bluuebunny/crossref_metadata_2025 huggingface dataset:
Methods for preparing high-quality powder for targets
Authors: Ren Zehua , He Jinjiang , Luo Junfeng , Ding Zhaochong , Yang Wenkui
Published: November 2023

Powder metallurgy process can produce excellent quality magnetic targets, in which powder quality affects the quality of the target to a large extent, the production of high-quality target has an important role. This paper mainly introduces the preparation methods of powder for targets, summarizes the preparation methods of fine powder and the characteristics of different preparation methods. Finally, it summarizes the shortcomings of the current research on powder for targets, proposes new research ideas, and prospects its future development.
Two-dimensional MSi2N4 (M = Ge, Sn, and Pb) monolayers: promising new materials for optoelectronic applications
Authors: Jahangirzadeh Varjovi Mirali , Ershadrad Soheil , Sanyal Biplab , Tosoni Sergio
Published: November 2023

The recent growth of two-dimensional (2D) layered crystals of MoSi2N4 and WSi2N4 has sparked significant interest due to their outstanding properties and potential applications. This development has paved the way for a new and large family of 2D materials with a general formula of MA
2
Z
4. In this regard, motivated by this exciting family, we propose two structural phases (1T- and 1H-) of MSi2N4 (M = Ge, Sn, and Pb) monolayers and investigate their structural, vibrational, mechanical, electronic and optical properties by using first-principles methods. The two phases have similar cohesive energies, while the 1T structures are found to be more energetically favorable than their 1H counterparts. The analysis of phonon spectra and ab initio molecular dynamics simulations indicate that all the suggested monolayers, except for 1H-GeSi2N4, are dynamically and thermally stable even at elevated temperatures. The elastic stability and mechanical properties of the proposed crystals are examined by calculating their elastic constants (C

ij
), in-plane stiffness (

Y

2D

), Poisson’s ratio (ν), and ultimate tensile strain (UTS). Remarkably, the considered systems exhibit prominent mechanical features such as substantial in-plane stiffness and high UTS. The calculated electronic band structures reveal that both the 1T- and 1H-MSi2N4 nanosheets are wide-band-gap semiconductors and their energy band gaps span from visible to ultraviolet region of the optical spectrum, suitable for high-performance nanoelectronic device applications. Lastly, the analysis of optical properties shows that the designed systems have isotropic optical spectra, and depending on the type of the system, robust absorption of ultraviolet and visible light (particularly in 1H-PbSi2N4 monolayer) is predicted. Our study not only introduces new members to the family of 2D MA
2
Z
4 crystals but also unveils their intriguing physical properties and suggests them as promising candidates for diverse nanomechanical and optoelectronic applications.
Multimodality radiomics prediction of radiotherapy-induced the early proctitis and cystitis in rectal cancer patients: a machine learning study
Authors: Abbaspour Samira , Barahman Maedeh , Abdollahi Hamid , Arabalibeik Hossein , Hajainfar Ghasem , Babaei Mohammadreza , Iraji Hamed , Barzegartahamtan Mohammadreza , Ay Mohammad Reza , Mahdavi Seied Rabi
Published: November 2023

Purpose. This study aims to predict radiotherapy-induced rectal and bladder toxicity using computed tomography (CT) and magnetic resonance imaging (MRI) radiomics features in combination with clinical and dosimetric features in rectal cancer patients. Methods. A total of sixty-three patients with locally advanced rectal cancer who underwent three-dimensional conformal radiation therapy (3D-CRT) were included in this study. Radiomics features were extracted from the rectum and bladder walls in pretreatment CT and MR-T2W-weighted images. Feature selection was performed using various methods, including Least Absolute Shrinkage and Selection Operator (Lasso), Minimum Redundancy Maximum Relevance (MRMR), Chi-square (Chi2), Analysis of Variance (ANOVA), Recursive Feature Elimination (RFE), and SelectPercentile. Predictive modeling was carried out using machine learning algorithms, such as K-nearest neighbor (KNN), Support Vector Machine (SVM), Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Naive Bayes (NB), Gradient Boosting (XGB), and Linear Discriminant Analysis (LDA). The impact of the Laplacian of Gaussian (LoG) filter was investigated with sigma values ranging from 0.5 to 2. Model performance was evaluated in terms of the area under the receiver operating characteristic curve (AUC), accuracy, precision, sensitivity, and specificity. Results. A total of 479 radiomics features were extracted, and 59 features were selected. The pre-MRI T2W model exhibited the highest predictive performance with an AUC: 91.0/96.57%, accuracy: 90.38/96.92%, precision: 90.0/97.14%, sensitivity: 93.33/96.50%, and specificity: 88.09/97.14%. These results were achieved with both original image and LoG filter (sigma = 0.5–1.5) based on LDA/DT-RF classifiers for proctitis and cystitis, respectively. Furthermore, for the CT data, AUC: 90.71/96.0%, accuracy: 90.0/96.92%, precision: 88.14/97.14%, sensitivity: 93.0/96.0%, and specificity: 88.09/97.14% were acquired. The highest values were achieved using XGB/DT-XGB classifiers for proctitis and cystitis with LoG filter (sigma = 2)/LoG filter (sigma = 0.5–2), respectively. MRMR/RFE-Chi2 feature selection methods demonstrated the best performance for proctitis and cystitis in the pre-MRI T2W model. MRMR/MRMR-Lasso yielded the highest model performance for CT. Conclusion. Radiomics features extracted from pretreatment CT and MR images can effectively predict radiation-induced proctitis and cystitis. The study found that LDA, DT, RF, and XGB classifiers, combined with MRMR, RFE, Chi2, and Lasso feature selection algorithms, along with the LoG filter, offer strong predictive performance. With the inclusion of a larger training dataset, these models can be valuable tools for personalized radiotherapy decision-making.
Research on the path extraction method of shoe upper grinding based on 3D vision
Authors: Zhang Yuewei , Wei Honglei , Lv Yan
Published: November 2023

