bluuebunny/crossref_metadata_2025 huggingface dataset:
Smoking
Authors: Benatar David
Published: July 2024

This chapter discusses the ethics of smoking (tobacco). There are ethical questions to be asked even when one smokes alone. However, the chapter focuses on smoking in the presence of non-smokers. There are two kinds of arguments against the permissibility of smoking in the presence of others—a harm-based argument and an offence-based argument. The chapter considers and rejects the objection that the risk increment to non-smokers is too negligible to impose a duty on the smoker. (This involves a comparison with car pollution.) Although offence arguments are typically weaker than harm arguments, it is argued that the particular kind of offence caused by smoke, along with some other factors, can ground a duty not to smoke in the presence of others. Attention is also given to electronic cigarettes, to obtaining consent from non-smokers to smoke in their presence, and to some additional ethical issues to which smoking gives rise.
Consequences and management of guidewire fracture—entrapment in the left circumflex artery: a case report
Authors: Paul Mathews
Published: July 2024

Background

Entrapment and fracture of the coronary guidewire are rare but major complications of percutaneous coronary intervention (PCI). The incidence of these complications is reported to be <1%.

Case summary

A 52-year-old male patient with diabetes and dyslipidaemia presented with posterior wall myocardial infarction. An angiogram revealed occlusion in the left circumflex (LCX) artery. Attempts to pass a guidewire through the lesion led to its entrapment and eventual fracture. Several techniques and manoeuvres failed to retrieve the fractured guidewire, which remained lodged in the LCX. An endovascular snare catheter also proved unsuccessful. The fragment was eventually removed using the triple-wire technique, although this caused coronary perforation and dissection. The perforation was identified and stented. A subsequent stent addressed a dissection in the left main/left ascending artery area, likely caused by the coronary snare. These interventions were crucial in stabilizing the patient’s condition, leading to recovery with a left ventricular ejection fraction of 50% and a viable LCX artery. The patient exhibited an uneventful progression at the 1-year follow-up.

Discussion

Coronary guidewire fracture during PCI is a rare event often associated with coronary calcifications. Percutaneous removal remains the mainstay treatment for fragment removal; however, it carries risks. The triple-wire technique, a newer method that entangles and extracts the fractured guidewire without specialized equipment, was effective in removing the fragmented guidewire. If asymptomatic, leaving the wire in situ is documented as a favourable approach. This case highlights that the triple-wire technique can effectively be used for the extraction of fractured guidewire fragments from the coronary vessels.
Awareness, information sources, and beliefs regarding palliative care in the general population in Japan: a nationwide cross-sectional survey (INFORM study 2023)
Authors: Uneno Yu , Mori Masanori , Saito Junko , Otsuki Aki , Kuchiba Aya , Sakurai Naomi , Nakaya Naoki , Fujimori Maiko , Shimazu Taichi ,   INFORM Study 2023 Group
Published: July 2024

Background

The diversification of information sources and changes in social structures necessitates updates on the state of public awareness of palliative care. Therefore, we clarified the status and determinants of awareness, information sources, and beliefs, regarding palliative care in Japan.

Methods

This nationwide cross-sectional survey included 10 000 participants aged ≥20 years enrolled through random sampling using a two-stage stratification in 2023. We used a mailed self-administered questionnaire (INFORM Study 2023). The questionnaire items were selected (partially modified) from the Health Information National Trends Survey (USA) to ensure comparability, included palliative care awareness, information sources, and beliefs. Weighted logistic regression was conducted to explore the determinants of awareness.

Results

Of the 3452 participants that responded (response rate: 35.3%), 65.2% had palliative care awareness. The weighted logistic regression analysis revealed that respondents less likely to have any palliative care awareness were younger, were male, had limited education history, had lower household income, and were non-Internet users. Of these, sex had the clear association (adjusted odds ratio for female vs. male: 3.20 [95% CI: 2.66–3.85]). Across all age groups, healthcare professionals (58.5%) and the Internet (30.5%) were the most trusted source of information. Younger participants frequently received information online. Most participants believed that palliative care was beneficial, although 82.0% associated it with death.

Conclusions

The Japanese population had a relatively high palliative care awareness, with the majority trusting information from healthcare professionals rather than the Internet. Further efforts are warranted to address barriers to receiving trustworthy palliative care information.
Vibration Control Solutions for Microscopy
Authors: Morgan John , Wigglesworth Wes
Published: July 2024

Vibration is always present in our environment at some level. It can have a deleterious effect on all types of microscopes and should always be considered when installing a microscope in a facility. Some microscope manufacturers, particularly those who make charged electron or particle beam microscopes, have detailed vibration specifications; others do not. In this article we discuss sources of vibration, techniques for mitigating vibration, and some general rules about which types of vibration control to use based on the type of microscope being used.
Tests of subgrid models for star formation using simulations of isolated disc galaxies
Authors: Nobels Folkert S J , Schaye Joop , Schaller Matthieu , Ploeckinger Sylvia , Chaikin Evgenii , Richings Alexander J
Published: July 2024

