bluuebunny/crossref_metadata_2025 huggingface dataset:
Navigating outpatient care of patients with type 2 diabetes after hospital discharge - a qualitative longitudinal study
Authors: Solh Dost Léa , Gastaldi Giacomo , Dos Santos Mamed Marcelo , Schneider Marie P.
Published: April 2024

Background

The transition from hospital to outpatient care is a particularly vulnerable period for patients as they move from regular health monitoring to self-management. This study aimed to map and investigate the journey of patients with polymorbidities, including type 2 diabetes (T2D), in the 2 months following hospital discharge and examine patients’ encounters with healthcare professionals (HCPs).

Methods

Patients discharged with T2D and at least two other comorbidities were recruited during hospitalization. This qualitative longitudinal study consisted of four semi-structured interviews per participant conducted from discharge up to 2 months after discharge. The interviews were based on a guide, transcribed verbatim, and thematically analyzed. Patient journeys through the healthcare system were represented using the patient journey mapping methodology.

Results

Seventy-five interviews with 21 participants were conducted from October 2020 to July 2021. The participants had a median of 11 encounters (min–max: 6–28) with HCPs. The patient journey was categorized into six key steps: hospitalization, discharge, dispensing prescribed medications by the community pharmacist, follow-up calls, the first medical appointment, and outpatient care.

Conclusions

The outpatient journey in the 2 months following discharge is a complex and adaptive process. Despite the active role of numerous HCPs, navigation in outpatient care after discharge relies heavily on the involvement and responsibilities of patients. Preparation for discharge, post-hospitalization follow-up, and the first visit to the pharmacy and general practitioner are key moments for carefully considering patient care. Our findings underline the need for clarified roles and a standardized approach to discharge planning and post-discharge care in partnership with patients, family caregivers, and all stakeholders involved.
Increasing and sustaining discharges by noon – a multi-year process improvement project
Authors: Bailey Ryan , Segon Ankur , Garcia Sean , Kottewar Saket , Lu Ting , Tuazon Nelson , Sanchez Lisa , Gelfond Jonathan A. , Bowling Gregory
Published: April 2024

High hospital occupancy degrades emergency department performance by increasing wait times, decreasing patient satisfaction, and increasing patient morbidity and mortality. Late discharges contribute to high hospital occupancy by increasing emergency department (ED) patient length of stay (LOS). We share our experience with increasing and sustaining early discharges at a 650-bed academic medical center in the United States. Our process improvement project followed the Institute of Medicine Model for Improvement of successive Plan‒Do‒Study‒Act cycles. We implemented multiple iterative interventions over 41 months. As a result, the proportion of discharge orders before 10 am increased from 8.7% at baseline to 22.2% (p < 0.001), and the proportion of discharges by noon (DBN) increased from 9.5% to 26.8% (p < 0.001). There was no increase in balancing metrics because of our interventions. RA-LOS (Risk Adjusted Length Of Stay) decreased from 1.16 to 1.09 (p = 0.01), RA-Mortality decreased from 0.65 to 0.61 (p = 0.62) and RA-Readmissions decreased from 0.92 to 0.74 (p < 0.001). Our study provides a roadmap to large academic facilities to increase and sustain the proportion of patients discharged by noon without negatively impacting LOS, 30-day readmissions, and mortality. Continuous performance evaluation, adaptability to changing resources, multidisciplinary engagement, and institutional buy-in were crucial drivers of our success.
Quantifying the impact of hospital catchment area definitions on hospital admissions forecasts: COVID-19 in England, September 2020–April 2021
Authors: Meakin Sophie , Funk Sebastian
Published: April 2024

Background

Defining healthcare facility catchment areas is a key step in predicting future healthcare demand in epidemic settings. Forecasts of hospitalisations can be informed by leading indicators measured at the community level. However, this relies on the definition of so-called catchment areas or the geographies whose populations make up the patients admitted to a given hospital, which are often not well-defined. Little work has been done to quantify the impact of hospital catchment area definitions on healthcare demand forecasting.

Methods

We made forecasts of local-level hospital admissions using a scaled convolution of local cases (as defined by the hospital catchment area) and delay distribution. Hospital catchment area definitions were derived from either simple heuristics (in which people are admitted to their nearest hospital or any nearby hospital) or historical admissions data (all emergency or elective admissions in 2019, or COVID-19 admissions), plus a marginal baseline definition based on the distribution of all hospital admissions. We evaluated predictive performance using each hospital catchment area definition using the weighted interval score and considered how this changed by the length of the predictive horizon, the date on which the forecast was made, and by location. We also considered the change, if any, in the relative performance of each definition in retrospective vs. real-time settings, or at different spatial scales.

Results

The choice of hospital catchment area definition affected the accuracy of hospital admission forecasts. The definition based on COVID-19 admissions data resulted in the most accurate forecasts at both a 7- and 14-day horizon and was one of the top two best-performing definitions across forecast dates and locations. The “nearby” heuristic also performed well, but less consistently than the COVID-19 data definition. The marginal distribution baseline, which did not include any spatial information, was the lowest-ranked definition. The relative performance of the definitions was larger when using case forecasts compared to future observed cases. All results were consistent across spatial scales of the catchment area definitions.

