bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Care Physician Perceptions of the Impact of CMS E/M Coding Changes and Associations with Changes in EHR Time
Authors: Maisel Natalya , Thombley Robert , Sinsky Christine A. , Blake Kathleen , Overhage J. Marc , Grumbach Kevin , Willard-Grace Rachel , Carlasare Lindsey , Adler-Milstein Julia
Published: February 2025

Background

In 2021, CMS changed ambulatory evaluation and management (E/M) documentation requirements to reduce physician documentation burden. No prior work has assessed primary care physician (PCP) perceptions of the impact of these changes.

Objective

To determine whether physicians both perceived and objectively experienced a reduction in documentation time.

Design

We used cross-sectional and longitudinal survey data of PCPs and linked it to electronic health record (EHR) data. The setting was a large academic medical center (UCSF Health).

Participants

Eighty-seven PCPs.

Main Measures

Physicians completed pre- and post-surveys about whether the CMS changes affected the amount of time and effort they spent on documentation. We compared survey data to objective audit log measures of documentation time per E/M encounter.

Key Results

PCPs perceived spending less time and effort on documentation of Review of Systems (84% reported a moderate or significant decrease) and History of Present Illness and Physical Exam (41%) after the E/M coding change. Further, we found a shift towards PCPs perceiving that they spend more time on clinically meaningful documentation. We did not find a significant association between perceived and actual changes in documentation time (b= −0.01, s.e.=0.019, p=0.666 for History of Present Illness and Physical Exam; b= −0.01, s.e.=0.021, p=0.780 for Review of Systems). Limitations of the study included using data from a single site and a relatively small sample of PCPs.

Conclusions

PCPs perceived spending less time and effort on documentation after implementation of the 2021 CMS E/M coding changes, changes intended to reduce documentation burden. Using physician perception as an indicator can potentially contribute to understanding the impact of federal policies aimed at reducing documentation burden.
Dimensionality Reduction for Clustering of Nonlinear Industrial Data: A Tutorial
Authors: Roh Hae Rang , Kim Chae Sun , Lee Yongseok , Lee Jong Min
Published: February 2025

Dimensionality reduction is essential for industrial process data with numerous nonlinear variables to retain only the important features for visualization or subsequent tasks. This study serves as a tutorial demonstrating how various dimensionality reduction techniques perform as the complexity of process variables in toy examples increases. Among the variables, there are those containing fault signals, aiming to demonstrate the process of performing a fault detection task. The results evaluated based on three criteria showed that Uniform Manifold Approximation and Projection (UMAP) demonstrated notable results, particularly with sparse and noisy data, while also offering adequate robustness to out-of-sample test data. This tutorial provides guidance on selecting the appropriate dimensionality reduction technique based on data complexity, ultimately enabling more effective execution of subsequent tasks.
Implementation of Virtual Reality Technology in Architecture Field, and Education: A Review
Authors: Elbadawy Henar , Farouk Abdelaziz
Published: February 2025

Nowadays, the architectural design process became more complex, the exponential growth of the architectural field, Made the design more critical for the designers, and student to understand. While creating an outstanding building, it must be free of clashes and well-coordinated. The rapid development of computer technology has accelerated the progress of architectural technology, and the application of virtual reality technology has become more and more common. Virtual reality (VR) provides a completely digital world of interaction that enables the users to modify, edit, and transform digital elements responsively. It has strong integration and comprehensive characteristics and covers many technologies such as computer graphics, simulation, artificial intelligence, sensing, display, and network processing. This paper focuses on adapting the already-existing methods and tools in architecture to the VR environment under the sustainable and architectural design domain. For this purpose, this literature benefits from the semantically enriched data platforms of Scientific Articles on Virtual Reality, BIM, Architectural design, and green building, which in the end state the potentiality of Virtual Reality in the Architectural field through different aspects. It plays an important role in optimizing and simulating architectural buildings and improving them to an optimum design. It facilitates the design process to get the optimum design through different programs, which leads us to BIM and collaboration between team members in order to Imagine and coordinate between different trades. The VR illustrates the important role of Green Building, through simulation and tests of the building before initiating it. Not only the simulation but the life cycle. Whereas its importance in education for both Students and teachers.
Expanding treatment indications in chronic hepatitis B: Should we treat all patients?
Authors: Hui Rex Wan-Hin , Mak Lung-Yi , Fung James , Seto Wai-Kay , Yuen Man-Fung
Published: February 2025