We use smoothed particle hydrodynamics simulations of isolated Milky Way-mass disc galaxies that include cold, interstellar gas to test subgrid prescriptions for star formation (SF). Our fiducial model combines a Schmidt law with a gravitational instability criterion, but we also test density thresholds and temperature ceilings. While SF histories are insensitive to the prescription for SF, the Kennicutt–Schmidt (KS) relations between SF rate and gas surface density can discriminate between models. We show that our fiducial model, with an SF efficiency per free-fall time of 1 per cent, agrees with spatially resolved and azimuthally averaged observed KS relations for neutral, atomic, and molecular gas. Density thresholds do not perform as well. While temperature ceilings selecting cold, molecular gas can match the data for galaxies with solar metallicity, they are unsuitable for very low-metallicity gas and hence for cosmological simulations. We argue that SF criteria should be applied at the resolution limit rather than at a fixed physical scale, which means that we should aim for numerical convergence of observables rather than of the properties of gas labelled as star-forming. Our fiducial model yields good convergence when the mass resolution is varied by nearly 4 orders of magnitude, with the exception of the spatially resolved molecular KS relation at low surface densities. For the gravitational instability criterion, we quantify the impact on the KS relations of gravitational softening, the SF efficiency, and the strength of supernova feedback, as well as of observable parameters such as the inclusion of ionized gas, the averaging scale, and the metallicity.
Sulphur storage in cold molecular clouds: the case of the NH4+SH- salt on interstellar dust grains
Authors: Vitorino J , Loison J -C , Wakelam V , Congiu E , Dulieu F
Published: July 2024

In comets and in the cold phase of the interstellar medium (ISM), ammonium salts are key molecular species due to their role in the retention of volatile compounds on cold surfaces. In the case of sulphur, the H$_2$S/OCS ratio observed in protostars could be explained by the presence of ammonium hydrosulphide (NH$_4$SH) salts. However, laboratory data on the properties of NH4SH in ISM cold relevant conditions are rather scarce, as they usually focus on the atmosphere of Jupiter. We propose to consolidate the laboratory data regarding NH$_4$SH on grains, by performing temperature programmed desorption experiments and Fourier transform infrared reflection spectroscopy. The salt was also exposed to H atoms to mimic the ISM conditions. NH$_4$SH was found to form in situ at 10 K, from a mixture of ammonia (NH$_3$) and hydrogen sulphide (H$_2$S). The NH$_4^+$ infrared feature (1485 cm$^{-1}$) is the most prominent one at 80 K. As pure species, H$_2$S and NH$_3$ desorb at 76 and 90 K, respectively, whereas they are released into the gas phase at 153 K when adsorbed in the form of salt. The presence of water delays the desorption of the salt until the very end of the water desorption, but does not affect the desorption kinetics. During H-exposure, the salt is dissociated and no new product was detected. As a comparative study, salts have been included in the Nautilus gas–grain model. The results show a good correlation with the observations of IRAS 16293−2422B, as opposed to when NH$_4$SH is not included in the model.
PhyloAln: A Convenient Reference-Based Tool to Align Sequences and High-Throughput Reads for Phylogeny and Evolution in the Omic Era
Authors: Huang Yu-Hao , Sun Yi-Fei , Li Hao , Li Hao-Sen , Pang Hong
Published: July 2024

The current trend in phylogenetic and evolutionary analyses predominantly relies on omic data. However, prior to core analyses, traditional methods typically involve intricate and time-consuming procedures, including assembly from high-throughput reads, decontamination, gene prediction, homology search, orthology assignment, multiple sequence alignment, and matrix trimming. Such processes significantly impede the efficiency of research when dealing with extensive data sets. In this study, we develop PhyloAln, a convenient reference-based tool capable of directly aligning high-throughput reads or complete sequences with existing alignments as a reference for phylogenetic and evolutionary analyses. Through testing with simulated data sets of species spanning the tree of life, PhyloAln demonstrates consistently robust performance compared with other reference-based tools across different data types, sequencing technologies, coverages, and species, with percent completeness and identity at least 50 percentage points higher in the alignments. Additionally, we validate the efficacy of PhyloAln in removing a minimum of 90% foreign and 70% cross-contamination issues, which are prevalent in sequencing data but often overlooked by other tools. Moreover, we showcase the broad applicability of PhyloAln by generating alignments (completeness mostly larger than 80%, identity larger than 90%) and reconstructing robust phylogenies using real data sets of transcriptomes of ladybird beetles, plastid genes of peppers, or ultraconserved elements of turtles. With these advantages, PhyloAln is expected to facilitate phylogenetic and evolutionary analyses in the omic era. The tool is accessible at https://github.com/huangyh45/PhyloAln.
Enhanced surveillance for the detection of psoriatic arthritis in a UK primary care psoriasis population: results from the TUDOR trial
Authors: McHugh Neil , Tillett William , Helliwell Philip , Packham Jonathan , Collier Howard , Davies Claire , Ransom Myka , Coates Laura , Brown Sarah T ,   PROMPT study group
Published: July 2024

Background

Our objective was to determine whether early detection of undiagnosed psoriatic arthritis (PsA) in a primary care psoriasis population improves outcome in physical function at 24 months post-registration.

