bluuebunny/crossref_metadata_2025 huggingface dataset:
Statistical Modeling of Within-Laboratory Precision Using a Hierarchical Bayesian Approach
Authors: Miyake Daisuke , Kanaya Shigehiko , Ono Naoaki
Published: August 2024

Background

Reproducibility has been well studied in the field of food analysis; the RSD is said to follow a Horwitz curve with certain exceptions. However, little systematic research has been done on predicting repeatability or intermediate precision.

Objective

We developed a regression method to estimate within-laboratory SDs using hierarchical Bayesian modeling and analyzing duplicate measurement data obtained from actual laboratory tests.

Methods

The Hamiltonian Monte Carlo method was employed and implemented using R with Stan. The basic structure of the statistical model was assumed to be a Chi-squared distribution, the fixed effect of the predictor was assumed to be a nonlinear function with a constant term and a concentration-dependent term, and the random effects were assumed to follow a lognormal distribution as a hierarchical prior.

Results

By analyzing over 300 instances, we obtained regression results that fit well with the assumed model, except for moisture, which was a method-defined analyte. The developed method applies to a wide variety of analytes measured using general principles, including spectroscopy, GC, and HPLC. Although the estimated precisions were within the Horwitz ratio criteria for repeatability, some cases using high-sensitivity detectors, such as mass spectrometers, showed SDs below that range.

Conclusion

We propose utilizing the within-laboratory precision predicted by the model established in this study for internal QC and measurement uncertainty estimation without considering sample matrices.

Highlights

Performing statistical modeling on data from double analysis, which is conducted as a part of internal QCs, will simplify the estimation of the precision that fits each analytical system in a laboratory.
Size matters: lower body weight pigs have a different response to immune challenge and amino acids supplementation above the estimated requirement compared to heavy pigs
Authors: Valini Graziela Alves da Cunha , Méthot Steve , Pomar Candido , Hauschild Luciano , Remus Aline
Published: August 2024

