bluuebunny/crossref_metadata_2025 huggingface dataset:
Half‐bridge flipped‐gamma Z‐source inverter with high voltage gain
Authors: Laali Sara , Babaei Ebrahim , Aalami Mohammadamin
Published: May 2024

In this paper, a new coupled inductor Z‐source inverter is proposed. The proposed topology can increase the boost factor value by increasing the number of turns ratio values. The proposed inverter is completely analyzed, and the related equations to the voltage and current of the used elements and boost factor are obtained. In addition, the values of the capacitors and inductors are designed to have a better performance based on the considered boost factor and input voltage level. Following, the proposed inverter is compared with several related topologies to determine the advantages and disadvantages of the proposed inverter. Finally, the accuracy performance of the proposed inverter is verified through results on experimental prototype.
Tidal versus fluvial point bars: Key features from the integration of outcrop, core and wireline log information of Triassic examples
Authors: Yeste Luis Miguel , Gil‐Ortiz Marc , García‐García Fernando , Viseras César , Mcdougall Neil David , Cabello Patricia , Caracciolo Luca
Published: May 2024

The Triassic red beds of the Tabular Cover of the Iberian Meseta are an excellent reservoir outcrop analogue, a direct consequence of high‐quality exposures, which offer exceptional three‐dimensional outcrops, as well as a wide variability of depositional environments. Fluvial and transitional with tide‐influenced and wave‐influenced settings are recognised. Three point bar geobodies of similar scale, but influenced by different processes, were selected from this succession. Point bar geobody 1 was influenced by purely fluvial processes while geobodies 2 and 3 were tide‐influenced. Both types of geobody were developed as point bar deposits in sinuous channels. A fully integrated study was carried out on these geobodies, utilising both outcrop and subsurface‐based approaches, to characterise the key differences between fluvial and tidal point bars in the sedimentary record. The outcrop‐based component involved traditional field data collection methods alongside digital techniques and data capture, including the use of digital outcrop models. Additionally, subsurface‐based methods were employed, utilising core and wireline logs obtained from wells drilled in close proximity to the outcrop. The integration of these approaches aims to accurately differentiate the depositional settings of the three different geobodies, which while apparently very similar in many key respects also exhibit considerable differences when considered from the perspective of subsurface management of potentially similar geobodies. This study also emphasises the need to clearly distinguish high‐sinuosity deposits based on their depositional sub‐environment in order to properly evaluate their potential for subsurface management. Additionally, it highlights the presence and importance of internal baffles that may well influence fluid migration and indeed even compartmentalise geobodies. Three point bar geobodies of similar scale, but influenced by different processes, have been selected in this succession. A fully integrated study was carried out on these geobodies, utilising both outcrop‐based and subsurface‐based approaches, to characterise the key differences between fluvial and tidal point bars in the sedimentary record.
Competition mode and soil nutrient status shape the role of soil microbes in the diversity–invasibility relationship
Authors: Li Haokun , Hu Xinyu , Geng Xinze , Xiao Bo , Miao Wei , Xu Zhiguang , Deng Yizhuo , Jiang Bohan , Hou Yuping
Published: May 2024

Understanding the relationship between plant diversity and invasibility is essential in invasion ecology. Species‐rich communities are hypothesized to be more resistant to invasions than species‐poor communities. However, while soil microorganisms play a crucial role in regulating this diversity–invasibility relationship, the effects of plant competition mode and soil nutrient status on their role remain unclear. To address this, we conducted a two‐stage greenhouse experiment. Soils were first conditioned by growing nine native species separately in them for 1 year, then mixed in various configurations with soils conditioned using one, three, or six species, respectively. Next, we inoculated the mixed soil into sterilized substrate soil and planted the alien species Rhus typhina and native species Ailanthus altissima as test plants. We set up two competition modes (intraspecific and interspecific) and two nutrient levels (fertilization using slow‐release fertilizer and nonfertilization). Under intraspecific competition, regardless of fertilization, the biomass of the alien species was higher in soil conditioned by six native species. By contrast, under interspecific competition, the biomass increased without fertilization but remained stable with fertilization in soil conditioned by six native species. Analysis of soil microbes suggests that pathogens and symbiotic fungi in diverse plant communities influenced R. typhina growth, which varied with competition mode and nutrient status. Our findings suggest that the soil microbiome is pivotal in mediating the diversity–invasibility relationship, and this influence varies according to competition mode and nutrient status.
The assessment of water quality by macroinvertebrate and water quality indices in small reservoir (Damsa, Türkiye)
Authors: Fındık Özlem , Aras Seval
Published: May 2024

