bluuebunny/crossref_metadata_2025 huggingface dataset:
Raising the stakes of the institutional contest over the normative dimension
Authors: Cooper Andrew F.
Published: January 2024

A major preoccupation across the spectrum of institutionalist international relations has been the comparative weight accorded instrumentality versus the normative dimension in organizational preference. Rational design scholars remain firm that a self-regulating utilitarian logic conditions institutional choice. As crafted by Keohane’s array of scholarly contributions, neo-institutionalism in parallel fashion to the rational design literature originally placed the onus on instrumentality. With this common starting point in mind, this chapter traces the striking manner in which the core rationalist institutionalist literature became bifurcated to some considerable degree on the normative dimension, which exposed a gap with Global South motivations and modalities.
Between aspirations and anxiety
Authors: Cooper Andrew F.
Published: January 2024

Bull poses a question glossed over by institutionalist international relations (IR) scholars: is ‘concerting’ with one another the exclusive preserve of the incumbents? At odds with the constricted interpretation across the body of institutionalist IR, this chapter argues that the cluster of non-incumbents encompassing developing countries in the Global South generally, and India and China as aspirant powers in particular, could at least contemplate institutional choice beyond the hold of formal multilateralism. Yet if the non-incumbent states believed in their entitlement to an uplifted status in the international system, formidable obstacles stood in the way of the obtainment of this goal. Although the dominant position of the established institutional formats, especially with respect to the hold of formal international organizations, could be challenged, the privileged status of these pillars remained intact.
Verbal Dispute and Metalinguistic Negotiation
Authors: Ball Derek
Published: January 2024

On one view, definitional disputes are primarily about how we should use words. TI reject this view is rejected. PI give precise accounts are given of two claims associated with this view: that definitional disputes are merely verbal disputes, and that definitional disputes are matters of metalinguistic negotiation. The idea that definitional disputes are merely verbal falsely predicts that purely practical considerations bear on the issues; this is calledI call this the Wrong Kinds of Reason Argument. The idea that definitional disputes are metalinguistic negotiations cannot make sense of many of the kinds of evidence and arguments that do bear on the issues; I call this is called the Argument Argument.
Contextualism, Relativism, and Metasemantics
Authors: Ball Derek
Published: January 2024

This chapter discusses context-sensitive expressions, including gradable adjectives such as “tall” and “rich”, and predicates of taste such as “tasty” and “funny”. AI develop a formal framework for theorising about context sensitivity is developed, and it is shown how a range of metasemantic questions relate to this formal framework. Extant answers to these questions in the literature—including views that focus on speaker intentions, as well as relativist views—fare badly, because they cannot give a good account of what is going on in disputes involving gradable adjectives and predicates of taste.
Temporal Externalism, Context Sensitivity, and Matters of Taste
Authors: Ball Derek
Published: January 2024

Building on the discussion in chapter 8, this chapter develops a temporal externalist theory of a range of context-sensitive expressions, including gradable adjectives and predicates of taste. It is shown that discussions involving these expressions mirror the definitional disputes discussed in chapters 5 and 6, and that David Lewis’s account of accommodation takes the first step toward a temporal externalist account. TI develop this account is developed further, and appliedy it to disputes about taste. It is shown that disputes about taste are not as distinctive as some theorists have argued, and in particular that the appearance that such disputes involve faultless disagreement is illusory.
Temporal Externalism: Choice Points
Authors: Ball Derek
Published: January 2024

This chapter presents a map through various ways temporal externalism might be developed. Issues discussed include: does temporal externalism apply to language, to thought, or to both? How much does meaning vary over time and between different discourses? How radically can we revise our definitional views? What makes temporal externalism true? What role do other speakers play in determining what we mean? Is temporal externalism committed to a kind of analyticity, or is it compatible with holism? Can judgements play a meaning-fixing role even if they are arrived at in epistemically problematic ways? What should the temporal externalist say about essentially contested concepts, and other kinds of discussion that do not resolve?
The Very Long Run
Authors: Meissner Christopher M.
Published: January 2024

How much economic integration existed prior to the industrial revolution? Although humans have been attempting to reap the gains from trade since the dawn of history, gains were limited in scope. The physical means of transporting products was under-developed until the early 19th century. Moreover, trade depends crucially on institutions and policies. Without an umbrella of security and a culture of integration, globalization scales poorly. Prior to the mid-19th century, integration remained limited. Notwithstanding, Eurasian and parts of Africa have, for a long time, been interacting economically in important ways. In many instances, these interactions were mutually beneficial, but coercion, violence, and power often shaped the evolution and impact of global integration.
The Great Migrations
Authors: Meissner Christopher M.
Published: January 2024

