bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating beam-column connections using triangular web profiled steel sections
Authors: Hashim Nor Salwani , De’nan Fatimah , Omar Norbaya
Published: August 2023

Purpose

Basically, connections are used to transfer the force supported by structural members to other parts of the structure. The flush end-plate bolted beam to column connection is one type that has been widely used because of its simplicity in fabrication and rapid site erection. The purpose of this study is to determine the moment-rotation curve, moment of resistance (MR) and mode of failure, and the results were compared with existing results for normal flat web connections.

Design/methodology/approach

In this study, the connection modeled was the flush end-plate welded with triangular web profile (TriWP) steel beam section and then bolted to a UKC column flange. The bolted flush end-plate semi-rigid beam to column connection was modeled using finite element software. The specimen was modeled using LUSAS 14.3 finite element software, with dimensions and parameters of the finite element model sizes being 200 × 200 × 49.9 UKC, 200 × 100 × 17.8 UKB and 200 × 100 with a thickness of 20 mm for the endplate.

Findings

It can be concluded that the MR obtained from the TriWP steel beam section is different from that of the normal flat web steel beam by 28%. The value of MR for the TriWP beam section is lower than that of the normal flat web beam section, but the moment ultimate is higher by 21% than the normal flat web. Therefore, it can be concluded that the TriWP section can resist more acting force than the normal flat web section and is suitable to be used as a new proposed shape to replace the normal flat web section for a certain steel structure based on the end-plate connection behavior.

Originality/value

As a result, the TriWP section has better performance than the flat web section in resisting MR behavior.
Long term monitoring reveals the importance of large, long unburnt areas and smaller fires in moderating mammal declines in fire‐prone Savanna of northern Australia
Authors: Einoder Luke D. , Fisher A. , Hill B. M. , Buckley K. , de Laive A. H. , Woinarski J. C. Z. , Gillespie G. R.
Published: August 2023

Biodiversity loss is often attributable to multiple interacting pressures that are moderated across environmental gradients. These processes contribute to complex responses that are challenging to interpret and understand. Well‐designed and well‐implemented monitoring can play a vital role in this but is rarely undertaken.

Mounting evidence suggests that current fire regimes across Savanna ecosystems have contributed to the decline of a range of biota. Hence, contemporary fire regimes are at odds with conservation goals.

Using an extensive spatiotemporal monitoring dataset from three large National Parks in northern Australia, we applied generalised linear mixed models to examine: (1) trends in mammal richness and abundance through time and variation across environmental gradients such as productivity or landscape position (e.g. terrain ruggedness); and (2) how fire, a potential driver, is moderated by environmental gradients.

Across 24 years, major declines in mammal richness and abundance were observed with greater reductions in less rugged and less mesic habitats. Patterns of decline were related to multiple aspects of fire regimes, but not changes in vegetation structure and composition, or cane toads, Rhinella marina, arrival and concomitant poisoning of predatory animals during consumption. More pronounced declines occurred in sites that were exposed to larger fires, had less long unburnt (>5 years without fire) vegetation and were more distant from large, long unburnt patches.

Relationships between mammal persistence and fire varied among vegetation communities, with the strongest fire effects observed in lowland woodland—drier with few barriers to fire spread—where the availability of long unburnt areas moderated declines more than in other vegetation communities.

Synthesis and applications. Current fire regimes are contributing to mammal declines in northern Australian Savanna. Collectively, our results highlight: (1) the value of long term monitoring, and importance of considering landscape position when assessing faunal responses to landscape‐level perturbations like fire; (2) that significant improvements in fire regimes are required to ameliorate mammal declines; and (3) the need to shift management focus from retaining small, short‐lived unburnt patches toward preserving relatively large contiguous areas of long unburnt habitat, particularly in less rugged lowland and sandstone woodlands.
The world's 100 worst invasive alien insect species differ in their characteristics from related non‐invasive species
Authors: Zhao Zihua , Hui Cang , Peng Shuo , Yi Shanqing , Li Zhihong , Reddy Gadi V. P. , van Kleunen Mark
Published: August 2023

While there has been great interest in species characteristics that promote invasiveness, still little is known about the characteristics that distinguish invasive from non‐invasive insects. Using a database on the naturalised distributions of alien insects and expert opinions about their impacts, we identified the world's 100 worst invasive insect species.

By comparing species characteristics reported in the literature using a meta‐analysis, between the 100 worst invasive species and related non‐invasive species, we found that invasive insects overall have more pathways of introduction, occur in more habitats, have higher fecundities, higher voltinism, more genes, shorted lifespans and faster development from egg to adult. Some of the differences in species characteristics related to propagule pressures, life‐histories and biotic interactions, conditional on whether the non‐invasive species compared is known to be naturalised somewhere, whether the invasive species is globally distributed, and the climatic region of the species.

