bluuebunny/crossref_metadata_2025 huggingface dataset:
The heterogeneous microstructure in an Al-Zn-Mg-Cu-Sc-Zr alloy produced by selective laser melting
Authors: Zhu Y Y , Pan W , Li Y Y , Huang T L , Zhang Y Z , Huang X
Published: August 2022

Fully dense and crack-free Al-Zn-Mg alloys with Sc and Zr additions were successfully fabricated by selective laser melting. The microstructures of as-built alloys with different Sc and Zr additions were characterized by scanning electron microscopy and transmission electron microscopy. The microstructure was composed of coarse columnar grains without Sc and Zr additions. In contrast, a fine heterogeneous microstructure, consisting of equiaxed grains at the bottom of the melt pool and columnar grains in the remaining volumes, was formed by adding 0.6 wt.% Sc and 0.26 wt.% Zr. In addition, a high density of precipitates was identified as η’ and I-phases that were distributed at grain boundaries and inside grains.
Revisiting plastic strain ratio determination in aluminium using crystal plasticity
Authors: Lindell D
Published: August 2022

Determination of plastic strain ratio (r, also known as the Lankford coefficient) from texture data is one of the most widely used applications of crystal plasticity methods. Early attempts using Taylor theory and x-ray texture data already provided practically useful information of e.g. drawability of sheet metals. Developments in recent decades within both electron backscatter diffraction and computational mechanics have significantly improved the accuracy of these calculations. Predictions can now be made that compares relatively well with experiments making r-value predictions from texture data a routine method within material and process development. The current work reviews recent studies on plastic strain ratio determination by computational means for aluminium sheet metal, with the aim to assess the expected accuracy using modern crystal plasticity methods. Furthermore, we investigate the major sources of error in these calculations by comparison between previous studies and with new experiments and calculations. In particular, we observe and investigate a maximum in the absolute error occurring typically at 45° to the rolling direction. The sources of this error are discussed in terms of both model conditions and the material heterogeneities giving rise to anisotropy.
Grain orientation dependence of deformation microstructure evolution and mechanical properties in face-centered cubic high/medium entropy alloys
Authors: Yoshida S , Fu R , Gong W , Ikeuchi T , Bai Y , Feng Z , Wu G , Shibata A , Hansen N , Huang X , Tsuji N
Published: August 2022

This study revealed characteristics of the deformation behavior in high/medium entropy alloys (HEAs/MEAs) with face-centered cubic (FCC) structure. A Co60Ni40 alloy and a Co20Cr40Ni40 MEA having low and high friction stresses (fundamental resistance to dislocation glide in solid solutions), respectively, but similar in other properties, including their stacking fault energy and grain sizes, were compared. The MEA exhibited a higher yield strength and work-hardening ability than those in the Co60Ni40 alloy at room temperature. Deformation microstructures of the Co60Ni40 alloy were composed of coarse dislocation cells (DCs) in most grains, and a few deformation twins (DTs) formed in grains with tensile axis (TA) nearly parallel to <111>. In the MEA, three microstructure types were found depending on the grain orientations: (1) fine DCs developed in TA~//<100>-oriented grains; (2) planar dislocation structures (PDSs) formed in grains with other orientations; and (3) dense DTs adding to the PDSs developed in TA~//<111>-oriented grains. The results imply difficulty in cross-slip of screw dislocations and dynamic recovery in the MEA, leading to an increase in the dislocation density and work-hardening rate. Our results suggest that FCC high-alloy systems with high friction stress inherently develop characteristic deformation microstructures advantageous for achieving high strength and large ductility.
Finite element modelling of indentation testing in an AA1050 microstructure
Authors: Goutianos S , Pan H , Zhang X
Published: August 2022

Heterogeneous microstructures can be produced in structural metals from heterogeneous deformation, and they can also be purposely designed to meet specific requirements in high-demanding engineering applications. When designing a heterogeneous microstructure in metallic materials, it is important to know the local mechanical properties such as the stress-strain behavior. However, due to the local varying microstructure, direct measurement of the local mechanical properties is not feasible either by bulk testing or by miniature testing. In this work, an iterative approach, based on the finite element method and under the assumption that the local mictrostructure is homogeneous, will be presented as an example to extract the local mechanical properties of cold-rolled AA1050 from indentation tests as an example. The uncertainties of the proposed method are discussed.
Characterization of local deformation and fracture behavior in ferrite + martensite dual-phase steels having different grain sizes
Authors: Park M H , Tagusari Y , Tsuji N
Published: August 2022

