bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomy and physiology
Authors: Grotelüschen Rainer , Ghadban Tarik , Bachmann Kai , Izbicki Jakob R.
Published: May 2023

The oesophagus and stomach form the upper part of the gastrointestinal tract. In addition to the mechanical preparation of food, chemical digestion begins here. As a relatively strong muscular tube, the oesophagus essentially transports food by peristaltic waves. Anatomically, the pars cervicalis (cervical oesophagus) is distinguished from the pars thoracica (thoracic oesophagus) and the pars abdominalis (abdominal oesophagus). Three physiological constrictions are defined: the constrictio cricoidea, the constrictio partis thoracicae, and the constrictio diaphragmatica. In addition, the oesophagus has an upper and lower sphincter, which prevent reflux. Blood is supplied via the inferior thyroid artery, bronchial arteries, and branches of the aorta and in the abdominal part via the left gastric and inferior phrenic artery. The accompanying lymph nodes are found deeply cervical, mediastinal, coeliacal, and in the area of the left gastric artery. In the transition area to the stomach, the stratified squamous epithelium of the oesophagus changes to the simple column epithelium of the stomach, recognizable macroscopically as a z-line. The stomach is divided into the pars cardiaca, the fundus, the corpus gastricus, and the pars pylorica. The pyloric sphincter controls gastric emptying. The blood supply is via branches of the coeliac trunk, along which the regional lymph nodes also run. Digestion, which has already started orally, continues in the stomach. The digestive hormones pepsinogen, gastrin, cholecystokinin, and intrinsic factor are secreted by different cells of the stomach and partly digest proteins and fats in an acidic environment. In addition, the absorption of liquid, some vitamins, and many substances is already taking place here.
Upper gastrointestinal bleeding
Authors: Nabi Zaheer , Reddy D. Nageshwar
Published: May 2023

Upper gastrointestinal (GI) bleeding is defined as bleeding originating from the part of the GI tract proximal to the ligament of Treitz. Among the various causes of upper GI bleeding, bleeding from peptic ulcer disease is the most common and responsible for 30–40% of all cases. Other common causes of upper GI bleeding include oesophageal varices, gastritis, and oesophagitis. The management of upper GI bleeding has improved substantially with widespread utilization of endoscopy and the availability of potent acid-suppressive medications. Consequently, recent trends show a decline in the incidence of hospitalization and mortality due to non-variceal upper GI bleeding. Haemodynamic resuscitation precedes endoscopy and other therapeutic options irrespective of the aetiology of upper GI bleeding. Pre-endoscopic risk stratification allows for the selective need of hospitalization and inpatient management in cases with non-variceal upper GI bleeding. This strategy improves the utilization of healthcare resources and directs them preferentially to sicker patients. With endoscopic risk stratification, the requirement of endoscopic haemostasis can be ascertained effectively. Endoscopic haemostasis is effective in 80–90% of cases with bleeding due to variceal or non-variceal causes. Strategies to prevent re-bleeding are important to reduce future recurrences. Proton pump inhibitors and anti-Helicobacter pylori regimens are efficacious in preventing re-bleeding in cases with peptic ulcer bleeds. Non-selective beta blockers and several sessions of endoscopic variceal ligation effectively prevent bleeding from oesophageal varices. With the currently available pharmacotherapy and endoscopic haemostatic modalities, the requirement of surgery has declined in both variceal and non-variceal upper GI bleeding. The increasing utilization of interventional radiology has further reduced the need for surgery in cases with refractory upper GI bleeding.
Obesity
Authors: Shah Rishabh , Montorfano Lisandro , Lo Menzo Emanuele , Szomstein Samuel , Rosenthal Raul J.
Published: May 2023

Obesity has reached epidemic proportions across the globe, especially in the last 40 years. As a result, the medical and economic consequences of such a surge have increased exponentially. While multiple pharmaceutical options continue to be developed to induce weight loss, surgery continues to provide the most effective and most durable results. Consequently, the number of bariatric operations performed worldwide has been increasing rapidly. While the Roux-en-Y gastric bypass, first described in the 1960s, remains the gold standard, several new procedures have been described. This chapter discusses the most common medical and surgical options and bariatric complications.
Oesophageal cancer
Authors: Tang Andrew , Rice Thomas , Ahmad Usman
Published: May 2023