Shoe upper grinding is a crucial step in the shoe manufacturing process, impacting both the bonding quality between the sole and the upper and the overall appearance of the shoe. Presently, many shoe companies rely on manual or semi-automated grinding methods for shoe uppers, resulting in low production efficiency and subpar grinding quality. This study proposes a 3D vision-based shoe upper grinding path extraction method for guiding a robotic arm to polish the shoe upper and address this issue. Initially, the RGB-D camera was used to obtain the point cloud data of the shoe surface, which was then preprocessed using point cloud filtering, smoothing and registration methods. Second, by combining RGB images with 3D point clouds, we propose a point-cloud region of interest (ROI) extraction method based on RGB information to obtain the feature point cloud of the shoe upper grinding line. Finally, we slice the feature point cloud of the shoe upper grinding line, extract the grinding points using an intersection algorithm, and fit them with a non-uniform rational B-spline curve (NURBS) to obtain the shoe’s upper grinding path. The research demonstrates that this method can effectively extract the shoe upper grinding trajectory curve, significantly reduce the time required to obtain the shoe upper grinding trajectory, and achieve good accuracy, with promising application prospects.
Rights and Votes
Authors: Levinson Daryl J
Published: November 2023

This chapter considers how state power, once it has been built, can be controlled, focusing on the two primary tools designed for doing so. Particular uses of state power can be prohibited by legal restrictions to protect vulnerable subjects against abuse (“rights”). Alternatively, the users of state power can be selected or influenced through a system of politics that empowers vulnerable subjects to protect themselves (“votes”). This simple way of assimilating rights and votes will come as counterintuitive to constitutionalists, who are accustomed to viewing rights and democracy as opposing forces. Internationalists, in contrast, have been more inclined to see political power and legal protections as working in parallel. Constitutional law has much to learn from that perspective. Conceiving of rights and votes as comparable tools illuminates how both can be best used to regulate and guard against state power, from the inside as well as the outside.
Epistles
Authors: Morgan Llewelyn
Published: November 2023

This chapter discusses the relationship of these poetic letters to Horace’s earlier satires, and explains how they adopt a poetic style appropriate to the kind of conversation pursued in a letter, slightly more formal than the style of the conversational satires, but still self-consciously less than overtly poetic. This kinship to satire is complemented by similarities to the lyrics of the Odes, especially the element of life advice, in these poems typically directed at younger men rising through Roman society. Horace’s characterization of himself as a man retired from active life—and even from writing real poetry—reinforces that claim of philosophical value. Alongside the appealingly humane letters of book 1, the longer poems addressed to Augustus and Florus are discussed, and the Ars Poetica. The latter in particular has foxed scholars seeking to pin down its literary purpose, but like all Horace’s work Epistles is full of brilliantly formulated and highly memorable statements of ethical and aesthetic principle.
How big and small are big and small?
Authors: Close Frank
Published: November 2023

This chapter considers the size, temperature, and characteristics of matter. It mentions how quarks and electrons are too small for people to measure even if they have intrinsic sizes. Thus, instruments like telescopes and special microscopes can help extend people’s senses and reveal Nature over a vast range of distance scales. The chapter then discusses the correspondence between scales of temperature and energy in electronvolts (eV). It details how the universe expanded after the explosive eruption of the Big Bang, which correlates with the measure of the temperature of the universe as a function of time and the Higgs field filling and stabilizing the vacuum.
The forces of Nature
Authors: Close Frank
Published: November 2023

This chapter elaborates on the fundamental forces of Nature that rule the universe: gravity, electromagnetic force, and the relative strengths of strong and weak. Quantum theory implies that forces manage to spread their effects across space through the action of intermediate agents, such as the exchange of particles. Additionally, the relative strengths of the various forces when acting between fundamental particles at low energies are typical of room temperature and change radically at very high temperature and energies. The chapter considers the mathematical structures underpinning the gauge theory that describes electromagnetic, weak, and strong forces to be generalized straightforwardly. It cites the significance of the Higgs field in the formation of the structure after the Big Bang.
Questions for the post-Higgs era
Authors: Close Frank
Published: November 2023

