bluuebunny/crossref_metadata_2025 huggingface dataset:
Is hospital volume related to quality of hip fracture care? Analysis of 43,538 patients and 68 hospitals from the Dutch Hip Fracture Audit
Authors: Würdemann Franka S. , van Zwet Erik W. , Krijnen Pieta , Hegeman Johannes H. , Schipper Inger B. ,   The Dutch Hip Fracture Audit Group, Calf A. H. , van Egmond P. W. , van Eijk M. , van Heijl M. , Luyten M. C. , Schutte B. G. , Voeten S. C. , Arends A. J. , Heetveld M. J. , Trappenburg M. C.
Published: January 2023

Purpose

Evidence for a hospital volume–outcome relationship in hip fracture surgery is inconclusive. This study aimed to analyze the association between hospital volume as a continuous parameter and several processes and outcomes of hip fracture care.

Methods

Adult patients registered in the nationwide Dutch Hip Fracture Audit (DHFA) between 2018 and 2020 were included. The association between annual hospital volume and turnaround times (time on the emergency ward, surgery < 48 h and length of stay), orthogeriatric co-treatment and case-mix adjusted in-hospital and 30 days mortality was evaluated with generalized linear mixed models with random effects for hospital and treatment year. We used a fifth-degree polynomial to allow for nonlinear effects of hospital volume. P-values were adjusted for multiple comparisons using the Bonferoni method.

Results

In total, 43,258 patients from 68 hospitals were included. The median annual hospital volume was 202 patients [range 1–546]. Baseline characteristics did not differ with hospital volume. Provision of orthogeriatric co-treatment improved with higher volumes but decreased at > 367 patients per year (p < 0.01). Hospital volume was not significantly associated with mortality outcomes. No evident clinical relation between hospital volume and turnaround times was found.

Conclusion

This is the first study analyzing the effect of hospital volume on hip fracture care, treating volume as a continuous parameter. Mortality and turnaround times showed no clinically relevant association with hospital volume. The provision of orthogeriatric co-treatment, however, increased with increasing volumes up to 367 patients per year, but decreased above this threshold. Future research on the effect of volume on complications and functional outcomes is indicated.
Simulations of rate of genetic gain in dry bean breeding programs
Authors: Lin Jennifer , Arief Vivi , Jahufer Zulfi , Osorno Juan , McClean Phil , Jarquin Diego , Hoyos-Villegas Valerio
Published: January 2023

Key message

A reference study for breeders aiming at maximizing genetic gain in common bean. Depending on trait heritability and genetic architecture, conventional approaches may provide an advantage over other frameworks.

Dry beans (Phaseolus vulgarisL.) are a nutrient dense legume that is consumed by developed and developing nations around the world. The progress to improve this crop has been quite steady. However, with the continued rise in global populations, there are demands to expedite genetic gains. Plant breeders have been at the forefront at increasing yields in the common bean. As breeding programs are both time-consuming and resource intensive, resource allocation must be carefully considered. To assist plant breeders, computer simulations can provide useful information that may then be applied to the real world. This study evaluated multiple breeding scenarios in the common bean and involved five selection strategies, three breeding frameworks, and four different parental population sizes. In addition, the breeding scenarios were implemented in three different traits: days to flowering, white mold tolerance, and seed yield. Results from the study reflect the complexity of breeding programs, with the optimal breeding scenario varying based on trait being selected. Relative genetic gains per cycle of up to 8.69% for seed yield could be obtained under the use of the optimal breeding scenario. Principal component analyses revealed similarity between strategies, where single seed descent and the modified pedigree method would often aggregate. As well, clusters in the direction of the Hamming distance eigenvector are a good indicator of poor performance in a strategy.
When stigmatization does not work: over-securitization in efforts of the Campaign to Stop Killer Robots
Authors: Solovyeva Anzhelika , Hynek Nik
Published: January 2023

This article reflects on securitization efforts with respect to ‘killer robots’, known more impartially as autonomous weapons systems (AWS). Our contribution focuses, theoretically and empirically, on the Campaign to Stop Killer Robots, a transnational advocacy network vigorously pushing for a pre-emptive ban on AWS. Marking exactly a decade of its activity, there is still no international regime formally banning, or even purposefully regulating, AWS. Our objective is to understand why the Campaign has not been able to advance its disarmament agenda thus far, despite all the resources, means and support at its disposal. For achieving this objective, we challenge the popular assumption that strong stigmatization is the universally best strategy towards humanitarian disarmament. We investigate the consequences of two specifics present in AWS, which set them apart from processes and successes of the campaigns to ban anti-personnel landmines, cluster munitions, and laser-blinding weapons: the complexity of AWS as a distinct weapons category, and the subsequent circumvention of its complexity through the utilization of pop-culture, namely science fiction imagery. We particularly focus on two mechanisms through which such distortion has occurred: hybridization and grafting. These provide the conceptual basis and heuristic tools to unpack the paradox of over-securitization: success in broadening the stakeholder base in relation to the first mechanism and deepening the sense of insecurity in relation to the second one does not necessarily lead to the achievement of the desired prohibitory norm. In conclusion, we ask whether it is not the time for a more epistemically-oriented expert debate with a less ambitious, lowest common denominator strategy as the preferred model of arms control for such a complex weapons category.
Understanding dynamics of polarization via multiagent social simulation
Authors: Haque Amanul , Ajmeri Nirav , Singh Munindar P.
Published: January 2023

