bluuebunny/crossref_metadata_2025 huggingface dataset:
Submillimetre galaxies as laboratories for dust grain coagulation
Authors: Hirashita Hiroyuki , Chen Chian-Chou
Published: October 2023

Coagulation in the dense interstellar medium (ISM) is an important process that determines the size of the largest grains. We use submillimetre galaxies (SMGs) as laboratories of grain coagulation, since some of them host the densest ISM on a galactic scale among various populations of galaxies known. We examine how large the grains can be in such dense environments based on the mean ISM density estimated from the observed typical dust mass density in SMGs. We also consider local density enhancement based on a model of supersonic turbulence, which is expected from strong stellar feedback. In the unlimited coagulation model, in which we do not impose any coagulation threshold velocity, grains as large as $\sim 30~\rm{\mu m}$ can form under the observationally estimated mean gas density if the Mach number of turbulence is $\mathcal {M}\gtrsim 3$. We exclude this possibility since the observed emissivity index β ≃ 2 in the far-infrared (FIR) indicates that such large grains cannot actively form in SMGs. This means that coagulation does not proceed in an unlimited way: 30-$\rm{\mu m}$ grains should have velocities larger than the coagulation threshold. If we use a coagulation threshold (upper limit) grain velocity (∼0.08 km s−1) taken from a theoretical study, grains likely grow only up to $\rm{\mu m}$ size, which is small enough not to affect the FIR emissivity index. The above results indicate that SMGs can be used to constrain the physical processes relevant to coagulation.
Energy Demand Unawareness and the Popularity of Bitcoin: Evidence from Nigeria
Authors: Platt Moritz , Ojeka Stephen , Drăgnoiu Andreea-Elena , Ibelegbu Oserere Ejemen , Pierangeli Francesco , Sedlmeir Johannes , Wang Zixin
Published: October 2023

Decentralized cryptocurrency networks, notably those with high energy demand, have faced significant criticism and subsequent regulatory scrutiny. Despite these concerns, policy interventions targeting cryptocurrency operations in the pursuit of sustainability have largely been ineffective. Some were abandoned for fear of jeopardizing innovation, whereas others failed due to the highly globalized nature of blockchain systems. In search of a more effective angle for energy policy measures, this study adopts a consumer-centric perspective, examining the sentiments of Nigerian cryptocurrency users ($n=158$) toward Bitcoin’s sustainability, a representative cryptocurrency known for its high electricity demand. Three main findings emerged: 1) Even among those self-identifying as highly knowledgeable, most considerably underestimated Bitcoin’s electricity consumption. 2) Participants with a more accurate understanding of Bitcoin’s energy demand were more inclined to support sustainability measures. 3) Most of this supportive cohort viewed private entities as the primary stakeholders for implementing such measures. Given these findings, we suggest that consumer education should be at the forefront of policy initiatives aimed at cryptocurrency sustainability.
How to Explain the Importance of Persons
Authors: Register Christopher
Published: October 2023

We commonly explain the distinctive prudential and moral status of persons in terms of our mental capacities. I draw from recent work to argue that the common explanation is incomplete. I then develop a new explanation: We are ethically important because we are the object of a pattern of self-concern. I argue that the view solves moral problems posed by permissive ontologies, such as the recent personite problem.
Paying attention to astronomical transients: introducing the time-series transformer for photometric classification
Authors: Allam Tarek , McEwen Jason D
Published: October 2023

Future surveys such as the Legacy Survey of Space and Time (LSST) of the Vera C. Rubin Observatory will observe an order of magnitude more astrophysical transient events than any previous survey before. With this deluge of photometric data, it will be impossible for all such events to be classified by humans alone. Recent efforts have sought to leverage machine learning methods to tackle the challenge of astronomical transient classification, with ever improving success. Transformers are a recently developed deep learning architecture, first proposed for natural language processing, that have shown a great deal of recent success. In this work, we develop a new transformer architecture, which uses multihead self-attention at its core, for general multivariate time-series data. Furthermore, the proposed time-series transformer architecture supports the inclusion of an arbitrary number of additional features, while also offering interpretability. We apply the time-series transformer to the task of photometric classification, minimizing the reliance of expert domain knowledge for feature selection, while achieving results comparable with state-of-the-art photometric classification methods. We achieve a logarithmic-loss of 0.507 on imbalanced data in a representative setting using data from the Photometric LSST Astronomical Time-Series Classification Challenge. Moreover, we achieve a micro-averaged receiver-operating-characteristic area under curve of 0.98 and micro-averaged precision–recall area under curve of 0.87.
Correlation between B-cell epitope profile and clinical features of anti-MDA5 antibody-positive dermatomyositis
Authors: Yamaguchi Koichi , Poland Paul , Bijoy George Tissa , Saygin Didem , Moghadam-Kia Siamak , Aggarwal Rohit , Oddis Chester V , Zhu Lei , Ascherman Dana P
Published: October 2023

Objectives

Anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive (MDA5+) dermatomyositis patients exhibit a variety of clinical features. We therefore investigated whether patterns of B-cell epitope recognition are linked to the clinical course of MDA5+ dermatomyositis.

