bluuebunny/crossref_metadata_2025 huggingface dataset:
Civil Justice
Authors: He Xin
Published: November 2024

Chapter 6 examines how Chinese courts handle civil cases. The chapter finds that, while the courts have incorporated some adversarial elements, state control has pushed them toward inquisitorialism. The chapter also highlights the outcome gap between those who have and have not, and the regime’s efforts to enhance legitimacy. Despite challenges, the chapter concludes that China’s courts have significantly improved their performance in handling civil cases, with local protectionism declining and enforcement of judgments becoming more effective, although the latter may come at the expense of fundamental rights. Several reasons for the decline in local protectionism, including the diversification of China’s economy, are explored in the chapter.
Criminal Justice
Authors: He Xin
Published: November 2024

Chapter 8 examines the impact of recent reforms on China’s criminal justice system, which has traditionally been shaped by the iron triangle of police, procuratorate, and courts. It argues that the plea leniency system, driven by efficiency and stability concerns, has positioned the procuratorate at center stage, further marginalizing the courts. Additionally, the death penalty is manipulated to bolster legitimacy and maintain stability, aligning with the decline of wrongful convictions and the trend of leniency. This chapter reveals how recent reforms have shifted power dynamics within the criminal justice system, emphasizing the role of the procuratorate and the strategic use of leniency.
Conclusion
Authors: He Xin
Published: November 2024

The Conclusion highlights the heightened focus on law in the official discourse of the Chinese party-state. It raises critical questions about whether such emphasis is merely a pretext for further control by an authoritarian state, and whether the rule of law can genuinely take root in China. The Conclusion argues that, while judges are likely to become more professional, they are not expected to deviate from the current, highly instrumentalist paradigm. It is unlikely that the Singaporean model, in which the laws are professionally practiced in civil and commercial cases, but a high value is placed on “social order” and “state stability” in political and constitutional matters, will be adopted in China. The policy-implementing nature of Chinese courts will likely persist, with rights protection serving the state’s legitimacy and governance.
Responses in adult pied flycatcher males depend on playback song similarity to local population
Authors: Gallego-Abenza Mario , Kraft Fanny-Linn H , Ma Lan , Rajan Samyuktha , Wheatcroft David
Published: November 2024

Song divergence driven by social learning has been proposed to be a key factor driving allopatric speciation in oscine birds. Songbirds often respond more to songs deriving from their local population, suggesting the potential for acoustic divergence across populations to shape both intra- and intersexual interactions. However, many of these studies were conducted on species with simple songs and, as a result, we know comparatively little about the emergence of population differences and song discrimination in species with complex songs. We addressed this question in the pied flycatcher (Ficedula hypoleuca) by calculating the dissimilarity of songs from 2 foreign populations as well as from our study site to the local centroid. We then conducted a paired-design playback experiment where both local and foreign songs were played simultaneously. We found that pied flycatcher males showed significantly stronger responses to those songs that sounded more similar to the local population. This suggests that despite the high complexity of the pied flycatcher song, individuals are still able to discriminate across populations. Our results support the hypothesis that learned song divergence can act as a mechanism for assortative mating and allopatric speciation.
siRNADiscovery: a graph neural network for siRNA efficacy prediction via deep RNA sequence analysis
Authors: Long Rongzhuo , Guo Ziyu , Han Da , Liu Boxiang , Yuan Xudong , Chen Guangyong , Heng Pheng-Ann , Zhang Liang
Published: November 2024

The clinical adoption of small interfering RNAs (siRNAs) has prompted the development of various computational strategies for siRNA design, from traditional data analysis to advanced machine learning techniques. However, previous studies have inadequately considered the full complexity of the siRNA silencing mechanism, neglecting critical elements such as siRNA positioning on mRNA, RNA base-pairing probabilities, and RNA–AGO2 interactions, thereby limiting the insight and accuracy of existing models. Here, we introduce siRNADiscovery, a Graph Neural Network (GNN) framework that leverages both non-empirical and empirical rule-based features of siRNA and mRNA to effectively capture the complex dynamics of gene silencing. On multiple internal datasets, siRNADiscovery achieves state-of-the-art performance. Significantly, siRNADiscovery also outperforms existing methodologies in in vitro studies and on an externally validated dataset. Additionally, we develop a new data-splitting methodology that addresses the data leakage issue, a frequently overlooked problem in previous studies, ensuring the robustness and stability of our model under various experimental settings. Through rigorous testing, siRNADiscovery has demonstrated remarkable predictive accuracy and robustness, making significant contributions to the field of gene silencing. Furthermore, our approach to redefining data-splitting standards aims to set new benchmarks for future research in the domain of predictive biological modeling for siRNA.
CCR8/CCL1 and CXCR3/CXCL10 axis-mediated memory T-cell activation in patients with recalcitrant drug-induced hypersensitivity
Authors: Chiu Tsu-Man , Chen Chun-Bing , Lu Chun-Wei , Hui Rosaline Chung-Yee , Chi Min-Hui , Chang Ya-Ching , Wu Jennifer , Chen Kuan-Yu , Lin Yang Yu-Wei , Lo Pei-Chi , Hsu Tsai-Ching , Wang Chuang-Wei , Chung Wen-Hung
Published: November 2024

Background

As a drug-induced hypersensitivity syndrome, drug reaction with eosinophilia and systemic symptoms (DRESS) is potentially fatal. Most patients with DRESS recover within a few weeks; however, some patients may suffer from a prolonged disease course and develop autoimmune sequelae.

