bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence, Relevant Patient Factors, and Clinical Outcomes of the Misdiagnosis of ST‐Segment–Elevation Myocardial Infarction: Results From the Korea Acute Myocardial Infarction Registry
Authors: Cho Kyung Hoon , Shin Min‐Ho , Kim Min Chul , Sim Doo Sun , Hong Young Joon , Kim Ju Han , Ahn Youngkeun , Kim Hyo‐Soo , Hur Seung‐Ho , Lee Sang Rok , Hwang Jin‐Yong , Oh Seok Kyu , Cha Kwang Soo , Jeong Myung Ho ,   the Korea Acute Myocardial Infarction Registry (KAMIR) Investigators*
Published: June 2023

Background

Data on the incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of ST‐segment–elevation myocardial infarction (STEMI) in the modern era of percutaneous coronary intervention are limited.

Methods and Results

Data from KAMIR (Korea Acute Myocardial Infarction Registry) between November 2011 and June 2020 were analyzed. Out of 28 470 patients with acute myocardial infarction, 11 796 were eventually diagnosed with STEMI following a coronary angiogram. They were classified into 2 groups: patients with an initial working diagnosis of STEMI before starting the initial treatment and patients with an initial working diagnosis of non‐STEMI (misdiagnosed group). Out of 11 796 patients with a final diagnosis of STEMI, 165 (1.4%) were misdiagnosed. The door‐to‐angiography time in the misdiagnosed group was 5 times longer than that in the timely diagnosed group (median 220 [interquartile range {IQR}, 66–1177] versus 43 [IQR, 31–58] minutes;
P
<0.001). In a multivariable adjustments model, patients with a history of heart failure, atypical chest pain, anemia, or symptom‐to‐door time ≥4 hours had significantly higher odds, whereas those with systolic blood pressure <100 mm Hg or anterior ST elevation or left bundle‐branch block on ECG had lower odds of STEMI misdiagnosis. For patients with culprit lesions in the left anterior descending artery (n=5838), the adjusted 1‐year mortality risk for STEMI misdiagnosis was 1.84 (95% CI, 1.01–3.38).

Conclusions

Misdiagnosis of STEMI is not rare and is associated with a significant delay in coronary angiography, resulting in increased 1‐year mortality for patients with culprit lesions in the left anterior descending artery.
Supervised Text Classification System Detects Fontan Patients in Electronic Records With Higher Accuracy Than
ICD
Codes
Authors: Guo Yuting , Al‐Garadi Mohammed A. , Book Wendy M. , Ivey Lindsey C. , Rodriguez Fred H. , Raskind‐Hood Cheryl L. , Robichaux Chad , Sarker Abeed
Published: June 2023

Background

The Fontan operation is associated with significant morbidity and premature mortality. Fontan cases cannot always be identified by
International Classification of Diseases
(
ICD
) codes, making it challenging to create large Fontan patient cohorts. We sought to develop natural language processing–based machine learning models to automatically detect Fontan cases from free texts in electronic health records, and compare their performances with
ICD
code–based classification.

Methods and Results

We included free‐text notes of 10 935 manually validated patients, 778 (7.1%) Fontan and 10 157 (92.9%) non‐Fontan, from 2 health care systems. Using 80% of the patient data, we trained and optimized multiple machine learning models, support vector machines and 2 versions of RoBERTa (a robustly optimized transformer‐based model for language understanding), for automatically identifying Fontan cases based on notes. For RoBERTa, we implemented a novel sliding window strategy to overcome its length limit. We evaluated the machine learning models and
ICD
code–based classification on 20% of the held‐out patient data using the
F
1
score metric. The
ICD
classification model, support vector machine, and RoBERTa achieved
F
1
scores of 0.81 (95% CI, 0.79–0.83), 0.95 (95% CI, 0.92–0.97), and 0.89 (95% CI, 0.88–0.85) for the positive (Fontan) class, respectively. Support vector machines obtained the best performance (
P
<0.05), and both natural language processing models outperformed
ICD
code–based classification (
P
<0.05). The sliding window strategy improved performance over the base model (
P
<0.05) but did not outperform support vector machines.
ICD
code–based classification produced more false positives.

Conclusions

Natural language processing models can automatically detect Fontan patients based on clinical notes with higher accuracy than
ICD
codes, and the former demonstrated the possibility of further improvement.
Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia: The Randomized RAIN‐FLOW Study
Authors: Gomez‐Lara Josep , Gracida Montserrat , Rivero Fernando , Gutiérrez‐Barrios Alejandro , Muntané‐Carol Guillem , Romaguera Rafael , Fuentes Lara , Marcano Ana , Roura Gerard , Ferreiro José Luis , Teruel Luis , Brugaletta Salvatore , Alfonso Fernando , Comín‐Colet Josep , Gomez‐Hospital Joan‐Antoni
Published: June 2023

Background

ST‐segment–elevation myocardial infarction complicated with no reflow after primary percutaneous coronary intervention is associated with adverse outcomes. Although several hyperemic drugs have been shown to improve the Thrombolysis in Myocardial Infarction flow, optimal treatment of no reflow remains unsettled. Saline infusion at 20 mL/min via a dedicated microcatheter causes (flow‐mediated) hyperemia. The objective is to compare the efficacy of pharmacologic versus flow‐mediated hyperemia in patients with ST‐segment–elevation myocardial infarction complicated with no reflow.

