bluuebunny/crossref_metadata_2025_split huggingface dataset:
Classifying MaNGA velocity dispersion profiles by machine learning
Authors: Duann Yi , Tian Yong , Ko Chung-Ming 
Published: September 2023

Abstract
We present a machine-learning (ML) approach for classifying kinematic profiles of elliptical galaxies in the Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey. Previous studies employing ML to classify spectral data of galaxies have provided valuable insights into morphological galaxy classification. This study aims to enhance the understanding of galaxy kinematics by leveraging ML. The kinematics of 2624 MaNGA elliptical galaxies are investigated using integral field spectroscopy by classifying their one-dimensional velocity dispersion (VD) profiles. We utilized a total of 1266 MaNGA VD profiles and employed a combination of unsupervised and supervised learning techniques. The unsupervised K-means algorithm classifies VD profiles into four categories: flat, decline, ascend, and irregular. A bagged decision trees classifier (TreeBagger)-supervised ensemble is trained using visual tags, achieving 100 ${{\ \rm per\ cent}}$ accuracy on the training set and 88 ${{\ \rm per\ cent}}$ accuracy on the test set. Our analysis identifies the majority (68 ${{\ \rm per\ cent}}$) of MaNGA elliptical galaxies presenting flat VD profiles, which requires further investigation into the implications of the dark matter problem.
Contribution of Health Care Practitioner and Maternity Services Factors to Racial Disparities in Alabama
Authors: Toluhi Angelina A. , Richardson Molly R. , Julian Zoe I. , Sinkey Rachel G. , Knight Candace C. , Budhwani Henna , Szychowski Jeff M. , Wingate Martha S. , Tita Alan T. , Baskin Monica L. , Turan Janet M. 
Published: September 2023

OBJECTIVE:
Black patients are three times more likely to die of pregnancy-related causes than White patients in the United States, and Alabama has the third worst maternal mortality rate in the nation. We sought to identify health care practitioner and maternity service factors contributing to disparities in Alabama, as well as potential strategies to address these contributors.

METHODS:
We conducted key informant interviews with obstetricians, nurses, doulas, lactation counselors, health system administrators, and representatives of professional organizations who deliver maternity care to racially and ethnically diverse patients in Alabama. The interview guide was developed using Howell's conceptual framework on racial and ethnic disparities in severe maternal morbidity and mortality. Adopting a thematic analysis approach, we coded and analyzed transcripts using NVivo 12 software. Open coding and selective coding were conducted to identify themes related to health care practitioner– and maternity services–level determinants.

RESULTS:
Overall, 20 health care practitioners or administrators were interviewed. Primary themes related to health care practitioners included implicit bias and explicit racism, lack of communication and lack of positive patient–health care practitioner relationships, lack of cultural sensitivity, and variation in clinical knowledge and experience. Primary themes related to maternity services included lack of accessibility, inadequate quality and content of care, lack of continuity of care, discriminatory facility policies, and workforce shortages and lack of diversity. Strategies suggested by participants to address these factors included bias trainings for health care practitioners, improvements in racial and interdisciplinary diversity in the maternity workforce, and evidence-based interventions such as group prenatal care, disparities dashboards, simulation trainings, early warning signs criteria, and coordinated care.

CONCLUSION:
We gained diverse perspectives from health care practitioners and administrators on how maternity health care practitioner and maternity health services factors contribute to inequities in maternal health in Alabama. Strategies to address these contributing factors were multifaceted.
Advancing Equity in U.S. Hospital Systems: Employee Understandings of Health Equity and Steps for Improvement
Authors: Uehling Melissa , Hall-Clifford Rachel , Kinnard Crystal , Wimberly Yolanda 
Published: September 2023

Goals:
Equity in the U.S. healthcare system remains a vital goal for healthcare leaders. Although many hospitals and healthcare systems have adopted a social determinants of health approach to more equitable care, many challenges have limited the effectiveness of their efforts. In this study, we wanted to explore whether healthcare leaders and providers understand the concept of equity and can link the concepts to practical applications within healthcare systems.

Methods:
We explored how hospital leadership and providers at a major public hospital in Atlanta, Georgia, understand equity topics both conceptually and at a practical implementation level. We conducted 28 focus groups for >4 months involving 233 staff members, during which participants were asked about their understanding of various equity-related terms and equity implementation within the hospital.

