bluuebunny/crossref_metadata_2025 huggingface dataset:
Politicians are better at estimating public opinion when they think it is more salient
Authors: Butler Chris , Walgrave Stefaan , Soontjens Karolin , Loewen Peter John
Published: March 2024

Politicians’ perceptions of public opinion matter for substantive representation, but previous work has concluded that they do not have very accurate perceptions of voters’ policy preferences. We add to the debate on the drivers of perceptual accuracy by exploring whether politicians have a more accurate understanding of public opinion when it matters either to voters or themselves, or when politicians think it matters more to voters. Drawing on survey data collected among elected representatives and citizens in Belgium, Canada, Switzerland, and Germany, we show that politicians have a better understanding of public opinion when they think the issue matters to voters. Further, when an issue is personally important to politicians they more accurately estimate their party supporters’ opinions. The results confirm that politicians hold more accurate perceptions of voters’ preferences when they think it is important to do so, but not necessarily when the issues actually are important to voters.
Formative assessment in physical education: teachers’ experiences when designing and implementing formative assessment activities
Authors: Slingerland Menno , Weeldenburg Gwen , Borghouts Lars
Published: March 2024

Formative assessment (FA) is an effective educational approach for optimising student learning and is considered as a promising avenue for assessment within physical education (PE). Nevertheless, implementing FA is a complex and demanding task for in-service PE teachers who often lack formal training on this topic. To better support PE teachers in implementing FA into their practice, we need better insight into teachers’ experiences while designing and implementing formative strategies. However, knowledge on this topic is limited, especially within PE. Therefore, this study examined the experiences of 15 PE teachers who participated in an 18-month professional development programme. Teachers designed and implemented various formative activities within their PE lessons, while experiences were investigated through logbook entries and focus groups. Findings indicated various positive experiences, such as increased transparency in learning outcomes and success criteria for students as well as increased student involvement, but also revealed complexities, such as shifting teacher roles and insufficient feedback literacy among students. Overall, the findings of this study underscore the importance of a sustained, collaborative, and supported approach to implementing FA.
Beyond the neoliberal label: A historical perspective on sexual actors and responsibility in HIV prevention in England (1986–2023)
Authors: Martinez-Lacabe Alvaro
Published: March 2024

Framed across three distinct periods of the history of neoliberalism and the HIV epidemic in England, this article conducts a detailed examination of the concept of personal responsibility and its contested uses within HIV prevention. The article questions the theoretical potential of neoliberal subjectivities to comprehend behaviours related to the pharmaceuticalised governance (or lack thereof) of gay men’s sexual health, exploring the gap between theories emphasising individual responsibility and the practical experiences of gay men. The analysis draws on testimonials from gay men in oral history interviews and archival sources. The article illustrates how the pervasive notion of personal responsibility in England has been co-opted by neoliberal ideologies, leading to the stigmatisation of gay men whose sexual behaviours diverge from public health mandates. The widespread stigmatisation resulting from this ideology underscores a significant limitation in the theoretical framework of neoliberal subjectivities. This constraint extends beyond merely failing to grasp the complexity of sexual behaviours; it also reflects a lack of understanding of any other behaviour related to public health. Therefore, the article concludes by advocating the necessity of employing and constructing alternative theoretical frameworks to comprehend the pharmaceutical governance or lack thereof of gay men’s sexual health. Through a concise autoethnography of the authors’ pharmaceutical sexual health governance, the article introduces the concept of biocommesuration as an illustrative analysis that transcends the limitations of neoliberal subjectivities.
Adaptive fuzzy finite-time output feedback fault-tolerant control for MIMO stochastic nonlinear systems with non-affine nonlinear faults
Authors: Yue Hongyun , Xue Arong , Li Junmin
Published: March 2024

This paper investigates adaptive fuzzy finite-time output feedback fault-tolerant tracking control problem for multiple-input multiple-output (MIMO) stochastic non-strict feedback nonlinear systems with non-affine nonlinear faults and states unmeasured. Firstly, high-gain fuzzy state observers are constructed to overcome the state unmeasured problem in the system. Secondly, the mean-value theorem and input compensation techniques are employed to decouple non-affine nonlinear faults, and the resulting unknown control coefficients problem is handled using Nussbaum functions. In addition, dynamic surface control techniques and error compensation mechanisms are considered in the controller design, which effectively decreases the computational complexity of the control scheme. By combining the adaptive backstepping technique with finite-time control, a novel adaptive fuzzy dynamic surface finite-time output feedback fault-tolerant tracking control algorithm is proposed. The designed controller guarantees that all signals in the stochastic systems are semi-global finite-time stable in probability (SGFSP) as well as the tracking errors can converge to a small neighborhood within the origin in finite-time. Finally, two simulation examples are introduced to verify the effectiveness of the suggested control strategy.
Effects of rejuvenators and aging conditions on the properties of blended bitumen and the cracking behavior of hot asphalt mixtures with a high RAP content
Authors: Nguyen Lan Ngoc , Truong Van Quyet , Dao Dong Van , Nguyen May Huu , Tran Trung
Published: March 2024

