bluuebunny/crossref_metadata_2025_split huggingface dataset:
H-ferritin in sows’ colostrum- and milk-derived extracellular vesicles: a novel iron delivery concept
Authors: Palsa Kondaiah , Connor James R , Flanagan John , Hines Elizabeth A 
Published: January 2023

Abstract
Iron deficiency anemia is a significant problem in piglets, as they are born with insufficient iron stores for supporting their rapid body growth. Further, sows’ milk contains inadequate iron levels for meeting the demands of piglet rapid growth in the pre-wean stage. The forms of iron present in the milk are essential to understanding bioavailability and potential routes for supplementing iron to mitigate iron deficiency anemia in piglets. Recently, our studies showed that H-ferritin (FTH1) is involved in iron transport to different tissues and can be used as an oral iron supplement to correct iron deficiency in rats and monkeys. In this study, we investigate the FTH1 levels in colostrum and milk in Yorkshires-crossbred sows (n = 27) and collected samples at the 1st, 15th, and 28th days of lactation to measure FTH1. Colostrum and milk were found to have FTH1, but there is no significant difference between the different days of lactation. FTH1 has been observed to be enriched in extracellular vesicles (EVs) of other species, and therefore examined the EVs in the samples. Colostrum-derived EVs were enriched with L-ferritin compared to FTH1, while in milk-derived EVs, only FTH1 was detected (P = 0.04). In milk-derived EVs, FTH1 was significantly higher (P = 0.021; P = 006) than FTH1 in colostrum-derived EVs. Furthermore, FTH1 levels of milk-derived EVs were significantly higher (P = 0.0002; P = 0004) than whole milk and colostrum FTH1. These results indicate that FTH1 is enriched in the milk-derived EVs and suggest that EVs play a predominant role in the FTH1 delivery mechanism for the piglet. The extent to which FTH1 in EVs accounts for the overall iron delivery mechanism in piglets is yet to be determined.
Alzheimer’s, Advance Directives, and Interpretive Authority
Authors: Barzun Charles L 
Published: January 2023

AbstractPhilosophers have debated whether the advance directives of Alzheimer’s patients should be enforced, even if patients seem content in their demented state. The debate raises deep questions about the nature of human autonomy and personal identity. But it tends to proceed on the assumption that the advance directive’s terms are clear, whereas in practice they are often vague or ambiguous, requiring the patient’s healthcare proxy to make difficult judgment calls. This practical wrinkle raises its own, distinct but related, philosophical question: what criteria may the proxy bring to bear when making such interpretive judgments on which the patient’s life may depend? After defending a general policy of enforcing advance directives on normative (rather than metaphysical) grounds, I argue that when advance directives are vague, a patient’s proxy may permissibly make her own fresh evaluation of the patient’s life as a whole and, in so doing, consider how the patient’s character as a demented person contributes or fails to contribute to that life.
Uncertainty, Evidence, and the Integration of Machine Learning into Medical Practice
Authors: Grote Thomas , Berens Philipp 
Published: January 2023

AbstractIn light of recent advances in machine learning for medical applications, the automation of medical diagnostics is imminent. That said, before machine learning algorithms find their way into clinical practice, various problems at the epistemic level need to be overcome. In this paper, we discuss different sources of uncertainty arising for clinicians trying to evaluate the trustworthiness of algorithmic evidence when making diagnostic judgments. Thereby, we examine many of the limitations of current machine learning algorithms (with deep learning in particular) and highlight their relevance for medical diagnostics. Among the problems we inspect are the theoretical foundations of deep learning (which are not yet adequately understood), the opacity of algorithmic decisions, and the vulnerabilities of machine learning models, as well as concerns regarding the quality of medical data used to train the models. Building on this, we discuss different desiderata for an uncertainty amelioration strategy that ensures that the integration of machine learning into clinical settings proves to be medically beneficial in a meaningful way.
Towards clarity: the ‘may be affected’ requirement and non-party intervention at the International Court of Justice
Authors: Avayiwoe Gracious 
Published: January 2023

