resistance evaluation of plasma samples from the women who seroconverted during the Microbicide Trials Network-025/HIV Open-label Prevention Extension (HOPE) study of DPV ring.

Methods:

Plasma collected on the visit at which seroconversion was detected was tested by next-generation sequencing with unique molecular identifiers for non-nucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutations (DRM) present at ≥1% frequency. Bulk-cloned plasma-derived recombinant HIV was phenotyped in a TZM-bl–based assay for susceptibility to DPV and other NNRTI. HIV-1 RNA was retrospectively quantified in plasma samples collected before HIV seroconversion.

Results:

Among 38 participants who seroconverted in HOPE, 7 (18%) had NNRTI DRM detected by next-generation sequencing with unique molecular identifiers including A98G, K103N, V106M, E138A, and V179D. Six of 7 samples with NNRTI DRM had <3-fold reduction in susceptibility to DPV. Only 1 sample with K103N and V179I polymorphism had 9-fold reduction in susceptibility to DPV, but this genotype occurred in an individual who did not use DPV ring, likely indicating transmitted resistance. Detection of NNRTI resistance was not higher in individuals who remained on DPV ring >3 months after acquiring HIV infection.

Conclusions:

NNRTI resistance among women who seroconverted during HOPE was infrequent and selection of DPV-specific mutations was not detected. DPV ring is considered a safe and effective option for HIV prevention in women.
Mucormycosis: update on clinical presentation, diagnosis, and treatment
Authors: Dailey Garnes Natalie J.M. , Kontoyiannis Dimitrios P.
Published: September 2023

Purpose of review

Mucormycosis (MCR) is a common opportunistic mold infection, and Mucorales were recently designated by WHO as priority pathogens. The interest in this infection has risen significantly since the major outbreak of MCR in the context of the COVID-19 pandemic, particularly in India. Herein, we summarize recently (last 24 months) published information regarding clinical aspects of MCR.

Recent findings

The disease remains protean in its clinical presentation, difficult to diagnose, and challenging to treat. In 2021, cases of COVID-19-associated mucormycosis (CAM) exploded in India during COVID-19 and manifested primarily as sino-orbital or sino-cerebral disease. Its classic risk factors included the triad of COVID-19, uncontrolled diabetes mellitus and use of corticosteroids. Despite difficulties in the timely diagnosis of MCR, significant progress has been made with the use of molecular techniques in blood to assist with earlier diagnosis, which can facilitate earlier appropriate therapy and improve outcomes. In addition, advances have been made in the use of imaging to stage the disease, determining what types of multimodal therapy are required depending on staging, and tissue-based identification of Mucorales.

Although the outlook for MCR has improved, effective new antifungals, risk stratification, and the optimal multimodality approaches remain an unmet need.
Imaging Features of Autoimmune Disease-Related Interstitial Lung Diseases
Authors: Walsh Simon L.F. , Lafyatis Robert A. , Cottin Vincent
Published: September 2023

Interstitial lung diseases (ILDs) associated with autoimmune diseases show characteristic signs of imaging. Radiologic signs are also used in the identification of ILDs with features suggestive of autoimmune disease that do not meet the criteria for a specific autoimmune disease. Radiologists play a key role in identifying these signs and assessing their relevance as part of multidisciplinary team discussions. A radiologist may be the first health care professional to pick up signs of autoimmune disease in a patient referred for assessment of ILD or with suspicion for ILD. Multidisciplinary team discussion of imaging findings observed during follow-up may inform a change in diagnosis or identify progression, with implications for a patient’s treatment regimen. This article describes the imaging features of autoimmune disease-related ILDs and the role of radiologists in assessing their relevance.
Elastic Registration Algorithm Based on Three-dimensional Pulmonary MRI in Quantitative Assessment of Severity of Idiopathic Pulmonary Fibrosis
Authors: Yang Xiaoyan , Yu Pengxin , Xu Wenqing , Sun Haishuang , Duan Jianghui , Han Yueyin , Zhu Lili , Xie Bingbing , Geng Jing , Luo Sa , Wang Shiyao , Ren Yanhong , Zhang Rongguo , Liu Min , Dai Huaping , Wang Chen
Published: September 2023

Purpose:

To quantitatively analyze lung elasticity in idiopathic pulmonary fibrosis (IPF) using elastic registration based on 3-dimensional pulmonary magnetic resonance imaging (3D-PMRI) and to assess its’ correlations with the severity of IPF patients.

Material and Methods:

Thirty male patients with IPF (mean age: 62±6 y) and 30 age-matched male healthy controls (mean age: 62±6 y) were prospectively enrolled. 3D-PMRI was acquired with a 3-dimensional ultrashort echo time sequence in end-inspiration and end-expiration. MR images were registered from end-inspiration to end-expiration with the elastic registration algorithm. Jacobian determinants were calculated from deformation fields on color maps. The log means of the Jacobian determinants (Jac-mean) and Dice similarity coefficient were used to describe lung elasticity between 2 groups. Then, the correlation of lung elasticity with dyspnea Medical Research Council (MRC) score, exercise tolerance, health-related quality of life, lung function, and the extent of pulmonary fibrosis on chest computed tomography were analyzed.