Principal Findings:
Our findings reveal that there is little consensus among staff regarding the conceptual meanings of various health equity–related terms, and only a small minority of staff can articulate a conceptual definition that reflects current research-based understandings of equity. Furthermore, there is little consensus regarding how staff believes that health equity is practically enacted through various hospital programs, even among interviewees who could correctly articulate equity topics. These findings have no association with a role in the organization or length of time employed at the hospital.

Practical Applications:
These findings indicate a need for a more nuanced understanding of health equity and further clarification and education on how to implement health equity. Although understanding at the conceptual level is an important first step, conceptual knowledge alone is not enough to support health equity at either the individual staff level or the system level. Our recommendations cover strategic development; education specific to the hospital system and its unique needs; consideration of the specific roles of individuals in the organization; and the designation of diversity, equity, and inclusion staff and offices in a hospital organization.
Development and validation of a novel nomogram to predict postoperative pancreatic fistula after pancreatoduodenectomy using Lasso-logistic regression: an international multi-institutional observational study
Authors: Gu Zongting , Du Yongxing , Wang Peng , Zheng Xiaohao , He Jin , Wang Chengfeng , Zhang Jianwei 
Published: September 2023

Background:
Existing prediction models for clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy lack discriminatory power or are too complex. This study aimed to develop a simple nomogram that could accurately predict clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy.

Methods:
A high-volume, multicenter cohort of patients who underwent pancreatoduodenectomy from the American College of Surgeons-National Surgical Quality Improvement Program database in the United States during 2014-2017 was used as the model training cohort (n=3609), and patients who underwent pancreatoduodenectomy from the Pancreatic Center of National Cancer Center Hospital in ***** during 2014-2019 were used as the external validation cohort (n=1347). The study used lasso penalized regression to screen large-scale variables, then logistic regression was performed to screen the variables and build a model. Finally, a prediction nomogram for clinically relevant postoperative pancreatic fistula was established based on the logistic model, and polynomial equations were extracted. The performance of the nomogram was evaluated by receiver operating characteristic curve, calibration curve, and decision curve analysis.

Results:
In the training and validation cohorts, there were 16.7% (601/3609) and 16.6% (224/1347) of patients who developed clinically relevant postoperative pancreatic fistula, respectively. After screening using Lasso and logistic regression, only 6 predictors were independently associated with clinically relevant postoperative pancreatic fistula, including 2 preoperative indicators (weight and pancreatic duct size), 1 intraoperative indicator (pancreatic texture), and 3 postoperative indicators (deep surgical site infection, delayed gastric emptying, and pathology). The prediction of the new nomogram was accurate, with an area under the curve of 0.855 (95% CI, 0.702-0.853) in the external validation cohort, and the predictive performance was superior to three previously proposed postoperative pancreatic fistula risk score models (all P<0.001, likelihood ratio test).

Conclusions:
A reliable Lasso-logistic method was applied to establish a novel nomogram based on 6 readily available indicators, achieving a sustained, dynamic, and precise postoperative pancreatic fistula prediction for pancreatoduodenectomy patients. With a limited number of variables and easy clinical application, this new model will enable surgeons to proactively predict, identify and manage pancreatic fistulas to obtain better outcomes from this daunting postoperative complication.
Incidence of Cirrhosis and Hepatocellular Carcinoma Among Veterans With Noncirrhotic Metabolic Dysfunction-associated Fatty Liver Disease
Authors: Yeoh Aaron , Yang Zeyuan , Cheung Ramsey , Do Albert , Ahmed Aijaz , Wong Robert J. 
Published: September 2023

Background and Aims:
Despite the high prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD), the long-term incidence of cirrhosis or hepatocellular carcinoma (HCC) among adults with MAFLD is not well described. Using a national cohort of United States Veterans, we evaluated the overall incidence and predictors of cirrhosis and HCC among adults with noncirrhotic MAFLD.

Methods:
Data from the 2010 to 2022 Veterans Affairs database were used to identify adults with noncirrhotic MAFLD using established definitions. Five and 10-year incidence of cirrhosis and HCC were assessed and stratified by demographics and relevant clinical variables. Multivariate Cox proportional hazard models were utilized to determine predictors of cirrhosis and HCC.

