bluuebunny/crossref_metadata_2025 huggingface dataset:
The three-dimensional structure of the EBV genome plays a crucial role in regulating viral gene expression in EBVaGC
Authors: Maestri Davide , Napoletani Giorgia , Kossenkov Andrew , Preston-Alp Sarah , Caruso Lisa B , Tempera Italo
Published: October 2023

Epstein–Barr virus (EBV) establishes lifelong asymptomatic infection by replication of its chromatinized episomes with the host genome. EBV exhibits different latency-associated transcriptional repertoires, each with distinct three-dimensional structures. CTCF, Cohesin and PARP1 are involved in maintaining viral latency and establishing episome architecture. Epstein–Barr virus-associated gastric cancer (EBVaGC) represents 1.3–30.9% of all gastric cancers globally. EBV-positive gastric cancers exhibit an intermediate viral transcription profile known as ‘Latency II’, expressing specific viral genes and noncoding RNAs. In this study, we investigated the impact of PARP1 inhibition on CTCF/Cohesin binding in Type II latency. We observed destabilization of the binding of both factors, leading to a disrupted three-dimensional architecture of the episomes and an altered viral gene expression. Despite sharing the same CTCF binding profile, Type I, II and III latencies exhibit different 3D structures that correlate with variations in viral gene expression. Additionally, our analysis of H3K27ac-enriched interactions revealed differences between Type II latency episomes and a link to cellular transformation through docking of the EBV genome at specific sites of the Human genome, thus promoting oncogene expression. Overall, this work provides insights into the role of PARP1 in maintaining active latency and novel mechanisms of EBV-induced cellular transformation.
Paralysed Governments: How Political Constraints Elicit Cabinet Termination
Authors: Improta Marco
Published: October 2023

A crucial feature of the democratic life cycle, government stability, has prompted the interest of many scholars across the globe. As a result, research on this matter has established itself as one of the most developed agendas in comparative politics. However, despite the abundance of studies on the drivers of government stability, the ruling parties’ capacity to promote policy change when in government remains unexplored. This study aims to fill this lacuna by testing the effect of political constraints on the premature end of cabinets. It does so by leveraging an original longitudinal multilevel dataset comprising information on 429 governments in 20 Western European countries on which event history analyses are performed. The study’s findings show that high political constraints significantly increase the risk of cabinet termination, indicating that seeking to survive in office without governing can be an impassable road for ruling parties.
Association between serum interleukin-17 levels and ectopic bone formation in OPLL patients with DISH
Authors: He Zhongyuan , Tung Nguyen Tran Canh , Yahara Yasuhito , Makino Hiroto , Yasuda Taketoshi , Seki Shoji , Suzuki Kayo , Futakawa Hayato , Kamei Katsuhiko , Kawaguchi Yoshiharu
Published: October 2023

Objective

To investigate the relationship between the severity and morphology of heterotopic ossification in the spinal ligaments including sacroiliac (SI) joints, and serum interleukin-17 (IL-17) levels in patients with ossification of the posterior longitudinal ligament (OPLL) with or without diffuse idiopathic skeletal hyperostosis (DISH), as well as a non-OPLL group.

Methods

A total of 103 patients with OPLL [DISH (−), n = 50; DISH (+), n = 53] and 53 age- and gender-matched controls were included. The serum levels of IL-17 were analysed, and the severity of ectopic ossification and the morphology of ectopic bone formation were evaluated. The SI joint morphological variations were categorized into four types.

Results

No significant differences were found in serum IL-17 levels between the OPLL and control groups. However, the DISH (+) group showed higher IL-17 levels than the DISH (−) group, especially in female patients (P = 0.003). Additionally, IL-17 levels were positively correlated with the number of flat vertebral units, this being one of the characteristic DISH ossification types (R2 = 0.199, P = 0.012). IL-17 levels in the type showing bridging osteophyte and bone fusion were significantly higher in the DISH (+) group than in the DISH (−) group.

Conclusion

The morphological characteristics of paravertebral bone formation in the entire spine, including the SI joint, are likely associated with serum IL-17 levels in OPLL. These findings provide pathological and serological evidence of local inflammation contributing to paravertebral ossification of OPLL patients.
Public perception of scientific advisory bodies: the case of France’s Covid-19 Scientific Council
Authors: Schultz Émilien , Ward Jeremy K , Atlani-Duault Laëtitia
Published: October 2023

During the Covid-19 pandemic, many governments have resorted to scientific advisory bodies to aid in public health decision-making. What then has been the public’s perception of those new structures of scientific advice? In this article, we draw on a survey conducted in November 2020 among a representative sample of the French adult population (n = 1,004) designed specifically to explore public perceptions of the dedicated Covid-19 Scientific Council created in March 2020 and of scientific advice in general. After only 8 months, three-quarters of French people said they had heard of it, but only a quarter had a positive opinion about its usefulness. Despite the diversity of perceptions of what scientific advice is and should be, it appeared that scientific advice bodies are perceived as useful mainly by a public already largely supportive of the delegation of the management of public life to the government and public institutions.
Foxk1 stimulates adipogenic differentiation via a peroxisome proliferator‐activated receptor gamma 2‐dependent mechanism
Authors: Zhang Shan , You Yanru , Li Yachong , Yuan Hairui , Zhou Jie , Tian Lijie , Liu Ying , Wang Baoli , Zhu Endong
Published: October 2023

