bluuebunny/crossref_metadata_2025 huggingface dataset:
Langmuir and Langmuir-Blodgett films from adsorbed Glucose Oxidase enzymes
Authors: Ivanov George R , Bogdanova Evgenia , Minkov Ivan , Dimov Asen , Staneva Galya , Johans Christoffer
Published: February 2025

Blood glucose (BG) concentration is a critical biomarker for the diagnosis and management of diabetes, necessitating the development of efficient detection methods due to the high global mortality associated with the disease. Glucose oxidase (GOx) is commonly employed in fabricating electrochemical BG sensors, with numerous generations of sensors utilizing this enzyme. This study presents a novel approach to preparing a sensing layer using GOx within a Langmuir-Blodgett (LB) film deposition system. Water-soluble GOx molecules, dissolved in the aqueous subphase, exhibit surface activity and generate surface pressure upon adsorption at the air-water interface. Subsequently, a fluorescently labeled phospholipid, DPPE-NBD, is introduced to form an insoluble monolayer (Langmuir film) at the interface. GOx penetrates this layer due to electrostatic and steric interactions, further increasing surface pressure. This nanoscale composite structure is then transferred onto a solid substrate as a monolayer using the LB method. This approach offers two key advantages over conventional deposition techniques: forming a nano-thin, uniform layer—crucial for rapid sensing—and enhanced enzyme protection against environmental degradation. The study reports the successful fabrication and characterization of these GOx-based monolayers, underscoring their potential for application in BG sensing technologies.
Investigation of the elastic properties of star polymers in semi-infinite space
Authors: Dudek Maciej , Danel Zoriana
Published: February 2025

We performed investigation of the elastic properties of three-armed, four-armed and five-armed star polymers in a semi-infinite space confined by a single wall with different boundary conditions and calculated Pincus force in the above mentioned cases. Calculations were carried out for three, four and five armed star polymers anchored (or grafted) to the substrate by one or two arms. Besides, the case of freely placed star polymers with different number of arms in semi-infinite space also was analyzed. The obtained results indicate that the Pincus force is affected by the number of arms anchored to the surface. For star polymer with center near the surface, the Pincus force is almost twice higher for the case of two attached arms to the substrate than for one attached arm. This difference increases as the distance of the star center from the wall increases. The results for the Pincus force agree with those obtained for the linear polymer chain previously, but have a larger value. Besides, we observe that the polymer topology have influence on the Pincus force value. The obtained results are interesting from scientific and practical point of view, because of their potential use in the production of paints, varnishes and functional materials. Star polymers can be used as viscosity modifiers, e.g. in engine oils, in cosmetics, and to increase the flexibility of the functional materials as well as drug or gene transporters.
On-ground observations of solar over-irradiance effects and their influence on the low-voltage electric power grid
Authors: Tyutyundzhiev N. , Angelov L. , Angelov Ch. , Arsov T. , Serafimov N.
Published: February 2025

The strong solar radiation variability during the Solar cycle 25 has revealed the vulnerability and fragility of Earth’s biosphere to external high-energy fluxes. The solar spectral irradiance constantly changes at all wavelengths and over different periods of time. The negative impact on the Earth and human society at solar maxima can be observed as solar over-irradiance in the UV-A, UV-B, VIS, IR over-heating, magnetic storms, atmospheric lightning, etc. In such extraordinary weather conditions, the big photovoltaic (PV) power plants are delivering a new kind of instability to the power grid. In this work, selective wavelength measurements of the solar irradiance are performed in order to distinguish and predict power disturbances. Correlations between solar events and low voltage (LV) power grid fluctuations are investigated.
Analysis of safety and reliability risk and study on key test study for power routers
Authors: Chen Susheng , Wang Tingting , Liu Xin
Published: February 2025

The power router is the core equipment of the future energy Internet, but there is no test standard for its electrical safety and reliability. In this paper, the possible existence of quality risk sources of power routers is classified and analyzed in detail, and safety testing items and indicators are listed, especially those focusing on electrical safety and reliability. A testing system for power routers was provided with the testing conditions based on application scenarios. Meanwhile, the test is done, and the results show that it is necessary to develop testing methods and conditions for the Power router.
Multi-timescale power self-balancing optimization and regulation of remote rural microgrids based on stochastic monte carlo method
Authors: Liu Minghong , Liao Mengke , Wang Pengchao , Li Changling , Zhao Xuehua
Published: February 2025

Conventional microgrid power self-balancing optimization and regulation methods are mainly based on real-time regulation mechanisms, but there is the problem of local optimum, which affects the regulation effect. Therefore, a stochastic Monte Carlo method is designed to optimize the power self-balancing regulation of remote rural microgrids in multiple time scales. The multi-time scale power imbalance characteristics of remote rural microgrids are extracted, and the load differentiation characteristics of remote rural areas are judged according to the regional economic development and resource endowment. Based on stochastic Monte Carlo, a microgrid multi-timescale power self-balancing optimization and regulation model is constructed to quantify the self-balancing capability of the microgrid, taking into account the temporal difference between wind power and remote rural load demand. Taking into account the inter-seasonal characteristics of remote rural loads and the dynamic balancing demand of sources and loads, the multi-timescale adjustable power of remote rural microgrids is optimally allocated to further balance the complexity of the regulation model and the solution time. Comparative experiments are conducted to verify that the self-balancing optimization effect is better and can be applied in real life.
How Workday Scaled and Sustained a Culture of Connection
Authors: Willburn Phil , Hampton Curtis
Published: February 2025

