bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Imaging of Blood Coagulation Within the Hematoma of Patients With Acute Hemorrhagic Stroke
Authors: Haque Muhammad E. , Boren Seth B. , Mills James , Schneider Kerry G. , Parekh Maria , Fraser Stuart M. , Bach Ivo , Hariharan Praveen , Zelnick Pamela J. , Guerra Castanon Felix S. , Naveed Asim , Tariq Muhammad , Arevalo Octavio D. , Hasan Khader M. , Escobar Miguel , Zhao Xiurong , Sitton Clark , Narayana Ponnada A. , Grotta James C. , Aronowski Jaroslaw , Savitz Sean I.
Published: January 2024

BACKGROUND:

The dynamics of blood clot (combination of Hb [hemoglobin], fibrin, and a higher concentration of aggregated red blood cells) formation within the hematoma of an intracerebral hemorrhage is not well understood. A quantitative neuroimaging method of localized coagulated blood volume/distribution within the hematoma might improve clinical decision-making.

METHODS:

The deoxyhemoglobin of aggregated red blood cells within extravasated blood exhibits a higher magnetic susceptibility due to unpaired heme iron electrons. We propose that coagulated blood, with higher aggregated red blood cell content, will exhibit (1) a higher positive susceptibility than noncoagulated blood and (2) increase in fibrin polymerization–restricted localized diffusion, which can be measured noninvasively using quantitative susceptibility mapping and diffusion tensor imaging. In this serial magnetic resonance imaging study, we enrolled 24 patients with acute intracerebral hemorrhage between October 2021 to May 2022 at a stroke center. Patients were 30 to 70 years of age and had a hematoma volume >15 cm
3
and National Institutes of Health Stroke Scale score >1. The patients underwent imaging 3×: within 12 to 24 (T1), 36 to 48 (T2), and 60 to 72 (T3) hours of last seen well on a 3T magnetic resonance imaging system. Three-dimensional anatomic, multigradient echo and 2-dimensional diffusion tensor images were obtained. Hematoma and edema volumes were calculated, and the distribution of coagulation was measured by dynamic changes in the susceptibilities and fractional anisotropy within the hematoma.

RESULTS:

Using a coagulated blood phantom, we demonstrated a linear relationship between the percentage coagulation and susceptibility (R
2
=0.91) with a positive red blood cell stain of the clot. The quantitative susceptibility maps showed a significant increase in hematoma susceptibility (T1, 0.29±0.04 parts per millions; T2, 0.36±0.04 parts per millions; T3, 0.45±0.04 parts per millions;
P
<0.0001). A concomitant increase in fractional anisotropy was also observed with time (T1, 0.40±0.02; T2, 0.45±0.02; T3, 0.47±0.02;
P
<0.05).

CONCLUSIONS:

This quantitative neuroimaging study of coagulation within the hematoma has the potential to improve patient management, such as safe resumption of anticoagulants, the need for reversal agents, the administration of alteplase to resolve the clot, and the need for surgery.
Legal Challenges in Prosecuting the Crime of Aggression in the Russo-Ukrainian War
Authors: Tsybulenko Evhen , Rinta-Pollari Henna
Published: January 2024

The Russian invasion of Ukraine has opened a debate over how to ensure accountability for the supreme international crime, namely the crime of aggression. Prosecuting the crime of aggression related to Russia’s attack on Ukraine is hampered by the fact that neither country, Russia nor Ukraine, are Member States of the Rome Statute, which established the International Criminal Court (icc) and transferred the crime to its jurisdiction. As a result, this article will examine how and in what ways the crime of aggression may be prosecuted in the context of the Russo-Ukrainian war, with a particular emphasis on prosecuting the crime through the icc, domestic courts, or by establishing an ad hoc tribunal.

Based on an analysis of the legal aspects of prosecuting the crime of aggression, the article suggests that currently, the most appropriate approach to prosecuting the crime in the context of the Russo-Ukrainian war is to establish an international ad hoc tribunal, either through a treaty signed by the United Nations and Ukraine on the basis of a referral from the United Nations General Assembly and the United Nations Secretary-General or a multilateral treaty between Ukraine and other states supported by the United Nations.
Between Dialogue, Conflict, and Competition: The Limits of Responsive Judicial Review in the Case of the Romanian Constitutional Court
Authors: Suteu Silvia
Published: January 2024

A response to Rosalind Dixon’s Responsive Judicial Review (Oxford University Press 2023) assessing her theory’s prospects and caveats in the Romanian constitutional context. The piece analyses recent case law from the Romanian Constitutional Court and highlights three important shortcomings that limit the applicability of Dixon’s framework: the tendency toward formalism in constitutional interpretation, an impoverished rights review culture, and the persistent conflictual positioning of the Constitutional Court vis-à-vis other constitutional actors. The article ends by speculating on developments that may yet render responsive judicial review more of a reality in Romanian constitutionalism than present conditions may allow.
Explaining Sectarian Dynamics in the Syrian Governorate of Deir Ezzor Through the Lens of Instrumentalism and Historical Sociology
Authors: Dukhan Haian , Hassan Mohammed
Published: January 2024

