bluuebunny/crossref_metadata_2025 huggingface dataset:
“I am a father”: Experiences of Fatherhood in Diaries of Fathers from the Warsaw Ghetto
Authors: Darmon Malka Tehila
Published: November 2024

While there has been considerable research on women and motherhood during the Holocaust, scholars have paid less attention to fatherhood. This article explores the experiences of Jewish fathers in the Warsaw ghetto during the Holocaust and sheds light on the roles and challenges they encountered in the face of extreme adversity as documented in their diaries. Many fathers, who traditionally had not been involved in household chores and childcare before the war, found themselves taking on these responsibilities in the ghetto. Harsh conditions and constant threats forced fathers to adapt to and take on new roles, both physically and emotionally. These roles included providing for their families, as well as nurturing their children’s well-being, both physically and psychologically. A close examination of the diaries of fathers in the Warsaw ghetto reveals their struggles to protect and care for their children amid an intimidating reality. The diaries convey a range of emotions, including fear, frustration, guilt, and love, and demonstrate the profound impact of their traumatic experiences on their sense of self. Fatherhood emerges as a dynamic construct shaped by circumstances, with extreme events requiring fathers to adapt and balance traditional roles with new challenges to protect their families. These diaries provide a unique perspective on how fatherhood was redefined and tested in the collapsing Warsaw ghetto.
Assessing the integration of sustainability and climate change in urban planning education: a Saudi Arabian perspective
Authors: Bahreldin Ibrahim , Samir Hossam , Maddah Rahif , Hammad Hazem , Hegazy Ibrahim
Published: November 2024

This study examines the integration of sustainability and climate change into Saudi Arabian urban planning education, a crucial step as cities confront rapid urbanization’s environmental, social, and economic impacts. Utilizing content analysis and purposive sampling, the research evaluates current curricula to identify challenges and opportunities. Findings indicate that while environmental sustainability is prioritized, economic and social aspects are less emphasized. Furthermore, local issues dominate, with a limited focus on global perspectives, and adaptation strategies are favored over mitigation. The study offers recommendations to strengthen sustainability’s role within Saudi urban planning education, promoting a more comprehensive approach to climate challenges.
Does the end justify the means? The European Commission’s proposed regulation laying down rules to prevent and combat child sexual abuse
Authors: Dushi Desara
Published: November 2024

The European Commission’s Proposed Regulation Laying Down Rules to Prevent and Combat Child Sexual Abuse aims to impose obligations related to detecting, reporting, removing, and blocking known and new online child sexual abuse material (CSAM), as well as the solicitation of children (grooming), on providers of hosting services, interpersonal communication services, software application stores, internet access services, and other relevant services. This paper navigates through state-of-the-art technological tools for detecting online CSAM, scrutinizing their potential legal impact and technical issues associated with each tool and unveiling potential fundamental rights implications. It strives to answer the question of whether the proposed rules are aligned with the state-of-the-art detection technologies in effectively addressing online CSAM without jeopardizing other fundamental rights, intending to foster a nuanced understanding of the proposal’s potential shortcomings. Upholding democracy and the presumption of innocence demands careful consideration of the impact of new technologies, emphasizing the importance of thorough studies to inform legal frameworks. Without such scrutiny, the proposed regulation risks undermining fundamental rights in its pursuit of child protection in the digital landscape.
A second-order correction method for loosely coupled discretizations applied to parabolic–parabolic interface problems
Authors: Burman Erik , Durst Rebecca , Fernández Miguel A , Guzmán Johnny , Liu Sijing
Published: November 2024

We consider a parabolic–parabolic interface problem and construct a loosely coupled prediction-correction scheme based on the Robin–Robin splitting method analyzed in [J. Numer. Math., 31(1):59–77, 2023]. We show that the errors of the correction step converge at $\mathcal O((\varDelta t)^{2})$, under suitable convergence rate assumptions on the discrete time derivative of the prediction step, where $\varDelta t$ stands for the time-step length. Numerical results are shown to support our analysis and the assumptions.
Functional characterization of novel RbTI gene from ricebean and validation of its insecticidal properties in transgenic tobacco
Authors: Katoch Rajan , Singh Sunil Kumar , Raj Kiran , Kumar Sandeep , Thakur Neelam , Hallan Vipin , Kumar Sudesh
Published: November 2024

Plant protease inhibitors (PI’s) inhibit the activity of gut proteases and thus provide resistance against insect attack. Previously we have published first report on cloning and characterization of a novel Bowman–Birk protease inhibitor gene (RbTI) from ricebean (Vigna umbellata). In this study, the RbTI gene was further characterized and validated as a potential candidate for transferring insect resistance in economically important crops. We have successfully generated transgenic tobacco plants expressing RbTI gene constitutively under CaMV35S promoter using Agrobacterium transformation. Genomic PCR and GUS analysis confirmed the successful integration of RbTI gene into tobacco plant genome. qRT-PCR analysis revealed highest RbTI gene expression in transformed tobacco leaves nearing maturity. Feeding of transformed tobacco leaf tissue showed prominent effect on larval mortality throughout the larval growth stages mainly during first three days of feeding. For functional analysis of RbTI gene, we estimated the inhibitory activity of protein extracts from normal and transformed tobacco plants against gut proteases of Spodoptera litura and H. armigera larval instars. Maximum inhibition of trypsin (82.42% and 73.25%) and chymotrypsin (69.50% and 60.64%) enzymes was recorded at early larval stages of both insects. The results of this study validated the future use of RbTI gene from ricebean legume as a potential candidate for transferring insect resistance in economically important crops.

