bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapamycin reduces atherosclerotic plaque inflammation in aged mice
Authors: De Mol J , De Korte D H , Smit V , Kuiper J , Foks A C
Published: May 2024

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): 1. ERA-CVD. Beat ATHERO consortium. 2. Dutch Heart Foundation

Aims

Aging is the most dominant risk factor of atherosclerotic cardiovascular disease (CVD), the main underlying cause of death worldwide. Both aging and atherosclerosis are associated with changes in the composition and function of the immune system, such as an enlarged T cell effector memory pool and elevated pro-inflammatory cytokine secretion. Since the accumulation of these pro-inflammatory factors contribute to atherosclerosis progression, halting inflammation might be a promising strategy to combat CVD. Rapamycin is an immunosuppressant that was recently discovered to increase lifespan due to the inhibition of senescent cells and effector T cells. We therefore hypothesized that rapamycin treatment can attenuate pro-atherogenic immunity in aged mice.

Methods

To explore the effects of rapamycin treatment, we administrated 1 mg/kg rapamycin or control solvent to aged (22 months old) male atherosclerotic Ldlr-/- mice (n=16 per group) three times a week intraperitoneally. After eight weeks, mice were sacrificed and their organs were collected for flow cytometry, single-cell RNA sequencing and histological analysis.

Results

Using flow cytometry, we revealed that rapamycin treatment decreased total T cell numbers in the atherosclerotic aorta and spleen compared to control treatment and attributed to a 24% increase in the relative frequency of immunosuppressive regulatory T cells in the aorta (rapa: 70.6±3.0% vs. ctrl: 57.1±3.8%, p<0.05), indicating skewing towards anti-atherogenic immunity. Within the reduced effector T cell pool of rapamycin-treated mice, we observed increased percentages of IL-10 and IFN-γ-expressing CD4+ and CD8+ T cells. In addition, rapamycin diminished the percentage of pro-atherogenic age-associated B cells (rapa: 7.5±1.8% vs. ctrl: 9.2±1.5%, p<0.05) in the mediastinal lymph nodes, and the percentage of pro-atherogenic age-associated B cells in the mediastinal lymph nodes, and reduced the expression of the senescent markers p19 and BTG2 in the spleen. In line with attenuated inflammation we observed a 36% reduction in relative plaque macrophage content in rapamycin-treated mice (rapa: 14.0±3.6% vs. ctrl: 21.8±5.5%, p<0.05).

Conclusions

Collectively, our study demonstrates that rapamycin treatment in aged atherosclerotic mice promotes regulatory T cells and reduces systemic and plaque accumulation of T cells, ABCs and macrophages. This provides a new understanding of rapamycin in regulating age-associated atherogenic immunity, indicating rapamycin could be a potential therapeutic to halt CVD.
Imbalance of thalamic metabolites in an experimental model of hypertension: role of bergamot polyphenols
Authors: Cardamone A , Carresi C , Coppoletta A R , Mollace A , Musolino V , Gliozzi M , Mollace V
Published: May 2024

Funding Acknowledgements 

None.

Hypertension is emerging as a pathogenic factor in vascular-based cognitive impairment, altering the structure and function of cerebral vasculature, and representing the main risk factor for cerebral small vessel diseases and neuronal loss. Some studies correlated a reduction in regional cerebral blood flow in the thalamus of elderly hypertensive brains with the decrease in certain cerebral metabolites, because of hypoperfusion. Patients with severe hypertension show a reduced oxygen consumption in regions with reduced cerebral blood flow suggesting that, the vascular dysfunction and the reduced cerebral blood flow could be related to reduced metabolic demands due to brain dysfunction and damage. Chronic cerebral hypoperfusion is associated with increased inflammatory state and oxidative stress. Herein, we hypothesized to prevent or reduce the onset of oxidative stress using natural occurring antioxidant compounds could be of particular importance for the management of hypertension-induced cerebral complications. Hypertension was induced on Wistar male rats by left renal artery ligation (RAL). After complete recovery from surgery, the animals were treated with 20 mg/kg deoxycorticosterone acetate twice a week for 4 weeks, and 1% sodium chloride (NaCl) water. A subgroup of hypertensive rats received Bergamot Polyphenolic Fraction (BPF) by gavage. A control group was treated with sub-cutaneous injection of saline. At baseline (T0), after 2 weeks (T1) and at the end of the experimental period (T2), the thalamic neurochemical profile were evaluated using proton magnetic resonance spectroscopy (1H-MRS), performed with a Bruker Pharmascan 70/16 7T. VAPOR water-suppression module was used and optimized to reduce residual water, then thalamic spectra were acquired using a short echo time single voxel point-resolved spectroscopy technique (voxel size 3x3x3 mm). The absolute quantification of metabolite concentrations has been performed using TARQUIN (v.4.3.10). A reduction tending to significance of the tNAA/tCr ratio, emerged in the thalamus of RAL DOCA-Salt rats compared to control rats at T2. A significant reduction of the tNAA/tCr ratio was observed in the group of RAL DOCA-Salt rats at the T2 compared to the same animals at the T1. In addition, a significantly decrease of the tCho/tCr ratio was highlighted in the RAL DOCA-Salt animals compared to the CTRL rats starting from the T1. The administration of BPF ameliorates the tNAA/tCr ratios in the thalamus of RAL DOCA-Salt rats. Such evidence of the influence of hypertension on tNAA/tCr and tCho/tCr ratios could better explain the relationship between brain structure and modulation of some metabolites, providing new insights into hypertension-induced brain complications and the contribution that the use of natural compounds could give to their management.
Efficacy and safety of pulsed field ablation compared to cryoballoon ablation in the treatment of atrial fibrillation: a meta-analysis
Authors: Rudolph Isabel , Mastella Giulio , Bernlochner Isabell , Steger Alexander , von Olshausen Gesa , Hahn Franziska , Wakili Reza , Laugwitz Karl-Ludwig , Martens Eimo , Rattka Manuel
Published: May 2024

