bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Workplace Discrimination Contribute to Sex Work for Trans and Nonbinary Workers?
Authors: Shircliff Jesse Ezra , Hutchinson Brook , Glass Christy , Suárez Mario , Miller Gabe H , Marquez-Velarde Guadalupe 
Published: December 2023

Abstract
Workplace discrimination contributes to economic precarity for trans individuals, and some evidence suggests that barriers to formal employment may contribute to engagement in sex work. This study examines whether particular types of workplace discrimination – including blocked access to jobs and termination due to trans status – represent a pathway into sex work for trans and nonbinary workers conditional upon social status, gender, and race. Our analysis relies on the 2015 U.S. Transgender Survey (USTS), where we stratify multiple logistic regression models for trans men, trans women, and nonbinary individuals and introduce an interaction term between workplace discrimination and race. We exploit two time horizons in the data for a lifetime analysis and a past-year analysis. We find strong support that trans women and nonbinary individuals are more likely to engage in sex work when they have experienced workplace discrimination compared to trans men. Predicted probabilities show that workplace discrimination amplifies the likelihood of sex work for most trans workers of color compared to those who are white. By contributing to the literature on “bad jobs” and anti-trans workplace bias from an intersectional approach, this study informs debates on anti-discrimination policies and practices that facilitate economic security for trans workers.
Spring wood phenology responds more strongly to chilling temperatures than bud phenology in European conifers
Authors: Lin Shaozhi , Wang Huanjiong , Dai Junhu , Ge Quansheng 
Published: December 2023

Abstract
A comparative assessment of bud and wood phenology could aid a better understanding of tree growth dynamics. However, the reason for asynchronism or synchronism in leaf and cambial phenology remains unclear. To test the assumption that the temporal relationship between the budburst date and the onset date of wood formation is due to their common or different responses to environmental factors, we constructed a wood phenology dataset from previous literature, and compared it with an existing bud phenology dataset in Europe. We selected three common conifers (Larix decidua Mill., Picea abies (L.) H. Karst. and Pinus sylvestris L.) in both datasets and analyzed 909 records of the onset of wood formation at 47 sites and 238,720 records of budburst date at 3051 sites. We quantified chilling accumulation (CA) and forcing requirement (FR) of budburst and onset of wood formation based on common measures of CA and FR. We then constructed negative exponential CA–FR curves for bud and wood phenology separately. The results showed that the median, variance and probability distribution of CA–FR curves varied significantly between bud and wood phenology for three conifers. The different FR under the same chilling condition caused asynchronous bud and wood phenology. Furthermore, the CA–FR curves manifested that wood phenology was more sensitive to chilling than bud phenology. Thus, the FR of the onset of wood formation increases more than that of budburst under the same warming scenarios, explaining the stronger earlier trends in the budburst date than the onset date of woody formation simulated by the process-based model. Our work not only provides a possible explanation for asynchronous bud and wood phenology from the perspective of organ-specific responses to chilling and forcing, but also develops a phenological model for predicting both bud and wood phenology with acceptable uncertainties.
Small‐molecule CEM3 strengthens single‐cell oscillators in the suprachiasmatic nucleus
Authors: van Beurden Anouk W. , Tersteeg Mayke M. H. , Michel Stephan , van Veldhoven Jaco P. D. , IJzerman Adriaan P. , Rohling Jos H. T. , Meijer Johanna H. 
Published: December 2023

AbstractA robust endogenous clock is required for proper function of many physiological processes. The suprachiasmatic nucleus (SCN) constitutes our central circadian clock and allows us to adapt to daily changes in the environment. Aging can cause a decline in the amplitude of circadian rhythms in SCN and peripheral clocks, which contributes to increased risk of several chronic diseases. Strengthening clock function would therefore be an effective strategy to improve health. A high‐throughput chemical screening has identified clock‐enhancing molecule 3 (CEM3) as small molecule that increases circadian rhythm amplitude in cell lines and SCN explants. It is, however, currently not known whether CEM3 acts by enhancing the amplitude of individual single‐cell oscillators or by enhancing synchrony among neurons. In view of CEM3's potential, it is of evident importance to clarify the mode of action of CEM3. Here, we investigated the effects of CEM3 on single‐cell PERIOD2::LUCIFERASE rhythms in mouse SCN explants. CEM3 increased the amplitude in approximately 80%–90% of the individual cells in the SCN without disrupting the phase and/or period of their rhythms. Noticeably, CEM3's effect on amplitude is independent of the cell's initial amplitude. These findings make CEM3 a potential therapeutic candidate to restore compromised amplitude in circadian rhythms and will boost the development of other molecular approaches to improve health.
Advances in the clinical use of patient-reported outcomes in thoracic surgery
Authors: Bou-Samra Patrick , Kneuertz Peter J. 
Published: December 2023

