bluuebunny/crossref_metadata_2025 huggingface dataset:
Advanced Design and Comparative Analysis of Methanol Production Routes from CO2 and Renewable H2: via Syngas vs. Direct Hydrogenation Processes
Authors: Cho Seolhee , Do Thai Ngan , Kim Jiyong
Published: September 2023

In this study, we propose two advanced processes, i.e., advanced syngas-to-methanol (AS2M) and direct CO2-to-methanol (DC2M) processes, for methanol production using waste CO2 and renewable H2 as feedstock. The AS2M process produces methanol from syngas after converting CO2 to CO via reverse water-gas shift and separating CO from a mixture through pressure swing adsorption. In comparison, the DC2M process directly synthesizes methanol from CO2 through direct hydrogenation. Different unit processes and recycles were synthesized to determine the optimal process configurations and operating conditions for maximizing the methanol production rate. The technoeconomic and environmental capabilities of the two proposed processes were analyzed with four evaluation criteria (carbon and energy efficiencies, CO2 reduction, and unit production cost) and compared with conventional CO2-to-methanol processes. A sensitivity analysis for various utilities and H2 supply strategies was performed to evaluate the economic feasibility and environmental benefits of the proposed systems with different design options. Our findings showed that both processes could achieve improved technical, economic, and environmental performances compared to conventional processes. In particular, the DC2M process showed the lowest unit production cost at $1.02/kg because of its simple configuration and mild operating conditions.
PTH-Related Protein Assays in Advanced Kidney Disease: Implications for Evaluation of Hypercalcemia
Authors: Woldemichael Jobira A. , Pirela Andres D. , Freedman Barry I.
Published: September 2023

Hypercalcemia is a common and potentially serious electrolyte abnormality that is often observed in patients with chronic kidney disease (CKD). When malignancy is considered, parathyroid hormone-related protein (PTHrP) levels are often measured. PTHrP is produced by cancer cells and mimics the effects of parathyroid hormone (PTH) to elevate serum calcium concentrations. The amino and carboxy termini of PTHrP are of functional relevance. C-terminal PTHrP levels accumulate with CKD and can be elevated in normocalcemic CKD patients who lack malignancy. The existence of amino (N)-terminal and carboxy (C)-terminal PTHrP assays and how their concentrations are impacted by CKD are reviewed herein. The case of a patient on maintenance hemodialysis who developed prolonged hypercalcemia with elevated PTHrP concentrations is presented. The workup revealed suppressed intact PTH, low 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D levels. The initial PTHrP assay returned elevated. However, it was unappreciated that it was the C-terminal assay and the patient underwent an unnecessary search for malignancy. A subsequent N-terminal PTHrP assay returned within the normal range. Many commercial labs run the C-terminal PTHrP assay as their first-line test. This can lead to inaccurate differential diagnoses in hypercalcemic patients with CKD. We emphasize the need to specifically request N-terminal PTHrP assays in patients with advanced kidney disease when humoral hypercalcemia of malignancy is suspected.
Elevator Ventilation and SARS-CoV-2-Relevant Particulate Matter Removal in Three Older California Elevators
Authors: Kado Michael J. , Perttula Kelsi , Noth Elizabeth M. , Moore David , Nguyen Patton Khuu , Perrino Charles , Nicas Mark , Hammond S. Katharine
Published: September 2023

The objective of this study was to measure particulate matter (PM) total loss rates in three older (1940s, 1960s, and 1980s) elevators in California during two phases and three low-cost intervention modes. Tracer gas decay and <2 μm aerodynamic diameter nontoxic NaCl particles (PM2) were used to calculate PM2 loss rates. The NaCl particles were considered surrogates for smaller particles carrying SARS-CoV-2. Empirical PM2 loss rates were paired with modeled dynamic scenarios to estimate SARS-CoV-2-relevant PM2 removal. Mean loss rates (hr-1) ranged from 1.8 to 184. Compared to a closed-door, stationary elevator, the moving elevators had a fourfold increased mean loss rate (hr-1), while an air cleaner in a stationary elevator increased the mean loss rates sixfold. In a dynamic particle removal simulation of a ten-story elevator, PM was removed 1.38-fold faster with an air cleaner intervention during bottom and top floor stops only (express ride) and 1.12-fold faster with an air cleaner during every other floor stops. The increase in removal rates due to the air cleaner was modest due to the higher moving and open-door removal rates, except during stationary phase. The half-life of PM2 particles in a stationary elevator after all passengers have left can be 8-12 minutes following a single emission and 2-5 minutes with an air cleaner. The low particle removal rate in the stationary elevator requires an intervention so that the particle removal rate will be high to eliminate infectious aerosol. If codes permit, keeping the door open when the elevator is stationary is most effective; otherwise, an air cleaner in a stationary elevator should be used. While an air cleaner is commonly seen as a substantial improvement in reducing potential virus concentration in air, in the moving elevator scenarios, the effect is quite modest. This paper provides empirical particle loss rates inside elevators, the effectiveness of air cleaners in a dynamic elevator space, two approaches to control infectious agents while the elevator is stationary, and support for a precautionary approach towards elevator use amidst a pandemic.
Early Diagnostic Value of KIM-1, NGAL, and NLR in Acute Kidney Injury Caused by Diquat Poisoning
Authors: Liu Tiezhen , Liu Qian , Qi Hongna , Xu Wenpin , Gao Xun , Wang Weizhan , Zhu Baoyue
Published: September 2023

