bluuebunny/crossref_metadata_2025 huggingface dataset:
Intensive care unit caseload and workload and their association with outcomes in critically unwell patients: a large registry-based cohort analysis
Authors: Zajic Paul , Engelbrecht Teresa , Graf Alexandra , Metnitz Barbara , Moreno Rui , Posch Martin , Rhodes Andrew , Metnitz Philipp
Published: September 2024

Background

Too high or too low patient volumes and work amounts may overwhelm health care professionals and obstruct processes or lead to inadequate personnel routine and process flow. We sought to evaluate, whether an association between current caseload, current workload, and outcomes exists in intensive care units (ICU).

Methods

Retrospective cohort analysis of data from an Austrian ICU registry. Data on patients aged ≥ 18 years admitted to 144 Austrian ICUs between 2013 and 2022 were included. A Cox proportional hazards model with ICU mortality as the outcome of interest adjusted with patients’ respective SAPS 3, current ICU caseload (measured by ICU occupancy rates), and current ICU workload (measured by median TISS-28 per ICU) as time-dependent covariables was constructed. Subgroup analyses were performed for types of ICUs, hospital care level, and pre-COVID or intra-COVID period.

Results

415 584 patient admissions to 144 ICUs were analysed. Compared to ICU caseloads of 76 to 100%, there was no significant relationship between overuse of ICU capacity and risk of death [HR (95% CI) 1.06 (0.99–1.15), p = 0.110 for > 100%], but for lower utilisation [1.09 (1.02–1.16), p = 0.008 for ≤ 50% and 1.10 (1.05–1.15), p < 0.0001 for 51–75%]. Exceptions were significant associations for caseloads > 100% between 2020 and 2022 [1.18 (1.06–1.30), p = 0.001], i.e., the intra-COVID period. Compared to the reference category of median TISS-28 21–30, lower [0.88 (0.78–0.99), p = 0.049 for ≤ 20], but not higher workloads were significantly associated with risk of death. High workload may be associated with higher mortality in local hospitals [1.09 (1.01–1.19), p = 0.035 for 31–40, 1.28 (1.02–1.60), p = 0.033 for > 40].

Conclusions

In a system with comparably high intensive care resources and mandatory staffing levels, patients’ survival chances are generally not affected by high intensive care unit caseload and workload. However, extraordinary circumstances, such as the COVID-19 pandemic, may lead to higher risk of death, if planned capacities are exceeded. High workload in ICUs in smaller hospitals with lower staffing levels may be associated with increased risk of death.
Transcriptional silencing in Saccharomyces cerevisiae: known unknowns
Authors: Dhillon Namrita , Kamakaka Rohinton T.
Published: September 2024

Transcriptional silencing in Saccharomyces cerevisiae is a persistent and highly stable form of gene repression. It involves DNA silencers and repressor proteins that bind nucleosomes. The silenced state is influenced by numerous factors including the concentration of repressors, nature of activators, architecture of regulatory elements, modifying enzymes and the dynamics of chromatin.Silencers function to increase the residence time of repressor Sir proteins at silenced domains while clustering of silenced domains enables increased concentrations of repressors and helps facilitate long-range interactions. The presence of an accessible NDR at the regulatory regions of silenced genes, the cycling of chromatin configurations at regulatory sites, the mobility of Sir proteins, and the non-uniform distribution of the Sir proteins across the silenced domain, all result in silenced chromatin that only stably silences weak promoters and enhancers via changes in transcription burst duration and frequency.These data collectively suggest that silencing is probabilistic and the robustness of silencing is achieved through sub-optimization of many different nodes of action such that a stable expression state is generated and maintained even though individual constituents are in constant flux.
Prevalence of cardiovascular events in a population-based registry of patients with systemic lupus erythematosus
Authors: Joyce Daniel P. , Berger Jeffrey S. , Guttmann Allison , Hasan Ghadeer , Buyon Jill P. , Belmont H. Michael , Salmon Jane , Askanase Anca , Bathon Joan , Geraldino-Pardilla Laura , Ali Yousaf , Ginzler Ellen M. , Putterman Chaim , Gordon Caroline , Helmick Charles G. , Barbour Kamil E. , Gold Heather T. , Parton Hilary , Izmirly Peter M.
Published: September 2024

Background

The Manhattan Lupus Surveillance Program (MLSP), a population-based retrospective registry of patients with systemic lupus erythematosus (SLE), was used to investigate the prevalence of cardiovascular disease events (CVE) and compare rates among sex, age and race/ethnicity to population-based controls.

Methods

Patients with prevalent SLE in 2007 aged ≥ 20 years in the MLSP were included. CVE required documentation of a myocardial infarction or cerebrovascular accident. We calculated crude risk ratios and adjusted risk ratios (ARR) controlling for sex, age group, race and ethnicity, and years since diagnosis. Data from the 2009–2010 National Health and Nutrition Examination Survey (NHANES) and the 2013–2014 NYC Health and Nutrition Examination Survey (NYC HANES) were used to calculate expected CVE prevalence by multiplying NHANES and NYC HANES estimates by strata-specific counts of patients with SLE. Crude prevalence ratios (PRs) using national and NYC estimates and age standardized prevalence ratios (ASPRs) using national estimates were calculated.

