bluuebunny/crossref_metadata_2025 huggingface dataset:
Programmed death ligand 1 expression in diffuse large B cell lymphoma: correlation with clinicopathological prognostic factors
Authors: Ibrahim Eman Mohamad , Refat Sherine , El-Ashwah Shaimaa , Fahmi Maryan Waheeb , Ibrahiem Afaf Taha
Published: May 2023

Background

The prognostic value of the level of programmed death ligand 1 (PD-L1) expression in non-Hodgkin lymphoma (NHL) is still debatable. This study examined the effect of the level of PD-L1 expression on the clinicopathological characteristics and prognosis of diffuse large B cell lymphoma (DLBCL).

Methods

A retrospective study was conducted on formalin-fixed paraffin-embedded tissue blocks of one hundred de novo DLBCL patients diagnosed from 2013 to 2016. PD-L1 expression was defined by a modified Combined-Positive Score (CPS) and their medical records were reviewed to collect their clinical, laboratory and radiological data, treatment, and outcome.

Results

The included patients were aged from 23 to 85 years and treated by rituximab- cyclophosphamide, doxorubicin, oncovin, prednisone (R-CHOP); 49% were males; 85% of the cases were presented at Ann Arbor stages III, IV; 33% of patients were seropositive for HCV and 87% of cases were presented with intermediate and high IPI. All included cases expressed PD-L1 using modified CPS. 27% of patients showed low PD-L1 expression (≥ 5% to < 50% of total tumor cellularity) while 73% of patients showed high PD-L1expression (≥ 50% of total tumor cellularity). High PD-L1 expression is statistically correlated with advanced stage (p 0.01), high IPI score (p 0.017), high incidence of stationary and progressive disease (p 0.002) and high incidence of relapse (p value 0.01). Five-year disease-free survival (DFS) was 29% for patients with high PD-L1 expression compared with 84.8% for patients with low PD-L1 expression (p 0.001).

Conclusions

This study suggests that high PD-L1 expression in DLBCL is associated with aggressive clinicopathological features and a decreased response to R-CHOP. The level of PD-L1 expression could be an independent predictor of DFS of DLBCL. More research is mandatory to standardize the cutoff value and scoring methods.
The terpene synthase (TPS) gene family in kiwifruit shows high functional redundancy and a subset of TPS likely fulfil overlapping functions in fruit flavour, floral bouquet and defence
Authors: Wang Wu , Wang Mindy Y. , Zeng Yunliu , Chen Xiuyin , Wang Xiaoyao , Barrington Anne M. , Tao Jianmin , Atkinson Ross G. , Nieuwenhuizen Niels J.
Published: May 2023

Volatile terpenes are important compounds that influence fruit flavour and aroma of kiwifruit. Terpenes in plants also impact on the floral bouquet and defence against pests and pathogens in leaves and fruit. To better understand the overlapping roles that terpenes may fulfil in plants, a systematic gene, chemical and biochemical analysis of terpenes and terpene synthases (TPS) was undertaken in Red5 kiwifruit (Actinidia spp.). Analysis of the Red5 genome shows it contains only 22 TPS gene models, of which fifteen encode full-length TPS. Thirteen TPS can account for the major terpene volatiles produced in different tissues of Red5 kiwifruit and in response to different stimuli. The small Red5 TPS family displays surprisingly high functional redundancy with five TPS producing linalool/nerolidol. Treatment of leaves and fruit with methyl jasmonate enhanced expression of a subset of defence-related TPS genes and stimulated the release of terpenes. Six TPS genes were induced upon herbivory of leaves by the economically important insect pest Ctenopseustis obliquana (brown-headed leaf roller) and emission, but not accumulation, of (E)- and (Z)-nerolidol was strongly linked to herbivory. Our results provide a framework to understand the overlapping biological and ecological roles of terpenes in Actinidia and other horticultural crops.
Older Adults With Newly Diagnosed AML: Hot Topics for the Practicing Clinician
Authors: Lai Catherine , Bhansali Rahul S. , Kuo Eric J. , Mannis Gabriel , Lin Richard J.
Published: May 2023

Over the past decade, our understanding of AML pathogenesis and pathophysiology has improved significantly with mutational profiling. This has led to translational advances in therapeutic options, as there have been 10 new US Food and Drug Administration (FDA) approvals for AML therapies since 2017, half of which target specific driver mutations in FLT3, IDH1, or IDH2. These new agents have expanded the therapeutic armamentarium for AML, particularly for patients who are considered ineligible for intensive chemotherapy with anthracycline- and cytarabine-containing regimens. These new treatment options are relevant because the median age at diagnosis is 68 years, and outcomes for patients older than 60 years have historically been dismal. However, the optimal approach to incorporating novel agents into frontline regimens remains a clinical challenge, particularly with regard to sequencing of therapies, considering the role of allogeneic hematopoietic stem cell transplantation and managing toxicities.
Developing Sustainable Cancer and Aging Programs
Authors: Hsu Tina , Elias Rawad , Swartz Kristine , Chapman Andrew
Published: May 2023