The utilization of Reclaimed Asphalt Pavement (RAP) in asphalt pavement has obtained global popularity because of its cost-efficiency, technical advantages, and positive environmental influence. However, incorporating RAP requires careful consideration of cracking resistance because of the existence of age hardening of bitumen in RAP. For the mixtures containing high RAP contents, rejuvenators are often applied to enhance the performances of aged bitumen and the cracking of mixtures. This research aims to evaluate the effects of different rejuvenators on the rheological properties of bitumen and the cracking resistance of the mixture under short and long-term aging conditions. To achieve this goal, three rejuvenators - namely, RA1 (petroleum-based), RA2 (waste vegetable oil-based), and RA3 (modified soybean oil-based) were evaluated at contents of 0%, 4%, 12%, and 20%, respectively. The dynamic shear rheometer (DSR) test results show that, under unaged and rolling thin-film oven (RTFO) aging conditions, blended bitumen with RA1 and RA3 have higher G*/sinδ than RA2. Conversely, under pressure aging vessel (PAV) aging conditions, blended bitumen with RA1 and RA3 has lower G*sinδ than that with RA2. Regarding the cracking resistance, the indirect tension asphalt cracking test results show that, under short-term oven aging (STOA) conditions, the mixture using RA2 and RA3 has a higher cracking tolerance index (CTIndex) than the one with RA1. However, under long-term oven aging (LTOA) conditions, the mixture using RA1 has the highest CTIndex value. In addition, the high correlations between G*sinδ with CTIndex and post-peak slope (|m75|) and between the CTIndex and |m75| are observed.
Mind the gaps: Challenges of implementing policy for Scotland's rural third sector
Authors: Mesek Melissa , Pérez-Landa Alejandro Jordan , Smith Anne MJ , Stouraitis Vasilios , Sheikh Shariq
Published: March 2024

After Brexit, pandemics and through continuing global economic shocks, the rural third sector continues to navigate a landscape of crisis and challenge while serving communities. We examine Scottish Government policy for the rural third sector and policy implementation mechanisms. Our paper argues, and our evidence shows, that current policy is aspirational and there are deficiencies between rural third sector policy making, policy implementation and the voice of rural communities. Our critical review of Scottish Government documentation examined policy for the third sector in rural conditions, then continued to search government documentation for evidence of action plans and viable implementation strategies. We found that policy makers were aspirational, there are few mechanisms or action plans that support sustainable policy implementation and limited examples of ongoing community consultation. The concern is that while gaps exist between policy making and implementation, government policy will underperform leaving a rural third sector struggling to service their communities and deliver their social mission.
Unraveling the white working-class conundrum: A closer look at its utility and pitfalls
Authors: Taylor Hill Sam
Published: March 2024

The term “white working-class” has emerged as a focal point in recent discourse, igniting fervent debates around its usage and purpose. Critics like Gillborn have contended that the term, often wielded by right-leaning academics and commentators, artificially segregates the working-class. In this article I seek to understand this, and other criticisms raised in relation to the rise of populism, which have been aimed at the usage and purpose of the term “white working-class”. By weighing these criticisms against one another and acknowledging the intersectionality inherent in class formation, I propose a more specific and limited application of the term that I think better aligns with scholarly pursuits and helps to mitigate some of these critics core concerns around the term’s overgeneralisation in-particular. Thus, while I also acknowledge that the term “white working-class” ignites debate, it can also unveil intricate social realities, as evidence from Skeggs and Reay suggest. It must ultimately be employed judiciously to avoid sidelining the struggles of other marginalised groups within the class. Balancing its use with caution is essential to harness its potential without undermining the broader context of class-based issues that affect individuals from all backgrounds.
The Good, the Bad, and the Narrative: How Youth Experience the ‘Gangsta’ in Rap Music
Authors: Dollinger Bernd
Published: March 2024

Rap is a music genre that is as dynamic and internationally successful as it is extensively discredited. This contribution begins here by focusing on the perception of young rap fans and asking what meaning they attach to rap specifically with regard to the criminality of gangstas. The empirical basis for the analyses is an ethnographic study with young rap fans in Germany. The results show that rappers as gangstas have a high identification potential for the young people – but not in every case. Rappers have to be authentic and show the young people possibilities to find ways out of disadvantaged and discriminating living conditions, if necessary with the help of crime. To appear credible in this respect, gangstas must rap about actual crimes and communicate experiences with which the young people, for their part, are familiar.
Structural rotor rub-impact diagnosis under intricate noise interferences based on targeted component extraction and stochastic resonance enhancement
Authors: Hou Yaochun , Wang Huan , Wang Yuxuan , Wu Peng , Huang Wenjun , Wu Dazhuan
Published: March 2024

