bluuebunny/crossref_metadata_2025 huggingface dataset:
Cell Surface Platelet Tissue Factor Expression: Regulation by P2Y
12
and Link to Residual Platelet Reactivity
Authors: Brambilla Marta , Becchetti Alessia , Rovati Gian Enrico , Cosentino Nicola , Conti Maria , Canzano Paola , Giesen Peter L.A. , Loffreda Alessia , Bonomi Alice , Cattaneo Marco , De Candia Erica , Podda Gian Marco , Trabattoni Daniela , Werba Pablo Josè , Campodonico Jeness , Pinna Christian , Marenzi Giancarlo , Tremoli Elena , Camera Marina
Published: August 2023

BACKGROUND:

ADP-induced platelet activation leads to cell surface expression of several proteins, including TF (tissue factor). The role of ADP receptors in platelet TF modulation is still unknown. We aimed to assess the (1) involvement of P2Y
1
and P2Y
12
receptors in ADP-induced TF exposure; (2) modulation of TF
pos
-platelets in anti-P2Y
12
–treated patients with coronary artery disease. Based on the obtained results, we revisited the intracellular localization of TF in platelets.

METHODS:

The effects of P2Y
1
or P2Y
12
antagonists on ADP-induced TF expression and activity were analyzed in vitro by flow cytometry and thrombin generation assay in blood from healthy subjects, P2Y
12
−/−
, and patients with gray platelet syndrome.

Ex vivo, P2Y
12
inhibition of TF expression by clopidogrel/prasugrel/ticagrelor, assessed by VASP (vasodilator-stimulated phosphoprotein) platelet reactivity index, was investigated in coronary artery disease (n=238). Inhibition of open canalicular system externalization and electron microscopy (TEM) were used for TF localization.

RESULTS:

In blood from healthy subjects, stimulated in vitro by ADP, the percentage of TF
pos
-platelets (17.3±5.5%) was significantly reduced in a concentration-dependent manner by P2Y
12
inhibition only (−81.7±9.5% with 100 nM AR-C69931MX). In coronary artery disease, inhibition of P2Y
12
is paralleled by reduction of ADP-induced platelet TF expression (VASP platelet reactivity index: 17.9±11%, 20.9±11.3%, 40.3±13%; TF
pos
-platelets: 10.5±4.8%, 9.8±5.9%, 13.6±6.3%, in prasugrel/ticagrelor/clopidogrel-treated patients, respectively). Despite this, 15% of clopidogrel good responders had a level of TF
pos
-platelets similar to the poor-responder group. Indeed, a stronger P2Y
12
inhibition (130-fold) is required to inhibit TF than VASP. Thus, a VASP platelet reactivity index <20% (as in prasugrel/ticagrelor-treated patients) identifies patients with TF
pos
-platelets <20% (92% sensitivity). Finally, colchicine impaired in vitro ADP-induced TF expression but not α-granule release, suggesting that TF is open canalicular system stored as confirmed by TEM and platelet analysis of patients with gray platelet syndrome.

CONCLUSIONS:

Data show that TF expression is regulated by P2Y
12
and not P2Y
1
; P2Y
12
antagonists downregulate the percentage of TF
pos
-platelets. In clopidogrel good-responder patients, assessment of TF
pos
-platelets highlights those with residual platelet reactivity. TF is stored in open canalicular system, and its membrane exposure upon activation is prevented by colchicine.
Isaiah 2:6b and the Bible of Justin Martyr
Authors: Yurovitskaya Maria
Published: August 2023

It has long been recognized that the syntactically incorrect phrase in the MT of Isa 2:6b (כִּי מָלְאוּ מִקֶּדֶם וְעֹנְנִים כַּפְּלִשְׁתִּים “for they are full from the east and soothsayers like the Philistines”) suffers from a textual error involving the omission of a word. According to the commonly accepted conjecture, a derivative of the root קסם must be reconstructed, which, being graphically similar to מִקֶּדֶם, may have been dropped out due to haplography. Contrary to previous research that viewed Justin’s version of the verse (ὅτι ἐπλήσθη ἡ χώρα αὐτῶν, ὡς τὸ ἀπ’ ἀρχῆς, µαντειῶν καὶ κληδονισµῶν, Dial. 135.6.5) as a reflection of inner-Greek development, I argue that it may provide support for the emendation, being the only surviving witness to the original Hebrew text of Isa 2:6b.
Type specimens and type localities of birds (Aves) collected by Gustav Adolf Fischer (1848–1886) in East Africa
Authors: FRAHNERT SYLKE , TURNER DONALD A. , BRACKER CORDULA
Published: August 2023

Gustav Adolf Fischer (1848–1886) was an important German naturalist and ornithological collector in Africa. The extensive ornithological collections from his several expeditions were sent to at least two different museums (Zoological Museum Berlin and Zoological Museum Hamburg), and to a smaller extent, some private sales are assumed. Together with Anton Reichenow, Fischer described many species new to science, so the many types in the collections make them especially important. We located 616 bird specimens in the collections of the Museum für Naturkunde Berlin and the Museum der Natur Hamburg along with a few further specimens in the collections of the Museum Heineanum Halberstadt, the Naturalis Biodiversity Center Leiden, The Natural History Museum-UK (Tring), the American Museum of Natural History, New York and the National Museum of Natural History, Washington, D.C. Among these, type specimens for 133 species and subspecies of birds were traced. For all of them, an update of the collecting localities with particular emphasis on some previously unknown locations is provided. A taxonomic update of the described species is given and a designation of lectotypes for the following four taxa was necessary: Francolinus Altumi G.A. Fischer & Reichenow, 1884, Accipiter minullus tropicalis Reichenow, 1898, Hypochera ultramarina var. orientalis Reichenow, 1894 and Spinus citrinelloides frontalis Reichenow, 1904b.
Molecular phylogenetics facilitates the first historical biogeographic analysis of the hammerhead worms (Platyhelminthes: Tricladida: Bipaliinae), with the description of twelve new species and two new genera
Authors: SOLÀ EDUARD , SLUYS RONALD , RIUTORT MARTA , KAWAKATSU MASAHARU
Published: August 2023