Objectives

To investigate the immune mechanism and therapeutic targets of patients with recalcitrant DRESS with a prolonged disease course.

Methods

Thirty-two patients with recalcitrant DRESS with a prolonged treatment course (≥ 8 weeks; ‘prolonged DRESS’), 28 patients with DRESS with a short treatment course (< 2 weeks; ‘short-duration DRESS’) and 26 healthy donors (HDs) were enrolled.

Results

Bulk transcriptome results showed that the mRNA expression levels of CCR8 and CXCR3 were significantly increased in blood samples from patients in the acute stage of prolonged DRESS [Padj = 1.50 × 10–9 (CCR8) and Padj = 2.60 × 10–4 (CXCR3), patients with prolonged DRESS compared with the HD group]. Serum and skin lesion concentrations of CCL1 and CXCL10 (ligands of CCR8 and CXCR3, respectively) were significantly increased in patients with prolonged DRESS compared with patients with short-duration DRESS. The results from high-parameter flow cytometry and autoantibody screening also identified significant increases in CD8+ GNLY+ CXCR3+ effector memory T cells, CD8+ central memory T cells, CD4+ CCR8+ T helper 2 cells and IgG anti-HES-6 autoantibodies in patients with prolonged DRESS. Furthermore, in vitro blocking assays revealed that Janus kinase inhibitors (JAKi; mainly tofacitinib and upadacitinib) significantly decreased the release of CCL1 and CXCL10. Some patients with prolonged DRESS were successfully treated with JAKi.

Conclusions

JAKi (tofacitinib and upadacitinib) were associated with decreased concentrations of CCL1 and CXCL10, suggesting that they may attenuate CCR8/CCL1 and CXCR3/CXCL10 axis-mediated memory T-cell activation, which contributes to disease pathogenesis in patients with recalcitrant DRESS and a long-term treatment course.

Graphical Abstract
Understanding Different Forms of Gun Violence in American Schools: An Analysis from 1980 to 2019
Authors: Hamlin Daniel E
Published: November 2024

Scholars theorize that the nature of school gun violence varies across school settings. Yet, there is a lack of statistical research testing this idea. This study investigates contextual factors associated with six forms of school gun incidents (N = 1,238) over a 40-year period (1980–2019) in the United States. To conduct the analyses, school, community, and state-level data were linked to school gun incidents recorded in a comprehensive K–12 school gun violence database. Results indicate that the most common form of school gun violence stems from school-related conflicts. Gun incidents from school-related conflicts (odds ratio [OR] = 2.22, p < .01) and suicides (OR = 3.08, p < .01) are also more likely to occur in high schools. Large cities (OR = 4.75, p < .001), midsize cities (OR = 2.35, p < .01), and suburbs (OR = 2.74, p < .05) report more school gun violence driven by criminal activity, whereas school gun violence from suicide and indiscriminate school shootings has a higher probability of occurring in rural schools and areas with comparatively low poverty. This study offers suggestive evidence that an emphasis on alleviating school conflicts may reduce school gun violence overall but that separate strategies may also be needed across different types of school contexts.
Positive definite functions on a regular domain
Authors: Buhmann Martin , Xu Yuan
Published: November 2024

We define positive and strictly positive definite functions on a domain and study these functions on a list of regular domains. The list includes the unit ball, conic surface, hyperbolic surface, solid hyperboloid and the simplex. Each of these domains is embedded in a quadrant or a union of quadrants of the unit sphere by a distance-preserving map, from which characterizations of positive definite and strictly positive definite functions are derived for these regular domains.
The ABCDs of Nutritional Assessment in Infectious Diseases Research
Authors: Locks Lindsey M , Parekh Aneri , Newell Katharine , Dauphinais Madolyn R , Cintron Chelsie , Maloomian Kimberly , Yu Elaine A , Finkelstein Julia L , Mehta Saurabh , Sinha Pranay
Published: November 2024

Malnutrition is the most common acquired cause of immunodeficiency worldwide. Nutritional deficiencies can blunt both the innate and adaptive immune response to pathogens. Furthermore, malnutrition is both a cause and consequence of infectious diseases. The bidirectional relationship between infectious diseases and undernutrition, as well as the inflammatory milieu of infectious diseases, can complicate nutritional assessment. This article aims to provide clinicians and researchers with an overview of commonly used tools to assess nutritional status, with a particular emphasis on their use in the context of infectious diseases. These tools include anthropometric, biochemical, clinical/physical, and dietary assessments to screen and evaluate undernutrition, diet quality, and food insecurity effectively.
The role of routine and structured social needs data collection in improving care in US hospitals
Authors: Richwine Chelsea , Patel Vaishali , Everson Jordan , Iott Bradley
Published: November 2024

Objectives

To understand how health-related social needs (HRSN) data are collected at US hospitals and implications for use.

Materials and Methods

Using 2023 nationally representative survey data on US hospitals (N = 2775), we described hospitals’ routine and structured collection and use of HRSN data and examined the relationship between methods of data collection and specific uses. Multivariate logistic regression was used to identify characteristics associated with data collection and use and understand how methods of data collection relate to use.