Rub-impact is a common nonlinear fault of the rotor system, occurring in rotating machines with radial clearance between the rotor and the stator, which may lead to serious consequences. Since the vibration response of rotor rub-impact is shown as multicomponent with time-varying characteristics of undulatory instantaneous frequency, it is desired to exploit advanced signal processing methods for rub-related feature excavation and failure diagnosis under complex noise interferences, which is of crucial significance to ensure the stable and efficient operation of the whole unit. This paper concerns the processing of acceleration signals and proposes a novel intrawave frequency modulation detection approach for structural rotor rubbing diagnosis based upon targeted component extraction and stochastic resonance enhancement. First, the acquired vibratory acceleration signal is converted into displacement signal via a two-stage integration strategy. Next, to extract the rotating frequency component of high information clarity for further time–frequency analysis from the multicomponent signal, an especially designed improved variational mode decomposition method based on the modified target frequency index is put forward, and the instantaneous frequency of the objective component is estimated. Then, the optimum stochastic resonance is leveraged for intrawave frequency modulation enhancement. Finally, the rotor rub-related symptom can be distinctly revealed and the diagnostic procedure can be performed. The effectiveness and superiority of the proposed rotor rub-impact diagnosis approach are demonstrated through both simulations and experiments, indicating that it is suitable to be implemented in practical applications, with high noise-resistance ability, and can efficiently extract the potential characteristics of rotor rub-impact malfunction from multicomponent signals.
Double, Double Toil and Trouble: Recurrent Episodes of Status Epilepticus Are Associated With Increasingly Worse Outcomes
Authors: Gaspard Nicolas
Published: March 2024

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Contemporary Assessment of Adhesiolysis and Resection for Adhesive Small Bowel Obstruction in the State of New York
Authors: Symer Matthew M. , Zheng Xinyan , Pua Bradley B. , Sedrakyan Art , Milsom Jeffrey W.
Published: March 2024

Background

Adhesive small bowel obstruction (aSBO) is a common surgical problem, with some advocating for a more aggressive operative approach to avoid recurrence. Contemporary outcomes in a real-world setting were examined.

Study Design

A retrospective cohort study was performed using the New York Statewide Planning and Research Cooperative database to identify adults admitted with aSBO, 2016-2020. Patients were stratified by the presence of inflammatory bowel disease (IBD) and cancer history. Diagnoses usually requiring resection were excluded. Patients were categorized into four groups: non-operative, adhesiolysis, resection, and ‘other’ procedures. In-hospital mortality, major complications, and odds of undergoing resection were compared.

Results

58,976 patients were included. 50,000 (84.8%) underwent non-operative management. Adhesiolysis was the most common procedure performed (n = 4,990, 8.46%), followed by resection (n = 3,078, 5.22%). In-hospital mortality in the lysis and resection groups was 2.2% and 5.9% respectively. Non-IBD patients undergoing operation on the day of admission required intestinal resection 29.9% of the time. Adjusted odds of resection were highest for those with a prior aSBO episode (OR 1.29 95%CI 1.11-1.49), delay to operation ≥3 days (OR1.78 95%CI 1.58-1.99), and non-New York City (NYC) residents being treated at NYC hospitals (OR1.57 95%CI 1.19-2.07).

Conclusion

Adhesiolysis is currently the most common surgery for aSBO, however nearly one-third of patients will undergo a more extensive procedure, with an increased risk of mortality. Innovative therapies are needed to reduce the risk of resection.
Laparoscopic-assisted retrieval of inferior vena cava filter: A case report and literature review
Authors: Wang Chenghao , Liu Qingquan , Xiao Dalei , Chen Xiaohua , Liu Rong , Wang Shikai
Published: March 2024

Background

The retrieval of inferior vena cava filters beyond the retrieval window poses challenges, requiring alternative techniques.

Objectives

To discuss the laparoscopy-assisted retrieval approach for difficult inferior vena cava filters.

Research Design

Case report.

Subjects

A 57-year-old male with a retrievable inferior vena cava filter placed 8 months prior.

Measures

Laparoscopy-assisted retrieval technique utilized after unsuccessful interventional attempts.

Results

Successful retrieval of the filter despite thickened intimal tissue involvement, with no postoperative complications.

Conclusions

Laparoscopy-assisted retrieval offers a direct visual approach for challenging filter removal, proving minimally invasive, safe, and effective.
“When” Versus “Whether” Gender/Sex Differences: Insights From Psychological Research on Negotiation, Risk-Taking, and Leadership
Authors: Bowles Hannah R. , Mazei Jens , Liu Heidi H.
Published: March 2024

