bluuebunny/crossref_metadata_2025 huggingface dataset:
High current density DC-DC converter with Modified PI controller for fast charging applications in EVs
Authors: Sridevi J. , Gayatri M. , Sharada K. , Begum Shabana , Shnain A.H.
Published: July 2024

As electric vehicles (EVs) become increasingly prevalent, the demand for efficient and high-performance DC–DC converters in the charging infrastructure is paramount. Electric vehicles, powered by rechargeable batteries or fuel cells, hence is necessary to have a cost-effective and efficient battery charger to deliver the consistent output current needed for the designated EV's battery. This paper adds a new and more effective approach of design and control of a DC–DC converter with bidirectional capability appropriate for incorporation in EV charging systems aimed at enhancing the current density and control issues inherent in the charging /discharging process. It appears to provide the necessary high current density besides battery out as soon as possible and also to impose an unimportant overshooting of the charging time for demanded lithium-ion battery system while charging it. The converter circuit contains the following equipment in its construction include single phase AC voltage source, linear transformer, passive component that includes the inductor and capacitor and bridge rectifier. Usually, Simulink/MATLAB is used for the purpose of various simulations. Using the MATLAB simulation the design of the concept system offered in this proposal has been proved. Monitored the current in amperes that the battery charger is supplying to the battery, closely observed the condition and voltage of the battery.
Ethics and responsibility in biohybrid robotics research
Authors: Mestre Rafael , Astobiza Aníbal M. , Webster-Wood Victoria A. , Ryan Matt , Saif M. Taher A.
Published: July 2024

The industrial revolution of the 19th century marked the onset of an era of machines and robots that transformed societies. Since the beginning of the 21st century, a new generation of robots envisions similar societal transformation. These robots are biohybrid: part living and part engineered. They may self-assemble and emerge from complex interactions between living cells. While this new era of living robots presents unprecedented opportunities for positive societal impact, it also poses a host of ethical challenges. A systematic, nuanced examination of these ethical issues is of paramount importance to guide the evolution of this nascent field. Multidisciplinary fields face the challenge that inertia around collective action to address ethical boundaries may result in unexpected consequences for researchers and societies alike. In this Perspective, we i) clarify the ethical challenges associated with biohybrid robotics, ii) discuss the need for and elements of a potential governance framework tailored to this technology; and iii) propose tangible steps toward ethical compliance and policy formation in the field of biohybrid robotics.
Elucidating the roles of electrolytes and hydrogen bonding in the dewetting dynamics of the tear film
Authors: Borkar Suraj , Baumli Philipp , Vance Travis , Sharma Ekta , Shi Xinfeng , Wu James Y. , Yao George , Myung David , Fuller Gerald G.
Published: July 2024

This study explores the impact of electrostatic interactions and hydrogen bonding on tear film stability, a crucial factor for ocular surface health. While mucosal and meibomian layers have been extensively studied, the role of electrolytes in the aqueous phase remains unclear. Dry eye syndrome, characterized by insufficient tear quantity or quality, is associated with hyperosmolality, making electrolyte composition an important factor that might impact tear stability. Using a model buffer solution on a silica glass dome, we simulated physiologically relevant tear film conditions. Sodium chloride alone induced premature dewetting through salt crystal nucleation. In contrast, trace amounts of solutes with hydroxyl groups (sodium phosphate dibasic, potassium phosphate monobasic, and glucose) exhibited intriguing phenomena: quasi-stable films, solutal Marangoni-driven fluid influx increasing film thickness, and viscous fingering due to Saffman–Taylor instability. These observations are rationalized by the association of salt solutions with increased surface tension and the propensity of hydroxyl-group-containing solutes to engage in significant hydrogen bonding, altering local viscosity. This creates a viscosity contrast between the bulk buffer solution and the film region. Moreover, these solutes shield the glass dome, counteracting sodium chloride crystallization. These insights not only advance our understanding of tear film mechanics but also pave the way for predictive diagnostics in dry eye syndrome, offering a robust platform for personalized medical interventions based on individual tear film composition.
Unveiling anomalies: harnessing machine learning for detection and insights
Authors: Gupta Shubh , Kumar Sanoj , Singh Karan , Saini Deepika
Published: July 2024

The rise of Internet of Things (IoT) devices has brought about an increase in security risks, emphasizing the need for effective anomaly detection systems. Previous research introduced a dynamic voting classifier to overcome overfitting or inaccurate accuracies caused by dataset imbalance. This article introduces a new method for IoT anomaly detection that employs a hybrid voting classifier, which combines several machine learning models. To solve the overfitting and class weight issues, an adaptive voting classifier is used that adjusts weights according to the highest preference for accuracy. The developing voting system increases the effectiveness of more accurate classifiers, enhancing the group’s overall capability. A proposed combined classifier combines Logistic Regression, AdaBoost, Gradient Boosting, and Multi-Layer Perceptron models using a soft voting method. To develop and assess this method, the CIC-IoT-2023 dataset is utilized, which contains 33 types of IoT attacks across 7 categories. This process includes thorough data preprocessing and feature selection from a pool of 42 available attributes. The performance of this approach is measured against individual classifiers across binary, 8-class, and 34-class classification tasks. The results highlight the effectiveness of the hybrid model. It achieves 98.95% accuracy, 76.72% recall, and 72.01% F1-score in the 34-class problem, surpassing the performance of all individual models. For the 8-class task, the hybrid classifier attains 99.39% accuracy, 90.89% recall, and an 83.01% F1-score. This demonstrates the high potential of the hybrid approach for IoT anomaly detection.
Creating an Insurgency
Authors: Drevon Jerome
Published: July 2024

