bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of preoperative respiratory distress on outcomes of slide tracheoplasty
Authors: Nguyen Kien Trung , Van Nguyen Anh Thi , Tran Vinh Quang , Nguyen Yen Thi , Le Chuong Thanh , Van Dang Thuc , Jun Tae-Gook , Nguyen Truong Ly Thinh
Published: June 2024

OBJECTIVES

Children with congenital tracheal stenosis born in the developing world face a high risk of mortality due to limited access to proper treatment. Patients who required preoperative respiratory support were suspected to have poor survival after slide tracheoplasty; however, this was not clearly demonstrated in the previous studies. This study aims to investigate the impact of preoperative respiratory conditions on outcomes of slide tracheoplasty.

METHODS

From 2016 to 2022, children who underwent slide tracheoplasty were retrospectively reviewed. Patients with respiratory distress requiring emergency operations (group A) were compared with patients in stable condition who were scheduled for surgery (group B).

RESULTS

Perioperative results revealed that group A (n = 43) had a longer bypass time (P < 0.001), operation time (P = 0.01), postoperative ventilation time (P < 0.001) and length of intensive care unit stay (P = 0.00125) than group B (n = 60). The early mortality rate was 7.8%, and the actuarial 5-year survival rate was 85.3%. The cumulative incidence test revealed that group A was highly significant for overall mortality [sudistribution (SHR) 4.5; 95% confidence interval (CI) 1.23–16.4; P = 0.023]. Risk factors for overall mortality were prolonged postoperative ventilation time (hazard ratio 3.86; 95% CI 1.20–12.48; P = 0.024), bronchial stenosis (hazard ratio 5.77; 95% CI 1.72–19.31; P = 0.004), and preoperative tracheal mucositis (hazard ratio 5.67; 95% CI 1.51–21.31; P = 0.01). Four patients needed reintervention during a follow-up of 28.4 months (interquartile range 15.3–47.3).

CONCLUSIONS

Preoperative respiratory distress negatively affected the outcomes of patients who required slide tracheoplasty. Therefore, early detection of congenital tracheal stenosis and aggressive slide tracheoplasty are crucial and obligatory to enhance long-term survival in this lethal congenital airway disease.
Prognosis and treatment strategies for atrial fibrillation in heart failure with mildly reduced ejection fraction
Authors: Schupp Tobias , Schmitt Alexander , Reinhardt Marielen , Abel Noah , Lau Felix , Abumayyaleh Mohammad , Dudda Jonas , Weidner Kathrin , Ayoub Mohamed , Akin Muharrem , Müller Julian , Akin Ibrahim , Behnes Michael
Published: June 2024

Aims

The study investigates the prognosis of atrial fibrillation (AF) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). Data concerning the prognostic impact of AF in patients with HFmrEF is scarce.

Methods and results

Consecutive patients with HFmrEF [i.e. left ventricular ejection fraction 41–49% and signs and/or symptoms of heart failure (HF)] were retrospectively included at one institution from 2016 to 2022. Patients with AF were compared with patients without with regard to the primary composite endpoint of all-cause mortality and HF-related rehospitalization at 30 months (median follow-up). Statistical analyses included Kaplan–Meier, multivariable Cox proportional regression analyses, and propensity score matching. A total of 2148 patients with HFmrEF were included with an overall prevalence of AF of 43%. The presence of AF was associated with a higher risk of the primary composite endpoint all-cause mortality and HF-related rehospitalization at 30 months [hazard ratio (HR) = 2.068; 95% confidence interval (CI) 1.802–2.375; P = 0.01], which was confirmed after propensity score matching (HR = 1.494; 95% CI 1.216–1.835; P = 0.01). AF was an independent predictor of both all-cause mortality (HR = 1.340; 95% CI 1.066–1.685; P = 0.01) and HF-related rehospitalization (HR = 2.061; 95% CI 1.538–2.696; P = 0.01). Finally, rhythm control may be associated with lower risk of all-cause mortality compared with rate control for AF (HR = 0.342; 95% CI 0.199–0.587; P = 0.01).

Conclusion

Atrial fibrillation affects 43% of patients with HFmrEF and represents an independent predictor of adverse long-term prognosis.
The relationship between low levels of albuminuria and mortality among adults without major cardiovascular risk factors
Authors: Claudel Sophie E , Waikar Sushrut S , Schmidt Insa M , Vasan Ramachandran S , Verma Ashish
Published: June 2024

Aims

The aim of this study is to determine whether elevated levels of albuminuria within the low range [urinary albumin-to-creatinine ratio (UACR) <30 mg/g] are linked to cardiovascular death in adults lacking major cardiovascular risk factors.

Methods and results

The association between UACR and cardiovascular mortality was investigated among 12 835 participants in the 1999–2014 National Health and Nutrition Examination Survey using Cox proportional hazard models and confounder-adjusted survival curves. We excluded participants with baseline cardiovascular disease, hypertension, diabetes, pre-diabetes, an estimated glomerular filtration rate <60 mL/min/1.73 m2, currently pregnant, and those who received dialysis last year. Over a median follow-up of 12.3 years, 110 and 621 participants experienced cardiovascular and all-cause mortality. In multivariable-adjusted models, each doubling of UACR was associated with a 36% higher risk of cardiovascular death [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.02–1.82] and a 24% higher risk of all-cause mortality (HR 1.24, 95% CI 1.10–1.39). The 15-year adjusted cumulative incidences of cardiovascular mortality were 0.91, 0.99, and 2.1% for UACR levels of <4.18, 4.18 to <6.91, and ≥6.91 mg/g, respectively. The 15-year adjusted cumulative incidences of all-cause mortality were 5.1, 6.1, and 7.4% for UACR levels of <4.18, 4.18 to <6.91, and ≥6.91 mg/g, respectively.

