bluuebunny/crossref_metadata_2025 huggingface dataset:
Business Challenges in the Transition to Sustainability
Authors: Fet Annik Magerholm , Keitsch Martina
Published: February 2023

The first chapter of this book presents a brief history of Sustainable Development (SD) and takes a closer look at business and industry and their attitudes and actions towards sustainability regarding technological development, environmental issues and challenges for organizations. The goal of the chapter is to advocate for the growing need for competence building in sustainability amongst business leaders as well as societal stakeholders. It prepares the reader to understand how this can be done via the tools and strategies that are discussed in the following chapters of this book.
The CapSEM Model
Authors: Fet Annik Magerholm , Knudson Haley
Published: February 2023

Organizations may feel pressurized to improve their sustainability performance and increase their orientation towards sustainability, but may not have either the knowledge as to where, or the capacity, to begin. This chapter therefore presents a systematized methodology of assessment and management tools for sustainability and environmental management known as the Capacity building in Sustainability and Environmental Management Model (the CapSEM Model). To help streamline their application for the business sector and industry, the methods and tools are positioned in relation to four levels of development: (1) production processes, (2) products and value chains, (3) organization and management and (4) larger systems, for example, industrial sectors or social systems.

The discussion and analysis of tools presented in this chapter and explained throughout this book, address the growing need to engage stakeholders and to consider environmental, social and economic impacts across the entire life cycles of products in business strategies and organization management. The CapSEM Model Levels move from incremental business tools and their application in production processes, to holistic tools for change in organizations and larger systems. The transition to sustainable societies is considered analogous to growth in both systems and performance complexity.
Looking Beyond the Factory Gates: Life Cycle Assessment, Supply Chain Management and Design for Environment
Authors: Fet Annik Magerholm , de Boer Luitzen , Keitsch Martina
Published: February 2023

This chapter gives an overview of the principles of life cycle assessment (LCA), supply chain management (SCM) and design for the environment (DfE). They are all placed at Level 2 in the CapSEM Model as tools for enhancing the product by improving the actual production processes that take place at different stages and subsystems in the life cycle of a product. One way of analysing and ameliorating the environmental performance of a product can be by analysing the environmental aspects and impacts initially by performing a life cycle assessment aimed at finding the most significant environmental impacts in the life cycle of the product. These hotspots can then be identified under different suppliers in the upstream value chain. Results from this analysis should then be addressed in the design of a new product, and further result in changes to the supply chain by supply chain management. An optimal solution for improving the environmental impacts at the different stages of the life cycle of a product, can be achieved at the end by introducing this into design principles as better specification of the performance at each stage in the life cycle of the product. This chapter also introduces green public procurement as a driver for change in the supply chain.
Conditions for suppressing dimension-five proton decay in renormalizable SUSY SO(10) GUT
Authors: Haba Naoyuki , Yamada Toshifumi
Published: February 2023

Abstract

The SUSY SO(10) GUT is in severe tension with the experimental bounds on proton partial lifetimes because proton decay mediated by colored Higgsinos (dimension-five proton decay) is too rapid. In this paper, we pursue the possibility that a texture of the Yukawa coupling matrices in a renormalizable SUSY SO(10) GUT model suppresses dimension-five proton decay. We focus on a general renormalizable SUSY SO(10) GUT model which contains 10 + 126 + $$ \overline{\textbf{126}} $$

126
¯

+ 120 representation fields and where the Yukawa coupling matrices of the 16 matter fields with the 10, $$ \overline{\textbf{126}} $$

126
¯

, 120 fields, Y10, Y126, Y120, provide the quark and lepton Yukawa couplings and Majorana mass of the singlet neutrinos. We find that if components in certain flavor bases, $$ {\left({Y}_{10}\right)}_{u_R{d}_R} $$

Y
10

u
R

d
R

, $$ {\left({Y}_{126}\right)}_{u_R{d}_R} $$

Y
126

u
R

d
R

, $$ {\left({Y}_{10}\right)}_{u_R{s}_R} $$

Y
10

u
R

s
R

, $$ {\left({Y}_{126}\right)}_{u_R{s}_R} $$

Y
126

u
R

s
R

, $$ {\left({Y}_{10}\right)}_{u_L{d}_L} $$

Y
10

u
L

d
L

, $$ {\left({Y}_{126}\right)}_{u_L{d}_L} $$

Y
126

u
L

d
L

, $$ {\left({Y}_{10}\right)}_{u_L{s}_L} $$

Y
10

u
L

s
L

, $$ {\left({Y}_{126}\right)}_{u_L{s}_L} $$

Y
126

u
L

s
L

, $$ {\left({Y}_{10}\right)}_{u_L{u}_L} $$

Y
10

u
L

u
L

, $$ {\left({Y}_{126}\right)}_{u_L{u}_L} $$

Y
126

u
L

u
L

, are all on the order of the up quark Yukawa coupling, dimension-five proton decay can be suppressed while the Yukawa coupling matrices still reproduce the realistic quark and lepton masses and flavor mixings. We numerically obtain specific Yukawa coupling matrices satisfying the above conditions, calculate proton partial lifetimes from them and evaluate how dimension-five proton decay is suppressed when these conditions are met.
First-order phase transitions in Twin Higgs models
Authors: Badziak Marcin , Nałęcz Ignacy
Published: February 2023

