bluuebunny/crossref_metadata_2025 huggingface dataset:
Parent Perceptions of Trainees in Pediatric Care: Cross-Sectional Study
Authors: Strouf Motley Haley , Kerr Bradley , Sklansky Daniel J , Eickhoff Jens , Moreno Megan A , Babal Jessica C
Published: November 2023

Background

Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance.

Objective

This study aims to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics.

Methods

We used data from a national cross-sectional web-based survey of 3000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes.

Results

Of the 3000 parents who completed the survey, 1543 met the inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an examination, and comfort with autonomously giving medical advice. LCA identified 3 latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age <30 years, household income < US $50,000, no college degree, and lesser desire to receive future care at a teaching hospital (all P<.05).

Conclusions

Parents may prefer greater clinical autonomy for residents than medical students. Importantly, views associated with the Trainee-Hesitant class may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine.
Validating the Safe and Effective Use of a Neurorehabilitation System (InTandem) to Improve Walking in the Chronic Stroke Population: Usability Study (Preprint)
Authors: Smayda Kirsten Elisabeth , Cooper Sarah Hodsdon , Leyden Katie , Ulaszek Jackie , Ferko Nicole , Dobrin Annamaria
Published: November 2023

BACKGROUND

Persistent walking impairment following a stroke is common. Although rehabilitative interventions exist, few exist for use at home in the chronic phase of stroke recovery. InTandem (MedRhythms, Inc) is a neurorehabilitation system intended to improve walking and community ambulation in adults with chronic stroke walking impairment.

OBJECTIVE

Using design best practices and human factors engineering principles, the research presented here was conducted to validate the safe and effective use of InTandem.

METHODS

In total, 15 participants in the chronic phase of stroke recovery (≥6 months after stroke) participated in this validation study. Participants were scored on 8 simulated use tasks, 4 knowledge assessments, and 7 comprehension assessments in a simulated home environment. The number and types of use errors, close calls, and operational difficulties were evaluated. Analyses of task performances, participant behaviors, and follow-up interviews were conducted to determine the root cause of use errors and difficulties.

RESULTS

During this validation study, 93% (14/15) of participants were able to successfully complete the critical tasks associated with the simulated use of the InTandem system. Following simulated use task assessments, participants’ knowledge and comprehension of the instructions for use and key safety information were evaluated. Overall, participants were able to find and correctly interpret information in the materials in order to answer the knowledge assessment questions. During the comprehension assessment, participants understood warning statements associated with critical tasks presented in the instructions for use. Across the entire study, 3 “use errors” and 1 “success with difficulty” were recorded. No adverse events, including slips, trips, or falls, occurred in this study.

CONCLUSIONS

In this validation study, people in the chronic phase of stroke recovery were able to safely and effectively use InTandem in the intended use environment. This validation study contributes to the overall understanding of residual use–related risks of InTandem in consideration of the established benefits.
Exploring user experience and use of the OpenMRS HIV electronic medical record in primary healthcare facilities of Rwanda: a qualitative study. (Preprint)
Authors: Mugisha Michael , Umubyeyi Aline , Ngenzi Joseph Lune , Richards Janise , Santas Xen , Condo Jeanine , Fraser Hamish
Published: November 2023

BACKGROUND

The adoption and usability of an electronic medical record (EMR) is a critical step towards its successful implementation and enhancing quality care. Use and usability of EMRs are rarely documented in primary healthcare settings. This study explored users’ experience in the use and usability of OpenMRS, an EMR used in HIV care in Rwanda for over 13 years.

OBJECTIVE

To determine the user experience of the EHR in long term use, the factors that were facilitators and barriers to use and recommendations for improvements.

METHODS

We used two qualitative methods: key informant interviews; and facility and specific task observations of EMR use in health facilities. We interviewed at least one nurse and a data manager or data entry clerk in 12 health centers. We analyzed data from key-informant interviews and observations using an informed grounded theory together with thematic analysis, grouping our findings into themes and sub-themes.

RESULTS

The OpenMRS EMR was used, together with paper-based registers and patient cards, in HIV care. Participants were generally able to perform tasks in OpenMRS EMR easily, although nurses could complete fewer tasks than data managers. Participants thought the system was useful, helped them retrieve patient information easily, and were able to create pre-formatted reports. Barriers to using the system included limited staff trained to use it, staff turnover, limited infrastructure, and double data entry requirements. Suggestions for more effective use of the system were work-based trainings, facility supervisions, improved infrastructure and decentralized technical support.

