bluuebunny/crossref_metadata_2025 huggingface dataset:
Game Theory Applied To The Brazilian Antitrust Leniency Program
Authors: Matias Sabino Douglas , Teodoro de Rezende Lara Fabiano , Santos Coelho Sarto Elisa
Published: November 2024

The Brazilian Antitrust Law established the Administrative Council for Economic Defence (CADE) as the body responsible for investigating and imposing sanctions for acts that violate the economic order, as well as for supervising acts of economic concentration. The field of game theory is concerned with the actions of decision-makers who are aware that their decisions affect one another. The objective of the proposed article is to analyse the legal framework of the Leniency Programme implemented by Brazil's Administrative Council for Economic Defence (CADE) using the tools provided by game theory, in particular sequential games with perfect information. The methodology employed is classified as theoretical research, utilising the deductive method with the objective of enhancing the proposed theme. In order to achieve this, two game models will be developed. Initially, it was observed that the benefits offered by the current Brazilian leniency programme are insufficient to persuade a potential cartel member to propose a leniency agreement. Conversely, in a second step, the introduction of immunity for applicants from civil damages caused by the cartel resulted in the conclusion that the Brazilian antitrust leniency programme becomes an important tool for deterring and combating cartels.
KEYWORDS: Antitrust Law. Cartel. Game theory. Leniency. Sequential games.
Políticas Constitucionais para a Proteção do Patrimônio Cultural Imaterial
Authors: Petters Melo Milena , Mengarda Uliana
Published: November 2024

As políticas constitucionais para a proteção do patrimônio cultural imaterial podem ser potencializadas através de diversos âmbitos do Direito e institutos jurídicos, envolvendo esforços no âmbito público e privado, ações do Estado e da sociedade, como instrumento e valor para a vida em comunidade. Dentre estes institutos, este artigo destaca a indicação geográfica como potencial instrumento auxiliar para a proteção do patrimônio cultural imaterial. O questionamento central em que se coloca o problema de pesquisa é: qual a contribuição da Indicação Geográfica para a salvaguarda do patrimônio cultural imaterial? Para responder a este questionamento, foi aplicado o método dedutivo na análise dos dois institutos contextualizados no sistema jurídico-constitucional brasileiro. Resultado de pesquisas bibliográficas e de documentos, na perspectiva metodológica do estudo do Direito como política constitucional, o objetivo deste artigo  enfatizar a importância da indicação geográfica como instrumento auxiliar para a proteção do patrimônio cultural imaterial, bem como para o fortalecimento de parcerias multisetoriais voltadas ao desenvolvimento sustentável.
Effects of speaking style and semantic predictability on vowel production
Authors: Song Yujin , Clopper Cynthia G.
Published: November 2024

Listener-oriented accounts of phonetic enhancement propose that talkers produce enhanced vowels to increase clarity when their interlocutor might experience communicative difficulty, e.g., for non-native interlocutors or for an unpredictable word given the semantic context. While style-driven enhancement has been shown to be a listener-oriented modification, it is less clear if semantic predictability effects are implemented by the same mechanism. Using three listener conditions, in which listeners varied in language proficiency, and two predictability contexts, the current study investigated how talkers tailor their speech to accommodate the varying proficiencies of their listeners and to what extent semantic predictability effects can interact with listener-oriented processes. Talkers produced longer and more dispersed vowels when talking to the low-proficiency non-native listener relative to the native and high-proficiency non-native listeners. Further, vowels were longer in low predictability contexts relative to high predictability contexts. Finally, talkers increased vowel F2 in low predictability contexts relative to high predictability contexts only for the low-proficiency non-native listener. No differences were found for the native and high-proficiency non-native listeners. The findings suggest that assessment of listeners' needs affects phonetic enhancement, and listener-oriented processes may influence predictability effects for at least some acoustic measures in some conditioning contexts.
Supplemental Material: Ordovician backarc setting in the Tongbai orogen, central China: Geochronological and geochemical constraints from the Erlangping metabasites
Authors: Zhang Feifei , al. et
Published: November 2024

Zircon U-Pb dating, whole-rock major oxides, trace elemental and Sr-Nd-Pb isotopic analysed results for the metabasites from the Erlangping Group in the Tongbai orogen.
Supplemental Material: Early Triassic mid-ocean-ridge basalt (MORB)-like diabase swarms in the southeastern segment of the Central Asian Orogenic Belt: A response to lithospheric extension triggered by Paleo-Asian oceanic slab break-off
Authors: Jing Yan , Ge Wen-chun , al. et
Published: November 2024

Supplemental Text S1 and Supplemental Tables S1-S5.
From Fluctuations and Disorder to Scaling and Control: The Emergence of Resistance in Microbial Communities
Authors: Moran Jacob , Wood Kevin B.
Published: November 2024

Antibiotics are a cornerstone of modern medicine, and antibiotic resistance is a growing threat to public health. The evolution of resistance is a multiscale process shaped by many of the same phenomena that have fascinated condensed matter physicists for decades: fluctuations, disorder, scaling, and the emergence of structure from local heterogeneous interactions. In this review, we offer a brief introduction to antibiotic resistance through the lens of these shared cross-disciplinary themes. We highlight conceptual connections shared across disciplines and aim to inspire continued investigation of this complex and important biomedical problem.
Nonmelanoma Skin Cancer in the Heart of the Middle East: Analysis of Mohs Micrographic Surgery Cases From a Tertiary Care Center in Lebanon
Authors: Berjawi Ahmad , Saade Namir , Tannous Zeina
Published: November 2024

