bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategies for improving independent oil palm smallholders’ welfare in Konawe Regency, Southeast Sulawesi
Authors: Purba S F , Witjaksono J , Djaenudin D , Taridala S A , Imran I , Yulianti A , Muslimin M , Fadwiwati A Y , Sitompul R F
Published: August 2024

The oil palm plantation sector in Konawe Regency, Southeast Sulawesi, plays a vital role in the regional economy: absorbing labour, encouraging economic growth, and improving oil palm smallholders’ welfare. The welfare of independent oil palm smallholders (farmers) has not been maximized, even though smallholders are faced with fulfilling their basic household needs. This research aims to identify strengths, weaknesses, opportunities, and threats and provide strategies for improving the welfare of independent palm oil smallholders in Konawe Regency. This study used primary data (interviews, observations, focus group discussions, and documentation) and secondary data (literature review). SWOT analysis was used to determine the factors of opportunities, threats, strengths, and weaknesses and formulate strategies to improve independent oil palm smallholders’ welfare. The research findings show that weaknesses and opportunities are the main priorities for strengthening smallholder welfare. Factors affecting the welfare of smallholders are the quality and selling price of fresh fruit bunches, oil palm workers and farmers’ skills, production costs, maintenance of oil palm plantations, and oil palm farming institutions. As for the results of the SWOT analysis, the primary strategy is the formation and enhancement of the role of independent oil palm smallholder institutions in Konawe Regency.
Vegetable oils marketing strategies: Multimodal discourse analysis on advertising in Indonesian television
Authors: Reflinaldi  , Triana H W , Hadi S , Tafiati  , Wartiman  , Ilham M
Published: August 2024

This study aims to map the marketing strategies for vegetable oils in Indonesian television advertisements. Qualitative-explanatory research was conducted on vegetable oil advertisements from 1992-2023. Theo van Leeuwen’s multimodal discourse analysis is used as an analytical framework to describe linguistic signs, images, and sounds in data sources. The results showed that among the marketing strategies for vegetable oils are exploring the features of palm fruit as a raw material, the oil processing process, which involves the latest technology, the chemical properties of the oil, and the vitamins and nutrients in the oil. Another strategy is to describe the delicious cooking results and the positive psychological effects consumers feel. Oil producers also elaborated on the economic aspects of consumers by promising low prices and lottery prizes. Environmental and health issues emphasise vegetable oils’ long-term positive impact. Several experts in relevant fields appeared to strengthen arguments for the features of each commodity. The marketing strategy through advertising is quite interesting, with stunning visual illustrations, sounds, and words. Paying attention to today’s digital world, this marketing strategy will continue according to the trends and media consumers widely use.
Jurisdictional risk assessment and implementation of theory of change to sustainable palm oil in Pelalawan District, Riau Province
Authors: Juniyanti L , Puspitaloka D , Setiyo O Y , Azzahra M , Ali M
Published: August 2024

The jurisdictional approach has been widely used to address multifaceted issues associated with commodity-driven deforestation. Risk assessment at the jurisdictional level is required to implement jurisdictional programs. We developed a risk framework and indicator to assess the risks associated with achieving sustainable palm oil, using Pelalawan District as a case study. Pelalawan scored 0.48 out of 1, with the highest risks in the percentage of deforestation driven by oil palm plantation in mineral forest and pressure due to demand by global trade/export. Risks that are not mitigated will hamper the district’s effort to achieve sustainability. Following the assessment, we brought together multistakeholder in a workshop to develop a common vision using the theory of change framework. This study introduces new ways to approach sustainable palm oil initiatives in the palm oil sector using risk assessment and a theory of change framework.
Phenomenological Study of the Simirah Information System in Addressing Cooking Oil Scarcity (2021-2023)
Authors: Toni A , Jauharotul M
Published: August 2024

This research explores the government policy regarding the surge in cooking oil prices in 2022, a topic of ongoing debate among stakeholders. The findings reveal that the direct cash assistance (BLT) program’s regulatory impact assessment underscores lower-class economic principles’ volatility and the challenges of simplifying government policies, often perceived as unfeasible. On the other hand, the monitoring of bulk cooking oil (MGCR) producers benefits entrepreneurs and does not directly alleviate poverty. However, the practical implementation of the Simirah application system, a significant tool in this context, presents substantial and urgent hurdles for small-scale vendors. Their limited understanding of the system, coupled with their lack of technological knowledge and insufficient socialisation about the monitoring procedures related to cooking oil distribution, severely impede their effective use of the system. Large traders and distributors of cooking oil, with their relatively good technological knowledge, often step in as support and representatives for these small-scale vendors.
Analysis of palm oil raw material supplies to support sustainable economic strategies at PT Perkebunan Nusantara VIII Bogor Regency
Authors: Yusiana E , Maryani S , Melani A , Abadi S
Published: August 2024