Abstract

We revisit phase transitions in Twin Higgs (TH) models. We show that strong first-order phase transitions (FOPTs) can occur provided that appropriate source of ℤ2 symmetry breaking between the twin and Standard Model (SM) sectors is present. We found FOPTs in two classes of models. First: with hard ℤ2 breaking in the scalar potential allowing for FOPT. Second: with ℤ2 broken by enhanced Yukawa couplings of twin leptons. We also considered supersymmetric UV completion of the second scenario with light sleptons. The signal of gravitational waves produced during these phase transitions is typically small but can be close to the reach of AEDGE and Einstein Telescope in the case of the FOPT induced by light twin sleptons. Our results open a way to generate SM baryon asymmetry in TH models.
A note on bifurcations from eigenvalues of the Dirichlet-Laplacian with arbitrary multiplicity
Authors: Correia Simão , Figueira Mário
Published: February 2023

In this short note, we consider the elliptic problem $$\begin{aligned} \lambda \phi + \Delta \phi = \eta |\phi |^\sigma \phi ,\quad \phi \big |_{\partial \Omega }=0,\quad \lambda , \eta \in {{\mathbb {C}}}, \end{aligned}$$

λ
ϕ
+
Δ
ϕ
=

η
|
ϕ
|

σ

ϕ
,

ϕ

|

∂
Ω

=
0
,

λ
,
η
∈
C
,

on a smooth domain $$\Omega \subset {{\mathbb {R}}}^N$$

Ω
⊂

R

N

, $$N\geqslant 1$$

N
⩾
1

. The presence of complex coefficients, motivated by the study of complex Ginzburg-Landau equations, breaks down the variational structure of the equation. We study the existence of nontrivial solutions as bifurcations from the trivial solution. More precisely, we characterize the bifurcation branches starting from eigenvalues of the Dirichlet-Laplacian of arbitrary multiplicity. This allows us to discuss the nature of such bifurcations in some specific cases. We conclude with the stability analysis of these branches under the complex Ginzburg-Landau flow.
Mobile applications in radiation oncology—current choices and future potentials
Authors: Janssen Stefan , El Shafie Rami A. , Ruder Arne M. , Buergy Daniel , Scafa Davide , Giordano Frank A. , Nicolay Nils H. , Vogel Marco M. E. , Combs Stephanie E. , Fahlbusch Fabian B. , Rades Dirk , Käsmann Lukas
Published: February 2023

Purpose

To review existing scientific literature on mobile applications (apps) in the field of radiation oncology and to evaluate characteristics of commercially available apps across different platforms.

Methods

A systematic review of the literature for publications presenting apps in the field of radiation oncology was carried out using the PubMed database, Cochrane library, Google Scholar, and annual meetings of major radiation oncology societies. Additionally, the two major marketplaces for apps, App Store and Play Store, were searched for available radiation oncology apps for patients and health care professionals (HCP).

Results

A total of 38 original publications which met the inclusion criteria were identified. Within those publications, 32 apps were developed for patients and 6 for HCP. The vast majority of patient apps focused on documenting electronic patient-reported outcomes (ePROs). In the two major marketplaces, 26 apps were found, mainly supporting HCP with dose calculations.

Conclusion

Apps used in (and for) scientific research in radiation oncology are rarely available for patients and HCP in common marketplaces.
Education and training as a key enabler of successful patient care in mass-casualty terrorist incidents
Authors: Hoth Patrick , Roth Johanna , Bieler Dan , Friemert Benedikt , Franke Axel , Paffrath Thomas , Blätzinger Markus , Achatz Gerhard ,   and the Deployment, Disaster, Tactical Surgery Section of the German Trauma Society
Published: February 2023

Background and purpose

The increase in terrorist attacks with sometimes devastating numbers of victims has become a reality in Europe and has led to a fundamental change in thinking and a reorientation in many fields including health policy. The purpose of this original work was to improve the preparedness of hospitals and to provide recommendations for training.

Material and methods

We conducted a retrospective literature search based on the Global Terrorism Database (GTD) for the period 2000 to 2017. Using defined search strategies, we were able to identify 203 articles. We grouped relevant findings into main categories with 47 statements and recommendations on education and training.

In addition, we included data from a prospective questionnaire-based survey on this topic that we conducted at the 3rd Emergency Conference of the German Trauma Society (DGU) in 2019.

Results

Our systematic review identified recurrent statements and recommendations. A key recommendation was that regular training should take place on scenarios that should be as realistic as possible and should include all hospital staff. Military expertise and competence in the management of gunshot and blast injuries should be integrated. In addition, medical leaders from German hospitals considered current surgical education and training to be insufficient for preparing junior surgeons to manage patients who have sustained severe injuries by terrorist events.

