bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical interaction between MSL2 and CLAMP assures direct cooperativity and prevents competition at composite binding sites
Authors: Eggers Nikolas , Gkountromichos Fotios , Krause Silke , Campos-Sparr Aline , Becker Peter B
Published: August 2023

MSL2, the DNA-binding subunit of the Drosophila dosage compensation complex, cooperates with the ubiquitous protein CLAMP to bind MSL recognition elements (MREs) on the X chromosome. We explore the nature of the cooperative binding to these GA-rich, composite sequence elements in reconstituted naïve embryonic chromatin. We found that the cooperativity requires physical interaction between both proteins. Remarkably, disruption of this interaction does not lead to indirect, nucleosome-mediated cooperativity as expected, but to competition. The protein interaction apparently not only increases the affinity for composite binding sites, but also locks both proteins in a defined dimeric state that prevents competition. High Affinity Sites of MSL2 on the X chromosome contain variable numbers of MREs. We find that the cooperation between MSL2/CLAMP is not influenced by MRE clustering or arrangement, but happens largely at the level of individual MREs. The sites where MSL2/CLAMP bind strongly in vitro locate to all chromosomes and show little overlap to an expanded set of X-chromosomal MSL2 in vivo binding sites generated by CUT&RUN. Apparently, the intrinsic MSL2/CLAMP cooperativity is limited to a small selection of potential sites in vivo. This restriction must be due to components missing in our reconstitution, such as roX2 lncRNA.
Competitive Intensity
Authors: Giachetti Claudio
Published: August 2023

Competitive intensity refers to the extent to which firms exert pressure on one another within a given industry, by attacking each other’s competitive position to increase their own performance at the expense of others’ performance. The competitive intensity among existing firms in an industry may manifest in a variety of forms, like price discounting, new product introductions, aggressive advertising campaigns, the offering of an increasing number of complementary services, among others. The intensity of competition can have a positive effect on an economic system as a whole, since a higher intensity forces firms to do better than their rivals, for example by introducing better innovations, with the aim to maximize their performance within the competitive environment. As a result, such a phenomenon usually leads to better products and services for consumers. However, the intensity of competition among firms in an industry could undermine their ability to generate profits, and highly competitive industries might discourage new firms to enter. Understanding the intensity of competition within an industry is important for many stakeholders. For example, it is crucial for new firms that are considering entering the industry and need to assess its attractiveness in terms of profit potential. It is also important for industry incumbents who may have to decide whether to increase their resources to sustain their performance or divest and enter into new industries. Furthermore, it is essential for national authorities and regulators, who are responsible for avoiding collusive behaviors among dominant players that could undermine consumers’ purchasing power. The purpose of this article is to present key themes that aid in understanding competitive intensity and to summarize relevant research works published on this topic, primarily in the management literature. In this way, it aims to assist students and academics in navigating this subject more effectively while developing their research work. Specifically, this bibliography is organized as follows. First, it discusses how the concept of competitive intensity has been examined across various streams of literature. It is worth noting that the focus of this article is on the competitive intensity among firms within an industry, rather than among a firm’s organizational units, subsidiaries, or employees. Second, it discusses the main antecedents of competitive intensity (i.e., those factors affecting the extent to which firms compete aggressively) presented by studies in the extant literature. Third, it discusses the main outcomes of competitive intensity explored so far in the literature in terms of firms’ performance and strategic responses to competition. Finally, it presents the main measurements of competitive intensity used by scholars to examine this construct empirically.
Founding Teams
Authors: Hsu David
Published: August 2023

In the field of entrepreneurship, founding teams have received attention because such individuals comprise the early (intangible) assets of the enterprise. Not only do such teams shape the trajectory of the venture, their choices, skills, and experience likely impact intermediate and long-term outcomes of the enterprise. The founding team is distinguished from production teams in that the former is responsible for setting higher-order formal and informal policies that likely have organization-wide implications. While the management and organizations literatures have a longer tradition of examining top management teams (TMTs), founding teams are distinguished in that they are often the first TMT of the organization. Often, founding teams are responsible for a general set of responsibilities, which are only narrowed once specialist job roles are created (often at the executive officer level) and filled. This transition process of the initial founder or founding team has also been an object of study in the literature. Another distinguishing feature of founding teams from the general TMT literature is that the imprint of the founding has been theorized and found to have long-lived effects on a variety of organizational trajectories. As a consequence, founding teams and the informal and formal policies they enact can have very long-lived consequences for the trajectory of organizational development. Founding team composition reflects individuals’ human and social capital. As a result, it is important to consider the literature relating to such capital and organizational outcomes. In general, the literature on individual training, education, and experience and new venture outcomes is much older and long-standing as compared to that of founding teams. The current state of the literature is moving beyond the individual level of human and social capital development to extend into the realm of founding team assets.
When bargaining is and is not possible: the politics of bureaucratic expertise in the context of democratic backsliding
Authors: Koga Natália Massaco , Karruz Ana Paula , Palotti Pedro Lucas de Moura , Soares Filho Marcos Luiz Vieira , Couto Bruno Gontyjo do
Published: August 2023

