bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Simulation Workflows, Tools, and Metrics for Beyond-Vision Effects in Multi-Objective Optimization: A Scoping Review
Authors: Tabbah Alyaá , Aries Myriam B C , Moscati Annika , Johansson Peter
Published: April 2024

Lighting in the built environment affects different aspects, ranging from building performance in terms of costs and energy consumption to human well-being in terms of thermal comfort, visual effects, and beyond-vision effects. Buildings optimised for specific performance metrics rarely consider different aspects simultaneously, leading to sub-optimised, unbalanced, or non-trade-off solutions. Therefore, multi-objective optimisation has commonly been used to overcome conflicting performance objectives. Recently, light effects beyond vision gained more interest in building design but it is unclear if and how they are integrated with other existing building performance metrics and simulation workflows. A scoping review investigated the state-of-art in multi-objective lighting design optimisation regarding building performance and human well-being focusing on performance metrics, simulation workflows, and the overall information flow. Results show that metrics for beyond-vision effects are not integrated with other human well-being and building performance metrics. The simulation workflows included multiple steps and computational tools in multi-objective optimisation. This process has limitations such as a long simulation time, no ubiquitous integrated tool, and a reduced information flow.
The Influence of Urban Lighting on the Sense of Belonging
Authors: Frutos Laura de , Pellizzari Luca , Hvass Mette
Published: April 2024

This research aims to gain a better understanding of the influence of artificial lighting on the sense of belonging in urban spaces and to investigate whether lighting is a determining factor in establishing bonds between humans and the city. An exploratory method is employed to give possible answers with the purpose of sparking a discussion in the lighting and urban design practice but without intending to be conclusive. The topic is addressed by an integration of a literature review on related concepts such as place attachment, the connections between urban lighting and atmospheres, the social dimension of urban lightscapes and placemaking, and input from conversations with professional lighting designers. The proposed answer consists of a series of models, design principles and methods for the lighting designer. It is argued that lighting can act as a generator of atmosphere, propitiating shared experiences in the outdoors, or as an object of memory when it acquires the category of a symbol. Both qualities can contribute to building a collective identity and, consequently, a sense of belonging. The lighting design - if unique, meaningful and sustaining social interaction - and the design process employed - if participatory - have a role in strengthening ties within the community.
People’s conceptual environmental appraisals of urban space in daylight and electric light
Authors: Johansson M , Tsiakiris G , Rahm J
Published: April 2024

Urban spaces should be resilient, inclusive and safe for all residents including children, elderly and vulnerable groups. This implies that urban planning, management and design should provide public spaces that support human needs of active mobility, social interaction and psychological restoration across seasonal and diurnal variation in natural light. Environmental psychology postulates that an understanding of how people experience or appraise an environment is a critical component in the relationship between urban design and human behaviour. In this conceptual paper we propose and discuss overarching (visual) impressions of the environment (environmental appraisals) that could be utilized to deepen the understanding of how people experience urban green spaces under different lighting conditions. In a certain setting, people respond to specific components of the environment; such perceived molecular environmental qualities make up the overall impression of the setting, and shape critical human-environment transactions fundamental to human well-being. The perceived stimuli are considered to act together to form the perceptual basis for higher order, molar aspects, so called conceptual environmental appraisals. We introduce Küller’s human-environment interaction model and Brunswik’s lens model to describe conceptual environmental appraisals. Recognising urban forests as important settings for physical active mobility, social interaction, and psychological restoration, we outline the theoretical underpinnings of three conceptual environmental appraisals: prospect – refuge pertaining to the perceived safety of the environment, environmental preferences, and the perceived restorative potential of the environment. The appraisals have been shown to be relevant in studies on electric lighting in urban space, and possible to assess by means of observer-based assessments also among children, elderly and vulnerable groups. Assessment outcomes may inform discussions on conflicting goals for sustainable development with regard to people’s health and well-being, energy use, light pollution and the welfare of other species in urban planning, management and design.
Spatial planning for dark hours in Sweden – conditions and proposal for action
Authors: Frænkel C , Tastare M , Billger M
Published: April 2024

The purpose of this study was to investigate how the absence of daylight are handled within spatial planning in Sweden, and to propose measures for action. The study includes a review of spatial planning documents, interviews with planning officers, and an overview of how outdoor lighting is included within the Swedish Planning and Building Act (PBL). The result shows that planning documents according to the PBL generally present few specific analyses and proposals linking to the design and the use of outdoor environments during dark hours, such as lighting. Instead, outdoor lighting is often managed within lighting masterplans, that lack a common methodology and a formal planning status. Possible consequences include that spatial planning provides limited support for how different public interests should be weighed against each other in a nocturnal context, and that citizens have little formal influence over strategic decisions on outdoor lighting. As a proposal, we suggest developing spatial planning for dark hours (‘nattstadsplanering’ in Swedish), that integrates the use, the design, and the outdoor lighting within the same planning process, using the PBL as a framework. The proposal includes clarification of lighting regulations, methodology development, and knowledge dissemination, which requires further research and investigations.
Darker Cities due to the Energy Crisis and the need for context-specific urban lighting
Authors: Hvass M
Published: April 2024

