bluuebunny/crossref_metadata_2025 huggingface dataset:
Image Manipulation Detection Based on Irrelevant Information Suppression and Critical Information Enhancement
Authors: Shao Yunxue , Wang Tingting , Wang Lingfeng
Published: January 2025

The image manipulation detection localization task differs from traditional computer vision tasks in that we focus more on capturing subtle and generic manipulation detection features in images. In this paper, we propose a novel method called irrelevant visual information suppression, which aims to alleviate the interference of irrelevant visual information in images on manipulation detection feature extraction, thereby obtaining generic manipulation traces that are more subtle and unrelated to semantic visual information. In general, most manipulation operations leave traces at manipulation edges. Therefore, we introduce a specially designed manipulated edge information enhancement branch aimed at identifying these edge artifacts more accurately. We construct a dual-branch network, where each branch uses ResNet-50 as the backbone to capture as many multi-scale manipulation features as possible. Finally, we adopt a multi-view feature learning method that combines the manipulated edge information enhancement branch with the irrelevant visual information suppression branch and is trained with multi-scale (pixel/edge/image/irrelevant visual information suppression) supervision. To validate the effectiveness of the proposed method, we conducted extensive experiments using five image manipulation localization datasets, including CASIAv1, CASIAv2, COVER, Columbia, and NIST16. The experimental results demonstrate that our proposed method can outperform state-of-the-art methods by a significant margin in terms of F1 score. Taking CASIAv1, COVER, and Columbia datasets as examples, compared with MVSS-Net published in ICCV 2021, our method has improved F1 scores by 7.1%, 6.3%, and 12.5%, respectively. The code used in this paper can be found at the following URL: https://github.com/ginwins/ISIE-Net .
Untreated exstrophy-epispadias complex: outcomes of Indiana pouch and primary abdominal wall closure
Authors: Kumar Niraj , Mandal Avishek , Kumar Sandeep , Yadav Siddharth , Karmungikar Somanath , Vasudeva Pawan
Published: January 2025

Background

We assessed the outcomes of adult patients with untreated exstrophy-epispadias complex who underwent Indiana continent catheterisable pouch type of urinary diversion along with primary closure of the abdominal wall utilizing the de-epithelised muscular coat of the vesical remnant.

Methods

This retrospective study analysed data between July 2019 and December 2023. All patients underwent a standard evaluation and surgical procedure and were followed up at 6 weeks, 3, 6 and 12 months and then annually. At each visit, renal function test and ultrasonography were performed and a 3 day CIC diary was obtained. The objective success was defined as complete diurnal and nocturnal continence with a pouch capacity of at least 300 ml, whereas the subjective success was defined as the Patient Global Impression of Improvement (PGI-I) score of 1 or 2 at 12 months post-surgery.

Results

A total of ten patients were included, and the mean operative time was 370 min, the mean blood loss was 400 ml and the mean hospital stay was 17 days. The overall complication rate was 40% and there was 1 Clavien IIIb complication. The mean duration of follow-up was 15.6 months and the mean maximum capacity of the pouch was 450 ml and the mean CIC frequency was 4.9 per day. The objective and subjective success rates were 100% and 100%, respectively.

Conclusion

Indiana pouch continent cutaneous urinary diversion is a feasible option with acceptable complication rates. It is a technically simpler procedure and obviates the need for extensive reconstructions and inter-departmental expertise and provides durable results.
The role of informal caregivers in suicide prevention for men– findings from a psychological autopsy study
Authors: Hofmann Laura , Springer Anna-Lena , Wagner Birgit
Published: January 2025

Background

Men have a significantly higher risk of dying by suicide than women and at the same time are less likely to make use of psychosocial support services. Therefore, informal caregivers who care for a person at risk play a significant role. This study aims to highlight the distress and support needs of informal caregivers for men in suicidal crises.

Methods

N = 15 participants who lost a man to suicide in the last 3–12 months were interviewed using psychological autopsy interviews. The interviews were analyzed using a comprehensive category system while following a deductive-inductive approach.

Results

The majority of participants reported experiencing significant stress as well as anxiety about leaving the affected men unsupervised. Only four participants indicated that they openly discussed their stress with their social environment, and just two sought professional support. Notably, only two caregivers anticipated the possibility of suicide. There was also little professional support for caregivers, resulting in participants using internet resources to inform themselves about suicidal ideation and behavior.

Conclusion

These findings highlight the significant stress and burden experienced by informal caregivers in suicide prevention for men. Lack of open communication and insufficient access to support exacerbate the emotional burden on caregivers. These results highlight the need for accessible resources and assistance to better support both caregivers and the individuals they care for.

Trial registration

German Clinical Trials Register, DRKS00030758, Registered on 11.11.2022.
Design and maintenance of medical oxygen concentrators in Sub-Saharan Africa: a systematic review
Authors: Ibrahim Nahimiya Husen , Wallace James , Piaggio Davide , Pecchia Leandro
Published: January 2025

Background

Oxygen therapy is critical and vital treatment for hypoxemia and respiratory distress, however, access to reliable oxygen systems remains limited in SSA. Despite WHO initiatives that distributed over 30,000 OC oxygen concentrators worldwide, SSA faces significant challenges related to their maintenance and use, due to harsh environmental conditions, technical skill shortages and inadequate infrastructure. This review aims to systematically identify and assess the literature on OC design adaptations, maintenance challenges, and knowledge gaps in SSA, providing actionable recommendations to inform innovative and context-sensitive solutions to improve healthcare delivery in the region.