Background. The kidney is the main excretory organ after diquat absorption. Acute kidney injury (AKI) is a common complication in diquat poisoning patients. Objectives. To identify the value of combined detection of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and neutrophil-lymphocyte ratio (NLR) in the early diagnosis of diquat-induced AKI. Materials and Methods. The retrospective cohort study included 42 diquat poisoning patients. Results. Forty-two patients with diquat poisoning were included, of which 20 had fulminant poisoning (47.6%). At admission (0 h), levels of KIM-1, NGAL, NLR, and acute physiology and chronic health evaluation (APACHE) II scores in the fulminant poisoning group were higher than that of the moderate to severe poisoning group (

P

 < 0.05), and they were all higher than in the control group (

P

 < 0.05), while blood urea nitrogen (BUN) and uric acid (UA) levels did not significantly differ across the three groups (

P

 > 0.05). At 12 h and 24 h, the levels of KIM-1, NGAL, NLR, UA, BUN, and APACHE II scores of patients in the fulminant poisoning group were higher than those in the moderate to severe poisoning group (

P

 < 0.05), 12 h were higher than 0 h, and 24 h were higher than 12 h (

P

 < 0.05). Among 42 patients with diquat poisoning, 28 had AKI (66.7%). At 0 h, the AKI group had higher levels of KIM-1, NGAL, NLR, and APACHE II scores than in the non-AKI (NAKI) group (

P

 < 0.05), while there was no significant difference in BUN and UA levels between the two groups (

P

 > 0.05). At 12 h and 24 h, the levels of KIM-1, NGAL, NLR, UA, BUN, and APACHE II scores in the AKI group were higher than those in the NAKI group (

P

 < 0.05), 12 h were higher than 0 h, and 24 h were higher than 12 h (

P

 < 0.05). KIM-1, NGAL, and NLR are independent risk markers for AKI in diquat poisoning patients. At admission (0 h), the combined application of KIM-1, NGAL, and NLR’s sensitivity, specificity, and area under the curve (AUC) for predicting AKI in diquat poisoning patients was 0.893, 0.859, and 0.903, respectively. Conclusions. KIM-1, NGAL, and NLR can be employed as early diagnostic indicators for the clinical prediction of AKI in diquat poisoning patients. Our findings may help clinicians reduce the occurrence of AKI.
ZleepNet: A Deep Convolutional Neural Network Model for Predicting Sleep Apnea Using SpO2 Signal
Authors: Chaw Hnin Thiri , Kamolphiwong Thossaporn , Kamolphiwong Sinchai , Tawaranurak Krongthong , Wongtanawijit Rattachai
Published: September 2023

Sleep apnea is one of the most common sleep disorders in the world. It is a common problem for patients to suffer from sleep disturbances. In this paper, we propose a deep convolutional neural network (CNN) model based on the oxygen saturation (SpO2) signal from a smart sensor. This is the reason why we called ZleepNet a network for sleep apnea detection. The proposed model includes three convolutional layers, which include ReLu activation function, 2 dense layers, and one dropout layer for predicting sleep apnea. In this proposed model, the use of signals for detecting the sleep apnea can be reduced from 25 sensors to 1 sensor. We conducted experiments to evaluate the performance of the proposed CNN using real patient data and compared them with traditional machine learning methods such as least discriminant analysis (LDA) and support vector machine (SVM), baggy representation tree, and artificial neural network (ANN) on publicly available sleep datasets using the same parameter setting. The results show that the proposed model outperformed the other methods with the accuracy of 91.30% with the split rate of 0.2% in which the training data are 20% and testing data are 80%. The accuracy of the proposed CNN is 90.33% when compared with the LDA which achieved 86.5% accuracy with the split rate of 0.5% in which training data are 50% and testing data are 50%. It achieved 91.56% accuracy when compared with the support vector machine (SVM) in which training data are 70% and testing data are 30%. The achieved accuracy of the proposed CNN is 91.89% when compared with bagging representation tree in which training data are 90% and testing data are 10%. The accuracy of the proposed CNN is 91.30% in which training data are 83% and testing data are 17% when compared with artificial neural networks (ANN).
RANK Expression as an Independent Predictor for Response to Neoadjuvant Chemotherapy in Luminal-Like Breast Cancer: A Translational Insight from the GeparX Trial
Authors: Link Theresa , Blohmer Jens-Uwe , Schmitt Wolfgang D. , Kuhlmann Jan Dominik , Just Marianne , Untch Michael , Stotzer Oliver , Fasching Peter A. , Thill Marc , Reinisch Mattea , Schneeweiss Andreas , Wimberger Pauline , Seiler Sabine , Huober Jens , Jackisch Christian , Rhiem Kerstin , Hanusch Claus , Sinn Bruno V. , Nekljudova Valentina , Loibl Sibylle , Denkert Carsten
Published: September 2023

Purpose:

The GeparX study investigated whether denosumab as add-on treatment to nab-paclitaxel–based neoadjuvant chemotherapy (NACT) with two different schedules (125 mg/m² weekly vs. day 1, 8 every 22 days) may increase pathologic complete response (pCR) rate. The addition of denosumab to NACT did not improve pCR rates as recently published. In this study, we investigated whether receptor activator of nuclear factor-kappa B (RANK) expression, as part of the denosumab target pathway: (i) may retrospectively identify a subgroup of patients with additional clinical benefit of denosumab or (ii) may predict response to nab-paclitaxel NACT.

