bluuebunny/crossref_metadata_2025 huggingface dataset:
RIS‐Assisted Coverage Optimization for 5G‐R Channel in Station Scenario Based on ML and RT
Authors: Lu Bin , Guo Xinghai , Shan Xinyi , Li Fang
Published: June 2023

As one of the most important radio communication scenarios in vertical industry, the high‐speed railway (HSR) station is facing the challenge of coverage optimization due to its complex structure. Regarding the wireless network planning and optimization of HSR stations as a part of the customized network, this paper makes an analysis on the 5G‐R channel in the HSR station scenario. Channel characteristics, including path loss, power ratio (PR), and angular spread (AS), are extracted on the basis of ray tracing (RT). Multipath components can also be distinguished based on RT. In order to achieve a better performance, the reconfigurable intelligent surface (RIS) technology is adopted to the network deployment. Moreover, machine learning (ML) is used to locate the best direction of the beam. The analysis results show that the received power in RIS‐assisted channels is significantly promoted. Our research can provide a deep understanding to the 5G‐R channel in station scenario and a well reference for the design and optimization of the customized network.
A Bit-Parallel Tabu Search Algorithm for FindingEs2-Optimal and Minimax-Optimal Supersaturated Designs
Authors: Morales Luis B. , Bulutoglu Dursun A.
Published: June 2023

We prove the equivalence of two-symbol supersaturated designs (SSDs) withN(even) rows,mcolumns, andsmax=4t+i, wherei∈0,2andt∈ℤ≥0and resolvable incomplete block designs (RIBDs) whose any two blocks intersect in at mostN+4t+i/4points. Using this equivalence, we formulate the search for two-symbolEs2-optimal and minimax-optimal SSDs withsmax∈2,4,6as a search for RIBDs whose blocks intersect accordingly. This allows developing a bit-parallel tabu search (TS) algorithm. The TS algorithm foundEs2-optimal and minimax-optimal SSDs achieving the sharpest knownEs2lower bound withsmax∈2,4,6of sizesN,m=16,25, (16, 26), (16, 27), (18, 23), (18, 24), (18, 25), (18, 26), (18, 27), (18, 28), (18, 29), (20, 21), (22, 22), (22, 23), (24, 24), and (24, 25). In each of these cases, no such SSD could previously be found.
Simultaneous Adsorption of Intact Glycoproteins and Phosphoproteins Using Hydrophilic Titanium (IV) Ion-Immobilized Cotton Fiber Functionalized by Phytic Acid Assembly
Authors: Zhang Dawei , Zhou Zhenhua , Sun Guifeng , Chen Shiying , Jiang Minzhi , Yao Zihan , Chukwunonso Ogbuehi Anthony , Wang Hao , Jin Lei
Published: June 2023

Protein glycosylation and phosphorylation are two important post-translational modifications and play significant roles in various biological processes. However, both glycoproteins and phosphoproteins are in low abundance in complex samples, which hinders their characterization. In this work, we developed a novel method for the simultaneous adsorption of glycoproteins and phosphoproteins based on solid phase extraction. By virtue of the unique structure of hydrophilic titanium (IV) ion immobilized cotton fiber functionalized with phytic acid (denoted as Ti4+-PA-cotton), glycoproteins, and phosphoproteins could be efficiently enriched in one-step incubation and eluted in sequence. The newly prepared Ti4+-PA-cotton was well characterized, and the adsorption isotherms and kinetics were studied. The maximum adsorption capacities of Ti4+-PA-cotton for β-casein and HRP were 833.3 mg/g and 384.6 mg/g with the adsorption rate of 259.1 and 63.1 mg/g·min. Standard protein mixture of BSA, HRP, and β-casein was used to test the enrichment ability as a proof of concept. The SDS-PAGE results demonstrated that Ti4+-PA-cotton had an excellent enrichment performance and possessed an outstanding application potential in the analysis of glycoproteins and phosphoproteins.
Data from Resolving the pathogenesis of anaplastic Wilms tumors through spatial mapping of cancer cell evolution
Authors: Rastegar Bahar , Andersson Natalie , Petersson Alexandra , Karlsson Jenny , Chattopadhyay Subhayan , Valind Anders , Jansson Caroline , Durand Geoffroy , Romerius Patrik , Jirstrom Karin , Holmquist Mengelbier Linda , Gisselsson David
Published: June 2023

Abstract
Purpose: While patients with intermediate-risk Wilms tumors (WT) now have an overall survival rate of almost 90%, those affected by high-stage tumors with diffuse anaplasia (DA) have an overall survival of only around 50%. We here identify key events in the pathogenesis of DA by mapping cancer cell evolution over anatomic space in WTs. Experimental Design: We spatially mapped subclonal landscapes in a retrospective cohort of 20 WTs using high-resolution copy number profiling and TP53 mutation analysis followed by clonal deconvolution and phylogenetic reconstruction. Tumor whole mount sections were utilized to characterize the distribution of subclones across anatomically distinct tumor compartments. Results: Compared to non-DA WTs, tumors with DA showed a significantly higher number of genetically distinct tumor cell subpopulations and more complex phylogenetic trees, including high levels of phylogenetic species richness, divergence and irregularity. All regions with classical anaplasia showed TP53 alterations. TP53 mutations were frequently followed by saltatory evolution and parallel loss of the remaining wild-type allele in different regions. Morphological features of anaplasia increased with copy number aberration (CNA) burden and regressive features. Compartments demarcated by fibrous septae or necrosis/regression were frequently (73%) associated with the emergence of new clonal CNAs, while clonal sweeps were rare within these compartments. Conclusions: WTs with DA display significantly more complex phylogenies compared to non-DA WTs, including features of saltatory and parallel evolution. The subclonal landscape of individual tumors was constrained by anatomic compartments, which should be considered when sampling tissue for precision diagnostics.
Adavosertib Enhances Antitumor Activity of Trastuzumab Deruxtecan in HER2-Expressing Cancers
Authors: DiPeri Timothy P. , Evans Kurt W. , Raso Maria Gabriela , Zhao Ming , Rizvi Yasmeen Q. , Zheng Xiaofeng , Wang Bailiang , Kirby Bryce P. , Kong Kathleen , Kahle Michael , Yap Timothy A. , Dumbrava Ecaterina E. , Ajani Jaffer A. , Fu Siqing , Keyomarsi Khandan , Meric-Bernstam Funda
Published: June 2023

