bluuebunny/crossref_metadata_2025 huggingface dataset:
Mary Shepherd
Authors: Boyle Deborah
Published: February 2024

Addressing issues of causation raised by Hume, Lady Mary Shepherd (1777–1847) argues in her 1824 treatise that we can know causal principles through reason and that conclusions we reach through induction are secure. Her second book (1827) uses her account of causation to argue, against Berkeley, that we can know that enduring, independently existing, external objects exist. In both stages of her project, Shepherd uses mathematical analogies to illuminate her arguments. In particular, Shepherd maintains that cause and effect are not simultaneous but synchronous and that causal relationships can be expressed by equations; in her argument to establish the existence of the external world, she says that our sensations are like “algebraic signs, by which we can compute and know the proportions of their qualities” and thereby understand objects in the external world. This chapter explores Shepherd’s arguments through a close examination of these mathematical analogies.
Piercing the Body in Mesoamerica
Authors: Testard Juliette , Olivier Guilhem , Pereira Grégory , Padilla Gutiérrez Eliseo F.
Published: February 2024

In ancient Mesoamerica, body piercing was used to display individual and collective identity. Closely linked to the use of facial ornaments, the act of piercing also seems to have been related to important rites de passages and to the notions of sacrifice and self-sacrifice, essential elements in in the ritual and sociopolitical Mesoamerican ontology. Thanks to archaeological, iconographic, and historical data, it is now possible to appreciate the meanings these practices had in ancient societies. The variety of nasal ornaments, ear ornaments, and labret is explored through their materiality and the contexts in which they have been found. Representation in anthropomorphic iconography (figurines, sculptures, codex) will allow to approach the relative identity of the facial ornament wearer (gender, ethnicity, and status). Moreover, later historical sources inform piercing ion their meanings and the contexts in which they were performed. Piercing in Mesoamerica appears as a robust social and cultural marker, conveying complex alterities.
The “AI Wave” in Space Operations
Authors: Raska Michael , Davis Malcolm
Published: February 2024

This chapter reviews why and how the diffusion of AI enabled systems and technologies accelerates the development of space capabilities, which in turn shape the fighting ability of modern military forces to use autonomous systems and engage in joint and integrated operations across multiple domains. Our reliance on networks of sensors and shooters, provided by AI-enabled mega-constellations of small satellites, to rapidly assess and understand the future battlespace, and generate rapid connectivity, together with faster machine-enhanced battlespace management and command and control, lies at the heart of the emerging “AI wave” in space operations.
Using Community Archaeology to Protect Indigenous Wells and Pastoral Biocultural Heritage in Northern Kenya
Authors: M'Mbogori Freda Nkirote , Abduba Katello , Gufu Ali , Gakii Kinyua Mercy , Tiki Waktole , Lane Paul J.
Published: February 2024

This chapter outlines how community archaeology research on cultural and biocultural heritage can empower communities to engage constructively with governments, companies, academics, and nongovernmental organizations. It presents the results of recent research conducted with pastoralist communities in northern Kenya. It examines how knowledge about biocultural heritage is used, maintained, and passed down through generations, and how this mechanism has helped in sustaining culturally valuable resources for centuries. This knowledge was co-produced with various pastoralist groups inhabiting the study area and involved a combination of archaeological survey and excavation, collection of oral histories, mapping of heritage sites using handheld GPS receivers and remote sensing, and stakeholder meetings to discuss how to mobilize the knowledge produced. The data presented here are derived from this collaborative research project involving archaeologists, anthropologists, historians, pastoralist communities and community-based organizations from the study areas, with a particular emphasis on knowledge coproduction from the inception of the project to the end.
Indigenous Archaeology Revisited
Authors: Watkins Joe
Published: February 2024

This chapter focuses on the key concepts and relevance of Indigenous Archaeology. The definition of Indigenous Archaeology changed over time, before ultimately settling on the definition of archaeology with, for, and by Indigenous peoples. Some people view Indigenous Archaeology as a contribution to furthering tribal perspectives on the way the Indigenous past is represented within Archaeology and the way it might be beneficial to Indigenous Identity. The chapter then looks into the interplay of Indigenous Archaeology with repatriation and decolonization, respectively. It considers the concepts of outsider involvement in archaeology as an alternative approach while referencing community-based participatory research.
Squirrels and Tribes
Authors: Chetia Hiranmoy , Krishna Murali C. , Koprowski John L.
Published: February 2024

The chapter contributes to both archaeological and ethnozoological research by describing the knowledge system of squirrel species use and the connection between squirrel species and the cultural beliefs of the tribes. The study, carried out from December 2018 to November 2019, aimed to document the utilization of squirrel species for various purposes by the Adi, Idu Mishmi, Miju Mishmi, Tangsa, Chakma, and Monpa tribes living near villages adjacent to protected areas in the districts of East Siang, Lower Dibang Valley, Dibang Valley, Lohit, Changlang, and West Kameng of Arunachal Pradesh, India. The study found that eleven squirrel species are used by these tribes for cultural, food, and medicinal purposes. The chapter details the various tools and techniques used by the tribes to hunt squirrels and their use of certain squirrel species as part of their traditional culture, including their names in English, the vernacular, and Latin.
Historical Ecology and the Archaeology of Islands and Coastlines
Authors: Rick Torben C. , Hofman Courtney A. , Mychajliw Alexis M.
Published: February 2024