The composition and spatial distribution of macroinvertebrates in the Damsa reservoir have been analysed. Also, reservoir water was evaluated with water quality index (WQI). Damsa reservoir is significant for both biodiversity and recreation in the region. Except for the winter season, the lake water is of good quality for WQI. There is pollution in the lake in terms of phosphorus, especially for winter. In terms of phosphate, all of the stations are mezotrophic for the OECD; however, Stations 4 and 5 are eutrophic for the Türkiye Surface Water Quality Management Regulation (the others are mezotrophic). Community variation and status of benthic macroinvertebrate were evaluated with Ecological Status Class Assessment Tools (ESCATs) indices which have been widely used in the literature. In the present study, 1062 individual benthic macroinvertebrates from 11 orders and 17 families were collected. A total of 46 macroinvertebrates taxa were identified. The first three dominant groups are Oligochaeta (42.66%), Hemiptera (Micronecta scholtzi, 23.07%) and Chironomidae (19.67%).
The effects of native seed mix composition and sowing density on plant community reassembly in wetlands
Authors: Robinson Rae , Beck Laura , Kettenring Karin M.
Published: May 2024

Seed‐based restoration of wetlands is often necessary to improve important ecosystem functions (e.g., invasion resistance and habitat provisioning) and meet society's need for wetland ecosystem services such as supporting recreational activities and improving water quality. However, persistent questions remain about the composition and sowing density of seed mixes needed to restore robust native wetland plant communities. In Great Salt Lake wetlands (Utah, USA), the revegetation of native species is crucial to recovering critical habitat and preventing reinvasion of the invasive, non‐native grass Phragmites australis and other invasive species (e.g., Typha spp.). In greenhouse and field experiments, we investigated the effects of seed mix composition and sowing density on plant community reassembly. We predicted that seed mixes containing native forb species with resource‐preempting traits (e.g., rapid seedling emergence and high aboveground growth rate) and high sowing densities (>5500 pure live seed m−2), would increase native plant light acquisition and establishment, thereby limiting invasive species. To our surprise, the effect of seed mix composition on native plant performance (cover and biomass) varied among the experiments, with distinct differences between plant functional groups arising. Native forb species had the highest performance in the greenhouse, but native grasses performed better in the field. Although multiple seed mix compositions show promise for establishing high native cover and biomass, these mixes may not always suppress invasive species. Interestingly, seed mix composition most often affected plant performance independent of sowing density. However, in one greenhouse experiment, we found that only slow‐growing mixes required a high sowing density to maximize native cover, an indication that the ideal sowing density may depend on the seed mix composition. Our research also supports the idea that in addition to reducing propagules of invasive species via appropriate management strategies, the application of higher sowing densities (>5500 pure live seed m−2) may lead to more favorable outcomes when a high density of invasive plant seeds remains or stressful field conditions are present. This research contributes to knowledge of plant community reestablishment in wetlands and demonstrates how seed‐based restoration strategies can catalyze native species revegetation and, in some situations, reduce the cover of invasive species.
Electrochemical Decarboxylation/Mumm Rearrangement towards Imides
Authors: Jiang Ping , Liang Chaoqiang , He Tianyu , Liu Rui , Meng Xiangtai , Zheng Yu , Huang Shenlin
Published: May 2024

We report an electrochemically promoted decarboxylation of readily available carboxylic acid and subsequent Mumm rearrangement to synthesize the corresponding imides. The reaction features external oxidant‐free, transition metal‐free mild conditions, and good functional group tolerance, affording various imides in moderate to good yields. Mechanistic studies reveal that the selective oxidation of aliphatic carboxylic acids appears to be the key step in this transformation.
Photosynthetıc Energy Nanogenerators
Authors: Bolsu Kariper Saliha Esra , Kariper İshak Afşin
Published: May 2024

Interest in the research of renewable natural energy sources, such as solar, wind, water, and biomass, which will both protect the environment in an ecological sense and contribute to sustainable development, is increased to prevent the energy crisis that may occur in the future with the decrease in energy resources. Low‐cost and environmentally friendly nanogenerator systems are developed to generate, efficiently use, and store the energy obtained from these sources. A small portion of sunlight is used by solar heat collection and energy panel systems developed to generate heat and electricity; the remaining large part, in contrast, is used by photosynthetic organisms such as plants and algae to ensure the photosynthetic cycle. Photosynthetic energy, nanomaterials used to collect this energy, device performances, the effect of the parts in the photosynthetic cycle on device efficiency, and recent developments are discussed, and the development of photosynthetic energy is reviewed. Nanostructured materials play an active role in increasing the photosynthetic effect while converting solar energy into electrical energy by photosynthesis. Further research on developing photosynthetic nanogenerators, particularly enhancing the generation of photosynthetic electrons using nanomaterials and ensuring their more efficient transfer, is recommended.
Therapeutic value of patent foramen ovale closure for drug‐resistant epilepsy: A case series report
Authors: Ji Shuming , Dong Bosi , Tang Yusha , Li Hua , Lai Wanlin , Li Yajiao , Chen Yucheng , Peng Anjiao , Chen Lei
Published: May 2024

Objective

Closure surgery of patent foramen ovale (PFO) has been found to effectively control cryptogenic stroke and migraine, but it is uncertain whether PFO closure could also alleviate epileptic seizures. This study aims to observe the therapeutic effect of PFO closure on epileptic seizures.

