bluuebunny/crossref_metadata_2025 huggingface dataset:
Governance Interrupted: Rebel Governance and Pro-Government Militias
Authors: Joo Minnie M , Sosa Santiago
Published: August 2023

Despite the benefits of rebel governance such as increased legitimacy and resource extraction, providing governance is also costly for rebel groups, as it entails constant investment of time and money as well as the need to protect their properties and territories. Rebels, therefore, weigh the costs of providing governance against the benefits in their decision to provide governance. In this paper, we explore the impact of pro-government militias (PGMs) on the cost-benefit analysis of rebel governance. We argue that governance becomes a suboptimal strategy for rebel groups in the presence of semi-official PGMs but not informal PGMs. This is because semi-official PGMs’ relationship with the government makes them more formally accountable to the government, which effectively bolsters the counterinsurgency capabilities of the state (and thereby weakens rebels) through providing credible and timely intelligence and undermining civilians support for the rebels, and even allowing rebel defection. We test our argument using data on rebel governance and PGMs and indeed find that semi-official—but not informal—PGMs decrease the likelihood of rebel governance.
Retained surgical item in inguinal canal of a patient with bilateral inguinal hernia: a case report
Authors: Mabrouk Ola , Ibrahim Khalid
Published: August 2023

Retained surgical items that remain inside patient’s body during operation are linked to increased mortality, morbidity and negative financial consequences. This case reports a 65-year’s-old male nurse with bilateral inguinal swelling. With history of right sided inguinal hernia 8 years ago that underwent open repair without mesh. Swelling was reducible on right side only, positive visible and palpable cough impulse bilaterally, and surgical scar on right iliac region. Diagnosed as left side inguinal hernia with recurrent right side inguinal hernia. After informed consent and preoperative assessment, open repair started with right side, sac excised after reducing content and mesh placed. Same procedure done on left, surgical gauze was found in inguinal canal and removed successfully, operation completed. Patient did well on follow-up. Collaboration and communication is crucial between staff during operations to prevent errors and promote safety.
A late presentation of inguinoscrotal cutaneous squamous cell carcinoma (cSCC) masquerading as hidradenitis suppurativa—a case report
Authors: Lahham Elias Edward , Billan Salem , Atrash Fadi , Fararja Walid
Published: August 2023

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects apocrine gland-bearing skin in intertriginous areas; it is characterized by persistent or recurrent abscesses that culminate in a purulent discharge, sinuses and scarring. Although it is a common condition, it is rarely associated with cutaneous squamous cell carcinoma (cSCC). Whereas the female-to-male ratio of HS is 3:1, SCC in HS has a female-to-male ratio of 1:5. In this study, we present a 50-year-old male patient with a late presentation of inguinoscrotal cSCC with extensive ulceration and erythema that was hidden by neglected HS and the presence of underlying human papillomavirus in the affected area. The histomorphologic and immunohistochemical findings support the diagnosis of cSCC. Timely detection is the key to improve prognosis, regular clinical examination and biopsy of any suspicious lesions in high-risk patients is highly recommended.
Variable Inclusion Strategies for Effective Quota Sampling and Propensity Modeling: An Application to SARS-CoV-2 Infection Prevalence Estimation
Authors: Li Yan , Fay Michael , Hunsberger Sally , Graubard Barry I
Published: August 2023

Public health policymakers must make crucial decisions rapidly during a pandemic. In such situations, accurate measurements from health surveys are essential. As a consequence of limited time and resource constraints, it may be infeasible to implement a probability-based sample that yields high response rates. An alternative approach is to select a quota sample from a large pool of volunteers, with the quota sample selection based on the census distributions of available—often demographic—variables, also known as quota variables. In practice, however, census data may only contain a subset of the required predictor variables. Thus, the realized quota sample can be adjusted by propensity score pseudoweighting using a “reference” probability-based survey that contains more predictor variables. Motivated by the SARS-CoV-2 serosurvey (a quota sample conducted in 2020 by the National Institutes of Health), we identify the condition under which the quota variables can be ignored in constructing the propensity model but still produce nearly unbiased estimation of population means. We conduct limited simulations to evaluate the bias and variance reduction properties of alternative weighting strategies for quota sample estimates under three propensity models that account for varying sets of predictors and degrees of correlation among the predictor sets and then apply our findings to the empirical data.
Sexuality experiences of women with multiple sclerosis reporting overactive bladder: a qualitative study
Authors: Dunya Cansu Polat , Özkan İlknur , Demir Serkan
Published: August 2023

Background

To effectively manage sexual dysfunction in women reporting overactive bladder, it is essential to know how patients perceive these problems, their lives, and their strategies.

Aim

In this study we aimed to understand the sexual life experiences of women with multiple sclerosis (MS) who report overactive bladder from their point of view.

Methods

This study included 12 women with MS and was conducted as a qualitative study with a hermeneutic phenomenological framework. The data were evaluated by using Van Manen’s thematic analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used.

Outcomes

In this study, thematic codes of sexual symptoms in women with MS with overactive bladder were defined and evaluated.

