bluuebunny/crossref_metadata_2025 huggingface dataset:
Blue diode lasers – Understanding and influencing melt pool dynamics in copper
Authors: Heine L. , Schlett M. , Britten S. , Arndt A. , Spurk C. , Hummel M. , Beckmann F. , Moosmann J.
Published: December 2023

Within the last years an increasing demand of copper components was observed, especially in the fields of energy transition, e-mobility, or digitalization. For joining those components, laser welding has become more and more popular. Infrared lasers are commonly used for metal welding. They are characterized by a low absorptivity in solid copper at room temperature. In contrast, lasers in the blue wavelength spectrum are characterized by a significantly higher absorptivity. This facilitates the initial energy input into the material and makes the welding process more efficient. Further, in the liquid state, the absorptivity change in copper is much smaller for the blue wavelength. This results in a continuous heating of the material, a more stable melt pool and a lower amount of spatter. One supplier of lasers in the visible wavelength spectrum is Laserline. In 2023, they launched a 4 kW blue diode laser, the currently highest available power for this wavelength. It makes accessible a broad variety of applications. But the scientific investigations for the blue wavelength at a power of several kilowatt are still limited. It is the paper’s purpose to extend them by analysing welding of copper and its alloys with a blue diode laser. One the one hand, synchrotron trials were performed allowing a look into the material during welding. A special focus was on the transition between heat conduction and deep penetration welding as well as the keyhole behaviour. On the other hand, conventional welding trials were performed analysing the impact of beam shaping on the melt pool dynamics.
Laser-induced reduction of iron ore: Trends of the chemical distribution across the domains
Authors: Kaplan A F H , Fedina T , Brueckner F , Naesstroem H
Published: December 2023

The reduction of iron ore powder in a laser-induced thermal cycle using several reducing agents was studied. The laser-assisted reduction process resulted in the formation of iron-rich domains, irregularly embedded in a slag matrix, and transitional phases. The appearance of these various chemical phases was categorized and geometrically evaluated with respect to representative dimensions using scanning electron microscopy. The statistical trends of the morphology are presented, in context with trends of the chemical composition across the domains, to gain a better understanding of the mechanisms behind the reduction process. Iron domains were predominately observed in the vicinity of the Si-rich zones, indicating the occurrence of the reduction reaction as a result of the Fe2O3-Si interaction. Furthermore, different appearances of the Fe-rich domains and other phases in the close proximity to iron were analyzed and discussed based on diffusion and coalescence phenomena. The obtained results show that the reduction occurs, but the process is still uncontrolled and only partially understood. Further analysis and experiments are, therefore, needed to investigate the prospects of the proposed method.
Experimental investigation of the polarity-switching process with different bipolar ionic liquid thruster operating frequencies
Authors: WU 吴 Xiangbei 湘蓓 , YANG 杨 Cheng 铖 , LUO 罗 Jiawei 嘉伟 , SHEN 沈 Yan 岩
Published: December 2023

The bipolar ionic liquid thruster employs ionic liquid as a propellant to discharge positively and negatively charged high-energy particles under an alternating current (AC) power source, effectively suppressing electrochemical reaction and ensuring charge neutrality. Determining an optimal AC supply power source frequency is critical for sustained stable thruster operation. This study focuses on the emission characteristics of the ionic liquid thruster under varied AC conditions. The AC power supply was set within the frequency range of 0.5–64 Hz, with eight specific frequency conditions selected for experimentation. The experimental results indicate that the thruster operates steadily within a voltage range of ±1470 to ±1920 V, with corresponding positive polarity current ranging from 0.41 to 4.91 μA and negative polarity current ranging from −0.49 to −4.10 μA. During voltage polarity switching, an emission delay occurs, manifested as a prominent peak signal caused by circuit capacitance characteristics and a minor peak signal resulting from liquid droplets. Extended emission test was conducted at 16 Hz, demonstrating approximately 1 h and 50 min of consistent emission before intermittent discharge. These findings underscore the favorable impact of AC conditions within the 8–16 Hz range on the self-neutralization capability of the ionic liquid thruster.
Updates in the treatment of asthma in pediatrics: A review for pharmacists
Authors: Smith Tara , Mills Kimberly , Cober M Petrea , Fenn Norman E , Hill Carolyn , King Morgan , Pauley Jennifer L , Eiland Lea , Sierra Caroline , Omecene Nicole E
Published: December 2023

Purpose

The purpose of this review is to summarize the management of asthma in children and to highlight different guideline-based approaches. This review also discusses literature regarding the use of corticosteroids, both inhaled and systemic, as well as biologic agents, in asthma management.

Asthma is a common chronic respiratory condition in the pediatric population and has evolved into a highly patient-specific disease. Of the 2 main asthma guidelines, one developed by the National Asthma Education and Prevention Program was recently published as a focused update in 2020. The other, from the Global Initiative for Asthma, focuses on a global strategy for management and prevention, with the most recent update in 2023. Both reports discuss diagnosis, assessment, and treatment of asthma in adults and children. Treatment is designed as a stepwise approach in both reports, although there are key differences. This article focuses on gaps in these guidelines, including the use of bronchodilators and inhaled corticosteroids with single maintenance and reliever therapy and long-acting muscarinic antagonists in children. It also reviews treatment in children under 5 years of age, although recommendations are limited due to a lack of evidence in this age group. Finally, this review discusses considerations for emerging treatments, including biologics, for patients who are difficult to treat.