This chapter examines the queries after the discovery of the Higgs field. The standard model of the fundamental particles and the forces that act among them explains mass by proposing that it is due to the Higgs field, which permeates all of space. Studying the Higgs boson with high precision is expected to unveil some deviations from theoretical expectations and thereby point the way to further progress. The chapter looks into electromagnetic radiation being outweighed by some mysterious dark matter that does not show up at any wavelength in telescopes. It also elaborates on the concept of supersymmetry and the possible role of massive neutrinos in solving the mystery of the missing antimatter.
A cross-sectional study on occupational exposure to microorganisms, endotoxin, hydrogen sulfide, and dust during work at drilling waste treatment plants
Authors: Daae Hanne Line , Graff Pål , Foss Oda Astrid Haarr , Kofoed Victor Carp , Afanou Anani Komlavi , Frederiksen Margit Wagtberg , Madsen Anne Mette
Published: November 2023

This cross-sectional study aims to obtain knowledge about workers’ exposure to airborne dust, bacterial and fungal species, endotoxin, biofilm formation, and hydrogen sulfide (H2S) in drilling waste treatment plants. In total, 408 full-shift personal samples, 66 work areas, 40 drilling waste, and reference (outdoor air and seawater) samples were analyzed. Some workers were exposed to high levels of endotoxin (207 EU/m3), bacteria (3.8 × 104 colony forming units (CFU)/m3 and 9.8 × 104 DNA copies/m3), or fungi (1.4 × 107 CFU/m3 and 3,600 copies/m3). The exposure levels to endotoxin, bacteria, and peaks of H2S were dependent on the treatment technique. All types of drilling waste contained large concentrations of bacteria compared to the seawater references. Elevated concentrations of airborne bacteria were found close to drilling waste basins. In total, 116, 146, and 112 different bacterial species were found in workers’ exposure, work areas, and the drilling waste, respectively. An overlap in bacterial species found in the drilling waste and air (personal and work area) samples was found. Of the bacterial species found, 49 are classified as human pathogens such as Escherichia coli, Enterobacter cloacae, and Klebsiella oxytoca. In total, 44 fungal species were found in the working environment, and 6 of these are classified as human pathogens such as Aspergillus fumigatus. In conclusion, across the drilling waste treatment plants, human pathogens were present in the drilling waste, and workers’ exposure was affected by the drilling waste treated at the plants with elevated exposure to endotoxin and bacteria. Elevated exposure was related to working as apprentices or chemical engineers, and working with cleaning, or slop water, and working in the daytime.
Adversarial training improves model interpretability in single-cell RNA-seq analysis
Authors: Sadria Mehrshad , Layton Anita , Bader Gary D
Published: November 2023

Motivation

Predictive computational models must be accurate, robust, and interpretable to be considered reliable in important areas such as biology and medicine. A sufficiently robust model should not have its output affected significantly by a slight change in the input. Also, these models should be able to explain how a decision is made to support user trust in the results. Efforts have been made to improve the robustness and interpretability of predictive computational models independently; however, the interaction of robustness and interpretability is poorly understood.

Results

As an example task, we explore the computational prediction of cell type based on single-cell RNA-seq data and show that it can be made more robust by adversarially training a deep learning model. Surprisingly, we find this also leads to improved model interpretability, as measured by identifying genes important for classification using a range of standard interpretability methods. Our results suggest that adversarial training may be generally useful to improve deep learning robustness and interpretability and that it should be evaluated on a range of tasks.

Availability and implementation

Our Python implementation of all analysis in this publication can be found at: https://github.com/MehrshadSD/robustness-interpretability. The analysis was conducted using numPy 0.2.5, pandas 2.0.3, scanpy 1.9.3, tensorflow 2.10.0, matplotlib 3.7.1, seaborn 0.12.2, sklearn 1.1.1, shap 0.42.0, lime 0.2.0.1, matplotlib_venn 0.11.9.
AdmixPipe v3: facilitating population structure delimitation from SNP data
Authors: Mussmann Steven M , Douglas Marlis R , Chafin Tyler K , Douglas Michael E
Published: November 2023

Quantifying genetic clusters (=populations) from genotypic data is a fundamental, but non-trivial task for population geneticists that is compounded by: hierarchical population structure, diverse analytical methods, and complex software dependencies. AdmixPipe v3 ameliorates many of these issues in a single bioinformatic pipeline that facilitates all facets of population structure analysis by integrating outputs generated by several popular packages (i.e. CLUMPAK, EvalAdmix). The pipeline interfaces disparate software packages to parse Admixture outputs and conduct EvalAdmix analyses in the context of multimodal population structure results identified by CLUMPAK. We further streamline these tasks by packaging AdmixPipe v3 within a Docker container to create a standardized analytical environment that allows for complex analyses to be replicated by different researchers. This also grants operating system flexibility and mitigates complex software dependencies.