Conclusions

Using catchment area definitions derived from context-specific data can improve local-level hospital admission forecasts. Where context-specific data is not available, using catchment areas defined by carefully chosen heuristics is a sufficiently good substitute. There is clear value in understanding what drives local admissions patterns, and further research is needed to understand the impact of different catchment area definitions on forecast performance where case trends are more heterogeneous.
Kawasaki disease in Kenya and review of the African literature
Authors: Migowa A. , Njeru CM. , Were E. , Ngwiri T. , Colmegna I. , Hitchon C. , Scuccimarri R.
Published: April 2024

Background

Kawasaki disease has been described across the globe, although publications from Africa are limited. To our knowledge, there are no publications on Kawasaki disease from Kenya, which triggered this report.

Methods

A retrospective cross-sectional study was undertaken to identify in-patients with a discharge diagnosis of Kawasaki disease, over 2 different 5-year periods, at two pediatric hospitals in Nairobi, Kenya. We reviewed the medical records of all patients and report their clinical findings, diagnostic workup and treatment. In addition, we undertook a detailed review of the literature.

Results

Twenty-three patients with Kawasaki disease were identified, of those 12 (52.2%) had incomplete disease. The mean age was 2.3 years (SD+/-2.2) (range 0.3–10.3) with a male to female ratio of 1:1. The mean duration of fever at diagnosis was 8.3 days (SD+/-4.7) (range 2–20). Oral changes were the most common clinical feature and conjunctivitis the least common. Thrombocytosis at diagnosis was seen in 52% (12/23). Twenty-one patients (91.3%) were treated with intravenous immunoglobulin and all except 1 received aspirin. Baseline echocardiograms were performed in 95.7% (22/23) and found to be abnormal in 3 (13.6%). Follow-up data was limited. Our literature review identified 79 publications with documented cases of Kawasaki disease in children from 22 countries across the African continent with a total of 1115 patients including those from this report. Only 153 reported cases, or 13.7%, are from sub-Saharan Africa.

Conclusions

This is the first publication on Kawasaki disease from Kenya and one of the largest reports from sub-Saharan Africa. It is the first to have a complete review of the number of published cases from the African continent. Challenges in the diagnosis and management of Kawasaki disease in many African countries include disease awareness, infectious confounders, access and cost of intravenous immunoglobulin, access to pediatric echocardiography and follow-up. Increasing awareness and health care resources are important for improving outcomes of Kawasaki disease in Africa.
Inflammation in aortic surgery: postoperative evolution of biomarkers according pathologies and segments of the aorta
Authors: Yates Martin T , Smith Alexander , Mistirian Alina A , Bigogno Carola M , Lee Michelle , Lopez-Marco Ana
Published: April 2024

Objectives

Aortic pathologies often present with elevated inflammatory biomarkers due to the nature of the disease. Open aortic surgery causes significant trauma to the body due to often mandatory ischemic periods, long cardiopulmonary bypass times and polytransfusion. We aim to determine postoperative trends on inflammation biomarkers for different aortic pathologies and type of surgery in different segments of the aorta.

Methods

Retrospective review of prospectively collected data of 193 consecutive patients who underwent aortic surgery in our centre between 2017 and 2021, grouped according to the type of aortic intervention: (1) Type A aortic dissection (AD) repair with ascending aorta/hemiarch replacement, (2) Aortic root replacement (ARR), (3) Aortic arch + Frozen elephant trunk (FET), (4) Descending thoracic aorta (DTA)/Thoraco-Abdominal aortic repair (TAA). Primary outcomes were daily values of white blood cells (WBC) and C-Reactive Protein (CRP) during the first 15 postoperative days.

Results

All groups had a similar inflammatory peak in the first 2–4 days (WBC 12-15 × 109 c/L). AD and FET groups show similar trends with WBC and CRP peaks on days 2 and 10. The ARR group didn’t experience the 2nd peak as most patients were already discharged. DTA/TAA patients experienced a more prolonged inflammatory response, reaching a plateau by day 5–10. AD group shows the highest WBC levels and the DTA/TAAA group the highest CRP levels. CRP levels remain elevated (100–200 mg/L) in all groups after 15 postoperative days.

Conclusions

Inflammatory biomarkers show different postoperative trends depending on the clinical presentation and complexity of the aortic procedure performed. Further understanding of the inflammatory response to different aortic pathologies and surgical procedures will permit reduction on the liberal use of antibiotics that this cohort of patients are usually exposed to. An earlier version of the data included in this manuscript was presented as Oral Abstract in the UK Society of Cardiothoracic Surgery Annual meeting in 2021
Bleeding sites and treatment strategies for cardiac tamponade by catheter ablation requiring thoracotomy: risks of catheter ablation in patients with left atrial diverticulum
Authors: Mitsuishi Atsuyuki , Miura Yujiro , Nomura Yoshinori , Hirota Takayoshi , Arima Naoki , Kitaoka Hiroaki , Tateiwa Hiroki , Katsumata Yoshifumi
Published: April 2024

Background

There is insufficient information regarding the bleeding sites and surgical strategies of cardiac tamponade during catheter ablation for atrial fibrillation (AF).