Insight, innovation, integration: Present study was conducted with the aim to utilize the state of art biotechnological techniques for transferring key pest resistant genes from underutilized promising crop ricebean. The tobacco plant has been utilized as modern plant for proof of concept where a protease inhibitor gene from Ricebean has been transferred to tobacco plant which induced larval mortality within first three days of feeding at all larval developmental stages. The biochemical assays on mid-gut total protein extract showed that the transgenic tobacco leaves have inhibiting effect on trypsin and chymotrypsin enzymes of insect which is otherwise required for digestion of food by them. Hence, we provide a novel gene that could be utilized for pest resistance in other crops different developmental stages.
Analytical Quality by Design-Assisted Eco-Friendly RP-HPLC Method for the Simultaneous Estimation of Artificial Sweeteners in Commercial Food Samples Utilizing a Green Ultrasound-Assisted Extraction Technique: Greenness, Blueness, and Whiteness Appraisal
Authors: Chakraborty Atyurmila , Jayaseelan Kavitha
Published: November 2024

Background

Acesulfame K (E950) and saccharin Na (E954) are commonly utilized synthetic sweeteners that are added to various processed food products to improve the sweet flavor. Environmentally friendly technology must be prioritized when evaluating the artificial sweeteners, as excessive consumption of these sweeteners presents serious health hazards.

Objective

The main aim of this study was to develop an analytical quality by design-aided eco-friendly RP-HPLC technique that can detect both acesulfame K and saccharin Na simultaneously, incorporating green analytical chemistry (GAC) principles and white analytical chemistry (WAC), using the ultrasound-assisted extraction (UAE) technique on commercial food samples.

Methods

The usage of ethanol was in accordance with eco-friendly ideals due to its ease of use, speed, and lack of environmental impact. Rotatable central composite design (rCCD) was used for method optimization. A mobile phase consisting of an ethanol–1% aqueous acetic acid (1 + 1, by volume) mixture was used and the separation was carried out on a Zorbax column (SB-C18, 150 × 4.6 mm, 5 µm) at a flow rate of 1 mL/min and a detection wavelength of 217 nm.

Results

Acesulfame K had a retention time of 1.134 min and saccharin Na of 2.134 min. Acesulfame K and saccharin Na recovery rates varied betweeen different commercially available food samples, ranging from 65 to 102% and 75 to 101%, respectively.

Conclusion

At the defined operating point, the developed procedure displays conformity with the previously defined requirements for linearity, accuracy, sensitivity, and repeatability. The most accurate assessments of greenness were produced by the Green Analytical Procedure Index (GAPI), Analytical Eco Scale (AES), and Analytical GREEnness metrics (AGREE) tools. Results from the Red-Green-Blue 12 (RGB 12) algorithm for whiteness and Blue Applicability Grade Index (BAGI) for blueness indicate that the method is very practical, cost-effective, and environmentally friendly.

Highlights

The results of this study could pave the way for more eco-friendly and effective AQbD methods to be used in the future for evaluating various sweeteners using green solvents.
Data Protection: Breach of Statutory Duty
Authors: Scherbel-Ball Jonathan , McMahon Felicity , Williams Hope
Published: November 2024

Chapter 7 examines the way in which data protection law in the United Kingdom operates to protect privacy rights and certain other rights in the context of journalism, media reporting, and freedom of expression. The introduction sets out the various data protection regimes, the rights protected by those regimes, and their relevance to media publications and journalism. Section B charts the incremental changes made in the transition from the Data Protection Act 1998 (DPA 1998) to the GDPR, UK GDPR, and Data Protection Act 2018 (DPA 2018). In Section C, the authors examine the following key elements of the UK GDPR and DPA 2018 in the context of the protection of privacy: key definitions and concepts, territorial scope, the obligations of data controllers, key principles including fairness and transparency, exemptions, the rights and remedies of data subjects, and criminal liability.
The Privacy Codes
Authors: Stables John , Gallop Ben
Published: November 2024

Alongside statute and the common law, a framework of regulation exists to control standards of print and broadcast media. This chapter considers that framework, and in particular the parts of it which serve to limit, and offer remedies for, intrusions into privacy. It focuses on the regulations of two key regulatory bodies—Ofcom (overseeing the Broadcasting Code) and IPSO (the Editor’s Code of Practice)—as well as the BBC’s Editorial Guidelines. Sections B and C explain how these codes are woven into law under the Human Rights Act 1998 (s 12)—being the ‘privacy codes’ for the purposes of that section—and the Data Protection Act 2018. In Section D, the relative merits for privacy complainants of pursuing judicial remedies and regulatory complaints, and their interplay, are considered. Section E gives an overview of Ofcom, the BBC, and IPSO. Section F describes in detail how privacy complaints function under the relevant privacy codes. In Section G, the codes’ limited application to new media—particularly internet publications, online apps, and on-demand services—is briefly discussed. Section H summarizes the internal procedures under the codes for challenging decisions of the regulators. Section I finally discusses the regulators’ status as ‘public authorities’ under the HRA. The practical implications of the regulators being classed as such, for the purposes of judicial review claims relying on Articles 8 and 10 ECHR, are considered.
Fatigue and Sleep-related Impairment as Predictors of the Effect of Nonpharmacological Therapies for Active duty Service Members With Chronic Pain: A Secondary Analysis of a Pragmatic Randomized Clinical Trial
Authors: Wi Dahee , Steffen Alana D , Flynn Diane M , Ransom Jeffrey C , Orr Kira P , McQuinn Honor M , Snow Tyler J , Burke Larisa A , Park Chang , Doorenbos Ardith Z
Published: November 2024

