bluuebunny/crossref_metadata_2025 huggingface dataset:
A ‘potential motherhood’ penalty? A longitudinal analysis of the wage gap based on potential fertility in Germany and the United Kingdom
Authors: Zamberlan Anna , Barbieri Paolo
Published: February 2023

While labour market penalties related to motherhood are a widely studied topic, less is known about the implications of signalled potential fertility. We thus posed the question of whether potential fertility—operationalized as the likelihood that a childless woman will transition to motherhood depending on observed sociodemographic characteristics—is associated with a wage penalty and—if so—what the drivers of this wage gap are. We further tested theory-driven hypotheses about heterogeneity across institutional contexts (i.e. in Germany and the United Kingdom) and socio-economic classes. In so doing, we relied on SOEP, BHPS, and UKHLS panel data to construct a synthetic measure of potential fertility over the period from 1991 to 2017. We first explored the overall association between potential fertility and wages and found a wage gap to the disadvantage of potential mothers in both contexts, albeit with non-negligible heterogeneity across time and socio-economic classes. Subsequently, we selected the top and bottom quartiles of the distribution of potential fertility and performed a 2-fold decomposition of the wage differential between potential mothers and women who are less likely to transition to motherhood. The observed wage gap can mostly be explained by compositional differences in observed characteristics between the two groups of women, thereby leaving little room for explanations based on employer discrimination.
The impacts of reducing atmospheric and oceanic de-aliasing model error on temporal gravity field model determination
Authors: Zhou Hao , Zheng Lijun , Pail Roland , Liu Shuhao , Qing Tiantian , Yang Fan , Guo Xiang , Luo Zhicai
Published: February 2023

The Gravity Recovery and Climate Experiment (GRACE) and its successor GRACE Follow-On mission have been estimating temporal gravity field models for various geoscience applications since 2002. While the errors in atmospheric and oceanic de-aliasing (AOD) model are still the key limitation for GRACE-type missions especially taking advantages of improved laser ranging interferometer (LRI), this paper explores the realistic assumption of continuously reducing AOD model error in global scale and regional scale (e.g. ocean, Greenland, Qinghai-Tibet plateau and South America) in the anticipated future. For this, using a realistic orbit scenario and error assumptions both for instrument and background model errors, the 5-yr full-scale simulations are implemented in the context of 26 scenarios with different AOD model errors. Our overall simulation results demonstrate that: (1) when the AOD model errors are reduced in the global scale, the corresponding gain in temporal gravity field determination is significant, with the cumulative geoid height error decrease from 11.28 to 6.25 mm in spectral domain, as well as 26.3–65.2 per cent noise reduction in terms of mean RMS residuals over ocean in spatial domain. (2) When the AOD model errors are reduced in the regional scale, the improvements of temporal gravity field estimations are diverse in different simulation scenarios. The most notable noise reduction, with 22.9–43.9 per cent noise reduction in spatial domain, is observed when the AOD model error decreases in ocean. The limited noise reductions (0.1 per cent and 1.3 per cent respectively in spectral and spatial domain) are observed in the temporal gravity field estimations if the AOD model is refined in other typical regions such as the Qinghai-Tibet plateau, the Greenland and the South America. (3) However, when the satellites passing over the AOD model refined regions, the along-orbit range rate analysis indicates that, there are visible differences by about 50.0 nm s−1 in terms of range rate residuals as well as 11.0–48.5 nm s−1 in terms of the mean RMS of range rate residuals. These results reflect the benefits of reducing AOD model error in both global and regional scale for improving GRACE-type temporal gravity estimation, especially considering the development of LRI technology.
Interplay between APP and glypican-1 processing and α-synuclein aggregation in undifferentiated and differentiated human neural progenitor cells
Authors: Cheng Fang , Fransson Lars-Åke , Mani Katrin
Published: February 2023

In Parkinson’s disease, there is an accumulation of α-synuclein (SYN) aggregates in neurons, which is promoted by neuroinflammation. In neural cells, cytokine-induced SYN aggregation is modulated by heparan sulfate (HS) derived from glypican-1 (GPC1) by amyloid precursor protein (APP) and nitric oxide (NO)-dependent cleavage. We have explored possible interplay between APP, GPC1, and SYN in undifferentiated and differentiated neural progenitor cells (NPCs) by modulating APP and GPC1 processing. Effects were monitored by immunofluorescence microscopy and slot immunoblotting using antibodies recognizing APP degradation products, HS released from GPC1, and SYN aggregates (filamentous SYN [SYNfil]). Suppression of HS release from GPC1 by inhibition of β-secretase or by NO deprivation resulted in no or slight increase in SYNfil aggregation. Stimulation of HS release by ascorbate did not further increase SYNfil staining. Interleukin-6 (IL-6) induced increased APP and GPC1 processing and SYNfil formation, which was reduced when β-secretase was inhibited and when HS release was impeded by NO deprivation. Ascorbate restored APP and GPC1 processing but did not affect SYNfil formation. Ascorbate-dependent differentiation of NPC resulted in the expression of tyrosine hydroxylase (TH) which colocalized with SYNfil. Suppression of APP processing by inhibition of β-secretase greatly disturbed the differentiation process. IL-6 induced coclustering of APP-degradation products, TH, HS, and SYNfil, which could be reversed by stimulation of HS release from GPC1 by excess ascorbate. We suggest that continuous release of HS from GPC1 moderates SYN aggregation and supports differentiation of NPC to dopaminergic neurons.
Assumptions and analysis planning in studies with missing data in multiple variables: moving beyond the MCAR/MAR/MNAR classification
Authors: Lee Katherine J , Carlin John B , Simpson Julie A , Moreno-Betancur Margarita
Published: February 2023

