bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-world Evidence Comparing Tofacitinib and Vedolizumab in Anti-TNF-experienced Patients With Ulcerative Colitis
Authors: Adimadhyam Sruthi , Lewis James D , Simon Andrew L , Wolfe Audrey E , Smith Samantha , Hou Laura , Moyneur Érick , Reynolds Juliane S , Toh Sengwee , Dobes Angela , Parlett Lauren , Haynes Kevin , Burris Jessica , Dorand Jennifer E , Long Millie D , Kappelman Michael D
Published: June 2023

Background

Antitumor necrosis factor (anti-TNF) inhibitors are first-line treatment among patients with ulcerative colitis (UC). With time, patients tend to lose response or become intolerant, necessitating switching to small cell biologics such as tofacitinib or vedolizumab. In this real-world study of a large, geographically diverse US population of TNF-experienced patients with UC, we evaluated the effectiveness and safety of newly initiating treatment with tofacitinib vs vedolizumab.

Methods

We conducted a cohort study using secondary data from a large US insurer (Anthem, Inc.). Our cohort included patients with UC newly initiating treatment with tofacitinib or vedolizumab. Patients were required to have evidence of treatment with anti-TNF inhibitors in the 6 months prior to cohort entry. The primary outcome was treatment persistence >52 weeks. Additionally, we evaluated the following secondary outcomes as additional measures of effectiveness and safety: (1) all-cause hospitalization; (2) total abdominal colectomy; (3) hospitalization for infection; (4) hospitalization for malignancy; (5) hospitalization for cardiac events; and (6) hospitalization for thromboembolic events. We used fine stratification by propensity scores to control for confounding by demographics, clinical factors, and treatment history at baseline.

Results

Our primary cohort included 168 new users of tofacitinib and 568 new users of vedolizumab. Tofacitinib was associated with lower treatment persistence (adjusted risked ratio, 0.77; 95% CI, 0.60 -0.99). Differences in secondary measures of effectiveness or safety between tofacitinib initiators vs vedolizumab initiators were not statistically significant (all-cause hospitalization, adjusted hazard ratio, 1.23; 95% CI, 0.83-1.84; total abdominal colectomy, adjusted HR, 1.79; 95% CI, 0.93-3.44;and hospitalization for any infection, adjusted HR, 1.94; 95% CI, 0.83-4.52).

Discussion

Ulcerative colitis patients with prior anti-TNF experience initiating tofacitinib demonstrated lower treatment persistence compared with those initiating vedolizumab. This finding is in contrast to other recent studies suggesting superior effectiveness of tofacitinib. Ultimately, head-to-head randomized, controlled trials that focus on directly measured end points may be needed to best inform clinical practice.
Optimal adaptive nonpharmaceutical interventions to mitigate the outbreak of respiratory infections following the COVID-19 pandemic: a deep reinforcement learning study in Hong Kong, China
Authors: Yao Yao , Zhou Hanchu , Cao Zhidong , Zeng Daniel Dajun , Zhang Qingpeng
Published: June 2023

Background

Long-lasting nonpharmaceutical interventions (NPIs) suppressed the infection of COVID-19 but came at a substantial economic cost and the elevated risk of the outbreak of respiratory infectious diseases (RIDs) following the pandemic. Policymakers need data-driven evidence to guide the relaxation with adaptive NPIs that consider the risk of both COVID-19 and other RIDs outbreaks, as well as the available healthcare resources.

Methods

Combining the COVID-19 data of the sixth wave in Hong Kong between May 31, 2022 and August 28, 2022, 6-year epidemic data of other RIDs (2014–2019), and the healthcare resources data, we constructed compartment models to predict the epidemic curves of RIDs after the COVID-19-targeted NPIs. A deep reinforcement learning (DRL) model was developed to learn the optimal adaptive NPIs strategies to mitigate the outbreak of RIDs after COVID-19-targeted NPIs are lifted with minimal health and economic cost. The performance was validated by simulations of 1000 days starting August 29, 2022. We also extended the model to Beijing context.

Findings

Without any NPIs, Hong Kong experienced a major COVID-19 resurgence far exceeding the hospital bed capacity. Simulation results showed that the proposed DRL-based adaptive NPIs successfully suppressed the outbreak of COVID-19 and other RIDs to lower than capacity. DRL carefully controlled the epidemic curve to be close to the full capacity so that herd immunity can be reached in a relatively short period with minimal cost. DRL derived more stringent adaptive NPIs in Beijing.

Interpretation

DRL is a feasible method to identify the optimal adaptive NPIs that lead to minimal health and economic cost by facilitating gradual herd immunity of COVID-19 and mitigating the other RIDs outbreaks without overwhelming the hospitals. The insights can be extended to other countries/regions.
Mixed-reality for quadruped-robotic guidance in SAR tasks
Authors: Cruz Ulloa Christyan , del Cerro Jaime , Barrientos Antonio
Published: June 2023