Conclusion

New treatment strategies and agents have emerged in the treatment of pediatric asthma. Pharmacists play a key role in providing education about, dispensing, and recommending the newest evidence-based treatment options for children.
Evaluation of the impact of a clinic infusion pharmacist on the retention of infusion therapy
Authors: Harsh Andrew , Gabbert Jared , Peek Grayson
Published: December 2023

Purpose

To evaluate the impact of an embedded clinic infusion pharmacist on the retention of outpatient infusion therapy.

Methods

This was a single-center, pre-post, retrospective and prospective cohort study at a large quaternary care academic medical center. Outpatient infusion administrations were included in this study if they originated from a clinic with an embedded clinic infusion pharmacist and were targeted high-impact medications. The primary outcome was the impact of embedded clinic infusion pharmacists on the number of infusion administrations from before to after implementation. Secondary outcomes included the time from order entry to first infusion, return on investment (ROI), and level of utilization of various infusion centers. Outpatient infusion and injection administrations were divided into 2 cohorts: a preimplementation cohort administered from April 2021 to March 2022 and a postimplementation cohort administered from April 2022 to March 2023.

Results

A total of 12,257 outpatient infusion administrations were included in the study from the inflammatory bowel disease, Vanderbilt Eye Institute, and neurology clinics. As the embedded infusion pharmacists began working within the respective clinics, a statistically significant increase could be seen in the overall administration of high-impact medications (from 5,683 infusions before implementation to 6,574 infusions after implementation; P < 0.001). The ROI for an embedded clinic infusion pharmacist’s services was greater than 2,500%.

Conclusion

Retention of outpatient infusion therapy can be significantly increased with a positive ROI through allocation of pharmacist resources to areas initiating infusions. Health systems can utilize this model to improve patient access to infusion and injection therapies at entity-owned clinics.
MMP3C: anin-silicoframework to depict cancer metabolic plasticity using gene expression profiles
Authors: Chen Xingyu , Deng Min , Wang Zihan , Huang Chen
Published: December 2023

Metabolic plasticity enables cancer cells to meet divergent demands for tumorigenesis, metastasis and drug resistance. Landscape analysis of tumor metabolic plasticity spanning different cancer types, in particular, metabolic crosstalk within cell subpopulations, remains scarce. Therefore, we proposed a new in-silico framework, termed as MMP3C (Modeling Metabolic Plasticity by Pathway Pairwise Comparison), to depict tumor metabolic plasticity based on transcriptome data. Next, we performed an extensive metabo-plastic analysis of over 6000 tumors comprising 13 cancer types. The metabolic plasticity within distinct cell subpopulations, particularly interplay with tumor microenvironment, were explored at single-cell resolution. Ultimately, the metabo-plastic events were screened out for multiple clinical applications via machine learning methods. The pilot research indicated that 6 out of 13 cancer types exhibited signs of the Warburg effect, implying its high reliability and robustness. Across 13 cancer types, high metabolic organized heterogeneity was found, and four metabo-plastic subtypes were determined, which link to distinct immune and metabolism patterns impacting prognosis. Moreover, MMP3C analysis of approximately 60 000 single cells of eight breast cancer patients unveiled several metabo-plastic events correlated to tumorigenesis, metastasis and immunosuppression. Notably, the metabolic features screened out by MMP3C are potential biomarkers for diagnosis, tumor classification and prognosis. MMP3C is a practical cross-platform tool to capture tumor metabolic plasticity, and our study unveiled a core set of metabo-plastic pairs among diverse cancer types, which provides bases toward improving response and overcoming resistance in cancer therapy.
AMGDTI: drug–target interaction prediction based on adaptive meta-graph learning in heterogeneous network
Authors: Su Yansen , Hu Zhiyang , Wang Fei , Bin Yannan , Zheng Chunhou , Li Haitao , Chen Haowen , Zeng Xiangxiang
Published: December 2023

Prediction of drug–target interactions (DTIs) is essential in medicine field, since it benefits the identification of molecular structures potentially interacting with drugs and facilitates the discovery and reposition of drugs. Recently, much attention has been attracted to network representation learning to learn rich information from heterogeneous data. Although network representation learning algorithms have achieved success in predicting DTI, several manually designed meta-graphs limit the capability of extracting complex semantic information. To address the problem, we introduce an adaptive meta-graph-based method, termed AMGDTI, for DTI prediction. In the proposed AMGDTI, the semantic information is automatically aggregated from a heterogeneous network by training an adaptive meta-graph, thereby achieving efficient information integration without requiring domain knowledge. The effectiveness of the proposed AMGDTI is verified on two benchmark datasets. Experimental results demonstrate that the AMGDTI method overall outperforms eight state-of-the-art methods in predicting DTI and achieves the accurate identification of novel DTIs. It is also verified that the adaptive meta-graph exhibits flexibility and effectively captures complex fine-grained semantic information, enabling the learning of intricate heterogeneous network topology and the inference of potential drug–target relationship.
Why nature matters: A systematic review of intrinsic, instrumental, and relational values
Authors: Himes Austin , Muraca Barbara , Anderson Christopher B , Athayde Simone , Beery Thomas , Cantú-Fernández Mariana , González-Jiménez David , Gould Rachelle K , Hejnowicz A P , Kenter Jasper , Lenzi Dominic , Murali Ranjini , Pascual Unai , Raymond Christopher , Ring Annalie , Russo Kurt , Samakov Aibek , Stålhammar Sanna , Thorén Henrik , Zent Egleé
Published: December 2023

