bluuebunny/crossref_metadata_2025 huggingface dataset:
Trocar‐site incisional hernia after 8‐mm robotic trocar placement: A prospective study
Authors: Cianfarani Agnese , Mongelli Francesco , Iaquinandi Fabiano , Xhepa Genti , Pini Ramon , Gaffuri Paolo , La Regina Davide
Published: May 2024

Background

The current literature supports the closure of trocar sites ≥10‐mm for the risk of developing incisional hernias, while there is no need to suture the abdominal fascia when using 5‐mm trocars. To date, evidence regarding the closure of 8‐mm trocars that are use by new robotic systems is weak. The aim of our study was to investigate the incidence of incisional hernia for 8‐mm trocars.

Methods

We prospectively collected data on all patients undergoing robotic‐assisted abdominal wall surgery from 2020 to 2023, in whom the abdominal fascia of all 8‐mm trocars was not closed. The enrolled patients underwent a follow‐up visit during which we conducted clinical and sonographic evaluations of all 8‐mm trocars, in addition to assessing the satisfaction levels of the patients. The primary outcome was the incidence of port‐site hernia.

Results

We enrolled 166 patients, 155 men and 11 women, for a total of 513 trocars accessed. Mean age was 61.1 ± 14.0 years, and mean BMI was 27.0 ± 3.9 kg/m2. The follow‐up visits were carried out after a median follow‐up of 14.5 (9.0–23.2) months. Only one case developed an asymptomatic 1 × 1 cm supra‐umbilical hernia that was not treated. Patient reported a satisfaction regarding the 8‐mm trocars and skin sutures of 9.8 ± 0.5 out of 10 points.

Conclusions

The occurrence of a trocar‐site hernia after 8‐mm robotic access is extremely low. Hence, the fascia closure may not be necessary.
Organizing leadership education and learning for liberation
Authors: Harper Jordan
Published: May 2024

This article offers key considerations regarding how leadership educators can alter their relations with institutions and campus community members (e.g., students, faculty, staff) to align with and advance liberatory struggles. The article also explores the drawbacks and contradictions of institutionalizing liberation within leadership learning and education spaces in colleges and universities. The author underscores the significance and immediacy of establishing spaces and advancing discourse outside the contours of institutional higher education where individuals, in collaboration and solidarity, can rehearse, plan, organize, and study the path toward collective liberation and the creation of an otherwise world that has yet to exist.
Equivalent single‐layer Mindlin theory of laminated piezoelectric plates and application
Authors: Lian MengMeng , Fan CuiYing , Qin GuoShuai , Wang BingBing , Lu Chunsheng , Zhao MingHao
Published: May 2024

Based on the Mindlin first‐order shear deformation theory, this paper proposes an equivalent single layer (ESL) plate theory to analyze the electro‐mechanical coupling problem of laminated piezoelectric plates (LPPs). The main features of the proposed approach are: (i) It assumes that the electric potential across the thickness is a polynomial function, ensuring its continuity at the interface. (ii) The electric displacements are continuous at the interface, in line with the interface continuity condition between laminated plates. The theoretical solutions for the deformation and electric potential of LPPs are obtained. The validity and accuracy of the theoretical solutions are confirmed through comparison with results of two‐ and four‐layer LPPs obtained from the three‐dimensional finite element method (FEM). The numerical results discuss the influence of different series expansions and emphasize the necessity of high‐order expansion. Meanwhile, the range of application of three‐dimensional FEM is discussed. It is expected that such a new analytical method can be instructive to the optimal design of piezoelectric device.
Black hole — wormhole transitions in two dimensional string theory
Authors: Betzios Panos , Gaddam Nava , Papadoulaki Olga
Published: May 2024

Abstract

We study charged black hole and wormhole solutions of Type 0A/IIA string theory in two dimensions, by analysing their low energy equations of motion at leading order in α′. There is a competition between Euclidean wormholes and near extremal black holes in the thermodynamic ensemble. In a certain regime of phase space, the former can disassociate into the latter. Since such solutions are of string scale near the wormhole throat that takes an AdS2 form, there is a need for an exact worldsheet description. We discuss relevant WZW coset models which we argue will shed light on this problem. Finally, we present appropriate versions of the Type 0A/IIA matrix quantum mechanics models that are expected to describe these geometries.
Effective potential and vacuum stability in the Litim-Sannino model
Authors: Steudtner Tom
Published: May 2024

Abstract

We revisit the scalar potential in the Litim-Sannino model. We compute for the first time the full quantum corrections to the classical potential and show that they significantly ameliorate the stability analysis at the UV fixed point. The quantum effective potential is computed at two-loop order and the numerical precision is further improved using resummations and parameter optimisations. As a result, we find a consistent widening of the UV conformal window across various approximations.
Fistulektomie mit primärer Sphinkterrekonstruktion bei transsphinktären Analfisteln
Authors: Gassel Laurens , Spiegl Felix , Cira Kamacay , Reischl Stefan , Kim Mia , Ruppert Reinhard , Neumann Philipp-Alexander
Published: May 2024

Hintergrund

In der Behandlung von transsphinktären Analfisteln mittels Fistulektomie und primärer Sphinkterrekonstruktion weist die aktuelle Literatur eine erhebliche Variation in den verfügbaren Daten zu Wirksamkeit und Morbidität auf. Ziel der Studie ist eine systematische Erfassung der Ergebnisse, Komplikationen und Patientenzufriedenheit an einem großen spezialisierten Zentrum.