Adipogenesis is a tightly regulated process, and its dysfunction has been linked to metabolic disorders such as obesity. Forkhead box k1 (Foxk1) is known to play a role in the differentiation of myogenic precursor cells and tumorigenesis of different types of cancers; however, it is not clear whether and how it influences adipocyte differentiation. Here, we found that Foxk1 was induced in mouse primary bone marrow stromal cells (BMSCs) and established mesenchymal progenitor/stromal cell lines C3H/10T1/2 and ST2 after adipogenic treatment. In addition, obese db/db mice have higher Foxk1 expression in inguinal white adipose tissue than nonobese db/m mice. Foxk1 overexpression promoted adipogenic differentiation of C3H/10T1/2, ST2 cells and BMSCs, along with the enhanced expression of CCAAT/enhancer binding protein‐α, peroxisome proliferator‐activated receptor γ (Pparγ), and fatty acid binding protein 4. Moreover, Foxk1 overexpression enhanced the expression levels of lipogenic factors during adipogenic differentiation in both C3H/10T1/2 cells and BMSCs. Conversely, Foxk1 silencing impaired these cells from fully differentiating. Furthermore, adipogenic stimulation induced the nuclear translocation of Foxk1, which depended on the mTOR and PI3‐kinase signaling pathways. Subsequently, Foxk1 is directly bound to the Pparγ2 promoter, stimulating its transcriptional activity and promoting adipocyte differentiation. Collectively, our study provides the first evidence that Foxk1 promotes adipocyte differentiation from progenitor cells by promoting nuclear translocation and upregulating the transcriptional activity of the Pparγ2 promoter during adipogenic differentiation.
Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia in Critically Ill Patients: A Cluster Analysis According to Baseline Characteristics, Biological Features, and Chest CT Scan on Admission
Authors: Grapin Kévin , De Bauchene Romain , Bonnet Benjamin , Mirand Audrey , Cassagnes Lucie , Calvet Laure , Thouy François , Bouzgarrou Radhia , Henquell Cécile , Evrard Bertrand , Adda Mireille , Souweine Bertrand , Dupuis Claire
Published: October 2023

BACKGROUND:

Inconsistent results from COVID-19 studies raise the issue of patient heterogeneity.

OBJECTIVE:

The objective of this study was to identify homogeneous subgroups of patients (clusters) using baseline characteristics including inflammatory biomarkers and the extent of lung parenchymal lesions on CT, and to compare their outcomes.

DESIGN:

Retrospective single-center study.

SETTING:

Medical ICU of the University Hospital of Clermont-Ferrand, France.

PATIENTS:

All consecutive adult patients aged greater than or equal to 18 years, admitted between March 20, 2020, and August 31, 2021, for COVID-19 pneumonia.

INTERVENTIONS:

Characteristics at baseline, during ICU stay, and outcomes at day 60 were recorded. On the chest CT performed at admission the extent of lung parenchyma lesions was established by artificial intelligence software.

MEASUREMENTS AND MAIN RESULTS:

Clusters were determined by hierarchical clustering on principal components using principal component analysis of admission characteristics including plasma interleukin-6, human histocompatibility leukocyte antigen-DR expression rate on blood monocytes (HLA-DR) monocytic-expression rate (mHLA-DR), and the extent of lung parenchymal lesions. Factors associated with day 60 mortality were investigated by univariate survival analysis. Two hundred seventy patients were included. Four clusters were identified and three were fully described. Cluster 1 (obese patients, with moderate hypoxemia, moderate extent of lung parenchymal lesions, no inflammation, and no down-regulation of mHLA-DR) had a better prognosis at day 60 (hazard ratio [HR] = 0.27 [0.15–0.46], p < 0.01), whereas cluster 2 (older patients with comorbidities, moderate extent of lung parenchyma lesions but significant hypoxemia, inflammation, and down-regulation of mHLA-DR) and cluster 3 (patients with severe parenchymal disease, hypoxemia, inflammatory reaction, and down-regulation of mHLA-DR) had an increased risk of mortality (HR = 2.07 [1.37–3.13], p < 0.01 and HR = 1.52 [1–2.32], p = 0.05, respectively). In multivariate analysis, only clusters 1 and 2 were independently associated with day 60 death.

CONCLUSIONS:

Three clusters with distinct characteristics and outcomes were identified. Such clusters could facilitate the identification of targeted populations for the next trials.
Botulinum Toxin: A Potential Cardiovascular Agent?
Authors: Williams Lauren E. , Frishman William H.
Published: October 2023

Botulinum neurotoxin (BoNT) is a toxin with a wide repertoire of well-known applications in cosmetics and medicine, such as treating migraine headaches, spasticity, and achalasia, and it has generally been shown to be safe and well-tolerated. In addition to its current successes in clinical practice, studies have also demonstrated the potential of BoNT to be used as a therapeutic agent for many cardiovascular conditions. Prior investigations, as well as trials currently underway, have showcased the safety and potential efficacy of BoNT in applications such as treating ischemia-reperfusion injury, hypertension, atrial fibrillation, and heart failure. While further study in humans, as well as improved statistical power in efficacy studies, are needed before its prospective use as a treatment for the aforementioned conditions, one might consider BoNT a potential cardiovascular agent.
Perioperative pain management models in four European countries
Authors: van den Heuvel Sandra A. , van Boekel Regina L. , Cox Felicia J. , Ferré Fabrice , Minville Vincent , Stamer Ulrike M. , Vissers Kris C. , Pogatzki-Zahn Esther M.
Published: October 2023

