bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association Between Doula Care and Childbirth‐Related Post‐Traumatic Stress Disorder Symptoms: The Mediating Role of Childbirth Experience
Authors: Lai Xiaolu , Chen Jingfen , Lu Demei , Wang Lu , Lu Xiafen , Chen Innie , Krewski Daniel , Wen Shi Wu , Xie Ri‐hua
Published: September 2024

Introduction

Although the benefits of doula care during childbirth are well‐known, its impact on childbirth‐related post‐traumatic stress disorder (CB‐PTSD) symptoms are less thoroughly characterized. This study aimed to explore the association between doula care and CB‐PTSD symptoms and the potential mediating role of childbirth experience on this association.

Methods

A prospective cohort study was conducted in a hospital in China, enrolling women with singleton live vaginal births. The exposure and primary outcome factors of interest were doula care and CB‐PTSD symptoms, with childbirth experience as a mediating factor. Questionnaires were administered to collect baseline data and childbirth experience at 3 days postpartum, and CB‐PTSD symptoms from participants at 42 days postpartum. Linear regression analysis was used to analyze the relationship between doula care, childbirth experience, and CB‐PTSD symptoms, while the mediating role of childbirth experience was analyzed using the SPSS (PROCESS) modeling tool.

Results

A total of 445 eligible women were included in the final analysis, including 120 who received doula care and 325 who did not. Linear regression analyses found that doula care was independently associated with CB‐PTSD symptoms (β = −0.11, p < 0.05) and childbirth experience (β = 0.50, p < 0.001). Childbirth experience was significantly associated with CB‐PTSD symptoms (β = −0.17, p < 0.001). Childbirth experience mediated the association between doula care and CB‐PTSD symptoms (indirect effect = −1.08, 95% CI −1.91 to −0.10), even after adjusting for potential confounders.

Conclusions

Childbirth experience serves as a mediator of the association between doula care and CB‐PTSD symptoms. By providing supportive care for women during childbirth, their childbirth experience could be improved, thereby reducing the risk of CB‐PTSD symptoms.
To pool or not to pool: Pooled metabarcoding does not affect estimates of prey diversity in spider gut content analysis
Authors: Melcher Anja Carina , Weber Sven , Birkhofer Klaus , Harms Danilo , Krehenwinkel Henrik
Published: September 2024

Gut content metabarcoding has provided important insights into the food web ecology of spiders, the most dominant terrestrial arthropod predators. In small invertebrates, like spiders, gut content analysis is often performed on whole body DNA extracts of individual predators, from which prey sequences are selectively enriched and sequenced.

Since many spider species are generalist predators, large numbers of samples comprising individual spider specimens must be analysed to recover an exhaustive image of a spider species' prey spectrum, which is costly and time‐consuming.

Pooled processing of bulk samples of multiple specimens has been suggested to reduce the necessary workload and cost while still recovering a representative estimate of the prey diversity. However, it is still unclear if pooling approaches lead to bias in recovering the prey spectrum and if the results are comparable with data from individually processed spiders.

Here, we test the effects of metabarcoding pooled spider gut content on the recovered taxonomic diversity and composition of prey. Using a newly adapted primer pair, which efficiently enriches COI barcode sequences of diverse arthropod prey groups while suppressing spider amplification, we test if pooling leads to reduced taxonomic diversity or skewed estimates of prey composition.

Our results show that pooling and individual processing recover highly correlated taxonomic diversity and composition of prey. The only exception are very rare prey items which were less well recovered by pooling. Our results support pooling as a cost‐effective and time‐efficient approach to recover the diet of generalist predators for population‐level studies of spider trophic interactions.
School Closures and the Spatial Ecology of Education Access in 10 U.S. Cities
Authors: Brazil Noli
Published: September 2024

Public school closures are increasing in frequency, number and size in U.S. cities. This study examines the spatial distribution of public school closures occurring in 10 U.S. cities between 2010 and 2019. I employ Exploratory Spatial Data Analysis (ESDA) techniques to measure the spatial concentration of school closures, or the degree to which school closures cluster. I also develop a measure of spatial accessibility across neighborhoods based on the time it would take to travel to the nearest closed school, in every block group in the 10 study cities. To take into account that traffic, congestion and other factors may play a role, I compute and compare times by car and foot, and compare access based on neighborhood ethnoracial and socioeconomic composition. Findings show that school closures geographically cluster, and neighborhoods with a greater percent of Black residents, whether higher poverty or not, will have longer commute times to the next nearest open school after a school closure. The geographic clustering of closures and the increased commute times to the nearest open school suggest that school deserts may be formed after school closings.
Alternative double strand break repair pathways shape the evolution of high recombination in the honey bee, Apis mellifera
Authors: Fouks Bertrand , Miller Katelyn J. , Ross Caitlin , Jones Corbin , Rueppell Olav
Published: September 2024