Methods

Our cross-sectional study used ELISA-based methods to determine the relationship between antibody recognition of overlapping 155 amino acid MDA5 subfragments and clinical features of 24 MDA5+ myositis patients. Correlations between clinical features and standardized anti-MDA5 subfragment antibody titres were assessed via Spearman’s rank correlation coefficients.

Results

Twenty-four MDA5+ patients submitted serum samples within a median of 0 (interquartile range, 0–74) days from the initial clinic visit. In addition to typical dermatomyositis rashes, these patients exhibited muscle symptoms (n = 11), vascular dysfunction (n = 9) and interstitial lung disease (ILD) (n = 16). Female patients exhibited higher titres of antibodies recognizing fragment H (aa 905–1026) compared with male patients. Muscle involvement was associated with higher levels of anti-fragment F (aa 646–801) antibody. Conversely, patients with vascular abnormalities had higher anti-fragment B (aa 130–284) and E (aa 517–671) antibody titres than those without vascular dysfunction. Four patients died due to ILD progression and showed higher anti-fragment A (aa 1–155) antibody titres than the other 20 patients. Differences in the ratio of anti-fragment to anti-full-length MDA5 antibody titres were found for sex (H: anti-MDA5) and vascular dysfunction (anti-fragment B, E: anti-MDA5).

Conclusions

Various clinical features of MDA5+ dermatomyositis correlated with levels of antibodies targeting selected subfragments of this autoantigen, providing a link between fragment-specific immune responses and disease course.
Opportunity or Exploitation? A Longitudinal Dyadic Analysis of Flexible Working Arrangements and Gender Household Labor Inequality
Authors: Wang Senhu , Cheng Cheng
Published: October 2023

It has been extensively debated over whether the rise of flexible working arrangements (FWAs) may be an “opportunity” for a more egalitarian gender division of household labor or reinforce the “exploitation” of women in the traditional gender division. Drawing on a linked-lives perspective, this study contributes to the literature by using longitudinal couple-level dyadic data in the UK (2010–2020) to examine how couple-level arrangements of flexible working affect within-couple inequality in time and different types of household labor. The results show that among heterosexual couples, women’s use of FWAs significantly intensifies their disproportionate share of housework and maintains their heavy childcare burden regardless of whether their husbands use FWAs. In contrast, men’s use of FWAs does not change the unequal gendered division of housework and childcare, even when their wives do not use any FWAs. These patterns of intensified gender inequalities are more pronounced in routine housework tasks (e.g., cooking, washing, and cleaning), and among the reduced hours and teleworking arrangements. Overall, rather than providing an “opportunity” for a more egalitarian division of household labor, the use of FWAs maintains or even exacerbates the “exploitation” of women under the existing traditional gender norms.
Role of CdTe quantum dots on peripheral Immunocytes and selenoprotein P: immunotoxicity at the molecular and cellular levels
Authors: Ma Nana , Lu Yudie , Wang Jing , Liang Xueyou , Dong Sijun , Zhao Lining
Published: October 2023

The extensive product and application of cadmium-quantum dots (Cd-QDs), one kind of semiconductor nanomaterials, lead to prolonged exposure to the environment. Cd-QDs have shown good properties in biomedical and imaging-related fields; the safety of Cd-QDs limits the application of these materials and technologies, however. The systematic distribution of CdTe QDs in organisms has been ascertained in previous studies. Nevertheless, it is relatively less reported about the toxicity of CdTe QDs to immune macromolecules and organs. Based on this, immunocytes (including lymphocyte subsets-CD4+ T and CD8+ T cells, splenocytes) and selenoprotein P (SelP) were chosen as targets for CdTe QDs immunotoxicity studies. Results indicate that CdTe QDs induced cytotoxicity to CD4+ T cells, CD8+ T cells and splenocytes by reducing cell viability and causing apoptosis as CdTe QDs and Cd2+ enter cells. At the molecular level, the direct interaction between CdTe QDs and SelP is proved by multispectral measurements, which demonstrated the alteration of protein structure. The combined results show that CdTe QDs induced adverse effects on the immune system at the cellular and molecular levels. This research contributes to a better understanding of CdTe QDs cause harmful damage to the immune system and provides new strategies for the inhibition and treatment of health damages caused by CdTe QDs.
The xerophilic genera Xerobiotus and Pseudohexapodibius (Macrobiotidae; Tardigrada): biodiversity, biogeography and phylogeny
Authors: Vincenzi Joel , Cesari Michele , Kaczmarek Łukasz , Roszkowska Milena , Mioduchowska Monika , Rebecchi Lorena , Kiosya Yevgen , Guidetti Roberto
Published: October 2023