Internationally, squamous cell carcinoma of the upper third of the oesophagus, secondary to smoking and alcohol, is the most prevalent form of oesophageal cancer. However, in Western countries where obesity, gastro-oesophageal reflux, and Barrett’s oesophagus are more prevalent, adenocarcinoma is the more common form of oesophageal cancer. Dysphagia is the most common presenting symptom and is typically related to the degree of tumour growth. Oesophageal cancers are diagnosed with oesophagogastroduodenoscopy and staged with endoscopic ultrasound and computed tomography. The latest iteration of oesophageal cancer staging was designed to reflect the changes in tumour characteristics and behaviour over the course of time and treatments. As perioperative care continues to improve and treatment options continue to expand, this will allow for finer tuning of staging. Future iterations of cancer staging will likely incorporate tumour-specific biomarkers that will help provide patient-specific prognoses.
Oesophageal cancer
Authors: Eyck Ben M. , van der Wilk Berend J. , van der Sangen Maurice J.C. , van der Gaast Ate , van Lanschot J. Jan B.
Published: May 2023

Surgery has been the cornerstone of curative treatment for patients with locally advanced oesophageal cancer. Over the last decades, the addition of chemotherapy and radiotherapy to surgery has been extensively tested to improve survival outcomes. Several studies have shown that there is no clear benefit from adding neoadjuvant radiotherapy, adjuvant radiotherapy, or adjuvant chemotherapy without any preoperative chemotherapy to surgery. It has been shown that neoadjuvant or perioperative chemotherapy as well as neoadjuvant chemoradiotherapy improve survival outcomes when given in addition to surgery. For squamous cell carcinoma, neoadjuvant chemoradiotherapy followed by surgery has been widely adopted as the treatment standard. For adenocarcinoma, both perioperative chemotherapy and neoadjuvant chemoradiotherapy have shown to be effective and no clear advantage of one over the other has yet been reported. Patients for whom surgery is contraindicated can be treated curatively with definitive chemoradiotherapy. More recently, promising results have been reported for the use of targeted therapies to treat oesophageal cancer. In many countries, adjuvant nivolumab has been approved for treating patients with pathologically residual disease after neoadjuvant chemoradiotherapy and surgery. In future, organ preservation after a clinically complete response to neoadjuvant treatment could also become a new treatment option.
Oesophageal cancer
Authors: Rösch Thomas
Published: May 2023

Oesophageal cancer in its two forms—squamous cell carcinoma as well as Barrett-related distal oesophageal adenocarcinoma—are two major challenges for upper gastrointestinal endoscopists worldwide with respect to diagnosis. There are no systematic screening programmes for both diseases in most parts of the world, so diagnosis relies on recognition of subtle lesions during endoscopy for other reasons, as well as during surveillance of Barrett’s oesophagus when diagnosed. Early and superficial lesions can be treated by means of endoscopic resection, namely endoscopic mucosal resection and endoscopic submucosal dissection. The eradication of the remaining risk mucosa in Barrett’s oesophagus adds an additional workload to the endoscopist. Long-term results of endotherapy under certain histological conditions are excellent and comparable to surgery, while the complication rate is substantially lower.
Advanced Practice Palliative Nursing 2nd Edition
Authors: Dahlin Constance , Coyne Patrick
Published: May 2023

This is the seminal textbook for advanced practice palliative nurses. This edition has been completely reorganized to meet the needs of the APRN according to role delineation and practice issues. Current issues of health equity, managing through crisis, and meeting the needs of diverse populations have been brought to the forefront. There is foundational information on leadership and practice. The various roles of the APRN—administrator, educator, policy advocate, and researcher—are delineated to assist the APRN in influencing those spheres of practice. The roles of APRNs across settings are described, including the acute care settings (clinical care unit, intensive care unit, and emergency department), the clinic (specialty care, primary care, and palliative care), the community, rehabilitation, residential facilities, and telehealth. Pediatric care has its own section where the APRN role is described in caring for patients across the acute care setting, the clinic, and the community, including perinatal and neonatal care and the communication skills unique to caring for children. Attention to special populations includes chapters on health disparities, economically disadvantaged urban dwellers, the LCBTQ+ community, veterans, and cancer survivors. The essential skill of communication is covered for adults and children, as is advance care planning, family meetings, and communication at end of life. A section on the psychosocial, cultural, and spiritual aspects of care is included. There is a significant section devoted to physical and psychological symptoms. Finally, a section on ethics includes navigation of ethics, palliative sedation, and discontinuation of cardiac, respiratory, and other life sustaining therapies.
The Palliative and Hospice APRN in Hospice and Home Health Programs
Authors: Hooper Rikki N. , Price Chari , Rouse Jamie Lee
Published: May 2023

Advanced practice registered nurses (APRNs) have a unique skill set ideally suited to working with people who are chronically seriously ill or at the end of life, being cared for either through a hospice or home health program. Using the nursing process, APRNs address the complex issues of seriously ill people by synthesizing complex data to develop and implement advanced person-centered care plans. This includes employing a well-organized, consistent approach that is both comprehensive and proactive in providing symptom management and addressing other issues. APRNs combine palliative nursing’s focus on the whole person and their advanced education to perform comprehensive physical evaluations, order and interpret diagnostic tests, and prescribe medications, depending on the state-specific APRN certifying regulations. Acting as a case manager, the palliative APRN involves the interdisciplinary team in both hospice and home health settings to provide a holistic approach to the care of patients with complex needs due to their disease process and resultant problems.
The Palliative APRN in the Rural Community
Authors: Sickich Traci
Published: May 2023

