bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards optimizing carbapenem selection in stewardship strategies: a prospective propensity score-matched study of ertapenem versus class 2 carbapenems for empirical treatment of third-generation cephalosporin-resistant Enterobacterales bacteraemia
Authors: Vasikasin Vasin , Panuvatvanich Bawornnan , Rawson Timothy M , Holmes Alison H , Nasomsong Worapong
Published: May 2023

Background

Third-generation cephalosporin-resistant Enterobacterales (3GCRE) are increasing in prevalence, leading to greater carbapenem consumption. Selecting ertapenem has been proposed as a strategy to reduce carbapenem resistance development. However, there are limited data for the efficacy of empirical ertapenem for 3GCRE bacteraemia.

Objectives

To compare the efficacy of empirical ertapenem and class 2 carbapenems for the treatment of 3GCRE bacteraemia.

Methods

A prospective non-inferiority observational cohort study was performed from May 2019 to December 2021. Adult patients with monomicrobial 3GCRE bacteraemia receiving carbapenems within 24 h were included at two hospitals in Thailand. Propensity scores were used to control for confounding, and sensitivity analyses were performed in several subgroups. The primary outcome was 30 day mortality. This study is registered with clinicaltrials.gov (NCT03925402).

Results

Empirical carbapenems were prescribed in 427/1032 (41%) patients with 3GCRE bacteraemia, of whom 221 received ertapenem and 206 received class 2 carbapenems. One-to-one propensity score matching resulted in 94 pairs. Escherichia coli was identified in 151 (80%) of cases. All patients had underlying comorbidities. Septic shock and respiratory failure were the presenting syndromes in 46 (24%) and 33 (18%) patients, respectively. The overall 30 day mortality rate was 26/188 (13.8%). Ertapenem was non-inferior to class 2 carbapenems in 30 day mortality (12.8% versus 14.9%; mean difference −0.02; 95% CI: −0.12 to 0.08). Sensitivity analyses were consistent regardless of aetiological pathogens, septic shock, source of infection, nosocomial acquisition, lactate levels or albumin levels.

Conclusions

Ertapenem may be of comparable efficacy to class 2 carbapenems in the empirical treatment of 3GCRE bacteraemia.
Genetic parameter analysis of bareness and tail traits in New Zealand sheep
Authors: Johnson Patricia L , Scobie David R , Dodds Ken G , Powdrell Sarah-Jane H , Rowe Suzanne J , McRae Kathryn M
Published: May 2023

Physical traits that improve welfare and disease outcomes for sheep are becoming increasingly important due to both increased climate challenges and societal expectations. Such traits include tail length, the amount of skin (vs. wool) on the underside of the tail, and the area of no-wool (hair) on the belly and breech areas (surrounding the anus) of the animal. An industry dataset consisting of records from individual stud breeders and industry progeny tests was available to estimate the genetic parameters associated with these traits and to investigate the potential for within-breed genetic selection. The heritability estimate for tail length was 0.68 ± 0.01 when breed was not fitted, and 0.63 ± 0.01 when breed was fitted. Similar trends were observed for breech and belly bareness which had heritability estimates around 0.50 (± 0.01). The estimates for these bareness traits are both higher than previous reports from animals of the same age. There was, however, between breed variation in the starting point for these traits, with some breeds having significantly longer tails and a wooly breech and belly, and limited variability. Overall, the results of this study show that flocks exhibiting some variation will be able to make rapid genetic progress in selecting for bareness and tail length traits, and therefore have the potential to make progress towards a sheep that is easier to look after and suffers fewer welfare insults. For those breeds that showed limited within-breed variation, outcrossing may be required to introduce genotypes that exhibit shorter tail length and bareness of belly and breech to increase the rate of genetic gain. Whatever approach is taken by the industry, these results support that genetic improvement can be used to breed “ethically improved sheep”.
Comparison of standardized ileal digestibility of amino acids in faba beans and field peas in broiler chickens and pigs
Authors: Adekoya Abidemi Abosede , Adeola Olayiwola
Published: May 2023

An experiment, using the same set of five diets was conducted to determine and compare the standardized ileal digestibility (SID) of amino acids (AA) in faba beans and three cultivars of field peas in broiler chickens and pigs. Four test diets were prepared to contain faba beans, DS-Admiral field peas, Hampton field peas, or 4010 field peas as the sole source of nitrogen. A nitrogen-free diet (NFD), as the fifth diet, was prepared to estimate the basal endogenous losses of AA to determine the SID of AA in the test ingredients. A total of 416 male broiler chickens with an initial body weight (BW) of 951 ± 111 g were allotted to five diets in a randomized complete block design with BW as a blocking factor on day 21 posthatching. There were 8 replicate cages with 10 birds per cage for diets containing test ingredients and 12 birds per cage for NFD. All birds were allowed ad-libitum access to feed for 5 days. On day 26 posthatching, all birds were euthanized by CO2 asphyxiation and digesta contents were collected from the distal two-thirds of the ileum. Twenty barrows with an initial BW of 30.2 ± 1.58 kg, surgically fitted with T-cannulas in the distal ileum, were divided into four blocks according to BW and each block was assigned to a 5 × 2 incomplete Latin Square design that consisted of five dietary treatments and two experimental periods. For each experimental period, there was a 5-day adaptation period followed by a 2-day collection of ileal digesta samples. The data were analyzed as a 2 × 4 factorial treatment arrangement with the effect of species (i.e., broiler chickens and pigs) and test diets (i.e., four test ingredients). For broiler chickens, the SID of Lys in faba beans, DS-Admiral field peas, and Hampton field peas were above 90% but in 4010 field peas, it was 85.1%. The SID of Lys in faba beans, DS-Admiral field peas, and Hampton field peas for pigs was above 80% but was 78.9% in 4010 field peas. The respective SID of Met in faba beans, DS-Admiral field peas, Hampton field peas, and 4010 field peas were 84.1%, 87.3%, 89.8%, and 72.1% for broiler chickens, and 71.5%, 80.4%, 81.8%, and 68.1% for pigs. The SID of AA in 4010 field peas was the least (P < 0.05) for chickens, but in pigs, it was comparable with faba beans. In conclusion, the SID of AA in faba beans and field peas was greater in broiler chickens compared with pigs and there was a cultivar effect.
Impact of dietary analyzed calcium to phosphorus ratios and standardized total tract digestible phosphorus to net energy ratios on growth performance, bone, and carcass characteristics of pigs
Authors: Williams Hadley R , Tokach Mike D , Woodworth Jason C , DeRouchey Joel M , Goodband Robert D , Gebhardt Jordan T , Vier Carine M , Lu Ning , Navales Ron , Spindler Matthew , Orlando Uislei , Zaragoza Luis , Betlach Alyssa M
Published: May 2023