Results

In 2023, 88% of hospitals collected HRSN data (64% routinely, 72% structured). While hospitals commonly used data for internal purposes (eg, discharge planning, 79%), those that collected data routinely and in a structured format (58%) used data for purposes involving coordination or exchange with other organizations (eg, making referrals, 74%) at higher rates than hospitals that collected data but not routinely or in a non-structured format (eg, 93% vs 67% for referrals, P< .05). In multivariate regression, routine and structured data collection was positively associated with all uses of data examined. Hospital location, ownership, system-affiliation, value-based care participation, and critical access designation were associated with HRSN data collection, but only system-affiliation was consistently (positively) associated with use.

Discussion

While most hospitals screen for social needs, fewer collect data routinely and in a structured format that would facilitate downstream use. Routine and structured data collection was associated with greater use, particularly for secondary purposes.

Conclusion

Routine and structured screening may result in more actionable data that facilitates use for various purposes that support patient care and improve community and population health, indicating the importance of continuing efforts to increase routine screening and standardize HRSN data collection.
Valorizing waste streams to enhance sustainability and economics in microbial oil production
Authors: Renegar Nicholas , Rhoades Seth , Nair Anusha , Sinskey Anthony J , Ward John P , Appleton David Ross
Published: November 2024

Driven by the demand for more sustainable products, research and capital investment has been committed to developing microbially produced oils. While researchers have shown oleaginous yeasts and other microbes can produce low-carbon footprint oils by leveraging waste streams as energy sources, previous analyses have not fully explored the quantity of available waste streams and in turn economy-of-scale enabled on capital and operating expenses. This paper makes parallels to 2G ethanol facilities, enabling a data-driven understanding of large-scale production economics. Production costs are broken down for a variety of scenarios. The analysis finds that reaching price parity with large-scale commodity oils (e.g., palm oil, high-oleic cooking oils, biofuels feedstock oils, lauric acid) is not possible today and unlikely even under aggressive future assumptions about strain productivity. Instead, commercial production must be targeted at end markets where sustainability-conscious consumers are willing to pay the price premiums identified in this paper.

One Sentence Summary

This paper makes parallels to 2G ethanol facilities, enabling a data-driven understanding of large-scale production economics for microbial lipids.
A rare case of tip appendicitis treated successfully with conservative management
Authors: Qunibi Hanan , Thalji Mariam , Ahmad Mutasem Sayyed , Fakhouri Sulaiman
Published: November 2024

Tip appendicitis is a rare and fatal complication after appendectomy. Diagnosing this condition requires a high level of suspicion due to its ambiguous and nonspecific symptoms. Radiological investigations such as ultrasound and computed tomography scans can aid in diagnosis. Early identification and treatment are of paramount importance for good patient outcomes. In most cases, Tip excision is the preferred treatment. However, antibiotics can also be a useful alternative. Conservative antibiotic treatment can be successful in certain situations, particularly when no fecaliths or perforation exists. Close monitoring is necessary to avoid the return of chronic appendicitis. We here introduce a case of a 47-year-old female patient who underwent an open appendectomy a year ago and is currently complaining of right lower quadrant abdominal pain. The patient was diagnosed with tip appendicitis. She was started on conservative antibiotic therapy and discharged home with good general conditions.
Ancient and Modern in Eighteenth-Century British Music Criticism: The Contradictory Case of Henry Purcell’s Te Deum and Jubilate
Authors: Herissone Rebecca
Published: November 2024

During the early modern period, the Quarrel of the Ancients and Moderns encapsulated profound changes in the way people conceived of the past in relation to their own present. While the Ancients continued to advocate emulating esteemed ancient authorities, the Moderns sought to break away from previous models through original invention. In reality, this binary opposition disguises a much more gradual process of change, which often resulted in contradictory perspectives on the past. This article uses music criticism from eighteenth-century Britain to explore these complexities, concentrating on how Henry Purcell’s Te Deum and Jubilate was appropriated by authors from both sides of the Quarrel to advance opposing viewpoints, using embryonic musical analysis as a hermeneutic tool. The study exposes the tensions underlying the developing historical narratives on which Purcell’s posthumous reputation was built, allowing us to place our own understanding of his reception more firmly within its socio-cultural context.
Variable reliability of the (1,3)-β-d-glucan test for screening Pneumocystis pneumonia in HIV-negative patients depending on the underlying condition
Authors: Kostka Eric , Le Govic Yohann , Damiani Céline , Totet Anne
Published: November 2024