The genera Xerobiotus and Pseudohexapodibius are xerophilic and characterized by reduced appendages and claws as adaptations to move between small interstices. To increase the knowledge of their biodiversity, biogeography and phylogeny, several specimens from European countries and Australia were analysed using an integrative approach, i.e. morphological, karyological and molecular studies (18S, 28S, cox1, cytb and ITS2). The phylogenetic position of Xerobiotus with respect to the three evolutionary lineages of Macrobiotus remains unchanged with respect to what was previously identified in the phylogeny of Macrobiotidae. The following new Xerobiotus species are described: Xerobiotus litus sp. nov., Xerobiotus arenosum sp. nov. and Xerobiotus reductus sp. nov. It is proposed that Macrobiotus naginae should be transferred to Xerobiotus (Xerobiotus naginae comb. nov.). Pseudohexapodibius degenerans clusters within Xerobiotus and shares morphological and genetic characters with this genus. Some discrepancies between genetic and phenotypic data are found among the analysed species. Even between the results obtained with analysed genes disagreements are found, with cox1 and cytb generally agreeing with phenotypic results more than ITS2. Genotypic and phenotypic data are useful tools for species identification, but they have to be evaluated critically to obtain reliable results.
Evaluation of Anaerobic Soil Disinfestation to Reduce Soilborne Diseases in Soilless and Soil-Based Substrates for Specialty Cut Flower Production
Authors: Gutierrez Yanez Daniela , Testen Anna L. , Peduto Hand Francesca
Published: October 2023

Anaerobic soil disinfestation (ASD) is a nonchemical soil treatment where an easily decomposable carbon source is incorporated into soil, which is then irrigated to saturation and tarped to create anaerobic conditions, which prompts shifts in the soil microbiota from aerobes to anaerobes. ASD has been tested successfully for soilborne disease management in a variety of cropping systems but has not been sufficiently investigated in ornamentals. In this study, ASD was evaluated in soil-based and soilless substrates commonly used in specialty cut flower production using two model pathosystems: Rhizoctonia solani–Zinnia elegans and Phytophthora drechsleri–Gerbera jamesonii. Each substrate was mixed with pathogen-infested vermiculite and amended with either wheat bran, tomato pomace, or soybean meal as the carbon source. Amended substrates were incubated at 25°C for 4 weeks and used as growing substrates for the two crops mentioned above, which were monitored weekly for disease development for up to 5 weeks posttransplant. Additional experiments tested the effect of plant age and inoculum concentration in the substrate on ASD efficacy. Results showed that ASD has the potential to be deployed successfully for the control of Rhizoctonia stem rot in both substrates. Conversely, ASD was not effective at controlling Phytophthora crown rot on gerbera daisy in any of the experiments conducted in this study. More research is needed to understand the influence of carbon amendments, inoculum thresholds, and environmental conditions on ASD efficacy.
Addressing Moral Distress After Dobbs v. Jackson Women’s Health Organization: A Professional Virtues-Based Approach
Authors: Chen Rebecca , Gordon Mollie , Chervenak Frank , Coverdale John
Published: October 2023

The June 2022 U.S. Supreme Court decision inDobbs v. Jackson Women’s Health Organizationabolished federal protections for reproductive choice. In states where subsequent legislation has restricted or banned access to abortion services, physicians and trainees are prevented from providing ethically justified evidence-based care when patients with previable pregnancies are seeking an abortion. Pregnant patients’ vulnerabilities, stress, and the undue burden that they experience when prevented from acting in accordance with their reproductive decision-making can evoke negative emotional consequences, including moral distress in clinicians. Moral distress occurs when clinicians feel a moral compulsion to act a certain way but cannot do so because of external constraints, including being hindered by state laws that curtail practicing in line with professional standards on reproductive health care. Moral distress has the potential to subvert prudent clinical judgment. The authors provide recommendations for managing moral distress in these circumstances based on the professional virtues. The fundamental professional virtues of integrity, compassion, self-effacement, self-sacrifice, and humility inform the management of moral distress and how to respond thoughtfully and compassionately, without over-identification or indifference to the plight of patients denied abortions. The authors also discuss the role of academic leaders and medical educators in cultivating a virtue-based professional culture at the forefront of clinical and educational processes in a post-Dobbsworld.
Age-Specific Probability of 4 Major Health Outcomes in Children with Spina Bifida
Authors: Gilbertson Kendra E. , Liu Tiebin , Wiener John S. , Walker William O. , Smith Kathryn , Castillo Jonathan , Castillo Heidi , Wilson Pamela , Peterson Paula , Clayton Gerald H. , Valdez Rodolfo
Published: October 2023

Objective:

This study aimed to estimate the age-specific probability of 4 health outcomes in a large registry of individuals with spina bifida (SB).

