bluuebunny/crossref_metadata_2025 huggingface dataset:
An appraisal of guidelines and practices for municipal infrastructure support agent to execute labour-intensive construction projects in South Africa
Authors: Ebekozien Andrew , Aigbavboa Clinton , Samsurijan Mohamad Shaharudin , Radin Firdaus Radin Badarudin , Ayo-Odifiri Solomon Oisasoje , Amadi Godpower C.
Published: July 2023

Purpose

Several studies have shown that the mechanism of labour-intensive construction (LIC) projects can mitigate high unemployment and create skilled development, especially in developing nations. The guidelines and practices for implementation may have faced some encumbrances in some countries. Whether the current guidelines and practices for municipal infrastructure support agent (MISA) to execute LIC projects face hindrances in South Africa has yet to receive in-depth studies. Thus, this study attempts to proffer policy solutions to improve the proposed revised guidelines and practices for MISA in LIC project execution in South Africa.

Design/methodology/approach

The study's objectives were accomplished via a combination of 16 virtual interviews of built environment professionals and government officials involved in LIC project execution in South Africa and supported by the analysed documents. A thematic approach was used to analyse the data and presented two main themes.

Findings

Findings show lax enforcement of discretionary funds, lax institutional capacity and inadequate individual skills, among others, as the gaps in existing South Africa's LIC guidelines and practices. Also, policy solutions to address the gaps were proffered.

Practical implications

The suggested feasible policies will improve the proposed revised guidelines and practices for MISA in LIC project execution in South Africa. This guide will promote the development of individual skills, institutional capacities and increase employment across South Africa.

Originality/value

This study promotes the use of LIC to create employment and contribute to proffering measures that will improve the proposed revised third edition of the guidelines and practices for MISA to execute LIC.
Does the influence of competition and compensation on hospital quality vary with ownership type?
Authors: Chen Linda H. , Eldenburg Leslie , Goodman Theodore H.
Published: July 2023

Purpose

The purpose of this study is to investigate how two types of drivers, namely, executive compensation and market competition, can affect hospital quality in the USA. Recently, patients, insurers and regulators have increasingly focused on hospital quality. Understanding the interplay of incentives in this industry is important because in 2019, hospital treatment contributed $1.161bn to health-care costs in the USA. This study answers the call for more studies in the so-called “mixed” industry, where ownership differences can affect organizational objectives and operating constraints.

Design/methodology/approach

This study explores the roles of hospital executive compensation and industry competition as determinants of health-care quality. Specifically, the study probes the heterogeneity in the factors that influence quality across hospital types in the USA.

Findings

Using California hospital data from 2006 through 2020, the findings show that the effects of compensation and competition on hospital quality differ by ownership type. Executive compensation is positively associated with quality in for-profit hospitals but is not associated with that of nonprofit hospitals, suggesting for-profit hospitals are more likely to use higher levels of compensation to attract managers with higher ability, whereas the utility function for nonprofit managers may be multidimensional. Within the nonprofit hospital group, competition is more positively associated with quality for religious nonprofits relative to secular nonprofits, suggesting that competition provides more monitoring for religious hospitals.

Originality/value

Taken together, the findings provide evidence that the drivers of quality vary across hospitals in ways consistent with differences in constraints and objectives across ownership types. The findings are important for regulators seeking to incentivize higher quality. For example, Medicare in the USA has incorporated quality measures into its new hospital reimbursement scheme (value-based purchasing) to incentivize quality. This study proposes that regulators should consider differences across ownership types when evaluating the best ways to incentivize hospital quality.
Corporate Social Responsibility and Firm Survival: Evidence from Chinese Listed Firms
Authors: Fernandes Filipa Da Silva , Sermpinis Georgios , Stasinakis Charalampos , Zhao Yang
Published: July 2023

This study examines the effect of corporate social responsibility (CSR) on Chinese firms’ probability of survival using 2426 firm‐year observations over the period 2011–2019. We find evidence that CSR has a positive effect on firms’ survival prospects. This effect is stronger for state‐owned enterprises (SOEs). The result is robust to an instrumental variable approach and several quasi‐natural experiments. We further decompose CSR into its components, and we identify a more prominent positive effect of the CSR environmental component for SOEs. SOEs generally appear to have an easier path to survival when engaged in CSR activities. The results remain valid when accounting for a set of robustness checks related to alternative CSR measures, financial constraints, provincial diversity, exogenous shocks, and placebo tests. Overall, this study provides evidence that CSR activities improve firms’ probability of survival in a government intervention setting.
Cross‐resistance and genetics of field‐evolved resistance to chlorfenapyr in Plutella xylostella
Authors: Qian Cheng , Li Jialin , Wu Shuwen , Yang Yihua , Wu Yidong , Wang Xingliang
Published: July 2023

