bluuebunny/crossref_metadata_2025 huggingface dataset:
Storytelling for persuasion: Insights from community health workers on how they engage family members to improve adoption of recommended maternal nutrition and breastfeeding behaviours in rural Bangladesh
Authors: Wable Grandner Gargi , Rasmussen Kathleen M. , Dickin Katherine L. , Menon Purnima , Yeh Tiffany , Hoddinott John
Published: July 2022

Community health workers (CHWs) increasingly provide interpersonal counselling to childbearing women and their families to improve adoption of recommended maternal and child nutrition behaviours. Little is known about CHWs' first‐hand experiences garnering family support for improving maternal nutrition and breastfeeding practices in low‐resource settings. Using focused ethnography, we drew insights from the strategies that CHWs used to persuade influential family members to support recommendations on maternal diet, rest and breastfeeding in a behaviour change communication trial in rural Bangladesh. We interviewed 35 CHWs providing at‐home interpersonal counselling to pregnant women and their families in seven ‘Alive & Thrive’ intervention sites. In‐depth probing focused on how CHWs addressed lack of family support. Thematic coding based on Fisher's narrative paradigm revealed strategic use of three rhetorical principles by CHWs: ethos (credibility), pathos (emotion) and logos (logic). CHWs reported selectively targeting pregnant women, husbands and mothers‐in‐law based on their influence on behavioural adoption. Key motivators to support recommended behaviours were improved foetal growth and child intelligence. Improved maternal health was the least motivating outcome, even among mothers. Logically coherent messaging resonated well with husbands, while empathetic counselling was additionally required for mothers. Mothers‐in‐law were most intransigent, but were persuaded via emotional appeals. Persuasion on maternal rest was most effort‐intensive, resulting in contextually appealing but scientifically inaccurate messaging. Our study demonstrates that CHWs can offer important insights on context‐relevant, feasible strategies to improve family support and uptake of nutrition recommendations. It also identifies the need for focused CHW training and monitoring to address scientifically flawed counselling narratives.
The potential mediating role of anxiety sensitivity in the impact of mindfulness training on anxiety and depression severity and impairment: A randomized controlled trial
Authors: Xie Qiang , Guan Ye , Hofmann Stefan G. , Jiang Ting , Liu Xinghua
Published: July 2022

The benefits of mindfulness‐based interventions to alleviate anxiety and depression have been supported by many studies. Given the effectiveness of mindfulness‐based interventions on anxiety and depression, the underlying mechanisms need to be explored. Using a randomized waitlist‐controlled design, this study investigated whether anxiety sensitivity was a potential mechanism for the impact of mindfulness training on anxiety and depression. Participants with high psychological distress were randomly assigned to an eight‐week mindfulness intervention (N = 35) or a wait‐list control group (N = 34). Before and after the intervention or corresponding waitlist period, participants completed measures of anxiety and depression severity and impairment and anxiety sensitivity. Separate mixed ANOVA demonstrated significant group (intervention vs. control group) × time (pre‐ vs. post‐test) interactions for anxiety sensitivity and overall anxiety severity and impairment and marginally significant interaction for overall depression severity and impairment. Moreover, simple mediation models showed that reductions of anxiety sensitivity from pre‐ to post‐test mediated the impact of mindfulness training on changes in anxiety and depression severity and impairment. The findings suggest that anxiety sensitivity is a potential mechanism underlying the effect of mindfulness training on anxiety and depression, which provides a new perspective for the study of processes of change of mindfulness‐based interventions.
How solitude relates to well‐being in old age: A review of inter‐individual differences
Authors: Chen Yunxiang , Liu Xiangping
Published: July 2022

Older adults are more likely to live alone and engage in solitary activities than young adults, leading to decrement in their well‐being. However, researchers have discovered beneficial implications of solitude, and some of them even have established that the negative and positive effects of solitude coexist. The study's purposes are to investigate the relationship between solitude and well‐being among older adults and to further examine the inter‐individual differences in this relationship. In the database of Google Scholar, the systematic review methods are used and 17 articles meet the inclusion criteria. The study concludes that older adults experience solitude both negatively and positively; the complex relationship between solitude and well‐being can be better understood and explained by inter‐individual differences based on intrapersonal, interpersonal, and cultural factors. This systematic review adopts a perspective that spans individual and social/cultural levels and helps grasp the link between solitude and well‐being in older adults. Based on this review, the researcher can develop appropriate interventions to help older people maximize the benefits of solitude while minimizing the drawbacks to further achieve a higher quality of life.
Deaerator Performance Monitoring and Inspection Guideline
Authors:   The Water Technology Subcommittee of the ASME Research and Technology Committee on Water and Steam in Thermal Power Systems
Published: July 2022

This guideline focuses on thermo-mechanical deaeration systems that utilize steam as the means to heat the incoming feedwater and liberate non-condensable gases. The storage section, whether supplied as a separate tank or as an integral part of the deaerator, is also covered in this guideline.
Front Matter
Authors:   The Water Technology Subcommittee of the ASME Research and Technology Committee on Water and Steam in Thermal Power Systems
Published: July 2022