Introduction

First-line treatments for chronic pain include selected complementary and integrative health therapies, including spinal manipulation, acupuncture, yoga, and massage; and standard rehabilitative care, including physical and occupational therapies. This study aimed to uncover critical factors that contribute to pain impact and the effectiveness of complementary and integrative health therapies and standard rehabilitative care among people with chronic pain, with a focus on the role of sleep-related impairment.

Materials and Methods

We conducted a secondary analysis of data from a pragmatic randomized clinical trial of 280 U.S. active duty service members with chronic pain.

Results

Our study’s multiple mediation analysis examined the indirect effect of complementary and integrative health therapies on pain impact through fatigue (β = − 0.43; 95% CI, −0.99 to −0.07). When stratified by sleep-related impairment, participants with T scores above the median of 62 demonstrated a significant negative indirect effect of complementary and integrative health therapies through fatigue (β = − 0.80; 95% CI, −2.31 to −0.14). This negative indirect effect was not significant for participants with sleep-related impairment T scores below the median (β = − 0.64; 95% CI, −1.48 to 0.07).

Conclusion

These findings suggest that complementary and integrative health therapies are particularly effective in reducing pain impact for individuals with higher levels of sleep-related impairment, and that the effect of complementary and integrative health therapies is supported primarily by reducing fatigue.
Action of the Axial U(1) Noninvertible Symmetry on the ’t Hooft Line Operator: A Simple Argument
Authors: Honda Yamato , Onoda Soma , Suzuki Hiroshi
Published: November 2024

Employing the modified Villain lattice formulation of the axion quantum electrodynamics, we present an alternative and much simpler derivation of the conclusion of Ref. [1] that the sweep of the axial $U(1)$ noninvertible symmetry operator over the (nongenuine) gauge-invariant ’t Hooft line operator with an integer magnetic charge does not leave any effect. The point is that such a ’t Hooft line can be represented by a boundary of a (nontopological) defect that is invariant under the axial transformation on the axion field.
Unique internal anatomy of vertebrae as a key factor for neck elongation in Triassic archosauromorphs
Authors: Rytel Adam , Surmik Dawid , Szczygielski Tomasz , Spiekman Stephan N F , van de Kamp Thomas , Zuber Marcus , Scheyer Torsten M
Published: November 2024

The Triassic was a key period in the evolution of vertebrates, and reptiles in particular, giving rise to a plethora of successful lineages, some of which are still extant. One of the groups that flourished during the early Mesozoic were the tanysaurians (Archosauromorpha: Tanysauria). They had elongate neck vertebrae that in some genera reached extreme proportions. Here, we provide the first comprehensive description of the internal structure of these extraordinary elements, focusing on the famously bizarre Tanystropheus. Through computed tomography and sectioning, we were able to reveal some intriguing features comparable to those seen in pterosaurs and birds. However, contrary to what we see in pneumatic bones, cervicals of tanysaurians contain a singular voluminous cavity. This results in a cylindrical structure in these vertebrae, which likely provided durability, while contributing less to the weight of the neck. These insights are relevant for better understanding of a unique and extreme anatomy among tetrapods, which evolved as a result of very strict selection for some particular function. Importantly, our findings demonstrate that major modifications of the internal anatomy of vertebrae were not unique to derived avemetatarsalians (pterosaurs and dinosaurs), but more widespread among reptiles.
Triple Pelvic Osteotomy for Hip Dysplasia: The Akbulut-Coskun Technique Using a Modified Stoppa Approach
Authors: Akbulut Deniz , Coşkun Mehmet , Aydin Abdurrahman , Arslanoğlu Fatih , Sevencan Ahmet , Çamurcu Yalkin
Published: November 2024

Background:

Many successful osteotomies have been reported for the treatment of acetabular dysplasia. However, triple pelvic osteotomy remains a technically challenging procedure with potential for significant complications. This study examined a series of Tönnis periacetabular osteotomy (TPAO) procedures performed using the modified Stoppa approach to treat acetabular dysplasia in adolescents.

Objective:

To describe the radiographic outcomes, complications, and early functional results of TPAO using the modified Stoppa approach for acetabular dysplasia in adolescents.

Methods:

This study included 16 patients (20 hips) who underwent TPAO using the modified Stoppa approach for symptomatic acetabular dysplasia. The characteristics of the patients and the surgical procedure were discussed. The radiologic outcome was evaluated using the lateral center-edge (CE) and Tönnis roof angles. Perioperative data including surgery duration, blood loss, and complications were recorded. Complications were also discussed.