Researchers faced with incomplete data are encouraged to consider whether their data are ‘missing completely at random’ (MCAR), ‘missing at random’ (MAR) or ‘missing not at random’ (MNAR) when planning their analysis. However, there are two major problems with this classification as originally defined by Rubin in the 1970s. First, when there are missing data in multiple variables, the plausibility of the MAR assumption is difficult to assess using substantive knowledge and is more stringent than is generally appreciated. Second, although MCAR and MAR are sufficient conditions for consistent estimation with specific methods, they are not necessary conditions and therefore this categorization does not directly determine the best approach for handling the missing data in an analysis. How best to handle missing data depends on the assumed causal relationships between variables and their missingness, and what these relationships imply in terms of the ‘recoverability’ of the target estimand (the population parameter that encodes the answer to the underlying research question). Recoverability is defined as whether the estimand can be consistently estimated from the patterns and associations in the observed data without needing to invoke external information on the extent to which the distribution of missing values might differ from that of observed values. In this manuscript we outline an approach for deciding which method to use to handle multivariable missing data in an analysis, using directed acyclic graphs to depict missingness assumptions and determining the implications in terms of recoverability of the target estimand.
Associations between serum high-density lipoprotein cholesterol levels and cause-specific mortality in a general population of 345 000 men and women aged 20–79 years
Authors: Mørland Jørg G , Magnus Per , Vollset Stein Emil , Leon David A , Selmer Randi , Tverdal Aage
Published: February 2023

Background

Benefits of elevated high-density lipoprotein cholesterol (HDL-C) levels are challenged by reports demonstrating U-shaped relations between HDL-C levels and all-cause mortality; the association with cause-specific mortality is less studied.

Methods

A total of 344 556 individuals (20–79 years, 52 % women) recruited from population-based health screening during 1985–2003 were followed until the end of 2018 for all-cause and cause-specific mortality by serum HDL-C level at inclusion of <30, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89, 90–99 and >99 mg/dl (< 0.78, 0.78–1.01, 1.04–1.27, 1.30–1.53, 1.55–1.79, 1.81–2.04, 2.07–2.31, 2.33–2.56, >2.56 mmol/L). Hazard ratios (HRs) were adjusted for sex, age, calendar period, smoking, total cholesterol, triglycerides, systolic blood pressure, physical activity, educational length, body mass index and ill health.

Results

During a mean follow-up of 22 years, 69 505 individuals died. There were U-shaped associations between HDL-C levels and all-cause, cancer and non-cardiovascular disease/non-cancer mortality (non-CVD/non-cancer), whereas for CVD there was increased risk of death only at lower levels. With HDL-C stratum 50–59 mg/dl (1.30–1.53 mmol/L) as reference, HRs [95% confidence intervals (CIs)] for levels >99 mg/dl (>2.56 mmol/L) were 1.32 (1.21–1.43), 1.05 (0.89–1.24), 1.26 (1.09–1.46) and 1.68 (1.48–1.90) for all–cause, CVD, cancer and non–CVD/non–cancer mortality, respectively. For HDL-C levels <30 mg/dl (0.78 mmol/L), the corresponding HRs (95% CIs) were 1.30 (1.24–1.36), 1.55 (1.44–1.67), 1.14 (1.05–1.23) and 1.19 (1.10–1.29). The mortality from alcoholic liver disease, cancers of mouth-oesophagus-liver, chronic liver diseases, chronic obstructive pulmonary disease, accidents and diabetes increased distinctly with increasing HDL-C above the reference level. HDL-C levels lower than the reference level were mainly associated with increased mortality of ischaemic heart disease (IHD), other CVDs, stomach cancer and diabetes.

Conclusions

Higher HDL-C levels were associated with increased mortality risk of several diseases which also have been associated with heavy drinking, and lower HDL-C levels were associated with increased mortality from IHD, other CVDs, gastric cancer and diabetes.
The Global Well-Posedness and Decay Estimates for the 3D Incompressible MHD Equations With Vertical Dissipation in a Strip
Authors: Lin Hongxia , Suo Xiaoxiao , Wu Jiahong
Published: February 2023

The three-dimensional incompressible magnetohydrodynamic (MHD) system with only vertical dissipation arises in the study of reconnecting plasmas. When the spatial domain is the whole space $\mathbb R^3$, the small data global well-posedness remains an extremely challenging open problem. The one-directional dissipation is simply not sufficient to control the nonlinearity in $\mathbb R^3$. This paper solves this open problem when the spatial domain is the strip $\Omega := \mathbb R^2\times [0,1]$ with Dirichlet boundary conditions. By invoking suitable Poincaré type inequalities and designing a multi-step scheme to separate the estimates of the horizontal and the vertical derivatives, we are able to establish the global well-posedness in the Sobolev setting $H^3$ as long as the initial horizontal derivatives are small. We impose no smallness condition on the vertical derivatives of the initial data. Furthermore, the $H^3$-norm of the solution is shown to decay exponentially in time. This exponential decay is surprising for a system with no horizontal dissipation. This large-time behavior reflects the smoothing and stabilizing phenomenon due to the interaction within the MHD system and with the boundary.
Development of an optimized and practical pharmacokinetics/pharmacodynamics analysis method for aztreonam/nacubactam against carbapenemase-producingK. pneumoniae
Authors: Igarashi Yuki , Takemura Wataru , Liu Xiaoxi , Kojima Nana , Morita Takumi , Chuang Victor Tuan Giam , Enoki Yuki , Taguchi Kazuaki , Matsumoto Kazuaki
Published: February 2023

