bluuebunny/crossref_metadata_2025 huggingface dataset:
Jackiw-Teitelboim gravity as a noncritical string
Authors: Dowd Eoin , Giribet Gaston
Published: October 2024

Jackiw Teitelboim (JT) gravity has proven to be an excellent tool for investigating aspects of quantum gravity and black hole physics. In recent years, the study of JT gravity and its deformations has helped us learn about the different contributions of geometries in the gravitational path integral, the quantum gravity Hilbert space, the space-time factorization problem, the role of averaging in holography, the black hole information paradox, and the matrix models. All this motivates the exploration of the JT gravity in different setups, with and without matter. Here, we consider JT gravity conformally coupled to Liouville field theory and matter fields. This model admits to be interpreted as a noncritical string theory on a linear dilaton background with a tachyonic Liouville potential along a null direction. The constant curvature constraint of JT gravity results in a neutralization of the Liouville mode, which makes it possible to compute the four-point correlation function of the theory analytically. Here we give the explicit derivation of the four-point function and briefly comment on its properties, such as monodromy invariance, crossing symmetry, factorization, and limits.

Published by the American Physical Society
2024
Magic angle of
Sr2RuO4
: Optimizing correlation-driven superconductivity
Authors: Profe Jonas B. , Rhodes Luke C. , Dürrnagel Matteo , Bisset Rebecca , Marques Carolina A. , Chi Shun , Schwemmer Tilman , Thomale Ronny , Kennes Dante M. , Hooley Chris A. , Wahl Peter
Published: October 2024

Understanding of unconventional superconductivity is crucial for engineering materials with specific order parameters or elevated superconducting transition temperatures. However, for many materials, the pairing mechanism and symmetry of the order parameter remain unclear: reliable and efficient methods of predicting the order parameter and its response to tuning parameters are lacking. Here, we investigate the response of superconductivity in Sr2RuO4 to structural distortions via the random phase approximation (RPA) and functional renormalization group (FRG), starting from realistic models of the electronic structure. Our results suggest that RPA misses the interplay of competing fluctuation channels. FRG reproduces key experimental findings. We predict a magic octahedral rotation angle, maximizing the superconducting Tc and a dominant dx2−y2 pairing symmetry. To enable experimental verification, we provide calculations of the phase-referenced Bogoliubov Quasiparticle Interference imaging. Our work demonstrates a designer approach to tuning unconventional superconductivity with relevance and applicability for a wide range of quantum materials.

Published by the American Physical Society
2024
Tree structures may be the leadership structures employed by group motions exhibiting hierarchy
Authors: Gao Jian , Gu Changgui , Shen Chuansheng , Yang Huijie
Published: October 2024

Collective behaviors leading to various fascinating movement patterns are believed to be the product of complex interplay among individuals. Previous studies have identified two types of leadership structures in pigeon flocks, i.e., hierarchical networks and reciprocal relationships. However, both of these leadership structures are predicated based on data analysis and lack substantial empirical evidence. Additionally, it is difficult to delineate a direct correspondence between leadership structures and trajectory data for pigeon flocks because birds cannot report their leadership structure. Herein, based on experiments involving volunteers, we found that tree structures may serve as the leadership structures employed by group motions exhibiting hierarchy. In the tree structure, each follower follows its only leader during collective motions, and the single top leader determines the direction of collective motions. By employing the tree structure, we introduced a model for describing collective motions. A method for obtaining the leadership structure through experimental trajectory data was proposed. This strategy was used to analyze flight trajectory data from a pigeon flock and elucidate the pigeons' leadership relationships. Our model can simulate the collective behavior of pigeon flocks, thus accurately replicating the findings of previous experimental studies. The results of this study provide insights regarding the leadership structure in pigeon flocks and have implications for artificial collective systems, e.g., autonomous formation control of multiple unmanned aerial vehicles or unmanned surface vehicles.

Published by the American Physical Society
2024
Orthogonality catastrophe beyond bosonization from post-selection
Authors: Stefanini Martino , Marino Jamir
Published: October 2024

We show that the dynamics induced by post-selected measurements can serve as a controlled route to access physical processes beyond the boundaries of Luttinger liquid physics. We consider a one-dimensional fermionic wire whose dynamics results from a sequence of weak measurements of the fermionic density at a given site, interspersed with unitary hopping dynamics. This realizes a non-Hermitian variant of the celebrated instance of a local scatterer in a fermionic system and its ensuing orthogonality catastrophe. We observe a distinct crossover in the system's time evolution as a function of the fermion density. In the high-density regime, reminiscent of the Hermitian case, a bosonized version of the model properly describes the dynamics while, as we delve into the low-density regime, the validity of bosonization breaks down, giving rise to irreversible behavior. Notably, this crossover from reversible to irreversible dynamics is nonperturbative in the measurement rate and can manifest itself even with relatively shallow measurement rates, provided that the system's density remains below the crossover threshold. Our results render a conceptually transparent model for exploring nonperturbative effects beyond bosonization, which could be used as a stepping stone to explore novel routes for the control of nonlinear dynamics in low-dimensional quantum systems.