The hammerhead worms constitute a land planarian subfamily (Platyhelminthes: Tricladida: Bipaliinae) that is popular among natural historians as well as citizen scientists due to their characteristic semi-lunar-shaped head, the striking colours of many species, and the worldwide presence of introduced species, which has raised much concern about their putative impact on the receiving ecosystems. Despite such current awareness, the majority of Bipaliinae species was described before the second half of the 20th century. Over the past few decades, description of new species has been rather scarce. In the present paper, we describe twelve new species and two new genera from Madagascar, Borneo, and Japan, mainly using specimens that form part of the collections of Naturalis Biodiversity Center, Leiden. Species identification has been based on morphology, inner anatomy, and, when available, molecular information. Our molecular phylogenetic tree suggests that either Malagasy or Bornean representatives form the sister-group to the rest of Bipaliinae. The phylogeny suggests also that the Bipaliinae comprises several new and, as yet, undescribed genera. Although the geographical origin of the subfamily is uncertain and may involve either Madagascar or the Bornean region, a molecular time-calibration of the phylogenetic tree indicated that the origin of the Bipaliinae may date back to about 253 Mya, placing its origin near the Permian-Triassic transition and, thus, on Pangea.
Turbulence and Diffusion on Weakly Stable and Stable Nights near a 300 m Tower in a Complex Landscape
Authors: Kurzeja Robert J. , Leclerc Monique Y. , Duarte Henrique F. , Zhang Gengsheng , Parker Matthew J. , Werth David W. , Chiswell Steven R. , Buckley Robert L.
Published: August 2023

Turbulence and winds below 328 m were measured on 5 successive nights in a program to study tracer transport in the nocturnal boundary layer at a site with moderately complex terrain and mixed land use. The instruments included sonic anemometers and CO2/H2O analyzers at four levels on a 328 m tall tower, a minisodar/RASS system, a midrange sodar, a ceilometer, and an array of 61 m towers. Preliminary simulations indicated satisfactory perfluorocarbon mixing to 68 m but insufficient transport to the 328 m level on both weakly stable and stable nights, possibly due to insufficient turbulence kinetic energy and/or small vertical mixing lengths, or the presence of meso-β fronts, e.g., sea-breeze fronts, that could transport trace chemicals efficiently to 328 m. To examine the problem further, time–height distributions of turbulence kinetic energy (TKE), mixing length, Richardson number, potential temperature, and winds were derived from the observations of mean winds and temperature and the TKE budget equation, interpolated to fit the observations, under the flux/gradient and z-less scaling assumptions, and displayed with aerosol profiles. The results indicated higher and more variable levels of TKE and mixing lengths above a typical turbulence maximum at 30–50 m. Oscillations with periods of ∼2 h were common and occasional meso-β fronts and shear zones between 75 and 150 m were seen, which increased TKE aloft and in some cases led to a poorly defined boundary layer top.

Significance Statement

The atmosphere’s boundary layer is the interface between the free atmosphere and natural and human activity near Earth’s surface. The daytime boundary layer has been studied extensively and, because of vigorous sun-driven mixing, is well understood and readily parameterized in forecast and global climate models. In contrast, the nocturnal boundary layer is less well understood or predictable because turbulence is weak and tends to decouple it from the surface and the free atmosphere above. This paper focuses on the least-studied upper part of the nocturnal boundary layer over the southeastern United States where topography and land–sea contrast affect winds, turbulence, and chemical transport.
Large-Amplitude Quasi-Stationary Rossby Wave Events in ERA5 and the CESM2: Features, Precursors, and Model Biases in Northern Hemisphere Winter
Authors: Fei Cuiyi , White Rachel H.
Published: August 2023

High-amplitude quasi-stationary Rossby waves (QSWs) have been connected to extreme weather events. By identifying particularly high-amplitude QSW events (QWEs) over Europe and North America, we study their characteristics in ERA5 data and in ensemble simulations from the CESM2 general circulation model. The CESM2 reproduces the overall statistics of QWEs, with ERA5 results within the ensemble spread. The ensemble spread is large, indicating a strong influence of internal variability. Composites of meridional wind anomalies for QWEs show a phase preference in both ERA5 and CESM2, resembling the climatological wave pattern. This is partly due to the definition of QSWs; with the day-of-year climatological meridional wind removed when identifying QSWs, the phase preference remains, albeit with a weaker signal. Significant tropical Pacific precipitation anomalies are seen 5–15 days before observed QWEs; the location of these anomalies is broadly reproduced in CESM2, but the magnitude is substantially underestimated and the time scale is biased. We find a narrowed and strengthened jet stream over the Pacific at the early stage of European QWEs, which may create enhanced waveguidability; this signal is generally reproduced in the models. Overall, the CESM2 can simulate QWEs; differences between the model ensemble mean and the reanalysis could result from model bias or internal variability, although biases are not reduced in CESM2 simulations forced with observed SSTs.
The Atmospheric Boundary Layer and the Initiation of the MJO
Authors: Johnson Richard H. , de Szoeke Simon P. , Ciesielski Paul E. , Brewer W. Alan
Published: August 2023