Methods

The study focused on medical oxygen concentrators in SSA countries. It was conducted by following the PRISMA statement and searching three databases, i.e., Scopus, PubMed, and Web of Science, for publications in the period 2001–2023, using the search terms: oxygen concentrator, therapy, cylinder, plant, supply, delivery, and availability, design, and maintenance. The screening process involved evaluating manuscripts based on their titles, abstracts and full texts, based on specific inclusion and exclusion criteria. The extracted information included the author’s publication year, country, study aim, and key findings.

Results

Overall, 1,057 papers were returned for our analysis, of which 20 met the inclusion criteria. These studies primarily examined the design, availability and cost-effectiveness of oxygen concentrators compared to cylinders, revealing a significant supply and demand gap for these devices in SSA. It also illustrated how the environmental challenges impacted the devices durability, highlighting the need for more locally adapted resilient solutions. Solar-powered systems provide a sustainable option in areas with unstable power supplies, although initial costs remain high. Robust maintenance strategies, capacity building and strict procurement protocols proved essential to ensuring equipment long-term functionality.

Conclusion

This review synthesized and critically assessed the current in the body of literature, enabling highlighting valuable insights for innovators and stakeholders with an interest in enhancing the oxygen availability in SSA. It highlighted a pressing need for improved healthcare infrastructure investment, context-aware OC design and novel standards and regulatory frameworks to support frugal innovation.
Maintaining operability at a high personal cost – a mixed method study on maternal healthcare workers’ experiences during the COVID-19 pandemic
Authors: Akerstrom Magnus , Wessberg Anna , Hadžibajramović Emina , Graner Sofie , Carlsson Ylva , Andersson Ola , Jonsson Maria , Naurin Elin , Veje Malin , Sengpiel Verena , Linden Karolina
Published: January 2025

Introduction

The COVID-19 pandemic forced leaders and employees in health care services to take difficult decisions to manage risks associated with employee health and the organizations’ functioning. This study aims to identify the changes in employee working routines, job demands, and job resources within Swedish maternal healthcare during the COVID-19 pandemic, and how these changes affected workload and health.

Methods

Data were derived from the longitudinal COPE Staff study involving midwives and physicians within maternal healthcare. Three focus group discussions with midwives and physicians (n = 13), and open-ended survey responses (n = 604) during the third wave of the pandemic (January to May 2021) were analyzed using deductive content analysis based on the Job Demands-Resources model. Quantitative measures of workload and burnout from three survey waves, both during the pandemic (January to May 2021 [n = 782] and January to March 2022 [n = 503]) and after the pandemic (February to March 2023 [n = 759]), were analyzed.

Results

Multiple changes in working routines were implemented to adhere to national and local guidelines aiming to decrease the spread of Sars-CoV-2. As a result, midwives and physicians experienced increased job demands, including an increased workload and higher emotional and cognitive demands. To balance these demands, new working routines were introduced, and managers increased their efforts to communicate and support the employees. Collegial support also grew. When surveyed, however, most of the maternal healthcare workers said they experienced a high workload. It was found that between 3–7% likely experienced burn out, while another 10% were at risk of burnout during and after the pandemic.

Conclusions

The pandemic had a large effect on maternal healthcare employees. Strategies and adaptations on an organizational, managerial, and individual level played an important role in modifying the impact on the organization’s operations and employees.
Long COVID and its risk factors in migrants: a nationwide register study from Sweden
Authors: Cederström Agneta , Mkoma George Frederick , Benfield Thomas , Agyemang Charles , Nørredam Marie , Rostila Mikael
Published: January 2025

Background

Many studies have found more severe COVID-19 outcomes in migrants and ethnic minorities throughout the COVID-19 pandemic, while recent evidence also suggests higher risk of longer-term consequences. We studied the risk of a long COVID diagnosis among adult residents in Sweden, dependent on country of birth and accounting for known risk factors for long COVID.

Methods

We used linked Swedish administrative registers between March 1, 2020 and April 1, 2023, to estimate the risk of a long COVID diagnosis in the adult population that had a confirmed COVID-19 infection. Poisson regressions were used to calculate incidence rate ratios (IRR) of long COVID by country/region of birth. The contribution of sex, preexisting health status, disease severity, vaccination status, and socioeconomic factors to differences in long COVID diagnosis by country/region of birth were further investigated.

Results

Of the 1,869,188 persons diagnosed with COVID-19 that were included, 7539 had received a long COVID diagnosis. Compared with residents born in Sweden, we found higher risks of long COVID among migrants from East Europe (IRR: 1.44 CI: 1.29–1.60), Finland (IRR: 1.36 CI: 1.15–1.61), South Asia (IRR: 1.28 CI: 1.03–1.59), Other Asia (IRR: 1.35 CI: 1.13–1.62), Other Africa (IRR: 1.48 CI: 1.17–1.87), and the Middle East (IRR: 1.43 CI: 1.27–1.63) in models adjusted for age and sex. We discovered that disease severity, i.e., whether the person was hospitalized (IRR: 18.6 CI: 17.3–20.0) or treated in an intensive care unit (IRR: 120.5 CI: 111.7–129.8), primarily contributed to the higher risk of long COVID found in migrants while the contribution of vaccinations and social conditions were moderate. Preexisting health problems did not contribute to the increased risk of long COVID in migrants.

