bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristic analysis of a controlled-clearance piston-cylinder assembly up to 1500 MPa using a finite element method
Authors: Liu Chunguang , Wang Can , Zhang Zhongli , Lin Zhenghao , Feng Miaolin
Published: September 2023

We utilized numerical methods to analyze the characteristics of the piston-cylinder assembly of a controlled-clearance piston gauge. The piston gauge was able to measure liquid pressure from 100 MPa to 1500 MPa with the relative expanded uncertainty of 0.02% (k = 3). We established a finite element model to solve the stress and strain of the structural problem. The effective areas were calculated based on Dadson’s formula using the converged solutions of the clearance and the pressure distribution within the distorted piston-cylinder engagement gap that were iteratively determined by the finite element model and a fluid mechanics model with pressure-dependent fluid’s properties. Results were compared to the effective areas calculated by the modified Heydemann–Welch model based on experimental data, and the relative differences were less than 0.02%. We found sharp declines of the clearance and pressure distribution near the exit of the piston-cylinder engagement gap, which may lead to wearing during long-time operation at high pressures. Numerical results indicated non-linear relationship between jacket pressure and the cubic root of piston fall speed, which was traditionally considered as linear. The stall jacket pressure obtained by cubic (instead of linear) fitting extrapolation was found more close to the ones determined directly by the finite element model. Numerical results also found non-linear relationships among jacket pressure, measuring pressure, jacket pressure distortion coefficient.
Excitation of quantum oscillator by electromagnetic wavelet pulses
Authors: Astapenko V A , Bergaliev T K
Published: October 2023

The excitation of a quantum oscillator at transitions between stationary states by wavelet pulses with zero and nonzero area as a function of their duration and amplitude is studied. The excitation from the ground state is examined in detail, together with the specific features of this process during excitation from excited states. Analytical expressions for the main characteristics of excitation probability under weak and strong perturbation of quantum oscillator were obtained within limits of strict consideration. Particularly, it was found that, on a qualitative and quantitative level, there is no difference between excitation by pulses with zero and non-zero area.
Time-warping invariant quantum recurrent neural networks via quantum-classical adaptive gating
Authors: Nikoloska Ivana , Simeone Osvaldo , Banchi Leonardo , Veličković Petar
Published: October 2023

Adaptive gating plays a key role in temporal data processing via classical recurrent neural networks (RNNs), as it facilitates retention of past information necessary to predict the future, providing a mechanism that preserves invariance to time warping transformations. This paper builds on quantum RNNs (QRNNs), a dynamic model with quantum memory, to introduce a novel class of temporal data processing quantum models that preserve invariance to time-warping transformations of the (classical) input-output sequences. The model, referred to as time warping-invariant QRNN (TWI-QRNN), augments a QRNN with a quantum–classical adaptive gating mechanism that chooses whether to apply a parameterized unitary transformation at each time step as a function of the past samples of the input sequence via a classical recurrent model. The TWI-QRNN model class is derived from first principles, and its capacity to successfully implement time-warping transformations is experimentally demonstrated on examples with classical or quantum dynamics.
Social progressivism: toward democracy in society
Authors: Zack Naomi
Published: September 2023

This chapter tackles the concept of social progressivism. Nineteenth-century moral progressivism was significant for the expansion of democratic government to democratic society. Political morality also contributes to new conceptions of democracy by extending democracy from government structure to societal reorganization toward equality. Meanwhile, 20th-century social progressivism relies on the optimism of bettering the lives of those disadvantaged in society. The chapter discusses the theories of progress proposed by Thomas Hobbes, David Hume, Adam Smith, Immanuel Kant, G. W. F. Hegel, Jeremy Bentham, John Stuart Mill, and Karl Marx. Key social movements of the abolition of slavery and women’s suffrage are also considered.
Nelson Mandela: A Very Short Introduction
Authors: Boehmer Elleke
Published: September 2023

Nelson Mandela: A Very Short Introduction outlines the long trajectory of the life of Nelson Mandela. It also considers images, narratives, politics, and more critical revisionist literature on Mandela in an effort to create the iconic image of Mandela. Mandela’s life greatly coincides with the historical and political context of the struggle against apartheid in South Africa and the post-apartheid period of difficult reconciliation. The VSI features the character and achievements of Mandela through the perspective of his influences, interests, and leading ideas. It explores the literature responding to Mandela’s death in 2013 and the subsequent legacy he left behind.
Influences and interactions
Authors: Boehmer Elleke
Published: September 2023

This chapter tackles the cultural and political influences, traditions of thought and activism in Nelson Mandela’s political life. It also considers his growing susceptibility to arguments in favour of active or armed resistance by Algeria-based anti-colonialist Frantz Fanon and the revolutionary elements within the South African Communist Party (SACP). Mandela and his generation were products of a remarkable period of black intellectual flowering in southern Africa. Religious institutions then became entirely responsible for the education of blacks and encouraged the ideas of social duty and modern belief in the autonomous self. The chapter notes how Mandela’s commitment to extending black self-representation through mass political mobilization inevitably raises the question of his affiliation to African American and Pan-African traditions of political thought.
Sophiatown sophisticate
Authors: Boehmer Elleke
Published: September 2023