Social insects, particularly honey bees, have exceptionally high genomic frequencies of genetic recombination. This phenomenon and underlying mechanisms are poorly understood. To characterise the patterns of crossovers and gene conversion in the honey bee genome, a recombination map of 187 honey bee brothers was generated by whole‐genome resequencing. Recombination events were heterogeneously distributed without many true hotspots. The tract lengths between phase shifts were bimodally distributed, indicating distinct crossover and gene conversion events. While crossovers predominantly occurred in G/C‐rich regions and seemed to cause G/C enrichment, the gene conversions were found predominantly in A/T‐rich regions. The nucleotide composition of sequences involved in gene conversions that were associated with or distant from crossovers corresponded to the differences between crossovers and gene conversions. These combined results suggest two types of DNA double‐strand break repair during honey bee meiosis: non‐canonical homologous recombination, leading to gene conversion and A/T enrichment of the genome, and the canonical homologous recombination based on completed double Holliday Junctions, which can result in gene conversion or crossover and is associated with G/C bias. This G/C bias may be selected for to balance the A/T‐rich base composition of eusocial hymenopteran genomes. The lack of evidence for a preference of the canonical homologous recombination for double‐strand break repair suggests that the high genomic recombination rate of honey bees is mainly the consequence of a high rate of double‐strand breaks, which could in turn result from the life history of honey bees and their A/T‐rich genome.
Incorporation of specific defects through ion bombardment for better ferroelectrics
Authors: Lu Yongshen , Zhang Jinyong , Ren Lin , Wang Weimin , Zhang Fan , Fu Zhengyi
Published: September 2024

Incorporating specific defects into complex oxides facilitates the exploration of exotic phenomena and novel functionalities based on the intricate coupling between the defects and lattice/charge. However, methods for maximizing the density of specific defects while enhancing the desired properties have been rarely explored. In this study, the effect of N+ ion bombardment‐driven specific defects on the properties of bismuth ferrite (BFO) thin films was investigated. Furthermore, atomic structure characterization and computational processing revealed the displacement and orientation of the Fe atoms, which are linearly related to the degree of polarization. The ion bombardment introduced deep‐level trap states within the lattice, leading to a significant reduction in the leakage current and improved insulation performance of the films. By precisely engineering the defect content through N+ ion bombardment, the pure BFO thin films with remarkable and stable ferroelectric properties (remnant polarization, Pr = ∼116.8 µC·cm−2; leakage current, J = ∼1.5 × 10−8 A·cm−2) were fabricated. This innovative defect engineering‐based approach enables the customization and optimization of local ferroelectric order parameters, thereby establishing a solid foundation for designing functionalities across various functional material systems.
The scale of myths of romantic love: Evidence of validity and reliability of a brief scale in Peru
Authors: Ventura‐León José , Lino‐Cruz Cristopher , Tocto‐Muñoz Shirley , Sánchez‐Villena Andy Rick , Martinez‐Munive Renzo , Talledo‐Sánchez Karim , Casiano‐Valdivieso Kenia
Published: September 2024

The study aimed to provide validity evidence and reliability of the Scale of Myths of Romantic Love (SMRL) in Peru among young and adult individuals. Focusing on how romantic love myths affect relationship satisfaction and their ties to interpersonal violence, sexism, and gender inequality, the methodology involved 308 participants, mainly females (75%), using the SMRL and Relationship Assessment Scale. Bayesian Confirmatory Factor Analysis (BCFA) assessed the scale's structure and reliability, complemented by descriptive statistics and correlation analyses to examine the myths' impact on intimate relationships. Results showed the SMRL's two‐dimensional structure, confirming its robust psychometric properties and satisfactory internal consistency. Descriptive findings revealed a skeptical view of traditional romantic myths among participants, indicating the scale's good reliability and successful adaptation to the Peruvian context. This validation highlights how debunking romantic love myths can improve relationship dynamics and satisfaction and addresses their wider societal effects.
It's all about relationships: Developing nurse‐led primary health care in rural communities
Authors: Randall Sue , Jones Debra M. , Hadaddan Giti , White Danielle , Einboden Rochelle
Published: September 2024

The role of nurses in leading the design and delivery of primary health care services to address health inequities is growing in prominence, specifically in rural Australia. However, limited evidence exists to inform nurse‐led primary health care in this context. Based on a focus group with nursing executives and semi‐structured interviews with registered nurses we describe nurse experiences of leading the design of a primary health care service in rural Australia and nurse transition to and practice in this service. Nurse experiences were analysed using reflexive thematic analysis. The study reveals the centrality of relational integration in service design and nurse acquisition of relational practice as it relates to nurse to care recipient and nurse to nurse relationships. Tensions between primary health care nurses and their peers, and resultant de‐valuing of primary health care practice, are described. The acquisition of nurse professional agency draws attention to investments required to position nurses to lead and sustain care innovations external to hospital settings. The authors propose that relational approaches may provide nurses with the opportunity to reframe their leadership and service contributions towards community literate primary health care provision and provide a pathway to professional emancipation from constrained practice expectations.
Online political adverts: The effect of disclosures and opportunities for clandestine campaigning
Authors: Stafford Tom , Gordon Hazel , Zhu Junyan , Dommett Katharine
Published: September 2024

