bluuebunny/crossref_metadata_2025 huggingface dataset:
Cosmogenic Nuclide Tracking of Sediment Recycling From a Frontal Siwalik Range in the Northwestern Himalaya
Authors: Mandal Sanjay Kumar , Kapannusch René , Scherler Dirk , Barnes Jason B. , Insel Nadja , Densmore Alexander L.
Published: November 2023

The Himalayan orogen exports millions of tons of sediment annually to the Indo‐Gangetic foreland basin, derived from both hinterland and foreland fold‐thrust belts (FTB). Although erosion rates in the hinterland are well‐constrained, erosion rates in the foreland FTB and, by extension, the sediment flux have remained poorly constrained. Here, we quantified erosion rates and sediment flux from the Mohand Range in the northwestern Himalaya by modeling and measuring the cosmogenic radionuclide (CRN) 10Be and 26Al concentrations in modern fluvial sediments. Our model uses local geological and geophysical constraints and accounts for CRN inheritance and sediment recycling, which enables us to determine the relative contributions of the hinterland and foreland FTB sources to the CRN budget of the proximal foreland deposits. Our model predictions closely match measured concentrations for a crustal shortening rate across the Mohand Range of 8.0 ± 0.5 mm yr−1 (i.e., approximately 50% of the total shortening across the Himalaya at this longitude) since  Ma. This shortening implies a spatial gradient in erosion rates ranging from 0.42 ± 0.03 to 4.92 ± 0.34 mm yr−1, controlled by the geometry of the underlying structure. This erosion pattern corresponds to an annual sediment recycling of ∼2.0 megatons from the Mohand Range to the downstream Yamuna foreland. Converted to sediment fluxes per unit width along the Himalaya, the foreland FTB accounts for ∼21% ± 5% of the total flux entering the foreland. Because these sediments have lower 10Be concentrations than hinterland‐derived sediment, they would lead to ∼14% overestimation of 10Be‐derived erosion rates, based on Yamuna sediments in the proximal foreland.
Milankovitch Record From Middle Jurassic Platform Supports Moderate Coolhouse Glaciation
Authors: Husinec A. , Read J. F.
Published: November 2023

There are few documentations of far‐field effects of coolhouse glaciation and its signature preserved within Middle Jurassic carbonate platforms. Through outcrop logging and time series analysis we document the cyclostratigraphy of the upper Bajocian‐Bathonian interval of the Adriatic Platform, Croatia. The 200 m thick, ∼3.3 Myr duration cyclic platform record consists of peritidal carbonate parasequences (n = 109) with high‐energy grainstone‐rudstone bases fining up into micritic carbonate caps. There is little evidence of long‐term exposure near purported sequence boundaries, indicating the succession is conformable above the parasequence scale. Time series were constructed using Dunham rank and stratigraphic position, and parasequence thickness and stratigraphic position. A statistical estimation of accumulation rates using average spectral misfit (ASM) and correlation coefficient (COCO) methods that compare spectral peaks with an astronomical model at various sedimentation rates suggests that these rates ranged from 4.5 to 6 cm/kyr, which is compatible with long‐term rates based on thickness divided by duration. The time series analysis of rank series and cycle thickness series indicates long‐term obliquity modulation (∼1 Myr), short obliquity modulation (173 kyr), strong obliquity, and weak precession. The 173 kyr cycle is particularly evident in the cycle thickness series. The similarity of the spectra to the obliquity‐dominated Cenozoic coolhouse supports moderate southern hemisphere glaciation driving glacioeustatic sea level changes during the Middle Jurassic.
Harnessing synthetic biology for advancing RNA therapeutics and vaccine design
Authors: Pfeifer Blaine A. , Beitelshees Marie , Hill Andrew , Bassett Justin , Jones Charles H.
Published: November 2023

Recent global events have drawn into focus the diversity of options for combatting disease across a spectrum of prophylactic and therapeutic approaches. The recent success of the mRNA-based COVID-19 vaccines has paved the way for RNA-based treatments to revolutionize the pharmaceutical industry. However, historical treatment options are continuously updated and reimagined in the context of novel technical developments, such as those facilitated through the application of synthetic biology. When it comes to the development of genetic forms of therapies and vaccines, synthetic biology offers diverse tools and approaches to influence the content, dosage, and breadth of treatment with the prospect of economic advantage provided in time and cost benefits. This can be achieved by utilizing the broad tools within this discipline to enhance the functionality and efficacy of pharmaceutical agent sequences. This review will describe how synthetic biology principles can augment RNA-based treatments through optimizing not only the vaccine antigen, therapeutic construct, therapeutic activity, and delivery vector. The enhancement of RNA vaccine technology through implementing synthetic biology has the potential to shape the next generation of vaccines and therapeutics.
Psychological inoculation strategies to fight climate disinformation across 12 countries
Authors: Spampatti Tobia , Hahnel Ulf J. J. , Trutnevyte Evelina , Brosch Tobias
Published: November 2023