Case presentation

Of the five patients with cardiac tamponade, three required surgical intervention and two required pericardiocentesis. In the first case of three cardiac tamponades requiring surgical intervention, considering that the peripheral route was used, the catecholamines did not reach the heart, and due to unstable vital signs, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was inserted. No bleeding point was identified, but a thrombus had spread around the left atrium (LA) with diverticulum. Hemostasis was achieved with adhesives placed around the LA under on-pump beating. In the second case, pericardiocentesis was performed, but the patient showed heavy bleeding and unstable vital signs. Thus, VA-ECMO was inserted. Heavy bleeding was expected, and safety was enhanced by attaching a reservoir to the VA-ECMO. The bleeding point was found between the left upper pulmonary artery and LA under cardiac arrest to obtain a good surgical view for suturing repair. In the third case, the LA diverticulum was damaged. Pericardiocentesis resulted in stable vitals, but sustained bleeding was present. A bleeding point was found at the LA diverticulum, and suture repair under on-pump beating was performed.

Conclusions

When cardiac tamponade occured in any patient with LA diverticulum, treatment could not be completed with pericardiocentesis alone, and thoracotomy was likely to be necessary. If the bleeding point could be confirmed, suturing technique is a more reliable surgical strategy than adhesive alone that leads to pseudoaneurysm. If the bleeding point is unclear, it is important to confirm the occurrence of LA diverticulum using a preoperative CT, and if confirmed, cover it with adhesive due to a high possibility of diverticulum bleeding. The necessity of CPB should be determined based on whether these operations can be completed while maintaining vital stability.
Osteoarthritis and hypertension: observational and Mendelian randomization analyses
Authors: Yang Zhi-Jie , Liu Yuan , Liu Yan-Li , Qi Bin , Yuan Xin , Shi Wan-Xin , Miao Liu
Published: April 2024

Background

The association between osteoarthritis (OA) and hypertension is a subject of ongoing debate in observational research, and the underlying causal relationship between them remains elusive.

Methods

This study retrospectively included 24,871 participants in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2020. Weighted logistic regression was performed to investigate the connection between OA and hypertension. Additionally, Mendelian randomization (MR) analysis was conducted to explore the potential causal relationship between OA and hypertension.

Results

In the NHANES data, after adjusting for multiple confounding factors, there was no significant relationship between OA and hypertension (OR 1.30, 95% CI, 0.97–1.73, P = 0.089). However, among males, OA appeared to be associated with a higher risk of hypertension (OR 2.25, 95% CI, 1.17–4.32, P = 0.019). Furthermore, MR results indicate no relationship between multiple OA phenotypes and hypertension: knee OA (IVW, OR 1.024, 95% CI: 0.931–1.126, P = 0.626), hip OA (IVW, OR 0.990, 95% CI: 0.941–1.042, P = 0.704), knee or hip OA (IVW, OR 1.005, 95% CI: 0.915–1.105, P = 0.911), and OA from UK Biobank (IVW, OR 0.796, 95% CI: 0.233–2.714, P = 0.715). Importantly, these findings remained consistent across different genders and in reverse MR.

Conclusions

Our study found that OA patients had a higher risk of hypertension only among males in the observational study. However, MR analysis did not uncover any causal relationship between OA and hypertension.
Options for making responsive future strategy to foster sustainability transitions in the German agri-food sector: a Delphi-based approach
Authors: Mangelkramer Delia
Published: April 2024

In response to pressing global challenges, sustainability transitions research has emerged as an interdisciplinary field focused on fundamental changes, necessitating novel approaches for strategy-making from research and innovation. Foresight practitioners need to extend their well-established methodological toolkit, which can inform subsequent planning processes about managing conflicts and shaping futures, to include the articulation of response options for contributing to the creation of more sustainable future systems. This research aims to contribute to this need by exploring future options characterized by discrepancies. Drawing from the Responsible Research and Innovation (RRI) literature to understand discrepancies between “desirability” and “probability” of future options as missed opportunities to secure social desirability in the future or as threats to it, this research argues for the collective identification and anticipation of discrepancies to reflect on options for making more responsive strategies. Thus, informed by RRI, a Delphi exercise was modified to engage experts from the German agri-food sector (n = 21) to assess divergent innovation-driven changes in the German agri-food sector that had been collectively anticipated and reflected upon beforehand. The results speak for a reduction of complexity by revealing specific actions necessary to redirect research and innovation processes away from unsustainable paths, as well as identifying determinants of discrepancies to do good or avoid harm.
The optimal glycemic target in critically ill patients: an updated network meta-analysis
Authors: Tanaka Aiko , Yatabe Tomoaki , Suhara Tomohiro , Egi Moritoki
Published: April 2024

Acute glycemic control significantly affects the clinical outcomes of critically ill patients. This updated network meta-analysis examines the benefits and harms of four target blood glucose levels (< 110, 110–144, 144–180, and > 180 mg/dL). Analyzing data of 27,541 patients from 37 trials, the surface under the cumulative ranking curve for mortality and hypoglycemia was highest at a target blood glucose level of 144–180 mg/dL, while for infection and acute kidney injury at 110–144 mg/dL. Further evidence is needed to determine whether 110–144 or 144–180 mg/dL is superior as an optimal glucose target, considering prioritized outcomes.
Genomic Landscape and Clinical Features of Advanced Thyroid Carcinoma: A National Database Study in Japan
Authors: Toda Soji , Hiroshima Yukihiko , Iwasaki Hiroyuki , Masudo Katsuhiko
Published: April 2024

Context

The relationship between the genomic profile and prognosis of advanced thyroid carcinoma requiring drug therapy has not been reported.

