bluuebunny/crossref_metadata_2025 huggingface dataset:
Occurrence Rate and Outcomes of Weaning Groups According to a Refined Weaning Classification: A Retrospective Observational Study*
Authors: Van Hollebeke Marine , Ribeiro Campos Débora , Muller Jan , Gosselink Rik , Langer Daniel , Hermans Greet
Published: February 2023

OBJECTIVES:

The weaning according to a new definition (WIND) classification groups mechanically ventilated (MV) patients into “short weaning,” “difficult weaning,” “prolonged weaning,” and “no weaning.” The aims of the study were: 1) to describe the weaning group distribution, 2) to evaluate if “short weaning” patients can be divided into groups with distinct characteristics and outcomes depending on the MV duration, and 3) to study 1-year outcomes related to weaning groups.

DESIGN:

Retrospective observational study.

SETTING:

Tertiary center with a mixed, mainly surgical ICU population.

PATIENTS:

MV patients admitted between April 11, 2018, and April 10, 2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A refined WIND classification was used, dividing “short weaning” patients into patients MV less than or equal to 24 hours, “short weaning a,” and those MV greater than 24 hours, “short weaning b.” Data were collected from electronic medical records. Of 1,801 MV patients, 65% were categorized as “short weaning a,” 13% “short weaning b,” 8% “difficult weaning,” 6% “prolonged weaning,” and 8% “no weaning.” “Short weaning a” patients were older, more frequently male, and had lower disease severity compared with “short weaning b.” Weaning duration (days: 0 [0–0] to 14 [10–21]), weaning success rate (99–69%), ICU length of stay (days: 2 [1–4] to 28 [19–48]), ICU mortality (1–37%), and hospital length of stay (days: 10 [7–18] to 48 [27–89]) and hospital mortality (4–42%; all p < 0.01) increasingly worsened from “short weaning a” to “prolonged weaning.” One-year mortality increased from “short weaning a” (9%) to “short weaning b” (27%), “difficult weaning” (39%), and “prolonged weaning” (49%). In adjusted analyses, weaning groups remained independently associated with 1-year mortality.

CONCLUSIONS:

The high proportion of “short weaning” patients in this mainly surgical ICU population could be divided into two groups with distinct characteristics. This refined WIND classification allowed to enhance prognostication, also beyond hospitalization, highlighting the need to further optimize the weaning process.
Transthoracic Salus Valve Feasibility Study: Short-Term Outcomes of a Transcatheter Self-Expandable Pulmonary Valve
Authors: Dong Jun , Su Junwu , Liu Aijun , Du Jing , Yang Jing , Li Qiangqiang , Li Bin , Yang Ming , Wang Zhijun , Bao Qian
Published: February 2023

Objective:

The size and morphology of the right ventricular outflow tract (RVOT) in patients suffering from long-term pulmonary regurgitation (PR) after native RVOT (NRVOT) reconstruction are important factors affecting the feasibility, safety, and effectiveness of transcatheter pulmonary valve replacement. The purpose of this study was to evaluate the feasibility, safety, and effectiveness of a transthoracic Salus valve (Balance Medical Technology Co., Ltd, Beijing, China) in patients with moderate-to-severe PR after NRVOT reconstruction.

Methods:

Patients with moderate-to-severe PR after NRVOT reconstruction were selected between June 2021 and November 2021 at Beijing Anzhen Hospital. Demographic data as well as preoperative, intraoperative, and follow-up data were reviewed.

Results:

Ten patients with moderate-to-severe PR after NRVOT reconstruction underwent physical examination, transthoracic echocardiography, and cardiovascular magnetic resonance imaging. Seven patients were selected for transthoracic Salus valve replacement. Six patients underwent implantation of the Salus valve successfully. One valve migrated and was embolized during recovery of the delivery device; the Salus valve was surgically explanted and sutured to the inner wall of the main pulmonary artery. At a mean follow-up of (5.5 ± 1.1) months, dysfunction or migration of the Salus valve embolism was not observed.

Conclusions:

This early feasibility study demonstrates the feasibility, safety, and effectiveness of transthoracic implantation of a Salus valve in patients with moderate-to-severe PR after NRVOT reconstruction. The short-term effectiveness is clear, medium and long-term effectiveness requires longer follow-up.
Burden of epilepsy in China and its provinces, 1990 to 2019: findings from the Global Burden of Disease Study 2019
Authors: Liu Wei , Xu Yangyang , Lin Yicong , Wang Lijun , Zhou Maigeng , Yin Peng , Zhao Guoguang
Published: February 2023

Background:

Epilepsy accounts for a significant portion of the global disease burden. However, little is known about the disease burden of epilepsy in China and its provinces.

Methods:

We assessed the burden of epilepsy in China and its provinces, municipalities, and autonomous regions from 1990 to 2019. Burden was measured as incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs), by age, sex, year, and province. We used the Socio-Demographic Index (SDI) to determine the association between the provincial development level and age-standardized DALY rates of epilepsy from 1990 to 2019.

