bluuebunny/crossref_metadata_2025 huggingface dataset:
Reinforcement learning for intensive care medicine: actionable clinical insights from novel approaches to reward shaping and off-policy model evaluation
Authors: Roggeveen Luca F. , Hassouni Ali el , de Grooth Harm-Jan , Girbes Armand R. J. , Hoogendoorn Mark , Elbers Paul W. G. ,   the Dutch ICU Data Sharing Against COVID-19 Collaborators
Published: March 2024

Background

Reinforcement learning (RL) holds great promise for intensive care medicine given the abundant availability of data and frequent sequential decision-making. But despite the emergence of promising algorithms, RL driven bedside clinical decision support is still far from reality. Major challenges include trust and safety. To help address these issues, we introduce cross off-policy evaluation and policy restriction and show how detailed policy analysis may increase clinical interpretability. As an example, we apply these in the setting of RL to optimise ventilator settings in intubated covid-19 patients.

Methods

With data from the Dutch ICU Data Warehouse and using an exhaustive hyperparameter grid search, we identified an optimal set of Dueling Double-Deep Q Network RL models. The state space comprised ventilator, medication, and clinical data. The action space focused on positive end-expiratory pressure (peep) and fraction of inspired oxygen (FiO2) concentration. We used gas exchange indices as interim rewards, and mortality and state duration as final rewards. We designed a novel evaluation method called cross off-policy evaluation (OPE) to assess the efficacy of models under varying weightings between the interim and terminal reward components. In addition, we implemented policy restriction to prevent potentially hazardous model actions. We introduce delta-Q to compare physician versus policy action quality and in-depth policy inspection using visualisations.

Results

We created trajectories for 1118 intensive care unit (ICU) admissions and trained 69,120 models using 8 model architectures with 128 hyperparameter combinations. For each model, policy restrictions were applied. In the first evaluation step, 17,182/138,240 policies had good performance, but cross-OPE revealed suboptimal performance for 44% of those by varying the reward function used for evaluation. Clinical policy inspection facilitated assessment of action decisions for individual patients, including identification of action space regions that may benefit most from optimisation.

Conclusion

Cross-OPE can serve as a robust evaluation framework for safe RL model implementation by identifying policies with good generalisability. Policy restriction helps prevent potentially unsafe model recommendations. Finally, the novel delta-Q metric can be used to operationalise RL models in clinical practice. Our findings offer a promising pathway towards application of RL in intensive care medicine and beyond.
Impact of the Kuroshio large meander on local atmospheric circulation and precipitation in winter
Authors: Sasaki Yoshi N. , Ito Ryunosuke
Published: March 2024

The Kuroshio, which flows to the south of Japan, typically takes two paths on decadal timescales; the straight path and the large meander path, or the so-called Kuroshio large meander. This phenomenon is characterized by the presence of the cyclonic cold-core eddy located south of Japan, which leads to both negative and positive sea surface temperature (SST) anomalies along the southeastern coast of Japan. To clarify the atmospheric response to these SST anomalies in winter, we conducted a control experiment employing a regional atmospheric model with observed SSTs and two sensitivity experiments in which the SST boundary conditions were substituted with those corresponding to the periods of for the Kuroshio large meander and the straight path. The differences in these two sensitivity experiments showed that the surface wind response to the SST anomalies associated with the Kuroshio large meander was not only characterized by wind divergence over the cyclonic cold-core eddy, as reported previously but also wind convergence along the southeastern coast of Japan. Interestingly, this wind anomaly blew into the positive SST anomaly along the east coast of Japan at around 36°N. Similar wind anomalies along the east coast of Japan were observed in a reanalysis product. The results of the model simulation and the reanalysis product showed that during the Kuroshio large meander period, the number of rainy days increased significantly over the warm SST anomaly, while the precipitation and the number of rainy days decreased over the cyclonic cold-core eddy. Moisture budget analysis revealed that the observed decrease in precipitation was attributed to the disparity between the reduced evaporation and the anomalous horizontal moisture convergence in a region where the surface winds were divergent. This moisture convergence was mainly induced by a decrease in specific humidity, implying this change in specific humidity effectively mitigated the variation in precipitation.
A case of giant nipple adenoma
Authors: Ono Shuko , Tanaka Masumi , Yoshinaga Yasuteru , Satou Toshihiko , Aoki Mikiko
Published: March 2024

Background

Nipple adenoma is a relatively rare benign disease. Clinically, it often presents with nipple erosions, and it should be differentiated from Paget’s disease.

Case presentation

The patient was a 63-year-old woman who complained of a lump in her left nipple for more than 30 years. Computed tomography performed for screening congestive heart failure suggested a left nipple mass of 40 mm in size. Needle biopsy revealed nipple adenoma, and skin biopsy was also performed to confirm the diagnosis. Nipple tumor resection was performed under local anesthesia, and we confirmed that the final diagnosis was nipple adenoma with negative margins. The patient has been free from recurrence for 2 years since the surgery.

