bluuebunny/crossref_metadata_2025 huggingface dataset:
The new robotic platform Hugo™ RAS for lateral transabdominal adrenalectomy: a first world report of a series of five cases
Authors: Raffaelli Marco , Gallucci Pierpaolo , Voloudakis Nikolaos , Pennestrì Francesco , De Cicco Roberto , Arcuri Giovanni , De Crea Carmela , Bellantone Rocco
Published: November 2022

Robotic assisted surgery is the most rapidly developing field of minimally invasive surgery. Its wide diffusion has led to the development and standardization of robotic-assisted approaches also for adrenalectomy. In this study, we present the first five robotic-assisted lateral transabdominal adrenalectomies performed with the new Hugo RAS™ system (Medtronic, Minneapolis, MN, USA). After an official training course of the surgical team, five consecutive patients scheduled for unilateral adrenalectomy, underwent robotic-assisted operations in our institution. Patients that were candidates for partial adrenalectomy were excluded. A description of the operating theatre, robotic arms and docking setup is provided. Four female and one male patient underwent lateral transabdominal adrenalectomy, three for lesions on the left side and two on the right. Median lesion size was 3.9 cm (range: 30–90) and preoperative diagnosis was Cushing’s syndrome in three patients, an adrenal cystic lesion and a pheochromocytoma. The median docking time was 5 min (range: 5–8) and the median console time was 55 min (range: 29–108). Procedures were performed without intraoperative complications and no conversions or additional ports were needed. System’s function and docking were uneventful. Based on our initial experience, adrenalectomy with the Hugo™ system is feasible. This study provides technical notes for other centres that wish to perform robotic-assisted adrenalectomies with the Hugo™ RAS as well as general information and our preliminary insights on this new platform.
Context vector-based visual mapless navigation in indoor using hierarchical semantic information and meta-learning
Authors: Li Fei , Guo Chi , Zhang Huyin , Luo Binhan
Published: November 2022

Visual mapless navigation (VMN), modeling a direct mapping between sensory inputs and agent actions, aims to navigate from a stochastic origin location to a prescribed goal in an unseen scene. A fundamental yet challenging issue in visual mapless navigation is generalizing to a new scene. Furthermore, it is of pivotal concern to design a method to make effective policy learning. To address these issues, we introduce a novel visual mapless navigation model, which integrates hierarchical semantic information represented by context vector with meta-learning to improve the generalization performance gap between known and unknown environments. Extensive experimental results on AI2-THOR benchmark dataset demonstrate that our model significantly outperforms the state-of-the-art model by $$15.79\%$$

15.79
%

for the SPL and by $$23.83\%$$

23.83
%

for the success rate. In addition, the exploration rate experiment shows that our model can effectively improve the invalid exploration behavior of the agent and accelerate the convergence speed of the model. Our implementation code and data can be viewed on https://github.com/zhiyu-tech/WHU-CVVMN.
MXene-Based Composites as Nanozymes in Biomedicine: A Perspective
Authors: Iravani Siavash , Varma Rajender S.
Published: November 2022

MXene-based nanozymes have garnered considerable attention because of their potential environmental and biomedical applications. These materials encompass alluring and manageable catalytic performances and physicochemical features, which make them suitable as (bio)sensors with high selectivity/sensitivity and efficiency. MXene-based structures with suitable electrical conductivity, biocompatibility, large surface area, optical/magnetic properties, and thermal/mechanical features can be applied in designing innovative nanozymes with area-dependent electrocatalytic performances. Despite the advances made, there is still a long way to deploy MXene-based nanozymes, especially in medical and healthcare applications; limitations pertaining the peroxidase-like activity and sensitivity/selectivity may restrict further practical applications of pristine MXenes. Thus, developing an efficient surface engineering tactic is still required to fabricate multifunctional MXene-based nanozymes with excellent activity. To obtain MXene-based nanozymes with unique physicochemical features and high stability, some crucial steps such as hybridization and modification ought to be performed. Notably, (nano)toxicological and long-term biosafety analyses along with clinical translation studies still need to be comprehensively addressed. Although very limited reports exist pertaining to the biomedical potentials of MXene-based nanozymes, the future explorations should transition toward the extensive research and detailed analyses to realize additional potentials of these structures in biomedicine with a focus on clinical and industrial aspects. In this perspective, therapeutic, diagnostic, and theranostic applications of MXene-based nanozymes are deliberated with a focus on future perspectives toward more successful clinical translational studies. The current state-of-the-art biomedical advances in the use of MXene-based nanozymes, as well as their developmental challenges and future prospects are also highlighted. In view of the fascinating properties of MXene-based nanozymes, these materials can open significant new opportunities in the future of bio- and nanomedicine.
Update zum Management der portalen Hypertonie nach Baveno VII – Was ist für die Praxis relevant?
Authors: Jachs Mathias , Mandorfer Mattias
Published: November 2022

