bluuebunny/crossref_metadata_2025 huggingface dataset:
Time to diagnosis among young patients with cancer
Authors: Winestone Lena E. , Wilkes Jennifer J. , Puccetti Diane , Keegan Theresa H. M. , Henk Henry J. , McPheeters Jeffrey , Kahn Justine M. , Ginsberg Jill , Wong Samantha , Timberline Sage , Malogolowkin Marcio , Pollock Brad H. , Alvarez Elysia
Published: June 2024

Background

Sociodemographic and clinical factors associated with diagnostic delays in pediatric, adolescent, and young adult cancers are poorly understood.

Methods

Using the Optum Labs Data Warehouse's de‐identified claims data for commercial health plan enrollees, we identified children (0–14 years) and adolescents/young adults (AYAs) (15–39 years) diagnosed with one of 10 common cancers from 2001 to 2017, who were continuously enrolled for 6 months preceding diagnosis. Time to diagnosis was calculated as days between first medical encounter with possible cancer symptoms and cancer diagnosis date. Median times from first symptom to diagnosis were compared using Wilcoxon rank sum test. Multivariable unconditional logistic regression identified sociodemographic factors associated with longer time (>3 months) to cancer diagnosis (from symptom onset).

Results

Of 47,296 patients, 87% presented prior to diagnosis with symptoms. Patients with central nervous system (CNS) tumors were most likely to present with symptoms (93%), whereas patients with cervical cancer were least likely (70%). Symptoms varied by malignancy. Of patients with symptoms, thyroid (105 days [range: 50–154]) and cervical (104 days [range: 41–151]) cancer had the longest median time to diagnosis. Females and patients at either end of the age spectrum were more likely to experience diagnosis delays of more than 3 months.

Conclusion

In a commercially insured population, time to diagnosis varies by cancer type, age, and sex. Further work is needed to understand the patient, provider, and health system‐level factors contributing to time from symptom onset to diagnosis, specifically in the very young children and the young adult patient population going forward.
Exome sequencing in fetuses with congenital diaphragmatic hernia in a nationwide cohort
Authors: Weller Katinka , Westra Dineke , Peters Nina C. J. , Wilke Martina , Van Opstal Diane , Feenstra Ilse , van Drongelen Joris , Eggink Alex J. , Diderich Karin E. M. , DeKoninck Philip L. J.
Published: June 2024

Objective

To evaluate the diagnostic yield of exome sequencing (ES) in fetuses and neonates with prenatally detected congenital diaphragmatic hernia (CDH) and normal copy number variant (CNV) analysis.

Methods

We conducted a retrospective cohort study of prenatally diagnosed CDH cases seen between 2019 and 2022. All cases who underwent prenatal or postnatal genetic testing were reviewed. The results from the ES analysis that identified pathogenic or likely pathogenic single nucleotide variants are described.

Results

In total, 133 fetuses with CDH were seen, of whom 98 (74%) had an isolated CDH and 35 (26%) had a complex CDH (associated structural anomalies) on prenatal examination. ES was performed in 68 cases, and eight pathogenic or likely pathogenic variants were found, accounting for a 12% diagnostic yield (10% [5/50] in isolated cases and 17% [3/18] in complex CDH).

Conclusions

In 12% of fetuses and neonates with CDH and normal CNV analysis results, pathogenic or likely pathogenic variants were identified with ES. These data indicate that there is a substantial diagnostic yield when offering ES in prenatally detected CDH, both in complex and isolated cases.
Incidence of serious infections in the working‐age Japanese adult population with rheumatoid arthritis treated with tumor necrosis factor‐α inhibitors and interleukin‐6 inhibitors: A nationwide retrospective cohort study
Authors: Ota Ryosuke , Hirata Atsushi , Hata Takeo , Nishihara Masami , Neo Masashi , Katsumata Takahiro
Published: June 2024

Aim

This retrospective cohort study aimed to compare the risk of serious infections in patients with rheumatoid arthritis (RA) treated with tumor necrosis factor‐α inhibitors (TNFαi) and interleukin‐6 inhibitors (IL‐6i), with no prior use of biological disease‐modifying antirheumatic drugs (bDMARDs).

Methods

We employed the nationwide insurance claims database encompassing the years 2005 to 2018 in Japan. The inclusion criteria specified patients who were prescribed any type of bDMARDs, including TNFαi and IL‐6i. The following exclusion criteria were applied: missing prescription dates, RA not diagnosed, below 16 years of age, bDMARDs prescribed within 6 months of registration, RA diagnosed post‐bDMARDs prescription, and incidence of serious infections within 2 weeks before bDMARDs therapy. We applied stabilized inverse probability weights and utilized a Cox regression model to estimate the risk of serious infections associated with TNFαi and IL‐6i.

Results

The cohort of 2493 patients with RA was categorized into a TNFαi group and an IL‐6i group of 2018 and 475 participants, respectively. The median follow‐up duration (interquartile range) was 347 (147–820) days in the TNFαi group and 369 (149–838) days in the IL‐6i group. In the inverse probability‐weighted cohort, the incidence rates (95% confidence interval) of serious infections were 2.13 (1.65–2.71) and 3.25 (2.15–4.69) per 100 person‐years for the TNFαi and IL‐6i groups, respectively. The hazard ratio (95% confidence interval) comparing the TNFαi group to the IL‐6i group was 0.66 (0.36–1.20, p = 0.168).