This paper traces the rise of sectarianism in the Syrian governorate of Deir Ezzor from the 1970s up to the current civil war. To this end, this research will focus on answering two main questions: “what factors made sectarianism prevalent in Deir Ezzor after 2003?” and “how did attempts by the Syrian regime, Iran, and Islamists to use sectarianism to mobilize people, lead to the catastrophe in Deir Ezzor during the Syrian civil war?” The primordial framework that considers sectarianism to be a consequence of age-old religious differences between Sunni and Shiʿite Muslims is rejected in this paper. This paper shows that a better understanding of sectarianism can be found through a synthesis of instrumentalism and historical sociology. The historical sociology framework provides an understanding of how adverse socioeconomic conditions and security threats in Deir Ezzor led to the rise of sectarianism, whilst instrumentalism explains how the regime, Iran, and the Islamists used sectarian identities to retain control over the population of Deir Ezzor.
Delosperma buysii (Aizoaceae subfam. Ruschioideae), a new purple-white-flowered vygie species from north-central South Africa
Authors: SMITH GIDEON F. , HANKEY ANDREW
Published: January 2024

Thus far, six species of Delosperma (Aizoaceae subfam. Ruschioideae) have been recorded from the Gauteng province in north-central South Africa, an essentially summer-rainfall region. Of these, two are purple-flowered, one is purple-white-flowered, while the other species are white- or yellow-flowered. We here describe a further purple-white-flowered species from northwestern Gauteng and adjacent North West province as D. buysii. The new species is contrasted with D. macellum, the only other purple-white-flowered species known from Gauteng. Among other differences, D. buysii has a smaller, more compact growth form in comparison to the larger-growing, often trailing D. macellum, while the sepals of D. buysii are equal in length while those of D. macellum are of two lengths.
Intrathermocline Eddy with Lens-Shaped Low Potential Vorticity and Diabatic Forcing Mechanism in the South China Sea
Authors: Liu Yuyi , Jing Zhiyou
Published: January 2024

Intrathermocline eddies (ITEs), characterized by subsurface lens-shaped low potential vorticity (PV), are pervasive in the ocean. However, the abundance and generation mechanisms of these low-PV lenses are poorly understood owing to their weak surface signals and awkward sizes, which present an observational barrier. Using in situ observations of the northern South China Sea (NSCS), a typical ITE with a lens-shaped low PV at a core depth of 30–150 m and a horizontal size of ∼150 km was captured in May 2021. Combined with PV budget analysis, we investigate the underlying generation mechanism of low PVs within these ITEs using high-resolution reanalysis products. The results suggest that wintertime surface buoyancy loss driven by atmospheric diabatic forcing rather than frictional forcing is a crucial favorable condition for the ITE formation. These enhanced surface buoyancy losses produce a net upward PV flux and decrease PV in the weakly stratified and deep winter mixed layer, which are preconditioned by anticyclonic eddies (AEs). While surface heating in the following spring tends to weaken the surface buoyancy loss and gradually causes a downward PV flux, the surface-injected high PV subsequently caps the low-PV water within the surface-intensified AEs and transforms them into ITEs. Approximately 22% of the 58 AEs detected by satellite altimetry in the NSCS are ITEs. More importantly, the lens-shaped low PVs within them are produced primarily by the enhanced surface buoyancy loss during wintertime. These findings provide a new dynamic explanation for the low-PV generation in ITEs, highlighting the crucial role of atmospheric diabatic forcing.

Significance Statement

Intrathermocline eddies (ITEs), characterized by a lens-like isopycnal structure that bounds low potential vorticity (PV), are active in the oceanic interior. Although a few previous studies revealed the existence of ITEs in the South China Sea, the source and dynamic generation mechanisms of the lens-shaped low PV still remain elusive. We find that the enhanced surface buoyancy loss due to atmospheric diabatic forcing drives an upward surface PV flux and is identified to produce the low PV. The preexisting anticyclonic eddy, combined with seasonal surface heating in spring, can be easily transformed into the ITE. This study provides a new dynamic understanding for the generation mechanism of ITEs’ low PVs and highlights the contribution of atmospheric diabatic forcing.
“Liturgy and Ecumenism, Contexts and Challenges”: A Glance from the African Context
Authors: Uzukwu Elochukwu
Published: January 2024

Ecumenical activities in East and West Africa, though modest, represent significant strides for Christianity in the continent of Africa. The narrative in this article, deliberately tilted toward African agency, is an attempt to capture aspects of the story. It begins with the ecumenical liturgical performance of Catholic Kongo-Angola slaves soliciting Holy Communion from Anglican divines, in South Carolina, early in the eighteenth century. Its impact in the overall understanding of ecumenism from the African context is underlined. Next, the article shifts to eastern and western Africa, where a divisive colonial Christian agenda was propagated, and, at the same time, contained, thanks to the initiative of African leadership, guided by the Holy Spirit. Further samples of the Holy Spirit guiding the community to Christian unity are drawn from the witness of the Ugandan martyrs. The article also refers to the liturgical melding of Christian denominations in the Charismatic and Pentecostal patterns of worship as an important statement on liturgical ecumenism.
Three-dimensional modeling of moisture transport in wood using near-infrared hyperspectral imaging and X-ray computed tomography in conjunction with finite element analysis
Authors: Zeng Wenpeng , Fujimoto Takaaki , Inagaki Tetsuya , Tsuchikawa Satoru , Ma Te
Published: January 2024

