bluuebunny/crossref_metadata_2025 huggingface dataset:
The Origins of Chinese Writing
Authors: Demattè Paola
Published: October 2024

Though writing is often said to have begun in China with the shell and bone inscriptions of the Shang dynasty (c.1300 bce), archaeological evidence shows that the earliest signs that can be associated with the origins of writing appear during the Late Neolithic (c.3000–2000 bce) in various parts of the territory both in the north and in the south. Neolithic signs are documented on pottery as well as on jade and stone, rarely on bone. These early sign traditions are associated with different neolithic societies that were probably in contact through trade relations. In the early Bronze Age (c.2000), these societies and their sign systems started to coalesce, leading to the emergence of a more integrated urban society and of a functional writing system. Some evidence documenting the continuous development of early Chinese writing from Neolithic signs to the mature system of the Bronze Age is missing from the archaeological records, as it is very likely that documents were kept on perishable material such as bamboo or wooden tablets.
Closing the Gap
Authors: Waal Willemijn
Published: October 2024

This chapter offers a diachronic overview of the use of writing in the Aegean from the Late Bronze Age to the Iron Age from a Near Eastern perspective. It is generally held that, in the Aegean, the use of writing was very restricted in the Late Bronze Age, and completely absent in the Early Iron Age until the introduction of the alphabet around 800 bce. Here, an alternative scenario is presented, in which, during the Late Bronze Age, the Linear B script was used more extensively than usually assumed, but mainly on perishable materials. It will further be argued that there was no long illiterate ‘Dark Age’ from c.1200 to 800 bce, but that the alphabet was already introduced much earlier, and comparable to Linear B, initially only written on perishable materials.
Deciphering a Writing System
Authors: Adiego Ignasi-Xavier
Published: October 2024

This chapter presents a series of reflections on the decipherment of undeciphered scripts. In contrast to other treatments, where the focus is on famous cases of decipherment and where the cases present the achievement of individual scholars, here the focus is on theoretical and methodological aspects common to different decipherment processes. Constraints and obstacles are analysed, together with the role played by several factors in building, and confirming, linguistic hypotheses. In addition, less-well-known cases are discussed and analysed, as well as the author’s own experience in deciphering the Carian alphabet.
The Cat in the Cretan Hieroglyphic Script
Authors: Weingarten Judith
Published: October 2024

The focus of this chapter is on the earliest widespread writing system on Crete, Cretan Hieroglyphic, which most probably appeared in Middle Minoan II and is found in its most developed form at Knossos, Malia, and Petras. Between fifty and one hundred years later, another script, Linear A, began to be used across the island, and Cretan Hieroglyphic essentially disappeared; with it went the practice of script on seals. All written documents were now written in Linear A. In addition to tablets, there was a rich variety of sealed clay documents, including the Minoan roundel, a document unique to Minoan culture. Based on our examination of the Hieroglyphic cat sign (ma), its use and proposed interpretation as an acrophonic abbreviation or an emblem for wool, we follow the sign into its Linear A manifestation as the syllabogram ma, combined with -ru to spell out the Minoan word MA+RU, the logogram for wool (A 559). In the process, we clarify the possible textile implications of A 301 and A 74 in Linear A administration.
Design and Origins of Linear A Picture-Based Signs
Authors: Montecchi Barbara
Published: October 2024

In the second millennium bce, three main scripts were used in the Aegean. Since the time of the first discoveries, spanning the late nineteenth and early twentieth centuries, scholars have been at great pains to explain how they relate to each other. Sir Arthur Evans treated this issue in strict evolutionary terms, from the ‘primitive pictographic system, the hieroglyphic’ to the ‘advanced linear systems of Classes A and B’. Evans’s terminology has become conventional, and the three scripts are still generally called ‘Cretan Hieroglyphic’, ‘Linear A’, and ‘Linear B’. Nevertheless, the Cretan Hieroglyphic graphic repertoire is not entirely picture based; likewise Linear A is not entirely linear or geometric. Indeed, the selection process for their sign shapes is at the centre of an ongoing debate. The aim of this chapter is to investigate Linear A picture-based phonetic signs by distinguishing those that seem to originate with Cretan Hieroglyphic from the ones that do not, at least on the evidence available so far. The shapes of the latter group will thus be compared to Egyptian scripts and to Egyptian and Aegean material cultures in order to shed new light on their origin and relationship with phonetic values.
IDIOM: A Digital Research Environment for the Documentation and Study of Maya Hieroglyphic Texts and Language
Authors: Prager Christian M. , Diederichs Katja , Grothe Antje , Grube Nikolai , Krempel Guido , Matsumoto Mallory , Mercer Tobias , Vertan Cristina , Wagner Elisabeth
Published: October 2024