Methodik

In die Studie wurden alle Patienten eingeschlossen, die im Zeitraum von 2017 bis 2022 an transsphinktären Analfisteln mittels Fistulektomie und direkter Sphinkterrekonstruktion in der München Klinik Neuperlach operiert wurden. Patienten mit Morbus Crohn wurden ausgeschlossen. Neben den unmittelbaren Krankenhausdaten wurde ein Follow-up durchgeführt, das sowohl telefonische als auch schriftliche Befragungen zur Langzeitverfolgung umfasste.

Ergebnisse

Insgesamt wurden innerhalb des Beobachtungszeitraums 601 Patienten an einer Analfistel operiert, von denen 185 Patienten die Einschlusskriterien erfüllten. In einem Follow-up von mindestens 1 Jahr (Median: 4,1 Jahre) konnten noch 143 Patienten befragt werden; zu diesem Zeitpunkt zeigten 79,0 % der Patienten eine gute bis perfekte Kontinenz. 14,7 % berichteten über moderate Inkontinenz und 6,3 % über schwere Inkontinenz. In 8,1 % aller Fälle trat postoperativ eine vollständige Dehiszenz auf. Der Großteil aller Patienten (88,8 %) zeigte keine erneuten Fisteln. 94,4 % aller Patienten erwiesen sich als zufrieden bis sehr zufrieden. Die Gesamtheilungsrate lag bei etwa 90,0 % und unter Berücksichtigung von Revisionen tendierte sie gegen 100 %.

Diskussion

Trotz möglicher Komplikationen weist dieses Verfahren eine äußerst geringe Rezidivrate und einen vergleichbaren Anteil an Inkontinenzproblemen auf. Die hohe Heilungsrate und Patientenzufriedenheit unterstützen den Erfolg dieser Methode. Ein erfahrener Chirurg ist jedoch von entscheidender Bedeutung.
Bias-constrained integer least squares estimation: distributional properties and applications in GNSS ambiguity resolution
Authors: Khodabandeh A. , Teunissen P. J. G.
Published: May 2024

To accommodate the presence of bounded biases in mixed-integer models, Khodabandeh (2022) extended integer estimation theory by introducing a new admissible integer estimator. The estimator follows the principle of integer least squares estimation and is computed via the integer search method of BEAT. In this contribution, we present the probability distributions of a class of estimators to which the proposed bias-constrained integer least squares estimation belongs. Some important interferometric measuring systems, whose estimation problems can be covered by BEAT, are identified. To show the proposed estimator at work, we apply BEAT to the problem of GLONASS single-differenced (SD) ambiguity resolution. Numerical results of several short-baseline datasets are presented to illustrate why one can achieve more accurate positioning solutions when considering between-receiver SD ambiguity resolution for the cases where carrier phase data are captured on frequency-varying signals with bounded SD receiver phase delays.
Antidepressant effects of activation of infralimbic cortex via upregulation of BDNF and β-catenin in an estradiol withdrawal model
Authors: Chen Jiali , Zhou Yiying , Lai Miaojun , Zhang Yanping , Hu Yifang , Zhuang Dingding , Zhou Wenhua , Zhang Yisheng
Published: May 2024

Rationale

Clinical and preclinical studies have demonstrated that estradiol withdrawal after delivery is one of important factors involved in the pathogenesis of postpartum depression (PPD). The infralimbic cortex (IL) is related to anxiety and mood disorders. Whether IL neurons mediate PPD is still unclear.

Objectives

This study was to observe the antidepressant effect and expression of BDNF and β-catenin in IL by allopregnanolone (ALLO) treatment or the selective activation or inhibition of IL neurons using a chemogenetic approach in a pseudopregnancy model of PPD.

Methods

Administration of estradiol combined with progesterone and the abrupt withdrawal of estradiol simulated the pregnancy and early postpartum periods to induce depression in ovariectomized rats. The relative expression levels of β-catenin and BDNF were observed by western blotting.

Results

Immobility time was significantly increased in the forced swim test and open-arm movement was reduced in the elevated plus maze test in the estradiol-withdrawn rats. After ALLO treatment, the immobility time were lower and open-arm traveling times higher than those of the estradiol-withdrawn rats. Meanwhile, the expression level of BDNF or β-catenin in the IL was reduced significantly in estradiol-withdrawn rats, which was prevented by treatment with ALLO. The hM3Dq chemogenetic activation of pyramidal neurons in the IL reversed the immobility and open-arm travel time trends in the estradiol-withdrawal rat model, but chemogenetic inhibition of IL neurons failed to affect this. Upregulated BDNF and β-catenin expression and increased c-Fos in the basolateral amygdala were found following IL neuron excitation in model rats.