Software and social cohesion may not seem related at first. But when best friends Dave Duffield and Aneel Bhusri cofounded Workday in 2005, they understood from the start that a strong sense of connection and a “we, not me” culture would be crucial differentiators in a crowded competitive landscape. The cloud-based software company, which specializes in enterprise applications for financial management and human capital management, has since grown to 19,000 employees in 34 countries—while winning accolades for its culture and high levels of employee engagement. This case study explores how network practices enabled Workday to safeguard and deepen its culture of connections during a period of intense hypergrowth and how this global organization leverages network analysis to nimbly navigate the future of work.
Emergency Response Coordination in Space
Authors: Landon Lauren Blackwell
Published: February 2025

Space flight is a dangerous, complex endeavor. A network of high-performing technical experts plans and trains for any conceivable emergency, but unforeseen events inevitably occur. During EVA 23 (i.e., an extravehicular activity, or spacewalk) outside the International Space Station, an astronaut nearly drowned in his spacesuit. The astronaut crew in space worked with the network of experts on the ground in Mission Control to save his life. In addition, NASA engaged in a comprehensive investigation to gather and apply lessons learned from this network so that it does not happen again. The acute emergency response and longer term approach to growing from lessons learned are discussed through this example to highlight how networks may be called on in times of crisis to save the day and make permanent, positive changes.
Designing the Science of Networks into Leadership Development at Workday
Authors: Campbell Michael
Published: February 2025

Preparing to double the size of the company’s workforce from 10,000 to 20,000, Workday designed network science into its leadership development to help scale without sacrificing its connected and cohesive culture. This case focuses on the leadership development program designed to enable the transition or career turn from director to vice president. Failing to nurture a positive and productive cross-functional network through this transition is likely to derail a career. Appreciating the impact of growing social capital alongside human capital, Workday researched and applied network-enhancing strategies, including personal network diagnostics, successful leader’s mental representations, collaborative learning in business simulations, and teaching practices to improve network effectiveness. Analysis of network-based measures provided an invaluable perspective on the impact of remote work on a leader’s network and key outcomes, including promotion, mobility, retention, and inclusion.
Engaging Employee Networks to Promote Workforce Diversity and Inclusion
Authors: Du Juan , Woehler Meredith , Cullen-Lester Kristin L
Published: February 2025

Organizations striving to enhance workforce diversity and foster inclusive work environments often struggle to achieve these goals. This chapter explores the often-overlooked role of employees’ networks in such endeavors. It investigates how networks influence an organization’s ability to attract a diverse pool of applicants, ensure fair selection and advancement processes, provide equitable development opportunities, and foster an inclusive culture that empowers a diverse workforce to feel valued and collaborate effectively. While informal networks have traditionally hindered workforce diversification efforts by perpetuating homogeneity, this chapter describes how employees’ networks can become part of the solution. By addressing biases and fostering inclusive networks, organizations can cultivate workplaces where all employees feel respected, valued, and empowered to reach their full potential. In addition, the chapter identifies opportunities to further the understanding of how to harness the potential of networks in advancing diversity and inclusion within organizations.
Cultivating Race
Authors: Tischler Julia
Published: February 2025

Cultivating Race examines the intersections and relationships between scientific knowledge in farming and race politics in early twentieth-century South Africa. Considering agricultural progressivism as both a Pan-Africanist and white supremacist movement from a transatlantic perspective, it discusses the ways in which the ‘agrarian question’ fed into the emergence of the global ‘colour line’. The book investigates rural transformations in a period of rapid industrial growth and agrarian commercialization through the lens of agricultural education—including agricultural colleges, extension services, children’s clubs, and domestic training. South Africa in the segregation period, as an extreme case of both rapid agrarian change and state racism, holds important insights into global questions of rural reform and race politics. The book addresses scholars and students of the history of knowledge and science, agrarian studies, environmental history, and South African history who seek to understand the intricate links between race, knowledge, and rural reform in the twentieth century.
White Farmers’ Provincial Science
Authors: Tischler Julia
Published: February 2025

Chapter 7 examines the example of Glen College of Agriculture, the main educational institution to serve white farmers in the Orange Free State (OFS), in order to explore the role of scientific knowledge in the increased pace of agricultural commercialization and modernization from the 1920s to the 1940s. Founded in 1919 near Bloemfontein, Glen College’s research and training activities show that the rise of science in farming was not a linear success story but involved multiple dead-ends and mistakes, as well as constant challenges to its legitimacy. Glen’s research and extension work represented a model of regional knowledge generation and dissemination that was reliant on the collaboration of farmers, whose experience officials regarded as a crucial source of knowledge. The knowledge that Glen co-produced and communicated extended beyond technical matters to project a masculinist image of the educated farmer, nations of paternalist rural leadership, as well as racialized work regimes. Moreover, the college was pivotal in creating a community of progressive agriculture that included improving OFS farmers and—albeit with less success—lower-class whites at the same time as actively excluding Black and coloured farmers from the benefits of agricultural science.
Eugenic Agriculture and Transnational Networks of Rural Education
Authors: Tischler Julia
Published: February 2025