Results

CVE occurred in 13.9% of 1,285 MLSP patients with SLE, and risk was increased among men (ARR:1.7, 95%CI:1.2–2.5) and older adults (age > 60 ARR:2.5, 95%CI:1.7–3.8). Compared with non-Hispanic Asian patients, CVE risk was elevated among Hispanic/Latino (ARR:3.1, 95%CI:1.4-7.0) and non-Hispanic Black (ARR:3.5, 95%CI1.6-7.9) patients as well as those identified as non-Hispanic and in another or multiple racial groups (ARR:4.2, 95%CI:1.1–15.8). Overall, CVE prevalence was higher among patients with SLE than nationally (ASPR:3.1, 95%CI:3.0-3.1) but did not differ by sex. Compared with national race and ethnicity-stratified estimates, CVE among patients with SLE was highest among Hispanics/Latinos (ASPR:4.3, 95%CI:4.2–4.4). CVE was also elevated among SLE registry patients compared with all NYC residents. Comparisons with age-stratified national estimates revealed PRs of 6.4 (95%CI:6.2–6.5) among patients aged 20–49 years and 2.2 (95%CI:2.1–2.2) among those ≥ 50 years. Male (11.3, 95%CI:10.5–12.1), Hispanic/Latino (10.9, 95%CI:10.5–11.4) and non-Hispanic Black (6.2, 95%CI:6.0-6.4) SLE patients aged 20–49 had the highest CVE prevalence ratios.

Conclusions

These population-based estimates of CVE in a diverse registry of patients with SLE revealed increased rates among younger male, Hispanic/Latino and non-Hispanic Black patients. These findings reinforce the need to appropriately screen for CVD among all SLE patients but particularly among these high-risk patients.
Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia
Authors: Zulu Joseph Mumba , Maritim Patricia , Halwiindi Hikabasa , Chavula Malizgani Paul , Munakampe Margarate , Matenga Tulani Francis L. , Mweemba Chris , Sinyangwe Ntazana N. , Habib Batuli , Musukuma Mwiche , Silumbwe Adam , Wang Bo , Kaonga Patrick , Chewe Mwimba , Fisa Ronald , Banda Jeremiah , Mubanga Angel , Phiri Henry
Published: September 2024

Background

Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia.

Methods

Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action.

Results

The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members.

Conclusion

This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens).
In-Vitro evaluation of antidiabetic, antioxidant, and anti-inflammatory activities in Mucuna pruriens seed extract
Authors: Yadav Jagat Pal , Pathak Prateek , Yadav Seema , Singh Abhishek , Palei Narahari N. , Verma Amita
Published: September 2024

Background

Mucuna pruriens var. utilis (Wall. ex Wight) belonging to the family Fabaceae. Renowned for its diverse array of phytochemicals, this plant has been historically employed in the treatment of various ailments. The objectives of this study are to evaluate the anti-diabetic, anti-inflammatory, and antioxidant properties of the optimized M. pruriens var. utilis seed extract.

Methods

The in-vitro anti-inflammatory activity of M. pruriens var. utilis ethanolic extracts was scrutinized using the Human Red Blood Cell (HRBC) method. To evaluate antioxidant activity, ABTS and DPPH assays were employed. Furthermore, the antidiabetic activity was assessed through α-amylase and α-glucosidase inhibition assays.

Results

In the ethanolic extract of M. pruriens var. utilis numerous phytoconstituents were found by doing a phytochemical analysis (alkaloids, flavonoids, phenols, saponins, steroids, glycosides, tannins). The total phenolic and flavonoid content were determined to be 112.07 ± 1.21 mg of gallic acid equivalents GAE/g and 101.41 ± 1.08 mg of quercetin equivalents QE/g respectively. In this investigation ethanolic extract of M. pruriens var. utilis exhibited a high anti-inflammatory, antioxidant and antidiabetic activities in a dose-dependent manner. The M. pruriens var. utilis extract shows that anti-inflammatory activity 32.26 ± 3.23%, potent antioxidant effect by ABTS radical scavenging assay IC50 67.46 ± 1.45 µg/mL and DPPH radical scavenging assay IC50 63.34 ± 2.27 µg/mL and in addition, showed promising antidiabetic potential by inhibiting α-amylase IC50 33.42 ± 1.35 µg/mL and α-glucosidase IC50 28.34 ± 1.41 µg/mL.

Conclusion

These findings provide additional support for the traditional medicinal use of M. pruriens var. utilis in treating inflammation, oxidative stress, and diabetes mellitus.
Enhancing nurse competence in early recognition of cardiotoxicity
Authors: Kolbus Jeff , Adeola Mopelola T. , Tipton Janelle M. , Luebcke Caitlin E. D.
Published: September 2024

Background

Preliminary research reveals that many nurses feel inadequate and possess limited knowledge when it comes to managing cardiotoxicity, underscoring the necessity for educational programs to enhance nursing skills in this area.

Methods

The aim of the study was to assess the impact of an educational intervention on nurses perceived self-efficacy in recognizing patients exhibiting symptoms of cancer treatment-related cardiotoxicity. The study was set in a 16-bed cardiac critical care unit (CCU) within a 462-bed hospital. The sample group was comprised of registered nurses (RNs) working on or floating to the CCU. The study used a within-subjects design. Participants completed a pre-education survey, attended one of six 30-minute education interventions, and completed a post-education survey. The outcome variables were 7 self-confidence questions from the Nursing Self-Efficacy Scale for Managing Cancer Treatment-Related Cardiotoxicity (NSS-CTC) on a 5-point Likert scale and one yes or no self-efficacy question. Descriptive statistics and paired T-tests were applied to analyze pre- and post-education surveys.