What determined where migrants would move to in the late 19th century? What was the impact of migration on workers’ wages? During the 19th century, nearly forty-five million people moved away from Europe and another fifteen million left their place of birth in Asia for other regions. A host of determinants mattered for where migrants went and when migrants decided to leave. Wage differentials and economic opportunities played a strong role, but so did transportation costs and information. Poor nations did not automatically witness a large exodus since emigration depended on the age distribution of the population, whether anyone from their region had previously migrated and on the status of structural economic change in their country. The United States, Canada, Australia, New Zealand, Brazil, and Argentina were some of the places where immigrants made up a large share of the population. Southern and Eastern European nations were the principal senders to the Americas and Australasia in Europe. In Asia, Chinese and Indian emigrants found opportunity in Southeast Asia, but also in the Caribbean. Wages tended to grow more slowly in receiving places and rose in sending areas. In 1882, the United States imposed the first stringent control on immigration with the Chinese Exclusion Act.
The Beginning of the End
Authors: Meissner Christopher M.
Published: January 2024

How did globalization in the 19th century impact local economies? While many countries involved in the Atlantic economy converged economically and grew richer, not all places did. The international slave trade and imperialism, examples of non-voluntary exchange, promoted trade and movement of people but led to large welfare losses and legacies of under-development. Free trade and declines in trade costs led to large shocks for local industries and sectors. With lower tariffs on wheat in Europe, farmers faced stiffer competition and lobbied for reimposing tariffs. Other countries in the New World raised tariffs to fend off international competition. Tariffs did little to promote economic development, possibly slowing the move a more modern economy. Immigration led to competition in the labor market and workers in the New World often clamored for restrictions on immigration.
Rebuilding the World Economy (Yet Again)
Authors: Meissner Christopher M.
Published: January 2024

International relations were a key concern after World War II. The United States encouraged and promoted strong economic growth and improved economic development for a range of countries. Economic growth in Western Europe was significantly faster than it had been historically. In East Asia, a number of economies including South Korea and Taiwan also experienced fast growth after the 1960s. Foreign aid and policy advice through the Marshall Plan and other efforts helped spur an unexpectedly strong recovery. Western European nations used a number of institutional devices to incentivize strong economic growth. In East Asia economic development and growth was driven by innovative policy approaches that turned out to be very successful. These policies promoted investment in key sectors and products which raised the productivity of a number of key industries. Initial conditions of low income inequality and high human capital also promoted the success of these activist policies. Strong economic growth and a revival of international integration went hand-in-hand in the period.
International Financial Flows and Financial Crises after the End of the Bretton Woods System
Authors: Meissner Christopher M.
Published: January 2024

International capital flows resumed in the 1970s. These international financial flows were often a driver for instability and crises instead of economic growth. The determinants of these crises varied over the years, but cross-border capital flows, fixed exchange rates were often involved. Incentive problems like moral hazard played a role, as did the structure of international lending and local policy choices. The successive waves of crises challenged the world to learn from and adapt to the new reality of financial flows with new policies. International lending and borrowing also created slow-burn, train-wreck-in-slow-motion debt crises in dozens of the world’s poorest countries. Unsustainable rises in foreign debt culminated in a powerful international movement in favor of debt relief. In these countries, odious debt—national debt piled up by despotic (and unaccountable) politicians—tended to crush the basis for economic growth for generations.
Prospects for the Global Economy in the 21st Century
Authors: Meissner Christopher M.
Published: January 2024

Is more integration beneficial or costly for nations? Is globalization simply a convenient scapegoat? What prospect is there for globalization in the future? As this book has shown, the global economy has expanded enormously since the 1980s. Many mainstream economists and other “globalists” have approved of “hyperglobalization.” At the same time, deep integration has been blamed by many others for a number of short-term economic problems. This chapter explores three recent economic shocks that illustrate the challenges for the global economy. These include the rise of China, the Eurozone financial crisis, and Brexit. Will the global economy withstand the pressures of globalization, or will countries fail to cooperate?
Alcohol Diplomacy, Gender and Power in the Late Seventeenth-Century Gold Coast Slaving Complex
Authors: Chambers Lila O’Leary
Published: January 2024

Across the seventeenth and eighteenth centuries, Atlantic African leaders confronted new challenges as the European demand for captive African labour transformed the political economy of the region and the experience of living within it. Among a range of new and remodelled strategies designed to protect their polities, West African leaders used alcohol diplomacy to facilitate political alliance, cross-cultural communication and economic exchange. This article draws on warehouse registers, European travelogues and joint-stock company correspondence to uncover Queen Tituba of Agona (c.1638–1707) in her efforts to manage the English Royal African Company. By tracing her adroit use of alcohol, it reveals how West Africans repurposed English commodities to fit their own patterns of consumption and exchange. From funnelling diplomatic gifts of brandy into Akan-speaking political hierarchies to resolving disputes over rum, the queen drew on alcohol to fortify her rule against other coastal powers and navigate the demands of her own officials, subjects and enslaved labourers. She deployed alcohol in these ways despite, and because of, the pressures placed on her as a woman political leader. Essential to trade and ritual, yet morally fraught, Queen Tituba’s use of alcohol upended the European hierarchies of race and gender that consigned West African women to the status of commodity rather than recognized them as strategic consumers. Following alcohol offers a way of unravelling the intersection between gender, consumption and authority in a period when the trafficking of enslaved African peoples fundamentally transformed Atlantic political economy.
Cynipid wasps systematically reprogram host metabolism and restructure cell walls in developing galls
Authors: Markel Kasey , Novak Vlastimil , Bowen Benjamin P , Tian Yang , Chen Yi-Chun , Sirirungruang Sasilada , Zhou Andy , Louie Katherine B , Northen Trent R , Eudes Aymerick , Scheller Henrik V , Shih Patrick M
Published: January 2024