Conclusions

The greater exposure and impact of the COVID-19 virus among migrants also affected longer-term consequences. Disease severity was the most important risk factor for long COVID in migrants. The findings emphasize the need for targeted health interventions for migrant communities during an infectious disease pandemic, such as strategic vaccination campaigns and extending social insurance schemes, focusing on reducing disease severity to mitigate the longer-term health consequences of an infection.
Alpha/beta values in pediatric medulloblastoma: implications for tailored approaches in radiation oncology
Authors: Jazmati Danny , Sohn Dennis , Hörner-Rieber Juliane , Qin Nan , Bölke Edwin , Haussmann Jan , Schwarz Rudolf , Niggemeier Niklas David , Borkhardt Arndt , Babor Florian , Brozou Triantafyllia , Felek Melissa , Tamaskovics Balint , Melchior Patrick , Beez Thomas , Timmermann Beate , Remke Marc , Corradini Stefanie , Schulz Rémi Till , Preugschas Ronja-Linda , Budach Wilfried , Matuschek Christiane
Published: January 2025

Background

Medulloblastoma is the most common malignant pediatric brain tumor, typically treated with normofractionated craniospinal irradiation (CSI) with an additional boost over about 6 weeks in children older than 3 years. This study investigates the sensitivity of pediatric medulloblastoma cell lines to different radiation fractionation schedules. While extensively studied in adult tumors, these ratios remain unknown in pediatric cases due to the rarity of the disease.

Materials and methods

Five distinct medulloblastoma cell lines (ONS76, UW228-3, DAOY, D283, D425) were exposed to varying radiation doses and fractionation schemes. In addition, ONS76 and UW228-3 stably overexpressing MYC were analyzed. Alpha/beta values, representing fractionation sensitivity, were quantified using the linear-quadratic model of radiation survival.

Results

The study unveiled elevated alpha/beta ratios across diverse medulloblastoma cell lines, with a weighted mean alpha/beta value of 11.01 Gy (CI: 5.23–16.79 Gy). Neither TP53 status nor the levels of MYC expression influenced fractionated radiosensitivity. Furthermore, differences in alpha/beta values cannot be correlated with molecular subgroups (p = 0.07) or radiosensitivity (SF2).

Conclusion

These in vitro findings strongly recommend normofractionated or hyperfractionated radiotherapy for paediatric medulloblastoma cases due to consistently high alpha/beta values across subgroups. Conversely, hypofractionated radiotherapy is not advisable within a curative approach. This study presents significant potential by enabling the estimation of radiobiological fractionations and dose effects in young, vulnerable patients, highlighting its importance for advancing patient-specific therapeutic strategies.
Molecular and cellular characteristics of cerebrovascular cell types and their contribution to neurodegenerative diseases
Authors: Garcia Francisco J. , Heiman Myriam
Published: January 2025

Many diseases and disorders of the nervous system suffer from a lack of adequate therapeutics to halt or slow disease progression, and to this day, no cure exists for any of the fatal neurodegenerative diseases. In part this is due to the incredible diversity of cell types that comprise the brain, knowledge gaps in understanding basic mechanisms of disease, as well as a lack of reliable strategies for delivering new therapeutic modalities to affected areas. With the advent of single cell genomics, it is now possible to interrogate the molecular characteristics of diverse cell populations and their alterations in diseased states. More recently, much attention has been devoted to cell populations that have historically been difficult to profile with bulk single cell technologies. In particular, cell types that comprise the cerebrovasculature have become increasingly better characterized in normal and neurodegenerative disease contexts. In this review, we describe the current understanding of cerebrovasculature structure, function, and cell type diversity and its role in the mechanisms underlying various neurodegenerative diseases. We focus on human and mouse cerebrovasculature studies and discuss both origins and consequences of cerebrovascular dysfunction, emphasizing known cell type-specific vulnerabilities in neuronal and cerebrovascular cell populations. Lastly, we highlight how novel insights into cerebrovascular biology have impacted the development of modern therapeutic approaches and discuss outstanding questions in the field.
Identification of major trauma using the simplified abbreviated injury scale to estimate the injury severity score: a diagnostic accuracy and validation study
Authors: Eidenbenz David , Gauss Tobias , Zingg Tobias , Darioli Vincent , Vallot Cécile , Carron Pierre-Nicolas , Bouzat Pierre , Ageron François-Xavier
Published: January 2025

Background

The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) grade the severity of injuries and are useful for trauma audit and benchmarking. However, AIS coding is complex and requires specifically trained staff. A simple yet reliable scoring system is needed. The aim of this study was two-fold. First, to develop and validate a simplified AIS (sAIS) chart centred on the most frequent injuries for use by non-trained healthcare professionals. Second, to evaluate the diagnostic accuracy of the sAIS (index test) to calculate the simplified ISS (sISS) to identify major trauma, compared with the reference AIS (rAIS) to calculate the reference ISS (rISS).

Methods

This retrospective study used data (2013–2014) from the Northern French Alps Trauma Registry to develop and internally validate the sAIS. External validation was performed with data from the Trauma Registry of Acute Care of Lausanne University Hospital, Switzerland (2019–2021). Both datasets comprised a random sample of 100 injured patients. Following the Standards for Reporting of Diagnostic Accuracy Studies 2015 guidelines, all patients completed the rAIS and the sAIS. The sISS and the rISS were calculated using the sAIS and the rAIS, respectively. Accuracy was evaluated with the mean difference between the sISS and the rISS and the Pearson correlation coefficient. A clinically relevant equivalence limit was set at ± 4 ISS points. Precision was analyzed using Bland-Altmann plots with 95% limits of agreement.