Results:

In 2019, epilepsy caused 1367.51 thousand (95% uncertainty interval [UI]: 979.92–1837.61 thousand) DALYs, and the age-standardized DALY rate was 99.77 (95%UI: 71.33–133.52)/100,000. The age-standardized incidence and prevalence rates for epilepsy in China were 24.65/100,000 and 219.69/100,000, increased by 45.00% (95%UI: 8.03–98.74%) and 35.72% (95%UI: 0.47–86.19%) compared with that in 1990, respectively. From 1990 to 2019, the proportion of DALY caused by epilepsy in the age group under 25 years steadily decreased. The proportion of DALYs caused by epilepsy in people aged 50 years and over increased from 9.45% and 10.22% in 1990 to 29.01% and 32.72% for male and female individuals in 2019, respectively. The highest age-standardized mortality rates were seen in Tibet (4.26 [95%UI: 1.43–5.66]/100,000), Qinghai (1.80 [95%UI: 1.15–2.36]/100,000), and Yunnan (1.30 [95%UI: 0.88–1.62]/100,000), and the lowest mortality rates were in Guangdong (0.48 [95%UI: 0.39–0.64]/100,000), Zhejiang (0.56 [95%UI: 0.44–0.70]/100,000), and Shanghai (0.57 [95%UI: 0.41–0.73]/100,000). The age-standardized DALY rates across the country and in provinces, municipalities, and autonomous regions generally decreased as their SDI increased.

Conclusions:

The disease burden of epilepsy is still heavy in China, especially in the western provinces. The incidence and prevalence of epilepsy increased between 1990 and 2019, and the burden of epilepsy in the elderly increases gradually. This study provides evidence on epilepsy prevention and care of different regions in China.
Feasibility and Acceptability of an Online Family Literacy Program in an Under-Resourced Community During the COVID-19 Pandemic
Authors: Choi Yewoon , Uthirasamy Nila , Córdoba David , Morrow Lesley Mandel , Perez-Cortes Silvia , Ramachandran Usha , Pai Shilpa , Lima Daniel , Shelton Patricia A. , Jimenez Manuel E.
Published: February 2023

Objective:

The objective of this study was to examine the feasibility and acceptability of an online family literacy program (FLP) among low-income Latino families during the COVID-19 pandemic.

Methods:

We conducted a mixed methods pilot study. Latino parent-child dyads participated in an 8-week online FLP conducted on video conferencing software, developed through a cross-sector health care-education partnership. We conducted surveys and structured observation to assess feasibility and acceptability and in-depth interviews to gain insight into the context of participants' experiences during the pandemic.

Results:

The 35 participating parent-child dyads all identified as Latino, 83% reported limited English proficiency, and 60% of parents did not achieve a high school diploma. Nearly two-thirds of families participated in at least half of the sessions. On average, parents welcomed, liked, approved, and found the program appealing. While 86% experienced a technology problem at least once during sessions, all were resolved with minimal assistance. During qualitative interviews, we identified 3 themes that provide insight into their experiences with the FLP within the broader context of the pandemic: (1) disruption in family routine and financial strain caused by COVID-19 intensified family stress, (2) the forced transition to remote learning highlighted the inequities experienced by Latino preschool children, and (3) the FLP empowered parents and enhanced health and education experiences.

Conclusion:

Latino families had high participation levels in an online FLP and found it acceptable. Additional work is needed to understand how similar primary care programs can be leveraged to promote optimal development during a time of heightened need.
Effects of Ketanserin, M100907 and Olanzapine on hallucinogenic like action induced by 2,5-dimethoxy-4-methylamphetamine
Authors: Li Kaixi , Liu Xiaoyan , Zhang Mei , Su Ruibin
Published: February 2023

2,5-dimethoxy-4-methylamphetamine (DOM) is a kind of hallucinogen of phenylalkylamine. Psychedelic effects mainly include audiovisual synesthesia, complex imagery, disembodiment etc. that can impair control and cognition leading to adverse consequences such as suicide. By now, there are no specific drugs regarding the management of classic hallucinogen use clinically. We evaluated the effects of three 5-HT2A receptor antagonists ketanseirn, M100907 and olanzapine on hallucination-like behavior in therapeutic and preventive administration with male C57BL/6J mice. Two models were used to evaluate the therapeutic potential of antagonists, one is head-twitch response (HTR) and the other is locomotion. Effects of ketanserin, M100907 and olanzapine on DOM-induced HTR were studied in preventive and therapeutic administration, respectively. In the preventive administration, the ID50 values of ketanseirn, M100907 and olanzapine were 0.4 mg/kg, 0.005 mg/kg and 0.25 mg/kg. In the therapeutic administration, the ID50 values of ketanseirn, M100907 and olanzapine were 0.04 mg/kg, 0.005 mg/kg and 0.03 mg/kg. Secondly, locomotor activity induced by DOM was performed to further evaluate the efficacy of three compounds. In locomotion, M100907(0.005 mg/kg) whenever in preventive or therapeutic administration, reduced the increase of movement distance induced by DOM. Although ketanserin (0.4 mg/kg) in the preventive administration also decreased the movement distance induced by DOM, it was alone administrated to influence the locomotor activity. Through HTR and locomotion, we compared the efficacy and latent side effects of ketanserin, M100907 and olanzapine against hallucinogenic like action induced by DOM. Our study provided additional experimental evidence on specific therapeutic drugs against hallucinogenic behavior induce by representative hallucinogen DOM.
Designer Benzodiazepines: Effects, Toxicity, and Interactions
Authors: El Balkhi Souleiman , Abbara Chadi
Published: February 2023

Purpose:

Although designer benzodiazepines (DBZDs) constitute a minor part of new psychoactive substances, they deserve the greatest attention because of their popularity among drug users and increasing number and availability. This review covers the effects of different DBZDs, available pharmacological evaluation tools, and their reported toxicity and potential pharmacodynamic and pharmacokinetic interactions with other drugs commonly co-abused with DBZDs.