The immune response varies between pigs, as not all pigs have the same response to a stressor. This variation may exist between individuals due to body weight (BW) or body composition, which may impact the capacity for coping with an immune challenge (IC). Tryptophan (Trp), threonine (Thr), and methionine (Met) requirements might also play a considerable part in supporting immune system activation while reducing variation between pigs; however, the latter has yet to be reported. This exploratory study investigated the effect of initial BW (light vs. heavy-weight) and supplementation of Trp, Thr, and Met above National Research Council (NRC) requirements on feeding behavior and the coping capacity of growing pigs under an IC. Eighty gilts were categorized into 2 groups according to BW: light-weight (LW, 22.5 kg) and heavy-weight pigs (HW, 28.5 kg). Both BW groups were group-housed for a 28-d trial in a good or poor sanitary condition (SC). Pigs within a poor SC were orally inoculated with 2 × 109 colony units of Salmonella Typhimurium, and fresh manure from a pig farm was spread on the floor. Pigs within good SC were not inoculated, nor was manure spread. Two diets were provided within each SC: control (CN) or supplemented (AA+) with Trp, Thr, and Met at 120% of NRC recommended levels. A principal component analysis was performed in R, and a feeding behavior index was calculated in SAS. Results showed that LW and HW pigs were clustered separately on day 0, where LW pigs had a positive correlation with body lipid percentage (r = 0.83), and HW pigs had a positive correlation with body protein percentage (r = 0.75). After the IC, the cluster configuration changed, with diets influencing LW more than HW pigs within poor SC. On day 14, LW fed AA + diet in poor SC was clustered separately from LW pigs fed CN diet, whereas LW fed AA + and CN diets in good SC were clustered together. For feeding behavior, in both analyzed periods (period 1: days 7 to 14; period 2: days 21 to 28), LW had lower total feed intake and shorter meals than HW pigs (P < 0.10), independent of the SC. Furthermore, LW pigs fed AA + diet had a more regular feed intake pattern than those fed CN diet, while a more irregular pattern was observed for HW pigs fed AA + diet than CN diet at period 2. These findings suggest that supplementing Trp, Thr, and Met above requirements may be a nutritional strategy for LW pigs under IC by improving feed intake regularity and reducing the probability of being susceptible to IC.
Liability for death or personal injury
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter covers Article 5, which concerns liability for death or injury. The provision limits the subject matter scope of the CISG in that it excludes the application of the Convention to a specific type of consequential damage, namely death and personal injury. The provision so far has remained virtually irrelevant in practice. The remaining key issue is whether recourse claims of a reseller against the initial seller on the grounds that the reseller had to compensate its customer for damage caused by death or personal injury are also excluded by Article 5 (‘any person’) or should be treated as monetary consequential losses suffered by the reseller due to non-conformity of the goods. The majority view takes the latter approach. The provision does not apply to damage to property which remain governed by the CISG.
Freedom of form
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter discusses Article 11. This article contains the principle of freedom from requirements as to form and therefor complements — as a counter-exception to Article 4, sentence 2(a). The provision includes and replaces not only substantive requirements as to form, as sentence 2 expressly includes the forms of evidence as well. This provision is subject to the possibility to make a reservation according to Article 96 in favour of the reservation State's formal requirements, for which Article 12 establishes the connecting provision in the convention. Article 13 defines — in an outdated kind of way — the writing requirements closer through two clarifications.
Effects of Article 96 reservation
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter turns to Article 12. This provision enforces the writing requirements of States having declared a reservation under Article 96 of the convention. Especially because of the exorbitant claim of validity of the Soviet requirements as to form the exact scope of the provision was in dispute for a long time. In essence, Articles 12, 96 merely eliminate the unification effect of Articles 11 and 29 for writing requirements of reservation States — as Article 12 mainly copies from Article 96 it might be seen superfluous. Decisive for the application of national form requirements in this case is the statute of form according to Article 11 Rom I Regulation and equivalent provisions.
Acceptance modifying the offer (including ‘battle of forms’)
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter examines Article 19. Article 19 supplements the basic provision on acceptances in Article 18 by a special provision addressing a practically common constellation, namely declarations by offerees that appear to be an ‘acceptance’, but partially deviate from the offer by containing different terms. If the traditional ‘mirror image’ rule was strictly applied in such scenarios, no contract would be concluded, because the terms of both party declarations do not perfectly match; accordingly, the ‘declaration of acceptance’ whose content deviates from that of the earlier offer could merely constitutes a counter-offer. The problem arising therefrom results from the experience that minor differences in terms between offer and acceptance often remain undetected in commercial practice or are being ignored by the parties, so that also contracts that have technically not (or not yet) been concluded are subsequently performed, either in part or completely. Against this background, the use of a strict mirror image approach brings with it the risk that one of the parties may later ‘detect’ a minor discrepancy between offer and acceptance, and may point to the technical lack of consensus between the parties in order to reject a contract that, for reasons entirely unrelated to its conclusion, has become unattractive for this party.
Place of delivery
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter looks into Article 31, which is primarily about the obligation of the sellers if they are not bound to deliver the goods to a specified location. It also covers the buyer’s right to require performance, avoid the contract, and claim damages from the seller. The Convention provides supplementary rules for determining the place of delivery if the contract does not specify the location of the delivery. The content of the delivery obligation and the place of delivery are vital in determining whether the seller breached the contract and whether the buyer can exercise the remedies available under Article 45.
Conformity of goods
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter looks into the conformity of goods addressed in Article 35. It notes the liability for defective goods in domestic legal systems alongside the requirements for conformity in line with discrepancies in quantity, quality, nature and packaging. Article 35 covers the goods deemed to conform with the contract. However, the article does not cover defects in title or third party claims based on industrial or other intellectual property since the matter is settled in Articles 41 and 42. The exclusions of liability include the awareness of the buyer, failure to give notice of non-conformity, and disclaimers. The chapter also discusses the object, burden, and standard of proof.
Relevant time for conformity of goods