Methods

A multicentre, prospective, parallel group cluster randomised controlled trial in patients with psoriasis was conducted. Participants with suspected inflammatory arthritis on screening were referred for an assessment of PsA (enhanced surveillance (ES) arm: at baseline, 12 and 24 months; standard care (SC) arm: at 24 months). The primary outcome measure was the Health Assessment Questionnaire Disability Index (HAQ-DI) at 24 months post registration in participants diagnosed with PsA.

Results

A total of 2225 participants across 135 GP practices registered: 1123 allocated to ES and 1102 to SC. The primary analysis population consisted of 87 participants with a positive diagnosis of PsA: 64 in ES, 23 in SC. The adjusted odds ratio (OR) for achieving a HAQ-DI score of 0 at 24 months post registration in ES compared with SC was 0.64 (95% CI (0.17, 2.38)), and the adjusted OR of achieving a higher (non-zero) HAQ-DI score at 24 months post registration in ES relative to SC arm was 1.12 (95% CI: 0.67, 1.86), indicating no evidence of a difference between the two treatment groups (p= 0.66).

Conclusion

The trial was underpowered for demonstrating the prespecified treatment effect; in patients with psoriasis there was no evidence that early diagnosis of PsA by ES in primary care changes physical function at 24 months compared with SC.

Clinical Trial Registration

The TUDOR trial is registered as ISRCTN38877516.
The effect of academic outcomes, equity, and student demographics on parental preferences for schools: evidence from a survey experiment
Authors: Thompson Marissa E
Published: July 2024

How does competition for school resources, along with racial and socioeconomic biases, shape parental preferences for schools? In this article, I investigate how school attributes affect preferences and choice, which sheds light on the processes that maintain school segregation. To do so, I conduct a survey experiment that explores parental preferences and the tradeoffs inherent in the process of school selection using school profiles that resemble those available on widely used education data platforms. I find that parents hold the strongest positive preferences for learning opportunities and overall school achievement compared to other attributes, including school racial and socioeconomic composition. Additionally, though parents prefer schools that have higher equity rankings, highly equitable schools are less desirable to parents than schools with more status and learning opportunities. However, parents also hold independent racial and socioeconomic preferences and —on average—avoid schools with more students of color and low-income students. Furthermore, results suggest they are largely unwilling to make tradeoffs that would result in schools with higher fractions of students of color or low-income students. Taken together, this study links prior studies on the segregating effects of educational data with literatures on school segregation by illustrating the specific dimensions that drive school choice.
Morin attenuates arsenic-induced toxicity in 3T3 embryonic fibroblast cells by suppressing oxidative stress, inflammation, and apoptosis: In vitro and silico evaluations
Authors: Unsal Velid , Cicek Mustafa , Aktepe Necmettin , Oner Erkan
Published: July 2024

This study aims to investigate the curative effects of Morin, a flavonoid, against arsenic toxicity in 3T3 embryonic fibroblast cells and its effect on the molecular mechanisms of cells. The cytotoxicity and viability of the cells were measured by MTT and LDH tests. Arsenic (0.74 μM) was used to trigger toxicity and Morin (50 μM) was used for treatment. The levels of oxidative stress biomarkers and the activities of antioxidant enzymes were measured by spectrophotometric method, and inflammatory markers were measured by ELISA method. While mRNA expression levels of Bax, Bcl-2 levels, and Caspase-3 activity were measured by qRT-PCR technique, TUNEL staining was performed to detect DNA breaks and DAPI staining to visualize nuclear changes. Protein structures were retrieved from the protein data bank. OpenBabel and Autodock programs were used for the molecular docking study. Morin rescued the 3T3 embryonic fibroblast cells exposed to arsenic. However, Arsenic decreased the activities of antioxidant enzymes in cells and significantly increased oxidative stress, inflammation, and apoptosis. Morin treatment reduced oxidative damage and TNF-α and IL-1β levels. Arsenic-induced Caspase-3 mRNA expression level and Bax protein mRNA expression level were significantly increased, while Bcl-2 mRNA expression level was significantly decreased. While Caspase-3 mRNA expression level and Bax protein mRNA expression level decreased with morin treatment, Bcl-2 mRNA expression level increased significantly. Molecular docking study results showed good binding affinity of morin in SOD, GSH-Px, Bax, Bcl-2, Caspase-3, TNF-α, and IL-1β structures. Morin showed antioxidant, anti-inflammatory, and anti-apoptotic effects against Arsenic-induced cellular toxicity.
The Development of Spinal Endoscopic Ultrasonic Imaging System With an Automated Tissue Recognition Algorithm
Authors: Jiang Chang , Xiang Yiwei , Zhang Zhiyang , Cao Yuanwu , Xu Nixi , Chen Yinglun , Yao Jiaqi , Jiang Xiaoxing , Ding Fang , Zheng Rui , Chen Zixian
Published: July 2024

Study Design:

Preclinical experimental study.

Objective:

To develop an intraoperative ultrasound-assisted imaging device, which could be placed at the surgical site through an endoscopic working channel and which could help surgeons recognition of different tissue types during endoscopic spinal surgery (ESS).