In recent years, exploration tasks in disaster environments, victim localization and primary assistance have been the main focuses of Search and Rescue (SAR) Robotics. Developing new technologies in Mixed Reality (M-R) and legged robotics has taken a big step in developing robust field applications in the Robotics field. This article presents MR-RAS (Mixed-Reality for Robotic Assistance), which aims to assist rescuers and protect their integrity when exploring post-disaster areas (against collapse, electrical, and toxic risks) by facilitating the robot’s gesture guidance and allowing them to manage interest visual information of the environment. Thus, ARTU-R (A1 Rescue Tasks UPM Robot) quadruped robot has been equipped with a sensory system (lidar, thermal, and RGB-D cameras) to validate this proof of concept. On the other hand, Human-Robot interaction is executed by using the Hololens glasses. This work’s main contribution is the implementation and evaluation of a Mixed-Reality system based on a ROS-Unity solution, capable of managing at a high level the guidance of a complex legged robot through different interest zones (defined by a Neural Network and a vision system) of a post-disaster environment (PDE). The robot’s main tasks at each point visited involve detecting victims through thermal, RGB imaging, and neural networks and assisting victims with medical equipment. Tests have been carried out in scenarios that recreate the conditions of PDE (debris, simulation of victims, etc.). An average efficiency improvement of 48% has been obtained when using the immersive interface and a time optimization of 21.4% compared to conventional interfaces. The proposed method has proven to improve rescuers’ immersive experience of controlling a complex robotic system.
Prognostic significance of pre-treatment albumin-bilirubin grade in metastatic urothelial carcinoma receiving pembrolizumab
Authors: Yamashita Shimpei , Wada Takuma , Deguchi Ryusuke , Mashima Nobuyuki , Higuchi Masatoshi , Miyai Haruka , Koike Hiroyuki , Kohjimoto Yasuo , Hara Isao
Published: June 2023

Background

Pre-treatment albumin-bilirubin grade is a useful biomarker for predicting prognosis in patients receiving immune checkpoint inhibitors for advanced malignancies. We evaluated the prognostic impact of pre-treatment albumin-bilirubin grade in patients receiving pembrolizumab for metastatic urothelial carcinoma.

Methods

In this multicenter retrospective study, we calculated pre-treatment albumin-bilirubin scores of 96 patients who received pembrolizumab for metastatic urothelial carcinoma between January 2018 and March 2022. Patients were classified according to albumin-bilirubin grade. Progression-free survival and cancer-specific survival were compared between the groups. To evaluate the prognostic impact of pre-treatment albumin-bilirubin grade, we also performed Cox proportional regression analyses for progression-free survival and cancer-specific survival.

Results

The median pre-treatment albumin bilirubin score was −2.52 (quartile: −2.76 to −2.10), and albumin-bilirubin grade was grade 1 in 37 patients (39%), grade 2a in 30 patients (31%), 2b in 22 patients (23%) and grade 3 in 7 patients (7%). The median progression-free survival and cancer-specific survival were 2 and 7 months, respectively. Progression-free survival and cancer-specific survival were significantly different between the albumin-bilirubin grade groups (P < 0.01 and P < 0.01, respectively) and prognosis became poorer as albumin-bilirubin grade increased. High albumin-bilirubin grade was shown in multivariable Cox proportional analyses to be independently associated with both poor progression-free survival and poor cancer-specific survival.

Conclusions

High pre-treatment albumin-bilirubin grade could be a significant independent predictor of poor prognosis in patients receiving pembrolizumab for advanced urothelial carcinoma.
Accurate age-grading of field-aged mosquitoes reared under ambient conditions using surface-enhanced Raman spectroscopy and artificial neural networks
Authors: Gao Zili , Harrington Laura C , Zhu Wei , Barrientos Luisa M , Alfonso-Parra Catalina , Avila Frank W , Clark John M , He Lili
Published: June 2023

Age-grading mosquitoes are significant because only older mosquitoes are competent to transmit pathogens to humans. However, we lack effective tools to do so, especially at the critical point where mosquitoes become a risk to humans. In this study, we demonstrated the capability of using surface-enhanced Raman spectroscopy and artificial neural networks to accurately age-grade field-aged low-generation (F2) female Aedes aegypti mosquitoes held under ambient conditions (error was 1.9 chronological days, in the range 0–22 days). When degree days were used for model calibration, the accuracy was further improved to 20.8 degree days (approximately equal to 1.4 chronological days), which indicates the impact of temperature fluctuation on prediction accuracy. This performance is a significant advancement over binary classification. The great accuracy of this method outperforms traditional age-grading methods and will facilitate effective epidemiological studies, risk assessment, vector intervention monitoring, and evaluation.
The evening crepuscular host-seeking activity ofAnophelesmosquitoes in northeast Brazil
Authors: Costa-Neta Benedita Maria , de Sousa Francisca Claudia da Silva , de Araújo Eudimara Carvalho , Viana Joany da Costa , Brito Jefferson Mesquita , Silva Francinaldo Soares
Published: June 2023

Studies on the timing of anopheline host-seeking are important for understanding mosquito ecology, behaviors, and possible role in disease transmission. To study the evening crepuscular host-seeking activity of anophelines and the effects of moonlight, anopheline mosquitoes were collected with light traps settled in a livestock area in the Brazilian Cerrado region. Traps (Silva traps) were placed next to animal enclosures at 1.5 m asl. The research was divided in 2 experiments: the first experiment (12 nights) comprised 2 trapping periods, one from 6 PM to 7 PM and one from 7 PM to 6 AM, and the second experiment (16 evenings) divided in three 20-min intervals based on the 3 twilight phases (civil: 6–6:20 PM; nautical: 6:20–6:40 PM; and astronomical: 6:40–7 PM). A total of 2,815 anopheline mosquitoes and 9 species were found. The main species were Anopheles triannulatus s.l., An. argyritarsis, An. goeldii, and An. evanse. Host-seeking mosquitoes were more frequently active during the first hour after sunset, with a significant peak in the second 20-min interval. After that, a decrease in the number of individuals was observed from the astronomical twilight onwards. Moonlight did not affect the evening flight activity of anophelines. By using LED-based passive light traps, the evening arrival time of anophelines at blood-feeding sites was demonstrated, and it may be a key time window for malaria vector control interventions.
Survival of adult Amblyomma americanum, Amblyomma maculatum, and Dermacentor variabilis (Acari: Ixodidae) in four habitats in southeastern Virginia
Authors: Bidder Lindsey , Gaff Holly
Published: June 2023