Nucleos(t)ide analogues (NUCs) are first-line agents for chronic hepatitis B (CHB). Current guidelines provide recommendations for NUC initiation, yet the guidelines are complex and restrictive. Accumulating data on hepatitis B virus (HBV) replication and HBV integration suggests that there are no real quiescent disease phases in CHB, and treatment-ineligible patients in current guidelines still have substantial risks of cirrhosis and hepatocellular carcinoma. Expanding CHB treatment indications can effectively reduce the risks of liver-related complications. Furthermore, treatment indication expansion can be cost-effective, and can simplify care pathways to remove treatment barriers. Potential caveats for treatment expansion include risks of non-compliance, long-term side effects from NUCs, and poor patient acceptability. Nonetheless, these caveats are not insurmountable, and the benefits of treatment expansion outweigh the disadvantages. There is consensus among hepatologists in supporting treatment indication expansion, although expert panels have varying recommendations on treatment strategies. A treat-all approach, which involves treating all CHB patients, has also been proposed. A treat-all strategy is straightforward, and should yield the greatest benefits from a population health perspective. However, the feasibility of new treatment strategies, especially the treat-all approach, is influenced by multiple factors including local epidemiology, healthcare resource availability, and socioeconomic factors. A one-size-fits-all approach is not optimal, and treatment expansion strategies that are tailored based on local data should yield the greatest impact toward hepatitis elimination.
Advancing Mediterranean food integrity: assessing a digital tool for consumer empowerment and traceability
Authors: Cea Gloria , Lombroni Ivana , Merino-Barbancho Beatriz , Dantas Adrián , Mallo Irene , Tsotsolas Nikos , Banias Georgios F. , Arredondo María Teresa
Published: February 2025

The Mediterranean Diet is widely renowned for its benefits in promoting longevity and well-being. However, ensuring the authenticity and traceability of Mediterranean food products remains a significant challenge. To tackle this, the food industry must adopt transparent and reliable supply chain practices that includes leveraging innovative technologies, essential to meet consumer demands, enhance efficiency, and promote sustainability. This study aims to validate the feasibility of the Med Food TTHubs Consumer App ensuring that the digital solution meets the needs and expectations of the target audience facilitating consumer adoption. User perceptions were assessed using the System Usability Scale (SUS) and the Technology Acceptance Model (TAM) with 21 participants. SUS analysis showed an average score of 74.5, indicating the solution’s acceptability fell short of good usability criteria. Notably, 66.7% found it acceptable (SUS Score ≥ 68), and 47.6% rated it as having good usability (SUS Score ≥ 80). TAM revealed a positive perception, showing potential acceptance and adoption. The acceptable Cronbach’s Alpha value of 0.721 indicates internal consistency. This digital solution emerges as an encouraging tool to enhance transparency, traceability, and consumer empowerment in the food sector. Despite identified usability issues, its user-friendly interface and comprehensive information contribute to informed decision-making and healthier food choices.
Thermal comfort modeling, aspects of land use in urban planning and spatial exposition under future climate parameters
Authors: Isinkaralar O. , Isinkaralar K. , Sevik H. , Küçük Ö.
Published: February 2025

Global urbanization and climate change have brought about crucial climatic pattern variations between urban areas and rural surroundings. The impact of global heating is influencing the climatological variables in the surrounding urban environment. Thermal comfort in an environment is an influential location choice for urban living quality and facilities. This study models the change in the spatial pattern of comfort zones in the Kastamonu province sample. Simulation plots were generated, and comfort requirements were investigated based on global climate models in the Coupled Model Intercomparison Project Phase 6. The spatio-temporal shifts in temperature, humidity, and ThC fields were optimized by Thom’s discomfort index. To assess the synergies of extreme hot weather events throughout the province, the current status of ThC areas and their potential concerns in 2040, 2060, 2080, and 2100 were modeled based on the Shared Socioeconomic Pathways scenarios: SSP2-4.5 and SSP5-8.5 using ArcMap 10.8 software. The research determined that cold, cool, and comfortable areas are predicted in the site based on SSP2-4.5 until 2100. According to the SSP5-8.5, coastal regions will dominate 15.3% of the area with marine characteristics above the comfort values (hot and very hot). According to the SSP5-8.5 climate projections, the 5 °C increase in the highest temperature value in the area and the 9.7% decrease in the relative humidity are remarkable for describing impreciseness in complex interacting human and environmental mechanisms. The research provides guiding and concrete spatial indicators for many interacting disciplines and decision-makers.

Graphical abstract
Teaching a Conversational Agent using Natural Language: Effect on Learning and Engagement
Authors: Love Rachel , Law Edith , Cohen Philip R. , Kulić Dana
Published: February 2025

Conversational teachable agents offer a promising platform to support learning, both in the classroom and in remote settings. In this context, the agent takes the role of the novice, while the student takes on the role of teacher, eliciting the Protégé effect, a pedagogical phenomenon known to increase engagement in the teaching task, and also improve cognitive outcomes. In prior work, interactions with teachable agents show frequent use of interface elements to support learning, and few examples utilise natural language as the sole interaction modality between both user and agent. This work investigates the effect of teaching using natural language while interacting with a virtual agent via the Curiosity Notebook on learning outcomes and engagement. A method of teaching by selecting sentences from source material is compared to paraphrasing from the source material and typing. The results indicate that teaching by paraphrasing in natural language is perceived as being more helpful for learning, but that this perception of improvement is not reflected in actual learning gain over a fixed interaction. Participants also show a short-term preference for teaching via sentence-selection, which they perceive as requiring less effort. There is a positive relationship between the amount of paraphrasing users engage in and improved learning outcomes.
Impatto dell’obesità sulla funzione sessuale delle donne in menopausa
Authors: Barbagallo Federica , Nappi Rossella E. , Calogero Aldo E.
Published: February 2025