Objective

To evaluate the treatment period and overall survival time for each genetic alteration in advanced thyroid carcinoma that requires drug therapy.

Methods

We conducted a retrospective observational study using a national database in Japan, which included 552 cases of thyroid carcinoma out of 53 543 patients in the database.

Results

The database included anaplastic thyroid carcinoma (23.6%), poorly differentiated thyroid carcinoma (10.0%), and differentiated thyroid carcinoma (66.4%). The most common genetic abnormalities were TERT promoter (66.3%), BRAF (56.7%), and TP53 (32.2%). The typical driver genes were BRAF V600E (55.0%), RAS (18.5%), RET fusion (4.7%), NTRK fusion (1.6%), and ALK fusion (0.4%). The most common regimen was lenvatinib, and the time to treatment failure was not different despite the presence of BRAF or RAS mutations. In differentiated thyroid carcinoma and poorly differentiated thyroid carcinoma, TP53 alterations independently predicted worse overall survival (hazard ratio = 2.205, 95% confidence interval: 1.135-4.283). In anaplastic thyroid carcinoma, no genetic alterations were associated with overall survival.

Conclusion

Genetic abnormalities with treatment options were found in 62.7% of advanced thyroid carcinomas. TP53 abnormality was an independent poor prognostic factor for overall survival in differentiated thyroid carcinoma. The time to treatment failure for lenvatinib was not different based on genetic profile.
Effect of Oral Bisphosphonate Drug Holiday on Mortality Following Hip Fracture
Authors: Leung Miriam T Y , Turner Justin P , Marquina Clara , Ilomaki Jenni , Tran Tim , Bell J Simon
Published: April 2024

Context

Current clinical guidelines recommend a drug holiday after extended use of oral bisphosphonates. However, no studies have investigated the effect of drug holidays before hip fractures on postfracture mortality.

Objective

This work aimed to investigate the effect of a drug holiday on postfracture mortality in patients with extended use of oral bisphosphonates.

Methods

This retrospective, population-based cohort study took place among all patients with hip fractures in Victoria, Australia, from 2014 to 2018. Patients were adherent to oral alendronate or risedronate for 5 years or more prior to hip fracture. Group-based trajectory modeling categorized patients into different bisphosphonate usage after 5-year good adherence. The main outcome measure was postfracture mortality.

Results

We identified 365 patients with good adherence (medication possession ratio ≥80%) to oral alendronate/risedronate for 5 years or more. Most patients (69%) continued to use oral bisphosphonates until admission for hip fracture; 17% had discontinued for 1 year and 14% had discontinued for 2 years. Postfracture mortality was higher in patients who had discontinued risedronate for 1 year (hazard ratio [HR] 2.37; 95% CI, 1.24-4.53) and 2 years (HR 3.08; 95% CI, 1.48-6.41) prior to hip fracture. No increase or decrease in postfracture mortality was observed in patients who had discontinued alendronate for 1 year (HR 0.59; 95% CI, 0.29-1.18) or 2 years (HR 1.05; 95% CI, 0.57-1.93) prior to hip fracture.

Conclusion

Postfracture mortality is higher in people who discontinue risedronate, but not alendronate, for 1 or 2 years after being adherent to treatment for at least 5 years. The type of bisphosphonate may be a factor to consider when planning drug holidays.
A rapid return to normal: temporal gene expression patterns following cold exposure in the bumble bee Bombus impatiens
Authors: Verble Kelton M. , Keaveny Ellen C. , Rahman Sarthok Rasique , Jenny Matthew J. , Dillon Michael E. , Lozier Jeffrey D.
Published: April 2024

Bumble bees are common in cooler climates and many species likely experience periodic exposure to very cold temperatures, but little is known about the temporal dynamics of cold response mechanisms following chill exposure, especially how persistent effects of cold exposure may facilitate tolerance of future events. To investigate molecular processes involved in the temporal response by bumble bees to acute cold exposure, we compared mRNA transcript abundance in Bombus impatiens workers exposed to 0°C for 75 min (inducing chill coma) and control bees maintained at a constant ambient temperature (28°C). We sequenced the 3′ end of mRNA transcripts (TagSeq) to quantify gene expression in thoracic tissue of bees at several time points (0, 10, 30, 120 and 720 min) following cold exposure. Significant differences from control bees were only detectable within 30 min after the treatment, with most occurring at the 10 min recovery time point. Genes associated with gluconeogenesis and glycolysis were most notably upregulated, while genes related to lipid and purine metabolism were downregulated. The observed patterns of expression indicate a rapid recovery after chill coma, suggesting an acute differential transcriptional response during recovery from chill coma and return to baseline expression levels within an hour, with no long-term gene expression markers of this cold exposure. Our work highlights the functions and pathways important for acute cold recovery, provides an estimated time frame for recovery from cold exposure in bumble bees, and suggests that cold hardening may be less important for these heterothermic insects.
Friends with Health Benefits: A Field Experiment
Authors: Gershon Rachel , Cryder Cynthia , Milkman Katherine L.
Published: April 2024