Methods

Since July 11th, 2017, in the neurology department of West China Hospital, Sichuan University, Chengdu, we have been regularly monitoring patients with epilepsy who have undergone PFO closure. The patient's clinical information, such as frequency, duration, and severity of seizures, before and after surgery was recorded in detail as well as postoperative safety events.

Results

Of the 31 epilepsy patients who confirmed PFO observed (27 cases were drug‐resistant epilepsy, 87.10%), average age of surgery was 23.74 years, and 12 cases were female (38.71%). After one‐year follow‐up, 26 patients (83.87%) achieved remission of seizure frequency, and 22 of whom (70.97%) experienced a remission of more than 50%. Additionally, compared to before surgery, 22 cases (70.97%) reported a decrease in the average seizure duration, and 20 cases (64.52%) reported a reduction in seizure severity. In the seizure indicators of frequency, average duration and severity, significant differences were identified between preoperative and postoperative comparisons with all test p values were <0.05. Furthermore, no serious safety events were reported except for one patient who briefly reported chest pain, and all patients expressed effective PFO closure.

Significance

The PFO closure has been shown for the first time to result in a significant reduction in the frequency, duration, and severity of seizures. Patients with drug‐resistant epilepsy and PFO with a large shunt are ideal candidates for undergoing PFO closure.

Plain Language Summary

Since PFO closure was found to have a good therapeutic effect on cryptogenic stroke and migraine, it has become a credible complementary therapy for the treatment of neurological diseases, and drug‐resistant epilepsy with PFO is expected to become the next target disease that PFO closure could significantly improve.
Theoretical modeling and experimental verification of a broadband microvibrational energy harvesting system
Authors: Wei Hongtao , Wang Wei , Gao Jiaqi , Zhang Qiang , Guo Pan , Hu Zhixin , Li Baolin , Li Zilin , Wei Ronghan
Published: May 2024

To scavenge energy from imperceptible vibrations, this paper investigates the broadband response and output performance of a microvibrational piezoelectric energy harvesting system with mechanical stopper. The energy harvesting system comprises a cantilever beam made of piezoelectric material, which is affixed with a coil at its unbound end and a mechanical stopper. The coil is placed in a magnetic field to provide an ultra‐low level excitation. The electromechanical model is derived according to force integration method (FIM) and Hertz's contact theory, and numerical simulations are undertaken to evaluate the influence of the excitation level, and the gap on the performance. For the linear counterpart without stopper, experimental results indicate the system generates a peak power of 24.12 μW with matched resistance under excitation with a level of 0.003 N and a frequency of 200.3 Hz. When a polydimethylsiloxane (PDMS) stopper is introduced, the vibration of the piezoelectric beam exhibits an obvious nonlinearity with an amplitude of micron scale. Increasing the excitation level and decreasing the gap could efficiently broaden the response bandwidth. Experimental results demonstrate that a copper stopper with larger elastic modulus results in a wider response frequency range, and the half‐power bandwidth could reach 37.1 Hz under excitation with a level of 0.003 N.
Transfiguring energy with an advantageous supercapacitor integrating MoS2/carbon quantum dots bi‐composites into a high‐performance polypyrrole matrix for unprecedented efficiency
Authors: Arora Rajat , Dhanda Monika , Yadav Meena , Pahuja Priti , Ahlawat Simran , Jhanjhariya Neeru , Nehra S. P. , Lata Suman
Published: May 2024

For the first time, a simple one‐step in situ chemical polymerization technique is used to create a novel molybdenum disulphide/sulphonated carbon quantum dots (CQDs) and polypyrrole (MCP) nanocomposite that is extended for successful use in charge storage supercapacitor (SC) device. By inheriting qualities of excellent electrical conductivity of MoS2, CQDs and improved pseudocapacitive activity of polypyrrole (PPy), the MCP nanocomposite provides a suitable SC electrode material. 0.6 MCP nanocomposited three‐electrode system demonstrates 93.21% retention after 5000 cycles, and a maximum specific capacity of 2253 F/g at 2 mV/s with higher side of energy density as 106.06 Wh/kg along with a considerable power density as 180.28 W/kg. Using MCP as anode and an AC or activated charcoal electrode as cathode, a solid‐state asymmetric supercapacitor (ASC) was constructed. The fabricated device supplies a greater value of specific capacitance as 154.09 F/g at 100 mV/s and 175 F/g at 0.1 A/g, also evidenced superior energy density data as 126 Wh/kg along with an appreciable power density of 604.8 W/kg. After charging the ASC for 2 min, the light emitting diode shone for 5 min. The findings underpin that MCP is a potential electrode material that could be utilized as a better alternative in futuristic supercapacitor devices.
A deep learning‐based multivariate decomposition and ensemble framework for container throughput forecasting
Authors: Kulshrestha Anurag , Yadav Abhishek , Sharma Himanshu , Suman Shikha
Published: May 2024