CONCLUSIONS

Staff from health centers experienced the OpenMRS EMR as a useful system that improves healthcare delivery process and patient care. The use of the EMR could be improved by increasing infrastructure, human resources capacity and technical support.
Pancoh Bercerita: Storynomics dalam Pengemasan Promosi Paket Wisata Seni dan Budaya
Authors: Sari Yulita Kusuma , Sushartami Wiwik , Aji Khusnul Bayu
Published: November 2023

The COVID-19 epidemic has impeded tourism activities worldwide. Pancoh Ecotourism Village is an instance of a tourist destination that was compelled to cease its operations amid the pandemic. Nevertheless, that does not imply that nothing can be accomplished.   Amidst the pandemic, it is imperative to create tourism offerings that are more inventive in order to adapt to the new normal period. The Pancoh Ecotourism Village offers an innovative tourism package that combines art and culture based on the concept of storynomics. This study employs the Participatory Action Research (PAR) method to engage village communities as active participants, rather than just sources of information. The aim is to involve them in the process of gathering, organizing, and presenting narratives about the local arts and culture that define the Ecotourism Villages of Pancoh.   This study discovered that the PAR technique is beneficial for students who are examining the extent of community involvement in developing a work plan, namely in this case, the creation of tour packages based on storynomics. However, PAR encounters challenges such as extended research duration, varying levels of informant motivation, and the researcher's requirement for considerable adaptability in terms of time and ability to engage with informants.
Editorial
Authors: Sushartami Wiwik
Published: November 2023

Tourism has served as and remains a significant driver of national development in many countries. Adopting a critical perspective in the field of tourism studies towards this circumstance will be advantageous for both the tourism sector and academia.   The Gadjah Mada Journal of Tourism Studies contributes to the broader field of tourism studies, which aims to enhance the prosperity of the worldwide community. The current edition of Gadjah Mada Journal of Tourism Studies features the publication of five papers.Managing Carbon Footprint at Music Festivals: A Study at Glastonbury FestivalKeterlibatan Perempuan secara Formal dalam Pengelolaan Kegiatan Pariwisata di Desa Wisata Kebonagung, BantulIdentifikasi Pengalaman Burnout Pekerja Front Office di The Phoenix Hotel Yogyakarta pada Masa Pandemi Covid-19Pancoh Bercerita: Storynomics dalam Pengemasan Promosi Paket Wisata Seni dan Budaya Identifikasi Potensi Psikoterapi Kawruh Jiwa Ki Ageng Suryomentaram Sebagai Wisata Kebugaran Berbasis Kearifan Lokal
Research on the Countermeasures of the Art Communication of Rare Operas under the Background of Rural Cultural Revitalization—Take the Wa Qing Opera in Tengchong, Yunnan Province as an Example
Authors: Shangqi Li
Published: November 2023

As a kind of traditional drama with local characteristics, the Wa nationality Qing opera itself has high artistic value, historical value and scientific research value. This paper mainly analyzes the spread of the contemporary process and characteristics of the wa opera, understand the present situation of the wa opera art spread, find out the difficulties and problems in the communication and inheritance of the wa opera art, try to explore spread potential of the wa in the background of rural cultural, explore new path and new strategies of rare operas dissemination under the new background.
Insights and Inspirations from Attempts of the EU to “Rebuild the Tower of Babel”
Authors: Yang Yujin
Published: November 2023

Based on the historical characteristics of Europe’s linguistic diversity, the EU has implemented a pluralistic language policy, aiming to “Rebuild the Tower of Babel” within its organization. However, the language governance in the process of the EU integration has not been smooth. The conflicts between linguistic legislation and linguistic practice, between efforts to preserve multilingualism and the reality of English monolingualism, and between the multiple participants in language governance and their varying interests are still nagging at the EU language policy-makers. The underlying reasons are those difficulties to reconcile administrative efficiency with multilingual equality, the pragmatic instrumental value of one language with its national symbolic value, and the interests of many countries behind languages race. Insights into the EU language governance provide good inspirations for China’s language policy and planning, which will help China better present Chinese language and culture to the world, telling China’s stories well and making China’s voice heard.
Preserve and Promote Cultural Values of the Temple Festival in Bim Son Town, Thanh Hoa Province
Authors: Son Le Xuan
Published: November 2023

The historical and cultural relic of Song Son Temple, also known as Song Temple - where Mother Goddess Lieu Hanh is worshiped, was built to meet most of the people's spiritual life needs for a form of sacred cultural activity which is called the Worship of Mother Goddess. Along with the profound humanistic cultural values, the traditional and modern rituals of the Song Temple festival also need to be learned.
Twitter Sentiment Analysis on Chatgpt Tweets
Authors: Jadhav Anurag
Published: November 2023

Abstract: This study investigates multilingual sentiment analysis within tweets on ChatGPT, an AI conversational model, employing Support Vector Machines (SVM) and BERT, an advanced language model. It aims to detect and classify emotions, including emoji identification, embedded within diverse messages across multiple languages on Twitter. By leveraging SVM's text classification and BERT's contextual understanding in various languages, the research delves into preprocessing techniques and feature engineering for sentiment analysis, encompassing multilingual and emoji detection. Furthermore, it explores the fusion of traditional SVM methods with BERT's state-of-the-art model for multilingual sentiment analysis, emphasizing emotion and emoji detection in AI-generated content on multilingual social media platforms like Twitter. This research yields insights into the successful detection of multilingual sentiment nuances and emotions, including emoji identification. It offers implications for advancing multilingual sentiment analysis in natural language processing across diverse linguistic contexts.
FeelFlow: Music Recommendation System Based on your Facial Expression
Authors: Navale Prof. Vandana , Phand Sanjana V. , Patil Pranav K. , Rangat Dhananjay V. , Sathe Rohan J.
Published: November 2023