Discussion

The results underscore the lack of evidence to preferentially favor either TNFαi or IL‐6i as later‐line therapy in the management of bDMARDs‐naive RA to mitigate the risk of serious infections.
A model for the combustion behavior of AP/HTPB propellant containing ultrafine aluminum
Authors: Chen Kaixuan , Xue Xiaochun , Yu Yonggang
Published: June 2024

Nano‐aluminum, renowned for its remarkable efficacy in augmenting propulsion efficiency and regressive velocity, stands out as a compelling choice for incorporation into heterogeneous propellant compositions. Nevertheless, the considerable expense of this ultrafine aluminum variant, coupled with the inherent hazards associated with conducting propellant trials, may deter extensive allocation of resources and efforts towards the intricate processes of amalgamation, molding, and comprehensive analysis of the combustion characteristics of freshly devised propellant blends. To provide theoretical support for predicting the chemical properties of nano‐Al composite propellant, we establish a numerical framework to study the combustion characteristics under the working environment of a solid rocket motor. A new five‐step kinetic mechanism is developed in this model to describe the reaction process in the gas phase while accounting for heat conduction, radiative effects, and non‐planar moving surfaces. The comparison between our theoretical work and experimental results confirms that making no distinction among Al particle sizes below 3 μm is reasonable. Finally, the effects of nano‐Al on combustion, burning rate variation, and temperature sensitivity are analyzed in detail.
Unraveling the interaction of co‐encapsulated Saccharomyces cerevisiae and Metarhizium brunneum in calcium alginate‐based attract‐and‐kill beads
Authors: Hermann Katharina M , Grünberger Alexander , Patel Anant V
Published: June 2024

BACKGROUND

Attract‐and‐kill (AK) beads are biological, microbial insecticides developed as an alternative to synthetic soil insecticides. For wireworm control, beads are based on calcium alginate/starch co‐encapsulating the carbon dioxide (CO2) producing yeast Saccharomyces cerevisiae H205 as the attract component, and the entomopathogenic fungus Metarhizium brunneum CB15‐III as the kill component. However, the physicochemical processes inside beads during co‐cultivation are still unclear. Here we reveal for the first time the spatiotemporal conditions of oxygen and pH inside AK beads measured with microelectrodes and describe the impact of S. cerevisiae on CO2 and conidia formation.

RESULTS

Measurements revealed a steep oxygen gradient already 2 days after co‐encapsulation, with an internal hypoxic zone. Encapsulating either S. cerevisiae or M. brunneum already decreased the average pH from 5.5 to 4.7 and 4.6, respectively. However, on day 3, co‐cultivation lead to temporal strong acidification of beads down to pH 3.6 which followed the maximum CO2 productivity and coincided with the maximum conidiation rate. Decreasing the yeast load decreased the total CO2 productivity to half, and the conidial production by 93%, while specific productivities normalized to 1% yeast load increased eight‐fold and three‐fold, respectively, with day 3 being an exception.

CONCLUSION

Our findings indicate a general beneficial interaction between M. brunneum and S. cerevisiae, but also suggest competition for resources. These findings will contribute to develop innovative co‐formulations with maximum efficiency to save application rates and costs. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
Dynamic RON Degradation Suppression by Gate Field Plate in Partially Recessed AlGaN/GaN Metal–Insulator–Semiconductor High‐Electron‐Mobility Transistors
Authors: Liang Ye , He Xiuyuan , Feng Xi , Zhang Yuanlei , Zhang Jie , Liu Wen
Published: June 2024

This study investigates the impact of gate field plate (G‐FP) lengths on the dynamic on‐resistance degradation in partially recessed‐gate D‐mode GaN metal–insulator–semiconductor high‐electron‐mobility transistors (MIS‐HEMTs). Devices with G‐FPs of varying lengths are fabricated, and their electrical characteristics are evaluated. It is found that G‐FPs effectively reduce electron trapping and suppress the dynamic on‐resistance degradation, leading to improved device performance. The study provides design suggestions for enhancing the reliability and stability of AlGaN/GaN‐based MIS‐HEMTs.
Comparative Study on Temperature‐Dependent Internal Quantum Efficiency and Light–Extraction Efficiency in III‐Nitride–, III‐Phosphide–, and III‐Arsenide–based Light‐Emitting Diodes
Authors: Park Jaehyeok , Shin Seokjun , Zheng Dong‐Guang , Kim Kyu Sang , Han Dong‐Pyo
Published: June 2024

This study attempts to understand and elucidate the factors limiting/determining the external quantum efficiency (EQE) of light‐emitting diodes (LEDs) depending on material systems, i.e., III‐arsenide (GaAs), III‐phosphide (AlGaInP), and III‐nitride (GaInN), via the temperature measurements (30–500 K). The behaviors of EQEs are investigated carefully in terms of the thermal droop and efficiency droop, revealing that the thermal droop in the AlGaInP and GaAs LEDs, while the efficiency droop in the GaInN LEDs, is a critical factor limiting the EQE. To deepen the insight, the EQE is separated into internal quantum efficiency (IQE) and light‐extraction efficiency (LEE). Further, the IQE is separated into radiative efficiency (RE) and injection efficiency (IE). The analysis shows that the LEE plays a significant role in the thermal droop for the AlGaInP and GaAs LEDs. Meanwhile, the IE and RE play a significant role in the EQE reduction of the blue and red LEDs at high temperatures and high current injection.
Mitigating Errors on Superconducting Quantum Processors Through Fuzzy Clustering
Authors: Ahmad Halima G. , Schiattarella Roberto , Mastrovito Pasquale , Chiatto Angela , Levochkina Anna , Esposito Martina , Montemurro Domenico , Pepe Giovanni P. , Bruno Alessandro , Tafuri Francesco , Vitiello Autilia , Acampora Giovanni , Massarotti Davide
Published: June 2024