Methods:

The association between age and 4 health outcomes was examined in individuals with myelomeningocele (MMC, n = 5627) and non-myelomeningocele (NMMC, n = 1442) from the National Spina Bifida Patient Registry. Sixteen age categories were created, 1 for each year between the ages of 5 and 19 years and 1 for those aged 20 years or older. Generalized linear models were used to calculate the adjusted probability and 95% prediction intervals of each outcome for each age category, adjusting for sex and race/ethnicity.

Results:

For the MMC and NMMC groups, the adjusted coefficients for the correlation between age and the probability of each outcome were −0.933 and −0.657 for bladder incontinence, −0.922 and −0.773 for bowel incontinence, 0.942 and 0.382 for skin breakdown, and 0.809 and 0.619 for lack of ambulation, respectively.

Conclusion:

In individuals with SB, age is inversely associated with the probability of bladder and bowel incontinence and directly associated with the probability of skin breakdown and lack of ambulation. The estimated age-specific probabilities of each outcome can help SB clinicians estimate the expected proportion of patients with the outcome at specific ages and explain the probability of the occurrence of these outcomes to patients and their families.
Danggui Niantong decoction ameliorates joint inflammation and cardiopulmonary injury in TNF-Tg mice
Authors: Yang Can , Chen Tao , Ma Mengjiao , Li Qiang , Liang Zhichao , Xu Hao , Wang Youhua , Li Ning , Liang Qianqian
Published: October 2023

Objective:

Rheumatoid arthritis (RA) is a common autoimmune disease characterized by multiple joint lesions and systemic complications. Danggui Niantong decoction (DGNTT) has been clinically used for RA treatment; however, its beneficial effect on cardiopulmonary complications has not been reported.

Methods:

Female tumor necrosis factor-transgenic (TNF-Tg) mice were used to evaluate the therapeutic effects of DGNTT on arthritis and cardiopulmonary complications. Methotrexate (MTX) served as a positive control. Histopathological assessment of the joint sections was performed using hematoxylin and eosin (HE), Alcian Blue/Orange G, and tartrate-resistant acid phosphatase staining. Bone mass was assessed by micro-computed tomography, inflammatory infiltrates in the heart and lungs were evaluated by HE staining, cardiopulmonary fibrotic injury was identified by Masson’s trichrome staining, and hypertrophy of mouse cardiomyocytes was measured by wheat germ agglutinin (WGA) staining.

Results:

DGNTT mitigated the inflammation of the ankle joint synovium, decreased the number of osteoclasts, and increased the area of cartilage and bone mass in TNF-Tg mice. In addition, DGNTT decreased the infiltration of inflammatory cells into the lung and heart tissues, accompanied by a reduction in cardiopulmonary fibrosis and myocardial cell hypertrophy in TNF-Tg mice. As a positive control drug, MTX attenuated the pathological changes in joints, but had no beneficial effect on cardiopulmonary inflammation and fibrosis in TNF-Tg mice.

Conclusions:

DGNTT improved joint lesions and alleviated cardiopulmonary complications in TNF-Tg mice.
Definitions for Keratoconus Progression and Their Impact on Clinical Practice
Authors: Koppen Carina , Jiménez-García Marta , Kreps Elke O. , Ní Dhubhghaill Sorcha , Rozema Jos J. ,   on behalf of The REDCAKE Study Group
Published: October 2023

Purpose:

There is currently no consensus on which keratoconus need cross-linking nor on how to establish progression. This study assessed the performance of diverse progression criteria and compared them with our clinical knowledge of keratoconus evolution.

Methods:

This was a retrospective, longitudinal, observational study. Habitual progression criteria, based on (combinations of) keratometry (KMAX), front astigmatism (AF), pachymetry (PMIN), or ABCD progression display, from 906 keratoconus patients were analyzed. For each criterion and cutoff, we calculated %eyes flagged progressive at some point (RPROG), individual consistency CIND (%examinations after progression detection still considered progressive), and population consistency CPOP (% eyes with CIND >66%). Finally, other monotonic and consistent variables, such as front steep keratometry (K2F), mean radius of the back surface (RmB), and the like, were evaluated for the overall sample and subgroups.

Results:

Using a single criterion (e.g., ∆KMAX >1D) led to high values of RPROG. When combining two, (KMAX and AF) led to worse CPOP and higher variability than (KMAX and PMIN); alternative criteria such as (K2F and RmB) obtained the best CPOP and the lowest variability (P<0.0001). ABC, as defined by its authors, obtained RPROG of 74.2%. Using wider 95% confidence intervals (95% CIs) and requiring two parameters over 95CI reduced RPROG to 27.9%.