Methods:

For this narrative review, a nonsystematic search was performed on PubMed, EMBASE, Google Scholar, and PubMed Central databases between June and July 2021.

Results:

The current consensus hypothesis suggests that DBZDs mediate their effects through interactions with the GABAA receptor, producing similar effects to benzodiazepines used in therapy, including sedation, hypnosis, anxiolysis, muscle relaxation, euphoria, amnesia, and addiction. Owing to the complexity of their action mechanism and the numerous GABAA subtype receptors, the pharmacodynamic metrics of DBZDs are very difficult to establish. The pharmacological effects of DBZD are related to their structure, influencing their binding to GABAA receptor subunits. Quantitative structure–activity relationship studies successfully predicted the biological activity and relative potency of DBZD but could not predict the main pharmacological effect of a given DBZD. Exploring the effects by netnographic studies is one of the available alternatives, despite its limitations. DBZDs are usually identified in the context of polysubstance use. Pharmacodynamic interactions between DBZDS and other CNS depressants, such as opioids, have been extensively reported. However, pharmacokinetic interactions between DBZDs and opioids are considered less important, and contradictory conclusions about their clinical significance have been reported.

Conclusions:

Understanding the mechanism of action and other pharmacological metrics is highly important in the clinical management of DBZDs.
Anteroinferior plating is an independent factor for decreasing symptomatic implant removal rates after plate fixation for midshaft clavicle fractures
Authors: Ariga Akane , Shimura Haruhiko , Fujita Koji , Nimura Akimoto
Published: February 2023

Objectives:

The factors that significantly influence the symptomatic implant removal rates after plate fixation for midshaft clavicle fractures remain controversial. The purpose of this study was to compare the symptomatic implant removal rates between 2 different types of plating technique and to evaluate independently associated factors.

Design:

Retrospective cohort study.

Setting:

Acute care center.

Patients/Participants:

A total of 71 patients 16 years or older who were diagnosed with displaced midshaft clavicle fractures from April 2016 to March 2020.

Intervention:

Thirty-nine patients were treated with superior plating (Group SP), and the remaining 32 patients were treated with anteroinferior plating (Group AIP).

Main Outcome Measurements:

Symptomatic implant removal rates after plate fixation for midshaft clavicle fractures.

Results:

Symptomatic implant removal rates were significantly lower in Group AIP (28.1%) than in Group SP (53.8%) (P = 0.033). Multivariate analyses showed that symptomatic implant removal rates were significantly decreased by three independent factors, namely AIP (odds ratio [OR] = 0.323) (P = 0.037), greater age (45 years or older) (OR = 0.312) (P = 0.029), and high body mass index (≥25 kg/m2) (OR = 0.117) (P = 0.034).

Conclusions:

AIP significantly and independently decreased the symptomatic implant removal rate. Among the three explanatory factors showing significant difference, plating technique is the only factor that can be altered by medical institutions. Therefore, we recommend this technique for displaced midshaft clavicle fractures to reduce a second surgery such as symptomatic implant removal.

Level of Evidence:

Level 3, retrospective cohort study
The differing effects of nociception and pain memory on isometric muscle strength in participants with and without a history of injury: A quasi-experimental study
Authors: Sueki Derrick G. , Dunleavy Kim , Puentedura Emilio J. , Heard Lindsey , Van der Heide Peter , Cheng Ming-Shun
Published: February 2023

OBJECTIVE

The goals of this study were to establish whether mechanical pressure pain, short-term memory recall of a painful stimulus, or long-term memory of a prior painful lower extremity injury alters isometric muscle strength and whether there was a difference in responses between participants with and without a previous history of injury.

DESIGN

59 pain-free participants (29 with previous injury and 30 without) participated in this study. Tibialis anterior isometric muscle strength was compared pre and post-noxious mechanical stimulus with instructions to recall pain (short-term and long-term).

RESULTS

Short-term and long-term pain recall produced a significant reduction in muscle strength (short-term: F(1,57) = 160.472, p < 0.001; long-term: F(1,57) = 128.899, p < 0.001). A greater decrease was experienced with short- and long-term pain memory than exposure to mechanical pain (mechanical pain: -14.8% or -32.98 kg, 95% CI (-41.57, -24.19); short-term: -24.1% or -52.70 kg, 95% CI (-60.98, -44.34); long-term: -20.3% or -44.63 kg, 95% CI (-52.77, -36.95)). There was no significant difference in responses associated with an injury history.

CONCLUSION

Findings suggest that recalled pain memory can impact motor responses and calls attention to the role of past injury history in the rehabilitation process.
The effect of a modified elastic band orthosis on gait and balance in stroke survivors
Authors: Thitithunwarat Nutkritta , Krityakiarana Warin , Kheowsri Suchittra , Jongkamonwiwat Nopporn , Richards Jim
Published: February 2023

Background:

Gait is crucial for independent living for stroke survivors and assistive devices have been developed to support gait performance. Ankle foot orthosis (AFOs) are commonly provided to stroke survivors to prevent foot drop during walking. However, previous studies have reported limitations of AFOs including them being too heavy, creating skin irritation, and being a stigma of disability.

Objective:

The purpose was to compare the gait and balance improvement between elastic band orthosis (EBOs) and AFOs.

Study Design:

Experimental study design.

