bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Comparison and Competition: General Frameworks, Focused Models, and Emerging Phenomena
Authors: Garcia Stephen M. , Tor Avishalom
Published: April 2023

Scholarship in psychology and related fields has been paying increasing attention in recent decades to the ways in which social comparison processes facilitate competitive attitudes, feelings, and behavior. As part of this development, we first advanced the Social Comparison Model of Competition (Garcia et al., 2013)—a general framework that accounted for the role of both individual and situational factors in this area—and later followed it with the more comprehensive Social Comparison Cycle of Competition (Garcia, Reese, et al., 2020). At the same time, researchers have also proposed a number of focused models to account for specific competitive relationships (e.g., rivalry), contexts (e.g., coaction), and more. In light of these important developments, this chapter briefly reviews the key takeaways from our general frameworks of social comparison and competition, demonstrates the insights offered by recognizing how more specific models fit into general frameworks, and illustrates the continued utility of these general frameworks for the study of emerging phenomena, such as social networks or sustainability, from the perspective of social comparison and competition.
Folk Art Reassessed
Authors: Urdea Alexandra , Buchczyk Magdalena
Published: April 2023

This chapter critically reassesses Romanian collections of “folk art” or “folklore” through the the lens of material culture studies. While it is conventional to think about rural artifacts as indicators of regional ethnographic zones, scholars of rural objects in Romania rarely reflect on the social role of these collections. Against this background, the chapter recognizes that such objects are constantly produced, acquired, displayed, and deployed to mark a range of complex practices of representation and identity formation in heritage and vernacular contexts. Based on anthropological research in the settings identified as sources for folk art objects, it demonstrates that a material culture approach offers a unique perspective on the variety of normative categories and meanings of the artifacts depending on their historical context and changing social and political uses. It is proposed that ethnographic studies of rural objects can open novel research possibilities and reveal the situated, social, historical, and political relations in which the things are entangled.
Dating Rock Art
Authors: Green Helen , Finch Damien , Gleadow Andrew , Fülöp Réka-H. , Jacobs Zenobia
Published: April 2023

To understand the spatial history of rock art and the cognitive evolution of our species, we must obtain accurate and reliable dates from rock art across the globe. However, in most environments, the oldest styles of art are particularly difficult to date, requiring new approaches and the adaptation of existing methodologies. The Kimberley region of northwest Australia hosts one of the richest collections of Indigenous rock art in the world. In this setting, researchers face several challenges when applying dating techniques, with pigments often lacking organic material, and art commonly found in exposed, sandstone shelters. Despite these difficulties, recent advances in Australian rock art research have dated a kangaroo motif to around 17,300 years old, indicating that representational motifs were being made in the Kimberley region by the end of the Last Glacial Maximum. Here, several dating techniques are examined in the context of adaptations and advances in the methodologies applied to rock art dating in the Kimberley region. The common limitations, criticisms, and future directions for each technique are also identified and are relevant to researchers working in similar environments across the globe.
Encountering the Past
Authors: Smith Claire , Brady Liam M. , Wilson Christopher
Published: April 2023

Ian McNiven recently argued that interpretive theoretical frameworks shaped by Indigenous worldviews offer the potential to enrich archaeological understandings of the past and inform archaeological practice in the present. In this chapter, the authors apply one of the core theoretical concepts McNiven identified—Indigenous experiences of encountering the past—to their work with Ngarrindjeri, Jawoyn, and Yanyuwa Aboriginal people. Through the lens of encountering the past, they focus on the notions of living landscapes, revelation by the ancestors, and ancestral remains as people, not objects. All three are underpinned by the concept of ancestors having and exerting agency that shapes how the ‘archaeological record’ is interpreted. In doing so, they are also contributing to research movements that seek to obtain interpretations of the past that are not only more closely aligned to the knowledge systems of the people who created the archaeological material and cultural landscapes but also grounded in emotional connections to people, place, and objects.
Spectral Moments
Authors: Campion Edmund
Published: April 2023

Already a formed composer upon his arrival in France in 1989, Edmund Campion began working with Gérard Grisey and interacting with other key figures and institutions in the Paris contemporary music scene. Beset by the powerful and contradictory forces shaping musical life in Paris at the time, Campion pursued an independent musical project, one that embedded many influences from the so-called spectral school. With a growing interest in computer-assisted composition, he was drawn to Gérard Grisey's overall thinking and practice, particularly his approach to time in music. Campion undertook a reworking of his musical identity, integrating some of the ideas and techniques of Grisey, while immersing himself in the rich musical communities throughout Paris. His music transformed in unexpected ways as he sought to translate and synthesize new influences. He describes his experiences and compositional transformations within the context of the confluence of competing musical concerns represented by the Paris Conservatory, the Groupe de Recherches Musicales (GRM), and Institut de Recherche et Coordination Acoustique/Musique (IRCAM).
The Adaptive Information Processing Model
Authors: Leeds Andrew M.
Published: April 2023

