bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe biventricular cardiomyopathy in both current and former long-term users of anabolic–androgenic steroids
Authors: Abdullah Rang , Bjørnebekk Astrid , Hauger Lisa E , Hullstein Ingunn R , Edvardsen Thor , Haugaa Kristina H , Almaas Vibeke M
Published: November 2023

Aims

This study aims to explore the cardiovascular effects of long-term anabolic–androgenic steroid (AAS) use in both current and former weightlifting AAS users and estimate the occurrence of severe reduced myocardial function and the impact of duration and amount of AAS.

Methods and results

In this cross-sectional study, 101 weightlifting AAS users with at least 1 year cumulative AAS use (mean 11 ± 7 accumulated years of AAS use) were compared with 71 non-using weightlifting controls (WLC) using clinical data and echocardiography. Sixty-nine were current, 30 former (>1 year since quitted), and 2 AAS users were not available for this classification. Anabolic–androgenic users had higher left ventricular mass index (LVMI) (106 ± 26 vs. 80 ± 15 g/m2, P < 0.001), worse left ventricular ejection fraction (LVEF) (49 ±7 vs. 59 ± 5%, P < 0.001) and right ventricular global longitudinal strain (−17.3 ± 3.5 vs. −22.8 ± 2.0%, P < 0.001), and higher systolic blood pressure (141 ± 17 vs. 133 ± 11 mmHg, P < 0.001) compared with WLC. In current users, accumulated duration of AAS use was 12 ± 7 years and in former 9 ± 6 years (quitted 6 ± 6 years earlier). Compared with WLC, LVMI and LVEF were pathological in current and former users (P < 0.05) with equal distribution of severely reduced myocardial function (LVEF ≤40%) (11 vs. 10%, not significant (NS)). In current users, estimated lifetime AAS dose correlated with reduced LVEF and LVGLS, P < 0.05, but not with LVMI, P = 0.12. Regression analyses of the total population showed that the strongest determinant of reduced LVEF was not coexisting strength training or hypertension but history of AAS use (β −0.53, P < 0.001).

Conclusion

Long-term AAS users showed severely biventricular cardiomyopathy. The reduced systolic function was also found upon discontinued use.
Co-factor independent oxidases ncnN and actVA-3 are involved in the dimerization of benzoisochromanequinone antibiotics in naphthocyclinone and actinorhodin biosynthesis
Authors: Baral Bikash , Matroodi Soheila , Siitonen Vilja , Thapa Keshav , Akhgari Amir , Yamada Keith , Nuutila Aleksi , Metsä-Ketelä Mikko
Published: November 2023

Streptomyces produce complex bioactive secondary metabolites with remarkable chemical diversity. Benzoisochromanequinone polyketides actinorhodin and naphthocyclinone are formed through dimerization of half-molecules via single or double carbon-carbon bonds, respectively. Here we sequenced the genome of S. arenae DSM40737 to identify the naphthocyclinone gene cluster and established heterologous production in S. albus J1074 by utilizing direct cluster capture techniques. Comparative sequence analysis uncovered ncnN and ncnM gene products as putative enzymes responsible for dimerization. Inactivation of ncnN that is homologous to atypical co-factor independent oxidases resulted in the accumulation of fogacin, which is likely a reduced shunt product of the true substrate for naphthocyclinone dimerization. In agreement, inactivation of the homologous actVA-3 in S. coelicolor M145 also led to significantly reduced production of actinorhodin. Previous work has identified the NAD(P)H-dependent reductase ActVA-4 as the key enzyme in actinorhodin dimerization, but surprisingly inactivation of the homologous ncnM did not abolish naphthocyclinone formation and the mutation may have been complemented by an endogenous gene product. Our data suggests that dimerization of benzoisochromanequinone polyketides require two-component reductase-oxidase systems.
Development of a multiplex recombinase polymerase amplification coupled with lateral flow dipsticks for the simultaneous rapid detection of Salmonella spp., Salmonella Typhimurium and Salmonella Enteritidis
Authors: Zhan Zeqiang , He Shoukui , Cui Yan , Yang Jinzeng , Shi Xianming
Published: November 2023

Objectives

Salmonella spp. is a world-leading foodborne pathogen and its rapid detection is essential for ensuring food safety. Conventional methods require expensive instruments, considerable operational skills and cannot provide fast mobile on-site systems to detect Salmonella in food.

Materials and Methods

A visual method was established based on multiple recombinase polymerase amplification (RPA) coupled with lateral flow dipsticks (LFD) for the simultaneous detection of Salmonella spp., Salmonella Enteritidis and Salmonella Typhimurium in vitro and food.