Experimental Design:

RANK protein was IHC-stained on pre-therapeutic core biopsies from patients of the GeparX study (n = 667) with the antibody RANK/Envision System HRP (DAB) and was analyzed for the percentage of membranous RANK tumor cell staining (>5% RANKhigh vs. ≤5% RANKlow).

Results:

We could not identify any patient subgroup with differential response under denosumab add-on treatment in patients with RANKhigh expression [139/667, 20.8%; OR, 0.86; 95% confidence interval (CI), 0.44–1.68; P = 0.667] or RANKlow expression (528/667 (79.2%) OR, 1.10; 95% CI, 0.78–1.56; P = 0.589; Pinteraction = 0.528). However, the pCR rate was higher in the RANKhigh subgroup compared with RANKlow (50% vs. 39%; OR, 1.52; 95% CI, 1.04–2.21; P = 0.037). RANK expression constituted an independent predictor of response to NACT frequently in patients with luminal-like subtype (HR+/HER2−; OR, 2.98; 95% CI, 1.30–6.79; P = 0.010). No predictive value of RANK expression among the different nab-paclitaxel regimens was observed.

Conclusion:

We report RANK expression to be an independent predictive biomarker for response to NACT in patients with luminal-like breast cancer.
Novel Clinical Trial Designs with Dose Optimization to Improve Long-term Outcomes
Authors: Thall Peter F. , Zang Yong , Chapple Andrew G. , Yuan Ying , Lin Ruitao , Marin David , Msaouel Pavlos
Published: September 2023

Conventional designs for choosing a dose for a new therapy may select doses that are unsafe or ineffective and fail to optimize progression-free survival time, overall survival time, or response/remission duration. We explain and illustrate limitations of conventional dose-finding designs and make four recommendations to address these problems. When feasible, a dose-finding design should account for long-term outcomes, include screening rules that drop unsafe or ineffective doses, enroll an adequate sample size, and randomize patients among doses. As illustrations, we review three designs that include one or more of these features. The first illustration is a trial that randomized patients among two cell therapy doses and standard of care in a setting where it was assumed on biological grounds that dose toxicity and dose–response curves did not necessarily increase with cell dose. The second design generalizes phase I–II by first identifying a set of candidate doses, rather than one dose, randomizing additional patients among the candidates, and selecting an optimal dose to maximize progression-free survival over a longer follow-up period. The third design combines a phase I–II trial and a group sequential randomized phase III trial by using survival time data available after the first stage of phase III to reoptimize the dose selected in phase I–II. By incorporating one or more of the recommended features, these designs improve the likelihood that a selected dose or schedule will be optimal, and thus will benefit future patients and obtain regulatory approval.
Sex-Specific Differences in Potent P2Y
12
Inhibitor Use in British Cardiovascular Intervention Society Registry STEMI Patients
Authors: Burgess Sonya N. , Shoaib Ahmad , Sharp Andrew S.P. , Ludman Peter , Graham Michelle M. , Figtree Gemma A. , Kontopantelis Evangelos , Rashid Muhammad , Kinnaird Tim , Mamas Mamas A.
Published: September 2023

BACKGROUND:

Sex-based outcome differences for women with ST-segment–elevation myocardial infarction (STEMI) have not been adequately addressed, and the role played by differences in prescription of potent P2Y
12
inhibitors (P-P2Y
12
) is not well defined. This study explores the hypothesis that disparities in P-P2Y
12
(prasugrel or ticagrelor) use may play a role in outcome disparities for women with STEMI.

METHODS:

Data from British Cardiovascular Intervention Society national percutaneous coronary intervention database were analyzed, and 168 818 STEMI patients treated with primary percutaneous coronary intervention from 2010 to 2020 were included.

RESULTS:

Among the included women (43 131; 25.54%) and men (125 687; 74.45%), P-P2Y
12
inhibitors were prescribed less often to women (51.71%) than men (55.18%;
P
<0.001). Women were more likely to die in hospital than men (adjusted odds ratio, 1.213 [95% CI, 1.141–1.290]). Unadjusted mortality was higher among women treated with clopidogrel (7.57%), than P-P2Y
12
-treated women (5.39%), men treated with clopidogrel (4.60%), and P-P2Y
12
-treated men (3.61%;
P
<0.001). The strongest independent predictor of P-P2Y
12
prescription was radial access (adjusted odds ratio, 2.368 [95% CI, 2.312–2.425]), used in 67.93% of women and 74.38% of men (
P
<0.001). Two risk adjustment models were used. Women were less likely to receive a P-P2Y
12
(adjusted odds ratio, 0.957 [95% CI, 0.935–0.979]) with risk adjustment for baseline characteristics alone, when procedural factors including radial access were included in the model differences were not significant (adjusted odds ratio, 1.015 [95% CI, 0.991–1.039]).