The Maya hieroglyphic script, an indigenous graphic notation system in the Americas, presents a formidable decipherment challenge. Approximately 40 per cent of its approximately one thousand known signs remain elusive owing to limited comprehension of the Classic Mayan language. Spanning modern-day south-eastern Mexico, Guatemala, Belize, and western Honduras, the Classic Maya civilization left over ten thousand inscriptions, primarily detailing the lives of political elites. The ‘Text Database and Dictionary of Classic Mayan’ project endeavours to unveil the script’s mysteries via an online text database and dictionary at https://classicmayan.org. Collaborative digital humanities methodologies and tools empower insights into the Maya’s cultural and historical legacy. The project catalogues inscribed artefacts and images in the virtual research environment TextGrid and the ‘Maya Image Archive (MIA)’, enhancing accessibility and collaboration. It further converts Maya hieroglyphic texts into machine-readable XML/TEI format and employs a novel sign classification framework. A new linguistic tool facilitates linguistic analysis and translation, enriching our understanding of Classic Mayan language and culture. Furthermore, the project compiles a vast repository of digitized Maya culture-related images and textual data, accessible online. As of 2024, it focuses on hieroglyphic texts from specific regions, with ongoing transliteration, transcription, and linguistic analysis. This digital approach not only facilitates dynamic Maya script research but also offers a platform for comprehensive source material evaluation and publication.
Looking for Writers in the Archives of King Nestor
Authors: Godart Louis
Published: October 2024

The analysis of the tablets drawn up by scribe 602 makes it possible to define the role of this official within the administration of the Mycenaean Palace of Pylos. He was particularly involved in the registration of the collection of bronze taxes within the sanctuaries of the Messenia region as surmised in tablet Jn 829. This scribe was also responsible for the collection of gold by important and secular figures scattered throughout the territory of the state. In addition, the reading of the first line of tablet Ma 397 related to taxation, and the identification of the sign *63 in the sequence a-*63-ta2 (a toponym that elsewhere is spelt a-si-ja-ti-ja) allows us to attribute the phonetic value sja to the sign *63. Finally, the considerations on the paleography of the documents in Linear B, together with the presence in the Ta tablet series of vases adorned with heads of animals comparable to Late Helladic III B1 vessels, suggest that the dating of the palace of Nestor and its demise should be reviewed, and that it should be placed in an earlier phase than hitherto suggested, between the very end of the Late Helladic IIIA2 period and the beginning of the Late Helladic IIIB1 period.
Spaces
Authors: Meer Marcus
Published: October 2024

Urban spaces were demarcated and furnished by heraldic signs in a variety of ways. Visible on towers and gates, heraldry identified the city as an entity separate from the countryside, just as it parcelled out smaller, separate spaces—from the municipal arms on the outside of town halls to the arms of guilds and families that marked their halls, houses, and even places of burial in the urban churches. Heraldic signs also served as reminders of the norms, values, and histories associated with interior spaces, and contributed to the communicative effort of identity formation and self-representation at their heart. Importantly, arms rarely appeared in isolation, instead visualizing and celebrating social relations in often complex arrangements of multiple heraldic signs that spoke to this distinguished status—notably ties to larger corporate or municipal bodies, friendship and kinship between fellow burgesses, and links to the nobility and even the monarchy.
Conflicts
Authors: Meer Marcus
Published: October 2024

Moments of conflict and crisis reveal the significance of monuments and their heraldic signs in relation to the urban space and questions of power. The display of heraldry gave rise to concerns and confrontations that disrupted the peace and threatened the order of urban society, which is why the authorities had to—or felt they had to—address heraldic matters in court and through legislation. Heraldry’s close relation to individual and collective identity underlay the ability of attacks on arms, whether instigated ‘from below’ or ‘from above’, to express opposition to individuals, institutions, and attempts to claim spaces. This relation was also taken for granted in criticisms and prohibitions that sought to limit the heraldic expression of identities—and their associated ambitions—in the medieval city, where the reality of social fragmentation clashed constantly with ideals of a single communal body united in harmony and embodied by its heraldry.
Crime Fiction in the Caribbean
Authors: Evans Lucy
Published: October 2024

Crime Fiction in the Caribbean is the first academic book to focus on crime fiction by anglophone Caribbean writers. Covering novels set in Trinidad and Tobago, Jamaica, Guyana, Barbados, Grenada, and Haiti, it explores how contemporary writers experiment with the crime genre in order to convey, contextualize, and comment on crime and justice in Caribbean countries. Crime fiction is presented as a versatile mode of writing that can be politically engaged, and that—in a Caribbean context—can expose power structures embedded in the region’s multi-layered history of colonial conquest, genocide of Indigenous populations, plantation agriculture, transatlantic slavery, and indentured labour. The book considers how fiction by anglophone Caribbean writers not only reflects upon the social realities of crime and crime control in the Caribbean, but also at times contests or complicates scholarly, popular, and legal perspectives. It argues that through their engagement with the crime genre, these writers raise pressing questions about what constitutes crime and justice in a Caribbean context, and about accountability. Looking beyond the traditional focus of crime fiction and criminology on individual acts of wrongdoing, their fiction highlights systemic social harms which are rooted in the region’s colonial past. Reading crime fiction through the lens of criminological research, this book brings the study of literary writing into scholarly debate on crime in the Caribbean. At the same time, it extends the global turn in crime fiction studies, focusing on a region that has been sidelined even in studies which examine the genre’s international dimensions.
Environmental crime and eco-noir
Authors: Evans Lucy
Published: October 2024

