bluuebunny/crossref_metadata_2025_split huggingface dataset:
Derivation and external validation of machine-learning models for risk stratification in chest pain with normal troponin
Authors: Fernández-Cisnal Agustín , Lopez-Ayala Pedro , Valero Ernesto , Koechlin Luca , Catarralá Arturo , Boeddinghaus Jasper , Noceda José , Nestelberger Thomas , Miró Òscar , Julio Núñez , Mueller Christian , Sanchis Juan 
Published: August 2023

Abstract

Aims
Risk stratification of patients with chest pain and a high-sensitivity cardiac troponin T (hs-cTnT) concentration &lt;upper reference limit (URL) is challenging. The aim of this study was to develop and externally validate clinical models for risk prediction of 90-day death or myocardial infarction in patients presenting to the emergency department with chest pain and an initial hs-cTnT concentration &lt;URL.

Methods and results
Four machine-learning-based models and one logistic regression (LR) model were trained on 4075 patients (single-centre Spanish cohort) and externally validated on 3609 patients (international prospective Advantageous Predictors of Acute Coronary syndromes Evaluation cohort). Models were compared with GRACE and HEART scores and a single undetectable hs-cTnT-based strategy (u-cTn; hs-cTnT &lt; 5 ng/L and time from symptoms onset &gt;180 min). Probability thresholds for safe discharge were derived in the derivation cohort. The endpoint occurred in 105 (2.6%) patients in the training set and 98 (2.7%) in the external validation set. Gradient boosting full (GBf) showed the best discrimination (area under the curve = 0.808). Calibration was good for the reduced neural network and LR models. Gradient boosting full identified the highest proportion of patients for safe discharge (36.7 vs. 23.4 vs. 27.2%; GBf vs. LR vs. u-cTn, respectively) with similar safety (missed endpoint per 1000 patients: 2.2 vs. 3.5 vs. 3.1, respectively). All derived models were superior to the HEART and GRACE scores (P &lt; 0.001).

Conclusion
Machine-learning and LR prediction models were superior to the HEART, GRACE, and u-cTn for risk stratification of patients with chest pain and a baseline hs-cTnT &lt;URL. Gradient boosting full models best balanced discrimination, calibration, and efficacy, reducing the need for serial hs-cTnT determination by more than one-third.

Clinical trial registration
ClinicalTrials.gov number, NCT00470587, https://clinicaltrials.gov/ct2/show/NCT00470587.
Ultrasound features and risk stratification system in NIFT-P and other follicular-patterned thyroid tumors
Authors: Matrone Antonio , Gambale Carla , Pieroni Erica , De Napoli Luigi , Torregrossa Liborio , Materazzi Gabriele , Elisei Rossella 
Published: August 2023

Abstract

Objective
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFT-P) is an encapsulated follicular variant of papillary thyroid carcinoma (PTC) with nonaggressive clinical behavior. However, since its diagnosis is exclusively possible after surgery, it represents a clinical challenge. Neck ultrasound (US) shows good sensitivity and specificity in suggesting malignancy in thyroid nodules. However, little information is available about its ability in identifying NIFT-P.

Design
The aim of this study was to evaluate the US features of NIFT-P, comparing them with other follicular-patterned thyroid tumors, and to test the ability of the main US risk stratification system (RSS) in identifying NIFT-P.

Methods
We retrospectively evaluated 403 consecutive patients submitted to thyroid surgery, with positive histology for at least 1 nodule being NIFT-P, follicular variant of PTC (FV-PTC), follicular thyroid carcinoma (FTC), or follicular adenoma (FA).

Results
The US features of NIFT-P (n = 116), FV-PTC (n = 170), FTC (n = 76), and FA (n = 90) were reported. Follicular variant of PTC and FTC more frequently showed irregular margins, presence of calcifications, “taller than wide” shape, and the absence of halo compared with NIFT-P. Furthermore, FTC and also FA were larger and more frequently hypoechoic than NIFT-P. Most cases (77%) showed an indeterminate cytology. Regardless of the US RSS considered, NIFT-P and FA were less frequently classified in the high-suspicious category compared with FV-PTC and FTC.