Abstract
Intervention at the International Court of Justice (the Court) has re-emerged as a trending topic amid the Application of the Genocide Convention (The Gambia v Myanmar) and Allegations of Genocide under the Genocide Convention (Ukraine v Russian Federation). This article advances an approach to straightening the indeterminacy regarding the threshold of proof of the ‘which may be affected by the decision in the case’ expression under Article 62 of the Court’s Statute for non-party intervention. The Court deems the wording a second and substantive condition of the provision, the assessment of which remains controversial. Notwithstanding the permissiveness of the latest Order, Jurisdictional Immunities of the State(Germany v Italy), the complication lingers. The said Order did not refer to the requirement. It fell outside the purview of maritime boundary, to which all previous and inconsistent orders of the Court on non-party intervention relate.
Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Variants on Short- and Mid-term Cardiac Outcomes in Multisystem Inflammatory Syndrome in Children
Authors: Pinninti Swetha , Hebson Camden , Collins Jacqueline , Trieu Connie , Boppana Sushma , Buchfellner Markus , Seripin Cathy , Yarbrough April , Poole Claudette , Ross Shannon , James Scott , Hutto Cecelia , Boppana Suresh 
Published: January 2023

Abstract
Cardiac outcomes of 131 children with multisystem inflammatory syndrome (MIS-C) were examined. The majority of the cohort was male (66.4%) and half were Black (49.6%). Cardiac involvement was evident in 25% of the cohort at diagnosis. Favorable short- and mid-term outcomes were documented on follow-up, irrespective of the severe acute respiratory syndrome coronavirus 2 variants causing the infection.
Emergency Savings among Persistently Poor Households: Evidence from a Field Experiment
Authors: Roll Stephen , Despard Mathieu , Grinstein-Weiss Michal , Bufe Sam 
Published: January 2023

AbstractLow-income households struggle to accumulate emergency savings, which increases economic vulnerability in the face of unexpected events like expensive car repairs. This vulnerability may be even greater among persistently low-income households, which might benefit most from building emergency savings using tax refunds. This study examined the effects of randomly assigned behavioral interventions that incorporated a choice architecture manipulation and savings-related messages aimed at encouraging refund saving and delivered through a free, online tax-filing software program. The study sample comprised 4,536 tax filers, including 1,235 with persistent low incomes. Using administrative tax data and data from a two-wave household financial survey, regression-adjusted treatment impacts were estimated using intent-to-treat analysis to examine whether filers had any of their tax refunds still in savings and how much of their refund they still had saved six months after filing their taxes. Results indicated directional but nonstatistically significant increases in these savings outcomes across three treatment groups for the full sample, yet statistically significant treatment effects among the persistently low-income subsample, effects that were moderated by the prefiling absence of emergency resources. These results suggested that tax-time savings interventions are most effective among low-income households with the greatest needs for emergency savings.
Effectiveness of Kurtosis-Adjusted Cumulative Noise Exposure in Assessing Occupational Hearing Loss Associated With Complex Noise
Authors: Xin Jiarui , Shi Zhihao , Qian Peiyi , Liu Shuangyan , Hao Yinzhu , Gao Xiangjin , Zhou Lifang , Yang Lei , Zhang Meibian 
Published: January 2023

Objectives:
Occupational noise-induced hearing loss (NIHL) is one of the most prevalent occupational diseases worldwide. Few studies have been reported on applying kurtosis-adjusted noise energy (e.g., kurtosis-adjusted cumulative noise exposure, CNE-K) as a joint indicator for assessing NIHL. This study aimed to analyze the effectiveness of CNE-K in assessing occupational hearing loss associated with complex noise in typical manufacturing industries.

Design:
A cross-sectional survey of 1404 Chinese manufacturing workers from typical manufacturing industries was conducted. General demographic characteristics, noise exposure data, and noise-induced permanent threshold shifts (NIPTS) at 3, 4, and 6 kHz (NIPTS346) were collected and analyzed. The role of kurtosis in high-frequency noise-induced hearing loss (HFNIHL) was also analyzed. The degree of overlap of the two logistic curves (i.e., between complex noise CNE-K and HFNIHL%, and between Gaussian noise CNE and HFNIHL%) was used to evaluate the effectiveness of CNE-K, using a stratified analysis based on age, sex, industry, or job type.