We present a conceptual framework of situational moderators of gender/sex effects in negotiation, risk-taking, and leadership—three masculine-stereotypic domains associated with gender/sex gaps in pay and authority. We propose that greater situational ambiguity and higher relevance and salience of gender/sex increase the likelihood of gender/sex-linked behaviors in these domains. We argue that greater ambiguity increases the extent to which actors and audiences must search inwardly (e.g., mental schema, past experience) or outwardly (e.g., social norms) for cues on how to behave or evaluate a situation and thereby widens the door for gender/sex-linked influences. Correspondingly, we propose that gender/sex effects on behavior and evaluations in these domains will be more likely when gender/sex is more relevant and salient to the setting or task. We propose further that these two situational moderators may work jointly or interactively to influence the likelihood of gender/sex effects in negotiation, risk-taking, and leadership. We conclude by discussing applications of our conceptual framework to psychological science and its translation to practice, including directions for future research.
Reducing the global burden of cerebral venous thrombosis: An international research agenda
Authors: Coutinho Jonathan M , van de Munckhof Anita , Aguiar de Sousa Diana , Poli Sven , Aaron Sanjith , Arauz Antonio , Conforto Adriana B , Krzywicka Katarzyna , Hiltunen Sini , Lindgren Erik , Sánchez van Kammen Mayte , Shu Liqi , Bakchoul Tamam , Belder Rosalie , van den Berg René , Boumans Elisheva , Cannegieter Suzanne , Cano-Nigenda Vanessa , Field Thalia S , Fragata Isabel , Heldner Mirjam R , Hernández-Pérez María , Klok Frederikus A , Leker Ronen R , Lucas-Neto Lia , Molad Jeremy , Nguyen Thanh N , Saaltink Dirk-Jan , Saposnik Gustavo , Sharma Pankaj , Stam Jan , Thijs Vincent , van der Vaart Michiel , Werring David J , Wong Ramos Diana , Yaghi Shadi , Yeşilot Nilüfer , Tatlisumak Turgut , Putaala Jukka , Jood Katarina , Arnold Marcel , Ferro José M
Published: March 2024

Background:

Due to the rarity of cerebral venous thrombosis (CVT), performing high-quality scientific research in this field is challenging. Providing answers to unresolved research questions will improve prevention, diagnosis, and treatment, and ultimately translate to a better outcome of patients with CVT. We present an international research agenda, in which the most important research questions in the field of CVT are prioritized.

Aims:

This research agenda has three distinct goals: (1) to provide inspiration and focus to research on CVT for the coming years, (2) to reinforce international collaboration, and (3) to facilitate the acquisition of research funding.

Summary of review:

This international research agenda is the result of a research summit organized by the International Cerebral Venous Thrombosis Consortium in Amsterdam, the Netherlands, in June 2023. The summit brought together 45 participants from 15 countries including clinical researchers from various disciplines, patients who previously suffered from CVT, and delegates from industry and non-profit funding organizations. The research agenda is categorized into six pre-specified themes: (1) epidemiology and clinical features, (2) life after CVT, (3) neuroimaging and diagnosis, (4) pathophysiology, (5) medical treatment, and (6) endovascular treatment. For each theme, we present two to four research questions, followed by a brief substantiation per question. The research questions were prioritized by the participants of the summit through consensus discussion.

Conclusions:

This international research agenda provides an overview of the most burning research questions on CVT. Answering these questions will advance our understanding and management of CVT, which will ultimately lead to improved outcomes for CVT patients worldwide.
Traditional game of spinning top gone wrong: Short communication of a pediatric facial penetrating injury
Authors: Khoo Jing Hern , Te Boon Chin , Sachlin Ida Sadja’ah
Published: March 2024

Introduction

A spinning top is a traditional game in some countries. The top is often made of wood or mud and the bottom is made of a sharp metal pin. Penetrating injuries can occur if the spinning top is incorrectly thrown.

Case report

We report a spinning top penetrating injury on the nose of an 8-year-old girl. Clinical examination revealed a spinning top that had penetrated her nasal bridge. Plain computed tomography (CT) of paranasal sinuses revealed a spinning top with its sharp pointed nail penetrating through the left nasal bone into the left nasal cavity. Examination under general anesthesia and rigid nasoendoscopy showed the tip of spinning top situated in between middle turbinate and nasal septum. The spinning top was then removed following the direction of entry.

Discussion

While air gun pellet facial injuries in pediatric patients have been reported, other playthings as culprits of facial penetrating injuries is still unheard of. Projectile objects can easily penetrate pediatric facial skeleton due to thinner facial bones. It is vital to exclude life- and sightthreatening injuries first, followed by imaging to assist decision-making and surgical planning. Computed tomography (CT) imaging is the gold standard for the radiographic evaluation of facial injuries. It assists in evaluating trauma extent, trajectory, depth, and course of foreign body. Following that, examination under anaesthesia including rigid nasal endoscopy is warranted.