Conclusion

Adults with elevated levels of albuminuria within the low range (UACR <30 mg/g) and no major cardiovascular risk factors had elevated risks of cardiovascular and all-cause mortality. The risk increased linearly with higher albuminuria levels. This emphasizes a risk gradient across all albuminuria levels, even within the supposedly normal range, adding to the existing evidence.
“It’s like crystal gazing”: The Lived Experience of Anticipating End-of-Life Choices in Older Adults and Their Close Ones
Authors: Antonides Marte Fleur , van Wijngaarden Els
Published: June 2024

Background and Objectives

Nowadays people increasingly try to take control over the end of their lives by anticipating end-of-life choices. Explication of these choices is encouraged using advance care planning (ACP). We aim to deepen our understanding of how choice-making processes are lived in real life, exploring the experience of community-dwelling older adults and their close ones over time.

Research Design and Methods

A multiperspective and longitudinal approach grounded in phenomenology was chosen. Ten triads consisting of an older adult (75+) and 2 close ones (n = 30) were interviewed, twice individually and once as a group, over 20 months (=70 interviews). Data were thematically analyzed both longitudinally and from all 3 perspectives.

Results

The essential meaning of anticipatory choice-making processes was described as a dynamic and relationally entangled decisional process, to navigate between paradoxical choices for an opaque future. Three fields of tension were created due to ambivalence in these choice-making processes: navigation between having and losing control, between taking away and burdening with responsibility, and between expressing and holding back oneself.

Discussion and Implications

Anticipation of choices for hypothetical end-of-life scenarios turned out to be complex and ambivalent. Most older adults resisted ambivalence and ignored complexity in an attempt to stay in control over their end of life. The burdening impact of choices on close ones illuminated the relationality of choice-making processes. These aspects of end-of-life choice-making processes should be integrated into ACP in order to better understand and care for people and their close ones faced with these choices.
Why does the cost of employer-sponsored coverage keep rising?
Authors: Kanimian Salpy , Ho Vivian
Published: June 2024

Over the past 25 years, the gap between the increase in health insurance costs and workers’ wages has significantly expanded. This trend has led to significant concerns about healthcare affordability, with surveys revealing conflicting opinions regarding whether hospitals or health insurance companies bear the blame for escalating costs. To better understand these dynamics, we examined consumer price indices for health insurance, hospital services, and professional services from 2006 to 2023 using Bureau of Labor Statistics data. Our analysis shows that the hospital price index rose steadily between 2006 and 2023, faster than insurance premiums or professional services. To examine whether differences in underlying costs are driving higher hospital price increases, we evaluated the profit margins of hospitals and health insurance companies using the National Academy for State Health Policy’'s Hospital Cost Tool and National Association of Insurance Commissioners Industry Reports. Our findings reveal that hospitals (for-profit and nonprofit) have consistently maintained higher profit margins than insurance companies. As health insurance costs continue to weigh heavily on working Americans, our analysis suggests that high hospital prices drive insurance premiums.
A novel tomato interspecific (Solanum lycopersicum var. cerasiforme and Solanum pimpinellifolium) MAGIC population facilitates trait association and candidate gene discovery in untapped exotic germplasm
Authors: Arrones Andrea , Antar Oussama , Pereira-Dias Leandro , Solana Andrea , Ferrante Paola , Aprea Giuseppe , Plazas Mariola , Prohens Jaime , Díez María José , Giuliano Giovanni , Gramazio Pietro , Vilanova Santiago
Published: June 2024

We developed a novel eight-way tomato multiparental advanced generation intercross (MAGIC) population to improve the accessibility of tomato relatives genetic resources to geneticists and breeders. The interspecific tomato MAGIC population (ToMAGIC) was obtained by intercrossing four accessions each of Solanum lycopersicum var. cerasiforme and Solanum pimpinellifolium, which are the weedy relative and the ancestor of cultivated tomato, respectively. The eight exotic ToMAGIC founders were selected based on a representation of the genetic diversity and geographical distribution of the two taxa. The resulting MAGIC population comprises 354 lines, which were genotyped using a new 12k tomato single primer enrichment technology panel and yielded 6488 high-quality single-nucleotide polymorphism (SNPs). The genotyping data revealed a high degree of homozygosity, an absence of genetic structure, and a balanced representation of the founder genomes. To evaluate the potential of the ToMAGIC population, a proof of concept was conducted by phenotyping it for fruit size, plant pigmentation, leaf morphology, and earliness. Genome-wide association studies identified strong associations for the studied traits, pinpointing both previously identified and novel candidate genes near or within the linkage disequilibrium blocks. Domesticated alleles for fruit size were recessive and were found, at low frequencies, in wild/ancestral populations. Our findings demonstrate that the newly developed ToMAGIC population is a valuable resource for genetic research in tomato, offering significant potential for identifying new genes that govern key traits in tomato. ToMAGIC lines displaying a pyramiding of traits of interest could have direct applicability for integration into breeding pipelines providing untapped variation for tomato breeding.
Ukraine and the opportunity costs of military aid
Authors: Glanville Luke , Pattison James
Published: June 2024

