bluuebunny/crossref_metadata_2025 huggingface dataset:
Health system-wide access to generative artificial intelligence: the New York University Langone Health experience
Authors: Malhotra Kiran , Wiesenfeld Batia , Major Vincent J , Grover Himanshu , Aphinyanaphongs Yindalon , Testa Paul , Austrian Jonathan S
Published: November 2024

Objectives

The study aimed to assess the usage and impact of a private and secure instance of a generative artificial intelligence (GenAI) application in a large academic health center. The goal was to understand how employees interact with this technology and the influence on their perception of skill and work performance.

Materials and Methods

New York University Langone Health (NYULH) established a secure, private, and managed Azure OpenAI service (GenAI Studio) and granted widespread access to employees. Usage was monitored and users were surveyed about their experiences.

Results

Over 6 months, over 1007 individuals applied for access, with high usage among research and clinical departments. Users felt prepared to use the GenAI studio, found it easy to use, and would recommend it to a colleague. Users employed the GenAI studio for diverse tasks such as writing, editing, summarizing, data analysis, and idea generation. Challenges included difficulties in educating the workforce in constructing effective prompts and token and API limitations.

Discussion

The study demonstrated high interest in and extensive use of GenAI in a healthcare setting, with users employing the technology for diverse tasks. While users identified several challenges, they also recognized the potential of GenAI and indicated a need for more instruction and guidance on effective usage.

Conclusion

The private GenAI studio provided a useful tool for employees to augment their skills and apply GenAI to their daily tasks. The study underscored the importance of workforce education when implementing system-wide GenAI and provided insights into its strengths and weaknesses.
Combining large broiler populations into a single genomic evaluation: dealing with genetic divergence
Authors: Tabet Joe-Menwer , Bussiman Fernando , Breen Vivian , Misztal Ignacy , Lourenco Daniela
Published: November 2024

Combining breeding populations that have diverged at some point is a conventional practice, particularly in the poultry industry, where generation intervals are short and genetic evaluations should be frequently available. This study aimed to assess the feasibility of combining large, distantly genetically connected broiler populations into a single genomic evaluation within the single-step GBLUP framework. The pedigree data for broiler lines 1 and 2 consisted of 428,790 and 477,488 animals, being 156,088 and 186,387 genotyped, respectively. Phenotypic data for body weight (kg), carcass yield (%), mortality (1 to 2), and feet health (1 to 7) were collected for 397,974 animals in line 1 and 458,881 in line 2. A 4-trait model was employed for the analyses, and genetic differences between the populations were addressed through different approaches: introducing an additional fixed effect accounting for the line of origin (M2) or making each fixed effect origin-specific (M3). Those models were compared against a conventional model (M1) that did not account for animal origin in the evaluation. Unknown parent groups (UPG) and Metafounders (MF) were fit to account for the genetic differences in M1, M2, and M3; they were set based on the animal’s line of origin and sex. Accuracy, bias, and dispersion were used to assess the performances of the models using the Linear Regression method. Validations were performed separately within individual lines and collectively after combining the 2 lines to better assess the advantages of combining the 2 populations. Overall, the accuracy increased when the 2 populations were combined compared to the accuracies obtained from evaluating each line individually. Notably, there were no apparent differences among the models regarding accuracy and dispersion. Regarding bias, using models M2 or M3 with UPG yields the least biased estimates in the combined evaluation. Thus, when combining different populations into a single genomic evaluation, accounting for the genetic and non-genetic differences among the lines ensures accurate and less biased predictions.
Response to Roberts, Stenglein, Wydeven, and others
Authors: Treves Adrian , Agan Suzanne W , Langenberg Julia A , Lopez-Bao Jose V , Louchouarn Naomi X , Parsons Dave R , Rabenhorst Mark F , Santiago-Ávila Francisco J
Published: November 2024

Human-caused mortality has been the major cause of death among wolves worldwide. In 2017, we summarized a 33-year data set of >933 Gray Wolf deaths from Wisconsin, United States, and estimated that poaching was the major source of mortality. Roberts et al. (2024; hereafter, just Roberts et al. unless using a direct quote from that paper) challenge our reinterpretation of data on causes of death and disappearances and urge us to use standard known-fates survival models rather than the combined time-to-event and total accounting methods that we used. They do not cite subsequent time-to-event and competing risk and incidence models that we published, raising an issue of selective citation of only their own work. Regarding reinterpretations, Roberts et al. neither present evidence for their claims nor revisit records of cause of death to argue their claims. Regarding traditional known-fate survival models, we review the violation of a critical assumption of such models. Namely, causes of death were not independent of censoring among Wisconsin collared wolves. Rates of disappearance approximating 42% of all collared animals are incompatible with the assumption that unknown-fate collared wolves died of the same causes as known-fate animals. We demonstrate that Roberts et al. made an erroneous claim that wolves frequently outlive the operational lives of their VHF collars. We present evidence of undisclosed competing interests among Roberts et al.’s coauthors. In scientific debates, the most transparent assumptions, methods, and data prevail because outside reviewers can judge for themselves. We stand by the conclusions of our combined analyses from 2017 to 2023.
Iatrogenic transmesenteric defect mimicking a Petersen’s space hernia after open pancreatic necrosectomy
Authors: Rendón Mejía Norman A , Aguilar Alejandra Aguirre , Benítez Membrila Carlos A , Marquez Enriquez Pedro A , Chora Rojas David O
Published: November 2024

