bluuebunny/crossref_metadata_2025 huggingface dataset:
Repairable ex vivo model of functional and degenerative mitral regurgitation
Authors: Morimura Hayato , Okamoto Yusei , Takada Jumpei , Tabata Minoru , Iwasaki Kiyotaka
Published: November 2023

OBJECTIVES

Transcatheter mitral valve repair is an emerging alternative to the surgical repair. This technology requires preclinical studies to assess efficacy in mitigating mitral regurgitation (MR). However, ex vivo MR models are not established. We developed 2 novel repairable models, functional and degenerative, which can quantitatively assess regurgitation and effect of intervention.

METHODS

We used porcine mitral valves and a pulsatile flow circulation system. In the functional MR model, the annulus was immersed in 0.1% collagenase solution and dilated using 3D-printed dilators. To control the regurgitation grade, the sizes of the dilator and silicone sheet in which the valve was sutured to were adjusted. Chordae of P2 were severed in the degenerative model, and the number of severed chordae was adjusted to control the regurgitation grade. Models were repaired using the edge-to-edge or artificial chordae technique.

RESULTS

The mean regurgitant fraction of the moderate–severe functional and degenerative models were 47.9% [standard deviation (SD): 2.2%] and 58.5% (SD: 8.0%), which were significantly reduced to 28.7% (SD: 4.4%) (P < 0.001) and 26.0% (SD: 4.4%) (P < 0.001) after the valve repair procedures. Severe functional model had a mean regurgitant fraction of 59.4% (SD: 6.0%).

CONCLUSIONS

Both functional and degenerative models could produce sufficient MR levels that meet the interventional indication criteria. The repairable models are valuable in evaluating the efficacy of valve repair procedures and devices. The ability to control the amount of regurgitation enhances the versatility and reliability of these models. These reproducible models could expedite the development of novel devices.
Statistical primer: using prognostic models to predict the future: what cardiothoracic surgery can learn from Strictly Come Dancing
Authors: Mawhinney Jamie A , Mounsey Craig A , O'Brien Alastair , Sádaba J Rafael , Freemantle Nick
Published: November 2023

OBJECTIVES

Prognostic models are widely used across medicine and within cardiothoracic surgery, where predictive tools such as EuroSCORE are commonplace. Such models are a useful component of clinical assessment but may be misapplied. In this article, we demonstrate some of the major issues with risk scores by using the popular BBC television programme Strictly Come Dancing (known as Dancing with the Stars in many other countries) as an example.

METHODS

We generated a multivariable prognostic model using data from the then-completed 19 series of Strictly Come Dancing to predict prospectively the results of the 20th series.

RESULTS

The initial model based solely on demographic data was limited in its predictive value (0.25, 0.22; R2 and Spearman’s rank correlation, respectively) but was substantially improved following the introduction of early judges’ scores deemed representative of whether contestants could actually dance (0.40, 0.30). We then utilize our model to discuss the difficulties and pitfalls in using and interpreting prognostic models in cardiothoracic surgery and beyond, particularly where these do not adequately capture potentially important prognostic information.

CONCLUSION

Researchers and clinicians alike should use prognostic models cautiously and not extrapolate conclusions from demographic data alone.
The genetic basis of apparently idiopathic ventricular fibrillation: a retrospective overview
Authors: Verheul Lisa M , van der Ree Martijn H , Groeneveld Sanne A , Mulder Bart A , Christiaans Imke , Kapel Gijs F L , Alings Marco , Bootsma Marianne , Barge-Schaapveld Daniela Q C M , Balt Jippe C , Yap Sing-Chien , Krapels Ingrid P C , Ter Bekke Rachel M A , Volders Paul G A , van der Crabben Saskia N , Postema Pieter G , Wilde Arthur A M , Dooijes Dennis , Baas Annette F , Hassink Rutger J
Published: November 2023

Aims

During the diagnostic work-up of patients with idiopathic ventricular fibrillation (VF), next-generation sequencing panels can be considered to identify genotypes associated with arrhythmias. However, consensus for gene panel testing is still lacking, and variants of uncertain significance (VUS) are often identified. The aim of this study was to evaluate genetic testing and its results in idiopathic VF patients.

Methods and results

We investigated 419 patients with available medical records from the Dutch Idiopathic VF Registry. Genetic testing was performed in 379 (91%) patients [median age at event 39 years (27–51), 60% male]. Single-gene testing was performed in 87 patients (23%) and was initiated more often in patients with idiopathic VF before 2010. Panel testing was performed in 292 patients (77%). The majority of causal (likely) pathogenic variants (LP/P, n = 56, 15%) entailed the DPP6 risk haplotype (n = 39, 70%). Moreover, 10 LP/P variants were found in cardiomyopathy genes (FLNC, MYL2, MYH7, PLN (two), TTN (four), RBM20), and 7 LP/P variants were identified in genes associated with cardiac arrhythmias (KCNQ1, SCN5A (2), RYR2 (four)). For eight patients (2%), identification of an LP/P variant resulted in a change of diagnosis. In 113 patients (30%), a VUS was identified. Broad panel testing resulted in a higher incidence of VUS in comparison to single-gene testing (38% vs. 3%, P < 0.001).