Availability and implementation

Source code, documentation, example files, and usage examples are freely available at https://github.com/stevemussmann/admixturePipeline. Installation is facilitated via Docker container available from https://hub.docker.com/r/mussmann/admixpipe. Usage under Windows operating systems requires the Windows Subsystem for Linux.
Interpretable prediction models for widespread m6A RNA modification across cell lines and tissues
Authors: Zhang Ying , Wang Zhikang , Zhang Yiwen , Li Shanshan , Guo Yuming , Song Jiangning , Yu Dong-Jun
Published: November 2023

Motivation

RNA N6-methyladenosine (m6A) in Homo sapiens plays vital roles in a variety of biological functions. Precise identification of m6A modifications is thus essential to elucidation of their biological functions and underlying molecular-level mechanisms. Currently available high-throughput single-nucleotide-resolution m6A modification data considerably accelerated the identification of RNA modification sites through the development of data-driven computational methods. Nevertheless, existing methods have limitations in terms of the coverage of single-nucleotide-resolution cell lines and have poor capability in model interpretations, thereby having limited applicability.

Results

In this study, we present CLSM6A, comprising a set of deep learning-based models designed for predicting single-nucleotide-resolution m6A RNA modification sites across eight different cell lines and three tissues. Extensive benchmarking experiments are conducted on well-curated datasets and accordingly, CLSM6A achieves superior performance than current state-of-the-art methods. Furthermore, CLSM6A is capable of interpreting the prediction decision-making process by excavating critical motifs activated by filters and pinpointing highly concerned positions in both forward and backward propagations. CLSM6A exhibits better portability on similar cross-cell line/tissue datasets, reveals a strong association between highly activated motifs and high-impact motifs, and demonstrates complementary attributes of different interpretation strategies.

Availability and implementation

The webserver is available at http://csbio.njust.edu.cn/bioinf/clsm6a. The datasets and code are available at https://github.com/zhangying-njust/CLSM6A/.
Seeing, Sharing and Supporting: Assertive Outreach as a Partial Solution to Rough Sleeping
Authors: Stambe Rose , Kuskoff Ella , Parsell Cameron , Plage Stefanie , Ablaza Christine , Perales Francisco
Published: November 2023

Assertive outreach is becoming an increasingly salient feature of policy responses to homelessness—and particularly rough sleeping—with the aim of supporting people to access secure housing. Despite its demonstrated successes, existing research points to structural challenges practitioners face in navigating complex and fragmented service systems to provide people sleeping rough with a continuum of care. This study examines an Australian organisation’s efforts to collaboratively and systematically overcome these challenges by bringing together government, community and service practitioners from multiple sectors in their delivery of an assertive outreach programme. Using an ethnographic research design, this article draws on observations of outreach practices and service provider administrative quantitative data, as well as qualitative interviews and focus groups conducted with assertive outreach service providers. Our findings demonstrate that through flexible and collaborative social work practices, practitioners were able to see people sleeping rough, share information across services and support people into a range of housing, health and other forms of services. Critically, however, structural barriers such as a lack of affordable and social housing prevented assertive outreach from ending people’s homelessness. We foreground the critical implications of these findings for social work.
Mixed purpuric and maculopapular eruption in a 70-year-old woman
Authors: Avallone Gianluca , Vocino Trucco Giulia , Roccuzzo Gabriele , Conti Luca , Lanzarone Giuseppe , Orlando Giulia , Agostini Andrea , Giunipero di Corteranzo Isotta , Astrua Chiara , Quaglino Pietro , Ribero Simone
Published: November 2023

A 70-year-old woman presented with diffuse mixed purpuric and erythematous maculopapular lesions that spared the folds. Histological examination revealed a discrete perivascular and interstitial lymphocytic infiltrate with a monomorphic appearance in the dermis.
Effectiveness and safety of direct oral anticoagulation vs. warfarin in frail patients with atrial fibrillation
Authors: Søgaard Mette , Ording Anne Gulbech , Skjøth Flemming , Larsen Torben Bjerregaard , Nielsen Peter Brønnum
Published: November 2023

Aims

Although frail patients with atrial fibrillation (AF) carry a high risk of stroke and treatment-related bleeding complications, evidence for the safety and effectiveness of anticoagulation remains sparse. This study investigated the effectiveness and safety of direct oral anticoagulant (DOAC) vs. warfarin in frail AF patients.

Methods and results

Nationwide registry-based cohort study including 32 048 anticoagulation naïve frail patients (median age 80 years, 53% female) with incident AF during 2012–20. Frailty was assessed using the hospital frailty risk score. To address baseline confounding, we applied inverse probability of treatment weighting (IPTW) and marginal structural models with weighted pooled regression to compute weighted hazard ratios (wHRs) and risk differences for thromboembolism and major bleeding comparing specific DOAC doses with warfarin. After AF diagnosis, 6747 (21.1%) initiated warfarin, 17 076 (50.3%) initiated standard-dose DOAC, and 9179 (28.6%) initiated reduced-dose DOAC. Comparative effectiveness analyses in the IPTW pseudo-populations revealed similar thromboembolism risk between standard-dose DOAC and warfarin [wHR 0.95, 95% confidence interval (CI) 0.80–1.13] and between reduced-dose DOAC and warfarin (wHR 0.97, 95% CI 0.77–1.23). The 1-year thromboembolic event-free survival difference was −0.2% for DOAC, regardless of dosing, vs. warfarin. Major bleeding risk was significantly lower with standard-dose DOAC (wHR 0.69, 95% CI 0.59–0.87) and reduced-dose DOAC (wHR 0.67, 95% CI 0.55–0.81) vs. warfarin. The 1-year bleeding risk difference with DOAC ranged from −1.3% to −3.0%.