Conclusion:

Previous clinical studies suggest that 20% to 30% of keratoconus cases are progressive. This clinical RPROG value should be considered when defining KC progression to avoid overtreatment. Using combinations of variables or wider margins for ABC brings RPROG closer to these clinical observations while obtaining better population consistency than current definitions.
Sex and age differences of major cardiovascular events in patients after percutaneous coronary intervention
Authors: Yang Ya-Ling , Chen Su-Chan , Wu Cheng-Hsueh , Huang Shao-Sung , Leong Chan Wan , Lin Shing-Jong , Chou Chia-Yu , Chen Jaw-Wen , Pan Ju-Pin , Charng Min-Ji , Chen Ying-Hwa , Wu Tao-Cheng , Lu Tse-Min , Hsu Pai-Feng , Huang Po-Hsun , Cheng Hao-Min , Huang Chin-Chou , Sung Shih-Hsien , Lin Yenn-Jiang , Leu Hsin-Bang
Published: October 2023

Background:

Women usually have higher risk after receiving percutaneous coronary interventions (PCIs) than men with coronary artery disease (CAD). The aim of this study was to investigate the association of sex differences with future outcomes in CAD patients undergoing PCI, to assess the role of age, and to extend observed endpoints to stroke and congestive heart failure.

Methods:

Six thousand six hundred forty-seven patients with CAD who received successful PCIs. The associations between clinic outcomes and sex were analyzed. The primary outcome was major cardiovascular events (MACE), including cardiac death, nonfatal myocardial infraction, and nonfatal stroke. The secondary outcome was MACE and hospitalization for heart failure (total CV events).

Results:

During a mean of 52.7 months of follow-up, 4833 men and 1614 women received PCI. Univariate and multivariate analyses showed that women were independently associated with an increased risk of cardiac death (HR, 1.78; 95% CI, 1.32-2.41), hospitalization for heart failure (HR, 1.53; 95% CI, 1.23-1.89), MACE (HR, 1.34; 95% CI, 1.10-1.63), and total CV events (HR, 1.39; 95% CI, 1.20-1.62). In the subgroup analysis, women aged under 60 years had higher cardiovascular risks than men of the same age category.

Conclusion:

Women with CAD after successful PCI had poorer cardiovascular outcomes than men. Additionally, younger women (aged <60 years) were especially associated with a higher risk of developing future adverse cardiovascular outcomes.
Sexual Practices and Predisposition to PrEP Use Among Men Ages 50 Years and Older Who Have Sex With Men: A Cross-Sectional Study
Authors: Nunes Rômulo Veloso , de Araújo Telma Maria Evangelista , de Oliveira Layze Braz , Almeida Priscilla Dantas , Lima Shirley Veronica Melo Almeida , Magalhães Rosilane de Lima Brito , Valle Andréia Rodrigues Moura da Costa , Fronteira Inês , Mendes Isabel Amélia Costa , de Sousa Álvaro Francisco Lopes
Published: October 2023

This study aimed to evaluate the sexual practices of men ages 50 years or older who have sex with men (MSM) and factors influencing their predisposition to use preexposure prophylaxis (PrEP). An analytical cross-sectional study was conducted in Brazil and Portugal with 718 MSM. Of these, 278 (38.7%) were categorized as being at high risk for HIV based on the HIV Incidence Risk Index (HIRI), and 418 (58.2%) expressed a predisposition to use PrEP. Overall, sociodemographic factors and specific sexual practices increased the likelihood of being classified as high risk for HIV, particularly sexual position and sexual activity. However, factors that influenced the predisposition to use PrEP included age group, receptive anal sex, knowledge of postexposure prophylaxis, high HIRI score, and a history of syphilis. These findings underscore the urgent need for health services to provide comprehensive and adequate attention to the realities of this population, considering its complexities and specificities.
Physicians’ Turnover Intention During the “Post–COVID-19” Era
Authors: Margheritti Simona , Giorgi Ines , Magnone Stefano , Miglioretti Massimo , Fiabane Elena
Published: October 2023

Purpose

This research investigates risk and protective factors affecting physicians’ turnover intention during the post–COVID-19 era.

Design/Methodology/Approach

A cross-sectional online survey study of 958 physicians working in Lombardy (Northern Italy) hospitals was conducted.

Findings

In the post–COVID-19 era, burnout significantly increases physicians’ turnover intention. The same is true for fear of being infected by COVID-19 (FIC), which indirectly affects turnover intention via burnout. The higher FIC and burnout, the higher intention to leave the job or working unity. Self-efficacy significantly decreases turnover intention by reducing FIC and burnout.

Originality/Value

Implementing turnover preventive programs in healthcare professionals is essential, mainly reducing BO and promoting physicians’ personal resources, such as self-efficacy.
Analyzing the Symptom Clusters Among Children With Acute Lymphoblastic Leukemia During Chemotherapy Based on Electronic Nursing Records
Authors: Wang Yuxin , Xie Hongxia , Jiang Hao , Chen Meijia , Ren Liya , Dong Chaoqun
Published: October 2023

Background

Children with acute lymphoblastic leukemia often experience various physical and psychological symptoms during chemotherapy. Previous studies have used predetermined symptom inventories to analyze the complex relationships between these symptoms, which has certain limitations.

Objective

The aim of this study was to explore the dynamic changes in symptom clusters among children with acute lymphoblastic leukemia during chemotherapy using electronic nursing records.

