bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating racial disparities in quality‐of‐life years after pediatric hematopoietic stem cell transplant
Authors: Shah Anuj , Regan Christina , Suwarno Serena , Foote Janet , Bernaud Victoria , Stahlecker Jennifer , Miller Holly , Booth Natalie , Giralt Daniella , Salzberg Dana , Sinno Mohamad G. , Campbell Courtney , Beebe Kristen , Schwalbach Charlotte , Adams Roberta H. , Ngwube Alexander
Published: June 2023

Background

While racial disparities in the clinical outcomes of hematopoietic stem cell transplant (HSCT) patients have been explored, racial disparities in quality of life (QoL) during the re‐adjustment phase after transplant are yet to be investigated in pediatric patients. The objective of this study was to examine the role of patient race in QoL at least 2 years after pediatric HSCT.

Procedure

We conducted a retrospective chart review of patients under 21 years of age at diagnosis who received an allogeneic transplant at our institution between January 2007 and December 2017. Patient QoL was assessed using the Pediatric Quality‐of‐Life Inventory Generic Score Scales (PedsQL TM 4.0) at least 2 years post transplant. Patient demographic, treatment, and transplant outcome data were obtained for subsequent analysis, where patient race was categorized as either Black, White, Hispanic, or Native American.

Results

Data were collected on 86 pediatric patients who underwent HSCT. Forty patients (46.5%) were non‐Hispanic White, 29 (33.7%) Hispanic, 10 (11.6%) Black, and seven (8.1%) Native American. Where preliminary analyses indicated a difference in QoL by patient race, there were no significant differences in physical, emotional, social, and school functioning by patient race after adjusting for transplant characteristics (age at transplant, sex, diagnosis, donor type, and conditioning regimen) and determinants of socioeconomic status (insurance type, estimated household income).

Conclusions

Pediatric patients had comparable QoL, regardless of race, at a median of 3 years after HSCT in our study cohort.
A pilot exome sequencing study suggests that germline variants influence methotrexate‐induced toxicities in pediatric patients with localized osteosarcoma
Authors: Minnai Francesca , Noci Sara , Mangano Nunzia , De Cecco Loris , Meazza Cristina , Terenziani Monica , Massimino Maura , Colombo Francesca
Published: June 2023

Introduction

Osteosarcoma (OS) is a rare pediatric cancer for which therapeutic approaches, including chemotherapy and surgery, show a wide interindividual variability in patient response, both in terms of adverse events and therapy efficacy. There is growing evidence that this individual variable response to therapies is also influenced by inherited genetic variations. However, the results obtained to date in these pediatric cancers have been contradictory and often lack validation in independent series. Additionally, these studies frequently focused only on a limited number of polymorphisms in candidate genes.

Methods

In order to identify germline coding variations associated with individual differences in adverse events occurrence in pediatric patients affected by localized OS, we carried out an exome‐wide association study in 24 OS patients treated with methotrexate, cisplatin, and doxorubicin, using the SNP‐Set (Sequence) Kernel Association Test (SKAT), optimized for small sample size.

Results

Gene sets significantly associated (FDR < .05) with neutropenia and hepatotoxicity induced by methotrexate were identified. Some of the identified genes map in loci previously associated with similar phenotypes (e.g., leukocyte count, alkaline phosphatase levels).

Conclusion

Further studies in larger series and with functional characterization of the identified associations are needed; nonetheless, this pilot study prompts the relevance of broadly investigating variants along the whole genome, to identify new potential pharmacogenes, beyond drug metabolism, transport, and receptor candidate genes.
Consequence analysis of CNG leakage at joint refueling and charging stations
Authors: Luo Zhenmin , Liu Lu , Su Bin , Song Fangzhi , Hao Ruolin , Zhang Chunyan , Kang Xiaofeng , Zhang Anbang
Published: June 2023

The number of new‐energy vehicles is steadily increasing worldwide, and joint refueling and charging stations will be increasingly constructed and developed in China. A CNG leakage at joint stations can lead to superimposed consequences, including fire (flash fire, pool fire, jet fire), explosion, and release of toxic and hazardous gases. Based on FLACS and SAFETI, the impact of leakage aperture and wind direction on CNG leakage diffusion are analyzed by modeling a joint refueling and charging station in Shaanxi, China. The safe distance between charging piles and leakage points is investigated in the worst case scenario. The superimposed consequences of leakage in joint stations under different scenarios are analyzed, and the individual risk is analyzed at stations. This study shows that the larger the leakage aperture, the larger the CNG leakage dispersion range under the same wind directions and wind speeds, and the higher the wind speed, the more volatile the gas under the same leakage apertures. The safety distance of the charging pile should reach at least 37 and 40 m considering leaks in the tanker and gas storage well, respectively. The impact range of superimposed consequences shows the descending order of jet fire > flash fire > pool fire.
Salvianolic acid A diminishes LDHA‐driven aerobic glycolysis to restrain myofibroblasts activation and cardiac fibrosis via blocking Akt/GSK‐3β/HIF‐1α axis
Authors: Hailiwu Renaguli , Zeng Hao , Zhan Meiling , Pan Ting , Yang Hua , Li Ping
Published: June 2023