Abstract: This study introduces an innovative Emotion-Aware Music Recommender System that leverages facial feature analysis for real-time emotion detection, aiming to elevate the personalization and user engagement in music recommendations. Through the integration of computer vision and machine learning techniques, the system interprets facial expressions to discern user’s emotional states before recommending music to them. Integrating advanced deep learning and evolutionary techniques improves the accuracy and efficiency of facial expression detection. Implementation of the proposed recommender system is performed using Viola-Jones algorithm, CNN, Principal Component Analysis (PCA) techniques. Experimental results confirm the effectiveness of this method and demonstrate its potential to improve music recommendations
Artificial intelligence service reduces customer citizenship behavior for warm brands versus competent brands
Authors: Guan Biyu , Chen Haiquan
Published: November 2023

Chatbot services powered by artificial intelligence (AI) have begun to replace staff on the frontline in various industries. This research examined how AI service affects customer citizenship behavior. Drawing on emotional spillover theory, we conducted two experiments (Ns =
140 and 200). The results demonstrated there was a negative effect of AI (vs. human) service on customer citizenship behavior and identified positive emotion as the underlying mechanism of this effect (Study 1). Additionally, brand stereotypes were found to moderate the relationship between
service type and positive emotions (Study 2). Specifically, the relationship became weaker for competent (vs. warm) brand service. These findings contribute to promoting customer citizenship behavior in unmanned contexts and provide insights for the application of AI services in frontline
operations.
Sensation seeking and automobile insurance coverage decisions: A moderated mediation model of gender and risk perception
Authors: Jiang Shi-MLe , Xiang Feiyun , Yang Iris
Published: November 2023

We explored how and when sensation seeking influences consumers’ automobile insurance purchasing behavior by taking risk perception as a mediator and gender as a moderator. We collected data from 413 participants who purchased automobile liability insurance in China and employed
the SPSS PROCESS macro for moderated mediation analysis. Our results revealed that sensation seeking had an indirect effect on insurance coverage purchasing behavior through risk perception, and that this mediating effect was moderated by gender. Men with higher (vs. lower) sensation seeking
were more likely to have a lower risk perception and tended to purchase less insurance coverage. However, the indirect effect of sensation seeking was not significant among women. Our findings provide insight into the psychological mechanisms that influence consumers’ automobile insurance
purchasing behavior.
Found a fossil: improving awareness, engagement, and communication strategies for heritage discoveries
Authors: Hurst Sally , Kosnik Matthew , Evans Linda , Brock Glenn A.
Published: November 2023

Fossils and Indigenous artefacts are often found by members of the general public. To gauge Australian awareness of heritage laws and willingness to report finds, the Found a Fossil project conducted a survey to understand barriers to reporting heritage material. Results showed enthusiasm to report but confusion over appropriate authorities to contact, lack of transparency by government, and poorly communicated legislation created barriers to heritage reporting. This project represents the first attempt to quantify reporting behaviours of Indigenous artefacts and fossils in Australia and recommends improvements for reporting, protection and communication of Australian heritage items and their historical narratives.
Abstraqt: Analysis of Quantum Circuits via Abstract Stabilizer Simulation
Authors: Bichsel Benjamin , Paradis Anouk , Baader Maximilian , Vechev Martin
Published: November 2023

Stabilizer simulation can efficiently simulate an important class of quantum circuits consisting exclusively of Clifford gates. However, all existing extensions of this simulation to arbitrary quantum circuits including non-Clifford gates suffer from an exponential runtime.To address this challenge, we present a novel approach for efficient stabilizer simulation on arbitrary quantum circuits, at the cost of lost precision. Our key idea is to compress an exponential sum representation of the quantum state into a single abstract summand covering (at least) all occurring summands. This allows us to introduce an abstract stabilizer simulator that efficiently manipulates abstract summands by over−approximating the effect of circuit operations including Clifford gates, non-Clifford gates, and (internal) measurements.We implemented our abstract simulator in a tool called Abstraqt and experimentally demonstrate that Abstraqt can establish circuit properties intractable for existing techniques.
Problems and Prospects for Improving the Territorial Organization of Local Self-Government (On the Example of Municipalities of the Republic of Tyva)
Authors: Zelentsov V. V.
Published: November 2023

The specificity of the socio-economic and ethno-cultural processes developing on the territory of the Republic of Tyva reflects the objective need for expert and scientific analysis of the problems of managing the territories of municipalities in the region in the general context of the transformation of the system of territorial organization of local self-government in Russia.

   The purpose of this study is to develop practical recommendations for improving the territorial organization of local self-government in the Republic of Tyva.

