bluuebunny/crossref_metadata_2025 huggingface dataset:
Convergence of measures after adding a real
Authors: Sobota Damian , Zdomskyy Lyubomyr
Published: August 2023

We prove that if $$\mathcal {A}$$
A
is an infinite Boolean algebra in the ground model V and $$\mathbb {P}$$
P
is a notion of forcing adding any of the following reals: a Cohen real, an unsplit real, or a random real, then, in any $$\mathbb {P}$$
P
-generic extension V[G], $$\mathcal {A}$$
A
has neither the Nikodym property nor the Grothendieck property. A similar result is also proved for a dominating real and the Nikodym property.
Systemic inflammatory effects of zinc oxide particles: is a re-evaluation of exposure limits needed?
Authors: Monsé Christian , Merget Rolf , Bünger Jürgen , Pallapies Dirk , Brüning Thomas
Published: August 2023

Exposure to airborne substances such as gases, vapours, and particles remains a relevant health risk in many workplaces. A current topic and cause for discussion is the investigation of the health effects of particles containing zinc oxide (ZnO). Among other data, those collected from our study on human exposure data of ZnO in 2018 prompted the National Research Centre for the Working Environment 2021 to formulate a new, sharply lowered proposed occupational exposure limit (OEL) for zinc in workplaces. Since the publication of the Danish report, further studies have been conducted with ZnO. In the following text, all arguments for deriving this new limit value for zinc from the report are discussed, extended with the more recent data since 2018. It should be noted that especially the application of time extrapolation factors needs further discussion and harmonization between regulatory authorities. From our point of view, the data situation can justify a higher OEL for zinc than that proposed by the Danish National Research Centre for the Working Environment.
A Machine Learning-Based Image Segmentation Method to Quantify In Vitro Osteoclast Culture Endpoints
Authors: Davies Bethan K. , Hibbert Andrew P. , Roberts Scott J. , Roberts Helen C. , Tickner Jennifer C. , Holdsworth Gill , Arnett Timothy R. , Orriss Isabel R.
Published: August 2023

Quantification of in vitro osteoclast cultures (e.g. cell number) often relies on manual counting methods. These approaches are labour intensive, time consuming and result in substantial inter- and intra-user variability. This study aimed to develop and validate an automated workflow to robustly quantify in vitro osteoclast cultures. Using ilastik, a machine learning-based image analysis software, images of tartrate resistant acid phosphatase-stained mouse osteoclasts cultured on dentine discs were used to train the ilastik-based algorithm. Assessment of algorithm training showed that osteoclast numbers strongly correlated between manual- and automatically quantified values (r = 0.87). Osteoclasts were consistently faithfully segmented by the model when visually compared to the original reflective light images. The ability of this method to detect changes in osteoclast number in response to different treatments was validated using zoledronate, ticagrelor, and co-culture with MCF7 breast cancer cells. Manual and automated counting methods detected a 70% reduction (p < 0.05) in osteoclast number, when cultured with 10 nM zoledronate and a dose-dependent decrease with 1–10 μM ticagrelor (p < 0.05). Co-culture with MCF7 cells increased osteoclast number by ≥ 50% irrespective of quantification method. Overall, an automated image segmentation and analysis workflow, which consistently and sensitively identified in vitro osteoclasts, was developed. Advantages of this workflow are (1) significantly reduction in user variability of endpoint measurements (93%) and analysis time (80%); (2) detection of osteoclasts cultured on different substrates from different species; and (3) easy to use and freely available to use along with tutorial resources.
Stability and Welfare in (Dichotomous) Hedonic Diversity Games
Authors: Darmann Andreas
Published: August 2023

In a hedonic diversity game (HDG) there are two types of agents (red and blue agents) that need to form disjoint coalitions, i.e., subgroups of agents. Each agent’s preferences over the coalitions depend on the relative number of agents of the same type in her coalition. In the special case of a dichotomous hedonic diversity game (DHDG) each agent distinguishes between approved and disapproved fractions only. We aim at outcomes that are stable against agents’ deviations, and at outcomes that maximize social welfare. In particular, we show that the strict core of a DHDG may be empty even in instances with only three agents, while each HDG with two agents has a non-empty strict core. We also provide several computational complexity results for DHDGs with respect to the number of fractions approved per agent. For instance, we prove that deciding whether a DHDG has a non-empty strict core is $$\textsf {NP}$$
NP
-complete even when each agent approves of at most three fractions. In addition, we show that deciding whether a DHDG admits a Nash stable outcome is $$\textsf {NP}$$
NP
-complete even in restricted settings with only two approved fractions per agent—therewith, improving a result in the literature. For the task of maximizing social welfare, we apply approval scores and Borda scores from voting theory. For DHDGs and approval scores, we draw the sharp separation line between polynomially solvable and $$\textsf {NP}$$
NP
-complete cases with respect to the fixed number of approved fractions per agent. We complement these findings with an $$\textsf {NP}$$
NP
-completeness result for HDGs under Borda scores.
Reverse Isoperimetric Inequality for the Lowest Robin Eigenvalue of a Triangle
Authors: Krejčiřík David , Lotoreichik Vladimir , Vu Tuyen
Published: August 2023