It is widely recognized that the Web contributes to user polarization, and such polarization affects not just politics but also peoples’ stances about public health, such as vaccination. Understanding polarization in social networks is challenging because it depends not only on user attitudes but also their interactions and exposure to information. We adopt Social Judgment Theory to operationalize attitude shift and model user behavior based on empirical evidence from past studies. We design a social simulation to analyze how content sharing affects user satisfaction and polarization in a social network. We investigate the influence of varying tolerance in users and selectively exposing users to congenial views. We find that (1) higher user tolerance slows down polarization and leads to lower user satisfaction; (2) higher selective exposure leads to higher polarization and lower user reach; and (3) both higher tolerance and higher selective exposure lead to a more homophilic social network.
The Role of Flavobacterium enshiense R6S-5-6 in the Wetland Ecosystem Revealed by Whole-Genome Analysis
Authors: Choi Ahhyeon , Cha In-Tae , Lee Ki-Eun , Son Youn Kyoung , Yu Jaewoong , Seol Donghyeok
Published: January 2023

The wetland is an important ecosystem for purifying pollutants and circulating nutrients. Numerous microorganisms contribute to maintaining this function. We obtained Flavobacterium enshiense R6S-5-6 which was isolated from Ungok (Ramsar) Wetland and conducted whole-genome sequencing to investigate what contribution R6S-5-6 could make to the wetland community. The complete genome sequence of R6S-5-6 has a size of 3,251,289 bp with 37.68% of GC content. Gene annotation revealed that R6S-5-6 has several pathways to break down pollutants, including denitrification, assimilatory sulfate reduction (ASR), and polyphosphate-accumulating process. Furthermore, R6S-5-6 has genes that can have a positive effect on plants living in wetlands, such as storing essential nutrients, promoting plant growth, and protecting plants against pathogens.
AUR1 and its pals: orchestration of intracellular rhizobia infection in legume for nitrogen fixation
Authors: Singh Jawahar , Varshney Vishal , Mishra Vishnu
Published: January 2023

Key message

We highlight the newly emerged regulatory role of a mitotic kinase AUR1, its activator, and its microtubule-associated proteins (MAPs) in infection thread formation for root nodule symbiosis.
Transport measurements in single-grain GdBCO+Ag bulk superconductors processed by infiltration growth
Authors: Cayado Pablo , Namburi Devendra K. , Erbe Manuela , Hänisch Jens , Cardwell David A. , Durrell John H. , Holzapfel Bernhard
Published: January 2023

Transport measurements performed on a cross-sectional slice prepared from a bulk GdBa2Cu3O7-x-Ag single-grain superconductor of 25 mm in diameter are described and the results presented. The sample, which was fabricated via the buffer-assisted top-seeded infiltration growth process, was capable of trapping a maximum magnetic field of ~ 1 T at 77 K. Transport measurements on superconducting, bulk single-grain RE-Ba-Cu-O [(RE)BCO] samples are generally very challenging due to their large critical current densities and poor mechanical properties. We present a straightforward and reliable approach to prepare reproducibly specimens from the parent single grain and results of transport property measurements on these samples in a commercial Physical Property Measurement System (PPMS). Critical current densities determined via magnetic and transport measurements are compared and discussed.
PLD plasma plume analysis: a summary of the PSI contribution
Authors: Schneider Christof W. , Lippert Thomas
Published: January 2023

We report on the properties of laser-induced plasma plumes generated by ns pulsed excimer lasers as used for pulsed laser deposition to prepare thin oxide films. A focus is on the time and spatial evolution of chemical species in the plasma plume as well as the mechanisms related to the plume expansion. The overall dynamics of such a plume is governed by the species composition in particular if three or more elements are involved. We studied the temporal evolution of the plume, the composition of the chemical species in the plasma, as well as their electric charge. In particular, ionized species can have an important influence on film growth. Likewise, the different oxygen sources contributing to the overall oxygen content of an oxide film are presented and discussed. Important for the growth of oxide thin films is the compositional transfer of light element such as oxygen or Li. We will show and discuss how to monitor these light elements using plasma spectroscopy and plasma imaging and outline some consequences of our experimental results.
Low-pressure ethylene/air laminar premixed flames: characterisations and soot diagnostics
Authors: Algoraini Safa , Sun Zhiwei , Dally Bassam B. , Alwahabi Zeyad T.
Published: January 2023