In past studies, finite element analysis (FEA) methods have been used to simulate the thermal and moisture coupling of wood. However, challenges remain in achieving high-quality three-dimensional (3D) simulations, mainly because of the heterogeneous and complex structure of wood and its difficult-to-detect internal structure, which makes modeling challenging, in addition to the lack of robust experimental techniques to validate simulation results. In this study, the FEA simulation model was refined by combining X-ray computed tomography (CT) and near-infrared hyperspectral imaging (NIR-HSI). CT was used to probe the 3D density of wood, and a novel FEA tetrahedral mesh was constructed based on the results. The NIR-HSI method visualizes the moisture distribution during adsorption and desorption inside the wood. This result is then used to adjust the parameters of the FEA simulation model and as a reference value to evaluate the simulation results. The visualization and simulation results fit well with the theoretical properties. The simulation results can more accurately reflect the spatial distribution and transfer trend of wood moisture at different points in time. Therefore, the CT and NIR-HSI-based 3D heat and moisture-coupled FEA model of wood proposed in this study can be used as a basis for optimizing drying parameters to provide high-quality wood.
Migraine - a borderland disease to epilepsy: near it but not of it
Authors: Paungarttner Jakob , Quartana Martina , Patti Lucrezia , Sklenárová Barbora , Farham Fatemeh , Jiménez Inés Hernando , Soylu M. Gokcen , Vlad Irina Maria , Tasdelen Semih , Mateu Teresa , Marsico Oreste , Reina Federica , Tischler Viktoria , Lampl Christian ,   on behalf of the European Headache Federation School of Advanced Studies (EHF – SAS)
Published: January 2024

Background

Migraine and epilepsy are two paroxysmal chronic neurological disorders affecting a high number of individuals and being responsible for a high individual and socioeconomic burden. The link between these disorders has been of interest for decades and innovations concerning diagnosing and treatment enable new insights into their relationship.

Findings

Although appearing to be distinct at first glance, both diseases exhibit a noteworthy comorbidity, shared pathophysiological pathways, and significant overlaps in characteristics like clinical manifestation or prophylactic treatment. This review aims to explore the intricate relationship between these two conditions, shedding light on shared pathophysiological foundations, genetic interdependencies, common and distinct clinical features, clinically overlapping syndromes, and therapeutic similarities. There are several shared pathophysiological mechanisms, like CSD, the likely underlying cause of migraine aura, or neurotransmitters, mainly Glutamate and GABA, which represent important roles in triggering migraine attacks and seizures. The genetic interrelations between the two disorders can be observed by taking a closer look at the group of familial hemiplegic migraines, which are caused by mutations in genes like CACNA1A, ATP1A2, or SCN1A. The intricate relationship is further underlined by the high number of shared clinical features, which can be observed over the entire course of migraine attacks and epileptic seizures. While the variety of the clinical manifestation of an epileptic seizure is naturally higher than that of a migraine attack, a distinction can indeed be difficult in some cases, e.g. in occipital lobe epilepsy. Moreover, triggering factors like sleep deprivation or alcohol consumption play an important role in both diseases. In the period after the seizure or migraine attack, symptoms like speech difficulties, tiredness, and yawning occur. While the actual attack of the disease usually lasts for a limited time, research indicates that individuals suffering from migraine and/or epilepsy are highly affected in their daily life, especially regarding cognitive and social aspects, a burden that is even worsened using antiseizure medication. This medication allows us to reveal further connections, as certain antiepileptics are proven to have beneficial effects on the frequency and severity of migraine and have been used as a preventive drug for both diseases over many years.

Conclusion

Migraine and epilepsy show a high number of similarities in their mechanisms and clinical presentation. A deeper understanding of the intricate relationship will positively advance patient–oriented research and clinical work.
In vivo confocal microscopy evaluation of infiltrated immune cells in corneal stroma treated with cell therapy in advanced keratoconus
Authors: El Zarif Mona , Abdul Jawad Karim , Alió Jorge L. , Makdissy Nehman , De Miguel María P.
Published: January 2024

Purpose

This study investigates immune cell (ICs) infiltration in advanced keratoconus patients undergoing autologous adipose-derived adult stem cell (ADASC) therapy with recellularized human donor corneal laminas (CL).

Methods

A prospective clinical trial included fourteen patients divided into three groups: G-1, ADASCs; G-2, decellularized CL (dCL); and G-3, dCL recellularized with ADASCs (ADASCs-rCL). Infiltrated ICs were assessed using in vivo confocal microscopy (IVCM) at 1,3,6, and12 months post-transplant.