Many insects have evolved the ability to manipulate plant growth to generate extraordinary structures called galls, in which insect larva can develop while being sheltered and feeding on the plant. In particular, cynipid (Hymenoptera: Cynipidae) wasps have evolved to form morphologically complex galls and generate an astonishing array of gall shapes, colors, and sizes. However, the biochemical basis underlying these remarkable cellular and developmental transformations remains poorly understood. A key determinant in plant cellular development is cell wall deposition that dictates the physical form and physiological function of newly developing cells, tissues, and organs. However, it is unclear to what degree cell walls are restructured to initiate and support the formation of new gall tissue. Here, we characterize the molecular alterations underlying gall development using a combination of metabolomic, histological, and biochemical techniques to elucidate how valley oak (Quercus lobata) leaf cells are reprogrammed to form galls. Strikingly, gall development involves an exceptionally coordinated spatial deposition of lignin and xylan to form de novo gall vasculature. Our results highlight how cynipid wasps can radically change the metabolite profile and restructure the cell wall to enable the formation of galls, providing insights into the mechanism of gall induction and the extent to which plants can be entirely reprogrammed to form unique structures and organs.
Implementation of Peer-Assisted Physical Activity Via Telehealth for Adults on the Autism Spectrum: A Mixed Methods Feasibility Study
Authors: Tovin Melissa M , Núñez-Gaunaurd Annabel
Published: January 2024

Objective

Adults on the autism spectrum are at risk for physical inactivity, obesity, and related health conditions. Physical activity provides physical, social, and mental health benefits across the lifespan. Previous research examined feasibility and effectiveness of physical activity intervention in autistic children, but very few studies target autistic adults. This study examined the feasibility and acceptability of Physical Activity Connections via Telehealth, implemented during the coronavirus disease 2019 (COVID-19) pandemic lockdown as an alternative to in-person programming for autistic adults aged 18 to 32.

Methods

The 10-week intervention utilized telehealth and remote technologies to deliver a theoretically grounded program to improve physical activity. Strategies included peer-guidance, coaching, individualized wellness goals, customized exercise programs, and wearable activity trackers. Feasibility and acceptability were examined using a mixed-methods design including observational and survey data collection, as well as participant interviews. Data were analyzed using descriptive statistics and content analysis.

Results

Findings support feasibility and acceptability of telehealth to promote physical activity among autistic adults who have cognitive capacity and ability to utilize remote technology, with applicability beyond pandemic-imposed challenges.

Conclusion

Telehealth delivery of physical activity interventions is a viable alternative to in-person programs and may enable autistic adults to overcome barriers to physical activity participation and access.

Impact

As the rate of autism continues to rise globally, rehabilitation professionals will play a significant role in promoting health and wellness for autistic individuals across the lifespan. Findings promote informed practice based on the health needs of this growing segment of society.
Clinical characteristics, allergic response to autologous semen, and desensitization in patients with postorgasmic illness syndrome
Authors: Xi Guang-Peng , Yang Ruo-Xuan , Zhang Jing , Ma Yue-Mei , Zhong Xiao-Yan
Published: January 2024

Introduction

Postorgasmic illness syndrome (POIS) is rare and includes a cluster of physical and cognitive symptoms that occur after ejaculation. The pathogenesis and effective treatments remain unclear.

Aim

This study aimed to characterize the symptomatology of POIS, study the allergic response of autologous semen in patients and controls, and evaluate the effects of desensitization therapy.

Methods

The clinical characteristics of 24 Chinese patients with POIS were analyzed. Skin prick tests, intracutaneous tests, and specific IgE detection were performed with autologous semen. Five patients were desensitized via subcutaneous injections of autologous semen.

Outcomes

Evaluated outcomes included the clinical features of POIS; scores of the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and visual analog scale (VAS) of symptoms; skin reactions; desensitization with diluted autologous seminal fluid; and the IgE reactivity patterns of immunoblotting and enzyme-linked immunosorbent assay in vitro.