We consider the Laplace operator on a triangle, subject to attractive Robin boundary conditions. We prove that the equilateral triangle is a local maximiser of the lowest eigenvalue among all triangles of a given area provided that the negative boundary parameter is sufficiently small in absolute value, with the smallness depending on the area only. Moreover, using various trial functions, we obtain sufficient conditions for the global optimality of the equilateral triangle under fixed area constraint in the regimes of small and large couplings. We also discuss the constraint of fixed perimeter.
Stability to Signorini Problem with Pointwise Damping
Authors: Rivera Jaime E. Muñoz , Naso Maria Grazia
Published: August 2023

We consider the Timoshenko beam model which can be in contact to two rigid obstacles and subject to a pointwise damping. We analyze the existence in time and the asymptotic behavior of solutions by using the hybrid method.
SSR white paper: guidelines for utilization and performance of direct MR arthrography
Authors: Chang Eric Y. , Bencardino Jenny T. , French Cristy N. , Fritz Jan , Hanrahan Chris J. , Jibri Zaid , Kassarjian Ara , Motamedi Kambiz , Ringler Michael D. , Strickland Colin D. , Tiegs-Heiden Christin A. , Walker Richard E.A.
Published: August 2023

Objective

Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion.

Materials and methods

The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations.

Results

Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus.

Conclusion

Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
Immersive virtual reality in orthopaedics—a narrative review
Authors: Combalia A. , Sanchez-Vives M. V. , Donegan T.
Published: August 2023

Purpose

This narrative review explores the applications and benefits of immersive virtual reality (VR) in orthopaedics, with a focus on surgical training, patient functional recovery, and pain management.

Methods

The review examines existing literature and research studies on immersive VR in orthopaedics, analyzing both experimental and clinical studies.

Results

Immersive VR provides a realistic simulation environment for orthopaedic surgery training, enhancing surgical skills, reducing errors, and improving overall performance. In post-surgical recovery and rehabilitation, immersive VR environments can facilitate motor learning and functional recovery through virtual embodiment, motor imagery during action observation, and virtual training. Additionally VR-based functional recovery programs can improve patient adherence and outcomes. Moreover, VR has the potential to revolutionize pain management, offering a non-invasive, drug-free alternative. Virtual reality analgesia acts by a variety of means including engagement and diverting patients’ attention, anxiety reduction, and specific virtual-body transformations.

Conclusion

Immersive virtual reality holds significant promise in orthopaedics, demonstrating potential for improved surgical training, patient functional recovery, and pain management but further research is needed to fully exploit the benefits of VR technology in these areas.
Becoming an Actionable Scientist: Challenges, Competency, and the Development of Expertise
Authors: Goolsby Julia B. , Cravens Amanda E. , Rozance Mary Ann
Published: August 2023

Demand has grown for actionable science to support real-world decision-making around climate change and related environmental management challenges. Producing actionable science requires scientists to hold a distinct set of competencies, yet relatively little is known about what these competencies are or how to train scientists to develop them. We conducted interviews with mid- and late-career scientists to empirically identify competencies they used when producing actionable science and to understand how they developed those competencies. We describe expertise in terms of 18 competencies—categorised as cognitive, interpersonal, or intrapersonal—that scientists integrated and applied to address the challenges associated with actionable science. We argue that scientists must engage in the social process of producing actionable science (i.e., learning by doing) to become an expert. Expert actionable scientists discussed the importance of learning through different contexts, processes, interactions, and relationships. By naming the competencies that constitute expertise, as well as methods for expertise development, our findings facilitate greater conscious awareness of the process of becoming an actionable scientist, a gradual process that starts during graduate training and continues as a career proceeds. Our results can inform the development of formal learning opportunities as well as the informal learning process that occurs whereby scientists take charge of their own learning.
Cryophilic Tardigrada have disjunct and bipolar distribution and establish long-term stable, low-density demes
Authors: Zawierucha Krzysztof , Kašparová Eva Štefková , McInnes Sandra , Buda Jakub , Ambrosini Roberto , Devetter Miloslav , Ficetola Gentile Francesco , Franzetti Andrea , Takeuchi Nozomu , Horna Patrik , Jaroměřská Tereza Novotná , Ono Masato , Šabacká Marie , Janko Karel
Published: August 2023