Historical ecology is the study of interactions between people, other organisms, and ecosystems in the past and how these perspectives can help understand present and future environmental conditions. Sitting at the interface of terrestrial and marine ecosystems, island and coastal regions are centers of biological diversity and have long been a focus of archaeological research. Island and coastal archaeology are deeply intertwined with historical ecology, often providing applications to conservation biology and restoration ecology. These include numerous interdisciplinary projects using diverse methodological toolkits to document long-term trends in species evaluations and reintroduction, invasions and translocations, landscape ecology and restoration, and climate change. In this time of dramatic environmental change and rapidly increasing human dominance of Earth’s ecosystems, archaeology and historical ecology are now more important than ever to bridge the gap between past ecosystem function and structure, present-day environmental challenges, collaboration with descendant and other stakeholder communities, and the persistence of biodiversity and human society in the future.
Torres Strait
Authors: McNiven Ian J.
Published: February 2024

The seascape world of Torres Strait Islanders takes in a 50,000-km2 archipelago between the mainlands of Australia and New Guinea. The Torres Plain transitioned to Torres Strait 8000–9000 years ago with rising sea levels at the end of the last Ice Age. Torres Strait Islanders’ identification as a sea people and marine subsistence specialists matches ethnographic observations of the past 150 years. Collaborative research projects between archaeologists and a wide range of island communities over the past three decades have revealed occupation back to the time of strait formation and marine resource use at least 7000 years ago. The appearance of new sites 3000–4000 years ago is associated with population increase and diversification of marine resource use, including hunting of dugongs. Further increases in sites 2000–2600 years ago coincide with the appearance of pottery and agriculture linked to the influx of people and ideas from New Guinea. The past 1000 years sees expansion of shoreline villages and ritual sites linked to the sea and emergence of the full range of ethnographically known cultural practices.
The Sailing Performance of Ancient Pacific Canoes
Authors: Irwin Geoffrey , Flay Richard G. J. , Dudley Loughlin , Johns Dilys
Published: February 2024

The islands of the Pacific Ocean were settled in a series of remarkable episodes of maritime migration. This chapter investigates the navigational and technological innovations that allowed Lapita canoes to sail east across the prevailing winds through Island Melanesia 3000 years ago and, after a “long pause” of at least 1500 years in West Polynesia, for Polynesian canoes to sail upwind into central East Polynesia. Lapita sailors invented the navigational technique of latitude sailing to transition from coastal seafarers to ocean explorers. Their canoes were dugouts raised by planks and stabilized by outriggers with fore-and-aft sails, and their seascape was a narrow latitudinal band of tropical islands. In the second episode some East Polynesian voyaging canoes had sophisticated planked hulls with improved upwind performance and they used Oceanic spritsails, and their seascape spanned latitudes from the northern tropics to the sub-Antarctic. These conclusions are based on archaeology and yacht engineering tests of relevant sails in a wind tunnel and canoe hulls in a towing tank, and simulated voyages by a virtual canoe based on the earliest-known archaeological East Polynesian voyaging canoe found at Anaweka, New Zealand, closely match the real voyages of the experimental replica canoe Hokule’a throughout Polynesia.
Archaeology and the Anthropocene in Island and Coastal Settings
Authors: Braje Todd J.
Published: February 2024

As part of a global conversation about the ongoing environmental crisis, the International Commission on Stratigraphy, part of the International Union of Geological Sciences, is considering defining a new geological epoch in Earth history—the Anthropocene. Likely to be set at some point in the last two hundred years, the Anthropocene is meant to define the transformative effects humans are now having on planetary systems and to draw attention to the dire need for global climate action. While the Anthropocene concept is exceptionally broad and has generated wide-ranging transdisciplinary debates, the author focuses this review on some of the most important issues related to archaeological studies of island and coastal environments and how the Anthropocene concept might be exceptionally important for helping build sustainable systems into the future.
Transnational Tamil Literature, Dialect, and Environment
Authors: Whittington Rebecca
Published: February 2024

This chapter aims to highlight the critical significance of socio-regional language varieties, which carry intimate knowledge of geographies, ecosystems, and environmental justice issues through habitation and livelihood, in transnational Tamil literatures with a focus on India and Sri Lanka. Dialect writing helps bridge the gaps between community-based and academic knowledges and between country- and area-based studies of texts in their historical and political contexts and broad studies of world literature, generating an approach to South Asian literary study that focuses on questions of language and environmental justice across national boundaries, yet remains rooted in local realities and imaginaries. The chapter thus offers a transnational approach that connects diverse geographical and political locations through local knowledges and practices of Adivasi/indigenous, migrant, refugee, and Dalit communities and of women, through readings of a small selection of fiction and poetry by V. Gowribalan, R. Canmukacuntaram, Bama, and Su. Tamilselvi.
Modelling the Leadership Influence Process
Authors: Hazy James K. , Mahmoodi Korosh
Published: February 2024