The Indian Ocean is a frequent site for the initiation of the Madden–Julian oscillation (MJO). The evolution of convection during MJO initiation is intimately linked to the subcloud atmospheric mixed layer (ML). Much of the air entering developing cumulus clouds passes through the cloud base; hence, the properties of the ML are critical in determining the nature of cloud development. The properties and depth of the ML are influenced by horizontal advection, precipitation-driven cold pools, and vertical motion. To address ML behavior during the initiation of the MJO, data from the 2011/12 Dynamics of the MJO Experiment (DYNAMO) are utilized. Observations from the research vessel Revelle are used to document the ML and its modification during the time leading up to the onset phase of the October MJO. The mixed layer depth increased from ∼500 to ∼700 m during the 1–12 October suppressed period, allowing a greater proportion of boundary layer thermals to reach the lifting condensation level and hence promote cloud growth. The ML heat budget defines an equilibrium mixed layer depth that accurately diagnoses the mixed layer depth over the DYNAMO convectively suppressed period, provided that horizontal advection is included. The advection at the Revelle is significantly influenced by low-level convective outflows from the southern ITCZ. The findings also demonstrate a connection between cirrus clouds and their remote impact on ML depth and convective development through a reduction in the ML radiative cooling rate. The emergent behavior of the equilibrium mixed layer has implications for simulating the MJO with models with parameterized cloud and turbulent-scale motions.
Trends in the Development of US–China Relations After the 2020 Presidential Election in the Context of the Information and Political Discourse of American Elites
Authors: Kozlov Vadim , Bocharova Alexandra
Published: August 2023

In a short period, from 2016 to 2020, China has transformed from the main trade and economic partner of the United States, during the years of Barack Obama’s presidency, to one of the leading opponents of the US administration. This article analyses the reasons for the growing tension in US–China relations and the trade war as the apogee of this confrontation considers the discourse of American political elites in the media regarding China’s participation and role in the demarcation between states and assesses the prospects of relations between the two countries under the Democratic administration of Joe Biden, with a focus on the information agenda in the United States. The quantitative results of the topic modelling analysis show that the ongoing ideological shift of discourse from the Democrats and lack of any discussion of trade negotiations resulted in 2022 demonstrate that the shift from the economic sphere to ideology has been completed. The tensions between China and the United States have transferred to the political-diplomatic stage with a new danger for the United States and NATO interests coming to the surface—Russia and its policy in Eastern Europe.
Ethical Challenges and Obligations in Health Journalism in India
Authors: Boga Dilnaz
Published: August 2023

In order to explore the intricacies that influence and inform health reportage in India, this study examines the ethical challenges posed to health reporters using qualitative research methods. The research findings highlight the seen and unseen influences on health reporters and probe whether they are able to adhere to ethical practices in their work and, if not, what are the impediments. The study also illuminates how journalists deal with a range of issues in delivering their professional responsibility of reporting matters relating to health and allied themes. The issues include, among others ethical dilemmas, gender discrimination in and outside the newsroom, conflict of interest, risk of breaching privacy and confidentiality while reporting on sensitive subjects pertaining to the public, especially marginalised groups.
Addressing Non-ignorable Panel Attrition Using External Population Data: Analysis of Demographic Events From Survey Data
Authors: Ermisch John
Published: August 2023

Empirical analysis of variation in demographic events within the population is facilitated by using longitudinal survey data because of the richness of covariate measures in such data, but there is wave-on-wave dropout. When attrition is related to the event, it precludes consistent estimation of the impacts of covariates on the event and on event probabilities in the absence of additional assumptions. The paper introduces an adjustment procedure based on Bayes Theorem that directly addresses the problem of nonignorable dropout. It uses population information external to the survey sample to convert estimates of event probabilities and marginal effects of covariates on them that are conditional on retention in the longitudinal data to unconditional estimates of these quantities. In many plausible and verifiable circumstances, it produces estimates of the marginal effect of covariates closer to the true unconditional quantities than the conditional estimates obtained from estimation using the survey data alone.
Psychometric Assessment of the Physicians’ Job Demands and Resources Scale
Authors: Moreira Sérgio , Oliveira Sofia , Vala Jorge , Costa-Lopes Rui , Marques-Pinto Alexandra
Published: August 2023

Job demands and resources have been consistently associated with the burnout syndrome in physicians, however the literature points to a lack of robust measures to assess these job characteristics across various medical specialties. This study aimed to develop a theoretically and empirically grounded physician-specific job demands and resources self-report measure – the Physicians’ Job Demands and Resources Scale. Relevant dimensions of physicians’ job demands and resources were identified, corresponding measurement items were generated and pre-tested, and the factor structure of the resulting 44 items was tested with a sample of 9,176 Portuguese physicians. The results of EFAs and CFAs with two random split samples provided consistent evidence of a nine-factor structure with 38 of the 44 items. Importantly, the nine-factor structure is consistent with the dimensions identified in the literature. The paper discusses the theoretical and practical impacts of the scale.
Seeking alternatives in music education: The effects of mobile technologies on students’ achievement in basic music theory
Authors: Uludag Ali Korkut , Satir Ugur Kartal
Published: August 2023