Sommario

La menopausa rappresenta una fase cruciale di transizione cardiometabolica durante la quale molte donne sperimentano un incremento ponderale e una significativa redistribuzione del grasso corporeo. Parallelamente, si osserva spesso un declino della funzione sessuale. Le donne affette da obesità sono esposte a una molteplicità di fattori di rischio, sia organici che psicosociali, che le predispongono maggiormente allo sviluppo di disfunzioni sessuali. La presente rassegna si propone di analizzare le evidenze scientifiche disponibili sulla correlazione tra obesità e disfunzioni sessuali nelle donne in menopausa e di fornire strumenti utili per agevolare il dialogo medico-paziente, diagnosticare le disfunzioni sessuali e offrire opzioni terapeutiche seguendo un modello bio-psico-sociale.
Box Height-Independent Differential Bar Cumulation (DBC) for 3D Raster Surface Fractal Dimension Analysis
Authors: Malleswar S. D. , Isoda Yuzuru , Nakaya Tomoki
Published: February 2025

The box-counting method is the predominant technique for calculating fractal dimensions (FD) for raster data. However, past studies focused primarily on measuring the FD of 2D binary raster. While fields like image analysis have advanced with methods such as differential box counting (DBC) to measure the FD of 3D surfaces, this approach has yet to be applied to geographical raster data, mainly due to challenges like various data depth formats, choice of box height, and type of distribution of raster values within data. In this study, we address these challenges, particularly focusing on selecting an appropriate box height which is also a methodological issue even for images. The difficulties in DBC, such as too-small and too-large box height problems, appear on finer and coarser scales of log–log plots, respectively, and there are optimal scales that represent the accurate FD somewhere in the middle. We proposed key modifications to the conventional DBC method theoretically to reduce the number of inappropriate scales due to the difficulties in DBC. To identify the effective scales in log–log plot, we introduced a novel visualization technique which can be used to detect subtle variations in log–log plots by visual inspection, aiding in the identification of box height problems and related difficulties. We applied and compared both the conventional and modified DBC method to two empirical datasets, population data and digital elevation model data, across the USA. Our results demonstrate that the log–log plots display greater consistency, and the FD values converge to a larger value as the box height decreases. The enhanced log–log plots from the results showed that there is no too-small box height problem at all, and the box height is smaller the better. Based on the empirical results, we proposed a derived method that eliminates the need for selecting a specific box height, addressing all three difficulties of DBC identified in this study. Since the derived method no longer uses the ceiling function and does not count boxes, the acronym DBC should now stand for differential bar cumulation.
A Risk-Based Pillar Design Approach Combining Stochastic Continuous and Discontinuous Modeling in an Underground Stone Mine
Authors: Monsalve Juan J. , Soni Aman , Bishop Richard , Hazzard Jim , Rodriguez-Marek Adrian , Chen Cheng , Ripepi Nino
Published: February 2025

The collapse of a mine pillar is a catastrophic event with great consequences for a mining operation. In spite of the low probability of occurrence for a pillar collapse in comparison to other ground control instability issues, these consequences make these events high risk. Therefore, the design of these structures should be considered from a risk perspective rather than from a factor-of-safety deterministic approach, as it has been traditionally done. This work presents a risk-based pillar design framework that enables to characterize discontinuities’ effect in pillar strength, as well as accounting for the possible range of stresses that will be acting on pillars. The proposed methodology is based on the integration of stochastic discrete element modeling for pillar strength estimation, and stochastic continuous modeling for pillar stress determination. This approach was evaluated in an underground dipping stone mine. Using the reliability analysis method, results from the stress estimation model were integrated with those obtained from the stochastic DEM approach, thereby enabling the probability of failure estimation for the pillars throughout the mine. Finally, the methodology was validated by comparing numerical modeling results with LiDAR and photogrammetric surveys from the mine. Results from this design framework provide additional decision-making tools to prevent pillar failure from the design stages by reducing uncertainty. The proposed method enables the integration of pillar design into the risk analysis framework of the mining operation, ultimately improving safety by preventing future pillar collapses.
“Lost in the crowd”: ethical concerns in crowdsourced evaluations of LLMs
Authors: Cheong Marc , Bush Gabby , Wildenauer Michael
Published: February 2025

With the acceleration of Large Language Model (LLM) use by the public, there is an urgent need to make sure the downstream effects have beneficial impacts on humans and society. Therefore, there is an increasing push for ethical evaluation of LLMs to look for potential bias, toxic behaviour, and misinformation. Thus, crowdsourcing has become a popular practice, such as OpenAI’s 2023 Evals initiative. Firstly, by reviewing the literature from software development and ethics, we wish to highlight several cautions on applying the crowdsourcing model to LLMs: including participant self-selection and non-representativeness; the diffusion of responsibility effect including ethics washing and burden shifting; and requisition of ‘incentives’ vis-a-vis issues faced by gig workers. Using the Evals GitHub repository as a case study, we study the effectiveness of an expert-driven, voluntary, crowdsourced scheme on GitHub to address socioethical issues in LLMs. This is achieved by evaluating the statistics of crowdsourced contributions on ethical and bias considerations, which pales in comparison to other technical contributions. This commentary hopes to highlight the issues of ethics, equity, and justice in LLM crowdsourcing, drawing upon interdisciplinary literature, and presents open considerations on how we can improve the state of play.
Are We Ready for the Metaverse? Implications, Legal Landscape, and Recommendations for Responsible Development
Authors: Tu Xinyi , de Castro e Silva Bruna
Published: February 2025