Aims

Pulmonary vein isolation (PVI) represents the gold standard in the treatment of atrial fibrillation (AF) and the use of single-shot techniques, such as cryoballoon ablation (CBA) and pulsed field ablation (PFA) using a pentaspline catheter, has gained prominence. Recent studies hypothesize that PFA might be superior to CBA, although procedural efficacy and safety data are inconsistent. A meta-analysis was conducted to compare both energy sources for the treatment of AF.

Methods and results

A structured systematic database search and meta-analysis were performed on studies investigating outcomes, periprocedural complications, and/or procedural parameters of AF patients treated by either CBA or PFA. Eleven studies reporting data from 3805 patients were included. Pulmonary vein isolation by PFA was associated with a significantly lower recurrence of atrial fibrillation/atrial tachycardia [odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.54–0.98, I2 = 20%] and fewer periprocedural complications (OR = 0.62, 95% CI = 0.40–0.96, I2 = 6%) compared to CBA. The lower complication rate following PFA was mainly driven by fewer phrenic nerve injuries (OR = 0.19, 95% CI = 0.08–0.43, I2 = 0%). However, there were more cases of cardiac tamponades after PFA (OR = 2.56, 95% CI = 1.01–6.49, I2 = 0%). Additionally, using PFA for PVI was associated with shorter total procedure times [mean difference (MD) = −9.68, 95% CI = −14.92 to −4.43 min, I2 = 92%] and lower radiation exposure (MD = −148.07, 95% CI = −276.50 to −19.64 µGy·mI2 = 7%).

Conclusion

Our results suggest that PFA for PVI, compared to CBA, enables shorter procedure times with lower arrhythmia recurrence and a reduced risk of periprocedural complications. Randomized controlled trials need to confirm our findings.
Whole Genome Linkage and Association Analyses Identify DLG Associated Protein-1 as a Novel Positional and Biological Candidate Gene for Muscle Strength: The Long Life Family Study
Authors: Santanasto Adam J , Acharya Sandeep , Wojczynski Mary K , Cvejkus Ryan K , Lin Shiow , Brent Michael R , Anema Jason A , Wang Lihua , Thyagarajan Bharat , Christensen Kaare , Daw E Warwick , Zmuda Joseph M
Published: May 2024

Background

Grip strength is a robust indicator of overall health, is moderately heritable, and predicts longevity in older adults.

Methods

Using genome-wide linkage analysis, we identified a novel locus on chromosome 18p (mega-basepair region: 3.4–4.0) linked to grip strength in 3 755 individuals from 582 families aged 64 ± 12 years (range 30–110 years; 55% women). There were 26 families that contributed to the linkage peak (cumulative logarithm of the odds [LOD] score = 10.94), with 6 families (119 individuals) accounting for most of the linkage signal (LOD = 6.4). In these 6 families, using whole genome sequencing data, we performed association analyses between the 7 312 single nucleotide (SNVs) and insertion deletion (INDELs) variants in the linkage region and grip strength. Models were adjusted for age, age2, sex, height, field center, and population substructure.

Results

We found significant associations between genetic variants (8 SNVs and 4 INDELs, p < 5 × 10−5) in the Disks Large-associated Protein 1 (DLGAP1) gene and grip strength. Haplotypes constructed using these variants explained up to 98.1% of the LOD score. Finally, RNAseq data showed that these variants were significantly associated with the expression of nearby Myosin Light Chain 12A (MYL12A), Structural Maintenance of Chromosomes Flexible Hinge Domain Containing 1 (SMCHD1), Erythrocyte Membrane Protein Band 4.1 Like 3 (EPB41L3) genes (p < .0004).

Conclusions

The DLGAP1 gene plays an important role in the postsynaptic density of neurons; thus, it is both a novel positional and biological candidate gene for follow-up studies aimed at uncovering genetic determinants of muscle strength.
Victim Agency, Relational Autonomy and Transitional Justice: Experience of Saturday Mothers
Authors: Daşlı Güneş
Published: May 2024

ABSTRACT∞

This article explores the political agency of victims and proposes a new concept for understanding complex political victims in violent political contexts. To do so, it first challenges the problematic dichotomy of victim-perpetrator identities in transitional justice, drawing on interdisciplinary studies of agency, victim mobilization and the phenomenon of enforced disappearance. I (re)conceptualize victims’ agency by applying the concept of ‘relational autonomy’ which considers the role of social relations in the agency-building process and highlights relational values that are under-appreciated in the liberal concept of agency. I examine the case of the Saturday Mothers, a victim movement in Turkey, to show how their agency has been re-established through their interaction within this social network, and how this shapes the sense of justice they imagine and practice in this social space.
Life history changes associated with over 400 generations of artificial selection on body size in Drosophila
Authors: Stewart Andrew D , Herrick Calvin M , Fitzgibbon Trevor R , Wehner James M , Lev Avigayil , Venti Patricia A , Pischedda Alison
Published: May 2024