In this article, we present results from a literature review of intrinsic, instrumental, and relational values of nature conducted for the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, as part of the Methodological Assessment of the Diverse Values and Valuations of Nature. We identify the most frequently recurring meanings in the heterogeneous use of different value types and their association with worldviews and other key concepts. From frequent uses, we determine a core meaning for each value type, which is sufficiently inclusive to serve as an umbrella over different understandings in the literature and specific enough to help highlight its difference from the other types of values. Finally, we discuss convergences, overlapping areas, and fuzzy boundaries between different value types to facilitate dialogue, reduce misunderstandings, and improve the methods for valuation of nature's contributions to people, including ecosystem services, to inform policy and direct future research.
Are nursery approaches maturing in their application to US fisheries management?
Authors: Trackenberg Stacy N , Baillie Christopher J , Fodrie F Joel , Bartusek Seth M , Wellman Emory H , Gittman Rachel K
Published: December 2023

There have been significant conceptual advances for identifying nursery habitats within coastal systems used by juvenile fishes and crustaceans. The approaches for delineating nursery areas include measures of juvenile abundance, growth, or survival; habitat characteristics; seascape connectivity; population fitness; and contribution to adult biomass (per unit area or total). We used all US coastal states as replicate trials to evaluate the integration of nursery concepts into fisheries management and found an obvious disconnect between expanding academic interest in nursery roles and management application. Among the few states that afford a subset of coastal environments with nursery status, easily obtained metrics (e.g., juvenile density or presence/absence of biogenic structure) are used, and it remains unclear what role nursery designations have played in promoting sustainable fisheries. Gathering the data necessary to use higher-order nursery approaches and metrics (e.g., connectivity and biomass contribution) to designate nurseries will require significant research investment and greater collaboration between ecologists and fisheries scientists.
FGL1 in plasma extracellular vesicles is correlated with clinical stage of lung adenocarcinoma and anti-PD-L1 response
Authors: Zhang Yuchen , Zhang Kunpeng , Wen Haoyu , Ge Di , Gu Jie , Zhang Chunyi
Published: December 2023

Fibrinogen-like protein-1 (FGL1) is confirmed a major ligand of lymphocyte activation gene-3 which could inhibit antigen-mediated T-cell response and evade immune supervision. Although hepatocytes secrete large amounts of FGL1, its high expression also be detected in solid tumors such as lung cancer, leading to a poor efficacy of immune checkpoint inhibitors therapy. Here we reported that FGL1 was overexpressed in lung adenocarcinoma (LUAD) but not in lung squamous cell carcinoma. However, FGL1 in tissue and plasma can only distinguish LUAD patients from healthy donors and cannot correlate with clinical Tumor Node Metastasis (TNM) stage. Using lung cancer cell lines, we confirmed that FGL1 can be detected on extracellular vesicles (EVs) and we established a method using flow cytometry to detect FGL1 on the surface of EVs, which revealed that FGL1 could be secreted via EVs. Both animal model and clinical samples proved that plasma FGL1 in EVs would increase when the tumor was loaded. The level of FGL1 in plasma EVs was correlated with clinical TNM stage and tumor size, and a higher level indicated non-responsiveness to anti-programmed cell death ligand 1 (anti-PD-L1) immunotherapy. Its effect on tumor progression and immune evasion may be achieved by impairing the killing and proliferating capacities of CD8+ T cells. Our result demonstrates that FGL1 levels in plasma EVs, but not total plasma FGL1, could be a promising biomarker that plays an important role in predicting anti-PD-L1 immune therapy in LUAD and suggests a new strategy in LUAD immunotherapy.
The Retreat from ‘High Technology’ in Post-War Britain
Authors: Kelsey Tom
Published: December 2023

This article argues that the 1970s saw an important change in the attitude of the British state to civil technological projects. It focuses on supersonic aviation and nuclear power policy as its case-studies, which were the key areas of techno-nationalist investment in the post-war period. It shows that Whitehall became radically more sceptical about state-led Research and Development, scrapped many core long-term projects, and cut back others. The politics and timing of this shift matter for our wider understanding of post-war British history, the history of technology, and histories of ‘neo-liberalism’. Thatcherism is supposed to have brought with it the decisive move away from industrial intervention by the state. Such a characterisation, while containing important truths, makes it difficult to see that the retreat from the most spectacular industrial investments of the British state in fact occurred during the 1970s in what was an economic liberalism from within, rather than a ‘neo-liberalism’ from without. This paper also challenges the narrative that the ‘technological disillusion’ of the 1970s came via the New Left and environmentalists, demonstrating the importance of an expert critique focused on economic and industrial arguments that emerged from inside the state itself.
Sublobar resection is associated with less lymph nodes examined and lower delivery of adjuvant therapy in patients with 1.5- to 2.0-cm clinical IA2 non-small-cell lung cancer: a retrospective cohort study
Authors: Rodriguez-Quintero Jorge Humberto , Kamel Mohamed K , Jindani Rajika , Vimolratana Marc , Chudgar Neel P , Stiles Brendon M
Published: December 2023

OBJECTIVES

CALGB140503, in which nodal sampling was mandated, reported non-inferior disease-free survival for patients undergoing sublobar resection (SLR) compared to lobectomy (L). Outside of trial settings, the adequacy of lymphadenectomy during SLR has been questioned. We sought to evaluate whether SLR is associated with suboptimal lymphadenectomy, differences in pathologic upstaging and survival in patients with 1.5- to 2.0-cm tumours using real-world data.