The Adaptive Information Processing (AIP) model is the theoretical foundation for the EMDR approach to psychotherapy. It guides all aspects of EMDR treatment including history taking, case conceptualization, preparation, memory reprocessing, and re-evaluation as treatment unfolds. The AIP model predicts treatment effects in posttraumatic stress disorder, stress-based anxiety disorders, and depressive disorders for which there is widespread research support, as well as in a range of less common and challenging to treat disorders. The AIP model proposes a bold yet concise framework by which psychological healing can be both comprehensive and rapid. It presents a compassionate framework for understanding and ameliorating human suffering and the evolution of consciousness.
Forging a Middlebrow Canon in Edwardian London
Authors: McVeigh Simon
Published: April 2023

The early years of the twentieth century saw the firming up of a middlebrow canon of orchestral music. Using London as a case study, this chapter explores the role of Sunday concerts in enabling new listeners to experience a core repertoire on a regular basis. Landon Ronald’s weekly concerts with the New Symphony Orchestra attracted audiences of eight thousand or more to the Royal Albert Hall, a reach extended through his portfolio of recordings for the Gramophone Company and through piano transcriptions for the domestic market. Combining an educational agenda with clear commercial objectives, Ronald was central to a middlebrow orchestral culture that has survived to the present day. Rather than endorsing a modernist critique of the middlebrow, the chapter argues that British audiences at his concerts were not merely passive consumers but took part in an active discourse about repertoire and programming.
Introduction
Authors: De Souza Jonathan , Steege Benjamin , Wiskus Jessica
Published: April 2023

This introduction presents a critical overview of the phenomenology of music, examining its origins, history, limits, and future possibilities. Since Plato, Western discourse about music has articulated a conflict between music’s mathematical, objective properties and its effects on embodied, situated human subjects. Edmund Husserl, the founder of phenomenology, approached similar philosophical problems via a theory of intentionality. If consciousness is always intentional (i.e., directed toward things), then there is an essential correlation between the subject and the world. Since 1900, phenomenological analysis of musical problems has taken several forms: (1) from around 1910 to 1940, a quest to define the very object of musical phenomenology in opposition to the contemporaneous trend toward a “naturalistic” music aesthetics; (2) from around 1940 to 1970, greater concern with aesthetic production (including both performance and modernist poetics); (3) from around 1970 to around 2000, the prioritization of musical “experience” as a counterweight to music-theoretical abstractions; and (4) from 2000 to the present, a growing acknowledgment of embodiment, technology, and the interaction of the two. ​​Because musical form is generated through time, because we make and feel music with our bodies and instruments, because music communicates shared meaning with others, and because music is performed in diverse social contexts, a phenomenology of music must work with key themes of phenomenology itself—time-consciousness, embodiment, intersubjectivity, and the lifeworld.
The Modifying Mirror
Authors: Taipale Joona
Published: April 2023

This chapter compares music listening with the infant’s experience of care. Several scholars have argued that music can be used for scaffolding one’s self-experience. Developmental psychologists, in turn, maintain a wide consensus over the claim that, in early interaction, the attuned caregiver supports and modifies the infant’s self-experience in various ways. The chapter brings these phenomena together, illustrating how the examination of the early self/other relation can teach us something important concerning the listener/music relation. The first section elaborates on the scaffolding function of music and clarifies two ambiguities haunting the debate. The second section relocates musical scaffolding in the register of vitality forms. Once the third section has dealt with early interaction, and analyzed the basic functions of the attuned caregiver, the fourth section uses the gained insights to examine the structural similarities between music listening and early experiences of attunement. Ultimately, this investigation reveals the “thanatic function” of music.
Historical Events That Shaped Contemporary Opioid Trends
Authors: Dunn Kelly E.
Published: April 2023

Opioid products originate in Papaver somniferum (e.g., the poppy plant), a naturally occurring botanical plant whose psychoactive ingredient (opium) has been used for centuries for its analgesic and reinforcing properties. In the mid-1800s the psychoactive ingredient of opium, morphine, was isolated and identified, leading to the medicalization of opioid products. In the 1900s, opioids were viewed primarily as useful therapeutics that were often compounded with other psychoactive ingredients and sold as elixirs. Within 20 years there was strong recognition of their potential for problematic use related to high rates of opioid-related problems. While the scientific field continued to focus on the identification and synthesis of new opioid analgesics, at a Federal level a series of acts were passed that sought to restrict access to opioids. This made for a complex environment to enact treatment programs, and many of the laws passed during those periods continue to shape our modern-day treatment infrastructure. Nonmedical opioid use continued throughout the 20th century, though it changed in important ways beginning around the 1980s when a series of landmark events occurred, each of which are believed to have played a role in shaping the current state of opioid use in the United States. This chapter provides a historical review of the experience of opioids, primarily in the United States, from the 1800s to today and discusses in detail how these events established a foundation upon which our contemporary medical, treatment, and societal approaches are premised.
Kratom (Mitragyna speciosa)
Authors: Smith Kirsten E. , Grundmann Oliver , Swogger Marc T. , Garcia-Romeu Albert
Published: April 2023