Western states have provided billions of dollars of military aid to Ukraine to help it in its war against Russia. Yet, despite numerous discussions of the ethical issues raised by the war, there has been little discussion of the opportunity costs of this military assistance. Is it right that the West has prioritized military assistance to Ukraine, when the conflict in Ukraine is just one of numerous challenges facing the world, from forced displacement to global poverty, preventable disease to climate change? This article offers the first detailed engagement with this issue, taking seriously the nonideal feasibility constraints that states face. It firsts set out the prima facie case against assisting Ukraine militarily due to the opportunity costs. It then explores—and largely rejects—two responses: that military assistance is required to protect Ukrainian self-determination and that it is needed to stop the march of authoritarianism. It argues that the opportunity costs objection has serious force and counts against much of the provision of military assistance to Ukraine (although not all). This argument has broader implications for the extent to which states should prioritize military aid over other means of addressing global challenges.
Predictors of long-term success after successful explantation of continuous flow left ventricular assist device support
Authors: Gyoten Takayuki , Amiya Eisuke , Saito Akihito , Ono Minoru
Published: June 2024

OBJECTIVES

Predictors and evaluations of continuous flow left ventricular assist device (cf-LVAD) explantation in recovered patients remain under discussion due to lack of evidence on long-term safety and efficacy. This study summarized our experiences regarding cf-LVAD explantation in non-ischaemic dilated cardiomyopathy patients and estimated a predictor for sufficient myocardial recovery allowing left ventricular assist device explant.

METHODS

We retrospectively identified 135 adult patients with cf-LVAD therapy as bridge to heart transplant due to non-ischaemic dilated cardiomyopathy. Of those, 13 patients underwent device explantation (recovery group) after myocardial recovery. Twelve (92%) of the explanted patients were evaluated using our weaning protocol and underwent surgical explantation. Meanwhile, the remaining 122 continued with cf-LVAD therapy (non-recovery group).

RESULTS

Multivariate logistic regression analysis revealed time interval between the first heart failure event and cf-LVAD implantation as an independent predictor for successful explantation. The optimal time interval cutoff value to predict cf-LVAD explantation was 7 months, with a sensitivity of 91.0% and specificity of 84.6%. Echocardiography in patients with successful cf-LVAD explantation showed significant improvement of left ventricular function and dimensions at 6 months postoperatively. The 13 explanted patients are currently alive at a median of 30 (interquartile range; 18–58) months after explantation. The survival rate free from rehospitalization due to heart failure following explantation was 100%. Left ventricular function and remodelling after explantation were also preserved.

CONCLUSIONS

In non-ischaemic dilated cardiomyopathy patients with a short interval between the first heart failure event and cf-LVAD therapy, left ventricular myocardium may recover in an early phase after device implantation.
First experiences with automated annular suturing device in totally endoscopic aortic and mitral valve replacement
Authors: El-Sayed Ahmad Ali , Salamate Saad , Granov Nermir , Bayram Ali , Sirat Sami , Doss Mirko , Silaschi Miriam , Akhavuz Ömür , Bakhtiary Farhad
Published: June 2024

OBJECTIVES

To overcome some of the challenges of endoscopic minimally invasive valve surgery, an automated annular suturing device has been used in aortic and mitral valve replacement surgeries. The current study investigates early clinical outcomes of patients who received aortic or mitral valve replacement with the help of the RAM® device as first experiences in minimally invasive valve surgery.

METHODS

Between September 2020 and June 2023, 66 consecutive patients (mean age 61.8 ± 11 years) underwent endoscopic minimally invasive aortic or mitral valve replacement through right anterior mini-thoracotomy at 2 cardiac surgery referral centres in Germany. The RAM® device was used in all Patients. 3.5 and 5.0 sizes were used in 16.7% and 83.3% of patients, respectively. Aortic, mitral and double valve surgery was performed in 81.8%, 15.2% and 1.5% of patients, respectively. Clinical data were prospectively entered into our institutional database.

RESULTS

Cardiopulmonary bypass time and cross-clamping time were 97.9 ± 20.9 and 66 ± 15.7 min, respectively. Intensive care unit and hospital stays were 1 [1–2] and 9 [7–13] days, respectively. No paravalvular leak and no other intraoperative complications occurred. 30-day and in-hospital mortality were zero. Conversion to sternotomy occurred in 1 (1.5%) patient due to bleeding.

CONCLUSIONS

The usage of the RAM® device is a safe, feasible and effective approach to the endoscopic implantation of aortic or mitral valves and yield excellent early outcomes. Larger size studies are needed to evaluate the efficacy and safety of RAM® device.
Examining the effects of adopting early maturing crop varieties on agricultural productivity, climate change adaptation, and mitigation
Authors: Liang Zhihui , Ruiz-Menjivar Jorge , Zhang Lu , Zhang Junbiao , Shen Xue
Published: June 2024