Methods and Results

In the RAIN‐FLOW (Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia) study, 67 patients with ST‐segment–elevation myocardial infarction and no reflow were randomized to receive either pharmacologic‐mediated hyperemia with intracoronary adenosine or nitroprusside (n=30) versus flow‐mediated hyperemia (n=37). The angiographic corrected Thrombolysis in Myocardial Infarction frame count and the minimal microcirculatory resistance, as assessed with intracoronary pressure‐thermistor wire, dedicated microcatheter, and thermodilution techniques, were compared after study interventions. Both Thrombolysis in Myocardial Infarction frame count(40.2±23.1 versus 39.2±20.7;
P
=0.858) and minimal microcirculatory resistance (753.6±661.5 versus 993.3±740.8 Wood units;
P
=0.174) were similar between groups. Thrombolysis in Myocardial Infarction 3 flow was observed in 26.7% versus 27.0% (
P
=0.899). Flow‐mediated hyperemia showed 2 different thermodilution patterns during saline infusion indicative of the severity of the no reflow phenomenon. In‐hospital death and nonfatal heart failure were observed in 10.4% and 26.9%, respectively.

Conclusions

Both treatments showed similar (and limited) efficacy restoring coronary flow. Flow‐mediated hyperemia with thermodilution pattern assessment allowed the simultaneous characterization of the no reflow degree and response to hyperemia. No reflow was associated with a high rate of adverse outcomes. Further research is warranted to prevent and to treat no reflow in patients with ST‐segment–elevation myocardial infarction.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04685941.
The PD Reflects Selection of Nontarget Locations, Not Distractor Suppression
Authors: Kerzel Dirk , Huynh Cong Stanislas
Published: June 2023

In visual search tasks, negative features provide information about stimuli that can be excluded from search. It has been shown that these negative features help participants to locate the target, possibly by attentional suppression of stimuli sharing the negative feature. Attentional suppression is assumed to be reflected in an event-related potential, the PD component. To provide a further test of these assumptions, we presented the color of the distractor at the start of a trial and asked participants to find the other colored stimulus in the subsequent search display. Consistent with attentional suppression, we observed a PD to a lateral distractor shown with a vertical target. However, the PD occurred in this condition only when target and distractor could also be on opposite sides of fixation. The effect of trial context on the PD suggests that the PD reflects a search strategy whereby participants select stimuli opposite to the distractor when trials with opposite placements occur during the experiment. Therefore, the PD to the distractor may in fact be an N2pc to the opposite stimulus, indicating that the distractor is not suppressed, but avoided by redirecting attentional selection to the opposite side.
Understanding What in Public Understanding of Science
Authors: Montuschi Eleonora , Bedessem Baptiste
Published: June 2023

What should citizens understand about science to participate in democratic life? Against the prevailing approach, we argue that “what” a public understanding of science is about strongly depends on the specific epistemological nature of the science related issues considered in different contexts and circumstances. We identify three specific categories of such issues and show how, equally, specific models of public understanding are required to address them. Only by endorsing such an alternative approach will citizens arguably be able to form sound opinions about those very issues, as well as to discuss and deliberate rationally about them.
Reality as Persistence and Resistance
Authors: Khalili Mahdi
Published: June 2023

This paper proposes a way to understand the meaning of reality (in science) on the basis of the concepts of persistence and resistance. It first supports the ontological view that reality consists of persistent potentialities, which resist being excluded from existence. A study of the cases of the Higgs boson and the hypothetical Ϝ-particle helps to illustrate how real entities persist and resist. The paper then suggests that, perceptually speaking, the results of ordinary perception or observational processes persistently appear under appropriate conditions, and they resist disappearance even when the appropriate conditions are not completely prepared. Finally, it argues that, epistemologically speaking, a truthful theory resists being falsified and persists across replicable observations and experiments.
Real Virtuality and Actual Transitions: Historical Reflections on Virtual Entities before Quantum Field Theory
Authors: Blum Alexander S. , Jähnert Martin
Published: June 2023

This paper studies the notion of virtuality in the Bohr-Kramers-Slater theory of 1924. We situate the virtual entities of BKS within the tradition of the correspondence principle and the radiation theory of the Bohr model. We show how, in this context, virtual oscillators emerged as classical substitute radiators and were used to describe the otherwise elusive quantum transitions. They played an effective role in the quantum theory of radiation while remaining categorically distinct and ontologically separated from the quantum world of the Bohr model. The notion of virtuality thus differs markedly from its counterpart in quantum mechanics or QFT.
Visual Writing Prompts: Character-Grounded Story Generation with Curated Image Sequences
Authors: Hong Xudong , Sayeed Asad , Mehra Khushboo , Demberg Vera , Schiele Bernt
Published: June 2023