Conclusion

Almost all patients from the registry underwent, albeit not broad, genetic testing. The genetic yield of causal LP/P variants in idiopathic VF patients is 5%, increasing to 15% when including DPP6. In specific cases, the LP/P variant is the underlying diagnosis. A gene panel specifically for idiopathic VF patients is proposed.
Phage selection drives resistance–virulence trade-offs in Ralstonia solanacearum plant-pathogenic bacterium irrespective of the growth temperature
Authors: Wang Jianing , Wang Xiaofang , Yang Keming , Lu Chunxia , Fields Bryden , Xu Yangchun , Shen Qirong , Wei Zhong , Friman Ville-Petri
Published: November 2023

While temperature has been shown to affect the survival and growth of bacteria and their phage parasites, it is unclear if trade-offs between phage resistance and other bacterial traits depend on the temperature. Here, we experimentally compared the evolution of phage resistance–virulence trade-offs and underlying molecular mechanisms in phytopathogenic Ralstonia solanacearum bacterium at 25 °C and 35 °C temperature environments. We found that while phages reduced R. solanacearum densities relatively more at 25 °C, no difference in the final level of phage resistance was observed between temperature treatments. Instead, small colony variants (SCVs) with increased growth rate and mutations in the quorum-sensing (QS) signaling receptor gene, phcS, evolved in both temperature treatments. Interestingly, SCVs were also phage-resistant and reached higher frequencies in the presence of phages. Evolving phage resistance was costly, resulting in reduced carrying capacity, biofilm formation, and virulence in planta, possibly due to loss of QS-mediated expression of key virulence genes. We also observed mucoid phage-resistant colonies that showed loss of virulence and reduced twitching motility likely due to parallel mutations in prepilin peptidase gene, pilD. Moreover, phage-resistant SCVs from 35 °C-phage treatment had parallel mutations in type II secretion system (T2SS) genes (gspE and gspF). Adsorption assays confirmed the role of pilD as a phage receptor, while no loss of adsorption was found with phcS or T2SS mutants, indicative of other downstream phage resistance mechanisms. Additional transcriptomic analysis revealed upregulation of CBASS and type I restriction-modification phage defense systems in response to phage exposure, which coincided with reduced expression of motility and virulence-associated genes, including pilD and type II and III secretion systems. Together, these results suggest that while phage resistance–virulence trade-offs are not affected by the growth temperature, they could be mediated through both pre- and postinfection phage resistance mechanisms.
Marine nitrogen-fixers in the Canadian Arctic Gateway are dominated by biogeographically distinct noncyanobacterial communities
Authors: Robicheau Brent M , Tolman Jennifer , Rose Sonja , Desai Dhwani , LaRoche Julie
Published: November 2023

We describe diazotrophs present during a 2015 GEOTRACES expedition through the Canadian Arctic Gateway (CAG) using nifH metabarcoding. In the less studied Labrador Sea, Bradyrhizobium sp. and Vitreoscilla sp. nifH variants were dominant, while in Baffin Bay, a Stutzerimonas stutzeri variant was dominant. In comparison, the Canadian Arctic Archipelago (CAA) was characterized by a broader set of dominant variants belonging to Desulfobulbaceae, Desulfuromonadales, Arcobacter sp., Vibrio spp., and Sulfuriferula sp. Although dominant diazotrophs fell within known nifH clusters I and III, only a few of these variants were frequently recovered in a 5-year weekly nifH times series in the coastal NW Atlantic presented herein, notably S. stutzeri and variants belonging to Desulfobacterales and Desulfuromonadales. In addition, the majority of dominant Arctic nifH variants shared low similarity (< 92% nucleotide identities) to sequences in a global noncyanobacterial diazotroph catalog recently compiled by others. We further detected UCYN-A throughout the CAG at low-levels using quantitative-PCR assays. Temperature, depth, salinity, oxygen, and nitrate were most strongly correlated to the Arctic diazotroph diversity observed, and we found a stark division between diazotroph communities of the Labrador Sea versus Baffin Bay and the CAA, hence establishing that a previously unknown biogeographic community division can occur for diazotrophs in the CAG.
The response of different-aged saplings to light gradients reveals new insights into the light requirements of an endangered woody plant species, Phoebe chekiangensis
Authors: Zhang Junhong , Xu Wenting , Zhou Shengcai , Liu Qiyan , Yang Qi , Tong Zaikang
Published: November 2023