Conclusions

We have reported our experience of a case of giant nipple adenoma.
Powerpenia Should be Considered a Biomarker of Healthy Aging
Authors: Freitas Sandro R. , Cruz-Montecinos Carlos , Ratel Sébastien , Pinto Ronei S.
Published: March 2024

To identify biomarkers that precede the decline of human function and independence during the lifespan, two important concepts have been introduced in recent decades: sarcopenia and dynapenia. While the former is originally focused on skeletal muscle loss, the latter is on maximal strength loss. Although the dynapenia concept implies the inclusion of skeletal muscle power, in practical terms, this has not been specifically addressed. For instance, only 2 out of 220 studies published between 2008 and 2023 have directly measured muscle power to classify individuals with dynapenia. As previous studies have shown a greater relevance of skeletal muscle power in healthy aging, we hereby propose the introduction of the term “powerpenia” to specifically reflect the loss of skeletal muscle power along lifespan, but also with disease and/or physical inactivity. Together with sarcopenia and dynapenia, we contend that powerpenia should be considered a biomarker of healthy aging.
Dermatological side effects of dipeptidyl Peptidase-4 inhibitors in diabetes management: a comprehensive review
Authors: Zaresharifi Shirin , Niroomand Mahtab , Borran Sarina , Dadkhahfar Sahar
Published: March 2024

Dipeptidyl peptidase-4 (DPP-4) inhibitors are a class of drugs that enhance the incretin-insulin pathway and offer effective glycemic control in type 2 diabetes mellitus. However, these drugs may be associated with various dermatological side effects, ranging from mild to severe. This review article summarizes the current literature on the dermatological side effects of DPP-4 inhibitors, including bullous pemphigoid, severe cutaneous adverse drug reactions, fixed drug eruptions, and other mucocutaneous reactions. The review also discusses the possible mechanisms, risk factors, diagnosis, and management of these side effects. This review aims to increase the awareness and vigilance of healthcare providers in recognizing and managing the dermatological side effects of DPP-4 inhibitors and to emphasize the need for further research and surveillance to optimize diabetes care and patient safety.
Towards equitable representation in long-term residential care: widening the circle to ensure “essential voices” in research teams
Authors: Hande Mary Jean , Owusu Prince , Aubrecht Katie , Cloutier Denise , Estabrooks Carole , Keefe Janice
Published: March 2024

The COVID-19 pandemic exposed long-standing inequities in Canada’s long-term residential care (LTRC) sector with life-threatening consequences. People from marginalized groups are overrepresented among those who live in, and work in LTRC facilities, yet their voices are generally silenced in LTRC research. Concerns about these silenced voices have sparked debate around ways to change LTRC policy to better address long-standing inequities and enhance the conditions that foster dignity for those who live and work in LTRC. Weaving an analysis of historical and cultural attitudes about LTRC, and promising strategies for engaging people with lived experience, we argue that the voices of people with lived experience of life and work (paid and unpaid) in LTRC are essential for ethically and effectively shifting long-standing inequities. Lessons from a 4-year, national, multi-disciplinary research study, known as the Seniors Adding Life to Years (SALTY) project, suggest that resident-determined quality of life can be prioritized by centring the perspectives of residents, their family/friends, direct care workers, volunteers, and people living with dementia in the research process. Accordingly, we highlight strategies to include these voices so that meaningful and impactful system change can be realized.
Simultaneous use of Beauveria bassiana and Bacillus subtilis-based biopesticides contributed to dual control of Trialeurodes vaporariorum (Hemiptera: Aleyrodidae) and tomato powdery mildew without antagonistic interactions
Authors: Komagata Yasuyuki , Sekine Takayuki , Oe Takaho , Kakui Shogo , Yamanaka Satoshi
Published: March 2024

Background

Implementing pest and disease control techniques that have low environmental impact is important for sustainable agriculture. Microbial biopesticides are an effective approach due to their low environmental impact and low risk of resistance development. Because it is not usually possible to control multiple pests and diseases with a single microbial biopesticide, it is essential to investigate the potential for combining microbial biopesticides with varying control spectrums effectively. Many biopesticides have antimicrobial activity and may therefore interact negatively in combination.

Results

This study demonstrated that a mixture of Beauveria bassiana and Bacillus subtilis formulations proved potential for simultaneous control of greenhouse whitefly (Trialeurodes vaporariorum Westwood) and tomato powdery mildew (Oidium neolycopersici). Three greenhouse experiments were conducted to assess the efficacy of mixed and single-use treatments. A laboratory experiment comparing the insecticidal effect of each treatment was also conducted. In all greenhouse experiments, the combined treatment controlled the greenhouse whitefly (78.9–88.3%) and tomato powdery mildew (47.2–81.0%) compared to untreated controls, which was as well as each treatment alone. In some greenhouse and laboratory experiments, the mixed treatment showed an approximately 1.32 to 1.78 times higher insecticidal effect compared to single-use treatments. Regarding the control efficacy against the pest and disease, negative effects of microbial agents on each other were not observed.