Published by the American Physical Society
2024
Intention to purchase sustainable food: the role of epistemic trust, credibility of science and scepticism about climate change
Authors: Pileri Jessica , Rocchi Giulia , Luciani Federica , Reho Matteo , Veneziani Giorgio , Lai Carlo
Published: October 2024

Purpose

This study investigated the role of epistemic trust in shaping consumers intentions towards purchasing sustainable food products by examining the relationships between epistemic trust, credibility of science, scepticism about climate change and intentions to purchase sustainable food.

Design/methodology/approach

Data were collected using a survey. A total of 391 consumers participated in the study. Structural equation modelling was employed for data analysis.

Findings

The results showed that the trust dimension was significantly and positively associated with credibility of science (p = 0.004) and negatively with scepticism about climate change (p = 0.018); mistrust was significantly and negatively associated with credibility of science (p = ≤0.001); credibility of science had a significant negative effect on scepticism about climate change (p = ≤0.001) and scepticism about climate change had a significant direct and negative impact on intention to purchase sustainable food (p = ≤0.001). Furthermore, results indicated that the link between trust, mistrust and intention to purchase sustainable food was significantly mediated by the credibility of science and scepticism about climate change.

Practical implications

The results can preliminarily suggest policies promoting transparency and direct consumer experiences in organisational practices, with implications extending to other sectors like education and public information.

Originality/value

For the first time, epistemic trust is specifically considered as an antecedent of intentions to purchase sustainable food, while also examining its relationships with scepticism about climate change and the credibility of science.
An integrative model of the key factors determining consumer behaviour towards street food
Authors: Soliman Mohammad , Al-Ghafri Naayama , Orea-Giner Alicia , Al Riyami Hafidh , Hawas Al-Aamri Musallam S.
Published: October 2024

Purpose

This study examines how street food affects urban culture, economics and sustainable tourism. It examines how street food stands, as a cultural and economic phenomenon, influence consumer behaviour and local traditions, particularly in Oman’s evolving street food scene.

Design/methodology/approach

Adopting a quantitative research design, this study utilises an integrated model combining the Stimulus-Organism-Response (S-O-R) and Attitude-Social-Influence-Efficacy (ASE) models. This approach facilitates a comprehensive analysis of the factors influencing consumer behaviour towards street food consumption. The methodology includes surveys and structured interviews with consumers and vendors to assess perceptions, attitudes and behaviours linked to street food in Oman.

Findings

The research identifies key sociocultural, economic and marketing factors that significantly influence consumer engagement with street food. It highlights how traditional elements, such as local customs and societal norms, interplay with contemporary marketing strategies to shape consumer preferences and experiences. The findings suggest that street food not only enhances the culinary experience for travellers but also plays a crucial role in the sustainable development of local tourism economies.

Originality/value

This study contributes to the existing literature by providing a novel empirical exploration of street food consumption in Oman, a relatively underexplored area within tourism research. It offers valuable insights into how street food can be leveraged to bolster local economies and enrich the tourist experience through sustainable practices. By integrating the S-O-R and ASE models, this research provides a unique framework for understanding the dynamic relationship between street food culture and consumer behaviour in a Middle Eastern context.
Factors influencing the adoption of extended reality (XR) applications in libraries for sustainable innovative services: a systematic literature review (SLR)
Authors: Shahzad Khurram , Khan Shakeel Ahmad Khan Ahmad , Javed Yasir , Ahmad Shakil
Published: October 2024

Purpose

This study aims to identify the factors influencing the adoption of extended reality (XR) applications in libraries for sustainable innovative services and reveal the challenges of adopting XR technology in libraries.

Design/methodology/approach

A systematic literature review was applied to address the study’s objectives. The 26 most relevant seminal studies published in peer-reviewed journals were selected to conduct the study.

Findings

The findings showed that access to digital collections, skill development, marketing, innovation and sustainable development factors influence the adoption of extended reality applications in libraries. The study illustrated that technical challenges, financial challenges, the unavailability of staff expertise and lack of institutional support caused barriers to the adoption of XR in libraries.

Originality/value

The study has added valuable literature to the existing body of knowledge. It has provided a framework to efficiently adopt extended reality in libraries for the delivery of sustainable, innovative services to library patrons.
Pricing policies for printed and electronic books in a triple-channel supply chain
Authors: Kianfar Kamran , Pashootanizadeh Mitra
Published: October 2024

Purpose

This study aims to investigate the pricing dynamics within a triple-channel supply chain. The publisher can sell printed books (p-books) through bookstores or online direct sales, and electronic books (e-books) are sold directly through the internet. The primary objectives include determining optimal wholesale and final prices for p-books, assessing the profitability of introducing e-books, comparing profits across channels and supply chain modes and identifying optimal demand volumes.

Design/methodology/approach

The research uses first-order derivatives and the Stackelberg game to analyze the pricing strategies. Two supply chain modes, centralized and decentralized, are considered, and various parameters are examined to understand their impact on prices, demand volumes and final sales profit.

Findings

The results indicate that the e-book is either not published or is introduced simultaneously with the printed version in both modes. In the decentralized mode, the wholesale price of a p-book is equivalent to the final price in the bookstore channel in the centralized mode. One channel among the three selling channels is used to maximize the total profit in the centralized supply chain, whereas all demand should be fulfilled through either online direct sales or e-book channels in the decentralized mode.