Decades after the scientific debate about the anthropogenic causes of climate change was settled, climate disinformation still challenges the scientific evidence in public discourse. Here we present a comprehensive theoretical framework of (anti)science belief formation and updating to account for the psychological factors that influence the acceptance or rejection of scientific messages. We experimentally investigated, across 12 countries (N = 6,816), the effectiveness of six inoculation strategies targeting these factors—scientific consensus, trust in scientists, transparent communication, moralization of climate action, accuracy and positive emotions—to fight real-world disinformation about climate science and mitigation actions. While exposure to disinformation had strong detrimental effects on participants’ climate change beliefs (δ = −0.16), affect towards climate mitigation action (δ = −0.33), ability to detect disinformation (δ = −0.14) and pro-environmental behaviour (δ = −0.24), we found almost no evidence for protective effects of the inoculations (all δ < 0.20). We discuss the implications of these findings and propose ways forward to fight climate disinformation.
Risk factors for templating mismatch of uncemented stems in bipolar hemiarthroplasty for femoral neck fracture
Authors: Kim Han Soul , Cho Sung Ha , Moon Dou Hyun , Kim Chul-Ho
Published: November 2023

Preoperative templating needs to be precise to optimize hip arthroplasty outcomes. Unexpected implant mismatches can occur despite meticulous planning. We investigated the risk factors for oversized and undersized stem mismatch during uncemented hemiarthroplasty using a double-tapered wedge rectangular stem for femoral neck fracture. Out of 154 consecutive patients who underwent hemiarthroplasty for femoral neck fracture, 104 patients were divided into three groups: (1) oversized (n = 17; 16.3%), (2) matched (n = 80; 76.9%), and (3) undersized stem group (n = 7; 6.7%). A smaller femoral head offset (odds ratio [OR] = 0.89, 95% confidence interval [95% CI] = 0.81–0.98, P = 0.017), smaller isthmus diameter (OR = 0.57, 95% CI = 0.35–0.92, P = 0.021), and smaller canal flare index (OR = 0.20, 95% CI = 0.04–0.98, P = 0.047) were significantly associated with oversized stem insertion, while older age (OR = 1.18, 95% CI = 1.01–1.39, P = 0.037) was associated with undersized stem insertion in logistic regression. In conclusion, when performing hemiarthroplasty for a femoral neck fracture with a double-tapered wedge rectangular stem, surgeons must pay close attention to proximal femoral geometry and patient age during preoperative planning to avoid stem mismatch.
An efficient hexadecimal network flow watermark method for tracking attack traffic
Authors: Cui Jun , Han Keya , Sha Lin , Liu Wei , Zhang Xiaofeng , Li Guangxu
Published: November 2023

Network flow watermark technology is a traffic marking technique that embeds watermark information into the characteristics of network flows to mark and trace attack flows generated by network attackers. However, with the development of network attack techniques, the time and number of packets required for network attacks have decreased. Existing network flow watermark technologies fail to balance watermark robustness and efficiency, resulting in poor practicality. To address this issue, this paper proposes an efficient hexadecimal network flow watermark method. The method introduces an efficient interval watermark algorithm and utilizes an interval synchronization algorithm to self-learn watermark parameters, thereby improving the encoding efficiency of the watermark. The design of watermark start and end markers ensures the practicality of network watermarks, enabling traceability and source attribution of attack flows in real network environments. The proposed method is experimentally tested using real network traffic, and the results demonstrate that even in the presence of a network jitter, the watermark detection success rate of this scheme remains above 95%. Compared to other network flow watermark schemes, the hexadecimal network flow watermark proposed in this paper achieves a 50% improvement in encoding and decoding efficiency while ensuring robustness. It also exhibits excellent resistance to network jitter, packet loss, and false packet insertion.
S-index periodicity detection based on multiple random spectral observations
Authors: Shen Yu-Fu
Published: November 2023

The solar magnetic activity cycle has a profound impact on our lives, yet its underlying causes remain elusive. While similar cycles have been observed in other stars, these results are scarce due to the significant challenge posed by the length of time required for observation. Continuous observation over an extended period is a luxury, making it difficult to gather large samples. However, multiple random observations can be made at a lower cost, and flexible time management enables non-professionals to become competent. In this study, we analyzed multiple random observations of the S-indices of several stars captured incidentally by the Large Sky Area Multi-Object Fiber Spectroscopic Telescope. Our findings reveal potential periodicity that could be associated with magnetic activity cycles. Notably, obtaining S-index is relatively less challenging, indicating the feasibility of developing dedicated commercial or charitable equipment for non-astronomers. A more extensive data is essential to establish a definitive correlation between S-index periodicity and magnetic activity cycles in stars, as well as to uncover additional magnetic activity cycles.
A responsive cascade drug delivery scaffold adapted to the therapeutic time window for peripheral nerve injury repair
Authors: Shan Yizhu , Xu Lingling , Cui Xi , Wang Engui , Jiang Fengying , Li Jiaxuan , Ouyang Han , Yin Tailang , Feng Hongqing , Luo Dan , Zhang Yan , Li Zhou
Published: November 2023

Schematic illustration of the structure and drug release process of a responsive cascade drug delivery scaffold (RCDDS) for peripheral nerve injury repair.
Solvent- and catalyst-dependent palladium-catalyzed switchable chemodivergent cascade cyclizations of trimethylenemethanes with ortho-formyl cinnamates
Authors: Liang Shuyuan , Tang Liangjian , Chen Ying , Huang Xueqiu , Wei Xueqin
Published: November 2023