Conclusions

These results demonstrated the effectiveness of concurrent use of two microbial pesticides examined on dual control of pest and disease and showed potential for improved control of certain pests. The knowledge of this work could suggest the possibility of more environmentally friendly pest control systems with the use of microbial pesticides.
Syntaxin 1A gene polymorphism in multiple sclerosis: a case–control study
Authors: Oraby Mohammed I. , Soliman Rasha H. , Abdel Kader Noha A. , Abdul Galil Esraa M. , Masoud Mohammed M.
Published: March 2024

Background

Syntaxin 1A is a member of a membrane-integrated nervous system-specific protein superfamily involved in the neuromediator release from synaptic vesicles and one of the proteins included in axonal integrity. Studies that discussed the role of Syntaxin 1A in multiple sclerosis are few and limited. Gene studying sometimes shows unexpected results in different populations. The aim of this work was to investigate Syntaxin 1A genetic polymorphism (rs1569061) in a sample of Egyptian patients with MS and the relation between Syntaxin 1A gene polymorphism and disease course and disability. A case–control study included 150 subjects; 75 Egyptian MS patients of different clinical courses and 75 age and sex matched healthy controls. Patients were subjected to clinical evaluation, assessment of disability, and cognition. Both patient and control groups were subjected to Syntaxin 1A genotyping.

Results

There was no significant difference between different genotypes distribution for Syntaxin 1A (rs 1569061) between MS patients and controls.

No significant difference was found between genotypes and allele distribution for Syntaxin 1A (rs 1569061) among cases of MS regarding EDSS or results of BICAMS). There was no statistically significant difference between syntaxin genotypes among cases of MS regarding demographic or clinical characteristics of the disease.

Conclusion

Here we show no statistically significant difference between MS patients and control regarding Syntaxin 1A genotypes and different alleles. Syntaxin 1A genotypes have no impact on clinical characteristics of the disease, disability, or cognition. These negative findings open the floor for the study of other MS related genes in Egypt.
Immunochemistry-based quantification of tumor-infiltrating lymphocytes and immunoscore as prognostic biomarkers in bladder cancer
Authors: Rejeb Sarra Ben , Elfekih Sirine , Kouki Nadia , Boulma Rami , Khouni Hassen
Published: March 2024

Background

Tumor-infiltrating lymphocytes (TILs) and the derived immunoscore (IS) have gained considerable attention over the last decade as prognostic markers in many solid cancers. However, in bladder cancer (BC), their prognostic value is not clearly established.

Methods

The present study aimed to quantify the TILs rates in BC, assess the derived immunoscore, and investigate their prognostic value. An immunochemistry-based quantification of the different subtypes of TILS was performed on paraffin-embedded blocks from patients with invasive urothelial carcinoma of the bladder. We have assessed the rates of TILs, respectively, on peri-tumoral (PT) and intra-tumoral (IT) areas and calculated for each case the corresponding IS which is the index: CD8+/CD3+ TILs. The IS was then classified as low (I0, I1) or high (I2, I3, I4). We included 30 cases in the analysis.

Results

The median age of patients was 65 years with a sex ratio of 9. TILs densities and distribution were significantly variable between IT and PT areas CD3+ (p = 0.03) and CD8+ (p = 0.004) with the highest rates on the PT areas. In univariate analysis, a low density of CD8+ TILs was significantly associated with an advanced age (p = 0.05), with the presence of lympho-vascular invasion (p = 0.02) and with the absence of specific histological subtype (p = 0.05). A low immunoscore was significantly associated with the presence of lympho-vascular invasion (p = 0.004). No significant association was found between TILs subpopulations, the IS, and the other clinicopathological and survival data. The overall survival (OS) and disease-free survival (DFS) medians were slightly superior in highly T (CD3+/CD8+)-cell infiltrated tumors as well as tumors with a high IS densities. However, the univariate analysis showed that TILs and immunoscore did not impact overall survival (OS) and disease-free survival (DFS).

Conclusion

TILs and immunoscore might be effective prognostic tools in BC. However, standardized quantification methods and further investigation on larger samples are highly recommended to definitively attest the prognostic value of TILs and IS in BC.
Can the abbreviated MRI protocol replace the standard full protocol in the detection and characterization of breast non-mass enhancement?
Authors: Hassan Alzahraa Sayed , Aboelhamd Eman , Yousef Hazem Abu Zeid , Moubark Mahmoud , Hassanein Sara , Ali Abeer Houssein
Published: March 2024

Background

Breast MRI full diagnostic protocol (FDP) showed great value in detecting and characterizing non-mass enhancement (NME); however, it is costly and time-consuming. MRI abbreviated protocol (AP) showed comparable accuracy to FDP in various indications but has not been specifically tested in NME. Our study purpose is to assess the accuracy of the AP in the detection and characterization of breast NME in comparison with the FDP and to perform time analysis of the AP.

Methods

Patients who demonstrated NME in dynamic contrast-enhanced MRI were included to be assessed using AP and FDP. Image analysis was performed blindly and independently. Firstly, reconstructed images from the pre- and first post-contrast T1WI (first maximum intensity projection and subtraction) were made available as AP. Later, the time/signal intensity curve and remaining images of the FDP were added to the assessment. Both protocols were compared regarding acquisition time, interpretation time, BI-RADS scores and accuracy in the detection and characterization of NME in correlation to histopathology and/or follow-up. Validity statistics, Cohen-Kappa and ROC curve were used.