Results

The pre-and post-education comparative analysis for each of the 7 NSS-CTC self-confidence questions was statistically significant with test statistics ranging from t = 3.43 to t = 8.69 and p-values ranging from 0.0021 to less than 0.0001. All 26 RNs answered “yes” in their ability to detect symptoms of cancer therapy-related cardiotoxicity after the education.

Conclusions

The lack of education for cardiac nurses against the backdrop of increasing cardiotoxicity in cancer patients showcases the essential need for cardiac nurse early symptom recognition education.
A rare differential diagnosis of aortic stenosis with a black aortic valve: A case report
Authors: Rangwala Zarin S. , Radhakrishnan Bineesh K. , Patel Pruthvi S. , Dash Prasanta K. , Gayathri G. , Pillai Vivek V.
Published: September 2024

Background

Cardiac ochronosis, presenting as a rare manifestation of alkaptonuria, an autosomal recessive disorder, is characterised by black pigmentation of calcified cardiac valves and atherosclerotic plaques. We report an intraoperative dilemma on the discovery on the black aortic valve in a case of an old lady with degenerative calcific aortic stenosis.

Case presentation

A 60-year-old lady was electively admitted for valve replacement with a bioprosthetic valve for severe aortic stenosis. She was symptomatic with complaints of headache and giddiness and had a pressure gradient of 113/17mmhg across the aortic valve. Intraoperatively, she was found to have cardiac ochronosis on the discovery of pigmented aortic intima extending to the valve leaflets and underwent valve replacement with a mechanical prosthetic valve. She was post-operatively evaluated for the same and diagnosed with alkaptonuria. Though the surgery went uneventful and the patient was discharged without any complication, she was advised to be on regular follow-up to assess valve gradients, paravalvular leaks and to monitor the disease progression.

Conclusion

The presented case sheds light on the rare cardiac manifestation of alkaptonuria. In the absence of definitive pre-operative diagnosis, intraoperative findings played a pivotal role in guiding the surgical approach and choice of prosthetic valve. The decision to use a mechanical valve was influenced by the potential risks associated with bioprosthetic valves in the setting of ochronosis. Ongoing follow-up and monitoring are essential to assess the durability of the chosen prosthetic valve and to manage any long-term consequences of the underlying metabolic condition.
Isolated diastolic hypertension and cardiovascular outcomes across different diagnostic guidelines: a systematic review and meta-analysis
Authors: Agarwal Abhimanyu , Mostafa Mohamed A. , Ahmad Muhammad Imtiaz , Soliman Elsayed Z.
Published: September 2024

Background

This systematic review aims to determine the impact of isolated diastolic hypertension (IDH) on cardiovascular outcomes.

Methods

We searched only English language articles on PubMed and SCOPUS until July 31, 2023 to investigate the association between IDH and cardiovascular outcomes.

Results

This meta-analysis of 19 studies evaluated the impact of different hypertension diagnostic guidelines (ACC/AHA: American Heart Association/American College of Cardiology; JNC7: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NICE/ESC: National Institute for Health and Care Excellence/European Society of Cardiology) on hypertension-related outcomes. Studies had varying sample sizes (173 to 2,969,679 participants) and study designs. In cohort studies using JNC7 guidelines, IDH was linked to increased cardiovascular disease (CVD) risk (HR: 1.45, 95% CI 1.17, 1.74), CVD mortality (HR: 1.54, 95% CI 1.23, 1.84), and coronary heart disease (CHD) risk (HR: 1.65). In studies using ACC/AHA guidelines, associations with CVD risk and CVD mortality were weaker [HR: 1.16 (95% CI 1.06, 1.25) and 1.10 (95% CI 0.95, 1.25), respectively]. Subgroup analysis revealed differences in outcomes on the basis of age and sex. Cross-sectional studies did not show significant associations with JNC7 and ACC guidelines; NICE guidelines were not used in cross-sectional studies.

Conclusion

IDH is associated with an increased risk of CVD. Higher diastolic blood pressure cutoffs were associated with higher cardiovascular risk. This association varied by study design and effect modification by sex and race influenced the association.
Exploring farmers attitudes towards genetically modified crops in northwest Bangladesh on the ground of epistemic emotions and cognitions
Authors: Iqbal Md. Hafiz
Published: September 2024

All GM crops fall into either the herbicide-tolerant (HT) or insect-resistant (IR) category. These crops play a crucial role in feeding the global population and ensuring food security for a larger number of population. However, the extent to which current assessments of supply-side effects inform food policy and cultivation decisions remains unclear. To advance knowledge in this area, it is essential to address existing evidence gaps and methodological design issues, which will influence the direction of future research. This study focuses on epistemological preferences among farmers in nortwest Bangladesh, aiming to modestly guide some direction for GM crops cultivation. The findings from the study reveal three distinct attitudinal discourses among investigated farmers. Some farmers are inclined to be positive toward the cultivation of GM crops, expecting benefits. Another group is more cautious, wary of the potential risks associated with GM crops but still likely to be reluctant adopters. A third group demonstrates a somewhat fatalistic perspective toward adopting GM crop cultivation, as revealed through the use of Q methodology. These findings contribute significantly to the ongoing GM debate by elaborating on the views of farmers from these three distinct groups and informing the design of policies related to GM crops.
The Effect of SGLT2 Inhibition on Brain-related Phenotypes and Aging: A Drug Target Mendelian Randomization Study
Authors: Chen Zhihe , Wu Xueyan , Yang Qianqian , Zhao Huiling , Ying Hui , Liu Haoyu , Wang Chaoyue , Zheng Ruizhi , Lin Hong , Wang Shuangyuan , Li Mian , Wang Tiange , Zhao Zhiyun , Xu Min , Chen Yuhong , Xu Yu , Lu Jieli , Ning Guang , Wang Weiqing , Luo Shan , Au Yeung Shiu Lun , Bi Yufang , Zheng Jie
Published: September 2024

Introduction

An observational study suggested sodium-glucose cotransporter 2 (SGLT2) inhibitors might promote healthy aging. However, whether brain-related phenotypes mediate this association is still a question. We applied Mendelian randomization (MR) to investigate the effect of SGLT2 inhibition on chronological age, biological age, and cognition and explore the mediation effects of brain imaging-derived phenotypes (IDPs).