Results:
The binary logistic regression analysis showed that in addition to age, sex, exposure duration, and Eight-hour Continuous Equivalent A-weighted Sound Pressure Level (LAeq,8h), kurtosis was a key factor influencing HFNIHL% in workers (odds ratio = 1.18, p < 0.05), and its odds ratio increased with an increase in kurtosis value. Multiple linear regression analysis demonstrated that the contribution of kurtosis to NIPTS346 was second to LAeq,8h. Complex noise led to a higher risk of NIHL than Gaussian noise at frequencies of 3, 4, 6, and 8 kHz after adjusting for age, sex, and CNE (p < 0.05). As kurtosis increased, the notch in the audiogram became deeper, and the frequency at which the notch began to deepen shifted from 3 to 1 kHz. The logistic curve between complex noise CNE-K and HFNIHL% nearly overlapped with that between Gaussian noise CNE and HFNIHL%, and the average difference in HFNIHL% between the two curves decreased from 8.1 to 0.4%. Moreover, the decrease of average difference in HFNIHL% between the two logistic curves was evident in several subgroups, such as male workers, aged <30 and 30 to 50 years, furniture and woodworking industries and gunning and nailing job types with relatively high kurtosis values.

Conclusions:
Kurtosis, as an indirect metric of noise temporal structure, was an important risk factor for occupational NIHL. Kurtosis-adjusted CNE metric could be more effective than CNE alone in assessing occupational hearing loss risk associated with complex noise.
Safety of Incision Placement with Nipple-sparing Mastectomy and Immediate Prepectoral Breast Reconstruction
Authors: Holland Michael , Wallace Adam , Viner Jennifer , Sbitany Hani , Piper Merisa 
Published: January 2023

Background:
In nipple-sparing mastectomy, adequate perfusion to the nipple-areolar complex (NAC) during reconstruction is paramount to avoiding unwanted outcomes. Previous studies have suggested that periareolar incisions may result in higher rates of NAC complications. However, studies to date have not specifically investigated this in prepectoral reconstruction. The purpose of this study is to evaluate the impact of incision location on NAC complications in patients undergoing prepectoral breast reconstruction.

Methods:
We performed a retrospective review of all patients who underwent immediate two-stage prepectoral breast reconstruction following nipple-sparing mastectomy between 2015 and 2018 at a single institution. We identified two types of incisions utilized: superior periareolar or inframammary fold (IMF). Patient demographics, comorbidities, and surgical details were compared between incision types, as were NAC complications.

Results:
A total of 181 consecutive prepectoral breast reconstructions were included for analysis. A superior periareolar incision was used in 113 reconstructions (62%), and an IMF incision was used in 68 reconstructions (38%). There were 33 (18%) total NAC complications in our series. The periareolar incision group had a higher rate of any NAC complication (25% versus 7.4%; P < 0.01), as well as a higher rate of nipple necrosis requiring debridement (9.7% versus 1.5%; P = 0.03).

Conclusions:
In patients undergoing immediate two-stage prepectoral breast reconstruction following nipple-sparing mastectomy, periareolar incisions are associated with an increased risk of NAC complications compared with IMF incisions. For patients who are candidates for either an IMF or periareolar incision, a periareolar incision should be avoided.
Barriers to Research: A National Survey of Physician Assistant Faculty
Authors: Lolar Sara , Welch Robert D. , Garino Alexandria 
Published: January 2023

Introduction
Success in research is a well-known challenge for physician assistant (PA) educators. Multiple barriers to research productivity have been proposed. This study examines potential barriers to PA research productivity.

Methods
Two hundred forty-seven PA programs were stratified by region and Carnegie classification, creating 28 strata. One program was randomly sampled from each stratum, and faculty from sampled programs were invited to participate (N = 214). An electronic survey was deployed via Qualtrics. Data were analyzed, accounting for the stratified survey sample design. Reported are proportions with associated 95% confidence intervals.