Purpose of review
Patient-reported outcomes (PROs) are increasingly recognized as a clinical tool for measuring and improving patient-centric care. This review provides a summary on recent advances in the use of PROs in the field of thoracic surgery.

Recent findings
PROs have been used as primary endpoints in clinical trials and observational studies evaluating clinical care pathways and quantifying the benefits of minimally invasive surgical techniques for patients undergoing lung surgery. Qualitative and quantitative research has yielded fundamental insights into which PRO domains are meaningful and valued by patients after lung surgery. Patient experience and recovery after esophagectomy have been further characterized by using PROs. New disease-specific survey tools for patients have been developed to track long-term symptoms after esophageal reconstruction. Patient satisfaction has emerged as the key metric used to gauge the patient centeredness of hospital systems.

Summary
Advances have been made in the application of PROs in multiple areas of thoracic surgery, which include lung and esophageal surgery. The growing focus on the use of PROs in clinical pathways has led to a better understanding on how to optimize patient experience.
Update on guidelines and recommendations for enhanced recovery after thoracic surgery
Authors: Cohen Joshua B. , Smith Brad B. , Teeter Emily G. 
Published: December 2023

Purpose of review
Enhanced recovery after thoracic surgery (ERATS) has continued its growth in popularity over the past few years, and evidence for its utility is catching up to other specialties. This review will present and examine some of that accumulated evidence since guidelines sponsored by the Enhanced Recovery after Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) were first published in 2019.

Recent findings
The ERAS/ESTS guidelines published in 2019 have not been updated, but new studies have been done and new data has been published regarding some of the individual components of the guidelines as they relate to thoracic and lung resection surgery. While there is still not a consensus on many of these issues, the volume of available evidence is becoming more robust, some of which will be incorporated into this review.

Summary
The continued accumulation of data and evidence for the benefits of enhanced recovery techniques in thoracic and lung resection surgery will provide the thoracic anesthesiologist with guidance on how to best care for these patients before, during, and after surgery. The data from these studies will also help to elucidate which components of ERAS protocols are the most beneficial, and which components perhaps do not provide as much benefit as previously thought.
Modern fluid management in thoracic surgery
Authors: Batchelor Timothy J.P. 
Published: December 2023

Purpose of review
To provide an approach to perioperative fluid management for lung resection patients that incorporates the entire patient pathway in the context of international guidelines on enhanced recovery after surgery (ERAS).

Recent findings
The concern with intraoperative fluid management is that giving too little or too much fluid is associated with worse outcomes after lung resection. However, it has not emerged as a key care element in thoracic ERAS programs probably due to the influence of other ERAS elements. Carbohydrate loading 2 h before surgery and the allowance of water until just prior to induction ensures the patient is both well hydrated and metabolically normal when they enter the operating room. Consequently, maintaining a euvolemic state during anesthesia can be achieved without goal-directed fluid therapy despite the recommendations of some guidelines. Intravenous fluids can be safely stopped in the immediate postoperative period.

Summary
The goal of perioperative euvolemia can be achieved with the ongoing evolution and application of ERAS principles. A focus on the pre and postoperative phases of fluid management and a pragmatic approach to intraoperative fluid management negates the need for goal-directed fluid therapy in most cases.
Innovative designs for trials informing the care of cardiac surgical patients: part I
Authors: Anusic Nikola , Sessler Daniel I. 
Published: December 2023

Purpose of review
Randomized clinical trials, now commonplace and regarded as top-tier evidence, are actually a recent development. The first randomized trial took place in 1948, just six decades ago. As anticipated from a relatively young field, rapid progress continues in response to an ever-increasing number of medical questions that demand answers. We examine evolving methodologies in cardiac anesthesia clinical trials, focusing on the transition towards larger sample sizes, increasing use of pragmatic trial designs, and the innovative adoption of real-time automated enrollment and randomization. We highlight how these changes enhance the reliability and feasibility of clinical trials.