Conclusion

We would like to highlight the importance of parental supervision and the value of pre-operative imaging. Neglecting seemingly harmless children’s toys can potentially cause fatal injuries.
Colonic malakoplakia in a pediatric renal transplant recipient case report
Authors: Valencia Deray Kristen G , Kellermayer Richard , Gomez Alexis C , Patel Kalyani R , Imani Peace , Kitagawa Seiji , Bocchini Claire E , Orjuela Alvaro
Published: March 2024

Malakoplakia is a rare, chronic granulomatous disease that mainly affects the genitourinary system of immunocompromised adults. It is caused by a bactericidal deficit in macrophages and, therefore, the treatment includes antimicrobials that reach high concentrations in macrophages. To our knowledge, we present the first case of malakoplakia in a pediatric solid organ transplant recipient. Our patient is a 15-year-old male renal transplant recipient who presented with recurrent diarrhea. Blood, urine, and gastrointestinal pathogen panel testing were positive for enteroaggregative Escherichia coli. A colonoscopy revealed diffuse malakoplakia. He had a complete resolution of symptoms with trimethoprim-sulfamethoxazole therapy. Unfortunately, his malakoplakia recurred after 9 months prompting the transition of therapy to oral gentamicin with subsequent remission. Malakoplakia should be considered in the differential of solid organ transplant recipients with recurrent gastrointestinal infections.
Combination drug therapy by herbal nanomedicine prevent multidrug resistance protein 1: promote apoptosis in Lung Carcinoma
Authors: Alemi Ashraf , Karamallah Mojtaba Haghi , Sabaghan Mohamad , Hosseini Seyed Ahmad , Veisi Ali , Karamallah Somayeh Haghi , Farokhifar Mohammad
Published: March 2024

Given the numerous adverse effects of lung cancer treatment, more research on non-toxic medications is urgently needed. Curcumin (CUR) and berberine (BBR) combat drug resistance by controlling the expression of multidrug resistant pump (MDR1). Fascinatingly, combining these medications increases the effectiveness of preventing lung cancer. Their low solubility and poor stability, however, restrict their therapeutic efficacy. Because of the improved bioavailability and increased encapsulation effectiveness of water-insoluble medicines, surfactant-based nanovesicles have recently received a great deal of attention. The current study sought to elucidate the Combination drug therapy by herbal nanomedicine prevent multidrug resistance protein 1: promote apoptosis in Lung Carcinoma. The impact of several tween (20, 60, and 80) types with varied hydrophobic tails on BBR/CUR-TNV was evaluated. Additionally, the MDR1 activity and apoptosis rate of the BBR/CUR-TNV combination therapy were assessed. The encapsulation effectiveness of TNV was affected by the type of tween. With the TNV made from tween 60, cholesterol, and PEG (47.5: 47.5:5), more encapsulation effectiveness was attained. By combining CUR with BBR, especially when given in TNV, apoptosis increased. Additionally, when CUR and BBR were administered in combination, they significantly reduced the risk of MDR1 development. The current work suggests that the delivery of berberine and curcumin as a combination medication therapy via tween-based nanovesicles may be a potential lung cancer treatment.
H pylori-Negative MALT-Associated Extranodal Marginal Zone Lymphoma: A Comprehensive Case Report and Literature Review
Authors: Qureshi Ammar , Patel Akash , Ajumobi Adewale B.
Published: March 2024

Extranodal marginal zone B-cell lymphoma (ENMZL) of mucosa-associated lymphoid tissue (MALT), a rare subtype of B-cell lymphoma, is typically associated with Helicobacter pylori ( H pylori) infection, especially in gastric cases. However, this article presents 2 unique cases of H pylori-negative colonic ENMZL, challenging the conventional understanding of the disease. The first case involves an 80-year-old male diagnosed with Stage 1E ENMZL in the descending colon, and the second describes a 74-year-old male with sigmoid colon ENMZL. Both cases lacked H pylori infection, adding complexity to their management. Accompanying these case studies is a comprehensive literature review, delving into the epidemiology, pathology, clinical features, diagnosis, and treatment of H pylori-negative ENMZL, with a focus on gastrointestinal involvement. This review highlights the importance of considering H pylori-negative cases in ENMZL diagnosis and management, illustrating the need for further research and individualized treatment approaches in this uncommon lymphoma subtype.
“Thinking Like an Activist”: Preservice Teachers Make Sense of the Past
Authors: Doornbos Linda , Piedmont Erin
Published: March 2024

History education holds strong potential for students to examine how racism and other intersecting forms of oppression embedded within U.S. institutions have and still impact today’s social fabric. When rooted in Martell and Stevens’ “thinking like an activist” framework, history education provides opportunities for preservice teachers (PSTs) to see, understand, and disrupt the dominant narrative. They can begin to reimagine their roles as future leaders in the classroom and beyond to ensure that all students thrive and not just survive. Thus, for this qualitative study, we engaged our PST in a book study of A Different Mirror for Young People: A History for Multicultural America. Through intentional content and pedagogical choices, we investigated the question, “ How do preservice teachers make sense of history using the ‘thinking like an activist’ framework?” Findings indicated how Takaki’s different mirror, as a counternarrative centering the perspectives and experiences of historically marginalized groups, allowed PSTs 1) to unlearn oppressive structures (cultural preparation), 2) begin to develop a sociopolitical consciousness of systemic oppression, albeit through an outsider’s perspective (critical analysis), and 3) to analyze how collective action in the past enacted change–although through an already, but not yet, understanding of their role in social change in the present (collective action).
Transition From Normative to Criterion-Based Grading in the Obstetrics and Gynecology Clerkship
Authors: Abraham Cynthia
Published: March 2024

OBJECTIVES

To compare grades, National Board of Medical Examiners (NBME) Shelf Exam scores, and student satisfaction with the Obstetrics and Gynecology (OB/GYN) clerkship after transitioning from normative to criterion-based grading.