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter expounds on Article 36, specifically on the time the goods must be in conformity with the agreed contract. As indicated in Article 36, the guarantees of durability are treated differently in various domestic systems. In line with Article 35 as well, the goods must conform with the contract at the time when the risk passes to the buyer. On the other hand, the seller is liable for a lack of conformity after the passing of risk if the non-conformity was caused by a breach of any of its obligations. The burden of proof is reversed in the case of a guarantee of durability.
Buyer’s examination of the goods
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter notes the purpose, method, period and costs of the examination of the goods in line with Article 38. Additionally, the buyer’s obligation to examine the goods within a period forms the basis of its obligation to notify the seller of defects under Article 39. The obligation to examine the goods and to notify the seller of any lack of conformity is intended to ensure the seller will deliver its remedy by the delivery of missing goods, by repair, or by reducing the buyer’s loss in some other way. Article 38 applies to all cases of lack of conformity within the meaning of Article 35.
Payment due without request from seller
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter focuses on Article 59 which states that the buyer must pay the price on the date fixed by or determinable from the contract or by the Convention without the need for any request or compliance with any formality on the part of the seller. It emphasizes that when the purchase price has become due and the buyer fails to pay, default interest will accrue on the purchase price for the period of the delay. Additionally, the seller may claim damages if he has incurred any loss. The chapter also explains that the application of Article 59 requires the purchase price to be fixed or determinable. If the contract does not fix the purchase price but provides for its determination by the seller, the buyer will only be required to pay the purchase price upon receipt of an invoice; interest will only accrue if payment is not made within a reasonable time after the receipt of the invoice. The discussion also includes the application of Article 59 to the payment of sums other than the purchase price.
Seller’s right to require performance
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter looks at the seller’s right to require the buyer to pay the purchase price, take delivery, or perform his or her other obligations. This mirrors the buyer’s obligations set forth by Article 53 on the remedies side. The chapter provides a brief comparison between common law and civil law systems before explaining the Convention on the International Sale of Goods-adopted procedure. In general, the buyer may be required to pay the purchase price, irrespective of whether or not delivery has taken place. In the case of a fundamental breach of contract or the buyer’s failure to perform within an additional period of time, the seller may declare the contract avoided. The problem of speculation on his or her loss will be addressed by the correct application of the damages provisions. The chapter also discusses the restrictions on the seller’s rights to require performance.
Obligation to pay interest
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter discusses Article 78, which establishes the obligation of a party to pay interest on any sum that is in arrears. The provision is applicable for all obligations based on the contract—regardless of whether it is a primary claim to performance or a secondary claim to damages, and regardless of whether the claim is expressly mentioned in the contract or derived from the Convention on the International Sale of Goods or national law applicable. The chapter zooms in on the preconditions of applying Article 78. It also highlights that the provisions of the payment, such as the place of payment and currency, are not expressly governed in this article. Furthermore, the chapter explains that an interest claim based on Article 78 stops accumulating if the principal obligation is paid in full.
Buyer’s loss of rights where restitution of goods is impossible
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter considers Article 82 as the successor of Article 79(1) ULIS, which compared to its predecessor, has been condensed and complemented by Article 82(2)(c), according to which resale, consumption, or transformation do not hinder avoidance of the contract. Article 82 poses a principle that may appear rather complicated and overly restrictive, but it was adopted and known to many predominant domestic sales laws in the world. It analyzes how Article 82 states that the buyer who cannot hand back to the seller the goods originally received is not entitled to declare the contract avoided. The chapter highlights the fact that the goods are no longer essentially in the condition in which the buyer had received them will deprive the buyer of its right to avoidance. Article 82 and its exception can essentially be traced back to classic Roman law.
Depositary
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter covers Article 90 that defines the Sales Convention’s sphere of application in cases in which another instrument, such as an international agreement, seeks application. It points out that clauses like Article 90 are frequently found in uniform law-making conventions and are variously referred to as compatibility clause, concurrence clause, conflict clause, delimitation norm, disconnection clause, Relationsnorm, special treaty clause governing precedence, or subsidiarity clause. The general treaty law background of Article 90 are the rules in Article 30 of the 1969 Vienna Convention on the Law of Treaties on the application of successive treaties relating to the same subject-matter. The chapter cites Article 30(2) of the 1969 Vienna Convention that expressly grants prevalence to relationship clauses in concurrent treaties. Article 90 displaces the further rules in Article 30(3), (4) of the 1969 Vienna Convention, which are residual in nature.
Reservation regarding Article 1(1)(b)
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter talks about Article 95, which authorizes each CISG Contracting State to declare a reservation, according to which it will not be bound by Article 1(1)(b). By authorizing an opting out of Article 1(1)(b), the reservation influences the Sales Convention’s sphere of applicability in courts of the reserving State in constellations not covered by Article 1(1)(a). It highlights how an Article 95 reservation does not affect the reservation State’s status as Contracting State in the sense of Article 1(1). The chapter reviews the historical reason for Article 95’s inclusion into the Sales Convention and the reservation itself was a true late-minute addition. As the Sales Convention is not establishing a give-and-take relationship between States but creating uniform commercial law rules for sales transactions between private parties, Article 95 is arguably ill-suited for this purpose.
Entry into force
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter examines the primary purpose of Article 99, which is to define the date of the Sales Convention’s entry into force for new CISG Contracting States. It details how Article 99 governs one aspect of the CISG’s temporal sphere of application. Article 99’s second purpose is to coordinate the transition of those States that were Contracting States of the 1980 Sales Convention’s predecessors to the Sales Convention. The chapter categorizes Article 99 to the purely diplomatic final provisions and exclusively directed at States in their treaty-making capacity. Article 99’s predecessors in the 1964 Hague Sales Conventions and 1974 Limitation Convention contained counterparts to the entry into force rules, which did not address the relation to the 1964 Hague Convention.
A study on factors related to sleep disorders and serum BDNF expression levels in patients with primary Sjögren’s syndrome
Authors: Han Yaxin , Chen Xixi , Tang Guo , Peng Qing , Liu Jiajun , Liu Yan , Zhou Qiao , Long Li
Published: August 2024