Quantum utility is severely limited in superconducting quantum hardware until now by the modest number of qubits and the relatively high level of control and readout errors, due to the intentional coupling with the external environment required for manipulation and readout of the qubit states. Practical applications in the Noisy Intermediate Scale Quantum (NISQ) era rely on Quantum Error Mitigation (QEM) techniques, which are able to improve the accuracy of the expectation values of quantum observables by implementing classical post‐processing analysis from an ensemble of repeated noisy quantum circuit runs. In this work, a recent QEM technique that uses Fuzzy C‐Means (FCM) clustering to specifically identify measurement error patterns is focused. For the first time, a proof‐of‐principle validation of the technique on a two‐qubit register, obtained as a subset of a real NISQ five‐qubit superconducting quantum processor based on transmon qubits is reported. It is demonstrated that the FCM‐based QEM technique allows for reasonable improvement of the expectation values of single‐ and two‐qubit gates‐based quantum circuits, without necessarily invoking state‐of‐the‐art coherence, gate, and readout fidelities.
Varicella‐zoster virus‐related neurological complications: From infection to immunomodulatory therapies
Authors: Hakami Mohammed Ageeli , Khan Farhan R. , Abdulaziz Osama , Alshaghdali Khalid , Hazazi Ali , Aleissi Awad F. , Abalkhail Adil , Alotaibi Bader S. , Alhazmi Abdulfattah Yahya M. , Kukreti Neelima , Binshaya Abdulkarim S.
Published: June 2024

The Varicella‐zoster virus (VZV), classified as a neurotropic member of the Herpesviridae family, exhibits a characteristic pathogenicity, predominantly inducing varicella, commonly known as chickenpox, during the initial infectious phase, and triggering the reactivation of herpes zoster, more commonly recognized as shingles, following its emergence from a latent state. The pathogenesis of VZV‐associated neuroinflammation involves a complex interplay between viral replication within sensory ganglia and immune‐mediated responses that contribute to tissue damage and dysfunction. Upon primary infection, VZV gains access to sensory ganglia, establishing latent infection within neurons. During reactivation, the virus can spread along sensory nerves, triggering a cascade of inflammatory mediators, chemokines, and immune cell infiltration in the affected neural tissues. The role of both adaptive and innate immune reactions, including the contributions of T and B cells, macrophages, and dendritic cells, in orchestrating the immune‐mediated damage in the central nervous system is elucidated. Furthermore, the aberrant activation of the natural defence mechanism, characterised by the dysregulated production of immunomodulatory proteins and chemokines, has been implicated in the pathogenesis of VZV‐induced neurological disorders, such as encephalitis, myelitis, and vasculopathy. The intricate balance between protective and detrimental immune responses in the context of VZV infection emphasises the necessity for an exhaustive comprehension of the immunopathogenic mechanisms propelling neuroinflammatory processes. Despite the availability of vaccines and antiviral therapies, VZV‐related neurological complications remain a significant concern, particularly in immunocompromised individuals and the elderly. Elucidating these mechanisms might facilitate the emergence of innovative immunomodulatory strategies and targeted therapies aimed at mitigating VZV‐induced neuroinflammatory damage and improving clinical outcomes. This comprehensive understanding enhances our grasp of viral pathogenesis and holds promise for pioneering therapeutic strategies designed to mitigate the neurological ramifications of VZV infections.
The ideal versus the real: Mismatches in reading instruction for emergent bilinguals in secondary science classrooms
Authors: Lew Shim
Published: June 2024

The emphasis on language and literacy in science education research has urged science teachers to include reading as an integral part of learning science. However, in US secondary schools, the percentage of students reading under grade level is high, and emergent bilinguals (EBs) are significantly represented among this group. While researchers across disciplines have proposed a number of prescriptive reading practices in science classrooms tightly aligned with instructional standards, few scholars have closely examined the starting point of reading instruction in science classrooms, and even fewer have focused on actual instruction for EBs in these classrooms. This study examines the nature of existing reading practices in science classrooms, with a particular focus on EBs. Using a qualitative multiple case study method, this study found significant mismatches between actual classroom practices and the ideal prescriptions about science reading instruction portrayed in educational standards and research. This study also found that teachers were battling numerous obstacles to implementing research/standards‐based prescriptions. With the implications of science reading instruction for EBs' language and science content learning, this article will contribute to developing reading instruction and practices grounded in real classrooms and improving the instructional environment for reading‐inclusive science classrooms.
Polymorphic Heterogeneous Polar Structure Enabled Superior Capacitive Energy Storage in Lead‐Free Relaxor Ferroelectrics at Low Electric Field
Authors: Xi Jiachen , Liu Jikang , Bai Wangfeng , Wu Shiting , Zheng Peng , Li Peng , Zhai Jiwei
Published: June 2024

