bluuebunny/crossref_metadata_2025 huggingface dataset:
Workplace mistreatment and mental health in female surgeons in Pakistan
Authors: Malik M A , Inam H , Martins R S , Janjua M B N , Zahid N , Khan S , Sattar A K , Khan S , Haider A H , Enam S A
Published: March 2021

Background

Despite workplace mistreatment, which includes harassment, bullying and gender discrimination(GD)/bias, being serious problems for female surgeons, there are limited data from lower–middle-income countries like Pakistan. This study explored harassment and GD/bias experienced by female surgeons in Pakistan, and the effects of these experiences on mental health and well-being.

Methods

A nationwide survey was conducted between July and September 2019 in collaboration with the Association of Women Surgeons of Pakistan, an organization consisting of female surgeons and trainees in Pakistan. An anonymous online survey was emailed directly, disseminated via social media platforms (such as Facebook, Twitter and Instagram), and sent to surgical programmes in Pakistan.

Results

A total of 146 women surgeons responded to the survey; 67.1 per cent were trainees and the rest attending surgeons. Overall, 57.5 per cent of surgeons reported experiencing harassment, most common being verbal (64.0 per cent) and mental (45.9 per cent), but this mostly went unreported (91.5 per cent). On multivariable analysis adjusted for age and specialty, workplace harassment (odds ratio 2.02 (95 per cent c.i. 1.09 to 4.45)) and bullying (odds ratio 5.14 (95 per cent c.i. 2.00–13.17)) were significantly associated with severe self-perceived burnout, while having a support system was protective against feelings of depression (odds ratio 0.35 (95 per cent c.i. 0.16 to 0.74)). The overwhelming majority (91.3 per cent) believed that more institutional support groups were needed to help surgeons with stress reduction (78.8 per cent), receiving mentorship (74.7 per cent) and work–life balance (67.8 per cent).

Conclusion

Workplace mistreatment, in particular harassment and bullying, has a damaging impact on the mental well-being of female surgeons, particularly trainees. The absence of support groups in Pakistan should be urgently addressed so that surgeons, especially trainees, may cope better with potentially harmful workplace stressors.
Functional Realignment of Frontoparietal Subnetworks during Divergent Creative Thinking
Authors: Beaty Roger E , Cortes Robert A , Zeitlen Daniel C , Weinberger Adam B , Green Adam E
Published: March 2021

Creative cognition has been consistently associated with functional connectivity between frontoparietal control and default networks. However, recent research identified distinct connectivity dynamics for subnetworks within the larger frontoparietal system—one subnetwork (FPCNa) shows positive coupling with the default network and another subnetwork (FPCNb) shows negative default coupling—raising questions about how these networks interact during creative cognition. Here we examine frontoparietal subnetwork functional connectivity in a large sample of participants (n = 171) who completed a divergent creative thinking task and a resting-state scan during fMRI. We replicated recent findings on functional connectivity of frontoparietal subnetworks at rest: FPCNa positively correlated with the default network and FPCNb negatively correlated with the default network. Critically, we found that divergent thinking evoked functional connectivity between both frontoparietal subnetworks and the default network, but in different ways. Using community detection, we found that FPCNa regions showed greater coassignment to a default network community. However, FPCNb showed overall stronger functional connectivity with the default network—reflecting a reversal of negative connectivity at rest—and the strength of FPCNb-default network connectivity correlated with individual creative ability. These findings provide novel evidence of a behavioral benefit to the cooperation of typically anticorrelated brain networks.
Securitization of Artificial Intelligence in China
Authors: Zeng Jinghan
Published: March 2021

This article studies the security politics of Artificial Intelligence (AI) in China. Using securitization as an analytical framework, it examines the official Chinese AI discourse and how AI is becoming a security matter. The article argues that the Chinese central government is securitizing AI to mobilize local states, market actors, intellectuals, and the general public. China’s historical anxieties about its technology and regime security needs are conducive to the rise of a security discourse in China’s AI politics, a trend also fuelled by tensions arising from great power competition. Although helpful in convincing domestic actors, this securitization trend could undermine Chinese key AI objectives by heading in an inward-looking, techno-nationalistic direction that may be seriously detrimental to China’s AI industry and leadership ambitions.
How to manage cigarette smoking in kidney transplant candidates and recipients?
Authors: Devresse Arnaud , Gohy Sophie , Robert Arnaud , Kanaan Nada
Published: March 2021

Tobacco smoking is a frequent problem affecting many kidney transplant (KT) candidates and recipients. The negative impact of active smoking on KT outcomes has been demonstrated. Consequently, most guidelines strongly recommend quitting smoking before considering kidney transplantation. However, nicotine addiction is a complex multifactorial disease and only 3–5% of the patients who try to quit by themselves achieve prolonged abstinence. Smoking cessation programmes (SCPs) have proven their efficacy in the general population to increase the rate of quitting and should therefore be proposed to all smoking KT candidates and recipients. Nevertheless, SCPs have not been evaluated in the KT field and not all KT centres have easy access to these programmes. In this work, we aim to review the current knowledge on the subject and provide an overview of the available interventions to help smoking patients quit. We detail non-pharmaceutical and pharmaceutical approaches and discuss their use in KT candidates and recipients.
Endovascular treatment of coronary subclavian steal syndrome: a case series highlighting the diagnostic usefulness of a multimodality imaging approach
Authors: Real Carlos , Vivas David , Martínez Isaac , Ferrando-Castagnetto Federico , Reina Julio , Nava-Muñoz Ángel , Serrano Javier , Vilacosta Isidre
Published: March 2021