There is general agreement that acute pain management is an important component of perioperative medicine. However, there is no consensus on the best model of care for perioperative pain management, mainly because evidence is missing in many aspects. Comparing the similarities and differences between countries might reveal some insights into different organisational models and how they work. Here, we performed a narrative review to describe and compare the structures, processes and outcomes of perioperative pain management in the healthcare systems of four European countries using Donabedian's framework as a guide. Our comparison revealed many similarities, differences and gaps. Different structures of acute pain services in the four countries with no common definition and standards of care were found. Protocols have been implemented in all countries and guidelines in some. If outcome is assessed, it is mainly pain intensity, and many patients experiencing more intense pain than others have common risk factors (e.g. preoperative pain, preoperative opioid intake, female sex and young age). Outcome assessment beyond pain intensity (such as pain-related physical function, which is important for early rehabilitation and recovery) is currently not well implemented. Developing common quality indicators, a European guideline for perioperative pain management (e.g. for patients at high risk for experiencing severe pain and other outcome parameters) and common criteria for acute pain services might pave the way forward for improving acute pain management in Europe. Finally, the education of general and specialist staff should be aligned in Europe, for example, by using the curricula of the European Pain Federation (EFIC).
The evolution of pharmacovigilance: the contributions of Michael D Rawlins
Authors: Routledge Philip A.
Published: October 2023

In the last 175 years, pharmacovigilance has evolved, albeit sometimes in response to serious incidents. The late Professor Sir Michael D Rawlins made major contributions to pharmacovigilance internationally. He proposed a widely used classification of adverse drug reactions (ADRs). He highlighted the importance of post-marketing surveillance immediately after a medicine's launch, and the strengths and weaknesses of existing spontaneous suspected ADR reporting systems. He encouraged the broadening of pharmacovigilance to involve all health professional groups, as well as patients. He highlighted the value of all sources of evidence and of judgement in making risk-benefit assessments. He was a strong early advocate of greater use of databases and registries, and of continuing surveillance throughout the lifespan of medicines as therapeutic agents.
Reliability of systolic blood pressure measured by parents in young children at home using a hand held doppler device and aneroid sphygmomanometer
Authors: Newton Joanna , Haseler Emily , Higgins Colin , Futcher Charlotte , Singh Cheentan , Sinha Manish D.
Published: October 2023

Objective:

We report data regarding systolic BP monitoring in children aged <5 years performed over a 2-week period by parents at home using a hand-held doppler device and aneroid sphygmomanometer for SBP measurements (HDBPM). Our objectives were to compare health professional measured office systolic BP by doppler device (Office-SBPDoppler) with parent measured home systolic BP using the same doppler device (Home-SBPDoppler). We also report data evaluating reliability and optimal number of days of measurement required.

Design and Methods:

We taught parents to measure systolic BP and assessed their technique using a hand-held doppler device and aneroid sphygmomanometer. We requested parents to perform three consecutive BP measurements twice daily (ideally morning and evening around similar times) when the child was awake, settled and cooperative.

Results:

Over a 3-year period, data from 48 of 62 children who underwent HDBPM measurements were evaluated with median (IQR) age of 1.9 (0.9, 3.6) years, 27 (56%) boys and 14 (29%) on antihypertensive medication. Office-SBPDoppler was 2.9 ± 8.9 mmHg [95% confidence interval (CI), −14.4 to 20.4, P = 0.026] higher than Home-SBPDoppler. Mean Home-SBPDoppler between Week-1 and Week-2 monitoring was similar −0.45 ± 3.5 mmHg (95% CI, −7.35 to 6.45, P = 0.41). Morning HDBPM measurements were lower than evening with a mean difference of -2.77 ± 3.92 mmHg, P < 0.001). Over Week-1, mean Home-SBPDoppler was closer to mean Office-SBPDoppler with increasing cumulative days of monitoring and with smaller standard deviations suggesting that readings become more reliable from day 4 onwards.

Conclusions:

HDBPM is a reliable method for measuring systolic BP in young children with BP levels measured by parents comparable to those performed by health professional in clinic. HDBPM technique described here and performed by parents over a 7-day period with a minimum of 4-days, offers a reliable and reproducible technique to measure blood pressure at home.
Prediction of the Clinical Course of Immune Thrombocytopenia in Children by Platelet Kinetics
Authors: Lejeune Julien , Raoult Violette , Dubrasquet Mathilde , Chauvin Romane , Mallebranche Coralie , Pellier Isabelle , Monceaux Françoise , Bayart Sophie , Grain Audrey , Gyan Emmanuel , Ravalet Noémie , Herault Olivier , Ternant David
Published: October 2023