Outdoor lighting has been dimmed or turned off in European municipalities due to the energy crisis. Dimming of outdoor lighting levels led to energy savings, advantages for biodiversity and less light pollution. But the dimming also triggers the basic human assumption that bright light is connected to safety and darkness is connected to fear. To discuss this basic assumption, human experience of dimmed lighting and perceived safety is explored through three case studies. One study explores human experiences of dimmed street lighting during energy crises, the second study investigates dimmed lighting levels around public transportation, and the third study is an example of a context-specific adaptation of street lighting in a residential area. The case studies reveal that dimmed lighting levels, minimized contrasts, and context-specific lighting can lead to an increased connectedness to the spatial and social urban context and an increased feeling of perceived safety. Thus, more light doesn’t always lead to more perceived safety. With a dimmed general lighting level, it is possible to introduce additional subtle lighting layers, structured in a lighting hierarchy to further enhance spatial and social qualities in outdoor contexts in the dark hours. in constructing both.
Pain Relieving Light – (How) Is it Possible?
Authors: Björner Brauer Hanna , Ryberg Karl , Wallin Kjell , Linde Mattias , Laike Thorbjörn , Karlsson Bodil S.A.
Published: April 2024

About 15% of the population suffer from migraines and it is estimated that about 40% of all people with migraines would benefit from preventive treatment, but only 3–13% use it. Migraine is a huge burden for society and individuals. Migraines can be intensified by light, and some patients need to stay in a dark room until the attack is over. People with this type of photosensitivity show a clear preference for light color, specifically green, which has been shown to be more comfortable and even pain relieving in some cases. We will present a feasibility study with the aim of preparing a series of experiments to investigate if regular short-term green-light-exposure can prevent migraines. We will present findings from the literature, developed light equipment, and plans for future testing of migraine friendly light solutions.
Methods for inclusive design processes at the early stages of a research project in School Environments
Authors: Angelaki S , Frelin A , Grannäs J , Besenecker U , Danielsson C B
Published: April 2024

This paper explores the use of participatory methods prior to designing interventions within a research project at a primary school in central Sweden. The approach presented in the paper is based on the principles of participatory design (PD), to enhance the use of these methods within the areas of educational research (ER), lighting, and architecture. This approach aims to include participants of educational spaces and incorporate their views prior to design interventions. Two workshops were designed to support teachers’ participation through hands-on activities. Twenty-eight teachers participated in the workshops. Scale models corresponding to two of the school’s classrooms were used to initiate discussions regarding the interconnection between spatial layouts, lighting, and learning activities. The workshops’ data collection analysis assisted the research group in understanding the school’s spatial and learning characteristics. The information gathered from the workshops provided additional knowledge and informed the research project in a way that allowed for further development and changes within the project related to the additional variables measured along with light. According to the analysis, there is a correlation between the activity and the desired layout of the space, while the type of equipment also varies according to the task.
Socially inclusive Lighting Design: exploring a method to enhance freedom of movement for marginalised groups.
Authors: Lund Kaja Glenne , Hvass Mette
Published: April 2024

Based on literature and field research, women and marginalised groups often experience unwanted attention in the public realm worldwide. This attention often produces a gendered fear, which can result in avoidance behaviour of urban public places. Universal design has been implemented to ensure everyone can access urban areas, but this access is still restricted for many vulnerable groups. This investigation aims to find relevant lighting design principles for making public urban spaces more inclusive for all marginalised groups. A literature review, case studies of three urban places, focus group interviews, and an experiment with torches in the field were the chosen methods to gain knowledge. The findings suggest that the participants experience fear in public places when they feel exposed as someone who can become a potential target. This results in a need to see their surroundings and have an awareness of the presence of others. In addition, the experiment showed how they wanted to use warm lighting and beautify the place by enhancing details. The conclusion suggests six different lighting design methods to create inclusive public areas, such as beautifying details and legibility with vertically lit surfaces. These six principles could make urban public places more socially inclusive for marginalised groups, women, and other vulnerable groups. The results should be compared and confirmed by using control groups with other non-marginalised groups.
Empathic Lighting Design for Healthcare Environments
Authors: Mathiasen Nanet , Øien Turid Borgestrand , Volf Carlo
Published: April 2024