Body size is a trait that shapes many aspects of a species’ development and evolution. Larger body size is often beneficial in animals, but it can also be associated with life history costs in natural systems. Similarly, miniaturization, the evolution of extremely small adult body size, is found in every major animal group, yet carries its own life history trade-offs. Given that these effects can depend on an animal’s environment and life stage and have mainly been studied in species that are already specialized for their size, the life history changes associated with evolutionary shifts in body size warrant additional investigation. Here, we used Drosophila melanogaster populations that had undergone over 400 generations of artificial selection on body size to investigate the changes in life history traits associated with the evolution of extremely large and extremely small body sizes. Populations selected for small body size experienced strong trade-offs in multiple life history traits, including reduced female fecundity and lower juvenile viability. Although we found positively correlated changes in egg size associated with selection for both large and small body size, after adjusting for female body size, females from populations selected for large size had the lowest relative investment per egg and females from populations selected for small size had the highest relative investment per egg. Taken together, our results suggest that egg size may be a key constraint on the evolution of body size in D. melanogaster, providing insight into the broader phenomenon of body size evolution in insects.
Exponential tilting for zero-inflated interval regression with applications to cyber security survey data
Authors: Roner Cristian , Di Caterina Claudia , Ferrari Davide
Published: May 2024

Non-negative ordered survey data often exhibit an unusually high frequency of zeros in the first interval. Zero-inflated interval regression models handle the excess of zeros by combining a split probit model and an ordered probit model. In the presence of data violating distributional assumptions, standard inference based on the maximum likelihood method gives biased estimates with large standard errors. In this paper, we consider robust inference based on the exponential tilting methodology for the zero-inflated interval regression model. The application considers data on cyber security to study the relationship between investments in cyber defences and losses from cyber breaches. Robust estimates obtained via tilting clearly show an effect of the investments in reducing the loss amount.
Oropouche in Brazil in 2024
Authors: Fujita Dennis Minoru , Salvador Felipe Scassi , da Silva Nali Luiz Henrique , de Andrade Júnior Heitor Franco
Published: May 2024

The Oropouche fever is emerging in Espirito Santo, Brazil, a coastal region distant from the typical Amazonian epicentre. The disease presents similar symptoms to other arboviruses, complicating diagnosis and potentially leading to underreporting. The outbreak underscores the need for diagnoses, proactive vector control strategies and heightened surveillance to mitigate transmission.
Selenium in soil enhances resistance of oilseed rape to Sclerotinia sclerotiorum by optimizing the plant microbiome
Authors: Han Chuang , Cheng Qin , Du Xiaoping , Liang Lianming , Fan Guocheng , Xie Jiatao , Wang Xu , Tang Yanni , Zhang Huan , Hu Chengxiao , Zhao Xiaohu
Published: May 2024

Plants can recruit beneficial microbes to enhance their ability to resist disease. It is well established that selenium is beneficial in plant growth, but its role in mediating microbial disease resistance remains poorly understood. Here, we investigated the correlation between selenium, oilseed rape rhizosphere microbes, and Sclerotinia sclerotiorum. Soil application of 0.5 and 1.0 mg kg–1 selenium [selenate Na2SeO4, Se(VI) or selenite Na2SeO3, Se(IV)] significantly increased the resistance of oilseed rape to Sclerotinia sclerotiorum compared with no selenium application, with a disease inhibition rate higher than 20% in Se(VI)0.5, Se(IV)0.5 and Se(IV)1.0 mg kg–1 treatments. The disease resistance of oilseed rape was related to the presence of rhizosphere microorganisms and beneficial bacteria isolated from the rhizosphere inhibited Sclerotinia stem rot. Burkholderia cepacia and the synthetic community consisting of Bacillus altitudinis, Bacillus megaterium, Bacillus cereus, Bacillus subtilis, Bacillus velezensis, Burkholderia cepacia, and Flavobacterium anhui enhanced plant disease resistance through transcriptional regulation and activation of plant-induced systemic resistance. In addition, inoculation of isolated bacteria optimized the bacterial community structure of leaves and enriched beneficial microorganisms such as Bacillus, Pseudomonas, and Sphingomonas. Bacillus isolated from the leaves were sprayed on detached leaves, and it also performed a significant inhibition effect on Sclerotinia sclerotiorum. Overall, our results indicate that selenium improves plant rhizosphere microorganisms and increase resistance to Sclerotinia sclerotiorum in oilseed rape.
As Good as Comedy Gold: Tracing Jewish Heritage and Humor in the Works of Joseph Heller
Authors: Ozias Joseph
Published: May 2024