Rural populations have their own unique healthcare challenges which can be amplified at end of life. The palliative advanced practice registered nurse (APRN) serves as a key community asset to assist with the complexity of providing care to those with serious illness in a rural community. Navigating challenges with healthcare access, healthcare provider shortages, and lack of overall available resources for patients and the APRN creates a dynamic environment to deliver competent care and requires an expert generalist approach to palliative care. Rural culture is rooted in concepts of resiliency, independence, and the use of informal networks of care. The landscape of providing quality, competent, end-of-life care for the rural population mirrors the complexity of healthcare needs of rural patients with serious illness.
The Pediatric Palliative APRN in Perinatal and Neonatal Palliative Care
Authors: Root Maggie C. , Fossa Mallory
Published: May 2023

Perinatal and neonatal palliative care address the needs of families and infants facing serious illness. Perinatal palliative care involves assessing and addressing the needs of the birthing woman, their support circle, and their family as they consider decisions regarding the care of their fetus before, during, and immediately after birth. Neonatal palliative care meets the family where they are, physically and metaphorically, in the neonatal intensive care unit. In both areas, the palliative care advanced practice registered nurse serves to elicit understanding of illness, support decision-making and advance care planning, communicate with other providers regarding the goals of care, and provide expert symptom management. This role can extend for months or years, through bereavement or survivorship.
The Pediatric Palliative APRN in Oncology
Authors: Haskamp Amy Corey , Greene Joanne M.
Published: May 2023

Pediatric hematology-oncology can be challenging for the palliative care advanced practice registered nurse (APRN). The palliative APRN must appreciate that children with a cancer or blood disease often suffer from a multitude of symptoms which threaten the intactness and quality of life of the child and family. Early integration of palliative care may mitigate suffering and fosters improved coping throughout the trajectory of the underlying disease. Specifically, the initiation of therapies with curative intent concurrently with those that ease suffering can promote quality of life and well-being. Due to the complexity of symptom management, essential crucial conversations, and the therapies’ impact on quality of life, the presence of a palliative APRN for these patients is vital.
Communication at the End of Life
Authors: McHugh Marlene E. , Buschman Penelope R. , Delisle Susan M.
Published: May 2023

Effective and compassionate communication is vital in palliative care, especially at the end of life. Using a family systems perspective, this chapter explores communication as the therapeutic thread woven through the fabric of a family’s grief over the trajectory of the patient’s illness and beyond the patient’s death. It discusses communication with families in person and by telephone when death is unexpected. It reviews significant barriers to end-of-life communication with vulnerable populations, such as those with sensory motor and cognitive deficits, severe and persistent mental illness, and developmental disabilities. It highlights communication challenges posed by COVID-19. It notes the importance of communication among advanced practice registered nurses to enhance their self-awareness and their ability to respond to patients at the end of life.
Life Review
Authors: Davis Jamil , Jenko Mimi , Pace James C.
Published: May 2023

Life review is a therapeutic process that allows patients and families to recast the past in the context of the present. The process may involve one or more sessions. The ultimate goals of life review are to restore a lost sense of harmony by resolving unsettled conflicts, celebrating epochal memories, reframing disconcerting experiences, and reaching new levels of positive consensus with self, others, and one’s higher power. The end result is new-found meaning in life, especially at the end-of-life. The palliative advanced practice registered nurse (APRN) works closely within the context of a team; when issues arise beyond the APRN’s scope of practice or areas of specialty or comfort then, consultation is then requested (e.g., chaplains, mental health providers, counselors).
Grief and Bereavement
Authors: Adelstein Katharine , Archer-Nanda Elizabeth
Published: May 2023

Patients, family caregivers, and palliative care advanced practice registered nurses themselves will experience grief and bereavement throughout a palliative care encounter. Palliative care nurses will encounter a myriad of grief-related experiences, including loss of independence and functioning, role strain or changes, disruption in relationships, and the death of an individual. To expertly manage grief and bereavement, the advanced practice nurse should understand common terms including loss, grief, and bereavement; be able to identify normal grief from complicated bereavement; know when to refer patients for psychiatric services; and employ strategies for self-care. This chapter provides a review of grief theories, essential assessment components, and strategies for supportive counseling and mental health referrals.
Discontinuation of Respiratory Therapies
Authors: Winn Brenna
Published: May 2023