Background

Coronary subclavian steal syndrome (CSSS) is an uncommon complication observed in patients after coronary artery bypass surgery with left internal mammary artery (LIMA) grafts. It is defined as coronary ischaemia due to reversal flow from the LIMA to the left subclavian artery (SA) when a proximal left SA stenosis is present. In practice, the entire clinical spectrum of ischaemic heart disease, ranging from asymptomatic patients to acute myocardial infarction, may be encountered.

Case summary

Three cases of CSSS recently detected at our hospital are being described. Two patients presented with an acute coronary syndrome, so diagnosis was suspected based on coronary angiography findings, as retrograde blood flow from LIMA to the distal SA was present. Myocardial ischaemia was documented by myocardial perfusion scintigraphy in one case. The third patient was asymptomatic and CSSS was suspected during physical examination and confirmed by computed tomography (CT). Endovascular intervention with balloon-expandable stent implantation of the stenotic SA was performed by vascular surgeons in all patients. No periprocedural complications occurred, and complete resolution of symptoms was achieved.

Discussion

In CSSS, subclavian angiography is the standard diagnostic test. However, other diagnostic techniques may be valuable to better clarify this challenging diagnosis. In the herein small series, the usefulness of a multimodality imaging approach including Doppler ultrasound, myocardial perfusion scintigraphy, and CT is well demonstrated. Furthermore, this study endorses the safety and utility of endovascular treatment in different clinical scenarios, including asymptomatic patients.
Intensive care unit management of percutaneous mechanical circulatory supported patients: the role of imaging
Authors: Montisci Andrea , Bertoldi Letizia F , Price Susanna , Hassager Christian , Møller Jacob , Pappalardo Federico
Published: March 2021

The clinical management of patients on Impella support requires multimodality monitoring and imaging. Upon intensive care unit admission, echocardiography is essential to ensure correct pump positioning/guide repositioning, to monitor acute myocardial infarction/device-related cardiac complications and to evaluate baseline left and right ventricular function. Over time, the echocardiographic assessment of myocardial viability has become an essential target for guiding mechanical circulatory support escalation and long-term strategies. The recognition and grading of any valvular dysfunction and damage in Impella patients are challenging, as the device interferes with the colour Doppler signal, and the loading conditions of the left ventricle are modified by the pump. Valvular disease in such patients is often secondary, and correct identification is pivotal for future therapeutic strategies. The emerging use of newer techniques, including speckle-tracking echocardiography, is of increasing interest in the imaging of critically ill patients.
The composition and function ofEnterococcus faecalismembrane vesicles
Authors: Afonina Irina , Tien Brenda , Nair Zeus , Matysik Artur , Lam Ling Ning , Veleba Mark , Jie Augustine Koh Jing , Rashid Rafi , Cazenave-Gassiot Amaury , Wenk Marcus , Wai Sun Nyunt , Kline Kimberly A
Published: March 2021

Membrane vesicles (MVs) contribute to various biological processes in bacteria, including virulence factor delivery, antimicrobial resistance, host immune evasion and cross-species communication. MVs are frequently released from the surface of both Gram-negative and Gram-positive bacteria during growth. In some Gram-positive bacteria, genes affecting MV biogenesis have been identified, but the mechanism of MV formation is unknown. In Enterococcus faecalis, a causative agent of life-threatening bacteraemia and endocarditis, neither mechanisms of MV formation nor their role in virulence has been examined. Since MVs of many bacterial species are implicated in host–pathogen interactions, biofilm formation, horizontal gene transfer, and virulence factor secretion in other species, we sought to identify, describe and functionally characterize MVs from E. faecalis. Here, we show that E. faecalis releases MVs that possess unique lipid and protein profiles, distinct from the intact cell membrane and are enriched in lipoproteins. MVs of E. faecalis are specifically enriched in unsaturated lipids that might provide membrane flexibility to enable MV formation, providing the first insights into the mechanism of MV formation in this Gram-positive organism.
Administering Exclusion: Statelessness, Identity Papers and Narrative Strategy in B. Traven’s Das Totenschiff (1926)
Authors: Mandelbaum Melina Marie
Published: March 2021