This chapter discusses the challenges, complexities, and benefits of using agent-based modelling in the study and practice of leadership in teams and organizations. After acknowledging these challenges, the chapter proposes a formal approach to defining leadership as an influence process for computational models and simulation purposes as well as in real-world organizations. This is intended to clarify how leadership can be specified, modelled, and operationalized more rigorously in the context of both research and practice. State-of-the-art studies in computational leadership research, including those with adaptive agents, adaptive environments, and emergent intelligence, are reviewed. These studies are organized and described along three distinct dimensions of leadership influence: aligning expectations in a collective with respect to opportunities and threats in its environment, initiating or sustaining repeatable instrumental momentum within organizations, and engendering an observable cooperating valence within a collective that reflects the presence of trust among agents at various levels of scale. The chapter closes with a proposed framework to guide future research in areas such as emergent leadership in hybrid human–machine environments and decision-making in the presence of localized deception during interactions as well as the potential to respond effectively to misinformation attacks from malicious actors on a much broader scale.
Agent-Based Manufacturing Control for Industry 4.0—Fundamentals and Open Challenges
Authors: Gehlhoff Felix , Fay Alexander
Published: February 2024

Manufacturing companies face different challenges like rising complexity of their manufacturing operations, the need to quickly develop and produce individualized products, and disruptions of traditional production systems due to changing market conditions, institutional rules, and customer preferences. Thus, there is a significant need for flexible and robust organization and control approaches to cope with these new realities. Industry 4.0 proclaims the automated and decentralized decision-making of products and resources based on digitalization, referring to the automated coordination of job allocation and execution. The decentralized coordination of products and resources also enables the local reaction to disturbances on the shop floor and within supply chains. Thus, to address the abovementioned challenges, Industry 4.0 provides a reference framework to utilize digitally enhanced technologies and recent computational developments like cyber-physical systems, the internet of things, and the smart factory to face these new challenges. Software agents, which are commonly associated with properties such as autonomy, intelligence, and sociability, provide the means to implement these new approaches. However, different aspects of the manufacturing control problem and engineering process, like interoperability, predictability, and business ethics, still need to be addressed.
Decision-Making Approaches and Foreign Policy
Authors: Houghton David Patrick
Published: February 2024

Human beings, as the psychologist Dan Ariely has noted, are ‘predictably irrational’; they use the same kind of cognitive short cuts over and over again, rather than in any sense living up to the high (and ‘reliably artificial’) standards of comprehensive rationality (Ariely 2009). Employing the latter, moreover, is atypical for human beings, since we more often utilize the fast-moving System I than we do the slow-moving System II (Kahneman 2012). Under the influence of what has become known as Behavioural Economics, that wider discipline has increasingly abandoned claims about comprehensive rationality. But we still know rather less than we should about the act of decision-making itself. Attempting to address this issue, the main section of this chapter reviews recent developments in decision-making as applied to foreign policy analysis, examining what might be called ‘the state of the art’ in that field. But gaps remain in the work so far conducted. The second part of this chapter, then looks in particular at how we might build on existing work, suggesting some ways in which we have so far failed to capitalize on research which is arguably of strong relevance to foreign policy scholars.
Foreign Policy of Middle Powers
Authors: Giacomello Giampiero , Verbeek Bertjan
Published: February 2024

Changes in the international political system have given more opportunities for states to seek a more prominent role as a middle power. The contestation of American hegemony and the fragile relations between China, India, and the United States present an external environment that invites states to reconsider their positions. Changes in the nature of power in international politics, both in hard and soft power, have made it possible for some states to seek specific forms of middle power status. This contribution argues that such states may pursue a role as an aspiring global power, a regional power, or a niche power. However, because the search for status in international politics originates from (often competing) ideas of national identity and roles and because the achievement of such status depends on its recognition by relevant other states, an understanding of the choices states make regarding the pursuit of middle power status, requires insights from the scholarship of Foreign Policy Analysis. The argument is illustrated with examples from, amongst others, Iran (regional power), Japan (aspiring global power), and the Netherlands (niche power).
Foreign Policy of Armed Non-State Actors
Authors: Darwich May
Published: February 2024

This chapter explores the foreign policy of armed non-state actors (ANSAs) as a new empirical domain for Foreign Policy Analysis (FPA). ANSAs not only challenge state authority in the international system through the use of violence, but there is substantial evidence of ANSAs maintaining foreign relations with other states and non-state actors during both war and peace times. While the study of ANSAs has grown exponentially in the last two decades, the foreign engagement of these actors has rarely been studied from a systematic perspective. This chapter repositions FPA into the study of ANSAs. It argues that adapting an FPA that focuses on decision-making processes and policy outputs can bring a novel understanding to ANSAs’ foreign engagement. Moreover, this endeavour would revitalize FPA by expanding its research agenda to questions of actorness and allow it to move beyond its state-centric confines.
LGBTI Discrimination at the Workplace
Authors: Rivas-Vallejo Pilar , Villagrasa-Alcaide Carlos
Published: February 2024