Chapter 9 discusses how, in the 1920s and 1930s, social scientists became key players in defining rural problems and proposing solutions. These education experts formed a dense transnational network of state-sponsored educators, sociologists, and welfare practitioners who were responding to the global crisis in agriculture after the First World War with high modernist social engineering. Experts travelling between the United States and South Africa produced generalizing reform blueprints, including eugenicist and segregationist measures for tackling rural destitution. Besides promoting agricultural education as a means of segregating Blacks from whites, social scientists also proposed a solution to the supposed threat posed by the rapid increase in ‘unfit’ whites. Reformers’ chauvinism towards lower-class whites culminated in the Carnegie Poor White Commission (1932) and its aggressive promotion of adapted education. This chapter explores vocational training, school farms, children’s clubs, and the ‘project system’, all of which the South African authorities partly adapted from Europe and the United States, as examples of a transnational Tuskegeeism for poor whites that was more often than not rejected by the targeted families.
Separate yet Similar Worlds
Authors: Tischler Julia
Published: February 2025

Improved farming lent itself to the politics of Black emancipation as much as to the aims of white supremacy, and it promoted patriarchal gender roles at the same time as fuelling the ambitions of Black and white rural women. By the 1940s, however, the ideal of progressive yeoman farming in South Africa had become muted, although it was never silenced completely. The concluding chapter describes the rapid decline of visions of independent yeoman farming, as the state committed to policies that would entrench the bifurcation of the agrarian sector between reproductive small-scale farming for Black people and a concentrated, rationalized commercial sector for whites.
Gradualism and Rupturism in the Contemporary Mapuche Movement in Chile
Authors: Seixlack Alessandra , Freire da Silva Danielle
Published: February 2025

Since the colonial period, Mapuche resistance in Chile has taken on different shades, oscillating between periods of warlike conflict and little dialogue with the winka (non-Indigenous) authorities and periods of intense political negotiations. Although the Mapuche political world is shaped by individual, collective, and circumstantial interests, it is possible to identify, according to Mapuche historian Fernando Pairican Padilla, two main paths adopted by the Mapuche struggle in contemporary Chile: gradualism and rupturism. While the former path seeks dialogue with the institutional route to achieve the demands of the Mapuche people, recovering the diplomatic tradition of parliaments celebrated since the 16th century, the latter distances itself from the state and political parties, finding in traditional leaders and community ties the basis for political action. Although they adopt different political dynamics, both the gradualist and rupturist paths of the Mapuche movement aim to achieve autonomy, self-determination, and the reconstruction of Wallmapu (Mapuche country).

Throughout Chile’s contemporary history, it is possible to see moments of greater influence of gradualist or rupturist proposals in Mapuche political mobilizations. At the beginning of the 20th century, the first Mapuche organizations, such as Sociedad Caupolicán, Federación Araucana, and Corporación Araucana, demanded political recognition from the Chilean state and fought to recover their lands using the tools made available by the institutional system. From the 1970s onward, the failure of institutional mechanisms to resolve demands for territorial restitution resulted in Mapuche communities developing direct action tactics, such as corridas de cerco (a form of struggle characterized by the displacement of the fence separating Indigenous land from private property), strengthening the path of the rupturist struggle that would be followed by associations such as Ad Mapu, Consejo de Todas Las Tierras, and Coordinadora Arauco Malleco. The context of the first Constitutional Convention, between 2021 and 2022, can be interpreted as the culmination of the confrontation between the political action strategies adopted by the gradualist and rupturist paths of the Mapuche movement. While the leaders of the rupturist organizations rejected the work carried out by the Convention, interpreting it as a legitimizing instance of the colonialist state, the members of the gradualist movement considered the seats reserved for Indigenous parliamentarians to be an unprecedented possibility of inserting Mapuche onto-epistemological principles into the constitutional text.
Well-Being
Authors: Cintron Dakota W. , Ong Anthony D.
Published: February 2025

Research on human well-being is divided into two distinct paradigms: hedonic and eudaimonic. The hedonic approach focuses on happiness, defined as the presence of positive emotions and the absence of negative emotions. In contrast, the eudaimonic approach emphasizes the importance of living a meaningful and purposeful life.
The 19th Century Slave Trade in Eastern Africa
Authors: Rockel Stephen J.
Published: February 2025