A Pd-catalyzed chemodivergent cyclization strategy of TMM with formyl cinnamates by regulating solvents and cocatalysts is proposed, affording hexahydrocyclopenta[a]inden-8-ols, tetrahydro-2H-indeno[1,2-b]furans and aryl cyclopentenes in good yields.
Water stimulus-responsive room temperature afterglow materials with color tunability based on inorganic/organic H–G hybrid systems
Authors: Hou Shanshan , Yang Jing , Li Peng
Published: November 2023

We propose an effective strategy to construct inorganic/organic hybrid afterglow systems by introducing benzoic acid derivative into the inorganic BA matrix, which exhibit diverse color tunable and unusual water-stimulus response characteristic.
An Observational Study on React Native (RN) Questions on Stack Overflow (SO)
Authors: Albesher Luluh , Aldossari Razan , Alfayez Reem
Published: November 2023

Mobile applications are continuously increasing in prevalence. One of the main challenges in mobile application development is creating cross‐platform applications. To facilitate developing cross‐platform applications, the software engineering community created several solutions, one of which is React Native (RN), which is a popular cross‐platform framework. The software engineering literature demonstrated the effectiveness of Stack Overflow (SO) in providing real‐world perspectives on a variety of technical subjects. Therefore, this study aims to gain a better understanding of the stance of RN on SO. We identified and analyzed 131,620 SO RN‐related questions. Moreover, we observed how the interest toward RN on SO evolves over time. Additionally, we utilized Latent Dirichlet Allocation (LDA) to identify RN‐related topics that are discussed within the questions. Afterward, we utilized a number of proxy measures to estimate the popularity and difficulty of these topics. The results revealed that interest toward RN on SO was generally increasing. Moreover, RN‐related questions revolve around six topics, with the topics of layout and navigation being the most popular and the topic of iOS issues being the most difficult. Software engineering researchers, practitioners, educators, and RN contributors may find the results of this study beneficial in guiding their future RN efforts.
Application of biomass as clean energy in magnetized roasting of iron tailings
Authors: Wu Yongqiang , Jiang Lan , Fu Gaofeng , Wang Xueqin
Published: November 2023

Biomass, as a clean energy source, has great potential in reducing emissions and protecting the environment. This study investigates the influence of biomass as a reducing agent on the magnetization roasting process of iron tailings, and utilizes methods such as TG, XRD, VSM to analyze the thermal decomposition of biomass, phase transition and magnetic transformation of iron tailings, in order to explain the mechanism of iron recovery through magnetization roasting. The results show that at a roasting temperature of 700 °C, roasting time of 15 min, and 10% of the poplar sawdust (PS) used, the iron grade of the concentrate obtained through weak magnetic separation is 65.2%, with iron recovery rate of 96%. The magnetic saturation intensity increases from 0.107 emu/g to 59.28 emu/g. The study demonstrates that the combination of biomass magnetization roasting and weak magnetic separation can effectively recover iron from low-grade iron tailings.
Hemp seed’s (Cannabis Sativa L) nutritional potential for the development of snack functional foods
Authors: Presa-Lombardi Joaquín , García Florencia , Gutierrez-Barrutia Maria Belen , Cozzano Sonia
Published: November 2023

Current trends in the snack bar market emphasize the incorporation of alternative protein sources while simultaneously addressing the criteria of being both “high in fiber” and “high in protein”. Hemp seed, the seed of non-psychoactive Cannabis Sativa L, stands out as a significant source of protein, dietary fiber, minerals, and unsaturated fats. This study aims to explore the nutritional potential of hemp seed to develop a functional food that responds to the needs of such a market highly demanding of plant-based alternatives. Along with seeds protein nutritional quality analysis and lipid profile characterization, three snack bar samples containing hemp seed as a functional ingredient were formulated, according to nutritional claims regulations. Two products with 20% hemp met sensory acceptability criteria. This study suggests hemp seed as a potential functional food ingredient to meet the demand for plant-based alternatives, offering quality protein, digestive benefits due to its high fiber content and an optimal omega 6 to omega 3 ratio. However, there appears to be an upper limit for hemp seed in product formulations due to sensory issues. This study showed that adding more than 40% to a snack bar significantly reduced consumer acceptability and purchase intent.
Design study of the collection optics for Polarimetric Thomson Scattering on ITER
Authors: Den Hartog D.J. , Thomas M.A.
Published: November 2023

The ITER Core Plasma Thomson Scattering (CPTS) system is the primary diagnostic for the electron temperature (Te
) and electron density (ne
) profiles. For high performance ITER operating scenarios in which core Te
 > 20 keV, the conventional spectral CPTS will not provide measurement accuracy sufficient for advanced machine control. Addition of polarimetric measurement capability to the CPTS diagnostic is projected to increase measurement accuracy in high temperature/low density plasmas to required levels. To determine the feasibility of Polarimetric TS implementation on ITER, the polarization characteristics of the CPTS scattered light collection system have been modeled as part of a conceptual design study. When linearly polarized light is propagated through the CPTS collections optics, polarization is rotated and ellipticized. This characteristic of the ITER collection optical system complicates separation and analysis of the depolarized component of the Thomson scattered light that is produced at high Te
. To address this challenge, a custom waveplate and polarizing beamsplitter should be mounted before the final lens in the CPTS collection optical system. Additionally, polarization performance should be one of the criteria by which materials and coatings are selected for the CPTS collection optical system.
Highly energy efficient housing can reduce peak load and increase safety under beneficial electrification
Authors: Maxim Alexandra , Grubert Emily
Published: November 2023