Results

Accuracy was good. The mean ISS difference of 0.97 (95% CI, −0.03 to 1.97) in the internal validation dataset and − 1.77 (95% CI, − 3.04 to 0.50) in the external validation dataset remained within the equivalence limit. The Pearson correlation coefficient was 0.93 in the internal validation dataset (95% CI, 0.90–0.95) and 0.82 in the external validation dataset (95% CI, 0.75–0.88). The limits of agreement were wider than the predetermined relevant range.

Conclusions

The sAIS is accurate, but slightly imprecise in calculating the ISS. The development of this scale increases the possibilities to use a scoring system for severely injured patients in settings with a reduced availability of the AIS.

Trial registration: Retrospectively registered.
Association between some environmental risk factors and attention-deficit hyperactivity disorder among children in Egypt: a case-control study
Authors: Hussein Riham Abdelhamid , Refai Rania Hussein , El-zoka Aleya Hanafy , Azouz Hanan Galal , Hussein Mohamed Fakhry
Published: January 2025

Background

Attention-Deficit Hyperactivity Disorder (ADHD) is a complex disease that negatively impacts the social and academic/occupational activities of children and is more common in boys than in girls.

Methods

This case-control study aimed to assess the association between some environmental risk factors and ADHD among children in Alexandria, Egypt. It was carried out at the outpatient clinics of El Shatby Pediatric University Hospital in Alexandria, Egypt, with 252 children (126 cases and 126 controls). Hair samples were collected for analysis of lead and manganese levels using Atomic Absorption Spectrophotometer. A pre-designed interview questionnaire was used to determine the important environmental risk factors that may be related to ADHD.

Results

Children from parents with low levels of education, living in crowded houses, and occupational exposure to chemical agents were found to be risk factors for ADHD. The mean ± SD hair lead level in ADHD children was 2.58 ± 1.95, while in controls was 1.87 ± 0.92, with a statistically significant difference (p < 0.001). The mean ± SD hair manganese level in ADHD children was 2.10 ± 1.54, while in controls was 1.11 ± 0.69, with a statistically significant difference (p < 0.001). The logistic regression model revealed that six factors had a significant association with ADHD: using of newspapers to wrap food 3 or more times a week (adjusted odds ratio (AOR) = 105.11, 95% CI: 11.18-988.26), daily TV watching by child for more than 5 h (AOR = 63.96, 95% CI: 2.56-1601.32), child’s eating commercially packed noodles 3 times or more per week (AOR = 57.73, 95% CI: 3.77–593.93), using unpackaged flour in cooking (AOR = 44.47, 95% CI: 1.83–629.80), eating sweets daily by child (AOR = 6.82, 95% CI: 1.23–37.94), and lastly elevated hair Manganese level (AOR = 3.57, 95% CI: 1.24–10.29).

Conclusions

ADHD is a multi-factorial disorder, where many environmental risk factors contribute to its development. Future efforts to determine the best preventive strategy in Egypt must be based on a better knowledge of the role of environmental risk factors in the etiology of the disorder. Eliminating non-essential uses of lead and providing public education regarding the importance of safe disposal of lead-acid batteries and computers are necessary.
Metabolic/bariatric surgery optimization: a position statement by Arabic association for the study of diabetes and metabolism (AASD)
Authors: Soliman Amin Roshdy , Magd eldin Saleem Hesham , El Meligi Amr Abel Hady , Naguib Mervat , Sobh Mohamed Rasha , Abdelaziz Ghada Rabie , Rakha Maha , Abdelghaffar Shereen , Hamed Abd ElKhalek , Hammad Hany Abd El Rahman saeed , Mahmoud Eman O , Shaltout Inass
Published: January 2025

For patients considering bariatric surgery, it is essential to have clear answers to common questions to ensure the success of the procedure. Patients should understand that surgery is not a quick fix but a tool that must be complemented by lifestyle changes, including dietary adjustments and regular physical activity. The procedure carries potential risks that should be weighed against the potential benefits. Health authorities play a critical role in ensuring that bariatric surgery is performed under the highest standards of care. Recommendations are provided to determine who is an appropriate candidate for surgery, what preoperative evaluations are necessary, and how to monitor patients postoperatively to maximize outcomes and minimize risks. Additionally, authorities are responsible for ensuring access to follow-up care, including nutritional support and psychological counseling, which are vital for the long-term success of bariatric surgery.