This chapter focuses on the cultural vibrancy of Sophiatown that influenced Nelson Mandela. It explains how Mandela fused the Edwardian style and the self-control of his school upbringing to achieve a vision of positive success. Moreover, Mandela was exposed to the compelling images of African American self-assertion from film and jazz and the edgy defensiveness of African nationalist machismo. The chapter highlights the significance of the Drum magazine, referencing how it communicated and represented role models for the target black bourgeois audience. It explains how Mandela developed the dynamism that allowed him to override the feelings of self-alienation and burst into the modern present.
Masculine performer
Authors: Boehmer Elleke
Published: September 2023

This chapter expounds on the breathtaking abilities of Nelson Mandela as a performer and manipulator of images. It then considers how his performances affected the political vision of the African National Congress (ANC). Mandela keenly embraced the precept of political success meant transmitting a more humanly convincing message than one’s rival. The chapter then elaborates on Mandela’s awareness of his iconic status as if it were itself an expression of his politics and his projection of consistently masterful masculinity with sensitivity and feeling. It explains how Mandela’s life may be interpreted as a model for African upward mobility and political success.
Tailored pre-procedural management and four-clip trans-catheter edge-to-edge repair procedure to efficiently treat torrential tricuspid regurgitation: a case report
Authors: Dreyfus Julien , Nakache Ariel , Nejjari Mohammed
Published: September 2023

Background

The use of trans-catheter treatment for tricuspid regurgitation (TR) is currently increasing, especially trans-catheter edge-to-edge repair (TEER). However, patients with very large coaptation gaps are usually considered not eligible for this treatment.

Case summary

We present the case of an 87-year-old man with symptomatic [New York Heart Association (NYHA) functional Class IV, right-sided heart failure signs] isolated torrential TR due to chronic atrial fibrillation who was initially considered not eligible for a tricuspid valve (TV) TEER because of a very large coaptation gap. A leadless pacemaker was implanted, and the patient received high doses of intravenous diuretics at home during 2 months. After heart team discussion, he was then considered suitable for a TEER procedure. A ‘zipping’ technique was performed, with the implantation of four TriClip devices, based on the anatomy of the TV and guided by fluoroscopy and bi- and tri-dimensional trans-oesophageal echocardiography, allowing an excellent procedural result (mild TR and mean TV gradient = 1 mmHg). At 6 months, TR was still mild, the patient reported a remarkable improvement (NYHA I, no heart failure signs), and 6-min walk test increased from 260 to 375 m.

Discussion

This case underscores the need for heart valve centres with dedicated and experienced teams and networks of care to adequately manage patients with severe TR from pre-procedural choice of cardiac pacing type and optimization of diuretic therapy to customized interventions with appropriate number and location of clips according to the anatomy of the valve and the mechanism of TR, guided by high-quality bi- and tri-dimensional echocardiography.
Transcatheter mitral valve implantation using the Tendyne valve in a patient with prior transcatheter aortic valve implantation: a case report
Authors: Shah Muhammad Azam , Almahrous Najeeb , Alreshidan Mohammed , Alshehri Halia Zain
Published: September 2023

Background

The presence of aortic and mitral disease in a patient who is not a suitable candidate for surgical correction poses significant challenges in the diagnostic workup as well as management plans. Percutaneous treatment can be staged to fix the aortic valve with transcatheter aortic valve implantation (TAVI) as a first step, followed by reassessment and percutaneous correction of mitral regurgitation (MR).

Case summary

A 65-year-old female with multiple co-morbidities presented with acute coronary syndrome and heart failure. She was diagnosed with three-vessel coronary artery disease and degenerative low-flow low-gradient severe aortic stenosis, along with severe degenerative MR with a left ventricular ejection fraction of 35%. Because of the high surgical risk, she underwent multi-vessel percutaneous coronary intervention with stenting. Transcatheter aortic valve implantation was done as a staged procedure, which partially improved her symptoms. Mitral regurgitation was not suitable for percutaneous mitral valve edge-to-edge repair. After a discussion by the heart team, she underwent transcatheter mitral valve implantation, for which the Tendyne mitral valve (Tendyne™; Abbott) was used through a transapical approach. There was no paravalvular leak, and the mean gradient across the valve was 2 mmHg. She was symptomatically better at follow-up and an echocardiogram showed a normally functioning aortic valve and Tendyne mitral valves.