Methods

We selected genetic variants associated with both expression levels of SLC5A2 (Genotype-Tissue Expression and eQTLGen data; n = 129 to 31 684) and hemoglobin A1c (HbA1c) levels (UK Biobank; n = 344 182) and used them to proxy the effect of SGLT2 inhibition. Aging-related outcomes, including parental longevity (n = 389 166) and epigenetic clocks (n = 34 710), and cognitive phenotypes, including cognitive function (n = 300 486) and intelligence (n = 269 867) were derived from genome-wide association studies. Two-step MR was conducted to explore the associations between SGLT2 inhibition, IDPs, and aging outcomes and cognition.

Results

SGLT2 inhibition was associated with longer father's attained age [years of life increase per SD (6.75 mmol/mol) reduction in HbA1c levels = 6.21, 95% confidence interval (CI) 1.27-11.15], better cognitive function (beta = .17, 95% CI 0.03-0.31), and higher intelligence (beta = .47, 95% CI 0.19-0.75). Two-step MR identified 2 IDPs as mediators linking SGLT2 inhibition with chronological age (total proportion of mediation = 22.6%), where 4 and 5 IDPs were mediators for SGLT2 inhibition on cognitive function and intelligence, respectively (total proportion of mediation = 61.6% and 68.6%, respectively).

Conclusion

Our study supported that SGLT2 inhibition increases father's attained age, cognitive function, and intelligence, which was mediated through brain images of different brain regions. Future studies are needed to investigate whether a similar effect could be observed for users of SGLT2 inhibitors.
Circadian Regulatory Networks of Glucose Homeostasis and Its Disruption as a Potential Cause of Undernutrition
Authors: Onuma Shinsuke , Kawai Masanobu
Published: September 2024

The circadian clock system, an evolutionarily conserved mechanism, orchestrates diurnal rhythms in biological activities such as behavior and metabolism, aligning them with the earth's 24-hour light/dark cycle. This synchronization enables organisms to anticipate and adapt to predictable environmental changes, including nutrient availability. However, modern lifestyles characterized by irregular eating and sleeping habits disrupt this synchrony, leading to metabolic disorders such as obesity and metabolic syndrome, evidenced by higher obesity rates among shift workers. Conversely, circadian disturbances are also associated with reduced nutrient absorption and an increased risk of malnutrition in populations such as the critically ill or the elderly. The precise mechanisms of these disturbances in leading to either overnutrition or undernutrition is complex and not yet fully understood. Glucose, a crucial energy source, is closely linked to obesity when consumed excessively and to weight loss when intake is reduced, which suggests that circadian regulation of glucose metabolism is a key factor connecting circadian disturbances with nutritional outcomes. In this review, we describe how the biological clock in various tissues regulates glucose metabolism, with a primary focus on studies utilizing animal models. Additionally, we highlight current clinical evidence supporting the association between circadian disturbance and glucose metabolism, arguing that such disruption could predominantly contribute to undernutrition due to impaired efficient utilization of nutrients.
Obesity as a risk factor for dementia and cognitive impairment - a systematic review
Authors: Cecot Jakub , Zarzecki Konrad , Mandryk Miłosz , Jerczyński Paweł , Dzik Dominika , Piasta Małgorzata
Published: September 2024

Obesity, affecting One in eight people, poses significant health risks, including an increased risk of cognitive impairment and dementia. This article is exploring the complex and multifaceted relationship between obesity and cognitive function, highlighting several mechanisms that may contribute to cognitive decline in obese individuals. Research reveals that obesity in middle age is associated with a higher risk of cognitive decline, while in older adults, it might provide some protection against rapid cognitive deterioration. In adolescents, obesity is linked to lower scores on cognitive tests, indicating damaging effects on cognitive abilities from an early age. Key mechanisms discussed include neuroinflammation, mitochondrial dysfunction, and insulin resistance. Neuroinflammation involves elevated levels of pro-inflammatory cytokines leading to increased blood-brain barrier permeability and potential neuronal damage. Mitochondrial dysfunction in obesity results in impaired neuronal function due to disrupted mitochondrial processes. Insulin resistance, a common feature of obesity, affects brain regions critical for memory and executive functions. Additionally, the impact of weight loss on cognitive function is examined, with evidence suggesting that weight reduction through bariatric surgery, lifestyle interventions, or pharmacological treatments can improve cognitive abilities. However, further research is needed to establish definitive causal relationships and to understand the underlying biological changes.
Porphyria in pregnancy with exacerbation after delivery due to COVID-19
Authors: Jartych Aleksandra , Michalska Karolina , Oleksak Izabela , Sauermann Janusz , Jamroz-Wiśniewska Anna , Rejdak Konrad
Published: September 2024

