Large Drop Research Articles

Comparison of the effectiveness and safety profile of centrifugal and membrane plasma separation in artificial liver therapy with a dual plasma molecular adsorption system

Objective: To compare the effectiveness and safety profile of centrifugal and membrane plasma separation model in artificial liver therapy with a dual plasma molecular adsorption system (DPMAS). Method: A retrospective study was conducted. Data of inpatients with liver failure who were treated with DPMAS therapy in the Liver Disease Center of Nanfang Hospital, Southern Medical University, from October 2022 to June 2024 were included. Clinical data such as demographic characteristics, etiology, DPMAS treatment-related indicators (including plasma separation method, vascular access, frequency of treatment, treatment duration, type of anticoagulant drugs, and membrane rupture condition), and laboratory test indicators before and after DPMAS treatment were collected. Categorical variables were compared by the χ² test. Continuous variables were compared using a t-test or a non-parametric test between groups. Result: Data of 232 cases with liver failure who received artificial liver therapy with DPMAS were included. A total of 473 times DPMAS treatment was given. The average age was 50 years old, and males accounted for 82.3%. Centrifugal plasma separation was the initial DPMAS treatment in 176 (75.9%) cases, while membrane plasma separation was used in 56 cases (24.1%). The most common vascular access for DPMAS treatment was the internal jugular vein. The most commonly used anticoagulant was unfractionated heparin. The treatment duration of DPMAS was significantly higher with centrifugal separation than that with membrane separation (P<0.001). Hemoglobin levels (mean before and after treatment in the centrifugal: 112.8 g/L vs. 106.3 g/L, P<0.001; mean before and after treatment in the membrane group: 108.4 g/L vs. 103.3 g/L, P<0.001), red blood cell count (mean before and after treatment in the centrifugal group: 3.7×109/L vs. 3.5×109/L, P<0.001; mean before and after treatment in the membrane group: 3.5×109/L vs. 3.3×109/L, P<0.001) and platelet count (mean before and after treatment in the centrifugal group: 134.5×109/L vs. 119.6×109/L, P<0.001; mean before and after treatment in the membrane group: 120.7 ×109/L vs. 97.3 ×109/L, P<0.001) were slightly decreased following initial DPMAS treatment in both groups. The decrease in platelets was significantly lower in centrifugal separation than that in membrane separation (median: 10.4% vs. 17.0%; P=0.003). There was no statistically significant difference observed in the proportion of puncture site bleeding in terms of plasma separation-related adverse events between the two groups, but plasma separator membrane rupture occurred two times in the DPMAS treatment. Conclusion: Centrifugal and membrane separation, both with DPMAS therapy, can cause a slight decrease in hemoglobin, red blood cell count, and platelets in patients with liver failure. Membrane separation causes a larger drop in platelets than centrifugal plasma separation. The operational convenience of medical personnel, the risk of membrane rupture, the coagulation markers, the patient's vascular condition, and other factors should be comprehensively considered when choosing the plasma separation model.

Clinical and Laboratory Features Predict Phenoconversion from Sporadic Adult-onset Ataxia to Multiple System Atrophy.

To determine predicting factors and frequency of phenoconversion from sporadic adult-onset ataxia (SAOA) to multiple system atrophy (MSA). We performed a retrospective review of all patients referred for cerebellar ataxia from 1998 to 2018 at Mayo Clinic, Minnesota. We analyzed clinical features, autonomic testing, and imaging for predictors of later diagnosis of MSA. Among 169 patients with ataxia at presentation, 60 (35.5%) phenoconverted to MSA. Clinical features in MSA phenoconverters included: early autonomic symptoms, stridor, and dream enactment behavior. Imaging features in phenoconverters included pontine atrophy and hot cross bun sign. On autonomic testing, MSA phenoconverters had higher supine blood pressures with larger drops, higher median composite autonomic severity scores, and higher percentage anhidrosis than patients with SAOA. Our findings show that at least a third of patients with SAOA phenoconverted to MSA. Clinical features, autonomic testing, and imaging at presentation may be helpful to identify such patients.

Cerebral Blood Flow Dynamics in Neurogenic Orthostatic Hypotension: A Systematic Review and Meta-Analysis.