Methods:

The AFOs and EBOs were provided to 17 stroke survivors, and changes in gait and balance were assessed compared to barefoot (control). Gait spatiotemporal parameters were measured using the zebris-FDM-Rehawalk® system, and balance ability was evaluated using the time up and go test (TUG). Satisfaction with the EBOs was determined using the Quebec user evaluation of satisfaction with assistive technology (QUEST2.0) questionnaire.

Results:

The EBO showed significant differences in; gait speed, cadence, stride length, stride time, step length unaffected side, stance phase and swing phase on the affected side, and pre-swing on the unaffected side, and balance performance (TUG) (p<0.05) when compared to the AFO and control conditions. The participants were quite satisfied with the EBOs with QUEST2.0 scores greater than 4 out of 5.

Conclusions:

EBOs could be provided to stroke survivors given their acceptability and properties to improve gait and balance. The EBO used in this study offered clinically important improvements in gait and balance when compare to AFO and control conditions, and could mitigate against some of the limitations reported in the use of AFOs in stroke survivors.
Treatment of Challenging Extracranial Arteriovenous Malformations
Authors: Jia Hechen , Chen Yuxi , Yang Xi , Lee Yuanbo , Zou Yun , Zhou Jingwei , Jin Yunbo , Hua Chen , Lin Xiaoxi
Published: February 2023

Extracranial arteriovenous malformation (AVM) is a high-flow congenital vascular malformation, where direct communication between the arteries and veins impedes perfusion of capillary beds and causes disfigurement of the affected tissue. Surgery and endovascular therapy are currently the main treatment for extracranial AVMs. Nevertheless, management of complex cases is sometimes challenging because of severe complications such as refractory ulceration, life-threatening bleeding, and even cardiac insufficiency. Here, we reviewed the development and potential treatment for extracranial AVMs and shared our single-center experiences of diagnosis and treatment of this challenging disease.
Application of Dual “Kite” Myomucosal Flaps for the Repair of Medium Lip Defects
Authors: Gao Zhiquan , Yang Weiyuan , Sun Haiyang , Wang Xinyu , Tan Xiaoyan , Yao Ping , Tang Dongsheng
Published: February 2023

Objective

To investigate the application of dual “kite” myomucosal flaps (subcutaneous pedicle advancement flap) for the repair of medium lip defects (one-third to one-half lip width).

Methods

Dual kite myomucosal flaps were designed in the adjacent area of the defect in 17 patients with medium lip defect with the principle of using homogenous tissue as far as possible without affecting local anatomical units.

Results

The follow-up time was 3 to 24 months; 16 patients showed primary wound healing, and 1 patient showed prolonged healing. The blood supply of the myomucosal flaps were reliable. The myomucosal flaps were smooth, with no proliferation of scars, and the local appearance was good.

Conclusion

The dual kite myomucosal flaps provide a reliable method for repairing medium lip defects, decreasing the need for additional excision of normal skin tissue, and reducing skin scar.
Management of Complex Forearm Injuries
Authors: Perruisseau-Carrier Anne , Tilhet Laura , Rouanet Marion , Henry Anne-Sophie , Hu Weiguo
Published: February 2023

The management of complex forearm injuries is challenging, not only because of the anatomical complexity of the region but also because of the dramatic functional consequences of these injuries. Preservation of the upper limb and restoration of hand function are the focus of the surgical management of these injuries. Decision making will consider several parameters such as the type of injury, the patient, the moment of reconstruction, the debridement, and the options available for reconstruction.

A multidisciplinary approach joining plastic surgeons and orthopedic surgeons in a team effort is essential to achieve the best outcomes. On the basis of their experience, the authors conclude that the keystone in complex forearm injuries management is represented by a careful assessment of the lesions, an aggressive and early debridement, the prevention of complications such as infection and compartment syndrome, and an “as early as possible” reconstruction.
Experience in Microsurgical Treatment of Complete Scalp Avulsion
Authors: Lin Jian , Wei Peng , Wang Yangjian , Song Qinghua , Yang Zhuan , Xu Yi
Published: February 2023

Background

Avulsion of the scalp is a rare destructive event worldwide. Before the emergence of microsurgery, skin transplantation, flap transplantation, greater omentum transplantation, and other methods were once widely used. However, replantation offers the optimum reconstruction.

Methods

Six cases of complete avulsion injury of a large scalp treated from May 2017 to May 2020 were retrospectively analyzed. Under the microsurgery technology, the wound was cleaned and explored, and the appropriate arteriovenous anastomosis was selected. Preoperative blood preparation and skin preparation were actively performed. Postoperative strict nursing and observation of the blood supply of replanted scalp were performed. Regular outpatient follow-up after discharge was performed.

Results

Replantation was successful in 5 cases and failed in 1 case, and in 1 case the occipital scalp (approximately 10% of the scalp area) died and crusted 2 months after the operation. After 6 to 24 months of follow-up, all patients were satisfied with the reconstructed appearance.

Conclusions

Superb microsurgical technique and more detailed anatomical knowledge are the key conditions for successful complete scalp avulsion replantation. Compared with other methods, successful replantation can achieve the best aesthetic and functional results.
A Review of 559 Sternal Wound Reconstructions at a Single Institution
Authors: Kuonqui Kevin , Janhofer David E. , Takayama Hiroo , Ascherman Jeffrey A.
Published: February 2023

Background

Sternal wound infection (SWI) and dehiscence after median sternotomy for cardiac surgery remain challenging clinical problems with high morbidity. Bilateral pectoralis major myocutaneous flaps are excellent for most sternal wounds but do not reach deeper mediastinal recesses. The omental flap may be a useful adjunct for addressing these deeper mediastinal infections.