Summary of Background Data:

ESS remains a challenging task for spinal surgeons. Great proficiency and experience are needed to perform procedures such as intervertebral discectomy and neural decompression within a narrow channel. The limited surgical view poses a risk of damaging important structures, such as nerve roots.

Methods:

We constructed a spinal endoscopic ultrasound system, using a 4-mm custom ultrasound probe, which can be easily inserted through the ESS working channel, allowing up to 10 mm depth detection. This system was applied to ovine lumbar spine samples to obtain ultrasound images. Subsequently, we proposed a 2-stage classification algorithm, based on a pretrained DenseNet architecture for automated tissue recognition. The recognition algorithm was evaluated for accuracy and consistency.

Results:

The probe can be easily used in the ESS working channel and produces clear and characteristic ultrasound images. We collected 367 images for training and testing of the recognition algorithm, including images of the spinal cord, nucleus pulposus, adipose tissue, bone, annulus fibrosis, and nerve roots. The algorithm achieved over 90% accuracy in recognizing all types of tissues with a Kappa value of 0.875. The recognition times were under 0.1 s using the current configuration.

Conclusion:

Our system was able to be used in existing ESS working channels and identify at-risk spinal structures in vitro. The trained algorithms could identify 6 intraspinal tissue types accurately and quickly. The concept and innovative application of intraoperative ultrasound in ESS may shorten the learning curve of ESS and improve surgical efficiency and safety.
Modeling Plutonium Decorporation in a Female Nuclear Worker Treated with Ca-DTPA after Inhalation Intake
Authors: Dumit Sara , Avtandilashvili Maia , McComish Stacey L. , Miller Guthrie , Swanson Jasen , Tolmachev Sergey Y.
Published: July 2024

The present work models plutonium (Pu) biokinetics in a female former nuclear worker. Her bioassay measurements are available at the US Transuranium and Uranium Registries. The worker was internally exposed to a plutonium-americium mixture via acute inhalation at a nuclear weapons facility. She was medically treated with injections of 1 g Ca-DTPA on days 0, 5, and 14 after the intake. Between days 0 and 20, fecal and urine samples were collected and analyzed for 239Pu and 241Am. Subsequently, she was followed up for bioassay monitoring over 14 y, with additional post-treatment urine samples collected and analyzed for 239Pu. The uniqueness of this dataset is due to the availability of: (1) both early and long-term bioassay data from a female with plutonium intake; (2) data on chelation therapy for a female; and (3) fecal measurement results. Chelation therapy with Ca- and/or Zn-salts of DTPA is known to aid in reducing the internal radiation dose by enhancing the excretion of plutonium and americium from the body. Such enhancement affects plutonium biokinetics in the human body, posing a challenge to the internal dose assessment. The current radiation dose assessment practice is to exclude the data affected by Ca-DTPA from the analysis. The present analysis is the first to explicitly model the chelation-affected bioassay data in a female by using a newly developed chelation model. Thus, the bioassay data collected during and after the Ca-DTPA administrations were used for biokinetic modeling and dose assessment. The Markov Chain Monte Carlo method was used to investigate model parameter uncertainty, based on the bioassay data and assumed prior probability distributions. A χ
2/nData (number of data points) ≈ 1 was observed in this study, which indicates self-consistency of the data with the model. Results of this study show that the worker’s 239Pu intake was 12 Bq, with a committed effective dose to the whole-body of 1.2 mSv and a committed equivalent dose to the bone surfaces, liver, and lungs of 37.8, 9.1, and 0.8 mSv, respectively. This study also discusses the worker’s dose reduction due to chelation treatment.
Diffusion tensor imaging biomarkers and clinical assessments in amyotrophic lateral sclerosis (ALS) patients: an exploratory study
Authors: Pezeshgi Saharnaz , Ghaderi Sadegh , Mohammadi Sana , Karimi Narges , Ziaadini Bentolhoda , Mohammadi Mahdi , Fatehi Farzad
Published: July 2024

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive loss of upper and lower motor neurons. Biomarkers are needed to improve diagnosis, gauge progression, and evaluate treatment. Diffusion tensor imaging (DTI) is a promising biomarker for detecting microstructural alterations in the white matter tracts. This study aimed to assess DTI metrics as biomarkers and to examine their relationship with clinical assessments in patients with ALS. Eleven patients with ALS and 21 healthy controls (HCs) underwent 3T MRI with DTI. DTI metrics, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD), were compared between key motor and extra-motor tract groups. Group comparisons and correlations between DTI metrics also correlated with clinical scores of disability (ALSFRS-R), muscle strength (dynamometry), and motor unit loss (MUNIX). Widespread differences were found between patients with ALS and HCs in DTI metrics, including decreased FA and increased diffusivity metrics. However, MD and RD are more sensitive metrics for detecting white matter changes in patients with ALS. Significant interhemispheric correlations between the tract DTI metrics were also observed. DTI metrics showed symmetry between the hemispheres and correlated with the clinical assessments. MD, RD, and AD increases significantly correlated with lower ALSFRS-R and MUNIX scores and weaker dynamometry results. DTI reveals microstructural damage along the motor and extra-motor regions in ALS patients. DTI metrics can serve as quantitative neuroimaging biomarkers for diagnosis, prognosis, monitoring of progression, and treatment. Combined analysis of imaging, electrodiagnostic, and functional biomarkers shows potential for characterizing disease pathophysiology and progression.
Implementation and Evaluation of Clinical Decision Support for Apixaban Dosing in a Community Teaching Hospital
Authors: Cope Rebecca , Sarsour Maram , Sasson Evan , Badran Hasan , Kim Ka Yeun , Quinn Rachel
Published: July 2024