Geriatric assessment (GA) has been shown to decrease toxicity from systemic therapy, improve completion of chemotherapy, and reduce hospitalizations in older adults with cancer. Given the aging of the cancer population, this has the potential to have a positive impact on the care of a large swath of patients seen. Despite endorsement by several international societies, including the American Society of Clinical Oncology, uptake of GA has been low. Lack of knowledge, time, and resources has been cited as reasons for this. Although challenges to developing and implementing a cancer and aging program vary depending on the health care context, GA is adaptable to every health care context from low- to high-resource settings, as well as those in which geriatric oncology is a well-established or just emerging field. We provide an approach for clinicians and administrators to develop, implement, and sustain aging and cancer programs in a doable and sustainable way.
Stranger Things: New Roles and Opportunities for Androgen Receptor in Oncology Beyond Prostate Cancer
Authors: Leo Javier , Dondossola Eleonora , Basham Kaitlin J , Wilson Nathaniel R , Alhalabi Omar , Gao Jianjun , Kurnit Katherine C , White Michael G , McQuade Jennifer L , Westin Shannon N , Wellberg Elizabeth A , Frigo Daniel E
Published: May 2023

The androgen receptor (AR) is one of the oldest therapeutic targets in oncology and continues to dominate the treatment landscape for advanced prostate cancer, where nearly all treatment regimens include some form of AR modulation. In this regard, AR remains the central driver of prostate cancer cell biology. Emerging preclinical and clinical data implicate key roles for AR in additional cancer types, thereby expanding the importance of this drug target beyond prostate cancer. In this mini-review, new roles for AR in other cancer types are discussed as well as their potential for treatment with AR-targeted agents. Our understanding of these additional functions for AR in oncology expand this receptor's potential as a therapeutic target and will help guide the development of new treatment approaches.
The Hemoglobin Wayne Variant and Association With Falsely Elevated HbA1c
Authors: Mulpuri Neha , Bryant Ananda , Shahin Daryoush , Soe Kyaw
Published: May 2023

The objective of this work is to explain the effect of the clinically silent hemoglobinopathy hemoglobin Wayne (Hb Wayne) variant on glycated hemoglobin A1c (HbA1c) assay. This variant can result in falsely high HbA1c values among euglycemic individuals without diabetes mellitus (DM). We discuss 3 patients who were diagnosed with type 2 DM based on spuriously high HbA1c values due to the presence of Hb Wayne. All 3 patients were found to have elevated HbA1c values that did not correlate with other glycemic parameters such as capillary blood sugar, 2-hour oral glucose tolerance test, and fructosamine levels. Hemoglobin electrophoresis revealed that each patient had a rare hemoglobinopathy called Hb Wayne variant. These patients were reassured that they did not have DM and were able to avoid unnecessary treatment. These cases emphasize the importance of clinical judgment in recognizing the limitations and caveats of the HbA1c test. It is always necessary to investigate further any discordance between HbA1c values and the clinical picture or other glycemic parameters.
Two Girls With Adrenal Insufficiency and Failing Gonads
Authors: Poon Sarah Wing-Yiu , Li Raymond Hang-Wun , Tung Joanna Yuet-Ling
Published: May 2023

Congenital lipoid adrenal hyperplasia (CLAH) is a rare cause of adrenal insufficiency caused by mutations in the steroidogenic acute regulatory (StAR) gene. Patients classically present with adrenal crisis in early infancy and female external genitalia irrespective of chromosomal sex. We report 2 Chinese patients with normal female external genitalia presenting with salt wasting in the neonatal period. However, the diagnosis of CLAH was made only during pubertal years when they developed hypergonadotropic hypogonadism. One of them was subsequently found to have a 46XY karyotype and gonadectomy was performed at age 15 years. The other patient developed gonadal insufficiency and polycystic ovaries after menarche with hemorrhage into ovarian cysts requiring cystectomy. These 2 cases illustrate the importance of recognizing atypical features in neonates presenting with adrenal crisis. In managing the newborn with adrenal insufficiency and female-appearing external genitalia, the possibility of sex reversal and diagnosis of CLAH should be considered. Accurate delineation of internal pelvic organs using reliable imaging modalities or even laparoscopy, together with careful interpretation of clinical and laboratory findings, are crucial to accurate diagnosis and subsequent management.
New-Onset Type 1 Diabetes in a Child With Diabetic Ketoacidosis and Severe Hypertriglyceridemia Without Pancreatitis
Authors: Vitale Rebecca J , Laffel Lori M B
Published: May 2023

Hypertriglyceridemia is a complication of diabetic ketoacidosis (DKA) secondary to insulin deficiency inhibiting lipoprotein lipase and increasing lipolysis, but it is rare in children. A 7-year-old boy with history of autism spectrum disorder (ASD) presented with abdominal pain, vomiting, and “heavy breathing.” Initial laboratory tests revealed pH 6.87 and glucose 385 mg/dL (21.4 mmol/L), consistent with new-onset diabetes and DKA. His blood appeared lipemic; triglycerides were 17 675 mg/dL (199.6 mmol/L) with normal lipase (10 units/L). He received intravenous insulin and DKA resolved within 24 hours. Insulin infusion continued through day 6 for management of hypertriglyceridemia; triglycerides decreased to 1290 mg/dL (14.6 mmol/L) during this period. He never developed pancreatitis (lipase peaked at 68 units/L) or required plasmapheresis. With his ASD history, he had a restrictive diet high in saturated fat, which included up to 30 breakfast sausages daily. His triglycerides normalized after discharge. Severe hypertriglyceridemia can complicate DKA in newly diagnosed type 1 diabetes (T1D). Hypertriglyceridemia can be safely managed with insulin infusion in the absence of end-organ dysfunction. This complication should be considered in patients with DKA at diagnosis of T1D.
Understanding Potentially Preventable Mortality Following Oesophago-Gastric Cancer Surgery: Analysis of a National Audit of Surgical Mortality
Authors: Liu David S. , Fayed Aly , Evans Penelope , Bright Tim , Aly Ahmad , Duong Cuong , Spillane John , Weinberg Laurence , Watson David I.
Published: May 2023