This study aimed to investigate the effect of mobile technology with music education content that supports basic music theory teaching on secondary school students’ achievement levels and learning. The study was carried out using a mixed-methods sequential explanatory design on sixth-grade secondary school students studying in Turkey (experimental group n = 43 and control group n = 40). The experimental group students attended an 8-week music lesson prepared through mobile technologies called NoteWorks (the names of the tunes, the letter notation, and their positions on the piano), Rhythm Cat (rhythm studies), GarageBand (arrangement studies), and Kids Piano (playing the melody by remembering). Basic music theory subjects were taught to the control group using traditional music teaching methods. Quantitative data showed that the music lesson activities developed and enriched with mobile technologies created a significant difference in the students in the experimental group’s basic music theory subjects’ achievement test scores. Post-intervention assessments (semi-structured interviews) increased students’ motivation levels, willingness to study outside the classroom, communication, musical development, and willingness to participate in the lesson. The research concludes with several recommendations and highlights points that need further attention in mobile technology research.
Commercially Available Media for Flushing Extracorporeal Bioartificial Liver Systems Prior to Connection to the Patient's Circulation: An in vitro Comparative Study in Two and Three Dimensional Porcine Hepatocyte Cultures
Authors: Flendrig L.M. , Sommeijer D. , Ladiges N.C.J.J. , Te Velde A.A. , Maas M.A.W. , Jörning G.G.A. , Daalhuisen J. , Chamuleau R.A.F.M.
Published: August 2023

Extracorporeal bioartificial liver (BAL) systems based on hepatocytes need to be flushed before clinical application, as hepatocyte culture media are not approved for medical use. Commercially available 0.9% NaCl solution and hemofiltration solution (both supplemented with 10% human albumin) were investigated in vitro to test their potential to wash BAL systems with minimal stress for the cultured hepatocytes. After a 2 hour incubation, the lidocaine metabolising capacity and release of liver enzymes were assessed. As hepatocytes have been cultured in bioreactors in either two or three dimensional cell configurations, we tested the media in respectively hepatocyte monolayers cultures and in our newly developed bioreactor in which hepatocytes reorganise as small hepatocyte aggregates. The three dimensional hepatocyte cultures tolerated both media well, and no significant differences were seen compared with hepatocytes cultured in Williams’ E (reference hepatocyte culture medium). The two dimensional hepatocyte cultures tolerated the supplemented hemofiltration solution and the reference medium equally well, but the condition of the porcine hepatocytes monolayer cultures was significantly impaired when incubated with the supplemented physiological saline solution. In conclusion, as a supplemented physiological saline solution may have detrimental effects on the condition of the hepatocytes, the more complex hemofiltration solution (bicarbonate buffered, glucose, essential minerals) was considered the better alternative for flushing bioartificial liver systems.
Supporting Reassigned Hospital Staff During the COVID-19 Pandemic in the Montreal Region: What Does it say About Leadership Styles?
Authors: Gautier Lara , Gabet Morgane , Duhoux Arnaud , Traverson Lola , Ridde Valéry , Zinszer Kate , David Pierre-Marie
Published: August 2023

Globally, the COVID-19 pandemic took a high toll on health human resources, especially in contexts where these resources were already fragile. In Quebec, to make up for the shortage of health human resources, and to contain the COVID-19 outbreaks in long-term care facilities, many hospital staff (including a majority of nurses) were sent to those facilities, with varying degrees of support. Building on the body of evidence linking leadership style and resilience, we conducted a qualitative comparative analysis of two hospitals in the Montreal Metropolitan Area, Quebec. We explored respondents’ experience of psychosocial support tools provided to hospital staff reassigned to COVID-affected facilities. Data from 27 in-depth interviews with high- and mid-level managers, and front-line workers, was analyzed through the lens of leadership styles. Our findings highlighted how the design and implementation of support tools revealed major differences across the two hospitals’ leadership styles (i.e., one hospital expressing leader-centered styles vs. the other expressing follower-centered leadership styles). The expression of these leadership styles was largely shaped by recent policies, notably a major political reform of 2015, which enforced more centralized decision-making. Our study offered additional empirical evidence that leadership styles fostering the recovery of health human resources may be a key indicator of successful response to crises.
A Genetic Algorithm Approach to Optimal Asset Allocation of Defined Contribution Pension Funds: Evidence From India’s National Pension System
Authors: Prasad Keshav Kant , Ghosh Amlan
Published: August 2023

Life cycle asset allocation has recently gained popularity and is the default option in pension funds worldwide. A line of recent studies has refuted its glory and argues that a balanced fund with a fixed allocation throughout the investment horizon may yield better results. The question arises from these studies: What should be the balanced fund’s optimum asset allocation weight? Therefore, the present study uses Genetic Algorithm to obtain the optimum asset allocation weight for India’s defined contribution pension plan subscribers. To validate our result, the study compares the results of a Genetic Algorithm to the outcomes of widely used asset allocation techniques, notably the life cycle and equally weighted strategies. This study holds important policy implications as, given the size of the pension asset and the long investment duration, even a trivial increase in return will substantially impact investment outcomes, affecting the subscribers’ well-being in old age.
Impact of a Pharmacist-Led Telemedicine Visit in a Geriatric Primary Care Clinic
Authors: Handshaw John V. , Celauro Lindsay , Francoforte Karen
Published: August 2023