Neurogenic orthostatic hypotension (nOH) causes pathological falls in standing blood pressure that may or may not be symptomatic. nOH also raises the risk of poor neurological outcomes irrespective of symptom presence, possibly reflecting subclinical cerebral hypoperfusion. Dynamic changes in cerebral blood flow velocity (CBFv) help infer how blood pressure fluctuations influence CBFv and cerebral autoregulation. Whether CBFv is impacted in nOH relative to related conditions without nOH and healthy controls (HC) remains unresolved. Whether nOH symptoms reflect greater CBFv falls is also unclear. This review aimed to compare CBFv between nOH and HC, nOH and disease-matched controls (eg, Parkinson disease±nOH), and between symptomatic and asymptomatic nOH. Embase and MEDLINE were searched up to April 2024. Means, SDs, and sample sizes for supine and upright CBFv were extracted to generate standardized effect sizes (Hedge g). Random-effects modeling compared postintervention between-group effect sizes. Seventeen studies were included for review. Thirteen studies were suitable for meta-analysis comparing nOH to HC, 2 comparing disease-matched controls to nOH and to HC, and 3 for symptomatic comparisons. Compared with HC, nOH had larger drops in CBFv (Hedge g, -0.64 [95% CI, -0.85 to -0.44]; P<0.001). CBFv falls between nOH and disease-matched controls were similar (P=0.17). Symptomatic nOH had larger CBFv drops (Hedge g, 0.84 [95% CI, 0.212-1.461]; P=0.009) than asymptomatic nOH. nOH causes significant orthostatic reductions in CBFv compared with HC, and symptomatic patients experience greater falls in CBFv than asymptomatic patients. Recognizing the clinical implications of CBFv in nOH is crucial for mitigating adverse outcomes.

The Potential for Long-lived Intermediate-mass Black Hole Binaries in the Lowest Density Dwarf Galaxies

Intermediate-mass black hole (IMBH) mergers with masses 104–106 M ⊙ are expected to produce gravitational waves detectable by the Laser Interferometer Space Antenna (LISA) with high signal-to-noise ratios from the present day to cosmic dawn. IMBH mergers are expected to take place within dwarf galaxies; however, the dynamics, timescales, and effect on their hosts are largely unexplored. In a previous study, we examined how IMBHs would pair and merge within nucleated dwarf galaxies. IMBHs in nucleated hosts evolve very efficiently, forming a binary system and coalescing within a few hundred million years. Although the fraction of dwarf galaxies (107 M ⊙ ≤ M ⋆ ≤ 1010 M ⊙) hosting nuclear star clusters is between 60% and 100%, this fraction drops to 20%–70% for lower-mass dwarfs (M ⋆ ≈ 107 M ⊙), with the largest drop in low-density environments. Here, we extend our previous study by performing direct N-body simulations to explore the dynamics and evolution of IMBHs within nonnucleated dwarf galaxies, under the assumption that IMBHs exist within these dwarfs. To our surprise, none of the IMBHs in our simulation suite merge within a Hubble time, despite many attaining high eccentricities e ∼ 0.7–0.95. We conclude that extremely low stellar density environments in the centers of nonnucleated dwarfs do not provide an ample supply of stars to interact with an IMBH binary, resulting in its stalling, in spite of triaxiality and high eccentricity, common means to drive a binary to coalescence. Our findings underline the importance of considering all detailed host properties to predict IMBH merger rates for LISA.

Change in Cardiometabolic Health Following Participation in Cardiac Rehabilitation for Coronary Heart Disease: Effect Modification by Metabolic Syndrome Status.