Skin cancer is the most common cancer worldwide. According to the Skin Cancer Foundation, Mohs micrographic surgery (MMS) is considered the most effective technique for treating nonmelanoma skin cancer (NMSC). Recurrence rate after MMS for treating NMSC ranges from 1.4% to 3.2% for primary tumors and 2.4%–6% for recurrent tumors. The aim of the study was to report data from a tertiary care center in Lebanon providing MMS to patients with NMSC. Retrospective cohort study was conducted through chart review of 94 patients at the Lebanese American University Medical Center (LAUMC‐RH) with a total of 115 cases of MMS identified. The study showed that most cases were males (72; 63%), and 77% were aged > 60 years (88). The average tumor size was 1.6 cm. Recurrence rate was zero in primary tumors and 0.9% in recurrent tumors. With respect to age, bivariate analysis showed that cases of males over 60 years of age were more significantly associated with undergoing Mohs surgery (69% vs. 31%; p = 0.012). With respect to maximum tumor diameter (MTD) > 1 cm, male gender was associated with a higher MTD when compared to females (74% vs. 26%; p = 0.02). Also, Area L was associated with a larger MTD when compared to areas H and M, respectively (90% vs. 61.1% vs. 37.7%; p = 0.01). Multivariate analysis of MTD showed that tumors with MTD > 1 cm were significantly associated with male gender, presence in low‐ or middle‐risk areas and being a recurrent tumor. This study shows that MMS is adequate for the treatment of NMSC at our center with minimal complications (< 1%) and recurrence (< 1%).
Repetitive Transcranial Magnetic Stimulation Coupled With Visual‐Feedback Cycling Exercise Improves Walking Ability and Walking Stability After Stroke: A Randomized Pilot Study
Authors: Wang Yixiu , Chen Xiaoming , Wang Menghuan , Pan Yingying , Li Shiyi , He Mengfei , Lin Feng , Jiang Zhongli
Published: November 2024

Background: Stroke survivors exhibit persistent abnormal gait patterns, particularly in diminished walking ability and stability, limiting mobility and increasing the risk of falling. The purpose of the study was to determine the effects of repetitive transcranial magnetic stimulation (rTMS) coupled with cycling exercise on walking ability and stability in patients with stroke and explore the potential mechanisms underlying motor cortex recovery.

Methods: In this double‐blinded randomized pilot trial, 32 stroke patients were randomly separated into the real‐rTMS group (RG, receiving rTMS during active cycling exercise) and the sham‐rTMS group (SG, receiving sham rTMS during active cycling exercise). Participants completed 10 exercise sessions (5 times per week). Lower extremity function was measured using the Fugl‐Meyer assessment of lower extremity (FMA‐LE), and functional balance ability was measured by the Berg balance scale (BBS). The 2‐min walk test (2MWT) and standing balance test were employed to evaluate walking and balance ability. Motor evoked potentials (MEPs) were measured to evaluate cortical excitability. The above assessments were administered at baseline and after the intervention. Additionally, the cycling exercise performance was recorded after the initial and final exercise sessions to evaluate the motor control during exercise.

Results: The RG showed significant improvements in lower extremity function (FMA‐LE) and functional balance ability (BBS) compared to the SG at postintervention. The walking and balance abilities, as well as the motor asymmetry of cycling exercise, significantly improved in RG. Additionally, participants in RG exhibited a higher elicitation rate of ipsilesional MEPs than that in SG. The improvements in motor asymmetry of cycling exercise in RG were significantly associated with increases in FMA‐LE scores and walking ability.

Conclusion: The combination of rTMS and cycling exercise effectively improves walking ability and walking stability in patients with stroke, which may be related to the excitability modulation of the motor cortex induced by rTMS.

Trial Registration: Clinical Trial Registry identifier: ChiCTR2400079360.
Table S3 from Spatial Context of Immune Checkpoints as Predictors of Overall Survival in Patients with Resectable Colorectal Cancer Independent of Standard Tumor–Node–Metastasis Stages
Authors: Kong Hao , Yang Qingxin , Wu Chunwei , Wu Xiangji , Yan Xinrui , Huang Li-Bin , Chen Lu , Zhou Zong-Guang , Wang Ping , Jiang Hong
Published: November 2024

Abs for FACS analysis
Winter population of raptor species in the Vellalore dump yard of Coimbatore City, India
Authors: V. Balaji  , R. Venkitachalam
Published: November 2024

