bluuebunny/crossref_metadata_2025 huggingface dataset:
Individual language experience determinants of morphosyntactic variation in heritage and attriting speakers of Bosnian and Serbian
Authors: Tomić Aleksandra , Rodina Yulia , Bayram Fatih , De Cat Cecile
Published: November 2024

Using a causal inference approach, we explored the relationships among the language experience determinants of
morphosyntactic sensitivity, to identify the factors that indirectly and directly cause its acquisition or maintenance in
immigration contexts. We probed the sensitivity to Serbian/Bosnian clitic placement violations with a self-paced listening task,
in a diverse group of bilinguals in Norway (n = 71), born to immigrant parents, or having emigrated in childhood
or adulthood. The outcomes included a metalinguistic violation detection score and a listening/processing time difference between licit and
illicit structures.

Structural Equation Models revealed that literacy (as reading practices) was among the most influential
determinants of the ability to detect violations, while Bosnian/Serbian use across contexts and age of bilingualism onset
determined violation sensitivity in processing. We identified a significant threshold of societal language (SL) exposure at age 8.
Rather than SL exposure before this age precluding bilinguals from developing and maintaining morphosyntactic sensitivity, this
threshold seems to reflect a protective effect against attrition which intensifies the later after age 8 SL exposure starts. The
length of residence in Norway did not determine attrition, suggesting that heritage and attrited speakers should be considered on
a continuum rather than as distinct bilingualism profiles.
Gene expression and soluble sugar accumulation in perennial fruits
Authors: Mahmood Alam Shariq , Tahir Rohoma , Thu Aye Myat , Li Yu-Jia , Khan Muhammad Abbas , Liu Yong-Zhong
Published: November 2024

Soluble sugars primarily contribute to fruit flavouring and are crucial for fruit quality. Carbohydrate accumulation in fruits is a multifaceted process that can be influenced by their biosynthesis capacity, sink strength, homeostasis, and vacuolar storage ability. Moreover, total soluble sugar contents in fruits also vary among different varieties/species and environmental conditions. Numerous studies have elucidated the carbohydrate regulatory mechanism in fruits; however, there is a knowledge gap regarding the most important contributor to soluble sugar accumulation in perennial fruits. Here, we briefly discussed the recent advances, including carbohydrate long-distance transportation, metabolism and vacuolar storage, and transcript factors for soluble sugar accumulation in fruits. Most importantly, we elucidated that the sink strength in fruit is the most crucial factor that can trap more soluble sugars by maintaining continuous unloading to fruit by genes of cell wall invertase; moreover, genes of sucrose transporters/pyrophosphatase play key roles in vacuolar storage of soluble sugars in perennial fruits. This review delivers a comprehensive summary of recent findings for soluble sugar regulation and fruit quality improvement, which may facilitate sugar optimisation in fruit crops for enhanced fruit quality.
Visualizing ER-phagy and ER architecture in vivo
Authors: Sang Yongjuan , Li Boran , Su Tinglin , Zhan Hanyu , Xiong Yue , Huang Zhiming , Wang Changjing , Cong Xiaoxia , Du Mengjie , Wu Yang , Yu Hang , Yang Xi , Ding Kezhi , Wang Xuhua , Miao Xiaolong , Gong Weihua , Wang Liang , Zhao Jingwei , Zhou Yiting , Liu Wei , Hu Xinyang , Sun Qiming
Published: November 2024

ER-phagy is an evolutionarily conserved mechanism crucial for maintaining cellular homeostasis. However, significant gaps persist in our understanding of how ER-phagy and the ER network vary across cell subtypes, tissues, and organs. Furthermore, the pathophysiological relevance of ER-phagy remains poorly elucidated. Addressing these questions requires developing quantifiable methods to visualize ER-phagy and ER architecture in vivo. We generated two transgenic mouse lines expressing an ER lumen–targeting tandem RFP-GFP (ER-TRG) tag, either constitutively or conditionally. This approach enables precise spatiotemporal measurements of ER-phagy and ER structure at single-cell resolution in vivo. Systemic analysis across diverse organs, tissues, and primary cultures derived from these ER-phagy reporter mice unveiled significant variations in basal ER-phagy, both in vivo and ex vivo. Furthermore, our investigation uncovered substantial remodeling of ER-phagy and the ER network in different tissues under stressed conditions such as starvation, oncogenic transformation, and tissue injury. In summary, both reporter models represent valuable resources with broad applications in fundamental research and translational studies.
Photocatalysis and adsorption coupling in S-scheme K and P doped g-C3N4/GO/MgFe2O4 photocatalyst for enhanced degradation of Congo red dye
Authors: Kumar Rohit , Khan Aftab Aslam Parwaz , Sudhaik Anita , Sonu Sonu , Kaya Savas , Singh Pardeep , Raizada Pankaj , Zayed Mohie E M , Arshad Muhammad Nadeem , Alzahrani Khalid A
Published: November 2024