Results:
Among 969,253 patients with noncirrhotic MAFLD (94.5% males, 70.2% non-Hispanic white, mean age of 62.7 ± 12.2 y), the 10-year incidence of cirrhosis and HCC was 3.70% (95% CI: 3.66-3.74) and 0.69% (95% CI: 0.67-0.70), respectively. When stratified by race/ethnicity, the 10-year incidence of cirrhosis was lowest among Asians (2.63%, 95% CI: 2.37-2.88) and highest among Hispanics (4.60%, 95% CI: 4.45-4.75), a pattern also observed with HCC. Significant disparities in risk of cirrhosis or HCC were observed when stratified by sex, substance use, and comorbidities. Risks of cirrhosis and HCC were highest in patients with baseline fibrosis-4 >2.67.

Conclusion:
This large study provides important epidemiological data describing the natural history of adults with MAFLD. Disparities in risk of cirrhosis and HCC were observed by demographic and clinical characteristics, emphasizing the importance of early identification of MAFLD with modifiable high-risk features to implement earlier interventions to improve long-term outcomes.
Nipple-Preserving Inferior-Ellipse Mastectomy: A New Technique for Gender-Affirming Top Surgery
Authors: Robinson Isabel S. , Salibian Ara , Zhao Lee C. , Bluebond-Langner Rachel 
Published: September 2023

Summary:
The 2 most common techniques for gender-affirming mastectomy are the double-incision free nipple graft and periareolar techniques. However, some patients are not well suited for either technique. When the nipples are high and on the pectoralis muscle, but there is marked breast tissue and skin redundancy, a double-incision free nipple graft would land the incision above the pectoral shadow, but a periareolar approach would not adequately remove the excess skin. In these patients, a nipple-preserving inferior-ellipse incision allows for appropriate chest contouring, leaving the nipple position unchanged and placing the incision in the pectoralis muscle shadow. A retrospective review identified all consecutive patients undergoing nipple-preserving inferior-ellipse mastectomy by the senior author (R.B.-L.). Indications were patients with moderate glandular tissue, skin excess, and a high nipple-areola complex (NAC) above the inferior border of the pectoralis major. Sixteen patients underwent inferior-ellipse mastectomy and were included. Mean follow-up was 203 days. Two patients (14%) required revision of the NAC. There was no partial or complete NAC loss. One patient (7%) developed postoperative seroma, which resolved with aspiration. For patients with moderate glandular tissue, excess skin in the inferior pole, and NAC position above the inferior border of the pectoralis major, the nipple-preserving inferior-ellipse mastectomy technique achieves excellent chest contour.
Does the Low and Short Medial Cut Affect Lingual Nerve Recovery after Sagittal Split Osteotomy?
Authors: Tolley Philip D. , Massenburg Benjamin B. , Higgins Julia , Ettinger Russell E. , Susarla Srinivas M. 
Published: September 2023

Background:
The purpose of this study was to evaluate the recovery of lingual nerve (LN) neurosensory function in patients undergoing sagittal split osteotomy (SSO) with a low and short medial horizontal cut.

Methods:
This was a prospective study of patients with mandibular deformities undergoing SSO with a low and short medial horizontal cut over a 4-year period. The outcomes of interest were neurosensory recovery of the LN, as assessed objectively using functional sensory recovery (FSR) and subjectively by patient report.

Results:
The sample included 123 SSOs in 62 subjects with a mean age of 19.3 ± 3.1 years. Thirty-seven subjects (61.7%) were female. Mandibular advancements were performed in 52 SSOs (42.3%); mandibular setbacks were performed in 71 SSOs (57.7%). One subject underwent revision BSSO. FSR was achieved at 122 LNs (99.1%) within 6 weeks postoperatively, with 120 sites (97.5%) having S4 sensation at 6 weeks. Decreased LN sensation was reported at 10 (8.3%) sites at 1 week postoperatively. At 6 weeks postoperatively, 118 sites (97.5%) had reported normal sensation. By 12 weeks postoperatively, all LN sites had S4 sensation and there were no subjective complaints. Revision sagittal split osteotomy was associated with prolonged (≥6 weeks) time to S4 sensation (P = 0.02) and subjective complaint of decreased sensation (P = 0.02).