Conclusion

A number of recommendations and lessons learned on education and training were repeatedly identified. They should be included in hospital preparations for mass-casualty terrorist incidents. There appear to be deficits in current surgical training which may be offset by establishing courses and exercises.
Die Genese des Informed Consent im Kontext der medizinischen Forschungsethik 1900–1931
Authors: Moll Friedrich H. , Krischel Matthis
Published: February 2023

An der Wende zum 20. Jahrhundert rückte die Problematik des Humanexperimentes sowie die Notwendigkeit der Einwilligung hierzu in den Fokus der Mediziner und einer allgemeinen Öffentlichkeit. Es wird u. a. am Fall des Venerologen Albert Neisser die Entwicklung forschungsethischer Standards zwischen dem Ende des 19. Jahrhunderts und 1931 in Deutschland nachgezeichnet. Das aus der Forschungsethik stammende Konzept des Informed Consent ist heute auch in der klinischen Ethik von zentraler Bedeutung.
Sustainable 4D printing of magneto-electroactive shape memory polymer composites
Authors: Lalegani Dezaki Mohammadreza , Bodaghi Mahdi
Published: February 2023

Typical techniques for creating synthetic morphing structures suffer from a compromise between quick shape change and geometric complexity. A novel approach is proposed for encoding numerous shapes and forms by magneto-electroactive shape memory polymer composite (SMPC) structures and integrating sustainability with 4D printing (4DP) technology. Electrically driven, remote controllability, and quick reaction are the features of these sustainable composite structures. Low-cost 4D-printed SMPC structures can be programmed remotely at high temperatures to achieve multi-stable shapes and can snap repeatedly between all programmed temporary and permanent configurations. This allows for multiple designs in a single structure without wasting material. The strategy is based on a knowledge of SMPC mechanics, magnetic response, and the manufacturing idea underlying fused deposition modelling (FDM). Iron-filled magnetic polylactic acid (MPLA) and carbon black-filled conductive PLA (CPLA) composite materials are investigated in terms of microstructure properties, composite interface, and mechanical properties. Characterisation studies are carried out to identify how to control the structure with a low magnetic field. The shape morphing of magneto-electroactive SMPC structures is studied. FDM is used to 4D print MPLA and CPLA adaptive structures with 1D/2D-to-2D/3D shapeshifting by the magnetic field. The benefits of switchable multi-stable structures are reducing material waste and effort/energy and increasing efficiency in sectors such as packaging.

Graphical Abstract
Radiotherapy and palliative care outpatient clinic: a new healthcare integrated model in Italy
Authors: Rossi Romina , Foca Flavia , Tontini Luca , Pieri Martina , Micheletti Simona , Nanni Oriana , Altini Mattia , Massa Ilaria , Pallotti Maria Caterina , Ricci Marianna , Romeo Antonino , Muolo Maria Giustina , Galeotti Gianluca , Valenti Vanessa , Tenti Maria Valentina , Donati Costanza Maria , Pensieri Maria Vittoria , Morganti Alessio Giuseppe , Maltoni Marco
Published: February 2023

Background

On the basis of substantial evidence demonstrate that palliative care combined with standard care improves patient, caregiver, and society outcomes, we have developed a new healthcare model called radiotherapy and palliative care (RaP) outpatient clinic were a radiation oncologist and a palliative care physician make a joint evaluation of advanced cancer patients.

Methods

We performed a monocentric observational cohort study on advanced cancer patients referred for evaluation at the RaP outpatient clinic. Measures of quality of care were carried out.

Results

Between April 2016 and April 2018, 287 joint evaluations were performed and 260 patients were evaluated. The primary tumor was lung in 31.9% of cases. One hundred fifty (52.3%) evaluations resulted in an indication for palliative radiotherapy treatment. In 57.6% of cases was used a single dose fraction of radiotherapy (8 Gy). All the irradiated cohort completed the palliative radiotherapy treatment. An 8% of irradiated patients received the palliative radiotherapy treatment in the last 30 days of life. A total of 80% of RaP patients received palliative care assistance until the end of life.

Conclusion

At the first descriptive analysis, the radiotherapy and palliative care model seem to respond to the need of multidisciplinary approach in order to obtain an improvement on quality of care for advanced cancer patients.
Impacts of seeding density on the oxidative stress response of the Greenshell™ mussel, Perna canaliculus
Authors: Reyden Carrie A. R. , Delorme Natalí J. , South Paul M. , Aguirre J. David
Published: February 2023

The Greenshell™ mussel, Perna canaliculus, is the most lucrative aquaculture species in New Zealand; however, losses of commercial juvenile mussels (spat) are common and can drastically reduce the yield of adults. Modification of seeding density is a potential method to manage loss of spat (~ 1–20-mm shell length), by reducing biofouling and intraspecific competition. Understanding the stress responses of spat in production systems during the early stages of aquaculture is a high priority for mussel farmers who aim to manage and optimise mussel production. Here, the effects of seeding density (low: 257, mid: 515, and high: 1030 mussels 10 cm−1 of culture rope), space (depth, site), and time (December 2019 and February 2020) on oxidative stress responses (total antioxidant capacity [TAC] and lipid peroxidation [LP] biomarkers) in spat and their viability (freshwater immersion test) were assessed in the Marlborough Sounds, New Zealand. The effect of seeding density on TAC was variable among depths, sites, and times, whereas seeding density had no impact on LP. In late summer (February 2020), oxidative stress appeared to be higher compared to early summer (December 2019). This indicates that mussels were exposed to more stressful conditions later in summer, although this did not reduce their short-term viability. This research found that seeding density had no major impact on oxidative stress biomarkers and suggests that stress responses and viability of Greenshell™ mussel spat during the summer months are not affected by the seeding density levels measured in this study.
Towards a Feminist Geo-legal Ethic of Caring Within Medical Supply Chains: Lessons from Careless Supply During the COVID-19 Pandemic
Authors: Zbyszewska Ania , Sekalala Sharifah
Published: February 2023

