bluuebunny/crossref_metadata_2025 huggingface dataset:
Link stability analysis of temporal international fertilizer trade networks
Authors: Li Mu-Yao , Wang Li , Xie Wen-Jie , Zhou Wei-Xing
Published: February 2023

Fertilizer availability is crucial for global food security, and international fertilizer trade plays a vital role in reallocating fertilizers across multiple economies. However, the stability of international fertilizer trade relationships between economies has not been studied. Using 29 year records of the global fertilizer trade from 1990 to 2018, we construct three temporal networks linked to three primary nutrients (nitrogen N, phosphorus P2O5, and potash K2O). After introducing the link stability indicator to the international fertilizer trade system, which shows a very strong positive correlation with whether the trade will continue in the future, we analyze the factors influencing the stability of the fertilizer trade and provide advice for trading participants to establish highly stable transactions. The supply side has a greater impact on the stability of the fertilizer trade than the demand side. For exporting economies, stable exports need to focus on the counterparty’s real demand rather than its economic situation. For importing economies, intermediaries and producers with good economic conditions are stable trading partners, and trade that is geographically closer is always more stable. The methodology used for link stability analysis in this work can be applied to analyzing other directed temporal networks.
Diel, seasonal, and inter-annual variation in carbon dioxide effluxes from lakes and reservoirs
Authors: Golub Malgorzata , Koupaei-Abyazani Nikaan , Vesala Timo , Mammarella Ivan , Ojala Anne , Bohrer Gil , Weyhenmeyer Gesa A , Blanken Peter D , Eugster Werner , Koebsch Franziska , Chen Jiquan , Czajkowski Kevin , Deshmukh Chandrashekhar , Guérin Frederic , Heiskanen Jouni , Humphreys Elyn , Jonsson Anders , Karlsson Jan , Kling George , Lee Xuhui , Liu Heping , Lohila Annalea , Lundin Erik , Morin Tim , Podgrajsek Eva , Provenzale Maria , Rutgersson Anna , Sachs Torsten , Sahlée Erik , Serça Dominique , Shao Changliang , Spence Christopher , Strachan Ian B , Xiao Wei , Desai Ankur R
Published: February 2023

Accounting for temporal changes in carbon dioxide (CO2) effluxes from freshwaters remains a challenge for global and regional carbon budgets. Here, we synthesize 171 site-months of flux measurements of CO2 based on the eddy covariance method from 13 lakes and reservoirs in the Northern Hemisphere, and quantify dynamics at multiple temporal scales. We found pronounced sub-annual variability in CO2 flux at all sites. By accounting for diel variation, only 11% of site-months were net daily sinks of CO2. Annual CO2 emissions had an average of 25% (range 3%–58%) interannual variation. Similar to studies on streams, nighttime emissions regularly exceeded daytime emissions. Biophysical regulations of CO2 flux variability were delineated through mutual information analysis. Sample analysis of CO2 fluxes indicate the importance of continuous measurements. Better characterization of short- and long-term variability is necessary to understand and improve detection of temporal changes of CO2 fluxes in response to natural and anthropogenic drivers. Our results indicate that existing global lake carbon budgets relying primarily on daytime measurements yield underestimates of net emissions.
Building a bridge: characterizing major anthropogenic point sources in the South African Highveld region using OCO-3 carbon dioxide snapshot area maps and Sentinel-5P/TROPOMI nitrogen dioxide columns
Authors: Hakkarainen Janne , Ialongo Iolanda , Oda Tomohiro , Szeląg Monika E , O’Dell Christopher W , Eldering Annmarie , Crisp David
Published: February 2023

In this paper, we characterize major anthropogenic point sources in the South African Highveld region using Orbiting Carbon Observatory-3 (OCO-3) Snapshot Area Map (SAM) carbon dioxide (CO2) and Sentinel-5 Precursor (S5P) TROPOspheric Monitoring Instrument (TROPOMI) nitrogen dioxide (NO2) observations. Altogether we analyze six OCO-3 SAMs. We estimate the emissions of six power stations (Kendal, Kriel, Matla, Majuba, Tutuka and Grootvlei) and the largest single emitter of greenhouse gas (GHG) in the world, Secunda CTL synthetic fuel plant. We apply the cross-sectional flux method for the emission estimation and we extend the method to fit several plumes at the same time. Overall, the satellite-based emission estimates are in good agreement (within the uncertainties) as compared to emission inventories, even for the cases where several plumes are mixed. We also discuss the advantages and challenges of the current measurement systems for GHG emission monitoring and reporting, and the applicability of different emission estimation approaches to future satellite missions such as the Copernicus CO2 Monitoring Mission (CO2M) and the Global Observing SATellite for GHGs and Water cycle (GOSAT-GW), including the joint analysis of CO2 and NO2 observations.
Dimensional reduction of the Dirac theory
Authors: Angelone Giuliano , Ercolessi Elisa , Facchi Paolo , Lonigro Davide , Maggi Rocco , Marmo Giuseppe , Pascazio Saverio , Pepe Francesco V
Published: February 2023

We perform a reduction from three to two spatial dimensions of the physics of a spin-

1
2

fermion coupled to the electromagnetic (EM) field, by applying Hadamard’s method of descent. We consider first the free case, in which motion is determined by the Dirac equation, and then the coupling with a dynamical EM field, governed by the Dirac–Maxwell equations. We find that invariance along one spatial direction splits the free Dirac equation in two decoupled theories. On the other hand, a dimensional reduction in the presence of an EM field provides a more complicated theory in