Conclusions
Ultrasound features of NIFT-P are frequently superimposable to those of nodules with low suspicion of malignancy. The NIFT-P is almost never classified in the high-suspicious category according to the main US RSS. Therefore, although the preoperative identification of NIFT-P remains a challenge, neck US can be integrated in the algorithm of management of nodules with indeterminate cytology, suggesting a possible conservative approach in those with low-suspicious features.
Modern subcutaneous implantable defibrillator therapy in patients with cardiomyopathies and channelopathies: data from a large multicentre registry
Authors: Migliore Federico , Biffi Mauro , Viani Stefano , Pittorru Raimondo , Francia Pietro , Pieragnoli Paolo , De Filippo Paolo , Bisignani Giovanni , Nigro Gerardo , Dello Russo Antonio , Pisanò Ennio , Palmisano Pietro , Rapacciuolo Antonio , Silvetti Massimo Stefano , Lavalle Carlo , Curcio Antonio , Rordorf Roberto , Lovecchio Mariolina , Valsecchi Sergio , D’Onofrio Antonio , Botto Giovanni Luca 
Published: August 2023

Abstract

Aims
Patients with cardiomyopathies and channelopathies are usually younger and have a predominantly arrhythmia-related prognosis; they have nearly normal life expectancy thanks to the protection against sudden cardiac death provided by the implantable cardioverter defibrillator (ICD). The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD and has evolved over the years. This study aimed to evaluate the rate of inappropriate shocks (IS), appropriate therapies, and device-related complications in patients with cardiomyopathies and channelopathies who underwent modern S-ICD implantation.

Methods and results
We enrolled consecutive patients with cardiomyopathies and channelopathies who had undergone implantation of a modern S-ICD from January 2016 to December 2020 and who were followed up until December 2022. A total of 1338 S-ICD implantations were performed within the observation period. Of these patients, 628 had cardiomyopathies or channelopathies. The rate of IS at 12 months was 4.6% [95% confidence interval (CI): 2.8–6.9] in patients with cardiomyopathies and 1.1% (95% CI: 0.1–3.8) in patients with channelopathies (P = 0.032). No significant differences were noted over a median follow-up of 43 months [hazard ratio (HR): 0.76; 95% CI: 0.45–1.31; P = 0.351]. The rate of appropriate shocks at 12 months was 2.3% (95% CI: 1.1–4.1) in patients with cardiomyopathies and 2.1% (95% CI: 0.6–5.3) in patients with channelopathies (P = 1.0). The rate of device-related complications was 0.9% (95% CI: 0.3–2.3) and 3.2% (95% CI: 1.2–6.8), respectively (P = 0.074). No significant differences were noted over the entire follow-up. The need for pacing was low, occurring in 0.8% of patients.

Conclusion
Modern S-ICDs may be a valuable alternative to transvenous ICDs in patients with cardiomyopathies and channelopathies. Our findings suggest that modern S-ICD therapy carries a low rate of IS.

Clinical Trial Registration
URL: http://clinicaltrials.gov/Identifier: NCT02275637.
Genome-wide association analysis identifies natural allelic variants associated with panicle architecture variation in African rice, Oryza glaberrima Steud
Authors: Ntakirutimana Fabrice , Tranchant-Dubreuil Christine , Cubry Philippe , Chougule Kapeel , Zhang Jianwei , Wing Rod A , Adam Hélène , Lorieux Mathias , Jouannic Stefan 
Published: August 2023

Abstract
African rice (Oryza glaberrima Steud), a short-day cereal crop closely related to Asian rice (Oryza sativa L.), has been cultivated in Sub-Saharan Africa for ∼ 3,000 years. Although less cultivated globally, it is a valuable genetic resource in creating high-yielding cultivars that are better adapted to diverse biotic and abiotic stresses. While inflorescence architecture, a key trait for rice grain yield improvement, has been extensively studied in Asian rice, the morphological and genetic determinants of this complex trait are less understood in African rice. In this study, using a previously developed association panel of 162 O. glaberrima accessions and new SNP variants characterized through mapping to a new version of the O. glaberrima reference genome, we conducted a genome-wide association study of four major morphological panicle traits. We have found a total of 41 stable genomic regions that are significantly associated with these traits, of which 13 co-localized with previously identified QTLs in O. sativa populations and 28 were unique for this association panel. Additionally, we found a genomic region of interest on chromosome 3 that was associated with the number of spikelets and primary and secondary branches. Within this region was localized the O. sativa ortholog of the PHYTOCHROME B gene (Oglab_006903/OgPHYB). Haplotype analysis revealed the occurrence of natural sequence variants at the OgPHYB locus associated with panicle architecture variation through modulation of the flowering time phenotype, whereas no equivalent alleles were found in O. sativa. The identification in this study of genomic regions specific to O. glaberrima indicates panicle-related intra-specific genetic variation in this species, increasing our understanding of the underlying molecular processes governing panicle architecture. Identified candidate genes and major haplotypes may facilitate the breeding of new African rice cultivars with preferred panicle traits.
Hyperactive Ras disrupts cell size control and a key step in cell cycle entry in budding yeast
Authors: DeWitt Jerry T , Chinwuba Jennifer C , Kellogg Douglas R 
Published: August 2023