(1,3)-β-d-Glucan (BG) assay is a non-invasive test commonly used in the diagnostic of invasive fungal diseases. Given its high sensitivity, it was suggested that a negative BG result is sufficient for excluding the diagnosis of Pneumocystis pneumonia (PCP). However, suboptimal performance has been described in human immunodeficiency virus (HIV)-negative patients, particularly those with haematological malignancies. We aimed to assess the sensitivity of the BG assay for diagnosing PCP in HIV-negative patients based on their underlying PCP risk factors. We conducted a single-center, retrospective study (2009–2021) enrolling HIV-negative patients diagnosed with PCP and who underwent BG testing. Patients colonized with Pneumocystis jirovecii were included as a control group. In all, 55 PCP patients and 61 colonized patients met the inclusion criteria. Patients were further categorized according to the underlying condition that exposes patients to PCP. Median BG concentration was significantly higher in the PCP group than in the colonization group (500 vs. 31 pg/ml; P < 10−4, Mann–Whitney test) and the BG assay demonstrated a sensitivity of 85% and a specificity of 82% for PCP diagnosis. Notably, sensitivity was significantly higher in non-cancer patients (100%) compared to those with solid cancer (72%) and haematologic cancer (79%) (P < .05, Fischer's exact test). These findings strengthen the high performance of BG testing for screening PCP in non-cancer patients, comparable to that observed in HIV-infected individuals. In contrast, they highlight its low reliability in patients with malignancies, emphasizing the importance of considering underlying conditions when interpreting BG results and refining the role of the test in PCP diagnosis.
Candida tropicalis morphotypes show altered cellular structure and gene expression pre- and post-exposure to fluconazole
Authors: dos Santos Murilo M , de Souza Cássia M , Furlaneto-Maia Luciana , Furlaneto Marcia C
Published: November 2024

A feature of Candida tropicalis is its ability to undergo phenotypic switching that can affect antifungal sensitivity and virulence traits. Here, we investigated the effect of switching on alterations at the cellular structure level of C. tropicalis morphotypes and whether exposure to fluconazole (FLC) in vitro could be associated with these alterations in a morphotype-dependent manner. Candida tropicalis morphotypes included clinical isolate (Parental) and two switch strains (Crepe variant and revertant of Crepe—RC). The minimum inhibitory concentration (MIC50) of fluconazole was determined according to EUCAST. Cell wall porosity, quantification of cell wall components, cell size/complexity, and expression of ERG11 and CDR1 genes in morphotypes pre- and post-exposure to fluconazole were determined. Crepe and RC showed an eightfold higher MIC50 (1 µg/ml) than the Parental (0.125 µg/ml). Exposure to FLC resulted in twofold higher MIC50 for Parental and RC. The Crepe variant exhibited a fourfold higher expression of ERG11, and the RC showed 10-fold higher expression of CDR1 than the clinical isolate. Switch strains showed reduced cell wall porosity compared to Parental, and exposure to FLC resulted in a significant reduction in the porosity of Parental and RC cells. Furthermore, phenotypic switching affected cell wall β-1,3-glucan and chitin contents in a morphotype-dependent manner. Our findings indicate that switching affects cellular structure in C. tropicalis and the occurrence of differential alterations between the clinical isolate and its switched states in response to fluconazole exposure.
Evolution of amplitude and longitude phase of tachocline Rossby waves diffusing to the photosphere
Authors: Dikpati Mausumi , Gilman Peter A , Raphaldini Breno , McIntosh Scott W
Published: November 2024

Physics of magnetohydrodynamic (MHD) Rossby waves in the tachocline-layer were studied by Dikpati et al., using a fluid-particle-trajectory approach along with solving vorticity and induction equations. By extending that model to include a hydrodynamic turbulent convection zone (CZ), we examine how MHD Rossby waves generated in the tachocline might diffuse upward through the CZ to solar surface. We find that pure hydrodynamic Rossby wave amplitudes decline with height due to viscous diffusion at a rate that is independent of viscosity and increases with longitude wavenumber. Fast MHD Rossby waves amplitude declines faster with height for increasing toroidal field, due to their longitude-phase shifting with height, which increases dissipation of kinetic energy in the wave velocities. Slow MHD Rossby waves decline even faster with height because their longitude-phase shifts more rapidly with height, due to their slow phase speed. We conclude that low wavenumber HD and fast MHD Rossby waves, originating in the tachocline, might be detected at the photosphere, but slow MHD Rossby waves should be virtually impossible to detect. We infer from fluid particle trajectories that wave amplitudes declining with height and longitude phase shifting with height associated with decline, implies a powerful mechanism for tangling of magnetic fields, distinct from convective turbulence effects. This could cause a sustained or dissipative local dynamo action triggered by Rossby waves.
Disc distortion revisited
Authors: Binney James
Published: November 2024

We revisit the dynamics of razor-thin, stone-cold, and self-gravitating discs. By recasting the equations into standard cylindrical coordinates, the linearized vertical dynamics of an exponential disc can be followed for several giga years on a laptop in a few minutes. An initially warped disc rapidly evolves into a flat inner region and an outward-propagating spiral corrugation wave that rapidly winds up and would quickly thicken a disc with non-zero radial-velocity dispersion. The Sgr dwarf galaxy generates a similar warp in the Galactic disc as it passes through pericentre, and the warp generated by the dwarf’s last pericentre $\sim 35\, \mathrm{Myr}$ ago is remarkably similar to the warp traced by the Galaxy’s H i disc. The resemblance to the observed warp is fleeting but its timing is perfect. For the adopted parameters, the amplitude of the model warp is a factor 3 too small, but there are several reasons for this being so. The marked flaring of our Galaxy’s low-$\alpha$ disc just outside the solar circle can be explained as a legacy of earlier pericentres.
Transcription factor PagWRKY33 regulates gibberellin signaling and immune receptor pathways in Populus
Authors: Yu Xiao-Qian , Niu Hao-Qiang , Zhang Yue-Mei , Shan Xiao-Xu , Liu Chao , Wang Hou-Ling , Yin Weilun , Xia Xinli
Published: November 2024