Kratom (Mitragyna speciosa) is a tree in the coffee family, indigenous to Southeast Asia (SEA), whose leaves have historically been used as a natural remedy and for its purported stimulating and analgesic properties. Kratom has gained popularity in recent years in the United States, where internet-based sales have driven growing numbers of people to experiment with kratom products. Kratom contains over 40 unique alkaloids displaying complex pharmacological properties including opioid- and non-opioid-receptor mediated effects. Data from animal research indicates therapeutic potential of kratom; for instance, as an analgesic agent or in mitigating opioid and alcohol withdrawal symptoms. Some adverse effects and risks are also attributable to kratom and its alkaloids, including possible liver damage and potential for dependence, particularly in the context of high dosage and/or chronic administration. However, in comparison to commonly used opioid medications, these risks are generally lower for kratom, consistent with human observational data from SEA and the US. Prevalence of kratom use remains difficult to conclusively assess, with estimates ranging between 1.8 to 15.6 million kratom-using adults in the US alone. The limited human data, comprised of survey and case report, suggest kratom may be effective for pain relief, to address mood and anxiety symptoms, and as a potential future aid in the treatment of substance use disorders and drug withdrawal. Overall, limited data indicate kratom and its alkaloids warrant a significant investment of rigorous basic and clinical research to better characterize its pharmacology, potential risks, and therapeutic benefits.
CAT within forensic settings part one
Authors: Ramm Mark , Shannon Karen
Published: April 2023

Cognitive analytic therapy (CAT) has a wide range of useful applications within forensic services. In addition to the more established use of CAT with clinical problems, it is equally helpful for understanding and addressing offending behaviour. CAT-based formulations can also make an important contribution to risk assessment and risk management. In addition, CAT can provide staff with a shared and consistent framework to guide and maintain the consistency of interventions in a context where a fundamental tension exists between the demands of managing risk and rehabilitation. CAT’s relational approach can become the main mechanism for achieving positive change particularly when individuals who have offended find it hard to engage. CAT can act as an overarching model to integrate forensic services, with contextual and systemic reformulation guiding service delivery at the organizational level. This chapter describes these applications of CAT in forensic services and highlights the available literature in this area.
Love and Infidelity
Authors: Carroll Noël
Published: April 2023

Polling shows that Americans believe that infidelity—commonly called “cheating”—is morally wrong. This chapter pursues the question of what—beyond the fact that it typically involves lying—is morally wrong about infidelity in cases that involve partners who are engaged in enduring romantic relationships that are presumed to be exclusive and permanent. The author argues that the most significant moral wrongs in such cases are based on the psychological damage the betrayer inflicts upon the betrayed in the relevant sorts of enduring romantic relationships. These relationships are constituted by means of a wealth of reciprocally transforming joint projects that shape the self-image of the partners in profound ways. The discovery of infidelity undermines that self-image in a way that typically engenders psychic injuries such as paranoia, self-doubt, and a lack of self-esteem, among other psychological wounds that are not only painful in their own right, but that may impair future behavior. Even when said infidelities go undetected, the betrayed lover is harmed insofar as he/she/they is deprived of the full range of choices available—such as exiting the relationship altogether.
The role of antidrug antibodies in ustekinumab therapy and the impact of methotrexate
Authors: Mojtahed Poor Sorwe , Henke Marina , Ulshöfer Thomas , Köhm Michaela , Behrens Frank , Burkhardt Harald , Schiffmann Susanne
Published: April 2023

Objective

We investigated the impact of concomitant MTX on ustekinumab (UST) levels and antidrug antibody (ADA) formation in PsA and evaluated consequences in pharmacodynamics and pharmacokinetics.

Methods

We conducted a post-hoc analysis on 112 PsA serum samples of subjects treated with open-label UST and either concomitant MTX (UST/MTX, n = 58) or placebo (UST/pbo, n = 54) obtained in a randomized (1:1), double-blind, multicentre trial. A validated antibody-binding-based multitiered testing was used to detect ADA and ADA with neutralizing capacity (nADA). The impact of MTX on UST immunogenicity was analysed by comparison of UST/pbo with UST/MTX cohorts at different time points. Patient- and disease-related predispositions for ADA formation were investigated with multiple linear regression analysis. Immunogenicity impact on pharmacokinetics, safety and efficacy was determined by cohort comparison between patients with and without ADA formation.

Results

Over 52 weeks, 11 UST/pbo- and 19 UST/MTX-treated patients developed ADA (P > 0.05). In the UST/pbo cohort, the visit-dependent UST levels were in the range of 0.047 (0.05) –0.110 (0.07) µg/ml overall, and 0.037 (0.04)–0.091 (0.08) µg/ml in ADA-confirmed subjects. In UST/MTX-treated patients, the UST levels exhibited an intervisit variation in the range of 0.0502 (0.04)–0.106 (0.07) µg/ml overall and 0.029 (0.03)–0.097 (0.07) µg/ml in ADA positive subjects (P > 0.05). At week 52, ADA-confirmed patients did not differ significantly (P > 0.05) in safety or clinical outcomes from ADA-negative patients.

Conclusion

Concomitant MTX had no significant impact on UST immunogenicity. Furthermore, ADA formation was not associated with impairments in UST safety, efficacy or trough levels.