Originality/value

This paper introduces a comprehensive triple-channel book supply chain model, considering cross-price sensitivities and lag times for e-books. The study provides insights into the dynamics of the book industry and compares them with existing literature, contributing to a broader understanding of the pricing strategies in a triple-channel context.
CSR disclosure, financial performance, and ownership: evidence from China
Authors: Ali Rizwan , Liu Yanping , Rehman Ramiz Ur , Naseem Muhammad Akram
Published: October 2024

Purpose

This study investigates the relationship between corporate social responsibility (CSR) disclosure and financial performance (FP), and ascertains whether ownership structure (OS) moderates the CSR disclosure–FP nexus.

Design/methodology/approach

We distinctly employed the well-established approach of panel data analysis to examine the comprehensive dataset of Shanghai A-share listed firms from 2008 to 2017 with 20,236-full sample and 4,190-disclosed sample firm-year observations. To test the hypotheses, the study used panel regression analysis. The study used CSR disclosure as an explanatory variable and accounting-based performance measures: return on equity (ROE) and earning per share (EPS) as dependent variables. In addition, we used CSR score to determine the extent of disclosure by each firm and employed matched pair sample analysis to check for the robustness of the earlier obtained results.

Findings

The findings indicate significant positive association among CSR disclosure and CSR score with ROE and EPS. Further, the CSR disclosure–FP nexus is more pronounced when the OS moderates it.

Research limitations/implications

The results of this study lack generalizability due to its unique setting. A limitation of this paper is that our sample period only covers 2008–2017. Future studies can extend our research to a more recent period to test whether our findings remain valid in other periods.

Practical implications

Our findings suggest stronger CSR disclosure measures to enhance the image of businesses in the eyes of stakeholders. The study findings are consistent and confirm the theoretical basis (stakeholder theory) that Chinese listed firms can be more beneficial from disclosing CSR related information, and they should put more emphasis on the improvement of CSR disclosure.

Originality/value

This research offers empirical evidence that sheds light on the importance of OS as the moderating effect on the nexus of CSR disclosure–FP measures. In doing so, this study’s findings contribute to the literature significantly, along with the regulators and shareholders.
Advanced hybrid neural network techniques for minimizing gas turbine emissions
Authors: Roy Atanu , Pramanik Sabyasachi , Mitra Kalyan , Chakraborty Manashi
Published: October 2024

Purpose

Emissions have significant environmental impacts. Hence, minimizing emissions is essential. This study aims to use a hybrid neural network model to predict carbon monoxide (CO) and nitrogen oxide (NOx) emissions from gas turbines (GTs) to enhance emission prediction for GTs in predictive emissions monitoring systems (PEMS).

Design/methodology/approach

The hybrid model architecture combines convolutional neural networks (CNN) and bidirectional long-short-term memory (Bi-LSTM) networks called CNN-BiLSTM with modified extrinsic attention regression. Over five years, data from a GT power plant was uploaded to Google Colab, split into training and testing sets (80:20), and evaluated using test matrices. The model’s performance was benchmarked against state-of-the-art emissions prediction methodologies.

Findings

The model showed promising results for GT CO and NOx emissions. CO predictions had a slight underestimation bias of −0.01, with root mean-squared error (RMSE) of 0.064, mean absolute error (MAE) of 0.04 and R2 of 0.82. NOx predictions had an RMSE of 0.051, MAE of 0.036, R2 of 0.887 and a slight overestimation bias of +0.01.

Research limitations/implications

While the model demonstrates relative accuracy in CO emission predictions, there is potential for further improvement in future research.

Practical implications

Implementing the model in real-time PEMS and establishing a continuous feedback loop will ensure accuracy in real-world applications, enhance GT functioning and reduce emissions, fuel consumption and running costs.

Social implications

Accurate GT emissions predictions support stricter emission standards, promote sustainable development goals and ensure a healthier societal environment.

Originality/value

This paper presents a novel approach that integrates CNN and Bi-LSTM networks. It considers both spatial and temporal data to mitigate previous prediction shortcomings.
Inbreeding accelerates reproductive senescence, but not survival senescence, in a precocial bird
Authors: Beccardi Matteo , Pen Ido , Bichet Coraline , Tschirren Barbara , Vedder Oscar
Published: October 2024

Inbreeding depression is predicted to increase with age, because natural selection is less efficient at purging deleterious alleles that are only expressed later in life. However, empirical results are scarce, and equivocal between studies.

Here we performed controlled matings between related and unrelated individuals of domesticated Japanese quail (Coturnix japonica), and monitored the performance of their offspring for all fitness components over their complete life course.

We found rapid senescence in adult survival and egg laying performance, and inbreeding depression at all life stages (reduced embryo viability, increased age at maturity, as well as reduced adult survival and reproduction).

Inbreeding depression did not increase at later ages for survival, but did so for egg laying, thereby accelerating reproductive senescence. Moreover, the effect of inbreeding on egg laying persisted after correcting for lifespan, indicating that both survival and reproduction were independently affected by inbreeding.

We suggest that in heterogeneous populations intra‐generational purging may at earlier ages already select out the individuals that are homozygous for the specific alleles responsible for depressed survival, preventing the appearance of increased inbreeding depression in survival with age. Given that inbreeding affects reproduction independent of survival this should not apply to reproductive senescence or homogeneous populations, which may explain equivocal results between traits and studies.
Reintroduction affects demographic rates but not their interannual correlations in an endangered shrub
Authors: Villellas Jesús , Sánchez de Dios Rut , Domínguez Lozano Felipe
Published: October 2024

Reintroducing endangered species constitutes an important conservation tool. The performance of reintroduced populations is commonly assessed through mean demographic rates (survival, growth, reproduction and fecundity), but rate correlations are less studied despite their role in extinction risk and trait evolution.