Enhanced autoimmunity often leads to impaired plant growth and development, and the coordination of immunity and growth in Populus remains elusive. In this study, we have identified the transcription factors PagWRKY33a/b as key regulators of immune response and growth maintenance in Populus. The disruption of PagWRKY33a/b causes growth issues and autoimmunity while conferring resistance to anthracnose caused by Colletotrichum gloeosporioides. PagWRKY33a/b binds to the promoters of N requirement gene 1.1 (NRG1.1) and Gibberellic Acid-Stimulated in Arabidopsis (GASA14) during infection, activating their transcription. This process maintains disease resistance and engages in GA signaling to reduce growth costs from immune activation. The oxPagWRKY33a/nrg1.1 mutant results in reduced resistance to C. gloeosporioides. Further, PagWRKY33a/b is phosphorylated and activated by mitogen-activated protein kinase kinase 1, which inhibits respiratory burst oxidase homolog D (RBOHD) and respiratory burst oxidase homolog I (RBOHI) transcription, causing reactive oxygen species bursts in wrky33a/b double mutants. This leads to an upregulation of PagNRG1.1 in the absence of pathogens. However, the wrky33a/b/nrg1.1 and wrky33a/b/rbohd triple mutants show compromised defense responses, underscoring the complexity of WRKY33 regulation. Additionally, the stability of PagWRKY33 is modulated by Ring Finger Protein 5 (PagRNF5)-mediated ubiquitination, balancing plant immunity and growth. Together, our results provide key insights into the complex function of WRKY33 in Populus autoimmunity and its impact on growth and development.
Police reform and involuntary hospitalization
Authors: Morabito Melissa S , Savage Jenna , Messina Peter , Harlow Dan , Fisher Courtney E
Published: November 2024

Involuntary hospitalization to receive a psychiatric evaluation is a serious mental health and legal matter that often requires involvement from the local police. It is, however, an understudied part of the police role despite the possibility for the use of force given the involuntary aspect of these encounters. Following the enactment of police reform legislation across Massachusetts in 2020, the Boston Police Department (BPD) has refined its approach to collecting, vetting, executing, and following up on involuntary hospitalization orders, also known as Section 12(a) of the Massachusetts General Laws. As of 2021, all Section 12(a) applications received directly by the BPD from external clinicians have been maintained in a centralized database overseen by the BPD Street Outreach Unit. First, we review the wider context of involuntary hospitalizations. We then review police reform efforts in Massachusetts—the context in which the BPD decided to formalize and make changes to its policy. We then explore the nature of those policy changes. Next, we use quantitative data from the involuntary hospitalization forms received by the Street Outreach Unit submitted by external mental health providers combined with information collected from the vetting of these applications, as well as BPD data detailing the outcomes of the resultant encounters, to closely examine the use and impact of the BPD’s Section 12 policy. The findings associated with these analyses provide a basis for a better understanding of police involvement in involuntary hospitalization.
Awareness and current knowledge of medicinal plants
Authors: Akram Muhammad , Mahmood Khalid
Published: November 2024

Objectives

This research attempts to investigate the historical applications of plants for therapeutic reasons, follow the development of these applications, and comprehend the influence of artificial methods on the use of medicinal plants.

Methods

The study involves the examination of antique writings from Mesopotamia, Egypt, Greece, and the Islamic world, as well as a 5000-year-old Sumerian clay tablet discovered in Nagpur. The study examined historical reports of a number of therapeutic plants, including Glycyrrhiza glabra, Cupressus sempervirens, Commiphora myrrha, Cedrus duham, and Papaver somniferum. It also looked at how improved methods of separating active plant components were developed in the early 19th century, as opposed to more crude treatments like tinctures and powders.

Key findings

Historical evidence reveals that ancient cultures used a wide variety of plants for medicinal reasons, preparing them in different ways. The development of synthetic methods in the 19th century completely changed the manufacture of pharmaceuticals by making it possible to replicate active ingredients precisely and in large quantities. With more than 250 000 plant species recognized, nature’s wide diversity of plant metabolites highlights the importance of plants in both traditional and contemporary medicine.

Conclusions

The development of contemporary synthetic approaches from traditional plant-based medicines serves as an example of how far medicine has come. While modern techniques have increased the effectiveness and scalability of medicinal manufacturing, the historical usage of plants demonstrates a profound grasp of their curative potential. The vast diversity of plant metabolites continues to be important for health and medicine despite advancements in synthetic approaches, highlighting the ongoing importance of natural resources in pharmaceutical research.
Probiotic Formulation for Patients With Bipolar or Schizophrenia Spectrum Disorder: A Double-Blind, Randomized Placebo-Controlled Trial
Authors: Borkent Jenny , Ioannou Magdalini , Neijzen Dorien , Haarman Bartholomeus C M , Sommer Iris E C
Published: November 2024

Background and Hypothesis

Probiotic augmentation offers a promising treatment for bipolar disorder (BD) and schizophrenia spectrum disorder (SSD). By targeting microbiome deviations, they may improve both gut and brain health.

Study Design

In this double-blind, randomized, placebo-controlled trial with the multi-strain probiotic formulation Ecologic BARRIER, we aimed to improve psychiatric and cognitive symptoms, intestinal permeability, and gastrointestinal symptoms in patients with BD or SSD. A total of 131 patients were randomized 1:1 to receive either the probiotic supplement (n = 67) or a placebo (n = 64) for 3 months, in addition to treatment-as-usual. The primary outcomes were symptom severity assessed by the Brief Psychiatric Rating Scale and cognitive functioning by the Brief Assessment of Cognition in Schizophrenia.