In looking at the complex relationship between expertise and power in policymaking, what is amiss are studies on how the expertise exchange bargain between politicians and bureaucracy works in practice, especially in antidemocratic contexts. To deal with this limitation, we use Christensen’s (Christensen, J. (2022). When bureaucratic expertise comes under attack. Public Administration) expertise bargain change model for examining the authority transaction between politicians and bureaucrats. Upon external shocks, such as democratic backsliding with the sidelining of policy advice, the extant expertise bargain is challenged. We explore how the bureaucracy acted toward the government’s adversarial (and even antagonistic) stance and how that relationship toward the expertise bargain changed in two policy areas in Brazil (health and environment) during Bolsonaro’s administration (2019–2022). Notably, this article relies mainly on qualitative data from in-depth interviews with bureaucrats who provided expertise to the government on these policy areas during the Bolsonaro administration’s transition. Ancillary documentary sources were examined to detail the strategies of attack from government toward bureaucratic expertise and ancillary documentary sources of quantitative data from a survey with bureaucrats fielded during the Bolsonaro administration’s first year. Results show three factors that condition bureaucratic expertise’s resilience: the nature of the attack (local or extensive), the knowledge base’s and epistemic community’s level of cohesion, and the advice system’s degree of institutionalization. This case study sheds light on how different policy advice arrangements respond and function under antidemocratic contexts, allowing the application and enrichment of policy expertise literature outside regular democratic politics.
Local Effects of Global Capital Flows: A China Shock in the U.S. Housing Market
Authors: Li Zhimin , Shen Leslie Sheng , Zhang Calvin
Published: August 2023

This paper studies the real effects of foreign real estate capital inflows. Using transaction-level data, we document (i) a “China shock” in the U.S. housing market characterized by surging foreign Chinese housing purchases after 2008, and (ii) “home bias” in these purchases, as they concentrate in neighborhoods historically populated by ethnic Chinese. Exploiting their temporal and spatial variation, we find that these capital inflows raise local employment, with the effect transmitted through a housing net worth channel. However, they displace local lower-income residents. Our results show that real estate capital inflows can both stimulate the real economy and induce gentrification.
Performance of GAP and ILD-GAP models in predicting lung transplant or death in interstitial pneumonia with autoimmune features
Authors: Allen Michael R , Alevizos Michail K , Zhang David , Bernstein Elana J
Published: August 2023

Objectives

To assess the ability of two risk prediction models in interstitial lung disease (ILD) to predict death or lung transplantation in a cohort of patients with interstitial pneumonia with autoimmune features (IPAF).

Methods

We performed a retrospective cohort study of adults with IPAF at an academic medical centre. The primary outcome was a composite of lung transplantation or death. We applied the patient data to the previously described Gender–Age–Physiology (GAP) and ILD-GAP models to determine the ability of these models to predict the composite outcome. Model discrimination was assessed using the c-index, and model calibration was determined by comparing the incidence ratios of observed vs expected deaths.

Results

Ninety-four patients with IPAF were included. Mean (s.d.) age was 58 (13.5) years and the majority were female (62%). The majority met serologic and morphologic criteria for IPAF (94% and 91%, respectively). The GAP model had a c-index of 0.664 (95% CI 0.547–0.781), while the ILD-GAP model had a c-index of 0.569 (95% CI 0.440–0.697). In those with GAP stage 1 or GAP stage 2 disease, calibration of the GAP model was satisfactory at 2 and 3 years for the cumulative end point of lung transplantation or death.

Conclusion

In patients with IPAF, the GAP model performed well as a predictor of lung transplantation or death at 2 years and 3 years from ILD diagnosis in patients with GAP stage 1 and GAP stage 2 disease.
Universities of applied sciences’ EU research project participation through the lens of differentiation
Authors: Cavallaro Marco
Published: August 2023

In European universities of applied sciences (UASs), the intensity of research activities and the level of differentiation from universities vary across countries. We investigate whether the differentiation in the research function of UASs is reflected in their participation in the European Union Framework Programs for Research and Innovation (EU-FPs). We focus on the current and former UASs in four higher education systems with distinct levels of differentiation—the UK, Norway, Switzerland, and the Netherlands. Our results show significant cross-country differences in the intensity and type of EU-FP projects acquired. The former UASs in the UK and Norway had a participation profile similar to that of universities. In more differentiated higher education systems, Swiss and Dutch UASs were more geared toward applied projects. Variations both across and within countries emphasize the importance of research capacities. Our results carry implications for how national and European authorities can foster UAS participation in EU-FPs.
The Cauchy Process on Phylogenies: A Tractable Model for Pulsed Evolution
Authors: Bastide Paul , Didier Gilles
Published: August 2023