CONCLUSIONS:

Women were less likely to be prescribed prasugrel or ticagrelor, were less likely to have radial access, and had a higher mortality when being treated for STEMI. Improving rates of P-P2Y
12
use and radial access may decrease outcome disparities for women with STEMI.
Reducing Catastrophic Forgetting With Associative Learning: A Lesson From Fruit Flies
Authors: Shen Yang , Dasgupta Sanjoy , Navlakha Saket
Published: September 2023

Catastrophic forgetting remains an outstanding challenge in continual learning. Recently, methods inspired by the brain, such as continual representation learning and memory replay, have been used to combat catastrophic forgetting. Associative learning (retaining associations between inputs and outputs, even after good representations are learned) plays an important function in the brain; however, its role in continual learning has not been carefully studied. Here, we identified a two-layer neural circuit in the fruit fly olfactory system that performs continual associative learning between odors and their associated valences. In the first layer, inputs (odors) are encoded using sparse, high-dimensional representations, which reduces memory interference by activating nonoverlapping populations of neurons for different odors. In the second layer, only the synapses between odor-activated neurons and the odor’s associated output neuron are modified during learning; the rest of the weights are frozen to prevent unrelated memories from being overwritten. We prove theoretically that these two perceptron-like layers help reduce catastrophic forgetting compared to the original perceptron algorithm, under continual learning. We then show empirically on benchmark data sets that this simple and lightweight architecture outperforms other popular neural-inspired algorithms when also using a two-layer feedforward architecture. Overall, fruit flies evolved an efficient continual associative learning algorithm, and circuit mechanisms from neuroscience can be translated to improve machine computation.
Fear of the Wolf: Are Human-Wildlife Conflicts Actually Human-Human Feuds?
Authors: Märcz Lisa , Gibbert Michael
Published: September 2023

This qualitative study explores the opinions of people who criticize the presence of wolves in Germany to understand what lies behind their concerns. It provides an intimate insight into the lives and fears of people and their relation to wolves and contributes to understanding the less considered critics of wolf management. By discussing the links between a fear of wolves, rural identity, and perceptions of nature, this paper proposes to explain how a human-wolf coexistence could still function for those who fail to be included in wolf management endeavors if wolf management added a social guideline on the basis of the presented problems. While a fear of wolves is generally ingrained in German society and wolves pose a real threat to farmed animals, for many people it is dysfunctional interhuman relations that pose a challenge in their coexistence with wolves, and less so the wolves themselves.
Direct Dependence on Philo in the Epistle to the Hebrews
Authors: Grindheim Sigurd
Published: September 2023

The near consensus opinion that the author of Hebrews was not directly influenced by Philo needs to be reevaluated. Even though there are no obvious cases of borrowing, the cumulative weight of the evidence indicates a more linear relationship than what may be accounted for by situating them both within Hellenistic Judaism. A number of parallels are sufficiently detailed to suggest direct dependence. These parallels are of a formal character, such as the metaphor of the dagger and the particular use of the terms ὑπόστασις, ἀρχηγός, τελειόω, ἄθλησις, τεχνίτης, and δημιουργός, as well of a material nature, concerning the development of key ideas, such as the eternal nature of the Son, his Melchizedekian high-priesthood, and the perception of the heavenly sanctuary.
Regulating Surrogacy as a Reproductive Practice in India and Sri Lanka
Authors: Jolly Stellina , Abeyrathna Danushika
Published: September 2023

Sri Lanka and India are desirable surrogacy destinations for various reasons. Although surrogacy can generate greater foreign revenue, it raises ethical and legal difficulties. India enacted the Surrogacy (Regulation) Act 2021 after decades of effort, whereas Sri Lanka continues with unregulated practice. This paper assesses to what extent Sri Lanka may learn from India. To that end, this paper investigates (i) the signifigance of Sri Lanka as a surrogacy destination and the surrounding ethical and legal issues; (ii) the legal validity and the legal framework governing surrogacy in Sri Lanka; (iii) the main characteristics of the legal landscape of surrogacy in India; and (iv) the adequacies and inadequacies of Indian legal approach to the surrogacy to determine the extent to which the Indian model can serve as a template for Sri Lanka. This paper concludes by proposing certain guiding principles for Sri Lanka in developing a legal framework for surrogacy.
Comparative Study of Selected Nigerian and Indian Labour Practices and the Law
Authors: Aina-Pelemo Adetutu Deborah
Published: September 2023

Labour practices include workplace routines like, the conditions of employment, remuneration, trade union, industrial relations, safety and welfare of workers, labour rights and responsibilities, etc. Labour relations are laced with both fair and unfair practices. This study examines the differences and similarities of labour practices in Nigerian and Indian industries, and how their respective courts interpreted their labour laws. The doctrinal research methodology involving systematic review of current legal propositions, cases, statutes, legislation, policies relating to labour practice in Nigeria and India was adopted. The study finds amongst others that both the Nigerian and Indian Labour industries are fraught with unfair labour practices and the rights of workers are the same, but India explicitly provides imprisonment for employer found guilty of unfair labour practices, and Nigerian labour legislation is silent on that. It concludes by recommending a review of Nigerian labour practice legal framework, reflecting some India’s advancement in labour practice.
Popular Participation in Renaissance Siena’s Romanitas Program
Authors: Perez Samantha
Published: September 2023