Results

The optimal volume and temperature for the multiplex RPA-LFD method were determined to be 25 μL and 38 °C, respectively. The reaction process was completed within 25 min and the results were observed visually. The limits of detection (LODs) were 2.8×102, 5.9×102, and 7.6×102 CFU/mL for Salmonella spp., S. Enteritidis and S. Typhimurium, respectively. Meanwhile, the results of the established method showed no cross-reactivity between the Salmonella cells and other common foodborne bacteria, which was highly specific for Salmonella. More importantly, the developed method exhibited good performance in artificially contaminated chicken samples with the LODs of 2.8×103, 5.9×103, and 7.6×103 CFU/mL for Salmonella spp., S. Enteritidis, and S. Typhimurium, respectively. Finally, the application of the multiple RPA-LFD methods in retailed food samples displayed that this method was effective and practical for the detection of Salmonella spp. in food.

Conclusion

The developed multiplex RPA-LFD method provides a new sensitive and rapid alternative for the specific detection of Salmonella spp. and its important serovars in food.
Mixing time of heterogeneities in a buoyancy-dominated magma ocean
Authors: Thomas B , Samuel H , Farnetani C G , Aubert J , Chauvel C
Published: November 2023

During the accretion stage, large impacts provided sufficient energy to melt the entire mantle into a terrestrial magma ocean. Processes occurring in the magma ocean may have led to the formation of heterogeneities still found in modern ocean island basalts. So far, no definitive mechanism exists to explain the survival of early heterogeneities for approximately 4.5 Ga. Addressing this question requires understanding the efficiency of convective mixing during both the early molten and the solid-state stages experienced by the Earth’s mantle. While mixing in the solid mantle and in an essentially crystallized magma ocean has been relatively well documented, the efficiency of convective mixing in a liquid magma ocean has received less attention. In this paper we characterized the mixing efficiency of a convecting fluid in a rotating spherical shell, accounting for inertial effects, by computing finite-time Lyapunov exponents (i.e. the Lagrangian strain rate). We conducted a series of numerical experiments for a regime where the influence of the buoyancy force dominates that of rotation and we derived scaling laws to predict the mixing efficiency. We found that for a terrestrial magma ocean, in its fully liquid state, mixing time is of the order of a few minutes or less, even for initially large (∼1000 km) heterogeneities. Therefore, passive early mantle heterogeneities cannot survive a fully molten magma ocean stage. This suggests that short-lived heterogeneities (e.g. 182Hf−182W) were either created at the end of the accretional stage, or were stored in deeper regions of the Earth.
European plaice movements show evidence of high residency, site fidelity, and feeding around hard substrates within an offshore wind farm
Authors: Buyse Jolien , Reubens Jan , Hostens Kris , Degraer Steven , Goossens Jolien , De Backer Annelies
Published: November 2023

Offshore wind farms (OWFs) are expanding rapidly in the North Sea, often creating spatial conflicts with fisheries. Managing such conflicts requires knowledge on the impact of OWFs on the spatial distribution and movement behaviour of fished species. However, such knowledge is still lacking, especially for soft sediment fish such as flatfish, which are vital fisheries resources in the region. Therefore, we used acoustic telemetry to examine the spatial behaviour of European plaice in relation to an OWF and its structures. In a small study area (1.37 km2), we observed high residency for plaice around the turbines and scour protection layer (SPL), which consists of large rocks around the turbine foundation. The fish primarily resided on sandy sediments near the hard substrates, but showed a diurnal pattern of proximity to the turbine, being closer during the day. Considering their trophic ecology, these findings suggest that plaice moves towards the SPL for feeding opportunities on the hard substrate, potentially leading to increased ecological fish production within OWFs. Although most plaice moved away from the OWF in winter, likely towards spawning grounds, many exhibited high site fidelity returning to the study area after the winter migration. OWFs thus offer protection from fishing mortality as “closed” feeding grounds in spring and summer, but not during winter spawning migrations, which may result in spillover effects. These insights should inform local fisheries management in relation to plaice movement within and around OWFs.
Malaria Species Positivity Rates Among Symptomatic Individuals Across Regions of Differing Transmission Intensities in Mainland Tanzania
Authors: Popkin-Hall Zachary R , Seth Misago D , Madebe Rashid A , Budodo Rule , Bakari Catherine , Francis Filbert , Pereus Dativa , Giesbrecht David J , Mandara Celine I , Mbwambo Daniel , Aaron Sijenunu , Lusasi Abdallah , Lazaro Samwel , Bailey Jeffrey A , Juliano Jonathan J , Ishengoma Deus S
Published: November 2023

Background

Recent data indicate that non-Plasmodium falciparum species may be more prevalent than thought in sub-Saharan Africa. Although Plasmodium malariae, Plasmodium ovale spp., and Plasmodium vivax are less severe than P. falciparum, treatment and control are more challenging, and their geographic distributions are not well characterized.

Methods

We randomly selected 3284 of 12 845 samples collected from cross-sectional surveys in 100 health facilities across 10 regions of Mainland Tanzania and performed quantitative real-time PCR to determine presence and parasitemia of each malaria species.

Results

P. falciparum was most prevalent, but P. malariae and P. ovale were found in all but 1 region, with high levels (>5%) of P. ovale in 7 regions. The highest P. malariae positivity rate was 4.5% in Mara and 8 regions had positivity rates ≥1%. We only detected 3 P. vivax infections, all in Kilimanjaro. While most nonfalciparum malaria-positive samples were coinfected with P. falciparum, 23.6% (n = 13 of 55) of P. malariae and 14.7% (n = 24 of 163) of P. ovale spp. were monoinfections.