Recent findings
Recent understanding in clinical trial methodology acknowledges the importance of large sample sizes, which increase the reliability of findings. As illustrated by P value fragility, small trials can mislead despite statistical significance. Pragmatic trials have gained prominence, offering real-world insights into the effectiveness of various treatments. Additionally, the use of real-time automated enrollment and randomization, particularly in situations where obtaining prior consent is impractical, is an important methodological advance.

Summary
The landscape of cardiac anesthesia clinical trials is rapidly evolving, with a clear trend towards large sample sizes and innovative approaches to enrollment. Recent developments enhance the quality and applicability of research findings, thus providing robust guidance to clinicians.
A decade-long analysis of gender, race, and ethnic representation of incoming cardiothoracic anesthesiology fellows
Authors: Sesi Jenna M. , Mansour Meghan R. , Soto Roy G. 
Published: December 2023

Purpose of review
This study calls attention to the necessity for increasing representation of minority groups among cardiothoracic fellowship programs.

Recent findings
Demographics in medicine are changing, with more women and varying ethnicities contributing to the physician pool. Despite this change, diversity among cardiothoracic anesthesia fellows has not mirrored this trend.

Summary
In November of 2022, medical student, anesthesia resident and cardiothoracic fellow demographics were analyzed from 2011 to 2021 to assess the changes in program diversity. Although male and female individuals have relatively similar representation in medical schools, female individuals only represent 34.8% of total US anesthesia residents. Cardiothoracic anesthesia fellowship programs continue to be male-sex dominant and white racial representation has consistently made up a majority of the total trainees. Increasing diversity amongst healthcare providers increases the likelihood of providing culturally competent care, thereby decreasing the healthcare gap in minority communities.
Blood-brain Barrier Permeability May Influence Vasopressor Effects in Anesthetized Patients With Brain Tumor: An Analysis of Magnetic Resonance Imaging Data
Authors: Rasmussen Mads , Koch Klaus U. , Espelund Ulrick S. , Mohamad Niwar , Korshøj Anders R. , Juul Niels , Angleys Hugo , Meng Lingzhong , Østergaard Leif , Mikkelsen Irene K. 
Published: December 2023

Objective:
This is a secondary analysis of data from a previous study of anesthetized brain tumor patients receiving ephedrine or phenylephrine infusions. 18 patients with magnetic imaging verified tumor contrast enhancement were included. We hypothesized that vasopressors induce microcirculatory flow changes, characterized by increased capillary transit time heterogeneity (CTH) and decreased mean transit time (MTT), in brain regions exhibiting BBB leakage.

Methods:
This is a secondary analysis of data from a previous study of anesthetized brain tumor patients receiving ephedrine or phenylephrine infusions. 18 patients with magnetic imaging verified tumor contrast enhancement were included. Postvasopressor to prevasopressor ratios of CTH, MTT, relative transit time heterogeneity (RTH), cerebral blood flow (CBF), cerebral blood volume, and oxygen extraction fraction (OEF) were calculated in tumor, peritumoral, hippocampal, and contralateral grey matter regions. Comparisons were made between brain regions and vasopressors.

Results:
During phenylephrine infusion, ratios of CTH, RTH, and CBF were greater, and ratios of MTT and OEF were lower, in the tumor region with contrast leakage compared with corresponding contralateral grey matter ratios. During ephedrine infusion, ratios of CTH, MTT, RTH, CBF, and cerebral blood volume were higher in the tumor region with leakage compared with contralateral grey matter ratios. In addition, the ratio of CBF was higher in all regions, the ratio of RTH was lower in the leaking tumor region, and the ratio of OEF was lower in peritumoral, hippocampal, and grey matter regions with ephedrine compared with phenylephrine.