With no clear textual or physical proof of an ancient Roman settlement, Siena faced considerable challenges to its assumed antiquity in the trecento and quattrocento. The damaging insistence by Giovanni Villani, Leonardo Bruni, and Flavio Biondo, among others, of Siena’s Gallic—and thus non-Roman—origins prompted the Sienese state to develop an elaborate civic program in defense of its antiquity and Roman-ness, or Romanitas. Building upon expanding literature of the republic’s endeavor to manufacture evidence of a Roman foundation, this paper examines the ways in which the general Sienese population engaged this state-endorsed effort to promote classical origins and participated in communal performances that popularized Siena’s Roman identity. Through the celebration of the she-wolf as a symbol of Siena, the continuation of key Roman practices, and spiritual devotion to patron saints selected from the early centuries of the church, the Sienese public proved critical to the success of the Renaissance city’s claim to antiquity.
On the Roles of Precipitation and Entrainment in Stratocumulus Transitions between Mesoscale States
Authors: Hoffmann Fabian , Glassmeier Franziska , Yamaguchi Takanobu , Feingold Graham
Published: September 2023

Stratocumulus occur in closed- or open-cell states, which tend to be associated with high or low cloud cover and the absence or presence of precipitation, respectively. Thus, the transition between these states has substantial implications for the role of this cloud type in Earth’s radiation budget. In this study, we analyze transitions between these states using an ensemble of 127 large-eddy simulations, covering a wide range of conditions. Our analysis is focused on the behavior of these clouds in a cloud fraction (fc) scene albedo (A) phase space, which has been shown in previous studies to be a useful framework for interpreting system behavior. For the transition from closed to open cells, we find that precipitation creates narrower clouds and scavenges cloud droplets for all fc. However, precipitation decreases the cloud depth for fc > 0.8 only, causing a rapid decrease in A. For fc < 0.8, the cloud depth actually increases due to mesoscale organization of the cloud field. As the cloud deepening balances the effects of cloud droplet scavenging in terms of influence on A, changes in A are determined by the decreasing fc only, causing a linear decrease in A for fc < 0.8. For the transition from open to closed cells, we find that longwave radiative cooling drives the cloud development, with cloud widening dominating for fc < 0.5. For fc > 0.5, clouds begin to deepen gradually due to the decreasing efficiency of lateral expansion. The smooth switch between cloud widening and deepening leads to a more gentle change in A compared to the transitions under precipitating conditions.

Significance Statement

By reflecting a substantial fraction of solar shortwave radiation back to space, shallow clouds constitute a major cooling agent in Earth’s radiation budget. To constrain this effect, a profound understanding of cloud cover and cloud albedo is necessary. In this study, we analyze the processes that drive the variability in these cloud properties in stratocumulus clouds, a very common cloud type covering approximately 20% of the globe. For these clouds, we show that changes from low to high or high to low cloud cover are different due to the underlying cloud micro- and macrophysics, elucidating this crucial aspect of aerosol–cloud–climate interactions.
The Cursed Promised Land? Demographic Risk Factors for Homegrown Extremism in the Squatter Enclaves of Mount Elgon Region of Western Kenya
Authors: Amakanji Graham Oluteyo , Okoth Pontian Godfrey , Maloba Edmond Were
Published: September 2023

Globally, conflicts are phenomenal and are caused by multivariate risk factors; however, purely land-use-based conflicts are gradually growing and becoming conspicuous. Authoritative studies project that violent conflicts over land and resource distribution are set to be on the upsurge with the African Continent set to bear the greatest brunt. These are set to take homegrown extremist trajectories thereby redefining global, regional, and national counter-violent extremist architecture. This paper sought to investigate demographic risk factors for homegrown extremism in the squatter enclaves of Mount Elgon region. Using a convergent parallel mixed method research design, primary data were collected from 400 households. Study findings on demographic risk factors for homegrown extremism are an antithesis of conventional Euro-American train of thoughts. The results established that that gender (being both male and female), age (being older) and being married posed a high risk factor to homegrown extremism. The paper recommends the need to expedite multi-stakeholder human development needs based approaches in pursuit to reverse the risk of homegrown extremism in the squatter enclaves of Mount Elgon region, Kenya.
Out-of-autoclave molding of carbon fiber laminates by consolidation with shape memory polymer foams
Authors: Iorio Leandro , Quadrini Fabrizio , Gallo Nicola , Santo Loredana
Published: September 2023

Carbon fiber reinforced (CFR) laminates have been manufactured by an innovative out-of-autoclave (OOA) process thanks to the use of smart materials. In this study, for the first time, a shape memory polymer (SMP) foam has been used into a pressure dome to apply the consolidation pressure to the laminate. Heat for resin curing was supplied by a thermal blanket between the laminate and the SMP foam. In order to test the OOA molding process, 24-ply CFR laminates were manufactured and tested. For comparison and reference, CFR laminates were also molded by traditional vacuum bagging and autoclave curing. Samples for bending tests were extracted from OOA and autoclave molded plates. Results show that the SMP-OOA process is able to provide optimal laminate consolidation, despite of the low applied pressure (about 1 bar). A comparable density and ply thickness was measured on samples by the innovative and the conventional molding process, whereas a higher bending strength (+5%) was found on OOA samples. A higher dispersion was also observed for the properties of SMP-OOA molded laminates in comparison with autoclave, probably due to the prototyping nature of the molding technique in comparison with the well-known autoclave practice. Nevertheless, the final quality of the molded laminates is very high, and the SMP-OOA process is a very promising candidate as a technology to repair CFR structures.
Teenage Resistance to a Parental Threat: Intercepting an Action-in-Progress as a Form of Resistance
Authors: Flint Natalie , Rhys Catrin S.
Published: September 2023