Complications of acute pancreatitis can be disastrous if appropriate treatment is not initiated. Pancreatic necrosis can occur without the presence of symptoms; however, in some cases, it can be accompanied by organic failure, abscess, pseudocyst, fistulas, and pancreatic exocrine disfunction. The surgical treatment of pancreatic necrosis can be managed with open surgical debridement of necrotic tissue. Hence, complications after surgery can appear even in patients without clinical background; complications mostly appear if the surgical technique is not done properly. We present a case of a 47-year-old woman who appeared with abdominal pain, nausea, vomiting, and oral intake intolerance. Symptoms were present for 1 week; she was admitted to the nearest clinic, and surgical management was offered. The patient went to an open pancreatic necrosectomy; however, she presented purulent exudate from the surgical wound and drains. Was referred to our center; on abdominal contrasted computed tomography, a transmesenteric defect and cutaneous-pancreatic fistula were found.
Primary pulmonary follicular lymphoma
Authors: Kim Sarah E , Steeno Daniel , Lynch Alexander P , Podbielski Francis J
Published: November 2024

Primary pulmonary follicular lymphoma is an extremely rare subset of extra-nodal non-Hodgkin’s lymphoma. We present a successful work-up and surgical management of this disease entity. The patient is a 74-year-old man who presented with an enlarging ground glass opacity on his computed tomography scan. Percutaneous biopsy was not diagnostic for malignancy, but given the underlying malignant potential, he underwent definitive operative resection rather than additional invasive diagnostic testing. Our case highlights challenges in the management of nondiagnostic preliminary pathology as well as the role of a multidisciplinary approach to treatment of a rare lung pathology.
Origin of the metal-rich versus metal-poor globular clusters dichotomies in the Milky Way: a sign of low black hole natal kicks
Authors: Rostami-Shirazi Ali , Zonoozi Akram Hasani , Haghi Hosein , Rabiee Malihe
Published: November 2024

The bimodal metallicity distribution of globular clusters (GCs) in massive galaxies implies two distinct subpopulations: metal-poor and metal-rich. Using the recent data of Gaia we highlighted three distinct dissimilarities between metal-poor and metal-rich GCs in the Milky Way (MW). Half-mass (light) radii of metal-poor GCs exhibit, on average, $\simeq 52 \pm$5 ($60 \pm$3) per cent more expansion than metal-rich ones. Furthermore, the lack of metal-poor GCs at low Galactocentric distances ($R_\mathrm{G}$) follows a triangular pattern in $R_\mathrm{G}$–[Fe/H] space, indicating that GCs with lower metallicities appear further away from the Galactic centre. Metal-poor GCs are more susceptible to destruction by the tidal field in the inner part of the MW. We perform a series of N-body simulations of star clusters, to study the impact of the BHs’ natal kicks on the long-term evolution of low- and high-metallicity GCs to explain these observational aspects. We found that the retention of BHs inside the cluster is crucial to reproducing the observed dissimilarities. The heavier and less expanded BH subsystem (BHSub) in metal-poor clusters leads to more intense few-body encounters, injecting more kinetic energy into the stellar population. Consequently, they experience larger expansion and higher evaporation rates rather than metal-rich clusters. The higher energy production within the BHSub of metal-poor GCs causes them to dissolve before a Hubble time near the Galactic centre, leading to a triangular pattern in $R_\mathrm{G}$–[Fe/H] space.
Comparing metallicity correlations in nearby non-AGN and AGN-host galaxies
Authors: Li Song-Lin , Li Zefeng , Wisnioski Emily , Krumholz Mark R , Sánchez Sebastián F
Published: November 2024

The gas-phase metallicity distribution within galaxies records critical information about galactic evolution. In this work, we investigate how active galactic nuclei (AGNs) influence this distribution by measuring the two-point correlation functions of gas-phase metallicity in 95 non-AGN and 37 AGN-host galaxies from the Calar Alto Legacy Integral Field spectroscopy Area integral field spectrographic survey. We measure metallicity using a novel Bayesian method that properly includes both stellar and AGN contributions to emission line fluxes and allows us to measure metallicities in both AGN-host and non-AGN galaxies in a single, consistent framework. We find that the two-point correlation functions of both AGN-host and non-AGN galaxies are well fit by a simple injection-diffusion model, and that the correlation lengths $l_\mathrm{corr}$ we derive for the non-AGN galaxies are reasonably consistent with those obtained in earlier work. The AGN-host galaxies generally have smaller $l_\mathrm{corr}$ than non-AGN galaxies at fixed stellar mass, but similar $l_\mathrm{corr}$ at fixed star formation rate (SFR), suggesting that the primary effect of hosting an AGN in this sample is a reduction in SFR at fixed stellar mass, and that this in turn suppresses the correlation length. Our findings further indicate that, while both SFR and stellar mass are positively correlated with metallicity correlation length $l_\mathrm{corr}$, the former is more fundamental, implying that fluctuations in the metallicity distribution within galaxies are driven more by short-term responses to physical processes such as star formation that can change much faster than a Hubble time.
Morphology and systematic position of Shaninopsis Isberg, 1934 (Bivalvia: Cryptodonta), from the Boda Limestone (Upper Ordovician), Sweden
Authors: Johnston Paul A , Collom Christopher J , Ebbestad Jan Ove R
Published: November 2024