Results

The most common symptom cluster was the general cluster, and the most prevalent symptoms were extreme fatigue and inattention. A total of 66.67% (14/21) of the patients had no symptoms or milder symptoms after nocturnal emission than after intercourse or masturbation. Of the patients, 87.5% (21/24) had psychiatric symptoms and 53.85% (7/13) had abnormal sex hormone levels. The SAS and SDS scores of the high and low VAS groups were significantly higher than those of the control group. Pearson analysis showed that the correlation coefficient between the SAS and VAS was 0.607 (P < .01) and that between the SDS and VAS was 0.490 (P < .05). The patients and healthy donors all had positive intracutaneous test results with their own semen, negative skin prick test results, and no IgE specific to autologous semen. Most patients (4/5) did not achieve ideal therapeutic effects with desensitization.

Clinical Implications

Allergy is not the main pathogenesis of POIS, and desensitization with autologous semen is not effective for most patients.

Strengths and Limitations

This project included the largest number of patients with POIS in China and assessed the allergic response to autologous semen and the effect of desensitization therapy. There is no objective method for evaluating the efficacy of desensitization with autologous semen.

Conclusions

IgE-mediated semen allergy is not the main pathogenesis of POIS, and there is a positive chance that POIS is related to psychological factors. Most patients do not respond to desensitization with autologous semen, and POIS treatment should be individualized, especially in cases with uncertain causes.
Microglia contribute to mammary tumor‐induced neuroinflammation in a female mouse model
Authors: Strehle Lindsay D. , Otto‐Dobos Lauren D. , Grant Corena V. , Glasper Erica R. , Pyter Leah M.
Published: January 2024

Following diagnosis but before treatment, up to 30% of breast cancer patients report behavioral side effects (e.g., anxiety, depression, memory impairment). Our rodent mammary tumor model recapitulates aspects of these behavioral sequelae, as well as elevated circulating and brain inflammatory mediators. Neuroinflammation is a proposed mechanism underlying the etiology of mood disorders and cognitive deficits, and therefore may be contributing to tumor‐associated behavioral side effects. The cellular mechanisms by which tumor‐induced neuroinflammation occurs remain unknown, making targeted treatment approaches inaccessible. Here, we tested the hypotheses that microglia are the primary cells driving tumor‐induced neuroinflammation and behavioral side effects. Young adult female BALB/c mice were induced with a 67NR mammary tumor; tumor‐free controls underwent a sham surgery. Mammary tumors increased IBA1+ and GFAP+ staining in the amygdala and hippocampus relative to tumor‐free controls. However, tumors did not alter gene expression of Percoll‐enriched microglia isolated from the whole brain. While cognitive, social, and anhedonia‐like behaviors were not altered in tumor‐bearing mice, tumors increased central tendency in the open‐field test; microglia depletion did not reverse this effect. Brain region RT‐qPCR data indicated that microglia depletion attenuated tumor‐induced elevations of neuroinflammatory gene expression in a region‐ and mediator‐specific manner. These results indicate a causal role of microglia in tumor‐induced neuroinflammation. This research advances our understanding of the cellular mechanisms underlying tumor‐induced neuroinflammation in order to understand how brain responses (e.g., behavior) may be altered with subsequent cancer‐related immune challenges.
Pharmacological effects of volatile oil from chrysanthemum and its associated mechanisms: a review
Authors: Zhang Jing , Su Weiqiang , Filipczak Nina , Luo Ying , Wan Anping , He Yao , Yan Shijuan , Li Xiang , Yang Ming
Published: January 2024

Volatile oil (VO) is the main chemical component of common plants in Chrysanthemum genus, and it possesses several beneficial pharmacological properties, including bacteriostatic, antioxidant, anti-tumor, anti-inflammatory, antipyretic, analgesic, anti-osteoporotic, antihypertensive, sedative, and hypnotic effects. To date, research on the effective components of Chrysanthemum extract has mainly focused on flavonoids, whereas limited data are available on the chemical constituents and underlying mechanisms of action of the VO components. In this review, the pharmacological activities and mechanisms of VO are comprehensively reviewed with the aim of providing a foundation for further development for medicinal, aromatherapy, and diet therapy applications.
Visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders
Authors: Aggarwal Manvi , Gour Abha , Gupta Nidhi , Singh Aastha , Sangwan Virender
Published: January 2024

Purpose:

To determine the visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders (OSDs).

Setting:

Tertiary eyecare center in North India.

Design:

Retrospective observational study.

Methods:

Patients with various OSDs with stabilized ocular surfaces who underwent cataract surgery during this period and had a minimum postoperative follow-up of 6 weeks were included. The primary outcome measures were postoperative corrected distance visual acuity (CDVA) at 6 weeks, best CDVA achieved, and postoperative complications.