Discussion

Transapical transcatheter mitral valve implantation using the Tendyne valve is a feasible option for patients with prior TAVI. This can be considered an alternative treatment for MR in patients who are not suitable for edge-to-edge mitral repair.
Diverging pathways: the effects of initial legal status on immigrant socioeconomic and residential outcomes in France
Authors: Lai Tianjian , McAvay Haley , Safi Mirna
Published: September 2023

Drawing on a unique, large-sample survey from France, Trajectories and Origins (TeO), this article provides an empirical assessment of the effects of migrants’ initial legal status on socioeconomic attainment focusing on three outcomes: household income, neighbourhood disadvantage, and concentration in immigrant neighbourhoods. Legal status effects are identified using a twofold strategy. First, our data comprise an exceptionally rich set of information on premigratory characteristics, which allows us to disentangle the effect of initial legal status from migratory selection processes. Furthermore, we implement an instrumental variable design to correct for the endogeneity of initial legal status. Findings show that some of the initial legal status effect is due to selection, whether measured by observable premigratory characteristics or other unobservable variables. Nonetheless, we also find robust evidence that refugees durably face socioeconomic disadvantage in terms of income and are more likely to live in immigrant-dense neighbourhoods. We discuss how these findings contribute both empirically and theoretically to the literature on the civic stratification of migrants’ pathways: first, by highlighting that we should disentangle the long-term civic stratification mechanisms from sorting into legal status categories, and second, by stressing that the theory should be more specific about which legal status categories are decisive in creating hierarchies between migrants.
An end-member modelling approach to pseudo-Thellier palaeointensity data
Authors: van Grinsven Liz , van Leeuwen Tristan , de Groot Lennart V
Published: October 2023

Absolute palaeointensities are notoriously hard to obtain, because conventional thermal Thellier palaeointensity experiments often have low success rates for volcanic samples. The thermal treatments necessary for these experiments potentially induce (magnetic) alteration in the samples, preventing a reliable palaeointensity estimate. These heating steps can be avoided by pseudo-Thellier measurements, where samples are demagnetized and remagnetized with alternating fields. However, pseudo-Thellier experiments intrinsically produce relative palaeointensities. Over the past years, attempts were made to calibrate pseudo-Thellier results into absolute palaeointensities for lavas by mapping laboratory induced anhysteretic remanent magnetizations (ARMs) to the thermally acquired natural remanent magnetizations (NRMs). Naturally occurring volcanic rocks, however, are assemblages of minerals differing in grain size, shape and chemistry. These different minerals all have their own characteristic mapping between ARMs and thermal NRMs. Here, we show that it is possible to find these characteristic mappings by unmixing the NRM demagnetization and the ARM acquisition curves into end-members, with an iterative method of non-negative matrix factorization. In turn, this end-member modelling approach (EMMA) allows for the calculation of absolute palaeointensities from pseudo-Thellier measurements. We tested our EMMA using a noise-free numerical data set, yielding a perfect reconstruction of the palaeointensities. When adding noise up to levels beyond what is expected in natural samples, the end-member model still produces the known palaeointensities well. In addition, we made a synthetic data set with natural volcanic samples from different volcanic edifices that were given a magnetization by heating and cooling them in a controlled magnetic field in the lab. The applied fields ranged between 10 and 70 µT. The average absolute difference between the calculated palaeointensity and the known lab field is around 10 µT for the models with 2–4 end-members, while the palaeointensity of almost all flows can be retrieved within a deviation of ±20 µT. The deviations between the palaeointensities and the known lab fields are almost Gaussian distributed around the expected values. Although the two data sets in our study show that there is potential for using this end-member modelling technique for finding absolute palaeointensities from pseudo-Thellier data, these synthetic data sets cannot be directly related to natural samples. Therefore, it is necessary to compile a data set of known palaeointensities from different volcanic sites that recently cooled in a known magnetic field to find the universal end-members in future studies.
Mixed Norm l2 Decoupling for Paraboloids
Authors: Dasu Shival , Jung Hongki , Li Zane Kun , Madrid José
Published: September 2023

We prove the sharp mixed norm $(l^{2}, L^{q}_{t}L^{r}_{x})$ decoupling estimate for the paraboloid in $d + 1$ dimensions.
A New Molecular Phylogeny of Salps (Tunicata: Thalicea: Salpida) and the Evolutionary History of Their Colonial Architecture
Authors: Damian-Serrano A , Hughes M , Sutherland K R
Published: September 2023

Synopsis

Salps are marine pelagic tunicates with a complex life cycle, including a solitary and colonial stage composed of asexually budded individuals. These colonies develop into species-specific architectures with distinct zooid orientations, including transversal, oblique, linear, helical, and bipinnate chains, as well as whorls and clusters. The evolutionary history of salp colony architecture has remained obscured due to the lack of an ontology to characterize architectures, as well as a lack of phylogenetic taxon sampling and resolution of critical nodes. We (1) collected and sequenced eight species of salps that had never been sequenced before, (2) inferred the phylogenetic relationships among salps, and (3) reconstructed the evolutionary history of salp colony architecture. We collected salp specimens via offshore SCUBA diving, dissected tissue samples, extracted their DNA, amplified their 18S gene, and sequenced them using Sanger technology. We inferred the phylogeny of Salpida based on 18S using both Maximum Likelihood and Bayesian approaches. Using this phylogeny, we reconstructed the ancestral states of colony architecture using a Bayesian ordered Markov model informed by the presence and absence of specific developmental mechanisms that lead to each architecture. We find that the ancestral salp architecture is either oblique or linear, with every other state being derived. Moreover, linear chains have evolved independently at least three times. While transversal chains are developmentally basal and hypothesized to be ancestral, our phylogenetic topology and reconstructions strongly indicate that they are evolutionarily derived through the loss of zooid torsion. These traits are likely critical to multijet locomotory performance and evolving under natural selection. Our work showcases the need to study the broader diversity of salp species to gain a comprehensive understanding of their organismal biology, evolutionary history, and ecological roles in pelagic ecosystems.
Government Ownership of IMF Conditionality Programs: Conceptualization, Measurement, and Validation
Authors: Konstantinidis Nikitas , Reinsberg Bernhard
Published: September 2023