Study Results

No significant effect of probiotics was observed on psychiatric symptoms, but borderline significant improvement was observed in the cognition category of verbal memory (Linear Mixed Model (LMM) 0.33; adjusted P = .059). Probiotics beneficially affected markers of intestinal permeability and inflammation, including zonulin (LMMserum = −18.40; adjusted P = .002; LMMfecal = −10.47; adjusted P = .014) and alpha-1 antitrypsin (LMM 9.26; adjusted P = .025). Indigestion complaints significantly decreased in male participants in the probiotics group (LMM = −0.70; adjusted P = .010). Adverse events were similar between groups.

Conclusions

Our study observed significant advantages of probiotics for gut health in BD and SSD, with excellent safety and tolerability. A borderline effect on verbal memory was also indicated. These results underscore the need for further research into microbiome-targeted interventions for patients with complex brain disorders.
Diversity of Oomycetes From Alabama Cotton Soils Using Culture-Independent Methods
Authors: Bragg Morgan , Olofintila Oluwakemisola , Noel Zachary Albert
Published: November 2024

Seedling disease management recommendations rely on comprehensive identification of the pathogens. A recent manuscript isolated oomycetes from diseased cotton (Gossypium hirsutum L.) roots to identify the species associated. However, culture-dependent surveys may miss species because of the microbiological medium and work required to isolate and maintain all cultured organisms. Alternatively, culture-independent methods using PCR amplification and high-throughput sequencing can identify species' presence and relative abundance, including obligate pathogens and rare members of communities. We used culture-independent sequencing from the same cotton soils in the culture-based survey to determine the oomycete species in oomycete-containing soils. The results of the two methods were generally similar regarding the species identified. Similarly to the culture-based method, Globisporangium irregular accounted for 24% of the relative abundance and was encountered in all fields sequenced. In contrast, we identified three operational taxonomic units matching Globisporangium ultimum, but accounted for less than 0.06% of total relative abundance, potentially explaining why it was not isolated from cotton roots in the original survey. Phytophthora nicotianae was identified in soils but not at the concentrations recorded in the culture-based study. The results of this study, combined with the results of the culture-based survey, demonstrate the most comprehensive identification of oomycetes associated with cotton in the cotton belt and the oomycetes related to seedling disease. The combined results will be essential for future research into the specific pathogen species mentioned and stimulate similar research in other states.
Enhancing the Graduate Nursing Student Experience Through Gamification
Authors: Mims Kennedie , Lambert Kenzie , Ross Olivia , Maddox Anna , Funchess Megan , Taylor Ken , Garner Shane , McMullan Susan , Yerdon Amy
Published: November 2024

Gamification, the use of game-styled learning methods in non-game contexts, encourages student participation, increases learning motivation, and maximizes the amount of information students can retain. An intervention was designed utilizing gamification principles to reinforce material learned during a week-long regional anesthesia intensive. Students participated in team-based competitions consisting of knowledge-based questions, critical thinking, and hands-on ultrasound skills. Anonymous survey results demonstrated a statistically significant increase in post-intervention student knowledge, confidence, and motivation. This project’s impact may encourage the integration of gamification in nursing education to increase student motivation and confidence while providing feedback to decrease knowledge gaps.
Racial Disparities in Utilization and Outcomes of Cervical Disc Arthroplasty
Authors: Arroyave Juan Sebastian , Restrepo Mejia Mateo , Ahmed Wasil , Rajjoub Rami , Poeran Jashvant , Stern Brocha Z. , Chaudhary Saad B.
Published: November 2024

Study Design:

Retrospective study.

Objective:

We examined racial disparities in (1) cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) utilization and (2) CDA in-hospital outcomes.

Summary of Background Data:

ACDF and CDA are established treatments for cervical disc disease. While CDA may offer certain advantages over ACDF, its utilization patterns have not been comprehensively explored.

Methods:

This study of 2012 to 2019 discharges from the National Inpatient Sample included White, Black, and Hispanic patients aged 18 years and older who underwent elective ACDF or CDA. Patient demographics, comorbidities, cervical spine diagnoses, and hospital characteristics were extracted. Survey-weighted logistic regression modeled the adjusted association between race and CDA (vs. ACDF) utilization; an interaction between race and year examined temporal changes in disparities. For CDA outcomes, multivariable logistic regression was used for binary outcomes (nonhome discharge, combined complications, and dysphagia) and linear regression for length of stay.

Results:

The cohort included 712,355 weighted procedures (97.6% ACDF; 84.2% White, 9.7% Black, 6.1% Hispanic). CDA utilization increased from 1.0% of the procedures in 2012 to 3.8% in 2019. Black and Hispanic patients had significantly lower odds than White patients of receiving CDA versus ACDF (OR=0.77, 95% CI: 0.66–0.89, P=0.001; OR=0.80, 95% CI: 0.69–0.93, P=0.003) respectively. There was no statistically significant interaction between race and discharge year (P=0.50). For in-hospital CDA-specific outcomes, Black (vs. White) patients were more likely to experience dysphagia (OR=2.70, 95% CI: 1.53–4.78, P=0.001) and combined complications (OR=3.10, 95% CI: 1.91–5.05, P <0.001). There were no significant differences in any CDA outcome for Hispanic versus White patients.