Phoebe chekiangensis is endemic to China and highly valued for art ware, furniture, and timber architecture, having a special status in Chinese history. Natural sources of P. chekiangensis are being depleted, and the species was listed as ‘VULNERABLE’ on the IUCN Red List of Threatened Species in 1998 (https://www.iucnredlist.org/) due to excessive anthropogenic deforestation and the plant’s weak self-regeneration ability. Most studies have attempted to elucidate this weak natural regeneration by culturing seedlings and community surveys, ignoring the different light requirements of seedlings at distinct ages. In this study, we examined five consecutive age groups of seedlings/saplings with current-year (seedling) and 1–4-year-olds exposed to four shading treatments (100%, 40%, 15%, and 5% of full sunlight) for 2 years, based on a randomized complete block design. Using analysis of variance and Duncan’s multiple comparison, the growth rate, photosynthetic response, photosynthetic pigments, and ultrastructure of chloroplasts were evaluated among the shading treatments. The results show that the light requirements of P. chekiangensis change during the development process. Moderate shading (40% of full sunlight) is beneficial for the early development of Phoebe seedlings, increasing height growth, photosynthetic efficiency, and photosynthetic pigment content and protecting the development of chloroplast structures. However, full exposure to sunlight is necessary for growing saplings (more than 2 years old) to meet the increased energy demands for growth and development. Overall, this study elucidates P. chekiangensis light utilization during the early regeneration phase, informing seedling cultivation activities and the development of silvicultural strategies of this endangered species.
Slip partitioning between subparallel strands of the North Anatolian Fault in the Marmara Region
Authors: Okur Yağızalp , Bulut Fatih , Garagon Aslı
Published: November 2023

Marmara Region hosts a substantial part of the inhabitants in Turkey, more than 30 per cent of the total population in the cities of Istanbul, Bursa and Kocaeli. This region has experienced several large earthquakes in the past and is still under threat of destructive earthquakes in the future. There, subparallel strands of the North Anatolian Fault (NAF) expand into the region, distributing the earthquake hazards across the whole region. Thus, it is a key issue to investigate how the tectonic process is distributed between these subparallel strands to discriminate their individual earthquake hazards. In this context, we used GPS slip rates to quantify the slip partitioning of the subparallel strands of the fault system. In addition to available slip rates compiled by Bulut et al. and Kreemer et al., we analysed 71 GPS sites (51 continuous and 20 campaign-based) to intensify the GPS network in the region. GPS observations reveal 81.7, 7.7 and 10.7 per cent slip ratios for northern, middle and southern strands. These ratios are also verified by the time series analysis of continuous GPS stations, leading us to the conclusion that the northern strand of the NAF hosts substantially shorter recurrence periods and, therefore, in the long term, the highest earthquake hazard in the Marmara Region.
Real-time prediction of distance and PGA from P-wave features using Gradient Boosting Regressor for on-site earthquake early warning applications
Authors: Iaccarino Antonio Giovanni , Cristofaro Amalia , Picozzi Matteo , Spallarossa Daniele , Scafidi Davide
Published: November 2023

On-site earthquake early warning (EEW) systems represent an important way to reduce seismic hazard. Since these systems are fast in providing an alert and reliable in the prediction of the ground motion intensity at targets, they are particularly suitable in the areas where the seismogenic zones are close to cities and infrastructures, such as Central Italy.

In this work, we use Gradient Boosting Regressor (GBR) to predict peak ground acceleration (PGA), and hypocentral distance (D) starting from P-wave features. We use two data sets of waveforms from two seismic sequences in Central Italy: L'Aquila sequence (2009) and the Amatrice–Norcia–Visso sequence (2016–2017), for a total of about 80 000 three-component waveforms. We compute 60 different features related to the physics of the earthquake using three different time windows (1 s, 2 s and 3 s). We validate and train our models using the 2016–2017 data sets (the bigger one) and we test it on the 2009 data set.

We study the performances of GBR predicting D and PGA in terms of prediction scores, finding that the models can well predict both targets even using 1 s window, and that, as expected, the results improve using longer time windows. Moreover, we perform a residual analysis on the test set finding that the PGA can be predicted without any bias, while the D prediction presents a correlation with the moment magnitude.

In the end, we propose a prototype for a probabilistic on-site EEW system based on the prediction of D and PGA. The proposed system is a threshold-based approach and it releases an alert on four possible levels, from 0 (far and small event) to 3 (close and strong event). The system computes the probability related to each alert level. We test two different set of thresholds: the Felt Alert and the Damage Alert. Furthermore, we consider the lead time (LT) of the PGA to distinguish between useful alerts (positive LT) and Missed Alerts (MA). In the end, we analyse the performance of such a system considering four possible scenarios: Successful Alert (SA), Missed Alert (MA), Overestimated Alert (OA) and Underestimated Alert (UA). We find that the system obtains SA rate about 80 per cent at 1 s, and that it decreases to about 65 per cent due to the increase in MA. This result shows how the proposed system is already reliable at 1 s, which would be a huge advantage for seismic prone regions as Central Italy, an area characterized by moderate-to-large earthquakes (Mw < 7).
Exploring motivations for engagement with the Healthy Lunch Box campaign on social media
Authors: Chan Lilian , Freeman Becky , Hughes Clare , Richmond Korina , Dibbs Jane , O’Hara Blythe J
Published: November 2023