Climate change is driving urgent investments in decarbonization. One core decarbonization strategy is to electrify energy services that currently directly use fossil fuels, because electricity can be generated from zero greenhouse gas energy resources. Shifting fossil-based services to electricity, however, requires a major expansion of electricity supply and increases dependence on electricity for critical services. Home heating is a particular challenge, especially in very cold climates. Unserved heating loads can be fatal. Electrified heating is expected to drive peak loads (and thus overall grid size) due to high coincident and nondeferrable loads. This study shows that highly efficient housing presents an opportunity to simultaneously protect people and structurally reduce peak load, reducing the need for electricity supply infrastructure while increasing people’s resilience to weather extremes. This study uses seven building efficiency scenarios from the National Renewable Energy Laboratory’s End Use Saving Shapes to investigate the impact of residential building efficiency on grid size in 2050, using the example of Pierre, South Dakota as a very cold weather location that might also experience substantial new housing demand due to climate-induced human mobility. We find that the deepest efficiency electrification scenario we investigate reduces peak demand by about half relative to low-efficiency electrification. Costs of about $3900/kilowatt (kW) peak load reduction are competitive with the cost of new decarbonized supplies capable of meeting peak load, though building efficiency costs are usually privatized while supply expansion costs are distributed across ratepayers. Decarbonization scenarios suggest the US grid might need to expand by a factor of 5–8 in the next 25 years: extremely rapid growth will be needed regardless, but targets might not be reachable with inefficient end users. Residential building efficiency presents an urgent opportunity to reduce peak demand and provide safer and more resilient housing.
Insights from exact social contagion dynamics on networks with higher-order structures
Authors: Kiss István Z , Iacopini Iacopo , Simon Péter L , Georgiou Nicos
Published: November 2023

Recently, there has been an increasing interest in studying dynamical processes on networks exhibiting higher-order structures, such as simplicial complexes, where the dynamics acts above and beyond dyadic interactions. Using simulations or heuristically derived epidemic spreading models, it was shown that new phenomena can emerge, such as bi-stability/multistability. Here, we show that such new emerging phenomena do not require complex contact patterns, such as community structures, but naturally result from the higher-order contagion mechanisms. We show this by deriving an exact higher-order Susceptible-Infected-Susceptible model and its limiting mean-field equivalent for fully connected simplicial complexes. Going beyond previous results, we also give the global bifurcation picture for networks with 3- and 4-body interactions, with the latter allowing for two non-trivial stable endemic steady states. Differently from previous approaches, we are able to study systems featuring interactions of arbitrary order. In addition, we characterize the contributions from higher-order infections to the endemic equilibrium as perturbations of the pairwise baseline, finding that these diminish as the pairwise rate of infection increases. Our approach represents a first step towards a principled understanding of higher-order contagion processes beyond triads and opens up further directions for analytical investigations.
Epigenetic changes induced by pathogenic Chlamydia spp
Authors: Stein Richard A , Thompson Lily M
Published: November 2023

Chlamydia trachomatis, C. pneumoniae, and C. psittaci, the three Chlamydia species known to cause human disease, have been collectively linked to several pathologies, including conjunctivitis, trachoma, respiratory disease, acute and chronic urogenital infections and their complications, and psittacosis. In vitro, animal, and human studies also established additional correlations, such as between C. pneumoniae and atherosclerosis and between C. trachomatis and ovarian cancer. As part of their survival and pathogenesis strategies as obligate intracellular bacteria, Chlamydia spp. modulate all three major types of epigenetic changes, which include deoxyribonucleic acid (DNA) methylation, histone post-translational modifications, and microRNA-mediated gene silencing. Some of these epigenetic changes may be implicated in key aspects of pathogenesis, such as the ability of the Chlamydia spp. to induce epithelial-to-mesenchymal transition, interfere with DNA damage repair, suppress cholesterol efflux from infected macrophages, act as a co-factor in human papillomavirus (HPV)-mediated cervical cancer, prevent apoptosis, and preserve the integrity of mitochondrial networks in infected host cells. A better understanding of the individual and collective contribution of epigenetic changes to pathogenesis will enhance our knowledge about the biology of Chlamydia spp. and facilitate the development of novel therapies and biomarkers. Pathogenic Chlamydia spp. contribute to epigenetically-mediated gene expression changes in host cells by multiple mechanisms.
Young people’s attitudes to Pre-Exposure Prophylaxis for HIV Prevention – a qualitative exploratory study
Authors: Rathbone A P , Cartwright N , Noble R , Cumming L , Budaiova K , Ashton M , Foster J , Payne B , Duncan S
Published: November 2023

Introduction

Young people aged 18-24 years old are a key demographic target for eliminating human immunodeficiency virus (HIV) transmission globally. Pre-exposure prophylaxis (PrEP), a prevention medication which reduces HIV transmission, is emerging as a key tool to reduce HIV transmission. Despite largely good uptake by gay and bisexual men who have sex with men, hesitancy to use PrEP has been observed in other socio-cultural groups, such as young people, heterosexuals, people from ethnic minority backgrounds and females.

Aim

The aim of this study was to explore young peoples’ perceptions and attitudes to using PrEP.

