bluuebunny/crossref_metadata_2025 huggingface dataset:
Platelet-Derived Exosomes Alleviate Knee Osteoarthritis by Attenuating Cartilage Degeneration and Subchondral Bone Loss
Authors: Xu Chenyue , Mi Ziyue , Dong Zhenyue , Chen Xiaobo , Ji Gang , Kang Huijun , Li Kehan , Zhao Bo , Wang Fei
Published: August 2023

Background:

Osteoarthritis (OA) is the most prevalent chronic degenerative joint disease among the aged population. However, current treatments for OA are limited to alleviating symptoms, with no therapies that prevent and regenerate cartilage deterioration.

Purpose:

To assess the effects of platelet-derived exosomes (Plt-exos) on OA and then to explore the potential molecular mechanism.

Study Design:

Controlled laboratory study.

Methods:

Exosomes derived from human apheresis platelets were isolated and identified. The effects of Plt-exos in protecting chondrocytes under interleukin 1β stimulation were evaluated by analyzing the proliferation and migration in human primary chondrocytes. RNA sequencing was later performed in vitro for primary chondrocytes to reveal the underlying mechanisms of Plt-exo treatment. Anterior cruciate ligament transection was used to construct an OA mice model, and intra-articular injection of Plt-exos was given once a week for 6 weeks. Mice were sacrificed 4 weeks after the last injection. Histologic and immunohistochemistry staining and micro–computed tomography analysis were performed to assess alterations of articular cartilage and subchondral bone.

Results:

Plt-exos significantly promoted proliferation and migration of chondrocytes within a dose-dependent manner, as well as dramatically promoted cartilage regeneration and attenuated abnormal tibial subchondral bone remodeling, thus slowing the progression of OA. After being treated with Plt-exos, 1797 genes were differentially expressed in chondrocytes (923 upregulated and 874 downregulated genes). Functional enrichment results and hub genes were mainly involved in anti-inflammatory effects, mediating cell adhesion, stimulating cartilage repair, promoting anabolism, and inhibiting catabolism.

Conclusion:

Our results demonstrated that Plt-exos promoted chondrocyte proliferation and migration in vitro, as well as attenuated cartilage degeneration, improved the microarchitecture of subchondral bone, and retarded OA progression in vivo.

Clinical Relevance:

Our study illustrated that the administered Plt-exos could alleviate knee OA by attenuating cartilage degeneration and subchondral bone loss, possibly serving as a novel promising treatment for OA in the future.
Association Between Symptom Cluster Endorsement at Initiation of a Graduated Return-to-Activity Protocol and Time to Return to Unrestricted Activity After Concussion in United States Service Academy Cadets
Authors: Aderman Michael J. , Brett Benjamin L. , Ross Jeremy D. , Malvasi Steven R. , McGinty Gerald , Jackson Jonathan C. , Estevez Carlos A. , Brodeur Rachel M. , Svoboda Steven J. , McCrea Michael A. , Broglio Steven P. , McAllister Thomas W. , Pasquina Paul F. , Cameron Kenneth L. , Roach Megan H.
Published: August 2023

Background:

The endorsement of symptoms upon initiation of a graduated return-to-activity (GRTA) protocol has been associated with prolonged protocols. It is unclear whether there are specific symptom clusters affecting protocol durations.

Purpose:

To describe the endorsement of specific concussion symptom clusters at GRTA protocol initiation and examine the association between symptom cluster endorsement and GRTA protocol duration.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

This study was conducted among cadets enrolled at 3 US service academies. Participants completed an evaluation upon GRTA protocol initiation. Participants endorsing symptoms were binarized based on 6 symptom clusters (cognitive, emotional, insomnia, physical, sensitivity, and ungrouped). The primary outcome of interest was GRTA protocol duration based on symptom cluster endorsement severity. Prevalence rates were calculated to describe symptom cluster endorsement. Kaplan-Meier survival estimates and univariate and multivariable Cox proportional hazards regression models were calculated for all 6 symptom clusters to estimate GRTA protocol duration while controlling for significant covariates.

Results:

Data from 961 concussed participants were analyzed. Of these, 636 participants were asymptomatic upon GRTA protocol initiation. Among the 325 symptomatic participants, the physical symptom cluster (80%) was most endorsed, followed by the cognitive (29%), insomnia (23%), ungrouped (19%), sensitivity (15%), and emotional (9%) clusters. Univariate results revealed a significant association between endorsing cognitive (hazard ratio [HR], 0.79; p = .001), physical (HR, 0.84; p < .001), insomnia (HR, 0.83; p = .013), sensitivity (HR, 0.70; p < .001), and ungrouped (HR, 0.75; p = .005) symptom clusters and GRTA protocol duration. Endorsing physical (HR, 0.84; p < .001) and sensitivity (HR, 0.81; p = .036) clusters maintained a significant association with GRTA protocol duration in the multivariable models.