Introduction

At a national level, understanding preventable mortality after oesophago-gastric cancer surgery can direct quality-improvement efforts. Accordingly, utilizing the Australian and New Zealand Audit of Surgical Mortality (ANZASM), we aimed to: (1) determine the causes of death following oesophago-gastric cancer resections in Australia, (2) quantify the proportion of potentially preventable deaths, and (3) identify clinical management issues contributing to preventable mortality.

Methods

All in-hospital mortalities following oesophago-gastric cancer surgery from 1 January 2010 to 31 December 2020 were analysed using ANZASM data. Potentially preventable and non-preventable cases were compared. Thematic analysis with a data-driven approach was used to classify clinical management issues.

Results

Overall, 636 complications and 123 clinical management issues were identified in 105 mortalities. The most common causes of death were cardio-respiratory in aetiology. Forty-nine (46.7%) deaths were potentially preventable. These cases were characterized by higher rates of sepsis (59.2% vs 33.9%, p = 0.011), multiorgan dysfunction syndrome (40.8% vs 25.0%, p = 0.042), re-operation (63.3% vs 41.1%, p = 0.031) and other complications compared with non-preventable mortality. Potentially preventable mortalities also had more clinical management issues per patient [median (IQR): 2 (1–3) vs 0 (0–1), p < 0.001), which adversely impacted preoperative (30.6% vs 7.1%, p = 0.002), intraoperative (18.4% vs 5.4%, p = 0.037) and postoperative (51.0% vs 17.9%, p < 0.001) care. Thematic analysis highlighted recurrent areas of deficiency with preoperative, intraoperative and postoperative patient management.

Conclusions

Almost 50% of deaths following oesophago-gastric cancer resections were potentially preventable. These were characterized by higher complication rates and clinical management issues. We highlight recurrent themes in patient management to improve future quality of care.
Nuclear SRP9/SRP14 heterodimer transcriptionally regulates 7SL and BC200 RNA expression
Authors: Gussakovsky Daniel , Booy Evan P. , Brown Mira J.F. , McKenna Sean A.
Published: May 2023

The SRP9/SRP14 heterodimer is a central component of signal recognition particle (SRP) RNA (7SL) processing and Alu retrotransposition. In this study, we sought to establish the role of nuclear SRP9/SRP14 in the transcriptional regulation of 7SL and BC200 RNA. 7SL and BC200 RNA steady-state levels, rate of decay, and transcriptional activity were evaluated under SRP9/SRP14 knockdown conditions. Immunofluorescent imaging, and subcellular fractionation of MCF-7 cells, revealed a distinct nuclear localization for SRP9/SRP14. The relationship between this localization and transcriptional activity at 7SL and BC200 genes was also examined. These findings demonstrate a novel nuclear function of SRP9/SRP14 establishing that this heterodimer transcriptionally regulates 7SL and BC200 RNA expression. We describe a model in which SRP9/SRP14 cotranscriptionally regulate 7SL and BC200 RNA expression. Our model is also a plausible pathway for regulating Alu RNA transcription and is consistent with the hypothesized roles of SRP9/SRP14 transporting 7SL RNA into the nucleolus for posttranscriptional processing, and trafficking of Alu RNA for retrotransposition.
A study of proton-induced reactions on natural Silicon targets
Authors: Nicolis Nikolaos George , Zafeiri Georgia
Published: May 2023

Experimental excitation functions of isotopes produced in reactions p + natSi are compared with the results of nuclear reaction program TALYS 1.95 and semi-empirical cross section formulas. We consider excitation functions of 7 isotopes (28Mg, 26Al, 24,22Na, 18F and 10,7Be) produced in  reactions at bombarding energies of 20-144 MeV. They are compared with the predictions of the code TALYS 1.95, the semi-empirical formulas of Silberberg-Tsao (code yieldx) and SPACS. Comparisons of the results of the code TALYS 1.95 and previously published results of code ALICE are made. The predictive power of code TALYS 1.95 may be questioned for reaction products with mass number very much smaller than the target and of semi-empirical formulas at lower energies.
The role of temperature on the tidal deformability of an inspiraling binary neutron star system
Authors: Kanakis-Pegios Alkiviadis
Published: May 2023

The detection of gravitational waves emitted by binary neutron star mergers consists a very promising tool for studying the properties of dense nuclear matter. The lack of exact evidence for a zero-temperature scenario regarding the inspiral phase of a coalescing binary neutron star system raises the question of the role of temperature. Based on some theoretical studies, the existence of temperature (about a few MeV) before the merger is possible. The main goal of our work is to study the thermal effects on the tidal deformability of neutron stars, by taking into consideration the observations of binary neutron star mergers. In our study, we used various hot equations of state, both isothermal and adiabatic, and for different nuclear models. The main finding is that for temperature below 1 MeV the tidal deformability as a function of the neutron star mass remains insensible. In the adiabatic case, this behavior is present up to entropy per baryon S=0.2 kB.
Characterization of a Novel CdZnTe Spectrometer for Measuring Radioactivity in the Marine Environment
Authors: Siltzovalis Georgios , Lagaki Varvara , Madesis Ioannis , Mertzimekis Theo J.
Published: May 2023