In our study, we reintroduced the endangered shrub Vella pseudocytisus subsp. paui in two locations in Spain and compared its demographic performance to that of two natural populations to assess reintroduction success. In both natural and reintroduced sites, we selected sub‐locations with presumably more favourable (clay) vs. more stressful (gypsum) soil conditions. We monitored a total of 1269 individuals in natural (12 years) and reintroduced populations (6 years) and compared their mean demographic rates and the within‐individual rate correlations between years.

In clay substrate, mean demographic rates of the natural and the reintroduced population were similar, suggesting a successful reintroduction. In contrast, the reintroduced population in gypsum showed higher reproduction and fecundity than the natural population, but lower survival and growth.

Contrary to mean demographic performance, interannual correlations among demographic rates did not vary between natural and reintroduced populations. While reproduction in a given year was positively correlated with later growth and later reproduction, growth in a given year had some negative consequences in subsequent plant performance, especially in gypsum substrate.

Synthesis and applications. Our study shows that stressful conditions may trigger individual‐level trade‐offs in resource allocation and population‐level compensation among demographic rates. Demographic shifts arising from reintroductions in different environmental conditions may be considered by managers as a potential mechanism of resilience against environmental change. Finally, the similarity in rate correlations among sites suggests that information about correlations, which can be relevant when focusing conservation efforts, may be extrapolated from natural to reintroduced populations. This might be particularly reliable for species where rate correlations are demographically influential, such as those living under generally stressful conditions, or lacking buffering mechanisms for demographic variation.
Bringing the group back in: Social class and resistance in adolescent smoking
Authors: McEvoy Olivia , Layte Richard
Published: October 2024

Absolute prevalence of tobacco smoking has fallen in recent decades but inequalities by socioeconomic position (SEP) persist. Adolescence is a critical period for smoking initiation and habits formed during this period likely continue into adulthood. Explanations for inequalities in adolescent smoking have tended to focus on individualistic theories based on differentials in knowledge and psychology. These have been criticised for their blindness to processes of social stratification and social context that influence smoking behaviours. Based on previous social theories, we put forward, and test empirically, two potential structural explanations for inequalities in smoking, using nationally representative longitudinal cohort data on 6039 Irish young people aged 9–18 years. Descriptive analyses confirmed the adverse SEP gradient in smoking prevalence as well as SEP gradients in variables representing individual‐level characteristics and structural‐level explanations. Despite lower self‐esteem being associated with a higher likelihood of smoking, there was no significant indirect pathway between SEP and smoking via self‐esteem. Path analyses found that differentials in exposure to parental smoking and levels of oppositional values mediate the relationship between SEP and smoking. Our results favour structural and group‐based explanations for inequalities, that is, the ‘smoking exposure’ and ‘social resistance’ models, over explanations based on individual psychology.
Misoprostol as Oral Solution or Oral Tablet for Induction of Labour (MISOBEST): A Randomised Controlled Non‐Inferiority Trial
Authors: Svensk Elin , Bessfelt Emelie , Brismar Wendel Sophia , Kopp Kallner Helena , Wallström Tove
Published: October 2024

Objective

To assess if off‐label oral solution of misoprostol compared with licensed oral tablet of misoprostol approved for induction of labour (IOL) is as efficient in resulting in vaginal delivery within 24 h, using a non‐inferiority design.

Design

Prospective, randomised, non‐inferiority, open‐label, blinded endpoint trial.

Setting

Two tertiary level hospitals, Stockholm, Sweden, January 2022 to May 2023.

Population

In all, 874 women, without previous caesarean section, with an unripe cervix and a singleton, cephalic foetus at 37 + 0 to 42 + 0 gestational weeks, with a normal cardiotocography, planned for IOL were included.

Methods

Women were randomised 1:1 to intervention (25 μg oral solution of misoprostol) or control (25 μg oral tablet of misoprostol) two‐hourly for a maximum of eight doses. Subsequent methods of induction followed clinical practice.

Main Outcome Measures

The primary outcome was vaginal delivery within 24 h tested using non‐inferiority testing procedures at a non‐inferiority margin of 5 percentage points. Secondary efficacy outcomes were tested for superiority of either treatment. Analyses were by intention‐to‐treat.

Results

There were 207 (47.4%) vaginal deliveries within 24 h for women receiving oral solution and 192 (43.9%) vaginal deliveries within 24 h for women receiving oral tablet, establishing non‐inferiority with an absolute risk difference of 3.4% (95% CI −3.2% to 10.0%). Women receiving oral solution required fewer doses to reach active labour than women receiving oral tablet (5.7 vs. 6.1, p = 0.007). There were no significant differences for other secondary or safety outcomes.

Conclusions

Off‐label oral solution of misoprostol was non‐inferior to the licensed oral tablet regarding efficacy of IOL defined as vaginal delivery within 24 h.