This chapter explores literary representations of environmental crime. Esther Figueroa’s Limbo: A Novel about Jamaica (2014) foregrounds the damaging effects of tourism and resource extraction. Environmental harms associated with these activities are presented as criminal acts driven by state and corporate interests. Edwidge Danticat’s Claire of the Sea Light (2013) raises questions of culpability and accountability surrounding Haiti’s 2010 earthquake. Danticat’s novel frames ‘natural’ disaster as eco-crime. In both texts, ecocide is presented as an ongoing catastrophe which links past, present, and future. This chapter draws on research in green criminology as well as critical writing on crime fiction and ecology. Figueroa’s and Danticat’s novels are read as eco-noir, a mode of writing that connects noir themes of ambivalence, disillusionment, and cynicism to the darkness of the Anthropocene era. The chapter considers how their fiction resonates with current scholarly, activist, and legal debates on eco-crime and environmental justice.
Epilogue
Authors: Chu Jinyi
Published: October 2024

The epilogue reflects on fin-de-siècle Russian culture’s China through its afterlife in the Soviet context: Akhmatova’s mid-twentieth-century translation of the Chinese poet Qu Yuan’s long poem Li Sao or “Overcoming Sorrow” (third century bce), an exiled aristocrat’s patriotic (and allegedly homoerotic) confession to his king. In collaboration with the Soviet Sinologist Nikolai Fedorenko, Akhmatova published the first Russian translation of Li Sao in 1954. This celebrated modernist poet, almost silenced under Stalin, found a rare opportunity for poetic expression in the voice of an ancient Chinese poet. Akhmatova and Fedorenko voiced their different views on translation. For Akhmatova, the chapter argues, China was a geopoetic bridge reconnecting them to the fin-de-siècle cultural milieu, a time and space they could never retrieve.
Find Your Bearings
Authors: Waleffe Fabian
Published: October 2024

Introduces notation and basic concepts, including cartesian, cylindrical and spherical representations of vectors in 2 and 3 dimensional space. Includes geometric and geographic applications and examples.
Vector Spaces
Authors: Waleffe Fabian
Published: October 2024

Reviews basic linear algebra concepts. The vector space Rn. Linear independence, basis, dimension. Illustrated with geometric examples and exercises.
Dot Product
Authors: Waleffe Fabian
Published: October 2024

Defines and investigates the geometric and algebraic properties of the dot product. Dicusses orthonormal bases. Extends definitions of dot product and norms for vectors in Rn.
Cross Product
Authors: Waleffe Fabian
Published: October 2024

Defines and investigates geometric and algebraic properties of the cross product and the double cross product. Discusses orientation of bases. Includes a rich set of applications and exercises, in particular to the rotation of vectors.
Determinant
Authors: Waleffe Fabian
Published: October 2024

Discusses mixed products and determinants. Derives geometric and algebraic properties of determinants. Connects with algebraic determinants. Makes use of cartesian index notation. Includes many applications and exercises, in particular to spherical trigonometry.
Points, Lines, Planes, etc.
Authors: Waleffe Fabian
Published: October 2024

Introduces the position (or radius) vector. Discusses cartesian, cylindrical and spherical coordinates. Investigates vector equations of lines and planes and their intersection. Introduces some coordinate systems beyond those three basic systems, including bipolar coordinates.
Matrices and Tensors
Authors: Waleffe Fabian
Published: October 2024

Discusses matrix notation and algebra. Matrix inverse. Symmetric and anti-symmetric matrices. Orthogonal and permutation matrices. Gram-Schmidt orthogonalization and QR decomposition. Introduces tensors, dyadic product and dyadic representations. Discusses eigenvalue problems and diagonalization of symmetric matrices.
Curves
Authors: Waleffe Fabian
Published: October 2024

Discusses concept and representations of curves. Studies conics and Bézier curves. Investigates geometric properties of curves, arclength, curvature, torsion and the Frenet frame. Moves on to integrals over curves (line integrals) with fundamental examples including area swept by the radius vector, and the winding and turning numbers. Concludes with a discussion of hanging chains and the catenary.
Curvilinear Coordinates
Authors: Waleffe Fabian
Published: October 2024

Discusses general coordinates for 3D space, and the geometry of coordinate curves and surfaces. Introduces Jacobian matrices and determinants, tangents and normals bases, that become the covariant and contravariant bases. Formula specific to general orthogonal coordinates are also derived. Considers line, surface and volume elements for general coordinates, then volume integrals and change of variables in multiple integrals.
Fields
Authors: Waleffe Fabian
Published: October 2024

This core chapter introduces and illustrates scalar and vector fields. The gradient of a scalar field is discussed with emphasis on geometric aspects. Fundamental gradients and gradient rules are established and their use to simplify calculations is demonstrated. Expression for the gradient in general coordinates are derived. Coordinate velocity and gradient bases are identified with covariant and contravariant bases. The curl and divergence of vector fields are discussed and derived in standard and general coordinates. The Stokes’ and divergence theorems readily follow. Vector identities are derived and their use to simplify calculations is illustrated. Expressions for the Laplacian are derived in standard, orthogonal and curvilinear coordinates for both scalar and vector fields. The heat equation is discussed.
Complex Algebra and Geometry
Authors: Waleffe Fabian
Published: October 2024

We begin with a brief review of the origin of complex numbers. Discuss the complex plane and the algebra of complex numbers. The chapter concludes with Argand’s proof of the fundamental theorem of algebra.
Complex Integration
Authors: Waleffe Fabian
Published: October 2024