The scope of this study is to characterize the response of a CdZnTe spectrometer to evaluate its performance for measuring radioactivity in the marine environment. CdZnTe semiconductor detectors have never been used before for such applications. More specifically, a spectrometer with a 4 cm3 CZT crystal was studied under various scenarios, by means of Monte Carlo simulations and lab measurements. Using the Monte Carlo code MCNP5, the effect of the water’s salinity on the detector’s efficiency, as well as the ability of the sensor to localize radioactive sources in the water were examined. Futhermore, the full energy peak efficiency curve and energy resolution of the spectrometer was calculated experimentally in air. Finally, the effective volume of the CdZnTe crystal was estimated through measurements using a collimated point source of 137Cs. First results are considered satisfactory, however additional scenarios should be examined in the near future to further characterize the response of the detector.
Cross Section Measurements of (n,x) Reactions In the Energy Range Between 16.4 and 18.9 MeV Using Highly Enriched Ge Isotopes
Authors: Chasapoglou Sotirios , Vlastou Roza , Kokkoris Michael , Diakaki Maria , Michalopoulou Veatriki , Stamatopoulos Athanasios , Axiotis Michael , Harissopulos Sotirios , Lagoyannis Anastasios , Savva Marilia I. , Stamatelatos Ion E. , Vasilopoulou Theodora , Lederer-Woods Claudia
Published: May 2023

In this work, the cross sections of the neutron induced reactions 70Ge(n,2n)69Ge, 76Ge(n,2n)75Ge, 73Ge(n,p)73Ga, 72Ge(n,p)72Ga, 73Ge(n,d/np)72Ga, 74Ge(n,d/np)73Ga, 74Ge(n,α)71mZn, 72Ge(n,α)69mZn, 73Ge(n,nα)69mZn have been measured in the energy range between 16.4 and 18.9 MeV via the activation technique with respect to the 27Al(n,α)24Na reference reaction. Most of the existing experimental datasets found in literature for these reactions, were obtained with the use of a natGe target. In this case however, the residual nucleus produced from some reaction channels, could also be produced from neutron induced reactions in neighboring isotopes that exist in the natGe in their natural abundance, acting as a contamination to the measured yield of the reaction of interest. This parasitic contribution should then be subtracted, based on theoretical calculations that bear their own uncertainties. Isotopically enriched targets on the other hand, do not suffer from such contaminations, leading to more accurate experimental cross section results. In this work, five highly enriched targets have been used that helped in the determination of accurate cross section data, especially in the case of the73Ge(n,d/np)72Ga, 74Ge(n,d/np)73Ga and 73Ge(n,nα)69mZn challenging reactions, that will be presented in detail in this manuscript. The experiments were carried out at the 5.5 MV Tandem Van de Graaff accelerator of N.C.S.R. “Demokritos”, implementing the 3H(d,n)4He reaction for the production of the quasi-monoenergetic neutron beams.
Switching Speed Analysis of MOSFET-Based Absorber Integrated Antenna for 5G/WiMAX/WLAN
Authors: O. Omoru Elliot , M. Srivastava Viranjay
Published: May 2023

A block-by-block performance analysis of a novel Metal Oxide Semiconductor Field Effect Transistor (MOSFET)-based absorber antenna has been presented. The proposed integrated antenna is a solution to the negative effect of impedance mismatch between the power amplifier and antenna in the front end of communication systems. The clockwise diode base quasi circulator device used in the proposed design has been observed to have an insertion loss (S21 and S32) of 7 dB and 9.2 dB, respectively, with a return loss (S22) of 2.8 dB. The MOSFET-based absorber presented an insertion loss, return loss, and absorption efficiency of 2.75 dB, 3.3 dB, and > 90%, respectively. The switching speed for the proposed MOSFET-based absorber antenna model has been observed as 0.15 ns.
Automating Internet of Things Network Traffic Collection with Robotic Arm Interactions
Authors: Jiang Xi , Apthorpe Noah
Published: May 2023

Consumer Internet of things research often involves collecting network traffic sent or received by IoT devices. These data are typically collected via crowdsourcing or while researchers manually interact with IoT devices in a laboratory setting. However, manual interactions and crowdsourcing are often tedious, expensive, inaccurate, or do not provide comprehensive coverage of possible IoT device behaviors. We present a new method for generating IoT network traffic using a robotic arm to automate user interactions with devices. This eliminates manual button pressing and enables permutation-based interaction sequences that rigorously explore the range of possible device behaviors. We test this approach with an Arduinocontrolled robotic arm, a smart speaker, and a smart thermostat, using machine learning to demonstrate that collected network traffic contains information about device interactions that could be useful for network, security, or privacy analyses. We also provide source code and documentation allowing researchers to easily automate IoT device interactions and network traffic collection in future studies.
Confidentiality Enhancement Using Spread Spectrum Modulation Technique for Aggregated Data in Wireless Sensor Networks
Authors: Shripad Tagare Trupti , Narendra Rajashree
Published: May 2023