Abstract
Severe defects in cell size are a nearly universal feature of cancer cells. However, the underlying causes are unknown. A previous study suggested that a hyperactive mutant of yeast Ras (ras2G19V) that is analogous to the human Ras oncogene causes cell size defects, which could provide clues to how oncogenes influence cell size. However, the mechanisms by which ras2G19V influences cell size are unknown. Here, we found that ras2G19V inhibits a critical step in cell cycle entry, in which an early G1 phase cyclin induces transcription of late G1 phase cyclins. Thus, ras2G19V drives overexpression of the early G1 phase cyclin Cln3, yet Cln3 fails to induce normal transcription of late G1 phase cyclins, leading to delayed cell cycle entry and increased cell size. ras2G19V influences transcription of late G1 phase cyclins via a poorly understood step in which Cln3 inactivates the Whi5 transcriptional repressor. Previous studies found that yeast Ras relays signals via protein kinase A (PKA); however, ras2G19V appears to influence late G1 phase cyclin expression via novel PKA-independent signaling mechanisms. Together, the data define new mechanisms by which hyperactive Ras influences cell cycle entry and cell size in yeast. Hyperactive Ras also influences expression of G1 phase cyclins in mammalian cells, but the mechanisms remain unclear. Further analysis of Ras signaling in yeast could lead to discovery of new mechanisms by which Ras family members control expression of G1 phase cyclins.
Unclean Cooking Fuel Use and Health Outcomes in Older Adults: Potential Mechanisms, Public Health Implications, and Future Directions
Authors: Smith Lee , López Sánchez Guillermo F , Soysal Pinar , Tully Mark A , Koyanagi Ai 
Published: August 2023

Abstract

Background
Unclean cooking fuels (ie, polluting fuels including kerosene/paraffin, and solid fuels) are a major contributor to diseases and mortality, specifically in low- and middle-income countries.

Methods
This review aimed to identify potential mechanisms, public health implications, and future directions of unclean cooking fuel use and health outcomes in older adults.

Results
There is an expanding body of literature to demonstrate associations between unclean cooking fuel use and multiple mental and physical health outcomes in older adults. Two key mechanisms likely driving such associations include inflammation and oxidative stress.

Conclusions
Considering that inflammation and oxidative stress have been implicated in multiple other health conditions (eg, arthritis and osteoporosis) in addition to those investigated to date on this topic it would be prudent to continue investigation of unclean cooking fuel use and with yet to be studied health outcomes. Moreover, future research is indeed now required to identify pathways to eliminating unclean cooking fuel globally to better the health of an aging global population and to support the implementation of Sustainable Development Goal 7.
Single-Cell Mapping of Large and Small Arteries During Hypertensive Aging
Authors: Cheng Jun , Wu Hong , Xie Cheng , He Yangyan , Mou Rong , Zhang Hongkun , Yang Yan , Xu Qingbo 
Published: August 2023