Chapter 2 provides a comprehensive analysis of the armed opposition’s emergence. It examines the role of Islamist groups under the Syrian Baathist regime until 2011, and how the regime’s repression led to the militarisation of the uprising and informed its early geography. The chapter then delves into the success of Ahrar al-Sham, which emerged as the most prominent group in the early stages of the conflict. What sets Ahrar al-Sham apart from other armed groups is its unique combination of several singular characteristics that allowed it to develop internal and external institutional foundations early on in the conflict without over-stretching. Meanwhile, Jabhat al-Nusra, which would become Ahrar al-Sham’s main contender for the leadership of the armed opposition later on, was much smaller initially and not as influential, despite its successful high-level attacks against regime targets.
Introduction
Authors: Pflücke Felix
Published: July 2024

This chapter briefly reviews the academic landscape in European consumer contract law and outlines that a study that measures levels and factors of e-commerce trader compliance still needs to be conducted. The chapter states why content analysis is the most suitable methodology to determine the levels of trader compliance in the empirical inquiry of the monograph. It enables the thorough evaluation of e-commerce traders’ websites against the European consumer contract rules, ensuring a comprehensive and nuanced assessment. It also explains further methodological choices made in the empirical investigation and outlines the limitations of the present study, especially concerning the dataset size.
Evidence-based Consumer Law and Policy
Authors: Pflücke Felix
Published: July 2024

This chapter depicts the transition towards an evidence-based approach in European consumer contract law. The chapter highlights that the European Union based early instruments on national practices rather than scientifically grounded evidence and theories. It demonstrates that the transition towards an evidence-based approach gained momentum with REFIT and the Better Regulation agenda, although several caveats remain. In particular, it can be argued on multiple occasions that the European Commission adopted legislation on policy-based evidence rather than evidence-based policy. After defining how good evidence should look, the chapter underscores that evidence should only inform the political discourse rather than dictate it.
Plant Thinkers of Twentieth-Century Bengal
Authors: Roy Sumana
Published: July 2024

Plant Thinkers of Twentieth-Century Bengal takes an unexpected cast of writers and artists and, in studying their work as ‘plant thinkers’, looks at how their stories and songs, art and films, and, of course, the idiomatic affected Bengali life and thought. Forest and garden, grass and root, weeds and magical plants—supported by a foliage of thought that allowed them to see beyond the botanical, Rabindranath Tagore, Bibhutibhushan Bandyopadhyay, Jibanananda Das, Shakti Chattopadhyay, Satyajit Ray, and others derived their worldview, their poetics and politics, from the plant world. Jagadish Chandra Bose’s scientific experiments, his research and the philosophy that propelled it, religions and rituals that involved an affective relationship with the natural world, a subterranean invocation of plant philosophy in actions and words, in living and in creative practice, and the political possibilities beyond the nation state that such thinking generated give this book its sap and flow. What might we take from these plant thinkers to rehabilitate our consciousness today?
Jagadish Chandra Bose
Authors: Roy Sumana
Published: July 2024

Beginning with Jagadish Chandra Bose’s biography, his family background and his initiation into the sciences, this chapter moves to his obsession with recording the language of response, whether it is with radio communication, or, later, in the plant sciences. To prove that plants were ‘living’ beings, Bose wanted to record the ‘handwriting’ of plants, what he called ‘torulipi’, the plant script. For this he designed and then created new and unexpected instruments, so that he could record the effect of external stimuli on plants. His intuitive observations about plant life, once mocked by the colonial science establishment, are now being proven by scientists.
Jibanananda Das
Authors: Roy Sumana
Published: July 2024

Entering Jibanananda Das’s poetics through his life, particularly his life in Barisal, his parents, and his initiation through them into literature, this chapter studies the philosophy and composition of ‘Rupashi Bangla’, the Bengal that is history, mythology, personal history, dream, geography, botany, and astronomy brought together into a universe where even the tiniest drop of dew has an unexpected significance. Moving through Das’s favoured forms of plant life, the flowers and fruits, the trees, and, of course, grass—Das’s attachment to grass is revolutionary, anticipating Deleuze and Guattari’s rhizome—we encounter a cosmology that is Bengal but also more than Bengal. It is from the plant world that Das gets his unique understanding of time and history, and it is the impress of this that allows us to understand why he wants to return to Bengal over and over again, as plant, as tree, as grass.
Adaptive space search-based molecular evolution optimization algorithm
Authors: Wang Fei , Cheng Xianglong , Xia Xin , Zheng Chunhou , Su Yansen
Published: July 2024

Motivation

In the drug development process, a significant portion of the budget and research time are dedicated to the lead compound optimization procedure to identify potential drugs. This procedure focuses on enhancing the pharmacological and bioactive properties of compounds by optimizing their local substructures. However, due to the vast and discrete chemical structure space and the unpredictable element combinations within this space, the optimization process is inherently complex. Various structure enumeration-based combinatorial optimization methods have shown certain advantages. However, they still have limitations. Those methods fail to consider the differences between molecules and struggle to explore the unknown outer search space.