Once an international best-seller but largely unknown today, B. Traven’s novel Das Totenschiff (The Death Ship) of 1926 presents a scathing critique of state bureaucracy and raises questions about the nature of authority, identity, home, and belonging in communal life. Reading the novel alongside relevant texts from political theory, I examine Traven’s text in the light of the history of bureaucracy and statelessness that surrounded and drove its production. Traven will be shown to provide a compelling critique of modern structures of communal organization, both on the level of content and in his multi-layered, non-linear style which runs counter to the more confined consecutive exposition of traditional forms, such as the biographical novel. By disrupting established ways of narrating the dynamics of individualization and belonging, Das Totenschiff reveals some of the complex elements of bureaucratically administered exclusion, as carried forth in objects such as the passport.
Short Physical Performance Battery as a Crosswalk Between Frailty Phenotype and Deficit Accumulation Frailty Index
Authors: Jung Hee-Won , Baek Ji Yeon , Jang Il-Young , Guralnik Jack M , Rockwood Kenneth , Lee Eunju , Kim Dae Hyun
Published: March 2021

Background

Growing evidence supports the clinical importance of evaluating frailty in older adults, with its strong outcome relevance. We aimed to assess whether the Short Physical Performance Battery (SPPB) correlates with frailty status according to phenotype and deficit accumulation models and can be used as a link between these models.

Methods

We analyzed records of 1064 individuals from the Aging Study of Pyeongchang Rural Area, a population-based, prospective cohort from South Korea. Frailty was determined using the Cardiovascular Health Study (CHS) phenotype (phenotype model), 26- and 34-item frailty indices (deficit accumulation model). Associations of SPPB score and frailty with a composite outcome of mortality or long-term institutionalization were assessed. Crosswalks for SPPB, the CHS frailty phenotype, and the frailty index were created.

Results

The mean age of the study population was 76.0 years, and 583 (54.8%) were women. According to the CHS phenotype, 26- and 34-item frailty indices, 242 (22.7%), 161 (15.1%), and 280 (26.3%) participants, respectively, had frailty. Sensitivities/specificities for classifying CHS phenotype, 26- and 34-item frailty indices were 0.93/0.55, 0.71/0.84, and 0.80/0.83 by SPPB cut points of ≤9, ≤6, and ≤7, respectively. C-index of SPPB score (0.78) showed a predictive ability for the composite outcome that was comparable to that of CHS frailty phenotype (0.79), 26- (0.78), and 34-item frailty indices (0.79).

Conclusions

We could create a crosswalk linking frailty phenotype and frailty index from correlations between SPPB and frailty models. This result may facilitate clinical adoption of the frailty concept in a broader spectrum of older adults.
Forecasting temporal variation of aftershocks immediately after a main shock using Gaussian process regression
Authors: Morikawa Kosuke , Nagao Hiromichi , Ito Shin-ichi , Terada Yoshikazu , Sakai Shin’ichi , Hirata Naoshi
Published: March 2021

Uncovering the distribution of magnitudes and arrival times of aftershocks is a key to comprehending the characteristics of earthquake sequences, which enables us to predict seismic activities and conduct hazard assessments. However, identifying the number of aftershocks immediately after the main shock is practically difficult due to contaminations of arriving seismic waves. To overcome this difficulty, we construct a likelihood based on the detected data, incorporating a detection function to which Gaussian process regression (GPR) is applied. The GPR is capable of estimating not only the parameters of the distribution of aftershocks together with the detection function, but also credible intervals for both the parameters and the detection function. The property that the distributions of both the Gaussian process and aftershocks are exponential functions leads to an efficient Bayesian computational algorithm to estimate hyperparameters. After its validation through numerical tests, the proposed method is retrospectively applied to the catalogue data related to the 2004 Chuetsu earthquake for the early forecasting of the aftershocks. The results show that the proposed method stably and simultaneously estimates distribution parameters and credible intervals, even within t ≤ 3 hr after the main shock.
A qualitative study on the health-seeking behavior and its determinants among carpet weavers in Kashmir
Authors: Khan Tanveer Ahmad , Farooqi Irfanullah , Swalehin Mohammad , Hamid Wasia
Published: March 2021

We conducted this study to examine the nature of treatment-seeking behavior among carpet weavers in Kashmir. We used a grounded theory approach to gain an in-depth understanding of the phenomenon. Data were collected through face-to-face interviews with 35 research participants recruited through purposive and theoretical sampling techniques. Based on the primary data, our study reveals that carpet weavers approached different agencies and used multiple methods for seeking treatment for their illness(es). The majority of the participants relied on spiritual healers, followed by traditional methods, Unani treatment, compounders and self-medication, while modern medicine was the last option for seeking treatment. We also found that participants base their choices about when and where to seek treatment on multiple socio-economic and cultural factors like financial constraints, perception towards illness, no provision for leave, costly and lengthy medical treatment, side effects of modern medicine, the nature of the disease, lack of infrastructure and insecurity due to conflict. These findings are relevant to employers and various government as well as non-government organizations. Additional implications of these findings for carpet weavers, public health, for practice and research are also discussed.
The effects of birth weight and estimated breeding value for protein deposition on nitrogen efficiency in growing pigs
Authors: Van der Peet-Schwering Carola M C , Verschuren Lisanne M G , Bergsma Rob , Hedemann Mette S , Binnendijk Gisabeth P , Jansman Alfons J M
Published: March 2021