When pursuing goals, we commonly choose between going it alone versus teaming up together. In a field experiment (n = 774), we tested the benefits of rewarding individual versus tandem goal pursuit. In a standard-reward condition, we experimentally offered gym members an individual cash reward each day they visited the gym for four weeks. Participants in a tandem-reward condition could earn the same reward but only if they surmounted an extra logistical hurdle: they had to visit the gym with a friend. Although this additional requirement made it more difficult for participants in the tandem-reward condition to earn equivalent incentives, participants with this extra hurdle visited the gym about 35% more frequently than those earning a standard reward. A follow-up survey suggests that tandem rewards provide nonmonetary incentives that change behavior, including increased accountability and enjoyment. Our findings illustrate the advantages of making desired behaviors social to promote follow-through.

This paper was accepted by Yan Chen, behavioral economics and decision analysis.

Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2022.01401 .
Uncertainty among patients with advanced-stage lung cancer
Authors: Wongkalasin Kiratiya , Matchim Yaowarat , Kanhasing Ruankwan , Pimvichai Sirinya
Published: April 2024

Background:

Uncertainty is the inability to define the meaning of illness-related events, which may result in anxiety, depression, poor coping, the self-perception of being a burden and low quality of life. Uncertainty among Thai patients with advanced-stage lung cancer (ASLC) has not been well documented.

Aims:

To assess uncertainty in patients with ASLC.

Methods:

A cross-sectional survey design was adopted. Data were collected from 60 patients with ASLC at a university hospital. A demographic data form and the Mishel Uncertainty in Illness Scale (MUIS) were used to collect data. The data were analysed using descriptive statistics.

Results:

The patients had moderate levels of uncertainty in illness (83.73±15.25). Ambiguity about the illness and unpredictability of the prognosis scored at a moderate level for patients, while complexity of treatment and the system of care and inconsistency or lack of information, about the diagnosis or severity of the illness were at a low level.

Conclusion:

The results of this study may help healthcare professionals better understand and manage uncertainty in patients with ASLC.
„Am Lëtzebuergesche ginn et esou vill Variatiounen an droleg Ausdréck“.
Authors: Entringer Nathalie
Published: April 2024

Language experiments have a long tradition in the field of dialectology to investigate phonological, lexical and syntactic variation. Methodologically, the repertoire ranges from written test procedures to standardized language production tests and interviews whereby different types of tasks (e. g. translation, picture-naming, evaluation tasks) are used. In order to investigate the variation and perception of morpho(phono)logical phenomena (e. g. the variation of the superlative dat schéinst/dat schéinsten/dat schéinstent Meedchen ‘the most beautiful girl’) in Luxembourgish, I developed a new test procedure, which is based on test procedures and tasks already used in other dialectological and variationist projects (e. g. Syntax Hessischer Dialekte (SyHD), cf. Fleischer/Lenz/Weiß 2015, Sprachvariation in Norddeutschland (SiN); cf. Elmentaler et al. 2015)). The development of a new method was indispensable, since firstly, it must be adapted to the analysis of morpho(phono)logical phenomena that are not linked to regional variation and secondly this test aims to analyse salience and pertinence, two relevant concepts within the scope of language perception and evaluation (cf. Purschke 2011), separately. This paper thus presents an experiment that aims to investigate the perception of morpho(phono)logical variation and its variants in Luxembourgish. The individual test procedures, a salience test, a specific form of scale-based test, a translation task and a supplementary questionnaire are described, contextualized and discussed in detail. The focus also lies on the special design of the test, which is able to ascertain the salience and pertinence of certain variants and to correlate them directly with the production of the variants and the self-evaluation of the individual participants.
Apprenticeship Reforms in West Africa: An Outcome-Process Evaluation of a Pilot Dual Training Model-Based Apprenticeship Reform Scheme in Ghana
Authors: Nunyonameh Collins , Obinnim Elizabeth , Adzivor Eric Kodzo
Published: April 2024