Methods

Electronic nursing records for 2021 (N = 14 490) were obtained from a pediatric hematology department. A natural language processing tool was used to identify the presence of 46 symptoms in 3 chemotherapy phases of induction, consolidation, and maintenance. Incidence of symptom documentation was calculated by notes and patients, and principal component analysis and cluster analysis were performed for symptoms with an incidence above 15%.

Results

The most common symptoms included bleeding, cough, and vomiting. The number of symptom clusters in each chemotherapy period was 7, 6, and 4, respectively. There were upper gastrointestinal, respiratory system, lower gastrointestinal, skin-related, psychological, self-image disorder, and other discomfort symptom clusters in the induction period. Notably, the upper gastrointestinal, respiratory system, lower gastrointestinal, and skin-related symptom clusters persisted through the consolidation and maintenance periods. Neurological and other discomfort symptom clusters were observed during the consolidation period.

Conclusion

Symptom clusters of children with acute lymphoblastic leukemia at various stages of chemotherapy showed a certain level of stability and dynamics, informing healthcare providers in developing continuous symptom management.

Implications for Practice

Medical staff should explore targeted intervention programs based on characteristics of symptom clusters at different chemotherapy stages, to improve the efficiency of symptom management and alleviate the symptom burden of children.
Implementation of a Modified Early Screening for Discharge Tool to Optimize Case Manager Efficiency and Impact Length of Stay
Authors: Grafton James , Bowen Brady Helene , Kelly Joanne , Kelly Margaret , Lang Kathleen , Wolski Paula , Ray Soumi , Loescher Cori , Pearson Madelyn , Mendu Mallika
Published: October 2023

Purpose of Study:

The postacute landscape has been challenged since the onset of the COVID-19 pandemic by staffing shortages and a decline in postacute bed availability. As a result, patients in acute care hospitals are experiencing longer lengths of stay (LOS) and case managers (CMs) are managing increasingly complex discharge plans. This project involved the design and implementation of a modified Early Screen for Discharge Planning (ESDP) tool to support prioritizing patients with complex discharge needs, with the primary outcome of decreasing LOS.

Primary Practice Setting:

The project took place in a community teaching hospital, part of a large academic health system in the Northeast, United States.

Methodology and Participants:

The project was designed as a prospective controlled study (between September 1 and November 30, 2021) with defined intervention and control cohorts, involving a modified ESDP electronic health record–based score including self-rated walking limitation, age, prior living status, and mobility level of assist. A modified ESDP score of 10 and greater indicated that patients would benefit from ongoing CM support, whereas those with an ESDP score of less than 10 were unlikely to have discharge planning needs. Participants were adult patients on medical and surgical inpatient units.

Results:

The project included 718 patients, 376 and 342 in the intervention and control cohorts, respectively. The modified ESDP performed comparably with the standard ESDP (14% discrepancy, with all patients appropriately identified for CM services). Implementation of the modified ESDP led to 53.5% of patients screening out of CM services, thereby increasing the time CMs were able to spend on complex discharge planning and was associated with a trend in LOS reduction (0.55 days).

Implications for Case Management Practice:

The findings of this project demonstrate that implementation of a modified ESDP can improve CM efficiency and improve hospital throughput. Given the unprecedented capacity challenges in both the acute and postacute settings, there is a need to implement CM workflow strategies that will optimize the effectiveness of critical resources, while ensuring that patients' complex discharge needs are met.
Palliative Care Nursing Case Management in Young Adults With Advanced Rare Cancer
Authors: Fusetti Viviana , Angi Martina , Caraceni Augusto T. , Di Guardo Lorenza , Regalia Enrico , Bosisio Marco , Lo Dico Silvia , Pigni Alessandra , Brunelli Cinzia , Lusignani Maura
Published: October 2023

Purpose/Objectives:

This case aims to identify the elements of care continuity that are lacking in young adult patients with advanced rare cancer, suggesting ways to enhance continuity of care through nurse case manager/management (NCM) interventions and describing their impact on the emotional burden of patients and their families.

Primary Practice Setting(s):

Comprehensive cancer center.

Findings/Conclusions:

The dyadic care alliance with the NCM can alleviate disease burden, fostering trust in the team and adherence to care advice, thus reducing the patient's distress. The NCM can be an efficient option to advocate for patient needs on the multidisciplinary team, addressing practical issues and the unmet needs of patients and their caregivers, and facilitating referrals to other professionals. The study also shows that caring for young adults with advanced rare cancers should include mindful evaluation of their significant others.

Implications for Case Management Practice:
Predictive and Associated Factors of Burnout in Nursing Faculty
Authors: Dugger Jennifer
Published: October 2023

Background:

Nurse educators are at high risk of experiencing burnout, resulting in high numbers of vacant faculty positions.