Current work on image-based story generation suffers from the fact that the existing image sequence collections do not have coherent plots behind them. We improve visual story generation by producing a new image-grounded dataset, Visual Writing Prompts (VWP). VWP contains almost 2K selected sequences of movie shots, each including 5-10 images. The image sequences are aligned with a total of 12K stories which were collected via crowdsourcing given the image sequences and a set of grounded characters from the corresponding image sequence. Our new image sequence collection and filtering process has allowed us to obtain stories that are more coherent, diverse, and visually grounded compared to previous work. We also propose a character-based story generation model driven by coherence as a strong baseline. Evaluations show that our generated stories are more coherent, visually grounded, and diverse than stories generated with the current state-of-the-art model. Our code, image features, annotations and collected stories are available at https://vwprompt.github.io/.
The Aramaic Inscription from a Cave Complex at Abraham’s House, Mount of Olives and the Hasmonean Calendar—A New Reading and Interpretation
Authors: Morgenstern Matthew , Ariel Chanan
Published: June 2023

This article presents a new reading and interpretation of the Aramaic burial inscription from the “Abraham’s House” complex. Rather than representing a curse, we propose that the inscription records the year in which the loculus was completed. Moreover, we suggested that year 99 is counted not from Hyrcanus’ death but rather from the time of his accession to high public office, either as king or as high priest. The use of a continuous numbering system extending back to a foundation date rather than the regnal years of an individual ruler is paralleled by the Seleucid calendar, and also echoes traditions found in Hebrew and Greek sources that such a system was current amongst the Hasmoneans. The identity of Hyrcanus and the implications for the dating of the inscription are also discussed.
The Plea of Necessity in Cyber Emergencies
Authors: Lahmann Henning
Published: June 2023

Although an increasing number of states has explicitly acknowledged the plea of necessity as a circumstance precluding wrongfulness to be applicable in situations of cyber emergencies, important doctrinal questions remain underexposed in both official expressions of opinio juris and in the literature. The article closes this gap by giving an account of three of the most salient issues in the context of the necessity defence: the “only way” requirement, the condition of non-contribution, and assistance by unaffected states to defensive measures taken in emergencies. It concludes that while recently growing academic criticism of the prevailing strict understanding of the “only way” criterion might be less relevant in the cyber context, states should consider more explicitly how emerging norms obliging states to observe a certain standard of cyber hygiene in regard to domestic cyber infrastructures could influence legal assessments as to a possible contribution to a situation of cyber emergency, potentially precluding the necessity defence. Finally, long-running doctrinal debates surrounding the exact legal nature of the defence within the larger context of the customary rules on state responsibility are revisited to examine whether third states could be permitted to come to the help of imperilled states even if the defence does not apply to them individually.
Cosmic Reality as Human Reality
Authors: van Haeften Chris
Published: June 2023

Directly after his first article for Philosophia Reformata (Dooyeweerd 1936a), Dooyeweerd published a long article in two installments about cosmic time. The first was entitled “Het tijdsprobleem en zijn antinomieën op het immanentiestandpunt i” (Dooyeweerd 1936b); its translation, entitled “The Problem of Time and Its Antinomies on the Immanence Standpoint,” was later published in Dooyeweerd (2017). This first installment lays out the basis of Dooyeweerd’s idea of transcendental time and can be regarded as a complete article in itself. According to Dooyeweerd (1953–1958, 1:28), the idea of cosmic time constitutes the basis of his theory of reality. In this article, we will take a close look at the significance of cosmic time in Dooyeweerd’s conception.
New Perspectives on the East Africa Campaign of the Second World War
Authors: Kleynhans Evert , van der Waag Ian
Published: June 2023

The East Africa campaign of the Second World War – although the first Allied victory of this conflict – has been largely forgotten by scholars and popular historians. The causes are multi-factored and due mainly, perhaps, to the concurrent and interrelated military operations that occurred in North Africa, the Soviet Union, Greece, and Crete between 1940 and 1941 – operations that had first call on Allied resources, and drew popular attention then as they continue to do now. The East African campaign is as a result one of the war’s forgotten campaigns, despite significant military engagements, the unique military operating environment, the allure of iconic personalities, and the rich human stories associated with it. The historiography remains fragmented with a focus on individual, national histories of the contributions made by the British, Italian, Indian and South African forces, for instance. This special issue, as a counterpoint, brings together a variety of articles covering a range of heretofore neglected topics. Most of the participants in the campaign are addressed in one form or another and in ways that address historical lacunae and complement this literature.
Sixth-Grade Students as Sustainable Town Designers
Authors: English Lyn D.
Published: June 2023

This article reports on a 6th-grade society-centred design activity, where students designed a new sustainable town with the goal of at least 50% renewable energy sources. The activity addressed both learning about and learning through design, together with designing for new directions. Through a case study methodology, students’ learning about design was apparent in their iterative processes of problem scoping, idea generation and modification, balancing of benefits and trade-offs, and reflections on and improvements of design features. Disciplinary content knowledge and applications emerged as students worked with renewable energy data and community needs, applied spatial reasoning in positioning town features, and considered budgetary constraints in reaching their “best” design. Students’ responses to how they applied mathematics and science included using the grid coordinates in their planning, meeting given constraints and conditions, coordinating the various town features, using properties of renewable energy sources, and taking into account the nature of the landscape. Reference to empathy and aesthetics were included in the students’ responses. Their design critiques revealed how they could identify positive and negative aspects of their own and their peers’ designs.
A review of Asian species of the genus Platymetopus (Coleoptera: Carabidae: Harpalini)
Authors: KATAEV BORIS M.
Published: June 2023