Traditional linear models struggle to capture the intricate relationship between dynamic container throughput and its complex interplay with economic fluctuations. This study introduces a novel, deep learning‐based multivariate framework for precision in demanding landscapes. The framework consistently outperforms eight established benchmark models by employing vital economic indicators like GDP and port tonnage, identified through rigorous predictor importance analysis of an initial set of four variables, including imports and exports. Statistical significance is demonstrably achieved through the Diebold–Mariano and Wilcoxon rank‐sum tests. Utilizing the Port of Singapore as a case study, the framework offers agile adaptability for the ever‐evolving global supply chain. Comprehensive analyses ensure robustness, decoding intricate throughput dynamics. Incorporating noise‐assisted multivariate empirical mode decomposition (NA‐MEMD) for nonlinear decomposition and bidirectional long short‐term memory (BiLSTM) for time series dependencies, this innovative approach holds promise for revolutionizing container throughput forecasting and enhancing competitiveness in the global market through optimized resource allocation and streamlined operations.
Intelligent algorithm based on deep learning to predict the dosage for anesthesia: A study on prediction of drug efficacy based on deep learning
Authors: Hu ZhiGang , Pan GuangJian , Wang XinZheng , Li KeHan
Published: May 2024

Background and Aims

Anesthetic drugs play a vital role during surgery, however, due to individual differences and complex physiological mechanisms, the prediction of anesthetic drug dosage has always been a challenging problem. In this study, we propose a model for predicting the dosage of anesthetic drugs based on deep learning to help anesthesiologists better control their dosage during surgical procedures.

Methods

We design a model based on the artificial neural network to predict the dosage of preoperative anesthetic, and use the SELU activation function and the loss function for weighted regularization to solve the problem of unbalanced sample. Moreover, we design a CNN‐based model for the prior extraction of intraoperative features by using a 7 × 1 convolution kernel to enhance the receptive field, and combine maximum pooling and average pooling to extract key features while eliminating noise. A predictive model based on the LSTM network is designed to predict the intraoperative dosage of the anesthetic, and the bidirectional propagation‐based LSTM network is used to improve the ability to learn the trend of changes in the physiological states of the patient during surgery. An attention module is added before the connection layer to appropriately attend to areas containing prominent features.

Results

The results of experiments showed that the proposed method reduced values of the MAPE to 15.83% and 12.25% compared with the traditional method in predictions of the preoperative and intraoperative doses of the anesthetic, respectively, and increased the values of to 0.887 and 0.915, respectively.

Conclusion

The intelligent anesthesia prediction algorithm designed in this study can effectively predict the dosage of anesthetic drugs needed by patients, assist clinical judgment of anesthetic drug dose, and assist the anesthesiologists to ensure the smooth progress of the operation.
Cytokine Mimetics with Various Modalities
Authors: Sakai Katsuya , Sato Hiroki , Matsumoto Kunio
Published: May 2024

Cytokines play a central role in regulating cell communication and signal transduction, since they influence processes such as immunity, hematopoiesis, inflammatory disease, cancer, neurological disorders, and tissue healing. Notably, certain cytokines have been used clinically as protein therapeutics for conditions such as cancer, autoimmune diseases, and viral infections. Despite their therapeutic potential, cytokines often pose challenges, including side effects, stability constraints, and suboptimal pharmacokinetics. To address these limitations, there is growing interest in using diverse modalities to develop alternative cytokines with enhanced properties and therapeutic benefits. Of these modalities, effective high‐throughput screening of macrocyclic peptides enabled by RNA‐based catalysis has emerged as a promising candidate method for the development of alternative cytokines. Here, we focus on the development of cytokine alternatives using various approaches and explore prospects for their future use as therapeutic agents.
Hot‐carrier engineering for two‐dimensional integrated infrared optoelectronics
Authors: Yu Yuanfang , Zhang Jialin , Wang Lianhui , Ni Zhenhua , Lu Junpeng , Gao Li
Published: May 2024

Plasmonic hot carrier engineering holds great promise for advanced infrared optoelectronic devices. The process of hot carrier transfer has the potential to surpass the spectral limitations of semiconductors, enabling detection of sub‐bandgap infrared photons. By harvesting hot carriers prior to thermalization, energy dissipation is minimized, leading to highly efficient photoelectric conversion. Distinguished from conventional band‐edge carriers, the ultrafast interfacial transfer and ballistic transport of hot carriers present unprecedented opportunities for high‐speed photoelectric conversion. However, a complete description on the underlying mechanism of hot‐carrier infrared optoelectronic device is still lacking, and the utilization of this strategy for tailoring infrared response is in its early stages. This review aims to provide a comprehensive overview of the generation, transfer and transport dynamics of hot carriers. Basic principles of hot‐carrier conversion in heterostructures are discussed in detail. In addition, progresses of two‐dimensional (2D) infrared hot‐carrier optoelectronic devices are summarized, with a specific emphasis on photodetectors, solar cells, light‐emitting devices and novel functionalities through hot‐carrier engineering. Furthermore, challenges and prospects of hot‐carrier device towards infrared applications are highlighted.