MATERIALS AND METHODS

Using the National Cancer Database(2018–2019), we evaluated patients with 1.5- to 2.0-cm non-small-cell lung cancer who underwent resection (sublobar versus lobectomy). We studied factors associated with nodal upstaging (logistic regression) and survival (Cox regression and Kaplan–Meier method) after propensity matching to adjust for differences among groups.

RESULTS

Among 3196 patients included, SLR was performed in 839 (26.3%) (of which 588 were wedge resections) and L was performed in 2357 (73.7%) patients. More patients undergoing SLR (21.7%) compared to L (2.1%) had no lymph nodes sampled (P < 0.001). Those undergoing SLR had fewer total lymph nodes examined (4 vs 11, P < 0.001) and were less likely to have pathologic nodal metastases (4.7% vs 9%, P < 0.001) compared to L. Multivariable analysis identified L [adjusted odds ratio (aOR) 2.21, 95% confidence interval, 1.47–3.35] to be independently associated with pathologic N+ disease. Overall survival was not associated with the type of procedure but was significantly decreased in those with N+ disease.

CONCLUSIONS

Despite comparable overall survival to L, SLR is associated with suboptimal lymphadenectomy in patients with 1.5–2.0 cm non-small-cell lung cancer. Surgeons should be careful to perform adequate lymphadenectomy when performing SLR to mitigate nodal under-staging and to identify appropriate patients for systemic therapy.
Comparing nodal with primary tumor desmoplasia uncovers metastatic patterns in multiple endocrine neoplasia 2B
Authors: Machens Andreas , Bensch Claudia , Wickenhauser Claudia , Dralle Henning , Lorenz Kerstin
Published: December 2023

Background

While primary tumor desmoplasia is a powerful biomarker of node metastases in sporadic medullary thyroid cancer (MTC), information for hereditary MTC is sparse.

Methods

This proof-of-concept study, comprising 3 consecutive children with multiple endocrine neoplasia 2B, evaluated simultaneously the metastatic behavior of multiple primary thyroid tumors of disparate size and extent of desmoplasia within patients.

Results

Altogether, MTC typically involved the ipsilateral central neck before spreading to the ipsilateral lateral and the contralateral neck. Medullary thyroid cancer in the upper thyroid lobe leaped the ipsilateral central neck to invade the ipsilateral lateral neck. Unlike the desmoplasia-positive 6-mm high-grade and 7-mm low-grade primary thyroid tumors, the desmoplasia-negative 8-, 11-, and 16-mm low-grade primary thyroid tumors did not spread to ipsilateral neck nodes. With extranodal growth, the extent of nodal desmoplasia was greater than with intranodal growth.

Conclusion

This proof-of-concept study suggests that primary tumor desmoplasia is an equally powerful biomarker of node metastasis in hereditary MTC.
Dissecting the major genetic components underlying cotton lint development
Authors: Sun Yali , Yuan Yuman , He Shoupu , Stiller Warwick , Wilson Iain , Du Xiongming , Zhu Qian-Hao
Published: December 2023

Numerous genetic loci and several functionally characterized genes have been linked to determination of lint percentage (lint%), one of the most important cotton yield components, but we still know little about the major genetic components underlying lint%. Here, we first linked the genetic loci containing MYB25-like_At and HD1_At to the fiberless seed trait of ‘SL1-7-1’ and found that MYB25-like_At and HD1_At were very lowly expressed in ‘SL1-7-1’ ovules during fiber initiation. We then dissected the genetic components involved in determination of lint% using segregating populations derived from crosses of fuzzless mutants and intermediate segregants with different lint%, which not only confirmed the HD1_At locus but identified the HD1_Dt locus as being the major genetic components contributing to fiber initiation and lint%. The segregating populations also allowed us to evaluate the relative contributions of MYB25-like_At, MYB25-like_Dt, HD1_At, and HD1_Dt to lint%. Haplotype analysis of an Upland cotton (Gossypium hirsutum) population with 723 accessions (including 81 fuzzless seed accessions) showed that lint% of the accessions with the LP allele (higher lint%) at MYB25-like_At, MYB25-like_Dt, or HD1_At was significantly higher than that with the lp allele (lower lint%). The lint% of the Upland cotton accessions with 3 or 4 LP alleles at MYB25-like and HD1 was significantly higher than that with 2 LP alleles. The results prompted us to propose a strategy for breeding high-yielding cotton varieties, i.e. pyramiding the LP alleles of MYB25-like and HD1 with new lint% LP alleles without negative impact on seed size and fiber quality.
On the Road to Silent Guns: Examining the Regional Regulation of States’ Use of Force during Counterterrorism Policing in Africa
Authors: Fenemigho Alero I
Published: December 2023

