bluuebunny/crossref_metadata_2025 huggingface dataset:
Women's Experience of the Consent Process to Planned Caesarean Section and Its Surgical Risk: A Qualitative Study
Authors: Nithiyananthan Malathy , Nicholls Jacqueline , Whitten Melissa , Maslowski Katherine , Lanceley Anne
Published: December 2024

Objective

To explore how women appreciated the risks discussed within the consent process for planned caesarean section (CS).

Design

Exploratory qualitative interview study.

Setting

NHS Teaching Hospital in Central London.

Population

Women over the age of 18, English speaking, scheduled for a planned CS.

Methods

Semi‐structured interviews were conducted before and after a woman's CS. Eighteen women were recruited and interviewed prior to undergoing CS and 12 of these were interviewed following CS. Interviews were audio‐recorded, transcribed and thematically analysed.

Main Outcome Measures

Themes generated from analysis of interviews exploring the experiences of women consenting to CS and specifically their awareness of postpartum haemorrhage (PPH), hysterectomy, organ damage and risk of placental abnormalities in future pregnancies.

Results

Two broad themes and four subthemes were identified (1) Untimely provision of risk information: (a) superficial risk discussions during the antenatal period and full risk disclosure on the day of surgery and (b) incompleteness absent or sparse risk disclosure prior to making the decision to undergo the CS, where women were unaware of specific risks and (2) Emotional overload: (a) fear of risks and (b) fear that a CS will be denied to them—women's cognitive response and notably their emotional response to their situation limited their understanding of risks disclosed.

Conclusion

The consent process for planned CS was found to lack appropriate and full risk disclosure. Risk disclosure was ill‐timed or deficient in facilitating women's understanding of risks reflecting a consent process which does not meet legal and professional standards of informed consent.
The effect of the EU's novel food regulations on firm investment decisions
Authors: Varacca Alessandro , Soregaroli Claudio , Kardung Maximilian , Espa Ilaria , Colombo Ilaria , Cortesi Beatrice , Wesseler Justus
Published: December 2024

In this study, we assess the effect of the European Union's novel food regulations on firms' incentives to invest in such products. We adopt a conceptual framework based on real option value theory, which underpins an empirical analysis of a detailed dataset comprising 326 applications submitted under both the 1997 EU novel food regulation and its 2018 replacement. We investigate the dynamics of novel food applications under these regulations and disentangle the determinants of successful cases. Our results show a relatively stable number of applications over the years, with a spike after the introduction of the 2018 regulation, which sought to simplify and centralise the approval process. This upsurge can be interpreted as a reduction in the real option value of postponing investments, attributable to the introduction of a transitional regime and of 5‐year data protection measures. However, the new regulation did not shorten the authorisation process, with the expected benefits of centralisation compromised by operational bottlenecks and a lower chance of approval. Finally, we find that approvals under the 2018 regulation are more likely when applicants are private entities from non‐EU countries and have substantial experience with novel foods. Our empirical evidence suggests that the new regulation may be insufficient to speed up and streamline the novel food assessment process, which is inevitably constrained by EU food safety principles. This, in turn, may discourage future investments.
Phenotypic Plasticity During Organofluorine Degradation Revealed by Adaptive Evolution
Authors: O'Connor Madeline R. , Thoma Calvin J. , Dodge Anthony G. , Wackett Lawrence P.
Published: December 2024

A major factor limiting the biodegradation of organofluorine compounds has been highlighted as fluoride anion toxicity produced by defluorinating enzymes. Here, two highly active defluorinases with different activities were constitutively expressed in Pseudomonas putida ATCC 12633 to examine adaption to fluoride stress. Each strain was grown on α‐fluorophenylacetic acid as the sole carbon source via defluorination to mandelic acid, and each showed immediate fluoride release and delayed growth. Adaptive evolution was performed for each recombinant strain by serial transfer. Both strains adapted to show a much shorter lag and a higher growth yield. The observed adaptation occurred rapidly and reproducibly, within 50 generations each time. After adaption, growth with 50–70 mM α‐fluorophenylacetic acid was significantly faster with more fluoride release than a preadapted culture due to larger cell populations. Genomic sequencing of both pre‐ and postadapted strain pairs revealed decreases in the defluorinase gene content. With both defluorinases, adaption produced a 56%–57% decrease in the plasmid copy number. Additionally, during adaption of the strain expressing the faster defluorinase, two plasmids were present: the original and a derivative in which the defluorinase gene was deleted. An examination of the enzyme rates in the pathway suggested that the defluorinase rate was concurrently optimised for pathway flux and minimising fluoride toxicity. The rapid alteration of plasmid copy number and mutation was consistent with other studies on microbial responses to stresses such as antibiotics. The data presented here support the idea that fluoride stress is significant during the biodegradation of organofluorine compounds and suggest engineered strains will be under strong selective pressure to decrease fluoride stress.
Proteome profiling of cerebrospinal fluid using machine learning shows a unique protein signature associated with APOE4 genotype
Authors: Shvetcov Artur , Thomson Shannon , Cho Ann‐Na , Wilkins Heather M. , Reed Joanne H. , Swerdlow Russell H. , Brown David A. ,   the Alzheimer's Disease Neuroimaging Initiative, Finney Caitlin A.
Published: December 2024