Conclusions:

This study revealed decreased utilization of CDA versus ACDF in minority patients, a pattern that persisted over time despite overall increasing CDA utilization. In addition, a higher burden of dysphagia and combined complications following CDA in Black patients warrants further examination.

Level of Evidence:

III
Implementing a Comprehensive CPR Education in New York State Public High Schools: Ideas, Drawbacks, & Future Directions
Authors: Whiteson Harris Z. , Jaishi Prakash Poudel , Frishman William H.
Published: November 2024

Cardiopulmonary resuscitation (CPR) is a lifesaving skill that can be employed when people experience cardiac arrest. While the benefits of CPR on survival are well known, much of the American population remains uneducated on how to perform it. There are many reasons for this, ranging from the cost of CPR courses to fear of making mistakes in emergency situations. There have been a variety of efforts across the United States that attempted to boost CPR education, one of which is education in schools. While not a federal law, many states now require some degree of CPR education to be provided to high school students. New York joined this coalition of states in September of 2014. Signed into law by then Governor Cuomo, Act 804-C helped pave the way for CPR education across many pupils in the state. While undoubtedly a step in the right direction, many elements of 804-C promote a disjointed, unequal, and sometimes insufficient CPR education across different schools and counties in the state. In this review, we will highlight some shortcomings of 804-C. We will also highlight ways in which New York State can improve upon their CPR education efforts while also acknowledging logistical and financial obstacles that our proposals might incur.
Recognition and Management of Postpartum Hemorrhage
Authors: Mohamed Tasabih Ali EL Hassan , Chandraharan Edwin
Published: November 2024

Postpartum hemorrhage (PPH) is an obstetric emergency and refers to excessive blood loss after birth. Loss of blood volume and oxygen-carrying capacity may lead to maternal hypovolemia and hypotension resulting in tissue hypoxia, the onset of anaerobic metabolism, and multiorgan failure. If timely and appropriate action is not taken, cardiac arrest and maternal death may occur. If the amount of blood loss exceeds 500 mL following a vaginal birth or 1000 mL during or following a cesarean section, it is termed PPH. Similar to any other surgical hemorrhage, PPH is classified into primary PPH (occurs within 24 hours of birth) or secondary PPH (between 24 hours and 12 weeks postpartum). PPH is a major contributor to maternal deaths worldwide, and it is estimated that a person dies because of PPH approximately every 5 minutes. Therefore, measures should be directed at prevention and early detection of PPH with prompt management. The prevalence of PPH varies globally and is influenced by location, socioeconomic factors, and the availability and quality of health care. The World Health Organization reported that PPH accounts for a quarter of global maternal deaths. The Mothers and Babies Reducing Risks through Audits and Confidential Enquiries report from the United Kingdom (2023) highlighted that despite rare mortality due to hemorrhage, the number of people dying of obstetric hemorrhage is not decreasing, particularly among people with abnormally invasive placentation. Additionally, substandard care was found to be responsible for more than 50% of deaths due to PPH in the United Kingdom. Therefore, it is vital that adequate healthcare infrastructure, trained and competent healthcare professionals, and immediate access to resources, interventions, and multidisciplinary teams are essential both in well-resourced and resource-restrained healthcare systems. Healthcare professionals must identify the potential risk factors for PPH and initiate preventive measures whenever possible. Additionally, they must respond swiftly if PPH occurs and ensure a multidisciplinary, multilayered approach for a synchronized response to optimize outcomes. This review article emphasizes the etiopathogenesis, diagnosis, and management of PPH based on current scientific evidence as well as international best practice recommendations.
Untangling the Exposure–Response Relationship of Allopurinol in the Setting of Chronic Kidney Disease and Diuretic Use: Implications for Dosing
Authors: Hishe Hailemichael Z. , Stocker Sophie L. , Stamp Lisa K. , Dalbeth Nicola , Merriman Tony R. , Wright Daniel F.B.
Published: November 2024

Background:

Allopurinol dose reduction proportional to creatinine clearance (CLcr) results in suboptimal urate lowering in patients with gout. Similarly, diuretic therapy reduces oxypurinol clearance but is unexpectedly associated with the need for higher allopurinol doses to achieve the serum urate target (<0.36 mmol/L). The authors aimed to clarify the relationship between oxypurinol exposure and urate-lowering response in patients with gout at different stages of chronic kidney disease and those taking diuretics to determine the implications for maintenance dose selection.

Methods:

Oxypurinol and urate data from 5 clinical studies were available. Model-derived steady-state oxypurinol areas under the concentration–time curves (AUCss0-tau) were estimated using a Bayesian methodology. The observed response metrics included the percentage reduction in urate from baseline and achievement of the target urate level. Exposure–response was explored graphically and using logistic regression. In addition, the influence of chronic kidney disease and diuretic use on the allopurinol dose and oxypurinol AUCss0-tau requirements to achieve the serum urate target were explored.

Results:

Data from 258 patients with gout taking allopurinol representing 1288 paired steady-state oxypurinol and serum urate measurements were available. Higher oxypurinol exposure seems to be required for urate-lowering response normalization and achieve the serum urate target in individuals with reduced kidney function and those taking diuretics. However, allopurinol dose requirements were reduced by 2-fold at the extremes of kidney function and unchanged in those taking or not taking diuretics.