Many patients with respiratory failure have benefited from recent advances in medical and respiratory technology. However, there are many patients in whom continued aggressive medical care fails, and palliative advanced practice registered nurses (APRNs) are faced with having conversations regarding discontinuing or withdrawing respiratory technology. Examples of respiratory technology include mechanical ventilation, noninvasive positive-pressure ventilation (NPPV), continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), extracorporeal membrane oxygenation (ECMO), and high-flow nasal oxygen (AIRVO). The palliative APRN must have a clear understanding of all treatment modalities, the complexity of respiratory failure, and the process of respiratory support discontinuation to facilitate the best possible end-of-life situation for the patient.
Medical Assessment of the Psychiatric Patient
Authors: Thomas Seth
Published: May 2023

In the United States, emergency physicians medically assess millions of patients annually with psychiatric complaints before they are transferred to psychiatric facilities. The goal of the medical assessment is to identify and stabilize unstable medical conditions and medical mimics of psychiatric disease. Despite adequate evidence that the vast majority of significant medical conditions can be identified during the history and physical exam alone, clinicians are routinely required to order comprehensive laboratory testing prior to transferring patients to psychiatric facilities. This chapter analyzes the history and available evidence surrounding the practice previously referred to as “medical clearance,” and it makes recommendations for the emergency physician and psychiatrist to use in their daily practice.
Assessing for Suicidality and Overall Risk of Violence
Authors: Schabbing Megan B.
Published: May 2023

Suicide was the 10th leading cause of death in the United States in 2018. Regardless of chief complaint, 10% of people who present to the emergency department have been found to have suicidal thoughts or behaviors. Since 1999, suicide rates in the United States have increased by 35%, and more than 50% of people who die by suicide did not have a known mental health condition. Because the majority of people who die by suicide had contact with a primary care provider in the year prior to completing suicide, screening for suicide in primary care settings, including the emergency department, is essential to suicide prevention efforts. Once a patient is identified as being at risk for suicide, a thorough suicide risk assessment must be done in order to determine how to best modify the patient’s risk factors for suicide and minimize the likelihood of future suicide attempts. Although no single validated tool exists for the determination of suicide risk assessment, an optimal suicide risk assessment should entail thorough consideration of a patient’s risk factors and protective factors for suicide, as well as an exploration of the patient’s suicidal thoughts, intent, plan, and suicidal behaviors. An individualized treatment plan should be developed for each at-risk patient, with safety planning, timely follow-up, and lethal means restriction.
Cultural Competence in Emergency Psychiatry
Authors: Aggarwal Arpit , Popoola Oluwole
Published: May 2023

The evaluation and management of culturally diverse patients in the emergency setting require unique approaches and expertise while working under time constraints. Psychiatric evaluation and treatment are greatly influenced by the culture of both patient and clinician. Patients have perspectives about their illness, its origin and plausible remedy that often differ from the clinician’s perspective. Ethnocultural variations in medication metabolism also affect treatment outcomes across cultures. The culturally competent emergency clinician will employ knowledge of these factors to maximize patient outcomes. Given psychiatric emergency services’ unique set of cultural challenges, it is imperative for the psychiatric emergency clinician to be culturally competent to become fully clinically competent.
Deception in the Emergency Setting
Authors: Barnett Laura W. , Ryan Eileen P.
Published: May 2023

Deception in medicine involves the faking, feigning, exaggeration, or actual production of signs and symptoms of a mental or physical disorder and may take the form of either malingering or factitious disorder, both of which are reviewed in this chapter. Malingering is the falsification or extreme exaggeration of illness (physical or mental) to gain external benefits. Those benefits may include avoiding work or responsibility, obtaining drugs, avoiding legal sanctions or trial, seeking attention, avoiding military service, or obtaining leave from school or paid leave from a job. Factitious disorder is also a form of deception and is characterized by falsification of physical and/or psychological signs or symptoms or induction of injury without any obvious external reward. Deception on the part of patients presenting to a psychiatric emergency service can be challenging to identify and perhaps even more unnerving to diagnose. This chapter reviews the scant research base on malingering in the psychiatric emergency setting. The focus is on assisting the clinician in detection and management of deception in this setting, including pitfalls in diagnosis, clues to the presence of deception, discharge management, and documentation.
Eating Disorders
Authors: Drom Claire
Published: May 2023

This chapter reviews the general epidemiology and diagnostic features of the eating disorders most commonly encountered in the emergency department, outlines the identification and management of acute medical and psychiatric crises, and provides a practical framework for managing psychiatric and medical risk and triage to appropriate levels of care. The chapter further expands on medical and psychiatric comorbidity in eating disorders. Included in the chapter are easily administered screening instruments, suggested clinical interview elements, and recommendations for behavioral interventions. The chapter provides a solid introduction on the physiologic consequences of restricting and purging behaviors and discusses important findings on the initial physical exam of a patient with disordered eating behaviors.
Trauma-Informed Care, Psychological First Aid, and Recovery-Oriented Approaches in the Emergency Room
Authors: Merotto Benjamin , Simpson Scott A.
Published: May 2023