Conclusions:
LN sensory recovery occurs rapidly following the low and short SSO, with 99% of sites achieving FSR and subjectively normal sensation within 6 weeks of surgery and all patients achieving FSR with S4 sensation by 12 weeks postoperatively. LN sensory recovery may be prolonged in patients undergoing revision SSO.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Structures of AT8 and PHF1 Phospho-Mimetic Tau: Insights Into the Posttranslational Modification Code of Tau Amyloid Formation
Authors: Mammeri Nadia El , Dregni Aurelio J. , Duan Pu , Hong Mei 
Published: September 2023

AbstractThe microtubule-associated protein tau aggregates into amyloid fibrils in Alzheimer’s disease and other neurodegenerative diseases. In these tauopathies, tau is hyperphosphorylated, suggesting that this posttranslational modification may induce pathological tau aggregation. Tau is also phosphorylated in normal developing brains. To investigate how tau phosphorylation induces amyloid fibrils, here we report the atomic structures of two phospho-mimetic full-length tau fibrils assembled without anionic cofactors. One set of phospho-mimetic mutations is targeted by the antibody AT8, while the other set is targeted by the antibody PHF1. Solid-state NMR and cryo-electron microscopy data reveal that AT8 tau forms a unique triangular fibril core that encompasses the entire C-terminal third of the protein, whereas PHF1 tau forms a triple-stranded core. These results demonstrate that specific post-translational modifications induce structurally specific tau aggregates. We propose that these aggregates may evolve into pathological filaments under suitable cellular conditions or remain as transient species in normal brains.
Sex-Related Outcomes of Transcatheter Aortic Valve Implantation with Self-Expanding or Balloon-Expandable Valves: Insights from the OPERA-TAVI Registry
Authors: Adamo Marianna , Branca Luca , Pezzola Elisa , Saia Francesco , Pilgrim Thomas , Abdel-Wahab Mohamed , Garot Philippe , Gandolfo Caterina , Fiorina Claudia , Sammartino Sofia , Latib Azeem , Santos Ignacio Amat , Mylotte Darren , De Marco Federico , De Backer Ole , Franco Luis Nombela , Akodad Mariama , Ribichini Flavio Luciano , Bedogni Francesco , Laterra Giulia , Mazzapicchi Alessandro , Tomii Daijiro , Laforgia Pietro , Cannata Stefano , Scotti Andrea , Fezzi Simone , Criscione Enrico , Poletti Enrico , Mazzucca Mattia , Lunardi Mattia , Mainardi Andrea , Andreaggi Stefano , Quagliana Angelo , Montarello Nicholas , Hennessey Breda , Mon-Noboa Matias , Meier David , Sgroi Carmelo , Reddavid Claudia Maria , Strazzieri Orazio , Motta Silvia Crescenzia , Frittitta Valentina , Dipietro Elena , Comis Alessandro , Melfa Chiara , Calì Mariachiara , Thiele Holger , Webb John G. , Sondergaard Lars , Tamburino Corrado , Metra Marco , Costa Giuliano , Barbanti Marco 
Published: September 2023

ABSTRACTBackgroundEvidence regarding sex-related differences in response to transcatheter aortic valve implantation according to the valve type is lacking. This study sought to evaluate the impact of sex on the treatment effect of Evolut-PRO/PRO+ (PRO) or Sapien 3 Ultra (ULTRA) devices on clinical outcomes.MethodsComparative Analysis of Evolut PRO vs Sapien 3 Ultra Valves for Transfemoral Transcatheter Aortic Valve Implantation (OPERA-TAVI) is a multicenter multinational registry including patients undergoing latest-iteration PRO or ULTRA implantation. Overall, 1174 out of 1897 patients were matched based on valve type and compared according to sex, while 470 males and 630 females were matched and compared according to valve type. Thirty-day and 1-year outcomes were evaluated.ResultsIn both PRO and ULTRA group, males had a higher comorbidity burden, while females had smaller aortic root. Both 30-day (device success [DS], early safety outcome, permanent pacemaker implantation [PPI], patient-prosthesis mismatch [PPM], paravalvular regurgitation [PVR], bleedings, vascular complications, and all-cause death) and 1-year outcomes (all-cause death, stroke and heart failure hospitalization) did not differ according to sex in both valve groups. However, male sex decreased the likelihood of 30-day DS with ULTRA versus PRO (p for interaction 0.047). A higher risk of 30-day PPI and 1-year stroke, and a lower risk of PPM was observed in PRO versus ULTRA, regardless of sex. No other differences were noted.ConclusionsSex did not modify the treatment effect of PRO versus ULTRA on clinical outcomes, with the exception of 30-day DS that was decreased in males (versus females) receiving ULTRA (versus PRO).
Hormonal and transcriptomic analysis reveals the role of ABA and BR in breaking the barrier of inter-subgeneric hybridization in water lily (Nymphaea)
Authors: Zhou Ping , Li Jingwen , Jiang Huiyan , Yang Zhijuan , Sun Chunqing , Wang Hongyan , Su Qun , Jin Qijiang , Wang Yanjie , Xu Yingchun 
Published: September 2023