Synthesis and applications. We show for the first time, using a multi‐species comparative approach, that invasive insects differ in several characteristics from related non‐invasive insects. Our results show that invasive species, such as Spodoptera frugiperda, typically are habitat generalists with a high fecundity, a short lifespan and fast development, whereas the importance of female body size and number of enemies are context dependent. Our study can guide and improve existing screening tools for assessing the invasion potential of alien insects.
Variations in soil nutrient availabilities and foliar nutrient concentrations of trees between temperate monsoon karst and non‐karst forest ecosystems on Mount Ibuki in Japan
Authors: Kajino Hirofumi , Fukui Misaki , Fujimoto Yutaro , Fujii Rei , Yokobe Tomohiro , Tatsumi Chikae , Sugai Tetsuto , Okada Naoki , Nakamura Ryosuke
Published: August 2023

Plants growing on karst soils, which are characterized by high pH (>7.5–8.0) and low phosphorus availability, often exhibit phosphorus deficiency. However, little is known about the soil nutrient availabilities and foliar nutrient concentrations of trees in karst ecosystems with lower soil pH (<7.0). In this study, we analyzed soil properties and nutrient concentrations of leaf litter from two secondary forests in the Asian monsoon temperate region of Japan, one on karst (limestone) soil and the other on non‐karst (sandstone) soil. We also compared the live leaf nutrient concentrations of four dominant tree species (Carpinus tschonoskii, Cornus macrophylla, Neolitsea sericea, and Quercus variabilis) found in both sites. The karst soil had a higher pH (6.5) than the non‐karst soil (5.6), as well as higher phosphorus concentrations and calcium availability, but lower potassium availability. The phosphorus concentrations measured using Truog ([NH4]2SO4) and Olsen (NaHCO3) extraction methods were both higher in the karst soil. The availabilities of ammonium and nitrate in the soil did not differ significantly between the sites. The concentrations of calcium, potassium, and phosphorus in the live leaves and leaf litter reflected their availability in the soil, and the litter nitrogen concentration was higher in the karst forest. Overall, this karst soil with a relatively low pH (6.5) was rich in phosphorus but poor in potassium. Karst soil may provide a large quantity of phosphorus for trees at low pH. Future research should investigate the change in phosphorus availability of karst soils at different degrees of weathering.
Shock index as a predictor of postpartum haemorrhage after vaginal delivery: Secondary analysis of a multicentre randomised controlled trial
Authors: Madar Hugo , Deneux‐Tharaux Catherine , Sentilhes Loïc ,   the TRAAP Study Group
Published: August 2023

Objective

To describe the shock index (SI) distribution during the first 2 hours after delivery and to evaluate its performance when measured 15 and 30 minutes after delivery for predicting postpartum haemorrhage (PPH) occurrence in the general population of parturients after vaginal delivery.

Design

Secondary analysis of a multicentre randomised controlled trial testing prophylactic administration of tranexamic acid versus placebo in addition to prophylactic oxytocin to prevent PPH.

Setting

15 French maternity units in 2015–2016.

Sample

3891 women with a singleton live fetus ≥35 weeks, born vaginally.

Methods

For each PPH‐related predicted outcome, we calculated the area under the receiver operating characteristic curve (AUROC) values of the SI at 15 and 30 minutes after delivery and its predictive performance for SI cut‐off values of 0.7, 0.9 and 1.1.

Main outcome measures

Quantitative blood loss ≥1000 ml (QBL ≥1000 ml) measured in a graduated collector bag and provider‐assessed clinically significant PPH (cPPH).

Results

Prevalence of QBL ≥1000 ml and cPPH was respectively 2.7% (104/3839) and 9.1% (354/3891). The distributions of the SI at 15 and 30 minutes after delivery were similar with a median value of 0.73 and 97th percentile of 1.11 for both. The AUROC values of the 15‐minute SI for discriminating QBL ≥1000 ml and cPPH were respectively 0.66 (lower limit of the 95% confidence interval [LCI] 0.60) and 0.56 (LCI 0.52); and for the 30‐minute SI 0.68 (LCI 0.61) and 0.49 (LCI 0.43).

Conclusions

The shock index at 15 and 30 minutes after delivery did not satisfactorily predict either QBL ≥1000 ml or clinical PPH.
Participation in a Medicare advanced primary care model and the delivery of high‐value services
Authors: He Fang , Gasdaska Angela , White Lindsay , Tang Yan , Beadles Chris
Published: August 2023

Objective

To evaluate whether primary care providers' participation in the Comprehensive Primary Care Plus Initiative (CPC+) was associated with changes in their delivery of high‐value services.

Data Sources

Medicare Physician & Other Practitioners public use files from 2013 to 2019, 2017 to 2019 Medicare Part B claims for a 5% random sample of Medicare Fee‐for‐Service (FFS) beneficiaries, the Area Health Resources File, the National Plan & Provider Enumeration System files, and public use datasets from the Centers for Medicare & Medicaid Services Physician Compare.

Study Design

We used a difference‐in‐difference approach with a propensity score‐matched comparison group to estimate the association of CPC+ participation with the delivery of annual wellness visits (AWVs), advance care planning (ACP), flu shots, counseling to prevent tobacco use, and depression screening. These services are prominent examples of high‐value services, providing benefits to patients at a reasonable cost. We examined both the likelihood of delivering these services within a year and the count of services delivered per 1000 Medicare FFS beneficiaries per year.

Data Collection/Extraction Methods

Secondary data are linked at the provider level.