To investigate changes in cardiometabolic risk factors after completion of cardiac rehabilitation (CR) for coronary heart disease (CHD) and ascertain whether the magnitude of improvement in cardiometabolic health differs between those with and without metabolic syndrome (MetS). In this observational cohort study, data were analyzed from 1984 patients enrolled in CR at the University of Michigan between 2011-01-01 and 2020-02-29 for the indication of CHD. Patient characteristics were collected from standardized health questionnaires and during CR intake evaluations. Cardiometabolic biomarkers were recorded from baseline laboratory data and re-examined upon completion of CR. Differences in baseline patient characteristics by MetS status were compared using chi-square tests. Wilcoxon rank-sum tests were used to compare baseline differences, and signed-rank tests were used to evaluate the change in variables between baseline and completion of CR. The difference of change by MetS status was assessed using difference-in-differences regression models. Of the 1984 patients, 1070 (53.9%) met the criteria for MetS at baseline, of which 770 were male (72.0%). Those with MetS lost 1.43 pounds more (95% CI: 0.56, 2.31, P = 0.001), experienced a 0.21 larger drop in body mass index (95% CI: 0.03, 0.37, P = 0.02), and had a 0.31 greater reduction in waist circumference (95% CI: 0.08, 0.54, P = 0.008). Difference-in-differences regression models revealed those with MetS experienced a greater reduction in triglycerides and fasting glucose, with a difference of change of -8.70 for triglycerides (95% CI: -15.04, -2.37, P = 0.007) and -5.48 for glucose (95% CI: -10.44, -0.53, P = 0.03). There was no significant difference in the change in HDL-C or LDL-C for MetS status. Compared to those without MetS, patients with MetS experienced a comparable or greater benefit from CR, particularly with respect to improvements in MetS components.

Representativeness of Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Trial Participants

Underrepresentation by race and ethnicity in oncology clinical trials, including those of hematopoietic cell transplantation (HCT), is a known challenge. This analysis studied accrual on Blood and Marrow Transplant Clinical Trials Network (BMT CTN) trials conducted in 2014 to 2020 by race/ethnicity, age, and sex, comparing these characteristics with those of potentially eligible patients identified from the Surveillance, Epidemiology, and End Results (SEER) and Center for International Blood and Marrow Transplant Research (CIBMTR) databases for the disease, age, and years of interest of BMT CTN studies. Five BMT CTN trials met the inclusion criteria, including 1 autologous HCT trial and 4 allogeneic HCT trials. Two studies focused on multiple myeloma (BMT CTN 1302 and 1401), 2 studies focused on graft-versus-host disease (GVHD) treatment (BMT CTN 1301 and 1501), and 1 study focused on post-HCT maintenance therapy in FLT3+ acute myelogenous leukemia (BMT CTN 1506). A decline in the proportion of patients from minority racial and ethnic groups was seen from the SEER population to trial enrollees, with the largest drop seen between the SEER population and all patients who underwent HCT (on or off trial) at US transplant centers. Allogeneic HCT trials that allowed alternative donor graft sources had less decrease from the SEER population. No decrease in clinical trial enrollment was seen with respect to older age and female HCT recipients. This study provides insight into the underrepresentation of racial and ethnic minority patients in BMT CTN clinical trials, owing largely to lack of access to HCT in general. Pathways expanding access to donors and improving the outreach of HCT programs to underserved populations are needed to improve access to clinical trials.

Vitamin C-Rich Guava Consumed with Mungbean Dal Reduces Anemia and Increases Hemoglobin but not Iron Stores: A Randomized Controlled Trial of Food-to-Food Fortification in Indian Children

BackgroundAdding vitamin C-rich fruit to staples containing iron could be an effective strategy to improve iron bioavailability and thereby reduce iron-deficiency anemia in children. ObjectivesWe aimed to assess the effect of consuming a mungbean-based meal with or without guava fruit on body iron stores, hemoglobin concentration, and anemia of children as part of a school feeding program. MethodsWe conducted a 7-mo randomized, controlled trial with 6- to 10-y-old school children (n = 200; 46% anemic, 71% iron-deficient) from a rural community in Haryana, North India. Children were assigned to 2 treatment groups to daily receive either a meal of mungbean dal only (3.0 mg iron; vitamin C:iron molar ratio ∼0.5:1), or mungbean dal with fresh guava (3.2 mg iron; ∼170 mg vitamin C; molar ratio ∼18:1). Meals were served every school day under supervision. The primary outcome was body iron stores, whereas concentrations of hemoglobin and other iron indicators were secondary outcomes. ResultsDaily consumption of mungbean dal along with guava did not result in an overall improvement of body iron stores [mean treatment effect: 0.65 mg/kg body weight; 95% confidence interval (CI): −0.34, 1.63; P = 0.197]. However, compared with children who consumed mungbean dal only, children in the guava group showed a larger increase in hemoglobin concentration (3.7 g/L; 95% CI: 1.6, 5.6; P = 0.001), and a larger drop in the prevalence of anemia (−51%; 95% CIs: −74, −10; P = 0.022) and iron-deficiency anemia (−56%, 95% CI: −83, 13; P = 0.087). These effects were more pronounced in children who were iron deficient at study start. ConclusionsAddition of guava to a mungbean-based meal containing a moderate amount of iron increased hemoglobin and reduced anemia but did not provide enough additional absorbed iron to also increase body iron stores. Food-to-food fortification by inclusion of vitamin C-rich fruits in iron-containing school meals may help alleviate the burden of anemia in children. Trial registration numberThis trial was registered at https://clinicaltrials.gov/ct2/show/NCT01191463.