Der internationale Baveno-VII-Konsensus brachte zahlreiche wichtige Neuerungen zum Management der portalen Hypertonie mit sich. Die Schwerpunkte lagen auf der nichtinvasiven Diagnosestellung der klinisch signifikanten portalen Hypertonie, um eine frühzeitige Initiierung einer Carvediloltherapie zur Prävention der hepatischen Dekompensation zu ermöglichen. In diesem Kontext wurden auch Empfehlungen zur risikoadaptierten Behandlung von Patient*innen mit geheilter/supprimierter Grunderkrankung abgegeben, insbesondere zu jenen mit geheilter Hepatitis C. Darüber hinaus wurden auch die Empfehlungen hinsichtlich der Therapie der akuten Varizenblutung inklusive präemptiver Implantationen eines transjugulären intrahepatischen portosystemischen Shunts adaptiert. In diesem Artikel werden die wichtigsten Änderungen als Update für die Praxis zusammengefasst.
Gendering the second demographic transition: gender asymmetry, gendered tension, and cohabitation in contemporary urban China
Authors: Zhou Yun
Published: November 2022

The Second Demographic Transition (SDT) framework highlights individuals’ ideational shift toward greater individualism in explaining the rise of non-marriage unions. Contemporary China has seen a substantial increase in premarital cohabitation. Drawing on 65 in-depth interviews with highly educated young urban Chinese women and men, this article examines the gendered ways in which young Chinese adults perceive and make decisions about premarital cohabitation, as they envision their ideal lives and what autonomy and self-realization mean to them. I demonstrate that while male respondents predominantly view cohabitation positively as a risk-reduction strategy for avoiding incompatible marriages, female respondents still consider cohabitation to be a risk-amplification arrangement in practice that increases the possibility of uncertain marriage prospect, unsafe sex, and reputational damages. Young women, but not men, often have to strategize—through carefully managing information disclosure—about persistent parental expectations that discourage women’s premarital cohabitation. As a result, while male respondents regard marriage to be neither the necessary precondition nor the end goal of cohabitation, female respondents, who otherwise emphasize autonomy and individualistic fulfillment, continue to desire a close linkage between cohabitation and marriage. Leveraging the unique strength of qualitative data in demographic research, this article articulates thegender asymmetryin how women and men perceive cohabitation’s risks, benefits, and link to marriage. I elucidate thegendered tensionbetween privately-held ideals of individualism vis-à-vis enduring social norms of female marriageability, as women and men differentially navigate parental expectations surrounding cohabitation. In so doing, this article makes a theoretical contribution by bringing a careful treatment of gender into the SDT framework.
Financing-Related Drivers and Barriers for Circular Economy Business: Developing a Conceptual Model from a Field Study
Authors: Saarinen Arttu , Aarikka-Stenroos Leena
Published: November 2022

The transition toward sustainability and the circular economy is shaping technology investment and business, leading to there being growing interest in financial aspects of circular economy businesses. As research on circular economy drivers and barriers, in addition to the literature on circular economy business and finance, has not yet provided a comprehensive view on drivers of and barriers to circular economy business financing, this study takes a theory-developing qualitative approach. It integrates extant theoretical knowledge and empirical new insights from an extensive field study in Finland, Europe, based on over 270 data sources, including interviews, workshops, reports, and media documents. From these data sources, this paper analyzes and conceptualizes the driving and inhibiting factors that have shaped the sources, criteria, and subjects of circular economy business financing. The study results that the sources of financing—being public and private sources—apply diverse criteria for financing, such as valuation and profitability of circular business models, their type, investment costs, and their business potential for financing industry itself, when they assess different subjects of financing, such as individual companies’ circular businesses, supply chains, and joint projects. Findings show that many factors that could serve as drivers have considered inhibitors. As a theoretical contribution, our study develops a conceptual model on the key factors shaping the financing of CE businesses and set of propositions on these factors inhibit and drive CE financing. Our findings provide guidance for practitioners such as managers and policy makers who aim to advance circular economy business.
Mycostructures—growth-driven fabrication processes for architectural elements from mycelium composites
Authors: Biala Eliza , Ostermann Martin
Published: November 2022

The paper discusses how characteristics of the mycelium growth process—namely different growth effectiveness depending on the nutrition content of the substrate, gradual solidification of the inoculated substrate, and bio-welding—can be a driving force for developing sustainable biofabrication processes of mycelium based composites (MBC) for architectural application. To explore this potential one-semester (12 weeks) seminar and one block seminar (2 weeks) with master-level students were held at the University of Stuttgart, and independent work within the Institute IBK2 was performed. The free experimentation with fabrication tactics resulted in the emergence of different investigation paths, tested with small-scale demonstrators, from which the most interesting three this paper presents in detail. The first is the two-phase printing process of mycelium substrate and subsidiary reusable support materials. It applied tests with the small, inorganic, loose substances (plastic pellets) extractable mechanically and meltable substances (wax) extracted by heating. The second path of investigation followed lost formworks created from hemp strings positioned inside the material. Finally, the third path is a particular case of lost formwork approach utilizing different tubular bandages stuffed with MBC and utilizing it later as a thick filament for other different form-giving deposition practices: layering, hanging, braiding, and knotting. All three investigation paths prove feasible, although their upscaling potential correlates strongly with the successful automation of the processes using CNC machines, which could provide the precision and sterility needed for this highly heterogenous and sensitive material. In addition, further developments in the material cultivation protocols are indispensable to provide a higher repetition of the results.
Principles of Magnetostatics
Authors: Fernow Richard C.
Published: November 2022