Adult, unfed Amblyomma americanum (Linnaeus), Amblyomma maculatum Koch, and Dermacentor variabilis (Say) ticks were housed inside environmental containers in situ from May through August 2015. The environmental containers were placed in 4 habitats in southeastern Virginia, United States. Two of the habitats were located in low ground and were prone to flooding; the other two consisted of a drier landscape located in a more upland habitat. A Cox Regression survival analysis indicated there was a significant difference in survival among species across all field sites. There was a 50.5-times higher risk of mortality for A. maculatum compared to A. americanum, a 4.3-times higher risk of mortality for A. maculatum compared to D. variabilis, and an 11.9-times higher risk of mortality for D. variabilis compared to A. americanum. There was also significantly higher mortality in field sites prone to flooding than in drier, upland field sites. We concluded that A. americanum was not negatively affected by increased flooding or the variable environmental conditions in southeastern Virginia. Dermacentor variabilis also was successful at remaining in the environment off-host, although increased flooding reduced survival over time. Amblyomma maculatum was more susceptible to mortality during long periods of time off-host in both environments, with high mortality rates in both dry upland and low-ground, flood-prone habitats.
A synthetic lure for Anopheles gambiae (Diptera: Culicidae) based on the attractive plant Parthenium hysterophorus
Authors: Nikbakhtzadeh Mahmood R
Published: June 2023

Sugar is the sole diet for male mosquitoes and a complementary meal for females. Searching for natural sources of sugar is mediated by semiochemicals. Floral nectars, extra floral nectaries, damaged tissues of plants and rotten fruits are the most common sources of sugar in nature. I provide laboratory evidence of the high attraction of Parthenium hysterophorus L., a weed that grows in tropical climates, to Anopheles gambiae Giles. This study has tried to identify the chemicals which might be involved in the chemical attraction of A. gambiae to this plant. Using quantitative GC-MS analysis, α-pinene, camphene, 1-octen-3-ol, β-pinene, cis-β-ocimene, bornyl acetate, α-caryophyllene, hexadecanoic acid, and α-linolenic acid were identified as the main constituents of P. hysterophorus volatiles. Successive olfactory assays helped a better understanding of the more attractive chemicals of P. hysterophorus to A. gambiae which was the basis for testing a possible synthetic blend. Olfactory experiments proved this synthetic blend to be as attractive as Parthenium intact plants for A. gambiae. A minimal blend, consisting of only α-pinene, camphene, and cis-β-ocimene, was also produced and laboratory experiments indicated its relative attraction for A. gambiae. This blend can be tested in the attractive toxic sugar bait stations for sampling, surveillance, or control programs of mosquitoes in tropical Africa, where A. gambiae sensu stricto transfer malaria among residents.
Species Preservation in the Face of Novel Threats: Cultural, Ecological, and Operational Considerations for Preserving Tree Species in the Context of Non-Indigenous Insects and Pathogens
Authors: D’Amato Anthony W , Orwig David A , Siegert Nathan W , Mahaffey Amanda , Benedict Les , Everett Tyler , Daigle John , Johnson Logan , Catanzaro Paul , Cusack Caitlin
Published: June 2023

Non-Indigenous insects and pathogens (NIIP) have functionally eliminated numerous tree species of immeasurable cultural and ecological significance over the past century, with the number of species introductions and associated impacts growing each year. Foresters are often on the frontlines of these impacts, tasked with quickly adapting management plans to recover potential economic losses and maintain future silvicultural options following tree species loss. We highlight that the irreplaceable cultural and ecological values provided by many tree species argues for renewed focus on applying integrated pest management and adaptive strategies in novel ways to sustain these values for future generations. To guide these efforts, we describe a framework for adapting to NIIP centered on three interrelated components: preservation value, preservation approach, and preservation strategy. This framework and emerging species preservation efforts provide an alternative path forward to sustain threatened species and their associated values in an era of increasing change.

Study Implications: The impact of non-indigenous insects and pathogens (NIIP) is one of the greatest challenges facing the long-term stewardship of forests in North America. Species preservation efforts that apply integrated pest management and adaptive strategies to maintain species in the face of NIIP are increasingly needed in foresters’ toolboxes to address these novel threats. Identifying the preservation values (ethical responsibility, cultural integrity, ecological function, genetic conservation) tied to a species preservation effort will help guide how preservation approaches and strategies are applied at stand and landscape scales to sustain species and associated cultural and ecological values into the future.
A systematic review of the association between zinc and anxiety
Authors: Azargoonjahromi Ali
Published: June 2023

Context

The incidence of anxiety, which stems from both intrinsic and extrinsic factors, has been increasing worldwide. Various methods by which it can be treated or prevented have been reported thus far. One of the most popular and effective treatments is supplementation therapy. Zinc, which is an essential nutrient found in various plants, animal foods, and supplements, has been shown to be a potential nutrient in anxiety reduction by acting on γ-aminobutyric acid (GABA), glutamatergic, serotonergic, neurogenesis, and immune systems. It can also influence important receptors, such as GPR39. Thus, zinc has received considerable attention with respect to its potential role as a therapeutic or detrimental factor for anxiety; yet, the available evidence needs to be analyzed systematically to reach a convergent conclusion.