Proteome changes associated with APOE4 variant carriage that are independent of Alzheimer's disease (AD) pathology and diagnosis are unknown. This study investigated APOE4 proteome changes in people with AD, mild cognitive impairment, and no impairment. Clinical, APOE genotype, and cerebrospinal fluid (CSF) proteome and AD biomarker data was sourced from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Proteome profiling was done using supervised machine learning. We found an APOE4‐specific proteome signature that was independent of cognitive diagnosis and AD pathological biomarkers, and increased the risk of progression to cognitive impairment. Proteins were enriched in brain regions including the caudate and cortex and cells including endothelial cells, oligodendrocytes, and astrocytes. Enriched peripheral immune cells included T cells, macrophages, and B cells. APOE4 carriers have a unique CSF proteome signature associated with a strong brain and peripheral immune and inflammatory phenotype that likely underlies APOE4 carriers' vulnerability to cognitive decline and AD as they age.
Scientific research on white potteries from the Nanzuo site in Qingyang, Gansu province
Authors: Wu Hanjun , Han Jianye , Zhang Xiaoning , Cui Jianfeng , Chen Guoke
Published: December 2024

Located in Qingyang, Gansu province, China, the Nanzuo site on the Loess Plateau is a large‐scale, high‐ranking central settlement of the late Yangshao period with capital city characteristics. We used a thermal dilatometer, energy‐dispersive X‐ray fluorescence (EDXRF), optical microscope, scanning electron microscopy with energy‐dispersive spectroscopy (SEM‐EDS), X‐ray diffraction (XRD) and Raman spectrometer to analyse the firing temperature, composition, microstructure and phase composition of the white potteries in the Nanzuo site. The results indicate that kaolin, china stone and local fusible white clay are the raw materials of the body. The surface coatings of white potteries are formed from shells. The main constituents that make up the internal surface coating are aragonite and calcite, which are derived from the prismatic and nacreous layers of shells. The external surface coating is composed of CaCO3 nanoparticles that arrange themselves as aragonite tablets within the nacreous layer. This exceptional pottery‐making technique is exclusive to Nanzuo and has not been reported at any other site in the world. This technique is significant for researchers to deepen our understanding of pottery‐making technology history in China.
State Capacity and Administrative Burdens on Citizens: Time for Export Controls and Transparency
Authors: Robson Jennifer
Published: December 2024

This article examines the relationships between state infrastructural capacity, administrative burdens, and incentives facing political actors. Three recent case studies of federal capacity‐building projects with limited success to date point to the roles of bureaucratic proceduralism, risk aversion, and internal administrative burdens imposed in the name of accountability. A path forward requires greater transparency by public servants and commitment by political elites to act as stewards of state capacity, ending the practice of exporting internally generated burdens outward to program users. In addition, political elites must shoulder more responsibility as active agents in the accountability process and providing political capital for risk‐taking and innovation in systems renewal and service delivery. Voters may not provide immediate rewards for this action, but citizens' trust in the institutions of the state will benefit over the longer‐term.
The Pigeons Coming Home to Roost: The Continuing Perils of Contracting Out in Canada
Authors: Migone Andrea , Howlett Michael
Published: December 2024

This article explores the growing trend of contracting‐out public services in Canada, highlighting its increasing impact on government activities as governments have expanded outsourcing from traditional goods like office supplies to complex infrastructure management and professional services. Recent cases, including federal government spending on consulting and high‐profile failures of Public Private Partnership (P3) projects, underscore the need for critical reassessment. Two major areas—professional services and large‐scale infrastructure management through P3s—are analyzed to understand the challenges and consequences of contracting out. The discussion highlights issues including inefficiencies, governance challenges, and risks associated with outsourcing, emphasizing the blurred lines and complications often existing between public, private, and non‐profit sectors in service delivery. The article calls for reforms to enhance accountability, transparency, and efficiency, while also reconsidering the role of private and non‐profit actors in public service delivery if sustainable effective outcomes are to be achieved.
Can Public Sector Service Delivery Be Improved?
Authors: Heintzman Ralph , Marson D. Brian
Published: December 2024

National surveys have documented a major decline in Canadians' satisfaction with public sector service delivery since 2020. Service satisfaction levels for federal services are back to levels not seen for two decades. Potential reasons for the recent declines in public sector service delivery performance are examined, as well as lessons from public organizations which have maintained high levels of service satisfaction in recent years despite the challenges. The article suggests the building blocks of a more robust approach and proposes a citizen‐centred, results‐based model for public sector service delivery in Canada, using service satisfaction as the primary results measure. Regular, measurable improvement in service satisfaction should be both the objective and the criterion of high performance in public sector service delivery and will require a sustained, multi‐channel approach to service improvement planning and implementation based on measurement of, and focus on, key drivers of service satisfaction.
Improving Interactions: Public Sector Reform and Parliamentary Committees
Authors: Nater John L. , Brock Kathy L.
Published: December 2024