Conclusions

Our results demonstrated that pseudopregnancy and estradiol withdrawal produced depressive-like behavior and anxiety. ALLO treatment or specific excitement of IL pyramidal neurons relieved abnormal behaviors and upregulated BDNF and β-catenin expression in the IL in the PPD model, suggesting that hypofunction of IL neurons may be involved in the pathogenesis of PPD.
Investigating the interfacial and bulk rheological properties of emulsions containing dry bean powder
Authors: Aslan Türker Duygu , Göksel Saraç Meryem , Doğan Mahmut
Published: May 2024

This study aimed to investigate the impact of varying proportions of dry bean powder on the rheological properties of oil-in-water emulsions. Emulsions were formulated utilizing xanthan gum or dry bean powder across a range of concentrations, including 1%, 3%, 5%, and 7%. Additionally, a control emulsion (CTR) was formulated using xanthan gum exclusively. The rheological properties of the resulting emulsions, both linear and nonlinear, were characterized. Moreover, the correlation between microstructural attributes and the interfacial rheological response within these emulsion systems was thoroughly examined. A prominent observation was the occurrence of shear thinning, characterized by a reduction in viscosity under applied shear stress. Notably, the control emulsion (CTR) displayed the lowest interfacial viscosity values, whereas emulsions incorporating increasing proportions of dry bean powder demonstrated a proportional rise in interfacial viscosity. The highest consistency coefficient and apparent viscosity was recorded in the 7%DB sample with a value of 3.23 Pa.sn and 0.56 Pa.s, respectively. This suggests that emulsions formulated with dry bean powder may yield a more resilient interfacial film, attributed to the protein content inherent in dry beans. The establishment of a viscoelastic interfacial layer facilitated by dry bean powder in appropriate concentrations significantly contributes to the long-term stability of the emulsion. Unraveling the intricate relationship between interfacial behaviors holds paramount importance in advocating for the utilization of dry bean powder as a plant-based protein source. In conclusion, the incorporation of dry bean powder enhances the formation of interfacial films in O/W emulsions.
Stress Tensor Bounds on Quantum Fields
Authors: Sanders Ko
Published: May 2024

The singular behaviour of quantum fields in Minkowski space can often be bounded by polynomials of the Hamiltonian H. These so-called H-bounds and related techniques allow us to handle pointwise quantum fields and their operator product expansions in a mathematically rigorous way. A drawback of this approach, however, is that the Hamiltonian is a global rather than a local operator and, moreover, it is not defined in generic curved spacetimes. In order to overcome this drawback we investigate the possibility of replacing H by a component of the stress tensor, essentially an energy density, to obtain analogous bounds. For definiteness we consider a massive, minimally coupled free Hermitean scalar field. Using novel results on distributions of positive type we show that in any globally hyperbolic Lorentzian manifold M for any $$f,F\in C_0^{\infty }(M)$$

f
,
F
∈

C
0
∞

(
M
)

with $$F\equiv 1$$

F
≡
1

on $$\textrm{supp}(f)$$

supp
(
f
)

and any timelike smooth vector field $$t^{\mu }$$

t
μ

we can find constants $$c,C>0$$

c
,
C
>
0

such that $$\omega (\phi (f)^*\phi (f))\le C(\omega (T^{\textrm{ren}}_{\mu \nu }(t^{\mu }t^{\nu }F^2))+c)$$

ω

(
ϕ

(
f
)

∗

ϕ

(
f
)

)

≤
C

(
ω

(

T

μ
ν

ren

(

t
μ

t
ν

F
2

)

)

+
c
)

for all (not necessarily quasi-free) Hadamard states $$\omega $$
ω
. This is essentially a new type of quantum energy inequality that entails a stress tensor bound on the smeared quantum field. In $$1+1$$

1
+
1

dimensions we also establish a bound on the pointwise quantum field, namely $$|\omega (\phi (x))|\le C(\omega (T^{\textrm{ren}}_{\mu \nu }(t^{\mu }t^{\nu }F^2))+c)$$

|
ω

(
ϕ

(
x
)

)

|
≤
C
(
ω

(

T

μ
ν

ren

(

t
μ

t
ν

F
2

)

)

+
c
)

, where $$F\equiv 1$$

F
≡
1

near x.
Reliability and validity of the Swedish indicator ‘Drugs that should be avoided in older people’—an appraisal of a set of potentially inappropriate medications
Authors: Parodi López Naldy , Svensson Staffan A. , Lönnbro Johan , Hoffmann Mikael , Wallerstedt Susanna M.
Published: May 2024

Purpose

To analyse the reliability and validity of the Swedish indicator ‘Drugs that should be avoided in older people’.

Methods

From a previous study that included consecutive primary care patients ≥ 65 years of age, all patients ≥ 75 years of age were analysed. Two physicians independently screened their medication lists and medical records, applying the Swedish indicator which includes potentially inappropriate medications (PIMs): long-acting benzodiazepines, drugs with anticholinergic action, tramadol, propiomazine, codeine, and glibenclamide. The clinical relevance of identified PIMs was independently assessed. Thereafter, the physicians determined in consensus whether some medical action related to the drug treatment was medically justified and prioritised before the next regular visit. If so, the drug treatment was considered inadequate, and if not, adequate.

Results

A total of 1,146 drugs were assessed in 149 patients (75‒99 years, 62% female, 0‒20 drugs per patient). In 29 (19%) patients, at least one physician identified ≥ 1 PIM according to the indicator at issue; 24 (16%) patients were concordantly identified with ≥ 1 such PIM (kappa: 0.89). Of 26 PIMs concordantly identified, the physicians concordantly assessed four as clinically relevant and 12 as not clinically relevant (kappa: 0.17). After the consensus discussion, six (4%) patients had ≥ 1 PIM according to the studied indicator that merited action. Using the area under the receiver operating characteristic (ROC) curve, the indicator did not outperform chance in identifying inadequate drug treatment: 0.56 (95% confidence interval: 0.46 to 0.66).