Results

As a result of the analysis of the data, four main themes and nine subthemes were identified. The main themes were “sexual self-concept,” “sexual relationships,” “sexual function,” and “coping with problems”. Subthemes such as body image, sexual esteem, the meaning of sexuality, communication, intimacy, coping with overactive bladder and sexual problems, and getting support showed that overactive bladder symptoms negatively affected women’s sexual health.

Clinical Implications

Given the variety of sexual problems experienced by women with MS who report overactive bladder, these problems should be a routine part of clinical evaluation.

Strengths and Limitations

This study is to our knowledge the first to examine the sexual life experiences of MS women reporting overactive bladder in depth based on the holistic view of sexuality theory. However, the sample is small and includes only women with MS who have reported overactive bladder.

Conclusions

The sexual experience of women with MS who reported overactive bladder was multi-dimensional. Women with MS cope with their sexual problems alone and cannot receive the necessary support from their husbands, nurses, or other health professionals.
Travel-related giardiasis: incidence and time trends for various destination countries
Authors: Hommes Franziska , Dörre Achim , Behnke Susanne C , Stark Klaus , Faber Mirko
Published: August 2023

Background

Giardiasis is a common gastrointestinal illness in travellers. Data on the actual giardiasis risk of travellers to different travel destinations are scarce. We aim to estimate the risk of giardiasis in travellers from Germany by destination country and region.

Methods

We analysed travel-related giardiasis cases, their countries and regions of exposure and the age and sex distribution of cases reported in 2014–19 in Germany. We defined a travel-related giardiasis case as a laboratory-confirmed (i.e. positive microscopy, antigen test or nucleic acid test) symptomatic individual with outbound travel abroad within 3–25 days before symptom onset. Based on the number of reported cases per exposure country and UNWTO travel data for Germany, we calculated the number of travel-related giardiasis cases per 100 000 travellers and compared the incidence in 2014–16 and 2017–19 to identify potential trends.

Results

In 2014–19, 21 172 giardiasis cases were reported in Germany, corresponding to an overall incidence of 4.3 per 100 000 population. Of all cases, 6879 (32%) were travel-related with a median age of 34 [interquartile range (IQR): 25–50], 51% were male. Southern Asia was the most frequently reported exposure region and had the highest incidence in travellers (64.1 per 100 000 returning travellers) in 2017–19, followed by Latin America (19.2) and Sub-Saharan Africa (12.9). We observed statistically significant decreasing trends for Southern Asia and Sub-Saharan Africa. Latin America was the only region with a statistically significant increasing trend.

Conclusions

Almost one-third of recent giardiasis cases in Germany were travel-related. Giardiasis incidence in travellers differs greatly depending on the destination region. Decreasing trends in many regions might be due to improvements in food hygiene or travel conditions. Our results may inform medical consultation pre and post patient’s travel.
The transcription factor EMB1444-like affects tomato fruit ripening by regulating YELLOW-FRUITED TOMATO 1, a core component of ethylene signaling transduction
Authors: Zhao Weihua , Wang Shan , Li Wenzhen , Shan Xuemeng , Naeem Muhammad , Zhang Lida , Zhao Lingxia
Published: August 2023

The fleshy fruit of tomato (Solanum lycopersicum) are climacteric and, as such, ethylene plays a pivotal role in their ripening and quality traits. In this study, a basic helix–loop–helix transcription factor, EMB1444-like, was found to induce the expression of YELLOW-FRUITED TOMATO 1 (YFT1), which encodes the SlEIN2 protein, a key element in the ethylene signaling pathway. Yeast one-hybrid and EMSA analyses revealed that EMB1444-like binds to the E-box motif (CACTTG, –1295 bp to –1290 bp upstream of the ATG start codon) of the YFT1 promoter (pYFT1). Suppression of EMB1444-like expression in tomato lines (sledl) using RNAi reduced ethylene production by lowering the expression of 1-AMINOCYCLOPROPANE-1-CARBOXYLATE SYNTHASE 2/4 (ACS2/4) and ACC OXIDASE1 (ACO1) in a positive feedback loop. sledl tomato also showed differences in numerous quality traits related to fruit ripening, compared with the wild type, such as delayed chromoplast differentiation, a decrease in carotenoid accumulation, and delayed fruit ripening in an ethylene-independent manner, or at least upstream of ripening mediated by YFT1/SlEIN2. This study elucidates the regulatory framework of fruit ripening in tomato, providing information that may be used to breed tomato hybrid cultivars with an optimal balance of shelf-life, durability, and high quality.
Detection and modelling of CH3NC in TMC-1
Authors: Tennis Jessica D , Xue Ci , Talbi Dahbia , Changala P Bryan , Sita Madelyn L , McGuire Brett , Herbst Eric
Published: August 2023