Terrorism is currently one of the principal threats to peace and security in Africa. In law enforcement responses to terrorism, affected states often employ excessive or indiscriminate force through their security forces. In addition to violating international legal standards, research suggests that this unlawful use of force is itself a driver of violence, potentially perpetuating terrorist violence in a continent vulnerable to violent extremism. This article assesses the legal and policy response of the African regional system to the use of excessive force during counterterrorism policing, focusing principally on the roles of the counterterrorism architecture and human rights system. The article finds that whilst some positive steps have been made towards greater respect of international norms, the current response has material gaps and inadequacies. A two-pronged framework for a comprehensive regional response to the problem is proposed, combining clarification of the applicable rules with greater action from regional institutions.
Genetic footprints of Quaternary climatic fluctuations on the endangered Tuco-tuco-das-dunas (Ctenomys flamarioni)
Authors: Gasparetto Luiza Flores , Fernández Gabriela Paula , Carnovale Cecilia Soledad , Maestri Renan , Galiano Daniel , Peçanha Willian Thomaz , Kubiak Bruno Busnello , de Freitas Thales Renato Ochotorena
Published: December 2023

The biogeographic history of a species results from responses to past and current processes, and understanding those responses at both temporal scales is essential. We explored phylogeographic and current genetic variation structure in Ctenomys flamarioni—a subterranean rodent that inhabits a small region of the coastal plain of Brazil—and contrasted the roles of “present-day niche suitability” versus “historical climate stability” to understand current and past intraspecific genetic diversity. We used both mitochondrial DNA sequences (concatenated Cytb and D-loop, n = 78) and nuclear DNA (9 microsatellites loci, n = 154) molecular markers for individuals across the entire distribution of the species. We used phylogeographic trees, Bayesian clustering, and haplotype networks to explore genetic variation and diversity. We correlated genetic diversity with measures of current niche suitability and potential areas of Late Quaternary paleostability. Phylogeographic patterns confirmed low levels of genetic diversity structured at different hierarchical levels. We also found a weak but significant pattern of isolation by distance, indicating that geographical distance partially modulates genetic differences among populations. We also observed a positive correlation between genetic diversity and climate paleostability for microsatellites at local and regional scales. However, we found no significant association between genetic diversity and niche suitability for microsatellites at local or regional scales. We observed several signatures of bottleneck and population expansion at different geographic scales. Our results suggest that Quaternary climatic fluctuations—acting together with habitat suitability and other contemporary factors—played a fundamental role in elucidating the evolutionary history of the species—including patterns of historical dispersal, and current patterns of habitat occupation and genetic structure. In addition, based on our molecular and environmental data sets from the across the range of the species and considering the restricted endemism of C. flamarioni, we emphasize the urgency of conservation actions to protect this endangered species.
Trends in Pediatric Emergency and Inpatient Healthcare Use for Mental and Behavioral Health Among North Carolinians During the Early COVID-19 Pandemic
Authors: Sielaty Rachel , Boutzoukas Angelique E , Zimmerman Kanecia O , Caison Bria , Charles Catherine O , CoyneSmith Taran , Darden Toni , Overman Robert A , Benjamin Daniel K , Brookhart M Alan
Published: December 2023

Background

Widespread school closures and health care avoidance during the COVID-19 pandemic led to disruptions in access to pediatric mental health care.

Methods

We conducted a retrospective study of emergency and inpatient administrative claims from privately insured children aged 6–20 years in North Carolina between January 2019 and December 2020. We compared rates of emergency department (ED) visits (per 100 000 person-days) and risks of hospitalizations (per 100 000 persons) with diagnosis codes in each category (mental/behavioral health; suicidal ideation, suicide attempt, and intentional self-harm [SI/SA/ISH]; and social issues) across 3 time periods (pre-pandemic, lockdown, and reopening). We calculated the proportion and 95% confidence intervals (CI) of total ED visits and total hospitalizations attributable to mental/behavioral health and SI/SA/ISH across the 3 time periods.

Results

Rates of all categories of ED visits decreased from pre-pandemic to the lockdown period; from pre-pandemic to the reopening period, mental/behavioral health visits decreased but rates of SI/SA/ISH visits were unchanged. The proportion of ED visits attributable to mental/behavioral health increased from 3.5% (95% CI 3.2%–3.7%) pre-pandemic to 4.0% (95% CI 3.7%–4.3%) during reopening, and the proportion of SI/SA/ISH diagnoses increased from 1.6% (95% CI 1.4%–1.8%) pre-pandemic to 2.4% (95% CI 2.1%–2.7%) during the reopening period. Emergency care use for social issues and hospital admissions for mental/behavioral health and SI/SA/ISH diagnoses were unchanged across the study periods.