Results:

The study included 20 men and 24 women. A total of 55 eyes were evaluated: Stevens-Johnson syndrome (SJS) 35 eyes, ocular cicatricial pemphigoid (OCP) 4 eyes, 8 eyes with dry eye disease (DED), 6 eyes with chemical injury and 2 eyes with vernal keratoconjunctivitis (VKC). The mean duration of OSD was 33.9 ± 52.17 months. The median preoperative CDVA was 2.0 (interquartile range [IQR], 1.45 to 2.0). The median CDVA ever achieved was 0.50 (IQR, 0.18 to 1.45) at 2 months and the median CDVA at 6 weeks was 0.6 (IQR, 0.3 to 1.5). Maximum improvement in CDVA was noted in patients with DED and SJS and the least in OCP. Phacoemulsification was performed in 47.27% eyes with intraoperative complications noted in 9% eyes. Postoperative surface complications occurred in 12 (21.82%) eyes. Other postoperative complications occurred in 9 (16%) eyes.

Conclusions:

Cataract surgery outcome can be visually rewarding in patients with OSDs provided ocular surface integrity is adequately maintained preoperatively and postoperatively.
Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers’ Compensation System? A 10-Year Study of Workers’ Compensation Claims From a Large Nationwide Workers’ Compensation Insurance Carrier
Authors: Tsourmas Nicholas F. , Bernacki Edward J. , Hunt Dan L. , Kalia Nimisha , Lavin Robert A. , Yuspeh Larry , Leung Nina , Green-McKenzie Judith , Tao Xuguang (Grant)
Published: January 2024

Background

Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population.

Objective

To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers’ compensation (WC).

Method

A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed.

Results

The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement.

Conclusions

Undergoing an AM is associated with an increased risk of TKA in WC claimants.
Ambient Temperature Effects on Hospitalization Risk Among Farmers
Authors: Tran Nu Quy Linh , Nguyen Thi Tuong Vy , Chu Cordia , Phung Hai , Nghiem Son , Phung Dung
Published: January 2024

Objective

The aim of the study is to assess the effect of high temperatures on hospitalization for all causes and heat-sensitive diseases among Vietnamese farmers.

Methods

The Poisson generalized linear model and distributed lag nonlinear model were used to investigate the temperature-hospitalization association for all causes and seven cause-specific disease groups.

Results

Every 1°C increase in daily mean temperature above the threshold increased the estimated relative risk (95% CI) of all-cause hospitalization by 1.022 (0.998–1.047) at the country level, 1.047 (1.007–1.089) in the south, and 0.982 (0.958–1.006) in the north. Infectious disease hospitalization was most affected by high temperatures (1.098 [1.057–1.140]). High temperatures significantly increased the risk of all-cause hospitalization for farmers 60 years and younger in three of the six provinces.

Conclusions

The findings emphasized the need for health promotion programs to prevent heat-related health issues.
The impact of genital lichen sclerosus in men and women on quality of life: a prospective cohort study
Authors: Jerkovic Gulin Sandra , Liljeberg Linnea , Seifert Oliver
Published: January 2024

Background:

Genital lichen sclerosus (LS) is a chronic inflammatory skin disorder that affects both sexes of all ages. The clinical characteristics include erosions, redness, and white plaques with atrophic skin, with symptoms such as pruritus, pain, dysuria, and dyspareunia.

Objective:

This prospective cohort study aimed to assess quality of life (QoL) in men and women with genital LS, both before and after treatment, using the Dermatology Quality of Life Index (DLQI) questionnaire.

Methods:

Patients diagnosed with genital LS were enrolled continuously in the study and were asked to complete the DLQI questionnaire before treatment and again after individualized treatment 12 weeks apart.

Results:

This study included 136 patients (48 females and 88 males) diagnosed with genital LS, with a median age of 62 years (range 18–86). The results showed a statistically significant decrease (P < .001) in DLQI score before treatment (median 6.0 [interquartile range (IQR), 1.0–11.0]) compared to after treatment (median 2.0 [IQR, 0.0–4.0)]. In males and females, the median DLQI scores before treatment were 3.0 (IQR, 0.0–10.0) and 8.0 (IQR, 4.5–11.5), respectively, and after treatment were 1.0 (IQR, 0.0–3.0) and 4.0 (IQR, 0.0–9.0), respectively. Females scored significantly higher (P < .001) than males.

Limitations:

The study’s limited generalizability stems from a small sample size of 136 patients, potentially restricting the application of findings to a broader population with genital lichen sclerosus. Additionally, the 12-week follow-up period may not adequately capture the long-term effects of interventions on quality of life. Reliance on self-reported data through the DLQI questionnaire introduces the possibility of bias, as participants may not accurately represent their symptoms and quality of life. The absence of a control group hinders the ability to attribute observed changes solely to the treatment, and the lack of detail on specific interventions makes it challenging to assess the effectiveness of individualized treatment approaches. The wide age range among participants (18–86 years) introduces potential confounding variables, as different age groups may respond differently to treatment.