Conclusion

The Swedish indicator has strong reliability regarding PIM detection but does not validly reflect the adequacy of drug treatment.
Joint EANM-SNMMI guideline on the role of 2-[18F]FDG PET/CT in no special type breast cancer
Authors: Vaz Sofia C. , Woll John Patrick Pilkington , Cardoso Fatima , Groheux David , Cook Gary J. R. , Ulaner Gary A. , Jacene Heather , Rubio Isabel T. , Schoones Jan W. , Peeters Marie-Jeanne Vrancken , Poortmans Philip , Mann Ritse M. , Graff Stephanie L. , Dibble Elizabeth H. , de Geus-Oei Lioe-Fee
Published: May 2024

Introduction

There is much literature about the role of 2-[18F]FDG PET/CT in patients with breast cancer (BC). However, there exists no international guideline with involvement of the nuclear medicine societies about this subject.

Purpose

To provide an organized, international, state-of-the-art, and multidisciplinary guideline, led by experts of two nuclear medicine societies (EANM and SNMMI) and representation of important societies in the field of BC (ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA).

Methods

Literature review and expert discussion were performed with the aim of collecting updated information regarding the role of 2-[18F]FDG PET/CT in patients with no special type (NST) BC and summarizing its indications according to scientific evidence. Recommendations were scored according to the National Institute for Health and Care Excellence (NICE) criteria.

Results

Quantitative PET features (SUV, MTV, TLG) are valuable prognostic parameters. In baseline staging, 2-[18F]FDG PET/CT plays a role from stage IIB through stage IV. When assessing response to therapy, 2-[18F]FDG PET/CT should be performed on certified scanners, and reported either according to PERCIST, EORTC PET, or EANM immunotherapy response criteria, as appropriate. 2-[18F]FDG PET/CT may be useful to assess early metabolic response, particularly in non-metastatic triple-negative and HER2+ tumours. 2-[18F]FDG PET/CT is useful to detect the site and extent of recurrence when conventional imaging methods are equivocal and when there is clinical and/or laboratorial suspicion of relapse. Recent developments are promising.

Conclusion

2-[18F]FDG PET/CT is extremely useful in BC management, as supported by extensive evidence of its utility compared to other imaging modalities in several clinical scenarios.
First thin-disk oscillator with ceramic Yb:LuScO3 in comparison to the operation with ceramic Yb:Lu2O3
Authors: Esser Stefan , Jing Wei , Xu Xiaodong , Graf Thomas , Abdou Ahmed Marwan
Published: May 2024

We report on the characterization and first laser operation of ceramic Yb:LuScO3 in a thin-disk oscillator. The optical performance achieved with a ceramic Yb:LuScO3 disk is compared to the one obtained with an existing ceramic Yb:Lu2O3 disk for reference. The characterization covers the measurement of the fluorescence spectra, the fluorescence lifetimes, and nomarsky imaging. The investigation on the laser operation covers the measurement of resonator losses, output powers, and thermal behavior during continuous-wave operation in a multimode thin-disk oscillator. An average output power of 149 W and a slope efficiency of 51.8% were achieved with the ceramic Yb:LuScO3 disk which reached a maximum surface temperature of about 150 °C. At the same temperature level, a disk made of the already established ceramic Yb:Lu2O3 delivered 957 W of output power with a slope efficiency of 75.7%.
Impact of atmospheric rivers on the winter snowpack in the headwaters of Euphrates-Tigris basin
Authors: Ezber Y. , Bozkurt D. , Sen O. L.
Published: May 2024

Understanding the hydrometeorological impacts of atmospheric rivers (ARs) on mountain snowpack is crucial for water resources management in the snow-fed river basins such as the Euphrates-Tigris (ET). In this study, we investigate the contribution of wintertime (December-January–February) ARs to precipitation and snowpack in the headwater regions of the ET Basin for the period of 1979–2019 using a state-of-the-art AR catalog and ERA5 reanalysis data. The results show that AR days in the headwaters region could be warmer by up to 3 °C and wetter by over 5 mm day−1 compared to non-AR days. The contribution of ARs to the total winter precipitation varies from year to year, with a maximum contribution of over 80% in 2010 and an average contribution of 60% over the 40-year period. While snow accumulation on AR days shows spatial variability, the average snow contribution is 27% of the seasonal average, ranging from 12 to 57% for different years. The south-facing parts of the mountain range experience significant snowmelt, with contributions ranging from 15 to 80% for different years. The high total precipitation (60%) and low snowpack (27%) contribution can be attributed to the semi-arid characteristics of the region and the occurrence of rain-on-snow events, where rain falling on existing snow rapidly melts the snowpack. The findings have implications for water resource management and call for continued research to improve our knowledge of ARs and their interactions with the complex terrain of the ET Basin.
Heated humidified high-flow nasal cannula: a new conservative approach for neonatal nasal stenosis
Authors: Havazelet Shany , Stafler Patrick , Zarzur Ihab , Coreanu Tara , Hod Roy , Armoni-Domany Keren , Gilony Dror
Published: May 2024

Purpose

The aim of this study is to evaluate the efficacy of heated humidified high flow nasal cannula (HFNC) therapy as a conservative treatment option for newborns suffering from nasal stenosis, a condition that often leads to respiratory distress and feeding difficulties. Given the increasing utilization of HFNC in various upper and lower respiratory tract indications, characterized by its flow-based mechanism and minimal mucosal damage, we seek to investigate its potential benefits in this specific patient population.