Low carbon dual-phase (DP) steels composed of soft ferrite and hard martensite have been widely used in the automotive industry due to their good strength-ductility balance and large strain hardening ability. DP steels have a wide variation in mechanical properties depending on several microstructural features such as grain size, phase fraction and distribution. Among them, the grain refinement of DP steels is known to be an effective option for enhancing mechanical performance in strength and ductility (especially post-uniform elongation). However, the exact reason for the significant improvement of post-uniform elongation by grain refinement has not been fully understood. It is considered that the characterization of local deformation behavior and micro-void formation/growth behavior in connection with microstructures is an essential approach for understanding the enhanced post-uniform elongation realized in the fine-grained DP specimen. In the present study, we prepared two kinds of DP specimens with mean ferrite grain sizes of 14.9 μm (coarse-grained DP) and 7.1 μm (fine-grained DP), and carefully investigated local strain distribution of tensile specimen and micro-void formation/growth behavior using digital image correlation (DIC) analysis and SEM observations. The fine-grained DP specimen exhibited a gradual strain localization after necking and had sufficient strain capacity that could endure against fracture. The fine-grained DP structure had a great number of micro-voids in the necked region, but almost all the micro-voids maintained a very small size, which was contrasted with the case of coarse-grained DP specimen containing very large-sized micro-voids. Such a significant difference in micro-void size/number characters between two kinds of DP specimens would be one possible reason for exhibiting greatly different post-uniform elongation behavior.
3D In-situ Stop Action Study of Recrystallization in Additively Manufactured 316L Stainless Steel: Reconstruction Optimization and Observations
Authors: Liu H , Zhang Y , Wilkin M , Park J-S , Kenesei P , Rollett A D , Suter R M
Published: August 2022

A volume of an additively manufactured 316L stainless steel sample has been tracked during its recrystallization using near- and far-field High Energy Diffraction Microscopy (HEDM) and absorption tomography at Advanced Photon Source beamline 1-ID. A near-field compatible in situ furnace allows monitoring of Bragg diffraction signals as they evolve out of a weak and diffuse background while the sample temperature is ≈ 1250° C. The sample is rapidly cooled to room temperature after observation of significant signal evolution and ∼ 0.035 mm3 is mapped by the near-field method. Four cycles of heat treatment follow the structure from a state of small, isolated grains through impingement of domains to near completion of recyrstallization. Here, the experiment and reconstructions are described, and recrystallized fractions, twin domains, and distributions of grain boundary types are discussed.
Bottom gate top contact organic transistors using thiophene and furan flanked diketopyrrolopyrrole polymers and its comparative study
Authors: Do Thu-Trang , Takeda Yasunori , Sekine Tomohito , Yadav Yogesh , Manzhos Sergei , Feron Krishna , Singh Samarendra P , Tokito Shizuo , Sonar Prashant
Published: August 2022

Herein, two donor–acceptor conjugated polymers based on dithieno[3,2-b:2′,3′-d]thiophene (DTT) and thiophene-flanked diketopyrrolopyrrole (DPP) or furan-flanked DPP, namely PDPPT-DTT and PDPPF-DTT were synthesised, characterised and evaluated for their electrical performance in transistor devices for comparison. The influence of the heteroatoms (thiophene and furan) flanked DPP on their thermal, optical, electronic structure and charge carrier transport properties were investigated. The absorption spectra of polymer PDPPT-DTT are broader and red-shifted (26–30 nm) compared with that of polymer PDPPF-DTT, indicating the resonance energy of thiophene is greater than furan, which may allow for different electron localization and result in the difference of optical properties. In addition, energy levels of polymers were slightly affected by the aromatic remote end-groups (thiophene to furan) in DPP-based molecule. Hole transport properties of copolymers were investigated by fabricating the field-effect transistors in the bottom gate top contact (BGTC) configurations for three different self-assembled monolayers (SAMs)/gate dielectric interfaces and different annealing temperatures of polymeric active layer. The BGTC organic thin film transistor (OFET) devices having PDPPT-DTT and PDPPF-DTT thin film annealed at 200 °C exhibit the hole mobility of 0.18 and 0.20 cm2 V−1 s−1, respectively. The OFET devices with trichloro(octyl)silane SAM, fabricated and characterized in ambient environment (temperature ∼25 °C, humidity ∼50%), were found to retain 90% of their performance up to 1000 h.
Galois cohomology of function fields of curves over non-archimedean local fields
Authors: Gosavi Saurabh
Published: August 2022

Let

F
F

be the function field of a curve over a non-archimedean local field. Let

m
≥
2

m \geq 2

be an integer coprime to the characteristic of the residue field of the local field. In this article, we show that every element in

H

3

(
F
,

μ

m

⊗
2

)

H^{3}(F, \mu _{m}^{\otimes 2})

is of the form

χ
∪
(
f
)
∪
(
g
)

\chi \cup (f) \cup (g)

, where

χ
\chi

is in

H

1

(
F
,

Z

/

m

Z

)

H^{1}(F, \mathbb {Z}/m\mathbb {Z})

and

(
f
)

(f)

,

(
g
)

(g)

in

H

1

(
F
,

μ

m

)

H^{1}(F, \mu _{m})

. This extends a result of Parimala and Suresh [Ann. of Math. (2) 172 (2010), pp. 1391–1405], where they show this when

m
m

is prime and when

F
F

contains

μ

m

\mu _{m}

.
The Impact of Abdominal Body Contouring Surgery on Physical Function After Massive Weight Loss: A Pilot Prospective Matched Comparison
Authors: Mardan-Dezfouli Sobhan , Reid Owen G , Fliss Matthew D , Stevenson Jordan , Harris David , Lyon Michael R , Koehle Michael S , Mitchell Cameron J
Published: August 2022

Background

Many individuals develop excess skin (ES) following massive weight loss (MWL). Patient-reported outcomes demonstrate that abdominal ES negatively impacts perceived physical function which is improved by abdominal body contouring surgery (ABCS). However, the effect of ABCS on objective measures of physical function is unknown.