Background

Nacubactam, a new β-lactamase inhibitor with antibacterial activity, is being developed as a single drug to be co-administered with cefepime or aztreonam. However, determining pharmacokinetics/pharmacodynamics (PK/PD) parameters in β-lactam/β-lactamase inhibitor combinations remains challenging. We aimed to establish a practical PK/PD analysis method for aztreonam/nacubactam that incorporates instantaneous MIC (MICi).

Methods

Based on chequerboard MIC measurements, MICi of aztreonam against carbapenemase-producing Klebsiella pneumoniae in the presence of nacubactam was simulated.

Results

The mean change in the bacterial count of thigh-infected mice in an in vivo PD study was plotted based on %fT>MICi and analysed using the inhibitory effect sigmoid Imax model. fT>MICi calculated from the PK experiments showed a high correlation with the in vivo bactericidal effect, suggesting that fT>MICi is the optimal PK/PD parameter for aztreonam/nacubactam. The target values of fT>MICi achieving growth inhibition, 1 log10 kill and 2 log10 kill, were 22, 38% and 75%, respectively.

Conclusions

The PK/PD analysis method proposed in this study is promising for determining practical PK/PD parameters in combination therapy. In addition, this is the first report of aztreonam/nacubactam showing a potent in vivo therapeutic effect against NDM-producing K. pneumoniae.
Partner-developed electronic health record tools to facilitate social risk-informed care planning
Authors: Gunn Rose , Pisciotta Maura , Gold Rachel , Bunce Arwen , Dambrun Katie , Cottrell Erika K , Hessler Danielle , Middendorf Mary , Alvarez Miguel , Giles Lydia , Gottlieb Laura M
Published: February 2023

Objective

Increased social risk data collection in health care settings presents new opportunities to apply this information to improve patient outcomes. Clinical decision support (CDS) tools can support these applications. We conducted a participatory engagement process to develop electronic health record (EHR)-based CDS tools to facilitate social risk-informed care plan adjustments in community health centers (CHCs).

Materials and Methods

We identified potential care plan adaptations through systematic reviews of hypertension and diabetes clinical guidelines. The results were used to inform an engagement process in which CHC staff and patients provided feedback on potential adjustments identified in the guideline reviews and on tool form and functions that could help CHC teams implement these suggested adjustments for patients with social risks.

Results

Partners universally prioritized tools for social risk screening and documentation. Additional high-priority content included adjusting medication costs and changing follow-up plans based on reported social risks. Most content recommendations reflected partners’ interests in encouraging provider–patient dialogue about care plan adaptations specific to patients’ social needs. Partners recommended CDS tool functions such as alerts and shortcuts to facilitate and efficiently document social risk-informed care plan adjustments.

Discussion and Conclusion

CDS tools were designed to support CHC providers and staff to more consistently tailor care based on information about patients’ social context and thereby enhance patients’ ability to adhere to care plans. While such adjustments occur on an ad hoc basis in many care settings, these are among the first tools designed both to systematize and document these activities.
A high-quality reference genome of the kelp surfperch, Brachyistius frenatus (Embiotocidae), a wide-ranging Eastern Pacific reef fish with no pelagic larval stage
Authors: Toy Jason A , Bernardi Giacomo
Published: February 2023

The surfperches (family Embiotocidae) are a unique group of mostly marine fishes whose phylogenetic position within the Ovalentaria clade (Percomorpha) is still unresolved. As a result of their viviparity and lack of a dispersive larval stage, surfperches are an excellent model for the study of speciation, gene flow, and local adaptation in the ocean. They are also the target of an immensely popular recreational fishery. Very few high-quality molecular resources, however, are available for this group and only for a single species. Here, we describe a highly complete reference genome for the kelp surfperch, Brachyistius frenatus, assembled using a combination of short-read (Illumina, ~47× coverage) and long-read (Oxford Nanopore Technologies, ~27× coverage) sequencing. The 596 Mb assembly has a completeness level of 98.1% (BUSCO), a contig N50 of 2.6 Mb (n = 56), and a contig N90 of 406.6 kb (n = 293). Comparative analysis revealed a high level of synteny between B. frenatus and its close relative, Embiotoca jacksoni. This assembly will serve as a valuable molecular resource upon which future evolutionary dynamics research will build, such as the investigation of local adaptation and the genomic potential for climate adaptation in wild populations.
Jasmonate: the Swiss army knife in the plant’s pocket
Authors: Zhu Ziqiang
Published: February 2023

Jasmonate is a well-known defence hormone for plants, but it is also necessary for growth and development. Indeed, the identification of the COI1 receptor was based on the jasmonate-triggered response of root growth inhibition. In this special issue, a collection of review papers and two research papers discuss the current state of progress in this field, covering areas from seed germination and flowering to the Jasminum sambac genome.
SHIMM: a versatile seeing monitor for astronomy
Authors: Perera Saavidra , Wilson Richard W , Butterley Tim , Osborn James , Farley Ollie J D , Laidlaw Douglas J
Published: February 2023