Principal Findings

We find that CPC+ participation was associated with increases in the likelihood of delivering AWVs (13.03 percentage points by CPC+'s third year, p < 0.001) and the number of AWVs per 1000 Medicare FFS beneficiaries (44 more AWVs by CPC+'s third year, p < 0.001). We also find that CPC+ participation was associated with more flu shots per 1000 beneficiaries (52 more shots by CPC+'s third year, p < 0.001) but not with the likelihood of delivering flu shots. We did not find consistent evidence for the association between CPC+ participation and ACP services, counseling to prevent tobacco use, or depression screening.

Conclusions

CPC+ participation was associated with increases in the delivery of AWVs and flu shots, but not other high‐value services.
The Effect of Client Industry Agglomerations on Auditor Industry Specialization
Authors: KNECHEL W. ROBERT , WILLIAMS DEVIN
Published: August 2023

Prior research on auditor industry specialization documents fee premiums for local audit offices that are industry specialists. This research assumes that the effects of specialization are uniform across markets. We examine industry specialization based on the economic theory of industry agglomeration (geographic areas with high industry concentration). Agglomeration economies can facilitate access to knowledge for auditors serving a specific industry in those locations. We find that industry specialists in agglomerations earn a fee premium in excess of specialists in other markets. We find that nonspecialist offices in agglomerations also earn fee premiums in that industry when compared to nonspecialists in other markets even when controlling for these groups’ absolute share of the national market. We also address whether or not this expertise can be shared among offices in an agglomeration specialist's firm. We find that audit offices that have easy connections to a within‐firm office in an agglomerated market can earn a fee premium relative to more distant offices, suggesting a benefit from knowledge transfer. This fee premium accrues to offices that would not be considered a specialist using traditional market share measures in a given industry. These findings indicate that the benefit of industry specialization depends on more than local market share.
Integrating subvolume dose and myocardial perfusion imaging parameters to assess the impact of radiation therapy on heart function in breast cancer patients: A comparative analysis between left‐ and right‐sided breast cancer
Authors: Wang Shan‐Ying , Tsai Wei‐Ta , Lin Kuan‐Heng , Yu Chih‐Wei , Yang Shu‐Ya , Shueng Pei‐Wei , Wu Yen‐Wen , Hsu Chen‐Xiong , Wu Tung‐Hsin
Published: August 2023

Background

This study aimed to utilize an innovative method of integrating the 20 subvolume dose of left ventricle and the Tl‐201 single photon emission computed tomography (SPECT) with myocardial perfusion imaging (MPI) parameters in patients with left‐ and right‐sided breast cancer after radiation therapy.

Methods

Female patients with breast cancer underwent SPECT MPI before commencing radiotherapy and 12 months later were enrolled from January 2014 to December 2018. The images of CT simulation and SPECT MPI were integrated into the treatment planning system. The differences of doses and parameters of MPI in all cardiac subvolumes between left‐ and right‐sided breast cancer patients were analyzed.

Results

Patients with left‐sided breast cancer (n = 61) received a higher radiation dose to the heart, left ventricular, and its territories and subvolumes, compared to patients with right‐sided breast cancer (n = 19). The 20‐segment analysis also showed statistically significant disparities in the average radiation doses received by the two groups. In different coronary artery territories, the end‐diastolic perfusion and end‐systolic perfusion showed a decrease in both sides, with no significant differences. However, the wall motion and wall thickening showed a significant decline in subregions within the left‐ and right‐sided coronary artery territories.

Conclusion

This study demonstrates an innovative integrated method combining the left ventricular 20 regional doses with SPECT MPI which shows that left‐sided breast cancer patients receive a higher subvolume dose than right‐sided breast cancer patients. Further research is needed to confirm the potential impact on heart function after radiotherapy on both sides.
Epidemic within a pandemic: Alcohol‐associated hepatitis and COVID‐19
Authors: Marlowe Natalie , Lam David , Liangpunsakul Suthat
Published: August 2023

Background

There was an increase in alcoholic beverage sales during the peak of the COVID pandemic in the United States. However, little is known about the impact of SARS‐CoV‐2 infection among hospitalized alcohol‐associated hepatitis (AH) patients.

Methods

We analyzed the available National Inpatient Data (NIS) data from 2020 to determine mortality and healthcare utilization among hospitalized AH patients with and without COVID‐19 in the United States.

Results

We observed a ~15.6% increase in cases of hospitalized AH patients from 136,620 in 2019 to 157,885 in 2020, a significant increase from an average of 5.5% per annum despite an 8.7% decline in US hospital admissions over the same time span. Men younger than 40 were the fastest growing AH group, with a 23% increase in 2020. Approximately 1.8% of hospitalized AH patients had a SARS‐CoV‐2 infection, which significantly worsened the mortality among patients with AH (11.4% vs. 4.1%, p < 0.0001). This was especially true among older AH patients with concomitant conditions such as clinically apparent cirrhosis, acute renal failure, upper gastrointestinal bleeding, and sepsis. AH patients with COVID‐19 also had a longer length of stay (8.6 vs. 6.1 days, p < 0.0001) and higher hospital charges during the stay ($93,670 vs. $66,283, p < 0.0001) than those without COVID‐19.