Myofibroblasts activation intensively contributes to cardiac fibrosis with undefined mechanism. Salvianolic acid A (SAA) is a phenolic component derived from Salvia miltiorrhiza with antifibrotic potency. This study aimed to interrogate the inhibitory effects and underlying mechanism of SAA on myofibroblasts activation and cardiac fibrosis. Antifibrotic effects of SAA were evaluated in mouse myocardial infarction (MI) model and in vitro myofibroblasts activation model. Metabolic regulatory effects and mechanism of SAA were determined using bioenergetic analysis and cross‐validated by multiple metabolic inhibitors and siRNA or plasmid targeting Ldha. Finally, Akt/GSK‐3β‐related upstream regulatory mechanisms were investigated by immunoblot, q‐PCR, and cross‐validated by specific inhibitors. SAA inhibited cardiac fibroblasts‐to‐myofibroblasts transition, suppressed collage matrix proteins expression, and effectively attenuated MI‐induced collagen deposition and cardiac fibrosis. SAA attenuated myofibroblasts activation and cardiac fibrosis by inhibiting LDHA‐driven abnormal aerobic glycolysis. Mechanistically, SAA inhibited Akt/GSK‐3β axis and downregulated HIF‐1α expression by promoting its degradation via a noncanonical route, and therefore restrained HIF‐1α‐triggered Ldha gene expression. SAA is an effective component for treating cardiac fibrosis by diminishing LDHA‐driven glycolysis during myofibroblasts activation. Targeting metabolism of myofibroblasts might occupy a potential therapeutic strategy for cardiac fibrosis.
“This is a Very Sensitive Point”: Bilingual Teachers' Interactions with Neo‐Nationalism in a Two‐Way Immersion Program in the United States
Authors: Lima Becker Mariana , Oliveira Gabrielle
Published: June 2023

Concurrent with the rise in U.S. neo‐nationalism is the growing influx of im/migrant children in the nation's schools. This article explores how a group of eight K‐3 Brazilian bilingual teachers in a Portuguese‐English Two‐Way Immersion (TWI) program in the United States interact with neo‐nationalist discourses pertaining to the theme of immigration. Drawing on recent theorizing about the intersections of neo‐nationalism, language, and bilingual education, this multi‐year ethnographic study leverages multiple formal interviews and informal conversations with TWI educators to understand their perspectives and classroom practices. We found that most of the interviewed teachers were keenly aware that their im/migrant students regularly shared complex narratives of immigration in their classrooms, at times during whole‐group instruction. However, these educators consistently evaded opportunities to engage in conversations about immigration with their students due to a range of perceived obstacles. The teachers also expressed willingness to eventually include a narrow range of “positive” or “neutral” images of immigration in their curriculum and instruction, which further decoupled issues of immigration from U.S. neo‐nationalism. Findings bear implications for language education researchers and practitioners since they indicate how neo‐nationalist discourses may shape elementary‐school educators' orientations and daily moves within bilingual classrooms designed to better serve racialized bilingual students.
When the sum is greater than the parts: Using a curriculum revision to enable improvements in undergraduate traditional instruction
Authors: Boyd Evelyn A. , Olsen Taimi , Trogden Bridget G.
Published: June 2023

This chapter focuses on intentional educational development activities designed to prepare faculty for effective teaching and assessment of student learning. Some benefits of such activities include improved alignment of courses with programmatic outcomes, higher success rates in course reviews, and better demonstration of student learning on common outcomes.
Evaluating instructor quality: Moving away from student evaluations to peer review
Authors: Quenette Andrea , Rybas Natalia
Published: June 2023

This chapter explores the use of peer review as a method for evaluating teaching, examining its role in both online and on‐campus courses as well as its importance in the promotion and tenure process. It also considers the benefits and challenges of using peer review as a form of evaluation.
Sedimentänderung wurde ein signifikantes Wasserbewirtschaftungsthema im Donaueinzugsgebiet – basierend auf dem EU-Projekt DanubeSediment
Authors: Habersack H. , Gmeiner P. , Krapesch M. , Baranya S. , Holubova K. , Mravcova K. , Vartolomei F. , Hödl E. , Liska I. , Mühlmann H. , Haimann M.
Published: June 2023