Catch-22 (1961) was both the best and worst thing to happen to Joseph Heller. While it set the stage for a promising career, it also cast a shadow from which Heller’s works struggled to escape. In terms of both popularity and critical reception, Heller’s subsequent novels were largely unsuccessful. For the rest of his career, Heller would struggle with two sometimes competing issues that either emanate from his writing or are wholly absent, marking a balancing act that Heller never mastered and, truthfully, never wished to. I explore two of these facets of Heller’s career that led to its downfall: his challenges with being pigeonholed as a comedic writer and his insecurities about expressing Jewishness in his work. Both of these issues were due mostly to the expectations of his critics and his audience. Heller’s struggle to clarify his ideals among his audience’s expectations (and his critics’) meant that he was constantly working against them despite his need for their support. This reading offers an intervention into the way we understand Heller’s decision to break free of his readers’ expectations, whether about his comedic style or Jewish ideals, and seeks to explain his choices in subject matter as his career progressed.
Filling the gaps in icosahedral superatomic metal clusters
Authors: He Wei-Miao , Hu Jia-Hua , Cui Yu-Jia , Li Jing , Si Yu-Bing , Wang Shuai-Bo , Zhao Yu-Jing , Zhou Zhan , Ma Lu-Fang , Zang Shuang-Quan
Published: May 2024

Chemically modified superatoms have emerged as promising candidates in the new periodic table, in which Au13 and its doped MnAu13−n have been widely studied. However, their important counterpart, Ag13 artificial element, has not yet been synthesized. In this work, we report the synthesis of Ag13 nanoclusters using strong chelating ability and rigid ligands, that fills the gaps in the icosahedral superatomic metal clusters. After further doping Ag13 template with different degrees of Au atoms, we gained insight into the evolution of their optical properties. Theoretical calculations show that the kernel metal doping can modulate the transition of the excited-state electronic structure, and the electron transfer process changes from local excitation (LE) to charge transfer (CT) to LE. This study not only enriches the families of artificial superatoms, but also contributes to the understanding of the electronic states of superatomic clusters.
Silicosis initially presenting with empyema
Authors: Reynolds C , Ross C , Cullinan P , Blanc P
Published: May 2024

The current global outbreak of artificial stone silicosis is a recrudescence of a major occupational disease in the context of a novel exposure source. Respirable crystalline silica exposure, even without frank pneumoconiosis, is associated with an increased risk of respiratory infection. Empyema is a well-recognized complication of bacterial pneumonia; pneumonia among working-age adults, in turn, has been epidemiologically linked to occupational exposure to fumes and dust, including silica. A connection between empyema and silica dust inhalation has not been reported, however, whether through antecedent pneumonia or another mechanism. We describe a case of silicosis initially presenting with empyema in a 31-year-old Computerized Numerical Control stone-cutting machine operator who had heavy exposure to artificial stone and other rock dust.
A deep analysis for New Horizons’ KBO search images
Authors: Yoshida Fumi , Yanagisawa Toshifumi , Ito Takashi , Kurosaki Hirohisa , Yoshikawa Makoto , Kamiya Kohki , Jiang Ji-an , Stern Alan , Fraser Wesley C , Benecchi Susan D , Verbiscer Anne J
Published: May 2024

Observation datasets acquired by the Hyper Suprime-Cam (HSC) on the Subaru Telescope for NASA’s New Horizons mission target search were analyzed through a method devised by JAXA. The method makes use of Field Programmable Gate arrays and was originally used to detect fast-moving objects such as space debris or near-Earth asteroids. Here we present an application of the method to detect slow-moving Kuiper Belt Objects (KBOs) in the New Horizons target search observations. A cadence that takes continuous images of one HSC field of view for half a night fits the method well. The observations for the New Horizons Kuiper Belt Extended Mission (NH/KEM) using HSC began in 2020 May, and are ongoing. Here we show our result of the analysis of the dataset acquired from 2020 May through 2021 June that have already passed the proprietary period and are open to the public. We detected 84 KBO candidates in the 2020 June and 2021 June datasets, when the observation field was close to opposition.
Chromosome-Scale Genome Assembly and Characterization of Top-Quality Japanese Green Tea Cultivar ‘Seimei’
Authors: Kawahara Yoshihiro , Tanaka Junichi , Takayama Kazuhiro , Wako Toshiyuki , Ogino Akiko , Yamashita Shuya , Taniguchi Fumiya
Published: May 2024

Japanese green tea, an essential beverage in Japanese culture, is characterized by the initial steaming of freshly harvested leaves during production. This process efficiently inactivates endogenous enzymes such as polyphenol oxidases, resulting in the production of sencha, gyokuro and matcha that preserves the vibrant green color of young leaves. Although genome sequences of several tea cultivars and germplasms have been published, no reference genome sequences are available for Japanese green tea cultivars. Here, we constructed a reference genome sequence of the cultivar ‘Seimei’, which is used to produce high-quality Japanese green tea. Using the PacBio HiFi and Hi-C technologies for chromosome-scale genome assembly, we obtained 15 chromosome sequences with a total genome size of 3.1 Gb and an N50 of 214.9 Mb. By analyzing the genomic diversity of 23 Japanese tea cultivars and lines, including the leading green tea cultivars ‘Yabukita’ and ‘Saemidori’, it was revealed that several candidate genes could be related to the characteristics of Japanese green tea. The reference genome of ‘Seimei’ and information on genomic diversity of Japanese green tea cultivars should provide crucial information for effective breeding of such cultivars in the future.
Children’s perceptions and feelings about the police: A comparative study between Roma and non-Roma children
Authors: Kypraiou Elpida  , Bonoti Fotini , Magos Konstantinos , Dermitzaki Irini
Published: May 2024

The study aims to add to our understanding of children’s perceptions and feelings for the police. 85 Roma and 85 non Roma children aged 7-12 years, living in a prefecture in Greece, matched in age, gender and school class, via individual interviews, were asked to describe the concept of the police and express their feelings for police officers. The results revealed that Roma children focus on the punitive role of the police and on negative feelings, which are related to direct and vicarious encounters with the police. In contrast, non-Roma children referred more to the protective role of the police and denoted positive feelings. Implications for police officers, educators and social services are discussed.
High prevalence of obstructive sleep apnea in a surgical aortic valve replacement cohort: an observational study
Authors: Oldham Mark A , Pigeon Wilfred R , Yurcheshen Michael , Hisamoto Kazuhiro , Knight Peter A , Lee Hochang B
Published: May 2024

Study Objectives

A high prevalence of sleep apnea has been reported among transcatheter aortic valve replacement (AVR) patients; however, the prevalence of sleep apnea in the younger and relatively healthier population of surgical AVR (SAVR) patients is unknown.