The COVID-19 crisis illustrates the fragility of supply chains. Countries with excellent health systems struggled to ensure essential supplies of food, medicines, and personal protective equipment which were vital to a fast and effective response. Using geo-legality, which maps the constitutive relations between law and space, we argue that the failure of supply chains in many western countries during the crisis reveals a fundamental tension between their role as facilitators of care and caring, and the logistic logics by which they operate. While supply chains link the intimate, domestic concerns of providing medical care with the globalised geographical concerns of moving goods across different jurisdictions at the right time, their contemporary organisation and regulation does not reflect the caring relations and public goods they are meant to support. Drawing on analysis of examples from Canada, the United Kingdom, and the United States, this article argues that a reconfiguration of supply chains in accordance with feminist approaches that place care at the centre of supply chain operation and organisation will be important to amendments of both domestic and global health law.
Study of nerve cell regeneration on nanofibers containing cerium oxide nanoparticles in a spinal cord injury model in rats
Authors: Rahimi Behnaz , Behroozi Zahra , Motamednezhad Ali , Jafarpour Maral , Hamblin Michael R. , Moshiri Ali , Janzadeh Atousa , Ramezani Fatemeh
Published: February 2023

Since the CNS is unable to repair itself via neuronal regeneration in adult mammals, alternative therapies need to be found. The use of cerium oxide nanoparticles to repair nerve damage could be a promising approach for spinal cord reconstruction. In this study, we constructed a scaffold containing cerium oxide nanoparticles (Scaffold-CeO2) and investigated the rate of nerve cell regeneration in a rat model of spinal cord injury. The scaffold of gelatin and polycaprolactone was synthesized, and a gelatin solution containing cerium oxide nanoparticles was attached to the scaffold. For the animal study, 40 male Wistar rats were randomly divided into 4 groups (n = 10): (a) Control; (b) Spinal cord injury (SCI); (c) Scaffold (SCI + scaffold without CeO2nanoparticles); (d) Scaffold-CeO2(SCI + scaffold containing CeO2nanoparticles). After creation of a hemisection SCI, scaffolds were placed at the site of injury in groups c and d, and after 7 weeks the rats were subjected to behavioral tests and then sacrificed for preparation of the spinal cord tissue to measure the expression of G-CSF, Tau and Mag proteins by Western blotting and Iba-1 protein by immunohistochemistry. The result of behavioral tests confirmed motor improvement and pain reduction in the Scaffold-CeO2group compared to the SCI group. Decreased expression of Iba-1 and higher expression of Tau and Mag in the Scaffold-CeO2group compared to the SCI group could be the result of nerve regeneration caused by the scaffold containing CeONPs as well as relief of pain symptoms.

Graphical Abstract
Microstructure investigation, strength assessment, and thermal modelling of concrete exposed to different heating cooling regimes
Authors: Anand N. , Thanaraj Daniel Paul , Andrushia Diana , Lublóy Éva Eszter , Kiran Tattukolla , Kanagaraj Balamurali , Kodur Venkatesh
Published: February 2023

Building fires are sometimes unavoidable due to unexpected accidents. During the fire, the structural elements are exposed to temperatures above 1000 °C. Structural concrete loses its strength and stiffness during the heating and cooling cycle. In most cases, during a real fire, the structural elements are cooled by water quenching. It is rare scenario that, buildings subjected to fire are cooled by natural air without forced water spraying. However, structural concrete’s residual strength (RS) in both cooling cases after the fire incident is entirely different. Therefore, an experimental study was conducted to understand concrete’s heating–cooling (H–C) behaviour subjected to standard fire temperature. Concrete with different grades, namely C20, C30, C40, and C50, is considered in the present investigation. Specimens were subjected to higher temperatures following ISO 834 guidelines, and then, temperature-exposed specimens were either cooled by natural air or spraying water. Investigations are carried out to evaluate fire-exposed concrete’s hardened, micro-structural, and thermal performance. The damage intensity of the concrete samples is investigated by observing the thermal crack pattern, crack width, and porosity. Relationships between the temperature exposure and RS of concrete were proposed to predict the RS of fire-affected air- and water-cooled specimens. Based on the results, it is found that water-sprayed specimens exhibit higher strength loss (SL) than natural air cool (AC). The difference in the RS of the two cooling regimes decreases with increase in heating durations. Damage level and intensity of thermal cracks are higher for water-cooled (WL) specimens having higher strength grades.
Nano Pt/TiO2 photocatalyst for ultrafast production of sulfamic acid derivatives using 4-nitroacetanilides as nitrogen precursor in continuous flow reactors
Authors: Mohamed Yasser M. A. , Attia Yasser A.
Published: February 2023