Based on the examined material and literature data, the Asian fauna of the genus Platymetopus Dejean, 1829 includes four species endemic to the Oriental region and East Asia, and one subspecies of the Afrotropical P. figuratus Boheman, 1848 (P. f. pictus Andrewes, 1923) distributed both in Afrotropical East Africa and South Asia east to India and Sri Lanka. The endemic Asian species are: P. flavilabris (Fabricius, 1798), P. tritus Bates, 1889, P. rugosus (Nietner, 1857) and P. quadrimaculatus Dejean, 1829. Platymetopus flavilabris is treated as a polytypical species with four subspecies: P. f. flavilabris, P. f. thumbergi Quensel, 1806, P. f. laticeps Dejean, 1829, stat. n. and P. f. punctulatus (MacLeay, 1825). The distinctive characters, synonymy and distribution of all taxa are discussed. Platymetopus rugosus obscurofemoratus subsp. n. is described from Vietnam, Thailand and Cambodia. The following synonymy is proposed: P. flavilabris flavilabris = P. keiseri Louwerens, 1956, syn. n.; and P. f. punctulatus = P. subrugosus Schauberger, 1938, syn. n. A key to all species and subspecies of the genus known from Asia is provided. The taxonomic position of Platymetopus is discussed which probably represents a lateral branch descending from Selenophori-like ancestor independently of Harpali genus group.
A new genus and species of Scirtothrips genus-group (Thysanoptera, Thripidae), with two new species of Scirtothrips, from Dipterocarp Forest canopy in Malaysia
Authors: NG Y.F. , AIN N. , RAFTI N.S. , LAU K.H.
Published: June 2023

A new genus and three new species are described from the canopy of Dipterocarp forest in Pasoh Forest Research in Malaysia: Daunothrips gen. n., D. striatus sp. n., Scirtothrips convexum sp. n. and Scirtothrips longifacies sp. n. The morphological characters of these new members of the Scirtothrips genus-group are discussed and illustrated.
Wind and Heat Forcings of the Seasonal and Interannual Sea Level Variabilities in the Southwest Pacific
Authors: Yang Lina , Zhao Xinyang , Liang Peng , Zhang Tianyu , Xie Lingling , Murtugudde Raghu
Published: June 2023

Sea level variabilities in the southwest Pacific contribute to the variations of equatorial current bifurcation and the Indonesian Throughflow transport. These processes are closely related to the recharge/discharge of equatorial heat content and dynamic distribution of anthropogenic ocean heating over the Indo-Pacific basin, thus being of profound significance for climate variability and change. Here we identify the major features of seasonal and interannual sea level variabilities in this region, confirming the dominance of the first baroclinic mode in the tropics (contributing 60%–80% of the variances) and higher baroclinic modes in the extratropics (40%–60% of the seasonal variance). Seasonally, except in the western Coral Sea where the Ekman pumping is significant, the wind-driven first-mode baroclinic Rossby waves originating to the east of the date line control the sea level variations over most tropical Pacific regions. In the domain where the 1.5-layer reduced gravity model becomes deficient, the surface heat fluxes dominate, explaining ∼40%–80% of sea level variance. For interannual variability, ∼40%–60% of the variance are El Niño–Southern Oscillation (ENSO) related. The wind-driven Rossby and Kelvin waves east of the date line explain ∼40%–78% of the interannual variance in the tropical Pacific. Outside the tropics, small-scale diffusive processes are presumed critical for interannual variability according to a thermodynamic analysis using an eddy-permitting ocean model simulation. Further process and predictive understandings can be achieved with the coupled climate models properly parameterizing the subgrid-scale processes.
Inferior Epigastric Artery Pseudoaneurysm Following Laparoscopic Appendectomy
Authors: Faulkner Justin , Beeson Seth , Fox Sarah , Yon James , Hope William
Published: June 2023

An inferior epigastric artery pseudoaneurysm is an exceptionally rare occurrence. Formation of an inferior epigastric artery pseudoaneurysm can be seen following surgical intervention and is more common after laparoscopy. A sixty-eight-year-old male presented with a right upper quadrant bulge at his incision site two months following laparoscopic appendectomy. The patient reported sudden onset of a non-reducible bulge at a 5 mm trocar incision site with minimal pain and without obstructive symptoms. Computed tomography of his abdomen and pelvis with intravenous contrast revealed a 4.2 cm pseudoaneurysm with peripheral thrombosis within the right inferior epigastric artery. The patient subsequently underwent open exploration with the evacuation of pseudoaneurysm thrombus and ligation of arteriovenous fistula. The patient recovered well without complication from pseudoaneurysm. Inferior epigastric artery pseudoaneurysm following any laparoscopic procedure is rare. This case highlights the importance of understanding the abdominal wall anatomy and its vascular supply to avoid such injury. We present this case to bring light to this rare occurrence and to highlight the importance of proper trocar placement during any laparoscopic procedure.
The Fragile Male: An Experimental Study of Transgender Classification and the Durability of Gender Categories
Authors: Khanna Katharine , Meadow Tey
Published: June 2023