Trial registration

ClinicalTrials.gov, https://clinicaltrials.gov, NCT03148860.
A tiered testing strategy based on in vitro phenotypic and transcriptomic data for selecting representative petroleum UVCBs for toxicity evaluation in vivo
Authors: Tsai Han-Hsuan Doris , House John S , Wright Fred A , Chiu Weihsueh A , Rusyn Ivan
Published: April 2023

Hazard evaluation of substances of “unknown or variable composition, complex reaction products and biological materials” (UVCBs) remains a major challenge in regulatory science because their chemical composition is difficult to ascertain. Petroleum substances are representative UVCBs and human cell-based data have been previously used to substantiate their groupings for regulatory submissions. We hypothesized that a combination of phenotypic and transcriptomic data could be integrated to make decisions as to selection of group-representative worst-case petroleum UVCBs for subsequent toxicity evaluation in vivo. We used data obtained from 141 substances from 16 manufacturing categories previously tested in 6 human cell types (induced pluripotent stem cell [iPSC]-derived hepatocytes, cardiomyocytes, neurons, and endothelial cells, and MCF7 and A375 cell lines). Benchmark doses for gene-substance combinations were calculated, and both transcriptomic and phenotype-derived points of departure (PODs) were obtained. Correlation analysis and machine learning were used to assess associations between phenotypic and transcriptional PODs and to determine the most informative cell types and assays, thus representing a cost-effective integrated testing strategy. We found that 2 cell types—iPSC-derived-hepatocytes and -cardiomyocytes—contributed the most informative and protective PODs and may be used to inform selection of representative petroleum UVCBs for further toxicity evaluation in vivo. Overall, although the use of new approach methodologies to prioritize UVCBs has not been widely adopted, our study proposes a tiered testing strategy based on iPSC-derived hepatocytes and cardiomyocytes to inform selection of representative worst-case petroleum UVCBs from each manufacturing category for further toxicity evaluation in vivo.
A meta-analysis on the prevalence of Taenia solium and Taenia saginata infections in India
Authors: Balodhi Ashutosh , Jain Khushi , Gupta Palak , Deeba Farah , Salam Nasir
Published: April 2023

Tapeworm infections in humans are considered to be a significant public health menace. Despite its public health importance, the data on tapeworm infection remains fragmented and underutilised. The present study reviews the overall burden and distribution of taeniasis and cysticercosis caused by Taenia solium and Taenia saginata in India by conducting a systematic review of the scientific literature based on Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Data from 19 eligible articles were analysed and the prevalence of T. solium–associated taeniasis/cysticercosis was found to be 11.06% (95% confidence interval [CI] 6.856 to 16.119) and the prevalence of T. saginata–associated taeniasis was found to be 4.7% (95% CI 3.301 to 6.301). This systematic review and meta-analysis provides a comprehensive analysis of the available literature on tapeworm infections and assesses the burden of Taenia infection from India, identifying areas of high prevalence requiring active surveillance and public health interventions.
Glutamatergic melanocortin‐4 receptor neurons regulate body weight
Authors: Liu Haodong , Li Xiaojing , Li Penghui , Hai Rihan , Li Jiacheng , Fan Qi , Wang Xing , Chen Yujie , Cao Xiaojuan , Zhang Xiaoyu , Gao Ruifeng , Wang Kun , Du Chenguang
Published: April 2023

The locus coeruleus (LC), enriched in vesicular glutamate transporter 2 (VGlut2) neurons, is a potential homeostasis‐regulating hub. However, the identity of melanocortin‐4 receptor (MC4R) neurons in the paraventricular nucleus (PVN) of the hypothalamus, PVNVGlut2::MC4R and LCVGlut2::MC4R regulation of body weight, and axonal projections of LCVGlut2 neurons remain unclear. Conditional knockout of MC4R in chimeric mice was used to confirm the effects of VGlut2. Interscapular brown adipose tissue was injected with pseudorabies virus to study the central nervous system projections. We mapped the LCVGlut2 circuitry. Based on the Cre–LoxP recombination system, specific knockdown of MC4R in VGlut2 neurons resulted in weight gain in chimeric mice. Adeno‐associated virus‐mediated knockdown of MC4R expression in the PVN and LC had potential superimposed effects on weight gain, demonstrating the importance of VGlut2 neurons. Unlike these wide‐ranging efferent projections, the PVN, hypothalamic arcuate nucleus, supraoptic nucleus of the lateral olfactory tegmental nuclei, and nucleus tractus solitarius send excitatory projections to LCVGlut2 neurons. The PVN → LC glutamatergic MC4R long‐term neural circuit positively affected weight management and could help treat obesity.
MENIN‐mediated regulation of gastrin gene expression and its role in gastrinoma development
Authors: Elvis‐Offiah Uloma B. , Duan Suzann , Merchant Juanita L.
Published: April 2023

The Multiple Endocrine Neoplasia I (MEN1) locus encodes the protein MENIN, which functions as a tumor suppressor protein in neuroendocrine tissues. Gastrinomas are neuroendocrine neoplasms that overproduce the hormone gastrin and can arise sporadically or as part of the MEN1 syndrome, in which mutations in the MEN1 gene lead to loss or inactivation of MENIN protein. Gastrin is a peptide hormone that is primarily synthesized in the gastric antrum and stimulates the secretion of histamine from enterochromaffin‐like (ECL) cells and subsequently acid from parietal cells in the gastric corpus. In addition, gastrin exerts a mitogenic function primarily on ECL cells and progenitor cells in the gastric isthmus. Current studies seek to understand how MEN1 mutations generate a mutant MENIN protein that abrogates its tumor suppressor function. Mutations in the MEN1 gene are broadly distributed throughout its nine protein‐coding exons, making it difficult to correlate protein structure with its function. Although disruption of the Men1 locus in mice causes functional neuroendocrine tumors in the pituitary and pancreas, gastrinomas do not develop in these transgenic animal models. Prior studies of human gastrinomas suggest that tissue‐specific microenvironmental cues in the submucosal foregut may contribute to tumorigenesis by reprogramming of epithelial cells toward the neuroendocrine phenotype. Accordingly, recent studies suggest that neural crest‐derived cells are also sensitive to reprogramming when MEN1 is deleted or mutated. Thus, the goal of this report is to review our current understanding of how MENIN modulates gastrin gene expression while highlighting its role in the prevention/suppression of neuroendocrine cell transformation.
Large Sternoabdominal Wound Dehiscence after Cardiac Surgery: Challenging Multimodal Treatment
Authors: Bundele Varsha , Aggarwal Neha , Bana Ajeet
Published: April 2023