Understanding these aspects by both patients and decision-makers is critical before proceeding with bariatric surgery. The following questions guide patients and healthcare professionals in making informed decisions about the procedure and managing the expectations and outcomes associated with bariatric surgery.
Analysis of HIV therapy in the liver using optimal control and pharmacokinetics
Authors: Nampala Hasifa , Jabłońska-Sabuka Matylda , Singull Martin
Published: January 2025

The main burden in treating human immunodeficiency virus (HIV) infection currently, is the side effects of the antiretroviral therapy (ART) used, because each treatment is toxic to the liver. This study uses optimal control theory applied to a mathematical model that describes the dynamics of HIV infection in the liver. The optimal controls are presented as therapy efficacy of reverse transcriptase inhibitors (RTIs), integrase inhibitors (INs) and protease inhibitors (PIs). An objective function is defined with an aim to investigate the optimal control strategy that minimises toxicity, viral load and cost of first-line and second-line HIV regimen. Results indicate that, in the first-line regimen with INs, a patient has to take medication for at least 98% of the treatment time and the regimen should be close to 100% efficacious regardless of the intervention cost. For second-line regimen, the period of drug administration of PIs largely depends on the weight constants. Inclusion of INs in the first-line regimen yields better HIV DNA suppression, as they are more efficacious than NRTIs. Of all drugs studied, nevirapine is highly efficacious but most toxic. The study recommends routine transaminase tests because results indicate liver enzyme elevation even with very low viral load. Numerical results with pharmacokinetic parameters further indicate an increase in HIV load at initiation of therapy, due to viral redistribution in plasma.
Livelihood training, food production, and food security among vulnerable communities in Bangladesh
Authors: Tran Andy , Fang Theresa , Oranga Beryl , Kopper Ryan , Kang Yunhee
Published: January 2025

Objectives

Massive influx of Rohingya refugees increases the risk of food insecurity in host communities in Bangladesh. This study explores intervention-related factors associated with food insecurity in the Bangladesh host households living near Rohingya refugees.

Methods

This secondary data analysis used the endline survey data from 660 host households who participated in the World Vision US Emergency Food System Security Project from 2019 to 2021. Logistic regression analysis was performed to explore the associations between program interventions and household dietary diversity score [HDDS: low (≤ 8) vs high (> 8)] and reduced coping strategy index [rCSI: high (> 3) vs. low (≤ 3)].

Results

A total of 64.7% of households (n = 427) had low HDDS, and 10.6% (n = 70) had high rCSI. Purchasing food using cash transfer was associated with higher odds of high rCSI (adjusted odds ratio [AOR] = 2.10; 95% CI 1.25–3.53) and low HDDS (AOR = 1.57; 95% CI 1.13–2.18). Those who received food aid had higher odds of low HDDS (AOR = 3.16; 95% CI 1.69–5.89). Participants who farmed had lower odds of having high rCSI and low HDDS [AOR = 0.41 (95% CI 0.21–0.77) and AOR = 0.57 (95% CI 0.34–0.98), respectively].

Conclusion

Our findings suggest that interventions focused on livelihood or farming training may yield the greatest reduction in food insecurity among host communities experiencing refugee influx. Humanitarian organizations should consider interventions that develop these farming skills over direct cash or food transfers to promote long-term self-sufficiency in the host population.
The role of BATF in immune cell differentiation and autoimmune diseases
Authors: Wang Xiaomeng , Hong Yue , Zou Jinmei , Zhu Bo , Jiang Chao , Lu Liwei , Tian Jie , Yang Jing , Rui Ke
Published: January 2025

As a member of the Activator Protein-1 (AP-1) transcription factor family, the Basic Leucine Zipper Transcription Factor (BATF) mediates multiple biological functions of immune cells through its involvement in protein interactions and binding to DNA. Recent studies have demonstrated that BATF not only plays pivotal roles in innate and adaptive immune responses but also acts as a crucial factor in the differentiation and function of various immune cells. Lines of evidence indicate that BATF is associated with the onset and progression of allergic diseases, graft-versus-host disease, tumors, and autoimmune diseases. This review summarizes the roles of BATF in the development and function of innate and adaptive immune cells, as well as its immunoregulatory effects in the development of autoimmune diseases, which may enhance the current understanding of the pathogenesis of autoimmune diseases and facilitate the development of new therapeutic strategies.
Technical aspects of neuraxial analgesia during labor and maternity care: an updated overview
Authors: Coviello Antonio , Iacovazzo Carmine , Frigo Maria Grazia , Ianniello Marilena , Cirillo Dario , Tierno Giuseppe , de Siena Andrea Uriel , Buonanno Pasquale , Servillo Giuseppe
Published: January 2025

Labor analgesia is increasingly widespread throughout the world with a rate ranging from 10 to 60%. The benefits regarding clinical and non-clinical maternal–fetal outcomes are currently discussed in international scientific literature. Even stage of labor needs a different and appropriate approach to control the pain; however, different techniques are reported in literature. The following study intends to give a brief overview of the characteristics of the different neuraxial and non-neuraxial techniques currently available and the non-technical skills necessary for effective assistance to pregnant women, providing insights on the topic to understand critical issues at the same time. After bibliographic research since 2018 to 2023, many randomized controlled trials, literature reviews, systematic reviews, and metanalysis were evaluated to create this brief overview. The following pharmacological and non-pharmacological approaches were assessed: spinal techniques, such as epidural analgesia (EA), combined spinal-epidural (CSE), dural puncture epidural (DPE), and continuous spinal anesthesia (CSA); pharmacological administration of nitrous oxide (N2O) and systemic opioids (morphine, fentanyl, and pethidine); as the third one transcutaneous electric nerve stimulation (TENS), acupressure/acupuncture, aromatherapy, and breathing exercises. All the assessed approaches are relatively safe and effective, but the association of technical and non-technical skills is needed to improve the maternal and fetus outcome. More studies are needed to clarify what is the best approach to labor analgesia.
State of Professional Well-Being, Satisfaction, and Career Plans Among US Oncologists in 2023
Authors: Schenkel Caroline , Levit Laura A. , Kirkwood Kelsey , Spence Rebecca , Burke John M. , Gallagher Colleen M. , Garrett-Mayer Elizabeth , McGinnis Molly , Morgante James D. , Page Ray D. , Paice Judith , Tetzlaff Eric , Winer Eric , Hlubocky Fay J. , Shanafelt Tait
Published: January 2025

PURPOSE

Recent data suggest that the rate of burnout among oncologists has risen over time. In addition to the negative effect of burnout on individuals, widespread burnout may prevent the oncology workforce from meeting patient care needs.