Objectives

The aim of this study was to examine the impact of ABCS on objective measures of physical function in individuals who have undergone MWL.

Methods

Patients who have undergone MWL with abdominal ES (grade, ≥2) underwent the following physical function assessments: 9-item modified physical performance test (mPPT), chair stand, star excursion balance test (SEBT), timed up and go (TUG), modified agility T test, and 6-minute walk test (6-MWT). Perception of physical exertion and BODY-Q questionnaire scales were also collected. Nonsurgical controls (n = 21) and those who had undergone ABCS (n = 6) after the first visit performed a second physical function assessment 8 to 12 weeks later to allow for postoperative healing.

Results

No ceiling or floor effect was detected for any physical function measure. The intraclass correlation coefficient was 0.78 (95% CI, 0.44, 0.91) for the mPPT and >0.80 for all other measures. The effect sizes were 0.74 (75% CI, 0.19, 1.28) for the mPPT, 0.54 (75% CI, 0.00, 1.08) for the SEBT, –0.63 (75% CI, –1.17, –0.09) for the modified agility T test, and 0.79 (75% CI, 0.24, 0.13) for the 6-MWT.

Conclusions

The mPPT and tests involving dynamic balance, agility, and walking were reliable and showed medium to large effect sizes, suggesting that these tests may be sensitive to change following ABCS.

Level of Evidence: 2
The Underappreciated Role of the Platysma Muscle in the Perioral Expressions in Young Adults
Authors: Sun Weiyi , Ma Hengyuan , Song Tao
Published: August 2022

Background

The platysma is involved in lower face movement, yet limited information on its functional role when making perioral expressions is available.

Objectives

The aim of this study was to use 3-dimensional (3D) photogrammetry to analyze platysma activity when making expressions.

Methods

Standardized frontal-view 3D images were obtained from 54 volunteers. Three perioral expressions were analyzed: a full smile, mouth corner depression, and a grimace to show the lower teeth. Positive volume change in the “heat map” of the neck skin surface—determined by the superimposed image subtraction technique—served as a sensitive indicator of platysma contraction.

Results

When making the 3 expressions, the proportions of platysma contraction were 42.6%, 75.9%, and 92.6%, respectively. The platysma worked as a more critical dynamic force than expected. In most smiles involving the platysma, its upper portion contracted. With the laterally downward traction on the lower lip increasing, the upper and lower portions of the platysma contracted together and formed muscular bands. The platysma contracted extensively in the other 2 expressions. In some cases, platysma bands were observed to form due to vigorous contraction of muscle fibers. In addition, the platysma was found to be highly functionally active in young individuals.

Conclusions

This study introduced a simple method that can sensitively identify the functional status of the platysma. The results showed the platysma’s highly active function in perioral expressions in young adults. These findings may assist surgeons in personalized decision-making toward platysma muscle-weakening strategies and work as an objective tool for outcome evaluation.

Level of Evidence: 4
Scoring personalized molecular portraits identify Systemic Lupus Erythematosus subtypes and predict individualized drug responses, symptomatology and disease progression
Authors: Toro-Domínguez Daniel , Martorell-Marugán Jordi , Martinez-Bueno Manuel , López-Domínguez Raúl , Carnero-Montoro Elena , Barturen Guillermo , Goldman Daniel , Petri Michelle , Carmona-Sáez Pedro , Alarcón-Riquelme Marta E
Published: August 2022

Objectives

Systemic Lupus Erythematosus is a complex autoimmune disease that leads to significant worsening of quality of life and mortality. Flares appear unpredictably during the disease course and therapies used are often only partially effective. These challenges are mainly due to the molecular heterogeneity of the disease, and in this context, personalized medicine-based approaches offer major promise. With this work we intended to advance in that direction by developing MyPROSLE, an omic-based analytical workflow for measuring the molecular portrait of individual patients to support clinicians in their therapeutic decisions.

Methods

Immunological gene-modules were used to represent the transcriptome of the patients. A dysregulation score for each gene-module was calculated at the patient level based on averaged z-scores. Almost 6100 Lupus and 750 healthy samples were used to analyze the association among dysregulation scores, clinical manifestations, prognosis, flare and remission events and response to Tabalumab. Machine learning-based classification models were built to predict around 100 different clinical parameters based on personalized dysregulation scores.

Results

MyPROSLE allows to molecularly summarize patients in 206 gene-modules, clustered into nine main lupus signatures. The combination of these modules revealed highly differentiated pathological mechanisms. We found that the dysregulation of certain gene-modules is strongly associated with specific clinical manifestations, the occurrence of relapses or the presence of long-term remission and drug response. Therefore, MyPROSLE may be used to accurately predict these clinical outcomes.