The effects of birth weight (BiW; low BiW [LBW] vs. high BiW [HBW]) and estimated breeding value (EBV) for protein deposition (low EBV [LBV] vs. high EBV [HBV]) on N retention, N efficiency, and concentrations of metabolites in plasma and urine related to N efficiency in growing pigs were studied. At an age of 14 wk, 10 LBW–LBV (BiW: 1.07 ± 0.09 [SD] kg; EBV: −2.52 ± 3.97 g/d, compared with an average crossbred pig with a protein deposition of 165 g/d), 10 LBW–HBV (BiW: 1.02 ± 0.13 kg; EBV: 10.47 ± 4.26 g/d), 10 HBW–LBV (BiW: 1.80 ± 0.13 kg; EBV: −2.15 ± 2.28 g/d), and 10 HBW–HBV (BiW: 1.80 ± 0.15 kg; EBV: 11.18 ± 3.68 g/d) male growing pigs were allotted to the experiment. The pigs were individually housed in metabolism cages and were subjected to an N balance study in two sequential periods of 5 d, after an 11-d dietary adaptation period. Pigs were assigned to a protein adequate (A) or protein restricted (R, 70% of A) regime in a change-over design. Pigs were fed 2.8 times the energy requirements for maintenance. Nontargeted metabolomics analyses were performed in urine and blood plasma samples. The N retention (in g/d) was higher in the HBW than in the LBW pigs (P < 0.001). The N retention (in g/[kg metabolic body weight (BW0.75) · d]) and N efficiency, however, were not affected by the BiW of the pigs. The N retention (P = 0.04) and N efficiency (P = 0.04) were higher in HBV than in LVB pigs on the A regime but were not affected by EBV in pigs on the R regime. Restricting the dietary protein supply with 30% decreased the N retention (P < 0.001) but increased the N efficiency (P = 0.003). Nontargeted metabolomics showed that a hexose, free amino acids (AA), and lysophosphatidylcholines were the most important metabolites in plasma for the discrimination between HBV and LBV pigs, whereas metabolites of microbial origin contributed to the discrimination between HBV and LBV pigs in urine. This study shows that BiW does not affect N efficiency in the later life of pigs. Nitrogen efficiency and N retention were higher in HBV than in LBV pigs on the A regime but similar in HBV and LBV pigs on the R regime. In precision feeding concepts aiming to further optimize protein and AA efficiency in pigs, the variation in EBV for protein deposition of pigs should be considered as a factor determining N retention, growth performance, and N efficiency.
Maternofetal inflammation induced for 2 wk in late gestation reduced birth weight and impaired neonatal growth and skeletal muscle glucose metabolism in lambs
Authors: Posont Robert J , Cadaret Caitlin N , Beard Joslyn K , Swanson Rebecca M , Gibbs Rachel L , Marks-Nelson Eileen S , Petersen Jessica L , Yates Dustin T
Published: March 2021

Intrauterine stress impairs growth and metabolism in the fetus and offspring. We recently found that sustained maternofetal inflammation resulted in intrauterine growth-restricted (MI-IUGR) fetuses with asymmetric body composition, impaired muscle glucose metabolism, and β-cell dysfunction near term. These fetuses also exhibited heightened inflammatory tone, which we postulated was a fetal programming mechanism for the IUGR phenotype. Thus, the objective of this study was to determine whether poor growth and metabolism persisted in MI-IUGR lambs after birth. Polypay ewes received serial lipopolysaccharide or saline injections in the first 2 wk of the third trimester of pregnancy to produce MI-IUGR (n = 13) and control (n = 12) lambs, respectively. Lambs were catheterized at 25 d of age. β-Cell function was assessed at 29 d, hindlimb glucose metabolism at 30 d, and daily blood parameters from day 26 to 31. Glucose metabolism was also assessed in flexor digitorum superficialis (FDS) muscle isolated at necropsy on day 31. Asymmetric body composition persisted in MI-IUGR neonates, as these lambs were lighter (P < 0.05) than controls at birth and 31 d, but body and cannon bone lengths did not differ at either age. FDS muscles from MI-IUGR lambs were smaller (P < 0.05) and exhibited reduced (P < 0.05) glucose oxidation and Akt phosphorylation but similar glucose uptake compared with controls when incubated in basal or insulin-spiked media. Similarly, hindlimb glucose oxidation was reduced (P < 0.05) in MI-IUGR lambs under basal and hyperinsulinemic conditions, but hindlimb glucose utilization did not differ from controls. Circulating urea nitrogen and cholesterol were reduced (P < 0.05), and triglycerides, high-density lipoprotein cholesterol, and glucose-to-insulin ratios were increased (P < 0.05) in MI-IUGR lambs. Glucose and insulin concentrations did not differ between groups during basal or hyperglycemic conditions. Although circulating monocyte and granulocyte concentrations were greater (P < 0.05) in MI-IUGR lambs, plasma tumor necrosis factor α (TNFα) was reduced (P < 0.05). FDS muscle contained greater (P < 0.05) TNF receptor 1 (TNFR1) and IκBα protein content. These findings indicate that maternofetal inflammation in late pregnancy results in fetal programming that impairs growth capacity, muscle glucose oxidation, and lipid homeostasis in offspring. Inflammatory indicators measured in this study appear to reflect heightened cytokine sensitivity in muscle and compensatory systemic responses to it.
Assessment of DNA Integrity From Trap-Captured Boll Weevil (Coleoptera: Curculionidae) for Use in a New PCR-Based Diagnostic Tool
Authors: Perkin L C , Oppert B , Duke S , Suh C P-C
Published: March 2021