Magnetostatics, the mathematical theory that describes the forces and fields resulting from the steady flow of electrical currents, has a long history. By capturing the basic concepts, and building towards the computation of magnetic fields, this book is a self-contained discussion of the major subjects in magnetostatics. Overviews of Maxwell's equations, the Poisson equation, and boundary value problems pave the way for dealing with fields from transverse, axial and periodic magnetic arrangements and assemblies of permanent magnets. Examples from accelerator and beam physics give up-to-date context to the theory. Both complex contour integration and numerical techniques for calculating magnetic fields are discussed in detail with plentiful examples. Theoretical and practical information on carefully selected topics make this a one-stop reference for magnet designers, as well as for physics and electrical engineering undergraduate students. This title, first published in 2016, has been reissued as an Open Access publication on Cambridge Core.
Conformal Methods in General Relativity
Authors: Kroon Juan A. Valiente
Published: November 2022

This book offers a systematic exposition of conformal methods and how they can be used to study the global properties of solutions to the equations of Einstein's theory of gravity. It shows that combining these ideas with differential geometry can elucidate the existence and stability of the basic solutions of the theory. Introducing the differential geometric, spinorial and PDE background required to gain a deep understanding of conformal methods, this text provides an accessible account of key results in mathematical relativity over the last thirty years, including the stability of de Sitter and Minkowski spacetimes. For graduate students and researchers, this self-contained account includes useful visual models to help the reader grasp abstract concepts and a list of further reading, making this an ideal reference companion on the topic. This title, first published in 2016, has been reissued as an Open Access publication on Cambridge Core.
Quantum Chromodynamics at High Energy
Authors: Kovchegov Yuri V. , Levin Eugene
Published: November 2022

Filling a gap in the current literature, this book is dedicated to high energy quantum chromodynamics (QCD) including parton saturation and the color glass condensate (CGC). It presents groundbreaking progress on the subject and describes many problems at the forefront of research, bringing postgraduate students, theorists and interested experimentalists up to date with research in this field. The material is presented in a pedagogical way, with numerous examples and exercises. Discussion ranges from the quasi-classical McLerran–Venugopalan model to the linear BFKL and nonlinear BK/JIMWLK small-x evolution equations. The authors adopt both a theoretical and an experimental outlook, and present the physics of strong interactions in a universal way, making it useful for physicists from across high energy and nuclear physics, and applicable to processes studied at high energy accelerators around the world. This title, first published in 2012, has been reissued as an Open Access publication on Cambridge Core.
Advanced Concepts in Particle and Field Theory
Authors: Hübsch Tristan
Published: November 2022

Uniting the usually distinct areas of particle physics and quantum field theory, gravity and general relativity, this expansive and comprehensive textbook of fundamental and theoretical physics describes the quest to consolidate the elementary particles that are the basic building blocks of nature. Designed for advanced undergraduates and graduate students and abounding in worked examples and detailed derivations, as well as historical anecdotes and philosophical and methodological perspectives, this textbook provides students with a unified understanding of all matter at the fundamental level. Topics range from gauge principles, particle decay and scattering cross-sections, the Higgs mechanism and mass generation, to spacetime geometries and supersymmetry. By combining historically separate areas of study and presenting them in a logically consistent manner, students will appreciate the underlying similarities and conceptual connections across these fields. This title, first published in 2015, has been reissued as an Open Access publication on Cambridge Core.
Impact of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial consumption and antimicrobial resistance at a small, local hospital in Japan
Authors: Sasaki Yasuhiro , Yano Masataka , Umehara Ayumi , Tagashira Yasuaki
Published: November 2022

The coronavirus disease 2019 (COVID-19) pandemic negatively affected antimicrobial stewardship programs at hospitals throughout Japan by diverting resources toward managing the pandemic. However, antimicrobial stewardship needs to continue regardless of hospital size or supervening crises. Herein, we discuss the impact of COVID-19 on antimicrobial stewardship at a small, local hospital in Japan.
Headache and Dizziness after Roller Coaster Rides: A Case Series of 31 Patients
Authors: Moskatel Leon S. , Smirnoff Liza
Published: November 2022

Previous literature on roller coaster injuries focuses on catastrophic injuries. We conducted a retrospective study of 31 adults with headache or dizziness after roller coaster rides. Twenty five of 31 (81%) patients presented with new or worsening headache, predominantly migraine (15/25, 60%), including 8/25 (32%) with chronic migraine. Of the chronic migraine patients, 4/8 (50%) already had the diagnosis and presented with an exacerbation. Five of the 25 (20%) were ultimately found to have a cerebrospinal fluid (CSF) leak. While persistent symptoms appear to be relatively rare, patients with chronic migraine and potential CSF leaks should consider skipping these attractions.
Law and the production of precarious work in Europe: an introduction
Authors: Bogoeski Vladimir , Costamagna Francesco
Published: November 2022