The Metaverse, an interconnected, immersive, and persistent multi-user environment blending physical and digital realities, has transformative potential for society but also poses significant risks for individuals, businesses, and the environment. This study addresses the research gap in understanding these multifaceted implications by employing an integrated research approach. Initially, a literature review explores the opportunities and risks presented by the Metaverse. We then focus on risks to six sets of fundamental rights, analyzing existing legal standards and their applicability through doctrinal analysis and socio-legal research. The legal frameworks included in this analysis are the General Data Protection Regulation (GDPR), the Charter of Fundamental Rights of the European Union, the Digital Services Act (DSA), and the EU AI Act (AIA). Finally, to mitigate identified risks, we provide dual-pronged recommendations that combine regulatory measures and technological strategies. The study serves as a white paper, mapping the Metaverse landscape and providing actionable insights for policymakers, industry stakeholders, and technology developers. Our findings emphasize the need for a comprehensive approach that integrates robust regulatory frameworks with cutting-edge technical safeguards to ensure responsible and sustainable Metaverse development.
Luciferase complementation for cellular assays beyond protein–protein interactions
Authors: Kawamura Genki , Ozawa Takeaki
Published: February 2025

Luciferase complementation assays have emerged in 2001 as a useful tool to analyze biological processes through diverse biological assays such as cellular studies and in vivo imaging. The assay has an advantage of wide dynamic ranges, high signal-to-noise ratios, and capability for real-time monitoring of dynamic biological events with a readout of bioluminescence. While it was initially harnessed for detecting protein–protein interactions, biosensors based on luciferase-fragment complementation have achieved significant advancements in their designs, expanding versatility and applicability beyond the initial scope. This review aims to provide a comprehensive overview of designing strategies employed in split luciferase complementation assays and to highlight their diverse bioanalytical applications. Because simple bi-molecular detection of protein–protein interactions by this approach is well-established, this review will focus on introducing diverse sensor designs using the concept of split luciferase complementation.

Graphical abstract
Short- and Long-Term Outcomes of Laparoscopic Spleen-Preserving Distal Pancreatectomy with Splenic Vessel Preservation for Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Single-Center Study
Authors: Cai Yu , Gao Pan , Chen Qiangxin , Chen Zixin , Cheng Ke , Cai He , Cai Yunqiang , Wang Xin , Wu Zhong , Peng Bing
Published: February 2025

Background

Intraductal papillary mucinous neoplasms (IPMN) often coexist with acute or chronic pancreatitis, which can complicate laparoscopic spleen-preserving distal pancreatectomy (LSPDP), especially with splenic vessel preservation (SVP-LSPDP). This study aims to evaluate the safety, feasibility, and long-term outcomes of SVP-LSPDP for IPMN.

Methods

A retrospective study was conducted on IPMN patients who underwent SVP-LSPDP between November 2017 and December 2022. Demographics, surgical outcomes, pathology reports, complication rates, mortality, and follow-up data (as of April 2023) were analyzed.

Results

The study included 21 patients who underwent SVP-LSPDP, with a median age of 62 (range 32–81) years. The operation time, intraoperative blood loss, and postoperative hospital stay were 185.52 ± 68.2 min, 89 ± 88.73 ml, and 9 (range 3–27) days, respectively. The Clavien-Dindo Grade II, Grade III, and Grade B pancreatic fistulas were 4.8%, 0, and 9.5%, respectively, with no fatal cases. The follow-up rate was 100%, with a median follow-up period of 27 (range 6–65) months. All patients survived without tumor recurrence or metastasis. Six patients developed new-onset diabetes after surgery, but exocrine pancreatic insufficiency was not observed in any patient. No patient developed splenic infarction or perigastric varices.

Conclusion

For IPMN cases in the body and tail of the pancreas, SVP-LSPDP is a safe and feasible surgical approach with good short- and long-term outcomes.
More Than Words
Authors: Parkinson Tom , Vyner Luke
Published: February 2025

English language teachers have long recognised pop songs' potential for engaging students and establishing positive classroom environments conducive to language learning. Educational publishers increasingly incorporate music into their coursebooks, including specially commissioned 'ELT songs', whose lyrics feature aspects of target language. This Element explores the phenomenon of ELT songs from the authors' insider perspective as songwriters. It considers the relationship between music and lyrics in songs, what this means for using songs in the language classroom, the historical developments through which ELT songs emerged, and the contexts in which they are written, listened to, and made. Through literature review and reflection, the authors derive a framework of twelve criteria and ten dilemmas to guide ELT songwriting, before applying it in an analysis of their songs and songwriting process. The final section proposes a model for multidisciplinary collaboration between songwriters and non-musician collaborators including authors, teachers, and publishers.
Investigating attitudes towards a changing use of anglicisms in Quebec French
Authors: Bouchard Marie-Eve
Published: February 2025