Trauma-informed care (TIC) is a philosophy and framework for delivering health care that respects the impacts that trauma has had on individuals’ lives. Most individuals experience and survive a trauma in their lifetimes, and many patients can find the experience of emergency department (ED) treatment too reactive. These anxieties may arise from the stress and pain of medical illness, triggering interactions with staff, or the chaotic environment of the ED. TIC also considers the impact of trauma on ED staff and providers. This chapter describes core elements of TIC in EDs and crisis services that can promote patient-centered and recovery-oriented care. The TIC approach is contrasted with historic—and still common—notions of traditional medicine that are often perceived by patients to be dehumanizing. Psychological first aid is a therapeutic approach that helps individual clinicians apply TIC to patients in the aftermath of individual or collective trauma.
Collaborations Within the Emergency Department
Authors: Owen Julie Ruth
Published: May 2023

In the United States, the number of hospital emergency department (ED) visits has steadily increased during the past decade, and the proportion of ED visits primarily involving psychiatric concerns (including substance use) has also been on the rise. Utilization of the ED by psychiatric patients has been linked to the mental health resources within the community and impacts ED clinical operations. This chapter explores the impact of and potential solutions, including boarding and prolonged length of stay, to psychiatric patients in EDs; various models of psychiatric care implemented to address these concerns; and possible future directions to pursue, with the goal of improving ED-based psychiatric patient care delivery and systems-based practices.
Collaborations Beyond the Emergency Department
Authors: Balfour Margaret E. , Goldman Matthew L.
Published: May 2023

A lot happens outside of the emergency department (ED) that affects the outcome of a behavioral health emergency. Many ED visits originate with a call for help from someone in the community, and there is wide variability throughout the United States in how that call for help is handled. Some people experiencing mental health or substance use related emergencies never make it to the ED, instead dying in police shootings or taken to jail instead of receiving the care they need. Fortunately, the new 988 mental health emergency number and police reform movements have created momentum for building behavioral health crisis response systems that deliver the same quality and consistency of care as expected for medical emergencies. As crisis systems grow and evolve, collaborative partnerships will be critical for solving problems that have long burdened the ED, such as psychiatric boarding and the “revolving door” of repeat ED utilization. This chapter discussed the growing number of options for crisis care outside the ED and provides practical suggestions for successful collaboration. The role of law enforcement and the various approaches to lessening the impact on individuals experiencing behavioral health emergencies are also discussed. In addition, the chapter provides an overview of the crisis continuum, including crisis hotlines, mobile teams, observation units, crisis residential programs, and peer wraparound services that can help ensure linkage to aftercare is successful. Practical suggestions for collaboration are included throughout the chapter to spark ideas for action or quality improvement projects.
Introduction
Authors: Ripp Jonathan A.
Published: May 2023

While many feel a “calling” to the profession of medicine, which has often been seen as a career path with the potential to be rewarding and meaningful, the changing landscape of health care and increasing demands placed on physicians have increasingly shifted the day-to-day focus of medical careers towards clerical and administrative burdens that may erode physician well-being. Furthermore, there presently exists significant literature and a growing national and international recognition that supports a link between physician well-being and the optimal functioning of healthcare organizations. Much of this attention has focused on the medical student and graduate medical education (GME) trainee and has presently evolved into a moral imperative that the well-being of these populations be addressed in order to enable future physicians to thrive and flourish. This book provides a framework for leaders and organizations to methodically approach efforts that support medical student and GME trainee well-being.
Raising Awareness and Ensuring Access to Mental Health Resources
Authors: Bernstein Carol A. , Haiman Claire , Mayer Laurel E. S.
Published: May 2023

The relationship between burnout and depression is critical to understand so that appropriate solutions and treatments in both areas can be developed and implemented. This chapter considers the relationship between well-being and mental health, focusing primarily on burnout and depression and whether this relationship is best appreciated as a dichotomy or along a spectrum; the stressors unique to medical training and the range of mental health concerns that can arise; models of care and mental health resources recommended to fully support the student and graduate medical education (GME) trainee during the long process of training; and common barriers that inhibit students and GME trainees from accessing mental health support and treatment. Through these issues, the authors explore the implications for organizational efforts, programming, and interventions to promote well-being, alleviate distress, and treat mental health pathology.
Addressing and Meeting Regulatory Requirements
Authors: Cunningham Tara K. , Leitman Michael
Published: May 2023