The shifting emphasis on performance evaluation and accountability in the context of financial lending or foreign-aid arrangements sponsored by international organizations (IOs) has brought to the fore the question of government ownership of reforms. While the concept of ownership has featured highly in academic and policy debates over the effects of IO conditionality, it arguably remains theoretically elusive, ill-identified, and under-specified. In this article, we focus on International Monetary Fund (IMF) programs and define government ownership with respect to the counterfactual level of de jure structural reforms that would be achieved in the absence of IMF conditionality. We then use the synthetic control method to identify continuous levels of ownership as a function of a treatment effect on treated compliers and operationalize the concept of ownership over external- and financial-sector conditionality across a restricted sample of uninterrupted IMF arrangements (1980–2014). Furthermore, we probe the criterion and construct validity of our measure with respect to known determinants, proxies, and outcomes of ownership. We argue that ours is a reliable, replicable, valid, robust, and systematic measure of ownership that can help better identify and estimate the indirect relationship between program design and policy implementation.
Selective prediction for extracting unstructured clinical data
Authors: Swaminathan Akshay , Lopez Ivan , Wang William , Srivastava Ujwal , Tran Edward , Bhargava-Shah Aarohi , Wu Janet Y , Ren Alexander L , Caoili Kaitlin , Bui Brandon , Alkhani Layth , Lee Susan , Mohit Nathan , Seo Noel , Macedo Nicholas , Cheng Winson , Liu Charles , Thomas Reena , Chen Jonathan H , Gevaert Olivier
Published: September 2023

Objective

While there are currently approaches to handle unstructured clinical data, such as manual abstraction and structured proxy variables, these methods may be time-consuming, not scalable, and imprecise. This article aims to determine whether selective prediction, which gives a model the option to abstain from generating a prediction, can improve the accuracy and efficiency of unstructured clinical data abstraction.

Materials and Methods

We trained selective classifiers (logistic regression, random forest, support vector machine) to extract 5 variables from clinical notes: depression (n = 1563), glioblastoma (GBM, n = 659), rectal adenocarcinoma (DRA, n = 601), and abdominoperineal resection (APR, n = 601) and low anterior resection (LAR, n = 601) of adenocarcinoma. We varied the cost of false positives (FP), false negatives (FN), and abstained notes and measured total misclassification cost.

Results

The depression selective classifiers abstained on anywhere from 0% to 97% of notes, and the change in total misclassification cost ranged from −58% to 9%. Selective classifiers abstained on 5%–43% of notes across the GBM and colorectal cancer models. The GBM selective classifier abstained on 43% of notes, which led to improvements in sensitivity (0.94 to 0.96), specificity (0.79 to 0.96), PPV (0.89 to 0.98), and NPV (0.88 to 0.91) when compared to a non-selective classifier and when compared to structured proxy variables.

Discussion

We showed that selective classifiers outperformed both non-selective classifiers and structured proxy variables for extracting data from unstructured clinical notes.

Conclusion

Selective prediction should be considered when abstaining is preferable to making an incorrect prediction.
Definitive radiotherapy for nasopharyngeal carcinoma in Japan: analysis of cases in the National Head and Neck Cancer Registry from 2011 to 2014
Authors: Koide Yutaro , Kodaira Takeshi , Kitayama Megumi , Kawakita Daisuke , Kirita Tadaaki , Yoshimoto Seiichi , Nakamizo Munenaga , Nibu Ken-Ichi
Published: October 2023

Objective

This study aimed to analyze the nationwide prognosis of patients with nasopharyngeal carcinoma who underwent definitive radiotherapy in Japan, utilizing the National Head and Neck Cancer Registry data.

Methods

A total of 741 patients diagnosed with primary nasopharyngeal carcinoma were screened from 2011 to 2014. The inclusion criteria were histologically proven nasopharyngeal squamous cell carcinoma, receiving definitive radiotherapy, and no distant metastases. Patients with unclear prognoses or unknown staging were excluded. The primary endpoint was 5-year overall survival, and secondary endpoints were 5-year progression-free survival and survival by stage.

Results

A total of 457 patients met the inclusion criteria. The median age was 60 years, and 80% were male. The proportions of patients with performance status 0, 1, 2 and 3 were 69, 10, 1 and 1%, respectively. Chemoradiotherapy was administered to 84.7%. Radiotherapy modalities were recorded only for 29 patients (three received intensity-modulated radiotherapy and 26 received two/three-dimensional radiotherapy). Of those included, 7.4, 24.7, 35.7, 24.5 and 7.7% had Stage I, II, III, IVA and IVB disease, respectively. The 5-year overall survival was 72.5% for all patients: 82.6, 86.6, 76.0, 51.4 and 66.5% for Stage I, II, III, IVA and IVB disease, respectively. The 5-year progression-free survival was 58.6%: 75.6, 66.8, 61.5, 43.7 and 46.5% for Stage I, II, III, IVA and IVB disease, respectively.