Methods

We assessed the prevalence of sleep apnea and overall sleep quality in patients having SAVR. Participants aged 50–89 were eligible for recruitment. All participants completed type II HST before SAVR. Sleep apnea was defined as an apnea–hypopnea index (AHI) ≥ 5 events/hour. The current use of positive airway pressure was exclusionary.

Results

The 46 participants (32 males/14 females) had a mean age of 66.6 years, body mass index of 30, AHI of 23.5, and obstructive AHI of 22.0. Only four participants had a prior sleep apnea diagnosis, yet all but one had sleep apnea on type II sleep testing. Two-thirds of sleep apnea was moderate or severe (AHI ≥ 15). A quarter of respiratory events were defined by arousals without desaturations. Whereas most sleep parameters resembled those of similarly aged community cohorts, mean percentage of N3 was reduced, accounting for only 3.8% of total sleep time.

Conclusions

Type II home sleep testing (HST) revealed a 97.8% prevalence of sleep apnea in this sample, most of which was undiagnosed obstructive sleep apnea. Roughly two-thirds of sleep apnea was moderate or severe. Such a high impact of obstructive sleep apnea among patients with severe aortic valve disease deserves further investigation on potential underlying mechanisms and clinical implications.
Promoting Longitudinal and Developmental Computer-Based Assessments of Clinical Reasoning: Validity Evidence for a Clinical Reasoning Mapping Exercise
Authors: Torre Dario M. , Mamede Silvia , Bernardes Teresa , Castiglioni Analia , Hernandez Caridad , Park Yoon Soo
Published: May 2024

Purpose

Clinical reasoning is vitally important for practitioners across the health professions. However, the assessment of clinical reasoning remains a significant challenge. Combined with other assessment methods, non–workplace-based assessment can increase opportunities to address multiple components of clinical reasoning, evaluate growth, and foster learning, but tools with validity evidence to assess clinical reasoning outside the workplace are scare. This study examined validity evidence for a novel clinical reasoning mapping exercise (CResME).

Method

Data include CResME performance scores from 120 third-year medical students at the University of Central Florida for 3 topics in May 2022. Each CResME was scored by 2 physician raters based on a scoring rubric that included a combined diagnosis and sequence score. Descriptive statistics were used to examine trends in scores. The authors gathered validity evidence for response process, internal structure, and relations to other variables.

Results

The overall mean (SD) score across cases was 66 (29). Internal consistency reliability of cases (Cronbach α) ranged from 0.75 to 0.91. The Phi and G coefficients were 0.45 and 0.56, respectively. Students accounted for 10% of the total variance, indicating the ability to differentiate high and low clinical reasoning skills; the interaction between learner and case accounted for 8.1% of the variance, demonstrating case specificity. There was a moderate correlation between the overall CResME scores and the mean overall score of patient encounter notes from an objective structured clinical examination performed at the end of the third year (0.46; P = .001). Significant associations were also found between the CResME scores and subject exam scores.

Conclusions

The CResME can be used to facilitate the assessment of clinical reasoning, supporting the developmental progress of learners throughout the curriculum. Future research is needed to gather validity evidence for CResMEs with different learners across different settings and formats.
The Potential of Real-Time Behavior and Well-Being Assessments to Improve Medical Student Wellness
Authors: Milne Ankrish , Novelli Alexandra , Watson Carly , Yousef Hakeem , Holterman Leigh Ann , Rosen Lee , Bai Yang , Curl Azilee , Gengel Bailey , Hudziak James J. , Copeland William E.
Published: May 2024

Problem

Medical students experience psychological distress more frequently than age-matched peers. Tracking medical student well-being has typically been limited to once- or twice-per-year questionnaires. Ongoing, real-time assessment of student behavior and well-being could facilitate individualized, timely interventions.

Approach

Faculty at the University of Vermont, in conjunction with the Larner College of Medicine Office of Medical Education, developed a novel smartphone app in 2021 called WE MD to track and support medical student wellness. The app included the following features: (1) nightly surveys assessing wellness-related behaviors (e.g., social interaction, sleep, exercise) and outcomes (i.e., mood, focus, stress, overall well-being); (2) health reports that enabled users to graph various combinations of their own behaviors and outcomes, allowing them to visualize trends and understand possible correlations between behaviors and outcomes; (3) a resource library with articles and educational videos related to specific wellness behaviors or outcomes; and (4) research-based “insights” or brief tips intended to promote healthy habits. Participants also received virtual “coins” for interacting with the app that could be exchanged for various items in an online store.