Conclusions

MyPROSLE (https://myprosle.genyo.es) allows molecular characterization of individual Lupus patients and it extracts key molecular information to support more precise therapeutic decisions.
ExplorePipolin: reconstruction and annotation of piPolB-encoding bacterial mobile elements from draft genomes
Authors: Chuprikova L , Mateo-Cáceres V , de Toro M , Redrejo-Rodríguez M
Published: August 2022

Motivation

Detailed and accurate analysis of mobile genetic elements (MGEs) in bacteria is essential to deal with the current threat of multiresistant microbes. The overwhelming use of draft, contig-based genomes hinder the delineation of the genetic structure of these plastic and variable genomic stretches, as in the case of pipolins, a superfamily of MGEs that spans diverse integrative and plasmidic elements, characterized by the presence of a primer-independent DNA polymerase.

Results

ExplorePipolin is a Python-based pipeline that screens for the presence of the element and performs its reconstruction and annotation. The pipeline can be used on virtually any genome from diverse organisms and of diverse quality, obtaining the highest-scored possible structure and reconstructed out of different contigs if necessary. Then, predicted pipolin boundaries and pipolin encoded genes are subsequently annotated using a custom database, returning the standard file formats suitable for comparative genomics of this mobile element.

Availability and implementation

All code is available and can be accessed here: github.com/pipolinlab/ExplorePipolin.

Supplementary information

Supplementary data are available at Bioinformatics Advances online.
Roles of intestinal Parabacteroides in human health and diseases
Authors: Cui Yanlong , Zhang Leshan , Wang Xin , Yi Yanglei , Shan Yuanyuan , Liu Bianfang , Zhou Yuan , Lü Xin
Published: August 2022

The stability of gut microbiota is essential for the host's health. Parabacteroides spp., core members of the human gut microbiota, have an average abundance of 1.27% in humans of 12 populations. Parabacteroides have recently been reported to have a close relationship with host health (e.g. metabolic syndrome, inflammatory bowel disease and obesity). Parabacteroides have the physiological characteristics of carbohydrate metabolism and secreting short chain fatty acids. However, antimicrobial resistance of Parabacteroides to antibiotics (such as clindamycin, moxifloxacin and cefoxitin) should not be ignored. In this review, we primarily focus on Parabacteroides distasonis, Parabacteroides goldsteinii, Parabacteroides johnsonii and Parabacteroides merdae and discuss their relationships with host disease, diet and the prevention or induction of diseases. Pa. distasonis and Pa. goldsteinii may be viewed as potential next generation probiotic candidates due to their protective effects on inflammation and obesity in mice. We also discuss the potential therapeutic application of Parabacteroides spp. in maintaining host–intestine homeostasis.
Real-World Evidence Prediction of a Phase IV Oncology Trial: Comparative Degarelix vs Leuprolide Safety
Authors: Merola David , Schneeweiss Sebastian , Sreedhara Sushama K , Zabotka Luke E , Quinto Kenneth , Concato John , Wang Shirley V
Published: August 2022

Background

Medical and regulatory communities are increasingly interested in the utility of real-world evidence (RWE) for answering questions pertaining to drug safety and effectiveness, but concerns about validity remain. A principled approach to conducting RWE studies may alleviate concerns and increase confidence in findings. This study sought to predict the findings from the PRONOUNCE trial using a principled approach to generating RWE.

Methods

This propensity score–matched observational cohort study used 3 claims databases to compare the occurrence of major adverse cardiovascular events among initiators of degarelix vs leuprolide. Patients were included if they had a history of prostate cancer and atherosclerotic cardiovascular disease. Patients were excluded if they did not have continuous database enrollment in the year before treatment initiation, were exposed to androgen deprivation therapy or experienced an acute cardiovascular event within 30 days before treatment initiation, or had a history or risk factors of QT prolongation.

Results

There were 12 448 leuprolide and 1969 degarelix study-eligible patients before matching, with 1887 in each arm after propensity score matching. The results for major adverse cardiovascular events comparing degarelix with leuprolide in the observational analysis (hazard ratio = 1.35, 95% confidence interval = 0.94 to 1.93) was consistent with the subsequently released PRONOUNCE result (hazard ratio = 1.28, 95% confidence interval  = 0.59 to 2.79).

Conclusions

This study successfully predicted the result of a comparative cardiovascular safety trial in the oncology setting. Although the findings are encouraging, limitations of measuring cancer stage and tumor progression are representative of challenges in attempting to generalize whether claims-based RWE can be used as actionable evidence.
Practical guidelines of online MR-guided adaptive radiotherapy
Authors: Okamoto Hiroyuki , Igaki Hiroshi , Chiba Takahito , Shibuya Keiko , Sakasai Tatsuya , Jingu Keiichi , Inaba Koji , Kuroda Kagayaki , Aoki Shigeki , Tatsumi Daisaku , Nakamura Mitsuhiro , Kadoya Noriyuki , Furuyama Yoshinobu , Kumazaki Yu , Tohyama Naoki , Tsuneda Masato , Nishioka Shie , Itami Jun , Onishi Hiroshi , Shigematsu Naoyuki , Uno Takashi
Published: August 2022

The first magnetic resonance (MR)-guided radiotherapy system in Japan was installed in May 2017. Implementation of online MR-guided adaptive radiotherapy (MRgART) began in February 2018. Online MRgART offers greater treatment accuracy owing to the high soft-tissue contrast in MR-images (MRI), compared to that in X-ray imaging. The Japanese Society for Magnetic Resonance in Medicine (JSMRM), Japan Society of Medical Physics (JSMP), Japan Radiological Society (JRS), Japanese Society of Radiological Technology (JSRT), and Japanese Society for Radiation Oncology (JASTRO) jointly established the comprehensive practical guidelines for online MRgART. These guidelines propose the essential requirements for clinical implementation of online MRgART with respect to equipment, personnel, institutional environment, practice guidance, and quality assurance/quality control (QA/QC).