Conclusion

Our study highlights the rise in AH cases during the COVID‐19 pandemic. Screening and appropriate management of excessive alcohol use and preventive measures such as COVID‐19 vaccination should be considered to reduce morbidity and mortality among patients with AH.
9/11, the power elite, and the U.S. think tanks that plan the future
Authors: McGinnis Ray
Published: August 2023

Four think tanks with close ties to the highest levels of government have shaped American foreign policy for decades. They are the Council on Foreign Relations, the RAND Corporation, the Bilderberg Group, and the Trilateral Commission. With direct ties to government officials who have engaged in various covert operations, these organizations provide a space within which advocates of global control can share ideas and develop new policies. Among the groups that have bravely questioned the consensus‐forming character of these think tanks are groups of people whose relatives died on 9/11. Because of their investigations into the government officials whose careers have blossomed as a result of 9/11, these ordinary citizens have become sharp critics of the expansionist ideology that was seemingly legitimized by 9/11.
Do Cost Behaviors Affect Cost of Equity: Evidence from Seasoned Equity Offering?
Authors: Xiao He
Published: August 2023

This study investigates the impact of firms' cost behavior on their seasoned equity offering (SEO) performance. The empirical findings show that cost‐stickier SEO firms experience more negative SEO cumulative abnormal returns (CARs). The economic mechanism of this association is that cost‐stickier SEO firms deal with higher information asymmetry and issue fewer debts, which reduce their SEO CARs. SEO firm cost behavior also affects corporate SEO decisions and announcement returns in different life cycles. Among the three economic mechanisms, the information asymmetry channel has been found as the dominant one. This study also indicates that cost‐stickier firms are less likely to conduct SEOs than their counterparts. In contrast, the motivation for Chinese SEO issuance for cost‐stickier firms is market timing rather than adjusting the capital structure or financing for investment and growth. Additionally, the negative impact of cost stickiness on corporate SEO returns is less pronounced for firms associated with industry‐specialized auditors and greater corporate governance capacity but more substantial for SEO firms with higher free cash flow. All main findings are consistent in a number of endogenous tests, including the two‐stage least squares test, the generalized method of moments estimation, and the control of alternative fixed effects. These conclusions also passed several robustness tests such as an alternative factor model and event windows and an alternative proxy of cost stickiness.
Peer support by and for people with learning disabilities
Authors: Ali Shalim , Allum Peter , Vassell Santino , Levitan Tony
Published: August 2023

Background

The emphasis of mental health services has changed to become more recovery focussed and is increasingly looking towards new roles such as peer support as a part of service provision (NHSE, 2019). However, services for people with learning disabilities and mental health difficulties have lagged behind with people with lived experience mainly involved in research and consultation to services rather than delivering interventions.

Methods

This article is based on four workshops held as part of a patient and public involvement and engagement (PPIE) consultation on a research study being developed to promote access to recovery colleges for people with learning disabilities. The workshops included three peer supporters with learning disabilities. In the article we describe our groups experiences and views on mental health, recovery and peer support.

Findings

Our group discussed our views on mental health, what recovery means and the impact of peer support on us. We also discussed the skills people need to do peer support and the support they need from others to do these roles well.

Conclusions

We thought that peer support for people with learning disabilities can challenge stigma and help people with difficult experiences such as low self esteem and loneliness. Staff supporting people with learning disabilities may benefit from more training to implement peer support. More research on the kinds of peer support that are on offer for people with learning disabilities is needed.
Creating a SNOMED CT reference set for common endocrine disorders based on routine clinic correspondence
Authors: Yap Shao Hao Alan , Philip Sam , Graveling Alex J. , Abraham Prakash , Downs Denise
Published: August 2023

Background

Routine clinical coding of clinical outcomes in outpatient consultations still lags behind the coding of episodes of inpatient care. Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) offers an opportunity for standardised coding of key clinical information. Identifying the most commonly required SNOMED terms and grouping these into a reference set will aid future adoption in routine clinical care.

Objective

To create a common endocrinology reference set to standardise the coding for outcomes of outpatient endocrine consultations, using a semi‐automated extraction of information from existing clinical correspondence.

Methods

Retrospective review of data from an adult tertiary outpatient endocrine clinic between 2018 and 2019. A total of 1870 patients from postcodes within two regional areas of NHS Grampian (Aberdeen City and Aberdeenshire) attended the clinic. Following consultation, an automated script extracted each problem statement which was manually coded using the ‘disorder’ concepts from SNOMED CT (UK edition).

Results

The review identified 298 relevant endocrine diagnoses, 99 findings and 142 procedures. There were a total of 88 (29.5%) commonly seen endocrine conditions (e.g., Graves' disease, anterior hypopituitarism and Addison's disease) and 210 (70.5%) less commonly seen endocrine conditions. Subsequently, consultant endocrinologists completed a survey regarding the common endocrine conditions; 28 conditions have 100% agreement, 25 have 90%–99% agreement, 31 have 50%–89% agreement and 4 have less than 59% agreement (which were excluded).