Outcomes

The WE MD program enrolled a substantial portion of the medical school population (43%); most of the students used the app on a regular basis. Students found the app to be acceptable and appreciated many features and also provided feedback on how to improve the app. Information from the nightly survey data converged with established measures but also identified variability over time in wellness behaviors and outcomes.

Next Steps

Data from the WE MD program suggest that app-based daily tracking of wellness behaviors and outcomes is a feasible, promising approach to promote student wellness and identify real-time patterns and risk periods for medical students. The app will be revised based on student feedback and adapted for use by students, residents, and faculty.
Development of a Transition to Residency Course Using a Design Thinking Framework
Authors: Quinn Antonia , Lazar Jason , Bianchi Riccardo
Published: May 2024

Problem

Transition to residency (TTR) courses help alleviate medical students’ concerns about preparing for residency; however, existing TTR courses are often limited to teaching clinical or procedural skills without addressing the nonclinical skills necessary for transitioning to practice. This report describes the use of design thinking (DT) to develop a learner-centered TTR course at the State University of New York Downstate Health Sciences University.

Approach

DT consists of 5 steps: discovery, interpretation, ideation, experimentation, and evolution. The first 3 steps were used for needs assessments and course design. During the discovery step, empathetic, semistructured interviews of interns, program directors, and graduating medical students were conducted to identify concerns about starting residency. During the interpretation step, thematic analysis of interviews was performed to identify areas of concerning attitudes and deficient skills and to inform content. In the ideation step, a 2-week curriculum was designed, including didactic lectures, small group discussions and workshops, simulation, and procedure labs, to address the defined content areas.

Outcomes

During the fourth step, implementation, a 2-week pilot elective course of the designed curriculum was conducted in spring 2021 with 6 students. Participant feedback from 2 students collected 6 months into internship found the procedures and simulated clinical skills cases high yield, appropriate, relevant to intern practice, and valuable. The course size in spring 2022 increased to 19 students, and the curriculum was refined based on the feedback of the previous pilot course (from 2 students and 4 faculty members) and from a precourse student survey (5 students).

Next Steps

The last step of DT, evolution, included determining larger-scale feasibility while maintaining learner-centeredness and conducting a programmatic evaluation. The iterative, adaptable approach of DT is suitable for TTR design and is generalizable. Other institutions can adapt the DT approach to develop their own institutional TTR programs.
Proximal Junctional Degeneration and Failure Modes
Authors: Cetik Riza M. , Glassman Steven D. , Dimar John R. , Campbell Mitchell J. , Djurasovic Mladen , Crawford Charles H. , Gum Jeffrey L. , Owens R. Kirk , McCarthy Kathryn J. , Carreon Leah Y.
Published: May 2024

Study Design.

Case-control study.

Objective.

To introduce a classification system that will include the major types of degenerative changes and failures related to the proximal junction, and to determine the clinical course and characteristics for the different types of proximal junctional degeneration.

Background.

Proximal junctional kyphosis and failures are well recognized after adult spinal fusion; however, a standardized classification is lacking.

Materials and Methods.

The proposed system identified 4 different patterns of proximal junctional degeneration: (1) Type 1 (multilevel symmetrical collapse), (2) Type 2 (single adjacent level collapse), (3) Type 3 (fracture), and (4) Type 4 (spondylolisthesis). A single-center database was reviewed from 2018 to 2021. Patients 18 years or older of age, who underwent posterior spinal fusion of ≥3 levels with an upper instrumented vertebral level between T8 and L2, and a follow-up of ≥2 years were included. Radiographic measurements, revision surgery, and time to revision were the primary outcomes.

Results.

One hundred fifty patients were included with a mean age of 65.1 (±9.8) years and a mean follow-up of 3.2 (±1) years. Sixty-nine patients (46%) developed significant degenerative changes in the proximal junction and were classified accordingly. Twenty (13%) were type 1, 17 (11%) were type 2, 22 (15%) were type 3, and 10 (7%) were type 4. Type 3 had a significantly shorter time to revision with a mean of 0.9 (±0.9) years. Types 3 and 4 had greater preoperative sagittal vertical axis, and types 1 and 3 had greater final follow-up lumbar lordosis. Bone density measured by Hounsfield units showed lower measurements for type 3. Types 1 and 4 had lower rates of developing proximal junctional kyphosis. Type 1 had the lowest revision rate with 40% (types 2, 3, and 4 were 77%, 73%, and 80%, respectively, P = 0.045).

Conclusion.

This novel classification system defines different modes of degeneration and failures at the proximal junction, and future studies with larger sample sizes are needed for validation.

Level of Evidence.

Level III.
Are There Differences Among Evidence-Based Psychotherapies for Treating Different DSM-5 PTSD Symptom Clusters? A Systematic Review and Meta-analysis of Controlled Clinical Trials
Authors: Melani Marina S. , Paiva Jéssica M. , Mendlowicz Mauro V. , Vilete Liliane , Luz Mariana P. , Ventura Paula Rui , Passos Roberta Benitez Freitas , Berger William
Published: May 2024