The design of reactors based on high performance photocatalysts is an important research in catalytic hydrogenation. In this work, modification of titanium dioxide nanoparticles (TiO2 NPs) was achieved by preparation of Pt/TiO2 nanocomposites (NCs) through photo-deposition method. Both nanocatalysts were used for the photocatalytic removal of SOx from the flue gas at room temperature in the presence of hydrogen peroxide, water, and nitroacetanilide derivatives under visible light irradiation. In this approach, chemical deSOx was achieved along with protection of the nanocatalyst from sulfur poising through the interaction of the released SOx from SOx-Pt/TiO2 surface with p-nitroacetanilide derivatives to produce simultaneous aromatic sulfonic acids. Pt/TiO2 NCs have a bandgap of 2.64 eV in visible light range, which is lower than the bandgap of TiO2 NPs, whereas TiO2 NPs have a mean size of 4 nm and a high specific surface area of 226 m2/g. Pt/TiO2 NCs showed high photocatalytic sulfonation of some phenolic compounds using SO2 as a sulfonating agent along with the existence of p-nitroactanilide derivatives. The conversion of p-nitroacetanilide followed the combination processes of adsorption and catalytic oxidation–reduction reactions. Construction of an online continuous flow reactor–high-resolution time-of-flight mass spectrometry system had been investigated, realizing real-time and automatic monitoring of completion the reaction. 4-nitroacetanilide derivatives (1a-1e) was converted to its corresponding sulfamic acid derivatives (2a–2e) in 93–99% isolated yields of within 60 s. It is expected to offer a great opportunity for ultrafast detection of pharmacophores.
Identification of LSD analogs, 1cP-AL-LAD, 1cP-MIPLA, 1V-LSD and LSZ in sheet products
Authors: Tanaka Rie , Kawamura Maiko , Mizutani Sakumi , Kikura-Hanajiri Ruri
Published: February 2023

Purpose

Many analogs of lysergic acid diethylamide (LSD) have recently appeared as designer drugs around the world. These compounds are mainly distributed as sheet products. In this study, we identified three more newly distributed LSD analogs from paper sheet products.

Methods

The structures of the compounds were determined by gas chromatography–mass spectrometry (GC–MS), liquid chromatography–photodiode array–mass spectrometry (LC–PDA–MS), liquid chromatography with hybrid quadrupole time-of-flight mass spectrometry (LC–Q-TOF-MS) and nuclear magnetic resonance (NMR) spectroscopy.

Results

From the NMR analysis, the compounds in the four products were identified as 4-(cyclopropanecarbonyl)-N,N-diethyl-7-(prop-2-en-1-yl)-4,6,6a,7,8,9-hexahydroindolo[4,3-fg]quinoline-9-carboxamide (1cP-AL-LAD), 4-(cyclopropanecarbonyl)-N-methyl-N-isopropyl-7-methyl-4,6,6a,7,8,9-hexahydroindolo-[4,3-fg]quinoline-9-carboxamide (1cP-MIPLA), N,N-diethyl-7-methyl-4-pentanoyl-4,6,6a,7,8,9-hexahydroindolo[4,3-fg]quinoline-9-carboxamide (1V-LSD) and (2’S,4’S)-lysergic acid 2,4-dimethylazetidide (LSZ). In comparison with the structure of LSD, 1cP-AL-LAD was converted at the positions at N1 and N6, and 1cP-MIPLA was converted at the positions at N1 and N18. The metabolic pathways and biological activities of 1cP-AL-LAD and 1cP-MIPLA have not been reported.

Conclusions

This is the first report showing that LSD analogs that were converted at multiple positions have been detected in sheet products in Japan. There are concerns about the future distribution of sheet drug products containing new LSD analogs. Therefore, the continuous monitoring for newly detected compounds in sheet products is important.
Colorectal cancer lymph node metastasis prediction with weakly supervised transformer-based multi-instance learning
Authors: Tan Luxin , Li Huan , Yu Jinze , Zhou Haoyi , Wang Zhi , Niu Zhiyong , Li Jianxin , Li Zhongwu
Published: February 2023

Lymph node metastasis examined by the resected lymph nodes is considered one of the most important prognostic factors for colorectal cancer (CRC). However, it requires careful and comprehensive inspection by expert pathologists. To relieve the pathologists’ burden and speed up the diagnostic process, in this paper, we develop a deep learning system with the binary positive/negative labels of the lymph nodes to solve the CRC lymph node classification task. The multi-instance learning (MIL) framework is adopted in our method to handle the whole slide images (WSIs) of gigapixels in size at once and get rid of the labor-intensive and time-consuming detailed annotations. First, a transformer-based MIL model, DT-DSMIL, is proposed in this paper based on the deformable transformer backbone and the dual-stream MIL (DSMIL) framework. The local-level image features are extracted and aggregated with the deformable transformer, and the global-level image features are obtained with the DSMIL aggregator. The final classification decision is made based on both the local and the global-level features. After the effectiveness of our proposed DT-DSMIL model is demonstrated by comparing its performance with its predecessors, a diagnostic system is developed to detect, crop, and finally identify the single lymph nodes within the slides based on the DT-DSMIL and the Faster R-CNN model. The developed diagnostic model is trained and tested on a clinically collected CRC lymph node metastasis dataset composed of 843 slides (864 metastasis lymph nodes and 1415 non-metastatic lymph nodes), achieving the accuracy of 95.3% and the area under the receiver operating characteristic curve (AUC) of 0.9762 (95% confidence interval [CI]: 0.9607–0.9891) for the single lymph node classification. As for the lymph nodes with micro-metastasis and macro-metastasis, our diagnostic system achieves the AUC of 0.9816 (95% CI: 0.9659–0.9935) and 0.9902 (95% CI: 0.9787–0.9983), respectively. Moreover, the system shows reliable diagnostic region localizing performance: the model can always identify the most likely metastases, no matter the model’s predictions or manual labels, showing great potential in avoiding false negatives and discovering incorrectly labeled slides in actual clinical use.