The introductory article sets out the background and the content of the Symposium on ‘Law and the Production of Precarious Work in Europe’. The analysis builds on the premise that European (EU) law, together with international and national law, is constitutive of precarious forms of work and work relations in different national and local contexts. The Symposium takes issue with the specific legal frameworks and regimes that are related to structuring various forms of precarious and exploitable labour, by exploring how (EU) law orders the world of work through legal regimes and regulatory frameworks governing specific forms of labour mobility across borders, as well as by looking at the other components of the structures and institutional interactions underlying the broader political economy where precarious forms of work materialise.
KURD QABURSTAN ON THE ERBIL PLAIN: FIELD RESEARCH 2016–2017
Authors: Schwartz Glenn M. , Creekmore Andrew T. , Smith Alexia , Weber Jill A. , Webster Lyndelle
Published: November 2022

A 2016 study season and 2017 excavation season at the 95-hectare walled site of Kurd Qaburstan on the Erbil plain have generated a variety of new results. Geophysical survey on the lower town revealed details of the Middle Bronze occupation in the southeast part of the site, including the city wall, a large open area, streets, houses, and a monumental temple comparable to examples from Tell al Rimah, Aššur, and Larsa. Excavations confirmed the Middle Bronze date of the temple and explored further Middle Bronze contexts elsewhere on the lower town. On the High Mound North Slope, Middle Bronze occupation included a fortification wall and large-scale architecture inside it. On the High Mound East, Late Bronze architecture of apparent elite character was documented. Archaeobotanical analyses complementing the excavations reveal the existence of naan-style bread in both Middle and Late Bronze contexts. Given radiocarbon and ceramic results, the Middle Bronze occupation at Kurd Qaburstan is datable to c. 1800 B.C., while the Late Bronze phases on the High Mound East belong to an early LB horizon in the 16–15th centuries B.C., perhaps predating the imposition of Mittani political authority in the region.
Hypersonic shock impingement studies on a flat plate: flow separation of laminar boundary layers
Authors: Chang Eric Won Keun , Chan Wilson Y.K. , McIntyre Timothy J. , Veeraragavan Ananthanarayanan
Published: November 2022

Interactions between shock waves and boundary layers produce flow separations and augmented pressure/thermal loads in hypersonic flight. This study provides details of Mach 7 impinging-shock-flat-plate experiments conducted in the T4 Stalker Tube. Measurements were taken at flow conditions of Mach 7.0 (2.44 MJ kg

$^{-1}$

) and Mach 7.7 (2.88 MJ kg

$^{-1}$

) flight enthalpies with a range of freestream unit Reynolds numbers from

$1.43 \times 10^{6}$

m

$^{-1}$

to

$5.01 \times 10^{6}$

m

$^{-1}$

. A shock generator at

$12^{\circ }$

or

$16^{\circ }$

to the freestream created an oblique shock which impinged on a boundary layer over a flat plate to induce flow separation. The flow field was examined using simultaneous measurements of wall static pressure, heat transfer and schlieren visualisation. Measured heat transfer along the flat plate without the shock impingement indicated that the boundary layer remained laminar for all flow conditions. The shock impingement flow field was successfully established within the facility test duration. The onset of separation was observed by a rise in wall pressure and a decrease in heat transfer at the location corresponding to the stem of the separation shock. Downstream of this initial rise, an increased pressure and higher heating loads were observed. The heat-transfer levels also indicated an immediate boundary layer transition due to the shock impingement. The separation data of the present work showed good agreement with our previous work on shock impingement on heated walls (Chang et al., J. Fluid Mech., vol. 908, 2021, pp. 1–13). A comparison with the previous scaling indicated that the separation also relates to the pressure ratio and the wall temperature parameter.
Female athlete triad affects rat intestinal morphology and sucrase-isomaltase expression
Authors: Aoki Kai , Ebina Kei , Shingu Hana , Kioka Kazuki , Sugasawa Takehito , Kawakami Yasushi , Takekoshi Kazuhiro , Omi Naomi
Published: November 2022

Female athletes follow a strict diet and perform rigorous exercise to boost their performance, which induces health issues called the female athlete triad (FAT), defined as the combination of disordered eating, amenorrhoea and low bone mineral density. It is known to have a significant effect on bones. However, its effects on the small intestine, which is responsible for nutrient uptake into the body, remain unclear. In this study, we created an animal model of FAT to examine its effects on digestive and absorptive molecules in the small intestine. Thirty 5-week-old female Sprague-Dawley (sd) rats with an initial body weight of about 147 g were divided into control (Con, n = 7), exercise (Ex, n = 7), food restriction (FR, n = 8) and exercise plus food restriction (FAT, n = 8) groups. The rats were subjected to 4 weeks of wheel running (Ex, FAT) and 50–40 % food restriction (FR, FAT) to examine the effects on bone and typical digestive enzymes and transporters in the jejunum. Two-way ANOVA and the Kruskal–Wallis test were used for statistical analysis of normal and non-normal data, respectively. Four weeks of exercise and food restriction decreased bone weight (vs. other group P < 0·01) and bone breaking power (vs. other group P < 0·01). Villus height decreased in the jejunum (vs. other group P < 0·01), but the expression of typical macronutrients digestive enzyme and absorptive molecules remained unchanged. In contrast, sucrase-isomaltase gene (v. Ex P = 0·02) and protein expression were increased (vs. other group P < 0·05). The study findings show that FAT affects sucrase-isomaltase without histone methylation changes.
Cognitive behavioral therapy in patients with deep brain stimulation for obsessive-compulsive disorder: a matched controlled study
Authors: Graat Ilse , Franken Sophie , van Rooijen Geeske , de Koning Pelle , Vulink Nienke , de Kroo Mirjam , Denys Damiaan , Mocking Roel
Published: November 2022

Background

Deep brain stimulation (DBS) is effective for refractory obsessive-compulsive disorder (OCD). Post-operative cognitive behavioral therapy (CBT) may augment the effects of DBS, but previous results are conflicting. Here, we investigated whether CBT augments the effect of DBS for OCD.