Conclusions

P. falciparum remains by far the largest threat, but our data indicate that malaria elimination efforts in Tanzania will require increased surveillance and improved understanding of the biology of nonfalciparum species.
Impact of a sustained, collaborative antimicrobial stewardship programme in spinal cord injury patients
Authors: Perera D , Vogrin S , Khumra S , Motaganahalli S , Batrouney A , Urbancic K , Devchand M , Mitri E , Clements R , Nunn A , Reynolds G , Trubiano J A
Published: November 2023

Background

In patients with spinal cord injuries (SCIs), infections continue to be a leading cause of morbidity, mortality and hospital admission.

Objectives

This study evaluated the long-term impact of a weekly, multidisciplinary Spinal/Antimicrobial Stewardship (AMS) meeting for acute-care SCI inpatients, on antimicrobial prescribing over 3 years.

Methods

A retrospective, longitudinal, pre-post comparison of antimicrobial prescribing was conducted at our tertiary hospital in Melbourne. Antimicrobial prescribing was audited in 6 month blocks pre- (25 April 2017 to 24 October 2017), immediately post- (27 March 2018 to 25 September 2018) and 3 years post-implementation (2 March 2021 to 31 August 2021). Antimicrobial orders for patients admitted under the spinal unit at the meeting time were included.

Results

The number of SCI patients prescribed an antimicrobial at the time of the weekly meeting decreased by 40% at 3 years post-implementation [incidence rate ratio (IRR) 0.63; 95% CI 0.51–0.79; P ≤ 0.001]. The overall number of antimicrobial orders decreased by over 22% at 3 years post-implementation (IRR 0.78; 95% CI 0.61–1.00; P = 0.052). A shorter antimicrobial order duration in the 3 year post-implementation period was observed (−28%; 95% CI −39% to −15%; P ≤ 0.001). This was most noticeable in IV orders at 3 years (−36%; 95% CI −51% to −16%; P = 0.001), and was also observed for oral orders at 3 years (−25%; 95% CI −38% to −10%; P = 0.003). Antimicrobial course duration (days) decreased for multiple indications: skin and soft tissue infections (−43%; 95% CI −67% to −1%; P = 0.045), pulmonary infections (−45%; 95% CI −67% to −9%; P = 0.022) and urinary infections (−31%; 95% CI −47% to −9%; P = 0.009). Ninety-day mortality rates were not impacted.

Conclusions

This study showed that consistent, collaborative meetings between the Spinal and AMS teams can reduce antimicrobial exposure for acute-care SCI patients without adversely impacting 90 day mortality.
Evaluation ofLentilactobacillus parafarraginisA6-2 strain for aluminum removal and anti-inflammatory effects: implications for alleviating Al toxicity
Authors: Lee Se-Won , Lim Jeong-Muk , Lee Gwang-Min , Park Jung-Hee , Seralathan Kamala-Kannan , Oh Byung-Taek
Published: November 2023

Aim

To assess the effectiveness of Lentilactobacillus parafarraginis A6-2 cell lysate for the removal of aluminum (Al), which induces neurotoxicity, and its protective effect at cellular level.

Methods and results

The cell lysate of the selected L. parafarraginis A6-2 strain demonstrated superior Al removal compared to live or dead cells. The Al removal efficiency of L. parafarraginis A6-2 cell lysate increased with decreasing pH and increasing temperature, primarily through adsorption onto peptidoglycan. Neurotoxicity mitigation potential of L. parafarraginis A6-2 was evaluated using C6 glioma cells. C6 cells exposed with increasing concentration of Al led to elevated toxicity and inflammation, which were gradually alleviated upon treatment with L. parafarraginis A6-2. Moreover, Al-induced oxidative stress in C6 cells showed a concentration-dependent reduction upon treatment with L. parafarraginis A6-2.

Conclusions

This study demonstrated that L. parafarraginis A6-2 strain, particularly in its lysate form, exhibited enhanced capability for Al removal. Furthermore, it effectively mitigated Al-induced toxicity, inflammation, and oxidative stress.
Staged revascularization and multi-modal mechanical circulatory supports in a patient with severe cardiogenic shock due to acute-on-chronic coronary syndrome
Authors: Horimoto Miri , Tsutsui Masahiro , Mochizuki Nobuhiro , Setogawa Yuki , Suzuki Fumitaka , Narita Masahiko , Hirofuzi Aina , Kunioka Shingo , Shirasaka Tomonori , Ishikawa Natsuya , Kamiya Hiroyuki
Published: November 2023