Conclusion

Automated text parsing of structured endocrine correspondence allowed the creation of a SNOMED CT reference set for common endocrine disorders. This will facilitate funding and planning of service provision in endocrinology by allowing more accurate characterisation of the patient cohorts needing specialist endocrine care.
What children exposed to domestic violence value when meeting social workers: A practice‐oriented systematic research review
Authors: Vikander Martina , Källström Åsa
Published: August 2023

Children exposed to domestic violence (DV) face a heightened risk of many types of short‐ and long‐term problems. Social workers can limit these risks if the support and help they offer is perceived as valuable by the child. The aims of this review were to identify what children exposed to DV value when meeting social workers, to suggest how this knowledge can be used in practice by professionals dedicated to working with these children and to identify and suggest key areas of focus for future research. A synthesis of 18 studies reveals that, in meetings with social workers, children exposed to DV value (1) basic requirements, (2) inclusion, (3) acknowledgement and (4) enjoyment. This review offers a smorgasbord of opportunities for practitioners to meet the wishes and needs of these children. However, comparative research is needed to facilitate adaptation and to distinguish between elements valued by children that are core prerequisites for helping them disclose their experiences and/or aiding their recovery and elements that are less crucial but still valued.
Marginal bone level change of immediately restored implants with simultaneous guided bone regeneration: A systematic review
Authors: Lin Xinyan , Yu Xinbo , Wang Feng , Wu Yiqun
Published: August 2023

Aim

To assess marginal bone level change (MBLc), clinical outcomes for soft tissue, and survival rates for immediately restored implants with simultaneous guided bone regeneration (GBR).

Materials and Methods

Electronic and manual searches were conducted in PubMed/MEDLINE, EMBASE, and CENTRAL for studies that investigated immediately restored implants in simultaneously grafted sites with a mean follow‐up of over 12 months. MBLc was the primary outcome. Soft tissue clinical parameters and implant survival rate (ISR) were the secondary outcomes.

Results

Twenty‐five studies (5 randomized controlled trials, 6 prospective studies, 2 retrospective studies, and 12 case series) were included, from which 692 immediately restored implants were analyzed. For studies that investigated bone grafts in the gap between the implant and the peripheral bone wall, the weighted mean MBLc was −0.73 ± 1.52 mm (range: −1.50 to 0.26 mm) for 475 implants. Pink esthetic score (PES) was improved in eight studies and the weighted cumulative ISR was 98.99% (Median: 100%) in 622 implants. Mean MBLc was −1.19 ± 0.26 mm for 30 implants in studies that reported gap with dehiscence and/or fenestration augmentation. Weighted cumulative ISR was 97.25% in 70 implants. A meta‐analysis was not possible due to the lack of studies with an eligible control group. Therefore, the data should be interpreted with caution.

Conclusion

Less marginal bone loss and more predictable soft tissue parameters can be achieved for immediately restored implants with simultaneous peri‐implant gap filling compared with gap with dehiscence/fenestration grafting. Increased ISR for implants with gap filling was observed. However, more evidence is needed to confirm whether immediate provisional prostheses should be utilized when bone defects are simultaneously augmented around the implants.
Return to intended oncologic therapy after colectomy for stage III colon adenocarcinoma: Does surgical approach matter?
Authors: Pointer David T. , Felder Seth I. , Powers Benjamin D. , Dessureault Sophie , Sanchez Julian A. , Imanirad Iman , Sahin Ibrahim , Xie Hao , Naffouje Samer A.
Published: August 2023

Aim

Return to intended oncologic treatment (RIOT) is an important paradigm for surgically resected cancers requiring multimodal treatment. Benefits of minimally invasive colectomy (MIC) may allow earlier initiation of adjuvant chemotherapy (ACT) and have associated survival benefits. We sought to determine if operative approach affects RIOT timing in resected stage III colon cancer.

Methods

NCDB identified pathological stage III colon adenocarcinoma patients who underwent resection and received ACT. Propensity score matching and kernel density estimation compared operative approaches and conversion impact on intervals to RIOT.

Results

A total of 15,132 open colectomies (OC) versus 14,107 MIC were included. MIC patients had two‐days shorter median length of stay (LOS) (4 vs. 6 days; p < 0.001), one‐week shorter median time to RIOT (6 vs. 7 weeks; p = 0.015) comparing 12,867 matched pairs. There was no difference in time interval to RIOT between the LC versus RC, converted MIC vs. OC groups. MIC was a favourable predictor of earlier RIOT (HR 1.14 [1.07–1.22]; p < 0.001).