The boll weevil, Anthonomus grandis grandis Boheman (Coleoptera: Curculionidae), is a major pest of commercial cotton (Gossypium hirsutum) in the southern United States and throughout Central and South America. Efforts are underway to develop a PCR-based diagnostic tool that can be used to rapidly and accurately differentiate boll weevils from other weevil species that are commonly captured in pheromone traps. However, the quantity and integrity of weevil DNA must be sufficient for a successful PCR assay. Currently, active eradication programs service traps weekly, but post-eradication programs service traps at 2- or 3-wk intervals. Consequently, captured weevils may be dead, dismembered, and exposed to environmental conditions for prolonged periods which may adversely affect the quantity and quality of weevil DNA. We documented DNA quantity and integrity in boll weevils and weevil body parts aged in traps over a 3-wk period under field conditions. The quantity of DNA extracted from whole weevils, heads, abdomens, and legs generally remained sufficient (> 1 ng/μl) for successful PCR amplification throughout the 21-d period. The integrity (fragment length) of extracted DNA declined over time but generally was sufficient (> 700 bp) for successful amplification. PCR amplification of three marker genes validated that the quality and integrity of DNA extracted from dead weevils and individual weevil body parts aged in traps up to 21 d remained at sufficient levels for the PCR-based assay. However, our data also suggested that rain events may accelerate degradation of weevil DNA.
Ending Impunity for Forced Marriage in Conflict Zones
Authors: Maloney Kathleen M
Published: March 2021

Countless women and girls have been abducted, raped, forcibly assigned as ‘wives’ to combatants and held captive within such forced marriages in conflict zones around the world. Forced marriage as an international crime remains controversial because it (i) is not codified in any international criminal statute, (ii) involves conduct overlapping with already-enumerated crimes against humanity and (iii) is inconsistently defined. Legal protections for girls in forced marriage reside in historical proscriptions against various forms of slavery — banned by jus cogens norms, international human rights and humanitarian law — including the crimes against humanity of sexual slavery and enslavement. Yet, despite similarities between forced marriage and numerous forms of slavery, international criminal courts have not yet prosecuted or convicted forced marriage as enslavement, and even its conviction as sexual slavery insufficiently captures the unique, multi-layered injuries its youngest victims suffer. International tribunals confronting evidence of very young girls captured as ‘wives’ and of female child soldiers serving as sex slaves have failed to adequately recognize or redress the egregious harms girl endure through forced marriage. Competing judicial and academic views on its proper classification have obscured courts’ oversight of forced marriage’s most vulnerable victims — female children. This article argues that, to advance justice for girls in conflict zones and end impunity for these atrocities, greater judicial emphasis is needed on the constellation of internationally recognized fundamental human rights of children violated by forced marriage, whether prosecuted as an ‘other inhumane act’ or slavery-related crime against humanity.
Regulation of nonsense-mediated mRNA decay in neural development and disease
Authors: Lee Paul Jongseo , Yang Suzhou , Sun Yu , Guo Junjie U
Published: March 2021

Eukaryotes have evolved a variety of mRNA surveillance mechanisms to detect and degrade aberrant mRNAs with potential deleterious outcomes. Among them, nonsense-mediated mRNA decay (NMD) functions not only as a quality control mechanism targeting aberrant mRNAs containing a premature termination codon but also as a posttranscriptional gene regulation mechanism targeting numerous physiological mRNAs. Despite its well-characterized molecular basis, the regulatory scope and biological functions of NMD at an organismal level are incompletely understood. In humans, mutations in genes encoding core NMD factors cause specific developmental and neurological syndromes, suggesting a critical role of NMD in the central nervous system. Here, we review the accumulating biochemical and genetic evidence on the developmental regulation and physiological functions of NMD as well as an emerging role of NMD dysregulation in neurodegenerative diseases.
Do New Romantic Couples Use More Similar Language Over Time? Evidence from Intensive Longitudinal Text Messages
Authors: Brinberg Miriam , Ram Nilam
Published: March 2021

The digital text traces left by computer-mediated communication (CMC) provide a new opportunity to test theories of relational processes that were originally developed through observation of face-to-face interactions. Communication accommodation theory, for example, suggests that conversation partners’ verbal (and non-verbal) behaviors become more similar as relationships develop. Using a corpus of 1+ million text messages that 41 college-age romantic couples sent to each other during their first year of dating, this study examines how linguistic alignment of new romantic couples’ CMC changes during relationship formation. Results from nonlinear growth models indicate that three aspects of daily linguistic alignment (syntactic—language style matching, semantic—latent semantic analysis, overall—cosine similarity) all exhibit exponential growth to an asymptote as romantic relationships form. Beyond providing empirical support that communication accommodation theory also applies in romantic partners’ CMC, this study demonstrates how relational processes can be examined using digital trace data.
Effects of clonal integration on allelopathy of invasive plantWedelia trilobataunder heterogeneous light conditions
Authors: Pu Lei , Cheng Lang , Li Ai , Liang Sha , Wei Qing , Wu Shulan , He Linxuan , Xu Xiangning , Lei Ningfei , Chen Jinsong
Published: March 2021