Abstract
Vascular aging is directly related to several major diseases including clinical primary hypertension. Conversely, elevated blood pressure itself accelerates vascular senescence. However, the interaction between vascular aging and hypertension has not been characterized during hypertensive aging. To depict the interconnectedness of complex mechanisms between hypertension and aging, we performed single-cell RNA sequencing of aorta, femoral and mesentery arteries, respectively, from male Wistar Kyoto rats and male spontaneously hypertensive rats aging 16 or 72 weeks. We integrated 12 data sets to map the blood vessels of senile hypertension from 3 perspective: vascular aging, hypertension, and vascular type. We found that aging and hypertension independently exerted a significant impact on the alteration of cellular composition and artery remodeling, even greater when superimposed. Consistently, smooth muscle cells (SMCs) underwent phenotypic switching from contractile toward synthetic, apoptotic, and senescent SMCs with aging/hypertension. Furthermore, we identified 3 subclusters of Spp1high, encoding protein osteopontin (OPN), synthetic SMCs, Spp1high matrix activated fibroblasts, and Spp1high scar-associated macrophage involved in hypertensive aging. Spp1high scar-associated macrophage enriched for reactive oxygen species metabolic process and cell migration-associated function. Cell–cell communication analysis revealed Spp1-Cd44 receptor pairing was markedly aggravated in the hypertensive aging condition. Importantly, the concentration of serum OPN significantly potentiated in aged hypertensive patients compared with the normal group. Thus, we provide a comprehensive cell atlas to systematically resolve the cellular diversity and dynamic cellular communication changes of the vessel wall during hypertensive aging, identifying a protein marker OPN as a potential regulator of vascular remodeling during hypertensive aging.
Spatial and network mapping of comorbidity with trachoma and visual-impairing NCDs in a pastoralist community in Kenya: implications for SDGs and UHC
Authors: Chweya R N , Onyango C A , Saigilu S , Mwangi C , Gachohi J M 
Published: August 2023

Abstract

Background
We explore the spatial distribution of comorbidity with trachoma and potentially visual-impairing non-communicable diseases (NCDs) and their risk factors among Kenyan pastoralists.

Methods
Using a cross-sectional study design, we recruited and clinically examined 262 study participants for NCDs (hypertension or diabetes) and trachoma using the World Health Organization grading system. Network models estimated interactions and risks linked with trachoma and NCDs while the Poisson point process determined their spatial distribution.

Results
Of the 262 participants, 140 (53%) had trachoma, with &gt;71% of these cases identified among females and those &gt;60 y of age. A total of 36 trachoma cases co-occurred with hypertension (26%) and diabetes (0.01%). NCDs were frequent among those with recurring trachoma (21%) and trachomatous trichiasis (14.3%). Trachoma and NCDs clustered together in &lt;1 km distances (R=0.18, p=0.02). In network analysis, age was strongly associated with trachoma and NCDs. Trachoma was linked with geographic location while diabetes was linked with water source distances. Education level became the central risk factor.

Conclusions
We demonstrate a twin trachoma–NCD burden that is higher among elderly pastoralists in southern Kenya. Attenuating adverse population-level visual impairment, including integrating the trachoma SAFE strategy with NCD comprehensive care, amplifies the benefits from economies of scale, accelerating realization of Sustainable Development Goal 3 and universal health coverage in hard-to-reach areas.
P01 The Australian experience of adapting and implementing ‘To Dip or Not to Dip’ in residential aged care facilities
Authors: Lim Lyn-li , Wroth Melanie , Williams Kathleen , Breen Juanita 
Published: August 2023

Abstract

Objectives
‘To Dip or Not to Dip’ (TDONTD) is a behavioural intervention focused on reducing inappropriate antibiotic prescribing for urinary tract infections (UTI) by changing urine dipstick testing practice. It was adapted by the Aged Care Quality and Safety Commission from a successful initiative in England’s care homes. We describe TDONTD adaptation and evaluation of TDONTD to support improvement in UTI management in Australian residential aged care facilities.

Methods
Data were collected in 12 facilities, from November 2021 to July 2022. Baseline and 3 month interviews were conducted with nurse and pharmacist champions implementing TDONTD and antibiotic prescribing audits.

Results
Australia’s most widely accepted national guideline for assessment of residents with suspected UTI discourages urine testing in asymptomatic persons, however, is not explicit on when to (or not) perform dipstick testing in residents who do not meet minimum criteria for UTI. We adapted key resources including case-based education, clinical pathway for assessing residents for suspected UTI and antibiotic audit tool to incorporate national guideline recommendations around dipstick testing. Surveys with nurse champions of urine dipstick practice showed improved practice in the facilities related to reduced testing for asymptomatic bacteriuria (ASB) and increased use of formal protocol to guide dipstick testing practice and UTI diagnosis. Qualitative interviews with champions identified: (i) increased knowledge around ASB, clinical signs and symptoms of suspected UTI; (ii) increased confidence in not relying on dipstick testing to diagnose suspected UTI; (iii) TDONTD challenged and changed nurse perceptions of how residents present with UTI; (iv) pressure from external healthcare professional providers and family to perform dipstick testing was common; and (v) TDONTD was a feasible intervention in Australian RACF setting. Oral antibiotic prescribing for all indications, including UTI, improved with the intervention as did prescribing appropriateness for UTI treatment but not prophylaxis (Table 1). Table 1.Oral antibiotic prescriptions for UTI at baseline, 3 months and 6 monthsOral antibiotic prescriptionsBaseline (%), 1074 residents3 months (%), 1054 residents6 months (%), 634 residentsFor all indications7.95.25.1For UTI32.61.6By appropriateness (indication and duration) For UTI treatment2758100 For UTI prophylaxis61814