Purpose:

The aims of this integrative review were to review the prevalence of measurable dimensions of professional burnout and discuss the predictive and associated factors of burnout and intent to leave nursing academia.

Approach:

This review used the Whittemore and Knafl integrative review methodology to perform a structured search of 4 electronic databases (CINAHL, ERIC, EMBASE, and PubMed).

Outcomes:

Nine empirical research studies measured 5 identifiable features of burnout in nursing educators: emotional exhaustion, depersonalization, lack of accomplishment, compassion satisfaction, and secondary traumatic stress. Five predictors of intent to leave nursing academia were identified: demographics, health status, salary, workload, and work-life imbalance.

Conclusions:

The highest contributing factor to burnout and intent to leave nursing academia is high workload levels and lack of work-life balance. Nursing faculty report moderate to high levels of all dimensions of professional burnout.
Medication adherence to oral chemotherapeutic agents: a qualitative study of patients' and cancer care professionals' perspectives
Authors: Torres Essie , Richman Alice , Koutlas Judy B. , DeAntonio Phyllis A. , Liles Darla K. , Romero-Trejo Katherine , Tripp Molly Robinson
Published: October 2023

Background:

Adherence is increasingly understood as a complex concept and is affected by many factors. Among rural patients with cancer, adherence behavior can be affected by increased psychosocial and physical distress as well as economic burden. This study explored facilitators and barriers to medication adherence to oral chemotherapeutic agents (OCAs) from the perspective of both rural patients with cancer and their cancer care providers.

Methods:

This study was conducted in a regional Cancer Center in North Carolina. Data for the cancer care providers (N = 10) were collected (January-February 2016), and data for the patients with cancer (N = 25) were collected (March-June 2016). Qualitative interviews were conducted with patients with cancer currently taking OCAs, and interviews/focus groups were conducted with cancer care providers. Data analysis was conducted using the immersion crystallization approach.

Results:

The results of this qualitative study provide valuable insights into the attitudes of both cancer care providers and patients with cancer and their perceptions of adherence barriers and facilitators. The main barriers to adherence were costs associated with treatment, side effect management, comorbidities and concomitant treatments, limited health literacy, lack of social support, and patient-provider communication. Facilitators to adherence include education and follow-up, social support networks, and adherence strategies.

Conclusion:

Better communication, education/information, and social support were identified as facilitators of adherence in this study. It is critical to develop tailored strategies such as self-management behaviors, adherence strategies, and effective communication that can improve medication adherence and empower patients and their caregivers in their treatment management.
Helicobacter pylori Eradication Rate Using Stool Antigen Test in Vietnamese Children: A Prospective Multicenter Study
Authors: Nguyen Tu Cam , Robert Annie , Pham Thu Hien Anh , Vo Khoa Hoang , Le Loc Duc , Ma Ha Tu , Le My Huynh Thao , Che Thai Hoang , Nguyen Hiep Thanh , Truong Dinh Quang , Bontems Patrick , Nguyen Phuong Ngoc Van
Published: October 2023

Objectives:

This study assessed the diagnostic value of a monoclonal immunoassay stool antigen test (HpSA) forHelicobacter pylori (H. pylori) infection and the eradication outcomes.

Methods:

Children undergoing digestive endoscopy at 2 Children’s Hospitals in Ho Chi Minh City were recruited. Treatment was offered toH. pylori-infected children. Stool samples were collected on the same day as the endoscopy procedure and after 6 weeks post-treatment for HpSA. Diagnostic value and optimal cutoff of HpSA were assessed using biopsy-based tests as the gold standard. Eradication was defined as a negative HpSA post-treatment. Ethical approval was obtained, and informed consent was signed by the participants.

Results:

In total, 394 patients participated in the study. The most common symptoms were epigastric pain (74.6%) and vomiting (37.3%).H. pyloristatus was positive in 78% of patients (306/394), doubtful in 10.1%, and negative in 12.2%. HpSA was positive in 73.2% (142/194). Excluding doubtful infections, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of HpSA were 87.4%, 95.2%, 99.2%, 51.3%, and 88.4%, respectively. The optimal cutoff value of 0.148 provided similar accuracy to the recommended cutoff. The eradication rate was 56.1% in per-protocol analysis and 27.9% in intention-to-treat analysis. Treatment success was higher in boys, but lower among malnourished children and those infected withcagA+strains.

Conclusions:

The HpSA is reliable for identifyingH. pyloriinfection in epidemiological studies and assessing eradication outcomes. The low eradication rate highlights the need for an appropriate intervention strategy in Vietnamese children.
Further Insight in Selecting the Ideal Vein for Lymphaticovenous Anastomosis: Utilizing the Venturi Effect
Authors: Cho Jeongmok , Yoon Johyun , Suh Hyunsuk Peter , Pak Changsik John , Hong Joon Pio
Published: October 2023

Background:

The functional and dilated lymphatic vessel and veins with minimal backflow and pressure are considered ideal for lymphaticovenous anastomosis (LVA). How to select the ideal vein remains to be determined. This study aimed to provide further insight into selecting the ideal vein.