Conclusion:

Participants endorsing physical or sensitivity symptom clusters displayed GRTA protocols prolonged by 16% to 19% compared with participants not endorsing that respective cluster after controlling for significant covariates.
How do different market-oriented news organizations portray news coverage about the CARES act?
Authors: Rossi Michelle
Published: August 2023

Drawing from CARES Act news coverage, this study investigated how different market-oriented news organizations modulated the debate on the most expansive stimulus bill in modern U.S. history, released in 2020, during the coronavirus pandemic. A comparative approach was used, between news articles produced by a strongly market-oriented and a weakly market-oriented news outlet, both national news outlets, based in the United States. Using market theory as a guide to explore published news content, this study focuses on showing the range of debate, news sources and journalistic role performances employed in coverage of the same topic, coming from differently funded newsrooms. Some of the findings of this research demonstrate differences in the assessment of objectivity as a journalistic norm, and similarities as the indirect use of government official sources. To conclude, some implications for the field of journalism are discussed, including a revision of objectivity as a journalistic norm.
A Comparative Study of Values-Based Fields of Adult Learning and Education in Austria, Scotland, and South Tyrol, Italy: Practitioners Resisting Neoliberal Tendencies Based on Their Ideas of Social Justice
Authors: Cennamo Irene , Kastner Monika , Tett Lyn
Published: August 2023

This article presents the findings of a comparative study of values-based adult learning and education (ALE) fields; specifically, in Austria, critical-emancipatory adult basic education; Scotland, learner-centered, community-based adult learning; and South Tyrol, Italy, the Winterschule, a radical-critical popular education format. We studied the voices of experienced practitioners to understand their challenges and constraints and how they resisted changes that did not reflect their values. It highlights local practices to promote visibility, create dialogue, and strengthen the understanding and recognition of these fields in which practitioners are unequivocally committed to social justice. Our findings highlighted repertoires of resistance, affirmed pedagogy as a values-based endeavor, and elucidated practitioners’ commitments to holistic approaches that re-negotiate ideas of social justice for people and the planet. Our analysis shows that when ideas of social justice are shared amongst allies, practitioners can effectively maintain their values-based approaches and thus re-affirm and protect democratic ALE practice.
Burden and Depression among Empirically-Derived Subgroups of Family Caregivers for Individuals With Dementia
Authors: Ahmad Nina , Kunicki Zachary J. , Ellen Tambor  , Gary Epstein-Lubow  , Tremont Geoffrey
Published: August 2023

Dementia caregiving experiences are not universal and different factors may influence the risk for burden and depression. This study examined factors such as the relationship with the care recipient, severity of dementia, and relationship satisfaction to uncover different types of caregiver burden profiles using baseline assessment for a telephone-based intervention study for dementia caregivers. Participants (n = 233) completed a battery of psychological and caregiving related surveys. The sample was predominantly White and female. Latent class analysis suggested four class models in subsamples of spousal caregivers and adult children caregivers. The results suggested four distinct classes among samples of spousal and adult child caregivers. Differences in burden emerged across both spouses and adult children, and differences in depression also emerged in the spousal sample. Our findings demonstrate the diversity of the caregiving experience and suggest that future psychosocial interventions may benefit from being tailored to the needs of caregiver subgroups.
A novel multi-element flame retardant containing phosphorus, nitrogen and sulfur for enhancing the fire safety of epoxy resin composites
Authors: Li Junwei , Liu Quanyi , Zhou Yumei , Cai Yuming , Shi Kaikai , Zhao Haihan , Meng Yawei , Zheng Penglun
Published: August 2023

To gain insight into more about how flame retardants containing phosphorus, sulfur, and nitrogen affect epoxy resin (EPs), a multicomponent flame retardant (Sp-ACDH) containing P/N/S was synthesized from sodium p-aminobenzene sulfonate (Sp-A), cinnamaldehyde and 9,10-dihydro-9-oxa-10-phosphaphenanthrene-10-oxide (DOPO) and applied to epoxy resin. Sp-ACDH enables the epoxy resin to achieve the desired flame retardancy. For example, with the addition of 10 wt% Sp-ACDH, the epoxy composite passed the UL-94 V-0 rating and achieved an LOI of 32.7%. Additionally, Sp-ACDH effectively slowed down EP’s ability to release heat, with EP-15 Sp-ACDH exhibiting a peak heat release rate (PHRR) that was 680 kW/m2 rather than pure EP’s 1204.4 kW/m2. Eventually, the samples were characterized using Scanning electron microscopy (SEM), Raman spectroscopy, and Thermogravimetric analysis-fourier transform infrared spectroscopy (TG-FTIR) spectra, and the samples were analyzed, it revealed that Sp-ACDH’s flame-retardant properties were active in both the gas and condensed phases.
Research on normal ice adhesion strength in icing wind tunnel
Authors: Wang Yusong , Xiong Ke , Zhu Chunling , Zhu Chengxiang , Guo Rongyin , Chen Lei
Published: August 2023