A total of 2,184 pigs (337 × 1,050, PIC; initially 12.4 ± 0.17 kg) were used in a 143-d study to evaluate the effects of feeding varying analyzed calcium to phosphorus ratios (Ca:P) at two standardized total tract digestible (STTD) phosphorus to net energy ratios (STTD P:NE). Pens of pigs (26 pigs per pen) were assigned to 1 of the 6 dietary treatments in a 2 × 3 factorial with main effects of STTD P:NE and Ca:P ratio. Diets consisted of two levels of STTD P:NE; High (1.80, 1.62, 1.43, 1.25, 1.10, and 0.99 g STTD P/Mcal NE from 11 to 22, 22 to 40, 40 to 58, 58 to 81, 81 to 104, and 104 to 129 kg, respectively); or Low (75% of the High levels), and three analyzed Ca:P ratios (0.90:1, 1.30:1, and 1.75:1). There were 14 pens per treatment. Diets were corn-soybean meal-based and contained a constant phytase concentration within each dietary phase with levels decreasing throughout the trial (phases 1 through 3, 500 FTU/kg, assumed release of 0.13% STTD P; phase 4, 400 FTU/kg, assumed release of 0.11% STTD P; phase 5, 290 FTU/kg, assumed release of 0.09% STTD P; and phase 6, 210 FTU/kg, assumed release of 0.07% STTD P). Overall, there was a Ca:P × STTD P:NE interaction (P < 0.05) observed for average daily gain (ADG), feed efficiency (G:F), final body weight (BW), hot carcass weight (HCW), bone mineral density, bone mineral content, and bone-breaking strength. When feeding Low STTD P:NE levels, increasing the analyzed Ca:P ratio decreased (linear, P < 0.001) ADG final BW, HCW, and tended to worsen G:F, bone mineral density, and bone mineral content (linear, P < 0.10). However, when feeding High STTD P:NE levels, increasing the analyzed Ca:P ratio significantly improved bone mineral content and bone mineral density (linear, P < 0.05), and tended to improve ADG and final BW (linear, P < 0.10) and G:F (quadratic P < 0.10). Additionally, increasing the analyzed Ca:P ratio worsened ADG, G:F, and bone mineralization with Low STTD P:NE but had marginal impacts when adequate STTD P:NE was fed.
Using time travel in virtual reality (VR) to increase efficacy perceptions of influenza vaccination
Authors: Lee Joomi , Wu Dai-Yun , Lin Jih-Hsuan (Tammy) , Kim Jooyoung , Ahn Sun Joo (Grace)
Published: May 2023

This study examined the unique affordance of time travel in virtual reality (VR) to enhance the perceived efficacy of influenza vaccination. Effective vaccine communication hinges on raising awareness of the risk of contracting a contagious virus and spreading the infection to others. According to the extended-parallel process model, behavioral changes are achieved when an individual perceives sufficient levels of threat and efficacy to prevent negative health outcomes. Findings from a 2 (interactivity: active vs. passive) × 2 (virtual time travel: yes vs. no) between-subjects experiment (N = 178) indicated that virtual time travel to receive vaccination after experiencing negative consequences of influenza in VR increased participants’ perceived efficacy of vaccination for self-protection and community protection. Moreover, interactivity in VR enhanced vaccination intention, mediated by spatial presence, message involvement, and response efficacy.
Elucidating the insecticidal mechanisms of zein nanoparticles on Anticarsia gemmatalis (Lepidoptera: Erebidae)
Authors: Bonser Colin A R , Astete Carlos E , Sabliov Cristina M , Davis Jeffrey A
Published: May 2023