Conclusion

MIC in stage III colon cancer is associated with a shorter time to RIOT when compared to OC. Since timely initiation of ACT may influence cancer outcome, MIC may be oncologically preferable. Prospective studies are needed to assess RIOT and survival outcomes in stage III colon cancer.
The Puzzle of Evaluating Moral Cognition in Artificial Agents
Authors: Reinecke Madeline G. , Mao Yiran , Kunesch Markus , Duéñez‐Guzmán Edgar A. , Haas Julia , Leibo Joel Z.
Published: August 2023

In developing artificial intelligence (AI), researchers often benchmark against human performance as a measure of progress. Is this kind of comparison possible for moral cognition? Given that human moral judgment often hinges on intangible properties like “intention” which may have no natural analog in artificial agents, it may prove difficult to design a “like‐for‐like” comparison between the moral behavior of artificial and human agents. What would a measure of moral behavior for both humans and AI look like? We unravel the complexity of this question by discussing examples within reinforcement learning and generative AI, and we examine how the puzzle of evaluating artificial agents' moral cognition remains open for further investigation within cognitive science.
A phase I, open‐label, single‐dose study to evaluate the effect of hepatic impairment on the pharmacokinetics and safety of futibatinib
Authors: Gao Ling , Yamamiya Ikuo , Pinti Mark , Rondon Juan Carlos , Marbury Thomas , Tomlinson Gareth , Makris Lukas , Hangai Nanae , Wacheck Volker
Published: August 2023

Futibatinib is a covalently binding FGFR1–4 inhibitor that received US Food and Drug Administration approval for the treatment of patients with previously treated, advanced intrahepatic cholangiocarcinoma harboring FGFR2 gene fusions/rearrangements. This phase I trial evaluated the pharmacokinetics (PKs), safety, and tolerability of futibatinib in subjects with impaired hepatic function and matched healthy volunteers. Twenty‐two subjects with hepatic impairment (8 mild [Child‐Pugh 5–6], 8 moderate [7–9], and 6 severe [10–15]) and 16 matched healthy control subjects received a single oral dose of futibatinib 20 mg. Futibatinib PKs were compared between subjects with mild/moderate/severe hepatic impairment and each corresponding control cohort and the overall control cohort. Relationships between futibatinib PKs and Child‐Pugh scores and liver function tests were examined via scatter/regression plots. Compared with matched controls, the area under the plasma concentration–time curve from time zero to infinity increased by 21%/20%/18% and the maximum plasma concentration (Cmax) increased by 43%/15%/10% in subjects with mild/moderate/severe hepatic impairment, respectively. Changes were not considered clinically relevant: geometric mean ratios were within 80%–125%, except for Cmax in subjects with mild hepatic impairment (143%). No obvious trends were observed among futibatinib PK parameters versus Child‐Pugh scores, bilirubin, albumin, international normalized ratio, and aspartate aminotransferase (all p > 0.05). Futibatinib was well‐tolerated, with only four grade 1 treatment‐emergent adverse events (mild hepatic impairment = 2 and control = 2). The results demonstrate that futibatinib dose adjustments due to mild/moderate/severe hepatic impairment are not necessary in patients receiving futibatinib 20 mg daily.
One Thing Leads to Another: Supporting DE&I and Mental Health Through Multisensory Workplace Design
Authors: Marsh Melissa
Published: August 2023

While the importance of mental health in the workplace is gaining attention, so is the impact that the physical workplace itself has on employee well‐being.

Explore the many intricacies of reimagining the workplace to prioritize worker mental health and well‐being—priorities that will ultimately improve employee morale and retention.
Fostering an Environment of Belongingness in the Post‐pandemic Workplace
Authors: Aftab Mersha , Pinnock Hannah
Published: August 2023

Post‐pandemic work is different, and many organizations have embraced this new way of working with little time to consider the policy, strategy, or impact on people.

Remote and hybrid work have changed and challenged how we interact with each other in our jobs, elevating the importance of fostering belongingness in the workplace.
Comparative evaluation of the sedative and physiological effects of dexmedetomidine alone and in combination with methadone, morphine, tramadol or pethidine in miniature donkeys
Authors: Samimi Amir Saeed , Molaei Mohammad Mahdi , Safizadeh Zahra , Allahtavakkoli Mohammad
Published: August 2023

Background

The use of combinations of α2‐adrenergic agonists and opioids has been published as providing superior sedation than either drug alone.

Objectives

The present study aimed to compare the sedative and physiological effects of intravenous (IV) administration of dexmedetomidine alone and in combination with methadone, morphine, tramadol or pethidine in miniature donkeys.

Study design

Experimental, crossover Latin square, randomised, blinded study.

Methods

Twelve clinically healthy miniature donkeys with a mean age of 6 ± 2 (mean ± SD) years, weight of 94 ± 5 kg and height at withers of 0.80 ± 0.06 m were assigned to six IV treatments. They received either 0.9% saline, 5 μg/kg dexmedetomidine, 5 μg/kg dexmedetomidine and 0.2 mg/kg methadone, 5 μg/kg dexmedetomidine and 0.1 mg/kg morphine, 5 μg/kg dexmedetomidine and 2 mg/kg tramadol or 5 μg/kg dexmedetomidine and 1 mg/kg pethidine, with a washout period of 8 days. The degree of sedation was investigated using a numerical ranking scale of 0–3. Heart rate (HR), respiratory rate (RR), rectal temperature (RT) and intestinal motility were performed before and 5, 10, 15, 30, 45, 60, 75, 90 and 120 min after drug administration.