This conversation analytic study explores a single case of a teenager's resistance to a parental threat. Resistance in the conversation analytic literature typically refers to an interactional move that displaces a sequentially relevant or normatively expected next action. A resistant turn, while not aligning with the ongoing course of action, also avoids overtly disaligning with it. In this paper, we make the case for a particular form of resistance that involves intercepting an action-in-progress. In our data, the teenager deploys this form of resistance as an alternative to either complying with or defying a parental threat. More specifically, our analysis shows how the threat recipient uses resources such as complex turn design, projectability and repair to anticipate and resist the projected trajectory of the sequence where the projected trajectory is compliance or defiance. The analysis also explores how participants invoke epistemics and deontics in this context as resources in resistance.
A double cross-linked hydrogel based on water-soluble chitosan and oxidized hyaluronic acid as an antibacterial dressing
Authors: Shi Wenjun , Zhang Quan , Du Lehan , Xie Fan , Shi Junhao , Luan Liang , Lu Jiaju , Kong Xiangdong
Published: September 2023

Quaternary ammonium chitosan (QCS) is a cationic polymer with high antimicrobial properties, but its cations can cause damage to normal cells. Thus, the biocompatibility of QCS in hydrogel dressings should be concerned. In this study, QCS was used as an additive in the preparation of the carboxymethyl chitosan (CMC) and oxidized hyaluronic acid (OHA) hydrogel, and the effect of its content in the hydrogel on antibacterial and biocompatibility was systematically investigated. First, QCS was mixed at a different ratio with CMC to form a QCS/CMC solution. Then, the QCS/CMC solution was added into the OHA solution to obtain the OHA-CMC/QCS hydrogel, which is a double cross-linked network formed by the Schiff base and electrostatic interaction. With the increase of the QCS content in the hydrogel, its mechanical and antibacterial properties were enhanced. The antibacterial rate of OHA-CMC/QCS5 hydrogel with 5% QCS content against Staphylococcus aureus reached 99.80%, and it also showed biocompatibility under the experimental conditions. This work provides a theoretical basis for the use of QCS to prepare the hydrogels that are both antibacterial and biocompatible. The prepared OHA-CMC/QCS5 hydrogel is an ideal candidate for antimicrobial dressings.
Performance characteristics of a prototype dialysate turbidity monitoring system to detect peritonitis in patients receiving peritoneal dialysis
Authors: Briggs Benjamin , Garcia-Garcia Guillermo , Ibarra-Hernandez Margarita , Alcantar-Vallin Luz , Walker Gary , Yu Eric , ElBadry Aly , Fisher Brian , Williamson Don , Chertow Glenn M
Published: September 2023

Background:

The risk of peritonitis has limited wider adoption of peritoneal dialysis (PD) in the United States. We developed a prototype bedside dialysate turbidity monitoring system, aiming to improve diagnostic accuracy relative to conventional approaches which depend on visual inspection and reporting of insensitive and non-specific symptoms.

Methods:

The prototype system was tested in a single-centre, proof-of-principle clinical study in patients receiving intermittent PD. We obtained multiple effluent dialysate samples from each consenting participant. We compared turbidity measurements with diagnostic criteria endorsed by the International Society of Peritoneal Dialysis (ISPD).

Results:

Overall, we analysed 983 specimens from 65 patients, including 105 samples from patients with peritonitis and 878 samples from patients without peritonitis. An operating point derived from a previous in vitro study yielded an unadjusted sensitivity and specificity of 95.2% and 91.5%, respectively. The majority of samples that did not meet ISPD diagnostic criteria were either cases detected before criteria were met or were related to active peritonitis treatment and resolution.

Conclusion:

This proof-of-principle study demonstrates the feasibility and diagnostic accuracy of a prototype dialysate turbidity monitoring system for peritonitis surveillance.
Navigating Choppy Water: Flexibility Ripple Effects in the COVID-19 Pandemic and the Future of Remote and Hybrid Working
Authors: Wheatley Daniel , Broome Matthew R. , Dobbins Tony , Hopkins Benjamin , Powell Owen
Published: September 2023

This article investigates the challenges of navigating the adoption of remote and hybrid working for large organizations with diverse functions. Focus groups with employees of the UK business of a multinational organization identify conceptual contributions to the sociology of work and employment and empirical findings in the context of the COVID-19 pandemic that inform future policy and practice. Location-based flexible working has a potential unintended ‘ripple’ effect wherein application of individual-level flexibility has wider-reaching consequences throughout the organization. Findings emphasize that organizations need to recognize and respond to new realities of location-based flexibility. Management must navigate potential ‘ripples’ in the development of flexible working policies and practice, shaped by various tensions, including an overarching autonomy–control paradox. This requires a coordinated approach centred on ‘inclusive flexibility’ and ‘responsible autonomy’ that involves moving away from one-size-fits-all strategies towards a tailored approach offering employees choice, agency and voice in decision-making, while accommodating different stakeholder needs.
Sexual partner referral and associated factors among patients with sexually transmitted disease in Jabi Tehnan district and Finote Selam town
Authors: Dagnew Zewdu , Mistir Limenih , Abebe Nurlign , Alemayehu Mulunesh , Tegegne Eniyew
Published: September 2023

Background

Partner referral (or contact tracing) is an essential approach for preventing sexually transmitted infections. Even though this approach has been used in Ethiopia, there is a scarcity of evidence in Ethiopia particularly in this study area.