Previous research suggested that positively charged zein nanoparticles [(+)ZNP] were toxic to neonates of Anticarsia gemmatalis Hübner and deleterious to noctuid pests. However, specific modes of action for ZNP have not been elucidated. Diet overlay bioassays attempted to rule out the hypothesis that A. gemmatalis mortality was caused by surface charges from component surfactants. Overlay bioassays indicated that negatively charged zein nanoparticles [(−)ZNP] and its anionic surfactant, sodium dodecyl sulfate (SDS), exhibited no toxic effects when compared to the untreated check. Nonionic zein nanoparticles [(N)ZNP] appeared to increase mortality compared to the untreated check, though larval weights were unaffected. Overlay results for (+)ZNP and its cationic surfactant, didodecyldimethylammonium bromide (DDAB), were found to be consistent with former research indicating high mortalities, and thus, dosage response curves were conducted. Concentration response tests found the LC50 for DDAB on A. gemmatalis neonates was 208.82 a.i./ml. To rule out possible antifeedant capabilities, dual choice assays were conducted. Results indicated that neither DDAB nor (+)ZNP were antifeedants, while SDS reduced feeding when compared to other treatment solutions. Oxidative stress was tested as a possible mode of action, with antioxidant levels used as a proxy for reactive oxygen species (ROS) in A. gemmatalis neonates, which were fed diet treated with different concentrations of (+)ZNP and DDAB. Results indicated that both (+)ZNP and DDAB decreased antioxidant levels compared to the untreated check, suggesting that both (+)ZNP and DDAB may inhibit antioxidant levels. This paper adds to the literature on potential modes of action by biopolymeric nanoparticles.
Reproductive biology of overwintering leaffooted bug Leptoglossus zonatus (Hemiptera: Coreidae) in California
Authors: Stahl Judith M , Daane Kent M
Published: May 2023

Leptoglossus zonatus (Dallas) (Hemiptera: Coreidae) is a polyphagous insect pest attacking a wide variety of crops. In California’s Central Valley, it is now the dominant leaffooted bug on almonds, pistachios, and pomegranates. Leptoglossus zonatus pest status depends largely on overwintering adult survival and reproductive potential, which determines its population size in spring and early summer when nut crops are particularly susceptible to bug damage. Here, we investigated the overwintering reproductive biology of L. zonatus in laboratory and field experiments to gain information about its ovary development, time of mating, and the impact of low temperatures on egg hatch. With dissections of laboratory-reared L. zonatus, we established a baseline for ovarian development and determined that the size of the spermathecal reservoir is larger in mated than in unmated females. Dissections and behavioral experiments of field-collected material provided evidence of mating events before dispersal from overwintering sites. Laboratory trials showed that temperature significantly impacted L. zonatus egg hatch. Leptoglossus zonatus reproductive biology presented provides valuable information on its population dynamics and dispersal from overwintering sites, and will contribute to the development of monitoring and management tools.
Understanding Russia’s Actions in Ukraine as the Crime of Genocide
Authors: Azarov Denys , Koval Dmytro , Nuridzhanian Gaiane , Venher Volodymyr
Published: May 2023

The new wave of Russia’s aggression against Ukraine that began on 24 February 2022, and the intensification of the armed conflict accompanied by grave breaches of international humanitarian law, has received significant scholarly attention. Many academic interventions have examined the developments in Ukraine through the frameworks of jus ad bellum and jus in bello. Some, however, have applied a genocide lens to make sense of reported numerous and widespread violations of international humanitarian and human rights law. This article contributes to the latter stream of scholarship by contextualizing the arguments for the existence of genocidal intent behind the seemingly unrelated crimes committed by the armed forces of the Russian Federation all over Ukraine. The authors pay particular attention to the language and pseudo-historical references used by Russia’s leaders as a justification for the invasion of Ukraine and argue that these statements and expressions indicate the existence of genocidal intent. This article also reflects on the issue of the systematic destruction of cultural heritage of Ukraine as further evidence of the intent to destroy the Ukrainian nation understood as a protected national group under the Genocide Convention, at least in part. Finally, the authors analyse the genocidal acts that have apparently been committed, including killings; the causing of serious bodily or mental harm; the forcible transfer of Ukrainian children to Russia, and the deliberate infliction of conditions of life aimed at the physical destruction of the Ukrainian nation. It is stressed that there are reasonable grounds to believe that the destruction of the Ukrainian nation by Russia has been pursued through commission of these prohibited acts. Their nature and large-scale character serve as further evidence of genocidal intent to destroy the Ukrainian nation.
Democratic Justifications for Patient Public Involvement and Engagement in Health Research: An Exploration of the Theoretical Debates and Practical Challenges
Authors: Frith Lucy
Published: May 2023

The literature on patient public involvement and engagement (PPIE) in health research has grown significantly in the last decade, with a diverse range of definitions and topologies promulgated. This has led to disputes over what the central functions and purpose of PPIE in health research is, and this in turn makes it difficult to assess and evaluate PPIE in practice. This paper argues that the most important function of PPIE is the attempt to make health research more democratic. Bringing this function to the fore and locating PPIE in the wider context of changes in contemporary forms of democratic engagement provides greater conceptual clarity over what PPIE in research should be trying to achieve. Conceptualizing PPIE as a form of democratization has a number of benefits. First, theories of what are appropriate, normatively justifiable and workable criteria for PPIE practices can be developed, and this can provide tools to address the legitimacy and accountability questions that have troubled the PPIE community. Second, this work can be used to form the basis of a research agenda to investigate how PPIE in health research operates, and how it can facilitate and/or improve democratic processes in health research.
Inconsistency between the Circulatory and the Brain Criteria of Death in the Uniform Determination of Death Act
Authors: Molina-Pérez Alberto , Bernat James L , Dalle Ave Anne
Published: May 2023