Methods

A retrospective chart review of newborns with congenital nasal stenosis treated with HFNC for respiratory distress or feeding difficulties in a pediatric tertiary center between 2014 and 2022. Data were collected for demographic characteristics, clinical presentation and ventilatory requirements, pre and post HFNC application.

Results

Six infants with nasal stenosis were included in the study cohort. Five were diagnosed with congenital pyriform aperture stenosis, three of whom had additional midnasal stenosis. One patient had nasal synechiae. Two patients had failed surgical treatment and all patients failed conservative treatment prior to HFNC treatment. Following HFNC use, improvement was noted in oxygen saturations, heart and respiratory rates, meal volumes and weight. None of the patients required any additional sinonasal surgical treatment. No complications were observed.

Conclusions

In this case series, we present the first documented use of HFNC treatment for nasal stenosis, showing favorable results. Further studies with a larger cohort, wider range of conditions and extended follow-up periods are needed to establish the risks and benefits of HFNC for neonatal nasal stenosis.
Forensic age estimation at the University Center of Legal Medicine Lausanne-Geneva: a retrospective study over 12 years
Authors: Thicot Frederique , Egger Coraline , Castiglioni Claudia , Magnin Virginie , Boudabbous Sana , Angelakopoulos Nikolaos , Grabherr Silke , Genet Pia
Published: May 2024

With the undeniable increase in asylum requests from unaccompanied alleged minors, age estimation of living individuals has become an essential part of the routine work in European forensic centers. This study aims to review the forensic age estimations performed in our center since 2010, to evaluate the state-of-the-art of this practice in Switzerland with the evolution of the methodology according to upcoming recommendations. Our institute's expert reports performed between 2010 and 2022 were retrospectively analyzed. We gathered the following parameters: demographic data, morphological characteristics, alleged age compared with the assessed minimum age, sexual maturation, dental and bone age. When available, we collected personal and family history, medical history, records of torture-related/self-inflicted injuries, and information about eating habits that might affect skeletal development. Data collection amounted to 656 cases. Forensic age estimations ordered by the Swiss Secretariat for Migration (SEM) represented 76.4% of cases, with 23.6% of them ordered by the Court/Public Prosecutor. Most alleged minors were male (94.5%) and came from Afghanistan (53.4%). Adjunction of CT scans of the sternoclavicular joints was necessary in 86.4% of cases. Only 25.2% of our reports concluded on most probable minority, with 55.6% of definite majors; in 19.2% of our cases, minority could not be excluded. This study aspires to further broaden our expertise regarding forensic age estimations. Given the increasing migratory flows, we can expect a notable increase in the frequency of these requests. Consequently, this study aims to promote a multidisciplinary approach and the international standardization of the methodology of these estimations.
Optical coherence tomography angiography suggests different retinal pathologies in multiple sclerosis and Sjögren’s syndrome
Authors: Wolf Elisabeth , Wicklein Rebecca , Aly Lilian , Schmaderer Christoph , Afzali Ali Maisam , Mardin Christian , Korn Thomas , Hemmer Bernhard , Hofauer Benedikt , Knier Benjamin
Published: May 2024

Background

While retinal vessel changes are evident in the eyes of patients with relapsing–remitting multiple sclerosis (RRMS), changes in the vasculature of possible MS mimics such as primary Sjögren’s syndrome (pSS) remain to be determined. We investigated the potential of retinal optical coherence tomography (OCT) angiography (OCTA) as diagnostic tool to differentiate between patients with RRMS and pSS.

Methods

This cross-sectional study included patients with RRMS (n = 36), pSS (n = 36) and healthy controls (n = 30). Participants underwent clinical examination, assessment of visual acuity, retinal OCT, OCTA, and serum markers of glial and neuronal damage. We investigated the associations between OCTA parameters, visual functions, and serum markers. Eyes with a history of optic neuritis (ON) were excluded from analysis.

Results

We observed a significant thinning of the combined ganglion cell and inner plexiform layer in the eyes of patients with RRMS but not with pSS, when compared to healthy controls. Retinal vessel densities of the superficial vascular complex (SVC) were reduced in both patients with RRMS and pSS. However, retinal vessel rarefication of the deep vascular complex (DVC) was only evident in patients with pSS but not RRMS. Using multivariate regression analysis, we found that DVC vessel loss in pSS patients was associated with worse visual acuity.

Conclusions

Compared to patients with RRMS, rarefication of deep retinal vessels is a unique characteristic of pSS and associated with worse visual function. Assuming a disease-specific retinal vessel pathology, these data are indicative of a differential affliction of the gliovascular complex in the retina of RRMS and pSS patients.
Quantifying climatic suitability for tourism in Southwest Indian Ocean Tropical Islands: Applying the Holiday Climate Index to Réunion Island
Authors: Prinsloo Ariel S. , Fitchett Jennifer M.
Published: May 2024