Eastern Africa was a source of enslaved African laborers for Indian Ocean markets for nearly two thousand years. However, it was only from the late 18th century that rising demand became closely linked to the industrializing economies of the Western world and their demand for tropical products. The slave trade in the 19th century consisted of two overlapping sectors. The first was a trade in enslaved Africans to markets along the Indian Ocean coast from northern Mozambique to southern Somalia, as well as export to destinations around the Indian Ocean. The plantations of the French Mascarene Islands were an early destination. From the first quarter of the 19th century, the main market for enslaved labor shifted to the clove plantations of the Omani Sultanate in Zanzibar and Pemba, as well as to coastal grain production. The second sector was an internal trade that provided labor for commercializing African societies and the infrastructure required for long-distance trade. For reasons related to the region’s geographical characteristics and disease environment, caravan transport by human porters was the only viable transport option to move ivory exports and cloth imports. Although in most regions east of Lake Tanganyika, caravan porterage was the work of Nyamwezi and Swahili waged laborers, enslaved labor increasingly characterized commercial agriculture, domestic work, and concubinage along the coast and in trade centers in the interior. Porterage west of Lake Tanganyika was largely the work of enslaved laborers. Slaving and the accumulation of enslaved individuals by commercially minded chiefs, warlords, farmers, and big traders followed the three main caravan routes as far as the Lake Victoria and Lake Tanganyika regions, the eastern Congo, and south-central Africa. As elsewhere in Africa, the trade rested on violence as labor demands increased. The long-distance trade system rapidly expanded due to the constant search for new sources of ivory and rising African consumption of imported products. Both sectors—the export of enslaved individuals and their accumulation at interior trading centers—were thus stimulated by the rapid integration of the region into the expanding capitalist global economy.
Rabih
Authors: Sehou Ahmadou
Published: February 2025

More widely known as Rabih, Rabih al Zabayr ibn Fadl Allah is a multidimensional and controversial figure in African history. Born along the Nile River in Sudan, Rabih quickly became involved in the military, and a warlord who ravaged a vast area from Sudan to Bornu capturing thousands of slaves through raids and destroying kingdoms until his death on April 22, 1900, in Kousséri, in the far north of modern-day Cameroon. In his wake, he left a trail of depravities suffered by African societies in the 19th century in a region comprising Anglo-Egyptian Sudan, the Ubangi, and the area around Lake Chad. His career involves the violence of the slave trade, the role of war in the process of state creation, and the way in which resistance to imperialist invasion was criminalized. He had a role as a slave raider and trader in central Africa during the period that saw the end of the Atlantic system, the progression of Western abolition, and the triumph of colonialism in the heart of the continent. As an African slave trader, it is instructive to move beyond his better-known reputation as a resistance fighter and an anti-imperialist nationalist.
Institutional Complexity in World Politics
Authors: Elsässer Joshua , Hickmann Thomas , Kang Yi Hyun
Published: February 2025

While the post-1945 period witnessed the rise of multilateralism and the creation of numerous international institutions to deal with cross-border issues, the 21st century is marked by their contestation and transformation. The United Nations, including its specialized agencies and several other bodies, has come under heavy criticism for the inability to effectively cope with global challenges. In this context, a wide array and diversity of new international institutions have been established by both state and non-state actors—some as complementary and others as alternatives to the United Nations system. These have different positions of power, interests, and motivations for addressing transboundary problems and operate in various domains of global affairs. Examples include clubs of like-minded governments tackling transboundary issues outside the United Nations, private certification initiatives aiming to set standards for responsible corporate behavior and practices, or multi-stakeholder partnerships spanning parties from different societal sectors that jointly work on specific policy problems. Such developments have led to an ever-growing degree of institutional complexity at the global level, which is the subject of intense debates among scholars of international relations. In general terms, complexity here alludes to the systemic, nonlinear, and dynamic relationships between institutions, which are interconnected via multiple flows within a network and exhibit some degree of legal and/or functional overlap. The increase in institutional complexity makes it difficult for all actors to navigate and develop adequate responses to transboundary problems—hence bearing crucial implications for the governance of interdependent policy areas. Yet it remains an open question whether the abundance of international institutions operating in world politics may lead to dead-ends in global policymaking in the short term or will open new opportunities for global cooperation and multilateral collaboration in the medium to long term.
Archaeology of the African Diaspora
Authors: Fennell Christopher C.
Published: February 2025

Archaeological investigations have uncovered the legacies of a remarkable diversity of African diaspora populations in the Americas. Overcoming the horrors of the trans-Atlantic slave trade, captive Africans further developed myriad forms of cultural knowledge and practices drawn from their homeland cultures and conveyed those aspects of heritage to their descendants and social affiliates. Special knowledge of agricultural industries led to transformed landscapes. Resilience and fights for freedom were represented in self-emancipation, rebellion communities, reverence of burial grounds, and commemorations of lost settlements and ancestors across terrains and seascapes. Adaptive strategies and creativity were expressed in material culture production of pottery, household spaces, foodways, and healthcare. Elements of cosmologies from multiple African cultures were integrated to form new religions and forms of cultural heritage.
Adjustment to atopic dermatitis: A cross-sectional study investigating the role of maladaptive self-schemas in a community sample of people with atopic dermatitis
Authors: Kalaki Elli , Mizara Alexandra
Published: February 2025

Background

Studies have demonstrated variability in adjustment to atopic dermatitis (AD).