Conclusions

In the early pandemic, pediatric mental health care and acute suicidal crises accounted for increased proportions of emergency care. During pandemic recovery, understanding the populations most impacted and increasing access to preventative mental health care is critical.
Simultaneous directional inference
Authors: Heller Ruth , Solari Aldo
Published: December 2023

We consider the problem of inference on the signs of n>1 parameters. We aim to provide 1−α post hoc confidence bounds on the number of positive and negative (or non-positive) parameters, with a simultaneous guarantee, for all subsets of parameters. We suggest to start by using the data to select the direction of the hypothesis test for each parameter; then, adjust the p-values of the one-sided hypotheses for the selection, and use the adjusted p-values for simultaneous inference on the selected n one-sided hypotheses. The adjustment is straightforward assuming the p-values of one-sided hypotheses have densities with monotone likelihood ratio, and are mutually independent. We show the bounds we provide are tighter (often by a great margin) than existing alternatives, and that they can be obtained by at most a polynomial time. We demonstrate their usefulness in the evaluation of treatment effects across studies or subgroups. Specifically, we provide a tight lower bound on the number of studies which are beneficial, as well as on the number of studies which are harmful (or non-beneficial), and in addition conclude on the effect direction of individual studies, while guaranteeing that the probability of at least one wrong inference is at most 0.05.
Benign mature teratoma of the cecum: a case report
Authors: Gellings Jaclyn , Nimmer Kaitlyn , Doucette Saryn , Merrill Jennifer R , Sheriff Salma A , Johnson Scott C , Kothari Anai N
Published: December 2023

A teratoma is a typically benign tumor derived from more than one embryonic cell line, and it is characterized by presence of tissue foreign to the tumor location site. With the unlikely primary location in the gastrointestinal tract and no history of malignancy, we present a rare case of a primary mature cystic teratoma of the cecum. The patient is a 66-year-old male with imaging demonstrating an extraluminal, seemingly fat-containing mass abutting the cecum. The patient underwent resection, and final pathology revealed a mature cystic teratoma. Primary mature teratoma of the cecum is exceptionally rare; thus, diagnosis can be challenging. As he had no primary testicular or retroperitoneal mass, this cystic lesion likely represents a developmental abnormality and not a true neoplasm. The radiographic features, presentation, differential diagnoses, and treatment recommendations are discussed.
Hypothetical chloroplast reading frame 51 encodes a photosystem I assembly factor in cyanobacteria
Authors: Dai Guo-Zheng , Song Wei-Yu , Xu Hai-Feng , Tu Miao , Yu Chen , Li Zheng-Ke , Shang Jin-Long , Jin Chun-Lei , Ding Chao-Shun , Zuo Ling-Zi , Liu Yan-Ru , Yan Wei-Wei , Zang Sha-Sha , Liu Ke , Zhang Zheng , Bock Ralph , Qiu Bao-Sheng
Published: December 2023

Hypothetical chloroplast open reading frames (ycfs) are putative genes in the plastid genomes of photosynthetic eukaryotes. Many ycfs are also conserved in the genomes of cyanobacteria, the presumptive ancestors of present-day chloroplasts. The functions of many ycfs are still unknown. Here, we generated knock-out mutants for ycf51 (sll1702) in the cyanobacterium Synechocystis sp. PCC 6803. The mutants showed reduced photoautotrophic growth due to impaired electron transport between photosystem II (PSII) and PSI. This phenotype results from greatly reduced PSI content in the ycf51 mutant. The ycf51 disruption had little effect on the transcription of genes encoding photosynthetic complex components and the stabilization of the PSI complex. In vitro and in vivo analyses demonstrated that Ycf51 cooperates with PSI assembly factor Ycf3 to mediate PSI assembly. Furthermore, Ycf51 interacts with the PSI subunit PsaC. Together with its specific localization in the thylakoid membrane and the stromal exposure of its hydrophilic region, our data suggest that Ycf51 is involved in PSI complex assembly. Ycf51 is conserved in all sequenced cyanobacteria, including the earliest branching cyanobacteria of the Gloeobacter genus, and is also present in the plastid genomes of glaucophytes. However, Ycf51 has been lost from other photosynthetic eukaryotic lineages. Thus, Ycf51 is a PSI assembly factor that has been functionally replaced during the evolution of oxygenic photosynthetic eukaryotes.
In the eye of beholder? The notions of quality in the humanities
Authors: Gedutis Aldis , Kirtiklis Kęstas
Published: December 2023

In this article we attempt to reconstruct the tacit and implicit notions of quality in the humanities. This reconstruction is based on a series of semi-structured qualitative interviews with 33 humanities scholars. Applying Max Weber’s theory of authority, we argue the quality notions have two different sources—external and internal. External sources correspond to the Weber’s types of authority: traditional authorities (academic tradition, professors, PhD advisors), rational-legal authorities (research administrators, policy makers) and charismatic authorities (‘the great minds’, ‘the founding fathers’ in a given academic field). Internal sources providing the quality notion do not fit into Weberian classification. These sources are based on the personal experience of a humanities researcher’s evaluation practices, which cannot be reduced to either type of authority above. Combining the interview data and Max Weber’s theory of authority, we try to demonstrate the existence of four different and sometimes incompatible notions of quality in the humanities: administrative; individual; semi-administrative, semi-individual; moderate individual. These notions are interpreted as ideal types, which serve as a regulative ideas rather than objective representations of research evaluation reality. The manuscript is important to Research Evaluation for the following reasons: first, it reconstructs the different types of notions of quality, which are crucial in better understanding peer review and other qualitative research evaluation practices; second, it provides better understanding of individual evaluator’s premises; third, it provides opportunity to have a glimpse beyond dominant administrative quality notions and criteria as usually the perspectives of the humanities researchers are neglected.
Agricultural Productivity and Land Inequality: Evidence from the Philippines
Authors: Bequet Ludovic
Published: December 2023