Aircraft icing seriously jeopardizes flight safety. The design of aircraft anti-icing/de-icing systems requires a thorough understanding of the adhesion between the ice and the substrate. In this research, an experimental device that can be housed within a wing is designed and constructed. Simulation analysis of the interfacial stresses is performed, which reveals that increasing the load and the interface size led to a deterioration in the uniformity of stresses at the interface. In addition, the ice layer does not undergo cohesive damage during the tests. The normal ice adhesion strength is evaluated in an icing wind tunnel using the methodology outlined in this paper. Glaze ice exhibits an increase in normal adhesion strength at lower temperatures, whereas the trend is reversed for rime ice. The minimum adhesion strength occurs near the medium volume diameter (MVD) of 30 µm. Furthermore, the normal strength is significantly enhanced by increase in wind speed and surface roughness, as well as by surface painting. The adhesion strength of aluminum substrates to ice is greater compared to titanium and stainless steel. Compared to shear adhesion strength, normal adhesion strength is less sensitive to various influencing factors. The proposed experimental framework provides precise measurement of normal adhesion strength of impact ice in the icing wind tunnel.
Association between serum complement 1q and the associated factors of acute ischemic stroke in patients with type 2 diabetes
Authors: Hu Zhen-ping , Wu Fang , Du Yuan-hong , Ye Mao
Published: August 2023

Objective

The aim of this study was to examine the association between serum complement 1q (C1q) and the associated factors of acute ischemic stroke in patients with type 2 diabetes (T2DM).

Methods

The baseline clinical variables of the participants were collected, and the levels of blood lipids, blood sugar, inflammatory cytokines, and C1q in the three groups were then compared. The variables which affected the associated factors of acute ischemic stroke in T2DM cases were determined.

Results

The levels of C1q in the DAIS group were increased significantly compared with those in the T2DM group. Receiver operating characteristic curve analyses showed that the AUC for C1q and the combined diagnosis of acute ischemic stroke were 0.830 (95%CI 0.747–0.914), with a sensitivity of 0.854 and specificity of 0.780. The results of Pearson’s correlation analyses demonstrated that C1q was associated positively with low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (PBG), 2-h postprandial blood glucose (2h PG), and high-sensitive C reaction protein (hs-CRP) (all p < .05). Stratified analysis showed that there was a positive relationship between C1q and the associated factors of acute ischemic stroke for partial LDL-C, and hs-CRP strata. Logistic model analysis suggested that C1q was an independent risk factor for acute ischemic stroke in patients with T2DM. After adjusting for potential confounders, a one-standard deviation (SD) increase in C1q level was strongly related to an approximately 1.5-fold increased risk of acute ischemic stroke in cases with a hs-CRP ≥1.78 mg/L.

Conclusion

In DAIS patients, the levels of C1q were increased significantly and were an independent associated factor which affected the occurrence of acute ischemic stroke.
Emigration and Back-Door Brain Drain: Do Restrictive Immigration Policies Make UnequalsWorse Off?
Authors: Chowdhury Sahana Roy
Published: August 2023

In contrast to the skilled emigration and brain drain literature unskilled labour emigration and its impact on skill accumulation in the source country caught limited attention so far. While skilled emigration pushes up skilled wages and directly impacts the skilled stock of the source country, unskilled emigration pushes up the opportunity cost (unskilled wage) of skill acquisition. This further weakens the incentive to build skills. Economic agents make rational educational investment decisions based on their wealth (inheritance) and endogenous market returns (wages). The wealth distribution of an economy plays a deterministic role in the skill formation process. This is especially when the capital market is imperfect and skill acquisition is costly. Among unequal countries, the article identifies conditions and explains the possibilities of a decrease in skilled stock following emigration. This has significant policy implications. The restrictive immigration policies of the host countries specifically for unskilled immigrants make these unequal economies worse off.

JEL: D31, F22, J24
“The System Tends to Scoop You Up and Spit You Out and They’re Done With You”: The Intersection of Intellectual/Developmental Disability and Homelessness From the Perspectives of Service Providers
Authors: Thurman Whitney , Heitkemper Elizabeth , Hutson Tara , Preston Angela , Hecht Jonathan
Published: August 2023

People with intellectual and developmental disabilities (IDD) experience elevated risk for poor health and social outcomes in adulthood and are at risk for experiencing homelessness and housing instability. Although the exact prevalence of IDD among homeless populations is unknown, a small body of literature related to the intersection of IDD and homelessness suggests differential health needs and service use patterns, with a need for targeted health and social services. In this study, we explore the perceptions and experiences of 18 homeless or disability service providers about (a) their clients at the intersection of IDD and homelessness and (b) their role and the services provided at the intersection of IDD and homelessness. Participants struggled to provide appropriate, accessible services for this population, owing to lack of training and awareness of specific needs, fragmented systems, and inadequately funded healthcare and housing support. Our findings also reveal that clients at this intersection have high contact with public systems, which places them at risk for losing their right to self-determination. Recommendations center on systems transformation to facilitate the ability of providers to collaborate and to make data-driven decisions to deliver person-centered care.
The Push to 120: Reconciling Credit Hours in Undergraduate Music Education
Authors: Maas Andrea , Wacker Aaron T. , Allen Ashley D.
Published: August 2023