A well‐functioning policy process requires a responsible public service that supports the government and implements its decisions, and a representative legislature that holds the executive to account for policy decisions and actions. Reform of either the public sector or Parliament alone is insufficient to ensure that the relationship between the two bodies works to the benefit of Canadians as intended. This article explores that relationship using committees as a focal point given their centrality to the operation of the policy system. It begins with a discussion of the role of the two bodies in the policy process and criteria for assessing any potential reforms, followed by a brief discussion of recent attempts at reform and their positive and negative lessons. We conclude by identifying three key reform options for the public sector and parliament to improve their interaction in this vital, yet often overlooked, part of the policy process.
Conclusion to “Re‐Setting the Public Service of Canada”: Resonances, Sustaining Reform, and Fostering Collaborative Research
Authors: Lindquist Evert A. , Shepherd Robert P.
Published: December 2024

This article considers the implications of the contributions to the special issue on “Re‐Setting the Public Service of Canada.” It first reflects on the reform directions proposed by contributors, the extent to which they resonate, and identifies overarching themes. It then considers the complexity of furthering and sustaining reform in large public‐sector systems, arguing that monitoring progress and motivating public servants will challenge governments and central agencies, especially during times of turbulence and disruption, and that the responsibility for monitoring progress should be more fully shared with Parliament and external observers. This will require investments to improve external reporting and support more systematic, applied and collaborative research from universities and think tanks with public servants, which would lead to fostering a new culture of public sector oversight and a larger community of applied researchers addressing public service issues.
School‐Based Fluoride Mouth‐Rinse Programs and Dental Caries Treatment Expenditure: An Ecological Study of the NDB Open Data Japan
Authors: Tadokoro Daisuke , Honda Kazue , Kusama Taro , Takeuchi Kenji , Osaka Ken , Aida Jun
Published: December 2024

Objectives

The prevalence of dental caries is high in Japan, leading to a huge burden of overall expenditure on dental caries treatment for the population. School‐based fluoride mouth‐rinse (S‐FMR) has been implemented as a public health intervention. However, its cost‐effectiveness remains unclear, where universal health insurance covers a broad range of dental treatments at relatively low cost. The aim of the study was to determine whether S‐FMR is associated with lower dental caries treatment expenditure in Japan, where the universal health insurance system widely covers dental treatments. In addition, the cost‐benefit of S‐FMR was estimated.

Methods

This ecological study examined the association between S‐FMR coverage and dental caries treatment expenditure in all 47 prefectures of Japan. Data were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data (NDB Open Data Japan), national survey data on the prevalence of S‐FMR, and other census data for each prefecture. The outcome variable was the average annual treatment expenditure of for children aged 5–14 per child. The explanatory variable was the S‐FMR coverage of children per prefecture, divided into quartiles: (Q1) 0.0%–0.48%, (Q2) 0.54%–6.9%, (Q3) 7.2%–25.0% and (Q4) 26.9%–80.4%. Linear regression analysis was performed with adjustment for the number of dental clinics per 100 000 individuals, per capita prefectural income, and percentage of the population aged between 5 and 14 years.

Results

The dental caries treatment expenditure was lower in prefectures with higher S‐FMR coverage: (Q1) 2378 JPY, (Q2) 2215 JPY, (Q3) 2217 JPY and (Q4) 2065 JPY. Linear regression analysis showed that, compared to the prefectures with the lowest S‐FMR coverage, the prefectures with the highest coverage exhibited significantly lower per person dental caries treatment expenditure by 186.0 (95% CI = 96.6, 275.4) JPY. When annual cost of S‐FMR per person was lower, 200 JPY, S‐FMR would save 0.9 billion JPY if all prefectures change from Q1 to Q4 (approximately 8.2 million USD).

Conclusions

Although public healthcare insurance in Japan covers most dental treatments at a relatively low cost, the current findings suggest that S‐FMR could still be a cost‐effective public health intervention.
Clinical Insights Into Default Mode Network Abnormalities in Mild Traumatic Brain Injury: Unraveling Axonal Injury Through Functional, Structural, and Molecular Analyses
Authors: Ru Dewen , Zhang Jun , Wei Lichao , Zhang Zengyu , Wang Yue , Zhou Fengyuan , Wu Gang , Yuan Qiang , Du Zhuoying , Wang Ersong , Hu Jin
Published: December 2024

Background

Mild traumatic brain injury (mTBI) frequently results in persistent cognitive, emotional, and functional impairments, closely linked to disruptions in the default mode network (DMN). Understanding the mechanisms driving these network abnormalities is critical for advancing diagnostic and therapeutic strategies.

Methods

This study adopted a multimodal approach, combining functional connectivity (FC) analysis, diffusion tensor imaging (DTI), and gene expression profiling to investigate DMN disruptions in mTBI. A primary focus was placed on the middle cingulate cortex (MCC), a region consistently identified with increased connectivity. We explored the structural and molecular changes underlying this phenomenon. Receiver operating characteristic (ROC) curve analysis was utilized to assess the diagnostic potential of DTI‐derived metrics, while white matter tractography was employed to explore structural connectivity between the MCC and the dorsolateral prefrontal cortex (DLPFC).