Photocatalysis is an environmentally friendly approach for harnessing solar light to degrade pollutants. This study investigates the degradation of Congo red (COR) dye by a visible light-active photocatalyst, with a primary focus on the efficiency and reusability of the photocatalytic material. We synthesized phosphorus- and potassium-doped graphitic carbon nitride photocatalysts attached to graphene oxide and MgFe2O4 (KPCN/GO/MgFe2O4). Doping graphitic carbon nitride enhanced light absorption, while graphene oxide improved the adsorption properties. The addition of magnetic MgFe2O4 enhanced charge separation and reusability. The KPCN/GO/MgFe2O4 composite was analyzed using a range of techniques. The activity of the synthesized materials for Congo red (COR) dye degradation was analyzed under visible light. The photocatalytic activities of bare, binary, and ternary photocatalysts were compared, and KPCN/GO/MgFe2O4 exhibited the highest photoactivity among all. The KPCN/GO/MgFe2O4 photocatalyst (60 mg) showed a 76% removal efficiency for 5 × 10−6 M Congo red within 60 min, which was 2.5 times higher than that of pure graphitic carbon nitride. The ·OH and ·O2- were the major reactive species during COR photodegradation. The photocatalyst also displayed good reusability after five cycles, enhancing its overall effectiveness.
Influence of high-latitude blocking and the northern stratospheric polar vortex on cold-air outbreaks under Arctic amplification of global warming
Authors: Hanna Edward , Francis Jennifer , Wang Muyin , Overland James E , Cohen Judah , Luo Dehai , Vihma Timo , Fu Qiang , Hall Richard J , Jaiser Ralf , Kim Seong-Joong , Köhler Raphael , Luu Linh , Shen Xiaocen , Erner Irene , Ukita Jinro , Yao Yao , Ye Kunhui , Choi Hyesun , Skific Natasa
Published: November 2024

It is widely accepted that Arctic amplification (AA)—enhanced Arctic warming relative to global warming—will increasingly moderate cold-air outbreaks (CAOs) to the midlatitudes. Yet, some recent studies also argue that AA over the last three decades to the rest of the present century may contribute to more frequent severe winter weather including disruptive cold spells. To prepare society for future extremes, it is necessary to resolve whether AA and severe midlatitude winter weather are coincidental or physically linked. Severe winter weather events in the northern continents are often related to a range of stratospheric polar vortex (SPV) configurations and atmospheric blocking, but these dynamical drivers are complex and still not fully understood. Here we review recent research advances and paradigms including a nonlinear theory of atmospheric blocking that helps to explain the location, timing and duration of AA/midlatitude weather connections, studies of the polar vortex’s zonal asymmetric and intra-seasonal variations, its southward migration over continents, and its surface impacts. We highlight novel understanding of SPV variability—polar vortex stretching and a stratosphere–troposphere oscillation—that have remained mostly hidden in the predominant research focus on sudden stratospheric warmings. A physical explanation of the two-way vertical coupling process between the polar vortex and blocking highs, taking into account local surface conditions, remains elusive. We conclude that evidence exists for tropical preconditioning of Arctic-midlatitude climate linkages. Recent research using very large-ensemble climate modelling provides an emerging opportunity to robustly quantify internal atmospheric variability when studying the potential response of midlatitude CAOs to AA and sea-ice loss.
Socialism and Self-Determination: Lenin, International Law, and National Liberation
Authors: Simpson Brad
Published: November 2024

This chapter argues that socialist theorists and states advanced a distinctive and evolving position on self-determination as a collective right initially rooted in their understanding of the so-called ‘national question’ in the early twentieth century. Like their liberal counterparts, however, many socialist theorists harboured concerns about the potentially disruptive force of proliferating self-determination claims among smaller territories, nations, and peoples, especially in Eastern and Southern Europe, concerns which persisted throughout the twentieth century. During the interwar period, the socialist position on self-determination began to cohere and coalesce around a more consistent anticolonial position. After 1945, socialist states advanced what is argued was a moderate anticolonial vision of self-determination in UN resolutions and the 1966 human rights covenants——supporting national independence for former colonies and the right to economic self-determination, but generally opposing sub-national, secessionist, and Indigenous movements. Socialist conceptions of self-determination contained their own contradictions, which were revealed in the wake of Soviet interventions in Eastern Europe and Afghanistan.
Decentring Marxism: The Poznań School and Socialist International Law in Eastern Europe after 1945
Authors: Szumski Jakub
Published: November 2024

While the project of socialist international law based on Marxism–Leninism is often seen as a total alternative to Western-led approaches, Soviet scholarship never settled on a coherent legal programme. This left the academic milieus across the Eastern Bloc to create their own versions of international law. Focusing on the Poznań School of International Law this chapter uses a historical and sociological approach to reveal how lawyers from the Eastern Bloc decentred or ignored the Marxist–Leninist script during the Cold War. Marxist methodology and certain doctrinal markers served as an obligatory point of reference for international law theory and practice throughout Eastern Europe but were blended with other traditions. The Poznań School was marked by continuities with the pre-socialist era and magnified these tendencies, which had their own variants across the Bloc. Although the decentring of socialist internationalism went the furthest in Poznań, this legal pluralism was visible across socialist Eastern Europe.
How China Came to Embrace International Institutions
Authors: Mitchell Ryan Martínez
Published: November 2024