Methods

A convenience sample of young people were recruited from England aged between 18 and 24 using a social media invitation posted by two authors which include details about the study with a registration link. Data was collected using semi-structured one-to-one interviews with graphic elicitation about current experiences of HIV care, awareness of using PrEP and decision making about accessing PrEP. Thematic analysis was used to identify codes and themes to describe participants’ experiences. Institutional ethical approval was obtained.

Results

Twenty-four young people took part. The sample was 58% female, 100% cisgendered, 54% had or were completing undergraduate study, 58% were straight, 58% had previously had a HIV test, 17% had previously used PrEP and a broad range of ethnicity were included. Key findings found young people had good levels of knowledge about HIV but had a poor understanding of using PrEP. In this information vacuum, negative stigma and stereotypes about HIV were transferred to using PrEP, which were reinforced by information on social media, television, and film - such as an association between using PrEP and being a promiscuous, white, gay males. In addition, young people from ethnic ethnicity communities appeared to have particularly negative attitudes to PrEP use, compared to ethnic majority counterparts. This meant the young people in our study were unable to make decisions about when to access and use PrEP.

Discussion/Conclusion

The findings indicate an information vacuum for young people regarding PrEP. A strength of the study is that theoretical data saturation was reached. A limitation of the study is that participants were all cisgendered and therefore the experiences of young trans people were not accounted for. Further work is needed to explore what information young people need, when and how this can be delivered to support informed decision-making about using PrEP. Pharmacists have a key role in supporting sexual health and further work should explore community pharmacies readiness to provide this information to young people.
Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tubercle Osteotomy in Carefully Selected Patients Results in a 5% Revision Rate: A Preliminary Analysis
Authors: Perkins Crystal A. , Egger Anthony C. , Busch Michael T. , Murata Asahi , Willimon Samuel C.
Published: November 2023

Purpose:

The purpose was to assess the outcomes of medial patellofemoral ligament (MPFL) allograft reconstruction with or without tibial tubercle osteotomy (TTO) in adolescents, with a focus on evaluating demographic and imaging characteristics on outcomes.

Methods:

A single-institution retrospective study was performed of patients ages 12 to 19 years who underwent MPFL reconstruction +/− TTO for the treatment of lateral patellar instability. Demographic, clinical, surgical, and postoperative information was collected. All x-ray and magnetic resonance imaging measurements were completed independently by 2 surgeons. Patients were contacted to complete patient-reported outcomes at a minimum of 2 years following surgery. The primary outcome measure was recurrent instability resulting in revision surgery.

Results:

Seventy-eight knees in 74 patients, with a median age of 15.3 years (interquartile range: 14.4, 16.1), were included. Forty-five knees underwent isolated MPFL reconstruction and 33 knees had a combined MPFL + TTO. The knees that underwent MPFL + TTO had significantly greater tibial tubercle-trochlear groove distance (19.0 mm vs. 15.4 mm, P=0.015) and patellar tendon-lateral trochlear ridge distance (10.9 mm vs. 5.9 mm, P=0.018) than the knees treated with isolated MPFL reconstruction. Four knees (5.1%) underwent revision stabilization surgery, including 3 knees in the MPFL cohort (6.7%) and 1 knee in the MPFL + TTO cohort (3.0%). The rate of failure between the MPFL and MPFL + TTO knees was not significantly different, P=0.634. There were no differences in age, sex, body mass index, number of dislocations, or any imaging characteristics in patients who underwent revision versus those who did not. Patient-reported outcomes were collected on 50 knees at a median of 36 months (interquartile range: 24, 54) after surgery, and no differences were noted between cohorts.

Conclusions:

Patellar stabilization surgery, including MPFL reconstruction and TTO in carefully selected patients, had excellent revision-free outcomes in 95% of this adolescent cohort. In this case series, those patients whose treatment included TTO had greater tibial tubercle-trochlear groove and patellar tendon-lateral trochlear ridge as compared to the isolated MPFL cohort. Despite previous literature suggesting demographic and imaging characteristics as risks for recurrent instability, we identified no characteristics within these two distinct surgical treatment groups to be predictive of the need for revision stabilization, regardless of the treatment group.

Level of Evidence:

Level III—retrospective comparison study
Definition, prediction, prevention and management of patients with severe ischemic stroke and large infarction
Authors: Hua Xing , Liu Ming , Wu Simiao
Published: November 2023

Severe ischemic stroke carries a high rate of disability and death. The severity of stroke is often assessed by the degree of neurological deficits or the extent of brain infarct, defined as severe stroke and large infarction, respectively. Critically severe stroke is a life-threatening condition that requires neurocritical care or neurosurgical intervention, which includes stroke with malignant brain edema, a leading cause of death during the acute phase, and stroke with severe complications of other vital systems. Early prediction of high-risk patients with critically severe stroke would inform early prevention and treatment to interrupt the malignant course to fatal status. Selected patients with severe stroke could benefit from intravenous thrombolysis and endovascular treatment in improving functional outcome. There is insufficient evidence to inform dual antiplatelet therapy and the timing of anticoagulation initiation after severe stroke. Decompressive hemicraniectomy (DHC) <48 h improves survival in patients aged <60 years with large hemispheric infarction. Studies are ongoing to provide evidence to inform more precise prediction of malignant brain edema, optimal indications for acute reperfusion therapies and neurosurgery, and the individualized management of complications and secondary prevention. We present an evidence-based review for severe ischemic stroke, with the aims of proposing operational definitions, emphasizing the importance of early prediction and prevention of the evolution to critically severe status, summarizing specialized treatment for severe stroke, and proposing directions for future research.
Reasons, safety and efficacy analysis for conversion of HAART to TAF/FTC/BIC among HIV-infected patients
Authors: Xiao Jiang , Gao Guiju , Ding Yi , Li Jialu , Gao Chengyu , Xu Qiuhua , Wu Liang , Liang Hongyuan , Ni Liang , Wang Fang , Duan Yujiao , Yang Di , Zhao Hongxin
Published: November 2023

Background:

This study aimed to determine the reasons for conversion and elucidate the safety and efficacy of transition to tenofovir alafenamide/emtricitabine/bictegravir sodium (TAF/FTC/BIC) in highly active antiretroviral therapy (HAART)-experienced HIV-infected patients in real-world settings.