The minimum requirements for related equipment and QA/QC tools, recommendations for safe operation of MRI system, and the implementation system are described. The accuracy of monitor chamber and detector in dose measurements should be confirmed because of the presence of magnetic field. The ionization chamber should be MR-compatible. Non-MR-compatible devices should be used in an area that is not affected by the static magnetic field (outside the five Gauss line), and their operation should be checked to ensure that they do not affect the MR image quality. Dose verification should be performed using an independent dose verification system that has been confirmed to be reliable through commissioning. This guideline proposes the checklists to ensure the safety of online MRgART. Successful clinical implementation of online MRgART requires close collaboration between physician, radiological technologist, nurse, and medical physicist.
From farm to the city? Understanding the motives of entrepreneurial Javanese migration to an Indonesian outer island
Authors: Akhmad Fandi , Utomo Ariane , Dressler Wolfram
Published: August 2022

This article examines the migration motives of entrepreneurial Javanese migrants residing in the regional town of Kupang, East Nusa Tenggara—a relatively resource-poor province in Eastern Indonesia. These migrants had generally worked in agriculture in their hometowns in Java but have engaged in and/or set up informal businesses since their arrival in Kupang. Drawing on a mixed-methods approach (household survey [n = 344]; in-depth interviews [n = 28]) in 2020, we identified the diverse underlying motives of Javanese entrepreneurial migration to Kupang. Most Javanese respondents emphasised the importance of a combination of factors, including their low levels of education in Java, greater opportunities to improve their quality of life, and tolerant and welcoming locals in Kupang. Associated with these factors, others migrated to escape the difficulties of agricultural work and the need to earn more income to fund their children’s education now and in the future. Our article offers new insights into how changing social and economic conditions in rural Java are increasingly driving migration to the rapidly growing urban clusters in Indonesia’s outer islands, leading to changing urban form, economic trajectories, and social relations.
Patients with diffuse idiopathic skeletal hyperostosis have an increased burden of thoracic aortic calcifications
Authors: Harlianto Netanja I , Westerink Jan , Hol Marjolein E , Wittenberg Rianne , Foppen Wouter , van der Veen Pieternella H , van Ginneken Bram , Verlaan Jorrit-Jan , de Jong Pim A , Mohamed Hoesein Firdaus A A ,   UCC-SMART Study Group, Asselbergs F W , Nathoe H M , de Borst G J , Bots M L , Geerlings M I , Emmelot M H , de Jong P A , Leiner T , Lely A T , van der Kaaij N P , Kappelle L J , Ruigrok Y M , Verhaar M C , Visseren F L J , Westerink J
Published: August 2022

Objectives.

DISH has been associated with increased coronary artery calcifications and incident ischaemic stroke. The formation of bone along the spine may share pathways with calcium deposition in the aorta. We hypothesized that patients with DISH have increased vascular calcifications. Therefore we aimed to investigate the presence and extent of DISH in relation to thoracic aortic calcification (TAC) severity.

Methods.

This cross-sectional study included 4703 patients from the Second Manifestation of ARTerial disease cohort, consisting of patients with cardiovascular events or risk factors for cardiovascular disease. Chest radiographs were scored for DISH using the Resnick criteria. Different severities of TAC were scored arbitrarily from no TAC to mild, moderate or severe TAC. Using multivariate logistic regression, the associations between DISH and TAC were analysed with adjustments for age, sex, BMI, diabetes, smoking status, non-high-density lipoprotein cholesterol, cholesterol lowering drug usage, renal function and blood pressure.

Results.

A total of 442 patients (9.4%) had evidence of DISH and 1789 (38%) patients had TAC. The prevalence of DISH increased from 6.6% in the no TAC group to 10.8% in the mild, 14.3% in the moderate and 17.1% in the severe TAC group. After adjustments, DISH was significantly associated with the presence of TAC [odds ratio (OR) 1.46 [95% CI 1.17, 1.82)]. In multinomial analyses, DISH was associated with moderate TAC [OR 1.43 (95% CI 1.06, 1.93)] and severe TAC [OR 1.67 (95% CI 1.19, 2.36)].

Conclusions.