Climate-smart agriculture is guided by three main goals: increased productivity, enhanced resilience (climate change adaptation), and reduced emissions (climate change mitigation). Early mature crop varieties have been promoted to minimize the impact of climate change and extreme weather events on farming activities. This study examined the effects of adopting early mature rice varieties on agricultural productivity, climate change adaptation, and mitigation. Data came from a cross-sectional sample of 1396 rice farmers in Hubei, China. Productivity was measured via mean rice yield. Production risk (variance of yield) and downside risk (skewness of rice yield) were used as proxies for adaptation. Life cycle assessment was used to calculate the greenhouse gas emissions of rice production. Results indicated that adopting early maturing varieties significantly increased mean rice yield and reduced production risk, downside risk, and greenhouse gas emissions. Altogether, this study provided evidence that using early maturing varieties positively contributed to the three goals of climate-smart agriculture. Our findings provide insight into formulating future policies and programs promoting agricultural sustainability and climate resilience in China and other developing nations in the region.
Space-time error estimates for approximations of linear parabolic problems with generalized time boundary conditions
Authors: Arendt W , Chalendar I , Eymard R
Published: June 2024

We first give a general error estimate for the nonconforming approximation of a problem for which a Banach–Nečas–Babuška (BNB) inequality holds. This framework covers parabolic problems with general conditions in time (initial value problems as well as periodic problems) under minimal regularity assumptions. We consider approximations by two types of space-time discretizations, both based on a conforming Galerkin method in space. The first one is the Euler $\theta -$scheme. In this case, we show that the BNB inequality is always satisfied, and may require an extra condition on the time step for $\theta \le \frac 1 2$. The second one is the time discontinuous Galerkin method, where the BNB condition holds without any additional condition.
Cytokine Biomarkers of Exacerbations in Sputum From Patients With Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study
Authors: Budroni Sonia , Taccone Marianna , Stella Maria , Aprea Susanna , Schiavetti Francesca , Bardelli Monia , Lambert Christophe , Rondini Simona , Weynants Vincent , Contorni Mario , Wilkinson Tom M A , Brazzoli Michela , Rossi Paccani Silvia
Published: June 2024

Background

We determined the relationships between cytokine expression in sputum and clinical data to characterize and understand chronic obstructive pulmonary disease (COPD) exacerbations in people with COPD.

Methods

We measured 30 cytokines in 936 sputum samples, collected at stable state and exacerbation visits from 99 participants in the Acute Exacerbation and Respiratory InfectionS in COPD (AERIS) study (ClinicalTrials.gov NCT01360398). We determined their longitudinal expression and examined differential expression based on disease status or exacerbation type.

Results

Of the cytokines, 17 were suitable for analysis. As for disease states, in exacerbation sputum samples, interleukin (IL) 17A, tumor necrosis factor alpha (TNF-α), IL-1β, and IL-10 were significantly increased compared to stable state sputum samples, but a logistic mixed model could not predict disease state. As for exacerbation types, bacteria-associated exacerbations showed higher expression of IL-17A, TNF-α, IL-1β, and IL-1α. IL-1α, IL-1β, and TNF-α were identified as suitable biomarkers for bacteria-associated exacerbation. Bacteria-associated exacerbations also formed a cluster separate from other exacerbation types in principal component analysis.

Conclusions

Measurement of cytokines in sputum from COPD patients could help identify bacteria-associated exacerbations based on increased concentrations of IL-1α, IL-1β, or TNF-α. This finding may provide a point-of-care assessment to distinguish a bacterial exacerbation of COPD from other exacerbation types.
A multi-tissue genome-scale model of Populus trichocarpa elucidates overexpression targets for improving drought tolerance
Authors: Simas Coutinho Barbosa Juliana , Schroeder Wheaton L , Suthers Patrick F , Jawdy Sara S , Chen Jin-Gui , Muchero Wellington , Maranas Costas D
Published: June 2024

Populus trichocarpa (poplar) is a fast-growing model tree whose lignocellulosic biomass is a promising biofuel feedstock. Enhancing its viability and yield in non-arable drought-prone lands can reduce biomass costs and accelerate adoption as a biofuel crop. Data from extensive -omics and phenotypic studies were leveraged herein to reconstruct a multi-tissue (root, stem and leaf) genome-scale model (GSM) of poplar, iPotri3463, encompassing 14 360 reactions, 12 402 metabolites and 3463 genes. Two condition-specific GSMs were extracted from iPotri3463: iPotri3016C (control) and iPotri2999D (drought), supported by condition-specific transcript levels and reaction essentiality for growth. Physiological constraints consistent with experimental measurements of drought-stressed plants were imposed on growth, photorespiration and carbon assimilation rates. Calculated increased flux capacity through the violaxanthin cycle and GABA biosynthetic pathways agree with established key strategies for improving drought tolerance. Differential gene expression analysis was performed on existing transcriptomes of poplar under different watering regimes. Computational flux knockdown was applied to reactions with increased flux capacity under drought that were associated with at least one downregulated gene. Several such reactions were essential for maintaining observed biomass yield and their associated genes are candidates for overexpression to improve drought tolerance. Glutamine synthetase is one whose overexpression in poplar confirms in silico predictions. However, the two most promising candidates are genes encoding ferulate-5-hydroxylase, Potri.007G016400 and Potri.005G117500, as their overexpression in other plant species led to demonstrably improved drought tolerance while previous overexpression in poplar reduced biomass recalcitrance. iPotri3463 is the first poplar-specific whole-plant GSM and the second one available for a woody plant.
Designing for Autonomy: A Process-Oriented Approach Based on Organismic Integration Theory
Authors: Gerstenberg Rebecca , Hassenzahl Marc , Laschke Matthias
Published: June 2024