Chlorfenapyr is a broad‐spectrum halogenated pyrrole insecticide with a unique mode of action. Due to the misuse and overuse of this chemical, resistance has been reported in several arthropods, including Plutella xylostella, which is one of the most destructive insect pests afflicting crucifers worldwide. A better understanding of the cross‐resistance and genetics of field‐evolved chlorfenapyr resistance could effectively guide resistance management practices. Here, the chlorfenapyr resistance of a field‐derived population of P. xylostella was introgressed into the susceptible IPP‐S strain using a selection‐assisted multigenerational backcrossing approach. The constructed near‐isogenic strain, TH‐BC5F2, shared 98.4% genetic background with the recurrent parent IPP‐S strain. The TH‐BC5F2 strain showed 275‐fold resistance to chlorfenapyr, but no significant cross‐resistance to spinosad, abamectin, chlorpyrifos, β‐cypermethrin, indoxacarb, chlorantraniliprole, or broflanilide (no more than 4.2‐fold). Genetic analysis revealed that resistance was autosomal, incompletely dominant, and conferred by 1 major gene or a few tightly linked loci. The synergism of metabolic inhibitors (PBO, DEM, and DEF) to chlorfenapyr was very weak (<1.7‐fold), and the metabolic enzyme activities in the TH‐BC5F2 strain were not significantly elevated compared with the IPP‐S strain. The results enhances our understanding of the genetic traits of chlorfenapyr resistance, and provides essential information for improving resistance management strategies.
Nutritional quality and price of plant‐based dairy and meat analogs in the Canadian food supply system
Authors: Lee Jennifer J. , Srebot Sophia , Ahmed Mavra , Mulligan Christine , Hu Guanlan , L'Abbé Mary R.
Published: July 2023

There has been an increased consumer interest and public health emphasis on plant‐based protein foods, resulting in a rise in the availability of highly processed plant‐based analogs. The objectives of this study were to assess the nutritional quality and the price of plant‐based dairy and meat analogs compared to their respective animal‐derived products and to examine the association between processing levels and the nutritional quality among these products. Using a branded food composition database, products in cheese, yogurt, milk, and meat categories were examined (n = 3231). Products were categorized as plant‐based analogs versus animal‐derived products using the ingredient list. Products were examined for their nutrient content, overall nutritional quality using the Food Standards Australia New Zealand nutrient profiling model, price, and processing levels using the NOVA classification. All plant‐based analogs had lower protein and higher total carbohydrate, sugar, and fiber content compared to their respective animal‐derived products. Compared to their respective animal‐derived products, plant‐based milk and meat analogs had lower energy, total fat, and saturated fat content; plant‐based yogurt and meat analogs had lower sodium content; and all plant‐based dairy analogs had lower calcium content. Plant‐based cheese and yogurt analogs were more expensive than animal‐based products; however, there was no significant difference among milk and meat products. There was no association between processing levels and overall nutritional quality among dairy and meat products. Plant‐based analogs may be part of a healthy and affordable diet to reduce the intakes of nutrients of concern; however, additional compositional guidelines and/or labeling may be needed to highlight the differences in the levels of nutrients to encourage.
A review on the identification of transgenic oilseeds and oils
Authors: Pan Pengyuan , Xing Yihang , Zhang Dingwen , Wang Ji , Liu Chunlei , Wu Dan , Wang Xiyan
Published: July 2023

Transgenic technology can increase the quantity and quality of vegetable oils worldwide. However, people are skeptical about the safety of transgenic oil‐bearing crops and the oils they produce. In order to protect consumers’ rights and avoid transgenic oils being adulterated or labeled as nontransgenic oils, the transgenic detection technology of oilseeds and oils needs careful consideration. This paper first summarized the current research status of transgenic technologies implemented at oil‐bearing crops. Then, an inspection process was proposed to detect a large number of samples to be the subject rapidly, and various inspection strategies for transgenic oilseeds and oils were summarized according to the process sequence. The detection indicators included oil content, fatty acid, triglyceride, tocopherol, and nucleic acid. The detection technologies involved chromatography, spectroscopy, nuclear magnetic resonance, and polymerase chain reaction. It is hoped that this article can provide crucial technical reference and support for staff engaging in the supervision of transgenic food and for researchers developing fast and efficient monitoring methods in the future.
Identification of the intersegmental plane via electromagnetic navigation for anatomical segmentectomy
Authors: Qiu Tong , Jiao Wenjie , Zhao Yandong , Xuan Yunpeng
Published: July 2023

Accurate identification of the physiological intersegmental plane is crucial for successful anatomical segmentectomy. Current techniques, such as the inflation‐deflation method, may result in uncertain cutting lines, leading to unsuitable resection extents. Here, we demonstrated the successful use of electromagnetic navigation with methylene blue dye‐marking to preoperatively and precisely identify the physiological intersegmental plane in two patients with small‐sized peripheral non‐small cell lung cancer (NSCLC). This novel technique offers the potential for precise cutting lines that align closely with the physiological intersegmental plane, thus improving the accuracy and efficacy of anatomical segmentectomy for these selected NSCLC patients.
Mutual funds' reporting frequency and firms' responses to undervaluation: The role of share repurchases
Authors: Bourveau Thomas , Li Xinlei , Macciocchi Daniele , Sun Chengzhu
Published: July 2023