Objective

The objective was to systematically review any potential connection between adult human anxiety and zinc intake.

Data Sources and Extraction

Nine original human studies, of which 2 assessed the relationship between zinc consumption and anxiety (based on a questionnaire) and 7 assessed the relationship between serum zinc levels and anxiety, were included based on specific selection criteria. Studies that had been written in English and published in peer-reviewed publications with no restrictions on the date of publication were searched in the Google Scholar and PubMed databases. This project was also reported according to the PRISMA guidelines.

Data Analysis

As per the studies analyzed in this review, there was a noticeable relationship between serum zinc levels and anxiety, which means that patients with anxiety have lower levels of zinc in their serum, as compared with healthy individuals. Furthermore, zinc consumption was inversely associated with anxiety.

Conclusion

The results provide plausible evidence for the positive role of zinc in the treatment of patients afflicted with anxiety, albeit with some limitations.
Synergistic toxicity of 2,4-dichlorophenoxyacetic acid and arsenic alters biomarkers in rats
Authors: Demirel Hasan Huseyin , Zemheri-Navruz Fahriye , Kucukkurt İsmail , Arslan-Acaroz Damla , Tureyen Ali , Ince Sinan
Published: June 2023

2,4-dichlorophenoxyacetic acid (2,4-D) and arsenic cause severe and extensive biological toxicity in organisms. However, their interactions and toxic mechanisms in co-exposure remain to be fully elucidated. In this study, 28 four-week-old female rats were divided into four groups and exposed to 100 mg/L arsenic or/and 600 mg/L 2,4-D through drinking water for a period of 28 days. As a result, it was revealed that biochemical indicators (ALT, AST, ALP, blood urea nitrogen, and creatinine) were increased and decreased hormonal parameters (FSH, LH, PG, and E2) in arsenic and 2,4-D and arsenic combination-treated groups. Moreover, increased lipid peroxidation (malondialdehyde level) and decreased antioxidant status (superoxide dismutase and catalase activities) were found in the co-exposure groups compared with the individual-exposure groups. Meanwhile, severe DNA damage was observed in co-exposure groups. Additionally, the levels of apoptotic (Bax, Caspase-3, Caspase-8, Caspase-9, p53, and PARP) and inflammation (NFκB, Cox-2, TNF-α, and TGFβI) indexes in the co-exposure groups were markedly increased, whereas the levels of anti-apoptosis index (Bcl-2) were decreased. It was also observed that co-exposure with 2,4-D and arsenic caused more histopathological changes in tissues. Generally, these results show that co-exposure to 2,4-D and arsenic can seriously cause oxidative stress, DNA damage, apoptosis and inflammation while having toxicological risk for organisms.
Analgesic Effectiveness of Motor-sparing Nerve Blocks for Total Knee Arthroplasty: A Network Meta-analysis
Authors: Hussain Nasir , Brull Richard , Vannabouathong Chris , Robinson Christopher , Zhou Steven , D’Souza Ryan S. , Sawyer Tamara , Terkawi Abdullah Sulieman , Abdallah Faraj W.
Published: June 2023

Background

The analgesic effectiveness of contemporary motor-sparing nerve blocks used in combination for analgesia in total knee arthroplasty is unclear. This network meta-analysis was conducted to evaluate the analgesic effectiveness of adding single-injection or continuous adductor canal block (ACB) with or without infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (iPACK) to intraoperative local infiltration analgesia (LIA), compared to LIA alone, after total knee arthroplasty.

Methods

Randomized trials examining the addition of single-injection or continuous ACB with or without single-injection block at the iPACK to LIA for total knee arthroplasty were considered. The two primary outcomes were area-under-the-curve pain scores over 24 to 48 h and postoperative function at greater than 24 h. Secondary outcomes included rest pain scores at 0, 6, 12, and 24 h; opioid consumption (from 0 to 24 h and from 25 to 48 h); and incidence of nausea/vomiting. Network meta-analysis was conducted using a frequentist approach.

Results

A total of 27 studies (2,317 patients) investigating the addition of (1) single-injection ACB, (2) continuous ACB, (3) single-injection ACB and single-injection block at the iPACK, and (4) continuous ACB and single-injection block at the iPACK to LIA, as compared to LIA alone, were included. For area-under-the-curve 24- to 48-h pain, the addition of continuous ACB with single-injection block at the iPACK displayed the highest P-score probability (89%) of being most effective for pain control. The addition of continuous ACB without single-injection block at the iPACK displayed the highest P-score probability (87%) of being most effective for postoperative function.

Conclusions

The results suggest that continuous ACB, but not single-injection ACB and/or single-injection block at the iPACK, provides statistically superior analgesia when added to LIA for total knee arthroplasty compared to LIA alone. However, the magnitude of these additional analgesic benefits is clinically questionable.