Purpose:

Cyclin E (CCNE1) has been proposed as a biomarker of sensitivity to adavosertib, a Wee1 kinase inhibitor, and a mechanism of resistance to HER2-targeted therapy.

Experimental Design:

Copy number and genomic sequencing data from The Cancer Genome Atlas and MD Anderson Cancer Center databases were analyzed to assess ERBB2 and CCNE1 expression. Molecular characteristics of tumors and patient-derived xenografts (PDX) were assessed by next-generation sequencing, whole-exome sequencing, fluorescent in situ hybridization, and IHC. In vitro, CCNE1 was overexpressed or knocked down in HER2+ cell lines to evaluate drug combination efficacy. In vivo, NSG mice bearing PDXs were subjected to combinatorial therapy with various treatment regimens, followed by tumor growth assessment. Pharmacodynamic markers in PDXs were characterized by IHC and reverse-phase protein array.

Results:

Among several ERBB2-amplified cancers, CCNE1 co-amplification was identified (gastric 37%, endometroid 43%, and ovarian serous adenocarcinoma 41%). We hypothesized that adavosertib may enhance activity of HER2 antibody–drug conjugate trastuzumab deruxtecan (T-DXd). In vitro, sensitivity to T-DXd was decreased by cyclin E overexpression and increased by knockdown, and adavosertib was synergistic with topoisomerase I inhibitor DXd. In vivo, the T-DXd + adavosertib combination significantly increased γH2AX and antitumor activity in HER2 low, cyclin E amplified gastroesophageal cancer PDX models and prolonged event-free survival (EFS) in a HER2-overexpressing gastroesophageal cancer model. T-DXd + adavosertib treatment also increased EFS in other HER2-expressing tumor types, including a T-DXd–treated colon cancer model.

Conclusions:

We provide rationale for combining T-DXd with adavosertib in HER2-expressing cancers, especially with co-occuring CCNE1 amplifications.

See related commentary by Rolfo et al., p. 4317
Early Changes in Circulating Cell-Free KRAS G12C Predict Response to Adagrasib in KRAS Mutant Non–Small Cell Lung Cancer Patients
Authors: Paweletz Cloud P. , Heavey Grace A. , Kuang Yanan , Durlacher Emily , Kheoh Thian , Chao Richard C. , Spira Alexander I. , Leventakos Konstantinos , Johnson Melissa L. , Ou Sai-Hong Ignatius , Riely Gregory J. , Anderes Kenna , Yang Wenjing , Christensen James G. , Jänne Pasi A.
Published: June 2023

Purpose:

Non-invasive monitoring of circulating tumor DNA (ctDNA) has the potential to be a readily available measure for early prediction of clinical response. Here, we report on early ctDNA changes of KRAS G12C in a Phase 2 trial of adagrasib in patients with advanced, KRAS G12C-mutant lung cancer.

Experimental Design:

We performed serial droplet digital PCR (ddPCR) and plasma NGS on 60 KRAS G12C-mutant patients with lung cancer that participated in cohort A of the KRYSTAL-1 clinical trial. We analyzed the change in ctDNA at 2 specific intervals: Between cycles 1 and 2 and at cycle 4. Changes in ctDNA were compared with clinical and radiographic response.

Results:

We found that, in general, a maximal response in KRAS G12C ctDNA levels could be observed during the initial approximately 3-week treatment period, well before the first scan at approximately 6 weeks. 35 patients (89.7%) exhibited a decrease in KRAS G12C cfDNA >90% and 33 patients (84.6%) achieved complete clearance by cycle 2. Patients with complete ctDNA clearance at cycle 2 showed an improved objective response rate (ORR) compared with patients with incomplete ctDNA clearance (60.6% vs. 33.3%). Furthermore, complete ctDNA clearance at cycle 4 was associated with an improved overall survival (14.7 vs. 5.4 months) and progression-free survival (HR, 0.3).

Conclusions:

These results support using early plasma response of KRAS G12C assessed at approximately 3 weeks to anticipate the likelihood of a favorable objective clinical response.
Circulating and Intratumoral Immune Determinants of Response to Atezolizumab plus Bevacizumab in Patients with Variant Histology or Sarcomatoid Renal Cell Carcinoma
Authors: Saliby Renee Maria , El Zarif Talal , Bakouny Ziad , Shah Valisha , Xie Wanling , Flippot Ronan , Denize Thomas , Kane M. Harry , Madsen Katrine N. , Ficial Miriam , Hirsch Laure , Wei Xiao X. , Steinharter John A. , Harshman Lauren C. , Vaishampayan Ulka N. , Severgnini Mariano , McDermott David F. , Lee Gwo-Shu Mary , Xu Wenxin , Van Allen Eliezer M. , McGregor Bradley A. , Signoretti Sabina , Choueiri Toni K. , McKay Rana R. , Braun David A.
Published: June 2023