The use of digital technology has become an increasingly prominent feature of election campaigns. While many of those using online tools are familiar partisan actors, many others are not. As concerns about electoral transparency have grown, policy makers have moved to implement regulation designed to help citizens recognize the identity of campaigners. In this paper, we test the rationale behind such regulations by asking how disclosures on online adverts—both informal badging and formal imprints—affect evaluation by UK voters. Using experimental survey design, we test the reactions of participants to real Facebook adverts, labeled as originating from both partisan and apparently non‐partisan sources. Across three experiments, we consistently find evidence to support concerns about what we term “clandestine campaigning”; a phenomenon whereby apparently non‐partisan groups can receive a more favorable reception for incongruous partisan advert content than overtly incongruous partisan‐badged campaign material.
Association between postterm birth and adverse growth outcomes in children aged 3–6 years: A national retrospective cohort study
Authors: Suhaimi Marini Ahmad , Zheng Yingyan , You Haizhen , Su Yuantao , Williams Gareth J. , Gupta Manish Prasad , Du Wenchong , Hua Jing
Published: September 2024

Background

Gestational age significantly influences children's growth and development. Yet, the effect of postterm birth (gestation beyond 42 weeks) on children's growth outcomes remains underexplored.

Objectives

This study aimed to assess the impact of postterm birth on adverse growth outcomes in children using a nationally representative sample from China.

Methods

A retrospective cohort study was conducted in China from 1 April 2018, to 31 December 2019. The final analysis included 141,002 children aged 3–6 years from 551 cities. Postterm birth was defined as children with postterm birth at a gestational age of 42 weeks or more. Obesity, overweight and thinness were assessed using body mass index‐for‐age (BMI‐for‐age) z‐scores, based on the World Health Organization (WHO) Child Growth Standards. Generalised additive models were employed to investigate the non‐linear relationship between maternal gestational age and BMI‐for‐age z scores. Poisson regression models and subgroup analyses with forest plots were performed to examine the associations between postterm birth and the risks of obesity, overweight and thinness in children.

Results

We included 141,002 mother–child pairs, of whom 7314 (5.2%) children were classified as postterm births. There exists a non‐linear relationship between gestational age and BMI‐for‐age z scores. Children born postterm exhibited a 46% increased risk of obesity, a 27% increased risk of combined overweight/obesity and a 13% increased risk of thinness. Similar associations were observed in most cases when further sensitivity and subgroup analysis were conducted.

Conclusions

Postterm birth was associated with elevated risks of obesity, overweight and thinness in children aged 3–6 years, independent of sex. These findings underscore the importance of further research across diverse populations to understand the implications of postterm births on child health outcomes.
Recruiting blood donors to the Canadian Blood Services Stem Cell Registry: A feasibility assessment
Authors: Parmar Gaganvir , Green Meagan , Ganz Kathy , Seftel Matthew D. , Allan David S.
Published: September 2024

Background

Allogeneic hematopoietic cell transplantation remains limited when stem cell registrants cannot be contacted, are not medically fit, are unavailable, or unwilling to proceed. In a recent report, registrants who were prior blood donors were more likely to be available for donation. In this study, we analyzed extent to which recruiting blood donors to the Canadian Blood Services Stem Cell Registry (CBS SCR) can meet targets for ethnic diversity, age, and proximity to collection facilities.

Methods and Results

We analyzed 124,496 active blood donors on July 1, 2023 regarding the criteria for recruitment to the CBS SCR. A total of 40,518 (32%) were younger than 36 years of age and 49% were first‐time donors (potential new recruits year over year). The ethnicity of blood donors younger than 36 years aligns more closely with the 2021 Canadian census compared to stem cell donors who were also previous blood donors, and to the current total inventory of all registrants on the CBS SCR. Of the blood donors, certain ethnic groups, including Black, Chinese, and First Nations/Indigenous, remain underrepresented. A greater proportion of active whole blood donors live within 400 km of a stem cell collection center (91%) compared to stem cell donors who donated during the past 10 years (80%).

Conclusions

Recruitment of blood donors offers an opportunity to improve the ethnic diversity of the CBS SCR and increase proximity of registrants to stem cell collection centers. The potential improved availability of registrants when matched to patients requires confirmation.
Immune biomarkers and secondary hemophagocytic lymphohistiocytosis: a scoping review protocol
Authors: Terrett Alice , Van Loo Magalie , Sundararajan Krishnaswamy , Brealey David , Singer Mervyn , Manson Jessica , Raith Eamon Patrick
Published: September 2024

Objective:

The objective of this review is to identify immunological pathways and markers of severity of illness associated with clinical outcomes that may represent potential therapeutic targets in the management of secondary hemophagocytic lymphohistiocytosis.

Introduction:

A broad range of immunomodulatory therapies is used to manage hemophagocytic lymphohistiocytosis, however, the supporting evidence for these therapies is scarce. Identifying patients likely to experience more severe disease or die is currently extremely difficult, if not impossible. The identification of implicated cytokines in secondary disease can provide further support for the identification of high-risk patients and the development of targeted therapies.

Inclusion criteria:

Studies reporting immune biomarker and cytokine measurement in adult patients (age ≥18 years) with secondary hemophagocytic lymphohistiocytosis will be considered for inclusion.