Methods

Records of 598 sternal wound reconstructions performed by a single surgeon (J.A.A.) from 1996 to 2022 were reviewed. At the time of surgery, patients underwent sternal hardware removal, debridement, and closure with bilateral pectoralis major myocutaneous flaps. Pedicled omental flaps were also mobilized when additional vascularized tissue was required within the deeper mediastinum.

Results

Complete data were available for 559 sternal wound reconstructions performed by the senior author during this period. Bilateral pectoralis and omental flaps were mobilized in 17 of 559 (3.04%) patients. Common indications for initial cardiac surgery included repair or replacement of diseased aortic roots (9/17; 52.94%), aortic valves (8/17; 47.06%), and mitral valves (6/17; 35.29). Mean American Society of Anesthesiologists score was 3.56. Preoperative morbidity included culture-positive wound infection (12/17; 70.59%), dehiscence (15/17; 88.24%), wound drainage (11/17; 64.71%), and inability to close the chest after the original sternotomy because of hemodynamic instability (6/17; 35.29%). Intraoperative deep mediastinal or bone cultures were positive in 8 of 17 (47.06%) patients. Postoperative complications included partial dehiscence (2/17; 11.76%), skin edge necrosis (1/17; 5.88%), seroma (1/17; 5.88%), abdominal hernia (1/17; 5.88%), and recurrent infection (2/17; 11.76%). Three patients (17.65%) died within 30 days of the reconstruction surgery.

Conclusions

Patients undergoing combined pectoralis major and omental flap closure frequently had a history of aortic root and valve disease, and other significant preoperative morbidities. However, postoperative complication rates after combined flap closure were relatively low. Combined pectoralis major and omental flap reconstruction thus appears to be an effective intervention in patients with sternal wounds extending into the deep mediastinum.
Beyond antipsychotics: the role of medication and nonmedication factors in female sexual dysfunctions in schizophrenia
Authors: Fayez Fiby , Saad Ahmed , El Sheikh Mona M. , Elhabiby Mahmoud , Elkholy Hussien , Abdel Aziz Karim , ELNahas Gihan
Published: February 2023

To date, few studies have investigated male sexual dysfunctions (FSDs) in schizophrenia in non-Western countries, with most studies focusing on the sexual side effects of antipsychotic medications. Therefore, we aimed to screen for FSD in a sample of Egyptian females with schizophrenia, compare them to controls and to investigate demographic and clinical parameters associated with FSD. We conducted a cross-sectional study of 72 medicated and unmedicated females with schizophrenia (27 unmedicated and 45 medicated) and 24 controls. They were assessed using the Female Sexual Function Index (FSFI) and data were collected for demographic and clinical parameters. We found that females with schizophrenia had significantly lower scores on the FSFI compared to controls and that 93.1% of females with schizophrenia reached the threshold for FSD (FSFI score ≤26), compared to 87.5% of controls. Medicated and unmedicated subjects did not differ significantly in most domains of the FSFI. Age, duration of illness, positive and negative syndrome Scale total, positive and negative symptom scores correlated significantly with the majority of domains of the FSFI. Rates of FSD are very high in both schizophrenia and controls and correlate in schizophrenia with a number of demographic and clinical parameters, suggesting that FSDs are not restricted to the side effects of medications. There is a need to screen for sexual function in routine practice, and for developing active strategies to tackle sexual dysfunctions.
Provenancing antiquarian museum collections using multi-isotope analysis
Authors: Neil Samantha , Evans Jane , Montgomery Janet , Schulting Rick , Scarre Chris
Published: February 2023

Many of the most significant archaeological sites in Europe were excavated by antiquarians over one hundred years ago. Modern museum collections therefore frequently contain human remains that were recovered during the nineteenth and early twentieth centuries. Here we apply multi-isotope analysis (87Sr/86Sr,δ18O,δ13C,δ15N) and14C dating to evaluate the provenance of human remains within a collection that is thought to have been recovered from one of the most important archaeological sites in Britain. Excavated in 1910, the site of Coldrum in Kent is a megalithic burial monument that may be one of the earliest sites associated with the transition to farming in Britain. The interpretation of this site is therefore key to understanding how agriculture began. Using isotope analysis we show that although the human skeletal collections attributed to Coldrum do contain some of the earliest dated Neolithic human remains in Britain, they also contain the remains of individuals of fifth to seventh centuries AD date. We evaluate subsistence and mobility patterns of early Neolithic populations and provide new information about the origins of those individuals in the collection that date to the fifth to seventh centuries AD. We demonstrate the utility of employing isotope analysis to provide direct and independent information about the provenance of human remains in museum collections.
Export of ice-nucleating particles from watersheds: results from the Amazon and Tocantins river plumes
Authors: Einbock Annika , Burtscher Emma , Frey Claudia , Conen Franz
Published: February 2023