Graphical Abstract
Prospective intraindividual comparison of a standard 2D TSE MRI protocol for ankle imaging and a deep learning-based 2D TSE MRI protocol with a scan time reduction of 48%
Authors: Keller Gabriel , Estler Arne , Herrmann Judith , Afat Saif , Othman Ahmed E. , Nickel Dominik , Koerzdoerfer Gregor , Springer Fabian
Published: February 2023

Purpose

Magnetic resonance imaging (MRI) scan time remains a limited and valuable resource. This study evaluates the diagnostic performance of a deep learning (DL)-based accelerated TSE study protocol compared to a standard TSE study protocol in ankle MRI.

Material and methods

Between October 2020 and July 2021 forty-seven patients were enrolled in this study for an intraindividual comparison of a standard TSE study protocol and a DL TSE study protocol either on a 1.5 T or a 3 T scanner. Two radiologists evaluated the examinations regarding structural pathologies and image quality categories (5-point-Likert-scale; 1 = “non diagnostic”, 5 = “excellent”).

Results

Both readers showed almost perfect/perfect agreement of DL TSE with standard TSE in all analyzed structural pathologies (0.81–1.00) with a median “good” or “excellent” rating (4–5/5) in all image quality categories in both 1.5 T and 3 T MRI. The reduction of total acquisition time of DL TSE compared to standard TSE was 49% in 1.5 T and 48% in 3 T MRI to a total acquisition time of 5 min 41 s and 5 min 46 s.

Conclusion

In ankle MRI the new DL-based accelerated TSE study protocol delivers high agreement with standard TSE and high image quality, while reducing the acquisition time by 48%.
The Coincidental Evolution of Virulence Partially Explains the Virulence in a Generalist Entomopathogenic
Authors: Trejo-Meléndez Víctor José , Méndez-López Texca T. , Contreras-Garduño Jorge
Published: February 2023

Purpose

The parasites’ virulence is labile after jumping to a new host species, and it might derivate in gaining virulence against a new host as a side effect of living in a non-host environment (coincidental evolution of virulence hypothesis).

Methods

To test this hypothesis, we monitored the experimental evolution of the Rhabditis regina nematode for over 290 generations (4 years) in three environments (strains): (1) the natural host, Phyllophaga polyphylla, (2) an alternate host, Tenebrio molitor, and (3) saprophytic medium (beef; the food that may provide evidence for the coincidental evolution of virulence). Each strain was exposed to P. polyphylla, T. molitor, or Galleria mellonella. We compared the host survival and immune response (proPO, PO, and lytic activity) of infected versus uninfected hosts.

Results

The saprophytic nematodes gained virulence only against G. mellonella. However, the P. polyphylla strain was more effective in killing P. polyphylla than T. molitor, and the T. molitor strain was more effective against T. molitor than P. polyphylla. Additionally, one dauer larva was sufficient to kill the hosts. Finally, the immune response did not differ between the challenged and control groups.

Conclusion

The coincidental evolution of virulence partially explains our results, but they might also support the short-sighted hypothesis. Additionally, we found evidence for immunomodulation because nematodes passed unnoticed to the immune response. It is crucial to analyze the virulence of entomopathogens from the point of view of the evolution of virulence to be aware of potential scenarios that might limit biological control.
Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes
Authors: Sánchez-Marcos Carolina , Jacob Javier , Llorens Pere , López-Díez María Pilar , Millán Javier , Martín-Sánchez Francisco Javier , Tost Josep , Aguirre Alfons , Juan María Ángeles , Garrido José Manuel , Rodríguez Rafael Calvo , Pérez-Llantada Enrique , Díaz Elena , Sánchez-Nicolás José Andrés , Mir María , Rodríguez-Adrada Esther , Herrero Pablo , Gil Víctor , Roset Alex , Peacock Frank , Miró Òscar ,   The ICASEMES Research Group researchers
Published: February 2023

Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%, p < 0.001), 30-day post-discharge adverse events were similar (27.2% vs. 28.4%, p = 0.599). After adjustment, there were no differences in the 30-day risk of mortality of discharged patients (adjusted HR 0.846, 95% CI 0.637–1.107) or adverse events (1.035, 0.914–1.173). In 337 pairs of PS-matched patients, there were no differences in mortality or risk of adverse event between patients directly discharged or admitted to an SSU (0.753, 0.409–1.397; and 0.858, 0.645–1.142; respectively). Direct ED discharge of patients diagnosed with AHF provides similar outcomes compared to patients with similar characteristics and hospitalized in a SSU.
Outcomes of continuous flow left ventricular assist device after surgical left ventricular restoration
Authors: Gyoten Takayuki , Ono Minoru
Published: February 2023

Objectives

This study aimed to report the clinical outcomes of continuous flow left ventricular assist device implantation in end-stage chronic heart failure patients with a history of surgical left ventricular restoration.