In vielen Flusseinzugsgebieten ist eine zunehmende Diskrepanz zwischen Überschuss und Defizit an Sedimenten zu beobachten. Dies führt zu einem Anstieg des Hochwasserrisikos, einer Einschränkung der Schifffahrtsmöglichkeiten und der Stromerzeugung aus Wasserkraft und wirkt sich negativ auf die Ökologie aus. Eine Hauptaufgabe des Wasserbaus ist daher die Verbesserung des Sedimentmanagements und der Flussmorphologie. Um bestehende Wissenslücken zu schließen, wurden entlang der gesamten Donau quantitative Sedimentdaten erhoben und analysiert. Es wurde eine Sedimentbilanz erstellt, die die Probleme aufzeigt, die sich aus der Sedimentdiskontinuität ergeben. Das Einzugsgebiet der Donau stellt insbesondere aufgrund der Unausgewogenheit des Sedimentregimes ein stark gestörtes System dar. Der Eintrag von Schwebstoffen in das Schwarze Meer wurde beispielsweise von rund 40 bis 60 Mio. Tonnen pro Jahr auf etwa 15 bis 20 Mio. Tonnen pro Jahr verringert, was zu einer verstärkten Küstenerosion führte. Darüber hinaus wurden in den letzten 200 Jahren lange Abschnitte der Donau eingeengt, reguliert und von den Überflutungsflächen abgetrennt sowie morphologisch degradiert. Dies hat zu erhöhten Sohlschubspannungen und in der Folge zu einer erhöhten Sedimenttransportkapazität geführt. Als Folge der longitudinalen und lateralen Unterbrechungen des Sedimentkontinuums und der zusätzlichen Auswirkungen der Regulierung sind die verbleibenden frei-fließenden Abschnitte der Sohlerosion ausgesetzt. Dies führt im Allgemeinen zu einem Verlust von Strukturen im Fluss, mit einem Verschwinden von Kiesbänken an der oberen Donau und Veränderungen von Sandbänken an der unteren Donau. In den Stauräumen herrscht das Gegenteil, nämlich Sedimentation, die teilweise auch Hochwasserschutzprobleme mit sich bringt. Da die Donau ein in Summe gestörtes Sedimentregime aufweist wurde im dritten Donau-Flussgebietsbewirtschaftungsplan die Änderung der Sedimentverhältnisse als signifikantes Wasserbewirtschaftungsthema verankert. Mögliche Antworten auf diese Probleme werden durch einen Maßnahmenkatalog gegeben.
Artisanal gold mining in Kakamega and Vihiga counties, Kenya: potential human exposure and health risk
Authors: Ondayo Maureene Auma , Watts Michael J. , Hamilton Elliott M. , Mitchell Clive , Mankelow Joseph , Osano Odipo
Published: June 2023

Artisanal and small-scale gold mining (ASGM) represents 20% of gold supply and 90% of gold mining workforce globally, which operates in highly informal setups. Pollutants from mined ores and chemicals introduced during gold processing pose occupational and inadvertent health risks to the extent that has not been well elucidated in Africa. Trace and major elements were analysed using inductively coupled plasma mass spectrometry in soil, sediment and water samples from 19 ASGM villages in Kakamega and Vihiga counties. Associated health risks for residents and ASGM workers were assessed. This paper focuses on As, Cd, Cr, Hg, Ni and Pb for which 96% of soil samples from mining and ore processing sites had As concentrations up to 7937 times higher than the US EPA 12 mg kg−1 standard for residential soils. Soil Cr, Hg and Ni concentrations in 98%, 49% and 68% of the samples exceeded respective USEPA and CCME standards, with 1–72% bioaccessibility. Twenty-five percentage of community drinking water sources were higher than the WHO 10 µg L−1 drinking water guideline. Pollution indices indicated significant enrichment and pollution of soils, sediment and water in decreasing order of As > Cr > Hg > Ni > Pb > Cd. The study revealed increased risks of non-cancer health effects (98.6) and cancer in adults (4.93 × 10−2) and children (1.75 × 10−1). The findings will help environment managers and public health authorities better understand the potential health risks in ASGM and support evidence-based interventions in ASGM processes, industrial hygiene and formulation of public health policy to protect residents and ASGM workers’ health in Kenya.
Inferring test models from user bug reports using multi-objective search
Authors: Guizzo Giovani , Califano Francesco , Sarro Federica , Ferrucci Filomena , Harman Mark
Published: June 2023

Bug reports are used by software testers to identify abnormal software behaviour. In this paper, we propose a multi-objective evolutionary approach to automatically generate finite state machines (FSMs) based on bug reports written in natural language, to automatically capture incorrect software behaviour. These FSMs can then be used by testers to both exercise the reported bugs and create tests that can potentially reveal new bugs. The FSM generation is guided by a Multi-Objective Evolutionary Algorithm (MOEA) that simultaneously minimises three objectives: size of the models, number of unrealistic states (over-generalisation), and number of states not covered by the models (under-generalisation). We assess the feasibility of our approach for 10 real-world software programs by exploiting three different MOEAs (NSGA-II, NSGA-III and MOEA/D) and benchmarking them with the baseline tool KLFA. Our results show that KLFA is not practical to be used with real-world software, because it generates models that over generalise software behaviour. Among the three MOEAs, NSGA-II obtained significantly better results than the other two for all 10 programs, detecting a greater number of bugs for 90% of the programs. We also studied the differences in quality and model performance when MOEAs are guided by only two objectives rather than three during the evolution. We found that the use of under-approximation (or over-approximation) and size as objectives generates infeasible solutions. On the other hand, using as objectives over-approximation and under-approximation generates feasible solutions yet still worse than those obtained using all three objectives for 100% of the cases. The size objective acts as a diversity factor. As a consequence, an algorithm guided by all three objectives avoids local optima, controls the size of the models, and makes the results more diverse and closer to the optimal Pareto set.
Does omega-3 supplementation improve the inflammatory profile of patients with heart failure? a systematic review and meta-analysis
Authors: Prokopidis Konstantinos , Therdyothin Atiporn , Giannos Panagiotis , Morwani-Mangnani Jordi , Ferentinos Panagiotis , Mitropoulos Alexandros , Isanejad Masoud
Published: June 2023