Wireless Sensor Networks (WSN) play a crucial role in transmitting bulk data remotely on Internet of Things (IoT). The data transmitted by the tiny sensor nodes of the network are basically the physical parameters of the environment like temperature, vibration, pressure etc. There exists a huge co-relation in the data sent by the nodes. This bulk data needs to be aggregated in order to conserve the energy of the network and thereby enhance the network lifetime. Although the aggregation might lead to loss of actual data, aggregating helps in reducing energy requirement during transmission which is of primary importance and hence is considered as a suitable method in WSN. Adding confidentiality to aggregated data helps in sending the data more securely. Spread spectrum modulation is a widely used technique to provide confidentiality in communication systems. In this research work, we implement a data aggregation technique and apply the spread spectrum modulation technique to provide confidentiality to the aggregated data that needs to be transmitted from the cluster head node to the gateway. Here, data aggregation process consists of averaging the number of data that are sensed by a sensor node and transmitting only its average value to the gateway. This reduces the amount of data transmission and helps in conserving energy. Further, the spread spectrum technique implements Binary Phase Shift Keying (BPSK) method with Frequency Hopping Spread Spectrum (FHSS) carried out using six different frequencies on MATLAB 2020a. The simulation results evaluate the performance of the system. The graphs are plotted for modulated and demodulated signals, spread and de-spread sequences, Bit Error Rate (BER) of BPSK/ FHSS over Rayleigh flat fading channel, Power Spectral Density (PSD) and Fast Fourier Transform (FFT) of frequency hopped signal. The results show that BER value decreases with increase in Signal to Noise Ratio (SNR). The maximum power consumption in the network is 7.518 mW at 5MHz frequency, for adding confidentiality to the aggregated data to be transmitted. Thus, the proposed work promises efficient energy consumption, longer network lifetimes with added confidentiality.
Managing Concurrent Queues for Efficient In- Vehicle Gateways
Authors: D. Grammatikakis Miltos , Ninidakis Stelios , Kornaros George , Bakoyiannis Dimitris , Mouzakitis Nikos , Staridas Alexis
Published: May 2023

In modern vehicles, electrical control units communicate over multiple in-vehicle networks via domainor zone-oriented gateway architectures. This work examines efficient frame transfer across incoming and outgoing Controller Area Network (CAN) interfaces at a gateway. In our embedded platform prototype, each CAN interface of a CAN-to-CAN gateway is controlled independently by a corresponding Portable Operating System Interface (POSIX) thread. Inter-thread communication and synchronization are implemented using shared data structures, either lock-free concurrent queues or traditional lock-based circular queues that embody single-producer single-consumer (SPSC) principles. Our experimental framework provides a realistic open automotive platform that integrates multiple CAN interfaces. An Odroid XU3 device acts as a gateway, providing two Universal Asynchronous Receiver- Transmitter (UART) to CAN interfaces that lead to Raspberry Pi 3B nodes (connected to CAN via Serial Peripheral Interface (SPI)). To increase communication reliability and performance by minimizing frame loss and improving the egress CAN frame rate, low-level parameters at the gateway are optimized, especially the inter-character delay of the UART-to-CAN interfaces. Our experiments show that the frame waiting time in the queue is shorter for the concurrent queue, while relaying messages is equally fast, reaching a maximum output rate of ~380 frames/s for large enqueue rates near saturation. Power consumption is almost four times higher for the concurrent queue implementation.
Hospital Reimbursement in the Presence of Cherry Picking and Upcoding
Authors: Savva Nicos , Debo Laurens , Shumsky Robert A.
Published: May 2023

Hospitals throughout the developed world are reimbursed based on diagnosis-related groups (DRGs). Under this scheme, patients are divided into clinically meaningful groups, and hospitals receive a fixed fee per patient episode tied to the patient DRG. The fee is based on the average cost of providing care to patients who belong to the same DRG across all hospitals. This scheme, sometimes referred to as “yardstick competition,” provides incentives for cost reduction, as no hospital wants to operate at a higher cost than average, and can be implemented using accounting data alone. Nevertheless, if costs within a DRG are heterogeneous, this scheme may give rise to cherry-picking incentives, where providers “drop” patients who are more expensive to treat than average. To address this problem, regulators have tried to reduce within-DRG cost heterogeneity by expanding the number of DRG classes. In this paper, we show that even if cost heterogeneity is eliminated, such expansion will fail to completely eliminate patient cherry picking. In equilibrium, the market will bifurcate into two groups, one of which will continue to cherry-pick patients and underinvest in cost reduction, whereas the other group treats all patients. Furthermore, we show that DRG expansion is particularly problematic if hospitals are also able to “upcode” patients, that is, intentionally assign patients to a more resource-intensive DRG than needed to increase income. Upcoding increases within-DRG cost heterogeneity and amplifies cherry-picking incentives. We examine potential solutions involving yardstick competition based on input statistics.

This paper was accepted by Carri Chan, healthcare management.