The Uniform Determination of Death Act (UDDA) provides that “an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” We show that the UDDA contains two conflicting interpretations of the phrase “cessation of functions.” By one interpretation, what matters for the determination of death is the cessation of spontaneous functions only, regardless of their generation by artificial means. By the other, what matters is the cessation of both spontaneous and artificially supported functions. Because each UDDA criterion uses a different interpretation, the law is conceptually inconsistent. A single consistent interpretation would lead to the conclusion that conscious individuals whose respiratory and circulatory functions are artificially supported are actually dead, or that individuals whose brain is entirely and irreversibly destroyed may be alive. We explore solutions to mitigate the inconsistency.
Tazemetostat for tumors harboring SMARCB1/SMARCA4 or EZH2 alterations: results from NCI-COG pediatric MATCH APEC1621C
Authors: Chi Susan N , Yi Joanna S , Williams P Mickey , Roy-Chowdhuri Sinchita , Patton David R , Coffey Brent D , Reid Joel M , Piao Jin , Saguilig Lauren , Alonzo Todd A , Berg Stacey L , Ramirez Nilsa C , Jaju Alok , Mhlanga Joyce C , Fox Elizabeth , Hawkins Douglas S , Mooney Margaret M , Takebe Naoko , Tricoli James V , Janeway Katherine A , Seibel Nita L , Parsons D Williams
Published: May 2023

Background

National Cancer Institute-Children’s Oncology Group Pediatric Molecular Analysis for Therapy Choice assigns patients aged 1-21 years with refractory solid tumors, brain tumors, lymphomas, and histiocytic disorders to phase II trials of molecularly targeted therapies based on detection of predefined genetic alterations. Patients whose tumors harbored EZH2 mutations or loss of SMARCB1 or SMARCA4 by immunohistochemistry were treated with EZH2 inhibitor tazemetostat.

Methods

Patients received tazemetostat for 28-day cycles until disease progression or intolerable toxicity (max 26 cycles). The primary endpoint was objective response rate; secondary endpoints included progression-free survival and tolerability of tazemetostat.

Results

Twenty patients (median age = 5 years) enrolled, all evaluable for response and toxicities. The most frequent diagnoses were atypical teratoid rhabdoid tumor (n = 8) and malignant rhabdoid tumor (n = 4). Actionable alterations consisted of SMARCB1 loss (n = 16), EZH2 mutation (n = 3), and SMARCA4 loss (n = 1). One objective response was observed in a patient with non-Langerhans cell histiocytosis with SMARCA4 loss (26 cycles, 1200 mg/m2/dose twice daily). Four patients with SMARCB1 loss had a best response of stable disease: epithelioid sarcoma (n = 2), atypical teratoid rhabdoid tumor (n = 1), and renal medullary carcinoma (n = 1). Six-month progression-free survival was 35% (95% confidence interval [CI] = 15.7% to 55.2%) and 6-month overall survival was 45% (95% CI = 23.1% to 64.7%). Treatment-related adverse events were consistent with prior tazemetostat reports.

Conclusions

Although tazemetostat did not meet its primary efficacy endpoint in this population of refractory pediatric tumors (objective response rate = 5%, 90% CI = 1% to 20%), 25% of patients with multiple histologic diagnoses experienced prolonged stable disease of 6 months and over (range = 9-26 cycles), suggesting a potential effect of tazemetostat on disease stabilization.
Drivers of Loneliness among Older Refugees
Authors: Horn Vincent , Fokkema Tineke
Published: May 2023

Although older refugees can be seen as particularly vulnerable to social isolation and loneliness, they are often overlooked by ageing and migration scholars. This article addresses this research gap by identifying and examining potential drivers of loneliness among older refugees. The study analysed data from the first two waves of the IAB-BAMF-SOEP Survey of Refugees, focusing on 958 individuals aged 45 and older who arrived in Germany between 2013 and 2016. Nearly half of the participants reported symptoms of loneliness. The major contributing factors included poor health, financial strain, lack of family ties in Germany, limited contact with Germans, insecure residence status, and perceived hostility towards them. The study highlights the need for a range of interventions at multiple levels targeting not only the older refugees themselves but also institutional arrangements and the people of the host country.
Bisphosphonate-treatment of secondary chronic osteomyelitis of the jaw – a case report
Authors: Heimes Diana , Kämmerer Peer W
Published: May 2023

Secondary chronic osteomyelitis (SCO) is caused by bacterial infection leading to progressive jawbone destruction. Antibiotics are used as first-line treatment; surgical therapy is usually extensive and may not provide a cure. Bisphosphonates have been reported to be successful in patients with primary nonbacterial osteomyelitis, and literature indicates promising results in SCO. A 38-year-old patient presented with a progressive mandible-destruction 17 years after wisdom tooth extraction. Several treatment attempts have been unsuccessful. Seeking a second opinion, the patient was then interdisciplinary treated with 90 mg of intravenous pamidronate every four weeks, three times. The patient did not experience side effects presenting a considerable improvement in mouth opening and reporting a dissolvent of signs of pain or infection. The MRI showed edema reduction and decreased contrast uptake. Therefore, bisphosphonate treatment of secondary chronic osteomyelitis of the jaw is a safe and effective option in selected cases after unsuccessful first- and second-line therapy.
Automated Classification for Open-Ended Questions with BERT
Authors: Gweon Hyukjun , Schonlau Matthias
Published: May 2023