Protection against discrimination at the workplace, meaning ‘workplace’ as access to employment and in relation to working conditions, employment’s benefits and dismissal, is granted by the Employment Equality Directive within the EU for LGBTI workers. However, this protection covers only sexual orientation, while gender diversity can be identified within the scope of protection of Equality Gender, according to the interpretation of the jurisprudence of the ECJ and ECHR, and within the scope of Article 8 of the European Convention of Human Rights. Within this limited protection, a favourable interpretation can be found for the inclusion of LGTBI people under the protection of the equality directives of the European Union under the coordinated consideration of the jurisprudence of both courts. Nevertheless, the protection of other protected categories linked to gender depends on national legislations, with very different answers. Likewise, European Law does not impose an obligation to formally acknowledge same-sex unions by national Law, but it does grant the treatment that, under its domestic law, is recognized in homologous situations, as a way to reach equal treatment.
Specific Issues Relating to Sports
Authors: Ziegler Andreas R. , Bagi Raphaël
Published: February 2024

In states without explicit anti-LGBTI violence and discrimination laws, LGBTI persons might find themselves in extremely dangerous situations, potentially endangering their own lives. This is particularly true in the practice of sports, including the organization of national and international events. How do LGBTI people’s engagement in sports suffer because of discrimination? Sport coexists with an atmosphere that maintains rigid conceptions of gender and masculinity. Stereotypes are worsened by the way sports is ‘gendered’ in the first place. Football, as an example, is often seen as a male sport. Female sports, on the other hand, are supposed to include ice skating or even synchronized swimming. Whether it is the sports authorities, the leaders in one specific sport, the supporters, the other players, the coach, or the young players, everyone can be held accountable for homotransphobia on their own and at their respective level, perpetuating not only the gender stereotypes associated with sports but also deepening the problems that LGBTI people may face while participating in their sports. In addition, when organizing international sporting events, the selection of countries that do not respect human rights can be very problematic regarding the community. One can wonder if we should allow these events to be held in countries where LGBTI people are persecuted or even killed. Whose responsibility is it to ensure that these rights are respected? What are the implications of these choices for the LGBTI community?
The Evolution of Intergroup Relations
Authors: Pan Xinyue , Landry Alex , Gelfand Michele J.
Published: February 2024

Humans are social animals. Group living provides us with security, food, and culturally transmitted knowledge, which has enabled the greatest achievements of human civilization. At the same time, categorizing individuals as ‘us’ vs ‘them’ also brings intergroup prejudice, discrimination, and even violent conflict, which has led to some of the deadliest events in human history. In this chapter, the authors discuss the complexity of intergroup relations from an evolutionary perspective. The authors first discuss the adaptive functions of group living and outline the mechanisms that maintain groups. Next, the authors discuss the evolutionary basis that contributes to the emergence of intergroup boundaries, hatred, and conflict. Although the tendency for intergroup conflict is pervasive, groups can sometimes overcome their boundaries and cooperate. In the last section, the authors explore factors that may attenuate intergroup conflict and provide suggestions for improving intergroup relations in this increasingly global world.
How New Dictatorships Begin
Authors: Geddes Barbara
Published: February 2024

This chapter summarizes changes over time in how and why dictatorships arise. Before 2000, the modal dictatorship began with a coup and replaced an older dictatorship. More new dictatorships arose during the 1960s than during other decades. This surge mirrors the large increase in newly independent countries at that time. A second upswing in new dictatorships occurred in the 1990s, when the dissolution of the Soviet Union and Yugoslavia allowed more nations to gain independence. This pattern in the emergence of new dictatorships suggests that newly independent countries may be more susceptible to dictatorial conspirators and interference by foreign interests than countries with longer histories of self-governance. Fewer new dictatorships have arisen since 2000, and most now replace democracies. Military officers stage fewer coups against the governments they have sworn to defend than in the past. Democratic backsliding orchestrated by a leader who was originally elected in a fair competitive election is now the most common way of establishing dictatorship.
All members of the Arabidopsis DGAT and PDAT acyltransferase families operate during high and low temperatures
Authors: Shomo Zachery D , Mahboub Samira , Vanviratikul Hathaichanok , McCormick Mason , Tulyananda Tatpong , Roston Rebecca L , Warakanont Jaruswan
Published: February 2024

The accumulation of triacylglycerol (TAG) in vegetative tissues is necessary to adapt to changing temperatures. It has been hypothesized that TAG accumulation is required as a storage location for maladaptive membrane lipids. The TAG acyltransferase family has five members (DIACYLGLYCEROL ACYLTRANSFERSE1/2/3 and PHOSPHOLIPID:DIACYLGLYCEROL ACYLTRANSFERASE1/2), and their individual roles during temperature challenges have either been described conflictingly or not at all. Therefore, we used Arabidopsis (Arabidopsis thaliana) loss of function mutants in each acyltransferase to investigate the effects of temperature challenge on TAG accumulation, plasma membrane integrity, and temperature tolerance. All mutants were tested under one high- and two low-temperature regimens, during which we quantified lipids, assessed temperature sensitivity, and measured plasma membrane electrolyte leakage. Our findings revealed reduced effectiveness in TAG production during at least one temperature regimen for all acyltransferase mutants compared to the wild type, resolved conflicting roles of pdat1 and dgat1 by demonstrating their distinct temperature-specific actions, and uncovered that plasma membrane integrity and TAG accumulation do not always coincide, suggesting a multifaceted role of TAG beyond its conventional lipid reservoir function during temperature stress.
Thioredoxin A regulates protein synthesis to maintain carbon and nitrogen partitioning in cyanobacteria
Authors: Mallén-Ponce Manuel J , Florencio Francisco Javier , Huertas María José
Published: February 2024