Palm oil is a very important plantation commodity, its availability is the main source for palm oil production. Therefore, raw material supplies are an effort to support the availability of palm oil raw materials. PT Perkebunan Nusantara VIII. Companies need to pay attention to the quality of raw materials and procurement to achieve maximum production goals. Factors determining success in procuring raw materials are important, such as transportation, as well as fluctuations in raw material prices in the sustainability of processing palm oil fresh fruit bunches. This research aims to analyze factors that influence the supply of palm oil raw materials. The sample used in this research is simple random sampling. The analysis technique used is multiple linear regression. The research results show that 80% of the variables of raw material prices, raw material sources and transportation influence the supply of palm oil raw materials.
Challenges and sustainable economic strategies in global vegetable oil trade: A qualitative analysis of cadets in nautical and technical programs
Authors: Bernadtua Simanjuntak Marudut , Sawitri Wulandari Retno , Barasa Larsen , Soritua Sijabat Panderaja , Mudakir  , Gunawan Malau April
Published: August 2024

The global trade of vegetable oils is a critical component of the global supply chain, with significant economic, environmental, and policy implications. This research focuses on cadets in nautical and technical programs, who are prospective seafarers responsible for the distribution of vegetable oils. Incorporating a qualitative research approach and a comprehensive literature review, this study aims to elucidate the cadets’ understanding of and perspectives on the challenges and sustainable economic strategies associated with vegetable oils. The methodology includes semi-structured interviews with cadets, followed by thematic data analysis. The findings are expected to provide insights for policy change, curriculum development, and industry strategies. Understanding the cadets’ viewpoints is crucial for crafting effective solutions in an industry marked by price fluctuations, environmental concerns, and geopolitical influences. This research emphasizes the importance of sustainable economic strategies in ensuring the long-term viability and environmental responsibility of the vegetable oil supply chain. By enhancing the awareness and preparedness of future seafarers, this study contributes to the ongoing dialogue on sustainable and economically viable vegetable oil trade.
Fluctuations oil prices in the world and their impact on Indonesian macroeconomics
Authors: Lizein B , Triansyah F A , Acheampong K , Ahmad S Y , Mosavi H
Published: August 2024

Changes in international crude oil prices can significantly impact economic outcomes. This study tested the impact of oil price fluctuations on macroeconomic variables in Indonesia. The data used is annual data from 1990 to 2021 with the specific purpose of solving the current research deficiency about swings in oil prices. study adds five macroeconomic variables as explanatory factors to accomplish this purpose. We use five macroeconomic variables: economic growth, inflation, interest rates, industrial production, and exchange rates. The impact of oil price fluctuations on GDP, inflation, exchange rates, interest rates, and industrial production indices in Indonesia is examined within a structural vector autoregressive (SVAR) framework. Research shows that oil price shocks significantly impact GDP, inflation, and exchange rate. The results also show that oil price shocks hurt two other variables: the interest rate variable and the industrial production index. The findings derived from the analysis of the impulse response function indicate a detrimental effect on the growth of production, while exerting a favourable influence on inflation. However, the impact on industrial production, interest rates, and exchange rates is very modest and characterised by a degree of uncertainty.
The South African Short Story in English, 1920-2010
Authors: Fossati Marta
Published: August 2024

This book explores, through a detailed close reading and several digressions into the history of print culture, the development of the South African short story in English from the late 1920s to the first decade of the new millennium. It explores a selection of short stories by Black South African writers (Rolfes and Herbert Dhlomo, Peter Abrahams, Can Themba, Alex La Guma, Mtutuzeli Matshoba, Ahmed Essop, and Zoë Wicomb) with particular focus on the dialogue between ethics and aesthetics performed by these texts with regards to the evolution of South Africa’s socio-political situation. By focusing on Black short fiction, this book problematizes and complicates the often-polarized readings of Black literature in South Africa, torn between the notions of literariness, protest, and journalism. Owing to a set of material constraints, short fiction in South Africa indeed circulated first and foremost through local print media, which this study analyses in some detail with a focus on the cross-fertilization between journalism and the short story. While rooted in the South African context, this book is also alert to the translocal dimension of the short stories considered, exploring the ethical and aesthetical practice of intertextuality. It is thus also a book that complicates the aesthetics/ethics binary, generic classifications, and the categories of the literary and the political.
Getting Away With It?
Authors: Nili Shmuel
Published: August 2024

Foreign exile has often served as an important solution to high-stakes standoffs between opposition forces and autocrats who dread imprisonment or death at the opposition’s hands. Commencing the book’s applied part, this chapter examines the morality of autocratic exile, focusing on the tension between exile’s contribution to domestic peace and its threat to global deterrence against autocracy. The chapter starts by arguing that transitioning societies normally have the moral prerogative of accepting an exile arrangement, even though such an arrangement harms global deterrence against autocracy. Applying Chapter 2’s relational priority principle, the chapter then argues that, absent clear evidence of domestic opposition to an exile arrangement, foreign countries who have been entangled in an autocrat’s rule normally ought to facilitate his exile, despite exile’s repercussions for global deterrence. Finally, the chapter anticipates the worry that autocratic exile could harm the evolving regime of international criminal accountability for mass atrocities.
Displaced Subjects and Ventriloquized Voices
Authors: Lawlor Hannie
Published: August 2024