Methods:

The proposed review will be conducted in line with the JBI methodology for scoping reviews. MEDLINE (Ovid) and Embase (Ovid) will be searched, without date limitations. Data will be extracted using a data extraction tool developed by the reviewers. Relevant sources will be retrieved, and their citation details imported into the JBI System for the Unified Management, Assessment and Review of Information.

Review registration:

Open Science Framework https://osf.io/9524e
An Experimental Study on the Effect of Intake Pressure on a Natural Gas-Diesel Dual-Fuel Engine
Authors: Dev Shouvik , Guo Hongsheng , Liko Brian , Yousefi Amin
Published: September 2024

Natural gas-diesel dual-fuel (NDDF) combustion can be a viable method to reduce diesel usage in compression ignition (CI) internal combustion engines. Potential benefits of NDDF engines in comparison to conventional diesel engines include decreases in particulate matter (PM) and carbon dioxide (CO2) emissions. This study focuses on the effect of intake pressure on a dual-fuel engine with intake port injected natural gas (NG) and in-cylinder direct injected diesel at two typical engine operation conditions—low load-high speed and high load-low speed. The research work was performed on a heavy-duty, four-stroke CI, single-cylinder research engine at a NG-diesel energy ratio of approximately 3:1. The results show that when the intake pressure was increased, the indicated thermal efficiency (ITE) decreased and increased at the low load-high speed and high load-low speed conditions, respectively, for NDDF combustion. For the low load-high speed NDDF combustion, increasing intake pressure increased the carbon monoxide, methane, and soot emissions, but decreased the nitrogen oxide (NOx) emissions. For the high load-low speed NDDF combustion, increasing intake pressure caused the methane emissions to increase, and the carbon monoxide, NOx, and soot emissions to decrease. In-cylinder temperature measured at the tip of the diesel injector showed that the injector tip temperatures were higher for NDDF cases compared to diesel cases and these temperatures could be correlated with the combustion phasing and the NOx emissions. Increasing intake pressure caused lower injector tip temperatures for both NDDF operating conditions. Equivalent CO2 emissions for the low load-high speed and high load-low speed NDDF cases were higher and lower than the corresponding diesel cases, respectively.
Briefe einer Antifaschistin: 1937
Authors: Obermayer August
Published: September 2024

Der Text enthält einige Briefe, die Marianne Angermann in Madrid an ihre Mutter, Charlotte, in Dresden schrieb. Im Laufe des Jahres 1937 wurde dieser direkte Briefwechsel wegen des Spanischen Bürgerkriegs zuerst erschwert und dann schließlich unmöglich gemacht. Charlotte Angermann fing dann an, ihre Sorgen um die Tochter in Form von Tagebucheintragungen zu schreiben. Marianne Angermann und ihr Ehemann, Franz Bielschowsky, engagierten sich für die republikanische Sache in Madrid und wurden beide im Militärlazarett von Madrid-Chamartín angestellt (Hospital militar no. 6).
The text contains several of Marianne Angermann's letters from Madrid during the Spanish Civil War to her parents in Dresden. When postal communication was no longer possible because of conditions during the War,  her mother began expressing her concerns for her daughter in the form of diary entries. Marianne and her husband, Franz Bielschowsky, worked at Military Hospital No. 6 in Madrid-Chamartín during the Siege of Madrid.
Briefe einer Antifaschistin: 1943
Authors: Obermayer August
Published: September 2024

Diese Eintragungen zeichnen das tägliche Leben während der Zeit des Nationalsozialismus auf, wie es Charlotte Angermann, Einwohnerin von Dresden, während des Zweiten Weltkrieges erlebte. Angermann beschreibt Bombenangriffe auf andere deutsche Städte, den Mangel an Lebensnotwendigem, der von der allgemeinen Bevölkerung erlitten wurde und den Tod von Freunden und Familienmitgliedern. Diese kurzen Texte erscheinen in Form einer direkten Anrede an ihre Tochter, Marianne Angermann-Bielschowsky, die, zusammen mit ihrem Ehemann Franz Bielschowsky, während des Spanischen Bürgerkrieges in einem Militärlazarett in Madrid gearbeitet hatte. Als 1939 die republikanische Sache verloren war, floh sie mit ihrem deutschen Ehemann Dr. Franz Bielschowsky nach Großbritannien, wo beide an der Universität Sheffield im Labor von Prof. H. N. Green eine Anstellung als Forschungsassistenten fanden.
The text records day to day life under National Socialism as it was experienced by Charlotte Angermann, a resident of Dresden during the Second World War. Angermann writes of bombing raids on other German cities, the shortages faced by the general population and the deaths of friends and family members. The diary entries are constructed as an address to her daughter, Marianne Angermann-Bielschowsky, who was at the time in Great Britain where worked as a research under Professor Green at the University of Sheffield.
Letters of an antifascist: 1937
Authors: Barton Peter
Published: September 2024

The text contains several of Marianne Angermann's letters from Madrid during the Spanish Civil War to her parents in Dresden. When postal communication was no longer possible because of conditions during the War,  her mother began expressing her concerns for her daughter in the form of diary entries. Marianne and her husband, Franz Bielschowsky, worked at Military Hospital No. 6 in Madrid-Chamartín during the Siege of Madrid.
Letters of an antifascist: 1939
Authors: Barton Peter
Published: September 2024