Results

In this study, we propose an adaptive space search-based molecular evolution optimization algorithm (ASSMOEA). It consists of three key modules: construction of molecule-specific search space, molecular evolutionary optimization, and adaptive expansion of molecule-specific search space. Specifically, we design a fragment similarity tree in a molecule-specific search space and apply a dynamic mutation strategy in this space to guide molecular optimization. Then, we utilize an encoder–encoder structure to adaptively expand the space. Those three modules are circled iteratively to optimize molecules. Our experiments demonstrate that ASSMOEA outperforms existing methods in terms of molecular optimization. It not only enhances the efficiency of the molecular optimization process but also exhibits a robust ability to search for correct solutions.

Availability and implementation

The code is freely available on the web at https://github.com/bbbbb-b/MEOAFST.
History of Zoning
Authors: Hirt Sonia , Zibanejadrad Beeson Sarah
Published: July 2024

How long the history of zoning seems to us largely depends on how we define zoning. Any walled town in the ancient and medieval world that was protected for defensive purposes was, in a way, “zoned”: the walls divided insiders and their built structures from those on the outside. And if we would take zoning to be a system of regulations governing building practices (but not necessarily regulations that vary by district or zone), we too could point to ancient origins. Arguably, the first laws governing building practices in the world were those in the Code of Hammurabi (c. 1755–1750 bce). In the early twenty-first century, zoning is understood as a system of government regulations, most often practiced at the level of the community (e.g., city, town, village, or county) that divides the community’s entire territory into districts or “zones,” each with a specific set of rules outlining what can and what cannot be built in this zone. A contemporary example of a zoning district is a multi-family residential zoning district that allows particular housing types alongside essential civic, educational, and cultural institutions. Usually, the regulations pertain to land uses (or functions), as well as the size and height of built structures and the lot area covered by them. Additional regulations may cover site layout, parking, landscaping, streetscaping, and other related issues. So, if we would take the term “zoning” literally—as the division of a community into zones—one could say that zoning is a practice as old as city-building. But if we define zoning in a more contemporary way, as the division of a community into zones, with detailed regulations regarding land use, buildings’ characteristics, lot coverage, and relation to the street and other lots, this type of zoning has been on the rise since the 1870s, with the regulations becoming only more complex over time. Aside from the great variety of zoning and zoning-like regulations throughout history, there is also a great variation among countries. In most countries, zoning is a legal practice embedded in national legal regimes (the United States, where zoning is practiced primarily at the local level via powers granted by state governments, rather than the national government, is an exception here). These legal regimes are grossly different in different nations. Hence, there are very few sources that cover zoning’s history or the present state of zoning in a broad international context. Most of the literature covers a narrow historical period in one country or a small group. Often, the best resources on the evolution of zoning can be found in book-length manuscripts that discuss planning history more generally. In-depth explorations of particular aspects of zoning are typically found either in chapters of edited volumes or in articles in scholarly journals. There are also opportunities to learn about zoning practices in different contexts by reviewing actual zoning ordinances, court cases, or related documents, which are included in various archival collections, including online.
The Built Environment of Historic Islamic Cities: Mosul
Authors: Nováček Karel
Published: July 2024

Mosul was founded as a garrison city (misr) in 640–641, shortly after the Muslim takeover of Iraq, on the western bank of Tigris opposite Assyrian Nineveh, and soon developed to become a capital of Northern Iraq. A millennium-long coexistence of different faiths and sects (represented, e.g., by Christians of at least four denominations; Jews; and Muslims including Shia, Sunni, and Sufi) and different ethnicities (e.g., Arab, Kurdish, Armenian, Turcoman) created a unique, heterogeneous, and eclectic built environment. Leaving aside the understudied Christian architecture, the oldest preserved layer of Mosul’s architecture dates from the reign of the Zangid Atabegs (reigned 1127–1234) and particularly Sultan Badr al-Din Lu’lu’ (reigned 1234–1259). Thanks to a long period of relative prosperity starting with the rule of the al-Jalili dynasty in the first half of the 18th century, a complex and authentic built environment emerged in the old city, a 290-ha (hectare) area with an organic pattern of narrow, winding streets. Even in the 1980s it counted about one thousand registered heritage structures, mainly mosques, churches, shrines, mausoleums, baths, commercial buildings, and residential houses. Compared to other cities of comparable size in the region, Mosul’s Old City has received very little scholarly attention, while large parts of it have been destroyed by modernization projects or long-term neglect. During the so-called Islamic State’s (ISIS, ISIL) occupation from June 2014 to July 2017, the most valuable Islamic architectural landmarks, centers of social life and memory, were deliberately demolished, and the extensive destruction of the old city was completed during the liberation in the spring and summer of 2017. In addition to a number of private initiatives, UNESCO, the Ministry of Sunni Endowments, and foreign Christian foundations are involved in the restoration of the city.
Samothrace
Authors: Blakely Sandra
Published: July 2024