Results

Our findings revealed significant disruptions in DMN connectivity, with the MCC prominently involved in mTBI pathology. DTI analyses identified pronounced axonal injury in the MCC, characterized by decreased fractional anisotropy (FA) and axial diffusivity (AD), alongside increased isotropy (ISO), indicating compromised white matter integrity and diffuse axonal injury. Gene expression profiling revealed the upregulation of pathways related to synaptic transmission, ion channel regulation, and axonal injury response. ROC analysis demonstrated that ISO serves as a particularly effective biomarker for mTBI, showing high diagnostic accuracy (AUC = 0.871). White matter tractography further confirmed strong structural connectivity between the MCC and the DLPFC, identifying potential therapeutic targets for neuromodulation.

Conclusion

This study provides robust evidence that diffuse axonal injury plays a pivotal role in DMN abnormalities observed in mTBI. The integration of FC, DTI, and gene expression profiling offers a comprehensive framework for understanding mTBI's impact on brain networks. Our findings also highlight the DLPFC as a promising target for therapeutic interventions aimed at addressing cognitive and emotional deficits associated with mTBI.
Brain‐Derived Exosomal miR‐9‐5p Induces Ferroptosis in Traumatic Brain Injury‐Induced Acute Lung Injury by Targeting Scd1
Authors: Zhang Yi , Sun Chang , Wang Bailun , Gu Angran , Zhou Ziyi , Gu Changping
Published: December 2024

Aims

This study aimed to explore the role and underlying mechanisms of brain‐derived exosomes in traumatic brain injury‐induced acute lung injury (TBI‐induced ALI), with a particular focus on the potential regulation of ferroptosis through miRNAs and Scd1.

Methods

To elucidate TBI‐induced ALI, we used a TBI mouse model. Exosomes were isolated from the brains of these mice and characterized using TEM and NTA. LC–MS analysis revealed an increase in the level of ferroptosis in the lung tissues of mice with TBI. Subsequent miRNA and mRNA sequencing revealed the upregulation of miR‐9‐5p and the downregulation of Scd1 in the pulmonary tissues of these mice. Ferroptosis was assessed by quantifying the levels of ROS, MDA, and Fe2+ and the expression of proteins associated with ferroptosis.

Results

TBI led to the release of exosomes enriched with miR‐9‐5p, which targeted Scd1 in lung tissue, thereby promoting ferroptosis. Treatment with antagomir 9‐5p reduced the level of ALI in TBI mice, indicating that exosomal miR‐9‐5p plays a significant role in TBI‐induced ALI.

Conclusion

This study revealed that brain‐derived exosomal miR‐9‐5p mediates ferroptosis in TBI‐induced ALI by targeting Scd1. These findings may provide new insights into the complex interplay between TBI and ALI and highlight the potential of miR‐9‐5p as a target for the development of novel therapeutic strategies.
The JNK Signaling Pathway Regulates Seizures Through ENT1 in Pilocarpine‐Induced Epilepsy Rat Model
Authors: Liu Shun , Luo Zhong , Li Fangjing , Zhang Lijia , Xie Mingxiang , Yang Juan , Xu Zucai
Published: December 2024

Objective

The study investigates whether the expression and function of ENT1 can be regulated by inhibiting the JNK signaling pathway, thereby altering the levels of extracellular adenosine and glutamate in neurons, and subsequently affecting the progression of epilepsy.

Methods

The adult male SD rats were randomly divided into four groups: EP + SP600125 group, EP + DMSO group, EP group, and normal control group. The expression levels of ENT1, p‐JNK, and JNK in the hippocampus of rats from each experimental group were detected using Western blotting technology. The expression and localization of ENT1 and p‐JNK in the CA1, CA3, and DG areas of the hippocampus were detected by immunohistochemical staining and immunofluorescence staining. Microdialysis combined with liquid chromatography‐mass spectrometry was used to determine the concentrations of adenosine and glutamate in the extracellular fluid of hippocampus in each experimental group.

Results

This study showed that the JNK‐specific inhibitor SP600125 could reduce ENT1 expression and seizure intensity in experimental rats. Statistical analysis confirmed that adenosine and glutamate levels in the extracellular fluid of the hippocampus increased significantly after seizures in rats, and the JNK‐specific inhibitor SP600125 could increase adenosine levels in the extracellular fluid but decrease glutamate levels.

Significance

The JNK‐specific inhibitor SP600125 can specifically inhibit the JNK signaling pathway and reduce the expression of ENT1 transporter. The mechanism is related to the transport of adenosine from the extracellular space to the intracellular space by ENT1 during epileptic states. Inhibition of ENT1 can increase the concentration of adenosine in the extracellular fluid of the hippocampus. The increase in adenosine concentration stopped glutamate from being released and reduced the amount of glutamate in the outside of the cell.
Motivating conservation action in the Upper Midwest: Source attention, information seeking and sharing, and farmers' land management decisions
Authors: Wald Dara M. , Diaz‐Manrique Miguel , Witzling Laura , Comito Jaqueline
Published: December 2024