Omega-3 fatty acids are potential anti-inflammatory agents that may exert beneficial outcomes in diseases characterised by increased inflammatory profile. The purpose of this study was to comprehensively evaluate the existing research on the effectiveness of n-3 fatty acid supplementation in lowering levels of circulating inflammatory cytokines in patients with heart failure (HF). From the beginning until October 2022, randomised controlled trials (RCTs) were the subject of PubMed, Scopus, Web of Science, and Cochrane Library literature search. Omega-3 fatty acid supplementation vs. placebo were compared in eligible RCTs to see how they affected patients with HF in terms of inflammation, primarily of tumour necrosis factor-alpha (TNF-a), interleukin-6 (IL-6), and c-reactive protein (CRP). A meta-analysis employing the random effects inverse-variance model and standardised mean differences was performed to assess group differences. Ten studies were included in this systematic review and meta-analysis. Our main analysis (k = 5) revealed a beneficial response of n-3 fatty acid supplementation on serum TNF-a (SMD: − 1.13, 95% CI: − 1.75– − 0.50, I2 = 81%, P = 0.0004) and IL-6 levels (k = 4; SMD: − 1.27, 95% CI: − 1.88– − 0.66, I2 = 81%, P < 0.0001) compared to placebo; however, no changes were observed in relation to CRP (k = 6; SMD: − 0.14, 95% CI: − 0.35–0.07, I2 = 0%, P = 0.20). Omega-3 fatty acid supplementation may be a useful strategy for reducing inflammation in patients with HF, but given the paucity of current studies, future studies may increase the reliability of these findings.
Improved spectral resolution of [13C,1H]-HSQC spectra of aromatic amino acid residues in proteins produced by cell-free synthesis from inexpensive 13C-labelled precursors
Authors: Van Raad Damian , Huber Thomas , Otting Gottfried
Published: June 2023

Cell-free protein synthesis using eCells allows production of amino acids from inexpensive 13C-labelled precursors. We show that the metabolic pathway converting pyruvate, glucose and erythrose into aromatic amino acids is maintained in eCells. Judicious choice of 13C-labelled starting material leads to proteins, where the sidechains of aromatic amino acids display [13C,1H]-HSQC cross-peaks free of one-bond 13C–13C couplings. Selective 13C-labelling of tyrosine and phenylalanine residues is achieved simply by using different compositions of the reaction buffers.
An exploration of reversible septenary number-conserving cellular automata: a survey of known methods
Authors: Wolnik Barbara , Dzedzej Adam , Dziemiańczuk Maciej , Wardyn Aleksander , De Baets Bernard
Published: June 2023

Little is known about the dynamics of k-ary (binary, ternary, quaternary, quinary, etc.) reversible number-conserving cellular automata. Here, we present some preliminary results in the case of seven states. In particular, we examine one of the most complex seven-state reversible and number-conserving rules and provide a full description of its dynamics.
Who accepts Savage’s axiom now?
Authors: Humphrey Steven J. , Kruse Nadia-Yasmine
Published: June 2023

We report the results of an experimental test of whether preaching the normative appeal of the sure-thing principle leads decision-makers to make choices that satisfy it. We use Allais-type decision problems to observe the incentive-compatible choices of 147 subjects, which either violate the sure-thing principle or adhere to it. Subjects are presented with normative arguments that support the counterfactual behaviour and then repeat their decisions. We observe violations of the sure-thing principle are robust to its normative justification. This result replicates a famous small-sample observation using hypothetical tasks that was published by Paul Slovic and Amos Tversky almost half a century ago. We argue that this finding is as relevant now as it was then and that their design can be usefully applied to address contemporary issues in behavioural economics.
The VA National Teleneurology Program (NTNP): Implementing Teleneurology to Improve Equitable Access to Outpatient Neurology Care
Authors: Wilkinson Jayne , Myers Laura , Daggy Joanne , Martin Holly , Bastin Grace , Yang Ziyi , Damush Teresa , Narechania Aditi , Schriber Steve , Williams Linda S.
Published: June 2023

Background

Telehealth is increasingly utilized in many healthcare systems to improve access to specialty care and better allocate limited resources, especially for rurally residing persons who face unique barriers to care.

Objectives

The VHA sought to address critical gaps in access to neurology care by developing and implementing the first outpatient National Teleneurology Program (NTNP).

Design

Pre-post evaluation of intervention and control sites.

Participants

NTNP sites and VA control sites; Veterans completing an NTNP consult and their referring providers.

Intervention

Implementation of the NTNP at participating sites.

Main Measures

NTNP and community care neurology (CCN) volume of consults before and after implementation; time to schedule and complete consults; Veteran satisfaction.

Key Results

In FY2021, the NTNP was implemented at 12 VA sites; 1521 consults were placed and 1084 (71.3%) were completed. NTNP consults were scheduled (10.1 vs 29.0 days,p < 0.001) and completed (44.0 vs 96.9 days,p < 0.001) significantly faster than CCN consults. Post-implementation, monthly CCN consult volume was unchanged at NTNP sites compared to pre-implementation (mean change of 4.6 consults per month, [95% CI − 4.3, 13.6]), but control sites had a significant increase (mean change of 24.4 [5.2, 43.7]). The estimated difference in mean change in CCN consults between NTNP and control sites persisted after adjusting for local neurology availability (p < 0.001). Veterans (N = 259) were highly satisfied with NTNP care (mean (SD) overall satisfaction score 6.3 (1.2) on a 7-point Likert scale).