METHODS

ASCO surveyed US-based oncologists in patient care roles about their professional well-being and satisfaction and the effect of both on their career plans. Burnout was assessed using measures of emotional exhaustion and depersonalization from the Maslach Burnout Inventory Human Services Survey. Data from the 2023 survey were compared with data from Shanafelt et al (JCO, 2014) collected about oncologist burnout/well-being in 2013.

RESULTS

In all, 328 responses to the 2023 survey were analyzed. Burnout was significantly higher compared with 2013, 45% in 2013 versus 59% in 2023 (
P
< .01). In 2023, <25% of oncologists reported feeling satisfied with their work-life integration, compared with nearly 35% in 2013 (
P
< .01). Burnout was significantly associated with being a caregiver in one’s personal life, being under age 50 years, and working more than 60 hours per week (all
P
< .05). Over 20% of respondents reported that it was likely or definite that they would reduce their clinical hours in the next 12 months. Additional practice/administrative support and reducing work hours were identified as potential solutions to improve job satisfaction.

CONCLUSION

Oncologists in 2023 are experiencing higher rates of burnout compared with a decade ago. System-based interventions to reduce burnout are necessary to maintaining an adequate workforce to provide care for current and future patients with cancer.
Ten-Year Trends in Clinician Well-Being and Burnout Among Oncology Fellows in Training: An ASCO State of Cancer Care in America Study
Authors: Schenkel Caroline , Levit Laura A. , Kirkwood Kelsey , Shanafelt Tait , Subbiah Ishwaria M.
Published: January 2025

PURPOSE

To better understand burnout in oncology and clinician well-being along the career continuum starting with training, we sought to characterize the professional well-being of physicians training in medical oncology in 2023 and to identify trends over time comparing to fellows from a decade prior.

METHODS

All US medical oncology fellows taking the 2023 ASCO Medical Oncology In-Training Exam (ITE) were invited to complete an optional post-exam survey evaluating fatigue, satisfaction with work-life integration (WLI), emotional exhaustion and depersonalization. 2023 ITE survey responses were compared to the 2013 ASCO post-ITE survey (n=1345). Two sample
t
tests and analysis of variance tests (continuous variables) and Chi-square tests (categorical variables) were used to assess differences in well-being dimensions between groups.

RESULTS

Of the 2217 fellows who took the 2023 ITE, 1589 (71%) answered the post-ITE survey's well-being items (33% first-year, 36% second-year, and 31% third-year fellows). In 2023, one in five fellows (20%) reported burnout (compared to 34% of fellows in 2013,
P
< .01) and 50% of fellows in 2023 reported satisfaction with WLI (
v
34% in 2013,
P
< .01). High emotional exhaustion was reported in 18% of all fellows in 2023 with the highest among first years (21%), compared to third (17%) and second years (16%,
P
= .04). High depersonalization was reported by 11% of fellows in 2023 without a significant difference across the years. Finally, in 2023, 93% (n = 1459) of medical oncology fellows reported that they would choose oncology again as their field, increasing significantly from 89% (n = 1056) in 2013 (
P
< .01).

CONCLUSION

Although US medical oncology fellows are doing better than in 2013, burnout and work-life integration continue to be issues. These findings underscore the significance of optimizing WLI and the need to better understand the drivers mediating a positive workplace experience and its evolution once in practice.
Metabolic Profiles of Pregnancy with Polycystic Ovary Syndrome: Insights into Maternal-Fetal Metabolic Communication
Authors: Ge Huisheng , Huang Dongni , Tan Lunbo , Luo Dan , Zhou Liu , Liu Hong , Zhang Yilan , Liu Dandan , Wu Xixi , Wang Lulu , Xiong Liling , Yang Yang , Han Ting-Li , He Chengjin , Qi Hongbo
Published: January 2025

Context

PCOS pregnancies are linked to metabolic disorders affecting maternal and fetal outcomes, with maternal metabolites differing from those in normal pregnancies.

Objective

To investigate the metabolic communication at the maternal-fetal interface in PCOS pregnancies.

Design

Placenta and umbilical cord serum were analyzed using gas chromatography-mass spectrometry. In-depth analysis was performed with clinical characteristics.

Setting

Placenta and umbilical cord serum were analyzed using gas chromatography-mass spectrometry, alongside clinical characteristics.

Participants

45 uncomplicated PCOS pregnancies and 50 normal pregnancies.

Intervention(s)

None.

Main Outcome Measure(s)

The metabolic characteristics at the maternal-fetal interface in PCOS pregnancies and the underlying mechanisms.