A study from December 2020 to March 2021 in the Vellalore dump yard, Coimbatore City in southern India recorded 34 bird species, including seven raptors. Notably, two vulnerable species of winter migrant raptors, the Greater Spotted Eagle Aquila clanga, and the Tawny Eagle Aquila rapax were the most frequently observed. The presence of cow carcasses, poultry, and fish waste in the dump yard attracted scavenger birds, particularly raptors. The study utilized the systematic vantage point method to gather data and aims to establish a baseline understanding of the winter raptor population and other bird species in the garbage dump yard. This research serves as a foundation for long-term monitoring and conservation efforts.
Indian Leopard predation on the sub-adult Himalayan Griffon Vulture (Accipitridae: Accipitriformes)
Authors: Chakraborty Soumya Sundar , Ray Debal , Sen Apurba , P.J. Harikrishnan  , Jha Nabi Kanta , Ghosh Rounaq
Published: November 2024

This study documents instances of predation on Himalayan Griffon Vulture Gyps himalayansis by Indian Leopards Panthera pardus fusca Meyer, 1794 near the pre-release aviary of the Buxa Vulture Conservation Breeding Centre within the Buxa Tiger Reserve. Camera trap monitoring revealed leopard predation on sub-adult vultures, highlighting a previously unreported threat to vulture populations. The adaptability of leopards to diverse ecosystems, coupled with their varied diet, underscores the need for further research to understand the implications of leopard predation on vulture conservation efforts. This documentation provides insights into the prey-predator interactions and emphasizes the importance of continued monitoring and conservation measures to safeguard vulnerable vulture populations.
Photographic record of Kashmir Gliding Squirrel Eoglaucomys fimbriatus (J.E. Gray, 1837) from the Gurez Valley, Jammu & Kashmir, India
Authors: Lone G. Mustufa , Bhat Bilal A. , Hussain Mir Shabir , Lone Arif Nabi
Published: November 2024

Around 48 species of gliding squirrels are present in the world; found mainly in tropical regions of North America, Eurasia, and southeastern Asia. The Kashmir Gliding Squirrel Eoglaucomys fimbriatus is a rare species of rodent that belongs to the family Sciuridae. It is a nocturnal species, resting during the daytime in tree shelters and emerging at night to feed. This paper documents the direct sighting of the Kashmir Gliding Squirrel from the Gurrai Nallah, Gurez Valley of Jammu & Kashmir.
Fairies of the day and angels of the night
Authors: Chitra Narayanasami
Published: November 2024

NA
The “KGB Wanted List” and the Evolving Soviet Pursuit of Defectors
Authors: Riehle Kevin P.
Published: November 2024

The 1969 edition of a document known as the “KGB Wanted List” was smuggled to the West in 1972 by a Soviet State Security Committee (KGB) officer who defected. The KGB periodically compiled the list to target people around the world whom the Soviet government accused of violating Soviet law, especially through defection. More than four decades after the 1969 list became available in the West, the Security Service of Ukraine—the main counterintelligence agency in independent Ukraine—declassified a later edition of the KGB list, dated 1979. This article compares these two editions of the list, analyzing the individuals included (and excluded) in each, the judicial sentences passed against subjects, and the KGB organizations responsible for handling their cases. The article shows that the Soviet view of defectors evolved throughout the Cold War and that the KGB was far from omnipotent even on Soviet territory. It further shows that post-Soviet Russia's pursuit of defectors bears many similarities to practices of the Soviet era, with equivalents of the KGB Wanted List reported in Russia today.
Humble Posture for Missional Peacemaking in the Church and Academy
Authors: Michener Ronald T.
Published: November 2024

Given rampant polarization across our global political and ecclesial contexts, a robust missional sensibility for navigating disagreements and bridge-building is imperative. Drawing inspiration from Rowan Williams’ Faith in the Public Square (2012), among others (Vainio, Franke, Olofinjana, Caputo, McInerney), and postliberal theological perspectives, this article suggests that our spheres of influence and/or participation may be intentionally and forthrightly Christian while at the same time avoiding acrimonious tones of Christian nationalism, partisanship and fundamentalism. Instead of posturing as strong, winsome, charismatic leaders, a missional leadership posture submits that an intentional manifestation of humility and vulnerability, accompanied by strong faith convictions will be explicitly, if not ironically, conciliatory.
“Blur the Preacher”: Media Remix and Digital Technocultural Practice in Pakistan”
Authors: Asif Hassan
Published: November 2024

This paper explores the transformative effect of remix practices on media production in Pakistan, focusing on the integration of Internet memes, Islamic religious sermons, and political speeches in novel cultural critiques. Using Critical Technocultural Discourse Analysis, it is observed that digital remix tools enable the incorporation of typically Islamically censured media elements, including Western electronic music samples, local controversial memes, and digitally available Muslim devotional content. These are creatively remixed into YouTube videos that often go viral, representing alternative Pakistani Muslim identities. The study argues that this negotiation generates a digital media environment open to sampling diverse media content, creating unprecedented meanings that challenge traditional regional media production norms. The values and meanings ascribed to these remixes are then analyzed, probing their influence on shaping audience perceptions. In conclusion, media remix is presented as a particular competency, acquired through participation in the constrained yet networked digital media environment of Pakistan.
Fluidity of Sharīʿa and the Modern State
Authors: Abbasi Muhammad Zubair
Published: November 2024