Conclusions

Implementation of NTNP resulted in more timely neurologic care than care in the community. The observed significant increase in monthly CCN consults at non-participating sites during the post-implementation period was not seen at NTNP sites. Veterans were highly satisfied with Teleneurology care.
Current Programs and Incentives to Overcome Rural Physician Shortages in the United States: A Narrative Review
Authors: Arredondo Kelley , Touchett Hilary N. , Khan Sundas , Vincenti Matthew , Watts Bradley V.
Published: June 2023

Access to healthcare continues to be a top priority and prominent challenge in rural communities, with 20% of the total U.S. population living in rural areas while only 10% of physicians practice in rural areas. In response to physician shortages, a variety of programs and incentives have been implemented to recruit and retain physicians in rural areas; however, less is known about the types and structures of incentives that are offered in rural areas and how that compares to physician shortages. The purpose of our study is to conduct a narrative review of the literature to identify and compare current incentives that are offered by rural physician shortage areas to better understand how resources are being allocated to vulnerable areas. We reviewed published peer-reviewed articles from 2015–2022 to identify incentives and programs designed to address physician shortages in rural areas. We augment that review by examining the gray literature, including reports and white papers on the topic. Identified incentive programs were aggregated for comparison and translated into a map that depicts high, medium, and low levels of geographically designated Health Professional Shortage Areas (HPSAs) and the number of incentives offered by state. Surveying current literature regarding different types of incentivization strategies while comparing to primary care HPSAs provides general insights on the potential influence of incentive programs on shortages, allows easy visual review, and may provide greater awareness of available support for potential recruits. Providing a broad overview of the incentives offered in rural areas will help illuminate whether diverse and appealing incentives are offered in the most vulnerable areas and guide future efforts to address these issues.
Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans
Authors: Patzel Mary , Barnes Chrystal , Ramalingam NithyaPriya , Gunn Rose , Kenzie Erin S. , Ono Sarah S. , Davis Melinda M.
Published: June 2023

Background

The 2019 VA Maintaining Systems and Strengthening Integrated Outside Networks Act, or MISSION Act, aimed to improve rural veteran access to care by expanding coverage for services in the community. Increased access to clinicians outside the US Department of Veterans Affairs (VA) could benefit rural veterans, who often face obstacles obtaining VA care. This solution, however, relies on clinics willing to navigate VA administrative processes.

Objective

To investigate the experiences rural, non-VA clinicians and staff have while providing care to rural veterans and inform challenges and opportunities for high-quality, equitable care access and delivery.

Design

Phenomenological qualitative study.

Participants

Non-VA-affiliated primary care clinicians and staff in the Pacific Northwest.

Approach

Semi-structured interviews with a purposive sample of eligible clinicians and staff between May and August 2020; data analyzed using thematic analysis.

Key Results

We interviewed 13 clinicians and staff and identified four themes and multiple challenges related to providing care for rural veterans: (1) Confusion, variability and delays for VA administrative processes, (2) clarifying responsibility for dual-user veteran care, (3) accessing and sharing medical records outside the VA, and (4) negotiating communication pathways between systems and clinicians. Informants reported using workarounds to combat challenges, including using trial and error to gain expertise in VA system navigation, relying on veterans to act as intermediaries to coordinate their care, and depending on individual VA employees to support provider-to-provider communication and share system knowledge. Informants expressed concerns that dual-user veterans were more likely to have duplication or gaps in services.

Conclusions

Findings highlight the need to reduce the bureaucratic burden of interacting with the VA. Further work is needed to tailor structures to address challenges rural community providers experience and to identify strategies to reduce care fragmentation across VA and non-VA providers and encourage long-term commitment to care for veterans.
Impact of Recreational Cannabis Legalization on Opioid Prescribing and Opioid-Related Hospital Visits in Colorado: an Observational Study
Authors: Buttorff Christine , Wang George Sam , Wilks Asa , Tung Gregory , Kress Amii , Schwam Dan , Pacula Rosalie Liccardo
Published: June 2023

Background

Cannabis may be a substitute for opioids but previous studies have found conflicting results when using data from more recent years. Most studies have examined the relationship using state-level data, missing important sub-state variation in cannabis access.

Objective

To examine cannabis legalization on opioid use at the county level, using Colorado as a case study. Colorado allowed recreational cannabis stores in January 2014. Local communities could decide whether to allow dispensaries, creating variation in the level of exposure to cannabis outlets.

Design

Observational, quasi-experimental design exploiting county-level variation in allowance of recreational dispensaries.

Subjects

Colorado residents

Measures

We use licensing information from the Colorado Department of Revenue to measure county-level exposure to cannabis outlets. We use the state’s Prescription Drug Monitoring Program (2013–2018) to construct opioid-prescribing measures of number of 30-day fills and total morphine equivalents, both per county resident per quarter. We construct outcomes of opioid-related inpatient visits (2011–2018) and emergency department visits (2013–2018) with Colorado Hospital Association data. We use linear models in a differences-in-differences framework that accounts for the varying exposure to medical and recreational cannabis over time. There are 2048 county-quarter observations used in the analysis.