Many health organisations seek social media engagement through their online health promotion campaigns, but there is little understanding of what engagement means in relation to the uptake of health messages. To understand the relevance of social media engagement, we need to look at the reasons why people engage with health content via social media. This exploratory study examined people’s motivations for engaging with health content through a case study of the Healthy Lunch Box campaign. Data was collected via online focus groups (n = 7), with participants being a convenience sample of people who had seen or engaged with the Healthy Lunch Box resources (n = 24). The discussions covered reasons for engaging with the Healthy Lunch Box campaign, and more broadly with health content on social media in general. The data was analysed using a reflexive approach to thematic analysis, with themes developed inductively. The study found that some of the reasons for engagement aligned with the paradigm of social media engagement being an intermediary step in the process towards health behaviour change. However, people also described other reasons, such as alignment with their personal values, consideration of their online presentation, or as a way of curating the content they wanted to be shown on social media. These results demonstrate that people’s decision to engage with health-related social media content involves more than consideration about the usefulness of the content, suggesting the need for a deeper examination of the assumptions made about the value of social media engagement in health campaign evaluations.
Public perception of the resumption of HPV vaccine recommendation in Japan: Twitter content analysis
Authors: Terada Marina , Okuhara Tsuyoshi , Nagasawa Tomomi , Okada Hiroko , Goto Eiko , Kiuchi Takahiro
Published: November 2023

On 12 November 2021, after a stagnation of 8.5 years, Japan decided to resume proactive recommendations for HPV vaccines. However, it is not known how the public reacted to the resumption of proactive recommendations for HPV vaccines, which are key elements in health communication that promote HPV vaccination. This study aimed to capture discussions on HPV vaccination on Twitter and to identify user characteristics, sentiments, discussed themes and their potential reach before and after 12 November 2021, when the Ministry of Health, Labour, and Welfare’s decision to resume proactive recommendation for HPV vaccines was first reported by the media in Japan. This study conducted a content analysis of tweets related to HPV vaccines posted on 11 November and 12 November 2021. Tweets were coded in terms of user characteristics, sentiments (i.e. positive, negative and neutral) and themes. Reach was measured by the number of retweets, likes and followers. A total of 3623 tweets were identified. The results showed that approximately 50% of health professionals and researchers tweeted neutral content about HPV vaccines. The most frequently discussed theme was the safety and side effects of HPV vaccines, which was accompanied by mainly negative sentiments. Although health professionals and researchers are influential on Twitter, half of them tweeted neutrally about HPV vaccines. Influential professionals, such as health professionals and researchers, are expected to disseminate accurate information to correct misinformation and recommend HPV vaccination on Twitter to overcome the HPV vaccination crisis, which is characterized by the low vaccination rates.
Subtyping and prognostic model construction based on vesicle-mediated transport-related genes in colorectal cancer
Authors: Wu Wei , Huang Tong , Li Shengwen , Gong Guangwei , Zhao Dan , Qiu Yue
Published: November 2023

Background

Colorectal cancer (CRC) is impacted by various environmental and genetic variables. Dysregulation of vesicle-mediated transport-related genes (VMTRGs) has been observed in many malignancies, but their effect on prognosis in CRC remains unclear.

Methods

CRC samples were clustered into varying subtypes per differential expression of VMTRGs. R package was utilized to explore differences in survival, immune, and drug sensitivity among different disease subtypes. According to differentially expressed genes (DEGs) between subtypes, regression analysis was employed to build a riskscore model and identify independent prognostic factors. The model was validated through a Gene Expression Omnibus (GEO) dataset. Immune landscape, immunophenoscore (IPS), and Tumor Immune Dysfunction and Exclusion (TIDE) scores for different risk groups were calculated.

Results

Two subtypes of CRC were identified based on VMTRGs, which showed significant differences in survival rates, immune cell infiltration abundance, immune functional activation levels, and immune checkpoint expression levels. Cluster2 exhibited higher sensitivity to anti-tumor drugs such as Nilotinib, Cisplatin, and Oxaliplatin compared to Cluster1. DEGs were mainly enriched in biological processes such as epidermis development, epidermal cell differentiation, and receptor-ligand activity, and signaling pathways like pancreatic secretion. The constructed 13-gene riskscore model demonstrated good predictive ability for CRC patients’ prognosis. Furthermore, differences in immune landscape, IPS, and TIDE scores were observed among different risk groups.

Conclusion

This study successfully obtained two CRC subtypes with distinct survival statuses and immune levels based on differential expression of VMTRGs. A 13-gene risk model was constructed. The findings had important implications for prognosis and treatment of CRC.
Vulnerability, Care Ethics and the Protection of Socioeconomic Rights via Article 3 ECHR
Authors: Morris Katie
Published: November 2023

Vulnerability analysis serves a distinct purpose within adjudication of Article 3 of the European Convention of Human Rights ('ECHR'), in that it has been used by the European Court of Human Rights (‘ECtHR’ or ‘the Court’) to lower the threshold for a finding of ill-treatment from which positive obligations relating to socioeconomic rights have arisen. However, the group-based notion of vulnerability invoked by the Court is extremely limited, producing minimal protection from deprivation whilst equally paternalizing and essentializing the populations it deems vulnerable. In light of these failings, this article proposes a new element to be incorporated within the Court’s vulnerability analysis which can deliver greater protection of socioeconomic rights via Article 3: the political theory of care. By highlighting care’s potential to transform the concepts of vulnerability and state responsibility whilst empowering the care-receiver, it argues that care can overcome the limitations of the Court’s current approach as a means of targeting destitution.
Single Nucleotide Polymorphisms of the MEFV Gene E148Q Are Highly Associated With Disease Phenotype in Crohn’s Disease
Authors: Yamada Satoshi , Honzawa Yusuke , Yamamoto Shuji , Matsuura Minoru , Kitamoto Hiroki , Okabe Makoto , Kakiuchi Nobuyuki , Toyonaga Takahiko , Kobayashi Taku , Hibi Toshifumi , Seno Hiroshi , Nakase Hiroshi
Published: November 2023