This text describes the experiences of Marianne Angermann-Bielschowsky who during the Spanish Civil War lived in Madrid, where she worked together with her husband, the physician Franz Bielschowsky, in a military hospital. Shortly before the Nationalists marched into Madrid at the end of that conflict the couple fled via France and Belgium to Great Britain. The text consists mainly of journal entries by Marianne's mother, Charlotte Angermann, who lived in Dresden. Charlotte records day to day life in Nazi Germany as the Second World War approached.
Letters of an antifascist: 1942
Authors: Barton Peter
Published: September 2024

These texts record daily life under National Socialism during the Second World War as it was experienced by Charlotte Angermann in Dresden. Angermann describes bombing raids on other German cities, the rationing of food and shortages of consumer goods, and the deaths of friends and family members. These short journal entries are written in the form of a direct address to Charlotte’s daughter, Marianne Angermann-Bielschowsky, who lived with her husband, the German-Jewish physician Franz Bielschowsky, in Great Britain where they both worked as researchers at the University of Sheffield.
Letters of an antifascist: 1943
Authors: Barton Peter
Published: September 2024

The text records day to day life under National Socialism as it was experienced by Charlotte Angermann, a resident of Dresden during the Second World War. Angermann writes of bombing raids on other German cities, the shortages faced by the general population and the deaths of friends and family members. The diary entries are constructed as an address to her daughter, Marianne Angermann-Bielschowsky, who was at the time in Great Britain where worked as a research under Professor Green at the University of Sheffield.
Letters of an antifascist: 1946
Authors: Barton Peter
Published: September 2024

The text records day to day life in 1946 under Soviet occupation as it was experienced by Charlotte Angermann, a resident of Dresden. Angermann writes of the death of her husband, Konrad Angermann, and her longing to see her daughter, Marianne Angermann-Bielschowsky, who was at the time in Great Britain where worked as a researcher under Professor Green at the University of Sheffield.
Bibliography
Authors: Barton Peter
Published: September 2024

Bibliography
Theory of the cubic autoproduct and its utility for noisy direction of arrival estimation
Authors: Joslyn Nicholas J. , Dowling David R.
Published: September 2024

Autoproducts are quadratic or higher products of frequency-domain acoustic fields that can mimic genuine fields at frequencies within or outside the original field's bandwidth. Past studies have found a variety of interesting autoproduct properties but have been limited to quadratic autoproducts. This paper presents cubic autoproduct theory and documents how noise suppression may be attained with the cubic frequency-difference autoproduct, a product of three frequency-domain acoustic fields. The cubic autoproduct's field equations, developed from the inhomogeneous Helmholtz equation, and analytical results in single- and two-path environments justify interpretating the cubic autoproduct as a pseudofield and underscore its similarities to the quadratic autoproducts. For nonzero field bandwidth, many frequency triplets satisfy the relationship for a single cubic autoproduct frequency. Thus, bandwidth averaging can lead to serendipitous noise suppression and is shown herein to facilitate field-phase-structure recovery from ideal free space fields corrupted by Gaussian noise. Cubic-autoproduct-based direction of arrival (DOA) estimation using signal and noise recordings collected in the ocean are found to be more accurate than conventional DOA estimates from the same data. In particular, cubic autoproduct results showed a 3–5 dB noise suppression advantage for 4- and 6-kHz direct- and reflected-path sounds broadcast 200 m to a four-element receiving array.
A 485-million-year history of Earth’s surface temperature
Authors: Judd Emily J. , Tierney Jessica E. , Lunt Daniel J. , Montañez Isabel P. , Huber Brian T. , Wing Scott L. , Valdes Paul J.
Published: September 2024

A long-term record of global mean surface temperature (GMST) provides critical insight into the dynamical limits of Earth’s climate and the complex feedbacks between temperature and the broader Earth system. Here, we present PhanDA, a reconstruction of GMST over the past 485 million years, generated by statistically integrating proxy data with climate model simulations. PhanDA exhibits a large range of GMST, spanning 11° to 36°C. Partitioning the reconstruction into climate states indicates that more time was spent in warmer rather than colder climates and reveals consistent latitudinal temperature gradients within each state. There is a strong correlation between atmospheric carbon dioxide (CO
2
) concentrations and GMST, identifying CO
2
as the dominant control on variations in Phanerozoic global climate and suggesting an apparent Earth system sensitivity of ~8°C.
Targeting cancer with small-molecule pan-KRAS degraders
Authors: Popow Johannes , Farnaby William , Gollner Andreas , Kofink Christiane , Fischer Gerhard , Wurm Melanie , Zollman David , Wijaya Andre , Mischerikow Nikolai , Hasenoehrl Carina , Prokofeva Polina , Arnhof Heribert , Arce-Solano Silvia , Bell Sammy , Boeck Georg , Diers Emelyne , Frost Aileen B. , Goodwin-Tindall Jake , Karolyi-Oezguer Jale , Khan Shakil , Klawatsch Theresa , Koegl Manfred , Kousek Roland , Kratochvil Barbara , Kropatsch Katrin , Lauber Arnel A. , McLennan Ross , Olt Sabine , Peter Daniel , Petermann Oliver , Roessler Vanessa , Stolt-Bergner Peggy , Strack Patrick , Strauss Eva , Trainor Nicole , Vetma Vesna , Whitworth Claire , Zhong Siying , Quant Jens , Weinstabl Harald , Kuster Bernhard , Ettmayer Peter , Ciulli Alessio
Published: September 2024