   In the article, based on the application of general scientific methods (logical method, comparative analysis and a systematic approach), the features of the territorial structure of local self-government in the Republic of Tuva are investigated, and the main problems of spatial and territorial development of municipalities are identified. A general conclusion is made that the republican government bodies, in cooperation with municipalities, need to jointly develop a draft “road map” for the transition to a single-level system of local self-government, taking into account the opinion of the population and repre-sentatives of the expert community. The author proposes a project of territorial reforms of local self-government in the region and gives a preliminary assessment of possible management decisions to transform the boundaries of the municipalities of the Tyva Republic (projected changes in population, area of municipalities, administrative and managerial effects, etc.).
Budaya Partisipatif BTS ARMY dalam Isu #BlackLivesMatter di Twitter
Authors: Novelyana Monica , Bangun Cendera Rizky Anugerah , Putranto Teguh Dwi
Published: November 2023

#BlackLivesMatter merupakan sebuah tagar yang digunakan untuk menyuarakan ketidakadilan yang dihadapi oleh kaum berkulit hitam. Tagar tersebut sempat mendominasi media sosial Twitter pada Mei 2020 sebagai respon dari kematian George Ffloyd dan sebagai wujud dukungan masyarakat bagi kaum berkulit hitam. Gerakan tersebut memunculkan dukungan dari berbagai pihak, termasuk fandom dari BTS, yaitu ARMY. Tanpa perintah langsung dari idola mereka, BTS ARMY berpartisipasi dengan menggunakan konten yang telah ada dalam fandomnya dan bekerja sama untuk mendukung #BlackLivesMatter di Twitter. Penelitian ini bertujuan untuk mengetahui bagaimana budaya partisipatif BTS ARMY dalam isu #BlackLivesMatter di Twitter dengan menggunakan metode studi kasus. Hasil penelitian menunjukkan bahwa budaya partisipatif yang terjadi selama keterlibatan mereka dalam isu ini dapat dikategorikan dalam bentuk affiliations, expressions, collaborative problem solving, dan circulation.
Parameter Estimation for Circular Simultaneous Functional Relationship Model (CSFRM) for Unequal Variances
Authors: BADARISAM FATIN NAJIHAH , Mohamad Anuar Mohd Syazwan
Published: November 2023

In this study, we propose an extended model of the Circular Simultaneous Functional Relationship Model from the Circular Functional Relationship Model. In this case, the circular model and the circular variable will be applied where assuming the error variances are not equal. All estimations of the parameter followed von Mises distribution. The angular and slope parameters are obtained using the ms function, while concentration parameter estimation is obtained from the polyroot function provided in the SPLUS statistical package. The simulation study has been conducted to assess the efficiency of the proposed model. The simulation results showed that as sample size and concentration parameters increase, all parameters’ estimates are close to the true value and have a smaller bias. The illustration of real wind and wave direction data from two different bases of data is given to show its practical applicability. We note that the proposed method for parameter estimation works well with the proposed model.
Nonlinear Autoregressive Neural Network for Forecasting COVID-19 Confirmed Cases in Malaysia
Authors: ABD RAHMAN NUR HAIZUM
Published: November 2023

A nonlinear autoregressive neural network (NARNN) model is a feedforward neural network for handling complex nonlinear time series problem. In this study, the tangent sigmoid (tansig) activation function with different number of past values and different number of hidden neurons for NARNN model is determined. The COVID-19 daily confirmed cases in Malaysia are collected with different amount of sample used which are 100, 500 and 900. Therefore, data of 100, 500 and 900 days prior to 21 September 2022 are extracted for the NARNN model training, validation and testing procedure. The lowest average mean squared error (MSE) are considered as the best combination. Result shown that the past value 1:10 and number of neurons of 10 when the sample size is 100. At sample size 500, past values of 1:10 and number of neurons of 8 enables the model to perform at its best. Whereas for sample size 900, network setting of 1:5 past value and 5 hidden neurons gives the least MSE. Multi-step ahead time series forecasting is conducted to forecast the number of COVID-19 confirmed cases in 7 days which is from 22 to 28 September 2022. The result shown for 7-days-ahead confirmed cases forecasting Malaysia datasets, the best forecasting outcome occurs when 900 samples are inputted.
Primary Care Perspectives on Education Scholarship: A Qualitative Synthesis
Authors: Liu Laura , Chen Betty , Nyhof-Young Joyce
Published: November 2023

Background and Objectives: A significant portion of medical education takes place in primary care settings with family medicine clinician teachers that have variable backgrounds in teaching. Ernest Boyer’s concept of education scholarship calls on faculty to systematically study and innovate their teaching practices. This meta-ethnographic review synthesizes the literature on primary care clinician teachers’ perspectives and experiences of integrating education scholarship in practice.
Methods: We conducted an electronic database search in PubMed/Medline, Scopus, ERIC, and Web of Science for primary research articles published between January 2000 and August 2021. In the included articles, researchers studied primary care physicians’ and/or residents’ perspectives of clinical teaching and reported qualitative results (eg, interviews, focus groups). Of the 1,454 articles found in the search, we included 33 in the final synthesis. We used line-by-line descriptive coding of the qualitative data to develop analytical themes.
Results: Four main themes emerged from our synthesis: (1) perceptions of clinical teaching (lack of confidence, presumed teaching competency, lack of formal recognition); (2) clinical teaching strategies (learner-centered teaching, ad hoc teaching, role modeling, mentorship); (3) benefits of clinical teaching (shared learning experience, networking, personal interest, career satisfaction); and (4) challenges of clinical teaching (inadequate time, compensation, conflicting responsibilities).
Conclusions: Clinician teachers identified several common factors regarding their scholarly roles but had difficulty describing them in relation to education scholarship. Institutional support, resources, and awareness are needed to assist family medicine clinician teachers to further implement Boyer’s concept of education scholarship in practice—specifically, to study, evaluate, and innovate current clinical teaching strategies.
Editorial: Emerging cross-disciplinary themes in corporate governance research
Authors: Galavotti Ilaria
Published: November 2023