METHODS

Between July 2021 and July 2022, the Icahn School of Medicine at Mount Sinai (ISMMS) adhered to a normative grading scheme in which ∼60% of students achieved a grade of Honors, 30% achieved a grade of High Pass and 10% achieved a grade of Pass for the OB/GYN clerkship. In July 2022, ISMMS transitioned to a criterion-based scheme. In this scheme, 6 competencies were created. Criteria were determined for each competency, delineating achieving a score of “Pass” versus “Honors” for the specific objective. Students needed to meet the criteria for Honors for 4 out of 6 of the competencies in order to ultimately receive a grade of Honors for the clerkship. The number of students achieving Honors, NBME shelf exam scores, and student clerkship satisfaction ratings between the normative and criterion-based schemes were compared.

RESULTS

The number of students studying in academic year (AY) 2021–2022 and AY 2022–2023 were 134 and 137, respectively. A significantly lower percentage of students received Honors in AY 2021–2022 than in AY 2022–2023 (66% vs. 96%, P < .01). Mean exam scores were significantly higher for those receiving Honors in AY 2021–2022 than in AY 2022–2023 ( P < .05); scores for AY 2021–2022 and AY 2022–2023 were 78.9, 95% CI [77.6, 80.1] and 76.7, 95% CI [75.6, 77.8], respectively. Mean exam scores for all students were not significantly different between the 2 academic cohorts (77.8 vs. 76.2, P = .06). Clerkship satisfaction rating was significantly higher in AY 2022–2023 than in AY 2021–2022 (4.1 vs. 3.7, P < .05).

CONCLUSIONS

These findings support a paradigm that compares learner performance to predefined measures as opposed to peer performance.
Absent leptomeningeal collateralization is associated with greatest benefit from mechanical thrombectomy in the 6-24 hour time window
Authors: Dittrich Tolga D , von Streng Tennessee , Toebak Anna M , Zietz Annaelle , Wagner Benjamin , Hänsel Martin , Sutter Raoul , Katan Mira , Peters Nils , Michels Lars , Kulcsár Zsolt , Karwacki Grzegorz M , Pileggi Marco , Cereda Carlo W , Wegener Susanne , Bonati Leo H , Psychogios Marios , De Marchis Gian Marco
Published: March 2024

Introduction:

The impact of leptomeningeal collateralization on the efficacy of mechanical thrombectomy (MT) in patients with anterior circulation large vessel occlusion (aLVO) presenting in the 6-24 h time window remains poorly elucidated.

Patients and methods:

Retrospective multicenter study of aLVO patients presenting between 6 and 24 h after stroke onset who received MT plus Best Medical Treatment (BMT) or BMT alone. Leptomeningeal collateralization was assessed using single-phase computed tomography angiography (grade 0: no filling; grade 1: filling ⩽50%; grade 2: filling >50% but <100%; grade 3: filling 100% of the occluded territory). Inverse probability of treatment weighted ordinal regression was performed to assess the association between treatment and shift of the modified Rankin Scale (mRS) score toward lower categories at 3 months. We used interaction analysis to explore differential treatment effects on functional outcomes (probabilities for each mRS subcategory at 3 months) at different collateral grades.

Results:

Among 363 included patients, 62% received MT + BMT. Better collateralization was associated with better functional outcomes at 3 months in the BMT alone group (collateral grade 1 vs 0: acOR 5.06, 95% CI 2.33–10.99). MT + BMT was associated with higher odds of favorable functional outcome at 3 months (acOR 1.70, 95% CI 1.11–2.62) which was consistent after adjustment for collateral status (acOR 1.54, 95% CI 1.01–2.35). Regarding treatment effect modification, patients with absent collateralization had higher probabilities for a mRS of 0–4 and a lower mortality at 3 months for the MT + BMT group.

Discussion and conclusion:

In the 6-to-24-h time window, aLVO patients with absent leptomeningeal collateralization benefit most from MT + BMT, indicating potential advantages for this group despite their poorer baseline prognosis.
Re-attaching to coal in a Climate Emergency: The case of the Whitehaven mine
Authors: Lewis Pancho
Published: March 2024