We present a case of acute intermittent porphyria (AIP) diagnosed in a pregnant woman with subsequent exacerbation after delivery due to COVID-19 infection. The patient’s symptoms manifested with acute neurovisceral attacks - abdominal pain followed by flaccid quadriparesis, sensory disturbances, hypertension and disturbance in electrolyte levels. The blood plasma test and a 24-hour urine collection revealed increased levels of urine porphobilinogen, 5-aminolevulinic acid and uroporphyrins, which led to the diagnosis of AIP. The patient received i.v. human hemin with positive outcome. After delivery she was again admitted to the hospital due to abdominal pain and trunk hyperesthesia that occurred after a mild course of COVID-19 infection. The second administration of human hemin led to the improvement of the patient's condition. The aim of this case report is to indicate that even with severe risk factors of AIP such as infection and pregnancy, proper diagnostics can increase the chance of quick recovery.
Experience of caregivers and healthcare professionals using a telemedicine programme in a paediatric palliative care unit
Authors: Carrasco Ana Suárez , Cantero María José Peláez , Piñero Jose Miguel García , Rodriguez Aurora Madrid
Published: September 2024

Background:

Telemedicine is a means of providing efficient treatment for children with complex chronic conditions and/or subsidiary palliative paediatric care.

Aim:

To evaluate how satisfied families and healthcare professionals are with a telemedicine programme.

Methodology:

This is a qualitative study of narrative design. Ten interviews were conducted with family members and professionals who had been using telemedicine for a year. Sampling was intentional and a discourse and content analysis was conducted.

Results:

Six thematic categories emerged from the analysis of the interviews: degree of satisfaction; usefulness; benefits according to patient needs and attention; technical and human difficulties; and implantation of the system and proposals for improvement.

Conclusions:

The study shows that telemedicine is a very useful complementary tool for healthcare professionals in a palliative care context. It is necessary to take into account the perception and needs of both families and healthcare professionals with regard to this tool since it can improve patient care.
Iranian Muslim women's adaptation after mastectomy
Authors: Shamloo Marzieh Beigom Bigdeli , Elahi Nasrin , Shamsi Aziz
Published: September 2024

Background:

Breast cancer is the most common malignancy among women. Women with breast cancer need to adapt all aspects of their life following their diagnosis.

Aim:

To investigate how women with breast cancer make adaptations in their lives to cope with the condition.

Methods:

A directed content analysis was used for this study and 23 participants were interviewed. The participants included women undergoing a mastectomy and their husbands, oncologists, oncology ward nurses and psychologists. Questions were asked regarding the participants' experiences of their adaptation to a mastectomy and cancer.

Results:

Data analysis led to the emergence of four dimensions; the physical dimension, self-concept, role-playing and interdependence. These four dimensions consisted of 21 main categories, 59 subcategories and 111 codes.

Conclusion:

The present study showed that despite the emergence of different coping approaches, women undergoing mastectomy have had various physical and mental problems that lead to role disruption. It is recommended that solutions be adopted to increase the adaptation of these patients.
The impact of toxic leadership
Authors: Ellis Peter , Abbott Jane
Published: September 2024

Peter Ellis discusses whether toxic leadership is becoming more prevalent and what kidney care professionals can do about if they think they might be becoming toxic or they are experiencing toxic leadership
GÜNÜMÜZ TÜRK BESTECİLERİNİN PİYANO ESERLERİNDE ÇAĞDAŞ MÜZİK TEKNİKLERİNİN KULLANIMI ÜZERİNE BİR İNCELEME
Authors: Eser Özgür , Beşevli Pınar
Published: September 2024

ÖZ
Yazılı kültürün ortaya çıkmasıyla birlikte toplumlar oluşturdukları müzik kültürünün belleklerden silinmesini önlemek ve nesiller boyu aktarımını sağlayabilmek için kültürlerine bağdaşık çeşitli semboller üreterek ses yazım sistemleri geliştirmişlerdir. Bu geliştirilen sistem ve semboller, müzik yazısı olarak adlandırılan notasyondur. Orta çağda kullanılmaya başlayıp günümüze kadar varlığını devam ettiren konvansiyonel nota sistemi, dönemlere ve zamanın müzikal ifadelerinin ihtiyaçlarına göre şekillenmiş ve özünü yirmi birinci yüzyıla kadar muhafaza etmeyi başarmıştır. Tarihsel süreç içerisinde özellikle yirminci yüzyılda çağdaş müzik akımlarının ortaya çıkmasıyla, müzikte çeşitli yeni teknikler kullanılmaya başlanmış ve müzikal değişimi aktarabilmek için notasyon üzerinde de çeşitli arayışlar, kullanımlar ve metotlar denenerek farklı notasyon biçimleri üretilmiştir. Yeni müzik tekniklerinin piyano için yazılan eserlerde sıklıkla rastlanır olması dolayısıyla bu çalışmada bu çalgı üzerine yazılmış eserlere yoğunlaşılmıştır. Bu çalışmada çağdaş müzik tekniklerinin neler olduğu ve konvansiyonel müzik yazısından nasıl ayrıldığı tarihsel bir betimlemeyle ele alınmıştır. Araştırmada günümüz Türk bestecilerinin piyano eserlerinde çağdaş müzik tekniklerini nasıl kullandıkları bunları notaya aktarım biçimleri ve bu teknikleri tercih etme sebeplerinin neler olduğunun ortaya çıkarılması amaçlanmaktadır. Bu doğrultuda yazdıkları piyano eserlerinde çağdaş müzik teknikleri kullanan günümüz Türk bestecilerinden altısı ile görüşülerek örnek eserler belirlenmiş ve eserlerinde kullandıkları teknikler ele alınmıştır. Çalışmada nitel bir araştırma yöntemi benimsemiştir. Literatür taraması ve yarı yapılandırılmış görüşme formu üzerinden elde edilen veriler, tarihsel bir dizgeyle ve betimsel analiz yöntemiyle değerlendirilmiştir. Araştırma, günümüz Türk bestecilerinin hangi çağdaş müzik tekniklerini nasıl kullandıklarına örnek oluşturma ve literatüre katkı sağlama amacını gütmektedir. Aynı zamanda çağdaş müzik alanında çalışan bestecilere, icracılara ve bu yönde çalışmalar yapan araştırmacılara önemli bir kaynak niteliği taşımaktadır.
16. YÜZYIL OSMANLI SARAY KUMAŞLARINDA VE TEZHİP SANATINDA ÇİÇEK SEVGİSİ: LÂLE
Authors: Uğurlu Servet Senem , Turgut Atilla Yusuf
Published: September 2024