Impact of gas adsorption of nitrogen, argon, methane, and CO2 on gas permeability in nanoporous rocks

Gas adsorption on the surface of nanoporous rocks is an important process that occurs in many applied scenarios such as shale gas production or CO2 enhanced gas recovery or storage. While there are few theoretical considerations on the effect of gas adsorption on permeability, a systematic laboratory investigation of the impact of gas adsorption on gas flow and permeability is still lacking. In this paper, permeability of four adsorptive gases, i.e., nitrogen, argon, methane, and carbon dioxide, was measured, along with helium permeability, for two nanoporous rock samples that have high and low total organic carbon (TOC) content, respectively. The measurements were conducted at a range of pore pressures from 150 to 1500 psi (1.03–10.34 MPa). Gas adsorption isotherms were also measured at the same conditions. A mathematical model that considers adsorption with specific boundary conditions for the experimental setup was used for data analysis. The results show that gas adsorption causes larger drop in pressure decay and greater retardation in pressure equilibrium. However, the reduction of permeability relative to helium (25%–46%) is similar for gases with different levels of adsorption, indicating the occurrence of single-layer adsorption for these gases. Comparison between the two samples further supports the concept of single-layer adsorption and signifies the impact of pore size on the permeability reduction due to adsorption. These new findings deepen the fundamental understanding and provide important clarification on the effect of gas adsorption on gas flow and permeability in nanoporous rocks.

Impact of state tuition guarantee policy on enrollment in public universities

PurposeThis study estimates the effect of the Truth-in-Tuition policy on the enrollment of first-year students, minority students and all students (total enrollment) in Illinois universities.Design/methodology/approachEconometric models yield robust estimates using state- and time-fixed effects. This research uses the nonparametric Difference-in-Difference (DID) method. Variation in the starting of the Truth-in-Tuition policy across the Midwestern states is used as a natural experiment.FindingsResults demonstrate that the Truth-in-Tuition policy helped increase freshman enrollment but did not significantly impact minority enrollment. This policy, however, shows a much larger drop in total enrollment in Illinois universities.Originality/valueA comparison between regionally competing institutions under different policy regimes was not analyzed earlier.

Effect of Work-related Stress on Breast Milk Feeding Beyond 6 Month of the Baby, among the Nursing Personnel: A Cross Sectional Study

Abstract Background: The largest drop in continuing breast milk feeding occurs with the return of the lactating mothers to work. Stress amongst the working mothers affects milk production. Nursing is a stressful job and work-related stress impacts nurses’ health-related quality of life. The effect of work-related stress on breast milk feeding beyond 6 months of the baby amongst nursing mothers is an unexplored area. Objectives: (a) To assess the work-related stress, (b) to estimate the proportion of discontinued breast milk feeding beyond 6 months of the baby and (c) to find out the association (if any) between work-related stress and discontinuation of breast milk feeding beyond 6 months, amongst the nursing personnel of Siliguri subdivision of Darjeeling district. Materials and Methods: A cross-sectional study was carried out amongst the eligible study population using a work-related stress questionnaire. Chi-square test was done as a test of association and binomial logistic regression was used to find out the adjusted odds ratio (AOR). Results: Work-related stress was present in 62.4% of the respondents, while 70.9% had discontinued breastfeeding beyond 6 months. 79.5% of respondents with work-related stress had discontinued breastfeeding. Nursing staffs having work-related stress had higher odds of discontinuing breastfeeding (AOR: 3.682; confidence interval: 1.4035–9.659). Conclusion: Work-related stress is present in a large proportion of nursing staffs and many of them have discontinued breast milk feeding beyond 6 months of age of their babies, which is influenced by work-related stress.