Manual coding of text data from open-ended questions into different categories is time consuming and expensive. Automated coding uses statistical/machine learning to train on a small subset of manually-coded text answers. Recently, pretraining a general language model on vast amounts of unrelated data and then adapting the model to the specific application has proven effective in natural language processing. Using two data sets, we empirically investigate whether BERT, the currently dominant pretrained language model, is more effective at automated coding of answers to open-ended questions than other non-pretrained statistical learning approaches. We found fine-tuning the pretrained BERT parameters is essential as otherwise BERT is not competitive. Second, we found fine-tuned BERT barely beats the non-pretrained statistical learning approaches in terms of classification accuracy when trained on 100 manually coded observations. However, BERT’s relative advantage increases rapidly when more manually coded observations (e.g., 200–400) are available for training. We conclude that for automatically coding answers to open-ended questions BERT is preferable to non-pretrained models such as support vector machines and boosting.
Cutaneous diphtheria most likely due to exposure in a detention camp in Libya
Authors: Taccari Francesco , Frondizi Federico , Salvati Federica , Giovannenze Francesca , Del Giacomo Paola , Damiano Fernando , Spanu Teresa , Graffeo Rosalia , Menchinelli Giulia , Mariotti Melinda , Sanguinetti Maurizio , Castri Federica , Neumayr Andreas , Brunetti Enrico , Errico Giulia , Murri Rita , Cauda Roberto , Scoppettuolo Giancarlo
Published: May 2023

A 24-year-old male Bangladeshi asylum seeker presented to the emergency department of Policlinico A. Gemelli of Rome, Italy with multiple nodular, pruritic lesions on both lower limbs and both elbows. We present a skin disease typical for persons living in crowded conditions.
On Getting it Wrong
Authors: Lemma Alessandra
Published: May 2023

This chapter discusses the importance of recognizing the ubiquity of therapist error and treatment failures. It considers different forms of ‘when things go wrong’ in an analytic dyad. This can cover, for example, misjudgements, lapses in attention or moments of misattunement. The term ‘violation’ is reserved to describe actual physical and/or sexual transgressions and sustained emotional abuse of the patient to meet the therapist’s own needs. Within the broad category of ‘getting it wrong’, two types of ethical breaches are distinguished: one that leads to fracture, that is it breaks the analytic relationship irreparably; the other creates a relational gap, which if mentalized, can potentially be transformed into an opening that adds perspective to the work of therapy. The chapter discusses occupational risks around boundary issues (fees, confidentiality, and endings) and the specific ethical risks of online therapy.
Principles in Action
Authors: Lemma Alessandra
Published: May 2023

By way of an illustration of applied ethics, Chapter 7 focuses in some detail on the author’s experience of how an applied ethics approach helped her to find a psychoanalytic position in relation to working with transgender young people. Consideration of the ethics of ‘conversion therapy’ further illustrates the process and merits of systematic ethical analysis. These examples serve as reminders of the importance of prioritizing the patient’s personal values to mitigate the dangers of a normative ideology guiding the analytic process whilst retaining the integrity of the therapist’s own understandings and values, which may differ from the patient’s. The chapter also critically examines the ‘interpretation of the transference’ as an example of the importance of questioning what drives adherence to the analytic techniques that are privileged and how this can be ethically compromising.
Developing the Ethical Chóros
Authors: Lemma Alessandra
Published: May 2023

Existing training in ethics mostly approximates the ‘ethical floor’ approach with, at one end, a focus on minimal obligations and, at the other end, a near-exclusive focus on the more egregious violations. This leaves a relative void in-between. This approach to teaching ethics is not adequate for our purposes. Instead this chapter argues the case for the allocation of space during training for consideration of the more everyday errors, ethical dilemmas, and breaches. This chapter focuses on ‘how’ we could teach ethics to increase protection for patients and ensure that teaching ethics does not become token. It is all too easy to dilute the real demand that the call to ethics places on the therapist. Rules and codes of ethics cannot protect the patient against the operation of the therapist’s unconscious. A detailed curriculum is set out with specified readings. It is suggested that the quality of a training is largely determined by what candidates are encouraged to question in themselves, in the analytic method, and in their institutions.
Operation Bushmaster: The Impact of Simulation-Based Education on Preparing the Next Generation of Military Medical Officers
Authors: Rudinsky CAPT Sherri L , Schwartz LTC James
Published: May 2023

Operation Bushmaster, a large-scale, immersive, multiday simulation experience, is the capstone event of the School of Medicine’s four-year longitudinal Military Unique Curriculum. Operation Bushmaster creates a realistic, far-forward deployed environment where military health profession students are provided the opportunity to put their military medical knowledge, skills, and abilities into practice. This use of simulation-based education is essential to accomplishing Uniformed Services University’s mission—to educate and train military health profession students to serve as future military health officers and leaders within the Military Health System. Simulation-based education (SBE) is effective in reinforcing operational medical knowledge and patient care skills. Additionally, we found SBE can be employed to develop other key competencies for military health care professionals such as professional identity formation, leadership, self-confidence, decision-making under stress, communication, and interpersonal collaboration. This special edition of Military Medicine highlights the educational impact of Operation Bushmaster on the training and development of future uniformed physicians and leaders within the Military Health System.
Health Facility Planning: A Key Global Health Engagement Capability
Authors: Goetschius James B
Published: May 2023

Health facility planning is a key global health engagement capability that assesses the health needs of a population and identifies the combination of services, equipment, facilities, and infrastructure necessary to support them. Collaboration with local health care and building professionals is essential to achieving local buy-in and sustainable solutions.
Simultaneous radio and X-ray observations of the magnetar Swift J1818.0−1607
Authors: Bansal Karishma , Wharton Robert S , Pearlman Aaron B , Majid Walid A , Prince Thomas A , Younes George , Hu Chin-Ping , Enoto Teruaki , Kocz Jonathon , Horiuchi Shinji
Published: May 2023