The People’s Republic of China (PRC) has become an increasingly active participant in international legal forums and processes in recent years. This activity reflects a broad set of influences comprising, inter alia, longstanding concerns of the Chinese state, including pre-PRC regimes; views drawn from the Cold War milieu of Soviet-aligned powers; Third World and anticolonial critiques; and discourses drawn from Western international legal thought. These elements, along with official ideology and Realpolitik, have resulted in an increasingly well-defined set of ‘Chinese approaches’ to norm legislation and interpretation. These coincide in an officially Marxist—Leninist superpower seeking to reconcile great power aspirations, anticolonial legacies, lingering socialist commitments, geopolitical and economic interests, and the existing technocratic toolkits of global governance. In areas ranging across and beyond the laws of war, trade, and the sea, Beijing has adopted a unique agenda of engagement that heavily emphasizes the legitimacy conferred by core international institutions.
State Socialist Contributions to the Criminalization of Apartheid
Authors: Grosescu Raluca
Published: November 2024

This chapter demonstrates the protagonism of state socialist governments and legal experts in criminalizing apartheid as a major international crime during the Cold War. It argues that African and Eastern European socialist countries were the most vocal proponents for the codification of apartheid as a crime against humanity and as a war crime in international conventions, due to their shared anti-capitalist and anti-Western imperialist agendas. Moreover, global mobilizations of legal experts with socialist orientations produced a far more radical anti-apartheid discourse than that of liberal experts in the West. It went beyond the condemnation of political repression and racial discrimination in South Africa as violations of the rule of law and connected the anti-apartheid cause to the denunciation of colonialism as a whole and the recognition of wars of national liberation as international armed conflicts.
Socialisms and International Law: Epilogue
Authors: Betts Paul
Published: November 2024

For decades socialist law and justice were both routinely dismissed as nothing but an ideological fig leaf obscuring brute communist power. Such a polemic view has changed dramatically in recent years, as historians and legal scholars have revisited the legacy of socialist law from fresh perspectives, with surprising results. This pioneering volume revisits the synergies between international law and socialism, and it reveals how socialist legal experts advanced profound critiques and contributions to the development of international legal norms, practices, and laws governing interstate conduct. It also incites to further research on the legacies of socialist interventions and their relevance for a possible alternative to the current crisis of liberal international law, ranging from peace to universal healthcare.
Setting the Stage
Authors: Fairbairn Donald
Published: November 2024

This chapter summarizes the scholarly discussion about whether Augustine’s Christology is ‘Antiochene’ or Chalcedonian/Cyrillian. It looks in some detail at the use of homo in Christological passages from Augustine’s later writings, in order to show that he is using the word to refer not to a quasi-independent man Jesus but to either the human nature of Christ or to the incarnate Son considered as a man. This discussion demonstrates the Cyrillian/Chalcedonian tenor of Augustine’s Christology in that he sees the Word/Son as the subject of the incarnate actions and experiences of Christ. The chapter examines passages from the end of Augustine’s life that link the predestination of Christ’s humanity to the predestination of a Christian, and it concludes that Augustine’s logic of grace moves from the Fall to predestination, thus inclining him to deal largely with the particular effects of the Incarnation in the elect, not with more general effects in all people.
John Cassian
Authors: Fairbairn Donald
Published: November 2024

This chapter argues that in De incarnatione Domini, Cassian is not concerned with Christological terminology or precision; he is concerned about the identity of the Saviour as the eternal Son of God, and he believes that Nestorius is denying that. The chapter argues that Cassian’s depiction of Nestorius’s Christ as a man who attained deity by his merits may constitute an amalgamation of Nestorian thought with that of the pre-correction Leporius, and this Leporianized ‘Nestorius’ would become the main target of other Gallic writers. The chapter then examines Conlatio 13 in the light of its monastic context in order to argue that it is not describing different people (some who can make the first move to God without grace, and others who cannot), as Prosper alleged, but different situations in the life of a monk in which he needs and receives different kinds of grace. The grace of the Incarnation makes the monk an adopted son, and particular and varied kinds of grace operate in the monk’s life. As a result, while Augustine and Cassian have a similar Christology, their understandings of grace are different because Augustine reasons from the Fall to predestination to the Incarnation, whereas Cassian reasons from the Fall to the Incarnation to the action of grace in a monk’s life.
Faustus of Riez
Authors: Fairbairn Donald
Published: November 2024

This chapter considers the question of whether Faustus’s championing the uia regia both in Christology and in charitology means that his thought seeks to balance competing emphases, and thus whether he may be properly called ‘Semi-Pelagian’. It examines Faustus’s Christology (especially in Epistula ad Graecum) and notes that while his use of homo can easily be read as ‘Nestorian’, the overall tenor of his thought is not actually ‘Nestorian’. Likewise, his balanced emphasis on divine and human action could easily be interpreted as ‘Semi-Pelagian’, but it is better understood as focusing first and very strongly on the universal aspects of grace (given both in creation and in the Incarnation) and then on particular aspects. Faustus’s reasoning is not merely from the Fall to the Incarnation to grace, but from the Fall back to prima gratia, and then to the Incarnation and to grace. What holds prima gratia and the grace of redemption together in Faustus’s thought is the fact that the same person, the eternal Son, gives both graces. The chapter concludes by suggesting that while Faustus certainly seems more ‘Semi-Pelagian’ than the other Gallic writers, even his thought nevertheless does not deserve that label and is consistent with the other Gallic writers of the fifth century on both Christology and grace.
Implementation of a university-wide health-system collaborative to provide pharmacy preceptor development across multiple institutions
Authors: Mnatzaganian Christina L , Dennehy Cathi , Pon Tiffany , Brown Mandy , Hall Brent , Sievers Theodore M , Ung Jennie , Wimer Dexter
Published: November 2024

Purpose

The University of California Preceptor Development Collaborative was established in 2022 across 5 academic medical centers and 3 schools of pharmacy. The collaborative aimed to streamline preceptor development efforts, enhance collaboration, and meet accreditation standards efficiently by providing quarterly preceptor development programming across all sites to residency and school preceptors. This article describes the implementation of the collaborative and assesses the number of attendees, attendee satisfaction, and cost during the pilot year.