In a classic study of bivalves from the Upper Ordovician (Katian) Boda Limestone, Sweden, Isberg (1934) named and described 18 species of the unusual bivalve Shaninopsis, all from the same locality. Our study of the type material indicates that only three species at most are present: Shaninopsis prona Isberg, 1934, Shaninopsis radiata Isberg, 1934, and an unnamed species. Shaninopsis features a thick, prosocline, tear-drop-shaped shell with an opisthogyrous larval shell. Anterodorsally, the shell outline appears truncated to strongly concave owing to an inset sical surface that frames a conspicuous pedal gape. Above the gape, the lunule accreted posteriorly (retrusive growth—new term) and abuts the anterior part of the ligament area, perhaps compensating for anterior splitting of the ligament during growth. The hinge plate is edentulous, with a broad, opisthodetic, monovincular ligament. Muscle scars visible include only the posterior adductor, which is set near the posteroventral shell margin. Relict calcite prismatic texture preserved on the ligament area indicates the external prismatic calcite shell layer underlaid the ligament as in cardiolid praecardioids and some inoceramiformians. Evidence for a retractable non-biomineralized sheath-like structure extending from the pedal gape is presented. Shaninopsis is reconstructed as an orthothetic, epifaunal or shallow semi-infaunal bivalve capable of deeply probing underlying sediment for H2S uptake for chemosynthesis. Shaninopsis is assigned to a new subfamily Shaninopsiinae in the family Lunulacardiidae (infraclass Cryptodonta), a group otherwise unknown in pre-upper Silurian rocks. Remarkable similarities of Shaninopsis with the Permian bivalve Eurydesma suggest a mutual though geochronologically distant phylogenetic relationship.
Canonical amplifications and CDKN2A/B loss refine IDH1/2-mutant astrocytoma prognosis
Authors: Ghosh Hia S , Patel Ruchit V , Claus Elizabeth B , Gonzalez Castro Luis Nicolas , Wen Patrick Y , Ligon Keith L , Meredith David M , Bi Wenya Linda
Published: November 2024

Background

Molecular features have been incorporated alongside histologic criteria to improve glioma diagnostics and prognostication. CDKN2A/B homozygous-loss associates with worse survival in IDH1/2-mutant astrocytomas (IDHmut-astrocytomas), the presence of which denotes a grade 4 tumor independent of histologic features. However, no molecular features distinguish survival amongst histologically defined grade 2 and 3 IDHmut-astrocytomas.

Methods

We assembled a cohort of patients ≥19 years old diagnosed with an IDHmut-astrocytoma between 1989 and 2020 from public datasets and several academic medical centers. Multivariate modeling and unbiased clustering were used to stratify risk.

Results

We identified 998 IDHmut-astrocytoma patients (41.5% female; 85.6% white). Tumor grade, CDKN2A/B loss, and/or ≥1 focal amplification were associated with reduced survival. Grade 2/3 patients with intact CDKN2A/B and no focal amplifications survived the longest (OS 205.7 months). Survival for grade 2/3 cases with either CDKN2A/B hemizygous-loss or focal amplifications (80.4, 88.7 months respectively) did not differ significantly from grade 4 cases with intact CDKN2A/B and no amplifications (91.5 months, P = .93). Grade 4 patients with either hemizygous or homozygous loss of CDKN2A/B had the shortest survival (OS 31.9, 32.5 months respectively), followed by grade 4 cases with intact CDKN2A/B and focal gene amplifications (OS 55.9 months). Integrating CDKN2A/B status and amplifications alongside histopathologic grade refined overall survival prediction. Unbiased clustering revealed 9 distinct molecular profiles, with differential survival. IDHmut-astrocytomas with any CDKN2A/B loss clustered together, regardless of grade, and exhibited the poorest outcomes.

Conclusions

Combining CDKN2A/B hemizygous-loss and focal gene amplifications reveals a group of IDHmut-astrocytoma patients with an intermediate prognosis, refining IDHmut-astrocytoma classification.
A rare case of endoscopic visualization of a metallic coil in a duodenal ulcer after transcatheter arterial embolization
Authors: Ameyaw Prince A , Jajja Ans A , Ilagan-Ying Ysabel
Published: November 2024

Transcatheter arterial embolization is the therapy of choice for recurrent peptic ulcer bleeding refractory to standard endoscopic hemostatic techniques. It offers a minimally invasive approach with high efficacy, lower mortality, and complication rates compared to surgery. However, rare adverse events attributed to coil migration including pulmonary embolism, stroke, myocardial infarction, and bowel obstruction have been reported. We report the case of a 72-year-old female with a massive duodenal ulcer bleed refractory to endoscopic hemostatic techniques of epinephrine injection and bipolar cautery. She had a successful transcatheter arterial embolization of the culprit vessels. Repeat esophagogastroduodenoscopy for increasing vasopressor requirements and transfusion unresponsive anemia revealed the visualization of the metallic coil in the duodenal ulcer base with no active bleeding which was successfully managed conservatively through multidisciplinary consultation.
Posterior localized nodular scleritis mimicking malignancy, a case report and clinical approach
Authors: Motamed Shariati Mehrdad , Shekarchian Farid , Sabermoghaddam Aliakbar , Abadi Mitra Karimi Amir , Shoeibi Nasser
Published: November 2024