Thioredoxins play an essential role in regulating enzyme activity in response to environmental changes, especially in photosynthetic organisms. They are crucial for metabolic regulation in cyanobacteria, but the key redox-regulated central processes remain to be determined. Physiological, metabolic, and transcriptomic characterization of a conditional mutant of the essential Synechocystis sp. PCC 6803 thioredoxin trxA gene (STXA2) revealed that decreased TrxA levels alter cell morphology and induce a dormant-like state. Furthermore, TrxA depletion in the STXA2 strain inhibited protein synthesis and led to changes in amino acid pools and nitrogen/carbon reserve polymers, accompanied by oxidation of the elongation factor-Tu. Transcriptomic analysis of TrxA depletion in STXA2 revealed a robust transcriptional response. Downregulated genes formed a large cluster directly related to photosynthesis, ATP synthesis, and CO2 fixation. In contrast, upregulated genes were grouped into different clusters related to respiratory electron transport, carotenoid biosynthesis, amino acid metabolism, and protein degradation, among others. These findings highlight the complex regulatory mechanisms that govern cyanobacterial metabolism, where TrxA acts as a critical regulator that orchestrates the transition from anabolic to maintenance metabolism and regulates carbon and nitrogen balance.
Constraining the Compression: Thermodynamic Depth and Composition
Authors: Beni Majid D
Published: February 2024

This paper examines Bird's account of restricted compositionality in terms of compression of information. Additionally, this paper proposes an alternative perspective (to Bird's) that links compositionality to the Free Energy Principle and the minimisation of collective entropy. Emphasising functional integration, this criterion provides a more focused and relatively more objective (patternist) account of composition.
Answering the Call of Automation: How the Labor Market Adjusted to Mechanizing Telephone Operation
Authors: Feigenbaum James , Gross Daniel P
Published: February 2024

In the early 1900s, telephone operation was among the most common jobs for American women, and telephone operators were ubiquitous. Between 1920 and 1940, AT&T undertook one of the largest automation investments in modern history, replacing operators with mechanical switching technology in over half of the U.S. telephone network. Using variation across U.S. cities in the timing of adoption, we study how this wave of automation affected the labor market for young women. Although automation eliminated most of these jobs, it did not reduce future cohorts’ overall employment: the decline in operators was counteracted by employment growth in middle-skill clerical jobs and lower-skill service jobs, including new categories of work. Using a new genealogy-based census-linking method, we show that incumbent telephone operators were most affected, and a decade later more likely to be in lower-paying occupations or no longer working.
Month of Birth and Cognitive Effort: A Laboratory Study of the Relative Age Effect among Fifth Graders
Authors: Radl Jonas , Valdés Manuel T
Published: February 2024

All around the world, school-entry cohorts are organized on an annual calendar so that the age of students in the same cohort differs by up to one year. It is a well-established finding that this age gap entails a consequential (dis)advantage for academic performance referred to as the relative age effect (RAE). This study contributes to a recent strand of research that has turned to investigate the RAE on non-academic outcomes such as personality traits. An experimental setup is used to estimate the causal effect of monthly age on cognitive effort in a sample of 798 fifth-grade students enrolled in the Spanish educational system, characterized by strict enrolment rules. Participants performed three different real-effort tasks under three different incentive conditions: no rewards; material rewards; and material and status rewards. We observe that older students outwork their youngest peers by two-fifths of a standard deviation, but only when material rewards for performance are in place. Despite the previously reported higher taste for competition among the older students within a school-entry cohort, we do not find that the RAE on cognitive effort increases after inducing competition for peer recognition. Finally, the study also provides suggestive evidence of a larger RAE among boys and students from lower social strata. Implications for sociological research on educational inequality are discussed. To conclude, we outline policy recommendations such as implementing evaluation tools that nudge teachers toward being mindful of relative age differences.
Miocene caddisflies from Australia: iron-rich sediments preserve internal organs, tracheoles, and corneal nanocoating of larvae and pupae
Authors: Frese Michael , McCurry Matthew R , Wells Alice
Published: February 2024

Trichoptera (caddisflies) are insects with terrestrial adults and aquatic larvae. Although caddisflies spend most of their lives as larvae and pupate in the water, fossils of these stages are rarely found. However, ~100 pupae and uncased larvae were discovered at McGraths Flat, an Australian Miocene Lagerstätte. Many of the fossils are extremely well preserved. In addition to external features that include a spinneret among the mouthparts and claws on the abdominal prolegs, some larvae show silk glands, parts of the gastrointestinal tract, and tracheoles. The pupae are all at the pharate stage; in some, large compound eyes can be seen, and some exhibit male genitalia. Scanning electron microscopy revealed ommatidial structures, such as rhabdoms, corneas, and most remarkably the corneal nanocoating. Two caddisfly morphotypes are preserved at McGraths Flat. The larger morphotype belongs to the suborder Annulipalpia and can be assigned, most probably, to the family Dipseudopsidae. The smaller morphotype closely resembles extant members of the family Hydroptilidae (suborder Spicipalpia). No adult caddisflies or individual wings, no immature pupae, and no larval or pupal cases have been found in the deposit. This unusual fossil record suggests an unstable palaeoenvironment characterized by abrupt change.
Preparing your patient to travel the globe
Authors: Flewelling Ty W.K.
Published: February 2024