Childhood immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by isolated thrombocytopenia. Prolonged ITP (persistent and chronic) leads to a reduced quality of life for children in many domains. To provide optimal support for children, with ITP, it is important to be able to predict those who will develop prolonged ITP. This study aimed to develop a mathematical model based on platelet recovery that allows the early prediction of prolonged ITP. In this retrospective study, we used platelet counts from the 6 months following the diagnosis of ITP to model the kinetics of change in platelet count using a pharmacokinetic–pharmacodynamic model. In a learning set (n = 103), platelet counts were satisfactorily described by our kinetic model. The Kheal parameter, which describes spontaneous platelet recovery, allowed a distinction between acute and prolonged ITP with an area under the curve (AUC) of 0.74. In a validation set (n = 58), spontaneous platelet recovery was robustly predicted using platelet counts from 15 (AUC = 0.76) or 30 (AUC = 0.82) days after ITP diagnosis. In our model, platelet recovery quantified using the kheal parameter allowed prediction of the clinical course of ITP. Future prospective studies are needed to improve the predictivity of this model, in particular, by combining it with the predictive scores previously reported in the literature.
Inflammation, lipid dysregulation, and transient receptor potential cation channel subfamily V member 4 signaling perpetuate chronic vulvar pain
Authors: Bekauri Tamari , Fischer Sarah , Honn Kenneth V. , Maddipati Krishna Rao , Love Tanzy , Little Chantelle , Wood Ronald W. , Bonham Adrienne D. , Linder Mitchell A. , Yule David I. , Emanuelle Chrysilla , Falsetta Megan L.
Published: October 2023

Localized provoked vulvodynia is characterized by chronic vulvar pain that disrupts every aspect of the patient's life. Pain is localized to the vulvar vestibule, a specialized ring of tissue immediately surrounding the vaginal opening involved in immune defense. In this article, we show inflammation is the critical first step necessary for the generation of pain signals in the vulva. Inflammatory stimuli alone or combined with the transient receptor potential cation channel subfamily V member 4 (TRPV4) agonist 4α-phorbol 12,13-didecanoate stimulate calcium flux into vulvar fibroblast cells. Activity is blocked by the TRPV4 antagonist HC067047, denoting specificity to TRPV4. Using lipidomics, we found pro-resolving lipids in the vulvar vestibule were dysregulated, characterized by a reduction in pro-resolving mediators and heightened production of inflammatory mediators. We demonstrate specialized pro-resolving mediators represent a potential new therapy for vulvar pain, acting on 2 key parts of the disease mechanism by limiting inflammation and acutely inhibiting TRPV4 signaling.
Race differences in ambulatory blood pressure monitoring parameters
Authors: Sakhuja Swati , Jaeger Byron C. , Yano Yuichiro , Shimbo Daichi , Lewis Cora E. , Clark III Donald , Tajeu Gabriel S. , Hardy Shakia T. , Allen Norrina B. , Shikany James M. , Schwartz Joseph E. , Viera Anthony J. , Muntner Paul
Published: October 2023

Background

Mean systolic and diastolic blood pressure (SBP and DBP) on ambulatory blood pressure (BP) monitoring (ABPM) are higher among Black compared with White adults. With 48 to 72 BP measurements obtained over 24 h, ABPM can generate parameters other than mean BP that are associated with increased risk for cardiovascular events. There are few data on race differences in ABPM parameters other than mean BP.

Methods

To estimate differences between White and Black participants in ABPM parameters, we used pooled data from five US-based studies in which participants completed ABPM (n = 2580). We calculated measures of SBP and DBP level, including mean, load, peak, and measures of SBP and DBP variability, including average real variability (ARV) and peak increase.

Results

There were 1513 (58.6%) Black and 1067 (41.4%) White participants with mean ages of 56.1 and 49.0 years, respectively. After multivariable adjustment, asleep SBP and DBP load were 5.7% (95% CI: 3.5–7.9%) and 2.7% (95% CI: 1.1–4.3%) higher, respectively, among Black compared with White participants. Black compared with White participants also had higher awake DBP ARV (0.3 [95%CI: 0.0–0.6] mmHg) and peak increase in DBP (0.4 [95% CI: 0.0–0.8] mmHg). There was no evidence of Black:White differences in awake measures of SBP level, asleep peak SBP or DBP, awake and asleep measures of SBP variability or asleep measures of DBP variability after multivariable adjustment.

Conclusion

Asleep SBP load, awake DBP ARV and peak increase in awake DBP were higher in Black compared to White participants, independent of mean BP on ABPM.
Kidney disease hotspots and water balance in a warming world
Authors: Contreras Nieves Marimar , Powers Angelina , Anand Shuchi , Vlahos Penny
Published: October 2023

Purpose of review

Geographically localized areas with a high prevalence of kidney disease exist currently in several regions of the world. Although the exact cause is unclear, environmental exposures accelerated by climate change, particularly heat exposure and ground water contamination, are hypothesized as putative risk factors. Aiming to inform investigations of water-related exposures as risk factors for kidney disease, we excavate the history of major water sources in three regions that are described as hotspots of kidney disease: the low-lying coastal regions in El Salvador and Nicaragua, the dry central region in Sri Lanka, and the Central Valley of California.

Recent findings

Historic data indicate that these regions have experienced water scarcity to which several human-engineered solutions were applied; these solutions could be hypothesized to increase residents’ exposure to putative kidney toxins including arsenic, fluoride, pesticides, and cyanobacteria. Combined with heat stress experienced in context of climate change, there is potential for multistressor effects on kidney function. Climate change will also amplify water scarcity, and even if regional water sources are not a direct risk factor for development of kidney disease, their scarcity will complicate the treatment of the relatively larger numbers of persons with kidney disease living in these hotspots.