Method

Patients with and without CBT following DBS of the ventral anterior limb of the internal capsule were included. First, we analyzed Yale–Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HAM-D) scores before, during and after CBT in all patients with CBT. Second, we matched patients with and without CBT based on clinical baseline variables and initial response to DBS and compared the course of Y-BOCS and HAM-D scores over the same timeframe.

Results

In total, 36 patients with and 16 patients without CBT were included. Average duration of CBT was 10.4 months (s.d. 6.4). In the 36 patients with CBT, Y-BOCS scores decreased on average by 3.8 points (14.8%) from start until end of CBT (p = 0.043). HAM-D scores did not decrease following CBT. Second, 10 patients with CBT were matched to 10 patients without CBT. In both groups, Y-BOCS scores decreased equally from start until end of CBT or over a similar timeframe (10% in CBT group v. 13.1% in no-CBT group, p = 0.741).

Conclusions

Obsessive-compulsive symptoms decreased over time in patients with and without post-operative CBT. Therefore, further improvement may be attributed to late effects of DBS itself. The present study emphasizes the need for prospective randomized controlled studies, examining the effects of CBT.
Long-term efficacy of brief psychological treatments for common mental disorders in Myanmar refugees in Malaysia: 12-month follow-up of a randomized, active-controlled trial of integrative adapt therapy v. cognitive behavioral therapy
Authors: Tay Alvin Kuowei , Mohsin Mohammed , Foo Cheryl Yunn Shee , Rees Susan , Silove Derrick
Published: November 2022

Background

Long-term efficacy of brief psychotherapies for refugees in low-resource settings is insufficiently understood. Integrative adapt therapy (IAT) is a scalable treatment addressing refugee-specific psychosocial challenges.

Methods

We report 12-month post-treatment data from a single-blind, active-controlled trial (October 2017–August 2019) where 327 Myanmar refugees in Malaysia were assigned to either six sessions of IAT (n = 164) or cognitive behavioral treatment (CBT) (n = 163). Primary outcomes were posttraumatic stress disorder (PTSD), depression, anxiety, and persistent complex bereavement disorder (PCBD) symptom scores at treatment end and 12-month post-treatment. Secondary outcome was functional impairment.

Results

282 (86.2%) participants were retained at 12-month follow-up. For both groups, large treatment effects for common mental disorders (CMD) symptoms were maintained at 12-month post-treatment compared to baseline (d = 0.75–1.13). Although participants in IAT had greater symptom reductions and larger effect sizes than CBT participants for all CMDs at treatment end, there were no significant differences between treatment arms at 12-month post-treatment for PTSD [mean difference: −0.9, 95% CI (−2.5 to 0.6), p = 0.25], depression [mean difference: 0.1, 95% CI (−0.6 to 0.7), p = 0.89), anxiety [mean difference: −0.4, 95% CI (−1.4 to 0.6), p = 0.46], and PCBD [mean difference: −0.6, 95% CI (−3.1 to 1.9), p = 0.65]. CBT participants showed greater improvement in functioning than IAT participants at 12-month post-treatment [mean difference: −2.5, 95% CI (−4.7 to −0.3], p = 0.03]. No adverse effects were recorded for either therapy.

Conclusions

Both IAT and CBT showed sustained treatment gains for CMD symptoms amongst refugees over the 12-month period.
Demonstration of a ‘leapfrog’ randomized controlled trial as a method to accelerate the development and optimization of psychological interventions
Authors: Blackwell Simon E. , Schönbrodt Felix D. , Woud Marcella L. , Wannemüller Andre , Bektas Büsra , Braun Rodrigues Max , Hirdes Josefine , Stumpp Michael , Margraf Jürgen
Published: November 2022

Background

The scale of the global mental health burden indicates the inadequacy not only of current treatment options, but also the pace of the standard treatment development process. The ‘leapfrog’ trial design is a newly-developed simple Bayesian adaptive trial design with potential to accelerate treatment development. A first leapfrog trial was conducted to provide a demonstration and test feasibility, applying the method to a low-intensity internet-delivered intervention targeting anhedonia.

Methods

At the start of this online, single-blind leapfrog trial, participants self-reporting depression were randomized to an initial control arm comprising four weeks of weekly questionnaires, or one of two versions of a four-week cognitive training intervention, imagery cognitive bias modification (imagery CBM). Intervention arms were compared to control on an ongoing basis via sequential Bayesian analyses, based on a primary outcome of anhedonia at post-intervention. Results were used to eliminate and replace arms, or to promote them to become the control condition based on pre-specified Bayes factor and sample size thresholds. Two further intervention arms (variants of imagery CBM) were added into the trial as it progressed.

