bluuebunny/crossref_metadata_2025 huggingface dataset:
A Qualitative Analysis on the Experiences of Mothers of Children in Burn Intensive Care Unit: “She burned on the outside, me inside...”
Authors: Karahan Sabri , Ay Kaatsiz Melike Ayça , Erbas Atiye , Kaya Yunus
Published: August 2023

Mothers closely follow the complex process due to the burning of their children. Caring for and supporting the child can pose various challenges for mothers. With the phenomenological method, this study was conducted to investigate mothers’ experiences staying with their children in the pediatric burn intensive care unit. Twelve mothers participated in the study. The semistructured face-to-face interviews obtained data. After each interview, the research team transcribed the interviews verbatim. Interpretive Phenomenological Analysis was used to analyze the data. The experiences of the mothers were classified in four contexts as a result of the interpretative phenomenological analysis; “first reactions to burn trauma” related to the awareness that the child has been burned, “being a mother in the burn intensive care unit” related to caring for the child as a companion in the burn intensive care unit, “coping” related to how they cope with the problems throughout the whole process, and “requirements” regarding the subjects it needs in the process. It was determined that mothers went through a physically and emotionally challenging process from the beginning of the burn trauma and throughout the intensive care unit. During this challenging process, it was observed that mothers could not use effective coping methods and did not receive the necessary professional support. In line with these results, it is recommended that psychological support programs be applied to the mothers and that care focused on the needs of the mothers should be provided.
Eileen Gray and Jean Badovici at Vézelay
Authors: Benton Tim
Published: August 2023

The study of collaborative work by architects and designers can present difficulties. The principal biographers of Eileen Gray asserted that she played the key role in the design of the houses that her friend Jean Badovici (1893–1956) acquired and transformed in Vézelay between 1926 and 1934 and that this work contributed to the design of her other buildings. This claim is worth investigating because the Vézelay houses present innovative and distinctive features, and because Jean Badovici’s qualities as architect have been insufficiently studied. A method is presented here for distinguishing between different hands based on the forensic analysis of individual words and letters. This approach could be of use in many contexts but particularly in the case of close collaboration between architects and designers. Applied initially to drawings for Badovici’s houses at Vézelay, the method can be applied to the many other drawings in the archives of the V&A, the Pompidou Centre, the Eileen Gray archive in the National Museum of Ireland, and the Badovici archive in the Getty Research Institute. The evidence from this analysis is set alongside other arguments for evaluating Gray’s involvement in the design of the Badovici houses at Vézelay. The aim of this essay is not to challenge Gray’s collaboration in the design process but to test claims of her sole or principal role in the design of these houses.
The global relevance of Tagore’s cosmopolitan educational philosophy for social justice in a post-Westphalian world
Authors: Banga Sunil
Published: August 2023

This article suggests that Tagore’s conception of cosmopolitan education can provide the basis for advancing matters of global social justice, when considering the problem posed by Nancy Fraser in her essay ‘Reframing Justice in a Globalizing World’: ‘How can we integrate struggles against maldistribution, misrecognition and misrepresentation within a post-Westphalian frame?’. To this end, the article briefly reflects on the perspective of cosmopolitanism, setting the scene for an exploration of Tagore’s distinctive cosmopolitan educational philosophy. The article develops the argument that framing pedagogy centred on Tagore’s principles of cosmopolitan education to produce cosmopolitan-minded citizens can help bring about social, political, and economic change at local, national, and international level, in order to integrate the three-dimensional struggle for social justice outlined by Fraser. The article concludes by suggesting what can be done at the institutional and curriculum levels to help foster the cosmopolitan attitude.
NtMYB1 and NtNCED1/2 control abscisic acid biosynthesis and tepal senescence in Chinese narcissus (Narcissus tazetta)
Authors: Yang Jingwen , Huang Jiazhi , Wu Xi , Xu Yun , Gu Zheng , Chen Yajue , Zhang Yu , Ren Yujun , Miao Ying
Published: August 2023

Chinese narcissus (Narcissus tazetta var. chinensis cv. ‘Jinzhanyintai’) is one of the 10 most famous traditional flowers of China, having a beautiful and highly ornamental flower with a rich fragrance. However, the flower longevity affects its commercial appeal. While petal senescence in Narcissus is ethylene-independent and abscisic acid-dependent, the regulatory mechanism has yet to be determined. In this study, we identified a R2R3-MYB gene (NtMYB1) from Narcissus tazetta and generated oeNtMYB1 and Ntmyb1 RNA interference mutants in Narcissus as well as an oeNtMYB1 construct in Arabidopsis. Overexpressing NtMYB1 in Narcissus or Arabidopsis led to premature leaf yellowing, an elevated level of total carotenoid, a reduced level of chlorophyll b, and a decrease in photosystem II fluorescence (Fv/Fm). A dual-luciferase assay and chromatin immunoprecipitation–quantitative PCR revealed that NtMYB1 directly binds to the promoter of NtNCED1 or NtNCED2 and activates NtNCED1/2 gene expression both in vitro and in vivo. Moreover, overexpressing NtMYB1 accelerated abscisic acid biosynthesis, up-regulated the content of zeatin and abscisic acid, and down-regulated the level of β-carotene and gibberellin A1, leading to petal senescence and leaf yellowing in Narcissus. This study revealed a regulatory process that is fundamentally different between non-photosynthetic organs and leaves.
Patient Satisfaction in Military Dental Clinics—Findings From the Department of Defense Dental Patient Satisfaction Survey
Authors: Buss Kathleen D , Schindler David K , Matis Steven A , Lopez Mitnik Gabriela V , Boroumand Shahdokht , Dye Bruce A
Published: August 2023

Introduction

An objective of the Military Health System is to deliver an improved health care experience. Patient satisfaction affects the patient experience, health outcomes, and treatment compliance. The purpose of this study is to identify indicators of high and low patient satisfaction within a military dental setting.