Results:

The mean age of the patients was 11.5±1.1 (10 to 13) years. The mean preoperative anteroposterior CE angle was 14.7±3 degrees (7 to 19 degrees), and the mean postoperative angle was 35.7±3.1 degrees (30 to 42 degrees; P<0.001). The mean preoperative Sharp’s angle was 55.9±5.4 degrees (48 to 65 degrees), and the postoperative mean was 33±5 degrees (24 to 40 degrees; P<0.001). The mean Tönnis angle before and after osteotomy was 23.3±7.1 degrees (17 to 36 degrees) and 7.1±2 degrees (4 to 10 degrees), respectively (P<0.001). The mean operative time was 42.2±10.3 minutes with a mean blood loss of 167.7±50.3 mL. One patient sustained a bladder injury as a major complication.

Conclusions:

The use of TPAO with the intrapelvic modified Stoppa approach in the treatment of hip dysplasia provides the benefits of a single incision, access to 2 hips in the same session, positional advantage, and abductor function preservation. Early results are satisfactory and safe.

Level of Evidence:

Level IV.
Long-term trends in the burden of breast cancer in China over three decades: a joinpoint regression and age-period-cohort analysis based on Global Burden of Disease 2021
Authors: Yuan Jiacheng , Li Pan , Yang Ming
Published: November 2024

We analyzed the trends in breast cancer (BC) morbidity, prevalence, and mortality among Chinese residents from 1990 to 2021. We then used joinpoint regression to further assess BC morbidity and mortality. We screened the morbidity, mortality, and prevalence of BC in Chinese residents (1990–2021) from the Global Burden of Disease. We used age-period-cohort (APC) modeling to assess the effects of age, period, and cohort on BC morbidity and mortality separately. We also used the joinpoint model to characterize trends in BC morbidity and mortality in China. From 1990 to 2021, age-standardized rates of morbidity have risen significantly, whereas mortality has declined. We discovered that the risk of morbidity and death rose with age by using the APC model. We also found that mortality and morbidity roughly continued to increase over time, and finally, we found that the later the birth cohort, the lower the mortality and the higher the morbidity. From 1990 to 2021, the burden of BC disease in China will continue to rise, and the situation of BC prevention and control will remain severe. Therefore, regular imaging and palpation examinations should be performed in the regular population over 40 years of age. When treating patients with BC, healthcare workers should develop individualized treatment plans to further reduce mortality.
An Innovative Therapy for the Treatment of Severe Frostbite Using the Prostacyclin Mimetic Iloprost
Authors: Zottola Albert M. , Frishman William H.
Published: November 2024

The medical treatments of human frostbite for decades have been viewed as relatively limited, in terms of practical therapeutic options. Historically, more severe cases of frostbite have often caused permanent damage and have subsequently required permanent treatment options, such as amputation, in order to help the patient. However, recent Food and Drug Administration (FDA) approval of the drug iloprost (Aurlumyn), a known treatment option for patients with pulmonary hypertension, has provided physicians with a greater ability to help prevent amputation in severe frostbite patients. This article aims to examine the overall issue of frostbite and its various classifications, as well as the physiological mechanisms by which frostbite affects the body. Furthermore, the article discusses the first line and clinical treatments for frostbite at various stages before the FDA approval of iloprost. Finally, the article delves into the newly approved vascular drug for frostbite, its mechanism of action, instructions for its use, and details regarding its pharmacology. The purpose of this article is to bring more attention to this novel and effective treatment for frostbite, which will hopefully give rise to future research concerning alternative methods to help prevent amputations in severe frostbite patients. Ideally, the newfound FDA approval of iloprost for frostbite treatment may inspire researchers to utilize alternative peripheral vasodilating drugs to aid in preventing permanent damage in patients suffering from acute bouts of frostbite.
Transcriptomics of Subcutaneous Tissue of Lipedema Identified Differentially Expressed Genes Involved in Adipogenesis, Inflammation, and Pain
Authors: Streubel Maria Karolin , Baumgartner Axel , Meier-Vollrath Ilka , Frambach Yvonne , Brandenburger Matthias , Kisch Tobias
Published: November 2024

Background:

Lipedema is a disease typically affecting women with a symmetrical, painful fat distribution disorder, which is hypothesized to be caused by impaired adipogenesis, inflammation, and extracellular matrix remodeling, leading to fibrosis and the development of edema in lipedema subcutaneous adipose tissue. The pathogenesis and molecular processes leading to lipedema have not yet been clarified.

Methods:

A whole transcriptome analysis of subcutaneous tissue of lipedema stages I (n = 12), II (n = 9), and III (n = 8) compared with hypertrophied subcutaneous tissue (n = 4) was performed. Further data about hormonal substitution and body morphology were collected. The study is registered at ClinicalTrials.gov (NCT05861583).

Results:

We identified several differentially expressed genes involved in mechanisms leading to the development of lipedema. Some genes, such as PRKG2, MEDAG, CSF1R, BICC1, ERBB4, and ACP5, are involved in adipogenesis, regulating the development of mature adipocytes from mesenchymal stem cells. Other genes, such as MAFB, C1Q, C2, CD68, CD209, CD163, CD84, BCAT1, and TREM2, are predicted to be involved in lipid accumulation, hypertrophy, and the inflammation process. Further genes such as SHTN1, SCN7A, and SCL12A2 are predicted to be involved in the regulation and transmission of pain.