2
+
1

dimensions, in which the method of decent is extended by using the covariant derivative. Equations simplify, but decoupling between different physical sectors occurs only if specific classes of solutions are considered.
On signed multiplicities of Schur expansions surrounding Petrie symmetric functions
Authors: Cheng Yen-Jen , Chou Meng-Chien , Eu Sen-Peng , Fu Tung-Shan , Yao Jyun-Cheng
Published: February 2023

For

k
≥
1

k\ge 1

, the homogeneous symmetric functions

G
(
k
,
m
)

G(k,m)

of degree

m
m

defined by
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="sigma-summation Underscript m greater-than-or-equal-to 0 Endscripts upper G left-parenthesis k comma m right-parenthesis z Superscript m Baseline equals product Underscript i greater-than-or-equal-to 1 Endscripts left-parenthesis 1 plus x Subscript i Baseline z plus x Subscript i Superscript 2 Baseline z squared plus midline-horizontal-ellipsis plus x Subscript i Superscript k minus 1 Baseline z Superscript k minus 1 Baseline right-parenthesis">

∑

m
≥
0

G
(
k
,
m
)

z
m

=

∏

i
≥
1

(

1
+

x
i

z
+

x
i
2

z
2

+
⋯
+

x
i

k
−
1

z

k
−
1

)

\sum _{m\ge 0} G(k,m) z^m=\prod _{i\ge 1} \big (1+x_iz+x^2_iz^2+\cdots +x^{k-1}_iz^{k-1}\big )

are called Petrie symmetric functions. As derived by Grinberg and Fu–Mei independently, the expansion of

G
(
k
,
m
)

G(k,m)

in the basis of Schur functions

s

λ

s_{\lambda }

turns out to be signed multiplicity free, i.e., the coefficients are

−
1

-1

,

0
0

and

1
1

. In this paper we give a combinatorial interpretation of the coefficient of

s

λ

s_{\lambda }

in terms of the

k
k

-core of

λ
\lambda

and a sequence of rim hooks of size

k
k

removed from

λ
\lambda

. We further study the product of

G
(
k
,
m
)

G(k,m)

with a power sum symmetric function

p
n

p_n

. For all

n
≥
1

n\ge 1

, we give necessary and sufficient conditions on the parameters

k
k

and

m
m

in order for the expansion of

G
(
k
,
m
)
⋅

p
n

G(k,m)\cdot p_n

in the basis of Schur functions to be signed multiplicity free. This settles affirmatively a conjecture of Alexandersson as the special case

n
=
2

n=2

.
Towards an Aesthetics of Archery
Authors: Bianchi Enea
Published: February 2023

This article discusses the relationship between archery and aesthetics, developing two central claims. First, in order to deliver successful results, the archer should attend not only to efficiency, technique and equipment tuning but also to the aesthetic experience; second, archery shooting methods embody and express ‘life-issue’ statements and desires concerning our relationship with the world. Depending on the archer’s shooting style, i.e., depending on the way in which a shot is executed and performed, the archer’s ‘sportive philosophy’ is, so to speak, unfolded and made apparent. Specifically, I will argue that instinctive archery strives for flexibility and versatility toward the environment and with respect to one’s own body, whereas non-instinctive approaches sharpen effectuality and results by flattening the surroundings and limiting one’s own performative freedom. Exploring this idea, I will discuss the aesthetic underpinnings of archery, also showing in which ways different shooting methods lay the ground for irreducible aesthetic experiences of self-expression.
Reading Finnis and Aquinas on Justice as the Evaluative Standard for Positive Law
Authors: Popović Petar
Published: February 2023

Justice is known to be an emblematic legal-philosophical criterion that forms part of the evaluative point of law for several prominent authors (such as Robert Alexy and Gustav Radbruch) who advocate that the nature of law is dual, namely, that law has at the same time an evaluative and descriptive nature. John Finnis, a proponent of a contemporary natural-law theory of law who supports a maximalist or full-range approach regarding the aspects of human good, acknowledges the legal importance of the requirement for justice. However, Finnis seems to conceptualize justice as a subset of what he deems the main evaluative standard within the nature of law—practical reasonableness. In this article, I argue that Finnis’s account of law and justice may be fruitfully upgraded by an emphasis on Thomas Aquinas’s texts that highlight the virtue of justice and its object, the juridical phenomenon (ius), as the central evaluative standard and the ideal end of positive law. I also show how a greater emphasis on justice is ultimately compatible with the role of practical reasonableness in explaining the nature of law.
Comparison of living-donor lobar lung transplantation and cadaveric lung transplantation for pulmonary hypertension
Authors: Kayawake Hidenao , Tanaka Satona , Yamada Yoshito , Baba Shiro , Kinoshita Hideyuki , Yamazaki Kazuhiro , Ikeda Tadashi , Minatoya Kenji , Yutaka Yojiro , Hamaji Masatsugu , Ohsumi Akihiro , Nakajima Daisuke , Date Hiroshi
Published: February 2023

OBJECTIVES

Living-donor lobar lung transplantation (LDLLT) is a life-saving procedure for critically ill patients with various lung diseases, including pulmonary hypertension (PH). However, there are concerns regarding the development of heart failure with pulmonary oedema after LDLLT in which only 1 or 2 lobes are implanted. This study aimed to compare the preoperative conditions and postoperative outcomes of LDLLT with those of cadaveric lung transplantation (CLT) in PH patients.