Chapter 2 turns to the second potential pitfall that Hirsch perceives in postmemorial narratives: the possible displacement of the second generation as the overwhelming nature of the inherited trauma threatens to overshadow their own life experiences. Through the lens of Dulce Chacón’s novel La voz dormida (The Sleeping Voice) (2002) and Lydie Salvayre’s autofictional account in Pas pleurer (Cry, Mother Spain) (2014), it compares approaches to articulating women’s repression and resistance during and after the Spanish Civil War, as narrative responsibility passes from the first to the second generation. Focusing on questions of ventriloquism, it reflects on how an ethical representation of the other’s voice might rely on subverting fixed subject positions and the sense that there is but one ‘place’ in the text from which the story is told.
Clashing Family Stories and Inconceivable Conversations
Authors: Lawlor Hannie
Published: August 2024

Chapter 5 compares attempts to represent both halves of a family history divided by the traumatic secret at its centre. Christine Angot’s Un amour impossible (An Impossible Love) (2015) gives an account of the incestuous abuse of the narrator by her father and her mother’s perceived silent complicity, while Cristina Fallarás’s Honrarás a tu padre y a tu madre (Honour Your Father and Mother) (2018) relays how, long before the marriage of their children, one of the narrator’s grandfathers formed part of the Nationalist firing squad that executed the other during the Spanish Civil War. In view of this painful conjunction between incompatible sides of the story, the chapter compares the extent to which the authors succeed in balancing the clashing versions of events. By examining the impossible conversations they stage, it investigates whether life writing can and should perform a kind of negotiation between versions and voices.
Determinants of preparedness in family caregivers of patients with heart failure
Authors: Li Ximiao , Zhang Jie , Li Jinliang , Fang Wenjie , Zhang Xiuting , Fan Xiuzhen
Published: August 2024

Aims

Inadequate preparedness of family caregivers contributes to adverse outcomes of patients with heart failure (HF). However, evidence on caregiver preparedness is limited. This study aims to examine the determinants and potential mechanisms of preparedness in family caregivers of patients with HF.

Methods and results

In the cross-sectional study, 298 HF patient–caregiver dyads were recruited from 4 tertiary hospitals in China. Preparedness, uncertainty in illness, family relational quality, social support, and positive aspects of caregiving (PAC) were assessed in family caregivers using self-reported questionnaires. In the path analysis model, uncertainty in illness had an indirect negative effect on preparedness via reduced PAC [indirect effect = −0.020; 95% confidence interval (CI) −0.050 to −0.002]. Whereas, family relational quality had direct (β = 0.266; P < 0.001) and indirect positive effects on preparedness through increased PAC (indirect effect = 0.027; 95% CI, 0.003–0.067). Similarly, social support also had direct (β = 0.184; P = 0.004) and indirect positive effects on preparedness through increased PAC (indirect effect = 0.027; 95% CI, 0.004–0.065).

Conclusion

This study highlights that diminishing uncertainty in illness may indirectly improve caregiver preparedness through the enhancement of PAC, while raising family relational quality and social support may improve caregiver preparedness both directly and indirectly by augmenting PAC. These findings provide insightful implications for healthcare professionals in developing tailored interventions to ameliorate preparedness in family caregivers of patients with HF.
Socio-economic status and head and neck cancer incidence in the Nordic countries
Authors: Nikkilä Rayan , Carpén Timo , Hansen Johnni , Heikkinen Sanna , Lynge Elsebeth , Martinsen Jan Ivar , Selander Jenny , Mehlum Ingrid Sivesind , Torfadóttir Jóhanna Eyrún , Mäkitie Antti , Pukkala Eero
Published: August 2024

Background

The impact of societal factors on the occurrence of head and neck cancers (HNCs) remains understudied, especially in the Nordic countries.

Methods

To quantify the association between socio-economic status (SES) and the occurrence of HNCs, this cohort study uses data from the Nordic Occupational Cancer project that combine occupational and cancer registry data from 1961 to 2005 of 14.9 million individuals aged between 30 and 64 years. Occupational categories were combined into seven socio-economic categories. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for the entire national study populations used as reference rates.

Results

Altogether, 83 997 HNCs—72% in men and 28% in women—were recorded. Among men, a gradient of risk associated with SES was observed for cancers of the tongue, other oral cavity subsites, pharynx, oropharynx and larynx in groups with lower SES. Managers showed decreased SIRs of 0.50 to –0.90 also for cancers of the lip, tongue, other oral cavity subsites, oropharynx, nasopharynx, nose and larynx. In contrast, excess risks of tongue, other oral cavity subsites, pharyngeal, oropharyngeal and laryngeal cancers were observed among clerical (SIRs 1.05–1.16), skilled workers (1.04–1.14), unskilled workers (1.16–1.26) and economically inactive men (1.38–1.87). Among women, no risk gradient similar to that in men was revealed.