Acute coronary syndrome with cardiogenic shock is a life-threatening condition, but with planned staged treatment combined with coronary revascularization and mechanical circulatory supports its management is increasingly possible. Here, we present our successful life-saving case. A 76-year-old male patient was diagnosed with ST-elevation myocardial infarction with cardiogenic shock due to severe stenosis of the left main coronary artery based on the severe triple vessel disease. We initially introduced Impella CP and performed a percutaneous coronary intervention without stenting on the patient. We maintained hemodynamics with Impella CP and performed coronary artery bypass grafting after a week. Intraoperatively, Impella CP was left to function as a left ventricular vent. The patient required upgrading to Impella 5.5 plus veno-arterial extracorporeal membrane oxygenation postoperatively, but his condition gradually improved, all mechanical circulatory supports could be weaned off, and he eventually survived.
Factors affecting upper limb ergonomics in robotic colorectal surgery
Authors: Wong Shing Wai , Ang Zhen Hao , Lim Ranah , Wong Xiuling Jasmine , Crowe Philip
Published: November 2023

The aim of the study was to examine the factors which may influence suboptimal ergonomic surgeon hand positioning during robotic colorectal surgery (RCS). An observational study of 11 consecutive RCS cases from June 2022 to August 2022 was performed. Continuous video footage of RCS cases was analysed concurrently with video recordings of surgeon’s hand positions at the console. The outcome studied was the frequency with which either hand remained in a suboptimal ergonomic position outside the predetermined double box outlines, as marked on the surgeon’s video, for >1 min. Situations which resulted in poor upper limb ergonomics were dissection in the peripheral operating field location, left-hand use, use of the stapler, dissection of the main mesenteric blood vessels, and multi-quadrant surgery. Being aware of situations when suboptimal ergonomic positions occur can allow surgeons to consciously compensate by using the clutch or pausing to take a rest break.

What does this paper add to the literature?

The study is important because it is the first to look at factors which may influence poor upper limb ergonomics during non-simulated RCS. By recognizing these factors and compensating for them, it may improve surgeon ergonomics with resultant better performance.
Comparison of chitosan and SLN nano-delivery systems for antibacterial effect of tea tree (Melaleuca alternifolia) oil against P. aeruginosa and S. aureus
Authors: Vase Hasti , Nemattalab Mehran , Rohani Masoumeh , Hesari Zahra
Published: November 2023

Treatment of wounds is challenging due to bacterial infections, including Staphylococcus aureus and Pseudomonas aeruginosa. Using the merits of alternative antimicrobials like tea tree oil (TTO) and nanotechnology, they can be helpful in combatting bacterial infections. Solid lipid nanoparticle (SLN) and chitosan (CS) nanoparticles show great potential as carriers for enhancing the stability and therapeutic benefits of oils. The aim of this study is to compare the influence of nanocarriers in enhancing the antibacterial effects of TTO. The study evaluates the physicochemical and antibacterial properties of TTO-SLN and TTO-CS against P. aeruginosa and S. aureus. The TTO-SLN nanoparticles showed a clear round shape with the average diameter size of 477 nm, while the TTO-CS nanoparticles illustrated very homogeneous morphology with 144 nm size. The encapsulation efficiency for TTO-CS and TTO-SLN was ∼88.3% and 73.5%, respectively. Minimum inhibitory concentration against S. aureus and P. aeruginosa for TTO-CS, TTO-SLN, and pure TTO were 35 and 45 µg ml−1, 130 and 170 µg ml−1, and 380 and 410 µg ml−1, respectively. Since TTO-CS revealed an impressively higher antimicrobial effects in comparison with TTO-SLN and TTO alone, it can be considered as a nanocarrier that produces the same antimicrobial effects with lower required amounts of the active substance.
Applying Theory to Practice
Authors: Fagin Ronald
Published: November 2023

By making use of three IBM case studies involving the author and colleagues, this paper is about applying theory to practice. In the first case study, the system builders (or practitioners) initiated the interaction. This interaction led to the following problem. Assume that there is a set of objects, each with multiple attributes, and there is a numerical score assigned to each attribute of each object. In the spirit of real-valued logics, there is a scoring function (such as the min or the average), and a ranking of the objects is obtained by applying the scoring function to the scores of each object’s attributes The problem is to find the top $k$ objects, while minimizing the number of database accesses. An algorithm is given that is optimal in an extremely strong sense: not just in the worst case or the average case, but (up to a constant factor) in every case! Even though the algorithm is only 8 lines long (!), the paper containing the algorithm won the 2014 Gödel Prize, the top prize for a paper in theoretical computer science. The interaction in the second case study was initiated by theoreticians, who wanted to lay the foundations for ‘data exchange’, in which data is converted from one format to another. Although this problem may sound mundane, the issues that arise are fascinating, and this work made data exchange a new subfield, with special sessions in every major database conference. This work won the 2020 Alonzo Church Award, the highest prize for research in logic and computation. The third case study, specifically on real-valued (or ‘fuzzy’) logic, arose as part of a large ‘Logical Neural Nets’ (LNN) project at IBM. The inputs to, say, an ‘and’ gate could each be any numbers in the interval [0,1]. The system builders of LNN wanted a sound and complete axiomatization for real-valued logic, so that they could arrive at truth values given other truth values whenever possible. This recent work provides a sound and complete axiomatization for a large class of real-valued logics, including the most common ones. It also allows weights, where the importance of some subformulas can be greater than that of other subformulas. This paper is aimed at both theoreticians and system builders, to show them the mutual benefits of working together. This is via the three case studies mentioned above: two initiated by the system builders, and one by the theoreticians. The moral for the theoreticians is to show by example how to apply theory to practice, and why applying theory to practice can lead to better theory. The moral for the system builders is the value of theory, and the value of involving theoreticians. This paper is written in a very informal style. In fact, it is based closely on a talk on ‘Applying theory to practice’ that the author has presented a number of times.
iMaNGA: mock MaNGA galaxies based on IllustrisTNG and MaStar SSPs. - III. Stellar metallicity drivers in MaNGA and TNG50
Authors: Nanni Lorenza , Neumann Justus , Thomas Daniel , Maraston Claudia , Trayford James , Lovell Christopher C , Law David R , Yan Renbin , Chen Yanping
Published: November 2023