Is maleness as durable a social classification as femaleness? Theories of gender suggest that men’s dominance in the gender hierarchy affords them greater privileges than women, whereas theories of status predict that men would be subject to greater scrutiny precisely because they occupy a higher-status position. We interrogate the nature of gender categories themselves by examining which theories hold in the context of gender nonconformity. Using a nationally representative survey experiment, we examine how a child’s sex assigned at birth affects their likelihood of being reclassified as transgender for engaging in gender-nonconforming behavior. We find that people are more likely to reclassify boys exhibiting feminine behavior into an alternative identity category (transgender) than girls exhibiting analogous masculine behavior. Thus, membership in the “male” category is more fragile than in the “female” category. These findings suggest that gender nonconformity is itself a gendered process, and that the durability of membership in a social category depends on the status of that social identity. This study provides the first causal evidence of the effect of gender nonconformity on perceptions of both transgender and homosexual identity.
Evaluation of Sugammadex Dosing for Neurological Examination in the Emergency Department
Authors: Hile Garrett B. , Ostinowsky Morgan E. , Sandusky Nicholas P. , Howington Gavin T.
Published: June 2023

Background: Prolong effects of non-depolarizing neuromuscular blocking agents after rapid sequence intubation may prevent meaningful neurological examination, delaying appropriate diagnosis and neurosurgical intervention. Sugammadex is indicated for the reversal of neuromuscular blockade induced by rocuronium. Objective: The objective of this study was to evaluate low- (2 mg/kg) vs standard-dose (4 mg/kg) sugammadex for rocuronium-induced deep neuromuscular blockade reversal in the emergency department (ED) by achieving a post-treatment train-of-four (TOF) of 4 to facilitate neurological examination. Methods: This was a single-center, retrospective, cohort study evaluating low-vs standard-dose sugammadex for neuromuscular blockade reversal in the ED. Results: 34 patients were identified within the designated time period, 24 of which were included in the final analysis ([n = 9 low-dose], [n = 15 standard-dose]). Median sugammadex doses were 2.3 mg/kg and 4.1 mg/kg for low- and standard-dose, respectively. The majority of patients presented for intraparenchymal hemorrhage (54.2%). No significant difference in success rate of NMBA reversal was found between low- and standard-dose sugammadex ([100.0% vs 93.3%], P = 1.000). A total of 9 patients had a neurosurgical procedure performed after sugammadex administration. Low-dose sugammadex was associated with significantly less acquisition cost compared to the standard dose ( P < .001). Conclusion: Low- (2 mg/kg) and standard-dose (4 mg/kg) sugammadex successfully reversed rocuronium-induced deep neuromuscular blockade in the ED by achieving a post-treatment TOF of 4 to facilitate neurologic examination. Low-dose sugammadex may be a viable option for deep NMBA reversal in the ED and is associated with decreased institutional cost.
Ubiquitous Luciferase Expression in “Firefly Rats” Does Not Alter the Pancreatic Islet Morphology, Metabolism, and Function
Authors: Gonzalez Nelson , Kato Hiroyuki , Tixi Wilma , Ortiz Jose , Orr Chris , Shih Hung-Ping , Ku Hsun Teresa , Yee Jiing-Kuan , Kandeel Fouad , Mullen Yoko , Kobayashi Eiji , Komatsu Hirotake
Published: June 2023

“Firefly rats” ubiquitously express the luciferase reporter gene under the control of constitutively active ROSA26 promoter in inbred Lewis rats. Due to the minimal immunogenicity of luciferase, wide applications of Firefly rats have been reported in solid organ/cell transplantation studies for in vivo imaging, permitting quantitative and non-invasive tracking of the transplanted graft. ROSA26 is a non-coding gene and generally does not affect the expression of other endogenous genes. However, the effect of ubiquitous luciferase expression on islet morphology and function has not been thoroughly investigated, which is critical for the use of Firefly rats as islet donors in islet transplantation studies. Accordingly, in vivo glucose homeostasis (i.e., islet function in the native pancreas) was compared between age-matched luciferase-expressing Firefly rats and non-luciferase-expressing rats. In vivo assessments demonstrated no statistical difference between these rats in non-fasting blood glucose levels, intraperitoneal glucose tolerance tests, and glucose-stimulated serum C-peptide levels. Furthermore, islets were isolated from both rats to compare the morphology, function, and metabolism in vitro. Isolated islets from both rats exhibited similar in vitro characteristics in post-isolation islet yield, islet size, beta cell populations, insulin content per islet, oxygen consumption rate, and glucose-stimulated insulin secretion. In conclusion, ubiquitous luciferase expression in Firefly rats does not affect their islet morphology, metabolism, and function; this finding is critical and enables the use of isolated islets from Firefly rats for the dual assessment of islet graft function and bioluminescence imaging of islet grafts.
Do High-Deductible Health Plans Incentivize Changing the Timing of Substance Use Disorder Treatment?
Authors: Hollander Mara A. G. , Kennedy-Hendricks Alene , Schilling Cameron , Meiselbach Mark K. , Stuart Elizabeth A. , Huskamp Haiden A. , Busch Alisa B. , Eddelbuettel Julia C. P. , Barry Colleen L. , Eisenberg Matthew D.
Published: June 2023