Results

We find mixed evidence of cannabis exposure on opioid-related outcomes at the county level. We find increasing exposure to recreational cannabis is associated with a statistically significant decrease in number of 30-day fills (coefficient: −117.6, p-value<0.01) and inpatient visits (coefficient: −0.8, p-value: 0.03), but not total MME nor ED visits. Counties with no medical exposure prior to recreational legalization experience greater reductions in the number of 30-day fills and MME than counties with prior medical exposure (p=0.02 for both).

Conclusions

Our mixed findings suggest that further increases in cannabis beyond medical access may not always reduce opioid prescribing or opioid-related hospital visits at a population level.
Rolling out PRIDE in All Who Served: Barriers and Facilitators for Sites Implementing an LGBTQ+ Health Education Group for Military Veterans
Authors: Wilson Sarah M. , Mulcahy Abigail C. , Lange Tiffany M. , Eldridge Madeleine R. , Weidenbacher Hollis J. , Jackson George L. , Gierisch Jennifer M. , Crowley Matthew J. , Calhoun Patrick S. , Hilgeman Michelle M.
Published: June 2023

Background/Objective

The Veterans Health Administration (VHA) PRIDE in All Who Served health education group (PRIDE) was developed to improve health equity and access to care for military veterans who are lesbian, gay, bisexual, transgender, queer, and/or other sexual/gender-diverse identities (LGBTQ+). This 10-week program rapidly spread to over 30 VHA facilities in 4 years. Veterans receiving PRIDE experience improved LGBTQ+ identity-related resilience and reductions in suicide attempt likelihood. Despite PRIDE’s rapid spread across facilities, information is lacking on implementation determinants. The current study’s goal was to clarify determinants of PRIDE group implementation and sustainment.

Methods

A purposive sample of VHA staff (N = 19) with experience delivering or implementing PRIDE completed teleconference interviews January–April 2021. The interview guide was informed by the Consolidated Framework for Implementation Research. Rapid qualitative matrix analysis was completed with methods to ensure rigor (e.g., triangulation and investigator reflexivity).

Results

Key barriers and facilitators of PRIDE implementation were heavily related to facility inner setting (what is happening inside the facility), including implementation readiness (e.g., leadership support for LGBTQ+-affirming programming, access to LGBTQ+-affirming care training) and facility culture (e.g., systemic anti-LGBTQ+ stigma). Several implementation process facilitators enhanced engagement at sites, such as a centrally facilitated PRIDE learning collaborative and a formal process of contracting/training for new PRIDE sites.

Discussion/Conclusion

Although aspects of the outer setting and larger societal influences were mentioned, the majority of factors impacting implementation success were at the VHA facility level and therefore may be more readily addressable through tailored implementation support. The importance of LGBTQ+ equity at the facility level indicates that implementation facilitation should ideally address institutional equity in addition to implementation logistics. Combining effective interventions with attention to local implementation needs will be required before LGBTQ+ veterans in all areas will benefit from PRIDE and other health equity-focused interventions.
Utility of histopathological revision in the management of gastro-entero-pancreatic neuroendocrine neoplasia
Authors: Marasco Matteo , Magi Ludovica , Rogges Evelina , Dell’Unto Elisabetta , Rinzivillo Maria , Pilozzi Emanuela , Annibale Bruno , Panzuto Francesco
Published: June 2023

Background

Histological evaluation and grading assessment are key points in the diagnostic work-up of gastroentero-pancreatic neuroendocrine neoplasms (GEP-NENs).

Aim

To analyze the impact of histopathological revision on the clinical management of patients with GEP-NEN.

Materials and methods

Patients referred to our Center of Excellence between 2015 and 2021 were included in this study. Immunohistochemical slides at the time of initial diagnosis were reviewed to assess tumor morphology, diagnostic immunohistochemistry, and Ki67.

Results

101 patients were evaluated, with 65 (64.4%) gastrointestinal, 25 (24.7%) pancreatic, and 11 (10.9%) occult neoplastic lesions suspected to be of GEP origin. The main changes resulting from the revision were: first Ki-67 assessment in 15.8% of patients, Ki-67 change in 59.2% of patients and grading modification in 23.5% of patients. An additional immunohistochemical evaluation was performed in 78 (77.2%) patients, leading to a confirmation of GEP origin in 10 of 11 (90.9%) of unknown primary site neoplastic lesions and an exclusion of NEN diagnosis in 2 (2%) patients. After histopathological revision, a significant modification in clinical management was proposed in 42 (41.6%) patients.

Conclusions

Histopathological revision in a referral NEN center is strongly advised in newly diagnosed GEP-NENs to properly plan prognostic stratification and therapeutic choice.
Impact of film thickness in laser-induced periodic structures on amorphous Si films
Authors: Xu Liye , Geng Jiao , Shi Liping , Cui Weicheng , Qiu Min
Published: June 2023

We report self-organized periodic nanostructures on amorphous silicon thin films by femtosecond laser-induced oxidation. The dependence of structural periodicity on the thickness of silicon films and the substrate materials is investigated. The results reveal that when silicon film is 200 nm, the period of self-organized nanostructures is close to the laser wavelength and is insensitive to the substrates. In contrast, when the silicon film is 50 nm, the period of nanostructures is much shorter than the laser wavelength, and is dependent on the substrates. Furthermore, we demonstrate that, for the thick silicon films, quasi-cylindrical waves dominate the formation of periodic nanostructures, while for the thin silicon films, the formation originates from slab waveguide modes. Finite-difference time-domain method-based numerical simulations support the experimental discoveries.