The iMaNGA project uses a forward-modelling approach to compare the predictions of cosmological simulations with observations from SDSS-IV/MaNGA. We investigate the dependency of age and metallicity radial gradients on galaxy morphology, stellar mass, stellar surface mass density (Σ*), and environment. The key of our analysis is that observational biases affecting the interpretation of MaNGA data are emulated in the theoretical iMaNGA sample. The simulations reproduce the observed global stellar population scaling relations with positive correlations between galaxy mass and age/metallicity quite well and also produce younger stellar populations in late-type in agreement with observations. We do find interesting discrepancies, though, that can inform the physics and further development of the simulations. Ages of spiral galaxies and low-mass ellipticals are overestimated by about 2–4 Gyr. Radial metallicity gradients are steeper in iMaNGA than in MaNGA, a discrepancy most prominent in spiral and lenticular galaxies. Also, the observed steepening of metallicity gradients with increasing galaxy mass is not well matched by the simulations. We find that the theoretical radial profiles of surface mass density Σ* are steeper than in observations except for the most massive galaxies. In both MaNGA and iMaNGA [Z/H] correlates with Σ*, however, the simulations systematically predict lower [Z/H] by almost a factor of 2 at any Σ*. Most interestingly, for galaxies with stellar mass log M* ≤ 10.80 M⊙, the MaNGA data reveal a positive correlation between galaxy radius and [Z/H] at fixed Σ*, which is not recovered in iMaNGA. Finally, the dependence on environmental density is negligible in both the theoretical iMaNGA and the observed MaNGA data.
TFCheckpoint database update, a cross-referencing system for transcription factors from human, mouse and rat
Authors: Acencio Marcio L , Vazquez Miguel , Chawla Konika , Lægreid Astrid , Kuiper Martin
Published: November 2023

Prior knowledge about DNA-binding transcription factors (dbTFs), transcription co-regulators (coTFs) and general transcriptional factors (GTFs) is crucial for the study and understanding of the regulation of transcription. This is reflected by the many publications and database resources describing knowledge about TFs. We previously launched the TFCheckpoint database, an integrated resource focused on human, mouse and rat dbTFs, providing users access to a comprehensive overview of these proteins. Here, we describe TFCheckpoint 2.0 (https://www.tfcheckpoint.org/index.php), comprising 13 collections of dbTFs, coTFs and GTFs. TFCheckpoint 2.0 provides an easy and versatile cross-referencing system for users to view and download collections that may otherwise be cumbersome to find, compare and retrieve.
Microbes in mass extinction: an accomplice or a savior?
Authors: Luo Genming , Liu Deng , Yang Hao
Published: November 2023

The invisible microbes are the main components of the biosphere and proliferated in many mass extinctions of animals. Whether the proliferation of microbes was an accomplice or a savior of the mass extinction remains uncertain. Future work has to quantify the dual effects of microbes on the environment.
Teaching Everyone Everywhere All at Once: Leveraging Social Media to Implement a Multisite Fungal Diagnostics Curriculum
Authors: Nematollahi Saman , Tackett Sean , Grieb Suzanne , Laracy Justin C , Belcher Anne , Marr Kieren A , Shoham Shmuel , Avery Robin K , Melia Michael T
Published: November 2023

Background

Environmental fungi are threats to personal and public health. Fungal in vitro diagnostics help diagnose invasive fungal infections (IFIs), but clinicians remain underinformed about their use and interpretation. Given the increasing use of social media to share infectious diseases–related content, we designed and implemented a multisite Twitter-based curriculum focused on IFIs and related diagnostics.

Methods

Questions were posted through a dedicated Twitter account twice weekly over 8 weeks. We surveyed clinicians at 3 US academic centers before and after completion of the curriculum and interviewed a subset of participants. We undertook quantitative and qualitative evaluations and reviewed Twitter analytics.