Light has the powerful capacity to generate a certain quality and atmosphere within a room. However, lighting design specification is often only characterized via quantitative metrics. In healthcare institutions, such as care homes, hospitals and rehabilitation centres, the use of lighting design may support a positive atmosphere, and potentially also support the health and wellbeing of patients. When people are hospitalised, they are in a difficult and often stressful situation, in which they meet nurses, physicians and relatives within new, unfamiliar surroundings. These situations call for supportive architectural spaces with atmospheres that help people relax and feel safe. Nevertheless, these spaces often lack a lighting design that supports this intent. The objective of this study is to implement two different lighting scenarios and investigate how they affect patients in a psychiatric affective healthcare unit at Copenhagen Psychiatric Centre. Two different lighting scenarios were implemented and tested in a SW-facing group therapy room, during one winter period (November 2022–March 2023). In all, the study included 12 patients. Through questionnaires, the patients were asked how they perceived the luminous environments of two lighting scenarios, one in the existing healthcare lighting vs. a new lighting setup. The patients indicated their preferences and how the lighting design affected and supported heir therapeutic session. The two lighting scenarios are: a) Four high-positioned LED-luminaires (H=2,65 m) in the ceiling; and b) Two low-positioned LED-luminaires suspended above the meeting table (H=1,50 m). The results of the survey showed that patients overall preferred the low-positioned, non-uniform lighting, which scored a total of 60 points in the semantic analysis, compared to 35 points for the high-positioned, uniform lighting. In addition, from a sustainability viewpoint, energy consumption for the low-positioned lighting scenario was only 21 W, compared to 140 W for the high-positioned lighting scenario, providing an 85% reduction in total energy consumption.
Lighting assessment in low-vision rehabilitation: Implementing N-Lited
Authors: Øien Turid Borgestrand , Nielsen Jeanette Bremer
Published: April 2024

Lighting assessments have been part of low-vision rehabilitation for decades, but more structured and evidence-based approaches have emerged in recent years. In Denmark, a mixed-method semi-structured protocol for lighting assessment was developed and tested as a pilot study from 2017–2019, and it showed promising results, in that it improved the visually impaired participants’ quality of life. Innovations are often developed in pilot studies, but implementing new approaches across communities of practice poses difficulties due to both individual and organizational norms. N-Lited is an implementation project that entails the dissemination of knowledge and instructions as well as practical trials, and its protocol has been implemented in seven low-vision centers from 2022–2023. Based on participants’ observations, document analysis of the framework, and a midway evaluation that assessed the potential for scalability and diffusion, this paper discusses the learning and change processes in the interpretation and role of the lighting measurements and lighting assessments in this project. Beyond mere instrumental learning, the findings reveal that it is crucial to address how individuals learn how to explore and question the difficulties that reveal mismatches or reconfigurations of values, norms, and assumptions to ensure a successful implementation of the method. The changing role of lighting measurements, from instrumental to more reflective, also illustrates the importance of the practical application and learning-by-doing aspects that are essential for learning how to reflect and “think with the metrics.” Furthermore, metrics and tools are an important part of the community of practice’s shared language. The uncertainty of navigating between the uniformity of the protocol and the flexibility needed for incorporating the method into individual professionals’ practices and the various organizational contexts emphasizes the relevance of the process of learning how to manage methodological innovations in practice.
Measuring Cognitive Function and Cognitive Decline With Response Time Data in the National Social Life, Health, and Aging Project
Authors: Sanders Seth , Schofield Lynne Steuerle , Schumm L Philip , Waite Linda
Published: April 2024

Objectives

Scholarly, clinical, and policy interest in cognitive function has grown over the last several decades in part due to large increases in Alzheimer’s disease and related dementias as populations age. However, adequate measures of cognitive function have not been available in many research data sets. We argue that a wealth of previously unexploited survey data exists to model cognition and cognitive decline.

Methods

We use metadata of the time it takes older respondents in the National Social Life, Health, and Aging Survey, which we label response times (RTs), to answer questions in a standard cognitive assessment. We compare several measures of RT to a survey-adapted form of the Montreal Cognitive Assessment (MoCA).

Results

We show that RTs predict both concurrent and future MoCA scores. Our results show that longer and more varied RT at baseline predict lower MoCA scores 5 years later, net of baseline scores and controls. We also show that the effect of RT measures on predicting current MoCA differs for individuals of different races and ages, but are not different by gender.