The Qurʾān grants a childless widow a one-fourth share in the inheritance of her husband. However, this right is limited to movable property under the Ithnā ʿAsharīyya school in South Asia (India, Pakistan, and Bangladesh). In December 2021, Pakistan’s parliament extended a childless widow’s inheritance right to include immovable property under the Ithnā ʿAsharīyya school. This paper examines the historical processes that contributed to the formulation and subsequent reformulation of the legal rule governing the inheritance right of a childless widow under the Ithnā ʿAsharīyya school. It identifies distinct but interconnected phases in which sharīʿa was transformed within the institutional structure of the modern state during the colonial and post-colonial periods. By doing so, the paper highlights the fluidity of sharīʿa as a legal tradition, which adapted to changing circumstances in different historical contexts.
Emended description and phylogenetic placement of Dermatosorus schoenoplecti (Ustilaginales)
Authors: PIĄTEK MARCIN , LUTZ MATTHIAS , MOSSEBO DOMINIQUE C. , PIĄTEK JOLANTA
Published: November 2024

The smut fungal genus Dermatosorus (Ustilaginales, Anthracoideaceae) currently contains six species that infect ovaries of host plants in the family Cyperaceae (from the so called Abildgaardieae—Eleocharideae—Fuireneae—Cypereae-Clade). This genus is poorly known and sparsely represented in nucleotide databases. An emended description, illustration and phylogenetic placement of the rare species Dermatosorus schoenoplecti collected in Cameroon are provided. In addition, the global diversity and distribution of Dermatosorus species are reviewed.
Identification of a terpene synthase arsenal using long-read sequencing and genome assembly of Aspergillus wentii
Authors: Olumakaiye Richard , Corre Christophe , Alberti Fabrizio
Published: November 2024

Background

Fungi are talented producers of secondary metabolites with applications in the pharmaceutical and agrochemical sectors. Aspergillus wentii CBS 141173 has gathered research interest due to its ability to produce high-value norditerpenoid compounds, including anticancer molecules. In this study, we aimed to expand the genomic information available for A. wentii to facilitate the identification of terpenoid biosynthetic genes that may be involved in the production of bioactive molecules.

Results

Long-read genome sequencing of Aspergillus wentii CBS 141173 was conducted using Oxford Nanopore Technologies (ONT) MinION MK1C. In addition, paired-end stranded RNA-seq data from two time points, 7 days and 30 days, was used for functional annotation of the assembled genome. Overall, we assembled a genome of approximately 31.2 Mb and identified 66 biosynthetic gene clusters from the annotated genome. Metabolic extracts of A. wentii were analysed and the production of the bioactive terpenoid asperolide A was confirmed. We further mined the assembled and annotated genome for BGCs involved in terpenoid pathways using a combination of antiSMASH and local BlastP and identified 16 terpene synthases. Phylogenetic analysis was conducted and allowed us to establish relationships with other characterised terpene synthases. We identified two terpene clusters potentially involved in pimarane-like diterpenoid biosynthesis. Finally, the analysis of the 16 terpene synthases in our 7-day and 30-day transcriptomic data suggested that only four of them were constitutively expressed under laboratory conditions.

Conclusion

These results provide a scaffold for the future exploration of terpenoid biosynthetic pathways for bioactive molecules in A. wentii. The terpenoid clusters identified in this study are candidates for heterologous gene expression and/or gene disruption experiments. The description and availability of the long-read genome assembly of A. wentii CBS 141173 further provides the basis for downstream genome analysis and biotechnological exploitation of this species.
Nanopore direct RNA sequencing reveals N6-methyladenosine and polyadenylation landscapes on long non-coding RNAs in Arabidopsis thaliana
Authors: Liang Qiaoxia , Zhang Jizhou , Lam Hon-Ming , Chan Ting-Fung
Published: November 2024

Background

Long non-coding RNAs (lncRNAs) play important roles in various biological processes, including stage development in plants. N6-methyladenosine (m6A) modification and polyadenylation are noteworthy regulatory processes that impact transcript functions by modulating their abundance. However, the specific landscapes of m6A modification and polyadenylation on lncRNAs remain largely unexplored. The advent of nanopore direct RNA sequencing (DRS) provides unprecedented opportunities for directly detecting m6A modifications and estimating polyadenine (poly[A]) tail lengths on individual RNA molecules.

Results

Here we utilized nanopore DRS to identify lncRNAs and map the transcriptome-wide m6A modification and polyadenylation landscapes in the model plant Arabidopsis thaliana. Leveraging the Low-abundance Aware Full-length Isoform clusTEr (LAFITE) assembly pipeline, we identified 1149 novel lncRNAs in seventeen nanopore DRS datasets from the wild-type Columbia-0. Through the precise detection of 2381 m6A modification sites on lncRNAs at single-base resolution, we observed that lncRNAs exhibited lower methylation levels compared to protein-coding RNAs, and m6A modification facilitated lncRNA abundance. Additionally, we estimated the poly(A) tail lengths of individual lncRNAs and found that poly(A) tails contributed to lncRNA stability, while their effect was not length-dependent. Furthermore, by comparing lncRNA abundance between 2-week seedlings and 5-week floral buds, we revealed the dynamic expression patterns of lncRNAs during the transition from the vegetative stage to the reproductive stage. These observations provided insights into their potential roles in specific tissues or stages in Arabidopsis, including regulating stage development. Moreover, by integrating information on m6A modification, we unveiled a positive correlation between methylation variances and differential expressions of lncRNAs during stage development.