Conclusion

Our findings indicate comparable thromboembolism risk and significantly lower bleeding risk with both standard and reduced DOAC regimens compared with warfarin in frail AF patients in routine care.
Stroke and bleeding risk in atrial fibrillation with CHA2DS2-VASC risk score of one: the Norwegian AFNOR study
Authors: Anjum Mariam , Ariansen Inger , Hjellvik Vidar , Selmer Randi , Kjerpeseth Lars J , Skovlund Eva , Myrstad Marius , Ellekjær Hanne , Christophersen Ingrid E , Tveit Arnljot , Berge Trygve
Published: November 2023

Background and Aims

The benefit of oral anticoagulant (OAC) therapy in atrial fibrillation (AF) and intermediate stroke risk is debated. In a nationwide Norwegian cohort with a non-sex CHA2DS2-VASc risk score of one, this study aimed to investigate (i) stroke and bleeding risk in AF patients with and without OAC treatment, and (ii) the risk of stroke in non-anticoagulated individuals with and without AF.

Methods

A total of 1 118 762 individuals including 34 460 AF patients were followed during 2011–18 until ischaemic stroke, intracranial haemorrhage, increased CHA2DS2-VASc score, or study end. One-year incidence rates (IRs) were calculated as events per 100 person-years (%/py). Cox regression models provided adjusted hazard ratios (aHRs [95% confidence intervals]).

Results

Among AF patients, the ischaemic stroke IR was 0.51%/py in OAC users and 1.05%/py in non-users (aHR 0.47 [0.37–0.59]). Intracranial haemorrhage IR was 0.28%/py in OAC users and 0.19%/py in non-users (aHR 1.23 [0.88–1.72]). Oral anticoagulant use was associated with an increased risk of major bleeding (aHR 1.37 [1.16–1.63]) but lower risk of the combined outcome of ischaemic stroke, major bleeding, and mortality (aHR 0.57 [0.51–0.63]). Non-anticoagulated individuals with AF had higher risk of ischaemic stroke compared to non-AF individuals with the same risk profile (aHR 2.47 [2.17–2.81]).

Conclusions

In AF patients at intermediate risk of stroke, OAC use was associated with overall favourable clinical outcomes. Non-anticoagulated AF patients had higher risk of ischaemic stroke compared to the general population without AF with the same risk profile.
Transitive Courant Algebroids and Double Symplectic Groupoids
Authors: Alvarez Daniel
Published: November 2023

In this work, we extend the Lu–Weinstein construction of double symplectic groupoids to any Lie bialgebroid such that its associated Courant algebroid is transitive and its Atiyah algebroid integrable. We illustrate this result by showing how it generalises many of the examples of double symplectic groupoids that have appeared in the literature. As preliminary steps for this construction, we give a classification of exact twisted Courant algebroids over Lie groupoids (CA-groupoids for short) and we show the existence of a foliation by twisted Courant algebroids on the base of a twisted CA-groupoid.
The Full Renormalization Horseshoe for Real Box Maps With Minimal Post-Critical Sets
Authors: Wang Yimin
Published: November 2023

In this paper, we consider the renormalization operator $\mathcal R$ for real box maps with minimal post-critical sets. We show the existence of the full renormalization horseshoe for real box maps with minimal post-critical sets. Moreover, the renormalization operator is exponentially contracting along the hybrid leaves.
Cutavirus Infection in Large-Plaque Parapsoriasis, a Premalignant Condition of Mycosis Fungoides
Authors: Hashida Yumiko , Nakajima Kimiko , Higuchi Tomonori , Ujihara Takako , Nakai Kozo , Daibata Masanori
Published: November 2023

Background

Cutavirus (CuV) is associated with mycosis fungoides; however, the CuV status in parapsoriasis en plaques (PP), a premalignant inflammatory condition of mycosis fungoides, has not been fully delineated.

Methods

Fifty-five Japanese patients with chronic inflammatory skin diseases, including 13 patients with PP, were studied.

Results

CuV DNA was detected significantly more frequently in biopsies of the lesional skin from patients with PP (38%; 4 of 13) than in those from patients with other inflammatory skin diseases (2%; 1 of 42; P = .009). All CuV-positive PP cases were of the large-plaque parapsoriasis (LPP) subtype. The viral loads ranged from 83 450 to 2 164 170 copies/103 cells. We recovered near–full-length CuV sequences from the CuV-positive LPP biopsies, all of which were of the Japanese/Asian genotype. The CuV genome appeared to be present within lymphoid cells infiltrating the epidermis and dermis. CuV NS1 and VP1 gene transcripts were also detected in the affected tissues.