Glaciers are inhabited by various cryophilic organisms ranging from single celled to multicellular, like Tardigrada (water bears). Owing to their scattered distribution, glaciers represent extremely fragmented habitats, and it remains unclear how their inhabitants survive and disperse among such isolated patches. This study investigates the biogeography of the tardigrade genus Cryoconicus, whose distribution, population stability, and interregional connectivity are examined by screening the collections from ~ 60 glaciers worldwide and by a phylogeographic analysis. We found that two Cryoconicus species occur at low densities on two Arctic glaciers in Svalbard, far from their previously reported Antarctic and Central Asian ranges. Screening of worldwide databases and DNA metabarcoding indicated that these species are absent or rare in the intermediate areas, suggesting large disjunctions in their ranges. In particular, the genetic data and multiyear resampling showed that Cryoconicus kaczmareki established a stable population on the Ebba Glacier (Svalbard), which has been isolated from its Asian core range since before the last glacial maximum. Our findings suggest that glacial invertebrates may possess wide yet largely disjunctive ranges. Interpolar- or intercontinental-scale movements of cryophilic meiofauna may occur, but migration connectivity is not sufficient to mitigate the differentiation of the local population. Revealed biogeographic patterns further demonstrate that inhabitants of extreme environments may establish isolated and highly fragmented populations that persist long term, even if at very low densities.
Are there distribution patterns and population structure differences among demersal fish species in relation to Antarctic benthic communities? A case study in the Weddell Sea
Authors: Baena Patricia , Santín Andreu , La Mesa Mario , Riginella Emilio , Owsianowski Nils , Gili Josep-Maria , Ambroso Stefano
Published: August 2023

Despite the general belief that the Southern Ocean harbors low fish biodiversity, the Weddell Sea hosts one of the richest fish communities in the region. Parallelly, the Weddell Sea is also known for the presence of dense and diverse macrobenthos. Most macrobenthic invertebrates, such as gorgonians, sponges and bryozoans, are considered ecosystem engineers as they generate a three-dimensional structure that increases habitat heterogeneity. This structural complexity serves as a refuge against predators as well as a nursery ground for many organisms, including fish species. By analyzing video transects recorded by a Remotely Operated Vehicle, we investigated density, spatial distribution and size-frequency of populations of the demersal fish species inhabiting macrobenthic communities in the southernmost part of the Weddell Sea. We also attempted to unveil whether there is any relationship between benthic and fish communities and substrate, as well as some fish behavioral patterns. The dominance of juveniles in the surveyed fish assemblages provides evidence that, at this life stage, some fish species appear to be positively associated with complex benthic communities conformed by bryozoans, sponges and gorgonians which are more common in sand matrix with sparse rocks substrates. Moreover, about 37% of all specimens recorded were resting on benthic invertebrates or were using them to hide, implying that Antarctic benthic communities might offer suitable habitat. As such, it can be concluded that there was an apparent relationship between certain species of fish and the different benthic communities, yet the exact triggers and/or factors behind such an association remain partially elusive.
Magnetic resonance imaging of pilonidal sinus disease: interobserver agreement and practical MRI reporting tips
Authors: Abdelatty Mohamed A. , Elmansy Noha , Saleh Mahmoud M. , Salem Amany , Ahmed Sara , Gadalla Amr A. , Osman Mohamed F. , Mohamed Shady
Published: August 2023

Objective

To evaluate the interobserver agreement for the features of natal cleft pilonidal sinus disease (PSD) on magnetic resonance imaging (MRI) and propose a standardized checklist for reporting PSD on MRI.

Materials and methods

Forty MRI studies of 39 discrete patients with PSD were retrospectively evaluated by five independent radiologists using a standardized checklist. Fleiss’ Kappa (k) coefficients of agreement were used to test the agreement between categorical variables. The MRI features of the natal cleft sepsis associated with PSD were classified into four main categories: morphology, branching and extensions, external skin openings, and the relationship of the PSD to the coccyx. A survey was created and disseminated online among general surgeons who treat patients with PSD to assess the relevance of the MRI features proposed in the standardized checklist.

Results

The overall agreement regarding the identification of morphology of the natal cleft sepsis was moderate (k = 0.59). Lateral and caudal extensions interobserver agreement was substantial (k = 0.64 and 0.71, respectively). However, the overall agreement regarding the individual parts of anal sphincter involved was moderate (k = 0.47). Substantial interobserver agreement was found in assessing the proximity of the PSD to the coccyx (k = 0.62).

Conclusion

Preoperative MRI can delineate the extensions and branching of PSD with substantial agreement. MRI is superior in describing the deep extensions of PSD with better reliability than assessing the number and locations of the external openings. Expert consensus agreement is needed to establish the MRI features necessary for optimal reporting of PSD.

Clinical relevance statement

MRI can offer valuable information about the extent of sepsis associated with pilonidal sinus disease, particularly in cases with involvement of critical anatomical structures such as the coccyx and anal triangle. MRI can potentially contribute to more accurate patient stratification and surgical planning.

Key Points

• The interobserver agreement for assessing PSD’s lateral and caudal extension on MRI is substantial.

• MRI can describe deep extensions and branching of PSD with superior reliability than assessing the number and site of external openings.