This front matter contains the Preface, Acknowledgements, and Contents. It is available for access by clicking on the PDF icon below.

eBook keywords: thermo-mechanical deaeration systems, deaerator inspection, deaerator operation, deaertor storage tank, feedwater, direct steam contact under positive pressure, steam/water cycle, chemical injection points, flow accelerated corrosion (FAC).
A CRISPR screen targeting PI3K effectors identifies RASA3 as a negative regulator of LFA-1–mediated adhesion in T cells
Authors: Johansen Kristoffer H. , Golec Dominic P. , Huang Bonnie , Park Chung , Thomsen Julie H. , Preite Silvia , Cannons Jennifer L. , Garçon Fabien , Schrom Edward C. , Courrèges Christina J. F. , Veres Tibor Z. , Harrison James , Nus Meritxell , Phelan James D. , Bergmeier Wolfgang , Kehrl John H. , Okkenhaug Klaus , Schwartzberg Pamela L.
Published: July 2022

The integrin lymphocyte function–associated antigen 1 (LFA-1) helps to coordinate the migration, adhesion, and activation of T cells through interactions with intercellular adhesion molecule 1 (ICAM-1) and ICAM-2. LFA-1 is activated during the engagement of chemokine receptors and the T cell receptor (TCR) through inside-out signaling, a process that is partially mediated by phosphoinositide 3-kinase (PI3K) and its product phosphatidylinositol 3,4,5-trisphosphate (PIP
3
). To evaluate potential roles of PI3K in LFA-1 activation, we designed a library of CRISPR/single guide RNAs targeting known and potential PIP
3
-binding proteins and screened for effects on the ability of primary mouse T cells to bind to ICAM-1. We identified multiple proteins that regulated the binding of LFA-1 to ICAM-1, including the Rap1 and Ras GTPase-activating protein RASA3. We found that RASA3 suppressed LFA-1 activation in T cells, that its expression was rapidly reduced upon T cell activation, and that its activity was inhibited by PI3K. Loss of RASA3 in T cells led to increased Rap1 activation, defective lymph node entry and egress, and impaired responses to T-dependent immunization in mice. Our results reveal a critical role for RASA3 in T cell migration, homeostasis, and function.
Introducing First-Year Undergraduate Students the Fundamentals of Antibiotic Sensitivity Testing through a Combined Computer Simulation and Face-to-Face Laboratory Session
Authors: Mahdi Layla , Denyer Gareth , Caruso Connie , Costabile Maurizio
Published: July 2022

Determining the antibiotic sensitivity of disease-causing microorganisms is a fundamental process in a clinical microbiology laboratory. With the continued use of antibiotics, the emergence of antibiotic resistance has become a significant health issue.
Discovery of Unannotated Small Open Reading Frames in Streptococcus pneumoniae D39 Involved in Quorum Sensing and Virulence Using Ribosome Profiling
Authors: Laczkovich Irina , Mangano Kyle , Shao Xinhao , Hockenberry Adam J. , Gao Yu , Mankin Alexander , Vázquez-Laslop Nora , Federle Michael J.
Published: July 2022

This work employed pleuromutilin-assisted ribosome profiling using retapamulin (Ribo-RET) to identify genome-wide translation start sites in the human pathogen
Streptococcus pneumoniae
. We identified 114 unannotated intergenic small open reading frames (sORFs).
Proportion attributable to contextual effects in general medicine: a meta-epidemiological study based on Cochrane reviews
Authors: Tsutsumi Yusuke , Tsujimoto Yasushi , Tajika Aran , Omae Kenji , Fujii Tomoko , Onishi Akira , Kataoka Yuki , Katsura Morihiro , Noma Hisashi , Sahker Ethan , Ostinelli Edoardo Giuseppe , Furukawa Toshi A
Published: July 2022

Objectives

Our objectives were to examine the magnitude of the proportion attributable to contextual effects (PCE), which shows what proportion of the treatment arm response can be achieved by the placebo arm across various interventions, and to examine PCE variability by outcome type and condition.

Design

We conducted a meta-epidemiological study.

Setting

We searched the Cochrane Database of Systematic Reviews with the keyword ‘placebo’ in titles, abstracts and keywords on 1 January 2020.

Participants

We included reviews that showed statistically significant beneficial effects of the intervention over placebo for the first primary outcome.

Main outcome measures

We performed a random-effects meta-analysis to calculate PCEs based on the pooled result of each included review, grouped by outcome type and condition. The PCE quantifies how much of the observed treatment response can be achieved by the contextual effects.

Public and patient involvement statement

No patient or member of the public was involved in conducting this research.