This paper draws on the concept of ‘attachment’ to examine pro-coal sentiment in Whitehaven – an English town at the centre of global political controversy because of a plan to open a coal mine in the area. Drawing on fieldwork data, I show that pro-mine persuasions among some residents are underpinned by a process of ‘re-attaching’ to coal. I argue that the case of the Whitehaven mine is a warning about how fossil fuels might re-emerge as promissory objects in other parts of the world, even when a transition away from fossil fuels has been completed. Paradoxically, the very disorientations and deepening traumas that climate change is causing threaten to spur on the rise of fossil fuel (re-)attachments. The paper also examines how pro-coal discourses linked to wider vested interests are received in a context where coal exists as ‘afterlife’. Consequently, local actors construct narratives that legitimise new coal extraction by (re)articulating discourses of delay. My findings are thus a reminder of the need to guard against over-valorising ‘the grassroots’, arguably a risk in environmental justice scholarship. I conclude by calling for further empirical research on the way attachments to high-carbon objects are (re/de)composed, an urgent task given the need for rapid societal decarbonisation – one which has received very little attention to date.
How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders?
Authors: Tilhou Alyssa Shell , Burns Marguerite , Chachlani Preeti , Chen Ying , Dague Laura
Published: March 2024

Background:

Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown.

Methods:

Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake (“offset”), and the share of visits completed by telemedicine (“share”).

Results:

The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only.

Conclusions:

Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.
Evidence for antigen presentation by human neutrophils
Authors: Moffat Angus , Gwyer Findlay Emily
Published: March 2024

Neutrophils are the first migrating responders to sterile and infectious inflammation and act in a powerful but nonspecific fashion to kill a wide variety of pathogens. It is now apparent that they can also act in a highly discriminating fashion; this is particularly evident in their interactions with other cells of the immune system. It is clear that neutrophils are present during the adaptive immune response, interacting with T cells in complex ways that differ between tissue types and disease state. One of the ways in which this interaction is mediated is by neutrophil expression of HLA molecules and presentation of antigen to T cells. In mice, this is well established to occur with both CD4+ and CD8+ T cells. However, the evidence is less strong with human cells. Here, we assembled available evidence for human neutrophil antigen presentation. We find that the human cells are clearly able to upregulate HLA-DR and costimulatory molecules; are able to process protein antigen into fragments recognized by T cells; are able to enter lymph node T cell zones; and, in vitro, are able to present antigen to memory T cells, inducing proliferation and cytokine production. However, many questions remain, particularly concerning whether the cell-cell interactions can last for sufficient time to trigger naïve T cells. These experiments are now critical as we unravel the complex interactions between these cells and their importance for the development of human immunity.
Decryption of the survival “black box”: gene family expansion promotes the encystment in ciliated protists
Authors: Jin Didi , Li Chao , Chen Xiao , Wang Yurui , Al-Rasheid Khaled A. S. , Stover Naomi A. , Shao Chen , Zhang Tengteng
Published: March 2024

Background

Encystment is an important survival strategy extensively employed by microbial organisms to survive unfavorable conditions. Single-celled ciliated protists (ciliates) are popular model eukaryotes for studying encystment, whereby these cells degenerate their ciliary structures and develop cyst walls, then reverse the process under more favorable conditions. However, to date, the evolutionary basis and mechanism for encystment in ciliates is largely unknown. With the rapid development of high-throughput sequencing technologies, genome sequencing and comparative genomics of ciliates have become effective methods to provide insights into above questions.

Results

Here, we profiled the MAC genome of Pseudourostyla cristata, a model hypotrich ciliate for encystment studies. Like other hypotrich MAC genomes, the P. cristata MAC genome is extremely fragmented with a single gene on most chromosomes, and encodes introns that are generally small and lack a conserved branch point for pre-mRNA splicing. Gene family expansion analyses indicate that multiple gene families involved in the encystment are expanded during the evolution of P. cristata. Furthermore, genomic comparisons with other five representative hypotrichs indicate that gene families of phosphorelay sensor kinase, which play a role in the two-component signal transduction system that is related to encystment, show significant expansion among all six hypotrichs. Additionally, cyst wall-related chitin synthase genes have experienced structural changes that increase them from single-exon to multi-exon genes during evolution. These genomic features potentially promote the encystment in hypotrichs and enhance their ability to survive in adverse environments during evolution.

Conclusions

We systematically investigated the genomic structure of hypotrichs and key evolutionary phenomenon, gene family expansion, for encystment promotion in ciliates. In summary, our results provided insights into the evolutionary mechanism of encystment in ciliates.
Generalizability of machine learning in predicting antimicrobial resistance in E. coli: a multi-country case study in Africa
Authors: Nsubuga Mike , Galiwango Ronald , Jjingo Daudi , Mboowa Gerald
Published: March 2024

Background

Antimicrobial resistance (AMR) remains a significant global health threat particularly impacting low- and middle-income countries (LMICs). These regions often grapple with limited healthcare resources and access to advanced diagnostic tools. Consequently, there is a pressing need for innovative approaches that can enhance AMR surveillance and management. Machine learning (ML) though underutilized in these settings, presents a promising avenue. This study leverages ML models trained on whole-genome sequencing data from England, where such data is more readily available, to predict AMR in E. coli, targeting key antibiotics such as ciprofloxacin, ampicillin, and cefotaxime. A crucial part of our work involved the validation of these models using an independent dataset from Africa, specifically from Uganda, Nigeria, and Tanzania, to ascertain their applicability and effectiveness in LMICs.