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Resurgence of destructive behavior following decreases in alternative reinforcement: A prospective analysis
Authors: Greer Brian D. , Shahan Timothy A. , Irwin Helvey Casey , Fisher Wayne W. , Mitteer Daniel R. , Fuhrman Ashley M.
Published: May 2024

Basic and retrospective translational research has shown that the magnitude of resurgence is determined by the size of the decrease in alternative reinforcement, with larger decreases producing more resurgence. However, this finding has not been evaluated prospectively with a clinical population. In Experiment 1, five participants experienced a fixed progression of reinforcement schedule‐thinning steps during treatment of their destructive behavior. Resurgence occurred infrequently across steps and participants, and when resurgence did occur, its clinical meaningfulness was often minimal. In Experiment 2, five new participants experienced these same schedule‐thinning steps but in a counterbalanced order. Resurgence occurred most often and was generally largest with larger decreases in alternative reinforcement programmed earlier in the evaluation. Large decreases in alternative reinforcement may be more problematic clinically when they occur earlier in treatment. Whether larger transitions can be recommended in the clinic following the success of smaller ones will require additional research.
Naringenin mitigates aluminum toxicity‐induced learning memory impairments and neurodegeneration through amelioration of oxidative stress
Authors: Rai Ravina , Jat Deepali , Mishra Siddhartha Kumar
Published: May 2024

Aluminum chloride (AlCl3) is a potent neurotoxic substance known to cause memory impairment and oxidative stress‐dependent neurodegeneration. Naringenin (NAR) is a dietary flavonoid with potent antioxidant and anti‐inflammatory properties which was implemented against AlCl3‐induced neurotoxicity to ascertain its neuroprotective efficacy. Experimental neurotoxicity in mice was induced by exposure of AlCl3 (10 mg/kg, p.o.) followed by treatment with NAR (10 mg/kg, p.o.) for a total of 63 days. Assessed the morphometric, learning memory dysfunction (novel object recognition, T‐ and Y‐maze tests), neuronal oxidative stress, and histopathological alteration in different regions of the brain, mainly cortex, hippocampus, thalamus, and cerebellum. AlCl3 significantly suppressed the spatial learning and memory power which were notably improved by administration of NAR. The levels of oxidative stress parameters nitric oxide, advanced oxidation of protein products, protein carbonylation, lipid peroxidation, superoxide dismutase, catalase, glutathione reductase, reduced glutathione, and the activity of acetylcholine esterase were altered 1.5–3 folds by AlCl3 significantly. Treatment of NAR remarkably restored the level of oxidative stress parameters and maintained the antioxidant defense system. AlCl3 suppressed the expression of neuronal proliferation marker NeuN that was restored by NAR treatment which may be a plausible mechanism. NAR showed therapeutic efficacy as a natural supplement against aluminum‐intoxicated memory impairments and histopathological alteration through a mechanism involving an antioxidant defense system and neuronal proliferation.
Narcissistic personality disorder in the ICD‐11: Severity and trait profiles of grandiosity and vulnerability
Authors: Day Nicholas J. S. , Green Ava , Denmeade Georgia , Bach Bo , Grenyer Brin F. S.
Published: May 2024

Modern diagnostic and classification frameworks such as the ICD‐11 and DSM‐5‐AMPD have adopted a dimensional approach to diagnosing personality disorder using a dual “severity” and “trait” model. As narcissistic personality has historically struggled to be adequately captured in dominant diagnostic systems, this study investigated the utility of the new ICD‐11 framework in capturing diverse narcissistic expressions. Participants were mental health clinicians (N = 180, 67% female, age = 38.9), who completed ratings of ICD‐11 personality severity, trait domains and a clinical reflection for two hypothetical case vignettes reflecting either prototypical “grandiose” or “vulnerable” narcissism. The majority of clinicians (82%) endorsed a diagnosis of personality disorder for both grandiose and vulnerable vignettes. Discriminant elements of personality impairment included rigid, unrealistically positive self‐view, low empathy and high conflict with others for grandiosity, and incoherent identity, low self‐esteem and hypervigilant, avoidant relations with others for vulnerability. Regarding trait profile, grandiose narcissism was predominately dissocial whereas vulnerable narcissism was primarily associated with negative affectivity and detachment. Qualitative responses highlight distinct clinical themes for each presentation. These findings suggest that clinicians using the ICD‐11 framework are able to identify common core elements of personality dysfunction in grandiose and vulnerable narcissism while also recognizing their distinctive differences.
The usefulness of trans‐splenic retrocardiac imaging in prone positioned critically ill patients
Authors: Catena Emanuele , Rizzuto Chiara , Borghi Beatrice , Bergomi Paola , Guglielmetti Luigi , Gambarini Matteo , Paratico Cristopher , Volontè Alessandra , Gavanna Giulia , Fossali Tommaso , Colombo Riccardo
Published: May 2024