Two closely related isomeric pairs of cyanides, CH3[CN/NC] and H2C[CN/NC], are studied in cold, dark interstellar cloud conditions. In contrast to the diverse detections of methyl cyanide (CH3CN) in space, methyl isocyanide (CH3NC) has previously only been observed in warm and hot star-forming regions. We report the detection of CH3NC in the cold pre-stellar core Taurus Molecular Cloud (TMC-1) using the Green Bank Telescope with a detection significance of 13.4σ. Hyperfine transitions in H2CCN and quadrupole interactions in CH3CN and CH3NC were matched to a spectral line survey from the Green Bank Telescope Observations of TMC-1: Hunting for Aromatic Molecules large project on the Green Bank Telescope, resulting in abundances with respect to hydrogen of $1.92^{+0.13}_{-0.07} \times 10^{-9}$ for the cyanomethyl radical (H2CCN), $5.02^{+3.08}_{-2.06} \times 10^{-10}$ for CH3CN, and $2.97^{+2.10}_{-1.37} \times 10^{-11}$ for CH3NC. Efforts to model these molecules with the three-phase gas-grain code nautilus in TMC-1 conditions overproduce both CH3CN and CH3NC, though the ratio of ∼5.9 per cent is consistent across observations and models of these species. This may point to missing destruction routes in the model. The models capture the larger abundance of H2CCN well. Dissociative recombination is found to be the primary production route for these molecules, and reactions with abundant ions are found to be the primary destruction routes. H + CH3NC is investigated with transition state theory as a potential destruction route, but found to be too slow in cold cloud conditions to account for the discrepancy in modelled and observed abundances of CH3NC.
Developmental Selection and the Perception of Mutation Bias
Authors: Majic Paco , Payne Joshua L
Published: August 2023

The notion that mutations are random relative to their fitness effects is central to the Neo-Darwinian view of evolution. However, a recent interpretation of the patterns of mutation accumulation in the genome of Arabidopsis thaliana has challenged this notion, arguing for the presence of a targeted DNA repair mechanism that causes a nonrandom association of mutation rates and fitness effects. Specifically, this mechanism was suggested to cause a reduction in the rates of mutations on essential genes, thus lowering the rates of deleterious mutations. Central to this argument were attempts to rule out selection at the population level. Here, we offer an alternative and parsimonious interpretation of the patterns of mutation accumulation previously attributed to mutation bias, showing how they can instead or additionally be caused by developmental selection, that is selection occurring at the cellular level during the development of a multicellular organism. Thus, the depletion of deleterious mutations in A. thaliana may indeed be the result of a selective process, rather than a bias in mutation. More broadly, our work highlights the importance of considering development in the interpretation of population-genetic analyses of multicellular organisms, and it emphasizes that efforts to identify mechanisms involved in mutational biases should explicitly account for developmental selection.
Interdisciplinary Analyses of Bronze Age Communities from Western Hungary Reveal Complex Population Histories
Authors: Gerber Dániel , Szeifert Bea , Székely Orsolya , Egyed Balázs , Gyuris Balázs , Giblin Julia I , Horváth Anikó , Köhler Kitti , Kulcsár Gabriella , Kustár Ágnes , Major István , Molnár Mihály , Palcsu László , Szeverényi Vajk , Fábián Szilvia , Mende Balázs Gusztáv , Bondár Mária , Ari Eszter , Kiss Viktória , Szécsényi-Nagy Anna
Published: August 2023

In this study, we report 21 ancient shotgun genomes from present-day Western Hungary, from previously understudied Late Copper Age Baden, and Bronze Age Somogyvár–Vinkovci, Kisapostag, and Encrusted Pottery archeological cultures (3,530–1,620 cal Bce). Our results indicate the presence of high steppe ancestry in the Somogyvár–Vinkovci culture. They were then replaced by the Kisapostag group, who exhibit an outstandingly high (up to ∼47%) Mesolithic hunter–gatherer ancestry, despite this component being thought to be highly diluted by the time of the Early Bronze Age. The Kisapostag population contributed the genetic basis for the succeeding community of the Encrusted Pottery culture. We also found an elevated hunter–gatherer component in a local Baden culture–associated individual, but no connections were proven to the Bronze Age individuals. The hunter–gatherer ancestry in Kisapostag is likely derived from two main sources, one from a Funnelbeaker or Globular Amphora culture–related population and one from a previously unrecognized source in Eastern Europe. We show that this ancestry not only appeared in various groups in Bronze Age Central Europe but also made contributions to Baltic populations. The social structure of Kisapostag and Encrusted Pottery cultures is patrilocal, similarly to most contemporaneous groups. Furthermore, we developed new methods and method standards for computational analyses of ancient DNA, implemented to our newly developed and freely available bioinformatic package. By analyzing clinical traits, we found carriers of aneuploidy and inheritable genetic diseases. Finally, based on genetic and anthropological data, we present here the first female facial reconstruction from the Bronze Age Carpathian Basin.
Nanofluidic memristor based on the elastic deformation of nanopores with nanoparticle adsorption
Authors: Zhou Xi , Zong Yuanyuan , Wang Yongchang , Sun Miao , Shi Deli , Wang Wei , Du Guanghua , Xie Yanbo
Published: August 2023