Climate is a key resource for tourists and tourism providers. Varied approaches to quantifying climate resources for tourism have been developed in the last 40 years, computing indices from a range of meteorological variables to measure the comparative climatic suitability of different destinations through time. This study provides the first application of a tourism climate index in the tropical southwest Indian Ocean, applying the recently developed Holiday Climate Index (HCI) for Réunion Island. The suitability of this index is evaluated for the case of this French department, with a particular focus on air conditioning availability in tourism accommodation establishments as this index excludes night-time thermal comfort. Both iterations of the HCI (HCIBeach and HCIUrban) are computed with meteorological data from Roland Garros Airport for the period 1991–2020, exploring monthly, annual, and seasonal climatic suitability. Mean monthly HCI scores reveal considerable seasonality in climatic suitability for tourism on the island with scores ranging from 89.3 (‘excellent’) to 36.9 (‘marginal’) for the HCIBeach and 85.0 (‘excellent’) to 27.5 (‘unacceptable’) for the HCIUrban, with more favourable scores calculated for July and August, displaying a clear austral winter peak seasonal classification. Over the 30-year period, there is no statically significant change in mean annual climatic suitability, and at a monthly scale, only one month of the year for each index displays statistically significant trends. These results are important in informing tourism strategies for the island to maximise visitor satisfaction through targeting advertising more deliberately for peak touristic climate suitability during the winter months.
Clinical and kinematic characterization of parkinsonian soft signs in essential tremor
Authors: Angelini Luca , Paparella Giulia , Cannavacciuolo Antonio , Costa Davide , Birreci Daniele , De Riggi Martina , Passaretti Massimiliano , Colella Donato , Guerra Andrea , Berardelli Alfredo , Bologna Matteo
Published: May 2024

Background

Subtle parkinsonian signs, i.e., rest tremor and bradykinesia, are considered soft signs for defining essential tremor (ET) plus.

Objectives

Our study aimed to further characterize subtle parkinsonian signs in a relatively large sample of ET patients from a clinical and neurophysiological perspective.

Methods

We employed clinical scales and kinematic techniques to assess a sample of 82 ET patients. Eighty healthy controls matched for gender and age were also included. The primary focus of our study was to conduct a comparative analysis of ET patients (without any soft signs) and ET-plus patients with rest tremor and/or bradykinesia. Additionally, we investigated the asymmetry and side concordance of these soft signs.

Results

In ET-plus patients with parkinsonian soft signs (56.10% of the sample), rest tremor was clinically observed in 41.30% of cases, bradykinesia in 30.43%, and rest tremor plus bradykinesia in 28.26%. Patients with rest tremor had more severe and widespread action tremor than other patients. Furthermore, we observed a positive correlation between the amplitude of action and rest tremor. Most ET-plus patients had an asymmetry of rest tremor and bradykinesia. There was no side concordance between these soft signs, as confirmed through both clinical examination and kinematic evaluation.

Conclusions

Rest tremor and bradykinesia are frequently observed in ET and are often asymmetric but not concordant. Our findings provide a better insight into the phenomenology of ET and suggest that the parkinsonian soft signs (rest tremor and bradykinesia) in ET-plus may originate from distinct pathophysiological mechanisms.
Two-stage advanced persistent threat (APT) attack on an IEC 61850 power grid substation
Authors: Akbarzadeh Aida , Erdodi Laszlo , Houmb Siv Hilde , Soltvedt Tore Geir
Published: May 2024

Advanced Persistent Threats (APTs) are stealthy, multi-step attacks tailored to a specific target. Often described as ’low and slow’, APTs remain undetected until the consequences of the cyber-attack become evident, usually in the form of damage to the physical world, as seen with the Stuxnet attack, or manipulation of an industrial process, as was the case in the Ukraine Power Grid attacks. Given the increasing sophistication and targeted nature of cyber-attacks, especially APTs, this paper delves into the substantial threats APTs pose to critical infrastructures, focusing on power grid substations. Through a detailed case study, we present and explore a 2-stage APT attack on an IEC 61850 power grid substation, employing a Hardware-in-the-Loop (HIL) testbed to simulate real-world conditions. More specifically, this paper discusses two significant experiments conducted to assess vulnerabilities in the control protocols used in IEC 61850 substations: IEC 60870-5-104 and IEC 61850. The integration of findings from these experiments revealed a number of previously undiscussed potential threats to power grid infrastructure that could arise from attacking one or more substations. To better address these potential threats, the paper proposes an extension to the Industrial Control System (ICS) kill chain that explicitly accounts for the consequences of attacks on the physical aspects of Cyber-Physical Systems (CPSs).
The ethos brief index—validation of a brief questionnaire to evaluate wellness based on a holistic perspective in patients with restless legs syndrome
Authors: Knutsson Susanne , Björk Maria , Odzakovic Elzana , Hellström Amanda , Sandlund Christina , Ulander Martin , Lind Jonas , Fridlund Bengt , Pakpour Amir , Broström Anders
Published: May 2024

Purpose

The aim of this study was to validate the Ethos Brief Index (EBI) in patients with Restless Legs Syndrome (RLS).

Methods

A cross-sectional design, including 788 subjects with RLS (65% women, 70.8 years, SD 11.3) from the Swedish RLS Association, was used. A postal survey was sent out to collect data regarding socio demographics, comorbidities, and RLS-related treatment data. Questionnaires included were EBI, the Restless Legs Syndrome-6 Scale (RLS-6), Restless Legs Syndrome—Quality of Life questionnaire (RLSQoL), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis (CFA) models. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age and gender groups, as well as insomnia, daytime sleepiness, RLS-related QoL and RLS severity were assessed.