Nephrologists and kidney disease researchers need to engage in systematic considerations of environmental exposures as potential risk factors for kidney disease, including water sources, their increasing scarcity, and threats to their quality due to changing climate.
Professional Success
Authors: Norwood Carrie M. , Zinkan J. Lynn , Perry Seth H. , Tofil Nancy M. , Gaither Stacy L. , Rutledge Chrystal
Published: October 2023

Nursing education focuses on nursing theory and the ability to perform tasks. There is a lack of education related to prioritization of nursing tasks. Therefore, new nurses transitioning into their roles sometimes struggle and, as a result, leave their units or, often enough, our facility. We developed a Professional Success Program that includes cognitive prioritization exercises and simulation scenarios to assist these nurses. After utilizing the program, our facility has seen an increase in nurse retention.
Early Prelicensure Nursing Students' Perceptions of Case Studies Through the Lens of the Clinical Judgment Measurement Model
Authors: Robinson Laurie , Mulvey Bridget K. , Aller Loretta
Published: October 2023

Background:

Research indicates new nursing graduates struggle with clinical reasoning, despite some related skill development throughout their education. The question remains, “Could an earlier focus on clinical reasoning in nursing programs enhance nursing students' clinical reasoning?”

Purpose:

This pilot study investigated how first-semester nursing students perceive the use of case studies in clinical reasoning skill development and the perceived benefits of case studies related to the NCSBN Clinical Judgment Measurement Model (NCJMM).

Methods:

Case studies and written reflections were introduced to a convenience sample (n = 45) of first-semester nursing students. Qualitative analysis was conducted on written reflections.

Results:

Students found case studies enhanced their knowledge and prepared them for clinical practice as a nurse.

Conclusions:

Findings suggest early introduction of case studies is a meaningful teaching strategy to develop clinical reasoning aligned with the NCJMM.
Impact of Nursing Clinical Elective Courses on New Graduate Nurses' Clinical Practice
Authors: Lewis Lisa S. , Hartman A. Michelle , Leonard Christina , Cadavero Allen , Reynolds Staci S.
Published: October 2023

Background:

Clinical elective courses provide additional specialty knowledge for prelicensure nursing students; however, it is unknown how these courses impact nurses' clinical practice after graduation.

Purpose:

To describe how clinical nursing electives impact graduates' clinical practice.

Methods:

A mixed-methods descriptive design was used. Students who graduated from a prelicensure nursing program were sent an electronic survey and participated in qualitative interviews.

Results:

Thirty-three graduates completed the survey, with 9 participating in interviews. Sixteen graduates worked in the clinical practice areas that were the same, or related to, the clinical elective they took. Many graduates felt that taking the elective course improved their confidence in the clinical setting and provided increased knowledge that put them at an advantage over their peers.

Conclusion:

Clinical electives may offer a means to meet health care system needs by preparing a more confident, knowledgeable new graduate in specialty areas in which nurses are needed most.
The Tenacious Treponema: A Retrospective Examination of Syphilis Treatment Disparities in Washington, DC
Authors: Liroff Kaitlin , Kassaye Seble G. , Spence Amanda B. , Kumar Princy N. , Natarajan Madhuri , Harold Rachel , Dorsey Kerri , Doshi Rupali K. , Visconti Adam J.
Published: October 2023

Background

Since 2000 there have been rising rates of syphilis infections nationally with higher incidence among minorities and persons living with HIV (PLWH). The purpose of this study was to determine syphilis treatment adequacy and factors associated with treatment delay.

Methods

This was a retrospective academic-public health collaboration with the District of Columbia Department of Public Health reviewing surveillance data of all primary, secondary, and early latent syphilis cases diagnosed between 1/1/2015 and 12/31/2019. Data were analyzed using multivariable logistic regression to identify factors associated with delayed treatment >14 days from diagnosis.

Results

Among 1852 individuals diagnosed with early syphilis, 93% (1730/1852) were male; 48% (893/1852) were co-infected with HIV; 43% (n = 796/1852) were African American/Black, 27% (n = 492/1852) were White, and race/ethnicity was unknown for 17% (n = 318/1852) of cases. Among 679 PLWH for whom viral load (VL) was known, 41% (278/679) had a viral load (VL) < 20 copies/mL, and 18% (123/679) had VL >10,000 copies/mL. Treatment adequacy overall was 96.5%. Median time to syphilis treatment was 6 days [IQR = 4,7]. Factors associated with delay of treatment included refused/unknown race (aOR = 1.95; CI = 1.00, 3.79), reporting provider veterans/military (aOR = 5.26; (CI = 1.51-18.28),and HIV VL > 10,000 copies/mL (aOR = 1.97; CI = 1.08-3.58).

Conclusions

The factors we identified associated with delayed treatment may reflect systemic factors contributing to the increased rates of infection among key populations. This highlights the importance of targeted public health efforts with the goal of reducing transmission of both HIV and syphilis.
A National Study of Expedited Partner Therapy Use in Emergency Departments: A Survey of Medical Director Knowledge, Attitudes, and Practices
Authors: Solnick Rachel E. , Cortes Rafael , Chang Ethan J. , Dudas Paul , Deng Daxuan , Jamison Cornelius D. , Mmeje Okeoma , Kocher Keith E.
Published: October 2023

Background

Emergency departments (EDs) are the primary source of health care for many patients diagnosed with sexually transmitted infections (STIs). Expedited partner therapy (EPT), treating the partner of patients with STIs, is an evidence-based practice for patients who might not otherwise seek care. Little is known about the use of EPT in the ED. In a national survey, we describe ED medical directors' knowledge, attitudes, and practices of EPT.