Conclusions

The detection of high levels of CuV DNA with the expression of viral mRNA suggests a potential role for CuV in the pathogenesis of LPP, making it necessary to study further the impact of CuV, especially regarding the viral genotype, on the outcomes of patients with CuV-positive LPP.
The Art of Feeling and Sensing with Technology
Authors: Smith Georgia
Published: November 2023

Camille Baker is an artist who uses technology to explore our emotions. Georgia Smith talks to her about her work, her hopes and her passions.
AI, Business and Digital Evolution
Authors: Aghnia Somayeh
Published: November 2023

Somayeh Aghnia, co-founder and CEO of Geeks, spoke to Grant Powell MBCS about her passion for helping today's businesses get the most from AI and her thoughts about its continuing evolution.
Artificial Intelligence
Authors: Ratnayake Deepthi
Published: November 2023

Dr Deepthi Ratnayake, Principal Lecturer in Computer Science at University of Hertfordshire, and L. Fox Thomas MBCS, Vice Chair of BCS ISSG explore AI and its impact on women's safety and security.
Innovative approaches to COVID-19 medical countermeasure development
Authors: Harris Gavin H , Adalja Amesh A
Published: November 2023

Background

The COVID-19 pandemic, while unfortunately notable for immense strain and death throughout the world, has also shown great promise in the development of medical countermeasures. As the global scientific community shifted almost entirely towards vaccines, diagnostics and therapeutics, new trial designs most significantly adaptive platform trials, began to be used with greater speed and broader reach. These designs allowed for deploying and investigating new therapeutics, repurposing currently existing therapeutics and flexibly removing or adding additional medications as data appeared in real-time. Moreover, public–private sector partnering occurred at a level not seen before, contributing greatly to the rapid development and deployment of vaccines.

Objectives

To provide a brief overview of the advances in preventative and therapeutic medical countermeasure development for COVID-19.

Methods

A narrative review of relevant major medical countermeasure trials was conducted using the date range February 2020–December 2022, representing the period of greatest productivity in research to investigate COVID-19.

Results

Among the most influential trial designs are the adaptive platform designs, which have been applied to the development of initial COVID-19 antivirals, monoclonal antibodies, repurposing of existing immunomodulatory therapy and assisted in the disproof of ineffective medical therapies. Some of the most prominent examples include the REMAP-CAP, RECOVERY and TOGETHER trials.

Conclusions

Adaptive platform trial designs hold great promise for utility in future pandemics and mass casualty events. Additionally, public–private sectoring is essential for rapid medical countermeasure development and should be further enhanced for future biopreparedness.
A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses’ activities in daily practice regarding antibiotic use
Authors: Bos Maria , Schouten Jeroen , De Bot Cindy , Vermeulen Hester , Hulscher Marlies
Published: November 2023

Background

Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use.

Objectives

To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements.

Methods

We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool.

Results

A total of 118 studies were included. The majority of the proposed nurses’ activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses’ activities.

Conclusions

Nurses’ activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.
Clonal spread of non-O157 Shiga toxigenic Escherichia coli O21:H25 in raw water buffalo milks
Authors: Uyanik Tolga , Gücükoğlu Ali , Gürler Hande , Kanat Sibel , Bölükbaş Ayşegül , Çadirci Özgür
Published: November 2023

Aims

This study was conducted to investigate the presence of Shiga toxin-producing O157 and non-O157 E. coli in raw water buffalo milk, as well as to determine the virulence gene profiles, phylogroups, sequence types, and serotypes of the isolated strains.

Methods and results

A total of 200 hand-milked raw water buffalo milk samples were collected from 200 different water buffaloes over a period of three months from 20 different farms. Isolation of STEC was performed using CHROMagar STEC. Presence of stx1, stx2, and eaeA genes were investigated by mPCR. Phylogroups and sequence types of E. coli strains were determined by Clermont phylotyping and MLST. Serotyping was performed using PCR or WGS. According to the results, two milk samples obtained from two different farms were found as STEC-positive. All Stx-positive E. coli isolates belonged to phylogenetic group A and were assigned to ST10. WGS results indicated that serotype of two isolates was O21:H25 and average nucleotide identity was detected at 99.99%. Thirteen additional registered E. coli O21:H25 assembled WGS data were obtained from EnteroBase and a phylogenetic tree was constructed.

Conclusions

With this study, the presence of stx2 harboring E. coli O21:H25 in milk was identified for the first time. Although the identified serotype is considered a non-pathogen seropathotype, we conclude it could play an important role in the environmental circulation of Stx-phages and consequently contribute to the emergence of new STEC-related outbreaks.
Work engagement among older workers: a systematic review
Authors: Mori Koji , Odagami Kiminori , Inagaki Mizuho , Moriya Kenta , Fujiwara Hidenori , Eguchi Hisashi
Published: November 2023

Objectives: Given current labor force conditions, including population aging, keeping older workers engaged in work and motivated is important. Aging may alter the effects that psychological and environmental factors have on work engagement. We conducted a systematic review to understand the features of work engagement among older workers.