Methods:

We conducted a retrospective cohort study. The treatment conversion rationales, safety, and effectiveness in 1684 HIV-infected patients with previous HAART experience who switched to TAF/FTC/BIC were evaluated at Beijing Ditan Hospital from September 2021 to Auguest 2022.

Results:

Regimen simplification (990/1684, 58.79%) was the most common reason for switching, followed by osteoporosis or osteopenia (375/1684, 22.27%), liver dysfunction (231/1684, 13.72%), decline in tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat (TAF/FTC/EVG/c) with food restriction (215/1684, 12.77%), virological failure (116/1684, 6.89%), and renal dysfunction (90/1684, 5.34%). In patients receiving non-nucleotide reverse transcriptase inhibitors (NNRTI)-containing regimens, lipid panel changes 1 year after switching indicated a difference of 3.27 ± 1.10 mmol/L vs. 3.40 ± 1.59 mmol/L in triglyceride (P = 0.014), 4.82 ± 0.74 mmol/L vs. 4.88 ± 0.72 mmol/L in total cholesterol (P = 0.038), 3.09 ± 0.70 mmol/L vs. 3.18 ± 0.66 mmol/L in low-density lipoprotein (P <0.001), and 0.99 ± 0.11 mmol/L vs. 0.95 ± 0.10 mmol/L in high-density lipoprotein (P <0.001). Conversely, among patients receiving booster-containing regimens, including TAF/FTC/EVG/c and lopinavir/ritonavir (LPV/r), lipid panel changes presented decreased trends. We also observed an improved trend in viral load suppression, and alanine transaminase (ALT), aspartate transaminase (AST), estimated glomerular filtration rate (eGFR), and serum creatinine levels after the transition (P <0.001).

Conclusion:

The transition to TAF/FTC/BIC demonstrated good treatment potency. Furthermore, this study elucidates the motivations behind the adoption of TAF/FTC/BIC in real-world scenarios, providing clinical evidence supporting the stable conversion to TAF/FTC/BIC for HAART-experienced patients.
Cardiovascular Rehabilitation With a WCD—Data From the CR3 Study (Cardiac Rehab Retrospective Review)
Authors: Rohrer Ursula , Reischl Anja , Manninger Martin , Binder Ronald K. , Fiedler Lukas , Gruska Michael , Altenberger Johann , Dorr Andreas , Steinwender Clemens , Stuehlinger Markus , Wonisch Manfred , Zirngast Birgit , Zweiker David , Zirlik Andreas , Scherr Daniel
Published: November 2023

Purpose:

Patients at risk for sudden cardiac death may temporarily need a wearable cardioverter-defibrillator (WCD). Exercise-based cardiac rehabilitation (CR) has a class I recommendation in patients with cardiac disease. The aim of this study was to evaluate the safety and feasibility of undergoing CR with a WCD.

Methods:

We performed a retrospective analysis of all patients with a WCD who completed a CR in Austria (2010-2020).

Results:

Patients (n = 55, 60 ± 11 yr, 16% female) with a median baseline left ventricular ejection fraction (LVEF) of 36 (30, 41)% at the start of CR showed a daily WCD wearing duration of 23.4 (22, 24) hr. There were 2848 (8 [1, 26]/patient) automatic alarms and 340 (3 [1, 7]/patient) manual alarms generated. No shocks were delivered by the WCD during the CR period. One patient had recurrent hemodynamically tolerated ventricular tachycardias that were controlled with antiarrhythmic drugs.

No severe WCD-associated adverse events occurred during the CR stay of a median 28 (28, 28) d. The fabric garment and the device setting needed to be adjusted in two patients to diminish inappropriate automatic alarms. Left ventricular ejection fraction after CR increased significantly to 42 (30, 44)% (P < .001). Wearable cardioverter-defibrillator therapy was stopped due to LVEF restitution in 53% of patients. In 36% of patients an implantable cardioverter-defibrillator was implanted, 6% had LVEF improvement after coronary revascularization, one patient received a heart transplantation (2%), two patients discontinued WCD treatment at their own request (4%).

Conclusion:

Completing CR is feasible and safe for WCD patients and may contribute positively to the restitution of cardiac function.
Relationship Between Extreme Pain Phenotypes and Psychosocial Outcomes in Persons With Chronic Pain Following Traumatic Brain Injury: A NIDILRR and VA TBI Model Systems Collaborative Project
Authors: Ketchum Jessica M. , Hoffman Jeanne M. , Agtarap Stephanie , Hammond Flora M. , Martin Aaron M. , Walker William C. , Zafonte Ross , Harrison-Felix Cynthia , Nakase-Richardson Risa
Published: November 2023

Objective:

To examine the relationship between extreme pain phenotypes (interference and improvement) and psychosocial outcomes among those with chronic pain after traumatic brain injury (TBI).