Results

We surveyed 450 participants. One hundred twenty-one participants (27%) completed the knowledge assessment precurriculum, 68 (15%) postcurriculum, and 53 (12%) pre- and postcurriculum. We found a significant increase (72% vs 80%, P = .005) in the percentage of correct answers in the pre- versus postcurriculum knowledge assessments. Perceived benefits included a well-executed curriculum that facilitated engagement with appropriately detailed tweetorials from a dedicated Twitter account. Perceived barriers included lack of awareness of tweetorial posts and timing, competing priorities, and the coronavirus disease 2019 pandemic. The Twitter account accrued 1400 followers from 65 countries during the 8-week period. Tweets with multiple-choice questions had a median of 14 904 impressions (interquartile range [IQR], 12 818–16 963), 798 engagements (IQR, 626–1041), and an engagement rate of 6.1% (IQR, 4.2%–6.6%).

Conclusions

Educators can leverage social media to share content with a large audience and improve knowledge while being mindful of the barriers associated with implementing a curriculum on social media.
The Institutional Topology of International Regime Complexes
Authors: Daßler Benjamin
Published: November 2023

The implicit topology of international institutional complexes varies greatly across policy areas. In some areas, the lion’s share of everyday policy cooperation is shaped by a single institution, with alternative and more regional institutions operating in its shadow. In other policy fields, institutional structures appear to be different, seeing a range of non-hierarchical, decentralized, alternative institutions. The Institutional Topology of International Regime Complexes: Mapping Interinstitutional Structures in Global Governance provides a systematic analysis of the varying institutional topologies underlying five regime complexes: intellectual property, tax avoidance, financial stability, development aid, and energy governance. The book offers a comprehensive analysis of both the empirical manifestation of interinstitutional structures across various policy fields of global governance and the issue specific factors that shape their long-term evolution. Theoretically, the book highlights the significant variation in institutional opportunity structures for states across issue areas. It suggests that these crucial differences translate into long-term centripetal or centrifugal effects on institutional topologies. Empirically, the book combines network analyses with qualitative case studies tracing institutionalization processes across five highly relevant issue areas of global governance. It shows how the nature of issue-specific cooperation problems translates into disparate structures among multilateral institutions occupying the same regime complex. In light of growing concerns about the future trajectories of global governance in times of heightened geopolitical tensions, this book offers a fresh perspective to comparatively capture the profoundly varying institutional landscapes across different issue areas and their associated challenges and opportunities of multilateral cooperation.
Climate change, complexity, and policy design
Authors: Braunerhjelm Pontus , Hepburn Cameron
Published: November 2023

The challenges of combatting climate change are unprecedented and now very urgent. Current approaches are not working fast enough. This paper, and this journal issue, conceive of the challenge as one of non-marginal structural and institutional change. Several different conceptual frameworks and pluralist theories are considered, emanating from complexity theory, economics, natural sciences, political economy, and strategy. These are deployed to identify potential accelerators, including synergies between climate action and other key political issues, and beneficial non-linear dynamics such as shifts in consumer preferences and technology learning curves. The delays in action also mean that removing carbon dioxide from the atmosphere is now necessary, and even unconventional geoengineering approaches may need to be considered. A pluralist and practical approach to climate action, accounting for different institutional and social contexts across countries, is argued to be required to accelerate action.
Development of a fast-response Parallel-Plate Avalanche Counter with strip-readout for heavy-ion beams
Authors: Hanai Shutaro , Ota Shinsuke , Kojima Reiko , Masuoka Shoichiro , Dozono Masanori , Imai Nobuaki , Michimasa Shin’ichiro , Shimoura Susumu , Zenihiro Juzo , Inaba Kento , Hijikata Yuto , Longhi Ru , Nakajima Ryo
Published: November 2023

A strip-readout parallel-plate avalanche counter (SR-PPAC) has been developed with the aim of high-detection efficiency and good position resolution in high-intensity heavy-ion measurements. The performance was evaluated using 115 MeV u-1 132Xe, 300 MeV u-1 132Sn, and 300 MeV u-1 48Ca beams. A detection efficiency of greater than 99 percent for these beams is achieved even at an incident beam intensity of 0.7 million particles per second. The best position resolution achieved is 100 µm.
Development of the Mandarin Digit-in-Noise Test and Examination of the Effect of the Number of Digits Used in the Test
Authors: Wang Shangqiguo , Wong Lena L. N.
Published: November 2023

Objectives:

The study aimed to develop and validate the Mandarin digit-in-noise (DIN) test using four digit (i.e., two-, three-, four-, and five-digit) sequences. Test-retest reliability and criterion validity were evaluated. How the number of digits affected the results was examined. The research might lead to more informed choice of DIN tests for populations with specific cognitive needs such as memory impairment.

Design:

The International Collegium of Rehabilitative Audiology guideline for developing the DIN was adapted to create test materials. The test-retest reliability and psychometric function of each digit sequence were determined among young normal-hearing adults. The criterion validity of each digit sequence was determined by comparing the measured performance of older adult hearing aid users with that obtained from two other well-established sentence-in-noise tests: the Mandarin hearing-in-noise test and the Mandarin Chinese matrix test. The relation between the speech reception thresholds (SRTs) of each digit sequence of the DIN test and working memory capacity measured using the digit span test and the reading span test were explored among older adult hearing aid users. Together, the study sample consisted of 54 young normal-hearing adults and 56 older adult hearing aid users.