Phylogenetic comparative methods use random processes, such as the Brownian Motion, to model the evolution of continuous traits on phylogenetic trees. Growing evidence for non-gradual evolution motivated the development of complex models, often based on Lévy processes. However, their statistical inference is computationally intensive and currently relies on approximations, high-dimensional sampling, or numerical integration. We consider here the Cauchy Process (CP), a particular pure-jump Lévy process in which the trait increment along each branch follows a centered Cauchy distribution with a dispersion proportional to its length. In this work, we derive an exact algorithm to compute both the joint probability density of the tip trait values of a phylogeny under a CP and the ancestral trait values and branch increments posterior densities in quadratic time. A simulation study shows that the CP generates patterns in comparative data that are distinct from any Gaussian process, and that restricted maximum likelihood parameter estimates and root trait reconstruction are unbiased and accurate for trees with 200 tips or less. The CP has only two parameters but is rich enough to capture complex-pulsed evolution. It can reconstruct posterior ancestral trait distributions that are multimodal, reflecting the uncertainty associated with the inference of the evolutionary history of a trait from extant taxa only. Applied on empirical datasets taken from the Evolutionary Ecology and Virology literature, the CP suggests nuanced scenarios for the body size evolution of Greater Antilles Lizards and for the geographical spread of the West Nile Virus epidemics in North America, both consistent with previous studies using more complex models. The method is efficiently implemented in C with an R interface in package cauphy, which is open source and freely available online.
A new classification of the family Ariidae (Osteichthyes: Ostariophysi: Siluriformes) based on combined analyses of morphological and molecular data
Authors: Marceniuk Alexandre Pires , Oliveira Claudio , Ferraris Carl J
Published: August 2023

We present a new classification of the catfish family Ariidae based on a total-evidence hypothesis, which incorporates data from the examination of 249 morphological and 5603 molecular characters from 131 species. The named taxa in the proposed classification represent groups of species found in the Maximum Parsimony, Maximum Likelihood, and Bayesian Inference analyses or, in some cases, two of the three methods. Each named taxon is provided with a diagnosis derived from a comprehensive summary of the morphological characters and their character-state transformations, as interpreted from the most parsimonious version of the total-evidence tree. Taxa newly named herein are: Cathoropsini, new tribe; Genidentini, new tribe; Sciadeini, new tribe; Aceroichthys, new genus (type species Arius dioctes Kailola, 2000); Bleekeriella, new genus (type species Arius leptaspis Bleeker, 1862); Betancurichthys, new genus (type species Arius madagascariensis Vaillant, 1894); Jayaramichthys, new genus (type species Arius leptonotacanthus Bleeker, 1849); Kyataphisa, new genus (type species Pimelodus nenga Hamilton, 1822); Megalosciades, new genus (type species Arius augustus Roberts, 1978); Paracinetodus, new genus (type species Arius carinatus Weber, 1913); Papuarius, new genus (type species Arius latirostris Macleay, 1883); and Pseudosciades, new genus (type species Arius sona Hamilton, 1822). A key to the genera of Ariidae is presented.
Alliance for Innovation on Maternal Health
Authors: Bauer Melissa E. , Albright Catherine , Prabhu Malavika , Heine R. Phillips , Lennox Chelsea , Allen Christie , Burke Carol , Chavez April , Hughes Brenna L. , Kendig Susan , Le Boeuf Maile , Main Elliott , Messerall Tiffany , Pacheco Luis D. , Riley Laura , Solnick Rachel , Youmans Andrew , Gibbs Ronald
Published: August 2023

Sepsis in obstetric care is one of the leading causes of maternal death in the United States, with Black, Asian/Pacific Islander, and American Indian/Alaska Native obstetric patients experiencing sepsis at disproportionately higher rates. State maternal mortality review committees have determined that deaths are preventable much of the time and are caused by delays in recognition, treatment, and escalation of care. The “Sepsis in Obstetric Care” patient safety bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people by preventing infection and recognizing and treating infection early to prevent progression to sepsis. This is one of several core patient safety bundles developed by AIM (the Alliance for Innovation on Maternal Health) to provide condition- or event-specific clinical practices that should be implemented in all appropriate care settings. As with other bundles developed by AIM, the “Sepsis in Obstetric Care” patient safety bundle is organized into five domains: Readiness, Recognition and Prevention, Response, Reporting and Systems Learning, and Respectful, Equitable, and Supportive Care. The Respectful, Equitable, and Supportive Care domain provides essential best practices to support respectful, equitable, and supportive care to all patients. Further health equity considerations are integrated into the elements of each domain.
Stoma Perceptions of Adults with an Ostomy: A Metaphor Analysis in a Single Center
Authors: Özlü Nazife Gamze Özer , Vural Fatma
Published: August 2023

OBJECTIVE

To use metaphor to evaluate stoma perceptions among adults with ostomies to conceptualize and portray their lived experiences using a figurative approach.

METHODS

A qualitative research design was used. Participants were 27 adults with an ostomy who were followed up in the stoma therapy unit. Individuals were included in the study if they had had a temporary or permanent ostomy for at least 2 months and spoke Turkish. Participants were asked to complete the sentence: “Stoma is like…/similar to… because….” The researchers used content analysis to evaluate participants’ responses. Interpretation of the metaphors developed by participants was carried out in five phases: coding, example metaphor compilation, theme development, ensuring trustworthiness, and transferring.

RESULTS

Participants expressed a total of 17 unique and 10 repeated metaphors for the concept of “stoma.” These metaphors were grouped under three different themes: positive (lifesaving), negative (punishment/enemy), and neutral (temporary/necessity for life). The most commonly used metaphors were life, savior, comfort, difficulty, fear, punishment, and necessity.