Conclusions

These findings highlighted the significance of epigenetic modification and post-transcriptional processing in shaping lncRNA expression and their functions during Arabidopsis stage development, contributing to the growing field of lncRNA research in plants.

Clinical trial number

Not applicable.
Anaesthetic management of an infant with MEGD(H)EL syndrome undergoing cochlear implant
Authors: Ahmed Nashwa
Published: November 2024

Background

The syndrome has these features: 3-methylglutaconic aciduria (MEG), deafness(D), encephalopathy (E), Leigh-like syndrome (L). This disorder is caused by biallelic mutations in serine active site-containing protein 1 (SERAC1) gene. When these patients experience hepatopathy (H) in addition to the above manifestations, the syndrome is referred to as MEGD(H)EL. The pathology of this syndrome shares features with diverse types of inborn errors of metabolism.

Case presentation

We discussed the anaesthetic management of an infant 2-year-old suffering from MEGD(H)EL syndrome undergoing cochlear implant. We discuss the pathology, genetics and significant aspects of this sporadic disease which is important for anaesthesiologist.

Conclusions

The usage of dexmedetomidine as the main anaesthetic drug might have the benefit of a non-triggering anaesthetic agent in patients with a mitochondrial disease. Mixture of dexmedetomidine and ketamine provide an effective combination for procedural sedation, predominantly in select populations who are at a high risk of perioperative complications due to underlying co-morbid conditions.
Is there a link between peripheral inflammation and blood brain barrier integrity in children with attention-deficit/hyperactivity disorder? A case-control study
Authors: Sayed Samira Zien , Hassan Zienab Osama , Abdelraheem Wedad M. , Refaat Rasha Samir , Abuelela Ibtehal Saad
Published: November 2024

Background

Claudin-5 is a vital constituent of tight junctions, which are critical elements of the blood-brain barrier. In people with neuropsychiatric disorders, peripheral inflammation is often found, although it is less common in healthy populations. The objective of this study was to examine the relationship between Claudin-5, peripheral immune cells, and the severity of symptoms in children with attention deficit hyperactivity disorder (ADHD).

Methods

The study included a cohort of 33 children diagnosed with ADHD and 29 control subjects, all aged between 5 and 12 years. The intensity of ADHD symptoms was evaluated using Conner’s questionnaire, which the parents completed. Each kid had serum level measurements of Claudin-5 and a complete blood count in order to establish a correlation with symptoms of ADHD.

Results

Serum Claudin-5 levels are lower in the ADHD group compared to the control group; median (IQR) = 30.94 (4-137) and 44.12 (4–223.3) respectively (p = 0.69). The levels of neutrophils and neutrophil/lymphocyte ratio are significantly higher in ADHD than in controls (p = 0.011 and 0.015, respectively). Lymphocytes have a significant positive correlation with ADHD symptoms severity, namely, total Conner’s scale and inattention (p = 0.021 and 0.004 respectively), while NLR has a significant negative correlation with total Conner’s score and impulsivity (p = 0.046, p = 0.038), also a negative correlation yet not significant between serum Claudin-5 level and total Conner’s score, hyperactivity, impulsivity, and inattention. Neutrophils were found to have a significant positive linear regression with Claudin-5 (p = 0.023).

Conclusion

These results revealed that BBB integrity is affected in ADHD children, as claudin-5 levels were found to be lower in children with ADHD, lymphocytes were found to be associated with increased ADHD symptoms severity, and NLR was associated with decreased symptoms severity, which may be via the positive effects of increased neutrophils on Claudin-5 levels.
The associations of positive and negative mental well-being with physical activity during the COVID-19 across late adulthood
Authors: Savikangas Tiina , Kekäläinen Tiia , Tirkkonen Anna , Sipilä Sarianna , Kokko Katja
Published: November 2024

Background

Mental well-being (MWB) may play an important role in physical activity (PA) behavior, but the independent associations of affective MWB indicators and depressive symptoms with PA are sparsely investigated in late adulthood. We investigated the associations of positive affect, negative affect, and depressive symptoms with PA during the COVID-19 restrictions across late adulthood.

Methods

Cross-sectional data came from two Finnish population-based studies. The younger cohort (N = 162, 56% women, 60–61 years) was drawn from the TRAILS study, and the older (N = 272, 60% women, 72–88 years) from the PASSWORD study. Data on PA frequency (1–7; from “not at all” to “approximately daily”) and perceived changes in PA (no change/increased/reduced) during COVID-19 restrictions were self-reported. MWB was assessed by positive and negative affect (International Positive and Negative Affect Schedule Short Form) and depressive symptoms (younger cohort: General Behavioral Inventory; older cohort: Geriatric Depression Scale). Associations between MWB and PA were analyzed using linear and multinominal logistic regression models.