Corporate governance as a field is witnessing an intellectual evolution, where the traditional theoretical paradigms and the established research questions genuinely coexist with and are fruitfully stimulated by fresh lines of inquiry. This issue of Corporate Board: Role, Duties and Composition represents a striking example of such a theoretical and thematic integration at the intersection of multiple fields
Active Gate Driver for SiC MOSFET Based on Switching Transient Feedback
Authors: Xu Cheng , Miao Yiru
Published: November 2023

Due to internal parasitic parameters and junction capacitance, silicon
carbide (SiC) power devices have great voltage and current overshoot and
high-frequency switching oscillation during high-speed switching
process, which seriously affects the operation reliability of SiC-Based
converters. In this paper, the switching characteristics of SiC MOSFET
are analyzed to reveal the mathematical relationship between gate
driving current and voltage/current overshoot. Then, a new active gate
drive circuit with variable driving current is proposed. In the current
or voltage rising stage of the switching process, the gate current is
actively regulated, so the overshoot and oscillation of the voltage and
current can be effectively suppressed, through the direct detection and
feedback of the transient drain current change rate
dId/t, drain-source voltage changes rate
dV/dt and driving voltage of SiC MOSFET
V. Finally, experimental results show that the
proposed method can effectively reduce voltage/current overshoot by 30%
~ 50%, and improve the operation reliability of SiC
MOSFET converter.
Analysis of Safe Electricity Consumption on Load Side Based on Attack and Defence Game Model
Authors: Du Pengcheng
Published: November 2023

With the improvement of digitalization and intelligence in the power
system, the safe operation of the power system is facing enormous
challenges. The safe use of electricity on the load side is the key to
achieving safe and reliable power system operation. The detection party
needs amounts of human and material resources when the power network is
attacked. In response to the current difficulties of low detection
ability and high detection costs, this paper proposes an attack and
defence game model that considers the differences between different
nodes, ensuring the safety and economy of electricity consumption while
reducing energy waste. At first, the structure of smart meters and the
attack characteristics of intruders are summarized, and a basic attack
and defence game model is constructed. The Nash equilibrium is then
solved, and the optimal strategy for the game between the defender and
the intruder is given to balance the relation between detection
performance and energy consumption. In response to the differences
generated by each node, strategies for attackers to launch attacks on
different nodes and the setting of optimal thresholds for other nodes in
the defence system are explored. Finally, case studies verify that the
proposed model could reduce the cost of intruder detection while
ensuring a specific detection rate.
Associations between severe influenza-complicated thromboembolism events, intensive care unit stays and mortality, and associated risk factors: a retrospective cohort study
Authors: LEE WEI CHUN , Chang Che-Chia , Ho Meng-Chin , LIN Chin-Kuo , Lin Chieh-Mo , Fang Yu-Hung , Huang Shu-Yi , Lin Yu-Ching , Chuang Min-Chun , Yang Tsung-Ming , Hung Ming-Szu , Chou Yen-Li , Tsai Ying-Huang , Hsieh Meng-Jer
Published: November 2023

Background: Compelling evidence suggests associations between influenza
infection and thromboembolism (TE) events. Risk factors related to the
outcomes of severe influenza-complicated TE in intensive care unit (ICU)
patients remain unknown. Methods: A retrospective cohort study was
conducted, recruiting consecutive patients with thromboembolism (TE)
events admitted to the intensive care unit (ICU) between December 2015
through December 2018 at our institution in Taiwan. A study cohort of
patients with severe influenza (n=108) and a control group of patients
with severe community-acquired pneumonia (n=192) were included.
Associations between complicated TE, length of ICU stay, 90-day
mortality were evaluated. Results: Thromboembolism events prevalence was
significantly higher in ICU patients with severe influenza than in ICU
patients with severe CAP (21.3% vs. 5.7%, respectively;
p<0.05). The ratio of mechanical ventilation use, length of
mechanical ventilation use, ICU stay and 90-day mortality increased
significantly in ICU patients with severe influenza after developing TE
compared with patients without TE (all p<0.05). Influenza
infection and hypertension are the risk factors for thromboembolic
events in patients with severe influenza (p< 0.05). Besides,
complicated TE and severity of APACHE II score are risk factors for
90-day mortality in ICU patients with severe influenza (p<
0.05). Conclusions: ICU patients with severe influenza and complicated
TE have an increased risk of extended ICU stay and 90-day mortality
compared to patients with severe CAP. Risk is significantly increased in
patients with higher APACHE II score. this study may help define better
strategies for early recognition and prevention of severe
influenza-complicated TE.
The first high-altitude autotetraploid haplotype-resolved genome assembled (Rhododendron nivale subsp. boreale) provides new insights into mountaintop adaptation
Authors: Lyu Zhen-Yu , Zhou Xiong-Li , Wang Si-Qi , Yang Gao-Ming , Sun Wen-Guang , Zhang Jie-Yu , Zhang Rui , Shen Shi-Kang
Published: November 2023