Materials and Methods

De-identified data from 248,342 responses to the DoD Dental Patient Satisfaction Survey conducted from October 2014 to March 2016 were used. The overall satisfaction and other related outcomes were analyzed by age, sex, beneficiary status, current rank, current Service, type of dental treatment, clinic location, and clinic size. Unpaired t-tests and logistic regression modeling were used to ascertain relationships between various aspects of patient satisfaction and variables of interest.

Results

Overall, 96% of patients attending military dental clinics were satisfied, whereas 72% of patients were satisfied with the number of days waited for an appointment. Air Force patients were the most satisfied compared to their Army, Navy, and Marine Corps counterparts. Patients treated in small dental clinics (less than 5 dentists) were 74% more satisfied than patients treated at large dental clinics (more than 12 dentists). Patients seeking routine dental treatment were significantly more satisfied with the number of days waiting for an appointment (odds ratio = 8.03; 95% CI: 7.64–8.43) compared to patients waiting for an emergency dental appointment.

Conclusions

There were important differences in patient satisfaction by military Service and clinic size, suggesting that improvement in satisfaction may need to be Service specific. These differences warrant further research that could inform policy changes directed at improving service members’ dental care and readiness.
Unilateral adrenalectomy as a treatment option in a patient with recurrent Cushing’s disease
Authors: Gosmanov Aidar R , Green Maria , Gerges Antoni Kafrouni , Ziganshina Anna P , Roy Mary P
Published: August 2023

In recurrent Cushing’s disease (CD), therapeutic management options may pose challenges related to risk-benefit profile of available pharmacological agents or bilateral adrenalectomy. Here, we describe a patient with recurrent CD who in context of progressive worsening of diabetes control and new diagnosis of coronary artery disease was offered a unilateral adrenalectomy (UA) to help alleviate the metabolic burden of hypercortisolemia. Within 6 months following UA she was able to stop her blood pressure medications; her anti-diabetes medications were significantly titrated down and she experienced significant weight loss. Currently, 18 months after the UA, the patient has not experienced new clinical events, her weight is stable and diabetes control is consistently optimal, and she remains off anti-hypertensive medications. This report adds to currently scarce body of literature that patients with difficult to manage CD can be considered as candidates for UA to potentially alleviate the metabolic burden of hypercortisolemia.
Food allergy masquerading as persistent proteinuria in post-infectious glomerulonephritis: a case report
Authors: Mohkam Masoumeh , Jamee Mahnaz , Mortazavi Nafiseh , Mirzaee Mahbubeh , Mansouri Mahboubeh
Published: August 2023

Background: Post-infectious glomerulonephritis (PIGN) is one of the most common causes of pediatric acute glomerulonephritis. Immune system dysregulation manifesting as food allergy may predispose PIGN patients to nephrotic-range proteinuria.

Case Presentation: The patient was a 3-year-old male that presented with edema, gross hematuria and reduced urine output following a mild fever, rhinorrhea and lethargy. Due to the persistence of proteinuria and hematuria, he underwent a kidney biopsy. The patient was diagnosed with atypical PIGN and was placed on oral prednisolone. During treatment, a relationship between the consumption of dairy products and the degree of proteinuria was noted. The clinical manifestations and urinalysis indices improved upon steroid discontinuation and initiation of a hypoallergic diet.

Conclusion: The association between the degree of proteinuria and consumption of dairy products in this PIGN patient led to the identification of food allergy as an underlying factor for nephrotic-range proteinuria.
Antipsychotic Medication and Risk of Metabolic Disorders in People With Schizophrenia: A Longitudinal Study Using the UK Clinical Practice Research Datalink
Authors: Eyles Emily , Margelyte Ruta , Edwards Hannah B , Moran Paul A , Kessler David S , Davies Simon J C , Bolea-Alamañac Blanca , Redaniel Maria Theresa , Sullivan Sarah A
Published: August 2023

Background and Hypothesis

Antipsychotics are first-line drug treatments for schizophrenia. When antipsychotic monotherapy is ineffective, combining two antipsychotic drugs is common although treatment guidelines warn of possible increases in side effects. Risks of metabolic side effects with antipsychotic polypharmacy have not been fully investigated. This study examined associations between antipsychotic polypharmacy and risk of developing diabetes, hypertension, or hyperlipidemia in adults with schizophrenia, and impact of co-prescription of first- and second-generation antipsychotics.

Study Design

A population-based prospective cohort study was conducted in the United Kingdom using linked primary care, secondary care, mental health, and social deprivation datasets. Cox proportional hazards models with stabilizing weights were used to estimate risk of metabolic disorders among adults with schizophrenia, comparing patients on antipsychotic monotherapy vs polypharmacy, adjusting for demographic and clinical characteristics, and antipsychotic dose.

Study Results

Median follow-up time across the three cohorts was approximately 14 months. 6.6% developed hypertension in the cohort assembled for this outcome, with polypharmacy conferring an increased risk compared to monotherapy, (adjusted Hazard Ratio = 3.16; P = .021). Patients exposed to exclusive first-generation antipsychotic polypharmacy had greater risk of hypertension compared to those exposed to combined first- and second-generation polypharmacy (adjusted HR 0.29, P = .039). No associations between polypharmacy and risk of diabetes or hyperlipidemia were found.