We examine a regulatory change that increased the reporting frequency of mutual funds' portfolios. Using a difference‐in‐differences design, we find that firms with greater ownership by mutual funds increase share repurchases following the regulatory change. We show that these share repurchases are a firm's rational response to undervaluation, which occurs because fund managers become shortsighted following the regulation and sell companies with good long‐term prospects. Collectively, our results shed light on an unintended consequence of more frequent reporting in a delegated asset management framework.
Tralokinumab therapy for moderate‐to‐severe atopic dermatitis: Clinical outcomes with targeted IL‐13 inhibition
Authors: Simpson Eric L. , Guttman‐Yassky Emma , Eichenfield Lawrence F. , Boguniewicz Mark , Bieber Thomas , Schneider Shannon , Guana Adriana , Silverberg Jonathan I.
Published: July 2023

Atopic dermatitis (AD) is a chronic, inflammatory, intensely pruritic skin disorder associated with significant patient burden. Interleukin (IL)‐13 is a cytokine that acts as a driver of immune dysregulation, skin‐barrier dysfunction, and microbiome dysbiosis that characterizes AD, and is consistently overexpressed in AD skin. Tralokinumab is a fully human immunoglobulin (Ig) G4 monoclonal antibody that binds specifically to IL‐13 with high affinity, thereby inhibiting subsequent downstream IL‐13 signaling. Three pivotal phase 3 clinical trials demonstrated that tralokinumab 300 mg every other week, as monotherapy or in combination with topical corticosteroids as needed, provides significant improvements in signs and symptoms of moderate‐to‐severe AD, as measured by Investigator's Global Assessment 0/1 (clear/almost clear) and Eczema Area and Severity Index‐75 at Week 16. Improvements were observed soon after tralokinumab initiation and were maintained over 52 weeks of therapy. Tralokinumab significantly improved patient‐reported outcomes such as itch and sleep, and demonstrated a safety profile comparable with placebo; conjunctivitis during tralokinumab therapy was generally mild. Similar results were observed in a phase 3 adolescent trial. The role of IL‐13 in the pathophysiology of AD justifies a targeted approach and a wealth of clinical data supports tralokinumab as a new therapeutic option for people with moderate‐to‐severe AD.
Crisis temporalities and ongoing capabilities in the lives of young people growing up on the streets of African cities: An ethnographic longitudinal perspective
Authors: van Blerk Lorraine , Hunter Janine , Shand Wayne
Published: July 2023

Understanding young people's lives through a focus on their micro‐geographies has been central for exercising young people's voices through research. However, such a focus has also neglected the multiple and complex realities of growing up that ripple throughout their lives, resulting in calls for more research to go beyond capturing daily snapshots of experience. This paper acknowledges that decades of research with and for young people living on city streets has underpinned activism and challenged western child rights discourse, helping to ensure that abuses and violations of street young people's rights are confronted. Yet, much of this research draws attention to lives lived in present moments – the difficulties encountered and capabilities displayed. It does not account for the temporal fluidity of how young people's realities are future impacted by slow crises and challenging daily life experiences as they grow towards adulthood. This paper explores the crisis temporalities of young people's street lives through a youth‐led ethnographic longitudinal approach. The paper focuses on 18 youth researchers and over 200 of their peers' experiences of research over three years while living on the streets of three African cities. The paper discusses the challenges of undertaking longitudinal research alongside the temporal affordances of surviving urban informality and the compounding effects of slow crises on present and future‐oriented survival. These affordances emerge as street youth respond to daily trials, experience setbacks, crises, triumphs, and failures, yet show resilience and employ capabilities. The paper concludes by demonstrating the crucial importance of ethnographic longitudinal research for policy and practice to ensure that youth who age on the streets, and their families, are supported in accordance with social justice concerns.
Drug shortages. Part 1. Definitions and harms
Authors: Aronson Jeffrey K. , Heneghan Carl , Ferner Robin E.
Published: July 2023