Conclusions:

In summary, the pathogenesis and development of lipedema might be caused by alterations in adipogenesis, inflammation, and extracellular matrix remodeling, leading to fibrosis and the formation of edema resulting in this painful disease. These processes differ from hypertrophied adipose tissue and may therefore play a main role in the formation of lipedema.
Current trends and challenges in infective endocarditis
Authors: Patel Shubh K. , Hassan Syed M. Ali , Côté Mahée , Leis Benjamin , Yanagawa Bobby
Published: November 2024

Purpose of review

Infective endocarditis (IE) is a complex disease with increasing global incidence. This review explores recent trends in IE infection patterns, including healthcare-associated IE (HAIE), drug-use-associated IE (DUA-IE), multidrug-resistant organisms (MDROs), and challenges in managing prosthetic valve and device-related infections.

Recent findings

Staphylococcus aureus has emerged as the leading cause of IE, especially in HAIE and DUA-IE cases. Increasingly prevalent MDROs, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, pose further clinical challenges. Advances in molecular diagnostics have improved the detection of culture-negative endocarditis. The introduction of the AngioVAC percutaneous aspiration device promises to change the management of right and possibly some left sided IE. Multidisciplinary team management and early surgery have demonstrated improved outcomes including partnerships with psychiatry and addictions services for those with intravenous DUA-IE.

IE presents significant diagnostic and therapeutic challenges due to evolving infection patterns, MDROs, and HAIE. Early diagnosis using advanced imaging, appropriate early antimicrobial therapy, and multidisciplinary care, including timely surgery, are critical for optimizing patient outcomes.
Oral LPCN 1148 improves sarcopenia and hepatic encephalopathy in male patients with cirrhosis: A randomized, placebo-controlled phase 2 trial
Authors: Bruno Benjamin J. , Weavil Joshua C. , Ogle Jonathan , Chidambaram Nachiappan , Carey Elizabeth J. , Danford Christopher J. , Fricker Zachary P. , Galati Joseph S. , Lee William M. , Mantry Parvez S. , Shetty Kirti , DelConte Anthony , Patel Mahesh V. , Lai Jennifer C. , Sanyal Arun J.
Published: November 2024

Background and Aims:

Sarcopenia is highly prevalent in patients with liver cirrhosis and is associated with adverse clinical outcomes, including HE. Androgen receptor agonists, androgen receptor agonists, can address these conditions through multimodal mechanisms of action; however, their safety and efficacy in patients with cirrhosis have not been well established.

Approach and Results:

In this multicenter, double-blind, phase 2 trial, men with sarcopenia and cirrhosis awaiting liver transplant were randomized 1:1 to receive either oral Androgen Receptor Agonist LPCN 1148 or placebo for 24 weeks (NCT04874350). The primary end point was the change from baseline to 24 weeks in skeletal muscle index measured by a CT scan of the L3 region, analyzed with a prespecified modified intent-to-treat population. The secondary end point was the number of overt HE events. Twenty-nine participants (mean age=59 y, MELD=17) received at least 1 dose of LPCN 1148 (n=15) or placebo (n=14). Baseline characteristics were similar between groups. Primary end point analysis demonstrated an increase in L3-skeletal muscle index measured by a CT scan of the L3 region in the LPCN 1148 group (n=15) compared to placebo (n=10), with a mean group difference of 4.4 cm2/m2 (95% CI: 1.3–7.4 cm2/m2, p=0.007). Participants in LPCN 1148 experienced fewer episodes of overt HE (Common Terminology Criteria for Adverse Events grade ≥2; p=0.02) than placebo. The number and severity of treatment-emergent adverse events were similar between arms.

Conclusions:

LPCN 1148 treatment improved sarcopenia and reduced the number of overt HE episodes in men with cirrhosis and sarcopenia awaiting liver transplant. These findings support additional research on the efficacy of LPCN 1148 in treating sarcopenia and preventing HE recurrence.
IDIOPATHIC RETINAL VASCULITIS, ANEURYSMS, AND NEURORETINITIS COMPLICATED BY CILIORETINAL ARTERY OCCLUSION: MULTIMODAL IMAGING AND 5-YEAR FOLLOW-UP
Authors: Ferreira Bruno F. A. , Sato Rodrigo H. , Conci Lívia S. , Nogueira Thiago M. , Freitas Vinícius A. P. , Martines Carolina M. , Júnior Hélio P. P. , Nakashima Yoshitaka , Souza Eduardo C.
Published: November 2024

Purpose:

To describe a multimodal imaging and a 5-year follow-up of a case of cilioretinal artery occlusion (CLRAO) in a 40-year-old woman with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome.

Methods:

Fundus photography, indocyanine green and fluorescein angiography, optical coherence tomography (OCT), OCT angiography (OCTA), and a literature review of retinal artery occlusions associated with IRVAN syndrome were performed.

Results:

Fundus examination revealed bilateral blurred margins of the discs and peri-vascular hard exudates. Fluorescein angiography (FA) demonstrated peripheral capillary nonperfusion areas in both eyes (OU). It also revealed an aberrant cilioretinal artery in the right eye (OD). OCT showed attenuation of the inner retinal layers and disruption of the outer retinal layers secondary to CLRAO in OD. OCTA allowed a clear identification of macular hypoperfusion in OU. Laser photocoagulation, along with anti-VEGF and corticosteroid intravitreal injections, was administered in OU. Best-corrected visual acuity remained stable, with no evidence of progression or development of neovascularization after a 5-year follow-up.