Methods

A cross-sectional study was conducted among 397 patients with curable sexually transmitted diseases. Factors associated to the practice of sexual partner referral were explored where variables having a p-value of <0.05 in multivariable analysis were considered statistically significant.

Result

Referrals for sexual partners were found to be 42.4% in this study (95% CI: 35.3, 45.3). Not expecting the end of the relationship among regular partnerships (AOR: 4.8; 95% CI: 1.9, 12.4), perceived risk of reinfection (AOR: 3.0; 95% CI: 1.8, 5.3), perceived self-efficacy (AOR: 3.8; 95% CI: 2.4, 6.3), intention to refer partners (AOR: 3.7; 95% CI: 2.0, 6.4), and knowledge of sexually transmitted infections (AOR: 3.0; 95% CI: 1.8, 5.0) were significantly associated with sexual partner referral.

Conclusions

This study showed that sexual partner referral was low. Perceived risks of reinfection, perceived self-efficacy, anticipating the end of a relationship, intention to refer partners, and knowledge of sexually transmitted infections were significant predictors of sexual partner referral. Intervention endeavors need to consider factors pointed out in this study to improve sexual partner referral.
Research for Cytomegalovirus Mutations Associated With Resistance to Antivirals in Kidney Transplant Receptors
Authors: Sant’ Anna Carla de Castro , Migone Silvia Regina da Cruz , Rocha Carlos Alberto Machado da , Mello Júnior Fernando Augusto Rodrigues , Seabra Aline Damasceno , Pontes Thaís Brilhante , Rodrigues João Marildo , Soares Salomé Aparecida , Rego Viviane de Paiva , Figueira Joana Paula , Rodrigues Ana Paula Monteiro , Burbano Rommel Mario Rodriguez
Published: September 2023

Cytomegalovirus (CMV) mutations associated with antiviral resistance have become a major problem related to high mortality in kidney transplant patients. The aim of the study was to investigate mutations in the CMV genes UL97 and UL54 associated with antiviral resistance. A retrospective observational cohort study was carried out at Hospital Ophir Loyola (HOL), a reference in Kidney Transplantation. A total of 81 patients who underwent kidney transplantation were followed up between 2016 and 2018 were monitored for CMV viral load by performing qPCR. Sanger sequencing was performed on 66 patients. All CMV-positive kidney transplant recipients were included. Mutations were observed in 15 samples (22.72%) from patients. Most cases involved UL97 mutations. Mutation in UL54 without mutation in UL97 was detected in only 2 cases. Resistance mutations in UL97 were identified, such as M460V, L595S, H520Q, two co-mutations D465R + Del524 and A594P + D413A and a 3 codon deletion (del598-601). The search for mutations in the CMV genes identified mutations that confer resistance to conventional antivirals, such as ganciclovir and cidofovir, used in the treatment of these patients. Confirmation of the association with increased CMV viral load in transplanted patients, due to mutation in resistance genes, requires phenotypic analysis for confirmation purposes. These were the first findings in patients in northern Brazil that we know of.
Comparative Efficacy of Conservative Surgery vs Minor Amputation for Diabetic Foot Osteomyelitis
Authors: Schöni Madlaina , Soldevila-Boixader Laura , Böni Thomas , Muñoz Laguna Javier , Uçkay Ilker , Waibel Felix W. A.
Published: September 2023

Background:

There is uncertainty regarding the optimal surgical intervention for diabetic foot osteomyelitis (DFO). Conservative surgery—amputation-free resection of infected bone and soft tissues—is gaining traction as an alternative to minor amputation. Our primary objective was to explore the comparative effectiveness of conservative surgery and minor amputations in clinical failure risk 1 year after index intervention. We also aimed to explore microbiological recurrence at 1 year, and revision surgery risk over a 10-year study period.

Methods:

Retrospective, single-center chart review of DFO patients undergoing either conservative surgery or minor amputation. We used multivariable Cox regression and Kaplan-Meier estimates to explore the effect of surgical intervention on clinical failure (recurrent diabetic foot infection at surgical site within 1 year after index operation), microbiological recurrence at 1 year, and revision surgery risk over a 10-year follow-up period.

Results:

651 patients were included (conservative surgery, n = 121; minor amputation, n = 530). Clinical failure occurred in 34 (28%) patients in the conservative surgery group, and in 111 (21%) of the minor amputation group at 1 year ( P = .09). After controlling for potential confounders, we found no association between conservative surgery and clinical failure at 1 year (adjusted hazard ratio [HR] 1.3, 95% CI 0.8-2.1). We found no between-group differences in microbiological recurrence at 1 year (conservative surgery: 8 [6.6%]; minor amputation: 33 [6.2%]; P = .25; adjusted HR 1.1, 95% CI 0.5-2.6). Over the 10-year period, the conservative group underwent significantly more revision surgeries (conservative surgery: 85 [70.2%]; minor amputation: 252 [47.5%]; P < .01; adjusted HR 1.3, 95% CI 0.9-1.8).

Conclusion:

We found that with comorbidity-based patient selection, conservative surgery in the treatment of DFO was associated with the same rates of clinical failure and microbiological recurrence at 1 year, but with significantly more revision surgeries during follow-up, compared with minor amputations.