We examined ice-nucleating particles (INPs) in the plumes of the Tocantins and Amazon rivers, which drain watersheds with different proportions of degraded land. The concentration of INPs active at −15°C (INP
−15
) was an order of magnitude lower in the Tocantins (mean = 13.2 ml
−1
; s.d. = 7.8 ml
−1
), draining the more degraded watershed, compared with the Amazon (mean = 175.8 ml
−1
; s.d. = 11.2 ml
−1
), where the concentration was also significantly higher than in Atlantic surface waters (mean = 3.2 ml
−1
; s.d. = 2.3 ml
−1
). Differences in heat tolerance suggest that INPs emitted by the Amazon rainforest to the atmosphere or washed into the river might originate from contrasting sources on top of and below the rainforest canopy, respectively. For the Amazon River, we estimate a daily discharge of 10
18
INP
−15
to Atlantic waters. Rivers in cooler climate zones tend to have much higher concentrations of INPs and could, despite a smaller water volume discharged, transfer even larger absolute numbers of INP
−15
to shelf waters than does the Amazon. To what extent these terrestrial INPs become aerosolized by breaking waves and bubble-bursting remains an open question.
Value attributed to text-based archives generated by artificial intelligence
Authors: Darda Kohinoor , Carre Marion , Cross Emily
Published: February 2023

Openly available natural language generation (NLG) algorithms can generate human-like texts across domains. Given their potential, ethical challenges arise such as being used as a tool for misinformation. It is necessary to understand both how these texts are generated from an algorithmic point of view, and how they are evaluated by a general audience. In this study, our aim was to investigate how people react to texts generated algorithmically, whether they are indistinguishable from original/human-generated texts, and the value people assign these texts. Using original text-based archives, and text-based archives generated by artificial intelligence (AI), findings from our preregistered study (N= 228) revealed that people were more likely to preserve original archives compared with AI-generated archives. Although participants were unable to accurately distinguish between AI-generated and original archives, participants assigned lower value to archivestheycategorized as AI-generated compared with those they categorized as original. People's judgements of value were also influenced by their attitudes toward AI. These findings provide a richer understanding of how the emergent practice of automated text creation alters the practices of readers and writers, and have implications for how readers' attitudes toward AI affect the use and value of AI-based applications and creations.
Bounded strategic reasoning explains crisis emergence in multi-agent market games
Authors: Patrick Evans Benjamin , Prokopenko Mikhail
Published: February 2023

The efficient market hypothesis (EMH), based on rational expectations and market equilibrium, is the dominant perspective for modelling economic markets. However, the most notable critique of the EMH is the inability to model periods of out-of-equilibrium dynamics without significant external news. When such dynamics emerge endogenously, the traditional economic frameworks prove insufficient. This work offers an alternate perspective explaining the endogenous emergence of punctuated out-of-equilibrium dynamics based on bounded rational agents. In a concise market entrance game, we show how boundedly rational strategic reasoning can lead to endogenously emerging crises, exhibiting fat tails in returns. We also show how other common stylized facts, such as clustered volatility, arise due to agent diversity (or lack thereof) and the varying learning updates across the agents. This work explains various stylized facts and crisis emergence in economic markets, in the absence of any external news, based on agent interactions and bounded rational reasoning.
Birds differentially prioritize visual and olfactory foraging cues depending on habitat of origin and sex
Authors: Rubene Diana , Low Matthew , Brodin Anders
Published: February 2023

Animals interpret their environment by combining information from multiple senses. The relative usefulness of different senses may vary between species, habitats and sexes; yet, how multimodal stimuli are integrated and prioritized is unknown for most taxa. We experimentally assessed foraging preferences of great tits (
Parus major
) to test whether urban and forest individuals prioritize visual and olfactory cues differently during foraging. We trained 13 wild-caught birds to associate multimodal (colour + odour) cues with a food reward and assessed their foraging preferences in a cue-separation test. In this, the birds could choose between the multimodal training cue and its olfactory or visual components. Our results suggest that the birds did not perceive multimodal cues in an integrated way, as their response was not stronger than for unimodal cue components. Urban birds preferred olfactory cues, while forest birds preferred visual cues. Nevertheless, female birds preferred the multimodal cue, while males foraged more randomly with respect to which cue was present. These findings contribute to our understanding of the relative roles of vision and olfaction in bird foraging behaviour. Future work should focus on how habitat- and sex-specific sensory prioritization modifies bird foraging behaviour and foraging success in the context of urban adaptations across populations.
Molecular interaction of a putative inhibitor with bacterial SHV, an enzyme associated with antibiotic resistance
Authors: Shakil Shazi , Danish Rizvi Syed M. , Greig Nigel H.
Published: February 2023

Tackling the ever-looming threat of antibiotic resistance remains a challenge for clinicians and microbiologists across the globe. Sulfhydryl variable (SHV) is a known bacterial enzyme associated with antibiotic resistance. The SHV enzyme has many variants. The present article describes identification and molecular interaction of a putative inhibitor with the bacterial SHV enzyme as a step towards novel antibacterial drug discovery. The MCULE-platform was used for screening a collection of 5 000 000 ligand molecules to evaluate their binding potential to the bacterial SHV-1 enzyme. Estimation of pharmacokinetic features was realized with the aid of the ‘SWISS ADME’ tool. Toxicity-checks were also performed. The docked complex of ‘the top screened out ligand’ and ‘the bacterial SHV-1 protein’ was subjected to molecular dynamics simulation of 101 ns. The obtained ligand molecule, 1,1'-(4H,8H-Bis[1,2,5]oxadiazolo[3,4-b:3′,4'-e]pyrazine-4,8-diyl)diethanone, displayed the most favourable binding interactions with bacterial SHV-1. A total of 15 amino acid residues were found to hold the ligand in the binding site of SHV-1. Noticeably, 12 of the 15 residues were found as common to the binding residues of the reference (PDB ID: 4ZAM). The RMSD values plotted against the simulation time showed that nearby 11 ns, equilibrium was reached and, thenceforth, the ‘SHV-1-Top ligand’ complex remained typically stable. Starting from around 11 ns and straight to 101 ns, the backbone RMSD fluctuations were found to be confined inside a range of 1.0–1.6 Å. The ligand, 1,1′-(4H,8H-Bis[1,2,5]oxadiazolo[3,4-b:3′,4′-e]pyrazine-4,8-diyl)diethanone, satisfied ADMET criteria. Furthermore, the practicability of the described ‘SHV-1-Top ligand’ complex was reinforced by a comprehensive molecular dynamics simulation of 101 ns. This ligand hence can be considered a promising lead for antibiotic design against SHV-1 producing resistant bacteria, and thus warrants wet laboratory evaluation.
Complex economic decisions from simple neurocognitive processes: the role of interactive attention
Authors: He Lisheng , Bhatia Sudeep
Published: February 2023