Bachelor of Music Education degrees, like many professional programs, require a high number of credit hours for graduation. The marketization of higher education and efforts toward equitable access to a college education drive efforts to eliminate “excess” credits. Despite state and institutional mandates to reduce credit requirements to 120 hrs, many programs still exceed this target with some reaching nearly 150 credit hours. This descriptive survey study with follow-up document review examined how schools of music are responding to credit hour reduction policies limiting credits at or near 120 hrs. The findings of this study confirmed tensions between accreditation requirements, credit hour reduction policies, and curricular aims of music teacher preparation programs. The authors present reports regarding influencing factors and strategies for reconciling credit hours. They further discuss emerging questions regarding credit allotment and course hours, implications for student wellness and curricular reform, and suggestions for future research.
Diana Scully's Legacy: Reflections From Former Students
Authors: Ramsey Rena
Published: August 2023

Six former students of Dr. Diana Scully share their memories of her and reflections on how she influenced them personally and professionally.
Novel surgical technique to manage iStent inject over-implantation
Authors: Ang Bryan Chin Hou , Chen Elizabeth Jiahui
Published: August 2023

Purpose

To describe a novel surgical technique to manage over-implantation of the iStent inject intra-operatively, utilizing only the iStent inject delivery system itself to perform both device extraction and reimplantation, without the need for additional instrumentation.

Methods

A demonstration of managing over-implantation of the iStent inject, with two case examples.

Results

Over-implantation of the iStent inject can be successfully managed intra-operatively to ensure ideal positioning to optimise post-operative outcomes, with the use of only the iStent inject delivery system itself for both device extraction and reimplantation.

Conclusion

This novel technique provides a cost-effective and feasible means to intra-operatively manage over-implantation of the iStent inject.
The Subject Is a Patient
Authors: Weiss Stephanie T
Published: August 2023

Although it is common in academic and government research settings to speak of study participants as “subjects,” this perspective piece argues against doing so. In particular, the relationship of the study physician with study participants is unique and still retains many elements of the usual patient-physician relationship that exists in general clinical practice.
Beyond peace: Media encounters between Israeli Jews and Palestinians as a new potential for connection in the face of violent conflict
Authors: Katz Yuval
Published: August 2023

Peace is usually studied by looking at nation-states. Recently, peace scholars have become interested in peace found in the everyday lives of ordinary people. Focusing on the Israeli-Palestinian conflict, I argue that media scholars can contribute to this effort because they are well-equipped to capture fleeting manifestations of everyday peace. However, the problematic legacy of peace in Israel/Palestine necessitates a different conceptual framework. I highlight encounters in and through media between Israeli Jews and Palestinians and contend that they present opportunities for constructive dialogue. I demonstrate this point by analyzing the Israeli television show Arab Labor, focusing on its production process, and the plight of Jewish and Palestinian characters on the show. By fusing text and context, I suggest that media do not persuade people to believe in peace; instead, media encounters, both on and off the screen, function as cultural forums for discussing complex issues undergirding violent conflicts.
Towards a ‘pluralist’ approach for examining structures of interwoven multimodal discourse on social media
Authors: Rathnayake Chamil , Suthers Daniel
Published: August 2023

This study proposes a framework for examining hashtagged content on social media, which captures how specific issue frames (i.e. hashtags) contribute to navigable structures. We introduce ‘interwoven multimodal discourse’ as a pluralist alternative to the widely applied unitary approach in which trending hashtags serve as primary sites of analysis. The study argues that ‘interweaving’ of social media discourse takes place through practices such as hashtag colocation, which result in ambient and navigable structures. Analysis of hashtag colocation networks can serve as an approach for mapping ambient affiliations accessible through such structures. We analyse a hashtag colocation network constructed using a sample of 1100 Instagram posts related to climate change uploaded during the United Nations Climate Change Conference 2021 (COP26) held in Glasgow to demonstrate two structural properties of interwoven discourse on Instagram: (1) hashtags contribute to multiple thematic clusters and (2) micro-level hashtags representing secondary topics are nested within larger thematic clusters.
Navigating the gray areas of content moderation: Professional moderators’ perspectives on uncivil user comments and the role of (AI-based) technological tools
Authors: Stockinger Andrea , Schäfer Svenja , Lecheler Sophie
Published: August 2023

Professional content moderators are responsible for limiting the negative effects of online discussions on news platforms and social media. However, little is known about how they adjust to platform and company moderation strategies while viewing and dealing with uncivil comments. Using qualitative interviews ( N = 18), this study examines which types of comments professional moderators classify as actionable, which (automated) strategies they use to moderate them, and how these perceptions and strategies differ between organizations, platforms, and individuals. Our results show that moderators divide content requiring intervention into clearly problematic and “gray area” comments. They (automatically) delete clear cases but use interactive or motivational moderation techniques for “gray areas.” While moderators crave more advanced technologies, they deem them incapable of addressing context-heavy comments. These findings highlight the need for nuanced regulations, emphasize the crucial role of moderators in shaping public discourse, and offer practical implications for (semi-)automated content moderation strategies.
Long-term continuous automatic modal tracking algorithm based on Bayesian inference
Authors: Sun Siyuan , Yang Bin , Zhang Qilin , Wüchner Roland , Pan Licheng , Zhu Haitao
Published: August 2023