During the pilot year, 5 live virtual preceptor development modules were developed for pharmacist preceptors. There were 631 credit hours claimed (196 from session 1, 106 from session 2, 68 from session 3, 123 from session 4, and 138 from session 5). Preceptor satisfaction, as measured from completed postsession evaluations (n = 704), was high (a median score of 5 on a Likert scale where 1 = none at all, 2 = a little, 3 = a moderate amount, 4 = a lot, and 5 = a great deal) for meeting educational, professional, teaching, or clinical needs. There was strong agreement (median score of 5 on Likert scale where 1 = strongly disagree, 2 = somewhat disagree, 3 = neither agree nor disagree, 4 = somewhat agree, and 5 = strongly agree) that the modules improved knowledge, ability to change practice, and ability to have positive impacts on trainees and patients. The cost per attendee for this series was $1.58 per continuing education credit.

Conclusion

A multi-institution state-wide preceptor collaborative effort produced quarterly continuing education for residency and school of pharmacy preceptors who were affiliated with the sites. This approach to preceptor development is a convenient, satisfactory, and cost-effective method to deliver training for pharmacy preceptors.
Comment on ‘Differential diagnosis of red scalp: the importance of trichoscopy’
Authors: Garcia Bielsa Cristina , Caballero-Uribe Natalia , Trüeb Ralph M
Published: November 2024

Trichoscopy has gained popularity as a valuable tool in the differential diagnosis of hair and scalp disorders. Nevertheless, as a diagnostic procedure, trichoscopy is to be understood as representing an integral part of a more comprehensive dermatological learning to include a stringent nosological classification based on a pathogenic understanding and proper nomenclature. This particularly holds true for red scalp, which represents an entity in its own right characterized by telangiectatic erythema of the scalp.
Atheroma transcriptomics identifies ARNTL as a smooth muscle cell regulator and with clinical and genetic data improves risk stratification
Authors: Narayanan Sampath , Vuckovic Sofija , Bergman Otto , Wirka Robert , Verdezoto Mosquera Jose , Chen Qiao Sen , Baldassarre Damiano , Tremoli Elena , Veglia Fabrizio , Lengquist Mariette , Aherrahrou Redouane , Razuvaev Anton , Gigante Bruna , Björck Hanna M , Miller Clint L , Quertermous Thomas , Hedin Ulf , Matic Ljubica
Published: November 2024

Background and Aims

The role of vascular smooth muscle cells (SMCs) in atherosclerosis has evolved to indicate causal genetic links with the disease. Single cell RNA sequencing (scRNAseq) studies have identified multiple cell populations of mesenchymal origin within atherosclerotic lesions, including various SMC sub-phenotypes, but it is unknown how they relate to patient clinical parameters and genetics. Here, mesenchymal cell populations in atherosclerotic plaques were correlated with major coronary artery disease (CAD) genetic variants and functional analyses performed to identify SMC markers involved in the disease.

Methods

Bioinformatic deconvolution was done on bulk microarrays from carotid plaques in the Biobank of Karolinska Endarterectomies (BiKE, n = 125) using public plaque scRNAseq data and associated with patient clinical data and follow-up information. BiKE patients were clustered based on the deconvoluted cell fractions. Quantitative trait loci (QTLs) analyses were performed to predict the effect of CAD associated genetic variants on mesenchymal cell fractions (cfQTLs) and gene expression (eQTLs) in plaques.

Results

Lesions from symptomatic patients had higher fractions of Type 1 macrophages and pericytes, but lower fractions of classical and modulated SMCs compared with asymptomatic ones, particularly females. Presence of diabetes or statin treatment did not affect the cell fraction distribution. Clustering based on plaque cell fractions, revealed three patient groups, with relative differences in their stability profiles and associations to stroke, even during long-term follow-up. Several single nucleotide polymorphisms associated with plaque mesenchymal cell fractions, upstream of the circadian rhythm gene ARNTL were identified. In vitro silencing of ARNTL in human carotid SMCs increased the expression of contractile markers and attenuated cell proliferation.