The authors report the case of a patient who presented with a nonhealing sternal wound 3 months after cardiac bypass surgery. The patient was treated with vacuum-assisted closure, surgical debridement, and IV antibiotics. Despite repeated flap closure procedures, a top closure device, and wound dressings, the patient developed an infection, and the wound size increased from 8 × 10 cm to 20 × 20 cm, advancing from the sternal to upper abdominal region. This wound was then treated with hyperbaric oxygen therapy and nonmedicated dressings until the patient was eligible to receive a split-thickness skin graft 1.5 years after initial presentation.

 The main takeaway from this case was that local and systemic factors affected the outcome of each surgical closure. The failure of each preceding treatment choice that led to further increases in size and area of the wound was the main challenge. Eliminating infection, preventing development of new infection, and managing the local and systemic factors before any definite surgery are key to the eventual wound closure.
Code-Switch Fatigue
Authors: Graham-Perel Ashley
Published: April 2023

A perspective on the enigmatic social practice of diverse nursing staff
Wanted: More Nurses in Office
Authors: Fauteux Nicole
Published: April 2023

More women are entering politics, but few are nurses.
Camp Nursing
Authors: Gaslin Tracey
Published: April 2023

These nurses serve millions of youths all year round.
Reducing CLABSIs in an Adult Cardiothoracic ICU
Authors: Orozco-Santana Emmanuel , Fowlds Taryn , Tamayo Michelle , Jew Christine , Young Patricia , Sheehan Patty , Murray Katrine , Marcarian Taline
Published: April 2023

Local problem:

Central line–associated bloodstream infections (CLABSIs) are associated with increased mortality and costs. In the cardiothoracic ICU (CTICU) of an academic medical center, nine CLABSIs occurred in fiscal year (FY) 2018.

Purpose:

The aim of this project was to reduce the CLABSI rate in the CTICU and sustain the results.

Methods:

Nurse residents on the CTICU initiated a quality improvement project with a single intervention and expanded it into an ongoing initiative with additional interventions by the unit-based performance improvement committee. Evidence-based interventions were identified and implemented, including education; rounding; auditing; and other unit-specific interventions, which included “Central Line Sunday,” accountability emails, and a blood culture algorithm with a tip sheet.

Results:

CLABSI incidence was reduced from nine in FY 2018 to one in each of the subsequent FYs (2019 and 2020), which had similar totals of central line days, and two in FY 2021, which had a slightly higher number of central line days. The CTICU was able to achieve zero CLABSIs from August 2019 through November 2020, more than 365 days.

Conclusions:

Coupled with strong support from nursing leadership, nurses on the unit successfully reduced CLABSIs by adopting novel, evidence-based strategies; ongoing monitoring; and multiple interventions.
The Architecture of a Research Study
Authors: Keeler Courtney , Curtis Alexa Colgrove
Published: April 2023

Editor's note: This is the 15th article in a series on clinical research by nurses. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation. To see all the articles in the series, go to https://links.lww.com/AJN/A204.
Silent Conversation
Authors: Smith Carre
Published: April 2023

A nurse imagines a startling and oddly comforting perspective during a code.
Problems and Challenges Associated with Renaming Non-alcoholic Fatty Liver Disease to Metabolic Associated Fatty Liver Disease
Authors: Zeng Minghui , Chen Lin , Li Yuqin , Mi Yuqiang , Xu Liang
Published: April 2023

Non-alcoholic fatty liver disease (NAFLD) has become the world’s largest chronic liver disease in the 21st century, affecting 20%–30% of the world’s population. As the epidemiology, etiology, and pathogenesis of NAFLD have been studied in-depth, it has been gradually recognized that most patients with NAFLD have one or more combined metabolic abnormalities known as metabolic syndrome. In 2020, the international expert group changed the name of NAFLD to metabolic-associated fatty liver disease (MAFLD) and proposed new diagnostic criteria for MAFLD and MAFLD-related liver cirrhosis, as well as the conceptual framework of other cause-related fatty liver diseases to avoid diagnosis based on the exclusion of other causes and better reflect its pathogenesis. However, there are still many ambiguities in the term, and changing the name does not address the unmet key needs in the field. The change from NAFLD to MAFLD was not just a change of definition. A comprehensive search was performed in MEDLINE and PubMed Central through June 2022. The problems and challenges are summarized as follows: epidemiology, children, rationality of “metabolism,” diagnostic criteria, double/multiple causes, drug discovery, clinical trials, and awareness raising. Metabolic-associated fatty liver disease has complex disease characteristics, and there are still some problems that need to be solved.
Change of Choroidal Microvasculature Dropout After Trabeculectomy as Assessed by Optical Coherence Tomography Angiography
Authors: Baek Min Su , Sung Kyung Rim , Shin Joong Won , Lee Jin Yeong , Kim Ko Eun
Published: April 2023

Précis:

Reduction in the angular circumference of choroidal microvascular dropout (CMvD AC) was found in POAG patients after trabeculectomy. Greater percentage of IOP reduction was significantly associated with decreased CMvD AC.