Results

Infiltrated ICs, encompassing granulocytes and agranulocytes, were observed across all groups, categorized by luminosity, structure, and area. Stromal ICs infiltration ranged from 1.19% to 6.62%, with a consistent increase in group-related cell density (F = 10.68, P < .0001), independent of post-op time (F = 0.77, P = 0.511); the most substantial variations were observed in G-3 at 6 and 12 months (2.0 and 1.87-fold, respectively). Similarly, significant size increases were more group-dependent (F = 5.76, P < .005) rather than time-dependent (F = 2.84, P < .05); G-3 exhibited significant increases at 6 and 12 months (3.70-fold and 2.52-fold, respectively). A lamina-induced shift in IC size occurred (F = 110.23, P < .0001), primarily with 50–100 μm2 sizes and up to larger cells > 300μm2, presumably macrophages, notably in G-3, indicating a potential role in tissue repair and remodeling, explaining reductions in cells remnants < 50μm2.

Conclusions

ADASCs-rCL therapy may lead to increased IC infiltration compared to ADASCs alone, impacting cell distribution and size due to the presence of the lamina. The findings reveal intricate immune patterns shaped by the corneal microenvironment and highlight the importance of understanding immune responses for the development of future therapeutic strategies.
Star allele search: a pharmacogenetic annotation database and user-friendly search tool of publicly available 1000 Genomes Project biospecimens
Authors: Gharani N. , Calendo G. , Kusic D. , Madzo J. , Scheinfeldt L.
Published: January 2024

Here we describe a new public pharmacogenetic (PGx) annotation database of a large (n = 3,202) and diverse biospecimen collection of 1000 Genomes Project cell lines and DNAs. The database is searchable with a user friendly, web-based tool (www.coriell.org/StarAllele/Search). This resource leverages existing whole genome sequencing data and PharmVar annotations to characterize *alleles for each biospecimen in the collection. This new tool is designed to facilitate in vitro functional characterization of *allele haplotypes and diplotypes as well as support clinical PGx assay development, validation, and implementation.
Prevalence of S. aureus and/or MRSA in hospitalized patients with diabetic foot and establishment of LAMP methods for rapid detection of the SCCmec gene
Authors: Qi Chunxia , Luo Xiangrong , Huang Jiali , Kong Danli , Zhang Yali , Zou Mengchen , Zhou Hao
Published: January 2024

Background

Patients with diabetic feet are prone to be infected due to the impaired immune system. However, the prognostic outcome of different microbial infections remains controversial. Identification and rapid screening of the pathogenic microorganisms that pose the greatest threat to the prognosis of patients with diabetic foot infections (DFIs) is critical.

Methods

Clinical data were statistically analyzed, which were obtained from 522 patients with DFIs, including pathogenic bacterial culture results and treatment outcomes at the last return visit. In addition, a loop-mediated isothermal amplification (LAMP) detection method was developed to identify the prevalent subtype of methicillin-resistant Staphylococcus aureus (MRSA) in DFIs patients. This study was approved by the Ethics Committee of Nanfang Hospital (NFEC-202012-K6) and registered on ClinicalTrials.gov (NCT04916457) on June 1, 2021.

Results

We found that the proportion of patients with infections of Staphylococcus aureus (S. aureus) and MRSA was 27.7% (145/522) and 33.7% (49/145), respectively. Additionally, the incidence of osteomyelitis was 46.9% (23/49) and amputation/disability was 40.8% (20/49) in patients with MRSA infection, which were significantly higher compared to patients with other types of bacterial infections such as methicillin-susceptible Staphylococcus aureus (MSSA). Notably, we demonstrated that the main prevalent subtype of MRSA in DFIs patients in our hospital was Staphylococcal chromosomal cassettes mec (SCCmec) type II. In addition, it only takes 1.5 h to complete the entire experimental procedure in this LAMP assay, providing high sensitivity (100%) and specificity (77.8%) in hospitalized patients with DFIs.

Conclusions

We demonstrated there is a very high rate of MRSA isolation in patients with DFIs and revealed that patients infected with MRSA are at a higher risk of developing osteomyelitis, and amputation or disability. Importantly, we have developed a method for quickly screening newly admitted patients for MRSA.
Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? – a 1-year prospective cohort study
Authors: Hellman-Bronstein Aino T. , Luukkaala Tiina H. , Ala-Nissilä Seija S. , Nuotio Maria S.
Published: January 2024

Background

Continence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up.

Methods

Study population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007–2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes.

Results

Of the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41–2.51) and DI (1.99, 95% CI 1.21–3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22–4.75) remained associated with the need for more assisted living arrangements.

Conclusions

Both pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.
Impact of social distancing from the COVID-19 pandemic on the immuno-inflammatory response of older adults
Authors: Nery Giulia Beletato , de Araujo Carlos Ariel Rodrigues , da Silva Giovanna Beatriz , Bittar Helena , Bordallo Valéria Pacheco , Amaral Jônatas B. , Hardt Markus , Marti Luciana , Birbrair Alexander , Jimenez Manuel , Bastos Marta Ferreira , Nali Luiz Henrique Silva , Longo Priscila Larcher , Laurentino Gilberto Candido , Bachi André L. L. , Heller Debora
Published: January 2024

Background

Older adults, as the population considered at increased risk for severe COVID-19, were the most impacted by social isolation. Thus, this study aimed to assess the salivary immune/inflammatory response of older adults before and during the COVID-19 pandemic.