The process of medical training, with its emphasis on achievement, high-stakes testing, and standing out in a field of highly accomplished peers, is already fraught with many of the stressors that are known to contribute to burnout in physicians. In an effort to mitigate these stressors, formal accreditation of undergraduate and graduate medical education has shifted from simply providing experiential learning opportunities to developing an environment conducive to learning that both promotes well-being within the educational years and models the incorporation of well-being into professional attitudes. This chapter provides the context and description of how the Liaison Committee on Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) provide the frameworks to support trainee well-being in medical education through their program requirements.
Walking the Elephant: Drawing as enactment of community
Authors: Vormittag Luise
Published: May 2023

The Elephant and Castle neighbourhood in London is well known as a centre for the Latin American community in the UK. The drastic demolition of the site threatens their continued presence. This article chronicles my work as an illustrator on a project that sought to represent this migrant community, their vibrancy, and vitality on the cusp of the site’s erasure. Through a series of participatory, creative workshops a range of illustrative documents were produced that, ultimately, became archival records. Working on the project enabled a reflection on the role of the illustrator in the context of cultural devastation, and retrieval and preservation of the relationship between migrants and the spaces they occupy. This gave rise to a deeper set of questions about the nature of community as such. Drawing on Jean-Luc Nancy’s philosophical work on community and Hannah Arendt’s writing on the public realm, I argue that this illustration project visualises and materialises experiences and expressions of community at a moment when this sociality was itself under threat.
Assessment of a physics-based retrieval of exoplanet atmospheric temperatures from infrared emission spectra
Authors: Schreier Franz , Grenfell J Lee , Wunderlich Fabian , Trautmann Thomas
Published: May 2023

Atmospheric temperatures are to be estimated from thermal emission spectra of Earth-like exoplanets orbiting M-stars as observed by current and future planned missions. To this end, a line-by-line radiative transfer code is used to generate synthetic thermal infrared (TIR) observations. The range of ‘observed’ intensities provides a rough hint of the atmospheric temperature range without any a priori knowledge. The equivalent brightness temperature (related to intensities by Planck’s function) at certain wavenumbers can be used to estimate the atmospheric temperature at corresponding altitudes. To exploit the full information provided by the measurement we generalize Chahine’s original approach and infer atmospheric temperatures from all spectral data using the wavenumber-to-altitude mapping defined by the weighting functions. Chahine relaxation allows an iterative refinement of this ‘first guess’. Analysis of the 4.3 and $15\rm \, \mu m$ carbon dioxide TIR bands enables an estimate of atmospheric temperatures for rocky exoplanets even for low signal-to-noise ratios of 10 and medium resolution. Inference of Trappist-1e temperatures is, however, more challenging especially for CO2 dominated atmospheres: the ‘standard’ 4.3 and $15\rm \, \mu m$ regions are optically thick and an extension of the spectral range towards atmospheric window regions is important. If atmospheric composition (essentially CO2 concentration) is known temperatures can be estimated remarkably well; quality measures such as the residual norm provide hints on incorrect abundances. In conclusion, temperature in the mid atmosphere of Earth-like planets orbiting cooler stars can be quickly estimated from thermal IR emission spectra with moderate resolution.
Superorbital periods of Be/X-ray binaries driven by stellar spin precession
Authors: Martin Rebecca G
Published: May 2023

Superorbital periods are observed in the optical light curves of many Be/X-ray binaries yet their origin has remained somewhat elusive. We suggest that precession of the spin axis of the Be star can drive superorbital periods, particularly for short orbital period binaries. We consider the short orbital period ($P_{\rm orb}=16.6\, \rm d$) and highly eccentric (eb = 0.72) Be/X-ray binary A0538−66 that has a superorbital period of $421\, \rm d$. First, we show that the spin axis precession time-scale is about twice the observed superorbital period. Then, with hydrodynamic simulations we show that the Be star decretion disc can remain locked to the equator of the precessing Be star. At each periastron passage of the neutron star, material is accreted into a disc around the neutron star. The neutron star disc nodally precesses on the same time-scale as the Be star disc and therefore both discs can contribute to the observed superorbital period. For wider and less eccentric binary systems, the Be star disc can have a larger radial extent and more complex behaviour is expected as a result of disc warping and breaking.
Law by Algorithm
Authors: Lim Ernest W K
Published: May 2023