Swift J1818.0−1607 is a radio-emitting magnetar that was discovered in X-ray outburst in 2020 March. Starting 4 d after this outburst, we began a nearly 5-month multifrequency observing campaign at 2.2, 8.4, and 32 GHz using telescopes in the NASA Deep Space Network. Using a dual-frequency observing mode, we were able to observe Swift J1818.0−1607 simultaneously at either 2.2 and 8.4 GHz or 8.4 and 32 GHz. Over the course of the campaign, we find that the flux density increases substantially and the spectrum changes from uncharacteristically steep (α < −2.2) to the essentially flat (α ≈ 0) spectrum typical of radio-emitting magnetars. In addition to the expected profile evolution on time-scales of days to months, we find that Swift J1818.0−1607 also exhibits mode switching where the pulse profile changes between two distinct shapes on time-scales of seconds to minutes. For two of the radio observations, we also had accompanying X-ray observations using the Neutron Star Interior Composition Explorer telescope that occurred on the same day. We find a near anti-alignment (0.40 phase cycles) between the peaks of the radio and X-ray pulse profiles, which is most likely explained by an intrinsic misalignment between the X-ray- and radio-emitting regions.
Filling in the gaps: can gravitationally unstable discs form the seeds of gas giant planets?
Authors: Baehr Hans
Published: May 2023

Circumstellar discs likely have a short window when they are self-gravitating and prone to the effects of disc instability, but during this time the seeds of planet formation can be sown. It has long been argued that disc fragmentation can form large gas giant planets at wide orbital separations, but its place in the planet formation paradigm is hindered by a tendency to form especially large gas giants or brown dwarfs. We instead suggest that planet formation can occur early in massive discs, through the gravitational collapse of dust which can form the seeds of giant planets. This is different from the usual picture of self-gravitating discs, in which planet formation is considered through the gravitational collapse of the gas disc into a gas giant precursor. It is familiar in the sense that the core is formed first, and gas is accreted thereafter, as is the case in the core accretion scenario. However, by forming a ∼1 M⊕ seed from the gravitational collapse of dust within a self-gravitating disc there exists the potential to overcome traditional growth barriers and form a planet within a few times 105 yr. The accretion of pebbles is most efficient with centimetre-sized dust, but the accretion of millimetre sizes can also result in formation within a Myr. Thus, if dust can grow to these sizes, planetary seeds formed within very young, massive discs could drastically reduce the time-scale of planet formation and potentially explain the observed ring and gap structures in young discs.
Constraints on the ultrafast outflows in the narrow-line Seyfert 1 galaxy Mrk 1044 from high-resolution time- and flux-resolved spectroscopy
Authors: Xu Yerong , Pinto Ciro , Rogantini Daniele , Bianchi Stefano , Guainazzi Matteo , Kara Erin , Jin Chichuan , Cusumano Giancarlo
Published: May 2023

Ultrafast outflows (UFOs) have been revealed in a large number of active galactic nuclei (AGN) and are regarded as promising candidates for AGN feedback on the host galaxy. The nature and launching mechanism of UFOs are not yet fully understood. Here we perform a time- and flux-resolved X-ray spectroscopy on four XMM–Newton observations of a highly accreting narrow-line Seyfert 1 (NLS1) galaxy, Mrk 1044, to study the dependence of the outflow properties on the source luminosity. We find that the UFO in Mrk 1044 responds to the source variability quickly and its velocity increases with the X-ray flux, suggesting a high-density ($10^{9}\!-\!4.5\times 10^{12}\, \mathrm{cm}^{-3}$) and radiatively driven outflow, launched from the region within a distance of $98\!-\!6600\, R_\mathrm{g}$ from the black hole. The kinetic energy of the UFO is conservatively estimated ($L_\mathrm{UFO}\sim 4.4~{{\ \rm per\ cent}}\, L_\mathrm{Edd}$), reaching the theoretical criterion to affect the evolution of the host galaxy. We also find that emission lines, from a large-scale region, have a blueshift of 2700–4500 km s−1 in the spectra of Mrk 1044, which is rarely observed in AGN. By comparing with other sources, we propose a correlation between the blueshift of emission lines and the source accretion rate, which can be verified by a future sample study.
Density biases and temperature relations for DESIRED H ii regions
Authors: Méndez-Delgado J E , Esteban C , García-Rojas J , Arellano-Córdova K Z , Kreckel K , Gómez-Llanos V , Egorov O V , Peimbert M , Orte-García M
Published: May 2023