Results

When each MWB indicator was investigated separately, higher positive affect was associated with higher PA frequency in both cohorts and with a higher likelihood of increased PA in the younger cohort; higher negative affect was associated with a higher likelihood of reduced PA in the older cohort; higher depressive symptoms were associated with lower PA frequency in both cohorts and with a higher likelihood of reduced PA in the older cohort (p ≤ 0.009 for all), In the final models including all three MWB indicators, socioeconomic, and health-related covariates, only the association between higher positive affect and higher odds of increased PA remained significant in the younger cohort (OR = 4.28, p = 0.006). In the older cohort, only the associations of higher depressive symptoms with lower PA frequency (β=-0.097, p = 0.024) and higher odds of reduced PA (OR = 1.26, p = 0.010) remained significant.

Conclusions

Positive affect was independently associated with increased PA during the COVID-19 restrictions in sixty-year-olds. Higher depressive symptoms were independently associated with lower PA frequency and a higher likelihood of reduced PA in 72-88-year-olds. Positive and negative aspects of MWB have different relations to PA among people aged 60 and 70 + when one’s daily routines are restricted.

Trial registration number

ISRCTN52388040 (the PASSWORD study).
Opioid prescriptions following behavioral health training among primary care providers
Authors: Huo Shutong , A. Bruckner Tim , Das Abhery , L. Xiong Glen , Marcovitz David , B. Neikrug Ariel , McCarron Robert
Published: November 2024

Background

Overdose deaths due to opioids are a major concern in the United States. Physicians often report inadequate training in chronic pain and substance use disorder management. Here, we evaluate whether a specialized program, the Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship, affected opioid prescription practices among primary care physicians.

Methods

We retrieved information from a publicly insured health program in Southern California on 11,975 patients and 180 primary care providers (PCPs) engaged in care between 2017 and 2021. Of the 180 PCPs, 38 received TNT training and 142 did not. We considered a patient as exposed to the provider’s TNT “treatment” if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of opioid prescriptions per patient per quarter-year as the key independent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification.

Results

Post-TNT training, PCPs prescribed fewer than expected opioids. This result remains robust after controlling for several covariates (coef: − 0.209 ; standard error = 0.052, p < 0.001) as well as after clustering patient observations by provider.

Conclusion

In a large Southern California healthcare system, the TNT training program preceded a reduction in primary care providers’ prescription rates of opioids. If replicated in larger samples, a low-cost provider training program has the potential to promote more judicious use of opioids for pain management. We encourage more studies to understand the program’s long-term impact on physician behavior and, potentially, on patient outcomes.
Peer teachers as ultrasound instructors? – a systematic literature review of peer teaching concepts in undergraduate ultrasound education
Authors: Winter Lone , Neubauer Ricarda , Weimer Johannes , Dietrich Christoph F. , Wittek Agnes , Schiestl Lina , Marinova Milka , Schäfer Valentin Sebastian , Strizek Brigitte , Recker Florian
Published: November 2024

Background

As ultrasound is one of the most utilized imaging procedures in clinical practice in Germany, its integration into undergraduate medical education is imperative. Thereby, the limited availability of qualified instructors is a major challenge. Peer tutors, who are trained to instruct their peers collaboratively, could resolve staff constraints. This systematic review explores the literature on peer teaching in undergraduate ultrasound education, aiming to provide an overview of methodologies, outcomes, and peer teacher training concepts.

Methods

Following the PRISMA guidelines, a systematic literature review was conducted on the subject of peer teaching in undergraduate ultrasound education. Using PubMed and Google Scholar as databases, studies in English or German involving training concepts for peer teachers in undergraduate ultrasound education, published up to November 21, 2023, were included. Data extraction of original studies followed the PICOS schema with special respect to didactic concepts of peer tutor training programs and the effectiveness of peer teachers compared to faculty instructors. A modified version of the Newcastle–Ottawa Scale (NOS) was used to assess the quality of included studies.

Results

Finally, the search resulted in 20 relevant original studies, including 16 studies exploring peer teacher training concepts. Predominantly, peer teachers studied in their 4th year of medical school and on average one year further compared to their students. Peer teacher training was integrated into curricula by course-based concepts (93.8%) and internships (50.0%). Didactic modalities varied, encompassing laboratory rotations including the scanning of patients, the scanning of fellow students, lectures, and didactic training. The median training duration was about ten days. Of six comparative studies, five found peer-assisted learning to be comparably effective and one even better than faculty-led courses.

Conclusion

Despite the growing amount of literature underlining the effectiveness and wide application of peer teaching in ultrasound education, training concepts stay heterogenous without a standardized system for training and qualifying peer teachers. Developing comprehensive guidelines for peer tutor education could increase acceptance and recognition of peer-assisted learning and ensure minimum training standards.
Natural language processing data services for healthcare providers
Authors: Au Yeung Joshua , Shek Anthony , Searle Thomas , Kraljevic Zeljko , Dinu Vlad , Ratas Mart , Al-Agil Mohammad , Foy Aleksandra , Rafferty Barbara , Oliynyk Vitaliy , Teo James T.
Published: November 2024

Purpose of Review

Embedding machine learning workflows into real-world hospital environments is essential to ensure model alignment with clinical workflows and real-world data. Many non-healthcare industries undergoing digital transformation have already developed data labelling and data quality management services as a vertically integrated business process.