Renal cell carcinoma (RCC) of variant histology comprises approximately 20% of kidney cancer diagnoses, yet the optimal therapy for these patients and the factors that impact immunotherapy response remain largely unknown. To better understand the determinants of immunotherapy response in this population, we characterized blood- and tissue-based immune markers for patients with variant histology RCC, or any RCC histology with sarcomatoid differentiation, enrolled in a phase II clinical trial of atezolizumab and bevacizumab. Baseline circulating (plasma) inflammatory cytokines were highly correlated with one another, forming an “inflammatory module” that was increased in International Metastatic RCC Database Consortium poor-risk patients and was associated with worse progression-free survival (PFS; P = 0.028). At baseline, an elevated circulating vascular endothelial growth factor A (VEGF-A) level was associated with a lack of response (P = 0.03) and worse PFS (P = 0.021). However, a larger increase in on-treatment levels of circulating VEGF-A was associated with clinical benefit (P = 0.01) and improved overall survival (P = 0.0058). Among peripheral immune cell populations, an on-treatment decrease in circulating PD-L1+ T cells was associated with improved outcomes, with a reduction in CD4+PD-L1+ [HR, 0.62; 95% confidence interval (CI), 0.49–0.91; P = 0.016] and CD8+PD-L1+ T cells (HR, 0.59; 95% CI, 0.39–0.87; P = 0.009) correlated with improved PFS. Within the tumor itself, a higher percentage of terminally exhausted (PD-1+ and either TIM-3+ or LAG-3+) CD8+ T cells was associated with worse PFS (P = 0.028). Overall, these findings support the value of tumor and blood-based immune assessments in determining therapeutic benefit for patients with RCC receiving atezolizumab plus bevacizumab and provide a foundation for future biomarker studies for patients with variant histology RCC receiving immunotherapy-based combinations.
Indagando as aparências, apontando as evidências: resquícios da cultura caipira no hit de Chitãozinho & Xororó
Authors: Santos Julio César Ribeiro dos
Published: June 2023

Parto da canção romântico-popular “Evidências” (Augusto; Valle, 1990) e suas traduções por Chitãozinho & Xororó nos álbuns Caubóis do Asfalto (1990), Elas em evidências (2015) e como tema de encerramento da turnê Evidências (2016-2020) no intento de investigar os refluxos e recrudescimentos do povo caipira naquilo que se chama canção sertaneja no âmbito da Indústria Cultural. Sirvo-me de alguns elementos teoria da linguagem proposta por Henri Meschonnic (2006; 2008; 2015) para elucidar a compreensão da maneira como afeto e conceito em um só bocado de palavra agem e transformam os modos de ver, de ouvir e  sentir  (Meschonnic 2015: 9). Índices como tonalidade anasalada, extensão de tessitura, falsetes, dupla melodia principal, alguma arrogância e idealização afetiva, presentes em Caubóis do asfalto (1990), revigoram via intertextualidade o povo caipira da Paulistânia (RIBEIRO, 1995), trazendo os brãos da roça (Corrêa 2014) e o sertanejo (Lima 1972) onde inicialmente havia pop; em Elas em evidências (2015), há deslocamentos dados, sobretudo, pelo acréscimo das diferentes formas de empoderamento feminino por distintas oralidades (Meschonnic 2006) numa importante articulação que atende ao escopo (Veermer 1996 apud Pyn 2017)  dos interesses de mercado. Já como tema de encerramento (Paladini 2015), emerge como virtuose o rock progressivo superando as expectativas do receptor e deslocando os limites das ordens do discurso.
Interpretantes formais e temáticos na adaptação: uma análise do filme Ghost in the Shell (1995) em relação à sua obra fonte
Authors: Pinheiro Felipe Duarte
Published: June 2023

A presente pesquisa analisa a adaptação cinematográfica do mangá Ghost in the Shell, de Masamune Shirow, dirigida por Mamoru Oshii. Considerando a adaptação como um ato de (re-)interpretação e (re)criação (Hutcheon, 2011) e com base no conceito de interpretantes (Venuti, 2007), procurou-se averiguar de que maneiras os interpretantes formais e temáticos aplicados na animação de Oshii afetaram a representação dos temas presentes no mangá de Shirow. A análise demonstra que tanto o recorte adotado quanto as alterações feitas na caracterização das personagens resultaram em uma adaptação com um tom muito mais sério, sugerindo uma postura mais crítica em relação ao tema das implicações dos avanços tecnológicos para a nossa concepção de humanidade em comparação à sua obra fonte.
“Suitors”, de Pauline Kaldas: uma tradução do conto e alguns comentários sobre o processo tradutório
Authors: Campello Priscila Campolina de Sá , Passos Arthur Almeida
Published: June 2023

Neste artigo, apresentamos uma tradução do conto “Suitors”, escrito pela autora egípcio-estadunidense Pauline Kaldas e constante da coletânea The Time Between Places: Stories that Weave in and out of Egypt and America. Antes disso, trazemos os pressupostos teóricos que orientaram a tradução, destacando pareceres de estudiosos que refletem sobre tradução e/ou literatura, tais como Márcio Seligmann-Silva (2005), Jean-Yves Masson (2019), José Pinheiro de Souza (1998), Umberto Eco (2003), Fabio Akcelrud Durão (2016), Victor Chklóvski (2013), Paulo Bezerra (2012) e Alfredo Bosi (1988). Ao fim do trabalho, tecemos alguns comentários sobre o processo tradutório que deu origem ao texto em português, a fim de justificar determinadas escolhas de ordem linguística e/ou literária voltadas a superar os desafios colocados pelo texto de partida e pela própria atividade de tradução, e chegamos a algumas conclusões acerca de todo o exercício empreendido em relação ao conto traduzido.
Estudo baseado em corpus das traduções para o inglês do vocábulo coisa em Água Viva de Clarice Lispector
Authors: Bonalumi Emiliana Fernandes
Published: June 2023