Context: Faced with deep challenges with access to formal education, many West African countries are increasingly taking steps to reform their informal apprenticeship systems to make them a quality skills development alternative for their teeming youth. A review of the literature shows that although different countries in the region are deploying different reform strategies, what is emerging as a dominant reform model is the "dual training model" (DTM), a collaborative arrangement in which the task of training apprentices is shared between informal trainers (master craftspersons, under their respective trade associations) and formal vocational training institutions (FVTIs). This paper presents an outcome-process evaluation of a DTM-based apprenticeship reform programme piloted in Ghana. 
Methods: Designed as a case study, the paper adopts an interpretivist approach, relying on diverse sources of data, both secondary and primary. Secondary data includes journal articles, attendance registers of participants, memorandums of understanding, relevant media reports, websites, and official reports by all relevant actors. The primary data originated from in-depth interviews with fourteen (14) key informants, as well as from overt and covert observations of respondents. 
Results: At the outcome level, the paper shows that the programme has largely failed in transferring new skills or in changing dominant poor practices among trainees, foundational objectives of the programme. At the process level, the paper revealed deep flaws in implementation; these are discussed in detail in an attempt to clarify the programme outcomes. 
Conclusion: The paper concludes that although the dual training model remains a potentially viable reform model in informal apprenticeships, its success ultimately depends on the quality of implementation, which in turn depends on the strength and quality of inter-stakeholder collaboration in programme design and implementation.
Resilience and agency in children living with domestic abuse: an alternative interpretation
Authors: Hall Kirsten Ellen
Published: April 2024

Children’s agency and resilience within situations of domestic abuse has been the focus of recent research, with an emphasis on children’s voices to inform knowledge. This has been underpinned by a move away from the witness model of domestic abuse. This article contributes to this growing understanding of how children react, respond, and interact when living with domestic abuse.

Qualitative interviews were completed with 16 relevant professionals, and 13 adult survivors of childhood domestic abuse. The research overall was conducted through the lens of the home to provide enhanced insight into day-to-day experiences of domestic abuse. Factors associated with resilience were part of an initial research question, whereas agency emerged as a strong theme through the analysis process.

This research has demonstrated that children engage in varying degrees of agency or display behaviours associated with resilience to cope with situations of domestic abuse, prevent or stop escalation of abuse or as protection for themselves and others. This article argues that agency and resilience can occur in contexts where adults – both inside and outside the home – have not prevented children from experiencing domestic abuse and its impacts. This has been conceptualised as children operating in the context of a ‘vacuum of responsibility’.
Be careful what you wish for: why more fragmentation might hurt global cybersecurity
Authors: Hansel Mischa , Silomon Jantje , Neuber Emilia
Published: April 2024

Governmental representatives often cite security concerns as a reason when justifying policies that contribute to internet fragmentation. Restrictions, such as on the use of foreign soft- and hardware or data localisation requirements, are meant to lessen cybersecurity risks, including disruptive cyberattacks or state-led surveillance campaigns. Intuitively, it seems self-explanatory that these measures translate into cybersecurity gains – the more control a government has over a system, the more secure it should be. Although critics strongly dispute such measures by making an economic case, they hardly ever question the assumption made regarding cybersecurity benefits.

Our article challenges this view, taking public goods theory as our analytical point of departure to criticise notions of ‘weaponized interdependence’. Furthermore, we challenge the idea of secure national controls, which are key building blocks within justifications of governmental fragmentation policies at the application layer. More specifically, we argue that such justifications ignore negative impacts on the availability of key public goods in global cybersecurity, as well as other externalities. For example, while technological decoupling may well lead to less vulnerability to cyberattacks, it may also eliminate important incentives for self-restraint on the part of attackers due to potential blowback effects. It is with a view to such unintended consequences that we call for a more thorough assessment of the security risks and benefits within public policy debates on digital trade restrictions and data localisation.
Devenir-sin: mosquitos transgénicos, control de enfermedades, y el valor del no-encuentro en las relaciones multiespecies
Authors: Reis-Castro Luísa
Published: April 2024

El zancudo Aedes aegypti, conocido como el vector de los virus del zika, dengue, chikungunya y fiebre amarilla, ha sido históricamente el objetivo de campañas de salud pública en las que se le concibe como un enemigo a eliminar. Sin embargo, han surgido nuevas estrategias, como el enfoque transgénico, que implicase modificar biológicamente el A. aegypti para utilizarlo en el control de su propia población. En este enfoque, la cría y el apareamiento de zancudos se convierten en un insecticida. Con ello, el insecto pasa a ser simultáneamente amigo y enemigo, recibe cuidados y es eliminado y debe establecer encuentros y no encuentros. Con base en un trabajo de campo etnográfico realizado en una «biofábrica» en el noreste de Brasil dedicada a la producción masiva de estos mosquitos transgénicos, Reis-Castro explora las nuevas dinámicas de trabajo y de generación de valor que surgen de estas contrastantes relaciones entre humanos y mosquitos. La autora también examina cómo este proyecto se inserta en el contexto más amplio de la experimentación y las concepciones de género más allá de lo humano. Al analizar las relaciones entre múltiples especies que se generan bajo la premisa de que es posible producir no encuentros, ella identifica los antecedentes históricos de transformar la capacidad reproductiva del A. aegypti en una labor orientada hacia su eliminación y las expectativas que se generan. Esta trasmutación da lugar a lo que Reis-Castro llama «el valor de no encuentro» en la reconfiguración científica de los zancudos, su devenir y su ser.
Cuerpos sin cabeza: corporalidades abyectas y nuda vida en Temporada de huracanes, de Fernanda Melchor
Authors: Blanco Rivera María Teresa
Published: April 2024