Objectives

This study aimed to describe and evaluate the transition from a specialty service-based prospective order approval system to a computerized clinical decision support (CCDS) tool for apixaban dosing at a community teaching hospital. The primary objective was to assess the impact of the transition on the appropriateness of apixaban prescribing.

Methods

A CCDS tool for apixaban dosing was developed and implemented using interprofessional collaboration. A retrospective chart review was conducted for apixaban orders placed before (preimplementation) and after (postimplementation) the CCDS transition. The primary outcome was the percent change in inappropriate apixaban orders, with secondary outcomes exploring percent change of apixaban orders with inappropriate dosing in different patient groups and indications per package insert.

Results

Fifty orders were assessed in both arms, with 8% of orders preimplementation and 10% postimplementation deemed inappropriate. After accounting for questionable orders, overall appropriateness of prescribing was 88% preimplementation and 84% postimplementation (P = 0.7). Challenges with implementation of CCDS included working with available information technology resources and facilitating acceptance of a new ordering process.

Conclusions

The implementation of a CCDS tool for apixaban dosing at a community teaching hospital demonstrated comparable rates of appropriateness to the previous specialty service-based approval process. While the transition streamlined resources and improved efficiency, ongoing efforts are needed to address specific dosing challenges. Future research should explore the sustainability and generalizability of CCDS tools in diverse healthcare settings.
Driving in the Wrong Direction: Exploring the Unintended Consequences of an Early Discharge Program on Length of Stay in Hospital Setting
Authors: Hodges Paul , Linke Christopher A. , Bjorgaard Johannah D. , Edgerton Megan E.
Published: July 2024

Background and Objectives:

Early discharge of patients has become standard work in acute care settings to reduce inpatient length of stay (LOS), improve patient flow, and reduce boarding in the emergency department (ED).

Retrospective analysis of outcomes from a “discharge by 11 am” program at an academic medical center from January 1, 2020, to June 30, 2022. The analysis addresses the effects of a discharge by 11 am goal on time from discharge order release to patient discharge, ED boarding, LOS, and observed-to-expected LOS.

Methods:

Patient-level electronic health record data included discharge order entry time, discharge time, LOS, and diagnosis-related group geometric LOS (GMLOS). Additional unit-level data for ED boarding volumes and hours were included. Analyses were conducted at the hospital and unit levels where indicated.

Results:

Patients with a discharge order by 9 am have longer mean hours from order to discharge than patients without a discharge order by 9 am (9.04 vs 2.48 hours, P < .001) ED boarding total (R
2 = 46.2%, P ≤ .001), percentage (R
2 = 50.4%, P ≤ .001), median minutes (R
2 = 24.6%, P = .005), and total minutes (R
2 = 40.8%, P ≤ .001) all increased as discharge by 11 am performance improved. The mean LOS is longer for the discharge by 11 am group than the non–discharge by 11 am group –1.67; 95% CI, –2.03 to −1.28, P < .001). Discharge by 11 am patients had a LOS/GMLOS ratio 21.9% higher than the non–discharge by 11 am cohort (difference –0.31; 95% CI, –0.36 to –0.26, P < .001).

Conclusions:

Discharge order entry and release by 9 am and patient physically discharged by 11 am initiatives demonstrate a statistical increase in time from discharge order to discharge time, ED boarding, LOS, and observed-to-expected LOS.
Roadmap for Research and Scholarship in General Surgery Residency Training
Authors: Hawn Mary T. , Matthews Jeff B. , Bumgardner Ginny L. , Economou James , Itani Kamal , Kelz Rachel , Tracy Thomas , Zeiger Martha A.
Published: July 2024

Objective:

To review the current state of research training during surgical residency and make recommendations commensurate with current surgical training and academic environment.

Background:

Research training has been a mainstay of academic surgical programs, yet the scientific disciplines have evolved significantly from the traditional years of bench research. It is time to reconsider how research training should prepare surgeons for future academic practice and ensure the foundational knowledge of research evidence.

Methods:

As part of the Blue Ribbon Committee II, a research subcommittee was tasked to make recommendations on research training during surgical residency. Our 8-member panel brought diverse perspectives on the roles and goals of research training. We also sought input from a convenience sample of current and recent surgical residents on the impact of research training during their residency.

Results:

We identified a lack of a common framework and foundational research training for all surgical residents. Participation in dedicated years of scholarly activity helped trainees meet several professional and personal goals. The lack of an integrated, dedicated research track may dissuade some medical school graduates from pursuing surgery.