Conclusions

This nationwide survey demonstrated favorable prognoses and provided valuable foundational data for similar future surveys to monitor the penetration of appropriate treatment and changes in clinical structures based on new evidence.
Observed decreasing trend in pan evaporation in a tropical rainforest region during 1959–2021
Authors: Jin Yan , Zhang Ying , Yang Xin , Zhang Mou , Guo Xin-Bo , Deng Yun , Hu Yue-Hua , Lu Hua-Zheng , Tan Zheng-Hong
Published: September 2023

Pan evaporation (Epan) is a critical measure of the atmospheric evaporation demand. Analyzing meteorological data from the Tropical Rainforest Comprehensive Meteorological Observation Field in the Xishuangbanna Tropical Botanical Garden (XTBG Meteorological Observing Station) based on physical models is helpful to improve our understanding of the state of the hydrological cycle in the Xishuangbanna tropical rainforest region. In this study, we investigated the long-term trend in Epan using the observation data from 1959 to 2021. Moreover, correlation analyses of Epan were performed, such as trend test, assessment of periodic properties and abrupt change analysis. Then, D20 Epan data and related meteorological data from 1979 to 2008 were used to drive Penman‒Monteith and PenPan models for simulating Epan. The partial derivative attribution method was used to analyze the dominant factors affecting Epan. The results showed that Epan exhibits obvious periodic changes, the 19a is the first primary period. In addition, there was a clear ‘evaporation paradox’ phenomenon in Xishuangbanna. Epan showed a decreasing trend during both 1959–2008 and 2009–2018, and the decreasing trend reached a significant level with a rate of −3.404 mm·a−2 during 1959–2008. Through comparative analysis, the PenPan model was considered more suitable for simulating Epan in Xishuangbanna. In order to identify the main meteorological factors influencing Epan, complete data from the D20 pan monitoring period, namely, 1979–2008, were selected for attribution calculations. The variations in the net radiation and saturated vapor pressure deficit are the main triggers that explain the ‘evaporation paradox’ phenomenon in Xishuangbanna.
Unanticipated Difficult Airway
Authors: Berkow Lauren C.
Published: September 2023

Difficulty with airway management in the perioperative setting remains a challenge for anesthesia providers. Prediction and recognition of risk factors for airway difficulty can allow advance planning and strategies to prevent unanticipated difficulty, but prediction remains a challenge. Once difficulty is encountered, efforts should focus on achieving and maintaining adequate oxygenation and ventilation, to allow time for alternate strategies or awakening the patient. In the emergent setting or a patient in extremis, usually awakening them is not an option, and airway access must be obtained. Supraglottic airway devices can often rescue failed mask ventilation and can also be used as a conduit for intubation after placement. The most experienced providers should perform airway maneuvers whenever possible. In the setting of failed direct laryngoscopy, videolaryngoscopy or flexible bronchoscopic intubation may be successful and should be considered if oxygenation is adequate. If ventilation and/or oxygenation are NOT adequate, it is important not to repeat airway interventions that have failed, and instead move on to another technique. A surgical airway can be lifesaving and should be performed early before hemodynamic instability or cardiac arrest occurs.
Tracheostomy Complications
Authors: Hernandez Matthew , Torres Arturo
Published: September 2023

Tracheostomy is a surgically created airway midline through the neck and into the proximal trachea. This procedure is utilized in patients with prolonged mechanical ventilation and in patients with anticipated difficult airway access. Although the procedure is relatively low risk in regards to cardiovascular status, it can have severe airway complications. When complications occur, they are mostly related to loss of the airway. The approach can be done open or percutaneously, or a combination of both. Both approaches can be done at the bedside, depending on local practices and surgical aptitude. If done in the operating room, then it is commonly performed via an open approach. The choice of approach is usually related to patient body habitus, vascular anatomy, airway anatomy, positioning, or risk of bleeding. The two most dangerous complications are bleeding and loss of the airway. Before a tracheostomy is attempted, there should be adequate advanced airway equipment and practitioners present trained in securing difficult airways. Quick recognition of the causes is essential to prevent life-threatening complications.
Venous Air Embolism
Authors: Nimma Sindhu Reddy , Seubert Christoph Nikolaus
Published: September 2023

Venous air embolism (VAE) is a gas embolism that may quickly lead to cardiovascular collapse if unrecognized or insufficiently treated. VAE is a well-known complication of neurosurgical procedures performed in the sitting position but has also occurred during central venous access, spine surgery, liver resections, penetrating and blunt chest trauma, as well as procedures using pressurized gas sources. VAE is typically an iatrogenic complication that occurs when gas enters the venous system. Two factors that determine morbidity and mortality are the total volume of gas entrained and the rate of gas entrainment. The higher the pressure gradient between the site of air entry and right atrium, the greater the risk for VAE. The clinical presentation of a VAE may range from mild hypotension and respiratory changes to complete cardiovascular collapse. VAE can be detected by noninvasive monitoring such as EtCO2 and precordial doppler. The most sensitive but invasive monitor is transesophageal echocardiography (TEE). If VAE is diagnosed or suspected, prompt treatment should encompass three steps: preventing further air entry, providing hemodynamic support, and decreasing the volume of air already entrained. Given the risk of cardiovascular collapse associated with VAE, clinicians must act in a coordinated manner to mitigate the consequences of entrained air.
Emergent Craniotomy
Authors: Algarra Nelson N. , Brown Taylor
Published: September 2023