Results

A total of 79 metabolites in the placenta and 25 in umbilical cord serum showed significant differences between polycystic ovary syndrome (PCOS) and normal pregnancies. The 10 most significant placental metabolites were identified through receiver operating characteristic (ROC) analysis, 9 of which correlated significantly with maternal serum testosterone levels. Lasso regression analysis identified 4 key placental metabolite combinations: gamma-aminobutyric acid, proline, glycine, and isoleucine, achieving an area under the curve (AUC) of 93.24%. In umbilical cord serum, 6 metabolites differed significantly between PCOS and normal pregnancies, with the highest AUC reaching 76.07%, and 5 of these metabolites showed significant correlations with maternal serum testosterone levels. Nine differential metabolites were shared between the placenta and umbilical cord serum, which also shared metabolic pathways, including ABC transporters and aminoacyl-tRNA biosynthesis, potentially influencing maternal-fetal interactions.

Conclusion

This study identifies the metabolomic profile and key pathways in maternal-fetal communication during PCOS pregnancies.
Anchoring the Sacred in the Mundane
Authors: Hong Wu
Published: January 2025

Baodingshan is a famous religious complex constructed primarily in the Southern Song period (1127–1270). The Great Buddha Bend (Dafowan), where a magnificent continuum of high-relief carvings was constructed along the cliff face, is a major site of the Baodingshan complex and the focus of this study. This paper takes a phenomenological approach to examine the experiential aspect of viewing these carvings. As a viewer encounters the carvings through his perceiving body rather than reading them as a flat, iconographic plan on the computer monitor, the spatial organization of the carvings, and their sizes and materiality are significant in affecting the viewer's perception of and psychological response to the divine. By analyzing the unconventional design tactics adopted at the Great Buddha Bend and their effects on the perceived relationship between the carved transcendent realm and the world of the earthly activities, this paper argues that the Great Buddha Bend reflects an intentional blurring of the boundaries between the sacred and the mundane. While pre-Song Buddhist settings exuded a detached, dignified solemnity separate from ordinary existence, the design philosophy at the Great Buddha Bend aimed to create a Buddhist environment that felt grounded in earthly experiences. This novel development is likely connected to the growing theatrical culture of the Song, but also reflects an understudied conceptual development during the Tang-Song transition. Probing into this transition provides a more nuanced understanding of the medieval people's envisioned relationship with the divine and offers fresh insights to the secularizing development of Buddhism during the Song dynasty.
Long-Term Outcomes of Jugular Paragangliomas Undergoing Gamma Knife Radiosurgery: A Single Center Experience
Authors: Daza-Ovalle Alberto , Bin-Alamer Othman , Wei Zhishuo , Abou-Al-Shaar Hussam , Hadjipanayis Constantinos G. , Gardner Paul , Niranjan Ajay , Lunsford L. Dade
Published: January 2025

BACKGROUND AND OBJECTIVES:

Jugular paragangliomas (JPG) pose a surgical challenge because of their vascularity and complex location. Stereotactic radiosurgery (SRS) offers a minimally invasive management for patients with JPG. Our aim was to evaluate outcomes of Gamma Knife radiosurgery (GKRS) for the treatment of JPG over the long term.

METHODS:

We reviewed our 3.5-decade 17 800 patients' GKRS database. Clinical behavior, treatment parameters, tumor control, complications, and functional status were assessed.

RESULTS:

Forty patients (median = 56 years [range, 18-88], women = 24) with 40 JPG were included. There were 28 primary and 12 adjuvant GKRS. The median margin dose was 13.5 Gy (range, 12-18) delivered at 50% isodose line. Among patients with adjuvant GKRS, there were more staged-volume SRS (2 sessions) (n = 1 vs n = 3, P = .035) associated with larger tumor volume [3.5 cc (1.1-26.7) vs 10.2 cc (3.3-45.9), (P = .038) and increased V12Gy (P = .031). Better House-Brackmann grade (P = .008) and Gardner-Robertson hearing class (P < .001) before GKRS correlated with better facial nerve function and unchanged cochlear nerve function after treatment, respectively. During an overall median follow-up of 69.7 months (range, 6.0-339.3 months), symptom control and preserved functionality were achieved in 39 patients (97.5%). Tumor control was obtained in 38 patients (95%) (regression = 23, stable = 15) after SRS. The 5-, 10-, and 15-year progression-free survival rates were all 100% after primary GKRS and 91.7%, 83.3%, and 83.3% for adjuvant GKRS (P = .101). Larger (≥10 cc) tumor volumes (HR: 1.35 [95% CI: 1.11-1.70], P = .013) and mFisch Di2 (HR: 1.40 [95% CI: 1.18-1.64], P = .016) were associated with worse progression-free survival. One patient required a second GKRS after asymptomatic progression with no further growth. One patient with 2 failed surgical resections died 8 months after adjuvant GKRS related to tumor progression and hydrocephalus.

CONCLUSION:

As a minimally invasive management, GKRS proved to be a safe and effective treatment of JPG. GKRS should be considered both as an optimal primary management and as an early adjuvant strategy for residual or recurrent tumors after initial resection.
A subpopulation of cortical neurons altered by mutations in the autism risk gene DDX3X
Authors: Flores Michael A. , Garcia-Forn Marta , von Mueffling Alexa , Ola Praise , Park Yeaji , Boitnott Andrea , De Rubeis Silvia
Published: January 2025