A mountainous island twenty-nine nautical miles south of the Thracian shore, Samothrace exemplifies the dynamic geomorphism of the northern Aegean and long-standing patterns of cultural exchange across ethnic divides. Greek colonists, arriving in the sixth century bce, encountered Thracian cultural groups with deep roots in the island and the regional networks of exchange; existing cult sites provided loci for interaction and shared celebration of local gods. The Greek settlers left behind a city wall whose scale attests significant economic success and the mutually beneficial nature of Greco-Thracian interactions. Samothrace is best known for the mystery cult that bore the island’s name. Attested from the sixth century bce through the fourth century ce, the island’s initiations and festivals drew individuals from East Greece and the Black Sea, the Aegean islands, and Rome. Competition in the giving of gifts to the gods transformed the sanctuary into a locus of extraordinary architectural refinement and innovation. The rites were as secret as the sanctuary was elaborate: no texts provide for Samothrace an analogy to the Homeric Hymn to Demeter for Eleusis. The very names of the gods were alternatively hidden under the euphemistic title “Great Gods,” or a matter of endless invention, so that dozens of possibilities emerge over some thousand years of ancient literature. The sanctuary became a theater for architectural innovation, refinement, and competitive dedication of votives, funded by Hellenistic powers from Alexandria and Asia Minor as well as the Roman patrons who knew the rites as early as the late third century bce. Architectural and geospatial studies have reconstructed these monuments, positioning the buildings in the lived experience of ritual topography as well as the prosopographies of patrons and initiates and Hellenistic and Roman political and cultural histories. The rites were distinctive in their promise to initiate safety in travel at sea; extensive epigraphic records both on and off the island open a view of the spaces in which these promises would be realized, and the rites’ reputation was created.
Educational Research Approaches: A Comparison
Authors: Schoonenboom Judith
Published: July 2024

Choosing a research approach is not an easy task, given the number and variety of viable alternatives in different educational research contexts. Educational research approaches hold different perspectives on reality and research. Foregoing these differences at a technical level, this article focuses on the fundamental questions that each research approach should address: Why do researchers conduct educational research? What is its aim? What is the object of study? What type(s) of entities exist? What is knowledge? Whose knowledge counts? How can knowledge be achieved? To such fundamental questions, different educational research approaches provide different answers. This article addresses these questions, with the aim to support educational researchers in selecting a research approach(es). The initial section discusses the Philosophical Backgrounds of Educational Research Approaches. Next, research approaches are presented and compared, divided into the following three broad groups based on the overall research aim: Discovering Causal Effects and Mechanisms, Transformative Approaches, and Investigating Realities. Within each group, various approaches are described. The last three sections discuss how research approaches can be compared and combined. Comparing Research Approaches: Handbooks on Education and Social Science Research discusses comparisons of approaches to education and social science research found in the methodological literature. In Comparing Research Approaches: Comparing Approaches in Action, to further underscore these differences, publications are presented in which various approaches have been used to examine the same real-life phenomenon. The final section presents the various ways in which researchers have been Combining Research Approaches.
Jacques Tati
Authors: Turvey Malcolm
Published: July 2024

Jacques Tati (b. 1907–d. 1982) is generally regarded as one of the greatest postwar European filmmakers. In his films, Tati crafted a distinctive visual and aural style, a dedramatized narrative form, and an innovative type of comedian comedy that was indebted to, but departed significantly from, the comedy of Charlie Chaplin, Buster Keaton, and other film comedians. Due to the creative control he was able to exert over his films, and to their uniqueness, Tati is widely considered an exemplary auteur. Tati started his career performing comic impersonations on the music-hall stage in France in the 1930s while also starring in several short comedy films. After World War II, he directed his first film, a comic short titled L’école des facteurs (1947), which he also wrote and starred in. The film was both a critical and commercial success, winning the Max Linder Prize, and Tati used its story as the basis of his first feature-length film, Jour de fête (1949), which won the prize for Best Original Screenplay at the Venice Film Festival. Tati shot the film in both black-and-white and color, but due to technical problems only the black-and-white version was released. As with all his subsequent features, Tati wrote, starred in, and directed Jour de fête, in which he plays François, an accident-prone postman in a rural French village. While a traveling fair is visiting, François tries and fails to adopt the modern American postal methods he has learned about in a documentary film shown at the fair, and Tati would go on to address the theme of the postwar modernization of France in all but his last feature film. In his second feature, the black-and-white Les Vacances de Monsieur Hulot (1953), Tati introduced his comic character Monsieur Hulot, who has trouble adapting to the modern environments and lifestyles of postwar France. Tati would star as Hulot in his next three feature films, all in color: Mon Oncle (1958), which won the Oscar for Best Foreign Language Film in 1959 and which concerns Hulot’s relationship with his sister’s family, the Arpels; Play Time (1967), which, while today considered Tati’s masterpiece, was a commercial failure that led to Tati’s bankruptcy and is about Hulot’s interaction with a group of American tourists over one night in Paris; and Trafic (1971), in which Hulot works as a designer for a car company. Tati’s final feature-length film, Parade (1974), which was made for Swedish television, captures an ostensibly live performance by Tati and a troupe of circus entertainers in which Tati revisits the sporting impressions and other live comic acts that originally made him famous in the 1930s.
Incorporation of Trauma-Informed Care Into Entrustable Professional Activities for Medical Student Assessment
Authors: Millham Lucia R.I. , Potter Jennifer , Hirsh David A. , Trinh Nhi-Ha , Royce Celeste S. , Levy-Carrick Nomi C. , Rittenberg Eve
Published: July 2024