The memristor is the building block of neuromorphic computing. We report a new type of nanofluidic memristor based on the principle of elastic strain on polymer nanopores. With nanoparticles absorbed at the wall of a single conical polymer nanopore, we find a pinched hysteresis of the current within a scanning frequency range of 0.01–0.1 Hz, switching to a diode below 0.01 Hz and a resistor above 0.1 Hz. We attribute the current hysteresis to the elastic strain at the tip side of the nanopore, caused by electrical force on the particles adsorbed at the inner wall surface. Our simulation and analytical equations match well with experimental results, with a phase diagram for predicting the system transitions. We demonstrate the plasticity of our nanofluidic memristor to be similar to a biological synapse. Our findings pave a new way for ionic neuromorphic computing using nanofluidic memristors.
Predicting the Public Health Impact of Bivalent Vaccines and Nirmatrelvir-Ritonavir Against Coronavirus Disease 2019
Authors: Park Hailey J , Tan Sophia T , León Tomás M , Jain Seema , Schechter Robert , Lo Nathan C
Published: August 2023

Background

Uptake of coronavirus disease 2019 (COVID-19) bivalent vaccines and the oral medication nirmatrelvir-ritonavir (Paxlovid) has remained low across the United States. Assessing the public health impact of increasing uptake of these interventions in key risk groups can guide further public health resources and policy and determine what proportion of severe COVID-19 is avertable with these interventions.

Methods

This modeling study used person-level data from the California Department of Public Health on COVID-19 cases, hospitalizations, deaths, and vaccine administration from 23 July 2022 to 23 January 2023. We used a quasi-Poisson regression model calibrated to recent historical data to predict future COVID-19 outcomes and modeled the impact of increasing uptake (up to 70% coverage) of bivalent COVID-19 vaccines and nirmatrelvir-ritonavir during acute illness in different risk groups. Risk groups were defined by age (≥50, ≥65, ≥75 years) and vaccination status (everyone, primary series only, previously vaccinated). We predicted the number of averted COVID-19 cases, hospitalizations, and deaths and number needed to treat (NNT).

Results

The model predicted that increased uptake of bivalent COVID-19 boosters and nirmatrelvir-ritonavir (up to 70% coverage) in all eligible persons could avert an estimated 15.7% (95% uncertainty interval [UI], 11.2%–20.7%; NNT: 17 310) and 23.5% (95% UI, 13.1%–30.0%; NNT: 67) of total COVID-19–related deaths, respectively. In the high-risk group of persons ≥65 years old alone, increased uptake of bivalent boosters and nirmatrelvir-ritonavir could avert an estimated 11.9% (95% UI, 8.4%–15.1%; NNT: 2757) and 22.8% (95% UI, 12.7%–29.2%; NNT: 50) of total COVID-19–related deaths, respectively.

Conclusions

These findings suggest that prioritizing uptake of bivalent boosters and nirmatrelvir-ritonavir among older age groups (≥65 years) would be most effective (based on NNT) but would not address the entire burden of severe COVID-19.
Phase I Study of Entinostat, Atezolizumab, Carboplatin, and Etoposide in Previously Untreated Extensive-Stage Small Cell Lung Cancer, ETCTN 10399
Authors: Gentzler Ryan D , Villaruz Liza C , Rhee John C , Horton Bethany , Mock Joseph , Hanley Michael , Kim Kyeongmin , Rudek Michelle A , Phelps Mitch A , Carducci Michael A , Piekarz Richard , Park Kwon-Sik , Bullock Timothy N , Rudin Charles M
Published: August 2023

Background

CREBBP and EP300 mutations occur at a frequency of 15% and 13%, respectively, in small cell lung cancer (SCLC), and preclinical models demonstrated susceptibility to targeting with HDAC inhibitors.

Methods

Patients with treatment-naïve extensive-stage SCLC, ECOG ≤2 were enrolled and treated with entinostat orally weekly (4 dose levels, DL) in combination with standard dose carboplatin, etoposide, and atezolizumab. Cohort allocation was determined by Bayesian optimal interval (BOIN) design targeting an MTD with a DLT rate of 20%.

Results

Three patients were enrolled and treated at DL1 with entinostat 2 mg. Patients were aged 69-83; 2 male, 1 female; 2 were ECOG 1, and 1 was ECOG 0. The most common adverse events (AEs) were anemia (3), neutropenia (3), thrombocytopenia (2), leukopenia (2), and hypocalcemia (2). Two experienced DLTs during cycle 1: (1) grade (Gr) 4 febrile neutropenia, and (1) Gr 5 sepsis. BOIN design required stopping accrual to DL1, and the trial was closed to further accrual. Entinostat and atezolizumab pharmacokinetics were both comparable to historical controls.