Many patients who travel internationally seek medical travel advice from their primary care provider, who may feel unprepared to provide this advice. This article describes online travel medicine resources and a structured approach to a basic pretravel assessment, office evaluation, and destination-specific consultation on travel health and safety.
Association of Sickle Cell Disease With Racial Disparities and Severe Maternal Morbidities in Black Individuals
Authors: Boghossian Nansi S. , Greenberg Lucy T. , Saade George R. , Rogowski Jeannette , Phibbs Ciaran S. , Passarella Molly , Buzas Jeffrey S. , Lorch Scott A.
Published: February 2024

(Abstracted from JAMA Pediatr 2023;177:808–817)

It has been shown that Black individuals bear a disproportionate burden of severe maternal morbidity (SMM). Some of this can be attributed to the more common presence of risk factors in this population, such as preeclampsia, chronic hypertension, and preexisting diabetes.
Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy in Patients With Advanced Ovarian Cancer (OVHIPEC-1): Final Survival Analysis of a Randomised, Controlled, Phase 3 Trial
Authors: Aronson S. Lot , Lopez-Yurda Marta , Koole Simone N. , Schagen van Leeuwen Jules H. , Schreuder Hendrik W.R. , Hermans Ralph H.M. , de Hingh Ignace H.J.T. , van Gent Mignon D.J.M. , Arts Henriëtte J.G. , van Ham Maaike A.P.C. , van Dam Peter A. , Vuylsteke Peter , Aalbers Arend G.J. , Verwaal Victor J. , Van de Vijver Koen K. , Aaronson Neil K. , Sonke Gabe S. , van Driel Willemien J.
Published: February 2024

(Abstracted from Lancet Oncol 2023;24:P1109–P1118)

Although the 5-year survival of patients with advanced ovarian cancer has improved, overall survival at 10 years remains approximately 13%. Hyperthermic intraperitoneal chemotherapy (HIPEC) involves the delivery of chemotherapeutic agents directly into the peritoneum in combination with hyperthermia, which enhances penetration and increases sensitivity to platinum compounds by inducing a transient state of homologous recombination deficiency.
Effectiveness and Safety of REBACIN as a Non-invasive Intervention for Persistent High-Risk Human Papillomavirus Infection: A Real-World Prospective Multicenter Cohort Study
Authors: Chen Fei , Zhang Guo-Nan , Lei Wei , Zhou Shu-Guang , Zhang Ying , Liu Lin , Jia Ying , Xie Rong-Kai , Tian Xiu-Fang , Guo Jie , Yang Yue-Bo , Wang Xue-Feng , Wu Xiao-Mei , Sun Qi-Jian , Zhou Xu , Lin Yang , Zhang You-Zhong , Ma Jun-Qi , Liu Yu-Xiu , Cheng Yi-Fan , Chen Jian-Cui , Qu Quan-Xin , Du Dong-Mei , Wang Gui-Yu , Wang Sheng , Ling Yu-Li , Wu Dai-Fei , Zhang Chun-Fa , Lang Jing-He
Published: February 2024

(Abstracted from Gynecol Oncol 2023;178:8–13)

High-risk human papillomavirus (hrHPV) infection is an essential factor in the development of cervical cancer, making timely treatment of this infection important. The number of individuals with persistent hrHPV in the gynecological outpatient setting remains high, and no effective hrHPV drug has been brought to market.
Treating Mild Chronic Hypertension During Pregnancy
Authors: Doshi Uma , Chaiken Sarina , Hersh Alyssa , Gibbins Karen J. , Caughey Aaron B.
Published: February 2024

OBJECTIVE:

To assess the cost effectiveness of targeting a blood pressure of less than 140/90 mm Hg compared with 160/105 mm Hg.

METHODS:

A decision-analytic model was constructed to compare the treatment of chronic hypertension in pregnancy at mild-range blood pressures (140/90 mm Hg) with the treatment of chronic hypertension before 20 weeks of gestation at severe-range blood pressures (160/105 mm Hg) in a theoretical cohort of 180,000 patients with mild chronic hypertension. Probabilities, costs, and utilities were derived from literature and varied in sensitivity analyses. Primary outcomes included incremental cost per quality-adjusted life-year (QALY), cases of preeclampsia, preeclampsia with severe features, severe maternal morbidity (SMM), preterm birth, maternal death, neonatal death, and neurodevelopmental delay. The cost-effectiveness threshold was $100,000 per QALY.

RESULTS:

Treating chronic hypertension in a population of 180,000 pregnant persons at mild-range blood pressures, compared with severe-range blood pressures, resulted in 14,177 fewer cases of preeclampsia (43,953 vs 58,130), 11,835 of which were cases of preeclampsia with severe features (40,530 vs 52,365). This led to 817 fewer cases of SMM (4,375 vs 5,192), and 18 fewer cases of maternal death (102 vs 120). Treating at a lower threshold also resulted in 8,078 fewer cases of preterm birth (22,000 vs 30,078), which led to 26 fewer neonatal deaths (276 vs 302) and 157 fewer cases of neurodevelopmental delay (661 vs 818). Overall, treating chronic hypertension at a lower threshold was a dominant strategy that resulted in decreased costs of $600 million and increased effectiveness of 12,852 QALYs.