Neurocognitive theories of value-based choice propose that people additively accumulate choice attributes when making decisions. These theories cannot explain the emergence of complex multiplicative preferences such as those assumed by prospect theory and other economic models. We investigate an
interactive attention
mechanism, according to which attention to attributes (like payoffs) depends on other attributes (like probabilities) attended to previously. We formalize this mechanism using a Markov attention model combined with an accumulator decision process, and test our model on eye-tracking and mouse-tracking data in risky choice. Our tests show that interactive attention is necessary to make good choices, that most participants display interactive attention and that allowing for interactive attention in accumulation-based decision models improves their predictions. By equipping established decision models with sophisticated attentional dynamics, we extend these models to describe complex economic choice, and in the process, we unify two prominent theoretical approaches to studying value-based decision making.
An anchovy ecosystem indicator of marine predator foraging and reproduction
Authors: Fennie H. William , Seary Rachel , Muhling Barbara A. , Bograd Steven J. , Brodie Stephanie , Cimino Megan A. , Hazen Elliott L. , Jacox Michael G. , McHuron Elizabeth A. , Melin Sharon , Santora Jarrod A. , Suca Justin J. , Thayer Julie A. , Thompson Andrew R. , Warzybok Pete , Tommasi Desiree
Published: February 2023

Forage fishes are key energy conduits that transfer primary and secondary productivity to higher trophic levels. As novel environmental conditions caused by climate change alter ecosystems and predator–prey dynamics, there is a critical need to understand how forage fish control bottom-up forcing of food web dynamics. In the northeast Pacific, northern anchovy (
Engraulis mordax
) is an important forage species with high interannual variability in population size that subsequently impacts the foraging and reproductive ecology of marine predators. Anchovy habitat suitability from a species distribution model (SDM) was assessed as an indicator of the diet, distribution and reproduction of four predator species. Across 22 years (1998–2019), this anchovy ecosystem indicator (AEI) was significantly positively correlated with diet composition of all species and the distribution of common murres (
Uria aalge
), Brandt's cormorants (
Phalacrocorax penicillatus
) and California sea lions (
Zalophus californianus
), but not rhinoceros auklets (
Cerorhinca monocerata
). The capacity for the AEI to explain variability in predator reproduction varied by species but was strongest with cormorants and sea lions. The AEI demonstrates the utility of forage SDMs in creating ecosystem indicators to guide ecosystem-based management.
Ageing across the great divide: tissue transformation, organismal growth and temperature shape telomere dynamics through the metamorphic transition
Authors: Burraco Pablo , Hernandez-Gonzalez Miguel , Metcalfe Neil B. , Monaghan Pat
Published: February 2023

Telomere attrition is considered a useful indicator of cellular and whole-organism ageing rate. While approximately 80% of animal species undergo metamorphosis that includes extensive tissue transformations (involving cell division, apoptosis, de-differentiation and
de novo
formation of stem cells), the effect on telomere dynamics is unknown. We measured telomeres in
Xenopus laevis
developing from larvae to adults under contrasting environmental temperatures
.
Telomere dynamics were linked to the degree of tissue transformation during development. Average telomere length in gut tissue increased dramatically during metamorphosis, when the gut shortens by 75% and epithelial cells de-differentiate into stem cells. In the liver (retained from larva) and hindlimb muscle (newly formed before metamorphosis), telomeres gradually shortened until adulthood, likely due to extensive cell division. Tail muscle telomere lengths were constant until tail resorption, and those in heart (retained from larva) showed no change over time. Telomere lengths negatively correlated with larval growth, but for a given growth rate, telomeres were shorter in cooler conditions, suggesting that growing in the cold is more costly. Telomere lengths were not related to post-metamorphic growth rate. Further research is now needed to understand whether telomere dynamics are a good indicator of ageing rate in species undergoing metamorphosis.
The prediction of cardiovascular events by phenotype of central and peripheral blood pressure in subjects without hypertension
Authors: Kim Min-Sik , Kim Gee-Hee
Published: February 2023

Background

Hypertension (HBP) is a common disease associated with aging, but the rate of recognition and control of the condition remains low. Most guidelines related to HBP have consisted of only peripheral blood pressure (BP) measurement. However, according to many studies, central BP (CBP) has a clearer relationship with the prediction of cardiovascular (CV) events than does peripheral BP and can more clearly express an individual’s BP status. Therefore, we aimed to evaluate the effect of CBP on the prediction of CV events and to investigate the prediction of CV events by phenotype of central and peripheral BP in subjects without hypertension.