Problem

Trauma-informed care (TIC) provides a medical framework for addressing and mitigating the negative consequences of trauma. In response to student and faculty advocacy, medical schools are developing trauma-informed curricular content. However, medical education literature does not present a comprehensive assessment rubric to evaluate medical students’ acquisition of trauma-informed clinical skills.

Approach

A committee of medical students, trainees, and faculty developed a longitudinal TIC curricular theme at Harvard Medical School (HMS). Guided by the National Collaborative on Trauma-Informed Health Care Education and Research competencies, the committee created a set of medical student TIC competencies from July to December 2019. From November 2021 to November 2022, 3 committee subgroups generated new TIC descriptors for each HMS entrustable professional activity (EPA), then circulated these to other subgroups, external experts, and stakeholders for review and feedback. From April to June 2023, the committee iteratively reviewed the materials until reaching consensus for content and pedagogy. The committee integrated TIC content into HMS’s existing EPAs expected of students, provided anchoring descriptions of each level, and achieved consensus using a process of iterative review with TIC content experts.

Outcomes

The committee identified 10 TIC competencies and revised all 13 general HMS EPAs to include specific items based on these competencies. The committee incorporated at least 1 trauma-informed competency into each HMS EPA.

Next Steps

This novel set of HMS EPAs provides a framework for assessment of TIC clinical skills. Faculty will be trained to correctly and reliably incorporate TIC competencies into patient care and to use the TIC-inclusive EPAs for student assessment, ensuring that TIC is standard medical practice at HMS. This work may facilitate the adoption of trauma-inclusive EPAs by other institutions to educate the next generation of physicians to practice TIC and thus promote a more accessible, safe, and equitable health care system.
Application in Parallel to U.S. Residency Training Programs in Multiple Specialties: Trends and Differences by Applicant Educational Background, 2009–2021
Authors: Bunting Samuel R. , Woodruff James N. , Vidyasagar Nitin , Sheth Neeral K. , Spitz Deborah , Babcock Christine , Arora Vineet
Published: July 2024

Purpose

The medical education community is pursuing reforms addressing unsustainable growth in the number of residency applications per applicant and application costs. Little research has examined the prevalence or contributions of parallel applications (application to residency in multiple specialties) to this growth.

Method

A retrospective analysis of Electronic Residency Application Service data provided by the Association of American Medical Colleges was conducted. The percentage of applicants applying to ≥ 1 specialty, mean number of specialties applied, number of submitted applications, and percentage of applicants to each specialty who were parallel applying were determined. MD, DO, and international (U.S. international medical graduate [IMG] and IMG) applicants were included.

Results

The sample contained 586,246 applicant records from 459,704 unique applicants. The percentage of applicants who parallel applied decreased from 41.3% to 35.4% between 2009 and 2021. DO applicants were the only group for whom the percentage parallel applying increased (30.6% vs 32.1%). IMG (60.4% vs 49.1%) or USIMG applicants (69.6% vs 63.1%) were groups with the greatest percentage of applicants parallel applying each year (2009–2021). The mean number of specialties applied to when parallel applying also decreased from 2.96 in 2009 to 2.79 in 2021, overall. Between 2009 and 2021, mean number of applications increased for all applicant types among both single-specialty applicant and parallel-applying applicants. Among applicants who were single-specialty applying, mean number of applications grew from 38.6 in 2009 to 74.6 in 2021 and from 95.2 to 149.8 for parallel-applying applicants.

Conclusions

All applicant groups experienced decreases in percentages parallel applying except for DO applicants. Parallel application appears to be common and slowly declining, and does not appear to significantly contribute to increasing numbers of applications per candidate. Efforts to control the growth of applications per applicant should continue to focus on applicants’ numbers of applications submitted to each specialty.
The role of cardiorespiratory fitness and body composition in the association between physical activity and menopausal symptoms
Authors: Hyvärinen Matti , Karvanen Juha , Karppinen Jari E. , Karavirta Laura , Juppi Hanna-Kaarina , Tammelin Tuija H. , Kovanen Vuokko , Laukkanen Jari , Aukee Pauliina , Sipilä Sarianna , Rantalainen Timo , Laakkonen Eija K.
Published: July 2024

Objective

The aim of the study was to conduct exploratory analyses on the role of cardiorespiratory fitness (CRF) and body composition in the association between physical activity and menopausal symptoms.