In human–computer interaction, self-determination theory (SDT) is best known for its concepts of intrinsic motivation and need fulfillment. In the field of behavior change technologies (BCTs), the need for autonomy, i.e. to act according to one’s own goals and values, has become increasingly important due to its strong positive impact on maintaining behavior change. Still, designers struggle with taking autonomy into account. We believe that organismic integration theory (OIT), an underutilized sub-theory of SDT, is a valuable addition as it allows for a process-oriented view on autonomy. OIT introduces different types of extrinsic motivation (external, introjected, identified and integrated) along a continuum of autonomy. It offers new ways to talk about people's experiences of using BCTs and calls for individualized design strategies. We propose a design approach based on OIT, which understands BCTs as active facilitators to progressively move people along the continuum from external to integrated motivation.
Fine-tuning large language models for rare disease concept normalization
Authors: Wang Andy , Liu Cong , Yang Jingye , Weng Chunhua
Published: June 2024

Objective

We aim to develop a novel method for rare disease concept normalization by fine-tuning Llama 2, an open-source large language model (LLM), using a domain-specific corpus sourced from the Human Phenotype Ontology (HPO).

Methods

We developed an in-house template-based script to generate two corpora for fine-tuning. The first (NAME) contains standardized HPO names, sourced from the HPO vocabularies, along with their corresponding identifiers. The second (NAME+SYN) includes HPO names and half of the concept’s synonyms as well as identifiers. Subsequently, we fine-tuned Llama 2 (Llama2-7B) for each sentence set and conducted an evaluation using a range of sentence prompts and various phenotype terms.

Results

When the phenotype terms for normalization were included in the fine-tuning corpora, both models demonstrated nearly perfect performance, averaging over 99% accuracy. In comparison, ChatGPT-3.5 has only ∼20% accuracy in identifying HPO IDs for phenotype terms. When single-character typos were introduced in the phenotype terms, the accuracy of NAME and NAME+SYN is 10.2% and 36.1%, respectively, but increases to 61.8% (NAME+SYN) with additional typo-specific fine-tuning. For terms sourced from HPO vocabularies as unseen synonyms, the NAME model achieved 11.2% accuracy, while the NAME+SYN model achieved 92.7% accuracy.

Conclusion

Our fine-tuned models demonstrate ability to normalize phenotype terms unseen in the fine-tuning corpus, including misspellings, synonyms, terms from other ontologies, and laymen’s terms. Our approach provides a solution for the use of LLMs to identify named medical entities from clinical narratives, while successfully normalizing them to standard concepts in a controlled vocabulary.
A Comparative Analysis of ChatGPT, ChatGPT-4, and Google Bard Performances at the Advanced Burn Life Support Exam
Authors: Alessandri-Bonetti Mario , Liu Hilary Y , Donovan James M , Ziembicki Jenny A , Egro Francesco M
Published: June 2024

Artificial intelligence and large language models (LLMs) have recently gained attention as promising tools in various healthcare domains, offering potential benefits in clinical decision-making, medical education, and research. The Advanced Burn Life Support (ABLS) program is a didactic initiative endorsed by the American Burn Association, aiming to provide knowledge on the immediate care of severely burn patients. The aim of the study was to compare the performance of three LLMs (ChatGPT-3.5, ChatGPT-4, and Google Bard) on the ABLS exam. The ABLS exam consists of 50 questions with 5 multiple-choice answers. The passing threshold is 80% of correct answers. The 3 LLMs were queried with the 50 questions included in the latest version of the ABLS exam, on July 18th, 2023. ChatGPT-3.5 scored 86% (43 out of 50), ChatGPT-4 scored 90% (45 out of 50), and Bard scored 70% (35 out of 50). No difference was measured between ChatGPT-3.5 and ChatGPT-4 (P = .538) and between ChatGPT-3.5 and Bard (P = .054), despite the borderline P-value. ChatGPT-4 performed significantly better than Bard (P = .012). Out of the 50 questions, 78% (n = 39) were direct questions, while 12% (n = 11) were presented as clinical scenarios. No difference in the rate of wrong answers was found based on the type of question for the 3 LLMs. ChatGPT-3.5 and ChatGPT-4 demonstrated high accuracy at the ABLS exam and outperformed Google Bard. However, the potential multiple applications of LLMs in emergency burn and trauma care necessitate appropriate surveillance and most likely should represent a tool to complement human cognition.
Carbon Monoxide-Related Vision Loss in an Acute Burn Patient
Authors: Setia Karishma , Newsom Megan , Hashimi Habiba , Collins Jay , Senthil-Kumar Prabhu , Feldman Michael J
Published: June 2024

Carbon monoxide poisoning can occur as part of smoke exposure in the burn population. Here we report the case of a 32-year-old, previously healthy male, with carbon monoxide-related blindness after smoke exposure in an apartment fire. Cerebral hypoperfusion was diagnosed using magnetic resonance imaging of the brain, and the patient was diagnosed with cortical visual impairment. He was treated with hyperbaric oxygen therapy following which he had partial recovery of his vision. There is a paucity of information regarding this phenomenon and its treatment.
Food Security: An Unmet Need in Outpatient Burn Care
Authors: Ross Erin E , Fobar Megan , Herrera-Gomez Laura , Gillenwater T Justin , Yenikomshian Haig A
Published: June 2024