Conclusions

Antipsychotic polypharmacy, particularly polypharmacy solely comprised of first-generation antipsychotics, increased the risk of hypertension. Future research employing larger samples, follow-up longer than the current median of 14 months, and more complex methodologies may further elucidate the association reported in this study.
Narratives of Rehabilitation in a South African Prison
Authors: Symkovych Anton
Published: August 2023

How individuals incarcerated in the Global South engage with the official rehabilitative model remains largely under-documented. Through analysis of the narratives of men and women living in a large, medium-security correctional complex in Gauteng, South Africa, I argue that the grandiloquent official discourse of rehabilitation constitutes an important resource for those incarcerated. Highlighting the importance of local context in debates about carceral rehabilitation, I demonstrate that not only prisoners’ personal circumstances, but also the wider socio-economic context of enduring colonial legacies of structural inequalities shape their interactions with the penal regime. By foregrounding what those subjected to penal power make of their incarceration, I argue that the official rehabilitative discourse helps many to make sense of their predicament, actualise their lives, and sustain hope. I highlight how individual narrative strategies are channeled by and mapped on the official discourse of rehabilitation, free will, and personal responsibility, attesting to the success of the disciplinary project of the post-apartheid prison. I demonstrate how prisoners incorporate engagement with the rehabilitative model into a moral order of carceral cohabitation. I suggest that narrative work in the prison constitutes a nexus of individual needs and private aspirations and structural regimes of inequality, poverty, deprivation, and neglect.
Genomic diversity, evolutionary history, and species limits of the endemic Ethiopian laminate-toothed rats (genus Otomys, Rodentia: Muridae)
Authors: Mizerovská Daniela , Martynov Aleksey A , Mikula Ondřej , Bryjová Anna , Meheretu Yonas , Lavrenchenko Leonid A , Bryja Josef
Published: August 2023

The Ethiopian Highlands represent one of the most important centres of endemism on Earth. Six endemic species of laminate-toothed rats have been reported from Ethiopia in a previous study based mostly on morphological analyses. Largely missing genetic data for some of the species, insufficient sampling across Ethiopia, and presence of a pseudogene on cytochrome b created knowledge gaps in basic taxonomy, distribution, and phylogenetic position of the Ethiopian taxa. Here we perform an integrative taxonomic revision of the group by using the largest available sets of genomic and morphological data. We first reconstructed the mitochondrial phylogeny of the whole genus, delimited major clades, and evidenced two independent colonization events of Otomys to Ethiopia. By using genome-scale SNPs, we delimited putative Ethiopian species and analysed their phylogenetic relationships. In genetically characterized specimens we assessed morphological variation of skulls. We confirmed the presence of six previously reported species and significantly extended the known distributional range for some of them. Furthermore, we discovered a genetically and morphologically distinct lineage in northern Ethiopia, probably representing a new species. The speciation processes are similar to other Afromontane Ethiopian endemic rodent clades, with prevailing allopatric diversification combined with reticulate processes.
The risk of pulmonary NTM infections and water-quality constituents among persons with cystic fibrosis in the United States, 2010–2019
Authors: Lipner Ettie M. , French Joshua P. , Mercaldo Rachel A. , Nelson Stephen , Zelazny Adrian M. , Marshall Julia E. , Strong Michael , Falkinham Joseph O. , Prevots D. Rebecca
Published: August 2023

Rationale:

The prevalence of nontuberculous mycobacterial (NTM) pulmonary disease varies geographically in the United States. Previous studies indicate that the presence of certain water-quality constituents in source water increases NTM infection risk.

Objective:

To identify water-quality constituents that influence the risk of NTM pulmonary infection in persons with cystic fibrosis in the United States.

Methods:

We conducted a population-based case-control study using NTM incidence data collected from the Cystic Fibrosis Foundation Patient Registry during 2010–2019. We linked patient zip code to the county and associated patient county of residence with surface water data extracted from the Water Quality Portal. We used logistic regression models to estimate the odds of NTM infection as a function of water-quality constituents. We modeled two outcomes: pulmonary infection due to Mycobacterium avium complex (MAC) and Mycobacterium abscessus species.

Results:

We identified 484 MAC cases, 222 M. abscessus cases and 2816 NTM-negative cystic fibrosis controls resident in 11 states. In multivariable models, we found that for every 1-standardized unit increase in the log concentration of sulfate and vanadium in surface water at the county level, the odds of infection increased by 39% and 21%, respectively, among persons with cystic fibrosis with MAC compared with cystic fibrosis-NTM-negative controls. When modeling M. abscessus as the dependent variable, every 1-standardized unit increase in the log concentration of molybdenum increased the odds of infection by 36%.

Conclusions:

These findings suggest that naturally occurring and anthropogenic water-quality constituents may influence the NTM abundance in water sources that supply municipal water systems, thereby increasing MAC and M. abscessus infection risk.
Pre-participation Withdrawal and Noncompletion of Cardiac Rehabilitation in Peripheral Artery Disease
Authors: Nguyen Cindy H. , Marzolini Susan
Published: August 2023

Purpose:

Despite the mortality benefit of cardiac rehabilitation (CR) participation, as well as its cost-effectiveness for people with peripheral artery disease (PAD), there are limited data on adherence and completion of CR in those with and without concomitant coronary artery disease (CAD). The objective of this study was to compare CR pre-participation withdrawal and noncompletion between patients with PAD and concomitant PAD and CAD (PAD/CAD) versus matched and unmatched patients with CAD (uCAD).