Objectives

We aimed to assess the sleep quality of patients with primary Sjögren’s syndrome (pSS) and the associated factors. Moreover, we conducted a preliminary exploration of the clinical significance of serum brain-derived neurotrophic factor (BDNF) in pSS patients with sleep disorders.

Methods

A self-report survey was administered to 111 pSS patients and 40 healthy individuals using the Pittsburgh Sleep Quality Index for sleep quality. Clinical data, and mental conditions were collected using on-site questionnaires and various scales. A total of 40 healthy controls from the health examination centre of the same hospital, who were age- and sex-matched. Detection of serum BDNF levels by enzyme-linked immunosorbent assay method. Use GraphPad Prism to analyze data and create graphs.

Results

Patients with pSS had higher scores on the Pittsburgh Sleep Quality Index than the healthy individuals. Abnormal sweating, high Patient Health Questionnaire-9 and EULAR Sjögren Syndrome Patient Reported Index scores were independent risk factors for sleep disorders. pSS patients had lower serum BDNF than the healthy individuals. The area under the curve of predicting sleep disorder in pSS patients using detection of serum BDNF level was 0.8470, and the sensitivity and specificity were 0.951 and 0.727, which were superior to Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7.

Conclusion

Compared with the healthy individuals, pSS patients had a higher prevalence of sleep disorders and lower serum BNDF. Serum BDNF level demonstrated greater predictive advantage for sleep disorder in pSS patients.
Pulmonary Artery Aneurysm in Behcet’s Disease Manifesting as Haemoptysis: A Case Report and Literature Review
Authors: Al-Yacopy Ali Akeel , Alhatemi Ahmed Qasim Mohammed , Hashim Hashim Talib , Al-Obaidi Ahmed Dheyaa , Abdulhussain Rand
Published: August 2024

Pulmonary artery aneurysm (PAA) in Behcet’s disease is a rare yet potentially life-threatening manifestation, often presenting as haemoptysis. We present a case report of a 33-year-old male with recurrent haemoptysis and a history of oral and genital ulcers, diagnosed with Behcet’s disease complicated by PAA. Diagnostic workup, including imaging and laboratory tests, confirmed the diagnosis, leading to prompt initiation of immunosuppressive therapy and meticulous follow-up. The patient showed significant clinical improvement with reduced ulcer severity and no new episodes of haemoptysis during one-year follow-up. Our case underscores the importance of early recognition, multidisciplinary management, and close monitoring to optimize outcomes in Behcet’s disease with pulmonary involvement. A comprehensive literature review further elucidates the clinical nuances, diagnostic challenges, and therapeutic strategies associated with this rare manifestation, highlighting the need for collaborative care and tailored interventions to mitigate complications and improve patient prognosis.

Key clinical message Behcet’s disease can present with pulmonary artery aneurysm, necessitating vigilant monitoring and prompt intervention to prevent severe complications like haemoptysis. Multidisciplinary collaboration is vital for tailored management and improved patient outcomes.
Darwin and the biological rhythms
Authors: de Andrade Tiago G , Beale Andrew D
Published: August 2024

While the formalization of chronobiology as a scientific discipline occurred in the mid-20th century, the exploration of rhythmic phenomena has a longer history, notably exemplified by De Mairan's observations of Mimosa pudica in darkness in 1729. In this historical narrative, Charles Darwin is known for his investigations into the “sleep movements” of plants. Nevertheless, the complete scope of Darwin's exploration of biological rhythms remains incompletely understood. Through a detailed examination of Darwin's writings, meticulous observations, experiments, and conceptualizations, we unveil a depth of engagement that surpasses his widely acknowledged work on plants, revealing a more extensive interest in and insight into biological rhythms than traditionally recognized.
Inflammatory signature-based theranostics for acute lung injury in acute type A aortic dissection
Authors: Liu Hong , Diao Yi-fei , Qian Si-chong , Shao Yong-feng , Zhao Sheng , Li Hai-yang , Zhang Hong-jia
Published: August 2024

Acute lung injury (ALI) is a serious adverse event in the management of acute type A aortic dissection (ATAAD). Using a large-scale cohort, we applied artificial intelligence-driven approach to stratify patients with different outcomes and treatment responses. A total of 2,499 patients from China 5A study database (2016–2022) from 10 cardiovascular centers were divided into 70% for derivation cohort and 30% for validation cohort, in which extreme gradient boosting algorithm was used to develop ALI risk model. Logistic regression was used to assess the risk under anti-inflammatory strategies in different risk probability. Eight top features of importance (leukocyte, platelet, hemoglobin, base excess, age, creatinine, glucose, and left ventricular end-diastolic dimension) were used to develop and validate an ALI risk model, with adequate discrimination ability regarding area under the receiver operating characteristic curve of 0.844 and 0.799 in the derivation and validation cohort, respectively. By the individualized treatment effect prediction, ulinastatin use was significantly associated with significantly lower risk of developing ALI (odds ratio [OR] 0.623 [95% CI 0.456, 0.851]; P = 0.003) in patients with a predicted ALI risk of 32.5–73.0%, rather than in pooled patients with a risk of <32.5 and >73.0% (OR 0.929 [0.682, 1.267], P = 0.642) (Pinteraction = 0.075). An artificial intelligence-driven risk stratification of ALI following ATAAD surgery were developed and validated, and subgroup analysis showed the heterogeneity of anti-inflammatory pharmacotherapy, which suggested individualized anti-inflammatory strategies in different risk probability of ALI.
High-quality research on physical therapy in psoriatic arthritis is needed: a systematic review
Authors: Kaerts Marlies , Swinnen Thijs W , Dankaerts Wim , de Vlam Kurt , Neerinckx Barbara
Published: August 2024

Objectives

Although physical therapy is recommended as part of the non-pharmacological management of patients with psoriatic arthritis (PsA), the evidence is still unclear. Therefore, this study aimed to systematically review and appraise the quality of research on physical therapy in the management of patients with PsA.

Methods

In June 2024, a systematic literature search using four different databases (Medline, Embase, Web of Science and the Cochrane Library) was performed to include interventional and observational studies examining physical therapy in patients with PsA (PROSPERO ID 255501). A risk of bias assessment was conducted. Due to the wide variety of interventions and outcomes, a narrative synthesis was used.