Aim: To report a patient with choroidal bulging, sub-retinal fluid, and optic nerve head (ONH) swelling who was finally diagnosed with focal nodular posterior scleritis. Case report: A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started. Conclusion: Posterior scleritis is an uncommon inflammatory condition that could be misdiagnosed with choroidal tumors, posterior uveitis, and orbital inflammation.
Induction chemotherapy plus chemoradiotherapy in esophageal cancer: long-term results and exploratory analyses of a randomized controlled trial
Authors: Liu Shiliang , Chen Baoqing , Zhu Yujia , Wang Sifen , Cheng Xingyuan , Wang Ruixi , Hu Yonghong , Liu Hui , Li Qiaoqiao , Zhang Li , Zhao Lei , Liu Mengzhong , Xi Mian
Published: November 2024

Background

Previous results of our trial demonstrated that the addition of induction chemotherapy (IC) prior to definitive chemoradiotherapy (CRT) failed to significantly improve the response rate or 3-year survival in patients with locally advanced esophageal squamous cell carcinoma (ESCC). Here, we report long-term results and exploratory analyses to further evaluate the therapeutic value of IC.

Methods

Patients with previously untreated, unresectable, stage II-IVA ESCC were randomly assigned to receive IC followed by CRT or CRT alone. The relationship between tumor response to IC and long-term survival was analyzed. Baseline tumor biopsies were collected for RNA-Seq to identify patients who may benefit from IC.

Results

Eligible patients were randomized to either the IC + CRT group (n = 55) or the CRT group (n = 55). With a median follow-up of 74.9 months, the 5-year overall survival rate was 31.8% in the IC + CRT group and 29.1% in the CRT group (P =.675; HR, 0.91; 95% CI, 0.58-1.43). Similarly, no significant differences were identified in 5-year progression-free survival between groups (30.5% vs 25.5%, P =.508; HR, 0.86; 95% CI, 0.56-1.34). Patients who responded to IC had significantly better survival than nonresponders. A risk-score model incorporating 6 key genes to predict IC efficacy was also constructed.

Conclusions

Compared with definitive CRT alone, the addition of IC before CRT still failed to demonstrate superior survival in patients with unselected ESCC, based on long-term follow-up. However, because IC responders were associated with more favorable survival, potential molecular biomarkers were identified for selection of benefit population from IC.

Clinical Trials Registration

NCT02403531.
Mongolia
Authors: Batbold Amarsanaa , Dashbalbar Gangabaatar
Published: November 2024

Mongolia has experienced a number of peaceful transfers of power within the thirty-two years of its democratic constitutional history. The 1992 Constitution has created a vibrant civil society, free media, and played a vital role in establishing a system of government based on a separation of powers. The State Great Khural of Mongolia adopted three sets of constitutional amendments within the last five years and this made the stability of the constitution a challenging issue. Whether these amendments will consolidate the still fragile democratic constitutionalism in Mongolia remains to be seen. This chapter focuses on constitutional reform in Mongolia and investigates the current challenges.
Warrior or guardian? Public perceptions of law enforcement during traffic encounters and domestic disputes
Authors: Graham Amanda , Somers Logan J
Published: November 2024

While police reform efforts have pushed for the adoption of a guardian mindset over that of a warrior, the public’s perception of these orientations is also relevant. As such, this study sought to use two experimental vignettes (N = 1,143) to understand the conditions that led officers to be viewed as guardians or warriors. Officers in both vignettes were more likely to be viewed as guardians when they provided a friendly and polite demeanor (as opposed to matter-of-fact) and a verbal warning (as opposed to a formal outcome). Additionally, whether the officer was viewed as a warrior or guardian weighed heavily on the perceived fairness of the outcomes. Thus, even with a shift in officer mindset from warrior to guardian, officers may face an uphill battle to be viewed by the public as guardians, especially when the use of formal sanctions is sometimes necessary.
Perceptions, Reality, and Tolerance for Voting Wait Times in American Elections and Their Consequences for Democracy
Authors: Panagopoulos Costas , Moniz Philip
Published: November 2024

Since 2012, voters in U.S. presidential elections have faced increasingly long wait times, depressing turnout, and undermining public confidence in the vote. While past studies have quantified differing levels of actual wait times, voters' perceptions about these wait times, which could directly influence their decision to vote, remain a black box. Using a novel nationally representative survey of the U.S. population, this study measures voters' perceptions of wait times, actual wait times, and willingness to wait. We ask whether some groups of voters expect longer waits and whether some are willing to wait longer than others. We also examine whether Americans who expect longer waits are actually less likely to vote. Overall, there seems to be more than willing to wait at the polls: 78 percent say they would wait over 30 minutes, while only 17 percent said they actually waited that long. At the individual level, women and nonwhite voters expect longer wait times, while lower-education voters marginally do. Women and less-educated voters, but not nonwhite voters, are less willing to wait at the polls. And the longer voters expect to wait, the less likely they are to vote. A voter who expects to wait 3 hours as opposed to not at all is 2.6 percentage points less likely to turn out. These findings highlight discrepancies between who expects and who is willing to wait through longer lines to cast their ballot. They bring with them important implications for policymakers.
Snail vectors of Schistosoma mansoni in Alagoas, Northeast Brazil: spatial distribution in the hydrographic grid of the state
Authors: Lima Maria Wilma da Silva , da Silva Glória Isabel Lisboa , Silva Laryssa Oliveira , Machado João Paulo Vieira , Lima Pedro Dantas , Ramos Rosália Elen Santos , Bezerra Leticia Pereira , Santos Israel Gomes de Amorim
Published: November 2024