Results

Fifty-nine NME lesions were identified. AP acquisition and interpretation times were significantly shorter than those of the FDP (3.3 vs. 35 min) and (45 “25–75 s” vs. 108 “80–150 s”) (P < 0.001), respectively. There was almost perfect agreement between the two protocols in the BIRADS grading of NME (k = 0.950, P < 0.001). In ROC curve analysis, the FDP was insignificantly more accurate than the AP (84.8% vs. 81.4%, P = 0.144).

Conclusions

Breast MRI–AP is comparable to the FDP in the detection and characterization of breast NME with advantageous time saving.
Co-designing strategies to implement long-acting injectable PrEP for sexual minority men in Chicago: a study protocol for an innovation tournament and implementation mapping
Authors: Van Pelt Amelia E. , Casline Elizabeth , Phillips Gregory , Cestou Jorge , Mustanski Brian , Cook Grace , Beidas Rinad S.
Published: March 2024

Background

Participatory design approaches can improve successful selection and tailoring of implementation strategies by centering the voices of key constituents. To reduce incidence of the human immunodeficiency virus (HIV) in the USA, co-design of implementation strategies is needed for long-acting injectable cabotegravir (CAB-LA), a new form of HIV pre-exposure prophylaxis, among the disproportionately impacted population of sexual minority men (SMM). This manuscript describes the protocol for participatory design approaches (i.e., innovation tournament and implementation mapping) to inform implementation of CAB-LA among SMM (≥ 12 years), particularly Black and Latino populations, in Chicago.

Methods

This research incorporates innovative methods to accomplish two objectives: (1) to crowdsource ideas for the design of implementation strategies for CAB-LA through a virtual innovation tournament and (2) to leverage the ideas from the innovation tournament to operationalize implementation strategies for CAB-LA thorough the systematic process of implementation mapping. A committee of constituents with diverse expertise and perspectives (e.g., SMM, implementation scientists, HIV clinicians, public health leadership, and community partners) will provide input throughout the design process.

Discussion

This research will produce a menu of co-designed implementation strategies, which can guide plans for CAB-LA integration in Chicago and provide insights for other EHE regions. Further, as the first innovation tournament focused on HIV prevention, this research can provide a framework for participatory approaches across the care continuum. Given that the co-design of implementation strategies often does not involve the participation of individuals with lived experiences, this work will center the voices of those who will benefit most.
Narrative review of the role of intravenous fluid in critically sick patients
Authors: Stoltzfus Mason , Kohli Aditya , Shah Priyanshi , Anamika Fnu , Kanagala Sai Gautham , Gupta Vasu , Patel Meet A. , Jain Rohit
Published: March 2024

Background

Intravenous fluid administration is regarded as a universal therapy in critical care. It is the mainstay of treatment in patients with dehydration, blood loss, sepsis, electrolyte imbalance, and shock. Crystalloids (for example, normal saline, lactated Ringer’s, Hartmann’s, Normosol, Isolyte, and PlasmaLyte solutions) and colloids (for example, albumin, or synthetic dextrans, gelatins, and starches) are the two types of commonly used IV fluids.

Main text

Resuscitation, replacement, and maintenance are the three main indications for intravenous fluid administration. Despite their widespread use, there is no standard therapeutic dose for IV fluids and clinicians are less familiar with the indications to stop IV fluid administration. Appropriate fluid management to maintain tissue perfusion while avoiding potentially harmful effects of IV fluid administration such as fluid overloading, metabolic acidosis, acute kidney injury, and electrolyte imbalance should be the core principle of treatment.

Conclusion

This review will focus on the role of different types of intravenous fluid in critically ill patients, including their side effects and applications in various types of shock.
Efficacy of adipose—derived stromal vascular fraction in treatment of osteoarthritis: an experimental study
Authors: Moussa Sherine Alaa El Din Mohamed , Zaki M. Gamal El Din , Mohamed Manal Osman , Abo Zeid Asmaa A , Farrag Dina A.
Published: March 2024

Background

Osteoarthritis OA is a common progressive disabling disease. Current research aims at finding therapies to prevent its progression. In this work, we assessed the therapeutic role of intra-articular injection of stromal vascular fraction SVF in collagenase induced knee OA in rats.

Results

Post right Knee OA induction in 42 Wistar rats, histopathological examination and quantification of articular cartilage degeneration using Mankin’s score revealed degenerative changes were significantly higher in untreated Group II compared to SVF treated Group III at 1 month (10.75 ± 0.50 and 2.50 ± 0.53, P = 0.001) and 2 months (8.50 ± 0.58, 0.50 ± 0.53, P = 0.001), respectively. Morphometric computerized image analysis revealed a significant difference between treated, untreated and healthy control group I regarding chondrocyte cellular count, articular cartilage thickness and optical density OD of the cartilage (P < 0.001). Group II contained the least chondrocyte cellular count. Also, articular cartilage thickness at 2 months was significantly less in Group II compared to SVF treated group (P < 0.001). The OD in Safranin-stained slides, as an indicator of proteoglycan content of the matrix, was highest in Group I followed by Group III and lowest in Group II with a highly significant difference between untreated and treated groups at 1 month (67.32 ± 4.25, 81.77 ± 3.09, P = 0.000) and 2 months (71.60 ± 3.49, 83.26 ± 5.47, P = 0.000), respectively.