Setting:

Community.

Participants:

In total, 1762 TBI Model Systems (TBIMS) participants 1 to 30 years postinjury reporting chronic pain.

Design:

Multisite, cross-sectional, observational cohort study.

Primary Measure(s):

Life satisfaction, posttraumatic stress, depression and anxiety symptoms, sleep and participation, the Brief Pain Inventory (BPI) interference scale, and the Patient's Global Impression of Change (PGIC).

Results:

Persons in the extreme high interference phenotype (vs extreme low interference phenotype) and/or extreme no change phenotype (vs extreme improvement phenotype) had poorer psychosocial outcomes, with extreme pain interference phenotypes having a larger effect on outcomes than extreme perceived improvement phenotypes. After controlling for covariates, large effect sizes (ES) related to pain interference were observed for posttraumatic stress symptoms (ES = −1.14), sleep quality (ES = −1.10), depression (ES = −1.08), anxiety (ES = −0.82), and life satisfaction (ES = 0.76); effect sizes for participation outcomes, although significant, were relatively small (ES = 0.21-0.36). Effect sizes related to perceived improvement were small for life satisfaction (ES = 0.20) and participation (ES = 0.16-0.21) outcomes. Pain intensity was identified as a meaningful confounding factor of the relationships between extreme phenotypes and posttraumatic stress, depression, anxiety, and sleep quality.

Conclusions:

Examination of extreme phenotypes provides important insights into the experience of individuals living with chronic pain and TBI. Results suggest that the relationships among a variety of characteristics of the person, their experience with pain, and treatment of pain are complex. Further research is needed to better understand these complex relationships and how differences in pain interference and perceived improvement from treatment can assist in assessment and treatment of chronic pain after TBI.
Exercising More Than 150 min/wk After Concussion Is Associated With Sleep Quality Improvements
Authors: Howell David R. , Wingerson Mathew J. , Smulligan Katherine L. , Magliato Samantha , Simon Stacey , Wilson Julie C.
Published: November 2023

Objective:

To examine whether a high volume of aerobic exercise after concussion (>150 min/wk) is associated with improved sleep quality over a 1-month period. We hypothesized that more than 150 min/wk of exercise would be associated with improved sleep quality across concussion recovery.

Design:

Prospective cohort observational study.

Setting:

Sports medicine clinic.

Participants:

Adolescents initially tested 8.4 ± 3.5 (range, 2-18) days postconcussion who returned for a follow-up assessment 34.3 ± 7.7 (range: 20-49) days postconcussion.

Main Outcome Measures:

Participants completed the Pittsburgh Sleep Quality Index and the Post-Concussion Symptom Inventory. No specific exercise or sleep recommendations were given beyond what their treating physician provided. Between study visits, participants recorded exercise performed via wrist-worn actigraphy. We calculated average exercise minutes per week and grouped participants as those who exercised more than 150 min/wk versus those who exercised 150 min/wk or less.

Results:

Thirty-six adolescents participated. Fifteen (42%) recorded more than 150 min/wk of aerobic exercise (age = 14.0 ± 1.7 years; 47% female; mean = 5.6 ± 1.2 d/wk of exercise; mean = 49.2 ± 17.5 min/session), and 21 recorded 150 min/wk or less of aerobic exercise (age = 15.0 ± 1.9 years; 76% female; mean = 2.7 ± 1.6 d/wk of exercise; mean = 30.2 ± 7.8 min/session). There were no significant group differences in the proportion of those who self-reported beginning physical activity prior to enrollment (47% vs 33%; P = .42) or for initial sleep quality rating (8.0 ± 3.7 vs 8.6 ± 4.1; P = .67) or initial concussion symptom severity rating (34.9 ± 28.0 vs 42.6 ± 25.9; P = .40). The group that exercised more than 150 min/wk between visits demonstrated significantly greater median PSQI rating improvements than those who exercised 150 min/wk or less, with a large effect size noted (median change [interquartile range] = 5 [3, 7] vs 1 [0, 4]; P = .008; Cohen d = 0.96).

Conclusion:

Current recommendations suggest that subsymptom aerobic exercise can be beneficial after concussion. Our findings indicate that an exercise volume of more than 150 min/wk led to greater sleep quality improvements than those who exercised below this level.
HeartWare Left Ventricular Assist Device Exercise Hemodynamics With Speed Adjustment Based on Left Ventricular Filling Pressures
Authors: Ali Omaima , Arnold Amy C. , Cysyk Joshua , Boehmer John , Zhu Junjia , Sinoway Lawrence I. , Eisen Howard , Weiss William
Published: November 2023