Methods

A cohort of 11 older adults (mean age 66.8 ± 6.1) was followed at three different time points: before (S1) and after 6 (S2) and 20 months (S3) of the beginning of the COVID-19 pandemic in Brazil. Unstimulated saliva samples were obtained to assess the levels of antibodies (secretory IgA, IgG and IgM) by ELISA and cytokines (IL-2, IL-5, IL-6, IL-8 and IL-10, TSLP, IFN-γ, TNF-α) by multiplex analysis. Significant differences were evaluated using the Kruskal–Wallis test with Dunn's post-test.

Results

None volunteer presented periodontal disease or caries. All volunteers received at least two doses of the COVID-19 vaccines after S2 and before S3. A tendency to increase salivary levels of SIgA and IgM at S2 and of IgG at S3 were observed compared to the values found at S1 and S2. Significantly decreased levels of IL-2 and IL-5 were found at S2 and S3 (p < 0.001) time points. Lower levels of IFN-γ were found at S2 as compared to the values observed at S1 (p < 0.01). A significant decrease in the IFN-γ/IL-10 ratio was found at S2 (p < 0.01). When assessing the Th1/Th2 ratios, a significant decrease was found in the IFN-γ/TSLP ratio at S2 (p < 0.001) and S3 (p < 0.001) when compared to the values at S1. In addition, a significant increase was observed in the TNF-α/IL-5 ratio at S2 (p < 0.001) and S3 (p < 0.001) in comparison to the values at S1. In a similar way, an increase in the TNF-α/IL-6 ratio (Fig. 5E) was observed at S3 (p < 0.001) when compared to the values at S1.

Conclusions

Overall, this study provides valuable insights into the impact of COVID-19-induced social isolation on immune/inflammatory responses in the upper airway mucosa, particularly those present in oral cavity, of older adults. It demonstrates that a controlled shift in Th1 and Th2 immune responses, both during infection and post-vaccination, can create favorable conditions to combat viral infections without exacerbating the immune response or worsening the pathology.
Impact of frailty, biomarkers and basic biochemical parameters on outcomes of comatose patients in status epilepticus: a single-center prospective pilot study
Authors: Krejzar Zdenek , Sila David , Waldauf Petr , Kuriscak Eduard , Mokrejs Petr , Spatenkova Vera
Published: January 2024

Background

Status epilepticus (SE) is a severe acute condition in neurocritical care with high mortality. Searching for risk factors affecting the prognosis in SE remains a significant issue. The primary study’s aim was to test the predictive values of the Clinical Frailty Scale (CFS) and the Modified 11-item Frailty Index (mFI-11), the biomarkers and basic biochemical parameters collected at ICU on the Glasgow Outcome Scale (GOS) assessed at hospital discharge (hosp), and three months later (3 M), in comatose patients with SE. The secondary aim was to focus on the association between the patient’s state at admission and the duration of mechanical ventilation, the ICU, and hospital stay.

Methods

In two years single-centre prospective pilot study enrolling 30 adult neurocritical care patients with SE classified as Convulsive SE, A.1 category according to the International League Against Epilepsy (ILAE) Task Force without an-/hypoxic encephalopathy, we evaluated predictive powers of CFS, mFI-11, admission Status Epilepticus Severity Score (STESS), serum protein S100, serum Troponin T and basic biochemical parameters on prognosticating GOS using univariate linear regression, logistic regression and Receiver Operating Characteristic (ROC) analysis.

Results

Our study included 60% males, with a mean age of 57 ± 16 years (44–68) and a mean BMI of 27 ± 5.6. We found CFS, mFI-11, STESS, and age statistically associated with GOS at hospital discharge and three months later. Among the biomarkers, serum troponin T level affected GOS hosp (p = 0.027). Serum C-reactive protein significance in prognosticating GOS was found by logistic regression (hosp p = 0.008; 3 M p = 0.004), and serum calcium by linear regression (hosp p = 0.028; 3 M p = 0.015). In relation to secondary outcomes, we found associations between the length of hospital stay and each of the following: age (p = 0.03), STESS (p = 0.009), and serum troponin T (p = 0.029) parameters.

Conclusions

This pilot study found promising predictive powers of two frailty scores, namely CFS and mFI-11, which were comparable to age and STESS predictors regarding the GOS at hospital discharge and three months later in ICU patients with SE. Among biomarkers and biochemical parameters, only serum troponin T level affected GOS at hospital discharge.
A case of bilateral amyloidosis localized to extraocular muscles mimicking thyroid eye disease
Authors: Yoshida-Hata Natsuyo , Mimura Masashi , Aikawa Miwa , Kashima Tomoyuki
Published: January 2024

Background

Amyloidosis is a rare condition characterized by the abnormal deposition of amyloid proteins in various tissues and organs. While systemic amyloidosis has been well-documented, amyloid deposition in extraocular muscles is an exceptionally rare occurrence, with only 35 reported cases. This case report sheds light on the importance of considering amyloidosis in the differential diagnosis of patients presenting with proptosis and diplopia, which are often associated with thyroid eye disease.