• Reporting the relationship between natal cleft sepsis in PSD and the anal region may influence the surgical approach and postoperative healing.
Fully automatic algorithm for detecting and tracking anatomical shoulder landmarks on fluoroscopy images with artificial intelligence
Authors: Croci Eleonora , Hess Hanspeter , Warmuth Fabian , Künzler Marina , Börlin Sean , Baumgartner Daniel , Müller Andreas Marc , Gerber Kate , Mündermann Annegret
Published: August 2023

Objective

Patients with rotator cuff tears present often with glenohumeral joint instability. Assessing anatomic angles and shoulder kinematics from fluoroscopy requires labelling of specific landmarks in each image. This study aimed to develop an artificial intelligence model for automatic landmark detection from fluoroscopic images for motion tracking of the scapula and humeral head.

Materials and methods

Fluoroscopic images were acquired for both shoulders of 25 participants (N = 12 patients with unilateral rotator cuff tear, 6 men, mean (standard deviation) age: 63.7 ± 9.7 years; 13 asymptomatic subjects, 7 men, 58.2 ± 8.9 years) during a 30° arm abduction and adduction movement in the scapular plane with and without handheld weights of 2 and 4 kg. A 3D full-resolution convolutional neural network (nnU-Net) was trained to automatically locate five landmarks (glenohumeral joint centre, humeral shaft, inferior and superior edges of the glenoid and most lateral point of the acromion) and a calibration sphere.

Results

The nnU-Net was trained with ground-truth data from 6021 fluoroscopic images of 40 shoulders and tested with 1925 fluoroscopic images of 10 shoulders. The automatic landmark detection algorithm achieved an accuracy above inter-rater variability and slightly below intra-rater variability. All landmarks and the calibration sphere were located within 1.5 mm, except the humeral landmark within 9.6 mm, but differences in abduction angles were within 1°.

Conclusion

The proposed algorithm detects the desired landmarks on fluoroscopic images with sufficient accuracy and can therefore be applied to automatically assess shoulder motion, scapular rotation or glenohumeral translation in the scapular plane.

Clinical relevance statement

This nnU-net algorithm facilitates efficient and objective identification and tracking of anatomical landmarks on fluoroscopic images necessary for measuring clinically relevant anatomical configuration (e.g. critical shoulder angle) and enables investigation of dynamic glenohumeral joint stability in pathological shoulders.

Key Points

• Anatomical configuration and glenohumeral joint stability are often a concern after rotator cuff tears.

• Artificial intelligence applied to fluoroscopic images helps to identify and track anatomical landmarks during dynamic movements.

• The developed automatic landmark detection algorithm optimised the labelling procedures and is suitable for clinical application.
Approval-based shortlisting
Authors: Lackner Martin , Maly Jan
Published: August 2023

Shortlisting is the task of reducing a long list of alternatives to a (smaller) set of best or most suitable alternatives. Shortlisting is often used in the nomination process of awards or in recommender systems to display featured objects. In this paper, we analyze shortlisting methods that are based on approval data, a common type of preferences. Furthermore, we assume that the size of the shortlist, i.e., the number of best or most suitable alternatives, is not fixed but determined by the shortlisting method. We axiomatically analyze established and new shortlisting methods and complement this analysis with an experimental evaluation based on synthetic and real-world data. Our results lead to recommendations which shortlisting methods to use, depending on the desired properties.
Befragung zu den Arbeits-, Weiterbildungs- und Forschungsbedingungen von Assistenzärztinnen und -ärzten in der internistisch-rheumatologischen Weiterbildung – BEWUSST
Authors: Proft Fabian ,   die Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Vossen Diana , Baraliakos Xenofon , Berliner Michael N. , Fleck Martin , Keyßer Gernot , Krause Andreas , Lorenz Hanns-Martin , Manger Bernhard , Schuch Florian , Specker Christof , Wollenhaupt Jürgen , Voormann Anna , Raspe Matthias , Krusche Martin , Pfeil Alexander
Published: August 2023

Hintergrund

Daten zur Aus- und Weiterbildungssituation von Assistenzärzt:innen des Fachgebietes Innere Medizin und Rheumatologie liegen für das Bundesgebiet nicht vor. Aus diesem Grund initiierte die Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie (DGRh) eine Umfrage zu den Arbeits‑, Weiterbildungs- und Forschungsbedingungen von Assistenzärztinnen und -ärzten in der rheumatologischen Weiterbildung.

Methodik

Es wurden 102 Fragen zu den Themenkomplexen Arbeitsbedingungen im Berufsalltag, ärztliche Fort- und Weiterbildung, Vereinbarkeit von Beruf und Familie, Vereinbarkeit von Arbeit und Forschung, Perspektive als Rheumatolog:in und praktische Tätigkeiten über einen Online-Fragebogen gestellt.