Conclusion

Addition of entinostat to atezolizumab, carboplatin, and etoposide is unsafe and resulted in early onset and severe neutropenia, thrombocytopenia. Further exploration of entinostat with carboplatin, etoposide, and atezolizumab should not be explored. (ClinicalTrials.gov Identifier: NCT04631029).
Europe’s Interaction with the Rest of the World
Authors: Klabbers Jan
Published: August 2023

This chapter aims to trace the influence of Europe on international law through viewing how Europe sees itself and is seen by other parts of the world. Subsequently, it discusses the contributions of the Council of Europe and the UN Economic Commission for Europe to international law. The former has pioneered human rights protection but also some law-making techniques, the latter has been remarkable for its focus on environmental protection and mundane but important matters. The chapter suggests that to think of Europe as a single entity or even sensibility may not always be plausible, but that Europe’s influence has nonetheless been huge.
The additional pressure of white dwarf stars generated by net charges
Authors: Pei Ting-Han
Published: August 2023

The upper-mass limit of a white dwarf star is predicted to be 1.44 ${M}_{\odot} $ based on an ideally degenerate Fermi electron gas at a temperature of absolute zero. However, more conditions should be considered, such as temperature and charge. In this research, first, we use the grand partition function in statistical mechanics to build expressions for the electron gas pressure and the particle number depending on temperature. At 1.16 × 107 K, there is a total of about 1.50 × 10−4 electrons exceeding the Fermi energy, and about 1.50 × 10−7 at 1.16 × 104 K. Because some of these Fermi electrons are extremely relativistic, some of them can escape the gravity and some return to the star after leaving. These two mechanisms result in a positively charged star and the net positive charges produce a repulsive force and pressure against gravity. The increased pressure is comparable to that of the Fermi electron gas at T = 0 when the star is charged at 1020 C. The net charges will decrease the mass density of the star but increase the upper-mass limit.
Large-scale culturing of Neogloboquadrina pachyderma, its growth in, and tolerance of, variable environmental conditions
Authors: WestgÅrd Adele , Ezat Mohamed M , Chalk Thomas B , Chierici Melissa , Foster Gavin L , Meilland Julie
Published: August 2023

The planktic foraminifera Neogloboquadrina pachyderma is a calcifying marine protist and the dominant planktic foraminifera species in the polar oceans, making it a key species in marine polar ecosystems. The calcium carbonate shells of foraminifera are widely used in palaeoclimate studies because their chemical composition reflects the seawater conditions in which they grow. This species provides unique proxy data for past surface ocean hydrography, which can provide valuable insight to future climate scenarios. However, little is known about the response of N. pachyderma to variable and changing environmental conditions.

Here, we present observations from large-scale culturing experiments where temperature, salinity and carbonate chemistry were altered independently. We observed overall low mortality, calcification of new chambers and addition of secondary calcite crust in all our treatments. In-culture asexual reproduction events also allowed us to monitor the variable growth of N. pachyderma’s offspring. Several specimens had extended periods of dormancy or inactivity after which they recovered. These observations suggest that N. pachyderma can tolerate, adapt to and calcify within a wide range of environmental conditions. This has implications for the species-level response to ocean warming and acidification, for future studies aiming to culture N. pachyderma and use in palaeoenvironmental reconstruction.
Recruiting women into policing: Experimentally testing the effectiveness of recruiting materials
Authors: Taniguchi Travis A , Rineer Jennifer R , Hoogesteyn Katherine , Wire Sean , Mangum Lauren
Published: August 2023

Law enforcement agencies are struggling to meet recruitment goals and are rarely representative of the communities they serve. In particular, women make up just 12% of sworn officers despite the fact that women officers act in ways that are more consistent with community-oriented policing and use less force. Despite this, there are few evidence-based strategies that agencies can use to improve outreach and messaging efforts focussed on improving candidate diversity. The current study experimentally explored the effectiveness of job advertisements formatted similarly to popular social media platforms (Facebook Ads and short-form videos) and variations on law enforcement officer job descriptions. Results indicated that women-focussed recruitment material significantly improve perceptions of motivation to apply, relevance, and positive perceptions of the material for women participants and that diversity-focussed job descriptions improved perceptions of task and skill variety and diversity climate. These results, however, were only found for video advertising. Agencies should consider tailoring marketing material to meet the needs of different potential applicants and be sensitive to differences in marketing channels.
All maximal gauged supergravities with uplift
Authors: Hassler Falk , Sakatani Yuho
Published: August 2023

Generalized parallelizable spaces permit the uplift of many maximal gauged supergravities to ten or eleven dimensions. Although some of the former are explicitly known, the literature is still lacking their systematic construction. We resolve this issue by going beyond the known existence proofs and present the explicit construction of all generalized parallelizable spaces for maximal gauged supergravities in four or more dimensions. In the process, all embedding tensors that can be realized without breaking the section condition of exceptional field theory are identified. This addresses the old question: “Which maximal gauged supergravities can be embedded in the low-energy limit of superstring/M-theory” and provides the basis to explore solution-generating techniques based on generalized dualities.
Subtracting Development through the Production of Il/legality of Young Refugees in Jordan and Lebanon
Authors: Brun Cathrine
Published: August 2023

This article analyses the production of legality and illegality of refugees and how it is experienced, negotiated, and shape young Palestinian and Syrian refugees’ possibilities for development in Jordan and Lebanon. In the two countries, refugees’ legal and illegal statuses are produced in the interaction between national and international security- and economic interests. This article discusses the meanings of development associated with protracted displacement. Despite increased emphasis on moving from a humanitarian approach towards development in long-term refugee situations, the experiences of young refugees in Lebanon and Jordan show that the production of legal status hampers the potential for development. This article analyses young people’s experience of their legal status by addressing the labour of staying legal, the experience of moving in and out of legality and its impact on education and employment. The analysis shows how the production of (il)legality is a subtracting process that leads to debilitation and constrained agency rather than development. In conclusion, this article thus reflects on the problem of using the development discourse with a humanitarian lens and the need for more critical discussion on the meaning of development in protracted displacement.
Ecomorphological correlates of inner ear shape in Australian limb-reduced skinks (Scincidae: Sphenomorphini)
Authors: Camaiti Marco , Wiles James , Aguilar Rocio , Hutchinson Mark N , Hipsley Christy A , Chapple David G , Evans Alistair R
Published: August 2023