Results

Model performance varied across antibiotics. The Support Vector Machine excelled in predicting ciprofloxacin resistance (87% accuracy, F1 Score: 0.57), Light Gradient Boosting Machine for cefotaxime (92% accuracy, F1 Score: 0.42), and Gradient Boosting for ampicillin (58% accuracy, F1 Score: 0.66). In validation with data from Africa, Logistic Regression showed high accuracy for ampicillin (94%, F1 Score: 0.97), while Random Forest and Light Gradient Boosting Machine were effective for ciprofloxacin (50% accuracy, F1 Score: 0.56) and cefotaxime (45% accuracy, F1 Score:0.54), respectively. Key mutations associated with AMR were identified for these antibiotics.

Conclusion

As the threat of AMR continues to rise, the successful application of these models, particularly on genomic datasets from LMICs, signals a promising avenue for improving AMR prediction to support large AMR surveillance programs. This work thus not only expands our current understanding of the genetic underpinnings of AMR but also provides a robust methodological framework that can guide future research and applications in the fight against AMR.
Health-related social needs information in the emergency department: clinician and patient perspectives on availability and use
Authors: Mazurenko Olena , Hirsh Adam T , Harle Christopher A , McNamee Cassidy , Vest Joshua R
Published: March 2024

Background

Patient health-related social needs (HRSN) complicate care and drive poor outcomes in emergency department (ED) settings. This study sought to understand what HRSN information is available to ED physicians and staff, and how HRSN-related clinical actions may or may not align with patient expectations.

Methods

We conducted a qualitative study using in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. We asked ED providers, ED staff, and ED patients from one health system in the mid-Western United Stated about HRSN information availability during an ED encounter, HRSN data collection, and HRSN data use. Interviews were recorded, transcribed, and analyzed using modified thematic approach.

Results

We conducted 24 interviews (8 per group: ED providers, ED staff, and ED patients) from December 2022 to May 2023. We identified three themes: (1) Availability: ED providers and staff reported that HRSNs information is inconsistently available. The availability of HRSN data is influenced by patient willingness to disclose it during an encounter. (2) Collection: ED providers and staff preferred and predominantly utilized direct conversation with patients to collect HRSNs, despite other methods being available to them (e.g., chart review, screening questionnaires). Patients’ disclosure preferences were based on modality and team member. (3) Use: Patients wanted to be connected to relevant resources to address their HRSNs. Providers and staff altered clinical care to account for or accommodate HRSNs. System-level challenges (e.g., limited resources) limited provider and staff ability to address patients HRSNs.

Conclusions

In the ED, HRSNs information was inconsistently available, collected, or disclosed. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. Accounting for such difference in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.
Evaluating CPR training: simulation vs. webinars for Iranian emergency medical technicians during COVID-19
Authors: Sarboozi-Hosseinabadi Shoaib , Sharifzadeh Gholamreza , Hosseini Seyed Mohammadreza
Published: March 2024

Introduction

The high prevalence of COVID-19 and the necessity for social distancing have impacted medical training. On the one hand, the high mortality rate following the disease led the American Heart Association (AHA) to issue guidelines in October 2020 for performing cardiopulmonary resuscitation on patients diagnosed or suspected of having COVID-19. Various methods exist for teaching these guidelines. However, the use of many of these methods is greatly challenged due to the high risk of disease transmission. Moreover, the published guidelines emphasize protection against COVID-19 infection. The present study aims to compare the impact of two educational methods, educational webinars and simulations, on the competence of performing cardiopulmonary resuscitation during the COVID-19 epidemic.

Methods

This semi-experimental study was conducted on 70 emergency medical technicians. A pre-test was administered to all participants, and then they were randomly assigned into two groups: an educational webinar group (35 people) and a simulation group (35 people). The educational webinar group received online training using Adobe Connect software version 2.6.9, while the simulation group received in-person training using a manikin simulator. The competence of performing cardiopulmonary resuscitation during the COVID-19 epidemic was compared between the two groups immediately after the training and again two months later. Data collection instruments utilized in this research included a demographic questionnaire and a competency questionnaire in performing CPR during the COVID-19 pandemic. The data were analyzed using SPSS software version 19 and statistical tests for comparison.

Results

The results indicated that in both the educational webinar and simulation groups, the average competence score for performing cardiopulmonary resuscitation (CPR) at the three stages under investigation showed significant differences (p < 0.001). Additionally, in both groups under study, the average competence score for performing CPR immediately and two months after training was significantly higher compared to before the training (p < 0.001); however, two months after training, it was significantly lower compared to immediately after the training (p < 0.001).

Conclusions

Based on the results obtained from the current research, both educational methods (educational webinar and simulation) had a significant effect on the competence of performing CPR during the COVID-19 epidemic and were equally effective. Moreover, the recall test results (two months later) showed a decrease in the competence of performing CPR during the COVID-19 epidemic in both training methods (webinar and simulation), indicating the need for periodic CPR training.