Göçebe ve yerleşik Türk kültüründe ve sanatlarında çiçek ve çiçek sevgisi daima önemli olmuştur. Diğer toplumlarda olduğu gibi Türkler de doğada ve yaşadıkları ortamda gördükleri çiçekleri, süsleme unsuru olarak düşünmüşlerdir. Türkler, motif, sembol, damga, simge haline getirdiği çiçekleri, Geleneksel Türk Sanatlarında süsleme unsuru olarak kullanmışlardır. Yaygın olarak kullanılan geleneksel Türk motiflerini, yaşadıkları doğadan ve bahçe çiçekleri arasından seçmişlerdir. Bu çiçeklerden biri de lale olmuştur. Lale çiçeği, görünümü ve anlamları açısından Geleneksel Türk Sanatlarında önemli bir yere sahiptir. Türk kültüründe lale çiçeğine duyulan sevgi, merak ve ilgi nedeniyle, her alan ve her dönemde kullanıldığı için Geleneksel Türk Sanatlarının karakteristik motiflerinden biri olmuştur.
Osmanlı’da çiçek kültürü, çiçek sevgisi ve yetiştiriciliği; 15. yüzyılda Fatih Sultan Mehmet döneminde başlamıştır. Osmanlı Saray Sanatı, bu dönemde kurulan Saray Nakkaşhanesi ve Ehl-i Hiref Örgütü kontrolünde şekillenmiştir. Osmanlı sarayının çiçek sevgisi, 16. yüzyılda Kanuni Sultan Süleyman döneminde daha da artmıştır. 16. yüzyılın ortalarından itibaren tüm Osmanlı Saray Sanatlarında olduğu gibi, saray kumaşları ve tezhip sanatında temel motif olarak çiçek motifleri kullanılmış ve çiçek motifleri ile oluşturulmuş desen kompozisyonları dikkati çekmektedir. Osmanlı saray sanatları incelendiğinde; gül, lale, karanfil ve sümbülün çiçek tasvirleri ile Geleneksel Türk Sanatlarında en çok tercih edilen motifler olduğu görülmektedir. Osmanlı kültüründe özellikle lale, sembolik anlamları nedeniyle en gözde çiçeklerden biri olmuştur. Bu nedenle lale motifi, çeşitli stilize edilmiş biçimleriyle Osmanlı sanatlarında sıkça kullanılmıştır.
Bu araştırmada, 16. yüzyıl Osmanlı saray kumaşları ve tezhip sanatı örneklerinde kullanılan lale çiçeği incelenecek, tasvirleri araştırılacak, konuyla ilgili bilgi ve görüşler bir araya getirilecektir.
Anahtar Kelimeler: Lale, kumaş, tezhip, Osmanlı, çiçek.
Intergenerational emotions and family history: temporal feelings and national stories
Authors: Barclay Katie , Crozier-De Rosa Sharon
Published: September 2024

Intergenerational emotions highlight the feelings that we have for our ancestors and descendants, drawing attention to a lineage of feeling and its temporalities. This article revisits the idea of intergenerational emotions as a conceptual tool and methodological approach that is used to explore how we grapple with feelings that persist across time, and which draws attention to the importance of temporalities in shaping social structures and emotional practices. It particularly positions the family as a key site where ideas of emotion and temporality are negotiated, and so to generating intergenerational emotions as a historical and cultural construct. To illustrate this discussion, it uses the example of family history making in an exhibition by the Windrush Generation Legacy Association.
Between a rock and a hard place: domestic abuse and being a migrant woman in England and Wales
Authors: Yong Adrienne
Published: September 2024

Legal responses to domestic abuse have been a political priority of the UK Government since at least 2010, eventually leading to the passing of the seminal legislation in this area for England and Wales, the Domestic Abuse Act 2021. However, the exclusion of protection for migrant victim-survivors with precarious immigration statuses under the Act demonstrates a failure in understanding that the experience and risk of domestic abuse differ for these individuals from that of the mainstream, due to their intersectional identities as (predominantly) migrant women. Many migrant victim-survivors still find themselves trapped in abusive situations, as the law fails to safeguard their rights to reside legally should they choose to present themselves to authorities by reporting their abuse. A distinct lack of acknowledgment as to inequalities faced by those at the intersection of migrant status and gender (Crenshaw, 1989; 1991) has led to increased insecurity for some of the most vulnerable. This article shines a light on this discrimination under the law in England and Wales. It adopts an intersectionality framework to examine such inequality, analysing Appendix Violence Domestic Abuse and the Migrant Victim Domestic Abuse Concession in UK immigration law, as well as the Support for Migrant Victims Pilot and its relevant Evaluation Report, against the international standards of the Istanbul Convention. It argues that the UK Government is failing to tackle the problem of migrant victim-survivors’ protection concerning domestic abuse, and in some situations, has made it worse.This article aims to state the law as of 1 May 2024.
Polar response strategies across modalities: Evidence from German Sign Language (DGS)
Authors: Loos Cornelia , Steinbach Markus , Repp Sophie
Published: September 2024