Discussion

Our paper demonstrates that RTs constitute a separate powerful measure of cognitive functioning. RTs may be remarkably useful both to clinicians and social scientists because they can increase the accuracy of cognitive assessment without increasing the time it takes to administer the assessment.
The Moduli Space of Cyclic Covers in Positive Characteristic
Authors: Dang Huy , Hippold Matthias
Published: April 2024

We study the $p$-rank stratification of the moduli space $\operatorname{\mathcal{A}\mathcal{S}\mathcal{W}}_{(d_{1},d_{2},\ldots ,d_{n})}$, which represents $\mathbb{Z}/p^{n}$-covers in characteristic $p>0$ whose $\mathbb{Z}/p^{i}$-subcovers have conductor $d_{i}$. In particular, we identify the irreducible components of the moduli space and determine their dimensions. To achieve this, we analyze the ramification data of the represented curves and use it to classify all the irreducible components of the space. In addition, we provide a comprehensive list of pairs $(p,(d_{1},d_{2},\ldots ,d_{n}))$ for which $\operatorname{\mathcal{A}\mathcal{S}\mathcal{W}}_{(d_{1},d_{2},\ldots ,d_{n})}$ in characteristic $p$ is irreducible. Finally, we investigate the geometry of $\operatorname{\mathcal{A}\mathcal{S}\mathcal{W}}_{(d_{1},d_{2},\ldots ,d_{n})}$ by studying the deformations of cyclic covers that vary the $p$-rank and the number of branch points.
Remaking the Urban: International Actors and the Post-war Reconstruction of Cities
Authors: Bădescu Gruia
Published: April 2024

The postwar reconstruction of cities has become an arena of international actors who mobilize different narratives of power and reshape conflict using other means. This article highlights how international actors use urban reconfigurations as a tool for intervening in the broader postconflict reconstruction of societies. First, it shows that the postwar reconstruction of cities is not only a set of spatial and economic processes of remaking the urban environment, but also a discursive practice of highlighting hegemonies through space. The article argues that reconstruction entanglements in inter-imperial space reflect both the endurance and the emergence of hegemonies of power. Second, urban reconstruction and other spatial interventions in contested urban space often prolong the tensions originating from war. In cities where destruction was caused by a mixture of internal and external actors, and where previous warring factions have to coexist in the postwar arrangements, like in Sarajevo and Beirut, domestic and international agendas reinforce and redirect one another. The article shows that the entanglement of local, national, and international actors in reconstructions play a role in transforming both place and conflict dynamics after peace treaties are signed.
Credibility in Crises: How Patrons Reassure Their Allies
Authors: Sukin Lauren , Lanoszka Alexander
Published: April 2024

Abstracts

How do citizens of US allies assess different reassurance strategies? This article investigates the effects of US reassurance policies on public opinion in allied states. We design and conduct a survey experiment in five Central–Eastern European states—Estonia, Latvia, Lithuania, Poland, and Romania—in March 2022. Set against the backdrop of Russia’s invasion of Ukraine, this experiment asked respondents to evaluate four types of reassurance strategies, each a critical tool in US crisis response policy: military deployments, diplomatic summitry, economic sanctions, and public reaffirmations of security guarantees. The international security literature typically values capabilities for their deterrence and reassurance benefits, while largely dismissing public reaffirmations as “cheap talk” and economic sanctions as being ineffective. Yet we find preferences for the use of economic sanctions and public statements as reassurance strategies during crises, in part because these approaches help states manage escalation risks.
Foreign Sponsorship of Armed Groups and Civil War
Authors: Rubin Michael A , Malone Iris
Published: April 2024

Abstracts

Under what conditions do armed groups escalate their campaigns to civil war? Existing research suggests foreign states’ material support is critical to explaining armed groups' conduct during civil war and, thereby, war intensification, duration, and outcomes. Thus far, little attention has been paid to understanding whether and how foreign support influences whether armed groups fight civil wars in the first place, largely due to data limitations. Armed group-level datasets have included only those already engaged in significant civil war violence, which introduces selection bias that precludes investigating factors that influence which groups fight civil wars. Leveraging the new Armed Groups Dataset (AGD), which measures characteristics of armed groups engaged in lower-level violence, we conduct a preliminary empirical investigation into the explanatory role of foreign sponsorship in group-level variation in civil war. While foreign sponsorship and civil war are correlated, there is little evidence that sponsorship has substantial independent explanatory value in predicting civil war. Rather, the evidence is consistent with claims that armed groups’ organizational characteristics account for both access to foreign sponsorship and, independently, their likelihood of escalating civil war.
Can large language models provide secondary reliable opinion on treatment options for dermatological diseases?
Authors: Iqbal Usman , Lee Leon Tsung-Ju , Rahmanti Annisa Ristya , Celi Leo Anthony , Li Yu-Chuan Jack
Published: April 2024

Objective

To investigate the consistency and reliability of medication recommendations provided by ChatGPT for common dermatological conditions, highlighting the potential for ChatGPT to offer second opinions in patient treatment while also delineating possible limitations.

Materials and Methods

In this mixed-methods study, we used survey questions in April 2023 for drug recommendations generated by ChatGPT with data from secondary databases, that is, Taiwan’s National Health Insurance Research Database and an US medical center database, and validated by dermatologists. The methodology included preprocessing queries, executing them multiple times, and evaluating ChatGPT responses against the databases and dermatologists. The ChatGPT-generated responses were analyzed statistically in a disease-drug matrix, considering disease-medication associations (Q-value) and expert evaluation.