Subjects with DISH have increased TACs, providing further evidence that patients with DISH have an increased burden of vascular calcifications.
Corporate Capture of Blockchain Governance
Authors: Ferreira Daniel , Li Jin , Nikolowa Radoslawa
Published: August 2022

We develop a theory of blockchain governance. In our model, the proof-of-work system, the most common set of rules for validating transactions in blockchains, creates an industrial ecosystem with specialized suppliers of goods and services. We analyze the interactions between blockchain governance and the market structure of the industries in the blockchain ecosystem. We show that the proof-of-work system may lead to a situation in which some large firms in the blockchain industrial ecosystem—blockchain conglomerates—capture the governance of the blockchain.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Targeting Serotonin With Common Antidepressants Induces Rapid Recovery From Cytopenia
Authors: Fouquet Guillemette , Rossignol Julien , Garcelon Nicolas , Hermine Olivier , Côté Francine , Coman Tereza
Published: August 2022

The hematopoietic system uses several, yet undiscovered, factors to adapt to stresses such as chemotherapy, infections, or bleeding. Serotonin is commonly known as a neurotransmitter but is also produced and used in peripheral organs. In particular, we have shown that serotonin synthesized in the bone marrow is necessary for erythroid progenitors’ survival and proliferation. Serotonin levels can be increased by FDA approved antidepressants called selective serotonin reuptake inhibitors (SSRI). In this work, we report a previously unknown role of SSRI in the recovery of cytopenia, after autologous hematopoietic stem cell transplantation in patients and after sub-lethal irradiation in mice. We also observed an unexpected cooperation between SSRI and G-CSF on the improvement of the 3 hematopoietic lineages. Of note, SSRI do not seem to affect blood cells production in the absence of stress-induced hematopoiesis. We propose that the serotonergic system could be a valuable therapeutic target in stress-induced cytopenia, especially as a rescue after radiation or chemotherapy.
Leading as Servant in Times of Crisis
Authors: Tagliareni M. Elaine , Sipe Margie Hamilton , Hill Rebecca , Reidy Patricia A. , Ciesielski Steven , Lucey Jason R.
Published: August 2022

Using servant leadership as a framework, leaders within a school of nursing guided faculty during the COVID-19 pandemic and called them to address social injustice in the summer of 2020. A model was developed to sustain growth and build resilience of students, faculty, and staff. Influenced by external and internal drivers that stimulated the need for change, strategies were implemented based on core principles of servant leadership. Outcomes emerged in three categories: collaborative strengths demonstrated by students, faculty, and staff; performance of the community to be intentional about change; and transformative practices leading to enhancement of internal and external partnerships.
Teaching in Times of Crisis Through a Palliative Care Lens
Authors: Bigelow April , Price Deborah , Mason Heidi , Harden Karen
Published: August 2022

The disruption of classroom and clinical education caused by the COVID-19 pandemic resulted in student distress and worry regarding the future of their education. Faculty trained in palliative care adapted the SPIKES mnemonic and applied it to real-time interactions with students in an effort to decrease distress and enable continued learning. Palliative care concepts, approaches, and techniques can be used to successfully facilitate faculty-student interactions during times of crisis and rapidly changing educational environments.
Foundations of Nursing
Authors: Perez Amelia , Andrews Angela , Reed Amy , Patino Jasmin
Published: August 2022

Research focusing on blended learning for foundations of nursing courses is limited. The purpose of this study was to compare course performance outcomes when teaching foundations using blended learning compared to face-to-face instruction and to evaluate learner satisfaction and perceptions of effectiveness regarding blended learning. No significant differences were found in exam or final course grades between the two modalities. Most participants perceived blended learning as effective in meeting the course objectives and rated the course as either excellent, very good, or good. Blended learning was a useful strategy for teaching foundations of nursing.
Can I Ask a Question About URiM Awards That I Don’t Know the Answer to? Designing an Award for Underrepresented Medical Education Researchers
Authors: Zaidi Zareen , Sewell Justin L. , Schumacher Daniel , Sukhera Javeed , Hunderfund Andrea N. Leep , Balmer Dorene F. , Park Yoon Soo , Kulasegaram Kulamakan , Young Meredith E. , Fung Cha-Chi , LaDonna Kori A.
Published: August 2022

Meaningful Equity, Diversity, and Inclusion (EDI) efforts may be stymied by concerns about whether proposed initiatives are performative or tokenistic. The purpose of this project was to analyze discussions by the Research in Medical Education (RIME) Program Planning committee about how best to recognize and support underrepresented in medicine (URiM) researchers in medical education to generate lessons learned that might inform local, national, and international actions to implement meaningful EDI initiatives. Ten RIME Program Planning Committee members and administrative staff participated in a focus group held virtually in August 2021. Focus group questions elicited opinions about “if and how” to establish a URiM research award. The focus group was recorded, transcribed, and thematically analyzed.

Recognition of privilege, including who has it and who doesn’t, underpinned the focus group discussion, which revolved around 2 themes: (1) tensions between optics and semantics, and (2) potential unintended consequences of trying to level the medical education playing field. The overarching storyline threaded throughout the focus group discussion was intentionality. Focus group participants sought to avoid performativity by creating an award that would be meaningful to recipients and to career gatekeepers such as department chairs and promotion and tenure committees. Ultimately, participants decided to create an award that focused on exemplary Equity, Diversity, and Inclusion (EDI) scholarship, which was eventually named the “RIME URiM Research Award.” Difficult but productive conversations about EDI initiatives are necessary to advance underrepresented in medicine (URiM) scholarship. This transparent commentary may trigger further critical conversations.
Improvisational and Standup Comedy, Graphic Medicine, and Theatre of the Oppressed to Teach Advancing Health Equity
Authors: Chin Marshall H. , Orlov Nicola M. , Callender Brian C. , Dolan James A. , Miller Doriane C. , Peek Monica E. , Rusiecki Jennifer M. , Vela Monica B.
Published: August 2022