Methods:

Consecutively referred patients between 2006-2017 with PAD (n = 271) and PAD/CAD (n = 610) were matched to CAD by age, sex, diabetes, smoking status, and referral year. The uCAD (n = 14 487) group was included for comparison. Reasons for withdrawal were ascertained by interview.

Results:

There were no significant differences in pre-participation withdrawal between PAD and matched CAD (46 vs 43%, P = .49), nor in noncompletion (22 vs 18%, P = .28). Results were similar for PAD/CAD and matched CAD (withdrawal: 36 vs 34%, P = .37) and (noncompletion: 25 vs 23%, P = .46). A smaller proportion of patients with uCAD withdrew (28%) than patients with PAD (P < .001) and PAD/CAD (P < .001), with no difference in noncompletion (P > .40, both). There were no differences between PAD and PAD/CAD and their matched counterparts for medical and nonmedical reasons for withdrawal and noncompletion (P ≥ .25, all).

Conclusion:

Pre-participation withdrawal rates were similar between patients with PAD, PAD/CAD, and their matched cohorts but greater than patients with uCAD. Once patients started CR, there were similar completion rates among all groups. Reports that patients with PAD are less likely to start CR may be related to their complex medical profile rather than PAD alone. Strategies to improve participation among patients with PAD should focus on the immediate post-referral period.
Preoperative and Intraoperative Risk Factors for Surgical Site Infection in Pediatric Cardiac Surgery
Authors: Takahashi Yoshihiro , Ueno Kentaro , Nakae Koji , Kawamura Junpei , Matsuba Tomoyuki , Okamoto Yasuhiro
Published: August 2023

Background:

Surgical site infection (SSI) is a major complication of pediatric cardiac surgery. If the risk of developing SSI can be predicted based on the patient’s preoperative background, appropriate preoperative management to prevent the development of SSI can be achieved.

Methods:

We retrospectively studied cases for patients younger than 7 years of age among surgeries performed through a median sternotomy at Kagoshima University Hospital from April 2011 to March 2021. SSI was diagnosed according to the Centers for Disease Control and Prevention guidelines and classified into 3 types: superficial incisional SSI (SiSSI), deep incisional SSI (DiSSI) and mediastinitis.

Results:

Of the 765 consecutive pediatric cardiac surgeries, 597 were included in the analysis based on the exclusion criteria. Of these, 17 (2.8%) developed SSI (3 SiSSI cases, 2 DiSSI cases and 12 mediastinitis cases), with Staphylococcus aureus as the major pathogen. Univariate analysis revealed that low preoperative serum protein (P = 0.049) and low serum albumin levels (P = 0.023) were risk factors for the development of SSI. No findings suggested impaired hepatic synthesis, inflammatory disease or protein loss from the kidney or intestinal tract. We concluded that malnutrition caused low serum protein and albumin levels.

Conclusions:

Low preoperative serum protein and albumin levels are risk factors for SSI development of SSI. Nutritional status should be regularly assessed in children scheduled for cardiac surgery, and interventions, such as nutritional guidance, should be considered if malnutrition is suspected.
Cochlear Implant Upper Stimulation Levels: eSRT vs. Loudness Scaling
Authors: Holder Jourdan T. , Henry Melissa R. , MacDonald Andrina E. , Gifford René H.
Published: August 2023

Objective

To assess the difference in speech recognition and sound quality between programming upper stimulation levels using behavioral measures (loudness scaling) and electrically evoked stapedial reflex thresholds (eSRTs).

Study Design

Double-blinded acute comparison study.

Setting

Cochlear implant (CI) program at a tertiary medical center.

Patients

Eighteen adult (mean age = 60 years) CI users and 20 ears.

Main Outcome Measures

Speech recognition scores and sound quality ratings.

Results

Mean word and sentence in noise recognition scores were 8 and 9 percentage points higher, respectively, for the eSRT-based map. The sound quality rating was 1.4 points higher for the eSRT-based map. Sixteen out of 20 participants preferred the eSRT-based map.

Conclusions

Study results show significantly higher speech recognition and more favorable sound quality using an eSRT-based map compared with a loudness-scaling map using a double-blinded testing approach. Additionally, results may be understated as 18 of 20 ears had eSRTs measured before study enrollment. Results underscore the importance of incorporating eSRTs into standard clinical practice to promote best outcomes for CI recipients.
Factors Determining Testicular Torsion and Consequent Orchiectomy in Pediatric Patients Presenting With Scrotal Pain
Authors: Yen Chen-Wei , Chang Yi-Jung , Ming Yung-Ching , Gau Chun-Chun , Wu Chang-Teng , Lee Jung
Published: August 2023

Objective

Factors associated with testicular torsion (TT) and consequent orchiectomy in patients presenting to pediatric emergency departments (PEDs) with scrotal pain (SP) are not well described. We report the factors predicting TT and consequent orchiectomy in children with SP.

Methods

The data on patients (aged ≤18 years) who presented with SP to PEDs at 4 branches of the Chang Gung Hospital through 10 years were analyzed.

Results

In all, 256 pediatric patients presented with SP. Their mean age was 11.60 ± 4.61 years and 72.7% (n = 186) were aged 10 to 18 years. The pain was left-sided in 54.7% (n = 140) and the interval between SP onset and PED arrival was 22.45 ± 31.27 hours. Overall, 84 (32.8%) patients needed surgery and 72 (28.1%) had TT. Of the patients with TT, 28 (38.9%) patients needed an orchiectomy. After analysis, TT and consequent orchiectomy were associated with a longer interval between SP onset and PED arrival, absent of testicular ultrasonic blood flow, interval between SP onset and surgery of more than 24 hours, and a high degree of TT. None of them experienced recurrent SP symptoms or TT again.