Plant invasion is one of the most serious threats to ecosystems worldwide. When invasive plants with the ability of clonal growth invading or colonizing in new habitat, their interconnected ramets may suffer from heterogeneous light. Effects of clonal integration on allelopathy of invasive plants are poorly understood under heterogeneous light conditions. To investigate the effects of clonal integration on allelopathy of invasive plant Wedelia trilobata under heterogeneous light conditions, a pot experiment was conducted by using its clonal fragments with two successive ramets. The older ramets were exposed to full light, whereas the younger ones were subjected to 20% full light. The younger ramets of each clonal fragment were adjacently grown with a target plant (one tomato seedling) in a pot. Stolon between two successive ramets was either severed or retained intact. In addition, two tomato seedlings (one as target plant) were adjacently grown in a pot as contrast. Compared with severing stolon, biomass accumulation, foliar chlorophyll and nitrogen contents, chlorophyll fluorescence parameters and net photosynthetic rates of the target plants as well as their root length and activity, were significantly decreased when stolon between interconnected ramets of W. trilobata retained intact. Under heterogeneous light conditions, transportation or sharing of carbohydrate between two successive ramets enhanced allelopathy of the young ramets subjected to 20% full light treatment. It is suggested that clonal integration may be important for invasion or colonization of invasive plants with ability of clonal growth under heterogeneous light conditions.
Secretion rates and protein composition of extracellular vesicles released by cancer-associated fibroblasts after radiation
Authors: Berzaghi Rodrigo , Islam Ashraful , Hellevik Turid , Martinez-Zubiaurre Inigo
Published: March 2021

Reciprocal communication between the malignant and non-malignant cellular elements in tumors is essential for cancer sustainability and plays an important role in the response of cancers to treatments. Some of this cellular crosstalk takes place via secretion of vesicles that are actively released into the extracellular space by most cell types in tumors. Recent studies have demonstrated radiation-induced changes in the secretion rate and composition of extracellular vesicles (EVs), with impact on radiation-related cellular communication. However, little is known about the effects of different radiation regimens on the release of EVs by cells of the tumor microenvironment. In this study, we provide a comprehensive molecular characterization of EVs released by cultured primary lung tumor fibroblasts. We explore the quantitative and morphological changes triggered by ionizing radiation (IR), delivered as a single dose of 18 Gy or three consecutive daily medium-doses of 6 Gy. Cancer-associated fibroblasts (CAFs) secrete EVs with sizes ranging from 80 to 200 nm, expressing some of the classical exosome markers. Exposing CAFs to a single-high radiation dose (1 × 18 Gy) or fractionated medium-dose did not alter the release of CAF-EVs. The protein composition of CAF-EVs was analyzed by LC-MS/MS proteomics and revealed that CAF-EVs are enriched with heat shock proteins, integrins, tetraspanins, proteinases, collagens, growth factors and an array of molecules involved in the regulation of cell migration and the immune system. Quantitative proteomic analyses revealed minor changes in the protein composition of CAF-EVs after radiation exposure. Taken together, this study presents original data on lung tumor CAF-EV composition and reveals that release and protein cargo of CAF-EVs are largely unaltered after exposing CAFs to IR.
Behavior of the electron spin resonance signals in X-ray irradiated human fingernails for the establishment of a dose reconstruction procedure
Authors: Hirota Seiko , Gonzales Chryzel Angelica B , Yasuda Hiroshi
Published: March 2021

The retrospective dosimetry that follows accidental X-ray exposure is becoming more significant for improving radiation diagnosis and treatment. We investigated the dosimetric properties of electron spin resonance (ESR) signals in X-ray irradiated fingernails under conditions that resemble realistic situations. We collected fingernails from 12 Japanese donors between the ages of 30 to 70. The sampled fingernails were utilized for X-ray irradiation, mechanical stimulation and background measurements. We also collected 10 toenails from one of the donors to evaluate their differences from fingernails. Additionally, we prepared 15 samples from two donors to compare the signals generated by γ-rays to those by X-rays. After observing the linear dose–response for both X- and γ-ray irradiated samples, we found that the sensitivity of the air-absorbed dose of γ-ray irradiated samples was identical to that of X-ray irradiated samples. The effect from secondary electrons seemed to be small in fingernails. The inter-individual variation in the sensitivity was no greater than the intra-individual variation. The signal intensities in each measurement fluctuated about the linear response curve, and the size of the fluctuation was dependent on the sample. The average fluctuation corresponded to 1.7 Gy, and the standard deviation was 1.3 Gy. The signal induced by X-rays could be erased by soaking the samples in water and subsequently drying them for four days, which allowed us to estimate the signal intensity prior to the exposure. These characteristics of the ESR signal induced by X-rays facilitate the development of a feasible protocol for fingernail dose reconstruction.
Update of the particle irradiation data ensemble (PIDE) for cell survival
Authors: Friedrich Thomas , Pfuhl Tabea , Scholz Michael
Published: March 2021