Purpose: Unintentional medication discrepancies (UMD) are common amongst geriatric patients. If not addressed, these UMD can lead to suboptimal care and increased health care spending. Ambulatory care pharmacists are trained to identify and resolve UMD, and help tailor medication regimens to assure optimized and safe patient-centered care. The purpose of this retrospective study was to highlight the role of a remote, ambulatory care pharmacist in a geriatric primary care setting. Methods: This was a multicenter, single cohort, retrospective chart review of patients enrolled in a geriatric primary care initiative. Patients met with an ambulatory care pharmacist for a 60-minute telemedicine appointment. The primary endpoint was the percent of patients seen by the ambulatory care pharmacist with at least 1 medication discrepancy identified. Results: A total of 275 visits were scheduled with the ambulatory care pharmacist during the 6-month study period. At least 1 unintentional medication discrepancy (UMD) was identified in 151 patients (66%). At least 1 edit was made to the patient’s medication list in 224 patients (97%). The ambulatory care pharmacist made recommendations to the provider in 210 patients (91%). The CPA was utilized in 75 patients (33%). Conclusion: This study highlights the utility of a remote, ambulatory care pharmacist in a geriatric primary care setting. Two-thirds of patients were noted to have at least 1 UMD, and more than 90% of patients were identified as having suboptimal regimens. This initiative shows the impact of a remote, ambulatory care pharmacist on patient care.
Energy-efficient adaptive cruise control system with acceleration prediction via long short-term memory
Authors: Jiang Shunming , Zheng Qinghui , Wu Kuo , Wu Pengpeng
Published: August 2023

An energy-efficient adaptive cruise control (ACC) system that predicts the preceding state is proposed to meet the demands of driving in different states and working conditions. The long short-term memory (LSTM) network predicts the trajectory of the preceding vehicle’s future acceleration, allowing for an adaptive time headway that takes acceleration into account. The acceleration of the preceding vehicle is also incorporated as an augmented state in the deep deterministic policy gradient (DDPG) algorithm, resulting in a combined algorithm called prediction deep deterministic policy gradient (PDDPG). A multi-objective reward function is constructed based on human driving data to evaluate the performance indexes of vehicle longitudinal control, including efficiency, safety, and economy. The rules for changing the weight of each target performance under various typical cycle conditions are determined through experiments. The Carsim-based urban, suburban and highway conditions together with the Simulink vehicle dynamics model are compared with human driving data and ACC of conventional algorithms. Based on the test results, the proposed algorithm can improve fuel efficiency by 19.36% in urban driving conditions and reduce acceleration fluctuations.
“I felt like a bad monster was rising up in me”: Empirical and clinical evidence of maternal disintegrative responses in the context of infant care
Authors: Chasson Miriam , Taubman – Ben-Ari Orit , Erel-Brodsky Hilit
Published: August 2023

In this paper, we sought to give voice to the unspoken issue of mothers’ disintegrative responses—that is, intrusive thoughts and dissociative experiences—in the context of infant care. Three methodologies were employed: (a) in-depth interviews were conducted with 23 Israeli women up to 3 months postpartum; (b) 126 Israeli women up to 12 months after childbirth responded to an open-ended questionnaire; and (c) a clinical case study was performed. Mothers referred to intrusive thoughts as “attacks,” and related primarily to three themes: fear of losing their grip, aggressive fantasies, and guilt and shame. Dissociative experiences were described as vague and elusive, with three major themes emerging: detachment, disorientation, and helplessness. We argue that the findings correspond with psychosocial approaches whereby disintegrative responses may be an indication of maternal ambivalence and a reflection of “contagious arousal” in which the mother identifies with the experience of the infant. The findings offer a new direction to clinicians working with mothers by suggesting that the mother's openness to these responses may be an opportunity for her to acknowledge subjective and repressed parts of herself and undergo a process of reintegration out of disintegration.
The possibility of AI-induced medical manslaughter: Unexplainable decisions, epistemic vices, and a new dimension of moral luck
Authors: Bartlett Benjamin
Published: August 2023

The use of artificial intelligence (AI) systems in healthcare provides a compelling case for a re-examination of ‘gross negligence’ as the basis for criminal liability. AI is a smart agency, often using self-learning architectures, with the capacity to make autonomous decisions. Healthcare practitioners (HCPs) will remain responsible for validating AI recommendations but will have to contend with challenges such as automation bias, the unexplainable nature of AI decisions, and an epistemic dilemma when clinicians and systems disagree. AI decisions are the result of long chains of sociotechnical complexity with the capacity for undetectable errors to be baked into systems, which introduces a new dimension of moral luck. The ‘advisory’ nature of AI decisions constructs a legal fiction, which may leave HCPs unjustly exposed to the legal and moral consequences when systems fail. On balance, these novel challenges point towards a legal test of subjective recklessness as the better option: it is practically necessary; falls within the historic range of the offence; and offers clarity, coherence, and a welcome reconnection with ethics.
A Narrative Review on the Administration of Inhaled Prostaglandins in Critically Ill Adult Patients With Acute Respiratory Distress Syndrome
Authors: Ware Lydia R. , Kim Christine S. , Szumita Paul M. , DeGrado Jeremy R.
Published: August 2023

Objective:

To describe the effect of inhaled prostaglandins on both oxygenation and mortality in critically ill patients with acute respiratory distress syndrome (ARDS), with a focus on safety and efficacy in coronavirus disease 2019 (COVID-19)-associated ARDS and non-COVID-19 ARDS.