Future amazon basin wetland hydrology under projected climate change

Climate change over the Amazon basin has the potential to cause major hydrological and ecological impacts over the region’s extensive wetlands. To investigate this the Joint UK Land Environment Simulator (JULES) land surface model is first extended to include riverine inundation. Potential impacts of future climate change on Amazon basin wetlands are then evaluated by driving this updated JULES model with modelled meteorology projections from six different climate simulations reaching approximately 4°C global warming at the end of the 21st Century. The projected changes in inundation extent and seasonality are assessed over four major wetland regions. The simulations project, on average, a significant decrease in total Amazon basin inundated area of 11% (range: -36% to +9%) by the 2090s. This considerable spread is primarily driven by disparity in simulated precipitation changes, ultimately driven by sea surface temperature differences. The wetter contemporary climate simulations simulate the greatest drying by the end of this Century, resulting in the largest wetland area reductions. The largest qualitative disagreement is over the western Iquitos wetland, with inundated area changes ranging from a very large reduction of -53% to an increase of 12%. A new wetland classification scheme is developed to summarise the projected changes in wetland seasonality. The largest drops in simulated wetland season length occur over the Central/East Manaus and West Iquitos wetland regions, with reductions of up to 10 and 8 months respectively. Such significant changes in future inundation are likely to have a major impact on regional wetland hydrology and their ecosystems.

Global, regional, and national burdens of atopic dermatitis under 14: a trend analysis and future prediction based on the global burden of disease study 2019.

The aim is to evaluate the global, regional, and national trends in the burden of children and adolescents under 14 from 1990 to 2019, as well as future trend predictions. In Global Burden of Disease (GBD), we reported the incidence, prevalence rate and the years lived with disability (YLDs), the incidence per 100,000 people, and the average annual percentage change (AAPC). We further analyzed these global trends by age, gender, and social development index (SDI). We use joinpoint regression analysis to determine the year with the largest global trend change. Bayesian age-period-cohort (BAPC) was used for predictions. From 1990 to 2019, the incidence rate, prevalence and YLDs of AD under 14 years old showed a downward trend. The incidence rate of AD among people under 5 years old has the largest decline [AAPC: -0.13 (95% CI: -0.15 to -0.11), P < 0.001]. The incidence rate, prevalence and YLDs of AD in women were higher than those in men regardless of age group. Regional, Asia has the highest AD incidence rate in 2019. National, Mongolia has the highest AD incidence rate in 2019. The largest drop in AD incidence rate, prevalence and YLDs between 1990 and 2019 was in the United States. From 1990 to 2019, the global incidence rate of children and adolescents under 14 declined. With the emergence of therapeutic drugs, the prevalence and YLDs rate declined significantly. From 2020 to 2030, there is still a downward trend.

Asian and Pacific Islander cancer mortality trends in the United States between 1999-2020.