This final chapter considers integration in the complex plane. Cauchy’s theorem is derived. Poles and singularities of complex functions are discussed. The calculus of residues is explained and illustrated with a few key examples. Cauchy’s formula and the generalized Cauchy formula are derived. Several classic examples of application of complex methods to the calculation of real integrals are presented.
How Do Personal Relationships Make a Moral Difference?
Authors: Stroud Sarah
Published: October 2024

When you share a personal relationship with someone, you often have duties concerning that person which you don’t have with respect to unrelated others. In that sense, personal relationships seem to make a moral difference. But how—that is, by what mechanism—do they make that difference? This chapter offers a precise formulation of the hypothesis that personal relationships do make a moral difference, and it presents four distinct models of how they could do that. Three of these models may look familiar. The fourth sources the moral impact of personal relationships in the actions which become possible only when you have a personal relationship with someone.
Prudence, Beneficence, and Time
Authors: Bradley Ben
Published: October 2024

A standard view about prudence states that an act is prudent if and only if it results in the best life for the agent. Recently this view has been rejected. According to Richard Pettigrew, it is sometimes prudent to refuse to sacrifice one’s present values for the values one will have in the future, even if this results in a worse life overall. According to Dale Dorsey, it is often prudent to refuse to change one’s present values to ones that would be better fulfilled in the future. This chapter argues that these views are mistaken. Against Pettigrew, it is argued that there is a tight connection between prudence and beneficence: roughly, a choice is prudent if and only if it would be chosen by one’s ideal benefactor. Time-relative views such as Pettigrew’s must deny this. Dorsey’s view, on the other hand, is committed to an implausible sort of prudential and beneficial inertia. The standard view does not have these problems, so we are better off keeping it.
The All or Nothing Ranking Reversal and the Unity of Morality
Authors: Tucker Chris
Published: October 2024

Supererogatory acts are, in some sense, morally better their non-supererogatory alternatives. In this sense, what is it for one option A to be better than an alternative B? This chapter argues for three main conclusions. First, relative rankings are a type of all-in action guidance. If A is better than B, then morality recommends that you A rather than B. Such all-in guidance is useful when acts have the same deontic status. Second, Right > Wrong: permissible acts are always better than their impermissible alternatives. If Right > Wrong were false, then morality’s deontic verdicts would sometimes conflict with its relative rankings. Such conflict would undermine the thought that morality is a coherent, authoritative guide to action. Third, the All or Nothing Problem is not a counterexample to Right > Wrong, as is commonly thought. Instead, it involves an interesting ranking reversal: whether A > B can depend on whether a certain alternative is added as a third option.
Expressive Duties Are Demandable and Enforceable
Authors: Eskens Romy
Published: October 2024

According to an influential view about directed expressive duties (e.g., duties to express gratitude to benefactors, remorse to victims, forgiveness to wrongdoers), these duties do not have rights as their correlates, because they are not demandable and enforceable. This chapter argues that this view is mistaken. Like other directed duties, directed expressive duties are demandable and enforceable. While this does not entail that these duties have rights as their correlates, it does create a strong presumption of this being the case. This shifts the burden of proof from those who hold that expressive duties correlate with rights to those who deny it.
Why Consequentialize?
Authors: Dreier Jamie
Published: October 2024

To consequentialize a moral theory is to construct a consequentialist version of the theory. The new theory is a ‘version’ of the old in the sense that they deliver the same deontic verdicts on actions: permissible, impermissible, required. This chapter gives some reasons for consequentializing and assesses some obstacles to completing the project consonant with those reasons. It considers the difficulties posed by theoretical verdicts of moral worth, by potential differences between theories not traceable to their ranking of outcomes, and by worries about whether reasons for action are really teleological.
Dominican Christology in the 1240s
Authors: Cross Richard
Published: October 2024

This chapter examines the two most significant Dominican Christologies of the 1240s, namely, those of Richard Fishacre and Albert the Great. Fishacre offers a clear delineation of Lombard’s three theories and accepts the subsistence theory. But he nevertheless sometimes uses the language of the homo assumptus theory, apparently without noticing the incongruity. He maintains, following Hugh of St Cher (on whom he relies in many ways), that the union between person and nature is nothing at all. Albert accepts that the union is a created relation and uses the account of the communication of divine esse as a way of explaining the union. He thus seems to presuppose the kind of distinction between essence and esse introduced into medieval Latin philosophy by the late twelfth-century translation of Avicenna’s philosophy.
Franciscan Christology in the 1240s
Authors: Cross Richard
Published: October 2024

The Franciscans of the 1240s, pre-eminently the Summa halensis and Richard Rufus of Cornwall, all adopt versions of the homo assumptus theory. Rufus does so by explicit appeal to an earlier text that is probably to be identified as the Eulogium written by John of Cornwall. According to the Summa halensis, there is no created tie between the human nature and the divine person. Rather, the nature is ‘drawn’ into the divine person’s esse. The text makes evident the Christological application of the principle that subsistence requires the lack of an inclination to union with another. According to Rufus, the union between Word and human nature is immediate.
Metapontion
Authors: Carter Joseph Coleman
Published: October 2024