Drug shortages are repeatedly in the news. The earliest drug shortages were reported during the First World War, but the numbers of shortages have increased in recent years. In the first part of this two‐part review, we discuss definitions of drug shortages and so‐called stockouts, which are localized shortages, and the harms that they can cause. Drug shortages make it difficult or impossible to meet the therapeutic needs of individual patients or populations, but we lack an adequate definition. The problems are too complicated to be encompassed in a brief intensional dictionary‐style definition, and that is reflected in the many different attempts at definition that have been proposed. We therefore propose an extensional operational definition that incorporates the processes by which products are manufactured, the causes of shortages and the contributory factors. A definition of this sort allows one to identify the main causes of a particular drug shortage and therefore the remedies that might prevent, mitigate or manage it. In the second part of the review we discuss the causes and solutions in more detail. Adverse drug reactions and medication errors attributable to shortages occur but are not often reported. Adverse reactions to substitute medicines are possible, and errors can occur because of unfamiliarity or unnecessary treatment with replacement medicines. Other harmful outcomes include withdrawal reactions, undertreatment, treatment delays and cancellations, failure of alternatives and disruption of clinical trials.
Drug shortages. Part 2: Trends, causes and solutions
Authors: Aronson Jeffrey K. , Heneghan Carl , Ferner Robin E.
Published: July 2023

Drug shortages make it difficult or impossible to meet the therapeutic needs of individual patients or populations. In the first part of this review we proposed an operational definition that incorporates the processes by which products are manufactured, the causes of shortages and stock‐outs (local shortages), and the contributory factors. Here we discuss causes and possible solutions. Drug shortages have complex causes, and a single cause cannot always be identified. Reasons include lack or shortage of raw materials, manufacturing difficulties, regulatory and political actions, voluntary recalls, just‐in‐time inventory systems, halts in production for financial or other business reasons, low demand (eg, orphan products, reduced usage), mergers, market shifts (eg, diversion to home markets) and unexpected increases in demand (eg, improved diagnosis, new trial information, epidemics and pandemics, inappropriate use, off‐label use). Potential solutions are as diverse as the potential causes. Prevention is hard, because shortages are not easily predicted. Everyone in the supply chain is involved in anticipating and managing shortages, with responsibilities for preventing them or at least trying to mitigate their effects. This includes manufacturers and suppliers, particularly of generic formulations, pharmacists, prescribers, patients and governments. Solutions can therefore be linked to the causes and classified according to where the responsibility for implementing them lies.
The shame of being undone by illness and the power of support through the body of Christ
Authors: Thompson Deanna A.
Published: July 2023

This paper examines shame that arises from living with a body that has been undone by cancer or other serious illness. It draws on first‐person narratives and social‐scientific studies of cancer patients to explore how bodies undone by illness often cease to conform to cultural standards of health as well as gendered expectations of bodies, and how experiences of shame arise from those shifts in how sick bodies appear and perform. Analysis of narratives by and qualitative data about those who are seriously ill also reveals how the undoing of the body by illness often precipitates an undoing of one's sense of self that leads to experiences of shame over an inability to fill roles and expectations in ways that were possible in life before serious illness. The paper then utilizes biblical and theological resources to explore ways religious communities can make space for those living with serious illness to lament what it's like to be undone by illness, to hold them up amid their experiences of vulnerability through public lament and acts of accompaniment, and to affirm their worth in the eyes of God and in the body of Christ.
Association of prediabetes progression and regression with cognitive decline: Findings from the CHARLS
Authors: Xing Xing , Wang Yining , Shen Ziyuan , Pan Faming , Cai Guoqi
Published: July 2023

Aim

The aim of the study was to describe the association of prediabetes progression and regression with change in cognitive function.

Methods

Data from three waves (2011, 2015 and 2018) of the China Health and Retirement Longitudinal Study (CHARLS) were analysed. Diabetic statuses in 2011 and 2015 were ascertained using the American Diabetes Association criteria. Cognitive function was assessed and standardized at all three waves, where a total score and its two components (episodic memory and metal status) were calculated. We evaluated the association of prediabetes progression and regression (from 2011 to 2015) with changes in cognitive function from 2011 to 2015 and from 2015 to 2018.

Results

Of 2590 participants (56% women, mean age 58.6 ± 8.4 years) with prediabetes, 12% progressed to diabetes and 41% regressed to normoglycaemia. Compared with participants who remained as prediabetes, those who progressed to diabetes showed a trend to have accelerated decline in episodic memory (β = −0.11, 95% confidence interval −0.22 to 0.003, p = 0.057). However, participants who regressed to normoglycaemia did not have less cognitive decline. Neither prediabetes progression nor regression predicted change in cognitive function from 2015 to 2018. In a separate group of participants who remained as normoglycaemia (n = 858), changes in cognitive function from 2011 to 2015 and from 2015 to 2018 were similar to those who remained as prediabetes.