Conclusions

The current study underscores the influence of SES on the incidence of HNCs and highlights the need for targeted interventions, including tobacco and alcohol control policies, and improved access to healthcare services, particularly for socio-economically disadvantaged populations.
Persistence of an Infectious Form of SARS-CoV-2 After Protease Inhibitor Treatment of Permissive Cells In Vitro
Authors: Nair Manoj S , Luck Maria I , Huang Yaoxing , Sabo Yosef , Ho David D
Published: August 2024

Reports have described severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rebound in coronavirus disease 2019 (COVID-19) patients treated with nirmatrelvir, a 3CL protease inhibitor. The cause remains a mystery, although drug resistance, reinfection, and lack of adequate immune responses have been excluded. We now present virologic findings that provide a clue to the cause of viral rebound, which occurs in approximately 20% of the treated cases. Persistence of infectious SARS-CoV-2 was experimentally documented in vitro after treatment with nirmatrelvir or another 3CL protease inhibitor, but not with a polymerase inhibitor, remdesivir. This infectious form decayed slowly with a half-life of approximately 1 day, suggesting that its persistence could outlive the treatment course to reignite SARS-CoV-2 infection as the drug is eliminated. Notably, extending nirmatrelvir treatment beyond 8 days abolished viral rebound in vitro. Our findings point in a particular direction for future investigation of virus persistence and offer a specific treatment recommendation that should be tested clinically.
Popular Control of Taxation, Accountability, and the Redefinition of Political Subordination (Germany, Seventeenth–Eighteenth Centuries)
Authors: Renault Rachel
Published: August 2024

Taxation is a well-known major instrument in the control of populations by powers, and in the collection of information about them. Starting from early modern Germany (Thuringia in the seventeenth and eighteenth centuries), I would like to show how it was also, conversely, an instrument of non-institutionalized control of the authorities by the taxpayers. By refusing to pay taxes to the Emperor, ordinary taxpayers constructed a means of negotiating political and social domination, creating a form of ordinary intelligence about the authorities’ practices, tax figures, and amounts and by making both of them public. What was at stake in those protest was indeed not only the burden of taxation, but also the transparency of its collection, the fairness (Billigkeit) of its distribution, and the delicate issue of tax consent. Transparency, equity, and consent were central, but debated political concepts, so that popular control also consisted of influencing the definition of those concepts and having a part in the definition of their concrete content. This also implies that popular control was neither marginal nor transitory, nor did build some kind of linear evolution towards modernity. While examining the specificities of the entangled configuration of power in Germany, which created specific forms of popular agency, this article would like to show how Empire taxation, as a regalian tool involving the definition of common good and the question of political representation, was a powerful vector for a demand for accountability from below, which aimed to redefine the conditions of subjection.
Rege Ribaldum: Participatory Punishment in the Pursuit of Urban Justice in Late Medieval Southern France
Authors: Turning Patricia
Published: August 2024

Utilizing the lens of popular control to assess criminal sentences highlights the significance of effective public agency in the later Middle Ages, instead of political oppression, especially in the urban realm. The people who inhabited cities played a participatory role in setting the parameters involved in the spectacles of judicial chastisement by accepting or rejecting what unfolded before them. And this became a way in which neighbors surveilled and corrected both the residents who lived in their midst, and the agents of authority expected to orchestrate restitution through performative executions. This article unpacks jurisdictional disputes from the city of Toulouse, in order to analyze the notion of accountability among the inhabitants and of citizens over judicial officers, especially in crimes involving contested sexuality. In 1332, for example, a customary punishment known as a rege ribaldum (where authorities forced a criminal to run the streets of the town) spiraled out of control at the hands of one of the spectators, resulting in a gruesome disfigurement. Rather than dismiss this event as senseless mob violence, concepts of popular control shed light on the cooperative element of the officers and their people as it informed the distribution of punishment, rooted in principles that were sometimes congruent, and sometimes not.
Introduction to Popular Control in Pre-modern Europe
Authors: Martín Romera María Ángeles , Sabapathy John
Published: August 2024

This introduction to a special issue on popular control in pre-modern Europe reviews both the contemporary resonance of the term in an era of reviving populism, and the conceptual challenges it poses for historians of all periods. It reconsiders the problem of the “popular,” the question of what constitutes effective control, and the relationship between collective and coordinated action. Briefly highlighting particular aspects of articles in the issue, it stresses above all the usefulness of thinking with concrete cases. Here those range from the late medieval Languedoc to eighteenth-century Germany via Castile, northern France, and England. Doing so helps us to see how popular control operated across a range of scales. It frequently developed from bottom-up political practice, often being articulated within a range of micro-sovereignties of different sorts. Here it remained volatile and plural within a set of shared but often contested norms. That volatility extended to those exercising popular control since they could pass into the ranks of those holding official powers just as, at other times, office-holders might equally be found amongst the ranks of those acting more informally.
Sex determination in bryophytes: current state of the art
Authors: Božović Djordje , Li Mingai , Sabovljević Aneta D , Sabovljević Marko S , Varotto Claudio
Published: August 2024