Abstract: Research on spoken languages has shown that response particles may indicate the truth of a previous utterance or the polarity of the response. In responses to negative antecedents, the two functions come apart and particles become ambiguous. We present the first quantitative study on response strategies in sign languages by discussing data from a production experiment in German Sign Language ( Deutsche Gebärdensprache ; DGS). The results indicate that DGS does not exploit the potential of simultaneous manual and nonmanual strategies to disambiguate responses. Still, the type of articulator influences the choice of response element. We propose an optimality-theoretic model to account for the role of articulator type, the disambiguation potential, and the morphosyntax of response elements in DGS.
Cue reliability, communicative efficiency, and differential subject marking: Evidence from Korean
Authors: Lee Hanjung
Published: September 2024

Abstract: This article investigates the role of situational context in differential case marking. Evidence from conversation data in Korean demonstrates that caseless subjects are predominantly found in event-reporting clauses that have an agent directly identifiable in the here and now, while case-marked subjects are not similarly restricted. Based on this evidence, I propose a new account of differential subject marking in terms of an efficiency principle of negative correlation between length/complexity and cue reliability. I argue that the association of caseless subjects with seemingly unrelated features such as grounding in the here and now, nonstativity, and definiteness follows from speakers' efficient use of case marking motivated by the availability of strong situational cues to the intended role interpretation of a subject referent.
Syntactically branching out beyond the traditional classroom: A report on the discovery method
Authors: Costa-Silva Jean , Lee-Schoenfeld Vera
Published: September 2024

Abstract: This article reports on the successful implementation of the discovery method in an undergraduate Generative Syntax course. Rather than reading textbooks on syntactic analysis and doing exercises to apply what was read, students embark on a nine-stage learning cycle consisting of interactive, guided, and independent work. They engage with problem sets to build their own analyses of syntactic phenomena step by step. This method—meant to resemble the work of real-life scientists—allows students to hypothesize, experiment, and build knowledge from trial and error (Kolb 1984, Prince 2004). To measure the effectiveness of our pedagogy, we analyzed course evaluations submitted from 2012 to the present. Learner feedback shows that they find the assignments and activities helpful, that the course challenges them to think and learn, and that they consider the weekly write-ups demanding, yet highly beneficial for their learning.
Word order in Cherokee: Information structure, thematic structure, and variability
Authors: Hsu Brian , Frey Benjamin
Published: September 2024

Abstract: Although Cherokee is known to show highly flexible clausal word order, the principles that predict speakers' preferences among possible orders are not extensively described. This article presents a new description of the grammatical properties that predict clausal word order in spoken Cherokee, based on a corpus study of word-order variation. Our results show that the placement of nominal expressions relative to verbs, and the relative order of nominal expressions within a clause, are determined in a probabilistic way by the cumulative interaction of several factors: referential accessibility, contrast, and thematic role. The findings suggest that thematic properties may have a greater word-order role than generally assumed in languages with nonconfigurational and/or polysynthetic properties.
Poemas católicos del ciclo de El silbo vulnerado de Miguel Hernández: El silbo vulnerado primitivo
Authors: Doménech José María Balcells
Published: September 2024

Abstract: El artículo se centra en diferentes poemas de Miguel Hernández (1910–1942) de carácter religioso compuestos en el transcurso de los años 1933 y 1934. Tales textos iban a ser probablemente incluidos por el poeta en el primer proyecto de libro al que puso el título de El silbo vulnerado. Estas composiciones se elaboraron en varios tipos de métrica, y tienen una titulación en la que la primera palabra va en letras capitales, significando un concepto en su grado más alto, y la segunda en minúsculas, con la manifestación circunstancial de ese concepto. Un guion separa ambas palabras subrayando el diferente sentido que tienen. Dos rasgos estilísticos predominan en ellas, el oxímoron y la paradoja. En una gran parte de esos poemas se contrastan la sombra y la luz, el todo y la nada, el alma y el cuerpo, muchas veces mencionado como carne, una voz que representa, junto al mundo y el demonio, uno de los tres enemigos del alma. Esos asuntos antitéticos y su tratamiento reflejan un período de la vida y escritura del autor en el que fue muy influido por su amigo Ramón Sijé, gran intelectual católico. Sin embargo, no revelan que Miguel Hernández los crease desde un ángulo sobre todo piadoso, sino mayormente literario.
Differentiating Female Adolescent Bodies in Dickens’s Our Mutual Friend : The Historic Thames and Menstrual Metaphors
Authors: Harris Jacqueline H.
Published: September 2024