Purpose:

The purpose of this study was to investigate the change of choroidal microvasculature dropout (CMvD) after trabeculectomy and its associated factors in primary open angle glaucoma (POAG) eyes using optical coherence tomography angiography.

Methods:

Fifty eyes of 50 POAG participants who had preoperative CMvD and underwent trabeculectomy were prospectively enrolled. Angular circumference (AC) of CMvD was determined from choroidal layer images by optical coherence tomography angiography preoperatively and at postoperative 1 year. The cutoff for significant AC of CMvD decrease was determined by the Bland-Altman method, and accordingly, patients were divided into 2, decreased and stable/increased CMvD AC groups. Changes in intraocular pressure (IOP) and CMvD AC were compared between the groups preoperatively and at postoperative 1 year. Factors associated with CMvD AC decrease were assessed by linear regression analysis.

Results:

The cutoff for significant CMvD AC decrease was 3.58 degrees; accordingly, 26 eyes (52.0%) were categorized as decreased CMvD AC group. No significant intergroup differences in baseline characteristics were found. However, the decreased CMvD AC group presented significantly lower IOP (10.7±3.7 vs. 12.9±2.6 mm Hg, P=0.022), lower CMvD AC (32.03±33.95% vs. 53.44±39.33%, P=0.044), and higher parapapillary choroidal vessel density (P=0.014) compared with the increased/stable CMvD AC group at postoperative 1 year. The greater percentage of IOP reduction was significantly associated with decreased CMvD AC (P=0.046).

Conclusions:

CMvD AC reduction associated with IOP lowering was found after trabeculectomy. The long-term clinical relevance of postoperative CMvD reduction should be further investigated.
Osteomyelitis in Sickle Cell Anemia: Does Age Predict Risk of Salmonella Infection?
Authors: Hegeman Erik M. , Bates Taylor , Lynch Tom , Schmitz Matthew R.
Published: April 2023

Background:

Osteomyelitis is a condition that disproportionately affects those with sickle cell anemia (SCA). Despite the frequency of osteomyelitis in this population, there are reports of increasing life expectancy and rates of Staphylococcus aureus infections, which contrasts the belief that Salmonella is the most common organism identified. The purpose of this systematic review is to determine the most commonly identified organism and identify whether age is associated with the development of Salmonella osteomyelitis in homozygous sickle cell patients.

Methods:

A search of PubMed, EMBASE Cochrane and databases was performed for studies of all levels of evidence pertaining to osteomyelitis in SCA. Reasons for exclusion included non-English language, case reports, literature reviews, isolated septic arthritis without bony involvement and isolated oral-facial bony involvement.

Results:

The most common pathogen cultured was nontyphoid Salmonella, which occurred in 117 of 192 (60.9%) of cases identified. This was followed by S. aureus 41 of 192 (21.8%) and other enteric bacteria 14 of 192 (7.2%). Subgroup analysis demonstrated differences at the age of initial presentation with Salmonella cohort at 6.8 years and S. aureus cohort at 22.1 years (P = 0.0001). On geographic analysis, African countries had an older average age of diagnosis at 13.1 years with decreased rates of Salmonella infections and increased rates of infections from other organisms compared with the US, Middle East and Europe.

Conclusions:

This systematic review suggests that Salmonella is most commonly identified in patients with SCA (HbSS phenotype) especially those <12 years old presenting with acute osteomyelitis. Sub-Saharan African countries had later ages of diagnosis compared with the US, Middle East and Europe with bacterial profiles that favors a diagnosis of chronic osteomyelitis and missed acute initial presentation. Therefore, age of presentation is likely a surrogate for geographic and socioeconomic factors such as availability of medical screening and treatment.
Optimal postoperative surveillance strategies for cancer survivors with gastric neuroendocrine carcinoma based on individual risk: a multicenter real-world cohort study
Authors: Xu Bin-bin , He Xin-Yang , Zhou Yan-bing , He Qing-liang , Tian Yan-tao , Hao Han-kun , Qiu Xian-tu , Jiang Li-xin , Zhao Gang , li Zhi , Xu Yan-chang , Fu Wei-hua , Xue Fang-qin , Li Shu-liang , Xu Ze-kuan , Zhu Zheng-gang , Li Yong , Li En , Chen Jin-ping , Li Hong-lang , Cai Li-sheng , Wu Dong , Li Ping , Zheng Chao-hui , Xie Jian-wei , Lu Jun , Huang Chang-Ming
Published: April 2023

Background:

The best follow-up strategy for cancer survivors after treatment should balance the effectiveness and cost of disease detection while detecting recurrence as early as possible. Due to the low incidence of gastric neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma [G-(MA)NEC], high-level evidence-based follow-up strategies is limited. Currently, there is a lack of consensus among clinical practice guidelines regarding the appropriate follow-up strategies for patients with resectable G-(MA)NEC.