Schistosomiasis mansoni is a parasitic infectious disease of significant epidemiological importance caused by Schistosoma mansoni. The intermediate hosts are snails of the genus Biomphalaria spp. As gastropods are crucial for the spread of the disease, this study aimed to assess the influence of water bodies on the distribution of snails responsible for transmitting S. mansoni in the state of Alagoas. It is an ecological study with a spatial approach, carried out from 1997 to 2017. We considered all Biomphalaria snails captured and positive for S. mansoni in the state. Representative maps were created for better data visualization, having as unit of analysis the municipalities of Alagoas. We also calculated the natural infection rate of the snails (number of positives/number of captured). During the study period, 34 619 Biomphalaria snails were captured, consisting of Biomphalaria glabrata (30 132), Biomphalaria straminea (4445) and Biomphalaria tenagophila (42). The seventh Health Region (HR) of the state had the highest number of specimens collected (B. glabrata=15 676), while the sixth HR had the highest positivity rate (9.2%). Regarding hydrography, these snails were primarily found along the Jacuípe, Mundaú, Paraíba, São Miguel, Coruripe, Piauí, Perucaba and Boacica rivers. Our data reinforce the occurrence of the three medically significant snail species responsible for schistosomiasis transmission in Alagoas. Additionally, our findings can be used as a basis for malacological activities because we report the presence of these animals in the main rivers of the state.
Long-term co-circulation of multiple arboviruses in southeast Australia revealed by xeno-monitoring and viral whole-genome sequencing
Authors: Vieira Carla Julia S. P , Onn Michael B , Shivas Martin A , Shearman Damien , Darbro Jonathan M , Graham Melissa , Freitas Lucas , van den Hurk Andrew F , Frentiu Francesca D , Wallau Gabriel L , Devine Gregor J
Published: November 2024

Arbovirus surveillance of wild-caught mosquitoes is an affordable and sensitive means of monitoring virus transmission dynamics at various spatial-temporal scales, and emergence and re-emergence during epidemic and interepidemic periods. A variety of molecular diagnostics for arbovirus screening of mosquitoes (known as xeno-monitoring) are available, but most provide limited information about virus diversity. Polymerase chain reaction (PCR)-based screening coupled with RNA sequencing is an increasingly affordable and sensitive pipeline for integrating complete viral genome sequencing into surveillance programs. This enables large-scale, high-throughput arbovirus screening from diverse samples. We collected mosquitoes in CO2-baited light traps from five urban parks in Brisbane from March 2021 to May 2022. Mosquito pools of ≤200 specimens were screened for alphaviruses and flaviviruses using virus genus-specific primers and reverse transcription quantitative PCR (qRT-PCR). A subset of virus-positive samples was then processed using a mosquito-specific ribosomal RNA depletion method and then sequenced on the Illumina NextSeq. Overall, 54,670 mosquitoes representing 26 species were screened in 382 pools. Thirty detections of arboviruses were made in 28 pools. Twenty of these positive pools were further characterized using RNA sequencing generating 18 full-length genomes. These full-length sequences belonged to four medically relevant arboviruses: Barmah Forest, Ross River, Sindbis-like, and Stratford viruses. Phylogenetic and evolutionary analyses revealed the evolutionary progression of arbovirus lineages over the last 100 years, demonstrating that different epidemiological, immunological, and evolutionary processes may actively shape the evolution of Australian arboviruses. These results underscore the need for more genomic surveillance data to explore the complex evolutionary pressures acting on arboviruses. Overall, our findings highlight the effectiveness of our methodology, which can be applied broadly to enhance arbovirus surveillance in various ecological contexts and improve understanding of transmission dynamics.
Characteristics and career effect on PA graduates of a doctor of medical science program
Authors: Kilgore James R. , Colletti Thomas , Rolfs Jenna , Shuler James A. , Watkins Elyse , Welsh Jeremy M. , Lewia Stephen
Published: November 2024

Objective:

This study examined the characteristics and effect of a doctoral degree on career metrics of physician associate/assistant (PA) graduates.

Methods:

This was a comparative analysis study of doctor of medical science (DMSc) program graduates. Characteristics from this survey were compared with program data and the National Commission on Certification of Physician Assistants Statistical Profile of Board Certified PAs for 2022.

Results:

Graduates self-reported that the DMSc degree was beneficial for receiving raises, promotions, and new leadership positions.

Conclusions:

The DMSc degree was considered a positive career benefit by graduates.
Low Prevalence of Anaerobic Bacteria in Pediatric Septic Arthritis Makes Obtaining Anaerobic Cultures of Questionable Value
Authors: Regan Maia D. , Spiegel David A. , Smith Kenneth , Goodbody Christine M. , Baldwin Keith D.
Published: November 2024

Background:

Pediatric acute septic arthritis necessitates urgent identification and treatment to avoid irreversible joint damage if not recognized and treated in a timely manner. Many centers routinely obtain both aerobic and anaerobic cultures for the purpose of pathogen identification; however, the yield of anaerobic culture results has been called into question. The goal of this study was to determine the positivity rate of anaerobic cultures collected intraoperatively in pediatric patients with clinically diagnosed septic arthritis.

Methods:

Patients with a clinical diagnosis of septic arthritis were extracted from a search of musculoskeletal infections at a large tertiary care pediatric hospital from 2007 to 2021. Cultures obtained from the operating room or through arthrocentesis were examined.