Background

Single nucleotide polymorphisms (SNPs) of the MEFV gene may modify inflammatory bowel disease (IBD) activity. The prevalence of MEFV gene SNPs in IBD patients and their involvement in IBD pathophysiology remains unclear.

Methods

We analyzed 12 MEFV gene SNPs in peripheral leukocytes of Japanese IBD patients (Crohn’s disease [CD]: 69 patients, ulcerative colitis: 32 patients) by polymerase chain reaction using next-generation DNA sequencing and evaluated their prevalence and association with the disease characteristics. Inflammasome activity and mature interleukin (IL)-1β and IL-18 production were evaluated in peripheral blood mononuclear cells obtained from CD patients stimulated with lipopolysaccharides and adenosine triphosphate, and compared between those with and without the E148Q SNP. COL1A1 and HSP47 gene expression was analyzed in CCD-18Co cells costimulated with IL-1β and other inflammatory cytokines.

Results

The prevalence of MEFV gene SNPs in IBD patients was similar to that in the human gene database. E148Q was the most common SNP. Compared with CD patients without E148Q, those with E148Q had a significantly greater frequency of the stricture phenotype, and their peripheral blood mononuclear cells exhibited significantly higher IL-1β and IL-18 levels and higher caspase-1 activity. IL-1β and IL-17A synergistically increased COL1A1 and HSP47 gene expression.

Conclusions

MEFV gene SNPs, including E148Q, modify the behavior of CD. IL-1β and IL-18 are produced through enhanced caspase-1 activity in monocytes of CD patients with E148Q. IL-1β promotes gene expression of fibrosis-related genes by cooperating with IL-17A in myofibroblasts. Therefore, E148Q might be a disease-modifying gene associated with the fibrostenosis phenotype in CD patients.
On Experiencing Music from Within
Authors: Skow Bradford
Published: November 2023

Experiencing the emotion in a piece of music “from within” involves imagining feeling that emotion, but just what does one imagine, and why? It has been suggested that one imagines, of one’s experience of hearing the sounds, that it is one’s feeling the emotion. This suggestion, it is argued here, is unworkable. A better idea is that one imagines oneself to be expressing one’s emotion in the sounds of the music. But imagining, by itself, is subject to few constraints; it is possible, with enough effort, to listen to an anxious piece of music, and imagine oneself expressing one’s joy through it. To vindicate the idea, then, the constraints under which one imagines when one listens “from within” must be described. It is argued that one imagines feeling, for example, sad when listening to sad music from within, because one begins by imagining one’s hearing the sounds to be one’s perceiving one’s own behavior, and then allows this imaginative episode to unfold involuntarily. An imagining that one feels sad is then generated, in part, by an offline-running of one’s disposition to infer what emotion one feels from internal perceptions of one’s behavior.
Insulting Religion: Penal Secularism and the Government of Feeling
Authors: Scott J Barton
Published: November 2023

This article revisits the Indian Penal Code’s restrictions on religious offense, especially Section 295A, with particular attention to nineteenth-century debates about secularizing the English common law of blasphemy. Building on scholarship that takes the histories of British and Indian secularisms as constitutively intertwined, I suggest that these entangled legal secularisms are best studied within a single analytic frame. I further suggest that this colonial secularism was, among other things, an affective apparatus. It linked the modern state to questions of sentiment or feeling, implicitly defining “religious feeling” as a species of affect with an intrinsic link to populational violence. Although colonial law ostensibly sought to reduce such violence, it instead had a more complex and perverse set of effects. Section 295A and its cousins turned law into a relay point for the circulation of affect, a mechanism for the transmission of populational pain.
Use of different anticholinergic scales and their correlation with anticholinergic symptom burden in a cohort of people living with HIV
Authors: Mazzitelli Maria , Trunfio Mattia , Coin Alessandra , Sasset Lolita , Farina Jacopo , Brundu Monica , Scaglione Vincenzo , Devita Maria , Sergi Giuseppe , Cattelan Anna M
Published: November 2023

Objectives

How to detect the clinical impact of anticholinergic (AC) burden in people with HIV (PWH) remains poorly investigated. We cross-sectionally described the prevalence and type of AC signs/symptoms and the screening accuracy of three AC scales in detecting their presence in a modern cohort of PWH.