METHODS

Between 2008 and 2021, 34 lung transplants for PH, including 12 LDLLTs (5 single and 7 bilateral) and 22 bilateral CLTs, were performed. Preoperative variables and postoperative outcomes were retrospectively compared between the 2 procedures.

RESULTS

Based on the preoperative variables of less ambulatory ability (41.7% vs 100%, P < 0.001), a higher proportion of World Health Organization class 4 (83.3% vs 18.2%, P < 0.001) and higher mean pulmonary artery pressure (74.4 vs 57.3 mmHg, P = 0.040), LDLLT patients were more debilitated than CLT patients. Nevertheless, hospital death was similar between the 2 groups (8.3% vs 9.1%, P > 0.99, respectively). Furthermore, the 5-year overall survival rate was similar between the 2 groups (90.0% vs 76.3%, P = 0.489).

CONCLUSIONS

Although LDLLT patients with PH had worse preoperative conditions and received smaller grafts than CLT patients, LDLLT patients demonstrated similar perioperative outcomes and prognoses as CLT patients. LDLLT is a viable treatment option for patients with PH.
Trends in and relations between children’s health-related behaviors pre-, mid- and post-Covid
Authors: de Bruijn Anne G M , te Wierike Sanne Cornelia Maria , Mombarg Remo
Published: February 2023

Background

Covid-19 has had a major negative impact on children’s engagement in health-related behaviors. This study examines trends in children’s screen time, outdoor play and sports club membership in pre- (2016–19), mid- (2020–21) and post- (2021–22) Covid years. Also, predicting factors (gender, age and active commuting) of these health-related behaviors are examined.

Methods

Data were collected via yearly self-report questionnaires among pupils in Grades 3–6 (mean age 10.14 ± 1.25 years; total n over the five cohorts = 6351, 50.8% girls). Multilevel path models were constructed in Mplus to examine whether children’s screen time, outdoor play and sports club membership differed between pre-, mid- and post-Covid years; and which factors predicted engagement in these health-related behaviors (using data of all cohorts).

Results

During and after Covid-19, children’s screen time was higher, while they engaged less in outdoor play and were less often member of a sports club than before. Although these negative trends peaked during Covid-19, they slowly seem to be returning to pre-Covid levels in recent year. Younger children, girls and active commuters had less minutes screen time per day and played outdoors more days per week; boys and active commuters were more often sports club member.

Conclusions

Although in the first year post-Covid children seem to be engaging more in health-related behaviors than during Covid-19, we still found lower levels of engagement than in the years before Covid-19, underlining the importance of early intervention to ensure an appropriate amount of engagement in health-related behaviors for all children.
HIV treatment, antiretroviral adherence and AIDS mortality in people who inject drugs: a scoping review
Authors: Uusküla Anneli , Feelemyer Jonathan , Des Jarlais Don C
Published: February 2023

Background

People who inject drugs (PWID) are a key population for the prevention and care of HIV infection.

Methods

This scoping review covers recent (post-2010) systematic reviews on engagement of PWID in sequential stages of HIV care from uptake, to achieving viral suppression, and to avoiding AIDS-related mortality.

Results

We found that data on engagement of PWID into antiretroviral therapy (ART) were particularly scarce, but generally indicated very low engagement in ART. Studies of adherence and achieving viral suppression showed varying results, with PWID sometimes doing as well as other patient groups. The severity of social, medical and psychiatric disability in this population poses significant treatment challenges and leads to a marked gap in AIDS mortality between PWID and other population groups.

Conclusions

Given the multi-level barriers, it will be difficult to reach current targets (UNAIDS fast-track targets of 95–95–95) for ART for PWID in many locations. We suggest giving priority to reducing the likelihood that HIV seropositive PWID will transmit HIV to others and reducing morbidity and mortality from HIV infection and from other comorbidities.
Importance and mechanisms ofS-adenosylmethionine and folate accumulation in sake yeast
Authors: Kanai Muneyoshi , Mizunuma Masaki , Fujii Tsutomu , Iefuji Haruyuki
Published: February 2023

Sake yeasts have a range of brewing characteristics that are particularly beneficial for sake making including high ethanol fermentability, high proliferative capacity at low temperatures, lactic acid tolerance, and high ester productivity. On the other hand, sake yeasts also accumulate a diverse range of functional components. For example, significantly greater accumulation of S-adenosylmethionine (SAM), a compound that plays important regulatory roles in a range of biological processes as a major donor of methyl groups, occurs in sake yeasts compared to other microorganisms. Significantly greater accumulation of folate, a bioactive water-soluble vitamin (vitamin B9), also occurs in sake yeasts compared to laboratory yeasts, and the methyl group on SAM is supplied by folate. Accordingly, fully characterizing ‘sake yeast identity’ requires detailed understanding of the mechanisms underlying both the nutritional characteristics (functional components) and the brewing characteristics in sake yeasts. Therefore, this mini-review focuses on the accumulation of SAM and folate in sake yeast including descriptions of the genes known to contribute to SAM and folate accumulation and the underlying mechanisms.
CRISPR/Cas9 editing of the polygalacturonaseFaPG1gene improves strawberry fruit firmness
Authors: López-Casado Gloria , Sánchez-Raya Cristina , Ric-Varas Pablo D , Paniagua Candelas , Blanco-Portales Rosario , Muñoz-Blanco Juan , Pose Sara , Matas Antonio J , Mercado Jose A
Published: February 2023