Ninety-minute virtual workshops that used improvisational comedy, standup comedy, graphic medicine, and Theatre of the Oppressed were implemented in 2020 within a required health equity course at the University of Chicago Pritzker School of Medicine to train 90 first-year medical students in advancing health equity. Learning objectives were to (1) deepen understanding of diverse human experiences by developing relationship skills, such as empathy, active listening, engagement, and observation; (2) recognize how diverse patients perceive students and how students perceive them to gain insight into one’s identity and how intersectional systems of oppression can stigmatize and marginalize different identities; and (3) engage in free, frank, fearless, and safe conversations about structural racism, colonialism, White and other social privileges, and systemic factors that lead to health inequities. With a 61% (109/180 [90 students × 2 workshops per student]) survey response rate, 72% of respondents thought workshops were very good or excellent, and 83% agreed or strongly agreed they would recommend workshops to others. Key recommendations are to (1) incorporate experiential storytelling and discussion; (2) define clear learning goals for each workshop, map exercises to these goals, and explain their relevance to students; and (3) create a safe, courageous, brave space for exploration and discussion.

For health equity, transformation happens as students share their perspectives of curriculum content from their intersectional identities, experiences, and varied privileges; are challenged by others’ perspectives; and attempt to understand how others can experience the same content differently. The arts create a powerful form of sharing beyond routine conversations or discussions, which is critical for honest dialogue on difficult topics, such as racism, homophobia, and White privilege and other social privileges. Educators should enable students to have the space, time, and courage to share their true perspectives and engage in authentic discussions that may be uncomfortable but transformative.
Competency-Based Frameworks in Medical School Education Programs: A Thematic Analysis of the Academic Medicine Snapshots, 2020
Authors: Ryan Michael S. , Blood Angela D. , Park Yoon Soo , Farnan Jeanne M.
Published: August 2022

Purpose

Educational program objectives (EPOs) provide the foundation for a medical school’s curriculum. In recent years, the Liaison Committee on Medical Education (LCME) endorsed an outcomes-based approach to objectives, to embrace the movement toward competency-based medical education (CBME). The purpose of this study was to explore the CBME frameworks used by medical schools in formulating their EPOs. A secondary aim was to determine factors related to the selection of specific frameworks.

Method

The authors performed a quantitative content analysis of entries to the 2020 Academic Medicine Snapshot. Publicly available data gathered included demographic features of each program (e.g., year founded, accreditation status, affiliation, etc.), participation in national medical education consortia, and presence of specific CBME frameworks identified in EPOs. Descriptive statistics were used to examine trends in frameworks used by medical schools. Bivariate comparisons between factors and frameworks were conducted using chi-square tests. Logistic regression was used to examine factors predicting use of more recently developed CBME frameworks.

Results

A total of 135 institutions submitted Snapshots (RR = 88%). All institutions endorsed 1 or more CBME frameworks, with 37% endorsing 2 and 20% endorsing 3 or more. The most common was the Accreditation Council for Graduate Medical Education core competencies (63%). In addition to published frameworks, 36% of institutions developed their own competencies. Schools with pending LCME visits were 2.61 times more likely to use a more recently developed curricular framework, P = .022.

Conclusions

Medical schools in the United States have embraced the CBME movement through incorporation of competency-based frameworks in their EPOs. While it is encouraging that CBME frameworks have been integrated in medical school EPOs, the variability and use of multiple frameworks identifies the pressing need for a unified CBME framework in undergraduate medical education.
Clinician Teacher as Leader: Creating Psychological Safety in the Clinical Learning Environment for Medical Students
Authors: McClintock Adelaide Hearst , Fainstad Tyra Leigh , Jauregui Joshua
Published: August 2022

Purpose

Psychological safety is the perception that a group environment is safe for interpersonal risk taking, exposing vulnerability, and contributing perspectives without fear of negative consequences. The presence of psychological safety has been tied to wellness, retention, and inclusiveness. National data demonstrate that many of the fundamental components of psychological safety are lacking in clinical learning environments. There is evidence that leadership behaviors can create psychological safety in traditional work environments. The authors sought to understand how clinical teachers’ leadership behaviors can create, destroy, and rescue psychological safety in the clinical learning environment.

Method

This was a multicenter, cross-sectional, qualitative study of fourth-year medical students from 2 institutions using semistructured interviews. Verbatim transcripts underwent constant comparison and iterative data reduction and analysis, continuing beyond thematic sufficiency.

Results

Eighteen students participated in interviews. Participants described key themes of relationships, an emphasis on learning, clear expectations, autonomy, and frequent feedback as promoting psychological safety. Safe environments lead to a sense of belonging and agency. They reported educator disinterest in students, dismissal of questions, lack of autonomy, and unclear expectations as destructive of psychological safety. Unsafe environments lead to withdrawal and a high extraneous cognitive load. Most students were unable to describe a time psychological safety was restored if lost.