Results

We included 328 out of 3175 Cochrane systematic reviews. The results of meta-analyses showed that PCEs varied greatly depending on outcome type (I2=98%) or condition (I2=98%), but mostly lie between 0.40 and 0.95. Overall, the PCEs were 0.65 (95% CI 0.59 to 0.72) on average. Subjective outcomes were 0.50 (95% CI 0.41 to 0.59), which was significantly smaller than those of semiobjective (PCE 0.78; 95% CI 0.72 to 0.85) or objective outcomes (PCE 0.94; 95% CI 0.91 to 0.97).

Conclusions

The results suggest that much of the observed benefit is not just due to the specific effect of the interventions. The specific effects of interventions may be larger for subjective outcomes than for objective or semiobjective outcomes. However, PCEs were exceptionally variable. When we evaluate the magnitude of PCEs, we should consider each PCE individually, for each condition, intervention and outcome in its context, to assess the importance of an intervention for each specific clinical setting.
Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent
Authors: Greenhalgh Trisha , Fisman David , Cane Danielle J , Oliver Matthew , Macintyre Chandini Raina
Published: July 2022

Evidence-based medicine (EBM’s) traditional methods, especially randomised controlled trials (RCTs) and meta-analyses, along with risk-of-bias tools and checklists, have contributed significantly to the science of COVID-19. But these methods and tools were designed primarily to answer simple, focused questions in a stable context where yesterday’s research can be mapped more or less unproblematically onto today’s clinical and policy questions. They have significant limitations when extended to complex questions about a novel pathogen causing chaos across multiple sectors in a fast-changing global context. Non-pharmaceutical interventions which combine material artefacts, human behaviour, organisational directives, occupational health and safety, and the built environment are a case in point: EBM’s experimental, intervention-focused, checklist-driven, effect-size-oriented and deductive approach has sometimes confused rather than informed debate. While RCTs are important, exclusion of other study designs and evidence sources has been particularly problematic in a context where rapid decision making is needed in order to save lives and protect health. It is time to bring in a wider range of evidence and a more pluralist approach to defining what counts as ‘high-quality’ evidence. We introduce some conceptual tools and quality frameworks from various fields involving what is known as mechanistic research, including complexity science, engineering and the social sciences. We propose that the tools and frameworks of mechanistic evidence, sometimes known as ‘EBM+’ when combined with traditional EBM, might be used to develop and evaluate the interdisciplinary evidence base needed to take us out of this protracted pandemic. Further articles in this series will apply pluralistic methods to specific research questions.
General practice residents’ perspectives on their professional identity formation: a qualitative study
Authors: Barnhoorn Pieter C , Nierkens Vera , Numans Mattijs E , Steinert Yvonne , Kramer Anneke WM , van Mook Walther NKA
Published: July 2022

Objectives

To move beyond professionalism as a measurable competency, medical educators have highlighted the importance of forming a professional identity, in which learners come to ‘think, act, and feel like physicians’. This socialisation process is known as professional identity formation (PIF). Few empirical studies on PIF in residency have been undertaken. None of these studies focused on PIF during the full length of GP training as well as the interplay of concurrent socialising factors. Understanding the socialisation process involved in the development of a resident’s professional identity and the roles of influencing factors and their change over time could add to a more purposeful approach to PIF. Therefore, we aimed to investigate the process of PIF during the full length of General Practice (GP) training and which factors residents perceive as influential.

Design

A qualitative descriptive study employing focus group interviews.

Setting

Four GP training institutes across the Netherlands.

Participants

Ninety-two GP residents in their final training year participated in 12 focus group interviews.

Results

Study findings indicated that identity formation occurs primarily in the workplace, as residents move from doing to becoming and negotiate perceived norms. A tapestry of interrelated influencing factors—most prominently clinical experiences, clinical supervisors and self-assessments—changed over time and were felt to exert their influence predominantly in the workplace.

Conclusions

This study provides deeper empirical insights into PIF during GP residency. Doing the work of a GP exerted a pivotal influence on residents’ shift from doing as a GP to thinking, acting and feeling like a GP, that is, becoming a GP. Clinical supervisors are of utmost importance as role models and coaches in creating an environment that supports residents’ PIF. Implications for practice include faculty development initiatives to help supervisors be aware of how they can perform their various roles across different PIF stages.
Efficacy and safety of edoxaban in patients with chronic thromboembolic pulmonary hypertension: protocol for a multicentre, randomised, warfarin-controlled, parallel group trial - KABUKI trial
Authors: Hosokawa Kazuya , Abe Kohtaro , Kishimoto Junji , Kobayakawa Yuko , Todaka Koji , Tamura Yuichi , Tatsumi Koichiro , Inami Takumi , Ikeda Nobutaka , Taniguchi Yu , Minatsuki Shun , Murohara Toyoaki , Yasuda Satoshi , Fukuda Keiichi , Tsutsui Hiroyuki
Published: July 2022

Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of prior pulmonary thromboembolism (PE), caused by incomplete clot dissolution after PE. In patients with CTEPH, lifelong anticoagulation is mandatory to prevent recurrence of PE and secondary in situ thrombus formation. Warfarin, a vitamin K antagonist, is commonly used for anticoagulation in CTEPH based on historical experience and evidence. The anticoagulant activity of warfarin is affected by food and drug interactions, requiring regular monitoring of prothrombin time. The lability of anticoagulant effect often results in haemorrhagic and thromboembolic complications. Thus, lifelong warfarin is a handicap in terms of safety and convenience. Currently, the use of direct oral anticoagulants (DOACs) in CTEPH has increased with the advent of four DOACs. The safety of DOACs is superior to warfarin, with less intracranial bleeding in patients with non-valvular atrial fibrillation and venous thromboembolism. Edoxaban, the latest DOAC, also has proven efficacy and safety for those diseases in two large clinical trials; the ENGAGE-AF trial and HOKUSAI-VTE trial. The present trial seeks to evaluate whether edoxaban is non-inferior to warfarin in preventing worsening of CTEPH.

Methods and analysis

The KABUKI trial (is an investigator-initiated, multicentre, phase 3, randomised, single-blind, parallel-group, warfarin-controlled, non-inferiority trial to evaluate the efficacy and safety of edoxaban versus warfarin (vitamin K Antagonist) in subjects with chronic thromBoembolic pUlmonary hypertension taking warfarin (vitamin K antagonIst) at baseline) is designed to prove the non-inferiority of edoxaban to warfarin in terms of efficacy and safety in patients with CTEPH.

Ethics and dissemination

This study is approved by the Institutional Review Board of each participating institution. The findings will be published in a peer-reviewed journal, including positive, negative and inconclusive results.

Trial registration number

NCT04730037.

Protocol version

This paper was written per the study protocol V.4.0, dated 29 January 2021.
Multicentre, randomised controlled trial to investigate the effects of parental touch on relieving acute procedural pain in neonates (Petal)
Authors: Cobo Maria M , Moultrie Fiona , Hauck Annalisa G V , Crankshaw Daniel , Monk Vaneesha , Hartley Caroline , Evans Fry Ria , Robinson Shellie , van der Vaart Marianne , Baxter Luke , Adams Eleri , Poorun Ravi , Bhatt Aomesh , Slater Rebeccah
Published: July 2022

Introduction

Newborn infants routinely undergo minor painful procedures as part of postnatal care, with infants born sick or premature requiring a greater number of procedures. As pain in early life can have long-term neurodevelopmental consequences and lead to parental anxiety and future avoidance of interventions, effective pain management is essential. Non-pharmacological comfort measures such as breastfeeding, swaddling and sweet solutions are inconsistently implemented and are not always practical or effective in reducing the transmission of noxious input to the brain. Stroking of the skin can activate C-tactile fibres and reduce pain, and therefore could provide a simple and safe parent-led intervention for the management of pain. The trial aim is to determine whether parental touch prior to a painful clinical procedure provides effective pain relief in neonates.

Methods and analysis

This is a multicentre randomised controlled trial. A total of 112 neonates born at 35 weeks’ gestation or more requiring a blood test in the first week of life will be recruited and randomised to receive parental stroking either preprocedure or postprocedure. We will record brain activity (EEG), cardiac and respiratory dynamics, oxygen saturation and facial expression to provide proxy pain outcome measures. The primary outcome will be the reduction of noxious-evoked brain activity in response to a heel lance. Secondary outcomes will be a reduction in clinical pain scores (Premature Infant Pain Profile-Revised), postprocedural tachycardia and parental anxiety.

Ethics and dissemination

The study has been approved by the London—South East Research Ethics Committee (ref: 21/LO/0523). The results will be widely disseminated through peer-reviewed publications, international conferences and via our partner neonatal charities Bliss and Supporting the Sick Newborn And their Parents (SSNAP). If the parental tactile intervention is effective, recommendations will be submitted via the National Health Service clinical guideline adoption process.

Study status

Commenced September 2021.

Trial registration number

NCT04901611; 14 135 962.
Mediating effect of kinesiophobia between self-efficacy and physical activity levels in post-CABG patients: protocol for a prospective, multicentre, cross-sectional study in China
Authors: Piao Jing jing , Gu Yanmei , Ling Yunpeng , Chi Liqun , Chen Yu , Wang Rong
Published: July 2022

Introduction

Physical activity (PA) can improve cardiac function, exercise capacity, and quality of life, in addition to reducing mortality by 20%–30% and preventing the recurrence of adverse cardiovascular events in patients following coronary artery bypass graft (CABG). However, PA levels are low in patients after CABG. This study intends to explore the mediating effect of kinesiophobia between self-efficacy and PA levels in patients following CABG.

Methods and analysis

The proposed study constitutes a prospective, multicentre and cross-sectional study comprising 413 patients. Four teaching hospitals with good reputations in CABG will be included in the study. All of them are located in Beijing, China, and provide medical service to the whole country. This study will assess the following patient-reported outcome measures: demographic information, International Physical Activity Questionnaire-Long, Social Support Rating Scale, Cardiac Exercise Self-Efficacy Instrument, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, and Tampa Scale for Kinesiophobia Heart.