Characterization of atmospheric optical turbulence is crucial for the design and operation of modern ground-based optical telescopes. In particular, the effective application of adaptive optics correction on large and extremely large telescopes relies on a detailed knowledge of the prevailing atmospheric conditions, including the vertical profile of the optical turbulence strength and the atmospheric coherence time-scale. The Differential Image Motion Monitor (DIMM) has been employed as a facility seeing monitor at many astronomical observing sites across the world for several decades, providing a reliable estimate of the seeing angle. Here, we present the Shack–Hartmann Image Motion Monitor (SHIMM), which is a development of the DIMM instrument, in that it exploits differential image motion measurements of bright target stars. However, the SHIMM employs a Shack–Hartmann wavefront sensor in place of the two-hole aperture mask utilized by the DIMM. This allows the SHIMM to provide an estimate of the seeing, unbiased by shot noise or scintillation effects. The SHIMM also produces a low-resolution (three-layer) measure of the vertical turbulence profile, as well as an estimate of the coherence time-scale. The SHIMM is designed as a low-cost, portable instrument. It is comprised of off-the-shelf components so that it is easy to duplicate and well suited for comparisons of atmospheric conditions within and between different observing sites. Here, the SHIMM design and methodology for estimating key atmospheric parameters will be presented, as well as initial field test results with comparisons to the Stereo-SCIntillation Detection And Ranging instrument.
The efficacy of genotype-based dietary or physical activity advice in changing behavior to reduce the risk of cardiovascular disease, type II diabetes mellitus or obesity: a systematic review and meta-analysis
Authors: King Alexandra , Graham Catherine A -M , Glaister Mark , Da Silva Anastacio Viviane , Pilic Leta , Mavrommatis Yiannis
Published: February 2023

Context

Despite clear evidence that adherence to dietary and physical activity advice can reduce the risk of cardiometabolic disease, a significant proportion of the population do not follow recommendations. Personalized advice based on genetic variation has been proposed for motivating behavior change, although research on its benefits to date has been contradictory.

Objective

To evaluate the efficacy of genotype-based dietary or physical activity advice in changing behavior in the general population and in individuals who are at risk of cardiovascular disease (CVD) or type II diabetes mellitus (T2DM).

Data Sources

MEDLINE, EMBASE, PsycInfo, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to January 7, 2022. Randomized controlled trials of a genotype-based dietary and/or physical activity advice intervention that aimed to change dietary and/or physical activity behavior were included.

Data Extraction

Abstracts of 7899 records were screened, and 14 reports from 11 studies met the inclusion criteria.

Data Analysis

Genotype-based dietary or physical activity advice was found to have no effect on dietary behavior in any of the studies (standardized mean difference [SMD] .00 [–.11 to .11], P = .98), even when analyzed by subgroup: “at risk” (SMD .00 [–.16 to .16, P = .99]; general population (SMD .01 [–.14 to .16], P = .87). The physical activity behavior findings were similar for all studies (SMD –.01 [–.10 to .08], P = .88), even when analyzed by subgroup: “at risk” (SMD .07 [–.18 to .31], P = .59); general population (SMD –.02 [–.13 to .10], P = .77). The quality of the evidence for the dietary behavior outcome was low; for the physical activity behavior outcome it was moderate.

Conclusions

Genotype-based advice does not affect dietary or physical activity behavior more than general advice or advice based on lifestyle or phenotypic measures. This was consistent in studies that recruited participants from the general population as well as in studies that had recruited participants from populations at risk of CVD or T2DM.

Systematic Review Registration

PROSPERO registration no. CRD42021231147.
Lipid profile and risk of cardiovascular disease in adult transgender men receiving cross-sex hormone therapy: a systematic review
Authors: Quintela-Castro Fernanda Cristina de Abreu , Pereira Taísa Sabrina Silva , Alves Danúbia Boy , Chiepe Letícia , Nascimento Laura Sperandio , Chiepe Kelly Cristina Mota Braga , Barcelos Rafael Mazioli , Costa Bruno Maia , Enriquez-Martinez Oscar Geovanny , Rossoni Joamyr Victor , Bellettini-Santos Tatiani
Published: February 2023

Context

A recent US national survey of the health status of the male transgender population has raised awareness about the little-studied relationship between testosterone hormone therapy in transgender men and cardiovascular outcomes.

Objective

The aim of this systematic review was to assess the relationship between cross-sex hormone therapy in transgender men and lipid profiles and cardiovascular risk.

Data Sources

The PubMed, SciELO, SpringerLink, and EBSCOhost databases were searched up to March 2021 for studies assessing the association between cross-sex hormone therapy and the incidence of outcomes related to cardiovascular disease in transgender men over 18 years of age .

Data Extraction

Data extracted were sorted into clinical data (systolic, diastolic, and mean blood pressure), anthropometric data (body mass index, weight, waist circumference, fat mass, and lean mass), and biochemical data (triglycerides, total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], very low-density lipoprotein cholesterol [VLDL-C], and the HDL-C to LDL-C ratio).