In this work, the structure of laminar premixed ethylene/air flat flames at low pressure are studied experimentally. The aim of the work is to exploit the spatial expansion of laminar 1D flames and advanced laser techniques to better understand the conditions and precursors affecting soot particles inception. Soot volume fraction (fv) profiles were measured using laser-induced incandescence (LII), while spatial distribution of the CH* and C2* radicals was measured using spatially resolved emission spectroscopy. Spatially resolved laser-induced fluorescence has been used to record emission from 2–3 rings, 3–4 rings and > 5 rings. The temperature of soot particles (Ts) was evaluated through fitting the spectrally resolved soot luminosity, while flame gaseous temperature (Tg) was measured using a fine thermocouple. The laminar flow velocity was modeled and used to evaluate the reaction time at each HAB. Taking advantage of the expanded flame structure at low pressure, the profiles of CH*, C2*, soot and temperatures, as a function of the height above the burner, were well resolved. It was found that CH* and C2* chemiluminescence overlap in space. The thickness of CH* layer is larger than that of C2*, and it peaks at slightly different location, CH* appears approximately 1 mm before C2*. The distance between the two peaks decreases linearly with the increase in pressure. The lowest value of the initial soot volume fraction (fv) was 0.19 ppb, measured at pressure 27 kPa. It was found that fv scales with the pressure following a power function of the form fv α Prn, where n is 2.15 ± 0.7. It was observed that, in all the flames investigated, the initial soot particles first appear at a common critical inception temperature, Tinception, of 1465 ± 66 K. It was found that the Tinception is lower than the maximum flame temperature, Tmax, by ~ 45° and appeared ~ 1 mm further than the location of Tmax. Using the Lagrangian quantity dfv/dt and fv, it was possible to reveal the soot growth rate, kSG. At pressure of 27 kPa, the value of kSG was evaluated as 20 s−1.
Uncertainty Diagnostics of Binomial Regression Trees for Ordered Rating Data
Authors: Simone Rosaria
Published: January 2023

The paper proposes a method to perform diagnostics of model-based trees for preference and evaluation data on the basis of surrogate residual analysis for ordinal data models. The discussion stems from the introduction of binomial regression trees and discusses how to perform local diagnostics of misspecification against alternative model extensions within the framework of mixture models with uncertainty. Three case studies concerning customer satisfaction and perceived trust for information sources illustrate usefulness and versatile applicative extent of the proposal.
Cyclic Polynomials in Dirichlet-Type Spaces in the Unit Ball of $${\mathbb {C}}^2$$
Authors: Kosiński Łukasz , Vavitsas Dimitrios
Published: January 2023

We characterize polynomials that are cyclic in Dirichlet-type spaces in the unit ball in $${\mathbb {C}}^2$$

C

2

.
Rapid ossification of a giant post-operative occipital pseudomeningocele following posterior fossa surgery
Authors: Lewis Daniel , Sethuraman Chitra , Varthalitis Dimitrios
Published: January 2023

Pseudomeningocele formation following posterior fossa surgery is a well-recognised complication, occurring in up to 33% of operated cases in some series. Ossification of a cranial pseudomeningocele is, however, an exceptionally rare event with only three prior reported cases. We present the unique case of a paediatric patient who developed rapid ossification of a giant occipital pseudomeningocele following posterior fossa surgery. An 8-year-old female patient underwent a midline posterior fossa craniotomy for resection of an exophytic brainstem low-grade glioma. Post-surgery, the patient developed pan-ventricular hydrocephalus and a large occipital pseudomeningocele, which initially increased in size despite a successful endoscopic third ventriculostomy (ETV) being performed. At approximately 3 months post-surgery, reduction of the pseudomeningocele was observed with associated prominent ossification of the pseudomeningocele wall on computed tomography (CT) imaging. Surgical excision was subsequently undertaken, and intra-operatively, a large ossified pseudomeningocele was found. Follow-up MRI 1 month later demonstrated almost complete resolution of the pseudomeningocele with an associated reduction in the degree of pan-ventricular ventriculomegaly. This case highlights that ossification of even giant pseudomeningoceles can occur over a time period of just a few months and clinicians should consider ossification whenever a change in size or consistency of a post-operative pseudomeningocele is encountered.
Recurrence of perforation and overall patient survival after penetrating keratoplasty versus amniotic membrane transplantation in corneal perforation
Authors: Elhardt Carolin , Schweikert Romina , Kamnig Rupert , Vounotrypidis Efstathios , Wolf Armin , Wertheimer Christian M.
Published: January 2023

Purpose

The following is a comparative analysis on the treatment outcomes of corneal perforations using amniotic membrane transplantation (AMT) or penetrating keratoplasty (PK).

Methods

This monocentric retrospective study was performed at the Department of Ophthalmology, University Hospital Ulm, Germany. A total of 78 eyes of 78 patients were included. Thirty-nine eyes received an AMT, and 39 patients were treated with a PK. Primary outcome was recurrence of perforation. Secondary outcomes were patient mortality and visual acuity.