Mutations in the Kirsten rat sarcoma viral oncogene homolog (KRAS) protein are highly prevalent in cancer. However, small-molecule concepts that address oncogenic KRAS alleles remain elusive beyond replacing glycine at position 12 with cysteine (G12C), which is clinically drugged through covalent inhibitors. Guided by biophysical and structural studies of ternary complexes, we designed a heterobifunctional small molecule that potently degrades 13 out of 17 of the most prevalent oncogenic KRAS alleles. Compared with inhibition, KRAS degradation results in more profound and sustained pathway modulation across a broad range of KRAS mutant cell lines, killing cancer cells while sparing models without genetic KRAS aberrations. Pharmacological degradation of oncogenic KRAS was tolerated and led to tumor regression in vivo. Together, these findings unveil a new path toward addressing KRAS-driven cancers with small-molecule degraders.
Model citizens
Rat City: Overcrowding and Urban Derangement in the Rodent Universes of John B. Calhoun
Jon Adams and Edmund Ramsden
Melville House, 2024. 384 pp.
Authors: Davidson Ian J.
Published: September 2024

John Calhoun’s rodent “universes” informed ideas about 20th-century urban life
Bill targeting Chinese firms worries U.S. researchers
Authors: Service Robert F.
Published: September 2024

Biosecure Act could hinder science collaborations, limit sequencer purchases
Temperature, sediment resuspension, and salinity drive the prevalence of
Vibrio vulnificus
in the coastal Baltic Sea
Authors: Fernández-Juárez Víctor , Riedinger David J. , Gusmao Joao Bosco , Delgado-Zambrano Luis Fernando , Coll-García Guillem , Papazachariou Vasiliki , Herlemann Daniel P. R. , Pansch Christian , Andersson Anders F. , Labrenz Matthias , Riemann Lasse
Published: September 2024

The number of
Vibrio
-related infections in humans, e.g., by
Vibrio vulnificus
, has increased along the coasts of the Baltic Sea. Due to climate change, vibriosis risk is expected to increase. It is, therefore, pertinent to design a strategy for mitigation of the vibriosis threat in the Baltic Sea area, but a prerequisite is to identify the environmental conditions promoting the occurrence of pathogenic
Vibrio
spp., like
V. vulnificus
. To address this, we sampled three coastal Baltic sites in Finland, Germany, and Denmark with salinities between 6 and 21 from May to October 2022. The absolute and relative abundances of
Vibrio
spp. and
V. vulnificus
in water were compared to environmental conditions, including the presence of the eelgrass
Zostera marina
, which has been suggested to reduce pathogenic
Vibrio
species abundance. In the water column,
V. vulnificus
only occurred at the German station between July and August at salinity 8.1–11.2. Temperature and phosphate (PO
4
3–
) were identified as the most influencing factors for
Vibrio
spp. and
V. vulnificus
. The accumulation of
Vibrio
spp. in the sediment and the co-occurrence with sediment bacteria in the water column indicate that sediment resuspension contributed to
V. vulnificus
abundance. Interestingly,
V. vulnificus
co-occurred with specific cyanobacteria taxa, as well as specific bacteria associated with cyanobacteria. Although we found no reduction in
Vibrio
spp. or
V. vulnificus
associated with eelgrass beds, our study underscores the importance of extended heatwaves and sediment resuspension, which may elevate the availability of PO
4
3–
, for
Vibrio
species levels at intermediate salinities in the Baltic Sea.

IMPORTANCE

Elevated sea surface temperatures are increasing the prevalence of pathogenic
Vibrio
at higher latitudes. The recent increase in
Vibrio
-related wound infections and deaths along the Baltic coasts is, therefore, of serious health concern. We used culture-independent data generated from three Baltic coastal sites in Denmark, Germany, and Finland from May to October (2022), with a special focus on
Vibrio vulnificus
, and combined it with environmental data. Our temporal model shows that temperature, combined with sediment resuspension, drives the prevalence of
V. vulnificus
at intermediate salinities in the coastal Baltic Sea.
Coinfection of cerebral toxoplasmosis and neurosyphilis as the first manifestation of AIDS
Authors: Duffus Emily , Chinta Sree , Patel Pooja , Finkel Diana G
Published: September 2024