Firmness is one of the most important fruit quality traits in strawberries. The postharvest shelf life of this soft fruit is highly limited by the loss of firmness, where cell wall disassembly plays an important role. Previous studies demonstrated that the polygalacturonase FaPG1 has a key role in remodelling pectins during strawberry softening. In this study, FaPG1 knockout strawberry plants have been generated using the CRISPR/Cas9 system delivered via Agrobacterium tumefaciens. Ten independent lines, cv. “Chandler”, were obtained, and all of them were successfully edited as determined by PCR amplification and T7 endonuclease assay. The targeted mutagenesis insertion and deletion rates were analyzed using targeted deep sequencing. The percentage of edited sequences varied from 47% up to almost 100%, being higher than 95% for seven of the selected lines. Phenotypic analyses showed that 7 out of the eight lines analyzed produced fruits significantly firmer than the control, ranging from 33 to 70% increase in firmness. There was a positive relationship between the degree of FaPG1 editing and the rise in fruit firmness. Minor changes were observed in other fruit quality traits, such as colour, soluble solids, titratable acidity or anthocyanin content. Edited fruits showed a reduced softening rate during postharvest, displayed a reduced transpirational water loss, and were less damaged by Botrytis cinerea inoculation. The analysis of four potential off-target sites revealed no mutation events. In conclusion, editing the FaPG1 gene using the CRISPR/Cas9 system is an efficient method for improving strawberry fruit firmness and shelf life.
‘I Did Digital Tidying up for a More Adult Stage of Life’: Ritualistic Technology Appropriations During Life Transitions
Authors: Wolf Sara , Mörike Frauke , Löffler Diana , Hurtienne Jörn
Published: February 2023

Life transitions, such as the transition from childhood to adulthood, are often accompanied by meaning-making actions such as rituals. Rituals increasingly involve the use of interactive technology. While previous research has focused on specific contexts or technologies, a bird’s eye view of the many appropriation styles during life transitions is missing. To identify the range of technology’s appropriations, we analysed stories from 84 participants and compared these across different life transitions and technologies. We identified three roles interactive technology can play during life transitions: the role of (i) a facilitator easing the accomplishment of tasks within life transitions, (ii) an enabler creating opportunities for new transition rituals and (iii) a social actor that itself is the trigger or the content of transition rituals. We propose the three roles as a classification scheme to structure existing and future research and reflect on the design challenges and evaluation approaches.
Psychometric Properties and The Best Form of The Revised Short-Form Mc-Gill Pain Questionnaire in Iranian Burn Patients
Authors: Gardashkhani Sevda , Imani khangah Nafiseh , Ebrahimi Belil Fatemeh
Published: February 2023

Pain is the most important factor that forces patients to seek help from health care systems. Burn injuries are associated with severe pain and the assessment and interventions are a focus of nursing care. The aim of this study was to evaluate the psychometric properties of the revised short-form Mc-Gill Pain Questionnaire (MPQ) in burn patients. The present study is a methodological study in which 153 burn patients were included by convenience sampling. To evaluate the psychometric properties of the 22-item revised MPQ, face validity, construct validity (exploratory factor analysis), and reliability were determined by Cronbach’s α coefficient and split-half method. Data analysis was performed using SPSS22.0 software. During the quantitative face validity test, four items were removed from the instrument due to the impact score of less than 1.5 by burn patients. The results of exploratory factor analysis showed five factors (emotional, neuropathic, continuous, stimulatory, and shooting), which explained 72.32% of the total variance. The overall Cronbach’s instrument was 0.836 and the coefficient obtained by the split-half method was 0.81. According to the validity and reliability, the 18-item MPQ obtained in the present study can be used to assess pain in Persian-speaking adult burn patients.
Flesh Flies (Diptera: Sarcophagidae) of Forensic Importance Collected From Pig Carcasses in the Cerrado of Northeastern Brazil
Authors: Silva José Orlando de A , Brasil Leandro S , Carvalho-Filho Fernando da S
Published: February 2023

Sarcophagidae is a family of true flies frequently found colonizing carcasses and corpses as adults and/or larvae, therefore, they are of great forensic value in the medico-legal field. Thus, this study aims to inventory the sarcophagids species and describe their succession process in the decomposition of swine carcasses in the Cerrado (savanna-like vegetation), Brazilian Northeastern region. A total of 10,819 specimens were collected, belonging to 45 sarcophagid species. Of this total, one species was recently described (Helicobia neuzalmeidae Silva, Brasil, De-Souza & Carvalho-Filho), two [Blaesoxipha (Acanthodotheca) denieri (Blanchard) and Dexosarcophaga pusilla Lopes] are new records for the Cerrado biome, five [Argoravinia (Argoravinia) catiae Carvalho Filho & Esposito, B. (A.) denieri, Nephochaetopteryx orbitalis (Curran & Walley), Peckia (Sarcodexia) tridentata (Hall) and Tricharaea (Sarcophagula) ramirezi (Lopes)] are new records for the Northeast region and eight are new records for the state of Maranhão. The species A. (A.) catiae, Blaesoxipha (Gigantotheca) stallengi (Lahille), D. pusilla, H. neuzalmeidae, Lipoptilocnema misella Lopes, Oxysarcodexia bakeri (Aldrich) and Retrocitomyia retrocita (Hall) were collected for the first time in pig carcasses. Peckia (Sarcodexia) lambens (Wiedemann) and Oxysarcodexia thornax (Walker) were the most abundant species. In both collection seasons, five species were carcasses pioneers at an early stage. The majority of species (42 spp.) were collected during the dry season, primarily during the black putrefaction (39 spp.) and butyric fermentation (30 spp.) stages. The greatest number specimens (n = 6,484) were recorded during the rainy season, at the butyric fermentation (n = 2,517) and black putrefaction (n = 2,080).
The tidal excitation ofrmodes in a solar-type star orbited by a giant planet companion and the effect on orbital evolution I: the aligned case
Authors: Papaloizou J C B , Savonije G J
Published: February 2023