Supplemental Material: The online appendices are available at https://doi.org/10.1287/mnsc.2023.4752 .
Influence via Ethos: On the Persuasive Power of Reputation in Deliberation Online
Authors: Manzoor Emaad , Chen George H. , Lee Dokyun , Smith Michael D.
Published: May 2023

Deliberation among individuals online plays a key role in shaping the opinions that drive votes, purchases, donations, and other critical offline behavior. Yet, the determinants of opinion change via persuasion in deliberation online remain largely unexplored. Our research examines the persuasive power of ethos—an individual’s “reputation”—using a seven-year panel of over a million debates from an argumentation platform containing explicit indicators of successful persuasion. We identify the causal effect of reputation on persuasion by constructing an instrument for reputation from a measure of past debate competition and by controlling for unstructured argument text using neural models of language in the double machine-learning framework. We find that an individual’s reputation significantly impacts their persuasion rate above and beyond the validity, strength, and presentation of their arguments. In our setting, we find that having 10 additional reputation points causes a 31% increase in the probability of successful persuasion over the platform average. We also find that the impact of reputation is moderated by characteristics of the argument content, in a manner consistent with heuristic information processing under cognitive overload. We discuss managerial implications for platforms that facilitate deliberative decision making for public and private organizations online.

This paper was accepted by Anandhi Bharadwaj, information systems.

Funding: This research was supported in part by the University of Wisconsin Madison Office of the Vice Chancellor for Research and Graduate Education with funding from the Wisconsin Alumni Research Foundation, and by the Carnegie Mellon University Graduate Student Assembly and Provost’s Office. Computing support was provided in part by the Social Science Computing Cooperative at the University of Wisconsin Madison.

Supplemental Material: Data and the online appendix is available at https://doi.org/10.1287/mnsc.2023.4762 .
Stigma by Association: The Unintended Interpersonal Consequences of Associating Oneself with an Abusive Supervisor
Authors: Yan Liuxin , Yam Kai Chi
Published: May 2023

Extant abusive supervision research has predominantly studied its prevalence and destructive effects through the lens of victims, potential victims, or third-party observers who witness such mistreatments. In the present research, we examine a neglected group of individuals—employees who are able to develop high-quality relationships and are closely associated with their abusive supervisors. Drawing insights from the stigma-by-association literature, we conceptualize abusive supervision as a unique form of moral stigma that might result in unintended spillover effects. Specifically, we found that observers tend to perceive employees who are closely associated with an abusive supervisor to be less moral and trustworthy for seemingly sharing a similar set of unethical values and beliefs, even though this might not necessarily be true in reality. As a downstream consequence, these employees are subject to unintended interpersonal backlashes (i.e., withdrawal from helping behaviors) imposed by their fellow coworkers. Furthermore, we investigate the moderating role of voluntary motive attribution, revealing that those who were attributed to voluntarily associate themselves with abusive supervisors received the highest levels of interpersonal backlashes. Results from one pilot study, one multiwave survey study (Study 2), and three preregistered experiments (Studies 1, 3, 4) supported our full theoretical model. Our research adds new insights to the abusive supervision literature by introducing a new unintended consequence on a previously overlooked group of employees who are presumed to be shielded from the negative impact of abusive supervision.

Funding: This work was supported by the Singapore Ministry of Education [Grant R-317-000-164-115].

Supplemental Material: The e-companion is available at https://doi.org/10.1287/orsc.2023.1678 .
Can perioperative psychological interventions reduce chronic pain after surgery?
Authors: Peters Madelon
Published: May 2023

Chronic post-surgical pain is a relatively common adverse effect following surgery. Several prognostic factors for chronic post-surgical pain have been identified, including psychological states and traits. Psychological factors are modifiable, and perioperative psychological interventions may reduce the incidence of chronic post-surgical pain. A meta-analysis showed preliminary evidence for the benefits of such interventions for the prevention of chronic post-surgical pain. Further research must be conducted to better understand the specific type, intensity, duration and timing of interventions that are most effective. The number of studies in this area has recently increased, with additional randomised controlled trials currently being carried out, which may allow for the development of more robust conclusions in the coming years. In order to implement perioperative psychological care alongside routine surgical interventions, efficient and accessible interventions should be available. In addition, demonstration of cost-effectiveness may be a prerequisite for wider adoption of perioperative psychological interventions in regular healthcare. Offering psychological interventions selectively to patients at risk of chronic post-surgical pain could be a means to increase cost-effectiveness. Stepped-care approaches should also be considered, where the intensity of psychological support is adapted to the needs of the patient.
Roles and skill sets
Authors: Wyatt Dan
Published: May 2023

In his second Student Column entry, Dan Wyatt shares his experiences of his most recent placement block in a hospital environment, reflecting on not only the skills and knowledge developed, but an understanding of the entire professional network involved in patient care
How paramedics apply the spinal immobilisation algorithm in trauma patients
Authors: Tinker Claire , Boswell Graham , Foster John
Published: May 2023

Background:

Validated criteria are included in the algorithm used in the UK prehospital setting to safely reduce the number of traumatically injured patients requiring full spinal immobilisation. The criteria improve the sensitivity in selecting patients with spinal injuries but evidence how UK ambulance clinicians apply them is sparse.

Aims:

This study aimed to identify the knowledge levels and the use of the spinal immobilisation algorithm by ambulance clinicians.

Methods:

A quantitative survey used a convenience sample of all frontline clinicians in London Ambulance Service NHS Trust.

Findings:

The algorithm is not routinely used when assessing traumatically injured patients at risk of spinal injury; recognition of the algorithm inclusion criteria is poor, especially regarding patients under the influence of drugs or alcohol. There is a belief that too many patients are immobilised unnecessarily.