A male in his 30s with a medical history of newly diagnosed HIV with a CD4 count of 292 cells/mm3presented with a bilateral frontal headache and left upper and lower extremity weakness and paraesthesias. A few months prior, the patient experienced a desquamating rash on his scalp and a pruritic, papular genital rash, which both self-resolved. CT head without contrast revealed extensive vasogenic oedema involving the right basal ganglia, thalamus, temporal and occipital lobes. MRI of the brain with and without contrast revealed two enhancing masses in the right lentiform nucleus and right temporal-occipital junction with associated vasogenic oedema. Cerebrospinal fluid (CSF) studies confirmed cerebral toxoplasmosis with positive CSF Toxoplasma gondii PCR and neurosyphilis with positive serum rapid plasma reagin and CSF venereal disease research laboratory test. He was treated with trimethoprim/sulfamethoxazole and intravenous penicillin G with the resolution of his symptoms.
Tobacco use, secondhand exposure and knowledge of secondhand and third-hand smoke among medical college students in Western Nepal: a cross-sectional study
Authors: Sagar Surabhi , Bhattarai Dikshya , Ghimire Srijana , Bhattarai Apeksha , Wagle Anupa , Subedi Krishna
Published: September 2024

Objectives

This study was conducted to assess the prevalence of tobacco use, secondhand smoke (SHS) exposure and knowledge about SHS and third-hand smoke (THS) exposure among students in a medical college in Western Nepal.

Design

This is a cross-sectional study.

Setting

Data collection was done from 8 July 2023 to 8 August 2023 in a medical college in Nepal.

Participants

This study was conducted on undergraduate students studying in a medical college in Western Nepal using a census (whole population) sampling technique.

Main outcome measures

Prevalence of tobacco use was assessed by asking a question, ‘Did you use tobacco products within the last 30 days?’. Secondhand smoke exposure and knowledge about SHS and THS exposure were assessed by using structured questionnaires. The χ2test was used to compare the group exposed and non-exposed to tobacco, SHS and THS by sociodemographic variables (sex, residence, year of study and academic stream).

Results

The response rate was 96.43% (n=595/617). The overall prevalence of tobacco use was found to be 16.30%. A total of 88.83% of students from clinical years knew about SHS which was more than preclinical students (p <0.001). The Bachelor of Medicine and Bachelor of Surgery students have higher knowledge of SHS as compared with others (p =0.003). More than 95% of students favoured banning smoking in public places. Nearly half of the participants (45.45%) experienced SHS exposure in the last 7 days. More than half proportion of the clinical students knew about THS, which was higher than preclinical students and interns (p <0.001).

Conclusions

Tobacco use prevalence among the participants was found to be lower in comparison to other studies including medical students in several Asian countries. Despite more than three-fourths of students knowing the harmful effects of SHS exposure, almost one-half of them were exposed to SHS. The proportion of students who knew about THS exposure was comparably lower.
Scoping review of the effectiveness of 10 high-impact initiatives (HIIs) for recovering urgent and emergency care services
Authors: Carroll Christopher , Kundakci Burak , Muhinyi Amber , Bastounis Anastasios , Jones Katherine , Sutton Anthea , Goodacre Steve , Marincowitz Carl , Booth Andrew
Published: September 2024

Introduction

Prolonged ambulance response times and unacceptable emergency department (ED) wait times are significant challenges in urgent and emergency care systems associated with patient harm. This scoping review aimed to evaluate the evidence base for 10 urgent and emergency care high-impact initiatives identified by the National Health Service (NHS) England.

Methods

A two-stage approach was employed. First, a comprehensive search for reviews (2018–2023) was conducted across PubMed, Epistemonikos and Google Scholar. Additionally, full-text searches using Google Scholar were performed for studies related to the key outcomes. In the absence of sufficient review-level evidence, relevant available primary research studies were identified through targeted MEDLINE and HMIC searches. Relevant reviews and studies were mapped to the 10 high-impact initiatives. Reviewers worked in pairs or singly to identify studies, extract, tabulate and summarise data.

Results

The search yielded 20 771 citations, with 48 reviews meeting the inclusion criteria across 10 sections. In the absence of substantive review-level evidence for the key outcomes, primary research studies were also sought for seven of the 10 initiatives. Evidence for interventions improving ambulance response times was generally scarce. ED wait times were commonly studied using ED length of stay, with some evidence that same day emergency care, acute frailty units, care transfer hubs and some in-patient flow interventions might reduce direct and indirect measures of wait times. Proximal evidence existed for initiatives such as urgent community response, virtual hospitals/hospital at home and inpatient flow interventions (involving flow coordinators), which did not typically evaluate the NHS England outcomes of interest.

Conclusions

Effective interventions were often only identifiable as components within the NHS England 10 high-impact initiative groupings. The evidence base remains limited, with substantial heterogeneity in urgent and emergency care initiatives, metrics and reporting across different studies and settings. Future research should focus on well-defined interventions while remaining sensitive to local context.
Patients’ experiences with ‘sludge’ (administrative burden) in the cancer screening process and its relationship with screening completion, experience and health system distrust
Authors: Rockwell Michelle S , Chang Brianna , Zagarese Vivian , Turner Jamie K , Southworth Ally , Wu YingXing , Yeaton Paul , Li Li , Stein Jeffrey S , Parker Sarah H , Epling John W
Published: September 2024

Objective

‘Sludge’ refers to administrative burdens or frictions that preclude people from getting what they want or need (eg, duplicative forms, complicated instructions, long waiting times). This mixed methods study evaluated patients’ perceptions of sludge in the colorectal cancer (CRC) screening process and some impacts of this sludge.