Materials and methods:

The study included patients diagnosed with G-(MA)NEC from 21 centers in China. The random forest survival model simulated the monthly probability of recurrence to establish an optimal surveillance schedule maximizing the power of detecting recurrence at each follow-up. The power and cost-effectiveness were compared with the National Comprehensive Cancer Network, European Neuroendocrine Tumor Society, and European Society for Medical Oncology Guidelines.

Results:

A total of 801 patients with G-(MA)NEC were included. The patients were stratified into four distinct risk groups utilizing the modified TNM staging system. The study cohort comprised 106 (13.2%), 120 (15.0%), 379 (47.3%), and 196 cases (24.5%) for modified groups IIA, IIB, IIIA, and IIIB, respectively. Based on the monthly probability of disease recurrence, the authors established four distinct follow-up strategies for each risk group. The total number of follow-ups 5 years after surgery in the four groups was 12, 12, 13, and 13 times, respectively. The risk-based follow-up strategies demonstrated improved detection efficiency compared to existing clinical guidelines. Further Markov decision-analytic models verified that the risk-based follow-up strategies were better and more cost-effective than the control strategy recommended by the guidelines.

Conclusions:

This study developed four different monitoring strategies based on individualized risks for patients with G-(MA)NEC, which may improve the detection power at each visit and were more economical, effective. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending follow-up strategies for G-(MA)NEC.
Coronary angiography after cardiac arrest
Authors: Nikolaou Nikolaos I.
Published: April 2023

Purpose of review

Acute coronary syndromes represent the commonest cause of out-of-hospital cardiac arrest (OHCA) in adults. Coronary angiography (CAG) followed by percutaneous coronary intervention (PCI) has been established as the treatment strategy for these patients. In this review, we aim first to discuss the potential risks and expected benefits from it, the caveats in its implementation, and the current tools for patient selection. Then summarize the recent evidence on the group of patients without ST-segment elevation on post-return of spontaneous circulation (ROSC) ECG.

Recent findings

The implementation of this strategy still shows a wide variation among the various systems of care.

The presence of ST-segment elevation on post-ROSC ECG remains the most reliable tool for patient selection for immediate CAG.

A primary PCI strategy is currently recommended for patients with ST-segment elevation on post-ROSC ECG regardless of the conscious state of patients.

Recently several randomised studies including patients without ST-segment elevation on post-ROSC ECG showed no benefit with immediate CAG compared to delayed/ elective CAG. This has led to a substantial although not uniform change in current recommendations.

Recent studies show no benefit with immediate CAG in groups of patients without ST-segment elevation on post-ROSC ECG. Further refinements in selecting the appropriate patients for immediate CAG seem necessary.
The Clinical Impact and Cost-Effectiveness of Clinic-Based Cognitive Behavioral Therapy for People With HIV, Depression, and Virologic Failure in South Africa
Authors: Gandhi Aditya R. , Hyle Emily P. , Scott Justine A. , Lee Jasper S. , Shebl Fatma M. , Joska John A. , Andersen Lena S. , O'Cleirigh Conall , Safren Steven A. , Freedberg Kenneth A.
Published: April 2023

Background:

Depression affects 25%–30% of people with HIV (PWH) in the Republic of South Africa (RSA) and is associated with both antiretroviral therapy (ART) nonadherence and increased mortality. We evaluated the cost-effectiveness of task-shifted, cognitive behavioral therapy (CBT) for PWH with diagnosed depression and virologic failure from a randomized trial in RSA.

Setting:

RSA.

Methods:

Using the Cost-Effectiveness of Preventing AIDS Complications model, we simulated both trial strategies: enhanced treatment as usual (ETAU) and ETAU plus CBT for ART adherence and depression (CBT-AD; 8 sessions plus 2 follow-ups). In the trial, viral suppression at 1 year was 20% with ETAU and 32% with CBT-AD. Model inputs included mean initial age (39 years) and CD4 count (214/μL), ART costs ($7.5–22/mo), and CBT costs ($29/session). We projected 5- and 10-year viral suppression, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs: $/QALY [discounted 3%/yr]; cost-effectiveness threshold: ≤$2545/QALY [0.5× per capita GDP]). In sensitivity analyses, we determined how input parameter variation affected cost-effectiveness.

Results:

Model-projected 5- and 10-year viral suppression were 18.9% and 8.7% with ETAU and 21.2% and 9.7% with CBT-AD, respectively. Compared with ETAU, CBT-AD would increase discounted life expectancy from 4.12 to 4.68 QALYs and costs from $6210/person to $6670/person (incremental cost-effectiveness ratio: $840/QALY). CBT-AD would remain cost-effective unless CBT-AD cost >$70/session and simultaneously improved 1-year viral suppression by ≤4% compared with ETAU.