Conclusions

The rate of TT in patients presenting to PEDs with an SP was 28.1%, and 38.9% of the patients with TT needed an orchiectomy. Early diagnosis and intervention helped to prevent subsequent orchiectomy in pediatric patients with TT.
Deep Learning Image Reconstruction Algorithm for CCTA: Image Quality Assessment and Clinical Application
Authors: Catapano Federica , Lisi Costanza , Savini Giovanni , Olivieri Marzia , Figliozzi Stefano , Caracciolo Alessandra , Monti Lorenzo , Francone Marco
Published: August 2023

Objective

The increasing number of coronary computed tomography angiography (CCTA) requests raised concerns about dose exposure. New dose reduction strategies based on artificial intelligence have been proposed to overcome limitations of iterative reconstruction (IR) algorithms. Our prospective study sought to explore the added value of deep-learning image reconstruction (DLIR) in comparison with a hybrid IR algorithm (adaptive statistical iterative reconstruction-veo [ASiR-V]) in CCTA, even in clinical challenging scenarios, as obesity, heavily calcified vessels and coronary stents.

Methods

We prospectively included 103 consecutive patients who underwent CCTA. Data sets were reconstructed with ASiR-V and DLIR. For each reconstruction signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) was calculated, and qualitative assessment was made with a four-point Likert scale by two independent and blinded radiologists with different expertise.

Results

Both SNR and CNR were significantly higher in DLIR (SNR-DLIR median value [interquartile range] of 13.89 [11.06–16.35] and SNR-ASiR-V 25.42 [22.46–32.22], P < 0.001; CNR-DLIR 16.84 [9.83–27.08] vs CNR-ASiR-V 10.09 [5.69–13.5], P < 0.001).

Median qualitative score was 4 for DLIR images versus 3 for ASiR-V (P < 0.001), with a good interreader reliability [intraclass correlation coefficient(2,1)e intraclass correlation coefficient(3,1) 0.60 for DLIR and 0.62 and 0.73 for ASiR-V].

In the obese and in the “calcifications and stents” groups, DLIR showed significantly higher values of SNR (24.23 vs 11.11, P < 0.001 and 24.55 vs 14.09, P < 0.001, respectively) and CNR (16.08 vs 8.04, P = 0.008 and 17.31 vs 10.14, P = 0.003) and image quality.

Conclusions

Deep-learning image reconstruction in CCTA allows better SNR, CNR, and qualitative assessment than ASiR-V, with an added value in the most challenging clinical scenarios.
Fast Quantitative Magnetic Resonance Imaging Evaluation of Hydrocephalus Using 3-Dimensional Fluid-Attenuated Inversion Recovery: Initial Experience
Authors: Goo Hyun Woo , Park Sang Hyub
Published: August 2023

Objective

This study aimed to demonstrate the initial experience of using fast quantitative magnetic resonance imaging (MRI) to evaluate hydrocephalus.

Methods

A total of 109 brain MRI volumetry examinations (acquisition time, 7 minutes 30 seconds) were performed in 72 patients with hydrocephalus. From the measured ventricular system and brain volumes, ventricle-brain volume percentage was calculated to standardize hydrocephalus severity (processing time, <5 minutes). The obtained values were categorized into no, mild, and severe based on the fronto-occipital horn ratio (FOHR) and the ventricle-brain volume percentages reported in the literature. The measured volumes and percentages were compared between patients with mild hydrocephalus and those with severe hydrocephalus. The diagnostic performance of brain hydrocephalus MRI volumetry was evaluated using receiver operating characteristic curve analysis.

Results

Ventricular volumes and ventricle-brain volume percentages were significantly higher in in patients with severe hydrocephalus than in those with mild hydrocephalus (FOHR-based severity: 352.6 ± 165.6 cm3 vs 149.1 ± 78.5 cm3, P < 0.001, and 26.8% [20.8%–33.1%] vs 12.1% ± 6.0%, P < 0.001; percentage-based severity: 359.5 ± 143.3 cm3 vs 137.0 ± 62.9 cm3, P < 0.001, and 26.8% [21.8%–33.1%] vs 11.3% ± 4.2%, P < 0.001, respectively), whereas brain volumes were significantly lower in patients with severe hydrocephalus than in those with mild hydrocephalus (FOHR-based severity: 878.1 ± 363.5 cm3 vs 1130.1 cm3 [912.1–1244.2 cm3], P = 0.006; percentage-based severity: 896.2 ± 324.6 cm3 vs 1142.3 cm3 [944.2–1246.6 cm3], P = 0.005, respectively). The ventricle-brain volume percentage was a good diagnostic parameter for evaluating the degree of hydrocephalus (area under the curve, 0.855; 95% confidence interval, 0.719–0.990; P < 0.001).

Conclusions

Brain MRI volumetry can be used to evaluate hydrocephalus severity and may provide guide interpretation because of its rapid acquisition and postprocessing times.
Assessment of Outer Retina and Choroid Using Swept Source Optical Coherence Tomography and Angiography in Patients With Multiple Sclerosis
Authors: Gao Yuzhu , Liu Yilin , Zhang Yifan , Lang Yanlin , Xu Hanyue , Tao Yunhan , Li Yating , Mou Kefan , Zhang Yiteng , Man Shulei , Chen Qing , Zhou Hongyu , Zhang Ming
Published: August 2023

Background:

For patients with multiple sclerosis (MS), both structure and microvasculature alterations in the inner retina have been investigated in several studies. However, little is known about the alterations in the outer retina and choroid. Hence, this study aimed to assess the outer retinal and choroidal changes in patients with MS with no history of optic neuritis (ON).