Conclusion

Treatment with adipose-derived SVF decreased the development of articular cartilage degenerative changes at early stages of induced OA in rats. Later, on follow-up, the preserved articular cartilage thickness, cellular count and increased proteoglycan content rendered SVF a promising regenerative therapy for Knee OA.
Plant genome editing to achieve food and nutrient security
Authors: Ceasar Stanislaus Antony , Kavas Musa
Published: March 2024

Genome editing enables precise genetic manipulation in plants, offering hope for tackling global food insecurity and malnutrition by enhancing crop traits and nutritional content. The BMC Methods Collection ‘Genome Editing in Plants’ will showcase advancements in the field, including target selection, delivery systems, off-target effects, and efficiency optimization.
Fault structure and hydrocarbon prospects of the Palawan Basin on the southeastern margin of the South China Sea based on gravity, magnetic, and seismic data
Authors: Zhang Chunguan , Liu Shixiang , Yuan Bingqiang , Zhang Gongcheng
Published: March 2024

To study the structural features and hydrocarbon prospects of the Palawan Basin in the South China Sea (SCS), the authors collect and collate the existing gravity and magnetic data and obtain edge recognition information from the potential fields. Combined with the seismic profile data, this paper analyzes the features of the gravity and magnetic anomalies and the edge recognition information of the potential fields, determines the fault system, and delineates favorable areas for oil and gas exploration in the Palawan Basin. The results indicate that four main groups of faults with northeast, northwest, near east–west, and near south–north trends developed in the Palawan Basin and adjacent areas in the SCS. The northeast-trending fault is the regional fault, whereas the northwest-trending fault is the main fault. The northwest-trending fault often terminated at the northeast-trending fault, indicating that the northwest-trending fault is formed subsequently. This investigation has characterized two different types of exploration favorable areas (type I and type II) based on the characteristics observed. The most notable characteristic of these exploration favorable areas is that they are located in the high-value zones of the local anomaly of the Bouguer gravity anomaly and their development is obviously controlled by the faults. The amplitude of the gravity anomalies is higher and the gradient of the gravity anomalies is steeper, and there are oil and gas wells and fields distributed in the type I favorable areas for exploration. Compared with the type I favorable areas, the amplitude of gravity anomalies is relatively small, and the gradient of the gravity anomalies is relatively gentle, corresponding to the type II favorable areas.
Normal fault reactivation induced by hydraulic fracturing: Poroelastic effects
Authors: Haddad Mahdi , Eichhubl Peter
Published: March 2024

Numerous surface-felt earthquakes have been spatiotemporally correlated with hydraulic-fracturing operations. Because large deformations occur close to hydraulic fractures (HFs), any associated fault reactivation and resulting seismicity must be evaluated within the length scale of the fracture stages and based on the precise fault location relative to the simulated rock volumes. To evaluate the changes in Coulomb failure stress (CFS) with injection, we conduct fully coupled poroelastic finite-element simulations using a pore-pressure cohesive zone model for the fracture and fault core in combination with a fault-fracture intersection model. The simulations quantify the dependence of CFS and the fault reactivation potential on the host rock and fault properties, spacing between the fault and the HF, and the fracturing sequence. We find that fracturing in an anisotropic in-situ stress state does not lead to fault tensile opening but rather dominant shear reactivation through a poroelastic stress disturbance over the fault core ahead of the compressed central stabilized zone. In our simulations, poroelastic stress changes significantly affect fault reactivation in all the simulated scenarios of fracturing 50–200 m away from an optimally oriented normal fault. Asymmetric HF growth due to the stress shadowing effect of the adjacent HFs leads to (1) a larger reactivated fault zone following the simultaneous and sequential fracturing of multiple clusters compared with single-cluster fracturing and (2) a larger unstable area ([Formula: see text].1) over the fault core or a higher potential of the fault slip following sequential fracturing compared with simultaneous fracturing. The fault reactivation area is further increased for a fault with lower conductivity and a higher opening-mode fracture toughness of the overlying layer. To reduce the risk of fault reactivation by hydraulic fracturing under the reservoir characteristics of the Barnett Shale, Fort Worth Basin, it is recommended to (1) conduct simultaneous fracturing instead of sequential and (2) maintain a minimum distance of approximately 200 m for HF operations from known faults.
Living Arrangements: Mise-en-scène and the Nouveau Roman in the Fiction of Ann Quin
Authors: Matore Daniel
Published: March 2024

Why is postwar experimental fiction so concerned with measuring and marking out scene and setting? This article analyzes the fiction of the avant-garde British novelist Ann Quin, both her short stories and her debut novel Berg, focusing on her mise-en-scène, choreography, and tableaux. It argues for a fraught relationship between twentieth-century fiction and setting, from Henry James’s “house of fiction” and Woolf’s denunciation of naturalist interiors, from the self-sufficient psyches of early modernism to the fastidious mapping of scene and place in the theory of the nouveau roman, especially that of Natalie Sarraute and Alain Robbe-Grillet. The importance of Quin’s work for postwar fiction, the article argues, is that it suspends, periodically, the free indirect style of early modernism but also departs from the austere topography of the nouveau roman, so that her fiction furnishes an elastic, anxious, and unstable mise-en-scène.
Opening the Black Box of Implementation: Developing the Creating Active Schools Logic Model
Authors: Helme Zoe E. , Chalkley Anna , Walker Timothy J. , Bartholomew John B. , Morris Jade L. , McLoughlin Gabriella M. , Bingham Daniel D. , Daly-Smith Andy
Published: March 2024