High‐performance energy storage dielectrics capable of low/moderate field operation are vital in advanced electrical and electronic systems. However, in contrast to achievements in enhancing recoverable energy density (Wrec), the active realization of superior Wrec and energy efficiency (η) with giant energy‐storage coefficient (Wrec/E) in low/moderate electric field (E) regions is much more challenging for dielectric materials. Herein, lead‐free relaxor ferroelectrics are reported with giant Wrec/E designed with polymorphic heterogeneous polar structure. Following the guidance of Landau phenomenological theory and rational composition construction, the conceived (Bi0.5Na0.5)TiO3‐based ternary solid solution that delivers giant Wrec/E of ≈0.0168 µC cm−2, high Wrec of ≈4.71 J cm−3 and high η of ≈93% under low E of 280 kV cm−1, accompanied by great stabilities against temperature/frequency/cycling number and excellent charging–discharging properties, which is ahead of most currently reported lead‐free energy storage bulk ceramics measured at same E range. Atomistic observations reveal that the correlated coexisting local rhombohedral‐tetragonal polar nanoregions embedded in the cubic matrix are constructed, which enables high polarization, minimized hysteresis, and significantly delayed polarization saturation concurrently, endowing giant Wrec/E along with high Wrec and η. These findings advance the superiority and feasibility of polymorphic nanodomains in designing highly efficient capacitors for low/moderate field‐region practical applications.
FDTD Simulation of a Small‐Scale Charged Airplane Model in an Ambient Electric Field between Two Flat Electrodes
Authors: Okada Shogo , Baba Yoshihiro , Tsubata Hiroyuki
Published: June 2024

When an airplane flies in an electric field under a thundercloud, electric fields at the edges and projected portions of the airplane are enhanced and leaders emanate from there. When a positive leader emanating upward from the airplane connects with a downward negative leader from the bottom of an ordinary thundercloud and a negative leader emanating downward from the airplane connects with an upward positive leader from the ground, a large lightning current flows along the channel bridged between the thundercloud and the ground through the airplane. Recently, a method to reduce the risk of lightning strikes to airplanes has been proposed. It controls the charge on the surface of an airplane to suppress the electric field at edges and projected portions of the airplane. In this paper, an airplane under a thundercloud is represented with a vertical conducting bar or a horizontal conducting bar with a small projected portion, which is placed between impulse‐high‐voltage‐applied two flat electrodes, and it is analyzed using the finite‐difference time‐domain (FDTD) method. Corona and leader discharges emanating from edges and projected portions of an airplane model are considered with their engineering representations: 40‐μS/m and 0.02 S/m conducting regions for corona and leader discharges, respectively. The airplane model is not pre‐charged or pre‐charged negatively. It follows from the FDTD‐computed results that pre‐charging an airplane model with a relevant amount of negative charge can avoid discharges from and to the airplane model. © 2024 Institute of Electrical Engineers of Japan and Wiley Periodicals LLC.
Investigation on parasitic infestation of Labeo rohita (Hamilton, 1822) in the south‐western region of Bangladesh
Authors: Ahammad Basir , Majumdar Bhaskar Chandra , Chowdhury Angkur , Mia Rasel , Rahman MD Zobayer
Published: June 2024

Background

Our investigation focused into Labeo rohita, commonly known as Rui, a freshwater aquatic species in Bangladesh. Despite their nutritional significance, these fish faced a pressing challenge: parasite infections threaten the economic stability of the aquaculture sector.

Objectives

The present study aimed to investigate the parasite and histological changes in major organs of L. rohita, collected from Khulna region – Dumuria, Paikgacha and Rupsha.

Methods

About 180 (30/month) specimens were collected between the month of March and August 2023 to observe the parasitic status in L. rohita.

Results

Through microscopic examination, a total of 323 parasites were uncovered, spanning categories including Cestode, Nematode, Acanthocephala, Trematode and Digenia, predominantly residing in the intestines of L. rohita. The highest prevalence rate (70%) was recorded in both March and May 2023, with peak mean intensity observed in July (3.73). Notably, the highest mean abundance (2.37) exhibited in July and index of infestation (45.34) in June. Histological analysis confirmed parasitic infestations in the gastrointestinal region, with displaying histological changes within major organs such as the liver, kidney, gills, spleen and testicles due to parasitic infection.

Conclusion

This study concluded that the indentified six categories of parasite and the affect of parasitic infestation in major organs of L. rohita within the study period. Urgent efforts to implement effective strategies for controlling the parasite infections in aquaculture to ensure the sustainable production of this invaluable fish species.
Home range and habitat selection of wolves recolonising central European human‐dominated landscapes
Authors: Vorel Aleš , Kadlec Ivo , Toulec Tadeáš , Selimovic Aldin , Horníček Jan , Vojtěch Oldřich , Mokrý Jan , Pavlačík Lukáš , Arnold Walter , Cornils Jessica , Kutal Miroslav , Duľa Martin , Žák Lukáš , Barták Vojtěch
Published: June 2024

Decades of persecution has resulted in the long‐term absence of grey wolves Canis lupus from most European countries. However, recent changes in both legislation and public attitudes toward wolves has eased the pressure, allowing wolves to rapidly re‐establish territories in their previous central European habitats over the last 20 years. Unfortunately, these habitats are now heavily altered by humans. Understanding the spatial ecology of wolves in such highly modified environments is crucial, given the high potential for conflict and the need to reconcile their return with multiple human concerns. We equipped 20 wolves, originating from seven packs in six central European regions, with GPS collars, allowing us to calculate monthly average home range sizes for 14 of the animals of 213.3 km2 using autocorrelated kernel density estimation. We then used ESA WorldCover data to assess the mosaic of available habitats used within each home range. Our data confirmed a general seasonal pattern for breeding individuals, with smaller apparent home ranges during the reproduction phase, and no specific pattern for non‐breeders. Predictably, our wolves showed a general preference for remote areas, and especially forests, though some wolves within military training areas also showed a broader preference for grassland, possibly influenced by local land use and high availability of prey. Our results provide a comprehensive insight into the ecology of wolves during their re‐colonisation of central Europe. Though wolves are spreading relatively quickly across central European landscapes, their permanent reoccupation remains uncertain due to conflicts with the human population. To secure the restoration of European wolf populations, further robust biological data, including data on spatial ecology, will be needed to clearly identify any management implications.
Method for evaluating and measuring cavity suitability for nesting wood ducks
Authors: Von Haugg Cindy L. , Anderson James T.
Published: June 2024