Graphical abstract
Bij welke sociaal-demografische groepen komt suïcide het meest voor?
Authors: Berkelmans Guus , Gilissen Renske , Bhulai Sandjai , van der Mei Rob , Schweren Lizanne
Published: June 2023

Samenvatting

Inleiding

Voor suïcidepreventie is het van belang om groepen met een verhoogd risico op suïcide zo goed mogelijk te identificeren. Tot nog toe is er weinig bekend over interacties van meerdere risicofactoren. Machine learning-methoden bieden nieuwe mogelijkheden voor flexibel, datagedreven, hypothesevrij en robuust onderzoek naar de interacties van risicofactoren voor suïcide.

Methode

In dit onderzoek is gebruikgemaakt van microdata van het Centraal Bureau voor de Statistiek met sociaal-demografische gegevens van alle Nederlandse inwoners. Er is een machine learning-model ontwikkeld en uitgevoerd om interacties van risicofactoren voor suïcide te vinden.

Resultaten

De resultaten laten disproportioneel hoge suïcide-incidenties zien onder 1) mensen met een arbeidsongeschiktheidsuitkering die nooit getrouwd zijn geweest, 2) arbeidsongeschikte mannen, 3) mensen tussen de 55 en 69 jaar oud, die alleen wonen, nooit getrouwd zijn en wiens huishoudinkomen laag is. Daarnaast hebben we hoge suïcidecijfers gevonden onder mensen tussen de 25 en 39 jaar met een laag opleidingsniveau en onder verweduwde mannen.

Conclusie

De bevindingen helpen om gericht interventies in te kunnen zetten om het aantal suïcides te verminderen.
How specific combinations of epoch length, non-wear time and cut-points influence physical activity
Authors: Burchartz Alexander , Kolb Simon , Klos Leon , Schmidt Steffen C. E. , von Haaren-Mack Birte , Niessner Claudia , Woll Alexander
Published: June 2023

This study assesses three factors that influence the quantification of children’s and adolescents’ physical activity (PA) using accelerometers: selection of (1) non-wear algorithm, (2) epoch length and (3) cut-points. A total of 1525 participants from MoMo wave 3 (2018–2022), aged 6–17 years, wore GT3X accelerometers (ActiGraph, LLC, Pensacola, FL, USA) during waking hours. Acceleration counts were reintegrated into lengths of 1, 5, 15, 30, and 60 s epochs. Two non-wear time algorithms and two sets of cut-points were applied to each epoch length. Differences were found in both the comparison of the non-wear time algorithms and the comparison of the cut-points when the different epoch lengths were considered. This may result in large differences in estimated sedentary behavior and PA values. We propose to pool the data by merging and combining multiple accelerometer datasets from different studies and evaluate them in a harmonized way in the future. In addition to the need for future validation studies using short epoch lengths for young children, we also propose to conduct meta-analyses. This allows the use of data from multiple studies to validate cut-points and to propose a consensual set of cut-points that can be used in different settings and projects. The high discrepancy between results when comparing different epoch lengths has to be considered when interpreting accelerometer data and is regarded a confounding variable when comparing levels of PA between studies.
Survival nomogram for patients with thymic squamous cell carcinoma, based on the SEER database and an external validation cohort
Authors: Guan Yelan , Xu Feiqi , Zheng Shuai , Gu Xiaodong , Sun Yan
Published: June 2023

Objective

This study aimed to construct a nomogram to effectively predict the 3 years and 5 years overall survival of patients with thymic squamous cell carcinoma (TSCC).

Method

From 2000 to 2019, a total of 355 patients with TSCC were enrolled in our research from the Surveillance, Epidemiology, and End Results (SEER) database and used as the training cohort. 106 patients were included from the Zhejiang Cancer Hospital, for the external validation cohort. A nomogram was constructed based on the risk factors affecting prognosis using a Cox proportional hazards regression model. The discrimination and calibration of the nomogram were evaluated by C-index and curve of calibration. The two cohorts were divided into low-risk and high-risk subgroups based on the median risk score.

Results

Age (p = 0.002), stage (p = 0.003), surgery therapy (p < 0.001), and radiotherapy (p = 0.030) were the independent prognostic factors for overall survival and were incorporated in the prognostic model. The discrimination of the nomogram revealed a good prognostic accuracy and clinical applicability as indicated by C-index values of 0.696 (95% confidence interval [CI] 0.676–0.716) and 0.717 (95% CI 0.640–0.794) for the training cohort and external validation cohort, respectively. In addition, the two cohorts were divided into a high-risk group and a low-risk group according to the median risk score. Significant differences in overall survival were observed between the high-risk and low-risk groups in the training (p < 0.0001) and external validation cohort (p < 0.0001).