Results

N = 188 participants were randomized across the five trial arms. The leapfrog methodology was successfully implemented to identify a ‘winning’ version of the imagery CBM, i.e. the version most successful in reducing anhedonia, following sequential elimination of the other arms.

Conclusions

The study demonstrates feasibility of the leapfrog design and provides a foundation for its adoption as a method to accelerate treatment development in mental health. Registration: clinicaltrials.gov, NCT04791137.
Visual Framing: The Use of COVID-19 in the Mobilization of Hong Kong Protest
Authors: Whitworth Katherine , Li Yao-Tai
Published: November 2022

This study focuses on the Hong Kong Lennon Walls and the communications posted there. We assert that the physical placement of COVID-19 related images on the Lennon Walls of Hong Kong and the replication of symbols and iconography from the Umbrella Movement and the Anti-ELAB Movement situated COVID-19 discourse not only physically within but also symbolically within the contentious politics of Hong Kong. We conclude that the messages and images posted on Lennon Walls between January and April 2020 have used COVID-19 to extend public expression of sentiment on the debates around the Hong Kong government and to further mobilize a sense of Hong Kong identity against China. The findings contribute to the understandings of how the cultural politics surrounding the pandemic became a collective action frame in the mobilization of a localized Hong Kong political identity against the Hong Kong and Chinese governments.
Disability Discrimination and Patient-Sensitive Health-Related Quality of Life
Authors: Nielsen Lasse
Published: November 2022

It is generally accepted that morally justified healthcare rationing must be non-discriminatory and cost-effective. However, given conventional concepts of cost-effectiveness, resources spent on disabled people are spent less cost-effectively, ceteris paribus, than resources spent on non-disabled people. Thus, it is reasonable to assume that standard cost-effectiveness discriminates against the disabled. Call this thedisability discrimination problem.Part of the disability discrimination involved in cost-effectiveness stems from the way in which health-related quality of life is accounted for and measured. This paper offers and defends a patient-sensitive account of health-related quality of life, which can effectively make cost-effectiveness less discriminatory against the disabled and thus more morally justified.
Cost-Effectiveness and the Avoidance of Discrimination in Healthcare: Can We Have Both?
Authors: Lippert-Rasmussen Kasper
Published: November 2022

Many ethical theorists believe that a given distribution of healthcare is morally justified only if (1) it is cost-effective and (2) it does not discriminate against older adults and disabled people. However, if (3) cost-effectiveness involves maximizing the number of quality-adjusted life-years (QALYs) added by a given unit of healthcare resource, or cost, it seems the pursuit of cost-effectiveness will inevitably discriminate against older adults and disabled patients. I show why this trilemma is harder to escape than some theorists think. We cannot avoid it by using age- or disability-weighted QALY scores, for example. I then explain why there is no sense of “discrimination” on which discrimination isbothunjust, and thus something healthcare rationing must avoid,andsomething cost-effective healthcare rationing inevitably involves. I go on to argue that many of the reasons we have for not favoring rationing that maximizes QALYs outside the healthcare context apply in healthcare as well. Thus, claim (1) above is dubious.
Cost-Effectiveness, Incompleteness, and Discrimination
Authors: Herlitz Anders
Published: November 2022

This paper argues that cost-effectiveness analysis in the healthcare sector introduces a discrimination risk that has thus far been underappreciated and outlines some approaches one can take toward this. It is argued that appropriate standards used in cost-effectiveness analysis in the healthcare sector fail to always fully determine an optimal option, which entails that cost-effectiveness analysis often leaves decision makers with large sets of permissible options. Larger sets of permissible options increase the role of decision makers’ biases, whims, and prejudices, which means that the discrimination risk increases. Two ways of mitigating this are identified: tinkering with standards used in the cost-effectiveness analysis and outlining anti-discrimination guidelines for decision makers.
Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia
Authors: Woodward Christina A. , Hertelendy Attila J. , Hart Alexander , Voskanyan Amalia , Harutyunyan Hakob , Virabyan Anushavan , Mukhaelyan Artak , Mahon Selwyn E. , Issa Fadi S. , Adnan Mohd Syafwan , Stepanyan Taguhi , Ciottone Gregory R.
Published: November 2022

Introduction:

Emergency Medical Services (EMS) is a critical part of Disaster Medicine and has the ability to limit morbidity and mortality in a disaster event with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training in the country. As a result, EMS physicians are trained in a variety of specialties.

Armenia is also a country prone to disasters, and recently, the Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War broke out in the midst of the SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic.

Study Objective:

This study aims to assess the current state of disaster preparedness of the Armenian EMS system and the effects of the simultaneous pandemic and war on EMS providers.

Methods:

This was a cross-sectional study conducted by anonymous survey distributed to physicians still working in the Yerevan EMS system who provided care to war casualties and COVID-19 patients.