Methods

A cross-sectional survey of medical directors from academic EDs was conducted from July to September 2020 using the Academy of Academic Administrators of Emergency Medicine Benchmarking Group. Primary outcomes were EPT awareness, support, and use. The survey also examined barriers and facilitators.

Results

Forty-eight of 70 medical directors (69%) responded. Seventy-three percent were aware of EPT, but fewer knew how to prescribe it (38%), and only 19% of EDs had implemented EPT. Seventy-nine percent supported EPT and were more likely to if they were aware of EPT (89% vs. 54%; P = 0.01). Of nonimplementers, 41% thought EPT was feasible, and 56% thought departmental support would be likely. Emergency department directors were most concerned about legal liability, but a large proportion (44%) viewed preventing sequelae of untreated STIs as “extremely important.”

Conclusions

Emergency department medical directors expressed strong support for EPT and reasonable levels of feasibility for implementation but low utilization. Our findings highlight the need to identify mechanisms for EPT implementation in EDs.
Modifications to Sexual Behaviors Associated With Mpox (Monkeypox) Virus Transmission Among Persons Presenting for mpox Vaccination, Washington, DC, August–October, 2022
Authors: Copen Casey E. , Delaney Kevin P. , Agnew-Brune Christine , Berry Isha , Griffin Isabel , Hassan Rashida , Oakley Lisa P. , Wondmeneh Sarah , Rhodes Trevor , Gillani Sarah , Lee Michelle , Ashley Patrick , Willut Christina , Mangla Anil T. , Waltenburg Michelle A. , Jackson David A. ,   DC Mpox Response Project Team
Published: October 2023

Background

Over 30,000 mpox cases were reported during the 2022 mpox outbreak with many cases occurring among gay, bisexual and other men who have sex with men (MSM). Decreases in U.S. mpox cases were likely accelerated by a combination of vaccination and modifications to sexual behaviors associated with mpox virus transmission. We assessed reports of sexual behavior change among participants receiving mpox vaccination in Washington, DC.

Methods

During August to October 2022, 711 adults aged ≥18 years receiving mpox vaccination at two public health clinics in Washington, DC completed a self-administered questionnaire that asked whether sexual behaviors changed since learning about mpox. We calculated the frequency and percentages of participants reporting an increase, decrease, or no change in 4 of these behaviors by demographic, clinical, and behavioral characteristics with 95% confidence intervals.

Results

Overall, between 46% and 61% of participants reported a decrease in sexual behaviors associated with mpox virus transmission, 39% to 54% reported no change in these behaviors, and <1% reported an increase. Approximately 61% reported decreases in one-time sexual encounters (95% confidence interval [CI], 56.8%–64.7%), 54.3% reduced numbers of sex partners (95% CI, 50.4%–58.0%), 53.4% decreased sex via a dating app or sex venue (95% CI, 49.7%–58.0%), and 45.6% reported less group sex (95% CI, 40.4%–50.9%). Reported decreases in these behaviors were higher for MSM than women; in non-Hispanic Black than non-Hispanic White participants; and in participants with human immunodeficiency virus than participants without human immunodeficiency virus.

Conclusions

Most participants receiving mpox vaccination reported decreasing sexual behaviors associated with mpox virus transmission, including groups disproportionately affected by the outbreak.
Clinical Report: Clinician Feedback on the Magnetic Levator Prosthesis
Authors: Houston Kevin E. , Nadeau Melanie , Paschalis Eleftherios I.
Published: October 2023

SIGNIFICANCE

Stakeholder engagement has been identified by national health organizations as a crucial step to successful translation of new health care treatments. In this clinical report, clinician-stakeholder feedback is presented for the magnetic levator prosthesis (MLP), a promising noninvasive spectacle device that restores eyelid motility with magnetic force.

PURPOSE

This study aimed to evaluate MLP clinical need and translational barriers.

METHODS

Ten vision rehabilitation optometrists who attended an educational presentation on the MLP and participated in a hands-on workshop in the fitting of a patient were invited to complete an anonymous online survey. Ten multiple-choice items gathered data on estimated patient need, current approaches, main barriers to MLP, temporary versus chronic use, cost barriers, and need for insurance coverage. Open fields allowed for additional comments.

RESULTS

Nine of 10 specialists completed the survey. Of those, seven answered that they could potentially see at least 1 to 5 patients for ptosis management within a year. The most common ptosis management options reported were the ptosis crutch, taping the eyelid open, and oxymetazoline drops, all with six responses each. Seven clinicians indicated that cost was a main concern. If cost to patient was not a barrier, all indicated they would be at least somewhat likely to try the MLP (1) for temporary management of ptosis, (2) as a pre-surgical trial, and (3) for long-term management of ptosis, with more selecting extremely likely and very likely than somewhat likely. Main comments were expressing enthusiasm for the technology and that it would be more appealing for patients if covered by insurance.