Trial Registration

Clinicaltrials.gov identifier: NCT05424445
Liver fibrosis in inflammatory arthritis patients treated with methotrexate and hydroxychloroquine: A FIB‐4 index analysis
Authors: Uzun Güllü Sandal , Bulat Buğu , Ayan Gizem , Kılıç Levent , Kalyoncu Umut
Published: October 2024

Objectives

To evaluate the risk of liver fibrosis and associated factors with the non‐invasive fibrosis score‐4 (FIB‐4) index in patients with inflammatory arthritis using methotrexate (MTX).

Methods

Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) who were followed up in the rheumatology outpatient clinic, who were on methotrexate only and for whom FIB‐4 index was could be calculated at methotrexate initiation and follow‐up were included. The FIB‐4 index was calculated according to the following formula: age (years) × AST(IU/L)/(platelet count(10 (9)/L) × √ALT(IU/L)). The patients' demographics, comorbidities, other treatments, cumulative MTX dose, and reasons for MTX cessation were assessed. For the multivariate analysis, possible factors associated with intermediate‐high risk FIB‐4 index at last visit were determined.

Results

A total of 107 patients were enrolled in the study, of whom 82 (76.6%) had RA and 25 (23.4%) had PsA. At the initiation of MTX, 24 (22.4%) patients had intermediate‐high risk FIB‐4 index. Comorbidities and the rate of ≥3–4 Charlson comorbidity index were more common in patients with intermediate‐high risk FIB‐4 index. A total of 37 (34.5%) patients had intermediate‐high risk FIB‐4 index at the last visit after median 3.6 (0.3–22.06) years follow‐up. The median cumulative MTX dose was 2550 mg (1050–13.991). Cumulative MTX dose [OR 1.18 (1.01–1.33), p = .03] and diabetes mellitus [OR 4.60 (1.74–12.50), p = .002] were associated factors with intermediate‐high risk FIB‐4 index. The concomitant use of hydroxychloroquine (HCQ) was found to be a low‐risk factor for FIB‐4 index [OR 0.28 (0.10–0.78) p = .015].

Conclusion

The FIB‐4 index is a non‐invasive method that can be used in daily rheumatology practice for the evaluation and follow‐up of patients who will use methotrexate. Comorbidities and cumulative MTX dose seem to be related with the risk of liver fibrosis. Concomitant use of HCQ with MTX may reduce the risk of liver fibrosis.
Low‐cost animal tracking using Bluetooth low energy beacons on a crowd‐sourced network
Authors: Farine Damien R. , Penndorf Julia , Bolcato Sofia , Nyaguthii Brendah , Aplin Lucy M.
Published: October 2024

Animal tracking has opened the door to address many fundamental questions in ecology and conservation. Whilst historically animals have been tracked as a means to understand their large‐scale movements, such as migration, there is now a greater focus on using tracking to study movements over smaller scales, individual variation in movement or how movements shape social network structure. With this shift in focus also comes different tracking needs, including the need to track larger numbers of individuals.

Tracking studies all face some technological limitations. For example, GPS and other active tracking solutions can collect fine‐scale movement data, but have a high cost per tag, limiting the number of individuals that can be followed. They also have high low‐energy costs of data acquisition and download, limiting time periods over which data can be collected. Low‐energy passive (e.g. PIT) or active (e.g. reverse GPS) tags can overcome these limitations, but instead require animals to remain within a bounded study area or to come into close proximity to detectors.

Here we describe one solution that can overcome many current limitations by employing the massive global network of personal mobile phones as gateways for tracking animals using Bluetooth low‐energy (BLE) beacons. In areas with medium to high density of people, these simple‐to‐make beacons can provide regular updates of position over long time periods (battery life 1–3 years). We describe how to use off‐the‐shelf components to produce BLE beacons that weigh c. 5–6 g and cost <$7USD. Using field‐testing, we then show that beacons are capable of producing high‐frequency tracking data that can be used to build home ranges or to detect spatiotemporal co‐occurrences among individuals.

BLE beacons are a low cost, low‐energy solution for studying organisms (e.g. birds, mammals and reptiles) living and moving in urban landscapes. Their low weight and small size makes them particularly well‐suited for tracking smaller species. When combined with fixed gateways, their use can also be extended to non‐urban habitats. Their high accessibility is likely to make them an attractive solution for many research projects.
Veno‐venous extracorporeal membrane oxygenation for severe COVID‐19 associated acute respiratory distress syndrome: A retrospective, nationwide, Danish cohort study
Authors: Pedersen Finn Møller , Grønlykke Lars , Eschen Camilla Tofte , Adelsten Janne , Madsen Søren Aalbæk , Sørensen Marc , Gjedsted Jakob , Møller‐Sørensen Peter Hasse , Nielsen Jonas , Christensen Steffen , Nielsen Dorthe Viemose , Jørgensen Vibeke Lind
Published: October 2024

Background

Severe acute respiratory syndrome (ARDS) may require veno‐venous extracorporeal membrane oxygenation (V‐V ECMO). The aim of this study was to provide data on patient selection and outcome in a nationwide cohort study of patients with COVID‐19 associated ARDS supported with V‐V ECMO.

Methods

We identified all patients with COVID‐19, who were supported with V‐V ECMO in Denmark from March 10, 2020, to December 31, 2021, and retrieved data on patients who were referred to‐ and accepted for ECMO, demographics, outcome data, and complications. Risk factors for mortality were analysed using multivariate Cox regression analysis.