Design

We employed an exploratory sequential mixed methods study design that comprised patient interviews and a patient survey. The interviews informed final survey revisions and captured contextual data about patients’ experiences with sludge. Interview transcripts were inductively and deductively analysed to identify overarching themes. The survey quantified sludge, delayed or forgone screenings, screening experience (Net Promoter Score) and health system distrust (Health System Distrust Scale). We used χ2or t-tests for univariable comparisons and logistic or linear regressions to evaluate the association between cumulative sludge score and delayed or forgone screenings, screening experience and health system distrust. Results were integrated for interpretation.

Setting

Southeastern United States.

Participants

Patients who were 45–75 years of age, at average risk for CRC and had either completed or been referred for CRC screening (colonoscopy or stool-based test) within the previous 12 months.

Results

22 interview participants and 255 survey participants completed the study. 38 (15%) survey participants rated their screening experience as poor (Net Promoter Score=0–7 out of 10). The mean (SD) Health System Distrust Scale score was 22.4 (6.3) out of 45 possible points (higher score=greater distrust). Perceptions of sludge in the CRC screening process varied, with long waiting times and burdensome communication being the most common sources (58% and 35% of participants, respectively). Sludge was positively associated with delayed or forgone screenings (OR=1.42, 95% CI 1.28, 1.57, p<0.001), poor screening experience (OR=1.15, 95% CI 1.04, 1.28, p=0.009) and health system distrust (β=0.47, p<0.001). Qualitative findings add descriptive detail about sludge encountered, context to impacts experienced, and illustrate the heavy emotional impact of sludge: ‘it just isn’t worth it’.

Conclusion

Efforts to reduce sludge in the CRC screening process may improve timely completion of CRC screening, enhance patient experience and restore trust in the health system.
When time is of the essence: ethical reconsideration of XAI in time-sensitive environments
Authors: Wabro Andreas , Herrmann Markus , Winkler Eva C
Published: September 2024

The objective of explainable artificial intelligence systems designed for clinical decision support (XAI-CDSS) is to enhance physicians’ diagnostic performance, confidence and trust through the implementation of interpretable methods, thus providing for a superior epistemic positioning, a robust foundation for critical reflection and trustworthiness in times of heightened technological dependence. However, recent studies have revealed shortcomings in achieving these goals, questioning the widespread endorsement of XAI by medical professionals, ethicists and policy-makers alike. Based on a surgical use case, this article challenges generalising calls for XAI-CDSS and emphasises the significance of time-sensitive clinical environments which frequently preclude adequate consideration of system explanations. Therefore, XAI-CDSS may not be able to meet expectations of augmenting clinical decision-making in specific circumstances where time is of the essence. This article, by employing a principled ethical balancing methodology, highlights several fallacies associated with XAI deployment in time-sensitive clinical situations and recommends XAI endorsement only where scientific evidence or stakeholder assessments do not contradict such deployment in specific target settings.
Acquisition of Prehospital Stroke Severity Scale is associated with shorter door-to-puncture times in patients with prehospital notifications transported directly to a thrombectomy center
Authors: Bhatt Nirav R , Martin-Gill Christian , Al-Qudah Abdullah , Dermigny Katharine , Doheim Mohamed F , Rios Rocha Lucas , Sultany Abdullah , Kakamyradov Guvanch , Rocha Marcelo , Starr Matthew , Patterson Rebecca , Al-Bayati Alhamza R , Guyette Francis X , Nogueira Raul G
Published: September 2024

Background

We sought to identify systemic factors influencing door-to-puncture times (DTP) among patients with pre-arrival notifications presenting directly to a comprehensive stroke center (CSC) and undergoing emergent mechanical thrombectomy (MT).

Methods

In this retrospective analysis of a prospectively maintained registry of acute ischemic stroke (AIS) patients undergoing MT at two CSCs between January 2021 and October 2023, we included consecutive AIS patients presenting directly to the CSC with pre-arrival notifications via emergency medical services (EMS) and who underwent emergent MT. We excluded patients with known confounders to DTP and divided this cohort into two groups: DTP ≤75 min and >75 min. We used variables with P value <0.2 in the univariate analysis to build a binary logistic regression model to identify their association with DTP >75 min, adjusting for door-to-CT time.

Results

Of 900 patients, 605 were inter-facility transfers, 89 were excluded due to known confounders/missing prehospital notifications, leaving 206 qualifying patients. On multivariable analysis, not meeting American Heart Association (AHA) level 1 criteria (adjusted OR (aOR) 3.04, 95% CI 1.62 to 5.82, P<0.001), lack of Prehospital Stroke Severity Scale (PSSS) acquisition (aOR 2.2, 95% CI 1.19 to 4.11, P=0.01), and presentation after-hours (aOR 2.27, 95% CI 1.23 to 4.28, P=0.01) were associated with >75 min DTP times. Most patients (62.3%) had no clearly documented reasons for delay in MT, whereas 25.8% of delays were attributed to prolonged medical decision-making.

Conclusion

Arrival outside business hours, not meeting AHA level 1 criteria, and lack of PSSS acquisition by EMS were associated with prolonged DTP. Impacting modifiable factors such as prehospital assessment of stroke severity is an optimal target for quality improvement.