Recent Findings

In this paper, we describe our experiences developing and implementing a first-of-its-kind clinical NLP (natural language processing) service in the National Health Service, United Kingdom using parallel harmonised platforms. We report on our work developing clinical NLP resources and implementation framework to distil expert clinical knowledge into our NLP models. To date, we have amassed over 26,086 annotations spanning 556 SNOMED CT concepts working with secondary care specialties.

Our integrated language modelling service has delivered numerous clinical and operational use-cases using named entity recognition (NER). Such services improve efficiency of healthcare delivery and drive downstream data-driven technologies. We believe it will only be a matter of time before NLP services become an integral part of healthcare providers.
Improving medication safety for intensive care patients transitioning to a hospital ward: development of a theory-informed intervention package
Authors: Bourne Richard S. , Jeffries Mark , Jennings Jennifer K. , Ashcroft Darren M. , Norman Paul
Published: November 2024

Background

Care of critically ill patients is complex, requiring effective collaboration co-ordination and communication across care teams and professions. Medicines are a fundamental component of the acute interventions intensive care unit (ICU) patients receive, requiring frequent review and optimisation according to patient needs. ICU patients recovering to transfer to a hospital ward are at risk of medication transition errors, contributing to poorer patient and health-system outcomes. We aimed to develop of a theory-informed intervention package to improve medication safety for ICU patients transferring to a hospital ward.

Methods

We conducted a qualitative study comprising two UK face-to-face focus group meetings in April and May 2022. There were ten participants in each meeting (7-8 healthcare professionals and 2-3 patient and public representatives). Each meeting had four foci: (i) What needs to change (intervention targets)? (ii) What are the core intervention components? (iii) What will the intervention components change and how (mechanisms of action), and what key outcomes will the changes impact on? (iv) What are the barriers and facilitators to intervention delivery? A background to the problem and previous intervention development work was provided. Meetings were digitally recorded and transcribed verbatim. Iterative analyses, informed by the Behaviour Change Wheel framework, were conducted to provide a behavioural diagnosis, identify key behaviour change techniques and outline the mechanisms of action through which the intervention might impact on key outcome.

Results

We identified what needs to change to improve medication safety for UK ICU patients on this care transition. A theory-informed intervention package was developed, based on seven core intervention components (e.g., medication review (targeted), task organisation and prioritisation). For each intervention component the mechanism of action, targeted change, and key outcomes were identified (e.g., medication review (targeted); action planning; decreases problematic polypharmacy; decreased preventable adverse drug events). Barriers and facilitators to intervention component delivery were described.

Conclusions

We developed a theory-informed core intervention package to address the limitations in medication safety for ICU patients transferring to a hospital ward. Understanding what needs to change, and the accompanying facilitators provides a basis for intervention feasibility testing and refinement prior to future evaluation of effectiveness.
Urinary metabolomics provide insights into coronary artery disease in individuals with type 1 diabetes
Authors: Antikainen Anni A. , Mutter Stefan , Harjutsalo Valma , Thorn Lena M. , Groop Per-Henrik , Sandholm Niina ,   the FinnDiane Study Group
Published: November 2024

Background

Type 1 diabetes increases the risk of coronary artery disease (CAD). High-throughput metabolomics may be utilized to identify metabolites associated with disease, thus, providing insight into disease pathophysiology, and serving as predictive markers in clinical practice. Urine is less tightly regulated than blood, and therefore, may enable earlier discovery of disease-associated markers. We studied urine metabolomics in relation to incident CAD in individuals with type 1 diabetes.

Methods

We prospectively studied CAD in 2501 adults with type 1 diabetes from the Finnish Diabetic Nephropathy Study. 209 participants experienced incident CAD within the 10-year follow-up. We analyzed the baseline urine samples with a high-throughput targeted urine metabolomics platform, which yielded 54 metabolites. With the data, we performed metabolome-wide survival analyses, correlation network analyses, and metabolomic state profiling for prediction of incident CAD.

Results

Urinary 3-hydroxyisobutyrate was associated with decreased 10-year incident CAD, which according to the network analysis, likely reflects younger age and improved kidney function. Urinary xanthosine was associated with 10-year incident CAD. In the network analysis, xanthosine correlated with baseline urinary allantoin, which is a marker of oxidative stress. In addition, urinary trans-aconitate and 4-deoxythreonate were associated with decreased 5-year incident CAD. Metabolomic state profiling supported the usage of CAD-associated urinary metabolites to improve prediction accuracy, especially during shorter follow-up. Furthermore, urinary trans-aconitate and 4-deoxythreonate were associated with decreased 5-year incident CAD. The network analysis further suggested glomerular filtration rate to influence the urinary metabolome differently between individuals with and without future CAD.

Conclusions

We have performed the first high-throughput urinary metabolomics analysis on CAD in individuals with type 1 diabetes and found xanthosine, 3-hydroxyisobutyrate, trans-aconitate, and 4-deoxythreonate to be associated with incident CAD. In addition, metabolomic state profiling improved prediction of incident CAD.

Graphical abstract
The timing and spatial distribution of mother–offspring interactions in an obligate hider
Authors: Baur Sophie , Stehr Ferdinand P. , Hewison A. J. Mark , Morellet Nicolas , Ranc Nathan , König Andreas , Menzel Annette , Peters Wibke
Published: November 2024

Background

Parental care is indispensable for the survival and development of dependent offspring, often requiring a delicate balance of time and energy allocation towards offspring by parents. Among ungulates employing a hider strategy, deciding when and where to provide care while also maintaining a sufficient distance to not reveal the offspring´s hiding place is likely crucial in determining their fate.