Objectives

The present study investigated whether adjustment to AD is mediated by psychological (maladaptive schemas/personality) or condition-only factors (age at onset) in a community sample.

Methods

A cross-sectional design was employed with two groups: a) early onset of AD (n = 74) and b) late onset (n = 76). All groups completed the Young Schema Questionnaire (Short Form 3) and the Adjustment to Chronic Skin Disease Questionnaire.

Results

There were no significant differences in adjustment levels between the two groups. Both groups presented with poor adjustment levels specifically on the itch-scratch, helplessness and anxious-depressive mood factors. Poor adjustment levels were predicted by maladaptive schemas and not by age of onset of AD.

Conclusions

Findings highlight and support that adjustment and coping with AD is strongly linked and predicted by core psychological factors such as maladaptive schemas. Understanding schema-level cognitions and offering interventions that can address them might prevent further life impairment and improve overall adjustment to AD.
The ulcerative colitis risk gene adenylyl cyclase 7 restrains the T helper 2 phenotype and Class II antigen presentation
Authors: Cardinale Christopher J , Liu Yichuan , Kevadia Aayush , Strong Alanna , Watts Val J , Hakonarson Hakon
Published: February 2025

Background and Aims

Genome-wide association studies have shown that the most risk-conferring genetic polymorphism for ulcerative colitis outside the human leukocyte antigen locus is the amino acid substitution p.Asp439Glu in the adenylyl cyclase 7 gene (ADCY7). ADCY7 is the main isoform in the hematopoietic system and produces the second messenger cyclic AMP (cAMP) downstream of G protein-coupled receptor signaling. Our aim was to determine the contribution of this polymorphism to UC risk by analyzing its effect on ADCY7 function in cell-based assays.

Methods

We characterized the p.Asp439Glu variant in cell lines using western blots, immunofluorescence, cAMP assay, and luciferase assay. We modeled this variant using siRNA knock-down in human primary CD4+ T cells and characterized them by RNA-seq, viability assay, flow cytometry, cAMP assay, and ELISA.

Results

The p.Asp439Glu variant is deficient in protein expression but retains membrane localization. This results in a 40% reduction in cAMP synthesis and luciferase reporter expression. Knock-down of ADCY7 in T cells reduces the expression of ribosomal proteins and cAMP signaling proteins, while skewing cytokine production towards a T helper 2 pattern and upregulating antigen presentation accompanied by increased surface expression of MHC Class II and CD86.

Conclusions

The ulcerative colitis risk-conferring variant, p.Asp439Glu, in ADCY7 reduces cyclic AMP signaling, leading to modifications in cytokine profile and antigen presentation. Medications that enhance cyclic AMP by direct activation of ADCY7 or by phosphodiesterase inhibition may be beneficial in this disease.
De novo whole genome assembly of the critically endangered southern muriqui (Brachyteles arachnoides)
Authors: Faulk Christopher , Walls Carrie , Nelson Brandie , Arakaki Paloma R , Gonzalez Irys H L , Banevicius Nancy , Teixeira Rodrigo H F , Medeiros Marina A , Silva Gessiane P , Talebi Mauricio , Chung Wilson C J , Takeshita Rafaela S C
Published: February 2025

The southern muriqui (Brachyteles arachnoides) is one of the two species of muriquis (genus Brachyteles), the largest body sized nonhuman primate from the Neotropics. Deforestation and illegal hunting have led to a continuing decline in the muriqui population, leading to their current classification as critically endangered. The lack of a reference genome for the genus Brachyteles prevents scientists from taking full advantage of genomic tools to improve their conservation status. This study reports the first whole-genome assemblies of the genus Brachyteles, using DNA from two zoo-housed southern muriqui females. We performed sequencing with Oxford Nanopore Technologies’ PromethION 2 Solo using a native DNA library preparation to preserve DNA modifications. We used Flye to assemble genomes for each individual. The best final assembly was 2.6 Gb, in 319 contigs, with an N50 of 58.8 Mb and L50 of 17. BUSCO completeness score for this assembly was 99.5%. The assembly of the second individual had similar quality, with length of 2.6 Gb, 759 contigs, N50 of 47.9 Mb, L50 of 18, and BUSCO completeness score of 99.04%. Both assemblies had <1% duplicates, missing, or fragments. Gene model mapper detected 24,353 protein coding genes, and repetitive elements accounted for 46% of the genome. We also reported the mitogenome, which had 16,562 bp over 37 genes, and global methylation of CpG sites, which revealed a mean of 80% methylation. Our study provides a high-quality reference genome assembly for the southern muriqui, expanding the tools that can be used to aid in their conservation efforts.
Burn Progression in Human Skin – A Review of Current Knowledge and Opportunities for Future Research
Authors: Junak Mary , Gibson Angela
Published: February 2025