Conclusions

This study shows the potential of combining scRNAseq data with vertically integrated clinical, genetic, and transcriptomic data from a large biobank of human plaques, for refinement of patient vulnerability and risk prediction stratification. The study revealed novel CAD-associated variants that may be functionally linked to SMCs in atherosclerotic plaques. Specifically, variants in the ARNTL gene may influence SMC ratios and function, and its role as a regulator of SMC proliferation should be further investigated.
The Persistent Objector Rule
Authors: Wood Michael , Sender Omri
Published: November 2024

This chapter discusses the persistent objector rule, according to which a State that has persistently objected to an emerging rule of customary international law, and maintains its objection after the rule has come into existence, is not bound by it. The chapter describes the evolution of the rule in international practice, its endorsement by the International Law Commission (ILC), and its systemic significance in international law. It also looks into the stringent conditions required for its invocation, and its inapplicability as regards peremptory norms of general international law (jus cogens). customary international law
Pleural Space Management in Thoracic Trauma
Authors: Devine Erin E. , Forrester Joseph D.
Published: November 2024

Thoracic injuries are common, occurring in up to 60% of polytrauma patients and represent 25% of trauma deaths. Thoracic trauma frequently involves injury to the pleural space resulting in hemothorax and pneumothorax—effective management of the pleural space is essential. Reviewed in this article is management of the pleural space in chest wall trauma (including pneumothorax and hemothorax), and chest tube placement, indications for video-assisted thoracoscopic surgery, management, and complications.
The Benefits of Awake Spinal Surgery on Minimizing Positioning-related Complications
Authors: Assis Maria Luisa Machado , Bojaxhi Elird , Abode-Iyamah Kingsley O. , Patterson Jennifer S. , White Kate E. , Gruenbaum Shaun E. , Rabai Ferenc , De Ruyter Marie L. , Riutort Kevin T. , Fleissner Zachary J. , Pirris Stephen M. , Barbosa Maria , Gruenbaum Benjamin F.
Published: November 2024

Study Design.

Literature review and institutional analysis.

Objective.

This review examines the potential advantages of awake spinal surgery under neuroaxial anesthesia in minimizing positioning-related complications compared to traditional general anesthesia.

Summary of Background Data.

Spinal surgeries performed in the prone position under general anesthesia are associated with perioperative complications, such as ocular injury and vision loss, nerve damage, and pressure ulcers.

Methods.

A comprehensive literature search was conducted for articles published from 1986 to 2023 focusing on awake spinal surgery and positioning-related complications. Additionally, insights from the Mayo Clinic team were incorporated to assess the potential benefits of awake spine surgery.

Results.

The review identified several positioning-related complications associated with prone positioning during spine surgery, including perioperative visual loss, neuropathies, pressure ulcers, and intraabdominal hypertension leading to systemic cardiovascular effects and potential organ dysfunction. Advances at the Mayo Clinic have enabled the use of awake spinal surgery under neuroaxial anesthesia for complex procedures such as robotic transforaminal lumbar interbody fusion. The use of awake lumbar spine surgery has demonstrated advantages, including reduced positioning-related complications, immediate patient feedback to avoid harmful maneuvers, shorter operating room times, and improved hemodynamic stability.

Conclusions.

Awake lumbar spine surgery offers notable advantages in reducing positioning-related complications and presents a promising alternative to general anesthesia.
Understanding Erythema Nodosum
Authors: Glover Gypsy , Wilson Jennifer , Leigh Katherine , Miller Barbara
Published: November 2024

Erythema nodosum is a common form of acute nodular septal panniculitis commonly found on the anterior tibial extensor surfaces. Although diagnosis is typically made based on clinical presentation, confirmation is made through biopsy that includes a portion of subcutaneous fat. Erythema nodosum is usually self-limiting, with routine treatment consisting of a conservative approach of supportive measures. Additionally, erythema nodosum is recognized as a cutaneous manifestation of systemic conditions, including inflammatory bowel disease. Dermatology providers should investigate the possibility of underlying inflammatory bowel disease and consider referral to a gastrointestinal specialist when appropriate. Therefore, the purpose of this article was to ensure providers have a thorough understanding of the diagnosis to determine appropriate treatment and identify when critical referrals are warranted. Utilizing an evidence-based, multidisciplinary approach that addresses both the gastrointestinal manifestations of inflammatory bowel disease and the cutaneous symptoms of erythema nodosum will improve both patient outcomes and satisfaction.
Influence of Qigong Wuqinxi on Pain, Sleep, and Tongue Features in Older Adults
Authors: CHOU Tzu-Wei , KUO Che-Chang , CHEN Kuei-Min , BELCASTRO Frank
Published: November 2024

Background

Chronic pain and sleep disorders are commonly seen symptoms in community-dwelling older adults at traditional Chinese medicine (TCM) clinics. TCM modalities such as herbal medication and acupuncture have side effects and usage limitations. Therefore, nonpharmacological and noninvasive interventions may be applied to relieve the symptoms of these conditions.

Purpose

This study was designed to test the effect of Qigong Wuqinxi exercise on chronic pain, sleep quality, TCM constitutions, and tongue features in community-dwelling older adults.

Methods

This was a cluster randomized controlled trial. Older adults in two community care centers who met the inclusion criteria were assigned by drawing lots to either the experimental group (n = 32) or the control group (n = 31). Experimental group members practiced the Qigong Wuqinxi exercise for 50 minutes three times each week for 12 weeks, whereas those in the control group maintained their normal daily routine. Before and after the 12-week study, data on chronic pain, sleep quality, TCM constitutions, and tongue features were collected from all participants to assess the effectiveness of the intervention. Between-group pretest and posttest comparisons were analyzed using independent samples t tests, and within-group differences were analyzed using paired t tests.