The challenges associated with climbing trees to measure cavity dimensions have limited the accumulation of knowledge regarding wood duck (Aix sponsa) nesting habitat and ecology. To overcome this issue, we developed a 2‐person method to measure external and internal tree‐cavity dimensions from the ground. Our approach uses a telescopic pole, wireless cavity inspection camera with a monitor, and reference scale, allowing an object of known length to be viewed and recorded inside the cavity. We tested our method using simulated cavities (n = 20), assessed accuracy by comparing the estimated and actual measurements, and evaluated precision between 2 observers. The average difference (±1 SE) between estimated and actual measurements (n = 40) for entrance width (0.9 ± 0.9 cm), entrance height (0.8 ± 1.1 cm), platform width (0.1 ± 3.7 cm), and platform length (1.0 ± 3.2 cm) were ≤1 cm. There was no significant difference between observer measurements for entrance width, entrance height, platform width, or platform length. Observers overestimated cavity depth by an average of 0.1 ± 1.6 cm and there was a significant difference (1.3 ± 2.2 cm) between observers for mean cavity depth. We applied the technique to naturally occurring cavities. The time to complete a natural‐cavity survey in the field (n = 37) averaged 12.2 ± 6.9 min. Our method increases the practicality, accessibility, and safety of researchers conducting cavity surveys for wood ducks and other cavity‐dependent wildlife through the use of a cost‐effective, cavity‐measuring tool.
Herausforderungen und Chancen für die chirurgische Weiterbildung
Authors: Schlottmann Frederik , Drossard Sabine , Dey Hazra Maria , Blank Beate , Herbolzheimer Marit , Mulorz Joscha , Kröplin Juliane , Huber Tobias , Doukas Panagiotis , Sadat Najla , Rüsseler Miriam , Rösch Romina , Bouffleur Frederic , Lif Keller Sarah , Freund Gerrit
Published: June 2024

Hintergrund

Die chirurgische Weiterbildung steht bereits jetzt vor erheblichen Herausforderungen. Durch die geplante Krankenhausstrukturreform kommen neue bürokratische und organisatorische Hürden hinzu, die zu einem erheblichen Qualitätsverlust der chirurgischen Weiterbildung führen können.

Fragestellung

Das vorliegende Positionspapier beschreibt aktuelle und zukünftige Herausforderungen für die chirurgische Weiterbildung und identifiziert mögliche Ansatzpunkte und Chancen für ihre Weiterentwicklung vor dem Hintergrund der geplanten Krankenhausstrukturreform.

Material und Methoden

Für die Erarbeitung dieses Positionspapiers wurden durch ein Gremium aus Vertreterinnen und Vertreter der Jungen Foren der Deutschen Fachgesellschaften der chirurgischen Fächer aktuelle Probleme und Herausforderungen des derzeitigen Weiterbildungssystems identifiziert, kritisch diskutiert und ein Forderungskatalog für ein zukunftsfähiges Weiterbildungskonzept formuliert.

Ergebnisse

Die geplante Ambulantisierung und Zentralisierung wurden als zentrale Herausforderungen für die chirurgische Weiterbildung identifiziert. Die ärztliche Weiterbildung muss bei allen Reformbestrebungen konsequent und von Anfang an mitgedacht werden. Neben einer transparenten und aufwandsgerechten Finanzierung der Weiterbildung fordern wir die Einbeziehung der Fachgesellschaften sowie eine Beachtung der sozialen Rahmenbedingungen für den chirurgischen Nachwuchs.

Schlussfolgerungen

Der von der Politik forcierte Strukturwandel der Krankenhauslandschaft in Deutschland birgt die Gefahr, dass es zu einem weiteren Qualitäts- und Erfahrungsverlust in der chirurgischen Versorgung und Weiterbildung kommt. Gleichzeitig bietet das geplante Reformvorhaben aber die einzigartige Chance, bestehende Probleme aufzugreifen und die chirurgische Weiterbildung zukunftsfähig weiterzuentwickeln.
Does high parasite load contribute to limitation of the poleward range of Acropora corals?
Authors: Sommer Brigitte , Chang Yuen Y. , Beger Maria , Pandolfi John M.
Published: June 2024

The role of species interactions in setting species range limits is rarely empirically explored. Here, we quantify host and parasite densities in subtropical eastern Australia (26.65°–30.20°S) to examine whether parasitism might contribute to range limitation of Acropora corals at their cold-range boundary. 79% of Acropora corals had endolithic barnacles (family Pyrgomatidae), with higher parasite load in larger corals and up to 141 barnacles per coral. Parasite load increased poleward and closer to the mainland and was greater in cooler and high nutrient environments. Parasite burden was higher at sites with fewer Acropora corals, broadly consistent with the hypothesis that parasites can fragment host populations where host densities are low, and the parasite is a better disperser than the host. Whilst the mechanism is unclear, our findings suggest that at the high densities recorded here, coral-barnacles could influence range dynamics of Acropora corals at their poleward range limit.
Quantitative analysis of temporal stability and instrument performance during field experiments of an airborne QCLAS via Allan–Werle-plots
Authors: Röder Lenard L. , Ort Linda , Lelieveld Jos , Fischer Horst
Published: June 2024