A high-deductible health plan (HDHP) may incentivize enrollees to limit health care use at the beginning of a plan year, when they are responsible for 100% of costs, or to increase the use of care at the end of the year, when enrollees may have less cost exposure. We investigated both the impact of the deductible reset that occurs at the beginning of a plan year and the option to enroll in an HDHP on the use of substance use disorder (SUD) treatment services over the course of a health plan year. We found decreases in SUD treatment use following the increase in cost exposure related to a deductible reset. There was no variation in this behavior between HDHP offer enrollees and comparison enrollees who were not offered an HDHP. These findings reinforce that cost-sharing poses a barrier to SUD care and continuity of care, which can increase the risk of adverse clinical outcomes.
Unilateral solitary choroidal tuberculoma as the presenting sign in disseminated tuberculosis in an immunocompetent patient
Authors: Kumar Madhu , Jain Hiteshi , Simakurthy Sriram , Kanakamedala Ashok , Gudimetla Jayamadhury , I M Sumanth
Published: June 2023

Introduction

Tuberculosis can involve any organ in the body including ocular tissue of which the uveal tissue is most commonly infected. Choroidal involvement ranges from choroidal tubercles to granulomas. This is one of the few cases of a solitary choroidal granuloma with no other systemic symptoms in an immunocompetent child.

Method

A case report.

Results

A 12-year-old female, presented with diminution of vision in the left eye for a month. The anterior segment of her left eye was normal. A fundus examination revealed an isolated orangish-yellow choroidal mass, 4 DD in size, involving the posterior pole with overlying subretinal exudation. CT scan of the thorax showed large pulmonary, cervical and pancreatic lymph nodes, along with lytic lesions of the thoracic vertebrae. Excision biopsy of the cervical lymph nodes showed caseating granulomas with no e/o malignancies on histopathology. The patient was started on anti-tubercular therapy. Six months after the treatment, the lesion had reduced in size and her vision had improved.

Conclusion

Isolated choroidal tuberculomas can be present in eyes with little associated ocular inflammation and no other symptoms of systemic tuberculosis. High suspicion, early diagnosis and rapid initiation of medication are important for the treatment of ocular and systemic tuberculosis.
A comparison of the effects of pulsatile and bolus flushing methods on lipid emulsion residues that lead to bacterial growth in intravenous catheters
Authors: Okamura Naoya , Yamaoka Ippei
Published: June 2023

Introduction:

The aim of this study was to compare the efficacies of pulsatile and bolus flushing methods for removing residual parenteral nutrients in common shapes of central venous (CV) and peripheral venous (PV) catheters.

Methods:

Straight or looped tubes filled with parenteral nutrients containing indocyanine green (ICG) were flushed with 10 mL of saline at various speeds with several pulsatile intervals. Pseudomonas aeruginosa engineered with a luciferase gene was inoculated in the flushed CV catheters. The imaging technique detected the ICG remaining and the bacterial growth in the flushed catheters.

Results:

In the CV catheter, the residue was greater with pulsatile flushing with longer intervals than with bolus flushing at a relatively high flushing speed. In the PV catheter, the flushing speed with any pulsatile intervals did not affect the residue. A looped catheter showed less residue than the straight catheter regardless of the flushing condition. Bacterial growth occurred in the nutrient residue in the flushed tubes.

Conclusion:

Speed of flushing and the shape of catheters, but not pulsatile flow generation, are essential components for the efficacious removal of parenteral nutrients in the catheter. Moreover, the slight differences in remaining nutrients inside the catheter affected subsequent bacterial growth.
Use of the MynxGrip vascular closure device in patients undergoing interventional diagnosis or treatment: The PANDA multicenter, open-label, randomized controlled trial
Authors: Song Ligang , Zhao Jichun , Xiong Fei , Yang Bin , Huang Hao , Zhao Boxiang , Wang Hua , Miao Zhongrong
Published: June 2023

Background:

MynxGrip is a non-suture, balloon catheter- and extravascular sealant-based vascular closure device designed to help hemostasis after an arterial puncture. This study evaluated the efficacy and safety of MynxGrip versus manual compression for femoral artery access closure in patients undergoing diagnostic or interventional procedures.

Methods:

The PANDA multicenter, parallel-group, open-label, randomized controlled trial enrolled patients undergoing a diagnostic or interventional procedure through femoral artery access between April 2019 and September 2020 at six centers in China. The participants were randomized 2:1 to the MynxGrip group and the manual compression group. Time to hemostasis and incidence of severe complications were the primary efficacy and safety endpoints, respectively.

Results:

A total of 304 consecutive participants were included. The baseline characteristics were similarly distributed in the MynxGrip ( n = 203) versus manual compression ( n = 101) groups. Compared with the manual compression group, the median time to hemostasis and time to ambulation were significantly shorter (3.0 (interquartile range: 2.0, 4.0) vs 18.0 (11.0, 22.0) min, and 479.0 (275.0, 932.0) vs 1410.3 (1121.0, 1476.0) min, respectively; both p = 0.0001) in the MynxGrip group, with similar procedural success rate, and without severe complications in either group. The incidence of device-related adverse events was 11.8% in the MynxGrip group, most possibly or definitely unrelated.