In the last few years prone positioning has been used increasingly in the treatment of patients with acute respiratory distress syndrome and this maneuver is now considered a simple and safe method to improve oxygenation. Hemodynamic monitoring by echocardiography may be required but prone positioning imposes certain challenges limiting standard examination. The article describes the application of the “trans‐splenic retrocardiac view,” a little‐known echographic window for obtaining Doppler parameters from the back in prone‐positioned patients.
Predictive genetic testing for Huntington's disease: Exploring participant experiences of uncertainty and ambivalence between clinic appointments
Authors: Ballard L. M. , Doheny S. , Dimond R. , Lucassen A. M. , Clarke A. J.
Published: May 2024

Ambivalence and uncertainty are key themes throughout the psychology of healthcare literature. This is especially so for individuals at risk of Huntington's disease (HD) deliberating the decision to undergo genetic testing because there is currently no treatment that modifies disease progression. A better understanding of the experience of making a decision about genetic prediction will help practitioners support and guide individuals through this process. Our aim was to capture participants' experiences of uncertainty and ambivalence in between their genetic counseling appointments. We explored these issues through the experiences of nine participants who were referred for predictive HD testing at four regional genetics services in England and Wales. Data consisted of recordings of clinic consultations, diaries, and an in‐depth interview conducted at the end of the testing process. Data were analyzed thematically. Four themes were identified representing four possible futures, each future dependent on the decision to undergo testing and the result of that test. Our results showed that participants, as well as attending more to a future that represents their current situation of not having undergone predictive testing, also attended more to a distant future where a positive predictive result is received and symptoms have started. Participants attended less to the two futures that were more immediate once testing was undertaken (a future where a positive result is received and symptoms have not started and a future where a negative result is received). The use of diaries gave us a unique insight into these participants' experiences of ambivalence and uncertainty, psychological distress, and the emotional burden experienced. These findings help inform discussions within the clinic appointment as well as encourage researchers to consider diary use as a method of exploring what happens for individuals outside of clinical encounters.
New initiation of opioids, benzodiazepines and antipsychotics following hospitalization for COVID‐19
Authors: Harrison Samantha , Capers Krystal , Chen Guanqing , Liu Ji T. , Pannu Ameeka , Goodspeed Valerie , Leibowitz Akiva , Bose Somnath
Published: May 2024

Background

Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored.

Objective

To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in‐patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge.

Design

Single center retrospective cohort study.

Setting and Participants

Patients admitted to a tertiary‐level medical center with either a primary diagnosis of RT‐PCR positive for COVID‐19 or high index of clinical suspicion thereof.

Intervention

None.

Main Outcome and Measures

Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28‐day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge.

Results

1319 patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42–4.12; p = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID‐19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28‐day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm.
Person‐centred interventions to improve patient−provider relationships for HIV services in low‐ and middle‐income countries: a systematic review
Authors: Beres Laura K. , Underwood Ashley , Le Tourneau Noelle , Kemp Christopher Galloway , Kore Gauri , Yaeger Lauren , Li Jingjia , Aaron Alec , Keene Claire , Mallela Deepthi Priyanka , Khalifa Banda A. A. , Mody Aaloke , Schwartz Sheree Renae , Baral Stefan , Mwamba Chanda , Sikombe Kombatende , Eshun‐Wilson Ingrid , Geng Elvin H. , Lavoie Marie‐Claude C.
Published: May 2024

Introduction

Person‐centred care (PCC) has been recognized as a critical element in delivering quality and responsive health services. The patient−provider relationship, conceptualized at the core of PCC in multiple models, remains largely unexamined in HIV care. We conducted a systematic review to better understand the types of PCC interventions implemented to improve patient−provider interactions and how these interventions have improved HIV care continuum outcomes and person‐reported outcomes (PROs) among people living with HIV in low‐ and middle‐income countries.

Methods

We searched databases, conference proceedings and conducted manual targeted searches to identify randomized trials and observational studies published up to January 2023. The PCC search terms were guided by the Integrative Model of Patient‐Centeredness by Scholl. We included person‐centred interventions aiming to enhance the patient−provider interactions. We included HIV care continuum outcomes and PROs.

Results

We included 28 unique studies: 18 (64.3%) were quantitative, eight (28.6.%) were mixed methods and two (7.1%) were qualitative. Within PCC patient−provider interventions, we inductively identified five categories of PCC interventions: (1) providing friendly and welcoming services; (2) patient empowerment and improved communication skills (e.g. supporting patient‐led skills such as health literacy and approaches when communicating with a provider); (3) improved individualized counselling and patient‐centred communication (e.g. supporting provider skills such as training on motivational interviewing); (4) audit and feedback; and (5) provider sensitisation to patient experiences and identities. Among the included studies with a comparison arm and effect size reported, 62.5% reported a significant positive effect of the intervention on at least one HIV care continuum outcome, and 100% reported a positive effect of the intervention on at least one of the included PROs.

Discussion

Among published HIV PCC interventions, there is heterogeneity in the components of PCC addressed, the actors involved and the expected outcomes. While results are also heterogeneous across clinical and PROs, there is more evidence for significant improvement in PROs. Further research is necessary to better understand the clinical implications of PCC, with fewer studies measuring linkage or long‐term retention or viral suppression.