Rhododendron nivale subsp. boreale Philipson et M. N. Philipson is a
kind of ornamental alpine woody flower from mountaintop scrub at an
altitude of approximately 4000 meters. Despite ecological significance,
the lack of genomic resources has hindered a comprehensive understanding
of its evolutionary and adaptive characteristics in high-altitude
environments. In this work, we sequenced and assembled the genome of R.
nivale subsp. boreale, which is an assembly of the first subgenus
Rhododendron and the first high-altitude woody flowering autotetraploid.
The assembly included 52 pseudochromosomes, which belonged to 4
haplotypes, harbor 127,810 predicted protein-coding genes. Comparative
genomic analysis revealed that R. nivale subsp. boreale originated as a
neopolyploid resulting from R. nivale and experienced two rounds of
ancient polyploidy event. Transcriptional expression analysis showed
that the expression differences of alleles were common, randomly
distributed in the genome. We identified signatures of positive
selection involved not only in adaptations to mountaintop ecosystem
(response to UV radiation and developmental regulation), but also in
strategy of autotetraploid reproduction (meiotic stabilization).
Notably, highly expressed ERF VIIs aid survival in hypoxic mountaintop
environments. Meanwhile, the expanded families was enriched in
brassinosteroid (BR) biosynthesis, which enhances adaptability to the
dramatic changes in alpine weather, is likely mediated by the increased
number of cytochrome P450 (CYP) genes. This valuable genome of
mountaintop woody flowering autotetraploids not only provides genetic
resources for studying high-altitude polyploid formation but also
provides new insights for understanding the evolution and adaptation
mechanism of high-altitude plants.
The effect of pairing assistance under medical alliance policy on healthcare utilization for patients with chronic diseases in rural China
Authors: Tang Haoqing , Li Mingyue , Zhu He , Cheng Xiaoran , Liu Xiaoyun
Published: November 2023

Pairing assistance (PA) of health professionals between county hospitals
and township health centers is one of the key components of the reform
of medical alliances in China to strengthen the development of health
workforce in primary health care (PHC). This study aims to examine the
effect of PA on healthcare utilization for patients with chronic
diseases in rural areas. Two waves of National Health Services Survey
(2013 and 2018) were used. A total of 13893 and 22725 rural residents
with chronic diseases were included in the 2013 and 2018 waves,
respectively. Multiple logistic regressions were used to examine the
associations between PA and outpatient and inpatient service utilization
in PHC. Chow test was used to examine the difference between PA in two
models. Among rural patients with chronic diseases, two-week outpatient
visits increased from 22.69% to 27.54%, and annual hospitalization
admission increased from 20.72% in 2013 to 25.44%. PA was associated
with a significant decrease in outpatient visits (p<0.001) in
2018 after controlling for individual and county characteristics.
Patients in PA counties were 1.45 times (95% CI 1.10-1.90) more likely
to use PHC outpatient care in 2013, but the difference disappeared in
2018 (OR=0.85, 95% CI 0.71-1.01). PA did not reverse the downward trend
in the share of PHC outpatient visits. PA under medical alliances in
China provides a potential model for building integrated people-centered
health systems for other low- and middle-income countries.
A macroevolutionary analysis of cryptic colouration in sexually dichromatic grasshoppers of the genus Sphenarium (Orthoptera: Pyrgomophidae).
Authors: Ramírez-Delgado Víctor , Serrano-Meneses Martín , Castillo Raul Cueva del
Published: November 2023

Background matching and disruptive colouration are defense mechanisms of
animals against visual predators. Disruptive colouration tends to evolve
in microhabitats that are visually heterogeneous, while background
matching is favored in microhabitats that are chromatically homogeneous.
This is one of the few comparative studies that have tested the relative
impact of background matching and disruptive markings in the chromatic
evolution. Controlling for the phylogeny, we explored the evolution of
the colouration and the marking patterns in the sexual dichromatic and
widely distributed Neotropical grasshoppers of the genus Sphenarium.
These grasshoppers represent an excellent model to investigate the
evolution of cryptic colouration on insects due to the heterogeneity of
the environments where they have evolved. We found a correlation between
the grasshoppers’ colouration and disruptive markings with the chromatic
properties of their environments that was inferred by the levels of
precipitation during the rainy season. The results suggest that colours
and marks patterns could evolve due to predation pressures. Colour in
both sexes could offer camouflage that is not perfectly background
matched to a single habitat but instead offers a degree of resemblance
to multiple backgrounds. Moreover, we found that males and females
chromatic properties differ between them and precipitation levels where
the species are found. This suggests that the sexes have diverged in
their response to the environments, favoring the evolution of sexual
dichromatism in these grasshoppers.
Survival of rhino-orbital-cerebral mucormycosis in SARS-COV-2 positive diabetic patients: Two case reports
Authors: Lädrach C. , Wartenberg Martin , Zimmerli S. , Anschuetz Lukas , Bohlen S. , Ebner J. , Pontouraude C. M. F. de Gouyon Matignon de , Caversaccio Marco , Wagner Franca
Published: November 2023