The inner ear labyrinth is an organ able to perceive balance and spatial orientation, but the drivers of its morphological variation across and within vertebrate lineages are unclear. We assess two competing hypotheses whether this organ, and specifically the semicircular canals, modifies its shape as a functional adaptation to ecology and locomotion, or according to the constraints of skull morphology. We test these using 52 species of Australian sphenomorphines, a group of scincid lizards that evolved changes in body shape and locomotory adaptations to fossoriality multiple times independently, by reducing their limbs. We find a correlation between semicircular canal shape and degree of limb reduction in these lizards, supporting a functional hypothesis. The interaction between body shape and substrate ecology is also a significant predictor. The wider and more eccentric semicircular canals of limb-reduced skinks indicate higher balance sensitivity and manoeuvrability compared with fully limbed skinks, probably as an adaptation to navigating cluttered environments. Conversely, our results show only a minimal influence of skull constraints on semicircular canal shape, having instead significant effects on size. This supports the hypothesis that in these skinks inner ear shape evolution is driven by specific locomotory strategies more than it is constrained by cranial anatomy.
Pan-Genomic Analysis Identifies the Chinese Strain as a New Subspecies of Xanthomonas fragariae
Authors: Wei Feng , Liang Xia , Shi Jian-Cheng , Luo Jing-Nan , Qiu Li-Juan , Li Xi-Xuan , Lu Li-Juan , Wen Ying-Qiang , Feng Jia-Yue
Published: August 2023

Xanthomonas fragariae is classified as a quarantine pathogen by the European and Mediterranean Plant Protection Organization. It commonly induces typical angular leaf spot (ALS) symptoms in strawberry leaves. X. fragariae strains from China (YL19, SHAQP01, and YLX21) exhibit ALS symptoms in leaves and more severe symptoms of dry cavity rot in strawberry crowns. Conversely, strains from other countries do not cause severe dry cavity rot symptoms in strawberries. After employing multilocus sequence analysis (MLSA), average nucleotide identity (ANI), and amino acid identity (AAI), we determined that Chinese strains of X. fragariae are genetically distinct from other strains and can be considered a new subspecies. Subsequent analysis of 63 X. fragariae genomes published at NCBI using IPGA and EDGAR3.0 revealed the pan-genomic profile, with 1,680 shared genes present in all 63 strains, including 71 virulence-related genes. Additionally, we identified 123 genes exclusive to all the Chinese strains, encompassing 12 virulence-related genes. The qRT-PCR analysis demonstrated that the expression of XopD, XopG1, CE8, GT2, and GH121 out of 12 virulence-related genes of Chinese strains (YL19) exhibited a constant increase in the early stages (6, 24, 54, and 96 hours postinoculation [hpi]) of strawberry leaf infected by YL19. So, the presence of XopD, XopG1, CE8, GT2, and GH121 in Chinese strains may play important roles in the early infection process of Chinese strains. These findings offer novel insights into comprehending the population structure and variation in the pathogenic capacity of X. fragariae.
Developing Evidence for Equitable Assessment Characteristics Based on Clinical Learner Preferences Using Discrete Choice Experiments
Authors: Perez Sandra , Schwartz Alan , Hauer Karen E. , Karani Reena , Hirshfield Laura E. , McNamara Margaret , Henry Duncan , Lupton Katherine L. , Woods Majka , Teherani Arianne
Published: August 2023

Purpose

Medical education is only beginning to explore the factors that contribute to equitable assessment in clinical settings. Increasing knowledge about equitable assessment ensures a quality medical education experience that produces an excellent, diverse physician workforce equipped to address the health care disparities facing patients and communities. Through the lens of the Anti-Deficit Achievement framework, the authors aimed to obtain evidence for a model for equitable assessment in clinical training.

Method

A discrete choice experiment approach was used which included an instrument with 6 attributes each at 2 levels to reveal learner preferences for the inclusion of each attribute in equitable assessment. Self-identified underrepresented in medicine (UIM) and not underrepresented in medicine (non-UIM) (N = 306) fourth-year medical students and senior residents in medicine, pediatrics, and surgery at 9 institutions across the United States completed the instrument. A mixed-effects logit model was used to determine attributes learners valued most.

Results

Participants valued the inclusion of all assessment attributes provided except for peer comparison. The most valued attribute of an equitable assessment was how learner identity, background, and trajectory were appreciated by clinical supervisors. The next most valued attributes were assessment of growth, supervisor bias training, narrative assessments, and assessment of learner’s patient care, with participants willing to trade off any of the attributes to get several others. There were no significant differences in value placed on assessment attributes between UIM and non-UIM learners. Residents valued clinical supervisors valuing learner identity, background, and trajectory and clinical supervisor bias training more so than medical students.