Results:

The slopes associated with the two-, three-, four-, and five-digit DIN test were 16.58, 18.79, 20.42, and 21.09 %/dB, respectively, and the mean SRTs were −11.11, −10.99, −10.56, and −10.02 dB SNR, respectively. Test-retest SRTs did not differ by more than 0.74 dB across all digit sequences, suggesting good test-retest reliability. Spearman rank-order correlation coefficients between SRTs obtained using the DIN across the four digit (i.e., two-, three-, four-, and five-digit) sequences and the two sentence-in-noise tests were uniformly high (r

s
= 0.9) across all participants, when data from all participants were considered. Results from the digit span test and reading span test correlated significantly with the results of the five-digit sequences (r

s
= −0.37 and −0.42, respectively) but not with the results of the two-, three-, and four-digit sequences among older hearing aid users.

Conclusions:

While the three-digit sequence was found to be appropriate for clinical use for assessment of auditory perception, the two-digit sequence could be used for hearing screening. The five-digit sequence could be difficult for older hearing aid users, and with its SRT related to working memory capacity, its use in the evaluation of speech perception should be investigated further. The Mandarin DIN test was found to be reliable, and the findings are in line with SRTs obtained using standardized sentence tests, suggesting good criterion validity.
Iterative Development: Going with the Flow to Improve Care
Authors: Cordero Chani A.
Published: November 2023

Healthcare can benefit immensely from implementing an Agile mindset. Specifically, Agile principles of value-driven delivery, adaptive planning, and continuous improvement can exert a positive impact on projects—especially amid the constant changes in laws, evidence-based practices, and technology in healthcare. The best way to apply Agile is to combine the discipline and structure of a traditional linear model with the adaptability of iterative development. That mix allows for certain controls but with the flexibility for stakeholders to provide input and call for adjustments at different stages. To start, an organization must build teams of multidisciplinary personnel with diverse perspectives. Delivering value should be addressed as soon as possible by considering stakeholder priorities, using tools for continuous project planning, and employing retrospectives to provide feedback and identify root causes. When leaders embrace value-driven delivery, adaptive planning, and continuous improvement, healthcare projects can lead to positive results and ultimately improve patient care.
Evaluating ChatGPT on Orbital and Oculofacial Disorders: Accuracy and Readability Insights
Authors: Balas Michael , Janic Ana , Daigle Patrick , Nijhawan Navdeep , Hussain Ahsen , Gill Harmeet , Lahaie Gabriela L. , Belliveau Michel J. , Crawford Sean A. , Arjmand Parnian , Ing Edsel B.
Published: November 2023

Purpose:

To assess the accuracy and readability of responses generated by the artificial intelligence model, ChatGPT (version 4.0), to questions related to 10 essential domains of orbital and oculofacial disease.

Methods:

A set of 100 questions related to the diagnosis, treatment, and interpretation of orbital and oculofacial diseases was posed to ChatGPT 4.0. Responses were evaluated by a panel of 7 experts based on appropriateness and accuracy, with performance scores measured on a 7-item Likert scale. Inter-rater reliability was determined via the intraclass correlation coefficient.

Results:

The artificial intelligence model demonstrated accurate and consistent performance across all 10 domains of orbital and oculofacial disease, with an average appropriateness score of 5.3/6.0 (“mostly appropriate” to “completely appropriate”). Domains of cavernous sinus fistula, retrobulbar hemorrhage, and blepharospasm had the highest domain scores (average scores of 5.5 to 5.6), while the proptosis domain had the lowest (average score of 5.0/6.0). The intraclass correlation coefficient was 0.64 (95% CI: 0.52 to 0.74), reflecting moderate inter-rater reliability. The responses exhibited a high reading-level complexity, representing the comprehension levels of a college or graduate education.

Conclusions:

This study demonstrates the potential of ChatGPT 4.0 to provide accurate information in the field of ophthalmology, specifically orbital and oculofacial disease. However, challenges remain in ensuring accurate and comprehensive responses across all disease domains. Future improvements should focus on refining the model’s correctness and eventually expanding the scope to visual data interpretation. Our results highlight the vast potential for artificial intelligence in educational and clinical ophthalmology contexts.
Rotational stability of a new hydrophobic acrylic intraocular lens platform
Authors: Werner Liliana , Hawn Vivian S. , Bundogji Nour , Eid Kevin , Kelkar Neil , Renschler Andy , Mamalis Nick
Published: November 2023

Purpose:

To evaluate rotational stability for ease of rotation of a new intraocular lens (IOL) platform with 4 haptics in an ex vivo model and compare it with a control single-piece lens with 2 open loops.

Setting:

Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design:

Experimental study.

Methods:

10 human cadaver eyes were prepared as per the Miyake-Apple technique. After injection of the test or control lens, clockwise and counterclockwise rotations were attempted with a hook, with and without an ophthalmic viscosurgical device in place. Ease of rotation was scored as (1) very easy, (2) easy, (3) difficult, and (4) very difficult. Rotation of the entire eye containing test or control IOL was also performed with a multipurpose rotator (2 minutes; 220 revolutions per minute) to evaluate its effect on IOL alignment.