Global guidance is driving systems thinking to the forefront of research, policy, and practice. To achieve this, we need to consider how things work to ensure successful implementation. The use of the implementation research logic model as a contemporary tool to aid the planning, reporting, synthesizing, executing, and evaluating of the novel Creating Active Schools (CAS) program is illustrated. A five-step iterative process, underpinned by the implementation research logic model, was undertaken to hypothesize and identify conceptual pathways between the CAS: 1) program determinants, 2) program components and actions, 3) implementation strategies, 4) mechanisms of action, and 5) outcomes. Throughout development, school-based and CAS stakeholders engaged in reviewing appropriate implementation theories, models and frameworks, terminology, and content. An in-depth CAS logic model was created to detail the CAS program and underpinning mechanisms. This article provides novel insights into how contemporary implementation tools can be applied and adapted to enhance the planning, reporting, synthesizing, executing, and evaluating of complex interventions and strategies. The CAS logic model provides a blueprint for future school-based interventions to develop evidence-based logic models and to increase the likelihood of acceptance, feasibility, and sustainability.
Smoking behavior intervention based on implicit approach: a cross-sectional pilot study
Authors: Hamdan Stephani Raihana , Moeliono Marisa F. , Srisayekti Wilis
Published: March 2024

Introduction Indonesia is the country with the highest smoking rate in Southeast Asia and the third-highest globally. Smoking has become one of Indonesia’s biggest addiction problems. The goal of this research is to develop smoking behavior intervention based on an implicit approach. Methods This article contains a two-step study that was part of a comprehensive study on smoking behavior in Indonesia. The first study, applying measurement of Stroop task to 117 male-university-students to examine attention bias among smokers. In the second study, the research aims to develop an intervention by investigating the effects of the experimental retraining by manipulating the automatic-avoidance-action tendencies using an approach-avoidance task (AAT) on 40 male university student smokers that proved to have an attentional bias in the first study. Results The first study results revealed that smoking behavior was associated with attention bias shows a significant difference between smokers and nonsmoker participants in reaction time to smoking-related stimuli (F (3,85)=20.665, p value stimuli 0.000<0.05). This result is the basis for developing an implicit approach-based intervention. The results showed that direct AAT had significantly different results when compared to the control group (t(10)=2,685, p<.05). The outcomes of the studies showed that the direct form retraining (six weeks, twice a week) proved to shape the AAT effect and reduce the cigarettes consumption of the smokers. Conclusions This pilot research becomes initial step examine attentional bias that strengthen smoking addiction and the first attempt to develop smoking cessation interventions in Indonesia using an implicit cognition approach.
Hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative pathogens: Understanding epidemiology, resistance patterns, and implications with COVID-19
Authors: Hammoudi Halat Dalal , Ayoub Moubareck Carole
Published: March 2024

The ongoing spread of antimicrobial resistance has complicated the treatment of bacterial hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Gram-negative pathogens, especially those with multidrug-resistant profiles, including Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, and Acinetobacter spp., are important culprits in this type of infections. Understanding the determinants of resistance in pathogens causing pneumonia is ultimately stressing, especially in the shadows of the COVID-19 pandemic, when bacterial lung infections are considered a top priority that has become urgent to revise. Globally, the increasing prevalence of these pathogens in respiratory samples represents a significant infection challenge, with major limitations of treatment options and poor clinical outcomes. This review will focus on the epidemiology of HAP and VAP and will present the roles and the antimicrobial resistance patterns of implicated multidrug-resistant (MDR) Gram-negative pathogens like carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Enterobacterales (CRE), as well as colistin-resistant Gram-negative pathogens and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. While emerging from the COVID-19 pandemic, perspectives and conclusions are drawn from findings of HAP and VAP caused by MDR Gram-negative bacteria in patients with COVID-19.
Agroecosystem exploration for Antimicrobial Resistance in Ahmedabad, India: A Study Protocol
Authors: Kalpana Pachillu , Falkenberg Timo , Yasobant Sandul , Saxena Deepak , Schreiber Christiane
Published: March 2024