Ergebnisse

Insgesamt haben sich 102 Teilnehmer:innen an der Umfrage beteiligt; 48,1 % der Befragten waren mit der beruflichen Situation zufrieden, 40,2 % der Teilnehmer:innen wurden durch eine/n fachärztliche/n Mentor:in betreut, und 54,9 % der Teilnehmer:innen sind wissenschaftlich tätig. Eine Vereinbarkeit von Familie und Beruf war für 34,7 % möglich. Nach Abschluss der Facharztausbildung strebten 52,9 % der Befragten eine kombinierte klinische und ambulante Tätigkeit an.

Diskussion

Die Hälfte der angehenden Rheumatolog:innen ist mit der beruflichen Tätigkeit zufrieden, wobei das Mentoring der Weiterbildungsassistent:innen eine weitere Verbesserung erfahren sollte. Hinsichtlich der gewünschten kombinierten klinischen und ambulanten Tätigkeit sollten die vorhandenen Optionen ausgebaut bzw. neue berufliche Tätigkeitsfelder etabliert werden, damit das Fachgebiet für den Nachwuchs attraktiv bleibt.
Relationship between the distribution of intra-retinal hyper-reflective foci and the progression of intermediate age-related macular degeneration
Authors: Verma Aditya , Corradetti Giulia , He Ye , Nittala Muneeswar G. , Nassisi Marco , Velaga Swetha B. , Haines Jonathan L. , Pericak-Vance Margaret A. , Stambolian Dwight , Sadda SriniVas R.
Published: August 2023

Purpose

To assess the relationship between the distribution of intra-retinal hyper-reflective foci (IHRF) on optical coherence tomography (OCT) and progression of intermediate age-related macular degeneration (iAMD) over 2 years.

Methods

Cirrus OCT volumes of the macula of subjects enrolled in the Amish Eye Study with 2 years of follow-up were evaluated for the presence of iAMD and IHRF at baseline. The IHRF were counted in a series of 5 sequential en face slabs from outer to inner retina. The number of IHRF in each slab at baseline and the change in IHRF from baseline to year 2 were correlated with progression to late AMD at 2 years.

Results

Among 120 eyes from 71 patients with iAMD, 52 eyes (43.3%) of 42 patients had evidence of both iAMD and IHRF at baseline. Twenty-three eyes (19.0%) showed progression to late AMD after 2 years. The total IHRF count increased from 243 at baseline to 604 at 2 years, with a significant increase in the IHRF number in each slab, except for the innermost slab 5 which had no IHRF at baseline or follow-up. The IHRF count increased from 121 to 340 in eyes that showed progression to late AMD. The presence of IHRF in the outermost retinal slabs 1 and 2 was independently associated with a significant risk of progression to late AMD. A greater increase in IHRF count over 2 years in these same slabs 1 and 2 was also associated with a higher risk of conversion to late AMD.

Conclusions

The risk of progression to late AMD appears to be significantly associated with the distribution and extent of IHRF in the outermost retinal layers. This observation may point to significant pathophysiologic differences of IHRF in inner versus outer layers of the retina.
Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus
Authors: Bray Lucy , Carter Bernie , Kiernan Joann , Horowicz Ed , Dixon Katie , Ridley James , Robinson Carol , Simmons Anna , Craske Jennie , Sinha Stephanie , Morton Liza , Nafria Begonya , Forsner Maria , Rullander Anna-Clara , Nilsson Stefan , Darcy Laura , Karlsson Katarina , Hubbuck Cath , Brenner Maria , Spencer-Little Sian , Evans Kath , Rowland Andrew , Hilliard Carol , Preston Jennifer , Leroy Piet L. , Roland Damian , Booth Lisa , Davies Jean , Saron Holly , Mansson Marie Edwinson , Cox Ann , Ford Karen , Campbell Steven , Blamires Julie , Dickinson Annette , Neufeld Michael , Peck Blake , de Avila Marla , Feeg Veronica , Mediani Henny Suzana , Atout Maha , Majamanda Maureen D. , North Natasha , Chambers Christine , Robichaud Fanny
Published: August 2023

Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020–2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

   Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child.

What is Known:• Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care.• Professionals report uncertainty and tensions in applying evidence-based practice to children’s procedural care.

What is New:• This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives.• The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.
Prevalence and incidence of personality disorders among children and adolescents in Danish mental health services: a nationwide register study
Authors: Klinkby Ida Maria Ingeholm , Hastrup Lene Halling , Bo Sune , Storebø Ole Jakob , Simonsen Erik , Kongerslev Mickey T.
Published: August 2023