Case presentation

A woman in her twenties sought medical attention due to a complaint of diplopia. Her ocular examination revealed almost normal findings except for exotropia and proptosis. Orbital magnetic resonance imaging displayed fusiform enlargement of nearly all eye muscles, a presentation typically observed in thyroid eye disease. However, despite corticosteroid therapy, her symptoms showed no improvement. Given the unusual lack of response to conventional treatment, and inhomogeneous enhancement of the muscle, an extraocular muscle biopsy was conducted. This biopsy yielded a unique finding—amyloid deposition within the muscle tissue. This discovery was particularly intriguing due to the extreme rarity of amyloidosis affecting extraocular muscles, with fewer than three dozen documented cases worldwide.

Conclusion

This unique case underscores the critical need for a comprehensive approach to diagnosing patients with proptosis and diplopia. While these symptoms are commonly attributed to thyroid eye disease, it is essential to consider alternative diagnoses such as amyloidosis, especially when standard treatments fail to yield results. The discovery of amyloid deposition in the extraocular muscles, although exceedingly rare, emphasizes the significance of a thorough differential diagnosis. In conclusion, this case report highlights the importance of vigilance in clinical practice, encouraging ophthalmologists to explore less common diagnostic possibilities when faced with challenging cases. Further research and clinical investigation are warranted to better understand the mechanisms and potential treatments for amyloidosis affecting the extraocular muscles.
Can federal policy help overcome systemically reinforced racial inequities in social determinants of health? An observational study of Georgia and neighboring U.S. states
Authors: Napierala Eric , Rencher Bill , Solomon Lori , Parker Chris
Published: January 2024

Background

Despite increasing attention to racial inequities in social determinants of health and health outcomes, less attention has been focused on how structural barriers — embedded in programs and codified in laws — shape opportunities to achieve health.

Methods

To better understand how U.S. federal policies targets structural barriers to opportunity and health at the population level, we conducted a legal review to identify landmark pieces of federal policy that held potential to impact key social determinants of health. Then, using publicly available data for Georgia and five neighboring U.S. states (Alabama, Florida, North Carolina, South Carolina, and Tennessee), we conducted an observational case study to examine recent trends for access to health care, housing, and education because they were each associated with comprehensive federal legislation meant to alleviate inequities resulting from long-standing structural barriers and were each identified by Healthy People 2030 as key social determinants of health.

Results

From 2010 to 2021, population-level improvements were seen in health insurance rates, mortgage and rental burden, and educational attainment, with improvements seen for both Black and White populations in Georgia, regionally in the Southeast region, and nationally in the United States. However, seemingly meaningful gaps between the Black and White populations across social determinants of health have not been eliminated at any geographical level.

Conclusions

This analysis adds to a growing body of evidence that historically racialized social structures hamper Black populations’ opportunities to build wealth, gain a quality education, own a home in a neighborhood of opportunity, and access health care, compared to their White peers. Given that the root causes of health disparities and inequities lie at the intersection of health, health care, economics, education, and other social systems, a multisectoral approach to policy is needed to address these systemic issues. While federal laws do provide momentum for proximal benefits for social change, in modern federalism they alone are insufficient to address needed local system change and nonlegal policy interventions, implemented at the local programmatic level, may serve as complementary mechanism to address the lingering effects of barriers to equal opportunity.
The effectiveness of community-based interprofessional education for undergraduate medical and health promotion students
Authors: Suwanchatchai Chawin , Khuancharee Kitsarawut , Rattanamongkolgul Suthee , Kongsomboon Kittipong , Onwan Manasvin , Seeherunwong Anantapat , Chewparnich Pacharapa , Yoadsomsuay Piyanuch , Buppan Pattakorn , Taejarernwiriyakul Ormjai , Thummajitsakul Sirikul , Chaovipoch Pimonporn , Krainara Sunisa , Sanguankittiphan Pariyakorn , Kosuwin Rattiporn , Srimee Pakarang , Odglun Yuparat , Wongtongtair Supim
Published: January 2024

Background

Community-based interprofessional education (CBIPE) has been proven effective in enhancing the interprofessional competencies of medical and health professional students. However, there is a lack of evaluation on the impact of experiential CBIPE among undergraduate medical and health promotion students in Thailand. Therefore, the objective of this study is to assess the influence of CBIPE learning on the collaborative competencies of these students.

Methods

A one-group pre-posttest design in 193 (152 medical students and 41 health promotion) students were involved in the CBIPE program, later divided into 12 groups. Data was collected by direct observations of mentors using the Interprofessional Collaborative Competencies Attainment Survey (ICCAS). The Wilcoxon matched-pairs signed-rank test was conducted to evaluate the effectiveness of the CBIPE program.

Results

A total of 175 (90.67%) completed ICCAS and satisfaction questions before and after the CBIPE program. The mean age of respondents was 20.29 ± 1.63 years; 60.57% were women and 39.43% were men. The results showed a significant increase in collaborative competencies before and after the 2-week course. Gender-stratified analysis showed an improvement after CBIPE training for all subscales in women, while the communication, collaboration, conflict management, and functioning team skills segment score was significantly higher in the post-assessment among men.