CONCLUSIONS

This clinical report suggests that the main barriers to clinical success of the MLP may be cost and insurance coverage, appearance of the device, and self-application. Possible solutions are cost-benefit analysis research, engineering efforts to reduce spectacle magnet size and improve the ease of eyelid magnet application.
Repeated Low-level Red-light Therapy: The Next Wave in Myopia Management?
Authors: Salzano Aaron D. , Khanal Safal , Cheung Nathan L. , Weise Katherine K. , Jenewein Erin C. , Horn Darryl M. , Mutti Donald O. , Gawne Timothy J.
Published: October 2023

SIGNIFICANCE

Exposure to long-wavelength light has been proposed as a potential intervention to slow myopia progression in children. This article provides an evidence-based review of the safety and myopia control efficacy of red light and discusses the potential mechanisms by which red light may work to slow childhood myopia progression.

The spectral composition of the ambient light in the visual environment has powerful effects on eye growth and refractive development. Studies in mammalian and primate animal models (macaque monkeys and tree shrews) have shown that daily exposure to long-wavelength (red or amber) light promotes slower eye growth and hyperopia development and inhibits myopia induced by form deprivation or minus lens wear. Consistent with these results, several recent randomized controlled clinical trials in Chinese children have demonstrated that exposure to red light for 3 minutes twice a day significantly reduces myopia progression and axial elongation. These findings have collectively provided strong evidence for the potential of using red light as a myopia control intervention in clinical practice. However, several questions remain unanswered. In this article, we review the current evidence on the safety and efficacy of red light as a myopia control intervention, describe potential mechanisms, and discuss some key unresolved issues that require consideration before red light can be broadly translated into myopia control in children.
Challenges of Families of Patients Hospitalized in the PICU: A Preplanned Secondary Analysis From the Navigate Dataset*
Authors: Tager Julia B. , Hinojosa Jessica T. , LiaBraaten Brynn M. , Balistreri Kathryn A. , Aniciete Danica , Charleston Elizabeth , Frader Joel E. , White Douglas B. , Clayman Marla L. , Sorce Lauren R. , Davies W. Hobart , Rothschild Charles B. , Michelson Kelly N. ,   on behalf of the Navigate Study Investigators
Published: October 2023

OBJECTIVES:

To describe challenges experienced by parents of children hospitalized in the PICU during PICU admission as reported by family navigators.

DESIGN:

A preplanned secondary analysis of open-response data coded via inductive qualitative approach from the Navigate randomized controlled trial (RCT) dataset (ID NCT02333396).

SETTING:

Two university-affiliated PICUs in the Midwestern United States as part of an RCT.

PATIENTS:

Two hundred twenty-four parents of 190 PICU patients.

INTERVENTIONS:

In 2015–2017, trained family navigators assessed and addressed parent needs, offered weekly family meetings, and provided post-PICU discharge parent check-ins as part of a study investigating the effectiveness of a communication support intervention (“PICU Supports”).

MEASUREMENTS AND MAIN RESULTS:

We analyzed qualitative data recorded by family navigators weekly across 338 encounters. Navigators described families’ “biggest challenge,” “communication challenges,” and ways the team could better support the family. We used an inductive qualitative coding approach and a modified member-checking exercise. The most common difficulties includedhome life,hospitalization, anddiagnosis distress(45.2%, 29.0%, and 17.2% of families, respectively). Navigators often identified that parents had co-occurring challenges. Communication was identified as a “biggest challenge” for 8% of families. Communication challenges includedlack of information, team communication, andcommunication quality(7.0%, 4.8%, and 4.8% of families, respectively). Suggestions for improving care included better medical communication, listening, rapport, and resources.

CONCLUSIONS:

This study describes families’ experiences and challenges assessed throughout the PICU stay. Family navigators reported families frequently experience stressors both internal and external to the hospital environment, and communication challenges between families and providers may be additional sources of distress. Further research should develop and assess interventions aimed at improving provider-family communication and reducing stressors outside the hospitalization itself, such as home life difficulties.
Pediatric Cardiovascular Computed Tomography
Authors: Kardos Marek , Curione Davide , Valverde Israel , van Schuppen Joost , Goo Hyun Woo , Kellenberger Christian J. , Secinaro Aurelio , Caro-Domínguez Pablo
Published: October 2023

Congenital heart diseases affect 1% of all live births in the general population. The prognosis of these children is increasingly improving due to advances in medical care and surgical treatment. Imaging is also evolving rapidly to assess accurately complex cardiac anomalies prenatally and postnatally. Transthoracic echocardiography is the gold-standard imaging technique to diagnose and follow-up children with congenital heart disease. Cardiac computed tomography imaging plays a key role in the diagnosis of children with congenital heart defects that require intervention, due to its high temporal and spatial resolution, with low radiation doses. It is challenging for radiologists, not primarily specialized in this field, to perform and interpret these studies due to the difficult anatomy, physiology, and postsurgical changes. Technical challenges consist of necessary electrocardiogram gating and contrast bolus timing to obtain an optimal examination. This article aims to define indications for pediatric cardiac computed tomography, to explain how to perform and report these studies, and to discuss future applications of this technique.
Deep Learning–Based Automated Labeling of Coronary Segments for Structured Reporting of Coronary Computed Tomography Angiography in Accordance With Society of Cardiovascular Computed Tomography Guidelines
Authors: Brandt Verena , Fischer Andreas , Schoepf Uwe Joseph , Bekeredjian Raffi , Tesche Christian , Aquino Gilberto J. , O’Doherty Jim , Sharma Puneet , Gülsün Mehmet A. , Klein Paul , Ali Asik , Few William Evans , Emrich Tilman , Varga-Szemes Akos , Decker Josua A.
Published: October 2023

Purpose:

To evaluate a novel deep learning (DL)–based automated coronary labeling approach for structured reporting of coronary artery disease according to the guidelines of the Society of Cardiovascular Computed Tomography (CT) on coronary CT angiography (CCTA).