It has been suggested that tidal interaction is important for shaping the orbital configurations of close orbiting giant planets. The excitation of propagating waves and normal modes (dynamical tide) will be important for estimating time-scales for orbital evolution. We consider the tidal interaction of a Jupiter mass planet orbiting a solar-type primary. Tidal and rotational frequencies are assumed comparable making the effect of rotation important. Although centrifugal distortion is neglected, Coriolis forces are fully taken into account. We focus in detail on the potentially resonant excitation of r modes associated with spherical harmonics of degrees three and five. These are mostly sited in the radiative core but with a significant response in the convective envelope where dissipation occurs. Away from resonance significant orbital evolution over the system lifetime is unlikely. However, tidal interaction is enhanced near resonances and the orbital evolution accelerated as they are passed through. This speed up may be sustained if near resonance can be maintained. For close orbits with primaries rotating sufficiently rapidly, this could arise from angular momentum loss and stellar spin-down through a stellar wind bringing about significant orbital evolution over the system lifetime.
A Predictive Model to Identify ComplicatedClostridiodes difficileInfection
Authors: Berinstein Jeffrey A , Steiner Calen A , Rifkin Samara , Alexander Perry D , Micic Dejan , Shirley Daniel , Higgins Peter D R , Young Vincent B , Lee Allen , Rao Krishna
Published: February 2023

Background

Clostridioides difficile infection (CDI) is a leading cause of health care–associated infection and may result in organ dysfunction, colectomy, and death. Published risk scores to predict severe complications from CDI demonstrate poor performance upon external validation. We hypothesized that building and validating a model using geographically and temporally distinct cohorts would more accurately predict risk for complications from CDI.

Methods

We conducted a multicenter retrospective cohort study of adults diagnosed with CDI. After randomly partitioning the data into training and validation sets, we developed and compared 3 machine learning algorithms (lasso regression, random forest, stacked ensemble) with 10-fold cross-validation to predict disease-related complications (intensive care unit admission, colectomy, or death attributable to CDI) within 30 days of diagnosis. Model performance was assessed using the area under the receiver operating curve (AUC).

Results

A total of 3646 patients with CDI were included, of whom 217 (6%) had complications. All 3 models performed well (AUC, 0.88–0.89). Variables of importance were similar across models, including albumin, bicarbonate, change in creatinine, non-CDI-related intensive care unit admission, and concomitant non-CDI antibiotics. Sensitivity analyses indicated that model performance was robust even when varying derivation cohort inclusion and CDI testing approach. However, race was an important modifier, with models showing worse performance in non-White patients.

Conclusions

Using a large heterogeneous population of patients, we developed and validated a prediction model that estimates risk for complications from CDI with good accuracy. Future studies should aim to reduce the disparity in model accuracy between White and non-White patients and to improve performance overall.
Using Large-Group Simulation Incorporating a Variety of Media Formats in Innovating Interprofessional Education
Authors: Watts Sarah Owens , Sewell Jeanna , Ellison Kathy Jo
Published: February 2023

Innovative teaching strategies incorporated into curricula can prepare students for interprofessional practice and have a positive impact on patient outcomes and team dynamics in health care. Our team of faculty from nursing, social work, and pharmacy developed and implemented an activity using simulation in the large classroom to improve students’ perceptions of working in interprofessional teams. Effectiveness was assessed using the Interprofessional Collaborative Competencies Attainment Survey with a pretest-posttest design. Our experience indicated that this teaching approach can be an effective strategy for maximizing resources and providing meaningful interprofessional student experiences.
An Innovative Academic-Practice Partnership Using Simulation to Provide End-of-Life Education for Undergraduate Nursing Students in Rural Settings
Authors: Graham Lucy , Emerson Kristy
Published: February 2023

Innovations that foster academic-practice partnerships can fill direct clinical care gaps and supplement faculty expertise, particularly in rural settings. An end-of-life simulation was cocreated by nursing faculty and regional certified hospice and palliative care nurses (CHPNs) as a course improvement project for traditional baccalaureate students who lacked direct care experience. Groups of students experienced skills-based pain management and end-of-life conversation-based scenarios using CHPNs as standardized patients. The simulation conformed to current standards in health care simulation, including prebriefing and debriefing components. Feedback from students and CHPNs supports the partnership as an effective teaching/learning strategy.
The Use of Interactive Technology to Improve Student Accuracy on Electrocardiographic Interpretation
Authors: Dzikowicz Dillon J. , Carey Mary G.
Published: February 2023