Results

During the study period, 1836 patients were admitted to Danish intensive care units (ICUs). In the same period, there were 197 enquiries for ECMO of whom 118 patients were considered eligible. Overall, 71 patients were cannulated for ECMO; three patients were cannulated for veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) due to right sided heart failure and 68 patients were cannulated for V‐V ECMO. Two patients accepted for V‐V ECMO died during cannulation. The median age was 55 years (IQR 45–60) and 66% were males. The median duration of ECMO support was 13 days (IQR 7–21), mechanical ventilation median 26 days (IQR 14–42), ICU stay median 34 days (IQR 17–46), and length of hospital stay median 41 days (IQR 25–56). Ninety‐day mortality was 43%. Age of 60 years or more was associated with an increased risk of mortality. Pre‐existing hypertension was associated with a decreased risk of mortality.

Conclusion

A nationwide, Danish cohort study of 68 COVID‐19 patients supported with V‐V ECMO, showed a 90‐day survival of 43%, which is in accordance with reports from comparable cohorts. Age of 60 years or more was associated with an increased risk of mortality. Pre‐existing hypertension was associated with a decreased risk of mortality.
Accuracy of estimating equations for the assessment of glomerular filtration rate in critically ill patients versus outpatients
Authors: Kiss Katalin , Saeed Aso , Ricksten Sven‐Erik , Bragadottir Gudrun
Published: October 2024

Background

Estimating equations for the assessment of glomerular filtration rate (GFR) have been poorly investigated in the critical care setting. We evaluated the agreement between the GFR measured with 51CrEDTA/iohexol (mGFR) and four estimating equations based on serum concentrations of creatine and/or cystatin C (eGFR) in two cohorts: critically ill patients and outpatients with normal‐to‐moderately reduced GFR.

Methods

Forty‐three patients in the critical care group and 48 patients in the outpatient group were included. GFR was measured (mGFR) by plasma infusion clearance of 51Cr‐EDTA/iohexol (critical care group) and the single injection, one‐sample plasma 51Cr‐EDTA clearance technique (outpatients). The following estimating equations (eGFR) were used: the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equation for creatinine (CKD‐EPICr), cystatin C (CKD‐EPICys C), creatinine+cystatin C (CKD‐EPICr + Cys C) and the Lund‐Malmö creatinine+cystatin C equation (LMCr + Cys C). Agreement between mGFR and eGFR was assessed by the Bland–Altman method and accuracy by calculating P30 and P10.

Results

In the critically ill group, the bias between the estimating equations and mGFR was −3.6 to 2.8 mL/min/1.73 m2, while the error was 121%–127% and the accuracy (P30) 33%–40%. In the outpatients, the bias between the estimating equations and mGFR was −13.0 to 7.6 mL/min/1.73 m2, while the error was 31%–41% and the accuracy (P30), 67%–96%.

Conclusions

All four equations performed poorly in assessing GFR in the critically ill cohort with an unacceptably high error and low accuracy in contrast to the outpatient group. To accurately assess GFR in critically ill patients, GFR must be measured not estimated.

Editorial Comment

For the assessment of glomerular filtration rate (GFR), it can be measured directly, but is frequently estimated using a point measure of serum creatinine concentration. In this study, ICU case GFR estimations, by different adjusted equations, done also for a cohort of outpatients, showed that these serum creatinine‐based estimations for ICU cases are not highly precise or reliable.
Increasing prevalence of galactose‐α‐1,3‐galactose sensitization in the Danish general adult population
Authors: Leth‐Møller Katja Biering , van Hage Marianne , Apostolovic Danijela , Sørensen Jennifer Astrup , Vestergaard Christian , Madsen Flemming , Kjær Lene Jung , Hansen Torben , Jonsson Anna , Thomsen Simon Francis , Linneberg Allan
Published: October 2024

Background

Alpha‐gal syndrome is a novel food allergy to the oligosaccharide galactose‐α‐1,3‐galactose (alpha‐gal) present in mammalian meat. Tick bites are considered an important route of sensitization to alpha‐gal. Data on alpha‐gal sensitization in the general population is scant. We utilized a unique data source of repeated population‐based health examination studies to assess prevalence, time trends, risk factors, and characteristics of alpha‐gal sensitization.

Methods

Alpha‐gal sensitization was assessed in >11.000 adults from four health examination studies of randomly invited residents in the Copenhagen region conducted in 1990–1991, 2011–2012, 2012–2015, and 2016–2017. Alpha‐gal sensitization was defined as serum specific IgE (sIgE) to alpha‐gal ≥0.1 kUA/L; ≥0.35 kUA/L; ≥0.7 kUA/L; ≥3.5 kUA/L. The population was characterized according to genetically determined ABO blood group, aeroallergen sensitization, and pets at home.

Results

The prevalence of sIgE to alpha‐gal ≥0.1 kUA/L was 1.3% in 1990–1991, 3.7% in 2012–2015 and 3.2% in 2016–2017. Of those sensitized to alpha‐gal >97% reported to consume red meat at least once a week, even for sIgE to alpha‐gal ≥3.5 kUA/L. Male sex, older age, aeroallergen sensitization, cat at home, and blood group A were associated with increased odds of alpha‐gal sensitization. The known protective effect of blood group B was confirmed.