Results

ChatGPT achieved a high 98.87% dermatologist approval rate for common dermatological medication recommendations. We evaluated its drug suggestions using the Q-value, showing that human expert validation agreement surpassed Q-value cutoff-based agreement. Varying cutoff values for disease-medication associations, a cutoff of 3 achieved 95.14% accurate prescriptions, 5 yielded 85.42%, and 10 resulted in 72.92%. While ChatGPT offered accurate drug advice, it occasionally included incorrect ATC codes, leading to issues like incorrect drug use and type, nonexistent codes, repeated errors, and incomplete medication codes.

Conclusion

ChatGPT provides medication recommendations as a second opinion in dermatology treatment, but its reliability and comprehensiveness need refinement for greater accuracy. In the future, integrating a medical domain-specific knowledge base for training and ongoing optimization will enhance the precision of ChatGPT’s results.
Feasibility of opportunistic colorectal cancer screening of hospitalized patients in tertiary care and community hospitals
Authors: Stevic Ivan , Singh Harminder , Sokoro AbdulRazaq
Published: April 2024

Background

Population screening for colorectal cancer (CRC) remains low, requiring alternative approaches for increasing participation. Opportunistic screening of hospitalized patients may aid in increasing uptake rates.

Objective

To assess whether inpatients can be recruited for opportunistic CRC screening using fecal immunochemical testing (FIT).

Methods

Inpatient charts were prospectively reviewed for study eligibility on admission of patients to the medical wards of 3 hospitals in Winnipeg, Canada. Eligible patients were approached for participation and consent. Inoculated FIT specimen collection tubes were sent to the hospital laboratory for testing. Patients with positive FIT results received a follow-up colonoscopy.

Results

In total, 1542 inpatient charts were screened for eligibility; 53 patients were identified for enrollment (51.9% were male; median age, 59 years), of whom 13 patients consented to participate but only 7 provided a stool specimen. One of those 7 patients had a positive FIT result. The overall screening rate was low, at 0.45%. The primary reason for exclusion of patients was age (outside of the range of 50-75 years), followed by patients having recent gastrointestinal bleeding and/or known intestinal diseases.

Conclusions

Our data suggest that it is infeasible to recruit inpatients for opportunistic CRC screening in routine clinical practice.
A Multi-Analytical Approach to Identify Colorants in the Qajar Painted Wooden Decorative False Ceilings, From Northwest Iran
Authors: Koochakzaei Alireza , Jelodarian Bidgoli Behrooz , Naserahari Mohaddesehsadat
Published: April 2024

The purpose of this study was to analyze the pigments used in the wooden paintings of Zarir Mosque, dating back to the Safavid era in Maragheh, Iran. These paintings, known as “Pardu,” were commonly used for decorative false ceilings in various regions of Iran, particularly the northwest, during the Safavid and Qajar periods. Raman spectroscopy, scanning electron microscopy-energy-dispersive X-ray spectroscopy, multiband imaging, and optical microscopy were employed to examine the pigments. Fourier-transform infrared spectroscopy was also used to investigate the binder. The results indicated the use of orpiment, red lead, artificial ultramarine, carbon black, and gypsum for yellow, red, blue, black, and white pigments, respectively. Light blue colour was achieved by mixing gypsum and indigo, and gypsum was used as the primer layer in the painting. The presence of a protein-based binder, likely egg tempera, was confirmed through FTIR spectroscopy. The presence of artificial ultramarine suggests that these paintings were created after 1828, when it was first synthesized, placing them in the Qajar period. The presence of an inscription from 1280 AH suggests that these panels may have been produced during the extensive renovations of the mosque in 1280 AH (1864 AD), during the Qajar era.
Earl Grey: A Fully Automated User-Friendly Transposable Element Annotation and Analysis Pipeline
Authors: Baril Tobias , Galbraith James , Hayward Alex
Published: April 2024

Transposable elements (TEs) are major components of eukaryotic genomes and are implicated in a range of evolutionary processes. Yet, TE annotation and characterization remain challenging, particularly for nonspecialists, since existing pipelines are typically complicated to install, run, and extract data from. Current methods of automated TE annotation are also subject to issues that reduce overall quality, particularly (i) fragmented and overlapping TE annotations, leading to erroneous estimates of TE count and coverage, and (ii) repeat models represented by short sections of total TE length, with poor capture of 5′ and 3′ ends. To address these issues, we present Earl Grey, a fully automated TE annotation pipeline designed for user-friendly curation and annotation of TEs in eukaryotic genome assemblies. Using nine simulated genomes and an annotation of Drosophila melanogaster, we show that Earl Grey outperforms current widely used TE annotation methodologies in ameliorating the issues mentioned above while scoring highly in benchmarking for TE annotation and classification and being robust across genomic contexts. Earl Grey provides a comprehensive and fully automated TE annotation toolkit that provides researchers with paper-ready summary figures and outputs in standard formats compatible with other bioinformatics tools. Earl Grey has a modular format, with great scope for the inclusion of additional modules focused on further quality control and tailored analyses in future releases.
Medical cannabis for children: Evidence and recommendations
Authors: Kelly Lauren E , Rieder Michael J , Finkelstein Yaron
Published: April 2024