Results

The results supported the unidimensionality of the EBI in the CFA (i.e., explaining 61.5% of the variance) and the Rasch model. The reliability of the EBI was confirmed using composite reliability and Cronbach’s alpha. No DIF was identified for gender, age, insomnia, daytime sleepiness, RLS severity or RLS-related QoL.

Conclusion

The EBI showed good validity and reliability and operated equivalently for male and female patients with RLS. Accordingly, healthcare professionals can use the EBI as a psychometrically sound tool to explore and identify patient-centered problems related to the whole life situation.
Environmental risk score of multiple pollutants for kidney damage among residents in vulnerable areas by occupational chemical exposure in Korea
Authors: Jang Hyuna , Choi Kyung-Hwa , Cho Yong Min , Han Dahee , Hong Young Seoub
Published: May 2024

This study aimed to develop an environmental risk score (ERS) of multiple pollutants (MP) causing kidney damage (KD) in Korean residents near abandoned metal mines or smelters and evaluate the association between ERS and KD by a history of occupational chemical exposure (OCE). Exposure to MP, consisting of nine metals, four polycyclic aromatic hydrocarbons, and four volatile organic compounds, was measured as urinary metabolites. The study participants were recruited from the Forensic Research via Omics Markers (FROM) study (n = 256). Beta-2-microglobulin (β2-MG), N-acetyl-β-D-glucosaminidase (NAG), and estimated glomerular filtration rate (eGFR) were used as biomarkers of KD. Bayesian kernel machine regression (BKMR) was selected as the optimal ERS model with the best performance and stability of the predicted effect size among the elastic net, adaptive elastic net, weighted quantile sum regression, BKMR, Bayesian additive regression tree, and super learner model. Variable importance was estimated to evaluate the effects of metabolites on KD. When stratified with the history of OCE after adjusting for several confounding factors, the risks for KD were higher in the OCE group than those in the non-OCE group; the odds ratio (OR; 95% CI) for ERS in non-OCE and OCE groups were 2.97 (2.19, 4.02) and 6.43 (2.85, 14.5) for β2-MG, 1.37 (1.01, 1.86) and 4.16 (1.85, 9.39) for NAG, and 4.57 (3.37, 6.19) and 6.44 (2.85, 14.5) for eGFR, respectively. We found that the ERS stratified history of OCE was the most suitable for evaluating the association between MP and KD, and the risks were higher in the OCE group than those in the non-OCE group.
A Narrative Review of the Pathophysiology and Treatment of Methamphetamine-Associated Psychosis
Authors: Stacy Peter , Frantz Jenna , Miller Genevieve , Merrill Brian , Gainer Danielle
Published: May 2024

The evaluation and management of methamphetamine-associated psychosis (MAP) is an area of study with a paucity of large-scale, longitudinal data. Methamphetamine use has soared in popularity worldwide in the past decade, leading to a surge in individuals experiencing its neurotoxic effects. Current evidence suggests that methamphetamine causes neurodegeneration and psychosis through VMAT2 inhibition which raises dopamine and GABA levels in the brain’s dopaminergic pathways, leading to oxidative stress and inflammation. Differentiating MAP from primary psychotic disorders is challenging; high rates of persistent psychosis leading to a diagnosis of primary psychotic disorder and an absence of an etiologic differentiation amongst the DSM-5 diagnostic criteria further complicate the diagnostic process. Once a diagnosis of methamphetamine-associated psychosis is made, benzodiazepines have been shown to provide temporary relief; in addition, depending on the severity and impact of psychotic symptoms, antipsychotics may be indicated both short and long terms for ongoing symptom management. Robust data for these treatments is limited and primarily draws on animal studies or case reports. Further research is needed to codify MAP treatment standards of care.
Can social adversity alter the epigenome, trigger oral disease, and affect future generations?
Authors: Khalid Sakr , Kearney Michaela , McReynolds David E.
Published: May 2024

The nature versus nurture debate has intrigued scientific circles for decades. Although extensive research has established a clear relationship between genetics and disease development, recent evidence has highlighted the insufficiency of attributing adverse health outcomes to genetic factors alone. In fact, it has been suggested that environmental influences, such as socioeconomic position (SEP), may play a much larger role in the development of disease than previously thought, with extensive research suggesting that low SEP is associated with adverse health conditions. In relation to oral health, a higher prevalence of caries (tooth decay) exists among those of low SEP. Although little is known about the biological mechanisms underlying this relationship, epigenetic modifications resulting from environmental influences have been suggested to play an important role. This review explores the intersection of health inequalities and epigenetics, the role of early-life social adversity and its long-term epigenetic impacts, and how those living within the lower hierarchies of the socioeconomic pyramid are indeed at higher risk of developing diseases, particularly in relation to oral health. A deeper understanding of these mechanisms could lead to the development of targeted interventions for individuals of low SEP to improve oral health or identify those who are at higher risk of developing oral disease.
Microphysiological Systems as Organ-Specific In Vitro Vascular Models for Disease Modeling
Authors: Nam Ungsig , Lee Seokhun , Ahmad Ashfaq , Yi Hee-gyeong , Jeon Jessie S.
Published: May 2024