Results

Of 9442 abstracts, 15 papers examining physical therapy uptake in clinical practice (N = 2) and different physical therapy interventions (N = 13) were included: cardiorespiratory exercises (N = 5), resistance exercises (N = 2), therapeutic modalities (N = 4) and mixed rehabilitation programs (N = 2). A low risk of bias was scored in only one RCT assessing cardiorespiratory exercises. The well-tolerated 11-week high-intensity interval training resulted in a long-term increase in peak oxygen uptake and a short-term decrease in truncal fat percentage in patients with low disease activity. Resistance training in patients with active disease did not increase muscle strength, but improved functional capacity, disease activity, pain and general health after the intervention. Evidence for other modalities was inconclusive.

Conclusion

High-quality evidence on physical therapy in PsA was scarce. Cardiorespiratory and resistance exercises demonstrated promising results to positively influence cardiometabolic risk as well as disease-related outcomes. Future research on physical therapy in PsA with adequate methodological quality is needed.
Unraveling the Ecological Niche Signals of Verticillium dahliae: Insights from Mediterranean Landscapes
Authors: Arias-Giraldo Luis F. , Cobos Marlon E. , Peterson A. Townsend , Landa Blanca B. , Navas-Cortés Juan A.
Published: August 2024

Verticillium wilt (VW), caused by the soilborne plant pathogenic fungus Verticillium dahliae, is a major disease affecting olive crops globally. In view of the lack of effective postinfection treatments, exclusion and avoidance strategies are essential in disease management. Assessing the risks posed by this pathogen is essential to prevent the spread and to ensure selection of suitable sites for new plantations. This study aimed to elucidate the environmental factors driving V. dahliae establishment in the Andalusia region in southern Spain, an emblematic Mediterranean landscape for olive cultivation. To this end, we explored ecological niche signals for this fungal pathogen by analyzing 62 environmental variables across 1.6 million ha dedicated to olive and cotton cultivation by using data from a 15-year survey on the presence or absence of VW incidence from both olive and cotton fields. To ensure robust identification of ecological niche signals, we employed randomization-based, nonparametric univariate tests to compare presence records with the broader sampling universe (including absence records). Our findings identified key environmental variables that are associated significantly with V. dahliae presence, including temperature range seasonality (including mean diurnal and annual ranges), summer temperature (maximum of the warmest month, mean of the warmest quarter), and moisture and water availability (near-surface humidity, potential evapotranspiration, vapor pressure) as core niche variables for V. dahliae. Our results replicated the pathogen’s known distribution, identifying the Guadalquivir Valley as a particularly high-risk area in view of its mild winters and distinct rainy seasons, providing new insights into the specific environmental conditions that facilitate the pathogen’s survival and spread. Furthermore, this study introduces a novel approach to niche modeling that prioritizes variables with consistent effects and significant impact on the presence and distribution of V. dahliae and identifies potential data artifacts. This approach enhances our understanding of ecological requirements in V. dahliae and informs targeted management strategies.
Barriers and Facilitators to Accessing Opioid Agonist Therapy for Street-involved Adolescents and Young Adults in Vancouver
Authors: Gallant Kat , Nijjar Preety , DeBeck Kora , Cui Michelle , Kerr Thomas
Published: August 2024

Objective

Opioid agonist therapy (OAT) remains the first-line therapy for people with opioid use disorder. Whereas overdose rates among adolescents and young adults (AYAs) remain high, little is known about their access to OAT. Therefore, we sought to evaluate factors that shape access to OAT among AYAs aged 14 to 26 years.

Methods

Data were derived from the At-Risk Youth Study, a prospective cohort study that involves street-involved AYAs who use illicit substances in Vancouver, Canada. Generalized estimating equations were used to identify factors associated with OAT enrollment from September 2005 to October 2021.

Results

A total of 759 AYAs reported at least weekly opioid or OAT use, with a median age of 23 years and 65.7% self-identifying as male. At baseline, 147 participants (19.4%) were on OAT, and another 199 (26.2%) initiated OAT during study follow-up (median number of follow-up visits, 5 [Q1–Q3, 2.5–8]). In a multivariable analysis, being <19 years old (adjusted odds ratio [AOR], 0.40; 95% confidence interval [CI], 0.23–0.71), Indigenous ancestry (OR, 0.72; 95% CI, 0.52–1.00), homelessness (AOR, 0.65; 95% CI, 0.54–0.77), drug dealing (AOR, 0.73; 95% CI, 0.61–0.87), daily opioid use (AOR, 0.47; 95% CI, 0.40–0.55), and nonfatal overdose (AOR, 0.73; 95% CI, 0.60–0.89) were negatively associated with OAT use.

Conclusions

This study identified a low rate of OAT access among AYAs. Adolescents and young adults were less likely to be on OAT if they were <19 years old, Indigenous, and possessed certain risk markers. These findings highlight the need for mitigation strategies to facilitate OAT access for this population and for additional harm reduction measures to support AYAs who do not want to use OAT.
Adherence to Wide-Abduction Brace Treatment is Associated With Improved Hip Abduction and Radiographic Outcomes in Legg-Calvé-Perthes Disease
Authors: Prasadh Jai Ganesh , Kang Michael Seungcheol , Shah Hitesh , Jo Chan-Hee , Kim Harry K.W.
Published: August 2024

Introduction:

The wide-abduction A-frame brace contains the femoral head to improve its remodeling in Legg-Calvé-Perthes disease (LCPD). There is no study of the effect of brace adherence on hip outcomes. The purpose of this study was to determine if patient adherence to A-frame brace treatment is associated with improved hip abduction range of motion and radiographic outcomes in children with LCPD.