Abstract Rhino-orbital-cerebral mucormycosis (ROCM) is a rare
angioinvasive fungal infection known to be associated with high
morbidity and over 50% mortality and has increased lately due to
increasing predisposing immunocompromising comorbidities as well as
COVID-19. In addition to the common acute disease progression, chronic
less aggressive courses have been described less often. In this paper we
report two cases – a 75-year-old woman with diabetes and a 39-year-old
man with recurrent diabetic ketoacidosis. Both presented initially with
acute sinonasal symptoms, were positive for SARS-COV-2 and later
diagnosed with acute ROCM. Both underwent mutilating surgical therapy as
well as high administered dose Amphotericin B and long term continuous
antifungal therapy. Patient 1 showed stable symptoms with
radiographically increasing disease and died of urosepsis 5 months after
first surgery. Patient 2 was first lost to follow-up after repatriation
to his home country and 1 year later sent us a holiday picture of
himself, having recovered from the disease. Key words:
Rhino-orbital-cerebral mucormycosis, mucormycosis, Amphotericin-B,
COVID-19, invasive fungal infection
The relation between dissipation and memory in two-fluid displacements in disordered media
Authors: Holtzman Ran , Dentz Marco , Planet Ramon , Ortín Jordi
Published: November 2023

We show that the return-point memory of cyclic macroscopic trajectories
enables the derivation of a thermodynamic framework for quasistatically
driven dissipative systems with multiple metastable states. We use this
framework to sort out and quantify the energy dissipated in quasistatic
fluid-fluid displacements in disordered media. Numerical computations of
imbibition–drainage cycles in a quasi-2D medium with gap thickness
modulations (imperfect Hele-Shaw cell) show that energy dissipation in
quasistatic displacements is due to abrupt changes in the fluid-fluid
configuration between consecutive metastable states (Haines jumps), and
its dependence on microstructure and gravity. The relative importance of
viscous dissipation is deduced from comparison with quasistatic
experiments.
ResORR: A Globally Scalable and Satellite Data-driven Algorithm for River Flow Regulation due to Reservoir Operations
Authors: Das Pritam , Hossain Faisal , Minocha Sanchit , Suresh Sarath , Darkwah George , Lee Hyongki , Andreadis Konstantinos M. , Oddo Perry C
Published: November 2023

Storage and release of surface water by reservoirs can alter the natural
streamflow pattern of rivers with negative impacts on the environment.
Such reservoir-driven river regulation is poorly understood at a global
scale due to a lack of publicly available in-situ data on reservoir
operations. However, with rapid advancements in satellite remote
sensing-based tracking of reservoir state, this gap in data availability
can be bridged. In this study, we modeled regulated flow of rivers using
only satellite-observed reservoir state and hydrological modeling forced
also with satellite precipitation data. We propose a globally scalable
algorithm, ResORR (Reservoir Operations driven River Regulation), to
predict regulated river flow and tested it over the heavily regulated
basin of the Cumberland River in the US. ResORR was found able to model
regulated river flow due to upstream reservoir operations of the
Cumberland River. Over a mountainous basin dominated by high rainfall,
ResORR was effective in capturing extreme flooding modified by upstream
hydropower dam operations. ResORR successfully captured the peak of the
regulated river flow altered by hydropower dam and flood control
operations during the devastating floods of 2018 in the South Indian
state of Kerala. On average, ResORR improved regulation river flow
simulation by more than 50% across all performance metrics when
compared to a hydrologic model without a regulation module. ResORR is a
timely algorithm for understanding human regulation of surface water as
satellite-estimated reservoir state is expected to improve globally with
the recently launched Surface Water and Ocean Topography (SWOT) mission.
Estimating the CO2 fertilization effect on extratropical forest productivity from Flux-tower observations
Authors: Zhan Chunhui , Orth Rene , Yang Hui , Reichstein Markus , Zaehle Soenke , Kauwe Martin G De , Rammig Anja , Winkler Alexander J.
Published: November 2023