CONCLUSIONS

Individuals with an ostomy mostly had negative metaphorical associations with stomas. The authors recommend that hospitals implement multifaceted interventions to bring positive metaphors to individuals with ostomies.
Clinical Phenotypes of Sepsis in a Cohort of Hospitalized Patients According to Infection Site
Authors: Schertz Adam R. , Eisner Ashley E. , Smith Sydney A. , Lenoir Kristin M. , Thomas Karl W.
Published: August 2023

OBJECTIVES:

Clinical sepsis phenotypes may be defined by a wide range of characteristics such as site of infection, organ dysfunction patterns, laboratory values, and demographics. There is a paucity of literature regarding the impact of site of infection on the timing and pattern of clinical sepsis markers. This study hypothesizes that important phenotypic variation in clinical markers and outcomes of sepsis exists when stratified by infection site.

DESIGN:

Retrospective cohort study.

SETTING:

Five hospitals within the Wake Forest Health System from June 2019 to December 2019.

PATIENTS:

Six thousand seven hundred fifty-three hospitalized adults with a discharge International Classification of Diseases, 10th Revision code for acute infection who met systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA), or Sequential Organ Failure Assessment (SOFA) criteria during the index hospitalization.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome of interest was a composite of 30-day mortality or shock. Infection site was determined by a two-reviewer process. Significant demographic, vital sign, and laboratory result differences were seen across all infection sites. For the composite outcome of shock or 30-day mortality, unknown or unspecified infections had the highest proportion (21.34%) and CNS infections had the lowest proportion (8.11%). Respiratory, vascular, and unknown or unspecified infection sites showed a significantly increased adjusted and unadjusted odds of the composite outcome as compared with the other infection sites except CNS. Hospital time prior to SIRS positivity was shortest in unknown or unspecified infections at a median of 0.88 hours (interquartile range [IQR], 0.22–5.05 hr), and hospital time prior to qSOFA and SOFA positivity was shortest in respiratory infections at a median of 54.83 hours (IQR, 9.55–104.67 hr) and 1.88 hours (IQR, 0.47–17.40 hr), respectively.

CONCLUSIONS:

Phenotypic variation in illness severity and mortality exists when stratified by infection site. There is a significantly higher adjusted and unadjusted odds of the composite outcome of 30-day mortality or shock in respiratory, vascular, and unknown or unspecified infections as compared with other sites.
Whole Blood Metal Levels in the Setting of an Oncologic Endoprosthesis: Is There Cause for Concern?
Authors: Houdek Matthew T. , Couch Cory G. , Wyles Cody C. , Taunton Michael J. , Rose Peter S. , Kremers Hilal Maradit , Lewallen David G. , Berry Daniel J.
Published: August 2023

Background

Massive modular endoprostheses have become a primary means of reconstruction after oncologic resection of a lower extremity tumor. These implants are commonly made with cobalt-chromium alloys that can undergo wear and corrosion, releasing cobalt and chromium ions into the surrounding tissue and blood. However, there are few studies about the blood metal levels in these patients.

Question/purpose

What is the whole blood cobalt and chromium ion level in patients with massive modular endoprostheses?

Methods

We performed a cross-sectional study of our total joints registry to identify patients with a history of an endoprosthetic reconstruction performed at our institution. Patients who were alive at the time of our review in addition to those undergoing an endoprosthetic reconstruction after an oncologic resection were included. Whole blood samples were obtained from 27 (14 male and 13 female) patients with a history of a lower extremity oncologic endoprosthesis. The median time from surgery to blood collection was 8 years (range 6 months to 32 years). Blood samples were collected and stored in metal-free ethylenediaminetetraacetic acid tubes. Samples were analyzed on an inductively coupled plasma mass spectrometer in an International Organization for Standardization seven-class clean room using polytetrafluoroethylene-coated instruments to reduce the risk of metal contamination. The analytical measuring range was 1 to 200 ng/mL for chromium and cobalt. Cobalt and chromium levels were considered elevated when the blood level was ≥ 1 ppb.

Results

Cobalt levels were elevated in 59% (16 of 27) of patients, and chromium levels were elevated in 26% (seven of 27). In patients with elevated metal ion values, 15 of 17 patients had a reconstruction using a Stryker/Howmedica Global Modular Replacement System implant.

Conclusion

Blood metal levels were elevated in patients who received reconstructions using modular oncology endoprostheses Future work is needed to establish appropriate follow-up routines and determine whether and when systemic complications occur because of elevated metal levels and how to potentially address these elevated levels when complications occur. Prospective and retrospective collaboration between multiple centers and specialty societies will be necessary to address these unknown questions in this potentially vulnerable patient group.

Level of Evidence

Level IV, therapeutic study.
Urinary congophilia in pregnancy: a marker of kidney injury rather than preeclampsia
Authors: Younis Dalia , Mosbah Alaa , Zakaria Mahmoud M. , Awadalla Amira , El-kannishy Ghada , Shemies Rasha S.
Published: August 2023

Background:

The differentiation between preeclampsia and similarly presenting kidney disease in pregnancy is a diagnostic challenge. Although some laboratory tests have been utilized, globally validated tools are yet needed, particularly in resource-limited settings. Congophilic proteins are abundantly detected in the urine of pregnant women who develop preeclampsia that is thought to be a marker of disease process. The present study aimed to assess the diagnostic and predictive utility of urinary congophilia in pregnant women with hypertensive disorders of pregnancy as well as kidney diseases.