Patients present for emergency craniotomy for a variety of reasons: evacuation of blood from a bleeding aneurysm, arteriovenous malformation, stroke or traumatic brain injury, or treatment of malignant edema due to tumor or sequelae of traumatic brain injury. Patients pose a special challenge as they often have comorbid conditions that require special attention. One can expect them to have a full stomach, possible cervical spine injury, increased intracranial pressure, multiorgan trauma, or shock. Patients usually have exhausted the compliance in the cranial vault and the increased pressure compromises vital central nervous system (CNS) functions. Physiologic adaptations to intracranial hypertension help to maintain supplies of oxygen, substrate, and blood flow to vital areas of the CNS. Few guidelines exist to guide the intraoperative management of patients requiring an emergency craniotomy. This chapter presents an organized and cohesive approach to the preparation and intraoperative management of patients requiring emergency craniotomy that follows guidelines developed by the Brain Trauma Foundation for the care of patients in the intensive care unit.
Local Anesthetic Systemic Toxicity (LAST)
Authors: Feldheim Timothy V. , Przkora Rene
Published: September 2023

Local anesthetic systemic toxicity (LAST) is a rare but serious complication that can occur in the setting of patients receiving or having recently received local anesthetics (LAs) for myriad reasons, but most often for nerve blockade. The symptoms of LAST can range from mild, such as drowsiness, perioral numbness, or tinnitus, to severe, involving the central nervous system (CNS) (such as seizure) and cardiovascular system (such as arrhythmia or cardiac arrest), and can even result in patient fatality. Several risk factors place a subset of patients at a higher risk of developing LAST, such as small size, acidosis, and baseline cardiac conduction abnormalities. Careful and vigilant administration can help avoid the complication altogether, such as the use of ultrasound and aspiration prior to injection of LAs. Patients should always be observed with proper monitoring equipment while receiving and after injection of LAs. The treatment for LAST includes prompt recognition of symptoms, securement of the airway, administration of intravenous 20% lipid emulsion, treatment of other symptoms such as pharmacological ablation of seizures if present, advanced cardiac life support if needed, and supportive care as clinically warranted.
The Processes, Skills, and Strategies of Motivational Interviewing
Authors: Meltzer Amelie , Faeder Morgan , Kelly Thomas M.
Published: September 2023

Many healthcare-related interactions develop quickly out of circumstances that cannot be foreseen. This chapter is a guide to the processes, skills, and strategies that you can use to establish rapport with your patients. Often treatment demands rapid judgment and decision-making that includes consideration of conditions that are occurring coincidently with a “primary problem.” This chapter focuses on the importance of trainees maintaining an empathic, even-tempered approach no matter how much their patient may, or may not be “engaging.” The authors demonstrate the importance of trainees paying attention to their own verbal and nonverbal behaviors, such as smiling, making eye contact, and showing that they are paying attention to the patient throughout the visit. The central tenets of the MI process (OARS: open-ended question, affirmations, reflective listening, and summaries) are discussed for bringing about “change talk,” which leads to positive outcomes. Recommendations (tips) on how to work through challenging interviews are included, as well as a two-part clinical vignette that demonstrates initial and follow-up interviews with a patient struggling with pain management.
Motivational Interviewing and Psychiatric Disorders
Authors: Collins Elliot , Goldstein Tina
Published: September 2023

The spirit of Motivational Interviewing (MI) invokes a collaborative effort between practitioners and their patients to achieve meaningful behavioral change. While well known for its broad applications in the field of addiction, MI has also been implemented with a wide variety of populations for whom meaningful behavioral change may be impactful. This includes application with individuals with a range of psychiatric disorders (e.g., affective, psychotic, personality, and developmental disorders), as well as across the developmental spectrum (i.e., children, adolescents, adults, and older adults). Herein we discuss the applications and effectiveness of MI and clinical considerations when implementing MI in psychiatric care. Two clinical vignettes of patients with suicidal behavior and bipolar disorder are presented. We conclude with recommendations for incorporating core MI processes, skills, and strategies to further enhance other effective therapeutic modalities employed with these populations.
Addressing Healthcare Access and Disparities Using Motivational Interviewing
Authors: Oyefusi Vivianne , South-Paul Jeanette
Published: September 2023