How do agricultural productivity gains affect the distribution of agricultural land? Exploiting three waves of census data from the Philippines covering 21 years and 17 million plots, this article finds that municipalities endowed with favorable soil and weather conditions for genetically modified (GM) corn cultivation experience a relative increase in landholding inequality. Agricultural land is decreasing during this period and this decrease is driven by a decline in the size of large farms. The introduction of GM corn slows down this process by keeping more land under cultivation, which contributes to the documented relative increase in inequality.
Systematic rearrangements in an all-genus phylogeny of side-gilled slugs (Heterobranchia: Pleurobranchida)
Authors: Moles Juan , Brenzinger Bastian , Berning Maria I , Martynov Alexander , Korshunova Tatiana , Schrödl Michael
Published: December 2023

The systematics of side-gilled slugs face long-lasting incongruencies provided by morphological and molecular data. Parsimonious morphological assessments divided the single superfamily Pleurobranchoidea into the shell-less Pleurobranchaeidae and the internally shelled Pleurobranchidae, including the aberrant helicoid-shelled Tomthompsonia. Molecular evidence has proven untrustworthy to date, revealing contrasting hypotheses. This study’s multilocus phylogeny benefits from a dense taxon sampling of 94 pleurobranchids, with 22 newly sequenced specimens, including type species for all known genera. We further evaluate the effects of masking with several algorithms to better enhance phylogenetic resolution. Our results support that Tomthompsonioidea superfam. nov. are the sister group of all other Pleurobranchida; the absence of an acidic oral gland and a helicoid shell are the diagnostic features. We also provide the first molecular evidence that Euselenops nests within Pleurobranchaeidae, and Pleurobranchella is related to Pleurobranchaea, but remains distinct morphologically. Regarding Pleurobranchidae, the genus Berthella is paraphyletic and now embodied in the four clades: Berthella s.s., Boreoberthella, Pleurehdera, and Tomoberthella gen. nov. The fact that, whereas there is a supposed low Antarctic diversity, we find hidden speciation in several tropical species suggests that side-gilled slugs pose an Antarctic origin or a relic that radiated in shallower, warmer waters.
Pathological-Features-Modified TNM Staging System Improves Prognostic Accuracy for Rectal Cancer
Authors: Yang Yuesheng , Yang Zifeng , Lyu Zejian , Ouyang Kaibo , Wang Junjiang , Wu Deqing , Li Yong
Published: December 2023

BACKGROUND:

Variations in survival outcomes are observed in the American Joint Committee on Cancer’s 8th edition TNM staging system.

OBJECTIVE:

Machine learning ensemble methods were used to develop and evaluate the effectiveness of a pathological-features-modified tumor node metastasis staging system in predicting survival for patients with rectal cancer by using commonly reported pathological features, such as histological grade, tumor deposits, and perineural invasion, to improve the prognostic accuracy.

DESIGN:

This was a retrospective population-based study.

SETTINGS:

Data were assessed from the database of the Surveillance, Epidemiology, and End Results Program.

PATIENTS:

The study cohort comprised 14,468 rectal cancer patients diagnosed between 2010 and 2015. The development cohort included those who underwent surgery as the primary treatment while patients who received neoadjuvant therapy were assigned to the validation cohort.

MAIN OUTCOME MEASURES:

The primary outcome measures included cumulative rectal cancer survival, adjusted hazard ratios, and both calibration and discrimination statistics to evaluate model performance and internal validation.

RESULTS:

Multivariable Cox regression analysis identified all three pathological features as prognostic factors, following which patients were categorized into four pathological groups based on the number of pathological features (i.e., 0, 1, 2, and 3). Distinct survival differences were observed among the groups, especially with stage III patients. The proposed pathological-features-modified tumor-node-metastasis staging outperformed the TNM staging in both the development and validation cohorts.

LIMITATIONS:

Retrospective in design and lack of external validation.

CONCLUSIONS:

The proposed pathological-features-modified tumor-node-metastasis staging could complement the current TNM staging by improving the accuracy of rectal cancer patients’ survival estimation. See Video Abstract.
Direct-to-Consumer Advertising Survey of Psychiatrists in Massachusetts and Michigan
Authors: Wechsler Bennett E. , Balon Richard , Shader Richard I. , Rothschild Anthony J.
Published: December 2023

Purposes/Background

The goals of this preliminary study were to survey psychiatrists and to examine the impact of advertisements on their prescription of psychotropic medications. The study specifically looked at psychiatrists in Massachusetts and Michigan, as the authors were able to readily contact the members of their respective state psychiatric societies.

Methods/Procedures

We used the survey software, Quatrics, to create an online survey that was sent via email link to the members of the Massachusetts Psychiatric Society (1400 estimated members), and the Michigan Psychiatric Society (700 estimated members). Details were obtained about how challenging it was for the psychiatrist to convince the patient that a medication was not indicated. Information regarding how the psychiatrist first heard about new medications and where they go to learn more about these medications was included in the survey.

Findings/Results

We received 162 partial or full responses to our survey, representing a response rate of 8%. Those who were less than 10 years out of training were less likely to find it “easy” to change the minds of these patients, when compared with those more than 10 years out of training (Fisher exact test, P = 0.0396). The most frequent medication named as a response to “which medications do patients request” was Rexulti (brexpiprazole), followed by Vraylar (cariprazine), Caplyta (lumateperone), and aripiprazole.