Conclusion

In people with prediabetes, progression to diabetes may be associated with accelerated cognitive decline but regression to normoglycaemia does not retard cognitive decline. Prediabetes progression and regression may not be predictive of change in cognitive function.
Chimeric antigen receptor T cells for acute myeloid leukemia
Authors: Fetsch Viktor , Zeiser Robert
Published: July 2023

The use of T cells expressing chimeric antigen receptors (CARs) that can target and eliminate cancer cells has revolutionized the treatment of B‐cell malignancies. In contrast, CAR T cells have not yet become a routine treatment for myeloid malignancies such as acute myeloid leukemia (AML) or myeloproliferative neoplasms (MPNs). For these disease entities, allogeneic hematopoietic cell transplantation (allo‐HCT) relying on polyclonal allo‐reactive T cells is still the major cellular immunotherapy used in clinical routine. Here, we discuss major hurdles of CAR T‐cell therapy for myeloid malignancies and novel approaches to enhance their efficacy and reduce toxicity. Heterogeneity of the malignant myeloid clone, CAR T‐cell induced toxicity against normal hematopoietic cells, lack of long‐term CAR T‐cell persistence, and loss or downregulation of targetable antigens on myeloid cells are obstacles for successful CAR T cells therapy against AML and MPNs. Strategies to overcome these hurdles include pharmacological interventions, for example, demethylating therapy to increase target antigen expression, multi‐targeted CAR T cells, and gene‐therapy based approaches that delete the CAR target antigen in the hematopoietic cells of the recipient to protect them from CAR‐induced myelotoxicity. Most of these approaches are still in preclinical testing but may reach the clinic in the coming years. In summary, we report on barriers to CAR T‐cell use against AML and novel therapeutic strategies to overcome these challenges, with the goal of clinical treatment of myeloid malignancies with CAR T cells.
Into the Pedocene—Pedology of a changing world
Authors: Hartemink Alfred E.
Published: July 2023

Pedology, or the study of soil, is often viewed focusing on soil formation, morphology, mapping and classification. But the study of soil has largely expanded beyond these four areas and now includes quantitative studies using soil legacy data combined with technological advances in data collection, soil sampling and computation. We have global availability of soil information and can retrieve pedological information for any location including some indication of its accuracy. Scientific and technological developments in pedology have been led by the rise of several subdisciplines including pedometrics, digital soil mapping, spectral pedology, digital soil morphometrics, hydropedology, microbial pedology, astropedology and the development of pedotransfer functions. With the expansion of pedology and its relevance for understanding the earth system and tackling global change, it is postulated that soil science has now entered the ‘Pedocene’—a soil epoch equivalent to the Anthropocene. The Pedocene is characterized by the quantitative understanding and evaluation of the global soil system, and the effects of human‐induced changes brought to soil.
Potential for carbon sequestration after biochar‐P fertilizer application: A biological and chemical assessment
Authors: Borges Bernardo M. M. N. , Barreto Matheus Sampaio C. , Pavinato Paulo S. , Franco Henrique C. J. , Carvalho João Luís Nunes , Strauss Mathias , Sohi Saran
Published: July 2023

Innovation is required on many fronts in agriculture, not only to improve nutrient use efficiency but also to mitigate the effects of climate change. Our previous studies presented the high agronomic efficiency of an experimental phosphate fertilizer using a biochar‐matrix, called ‘BioFert’. However, the efficiency of BioFert for soil carbon sequestration goals has not yet been evaluated. We incubated BioFert and initial raw sugarcane‐biochar over 56 days in two soils (i.e., Ferralsol and Alisol) and measured the total CO2 and δ13C‐CO2 to quantify the contribution of native soil organic matter, sugarcane‐biochar, or BioFert to carbon mineralization. There was no significant difference in cumulative CO2 release between BioFert and the control (without carbon addition), and BioFert was less mineralized than carbon from sugarcane‐biochar regardless of soil type. In addition, accelerated aging by thermal oxidation of these carbon sources revealed that more than 80% of BioFert‐carbon was prevented from accelerated mineralization, while sugarcane‐biochar achieved ~80% of carbon mineralization. The residual solids after oxidation were analysed by X‐ray photoelectron spectroscopy and indicated aliphatic/aromatic and carboxylic chemical bonds on the BioFert surface, which might offer new cation exchange sites over time. We conclude that BioFert is not only a phosphate fertilizer with high phosphorus use efficiency but also a stable source of carbon for soil carbon sequestration purposes.
Lipid biomarkers recording marine microbial community structure changes through the Frasnian‐Famennian mass extinction event
Authors: Chen Jian , Hogancamp Nicholas , Lu Man , Ikejiri Takehito , Malina Natalia , Ojeda Ann , Sun YongGe , Lu YueHan
Published: July 2023