Introduction Antimicrobial resistance (AMR) has emerged as one of the leading threats to public health. AMR possesses a multidimensional challenge that has social, economic, and environmental dimensions that encompass the food production system, influencing human and animal health. The One Health approach highlights the inextricable linkage and interdependence between the health of people, animal, agriculture, and the environment. Antibiotic use in any of these areas can potentially impact the health of others. There is a dearth of evidence on AMR from the natural environment, such as the plant-based agriculture sector. Antibiotics, antibiotic-resistant bacteria (ARB), and related AMR genes (ARGs) are assumed to present in the natural environment and disseminate resistance to fresh produce/vegetables and thus to human health upon consumption. Therefore, this study aims to investigate the role of vegetables in the spread of AMR through an agroecosystem exploration in Ahmedabad, India. Protocol The present study will be executed in Ahmedabad, located in Gujarat state in the Western part of India, by adopting a mixed-method approach. First, a systematic review will be conducted to document the prevalence of ARB and ARGs on fresh produce in South Asia. Second, agriculture farmland surveys will be used to collect the general farming practices and the data on common vegetables consumed raw by the households in Ahmedabad. Third, vegetable and soil samples will be collected from the selected agriculture farms and analyzed for the presence or absence of ARB and ARGs using standard microbiological and molecular methods. Discussion The analysis will help to understand the spread of ARB/ARGs through the agroecosystem. This is anticipated to provide an insight into the current state of ARB/ARGs contamination of fresh produce/vegetables and will assist in identifying the relevant strategies for effectively controlling and preventing the spread of AMR.
FATTY ACID CONTENT AND MORPHOLOGICAL INDICATORS OF WINTER WHEAT (TRITICUM AESTIVUM L.) SEEDLINGS GROWN FROM SEEDS TREATED WITH OZONE
Authors: Kapustina Irina S. , Lazukin Alexander V. , Nurminsky Vadim N. , Grabelnykh Olga I. , Ozolina Natalia V. , Gurina Veronika V. , Spiridonova Ekaterina V.
Published: March 2024

Background. Presently, a selection of environmentally friendly technologies for pre-sowing treatment of wheat seeds is conducted in agriculture. Ozone, an allotropic form of oxygen, is highly reactive, acts as an effective insecticide, promotes seed improvement, and reduces soil contamination. The impact of ozone on seeds is one of the promising technologies to improve the quality of seedlings. It is known that the field germination of winter wheat may be less than 50%, depending on the environmental conditions, and therefore the quality of seedlings is very important.

Purpose. To evaluate the effect of different ozone concentrations on morphological parameters and synthesis of fatty acids (FA) in winter wheat seedlings.

Materials and methods. The object of the study was the seeds of soft winter wheat (variety Irkutskaya). The ozonation was conducted with ozone concentrations of 2, 4, 6 and 8 g/m3 during 15, 30, 45 and 60 min. The germination of treated and control seeds was carried out for three days in the dark in a thermostat (24±1°C). On the third day, the morphometric characteristics were measured. The extraction of lipids from shoots and roots was carried out according to the method of Bligh, Dyer [14]. The methyl esters of lipid fatty acids were analyzed by chromato-mass spectrometry. Statistical data processing was conducted with the use of R programming language and SigmaPlot v. 12.5.

Results. Ozone in concentrations of 2, 4, 6 g/m3 has a stimulating effect on seedling germination, the length of the shoots and roots increases. At ozone concentration of 8 g/m3, the length of the shoots and roots decreases.

There is a general trend in the content of fatty acids, in the shoots of seedlings there is some decrease in lipid unsaturation, and in the roots - some increase in lipid unsaturation.

Conclusion. Ozone in concentrations up to 8 g/m3 is suitable for pre-sowing seed treatment and improves seedling performance.
ON ASSESSING THE GROWTH POTENTIAL OF THE LIFE EXPECTANCY OF THE POPULATION AS A RESULT OF IMPLEMENTING INTEGRATED MEASURES (ON THE EXAMPLE OF A CONSTITUENT ENTITY OF THE RUSSIAN FEDERATION)
Authors: Zaitseva Nina V. , Kleyn Svetlana V. , Glukhikh Maxim V. , Kamaltdinov Marat R.
Published: March 2024

The development vector of the current government policy in the Russian Federation aimed at improving social conditions – one of the critical indicators of which is life expectancy at birth [LE] – dictates the research relevance. Currently, the search and testing of new analytical systems capable of forecasting LE, considering the multifactorial influence on this indicator, remains relevant and timely. The research goal is to establish the growth potential of LE of the population estimation on the example of one of the constituent entities of the Russian Federation, considering integrated heterogeneous factors that possess a modifying effect on LE. The estimation includes modeling cause-and-effect relationships between indicators of habitat, quality of life, and life patterns – determinants of population health. The utilized model is a set of algebraic equations in the form of a factor transformation of independent variables and an artificial neural network and is implemented in three stages. They include (1) developing the basic scenario and calculating LE, (2) developing the target scenario and calculating LE, and (3) calculating the growth potential of LE as the difference between the indicators obtained at previous stages. The developed model and the three-stage algorithm application allows one to obtain the growth potential of LE on the example of one constituent entity of the Russian Federation in the context of a single change in determinants by 2024, which amounts to +1.24 years (453.0 days) relative to the baseline scenario (the actual LE value in 2018). The forecast value of LE is 70.47 years. Ranking of individual indicator groups according to their isolated effect on LE demonstrates that the most significant determinant groups are (1) socio-demographic indicators (2.6 years – 949.0 days), (2) indicators of sanitary and epidemiological safety (1.75 years – 638.75 days), and the (3) population lifestyle indicators (1.41 years – 514.65 days). The obtained results confirm the predominance of the influence of social indicators on population health in the form of LE on the example of the analysis of changes in the indicators of one of the constituent entities of the Russian Federation. The research relevance implies studying the combined influence of heterogeneous factors of the environment and lifestyle on the indicative indicator of population health (LE), a complex system with the properties of emergence, variability, opposite influence, and adaptation.
HYGIENIC ASSESSMENT OF THE IMPACT OF OFF-GRID HEAT SOURCES ON AMBIENT AIR QUALITY AND THE FORMATION OF PUBLIC HEALTH RISKS
Authors: Zaitseva Nina V. , Kleyn Svetlana V. , Andrishunas Alena M. , Balashov Stanislav Yu. , Chigvintsev Vladimir M.
Published: March 2024

Background. The study is relevant due to a significant number (more than 74 thousand) of autonomous heat sources (AHS) in the Russian Federation, especially in its eastern regions. Such sources use solid fuels (coal). AHS, along with other heat and power objects, make a considerable contribution to ambient air pollution in the ground layers and consequently produce harmful effects on public health.