Data Analysis

Study quality was appraised independently by two reviewers using the Cochrane tools for assessment of methodological quality or risk of bias in nonrandomized studies, and the Newcastle-Ottawa Scale was applied. Of 735 studies identified, 11 were included in the review. Most studies reported no change in cholesterol or triglyceride levels after hormone treatment. A reduction in HDL-C levels was observed in 7 of 11 studies, although this alone cannot be considered a cardiovascular risk factor. Likewise, clinical and anthropometric findings showed no changes predictive of cardiovascular risk.

Conclusions

Although these findings suggest that hormone therapy may lead to a decrease in HDL-C levels and an increase in LDL-C levels, they are insufficient to establish a relationship with cardiovascular disease. Furthermore, no significant effects on metabolic and anthropometric values were found. Further studies with higher quality and longer follow-up periods are needed to establish cardiovascular risk.

Systematic Review Registration

PROSPERO registration number CRD 42020212560.
Radiation-supported new-type tori in the Newtonian and logarithmic potentials
Authors: Fukue Jun , Fukue Tsubasa , Fukue Kei
Published: February 2023

We examine radiation-supported rotating tori in the Newtonian and logarithmic potentials, using the similarity method, and analytically find new-type self-similar solutions of astrophysical tori for both cases. In the Newtonian case around a central point mass, radiative quantities such as fluxes and energy density are expressed in a simple form, although the expression for the gas density is somewhat complicated. It is noted that the gaseous configuration in the Newtonian (point-mass) case has a conical surface, where the radiation energy density vanishes. In the logarithmic case in, e.g., dark matter, on the other hand, simple analytical solutions for matter and radiation distributions are obtained. In the logarithmic case, furthermore, the gaseous configuration extends over the whole space, if it exists. In both cases, the density contours have toroidal shapes, and elongate in the equatorial direction due to rotation.
A proper headache: trust drafting and the proper purpose rule after Grand View v Wong
Authors: McPhail Tom
Published: February 2023

The decision of the Board of the Privy Council in Grand View v Wong has given much greater prominence to the proper purpose rule in the context of the exercise by trustees of their powers. This article argues that, while the apparent desire of the Board to control abuse of trust arrangements is understandable, the judgment risks undermining trustee decision-making and encouraging litigation and unnecessary court applications.
BMI and Revision Surgery for Abdominoplasties: Complication Definitions Revisited Using the Clavien-Dindo Classification
Authors: Reischies Frederike M. J. , Tiefenbacher Fabian , Holzer-Geissler Judith C. J. , Wolfsberger Christina , Eylert Gertraud , Mischitz Madeleine , Pregartner Gudrun , Meikl Tobias , Winter Raimund , Kamolz Lars-Peter , Lumenta David B.
Published: February 2023

Background:

After body contouring surgery of the lower trunk (CSLT), the definition, rate (4%–70%), and documentation of complications vary.

Objectives:

We analyzed the effect of risk factors on the outcome based on the Clavien-Dindo classification (CDC) after CSLT surgery and polled postoperative satisfaction among patients.

Methods:

All patients undergoing CSLT from 2001 to 2016 were included and were classified according to the CDC for postoperative events. Statistical analysis included proportional odds logistic regression analysis. We polled patients to grade their satisfaction with the postoperative result and whether they would have the operation performed again.

Results:

A total of 265 patients were included: 60 (22.6%), 25 (9.4%), 28 (10.6%), and 21 (7.9%) were in CDC grades I, II, IIIa, and IIIb, respectively. A high preoperative body mass index significantly increased the odds for a postoperative event requiring revision surgery under general anesthesia (CDC grade IIIb, odds ratio 0.93, 95% confidence interval 0.89–0.97, P = 0.001). One-hundred twenty-eight patients (48.3%) participated in the poll: 101 (78.9%) were either happy or content with the postoperative results, and 117 (91.4%) would have the procedure performed again, including all nine patients with CDC grade IIIb.

Conclusions:

Our results confirm that a high body mass index is a statistically significant risk factor for requiring major revision surgery after CSLT. Despite being a complication prone intervention, postoperative satisfaction after CSLT was ranked favorably in our sample. We recommend that the CDC be used in all surgical specialties to evaluate complications and permit future comparability of pooled data.
Surgical Technique for Targeted Muscle Reinnervation in Knee Disarticulation Amputation for Nonambulatory Patients
Authors: Felder John M. , Saoud Karim
Published: February 2023

Chronic neuropathic pain following major limb amputation has historically been difficult to treat. In patients undergoing lower extremity amputation, “preemptive” targeted muscle reinnervation (TMR) nerve transfers may be performed concurrently with the amputation to help mitigate the risk of chronic neuropathic postoperative pain. Despite clinical studies demonstrating efficacy of TMR in lower extremity amputations, few procedural descriptions have been written, and none have been written regarding performing TMR at the knee disarticulation (KD) level of amputation. Although uncommonly utilized, the KD amputation has clear functional benefits over other levels of amputation for nonambulatory patients. As nonambulatory patients are also subject to the occurrence of chronic neuropathic postamputation pain, it stands to reason that the addition of TMR to KD surgery could be an improvement to standard techniques. In this report, we provide a technical description for concurrent TMR with KD and describe the rationale for its use.
Sleep irregularity and the association with hypertension and blood pressure levels: the ELSA-Brasil study
Authors: Parise Barbara K. , Santos Ronaldo B. , Mesas Arthur E. , Silva Wagner A. , Giatti Soraya , Aielo Aline N. , Cunha Lorenna F. , Souza Silvana P. , Bortolotto Luiz A. , Griep Rosane H. , Lotufo Paulo A. , Bensenor Isabela M. , Drager Luciano F.
Published: February 2023

Objective:

To evaluate the associations of sleep irregularity with hypertension (HTN) and blood pressure (BP) levels.