Allan–Werle-plots are an established tool in infrared absorption spectroscopy to quantify temporal stability, maximum integration time and best achievable precision of a measurement instrument. In field measurements aboard a moving platform, however, long integration times reduce time resolution and smooth atmospheric variability. A high accuracy and time resolution are necessary as well as an appropriate estimate of the measurement uncertainty. In this study, Allan-Werle-plots of calibration gas measurements are studied to analyze the temporal characteristics of a Quantum Cascade Laser Absorption Spectrometer (QCLAS) instrument for airborne operation. Via least-squares fitting the individual noise contributions can be quantified and different dominant regimes can be identified. Through simulation of data according to the characteristics from the Allan-Werle-plot, the effects of selected intervals between in-flight calibrations can be analyzed. An interval of $$30\,$$

30

min is found sufficient for successful drift correction during ground operation. The linear interpolation of the sensitivity increases the accuracy and lowers the measurement uncertainty from $$1.1\,\%$$

1.1

%

to $$0.2\,\%$$

0.2

%

. Airborne operation yields similar results during segments of stable flight but suffers from additional flicker and sinusoidal contributions. Simulations verify an appropriate interval of $$30\,$$

30

min in airborne operation. The expected airborne measurement uncertainty is 2.45 ppbv.
Prolonged pre-firing pancreatic compression with linear staplers in distal pancreatectomy: a valuable technique for post-operative pancreatic fistula prevention
Authors: Quero Giuseppe , Laterza Vito , Schena Carlo Alberto , Massimiani Giuseppe , Lucinato Chiara , Fiorillo Claudio , Mezza Teresa , Taglioni Flavia , Menghi Roberta , Di Cesare Ludovica , Biffoni Beatrice , De Sio Davide , Rosa Fausto , Tondolo Vincenzo , Alfieri Sergio
Published: June 2024

Purpose

Post-operative pancreatic fistula (POPF) remains the main complication after distal pancreatectomy (DP). The aim of this study is to evaluate the potential benefit of different durations of progressive stapler closure on POPF rate and severity after DP.

Methods

Patients who underwent DP between 2016 and 2023 were retrospectively enrolled and divided into two groups according to the duration of the stapler closure: those who underwent a progressive compression for < 10 min and those for ≥ 10 min.

Results

Among 155 DPs, 83 (53.5%) patients underwent pre-firing compression for < 10 min and 72 (46.5%) for ≥ 10 min. As a whole, 101 (65.1%) developed POPF. A lower incidence rate was found in case of ≥ 10 min compression (34–47.2%) compared to < 10 min compression (67- 80.7%) (p = 0.001). When only clinically relevant (CR) POPFs were considered, a prolonged pre-firing compression led to a lower rate (15–20.8%) than the < 10 min cohort (32–38.6%; p = 0.02). At the multivariate analysis, a compression time of at least 10 min was confirmed as a protective factor for both POPF (OR: 5.47, 95% CI: 2.16–13.87; p = 0.04) and CR-POPF (OR: 2.5, 95% CI: 1.19–5.45; p = 0.04) development. In case of a thick pancreatic gland, a prolonged pancreatic compression for at least 10 min was significantly associated to a lower rate of CR-POPF compared to < 10 min (p = 0.04).

Conclusion

A prolonged pre-firing pancreatic compression for at least 10 min seems to significantly reduce the risk of CR-POPF development. Moreover, significant advantages are documented in case of a thick pancreatic gland.
Pharmacological inhibition of RUNX1 reduces infarct size after acute myocardial infarction in rats and underlying mechanism revealed by proteomics implicates repressed cathepsin levels
Authors: Chen Hengshu , Wang Si , Zhang Xiaoling , Hua Xing , Liu Meng , Wang Yanan , Wu Simiao , He Weihong
Published: June 2024

Myocardial infarction (MI) results in prolonged ischemia and the subsequent cell death leads to heart failure which is linked to increased deaths or hospitalizations. New therapeutic targets are urgently needed to prevent cell death and reduce infarct size among patients with MI. Runt-related transcription factor-1 (RUNX1) is a master-regulator transcription factor intensively studied in the hematopoietic field. Recent evidence showed that RUNX1 has a critical role in cardiomyocytes post-MI. The increased RUNX1 expression in the border zone of the infarct heart contributes to decreased cardiac contractile function and can be therapeutically targeted to protect against adverse cardiac remodelling. This study sought to investigate whether pharmacological inhibition of RUNX1 function has an impact on infarct size following MI. In this work we demonstrate that inhibiting RUNX1 with a small molecule inhibitor (Ro5-3335) reduces infarct size in an in vivo rat model of acute MI. Proteomics study using data-independent acquisition method identified increased cathepsin levels in the border zone myocardium following MI, whereas heart samples treated by RUNX1 inhibitor present decreased cathepsin levels. Cathepsins are lysosomal proteases which have been shown to orchestrate multiple cell death pathways. Our data illustrate that inhibition of RUNX1 leads to reduced infarct size which is associated with the suppression of cathepsin expression. This study demonstrates that pharmacologically antagonizing RUNX1 reduces infarct size in a rat model of acute MI and unveils a link between RUNX1 and cathepsin-mediated cell death, suggesting that RUNX1 is a novel therapeutic target that could be exploited clinically to limit infarct size after an acute MI.
Bioinformatic Analysis Reveals the Association of Human N-Terminal Acetyltransferase Complexes with Distinct Transcriptional and Post-Transcriptional Processes
Authors: Koufaris C. , Demetriadou C. , Nicolaidou V. , Kirmizis A.
Published: June 2024