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The role of gastric ultrasound in anaesthesia for emergency surgery
Authors: Godschalx Vincent , Vanhoof Marc , Soetens Filiep , Van de Putte Peter , Hadzic Admir , Van de Velde Marc , Van Herreweghe Imré
Published: June 2023

BACKGROUND

The timing and technique of anaesthesia are challenging in patients with a history of recent food intake. The presence of gastric contents increases the risk of aspiration, potentially resulting in acute lung injury, pneumonia, or death. Delayed gastric emptying complicates the estimation of aspiration risk. Surprisingly, there are no fasting guidelines for emergency surgery. Point-of-care gastric ultrasound is a time-efficient, cost-efficient and accurate bedside tool with which to estimate residual gastric content and to guide decision-making in airway management and timing of general anaesthesia. This review summarises the prevailing concepts of ultrasound-guided gastric content assessment for emergency surgery.

METHODS

Medline and Embase databases were searched for studies using ultrasound for the evaluation of gastric content in adults scheduled for emergency surgery.

RESULTS

Five prospective observational studies representing 793 emergency surgery patients showed that the incidence of ‘full stomach’ was between 18 and 56% at the time of induction. Risk factors for a full stomach before emergency surgery were abdominal or gynaecological/obstetric surgery, high body mass index and morphine consumption. No correlation between preoperative fasting time and the presence of a full/empty stomach was found. No deaths due to aspiration were reported.

CONCLUSION

The preoperative presence of gastric content before emergency surgery is high and the estimates used for clinical management are unreliable. This review demonstrates that gastric ultrasound is a valuable tool for evaluating gastric content. A flow chart for medical decision-making using gastric ultrasound before emergency surgery was developed to assist in clinical decision-making. The validity and practical applicability should be assessed in future studies.
Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Escitalopram Pharmacokinetics: A Cohort Study
Authors: Schoretsanitis Georgios , Strømmen Magnus , Krabseth Hege-Merete , Helland Arne , Spigset Olav
Published: June 2023

Background:

Changes in the gastrointestinal physiology after bariatric surgery may affect the pharmacokinetics of medications. Data on the impact of different surgical techniques on the pharmacokinetics of commonly prescribed antidepressants such as escitalopram are limited.

Methods:

This case-only prospective study investigated escitalopram-treated patients who underwent bariatric surgery at hospitals in Central Norway. Escitalopram concentrations were assessed using serial blood samples obtained during a dose interval of 24 hours preoperatively and at 1, 6, and 12 months, postoperatively. The primary outcomes were changes in the area under the time–concentration curve (AUC0-24) with secondary outcomes, including full pharmacokinetic profiling. We performed repeated-measures analysis of variance for the AUC0-24 and secondary outcomes.

Results:

Escitalopram-treated obese patients who underwent sleeve gastrectomy (n = 5) and Roux-en-Y gastric bypass (n = 4) were included. Compared with preoperative baseline, dose-adjusted AUC0-24 values were within ±20% at all time points, postoperatively in the sleeve gastrectomy and oux-en-Y gastric bypass groups, with the largest changes occurring 1 month postoperatively (+14.5 and +17.2%, respectively). No statistically significant changes in any pharmacokinetic variables over time were reported; however, there was a trend toward increased maximum concentrations after surgery (P = 0.069).

Conclusions:

Our findings suggest that bariatric surgery has no systematic effect on the pharmacokinetics of escitalopram. However, because of the substantial interindividual variation, therapeutic drug monitoring can be considered to guide postoperative dose adjustments.
Program Evaluation of Parent Engagement Activities With Postoperative Cardiac Surgery Patients in the Pediatric Cardiac Intensive Care Unit
Authors: Bos Cheryl A. , VanderKooi Marie E. , Spoelstra Sandra L.
Published: June 2023

Objective:

The pediatric cardiac intensive care unit, a department dedicated to caring for cardiac patients, conducted a program evaluation to identify registered nurse (RN) and family perceptions of barriers and facilitators to parent engagement during postoperative care after surgery.

Methods:

A quasi-experimental presurgical/postsurgical design examined RN data using the Questionnaire of Factors That Influence Family Engagement and parent perception of engagement data via a survey.

Results:

Nearly half (44.6%) of RNs responded; most were younger (30–49 years old, 44.8%), female (91.4%), and White (94.8%) and held a bachelor's degree (72.4%). Those with more experience (>15 vs. <5 years) had a higher parent engagement score ( p = .021). RNs indicated that workflow (τb = .579, p = .000), unit environment (τb = .572, p = .000), nurse attitude (τb = .520, p = .000), and patient acuity (τb = .519, p = .000) correlated with overall family engagement score. The nine parents (100%) invited responded; most were mothers ( n = 7, 77.8%) and married ( n = 6, 66.7%), and 56% (n = 50) indicated this was not the child's first hospitalization. Parent overall safety score improved (presurgery/postsurgery, Z = −2.000, p = .046). RN barriers for family engagement included lack of written policy. For parents, a facilitator for engagement was safety. Both groups identified collaboration, communication, and shared decision making as a facilitator.