Results:

There were statistically significant differences regarding ease of rotation between test and control lenses in all 4 scenarios, with rotation being more difficult with the test lens (P < .05, Wilcoxon signed-rank test). No change in the alignment of test or control lenses was observed after eye rotation with the multipurpose rotator.

Conclusions:

The new IOL platform showed greater rotational stability than the control lens in this model, owing to design features such as 4 small arcs of contact between the haptics and the bag equator, a bulge at the distal end of each haptic, and arcuate haptics with curvatures oriented toward each other.
Major adverse cardiovascular events of vascular endothelial growth factor tyrosine kinase inhibitors among patients with different malignancy: A systemic review and network meta-analysis
Authors: Chen Yen-Chou , Chen Jin-Hua , Hsieh Fang-I
Published: November 2023

Background:

Vascular endothelial growth factor tyrosine kinase inhibitors (VEGF-TKIs) are a common cancer treatment. However, the pharmacologic characteristics of VEGF-TKIs may influence cardiovascular risks. The relative risks of major adverse cardiovascular events (MACEs) associated with VEGF-TKIs are poorly understood.

Methods:

We searched PubMed, Embase, and ClinicalTrials.gov from inception until August 31, 2021, for phase II/III randomized controlled trials of 11 VEGF-TKIs (axitinib, cabozantinib, lenvatinib, pazopanib, ponatinib, ripretinib, regorafenib, sorafenib, sunitinib, tivozanib, and vandetanib). The endpoints were heart failure, thromboembolism, and cardiovascular death. The Mantel-Haenszel method was used to calculate the risk of VEGF-TKI among users by comparing it to nonusers. Pairwise meta-analyses with a random-effects model were used to estimate the risks of the various VEGF-TKIs. We estimated ranked probability with a P-score and assessed credibility using the Confidence in Network Meta-Analysis framework.

Results:

We identified 69 trials involving 30 180 patients with cancer. The highest risk of MACEs was associated with high-potency tivazonib (odds ratio [OR]: 3.34), lenvatinib (OR: 3.26), and axitinib (OR: 2.04), followed by low-potency pazopanib (OR: 1.79), sorafenib (OR: 1.77), and sunitinib (OR: 1.66). The risk of heart failure significantly increased in association with less-selective sorafenib (OR: 3.53), pazopanib (OR: 3.10), and sunitinib (OR: 2.65). The risk of thromboembolism significantly increased in association with nonselective lenvatinib (OR: 3.12), sorafenib (OR: 1.54), and sunitinib (OR: 1.53). Higher potency (tivozanib, axitinib) and lower selectivity (sorafenib, vandetanib, pazopanib, sunitinib) were associated with a higher probability of heart failure. Low selectivity (lenvatinib, cabozantinib, sorafenib, sunitinib) was associated with a higher probability of thromboembolism.

Conclusion:

Higher-potency and lower-selectivity VEGF-TKIs may influence the risks of MACEs, heart failure, and thromboembolism. These findings may facilitate evidence-based decision-making in clinical practice.
Correlation between baseline immature platelets fraction levels and peak troponin in patients with acute myocardial infarction
Authors: Roguin Nir , Dahan Shani , Reiner-Benaim Anat , Laish-Farkash Avishag , Yahud Ella , Kogan Yonatan , Vasilenko Luba , Lev Eli I. , Ben-Assa Eyal
Published: November 2023

Introduction

Elevated peak cardiac troponin levels have been linked with increased morbidity and mortality in patients with acute myocardial infarction (AMI). Immature Platelets are young and relatively large platelets that are hyper-reactive and pro-thrombotic compared to regular platelets. Increased immature platelet fraction (IPF) has been associated with an elevated risk of thrombotic events. We hypothesize that patients with higher IPF levels during AMI, will experience a more severe infarct, leading to elevated peak troponin levels.

Methods

Clinical data from patients admitted to the cardiology division between 2018 and 2022, who were diagnosed with AMI and underwent an IPF testing. Univariate and multivariate regression analyses were performed to identify predictors of elevated peak troponin.

Results

Among the 277 patients diagnosed with AMI who underwent IPF testing, 113 had (STEMI) and 164 had (NSTEMI). The median value of IPF of 4.2% was used as the threshold for defining elevated IPF. Notably, among STEMI patients, those with IPF ≥ 4.2% had significantly higher peak troponin levels (P = 0.021). Conversely, no significant difference in peak troponin levels was observed among NSTEMI patients (P = 0.348). Multivariate analysis identified patients with STEMI in the higher IPF group as one of the significant predictors for elevated peak troponin levels.

Conclusion

This study revealed a correlation between higher baseline IPF levels and increased peak troponin levels specifically in STEMI patients, while no such association was found in NSTEMI patients. Incorporating IPF levels above the median into risk stratification scores for STEMI patients may provide valuable support for adopting a more proactive therapeutic approach.