Methods:

This retrospective study included patients aged 4 to 11 years with LCPD treated with an A-frame brace. Patients aged >11 and those treated with osteotomy before completing brace treatment were excluded. Built-in temperature sensors measured brace wear. Hip abduction was measured on examination before and after bracing. Deformity index (DI) and sphericity deviation score (SDS) were measured from radiographs at the 2-year follow-up and healed stage, respectively. Pearson correlation and multiple regression analyses were performed.

Results:

Fifty-seven patients (44 male; 77%) were included with a mean age of 7.0±1.6 at brace treatment and mean adherence of 0.66±0.28. Brace adherence was associated with increased hip abduction (R=0.36; P=0.006) and decreased DI (R=−0.37; P=0.042) across all patients, and decreased SDS in patients <9 years old at the time of brace treatment (R=−0.58; P=0.024). A +0.50 increase in adherence was associated with +9.4° hip abduction (P=0.018), −0.13 DI (P=0.027), and −17.7 SDS (P=0.019).

Conclusions:

Adherence to A-frame brace treatment was associated with increased hip abduction, decreased femoral head deformity, and increased sphericity. Patients and parents can be counseled regarding brace adherence to maximize outcomes of treatment.

Level of Evidence:

III–Therapeutic Study.
Epidemiology of Brachial Plexus Birth Injury and the Impact of Cesarean Section on Its Incidence
Authors: DeFrancesco Christopher J. , Mahon Scott J. , Desai Vineet M. , Pehnke Meagan , Manske M. Claire , Shah Apurva S.
Published: August 2024

Background:

While prior research provided thorough analysis of the epidemiology of brachial plexus birth injury (BPBI) from 1997 to 2012, recent trends are unknown. The goal of this study was to update the understanding of the epidemiology and risk factors for BPBI.

Methods:

Installments of the Kids’ Inpatient Database (1997 to 2019) were used to estimate BPBI incidence in the United States in comparison to several independent variables over time. An interaction between cesarean (C-) section and newborn weight was explored by defining BPBI rates in a stratified manner. A logistic regression model accounting for this interaction was developed to produce odds ratios for independent factors. Lastly, the temporal relationship between BPBI rates and C-section rates was explored using linear regression.

Results:

BPBI rates were steady around 0.9 to 1.1 per 1000 live births between 2006 and 2019. C-section rates were similarly stable between 32.3% and 34.0% over this period. Stratified analysis indicated C-section delivery was protective against BPBI across newborn weight classes, but the magnitude of this protective value was highest among newborns with macrosomia. Shoulder dystocia was the strongest risk factor for BPBI in the logistic regression model [adjusted odds ratio (AOR): 56.9, P<0.001]. The AOR for a newborn with macrosomia born through C-section (AOR: 0.581, 95% CI: 0.365-0.925) was lower than that for a normal weight newborn born vaginally (AOR: 1.000, P=0.022). Medicaid insurance coverage (AOR: 1.176, 95% CI: 1.124-1.230, P<0.001), female sex (AOR: 1.238, 95% CI: 1.193-1.283, P<0.001), and non-White race (AOR: 1.295, 95% CI: 1.237-1.357, P<0.001) were independent risk factors for BPBI. Over time, the rate of BPBI correlated very strongly with the rate of C-section (R
2=0.980).

Conclusions:

While BPBI and C-section rates were relatively stable after 2006, BPBI incidence strongly correlated with C-section rates. This highlights the need for close surveillance of BPBI rates as efforts to lower the frequency of C-section evolve. Female, Black, and Hispanic newborns and children with Medicaid insurance experience BPBI at a higher rate, a finding which could direct future research and influence policy.

Level of Evidence:

Level IV—case series.
Impact of the Prognostic Nutritional Index on Outcomes in Native Spine Infection
Authors: Ezeonu Teeto , Narayanan Rajkishen , Alfonsi Samuel , Lee Yunsoo , Gibbons John Liam , McCormick Christian , Spring Jacob , Kozlowski Gabrielle , Mangan John J. , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K.
Published: August 2024

Study Design.

Retrospective cohort study.

Objective.

The objective of this study was to determine if a baseline prognostic nutritional index (PNI) score could be used to predict outcomes in patients with native spine infections, including the need for operative intervention.

Summary of Background Data.

Nutritional status is an important, potentially modifiable risk factor to consider in the native spine population. The PNI score is a tool that has demonstrated utility as a marker of preoperative nutritional status in patients undergoing surgery; however, it has not yet been studied in the context of native spine infection.

Methods.