Conclusions

Improved understanding of PCC domains, mechanisms and consistency of measurement will advance PCC research and implementation.
Use of pure recombinant human enzymes to assess the disease‐causing potential of missense mutations in urea cycle disorders, applied to N‐acetylglutamate synthase deficiency
Authors: Gougeard Nadine , Sancho‐Vaello Enea , Fernández‐Murga M. Leonor , Martínez‐Sinisterra Borja , Loukili‐Hassani Badr , Häberle Johannes , Marco‐Marín Clara , Rubio Vicente
Published: May 2024

N‐acetylglutamate synthase (NAGS) makes acetylglutamate, the essential activator of the first, regulatory enzyme of the urea cycle, carbamoyl phosphate synthetase 1 (CPS1). NAGS deficiency (NAGSD) and CPS1 deficiency (CPS1D) present identical phenotypes. However, they must be distinguished, because NAGSD is cured by substitutive therapy with the N‐acetyl‐L‐glutamate analogue N‐carbamyl‐L‐glutamate, while curative therapy of CPS1D requires liver transplantation. Since their differentiation is done genetically, it is important to ascertain the disease‐causing potential of CPS1 and NAGS genetic variants. With this goal, we previously carried out site‐directed mutagenesis studies with pure recombinant human CPS1. We could not do the same with human NAGS (HuNAGS) because of enzyme instability, leading to our prior utilization of a bacterial NAGS as an imperfect surrogate of HuNAGS. We now use genuine HuNAGS, stabilized as a chimera of its conserved domain (cHuNAGS) with the maltose binding protein (MBP), and produced in Escherichia coli. MBP‐cHuNAGS linker cleavage allowed assessment of the enzymatic properties and thermal stability of cHuNAGS, either wild‐type or hosting each one of 23 nonsynonymous single‐base changes found in NAGSD patients. For all but one change, disease causation was accounted by the enzymatic alterations identified, including, depending on the variant, loss of arginine activation, increased KmGlutamate, active site inactivation, decreased thermal stability, and protein misfolding. Our present approach outperforms experimental in vitro use of bacterial NAGS or in silico utilization of prediction servers (including AlphaMissense), illustrating with HuNAGS the value for UCDs of using recombinant enzymes for assessing disease‐causation and molecular pathogenesis, and for therapeutic guidance.
The neuronal ceroid lipofuscinosis type 2 – associated variants: An analysis of alterations in the TPP1 gene and genotype–phenotype correlation in Ukraine
Authors: Olkhovych Nataliia , Pichkur Nataliia , Mytsyk Nataliia , Tonin Rodolfo , Kormoz Svitlana , Hregul Iryna , Samonenko Nataliia , Shklyarskaya Tetiana , Olkhovych Volodymyr , Buryak Olexandr , Morrone Amelia , Gorovenko Nataliia
Published: May 2024

The neuronal ceroid lipofuscinosis type 2 (CLN2) is a heterogeneous group of neurodegenerative lysosomal storage disorders caused by autosomal recessive inheritance of two pathogenic variants in trans in the TPP1 gene. Classical late‐infantile CLN2 disease has a very well‐defined natural history. However, a small number of patients with TPP1 enzyme deficiency present a later onset or protracted disease course within this group there are phenotypic variants. Our work aimed to identify pathological variants in the TPP1 gene that conditioned the development of CLN2 disease in Ukrainian patients, to compare these variants with those found in patients from other European and non‐European regions, and to make genotype–phenotype associations for this disease. The phenotypes and genotypes of the 48 CLN2‐affected individuals belonging to 43 families were profiled through clinical data collection, enzyme analysis, and genotyping. In most patients, genotype and phenotype correlation are in keeping with the data of previous studies. The clinical signs of the disease in patients with new, previously undescribed variants, allowed us to augment existing data about genotype–phenotype correlations for CLN2 disease. The combination of genotype and clinical form of the disease demonstrated that predicting the type and clinical course of the disease based on genotype is very complicated. The data we obtained supplements existing information on genotype–phenotypic correlations in this rare disease, which, in turn, lays the foundation for a personalized approach to the management of this disease.
Clinical and pathophysiologic determinants of catheter ablation outcome in hypertrophic cardiomyopathy with atrial fibrillation
Authors: Lee Jae‐Hyuk , Cho Iksung , Choi Sung Hwa , Yu Hee Tae , Kim Tae‐Hoon , Uhm Jae‐Sun , Joung Boyoung , Lee Moon‐Hyoung , Hong Geu‐Ru , Hwang Chun , Pak Hui‐Nam
Published: May 2024

Background

Hypertrophic cardiomyopathy (HCM) is frequently associated with atrial fibrillation (AF). We compared clinical, echocardiographic, and electrophysiological parameters between HCM subtypes and those without HCM at AF catheter ablation (AFCA) and analyzed post‐AFCA reverse remodeling and AF recurrence based on HCM presence and subtype.

Methods

Among 5161 consecutive patients who underwent de novo AFCA, we included HCM patients and control patients who were age‐, gender‐, and AF type‐matched. Between AF‐HCM patients and controls, we compared baseline values for left atrium (LA) wall thickness (LAWT), reverse remodeling at 1‐year follow‐up, and procedural outcomes over the course of follow‐up between two groups.