This article investigates speakers’ attitudes towards the use of anglicisms in Quebec French, particularly verbs. The common practice in Quebec French is to morphologically integrate these anglicisms into the French language (e.g., il m'a ghosté). However, in recent years, some French-speaking Quebecers have been using the unintegrated forms (e.g., il m'a ghost). This change of practice for the use of English-origin verbs is a linguistic innovation that is emerging from young French speakers in the Montreal area (M-E Bouchard 2023a). To investigate attitudes towards the use of anglicisms (integrated and non-integrated forms), 675 French-speaking Quebecers were asked the following open-ended question: Do you have anything to say about the use of anglicisms in Quebec French? The current study consists of a qualitative analysis of the participants’ answers to this specific question. This study has found evidence of linguistic hierarchies between the use of anglicisms that are morphologically integrated and those that are not. The anglicisms that are not morphologically integrated into the French language are perceived by many participants as incorrect and as challenging communication and understanding between users and non-users of the unintegrated forms. Participants associate the use of the unintegrated forms with young people.
Mother's education and early childhood educational care
Authors: Akar Betul , Akyol Pelin , Okten Cagla
Published: February 2025

We analyze the impact of extending mandatory education from five to eight years on mothers’ involvement in early childhood educational activities, using data from the Turkish Time Use Survey. The compulsory education reform substantially increased the likelihood of mothers completing at least middle school (eight years of schooling). However, it had no significant effect on mothers’ time spent on early childhood educational activities, such as reading, playing, and talking to children. Instead, the reform increased mothers’ total time with children, particularly through housework and social activities involving children. These findings suggest that studies linking maternal education to greater time investment in childcare may suffer from omitted variable bias, as unobserved factors like maternal intelligence and values influence both educational attainment and childcare behaviors. Our findings are critical given that nearly half of pre-primary-age children globally are not enrolled in formal education and primarily remain in home settings.
Transformed by Fire: Body Perception in Cremation Burial Practices in Middle Balsas River Basin, Michoacán Tierra Caliente, during the Postclassic Period
Authors: Budziszewski Adam , Gastelum-Strozzi Alfonso , Punzo Díaz José Luis
Published: February 2025

This article explores the cremation burial practices of a pre-Tarascan community at Los Tamarindos, focusing on the perceptions of the bodies of those cremated. To reconstruct this element of mortuary practices in the Middle Balsas River basin during the Postclassic period, we analyzed the thermal alterations, anatomical arrangements, and spatial distribution of cremains within funerary urns. Our findings shed light on the low efficiency of cremation processes, which affect the resistance of cremains to mechanical damage and influences the spatial distribution of cremains in the burials. As a result, we were able to register only one case of an intentional distribution of human remains within a funerary urn: skull fragments were dominant in the upper part of the funerary vessel, with a gradual reduction in favor of the lower limb fragments toward the bottom. We also explored the potential presence of intentional manipulation of human remains in the majority of adult burials, offering new perspectives on cremation mortuary rites during the Middle and Late Postclassic period in the Middle Balsas region.
Friends Are the Cream of Life: Mary Antin and Jessie Sampter’s Religious Creativity
Authors: Gross Rachel B. , Imhoff Sarah
Published: February 2025

American Jewish writers Mary Antin and Jessie Sampter met as teenagers in 1899. Throughout the next four decades, they wrote letters and visited each other, discussing literature, politics, and life. Independently, both women achieved some professional success. Antin’s autobiography, The Promised Land, launched her to national fame, before she withdrew from public life to focus on religious pursuits. Sampter supported Zionist efforts from the United States, then moved to Palestine. Both women experimented with religious thought and intentional communities. Both women were disabled: Antin struggled with her mental and physical health; Sampter also struggled with mental health and had post-polio syndrome.

Drawing on Antin and Sampter’s correspondence with each other and with others, this article argues that their friendship was a crucial part of their subjectivity, their intellectual development, and their religious creativity. Intimacy and relationality were not merely supplementary to the real work of solitary thinkers but key for these women’s intellectual and spiritual development. In studying Antin and Sampter’s friendship, we suggest that studying disabled thinkers provides a lens for all significant friendships, in which each partner admits and permits vulnerability and each brings what they can. Their relationship points us to the importance of analyzing how bodies and vulnerability work in all friendships, and how the interdependence of non-romantic friendships can be essential to women’s creative work as religious thinkers and practitioners. Antin and Sampter’s friendship also demonstrates how religious thought happens within relationships, rather than being solely created by an autonomous, isolated subject.
The Homosocial Gospel: Winnifred Wygal and the Women Couples of the Young Women’s Christian Association of the USA
Authors: Izzo Amanda
Published: February 2025

abstract

In the first decades of the twentieth century, several same-sex couples populated the professional workforce of the Young Women’s Christian Association of the USA (YWCA), one of the largest and most influential US women’s organizations. At the same time, discourses of medicine and law hardened around binary categories of sexual identity, giving rise to the regulation of homosexuality as a pathology and crime. Contesting assumptions that Christianity has historically served to suppress and punish same-sex romance and sexuality, this article investigates how middle-class white women employed by the national administration of the YWCA carved out an institutional space that was at once welcoming to female couples and deeply dedicated to Protestant faith traditions. While the ongoing influence of nineteenth-century ideals of homosocial romantic friendship had considerable influence on this space, an inquiry into the work of the YWCA theologian Winnifred Wygal reveals the ways in which liberal Christianity could be used to authorize, rather than prohibit, love between women in the face of modern frameworks of sexual identity.
Competition Shocks, Rival Reactions, and Stock Return Comovement
Authors: de Bodt Eric , Eckbo B. Espen , Roll Richard W.
Published: February 2025