Conclusion:

The study findings confirmed that individuals with genital LS experience a small decline in QoL, as observed in both males and females. This study also highlights that effective management of genital LS can significantly improve QoL in both sexes.
Implementing an evidence-based guideline to decrease opioids after cardiac surgery
Authors: Galao-Malo Roberto , Davidson Alison , D'Aoust Rita , Baker Deborah , Scott Mackenzy , Swain Julie
Published: January 2024

Background:

Deaths related to overdoses continue growing in the United States. The overprescription of opioids after surgical procedures may contribute to this problem.

Local problem:

There is inconsistency in the prescription of opioids in cardiovascular surgery patients. Recommendations regarding the reduction of opioids at discharge are not fully implemented.

Methods:

This is a single-center, pre–post quality improvement project in adult patients after elective cardiac surgery through sternotomy.

Interventions:

Changes in guidelines, modification of order sets, creation of dashboards, and education to the providers to increase the prescription of acetaminophen around the clock on the step-down unit and at discharge, decrease the number of opioid tablets to 25 or less at discharge and decrease the prescription of opioids to 25 or less morphine milligram equivalents (MME) at discharge.

Results:

The preintervention group included 67 consecutive patients who underwent cardiac surgery from November to December 2021. The postintervention group had 67 patients during the same period in 2022. Acetaminophen prescription on the step-down unit increased from 9% to 96% (p < .001). The proportion of patients discharged with 25 or less opioid tablets increased from 18% to 90% (p < .001) and with 25 or less MME from 30% to 55% (p < .01). Acetaminophen prescription at discharge increased from 10% to 48% (p < .001).

Conclusions:

Our intervention increased the use of acetaminophen and decreased the overprescription of opioids in cardiac surgery patients at discharge. Further research is necessary to continue improving pain management to reduce the number of opioids prescribed at discharge.
Acupuncture: Effective and Recommended But More Implementation Needed
Authors: Koppelman Mel Hopper
Published: January 2024

Acupuncture enjoys a robust evidence base for dozens of clinical conditions and decades of research exploring its mechanisms of action. It has over 9,000 positive recommendations from official government and clinical guidelines. However, it still remains relatively inaccessible in the United States, Europe and elsewhere, especially compared to the strength of evidence-based recommendations for its use. Acupuncture would benefit from robust implementation strategies, utilizing insights and approaches from implementation science. The clinical use of Botox for migraine suffered from weaker evidence of effectiveness and greater evidence of harm, but using a streamlined and robust implementation strategy, Allergan was able to achieve widespread implementation from when it began its efforts around 2010. Such a systematic approach that identifies and overcomes barriers to implementation for acupuncture would benefit millions of people who currently are offered less effective and more invasive treatments, contrary to the recommendations of clinical guidelines.
Vascular microphysiological systems
Authors: Shelton Sarah E.
Published: January 2024

Purpose of review

This review summarizes innovations in vascular microphysiological systems (MPS) and discusses the themes that have emerged from recent works.

Recent findings

Vascular MPS are increasing in complexity and ability to replicate tissue. Many labs use vascular MPS to study transport phenomena such as analyzing endothelial barrier function. Beyond vascular permeability, these models are also being used for pharmacological studies, including drug distribution and toxicity modeling. In part, these studies are made possible due to exciting advances in organ-specific models. Inflammatory processes have also been modeled by incorporating immune cells, with the ability to explore both cell migration and function. Finally, as methods for generating vascular MPS flourish, many researchers have turned their attention to incorporating flow to more closely recapitulate in vivo conditions.

These models represent many different types of tissue and disease states. Some devices have relatively simple geometry and few cell types, while others use complex, multicompartmental microfluidics and integrate several cell types and origins. These 3D models enable us to observe model evolution in real time and perform a plethora of functional assays not possible using traditional cell culture methods.
Teaching the Teacher
Authors: Goering Mary DeGrote
Published: January 2024

Background:

Faculty can support successful preceptor-led clinical experiences by providing registered nurses with educational resources to guide them in the preceptor role.

Purpose:

To upgrade our institution's educational resources using an online platform that enables just-in-time access.

Method:

This was a quality improvement project to create and implement an educational resource tool kit for prelicensure nursing preceptors.

Results:

Half of our preceptors (n = 46, 52%) had no formal preceptor education. The preceptors used all the resources and were satisfied with the tool kit's content and ease of use.

Conclusion:

Implementing the tool kit was feasible. Further development includes (a) adding content regarding diverse students and trauma-informed nursing care, (b) incorporating interactive educational materials, (c) exploring avenues to reduce cognitive load, (d) creating a prelicensure preceptor preparation course, and (e) considering avenues for providing open access for nursing faculty of prelicensure programs.
Learning Environments in Undergraduate Nursing Education During COVID-19
Authors: Lee Anna , Kim Sinhye , Noh Wonjung
Published: January 2024

Background:

The COVID-19 pandemic radically changed nursing education.