With the advent of genomic and other omics technologies, the last decades have witnessed a series of steady and important breakthroughs in the understanding of genetic determinants of different reproductive systems in vascular plants and especially on how sexual reproduction shaped their evolution. In contrast, the molecular mechanisms of these fundamental aspects of the biology of bryophytes, a group of non-vascular embryophyte plants sister to all tracheophytes, are still largely obscure. The recent characterization of the sex chromosomes and genetic switches determining sex in bryophytes and emerging approaches for molecular sexing of gametophytes hold great promise for elucidation of the evolutionary history as well as the conservation of this species-rich but understudied group of land plants.
quantizer: a new collisionless N-body code optimized for small-scale devices
Authors: Contreras Felipe , Candlish Graeme , Bunte Kerstin
Published: August 2024

We present quantizer, a new collisionless N-body code tailored for cosmological and galaxy-scale simulations. The code uses the particle-mesh method, combined with a novel adaptive mesh refinement (AMR) technique. The design of the AMR method of quantizer maximizes the efficient use of refinement zones by combining a cell-by-cell scheme with parallelization-friendly regular patches. We test the code using three astrophysical systems: a binary system of two particles without AMR to test orbital accuracy; an isolated elliptical galaxy modelled as a Plummer sphere; and a merger of two disc galaxies. Comparisons are made with the well-known particle-mesh AMR code ramses, and with our own direct particle-particle solver. The results show that the accuracy of quantizer is equal to or better than ramses, and the runtime is approximately 2.5 to 10 times faster than that code, depending on the problem.
Metallicities for globular clusters in the fornax, sagittarius, and canis major dwarf spheroidal galaxies and their total luminosities
Authors: Sarajedini Ata
Published: August 2024

We present [Fe/H] values for globular clusters associated with the Fornax, Sagittarius, and Canis Major dwarf spheroidal galaxies based on the light curve properties of their ab-type RR Lyrae variables. Fornax is a classical dwarf spheroidal containing five globular clusters and exhibiting a spheroidal shape in the sky. Sagittarius and Canis Major, possess six and four globular clusters, respectively, and have both been tidally disrupted to a significant degree by the gravitational field of the Milky Way galaxy. Based on an analysis of the periods and light curve amplitudes of 76 globular cluster ab-type RR Lyraes in Fornax, 103 in Sagittarius, and 29 in Canis Major, we find mean metallicities of $\langle$[Fe/H]$\rangle$ = –1.67 ± 0.05, –1.76 ± 0.12, and –1.69 ± 0.25 for the globular clusters in Fornax, Sagittarius, and Canis Major, respectively. Given the similarity of these three values, and coupled with the well-established correlation between the mean metal abundance and total luminosity for dwarf spheroidal galaxies, we conclude that the absolute V-band magnitudes of these three galaxies are indistinguishable to within ∼0.8 mag.
Molecular delimitation of cryptic Australian squid species of the genus Uroteuthis Rehder, 1945 (Cephalopoda: Loliginidae), provides a baseline of diversity to resolve classification challenges throughout the Indo-Pacific
Authors: Morgan Jess A T , Dunning Malcolm C , Ovenden Jennifer R , Broderick Damien , Street Raewyn , Davies Julia , Hall Karina C
Published: August 2024

This study provides a comprehensive molecular phylogenetic analysis of Uroteuthis squid from the Indo-Pacific region. The main aim was to increase sample coverage from northern and eastern Australian waters to resolve the identity and distribution of Uroteuthis species taken by local fisheries. Two mitochondrial regions, cytochrome c oxidase subunit I (COI) and 16S ribosomal RNA (16S rRNA), were sequenced from 220 new specimens and analysed with a further 51 sequences from GenBank to create a combined phylogeny for the genus. Three nuclear regions, 18S ribosomal DNA (18S rDNA), 28S ribosomal DNA (28S rDNA) and rhodopsin, were also sequenced from representatives of each species. Based on the mitochondrial phylogeny plus distance and tree-based delimitation models, a COI species barcode gap of 4–5% is proposed for discriminating Uroteuthis species. Applying this gap partitioned many described species into species complexes; for example, U. duvaucelii, U. noctiluca and U. edulis resolved into 10 species. Although more conserved, mitochondrial 16S rRNA sequences differentiated all new species clades, whereas none of the nuclear markers resolved the closest species. Results confirm that neither U. chinensis nor U. edulis occurs in Australian waters. Five undescribed species are identified from northern and eastern Australia, of which four are consistent with earlier allozyme studies (and two align with existing DNA sequences). One is a new southeastern, deeper shelf species differentiated in this study, along with a sixth undescribed species from Indonesian waters. Results of the molecular analysis are now being used to inform complementary morphometric analyses for new species descriptions, and genetic stock structure assessments of these important fisheries resources.
Effect of Sound Genre on Emotional Responses for Adults With and Without Hearing Loss
Authors: Marcrum Steven C. , Rakita Lori , Picou Erin M.
Published: August 2024

Objectives:

Adults with permanent hearing loss exhibit a reduced range of valence ratings in response to nonspeech sounds; however, the degree to which sound genre might affect such ratings is unclear. The purpose of this study was to determine if ratings of valence covary with sound genre (e.g., social communication, technology, music), or only expected valence (pleasant, neutral, unpleasant).