To protect inframarginal rents, rivals react to competition shocks by increasing product differentiation or lowering costs by standardizing products and production processes. We test these two mutually exclusive reactions by exploiting changes in rivals’ idiosyncratic stock return comovement following significant tariff cuts. While increased product differentiation implies a reduction in return comovement, greater standardization implies the opposite (a comovement increase). Difference-in-differences (DID) tests indicate that tariff cuts cause a significant increase in return comovement—in particular among within-industry “followers.” Treatment effects on cash flows, product counts, similarity scores, and business segment counts further support cost-cutting strategies.
Long-term outcomes of individualised repair in patients with primary pulmonary vein stenosis
Authors: Wang Zhangwei , Yang Yang
Published: February 2025

Objectives:

Primary pulmonary vein stenosis is a rare congenital heart condition and carries a poor prognosis. Various surgical techniques have been introduced to treat primary pulmonary vein stenosis. However, there is no consensus on the optimal approach. This study aimed to evaluate the outcomes of surgical treatment of primary pulmonary vein stenosis, identify the risk factors for pulmonary vein restenosis and reintervention, and determine the optimal strategy for primary pulmonary vein stenosis repair.

Methods:

From December 2008 to December 2023, 64 patients with primary pulmonary vein stenosis undergoing surgical repair in our institution were included [non-sutureless group, n = 42; sutureless group, n = 22]. The Cox proportional hazard model was used to identify risk factors for pulmonary vein restenosis and pulmonary vein restenosis-related reintervention.

Results:

There were three in-hospital deaths and one late death. The survival rates at 1, 5, and 15 years were 91.9%, 84.2%, and 69.8%, respectively, in the whole cohort. Compared with the non-sutureless group, the sutureless group did not significantly improve the long-term survival of primary pulmonary vein stenosis patients (P = 0.484). Pulmonary vein restenosis occurred in 15 patients. Multivariable analysis showed that Involvement of the left inferior pulmonary vein (P < 0.001) was the only independent risk factor for pulmonary vein restenosis, while sutureless repair (P = 0.037) was a protective factor. Pulmonary vein restenosis-related reintervention occurred in 12 patients. On multivariate analysis, three or four pulmonary veins involvement (P = 0.001) and preoperative severity score exceeding 5 (P = 0.050) were found to be independent risk factors associated with pulmonary vein restenosis-related reintervention; however, sutureless repair (P = 0.021) was a protective factor.

Conclusions:

Management of infants with primary pulmonary vein stenosis is challenging. Surgical repair of primary pulmonary vein stenosis can be safely achieved using different techniques, with similar long-term mortality. Compared with non-sutureless repair, sutureless repair was significantly associated with decreased pulmonary vein restenosis and decreased pulmonary vein restenosis-related reintervention, respectively. Preoperative severity score exceeding 5, 3, or 4 pulmonary veins involvement, and left inferior pulmonary vein involvement are independent risk factors for adverse outcomes.
Facing Democratic Challenges: The Role of Civil Society Organizations in the Governance of Genomic Technologies
Authors: Frazzetta Federica , Felicetti Andrea
Published: February 2025

The discovery of CRISPR has fuelled the debate surrounding new genomic techniques (NGTs). This is of paramount importance given their potential impact on societies and ecosystems. Despite early enthusiasm about the potential of NGTs to “democratize” genome editing, it is increasingly evident that their introduction poses substantial challenges from a democratic point of view. Although greater engagement with the public sphere is urgently needed, it is something that is currently not widely studied from a political science standpoint. In this paper we offer an overview of the actors who have mobilized in relation to NGTs, with a particular focus on unduly neglected actors, such as civil society organizations. We also consider the views of those who have made proposals regarding the governance of NGTs more generally. The perspectives of these actors are not easy to reconcile with those of stakeholders, and we reflect on the democratic implications of this aspect.
Abortion, Contraception, and the Comstock Law’s Original Medical Exemption, 1873–1936
Authors: Thompson Lauren MacIvor
Published: February 2025

The Comstock Act of 1873 was not meant to be, nor did it ever function as, a total abortion ban.1 This fact is important to emphasize in our current political moment because those who want to revive the statute have argued that the Comstock Act is an existing (if dormant) law that already bans abortion on a federal level. They have also argued that the law completely outlawed abortion in the past.2 The statute’s legislative and enforcement history, however, tells a different story. It was first and foremost a law about obscenity and sexual purity.3 It contained provisions for outlawing abortion and contraception, but the bill’s author, Anthony Comstock, along with his fellow vice crusaders, were mostly concerned about controlling illicit sexuality and censoring sexual material. From the beginning, the law was inconsistently and less often applied to violations involving abortion and contraception than it was against other forms of obscenity.4
Robert W. McAfee: The Comstock of Chicago
Authors: Zier Magdalene
Published: February 2025