Nutrition is paramount for wound healing after burn injury. With rising food prices and time off work due to burn injuries, access to adequate nutrition may be a significant financial stressor. We asked patients at an outpatient burn clinic to complete the Household Food Security Module, which queries about food security over the preceding 12 months. Demographics and burn characteristics were abstracted from the medical record. We assessed the overall prevalence of food insecurity, risk factors for food insecurity, and potential effects of food insecurity on nutritional status and wound healing time. Wound healing time was assessed via Cox regression while adjusting for burn depth, total body surface area burned, and diabetes. Over 40% of participants reported experiencing food insecurity; it was more common in patients who preferred Spanish language (P = 0014) or were unemployed (P = .049). Just over half of participants experiencing food insecurity were using any food assistance resources. Among patients more than 30 days from burn injury, patients who were food insecure had larger burns (P = .01). Experience of food insecurity was not associated presence of malnutrition on nutrition-focused physical exam (P = .47). Wound healing time for burns managed in the outpatient setting was associated with burn depth (P < .001), but not food insecurity (P = .95), burn size (P = .17), or diabetes (P = .14). Although food insecurity did not result in malnutrition or negatively impact wound healing time, it is important for providers to routinely screen for food insecurity due to increased nutritional requirements and loss of wages after burn injury.
Mining in investment arbitration: an analysis of mining companies’ legitimate expectations
Authors: López Clara
Published: June 2024

International investment agreements (IIAs) can be ‘obstacles’ to the green transition, but can also serve as potential ‘enablers’ of clean energy. This article analyses the role of IIAs in protecting mining investments, necessary to develop green technologies in the fight against climate change. As a result of increasing mineral extraction, more investment tribunals adjudicate mining disputes. The article provides a sectoral analysis of the legitimate expectations of investors in the mining sector. It argues that domestic norms are central to resolving investment treaty disputes and that investment tribunals must consider environmental and human rights domestic norms which impose limits on investment protection and configure investor’s property rights. Only by doing so can investment tribunals protect investments in accordance with the ethos of IIAs of promoting sustainable development.
Colorectal cancer screening with fecal immunochemical testing or primary colonoscopy: inequities in diagnostic yield
Authors: Bonander Carl , Westerberg Marcus , Chauca Strand Gabriella , Forsberg Anna , Strömberg Ulf
Published: June 2024

Background

Socioeconomic inequalities in the uptake of colorectal cancer screening are well documented, but the implications on inequities in health gain remain unclear.

Methods

Sixty-year-olds were randomly recruited from the Swedish population between March 2014 and March 2020 and invited to undergo either 2 rounds of fecal immunochemical testing (FIT) 2 years apart (n = 60 137) or primary colonoscopy just once (n = 30 400). By linkage to Statistics Sweden’s registries, we obtained socioeconomic data. In each defined socioeconomic group, we estimated the cumulative yield of advanced neoplasia in each screening arm (intention-to-screen analysis). In the biennial FIT arm, we predicted the probability of exceeding the yield in the primary colonoscopy arm by linear extrapolation of the cumulative yield to (hypothetical) additional rounds of FIT.

Results

In the lowest income group, the yield of advanced neoplasia was 1.63% (95% confidence interval [CI] = 1.35% to 1.93%) after 2 rounds of FIT vs 1.93% (95% CI = 1.49% to 2.40%) in the primary colonoscopy arm. Extrapolation to a third round of FIT implied a 86% probability of exceeding the yield in the primary colonoscopy arm. In the highest income group, we found a more pronounced yield gap between the 2 screening strategies—2.32% (95% CI = 2.15% to 2.49%) vs 3.71% (95% CI = 3.41% to 4.02%)— implying a low (2%) predicted probability of exceeding yield after a third round of FIT.

Conclusions

Yield of advanced neoplasia from 2 rounds of FIT 2 years apart was poorer as compared with primary colonoscopy, but the difference was less in lower socioeconomic groups.

Clinical Trial Registration

ClinicalTrials.gov identifier NCT02078804
Decolonizing the curriculum: philosophical perspectives—an introduction
Authors: English Andrea R , Heilbronn Ruth
Published: June 2024

This Special Issue is focused on supporting the transformation of education called for in the decolonizing the curriculum movement by advancing discourse on the diverse philosophical ideas, concepts, and theories that can undergird practical efforts to decolonize curricula across education sectors. The special issue brings together voices from a range of backgrounds, who draw from a variety of theoretical positions within and beyond philosophies of education. The authors offer diverse forms of scholarly contributions, including philosophical articles, practice-focused reflections, and a reflection on ‘education’ in the public sphere. In this introduction, we consider the relevance of educational-philosophical thinking to the pressing issue of decolonizing the curriculum. The volume is divided into two parts, with the first covering issues of university and postcompulsory education, and the second discussing issues related to schools. We discuss three interconnected themes that permeate both sections: (i) whose knowledge and whose narratives are embodied in curricula? (ii) who is the curriculum for? Who is the learner? What does it mean to be human? (iii) what implications does decolonizing the curriculum have for pedagogy? With these themes, we indicate some of the ways that the articles contribute to a critical extension of the meaning of education itself.
Immunogenicity, Immunological Memory and Monitoring of Disease Activity Following an Anamnestic Immunization With the 13-Valent Pneumococcal Conjugate Vaccine in Children With Idiopathic Nephrotic Syndrome
Authors: Kitsou Konstantina , Askiti Varvara , Tzanoudaki Marianna , Mitsioni Andromachi , Papadatou Ioanna , Liatsis Emmanouil , Kanaka-Gantenbein Christina , Magiorkinis Gkikas , Spoulou Vana
Published: June 2024