Results

A total of 122 AF‐HCM patients and 318 control patients were included. AF‐HCM patients had more frequent heart failure and higher LA diameter, E/Em, and LA pressure (all, p < .001). However, LAWT did not differ from control group. A year after AFCA, degree of LA reverse remodeling was significantly lower in AF‐HCM than in control group (ΔLA dimension, p = .025). Nonapical HCM (HR 1.71; 95% CI 1.05–2.80), persistent AF (HR 1.46; 95% CI 1.05–2.04), and LA dimension (HR 1.04; 95% CI 1.01–1.06) were independent risk factors for AF recurrence. During 78.0 months of follow‐up, nonapical HCM patients showed higher AF recurrence rate than both apical HCM (log‐rank p = .005) and control patients (log‐rank p = .002).

Conclusions

The presence of HCM, particularly nonapical HCM, displayed increased LA hemodynamic loading with diastolic dysfunction and had poorer rhythm outcomes after AFCA compared to both apical HCM and control group.
Ultrasound‐based jawbone surface quality evaluation after alveolar ridge preservation
Authors: Rodriguez Amanda B. , Kripfgans Oliver D. , Kozloff Kenneth M. , Samal Ankita , Woo Jae‐man , Shehabeldin Mostafa , Chan Hsun‐Liang
Published: May 2024

Background

Bone readiness for implant placement is typically evaluated by bone quality/density on 2‐dimensional radiographs and cone beam computed tomography at an arbitrary time between 3 and 6 months after tooth extraction and alveolar ridge preservation (ARP). The aim of this study is to investigate if high‐frequency ultrasound (US) can classify bone readiness in humans, using micro‐CT as a reference standard to obtain bone mineral density (BMD) and bone volume fraction (BVTV) of healed sockets receiving ARP in humans.

Methods

A total of 27 bone cores were harvested during the implant surgery from 24 patients who received prior extraction with ARP. US images were taken immediately before the implant surgery at a site co‐registered with the tissue biopsy collection location, made possible with a specially designed guide, and then classified into 3 tiers using B‐mode image criteria (1) favorable, (2) questionable, and (3) unfavorable. Bone mineral density (hydroxyapatite) and BVTV were obtained from micro‐CT as the gold standard.

Results

Hydroxyapatite and BVTV were evaluated within the projected US slice plane and thresholded to favorable (>2200 mg/cm3; >0.45 mm3/mm3), questionable (1500–2200 mg/cm3; 0.4–0.45 mm3/mm3), and unfavorable (<1500 mg/cm3; <0.4 mm3/mm3). The present US B‐mode classification inversely scales with BMD. Regression analysis showed a significant relation between US classification and BMD as well as BVTV. T‐test analysis demonstrated a significant correlation between US reader scores and the gold standard. When comparing Tier 1 with the combination of Tier 2 and 3, US achieved a significant group differentiation relative to mean BMD (p = 0.004, true positive 66.7%, false positive 0%, true negative 100%, false negative 33.3%, specificity 100%, sensitivity 66.7%, receiver operating characteristics area under the curve 0.86). Similar results were found between US‐derived tiers and BVTV.

Conclusion

Preliminary data suggest US could classify jawbone surface quality that correlates with BMD/BVTV and serve as the basis for future development of US‐based socket healing evaluation after ARP.
Trauma exposure correlates among patients receiving care in federally qualified health centers
Authors: Blanchard Brittany E. , Bluett Ellen J. , Johnson Morgan , Zimberoff Anya , Fortney John C.
Published: May 2024

Over 80% of adults in the general population experience trauma. Rates of patients with posttraumatic stress disorder (PTSD) are high in primary care settings and are likely to be even higher in federally qualified health centers (FQHCs). Trauma exposure has been linked to psychiatric symptoms and physical health comorbidities, though little research has focused on FQHC patients. This study addresses this by examining clinical and sociodemographic correlates of specific trauma types among FQHC patients. We analyzed secondary data from patients who screened positive for PTSD and were receiving health care in FQHCs in a clinical trial (N = 978). Individuals who did versus did not experience a specific trauma type were compared using between‐group tests. In the sample, 91.3% of participants were exposed to a DSM‐5 Criterion A traumatic event, with 79.6% experiencing two or more trauma types. Witnessing a life‐threatening event (57.3%) and physical assault (55.7%) were the most common traumatic experiences. Physical health comorbidities and worse physical health functioning were associated with a higher likelihood of exposure to all trauma types, with effect sizes larger than PTSD, ds = 0.78–1.35. Depressive and anxiety symptoms were also associated with a higher likelihood of experiencing nearly all trauma types to a lesser magnitude. People of color, OR = 2.45, and individuals experiencing financial inequities, OR = 1.73, had higher odds of experiencing serious accidents as well as other trauma types. The findings highlight the need for trauma‐informed care, including routine trauma and PTSD screening, for FQHC patients.