Data Sources:

A literature search of MEDLINE was performed using the following search terms: inhaled prostaglandins, inhaled epoprostenol, inhaled nitric oxide, ARDS, critically ill. All abstracts were reviewed.

Study Selection and Data Extraction:

Relevant English-language reports and studies conducted in humans between 1980 and June 2023 were considered.

Data Synthesis:

Data regarding inhaled prostaglandins and their effect on oxygenation are limited but show a benefit in patients who respond to therapy, and data pertaining to their effect on mortality is scarce. Concerns exist regarding the formulation of inhaled epoprostenol (iEPO) utilized in addition to modes of medication delivery; however, the limited data surrounding their use have shown a reasonable safety profile. Other avenues and beneficial effects may exist with inhaled prostaglandins, such as use in COVID-19-associated ARDS or non-COVID-19 ARDS patients undergoing noninvasive mechanical ventilation or during patient transport.

Relevance to Patient Care and Clinical Practice:

The use of inhaled prostaglandins can be considered in critically ill patients with COVID-19-associated ARDS or non-COVID-19 ARDS who are experiencing difficulties with oxygenation refractory to nonpharmacologic strategies.

Conclusions:

The use of iEPO and other inhaled prostaglandins requires further investigation to fully elucidate their effects on clinical outcomes, but it appears these medications may have a potential benefit in COVID-19-associated ARDS and non-COVID-19 ARDS patients with refractory hypoxemia but with little effect on mortality.
Clinical outcomes of indwelling needle-delivered urokinase thrombolysis in the treatment of thrombosed arteriovenous grafts
Authors: Zhou Yu , Li Wenqin , Chen Bo , Chen Ling , Lai Qiquan , Tu Bo , Wan Ziming , Zhao Qinghua
Published: August 2023

Background:

To investigate the clinical outcomes of indwelling needle-delivered local urokinase thrombolysis, a cost-saving thrombolytic approach, in the treatment of thrombosed arteriovenous grafts (AVGs).

Methods:

The clinical data of 71 patients with a first episode of thrombosed AVG were analyzed. Among them, 49 patients underwent urokinase thrombolysis and percutaneous transluminal angioplasty (PTA), and 22 patients underwent thrombectomy and PTA. The operation success rate, operation time, perioperative and postoperative complications, primary patency, and secondary patency were compared.

Results:

Clinical success was achieved in all 71 PTAs. After thrombolysis, 29 patients achieved complete lysis, and 20 patients achieved partial lysis. All patients achieved thrombus clearance after PTA. The operating room usage time was 37.48 ± 5.33 min for the complete thrombolysis group and 41.70 ± 6.16 min for the incomplete thrombolysis group, and these values were not significantly different (p = 0.853). The operating room usage time of the thrombectomy group was 124.73 ± 5.08 min, which was significantly longer than that of the other groups (p < 0.001). The log-rank test indicated no significant difference in the 90-, 180-, and 360-day primary patency and corresponding secondary patency (all p > 0.05). The Cox regression showed that no significant difference was noted in the changing rate of primary or secondary patency among the groups (all p > 0.05). No major complications occurred in any of the groups, and the difference in the complication incidence was not significant (p = 0.336).

Conclusions:

Indwelling needle-delivered urokinase thrombolysis is an acceptable method for the treatment of thrombosed AVGs. Compared with thrombectomy and PTA, thrombolysis and PTA can significantly shorten the time to use the operating room without reducing primary and secondary patency or increasing complications.
Functions for platelet factor 4 (PF4/CXCL4) and its receptors in fibroblast-myofibroblast transition and fibrotic failure of arteriovenous fistulas (AVFs)
Authors: Xiao Yuxuan , Martinez Laisel , Zigmond Zachary , Woltmann Daniel , Singer Diane V , Singer Harold A , Vazquez-Padron Roberto I , Salman Loay H
Published: August 2023

Background:

Over 60% of End Stage Renal Disease (ESRD) patients are relying on hemodialysis (HD) to survive, and the arteriovenous fistula (AVF) is the preferred vascular access method for HD. However approximately half of all newly created AVF fail to mature and cannot be used without a salvage procedure. We have recently demonstrated an association between AVF maturation failure and post-operative fibrosis, while our RNA-seq study also revealed that veins that ultimately failed during AVF maturation had elevated levels of platelet factor 4 (PF4/CXCL4). However, a link between these two findings was yet to be established.

Methods:

In this study, we investigated potential mechanisms between PF4 levels and fibrotic remodeling in veins. We compared the local expression of PF4 and fibrosis marker integrin β6 (ITGB6) in veins that successfully underwent maturation with that in veins that ultimately failed to mature. We also measured the changes of expression level of α-smooth muscle actin (αSMA/ ACTA2) and collagen (Col1/ COL1A1) in venous fibroblasts upon various treatments, such as PF4 pharmacological treatment, alteration of PF4 expression, and blocking of PF4 receptors.