Clarice Lispector é uma escritora de grande notoriedade dentro e fora do Brasil. Este artigo aborda as traduções de quatro frases lexicais (FLs) provenientes do vocábulo coisa em Água Viva, da Autora. Analisamos a obra e as traduções para o inglês de 1989 por Earl Fitz e Elizabeth Lowe, e a de 2012 por Stefan Tobler. Utilizamos a ferramenta computacional WordSmith Tools (Scott, 1999), a fim de gerar uma lista dos vocábulos recorrentes e preferenciais da obra. Selecionamos o vocábulo coisa, uma vez que foi o terceiro na lista de palavras, além de sua importância no romance. Este estudo fundamentou-se nos estudos da tradução baseados em corpus de Baker (1993, 1995, 1996, 1999, 2004a, 2004b), nos princípios da linguística de corpus de Berber Sardinha (2000, 2004), assim como na abordagem interdisciplinar de YYY (2005, 2007). O intuito foi analisar se houve variação e identificar as semelhanças e diferenças encontradas nas FLs selecionadas. Verificamos que houve mais aproximações entre a obra original e a traduzida de 1989; já, em relação ao original e à tradução de 2012, observou-se mais distanciamentos, isto é, foram utilizadas mais variações na obra traduzida de 2012 se comparada com a tradução de 1989.
Genetic Susceptibility to Atrial Fibrillation Identified via Deep Learning of 12-Lead Electrocardiograms
Authors: Wang Xin , Khurshid Shaan , Choi Seung Hoan , Friedman Samuel , Weng Lu-Chen , Reeder Christopher , Pirruccello James P. , Singh Pulkit , Lau Emily S. , Venn Rachael , Diamant Nate , Di Achille Paolo , Philippakis Anthony , Anderson Christopher D. , Ho Jennifer E. , Ellinor Patrick T. , Batra Puneet , Lubitz Steven A.
Published: June 2023

BACKGROUND:

Artificial intelligence (AI) models applied to 12-lead ECG waveforms can predict atrial fibrillation (AF), a heritable and morbid arrhythmia. However, the factors forming the basis of risk predictions from AI models are usually not well understood. We hypothesized that there might be a genetic basis for an AI algorithm for predicting the 5-year risk of new-onset AF using 12-lead ECGs (ECG-AI)-based risk estimates.

METHODS:

We applied a validated ECG-AI model for predicting incident AF to ECGs from 39 986 UK Biobank participants without AF. We then performed a genome-wide association study (GWAS) of the predicted AF risk and compared it with an AF GWAS and a GWAS of risk estimates from a clinical variable model.

RESULTS:

In the ECG-AI GWAS, we identified 3 signals (
P
<5×10
−8
) at established AF susceptibility loci marked by the sarcomeric gene
TTN
and sodium channel genes
SCN5A
and
SCN10A
. We also identified 2 novel loci near the genes
VGLL2
and
EXT1
. In contrast, the clinical variable model prediction GWAS indicated a different genetic profile. In genetic correlation analysis, the prediction from the ECG-AI model was estimated to have a higher correlation with AF than that from the clinical variable model.

CONCLUSIONS:

Predicted AF risk from an ECG-AI model is influenced by genetic variation implicating sarcomeric, ion channel and body height pathways. ECG-AI models may identify individuals at risk for disease via specific biological pathways.
Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here?
Authors: Urbina Elaine M. , Daniels Stephen R. , Sinaiko Alan R.
Published: June 2023

The association between hypertension in adulthood and cardiovascular morbidity and death is well known. Based on that association, a diagnosis of elevated blood pressure in children has been clinically interpreted as early cardiovascular disease. The objective of this review is to discuss historical data and new research on the relationship between elevated blood pressure and early preclinical and later adult cardiovascular disease. After summarizing the evidence, we will address the gaps in knowledge around Pediatric hypertension in an effort to stimulate research into the important role that control of blood pressure in youth may play in preventing adult cardiovascular disease.
Development and Impact of an Intercultural STEAM Program on Science Classroom Creativity
Authors: Kim Ei Seul , Chu Hye-eun , Song Jinwoong
Published: June 2023

As collaboration among scientists from diverse backgrounds can help generate theories and foster the discovery of natural phenomena, the importance of creativity via collaboration in science learning has been widely recognized. This study aimed to investigate the science classroom creativity of Korean high school students who participated in an Australia-Korea intercultural STEAM program (ISP). Due to COVID-19 restrictions, data was only collected from Korean students. The Revised Science Classroom Creativity Questionnaire (R-SCCQ) was administered to 25 Korean students, and interviews were conducted with 10 students to explore creative behavior. The results showed a significant increase in students’ science classroom creativity following their participation in the ISP. This study shows that the intercultural experience provided by the program can help induce a more flexible mindset and encourage different perspectives, ultimately enhancing science classroom creativity. This finding is significant as it highlights the potential of the ISP as a new teaching method for promoting creativity in science education.
Using an Artificial Intelligence Chatbot in Scientific Inquiry: Focusing on a Guided-Inquiry Activity Using Inquirybot
Authors: Chang Jina , Park Joonhyeong , Park Jisun
Published: June 2023