Discussion:

Results contribute to planning and implementing quality improvement initiatives. Understanding and developing a partnership between parents and RNs, nurturing mutual respect, and enhancing shared decision making improves parent engagement in care and, ultimately, a child's physical and psychological health.
Pilon fractures: Consensus and controversy
Authors: Flores Michael , Ciminero Matthew , Kottmeier Stephen A. , Botros Daniel , Zelle Boris A. , Shearer David W.
Published: June 2023

Pilon fractures are complex injuries that require an individualized approach to treatment to avoid complications and achieve good outcomes. Staged open reduction internal fixation remains the gold standard for most cases to achieve anatomic articular reduction while minimizing soft tissue complications and infection. Careful preoperative planning based on computed tomography dictates the surgical approach for reduction. A subset of cases may be amenable to early definitive or provisional open reduction and internal fixation based on fracture pattern. In some cases of severe articular comminution where reconstruction is not possible, primary ankle arthrodesis may be a good alternative.
HPV Infection in Squamous Cell Carcinoma of the Hypopharynx, Larynx, and Oropharynx With Multisite Involvement
Authors: Kuga Ryosuke , Yamamoto Hidetaka , Jiromaru Rina , Hongo Takahiro , Yasumatsu Ryuji , Matsuo Mioko , Hashimoto Kazuki , Taniguchi Midori , Nakagawa Takashi , Oda Yoshinao
Published: June 2023

The prevalence and prognostic significance of high-risk human papillomavirus (HR-HPV) have been well-established in oropharyngeal squamous cell carcinoma (OPSCC), but not in hypopharyngeal squamous cell carcinoma (HPSCC) or laryngeal squamous cell carcinoma (LSCC). Moreover, HR-HPV infection in squamous cell carcinoma with multisite involvement has not been examined. To clarify these issues, we retrospectively collected 480 invasive tumors from 467 patients with HPSCC, LSCC, or OPSCC, and comprehensively analyzed the detailed tumor localization, transcriptionally active HR-HPV infection by messenger RNA in situ hybridization, and immunohistochemical staining for p16 and Rb. HR-HPV infection was observed in 115/480 tumors (24%). Human papillomavirus (HPV)-positive cases were closely related with p16 positivity and the partial loss pattern of Rb. HR-HPV was detected in 104 of 161 tumors (64.6%) in the pure OPSCC group and only 1 of 253 tumors (0.4%) in the pure HP/LSCC group; the positive case occurred in the vocal cords. In the multisite-involving combined-type squamous cell carcinoma group, HPV infection was observed in 10/40 (25%) cases, and the 10 HPV-positive cases had OPSCC extending to the larynx or hypopharynx. Among high T-stage (T3/T4) cases of pure OPSCC, HPV-positive cases showed a better prognosis (P=0.0144), whereas the HPV-positive combined OPSCC group did not show a better prognosis (P=0.9428), as compared with HPV-negative counterpart. The results suggest that HR-HPV infection in pure HPSCC and LSCC may be extremely rare. HR-HPV infection seems to be present in a substantial proportion of patients with combined OPSCC and HPSCC/LSCC, but it may not improve prognosis at such advanced disease stages. Confirmation of these points awaits future studies with larger cohorts.
Personal and Interpersonal Factors Moderate the Relation Between Human-Made Trauma and Hypertension: A Path Analysis Approach
Authors: Bapolisi Achille M. , Maurage Pierre , Georges Coralie M.G. , Petit Géraldine , Balola Mitterrand , Cikomola Cirhuza J. , Rime Bernard , Philippot Pierre , Persu Alexandre , de Timary Philippe
Published: June 2023

Background

Although the link between trauma, posttraumatic stress disorder (PTSD), and hypertension is established, its underlying mechanisms remain underexplored.

Objective

This study tested a theoretical model exploring the moderating influence of psychological (emotion regulation) and interpersonal (social support) factors on the mediation between trauma and hypertension, through PTSD.

Methods

We measured these variables through self-reported questionnaire on 212 patients, recruited from internal medicine in a general hospital of Bukavu, a region affected by more than 25 years of armed conflicts. We first evaluated the PTSD mediation in the absence of moderators, before testing each moderator using moderated path analysis.

Results

Results showed that PTSD partially mediates the relationship between human-made trauma and hypertension, whereas social support and maladaptive emotion regulation moderate the relationship between human-made trauma and PTSD.

Conclusions

The relationship between human-made trauma, PTSD, and hypertension might be modulated by psychological and interpersonal factors, which paves the way for new interventions targeting emotion regulation and social support to reduce PTSD and hypertension in populations exposed to human-made violence.
300 Million years of coral treaders (Insecta: Heteroptera: Hermatobatidae) back to the ocean in the phylogenetic context of Arthropoda
Authors: Wang Yan-hui , Luan Yun-xia , Luo Jiu-yang , Men Yu , Engel Michael S. , Damgaard Jakob , Khila Abderrahman , Chen Ping-ping , Figueiredo Moreira Felipe Ferraz , Rafael José A. , Xie Qiang
Published: June 2023