Treatment of a burn wound often depends on the vertical depth of injury, which is commonly determined by visual assessment. Burn progression is the concept that in the early post-burn period, a partial thickness burn may progress to a deeper burn requiring surgery. Therefore, the initial appearance of the wound may not be indicative of the eventual extent of injury. Several preclinical studies attribute burn wound progression to events such as vasoconstriction, inflammation, programmed cell death, free radical damage, and microvascular occlusion. Due to the concern for translatability of animal models for burn wounds, human studies are essential to understand burn progression in patients. Unfortunately, only a few small human studies exploring mechanisms including apoptosis, ischemia, and infection exist. Inherent to determining burn progression is burn depth determination and healing potential, an area of research that has many ongoing investigations without a clear standard method to replace visual evaluation. Treatments to prevent burn progression in humans, including use of negative pressure wound therapy and application of cooling dressings, have been studied with small sample sizes. Here, we aim to summarize the current data on human burn progression. Additionally, we discuss novel methods that could be used in future research to define early burn wound progression. Future work in human tissue should focus on the assessment and timeline of progression, explore the reversibility and prevention of injury progression and use animal models in parallel as complementary tools for hypothesis-driven research based on findings in humans.
What We Can Learn from Extreme Moral Exemplars: The Significance of Moral Saints and Heroes for Character Education
Authors: Chen Yi-Lin
Published: February 2025

Moral ‘saints and heroes’ are generally considered to be admirable, moral exemplars worthy of emulation. J. O. Urmson characterizes them as morally laudable agents who perform supererogatory actions. This characterization, combined with relevant empirical evidence, presents a paradox in which supererogatory acts appear to become, not optional, but obligatory for moral saints and heroes. This is termed the ‘agent–observer disparity’. Drawing on Bernard Williams’ ideas, the concepts of practical necessity and moral incapacity, which are expressive of and grounded in one’s character, are utilized to account for moral saints and heroes’ subjective morality and illuminate their exceptional strength of character. In response to misgivings regarding the imitability of moral saints and heroes and the attainability of their excellences of character, this study suggests that the considerable gap between the characteristics of extreme exemplars and ordinary individuals can provide ordinary individuals with the freedom to consider the moral perspectives of these exemplars that evoke wonder without the exemplars’ actions becoming a threat to ordinary people’s self-concept. The earnest aspiration to reach the moral ideals of moral saints and heroes can move ordinary individuals and trigger an aretaic impulse to act more virtuously without causing stress. It is concluded that moral saints and heroes as extreme exemplars complement the influence of ordinary ‘close-by’ moral mentors and both are key in exemplar-based character education.
A rare case of sporadic metastatic colorectal cancer with glioblastoma multiforme: a challenging clinical scenario
Authors: Awad Farah , Abdallah Firas , Alhalabieh Ahmad , Aljaafreh Imad , Naserallah Salam , Lahham Elias Edward
Published: February 2025

Colorectal cancer (CRC) is the third most commonly diagnosed and leading cause of death worldwide. On the other hand, glioblastoma multiforme (GBM) is the most prevalent and aggressive primary malignant brain tumor in adults. Inherited diseases of DNA mismatch repair (MMR) can cause multiple cancers in the same patient including CRC and GBM. In this study, we report a 59-year-old woman presented with fatigue, constipation, abdominal distention, perianal pain, right-sided arm weakness, and personality changes. After investigations, it was diagnosed that sporadic metastatic CRC and GBM occurred simultaneously in the same patient, which was confirmed by colonoscopy, biopsy, imaging, and molecular testing. As the treatment of two cancers in the same patient is unique and complex, the absence of guidelines for such cases was discussed in a multidisciplinary tumor board including surgeons, medical, and radiation oncologists.
Schistosomiasis: an unexpected finding in appendicitis
Authors: Dholakia Jhanvi , Smith Maiko
Published: February 2025

Schistosomiasis is an uncommon cause of appendicitis in the developed world. It needs to be correctly identified, as it has further treatment implications for the patient. We present the case of a 34-year-old Zimbabwean migrant with appendicitis and associated adjacent peritoneal nodules. Histological testing showed these to be parasitic larvae, Schistosoma. He was followed up by the infectious diseases team and treated with Praziquantel as eradicative therapy. Appendicitis may be the only sign of a Schistosoma infection, which would enable early eradicative treatment, thus preventing the development of more serious hepato-intestinal complications.
Hendrick ter Brugghen
Authors: Seaman Natasha
Published: February 2025