Modal tracking plays a vital role in structural health monitoring since changes in modal parameters help us understand a structure’s dynamic characteristics and may reflect the potential deterioration of structural performance. Although numerous modal parameter estimation (MPE) methods exist, it is not guaranteed that an MPE process will exclude all spurious modes and not lose any physical modes every time over a long-term monitoring period. Relatively large damping of a structure, poor data quality, and significant changes in structural modal parameters may make the estimated modal parameters spurious, missing, or misclassified. It makes long-term modal tracking semiautomated or manual, which constrains timely downstream applications such as anomaly detection, condition assessment, and decision making. This research aims to propose a long-term continuous automatic modal tracking algorithm based on Bayesian inference even when the modal parameters, damping, and data quality change significantly. Bayesian inference is used to determine the physical modes from the results of existing MPE methods. Both the modes identified from the most recent response set and the modal probability model from multiple previous response sets are considered in the Bayesian model to better determine the physical modes from the results of MPE. Moreover, the proposed algorithm requires only three extra hyperparameters compared to general modal tracking algorithms, and they can be quickly determined by a grid search method. The performance of the proposed algorithm is verified by a numerical example and a real-world civil structure Z24 Bridge benchmark.
An Externally Validated Nomogram for Predicting the Overall Survival of Patients With Diffuse Large B-Cell Lymphoma Based on Clinical Characteristics and Systemic Inflammatory Markers
Authors: Liu Yajiao , Sheng Li , Hua Haiying , Zhou Jingfen , Zhao Ying , Wang Bei
Published: August 2023

Background: Systemic inflammatory indicators are clinically significant in guiding diffuse large B-cell lymphoma (DLBCL) prognosis. However, which inflammatory markers are the best predictors of DLBCL prognosis is still unclear. In this study, we aimed to create a nomogram based on the best inflammatory markers and clinical indicators to predict the overall survival of patients with DLBCL. Patients and methods: We analyzed data from 423 DLBCL patients from two institutions and divided them into a training set, an internal validation set, and an external validation set (n = 228, 97, and 98, respectively). The least absolute shrinkage and selection operator and Cox regression analysis were used to develop nomograms. We assessed model fit using the Akaike information criterion and Bayesian information criterion. The concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to assess the nomogram's predictive performance and clinical net benefit and compared with the International Prognostic Index (IPI) and National Comprehensive Cancer Network (NCCN)-IPI. Results: The inclusion variables for the nomogram model were age, Eastern Cooperative Oncology Group performance status, lactate dehydrogenase level, the systemic immune-inflammation index (SII), the prognostic nutritional index (PNI), and β-2 microglobulin (β-2 MG) level. In the training cohort, the nomogram showed better goodness of fit than the IPI and NCCN-IPI. The C-index of the nomogram (0.804, 95% CI: 0.751-0.857) outperformed the IPI (0.690, 95% CI: 0.629-0.751) and NCCN-IPI (0.691, 95% CI: 0.632-0.750). The calibration curve, ROC curve, and DCA curve analysis showed that the nomogram has satisfactory predictive power and clinical utility. Similar results were found in the validation cohort. Conclusion: The nomogram integrated with the clinical characteristics and inflammatory markers is beneficial to predict the prognosis of patients with DLBCL.
Photoresponsive Inorganic Nanomaterials in Oncology
Authors: Barbero Francesco , Gul Shagufta , Perrone Guido , Fenoglio Ivana
Published: August 2023

The diagnosis and treatment of cancer are continuously evolving in search of more efficient, safe, and personalized approaches. Therapies based on nanoparticles or physical stimuli-responsive substances have shown great potential to overcome the inherent shortcomings of conventional cancer therapies. In fact, nanoparticles may increase the half-life of chemotherapeutic agents or promote the targeting in cancer tissues while physical stimuli-responsive substances are more effective and safer with respect to traditional chemotherapeutic agents because of the possibility to be switched on only when needed. These 2 approaches can be combined by exploiting the ability of some inorganic nanomaterials to be activated by light, ultrasounds, magnetic fields, or ionizing radiations. Albeit the development of stimuli-responsive materials is still at the early stages, research in this field is rapidly growing since they have important advantages with respect to organic nanoparticles or molecular substances, like higher stability, and higher efficiency in converting the stimulus in heat or, in some cases, reactive oxygen species. On the other hand, the translation process is slowed down by issues related to safety and quality of the formulations. This literature review summarizes the current advancements in this research field, analysing the most promising materials and applications.
Identification of Memorable Game Experiences: Analysis of Escape Rooms Visitors’ Experiences
Authors: Nowacki Marek , Stasiak Andrzej
Published: August 2023