AbstractUnderstanding the process of signal communication between pollen and stigma is of significant importance for plant sexual reproduction. In the case of inter-subgeneric hybridization in water lily, there exists a pre-fertilization hybridization barrier, the regulatory mechanism of which remains unclear. In this study, we conducted hormone and transcriptome analyses of unpollinated stigmas (Mock), self-pollinated stigmas (SP), cross-pollinated stigmas within the same subgenus (CP), and inter-subgenus cross-pollination stigmas (ISCP) in water lily to elucidate the formation mechanism of the inter-subgeneric hybridization barrier. Our results indicated that the lack of ABA and BR in ISCP stigmas are key factors contributing to the formation of the inter-subgeneric hybridization barrier in water lily. Exogenous application of ABA and BR can help overcome the barrier between inter-subgeneric water lily crosses. Through transcriptome analysis, we identified nine candidate genes involved in regulating the inter-subgeneric hybridization barrier in water lily. In addition, we further demonstrated the importance of the NCED2-mediated ABA synthesis pathway in the hybridization process through AS-ODN technology. Our study confirms that ABA and BR are critical for breaking the inter-subgeneric hybridization barrier in water lily. The identification of the nine candidate genes provides important clues for further research on the hybridization recognition mechanism in water lily.
Prevalence and factors associated with sarcopenia among older adults in a post-acute hospital in Singapore
Authors: Tan Charmaine You Mei , Seah Sharna Si Ying , Lim Doris Yanshan , Koh Siew Van , Ganeshan Karthikeyan , Xia Olivia Jiawen , Low Xuan Lin , Quek Hui Yi , Ong Andrea Shuyi , Low Lian Leng , Aw Junjie 
Published: September 2023

AbstractBackgroundSarcopenia is common in older adults worldwide, but its prevalence varies widely owing to differences in diagnostic criteria, population sampled, and care setting. We aimed to determine the prevalence and factors associated with sarcopenia in patients aged 65 and above admitted to a post-acute hospital in Singapore.MethodsThis was a cross-sectional study of 400 patients recruited from a community hospital in Singapore. Data including socio-demographics, physical activity, nutritional status, cognition, clinical and functional status, as well as anthropometric measurements were collected. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 criteria (AWGS2019).ResultsOf the 383 patients with complete datasets, overall prevalence of sarcopenia was 54% while prevalence of severe sarcopenia was 38.9%. Participants with increased age, male gender and a low physical activity level were more likely to be sarcopenic, while those with higher hip circumference and higher BMI of ≥27.5m/kg2 were less likely to be sarcopenic. Other than the above-mentioned variables, cognitive impairment was also associated with severe sarcopenia.ConclusionsThere is a high prevalence of sarcopenia in older patients admitted to a post-acute hospital in Singapore. There is an urgent need to address this important clinical syndrome burden and to identify patients at higher risk of sarcopenia in post-acute settings in Singapore for early intervention.Key pointsOne in two older adults are sarcopenic and one in three older adults are severely sarcopenic in a post-acute setting, indicating a high prevalence of sarcopenia and underscoring the urgency to address sarcopenia now.Age, sex, physical activity, hip circumference and BMI are associations with sarcopenia. In addition, cognition is also associated with severe sarcopenia.This is the first inpatient study in Singapore looking at sarcopenia associations and it lends support to global literature on associations of sarcopenia and allows for possible interventions to target modifiable risk factors in sarcopenia.