Hendrick ter Brugghen (b. 1588–d. 1629) is best known as one of the Dutch artists who, along with his younger contemporaries Gerrit van Honthorst (b. 1592–d. 1656) and Dirck van Baburen (b. c. 1595–d. 1624) transmitted the style of Michelangelo Merisi da Caravaggio (b. 1571–d. 1610) to Dutch artists, with significant impact on the art of Jan Lievens (b. 1607–d. 1674), Rembrandt van Rijn (b. 1606–d. 1669), and, more distantly, Johannes Vermeer (b. 1632–d. 1675). Although he was likely born in the Hague, where his father was a civil servant, he moved with his family to Utrecht in the early years of the seventeenth century. In Utrecht, Ter Brugghen probably studied with Mannerist painter Abraham Bloemaert (b. 1564–d. 1651), and then he spent several years in Italy, possibly starting as early as 1607. While Italianate habits and motifs are clear in his art, any paintings made in Italy are lost. Additionally, while Ter Brugghen joined the newly formed artist guild in Utrecht upon his return in 1614, little of his work before 1619 survives. In the ensuing ten years before his premature death at age 42 in 1629, however, he produced a significant oeuvre consisting of religious paintings and half-length genre works. Unfortunately, no first owner information is known for any of Ter Brugghen’s paintings, complicating the understanding of his most significant works, such as the early monumental Christ Crowned with Thorns (1620, Copenhagen), the Crucifixion (c. 1625, New York), St. Sebastian Tended by Irene (c. 1625, Oberlin OH), The Concert (c. 1626, London), and depictions of Jacob, Laban, and Leah (1627 and 1628, Cologne and London). Early scholarship assumed Ter Brugghen was Catholic because his grandfather was a Catholic priest, his depiction of religious subjects, and the continued predominance of Catholicism in Utrecht. However, archival research showed that he married a Protestant, and all his children were baptized Protestant, suggesting an affinity for that faith. Ter Brugghen was little remarked in art criticism of his time; the most prominent mention, by Joachim von Sandrart (b. 1606–d. 1688), faulted him for his intense naturalism. Although several of his paintings sold for respectable prices at auction later in the seventeenth century, until the twentieth century Ter Brugghen’s reputation was overshadowed by the more conventional and successful Gerrit van Honthorst, to whom his works were sometimes ascribed in auction catalogues and inventories.
Outpatient Alcohol Withdrawal Management in a Substance Use Disorder Bridge Clinic: An Opportunity for Low-barrier Engagement and Shared Decision-making
Authors: Peterkin Alyssa F. , Laks Jordana , Farrell Natalija , Weisenthal Karrin , Taylor Jessica L.
Published: February 2025

Objective:

To describe the implementation of outpatient alcohol withdrawal management in a low-barrier substance use disorder (SUD) bridge clinic and short-term clinical outcomes.

Methods:

A bridge clinic in Boston, MA implemented outpatient benzodiazepine tapers for alcohol withdrawal in patients at low risk of alcohol withdrawal seizures or delirium tremens. We conducted a retrospective chart review of patients who received one or more benzodiazepine doses between April 2021 and January 2023. We described patient characteristics and evaluated rates of taper completion, clinical complications, and medication for alcohol use disorder (AUD) initiation.

Results:

Forty-six patients with alcohol withdrawal were treated during the study period. Their mean age was 43 years and the majority identified as male (76%); ∼30% were Black/African American and 30% Hispanic/Latinx, and 24% spoke a primary language other than English. Most had severe AUD (76%), and 30% had a history of complicated withdrawal, counter to typical clinical eligibility criteria. Over a third of patients (19/46, 41.6%) completed their planned withdrawal treatment course, 18 (39.1%) patients did not follow up in the bridge clinic within the first 3 days, and 1 (2%) experienced a documented seizure during treatment. Twenty-four patients (52%) initiated medication for AUD.

Conclusion:

Outpatient alcohol withdrawal management in a bridge clinic provides an opportunity to engage patients from marginalized groups, including those at higher risk for complicated alcohol withdrawal who decline inpatient care. More work is needed to improve patient follow-up and assess treatment outcomes.
External review of procedure codes for intensive care, mechanical ventilation and extracorporeal membrane oxygenation for critically ill COVID-19 patients in the Swedish inpatient register
Authors: Rosendal Ebba , Kalucza Sebastian , Nyström Helena , Schien Matthias , Berggren Ritva Kiiski , Jerndal Hanna , Fonseca-Rodriguez Osvaldo , Fors Connolly Anne-Marie
Published: February 2025

BACKGROUND

The quality of registry data is important for epidemiological research. The Swedish inpatient registry (IPR) is a national database with mandatory registration of all hospitalisations since 1987, and since 2007, the medical procedure codes which can be used for grading severity of infectious diseases. However, the completeness of procedure code registration has rarely been studied.

OBJECTIVES

To determine the quality and completeness of procedure codes for ICU admission, mechanical ventilation and extra-corporeal membrane oxygenation (ECMO) in the Swedish IPR utilising the Swedish Intensive Care Registry (SIR) as the gold standard.

DESIGN

A Swedish nationwide observational study.

SETTING

Covid-19 patients in Sweden who required intensive care in Sweden between March 2020 and August 2022.

PATIENTS

Covid-19 patients with a laboratory-verified SARS-CoV-2 infection who required ICU admission (n = 8992), mechanical ventilation (n = 5262) or ECMO (n = 29).

MAIN OUTCOME MEASURES

The sensitivity and/or positive predictive values of procedure code registration for ICU, mechanical ventilation, ECMO and Covid-19 diagnosis code registration in the IPR were evaluated using SIR as the reference. Factors associated with low reporting were explored and the dates of ICU admission registration compared between IPR and SIR.