Results:

Survey response rate was 70.6%. Most participants had been a physician (52.1%) or EMS physician (66.7%) for three or less years. The majority were still in residency (64.6%). Experience in battlefield medicine was limited prior to the war, with the majority reporting no experience in treating mass casualties (52.1%), wounds from explosives (52.1%), or performing surgical procedures (52.1%), and many reporting minimal to no experience in treating gunshot wounds (62.5%), severe burns (64.6%), and severe orthopedic injuries (64.6%). Participants had moderate experience in humanitarian medicine prior to war. Greater experience in battlefield medicine was found in participants with more than three years of experience as a physician (z-score −3.26; P value <.01) or as an EMS physician (z-score −2.76; P value <.01) as well as being at least 30 years old (z-score −2.11; P value = .03). Most participants felt they were personally in danger during the war at least sometimes (89.6%).

Conclusion:

Prior to the COVID-19 pandemic and simultaneous 2020 Nagorno-Karabakh War, EMS physicians in Armenia had limited training and experience in Disaster Medicine. This system, and the frontline physicians on whom it relies, was strained by the dual disaster, highlighting the need for Disaster Medicine training in all prehospital medical providers.
Farmers' preferences for sustainable intensification attributes in sorghum-based cropping systems: evidence from Mali
Authors: Badolo Felix , Kotu Bekele Hundie , Oyinbo Oyakhilomen , Sanogo Karamoko , Birhanu Birhanu Zemadim
Published: November 2022

Sorghum plays a crucial role in the rural economy and nutrition of rural households in Mali. Yet the productivity of this crop is constrained by limited adoption of agricultural intensification technologies, which could be partly because technology development does not properly consider farmers' preferences. This study with smallholder farmers in southern Mali aimed to assess farmers' preferences for different attributes of sorghum technologies through the lens of sustainable intensification. The study used a discrete choice experiment, a method which involves asking individuals to state their preference over hypothetical alternative scenarios, goods or services. We considered six attributes corresponding to different domains of sustainable intensification: grain yield, risk of yield loss, soil fertility, nutrition, labor requirement and fodder yield. We analyzed the data using the mixed logit model, while considering the multinomial logit model as a robustness check. The findings revealed that smallholder farmers are strongly interested in transitioning from their existing sorghum-based cropping systems to those that closely align with these domains of sustainable intensification. However, there were diverse preferences among all the smallholder farmers studied, and between distinct sub-groups of smallholder farmers characterized by their social networks and agroecological zones, which yield relevant policy implications. Overall, these results support the growing research and development prioritization and policy interests toward scaling sustainable intensification among farmers, with a particular focus on human nutrition.
Political parties, issue salience, and the appointment of women cabinet members
Authors: Höhmann Daniel
Published: November 2022

Do parties relegate female ministers to portfolios that are politically less important for them? This research note contributes to this debate and examines whether the issue salience of parties for specific policy areas has an effect on the nomination of a female minister. Previous theoretical work assumes that party leaders will be more likely to select men for those portfolios that are highly salient for the party. To test this assumption empirically, the paper analyzes the appointment of women cabinet members in the German states between 2006 and 2021. Notably, the findings contradict the theoretical expectations as well as previous empirical results from a cross-national study: On the German sub-national level the nomination of a female minister is more likely if the respective portfolio is highly salient for the governing party. Parties and their policy-preferences seem to be an important factor in explaining the share of women in sub-national cabinets.
High Spatial Variability of Biomass Burning Emissions Observed at Three Tibetan Plateau Sites
Authors: Zhu Chong‐Shu , Qu Yao , Zhang Zhi‐Sheng , Zhang Ting , Dai Wen‐Ting , Cao Jun‐Ji
Published: November 2022

Aerosol from biomass burning (BB) can affect regional and global climate by changing radiation balance and cloud properties, especially over the high altitude environ‐vulnerable region. To investigate the contributions of BB on atmospheric particulate matter trans‐the Tibetan Plateau (TP), the total suspended particle samples were collected at three high altitude sites over the northeastern (Qinghai lake, 3,200 m a.s.l.), central (Beiluhe, 4,659 m a.s.l.), and southwestern TP (Ngari, 4,360 m a.s.l.), respectively. Highly spatial variations of BB tracers (including levoglucosan, mannosan, and galactosan) were obtained. Elevated BB tracer concentrations were observed in the northeastern and southwestern sites compared to the central TP site. The heighten concentrations of particulate matter from biomass burning and organic carbon from biomass burning were obtained at Ngari (with 5260.3 and 2257.7 ng m−3) and Qinghai lake (with 1508.8 and 647.6 ng m−3) compared with those at Beiluhe (with 18.8 and 8.1 ng m−3), respectively. The results indicated that the BB contributions to aerosol were significant on the margin of the TP. In addition to the long‐range transport of BB pollutant, the local emissions may be an important contributor in the northeastern and southwestern TP. The present study can improve the understanding of BB characteristics and effects in the TP.
Toward More Actionable Flood‐Risk Information
Authors: Cooper C. M. , Sharma S. , Nicholas R. E. , Keller K.
Published: November 2022