Functional capacity remains limited in heart failure patients with left ventricular assist devices (LVADs) due to fixed pump speed and inability to offload the left ventricle adequately. We hypothesized that manually adjusting LVAD speed during exercise based on pulmonary capillary wedge pressures would increase total cardiac output and maximal oxygen consumption. Two participants with a HeartWare LVAD underwent an invasive ramp study at rest followed by an invasive cardiopulmonary stress test exercising in two randomized phases: fixed speed and adjusted speed. In the latter phase, speed was adjusted every 1 minute during exercise at ±20 rpm/1 mm Hg change from baseline pulmonary capillary wedge pressure. There was no difference in maximal oxygen consumption between the two phases, with a modest increase in total cardiac output during speed adjustment. Filling pressures were initially controlled during speed adjustment until speed was capped at 4,000 rpm, at which point filling pressures increased. Blood pressure was variable. The pressure across the head of the pump (ΔP) was higher with speed adjustment. Contrary to our hypothesis, LVAD speed adjustment during exercise did not improve total cardiac output and functional capacity. This variable response may be attributed to the native cardiac reserve and baroreceptor response; however, additional studies are needed.
Contemporary Outcomes of Children With Acute Fulminant Myocarditis Supported With Peripheral Extracorporeal Membrane Oxygenation
Authors: Kobayashi Ryan L. , Przybylski Robert , Gauvreau Kimberlee , Esteso Paul , Nathan Meena , Fynn-Thompson Francis , Teele Sarah A.
Published: November 2023

Despite extracorporeal membrane oxygenation (ECMO) utilization in nearly 20% of cases, there are limited data in children with acute fulminant myocarditis (AFM) requiring ECMO. Herein we identify risk factors for death or heart transplant (HT) in children with AFM supported with ECMO, describe our experience with left atrial (LA) decompression, and depict long-term outcomes of survivors. We performed a retrospective cohort of patients <18 years with AFM (≤14 days of symptoms, rapid cardiogenic shock, and normal left ventricular [LV] size on presentation) supported with ECMO admitted to a single intensive care unit from 1997 to 2021. Among 28 patients (median age 9 years), 21 (75%) survived to discharge without HT. Patients were supported on ECMO for a median of 6 days. Three patients were bridged to HT with durable ventricular assist devices (VAD). Four patients died, two of whom were supported with VAD. At presentation, seven (25%) patients had high grade or complete atrioventricular block and eight (29%) had ventricular tachycardia. Before ECMO cannulation, 21 (75%) patients received CPR. The death/HT group had higher peak troponin levels (12.5 vs. 1.0 ng/ml, p = 0.02) and initial mean LA or pulmonary capillary wedge pressure (27 vs. 18 mm Hg, p = 0.03). Left atrial decompression was performed in 22 patients (79%). Twenty-two (79%) had acute myocarditis on endomyocardial biopsy. Among transplant-free survivors, 18 (86%) had normalization in LV function (median 7 days); the remaining three patients had persistent mild LV dysfunction at last follow-up (median 842 days). Transplant-free survival of pediatric patients with AFM supported on ECMO was 75% and associated with lower initial LA pressure and lower peak troponin. Recovery in ventricular function among survivors was rapid and durable.
Emerging phenotypes in kidney transplant rejection
Authors: Mengel Michael , Adam Benjamin A.
Published: November 2023

Purpose of review

This review focuses on more recently emerging rejection phenotypes in the context of time post transplantation and the resulting differential diagnostic challenges. It also discusses how novel ancillary diagnostic tools can potentially increase the accuracy of biopsy-based rejection diagnosis.

Recent findings

With advances in reducing immunological risk at transplantation and improved immunosuppression treatment renal allograft survival improved. However, allograft rejection remains a major challenge and represent a frequent course for allograft failure. With prolonged allograft survival, novel phenotypes of rejection are emerging, which can show complex overlap and transition between cellular and antibody-mediated rejection mechanisms as well as mixtures of acute/active and chronic diseases. With the emerging complexity in rejection phenotypes, it is crucial to achieve diagnostic accuracy in the individual patient.

The prospective validation and adoption of novel molecular and computational diagnostic tools into well defined and appropriate clinical context of uses will improve our ability to accurately diagnose, stage, and grade allograft rejection.
Psychosocial Adjustment Experiences Among Nasopharyngeal Carcinoma Survivors
Authors: Jiang Jie , Yan Ming-Hui , Fan Yu-Ying , Zhang Jun-E
Published: November 2023

Background

Nasopharyngeal carcinoma (NPC) has serious effects on the daily lives and psychosocial adjustment of survivors. In particular, psychosocial problems are a prominent concern.

Objective

The aim of this study was to understand the lived experiences of NPC survivors regarding psychosocial adjustment.

Methods

A qualitative design using individual semistructured interviews was conducted with 20 NPC survivors. Each participant was asked open-ended questions about their lived experience with psychosocial adjustment. The data were then subjected to thematic analysis.

Results

The following 4 themes, which had subthemes, were identified from the data: (1) grappling with discomforts (symptoms distress of late toxicities, impaired body image, and returning-to-work restrictions), (2) struggling with uncertainty (disease attribution with self-blame, contradictory rehabilitation information, fear of cancer recurrence, and distance from medical staff), (3) changing social patterns (special favors, social isolation, and social discrimination), and (4) cultivating positive change (healthy lifestyle and positive mindset).

Conclusions

Nasopharyngeal carcinoma survivors experience many obstacles, as well as positive changes, during psychosocial adjustment. This study highlights the pressing need to consider NPC survivors’ concerns about their psychosocial adjustment.

Implications for Practice

Medical staff should provide NPC survivors with sufficient rehabilitation information to help them deal with possible late toxicities and mitigate their uncertainty and misunderstanding. Effective public education measures are needed to address misunderstandings about cancer in Chinese cultural settings.