This study aims to explore how to use an AI chatbot pedagogically in scientific inquiry by developing a guided-inquiry activity using an AI chatbot and applying it. The developed guided-inquiry activity consisted of designing and doing inquiry activities using the transmission of sound as the topic. In this activity, a chatbot, which was given the name Inquirybot, was designed with conversation flow and scripts for guiding the inquiry design process. By applying the developed inquiry activities and Inquirybot to fifth- and sixth-grade gifted students, we found several practical possibilities and challenges for using an AI chatbot in scientific inquiry. Based on the results, future tasks and educational implications are discussed in terms of efficiently adapting AI chatbots in scientific-inquiry activities.
Second-step lectotypifications of two names in Festuca subgenus Erosiflorae (Loliinae, Pooideae, Poaceae)
Authors: ARNELAS ITZIAR , MORENO-AGUILAR MARÍA FERNANDA , CATALÁN PILAR
Published: June 2023

N/A
Opposite Changes in Monsoon Precipitation and Low Pressure System Frequency in Response to Orographic Forcing
Authors: Thomas Tresa Mary , Bala Govindasamy , Vemavarapu Srinivas Venkata , Boos William R.
Published: June 2023

Monsoon low pressure systems (LPS) are synoptic-scale disturbances that form along the quasi-stationary trough of the larger-scale South Asian summer monsoon, producing a large fraction of total monsoon precipitation. Here, we use an Earth system model to investigate the influence of Tibetan and Himalayan orography (THO) on mean monsoon strength and LPS activity. The influence of THO height on LPS activity has not been investigated before. The model simulates decreased mean monsoon circulation and precipitation when THO is removed, but the number of LPS and the meridional extent of LPS activity increase; this is an unexpected, important finding given that LPS are principal rain-bearing systems of the monsoon. The decreased mean monsoon circulation and precipitation on removal of THO are attributed to enhanced mixing of dry extratropical air into the humid monsoon domain, as demonstrated by prior studies. The increase in LPS frequency and the meridional extent of LPS activity is attributed to the increase in magnitude and meridional extent of the low-level meridional shear of zonal wind, which previous work showed amplifies LPS through barotropic growth. Specifically, as monsoon precipitation decreases, the sensible heat-driven low-level trough intensifies and shifts equatorward; this strengthens the shear zone in which LPS grow. Conversely, increasing THO height decreases the magnitude and meridional extent of cyclonic shear over India, decreasing LPS frequency and the spatial extent of LPS activity while increasing total monsoon precipitation. These results demonstrate that LPS activity and total monsoon rainfall can undergo large, opposing changes in response to imposed forcings.

Significance Statement

Monsoon low pressure systems (LPS) are propagating atmospheric vortices that deliver a large fraction of seasonal-mean precipitation to agricultural regions of India. The influence of Tibetan and Himalayan orography (THO) on the South Asian monsoon is an active area of research, but its effect on LPS has remained unexplored. Here, a global climate model is used to simulate LPS characteristics for different heights of THO. Flattening the THO reduces total summer monsoon precipitation but increases the number of LPS and the spatial extent of LPS activity. We attribute these LPS changes to a decrease in the magnitude and meridional extent of the hydrodynamically unstable low-level cyclonic shear zone over South Asia that occurs when orography is flattened.
Response of the Snowball Earth Climate to Orbital Forcing at a High CO2 Level
Authors: Wu Jiacheng , Liu Yonggang
Published: June 2023

How the climate responded to orbital forcing during the Neoproterozoic snowball Earth events, the most extreme glaciations on Earth, is still unclear. Here, we investigate this problem using a climate model. To simplify the analysis, continents are removed. The results show that even in this simplified situation, the snowball Earth climate is sensitive to orbital configurations. The globally averaged annual surface temperature can differ by 2.4°C, and the maximum monthly mean temperature can differ by 3.7°C under different orbital configurations. Therefore, a snowball Earth could be deglaciated more easily in some orbital configurations than in others. The climatic effect of a particular orbital parameter is highly dependent on the values of other parameters. For example, the effect of obliquity on tropical surface temperature is generally small (<1°C), but it can become large (3.8°C) when eccentricity is large and the northern autumn occurs at perihelion (precession = 180°). Surprisingly, the global temperature is generally lower at high eccentricity than at near-zero eccentricity, even though the total insolation received by Earth is higher in the former than in the latter. Moreover, we find that the Milankovitch hypothesis is valid not only in the extratropical region, but also in the tropics; the snow thickness in the tropical region is inversely proportional to the maximum monthly insolation received in this region.
Hypothyroidism Complicated by Vitamin C and Thiamin Deficiency in Surgical Patients
Authors: Bonatti Hugo J. R. , Gona Sridhar Rao , Feaga Catherine , George Aaron E.
Published: June 2023

Multiple vitamin deficiencies together with endocrinopathy may be encountered in individuals presenting with critical illness. Following the surprise postmortem diagnosis of concomitant scurvy, Wernicke, and hypothyroidism in an elderly woman presenting with a mix of atypical symptoms, patients considered at risk were tested for TSH, vitamin C, and thiamin levels. Between September 1, 2018, and December 31, 2022, 801 vitamin C levels in 679 patients were measured in our rural hospital and 309 (39%) were found <0.4 mg/dL. In this population, 39% of 626 thiamin levels were found to be low. Twenty-two patients with vitamin C and/or thiamin deficiency and elevated TSH levels were identified. Two patients died from scurvy; one also had myxedema. The incidence of vitamin C and thiamin deficiency in our patient population was higher than expected. Further studies should determine if this is unique to our rural setting or part of a bigger trend associated with poor dietary choices.
Gallstone Ileus With Persistent Cholelithiasis and Choledocholithiasis
Authors: Ayres Megan , Kim Cecelia , Ramos Trevy , Burns Bracken
Published: June 2023