Adoption of on‐farm conservation strategies, such as edge‐of‐field practices, has the potential to reduce nutrient runoff, promote greater biodiversity, and improve water quality. To date, adoption rates among farmers are extremely low. Communication with farmers has been identified as a vital strategy to encourage the voluntary adoption of these practices and policies that promote on‐farm conservation. Yet little is known about which information sources shape farmers' concerns about conservation practices, perceptions of the risks and benefits of conservation practices, and ultimately, adoption behaviors. Using the Social Amplification of Risk Framework, the Risk Information Seeking and Processing Model, and a cross‐sectional survey, we examined farmers' concerns about nitrate loss and water quality, perceptions of the risks and benefits of conservation practices, attention to messages and information sources, and communication behaviors. We received N = 474 completed surveys. Attention to agricultural associations was associated with decreased concern about nitrates and diminished perceptions of the benefits of edge‐of‐field practices. Farmers paying greater attention to non‐agricultural and social media sources were more likely to share and seek information. Attention to interpersonal sources was associated with greater adoption behaviors. This work highlights the importance of farmers' social networks, exposure to multiple information sources, and the need to identify new strategies for engagement and direct communication with hard‐to‐reach audiences. We conclude with a discussion of the implications of this work for conservation communication and land management practices to promote environmental health.
To mix, or not to mix?: Mitogenomic insights for risk assessment of an interpopulation translocations of the critically endangered European mink
Authors: Skorupski Jakub , Seebass Christian , Festl Wolfgang , Kiseleva Natalia , Śmietana Przemysław , Marinov Mihai
Published: December 2024

This study provides a comprehensive, population‐scale analysis of the mitogenome of the critically endangered European mink, Mustela lutreola, involving 52 individuals from Russia, Germany (conservation breeding stock), Romania, and France‐Spain. Significant mitogenomic diversity was identified within the previously presumed genetically homogenous French‐Spanish population, challenging concerns of inbreeding. Despite having lower nucleotide diversity (π = 0.00024) than the German (π = 0.00055) and Russian (π = 0.00048) populations, the French‐Spanish group exhibited impressive haplotype diversity (h = 0.9810) compared to Russian (h = 0.8727) and German (h = 0.7826) populations. Considering genetic diversity and uniqueness, the French‐Spanish population ranked highest in conservation importance, second only to the combined assessment of all other populations. The extensive population structuring identified two distinct haplogroups—the Central‐Eastern European and the Aquitaine‐Navarre—suggesting reconsideration of their conservation status. These findings guide tailored conservation strategies, emphasizing the need for careful interpopulation translocations to protect genetic diversity and prevent outbreeding depression. A decision algorithm for these translocations has been proposed.
Practical recommendations for therapy and monitoring of mogamulizumab patients in Germany
Authors: Assaf Chalid , Booken Nina , Dippel Edgar , Dobos Gabor , Eich Hans‐Theodor , Klemke Claus‐Detlev , Mitteldorf Christina , Nicolay Jan P. , Theurich Sebastian , Wobser Marion , Stadler Rudolf
Published: December 2024

Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of the heterogeneous group of cutaneous T‐cell lymphomas (CTCL). With the expansion of the biologic treatment landscape, new treatment options have become available in recent years, most notably the C‐C chemokine receptor 4 (CCR4)‐directed monoclonal antibody mogamulizumab. Based on the phase III pivotal trial, mogamulizumab is recommended by the German S2k guidelines for the second‐line treatment of stage IB and above SS and MF, after at least one prior systemic therapy. Since then, new insights on safety and efficacy of mogamulizumab were generated by post hoc analyses and real‐world evidence. A panel of CTCL‐experts discussed available literature and own experiences and developed relevant recommendations on the use of mogamulizumab in clinical practice in Germany. The recommendations cover patient criteria, prior therapies, use of mogamulizumab as monotherapy or combination therapy, management of side effects, duration of therapy, and monitoring schedules. The aim of these clinical recommendations is to support healthcare professionals in their decision‐making and use of mogamulizumab in daily practice.
Position statement of the World Endoscopy Organization: Role of endoscopy in screening, diagnosis, and treatment of esophageal superficial squamous neoplasia
Authors: Hassan Cesare , Antonelli Giulio , Chiu Philip Wai‐yan , Emura Fabian , Goda Kenichi , G. Iyer Prasad , Al Awadhi Sameer , Al Lehibi Abed , Arantes Vitor , Cerisoli Cecilio L. , Draganov Peter , Fleischer David , Fluxá Fernando , Gonzalez Nicolas , Inoue Haruhiro , John Sneha , Kashin Sergey , Khashab Mouen , Kim Gwang Ha , Kothari Shivangi , Ngamruengphong Saowanee , Remes‐Troche Jose Maria , Sharara Ala I. , Shimamura Yuto , Villa‐Gomez Guido , Wang Kenneth K. , Wang Wen‐Lun , Yip Hon‐Chi , Sharma Prateek
Published: December 2024