Abstract: In analyzing nineteenth-century fiction featuring and written for the coming-of-age female, I show how authors manifested their own authorized vocabularies in relation to bio-politics—a coded language that euphemistically, metaphorically, and thematically reveals the signs of the sexually developing female body. In so doing, these men and women defy hierarchical structures of the dominant medical, scientific, political, and social communities that enforced codes of propriety upon others by their dissemination of texts to lower-, middle-, and upper-class audiences that include these physical signifiers.
Renal Mast Cell-Specific Proteases in the Pathogenesis of Tubulointerstitial Fibrosis
Authors: Atiakshin Dmitrii , Morozov Sergey , Dlin Vladimir , Kostin Andrey , Volodkin Artem , Ignatyuk Michael , Kuzovleva Galina , Baiko Sergey , Chekmareva Irina , Chesnokova Svetlana , Elieh-Ali-Komi Daniel , Buchwalow Igor , Tiemann Markus
Published: September 2024

Chronic kidney disease is detected in 8–15% of the world’s population. Along with fibrotic changes, it can lead to a complete loss of organ function. Therefore, a better understanding of the onset of the pathological process is required. To address this issue, we examined the interaction between mast cells (MCs) and cells in fibrous and intact regions, focusing on the role of MC proteases such as tryptase, chymase, and carboxypeptidase A3 (CPA3). MCs appear to be involved in the development of inflammatory and fibrotic changes through the targeted secretion of tryptase, chymase, and CPA3 to the vascular endothelium, nephron epithelium, interstitial cells, and components of intercellular substances. Protease-based phenotyping of renal MCs showed that tryptase-positive MCs were the most common phenotype at all anatomic sites. The infiltration of MC in different anatomic sites of the kidney with an associated release of protease content was accompanied by a loss of contact between the epithelium and the basement membrane, indicating the active participation of MCs in the formation and development of fibrogenic niches in the kidney. These findings may contribute to the development of novel strategies for the treatment of tubulointerstitial fibrosis.
Pathaan, precarity and the Muslim question in neoliberal India
Authors: Anwer Megha , Arora Anupama
Published: September 2024

In India’s current censorial political climate, Pathaan’s subtle jabs against authoritarianism, jingoistic nationalism and communal ideologies make it an unusual and innovative cinematic-political intervention despite its clichéd genre-elements. Yet we argue that the film’s diagnosis of what needs intervention is inadequate and its interventionist apparatus is counterproductive. The film uses all the accoutrements of a neo-liberal image-economy (globe-trotting mobility, jet-setting lifestyles, glitzy hotels, sexy bodies, monster automobiles) and the neocolonial ‘big brother’ rationality of a hyper-militarized, surveillance-driven, paranoid security-state to make an argument about religious tolerance and a nationalism grounded in compassion. We invite an analysis of the film that is not caught between a wide-eyed celebration of the film or an angry dismissal of its betrayals, though perhaps Pathaan deserves both. Instead, in reading the film as an example of ‘cinema of precarity’, we identify its structures of resistance and explore why they amount to so little. The film thus also allows us to register the limits of neo-liberal stardom as an adequate foil to religious authoritarianism.
The Bollywood audience we were waiting for? Pathaan’s dancing-fans
Authors: Magazine Aakshi
Published: September 2024

This article examines the celebratory reception of the many videos of Pathaan’s ‘dancing-fans’ that circulated on social media during the film’s release. It argues that an un-nuanced celebration of this vocal fan obscures the inaccessibility of the cinema theatre as a public space of leisure in neo-liberal India. Shot on mobile phone cameras inside cinemas, these videos were heralded as evidence of the ‘return’ of the Hindi film audience. The celebratory discourse around this new dancing-fan is in sharp contrast to the anxieties that such vocal fandom has historically generated in cinema discourses in India, being associated instead with the ‘rowdy’ lower-class fan, pejoratively termed the ‘frontbencher’. The article suggests that the desirability of the contemporary dancing-fan reflects a professionalization of Hindi film fandom. It reads this as a new stage in what Tejaswini Ganti identifies as a process of gentrification that began with the emergence of Bollywood in post-liberalization India.
The Invention of the Photolithographic Microarray
Authors: Pirrung Michael
Published: September 2024

DNA chips, or photolithographic nucleic acid microarrays, had a transformative effect on post-genomic genetic analysis. Their means of fabrication also shepherded in an era of high-throughput / combinatorial chemistry that had a major impact on discovery in chemistry and allied fields (genetics, medicinal chemistry, others). As an industrially developed technology, some aspects of their creation have been more obscure than they might be for breakthroughs emerging from academia. A variety of narratives have been put forth concerning the circumstances of their invention. This is a first-person account from one of the named inventors of a widely-adopted microarray technology about how this invention arose.
Pendidikan Akhlak Bagi Anak dan Pendekatannya
Authors: Azhariansyah Azhariansyah
Published: September 2024

Manusia dibekali oleh dua potensi, yaitu potensi untuk menjadi orang yang baik dan potensi untuk menjadi orang yang jahat. Kecenderungan manusia dalam melakukan akhlak baik atau buruk, merupakan bentuk dari proses, dari baik ke buruk dan kembali lagi ke baik, atau tetap dalam keburukan dan dari baik tetap kepada yang baik. Proses inilah yang sebenarnya sangat berperan dalam membentuk terminal akhir dari kecenderungan manusia. Proses ini harus dimulai sejak kecil. Untuk mencapai maksud tersebut, diperlukan sebuah usaha agar mereka tetap bertahan dalam kebaikan. Cara yang paling efektif adalah dengan pendidikan akhlak. Akan tetapi, usaha tersebut sulit akan tercapai dengan optimal jika tidak diimbangi dengan pemahaman yang memadai dalam penyampaiannya. Pendekatan yang mungkin dapat dipergunakan adalah (1) pendidikan secara langsung, (2) pendidikan secara tidak langsung, dan (3) mengambil manfaat dari kecenderungan dan pembawaan anak.