Research shows that stress on the individual, household, and even societal levels is a significant contributor to healthcare disparities and may contribute to the exacerbation of existing disease burden. This chapter focuses on accounting for the demographic factors most associated with chronic diseases, including race, ethnicity, gender, sexual orientation, nationality, religion, education, income, geographic location, language spoken, and disability. An assessment of these factors at first contact drives the clinical encounter in a positive or negative direction. The authors review the effects of socioeconomic status, race and ethnicity, gender, and religion on counseling generally, and on the practice of Motivational Interviewing (MI) specifically. Case examples are presented whereby MI is practiced while taking account of these stress factors, and how doing so improves health-related outcomes.
Integration of Motivational Interviewing into the Electronic Health Record and Electronic Communication
Authors: Post Jordon , Gannon Jessica
Published: September 2023

Use of the electronic health record (EHR) has become standard in medical practice over the past 2 decades, with over 80% of physicians in the United States using them in outpatient practice and 96% of nonfederal acute care hospitals deploying a certified EHR according to the Office of the National Coordinator for Health Information Technology in 2019. EHR facilitates and enhances interdisciplinary collaboration and information sharing between all current and future practitioners, as well as with the patient through advanced patient health portals. In this chapter we review strategies for using a Motivational Interviewing (MI)-adherent approach during appointments where EHR is being used. Room set-up is shown to enhance the efficiency of sharing digital information with patients. Emphasis is placed on best-practice regarding documentation of the visit. A sample case vignette is presented whereby the practitioner and patient summarize an appointment and the patient is encouraged to use the patient portal for accessing the practitioner as needed.
Virial black hole mass estimates of quasars in the XQ-100 legacy survey
Authors: Lai Samuel , Onken Christopher A , Wolf Christian , Bian Fuyan , Cupani Guido , Lopez Sebastian , D’Odorico Valentina
Published: October 2023

The black hole (BH) mass and luminosity are key factors in determining how a quasar interacts with its environment. In this study, we utilize data from the European Southern Observatory Large Programme XQ-100, a high-quality sample of 100 X-shooter spectra of the most luminous quasars in the redshift range 3.5 < z < 4.5, and measure the properties of three prominent optical and ultraviolet broad emission lines present in the wide wavelength coverage of X-shooter: C iv, Mg ii, and H β. The line properties of all three broad lines are used for virial estimates of the BH mass and their resulting mass estimates for this sample are tightly correlated. The BH mass range is $\log {(\rm {\mathit{ M}_{BH}}/\rm {M_\odot })} = 8.6{\!-\!}10.3$ with bolometric luminosities estimated from the 3000 Å continuum in the range $\log {(\rm {\mathit{ L}_{bol}}/\rm {erg\, s^{-1}})} = 46.7{\!-\!}48.0$. Robustly determined properties of these quasars enable a variety of follow-up research in quasar astrophysics, from chemical abundance and evolution in the broad-line region to radiatively driven quasar outflows.
Effect of iron and calcium on radiation sensitivity in prostate cancer patients relative to controls
Authors: Dhillon Varinderpal S , Deo Permal , Fenech Michael
Published: October 2023

High intake of red meat and/or dairy products may increase the concentration of iron and calcium in plasma—a risk factor for prostate cancer (PC). Despite our understandings of nutrients and their effects on the genome, studies on the effects of iron and calcium on radiation sensitivity of PC patients are lacking. Therefore, we tested the hypothesis that high plasma levels of iron and calcium could increase baseline or radiation-induced DNA damage in PC patients relative to healthy controls. The present study was performed on 106 PC patients and 132 age-matched healthy individuals. CBMN assay was performed to measure mi-cronuclei (MN), nucleoplasmic bridges (NPBs), and nuclear buds (NBuds) in lymphocytes. Plasma concentrations of iron and calcium were measured using inductively coupled plasma atomic emission spectroscopy. MN, NPBs, and NBuds induced by radiation ex vivo were significantly higher in PC patients with high plasma iron (P = .004, P = .047, and P = .0003, respectively) compared to healthy controls. Radiation-induced MN and NBuds frequency were also significantly higher in PC patients (P = .001 and P = .0001, respectively) with high plasma calcium levels relative to controls. Furthermore, radiation-induced frequency of NBuds was significantly higher in PC patients (P < .0001) with high plasma levels of both iron and calcium relative to controls. Our results support the hypothesis that high iron and calcium levels in plasma increases the sensitivity to radiation-induced DNA damage and point to the need of developing nutrition-based strategies to minimize DNA damage in normal tissue of PC patients undergoing radiotherapy.
Cleavage kinetics of human mitochondrial RNase P and contribution of its non-nuclease subunits
Authors: Vilardo Elisa , Toth Ursula , Hazisllari Enxhi , Hartmann Roland K , Rossmanith Walter
Published: October 2023