Posttraumatic stress disorder (PTSD) is a heterogeneous disease defined by four Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) symptom clusters: reexperiencing, avoidance, negative alterations in cognitions and mood, and hyperarousal. There are effective evidence-based psychotherapies (EBPs) for PTSD. However, given the variety of PTSD clinical presentations, we conducted the first meta-analysis investigating whether DSM-5 PTSD symptom clusters show different responses to EBPs. We systematically reviewed the literature for controlled clinical trials in five databases, performed a meta-analysis, and evaluated the methodological quality of the studies. We screened 633 studies and included seven. Three showed high risk, two showed some concerns, and one showed a low risk of bias. The symptom clusters do not seem to respond differently to EBPs (SMD cluster B: −0.40; 95% confidence interval [CI], −0.87 to 0.08; cluster C: −0.49; 95% CI, −0.90 to −0.08; cluster D: −0.44; 95% CI, −0.94 to 0.05; cluster E: −0.54; 95% CI, −1.07 to −0.0), even when analyzed by the therapeutic focuses. The findings dovetail nicely with the network theory of PTSD symptom, as although it is a heterogeneous disorder, the EBPs seem to promote a kind of cascade of symptom improvement.
New Frontiers in Wide-Awake Surgery
Authors: Lalonde Donald H. , Gruber Meegan M. , Ahmad Amir A. , Langer Martin F. , Sepehripour Sarvnaz
Published: May 2024

Learning Objectives:

After studying this article, the participant should be able to: 1. Explain the most important benefits of wide-awake surgery to patients. 2. Tumesce large parts of the body with minimal pain local anesthesia injection technique to eliminate the need for sedation for many operations. 3. Apply tourniquet-free surgery to upper and lower limb operations to avoid the sedation required to tolerate tourniquet pain. 4. Move many procedures out of the main operating room to minor procedure rooms with no increase in infection rates to decrease unnecessary cost and solid waste in surgery.

Three disruptive innovations are changing the landscape of surgery: (1) minimally painful injection of large-volume, low-concentration tumescent local anesthesia eliminates the need for sedation for many procedures over the entire body; (2) epinephrine vasoconstriction in tumescent local anesthesia is a good alternative to the tourniquet and proximal nerve blocks in extremity surgery (sedation for tourniquet pain is no longer required for many procedures); and (3) evidence-based sterility and the elimination of sedation enable many larger procedures to move out of the main operating room into minor procedure rooms with no increase in infection rates. This continuing medical education article explores some of the new frontiers in which these changes affect surgery all over the body.
“Why Not Just go on PrEP?”: A Study to Inform Implementation of an HIV Prevention Intervention Among Hispanic/Latino Men Who Have Sex With Men in the Northeastern United States
Authors: Rogers Brooke G. , Toma Emily , Harkness Audrey , Arnold Trisha , Nagel Katherine , Bajic Jade , Maynard Michaela , Almonte Alexi , Nunn Amy , Chan Philip
Published: May 2024

Background:

Preexposure prophylaxis (PrEP) is an effective biological option for HIV prevention yet persistent disparities in PrEP uptake and retention exist among Hispanic/Latino men who have sex with men (MSM). We evaluated barriers and facilitators to PrEP care among Hispanic/Latino MSM at risk for and living with HIV.

Setting:

A small urban setting in the Northeastern United States.

Methods:

This was a mixed-methods, exploratory, sequential, qualitative and quantitative pilot study among Latino MSM at-risk and/or living with HIV across (1) semistructured qualitative interviews (N = 15) and (2) cross-sectional survey (N = 98).

Results:

Participants reported a diverse range of sexual identities, HIV statuses, and PrEP statuses. Qualitative participants described feelings of isolation in both Hispanic/Latino and queer communities that made it challenging to learn about HIV prevention or PrEP from peers. Participants in the survey indicated that they would be more inclined to uptake PrEP if PrEP were offered in primary care settings (n = 61; 62.2%); there were specific LGBTQ+ affirming medical settings (n = 36; 36.7%); and/or they could meet other people who are currently on PrEP and sharing experiences online (n = 46; 46.9%) or in person (n = 38; 38.8%). Findings were organized to reflect determinants and implementation strategies that could be used to improve PrEP uptake among this population.

Conclusions:

This mixed-methods study identified several challenges and opportunities for increasing the reach of PrEP to Hispanic/Latino MSM. These findings should be used to inform tailored implementation strategies to promote PrEP uptake among this at-risk yet currently underserved population.
Craniofacial Trauma of Equestrian Origin
Authors: Boiron Adeline , Barazer Camille , Clement Camille , Sahli Vivicorsi Sonia , Bellamy Lorenn , Le Toux Guy , Boisramé Sylvie
Published: May 2024

Horse riding is a popular yet dangerous sport, often resulting in facial traumas due to unpredictable horse reactions or falls. This retrospective study examines 20 patients. The aim of the study is to analyze maxillofacial traumas of equine origin and discuss prevention strategies. Conducted from 2004 to 2021 at our university hospital’s emergency department in France, inclusion criteria encompassed patients with maxillofacial trauma admitted to the emergency department and referred to ENT and/or dentistry post-horse-related accidents. Patients were identified from the Health Data warehouse. While 35 medical files were accessed, 15 did not meet inclusion criteria. Analysis of patient parameters, including age, sex, injury date, circumstances, injury type, management, helmet usage, operative interventions, and potential sequelae, revealed a predominantly female population (16 versus 4) under 48 years old. Traumas were most prevalent in summer (80%) and frequently involved riders on foot (60%). Seventy percent of patients sustained at least 1 facial fracture, with helmet use documented in only 1 case. In conclusion, horse riding can lead to various traumas, often necessitating surgical intervention. Preventive measures such as protective helmets, even for nonmounted riders, are crucial as the literature highlights many injuries occurring due to helmet omission.
Opportunities and Applications of Educational Technologies in Surgical Education and Assessment
Authors: Fried Gerald M. , Varas Julián , Telem Dana A. , Greenberg Caprice C. , Hashimoto Daniel A. , Paige John T. , Pugh Carla
Published: May 2024

Objective:

Describe the latest technological in surgical education and assessment.