The increasingly urgent need to develop knowledge and practices to manage flood risks drives innovative information design. However, experts often disagree about design practices. As a result, flood‐risk estimates can diverge, leading to different conclusions for decision‐making. Using examples of household‐scale fluvial (riverine) flood‐risk information in the United States, we assess design features and risk communication approaches that may lead to more actionable information for decision‐making. We argue that increased attention to uncertainty characterization and model diagnostics is a critical intermediate step for developing simpler approaches for designing flood‐risk information. Simpler frameworks are desirable because flood risks change over time, and simpler frameworks are less costly to update. Developing frameworks for large spatial domains require collaboration grounded in principles of open science. Finally, systematically evaluating how decision‐makers access and use information can provide new insights to guide risk communication and information design.
The Shortwave Radiative Flux Response to an Injection of Sea Salt Aerosols in the Gulf of Mexico
Authors: Goddard P. B. , Kravitz B. , MacMartin D. G. , Wang H.
Published: November 2022

Marine cloud brightening (MCB) has been proposed as a potential means of geoengineering the climate, temporarily providing cooling to offset some of the effects of climate change. Marine sky brightening (MSB), involving the direct scattering of sunlight from sea salt injection into the marine boundary layer, has been proposed as an additional geoengineering method that could work in areas that are not regularly cloudy. Here, we use a regional atmospheric model to simulate MCB and MSB over the Gulf of Mexico and nearby land, a highly populated and economically important region that is not characterized by persistent marine stratocumulus cloud cover. Injection of sea salt in the Aitken mode from a region in the central Gulf of Mexico equivalent to 10.8 Tg yr−1 produces an upwards 8.4 W m−2 radiative flux change across the region at the top of the atmosphere, largely due to cloud property changes. Comparatively, a similar mass injection in the accumulation mode produces a 3.1 W m−2 radiative flux change driven primarily by direct scattering. Injection of even larger particles produces a much smaller radiative flux change. Shortwave flux changes due to clouds are largely driven by an increase in cloud droplet number concentration and an increase in cloud liquid water path (each contributing about 45% to the flux change), with a much lower contribution from cloud fraction changes (10%).
Maternal stress and vulnerability to depression: coping and maternal care strategies and its consequences on adolescent offspring
Authors: Alves Renata L. , Portugal Camila C. , Lopes Igor M. , Oliveira Pedro , Alves Cecília J. , Barbosa Fernando , Summavielle Teresa , Magalhães Ana
Published: November 2022

Depressive mothers often find mother-child interaction to be challenging. Maternal stress may further impair mother-child attachment, which may increase the risk of negative developmental consequences. We used rats with different vulnerability to depressive-like behavior (Wistar and Kyoto) to investigate the impact of stress (maternal separation-MS) on maternal behavior and adolescent offspring cognition. MS in Kyoto dams increased pup-contact, resulting in higher oxytocin levels and lower anxiety-like behavior after weaning, while worsening their adolescent offspring cognitive behavior. Whereas MS in Wistar dams elicited higher quality of pup-directed behavior, increasing brain-derived neurotrophic factor (BDNF) in the offspring, which seems to have prevented a negative impact on cognition. Hypothalamic oxytocin seems to affect the salience of the social environment cues (negatively for Kyoto) leading to different coping strategies. Our findings highlight the importance of contextual and individual factors in the understanding of the oxytocin role in modulating maternal behavior and stress regulatory processes.
Effect of human mesenchymal stem cell secretome administration on morphine self-administration and relapse in two animal models of opioid dependence
Authors: Quintanilla María Elena , Quezada Mauricio , Morales Paola , Berríos-Cárcamo Pablo , Santapau Daniela , Ezquer Marcelo , Herrera-Marschitz Mario , Israel Yedy , Ezquer Fernando
Published: November 2022

The present study investigates the possible therapeutic effects of human mesenchymal stem cell-derived secretome on morphine dependence and relapse. This was studied in a new model of chronic voluntary morphine intake in Wistar rats which shows classic signs of morphine intoxication and a severe naloxone-induced withdrawal syndrome. A single intranasal-systemic administration of MSCs secretome fully inhibited (>95%; p < 0.001) voluntary morphine intake and reduced the post-deprivation relapse intake by 50% (p < 0.02). Since several studies suggest a significant genetic contribution to the chronic use of many addictive drugs, the effect of MSCs secretome on morphine self-administration was further studied in rats bred as high alcohol consumers (UChB rats). Sub-chronic intraperitoneal administration of morphine before access to increasing concentrations of morphine solutions and water were available to the animals, led UChB rats to prefer ingesting morphine solutions over water, attaining levels of oral morphine intake in the range of those in the Wistar model. Intranasally administered MSCs secretome to UChB rats dose-dependently inhibited morphine self-administration by 72% (p < 0.001); while a single intranasal dose of MSC-secretome administered during a morphine deprivation period imposed on chronic morphine consumer UChB rats inhibited re-access morphine relapse intake by 80 to 85% (p < 0.0001). Both in the Wistar and the UChB rat models, MSCs-secretome administration reversed the morphine-induced increases in brain oxidative stress and neuroinflammation, considered as key engines perpetuating drug relapse. Overall, present preclinical studies suggest that products secreted by human mesenchymal stem cells may be of value in the treatment of opioid addiction.