Results:

We identified 470 cases of pediatric septic arthritis of which only 3 cultures were positive (0.6%) for anaerobic organisms. All cases involved a single isolate. The anaerobic bacteria that were detected included 1 facultative anaerobe, 1 strict anaerobe, and 1 relatively aerotolerant anaerobe. Four aerobic organisms grew on the anaerobic cultures. Three of the false positives also grew on aerobic culture media, whereas 1 aerobic specimen grew explicitly on anaerobic media. Neither the facultative anaerobe nor the aerotolerant anaerobe grew on aerobic culture media.

Conclusions:

Over a 14-year period, only 0.6% (3 cases) of septic arthritis cases yielded positive anaerobic cultures that were not able to be cultured on aerobic media. As such, an anaerobic culture was more likely to culture a bacterium that would have also been cultured on aerobic media. In addition, a true positive anaerobic culture that would not have been diagnosed on aerobic cultures only occurs about once every 5 years at our institution. If one were to decide against obtaining anaerobic cultures, they would only miss 3 infections out of almost 500 (0.6%), and antibiotics would only have changed 0.6% of the time. These results suggest that routinely obtaining anaerobic cultures may be of limited value in pediatric septic arthritis. The false-positive rate of anaerobic labs exceeds that of true-positive cases. These results provide actionable opportunity to help guide clinician decision-making in a more cost-effective and efficient management of pediatric septic arthritis.

Level of Evidence:

IV.
Talazoparib for the Treatment of Metastatic Castration-resistant Prostate Cancer
Authors: Qureshi Zaheer , Fatima Eeshal , Safi Adnan , Khanzada Mikail , Altaf Faryal
Published: November 2024

Breast and prostate cancer are among the most commonly diagnosed cancers worldwide. Recent advances in tumor sequencing and gene studies have led to a paradigm shift from treatment centered on the type of tumor to therapy more focused on specific immune phenotype markers and molecular alterations. In this review, we discuss the utility and function of talazoparib concerning prostate cancer treatment and summarize recent and planned clinical trials on talazoparib. We searched medical databases for articles relating to the use of talazoparib in prostate cancer from inception. Poly ADP ribose polymerase (PARP) is a family of 17 necessary DNA repair enzymes responsible for base excision repair, single-strand break repair, and double-strand break repair. PARP inhibitors are a class of oral targeted therapies that compete for the NAD+ binding site on PARP molecules. Talazoparib, a potent PARP inhibitor, has emerged as a significant therapeutic option in the treatment of metastatic castration-resistant prostate cancer (mCRPC), particularly for patients with specific genetic alterations. Its role as a PARP inhibitor makes it a targeted therapy, focusing on cancer cells with DNA repair deficiencies. Talazoparib’s role as a biomarker-directed therapy in advanced prostate cancer has been increasingly recognized. The TALAPRO-1 demonstrated durable antitumor activity in mCRPC patients. TALAPRO-2 is a notable clinical trial, specifically examining the effectiveness of Talazoparib when used in combination therapies. Current investigations demonstrate a significant improvement in survival outcomes for the patients of mCRPC, making Talazoparib a promising intervention.
Cutaneous Hemophagocytosis in a Sweet Syndrome—An Unusual Phenomenon in a Rare Guise
Authors: Avci Pinar , Page Basile , Blum Roland , Borradori Luca , Feldmeyer Laurence , Wolf Ronald
Published: November 2024

Cutaneous hemophagocytosis is typically known as skin manifestation of syndromal hemophagocytic lymphohistiocytosis, which presents with fever, splenomegaly, cytopenia, hyperferritinemia, and hypertriglyceridemia. Pathophysiologically, an ineffective pathogen elimination has been postulated, which is compensated by excessive macrophage activation. In this study, we present an unusual case of skin limited cutaneous hemophagocytosis within a rare manifestation of a Sweet syndrome triggered by an upper respiratory infection and drug cofactors. A 38-year-old female patient presented with a painful skin rash and a right swollen knee joint that occurred after the onset of streptococcal angina treated with amoxicillin and acetylsalicylic acid. Skin lesions presented as succulent livid red plaques from the forehead to the extensor sides of the upper arms. Clinically, a classical Sweet syndrome was diagnosed by postinfectious onset, distribution and morphology of skin lesions, and abnormal laboratory values including neutrophilic leukocytosis. Histopathologic examination revealed typical characteristics of an acute Sweet syndrome but further showed hemophagocytosis of neutrophils and eosinophils by macrophages. There was a rapid regression of the complaints and skin lesions under systemic high-dose prednisone therapy. Extensive investigations are recommended only if indicators for a syndromal hemophagocytic lymphohistiocytosis are present.
Secondary Syphilis Presenting With an Interstitial Granuloma Annulare-Like Histopathologic Pattern: A Report of 2 Cases
Authors: João David Afonso , Pancsa Tamás , Kicko Peter , Langerová Eliška , Šíma Radek , Hercogová Jana , Skálová Alena , Michal Michal , Kacerovská Denisa
Published: November 2024