Methods

We retrospectively identified 190 patients undergoing continuous flow left ventricular assist device implantation at our center from November 2007 to April 2020. In total, six patients underwent continuous flow left ventricular assist device implantation after various types of surgical left ventricular restoration procedures, including endoventricular circular patch plasty (n = 3), posterior restoration procedure (n = 2), and septal anterior ventricular exclusion (n = 1).

Results

Continuous flow left ventricular assist device (Jarvik 2000, n = 2; EVAHEART, n = 1; HeartMate II, n = 1; DuraHeart, n = 1; HVAD, n = 1) was successfully implanted in all patients. During a median follow-up of 48 months (interquartile range, 39–60 months; censoring heart transplantation), no death was documented, which means that overall survival after left ventricular assist device implantation was 100% at any time point. Finally, three patients received heart transplantation (waiting time: 39, 56, and 61 months, respectively) and the other three patients are still awaiting heart transplantation (waiting time: 12, 41, and 76 months, respectively).

Conclusions

In our series, continuous flow left ventricular assist device implantation after surgical left ventricular restoration was safe and feasible, even if an endoventricular patch was used, and effective for bridge to transplant strategy.
Role of Hounsfield Unit in Predicting Outcomes of Shock Wave Lithotripsy for Renal Calculi: Outcomes of a Systematic Review
Authors: Garg Megha , Johnson Hans , Lee Su-min , Rai Bhavan Prasad , Somani Bhaskar , Philip Joe
Published: February 2023

Purpose of Review

Extracorporeal shock wave lithotripsy success rates depend on several stone and patient-related factors, one of which is stone density which is calculated on computed tomography scan in Hounsfield Units. Studies have shown inverse correlation between SWL success and HU; however, there remains considerable variation between studies. We performed a systematic review regarding the use of HU in SWL for renal calculi to consolidate the current evidence and address current knowledge gaps.

Recent Findings

Database including MEDLINE, EMBASE, and Scopus were searched from inception through August 2022. Studies in English language analysing stone density/attenuation in adult patients undergoing SWL for renal calculi were included for assessment of Shockwave lithotripsy outcomes, use of stone attenuation to predict success, use of mean and peak stone density and Hounsfield unit density, determination of optimum cut-off values, nomograms/scoring systems, and assessment of stone heterogeneity. 28 studies with a total of 4,206 patients were included in this systematic review with sample size ranging from 30 to 385 patients. Male to female ratio was 1.8, with an average age of 46.3 years. Mean overall ESWL success was 66.5%. Stone size ranged from 4 to 30 mm in diameter. Mean stone density was used by two-third of the studies to predict the appropriate cut-off for SWL success, ranging from 750 to 1000 HU. Additional factors such as peak HU and stone heterogeneity index were also evaluated with variable results. Stone heterogeneity index was considered a better indicator for success in larger stones (cut-off value of 213) and predicting SWL stone clearance in one session. Prediction scores had been attempted, with researchers looking into combining stone density with other factors such as skin to stone distance, stone volume, and differing heterogeneity indices with variable results.

Numerous studies demonstrate a link between shockwave lithotripsy outcomes and stone density. Hounsfield unit < 750 has been found to be associated with shockwave lithotripsy success, with likelihood of failure strongly associated with values over 1000. Prospective standardisation of Hounsfield unit measurement and predictive algorithm for shockwave lithotripsy outcome should be considered to strengthen future evidence and help clinicians in the decision making.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO) database: CRD42020224647
Minimally Invasive Video-Assisted Thoracoscopic One-Stage Resection of Left Atrial Myxoma and Right Upper Lobectomy for Lung Cancer: Case Report
Authors: Chen Xiaofan , Li Weidong
Published: February 2023

We report a case of a 74-year-old man with diagnosis of concomitant primary cardiac tumor and right upper lobe of lung cancer. Both tumors were evaluated to be resectable with no further metastasis. A one-stage resection of both tumors through right mini-thoracotomy with endoscopic assistance was performed. The cardiac tumor resection during cardiopulmonary bypass was performed first, followed by right upper lobectomy and lymph nodes dissection with the same incision and position. Short-term results were satisfying and previous literature was reviewed to evaluate this method.
CRISPR-Fortschritte — Schnitt für Schnitt zu neuen Möglichkeiten
Authors: Pakari Kaisa , Wittbrodt Joachim , Thumberger Thomas
Published: February 2023