Purpose:

To map the existing literature on learning environments (LEs) in undergraduate nursing education during COVID-19 and identify the LE elements based on the 4 domains of Gruppen's conceptual framework: personal, social, organizational, and physical and virtual spaces.

Method:

Eligible articles were reviewed using the Joanna Briggs framework.

Results:

The search retrieved 5003 articles, of which 80 met the inclusion criteria. Most studies were cross-sectional and conducted in the United States. Of the studies included, 68 studies focused on the personal component of students, 67 investigated physical and virtual space components, 19 examined the social domain, and 15 examined organizational aspects.

Conclusions:

The COVID-19 pandemic significantly influenced the LE of nursing students. Based on the current review of LE in nursing education, nurse educators and researchers can develop interventions to maintain the quality and accessibility of nursing education in future crises.
Clinical, Morphologic, and Molecular Features of MAP3K8 Rearranged Spitz Neoplasms
Authors: Patel Pragi , Hagstrom Michael , Sharma Natasha , Chen Alice , Dhillon Soneet , Fumero-Velázquez Mónica , Olivares Shantel , Gerami Pedram
Published: January 2024

Previous studies regarding the clinical behavior of Spitz neoplasms lack genomic characterization. We aim to assess our hypothesis that most MAP3K8 Spitz neoplasms are indolent despite MAP3K8 being the single most common driver of Spitz melanoma. Further, we aim to identify genomic features associated with aggressive behavior and to better characterize the morphology of these cases. We analyzed the outcomes of MAP3K8 Spitz neoplasms. We also performed a meta-analysis of the outcomes of MAP3K8 Spitz from the literature. Morphologic features were compared with other variants of Spitz using a Student t test and χ2 test. Two of 35 cases resulted in local recurrence and one of these cases had local regional metastasis; all other cases had no evidence of recurrence (mean follow-up time: 33 mo). MAP3K8 Spitz only rarely results in aggressive behavior. Metastatic cases have genomic mutations associated with tumor progression. Morphologically, MAP3K8 Spitz neoplasms frequently showed nodular silhouette, large cell size, epithelioid morphology, and severe nuclear atypia resulting in more frequent diagnosis as Spitz melanoma. Most MAP3K8 Spitz neoplasms have excellent prognoses, apart from rare cases harboring additional genomic abnormalities associated with tumor progression.
Immunocompromised-Associated Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study*
Authors: Gertz Shira J. , Bhalla Anoopindar , Chima Ranjit S. , Emeriaud Guillaume , Fitzgerald Julie C. , Hsing Deyin D. , Jeyapalan Asumthia S. , Pike Francis , Sallee Colin J. , Thomas Neal J. , Yehya Nadir , Rowan Courtney M. ,   on behalf of the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: January 2024

OBJECTIVES:

To characterize immunocompromised-associated pediatric acute respiratory distress syndrome (I-PARDS) and contrast it to PARDS.

DESIGN:

This is a secondary analysis of the 2016–2017 PARDS incidence and epidemiology (PARDIE) study, a prospective observational, cross-sectional study of children with PARDS.

SETTING:

Dataset of 145 PICUs across 27 countries.

PATIENTS:

During 10 nonconsecutive weeks (from May 2016 to June 2017), data about immunocompromising conditions (ICCs, defined as malignancy, congenital/acquired immunodeficiency, posttransplantation, or diseases requiring immunosuppression) were collected.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 708 subjects, 105 (14.8%) had ICC. Before the development of I-PARDS, those with ICC were more likely to be hospitalized (70% vs. 35%,p< 0.001), have more at-risk for PARDS (p= 0.046), and spent more hours at-risk (20 [interquartile range, IQR: 8–46] vs. 11 [IQR: 4–33], [p= 0.002]). Noninvasive ventilation (NIV) use was more common in those with ICC (p< 0.001). Of those diagnosed with PARDS on NIV (n= 161), children with ICC were more likely to be subsequently intubated (n= 28/40 [70%] vsn= 53/121 [44%],p= 0.004). Severe PARDS was more common (32% vs 23%,p< 0.001) in I-PARDS. Oxygenation indices were higher at diagnosis and had less improvement over the first 3 days of PARDS (p< 0.001). Children with I-PARDS had greater nonpulmonary organ dysfunction. Adjusting for Pediatric Risk of Mortality IV and oxygenation index, children with I-PARDS had a higher severity of illness-adjusted PICU mortality (adjusted hazard ratio: 3.0 [95% CI, 1.9–4.7]p< 0.001) and were less likely to be extubated alive within 28 days (subdistribution hazard ratio: 0.47 [95% CI, 0.31–0.71]p< 0.001).