Electrocardiography (ECG) instruction relies heavily on memorization of interpretation rules and lacks opportunities for hands-on practice. Consequently, nursing students struggle with ECG interpretation. In an online undergradute nursing course, we implemented interactive technology to facilitate kinesthetic pedagogy. Accuracy was evaluated at midterm and during final assessments by two experts using a standardized rubric. Students who engaged with interactive technology at both assessments demonstrated consistent accuracy of ECG interpretation; students who did not failed to demonstrate consistent accuracy with ECG interpretation. Incorporating interactive technology to facilitate psychomotor learning may be essential in improving the accuracy of ECG interpretation.
Integrating Artificial Intelligence (AI) Simulations Into Undergraduate Nursing Education: An Evolving AI Patient
Authors: Lebo Chelsea , Brown Norma
Published: February 2023

Utilizing an evolving artificial intelligence (AI) virtual patient that will age with students as they progress throughout the nursing program is an innovative use of simulation. The students are introduced to the AI patient as sophomores where they begin with basic patient interviewing and assessment skills. They revisit the AI patient as juniors and seniors in their medical-surgical courses, where they see the patient aging and developing complex medical conditions. As the AI patient and the student grow together, student competence increases. Students complete an evaluation at the conclusion of each simulation experience.
Evaluating Knowledge of Public Health Nursing Competencies in Baccalaureate Nursing Students
Authors: Brown Robin , Plemmons Christina , Abuatiq Alham , Hultman Cassy , Currier Danielle , Schmit Marie , Kvigne Valborg , Walstrom Beth , Horsley Leann , Mennenga Heidi
Published: February 2023

Community health workers are projected to grow in number by 17 percent by 2030. A baccalaureate degree in nursing (BSN) provides a foundation for public health nursing practice. The Competencies for Public Health Nursing Practice instrument was distributed to BSN students at a Midwestern university before and after an educational intervention. Students completed a pretest (n = 269) and posttest (n = 154). All four subscales and total score indicated a significant increase in competence (p < .001). There is a need to develop interactive public health nursing simulations with an interprofessional venue to help students improve teamwork and communication competencies.
A Generation Ready for Change: Preparing for the Deregulation of Medications for Opioid Use Disorder in Undergraduate Medical Education
Authors: Demuynck Sophia
Published: February 2023

The U.S. Department of Health and Human Services recently released updated guidance that allows providers under standard licensure to treat 30 or fewer patients with buprenorphine, a partial opioid agonist shown to be safe and effective as an office-based treatment for opioid use disorder (OUD). Previously, physicians and advanced practice providers needed to complete specialized training and certification under the Drug Addiction Treatment Act (DATA) of 2000 before prescribing medications for OUD (MOUD). This deregulatory action comes as rates of opioid-involved overdose have accelerated during the COVID-19 pandemic. Given the limited success of stepwise efforts to legislate for expanded access to MOUD, providers, professional associations, and other advocates have called for the elimination of the DATA requirements for all practitioners. An understanding of the statutory and regulatory history of MOUD may prove critical as legislative and policy actions continue to reshape clinical practice. Incorporating MOUD training as a standard in undergraduate medical education represents a unique opportunity for the medical community to prepare trainees for future deregulation of MOUD. Indeed, medical schools already offering or requiring MOUD training have demonstrated success in improving MOUD knowledge, skills, and attitudes among medical students and graduates. Existing virtual and hybrid training tools designed to meet DATA standards represent an accessible means to ensure critical learning for future generations of physicians uniquely ready and willing and to provide quality, evidence-based care to patients with OUD.
Assessment of COVID-19–Driven Changes in an Integrated OBGYN-Addiction Treatment Clinic and Future Implications
Authors: Smarony Sumaya , Parlier-Ahmad Anna Beth , Shadowen Hannah , Thakkar Bhushan , Scheikl Marjorie O. , Martin Caitlin E.
Published: February 2023

Objective

The COVID-19 pandemic prompted healthcare delivery changes, but the associated impacts on substance use disorder treatment outcomes among pregnant and parenting people are unknown. This study aims to (1) describe COVID-19–driven clinical practice changes, (2) evaluate clinic-level visit attendance patterns, and (3) compare patient-level treatment engagement outcomes across 3 COVID-19 pandemic phases in an OBGYN-addiction treatment clinic.

Methods

COVID-19 phases include pre–COVID-19 (August 2019–February 2020), early COVID-19 (March–December 2020), and COVID-19 vaccine (January–July 2021). OBGYN-addiction treatment clinical practice changes were summarized. Clinic-level attended medical provider visits were analyzed. Patient-level treatment engagement outcomes (buprenorphine continuation, visit attendance, and virtual visits) were assessed in a cohort of pregnant and parenting people enrolled in a clinic research registry. Mixed-level logistic regression models determined the relationship between the COVID-19 phases and the patient-level outcomes.

Results

The study site made several COVID-19–driven clinical practice changes, including implementing a hybrid virtual/in-person system for medical visits. Clinic-level medical provider appointments increased between the first and second COVID-19 phases and remained high in the third phase. Among participants included in patient-level outcome analyses (N = 27), there were no differences in the early COVID-19 phase compared with the pre–COVID-19 phase in buprenorphine continuation, any visits, or medical visits. There was a decrease in all patient-level outcomes in the COVID-19 vaccine phase compared with pre–COVID-19 (P < 0.05). Virtual visits increased between the first 2 phases and remained high during the third.