CRISPR/Cas9 systems and recently established base editors are essential tools for precise, targeted genome editing for translational and basic research applications. Here we present small, easily combined improvements to reach editing versatility and enhanced efficiency. This is achieved by improved nuclear localization of Cas9, protected DNA sequences for homology directed repair and a combinatorial use of base editors to reach initially inaccessible target sites.
Transformation from a global spherical to an adjusted local rectangular harmonic model
Authors: Panou Georgios , Korakitis Romylos
Published: February 2023

This work presents a technique to transform a global spherical to an adjusted local rectangular harmonic model. First, the mathematical form of a global spherical harmonic model is presented. Second, the necessary conversion from global (geocentric) into local rectangular coordinates is given. Third, Laplace’s equation is solved by the method of separation of variables in local rectangular coordinates and its solutions in different functional forms are presented. Then, the estimation of the coefficients of these mathematical models by a least squares’ adjustment process is described, using as data the values of the disturbing potential of the Earth’s gravity field. The strategy for the selection of the best mathematical model for a successful transformation is described and validated in different case studies. These refer to areas in Greece, China and Germany and include comparisons with other models or methods. The results show the applicability of the presented transformation and confirm its advantages.
“I Always Knew I Was Different”: Experiences of Receiving a Diagnosis of Autistic Spectrum Disorder in Adulthood—a Meta-Ethnographic Systematic Review
Authors: Gellini Hannah , Marczak Magda
Published: February 2023

A broadening of diagnostic criteria and increased awareness of autism has led to a large number of individuals whose difficulties remained undetected until adulthood. This systematic review aimed to synthesise empirical evidence of the experience of individuals who received their diagnosis of autism in adulthood. Eight studies met the inclusion criteria. A meta-ethnographic approach was used to synthesise the findings. Analysis revealed two meta-themes: feeling “like an alien” and the “not guilty” verdict, each with three associated subthemes. The findings indicate the need for timely diagnosis and provision of post-diagnostic support to alleviate the mental health implications of not having a framework to understand one’s experiences and to support the process of adjustment to the diagnosis.
Predictors of caregiver burden before starting family-based treatment for adolescent anorexia nervosa and associations with weight gain during treatment
Authors: Matthews Abigail , Bruening Amanda B. , Aarnio-Peterson Claire M. , Kramer Rachel
Published: February 2023

Purpose

Caregivers play a pivotal role in the success of family-based treatment (FBT) for anorexia nervosa (AN). Caregiver burden is frequently demonstrated in eating disorders (EDs) and may impact FBT outcomes. This study examined factors associated with caregiver burden before starting FBT and whether pre-treatment caregiver burden was associated with weight gain during FBT.

Methods

Participants included 114 adolescents with AN or atypical AN (mean age = 15.6 years, SD = 1.4) and a primary caregiver (87.6% mothers) who received FBT in the United States. Before starting treatment, participants completed self-report measures of caregiver burden (via the Eating Disorder Symptom Impact Scale), caregiver anxiety, caregiver depression, and ED symptoms. Clinical characteristics and percentage of target goal weight (%TGW) at FBT session 1 and 3 and 6 months after starting treatment were obtained via retrospective chart review. Hierarchical regressions examined predictors of caregiver burden before FBT initiation. Associations between pre-treatment caregiver burden and %TGW gain at 3 and 6 months after starting FBT were assessed with hierarchical regressions.

Results

Caregiver anxiety (p < 0.001), family history of EDs (p = 0.028), adolescent mental health treatment history (p = 0.024), and ED symptoms (p = 0.042) predicted caregiver burden before starting FBT. Pre-treatment caregiver burden was not associated with %TGW gain at 3 or 6 months. Males demonstrated less %TGW gain than females at 3 months (p = 0.010) and 6 months (p = 0.012).

Conclusion

Proactively evaluating caregiver burden before starting FBT is suggested. Providing recommendations and/or referrals for identified caregiver vulnerabilities could indirectly impact FBT progress. Males in FBT could require longer courses of treatment and extra vigilance to this demographic is suggested.

Level of evidence: Level III, case–control analytic study.
The Role of Psychological Safety in Enhancing Medical Students’ Engagement in Online Synchronous Learning
Authors: McLeod Emma , Gupta Shalini
Published: February 2023

Background

The COVID-19 pandemic instigated a global change in the delivery of undergraduate medical education, with an eminent shift from in-person to online teaching. The virtual methods that were utilised to a limited extent previously have now become the mainstay in education. The concept of psychological safety has been studied previously within medical education, but not in the distance learning context. The aim of the study was to explore students’ experiences of online learning and to gain an understanding of the factors affecting psychological safety and its subsequent impact on their learning.

Methods

A qualitative, social constructivist approach was adopted in this research. Data collection involved semi-structured interviews with 15 medical students from the University of Dundee. There was a representation from each year group on the undergraduate medical course. Data was transcribed verbatim and analysed thematically.

Results

Five key themes were identified as motivation for learning, engagement with learning, fear of judgement, group learning and adjustment to online learning. Each of these comprised of interlinked subthemes related to peer and tutor interactions.

Conclusions

Drawing on students’ experiences, the paper presents the significant interplay of group interactions and tutor attributes operating in the virtual synchronous learning environment. The relevance of psychological safety in student learning and experience, and strategies to foster it in online classrooms are discussed in the context of existing literature and proposed future developments.