Gallstone ileus is an uncommon but well-described occurrence in general surgery. However, discrepancy regarding optimal surgical management with 1 or 2 stage operation is still debated. This case report presents a 73-year-old woman who presented to the emergency department (ED) with a small bowel obstruction due to a gallstone lodged in a portion of the proximal ileum. The patient was also noted to have persistent cholelithiasis and cholecystoduodenal fistula. A single-stage surgery involving enterolithotomy, cholecystectomy, fistula repair, and cholangioscopy was performed. The patient progressed well and was discharged home without recurrent symptoms. Therefore, in a hemodynamically stable patient with persistent cholelithiasis or choledocholithiasis, it is reasonable to perform a definitive single-stage operation.
Learning Curves in Establishing a New Minimally Invasive Pancreas Program
Authors: Park Joon Y. , Mirzaie Sarah , Premji Aly , Seo Youngji , Mederos Michael , Hines Joe , Donahue Timothy , Tomlinson James , King Jonathan , Girgis Mark
Published: June 2023

Introduction

Robotic pancreaticoduodenectomy (rPD) is a complex operation with a reported learning curve of 80 cases. Two recent graduates of a formal robotic complex general surgical oncology training program have been performing rPD at our institution since 2016, which had no previous institutional experience with rPD.

Objective

To evaluate the learning curve associated with developing a new robotic pancreaticoduodenectomy (rPD) program by fellowship trained surgeons with institutional support.

Methods

Sixty patients undergoing rPD from 2016 to 2022 were reviewed for and compared with proficiency benchmarks set by the University of Pittsburg experience.

Results

By 30 cases, operative time met the proficiency benchmark of 391 minutes. Additionally, the entire cohort had comparable rates of clinically relevant postoperative pancreatic fistula (6.7% vs 3%, P = .6), 30-day mortality (0% vs 3%, P = .18), major complications (Clavien >2; 23% vs 17%, P = .14), and length of stay (6 vs 7 days, P = .49) when compared to the benchmark.

Conclusion

Perioperative outcomes were comparable to proficiency benchmarks from initiation of the new rPD program, and operative time reached proficiency benchmark by 30 cases. This data suggests that graduates of formal rPD training programs can safely establish new minimally invasive pancreas programs at sites with no previous institutional rPD experience.
Prospective Assessment of Social Determinants of Health and Length of Stay Among Emergency General Surgery and Trauma Patients
Authors: DePolo Nicole , Bathan Karen , Tran Zachary , Peng Jiahao , Singh Pramil , Lum Sharon S. , Wu Esther
Published: June 2023

Background

Social determinants of health (SDOH) including insurance and substance use affect 50-90% of health outcomes, yet there remains no standard means to quantify or predict their impact. We prospectively evaluated the effects of SDOH on length of stay (LOS) and readmissions among emergency general surgery (EGS) and trauma patients. We compared these outcomes with Medicare Diagnosis Related Group (DRG) data to better quantify the impact of SDOH.

Methods

Adult (≥18 years old) EGS/trauma patients admitted July 7-28, 2020 at a Level 1 trauma center were prospectively enrolled. Primary outcomes were overall LOS, one-year readmissions, and excess LOS (eLOS), defined as days beyond DRG mean LOS.

Results

Assessment of SDOH among the 52 patients enrolled revealed that 5.8% of patients were homeless; 26.9% experienced substance abuse; 13.5% were uninsured on admission; and 7.7% on discharge. Mean LOS was 5 ± 4 days; 1-year readmission rate 25.0%; eLOS mean 1.75 ± 2.4 days. LOS was associated with substance use (OR 70.6 95% CI 11.7-160.4). eLOS was associated with substance use (OR 6.1, 95% CI 1.5-25.1) and public or no insurance (OR 26.0, 95% CI 4.9-138.1). No correlations were found between SDOH and readmission rates.

Discussion

EGS and trauma patients experience high rates of negative SDOH which affect clinical outcomes including LOS and readmissions. Medicare DRG determined eLOS is a fiscally relevant measure of the impact of SDOH and differs from LOS and readmissions. Further investigation is required to determine if eLOS can delineate the effects of other SDOH on admission outcomes for this patient population.
Assessment of Near-Infrared and Raman Spectroscopy as Analytical Tools to Predict Viscosity of Ice Cream Mixes
Authors: Cruz Carolina , Arafeh Ali , Martin Philip A. , Fonte Cláudio P. , De Simone Antonio , Oppong Felix K. , Jeatt Will , Rodgers Thomas L.
Published: June 2023

Ice cream is a complex product containing four different phases that affect its microstructure. Viscosity is a critical ice cream quality parameter that is typically measured using off-line methodologies, such as rheometry. In-line viscosity measurements allow continuous and instant analysis compared to off-line methodologies, yet they still constitute a challenge. This work focused on the preliminary study of the potential application of near-infrared (NIR) and Raman spectroscopy as analytical tools to assess the viscosity of ice cream mixes. Historically, partial least squares regression (PLSR) is a standard algorithm used for analysis of spectral data and in the development of predictive models. This methodology was implemented over a range of viscosity values, obtained by varying the ice cream fat content and homogenization conditions. Individual PLSR models showed some predictive ability and better performance compared to the integrated model obtained by data fusion. Lower prediction errors and higher coefficients of determination were obtained for NIR, making this technique more suitable based on model performance. However, other considerations should be accounted during the selection of the best method, such as implementation limitations. This study offers a preliminary comparison of the spectroscopic methods for quantitative analysis of viscosity of aged ice cream mixes and a starting point for an in-situ application study.
Publication of foreigners’ human rights abuses and retaliation between Convention Against Torture (CAT) states
Authors: Nisser Sara Kahn
Published: June 2023