Abstract—

This review article offers a critical analysis of Horst Eidenmüller and Gerhard Wagner’s Law by Algorithm by focusing on four major sets of issues that are covered in this important work: (i) separate legal personality for artificial intelligence (AI) systems; (ii) the exploitation and protection of consumers; (iii) liability; and (iv) online dispute resolution. On separate legal personality, it is shown that neither unbundled products nor difficulties in proving that the systems resulted in damage or losses necessarily justify giving legal personality to AI systems. On consumer protection, it is argued that exploitation of consumers can be regulated by consumer protection legislation provided that reforms are made to remove enforcement hurdles. On liability, the issues arising from product liability legislation and problems associated with proving causation are critically examined. On online dispute resolution, smart contracts and self-driving contracts are distinguished, and a distinction is drawn between AI-assisted and AI-substitutionary adjudication.
Integration of Multi-omic Data in a Molecular Tumor Board Reveals EGFR-Associated ALK-Inhibitor Resistance in a Patient With Inflammatory Myofibroblastic Cancer
Authors: Hunt Allison L , Nutcharoen Aratara , Randall Jamie , Papazian Alyssa , Deeken John , Maxwell G Larry , Bateman Nicholas W , Petricoin Emanuel F , Benyounes Amin , Conrads Thomas P , Cannon Timothy L
Published: May 2023

Inflammatory myofibroblastic tumors (IMTs) are intermediate-grade mesenchymal neoplasms commonly characterized by chromosomal rearrangements causing constitutive activation of anaplastic lymphoma kinase (ALK) and/or ALK mutations causing reduced sensitivity to ALK tyrosine kinase inhibitors (TKI). We present a patient with an IMT who initially responded to first-line alectinib, but who later suffered disease relapse and presently survives with moderate residual disease after receiving second-line lorlatinib. Biopsy specimens were analyzed using next generation sequencing (DNA-seq and RNA-seq) and reverse phase protein microarray (RPPA) as part of an institutional Molecular Tumor Board (MTB) study. An EML4-ALK rearrangement and EGFR activation (pEGFRY1068) were present in both the primary and recurrent tumors, while a secondary ALK I1171N mutation was exclusive to the latter. EGFR signaling in the background of a secondary ALK mutation is correlated with reduced ALK TKI sensitivity in vitro, implicating an important mechanism of drug resistance development in this patient. The RPPA results also critically demonstrate that ALK signaling (ALKY1604) was not activated in the recurrent tumor, thereby indicating that standard-of-care use of third- or fourth-line ALK TKI would not likely be efficacious or durable. These results underscore the importance of real-time clinical integration of functional protein drug target activation data with NGS in the MTB setting for improving selection of patient-tailored therapy.
Melt Inclusions in Arclogitic Xenoliths Constrain the Genesis of the Lower Continental Arc Crust beneath the Northern Volcanic Zone, Colombia
Authors: Gianola Omar , Costa Benedetta , Ferri Fabio , Gilio Mattia , Petrelli Maurizio , Murri Mara , Barbaro Anna , Alvaro Matteo , Rodríguez-Vargas Andrés , Poli Stefano , Cesare Bernardo
Published: May 2023

Volcanic arcs above subduction zones are thought to be the principal locations where juvenile magmatic crust forms and is refined to become continental crust with an andesitic composition. During this refinement mechanism, the formation of dense garnet pyroxenites (arclogites), represented by high-pressure cumulates and restites after partial melting, leads to the delamination of the lower arc crust. The Mercaderes-Río Mayo area in southern Colombia is the only known locality in an active volcanic arc where arclogitic xenoliths have been recovered. These xenoliths are entrained in the Granatifera Tuff, a late Cenozoic volcanic vent, and they mainly consist of garnet, clinopyroxene, amphibole, plagioclase, rarely scapolite, and accessory mineral inclusions of rutile, apatite, zircons, and quartz. Moreover, the arclogites are also characterized by the presence of melt inclusions (MI), which are mainly found within garnet, but can be also observed in amphibole, plagioclase, clinopyroxene, and scapolite. The glasses measured for the MI in garnet and scapolite typically have SiO2 contents >57 wt.%, ranging from andesite to rhyolite in composition. Petrographic and geochemical investigations allowed to discriminate between cumulitic and restitic arclogites, with the latter showing the concomitant presence of primary MI and quartz inclusions within the peritectic garnets. Therefore, our study provides for the first time a strong evidence, at the microscale, for the anatectic origin of some arclogitic xenoliths. Pressure and temperature conditions for the studied arclogites were estimated by intracrystalline geothermometry, elastic geothermobarometry, phase equilibria modelling and classical Fe–Mg exchange between garnet and clinopyroxene. Results fall within the range of 960°C to 1150°C and 1.6 to 1.9 GPa for most samples. We suggest that the investigated arclogites derive from the root of the active Colombian volcanic arc, where differentiation processes from mantle-derived melts and lower crust anatexis occur in close association.
Should we reconsider how to assess eutrophication?
Authors: Polimene L , Parn O , Garcia-Gorriz E , Macias D , Stips A , Duteil O , Ferreira-Cordeiro N , Miladinova S , Piroddi C , Serpetti N
Published: May 2023