Conclusion

The implementation of CBIPE learning was successful in enhancing collaborative competencies among both medical and health promotion students. These findings will provide valuable insights for the design and improvement of CBIPE learning programs in other universities.
Development of a generative deep learning model to improve epiretinal membrane detection in fundus photography
Authors: Choi Joon Yul , Ryu Ik Hee , Kim Jin Kuk , Lee In Sik , Yoo Tae Keun
Published: January 2024

Background

The epiretinal membrane (ERM) is a common retinal disorder characterized by abnormal fibrocellular tissue at the vitreomacular interface. Most patients with ERM are asymptomatic at early stages. Therefore, screening for ERM will become increasingly important. Despite the high prevalence of ERM, few deep learning studies have investigated ERM detection in the color fundus photography (CFP) domain. In this study, we built a generative model to enhance ERM detection performance in the CFP.

Methods

This deep learning study retrospectively collected 302 ERM and 1,250 healthy CFP data points from a healthcare center. The generative model using StyleGAN2 was trained using single-center data. EfficientNetB0 with StyleGAN2-based augmentation was validated using independent internal single-center data and external datasets. We randomly assigned healthcare center data to the development (80%) and internal validation (20%) datasets. Data from two publicly accessible sources were used as external validation datasets.

Results

StyleGAN2 facilitated realistic CFP synthesis with the characteristic cellophane reflex features of the ERM. The proposed method with StyleGAN2-based augmentation outperformed the typical transfer learning without a generative adversarial network. The proposed model achieved an area under the receiver operating characteristic (AUC) curve of 0.926 for internal validation. AUCs of 0.951 and 0.914 were obtained for the two external validation datasets. Compared with the deep learning model without augmentation, StyleGAN2-based augmentation improved the detection performance and contributed to the focus on the location of the ERM.

Conclusions

We proposed an ERM detection model by synthesizing realistic CFP images with the pathological features of ERM through generative deep learning. We believe that our deep learning framework will help achieve a more accurate detection of ERM in a limited data setting.
Theories used to develop or evaluate social prescribing in studies: a scoping review
Authors: Evers Sinah , Husk Kerryn , Napierala Hendrik , Wendt Lydia , Gerhardus Ansgar
Published: January 2024

Objective

This scoping review aims to provide an overview of how theories were used in the development or evaluation of social prescribing (SP) intervention studies.

Background

SP describes a patient pathway where general practitioners (GPs) connect patients with community activities through referrals to link workers. This review seeks to understand the explanations provided for the outcomes and implementation process of SP.

Inclusion criteria

Studies using a defined theory to develop or evaluate a specific SP intervention in primary care and the community sector.

Methods

This scoping review was conducted in accordance with JBI methodology. The following databases were searched on 8th of July 2022: PubMed, ASSIA, Cochrane, Cinahl, PsycINFO, Social Care Online, Sociological Abstracts, Scopus, and Web of Science. The search only considered English language texts. Additional literature was identified by searching relevant web pages and by contacting experts. The selection of sources and the data extraction was done by two reviewers independently.

Results

The search resulted in 4240 reports, of which 18 were included in the scoping review. Of these, 16 were conducted in the UK, one in Canada and one in Australia. The majority of reports employed a qualitative approach (11/18). Three were study protocols. 11 distinct theories were applied to explain outcomes (4 theories), differences in outcomes (3 theories), and the implementation of the intervention (4 theories). In terms of practical application, the identified theories were predominantly used to explain and understand qualitative findings. Only one theory was used to define variables for hypothesis testing. All theories were used for the evaluation and none for the development of SP.

Conclusion

The theories influenced which outcomes the evaluation assessed, which causal pathway was expected to generate these outcomes, and which methodological approaches were used. All three groups of theories that were identified focus on relevant aspects of SP: fostering positive patient/community outcomes, addressing inequalities by considering the context of someone’s individual circumstances, and successfully implementing SP by collaboratively working across professions and institutional boundaries. Additional insight is required regarding the optimal use of theories in practical applications.
Identifying the most at-risk age-group and longitudinal trends of drug allergy labeling amongst 7.3 million individuals in Hong Kong
Authors: Chiang Valerie , Kan Andy Ka Chun , Saha Chinmoy , Au Elaine Y. L. , Li Philip H.
Published: January 2024

Background

Incorrect drug ‘allergy’ labels remain a global public health concern. Identifying regional trends of drug allergy labeling can guide appropriate public health interventions, but longitudinal or population drug allergy studies remain scarce. We analysed the serial epidemiology of drug allergy labeling to identify specific subgroups at highest risk of drug allergy labeling for potential interventions.

Methods

Longitudinal, population-wide drug allergy labels and clinical data from over 7,337,778 individuals in Hong Kong between 2016 and 2021 were analysed.