Institutions that monitor violations of human rights, particularly of victims living outside their home countries, will often name the victims’ countries of origin in their reports. This article looks at this understudied practice and argues that it unintentionally creates bilateral retaliation dynamics between the victims’ home country and the country violating the victims’ rights. The article defines retaliation and explains why countries care about violations of their citizens’ rights that take place abroad. Through empirical analysis, the article shows that countries retaliate in response to violations of their citizens’ rights which have been identified and publicized by the UN Committee Against Torture. I use a new dyadic dataset on the abuse of foreigners’ human rights, as identified by Amnesty International and the Committee Against Torture, to test the hypothesis that a country's abuse of foreigners from a peer country is associated with that peer country's abuse of rights of citizens from the observed country. I then examine the Syrian–Lebanese case to trace the process of retaliation. These analyses support the hypothesis that countries retaliate against violations of their citizens’ rights abroad.
Effect of Tooth Loss on Cognitive Function among Older Adults in Singapore
Authors: Kiuchi S. , Cooray U. , Aida J. , Osaka K. , Chan A. , Malhotra R. , Peres M.A.
Published: June 2023

Evidence suggests a longitudinal association between tooth loss and cognitive function. However, the temporality of this association is not well understood. We investigated the effect of several emulated tooth loss prevention scenarios on cognitive function. We used data from 3 waves (baseline: 2009, second wave: 2011–2012, and third wave: 2015) of the Panel on Health and Ageing of Singaporean Elderly (PHASE). PHASE targeted older adults, aged ≥60 y, in Singapore. Number of teeth was used as a time-varying exposure (baseline, second wave). Cognitive function (Short Portable Mental Status Questionnaire score) in the third wave was assessed as the outcome. Multiple time-invariant (baseline) and time-varying (baseline and second wave) covariates were included. The “longitudinal modified treatment policy approach” combined with targeted minimum loss–based estimation was used to define and estimate additive effects of emulated tooth loss prevention scenarios. Emulated scenarios were the following: what if edentate people retained 1 to 4 teeth (scenario 1), what if those with <5 teeth retained 5 to 9 teeth (scenario 2), what if those with <10 teeth retained 10 to 19 teeth (scenario 3), and what if everyone retained ≥20 teeth (scenario 4)? A total of 1,516 participants, excluding those with severe cognitive impairment, were included (male: 41.6%). The mean age at baseline was 70.6 y (SD = 7.1). The mean SPMSQ score at baseline was 2.06 (SD = 0.02) for edentulous, 1.55 (SD = 0.04) for 1 to 4 teeth, 1.61 (SD = 0.03) for 5 to 9 teeth, 1.73 (SD = 0.02) for 10 to 19 teeth, and 1.71 (SD = 0.02) for ≥20 teeth. Additive effect of hypothetical intervention gradually increased with intensity of prevention from scenario 1 to scenario 4 (scenario 1: −0.02 [95% CI, −0.08 to 0.04], scenario 2: −0.05 [95% CI, −0.11 to −0.00], scenario 3: −0.07 [95% CI, −0.14 to −0.00], scenario 4: −0.15 [95% CI, −0.23 to −0.06]). Emulated tooth loss prevention interventions were associated with better cognitive function score. Therefore, preventing tooth loss could potentially benefit maintenance of cognitive function among older adults.
Is There Such a Thing as Theological Medicine?
Authors: von Schwarz Ernst R. , Vartanian Karine , Schwarz Aubriana Angel , de Kiev Laurent Cleenewerck
Published: June 2023

The idea that science must be understood in existential contradiction to religion and even theology is more of a conviction than a philosophical or experiential necessity. Indeed, we may now propose “Theological Medicine” as a new terminology for a perennial reality: that most physicians, health care providers, patients, and their caretakers experience the reality of illness within a theological framework, at least for those who have some degree of spiritual or religious belief. Developing a curriculum in Theological Medicine could develop a mechanism to offer appropriate training to healthcare providers. Such a course would have to be created and delivered by experienced physicians and nursing staff, spiritual advisors, clergy representatives such as pastors or priests from different churches or faith communities, bioethicists, psychologists, social workers, psychotherapists, patient support group members, members of institutional review boards, researchers, and even legal advisors, if available. Continuing professional education requirements also create an opportunity to introduce and evaluate competency in theological medicine, an emerging discipline that could add significant value to the lived experience of medical practice which remains based on the uniquely rich relationship between physician and patient.
The Relationship Between Stress and Resilience of Nurses in Intensive Care Units During the COVID-19 Pandemic
Authors: Aqtam Ibrahim , Ayed Ahmad , Toqan Dalia , Salameh Basma , Abd Elhay Eman Sameh , Zaben Kefah , Mohammad Shouli Mustafa
Published: June 2023