A few epidemiological studies have examined personality disorders (PDs) among children and adolescents in secondary mental health services. This study aims to describe the prevalence and incidence of PDs among children and adolescents who have attended Danish child and adolescent psychiatric services (CAPS). Using register-based data, we studied all patients under the age of 18 years who were admitted to in- and outpatient CAPS (N = 115,121) in Denmark from 2007 to 2017. A total of 4952 patients were diagnosed with a PD during the study period. The mean prevalence was 859 patients per year, and the mean incidence was 274 patients per year, including an increased incidence and prevalence of borderline, anxious, and unspecified PDs over the decade. The number of patients diagnosed with PDs increased from 700 to 851 per year, but the proportion of patients with PDs compared to all psychiatric diagnoses decreased from 4.2% to 2.8% over the study period. The PD population had an older age (14.8 years vs. 11.3 years; p < 0.001), a higher likelihood of being female (74% vs. 44%; p < 0.001), and four times more contacts with the psychiatric emergency departments than other patients with a psychiatric diagnosis. Future studies should focus on (a) implementing further epidemiological studies in different countries; (b) tracking diagnostic practices to facilitate comparisons and provide feedback for training clinicians and raising awareness; and (c) estimating trajectories of PDs, including costs within the CAPS, to facilitate informed decision-making regarding the future organization and provision of services to these children, adolescents, and their families.
Effect of onset age on the long-term outcome of early-onset psychoses and other mental disorders: a register-based Northern Finland Birth Cohort 1986 study
Authors: Majuri Tuomas , Haapea Marianne , Nordström Tanja , Säynäjäkangas Veera , Moilanen Kristiina , Tolonen Jonna , Ala-Mursula Leena , Miettunen Jouko , Jääskeläinen Erika
Published: August 2023

Psychiatric illnesses can affect the social transitions of adolescence and young adulthood, such as completing education and entering working life and relationships. However, associations between earlier onset age and long-term outcomes among those with early-onset psychoses (EOP) are unclear, as are the long-term outcomes of EOP compared to non-psychotic disorders. We used national register data of the Northern Finland Birth Cohort 1986 to detect persons with EOP and other early-onset psychiatric disorders. The long-term clinical and work-family outcomes of persons with onset age before 18 years (n = 41 psychoses, n = 495 non-psychoses) or between 18–22 years (n = 61 psychoses, n = 377 non-psychoses) were compared. Individuals with the onset of psychosis between 18–22 years had significantly more unfavourable long-term outcomes when compared to those with psychosis onset before 18 years. Persons with psychosis onset before the age of 18 years had similar outcomes to those with non-psychotic psychiatric disorder onset before 18 years regarding educational level, marital status, having children, and substance use disorders. Individuals with EOP were more often on a disability pension compared to those with other early-onset mental disorders. Adjusting for sex, educational level and substance use only slightly diluted these results. Unexpectedly, later onset age of EOP was associated with worse outcomes. Those with psychosis onset between 18–22 years of age are in a critical period, which underlines the importance of investing on interventions in this age group. Further studies on the effect of the onset age on later outcomes in EOP are needed.
Modelling diffusion controlled electro-deoxidation of metal oxide to metal in molten salt
Authors: Osarinmwian C. , Roberts E. P. L.
Published: August 2023

Diffusion is a fundamental irreversible process intervening in the evolution of many out-of-equilibrium systems and is successfully described by Fick’s law obtained from non-equilibrium thermodynamics. Despite this, numerical simulations of solid state electro-deoxidation in the diffusion-controlled regime in molten salt remain elusive. Here, a new model for diffusion controlled three-phase interline (3PI) penetration in a porous cathode during electro-deoxidation is validated against experimental observation. This penetrating 3PI model is applied at high overpotential and benchmarked using the oxygen ionisation TiO2(s) + 4e−  → Ti(s) + 2O2− at the 3PI. The model couples slow diffusive transport and fast oxygen ionisation while assuming a negligible ohmic potential drop in bulk molten CaCl2 electrolyte. The 14 nm s−1 penetration rate of the 3PI and the order of magnitude of 3PI currents (derived from an exchange current density and cathodic transfer coefficient of 0.32 A cm−2 and 0.01, respectively) in the chronoamperometric data for porous cathodes are in good agreement with experimental observation.
Blended-Learning-Ansatz für die klinische Epileptologie
Authors: Claß S. , von Wrede R. , Baumgartner T. , Surges R.
Published: August 2023

Hintergrund

Die Kompetenz zum Erkennen episodischer Störungen mit vorübergehenden Symptomen, wie z. B. epileptischen Anfällen, ist in der klinischen Lehre mitunter schwierig zu vermitteln. Spezialisierte Aufzeichnungsmethoden wie das Video-EEG-Monitoring dokumentieren jedoch ein großes Spektrum an vorübergehenden Episoden und können für die Lehre im Medizinstudium herangezogen werden.

Ziel der Arbeit

Es sollte für den epileptologischen Teil der studentischen Ausbildung im Fach Neurologie ein digitales Lernangebot im Inverted-Classroom-Modell (ICM) neu konzipiert und entwickelt werden, das sowohl Grundlagen und Terminologie der klinischen Epileptologie vermittelt als auch die Anfallserkennung mit Anfallsvideos aus der Klinik schult.