Methods

This was a cross-sectional (N = 298) study of women aged 51–59 years including a subsample of 82 women followed for 4 years. The severity of menopausal symptoms was assessed with the Menopause Rating Scale in total symptoms as well as using the somato-vegetative, psychological, and urogenital subscales. Physical activity was assessed with accelerometers and self-reports, body composition with dual-energy x-ray absorptiometry, and CRF with a custom-made prediction model based on the six-minute walking distance and spiroergometry. The associations of interest were studied using unstandardized regression coefficients derived from multiple linear regression models with the severity of menopausal symptoms as the outcome.

Results

Higher total body and fat mass (kg) were associated with more severe total symptoms (B = 0.06 [95% CI, 0.01 to 0.12] and 0.07 [0.01 to 0.14], respectively) as well as somato-vegetative (0.03 [0.01 to 0.05]; 0.04 [0.01 to 0.06]) and psychological symptoms (0.03 [0.00 to 0.05]; 0.03 [0.00 to 0.06]) in cross-sectional design. Total and lean body mass interacted with physical activity in total and psychological symptoms with stronger indirect associations being observed in participants with lower total and lean body mass. CRF was not associated with menopausal symptoms and did not interact with physical activity.

Conclusions

Maintaining a healthy weight is associated with less severe menopausal symptoms in middle-aged women. The association between physical activity and the severity of menopausal symptoms varied based on the differences in total and lean body mass.
Development of the Menopause Perception Scale
Authors: Abay Halime , Altun Esra , Kaplan Sena
Published: July 2024

Objective

How women perceive menopause depends on how well they go through that period of time. However, there is no measure that can be used to assess how women perceive menopause. Therefore, we developed a valid and reliable scale (Menopause Perception Scale [MPS]) to assess how women perceive menopause.

Methods

This methodological research was conducted in three stages. First, we developed items and assessed their content validity. Second, we collected data from 470 women. Third, we assessed the scale for validity and reliability. Exploratory factor analysis and confirmatory factor analysis were used for construct validity. Cronbach's α was calculated for reliability. Pearson's correlation coefficient was used for criterion validity. Mean comparison tests were performed for known-groups validity.

Results

The MPS had a content validity index of 0.90. It had a Kaiser-Meier-Olkin score of 0.768, for which Bartlett's test of sphericity was significant (1,778.047; P < 0.001). The values were acceptable. The exploratory factor analysis yielded an 18-item structure with factor loads greater than 0.40. It also revealed a four-factor model (acceptance, perceived sexuality, normalization, and perceived support) confirmed by the confirmatory factor analysis. The fit indexes were acceptable. The model explained 56.64% of the total variance. The internal consistency was acceptable (Cronbach's α = 0.824). There were positive correlations between the scale and its subscales. Furthermore, the MPS was significantly correlated with the Menopause Attitude Assessment Scale (r = 0.334, P < 0.001) and the Menopause Rating Scale (r = −0.286, P < 0.001).

Conclusions

The MPS is a valid, reliable, user-friendly, and practical self-report measure with satisfactory psychometric properties. Researchers should conduct cross-cultural studies to adapt it to other cultures.
Stem cell transplantation therapy for advanced liver damage-associated neurodegenerative disorders
Authors: Sharma Anjna , Sharma Ameya , Dheer Divya , Sharma Raghu Rai , Puri Vivek , Bibi Shabana , Shamas Amina , Memon Sameeullah , Goyal Rajat , Priyanka  , Chopra Hitesh
Published: July 2024

Hepatic encephalopathy and other neurodegenerative disorders have profound implications for extensive liver impairment, calling for new ways of treating the condition. The application of stem cell transplantation to treat these severe disorders is a new and encouraging technique. This review article digs deep into the subject of stem cell transplantation therapy, neurodegenerative disorders associated with advanced liver damage, and liver transplantation. It comprehensively analyses the background, rationale, scope, and objectives of using stem cells to treat such challenging conditions. The topic of discussion includes the subtleties of neurodegenerative disorders, the function of liver transplantation, and the possible advantages and disadvantages associated with it. The relevance of patient selection, intraoperative concerns and post-transplant care is discussed. Further, the article explores how stem cell-based therapies can benefit from nanotechnology, specifically how it can improve stem cell distribution, survival, and integration for better therapeutic results. This review aims to offer a thorough analysis of regenerative medicine’s present and future possibilities in dealing with the intricate relationship between neurodegeneration and liver damage. It does this by examining the efficacy, safety, and long-term impacts of stem cell transplantation in treating neurodegenerative disorders associated with advanced liver damage. This will incorporate insights from ongoing clinical trials, the patent landscape, and future directions. The goal is to pave the way for innovative and personalized treatment approaches in this evolving research and clinical practice field. Therefore, these efforts represent a promising frontier in medical research that can alleviate the burden of HE and associated neurological complications combined with liver cirrhosis.
Prognosis of hepatocellular carcinoma using the albumin to alkaline phosphatase ratio, literature review, and meta-analysis
Authors: Ibn Awadh Abdulrahman , Alanazi Khulud , Alkhenizan Abdullah
Published: July 2024

Background:

Data about the impact of albumin-to-alkaline phosphatase ratio (AAPR) on prognosis in hepatocellular cancer (HCC) patients are inconclusive and conflicting.