The vascular system, essential for human physiology, is vital for transporting nutrients, oxygen, and waste. Since vascular structures are involved in various disease pathogeneses and exhibit different morphologies depending on the organ, researchers have endeavored to develop organ-specific vascular models. While animal models possess sophisticated vascular morphologies, they exhibit significant discrepancies from human tissues due to species differences, which limits their applicability. To overcome the limitations arising from these discrepancies and the oversimplification of 2D dish cultures, microphysiological systems (MPS) have emerged as a promising alternative. These systems more accurately mimic the human microenvironment by incorporating cell interactions, physical stimuli, and extracellular matrix components, thus facilitating enhanced tissue differentiation and functionality. Importantly, MPS often utilize human-derived cells, greatly reducing disparities between model and patient responses. This review focuses on recent advancements in MPS, particularly in modeling the human organ-specific vascular system, and discusses their potential in biological adaptation.
Analyzing the dynamics of monetary policy and economic growth in Ethiopia: an autoregressive distributed lag (ARDL) approach
Authors: Abdulkadr Ahmed Abduletif , Asnakew Yibeltal Walle , Sendkie Fentahun Baylie , Workineh Ermias Berihun , Asfaw Dagmawe Menelek
Published: May 2024

Numerous studies conducted by various scholars have aimed to ascertain the impact of monetary policy on economic growth. However, these empirical investigations have not reached a unanimous consensus. Therefore, this study analyzes the effect of monetary policy. To address this objective, this study employed ARDL and error correction model (ECM) based on annual data from 1993 to 2022. Granger causality test was also employed to check the direction of causal effects of one variable on the other variable. All required pre and post estimation tests were performed and verified that the model was statistically viable. The study revealed that, in the short run, deposit interest rate, reserve required amount, and open market operation have positive and statistically significant effects on real GDP growth of Ethiopia; however, money supply has negative and statistically significant effects on real GDP growth of Ethiopia. In the long run, money supply has positive and statistically significant effects on real GDP growth of Ethiopia; however, deposit interest rate and reserve required have negative and statistically significant effects on real GDP growth of Ethiopia. To sum up, in the short run, contractionary monetary policy was promising, and in the long run, expansionary monetary policy was favorable for economic growth. The Granger causality test result shows that there is bidirectional causality between monetary policy and economic growth; except there was a unidirectional relationship between deposit interest rate and economic growth. Ultimately, this research suggests the following policy recommendation: for short-term economic enhancement, it is advisable for the government to opt for a contractionary monetary policy rather than an expansionary one. On the other hand, for long-term economic improvement, an expansionary monetary policy is more favorable than a contractionary one.
Complete Artworks without Authors
Authors: Trogdon Kelly
Published: May 2024

Genetically complete yet authorless artworks seem possible, yet it is hard to understand how they might really be possible. A natural way to try to resolve this puzzle is by constructing an account of artwork completion on the model of accounts of artwork meaning that are compatible with meaningful yet authorless artworks. However, I argue that such an account of artwork completion is implausible. Therefore, I leave the puzzle unresolved.
Asymptotic profiles of a nonlocal dispersal SIS epidemic model with saturated incidence
Authors: Feng Yan-Xia , Li Wan-Tong , Yang Fei-Ying
Published: May 2024

Infection mechanism plays a significant role in epidemic models. To investigate the influence of saturation effect, a nonlocal (convolution) dispersal susceptible-infected-susceptible epidemic model with saturated incidence is considered. We first study the impact of dispersal rates and total population size on the basic reproduction number. Yang, Li and Ruan (J. Differ. Equ. 267 (2019) 2011–2051) obtained the limit of basic reproduction number as the dispersal rate tends to zero or infinity under the condition that a corresponding weighted eigenvalue problem has a unique positive principal eigenvalue. We remove this additional condition by a different method, which enables us to reduce the problem on the limiting profile of the basic reproduction number into that of the spectral bound of the corresponding operator. Then we establish the existence and uniqueness of endemic steady states by a equivalent equation and finally investigate the asymptotic profiles of the endemic steady states for small and large diffusion rates to provide reference for disease prevention and control, in which the lack of regularity of the endemic steady state and Harnack inequality makes the limit function of the sequence of the endemic steady state hard to get. Finally, we find whether lowing the movements of susceptible individuals can eradicate the disease or not depends on not only the sign of the difference between the transmission rate and the recovery rate but also the total population size, which is different from that of the model with standard or bilinear incidence.
PREPARING FOR THE NEXT PANDEMIC
Authors: Buchanan Allen
Published: May 2024

My aim in this essay is to argue for a better moral-conceptual framework and for institutional innovation in preparation for the next pandemic. My main conclusions are as follows. (1) The primary moral principle that should guide responses to the next pandemic is the duty to prevent and mitigate serious harms. (2) A proper understanding of the moral foundations and scope of the duty to prevent and mitigate serious harms requires rejecting both Extreme Nationalism and Extreme Cosmopolitanism. (3) A better response to the next pandemic requires transforming the moral landscape through institutional innovation by developing an international institution that can perfect indeterminate duties (i) by identifying duty-bearers, (ii) by specifying their duties to provide medical resources and other forms of aid, (iii) by allocating the specified duties to various public and private entities in such a way as to ensure effective coordination and that the costs of providing aid are fairly distributed, and (iv) by providing effective mechanisms for compliance with the specified duties. (4) Institutional innovation is morally required, regardless of whether the harm prevention and mitigation duties of the better-off are duties of justice or of beneficence, because without institutionalization, some duties of justice, including those requiring the prevention and mitigation of serious harms, suffer some of the same indeterminacies that are present in duties of beneficence.