The particle irradiation data ensemble (PIDE) is the largest database of cell survival data measured after exposure to ion beams and photon reference radiation. We report here on the updated version of the PIDE database and demonstrate how to investigate generic properties of radiation dose response using these sets of raw data. The database now contains information of over 1100 pairs of photon and ion dose response curves. It provides the originally published raw data of cell survival in addition to given linear quadratic (LQ) model parameters. If available, the raw data were used to derive LQ model parameters in the same way for all experiments. To demonstrate the extent of the database and the variability among experiments we focus on the dose response curves after ion and photon radiation separately in a first step. Furthermore, we discuss the capability and the limitations of the database for analyzing properties of low and high linear energy transfer (LET) radiation response based on multiple experiments. PIDE is freely available to the research community under www.gsi.de/bio-pide.
Evaluating XR: Standards for an emerging DH medium
Authors: Szabo Victoria
Published: March 2021

Evaluating scholarly work in extended reality for the humanities requires understanding of both scientific and humanistic standards for the work. This article shows how humanities values and interests intersect, and at times conflict, with norms developed for the medium in scientific contexts, and reflects on the risks humanists take in exploring new approaches to scholarly practice. The discussion draws upon the work of a recent Digital Humanities (DH) institute that reflected on how the Extended Reality (XR) goals of immersiveness, completeness, and realism compete with valuing the visible traces of ambiguity, uncertainly, incompleteness, and foregrounding argument and documentation. It considers approaches to creating evaluation guidelines for XR as an extension of existing DH guidelines published by scholarly societies, and suggests ways in which multiple of these approaches to evaluation might converge in, on the one hand, multi-modal and reflective XR documentation practices that include written supplements, and on the other, in broadening the scope of what kinds of creative and storytelling work fit into academic evaluation contexts in the humanities.
Committing to an Infection Prevention Initiative
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

What motivates a hospital administration to take on an infection prevention initiative? It may simply reflect a hospital’s culture of excellence, a commitment to patient safety, though that may be combined with a determination to keep up with competing institutions or to avoid federal financial penalties. Quality initiatives can drain staff time and energy but save substantial dollars in the long run. Once the decision to proceed with the catheter-associated urinary tract infection initiative is made, hospital leaders start a team-building process, choosing an executive sponsor with experience on the wards, the project’s main venue. The sponsor in turn selects a project manager, who will find physician and nurse champions to carry the goals and content of the initiative to the staff. The initiative calls for the adoption of a bundle of evidence-based behaviors—in this case, to reduce the unnecessary use of indwelling urinary catheters known as Foleys.
Types of Interventions
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

Prevention of central line–associated bloodstream infection (CLABSI), while initially making great strides in 2003, has declined as use of peripherally inserted central catheters (PICCs) has grown tremendously over the past two decades. The convenience of a PICC has led to sicker patients being treated outside the intensive care unit, and there has been little recognition of a trade-off between benefits and risks after PICC placement. For these reasons, CLABSI prevention has become more challenging. This chapter describes the contents of an infection prevention bundle for CLABSI. In the case of CLABSI, the intervention outlines appropriate and inappropriate uses of central lines. Several new tools are discussed, which help doctors and nurses think through which device is most appropriate for any given patient.
Building the Team
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

The recruitment of a nurse champion and a physician champion is described in detail. At in-person meetings and via online presentations, team members familiarize themselves with current catheter practices and absorb the new protocols. They decide which medical floor unit will be the first target and pilot project for the initiative. Their criteria: a unit with a track record for cooperating with interventions and that also has a sizable number of Foleys and catheter-associated urinary tract infection cases. The project manager, champions, and other team members work out implementation details—promoting the project’s goals throughout the hospital, coordinating with other ongoing quality initiatives in the hospital, and identifying those people who will need special convincing. The changes will drive staff from their comfort zones, add to their workload, and challenge traditional relationships between nurses and doctors.
Taking on Clostridioides difficile
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

The adaptive approach used in the previous chapters to prevent catheter-associated urinary tract infection (CAUTI) is applied to an initiative to prevent Clostridioides difficile (formerly Clostridium difficile) infection. These two initiatives differ regarding their scope, the members of their teams, and the elements of their bundles. For preventing C. difficile, for example, the most important bundle item is antimicrobial stewardship since the use of broad-spectrum antibiotics vastly increases a person’s risk of becoming infected. Infectious diseases physicians or clinical pharmacists are to examine the circumstances of antimicrobial prescriptions they have filled to see whether they meet infection prevention standards; if not, the prescribing physician will receive prompt feedback. Differences aside, the basic elements of the CAUTI framework apply, from the C-suite’s decision to go ahead with the initiative to the tactics used to sell the C. difficile bundle to the hospital staff.
How Many More Are There?
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