Conclusions:

We recommend incorporating a minimum standard for all trainees and flexibility in dedicated scholarly training to meet the needs of future academic surgeons.
Characterization of a nosocomial outbreak caused by VIM-1Klebsiella michiganensisusing Fourier-Transform Infrared (FT-IR) Spectroscopy
Authors: Rodriguez-Temporal David , Sánchez-Cueto María , Buenestado-Serrano Sergio , Blázquez-Sánchez Mario , Cercenado Emilia , Gutiérrez-Pareja Mark , Molero-Salinas Andrea , López-Camacho Elena , Muñoz Patricia , García de Viedma Darío , Pérez-Lago Laura , Rodríguez-Sánchez Belén
Published: July 2024

Healthcare-associated infections (HAIs) are a significant concern worldwide due to their impact on patient safety and healthcare costs.Klebsiellaspp., particularlyKlebsiella pneumoniaeandKlebsiella oxytoca, are frequently implicated in HAIs and often exhibit multidrug resistance mechanisms, posing challenges for infection control. In this study, we evaluated Fourier-transform Infrared (FT-IR) spectroscopy as a rapid method for characterizing a nosocomial outbreak caused by VIM-1-producingK. oxytoca.

A total of 47 isolates, including outbreak strains and controls, were collected from Hospital Universitario Gregorio Marañón, Spain and the University Hospital Basel, Switzerland. FT-IR spectroscopy was employed for bacterial typing, offering rapid and accurate results compared to conventional methods like pulsed-field gel electrophoresis (PFGE) and correlating with whole-genome sequencing (WGS) results. The FT-IR spectra analysis revealed distinct clusters corresponding to outbreak strains, suggesting a common origin.

Subsequent WGS analysis identifiedKlebsiella michiganensisas the causative agent of the outbreak, challenging the initial assumption based on FT-IR results. However, both FT-IR and WGS methods showed high concordance, with an Adjusted Rand index (AR) of 0.882 and an Adjusted Wallace coefficient (AW) of 0.937, indicating the reliability of FT-IR in outbreak characterization.

Furthermore, FT-IR spectra visualization highlighted discriminatory features between outbreak and non-outbreak isolates, facilitating rapid screening in case and outbreak is suspected.

In conclusion, FT-IR spectroscopy offers a rapid and cost-effective alternative to traditional typing methods, enabling timely intervention and effective management of nosocomial outbreaks. Its integration with WGS enhances the accuracy of outbreak investigations, demonstrating its utility in clinical microbiology and infection control practices.
Small Extracellular Vesicles from Human Bone Marrow Mesenchymal Stromal Cells enhance migration and regulate gene expression of reparative mechanisms in human dermal fibroblasts
Authors: Lei Rui , Borges da Silva Tamiris , Cui Zhanfeng , Ye Hua
Published: July 2024

Studies have showed that mesenchymal stromal cells (MSCs) could secrete a variety of bioactive particles, including small extracellular vesicles (sEVs), a type of membrane bound vesicle produced by cells, that might be a key intermediate to the beneficial paracrine effects of MSC therapy. In this study, we harvested the conditioned medium (CM) from both human bone marrow mesenchymal stromal cells (hBM-MSCs) and normal human dermal fibroblasts (NHDFs), fractionated CM of each into the sEV fraction and non-small extracellular vesicle (NsEV) fraction and compared their functions on NHDF-based migration and proliferation assays, as crucial processes in wound healing, coupled with transcriptomic analysis through mRNA sequencing to assess the regulation on gene expression of the recipient NHDFs by secretome exposure. Our findings show that both sEV and NsEV as well as CM from hBM-MSCs showed an overall promotive effect on migration behaviour of NHDFs, but MSC-sEV seems to be more potent for NHDF migration among different MSC secretome fractions and is also superior in effect to the corresponding sEVs produced by the recipient NHDFs (HDF-sEV). Gene ontology analysis revealed enrichment of pathways related to migration, corroboratingin vitroresults; changes in genes within the regulation of proliferation pathway were also significant. Our study provides referential significance for the choice of cellular secretome fractions to be used in wound healing studies and trials. The secretome fractionation and functional comparison strategy using cell-based model and comparative transcriptomics analysis would be a useful tool for comprehensive functional evaluation of cellular secretome.
DdmDE eliminates plasmid invasion by DNA-guided DNA targeting
Authors: Yang Xiao-Yuan , Shen Zhangfei , Wang Chen , Nakanishi Kotaro , Fu Tian-Min
Published: July 2024