Adult patients (≥18 y) with a diagnosis of spine infection from 2017 to 2022 were retrospectively identified. Native spine infection was defined as a diagnosis of spinal infection in the absence of prior spine surgery within 3 months of diagnosis. PNI was calculated using the equation: PNI=10×serum albumin (g/dL)+0.005 total lymphocyte count (/μL). Patients were stratified into high or low PNI groups based on their PNI being above or below the average, respectively.

Results.

There were 45 patients in the low PNI group and 56 patients in the high PNI group. Patients in the low PNI group were more likely to require surgery (P=0.046), had more levels decompressed (P=0.012), and were more likely to undergo two or more irrigation and debridement procedures (P=0.016). Patients in the low PNI group were also less likely to be discharged home (P=0.016). There was no difference in length of stay, inpatient complications, 90-day readmissions, 90-day ED visits, or 1-year reoperations between groups.

Conclusion.

While postadmission outcomes and inpatient complications were similar across PNI groups, PNI on admission provides useful insight into the severity of infection and predicts the need for operative intervention in patients presenting with native spine infection.
Professional Development Program for New Psychiatry Graduates in an Outpatient Telepsychiatry Practice
Authors: Sharoha Nidhi , Petti Anna , Banner Bethany , Perlmutter Ilisse
Published: August 2024

Telehealth has grown in recent years and with it, the need for educational interventions for new graduates entering this practice environment. This article evaluates a six-month professional development program designed to help psychiatrists joining our practice directly out of training acclimate to independent practice and the telepsychiatry setting. Our New Graduate Development Program included advisory sessions, lectures, board preparation, and flash mentorship for 87 new graduates who joined our telepsychiatry practice between July and December 2022. An anonymous retrospective pre-/postsurvey evaluated the efficacy of each component on a five-point Likert scale and a 10-point interval scale. Twenty-three percent of new graduates completed the survey. After participating in the program, 94.40% of respondents indicated that the program helped them acclimate to our practice, prepared them for independent practice, and enhanced their competence in telepsychiatry; 82.35% of respondents agreed that the program improved their performance as a new psychiatrist. The New Graduate Development Program helped participants acclimate to independent practice and the telepsychiatry setting; however, some revisions to our approach are needed for future iterations of the program.
An evaluation of couples undergoing intrauterine insemination at the BioART Fertility Centre, Johannesburg
Authors: Feti Mulema Noel , Adam Yasmin , Mohamed Tasneem
Published: August 2024

Objective:

To describe couples who underwent intrauterine insemination (IUI) and determine predictors of successful IUI in low and middle-income countries.

Background:

Assisted reproductive technology is still largely unavailable or inaccessible in most low and middle-income countries. IUI, which consists of the deposition of processed sperm from the partner or donor into the cavity of the uterus around ovulation time, is one of the oldest methods used and is still widely practiced to this day.

Methods:

A retrospective descriptive study was done at the BioArt Fertility Centre from January 2019 to June 2021. In total, 451 IUI cycles were analyzed in 273 couples. The main outcome measure was a clinical pregnancy on transvaginal ultrasound 4 weeks post-IUI. Multivariate logistic regression was done to find predictors of successful IUI.

Results:

The mean male age was 37.15 years (SD ± 5.16), with most male participants having a processed total motile sperm count (PTMSC) of >39×106/mL. The mean female age was 33.51 years (SD ± 4.83). The main etiology of infertility was ovulatory dysfunction (37.7%). The clinical pregnancy rate and the live birth rate per cycle were 12.4% and 11.9%, respectively, for a cumulative pregnancy rate of 21.6% for couples that underwent 3 cycles. The PTMSC, female age, duration of infertility, and follicle size were directly correlated with an increased pregnancy rate (P < 0.05).

Conclusion:

IUI is an effective choice of therapy for infertility in selected couples, achieving acceptable pregnancy rates for up to 3 treatment cycles, especially in females <40 years with <5 years duration of infertility, and in males with a PTMSC of >39×106/mL.
A functional genomic framework to elucidate novel causal metabolic dysfunction–associated fatty liver disease genes
Authors: Saliba-Gustafsson Peter , Justesen Johanne M. , Ranta Amanda , Sharma Disha , Bielczyk-Maczynska Ewa , Li Jiehan , Najmi Laeya A. , Apodaka Maider , Aspichueta Patricia , Björck Hanna M. , Eriksson Per , Schurr Theresia M. , Franco-Cereceda Anders , Gloudemans Mike , Mujica Endrina , den Hoed Marcel , Assimes Themistocles L. , Quertermous Thomas , Carcamo-Orive Ivan , Park Chong Y. , Knowles Joshua W.
Published: August 2024

Background and Aims:

Metabolic dysfunction–associated fatty liver disease (MASLD) is the most prevalent chronic liver pathology in western countries, with serious public health consequences. Efforts to identify causal genes for MASLD have been hampered by the relative paucity of human data from gold standard magnetic resonance quantification of hepatic fat. To overcome insufficient sample size, genome-wide association studies using MASLD surrogate phenotypes have been used, but only a small number of loci have been identified to date. In this study, we combined genome-wide association studies of MASLD composite surrogate phenotypes with genetic colocalization studies followed by functional in vitro screens to identify bona fide causal genes for MASLD.