Patients and Methods:

A retrospective cohort of 104 patients (60.3 ± 10.7 y, 61% males) who had undergone prospectively electrocardiogram-synchronized CCTA were included. Coronary centerlines were automatically extracted, labeled, and validated by 2 expert readers according to Society of Cardiovascular CT guidelines. The DL algorithm was trained on 706 radiologist-annotated cases for the task of automatically labeling coronary artery centerlines. The architecture leverages tree-structured long short-term memory recurrent neural networks to capture the full topological information of the coronary trees by using a two-step approach: a bottom-up encoding step, followed by a top-down decoding step. The first module encodes each sub-tree into fixed-sized vector representations. The decoding module then selectively attends to the aggregated global context to perform the local assignation of labels. To assess the performance of the software, percentage overlap was calculated between the labels of the algorithm and the expert readers.

Results:

A total number of 1491 segments were identified. The artificial intelligence–based software approach yielded an average overlap of 94.4% compared with the expert readers’ labels ranging from 87.1% for the posterior descending artery of the right coronary artery to 100% for the proximal segment of the right coronary artery. The average computational time was 0.5 seconds per case. The interreader overlap was 96.6%.

Conclusions:

The presented fully automated DL-based coronary artery labeling algorithm provides fast and precise labeling of the coronary artery segments bearing the potential to improve automated structured reporting for CCTA.
Lung–Reporting and Data System 2.0
Authors: Chelala Lydia , Hossain Rydhwana , Jeudy Jean , Nader Ziad , Kastner Julia , White Charles
Published: October 2023

Purpose:

To determine the frequency of malignancy of nonperifissural juxtapleural nodules (JPNs) measuring 6 to < 10 mm in a subset of low-dose chest computed tomographies from the National Lung Cancer Screening Trial and the rate of down-classification of such nodules in Lung-Reporting and Data System (RADS) 2.0 compared with Lung-RADS 1.1.

Materials and Methods:

A secondary analysis of a subset of the National Lung Screening Trial was performed. An exemption was granted by the Institutional Review Board. The dominant noncalcified nodule measuring 6 to <10 mm was identified on all available prevalence computed tomographies. Nodules were categorized as pleural or nonpleural. Benign or malignant morphology was recorded. Initial and updated categories based on Lung-RADS 1.1 and Lung-RADS 2.0 were assigned, respectively. The impact of the down-classification of JPN was assessed. Both classification schemes were compared using the McNemar test (P < 0.01).

Results:

A total of 2813 patients (62 ± 5 y, 1717 men) with 4408 noncalcified nodules were studied. One thousand seventy-three dominant nodules measuring 6 to <10 mm were identified. Three hundred forty-eight (32.4%) were JPN. The updated scheme allowed down-classification of 310 JPN from categories 3 (n = 198) and 4A (n = 112) to category 2. We, therefore, estimate a 4.8% rate of down-classification to category 2 in the entire National Lung Screening Trial screening group. Two/348 (0.57%) JPN were malignant, both nonbenign in morphology. The false-positive rate decreased in the updated classification (P < 0.01).

Conclusion:

This study demonstrates the low malignant potential of benign morphology JPN measuring 6 mm to <10 mm. The Lung-RADS 2.0 approach to JPN is estimated to reduce short-term follow-ups and false-positive results.
Identifying Coronary Artery Calcification Using Chest X-ray Radiographs and Machine Learning
Authors: Jeong Hyunseok , Park Hyung-Bok , Hong Jongsoo , Lee Jina , Ha Seongmin , Heo Ran , Jung Juyeong , Hong Youngtaek , Chang Hyuk-Jae
Published: October 2023

Purpose:

To evaluate the ability of radiomics score (RS)–based machine learning to identify moderate to severe coronary artery calcium (CAC) on chest x-ray radiographs (CXR).

Materials and Methods:

We included 559 patients who underwent a CAC scan with CXR obtained within 6 months and divided them into training (n = 391) and validation (n = 168) cohorts. We extracted radiomic features from annotated cardiac contours in the CXR images and developed an RS through feature selection with the least absolute shrinkage and selection operator regression in the training cohort. We evaluated the incremental value of the RS in predicting CAC scores when combined with basic clinical factor in the validation cohort. To predict a CAC score ≥100, we built an RS-based machine learning model using random forest; the input variables were age, sex, body mass index, and RS.

Results:

The RS was the most prominent factor for the CAC score ≥100 predictions (odds ratio = 2.33; 95% confidence interval: 1.62-3.44; P < 0.001) compared with basic clinical factor. The machine learning model was tested in the validation cohort and showed an area under the receiver operating characteristic curve of 0.808 (95% confidence interval: 0.75-0.87) for a CAC score ≥100 predictions.

Conclusions:

The use of an RS-based machine learning model may have the potential as an imaging marker to screen patients with moderate to severe CAC scores before diagnostic imaging tests, and it may improve the pretest probability of detecting coronary artery disease in clinical practice.