Metapontion was founded c. 630, about a century after its neighbors Taras and Sybaris; it soon became known for the abundance of its grain production. Although textual sources for Metapontion are scarce, the archaeological record is extraordinarily full and offers particular insight into the diachronic development of the chōra, including a massive flood control and land improvement program carried out in the sixth century. The evidence from Metapontion allows us to see, in more detail than almost any other place, a dominant feature of life in ancient Greece: agricultural activity outside the main urban center.
Anti-peptide antibodies, anti-SNRK and anti-HUWE1 antibodies as potential predictors of good response to tofacitinib therapy in rheumatoid arthritis patients
Authors: Chen Po-Ku , Chen Yi-Ming , Chen Jeremy J W , Chen Der-Yuan
Published: October 2024

Objectives

To maximize the cost-effectiveness of tofacitinib, one of the Janus kinase inhibitors, there is an unmet need to identify predictors of therapeutic response. Utilizing phage immunoprecipitation sequencing (PhIP-Seq), we aim to identify peptide biomarkers for predicting good response to tofacitinib in rheumatoid arthritis (RA) patients.

Methods

We enrolled 106 patients who had received 24-week tofacitinib therapy, including 12 patients undergoing PhIP-Seq analysis in the discovery stage and 94 patients validated with enzyme-linked immunosorbent assay (ELISA) in the replication stage. Disease activity was assessed using the 28-joint disease activity score-erythrocyte sedimentation rate, and therapeutic response was evaluated using EULAR response criteria. Plasma levels of caspase-1 and IL-18 were determined using ELISA.

Results

PhIP-Seq analysis identified antibodies to sucrose non-fermenting-related kinase (SNRK) and HUWE1 (ubiquitin E3 ligase) as peptide biomarkers for discriminating good responders from the non-good responders. Using ELISA for validation on another cohort, an optimal cut-off value of anti-SNRK antibody for predicting good response was 0.381, with AUC 0.823, specificity 80.6% and sensitivity 78.1% (P = 3.01E-07), and anti-HUWE1 antibody at 0.362, with AUC 0.740, specificity 74.2% and sensitivity 62.5% (P < 0.001). Plasma levels of anti-SNRK and anti-HUWE1 antibodies were positively correlated with levels of caspase-1 and IL-18 (both P < 0.05). Multivariate logistic regression analysis revealed anti-SNRK antibody as a significant predictor of good therapeutic response. After tofacitinib therapy, anti-SNRK antibody levels significantly declined in good responders, but not in non-good responders.

Conclusion

We identify two peptide antibodies, anti-SNRK and anti-HUWE1 antibodies, as pretreatment predictors of good therapeutic response to tofacitinib in RA patients.
Integration of a dose management system in the public hospitals of Cyprus: Key areas and initial outcomes
Authors: Skouridi Eleni , Metaxas Vasileios , Kaolis Demetris , Kokona Georgiana
Published: October 2024

Despite the growing use of dose management systems (DMSs), there is limited guidance on their optimal setup. This study aims to fill this gap by outlining the process followed to integrate “DOSE” (Qaelum NV, Belgium) DMS within the Cypriot public hospitals. DOSE was connected to the available central PACS, followed by a thorough data and functioning validation. A preliminary study was also conducted to assess the DOSE’s ability to establish typical dose values in diagnostic radiography. Overall, over 70 x-ray units were configured. For some connections, it was necessary to first adjust the unit’s DICOM attributes or to utilise the DICOM coercion technique. The DICOM image header was sometimes preferred over the DICOM RDSR, as the chosen data source. This study underscored the importance of understanding the equipment’s technical capabilities for a successful DMS integration, while personnel with expertise in diagnostic radiology and the IT aspects of medical physics proved to have a vital role in the process. The pilot study showed that DOSE is an effective tool for establishing typical dose values and assessing compliance with relevant dose levels.
A replicate crossover trial on the interindividual variability of sleep indices in response to acute exercise undertaken by healthy men
Authors: Yang Yuting , Thackray Alice E , Shen Tonghui , Alotaibi Tareq F , Alanazi Turki M , Clifford Tom , Hartescu Iuliana , King James A , Roberts Matthew J , Willis Scott A , Lolli Lorenzo , Atkinson Greg , Stensel David J
Published: October 2024

Study Objectives

Using the necessary replicate-crossover design, we investigated whether there is interindividual variability in home-assessed sleep in response to acute exercise.

Methods

Eighteen healthy men (mean [SD]: 26[6] years) completed two identical control (8 hour laboratory rest, 08:45–16:45) and two identical exercise (7 hour laboratory rest; 1 hour laboratory treadmill run [62(7)% peak oxygen uptake], 15:15–16:15) trials in randomized sequences. Wrist-worn actigraphy (MotionWatch 8) measured home-based sleep (total sleep time, actual wake time, sleep latency, and sleep efficiency) two nights before (nights 1 and 2) and three nights after (nights 3–5) the exercise/control day. Pearson’s correlation coefficients quantified the consistency of individual differences between the replicates of control-adjusted exercise responses to explore: (1) immediate (night 3 minus night 2); (2) delayed (night 5 minus night 2); and (3) overall (average post-intervention minus average pre-intervention) exercise-related effects. Within-participant linear mixed models and a random-effects between-participant meta-analysis estimated participant-by-trial response heterogeneity.