Methods:

This cohort study included 157 pregnant women, classified as healthy controls (n = 38), preeclampsia/eclampsia (n = 45), gestational hypertension (n = 9), chronic hypertension (n = 8), chronic kidney disease (CKD) (n = 27), and pregnancy-related acute kidney injury (PR-AKI) (n = 30). Urinary congophilia was assessed by Congo Red Dot Blot assay.

Results:

Congo red retention (CRR) values were significantly higher in women with preeclampsia/eclampsia (P ≤ 0.001), chronic hypertension (P = 0.029), gestational hypertension (P = 0.017), CKD (P ≤ 0.001), PR-AKI secondary to preeclampsia (P ≤ 0.001), and PR-AKI secondary to other causes (P = 0.001), compared with healthy controls. Women with preeclampsia, CKD, and PR-AKI (non-preeclampsia related) exhibited the highest levels of CRR. CRR positively correlated to proteinuria (P = 0.006) and serum creatinine (P = 0.027). CRR did not significantly vary between women who presented antepartum and those presented postpartum after removal of the placenta (P = 0.707). CRR at a cut-off point of at least 1.272 had 91% specificity and 61.1% sensitivity in predicting renal recovery in PR-AKI patients. CRR had a poor specificity in discriminating preeclampsia from the other clinical presentations.

Conclusion:

Urinary congophilia could not discriminate preeclampsia from similarly presenting kidney diseases in pregnancy. Further studies are needed to improve differentiation of these conditions.
Impact of Foveal Status and Timing of Surgery on Visual Outcome in Rhegmatogenous Retinal Detachment
Authors: Haq Zeeshan , Mittra Robert A. , Parke D. Wilkin , Yonekawa Yoshihiro , Hsu Jason , Gupta Omesh , Williams George A. , Shah Gaurav K. , Ryan Edwin H.
Published: August 2023

Purpose:

To investigate the impact of surgical timing on visual acuity (VA) outcomes in retinal detachments (RD) based on preoperative foveal status.

Methods:

A retrospective multicenter cohort study was conducted. Cases were stratified into fovea-on, fovea-split, and fovea-off groups. Days to surgery was defined as the time between the preoperative examination and surgery. The main outcome measure was final postoperative VA.

Results:

1675 cases were studied. More than 80% of fovea-on/fovea-split and fovea-off cases had surgery within 1 and 3 days, respectively. The mean final postoperative VA did not differ significantly between the fovea-on and fovea-split groups (SE 20/33 ± 20/49 and 20/32 ± 20/39, p = 1.000) and did not change significantly based on days to surgery in either group. The mean final postoperative VA was lowest in the fovea-off group (Snellen equivalent [SE] = 20/56 ± 20/76, p < 0.001) and was significantly lower in cases where surgery was performed after 2 or more days when compared to cases performed within 1 day (SE 20/74 ± 20/89 vs 20/46 ± 20/63, p < 0.001).

Conclusions:

Fovea-on and fovea-split RDs demonstrated comparable visual outcomes. Fovea-off RDs demonstrated worse visual outcomes, which declined further when surgery was delayed by 2 or more days.
Photodynamic acute exudative maculopathy in a case series of circumscribed choroidal hemangioma.
Authors: Fernández-Vigo José Ignacio , Valverde-Megías Alicia , García-Caride Sara , Burgos-Blasco Bárbara , Oribio-Quinto Carlos , Donate-López Juan
Published: August 2023

Purpose:

To describe the incidence, features, and clinical outcomes of photodynamic therapy (PDT)-induced acute exudative maculopathy (PAEM) in circumscribed choroidal hemangioma (CCH).

Methods:

Prospective series of 10 patients that underwent standard-fluence PDT for CCH. Best-corrected visual acuity (BCVA) in the Early Treatment Diabetic Retinopathy Score and swept-source optical coherence tomography (SS-OCT) were performed before, 3 days and 1 month after. Central retinal thickness (CRT), CCH retinal thickness and subretinal fluid (SRF) were measured. PAEM was considered as an increase ≥50 µm in SRF or IRF or the appearance of fibrin 3 days after PDT.

Results:

Six males and 4 females were included; median age was 55 years (19 to 69). The incidence rate of PAEM was 7/10. Five PAEM patients showed an increase in IRF, two in SRF and one developed abundant fibrin. Median BCVA at baseline was 57.5 letters (5 to 76) being stable at one month (64 letters; 5 to 80) (p=0.03). Median CRT increased from 516µm (262 to 1265) to 664.5µm 3 days after and diminished to 245µm after one month (156 to 1363) (p≤0.022). In 6/7 of PAEM, a complete resolution of the fluid was obtained.

Conclusion:

PAEM was frequent in CCH, although a favorable prognosis was observed in most cases.
Effect of Keratoconus Stage and Classification Parameters on Deep Anterior Lamellar Keratoplasty Outcomes
Authors: Kemer Atik Burcu , Emul Merve , Kirgiz Ahmet , Cubuk Mehmet Ozgur , Ahmet Sibel , Kandemir Besek Nilay
Published: August 2023

Purpose:

The aim of this study was to investigate the effect of the keratoconus (KC) stage according to the Amsler–Krumeich classification system and the parameters used in this classification on deep anterior lamellar keratoplasty outcomes.