Anthony Comstock is synonymous with the Gilded Age crusade against vice. The 1873 “Act of the Suppression of the Trade in, and Circulation of, Obscene Literature and Articles of Immoral Use” – better known, then and now, as the “Comstock Act” – secured its namesake’s enduring notoriety. Most federal laws with an appellation honor a congressional sponsor, or, in more recent years, a victim of the issue that the law aims to address. Only the Comstock Act memorializes a man who was both the chief civilian proponent of its passage and the government bureaucrat tasked with its enforcement.1
A Cys-2088-Arg mutation in ACCase confers cross-resistance to ACCase-inhibiting herbicides in barnyard grass (Echinochloa crus-galli)
Authors: Hu Wei , Li Yuguo , Zhao Chaowei , Zhang Liya , Ma Yumeng , Gao Quan , Cao Haiqun , Liao Min
Published: February 2025

Barnyardgrass [Echinochloa crus-galli (L.) P. Beauv.] is a dominant weed species occurring in rice fields across China. Metamifop, a common herbicide, is frequently applied to control E. crus-galli and other grassy weeds in rice fields. Herein, HS01, an E. crus-galli population suspected to be resistant (R) to metamifop, was collected from Hanshan County in Anhui Province. Whole-plant dose-response testing revealed that, compared with the susceptible (S) population FD03, HS01 had developed high-level resistance to metamifop with a resistance index (RI) of 11.76 and showed cross-resistance to cyhalofop-butyl (RI=9.33), fenoxaprop-P-ethyl (RI=5.80) and clethodim (RI=3.24). Gene sequencing revealed a Cys-2088-Arg mutation in ACCase 1,5 allele of all the R plants, while ACCase gene overexpression was not involved in the resistance. Molecular docking indicated that the less negative binding energies might be the main reason for the resistance of HS01 to ACCase-inhibiting herbicides. A derived cleaved amplified polymorphic sequence (dCAPS) method was developed for the rapid identification of the Cys-to-Arg mutation in the ACCase gene at codon position 2088 in E. crus-galli. Additionally, pretreatment with the cytochrome P450 inhibitor piperonyl butoxide or the glutathione S-transferase inhibitor 4-chloro-7-nitrobenzoxa-diazole had no significant effects (p> 0.05) on the resistance of HS01 to metamifop. To our knowledge, this is the first report of a Cys-2088-Arg mutation in E. crus-galli ACCase that confers cross-resistance to ACCase-inhibiting herbicides.
Short‐Term Associations Between Ambient Ozone and Acute Myocardial Infarction Onset Among Younger Patients: Results From the VIRGO Study
Authors: Zhang Siqi , Chu Lingzhi , Lu Yuan , Wei Jing , Dubrow Robert , Chaudhry Sarwat I. , Spatz Erica , Krumholz Harlan , Chen Kai
Published: February 2025

The association between ambient ozone (O3) and acute myocardial infarction (AMI) onset is unclear, particularly for younger patients and AMI subtypes. This study examined the short‐term association of O3 with AMI onset in patients aged 18–55 years and explored differences by AMI subtypes and patient characteristics. We analyzed 2,322 AMI patients admitted to 103 US hospitals (2008–2012). Daily maximum 8‐hr O3 concentrations estimated using a spatiotemporal deep learning approach were assigned to participants' home addresses. We used a time‐stratified case‐crossover design with conditional logistic regression to assess the association between O3 and AMI, adjusting for fine particulate matter, air temperature, and relative humidity. We conducted stratified analyses to examine associations for AMI subtypes and effect modification by sociodemographic status, lifestyle factors, and medical history. An interquartile range (16.6 ppb) increase in O3 concentrations was associated with an increased AMI risk at lag 4 days (odds ratio [OR] = 1.21, 95% confidence interval [CI]: 1.08–1.34) and lag 5 days (OR = 1.11, 95% CI: 1.00–1.24). The association was more pronounced for non‐ST‐segment elevation AMI and type 2 AMI compared with ST‐segment elevation AMI and type 1 AMI, respectively. Stronger O3‐AMI associations were observed in non‐Hispanic Blacks than in non‐Hispanic Whites. Our study provides evidence that short‐term O3 exposure is associated with increased AMI risk in younger patients, with varying associations across AMI subtypes. The effect modification by race/ethnicity highlights the need for population‐specific intervention strategies.
Improved prognosis of advanced-stage extranodal NK/T-cell lymphoma: results of the NKEA-Next study
Authors: Fujimoto Ayumi , Miyazaki Kana , Yakushijin Kimikazu , Fujino Takahiro , Munakata Wataru , Ejima Yasuo , Maruyama Dai , Kubota Nobuko , Maeda Takeshi , Takizawa Jun , Hiramoto Nobuhiro , Takeuchi Masahiro , Sakai Rika , Fukuhara Noriko , Taguchi Senzo , Asano Naoko , Yamaguchi Motoko , Suzuki Ritsuro
Published: February 2025