Esophageal squamous cell carcinoma (ESCC) remains a significant global health challenge, being the sixth leading cause of cancer mortality with pronounced geographic variability. The incidence rates range from 125 per 100,000 in northern China to 1–1.5 per 100,000 in the United States, driven by environmental and lifestyle factors such as tobacco and alcohol use, dietary habits, and pollution. Major modifiable risk factors include tobacco and alcohol consumption, with a synergistic risk increase when combined. Nonmodifiable risk factors include previous diagnoses of head and neck squamous cell carcinoma (H&N SCC), achalasia, and prior radiotherapy. Prevention strategies must be tailored to specific regional burdens to efficiently allocate medical and financial resources. Gastrointestinal endoscopy is crucial in reducing ESCC burden through early detection and characterization of neoplastic changes, such as high‐grade dysplasia. Early diagnosis significantly improves survival rates, while endoscopic resection of noninvasive dysplasia can prevent ESCC onset, reducing treatment burden for advanced disease. Postresection surveillance can detect high‐risk metachronous lesions. Despite these benefits, endoscopic prevention faces challenges, including the lack of high‐level evidence supporting its efficacy, opportunity costs, the need for specialized training and techniques, and the requirement for advanced technology investments. This Position Statement from the World Endoscopy Organization (WEO) aims to address these challenges, supplying recommendations for the exploitation of endoscopic resources regarding the possible role of screening, quality, and training for the detection, characterization, resection, and surveillance of ESCC.
Endoscopic hemostasis with a self‐assembling peptide gel during endoscopic submucosal dissection and cold‐snare polypectomy in the duodenum: Prospective exploratory study (with video)
Authors: Seya Mayuko , Dohi Osamu , Fukui Hayato , Iwai Naoto , Ochiai Tomoko , Mukai Hiroki , Yamauchi Katsuma , Miyazaki Hajime , Yasuda Takeshi , Yoshida Takuma , Ishida Tsugitaka , Doi Toshifumi , Hirose Ryohei , Inoue Ken , Yoshida Naohisa , Uchiyama Kazuhiko , Ishikawa Takeshi , Takagi Tomohisa , Konishi Hideyuki , Itoh Yoshito
Published: December 2024

Objectives

A novel self‐assembling peptide gel (SAPG) was recently developed for hemostasis during endoscopic resection (ER) as an alternative for electrocoagulation and clip placement. Therefore, this exploratory study aimed to evaluate the hemostatic effect of SAPG on bleeding during ER of the duodenum.

Methods

Patients with superficial duodenal epithelial tumors who underwent endoscopic submucosal dissection (ESD) or cold‐snare polypectomy (CSP) between June 2022 and October 2023 were enrolled in the study. SAPG was used for hemostasis of the intraprocedural bleeding when spontaneous hemostasis was essential for the continuation of ESD or was not achieved within 30 s after CSP. The primary outcome was a successful hemostatic rate using SAPG.

Results

Among the included patients, 15 and 8 underwent ESD and CSP, respectively. Forty‐two points of intraoperative bleeding were noted during ESD, of which 39 (92.9%) and 3 (7.1%) were oozing and nonspurting bleedings, respectively. Successful hemostatic rates were 84.6% and 0% in the oozing and nonspurting bleedings, respectively. All nonspurting bleedings were weakened after SAPG use. Of the 70 CSPs, 60 were oozing bleedings (85.7%), which were successfully stopped with SAPG. The median time to hemostasis from SAPG application was 30 s (interquartile range [IQR] 17–40 s) and 25 s (IQR 10–33 s) during ESD and CSP, respectively. No adverse event was observed in any of the cases during the perioperative period.

Conclusion

Self‐assembling peptide gel has an acceptable effect of successful hemostasis for intraoperative oozing bleeding during duodenal ESD and CSP.
Complex and Dynamic Gene‐by‐Age and Gene‐by‐Environment Interactions Underlie Functional Morphological Variation in Adaptive Divergence in Arctic Charr (Salvelinus alpinus)
Authors: Ouellet‐Fagg Christine L. , Easton Anne A. , Parsons Kevin J. , Danzmann Roy G. , Ferguson Moira M.
Published: December 2024

The evolution of adaptive phenotypic divergence requires heritable genetic variation. However, it is underappreciated that trait heritability is molded by developmental processes interacting with the environment. We hypothesized that the genetic architecture of divergent functional traits was dependent on age and foraging environment. Thus, we induced plasticity in full‐sib families of Arctic charr (Salvelinus alpinus) morphs from two Icelandic lakes by mimicking prey variation in the wild. We characterized variation in body shape and size at two ages and investigated their genetic architecture with quantitative trait locus (QTL) analysis. Age had a greater effect on body shape than diet in most families, suggesting that development strongly influences phenotypic variation available for selection. Consistent with our hypothesis, multiple QTL were detected for all traits and their location depended on age and diet. Many of the genome‐wide QTL were located within a subset of duplicated chromosomal regions suggesting that ancestral whole genome duplication events have played a role in the genetic control of functional morphological variation in the species. Moreover, the detection of two body shape QTL after controlling for the effects of age provides additional evidence for genetic variation in the plastic response of morphological traits to environmental variation. Thus, functional morphological traits involved in phenotypic divergence are molded by complex genetic interactions with development and environment.
Formation and Finitude: Jean‐Luc Nancy on the Arts as Ontological Doorways
Authors: Higgins Chris
Published: December 2024

In this article Chris Higgins considers two works by Jean‐Luc Nancy — “On Being Singular Plural” and “Why Are There Several Arts and Not Just One?” — in light of the formative task to do justice to the diverse dimensions of oneself given the offerings and demands of the world, a task made difficult by our finitude and the existence of incommensurable goods. While Nancy helps us appreciate the value pluralism animating the (liberal) arts, Higgins argues, Nancy himself shies away from the full implications of his relational ontology. Rather than follow individual arts and artworks into the local habitations they open — accepting the anguish of the arbitrary as the price of our finite but fulsome excursions into the reticulated real — Nancy retreats to the level of a global account (if a lyrical one) of the local.
Can the large language model ChatGPT‐4omni predict outcomes in adult patients with status epilepticus?
Authors: Amacher Simon A. , Baumann Sira M. , Berger Sebastian , Arpagaus Armon , Egli Simon B. , Grzonka Pascale , Kliem Paulina S. C. , Hunziker Sabina , Fisch Urs , Gebhard Caroline E. , Sutter Raoul
Published: December 2024