Horizontal gene transfer is a key driver of bacterial evolution, but it also presents severe risks to bacteria by introducing invasive mobile genetic elements. To counter these threats, bacteria have developed various defense systems, including prokaryotic Argonautes (pAgo) and theDNADefenseModule DdmDE system. Through biochemical analysis, structural determination, andin vivoplasmid clearance assays, we elucidate the assembly and activation mechanisms of DdmDE, which eliminates small, multicopy plasmids. We demonstrate that DdmE, a pAgo-like protein, acts as a catalytically inactive, DNA-guided, DNA-targeting defense module. In the presence of guide DNA, DdmE targets plasmids and recruits a dimeric DdmD, which contains nuclease and helicase domains. Upon binding to DNA substrates, DdmD transitions from an autoinhibited dimer to an active monomer, which then translocates along and cleaves the plasmids. Together, our findings reveal the intricate mechanisms underlying DdmDE-mediated plasmid clearance, offering fundamental insights into bacterial defense systems against plasmid invasions.
Fine-tuning large language models for effective nutrition support in residential aged care: a domain expertise approach
Authors: Alkhalaf Mohammad , Shen Jun , Chang Hui-Chen (Rita) , Deng Chao , Yu Ping
Published: July 2024

Purpose

Malnutrition is a serious health concern, particularly among the older people living in residential aged care facilities. An automated and efficient method is required to identify the individuals afflicted with malnutrition in this setting. The recent advancements in transformer-based large language models (LLMs) equipped with sophisticated context-aware embeddings, such as RoBERTa, have significantly improved machine learning performance, particularly in predictive modelling. Enhancing the embeddings of these models on domain-specific corpora, such as clinical notes, is essential for elevating their performance in clinical tasks. Therefore, our study introduces a novel approach that trains a foundational RoBERTa model on nursing progress notes to develop a RAC domain-specific LLM. The model is further fine-tuned on nursing progress notes to enhance malnutrition identification and prediction in residential aged care setting.

Methods

We develop our domain-specific model by training the RoBERTa LLM on 500,000 nursing progress notes from residential aged care electronic health records (EHRs). The model’s embeddings were used for two downstream tasks: malnutrition note identification and malnutrition prediction. Its performance was compared against baseline RoBERTa and BioClinicalBERT. Furthermore, we truncated long sequence text to fit into RoBERTa’s 512-token sequence length limitation, enabling our model to handle sequences up to1536 tokens.

Results

Utilizing 5-fold cross-validation for both tasks, our RAC domain-specific LLM demonstrated significantly better performance over other models. In malnutrition note identification, it achieved a slightly higher F1-score of 0.966 compared to other LLMs. In prediction, it achieved significantly higher F1-score of 0.655. We enhanced our model’s predictive capability by integrating the risk factors extracted from each client’s notes, creating a combined data layer of structured risk factors and free-text notes. This integration improved the prediction performance, evidenced by an increased F1-score of 0.687.

Conclusion

Our findings suggest that further fine-tuning a large language model on a domain-specific clinical corpus can improve the foundational model’s performance in clinical tasks. This specialized adaptation significantly improves our domain-specific model’s performance in tasks such as malnutrition risk identification and malnutrition prediction, making it useful for identifying and predicting malnutrition among older people living in residential aged care or long-term care facilities.
Ownership structure and financial distress: is the tale from Sub-Saharan Africa different?
Authors: Abdulkadir Mohammed , Kariuki Samuel Nduati , Kariuki Peter Wang’ombe
Published: July 2024

Purpose

The paper investigates the effect of ownership structure on the financial distress of firms listed in sub-Saharan Africa.

Design/methodology/approach

Using secondary data from 106 non-financial firms listed in 9 selected SSA countries from 2016 to 2021, the research using paired t-tests and conditional logistic regression model analysed a sample of 174 distressed observations matched with 174 non-distressed observations.

Findings

T-tests determined significant differences between distressed and non-distressed groups concerning institutional, foreign, and local ownership. Conditional logistic results established that institutional, foreign, and state ownership significantly reduce distress. However, managerial ownership does not influence financial distress while a significant positive relationship is observed between local ownership and financial distress.

Originality/value

This is the first study to investigate the influence of ownership structure, including local ownership, on financial distress in SSA, employing a unique methodology of matched design and conditional logistic regression analysis. Furthermore, the paper presents cross-country evidence from emerging frontier markets, highlighting the importance of governance frameworks in firms’ stability.
MD-LDA: a supervised LDA topic model for identifying mechanism of disease in TCM
Authors: Li Meiwen , Xia Liye , Wu Qingtao , Wang Lin , Zhu Junlong , Zhang Mingchuan
Published: July 2024

Purpose

In traditional Chinese medicine (TCM), the mechanism of disease (MD) constitutes an essential element of syndrome differentiation and treatment, elucidating the mechanisms underlying the occurrence, progression, alterations and outcomes of diseases. However, there is a dearth of research in the field of intelligent diagnosis concerning the analysis of MD.

Design/methodology/approach

In this paper, we propose a supervised Latent Dirichlet Allocation (LDA) topic model, termed MD-LDA, which elucidates the process of MDs identification. We leverage the label information inherent in the data as prior knowledge and incorporate it into the model’s training. Additionally, we devise two parallel parameter estimation algorithms for efficient training. Furthermore, we introduce a benchmark MD identification dataset, named TMD, for training MD-LDA. Finally, we validate the performance of MD-LDA through comprehensive experiments.

Findings

The results show that MD-LDA is effective and efficient. Moreover, MD-LDA outperforms the state-of-the-art topic models on perplexity, Kullback–Leibler (KL) and classification performance.