Results:

We found that PF4 is expressed in veins and co-localizes with αSMA. In venous fibroblasts, PF4 stimulates expression of αSMA and Col1 via different pathways. The former requires integrins αvβ5 and α5β1, while chemokine receptor CXCR3 is needed for the latter. Interestingly, we also discovered that the expression of PF4 is associated with that of ITGB6, the β subunit of integrin αvβ6. This integrin is critical for the activation of the major fibrosis factor TGFβ, and overexpression of PF4 promotes activation of the TGFβ pathway.

Conclusions:

These results indicate that upregulation of PF4 may cause venous fibrosis both directly by stimulating fibroblast differentiation and expression of extracellular matrix (ECM) molecules and indirectly by facilitating the activation of the TGFβ pathway.
Iopromide for Contrast-Enhanced Mammography: A Systemic Review and Meta-Analysis of Pertinent Literature
Authors: Endrikat Jan , Khater Hassan , Boreham Alexander DP , Fritze Sabine , Schwenke Carsten , Bhatti Aasia , Trnkova Zuzana Jirakova , Seidensticker Peter
Published: August 2023

Background:

Contrast-enhanced mammography (CEM) is an emerging breast imaging modality. Clinical data is scarce.

Objectives:

To summarize clinical evidence on the use of iopromide in CEM for the detection or by systematically analyzing the available literature on efficacy and safety.

Design:

Systematic review and meta-analysis.

Data sources and methods:

Iopromide-specific publications reporting its use in CEM were identified by a systematic search within Bayer’s Product Literature Information (PLI) database and by levering a recent review publication. The literature search in PLI was performed up to January 2023. The confirmatory-supporting review publication was based on a MEDLINE/EMBASE + full text search for publications issued between September 2003 and January 2019. Relevant literature was selected based on pre-defined criteria by 2 reviewers. The comparison of CEM vs traditional mammography (XRM) was performed on published results of sensitivity and specificity. Differences in diagnostic parameters were assessed within a meta-analysis.

Results:

Literature search: A total of 31 studies were identified reporting data on 5194 patients. Thereof, 19 studies on efficacy and 3 studies on safety. Efficacy: in 11 studies comparing iopromide CEM vs XRM, sensitivity was up to 43% higher (range 1%-43%) for CEM. Differences in specificity were found to be in a range of −4% to 46% for CEM compared with XRM. The overall gain in sensitivity for CEM vs XRM was 7% (95% CI [4%, 11%]) with no statistically significant loss in specificity in any study assessed. In most studies, accuracy, positive predictive value, and negative predictive value were found to be in favor of CEM. In 2 studies comparing CEM with breast magnetic resonance imaging (bMRI), both imaging modalities performed either equally well or CEM tended to show better results with respect to sensitivity and specificity. Safety: eight cases of iopromide-related adverse drug reactions were reported in 1022 patients (0.8%).

Conclusions:

Pertinent literature provides evidence for clinical utility of iopromide in CEM for the detection or confirmation of breast cancer. The overall gain in sensitivity for iopromide CEM vs XRM was 7% with no statistically significant loss in specificity.
Dapagliflozin attenuates cardiac remodeling and dysfunction in rats with β-adrenergic receptor overactivation through restoring calcium handling and suppressing cardiomyocyte apoptosis
Authors: Liu Tao , Wu Jinchun , Shi Shaobo , Cui Bo , Xiong Feng , Yang Shuang , Yan Min
Published: August 2023

Background: Long-term β-adrenergic receptor (β-AR) activation can impair myocardial structure and function. Dapagliflozin (DAPA) has been reported to improve clinical prognosis in heart failure patients, whereas the exact mechanism remains unclear. Here, we investigated the effects of DAPA against β-AR overactivation toxicity and explored the underlying mechanism.

Methods and Results: Rats were randomized to receive saline + placebo, isoproterenol (ISO, 5 mg/kg/day, intraperitoneally) + placebo, or ISO + DAPA (1 mg/kg/day, intragastrically) for 2-week. DAPA treatment improved cardiac function, alleviated myocardial fibrosis, prevented cardiomyocytes (CMs) apoptosis, and decreased the expression of ER stress-mediated apoptosis markers in ISO-treated hearts. In isolated CMs, 2-week ISO stimulation resulted in deteriorated kinetics of cellular contraction and relaxation, increased diastolic intracellular Ca2+ level and decay time constant of Ca2+ transient (CaT) but decreased CaT amplitude and sarcoplasmic reticulum (SR) Ca2+ level. However, DAPA treatment prevented abnormal Ca2+ handling and contractile dysfunction in CMs from ISO-treated hearts. Consistently, DAPA treatment upregulated the expression of SR Ca2+-ATPase protein and ryanodine receptor 2 (RyR2) but reduced the expression of phosphorylated-RyR2, Ca2+/calmodulin-dependent protein kinase II (CaMKII), and phosphorylated-CaMKII in ventricles from ISO-treated rats.

Conclusion: DAPA prevented myocardial remodeling and cardiac dysfunction in rats with β-AR overactivation via restoring calcium handling and suppressing ER stress-related CMs apoptosis.
Pituitary volume changes in pregnancy and the post-partum period
Authors: Benson John C , Malyuk David F , Madhavan Ajay , Guerin Julie B , Krecke Karl N , Little Jason T , Passe Theodore J , DeLone David R , Lindell Edward P , Eckel Laurence J
Published: August 2023

Purpose

Imaging changes in the pituitary volume during pregnancy remains scantly researched. This study set out to assess the differences in total, anterior, and posterior pituitary volume in pregnant women compared to nulliparous and post-partum women.