Methods:

Adult participants from the ELSA-Brasil performed a clinical evaluation including objective sleep duration (actigraphy), insomnia, and a sleep study for defining obstructive sleep apnoea (OSA). To quantify sleep irregularity, we used two parameters obtained through actigraphy: 7-day standard deviation (SD) of sleep duration and 7-day SD of sleep-onset timing. A multivariate analysis was used to determine the independent associations of sleep irregularity with HTN and SBP/DBP values.

Results:

We studied 1720 participants (age 49 ± 8 years; 43.4% men) and 27% fulfilled the HTN diagnosis. After adjustments for age, gender, race, BMI, excessive alcohol consumption, physical activity intensity, urinary sodium excretion, insomnia, objective sleep duration and OSA (apnoea–hypopnoea index ≥15 events/h), we found that the continuous analysis of 7-day SD of sleep duration was modestly associated with prevalent HTN. However, 7-day SD of sleep duration more than 90 min was independently associated with SBP [β: 1.55; 95% confidence interval (CI) 0.23–2.88] and DBP (β: 1.07; 95% CI 0.12–2.01). Stratification analysis excluding participants with OSA revealed that a 7-day SD of sleep duration greater than 90 min was associated with a 48% higher chance of having HTN (OR: 1.48; 95% CI: 1.05–2.07). No significant associations were observed for the SD of sleep-onset timing.

Conclusion:

Objective measurement of sleep irregularity, evaluated by SD of sleep duration for 1 week, was associated with HTN and higher BP levels, especially in participants without OSA.
Extended Cellular Deposits on Gas Exchange Capillaries Are Not an Indicator of Clot Formation: Analysis of Different Membrane Oxygenators
Authors: Dropco Ivor , Philipp Alois , Foltan Maik , Lunz Dirk , Lubnow Matthias , Lehle Karla
Published: February 2023

Antithrombogenic coatings of artificial surfaces within extracorporeal membrane oxygenation (ECMO) circuits improved its bio- and hemocompatibility. However, there is still a risk of thrombus formation in particular within the membrane oxygenator (MO). Since inflammatory cells are essential components within clots, the aim was to identify the extent of cellular accumulations on gas exchange capillaries from different ECMO systems. Thirty-four MOs (PLS, n = 27, Getinge; Hilite 7000 LT, n = 7, Fresenius Medical Care, Germany) were collected from adult patients. The extent of cellular deposits on gas exchange capillaries was classified using nuclear 4′,6-diamidino-2-phenylindole staining and fluorescence microscopy. All Hilite oxygenators exhibited small cellular deposits. In contrast, the cellular distribution was heterogeneous on capillaries from PLS oxygenators: small deposits (34%), clusters (44%) and membrane-spanning cell structures (pseudomembranes) (22%). Overall, the median fluorescence intensity was significantly higher in the PLS group. Nevertheless, within 3 days before MO removal, there was no alteration in critical parameters (d-dimer and fibrinogen levels, platelet counts, and pressure drop across the MO). In conclusion, despite the histological differences on the gas capillaries from different types of oxygenators, there was no further evidence of increased inflammation and coagulation parameters that indicate clot formation within oxygenators.
Timing of Referrals to a Down Syndrome Parent Group by Race
Authors: Ansong Elsie O. , Jones Kari , Santoro Stephanie L.
Published: February 2023

Introduction:

The Down Syndrome Association of Central Ohio (DSACO) is a nonprofit organization that supports families, promotes community involvement, and encourages lifetime opportunities for people with Down syndrome.

Methods:

At DSACO, ongoing efforts for quality improvement included: a Medical Advisory Committee in 2016, the creation of resources groups for Latino families in 2017, for Somali families from 2018 to 2019, and for African American families in fall 2018, presentations at birth hospitals, and close tracking of referrals from hospitals when an infant with Down syndrome is born. In addition, the timing of referrals, either “early” (on the day of birth or the first day after birth) or “late” (2 or more days after birth), were tracked and plotted in p charts.

Results:

From January 2017 to April 2021, DSACO received 167 referrals; of these, a median of 65% was received “early.” When analyzing all referrals to DSACO, no special cause was seen over the time studied. When evaluating the timing of referral to DSACO by race, referrals for 78% of White families were early (105/135 referrals). In comparison, referrals for 9% of minority families were early (3/32 referrals).

Conclusions:

The timing of DSACO referral differed by race. Outreach efforts did not change referral timing but led to a more diverse DSACO membership. Future study is needed to confirm if there is racial disparity in the timing of referrals to resources nationally and to understand the barriers in referring diverse families to Down syndrome nonprofit organizations.
Improving Management of Suspected Chlamydia and Gonorrhea in Adolescents with a Rapid Diagnostic Test
Authors: Frost Holly M. , Wilson Michael L. , Roosevelt Genie E.
Published: February 2023

Introduction.