The coronavirus infection COVID-19 has been a risk to world health, particularly for individuals who are vulnerable to it. Critical care nurses have described experiencing extremely high levels of stress under these struggling conditions. This study aimed to assess the relationship between stress and resilience of intensive care unit nurses during the COVID-19 pandemic. A cross-sectional study was conducted on 227 nurses who are working in the intensive care units in the West Bank hospitals, Palestine. Data collection utilized the Nursing Stress Scale (NSS) and the Brief Resilient Coping Scale (BRCS). Two hundred twenty-seven intensive care nurses completed the questionnaire; (61.2%) were males, and (81.5%) had documented COVID-19 infection among their friends, family, or coworkers. Most intensive care nurses reported high levels of stress (105.9 ± 11.9), but low levels of resilience (11.0 ± 4.3). There was a moderate negative correlation between nurses’ stress and their resilience ( P < .05) and a small to moderate negative correlation between nurses’ stress sub-scales and resilience ( P < .05). Also, the results revealed a statistically significant difference between the stress score mean and the nurses who had documented COVID-19 infection among their friends, family, or coworkers ( P < .05), and between the resilience mean score and the nurses’ gender ( P < .05). During the COVID-19 outbreak, intensive care nurses’ stress levels were high, and their resilience was low. Thus, controlling nurses’ stress levels and identifying possible stress sources related to the COVID-19 pandemic are important to maintain patients’ safety and improve the quality of care.
The Political Embeddedness of Voluntary Action: The Case of Local Philanthropic COVID-19 Relief Funds
Authors: Paarlberg Laurie E. , Ai Jin , LePere-Schloop Megan , Walk Marlene
Published: June 2023

Scholars and policymakers have long been interested in the complex relationships between political institutions and voluntary collective action. However, the reciprocal nature of their relationships complicates empirical analysis: voluntary action supports democratic institutions and political institutions enable voluntary action. This article examines the relationship between political institutions and the activation of local voluntary action in the context of COVID-19 funds managed by community philanthropic organizations. We find that political engagement, policy signaling, and political competition all support the emergence of a COVID-19 fund. The findings advance our understanding of the significant role that political institutions play in activating voluntary action.
Assessment of the Elderly Adult Patients with Deep Neck Infection: A Retrospective Study
Authors: Hsiao Fu-Yuan , Ho Chia-Ying , Chan Kai-Chieh , Wang Yu-Chien , Chin Shy-Chyi , Chen Shih-Lung
Published: June 2023

Background: Deep neck infection (DNI) is a potentially lethal infectious disease affecting middle-aged adults and can compromise the airway. There are limited data on the prognosis and outcomes of elderly (aged > 65 years) DNI patients, who tend to be immunocompromised. This study analyzed the clinical characteristics of elderly and adult (aged 18-65 years) DNI patients. Methods: Between November 2016 and November 2022, 398 patients with DNIs, including 113 elderly patients, were admitted to our hospital and enrolled in this study. The relevant clinical variables were investigated and compared. Results: The elderly DNI patients had longer hospital stays ( P < .001), higher C-reactive protein levels ( P = .021), higher blood sugar levels ( P = .012), and a higher likelihood of diabetes mellitus ( P = .025) than the adult patients. The higher blood sugar level is an independent risk factor for elderly (odds ratio = 1.005, 95% confidence intervals 1.002-1.008, P < .001). Moreover, the rates of intubation to protect the airway ( P = .005) and surgical incision and drainage (I&D; P = .010) were higher in the elderly group. However, there were no group differences in pathogen distributions. Conclusion: The elderly DNI patients in this study had a more severe disease course, and poorer prognosis than the adult patients, as well as higher rates of intubation and I&D. However, the pathogen distributions did not differ significantly between the groups. Prompt intervention and treatment are important for elderly DNI patients.
Non-GAAP Disclosure Following Going Concern Opinions
Authors: Liu Junjun
Published: June 2023

This paper examines whether firms change their non-GAAP reporting behavior after receiving a first-time going concern opinion (GCO). I find that the likelihood of disclosing non-GAAP earnings decreases while the quality of disclosed non-GAAP earnings increases following the receipt of a first-time GCO. The results are consistent with the notion that managers change their non-GAAP reporting behavior during the period of heightened investor scrutiny. Further analyses indicate that such changes in non-GAAP disclosure are more pronounced in firms with weaker corporate governance.
Assessment of cardiac load-responsiveness in veno-arterial extracorporeal life support: A case series
Authors: Cornelisse Y , Weerwind PW , Bol ME , Simons AP
Published: June 2023

Introduction

Well-timed explant of veno-arterial extracorporeal life support (V-A ECLS) depends on adequate assessment of cardiac recovery. Often, evaluation of cardiac recovery consists of reducing support flow while visualizing cardiac response using transoesophageal echocardiography (TEE). This method, however, is time consuming and based on subjective findings. The dynamic filling index (DFI) may aid in the quantitative assessment of cardiac load-responsiveness. The dynamic filling index is based on the relationship of support flow and pump speed, which varies with varying hemodynamic conditions. This case series intends to investigate whether the DFI may support TEE in facilitating the assessment of cardiac load-responsiveness.

Methods

Measurements for DFI-determination were performed in seven patients while simultaneously assessing ventricular function by measuring the aortic velocity time integral (VTI) using TEE. Measurements consisted of multiple consecutive transient speed manipulations (∼100 r/min) during weaning trials, both at full support and during cardiac reloading at reduced support.

Results

The VTI increased between full and reduced support in six weaning trials. In five of these trials DFI decreased or remained equal, and in one case DFI increased. Of the three trials in which VTI decreased between full and reduced support, DFI increased in two cases and decreased in one case. Changes in DFI, however, are mostly smaller than the detection threshold of 0.4 mL/rotation.

Conclusion

Even though current level of accuracy of the parameter requires further investigation to increase reliability and possibly predictability, DFI seems likely to be a potential parameter in supporting TEE for the assessment of cardiac load-responsiveness.