Conclusion

Within our OBGYN-addiction treatment clinic, implementation of tailored, patient-centered treatment strategies supported clinic- and patient-level treatment engagement throughout the pandemic.
Homelessness and Treatment Outcomes Among Black Adults With Opioid Use Disorder: A Secondary Analysis of X:BOT
Authors: Justen Marissa , Scodes Jennifer , Pavlicova Martina , Choo Tse-Hwei , Gopaldas Manesh , Haeny Angela , Opara Onumara , Rhee Taeho Greg , Rotrosen John , Nunes Edward V. , Hawk Kathryn , Edelman E. Jennifer
Published: February 2023

Objective

We sought to identify the sociodemographic and clinical characteristics associated with homelessnesss, and explore the relationship between homelessnesss and treatment outcomes among Black individuals.

Methods

This is a secondary analysis of the subgroup of Black participants (n = 73) enrolled in “X:BOT,” a 24-week multisite randomized clinical trial comparing the effectiveness of extended-release naltrexone versus sublingual buprenorphine-naloxone (n = 570). Outcomes included medication initiation, return to extramedical use of opioids assessed by both self-report and urine toxicology, and engagement in medications for opioid use disorder (MOUD) treatment at 28 weeks postrandomization. Descriptive statistics were performed.

Results

Black participants were mostly unmarried and male, and about a third were aged 21–30 years. Among people experiencing homelessnesss, more were uninsured (45.5% [10/22] vs 19.6% [10/51]), unemployed (77.3% [17/22] vs 64.7% [33/51]), and reported alcohol (40.9% [9/22] vs 23.5% [12/51]) and sedative use (54.5% [12/22] vs 17.6% [9/51]) within the previous 30 days. Compared with housed Black individuals, a slightly higher proportion of Black individuals experiencing homelessnesss successfully initiated study medication (81.1% [18/22] vs 72.6% [37/51]); similar proportions returned to opioid use during the trial (68.2% [15/22] vs 68.6% [35/51]) and were engaged in MOUD at 28 weeks after trial entry (72.2% [13/18] vs 69.7% [23/33]) among participants located for follow-up.

Conclusions

These descriptive results among Black patients participating in a trial of MOUD suggest that efficacious MOUD is possible despite homelessnesss with additional clinical supports such as those provided by a clinical trial.
Trends in the Prioritization and Implementation of Substance Use Programs by Nonprofit Hospitals: 2015–2021
Authors: Chang Ji Eun , Cronin Cory E. , Pagán José A. , Simon Janet , Lindenfeld Zoe , Franz Berkeley
Published: February 2023

Objectives

Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals’ prioritization and implementation of substance use disorder (SUD) programs.

Methods

We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using two waves (wave 1: 2015–2018; wave 2: 2019–2021) by examining hospital community benefit reports. We utilized t or χ2 tests to understand whether there were significant differences in the prioritization and implementation of SUD programs across waves. We used multilevel logistic regression to evaluate the relation between prioritization and implementation of SUD programs, hospital and community characteristics, and wave.

Results

Hospitals were less likely to have prioritized SUD but more likely to have implemented SUD programs in the most recent 3 years compared, even after adjusting for the local overdose rate and hospital- and community-level variables. Although most hospitals consistently prioritized and implemented SUD programs during the 2015–2021 period, a 11% removed and 15% never adopted SUD programs at all, despite an overall increase in overdose rates.

Conclusions

Our study identified gaps in hospital SUD infrastructure during a time of elevated need. Failing to address this gap reflects missed opportunities to engage vulnerable populations, provide linkages to treatment, and prevent complications of substance use.
Widespread Distribution of Xylazine Detected Throughout the United States in Healthcare Patient Samples
Authors: Holt Andrew C. , Schwope David M. , Le Kathy , Schrecker Joshua P. , Heltsley Rebecca
Published: February 2023

Objectives

Xylazine is a tranquilizer commonly added into the illicit drug supply and a likely contributor to overdoses because it does not respond to naloxone reversal. The objective of this study was to perform a retrospective data analysis on xylazine-positive samples collected from patients in various outpatient healthcare settings to illustrate geographic distribution and common copositive substances, which may also contribute to risk of adverse events.

Methods

Samples for which providers ordered testing for xylazine were subjected to enzymatic hydrolysis, extracted, and analyzed using liquid chromatography–tandem mass spectrometry. Retrospective analysis was performed on xylazine-positive samples collected from April 2021 to March 2022, to include geographic location and copositive substances.

Results

Xylazine was identified in 413 of 59,498 samples from adults aged 20–73 years and originated from 25 of the 39 states where xylazine testing was ordered. The most common routine substances detected with xylazine were fentanyl, buprenorphine, naloxone, cocaine, d-methamphetamine, and delta-9-tetrahydrocannabinol. The most common designer drugs detected included fentanyl analogs, isotonitazene, and designer benzodiazepines.