We aimed to determined the impact of an intervention using rapid chlamydia (CT)/gonorrhea (GC) testing on reducing unnecessary antibiotic use, undertreatment of CT and/or GC, and length of stay (LOS) in an urban safety-net pediatric emergency department.

Methods.

Before 2020, we tested for CT/GC using a batched nucleic acid amplification test, with results available the following day. Starting in January 2020, we implemented rapid nucleic acid amplification test. Our primary outcome variables were undertreatment and overtreatment. We defined undertreatment as GC and/or CT-positive patients who did not receive appropriate treatment. We defined overtreatment as GC or CT-negative patients who received antibiotics. The balancing measure was the LOS.

Results.

There were 758 patients evaluated in the preimplementation period (2019), 612 in the implementation period (2020), and 626 in the postimplementation period (2021). Postimplementation, overtreatment decreased from 18.4% to 8.1%. Undertreatment did not differ by period but was less common among those tested with rapid versus standard testing (12.7% versus 9.9%, P = 0.05). Median LOS increased from 166 minutes (preimplementation) to 187 minutes (implementation) and 202 minutes (postimplementation; P < 0.001).

Conclusions.

Rapid CT/GC testing reduced unnecessary antibiotic use but increased LOS due to patients waiting for the test results before being discharged. Given the rapid increases in CT/GC rates and antimicrobial resistance, health systems should consider implementing rapid testing to appropriately direct antimicrobials to patients most likely to benefit.
Making the Case for Virtual Surgical Planning: Bilateral Sequential Fibula Flaps with Immediate Dental Implants for Maxillectomy
Authors: Taylor Erin M. , Vorstenbosch Joshua , Morrison Edwin , Janssen Pierce L. , Kronstadt Kenneth L. , Randazzo Joseph , Rosen Evan B. , Cordeiro Peter G , Shahzad Farooq , Ganly Ian , Matros Evan
Published: February 2023

Oncologic maxillectomy defects requiring bony reconstruction are amongst the most challenging of head and neck cases due to complex 3-D geometry of the midface. 1-5 Virtual surgical planning (VSP) technology is advantageous in these cases because it provides superior positional precision and accuracy compared to traditional techniques, and facilitates prosthodontic rehabilitation. 6,7 Maxillary cancer recurrence after an initial fibula flap reconstruction presents a unique challenge. The authors report the first two cases of sequential fibula flaps following second or recurrent cancer of the maxilla. VSP facilitated resection with adequate tumor margins, optimized anatomical positioning of the fibula construct with 3-D printed plates, and enabled immediate functional dental implant placement.
The Ratings Game: Demographic and Practice Factors Affecting Yelp © Ratings of Plastic Surgeons
Authors: Mark Erica J. , Driskill Elizabeth K. , Fisher Caroline T. , Swinehart Sarah V. , Bradford Perry S. , Jones Marieke , DeGeorge Brent R.
Published: February 2023

Background:

Review platforms such as Yelp © are increasingly utilized by patients establishing care and may contain substantial information regarding patient preferences and potential biases. Our aims were to (1) analyze patient satisfaction through identifying factors associated with positive and negative patient reviews for plastic surgery providers across the United States, and (2) investigate the association between overall rating and different physician and practice factors based on gender and race.

Methods:

Reviews of Plastic Surgery provider practices from cities across seven different regions within the United States were obtained from Yelp ©. Quantitative and qualitative analyses were performed. Chi-square tests were used to determine if race or gender was associated with overall rating (out of 5 stars) and qualitative themes.

Results:

5,210 reviews met inclusion criteria. 80.3% received a 5-star rating and 13.5% received a 1-star rating. Positive Yelp © reviews and higher ratings were associated with positive comments regarding: surgical and injectable outcomes, physical exam, communication, competency/knowledge base, temperament, scheduling, and staff interactions. When the following factors were mentioned negatively, the practice was more likely to receive a lower rating: temperament, communication, cost consciousness, surgical and injectable outcomes, physical exam, billing/insurance, scheduling, interactions with staff, and wait times. No association was identified in terms of overall physician rating based on gender or race however there were differences noted in distribution of positive and negative themes.

Conclusions:

Patient reviews on Yelp © indicate that several physician and practice factors influence patient satisfaction. The themes reported in this study may be used by plastic surgery providers to identify areas for practice improvement in order to enhance the overall patient experience.
Longitudinal characterization of circulating extracellular vesicles and small RNA during simian immunodeficiency virus infection and antiretroviral therapy
Authors: Huang Yiyao , Liao Zhaohao , Dang Phuong , Queen Suzanne , Abreu Celina Monteiro , Gololobova Olesia , Zheng Lei , Witwer Kenneth W.
Published: February 2023

Objectives:

Latent infection by HIV hinders viral eradication despite effective antiretroviral treatment (ART). Among proposed contributors to viral latency are cellular small RNAs that have also been proposed to shuttle between cells in extracellular vesicles. Thus, we profiled extracellular vesicle small RNAs during different infection phases to understand the potential relationship between these extracellular vesicle associated small RNAs and viral infection.

Design:

A well characterized simian immunodeficiency virus (SIV)/macaque model of HIV was used to profile extracellular vesicle enriched blood plasma fractions harvested during preinfection, acute infection, latent infection/ART treatment, and rebound after ART interruption.