Syphilis, known as “the great mimicker,” is caused by the spirochete Treponema pallidum and is characterized by a diverse array of clinical and histopathologic presentations. In secondary cutaneous syphilis, the most consistent morphological features include a superficial and deep perivascular infiltrate containing plasma cells, varying degrees of endothelial swelling, irregular acanthosis, elongation of rete ridges, a vacuolated pattern, and the presence of plasma cells. Although serologic tests are essential for definitive diagnosis, spirochetes can sometimes be directly identified in silver-stained tissue slides or through immunohistochemistry. Granuloma annulare is a relatively common, benign, self-limiting condition with 3 main variants: conventional, subcutaneous, and interstitial, each with distinct characteristics. In this study, we report 2 cases of cutaneous secondary syphilis with a striking granulomatous reaction pattern that closely mimics the interstitial variant of granuloma annulare. Owing to the severity of the tertiary stage of syphilis, distinguishing between these 2 entities is crucial.
Spinoplastic Reconstruction Using Iliac Crest Vascularized Bone Graft following Sacral Ependymoma Resection
Authors: Reece Edward M. , Van Spronsen Nicole , Velluto Calogero , Jeger Jonathan L. , Fullmer Christopher , Abdulwadood Isra , Meyer Jenna , Ropper Alexander E. , Winocour Sebastian , Bohl Michael A. , Kalani Maziyar A.
Published: November 2024

Sacral reconstruction post tumor resection has historically been executed with the placement of hardware or free tissue transfer. Reconstruction using a vascularized bone graft is an alternative that avoids the complications associated with hardware placement or free tissue transfer. This article describes the first documented case of spinoplastic reconstruction using an iliac crest vascularized bone graft (IC-VBG) after the resection of a sacral ependymoma. This is a case of a 17-year-old boy with a history of a sacral myxopapillary ependymoma. He presented to a local emergency department complaining of 6 months of urinary incontinence and progressive paresthesias affecting the left lower extremity. Magnetic resonance imaging was significant for a lesion located in the extradural spinal canal. Biopsy confirmed a myxopapillary ependymoma, World Health Organization grade II. The initial intervention involved tumor resection with titanium hardware placement. He subsequently required replacement of the titanium hardware with carbon fiber, secondary to the need for surveillance imaging. He underwent harvesting and inset of the IC-VBG at the time of hardware replacement. IC-VBG is a safe and effective modality for spinoplastic reconstruction. It enhances the potential for solid bony union and offers a practical alternative to free bone transfer. This approach provides an asset to add to a reconstructive surgeon’s armamentarium, making it an essential tool for reconstructive surgeons working in conjunction with spinal surgery colleagues.
Implementation of a Clinical Decision Support Tool to Improve Cardiac Rehabilitation Referral
Authors: Nowatzke Joseph F. , O’Leary Jared M. , Huang Shi , Wright Adam , Patterson T. Lorraine , Bachmann Justin M.
Published: November 2024

Purpose:

Inadequate referral to cardiac rehabilitation (CR) is a major barrier to CR participation. We investigated the implementation of a clinical decision support (CDS) tool on improving CR referral for patients hospitalized with acute myocardial infarction (AMI) at an academic medical center.

Methods:

We developed a CDS tool that identified patients admitted with AMI and reminded physicians to refer patients to CR. We used multivariable-adjusted logistic regression to evaluate predictors of CR referral prior to the CDS tool. We then conducted an interrupted time series (ITS) analysis on CR referral rates before and after intervention.

Results:

A total of 1985 patients admitted with acute MI from December 2014 through March 2023 were included. Prior to CDS implementation, 1218 of 1657 patients (74%) were referred to CR. Multivariable-adjusted logistic regression demonstrated that ST-segment elevation myocardial infarction on arrival (OR = 1.70: 95% CI, 1.29-2.23, P < .001) and percutaneous coronary intervention during the hospitalization (OR = 2.25: 95% CI, 1.60-3.15, P < .001) were associated with a higher odds of CR referral. After implementation of the CDS tool, 308 of 328 patients (94%) received CR referrals. An ITS analysis demonstrated that the increase in CR referral from 74-94% after the CDS tool was highly significant (P < .01).

Conclusions:

The implementation of a CDS tool reminding physicians to refer patients with AMI to CR markedly improved CR referral rates at our institution. These findings are important for institutions seeking to improve outcomes in patients with AMI.
Independent and joint effect of central and brachial SBP on incident stroke in hypertensive adults
Authors: Ding Congcong , Cao Tianyu , Cheng Zaihua , Liu Lishun , Chen Zihan , Lu Wenyang , Yu Yaren , Gao Lan , Jiang Chongfei , Song Yun , Li Junpei , Fan Fangfang , Zhang Yan , Li Jianping , Huo Yong , Wang Hong , Wang Xiaobin , Parati Gianfranco , Huang Xiao , Cheng Xiaoshu
Published: November 2024

Objective:

It is unclear whether central SBP (cSBP) is an independent predictor of stroke above and beyond brachial SBP (bSBP). This study aimed to investigate the difference between cSBP and bSBP in predicting first stroke and the joint effect of cSBP and bSBP on the risk of first stroke in hypertensive adults.

Methods:

A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified.

Results:

A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified. The risk of first stroke increased by the same 16% [hazard ratio: 1.16, 95% confidence interval (95% CI): 1.07–1.26] for per SD increment in both cSBP and bSBP. The differences in areas under the curves, continuous net reclassification indices, and integrated discrimination indices of bSBP and cSBP models for predicting first stroke were 0.003 (95% CI: −0.003, 0.008), 0.007 (95% CI: −0.058, 0.071), and −0.0002 (95% CI: −0.0028, 0.0013), respectively. When cSBP and bSBP were evaluated jointly, participants in the highest tertiles of both cSBP and bSBP had the highest risk of first stroke compared with their counterparts (hazard ratio: 1.59, 95% CI: 1.29–1.96; P-interaction = 0.034). Similar results were found for ischemic stroke and hemorrhagic stroke.