Interest in using cannabis products for a medical purpose in children under the age of 18 years is increasing. There are many medical cannabis products available that can include cannabidiol (CBD) or delta-9-tetrahydrocannabinol (THC), or both. Despite many therapeutic claims, there are few rigorous studies to inform the dosing, safety, and efficacy of medical cannabis in paediatric clinical practice. This statement reviews the current evidence and provides recommendations for using medical cannabis in children. Longer-term (2-year) reports support the sustained tolerability and efficacy of cannabidiol therapy for patients with Lennox-Gastaut and Dravet syndromes. CBD-enriched cannabis extracts containing small amounts of THC have been evaluated in a small number of paediatric patients, and further research is needed to inform clinical practice guidelines. Given the widespread use of medical cannabis in Canada, paediatricians should be prepared to engage in open, ongoing discussions with families about its potential benefits and risks, and develop individualized plans that monitor efficacy, reduce harms, and mitigate drug–drug interactions.
Pope’s Scrapes and Ghosts
Authors: Hone Joseph
Published: April 2024

This essay describes a previously overlooked feature of Alexander Pope’s early poetic manuscripts: the erasure of words by scraping. It contextualizes this habit within Pope’s broader practice as a maker of manuscript books for circulation among friends and patrons, and recovers for the first time several previously unnoticed variants in major early poems.
Chronic, Disruptive, or Resistant? Target Ecologies and the Medicalization of Homelessness in California
Authors: Rekenthaler Nick , Barnard Alex V
Published: April 2024

How do place and social context shape how policymakers construct the targets of state interventions? This paper analyzes recent proposals in California to subject people experiencing homelessness to involuntary psychiatric treatment. Using newspaper articles, legislative hearings, government reports, and interviews, we show how policymakers frame “the homeless mentally ill” in distinctive ways: Chronic and contained people who require extended institutionalization, disruptive and visible individuals who need a period of forced sobriety, and a service-resisting and underserved population whom mental health agencies have overlooked, but who could comply with treatment with a coercive incentive. We argue these constructions reflect how policymakers represent specific target ecologies: concentrated but confined homelessness on LA’s Skid Row, frequent and expensive use of emergency services in San Francisco’s Tenderloin, and expanding homelessness in jurisdictions traditionally reticent to provide care, as in San Diego County. This paper shows the value of disaggregating broad population categories to show how they are differentially problematized, as policymakers seek to gain support and justify intervention in specific places. We also illustrate a broader policy trend of reframing involuntary treatment as a progressive and compassionate response to substance use, homelessness, and urban disorder.
Impact of Parent Presence and Engagement on Stress in NICU Infants
Authors: Horner Susan
Published: April 2024

Background:

Infants in neonatal intensive care units (NICUs) are exposed to frequent stressors that impact their neurodevelopmental outcomes. Parent presence and engagement are considered critical to improving infant outcomes, yet associations between cumulative NICU parent presence, engagement, and infant stress are infrequently examined.

Purpose:

To examine associations between NICU infant stress and the amount (hours per week) or frequency (days per week) of parent presence and skin-to-skin care (SSC).

Methods:

A secondary analysis of a data set representing 78 NICU families was conducted. Infant acuity was measured using Neonatal Medical Index (NMI) scores. Parent presence and SSC data were collected from electronic medical records. Infant stress was measured using resting salivary cortisol levels collected at NICU discharge (median = 33 days of life).

Results:

More cumulative SSC was associated with lower discharge cortisol in NICU infants for SSC measured in hours per week (P = .03) or days per week (P = .05). Cumulative parent presence was not significantly associated with infant cortisol at discharge. Hierarchical regression analyses examining timing of parent presence supported a model including admission cortisol, NMI score, and parent presence during weeks 1 to 4 of life for explaining infant stress at discharge (R
2 = 0.44, P = .004). Analyses examining timing of SSC supported a model including admission cortisol, NMI score, and frequency of SSC during week 1 for explaining infant stress at discharge (R
2 = 0.21, P = .04).

Implications for Practice and Research:

Early, frequent SSC to mitigate stress in NICU infants was supported. Results suggested that timing of parent presence impacts NICU infant stress; however, additional study is recommended.
Pioneering Microsurgery Services in Low-income Countries: Insights from a Plastic Surgeon’s Experience in Ethiopia
Authors: Gebremariyam Zenebe T. , Weldemichael Nebiyat A.
Published: April 2024

Background:

Microsurgery, a revolutionary tool in reconstructive procedures, has historically faced challenges in implementation within resource-limited settings. This article presents the journey of establishing microsurgery services at Jimma University Medical Center (JUMC) in Ethiopia, a nation where a significant portion of the population lacks access to microsurgery. The objective was to provide a guide for establishing a microsurgery center in resource-limited settings and share experiences, challenges, and successes encountered during the establishment of the microsurgery unit at JUMC.