Results

No statistically significant difference was observed with regard to a recurrence of perforation between the two groups (26% in AMT vs 23% in PK, p > 0.99). The time of recurrences was within the first two years and did not differ statistically (p = 0.97). In addition, a proportional hazards model with cox regression regarding recurrent perforation showed no significant differences (p = 0.5). After AMT, 41% and after KP, 28% of the patients died during follow-up (p = 0.2), respectively. The Charlson Comorbidity Index (p < 0.0001) and the age at the time of surgery (p = 0.0002) were statistically significantly higher in those who were deceased. A mean follow-up of 485 ± 517 days was recorded.

Conclusion

Both surgical methods show good results and no statistically significant difference regarding recurrent perforation rate. About a third of the patients died during the follow-up period. The decision regarding the appropriate method should therefore be based on a combination of all factors.
Oligometastatic disease and visceral resections in advanced malignant melanoma: a propensity-matched analysis
Authors: Urbanski Alexander , Minnemann Julia , Mauch Cornelia , Schmidt Thomas , Kreuzberg Nicole , Schlaak Max , Bruns Christiane J. , Stippel Dirk L. , Wahba Roger
Published: January 2023

Purpose

Malignant melanoma is among the tumours with the highest increase in incidence of solid tumours in Germany. While most patients are diagnosed at an early stage and show a good prognosis, advanced stages of malignant melanoma are accompanied with a poor prognosis and limited treatment options. Comparable to other tumour entities, the resection of visceral metastases could lead to a better prognosis. Supplementary, the subgroup of oligometastatic patients might benefit from surgical therapy to a greater extent.

Methods

This retrospective study analysed 351 patients treated between 2006 and 2017 at the University Hospital of Cologne. A total of 121 patients showed visceral metastases, with which we compared patients with a diffuse tumour spread to patients in an oligometastatic state. Furthermore, we evaluated the effect of visceral resection of oligometastatic, malignant melanoma.

Results

Our analysis showed that patients with an oligometastatic malignant melanoma had a significantly better prognosis than patients with a diffuse pattern of metastases, if they showed visceral metastases. Furthermore, the resection of visceral metastases leads to a significant gain in median overall survival time (13.6 vs. 34.2 months) and in progression-free survival (9.6 vs. 3.8 months).

Conclusion

The resection of visceral metastases is a rational treatment option in advanced malignant melanoma. Although our study is limited by a small cohort of patients (n = 18), we believe that the resection of visceral metastases will be fundamental in the treatment of malignant melanoma. In particular, patients in an oligometastatic stage could be an eligible group for surgical treatment.
Nitrogen-mediated metabolic patterns of susceptibility to Botrytis cinerea infection in tomato (Solanum lycopersicum) stems
Authors: Lacrampe Nathalie , Colombié Sophie , Dumont Doriane , Nicot Philippe , Lecompte François , Lugan Raphaël
Published: January 2023

Main conclusion

Severe N stress allows an accumulation of C-based compounds but impedes that of N-based compounds required to lower the susceptibility of tomato stem toBotrytis cinerea.

Botrytis cinerea, a necrotrophic filamentous fungus, forms potentially lethal lesions on the stems of infected plants. Contrasted levels of susceptibility to B. cinerea were obtained in a tomato cultivar grown on a range of nitrate concentration: low N supply resulted in high susceptibility while high N supply conferred a strong resistance. Metabolic deviations and physiological traits resulting from both infection and nitrogen limitation were investigated in the symptomless stem tissue surrounding the necrotic lesion. Prior to infection, nitrogen-deficient plants showed reduced levels of nitrogen-based compounds such as amino acids, proteins, and glutathione and elevated levels of carbon-based and defence compounds such as α-tomatine and chlorogenic acid. After B. cinerea inoculation, all plants displayed a few common responses, mainly alanine accumulation and galactinol depletion. The metabolome of resistant plants grown under high N supply showed no significant change after inoculation. On the contrary, the metabolome of susceptible plants grown under low N supply showed massive metabolic adjustments, including changes in central metabolism around glutamate and respiratory pathways, suggesting active resource mobilization and production of energy and reducing power. Redox and defence metabolisms were also stimulated by the infection in plants grown under low N supply; glutathione and chlorogenic acid accumulated, as well as metabolites with more controversial defensive roles, such as polyamines, GABA, branched-chain amino acids and phytosterols. Taken together, the results showed that nitrogen deficiency, although leading to an increase in secondary metabolites even before the pathogen attack, must have compromised the constitutive levels of defence proteins and delayed or attenuated the induced responses. The involvement of galactinol, alanine, cycloartenol and citramalate in the tomato stem response to B. cinerea is reported here for the first time.
Translating evidence in a priority setting partnership: knowledge gaps between healthcare providers and oesophageal cancer patients
Authors: McDonnell Sarah , Breslin Tara , Mascan Bianca , Shahruddin Nur Shuhada , Elnour Mawaheb , Fanning Michelle , Galvin Anthony , Moore Jennifer , Ravi Narayansamy , Reynolds John V. , Donohoe Claire L.
Published: January 2023

Introduction

Despite the fact that health information is now more accessible than ever, knowledge gaps remain between patients and healthcare providers (HCPs). To date, the patients’ need for information following a diagnosis of oesophageal cancer has not been adequately met.