Results

Animals in dexmedetomidine or dexmedetomidine/opioid treatments were sedated for 5–60 min. Sedation was significantly higher in dexmedetomidine/opioid treatments than in dexmedetomidine at 15–30 min (p < 0.05). In all treatments, HR and RR significantly decreased from baseline at 5–75 and 30–60 min, respectively (p < 0.05). Intestinal motility was decreased in dexmedetomidine and dexmedetomidine/opioid treatments at 5–60 and 5–90 min, respectively. Compared to dexmedetomidine, intestinal motility was significantly lower in dexmedetomidine/opioid treatments at 75–90 min.

Main limitations

Assessment of only HR and RR are inadequate to describe the cardiorespiratory effects of dexmedetomidine/opioids.

Conclusions

The use of combinations of dexmedetomidine/opioids would be considered for superior sedation for 15–30 min after administration in miniature donkeys. No significant differences were detected between opioids in combination with dexmedetomidine in miniature donkeys.
Functional non‐equivalence in ecosystem engineers? Different freshwater mussels (Bivalvia: Unionidae) are associated with different macroinvertebrate communities in a subtropical lake
Authors: Ollard Isobel , Chowdhury Gawsia W. , Aldridge David C.
Published: August 2023

Freshwater mussels (Bivalvia: Unionidae) are often described as ecosystem engineers, with the capacity to alter abiotic habitats; this can facilitate certain macroinvertebrate taxa, increasing biodiversity and potentially altering community composition. Mussel species are often implicitly considered to be broad ecological equivalents, with similar impacts on abiotic environments and benthic communities. This assumption of redundancy is important in conservation approaches that aim to preserve ecosystem functioning, rather than species identity. We tested this assumption of equivalence in two species of subtropical freshwater mussels, Lamellidens marginalis and Parreysia caerulea, studying the associations between these mussel species and macroinvertebrate communities.

We measured mussel density and abundance of macroinvertebrates, identified to family level, at 50 sites within Dhanmondi Lake, a heavily polluted sub‐tropical urban lake in Dhaka, Bangladesh. We investigated the associations of mussel density on different macroinvertebrate families, which we further classified into functional feeding groups (predators, scrapers, collectors and shredders).

We found that densities of the two mussel species were negatively correlated in the 1–3‐m nearshore zone; average density of Lamellidens was 46.4 ± SE 3.6 individuals/0.25 m2, and average density of Parreysia was 6.4 ± SE 1.4 individuals/0.25 m2. In total, 2319 Lamellidens and 320 Parreysia specimens were recorded. Sites containing higher densities of Lamellidens had greater similarity in macroinvertebrate community composition, while there was no effect for Parreysia. Particular macroinvertebrate families and functional feeding groups were also associated with mussels; the majority of significant associations were with Lamellidens but not Parreysia. The clearest associations were with predators and scrapers, which increased in abundance with Lamellidens density.

This provides support for a possible role for mussels in structuring freshwater invertebrate communities and emphasises the importance of species identity in these effects, with one possible keystone species (Lamellidens) largely accounting for mussel–invertebrate associations. While microhabitat variables (shading and sediment type) were poor predictors of abundance in any invertebrate taxa (including mussels), manipulative studies are needed to disentangle the direct effects of mussels from the role of overlapping habitat preference between mussels and other invertebrates.

Our results highlight the importance of species identity in patterns of community composition, particularly for ecosystem engineer species. We also reinforce the need to test the assumption of ecological redundancy within communities.
Ensilibility and protein degradation characteristics of forage from mountain grasslands containing tanniferous species
Authors: Ineichen Simon , Seiler Andrea B. , Wyss Ueli , Malisch Carsten S. , Reidy Beat
Published: August 2023

Ensiling forage from species‐rich mountain grasslands is challenging. Low concentrations of fermentable carbohydrates and the coarse morphological structure of the forage promote the activity of butyric acid forming bacteria. This is associated with the formation of ammonia from protein degradation, resulting in an insufficient pH decline. On the other hand, forage from species‐rich swards may contain tanniferous plant species which contain varying contents of condensed tannins (CT). Therefore, the silage quality of forage prepared from species‐rich mountain grasslands and the role CT may play in silage fermentation was studied. A set‐up of two long‐term mineral fertilization field experiments, located in the Jura mountains and the Alps in Switzerland were used to obtain forage with contrasting species and chemical composition. Collection was done during both the generative and vegetative growth stage from three differently fertilized swards: unfertilised (“0”), fertilized with phosphorus and potassium (“PK”) or fertilized with PK and nitrogen (“NPK”). The forage was wilted to approximately 37% dry matter (DM), chopped to 2 cm lengths and ensiled for at least 65 days as laboratory‐scale silages. The wilted forage was characterized by concentrations of crude protein between 117 and 130 g/kg DM and water‐soluble carbohydrates varying from 84 to 148 g/kg DM. Concentrations of CT ranged from 6 g to 14 g/kg DM and those of soluble CT from 1.8 to 7.6 g/kg DM. All silages contained butyric acid, irrespective of the type of fertilization or harvest stage (range: 1.5 g to 16 g/kg DM). Concentrations of acetic and lactic acid ranged from 2.1 g to 15.0 g/kg DM and from 21.0 to 44.0 g/kg DM, respectively. Concentrations of unfermented sugar remained high and pH levels were above those expected. Formation of non‐protein‐N (NPN) increased in the range of 130 to 264 g/kg N from wilted to ensiled forage. The negative correlations of CT or soluble CT contents with ammonia‐N or NPN in silage were found in both forage from the generative and vegetative harvests indicating a possible relationship with protein degradation during ensiling.
Effects of PK‐guided prophylaxis on clinical outcomes and FVIII consumption for patients with moderate to severe Haemophilia A
Authors: Young Guy , Callaghan Michael U. , Balasa Vinod , Soni Amit , Ahuja Sanjay , Roberts Jonathan C. , Simpson Mindy L. , Kizilocak Hande , Frick Andrew , Mokdad Ali G. , Xing Shan , Caicedo Jorge
Published: August 2023