e23307 Background: The Asian and Pacific Islander (API) population is the fastest growing in the United States, composing nearly 7% of the US population. Although cancer is the second leading cause of death overall in the U.S., it is the leading cause of death in the API population. Despite this, no study has assessed trends in cancer mortality in API individuals in the US. Our aim was to analyze differences and trends in API cancer mortality in the U.S. between 1999 to 2020. Methods: The CDC WONDER database was used to determine mortality statistics for patients, classified as non-Hispanic Asian or Pacific Islander, with cancer (ICD-10 codes C00-C97) as the underlying cause of death between 1999 and 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths, and were stratified by cancer type, sex, population density, U.S. census region, and age. Joinpoint regression software was used to identify temporal trends. Average annual percent change (APC) was considered statistically significant if p &lt; 0.05. Results: Between 1999 and 2020, cancer accounted for 305,386 deaths in API individuals. During this period, there was a 30% decrease in mortality due cancer and a decrease in APC of -1.5% (p &lt; 0.05). When stratified by cancer site, the largest decrease in APC was in stomach cancer at -3.7% (p &lt; 0.05), and the largest increase was in uterine cancer at 2.6% (p &lt; 0.05). In 1999, males experienced an overall cancer-related AAMR of 151, 48% higher than females at 103; however, by 2020 these differences reduced, with males having a cancer-related AAMR of 105.6 vs API females of 80.9, a 25% difference. Males experienced a larger decrease in APC (-1.8%, p &lt; 0.05), compared with females (-1%, p &lt; 0.05). Rural populations had the largest cancer-related AAMR (113.0) and largest drop in APC (-2%, p &lt; 0.05), compared with urban groups with a cancer-related AAMR of 106.7 and APC drop (-1.3%, p &lt; 0.05). The highest cancer related AAMRs was seen in lung cancer (24.3 in urban vs 25.4 in rural). Liver-cancer related AAMR was highest in urban populations at 10.4 and lowest in rural populations at 8.2. Western census regions had the highest AAMR at 113.7 with an APC decrease of –1.4% and Southern census regions had the lowest AAMR at 90.5 with an APC decrease of –1.2%. Adults aged &gt; 65 experienced the highest cancer related AAMR at 588.2, and adults aged 25-44 demonstrated the lowest AAMR at 14.7. However, adults aged 25-44 experienced the largest decrease in APC at -2% (p &lt; 0.05), compared with adults aged &gt; 65 at -1.4% (p &lt; 0.05). Conclusions: Our study identifies a significant decrease in cancer mortality in API individuals between 1999 and 2020. The largest decrease seen was in stomach cancer; however, uterine cancer mortality has increased. Notably, liver cancer mortality was higher in urban rather than rural groups. Further studies may examine differences amongst API and other racial groups, and potential sources for the disparities seen amongst API individuals.

Testing the generalizability and effectiveness of deep learning models among clinics: sperm detection as a pilot study

BackgroundDeep learning has been increasingly investigated for assisting clinical in vitro fertilization (IVF). The first technical step in many tasks is to visually detect and locate sperm, oocytes, and embryos in images. For clinical deployment of such deep learning models, different clinics use different image acquisition hardware and different sample preprocessing protocols, raising the concern over whether the reported accuracy of a deep learning model by one clinic could be reproduced in another clinic. Here we aim to investigate the effect of each imaging factor on the generalizability of object detection models, using sperm analysis as a pilot example.MethodsAblation studies were performed using state-of-the-art models for detecting human sperm to quantitatively assess how model precision (false-positive detection) and recall (missed detection) were affected by imaging magnification, imaging mode, and sample preprocessing protocols. The results led to the hypothesis that the richness of image acquisition conditions in a training dataset deterministically affects model generalizability. The hypothesis was tested by first enriching the training dataset with a wide range of imaging conditions, then validated through internal blind tests on new samples and external multi-center clinical validations.ResultsAblation experiments revealed that removing subsets of data from the training dataset significantly reduced model precision. Removing raw sample images from the training dataset caused the largest drop in model precision, whereas removing 20x images caused the largest drop in model recall. by incorporating different imaging and sample preprocessing conditions into a rich training dataset, the model achieved an intraclass correlation coefficient (ICC) of 0.97 (95% CI: 0.94-0.99) for precision, and an ICC of 0.97 (95% CI: 0.93-0.99) for recall. Multi-center clinical validation showed no significant differences in model precision or recall across different clinics and applications.ConclusionsThe results validated the hypothesis that the richness of data in the training dataset is a key factor impacting model generalizability. These findings highlight the importance of diversity in a training dataset for model evaluation and suggest that future deep learning models in andrology and reproductive medicine should incorporate comprehensive feature sets for enhanced generalizability across clinics.