Purpose

The purpose of this study was to identify why knowledge gaps exist between oesophageal cancer patients and HCPs and how to address them.

Methods

Purposive sampling of a group of people living with and after oesophageal cancer who had participated in a priority-setting partnership where 45% of questions from patients had existing evidence-based answers. A 7-set question series was developed for use in a patient/HCP focus group in addition to 11 individual phone interviews with survivors of oesophageal cancer. Qualitative semistructured interviews were conducted to explore oesophageal cancer patients’ access to information. The data was analysed thematically, which involved coding all patient transcripts before identifying and reviewing key themes.

Results

The three primary themes that emerged were as follows: opportunity (HCP team factors and relationship development), ability (patient factors) and priority (pacing of information delivery).

Conclusion

Effective communication between patients and HCPs was identified as an integral component of the enhancement of patient knowledge. HCPs should continue to refine and improve methods of information delivery and encourage conversations regarding information preferences.
High patient satisfaction and increased physical activity following a remote multidisciplinary team multiple myeloma clinic
Authors: Lecat Catherine S. Y. , Fisher Abigail , Atta Maria , Camilleri Marquita , McCourt Orla , Land Joanne , Worthington Sarah , Hart Alyse , Daniel Angela , Uddin Inayah , Roche Charlotte , Auner Holger W. , Yong Kwee
Published: January 2023

Purpose

Patients with multiple myeloma suffer from disease-related complications such as bone destruction, toxicities from repeated therapies and age-related co-morbidities. With improved treatment options, patients are living longer and have specific survivorship needs such as low exercise levels that need to be addressed. In this study, we designed, implemented and evaluated a multidisciplinary team (MDT) myeloma clinic that provided participants with tailored exercise and lifestyle advice.

Methods

The Promoting Individualised Self-Management and Survivorship (PrISMS) clinic was set up in two UK myeloma centres. This remote MDT clinic comprised of a doctor, a nurse specialist and a physiotherapist. Patients were required to complete blood tests and a questionnaire about their symptoms and concerns before each consultation. Patient-reported outcome measures were captured using validated questionnaires. Patient feedback was collected using a specially designed survey and structured telephone interviews.

Results

Sixty-one patients were enrolled in the pilot clinic with 210 consultations held during the study period. Nine patients had disease progression and were referred safely back to face-to-face clinics. There was a significant improvement in patients’ exercise score (p = 0.02) after PrISMS clinic. Patient satisfaction was high, with 83% feeling more confident in self-managing myeloma after PrISMS clinic.

Conclusion

PrISMS clinic is safe and feasible, with high patient compliant and acceptability. It empowers patients to self-manage their condition and encourages physical activity, which is associated with improved quality of life and fatigue level. Future randomised controlled trials will help to confirm its benefits on patient clinical outcomes and cost-effectiveness.
Prognostic factors associated with outcome following an epidural steroid injection for disc-related sciatica: a systematic review and narrative synthesis
Authors: Nagington Alan , Foster Nadine E. , Snell Kym , Konstantinou Kika , Stynes Siobhán
Published: January 2023

Purpose

Clinical guidelines recommend epidural steroid injection (ESI) as a treatment option for severe disc-related sciatica, but there is considerable uncertainty about its effectiveness. Currently, we know very little about factors that might be associated with good or poor outcomes from ESI. The aim of this systematic review was to synthesise and appraise the evidence investigating prognostic factors associated with outcomes following ESI for patients with imaging confirmed disc-related sciatica.

Methods

The search strategy involved the electronic databases Medline, Embase, CINAHL Plus, PsycINFO and reference lists of eligible studies. Selected papers were quality appraised independently by two reviewers using the Quality in Prognosis Studies tool. Between-study heterogeneity precluded statistical pooling of results.

Results

3094 citations were identified; 15 studies were eligible. Overall study quality was low with all judged to have moderate or high risk of bias. Forty-two prognostic factors were identified but were measured inconsistently. The most commonly assessed prognostic factors were related to pain and function (n = 10 studies), imaging features (n = 8 studies), patient socio-demographics (n = 7 studies), health and lifestyle (n = 6 studies), clinical assessment findings (n = 4 studies) and injection level (n = 4 studies). No prognostic factor was found to be consistently associated with outcomes following ESI. Most studies found no association or results that conflicted with other studies.