Among hundreds of insect families, Hermatobatidae (commonly known as coral treaders) is one of the most unique. They are small, wingless predaceous bugs in the suborder Heteroptera. Adults are almost black in colour, measuring about 5 mm in body length and 3 mm in width. Thirteen species are known from tropical coral reefs or rocky shores, but their origin and evolutionary adaptation to their unusual marine habitat were unexplored. We report here the genome and metagenome of
Hermatobates lingyangjiaoensis
, hitherto known only from its type locality in the South China Sea. We further reconstructed the evolutionary history and origin of these marine bugs in the broader context of Arthropoda. The dated phylogeny indicates that Hexapoda diverged from their marine sister groups approximately 498 Ma and that Hermatobatidae originated 192 Ma, indicating that they returned to an oceanic life some 300 Myr after their ancestors became terrestrial. Their origin is consistent with the recovery of tropical reef ecosystems after the end-Triassic mass extinction, which might have provided new and open niches for them to occupy and thrive. Our analyses also revealed that both the genome changes and the symbiotic bacteria might have contributed to adaptations necessary for life in the sea.
Toward an evolutionary ecology of (in)equality
Authors: Smith Eric Alden , Smith Jennifer E. , Codding Brian F.
Published: June 2023

Inequality is increasingly recognized as a major problem in contemporary society. The causes and consequences of inequality in wealth and power have long been central concerns in the social sciences, whereas comparable research in biology has focused on dominance and reproductive skew. This theme issue builds on these existing research traditions, exploring ways they might enrich each other, with evolutionary ecology as a possibly unifying framework. Contributors investigate ways in which inequality is resisted or avoided and developed or imposed in societies of past and contemporary humans, as well as a variety of social mammals. Particular attention is paid to systematic, socially driven inequality in wealth (defined broadly) and the effects this has on differential power, health, survival and reproduction. Analyses include field studies, simulations, archaeological and ethnographic case studies, and analytical models. The results reveal similarities and divergences between human and non-human patterns in wealth, power and social dynamics. We draw on these insights to present a unifying conceptual framework for analysing the evolutionary ecology of (in)equality, with the hope of both understanding the past and improving our collective future.

This article is part of the theme issue ‘Evolutionary ecology of inequality’.
The interdependence of relational and material wealth inequality in Pemba, Zanzibar
Authors: Redhead Daniel , Maliti Emmanuel , Andrews Jeffrey B. , Borgerhoff Mulder Monique
Published: June 2023

The extent of inequality in material wealth across different types of societies is well established. Less clear, however, is how material wealth is associated with relational wealth, and the implications of such associations for material wealth inequality. Theory and evidence suggest that material wealth both guides, and is patterned by, relational wealth. While existing comparative studies typically assume complementarity between different types of wealth, such associations may differ for distinct kinds of relational wealth. Here, we first review the literature to identify how and why different forms of relational wealth may align. We then turn to an analysis of household-level social networks (food sharing, gender-specific friendship and gender-specific co-working networks) and material wealth data from a rural community in Pemba, Zanzibar. We find that (i) the materially wealthy have most relational ties, (ii) the associations between relational and material wealth—as well as relational wealth more generally—are patterned by gender differences, and (iii) different forms of relational wealth have similar structural properties and are closely aligned. More broadly, we show how examining the patterning of distinct types of relational wealth provides insights into how and why inequality in material wealth remains muted in a community undergoing rapid economic change.

This article is part of the theme issue ‘Evolutionary ecology of inequality’.
Modelling the role of environmental circumscription in the evolution of inequality
Authors: Perret Cedric , Currie Thomas E.
Published: June 2023

Circumscription theory proposes that complex hierarchical societies emerged in areas surrounded by barriers to dispersal, e.g. mountains or seas. This theory has been widely influential but the lack of formal modelling has resulted in theoretical and empirical challenges. This theory shares parallels with reproductive skew models from evolutionary ecology where inequality depends on the capacity of subordinates to escape from despotic leaders. Building on these similarities, we extend reproductive skew models to simulate the concurrent evolution of inequality in many connected groups. Our results show that cost of migration does not directly limit inequality in the long term, but it does control the rate of increase in inequality. Second, we show that levels of inequality can be reduced if there are random errors made by dominants, as these lead to variations that propagate between polities. Third, our model clarifies the concept of circumscription by relating it to geographical features: the size of a region and the connectivity between polities. Overall, our model helps clarify some issues about how migration may affect inequality. We discuss our results in the light of anthropological and archaeological evidence and present the future extensions required to build towards a complete model of circumscription theory.

This article is part of the theme issue ‘Evolutionary ecology of inequality’.
Reproductive inequality among males in the genusPan
Authors: Mouginot Maud , Cheng Leveda , Wilson Michael L. , Feldblum Joseph T. , Städele Veronika , Wroblewski Emily E. , Vigilant Linda , Hahn Beatrice H. , Li Yingying , Gilby Ian C. , Pusey Anne E. , Surbeck Martin
Published: June 2023

Reproductive inequality, or reproductive skew, drives natural selection, but has been difficult to assess, particularly for males in species with promiscuous mating and slow life histories, such as bonobos (Pan paniscus) and chimpanzees (Pan troglodytes). Although bonobos are often portrayed as more egalitarian than chimpanzees, genetic studies have found high male reproductive skew in bonobos. Here, we discuss mechanisms likely to affect male reproductive skew inPan, then re-examine skew patterns using paternity data from published work and new data from the Kokolopori Bonobo Reserve, Democratic Republic of Congo and Gombe National Park, Tanzania. Using the multinomial index (M), we found considerable overlap in skew between the species, but the highest skew occurred among bonobos. Additionally, for two of three bonobo communities, but no chimpanzee communities, the highest ranking male had greater siring success than predicted by priority-of-access. Thus, an expanded dataset covering a broader demographic range confirms that bonobos have high male reproductive skew. Detailed comparison of data fromPanhighlights that reproductive skew models should consider male–male dynamics including the effect of between-group competition on incentives for reproductive concessions, but also female grouping patterns and factors related to male–female dynamics including the expression of female choice.