Methodik

Verschiedene interaktive digitale Lernmaterialien und Anfallsvideos wurden den Studierenden innerhalb eines digitalen Selbstlernmoduls im Vorfeld der zweitägigen Präsenzveranstaltung zur Verfügung gestellt. Die Zufriedenheit mit dem Lernangebot wurde über einen Fragebogen evaluiert. Außerdem wurden die Klausurergebnisse zwischen den Studierenden, die nur an der Präsenzveranstaltung teilgenommen hatten, und denen, die zusätzlich das digitale Lernangebot absolvierten, retrospektiv verglichen.

Ergebnisse und Diskussion

Die Befragung der Studierenden zeigte eine große Zufriedenheit mit dem digitalen Lernangebot und eine hohe Teilnahmequote von etwa 90 %. Klinisches Videomaterial, als Lernvideos aufbereitet, erwies sich als geeignet, um die Semiologie und Analyse epileptischer Anfälle anschaulich zu vermitteln. Der Vergleich der Klausurergebnisse zwischen den Studierenden mit und ohne digitales Lehrangebot war ohne signifikanten Unterschied, möglicherweise durch den retrospektiven Ansatz ohne neu konzipierte Fragen mit konkretem Bezug zum digitalen Lehrangebot.
A new method to improve RF safety of implantable medical devices using inductive coupling at 3.0 T MRI
Authors: Park Bu S. , Guag Joshua W. , Jeong Hongbae , Rajan Sunder S. , McCright Brent
Published: August 2023

Objective

To enhance RF safety when implantable medical devices are located within the body coil but outside the imaging region by using a secondary resonator (SR) to reduce electric fields, the corresponding specific absorption rate (SAR), and temperature change during MRI.

Materials and methods

This study was conducted using numerical simulations with an American Society for Testing and Materials (ASTM) phantom and adult human models of Ella and Duke from Virtual Family Models, along with corresponding experimental results of temperature change obtained using the ASTM phantom. The circular SR was designed with an inner diameter of 150 mm and a width of 6 mm. Experimental measurements were carried out using a 3 T Medical Implant Test System (MITS) body coil, electromagnetic (EM) field mapping probes, and an ASTM phantom.

Results

The magnitudes of B1+ (|B1+|) and SAR1g were reduced by 15.2% and 5.85% within the volume of interest (VoI) of an ASTM phantom, when a SR that generates opposing electromagnetic fields was utilized. Likewise, the Δ|B1+| and ΔSAR1g were reduced by up to 56.7% and 57.5% within the VoI of an Ella model containing a copper rod when an opposing SR was used.

Conclusion

A novel method employing the designed SR, which generates opposing magnetic fields to partially shield a sample, has been proposed to mitigate the risk of induced-RF heating at the VoI through numerical simulations and corresponding experiments under various conditions at 3.0 T.
A comparison of health policies, public opinion and vaccination rates in France and Germany
Authors: Mathieu Louison , Wittwer-Backofen Ursula , Strasser Georgina
Published: August 2023

Objectives

France and Germany have different approaches towards childhood immunisation. The aim of this study was to determine the similarities and differences between France and Germany in terms of heath policies, vaccination rates and public opinion as far as infant vaccinations were concerned.

Study design

Literature review.

Subject and methods

We used the databases of the Robert Koch Institute (RKI) and of Santé publique France (SpF) to compare the vaccination rates of children in the year 2017. The state of public opinion was principally assessed by comparing data from SpF and the German Federal Center for Health Education (BZgA).

Results

Vaccination rates were higher in French pre-school children in 2017 for the hexavalent and anti-pneumococcal vaccines, whereas Measles–Mumps–Rubella and anti-meningococcal vaccination rates were higher in Germany. Public opinion was more favourable towards vaccines in Germany than in France. Some vaccines, especially against seasonal influenza and hepatitis B, were viewed with criticism in France, whereas German parents considered hepatitis B immunisation to be important for their children. Moreover, both countries showed higher immunisation rates in northern regions. This correlated with the state of vaccine confidence in France. In Germany, eastern regions were more favourable towards vaccines, which correlated with higher immunisation rates in these regions.

Conclusions

The state of vaccine confidence seemed to correlate with immunisation rates in both countries. The need for information about vaccines is still high in both countries and trust in the medical community as well as in the immunisation policymakers should be reinforced as a priority.
Habitual Leadership Ethics: Timelessness and Virtuous Leadership in the Jesuit Order
Authors: Bento da Silva Jose , Grint Keith , Pereira Sandra , Thoene Ulf , Wiedner Rene
Published: August 2023