Studying the response and recovery of marine microbial communities during mass extinction events provides an evolutionary window through which to understand the adaptation and resilience of the marine ecosystem in the face of significant environmental disturbances. The goal of this study is to reconstruct changes in the marine microbial community structure through the Late Devonian Frasnian‐Famennian (F‐F) transition. We performed a multiproxy investigation on a drill core of the Upper Devonian New Albany Shale from the Illinois Basin (western Kentucky, USA). Aryl isoprenoids show green sulfur bacteria expansion and associated photic zone euxinia (PZE) enhancement during the F‐F interval. These changes can be attributed to augmented terrigenous influxes, as recorded collectively by the long‐chain/short‐chain normal alkane ratio, carbon preference index, C30 moretane/C30 hopane, and diahopane index. Hopane/sterane ratios reveal a more pronounced dominance of eukaryotic over prokaryotic production during the mass extinction interval. Sterane distributions indicate that the microalgal community was primarily composed of green algae clades, and their dominance became more pronounced during the F‐F interval and continued to rise in the subsequent periods. The 2α‐methylhopane index values do not show an evident shift during the mass extinction interval, whereas the 3β‐methylhopane index values record a greater abundance of methanotrophic bacteria during the extinction interval, suggesting enhanced methane cycling due to intensified oxygen depletion. Overall, the Illinois Basin during the F‐F extinction experienced heightened algal productivity due to intensified terrigenous influxes, exhibiting similarities to contemporary coastal oceans that are currently undergoing globalized cultural eutrophication. The observed microbial community shifts associated with the F‐F environmental disturbances were largely restricted to the extinction interval, which suggests a relatively stable, resilient marine microbial ecosystem during the Late Devonian.
Exploring the association between educational aspirations and intentions to migrate among youth in Central Mexico by gender
Authors: Marsiglia Flavio F. , Campos Ana Paola , Wu Shiyou , Nuño‐Gutiérrez Bertha L. , García‐Pérez Hilda , Glick Jennifer E.
Published: July 2023

We assessed the association between educational aspirations and the intention to migrate among 1446 adolescents aged 11–17 years, living in semi‐urban/rural communities in Jalisco, Mexico. Analyses rely on survey data from the Family Migration and Early Life Outcomes study. The outcome variable was the intention to migrate, a three‐category variable coded as no intention to migrate, intention to migrate within Mexico, and intention to migrate internationally. The main independent variable was the adolescents' educational aspirations, conceptualized as the intention to achieve higher education. Multinomial logistic regression models were used to examine associations. We found an association between educational aspirations and intentions to migrate, and it was moderated by gender. Girls with the highest educational aspirations intended to migrate internationally, while higher educational aspirations were not a driver for boys' migration intentions. The study findings have implications for education and migration policies and future research.
Gastrointestinal mucosal toxicities from immune checkpoint inhibitors: Current understanding and future directions
Authors: Dougan Michael
Published: July 2023

Immune checkpoint inhibitor (ICI) therapy has revolutionized the field of oncology over the past decade, leading to durable remissions in some patients but also producing a wide spectrum of treatment‐limiting inflammatory toxicities that are referred to as immune‐related adverse events (irAEs). Although irAEs can involve any organ system in the body, they most commonly affect the barrier tissues, including the gastrointestinal tract with colitis and enterocolitis affecting a significant fraction of patients on ICIs. We are beginning to understand the mechanisms that drive ICI colitis, with early experiments indicating a role for CD8+ resident memory T cells (TRMs) in the gut, which become activated and differentiate into cytotoxic cells in response to ICI therapy. The risk factors that define who will develop ICI colitis are not understood and substantial efforts are underway to identify potential biomarkers for risk of this and other toxicities. Optimal management of ICI colitis is also an area of active investigation. Current standard treatments are based largely on small, retrospective analyses, and while drugs like systemic glucocorticoids or the TNFα inhibitor infliximab do appear to be highly active in ICI colitis, the impact of these therapies on antitumor responses is poorly understood. As discussed in this review, future work will have to define the immune mechanisms driving ICI colitis in more detail and in comparison to antitumor responses in order to identify candidate pathways that can be targeted to improve ICI colitis without interfering in antitumor immunity. Studying these interventions will require randomized, controlled trials with both tumor and colitis endpoints, a goal that will necessitate collaboration across institutions and funding agencies. We are at a point where such collaborative trials are feasible, and have the potential to greatly improve the care of patients with ICI colitis as well as other irAEs.
Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes
Authors: Shoham Yaron , Gasteratos Konstantinos , Singer Adam J. , Krieger Yuval , Silberstein Eldad , Goverman Jeremy
Published: July 2023

In 2012 the European Medicines Agency approved a pineapple stem‐derived Bromelain‐based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013–2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta‐Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain‐based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non‐surgical eschar removal treatment modality. The benefits of Bromelain‐based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain‐based debridement are expanding to cover “off‐label” cases with significant benefits to the global healthcare economy.
An initiative to promote value‐based stress test selection in primary care and cardiology clinics: A mixed methods evaluation
Authors: Kling Samantha M. R. , Kalwani Neil M. , Winget Marcy , Gupta Kush , Saliba‐Gustafsson Erika A. , Baratta Juliana , Garvert Donn W. , Veruttipong Darlene , Brown‐Johnson Cati G. , Vilendrer Stacie , Gaspar Cindie , Levin Eleanor , Tsai Sandra
Published: July 2023

Objectives

Exercise stress echocardiograms (stress echos) are overused, whereas exercise stress electrocardiograms (stress ECGs) can be an appropriate, lower‐cost substitute. In this post hoc, mixed methods evaluation, we assessed an initiative promoting value‐based, guideline‐concordant ordering practices in primary care (PC) and cardiology clinics.