Implications/Conclusions

This survey points to the prevalence of psychiatrists getting requests for these advertised medications and illustrates that those with fewer years out of training may have a more difficult time redirecting patients from medications that are not indicated for their illness.
Effects of Clozapine on Cortical Inhibition
Authors: Karaçam Doğan Melike , Yildiz Fatma Gökçem , Temuçin Çağri Mesut , Ertuğrul Aygün
Published: December 2023

Background

Preclinical and clinical investigations have revealed deficits in cortical inhibition in individuals with schizophrenia. Transcranial magnetic stimulation, a commonly used noninvasive measurement technique, is used for assessing these deficits. Limited research has been conducted on the effects of antipsychotic medications on cortical inhibition. This study aimed to evaluate the effects of clozapine on cortical inhibition with transcranial magnetic stimulation longitudinally and compare it with unaffected controls.

Methods

Ten patients who started clozapine were assessed at baseline, with 8 reassessed after 4 months. Eight age- and sex-matched unaffected controls were included. Psychopathology, neurocognitive performance, formal thought disorder, and disability were assessed, and the cortical excitability parameters (resting motor threshold, cortical silent period, short-interval intracortical inhibition, intracortical facilitation, and short-latency afferent inhibition [SAI]) were measured at baseline and four months after clozapine treatment.

Results

Resting motor threshold, ICF, and SAI were significantly different between patients and controls at baseline, whereas resting motor threshold, SAI, and ICF became similar to controls after clozapine with only ICF having a trend for significance. Clozapine prolonged cortical silent period significantly in the patients.

Conclusions

This is the first study to investigate the effect of clozapine on SAI, a potential cholinergic biomarker, and the first follow-up study to investigate the relationship between the effects of clozapine on cortical inhibition and cognition. Clozapine seems to cause an increase in cortical inhibition through GABAergic and possibly cholinergic mechanisms. However, additional follow-up studies with larger sample sizes are required to reach more robust conclusions.
A Narrative Review on Pharmacogenomics in Psychiatry
Authors: Palumbo Sara , Mariotti Veronica , Pellegrini Silvia
Published: December 2023

Purpose/Background

Pharmacogenetics (PGx) studies the genetic factors underlying interindividual variability in drug response. Only a few countries around the world are already using PGx testing in psychiatric clinical practice, whereas others are still far from adopting it. The main barrier to the clinical adoption of PGx testing seems to be the limited knowledge among psychiatrists regarding the clinical relevance of specific genetic variants to personalize therapies and the accessibility of PGx data. This review aims at further highlighting the importance of PGx-driven clinical decision making for psychotropic medications and raising psychiatrists' awareness of the value of PGx testing in psychiatry.

Methods/Procedures

We summarize the genes for which substantial evidence exists about the clinical utility of integrating their PGx testing in psychiatry. Specifically, we systematically describe the functional role of clinically relevant allelic variants, their frequency across different ethnic groups, and how they contribute to classify patients in relation to their capability in metabolizing psychotropic drugs.

Findings/Results

Briefly, clinical guidelines recommend considering PGx testing of the cytochrome class 2 C9 (CYP2C9), C19 (CYP2C19), and D6 (CYP2D6) genes and the human leukocyte antigen (HLA)-A and -B genes for several psychotropic drugs.

Implications/Conclusions

Extensive studies have been carried out to provide a solid rationale for the inclusion of PGx testing in psychiatry. Comprehensive clinical guidelines are readily accessible to support health care providers in tailoring the prescription of psychotropic drugs based on patient's genotype information. This approach presents a tangible opportunity to significantly improve individual responses to psychiatric medications.
Increasing Hospital at Home Enrollment Through Decentralization With Agile Science
Authors: Shadbolt Erin , Paulson Margaret , Divine Lorin T. , Ellis Julie , Myers Lucas , Mucks Karly , Boustani Malaz , Dumic Igor , Maniaci Michael , Lindroth Heidi
Published: December 2023

The use of hospital at home (HaH) programs are rapidly increasing due to virtual capabilities, hospital capacities, and patient preferences. In 2020, a large hospital system instituted a multistate HaH program with a single command center. It is not known whether decentralizing command centers to local hospital sites increases patient enrollment in HaH programs. This article outlines how the Agile Implementation Process was applied to rapidly decentralize patient enrollment to a local hospital site and reports pre–post data on the number of patient enrollments per month, staff satisfaction, and qualitative quotes describing how the Agile Implementation process supported interprofessional staff engagement. In brief, 235 patients were included from the local site (pre: n = 105, post: n = 130) with a mean age of 70 years (SD 2.73), 55% male, and primarily Caucasian (99%). Postdecentralization, staff satisfaction increased by 63% (4.4–7.2) and the mean number of patients enrolled per month significantly increased from 15 to 22 (p = .01). An approximate 10% decrease in patient satisfaction was observed preintervention to postintervention (98.2–88.2%). In summary, the Agile Implementation quality improvement approach successfully decentralized patient enrollment to local hospital sites, increased patient enrollment, and staff satisfaction through staff engagement.

Level of Evidence:

4, Descriptive quality improvement project.