Methods:

The preoperative KC stage was determined, and the presence of corneal scarring was noted. The preoperative and postoperative best-corrected visual acuity (BCVA), refractive error, mean central keratometry (Kmean) readings, topographic astigmatism, and minimum corneal thickness (CT) values were recorded. Intraoperative and postoperative complications were also noted.

Results:

One hundred thirty-seven eyes (54 eyes in stage 3–83 eyes in stage 4) were included in the study. The mean follow-up period was 42.20 ± 24.36 months. There was no statistically significant difference between stage 3 and 4 KC groups for postoperative BCVA, Kmean, CT, spherical equivalent, and topographic astigmatism values (each P value >0.05). The effect of preoperative BCVA, Kmean, CT, and refractive error values on postoperative BCVA could not be demonstrated (P = 0.264). In addition, no statistically significant correlation was found between postoperative and preoperative values (each P value > 0.05). Although intraoperative Descemet membrane perforation and postoperative early suture loosening were observed more frequently in stage 4 KC than in stage 3 KC, the 2 groups were statistically similar for these and other complications (each P value >0.05).

Conclusions:

The preoperative KC stage and the parameters used in classification are not useful in predicting postoperative deep anterior lamellar keratoplasty outcomes. The timing of the surgery should be planned with the awareness that the progression of the disease will not have a negative effect on outcomes.
Triple Procedure: A Stepwise Combination of Deep Anterior Lamellar Keratoplasty and Cataract Surgery
Authors: Alfonso-Bartolozzi Belén , Fernández-Vega-Cueto Luis , Fernández-Vega Luis , Martínez-Alberquilla Irene , Madrid-Costa David , Alfonso José F.
Published: August 2023

Purpose:

The aim of this study was to evaluate clinical outcomes of the combined surgery (triple procedure) of deep anterior lamellar keratoplasty (DALK), phacoemulsification, and intraocular lens (IOL) implantation using a new surgical strategy.

Methods:

The study included 43 eyes of 43 patients who underwent a triple procedure. Twenty-six eyes with good visibility through the cornea underwent phacoemulsification before the stromal dissection. Seventeen eyes with bad visibility underwent the DALK procedure first until achieving enough visibility to perform the lensectomy. IOL power calculation was performed for a postoperative estimated flat keratometry of 43.5 and aiming to avoid hyperopic postoperative refraction. The postoperative visual examination included uncorrected and corrected distance visual acuity (CDVA) measurements and manifest refraction.

Results:

The mean follow-up time after suture removal was 3.06 ± 2.14 years. Mean CDVA significantly changed from 0.86 ± 0.56 logMAR preoperatively to 0.37 ± 0.28 logMAR in the last visit (P < 0.0001). The percentage of eyes with CDVA ≤0.3 logMAR changed from 6.9% preoperatively to 62.8%. No eyes lost lines of vision after surgery, and 80% experienced an improvement of 2 or more lines. The safety index was 2.2. The mean postoperative refractive sphere was +0.13 ± 2.04 D, and the postoperative refractive cylinder was −4.02 ± 2.24 D. Only 2 cases (4.65%) obtained postoperative hyperopic astigmatism. No intraoperative complications were found.

Conclusions:

Combined surgery of DALK, phacoemulsification, and IOL implantation is an effective and safe procedure. Depending on the corneal transparency, different surgical strategies can be established to provide more efficacy and safety.
Early oral diet may enhance recovery from benign gynecologic surgery: A single center prospective study
Authors: Yang Szu-Ting , Kuo Shu-Chen , Liu Hung-Hsien , Huang Kuan-Min , Liu Chia-Hao , Chen Shu-Fen , Wang Peng-Hui
Published: August 2023

Background:

Early dietary intake enhanced recovery after surgery (ERAS). There remains a gap in the recognition and implementation of early diet after surgery in medical institutions in Taiwan. This study aimed to investigate whether early oral intake after benign gynecologic surgery results in favorable outcomes in Taiwanese patients.

Methods:

This was a prospective controlled nonrandomized cohort study. Patients who underwent benign gynecological surgery were included in the early- and conventional-diet groups. The primary outcome was length of hospital stay, and the secondary outcome was postoperative complications.

Results:

Forty and 38 patients were included in the early and conventional-diet groups, respectively. The early-diet group demonstrated significantly reduced length of hospital stay (the early-diet group, 2.58 ± 0.93 days; conventional-diet group, 4.16 ± 1.13 days; p < 0.001). No increase in postoperative complications was observed in the early-diet group. Laparoscopic surgery reduced the length of hospital stay (β, −0.65; 95% confidence interval [CI], −1.22 to −0.08; p = 0.027), while an increased length of hospital stay was associated with higher visual analog scales (VAS, β, 0.21; 95% CI, 0.03-0.39; p = 0.026) and the conventional-diet group (β, 1.13; 95% CI, 0.65-1.61; p < 0.001) as assessed by multivariate regression analysis.