Methods:

The authors systematically searched literatures from seven databases (PubMed, Medline, Web of Science, Cochrane Library, Embase, Google Scholar, and CINAHL), updated to September 2023. Hazard ratios (HRs) and 95% CIs were pooled and synthesized using Comprehensive Meta-Analysis version 3 in order to assess the overall impact of AAPR on patient’s prognosis.

Results:

In total, 8 studies involving 13 cohorts with 3774 cases were included. Pooled results from both univariate and multivariate analyses revealed that higher AAPR was an independent prognostic factor for overall survival (HR=0.429, 95% CI: 0.361–0.509, P=0.001; HR=0.476, 95% CI: 0.421–0.538, P=0.001; respectively). Similarly, pooled multivariate results showed that higher AAPR was associated with better disease-free survival (HR=0.558, 95% CI: 0.452–0.688, P=0.001). Moreover, pooled results from both univariate and multivariate analyses revealed that higher AAPR was an independent prognostic factor for recurrence-free survival (HR=0.540, 95% CI: 0.420–0.694, P=0.001; HR=0.647, 95% CI: 0.494–0.848, P=0.002; respectively). Subgroups analysis showed that elevated AAPR still significantly correlated with better overall survival across the confounding factors. Moreover, sensitivity analysis suggested the robustness of these findings and no publication bias was detected.

Conclusions:

In summary, higher AAPR could be considered as a reliable prognostic factor in patients with HCC, which could be used as a routine inspection of HCC patients to individualized prognosis prediction and clinical decision making.
Drug Trends in the Teenage Postmortem Population From 2017 to 2021
Authors: Swatek Jennifer L. , Peterson Brianna L.
Published: July 2024

The teenage population is highly vulnerable to drug exposure, use, and misuse due to the physical and emotional development that occurs at those ages. Social influences, like the isolation experienced during the COVID-19 pandemic and social media, can exacerbate this vulnerability. To better understand the potential impact of these influences on teenage drug use, postmortem results reported by a large reference laboratory from 2017 to 2021 corresponding to the teenage population were evaluated for various drugs of misuse. These data revealed a marked increase (385%) in reported fentanyl cases and a 13% increase in positivity rate. Methamphetamine- and cocaine-positive cases also increased 126% and 54%, with a net percent positivity of +0.6% and −0.5%, respectively. Conversely, heroin showed a consistent decline in reported cases (67%) and a net decrease of 1.0% in positivity rate. In addition to commonly misused drugs, trends for other substances that are prevalent in social media and therefore may disproportionally impact teens, MDMA/MDA, mitragynine, and diphenhydramine, were also assessed. A discussion of drug-related social media trends is presented to provide additional context for the data and trends reported herein, ultimately creating a framework through which social influences on teenage drug use can be better understood.
Identified Needs in Pediatric Education for Emergency Medicine Physicians
Authors: Toto Regina L. , Fischer Jason , Mamtani Mira , Scott Kevin R. , Bauman Brooke , Delgado Eva M.
Published: July 2024

Objectives

General emergency medicine (EM) physicians provide most pediatric emergency care in the United States, yet EM physicians feel underprepared to manage pediatric emergencies. Pediatric emergency medicine (PEM) education during EM residency is variable, and learner preferences regarding educational experiences have not been widely explored through a qualitative lens. We aimed to better describe EM physicians' PEM educational needs and preferred teaching methods.

Methods

In 2021, as part of a survey querying senior EM residents and recent graduates from 8 diverse EM programs regarding perceived preparedness for PEM emergencies, educational needs and content delivery methods were assessed using 2 free-text questions. Qualitative analysis included deidentification and iterative coding of the data with double coding of 100% of the comments. We performed conventional content analysis of responses to identify emerging themes.

Results

The overall response rate for the survey was 53% (N = 129 out of 242 eligible participants) with 84 distinct free-text responses. Major themes included: 1) desire for education regarding neonates, infants, and critically ill children, especially airway management and 2) need for help translating lessons from PEM rotations to community EM practice. Respondents desired more autonomy during training. Their preferred PEM educational modality was simulation, and they appreciated online clinical pathways for just-in-time decision support.