Results

The experimental group reported significantly greater average posttest improvements in chronic pain, yang deficiency, phlegm-stasis, thick fur, and red dots than the control group (all ps < .05). The maximum change in pretest to posttest pain scores favored the experimental group (−0.56 ± 0.76 vs. 0.39 ± 1.91, p = .011). Also, the experimental group had a significantly better change in the pain interference index (−3.31 ± 3.30 vs. −0.58 ± 1.91, p < .001). In addition, the experimental group exhibited greater improvements in yang-deficiency tendency (−2.38 ± 4.89 vs. 0.35 ± 4.67, p = .027), phlegm and stasis tendency (−2.19 ± 4.52 vs. 1.77 ± 2.47, p < .001), thick fur (1.44 ± 11.28 vs. 6.03 ± 6.04, p = .049), and red dots (−5.09 ± 21.45 vs. 2.81 ± 4.03, p = .048). However, no significant between-group difference in posttest sleep quality (p = .357) was observed.

Conclusions/Implications for Practice

The Qigong Wuqinxi exercise was found to positively improve chronic pain and TCM constitutions in community-dwelling older adults and may be promoted in community care centers to improve the health status of older adults.
Beyond single-use: a systematic review of environmental, economic, and clinical impacts of endoscopic surgical instrumentation
Authors: Eussen Myrthe M.M. , Moossdorff Martine , Wellens Lianne M. , de Reuver Philip R. , Stobernack Tim , Bijlmakers Leon , Kimman Merel L. , Bouvy Nicole D.
Published: November 2024

Background:

The evolution of endoscopic surgery has introduced a multitude of instruments, available in both disposable and reusable variants, influencing practices across various surgical specialties. Instrument selection is complex, considering individual preferences and institutional factors such as costs, instrument performance, and factors related to cleaning and sterilization. Notably, environmental sustainability has gained prominence due to the threat of climate change. This review assessed the existing literature to facilitate evidence-informed decision-making, encompassing clinical and economic efficacy, environmental friendliness, and other important criteria.

Materials and Methods:

Following PRISMA guidelines, searches were conducted in Pubmed, Embase, Web of Science, and The Cochrane Library for studies comparing the environmental impact, costs, instrument performance, and contamination risk of disposable versus reusable instruments or new versus reprocessed disposables in endoscopic surgery. Life-Cycle Assessments (LCAs) were included to quantify the climate impact. Exclusions included veterinary studies, general endoscopic procedures, and novel instruments.

Conclusion:

The search yielded 15 809 studies, 53 studies meeting the inclusion criteria: 38 compared disposable versus reusable instruments and 15 examined new versus reprocessed disposables. Reusables and/or reprocessed disposables showed favorable environmental and economic outcomes compared to new disposables. Instrument performance was comparable between the two groups. No studies were identified that investigated the clinical implications of contamination risk of disposables versus reusables. Six studies evaluating the contamination risk of reusables and reprocessed disposables showed residual pollution after cleaning and sterilization, although data on clinical outcome lacked.

Interpretation:

This review underscores the environmental benefits of reusables and favors both reusable and reprocessed disposables for their economic advantages. The lack of clear evidence favoring one type over the other in instrument performance necessitates further research. Addressing contamination risks requires additional studies on the clinical impact of residual substances. Future research should report outcomes on environmental sustainability, costs, instrument performance, and contamination risk.
Trends and disparities in age, sex, ethnoracial background, and urbanization status in adult mortality due to thoracic aortic aneurysm: a retrospective nationwide study in the United States
Authors: Goyal Aman , Saeed Humza , Shamim Urooj , Siddiqui Momina R. , Abdullah  , Arshad Muhammad K. , Jain Hritvik , Daoud Mohamed , Khan Rozi , Bansal Kamna
Published: November 2024

Introduction:

Thoracic aortic aneurysms (TAA) are a significant health concern, with the true prevalence likely underestimated due to undiagnosed cases. Outcomes in TAA are influenced by factors like age, sex, and comorbidities such as hypertension. This study examines mortality trends and disparities associated with TAA in US adults.

Methodology:

This study analyzed death certificates from 1999 to 2020 using the CDC WONDER Database to identify TAA-related deaths in individuals aged 25 and older using ICD-10 codes I71.1 and I71.2. Age-adjusted mortality rates (AAMRs) per 1 000 000 and annual percent changes (APCs) were calculated and stratified by year, sex, age group, race/ethnicity, region, and urbanization status.

Results:

Between 1999 and 2020, 47 136 TAA-related deaths were reported among US adults. The AAMR decreased from 16.2 to 8.2 per 1 000 000, with a significant decline from 1999 to 2013 (APC: −5.00; 95% CI: −5.54 to −4.54; P<0.001). Older adults had the highest AAMRs at 44.6 per 1 000 000. Men had higher AAMRs than women (11.2 vs. 9). AAMRs were highest among non-Hispanic (NH) Black (11), followed by NH White (10.3), NH Asian or Pacific Islander (9.5), NH American Indian or Alaska Native (7.8), and Hispanic (5.2) populations. Nonmetropolitan areas had higher AAMRs than metropolitan areas (11 vs. 9.8).