Conclusion:

Research is required on how ambulance clinicians use checklists and paramedic education on spinal immobilisation rules requires review.
Use of flumazenil to treat poisoning in prehospital care
Authors: Bainbridge Sarah
Published: May 2023

A discussion exploring antidotes available for drug toxicity is presented, focusing specifically on flumazenil, within the prehospital setting. This critical review was carried out to establish whether this antidote would be useful in prehospital care and details the potential for practice development for the role of the ambulance-based paramedic. Analysis suggests that further research is required in order to determine the requisite of this antidote.
DECOLONIALISMO NOS INDIE GAMES BRASILEIROS: história e imaginário em Dandara
Authors: Martins Maia Ana Flávia , Torres Silva Tarcisio
Published: May 2023

Este trabalho discute os indie games no Brasil em sua relação com o decolonialismo a fim de destacar a importância dos jogos independentes para a re-inscrição de narrativas historicamente apagadas. Para delimitar a análise, faremos um percurso pela narrativa do jogo Dandara, lançado pelo estúdio Long Hat House em 2018. Nele buscaremos compreender e estabelecer relações com diferentes aspectos referentes à história e à cultura brasileira. Como dispositivo analítico traremos elementos da Teoria do Imaginário de Gilbert Durand para enfatizar determinados elementos narrativos e seus empregos no jogo.
Outcomes of remote versus face-to-face ear, nose and throat outpatient consultation on patient pathways
Authors: Gupta T , Bhutta MF
Published: May 2023

Introduction

Remote consultation has potential benefits in increasing patient pathway efficiency and has been found to reduce costs and carbon emissions. Previous studies of remote consultation in ear, nose and throat (ENT) practice have reported mixed results and used relatively small sample sizes. The aim of this article is to study the impact of remote telephone consultation on ENT clinic outcomes and pathway efficiency, compared with in-person review, within new and follow-up patient cohorts and subspeciality, where previous studies demonstrate mixed and inconclusive results.

Methods

This was a comparison of remote clinic appointment outcomes over a 2-month period from a single ENT referral centre (426) with an equivalent data set of face-to-face clinic appointments over a similar time frame (1,533). Statistical analysis included chi-squared test for clinic outcomes and two-sample t-squared test for mean hand-off between both cohorts (p < 0.05).

Results

For new referrals, remote consultation was associated with statistically significantly greater rates of follow-up (p < 0.00001), investigation (p = 0.00251) and hand-off (p < 0.00013) than patients seen face-to-face – particularly where presenting with head and neck symptoms. For follow-up patients, remote consultation had similar rates of investigation (p = 0.11071) or further follow-up (p = 0.08) and mean hand-off (p < 0.11764) to those seen face-to-face.

Conclusions

Remote consultation in ENT could become the norm for follow-up patients, but should be used with caution in the initial consultation of new patients.
Gastric outlet obstruction secondary to a wandering spleen: systematic review and surgical management of a case
Authors: Moore E , O’Brien JW , Merali N , Farkas N , Madhavan A , Abbassi-Ghadi N , Preston S , Singh P
Published: May 2023

Introduction

A wandering spleen occurs when laxity or absence of the suspensory ligaments allows migration throughout the abdomen. Gastric outlet obstruction resulting from this abnormality is rare. We present a systematic literature search and a case that was managed successfully with surgical intervention at our centre.

Methods

A systematic search of the PubMed, Embase™, Medline® and Google Scholar™ databases was carried out employing the combined search terms “gastric outlet obstruction” AND “wandering spleen”. Six results were included for final analysis.

Results

All six search results described a single case each. Patients underwent surgical management (open or laparoscopic) after initial investigation utilising a range of modalities. There were no mortalities reported at 90 days. The single case we present was complicated by gastric perforation; the patient made a successful recovery following open splenopexy and stapled wedge resection of the stomach.

Conclusions

A wandering spleen is a rare diagnosis and there are only six reported cases of gastric outlet obstruction secondary to a wandering spleen in the literature. None report associated gastric perforation. There are a variety of presenting symptoms, intraoperative findings and operative techniques used to address the gastrosplenic abnormality. The case reported by our centre adds to this limited evidence base and demonstrates a successful outcome from definitive surgical management. We highlight the need to seek early gastro-oesophageal expertise if any gastric pathology is found together with anatomical abnormality of the spleen.
Indeterminate thyroid nodules (Thy3): malignancy rate and characteristics in a study of 118 patients
Authors: Dimitriadis PA , Moinie A , Michaels J , Bance R , Vijendren A , Mochloulis G
Published: May 2023

Introduction

Thyroid nodules are common, and the combined use of ultrasound and fine needle aspiration cytology provides useful information on their malignancy risk. The Thy reporting system is widely used in the United Kingdom, with malignancy rates for Thy3 cytology being quoted between 5% and 30%. This study aims to establish the risk of thyroid cancer in operated patients with Thy3 cytology and correlate it with patient demographics and nodule size.

Methods

This is a retrospective observational study of all thyroidectomies that took place in a single institution over a 3-year period (2019–2022). Those with a preoperative cytology of Thy3 were analysed further and in particular, nodule size, final histology and patients’ demographics were documented.