Conclusions

This study offers support for the components of an antideficit-focused model for equity in assessment and informs efforts to promote UIM learner success and guide equity, diversity, and inclusion initiatives in medical education.
When Feedback is Not Perceived as Feedback: Challenges for Regulatory Body–Mandated Peer Review
Authors: LaDonna Kori A. , Cowley Lindsay , Ananny Lesley , Regehr Glenn , Eva Kevin W.
Published: August 2023

Purpose

Safe and competent patient care depends on physicians recognizing and correcting performance deficiencies. Generating effective insight depends on feedback from credible sources. Unfortunately, physicians often have limited access to meaningful guidance. To facilitate quality improvement, many regulatory authorities have designed peer-facilitated practice enhancement programs. Their mandate to ensure practice quality, however, can create tension between formative intentions and risk (perceived or otherwise) of summative repercussions. This study explored how physicians engage with feedback when required to undergo review.

Method

Between October 2018 and May 2020, 30 physicians representing various specialties and career stages were interviewed about their experiences with peer review in the context of regulatory body–mandated programs. Twenty had been reviewees and reviewers and, hence, spoke from both vantage points. Interview transcripts were analyzed using a 3-stage coding process informed by constructivist grounded theory.

Results

Perceptions about the learning value of mandated peer review were mixed. Most saw value but felt anxiety about being selected due to being wary of regulatory bodies. Recognizing barriers such perceptions could create, reviewers described techniques for optimizing the value of interactions with reviewees. Their strategies aligned well with the R2C2 feedback and coaching model with which they had been trained but did not always overcome reviewees’ concerns. Reasons included that most feedback was “validating,” aimed at “tweaks” rather than substantial change.

Conclusions

This study establishes an intriguing and challenging paradox: feedback appears often to not be recognized as feedback when it poses no threat, yet feedback that carries such threat is known to be suboptimal for inducing performance improvement. In efforts to reconcile that tension, the authors suggest that peer review for individuals with a high likelihood of strong performance may be more effective if expectations are managed through feedforward rather than feedback.
The Problem and Power of Professionalism: A Critical Analysis of Medical Students’ and Residents’ Perspectives and Experiences of Professionalism
Authors: Maristany Daniela , Hauer Karen E. , Leep Hunderfund Andrea N. , Elks Martha L. , Bullock Justin L. , Kumbamu Ashok , O’Brien Bridget C.
Published: August 2023

Purpose

Professionalism has historically been viewed as an honorable code to define core values and behaviors of physicians, but there are growing concerns that professionalism serves to control people who do not align with the majority culture of medicine. This study explored how learners, particularly those from historically marginalized groups, view the purpose of professionalism and how they experience professionalism as both an oppressive and valuable force.

Method

The authors conducted a qualitative study with a critical orientation. In 2021 and 2022, they interviewed fourth-year medical students and senior residents at 3 institutions about their perceptions and experiences of professionalism. After cataloguing participants’ stories, the authors combined critical theory with narrative and thematic analysis to identify mechanisms by which professionalism empowered or disempowered individuals or groups based on identities.

Results

Forty-nine trainees (31 medical students and 18 senior residents from multiple specialties) participated in interviews; 17 identified as a race/ethnicity underrepresented in medicine and 15 as people of color not underrepresented in medicine. Their stories, especially those of participants underrepresented in medicine, identified professionalism as an oppressive, homogenizing force that sometimes encoded racism through various mechanisms. These mechanisms included conflating differences with unprofessionalism, enforcing double standards of professionalism, and creating institutional policies that regulated appearance or hindered advocacy. Participants described deleterious consequences of professionalism on their learning and mental health. However, participants also described useful aspects of professionalism as a means of advocating for marginalized groups. Additionally, participants described how they reconceived professionalism to include their own identities and values.

Conclusions

Trainees, especially those from historically marginalized groups, experience professionalism as a restrictive, assimilative force while also finding value in and constructive adaptations for professionalism. Understanding both the destructive and empowering aspects of professionalism on individual and institutional levels can help improve the framing of professionalism in medical education.
A Chief Health Security Officer for Every Academic Health Center: Improving Readiness, Response, Recovery, and Resilience
Authors: Maggio Lauren A. , Byington Carrie L. , Toner Eric S. , Kanter Steven L.
Published: August 2023