Methods:

The methodology involved a needs assessment, collaboration with Operation Smile, training and capacity building, team and system building, and infrastructure and equipment setup. Strategies included identifying the demand for microsurgery services, collaborating with Operation Smile for resource acquisition, conducting training initiatives in India, and forming a multidisciplinary team.

Results:

The article introduces the initial series of free flap procedures conducted at JUMC, marking a significant milestone in the region’s surgical capabilities. Cases include forearm dermatofibrosarcoma protuberans, postburn exposed calcaneal bone, and buccal squamous cell carcinoma, demonstrating the diversity and complexity of cases that necessitate microsurgical intervention.

Conclusions:

The journey of establishing microsurgery services at JUMC represents a significant milestone. Lessons learned provide valuable insights for other centers in developing countries aiming to initiate or enhance their microsurgery programs. Recommendations include continuous training, expanding collaborative networks, advocating for sustainable resource allocation, research and outcome monitoring, incorporating microsurgery into formal curricula, and adapting protocols based on local realities. Implementing these recommendations can contribute to the growth and sustainability of microsurgery initiatives in resource-limited settings.
Lateral Epicondylitis: Treatment Preferences from the Potential Patient Perspective
Authors: Parikh Harin B. , Stanley Mackinzie , Tseng Cassie C. , Kulber David A. , Kuschner Stuart H.
Published: April 2024

Background:

Knowing the questions and concerns that patients have regarding treatment options for lateral epicondylitis may allow for shared-decision making and potentially superior patient outcomes and satisfaction. In the present study, we aimed to further delineate patient preferences with treatment of lateral epicondylitis.

Methods:

An online, survey-based, descriptive study was conducted through Amazon Mechanical Turk. Survey participants were presented with a clinical scenario regarding lateral epicondylitis and asked four questions regarding treatment preferences for nonoperative treatment, whether they would consider platelet-rich plasma (PRP) injection, and whether they would consider surgical intervention for recalcitrant symptoms. A Likert scale was used for responses. McNemar chi-square test was used for paired nominal data for statistical analysis.

Results:

A total of 238 survey responses were included. A majority (63%) of respondents elected to proceed with formal physical therapy. When given additional information regarding corticosteroid injections, 50.8% of respondents reported preferring physical therapy. There were no differences between groups for questions 1 and 2 (P = 0.90). Of the respondents, 75.2% were “likely” or “extremely likely” to consider PRP injection. When asked about surgical intervention, 74.8% of respondents were “likely” or “extremely likely” to proceed with continued symptoms.

Conclusions:

It is important to include patient preferences in treatment discussions of lateral epicondylitis. Survey respondents preferred formal physical therapy for initial treatment. A surprising majority of respondents were likely to consider a PRP injection. With prolonged symptoms, respondents were interested in discussions of surgical intervention and thus, it should continue to be offered to patients with recalcitrant symptoms.
Medial Femoral Condyle Free Flap: A Systematic Review and Proportional Meta-analysis of Applications and Surgical Outcomes
Authors: Scampa Matteo , Mégevand Vladimir , Martineau Jérôme , Schaefer Dirk J. , Kalbermatten Daniel F. , Oranges Carlo M.
Published: April 2024

Background:

Recalcitrant bone nonunion and osseous defect treatment is challenging and often requires vascularized bone transfer. The medial femoral condyle flap has become an increasingly popular option for reconstruction. The study aims at reviewing its different applications and synthesizing its surgical outcomes.

Method:

A systematic review including all studies assessing surgical outcomes of free medial femoral condyle flap for bone reconstruction in adults was conducted on January 31, 2023. Flap failure and postoperative complications were synthesized with a proportional meta-analysis.

Results:

Forty articles describing bony reconstruction in the head and neck, upper limb, and lower limb areas were selected. Indications ranged from bony nonunion and bone defects to avascular bone necrosis. Multiple flaps were raised as either pure periosteal, cortico-periosteal, cortico-cancellous-periosteal, or cortico-chondro-periosteal. A minority of composite flaps were reported. Overall failure rate was 1% [95% confidence interval (CI), 0.00–0.08] in head & neck applications, 4% in the lower limb (95% CI, 0.00–0.16), 2% in the upper limb (95% CI, 0.00–0.06), and 1% in articles analyzing various locations simultaneously (95% CI, 0.00–0.04). Overall donor site complication rate was 4% (95% CI, 0.01–0.06). Major reported complications were: femoral fractures (n = 3), superficial femoral artery injury (n = 1), medial collateral ligament injury (n = 1), and septic shock due to pace-maker colonization (n = 1).