Escape room is a type of game in which players have to solve several puzzles to leave the room in a limited time. It is a relatively new form of recreation but thanks to the global diffusion of innovations, the game has reached all continents over the decade, gaining unprecedented popularity, especially in large cities. The article aims to identify and characterize the attributes of memorable game experiences (MGEs) of escape room customers in Budapest, Hungary (the eldest in Europe, well-established market for this entertainment). The paper attempts to define the components of MGEs innovatively, using text-mining analysis of big data. This study used mixed methods: quantitative and qualitative. The research material consisted of 6203 opinions on experiences in 29 escape rooms in Budapest posted on TripAdvisor. The main components of positive experiences of users of escape rooms are puzzles as well as the arrangement and decoration. Other key components of the experience include staff, storytelling, the value of service, ambience, and atmosphere. Memorable game experiences are strongly saturated with emotions, resulting from the players’ high involvement in the game and their full immersion in an artificially arranged problem situation. The obtained results indicate both the key areas necessary to create positive experiences and the elements resulting in the formation of negative experiences.
How to Do It: Transbrachial Impella Placement to Facilitate Percutaneous Coronary Intervention
Authors: Waterford Stephen D. , Schwartz Bryan G. , Ferdinand Francis D. , Kaczorowski David J. , Rizzoni Walter E.
Published: August 2023

A 64-year-old man with diffusely diseased iliofemoral vessels and an ejection fraction of 20% to 25% presented with a non-ST elevation myocardial infarction and proximal left anterior descending (LAD) and left circumflex (LCx) coronary artery disease, with a chronically occluded right coronary artery. The iliofemoral system was not suitable for Impella placement, and bilateral axillary arteries were heavily calcified. The proximal left brachial artery was chosen for placement of both an Impella CP (Abiomed, Danvers, MA, USA) and percutaneous coronary intervention (PCI) sheath through a graft sewn to the brachial artery in this single-access technique. A 6 mm graft was sewn to the brachial artery, through which the Impella CP was placed. The Impella CP sheath was then used to introduce a 7F sheath for PCI. Successful PCI with drug-eluting stents was carried out to the LAD and LCx arteries, the Impella was weaned and removed, and the graft was stapled. The patient was discharged without any access or PCI complications. This report demonstrates the feasibility of the single-access Impella technique through a brachial artery cutdown approach.
Lifestyle Medicine Intensivist Competencies: 2023 Expert Consensus Update
Authors: Kelly John H. , Lianov Liana , Shurney Dexter , Guimarães Sley T. , Palma Mechelle , Esselstyn Caldwell , Stoll Scott , Patel Padmaja , Rea Brenda , Reddy Koushik , Guthrie George , Reiss Michelle , Karlsen Micaela C.
Published: August 2023

Objective: The objective of this expert consensus process was to identify the competencies that lifestyle medicine (LM) Intensivists should be expected to have within their skill set. Methods: Expert panel members with experience in intensive, therapeutic lifestyle change (ITLC) updated and expanded a previously published set of competencies for this intensive LM practice, using an established process for developing consensus statements adapted for the topic. The previously published set of competencies was discussed for possible revision and expansion. Proposed changes were assessed for consensus using a modified Delphi process. Results: The expert panel revised the original list of 34 competencies, maintaining the 6 initial proposed topics that were previously published as Specialist Competencies: (1) Practice-Based Learning and Improvement, (2) Patient Care and Procedural Skills (3) Systems-Based Practice, (4) Medical Knowledge, (5) Interpersonal and Communication Skills, and (6) Professionalism. After a series of meetings and an iterative Delphi process of voting and revision, a final set of 46 competency statements for LM Intensivists achieved consensus. Conclusion: These competencies define the scope of practice and desired skill set for LM Intensivists. Further, these competencies establish a standard for certification of LM Intensivists.
Influence of coupling factors on structural reliability based on polynomial response surface optimization model
Authors: Jiang Kaijia , Wang Junhao , Chen Zhongquan , Zhou Qiangqiang , Jiang Shuheng
Published: August 2023

The sensitivity analysis model is frequently used to express the influence of conditional elements on structural reliability. However, the traditional sensitivity analysis model is limited to a few influencing factors, and has a small scope of application. In this paper, a modified sensitivity model is proposed by combining the optimal polynomial response surface function with the Sobol sensitivity algorithm. And the sensitivity calculation approach was combined with coupling factor test design, range verification, multi-body dynamics analysis and structural statics analysis, which enables to achieve the quantitative sensitivity value of the influence of conditional factors on structural reliability. Finally, a typical harvester structure is selected as a case, to verify the evaluation accuracy and effectiveness of the revised model. The results show that the sensitivity of threshing drum speed has the greatest influence, while the sensitivity of granary load has the least influence. The average quantitative prediction accuracy of revised approach is up to 97.36%. The revised model can accurately evaluate the sensitivity value of coupled influencing factors for industrial equipment.
Leaving the table: Organisational (in)justice and the relationship with police officer retention
Authors: Tyson Jemma , Charman Sarah
Published: August 2023