Conclusion:

Patients who underwent benign gynecologic surgery tolerated an early oral diet well without an increase in complications. Laparoscopic surgery and lower pain scores also enhanced postoperative recovery.
Skin tone representation in dermatologic direct-to-consumer advertisements: a cross-sectional analysis and call to action
Authors: Okeke Chidubem A. V. , Tran Joseph , Wright Ixavion , Okoye Ginette A. , Burgess Cheryl M. , Byrd Angel S.
Published: August 2023

Background:

Direct-to-consumer advertisements (DTCAs) in medical marketing serve as a prominent modality to deliver information to an increasingly diverse audience of consumers and increase prescription sales. In dermatology, advertisements have the potential to shape the public’s opinions, aid in the understanding of skin conditions, and raise awareness of available treatments.

Objective:

To investigate and characterize the representation of skin tones in DTCAs.

Methods:

Nielsen ratings were utilized to identify the networks most watched by Black viewers in 2022. Programming on NBCUniversal, ABC, CBS, and FOX that aired in the District of Columbia, suburban Maryland, and Northern Virginia from June 2022 to July 2022 was reviewed for DTCAs. DTCAs were then analyzed to determine the skin tones of models and skin conditions depicted on models with darkly pigmented skin.

Results:

Of the 106 DTCAs related to dermatologic conditions, there were 13 unique advertisements featuring 32 unique models. Four advertisements depicted the skin condition on darkly pigmented skin tones. Using the Monk Skin Tone (MST) scale to assess the 32 unique individuals, only 25% (n = 8) were rated at an MST 7 or above, and 6.25% (n = 2) were rated at an MST 10.

Limitations:

This study has the limitation of only sampling DTCAs from Washington, District of Columbia which does not fully represent all dermatology-related DTCAs in the United States.

Conclusion:

Results of this content analysis demonstrate that the number of persons of color within dermatologic DTCAs is 23%, whereas there are 13.6% Black individuals in the 2021 US census. This suggests that DTCAs are becoming more diverse since 2018. However, findings also show that the vast majority of DTCAs do not include models with darkly pigmented skin, and there remains a lack of advertisements depicting skin disease among people of color. Given the role of DTCAs in informing and aiding patients’ requests for prescription drugs, representation of all skin tones is essential for this communication to be effective, especially in the field of dermatology.
Choosing Veterans Affairs: Determinants of post-9/11 Veterans’ enrollment in Veterans Affairs health care
Authors: Vanneman Megan E. , Samore Matthew H. , Zheng Tianyu , Pettey Warren B.P. , Fagerlin Angela , Harris Alex H.S.
Published: August 2023

Following recent policy changes, younger Veterans have particularly increased options for where to receive their health care. Although existing research provides some understanding of non-modifiable individual (e.g., age) and external community (e.g., non-VA provider supply) factors that influence VA enrollment, this study focused on modifiable facility access and quality factors that could influence Veterans’ decisions to enroll in VA. In this cohort study, we examined enrollment in and use of VA services in the year following military separation as the binary outcome using mixed-effects logistic regressions, stratified by Active and Reserve Components. This study included 260,777 Active and 101,572 Reserve Component post-9/11 Veterans separated from the military in fiscal years 2016 to 2017. Independent variables included 4 access measures for timeliness of VA care and 3 VA quality measures, which are included in VA Medical Centers’ performance plans. Eligible Veterans were more likely to enroll in VA when the closest VA had higher quality scores. After accounting for timeliness of VA care and non-modifiable characteristics, rating of primary care (PC) providers was associated with higher VA enrollment for Active Component (odds ratio [OR] = 1.014, 95% confidence interval [CI]: 1.007–1.020). Higher mental health (MH) continuity (OR = 1.039, 95% CI: 1.000–1.078) and rating of PC providers (OR = 1.009, 95% CI: 1.000–1.017) were associated with higher VA enrollment for Reserve Component. Improving facility-specific quality of care may be a way to increase VA enrollment. In a changing policy environment, study results will help VA leadership target changes they can make to manage enrollment of Veterans in VA and deliver needed foundational services.
Protecting the health care workforce from cytotoxic drugs contamination in the hospital wards: the results of the pan-European MASHA-2 project
Authors: Korczowska Ewelina , Crul Mirjam , Wolc Anna , Meier Klaus
Published: August 2023

Background:

A fundamental requirement to ensure the safety of health care workers is to reduce environmental contamination with cytotoxic medicines.

Objectives:

The primary objective of this collaborative project between the European Society of Oncology Pharmacy (ESOP) and the European Society for Medical Oncology (ESMO) was to evaluate cytotoxic medicine contamination on surfaces in European hospital wards. The secondary objectives were (a) to detect possible internal bodily exposure in staff members and (b) to evaluate the impact of teaching safe handling practices.

Materials and methods:

Surface contamination in the chemotherapy administration areas was measured in 28 hospitals from 16 European countries before (part I) and after (part II) staff training through a standardized tutorial. Contamination with four antineoplastic medicines and total platinum was assessed using wipe samples taken from four comparable surfaces in each part of the project. In addition, hospitals that showed a high level of surface contamination, collected 24-hour urine of five staff members (part III). The samples were analyzed by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) and inductively coupled plasma-mass spectrometry (ICP-MS).

Results:

In total, 112 and 104 wipe samples (part I and part II) and 32 urine samples (part III) were collected. Surface contamination occurred in all participating hospitals. The most contaminated spot was the floor in the nurses' station. The most frequently found compound was platinum, and the medicine that showed the highest amount of contamination was cyclophosphamide (8.18 ng/cm2 in part I and 0.53 ng/cm2 in part II). Urine samples were positive for gemcitabine and cyclophosphamide in 1 and 2 nurses, respectively. The intervention by tutorial lowered the levels of contamination, both in number (from 48% to 41%) and in amount of contamination.