Objective

Large language models (LLMs) have recently gained attention for clinical decision‐making and diagnosis. This study evaluates the performance of the recently updated LLM Chat Generative Pre‐Trained Transformer‐4omni (ChatGPT‐4o) in predicting clinical outcomes in patients with status epilepticus and compares its prognostic performance to the Status Epilepticus Severity Score (STESS).

Methods

This retrospective single‐center cohort study was performed at the University Hospital Basel (tertiary academic medical center) from January 2005 to December 2022. It included consecutive adult patients (≥18 years of age) with a diagnosis of status epilepticus. The primary outcome was survival at hospital discharge, and the secondary outcome was return to premorbid neurological function at hospital discharge. The performance characteristics of ChatGPT4‐o (sensitivity, specificity, Youden Index) were evaluated and compared to those of the STESS.

Results

Of 760 patients, 689 patients (90.7%) survived to discharge, and 317 survivors (41.7%) regained their premorbid neurological function at discharge. ChatGPT‐4o predicted survival in 567 of 760 patients (74.6%), of which 45 died. ChatGPT‐4o predicted death in 193 of 760 patients (25.4%), of which 167 survived, resulting in a sensitivity of 75.8% and a specificity of 36.6% (Youden Index 0.12, 95% confidence interval [CI] 0–.28) for predicting survival.

ChatGPT‐4o predicted return to premorbid neurologic function in 249 of 760 patients (32.8%), of which 112 did not return to their premorbid neurological function. ChatGPT‐4o predicted no return to premorbid function in 511 of 760 patients (67.2%), of which 180 returned to their premorbid function, resulting in a sensitivity of 43.2% and a specificity of 74.7% (Youden Index .12, 95% CI .08–.28) for predicting return to premorbid neurological function.

There was no difference in the prognostic performance of ChatGPT‐4o and the STESS. A second round of prompting did not increase the predictive performance of ChatGPT‐4o.

Significance

ChatGPT‐4o unreliably predicts outcomes in patients with status epilepticus. Clinicians should refrain from using ChatGPT‐4o for prognostication in these patients.
Users' Perspectives on the Organization of Rehabilitation Services – A Focus Group Study of User Organization Representatives in Norway
Authors: Søberg Helene Lundgaard , Solvang Per Koren , Andelic Nada , Røe Cecilie , Kirkevold Marit
Published: December 2024

Background

User organizations for people with disabilities in Norway work for social equality and participation, and quality of health services for people with disabilities, chronic illnesses and reduced functional capacity. Consideration of the experiences from user representatives is necessary when determining the quality and appropriateness of the rehabilitation services. Rehabilitation services constitute the provision and delivery of intangible products to maintain or improve functioning in individual patients or patient groups. Rehabilitation services can be characterized at the policy (macro), organizational (meso) and individual (micro) levels.

Objectives

To explore user representatives' perspectives on rehabilitation service provision and organization and how they experience the influence they exert.

Methods

Focus group interviews with 14 representatives nominated from 11 user organizations in Norway conducted in 2021. Two online focus groups using a semi‐structured interview guide were conducted. Data analysis was performed according to Braun and Clarke's thematic data analysis.

Results

Six core themes were developed when analyzing the participants' experiences and opinions regarding rehabilitation services. The themes were inter‐connected and addressed perspectives on Access to services, Integration of care, Rehabilitation team, Person centeredness, System and governance and Modes of user representation and contribution.

Conclusion

The user representatives revealed tension and complexity influencing the provision and organization of rehabilitation services from individual access to health policy and regulation. Empowering user representatives through training was important to fight tokenism. Filling the role of a user representative at the meso level requires the integration of personal and peer experiences at the micro level, and knowledge of health policy regulations at the macro level.

Patient or Public Contribution

The Norwegian Federation of Organisations of Persons with Disabilities recruited user representatives in this study. The user representatives participated in the assessment and discussion of the results of the study. The results were presented for discussion to the User panel at the Research Centre for Habilitation and Rehabilitation Models & Services (CHARM) at the University of Oslo.
Enhancing bone graft efficacy: Antibacterial and osteogenic effects of cerium‐doped biphasic calcium phosphate scaffolds
Authors: Mangaraj Sangita , Swain Subhasmita , Rautray Tapash R.
Published: December 2024