Conclusions:

A lower allopurinol maintenance dose was required in patients with reduced kidney function (CLcr <30 mL/min), but this was not proportional to CLcr. Diuretic therapy did not influence allopurinol dose requirements.
PARS PLANA VITRECTOMY FOR RETINAL DETACHMENT REPAIR AS A LATE COMPLICATION FOR PREVIOUS ABUSIVE HEAD TRAUMA
Authors: Esa Saleh , Rubowitz Alex
Published: November 2024

Purpose:

The purpose of this study was to document the possibility of late retinal detachment after abusive head trauma (also known as shaken baby syndrome). Abusive head trauma has been associated with different retinal findings, very rarely with retinal detachment.

Methods:

One patient with previous abusive head trauma and current late retinal detachment underwent complete ocular examination, fundus photography with the Optos introduced ultra-widefield retinal imaging before and after pars plana vitrectomy for retinal detachment repair.

Results:

The patient underwent a successful pars plana vitrectomy, posterior hyaloid peeling, endolaser, and silicone oil injection.

Conclusion:

Retinal detachment may occur as late complication of abusive head trauma.
Keratoconus Detection in High-Astigmatism Pediatric Patients: Optimal Pentacam Indices and Cutoff Points
Authors: Souza Oliveira Renato , Gil João Quadrado , Rosa Andreia , Quadrado Maria João , Campos Mauro
Published: November 2024

Purpose:

To assess the accuracy of various Pentacam indices in distinguishing keratoconus (KC) in pediatric patients with high astigmatism and to establish appropriate cutoff values.

Methods:

This prospective multicenter cross-sectional study included 312 eyes from 167 patients aged 6 to 18 years (mean age, 13.1 ± 3.2 years) evaluated with Oculus Pentacam HR. Patients were categorized into 4 groups: KC, forme fruste keratoconus, astigmatism greater than 2 diopters (Cyl2D), and control. A subgroup of Cyl2D comprised patients with astigmatism greater than 4 diopters (Cyl4D). Twenty-three Pentacam indices were analyzed, and receiver operating characteristic curves determined optimal cutoff points, sensitivity, and specificity.

Results:

The best indices for distinguishing KC from Cyl2D were high-order aberration root mean square of the anterior corneal surface (area under the receiver operating characteristic curve 0.987), Belin/Ambrosio enhanced ectasia total derivation (0.971), index of vertical asymmetry (0.971), average pachymetric progression index (0.962), maximum Ambrosio relational thickness (0.960), posterior elevation (0.952), and anterior elevation (0.948). The accuracy of these indices was highest in the control group and lowest in the Cyl4D group. Area under the receiver operating characteristic curve was significantly lower for fruste keratoconus than KC. Optimal cutoff values were higher for astigmatic patients than for those with no refractive error.

Conclusions:

Most indices effectively distinguished between KC and normal pediatric patients. For individuals with high astigmatism, we suggest focusing on specific indices such as high-order aberration root mean square, Belin/Ambrosio enhanced ectasia total derivation value, maximum Ambrosio relational thickness, average pachymetric progression index, and index of vertical asymmetry. Optimal cutoff points for these patients were higher than those for nonastigmatic children and differed from adult populations.
Comparative risk of mortality in new users of prescription opioids for noncancer pain: results from the International Pharmacosurveillance Study
Authors: Jani Meghna , Girard Nadyne , Bates David W. , Buckeridge David L. , Dixon William G. , Tamblyn Robyn
Published: November 2024

Although opioids continue to be used internationally for noncancer pain, evidence to date on the comparative safety of different opioids is sparse and conflicting. The aim of this study was to examine the comparative risk of all-cause mortality in patients newly initiated on opioids for noncancer pain, across 3 jurisdictions in the United Kingdom (UK), United States, and Canada. A multicentre retrospective, population-based cohort study was conducted. Data sources included UK national primary care electronic health records (Clinical Practice Research Datalink), The Partners HealthCare Research Patient Data in Boston (US), and The Montreal Population Health Record data (Canada). New users of opioids aged ≥18 years without cancer were included. Patients with a diagnosis of a pain condition and with known back pain were analysed separately. Fully adjusted hazard ratios (HRs) were calculated using Cox-proportional models and adjusted for confounders. In total, 1,066,216 patients were included (UK: n = 993,294; Boston, US: n = 43,243; Montreal, Canada: n = 26,116). Compared with codeine, patients using morphine had a significantly higher adjusted risk in the UK {HR: 12.58 [95% confidence interval (CI), 11.87-13.32]}, US (HR: 8.62 [95% CI, 3.34-22.27]), and Canadian cohorts (HR: 6.69; [95% CI, 1.35-32.22]). In addition, other factors associated with higher mortality were being on combination opioids, fentanyl, buprenorphine, and oxycodone. Compared with those on <50 morphine milligram equivalents/day, patients on higher-doses experience an incremental increase in risk. In new users of opioids, compared with codeine, strong opioids, including morphine, fentanyl, buprenorphine, oxycodone, and combination opioids, and those on ≥50 morphine milligram equivalent/day were associated with a higher subsequent risk of all-cause mortality.