Policing has been beset by controversy in recent years predominantly concerning issues of justice, fairness and trust including widespread concerns over police misconduct. Alongside the continued fallout of budgetary controls and a global pandemic, policing in England and Wales is facing another growing problem – police officer retention. This article takes the conceptual framework of organisational justice, incorporating both distributive and procedural elements, to qualitatively examine voluntary resignations from the police in England and Wales. The findings indicate that those voluntarily resigning from the police service experience a lack of voice, lack of recognition of skills and experience, and barriers to career development and progression which focus on both organisational processes and outcomes. This article significantly contributes to the scarce academic literature on organisational justice within policing organisations from a qualitative perspective and can have a direct impact on policing services in addressing the rising numbers of preventable voluntary resignations.
Fuyuan Huoxue Decoction Promotes Skin Flap Survival Via the P38MAPK/IKK/NF-κB Pathway in Rats
Authors: Zeng Jingda , Yang Lin , Zhang Jian , Luo Xuchao , Zou Yonggen , Chen XiaoJun
Published: August 2023

Objective

Fuyuan Huoxue decoction (FHD) is a traditional Chinese medicine that can promote blood circulation, inhibit inflammatory reactions and effectively relieve pain. This study investigated the effect of FHD on rat skin flap survival and the p38 MAPK/IKK/NF-κB pathway.

Methods

The pathological condition of the flap tissue was examined by H&E staining. The expression levels of CD34 and VEGF in skin flap tissues were examined by immunohistochemistry. The levels of TNF-α, IL-6, CRP, and HO-1, superoxide dismutase (SOD) activity, and MDA content were detected by ELISA. The protein expression levels of Bax, Bcl-2, cleaved-caspase 3, p-IKKαβ, p-p38, p-p65, α-SMA, CK14, CK15, and SOX2 were detected by western blotting.

Results

Fuyuan Huoxue decoction upregulated the levels of CD34, VEGF, and Bcl-2, downregulated the expression of TNF-α, IL-6, p-IKKαβ, P-P38, P-P65, Bax, and cleaved-caspase 3, increased the activity of SOD, and inhibited the level of MDA. In addition, FHD promoted the proliferation and differentiation of skin flap.

Conclusions

Fuyuan Huoxue decoction improved the survival of the rat skin flap model by regulating the p38MAPK/IKK/NF-κB signaling pathway, and the mechanism may be related to the promotion of skin flap proliferation, differentiation, and revascularization and the inhibition of inflammation and oxidative stress.
Three Minor Flavone Glycosides from Aeschynanthus Species and Cultivars (Gesneriaceae)
Authors: Iwashina Tsukasa , Rahayu Sri , Nakane Takahisa , Mizuno Takayuki , Tsutsumi Chie , Widyatmoko Didik
Published: August 2023

Three minor flavonoids were isolated from the corollas and leaves of Aeschynanthus species and cultivars using MeOH, and identified as scutellarein 7- O-(6″-methylglucuronopyranoside) (1), 6-hydroxyluteolin 7- O-(6″-methylglucuronopyranoside) (2) and nepetin 4′- O-glucuronopyranoside (3) by UV and 1H NMR spectroscopy, LC–MS, and acid hydrolysis. These flavone glycosides are reported in nature for the first time.
Internal but Not External Building Design Associated With More Occupational Physical Activity
Authors: Gallagher Jacob , Carr Lucas J.
Published: August 2023

Background:

Few studies have explored the impact of internal building design features on physical activity. The purpose of this study is to determine building design features associate with physical activity and sedentary behaviors.

Methods:

Full-time workers ( n = 114) wore an ActivPal monitor for 4 work days to measure physical activity and sedentary behaviors. Participants completed a 25-item survey about the presence of external, internal, and staircase design features at their worksite. Participants also reported their desk type. General linear models were used to examine relations between the number of features present for each category and physical activity (steps per hour) and sedentary behavior (sitting time per hour).

Results:

Internal design scores were positively associated with occupational physical activity. Each single item increase in facilitating internal design features was associated with +64.5 steps/hr ( p = .045) at work. Workers who reported having a desk job walked 538 fewer steps/hr ( p < .01) and sat 17 min more/hr at work than workers who reported not having a desk.

Conclusion:

These results suggest that internal design features can promote more movement and less sitting at work. Future studies that examine the longitudinal effect of changing internal design features on occupational physical activity and sedentary behaviors are warranted.
Predictors of Prolonged Length of Stay After Pituitary Adenoma Resection: A Large Cohort Analysis Using the National Inpatient Sample (2016-2019)
Authors: Vasan Vikram , Dullea Jonathan T , Devarajan Alex , Vasa Devarshi , Ali Muhammad , Nichols Noah , Henson Philip , Porras Christian , Lopez Christine , Luna Diego , Liou Lathan , Iloreta Alfred Marc , Govindaraj Satish , Bederson Joshua , Shrivastava Raj K
Published: August 2023

Objective

In this nationwide retrospective study, the authors aimed to identify demographic, clinical, and baseline health risk factors predictive of a prolonged length of stay (PLOS) for patients with pituitary adenomas (PAs).

Methods

The National Inpatient Sample dataset from 2016 to 2019 was utilized to identify all included hospitalizations for PA resection as identified by the appropriate diagnosis-related group code. Comorbidities were classified based on the Charlson Comorbidity Index mapping of ICD-10 codes, and PLOS was identified as any stay longer than 3 days. Univariable and multivariable logistic regression models, accounting for the sample design, were built to determine factors associated with PLOS and emergent surgery.