Conclusions

This qualitative study of EM physicians proximal to training adds to a prior needs assessment by describing in detail desired pediatric content and preferred delivery. The findings can be used to better inform the development of PEM curricula for this group of EM physicians.
Implementing Self-Measured Blood Pressure Monitoring With Clinical Support: A Qualitative Study of Federally Qualified Health Centers
Authors: Zook Heather G. , Cruz Rachel S. , Capesius Traci R. , Haynes Melissa Chapman
Published: July 2024

Context:

Self-measured blood pressure monitoring (SMBP) with clinical support is effective at reducing blood pressure for people with hypertension. Although strengths and challenges around SMBP are well-documented, few studies describe the complexities of real-world implementation of SMBP with clinical support in the Federally Qualified Health Center (FQHC) setting.

Program:

Between 2019 and 2023, the Ohio Department of Health funded the Ohio Association of Community Health Centers to manage a multiyear quality improvement (QI) project with 21 FQHCs. The project aimed to improve the identification and management of patients with hypertension, diabetes, and prediabetes. This study focuses on the activities implemented to provide SMBP support to patients with hypertension.

Implementation:

FQHCs implemented clinical SMBP support using multiple roles, approaches, and resources. FQHCs established a process to identify patients eligible for SMBP support, provide blood pressure monitors, train patients on SMBP, track blood pressure readings, follow up with patients, and connect patients to resources.

Evaluation:

External evaluators interviewed 13 staff members within seven FQHCs from the QI project. Interviewed FQHCs were located across Ohio and represented urban, rural, suburban, and Appalachian areas. Clinical activities to support SMBP, facilitators, and barriers were identified with thematic analysis. The National Association of Community Health Centers SMBP Implementation Toolkit was used as a framework to assess SMBP activities. Facilitators included team-based care, health information technology capacity, funding for blood pressure monitors and staff time, leadership and staff support, and external support. Barriers included technology challenges, staffing shortages, low patient engagement, sustainability, and the COVID-19 pandemic.

Discussion:

This study demonstrates how FQHCs can use a variety of staff, processes, and resources to implement clinical SMBP support across a range of geographic regions. To facilitate this, FQHCs and patients may need more comprehensive insurance coverage of blood pressure monitors, reimbursement for staff time, and technology support.
Metformin Preconditioning Augments Cardiac Perfusion and Performance in a Large Animal Model of Chronic Coronary Artery Disease
Authors: Stone Christopher , Sabe Sharif A. , Harris Dwight D. , Broadwin Mark , Kant Rajeev J. , Kanuparthy Meghamsh , Abid M. Ruhul , Sellke Frank W.
Published: July 2024

Objective:

To test the efficacy of metformin (MET) during the induction of coronary ischemia on myocardial performance in a large animal model of coronary artery disease (CAD) and metabolic syndrome (MS), with or without concomitant extracellular vesicular (EV) therapy.

Background:

Although surgical and endovascular revascularization are durably efficacious for many patients with CAD, up to one-third are poor candidates for standard therapies. For these patients, many of whom have comorbid MS, adjunctive strategies are needed. EV therapy has shown promise in this context, but its efficacy is attenuated by MS. We investigated whether MET pretreatment could ameliorate therapeutic decrements associated with MS.

Methods:

Yorkshire swine (n = 29) were provided a high-fat diet to induce MS, whereupon an ameroid constrictor was placed to induce CAD. Animals were initiated on 1000 mg oral MET or placebo; all then underwent repeat thoracotomy for intramyocardial injection of EVs or saline. Swine were maintained for 5 weeks before the acquisition of functional and perfusion data immediately before terminal myocardial harvest. Immunoblotting and immunofluorescence were performed on the most ischemic tissue from all groups.

Results:

Regardless of EV administration, animals that received MET exhibited significantly improved ejection fraction, cardiac index, and contractility at rest and during rapid myocardial pacing, improved perfusion to the most ischemic myocardial region at rest and during pacing, and markedly reduced apoptosis.

Conclusions:

MET administration reduced apoptotic cell death, improved perfusion, and augmented both intrinsic and load-dependent myocardial performance in a highly translatable large animal model of chronic myocardial ischemia and MS.
Imitation versus serendipity in ranking dynamics
Authors: De Domenico Federica , Caccioli Fabio , Livan Giacomo , Montagna Guido , Nicrosini Oreste
Published: July 2024

Participants in socio-economic systems are often ranked based on their performance. Rankings conveniently reduce the complexity of such systems to ordered lists. Yet, it has been shown in many contexts that those who reach the top are not necessarily the most talented, as chance plays a role in shaping rankings. Nevertheless, the role played by chance in determining success, i.e. serendipity, is underestimated, and top performers are often imitated by others under the assumption that adopting their strategies will lead to equivalent results. We investigate the tradeoff between imitation and serendipity in an agent-based model. Agents in the model receive payoffs based on their actions and may switch to different actions by either imitating others or through random selection. When imitation prevails, most agents coordinate on a single action, leading to non-meritocratic outcomes, as a minority of them accumulate the majority of payoffs. Yet, such agents are not necessarily the most skilled ones. When serendipity dominates, instead, we observe more egalitarian outcomes. The two regimes are separated by a sharp transition, which we characterize analytically in a simplified setting. We discuss the implications of our findings in a variety of contexts, ranging from academic research to business.