Tailoring the wrap: intraoperative functional lumen imaging probe (FLIP) during hiatal hernia repair

IntroductionThe introduction of the functional lumen imaging probe (FLIP) has provided objective, real-time feedback on the geometric variations with each component of a hiatal hernia repair (HHR). The utility of this technology in altering intraoperative decision-making has been scarcely reported. Herein, we report a single-center series of intraoperative FLIP during HHR.MethodsA retrospective review of electronic medical records between 2020 and 2022 was conducted and all patients undergoing non-recurrent HHR with FLIP were queried. Patient and hernia characteristics, intraoperative FLIP values and changes in decision-making, as well as early post-operative outcomes were reported. Both diameter and distensibility index (DI) were measured at 40 ml and 50 ml balloon inflation after hiatal dissection, after hiatal closure, and after fundoplication when indicated.ResultsThirty-three patients met inclusion criteria. Mean age was 62 ± 14 years and mean BMI was 28 ± 6 kg/m2. The majority (53%) were type I hiatal hernias. The largest drop in DI occurred after hiatal closure, with minimal change seen after fundoplication (mean DI of 4.3 ± 2. after completion of HH dissection, vs 2.7 ± 1.2 after hiatal closure and 2.3 ± 1 after fundoplication when performed). In 13 (39%) of cases, FLIP values directly impacted intraoperative decision-making. Fundoplication was deferred in 4/13 (31%) patients, the wrap was loosened in 2/13 (15%); the type of fundoplication was altered to achieve adequate anti-reflux values in 2/13 (15%) patients, and in 1/13 (3%) the wrap was tightened.ConclusionFLIP measurements can be used intraoperatively to guide decision-making and alter management plan based on objective values. Long-term outcomes and further prospective studies are required to better delineate the value of this technology.

Caregivers with limited English proficiency: Satisfaction with primary pediatric healthcare.

With a growing 25.5 million people in the United States experiencing limited-English proficiency (LEP), there is a concern over these individuals' experiences in healthcare. Health outcomes of LEP status are well-documented for adults in hospitals; however, less is known about patient experience, pediatric populations, and primary care settings. This study investigated differences in caregiver satisfaction between families with and without LEP receiving healthcare for their child. A sample of 25,118 caregivers whose children from birth to 17years had met with any healthcare providers in the past year was used. Analyses consisted of unpaired t-tests comparing mean satisfaction of LEP and English-proficient (EP) caregivers in the domains of how often primary healthcare providers spent enough time with the child, listened, provided specific information, demonstrated sensitivity to the family's values, and made the respondent feel like a partner. In all aspects of caregiver satisfaction, mean satisfaction scores were significantly lower for LEP caregivers than EP caregivers. The largest drops were seen in perceived time and sensitivity. These results highlight a need to ensure LEP families receive equitable and high-quality primary care services, ultimately building trust in the healthcare system and improving children's health and well-being.

HIV-derived Proteins induce Hypertension, Sympatho-activation, and neuroinflammation via T cell-dependent mechanisms

Combination antiretroviral therapy (cART) has markedly increased life expectancy in people living with HIV (PLWH) and induced a switch in the cause of death from opportunistic diseases to cardiovascular disease (CVD). CVD is currently the leading cause of death in PLWH and hypertension, the primary risk factor for CVD, presents in more than 65% of them. However, the mechanisms whereby hypertension develops in PLWH remain unknown. In PLWH on cART, T lymphocytes (T cells) remain a viral reservoir for HIV and continue to secrete viral proteins. Viral proteins remain in circulation and are expressed in the central nervous system. Herein, we tested the hypothesis that expression of HIV-derived proteins increases blood pressure (BP), induces sympatho-activation and inflammation of the central nervous system. We utilized the Tg26 mouse model which expresses 7/9 viral proteins. Quantitative PCR analysis of viral protein expression showed that Tat, gp120, Nef, Vif, and Vpr are primarily expressed in spleen, lung, and brain tissues in Tg26 mice. Morphometric analysis revealed slight but significant increases and decreases in lean mass and fat weights respectively in Tg26. Flow cytometry analysis showed no reduction in CD4+ T cells in Tg26 mice indicating that this mouse model does not progress to AIDS and reproduce the conditions of virally suppressed PLWH. Blood pressure (BP) measurement via telemetry revealed a hypertensive phenotype in male and female Tg26 mice. Hypertension was associated with a larger drop in BP in response to ganglionic blockade but no alterations in heart rate responses to muscarinic and β-adrenergic receptor blockade in Tg26 mice, indicating that viral proteins expression increases neurogenic control of BP but did not alter cardiac autonomic control. β-adrenergic receptor blockade did not reduce BP in Tg26 mice. Tg26 mice also display increased aortic vasoconstriction to phenylephrine. To test the contribution of T cells in BP regulation and sympatho-activation, mice were subjected to a CTLA-4 inhibitor, abatacept, which inhibits T cell activation. Abatacept treatment significantly reduced BP, sympatho-activation, and phenylephrine constriction in Tg26 mice with no effects on wild-type mice. To determine whether the increase in sympatho-activation involves central inflammation, inflammatory cytokines and T cell markers levels were measured in the brain. Levels of pro-inflammatory cytokines including IL-1α, TNFα, IL-6, and CCL2 were increased in the brain of Tg26 mice as well as levels of the T-cell marker GATA3. Altogether, our data shows that the expression of HIV-derived proteins increases BP, sympatho-activation, and vascular adrenergic contractility via T cell-dependent mechanisms likely through central mechanisms involving neuro-inflammation. R01HL147639-01A1, R01HL15526501 and 19EIA34760167 (E.J.B). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Droplet Formation and Energy Input during Induction Wire Melting with Pulsed and Constant Generator Power