Conclusions

Xylazine is geographically spread throughout the United States, indicative of a wide incorporation into the illicit drug supply. These findings differ from previous studies in that these samples originated from healthcare providers in routine care settings, where other reports typically involve overdose deaths. This analysis illustrates that routine testing for xylazine in outpatient settings can afford providers the opportunity to educate individuals and adjust harm reduction measures to potentially mitigate overdose risk.
Illuminating the Contributions of African American Nurse Scientists Despite Structural Racism Barriers
Authors: Statler Marie Campbell , Wall Barbra Mann , Richardson Jeanita W. , Jones Randy A. , Kools Susan
Published: February 2023

A qualitative descriptive approach examined African American nurse scientists' (AANSs') experiences with African American research participants despite obstacles of structural racism. Fourteen nurse scientists participated in semistructured interviews that provided data for the thematic analysis. Major themes included barriers to overcome as doctoral students, cultural experiences with structural racism, designers of culturally sensitive research, and humanitarian respect and relationship depth. This is the first research study to illuminate the contributions of AANSs who lead research in health disparities. Therefore, nursing leadership needs to illuminate AANSs' contributions, increase nurse diversification, and dismantle structural racism that creates obstacles that ultimately impact population health.
Concept Analysis
Authors: Roman Laporte Roberto L. , De Santis Joseph P.
Published: February 2023

Clients who identify as lesbian, gay, bisexual, transgender, queer/questioning (LGBT+) may experience barriers in health care access and services. LGBT+ clients want a welcoming, inclusive, and affirming encounter with nurses and other health care providers. This concept analysis used a modified Walker and Avant method to clarify the concept of LGBT+ inclusive health care. Antecedents, attributes, and consequences of LGBT+ inclusive health care were identified from the literature. The results of this concept analysis of LGBT+ inclusive health care can inform future research, policy, education, and practice to address the health care needs of this population.
Ageism in the Nursing Care of Older Adults
Authors: Hammouri Ammar , Taani Murad H. , Ellis Julie
Published: February 2023

Despite the high prevalence of ageism worldwide, it is still underestimated and unrecognized by many nurses. Concept clarification is required to delineate the meaning of the word “ageism” in nursing. The purpose of this concept analysis is to clearly define the concept of ageism relative to nursing discipline using the Walker and Avant method. Defining the concept of ageism will provide nurses with a better understanding of its causes and consequences. It will aid policy makers in developing policies and interventions to help decrease ageism in health care environments.
The Routine Use of Running Subcuticular Closures in Orthopaedic Trauma Patients Does Not Increase Wound Complications
Authors: Aravindan Shreyaas , Kim Ye Joon , Tucker Nicholas J. , Heare Austin , Parry Joshua A.
Published: February 2023

Objective:

To investigate whether the routine use of running subcuticular closures (RSC) in orthopaedic trauma patients increases the rate of wound complications and reoperations.

Design:

Retrospective comparative study.

Setting:

Urban Level 1 trauma center.

Patients/Participants:

Two hundred sixty-six patients undergoing orthopaedic trauma procedures between June 2020 and March 2022.

Intervention:

Adoption of an RSC protocol where any incision/wound that could be approximated with interrupted subcuticular 2-0 monofilament sutures was closed with a running subcuticular 3-0 monofilament suture.

Main Outcome Measurements:

Wound complications and subsequent reoperations.

Results:

With adoption of the RSC protocol, 91.0% of all orthopaedic trauma procedures were closed with RSC compared with 7.5% of the historical control group. There were no observed differences in the rate of wound complications (proportional difference (PD) 6.0%, confidence interval (CI) −2.3% to 14.1%; P = 0.15) or reoperations (PD 5.2%, CI −1.9% to 12.2%; P = 0.14) between the RSC and the control group. Wound complications were not associated with RSC on univariate analysis (PD 7.2%, CI −10.0% to 24.0%; P = 0.41). On multivariate analysis, an ASA>2 (odds ratio (OR) 2.4, CI 1.0 to 5.7; P = 0.03), lower extremity injuries (OR 4.9, CI 1.3 to 17.8; P = 0.01), and open reduction internal fixation procedures (OR 2.8, CI 1.1 to 7.2; P = 0.02) were found to be independently associated with wound complications.

Conclusion:

RSC for orthopaedic trauma procedures was not associated with increased wound complications when compared a historical cohort.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
How Many Patients Do We Need? Predictors of Consent to Participate in Clinical Research Studies in Orthopaedic Trauma
Authors: Wally Meghan K. , Seymour Rachel , Roomian Tamar , Churchill Christine , Haines Nikkole , Hsu Joseph R. , Bosse Michael , Karunakar Madhav A. ,   and Evidence-Based Musculoskeletal Injury & Trauma Collaborative (EMIT)
Published: February 2023

Objectives:

To characterize the recruitment rates at a Level I trauma center enroling for multiple prospective orthopaedic trauma research studies and identify patient-related and study-related predictors of consent.

Design:

We conducted a case–control study to identify predictors of study consent. The authors categorized studies based on intensity of the study intervention (low, intermediate, or high). A 2-level generalized linear model with random intercept for study was used to predict study consent.

Setting:

This analysis includes data from 10 federally funded studies conducted as part of a large, national consortium that were enroling patients in 2013–2014.

Patients/Participants:

Three hundred thirty-four patients were approached for at least 1 study and included in the analysis.

Intervention:

N/A.

Main Outcome Measures:

Consent to participate in the research study.

Results:

A total of 315 patients consented to be in a study (71% of approached patients). Consent rate varied by study (45%–95%). No patient characteristics (race, age, or sex) were associated with consent. Patients approached for studies of intermediate intensity were 83% less likely to consent (odds ratio = 0.17; 95% confidence interval: 0.04–0.67), and those approached for studies of high intensity were 91% less likely to consent (odds ratio = 0.09; 95% confidence interval: 0.03–0.32).

Conclusion:

Patient factors were not associated with consent. Study intensity is a major driver of consent rates. Studies of higher intensity will require the study team to approach up to twice as many patients as the target enrolment. This study provides a framework that can be used in study planning and determination of feasibility.