Cell fate decisions during cortical development sculpt the identity of long-range connections that subserve complex behaviors. These decisions are largely dictated by mutually exclusive transcription factors, including CTIP2/Bcl11b for subcerebral projection neurons and BRN1/Pou3f3 for intra-telencephalic projection neurons. We have recently reported that the balance of cortical CTIP2-expressing neurons is altered in a mouse model of DDX3X syndrome, a female-biased neurodevelopmental disorder associated with intellectual disability, autism spectrum disorder, and significant motor challenges. Here, we studied the developmental dynamics of a subpopulation of cortical neurons co-expressing CTIP2 and BRN1. We found that CTIP2+BRN1+ neurons are born during early phases of neurogenesis like other CTIP2+ neurons, peak in expression during perinatal life, and persist in adult brains. We also found that CTIP2+BRN1+ neurons are excessive in number in prenatal and mature cortical motor areas of Ddx3x mutant mice, translating into altered laminar distribution of subcerebral projection neurons extending axons to the brainstem. These findings underscore the critical role of molecular specification during cortical development in health and disease.
Mitochondria–plasma membrane contact sites regulate the ER–mitochondria encounter structure
Authors: Casler Jason C. , Harper Clare S. , Lackner Laura L.
Published: January 2025

Cells form multiple, molecularly distinct membrane contact sites (MCSs) between organelles. Despite knowing the molecular identity of several of these complexes, little is known about how MCSs are coordinately regulated in space and time to promote organelle function. Here, we examined two well-characterized mitochondria–endoplasmic reticulum (ER) MCSs – the ER–mitochondria encounter structure (ERMES) and the mitochondria–ER–cortex anchor (MECA) in Saccharomyces cerevisiae. We report that loss of MECA results in a substantial reduction in the number of ERMES contacts. Rather than reducing ERMES protein levels, loss of MECA results in an increase in the size of ERMES contacts. Using live-cell microscopy, we demonstrate that ERMES contacts display several dynamic behaviors, such as de novo formation, fusion and fission, that are altered in the absence of MECA or by changes in growth conditions. Unexpectedly, we find that the mitochondria–plasma membrane (PM) tethering, and not the mitochondria–ER tethering, function of MECA regulates ERMES contacts. Remarkably, synthetic tethering of mitochondria to the PM in the absence of MECA is sufficient to rescue the distribution of ERMES foci. Overall, our work reveals how one MCS can influence the regulation and function of another.
Light alters calling-song characteristics in crickets
Authors: Levy Keren , Aidan Yossef Yits'hak , Paz Dror , Medlij Heba , Ayali Amir
Published: January 2025

Communication is crucial for mate choice and thus for the survival and fitness of most species. In the cricket, females choose males according to their calling-song attractiveness and, exhibiting positive phonotaxis, they approach the chosen male. Light has been widely reported to induce changes in crickets' daily activity patterns, including the males' stridulation behavior. It had remained unknown, however, whether light also affects the calling-song properties and thus may consequently also alter female choice. Here, we present a novel semi-automated process, enabling the analysis of calling-song properties in an extremely large sample size of recording sections from males subjected to lifelong light:dark (LD) or constant light (LL) conditions. Our findings revealed that the LD calling songs consisted of longer chirps, longer inter-syllable intervals and a higher proportion of 4-syllable chirps compared with those of LL males. We also conducted some preliminary female choice experiments suggesting that females (reared in LD conditions) exposed to playbacks of male calling songs exhibit a preference towards LD over LL recordings. We therefore conclude that illumination conditions such as constant light affect the male crickets' calling-song properties in a manner that may be discernible to the females. It remains unclear, however, how and to what extent female mate choice and the species' overall fitness are affected by these changes.
The Modern Wholesaler: Global Sourcing, Domestic Distribution, and Scale Economies
Authors: Ganapati Sharat
Published: January 2025

Half of all transactions in the $6 trillion market for manufactured goods in the United States were intermediated by wholesalers in 2012, up from 32 percent in 1992. Seventy percent of this increase is due to the growth of “superstar” firms—the largest 1 percent. Estimates based on detailed administrative data show that the rise of the largest firms was driven by an intuitive linkage between their sourcing of goods from abroad and an expansion of their domestic distribution network to reach more buyers. Both elements require scale economies and lead to increased wholesaler market shares and markups. (JEL D22, D24, F14, L15, L60, L81)
The Inner Workings of a Hub-and-Spoke Cartel in the Automotive Fuel Industry
Authors: Chaves Daniel , Duarte Marco
Published: January 2025

We study the inner workings of a hub-and-spoke cartel in the Brazilian automotive fuel industry. Based on court documents and detailed price and sales data, we discuss how gas station owners (spokes) operating inside the federal capital received help from fuel distributors (hub) to reduce dispersion of and increase gasoline’s retail price. We provide evidence that distributor cartel members benefited by raising wholesale prices while keeping competitors from supplying retail cartel members. We also provide theoretical foundations and empirical evidence for a new mechanism through which hubs help spokes: smoothing cost fluctuations. (JEL K21, L12, L22, L32, L71, L81, O14)
Estimating Models of Supply and Demand: Instruments and Covariance Restrictions
Authors: MacKay Alexander , Miller Nathan H.
Published: January 2025

We consider the identification of empirical models of supply and demand with imperfect competition. We show that a restriction on the covariance between unobserved demand and cost shocks can resolve endogeneity and identify the price parameter. We demonstrate how to employ this approach in estimation, and we compare it to the method of instrumental variables. Our formal results also indicate that weaker covariance restrictions can bound the price parameter. We illustrate the covariance restriction approach with applications to ready-to-eat cereal, cement, and airlines. (JEL C51, D12, L13, L61, L66, L93)