A partir de la noción de «campo de concentración» como espacio paradigmático de la biopolítica moderna planteado por Giorgio Agamben, Temporada de huracanes destaca como un referente literario representativo de la nuda vida en una región limítrofe de México, donde los personajes son encarnaciones de un homo sacer que ve reducida su existencia a una lógica de explotación del cuerpo, y donde se nace y se muere inserto/a en una zona liminar en la que se transita entre el adentro y el afuera como víctimas, pero también como victimarios. Los «cuerpos sin cabeza» son metáfora de estas vidas desnudas que son descabezadas, esto es, despojadas de toda posibilidad de reformular su existencia. En ese sentido, el texto mismo funciona como objeto abyecto en la configuración espaciotemporal de la obra.
El asesinato en el origen en Titus Andronicus y Matar a Rómulo
Authors: Contreras Godoy María Loreto
Published: April 2024

El presente artículo es una lectura comparada entre Titus Andrónicus de William Shakespeare y su reescritura Matar a Rómulo de Luis Barrales. El objetivo es exponer los aspectos fundamentales de la elaboración del hipotexto, teniendo como principal hilo conductor la violencia como sustrato histórico en la construcción del proyecto político civilizatorio occidental. Se analizarán los motivos de la venganza, la construcción del Otro y la violencia histórica para establecer que la escritura revisionaria de la obra de Shakespeare por parte de Barrales tiene como tesis que el crimen y la violencia son el origen de los problemas civilizatorios.
Performance analysis of the FSO communication system with random jamming over a composite Málaga turbulence fading channel
Authors: Wang Jingyu , Gao Dingshan , Li Juan , Chen Dongliang , Ding Deqiang , Dong Yuzhao
Published: April 2024

The performance analysis of a free space optical (FSO) communication system in the presence of random jamming is presented over a Málaga (M) distributed channel model with pointing errors and atmospheric attenuation. Firstly, the probability density function expressions of the transmission channel, signal-to-jamming ratio, and signal-to-noise ratio are derived. Then, considering the probability of the jammer and Gaussian white noise, the closed-form expressions for the ergodic channel capacity, outage probability, and average bit error rate are derived. Moreover, asymptotic expressions for the aforementioned performance metrics are also derived to ascertain the diversity gain of the system. Extensive Monte Carlo simulations are performed to demonstrate the credibility of this theoretical analysis. Results indicate that the adverse impact of random jamming is higher than that of Gaussian noise for the FSO communication system. Besides, this observation highlights the pulsating nature of the jamming effect, showcasing that within high signal-to-jamming ratio regions, a low probability jammer exerts the most significant impact on the FSO system.
Controlling the bandwidth of high harmonic emission peaks with the spectral polarization of the driver
Authors: Ragonis Eldar , Ben-Arosh Eran , Merensky Lev , Fleischer Avner
Published: April 2024

We demonstrate a high harmonic-generation scheme that offers control over the bandwidth of the spectral peaks. The scheme uses a vectorial two-color driver with close central frequencies, generated by spectrally splitting a linearly polarized input femtosecond-duration laser pulse and subsequently recombining the two halves after their polarizations are made cross-elliptical and counter-rotating. This results in the generation of new emission channels that coalesce into broad odd-integer HHG peaks, the bandwidth of each being proportional to the frequency difference between the two colors, to the harmonic order and inversely proportional to the driver fields’ ellipticities. Peak broadening to the extent that a supercontinuum is formed is also demonstrated. This source will find use in HHG applications benefiting from high-flux broadband extreme ultraviolet radiation, such as attosecond transient absorption spectroscopy.
Errors Correction Analysis of Wavefront Testing in Quadriwave Lateral Shearing Interferometry
Authors: Zhu Yahui , Ailing Tian , liu cai , Hongjun Wang
Published: April 2024

The quadriwave lateral shearing interferometry (QWLSI) based on double birefringent crystals of beam displacer (DBCs-BD), which can generate the lateral shearing interference wavefront of four beams of overlapped replicas in the DBCs-BD orthogonal directions. When the replica waves of overlapped incident to the analyzer, and it’s the direction of transmission axis is set as 45° or 135°, the QWLSI’s polarization interferogram can be obtained. This paper deduced the principle of QWLSI in detail, and showed the phase retrieval by the Fourier analysis of the QWLSI’s interferogram, then the wavefront can be reconstructed by using the differential Zernike polynomial fitting. In our investigation, the correction range of PBD’s orthogonal angle error is within –0.5° ~ 0.5°, the maximum error in PV: 0.0012λ and the maximum error in RMS: 1.3789×10-4λ in wavefront reconstruction. Moreover, when the testing light tilts to incident on the PBD in the range of –0.4° ~ 0.4°, by correcting the shear distance be used for wavefront reconstruction to achieve high-precision wavefront testing result. Finally, the experiment shows that the DBCs-BD-QWLSI exhibits feasibility, and high precision.
A mathematically-derived unified formula for Time-Varying Doppler effect, Cosmological red-shift and Cherenkov radiation
Authors: Chen Qian
Published: April 2024