We present a first study based on the analysis of the DEep Spectra of Ionized REgions Data base (DESIRED). This is a compilation of 190 high signal-to-noise ratio optical spectra of $\mathrm{H\, \scriptstyle II}$ regions and other photoionized nebulae, mostly observed with 8–10 m telescopes and containing ∼29 380 emission lines. We find that the electron density –ne– of the objects is underestimated when [$\mathrm{S\, \scriptstyle II}$] λ6731/λ6716 and/or [$\mathrm{O\, \scriptstyle II}$] λ3726/λ3729 are the only density indicators available. This is produced by the non-linear density dependence of the indicators in the presence of density inhomogeneities. The average underestimate is ∼300 cm−3 in extragalactic $\mathrm{H\, \scriptstyle II}$ regions, introducing systematic overestimates of Te([$\mathrm{O\, \scriptstyle II}$]) and Te([$\mathrm{S\, \scriptstyle II}$]) compared to Te([$\mathrm{N\, \scriptstyle II}$]). The high-sensitivity of [$\mathrm{O\, \scriptstyle II}$] λλ7319 + 20 + 30 + 31/λλ3726 + 29 and [$\mathrm{S\, \scriptstyle II}$] λλ4069 + 76/λλ6716 + 31 to density makes them more suitable for the diagnosis of the presence of high-density clumps. If Te([$\mathrm{N\, \scriptstyle II}$]) is adopted, the density underestimate has a small impact in the ionic abundances derived from optical spectra, being limited to up to ∼0.1 dex when auroral [$\mathrm{S\, \scriptstyle II}$] and/or [$\mathrm{O\, \scriptstyle II}$] lines are used. However, these density effects are critical for the analysis of infrared fine structure lines, such as those observed by the JWST in local star forming regions, implying strong underestimates of the ionic abundances. We present temperature relations between Te([$\mathrm{O\, \scriptstyle III}$]), Te([$\mathrm{Ar\, \scriptstyle III}$]), Te([$\mathrm{S\, \scriptstyle III}$]), and Te([$\mathrm{N\, \scriptstyle II}$]) for the extragalactic $\mathrm{H\, \scriptstyle II}$ regions. We confirm a non-linear dependence between Te([$\mathrm{O\, \scriptstyle III}$]) and Te([$\mathrm{N\, \scriptstyle II}$]) due to a more rapid increase of Te([$\mathrm{O\, \scriptstyle III}$]) at lower metallicities.
Aerosol parameters for night sky brightness modelling estimated from daytime sky images
Authors: Kocifaj M , Kundracik F , Barentine J
Published: May 2023

Atmospheric turbidity is one of the key factors influencing the propagation of artificial light into the environment during cloudless nights. High aerosol loading can reduce the visibility of astronomical objects, and thus information on atmospheric pollution is critical for the prediction of the night sky brightness (NSB) distribution. In particular, the aerosol optical depth (AOD) and asymmetry parameter (g) are among the most important aerosol properties influencing the NSB amplitudes. However, these two parameters are rarely available at astronomical sites. Here, we develop a method for AOD and g retrievals from clear-sky radiometry carried out around sunset or sunrise, shortly before or after night-time observation is intended. The method allows for reducing the number of unknowns needed in the processing and interpretation of night sky radiances, and thus provides an efficient tool for gathering input data to present skyglow simulators. The practice of collecting information about aerosols in this way could become a routine part of astronomical observations, much like observing standard stars to obtain extinction coefficients. If the procedure were conducted around sunset and the data were quickly reduced, it could offer an on-the-spot estimate of the NSB for the night ahead. The error analysis is performed using the theoretical model, while taking into account experimental errors of radiance readings. The capability of the method is demonstrated in a field experiment conducted under cloudless conditions.
Comparative analysis of Ag NPs functionalized with olive leaf extract and oleuropein and toxicity in human trophoblast cells and peripheral blood lymphocytes
Authors: Pirković Andrea , Lazić Vesna , Spremo-Potparević Biljana , Živković Lada , Topalović Dijana , Kuzman Sanja , Antić-Stanković Jelena , Božić Dragana , Jovanović Krivokuća Milica , Nedeljković Jovan M
Published: May 2023

Dry olive leaf extract (DOLE) and its active component oleuropein (OLE) were applied as reducing and stabilizing agents to prepare colloidal 20–25 nm silver nanoparticles (Ag NPs). The Ag NPs were characterized using transmission electron microscopy, X-ray diffraction analysis, and absorption spectroscopy. The cytotoxic actions of coated Ag NPs, and their inorganic and organic components, were examined against trophoblast cells and human peripheral blood lymphocytes (PBLs), Gram-positive, Gram-negative bacteria, and yeast. The genotoxic potential was evaluated in PBLs in vitro with the comet assay. Ag/DOLE and Ag/OLE induced cytotoxic effects in both types of cells after 24 h exposure when silver concentrations were 0.025–0.2 mM. However, the most pronounced cytotoxicity exhibits Ag/OLE. Both colloids also caused reduced ROS production in both cell types at 0.1 mM and 0.2 mM, while bare Ag NPs did not alter ROS levels at any of the conditions. Functionalized Ag/DOLE and Ag/OLE did not show genotoxic effects in PBLs, while bare AgNPs increased DNA damage significantly only at 0.2 mM. Regarding the antimicrobial effects, the Ag/OLE had MIC values for all evaluated microorganisms from 0.0625 to less than 0.0312 mM. Also, the antimicrobial effect of Ag/DOLE was significantly higher on Gram-negative bacteria and yeast than on Gram-positive bacteria. Obtained results indicate that Ag/OLE induced the most pronounced biological effects, beneficial for its application as an antimicrobial agent, but with potential risks from exposure to high concentrations that could induce cytotoxicity in healthy human cells.
The correlation between occupation type and fibromyalgia severity
Authors: Mohabbat A B , Wight E C , Mohabbat N M L , Nanda S , Ferguson J A , Philpot L , Adusumalli J
Published: May 2023

Background

Fibromyalgia (FM) is a chronic pain disorder associated with financial burden, decreased work productivity and absenteeism. Occupational stressors and specific employment factors may contribute to the severity of FM.

Aims

To determine if occupation type or employment status correlates with FM diagnostic and severity parameters, as assessed via validated instruments including tender points (TP), Widespread Pain Index (WPI), Symptom Severity (SS) and pain regions.