Level of Evidence:

Level III, retrospective comparative effectiveness study.
Chinese Women's Acceptance of Intimate Partner Violence Against Women
Authors: Li Carrie K. W. , Liu Jianhong , Chen Xuan
Published: September 2023

Few studies have empirically examined factors influencing attitudes toward acceptance of intimate partner violence (IPV), and no study has yet studied the topic in China. We empirically test the effects of attitudes toward gender roles and exposure to violence during childhood on the acceptance of IPV and the moderating effects of education and income on these relationships. Using survey data collected from 600 Chinese women from southern China, we found that education and income moderate the relationship between belief in gender equality and acceptance of IPV. The effect of exposure to parental physical violence on the acceptance of IPV is moderated by education.
Residential overcrowding in relation to children’s health, environment and schooling – a qualitative study
Authors: Lorentzen Johnny C. , Georgellis Antonios , Albin Maria , Jonsson Marina
Published: September 2023

Aim:

To explore how overcrowding affects children’s health, environment and schooling.

Methods:

A qualitative study was conducted with individual interviews among 20 participants with occupational experience from overcrowded Stockholm areas but diverse in professions, locations and employers. The interviews were recorded, transcribed and analysed with Systematic Text Condensation.

Results:

Almost all participants expressed that overcrowding has a negative impact on children’s health, environment and schooling – based on perceptions of precarious and different living conditions for children in overcrowded areas, for example, substandard homes, vulnerability, stress, exclusion, limited resources, lack of learning opportunities, gender differences, confinement, shame, insecurity, conflicts, risk of criminality, and bodily impact, both physical and psychological.

Conclusions:

Our qualitative evidence suggest that overcrowding has a negative impact on children’s health, environment and schooling.
Establishing an hTERT-driven immortalized umbilical cord-derived mesenchymal stem cell line and its therapeutic application in mice with liver failure
Authors: Chen Qi , Jin Meixian , Wang Simin , Wang Kexin , Chen Liqin , Zhu Xiaojuan , Zhang Ying , Wang Yi , Li Yang , Li Shao , Zeng Youmin , Feng Lei , Yang Wanren , Gao Yi , Zhou Shuqin , Peng Qing
Published: September 2023

Acute liver failure (ALF) is characterized by rapid liver cell destruction. It is a multi-etiological and fulminant complication with a clinical mortality of over 80%. Therapy using mesenchymal stem cells (MSCs) or MSCs-derived exosomes can alleviate acute liver injury, which has been demonstrated in animal experiments and clinical application. However, similar to other stem cells, different cell sources, poor stability, cell senescence and other factors limit the clinical application of MSCs. To achieve mass production and quality control on stem cells and their exosomes, transfecting umbilical cord mesenchymal stem cell (UCMSC) with lentivirus overexpressing human telomerase reverse transcriptase (hTERT) gene, the hTERT-UCMSC was constructed as an immortalized MSC cell line. Compared with the primary UCMSC (P3) and immortalized cell line hTERT-UCMSC at early passage (P10), the hTERT-UCMSC retained the key morphological and physiological characteristics of UCMSC at the 35th passage (P35), and showed no signs of carcinogenicity and toxic effect in mice. There was no difference in either exosome production or characteristics of exosomes among cultures from P3 primary cells, P10 and P35 immortalized hTERT-UCMSCs. Inoculation of either hTERT-UCMSC (P35) or its exosomes improved the survival rate and liver function of ALF mice induced by thioacetamide (TAA). Our findings suggest that this immortalized cell line can maintain its characteristics in long-term culture. Inoculation of hTERT-UCMSC and its exosomes could potentially be used in clinics for the treatment of liver failure in the future.
Association of hyponatremia with bone mineral density and fractures: a narrative review
Authors: Tzoulis Ploutarchos , Yavropoulou Maria P.
Published: September 2023

Recent studies suggest a possible association of hyponatremia with osteoporosis, falls and bone fractures. The objectives of this narrative review were to further explore this association and the related pathophysiological mechanisms and to suggest a practical approach to patients with osteoporosis or chronic hyponatremia in clinical practice. We conducted an extensive PubMed search until October 2022 with the combination of the following keywords: ‘hyponatremia’ or ‘sodium’ or ‘SIADH’ and ‘fractures’ or ‘bone’ or ‘osteoporosis’, as MeSH Terms. Review of numerous observational studies confirms a significant independent association of, even mild, hyponatremia with two- to three-fold increase in the occurrence of bone fractures. Hyponatremia is a risk factor for osteoporosis with a predilection to affect the hip, while the magnitude of association depends on the severity and chronicity of hyponatremia. Chronic hyponatremia also increases the risk for falls by inducing gait instability and neurocognitive deficits. Besides the detrimental impact of hyponatremia on bone mineral density and risk of falls, it also induces changes in bone quality. Emerging evidence suggests that acute hyponatremia shifts bone turnover dynamics towards less bone formation, while hyponatremia correction increases bone formation. The key unanswered question whether treatment of hyponatremia could improve osteoporosis and lower fracture risk highlights the need for prospective studies, evaluating the impact of sodium normalization on bone metabolism and occurrence of fractures. Recommendations for clinical approach should include measurement of serum sodium in all individuals with fracture or osteoporosis. Also, hyponatremia, as an independent risk factor for fracture, should be taken into consideration when estimating the likelihood for future fragility fracture and in clinical decision-making about pharmacological therapy of osteoporosis. Until it is proven that normalization of sodium can lower fracture occurrence, correcting hyponatremia cannot be universally recommended on this basis, but should be decided on a case-by-case basis.