Methods

Change in percent of stress ECGs ordered of all exercise stress tests (stress ECGs and echos) was calculated between three periods: baseline (January 2019–February 2020); Period 1 with reduced stress ECG report turnaround time + PC‐targeted education (began June 2020); and Period 2 with the addition of electronic health record‐based alternative alert (AA) providing point‐of‐care clinical decision support. The AA was deployed in two of five PC clinics in July 2020, two additional PC clinics in January 2021, and one of four cardiology clinics in February 2021. Nineteen primary care providers (PCPs) and five cardiologists were interviewed in Period 2.

Results

Clinicians reported reducing ECG report turnaround time was crucial for adoption. PCPs specifically reported that value‐based education helped change their practice. In PC, the percent of stress ECGs ordered increased by 38% ± 6% (SE) (p < 0.0001) from baseline to Period 1. Most PCPs identified the AA as the most impactful initiative, yet stress ECG ordering did not change (6% ± 6%; p = 0.34) between Periods 1 and 2. In contrast, cardiologists reportedly relied on their expertise rather than AAs, yet their stress ECGs orders increased from Period 1 to 2 to a larger degree in the cardiology clinic with the AA (12% ± 5%; p = 0.01) than clinics without the AA (6% ± 2%; p = 0.01). The percent of stress ECGs ordered was higher in Period 2 than baseline for both specialties (both p < 0.0001).

Conclusions

This initiative influenced ordering behaviour in PC and cardiology clinics. However, clinicians' perceptions of the initiative varied between specialties and did not always align with the observed behaviour change.
Rules, practices and principles: Putting bioethical principles in their place
Authors: Hardman Doug , Hutchinson Phil
Published: July 2023

Bioethics seems preoccupied with establishing, debating, promoting and sometimes debunking principles. While these tasks trade on the status of the word ‘principle’ in our ordinary language, scant attention is paid to the way principles operate in language. In this paper, we explore how principles relate to rules and practices so as to better understand their logic. We argue that principles gain their sense and power from the practices which give them sense. While general principles can be, and are, establishable in abstraction from specific practices, as they are in principlist bioethics, such principles are impotent as moral guides to action. We show that the purchase any principle has as a moral guide to action emerges from its indexical properties as a principle which has sense in a specific practice. The meaning of any principle is internal to the practice and context in which it is invoked and, therefore, principles are not kinds of master rule which dictate moral judgement in new contexts but rather chameleon‐like rules which change with the contexture in which they are invoked.
Child traumatic physical abuse rates and comparisons during the COVID‐19 pandemic: Retrospective paediatric single institution review in Texas
Authors: Ezeokoli Ekene U , Pang Lon Kai , Loyd Nathaniel G , Borici Neritan , Bachim Angela , Vogel Adam M , Rosenfeld Scott B
Published: July 2023

Aim

The COVID‐19 pandemic drastically altered human behaviour and socialisation and may have created an environment that could lead to increased incidence of domestic abuse and non‐accidental trauma, or child physical abuse (CPA). Initial reports about the effect of the COVID‐19 pandemic on the rates of CPA have been mixed. The purpose of this study is to describe the effects of COVID‐19 on rates of CPA in a large metropolitan paediatric hospital and level I paediatric trauma centre.

Methods

We identified and compared all CPA admissions under 18 years from May 2019 to February 2020 and considered that to be the pre‐COVID time frame. The ensuing 12‐month period of March 2020 to February 2021 was considered to be the intra‐COVID time frame.

Results

There were 49 (0.32%) unique CPA patients pre‐COVID and 83 (0.85%) unique CPA patients intra‐COVID (P < 0.001) with lower total admissions for any reason during the intra‐COVID time frame. Monthly CPA cases were increased (P < 0.03) during the intra‐COVID time period (mean 6.9, 95% confidence interval: 5.8–12.7) compared to the pre‐COVID time period (mean 4.9, 95% confidence interval: 3.3–8.2).