Conclusion

We developed a nomogram to predict 3- and 5 year survival rate for TSCC. This nomogram provides a convenient and reliable tool for assessing the condition of patients with TSCC and assisting clinicians in making decisions.
What Takes the Wind out of Their Sails? A Micro-Foundational Perspective of Challenges for Building Dynamic Capabilities Towards Digital Business Model Innovation
Authors: Witschel Daliborka , Müller Julian Marius , Voigt Kai-Ingo
Published: June 2023

While dynamic capabilities (DCs) are recognized as an important enabler of digital transformation, research lacks knowledge about the underlying challenges and adequate responses of building these capabilities. More specifically, this study aims to shed light into successful digital business model innovation (BMI) by adopting a micro-foundational approach that covers both challenges and successful measures on this path for incumbent industrial firms. Therefore, six case studies building on qualitative empirical research are analyzed that either focus on Internet of Things (IoT)-driven platform BMI or software as a service (SaaS) BMI. The results offer a variety of insights regarding challenges and respective responses. These findings are attributed to DCs and its subdimensions of sensing, seizing and transforming, further revealing the interplay of various factors for specific contexts. Additionally, the study reveals that many challenges and thus required responses are the result of individuals, processes, and structures.
A Decision Support GIS Framework for Establishing Zero-Emission Maritime Networks: The Case of the Greek Coastal Shipping Network
Authors: Karountzos Orfeas , Kagkelis Georgios , Kepaptsoglou Konstantinos
Published: June 2023

Sustainability of maritime operations is a topic widely considered in recent years, as the shipping industry attempts to limit its environmental impact and meet the decarbonization goals set by the International Maritime Organization (IMO). As alternative fuels and newer ship technologies are gaining interest, the shift to more environmentally friendly fleets is quickly becoming a reality. In this context, potential areas for such shifts need to be determined, to expedite decarbonization efforts and provide passengers with a more sustainable way of travel. Greece is an insular country, with a complex coastal shipping network connecting the mainland with the islands and being of paramount importance for their economic growth. Recognizing accessibility and decarbonization needs, this paper examines whether the Greek coastal shipping network (GCSN) can be restructured, by introducing zero-emission sub-networks operated by electric ferries. The aim is to propose a methodological framework for the spatial analysis and evaluation of coastal networks, with the implementation of exploratory spatial data analysis (ESDA) methods and determination of local indicators of spatial association (LISA) with the help of geographic information systems (GIS). The proposed framework provides insight on whether and where such a restructuring is possible, with the introduction of new transshipment port hubs in the islands from which electric ferries could operate, thus determining potential electrification areas with additionally high renewable resource potential. Final conclusions indicate that a potential electrification of certain parts of the GCSN could be possible, while results for GHG emissions reduced by the introduction of electric ferries are calculated.
Wiriyamu and the Colonial Archive: Reading It Against the Grain? Along the Grain? Read It at All!
Authors: Zeman Andreas
Published: June 2023

“The archives are silent.” The starting point of this article is the alleged non-existence of archival sources on the Portuguese massacre of Wiriyamu (1972). The article proves this claim to be false and shows how the available sources can be used to improve our knowledge of the massacre. The article suggests that scholars’ ignorance of these sources is connected to general misconceptions about colonial archives and their alleged silence on wartime atrocities, which are based on the belief that such atrocities do only appear in the sources, if they are read against the grain. Revealing the explicit presence of war atrocities in the sources, the article argues that the legitimate concern about reading such sources against the grain should not prevent us from reading them at all.
An empirical model of noise sources in subsonic jets
Authors: Karban U. , Bugeat B. , Towne A. , Lesshafft L. , Agarwal A. , Jordan P.
Published: June 2023

Modelling the noise emitted by turbulent jets is made difficult by their acoustic inefficiency: only a tiny fraction of the near-field turbulent kinetic energy is propagated to the far field as acoustic waves. As a result, jet-noise models must accurately capture this small, acoustically efficient component hidden among comparatively inefficient fluctuations. In this paper, we identify this acoustically efficient near-field source from large-eddy simulation data and use it to inform a predictive model. Our approach uses the resolvent framework, in which the source takes the form of nonlinear fluctuation terms that act as a forcing on the linearised Navier–Stokes equations. First, we identify the forcing that, when acted on by the resolvent operator, produces the leading spectral proper orthogonal decomposition modes in the acoustic field for a Mach 0.4 jet. Second, the radiating components of this forcing are isolated by retaining only portions with a supersonic phase speed. This component makes up less than 0.05 % of the total forcing energy but generates most of the acoustic response, especially at peak (downstream) radiation angles. Finally, we propose an empirical model for the identified acoustically efficient forcing components. The model is tested at other Mach numbers and flight-stream conditions and predicts noise within 2 dB accuracy for a range of frequencies, downstream angles and flight conditions.
Competition and childcare quality: Evidence from Quebec
Authors: Chandler Vincent , Dilmaghani Maryam
Published: June 2023

Since 1997, the Canadian province of Quebec has put in place a heavily subsidized universal childcare program for all children under the school age. The present paper examines how the level of competition among individual providers associates with the quality of childcare in Quebec. The quality of childcare is measured by the number of violations and penalties recorded in the inspections conducted by the Quebec Ministry of Family Affairs. The analysis indicates that the intensity of parental competition for daycare spots, as opposed to childcare centres’ competition to attract parents, negatively associates with the quality of childcare. Critically, this association is mainly driven by less affluent neighbourhoods. In addition, these associations are found to be stronger for more serious violations. The policy implications for both childcare quality and childcare equality are discussed.