Conclusion:

IRVAN syndrome may be complicated by CLRAO, resulting in poor final visual acuity despite reperfusion of the occluded artery. In such cases, multimodal imaging allows the identification of complications such as macular atrophy on OCT and hypoperfusion areas that may not be detected on FA on OCTA.
Autologous Serum Tear Production in Anticoagulated Patients
Authors: Harrington Maya T. , Su Leon , Adamski Jill , Patel Dave R. , Shusko Alexander R. , Shen Joanne F.
Published: November 2024

Purpose:

Autologous serum tears (ASTs) are produced from serum obtained by blood draw and used to treat severe dry eye diseases. Multiple cases of failed AST production occurred due to serum becoming a solidified, gel-like substance after centrifugation. The aim of this study was to identify risk factors associated with inability to compound AST.

Methods:

From January 2019 to December 2022, 99 patients received AST produced at Mayo Clinic in Arizona. Patient demographics, medical diagnoses, medications, laboratory results, and events surrounding blood draws were obtained through an IRB-approved retrospective chart review. The laboratory and pharmacy protocol procedures were observed in person after the occurrence of the last production issue.

Results:

Ten total clotted serum episodes occurred in 4 patients, each with multiple occurrences. The indication for AST was chronic ocular graft-vs-host disease (n = 3) and Sjögren syndrome (n = 1). Eighty percent of episodes were associated with either a systemic infection (n = 7) or pulmonary embolism (n = 1) within the prior month. At the time of blood draw, all 4 patients were treated with antiplatelet and/or anticoagulation medications, including rivaroxaban, apixaban, aspirin, and low–molecular-weight heparin.

Conclusions:

The AST protocol was increased from 30 to 60 minutes of resting time to allow clotting before centrifugation. Inadequate clotting during this stasis period likely resulted in fibrinogen remaining suspended in the serum, leading to solidified plasma instead of liquid serum. We hypothesize risk of inadequate clotting would be increased in patients taking anticoagulation or antiplatelet medications. Our recommendations include ensuring 60-minute collection tube resting time for all patients, including those on anticoagulation medication.
Kidney Stone Prevalence Among US Population: Updated Estimation from NHANES Data Set
Authors: Alibrahim Hidar , Swed Sarya , Sawaf Bisher , Alkhanafsa Mohammed , AlQatati Fadel , Alzughayyar Tareq , Abdeljawwad Abumunshar Namir Amer , Alom Mulham , Qafisheh Qutaiba , Aljunaidi Roa'a , Mosleh Osayd , Oum Muhamad , Bakkour Agyad , Barakat Lolwa
Published: November 2024

Importance:

Kidney stones are a significant public health issue in the United States, affecting a substantial portion of the adult population. Understanding the prevalence and risk factors associated with this condition is crucial for developing effective prevention and treatment strategies.

Objective:

To estimate the prevalence of kidney stones among the US adult population and identify key demographic and health-related risk factors associated with the condition using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020.

Design:

This was a cross-sectional study utilizing NHANES data from 2007 to 2020. The analysis reported here includes data collected over this 13-year period, with no additional follow-up duration.

Setting:

The study setting was population-based, utilizing a nationwide survey that is representative of the US civilian noninstitutionalized population.

Participants:

Participants were US adults aged 20 years and older. The final sample size consisted of 37,857 individuals.

Exposures:

In this observational study, the exposures of interest were the demographic and health-related factors that may influence the prevalence of kidney stones. These factors included age, gender, race/ethnicity, BMI, physical activity, smoking status, and medical diagnoses such as diabetes and hypertension. The study used preexisting data from the NHANES database, spanning from 2007 to 2020.

Main Outcomes and Measures:

The primary outcome measured was the prevalence of kidney stones among the study participants. The presence of kidney stones was determined based on participants’ responses to the question, “Have you ever had kidney stones?” in the NHANES survey.

Results:

The study included a final sample of 37,857 US adults after exclusions. Of these, 9.25% reported having had kidney stones. The prevalence was higher in men (54.8%) than in women (45.2%), and increased with age, peaking at 23.9% in individuals aged 70 years and older. Non-Hispanic White individuals had the highest prevalence of kidney stones at 52.5%. Physically inactive individuals and those with conditions such as hypertension (51.3%) and diabetes (22.7%) also showed higher prevalence rates.

Conclusions and Relevance:

The study concluded that kidney stones are a prevalent condition in the United States, affecting approximately 1 in 11 adults, with a higher incidence in older adults, men, non-Hispanic White individuals, and individuals with certain health conditions such as hypertension and diabetes. The findings underscore the importance of targeted public health interventions and preventive measures focusing on these high-risk groups.
Unusual Presentation of Ureteral Hunner Lesion: A Case Report
Authors: Owens R. Grant , Tracy Chad R. , Humble Robert M. , Kreder Karl J.
Published: November 2024