Originality/value

The proposed MD-LDA can be applied for the MD discovery and analysis of TCM clinical diagnosis, so as to improve the interpretability and reliability of intelligent diagnosis and treatment.
Sling Aircraft: gearing up for the big time
Authors: Murimbika McEdward , Beswick Claire , Thomson Richard
Published: July 2024

Learning outcomes

At the end of this case study discussion, students should be able to critically analyse the strategic options for a global small and medium-sized enterprise seeking competitive advantage in a highly specialised industry, determine the strategic management and operational approaches to introducing a new product line using the case study options as an example, determine the best investment approach for a global operational strategy considering the financial analysis of associated costs and the best form of financial capital/investment in terms of risks and control references and carry out a financial analysis and make evidence-based decisions with respect to addressing how strategic recommendations will affect the future of a firm’s competitive advantage.

Case overview/synopsis

In 2021, Mike Blyth and his business partners, James Pitman and Andrew Pitman, were facing new challenges the business had never faced before. Despite the global upheaval and economic devastation caused by the COVID-19 pandemic, 2020 had been a productive year for the South African small-aircraft manufacturer. Globally, sales of Sling Aircraft’s aeroplanes had been good and the company had just finished a development prototype of a high-wing four-seater. Blyth, Andrew and James felt certain that there was space in the market for a five-seater aeroplane and they were meeting to discuss how to set up the business for further success. The strategic choices required to take the company in the new direction seemed clear and obvious, but it became apparent that they faced a dilemma regarding how to set up or restructure the company for success by exploiting the new opportunity without putting all of the hard work of the past 15 years in jeopardy.

Complexity academic level

This teaching activity is aimed at Master of Business Administration (MBA) and Master of Management.

Supplementary materials

Teaching notes are available for educators only.

Subject code

CSS 11: Strategy.
Students' reflections of quality (RoQ) in work-integrated learning (WIL): a systematic review and framework
Authors: Eady Michelle J. , Drewery David , Burney Monica , Li Wincy , Livingstone Kimberley
Published: July 2024

Purpose

In light of the expanding prominence of work-integrated learning (WIL), the pedagogical model that integrates work experiences into an academic curriculum, this paper presents a systematic review that uncovers little-explored students’ reflections of quality (RoQ).

Design/methodology/approach

Drawing on the concept of wayfinding rocks and Bronfenbrenner’s (1979) ecological systems theory, the “students’ RoQ (pronounced [ROK]) WIL model” offers guidance for future research, policy development and educational interventions aimed at optimizing students' experiences of WIL.

Findings

This paper highlights RoQ WIL through student voice. The outcomes offer a model, contributing insights for institutions, employers and students involved in WIL experiences.

Research limitations/implications

While the study addresses specific limitations such as the use of specific search terms and potential biases, future research is needed to explore cultural capital’s influence on WIL quality. A focus on broadening the scope of data collection to include a more comprehensive range of student perspectives is needed.

Practical implications

The paper suggests practical implications for institutions, employers and educators in designing WIL programs that prioritize student perspectives, ultimately enhancing the quality of WIL experiences.

Originality/value

By focusing on students' RoQ in WIL, this paper fills a significant gap in the literature and provides a foundation for future research and practice in optimizing WIL engagement and outcomes.
Designing a model for enhancing intention to accept renewable energy technologies in rural communities of Ilam province, Iran
Authors: Torfei Monfared Kobra , Vahedi Marjan , Eshraghi Samani Roya , Moradnezhadi Homayoon
Published: July 2024

Purpose

The purpose of this research is to investigate factors influencing the intention of villagers to use renewable energy. In this regard, by using the modified model of planned behavior, perceived behavioral control factors, perceived usefulness, perceived ease, mental norm and attitude toward energy sources for the intention of villagers to use energy sources. Therefore, the impact of each of these five variables was investigated in the form of research hypotheses.

Design/methodology/approach

This research has been done using a quantitative paradigm and a descriptive-correlation method. The statistical population of the study consisted of households (384) living in rural areas of Ilam province. A multistage cluster method was used to select the sample size. The data collection tool was a researcher-made questionnaire that was developed based on the research background and research problem. Face validity of the research tool by professors of Islamic Azad University of Ilam and construct validity and reliability of research tools were confirmed by Cronbach’s alpha coefficient and composite reliability. Data were analyzed statistically using SPSS26 and SmartPLS3 software.

Findings

The results showed that the intention to use renewable energies (REs) among the rural peoples of Ilam province is affected by factors such as mental norms, attitude, perceived usefulness and perceived behavioral control and there is a positive and significant relationship between them.

Originality/value

In Iran, there is a lot of potential for usage of RE in rural communities, but compared to fossil fuels, had a small share in the current energy supply (Rezaei et al., 2022). RE technologies have not been sufficiently accepted and used by Iranian rural people (Rezaei and Ghafranfarid, 2018). Se the public acceptance of RE technologies is vital for successful process energy transfer (Huijts et al., 2012), non-acceptance of RE by society is a major obstacle to establishing RE technologies in Iran (Savari and Razmavar, 2022). It is expected that this research will fill the gap in the research literature.