Results

For all comparisons and sleep outcomes, the between-replicate correlations were nonsignificant, ranging from trivial to moderate (r range = −0.44 to 0.41, p ≥ .065). Participant-by-trial interactions were trivial. Individual differences SDs were small, prone to uncertainty around the estimates indicated by wide 95% confidence intervals, and did not provide support for true individual response heterogeneity. Meta-analyses of the between-participant, replicate-averaged condition effect revealed that, again, heterogeneity (τ) was negligible for most sleep outcomes.

Conclusions

Control-adjusted sleep in response to acute exercise was inconsistent when measured on repeated occasions. Interindividual differences in sleep in response to exercise were small compared with the natural (trial-to-trial) within-subject variability in sleep outcomes.

Clinical trials information

https://clinicaltrials.gov/study/NCT05022498. Registration number: NCT05022498.
An Introduction to Types of Quasi-Experimental Designs
Authors: Capili Bernadette , Anastasi Joyce K.
Published: October 2024

Editor's note: This is the 24th article in a series on clinical research by nurses. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation. To see all the articles in the series, go to https://links.lww.com/AJN/A204.
The False Divide Between Body and Mind
Authors: Brown Theresa
Published: October 2024

A riveting new book argues for true collaborative care.
Osteochondral Autograft Transplantation for Symptomatic Full-thickness Patellar Cartilage Defects in Adolescents
Authors: Masquijo Javier , Carabajal Mattar Miguel , Ron Marqués Alejandra , Losa Alberto , Cabello Blanco Juan , Nuñez de Armas Joaquín , Tuca Maria J.
Published: October 2024

Background:

This study aimed to review the clinical, radiographic, and magnetic resonance imaging (MRI) outcomes of osteochondral autograft transplantation applied to patellar cartilage lesions of patients under 18 years of age.

Methods:

Data from nine consecutive patients were retrospectively analyzed for indications, preoperative complications, and clinical-radiographic outcomes. Patients were clinically evaluated using the Pedi-IKDC and Lysholm scores. In addition, return to sports and knee pain were assessed. MRI evaluation included an analysis of osteochondral graft integration using the magnetic resonance observation of cartilage repair tissue 2.0 score and radiographic classification of osteoarthritis using the Kellgren-Lawrence system.

Results:

Nine patients (9 knees, 6 males) with a mean age of 14 years (SD: 1.7, range; 11 to 17 y) were analyzed. Lesions were located on the medial facet (N=5), lateral facet (N=3), and central ridge of the patella (N=1). One or 2 cylindrical osteochondral grafts were transplanted, with a median diameter of 9 mm (range: 8 to 10 mm). The average lesion size was 102.9 mm2. At a mean follow-up of 45.1 months (range: 23 to 117 mo), the mean Pedi-IKDC score was 89.2 (SD: 9.8), and the Lysholm score was 94.4 (SD: 4.8). Patients returned to sports in an average of 7.3 months (SD: 2, range: 6 to 12 mo). MRI of 8 patients showed osteochondral graft integration with a mean magnetic resonance observation of cartilage repair tissue 2.0 score of 86.9 (SD: 7, range: 80 to 100). Six knees showed Kellgren-Lawrence grade 0 joint space on radiographs, and 3 showed grade 1. Eight patients were asymptomatic at the last follow-up, and 1 reported occasional mild pain with intense physical activity. One patient developed arthrofibrosis, requiring arthroscopic lysis of adhesions and manipulation.

Conclusion:

Osteochondral autograft transplantation is a safe and effective technique for treating symptomatic patellar full-thickness chondral lesions in adolescents. Long-term follow-up studies will determine whether the affected area maintains structural and functional integrity over time.

Level of Evidence:

Level IV—therapeutic study.
Risk Factors for Adjacent Vertebral Fractures Following Cement Vertebroplasty
Authors: Huang Po-Hao , Chen Chih-Wei , Hu Ming-Hsiao , Yang Shu-Hua , Huang Chuan-Ching
Published: October 2024

Study Design:

A retrospective cohort study.

Objective:

The study retrospectively analyzed the factors associated with the development of adjacent vertebral fractures.

Summary of Background Data:

Adjacent vertebral fractures (AVF) may occur following cement vertebroplasty, and several risk factors have been reported with controversies.

Methods:

A total of 123 patients, with a mean age of 79.2 years, who underwent single-level vertebroplasty were included in the investigation. We systematically collected data encompassing baseline demographics, osteoporosis parameters, surgical details, radiologic measurements, and Hounsfield unit (HU) values in the lumbar spine. Subsequently, univariable, followed by multivariable logistic regression analyses, were employed to identify the risk factors of AVFs.

Results:

Thirty of 123 patients had AVFs within 6 months following vertebroplasty. The AVF group exhibited a higher percentage of multiple preexisting vertebral compression fractures (P=0.006), a greater volume of injected cement (P=0.032), and a more pronounced reduction in local kyphosis (P=0.007). Multivariable logistic regression analysis revealed multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees were independent risk factors for AVFs (P=0.008 and 0.003, respectively), with odds ratios of 3.78 (95% confidence interval: 1.41–10.12) and 4.16 (95% CI: 1.65–10.50), respectively. Subgroup analysis showed that patients with multiple preexisting vertebral compression fractures (VCFs) had significantly lower bone mineral density Z-score, T-score, and HU values compared with those without preexisting VCFs (P<0.05). Conversely, there were no significant differences in T-score or HU values between patients with no VCFs and those with a single VCF.