Conclusions:

Compared with manual compression, the MynxGrip vascular closure device significantly shortens the times to hemostasis and ambulation without severe complications after diagnostic or interventional procedures through the femoral artery access.
A basic income for every crisis? Building blocks of a political economy framework
Authors: Chrisp Joe , De Wispelaere Jurgen
Published: June 2023

In the wake of several recent crises, universal basic income has emerged as a serious policy solution. Not only is basic income pitched as a tool to mitigate the effects of a diverse set of emergencies, it has been argued that successive crises have importantly contributed to the surge in media and policy interest in basic income. In this article we critically examine this proposition. We first argue against the inherent functionalism of many accounts and instead propose a political economy framework that ties basic income directly to a series of mechanisms that may explain the opening up of basic income policy windows during recent crises, including the Covid-19 pandemic. It is equally important to carefully distinguish between different types of crises and we argue that two key competing types – cyclical and permanent crises – face a distinctive set of political economy constraints. We illustrate our approach by analysing the prospects of basic income in six distinct crisis events.
Maximum versoria criterion applied to hybrid active noise control algorithm for the impulsive noise
Authors: Zhang Rui , Cheng Yabing , Chen Shuming
Published: June 2023

In the conventional hybrid active noise control (CHANC) algorithm, the filtered-x least mean square (FXLMS) algorithm is used in both feedforward and feedback structures. However, the FXLMS algorithm does not process the reference signal and the error signal before updating the weight vector, which leads to the inadequate robustness of the CHANC algorithm in the impulsive noise environment. To solve this problem, the maximum versoria criterion is incorporated into the HANC (MVC-HANC) algorithm in this paper. Firstly, the MVC-HANC algorithm employs a novel nonlinear function to compress the error signal. Secondly, the proposed algorithm uses the modified sigmoid function to constrain the reference signal. To further improve the noise attenuation performance, the MVC-HANC algorithm uses a novel exponential function to adjust the step-size adaptively. Simulation and experiment results demonstrate that the proposed algorithm has the better attenuation performance than the conventional HANC algorithm.
Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients?
Authors: Overgaard Katrine S , Andersen Thomas R , Mohamed Roda A , Heinsen Laurits J , Binderup Helle G , Möller Sören , Auscher Søren , Lambrechtsen Jess , Egstrup Kenneth
Published: June 2023

We investigated whether prediabetes diagnosed by hemoglobinA1c (HbA1c) or oral glucose tolerance test (OGTT) could predict presence and severity of coronary artery disease (CAD) in symptomatic patients. The presence of plaque, stenosis, plaque characteristics, and coronary artery calcium (CAC) were evaluated by coronary CT angiography in 702 patients with suspicion of CAD. Patients were classified by glycemic status using the American Diabetes Association criteria for HbA1c and OGTT, and compared to their respective normal ranges. Prediabetes was observed in 24% by HbA1c and 72% by OGTT. Both prediabetes classifications were associated with increased presence of plaque, stenosis, calcified plaques, CAC >400, and a lower frequency of zero CAC compared to their respective normal range (all, p < 0.05). After adjusting for potential confounders, patients with HbA1c-prediabetes had an odds ratio of 2.1 (95% CI: 1.3–3.5) for CAC >400 and 1.5 (95% CI: 1.0–2.4) for plaque presence, while none of the associations for OGTT-prediabetes were significant. The receiver operating characteristic-curve for HbA1c-prediabetes showed an area under the curve of 0.81 for CAC >400 and 0.77 for plaque presence. Prediabetes defined by HbA1c predicts presence and severity of CAD. Although OGTT identified more patients with prediabetes, their risk of CAD were not explained by prediabetes using these diagnostic-criteria.
COVID-19 Infection Outcomes and Physical Activity Intensity in a Sample of College Students
Authors: Lepp Andrew , Smith-Ricketts Jessica , Barkley Jacob E.
Published: June 2023

Given the ongoing COVID-19 pandemic, it is important to identify lifestyle factors associated with infection outcomes. Physical activity is a lifestyle factor which measurably decreased during the pandemic. Purpose: To examine the relationship between physical activity and COVID-19 infection outcomes. Method: College students owning an iPhone with the Health app calculated their average daily steps for the 6-month period immediately before the pandemic and 2 years later. At the second time point, students provided levels of mild, moderate, and vigorous physical activity, hours/week of weightlifting, whether they had ever tested positive for COVID-19, and if so, the infection outcome. Results: Objectively measured pre-pandemic steps were significantly and positively correlated with steps 2 years later ( P ≤ .001) as well as weightlifting, and mild and vigorous physical activity ( P ≤ .033) suggesting that present physical activity participation may be returning to pre-pandemic levels. There were no differences between those who tested positive for COVID-19 and those who did not for any physical activity variable ( P ≥ .275). However, among those infected, outcomes were negatively associated with weightlifting ( P = .026) and vigorous physical activity ( P = .055) suggesting that greater participation in these activities was associated with less severe outcomes.
Effects of Different Loading Types on the Validity and Magnitude of Force-Velocity Relationship Parameters
Authors: Jankovic Goran , Janicijevic Danica , Nedeljkovic Aleksandar , Petrovic Milos R. , Cosic Marko , Garcia-Ramos Amador
Published: June 2023

Background:

Force-velocity ( F-V) relationship models gained popularity as a tool for muscle mechanical assessment. However, it is not clear whether the validity of the F-V relationship parameters (maximal theoretical force [ F0], velocity [ V0] and power [ Pmax]) is affected using different load types: gravitational ( W, rubber bands pulling the barbell downward), inertial ( I, rubber bands pulling the barbell, which is equalized to the weight of the added plates upward), and combined ( W + I, weight of the plates).

Hypothesis:

Load type would affect both the magnitude and validity of F-V relationship parameters. The highest magnitude and validity was expected for F0 using a W, for V0 using an I, and for Pmax using a W + I load.