Anamnestic 13-valent pneumococcal conjugate vaccine immunization did not affect the relapse risk in pediatric idiopathic nephrotic syndrome. Pneumococcal serotype (PS)-specific antibody titers increased significantly in all groups. Children receiving immunomodulatory treatments (IMTs) displayed significantly lower levels of PS-specific antibodies for 3/8 serotypes tested. PS-specific B-cell counts significantly increased only in healthy controls and patients receiving corticosteroids.
How to build a gymnastics team
Authors: Houlihan Kathleen , Yan Jun
Published: June 2024

At the 2020 Tokyo Olympics, the US women’s artistic gymnastics team was the only team to win a medal in all six categories. On the eve of the 2024 Summer games in Paris, Kathleen Houlihan and Jun Yan assess what metric should be used to pick the perfect team and once again make history
Q&A: John Bailer
Authors: Britten Anna
Published: June 2024

Post-retirement means seeking joy for the award-winning Stats + Stories podcaster
Extratunical grafting for minimally invasive management of complex Peyronie’s disease deformities
Authors: Ceballos Brian , Baumgarten Adam S , Krug Aaron M , Morey Allen F
Published: June 2024

Background

Penile deformities due to Peyronie’s Disease (PD) often significantly impair men’s sexual health and quality of life.

Aim

In this article we discuss the extratunical graft (ETG) procedure as a management strategy for PD patients with hourglass or indent penile deformities.

Methods

We compiled descriptions of surgical techniques and performed a review of the literature regarding ETG for PD.

Outcomes

The ETG procedure appears to have promising results in the management of indent/hourglass deformity of PD.

Results

The findings of this review of the literature demonstrate that ETG is a safe and effective reconstructive technique for penile deformity with minimal side effects.

Clinical Implications

We recommend utilizing ETG with or without plication for PD patients with indent or hourglass deformities.

Strengths and Limitations

Strengths of ETG are the improvement in patients with tunical indents and hourglass deformities secondary to PD. Additionally, patients who underwent ETG maintained sexual function given no significant change in penile length and intact erectile function. Limitations, however, are that the procedure is relatively new, and data are limited to small cohorts.

Conclusion

The ETG procedure is a safe and effective for management of complex PD in the short- and intermediate-term follow-up cohort.
Exploring the puzzle of reactive oxygen species acting on root hair cells
Authors: Lopez Leonel E , Ibeas Miguel A , Diaz Dominguez Gabriela , Estevez Jose M
Published: June 2024

Reactive oxygen species (ROS) are essential signaling molecules that enable cells to respond rapidly to a range of stimuli. The ability of plants to recognize various stressors, incorporate a variety of environmental inputs, and initiate stress-response networks depends on ROS. Plants develop resilience and defensive systems as a result of these processes. Root hairs are central components of root biology since they increase the surface area of the root, anchor it in the soil, increase its ability to absorb water and nutrients, and foster interactions between microorganisms. In this review, we specifically focused on root hair cells and we highlighted the identification of ROS receptors, important new regulatory hubs that connect ROS production, transport, and signaling in the context of two hormonal pathways (auxin and ethylene) and under low temperature environmental input related to nutrients. As ROS play a crucial role in regulating cell elongation rates, root hairs are rapidly gaining traction as a very valuable single plant cell model for investigating ROS homeostasis and signaling. These promising findings might soon facilitate the development of plants and roots that are more resilient to environmental stressors.
The Tree Reconstruction Game: Phylogenetic Reconstruction Using Reinforcement Learning
Authors: Azouri Dana , Granit Oz , Alburquerque Michael , Mansour Yishay , Pupko Tal , Mayrose Itay
Published: June 2024

The computational search for the maximum-likelihood phylogenetic tree is an NP-hard problem. As such, current tree search algorithms might result in a tree that is the local optima, not the global one. Here, we introduce a paradigm shift for predicting the maximum-likelihood tree, by approximating long-term gains of likelihood rather than maximizing likelihood gain at each step of the search. Our proposed approach harnesses the power of reinforcement learning to learn an optimal search strategy, aiming at the global optimum of the search space. We show that when analyzing empirical data containing dozens of sequences, the log-likelihood improvement from the starting tree obtained by the reinforcement learning–based agent was 0.969 or higher compared to that achieved by current state-of-the-art techniques. Notably, this performance is attained without the need to perform costly likelihood optimizations apart from the training process, thus potentially allowing for an exponential increase in runtime. We exemplify this for data sets containing 15 sequences of length 18,000 bp and demonstrate that the reinforcement learning–based method is roughly three times faster than the state-of-the-art software. This study illustrates the potential of reinforcement learning in addressing the challenges of phylogenetic tree reconstruction.
Genomic and Phenotypic Adaptations ofRattus tanezumito Cold Limit Its Further Northward Expansion and Range Overlap withR. norvegicus
Authors: Zhang Ming-Yu , Cao Rui-Dong , Chen Yi , Ma Jian-Cang , Shi Cheng-Min , Zhang Yun-Feng , Zhang Jian-Xu , Zhang Yao-Hua
Published: June 2024