Biphasic calcium phosphate powders, composed of hydroxyapatite and β‐tricalcium phosphate, have gained significant interest as excellent substitutes because of their similarity to natural bone mineral and biocompatibility. The objective was to enhance the biological efficacy of biphasic calcium phosphate powder‐based bone graft materials by incorporating trace elements, such as cerium, into the material. In the context of this investigation, a simple wet chemical precipitation technique was established for the purpose of fabricating microporous biphasic calcium phosphate powders scaffolds of cerium followed by gel casting. The 10% Ce in biphasic calcium phosphate powders scaffolds displayed a network of linked microporous structures characterized by consistent micropore size having 250 ± 25 swelling value. There were no observable alterations in the phase composition and microstructure of the scaffolds when cerium was doped. Further, Staphylococcus aureus was used in the polarization‐induced in vitro antibacterial investigation while the survival of bacteria was greatly reduced on polarized surfaces. The biological activity studies revealed that the 10% cerium‐doped biphasic calcium phosphate powders scaffold exhibited superior efficacy in promoting osteogenic differentiation and antibacterial activities compared to its counterpart. Additionally, polarization improves the antibacterial capabilities of these synthetic scaffolds. The stored charge was found to be 4.02 µC.cm−2 at 550°C.
Synergistically reinforced boron carbide ceramics by introduction of Fe and BN
Authors: Wang Shuai , Du Wenxuan , Xing Pengfei , Zhuang Yanxin
Published: December 2024

Boron carbide (B4C)‐FeB ceramics and B4C‐FeB‐BN ceramics are prepared via hot pressing with B4C plus different contents of iron (Fe) and B4C plus 5 wt% Fe and different contents of boron nitride (BN), respectively. The phase composition, microstructure, and mechanical properties of the prepared ceramics are studied in detail. The synergistic effect of Fe and BN on hot‐pressed B4C ceramics is discussed. Results indicate that Fe can react with B4C to form FeB, and enhance the densification and mechanical property of B4C ceramics. 5 wt% Fe is the optimal addition amount. Fe and BN can synergistically reinforce B4C ceramics. The ceramics fabricated with B4C‐5 wt% Fe‐4 wt% BN have the optimal comprehensive performance, of which the relative density, hardness, flexural strength, and fracture toughness reach 98.5%, 32.74 GPa, 668.92 MPa, and 4.09 MPa·m1/2, respectively, higher than those of the ceramics fabricated with B4C or with B4C plus Fe. The liquid formed by Fe during sintering enhances the dispersion of BN, which is beneficial to realizing the function of pinning grain boundary and pulling out. The toughening phenomena include intergranular and transgranular fracture, particle pulling out, and bridging.
Four Decades of Sensory Marketing: A Hybrid Review and Future Research Agenda
Authors: Pandey Vaishali , Tripathi Vibhuti
Published: December 2024

Sensory marketing has garnered significant attention from researchers due to its ability to effectively influence consumer behavior at a subconscious level. However, existing reviews are constrained by either limited scope or methodology, often focusing on specific senses, or domains, or using solely quantitative or qualitative methods. This offers an opportunity to comprehensively synthesize the existing literature and provide direction for future research. Building on this, the present study examines 535 articles assembled, arranged, and assessed using the SPAR‐4‐SLR protocol for a thorough review of sensory marketing literature spanning four decades (1984–2023). The review employs both quantitative and qualitative methods to summarize the diverse research and provide detailed insights from the existing body of literature. The quantitative approach, utilizing keyword co‐occurrence analysis identifies five thematic clusters—sensory cues as communication strategy, sensory experiences in technologically advanced era, taste perception and food consumption, visual perception, and olfactory perception. Furthermore, the qualitative review technique, utilizing the Theory, Context, Characteristics, and Methodology (TCCM) framework reveals prevalent theories and primary research contexts, along with distinctive characteristics and methodologies. Based on these analyses suggestions for potential areas of future research have been stated.
Co‐Producing Employee Engagement Approaches in a Workplace Partnership: A Route to Partial Success in Public Health Workplaces
Authors: Findlay Patricia , Lindsay Colin , Stewart Robert
Published: December 2024

While employee engagement might enhance staff wellbeing alongside organisational performance, delivering mutual gains can be challenging. This article assesses co‐production as a route to engagement in a public health workplace, and finds that co‐produced engagement strategies and mutual gains outcomes are possible where underpinned by genuinely collaborative organisational governance arrangements.
Ab initio investigation of the thermophysical properties of barium orthovanadate
Authors: Yang Ningxi , Yuan Meilin , Yang Jiali , Ding Xianyong , Wei Haoran , Zhong Chengyong , Li Dongmei , Lv Xuewei , Yu Peng , Jin Xin
Published: December 2024

Metal vanadates have garnered widespread attention across various scientific fields due to their exceptional performance. In this work, we investigate the lattice dynamics and thermophysical properties of barium orthovanadate (Ba3V2O8) using first‐principles calculations. We provide reliable thermodynamic data, including entropy and heat capacity across a broad temperature range. The complex crystal structure of Ba3V2O8 leads to strong phonon anharmonicity, which greatly suppresses the contribution of propagative phonons to the lattice thermal conductivity (κL). Moreover, utilizing the unified theory, we find that the significant contribution of coherent phonon transport makes κL exhibit low‐temperature dependence. Notably, coherent phonons along the a‐axis begin to exceed the contribution of propagative phonons at around 400 K and reach a high proportion of 71.9% at 800 K, leading to an anomalous change in κL. This research emphasizes the significant impact of strong anharmonicity and coherent phonon channels on the thermal transport process in Ba3V2O8, providing a crucial perspective for predicting and understanding the thermophysical properties of metal vanadates and contributing to the further regulation of the thermal transport characteristics.