CONCLUSIONS:

I-PARDS is a unique subtype of PARDS associated with hospitalization before diagnosis and increased: time at-risk for PARDS, NIV use, hypoxia, nonpulmonary organ dysfunction, and mortality. The opportunity for early detection and intervention seems to exist. Dedicated study in these patients is imperative to determine if targeted interventions will benefit these unique patients with the ultimate goal of improving outcomes.
Recent advances in Alzheimer disease genetics
Authors: Nicolas Gaël
Published: January 2024

Purpose of review

Genetics studies provide important insights into Alzheimer disease (AD) etiology and mechanisms. Critical advances have been made recently, mainly thanks to the access to novel techniques and larger studies.

Recent findings

In monogenic AD, progress has been made with a better understanding of the mechanisms associated with pathogenic variants and the input of clinical studies in presymptomatic individuals. In complex AD, increasing sample sizes in both DNA chip-based (genome-wide association studies, GWAS) and exome/genome sequencing case-control studies unveiled novel common and rare risk factors, while the understanding of their combined effect starts to suggest the existence of rare families with oligogenic inheritance of early-onset, nonmonogenic, AD.

Most genetic risk factors with a known consequence designate the aggregation of the Aβ peptide as a core etiological factor in complex AD thus confirming that the research based on monogenic AD – where the amyloid cascade seems more straightforward – is relevant to complex AD as well. Novel mechanistic insights and risk factor studies unveiling novel factors and attempting to combine the effect of common and rare variants will offer promising perspectives for future AD prevention, at least regarding early-onset AD, and probably in case of later onset as well.
Clinical Characteristics of Idiopathic Intracranial Hypertension in Older Adults
Authors: Sabet Sina J. , Gasquet Nicolas C. , Henderson Amanda D. , Carey Andrew R.
Published: January 2024

Background:

Idiopathic intracranial hypertension (IIH) is a condition that classically affects obese women of child-bearing age. However, it is sometimes encountered in older patients. The purpose of this study was to help clinicians better understand how this disease can present differently in these age groups.

Methods:

This is a retrospective chart review from a single academic center of baseline characteristics of adult patients diagnosed with IIH based on the modified Dandy criteria. The patients were divided into 2 groups: (1) those 18–44 years old and (2) those older than 45 years at diagnosis.

Results:

One hundred sixty-seven patients were identified; 135 in the younger group and 32 in the older group. The younger group had a higher rate of headaches (90% vs 63%, P = 0.0004), higher body mass index (38.9 vs 36.1, P = 0.046), higher opening pressure (38 vs 31 cm H2O, P = 0.005), and thicker peripapillary retinal nerve fiber layer average thickness (right eye 178 vs 131 μm, P = 0.02; left eye 184 vs 136 μm, P = 0.045). The older group had higher rates of empty sella (90% vs 62%, P = 0.0039). In addition in the younger group, there was a trend toward higher rates of pulsatile tinnitus (63% vs 45%, P = 0.08), transient visual obscurations (50% vs 32%, P = 0.07), and lower rates of spontaneous cerebrospinal fluid leak (4% vs 13%, P = 0.08). Sex, rates of obesity, other MRI findings typical of elevated intracranial pressure, frequency and Frisen grading of papilledema, and visual field loss were not statistically different between the groups.

Conclusions:

The older age group had milder signs and symptoms of IIH and a higher prevalence of empty sella than the younger group, but otherwise had typical characteristics. These findings suggest that IIH in the older age group may represent milder chronic disease that was previously undiagnosed.
MAPK activity and MAP kinase phosphatase 2 (AtMKP2) protein stability under altered glutathione homeostasis inArabidopsis thaliana
Authors: Yang Yingxue , Matern Sanja , Steininger Heike , Vinde Marcos Hamborg , Rausch Thomas , Peskan-Berghöfer Tanja
Published: January 2024

Mitogen-activated protein kinases (MAPKs) are important signaling players involved in various responses to diverse environmental stresses. MAP kinase phosphatases (MKPs) are crucial negative regulators of MAPKs and control the intensity and duration of MAPK activation. It has been shown that transgenic tobacco plants with increased glutathione content display an oxidative shift and have constitutively active immunity-related MAPKs. The mechanism by which glutathione can activate or keep these MAPKs in activated state is unclear. In this study, it is shown that theArabidopsisstress-related MAPKs, AtMPK3 and AtMPK6 are hypersensitive to a pathogen-associated molecular pattern flg22 in thecat2-1line, under the conditions causing an altered glutathione homeostasis and elevated oxidative stress responses in this background. As AtMKP2 is the only dual specificity phosphatase deactivating AtMPK3 and AtMPK6 in response to oxidative stress, the stability of the wild-type AtMKP2 protein and the mutant version of the protein with the substitution of the cys109 in the active site with serine has been studied in wild type (Col-0) andcat2-1background. The results indicate that AtMKP2 is a stable protein in both genetic backgrounds, whereas the active site cys109 stabilizes the protein under severe oxidative stress conditions and can be glutathionylatedin vitro.