Methods:

Patients with MS and healthy control participants were enrolled in this cross-sectional study. Quantitative analyses were performed using swept source optical coherence tomography and swept source optical coherence tomography angiography images to assess outer retina thickness (ORT) and choroid thickness (CT), vessel density (VD) of choriocapillaris, and choroidal vascularity index (CVI), which were then compared between the groups.

Results:

A total of 37 participants with MS (72 eyes) and 74 healthy control participants (148 eyes) were included in this study. Compared with healthy controls, patients with MS with no history of ON showed reduced VD of the choriocapillaris and CVI. There was no significant difference in ORT and CT between 2 groups. Meanwhile, in patients with MS, no correlation between OCTA parameters and expanded disability status scale score were found in this study.

Conclusions:

Our study indicates that patients with MS with no history of optical neuritis have reduced choriocapillaris vessel density and decreased choroidal vascularity index without detectable alteration in outer retina thickness and choroid thickness. The findings complement the outer retinal and choroidal component of MS, providing deeper insight into the pathophysiology of MS.
Microbe Profile: Ruminococcus gnavus: the yin and yang of human gut symbionts
Authors: Juge Nathalie
Published: August 2023

Graphical abstract
First-Time Prescribing of GLP-1 Receptor Agonists from 2018-2023: A Descriptive Analysis
Authors: Rodriguez Patricia J , Gratzl Samuel , Goodwin Cartwright Brianna M , Brar Rajdeep , Gluckman Ty J , Stucky Nicholas L
Published: August 2023

Aims

Limited recent data exist on prescribing patterns and patient characteristics for glucagon-like peptide 1 receptor agonists (GLP-1 RAs), an important drug class for patients with type 2 diabetes mellitus (T2D) and/or overweight or obesity. We describe trends in first-time prescribing of GLP-1 RAs.

Materials and Methods

Using aggregated US electronic health record data, we identified first-time prescriptions of GLP-1 RAs between January 2018 and June 2023 for adults receiving regular care. We describe prescribing volumes stratified by patient characteristics, specific drug, and FDA-labelled indication. The 5.5-year analysis period was divided into six-month periods.

Results

In total, 274,562 patients were newly prescribed a GLP-1 RA, with a significant increase over time (January to June, 2018: 9,642 versus 2023: 66,569; p < 0.001). Overall, 181,860 (66.2%) patients had T2D and 229,715 (83.7%) had obesity or overweight. The proportion with T2D decreased over time (January through June, 2018: 84.1% versus 2023: 49%; p < 0.001), while the proportion with overweight or obesity increased (January through June, 2018: 75.9% versus 2023: 90.7%; p <.001). Of prescriptions with a known FDA-labelled indication (74.2%), 87% were labelled for T2D and 13% were labelled for overweight or obesity. Patients first prescribed a GLP-1 RA labelled for T2D were 59.1% female with a mean (SD) age of 58.6 (13) years, while those prescribed a GLP-1 RA labelled for overweight or obesity were 82.9% female, with a mean (SD) age of 48.2 (12.2) years.

Conclusions

We observed an increase in first-time prescribing of GLP-1 RAs overall, and a shift away from a predominately T2D population.
Developing and Evaluating Pediatric Phecodes (Peds-Phecodes) for High-Throughput Phenotyping Using Electronic Health Records
Authors: Grabowska Monika E. , Van Driest Sara L. , Robinson Jamie R. , Patrick Anna E. , Guardo Chris , Gangireddy Srushti , Ong Henry , Feng QiPing , Carroll Robert , Kannankeril Prince J. , Wei Wei-Qi
Published: August 2023

Objective

Pediatric patients have different diseases and outcomes than adults; however, existing phecodes do not capture the distinctive pediatric spectrum of disease. We aim to develop specialized pediatric phecodes (Peds-Phecodes) to enable efficient, large-scale phenotypic analyses of pediatric patients.

Materials and Methods

We adopted a hybrid data- and knowledge-driven approach leveraging electronic health records (EHRs) and genetic data from Vanderbilt University Medical Center to modify the most recent version of phecodes to better capture pediatric phenotypes. First, we compared the prevalence of patient diagnoses in pediatric and adult populations to identify disease phenotypes differentially affecting children and adults. We then used clinical domain knowledge to remove phecodes representing phenotypes unlikely to affect pediatric patients and create new phecodes for phenotypes relevant to the pediatric population. We further compared phenome-wide association study (PheWAS) outcomes replicating known pediatric genotype-phenotype associations between Peds-Phecodes and phecodes.

Results

The Peds-Phecodes aggregate 15,533 ICD-9-CM codes and 82,949 ICD-10-CM codes into 2,051 distinct phecodes. Peds-Phecodes replicated more known pediatric genotype-phenotype associations than phecodes (248 versus 192 out of 687 SNPs, p<0.001).

Discussion

We introduce Peds-Phecodes, a high-throughput EHR phenotyping tool tailored for use in pediatric populations. We successfully validated the Peds-Phecodes using genetic replication studies. Our findings also reveal the potential use of Peds-Phecodes in detecting novel genotype-phenotype associations for pediatric conditions. We expect that Peds-Phecodes will facilitate large-scale phenomic and genomic analyses in pediatric populations.