Conclusions

There is little, and low quality, evidence to guide practice in terms of factors that predict outcomes in patients following ESI for disc-related sciatica. The results can help inform some of the decisions about potential prognostic factors that should be assessed in future well-designed prospective cohort studies.
The two-network framework of number processing: a step towards a better understanding of the neural origins of developmental dyscalculia
Authors: Klein Elise , Knops André
Published: January 2023

Developmental dyscalculia is a specific learning disorder that persists over lifetime and can have an enormous impact on personal, health-related, and professional aspects of life. Despite its central importance, the origin both at the cognitive and neural level is not yet well understood. Several classification schemas of dyscalculia have been proposed, sometimes together with an associated deficit at the neural level. However, these explanations are (a) not providing an exhaustive framework that is at levels with the observed complexity of developmental dyscalculia at the behavioral level and (b) are largely mono-causal approaches focusing on gray matter deficits. We suggest that number processing is instead the result of context-dependent interaction of two anatomically largely separate, distributed but overlapping networks that function/cooperate in a closely integrated fashion. The proposed two-network framework (TNF) is the result of a series of studies in adults on the neural correlates underlying magnitude processing and arithmetic fact retrieval, which comprised neurofunctional imaging of various numerical tasks, the application of probabilistic fiber tracking to obtain well-defined connections, and the validation and modification of these results using disconnectome mapping in acute stroke patients. Emerged from data in adults, it represents the endpoint of the acquisition and use of mathematical competencies in adults. Yet, we argue that its main characteristics should already emerge earlier during development. Based on this TNF, we develop a classification schema of phenomenological subtypes and their underlying neural origin that we evaluate against existing propositions and the available empirical data.
Praxis der präklinischen Schlaganfallversorgung im deutschsprachigen Raum
Authors: Lier Martin , Euler Maximilian , Roessler Markus , Liman Jan , Goericke Meike Bettina , Baubin Michael , Mueller Stefan Matthias , Kunze-Szikszay Nils
Published: January 2023

Hintergrund

Eine leitlinienadhärente rettungsdienstliche Versorgung kann die Prognose von Schlaganfallpatienten positiv beeinflussen.

Ziel der Arbeit

Durchführung einer Bestandsaufnahme der Organisation der präklinischen Schlaganfallversorgung im Hinblick auf die Empfehlungen aktueller Versorgungsleitlinien.

Material und Methoden

Die ärztlichen Leitungen Rettungsdienst (ÄLRD) in Deutschland (n = 178), Österreich (n = 9) und der Schweiz (n = 32) wurden zu einer Onlinebefragung (unipark.com, Tivian XI GmbH, Köln, Deutschland) eingeladen. Die Umfrage war über 10 Wochen (22.04. bis 30.06.2020) erreichbar, erfolgte anonym und schloss Angaben zu Strukturdaten, zur klinischen Versorgung und zur Alarmierungs- bzw. Versorgungsstrategie ein.

Ergebnisse

Die Umfrage wurde 69-mal beendet und 65 Datensätze in die Auswertung einbezogen (4-mal kein ÄLRD). Die Merheit von 73,8 % (n = 48) waren ÄLRD in Deutschland, 15,4 % (n = 10) in der Schweiz und 10,8 % (n = 7) in Österreich. Es ergaben sich wesentliche Unterschiede in der infrastrukturellen Ausstattung der RD-Bereiche: 93,3 % (n = 61) der Befragten gaben an, eine SOP zur allgemeinen Schlaganfallversorgung zu nutzen, 37 % (n = 24) unterschieden zwischen Schlaganfällen mit leichter und schwerer Symptomatik und 15,4 % (n = 10) nutzten einen spezifischen Score zur Vorhersage von proximalen Gefäßverschlüssen mit hoher Thrombektomiewahrscheinlichkeit.

Diskussion

Die präklinische Schlaganfallversorgung ist sehr heterogen organisiert. In Hinblick auf Leitlinienadhärenz und die Einschätzung der Thrombektomiewahrscheinlichkeit besteht, unter anderem durch einheitliche Nutzung präklinischer Vorhersagescores, ein erhebliches Optimierungspotenzial.

Graphic abstract
Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers
Authors: Campos-Madueno Edgar I. , Moradi Melika , Eddoubaji Yasmine , Shahi Fatemeh , Moradi Sina , Bernasconi Odette J. , Moser Aline I. , Endimiani Andrea
Published: January 2023

The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales (Ent) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens—especially Escherichia coli and Klebsiella pneumoniae—may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR-Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR-Ent. In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR-Ent carriers.
Differential instructional effectiveness: overcoming the challenge of learning to solve trigonometry problems that involved algebraic transformation skills
Authors: Ngu Bing Hiong , Phan Huy P.
Published: January 2023

The design principles of cognitive load theory and learning by analogy has independently contributed to our understanding why an instruction will or will not work. In an experimental study involving 97 Year 9 Australian students conducted in regular classrooms, we evaluated the effect of the unguided problem-solving approach, worked examples approach and analogy approach on learning to solve two types of trigonometry problem. These trigonometry problems (sin40° = $$\frac{x}{6}$$

x
6

vs. cos50° = $$\frac{14}{x}$$

14
x

) exhibited two levels of complexity owing to the location of the pronumeral (numerator vs. denominator). The solution procedure of worked examples provided guidance, whereas the unguided problem-solving was without any guidance. Analogical learning placed emphasis on comparing a pair of isomorphic examples to facilitate transfer. Across the three approaches, solving practice problems contributed towards performance on the post-test. However, the worked examples approach and analogy approach were more efficient than the unguided problem-solving approach for acquiring skills to solve practice problems regardless of their complexity. Therefore, the worked examples approach and analogy approach that emphasizes algebraic transformation skills have the potential to reform instructional efficiency for learning to solve trigonometry problems.
Properties and Stability of Mining-Induced Meromixis in Two Small Boreal Lakes in Eastern Finland
Authors: Kehusmaa Karoliina , Kauppila Tommi , Österholm Peter , Juntunen Janne , Saarni Saija
Published: January 2023