The aim of this study was to perform hygienic assessment of negative effects produced by autonomous heat sources (AHS) on ambient air quality, health risks and additional associated incidence on the example of a territory included into the Clean Air Federal project.

Materials and methods. We calculated dispersion of pollutants in ambient air in residential areas due to AHS; performed hygienic assessment of calculated and instrumental data on ambient air quality; assessed public health risks; identified the number of additional associated diseases in accordance with the conventional established methods and algorithms valid at the present moment.

Results. More than 170 AHS are located on the analyzed territory; they all use soli fuel (coal). Hygienic standards are violated in areas influenced by AHS for four out of sever chemicals emitted by chimneys of private houses. Pollutant levels reach 5.1 single maximum MPC for four pollutants according to dispersion calculation; 4.8 single maximum MPC, 38 average daily MPC and 4.7 average annual MPC for four pollutants according to instrumental data; 29.9 single maximum MPC, 3.5 average daily MPC and 7.0 average annual MPC for three pollutants according to verified data. Identified carcinogenic, acute, and chronic health risks are ranked as ‘alerting’ and ‘high’ in areas under direct influence of AHS; these risks reach 13.4 HQ (acute), 7.0 HQ (chronic), CRT 1.19∙10-7 (carcinogenic). AHS create more than 11 thousand additional respiratory diseases (6,379.9 cases per 100 thousand people); of them, 98% cases are registered in children.

Conclusion. AHS create high levels of exposure to harmful pollutants and elevated health risks as well as additional incidence associated with ambient air quality. This situation requires immediate attention of the local authorities, control and surveillance organs; it is necessary to develop and implement complex air protection activities as soon as possible.
SAFETY OF MILK AND MEAT PRODUCTS IN THE RUSSIAN FEDERATION IN DYNAMICS: RESULTS OF SANITARY-EPIDEMIOLOGICAL CONTROL (2013-2022)
Authors: May Irina V. , Nikiforova Nadezhda V.
Published: March 2024

Background. The study addresses an extremely important issue, namely quality and safety of meat and milk products that are consumed daily by majority of the population in the Russian Federation.

Aim. To investigate safety of animal food products (meat and milk products) in dynamics.

Materials and methods. We performed retrospective analysis of the branch statistical report with the results of control (surveillance) over milk and meat products obtained in the period between 2013 and 2022. We estimated safety levels in dynamics and spatial distribution of shares of unsafe goods as per priority indicators.

Results. Frequency of cases when mandatory requirements to safety of milk and meat products were violated amounted to 4.0 % and approximately 3.0 % accordingly. Hygienic requirements were most frequently violated as per microbiological and physical-chemical indicators, 3.84 % and 2.69 % accordingly for meat products and 4.2 % and 6.0 % accordingly for milk products. We analyzed safety of meat products in dynamics and established positive trends to be rather weak and multidirectional as per different indicators; as for milk products, shares of unsafe products went down as per all the standardized indicators except from sanitary-chemical ones. 

Conclusion. Our study didn’t reveal any obvious positive dynamics (descending trends) in the shares of food product samples deviating from the safety standards. This means it is necessary to improve the current system for control (surveillance) over meat and milk products. More effective control (surveillance) can be provided by creating ‘risk profiles’ of a product with information about the most risky indicators to describe hazards associated with it. These indicators should be the first to be included into programs of product laboratory testing. In addition, it is vital to create regional registers of food products assigned into specific categories as per associated health risks. Such registers can also be used to select groups and types of products that should be covered by surveillance. The development of the risk-based surveillance can facilitate elimination of low quality and unsafe food products form the market.
The Financial Consequences of Online Review Aggregators: Evidence from Yelp Ratings and SBA Loans
Authors: Huang Ruidi
Published: March 2024

This paper demonstrates the financial and real consequences of online review aggregators. Exploiting a regression discontinuity design that overcomes the endogenous relationship between Yelp reviews and Small Business Administration loan outcomes, I show that higher coarse Yelp ratings lead to improved loan terms and performance. Specifically, a one-half-star increase in Yelp ratings corresponds to a 25-basis-point decrease in loan spread and 6% lower collateral requirements. The effects are more pronounced when banks have less borrower information. Higher Yelp ratings also contribute to increased consumer demand and the likelihood of future business openings. These findings indicate that online review aggregators influence both consumer choices and banks’ financing decisions.

This paper was accepted by Gustavo Manso, finance.

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2020.03003 .