Patients accurately diagnosis with multiple personality disorder (MPD)/dissociative identity disorder (DID) presenting with a complaint of chronic pain are rare. However, it is likely that one may have encountered such a patient and not been aware of it. When one is able to interact with the individual “personalities,” it presents a fantastic learning opportunity. There may be enormous differences in their experience of pain and the way they cope. Indeed, one or more of the “alters” may claim they do not, in fact, feel pain. MPD/DID is often triggered by some type abuse early in life. Studies have identified difference between the personalities in areas such as physical symptoms, brain wave activity, visual-evoked potential, visual function, galvanic skin response, dominant handedness, response to the same medication, allergic sensitivities, autonomic and endocrine function, and electroencephalogram. MPD/DID is very refractory to treatment. Patient should be managed is a very compassionate fashion.
An All-Consuming Problem
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

This case is particularly relevant in the chronic pain setting. Patients seeking medical management, especially if they specify a particular opioid, are viewed with great suspicion. Caution is useful, but a proper assessment is necessary. A targeted prescreening can be beneficial to both the clinician and patient. It is critical to understand the difference between abnormal (aberrant) drug behavior, substance (opioid) use disorder, and addiction. All too often, a label, especially addiction, is applied inappropriately but becomes part of the medical record and follows the patient, creating a bias. Addiction has come to be regarded as a disease. There are some aspects of treatment, such as medically assisted therapies, that can be carried out by any trained clinician. However, meaningful treatment is more complicated and involves more than just trying to suppress urges. There is a tendency to take a draconian approach when addressing even the slightest vitiation of a medical agreement.
The Patient Who Remembers Tomorrow
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

As the percentage of individuals in the 65 years and older group grows, the probability of a patient with chronic pain and a comorbid cognitive dysfunction increases. The causes and severity of cognitive dysfunction are highly variable. The impact on the patient’s perception of, and ability to report, their pain experience can be significant. It is important to use multiple types and sources of data. Response to treatment, especially pharmacological, can be very unpredictable. The risk of adverse events is substantially greater. Treatment often requires the involvement of significant others or staff members, if the patient resides in some type of residential facility. Palliation rather than functional restoration may the goal for many. Unfortunately, it easy to underestimate, if not discount, chronic pain in the elderly and cognitively impaired. These patient deserve our utmost attention and consideration.
The Easy but Harmful Solution
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

This case may represent one of the common problems faced by clinicians involved in treatment patients with chronic pain. There appears to be a growing number of patients with a sense of entitlement, which manifests itself in requests to medications to address a plethora of problems. They often resist, if not resent, suggestions for lifestyle changes, (eg, exercise, diet, smoking reduction, use of nutritional supplements, stress management, etc.). They perceive and prefer pharmacological therapy (ie, chemical coping). This helps to dissolver them of any responsibility for the problems and encourages iatrogenic dependence on the medical system. Sometimes writing a prescription is the most efficient way to end on office-based consultation. This approach, however, may be detrimental to the patient in the long run.
Is This All There Is?
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

The angry and dissatisfied patient is a reality that every clinician will face eventually. In many cases, this is related to unrealistic treatment goals and expectations. Some patients are perpetually angry, for reasons that are often unclear. Their anger, and manner in which it is expressed, can contribute to the intensity and impact of the pain. Their emotional displays can be somewhat histrionic and disruptive. Some are included tor act out via medication abuse or threats of litigation. Early assessment and the ruling out of a personality disorder should be considered. Boundaries need to be set and appropriate consequences enforced. The clinician must maintain a professional attitude. The difficult patient often finds creating chaos reinforcing.
Teenager With Disabling Leg Pain
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

The incidence and prevalence of chronic pain among children and adolescents appears to be increasing. The treatment options are limited. Understandably, one would want to minimize, if not avoid, long-term use of opioids. There are a number of modality and nonopioid therapies available. One approach often overlooked and underutilized, with all age groups, in the use of nutritional and dietary supplements. Many painful conditions, especially neuropathic pain, can be initialed and maintained by neuroinflammatory substances. Certain nutritional and dietary supplements can alter the effect of these substances and the abnormal neuronal functioning associated with pain. Unfortunately, the increased incidence of obesity, even among the younger age groups, reflects a continued trend toward poor dietary habits and food selection. This, along with other lifestyle issues, results in a population that is more vulnerable to developing painful disorders. For this reason, nutritional pain management should be given serious consideration.
The Psychology of Opioid Tapering
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

The pendulum has swung; in this case, it may be a double pendulum. The double pendulum is a pendulum hanging from a pendulum. It is a simple physical system used in physics to demonstrate mathematical chaos. When the motion of its tip is monitored, it appears very predictable at the outset, but soon reveals a very chaotic and unpredictable pattern. It is very difficult to know where the tip of the double pendulum will be at any given time in the future. This seems to describe the course of the use of opioids, especially for the treatment of chronic pain. Once, all but ignored, then heralded, and then demonized. At every step of the way, pundits will argue the incompleteness, absence, or misinterpretation of existing data. It is important to understand the psychological environment is which the opioid tapering movement occurs and to carefully consider the process in the context of the individual patient. Simply instituting another set of presumptive evidence-based guidelines could have unforeseen, and potentially tragic, consequences for the patient.