Mine waters are a significant point source stressor for aquatic environments, not only due to their acidity and high metal concentrations, but also because of their high electrolyte concentrations. Ion-rich mine waters can disturb the seasonal mixing of lake waters, even leading to permanent stratification, i.e. meromixis. In this study, we investigated two small natural lakes receiving waters from closed Ni-Cu mines. To characterize the present chemical and physical conditions of these two boreal lakes, we collected water samples and in-situ water column measurements seasonally in 2017 and 2018. We modelled the stability of meromixis in the lakes under varying physico-chemical and meteorological conditions with the MATLAB-based open-source model code, MyLake. Chemical analyses and water column measurements show that both lakes are currently meromictic with a chemocline separating the circulating, well-oxygenated upper water from the non-circulating, hypoxic bottom water. The main anion was SO4 in both lakes, while the main cations were Ca, Mg, Na, and K. Elevated concentrations of conservative elements flowing from the mine areas are crucial in maintaining the meromixis. Modelling scenarios suggest that the meromixis would be sustained for several decades even if the external load ceased completely. Lake morphology and sheltered surroundings also seem to contribute to maintaining the meromixis in these lakes. Consequently, our results indicate that small headwaters are sensitive to persistent meromixis even when external loading is mild.
Clinician educators’ conceptions of assessment in medical education
Authors: Sims D. A. , Cilliers F. J.
Published: January 2023

In pursuing assessment excellence, clinician-educators who design and implement assessment are pivotal. The influence of their assessment practice in university-run licensure exams on student learning has direct implications for future patient care. While teaching practice has been shown to parallel conceptions of teaching, we know too little about conceptions of assessment in medical education to know if this is the case for assessment practice and conceptions of assessment. To explore clinician-educators’ conceptions of assessment, a phenomenographic study was undertaken. Phenomenography explores conceptions, the qualitatively different ways of understanding a phenomenon. Data analysis identifies a range of hierarchically inclusive categories of understanding, from simple to more complex, and the dimensions that distinguish each category or conception. Thirty-one clerkship convenors in three diverse Southern settings were interviewed in three cycles of iterative data collection and analysis. Four conceptions of assessment were identified: passive operator, awakening enquirer, active owner and scholarly assessor. Six dimensions were elucidated to describe and distinguish each conception: purpose of assessment; temporal perspective; role and responsibility; accountability; reflexivity and emotional valence. Additionally, three characteristics that appeared to track the progressive nature of the conceptions were identified: professional identity, assessment literacy and self-efficacy. These conceptions encompass and extend previously described conceptions across different educational levels, disciplines and contexts, suggesting applicability to other settings. There is some evidence of a relationship between conceptions and practice, suggesting, together with the hierarchical nature of these conceptions, that targeting conceptions during faculty development may be an effective approach to enhance assessment practice.
Homopositivity Across Europe: Predictors, Pathways, and Moderators
Authors: Whitworth Adam , Moretti Angelo
Published: January 2023

Although homopositivity, the attitudinal acceptance of homosexuality, has generally increased across Western societies, there remains considerable homonegativity across certain regions of the world as well as certain demographic and socioeconomic groups. Although previous cross-national research has successfully identified the key factors affecting homopositive attitudes, the literature neglects both potentially key mediation pathways and moderating interactions between those factors that may unlock more nuanced understanding of these variations in homopositive attitudes across individuals and places. In response, the present study innovatively applied a multivariate structural equation modelling approach to the latest Wave 9 (2018 data) of the large-scale cross-national European Social Survey data in order to shed new light on these currently neglected predictors, pathways, and moderating influences on homopositive attitudes. It used a three-item latent variable to measure the homopositive attitudes outcomes construct. Its explanatory variables were focused across three key sets of factors identified in theoretical and empirical literature (socioeconomics, religiosity, and values) alongside various wider controls. Our analyses made several innovative methodological and empirical contributions to existing debate. Key innovative findings include the original identification of important indirect effects of religious beliefs on homopositive attitudes via religious practices, important indirect effects of education on homopositive attitudes via household income, and the role of national welfare regimes to homopositive attitudes (and with its effects interestingly not moderated by household income).
Evaluation of roost culling as a management strategy for reducing invasive rose-ringed parakeet (Psittacula krameri) populations
Authors: Anderson C. Jane , Brennan Leonard A. , Bukoski William P. , Hess Steven C. , Hilton Clayton D. , Shiels Aaron B. , Siers Shane R. , Kluever Bryan M. , Klug Page E.
Published: January 2023