Results
Survey response rate was 53% (N = 114). The mean age was 46.7 years [44.5, 48.8 years] and 61% [52.4, 70.4] of respondents were female. Most respondents (53.5%; [44.2, 62.8]) were assistant professors and reported being employed as PA faculty for a mean of 12.4 years [11.2, 13.7 years]. Most respondents (68.1%; [59.7, 76.6]) reported 0 peer-reviewed research articles regardless of number of years as faculty. Few reported an interest in research (22.3%; [14.3, 29.9]) or felt internally driven to perform research (35.4%; [26.6, 44.2]). Most pursued a faculty position to teach (78.1%; [70.5, 85.7]) and spent little time pursuing research. Only 15.8% ([9.7, 21.9]) received research mentorship.

Discussion
This study identified lack of interest in research by faculty and lack of mentorship engagement as important factors underlying the profession’s poor scholarly output. Initiatives to increase scholarship must first focus on fostering individual interest and increasing motivation.
Clinical and Demographic Features of 49 Patients With Human Monkeypox Virus–Confirmed Infection in a Tertiary Care Center in Valencia, Spain: A Descriptive Study
Authors: Grau Echevarría Andrés , Peñuelas Leal Rodrigo , Martínez Domenech Álvaro , Labrandero Hoyos Carolina , Lorca Spröhnle Javier , Casanova Esquembre Andrés , García Deltoro Miguel , Ocete-Mochón María Dolores , Magdaleno Tapial Jorge , Pérez Ferriols Amparo , Sánchez Carazo José Luis , Hernández Bel Pablo 
Published: January 2023

This was a study of monkeypox-infected patients in a tertiary care center in Spain describing the epidemiologic, clinical, and microbiologic features of 49 patients.

Background
Monkeypox is a previously rare viral zoonosis affecting predominantly the African continent. Since May 2022, an increasing number of cases with no known epidemiologic link to Africa have been reported for the first time in the rest of the world.

Methods
We described the epidemiologic and clinical characteristics of all patients attended at our center until August 9 with a confirmed diagnosis of monkeypox.

Results
Forty-nine patients were included. The mean age was 37.6 years. Ninety-eight percent of patients were male, 96% were men who have sex with men, and 4% were heterosexual. Thirty-one percent of patients had a history of human immunodeficiency virus infection. Ninety-six percent of patients declared a unprotected sexual relationship before the onset of symptoms, and 41% had a history of recent travel. Ninety-eight percent of patients presented with cutaneous involvement affecting the genital (59%), perianal (41%), and perioral (35%) regions. Systemic symptoms were present in 80% of the patients and included lymphadenopathies (71%), asthenia (65%), fever (65%), headache (37%), arthromyalgias (45%), pharyngitis (35%), proctitis (29%), and dysuria (6%). Coinfection by other sexually transmitted infections was detected in 20% of patients. The sensitivity values of polymerase chain reaction test for monkeypox in urethral, anal, and oropharyngeal exudates analyzed were 88%, 79%, and 68%, respectively. Complications included a myopericarditis that represented the only hospitalized patient, edema (8%) and bacterial superinfection (4%). No deaths were reported.

Conclusions
The findings of this case series support the sexual contact as the main route of transmission of the disease and highlight some atypical clinical presentations not described in endemic cases.
Optic neuritis: current challenges in diagnosis and management
Authors: Benard-Seguin Etienne , Costello Fiona 
Published: January 2023

Purpose
The primary aim of this review is to describe the clinical course, salient imaging features, and relevant serological profiles of common optic neuritis (ON) subtypes. Key diagnostic challenges and treatment options will also be discussed.

Recent findings
ON is a broad term that describes an inflammatory optic nerve injury arising from a variety of potential causes. ON can occur sporadically, however there is particular concern for co-associated central nervous system (CNS) inflammatory syndromes including multiple sclerosis (MS), neuromyelitis optic spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD). The ON subtypes that often herald MS, NMOSD, and MOGAD differ with respect to serological antibody profile and neuroimaging characteristics, yet there is significant overlap in their clinical presentations. A discerning history and thorough examination are critical to rendering the correct diagnosis.