Ethics and dissemination

This study conforms to the principles of the Declaration of Helsinki and relevant ethical guidelines. Ethical approval has been obtained from the Ethics Committee of The Sixth Medical Centre of PLA General Hospital (approval number: HZKY-PJ-2022–2). All study participants will provide written informed consent. Findings from this study will be published in Chinese or English for widespread dissemination of the results.

Trial registration number

Chinese Clinical Trial Register, ChiCTR2100054098.
How safe are paediatric emergency departments? A national prospective cohort study
Authors: Plint Amy C , Newton Amanda S , Stang Antonia , Cantor Zach , Hayawi Lamia , Barrowman Nick , Boutis Kathy , Gouin Serge , Doan Quynh , Dixon Andrew , Porter Robert , Joubert Gary , Sawyer Scott , Crawford Tyrus , Gravel Jocelyn , Bhatt Maala , Weldon Patrick , Millar Kelly , Tse Sandy , Neto Gina , Grewal Simran , Chan Melissa , Chan Kevin , Yung Grant , Kilgar Jennifer , Lynch Tim , Aglipay Mary , Dalgleish Dale , Farion Ken , Klassen Terry P , Johnson David W , Calder Lisa A
Published: July 2022

Background

Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department.

Methods

Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified ‘flagged outcomes’ (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients’ health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred.

Results

We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6–9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit.

Conclusion

In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care.
Clinical utility of GI pathology data: implications for practising pathologists
Authors: Loughrey Maurice B , Wong Newton A C S
Published: July 2022

Gastrointestinal (GI) tract pathology represents one of the largest individual specialties within cellular pathology departments globally. As with other specialties, clear communication with clinicians providing primary care for the patient is of utmost importance for optimal management and for appropriate use of resources such as endoscopy. A wide breadth of neoplastic and inflammatory conditions afflicts the GI tract. Here, we aim to illustrate how pathology reporting of GI tract specimens influences patient management and specifically how precise reporting of key parameters in different specimen types and different disease processes can directly impact patient care. We describe the potential clinical relevance of selected pathology data items pertinent to specific conditions and highlight areas of contention with respect to the significance of some pathology features. Recent guidelines are described where a change, for example, in diagnostic criteria for a condition is described, or criteria influencing further management such as endoscopic surveillance. The aim of this review is to focus on the clinical importance of careful written communication between the pathologist and primary clinician, illustrated by selective clinical scenarios involving the upper and lower GI tracts.
Clinical utility of pathology data: endometrial and tubo-ovarian carcinomas
Authors: Shah Varsha Ishverlal , McCluggage W Glenn
Published: July 2022

Cancer resection specimens are usually reported using standardised proformas that consist of a list of elements, which include core (required) and non-core (recommended) items. Although all elements are generally included in the reports, the clinical importance of a particular parameter often depends on a variety of factors, including the clinical setting, local management guidelines and other pathological parameters. In this review, we briefly outline how histopathology data are used to guide management of patients with endometrial and tubo-ovarian cancers, the most common gynaecological malignancies, and provide advice as to which data elements are important in particular scenarios.
Clinical experience with the Bendit steerable microcatheter: a new paradigm for endovascular treatment
Authors: Killer-Oberpfalzer Monika , Chapot René , Orion David , Barr John D , Cabiri Oz , Berenstein Alejandro
Published: July 2022

Background

Vessel tortuosity poses a challenge during endovascular treatment of neurovascular lesions. Bendit Technologies (Petah Tikva, Israel) has developed flexible, steerable microcatheters designed with unique bending and torquing capabilities.

Objective

To describe our first-in-human trial of Bendit21.

Methods

Bendit21 was used in our exploratory, prospective, multicenter, open-label, single-arm clinical study, and in two compassionate use cases. Procedures were conducted at four centers in Austria, Germany, Israel, and the United States between May 2021 and March 2022, in patients with neurovascular conditions. The primary endpoints were device-related safety events, successful navigation through the neurovasculature, and, when intended, successful delivery of contrast or therapy.

Results

Two patients with giant aneurysms were treated successfully under compassionate use approval. The clinical study included 25 patients (mean age: 63.4±11.8 years; 32.0% female). Fourteen patients (56.0%) had aneurysms, two had arteriovenous malformations/fistulas (8.0%), one had a stroke (4.0%), four (16.0%) had intracranial stenosis, and four (16.0%) had other conditions. Bendit21 was used without a guidewire in 12/25 (48.0%) procedures. Bendit21 was successfully navigated through the vasculature without delays or spasms in all cases (100%). Contrast was delivered as intended in 7/7 (100%) cases. Therapeutic devices were delivered successfully with Bendit as intended in 14/18 (77.8%) cases; four deficiencies occurred in three patients with aneurysms, in whom delivery of coils, an intrasaccular device, or a flow diverter was attempted. There were no device-related safety events or mortalities.