Conclusions

Clinical teachers’ leadership behaviors can directly impact students’ perception of psychological safety in the clinical learning environment. Psychological safety increases students’ sense of belonging, self-efficacy, and engagement. The findings demonstrate that while it is difficult to repair an atmosphere that is psychologically unsafe, there are several actions that can be put into motion early on to ensure the learning environment is safe and remains so. Future research should investigate whether psychologically safe environments lead to meaningful differences in assessments of student learning and effective cultural change.
Self-Assessment in Feedback Conversations: A Complicated Balance
Authors: Robb Katharine A. , Rosenbaum Marcy E. , Peters Lauren , Lenoch Susan , Lancianese Donna , Miller Jane L.
Published: August 2022

Purpose

Learner-centered feedback models encourage educators to ask learners to self-assess at the start of feedback conversations. This study examines how learners perceive and respond to self-assessment prompts during feedback conversations and assesses medical students’ perceptions of and approach to self-assessment used as the basis for these conversations.

Method

All rising second-, third-, and fourth-year medical students at a midwestern U.S. medical school were invited to participate in this study. Students participated in 1-on-1 interviews between June and August 2019 during which they were asked open-ended questions about their experiences with self-assessment and feedback during medical school. The interviews were audio recorded and transcribed, and comments related to self-assessment in feedback conversations were extracted. Thematic analysis was used to identify recurrent ideas and patterns within the transcripts, and all excerpts were reviewed and coded to ensure that the identified themes adequately captured the range of student responses.

Results

A total of 25 students participated in the study. Although some students noted improvement in their self-assessment abilities with increasing experience, no consistent gender, race, or training-level differences were found in reported attitudes or preferences. Students identified many benefits of self-assessment and generally appreciated being asked to self-assess before receiving feedback. Students had varied responses to specific self-assessment prompts, with no clear preferences for any particular self-assessment questions. Students described weighing multiple factors, such as image concerns and worries about impact on subsequent evaluations, when deciding how to respond to self-assessment prompts.

Conclusions

The process by which learners formulate and share self-assessments in feedback conversations is not straightforward. Although educators should continue to elicit self-assessments in feedback discussions, they should recognize the limitations of these self-assessments and strive to create a safe environment in which learners feel empowered to share their true impressions.
Hands-free Femoral Traction Using the Bookwalter Retractor System During Anterior Approaches to the Acetabulum
Authors: Tyler Andrew F. , Vincent Chris , Stevens Nicole M. , Payton Harris , Boyce Robert H. , Collinge Cory A. , Mitchell Phillip M.
Published: August 2022

Displaced acetabular fractures with medial and cranial displacement of the femoral head commonly require an anterior approach for reduction and stabilization. Restoration of the femoral head to its native position under the reduced acetabular dome is a primary goal of surgery. We present a surgical technique for applying traction to the proximal femur using the Bookwalter retractor system during the repair of acetabular fractures when using an anterior approach. By placing traction in line with the femoral neck, the femoral head is moved to a more anatomical position allowing acetabular fracture fragments to be reduced unimpeded and the femoral head may be used as a reconstructive template. We review a case series of 116 patients treated using this technique and report the short- and long-term radiographic and clinical results of treatment.
Functional Outcomes of Dorsal Bridge Plating for Lisfranc Injuries With Routine Implant Retention: A Major Trauma Center Experience
Authors: Onochie Elliot , Bua Nelson , Mmerem Kingsley , Heidari Nima , Vris Alexandros , Malagelada Francesc , Parker Lee , Jeyaseelan Luckshmana
Published: August 2022

Objectives:

To assess medium-term functional outcomes and the complication profile for unstable Lisfranc injuries treated with dorsal bridge plate (DBP) fixation when implants are not routinely removed.

Design:

Large single-center retrospective case series.

Setting:

Level-1 Trauma Center, London, United Kingdom.

Patients:

Consecutive cases of skeletally mature individuals with unstable Lisfranc injuries treated operatively between 2014 and 2019.

Intervention:

Open reduction and DBP fixation with implants not routinely removed.

Main Outcome Measurements:

Patient-reported outcome measures at final follow-up. The Manchester-Oxford Foot Questionnaire summary index was the primary outcome measure. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale, complications, and all-cause reoperation rates were secondary outcome measures. Logistic regression models were used to identify risk factors that influenced outcomes.

Results:

Eighty-five patients were included. Mean follow-up was 40.8 months (24–72). The mean Manchester-Oxford Foot Questionnaire Summary Index was 27.0 (SD 7.1) and mean AOFAS score 72.6 (SD 11.6). The presence of an intra-articular fracture was associated with poorer outcomes, with worse MOXFQ and AOFAS scores (both P < 0.001). Eighteen patients (21%) required implants removal, with this more likely in female patients (OR 3.89, 95% confidence interval, 1.27 to 12.0, P = 0.02). Eight patients (9%) required secondary arthrodesis.

Conclusions:

This is the largest series of Lisfranc injuries treated with DBP fixation reported to-date and the only to routinely retain implants. Medium-term outcomes are comparable to existing literature in which implants are routinely removed. The presence of an intra-articular fracture is a poor prognostic indicator. Implant removal is more likely to be needed in female patients.

Level of Evidence:

Therapeutic Level IV. See Instructions for authors for a complete description of levels of evidence.