RNase P is the endonuclease responsible for the 5′ processing of precursor tRNAs (pre-tRNAs). Unlike the single-subunit protein-only RNase P (PRORP) found in plants or protists, human mitochondrial RNase P is a multi-enzyme assembly that in addition to the homologous PRORP subunit comprises a methyltransferase (TRMT10C) and a dehydrogenase (SDR5C1) subunit; these proteins, but not their enzymatic activities, are required for efficient pre-tRNA cleavage. Here we report a kinetic analysis of the cleavage reaction by human PRORP and its interplay with TRMT10C-SDR5C1 including 12 different mitochondrial pre-tRNAs. Surprisingly, we found that PRORP alone binds pre-tRNAs with nanomolar affinity and can even cleave some of them at reduced efficiency without the other subunits. Thus, the ancient binding mode, involving the tRNA elbow and PRORP’s PPR domain, appears basically retained by human PRORP, and its metallonuclease domain is in principle correctly folded and functional. Our findings support a model according to which the main function of TRMT10C-SDR5C1 is to direct PRORP’s nuclease domain to the cleavage site, thereby increasing the rate and accuracy of cleavage. This functional dependence of human PRORP on an extra tRNA-binding protein complex likely reflects an evolutionary adaptation to the erosion of canonical structural features in mitochondrial tRNAs.
The Challenges of Tobacco Fiscal Policy Implementation in Mexico From the Perspective of Key Actors
Authors: Théodore Florence L , González-Ángeles Livia Roxana , Reynales-Shigematsu Luz Myriam , Saenz-de-Miera Belen , Antonio-Ochoa Erick , Llorente Blanca
Published: October 2023

Introduction

Raising tobacco taxes is considered the most effective strategy to avoid smoking initiation and discourage its use, especially among vulnerable groups. However, few low- and middle-income countries have adopted high tobacco taxes. Raising taxes is, therefore, an opportunity to strengthen and accelerate tobacco control. The objective of this study is to analyze the barriers and facilitators to the tobacco tax increase in Mexico.

Aims and Methods

Based on the Governance Analytical Framework, data were generated through 17 in-depth interviews with key intersectoral actors for fiscal policy. The interviews were transcribed and coded according to Hufty’s theory of governance.

Results

Robust scientific evidence, intersectoral coordination, and the presence of “champions” boosted progress in tobacco control (facilitators). The main barriers were the incomplete implementation of the World Health Organization—Framework Convention on Tobacco Control (WHO-FCTC) and MPOWER package and lack of commitment (“political will”) by government decision makers and legislators, misinformation about the effects of tobacco taxes, and strong tobacco industry interference.

Conclusions

Robust evidence is necessary but not sufficient to advance the implementation of the MPOWER (WHO-FCTC) actions. To achieve tobacco tax increases and public policies that protect people from unhealthy products in general, the implementation of policies or legal frameworks against industry interference in the development of public policies is imperative.

Implications

By analyzing the barriers and facilitators to increasing the tobacco tax in Mexico, this study identifies two key messages: (1) The need to sensitize legislators and the general population to the problem of smoking not only through epidemiological data but also through testimonies that highlight the life experiences and adversities faced by people who smoke. (2) The need for a regulatory framework to prevent industry interference in public affairs and conflicts of interest. The same framework could be very useful for public health policies to control the consumption of ultra-processed food products or alcohol.
Apportionment of Responsibility
Authors: Goudkamp James , Nolan Donal
Published: September 2023

Chapter 4 addresses the consequences of a finding of contributory negligence, and in particular the process of apportionment in which a court engages once the existence of contributory negligence has been established. The discussion begins by looking at how the courts fix the sum of damages to which the claimant would be entitled but for the fact of their contributory negligence, before moving on to some general observations on the apportionment exercise. These are followed by consideration of the criteria of apportionment; aggravating and mitigating factors; guideline discounts; the discounts employed; and apportionment in cases involving multiple defendants and absent tortfeasors.
Related Doctrines
Authors: Goudkamp James , Nolan Donal
Published: September 2023

The fact that the claimant failed to take reasonable care for their own safety or interests may be relevant to doctrines other than that of contributory negligence. These doctrines and their relationship with the law of contributory negligence are discussed in Chapter 5, along with rules (such as those governing contribution between wrongdoers) that are related to the law of contributory negligence in other ways. The related rules considered in this chapter are (i) legal causation (‘novus actus interveniens’), (ii) illegality, (iii) volenti non fit injuria/voluntary assumption of risk, (iv) default of the claimant, (v) contribution between wrongdoers, (vi) the avoidable consequences rule, (vii) provocation, (viii) limitation of actions, and (ix) the principle in Ginty v Belmont Building Supplies Ltd, which excludes claims in breach of statutory duty where the breach was brought about solely by the wrongful conduct of the claimant.
Introduction
Authors: Carlin Ryan E. , Hartlyn Jonathan , Hellwig Timothy , Love Gregory J. , Martínez-Gallardo Cecilia , Singer Matthew
Published: September 2023

This chapter surveys the cross-national research on government popularity, identifying a set of emerging economic and political factors that might be challenging the economy’s role as the chief driver of popular support for democratic governments. Among them the authors highlight economic issues that are newly salient, non-economic issues that compete for the public’s attention, partisan polarization, and populism. They then provide an initial comparison of the link between the economy and government popularity in twenty countries over thirty years. Echoing Paldam thirty years on, the authors show that the relationship varies considerably across countries. Yet they also document substantial variation in the economy–approval relationship within countries over time, which has received much less attention. In most countries considered here, the economy’s effect on approval has weakened over time. In some places, however, its effect has grown over time, while in yet other places the authors observe a declining role for the economy in the first decade of the century only to see a rebound after the Great Recession. This variation sets the stage for the chapters that follow.