Conclusion

During the COVID‐19 pandemic, there were decreased overall hospital admissions in the period of mandated shutdowns and isolation. However, we saw an increased rate of CPA admissions compared to the time period prior to the pandemic. Knowledge of such data, trends and circumstances will help keep health‐care providers alert and vigilant in identifying children at risk for maltreatment, and may impact child abuse protocols and guidelines.
An update on mobility assessment of dogs with musculoskeletal disease
Authors: Clark N. , Comerford E.
Published: July 2023

Mobility impairments associated with musculoskeletal diseases, such as osteoarthritis and degenerative joint disease, affect approximately 200,000 dogs annually and pose a notable challenge to canine health and welfare. Osteoarthritis causes the remodelling of synovial joints, alongside inflammation and impaired mechanical function which can be extremely debilitating. Secondary osteoarthritis commonly affects dogs and can be exacerbated by previous joint abnormalities, such as patellar luxation or cranial cruciate ligament rupture. Although musculoskeletal diseases can affect dogs of any age, the early subtle signs of gait abnormalities are perhaps missed by owners, thus, dogs may be in the latter stages of osteoarthritis progression when they are presented to veterinarians. Dogs showing subtle signs of gait abnormalities must be presented to veterinary practices for acute diagnosis to prevent long‐term deterioration. Musculoskeletal diseases, such as osteoarthritis and degenerative joint disease, are commonly diagnosedviavisible radiographic changes. However, veterinarians can use a combination of subjective and objective clinical scoring systems, such as clinical metrology instruments and gait assessment in conjunction with radiography to aid their diagnosis and longitudinal monitoring of musculoskeletal diseases. These scoring systems may be more sensitive to earlier signs of mobility impairments in dogs, ultimately, promoting increased canine health and welfare by enabling pain reduction, improvement of muscle strength and preservation of joint function. Current canine mobility scoring systems available to veterinarians will be discussed in turn throughout this review for implementation into clinical practice.
Epistemic Silences and Experiential Knowledge in Decisions After a First Cesarean: The case of a vaginal birth after cesarean calculator
Authors: Rubashkin Nicholas
Published: July 2023

Evidence‐based obstetrics can employ statistical models to justify greater use of cesareans, sometimes excluding experiential elements from informed decision making. Over the past decade, prenatal providers adopted a vaginal birth after cesarean (VBAC) calculator designed to support patients in making informed decisions about their births by estimating their probability for a VBAC. Among other factors, the calculator used race and ethnicity to make its estimate, assigning lower probabilities for a successful VBAC to Black and Hispanic patients. I analyze how a diverse group of women and their providers engaged with the VBAC calculator. Some providers used low calculator scores to remove a shared decision‐making model by prescriptively counseling Black and Hispanic women who desired a VBAC into undergoing repeat cesareans. Consequently, women racialized by the calculator as Black or Hispanic used experiential knowledge to challenge the calculator's assessment of their supposed lesser ability to give birth vaginally.
Relationships between phenotypic plasticity and epigenetic variation in two Caribbean Acropora corals
Authors: Hackerott Serena , Virdis Francesca , Flood Peter J. , Souto Daniel Garcia , Paez Wendy , Eirin‐Lopez Jose M.
Published: July 2023

The plastic ability for a range of phenotypes to be exhibited by the same genotype allows organisms to respond to environmental variation and may modulate fitness in novel environments. Differing capacities for phenotypic plasticity within a population, apparent as genotype by environment interactions (GxE), can therefore have both ecological and evolutionary implications. Epigenetic gene regulation alters gene function in response to environmental cues without changes to the underlying genetic sequence and likely mediates phenotypic variation. DNA methylation is currently the most well described epigenetic mechanism and is related to transcriptional homeostasis in invertebrates. However, evidence quantitatively linking variation in DNA methylation with that of phenotype is lacking in some taxa, including reef‐building corals. In this study, spatial and seasonal environmental variation in Bonaire, Caribbean Netherlands was utilized to assess relationships between physiology and DNA methylation profiles within genetic clones across different genotypes of Acropora cervicornis and A. palmata corals. The physiology of both species was highly influenced by environmental variation compared to the effect of genotype. GxE effects on phenotype were only apparent in A. cervicornis. DNA methylation in both species differed between genotypes and seasons and epigenetic variation was significantly related to coral physiological metrics. Furthermore, plastic shifts in physiology across seasons were significantly positively correlated with shifts in DNA methylation profiles in both species. These results highlight the dynamic influence of environmental conditions and genetic constraints on the physiology of two important Caribbean coral species. Additionally, this study provides quantitative support for the role of epigenetic DNA methylation in mediating phenotypic plasticity in invertebrates.
Population dynamics in newts of the Carpathian Mountains
Authors: Finch Kristen N. , Leaché Adam D.
Published: July 2023

Rarity, range restriction, and narrow endemism tend to carry dire and urgent conservation implications for imperilled species. What is also clear is that human‐associated extinction risk factors such as urbanization and deforestation pose overwhelming threats to range‐restricted species. In this issue of Molecular Ecology, Antunes et al. (2022) demonstrate that these threats can also impact widespread species. By comparing newts in the genus Lissotriton that co‐occur in the same geographical region, they expose the distinctness of risks facing species with different habitat preferences. Their study emphasizes the importance of local‐scale landscape genetics to reveal the nuances of population connectivity that might otherwise be missed by studying a broader spatial scale.