Approach and Results:

We used the UK Biobank to explore the associations of our novel MASLD score, and genetic colocalization to prioritize putative causal genes for in vitro validation. We created a functional genomic framework to study MASLD genes in vitro using CRISPRi. Our data identifyVKORC1,TNKS,LYPLAL1, andGPAMas regulators of lipid accumulation in hepatocytes and suggest the involvement ofVKORC1in the lipid storage related to the development of MASLD.

Conclusions:

Complementary genetic and genomic approaches are useful for the identification of MASLD genes. Our data supportsVKORC1as a bona fide MASLD gene. We have established a functional genomic framework to study at scale putative novel MASLD genes from human genetic association studies.
An Occupational Health Literacy Intervention in Nursing Homes Improved Organizational Health Literacy—A Quasi-Experimental Stepped Wedge Cluster Trial
Authors: Larsen Anne Konring , Thygesen Lau Caspar , Nyvang Stilling Mia , Rasmussen Charlotte Diana Nørregaard , Osborne Richard H. , Jørgensen Marie Birk
Published: August 2024

Objective

This study examined the effectiveness of a workplace health literacy intervention on individual, interpersonal, and organizational health literacy.

Method

Using a quasi-experimental stepped wedge cluster design, we evaluated an intervention for 509 nursing home employees with two elements: 1) courses for employees and management on pain prevention, management, and communication and 2) structured dialogues between employees and supervisors, emphasizing pain prevention.

Results

One organizational health literacy item improved, with supervisors helping with pain prevention increasing by 0.42 points (95% CI 0.11;0.73). Positive trends were observed in supervisor actions when informed about pain (0.39 points, 95% CI −0.09;0.86), ease of finding workplace pain solutions (0.12 points, 95% CI −0.03;0.79), and employees having pain management information (0.44 points, 95% CI −0.03;0.92).

Conclusion

The intervention improved one organizational health literacy item, with positive trends in three other items.
Toxicant Exposures and Health Symptoms in Military Pesticide Applicators From the 1991 Gulf War
Authors: Krengel Maxine , Sullivan Kimberly , Zundel Clara G. , Keating Dylan , Orlinsky Leah , Bradford William , Stone Callie , Thompson Terri-Ann , Heeren Timothy , White Roberta F.
Published: August 2024

Objective

The chronic impact of acetylcholinesterase inhibitors and other toxicants on Gulf War (GW) veterans’ health symptoms is unclear.

Methods

Building on reports of adverse neuropsychological outcomes in GW pesticide applicators exposed to pesticides and pyridostigmine bromide, we now report on health symptoms in this group.

Results

In adjusted analyses, applicators with high exposures/impact to pesticides reported significantly more symptoms (18/34 symptoms) than applicators with lower exposures/impact and were more likely to meet modified Kansas and CDC Gulf War Illness criteria. The high pyridostigmine bromide exposure/impact group was 3 times more likely to report irregular heart rates. With regard to specific pesticide types, fly baits, pest strips, and delousers were the most associated with increased health symptom reporting.

Conclusions

These results suggest that GW veterans with high acetylcholinesterase inhibitor and organochlorine exposures are most at risk for chronic health symptoms.
Clinical features and surgical strategy of retroperitoneal liposarcoma involving the kidney capsule: a retrospective comparative cohort study
Authors: Li Yiyuan , Zhao Jichun , Huang Bin , Guo Qiang
Published: August 2024

Background:

Valid and generalizable data on the clinical features and surgical strategies for retroperitoneal liposarcoma (LPS) involving the kidney capsule remain scarce. This study aimed to investigate the clinical characteristics, morbidity, mortality, and long-term survival of patients with retroperitoneal LPS involving the kidney capsule.

Methods:

The authors analyzed a prospectively maintained database of patients who underwent surgical resection for retroperitoneal LPS between 2015 and 2020. The patients were categorized into kidney capsule or no kidney capsule groups based on the presence or absence of kidney capsule involvement. A kidney-sparing strategy for retroperitoneal LPS involving the kidney capsule was developed. The primary outcome measure was overall survival (OS). The cumulative event probability curve was estimated using the Kaplan–Meier, and differences between groups using the Log-Rank.

Results:

The study population consisted of 128 patients—54 with and 74 without kidney capsule involvement. Of these patients, 70 were female (54.7%) and 58 were male (45.3%), with a median age of 55. The median follow-up duration was 35 months. Postoperative morbidity, mortality, length of hospital stay, length of ICU stay, OS, and recurrence-free survival (RFS) did not differ significantly between the groups. Eleven patients developed postoperative acute kidney injury (AKI), and one patient required dialysis during the follow-up period. In multivariable logistic regression analysis, only nephrectomy was independently associated with postoperative AKI. Subgroup analysis of patients with kidney capsule involvement showed that nephrectomy did not improve OS or RFS but significantly decreased postoperative estimated glomerular filtration rate.

Conclusion:

Nephrectomy was associated with an increased risk of postoperative AKI after retroperitoneal LPS resection. A kidney-sparing strategy for retroperitoneal LPS involving the kidney capsule achieved optimal clinical outcomes.