Conclusion

Peds-Phecodes capture higher-quality pediatric phenotypes and deliver superior PheWAS outcomes compared to phecodes.
Potent and broadly neutralizing antibodies against sarbecoviruses induced by sequential COVID-19 vaccination
Authors: Zhao Xiaoyu , Qiu Tianyi , Huang Xiner , Mao Qiyu , Wang Yajie , Qiao Rui , Mao Tiantian , Wang Yuan , Li Jiayan , Luo Cuiting , Yoon Chaemin , Wang Xun , Li Chen , Cui Yuchen , Zhao Chaoyue , Li Minghui , Chen Yanjia , Cai Guonan , Geng Wenye , Hu Zixin , Cao Jinglei , Zhang Wenhong , Cao Zhiwei , Chu Hin , Sun Lei , Wang Pengfei
Published: August 2023

The current SARS-CoV-2 variants strikingly evade all authorized monoclonal antibodies and threaten the efficacy of serum-neutralizing activity elicited by vaccination or prior infection, urging the need to develop antivirals against SARS-CoV-2 and related sarbecoviruses. Here, we identified both potent and broadly neutralizing antibodies from a five-dose vaccinated donor who exhibited cross-reactive serum neutralizing activity against diverse coronaviruses. Through single B cell sorting and sequencing followed by a tailor-made computational pipeline, we successfully selected 86 antibodies with potential cross-neutralizing ability from 684 antibody sequences. Among them, one potently neutralized all SARS-CoV-2 variants that arose prior to Omicron BA.5, and the other three could broadly neutralize all current SARS-CoV-2 variants of concern, SARS-CoV and their related sarbecoviruses (Pangolin-GD, RaTG13, WIV-1, and SHC014). Cryo-EM analysis demonstrates that these antibodies have diverse neutralization mechanisms, such as disassembling spike trimers, or binding to RBM or SD1 to affect ACE2 binding. In addition, prophylactic administration of these antibodies significantly protects nasal turbinate and lung infections against BA.1, XBB.1 and SARS-CoV viral challenge in golden Syrian hamsters, respectively. This study reveals the potential utility of computational process to assist screening cross-reactive antibodies, as well as the potency of vaccine-induced broadly neutralizing antibodies against current SARS-CoV-2 variants and related sarbecoviruses, offering promising avenues for the development of broad therapeutic antibody drugs.
Unravelling the influence of affective stimulation on functional neurological symptoms: A pilot experiment examining potential mechanisms
Authors: Pick Susannah , Merritt Millman L. S. , Ward Emily , Short Eleanor , Stanton Biba , Reinders A.A.T.S. , Winston Joel S. , Nicholson Timothy R. , Edwards Mark J. , Goldstein Laura H. , David Anthony S. , Chalder Trudie , Hotopf Matthew , Mehta Mitul A.
Published: August 2023

Background

Differences in affective processing have previously been shown in functional neurological disorder (FND); however, the mechanistic relevance is uncertain. We tested the hypotheses that highly arousing affective stimulation would result in elevated subjective functional neurological symptoms (FNS), and this would be associated with elevated autonomic reactivity. The possible influence of cognitive detachment was also explored.

Methods

Individuals diagnosed with FND (motor symptoms/seizures; n=14) and healthy controls (HCs; n=14) viewed Positive, Negative, and Neutral images in blocks, whilst passively observing the stimuli (“Watch”) or detaching themselves (“Distance”). The FND group rated their primary FNS, and all participants rated subjective physical (arousal, pain, fatigue) and psychological states (positive/negative affect, dissociation), immediately after each block. Skin conductance (SC) and heartrate (HR) were monitored continuously.

Results

FNS ratings were higher after Negative compared to Positive and Neutral blocks in the FND group (p=0.002, ηp2=0.386); however, this effect was diminished in the Distance condition relative to the Watch condition (p=0.018, ηp2=0.267). SC and/or HR correlated with FNS ratings in the Negative-Watch and Neutral-Distance conditions (r-values: 0.527-0.672, p-values: 0.035-0.006). The groups did not differ in subjective affect or perceived arousal (p-values: 0.541-0.919, ηp2: <0.001-0.015).

Conclusions

Emotionally significant events may exert an influence on FNS which is related to autonomic activation rather than altered subjective affect or perceived arousal. This influence may be modulated by cognitive detachment. Further work is needed to determine the relevance and neural bases of these processes in specific FND phenotypes.
Detection and characterisation of copy number variants from exome sequencing in the DDD study
Authors: Danecek Petr , Gardner Eugene J. , Fitzgerald Tomas W. , Gallone Giuseppe , Kaplanis Joanna , Eberhardt Ruth Y. , Wright Caroline F. , Firth Helen V. , Hurles Matthew E.
Published: August 2023

Purpose

Structural variants such as multi-exon deletions and duplications are an important cause of disease, but are often overlooked in standard exome/genome sequencing analysis. We aimed to evaluate the detection of copy number variants (CNVs) from exome sequencing (ES) in comparison to genome-wide low-resolution and exon-resolution chromosomal microarrays (CMA), and to characterise the properties ofde novoCNVs in a large clinical cohort.

Methods

We performed CNV detection using ES of 13,462 parent-offspring trios in the Deciphering Developmental Disorders (DDD) study, and compared them to CNVs detected from exon-resolution array comparative genomic hybridization (aCGH) in 5,197 probands from the DDD study.

Results

Integrating calls from multiple ES-based CNV algorithms using random forest machine learning generated a higher quality dataset than using individual algorithms. Both ES- and aCGH-based approaches had the same sensitivity of 89% and detected the same number of unique pathogenic CNVs not called by the other approach. Of DDD probands pre-screened with low resolution CMA, 2.6% had a pathogenic CNV detected by higher resolution assays.De novoCNVs were strongly enriched in known DD-associated genes and exhibited no bias in parental age or sex.