Introduction

In recent years, there has been increased focus on individualizing treatment for persons with hemophilia including pharmacokinetic‐guided (PK) dosing.

Aims

In this retrospective study clinical outcomes before and after PK‐guided prophylaxis were examined.

Materials and methods

Eight Haemophilia Treatment Centres from the United States participated in the study and included 132 patients classified into two cohorts: those undergoing a PK‐assessment for product switch (switchers) or to optimize treatment (non‐switchers). Subset analyses for the two most common products and patients with dosing per prescription label were included for annual bleeding rates (ABR), mean weekly consumption outcomes, and annualized cost of prophylaxis.

Results

The most common products before and after index date were octocog alfa, rurioctocog alfa pegol, and efmoroctocog alfa. Seventy‐four (56%) patients were identified as switchers and 58 (44%) patients were classified as non‐switchers. The majority of patients (78.0%) experienced either a decrease in ABR post‐index or maintained 0 ABR during pre‐ and post‐index time periods, with similar proportions identified in both switchers (77.0%) and non‐switchers (79.3%) populations. Non‐switchers were identified as having no significant change in cost of therapy, while switchers experienced increased cost of therapy driven by higher price of extended half‐life products. Within subset analyses, patients receiving rurioctocog alfa pegol and efmoroctocog alfa had mean ABR under 1 after index date.

Conclusion

PK‐guided prophylaxis has the potential to improve clinical outcomes without increase in cost of therapy for patients maintaining product and can aid in maintaining effective protection against bleeds in those switching product.
Emergency department patient‐centred care perspectives from deaf and hard‐of‐hearing patients
Authors: James Tyler G. , Sullivan Meagan K. , McKee Michael M. , Rotoli Jason , Maruca David , Stachowiak Rosemarie , Cheong JeeWon , Varnes Julia R.
Published: August 2023

Background

Deaf and hard‐of‐hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non‐DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient–provider communication. This qualitative study aimed to describe ED care‐seeking and patient‐centred care perspectives among DHH patients.

Methods

This qualitative study is the second phase of a mixed‐methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non‐DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)‐users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach.

Results

Two themes were developed: (1) DHH patients engage in a complex decision‐making process to determine ED utilization and (2) patient‐centred ED care differs between DHH ASL‐users and DHH English speakers. The first theme describes the social‐behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes.

Conclusions

This study underscores the importance of better understanding, and intervening in, DHH patient ED care‐seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity‐relevant indicator. We also discuss recommendations for emergency medicine.

Patient or Public Contribution

This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co‐authorship are listed in the byline, with others in the acknowledgements. In addition, several academic‐based co‐authors are also deaf or hard of hearing.
Anastomosing haemangioma of the adrenal gland: A clinicopathological series of seven cases
Authors: Alaghehbandan Reza , Remer Erick M , Berber Eren , McKenney Jesse K
Published: August 2023

Aims

Anastomosing haemangioma is a rare benign vascular neoplasm that may histologically mimic angiosarcoma. We report the largest single institution series of anastomosing haemangioma in the adrenal gland with emphasis on clinical and radiological features.

Methods and results

Our laboratory information system was searched for a 25‐year period (1999–2023), yielding seven cases confirmed as anastomosing haemangioma of the adrenal gland after pathological re‐review. Clinical, radiological and pathological information was obtained from medical charts and submitting pathologists. Of a total of seven patients, four (57.1%) were men and three women, ranging in age from 37 to 75 years (mean = 61). Six of seven patients underwent adrenalectomies and one had radical nephrectomy. Tumours ranged from 0.7 to 6.4 cm (mean = 2.1 cm) and five of seven (71%) were grossly well‐circumscribed. Five of seven lesions were found incidentally at imaging for other indications. All tumours were unifocal except one, which presented with multifocal disease with a concurrent adjacent retroperitoneal anastomosing haemangioma. Three of five tumours imaged with contrast enhancement were almost completely hyperenhancing with a small central non‐enhancing portion, features overlapping with pheochromocytoma. One of seven tumours involved the peri‐adrenal adipose tissue with a focally infiltrative pattern. There were no recurrences or metastases in six patients with available follow‐up data (median = 95 months).

Conclusions

Benign anastomosing haemangiomas of the adrenal gland tend to occur in older patients, may mimic pheochromocytoma on imaging and must be distinguished from angiosarcoma pathologically. Better awareness of this entity by pathologists, radiologists and surgeons is crucial to appropriate work‐up, diagnosis and management.