Conclusion

In this general adult population, the prevalence of alpha‐gal sensitization had doubled from 1990–1991 to 2016–2017. This could potentially be due to increased tick exposure and an increased atopic predisposition.
Show and slow codes: A historical analysis of clinicians' adaptations to ethical overreach
Authors: Baker Robert
Published: October 2024

After briefly reviewing the historical development and ethical regulation of resuscitative technologies, this study probes why clinicians engage in the morally problematic practice of show and slow coding and why hospitals tolerate it? Studies conducted in 1995 and 2020 indicate that conscientious clinicians engage in these practices to protect their patients from abusive or futile resuscitation. And hospitals' clinical cultures tolerate these practices to protect conscientious clinicians from censure, dismissal, delicensing, or legal prosecution for withholding or withdrawing abusive or futile resuscitative technologies without prior patient or surrogate consent. Show and slow coding evolved in American clinical cultures in the second half of the 20th century when closed‐chest cardiac massage, defibrillators, ventilators, and other resuscitative technologies raised seemingly novel ethical questions. To address these questions, bioethics commissions, healthcare societies, lawmakers, and a Roman Catholic Pope developed ethics standards requiring clinicians to obtain patient or surrogate consent before withholding or withdrawing resuscitative technologies. They thus conferred on patients an implicit right of resuscitation even if it was abusive and/or futile. Conscientious clinicians circumvented this implicit right by show and slow coding to protect patients from abusive resuscitation. Recognizing clinicians' benign intent, hospitals' clinical cultures tolerate show and slow coding as acts of conscience, akin to civil disobedience. Thus, rescinding ethics standards and laws requiring prior patient/surrogate consent for non‐resuscitation or for cessation of resuscitative technologies decisions should end show/slow coding. Such a reform should also recognize clinicians' right of conscientious refusal to perform CPR.
Comparison of HLA‐haploidentical donors with post‐transplant cyclophosphamide versus HLA‐matched unrelated donors in peripheral blood stem cell transplantation for acute myeloid leukaemia
Authors: Moriguchi Makoto , Nakamae Hirohisa , Nishimoto Mitsutaka , Sugita Junichi , Yanada Masamitsu , Toubai Tomomi , Hasegawa Yuta , Hino Masayuki , Nishida Tetsuya , Kurita Naoki , Sawa Masashi , Fukuda Takahiro , Jinguji Atsushi , Ota Shuichi , Matsuoka Ken‐ichi , Eto Tetsuya , Hiramoto Nobuhiro , Ando Toshihiko , Kawamura Koji , Kanda Yoshinobu , Atsuta Yoshiko , Ohbiki Marie , Nakasone Hideki , Konuma Takaaki
Published: October 2024

HLA‐haploidentical haematopoietic cell transplantation with post‐transplant cyclophosphamide (PTCy‐haplo) is emerging as an effective alternative due to donor availability and safety. We conducted a nationwide retrospective study comparing the outcomes of PTCy‐haplo with both anti‐thymocyte globulin (ATG)‐free and ATG‐administered matched unrelated donors (MUD) transplantation, using peripheral blood stem cells as the first transplantation for acute myeloid leukaemia (AML). Our study showed a lower and slower haematopoietic recovery and a higher incidence of infection‐related deaths after PTCy‐haplo than after MUD transplantation. In addition, we revealed an increased risk of acute and chronic graft‐versus‐host disease (GVHD) in ATG‐free MUD transplantation in comparison to PTCy‐haplo. For grades III–IV acute GVHD, the hazard ratio (HR) was 2.71 (95% CI, 1.46–5.01), and for extensive chronic GVHD, the HR was 3.11 (95% CI, 2.07–4.68). There was no significant difference regarding overall survival amongst the groups. In addition, GVHD‐free relapse‐free survival (GRFS) was lower in ATG‐free MUD transplantation than in PTCy‐haplo (HR, 1.46; 95% CI, 1.17–1.82). Notably, ATG‐administered MUD transplantation showed no significant difference in GRFS from PTCy‐haplo, negating the advantage of PTCy. Our results suggest that PTCy‐haplo could be viable for AML patients without an HLA‐matched related donor.
Association of Radioactive Iodine Administration With Outcome Among Patients With Low‐Risk Differentiated Thyroid Cancer: A Real‐World Data Analysis
Authors: Xu Yang , Huang Peiyin , Wang Liying , Ke Najun , Guo Fangting , Su Lijia , Shen Qingbao , Lin Tintin , Huang Kunzhai , Zhang Yi , Xiao Fangsen
Published: October 2024

Objective

Despite the generally favourable long‐term prognosis of low‐risk differentiated thyroid cancer (DTC), questions remain about disease‐free survival (DFS) after initial treatment, particularly regarding the use of radioactive iodine (RAI). Although there are RCT trial confirming that RAI ablation therapy is not superior to follow‐up in terms of the 3‐year DFS rate in low‐risk thyroid cancer, its longer‐term prognosis remains to be established. The objective of this study was to assess the impact of RAI ablation on the presence of structural persistent/recurrent disease in patients with low‐risk DTC.

Methods

We retrospectively identified 720 low‐risk DTC patients who had undergone total or near‐total thyroidectomy (TT) at a tertiary medical centre between January 2008 and July 2018. Propensity scores were calculated using a multivariable logistic regression model that accounted for age, sex, tumour size, neck dissection, multifocality, capsular invasion and lymph node (LN) metastasis. We compared DFS between patients who received RAI and those who did not using log‐rank tests and multivariate Cox analyses. Subgroup analyses were also conducted.