Conclusion:

The MASHA-2 study shows that contamination of surfaces with cytotoxic medicines in European hospitals is a widespread phenomenon. Bodily exposure of nurses was clearly detected. Surface contamination decreased after training on safe handling practices. Nevertheless, further optimization of occupational safety is warranted.
Clinicopathological Impacts of Expression of Neuronal Markers in Lymphangioleiomyomatosis
Authors: Kishi Monami , Hayashi Takuo , Mitani Keiko , Tsuboshima Kenji , Kurihara Masatoshi , Hosoya Masaki , Sekimoto Yasuhito , Okura Makiko K. , Mitsuishi Yoichiro , Okada Yoshinori , Kanno Jun , Yao Takashi , Takahashi Kazuhisa , Seyama Kuniaki
Published: August 2023

Lymphangioleiomyomatosis (LAM) is a tuberous sclerosis complex (TSC)-associated tumor, characterized by the expression of neural crest lineages including neuronal markers. Neural crest cells can differentiate into multiple cell types that contribute to tissues associated with TSC-related tumors, and TSC-related tumors could be specifically associated with distinct neural crest subtypes. This study aimed to clarify the clinicopathological effects of expression of neuronal markers in LAM. Lung tissues from 40 patients with LAM (of whom 13, 1, and 26 had undergone lung transplantation, lobectomy, and partial lung resection, respectively) were immunohistochemically analyzed. All patients were women, and their median age was 36 years (range: 24–62 y). All patients who underwent lung transplantation or lobectomy were classified as LAM histologic score (LHS)-3, whereas those who underwent partial lung resection were classified as LHS-1. LAM cells expressed peripherin (65%), and neuron-specific βIII-tubulin (43%). A comparison of the early (LHS-1) and advanced (LHS-3) stages of LAM revealed that neuron-specific βIII-tubulin was significantly expressed in the early stage of LAM (P = 0.0009). Neuron-specific βIII-tubulin-positive LAM was associated with younger age (P < 0.0001), the coexistence of renal angiomyolipoma (P = 0.027), and the absence of retroperitoneal LAM (P = 0.045). Furthermore, based on the expression levels of immunohistochemical markers in LAM, 2 distinct clusters with different expression levels of neuronal markers were observed. Approximately 40% to 60% of patients with LAM expressed neuron-specific βIII-tubulin and peripherin. Neuronal expression may be associated with disease severity.
Tracheostomy Timing During Pediatric Cardiac Intensive Care: Single Referral Center Retrospective Cohort
Authors: Fox Miriam T. , Meyer-Macaulay Colin , Roberts Hanna , Lipsitz Stuart , Siegel Bryan D. , Mastropietro Chris , Graham Robert J. , Moynihan Katie M.
Published: August 2023

OBJECTIVES:

To describe associations between the timing of tracheostomy and patient characteristics or outcomes in the cardiac ICU (CICU).

DESIGN:

Single-institution retrospective cohort study.

SETTING:

Freestanding academic children’s hospital.

PATIENTS:

CICU patients with tracheostomy placed between July 1, 2011, and July 1, 2020.

INTERVENTIONS:

We compared patient characteristics and outcomes between early and late tracheostomy based on the duration of positive pressure ventilation (PPV) before tracheostomy placement, fitting a receiver operating characteristic curve for current survival to define a cutoff.

MEASUREMENTS AND MAIN RESULTS:

Sixty-one patients underwent tracheostomy placement (0.5% of CICU admissions). Median age was 7.8 months. Eighteen patients (30%) had single ventricle physiology and 13 patients (21%) had pulmonary vein stenosis (PVS). Primary indications for tracheostomy were pulmonary/lower airway (41%), upper airway obstruction (UAO) (31%), cardiac (15%), neuromuscular (4%), or neurologic (4%). In-hospital mortality was 26% with 41% survival at the current follow-up (median 7.8 [interquartile range, IQR 2.6–30.0] mo). Late tracheostomy was defined as greater than or equal to 7 weeks of PPV which was equivalent to the median PPV duration pre-tracheostomy. Patients with late tracheostomy were more likely to be younger, have single ventricle physiology, and have greater respiratory severity. Patients with early tracheostomy were more likely to have UAO or genetic comorbidities. In multivariable analysis, late tracheostomy was associated with 4.2 times greater mortality (95% CI, 1.9–9.0). PVS was associated with higher mortality (adjusted hazard ratio [HR] 5.2; 95% CI, 2.5–10.9). UAO was associated with lower mortality (adjusted HR 0.2; 95% CI, 0.1–0.5). Late tracheostomy was also associated with greater cumulative opioid exposure.

CONCLUSIONS:

CICU patients who underwent tracheostomy had high in-hospital and longer-term mortality rates. Tracheostomy timing decisions are influenced by indication, disease, genetic comorbidities, illness severity, and age. Earlier tracheostomy was associated with lower sedative use and improved adjusted survival. Tracheostomy placement is a complex decision demanding individualized consideration of risk-benefit profiles and thoughtful family counseling.