Materials and Methods

A retrospective review was completed of women that had undergone MRI imaging of the brain. Patients were divided into three cohorts: pregnant, nulliparous, and post-partum (defined as being within 12 months of delivery). Anterior and posterior pituitary volumes were manually measured.

Results

171 patients were included, of which 68 were pregnant, 52 were post-partum, and 51 were nulliparous. The average anterior (621.0 ± 171.6 mm3) and total (705.4 ± 172.2 mm3) pituitary volumes were significantly larger in pregnant patients than nulliparous women (522.6 ± 159.8 mm3 and 624.5 ± 163.7 mm3, respectively) ( p = .002 and p = .01, respectively). The posterior pituitary volume was significantly smaller in pregnant women (84.4 ± 32.9 mm3) compared to both post-partum (101.2 ± 42.0 mm3) and nulliparous (102.0 ± 46.1 mm3) women ( p = .02 for both).

Conclusions

The anterior and total pituitary volumes are significantly larger during pregnancy persisting into the post-partum period. The posterior pituitary volume, conversely, decreases during pregnancy, and returns to its normal size in the post-partum period.
The effects of fragmented and sticky smartphone use on distraction and task delay
Authors: Siebers Teun , Beyens Ine , Valkenburg Patti M.
Published: August 2023

The smartphone has become an integral part of adolescents’ daily life. Despite the countless affordances of smartphones, concerns have been raised about their enormous potential to cause failures in self-regulation, such as distraction and task delay. The current study investigated whether two smartphone usage patterns, fragmented and sticky smartphone use, are associated with distraction and task delay. For three weeks, we logged the smartphone usage of 160 adolescents (733,359 observations) and assessed their distraction and task delay six times a day with experience sampling (12,723 observations). Using Dynamic Structural Equation Modeling, we found that, overall, adolescents felt more distracted when their smartphone use was more fragmented or sticky. Exploratory analyses indicated that 77% of adolescents experienced increased distraction (i.e., β > .05) when their smartphone use was more fragmented, and 55% when it was sticky. Overall, adolescents did not report more task delay as their smartphone use was more fragmented or sticky. Nonetheless, 22% experienced increased task delay when their smartphone use was more fragmented, and 42% when it was sticky. Together, our findings underline the dynamic nature of smartphone use and its differential impact on self-regulation outcomes.
Farmers’ Perception Towards the Benefits of Organic Farming in Haryana
Authors: Malhan Pardeep , Ram Tika
Published: August 2023

This study aims to examine the farmers’ perception towards the benefits of organic farming in Haryana. These benefits are categorised into three parts: health benefits, environmental benefits and economic benefits. The new era of modernisation required the sustainable growth of mankind as the advancement in all aspects of human life has serious drawbacks. In terms of agriculture and allies, organic farming is considered more friendly to human life and the universe. So, this study has been related to agriculture as the farmers who are engaging in organic farming–related activities are included in this study. The data were collected with a semi-structured questionnaire, and convenience and snowball sampling were used for data collection. A total of 250 farmers were included in this study. Statistical tools such as frequency, percentage, t-test and one-way ANOVA were employed for data analysis. The results revealed that certified, educated and experienced farmers have high agreement towards the benefits of organic farming. So, the concerned authorities should motivate educated farmers to adopt organic farming and ensure the certification of their products.
Role of Fear on Consumers’ Buying Tendencies: Mediating Role of Social Media Usage
Authors: Verma Aastha , Joshi Gaurav , Shri Charu , Chaturvedi Alka , Gupta Siddharth
Published: August 2023

The present study empirically examines the impact of fear on consumers’ buying tendencies (Impulse buying, Panic buying and Online purchase intention). The study assesses the role of social media usage as a mediating variable in the above relationship. Also, it investigates the variation in consumer buying tendencies, fear, and social media usage across demographics. A total of 389 survey responses were collected online through a structured questionnaire using a snowball sampling technique from consumers of Delhi, India. A causal relationship established using Structural Equation Modelling reveals linkages of fear with panic buying and social media usage fully mediates this relationship, Further, the link between fear and online purchase is partially mediated by social media usage, and no linkage is found with impulse buying. ANOVA and T-test results show that panic buying tendency is higher in females and married individuals, social media usage is higher in unmarried younger age group people and online purchase intention is practiced more by males in middle- and upper-income groups. The study concludes by providing theoretical and practical implications.
Untouchability, Caste and Supremacy of Hinduism: Rereading Swami Vivekananda
Authors: Singh Mayengbam Nandakishwor
Published: August 2023

Swami Vivekananda was a multi-faceted personality. Some of his primal ideas on India are timelessly resounding. One of the recurrent themes is Vivekananda’s agile efforts to revolutionize Hinduism. Hordes of literature emphatically explore Vivekananda’s profound views on Hinduism. Vivekananda is overwhelmingly credited as the towering figure who also spiritually revitalizes the vitals of Hinduism. At the same time, no sufficient attention is directed towards the question of untouchability and caste as presented by Vivekananda. Vivekananda’s whole body of ideas on caste and untouchability are largely left untouched, not least in the discourse on contemporary India. Are caste and untouchability interrelated according to Swami Vivekananda? Does Vivekananda consider caste and untouchability as the bane of Hinduism? Does Vivekananda call for the abolition of untouchability and caste? Does Vivekananda proffer the philosophical groundings about the supremacy of Hinduism? This article primarily attempts to dissect these immanent questions afresh.