Summary
Optic neuritis subtypes vary with respect to their long-term prognosis and accordingly, require different acute treatment strategies. Moreover, delays in identifying MOGAD, and certainly NMOSD, can be highly detrimental because affected individuals are vulnerable to permanent vision loss and neurologic disability from relapses.
Longitudinal gut microbial signals are associated with weight loss: insights from a digital therapeutics program
Authors: Kumbhare Shreyas V. , Pedroso Inti , Joshi Bharat , Muthukumar Karthik M. , Saravanan Santosh K. , Irudayanathan Carmel , Kochhar Gursimran S. , Dulai Parambir S. , Sinha Ranjan , Almonacid Daniel E. 
Published: January 2023

AbstractObesity is a significant health problem due to its profound health deteriorating effects and high costs for healthcare systems. There exist lifestyle and pharmacological interventions available to prevent and reverse obesity; however, at the population level, these have shown to be insufficient, and we continue to see a worldwide increase in obesity prevalence. The gut microbiome has been shown to influence the susceptibility to weight gain and difficulty in losing weight and to be associated with successful long-term weight loss. Therefore, multiple studies have suggested that obesity interventions should consider the gut microbiome as a primary target through an improved diet and a crucial endpoint to monitor. However, there is a paucity of evidence regarding how to tailor the diet for an individual’s microbiome and what changes are expected to occur due to successful weight management. Digital therapeutics solutions have emerged as an exciting alternative to increase population access, reduce costs, and have the potential to accompany individuals on their health-promoting journey closely. Digbi Health has developed a dietary and lifestyle program to achieve weight loss that effectively reduces weight and improves diverse health outcomes by prioritizing and personalizing food ingredients to match an individual’s genetic profile and nurture the gut microbiome. In this study, we analyze the weight loss pattern and microbiome profile of 103 individuals to identify the effects of the weight loss program on the gut microbiome between their baseline and follow-up samples. We found that 80% of individuals lost weight during the study.Analysis of their gut microbiome identified genera, functional pathways, and microbial communities associated with BMI changes and dietary and lifestyle program. The microbial genera and functional pathways associated with a reduction in BMI during the study include several previously reported in the literature, includingAkkermansia, Christensenella, Oscillospiraceae,Alistipes, andSutterella, short-chain fatty acid (SCFA) production and degradation of simple sugars like arabinose, sucrose, and melibiose. Network analysis identified two microbiome communities associated with BMI, one of which also significantly responded to the weight loss program, which includes multiple known associations with BMI and obesity. Our findings provide additional evidence for using the gut microbiome as an endpoint of weight loss program and highlight how it positively impacts the gut microbiome, with significant parallels in weight loss and health outcomes. These results provide additional evidence for known microbiome biomarkers of obesity and highlight new ones that warrant further research.
A tissue centric atlas of cell type transcriptome enrichment signatures
Authors: Dusart P , Öling S , Struck E , Norreen-Thorsen M , Zwahlen M , von Feilitzen K , Oksvold P , Bosic M , Iglesias MJ , Renne T , Odeberg J , Pontén F , Lindskog C , Uhlén M , Butler LM 
Published: January 2023

SUMMARYGenes with cell type specific expression typically encode for proteins that have cell type specific functions. Single cell RNAseq (scRNAseq) has facilitated the identification of such genes, but various challenges limit the analysis of certain cell types and lowly expressed genes. Here, we performed an integrative network analysis of over 6000 bulk RNAseq datasets from 15 human organs, to generate a tissue-by-tissue cell type enrichment prediction atlas for all protein coding genes. We profile all the major constituent cell types, including several that are fragile or difficult to process and thus absent from existing scRNAseq-based atlases. The stability and read depth of bulk RNAseq data, and the high number of biological replicates analysed, allowed us to identify lowly expressed cell type enriched genes that are difficult to classify using existing methods. We identify co-enriched gene panels shared by pancreatic alpha and beta cells, chart temporal changes in cell enrichment signatures during spermatogenesis, and reveal that cells in the hair root are a major source of skin enriched genes. In a cross-tissue analysis, we identify shared gene enrichment signatures between highly metabolic and motile cell types, and core identity profiles of cell types found in across tissue types. Our study provides the only cell type gene enrichment atlas generated independently of scRNAseq, representing a new addition to our existing toolbox of resources for the understanding of gene expression across human tissues.