Methods: A systematic search was conducted in July 2022 using 4 databases. The review included relevant articles that focused on participants aged 40 years and older.

Results: Fifty articles were selected for our review, which were grouped into 5 categories: (1) studies examining the relationship between chronological age and work engagement, (2) studies investigating the moderating effects of age on the relationship between job-related psychological factors and work environment factors and work engagement, (3) studies comparing the relationship of job-related psychological factors and work environment factors with work engagement across different age groups, (4) studies exploring the relationship between work engagement and retirement intentions or continued employment beyond retirement age, and (5) other studies discussing work engagement in the context of older workers. Most articles focused on workers in Europe and the United States and used observational study designs.

Conclusions: Work engagement increases with age, and is mainly mediated by increased emotional regulation. In addition, age moderates the relationships between various job-related psychological and work-environmental factors and work engagement. Work engagement is associated with working beyond retirement age. Organizations should understand the characteristics of work engagement among older workers and make age-conscious efforts to support them in adapting to social changes.
Breathing from the neck: Tracheostomy emergencies
Authors: Crawford Paul , Hypes Cameron
Published: November 2023

This chapter reviews commonly encountered tracheostomy emergencies. It briefly discusses tracheostomy placement and anatomy, including the anatomy of the innominate artery and the ideal location for tracheostomy placement. It then covers the various emergent presentations related to tracheostomies, focusing on tracheostomy bleeding and tracheo-innominate artery fistulas. It discusses etiologies of bleeding, concerning signs and features, and methods of evaluation as well as initial management. It includes figures demonstrating techniques used to control bleeding. The definitive management and disposition of these patients are also discussed. Finally, airway considerations for emergent ventilation are discussed. Specifically discussed are anatomic alterations and the possibility of laryngectomy and discontinuity of the oropharynx and the trachea.
The challenge down under: Subglottic airway access issues
Authors: Eppich Christopher I. , Mosier Jarrod M.
Published: November 2023

This chapter reviews a number of important points on how emergency physicians can recognize and manage subglottic airway access issues, such as tracheal stenosis, that occur in the emergency department. The authors review the common causes and possible presentations of patients with tracheal stenosis and provide guidance on how to manage the airway of these patients in the emergency setting. It also touches on other causes of subglottic airway access problems, including patients with laryngectomies and those with Montgomery T-tubes. The authors also discuss the anatomic challenges and complications as well as management options for patients presenting in respiratory distress.
Problems outside the lung: Pneumothorax and pleural effusions
Authors: Bruno John , Axelband Jennifer
Published: November 2023

Pleural diseases, including pleural effusion and pneumothorax, are widely prevalent in critically ill patients and contribute significantly to the morbidity and mortality of patients admitted to ICUs. Management often includes thoracentesis or tube thoracostomy, and drained pleural fluid can be analyzed for further diagnostics and evaluation using Light’s criteria. Lung ultrasound to facilitate pleural drainage or tube thoracostomy may decrease the rate of procedure-related complications. Infected pleural collections, including parapneumonic effusion and empyema, have a high rate of treatment failure and are particularly challenging to manage, often requiring several bedside and/or surgical procedures. They are best managed by a multidisciplinary team of intensivists, pulmonologists, and thoracic surgeons.
Intubated and boarded in the ED: Ventilator 101
Authors: Fozard Jessica , Shafer Krystle
Published: November 2023

Emergency physicians can be empowered by knowing the basics of how to safely ventilate patients with the mechanical ventilator. Learning how to initiate mechanical ventilation with appropriate settings is an important skill to learn, as inappropriate settings can increase length of stay, lengthen time on the ventilator, and negatively impact mortality. After choosing the mode of ventilator (the authors recommend volume-control mode), the four settings that must be set are respiratory rate, tidal volume, positive end-expiratory pressure, and fraction of inspired oxygen. A lung-protective ventilation strategy should be used for all patients. Additional parameters are titrated based on the patient’s comorbidities and indication for mechanical ventilation.
Too slow to go: Symptomatic bradycardia
Authors: VanDyck Tyler , Simpson Scott
Published: November 2023

The approach to bradycardia in the emergency department necessitates prompt, early recognition of the stability of the patient to guide treatment. For the unstable patient, treatment should proceed quickly from medications to pacing modalities, which include transcutaneous and transvenous approaches. Transcutaneous pacing can be provided in a quick, straightforward manner with most modern defibrillators. Progression to the use of temporary transvenous pacing is often required when the underlying etiology is not easily reversible. Emergency physicians must be familiar with the technical aspects of transvenous pacemaker insertion so that they can perform this procedure even if specialist consultation is not immediately available.
Brain on fire: Status epilepticus
Authors: Bux Michael , Niehaus Matthew T.
Published: November 2023