Global climate change has led to shifts in the distribution ranges of many terrestrial species, promoting their migration from lower altitudes or latitudes to higher ones. Meanwhile, successful invaders have developed genetic adaptations enabling the colonization of new environments. Over the past 40 years, Rattus tanezumi (RT) has expanded into northern China (Northwest and North China) from its southern origins. We studied the cold adaptation of RT and its potential for northward expansion by comparing it with sympatric Rattus norvegicus (RN), which is well adapted to cold regions. Through population genomic analysis, we revealed that the invading RT rats have split into three distinct populations: the North, Northwest, and Tibetan populations. The first two populations exhibited high genetic diversity, while the latter population showed remarkably low genetic diversity. These rats have developed various genetic adaptations to cold, arid, hypoxic, and high-UV conditions. Cold acclimation tests revealed divergent thermoregulation between RT and RN. Specifically, RT exhibited higher brown adipose tissue activity and metabolic rates than did RN. Transcriptome analysis highlighted changes in genes regulating triglyceride catabolic processes in RT, including Apoa1 and Apoa4, which were upregulated, under selection and associated with local adaptation. In contrast, RN showed changes in carbohydrate metabolism genes. Despite the cold adaptation of RT, we observed genotypic and phenotypic constraints that may limit its ability to cope with severe low temperatures farther north. Consequently, it is less likely that RT rats will invade and overlap with RN rats in farther northern regions.
Local vaginal bioelectrical impedance can predict preterm delivery in mice
Authors: Komatsu Reina , Nakamura Hitomi , Hosono Takayoshi , Masuda Tatsuo , Jones Carolyn J P , Aplin John D , Mimura Kazuya , Endo Masayuki , Kimura Tadashi
Published: June 2024

Preterm birth is a serious pregnancy complication that affects neonatal mortality, morbidity, and long-term neurological prognosis. Predicting spontaneous preterm delivery (PTD) is important for its management. While excluding the risk of PTD is important, identifying women at high risk of PTD is imperative for medical intervention. Currently used PTD prediction parameters in clinical practice have shown high negative predictive values, but low positive predictive values. We focused on sulfated and sialylated glycocalyx changes in the uterus and vagina prior to the onset of parturition and explored the potential of electrophysiological detection of these changes as a PTD prediction parameter with a high positive predictive value. In vivo local vaginal bioelectrical impedance (VZ) was measured using two different mouse PTD models. PTD was induced in ICR mice through the subcutaneous injection of mifepristone or local intrauterine injection of lipopolysaccharide (LPS). The PTD rates were 100% and 60% post-administration of mifepristone (16–20 h, n = 4) and LPS (12–24 h, n = 20), respectively. The local VZ values (15 and 10 h after mifepristone or LPS treatment, respectively) were significantly lower in the PTD group than in the non-PTD group. Receiver operator characteristic (ROC) curve analysis of VZ at 125 kHz as a predictor of PTD showed an area under the ROC curve of 1.00 and 0.77 and positive predictive values of 1.00 and 0.86, for the mifepristone and LPS models, respectively, suggesting that local VZ value can predict PTD. Histological examination of the LPS-treated model 6 h post-treatment revealed increased expression of sulfomucins and/or sulfated proteoglycans and sialomucins in the cervical epithelium, cervical stroma and vaginal stroma. In conclusion, local VZ values can determine sulfated and sialylated glycocalyx alterations within the uterus and vagina and might be a useful PTD prediction parameter.
Population dynamics of Ruditapes philippinarum (A. Adams & Reeve, 1850) after the major ecological crisis of 2018 of the Berre lagoon, southern France
Authors: Mahé Mathilde , Camus Louise , Marschal Christian , Grisel Raphaël , Poggiale Jean-Christophe , Mayot Nicolas
Published: June 2024

Coastal lagoons are environments with an important ecological richness, which makes them socio-economically highly important environments. However, they are often subject to anthropogenic pressures that may seriously threaten them. The phenomenon of anoxia is regularly the cause of massive mortality and loss of biodiversity. For example, in the Berre lagoon (France), in 2018, an anoxic crisis decimated the Zostera meadow and the stock of Manila clams, Ruditapes philippinarum (A. Adams & Reeve, 1850). As clams are a fished species, this massive mortality has resulted in a fishing cessation and thus is having a significant economic impact. This study is a contribution to our understanding of the resilience of species after a strong perturbation. In our case, we aim to understand the time needed for the stock of R. philippinarum to recover after the ecological crisis of 2018 by providing an analysis of the population dynamics between October 2018 and October 2020. The gonad development stage and condition index highlighted that clam size at sexual maturity was between 20 and 23 mm. The clam's reproduction season is continuous between March and October, with differences observed between sites, and between years at the same site in the Berre lagoon. Long-term field monitoring (in situ cages coupled with sclerochronology) was performed to estimate the growth rate and the mortality. von Bertalanffy growth function parameters show a high growth rate (K = 1.42 yr−1) with a small ${{L}_\infty }$ (35.70 mm). This means that clams need 1.5 yr to reach 30 mm in length: the minimum catch size for the fishery in the Berre lagoon. The mortality rate was 2.52 yr−1, which is possibly due to significant variations in water temperature and episodes of hypoxia and anoxia. These data on the population dynamics of R. philippinarum in the Berre lagoon show that the clam's recovery time can be relatively fast (some years) only if the environment becomes favourable and the anoxic conditions are absent.