Conclusion:

The medial femoral condyle flap is a versatile option for bone reconstruction with high success rates and low donor site morbidity.
Novel Finding of an Excess Bone in Postaxial Polydactyly of the Foot
Authors: Umeda Chizuru , Ueda Koichi , Hirota Yuka
Published: April 2024

Background:

Postaxial polydactyly is a common congenital foot anomaly. However, the severity of the anomaly varies from simple cases with only soft tissue duplication to complex cases with bone and joint disorders. In our clinical practice, we found a new morphological anomaly of postaxial polydactyly. We encountered several cases of postaxial polydactyly with bone fragments located between the fourth and fifth toes. The bone fragments were independent of the joint cavity. The mechanisms underlying its development remain unknown because it is a novel disorder. In the present study, we investigated the characteristics of the excess bone to formulate an embryological hypothesis.

Methods:

We examined the frequency and trends in the occurrence of excess bone using data from photographs and radiographs of these cases. An example of a disorder similar to excess bone is mosaic-like alignment, as reported by Iba et al. We also compared the characteristics of the mosaic-like alignment with those of the excess bone. Based on these data and existing embryological knowledge, we hypothesized the origin of the excess bone.

Results:

Excess bone and mosaic-like alignments showed different characteristics. Therefore, both were considered completely different disorders. We hypothesized that excess bone was caused by damage to the interdigital ectoderm immediately before interdigital programmed cell death.

Conclusions:

We encountered a new form of postaxial polydactyly. This can be a factor influencing the treatment strategy because it can affect alignment and stability.
Twelve Years and over 2400 Implants Later: Augmentation Mammoplasty Risk Factors Based on a Single Plastic Surgeon’s Experience
Authors: Montemurro Paolo , Pietruski Piotr
Published: April 2024

Background:

Breast augmentation is one of the most commonly performed aesthetic surgery procedures. Yet, few reports in the literature analyze individual surgeon experiences with a unified surgical method on a large group of patients. This study aimed to analyze a single surgeon’s complications rate and experience with the Akademikliniken augmentation mammaplasty method from the beginning of his career.

Methods:

A retrospective outcome analysis of all patients (n = 1646) who underwent breast augmentation between 2009 and 2021 performed by a single surgeon was conducted. Complications and reoperation rates were evaluated. In addition, correlations with the patient and implant characteristics and insertion-method–related risk factors were analyzed.

Results:

In total, 1212 female patients (mean age, 31.47 years) were analyzed. The minimal follow-up for every patient was 6 months (mean follow-up, 18.35 months). The total complication rate was 7.1%, and the most common complication (2.64%) was capsular contracture (Baker scale III/IV). Implant insertion with a funnel significantly lowered the overall risk of complications (P = 0.009). Statistical analysis indicates that the single independent risk factors for primary breast augmentation are patient age younger than 27 years, initial breast size B and C, and tobacco smoking.

Conclusions:

This study indicated that capsular contracture and implant rotation are the most common complications of analyzed primary augmentation mammoplasty. It also identifies various risk and protection factors, such as funnel usage, which should be considered by the surgeon when performing this type of procedure.
Concurrent management of HIV and malaria: A comprehensive review of strategies to enhance quality of life
Authors: Obeagu Emmanuel Ifeanyi , Obeagu Getrude Uzoma , Ubosi Nwanganga Ihuoma , Uzoma Ijeoma Chinwe , Tayrab Eltayeb Mohamed Ahmed
Published: April 2024

The co-occurrence of human immunodeficiency virus and malaria presents a complex medical scenario, significantly impacting the quality of life for affected individuals. This comprehensive review synthesizes current knowledge, challenges, and strategies concerning the concurrent management of these infections to improve overall well-being. Epidemiological insights reveal the prevalence and demographic trends, highlighting geographical areas of concern and socioeconomic factors contributing to the burden of co-infection. Pathophysiological interactions elucidate the compounding effects, altering disease progression and treatment outcomes. Healthcare challenges underscore the necessity for integrated care models, evaluating existing healthcare frameworks and their efficacy in addressing dual infections. In-depth analysis of interventions explores pharmacological, behavioral, and preventive measures, evaluating their efficacy and safety in co-infected individuals. Additionally, the review assesses psychosocial support mechanisms, emphasizing community-based interventions and peer networks in enhancing holistic care. Consideration is given to the role of antiretroviral therapy, malaria prevention strategies, and the evolving landscape of healthcare delivery in optimizing outcomes for this vulnerable population. The paper concludes by emphasizing the significance of multidisciplinary approaches and integrated care models, stressing the need for continued research and collaborative efforts to advance interventions and improve the quality of life for those navigating the complexities of human immunodeficiency virus and malaria co-infection.