This article is part of the theme issue ‘Evolutionary ecology of inequality’.
CHALLENGES IN THE DIAGNOSIS AND MANAGEMENT OF ATYPICAL FUNGAL KERATITIS DURING COVID-19 PANDEMIC: A CASE SERIES
Authors: Ali Dideeya , Vijayan Ajith , Shenoy Kashinatha , Antony Ann Tresa , Ramachandran Reshmi
Published: June 2023

Fungal keratitis is a time-sensitive ocular infection that often requires a high index of suspicion followed by intensive medical/surgical interventions to achieve a successful clinical outcome. COVID-19 pandemic-related restrictions, necessitated the modification of conventional protocols and guidelines associated with the treatment of keratomycosis. We report four cases of atypical fungal keratitis with poorly differentiated clinical characteristics. The challenges faced during their management were:1)the dilemma of clinically differentiating fungal (Scedosporium and Purpureocillium lilacinum) and bacterial keratitis; 2) treatment of Scedosporium and Trichosporon keratitis with natamycin monotherapy; 3) mixed infection of  Candida albicans and Aureobasidium pullulans and continuing medications before rescraping the corneal ulcer against the recommended treatment guidelines; 4) phenotypic identification and differentiation among morphologically resembling fungi; and 5) decision making arising out of disparities between KOH and fungal culture results. Three patients responded well to conservative treatments. The fourth patient underwent therapeutic keratoplasty but was lost to follow-up due to travel-related pandemic restrictions.  This case series seeks to broaden the clinician's knowledge of rare and emerging moulds as presumptive aetiologies of keratomycosis.  It also intends to emphasize the significance of early microbiological investigations, (direct microscopy and culture), in resource limited settings, for initiating empirical treatment for a better visual prognosis.
BactoBattle: a game-based learning companion for medical bacteriology
Authors: Imwattana Korakrit , Methawirune Areeya , Voralakkulchai Isara , Ngamskulrungroj Popchai
Published: June 2023

A card game called BactoBattle has been developed to help medical students who have just started learning medical bacteriology to improve their learning efficacy and satisfaction, especially on the topic of antimicrobial resistance. Copies of the game were placed in the students’ study room (approximately 1 set per 12 students) and made available to the students throughout the study period so that they could choose to play the game during their free time if desired. After the study period had ended, the students were asked to complete a questionnaire and a post-test. In total, 33 students completed the questionnaire, and were split into 2 groups: the player group, comprising 12 (36.4 %) students who had played the game, and the non-player group. The player group perceived that they could memorize more knowledge compared to the non-player group and indeed recorded higher post-test scores than the non-player group (10.4 vs 8.3 out of 15 points, P=0.031). However, there was no difference in learning motivation (P=0.441) or enjoyment (P=0.562) between the two groups. A majority of the players said they would continue playing the game after the study period and would recommend the game to other students. In short, the BactoBattle game can be a useful tool to improve the learning efficacy of students, but its effect on learning satisfaction remains unclear.
Early divergence and gene exchange highways in the evolutionary history ofMesoaciditogales
Authors: Farrell Anne A. , Nesbø Camilla L. , Zhaxybayeva Olga
Published: June 2023

The placement of a non-hyperthermophilic orderMesoaciditogalesat the base ofThermotogotatree challenges the prevailing hypothesis that the last common ancestor ofThermotogotawas a hyperthermophile. Yet, given the long branch leading to the only twoMesoaciditogalesdescribed to-date, the phylogenetic position of the order may be due to the long branch attraction artifact. By testing various models and applying data recoding in phylogenetic reconstructions, we observed thatMesoaciditogales’ basal placement is strongly supported by the conserved marker genes assumed to be vertically inherited. However, based on the taxonomic content of 1,181 gene families and a phylogenetic analysis of 721 gene family trees, we also found that a substantial number ofMesoaciditogalesgenes are more closely related to species from the orderPetrotogales. These genes contribute to coenzyme transport and metabolism, fatty acid biosynthesis, genes known to respond to heat and cold stressors, and include many genes of unknown functions. ThePetrotogalescomprise moderately thermophilic and mesophilic species with similar temperature tolerances to that ofMesoaciditogales. Our findings hint at extensive horizontal gene transfer between, or parallel independent gene gains by, the two ecologically similar lineages, and suggest that the exchanged genes may be important for adaptation to comparable temperature niches.

Significance

The high-temperature phenotype is often referenced when conjecturing about characteristics of the last common ancestor of all present-day organisms. Such inferences rely on accuracy of phylogenetic trees, especially with respect to lineages that branch closest to the last common ancestor. Here, we examined evolutionary history ofMesoaciditogales, an early-branching lineage withinThermotogotaphylum, which is one of the early-diverging groups of bacteria.Thermotogotais composed of thermophiles, hyperthermophiles and mesophiles, who collectively can grow between 20 to 90 degrees Celsius, making it challenging to infer the growth temperature of their common ancestor. Our analysis revealed a complex evolutionary history ofMesoaciditogales’genome content impacted by horizontal gene transfer, highlighting the challenges of ancestral phenotype inferences using present-day genomes.