CONCLUSION:

Treating chronic hypertension at a threshold of mild-range blood pressures is a dominant (lower costs, better outcomes) and cost-effective strategy that results in fewer neonatal and maternal deaths compared with the standard treatment of treating at severe range blood pressures.
Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial
Authors: Hasselgren Kristina , Henriksson Martin , Røsok Bård I. , Larsen Peter N. , Sparrelid Ernesto , Lindell Gert , Schultz Nicolai A. , Bjørnbeth Bjorn A. , Isaksson Bengt , Rizell Magnus , Larsson Anna Lindhoff , Sandström Per , Björnsson Bergthor
Published: February 2024

Objective:

This is a preplanned, health economic evaluation from the LIGRO trial. One hundred patients with colorectal liver metastases (CRLM) and standardized future liver remnant <30% were randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or two-staged hepatectomy (TSH).

Summary Background Data:

TSH, is an established method in advanced CRLM. ALPPS has emerged providing improved resection rate and survival. The health care costs and health outcomes, combining health-related quality of life (HRQoL) and survival into quality-adjusted life years (QALYs), of ALPPS and TSH have not previously been evaluated and compared.

Methods:

Costs and QALYs were compared from treatment start up to 2 years. Costs are estimated from resource use, including all surgical interventions, length of stay after interventions, diagnostic procedures and chemotherapy, and applying Swedish unit costs. QALYs were estimated by combining survival and HRQoL data, the latter being assessed with EQ-5D 3L. Estimated costs and QALYs for each treatment strategy were combined into an incremental cost-effectiveness ratio (ICER). Nonparametric bootstrapping was used to assess the joint distribution of incremental costs and QALYs.

Results:

The mean cost difference between ALPPS and TSH was 12,662€, [95% confidence interval (CI): −10,728–36,051; P = 0.283]. Corresponding mean difference in life years and QALYs was 0.1296 (95% CI: −0.12–0.38; P = 0.314) and 0.1285 (95% CI: −0.11–0.36; P = 0.28), respectively. The ICER was 93,186 and 92,414 for QALYs and life years as outcomes, respectively.

Conclusions:

Based on the 2-year data, the cost-effectiveness of ALPPS is uncertain. Further research, exploring cost and health outcomes beyond 2 years is needed.
A Day in the Life of a Surgical Instrument: The Cycle of Sterilization
Authors: George Robert E. , Bay Caroline C. , Shaffrey Ellen C. , Wirth Peter J. , Rao Venkat K.
Published: February 2024

Surgeons must be confident that the instruments they use do not pose risk of infection to patients due to bioburden or contamination. Despite this importance, surgeons are not necessarily aware of the steps required to ensure that an instrument has been properly sterilized, processed, and prepared for the next operation. At the end of an operation, instruments must be transported to the sterile processing unit. There, instruments are decontaminated before being sterilized by heat, chemical, or radiation-based methods. Following this, they are stored before being brought back into use. This review highlights the intricacies of the processing of surgical instruments at the conclusion of an operation so that they are ready for the next one.
Diversity Management: Practical Application in a Healthcare Organization
Authors: Gardenswartz Lee , Rowe Anita
Published: February 2024

If you are not confused, you don't know what's going on.

—Jack Welch

In commenting on the business environment today (1994), Jack Welch could have been talking about healthcare organizations experiencing the double-barreled assault on two sweeping changes simultaneously. Not only are hospitals preparing for yet-to-be-determined changes in national healthcare delivery systems but they are doing so in the midst of shifting demographics in both the population and employee base. While many make the case for managing diversity, we would like to go one step further in offering a framework for developing an organization's ability to build an inclusive environment that gets the best from its staff and provides the best service to its customers.
Taking New Approaches to Coaching and Care Can Lift Nursing Numbers
Authors: Kelly Kecia M.
Published: February 2024

Nurses are the backbone of healthcare. Their retention and recruitment are essential to the success and sustainability of healthcare providers. For many years, Portland, Oregon-based Legacy Health enjoyed the luxury of a registered nurse (RN) turnover rate consistently as low as 7.6 percent and a vacancy rate of 2.49 percent. Suddenly, COVID-19 and a confounding exodus of nurses from the profession overran this excellent track record. Today, Legacy Health is rebuilding its RN workforce and staff resilience through new initiatives. Even with a dwindling RN talent pool and vacancy rates rapidly growing into the double digits, the leadership is closing the gap. For example, a coach model for precepting new graduate nurses has allowed the RN residency program to grow by more than 300 percent. Programs such as Schwartz Rounds, Code Lavender, and an inpatient throughput initiative are also improving RN wellness, reducing stress, and increasing retention.
Overcoming Barriers to Collaborative Team Practice: A System Approach
Authors: Sanford Kathleen D.
Published: February 2024