Conclusions

Our initial clinical experience with the Bendit21 microcatheter demonstrates its usefulness in achieving technical success in patients with challenging neurovascular conditions.
Accuracy of augmented reality-guided drainage versus stereotactic and conventional puncture in an intracerebral hemorrhage phantom model
Authors: Demerath Theo , Stanicki Amin , Roelz Roland , Farina Nunez Mateo Tomas , Bissolo Marco , Steiert Christine , Fistouris Panagiotis , Coenen Volker Arnd , Urbach Horst , Fung Christian , Beck Jürgen , Reinacher Peter Christoph
Published: July 2022

Background

Minimally invasive intracranial drain placement is a common neurosurgical emergency procedure in patients with intracerebral hemorrhage (ICH). We aimed to retrospectively investigate the accuracy of conventional freehand (bedside) hemorrhage drain placement and to prospectively compare the accuracy of augmented/mixed reality-guided (AR) versus frame-based stereotaxy-guided (STX) and freehand drain placement in a phantom model.

Methods

A retrospective, single-center analysis evaluated the accuracy of drain placement in 73 consecutive ICH with a visual rating of postinterventional CT data. In a head phantom with a simulated deep ICH, five neurosurgeons performed four punctures for each technique: STX, AR, and the freehand technique. The Euclidean distance to the target point and the lateral deviation of the achieved trajectory from the planned trajectory at target point level were compared between the three methods.

Results

Analysis of the clinical cases revealed an optimal drainage position in only 46/73 (63%). Correction of the drain was necessary in 23/73 cases (32%). In the phantom study, accuracy of AR was significantly higher than the freehand method (P<0.001 for both Euclidean and lateral distances). The Euclidean distance using AR (median 3 mm) was close to that using STX (median 1.95 mm; P=0.023).

Conclusions

We demonstrated that the accuracy of the freehand technique was low and that subsequent position correction was common. In a phantom model, AR drainage placement was significantly more precise than the freehand method. AR has great potential to increase precision of emergency intracranial punctures in a bedside setting.
Improving resident well-being: a narrative review of wellness curricula
Authors: Ahart Erin R , Gilmer Lisa , Tenpenny Kelsey , Krase Kelli
Published: July 2022

Background

To improve wellness among residents, many graduate medical education programs have implemented formal wellness curricula. Curricular development has recently shifted focus from drivers of burnout to promotion of wellness. The specific components of successful wellness curricula, however, are not yet well defined.

Objective

To review the published literature assessing core components of wellness curricula in graduate medical education programs.

Methods

Searches were conducted through June 2020 in PubMed, Education Resources Information Center, Google Scholar and Web of Science using the search terms wellness curricula, wellness programs, well-being and graduate medical education. Additional articles were identified from reference lists. Curricula from primarily undergraduate medical education, singular interventions, non-peer-reviewed studies and non-English language studies were excluded.

Results

Eighteen articles were selected and reviewed by three authors. Critical drivers of success included support from program leadership and opportunities for resident involvement in the curriculum implementation. Most curricula included interventions related to both physical and mental health. Curricula including challenging components of professionalisation, such as critical conversations, medical errors and boundary setting, seemed to foster increased resident buy-in. The most frequently used curricular assessment tools were the Maslach Burnout Inventory and resident satisfaction surveys.

Conclusions

Different specialties have different wellness needs. A resource or ‘toolbox’ that includes a variety of general as well as specialty-specific wellness components might allow institutions and programs to select interventions that best suit their individual needs. Assessment of wellness curricula is still in its infancy and is largely limited to single institution experiences.
Stand dynamics and structure of old-growth Fraxinus nigra stands in northern Minnesota, USA
Authors: Fraver Shawn , D'Amato Anthony W. , Reinikainen Mike , Gill Kyle G. , Palik Brian J.
Published: July 2022

Black ash ( Fraxinus nigra Marsh.) forests of north-central North America are currently threatened by the non-native emerald ash borer ( Agrilus planipennis, EAB). Despite the wide distribution of F. nigra ecosystems, and the concern over EAB impact, little is known about their structure and natural stand dynamics. We sampled six old-growth F. nigra stands to assess structure, composition, tree recruitment, and past disturbance. Dendrochronological results revealed that disturbance rates fluctuated markedly over the past 200 years or more, but remained relatively low, suggesting small- to moderate-scale disturbances. Recruitment age structures revealed that ( i) F. nigra is able to maintain long-term dominance through extended longevity as a canopy tree, and ( ii) these systems have fairly continuous recruitment over time, with most sites showing F. nigra recruitment in every decade in the chronology. We speculate that recruitment is coupled with water table fluctuations, in addition to canopy disturbance, as these stands are subject to both frequent flooding and effective soil drought (given the shallow root systems). The low rates of past canopy disturbance and associated gap-phase replacement by F. nigra highlight the potential for dramatic shifts in these systems following emerald ash borer invasion and subsequent canopy tree mortality.
Katian volcanism in Central Armorican Domain (France) and Central Iberian Zone (Portugal): a single monogenetic basaltic field?
Authors: Caroff Martial
Published: July 2022