Results

Overall, 30 945 patients were included in this study with 10 535 patients having PLOS. Female patients experienced an increased odds of PLOS (odds ratio [OR]: 1.29; P < .001). Black patients (OR: 1.49; P < .001) and Hispanic patients (OR: 1.30; P = .003) had 1.49 times and 1.30 times the odds of PLOS compared to White patients, respectively. Compared to patients insured by Medicare, patients insured by Medicaid had an increased odds of PLOS (OR: 1.36; P = .007) as well as emergent surgery (OR: 5.40; P < .001). When stratified by emergent surgeries, Black patients (OR: 1.89; P < .001), Hispanic patients, (OR: 2.14; P < .001), and patients on Medicaid insurance (OR: 1.71; P < .001) were at an increased risk of emergent procedures. However, female sex (OR: 0.65; P < .001), upper third quartile (OR: 0.73; P = .017), and fourth quartile (OR: 0.69; P = .014) of patients categorized by zip code income were at decreased odds of an emergent procedure.

Conclusions

Black and Hispanic patients, patients with Medicaid insurance, and patients of low socioeconomic status patients are at significantly higher risk of emergent PA resection and PLOS. Efforts to prevent emergent surgeries and shorten hospitalization after pituitary surgery may need to primarily focus on patient groups with select sociodemographic characteristics.
HaEmaturia After Transurethral resection of bladder Tumour (HEATT): A multicentre, regional collaborative analysis of factors associated with emergency re-admission with haematuria following TURBT
Authors: Sarmah Piyush B ,   West Midlands Urology Research Collaborative HEATT study group, Al-Dhahir Wesam , Chellapuri Akhil , Damola Adebiyi , Eli Nnaemeka , Foulger Rebecca , Harrington-Vogt Maria , Hulligan Stephen , Kanthabalan Abi , Kitchen Mark O , Malik Salim , Moore Madeline , Nyanhongo Donald , Sohawon Ridwaan , Thursby Helen , Yallappa Sachin , Mak David , Chakravarti Aniruddha
Published: August 2023

Objective:

To calculate the re-admission rate with haematuria within 30 days of elective transurethral resection of bladder tumour (TURBT), and identify factors associated with this.

Materials and Methods:

This was a multicentre, retrospective audit, identifying all adult patients over the age of 16 who underwent elective TURBT between 1 September and 30 November 2019. Data were collected from medical records and operation notes on patient demographics, intra-operative factors and post-operative management. Primary outcome measure was the proportion of patients emergently re-admitted with haematuria. Secondary outcome measures were the re-operation rate for haematuria, and the rate of new acute thrombotic event (TE). Fisher’s exact test was used to calculate p values within subgroups for re-admission rates.

Results:

443 patients from 12 hospitals were included. Median age was 75 years (17–99). 15 patients (3.4%) were re-admitted with haematuria. Subgroup analysis demonstrated higher rate of re-admission for pre-existing antithrombotic agents (ATAs) (2.0% vs. 6.1%, p = 0.046), increased for non-Aspirin ATAs (10.5%, p = 0.0015). 52% of non-Aspirin ATAs were restarted within 48 hours of surgery; post-operative plan for restarting was not documented in 22.1%. One patient (0.23%) developed acute TE (pulmonary embolus).

Conclusion:

Pre-existing use of non-Aspirin ATAs is associated with increased risk of post-TURBT haematuria, with variable practice in post-operative recommencement.

Level of evidence:

Level 3
Oculus power! Arts and technology’s mediation of postcolonial neoliberal nationalism in Hong Kong
Authors: Shum Holy
Published: August 2023

In the Hong Kong Chief Executive’s 2020 Policy Address, the Hong Kong Special Administrative Region (HKSAR) Government implemented strategies to integrate arts and technology as a new trend in cultural development. With the co-existence of a governmental initiative in ‘arts and technology’ (‘arts tech’) development and the rapid advancement of new technologies, it is frequently seen that new technologies (e.g., virtual reality [VR] and augmented reality) have been widely adopted in interactive media art productions in Hong Kong. Drawing on ethnographic research on a commercial virtual event, and a VR theatre performance produced by a Hong Kong cross-media creative studio, this study unveils discrepancies existing between government officials, commercial marketers, and art creators, ranging from objectives to practices in applying technologies to virtual art production. The juxtaposition of a market-driven commercial virtual campaign and the Chinese nationalist agenda embodied in the government-funded arts tech project reflects how the socio-historical background and changing political situation in Hong Kong extends its postcolonial neoliberal nationalism (PNN) to the arts tech arena. The contribution of this paper is two-fold: first, by adopting ‘China as method’ as epistemological analysis, the mediation of PNN by arts tech explains a ‘southbound imaginary’ in Hong Kong’s arts and cultural practices through a changing relationship between Hong Kong and mainland China. Second, in contrast to the current scholarship focusing on human governance in the formation of neoliberal nationalism, this paper underscores the ‘power’ of techno-cultural material in mediating the neoliberal nationalism of Hong Kong, after its reversion to China, through arts tech development.