Conclusion

ES-based CNV calling has higher sensitivity than low-resolution CMAs currently in clinical use, and comparable sensitivity to exon-resolution CMA. With sufficient investment in bioinformatic analysis, exomebased CNV detection could replace low-resolution CMA for detecting pathogenic CNVs.
Harnessing the Open Access Version of ChatGPT for Enhanced Clinical Opinions
Authors: Tenner Zachary M , Cottone Michael , Chavez Martin
Published: August 2023

With the advent of Large Language Models (LLMs) like ChatGPT, the integration of AI into clinical medicine is becoming increasingly feasible. This study aimed to evaluate the ability of the freely available ChatGPT-3.5 to generate complex differential diagnoses, comparing its output to case records of the Massachusetts General Hospital published in the New England Journal of Medicine (NEJM). Forty case records were presented to ChatGPT-3.5, with prompts to provide a differential diagnosis and then narrow it down to the most likely diagnosis. Results indicated that the final diagnosis was included in ChatGPT-3.5’s original differential list in 42.5% of the cases. After narrowing, ChatGPT correctly determined the final diagnosis in 27.5% of the cases, demonstrating a decrease in accuracy compared to previous studies using common chief complaints. These findings emphasize the need for further investigation into the capabilities and limitations of LLMs in clinical scenarios, while highlighting the potential role of AI as an augmented clinical opinion. With anticipated growth and enhancements to AI tools like ChatGPT, physicians and other healthcare workers will likely find increasing support in generating differential diagnoses. However, continued exploration and regulation are essential to ensure the safe and effective integration of AI into healthcare practice. Future studies may seek to compare newer versions of ChatGPT or investigate patient outcomes with physician integration of this AI technology. By understanding and expanding AI’s capabilities, particularly in differential diagnosis, the medical field may foster innovation and provide additional resources, especially in underserved areas.
Herptile gut microbiomes: a natural system to study multi-kingdom interactions between filamentous fungi and bacteria
Authors: Vargas-Gastélum Lluvia , Romer Alexander S. , Alexander N. Reed , Ghotbi Marjan , Moe Kylie C. , McPhail Kerry L. , Neuhaus George F. , Shadmani Leila , Spatafora Joseph W. , Stajich Jason E. , Tabima Javier F. , Walker Donald M.
Published: August 2023

Reptiles and amphibians (herptiles) represent some of the more endangered and threatened species on the planet and numerous conservation strategies are being implemented with the goal of ensuring species recovery. Little is known, however, about the wild gut microbiome of herptiles and how it relates to the health of wild populations. Here we report results from both a broad survey of hosts and a more intensive sampling of hosts and geography of fungi and bacteria associated with herptile gut microbiomes. We demonstrate that bacterial communities sampled from frogs, lizards and salamanders are structured by the host higher level taxonomy and that the fungusBasidiobolusis a common and natural component of these wild gut microbiomes. Intensive sampling of multiple hosts across the ecoregions of Tennessee revealed that geography and host:geography interactions are strong predictors of distinctBasidiobolusOTUs present within a given host. Co-occurrence analyses ofBasidiobolusand bacterial community diversity supports a correlation and interaction betweenBasidiobolusand bacteria, suggesting thatBasidiobolusmay play a role in structuring the bacterial community. We further the hypothesis that this interaction is advanced by unique specialized metabolism originating from horizontal gene transfer from bacteria toBasidiobolus, and demonstrate thatBasidiobolusis capable of producing a diversity of specialized metabolites including small cyclic peptides.

IMPORTANCE

This work significantly advances our understanding of interactions in herptile microbiomes; the role that fungi play as a structural and functional member of herptile gut microbiomes; and the chemical functions that structure host:microbiome phenotypes. We also provide an important observational system of how the gut microbiome represents a unique environment that selects for novel metabolic functions through horizontal gene transfer between fungi and bacteria. Such studies are needed to better understand the complexity of gut microbiomes in nature and will inform conservation strategies for threatened species of herpetofauna.
Sex-dependent, lateralized engagement of anterior insular cortex inputs to the dorsolateral striatum in binge alcohol drinking
Authors: Haggerty David L. , Atwood Brady K.
Published: August 2023

How does alcohol consumption alter synaptic transmission across time, and do these alcohol-induced neuroadaptations occur similarly in both male and female mice? Previous work shows that anterior insular cortex (AIC) projections to the dorsolateral striatum (DLS) are uniquely sensitive to alcohol-induced neuroadaptations in male, but not female mice, and play a role in governing binge alcohol consumption in male mice. Here, by using high-resolution behavior data paired within-vivofiber photometry, we show how similar levels of alcohol intake are achieved via different behavioral strategies across sex, and how inter-drinking session thirst states predict future alcohol intakes in females, but not males. Further, we show how presynaptic calcium activity recorded from AIC synaptic inputs in the DLS across 3 weeks of water consumption followed by 3 weeks of binge alcohol consumption change across, fluid, time, sex, and brain circuit lateralization. By time-locking presynaptic calcium activity from AIC inputs to the DLS to peri-initiation of drinking events we also show that AIC inputs into the left DLS robustly encode binge alcohol intake behaviors relative to water consumption and AIC inputs into the right DLS in males, but not females. These findings suggest a fluid-, sex- and lateralization-dependent role for the engagement of AIC inputs into the DLS that encode binge alcohol consumption behaviors and further contextualize alcohol-induced neuroadaptations at AIC inputs to the DLS.