The Crozon peninsula and Buçaco syncline belong respectively to the Central Armorican Domain and the Central Iberian Zone, located to either side of the Variscan ‘Ibero-Armorican Arc’ structure at present. The Ordovician sedimentary successions at both sites are known to display identical lithofacies. The paired Upper Katian formations also exhibit comparable volcanic successions of anorogenic affinity, including volcaniclastic beds and pillow lavas. The tephra deposits are inferred to have resulted from the activity of subaqueous monogenetic basaltic tuff cones above a <100 m deep calcareous soft substrate, in the context of a passive margin. The Surtseyan-style hydrovolcanic eruptions were followed by effusion of pillow lavas. Both sites also display a large range of similar peperite facies, sometimes related to magmatic segregation structures likely to derive from vapour differentiation. The deeper doleritic dykes and sills, comparable in terms of mineralogy and geochemistry, contain identical metasedimentary xenoliths, whose high-temperature phyllosilicates display a very restricted range of compositions. In the Late Ordovician, Crozon and Buçaco were probably nearby volcanic edifices belonging to a single monogenetic field inside the Armorica microplate. The sudden appearance of high-latitude Katian carbonates, associated with volcanism only at these two peri-Gondwanan sites, just preceded the Gondwanan Hirnantian glaciation.

Supplementary material:
Analytical data for minerals and whole-rock samples and an M
+
–4Si–R
2+
diagram are available at
https://doi.org/10.6084/m9.figshare.c.6096737
CDNs’ Dark Side: Security Problems in CDN-to-Origin Connections
Authors: Shobiri Behnam , Mannan Mohammad , Youssef Amr
Published: July 2022

Content Delivery Networks (CDNs) play a vital role in today’s Internet ecosystem. To reduce the latency of loading a website’s content, CDNs deploy edge servers in different geographic locations. CDN providers also offer important security features including protection against Denial of Service (DoS) attacks, Web Application Firewalls (WAFs), and recently, issuing and managing certificates for their customers. Many popular websites use CDNs to benefit from both the security and the performance advantages. For HTTPS websites, Transport Layer Security (TLS) security choices may differ in the connections between end-users and a CDN (front-end or user-to-CDN), and between the CDN and the origin server (back-end or CDN-to-Origin). Modern browsers can stop/warn users if weak or insecure TLS/HTTPS options are used in the front-end connections. However, such problems in the back-end connections are not visible to browsers or end-users, and lead to serious security issues (e.g., not validating the certificate can lead to MitM attacks). In this article, we primarily analyze TLS/HTTPS security issues in the back-end communication; such issues include inadequate certificate validation and support for vulnerable TLS configurations. We develop a test framework and investigate the back-end connection of 14 leading CDNs (including Cloudflare, Microsoft Azure, Amazon, and Fastly), where we could create an account. Surprisingly, for all the 14 CDNs, we found that the back-end TLS connections are vulnerable to security issues prevented/warned by modern browsers; examples include failing to validate the origin server’s certificate, and using insecure cipher suites such as RC4, MD5, SHA-1, and even allowing plain HTTP connections to the origin. We also identified 168,795 websites in the Alexa top 1 million that are potentially vulnerable to Man-in-the-Middle (MitM) attacks in their back-end connections regardless of the origin/CDN configurations chosen by the origin owner.
BiqBin: A Parallel Branch-and-bound Solver for Binary Quadratic Problems with Linear Constraints
Authors: Gusmeroli Nicolò , Hrga Timotej , Lužar Borut , Povh Janez , Siebenhofer Melanie , Wiegele Angelika
Published: July 2022

We present BiqBin, an exact solver for linearly constrained binary quadratic problems. Our approach is based on an exact penalty method to first efficiently transform the original problem into an instance of Max-Cut, and then to solve the Max-Cut problem by a branch-and-bound algorithm. All the main ingredients are carefully developed using new semidefinite programming relaxations obtained by strengthening the existing relaxations with a set of hypermetric inequalities, applying the bundle method as the bounding routine and using new strategies for exploring the branch-and-bound tree.

Furthermore, an efficient C implementation of a sequential and a parallel branch-and-bound algorithm is presented. The latter is based on a load coordinator-worker scheme using MPI for multi-node parallelization and is evaluated on a high-performance computer.