Study Design:

Cross-sectional.

Level of Evidence:

Level 3.

Methods:

A total of 13 resistance-trained men (body mass, 87.7 ± 11.2 kg and body height, 183.9 ± 6.4 cm) performed bench press (BP) throws (BPTs) using 3 types of loads against 30 to 80 kg. The validity of F-V relationship parameters was explored with respect to the tests used traditionally for force (maximal voluntary contraction and 1-repetition maximum [1RM]), velocity (maximal velocity achieved during almost unloaded tasks), and power (BPT against the 50%1RM and medicine ball throws) assessment.

Results:

The W + I loading promoted the highest values of F0 and Pmax, while the highest magnitude of V0 was promoted by the I loading. The validity was acceptable for F0 obtained using the 3 loading conditions with respect to the BP 1RM ( r range, 0.30-0.83), and V0 obtained using the I loading with respect to the stick throw ( r = 0.54).

Conclusion:

The magnitude of the F-V relationship parameters is affected by load type, but their validity with respect to standardized tests is comparable, with the exception of the higher validity of V0 when obtained using the I loading.

Clinical Relevance:

Any load type can be used for assessing F0, while I load should be selected when assessing V0.
Participation of trade unions in corporate codetermination: Legitimisation, economic impacts and legal protection
Authors: Stöhr Alexander
Published: June 2023

Corporate codetermination is one of the most controversial parts of labour law. This applies, in particular, to the participation of trade unions, which is notably permitted in Germany and Sweden. This article examines the legitimisation and economic impacts of union participation. Special attention will be given to the recent decision of the ECJ concerning the legal protection of trade union involvement in the course of a transformation into a European company (SE). The general aim of this article is to bring the various interests into appropriate balance.
Drivers of Rural Entrepreneurship in Northern Ghana: A Community Capitals Framework Approach
Authors: Asitik Akanganngang Joseph
Published: June 2023

This article critically examines the entrepreneurial potentials of rural northern Ghana within the Community Capitals Framework context to establish which capitals are drivers and barriers to rural entrepreneurship development in the study area. The study adopts a qualitative research approach (n = 58) to examine the community capitals within three case study districts and communities. Focus groups and semi-structured interviews were conducted, gathering two different data at the district and community levels, using the Trans-TMM model to obtain reliable data through translation at the community level. The findings reveal that the cultural, social and political capitals and aspects of the research communities’ human capital offer significant entrepreneurial potential. However, in contrast, the scarcity of financial capital and low quality of the human capital in the communities poses a considerable challenge to significant entrepreneurial development and sustainability and therefore required attention. The article provides insight into entrepreneurship resources in rural northern Ghana for the government and organisations perceiving entrepreneurship as a development model towards poverty reduction, recognises the barriers, and addresses such deficiencies to guarantee the chances of success of such a programme.
Accumulation of arsenic and other metals in soil and human consumable foods of Meherpur district, southwestern Bangladesh, and associated health risk assessment
Authors: Rahman Md. Shazzadur , Reza A. H. M. Selim , Siddique Md. Abu Bakar , Akbor Md. Ahedul , Hasan Mehedi
Published: June 2023

Groundwater and soil contaminated with arsenic (As) are significant environmental health concerns worldwide and have become a serious health issue for millions of Bangladeshis. This contaminated groundwater is commonly used for Boro rice production during the dry season in Bangladesh, leading to long-term As deposition in soils. The consequences of long-term irrigation with As-contaminated groundwater for bioaccumulation in food crops and hence dietary exposure to As and other metals are a threat to the resident. Highly arsenic (292 µg L−1) contaminated groundwater used to irrigate in the study area increases the As content (mean: 24.5 mg kg−1) in irrigated soil than non-irrigated soil (mean: 8.43 mg kg−1). The high enrichment factor (mean: 16.8) and geo-accumulation index (mean: 2.33) revealed that the soil of that particular area is strongly contaminated by As. In paddy, roots showed the maximum As concentration (mean: 139.8 mg kg−1) followed by straws (mean: 5.25 mg kg−1) and grains (mean: 1.23 mg kg−1) where 85–95% As exist in the roots of paddy, and only 0.8–1% As translocate to the harvesting part of the rice in the study area. In food samples, two rice grains (R-1, R-3) and a drumstick (FS-5) exceed the Indian standard of As concentration (As: 1.1 mg kg−1) in food. According to World Health Organization, the metals concentrations in all food samples exceeded the permissible limit except for Cu and Pb in red amaranth; Cr, Cd, and Pb in guava; and Cu and Cd in drumsticks. Higher values of bioaccumulation factor (BAF: 2.94) and the net translocation coefficient (NTC: 6.17) indicate As-accumulation in food from adjacent contaminated soil. Daily metal intake from food consumption suggests that the heavy metal(loid)s like As, Ni, and Pb represent high concentrations and exceed the daily ingestion limits (As: 3 µg kg−1 day−1, Ni: 1.3 µg kg−1 day−1, and Pb: 3.57 µg kg−1 day−1) developed by the Food and Agriculture Organization and European Food Safety Authority. Carcinogenic (> 10–6) and non-carcinogenic (HQ > 1) health risks of As, Pb, Cd, and Cu suggest that the community was at potential health risk according to the United States Environmental Protection Agency.