Conclusions:
Vasopressors can induce distinct microcirculatory flow alterations in regions with compromised brain tumor barrier or BBB. Ephedrine, a combined α and β-adrenergic agonist, appears to result in fewer flow alterations and less impact on tissue oxygenation compared with phenylephrine, a pure α-adrenergic agonist.
Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions
Authors: Bauer Melissa E. , Fuller Matt , Kovacheva Vesela , Elkhateb Rania , Azar Kristen , Caldwell Morgan , Chiem Vanna , Foster Mindy , Gibbs Ronald , Hughes Brenna L. , Johnson Rebecca , Kottukapally Nobin , Rosenstein Melissa G. , Cortes Magdalena Sanz , Shields Laurence E. , Sudat Sylvia , Sutton Caitlin D. , Toledo Paloma , Traylor Austin , Wharton Kurt , Main Elliott 
Published: December 2023

OBJECTIVE:
To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions.

METHODS:
This was a case–control study using electronic health record data obtained between 2016 and 2021 from 67 hospitals for antepartum sepsis admissions and 71 hospitals for postpartum readmissions up to 42 days. Patients in the sepsis case group were matched in a 1:4 ratio to a comparison cohort of patients without sepsis admitted antepartum or postpartum. The following screening criteria were evaluated: the CMQCC (California Maternal Quality Care Collaborative) initial sepsis screen, the non–pregnancy-adjusted SIRS (Systemic Inflammatory Response Syndrome), the MEWC (Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System) obstetric SIRS, and the MEWT (Maternal Early Warning Trigger Tool). Time periods were divided into early pregnancy (less than 20 weeks of gestation), more than 20 weeks of gestation, early postpartum (less than 3 days postpartum), and late postpartum through 42 days. False-positive screening rates, C-statistics, sensitivity, and specificity were reported for each overall screening tool and each individual criterion.

RESULTS:
We identified 525 patients with sepsis during an antepartum hospitalization and 728 patients with sepsis during a postpartum readmission. For early pregnancy and more than 3 days postpartum, non–pregnancy-adjusted SIRS had the highest C-statistics (0.78 and 0.83, respectively). For more than 20 weeks of gestation and less than 3 days postpartum, the pregnancy-adjusted sepsis screening tools (CMQCC and UKOSS) had the highest C-statistics (0.87–0.94). The MEWC maintained the highest sensitivity rates during all time periods (81.9–94.4%) but also had the highest false-positive rates (30.4–63.9%). The pregnancy-adjusted sepsis screening tools (CMQCC, UKOSS) had the lowest false-positive rates in all time periods (3.9–10.1%). All tools had the lowest C-statistics in the periods of less than 20 weeks of gestation and more than 3 days postpartum.

CONCLUSION:
For admissions early in pregnancy and more than 3 days postpartum, non–pregnancy-adjusted sepsis screening tools performed better than pregnancy-adjusted tools. From 20 weeks of gestation through up to 3 days postpartum, using a pregnancy-adjusted sepsis screening tool increased sensitivity and minimized false-positive rates. The overall false-positive rate remained high.
Anaerobic and aerobic contributions to repeated supramaximal cycling exercises and their adaptation to high-intensity interval training in obese perimenopausal and postmenopausal women
Authors: Jabbour Georges , Iancu Horia D. 
Published: December 2023

Abstract

Objective
This study investigated the anaerobic and aerobic contributions to total energy release during repeated supramaximal cycling exercises (SCE) and their adaptation in response to 6 weeks of high-intensity interval training (HIIT) in obese perimenopausal and postmenopausal women.

Methods
Nineteen perimenopausal women and 21 postmenopausal women with an average age of 50.1 years participated in the 6-week HIIT intervention. Before and after the training, the accumulated oxygen deficits (mL·min−1) and anaerobic and aerobic contributions (%) were measured in all groups via repeated SCE.

Results
The results showed that, before training, the anaerobic contributions to repeated SCE did not differ between the perimenopausal and postmenopausal women for the first three repetitions. However, a higher decrease was reported for postmenopausal women at the fourth and fifth repetitions (P < 0.01, respectively). After HIIT, anaerobic contributions increased significantly in both groups (P < 0.01, respectively). Nevertheless, postmenopausal women still had significantly lower anaerobic contributions to repeated SCE compared with perimenopausal women (P < 0.01, respectively). Multiple linear regression analysis indicated that menopause status was an independent predictor of anaerobic contribution, accounting for 17%, 21%, 15%, 19%, and 22% of variations (β = 0.28, P = 0.03; β = 0.29, P = 0.04; β = 0.18, P = 0.05; β = 0.22, P = 0.05; and β = 0.33, P = 0.03 for the first to the fifth repetitions consecutively for perimenopausal vs postmenopausal groups).