Design:

As part of larger study protocols, participants rated valence and arousal in response to nonspeech sounds. For this study, data were reanalyzed by assigning sounds to unidimensional genres and evaluating relationships between hearing loss, age, and gender and ratings of valence. In total, results from 120 adults with normal hearing (M = 46.3 years, SD = 17.7, 33 males and 87 females) and 74 adults with hearing loss (M = 66.1 years, SD = 6.1, 46 males and 28 females) were included.

Results:

Principal component analysis confirmed valence ratings loaded onto eight unidimensional factors: positive and negative social communication, positive and negative technology, music, animal, activities, and human body noises. Regression analysis revealed listeners with hearing loss rated some genres as less extreme (less pleasant/less unpleasant) than peers with better hearing, with the relationship between hearing loss and valence ratings being similar across genres within an expected valence category. In terms of demographic factors, female gender was associated with less pleasant ratings of negative social communication, positive and negative technology, activities, and human body noises, while increasing age was related to a subtle rise in valence ratings across all genres.

Conclusions:

Taken together, these results confirm and extend previous findings that hearing loss is related to a reduced range of valence ratings and suggest that this effect is mediated by expected sound valence, rather than sound genre.
Current efforts and historical perspectives on classification of idiopathic inflammatory myopathies
Authors: Glaubitz Stefanie , Saygin Didem , Lundberg Ingrid E.
Published: August 2024

Purpose of review

The classification of idiopathic inflammatory myopathies is challenging due to the large number of clinical, serological, histopathological and genetic findings, as well as the latest findings and developments in the field of myositis research. The latest official classification criteria are the 2017 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) classification criteria for adult and juvenile idiopathic inflammatory myopathies, which have been extensively reviewed in recent years for their applicability, sensitivity and specificity.

Recent findings

The sensitivity and specificity of the 2017 ACR/EULAR criteria are sometimes performing better, but usually at the same level as the previous criteria. A large number of further suggestions for amendments to the criteria have been made. In particular there is a need to revise the criteria with regard to the addition of new myositis-specific autoantibodies, newly defined subgroups (especially antisynthetase syndrome, immune medicated necrotizing myopathy and overlap myositis) and possibly the addition of further diagnostic procedures (for instance, muscle MRI or PET CT) to improve the accuracy and timeliness of the criteria.

Efforts to optimize the myositis classification criteria have been extensive in recent years and a new global interdisciplinary collaboration of clinicians is currently taking place based on the previous results with the aim of revising the 2017 EULAR/ACR classification criteria.
Buckling of the Ligamentum Flavum in Patients with Lumbar Spinal Canal Stenosis
Authors: Yabe Yutaka , Ishikawa Keisuke , Kurosawa Daisuke , Murakami Eiichi , Aizawa Toshimi
Published: August 2024

Study Design.

Experimental study.

Objective.

We sought to elucidate the association between ligamentum flavum thickening and tissue buckling, and the clinical and imaging factors related to buckling by comparing the ligamentum flavum thickness on MRI images and within the actual tissue.

Summary of Background Data.

Ligamentum flavum thickening is a main contributor to lumbar spinal canal stenosis. Buckling of the tissue may contribute to ligamentum flavum thickening along with tissue hypertrophy; however, this association has not been established conclusively.

Materials and Methods.

Ligamentum flavum samples (135 ligament samples) from 70 patients with lumbar spinal canal stenosis were evaluated. The ligamentum flavum thicknesses on magnetic resonance imaging (MRI) and in the tissue samples were compared to assess for the presence of buckling. The ligamentum flavum samples were divided into groups with or without buckling based on the difference between their thicknesses on MRI and in the tissues. The Pearson correlation coefficient test was used to assess the relationships between the LF thicknesses on MRI and in the tissues, MRI-tissue difference and LF thickness in the tissues, and MRI-tissue difference and LF thickness on MRI. Further, differences between the buckling+ and buckling– groups were compared using the unpaired t-test (LF thickness on MRI, LF thickness in the tissues, age, disc angle, and disc height) and χ2 (disc level, disc degeneration, and receival/nonreceival of dialysis) test.

Results.

The ligamentum flavum thickness on MRI and in the tissues had a positive linear relationship, although the thickness was estimated to be significantly larger on MRI than in the tissues themselves. The ligamentum flavum with buckling had a larger thickness on MRI, less tissue hypertrophy, more severe disc degeneration, and was present in patients with a higher rate of dialysis. There were no differences in age and disc height, angle, or level between the two groups.