Although Doppler effect is a well-known phenomenon, its nature was not fully clear. Currently, many different formulas are required to describe Doppler effect in different cases, and all formulas don’t include the timing of velocity which implies they only work for constant velocities. In this paper, a general formula is mathematically derived purely from the principle of constant light speed without any other assumption. This unified formula provides a straightforward mathematical explanation of the fundamental nature of Doppler effect, Cosmological red-shift, and Cherenkov radiation. It is also supported by existing experiments and theoretically proved by Maxwell’s wave equations. This formula covers both the classical and transverse Doppler effects and applies to time-varying velocities. Furthermore, it also provides a straightforward mathematical explanation of Cherenkov radiation and Cosmological red shift. The fact that all these physical phenomena can be mathematically explained by a unified formula is interesting. Our findings reveal the intrinsic connection between these phenomena, attributing them to a common time scaling factor arising from relative motion between light source and observer. These results are just part of a new theoretical framework mathematically derived from the principle of constant light speed, named as “Asymmetry Theory”, which is comprehensive, self-consistent, and in harmony with all existing experiments. Moreover, our results suggest potential applications, including the discussion of time-varying recessional velocities in Hubble's law, which may shed new light to puzzles like “Hubble tension”.
Encoding surprise by retinal ganglion cells
Authors: Despotović Danica , Joffrois Corentin , Marre Olivier , Chalk Matthew
Published: April 2024

The efficient coding hypothesis posits that early sensory neurons transmit maximal information about sensory stimuli, given internal constraints. A central prediction of this theory is that neurons should preferentially encode stimuli that are most surprising. Previous studies suggest this may be the case in early visual areas, where many neurons respond strongly to rare or surprising stimuli. For example, previous research showed that when presented with a rhythmic sequence of full-field flashes, many retinal ganglion cells (RGCs) respond strongly at the instance the flash sequence stops, and when another flash would be expected. This phenomenon is called the ‘omitted stimulus response’. However, it is not known whether the responses of these cells varies in a graded way depending on the level of stimulus surprise. To investigate this, we presented retinal neurons with extended sequences of stochastic flashes. With this stimulus, the surprise associated with a particular flash/silence, could be quantified analytically, and varied in a graded manner depending on the previous sequences of flashes and silences. Interestingly, we found that RGC responses could be well explained by a simple normative model, which described how they optimally combined their prior expectations and recent stimulus history, so as to encode surprise. Further, much of the diversity in RGC responses could be explained by the model, due to the different prior expectations that different neurons had about the stimulus statistics. These results suggest that even as early as the retina many cells encode surprise, relative to their own, internally generated expectations.
Effectiveness of COVID-19 mRNA vaccine in preventing infection against Omicron strain: Findings from the Hiroshima Prefecture COVID-19 version J-SPEED for PCR center
Authors: Yumiya Yui , Kawanishi Kenya , Chimed-Ochir Odgerel , Kishita Eisaku , Sugiyama Aya , Tanaka Junko , Kubo Tatsuhiko
Published: April 2024

Background and purpose

Despite the widespread adoption of various preventive measures since the spread of COVID-19, there remains a lack of consensus on universally acknowledged best practices. However, the significance of vaccination has risen to prominence as a paramount preventive strategy. Numerous investigations have demonstrated vaccine effectiveness against the omicron strain in severe disease and symptomatic disease, however, the scope of research pertaining to vaccine effectiveness in preventing infection is presently limited. Therefore, the current study aimed to evaluate COVID-19 mRNA (Pfizer-BioNTech BNT162b2 or Moderna mRNA-1273) vaccine effectiveness in preventing infection.

Methods

We conducted a test-negative case-control study using a dataset of 117,335 individuals. These data were collected through the COVID-19 J-SPEED form in the PCR center at Hiroshima Prefecture, Japan from 1 February to 17 March 2022. We estimated propensity score matching for vaccine status based on participants’ demographic characteristics. Subsequently, odds ratio was calculated from logistic regression to determine the association between vaccination status and test positivity rate adjusting for symptoms, exposure to close contact, and previous infection history. Vaccine effectiveness was defined as (1 –aORs) ×100%.

Results

The PCR test positivity rates were 7.9%, 4.5%, and 2.8% for the non-vaccinated (non-vaccinated, vaccinated with a single dose, and vaccinated with two doses less than 14 days ago), vaccinated with two doses (vaccinated over 14 days ago), and three doses, respectively. In unadjusted and adjusted analyses, vaccine effectiveness of two doses against infection were 38.5% (95% confidence interval [CI]: 32.8%–43.8%) and 34.7% (95%CI: 28.4%–40.4%), respectively, compared to non-vaccinated group. Vaccine effectiveness of three doses were 33.8% (95%CI: 25.0%–41.5%) and 26.4% (95%CI: 16.4%–35.2%), respectively, compared to those vaccinated with two doses.

Conclusions

These results illustrate the protective effect of mRNA vaccines against Omicron strain infections and emphasize the significance of completing the suggested vaccination schedule.