Results

The absolute prevalence and incidence of documented drug allergy were 5.61% and 277/100,000 population, respectively. Annual incidence of new allergy labels was stable between 2016 and 2019, until a significant drop in 2020 (−16.3%) during the COVID19 pandemic. The most common allergy labels were anti-infectives (245,832 [44.5%]), non-steroidal anti-inflammatory (106,843 [19.3%]), and nervous system drugs (45,802 [8.3%]). The most common labeled culprits for the most severe immediate-type (anaphylaxis) and non-immediate-type (Stevens-Johnson syndrome) reactions were beta-lactams and nervous system drugs, respectively. For individuals at highest risk of labeling, there was significantly higher incidence of overall drug and beta-lactam allergy labeling amongst individuals aged > 40 years which contributed to the majority of newly labeled allergies (377,004, 68.2%).

Conclusions

Contrary to traditional dogma, we identified disproportionately higher incidence of drug allergy labeling amongst older individuals, rather than the paediatric age group. We advocate for more population-wide drug allergy studies to investigate this phenomenon in other cohorts as well as future preventative and delabeling efforts focusing on the adult population.
Production and secretion of recombinant spider silk in Bacillus megaterium
Authors: Connor Alexander , Zha R. Helen , Koffas Mattheos
Published: January 2024

Background

Silk proteins have emerged as versatile biomaterials with unique chemical and physical properties, making them appealing for various applications. Among them, spider silk, known for its exceptional mechanical strength, has attracted considerable attention. Recombinant production of spider silk represents the most promising route towards its scaled production; however, challenges persist within the upstream optimization of host organisms, including toxicity and low yields. The high cost of downstream cell lysis and protein purification is an additional barrier preventing the widespread production and use of spider silk proteins. Gram-positive bacteria represent an attractive, but underexplored, microbial chassis that may enable a reduction in the cost and difficulty of recombinant silk production through attributes that include, superior secretory capabilities, frequent GRAS status, and previously established use in industry.

Results

In this study, we explore the potential of gram-positive hosts by engineering the first production and secretion of recombinant spider silk in the Bacillus genus. Using an industrially relevant B. megaterium host, it was found that the Sec secretion pathway enables secretory production of silk, however, the choice of signal sequence plays a vital role in successful secretion. Attempts at increasing secreted titers revealed that multiple translation initiation sites in tandem do not significantly impact silk production levels, contrary to previous findings for other gram-positive hosts and recombinant proteins. Notwithstanding, targeted amino acid supplementation in minimal media was found to increase production by 135% relative to both rich media and unaltered minimal media, yielding secretory titers of approximately 100 mg/L in flask cultures.

Conclusion

It is hypothesized that the supplementation strategy addressed metabolic bottlenecks, specifically depletion of ATP and NADPH within the central metabolism, that were previously observed for an E. coli host producing the same recombinant silk construct. Furthermore, this study supports the hypothesis that secretion mitigates the toxicity of the produced silk protein on the host organism and enhances host performance in glucose-based minimal media. While promising, future research is warranted to understand metabolic changes more precisely in the Bacillus host system in response to silk production, optimize signal sequences and promoter strengths, investigate the mechanisms behind the effect of tandem translation initiation sites, and evaluate the performance of this system within a bioreactor.
The role of stigma in cannabis use disclosure: an exploratory study
Authors: King Daniel D. , Gill Christopher J. , Cadieux Carey S. , Singh Neha
Published: January 2024

Background

Although cannabis use incidence, societal acceptance, and legislation all trend positively, cannabis remains federally illegal in the USA. Prior studies have revealed that patients are reluctant to disclose their cannabis use history in the healthcare system, which can negatively impact patient care. This study reports the frequency of cannabis use disclosure with special considerations for stigmatization. To better understand the limitations, providers face in providing collaborative, comprehensive, and informed care, this study evaluated four domains of stigma: perceived, anticipated, enacted, and internalized.

Methods

This study used a descriptive exploratory design. Data collection occurred using an anonymous, online national survey with a convenience sample in the USA. Recruitment relied on electronic media and occurred between July and December 2022. Participants were adults older than 21 years and self-identified as having used cannabis and accessed the healthcare system within the last five years. The survey measured demographic characteristics, cannabis use, and disclosure patterns. Stigma was measured using the Stigma Use Stigma Mechanism Scale (SU-SMS) and Substance Abuse Use Self-Stigma Scale (SASSS) with language modifications for cannabis. Ordinal logistic regression models were performed to evaluate associations between the frequency of cannabis use disclosure patterns and each stigma category. Associations were assessed using Chi-squared or Fisher’s exact tests.

Results

Data were available for 249 respondents. Most participants (57.1%) reported initiating a conversation about cannabis with their healthcare provider; 27.8% of the time, cannabis is never discussed, and healthcare providers initiate only 15.1% of related discussions. Anticipated stigma [95% CI 1.045–1.164] and total stigma [95% CI 1.001–1.039] had statistically significant associations with nondisclosure. Annual household income (p = .04), chronicity of cannabis use (p = .03), frequency of cannabis use (p = .02), and a known amount of CBD in products consumed (p = .01) had statistically significant associations with the frequency of cannabis use disclosure.

Conclusions

Patients who use cannabis experience stigmatization in the healthcare setting that may limit disclosure of cannabis use history. Future studies would be well served to explore anticipated stigma more deeply. Healthcare providers should be knowledgeable to lead such conversations relating to cannabis while maintaining an unbiased perspective.