Conclusions
A 6-week HIIT intervention increased the anaerobic contributions to energy in response to repeated SCE in obese perimenopausal and postmenopausal women. However, postmenopausal women had lower anaerobic contributions at the fourth and fifth repetitions mainly due to the effects of menopause.
m6A-mediated gluconeogenic enzyme PCK1 upregulation protects against hepatic ischemia-reperfusion injury
Authors: Yu Shanshan , Liu Xiao , Xu Yan , Pan Lijie , Zhang Yihan , Li Yanli , Dong Shuai , Tu Dan , Sun Yuetong , Zhang Yiwang , Zhou Zhuowei , Liang Xiaoqi , Huang Yiju , Chu Jiajie , Tu Silin , Liu Chang , Chen Huaxin , Chen Wenjie , Ge Mian , Zhang Qi 
Published: December 2023

Background and Aims:
Ischemia-reperfusion (I/R) injury frequently occurs during liver surgery, representing a major reason for liver failure and graft dysfunction after operation. The metabolic shift from oxidative phosphorylation to glycolysis during ischemia increased glucose consumption and accelerated lactate production. We speculate that donor livers will initiate gluconeogenesis, the reverse process of glycolysis in theory, to convert noncarbohydrate carbon substrates (including lactate) to glucose to reduce the loss of hepatocellular energy and foster glycogen storage for use in the early postoperative period, thus improving post-transplant graft function.

Approach and Results:
By analyzing human liver specimens before and after hepatic I/R injury, we found that the rate-limiting enzyme of gluconeogenesis, PCK1, was significantly induced during liver I/R injury. Mouse models with liver I/R operation and hepatocytes treated with hypoxia/reoxygenation confirmed upregulation of PCK1 during I/R stimulation. Notably, high PCK1 level in human post-I/R liver specimens was closely correlated with better outcomes of liver transplantation. However, blocking gluconeogenesis with PCK1 inhibitor aggravated hepatic I/R injury by decreasing glucose level and deepening lactate accumulation, while overexpressing PCK1 did the opposite. Further mechanistic study showed that methyltransferase 3-mediated RNA N6-methyladinosine modification contributes to PCK1 upregulation during hepatic I/R injury, and hepatic-specific knockout of methyltransferase 3 deteriorates liver I/R injury through reducing the N6-methyladinosine deposition on PCK1 transcript and decreasing PCK1 mRNA export and expression level.

Conclusions:
Our study found that activation of the methyltransferase 3/N6-methyladinosine-PCK1-gluconeogenesis axis is required to protect against hepatic I/R injury, providing potential intervention approaches for alleviating hepatic I/R injury during liver surgery.
Relentless bilateral accommodation spasm in an adolescent treated with clear lens extraction
Authors: Barbosa Renato Correia , Lemos José Alberto 
Published: December 2023

Introduction:
Pathologic accommodation spasm occurs when persistent contraction of the ciliary muscle of the eye induces pseudomyopia. The purpose of this report was to describe the case of an adolescent with recurrent ciliary spasm, refractory to medical treatment for several years.

Patient and Clinical Findings:
A 10-year-old girl was evaluated because of complaints of decreased visual acuity (VA) and frequent headaches.

Diagnosis, Intervention and Outcomes:
The diagnosis of pseudomyopia due to accommodation spasm was established. No organic causes were detected. She started treatment with cycloplegics, which were successively titrated at different doses, along with the use of spectacles, over the following years. After 7 years of follow-up, the lack of efficacy of treatment and intolerance to its side effects demanded further action, so a clear lens extraction was performed, with the implantation of continuous focus transition multifocal intraocular lenses. Her final uncorrected distance VA was 6/6 in each eye, with good intermediate vision and J1 near vision with +2.00 addition.

Conclusions:
In severe cases of ciliary spasm, medical therapy and spectacle prescription may not be sufficient to control the disease. Intraocular lens implantation may be the only remaining therapeutic option to provide quality of life to the patient.