Conclusion:

This study demonstrated that both bone strength and local alignment are key factors associated with adjacent vertebral fractures. Specifically, having multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees are independent risk factors. The presence of more than one previous vertebral compression fracture serves as a significant clinical indicator of advanced bone density reduction in patients with osteoporosis, offering a quick and straightforward method for identifying high-risk patients. Patients exhibiting these risk factors should be monitored more closely for favorable clinical outcomes.

Level of Evidence:

Level III—retrospective nonexperimental study.
Does Early Exposure Change Pediatric Residents' Perceptions of Developmental-Behavioral Pediatric Care?
Authors: Stefanski Kristen J. , Foster Jessica , Brown Miraides , Langkamp Diane
Published: October 2024

Objective:

To explore the impact of a new “Intro to DBP” rotation on pediatric residents' interest in developmental-behavioral pediatrics (DBP) and comfort in providing DBP care.

Methods:

All first-year pediatric residents participated in a new 1-week DBP rotation. Experiences included clinic visits; interdisciplinary evaluations; asynchronous online learning; and lectures, journal clubs, and/or case conferences. Participants completed pre- and postrotation surveys. Surveys focused on awareness of the DBP field; career plans; and perceived importance of, comfort with, and interest in learning about DBP care. We analyzed data using descriptive statistics and Bhapkar's test to compare distribution differences on pre- and postrotation Likert scales; we reviewed open-ended questions to identify themes.

Results:

Thirty-two residents participated; 56% had no previous exposure to DBP. After the rotation, there was a statistically significant increase in resident-reported importance of DBP care (p < 0.0001), comfort in providing DBP care (p < 0.0001), and interest in pursuing a DBP fellowship (p = 0.0048). Themes identified from open-ended responses suggested that the rotation led to a broader understanding of the DBP field, reinforcement and expansion of knowledge pertinent to all pediatric care, and improved understanding of systems of care.

Conclusion:

Brief, early exposure to DBP during pediatric residency training led to increased awareness of and comfort in providing DBP care. Residents described a broader understanding of the depth and breadth of DBP and its applicability to all aspects of pediatric care. Early introduction to DBP during residency training may stimulate greater interest in the field and greater comfort among general pediatricians to provide DBP care.
A patient-centered approach to dietary supplements for patients with chronic liver disease
Authors: Lai Jennifer C. , Ring Melinda , Dhruva Anand , Yeh Gloria Y.
Published: October 2024

The use of dietary supplements by patients with chronic liver disease is prevalent and rising. Despite the known risks of dietary supplements, including hepatotoxicity, adulteration, and contamination, patients with chronic liver disease often turn to dietary supplements to support their liver and/or overall health but are not necessarily empowered with the information or guidance from their liver practitioner to do so. This article provides practitioners with a framework for balancing the risks and benefits of dietary supplements in patients with chronic liver disease, offering examples of independent resources and certifications to use this framework in clinical practice. We offer 3 common clinical scenarios to highlight how the use of this framework can improve communication and decision-making in clinical practice. By adapting principles from Integrative Medicine, this article advocates for a patient-centered approach to dietary supplements in patients with chronic liver disease, encouraging open dialogue between clinicians and their patients to facilitate informed decision-making and personalized care.
Prevalence of hypertension and uncontrolled hypertension after solid organ transplantation: a 5-year follow-up of the Swiss Transplant Cohort Study
Authors: Schwotzer Nora , Lu Yimin , Halfon Matthieu , Pascual Manuel , Marques-Vidal Pedro , Golshayan Dela , Wuerzner Gregoire ,   the Swiss Transplant Cohort Study
Published: October 2024

Objective:

Hypertension (HTN) increases cardiovascular risk and is a frequent finding across all solid organ transplant recipients. We describe the prevalence of HTN and uncontrolled HTN, as well as details on pharmacologic treatment of HTN across solid organs transplant recipients up to five years after transplantation.

Methods:

This retrospective study is nested in the prospective Swiss Transplant Cohort Study (www.stcs.ch) that includes kidney, heart, lung, and liver transplantation. Data extraction from 2008 to 2019 was used for this study and follow-up data at 6, 12 and 60 months was analyzed.

Results:

A total of 3865 transplant recipients were included for analysis. The prevalence of HTN at 6 and 60 months was 88.9% and 90.4% in kidney (P = 0.21), 61.8% and 76.1% in liver (P < 0.01), 72.6% and 84.9% in lung (P < 0.01), and 89.3% and 85.8% in heart (P = 0.33) transplant recipients, respectively. The prevalence of uncontrolled HTN at 6 and 60 months was 40.3% and 38.9% in kidney (P = 0.48), 21.2% and 30.5% in liver (P = 0.05), 26.0% and 36.8% in lung (P = 0.03) and 38.9% and 18.5% in heart (P < 0.01) transplant recipients, respectively. At 12 months, compared to heart transplant recipients, kidney [odds ratio (OR) = 1.6, 95% confidence interval (CI) 1.1–2.1], liver (OR = 1.7, 95% CI 1.1–2.6) and lung (OR = 2.6, 95% CI 1.6–4.0) transplant recipients had a higher likelihood of presenting with uncontrolled HTN.