Status epilepticus (SE) is a diagnosis with a high morbidity and mortality rate, particularly in adults. It becomes increasingly difficult to treat with every delay in recognition or initiation care. SE is defined as a seizure lasting longer than 5 minutes or more than one seizure between which there is not full recovery of cognition. Treatment algorithms define four phases of care that should occur within the first hour of seizure: stabilization (first 5 minutes), initial therapy (emergent—benzodiazepine), second-tier therapies (urgent), and third-tier therapies (for refractory cases). The causes of SE are broad but will require investigation in order to correct the underlying etiology if possible. By recognizing patients and stabilizing them early with timely treatment, the astute emergency physician can reduce the risk of morbidity and mortality.
I can’t pee: Acute renal failure
Authors: Nobile Joseph , Dave Sagar B. , Haase Daniel
Published: November 2023

Acute kidney injury (AKI) is a problem that is commonly encountered in patients who present to the emergency department, and it can carry significant morbidity and mortality. AKI is a syndrome with many potential etiologies that can be divided and classified based on the anatomic relationship of the injury to the kidney. Emergency department management should be centered around identification, volume assessment, resuscitation, and stabilization of metabolic derangements that occur in severe AKI. Although it is emergently necessary in only a minority of patients, renal replacement therapy can be a lifesaving intervention for patients with severe AKI with life-threatening complications.
Hot as a hare: Critically ill toxidromes
Authors: Garcia Samuel , Skolnik Aaron
Published: November 2023

This chapter summarizes critical toxidromes that are commonly encountered in the emergency department and provides an in-depth review of anticholinergic poisoning. It describes the classic presentation for five common toxidromes: opioid, sedative–hypnotic, sympathomimetic, cholinergic, and anticholinergic. A case is presented of a patient with a known overdose of an anticholinergic drug who arrives to the emergency department in extremis: She is tachycardic, hypertensive, hyperthermic, and anhidrotic and has altered mentation. The presentation, diagnosis, treatment, and disposition of patients experiencing acute anticholinergic toxicity is reviewed. The management of anticholinergic toxicity using physostigmine versus non-antidote therapy is discussed based on current best evidence.
Dying in the Emergency Department: Death trajectories and palliative care in the emergency department
Authors: Pinto April Jessica , Elie Marie-Carmelle
Published: November 2023

End-of-life care in the emergency department (ED) has become increasingly prevalent as our population ages. Moreover, as the field of palliative care and hospice grows, it will be common to encounter patients in the ED that utilize hospice and palliative care services. Providers will need to be prepared to have the skills to engage in communication to ensure goal-concordant care. These skills also include strategies to enhance the palliation of symptoms during routine care, medical de-escalation, or withdrawal of life-prolonging treatments. Importantly, the management of transitional symptoms in the final hours of life aims to improve comfort for both the patient and their loved ones.
Introduction and Overview
Authors: Usrey W. Martin , Sherman S. Murray
Published: November 2023

The Cerebral Cortex and Thalamus is guided by two central and related tenets: the thalamus plays an ongoing and essential role in cortical functioning, and the cortex is essential for thalamic functioning. Accordingly, neither the cortex nor the thalamus can be understood in any meaningful way in the absence of the other. With chapters written by more than 100 leading experts in the field, The Cerebral Cortex and Thalamus provides a comprehensive account of the structure, function, development, and evolution of the circuitry interconnecting the thalamus and cortex and the consequences of pathology on these circuits. The introductory chapter provides important background information for the chapters that follow, as well as a discussion on some of the challenges facing progress in the understanding of the relationship between thalamus and cortex.
Heterogeneity of Thalamic Input Landscapes
Authors: Acsády László
Published: November 2023

Unlike cortical neurons, thalamocortical neurons are not connected to each other via a rich recurrant collateral system. As a consequence, thalamic computation is dominated by the integration of extrinsic inputs, not by the interactions among intrinsic elements. The thalamus represents a critical bottleneck in the communication between the cortex and the rest of the brain. The cortex provides by far the most numerous inputs to the thalamus but a variety of other afferents arise from almost the entire neuraxis. Axon terminals in the thalamus display substantial morphological heterogeneity and associated variability in short-term dynamics of neurotransmission. Axon terminals having different origins, transmitters, and synapse numbers can be integrated in many distinct ways in different thalamic territories. Thus there is no canonical input integration in the thalamus. Instead, a rich complexity of uni- and multisynaptic terminals in the thalamus suggests that a core feature of thalamic afferents is the heterogeneous dynamics of synaptic transmission associated with inputs having different number of synapses.
Neuromodulation in Cortical Circuits
Authors: Galvin Veronica C. , Disney Anita A.
Published: November 2023

The processing “state” of a cortical circuit is, in part, dynamically specified by the extracellular concentration of tens to hundreds of neuromodulatory molecules that originate from tissues across the brain and body. This neuromodulation is critical for proper cortical function, yet is relatively poorly understood. With a focus on primate cortex, this chapter introduces the 5 major neuromodulators of subcortical origin that are active in cortical circuits—acetylcholine, dopamine, histamine, norepinephrine, and serotonin—and also briefly considers the modulatory actions of the primary cortical neurotransmitters, glutamate and GABA. Particular attention is paid to the implications of the multiple cellular integrators for modulatory signals, and to evidence for, and consequences of, extrasynaptic transmission.