Methods

We calculated AC Burden Scale (ABS), AC Risk Score (ARS) and AC Drug Score (ADS) in 721 adult PWH and recorded the presence of AC signs/symptoms over the previous 3 months. High AC risk was defined by ABS score ≥2, and ARS or ADS score ≥3. Comparisons among the scale were based on Cohen’s inter-rater agreement, and their screening accuracy was assessed by receiver operating characteristics (ROC) curves and performance measures.

Results

We enrolled 721 PWH, of whom 72.0% of participants were male; the median age was 53 years, and 164 participants (22.7%) were on at least one AC drug. Among these, 28.6% experienced at least one AC sign/symptom. Agreement in AC risk classification was substantial only between ARS and ADS (k = 0.6). Lower and higher risk of AC signs/symptoms was associated with dual regimens [adjusted OR (aOR) = 0.12 versus three-drug regimens, P = 0.002] and increasing number of AC drugs (aOR = 12.91, P < 0.001). Depression and COPD were also associated with higher risk of AC signs/symptoms in analysis unadjusted for number of AC drugs. ABS and ADS showed the best area under the ROC curve (AUROC) of 0.85 (0.78–0.92) and 0.84 (0.75–0.92; P < 0.001 for both). However, at the cut-off used for the general population, the sensitivity of all three scales was very low (34.0%, 46.8% and 46.8%).

Conclusions

Up to one-fourth of participants in our cohort were exposed to at least one AC drug, and among them AC signs/symptoms affected more than one-fourth. Both polypharmacy (as number of antiretrovirals and of co-medications with AC properties) and to a lesser extent specific comorbidities shaped the risk of developing AC signs/symptoms. Sensitive screenings for AC risk in PWH should prefer ABS or ADS based on lower cut-offs than those suggested for the general population.
Prediction of multiclass surgical outcomes in glaucoma using multimodal deep learning based on free-text operative notes and structured EHR data
Authors: Lin Wei-Chun , Chen Aiyin , Song Xubo , Weiskopf Nicole G , Chiang Michael F , Hribar Michelle R
Published: November 2023

Objective

Surgical outcome prediction is challenging but necessary for postoperative management. Current machine learning models utilize pre- and post-op data, excluding intraoperative information in surgical notes. Current models also usually predict binary outcomes even when surgeries have multiple outcomes that require different postoperative management. This study addresses these gaps by incorporating intraoperative information into multimodal models for multiclass glaucoma surgery outcome prediction.

Materials and methods

We developed and evaluated multimodal deep learning models for multiclass glaucoma trabeculectomy surgery outcomes using both structured EHR data and free-text operative notes. We compare those to baseline models that use structured EHR data exclusively, or neural network models that leverage only operative notes.

Results

The multimodal neural network had the highest performance with a macro AUROC of 0.750 and F1 score of 0.583. It outperformed the baseline machine learning model with structured EHR data alone (macro AUROC of 0.712 and F1 score of 0.486). Additionally, the multimodal model achieved the highest recall (0.692) for hypotony surgical failure, while the surgical success group had the highest precision (0.884) and F1 score (0.775).

Discussion

This study shows that operative notes are an important source of predictive information. The multimodal predictive model combining perioperative notes and structured pre- and post-op EHR data outperformed other models. Multiclass surgical outcome prediction can provide valuable insights for clinical decision-making.

Conclusions

Our results show the potential of deep learning models to enhance clinical decision-making for postoperative management. They can be applied to other specialties to improve surgical outcome predictions.
Complementary and Integrative Health Information in the literature: its lexicon and named entity recognition
Authors: Zhou Huixue , Austin Robin , Lu Sheng-Chieh , Silverman Greg Marc , Zhou Yuqi , Kilicoglu Halil , Xu Hua , Zhang Rui
Published: November 2023

Objective

To construct an exhaustive Complementary and Integrative Health (CIH) Lexicon (CIHLex) to help better represent the often underrepresented physical and psychological CIH approaches in standard terminologies, and to also apply state-of-the-art natural language processing (NLP) techniques to help recognize them in the biomedical literature.

Materials and methods

We constructed the CIHLex by integrating various resources, compiling and integrating data from biomedical literature and relevant sources of knowledge. The Lexicon encompasses 724 unique concepts with 885 corresponding unique terms. We matched these concepts to the Unified Medical Language System (UMLS), and we developed and utilized BERT models comparing their efficiency in CIH named entity recognition to well-established models including MetaMap and CLAMP, as well as the large language model GPT3.5-turbo.

Results

Of the 724 unique concepts in CIHLex, 27.2% could be matched to at least one term in the UMLS. About 74.9% of the mapped UMLS Concept Unique Identifiers were categorized as “Therapeutic or Preventive Procedure.” Among the models applied to CIH named entity recognition, BLUEBERT delivered the highest macro-average F1-score of 0.91, surpassing other models.