Academic health centers (AHCs) require expertise to ensure readiness for health security events, such as cyberattacks, natural disasters, and pandemics, as well as the ability to respond to and recover from these events. However, most AHCs lack an individual to coordinate efforts at an enterprise level across academic and operational units during an emergency; elevate the coordination of individual AHCs with local and state public health entities; and through professional organizations, coordinate the work of AHCs across national and international public health entities. Informed by AHCs’ responses to the COVID-19 pandemic and a series of focused meetings in 2021 of the Association of Academic Health Centers President’s Council on Health Security, the authors propose creating a new C-suite role to meet these critical needs: the chief health security officer (CHSO). The CHSO would be responsible for the AHC’s overall health security and would report to the AHC’s chief executive officer or president. The authors describe the role of CHSO in relation to the preparation, response, and recovery phases of public health events necessary for health security. They also propose key duties for this position and encourage institutions to offer training and credentials to facilitate the creation and define the portfolios of CHSO positions at AHCs and beyond.
Berberine might block colorectal carcinogenesis by inhibiting the regulation of B-cell function by Veillonella parvula
Authors: Qian Yun , Kang Ziran , Zhao Licong , Chen Huimin , Zhou Chengbei , Gao Qinyan , Wang Zheng , Liu Qiang , Cui Yun , Li Xiaobo , Chen Yingxuan , Zou Tianhui , Fang Jingyuan
Published: August 2023

Background:

Colorectal carcinogenesis and progression are related to the gut microbiota and the tumor immune microenvironment. Our previous clinical trial demonstrated that berberine (BBR) hydrochloride might reduce the recurrence and canceration of colorectal adenoma (CRA). The present study aimed to further explore the mechanism of BBR in preventing colorectal cancer (CRC).

Methods:

We performed metagenomics sequencing on fecal specimens obtained from the BBR intervention trial, and the differential bacteria before and after medication were validated using quantitative polymerase chain reaction. We further performed Apc
Min/+ animal intervention tests, RNA sequencing, flow cytometry, immunohistochemistry, and enzyme-linked immunosorbent assays.

Results:

The abundance of fecal Veillonella parvula (V. parvula) decreased significantly after BBR administration (P = 0.0016) and increased through the development from CRA to CRC. Patients with CRC with a higher V. parvula abundance had worse tumor staging and a higher lymph node metastasis rate. The intestinal immune pathway of Immunoglobulin A production was activated, and the expression of TNFSF13B (Tumor necrosis factor superfamily 13b, encoding B lymphocyte stimulator [BLyS]), the representative gene of this pathway, and the genes encoding its receptors (interleukin-10 and transforming growth factor beta) were significantly upregulated. Animal experiments revealed that V. parvula promoted colorectal carcinogenesis and increased BLyS levels, while BBR reversed this effect.

Conclusion:

BBR might inhibit V. parvula and further weaken the immunomodulatory effect of B cells induced by V. parvula, thereby blocking the development of colorectal tumors.

Trial Registraion:

ClinicalTrials.gov, No. NCT02226185.
Diagnosis and Management of Acral Pigmented Lesions
Authors: Ingrassia Jenne P. , Stein Jennifer A. , Levine Amanda , Liebman Tracey N.
Published: August 2023

BACKGROUND

Survival outcomes in acral lentiginous melanoma (ALM) are worse than for cutaneous melanoma. Diagnostic delays are believed to contribute to worse outcomes in ALM, including advanced-stage disease at initial presentation. Acral lentiginous melanoma, especially in its early stages, may be difficult to discern from benign pigmented acral lesions.

OBJECTIVE

The purpose of this article is to provide a comprehensive review of the diagnosis and management of acral pigmented lesions.

MATERIALS AND METHODS

A literature review was performed. The outcomes included were the clinical and dermoscopic features and the management frameworks and considerations for acquired and congenital melanocytic nevi, acral melanosis, nonmelanocytic pigmented lesions, and ALM.

RESULTS

Original research studies were primarily included. The use of dermoscopy, such as the 3-step algorithm and blotch (irregular), ridge pattern (parallel), asymmetry of structures, asymmetry of colors, furrow pattern (parallel), fibrillar pattern (BRAAFF) checklist, increases the diagnostic accuracy of acral pigmented lesions with high specificity and sensitivity. Short-term digital dermoscopic surveillance can be used to manage acral lesions, and histopathology should be collected when there is a concern for ALM.

CONCLUSION

The use of dermoscopy and an understanding of how to manage acral lesions may limit the number of biopsies performed on the acral skin, decrease the time to diagnosis, and facilitate early detection of ALM.
The ECLiPSE Procedure as an Alternative to Mastopexy following Implant Removal
Authors: Wilssens Nicholas , Singla Apresh , Hoffman Stuart , Graham Susannah , Jayatilleke Nipu , Lajevardi Sepehr , Barker Anthony , Deva Anand K.
Published: August 2023

Background:

With the rise in number of breast implant removals for a variety of indications, strategies to improve aesthetic outcomes, while minimizing scars and operating time, will prove to be of benefit. We present here a novel periareolar sickle skin excision as a good option for women with mild to moderate ptosis and central loss of breast volume following implant removal/capsulectomy.

Methods:

The ECLiPSE (Explant, Capsulectomy, Lift using Periareolar Sickle skin Excision) was utilized in 53 patients with a median follow-up of 24 weeks.

Results:

The majority of these patients had breast implants for cosmetic augmentation and the most common indication for implant removal was capsular contracture (n = 47, 88.7%). Forty-six patients (86.8%) scored a high or very high satisfaction with the outcome of the procedure.

Conclusion:

We believe that the ECLiPSE procedure is a useful option that can produce a reasonable aesthetic outcome following implant removal/capsulectomy while minimizing visible scarring.