The new solver is benchmarked against BiqCrunch, GUROBI, and SCIP on four families of (linearly constrained) binary quadratic problems. Numerical results demonstrate that BiqBin is a highly competitive solver. The serial version outperforms the other three solvers on the majority of the benchmark instances. We also evaluate the parallel solver and show that it has good scaling properties. The general audience can use it as an on-line service available athttp://www.biqbin.eu.
On the Explainability of Natural Language Processing Deep Models
Authors: Zini Julia El , Awad Mariette
Published: July 2022

Despite their success, deep networks are used as black-box models with outputs that are not easily explainable during the learning and the prediction phases. This lack of interpretability is significantly limiting the adoption of such models in domains where decisions are critical such as the medical and legal fields. Recently, researchers have been interested in developing methods that help explain individual decisions and decipher the hidden representations of machine learning models in general and deep networks specifically. While there has been a recent explosion of work on Explainable Artificial Intelligence (ExAI) on deep models that operate on imagery and tabular data, textual datasets present new challenges to the ExAI community. Such challenges can be attributed to the lack of input structure in textual data, the use of word embeddings that add to the opacity of the models and the difficulty of the visualization of the inner workings of deep models when they are trained on textual data.

Lately, methods have been developed to address the aforementioned challenges and present satisfactory explanations on Natural Language Processing (NLP) models. However, such methods are yet to be studied in a comprehensive framework where common challenges are properly stated and rigorous evaluation practices and metrics are proposed.

Motivated to democratize ExAI methods in the NLP field, we present in this work a survey that studies
model-agnostic
as well as
model-specific
explainability methods on NLP models. Such methods can either develop
inherently
interpretable NLP models or operate on pre-trained models in a
post hoc
manner. We make this distinction and we further decompose the methods into three categories according to what they explain: (1) word embeddings (input level), (2) inner workings of NLP models (processing level), and (3) models’ decisions (output level). We also detail the different evaluation approaches interpretability methods in the NLP field. Finally, we present a case-study on the well-known neural machine translation in an appendix, and we propose promising future research directions for ExAI in the NLP field.
Logics for Temporal Information Systems in Rough Set Theory
Authors: Khan Md. Aquil , Banerjee Mohua , Panda Sibsankar
Published: July 2022

The article discusses temporal information systems (TISs) that add the dimension of time to complete or incomplete information systems. Through TISs, one can accommodate the possibility of domains or attribute values for objects changing with time or the availability of currently missing information with time. Different patterns of flow of information give different TISs. The corresponding logics with sound and complete axiomatization are presented.
Exploiting Multi-modal Contextual Sensing for City-bus’s Stay Location Characterization: Towards Sub-60 Seconds Accurate Arrival Time Prediction
Authors: Mandal Ratna , Karmakar Prasenjit , Chatterjee Soumyajit , Das Spandan Debaleen , Pradhan Shouvit , Saha Sujoy , Chakraborty Sandip , Nandi Subrata
Published: July 2022

Intelligent city transportation systems are one of the core infrastructures of a smart city. The true ingenuity of such an infrastructure lies in providing the commuters with real-time information about citywide transport like public buses, allowing them to pre-plan their travel. However, providing prior information for transportation systems like public buses in real-time is inherently challenging because of the diverse nature of different stay-locations where a public bus stops. Although straightforward factors like stay duration extracted from unimodal sources like GPS at these locations look erratic, a thorough analysis of public bus GPS trails for 1,335.365 km at the city of Durgapur, a semi-urban city in India, reveals that several other fine-grained contextual features can characterize these locations accurately. Accordingly, we develop 
BuStop
, a system for extracting and characterizing the stay-locations from multi-modal sensing using commuters’ smartphones. Using this multi-modal information 
BuStop
extracts a set of granular contextual features that allows the system to differentiate among the different stay-location types. A thorough analysis of 
BuStop
using the collected in-house dataset indicates that the system works with high accuracy in identifying different stay-locations such as regular bus stops, random ad hoc stops, stops due to traffic congestion, stops at traffic signals, and stops at sharp turns. Additionally, we develop a proof-of-concept setup on top of 
BuStop
to analyze the potential of the framework in predicting expected arrival time, a critical piece of information required to pre-plan travel at any given bus stop. Subsequent analysis of the PoC framework, through simulation over the test dataset, shows that characterizing the stay-locations indeed helps make more accurate arrival time predictions with deviations less than 60 seconds from the ground-truth arrival time.
Divergence of Velocity Fields in Electrochemical Systems
Authors: Balsara Nitash P. , Newman John
Published: July 2022

The passage of current through electrochemical systems results in the development of concentration gradients in the electrolytic phase that can be modeled using concentrated solution theory. Application of this theory requires knowledge of three concentration-dependent transport coefficients, which are often taken to be conductivity, diffusion coefficient, and the cation transference number with respect to the solvent velocity. The governing diffusion equation for molar concentration contains two additional terms—the thermodynamic factor which is related to activity of the electrolytic species and the solvent velocity. The main advance in this paper is the derivation of an expression for the divergence of the solvent velocity. Solving this equation requires knowledge of the partial molar volume of the electrolyte. Analogous expressions are derived for the mass average and molar average velocities. These velocities occur naturally in the diffusion equation if concentration is expressed as weight fraction and mole fraction of the electrolytic species, respectively.