Conclusions.

Buckling of the ligamentum flavum coexists with tissue hypertrophy and contributes to perceived ligamentum thickening on imaging. Buckling of the ligamentum flavum tends to occur in less hypertrophied tissues and is associated with the grade of disc degeneration and the presence of other characteristics associated with spinal degeneration.
Incorporating Patient Values in Large Language Model Recommendations for Surrogate and Proxy Decisions
Authors: Nolan Victoria J. , Balch Jeremy A. , Baskaran Naveen P. , Shickel Benjamin , Efron Philip A. , Upchurch Gilbert R. , Bihorac Azra , Tignanelli Christopher J. , Moseley Ray E. , Loftus Tyler J.
Published: August 2024

Background:

Surrogates, proxies, and clinicians making shared treatment decisions for patients who have lost decision-making capacity often fail to honor patients’ wishes, due to stress, time pressures, misunderstanding patient values, and projecting personal biases. Advance directives intend to align care with patient values but are limited by low completion rates and application to only a subset of medical decisions. Here, we investigate the potential of large language models (LLMs) to incorporate patient values in supporting critical care clinical decision-making for incapacitated patients in a proof-of-concept study.

Methods:

We simulated text-based scenarios for 50 decisionally incapacitated patients for whom a medical condition required imminent clinical decisions regarding specific interventions. For each patient, we also simulated five unique value profiles captured using alternative formats: numeric ranking questionnaires, text-based questionnaires, and free-text narratives. We used pre-trained generative LLMs for two tasks: 1) text extraction of the treatments under consideration and 2) prompt-based question-answering to generate a recommendation in response to the scenario information, extracted treatment, and patient value profiles. Model outputs were compared with adjudications by three domain experts who independently evaluated each scenario and decision.

Results and Conclusions:

Automated extractions of the treatment in question were accurate for 88% (n = 44/50) of scenarios. LLM treatment recommendations received an average Likert score by the adjudicators of 3.92 of 5.00 (five being best) across all patients for being medically plausible and reasonable treatment recommendations, and 3.58 of 5.00 for reflecting the documented values of the patient. Scores were highest when patient values were captured as short, unstructured, and free-text narratives based on simulated patient profiles. This proof-of-concept study demonstrates the potential for LLMs to function as support tools for surrogates, proxies, and clinicians aiming to honor the wishes and values of decisionally incapacitated patients.
Assessment of Missing Data on Glaucoma Severity Among Participants in the NIH All of Us Research Program of the United States
Authors: Acuff Kaela N. , Radha Saseendrakumar Bharanidharan , Weinreb Robert N. , Baxter Sally L.
Published: August 2024

Précis:

There were statistically significant differences across multiple socioeconomic characteristics and self-reported barriers to care among primary glaucoma patients with severity staging data versus those missing this data in the NIH All of Us database.

Purpose:

To characterize missing data among glaucoma patients within All of Us.

Materials and Methods:

We used diagnosis codes to define cohorts of primary glaucoma patients with and without severity staging specified. Descriptive analyses were conducted by presence of disease severity stage. Analysis of missing data was conducted using a set intersection plot and the Little Test of Missing Completely at Random. T tests were performed to evaluate differences.

Results:

Of 2982 participants, 1714 (57%) did not have glaucoma severity stage specified, and 11 of 23 analyzed variables had missing data. The Little Test indicated data was not missing completely at random (P<0.001). Significant differences existed between the 2 cohorts with respect to age, age of first glaucoma diagnosis, gender, ethnicity, education, income, insurance, history of glaucoma surgery and medication use, and answers regarding the ability to afford eyeglasses and having seen an eye care provider in the last 12 months (all P-values ≤0.01).

Conclusion:

There were significant differences between glaucoma participants with glaucoma severity stage specified versus those with unstaged disease across multiple socioeconomic characteristics and self-reported barriers to care. Glaucoma severity staging data was not missing completely at random. The unstaged cohort included higher rates of multiple underrepresented communities, which may potentially contribute to bias in ophthalmology research as participants from vulnerable populations may be disproportionately excluded from electronic health records or claims data studies where diagnosis codes with severity/staging levels are used to examine risk factors for disease, progression, and treatment efficacy.
Reporting and Management of Equinus Deformity After Partial Foot Amputation: A Scoping Review
Authors: Hickson Taylor N. , Kenworthy Sally A. , Finco M.G. , Mullen Ashley H.
Published: August 2024

Introduction

Partial foot amputation (PFA) is a common strategy used to preserve limb length for patients requiring lower-limb amputation. Equinus development following PFA results in complications that may be addressed perioperatively or postoperatively. We sought to evaluate how equinus deformity was reported in recent literature related to PFA. If it was reported, we sought to document how it was measured and/or treated.