N-terminal acetyltransferases (NAT) are the protein complexes that deposit the abundant N-terminal acetylation (Nt-Ac) on eukaryotic proteins, with seven human complexes currently identified. Despite the increasing recognition of their biological and clinical importance, NAT regulation remains elusive. In this study, we performed a bioinformatic investigation to identify transcriptional and post-transcriptional processes that could be involved in the regulation of human NAT complexes. First, co-expression analysis of independent transcriptomic datasets revealed divergent pathway associations for human NAT, which are potentially connected to their distinct cellular functions. One interesting connection uncovered was the coordinated regulation of the NatA and proteasomal genes in cancer and immune cells, confirmed by analysis of multiple datasets and in isolated primary T cells. Another distinctive association was of NAA40 (NatD) with DNA replication, in cancer and non-cancer settings. The link between NAA40 transcription and DNA replication is potentially mediated through E2F1, which we have experimentally shown to bind the promoter of this NAT. Second, the coupled examination of transcriptomic and proteomic datasets revealed a much greater intra-complex concordance of NAT subunits at the protein compared to the transcript level, indicating the predominance of post-transcriptional processes for achieving their coordination. In agreement with this concept, we also found that the effects of somatic copy number alterations affecting NAT genes are attenuated post-transcriptionally. In conclusion, this study provides novel insights into the regulation of human NAT complexes.
Comparative analysis of the addition of empagliflozin versus doubling the furosemide dose in decompensated heart failure
Authors: Polat Fuat , Kaya Zeynettin , Süleymanoğlu Cuma
Published: June 2024

Introduction

This study aims to compare the addition of SGLT2 inhibitors or doubling the diuretic dose in patients receiving treatment with beta-blockers, angiotensin-converting enzyme inhibitors (ACEi), or angiotensin receptor blockers (ARB), as well as mineralocorticoid receptor antagonists (MRA), for heart failure with reduced ejection fraction (HFrEF) who present to the emergency department with decompensated heart failure.

Methods

This study is a single-center and prospective analysis. A total of 980 decompensated heart failure (HFrEF) patients receiving optimal medical therapy (OMT) according to the 2021 European heart failure guidelines were randomized in a 2:1 ratio into the furosemide and empagliflozin treatment arms. The analysis includes patient clinical characteristics, laboratory results, and echocardiographic data. Factors influencing rehospitalization were identified through multivariate Cox regression analysis. Log-rank analysis was employed to assess factors affecting rehospitalization.

Results

The mean age of the patients was 67.9 years, with 52.1% being men. There was no significant impact of demographic, clinical, or echocardiographic factors on rehospitalization at 1 month; only the effect of treatment subgroups on rehospitalization was observed (p = 0.039). Significant echocardiographic and clinical improvements were seen in both treatment arms. The empagliflozin group exhibited significant improvements in 6-min walk distance, heart rate, body weight, NT-pro BNP levels, and eGFR level compared to the furosemide group. The rate of rehospitalization in the first month was significantly lower in those receiving empagliflozin (28.7%) compared to those receiving a double dose of furosemide (40.2%) (log-rank p = 0.013).

Discussion and conclusion

This study provides valuable insights into the management of decompensated HFrEF and demonstrates that SGLT2 inhibitors offer benefits beyond glycemic control in this patient group. The significant reduction in rehospitalization rates and improvements in echocardiographic parameters underscore the potential of SGLT2 inhibitors in reducing acute heart failure episodes.
Cardioprotection with Intralipid During Coronary Artery Bypass Grafting Surgery on Cardiopulmonary Bypass: A Randomized Clinical Trial
Authors: Hadebe Nkanyiso , Cour Martin , Imamdin Aqeela , Petersen Tarra , Pennel Timothy , Scherman Jacques , Snowball Jane , Ntsekhe Mpiko , Zilla Peter , Swanevelder Justiaan , Lecour Sandrine
Published: June 2024

Purpose

Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB) is associated with myocardial ischemia–reperfusion injury (IRI), which may limit the benefit of the surgery. Both experimental and clinical studies suggest that Intralipid, a lipid emulsion commonly used for parenteral nutrition, can limit myocardial IRI. We therefore aimed to investigate whether Intralipid administered at reperfusion can reduce myocardial IRI in patients undergoing CABG on CPB.

Methods

We conducted a randomized, double-blind, pilot trial in which 29 adult patients scheduled for CABG were randomly assigned (on a 1:1 basis) to receive either 1.5 ml/kg Intralipid 20% or Ringer’s Lactate 3 min before aortic cross unclamping. The primary endpoint was the 72-h area under the curve (AUC) for troponin I.

Results

Of the 29 patients randomized, 26 were included in the study (two withdrew consent and one was excluded before surgery). The 72-h AUC for troponin I did not significantly differ between the control and Intralipid group (546437 ± 205518 versus 487561 ± 115724 arbitrary units, respectively; P = 0.804). Other outcomes (including 72-h AUC for CK-MB, C-reactive protein, need for defibrillation, time to extubation, length of ICU and hospital stay, and serious adverse events) were similar between the two groups.