This case report presents a rare and atypical manifestation of a ureteral Hunner lesion (HL). The patient initially presented with right ureteral stenosis, abnormal urine cytology, intermittent flank pain, gross hematuria, and lower urinary tract symptoms. Diagnostic evaluation involved various imaging studies, endoscopic procedures, and medical interventions. Eventually, the patient underwent right segmental ureterectomy resulting in symptom improvement. Pathology revealed findings consistent with a HL. This case report highlights the challenges in diagnosis, management, and the importance of considering ureteral HL as a potential cause of ureteral symptoms.
Charting a National Path for Well-Being Through Healthy People 2030
Authors: Hoyer Deborah , Ochiai Emmeline , Blakey Carter
Published: November 2024

The Office of Disease Prevention and Health Promotion (ODPHP) at the US Department of Health and Human Services (HHS) oversees Healthy People 2030, the nation’s decennial health promotion and disease prevention framework and plan, which sets national goals and identifies science-based measurable objectives with targets to evaluate efforts to improve health and well-being. With science recognizing the relationship between health and well-being, Healthy People 2030 is broadening its understanding of national-level well-being by gathering new data for and coordinating across the federal government on well-being. The addition of well-being in Healthy People 2030 elevates well-being as a national priority and creates opportunities for the well-being of the nation to be assessed, disparities to be identified, and collaborative efforts to be coordinated to support a society in which all people can achieve their full potential for health and well-being. This article discusses the inclusion of well-being to Healthy People 2030, details the approach and rationale for the selection of the national well-being metrics, and articulates opportunities for improving population-level well-being and federal collaboration.
A Comparison of Delivery Modalities for Pregnancy Clinical Care Management
Authors: Williams Kelly , Winger Mary , McIntyre Aisling , Domalakes Katie , Stevenson Heidi , Khouri Natasha
Published: November 2024

Objective:

Given the high prevalence of maternal morbidity and mortality, it is imperative that maternal health interventions are comprehensively evaluated, so they can be scaled with fidelity. Community-based care management models focused on perinatal health care are a priority for health care systems and payers. Alternative care management delivery modalities, such as video visits, are needed to expand program reach amidst growing system-level challenges. This evaluation explores the feasibility, acceptability, and impact of video versus telephonic care in perinatal care management.

Methods:

Using a mixed methods approach, we implemented a quality improvement project to learn about the integration and impact of video-enabled care into the UPMC Health Plan “Pregnancy Clinical Support” (PCS) care management delivery model. Focus groups were conducted with PCS care managers (CMs) to explore their perspectives on video-visit integration. Video-only members were propensity scores matched to telephonic-only members; statistical comparisons were conducted to assess between-group differences in engagement.

Results:

PCS CMs discussed ways to structure effective video-visit onboarding, strengths, and drawbacks of video-enabled care, workflow integration challenges, and best practices for introducing video visits to members. Video-only members had significantly (P < 0.0001) more clinical sessions (2.56 ± 1.57 vs 2.05 ± 1.52) and longer case duration measured in calendar days (209 ± 80 vs 169 ± 94) during the 17-month project period than telephonic-only members.

Conclusion:

Evidence generated provides direct guidance on successfully integrating video visits into workflows of community-based CMs while improving engagement in care across diverse member populations.
Financial Well-Being of U.S. Military Veterans and Health Impact
Authors: Elbogen Eric B. , Serrano Bethzaida N. , Huang Jovin
Published: November 2024

Objective:

Research has shown that psychosocial well-being in veterans, including financial status, is related to better clinical outcomes after leaving military service. The current study examines variables linking financial well-being to physical health in veterans and non-veterans and identifies financial variables related to veteran status.

Methods:

We analyzed data from the nationally representative 2021 Survey of Household Economics and Decisionmaking conducted by the U.S. Federal Reserve Board and compared the responses of veterans (N = 1176) to a non-veteran sample matched by age, sex, education, race, ethnicity, and geographic region (N = 1176).

Results:

Multivariable analyses revealed that although veterans and non-veterans were similar in many financial domains, veterans were more likely to spend money on the lottery and gambling, pay overdraft fees on bank accounts, and take out payday or pawn shop loans. Analyses showed over one-third (35%) of veterans reported credit card debt, significantly higher than non-veterans. In veterans and non-veterans, higher physical health ratings were related to higher income, lacking medical debt, living in a community of greater economic advantage, and having a rainy-day fund in case of financial emergencies. Ratings of one’s credit score were also significantly associated with ratings of one’s physical health, in both veterans and non-veterans.

Conclusions:

The data pinpoint specific financial domains to inform policy, education, and outreach aimed at improving veterans’ psychosocial well-being. The results also reveal that individual and environment-level financial variables were related to physical health in this national survey, demonstrating the value of assessing financial well-being in the context of medical care, for both veteran and non-veteran patients.
Presence of Sonographic Secondary Signs Without Visualization of Appendix Is Indicative of Appendicitis in Children Younger Than 5 Years
Authors: Keane Olivia A. , Smith Savannah R. , He Zhulin , Straub Evan T. , Short Heather L. , Riedesel Erica L. , Santore Matthew T.
Published: November 2024

Purpose

Diagnosis of acute appendicitis is more difficult in children aged 0–4 years due to atypical clinical presentation, leading to delay in diagnosis and higher incidence of complications. Nonvisualization of the appendix on ultrasound increases diagnostic challenge. We examined the utility of standardized reporting of sonographic secondary signs of appendicitis in children younger than 5 years with nonvisualization of the appendix.