Eutrophication in marine waters is traditionally assessed by checking if nutrients, algal biomass and oxygen are below/above a given threshold. However, increased biomass, nutrient concentrations and oxygen demand do not lead to undesirable environmental effects if the flow of carbon/energy from primary producers toward high trophic levels is consistently preserved. Consequently, traditional indicators might provide a misleading assessment of the eutrophication risk. To avoid this, we propose to evaluate eutrophication by using a new index based on plankton trophic fluxes instead of biogeochemical concentrations. A preliminary, model-based, assessment suggests that this approach might give a substantially different picture of the eutrophication status of our seas, with potential consequences on marine ecosystem management. Given the difficulties to measure trophic fluxes in the field, the use of numerical simulations is recommended although the uncertainty associated with biogeochemical models inevitably affects the reliability of the index. However, given the effort currently in place to develop refined numerical tools describing the marine environment (Ocean Digital Twins), a reliable, model-based, eutrophication index could be operational in the near future.
‘It depends’: Officer insights on the potential for body-worn cameras to change police and citizen behaviour
Authors: Wood Jennifer D , Groff Elizabeth R , Talley Dijonée
Published: May 2023

This study mined officers’ perspectives on whether body-worn cameras (BWCs) could change the behaviour of citizens and police. Officers reinforced themes from prior studies on the professionalizing effect of BWCs, the potential for passivity, and the concern with ‘second-guessing’. Officers also stressed the theme of ‘it depends’, where behaviour change is contingent on the citizen, the situation, and the officer. Findings resonated with the concept of police encounters as two-way social interactions and related insights from regulation scholarship on ‘motivational posturing’. Results underscore the need for more observational studies (including ethnographies and systematic social observations) that identify the variety of encounters and settings where BWC activation might alter behavioural norms and encounter dynamics. Relatedly, BWC footage could be mined to inform reviews of everyday police work that identify the unique ways in which BWC activation could be leveraged to change behaviour in a variety of situations with different posturing dynamics. Policymakers should emphasize the complexity of the implementation environments surrounding the uptake of BWCs and other technology, with a view to encouraging research that measures the many dimensions of officers’ perceptions. Understanding the place and role of BWCs within the contexts of officers’ holistic experiences should help policymakers understand both the limits and potential of cameras to change everyday policing.
Impact of TNF inhibitor medication on working ability in axial spondyloarthritis: an observational national registry-based cohort study
Authors: Hokkanen Anna-Mari , Aaltonen Kalle , Relas Heikki , Rutanen Jarno , Kononoff Aulikki , Taimen Kirsi , Kauppi Markku , Puolakka Kari , Trokovic Nina , Nordström Dan
Published: May 2023

Objective

The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axial SpA patients in a real-life setting.

Methods

Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in- and outpatient days and rehabilitation rates, 1 year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis.

Results

Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr-axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected.

Conclusion

TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work.
Kinetically inert manganese (II)-based hybrid micellar complexes for magnetic resonance imaging of lymph node metastasis
Authors: Chen Kai , Cai Zhongyuan , Cao Yingzi , Jiang Lingling , Jiang Yuting , Gu Haojie , Fu Shengxiang , Xia Chunchao , Lui Su , Gong Qiyong , Song Bin , Ai Hua
Published: May 2023

The localization and differential diagnosis of the sentinel lymph nodes (SLNs) are particularly important for tumor staging, surgical planning and prognosis. In this work, kinetically inert manganese (II)-based hybrid micellar complexes (MnCs) for magnetic resonance imaging (MRI) were developed using an amphiphilic manganese-based chelate (C18-PhDTA-Mn) with reliable kinetic stability and self-assembled with a series of amphiphilic PEG-C18 polymers of different molecular weights (C18En, n = 10, 20, 50). Among them, the probes composed by 1:10 mass ratio of manganese chelate/C18En had slightly different hydrodynamic particle sizes with similar surface charges as well as considerable relaxivities (∼13 mM−1 s−1 at 1.5 T). In vivo lymph node imaging in mice revealed that the MnC MnC-20 formed by C18E20 with C18-PhDTA-Mn at a hydrodynamic particle size of 5.5 nm had significant signal intensity brightening effect and shortened T1 relaxation time. At an imaging probe dosage of 125 μg Mn/kg, lymph nodes still had significant signal enhancement in 2 h, while there is no obvious signal intensity alteration in non-lymphoid regions. In 4T1 tumor metastatic mice model, SLNs showed less signal enhancement and smaller T1 relaxation time variation at 30 min post-injection, when compared with normal lymph nodes. This was favorable to differentiate normal lymph nodes from SLN under a 3.0-T clinical MRI scanner. In conclusion, the strategy of developing manganese-based MR nanoprobes was useful in lymph node imaging.