Conclusion

In patients undergoing CABG on CPB, Intralipid did not limit myocardial IRI compared to placebo.

Trial Registration

ClinicalTrials.gov Identifier: NCT02807727 (registration date: 16 June 2016).
Densities and Molar Volumes for Binary Solutions of Tri-iso-Amyl Phosphate and n-Dodecane in the Temperature Range of 283.15–363.15 K
Authors: Kumar Shekhar
Published: June 2024

Tri-n-butyl phosphate (TBP) has remained workhorse of PUREX based nuclear recycle operations since 1956. However due to its associated disadvantages like third phase formation and tendency to react violently with nitric acid at elevated temperatures generated requirement of an alternate extractant for PUREX process. Tri-iso-amyl phosphate (TiAP) has better attributes than TBP on both the counts. Density of solutions is an important process parameter for design of equipment, process operations and control and safety analysis. In this work, experimental data on the density of binary solution of tri-iso amyl phosphate and n-dodecane are reported for several temperature levels. The related volumetric parameters were also estimated from experimental data as well as Kirkwood–Buff integrals. Derivative parameters like linear coefficients of preferential solvation $$\delta_{ij(i \ne j)}^{o}$$

δ

i
j
(
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≠
j
)

o

and local mole fractions $$x_{ij(i \ne j)}$$

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j
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at 298.15 K were also estimated and reported.

Graphical Abstract
Building Better Bridges: Outcomes of a Community-Partnered New School Transition Intervention for Students on the Autism Spectrum
Authors: Nuske Heather J. , Smith Tristram , Levato Lynne , Bronstein Briana , Sparapani Nicole , Garcia Consuelo , Castellon Fernanda , Lee Hyon Soo , Vejnoska Sarah F. , Hochheimer Samantha , Fitzgerald Amber R. , Chiappe Jenny C. , Nunnally Amanda Dimachkie , Li Jennica , Shih Wendy , Brown Ashlee , Cullen Michelle , Hund Lisa M. , Stahmer Aubyn C. , Iadarola Suzannah , Mandell David S. , Hassrick Elizabeth McGhee , Kataoka Sheryl , Kasari Connie
Published: June 2024

New school transitions can be challenging for students on the autism spectrum. No published, evidence-based interventions exist to support families and teachers of students transitioning to elementary and secondary school during this critical period. Using Community Partnered Participatory Research, we developed Building Better Bridges (BBB), a caregiver coaching intervention that includes training on effective school communication, educational rights, advocacy, and child preparation strategies. We compared BBB (n = 83) to a module/resources-only comparison (n = 87) in a four-site randomized controlled trial in racially and ethnically diverse, under-resourced communities. In our intent-to-treat analysis, caregivers and teachers in BBB rated students’ transitions to the new classroom as more positive, relative to the comparison group. Results suggest this low-cost intervention can improve the transition process for families and students at high risk of poor transitions.
Large-scale school improvement: results of and conditions for systemic changes within coupled school systems
Authors: Adolfsson Carl-Henrik
Published: June 2024

The aim of this study was to explore the results of and conditions for systemic large-scale school improvement. Through a multi-level analysis and a theoretical framework inspired by organization- and sensemaking-oriented theories, the study examines how a Swedish large-scale school improvement program, “Collaboration for the Best School Possible,” played out in two Swedish municipalities. School actors at four organizational levels (at the National Education Agency, Local Education Authority, school leader, and teacher levels) in the two municipalities were interviewed. Because these school actors’ sensemaking is linked to different aspects of the national largescale improvement program, the analysis shows a variation in the strengthening of the couplings between these organizational levels. The different nature of the couplings affected the implementation process and the results of the program. While the national large-scale program seemed to have contributed to an improvement in the schools’ quality assurance systems and leadership practices, there were difficulties in maintaining general and sustainable changes in schools’ instructional practices. The conclusion of the study was that, even if a national large-scale school improvement program is well designed and backed up with many resources, it must be perceived as legitimate among the local school actors at the different organizational levels. This points to the importance of managing the balance between top-down efforts and visions and local professional knowledge and experience.
A light-detecting Ru(II)/Si heterojunction system involving a binuclear Ru (II) complex with pyridine-2,6-diimine (pydim) ligand
Authors: Koç Mümin Mehmet , Dayan Osman , Dere Ayşegul , Çetinkaya Bekir , Coşkun Burhan , Yakuphanoğlu Fahrettin
Published: June 2024

A meticulously detailed chemical procedure was employed to synthesize the Ru (II)-containing pyridine-2,6-diimine (pydim) organometallic complex. The resulting complex was then applied to Al-coated Si wafers using the spin-coating technique, leading to the production of Al/Ru(II) organometallic complex/n-Si/Al photodiodes. The light responsiveness of these photodiodes was demonstrated through the acquisition of I-V and I-t characteristics. Subsequently, essential parameters such as ideality factor, photosensitivity, barrier height, and photoresponse values were evaluated based on the obtained I-V and I-t plots. The calculations yielded ideality factors and barrier heights, resulting in average values of 6.41 and 0.552 eV, respectively. Furthermore, an in-depth analysis of the electrical properties of the diodes was conducted using G-V and C-V assessments, revealing a strong dependence on AC signal frequency. This investigation underscored that the observed frequency-related electrical behaviour is rooted in series resistance and interface states.