The land sink of anthropogenic carbon emissions, a crucial component of
mitigating climate change, is primarily attributed to the CO₂
fertilization effect on global gross primary productivity (GPP).
However, direct observational evidence of this effect remains scarce,
hampered by challenges in disentangling the CO₂ fertilization effect
from other long-term drivers, particularly climatic changes. Here, we
introduce a novel statistical approach to separate the CO₂ fertilization
effect on GPP and daily maximum net ecosystem production (NEPmax) using
eddy covariance records across 38 extratropical forest sites. We find
the median stimulation rate of GPP and NEPmax to be 16.4 ± 4% and 17.2
± 4% per 100 ppm increase in atmospheric CO₂ across these sites,
respectively. To validate the robustness of our findings, we test our
statistical method using factorial simulations of an ensemble of
process-based land surface models. We acknowledge that additional
factors, including nitrogen deposition and land management, may impact
plant productivity, potentially confounding the attribution to the CO₂
fertilization effect. Assuming these site-specific effects offset to
some extent across sites as random factors, the estimated median value
still reflects the strength of the CO₂ fertilization effect. However,
disentanglement of these long-term effects, often inseparable by
timescale, requires further causal research. Our study provides direct
evidence that the photosynthetic stimulation is maintained under
long-term CO₂ fertilization across multiple eddy covariance sites. Such
observation-based quantification is key to constraining the
long-standing uncertainties in the land carbon cycle under rising CO₂
concentrations.
Effective Characterization of Fractured Media with PEDL: A Deep Learning-Based Data Assimilation Approach
Authors: Nan Tongchao , Zhang Jiangjiang , Xie Yifan , Cao Chenglong , Wu Jichun , Lu Chunhui
Published: November 2023

In various research fields such as hydrogeology, environmental science
and energy engineering, geological formations with fractures are
frequently encountered. Accurately characterizing these fractured media
is of paramount importance when it comes to tasks that demand precise
predictions of liquid flow and the transport of solute and energy within
them. Since directly measuring fractured media poses inherent
challenges, data assimilation (DA) techniques are typically employed to
derive inverse estimates of media properties using observed state
variables like hydraulic head, concentration, and temperature.
Nonetheless, the considerable difficulties arising from the strong
heterogeneity and non-Gaussian nature of fractured media have diminished
the effectiveness of existing DA methods. In this study, we formulate a
novel DA approach known as PEDL (parameter estimator with deep learning)
that harnesses the capabilities of DL to capture nonlinear relationships
and extract non-Gaussian features. To evaluate PEDL’s performance, we
conduct two numerical case studies with increasing complexity. Our
results unequivocally demonstrate that PEDL outperforms three popular DA
methods: ensemble smoother with multiple DA (ESMDA), iterative local
updating ES (ILUES), and ES with DL-based update (ESDL). Sensitivity
analyses confirm PEDL’s validity and adaptability across various
ensemble sizes and DL model architectures. Moreover, even in scenarios
where structural difference exists between the accurate reference model
and the simplified forecast model, PEDL adeptly identifies the primary
characteristics of fracture networks.
Experimental characterization of pure copper heat sinks fabricated by powder metallurgy
Authors: Meral Zeynep , Parlak Nezaket
Published: November 2023

In this study, porous copper plates were produced to be used as heat sinks for cooling purposes. Copper powders were used in the production process and powder metallurgy steps were followed. The relationship between pressure, sintering temperature, time and powder size affecting the porosity level and volume was revealed using the Taguchi experimental design method. Copper powders of 5 ?m and 50 ?m sizes were used in the experiments, and the powders were compressed in the mold at two different pressures, 50 and 60 bar, and sintered at 700 and 900oC temperatures for 30 and 60 minutes. The L8 orthogonal array was chosen by targeting the surface with the highest porosity in the Taguchi method. The effect ratios of each design parameter on porosity were determined with the analysis of variance (ANOVA). The microstructure characterization, thermal and mechanical properties of the produced samples were analyzed, comparatively.
Evaluating the Efficacy and Safety of 4% 5-Fluorouracil Cream in Patients with Actinic Keratosis: An Expert Opinion
Authors: Stockfleth Eggert , Heppt Markus V. , Bégeault Nathalie , Delarue Alain
Published: November 2023

Actinic keratosis is a lesion that develops in sun-exposed areas of the skin and is considered to be a precancerous condition or an early in situ squamous cell carcinoma. Treatment of actinic keratosis is important for reducing skin cancer risk, with treatment choice based on patient-, lesion- and treatment-related considerations. Of the topical treatments used for field-directed therapy, those containing 5-fluorouracil are among the most effective and widely prescribed. The most recently developed topical 5-fluorouracil preparation (Tolak®; Pierre Fabre, France) contains 4% 5-fluorouracil in an aqueous cream. This narrative review discusses data on 4% 5-fluorouracil cream to treat actinic keratosis, and provides the authors’ expert opinion on issues associated with it use. The effect of the cream has been evaluated in phase 2 and 3 trials of adult patients with actinic keratosis on the face, ears or scalp. These trials included patients with severe baseline disease, defined by high lesion counts and large-size treatment fields, which possibly affected the proportion of patients who were able to achieve complete clearance. Other efficacy parameters (e.g. percentage change in lesion count, ≥ 75% clearance of lesions or clinically significant changes in validated severity scales) should also be assessed to fully evaluate 4% 5-fluorouracil treatment efficacy in these patients. Nevertheless, 4% 5-fluorouracil is associated with high efficacy, a low level of recurrence and a satisfactory safety profile.