Methods:

Measurement of extracellular vesicle concentration, size distribution, and morphology was complemented with qPCR array for small RNA expression, followed by individual qPCR validations. Iodixanol density gradients were used to separate extracellular vesicle subtypes and virions.

Results:

Plasma extracellular vesicle particle counts correlated with viral load and peaked during acute infection. However, SIV gag RNA detection showed that virions did not fully explain this peak. Extracellular vesicle microRNAs miR-181a, miR-342–3p, and miR-29a decreased with SIV infection and remained downregulated in latency. Interestingly, small nuclear RNA U6 had a tight association with viral load peak.

Conclusion:

This study is the first to monitor how extracellular vesicle concentration and extracellular vesicle small RNA expression change dynamically in acute viral infection, latency, and rebound in a carefully controlled animal model. These changes may also reveal regulatory roles in retroviral infection and latency.
An estimate of excess deaths among people with HIV during the coronavirus disease 2019 pandemic in the United States, 2020
Authors: Zhu Weiming , Huang Ya-lin A. , Song Ruiguang , Wiener Jeffrey , Neblett-Fanfair Robyn N. , Kourtis Athena P. , Hoover Karen W.
Published: February 2023

We developed an ad hoc method to estimate the number of excess deaths among persons with HIV (PWH) during the coronavirus disease 2019 (COVID-19) pandemic in the United States. Using this method, we estimated approximately 1448 excess deaths from COVID-19 among PWH in 2020 in the United States. We also developed an Excel workbook for use as a tool to quickly assess excess deaths among PWH in settings with limited surveillance data.
Lower T cell response against SARS-CoV-2 variants of concern after mRNA vaccine and risk of breakthrough infections in people with HIV
Authors: Casado José L. , Vizcarra Pilar , Martín-Colmenarejo Sara , del Pino Judith , Gomez-Maldonado Sandra , Martín-Hondarza Adrían , Vallejo Alejandro
Published: February 2023

Objectives:

We evaluated T-cell immune responses against SARS-CoV-2 variants of concern (VOC) after vaccination in people with HIV (PWH), and their impact on the incidence of disease.

Methods:

A prospective cohort study. Peripheral blood mononuclear cells (PBMCs) were collected a median of 53 days after second dose of mRNA vaccine. Humoral response and T cell responses against the spike (S) glycoprotein of wild-type SARS-CoV-2 (ancestral Wuhan variant) and mutated S-protein regions found in the Delta and Omicron variants were assessed by flow cytometry analysis.

Results:

In 142 PWH without preceding SARS-CoV-2 infection, bivariate correlations showed a close association between T-cell responses to the different variants. However, despite at least 70% of PWH having a cellular immune response to any variant, CD4+ and CD8+ T cell responses against VOC were lower in frequency and magnitude (-3% and -20% for Delta, -33% and -28% for Omicron variant) compared with that observed against the Wuhan strain. A higher magnitude of SARS-CoV-2 spike-specific CD8+ T cell responses against all the variants was observed in those PWH with greater immune reconstitution. Notably, 27 symptomatic breakthrough infections (19%) in the setting of Delta and Omicron transmission were observed during follow-up, associated with a significant lower humoral and T-cell response to ancestral strain and VOC. On the contrary, only one PWH with COVID-19 (4%) required hospitalization.

Conclusion:

A blunted T-cell response against Delta and Omicron variant is observed in PWH who received two doses of mRNA vaccine. This lower immune response is associated with breakthrough SARS-CoV-2 infections.
Role of myeloid cells in system-level immunometabolic dysregulation during prolonged successful HIV-1 treatment
Authors: Svensson Akusjärvi Sara , Krishnan Shuba , Ambikan Anoop T. , Mikaeloff Flora , Munusamy Ponnan Sivasankaran , Vesterbacka Jan , Lourda Magda , Nowak Piotr , Sönnerborg Anders , Neogi Ujjwal
Published: February 2023

Objective:

Why people with HIV-1 on ART (PWHART) display convoluted metabolism and immune cell functions during prolonged suppressive therapy is not well evaluated. In this study, we aimed to address this question using multiomics methodologies to investigate immunological and metabolic differences between PWHART and HIV-1 negative individuals (HC).

Design:

Cross-sectional study

Methods:

Untargeted and targeted metabolomics was performed using gas and liquid chromatography/mass spectrometry, and targeted proteomics using Olink inflammation panel on plasma samples. The cellular metabolic state was further investigated using flow cytometry and intracellular metabolic measurement in single-cell populations isolated by EasySep cell isolation. Finally, flow cytometry was performed for deep-immunophenotyping of mononuclear phagocytes.

Results:

We detected increased levels of glutamate, lactate, and pyruvate by plasma metabolomics and increased inflammatory markers (e.g. CCL20 and CCL7) in PWHART compared to HC. The metabolite transporter detection by flow cytometry in T cells and monocytes indicated an increased expression of glucose transporter 1 (Glut1) and monocarboxylate transporter 1 (MCT-1) in PWHART. Single cell-type metabolite measurement identified decreased glucose, glutamate, and lactate in monocytic cell populations in PWHART. Deep-immunophenotyping of myeloid cell lineages subpopulations showed no difference in cell frequency, but expression levels of CCR5 were increased on classical monocytes and some dendritic cells.

Conclusions:

Our data thus suggest that the myeloid cell populations potentially contribute significantly to the modulated metabolic environment during suppressive HIV-1 infection.