Conclusions:

CBT for PWH with depression and virologic failure in RSA could improve life expectancy and be cost-effective. Such targeted mental health interventions should be integrated into HIV care.
Brenneria bubanii sp. nov., isolated from decaying plant tissues
Authors: Tóth Tímea , Lakatos Tamás
Published: April 2023

Gram-negative, motile, rod-shaped bacterial strains (designated 4F2T and Kf) were isolated from decaying tissues of various deciduous tree species. Phylogenetic analyses based on their 16S rRNA gene sequences showed that the novel isolates belong to the genus

Brenneria

and showed highest (98.3 %) sequence similarity to

Brenneria goodwinii

. Isolate 4F2T formed a separate branch on the phylogenetic tree based on concatenated sequences of four housekeeping genes or whole genome sequences, clearly separate from

Brenneria goodwinii

, suggesting that novel isolates should belong to a novel species. Orthologous average nucleotide identity scores and in silico DNA–DNA hybridization values between isolate 4F2T and type strains of other species in the genus

Brenneria

were less than 85 and 30 %, respectively, significantly lower than the species boundary cut-off values (95 and 70 %). A negative reaction for β-galactosidase, the ability to use dextrin and maltose as carbon sources, and an inability to use lactose are the main phenotypic characteristics that can be used to differentiate the novel isolates from

B. goodwinii

. Based on phenotypic and genotypic characteristics, isolates 4F2T and Kf belong to a novel species of the genus

Brenneria

, for which the name Brenneria bubanii sp. nov. is proposed. The type strain is 4F2T (=NCAIM B 02661T=LMG 32183T).
Predicting neoadjuvant treatment response in triple-negative breast cancer using machine learning
Authors: Bhattarai Shristi , Saini Geetanjali , Li Hongxiao , Duanmu Hongyi , Seth Gaurav , Fisher Timothy B. , Janssen Emiel A.M. , Kiraz Umay , Kong Jun , Aneja Ritu
Published: April 2023

Background

Neoadjuvant chemotherapy (NAC) is the standard treatment for early-stage triple negative breast cancer (TNBC). The primary endpoint of NAC is a pathological complete response (pCR). NAC results in pCR in only 30%–40% of TNBC patients. Tumor-infiltrating lymphocytes (TILs), Ki67 and phosphohistone H3 (pH3) are a few known biomarkers to predict NAC response. Currently, systematic evaluation of the combined value of these biomarkers in predicting NAC response is lacking. In this study, the predictive value of markers derived from H&E and IHC stained biopsy tissue was comprehensively evaluated using a supervised machine learning (ML)-based approach. Identifying predictive biomarkers could help guide therapeutic decisions by enabling precise stratification of TNBC patients into responders and partial or non-responders.

Methods

Serial sections from core needle biopsies (n=76) were stained with H&E, and immunohistochemically for the Ki67 and pH3 markers, followed by whole slide image (WSI) generation. The resulting WSI triplets were co-registered with H&E WSIs serving as the reference. Separate mask region-based CNN (MRCNN) models were trained with annotated H&E, Ki67 and pH3 images for detecting tumor cells, stromal and intratumoral TILs (sTILs and tTILs), Ki67+, and pH3+cells. Top image patches with a high density of cells of interest were identified as hotspots. Best classifiers for NAC response prediction were identified by training multiple ML models, and evaluating their performance by accuracy, area under curve, and confusion matrix analyses.

Results

Highest prediction accuracy was achieved when hotspot regions were identified by tTIL counts and each hotspot was represented by measures of tTILs, sTILs, tumor cells, Ki67+, and pH3+features. Regardless of the hotspot selection metric, a complementary use of multiple histological features (tTILs, sTILs) and molecular biomarkers (Ki67 and pH3) resulted in top ranked performance at the patient level.

Conclusions

Overall, our results emphasize that prediction models for NAC response should be based on biomarkers in combination rather than in isolation. Our study provides compelling evidence to support the use of ML-based models to predict NAC response in patients with TNBC.
Deficiency of macrophage-derived Dnase1L3 causes lupus-like phenotypes in mice
Authors: Engavale Minal , Hernandez Colton J. , Infante Angelica , LeRoith Tanya , Radovan Elliott , Evans Lauryn , Villarreal Johanna , Reilly Christopher M. , Sutton R. Bryan , Keyel Peter A.
Published: April 2023

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease caused by environmental factors and loss of key proteins. One such protein is a serum endonuclease secreted by macrophages and dendritic cells, Dnase1L3. Loss of Dnase1L3 causes pediatric-onset lupus in humans is Dnase1L3. Reduction in Dnase1L3 activity occurs in adult-onset human SLE. However, the amount of Dnase1L3 necessary to prevent lupus onset, if the impact is continuous or requires a threshold, and which phenotypes are most impacted by Dnase1L3 remain unknown. To reduce Dnase1L3 protein levels, we developed a genetic mouse model with reduced Dnase1L3 activity by deletingDnase1L3from macrophages (cKO). Serum Dnase1L3 levels were reduced 67%, though Dnase1 activity remained constant. Sera were collected weekly from cKO and littermate controls until 50 weeks of age. Homogeneous and peripheral anti-nuclear antibodies were detected by immunofluorescence, consistent with anti-dsDNA antibodies. Total IgM, total IgG, and anti-dsDNA antibody levels increased in cKO mice with increasing age. In contrast to global Dnase1L3−/−mice, anti-dsDNA antibodies were not elevated until 30 weeks of age. The cKO mice had minimal kidney pathology, except for deposition of immune complexes and C3. Based on these findings, we conclude that an intermediate reduction in serum Dnase1L3 causes mild lupus phenotypes. This suggest that macrophage-derived DnaselL3 is critical to limiting lupus.