Conclusion

Our CIHLex significantly augments representation of CIH approaches in biomedical literature. Demonstrating the utility of advanced NLP models, BERT notably excelled in CIH entity recognition. These results highlight promising strategies for enhancing standardization and recognition of CIH terminology in biomedical contexts.
AutoCriteria: a generalizable clinical trial eligibility criteria extraction system powered by large language models
Authors: Datta Surabhi , Lee Kyeryoung , Paek Hunki , Manion Frank J , Ofoegbu Nneka , Du Jingcheng , Li Ying , Huang Liang-Chin , Wang Jingqi , Lin Bin , Xu Hua , Wang Xiaoyan
Published: November 2023

Objectives

We aim to build a generalizable information extraction system leveraging large language models to extract granular eligibility criteria information for diverse diseases from free text clinical trial protocol documents. We investigate the model’s capability to extract criteria entities along with contextual attributes including values, temporality, and modifiers and present the strengths and limitations of this system.

Materials and Methods

The clinical trial data were acquired from https://ClinicalTrials.gov/. We developed a system, AutoCriteria, which comprises the following modules: preprocessing, knowledge ingestion, prompt modeling based on GPT, postprocessing, and interim evaluation. The final system evaluation was performed, both quantitatively and qualitatively, on 180 manually annotated trials encompassing 9 diseases.

Results

AutoCriteria achieves an overall F1 score of 89.42 across all 9 diseases in extracting the criteria entities, with the highest being 95.44 for nonalcoholic steatohepatitis and the lowest of 84.10 for breast cancer. Its overall accuracy is 78.95% in identifying all contextual information across all diseases. Our thematic analysis indicated accurate logic interpretation of criteria as one of the strengths and overlooking/neglecting the main criteria as one of the weaknesses of AutoCriteria.

Discussion

AutoCriteria demonstrates strong potential to extract granular eligibility criteria information from trial documents without requiring manual annotations. The prompts developed for AutoCriteria generalize well across different disease areas. Our evaluation suggests that the system handles complex scenarios including multiple arm conditions and logics.

Conclusion

AutoCriteria currently encompasses a diverse range of diseases and holds potential to extend to more in the future. This signifies a generalizable and scalable solution, poised to address the complexities of clinical trial application in real-world settings.
Knowledge and Practices of Public Related to Burns Management in Saudi Arabia: A Cross-Sectional Study
Authors: Alruwaili Abdullah , Alsalem Mohammed , Alninyaa Mohammed , Alabdulqader Khallad , Alibrahim Mohammed , Al Asmri Saud , Alanazy Ahmed
Published: November 2023

Burn injuries are a significant global health challenge, with physical and psychological consequences affecting 180 000 people annually. This study aimed to evaluate public knowledge and practices regarding burn management. This cross-sectional survey included 582 participants to assess their knowledge and practices related to burn management between January 2023 and May 2023. Non-healthcare participants in Al Ahsa city in Saudi Arabia were asked questions about demographic data on age, sex, education, and nationality, along with assessing knowledge of burn first aid, sources of information, awareness of burn degree, chemical burn management, personal burn exposure, and traditional treatments. Our study of 582 participants highlighted significant findings related to sex and educational levels in burn management knowledge and practice. Females were more likely to receive information about burn first aid (69.3%), with a preference for social media as their information source, while males favored official courses (31.3%). Males displayed higher self-perceived knowledge were more inclined to consider first-degree burns the most dangerous (44.7%) and were better informed about managing chemical burns (24.2%). Females reported higher burn exposure (72.5%) and were more likely to manage burns themselves (76.5%). Informed participants with prior knowledge exhibited a greater interest in learning more about burn first aid (97%) and were more knowledgeable about burn degree and chemical burn management. These findings underscore the importance of tailoring public health education to burn first aid based on sex and education level. Such targeted approaches can enhance population-level preparedness and reduce burn injuries’ affect more effectively.
How Traditional Production Shapes Perceptions of Product Quality
Authors: Wilcox Keith , Laporte Sandra , Ward Gabriel
Published: November 2023

The current research examines how the knowledge that a product is made using a traditional method influences perceptions of its quality. We propose that consumers believe that a brand using traditional methods is beneficial for society because it is concerned about cultural preservation and this belief has a positive effect on perceived quality. Six experimental studies show that consumers evaluate products produced with a method described as traditional to be higher in quality than similar products that are not described as traditionally made and this effect is mediated by the belief that the brand is beneficial for society. Consistent with this theory, the positive effect of traditional production on perceived quality is attenuated when consumers view the brand to be unconcerned about cultural preservation, such as when the use of a traditional method is framed as a follower strategy (i.e., it imitates the actions of other brands) or when the brand is a multinational company. By showing that the mere mention of a traditional method can be another subtle way to position a brand as a moral actor, these findings contribute to the understanding of the link between perceived social responsibility and product evaluations.
How Much Should the Polluter Pay? Indian Courts and the Valuation of Environmental Damage
Authors: Mukherjee Sroyon
Published: November 2023

On the face of it, the polluter pays principle (PPP) simply prescribes that the costs of pollution should be borne by those who were responsible for causing it. In practice, implementing the PPP raises a number of complex questions. In this article, I focus on one such key question, as interpreted by higher courts in India: how much should the polluter pay? I propose—and then apply—a three-part choice framework for analysing judicial interpretations of the PPP. Indian case law on the subject is often presumed to be relatively coherent and consistent. However, a methodical application of the aforementioned framework reveals three distinct strands in the approaches taken by Indian courts, thus contributing to a more in-depth and systematic understanding of the PPP jurisprudence. I also identify certain gaps and inconsistencies in these approaches, and suggest ways in which they can be resolved, making the application of the set principle more consistent, logical and effective.
Intraoperative traction has a negligible time-dependent influence on patient-reported outcomes after hip arthroscopy: a cohort study
Authors: Feingold Jacob D , Ryan R. Thacher , Maniar Adit , Mitrasinovic Stefan , Menta Samarth Venkata , Ranawat Anil
Published: November 2023

The aim of this study is to determine if post-operative patient-reported outcome measures (PROMs) are influenced by hip arthroscopy traction duration.