Conclusions
We found that TDONTD supported improved clinical management of residents with suspected UTI in an Australian aged care setting. Knowledge, skills and environmental context and resources contributed towards practice change. External healthcare professional providers and family were barriers to change suggesting that education around dipstick testing should be expanded to broader community and hospital healthcare settings in Australia.
Diagnostic concordance among nursing clinical decision support system users: a pilot study
Authors: dos Santos Diogo Regina Célia , Silva Butcher Rita de Cassia Gengo e , Peres Heloísa Helena Ciqueto 
Published: August 2023

Abstract

Objective
To analyze the nursing diagnostic concordance among users of a clinical decision support system (CDSS), The Electronic Documentation System of the Nursing Process of the University of São Paulo (PROCEnf-USP®), structured according to the Nanda International, Nursing Intervention Classification and Nursing Outcome Classification (NNN) Taxonomy.

Materials and Methods
This pilot, exploratory-descriptive study was conducted from September 2017 to January 2018. Participants were nurses, nurse residents, and nursing undergraduates. Two previously validated written clinical case studies provided participants with comprehensive initial assessment clinical data to be registered in PROCEnf-USP®. After having registered the clinical data in PROCEnf-USP®, participants could either select diagnostic hypotheses offered by the system or add diagnoses not suggested by the system. A list of nursing diagnoses documented by the participants was extracted from the system. The concordance was analyzed by Light’s Kappa (K).

Results
The research study included 37 participants, which were 14 nurses, 10 nurse residents, and 13 nursing undergraduates. Of the 43 documented nursing diagnoses, there was poor concordance (K = 0.224) for the diagnosis “Ineffective airway clearance” (00031), moderate (K = 0.591) for “Chronic pain” (00133), and elevated (K = 0.655) for “Risk for unstable blood glucose level” (00179). The other nursing diagnoses had poor or no concordance.

Discussion
Clinical reasoning skills are essential for the meaningful use of the CDSS.

Conclusions
There was concordance for only 3 nursing diagnoses related to biological needs. The low level of concordance might be related to the clinical judgment skills of the participants, the written cases, and the sample size.
Interference of the novel designer benzodiazepine 4ʹ-chloro deschloroalprazolam with alprazolam analysis in toxicology and seized drug DUID casework
Authors: Reber Jami D , Rodgers Corissa , Ayala Jessica L , Miller James , Stout Peter , Lee Dayong 
Published: August 2023

Abstract
In recent years, the emergence of the novel designer benzodiazepine 4ʹ-chloro deschloroalprazolam has presented a new challenge for forensic laboratories by interfering with the identification and quantitation of alprazolam. As an isomer of alprazolam, 4ʹ-chloro deschloroalprazolam has similar physicochemical properties and can be misidentified in casework samples as alprazolam without a specific method to differentiate the two analytes. Starting in late 2021, the Houston Forensic Science Center (HFSC) received toxicological and seized drug evidence indicating the presence of 4ʹ-chloro deschloroalprazolam. An interference study was performed to supplement the laboratory’s validated benzodiazepines method for toxicological samples to differentiate alprazolam from 4ʹ-chloro deschloroalprazolam. This study showed that while the isomers could not be chromatographically resolved using the current method, they could be differentiated based on their retention times relative to the internal standard, alprazolam-d5. Based on these findings, the HFSC toxicology laboratory reports test results as “unsuitable for analysis due to an interference” if a suspected alprazolam peak elutes before the alprazolam-d5 peak, even if all identification and quantification criteria (e.g., retention time) were acceptable. Additionally, the seized drug and toxicology laboratories re-evaluated previously analyzed alprazolam-positive casework to determine if suspected 4ʹ-chloro deschloroalprazolam had been misidentified as alprazolam. This report presents three cases: one case with toxicological evidence indicating the presence of both 4ʹ-chloro deschloroalprazolam and alprazolam, and two cases with both seized drug material and toxicology evidence indicating the presence of 4ʹchloro deschloroalprazolam with no detected alprazolam.