Rose-ringed parakeets (Psittacula krameri) are one of the most widespread invasive avian species worldwide. This species was introduced to the island of Kaua‘i, Hawai‘i, USA, in the 1960s. The rapidly increasing population has caused substantial economic losses in the agricultural and tourism industries. We evaluated the efficacy of a roost culling program conducted by an independent contractor from March 2020 to March 2021. We estimated island-wide minimum abundance was 10,512 parakeets in January 2020 and 7,372 in April 2021. Over 30 nights of culling at four roost sites, approximately 6,030 parakeets were removed via air rifles with 4,415 (73%) confirmed via carcasses retrieval. An estimated average of 45 parakeets were removed per hour of shooter effort. The proportion of adult females removed in 2020 was 1.9 × greater when culled outside of the estimated nesting season. Of the four roosts where culling occurred, the parakeets fully abandoned three and partially abandoned one site. Of the three fully abandoned roosts, an estimated average of 29.6% of birds were culled prior to roost abandonment. The roost culling effort was conducted during the COVID-19 pandemic, when tourist numbers and foot traffic were greatly reduced. It is unknown how public perception of roost culling in public areas may impact future efforts. Findings suggest roost culling can be utilized for management of nonnative rose-ringed parakeet populations when roost size is small enough and staff size large enough to cull entire roosts in no greater than two consecutive nights (e.g., if two shooters are available for three hours per night, roost culling should only be attempted on a roost with ≤ 540 rose-ringed parakeets).
Seasonal fluctuations of extracellular enzyme activities are related to the biogeochemical cycling of C, N and P in a tropical terra-firme forest
Authors: Schaap Karst J. , Fuchslueger Lucia , Quesada Carlos Alberto , Hofhansl Florian , Valverde-Barrantes Oscar , Camargo Plínio B. , Hoosbeek Marcel R.
Published: January 2023

Extracellular enzymes (EE) play a vital role in soil nutrient cycling and thus affect terrestrial ecosystem functioning. Yet the drivers that regulate microbial activity, and therefore EE activity, remain under debate. In this study we investigate the temporal variation of soil EE in a tropical terra-firme forest. We found that EE activity peaked during the drier season in association with increased leaf litterfall, which was also reflected in negative relationships between EE activities and precipitation. Soil nutrients were weakly related to EE activities, although extractable N was related to EE activities in the top 5 cm of the soil. These results suggest that soil EE activity is synchronized with precipitation-driven substrate inputs and depends on the availability of N. Our results further indicate high investments in P acquisition, with a higher microbial N demand in the month before the onset of the drier season, shifting to higher P demand towards the end of the drier season. These seasonal fluctuations in the potential acquisition of essential resources imply dynamic shifts in microbial activity in coordination with climate seasonality and resource limitation of central-eastern Amazon forests.
The Role of Ambient Turbulence in Canopy Wave Generation by Kelvin–Helmholtz Instability
Authors: Smyth W. D. , Mayor S. D. , Lian Q.
Published: January 2023

We test the hypothesis that internal waves observed in flow over forest canopies are generated by Kelvin–Helmholtz instability. The waves were observed at night, under stably stratified and weak wind conditions, with a horizontally scanning aerosol lidar and an instrumented tower. The lidar images are used to determine the salient wavelength and phase propagation velocity of each episode. Time series data measured at the tower are then used to form vertical profiles of background velocity and buoyancy just before each observed wave event. The profiles are input to the Taylor–Goldstein equation to predict the phase velocity, wavelength and period of the fastest-growing linear instability, and the results compared with the lidar observations. The observed wavelengths tend to be longer than predicted by the Taylor–Goldstein theory, typically by a factor of two. That discrepancy is removed when the theory is extended to account for the effects of ambient, small-scale turbulence.
A combination of surface-initiated controlled radical polymerization (SET-LRP) and click-chemistry for the chemical modification and fluorescent labeling of cellulose nanofibrils: STED super-resolution imaging of a single fibril and a single fibril embedded in a composite
Authors: Jiang Xuehe , Mietner J. Benedikt , Navarro Julien R. G.
Published: January 2023

A strategy is developed to modify cellulose nanofibril (CNF) surfaces with a combination of Cu0-mediated radical polymerization (SET-LRP) and CuI-catalyzed azide-alkyne click-chemistry (CuAAC). CNFs were grafted with statistical copolymers of di(ethylene glycol) ethyl ether acrylate (DEGEEA) and acrylic acid 3-trimethylsilyl-prop-2-ynyl ester (TMSPgA) that allows labeling of multiple fluorescent dyes, e.g. AF488 and ATTO633, special dyes for confocal laser scanning microscopy and stimulated emission depletion (STED) microscopy. Through our strategy and these microscopic techniques, we visualized isolated fibrils and fibrils embedded in a PVA composite in a high resolution. This work also provides new insight into the effect of the clickable entity/precursor on the compatibility of modified fibrils with the composite matrix.

Graphical abstract