A retrospective study of extranodal natural killer/T-cell lymphoma (ENKL) patients diagnosed between 2014 and 2021 in Japan was conducted. Among 351 patients with sufficient data, 116 (33%) were in the advanced stage (5 in stage III and 111 in stage IV) at diagnosis, and were further analyzed. The median age was 60 years (range: 19–90), and 68 (59%) were male. Ninety-four (85%) of stage IV patients had two or more extranodal involvements. The most common first-line regimen was SMILE (steroid, methotrexate, ifosfamide, L-asparaginase, and etoposide; 52%). The 2-year overall survival (OS) for all patients was 38.5%, which was significantly improved after 2017 (25.2% for 2014–2017 vs. 50.7% for 2018–2021; P = 0.008). Patients treated with SMILE showed better OS than those treated with DeVIC or CHOP (2y-OS: 57.1%, 35.8%, and 0%, respectively; P < 0.001). The prognosis was significantly better in patients who received hematopoietic stem cell transplantation (HSCT) than in those who did not (2-year OS: 68.3% vs. 17.6%, P < 0.001). Multivariate analysis showed SMILE and HSCT were significant factors for OS. In conclusion, the prognosis of advanced-stage ENKL has improved in recent years. The L-asparaginase-containing chemotherapy and subsequent HSCT is considered the recommended strategy.
Deletion of 17p in cancers: Guilt by (p53) association
Authors: van Kampen Francisca , Clark Abigail , Soul Jamie , Kanhere Aditi , Glenn Mark A. , Pettitt Andrew R. , Kalakonda Nagesh , Slupsky Joseph R.
Published: February 2025

Monoallelic deletion of the short arm of chromosome 17 (del17p) is a recurrent abnormality in cancers with poor outcomes. Best studied in relation to haematological malignancies, associated functional outcomes are attributed mainly to loss and/or dysfunction of TP53, which is located at 17p13.1, but the wider impact of deletion of other genes located on 17p is poorly understood. 17p is one of the most gene-dense regions of the genome and includes tumour suppressor genes additional to TP53, genes essential for cell survival and proliferation, as well as small and long non-coding RNAs. In this review we utilise a data-driven approach to demarcate the extent of 17p deletion in multiple cancers and identify a common loss-of-function gene signature. We discuss how the resultant loss of heterozygosity (LOH) and haploinsufficiency may influence cell behaviour but also identify vulnerabilities that can potentially be exploited therapeutically. Finally, we highlight how emerging animal and isogenic cell line models of del17p can provide critical biological insights for cancer cell behaviour.
Small molecule-mediated inhibition of the oxidoreductase ERO1A restrains aggressive breast cancer by impairing VEGF and PD-L1 in the tumor microenvironment
Authors: Varone Ersilia , Retini Michele , Cherubini Alessandro , Chernorudskiy Alexander , Marrazza Alice , Guidarelli Andrea , Cagnotto Alfredo , Beeg Marten , Gobbi Marco , Fumagalli Stefano , Bolis Marco , Guarrera Luca , Barbera Maria Chiara , Grasselli Chiara , Bleve Augusto , Generali Daniele , Milani Manuela , Mari Michele , Salmona Mario , Piersanti Giovanni , Bottegoni Giovanni , Broggini Massimo , Janssen-Heininger Yvonne M. W. , Cho Jaehyung , Cantoni Orazio , Zito Ester
Published: February 2025

Cancer cells adapt to harsh environmental conditions by inducing the Unfolded Protein Response (UPR), of which ERO1A is a mediator. ERO1A aids protein folding by acting as a protein disulfide oxidase, and under cancer-related hypoxia conditions, it favors the folding of angiogenic VEGFA, leading tumor cells to thrive and spread. The upregulation of ERO1A in cancer cells, oppositely to the dispensability of ERO1A activity in healthy cells, renders ERO1A a perfect target for cancer therapy. Here, we report the upregulation of ERO1A in a cohort of aggressive triple-negative breast cancer (TNBC) patients in which ERO1A levels correlate with a higher risk of breast tumor recurrence and metastatic spread. For ERO1A target validation and therapy in TNBC, we designed new ERO1A inhibitors in a structure-activity campaign of the prototype EN460. Cell-based screenings showed that the presence of the Micheal acceptor in the compound is necessary to engage the cysteine 397 of ERO1A but not sufficient to set out the inhibitory effect on ERO1A. Indeed, the ERO1 inhibitor must adopt a non-coplanar rearrangement within the ERO1A binding site. I2 and I3, two new EN460 analogs with different phenyl-substituted moieties, efficiently inhibited ERO1A, blunting VEGFA secretion. Accordingly, in vitro assays to measure ERO1A engagement and inhibition confirmed that I2 and I3 bind ERO1A and restrain its activity with a IC50 in a low micromolar range. EN460, I2 and I3 triggered breast cancer cytotoxicity while specifically inhibiting ERO1A in a dose-dependent manner. I2 more efficiently impaired cancer-relevant features such as VEGFA secretion and related cell migration. I2 also acted on the tumor microenvironment and viability of xenografts and syngeneic TNBC. Thus, small molecule-mediated ERO1A pharmacological inhibition is feasible and promises to lead to effective therapy for the still incurable TNBC.