Results

Of the total cohort, 180 (25.0%) patients received RAI, while 540 (75.0%) did not before matching. The median follow‐up duration was 59.5 months. After matching, the RAI group comprised 135 (39.8%) patients and the non‐RAI group comprised 204 (60.2%) patients. In the entire cohort, the 5‐year DFS rate was 97.6% for patients receiving RAI compared to 96.8% for those not receiving RAI (p = 0.704). In the matched cohort, the rates were 98.5% and 95.6%, respectively (p = 0.090). Matched multivariate Cox analysis demonstrated that RAI was neither significantly nor independently associated with DFS (hazard ratio [HR] = 0.29; 95% CI 0.06–1.37; p = 0.118). Further subgroup analyses reaffirmed that RAI ablation did not significantly reduce the risk of developing structural persistent/recurrent disease.

Conclusion

Administering RAI ablation following TT did not result in improved DFS for low‐risk DTC patients. Our findings suggest that decisions regarding RAI should be made judiciously to avoid overtreatment in this clinical scenario.
Fine Needle Aspiration of CD20‐Negative Diffuse Large B Cell Lymphoma Presenting as an Anterior Neck Mass
Authors: Hartzell Connor , Mason Emily F. , O'Conor Christopher
Published: October 2024

Aggressive lymphoma of the neck presenting with life‐threatening airway compromise requires quick diagnosis, which can be rendered with fine needle aspiration cytology. In atypical cases, using multiple B cell markers can be helpful to avoid misdiagnosis.
Screen Time, Nature, and Development: Baseline of the Randomized Controlled Study “Screen‐free till 3”
Authors: Schwarz Silke , Krafft Hanno , Maurer Tobias , Lange Silke , Schemmer Juliane , Fischbach Thomas , Emgenbroich Anke , Monks Sean , Hubmann Michael , Martin David
Published: October 2024

In the first years of life, increased screen media use is presumably associated with health consequences and developmental impairments. “Screen‐free till 3” is a prospective Germany‐wide randomized intervention study, started in May 2022 with a duration of 3 years. In the intervention group, 2581 pediatric practices received stickers, which were systematically placed in the screening booklet of all children, along with advice to parents to keep children free from screens until the age of 3. A volunteer sample of 17,436 parents received an invitation to take part in the preinterventional questionnaire. The outcomes were parents' internet use (CIUS test), parental screen time in the presence of children, time of screen media in the background, and children's development. Four thousand twenty‐one parents answered the questionnaire. 16.7% of mothers and 31.0% of fathers reached the CIUS score of an internet‐related disorder. Parents whose children use screen media at an early age had significantly higher CIUS values on average (M = 4.07) than the parents of children who do not yet have any screen time (p < 0.001). Combined developmental characteristics show a negative correlation with parental screen time (p < 0.001). Time spent in nature was positively associated with development (p < 0.001). The evaluation of the survey shows that screen media is to a large extent used on a daily basis. The study confirms the assumption that high screen media use by parents is linked to higher screen media use by children and also has a negative impact on child development.

Trial Registration: Number: RKS00032258; https://drks.de/search/en/trial/DRKS00032258
Breaking from the past? Environmental narratives, logics of power, and the (re)production of food insecurity in South Sudan
Authors: Sennesael Francois , Verhoeven Harry
Published: October 2024

Skyrocketing commodity prices and conflict‐induced mass hunger in recent years have resuscitated discussions about why famines frequently reoccur in specific spaces of vulnerability. Intervention efforts still too often isolate food (in)security from its interwovenness in the political economy of water and energy and from the role of ideas in forging these interconnections across long time periods. Using (South) Sudanese history to rethink the causes of recurrent food insecurity, we underscore the need to analyse how political elites imagine the role of the water–energy–food nexus and associated environmental narratives in consolidating power. South Sudan's 2011 secession (from Sudan) marked the culmination of a struggle against a state that insurgents regarded as having starved its citizens. However, since independence, its leaders have replicated the nostrum they once combatted: Sudanese resources must ‘feed the world’. A fixation with inserting water, energy, and food resources into global markets infuses their strategy, even if such an approach will not engender food abundance.
Evidence‐Based Data on the Diagnostic Role and Clinical Usefulness of [18F]FDG PET/CT in Endocarditis and Cardiac Device Infections
Authors: Caporali Elena , Paone Gaetano , Moschovitis Giorgio , De Perna Maria Luisa , Lo Priore Elia , Bernasconi Enos , Pedrazzini Giovanni , Treglia Giorgio
Published: October 2024

Infective endocarditis and infection of cardiac devices are conditions characterized by high morbidity and mortality, thus requiring a prompt diagnosis. Advanced imaging modalities are often required in the management of infectious endocarditis according to guidelines. The aim of this review is to collect and describe evidence‐based knowledge about the diagnostic role and clinical usefulness of [18F]FDG PET/CT in endocarditis and cardiac device infections based on published systematic reviews and meta‐analyses on this topic and on recent guidelines. [18F]FDG PET/CT is recommended only in selected cases. This imaging method has good diagnostic accuracy in detecting prosthetic valve endocarditis and cardiac device infection. Furthermore, it can identify extra‐cardiac infectious foci changing the clinical management in a significant percentage of cases.