Conclusion:

Although cSBP was not found to be superior to bSBP in predicting first stroke, cSBP and bSBP were jointly associated with the risk of first stroke among hypertensive adults.
Onyx as an adjunctive embolic material for transvenous embolization of cavernous sinus dural arteriovenous fistula after coiling
Authors: Luo Chao-Bao , Lee Chien-Hui , Lo Hsiang-Yun , Chang Feng-Chi , Lin Chung-Jung
Published: November 2024

Background:

Transvenous coil embolization (TVCE) is a common and effective treatment for cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some patients may experience residual fistulas or worsening visual symptoms after the procedure. This study aimed to compare the effectiveness of transvenous coil and Onyx embolization (TVCOE) with TVCE in treating CSDAVFs.

Methods:

The study included 207 patients with 222 CSDAVFs referred for TVCE, all of whom had complete angiographic follow-up over 9 years. Ninety patients (mean age, 65.3 years) with 97 CSDAVFs underwent TVCOE after coiling. Clinical data, angioarchitecture, and outcomes were retrospectively assessed and compared to 125 CSDAVFs treated with TVCE.

Results:

Key reasons for selecting TVCOE included improvement in immediate complete obliteration (CO) of CSDAVFs (n = 47, 48.5%), presence of cranial nerve palsy (n = 26, 26.8%), residual fistula with persistent pial venous reflux (PVR, n = 22, 22.7%), and redirection of fistula flow to PVR (n = 2, 2.1%). The average volume of Onyx used in TVCOE was 1.7 ml per CSDAVF. The mean coil lengths for TVCOE and TVCE were 143 cm and 228 cm, respectively, with a statistically significant difference (p < 0.05). Immediate digital subtraction angiography showed CO or nearly CO of CSDAVFs in TVCOE and TVCE at rates of 97.9% and 76.8%, respectively, indicating statistical significance in immediate CO (p < 0.05). Transient hemodynamic instability occurred in 81 (90.0%) patients due to Onyx toxicity, and 1 patient (1.1%) experienced hemorrhagic complications during TVCOE.

Conclusion:

The use of a small volume of Onyx as an adjunctive embolic material in TVCOE resulted in reduced coil use and improved immediate CO. This technique is viable for patients with PVR. Aside from the transient hemodynamic instability, periprocedural complications and follow-up angiographic outcomes did not show significant differences between the two groups.
Agitated Depression and the Potential Response to Gama-Amino Butyric Acid Agonist
Authors: Alhau Rawan , Rimawi Motaz , Zubrzycka Izabela , Mahgoub Yassir
Published: November 2024

Purpose/Background

Agitated depression is a specific variant of depressive disorder characterized by marked psychomotor agitation, including prominent restlessness and pacing, intense anxiety, irritability, and insomnia. These symptoms can be severe, and patients might be at increased risk of suicide. Authors have suggested that agitated depression can worsen with the use of antidepressants but can respond to options such as electroconvulsive therapy (ECT), lithium, anticonvulsants, antipsychotics, and benzodiazepines. Appropriate identification of this variant of depressive disorder is essential for proper treatment, as some of these patients might be labeled as resistant to treatment due to the worsening or lack of response to several antidepressant trials.

Methods/Procedure

Summary of 2 recent cases and literature review on agitated depression symptoms and treatment.

Finding/Results

Our 2 patients presented with symptoms of depressed mood, increased anxiety, irritability, poor sleep, poor appetite, restlessness, rumination, indecisiveness, and psychosis. Both patients had worsening symptoms with the use of various antidepressants but improved with the use of lorazepam and olanzapine. We review literature describing this variant of depressive disorder and its suggested treatment.

Implication/Conclusion

Agitated depression has been poorly characterized in the literature. The criteria suggested by Koukopoulos et al (Acta Psychiatr Scand. 2007;115:50–57) and the provisional criteria for melancholia, as indicated by Mahgoub et al (Front Psychiatry. 2024;15:1372136), might help recognize this variant of depressive disorder. These patients might have a poor response or worsen with the use of antidepressants while responding to options like gamma-amino butyric acid (GABA) agonists, antipsychotics, and ECT.
Anatomical Aspects and Long-Term Outcomes of Additional Surgical Repair During Heart Transplantation in Adult Congenital Heart Disease
Authors: Pradegan Nicola , Cattapan Claudia , Tessari Chiara , Toscano Giuseppe , D’Onofrio Augusto , Tarzia Vincenzo , Gambino Antonio , Fedrigo Marny , Vida Vladimiro L. , Angelini Annalisa , Gerosa Gino
Published: November 2024

Adult patients with congenital heart disease (ACHD) requiring heart transplantation (HT) usually show complex anatomies, posing surgical challenges. Consequently, we analyzed technical aspects and early and long-term outcomes of additional surgical repairs during HT in ACHD. Forty patients were identified (23 males, median age: 38 years, interquartile range [IQR]: 26–50). Of these, 17 (42.5%) required additional surgical repair (7 systemic veins repair, 13 pulmonary arteries repair). These procedures were more associated with univentricular physiology (p < 0.001) and prior Fontan palliation (p < 0.001). Eight (20.0%) experienced 30 day mortality. At a median follow-up of 5.6 (IQR: 2.0–11.9) years, 5 (12.5%) patients died. Additional surgical repair did not affect postoperative 30 day and long-term follow-up mortality (p = 0.451 and p = 0.330, respectively).