Patients from a local prospective hip arthroscopy database were retrospectively analyzed. Four hip-specific PROMs were utilized: modified Harris Hip Score (mHHS), Hip Outcome Score—Activities of Daily Living (HOS-ADL), Hip Outcome Score—Sports Specific (HOS-SS), and international Hip Outcome Tool (iHOT). PROMs were collected pre-operatively and 6 months, 1 year and 2 years post-operatively. Two cohorts were created based on a cut-off corresponding to the 66th percentile for our patient cohort. Analyses were completed for each PROM at each post-operative interval with univariable statistics. Multivariable statistics were examined to identify the variables that were predictive of achieving post-operative minimal clinically important difference (MCID) at the 2-year follow-up.

Overall, 222 patients met the inclusion criteria. The mean age was 32.4 ± 9.4 years, and 116 (52.3%) were female. The average traction time of the study population was 46.1 ± 12.9 min. A total of 145 patients were included in the short traction cohort (65%) with traction times of <50 min (66th percentile). No significant differences were found regarding PROM scores or MCID achievement rates between both cohorts at any post-operative period. In multivariable analyses, achievement of MCID was predicted by a decrease in traction time for all PROMs and pincer-type resection for mHSS, HOS-ADL and iHOT.

There was no difference in PROMs and MCID achievement between longer and shorter traction time cohorts. On multivariable analysis, a decrease in traction time is predictive of MCID for all PROM scores and pincer-type resection was predictive of MCID for most PROM scores.

Level of evidence: Level III, cohort study
Development of a simulation system for femoroacetabular impingement detection based on 3D images
Authors: Chen Chun-Ming , Lin Shang-Chih , Wu Chen-Te , Chan Yi-Sheng
Published: November 2023

Image-based criteria have been adopted to diagnose femoroacetabular impingement (FAI). However, the overlapping property of the two-dimensional X-ray outlines and static and supine posture of taking computed tomography (CT) and magnetic resonance imaging images potentially affect the accuracy of the criteria. This study developed a CT image–based dynamic criterion to effectively simulate FAI, thereby providing a basis for physicians to perform pre-operative planning for arthroscopic surgery. Post-operative CT images of 20 patients with satisfactory surgical results were collected, and 10 sets of models were used to define the flexion rotation centre (FRC) of the three-dimensional FAI model. First, let these 10 groups of models simulate the FAI detection action and find the best centre offset, and then FRC is the result of averaging these 10 groups of best displacements. The model was validated in 10 additional patients. Finally, through the adjustment basis of FRC, the remaining 10 sets of models can find out the potential position of FAI during the dynamic simulation process. Rotational collisions detected using FRC indicate that the patient’s post-operative flexion angle may reach 120° or greater, which is close to the actual result. The recommended surgical range of the diagnostic system (average length of 6.4 mm, width of 4.1 mm and depth of 3.2 mm) is smaller than the actual surgical results, which prevents the doctor from performing excessive resection operations, which may preserve more bones. The FRC diagnostic system detects the distribution of FAI in a simple manner. It can be used as a pre-operative diagnosis reference for clinicians, hoping to improve the effect and accuracy of debridement surgery.
A bibliometric analysis and visualization of research trends on periacetabular osteotomy
Authors: Wei Tengfei , Xiao Fangjun , He Xiaoming , Peng Peng , He Wei , He Mincong , Wei Qiushi
Published: November 2023

Bernese periacetabular osteotomy (PAO) is a practical and safe acetabular reorientation technique used to correct structural hip deformities, and much relevant literature has been published over the past decades. This bibliometric study aims to determine the status of PAO research between 1994 and 2022. Information about PAO research publications from 1994 to 2022 was obtained from the Web of Science Core Collection. This bibliometric study is implemented and analyzed through three bibliometric tools with respect to publication counts, countries, institutions, authors, journals, funding agencies, references and keywords. In total, 634 publications concerning PAO were identified. The United States and Washington University in St. Louis have published the most literature in terms of country and institution. Additionally, Switzerland and the University of Bern are the country and the institution with the highest average number of citations in the PAO field. The most published and co-cited journal is Clinical Orthopaedics and Related Research. Burst keyword detection has discovered that ‘patient-reported outcome’, ‘instability’, ‘risk’, ‘survivorship’ and ‘outcome’ are regarded as the current research frontier. In summary, our findings provide insight into the bibliometric overview of research status in the PAO field, which may offer later investigators’ references in exploring further research directions.