RESULTS

For Covid-19 patients registered in SIR as needing intensive care, mechanical ventilation or ECMO, the completeness of procedure codes in the IPR was 39.7, 78.2 and 100%, respectively. Of the 39.7% with an ICU code in the IPR, the ICU date in the IPR corresponding to the actual ICU admission date was 52.3%. The completeness of ICU registration in the IPR varied from 0.6 to 96.9% between healthcare regions

CONCLUSIONS

Procedure codes for intensive care in the Swedish IPR showed low sensitivity and varied greatly between healthcare regions. This negatively influences their usability for epidemiological research and calls for updated guidelines on coding.
The immunomodulatory effect of sugammadex in vitro and after total hip arthroplasty
Authors: Bijkerk Veerle , Jacobs Lotte M.C. , Visser Jetze , van Helden Esmee V. , Keijzer Christiaan , Helder Leonie S. , Albers Kim I. , Warlé Michiel C.
Published: February 2025

BACKGROUND

Postoperative immunosuppression is a well known phenomenon associated with infectious complications. Peri-operative immune dysregulation is likely induced by surgical damage and anaesthetics, but remains far from comprehensively characterised. To address this, the effects of individual drugs on immune function must be explored. Sugammadex, a cyclodextrin that encapsulates rocuronium, also binds other drugs and structures and may influence the inflammatory response.

OBJECTIVE

Investigate the potential immunomodulatory effect of sugammadex

DESIGN

An in-vitro experiment, randomised controlled pilot study and retrospective cohort study

SETTING

Tertiary teaching hospital

PATIENTS

Twelve healthy donors, 20 adults undergoing total hip arthroplasty and 1000 major abdominal surgery patients

INTERVENTION

In vitro: isolated peripheral blood mononuclear cells were exposed to sugammadex and rocuronium before stimulation with Escherichia coli lipopolysaccharides (LPS).

Pilot study: patients undergoing total hip arthroplasty under single shot spinal anaesthesia randomised to sugammadex (8 mg kg-1) or placebo at the end of surgery.

MAIN OUTCOME MEASURE

In vitro: TNF, IL-1β and IL-6 production capacity.

Pilot study: Ex-vivo cytokine production capacity after whole blood stimulation with LPS.

Retrospective cohort: sugammadex as a predictor of postoperative infectious complications

RESULTS

In vitro: rocuronium suppressed TNF and IL-1β production capacity. Higher doses of sugammadex (100 and 1000 μg ml-1; 100 μg ml-1 corresponds to plasma concentration reached upon 8 mg kg-1 sugammadex) restored suppression of TNF and IL-1β.

Pilot study: no differences in ex-vivo cytokine production capacity between the sugammadex and placebo group at the end of surgery or on postoperative day 1.

Retrospective cohort study: no association between sugammadex and postoperative infectious complications (OR = 1.000, 95% CI 0.998 to 1.002).

CONCLUSION

Sugammadex preserved cytokine production capacity of TNF and IL-1β in vitro. The clinical pilot study and retrospective cohort study revealed no early postoperative immunomodulatory effects for sugammadex in the clinically used dosing range.

TRIAL REGISTRATION

clinicaltrials.gov identifier: NCT05723406 and NCT05244655.
Effectiveness of Intraoperative Ketorolac in Outpatient Breast Surgery: A Double-blinded Prospective Randomized Controlled Trial
Authors: Choi Joowon M. , Rodriguez Jose D. , Saccocci Michael A. , Shafer Robert P. , Feldmann Mark E. , Moyer Kurtis E. , Thompson James T.
Published: February 2025

Background:

The use of nonnarcotic analgesics, such as ketorolac, has been shown to reduce postoperative pain and opioid consumption. This double-blinded randomized trial is designed to assess the efficacy of intraoperative ketorolac in reducing postoperative narcotic use in outpatient breast reconstruction and reduction procedures.

Methods:

This study is a prospective double-blinded randomized controlled trial. Adult patients, 18–64 years of age, undergoing breast surgery were randomized to receive 15 mg of ketorolac, 30 mg of ketorolac, or a placebo dose of saline. Patients’ opioid requirements in the postoperative anesthesia care unit and postoperative opioid utilization and pain scores were collected through a daily survey. Postoperative hematomas were assessed before discharge and at subsequent follow-up visits for a period of 14 days.

Results:

Of the 63 patients included in the study, 31 patients underwent delayed reconstruction following mastectomy and 35 patients underwent breast reduction surgery. Patients who received 30 mg of ketorolac had the fastest pain resolution (P < 0.05). The rate of opioid discontinuance was the fastest overall in patients who received 15 mg of ketorolac (rate = −0.072) when compared with the 30-mg ketorolac group (rate = −0.071) and the placebo group (rate = −0.065). Total opioid usage in the postoperative anesthesia care unit was not statistically different across the 3 groups. Only 1 patient developed a hematoma in the 15-mg ketorolac group.

Conclusions:

This study demonstrates that a single dose of intraoperative ketorolac was associated with reduced opioid usage and postoperative pain. However, due to the study size, the difference in hematoma rate was not statistically significant.