Conclusions:

The analysis showed a significant decline in TAA mortality since 1999, with recent stabilization. However, disparities persist, with higher AAMRs among men, older adults, NH Black adults, and nonmetropolitan residents, highlighting the need for targeted and equitable interventions.
Molecular alterations influencing the prognostic outcome in small pancreatic cancer (≤ 2 cm)
Authors: Takematsu Toru , Hayashi Hiromitsu , Ogawa Daisuke , Nakao Yosuke , Yamao Takanobu , Kitano Yuki , Nakagawa Shigeki , Mima Kosuke , Baba Yoshifumi , Baba Hideo
Published: November 2024

Purpose

Pancreatic cancer (PC) is the most lethal cancer. The prognosis of small PC (tumor smaller than 20 mm) is better than that of larger PC tumors, indicating the importance of detecting early-stage PC for patient outcome. The aim of this study was to elucidate the molecular features in small PC (≤ 20 mm).

Methods

This study included 79 PC tumors (≤ 20 mm in pathological examination) resected between 2004 and 2022. c-Myc, Caveolin-1, Smad4, and Thrombospondin-1 were examined by immunostaining. These molecular alterations were compared in PC patients with tumor size ≤10 mm (n = 11) (14%) and 10 mm < tumor size ≤20 mm (n = 68) (86%). Mutation analyses of KRAS, PIK3CA, and BRAF were performed by pyrosequencing in 22 PCs.

Results

PC with 10 mm < tumor size ≤20 mm showed significantly worse overall survival and disease-free survival than PC with tumor size <10 mm (P = 0.024 and P = 0.028). Tumor c-Myc and stromal Caveolin-1 expressions were significantly increased in tumors larger than 10 mm (P = 0.02 and P = 0.04). c-Myc and Caveolin-1 expressions were associated with poor disease-free survival and overall survival. KRAS, PIK3CA, and BRAF mutation status did not differ between the two groups.

Conclusions

Tumor c-Myc and stromal Caveolin-1 overexpressions were detected in tumors larger than 10 mm. Their overexpressions were associated with worse prognosis even in small PC. These molecular alterations in small PC may be a clue for the detection of early-stage PC.
Weathering the Storm
Authors: Nesbitt Janice
Published: November 2024

The provision of palliative care has been seen to have a significant impact on the interprofessional health care team. Being emotionally present to support patients and families at their most stressful points in life can result in compassion satisfaction or compassion fatigue. Providing palliative care through the COVID-19 pandemic added another layer of complexity to this professional caregiving experience. Although efforts have been made by employers to support health care providers in the practices of self-care and mindfulness, the true experience of care providers was not known. This study was conducted from June 2020 to October 2020 to better understand the experiences of physicians, nurses, social workers, and spiritual care providers who were providing palliative care during the first wave of the pandemic. Twenty-five participants completed the Professional Quality of Life (The Concise ProQOL Manual: The Concise Manual for the Professional Quality of Life Scale) measure and open-ended questions to evaluate their experiences as health care providers. The findings resulted in an overarching theme of “Weathering the Storm” with 6 themes describing the experiences of the interprofessional team.
Understanding Disenfranchised Grief in a Post–COVID-19 World—A Pilot Study of Advanced Practice Registered Nurses in Palliative Care
Authors: Owens Darrell , Morse Rebecca , Garcia-Greenwood Lindsey , Daly Cathleen , Phan Tri Minh
Published: November 2024

Disenfranchised grief is a form of grief that remains unacknowledged and unsupportive. Building on Doka’s foundational concept of disenfranchised grief, the guiding framework for this pilot project was the Knowledge to Action framework. This study is a quantitative cross-sectional web-based survey, which included a validated questionnaire: the Witnessing Disenfranchised Grief Scale. The Witnessing Disenfranchised Grief Scale measures how participants feel their grief is recognized and validated by friends and family versus administrators or supervisors. A χ
2 analysis (P < .05) was completed with findings suggesting that palliative care advanced practice registered nurses broadly experienced higher levels of support from witness C types (colleagues, coworkers, family, or friends) when compared with witness A types (supervisors, bosses, or persons with administrative responsibility). A 2-sample t test also demonstrated significance when comparing both witness groups. Overall mean scores were significantly higher (P < .001) in the witness C group (mean, 68.7) versus the witness A group (mean, 51.2). Higher mean scores indicate a higher level of support reported by the participant. The findings affirm that advanced practice registered nurses working in palliative care continue to grieve both death and non–death-related losses and report a higher degree of witnessed grief by their friends, family members, and colleagues. Participants’ supervisors, bosses, or administrators provide less grief acknowledgment.
Theoretically Based Factors Associated With Stroke Family Caregiver Health
Authors: Kum Cleopatra , Jones Holly J. , Miller Elaine L. , Kreitzer Natalie , Bakas Tamilyn
Published: November 2024

Purpose

Most persons who have had strokes are cared for at home by family members—many of whom experience depressive symptoms and quality of life changes as a result of providing care. The objective of this study is to determine theoretically based factors associated with unhealthy days in stroke family caregivers.

Research Design and Methods

Secondary data analysis was conducted using baseline data from a large randomized controlled clinical trial testing the Telephone Assessment and Skill-Building Kit program with 254 family caregivers of persons who have had strokes. Guided by a conceptual model derived from Lazarus’ transactional approach to stress, data were analyzed using multiple regression with unhealthy days as the dependent variable and theoretically based factors as independent variables.