This paper is about the relationship between leadership, organisational morals, and temporality. We argue that engaging with questions of time and temporality may help us overcome the overly agentic view of organisational morals and leadership ethics that dominates extant literature. Our analysis of the role of time in organizational morals and leadership ethics starts from a virtue-based approach to leading large-scale moral endeavours. We ask: how can we account for organizational morality across generations and independently of the leader? To address this question, we studied the leadership model of the Jesuits, a Catholic Religious Order. Our case reveals that a virtue-based model of leadership does not necessarily imply that those who are selected to lead the organization are themselves virtuous, but that the processes underpinning the exercise of leadership are cyclical and repeated as truthfully as possible. Virtuous leadership, for the Jesuits, is therefore about the construction of an ideal type of leadership against which the processes which sustain it were designed. Our theoretical contribution is twofold. First, we propose an habitual understanding of moral forms of leadership, in which the procedural is constitutive of moral forms of organising; second, we explain how “timelessness”, understood as the quality of not changing as years go by, allowed the Jesuits to centre the processes which sustain their ethical model on the repetition, across space and time, of said processes, rather than on their outcome. We conclude that the search for virtue might be more relevant for large-scale moral endeavours than virtue itself.
Climate change adaptation activities planning and implementation in large cities: results of research carried out in Poland and selected European cities
Authors: Pancewicz Alina , Anczykowska Wiktoria , Żak Natalia
Published: August 2023

Continuous climate change forces cities to take actions to prevent risks and adapt urban spaces to new conditions. The experience of many European cities in recent years shows that actions adapting urban space to climate change have become an important part of local policy. The subject of the article is the adaptation activities planned and implemented for climate change in urban spaces. The purpose of this article is to classify and identify adaptation activities carried out in large cities. The authors analyzed data from 44 Polish cities and placed them in the context of leading adaptation activities carried out in selected European cities. The purpose of the detailed research is to compare the number and type of activities planned and implemented on the scale of individual Polish cities, indicating dominant and minority activities. The authors conclude that with the passage of time, climate change adaptation activities will have an increasing impact on shaping the landscape of European cities, including those of Poland. Their number will gradually increase, as will the awareness of the city authorities and the activity of local communities. The types of activity will also change and, with them the quality of urban spaces and the quality of life of residents. The authors also conclude that further research will need to conduct quantitative and qualitative studies in the context of the effectiveness of the adaptation process in urban spaces, resulting from the evaluation and monitoring of both systematically updated planning and strategic documents and implemented spatial programs and interventions.
Consumer Vulnerability, Digital Fairness, and the European Rules on Unfair Contract Terms: What Can Be Learnt from the Case Law Against TikTok and Meta?
Authors: Durovic M. , Poon J.
Published: August 2023

Directive 1993/13/EEC on unfair contract terms (UCTD) is one of the oldest pieces of European consumer legislation, formulated before the development of the Internet as the leading marketplace, and still in force, with no major changes since its adoption. As the most significant piece of consumer legislation not substantially amended following the consumer law Fitness Check that resulted in the adoption of Directive 2019/2161/EU, it is questionable whether the UCTD remains fit for purpose in regulating the terms and conditions in the user agreements and policies of social media platforms to address the existence of the social platform related digital vulnerabilities of consumers. This paper assesses the potential and limits of data-based reforms to the UCTD, in procedural notification requirements and substantive unfair terms controls, before demonstrating how the UCTD could be brought up-to-date while preserving commercial certainty and avoiding dramatic changes. This could be done simply by mandating measures that are already being taken, either by social media platforms themselves or by other major tech companies, and by elaborating existing requirements with standards that are analogous to other already-existing consumer rights. The assessment of the real unfair-terms problems highlighted by regulatory actions around the world against two major traders, TikTok and Meta (including Facebook and WhatsApp), may illustrate well the inadequacies in the minimum protections currently afforded by the UCTD.
Sex differences in transthyretin cardiac amyloidosis
Authors: Aimo Alberto , Panichella Giorgia , Garofalo Manuel , Gasparini Simone , Arzilli Chiara , Castiglione Vincenzo , Vergaro Giuseppe , Emdin Michele , Maffei Silvia
Published: August 2023

Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive disease characterized by the deposition of abnormal transthyretin protein fibrils in the heart, leading to cardiac dysfunction. Recent evidence suggests that sex differences may play a significant role in various steps of ATTR-CA, including clinical presentation, diagnostic challenges, disease progression, and treatment outcomes. ATTR-CA predominantly affects men, whereas women are older at presentation. Women generally present with a history of heart failure with preserved ejection fraction and/or carpal tunnel syndrome. When indexed, left ventricular (LV) wall thickness is equal, or even increased, than men. Women also have smaller LV cavities, more preserved ejection fractions, and apparently a slightly worse right ventricular and diastolic function. Given the under-representation on women in clinical trials, no data regarding sex influence on the treatment response are currently available. Finally, it seems there are no differences in overall prognosis, even if premenopausal women may have a certain level of myocardial protection. Genetic variations, environmental factors, and hormonal changes are considered as potential contributors to observed disparities. Understanding sex differences in ATTR-CA is vital for accurate diagnosis and management. By considering these differences, clinicians can improve diagnostic accuracy, tailor treatments, and optimize outcomes for both sexes with ATTR-CA.