Induction heating is a fast, reproducible, and efficient heating method used in various manufacturing processes. However, there is no established additive manufacturing (AM) process based on induction heating using wire as feedstock. This study investigates a novel approach to AM based on inductive heating, where a steel wire is melted and droplets are detached periodically using a two-winding induction coil. The process parameters and energy input into the droplets are characterized. The induction generator exhibits a sluggish response to the excitation voltage, resulting in a lag in the coil current. The process is captured using a high-speed camera, revealing a regular droplet formation of 14 Hz and uniform shapes and sizes between 2.11 and 2.65 mm in diameter when operated within an appropriate process window. Larger drops and increased spatter formation occur outside this window. The proposed method allows for the production of droplets with almost spherical shapes. Further analysis and characterization of droplet formation and energy input provide insights into process optimization and indicate an overall efficiency of approximately 10%.

Compensatory advantage and inequality in educational aspirations

Using two administrative and survey-based datasets from Hungary, I look at how children from different socioeconomic backgrounds update their educational aspirations in response to having to repeat a grade late in primary school. I find that grade retention is detrimental to aspirations and later secondary school track choice, and on average, it affects children of lower socioeconomic backgrounds more adversely. The average effect masks heterogeneities by the reasons for repeating: those children who are likely to repeat seventh grade due to poor mathematics performance do not change their aspirations significantly after retention, regardless of their socioeconomic background. However, they are less likely to attend a secondary school track that provides access to tertiary education. As we move towards higher performers in mathematics – and consequently, more heterogeneous reasons for repeating –, retention results in a larger drop in aspirations and the probability of a secondary track ending with a high school diploma. In both outcomes, high socioeconomic status largely and, in some cases, entirely offsets the adverse effects.

Gaze Estimation by Attention-Induced Hierarchical Variational Auto-Encoder.

Appearance-based gaze estimation has been widely studied recently with promising performance. The majority of appearance-based gaze estimation methods are developed under the deterministic frameworks. However, the deterministic gaze estimation methods suffer from large performance drop upon challenging eye images in low-resolution, darkness, partial occlusions, etc. To alleviate this problem, in this article, we alternatively reformulate the appearance-based gaze estimation problem under a generative framework. Specifically, we propose a variational inference model, that is, variational gaze estimation network (VGE-Net), to generate multiple gaze maps as complimentary candidates simultaneously supervised by the ground-truth gaze map. To achieve robust estimation, we adaptively fuse the gaze directions predicted on these candidate gaze maps by a regression network through a simple attention mechanism. Experiments on three benchmarks, that is, MPIIGaze, EYEDIAP, and Columbia, demonstrate that our VGE-Net outperforms state-of-the-art gaze estimation methods, especially on challenging cases. Comprehensive ablation studies also validate the effectiveness of our contributions. The code will be publicly released.