All healthcare systems are challenged to provide sufficient access to appropriate care for the individuals and communities they serve. Among the commonly discussed interventions in an era of clinical shortages is the establishment of team-based care, where team members can practice at the top of their license. This solution ensures that talent and ability are amplified. However, this vision has been thwarted by several barriers. Recognizing that complex causes prevent team-based care, CommonSpirit Health leadership has embarked on a multifaceted implementation of tactics to mitigate the barriers. The strategy addresses issues ranging from regulations, laws, and payment practices to a lack of knowledge and understanding between professions. A combination of solutions, rather than discrete tactics, holds the key to the system's strategy. The complement of actions put in place at CommonSpirit Health has included new executive roles, dyad leadership models, shared multidisciplinary education, targeted advocacy, best practice playbooks, and the flexibility to individualize local models as part of the journey to a more effective and efficient model of care.
Unresponsiveness of Activated Partial Thromboplastin Time to Bivalirudin in Adults Receiving Extracorporeal Membrane Oxygenation
Authors: Jatis Andrew J. , Nei Scott D. , Seelhammer Troy G. , Mara Kristin C. , Wieruszewski Patrick M.
Published: February 2024

Activated partial thromboplastin time (aPTT) is the standard for monitoring bivalirudin but demonstrates a nonlinear response at higher drug concentrations. The objective of this study was to assess the relationship between bivalirudin dose and aPTT in patients receiving extracorporeal membrane oxygenation (ECMO) to determine a threshold where aPTT unresponsiveness occurs. Two hundred fourteen adults receiving bivalirudin during ECMO between 2018 and 2022 were included. Piecewise regression in a linear mixed effects model was used to determine a bivalirudin dose threshold of 0.21 mg/kg/hr for aPTT unresponsiveness. For doses of less than 0.21 mg/kg/hr (n = 135), every 0.1 mg/kg/hr dose increase led to an aPTT increase of 11.53 (95% confidence interval [CI] = 9.85–13.20) seconds compared to only a 3.81 (95% CI = 1.55–6.06) seconds increase when dose was greater than or equal to 0.21 mg/kg/hr (n = 79) (p
interaction < 0.001). In multivariable logistic regression, venovenous configuration (odds ratio [OR] = 2.83, 95% CI = 1.38–5.77) and higher fibrinogen concentration (OR = 1.22, 95% CI = 1.05–1.42) were associated with greater odds of unresponsiveness, whereas older age (OR = 0.79, 95% CI = 0.63–0.98), kidney dysfunction (OR = 0.48, 95% CI = 0.25–0.92), and a higher baseline aPTT (OR = 0.89, 95% CI = 0.82–0.97) were associated with lower odds. Alternative methods are necessary to ascertain bivalirudin’s hemostatic impact when doses exceed 0.21 mg/kg/hr during ECMO.
Primary and Specialty Care Trainees’ Perceptions About Proton Pump Inhibitor Use
Authors: Al Khoury Alex , Taheri Tanjani Maryam , Hari Bretton , Almadi Majid A. , Martel Myriam , Barkun Alan N.
Published: February 2024

Objective:

Proton pump inhibitors (PPIs) are widely prescribed with proven efficacy in many indications, yet longstanding controversy about potential adverse events persists. We aimed to acquire knowledge about perceptions of outpatient PPI long-term prescribing (≥8 wk) among primary and specialty care trainees at 2 Canadian Universities.

Methods:

Family medicine, internal medicine, and gastroenterology trainees completed a web-based survey that included 20 clinical scenarios assessing trainee knowledge about PPI efficacy. Contextual PPI prescribing decisions were also elicited, balancing possible PPI indications versus side effects. Management strategies were compared between junior and senior trainees, as well as across training programs.

Results:

Over a 4-month period,163 trainees (age <26 y: 12%; age 26 to 45: 88%; 59% females) participated in the survey (family medicine: 51%, internal medicine: 44%, and gastroenterology: 5%); 83% were considered junior residents. Only 42% had received formal education on prescribing PPI long-term. Overall, 93% believed they would benefit from such teaching, with 98% stating they would follow related guidelines. No between-group differences were noted in knowledge of appropriate PPI indications nor possible side effects when comparing juniors to seniors, or among different specialties. Across different management scenarios, inappropriate PPI discontinuation was chosen by 14.3% to 67.2%, whereas inappropriate PPI continuation was reported in up to 57%. Trainee seniority and specialty did not differ in appropriate deprescribing rates.

Conclusions:

Training level and primary versus specialty care settings are associated with frequent inappropriate PPI prescribing and deprescribing. These findings highlight the need for and may inform future educational programs on PPI usage.
A Review of IgG4-related Sclerosing Cholangitis (IgG4-SC)
Authors: Khoury Neil C. , Birk John W.
Published: February 2024

IgG4-related sclerosing cholangitis (IgG4-SC) is a unique, steroid-responsive, fibroinflammatory condition that is more commonly found in older men and is strongly associated with autoimmune pancreatitis (AIP). It may pose a diagnostic challenge at times due to closely mimicking hepatobiliary diseases such as primary sclerosing cholangitis (PSC), secondary sclerosing cholangitis (SSC), and cholangiocarcinoma. IgG4-SC has an excellent prognosis when promptly diagnosed and treated with steroids. Literature search strategy: The authors searched PubMed and Google Scholar, for articles with the search terms “autoimmune cholangiopathy” and “IgG4 cholangiopathy.”