Method

A total of 2,910 patients were enrolled from June 2011 to December 2016 and were followed up through October 2022. CBP was measured using radial tonometry. The primary endpoint was a composite outcome.

Result

The median follow-up period for enrolled patients was 7.5 years. Out of a total of 722 patients (mean age of 52.5 ± 13.7 years) without HBP, 21 patients (2.9%) had events of the primary endpoint during the follow-up period. Systolic BP averaged 126 mmHg (±15 mmHg) in the event-free group and 136 mmHg (±15 mmHg) in the CV event group, while CBP measured 115 mmHg (±16 mmHg) in the event-free group and 126 mmHg (±16 mmHg) in the CV event group. In a Cox proportional hazards model, every 10 mmHg increase in CBP and systolic BP showed an increase in risk of 30% and 40%, respectively. Isolated central systolic hypertension and dual central and peripheral systolic hypertension showed 4.9% and 6% of the CV event rate, respectively (p=0.897).

Conclusion

Irrespective of the brachial BP status, isolated central hypertension increased CV events. Therefore, to prevent CV events, it is essential to control not only peripheral BP but also CBP.
Development and Validation of an MGBP Nomogram for 3-month Unfavorable Functional Prognosis Prediction of Nontraumatic Pediatric Intracerebral Hemorrhage in Chinese Patients: 10-year Experience from a National Children’s Medical Center
Authors: Zhou Ji-Hua , Zhang Zhen-Yu , Chen Yang , Ming Mei-Xiu , Shen Quan-Li , Zheng Ji-Cui , Pan Gang , Zhang Yi , Chen Wei-Ming , Lu Guo-Ping
Published: February 2023

Background

Pediatric intracerebral hemorrhage (pICH) remains a considerable cause of mortality. This study aimed to explore functional prognosis predictors in Chinese patients with pICH and attempted to develop and validate a nomogram for estimating individual risk probability of short-term unfavorable functional prognosis.

Methods

A retrospective case-control study through records reviewing was conducted, non-neonate patients with nontraumatic pICH discharged from the Children’s Hospital of Fudan University between January 2012 and December 2021 were all originally included. The primary outcome was unfavorable functional prognosis at 3 months post pICH defined as a score of 3–6 as measured using the modified Rankin Scale (ranging from 0 [asymptomatic] to 6 [death]). Multivariate logistic regression analysis was performed to screen prognosis predictors, a prediction model-based nomogram was developed. Internal validation was assessed and quantified as receiver operating characteristic (ROC) curve and bootstrapped calibration curve.

Results

A total of 269 pICH patients were enrolled, the median age was 57.2 months (interquartile range, 5.4–115.1), and 157 (58.4%) patients were male. The median follow-up time was 3.2 months (interquartile range, 2.8–3.6), 112 (41.6%) patients had unfavorable functional outcome. Cerebral vascularmalformation as etiology, modifiedGlasgow Coma Score on admission,brainstem location, and intracerebral hemorrhage volume aspercentage of total brain volume were identified as functional prognosis predictors. A nomogram was established comprising these four predictors, abbreviated to MGBP, the area under the ROC curve of the nomogram was 0.827 (95% Confidence Interval, 0.778–0.877) with good calibration (P=0.803 for the Spiegelhalter’s Z-test).

Conclusions

The MGBP nomogram is the first model developed and validated in a consecutive cohort to predict 3-month unfavorable functional prognosis post nontraumatic pICH in Chinese children, which may provide clinicians with a potentially effective approach for early prediction and timely management of pICH.
Application and validation of an algorithmic classification of early impairment in cognitive performance
Authors: Cai Yurun , Schrack Jennifer A. , Agrawal Yuri , Armstrong Nicole M. , Wanigatunga Amal , Kitner-Triolo Melissa , Moghekar Abhay , Ferrucci Luigi , Simonsick Eleanor M. , Resnick Susan M. , Gross Alden L.
Published: February 2023

Objective

Due to the long prodromal period for dementia pathology, approaches are needed to detect cases before clinically recognizable symptoms are apparent, by which time it is likely too late to intervene. This study contrasted two theoretically-based algorithms for classifying early cognitive impairment (ECI) in adults aged ≥50 enrolled in the Baltimore Longitudinal Study of Aging.

Method

Two ECI algorithms were defined as poor performance (1 standard deviation [SD] below age-, sex-, race-, and education-specific means) in: (1) Card Rotations or California Verbal Learning Test (CVLT) immediate recall and (2) ≥1 (out of 2) memory or ≥3 (out of 6) non- memory tests. We evaluated concurrent criterion validity against consensus diagnoses of mild cognitive impairment (MCI) or dementia and global cognitive scores using receiver operating characteristic (ROC) curve analysis. Predictive criterion validity was evaluated using Cox proportional hazards models to examine the associations between algorithmic status and future adjudicated MCI/dementia.

Results

Among 1,851 participants (mean age=65.2±11.8 years, 50% women, 74% white), the two ECI algorithms yielded comparably moderate concurrent criterion validity with adjudicated MCI/dementia. For predictive criterion validity, the algorithm based on impairment in Card Rotations or CVLT immediate recall was the better predictor of MCI/dementia (HR=3.53, 95%CI: 1.59-7.84) over 12.3 follow-up years.

Conclusions

Impairment in visuospatial ability or memory may be capable of detecting early cognitive changes in the preclinical phase among cognitively normal individuals.