Results

Some 260 thyroidectomies were performed during the study period. Of these, 118 patients had Thy3 cytology. In the Thy3a group (n = 70), the malignancy rate was 27.1%. The average age of those with thyroid cancer was 51.4 vs 51.2 years for those with benign disease. The nodule size was under 40mm for both groups (36mm vs 39.7mm). In the Thy3f group (n = 48), the malignancy rate was 43.8%. The average age of those with thyroid cancer was 53.5 vs 56.2 years for those with benign disease. The nodule size was similar (24.5mm vs 27.6mm).

Conclusions

In this study, one in three patients with Thy3 cytology was diagnosed with thyroid cancer. We urge local units to analyse their data, to aid patients’ informed decision-making. Within the subgroups, there was no significant difference in average nodule size or patients’ age.
The privileges of office
Authors: Mortensen Neil
Published: May 2023

Our President discusses a recent trip to Downing Street to discuss the government's approach to tackling NHS waiting times this year.
Henry Vandyke Carter’s diary of work (1853-1855)
Authors: Mackay Saffron
Published: May 2023

Our Archives team takes us through the legacy of Henry Vandyke Carter
The right to strike
Authors: Mortensen Neil
Published: May 2023

Our President discusses the significance of the junior doctor strikes and the importance of supporting our colleagues.
The Health Education England extended surgical teams pilot project
Authors: Sadler P , Dalby S
Published: May 2023

How the pilot project aims to support the surgical care team by developing an alternative workforce.
Time for change?
Authors: Sutherland C
Published: May 2023

Is it time to address the difference within surgical roles in order to successfully develop the extended surgical care team?
The extended surgical team: are we robbing Peter to pay Paul?
Authors: Mallender J
Published: May 2023

How do we measure the value of investing in the EST?
The extended surgical team: a trainee perspective
Authors: King M
Published: May 2023

How can we develop the extended surgical team to ensure the next generation of trainees are protected?
The emergency general surgery team: the Barcelona experience
Authors: Gonzalez Castillo AM
Published: May 2023

What is involved in being part of an emergency general surgery team?
Legacy gifts 72 years in the making: a surgical research fellowship funded jointly by a father and daughter
Authors: Extance-Vaughan N
Published: May 2023

How you can still leave a legacy gift to RCS England whilst ensuring your loved ones are protected.
Dentistry and incapacity
Authors: Wheeler Robert
Published: May 2023

Our Legal editor explores the issue of capacity when making important medical decisions about treatment.
Hospital dentists seeking to attend the ATLS® course: like pulling teeth?
Authors: MacKenzie-Gureje Anthony
Published: May 2023

The Advanced Trauma Life Support® (ATLS®) course was first run in the US in 1978 and in the decades since, it has been disseminated and taught all over the world. In the UK, it has become an integral component of surgical training for many specialties including oral and maxillofacial surgery (OMFS), and it is considered an extremely useful adjunct to clinical practice.

OMFS requires independent practitioners to be qualified in both medicine and dentistry. The training pathway has multiple entry routes, with some trainees first qualifying in medicine before doing dentistry and vice versa. While the ATLS® steering group has expanded the eligibility criteria to include many types of advanced practitioners, there remain some caveats to the inclusion of hospital dentists. The default position is that they are instead subject to individual review by the chair of the ATLS® steering group if they wish to apply for the ATLS® course. This inevitably brings their competence into question even though they often routinely work with dental or OMFS trauma.

This paper highlights a possible perception among some hospital dentists of ineligibility to participate and perceived inequity in accessing the course. Furthermore, there is a mild but nevertheless apparent discrepancy between wording from the ATLS® steering group and guidance from the British Association of Oral and Maxillofacial Surgeons, and the General Dental Council. In order to remedy these issues, it is proposed that there should be joint or concordant, explicit, published guidance from these institutions regarding the participation of non-medically trained OMFS trainees and other hospital dentists on the ATLS® course.
Consent for the paediatric patient
Authors: Jones Andrew , Hyde James , Lee Sharon , Albadri Sondos , Gartshore Laura
Published: May 2023

Introduction

Obtaining valid consent is a fundamental process in dentistry. Written consent must be obtained where treatment involves conscious sedation or general anaesthesia. For children, consent may be provided by a person with parental responsibility (PR).

Methods

A retrospective evaluation was completed of 160 children over 2 UK hospital sites with paediatric services. Cases involving conscious sedation or general anaesthesia for dental treatment were selected. Data were obtained to establish whether it was documented that the correct person had provided consent for a child and whether all possible individuals with PR for the child were identified at the initial visit. UK national legislation and guidance was reviewed, from which a PR form (to determine PR status for a child) was created and implemented. A second evaluation was subsequently completed, again with 160 children.

Results

Combined data from both sites confirmed documentation of an appropriate person providing consent in 127 cases (79%) in the first evaluation. This improved to 155 cases (97%) following implementation of the PR form. All possible individuals who had PR for the child were identified at the initial visit in 35 cases (22%). This improved to 139 cases (87%) following the introduction of the PR form.

Conclusions

Use of a PR form improved documentation regarding valid consent for children.
Does the early bird catch the worm? Tick box culture and precocious teaching qualifications for aspiring specialty trainees
Authors: Donnell Christopher , Rogers Helen
Published: May 2023

Progression up the dental career ladder into dental specialty training is notoriously tough, with rising numbers of applicants and the introduction of national recruitment creating fierce competition for training places. This paper explores the emerging tick-box culture surrounding specialty recruitment applications and the issues accompanying precocious portfolio point-seeking, with a particular focus on recognised postgraduate teaching courses.