Methods

A search of the literature was conducted on February 15, 2023, using PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete online databases. Studies related to PFA were analyzed following scoping review guidelines.

Results

Literature from January 1, 2013 to February 15, 2023, were included in the analysis. Twenty-seven studies reported how equinus deformity following PFA was measured, reported, or treated perioperatively, postoperatively, and/or with orthotic or prosthetic intervention.

Conclusions

Although there is general consistency in reporting practices regarding development of equinus deformity following amputation at the transmetatarsal level, additional research is necessary for the standardization of reporting practices following Lisfranc and Chopart amputations to further inform clinical considerations.

Clinical Relevance

This scoping review highlights a lack of standardization of reporting practices and orthotic/prosthetic interventions for management of equinus deformity following Lisfranc and Chopart amputations.
A tale of 2 diseases: ALD and MASLD requirements and monitoring for liver transplantation
Authors: Robinson Benjamin L. , Ciobanu Camelia , Brown Jr. Robert S. , Russo Mark W.
Published: August 2024

The requirements for eligibility and monitoring before and after liver transplantation for alcohol-associated liver disease (ALD) and metabolic dysfunction–associated steatotic liver disease (MASLD) are different and not as well defined for MASLD as they are for ALD. Two groups of patients with ALD considered for liver transplant (LT) include those with decompensated cirrhosis from alcohol and those with severe alcohol-associated hepatitis. Both groups are required to commit to lifelong abstinence from alcohol. Pretransplant eligibility criteria for LT in those with ALD varies between transplant centers, but generally, a period of alcohol abstinence with or without counseling is required to be considered for an LT, or the candidate must meet specific requirements. In contrast to ALD, the pre-LT requirements for patients with MASLD, such as weight loss goals or control of metabolic diseases, are not as well defined. Reviews and consensus statements on MASLD and LT discuss risk stratification and management for conditions associated with MASLD, but there are no consensus recommendations regarding obesity and metabolic disease goals before and after transplant. Candidates and recipients of LT may be held to more stringent requirements and monitoring for alcohol use compared to weight loss goals and metabolic parameters advised for patients with MASLD. Because of the disparities in requirements between ALD and MASLD, consensus recommendations should be developed for pre-LT and post-LT monitoring and requirements for candidates and recipients with MASLD.
Lung transplant referral considerations for individuals with cystic fibrosis
Authors: McLafferty Fred S. , Gray Alice L.
Published: August 2024

Purpose of review

The cystic fibrosis (CF) Foundation issued guidelines to promote timely lung transplant referral for people with cystic fibrosis (pwCF) in 2019. Since then more has been published to help refine this complex decision. The goal of this review is to summarize the recent literature informing disease severity in CF, barriers to referral for pwCF and guide timely and appropriate lung transplant referrals.

Recent Findings

Existing guidelines utilize the degree of airflow limitation as the primary criteria to refer for lung transplant, yet this variable has some prognostic uncertainty. Novel prognostic tools may provide more reliable metrics for predicting who with CF is at greatest risk of dying from their lung disease and could be used as an indicator for when to refer. In addition, updated analyses of national registry data have highlighted the significance of hemoptysis, low body mass index, and extra-pulmonary organ failure, as important prognostic markers. PwCF with these complications have historically been under-referred for lung transplant despite data suggesting lung transplant can be safe for some in these populations. Early referral should be considered in the presence of these complications.

This review builds on existing guidelines by incorporating novel data to better determine when lung transplant referral is most appropriate. Improved prognostic tools are still needed to decrease the chances of pwCF dying without consideration of lung transplant. It is still unclear how novel therapies for CF may change the need and timing for lung transplant referral.
The impact of chronic kidney disease on cognitive function
Authors: Pépin Marion , Levassort Hélène , Massy Ziad A.
Published: August 2024

Purpose of review

The risk of cognitive impairment is higher in people with CKD than in the general population. The complex relationship between CKD and cognitive dysfunction has not been extensively characterized. Here, we review epidemiological associations, specific patterns of CKD-related cognitive impairment, the underlying mechanisms, and recently published data on relevant biomarkers.

Recent findings

Despite some discrepancies, recent published studies have confirmed that CKD is associated with cognitive function (e.g. incident cognitive events). Although patients with CKD often exhibit impairments in executive functions and attention, it is noteworthy that other cognitive functions (e.g. memory) can be preserved. The key mechanisms described recently include vascular damage, genetic factors, the accumulation of uremic toxins, disruption of the blood–brain barrier, glymphatic system dysfunction, and changes in the gut–brain axis. Kidney function is increasingly seen as a game changer in the interpretation of biomarkers of cognitive impairment and, especially, hallmarks of Alzheimer disease.

The data reviewed here highlight the need for interdisciplinary collaboration between nephrologists and neurologists in the care of patients with CKD at risk of cognitive impairment. In order to further improving diagnosis and therapy, future research must elucidate the mechanisms underlying the CKD–cognitive impairment association and confirm the value of biomarkers.