Conclusion:

HTN prevalence after solid organ transplantation is high. Uncontrolled and untreated HTN remain a major issue post transplantation, particularly in organ recipients not necessarily suffering from cardiovascular diseases such as liver or lung transplant recipients.
Cardiovascular and arrhythmic manifestations of Bartter's and Gitelman's syndromes: do not forget the heart. A narrative literature review
Authors: Giordani Andrea S. , Menghi Caterina , Proietti Riccardo , Stefanelli Lucia Federica , Cacciapuoti Martina , Calò Lorenzo A.
Published: October 2024

Bartter's and Gitelman's syndromes (BS/GS) are genetically determined kidney tubulopathies leading to electrolyte and neurohormonal abnormalities. Although considered benign entities, major adverse cardiovascular events may complicate both syndromes, in form of ventricular arrhythmias leading to palpitations, syncope or sudden cardiac death, microvascular cardiac dysfunction and exercise-induced myocardial contractile deficit. The mechanisms leading to cardiovascular complications are not only driven by chronic electrolyte abnormalities, i.e. chronic hypokalemia and hypomagnesemia, but also by neurohormonal alterations that can impair vascular tone and myocardial contractility. In presence of triggering factors, BS/GS patients may experience a spectrum of cardiac arrhythmias necessitating prompt diagnosis and treatment. The aim of this review is to explore the pathophysiological mechanisms of BS and GS, highlighting those responsible for cardiovascular involvement, and to analyze the spectrum of associated cardiovascular complications. This highlights the importance of an integrated shared management of GS/BS patients between Nephrologist and Cardiologist.
Discordance between preclinical and clinical testing of NaV1.7-selective inhibitors for pain
Authors: Yang Jane , Xie Yu-Feng , Smith Russell , Ratté Stéphanie , Prescott Steven A.
Published: October 2024

The voltage-gated sodium channel NaV1.7 plays an important role in pain processing according to genetic data. Those data made NaV1.7 a popular drug target, especially since its relatively selective expression in nociceptors promised pain relief without the adverse effects associated with broader sodium channel blockade. Despite encouraging preclinical data in rodents, NaV1.7-selective inhibitors have not yet proven effective in clinical trials. Discrepancies between preclinical and clinical results should raise alarms. We reviewed preclinical and clinical reports on the analgesic efficacy of NaV1.7-selective inhibitors and found critical differences in several factors. Putting aside species differences, most preclinical studies tested young male rodents with limited genetic variability, inconsistent with the clinical population. Inflammatory pain was the most common preclinical chronic pain model whereas nearly all clinical trials focused on neuropathic pain despite some evidence suggesting NaV1.7 channels are not essential for neuropathic pain. Preclinical studies almost exclusively measured evoked pain whereas most clinical trials assessed average pain intensity without distinguishing between evoked and spontaneous pain. Nearly all preclinical studies gave a single dose of drug unlike the repeat dosing used clinically, thus precluding preclinical data from demonstrating whether tolerance or other slow processes occur. In summary, preclinical testing of NaV1.7-selective inhibitors aligned poorly with clinical testing. Beyond issues that have already garnered widespread attention in the pain literature, our results highlight the treatment regimen and choice of pain model as areas for improvement.
Results of hepatocellular carcinoma downstaging through hepatic transarterial chemoembolization in liver transplantation
Authors: de Morais Beatriz G. , Horbe Alex F. , Coral Gabriela Perdomo , Jotz Raquel de F. , Fontana Priscila C. , Mattos Angelo A.
Published: October 2024

Introduction and aim:

Liver transplantation plays an important role in treating hepatocellular carcinoma (HCC). However, diagnosis often occurs when the tumor size exceeds Milan criteria. In this context, locoregional treatments are frequently indicated. The aim of this study is to evaluate cirrhotic patients with HCC undergoing transarterial chemoembolization (TACE) for downstaging.

Methods:

This retrospective study assessed medical records of patients aged 18 years or older, diagnosed with HCC, who underwent TACE with the aim of downstaging. In the survival analysis, the Kaplan–Meier method was used. P-value <0.05 was considered statistically significant.

Results:

One hundred and twenty-three patients were evaluated, of which 44.7% underwent liver transplantation after downstaging. Mortality in these patients was 32.7% and the probability of survival at 1, 2, and 5 years after liver transplantation was, respectively, 80%, 70.8%, and 57%. When comparing with the unsuccessful group, there was a significant difference regarding number of nodules, size of the largest nodule, and response by Modified Response Evaluation Criteria in Solid Tumor. The characteristics of the group undergoing TACE for downstaging and the group undergoing TACE as a bridge to transplantation were also compared, and patients were selected through the propensity score. A more significant number of nodules was observed in patients who underwent downstaging (P = 0.014) and they exceeded Milan criteria in the explanted liver more frequently (P = 0.007). Survival in the downstaging group and in the bridge group was not different (P = 0.342).

Conclusion:

Liver transplantation in patients with HCC after successful downstaging proved to be effective, as patients had adequate survival.