Background:

Surgical education is challenged by continuously increasing clinical content, greater subspecialization, and public scrutiny of access to high-quality surgical care. Since the last Blue Ribbon Committee on surgical education, novel technologies have been developed, including artificial intelligence and telecommunication.

Methods:

The goals of this Blue Ribbon Sub-Committee were to construct a framework for applying these technologies to improve the effectiveness and efficiency of surgical education and assessment.

An additional goal was to identify implementation frameworks and strategies for centers with different resources and access. All subcommittee recommendations were included in a Delphi consensus process with the entire Blue Ribbon Committee (N = 67).

Results:

Our subcommittee found several new technologies and opportunities that are well-poised to improve the effectiveness and efficiency of surgical education and assessment (Tables 1–3). Our top recommendation was that a Multidisciplinary Surgical Educational Council be established to serve as an oversight body to develop consensus, facilitate implementation, and establish best practices for technology implementation and assessment. This recommendation achieved 93% consensus during the first round of the Delphi process.

Conclusions:

Advances in technology-based assessment, data analytics, and behavioral analysis now allow us to create personalized educational programs based on individual preferences and learning styles. If implemented properly, education technology has the promise of improving the quality and efficiency of surgical education and decreasing the demands on clinical faculty.
Dynamics of centipede locomotion revealed by large-scale traction force microscopy
Authors: Rieu J. P. , Delanoë-Ayari H. , Barentin C. , Nakagaki T. , Kuroda S.
Published: May 2024

We present a novel approach to traction force microscopy (TFM) for studying the locomotion of 10 cm long walking centipedes on soft substrates. Leveraging the remarkable elasticity and ductility of kudzu starch gels, we use them as a deformable gel substrate, providing resilience against the centipedes’ sharp leg tips. By optimizing fiducial marker size and density and fine-tuning imaging conditions, we enhance measurement accuracy. Our TFM investigation reveals traction forces along the centipede’s longitudinal axis that effectively counterbalance inertial forces within the 0–10 mN range, providing the first report of non-vanishing inertia forces in TFM studies. Interestingly, we observe waves of forces propagating from the head to the tail of the centipede, corresponding to its locomotion speed. Furthermore, we discover a characteristic cycle of leg clusters engaging with the substrate: forward force (friction) upon leg tip contact, backward force (traction) as the leg pulls the substrate while stationary, and subsequent forward force as the leg tip detaches to reposition itself in the anterior direction. This work opens perspectives for TFM applications in ethology, tribology and robotics.
Human
in vivo
midtarsal and subtalar joint kinematics during walking, running and hopping
Authors: Behling Anja-Verena , Welte Lauren , Kelly Luke , Rainbow Michael J.
Published: May 2024

The interaction among joints of the midtarsal complex and subtalar joint is important for locomotor function; however, its complexity poses substantial challenges in quantifying the joints’ motions. We determine the mobility of these joints across locomotion tasks and investigate the influence of individual talus morphology on their motion. Using highly accurate biplanar videoradiography, three-dimensional bone kinematics were captured during walking, running and hopping. We calculated the axis of rotation of the midtarsal complex and subtalar joint for the landing and push-off phases. A comparison was made between these rotation axes and the morphological subtalar axis. Measurement included total rotation about and the orientation of the rotation axes in the direction of the subtalar joint and its deviation via spatial angles for both phases. The rotation axes of all three bones relative to the talus closely align with the morphological subtalar axis. This suggests that the midtarsal and subtalar joints’ motions might be described by one commonly oriented axis. Despite having such an axis, the location of the axes and ranges of motion differed among the bones. Our results provide a novel perspective of healthy foot function across different sagittal plane-dominant locomotion tasks underscoring the importance of quantifying midtarsal complex and subtalar motion while accounting for an individual’s talus morphology.
The puncture mechanics: an example from the bed bug
Cimex lectularius
showing traumatic insemination using the paramere
Authors: Matsumura Yoko , Krings Wencke , Kovalev Alexander , Gorb Stanislav N.
Published: May 2024

Cimicidae are well-known for traumatic insemination, and males pierce females with their parameres and transfer sperm through them. The shape of parameres is relatively stable in the family, but in some genera, the paramere is elongated, appearing less resistant against lateral deflection. To understand the mechanical limitations of the paramere, we studied its penetration mechanics of the common bed bug,
Cimex lectularius
. We examined the post-abdominal morphology, paramere geometry and material properties and conducted breaking stress experiments on the paramere under wet and dry conditions. Mechanical property gradients are present with the paramere tip as the stiffest region and the base as the most flexible one. These mechanical properties relate to the presence of Ca, Zn and Si. The basal wing-shaped structure is flexible, enabling it to interlock with the anal region during mating. The paramere is slightly twisted; the tip region is circular in cross-section, and the geometry of the rest is rather complex. In the mechanical tests, wet parameres mainly buckled, while dried parameres broke off. The level of structural failures depended on directions from which the compression forces were applied. Structural, material and mechanical strengthening mechanisms preventing the paramere from mechanical failure are discussed.