Results:

The Jac-mean of IPF patients (−0.19, [IQR: −0.22, −0.15]) decreased (absolute value), compared with healthy controls (−0.28, [IQR: −0.31, −0.24], P<0.001). The lung elasticity in IPF patients with dyspnea MRC≥3 (Jac-mean: −0.15; Dice: 0.06) was significantly lower than MRC 1 (Jac-mean: −0.22, P=0.001; Dice: 0.10, P=0.001) and MRC 2 (Jac-mean: −0.21, P=0.007; Dice: 0.09, P<0.001). In addition, the Jac-mean negatively correlated with forced vital capacity % (r=−0.487, P<0.001), forced expiratory volume 1% (r=−0.413, P=0.004), TLC% (r=−0.488, P<0.001), diffusing capacity of the lungs for carbon monoxide % predicted (r=−0.555, P<0.001), 6-minute walk distance (r=−0.441, P=0.030) and positively correlated with respiratory symptoms (r=0.430, P=0.042). Meanwhile, the Dice similarity coefficient positively correlated with forced vital capacity % (r=0.577, P=0.004), forced expiratory volume 1% (r=0.526, P=0.012), diffusing capacity of the lungs for carbon monoxide % predicted (r=0.435, P=0.048), 6-minute walk distance (r=0.473, P=0.016), final peripheral oxygen saturation (r=0.534, P=0.004), the extent of fibrosis on chest computed tomography (r=−0.421, P=0.021) and negatively correlated with activity (r=−0.431, P=0.048).

Conclusion:

Lung elasticity decreased in IPF patients and correlated with dyspnea, exercise tolerance, health-related quality of life, lung function, and the extent of pulmonary fibrosis. The lung elasticity based on elastic registration of 3D-PMRI may be a new nonradiation imaging biomarker for quantitative evaluation of the severity of IPF.
Findings on High Resolution Computed Tomography in Symptomatic Veterans with Deployment-Related Lung Disease
Authors: Rose Cecile S. , Zell-Baran Lauren M. , Cool Carlyne , Moore Camille M. , Wolff Jenna , Oh Andrea S. , Koelsch Tilman , Richards John C. , Krefft Silpa D. , Wilson Carla G. , Lynch David A.
Published: September 2023

Purpose:

Military deployment to dusty, austere environments in Southwest Asia and Afghanistan is associated with symptomatic airways diseases including asthma and bronchiolitis. The utility of chest high-resolution computed tomographic (HRCT) imaging in lung disease diagnosis in this population is poorly understood. We investigated visual assessment of HRCT for identifying deployment-related lung disease compared with healthy controls.

Materials and Methods:

Chest HRCT images from 46 healthy controls and 45 symptomatic deployed military personnel with clinically confirmed asthma and/or biopsy-confirmed distal lung disease were scored by 3 independent thoracic radiologists. We compared demographic and clinical characteristics and frequency of imaging findings between deployers and controls, and between deployers with asthma and those with biopsy-confirmed distal lung disease, using χ2, Fisher exact or t tests, and logistic regression where appropriate. We also analyzed inter-rater agreement for imaging findings.

Results:

Expiratory air trapping was the only chest CT imaging finding that was significantly more frequent in deployers compared with controls. None of the 24 deployers with biopsy-confirmed bronchiolitis and/or granulomatous pneumonitis had HRCT findings of inspiratory mosaic attenuation or centrilobular nodularity. Only 2 of 21 with biopsy-proven emphysema had emphysema on HRCT.

Conclusions:

Compared with surgical lung biopsy, visual assessment of HRCT showed few abnormalities in this small cohort of previously deployed symptomatic veterans with normal or near-normal spirometry.
Lung Magnetic Resonance Imaging for Prediction of Progression in Patients With Nonidiopathic Pulmonary Fibrosis Interstitial Lung Disease
Authors: Ruano Carina A. , Moraes-Fontes Maria Francisca , Borba Alexandra , Grafino Mónica , Veiga José , Fernandes Otília , Bilhim Tiago , Irion Klaus L.
Published: September 2023

Purpose:

Correlate magnetic resonance imaging (MRI) parameters at baseline with disease progression in nonidiopathic pulmonary fibrosis interstitial lung disease (ILD).

Materials and Methods:

Prospective observational cohort study, in which patients with non-idiopathic pulmonary fibrosis ILD underwent MRI at baseline (1.5 T). T2-weighted images (T2-WI) were acquired by axial free-breathing respiratory-gated fat-suppressed “periodically rotated overlapping parallel lines with enhanced reconstruction” and T1-weighted images (T1-WI) by coronal end-expiratory breath-hold fat-suppressed “volumetric interpolated breath-hold examination” sequences, before and at time points T1, T3, T5, and T10 minutes after gadolinium administration. After MRI segmentation, signal intensity values were extracted by dedicated software. Percentage of the ILD volume and a ratio between signal intensity of ILD (SIILD) and normal lung (SInormal lung) were calculated for T2-WI; percentage of signal intensity (%SI) at each time point, time to peak enhancement, and percent relative enhancement of ILD in comparison with normal lung (%SIILD/normal lung) were calculated for T1-WI. MRI parameters at baseline were correlated with diagnosis of disease progression and variation in percent predicted forced vital capacity (%FVC) and diffusing capacity of the lung for carbon monoxide after 12 months.

Results:

Comprehensive MRI evaluation (T2-WI and T1-WI) was performed in 21 of the 25 patients enrolled (68% females; mean age: 62.6 y). Three of the 24 patients who completed follow-up fulfilled criteria for disease progression. Baseline T2-WI SIILD/SInormal lung was higher for the progression group (P = 0.052). T2-WI SIILD/SInormal lung and T1-WI %SIILD/normal lung at T1 were positively correlated with the 12-month variation in %FVC (r = 0.495, P = 0.014 and r = 0.489, P= 0.034, respectively).

Conclusions:

Baseline MRI parameters correlate with %FVC decline after 12 months.