Results

Caregivers were mostly female (78%), White (71%), spouses (47%), or adult children (29%). Caregivers reported nine unhealthy days on average within the past month. A total of 37.8% of the variance in unhealthy days was explained by caregiver task difficulty, level of optimism, threat appraisal, depressive symptoms, and life changes with depressive symptoms being the strongest individual predictor because of shared variance.

Clinical Relevance

Unhealthy days is an important part of stroke family caregiver health. Factors associated with unhealthy days in this study provide areas to consider in future intervention development.
Improving the Discharge Process at the VA Palo Alto Through Change Management and Implementation of Project Re-Engineered Discharge
Authors: Arredondo Kelley , Renfro David R. , Naungayan Aileen , Renfro Denise , Burgos Sharlene , Yarlagadda Sudha , Horstman Molly J. , Naik Aanand D. , Godwin Kyler M.
Published: November 2024

This quality improvement project demonstrates that nursing leadership with Project Re-Engineered Discharge can effect change in the discharge process and improve patient outcomes.
Measurement of Physical Activity Among Hospitalized Older Adults Living With Dementia
Authors: Resnick Barbara , Boltz Marie , Galik Elizabeth , Kuzmik Ashley , McPherson Rachel , Drazich Brittany , Kim Nayeon , Zhu Shijun , Wells Chris L.
Published: November 2024

The purpose of this secondary data analysis was to describe physical activity and the factors associated with physical activity among older adults living with dementia on medical units in acute care settings. Measures included accelerometry data from the MotionWatch 8, behavioral and psychological symptoms associated with dementia, use of psychotropic medications, subjective reports of activities of daily living and other types of physical activity (e.g., walking to the bathroom, participating in therapy), delirium severity, and medications. The majority of the 204 participants were White (70%) and female (62%), with a mean age of 83 years. Over 24 hours of assessment, participants engaged in 15 (SD = 46) minutes of vigorous activity, 43 (SD = 54) minutes of moderate activity, 2 hours 50 (SD = 2) minutes of low-level activity, and 20 (SD = 3) hours of sedentary activity. Subjective walking activities, toileting, evidence of disinhibition, delirium severity, agitation, and use of psychotropic medications were associated with increased physical activity based on the MotionWatch 8. The findings provide information for rehabilitation nurses regarding factors associated with physical activity among patients with dementia admitted to acute care settings as well as some of the challenges associated with measurement of physical activity. Future research needs to continue to explore the impact of behavioral symptoms associated with dementia on physical activity and increase participation in activities that are functionally relevant.
How Do Nurses Assess Cognition in Adults With Neurological Conditions? A Scoping Review
Authors: Xiong Jiayue , Bhimani Rozina , McMahon Siobhan , Chi Chih-Lin , Anderson Lisa
Published: November 2024

Background

According to epidemiological studies, neurological cognitive problems are increasingly prevalent in the aging population, with estimates that the number of people living with cognitive impairment will triple by 2050. Therefore, early detection in rehabilitation settings is needed to manage cognitive changes to ensure that individuals living with these conditions receive care and support that addresses their needs.

Purpose

This scoping review, based on the Arksey and O’Malley method, aims to investigate the cognitive assessments used for patients with neurological conditions in current nursing practice.

Method

PubMed, Ovid Medline, and CINAHL databases were searched to identify relevant articles published from 2017 to 2023 in English. Twenty-four articles met the inclusion criteria. Cognitive assessments were evaluated across acute care/hospital, outpatient/clinic, community, and long-term care/nursing home settings.

Results

The Mini-Mental State Examination is the most frequently used tool across all settings except for long-term care. Cognition includes many different domains such as executive functioning and speed of processing information; however, most tools only capture memory. The nursing profession must expand its standardized nursing vocabulary to capture cognition better.

Conclusions

As rehabilitation nurses navigate diverse clinical environments, recognition of contextual nuances is important in selecting cognitive function measurement tools most suitable for their setting.
Subjective Well-Being, Positive Affect, Life Satisfaction, and Happiness With Multiple Sclerosis
Authors: Chang Julia H. C. , Bethoux Francois , Plow Matthew A.
Published: November 2024

Purpose

People with multiple sclerosis (MS) may face challenges maintaining their subjective well-being, life satisfaction, happiness, and positive emotions. This scoping review’s purpose was to summarize studies on these positive psychological constructs among people with MS.

Methods

Observational and interventional studies that included measures of subjective well-being, life satisfaction, happiness, or positive affect were identified. Variables associated with these constructs were classified using the International Classification of Functioning, Disability and Health (ICF).

Results

The review included 22 observational and 10 interventional studies. Variables were categorized into each of the ICF domains. Cognitive behavior therapy was the most common intervention, with content and dosing varying widely.

Clinical Relevance

Subjective well-being, life satisfaction, happiness, and positive affect are crucial components of community and individual health. The findings of this scoping review highlight the complex interplay between function, personal factors, and environmental conditions in influencing positive psychological constructs. Given the limited evidence, rehabilitation nurses should leverage their skills in delivering holistic care and adopt data-driven approaches to integrate positive psychological strategies into care plans.

Conclusion

Further research is needed to measure and compare interventions aimed at improving these constructs and to examine the influence of personal and environmental factors among diverse MS populations.