Methods

A retrospective cohort study of children younger than 5 years who underwent appendectomy following nonvisualization of the appendix on ultrasound from 2016 to 2022 was performed. Primary outcome was comparison of ultrasound and intraoperative findings. Two-sample t test and Wilcoxon sum-rank test compared continuous variables, and Fisher exact test compared categorical variables. Univariate and multivariate logistic regression analyses were performed to assess risk factors for complicated appendicitis in those with category 3 ultrasounds.

Results

Overall, 92 patients whose appendix was not visualized on ultrasound were included: 26 without secondary signs (category 2) and 66 with secondary signs (category 3). Significant differences in intraoperative findings between category 2 and category 3 patients existed (P < 0.001). On intraoperative assessment of patients with ultrasound category 2, 3.8% had no appendicitis, 46.2% had simple appendicitis, 34.6% had complicated appendicitis, and 15.4% underwent interval appendectomy. Conversely, of category 3 patients, 0% had no appendicitis, 7.6% had simple appendicitis, 48.5% had complicated appendicitis, and 43.9% underwent interval appendectomy. On logistic regression, in children with category 3 ultrasounds, presence of both fluid collection and free fluid as secondary signs was associated with intraoperative findings of complicated appendicitis. However, number of secondary signs was not significantly associated with increased likelihood of complicated appendicitis intraoperatively.

Conclusion

Presence of secondary signs without visualization of the appendix was shown to be indicative of appendicitis, with high suspicion for complicated appendicitis, in patients younger than 5 years. Further validation of the presence of secondary signs on right-lower-quadrant ultrasound may lead to more expedient diagnosis, reduction in cross-sectional imaging, and earlier treatment of complicated appendicitis.
Evaluation of Antivenom Therapy for Middle East Scorpion Envenomations
Authors: Kestenbom Inbal , Test Gidon , Kaplan Or , Bar-Moshe Shaked , Grupel Tal , Shilo Michael , Bilenko Natalya , Friger Michael , Maimon Michal S. , Scolnik Dennis , Glatstein Miguel M.
Published: November 2024

Introduction

Scorpion envenomation is a leading cause of envenomation in our region. Antivenom has been used successfully to treat the systemic manifestations of envenomations inflicted by toxic scorpions. Toxic scorpions common in our area include Leiurus quinquestriatus, Androctonus australis, and Buthus occitanus. This study describes the outcomes of children envenomated by these scorpions, and treated with SCORPIFAV, a polyvalent scorpion antivenom F(ab’)2 (equine), used since 2016 at our institution.

Methods

A retrospective chart review of all children admitted with symptoms and signs of scorpion envenomation to Soroka University Medical Center, between September 1, 2019, and December 1, 2020, who received antivenom SCORPIFAV. Our center has a protocol mandating antivenom therapy for all patients manifesting autonomic excitation, agitation, and anxiety, or more pronounced symptoms, following suspected scorpion envenomation.

Results

Three hundred patients were seen in the pediatric emergency department for scorpion envenomation during the study period, and 49 required antivenom (SCORPIFAV) as per departmental policy. Four of 49 developed allergic reactions during antivenom treatment: 2 manifested minor skin rashes treated with antihistamines only, and a further 2 required intramuscular adrenaline. There were no deaths in the study cohort and all patients recovered fully, with complete resolution of symptoms, signs, and laboratory features.

Conclusions

Patients treated with antivenom exhibited rapid resolution of symptoms without severe hypersensitivity. We recommend broadened availability of antivenom at sites where it is needed.
Analyzing research trends and developments in osseointegration in patients with extremity amputations: Systematic bibliometric analysis and research recommendations
Authors: Saleib Raphael-Kyrillos M. , Pekbay Begüm , Verhofstad Michiel H. J. , Paping Maria A. , Van Vledder Mark G. , Van Waes Oscar J. F.
Published: November 2024

Background:

Bone-anchored protheses (BAPs) by means of osseointegrated implants are increasingly being used in amputees with socket-related issues. Clinical advancements are being published by more and more centers worldwide. Although the number of publications and interest in BAP is growing, a systematic evaluation of scholarly output is lacking.

Objective:

To identify scholarly output, understand research trends and make research recommendations in the clinical field of BAP.

Methods:

Systematic searches in Medline All, Embase, Web of Science Core Collection, Cochrane Library, and Google Scholar were completed in February 2023. The results were deduplicated, screened, and assessed for quality by independent reviewers. Inclusion criteria were as follows: clinical studies and BAP in the extremities. Articles were excluded if they were animal or fundamental studies, nonclinical reports, had a study population less than 10 patients, or BAP was performed in areas other than extremities.

Results:

One hundred twelve articles were included and published between 1993 and 2023. An annual growth rate of 10.3% was found and research was published in 62 different journals. Prosthetics and Orthotics International, Clinical Orthopaedics and Related Research and The Bone & Joint Journal were the most prolific journals. Hagberg K, Aschoff HH, and Branemark R were major contributors to BAP research. Collaborations are predominantly among high-income countries. Main research trends were on rehabilitation, questionnaires, complication managements, and implant treatment.

Conclusions:

Research on BAP shows an increasing global trend, highlighting key research areas and authors. A unified global research agenda, stakeholders' collaborations, and consensus are essential for addressing knowledge gaps and development future direction of BAP.