Methods

In this study, we analyzed the timing and spatial distribution of mother–offspring interactions in roe deer females (Capreolus capreolus L.). We fitted roe deer mothers and their neonates with GPS-collars combined with a proximity sensor in south Germany to address the spatial and temporal distribution of mother-fawn interactions during the first two months of the fawns’ lives.

Results

We observed variations in the distance between mother and fawn, which initially increased over the first month and then decreased as the fawns grew older. The timing of mother-fawn contacts was strongly linked with the circadian rhythm of the mother, aligning closely with their typical bimodal activity peaks at dawn and dusk. Furthermore, we observed differences in habitat use between mother and offspring, reflecting the mother's requirements for food and protection (e.g. greater use of forests, higher distances to roads), as well as the fawn's priority requirement for protection (e.g. higher use of unmown grassland). We documented variations over time, highlighting how these requirements changed as the fawn ages. Interestingly, during the initial two weeks, most of the contacts occurred in habitats that were particularly favored by mothers. However, as the fawns aged, contacts occurred increasingly often in habitats that were routinely used by fawns.

Conclusions

Understanding the timing, frequency, and spatial distribution of mother–offspring interactions provides valuable insights into the care strategies of hider ungulates. The observation that mothers leave their fawns in agricultural fields during the first few weeks of life has strong implications for wildlife management, as this behavior constitutes a kind of evolutionary trap under current agricultural practices and mowing regimes. Whether females can adjust their maternal care tactics to these novel selection pressures in human-altered landscapes is likely key to predicting the population dynamics of this obligate hider.
Randomized Controlled Trial of a Virtually Delivered Exercise and Stress Management Program to Improve Physical Performance of Hematopoietic Cell Transplant Survivors
Authors: Ma David D. , Liu Zhixin , Au Kimberley , Tran Mei , Artuz Crisbel M. , Greenwood Matthew , Bilmon Ian , Kliman David
Published: November 2024

PURPOSE

Because of advances in hematopoietic cell transplant (HCT), meeting the long-term health needs of increasing numbers of HCT survivors remains challenging. This multicenter trial aimed to assess the short- and long-term effects of an exercise and mindfulness intervention delivered by telehealth.

METHODS

One hundred thirty-nine participants >6 months post-HCT were randomly assigned 1:1 to a 6-week personalized exercise and mindfulness training with three motivation sessions at 3-6 months via an online meeting platform or usual care. Physical and quality-of-life (QOL) assessments were conducted online for 12 months. The primary end point was the 6-minute walk test (6-MWT) at 3 months.

RESULTS

The median time post-HCT was 21 months (range, 7-67 months). Improvement in mean difference of 6-MWT was found in the intervention group compared with control (intention-to-treat) at 3 months (51.4 m [95% CI, 27.3 to 75.5];
P
< .001; effect size [ES], 0.52) and was maintained at 12 months (59.3 m,
P
= .003; ES, 0.60). Sustained improvements in mean difference for sit-to-stand (STS) at 3 and 12 months were seen. There were no significant changes in hand grip strength or QOL outcomes between groups. A significant difference in serum soluble intercellular adhesion molecule-1 (sICAM-1) concentration was observed between the intervention and control groups in the exploratory study. No intervention adverse events were found.

CONCLUSION

The supervised multimodal telehealth intervention provided clinically meaningful and durable improvement of physical capacity in HCT survivors. This home-based program has the potential to provide an unmet need for HCT survivors. Similar programs may benefit survivors of other cancers, organ transplants, and chronic disorders.
Joachim Bruhn’s Left-Wing Critique of Anti-Zionism and the Capitalist State in the 1990s: An Intellectual History of the Antideutsche
Authors: Stratford Will
Published: November 2024

In one of the greatest alliances of the German extraparliamentary Left since 1968, rival factions from more than one hundred organizations came together in 1990 to express their opposition to German reunification, sparking the Antideutsche (Anti-German) current within the German Left. The theoretically sophisticated but little-studied Antideutsche group, the Initiative Sozialistisches Forum (Socialist Forum Initiative), led by Joachim Bruhn, used the occasion of unification skepticism and increased anti-immigrant violence in the 1990s to develop a unique Kapitalismuskritik, before the Antideutsche movement liquidated its critical edge around the turn of the century. Bruhn drew on German leftist national self-hatred from the nineteenth century to the 1970s New Left, Moishe Postone’s theory of structural anti-Semitism from the 1970s, and the Frankfurt School’s critique of “state capitalism” from the 1930s and 1940s to develop a threefold critique of a “German” predilection for reactionary-conservative anti-capitalism, left-wing anti-Zionism as concealed Stalinism, and de facto nationalist and statist ideology, respectively. While Bruhn brought to the surface several repressed ideological concessions of the German Left, his fixation on historical national guilt and the purely negative aspects of the capitalist state prohibited a genuinely dialectical critique revealing opportunities from within the apparent impasse.