Methods

We performed a cross-sectional study of 200 adult patients diagnosed with FM at a single-centre FM clinic. Demographic and clinical data were extracted from the electronic medical records. Occupations were manually grouped in an iterative modified-Delphi approach and participants were grouped by employment status (Working, Not Working/Disabled or Retired) for analysis.

Results

In our cohort, 61% were employed and 24% were not working/disabled, while the remainder were students, homemakers or retired. SS score was significantly higher (P < 0.001) in not working/disabled patients compared to those employed. Business owners had the lowest TP count (median = 14) and the lowest median SS score (median = 7). WPI was highest for Others (Arts/Entertainment, Driver/Delivery and Housekeeper/Custodian workers; median=16) and the lowest for Retail/Sales/Wait Staff (median = 11).

Conclusions

Work-related factors, occupation type and employment status correlate with diagnostic and severity parameters of FM. Employed participants had significantly lower SS scores suggesting that work loss correlates with SS. Participants employed in entry-level jobs or jobs with higher physical or financial stressors may experience greater FM symptoms. Further studies are required to explore work-related factors and their impact on the diagnostic and severity parameters of FM.
Relative Effectiveness of BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines and Homologous Boosting in Preventing COVID-19 in Adults in the US
Authors: Hung Nguyen Van , Boileau Catherine , Bogdanov Alina , Sredl Meg , Bonafede Mac , Ducruet Thierry , Chavers Scott , Rosen Andrew , Martin David , Buck Philip , Esposito Daina , Van de Velde Nicolas , Mansi James A
Published: May 2023

Background

Few head-to-head comparisons have been performed on the real-world effectiveness of coronavirus disease 2019 (COVID-19) booster vaccines. We evaluated the relative effectiveness (rVE) of a primary series of mRNA-1273 vs BNT162b2 and Ad26.COV2.S and a homologous mRNA booster against any medically attended, outpatient, and hospitalized COVID-19.

Methods

A data set linking primary care electronic medical records with medical claims data was used for this retrospective cohort study of US patients age ≥18 years vaccinated with a primary series between February and October 2021 (Part 1) and a homologous mRNA booster between October 2021 and January 2022 (Part 2). Adjusted hazard ratios (HRs) were derived from 1:1 matching adjusted across potential covariates. rVE was (1 – HRadjusted) × 100. Additional analysis was performed across regions and age groups.

Results

Following adjustment, Part 1 rVE for mRNA-1273 vs BNT162b2 was 23% (95% CI, 22%–25%), 23% (95% CI, 22%–25%), and 19% (95% CI, 14%–24%), while the rVE for mRNA-1273 vs Ad26.COV2.S was 50% (95% CI, 48%–51%), 50% (95% CI, 48%–52%), and 57% (95% CI, 53%–61%) against any medically attended, outpatient, and hospitalized COVID-19, respectively. The adjusted rVE in Part 2 for mRNA-1273 vs BNT162b2 was 14% (95% CI, 10%–18%), 13% (95% CI, 8%–17%), and 19% (95% CI, 1%–34%) against any medically attended, outpatient, and hospitalized COVID-19, respectively. rVE against medically attended COVID-19 was higher in adults age ≥65 years (35%; 95% CI, 24%–47%) than in those age 18–64 years (13%; 95% CI, 9%–17%) after the booster.

Conclusions

In this study, mRNA-1273 was more effective than BNT162b2 or Ad26.COV2.S following a primary series during the Delta-dominant period and more effective than BNT162b2 as a booster during the Omicron-dominant period.
Passive acoustic monitoring indicates Barred Owls are established in northern coastal California and management intervention is warranted
Authors: Watson Whitney A , Wood Connor M , Kelly Kevin G , Hofstadter Daniel F , Kryshak Nicholas F , Zulla Ceeanna J , Whitmore Sheila A , O’Rourke Virginia , Keane John J , Peery M Zachariah
Published: May 2023

Barred Owls (Strix varia) have recently expanded westward from eastern North America, contributing to substantial declines in Northern Spotted Owls (Strix occidentalis caurina). Passive acoustic monitoring (PAM) represents a potentially powerful approach for tracking range expansions like the Barred Owl’s, but further methods development is needed to ensure that PAM-informed occupancy models meaningfully reflect population processes. Focusing on the leading edge of the Barred Owl range expansion in coastal California, we used a combination of PAM data, GPS-tagging, and active surveys to (1) estimate breeding home range size, (2) identify patterns of vocal activity that reflect resident occupancy, and (3) estimate resident occupancy rates. Mean breeding season home range size (452 ha) was reasonably consistent with the size of cells (400 ha) sampled with autonomous recording units (ARUs). Nevertheless, false-positive acoustic detections of Barred Owls frequently occurred within cells not containing an activity center such that site occupancy estimates derived using all detected vocalizations (0.61) were unlikely to be representative of resident occupancy. However, the proportion of survey nights with confirmed vocalizations (VN) and the number of ARUs within a sampling cell with confirmed vocalizations (VU) were indicative of Barred Owl residency. Moreover, the false positive error rate could be reduced for occupancy analyses by establishing thresholds of VN and VU to define detections, although doing so increased false negative error rates in some cases. Using different thresholds of VN and VU, we estimated resident occupancy to be 0.29–0.44, which indicates that Barred Owls have become established in the region but also that timely lethal removals could still help prevent the extirpation of Northern Spotted Owls. Our findings provide a scalable framework for monitoring Barred Owl populations throughout their expanded range and, more broadly, a basis for converting site occupancy to resident occupancy in PAM programs.