Methods:

This is a retrospective study evaluating 166 limbs with lymphedema with a minimal follow-up period of 12 months. The surgical approach included side-to-end LVA, including 1 group with a non-Venturi LVA and another with a small branch draining into a major vein (Venturi LVA). Preoperative and 1, 3, 6, and 12 months postoperative limb volume, circumference, reduction volume, and ratio were evaluated.

Results:

The postoperative volume reduction was significant for both groups when compared with their respective preoperative volume. When compared between the 2 groups, the Venturi LVA had a significantly higher reduction volume and ratio at postoperative 1 month (240.82 ± 260.73 cm³ versus 364.27 ± 364.08 cm³, 6.13 ± 5.62% versus 8.77 ± 6.64%; P < 0.05) and 3 months (289.19 ± 291.42 cm³ versus 432.50 ± 395.04 cm³, 7.31 ± 6.39% versus 10.55 ± 6.88%; P < 0.05) However, the reduction volume and ratio was not significant by months 6 and 12.

Conclusions:

This study provides further insight into selecting the ideal vein for LVA. By using a small vein draining into the main vein, valves play a role in reducing backflow. Furthermore, the Venturi effect allows significantly enhanced drainage, especially in the initial period after surgery. The effect slowly plateaus after few months, ultimately having a similar outcome of reduction at 12 months.
Nasal Tip Flexibility and Stability: Comparison of Septal Extension Grafts and Columellar Strut Grafts in a Prospective Trial
Authors: Kucukguven Arda , Çelik Murat , Altunal Sinan K. , Kocer Ugur
Published: October 2023

Background:

The stability of nasal tip rotation and projection, and providing a flexible nasal tip, are important elements in rhinoplasty. Two common options to provide these requirements are the septal extension graft (SEG) and the columellar strut graft (CSG). This study aims to compare nasal tip stability and flexibility between the 2 graft options.

Methods:

A prospective randomized study was carried out in 60 patients operated on with either the CSG or the SEG. Tip rotation and projection stability were analyzed with photographic evaluation at the immediate postoperative period, the first month, and the first year. Nasal tip flexibility was evaluated with a newton meter at the preoperative period and postoperative first, third, and sixth months and the first year.

Results:

The CSG showed a significant loss of projection and rotation, whereas the SEG showed better preservation of projection and rotation. However, both options showed a greater loss of projection and rotation in the first month and then a slight decrease in the following months. Although the SEG had lesser flexibility compared with the CSG anteroposteriorly, there was no flexibility difference between them in the lateral direction in the long term.

Conclusions:

The SEG provides better nasal tip stability compared with the CSG. The greatest downside of the SEG is decreased flexibility compared with the CSG. Surgeons should be aware of the loss of projection and rotation with both graft options and adjust their operation plan according to these points.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Cone Beam Computed Tomographic Evaluation of Schneiderian Membrane Thickness
Authors: Al-Bahrani Zainab M. , Al-Ghurabi Zainab H.
Published: October 2023

Objective:

This study aimed to determine the measurements and classification of Schneider membrane thickness correlated to age and sex factors using cone beam computed tomography (CBCT).

Methods:

The study included CBCT images for 100 maxillary sinuses of 50 consecutive patients, and the thickness of the maxillary sinus membrane (Schneiderian membrane) was measured in coronal view from the lowest point in the floor of the maxillary sinus to the highest point. The thickness of the Schneiderian membrane was classified into 4 types.

Results:

The study result revealed that out of the total cases, 45% of sinus membranes were classified as type 2, while only 10% were classified as type 4. The most frequent type of membrane thickness diagnosed in the age group 20 to 30 as type 1, whereas in age groups 31 to 40 and 41 to 50, regarding sex, type 4 was more obvious in males with membrane thickening >6 mm.

Conclusions:

Measurement and classification of sinus membrane thickness can be performed accurately with CBCT, and it is affected by age and sex factors.
Transcriptomics of mussel transmissible cancer MtrBTN2 suggests accumulation of multiple cancer traits and oncogenic pathways shared among bilaterians
Authors: Burioli E. A. V. , Hammel M. , Vignal E. , Vidal-Dupiol J. , Mitta G. , Thomas F. , Bierne N. , Destoumieux-Garzón D. , Charrière G. M.
Published: October 2023

Transmissible cancer cell lines are rare biological entities giving rise to diseases at the crossroads of cancer and parasitic diseases. These malignant cells have acquired the amazing capacity to spread from host to host. They have been described only in dogs, Tasmanian devils and marine bivalves. The
Mytilus trossulus
bivalve transmissible neoplasia 2 (MtrBTN2) lineage has even acquired the capacity to spread inter-specifically between marine mussels of the
Mytilus edulis
complex worldwide. To identify the oncogenic processes underpinning the biology of these atypical cancers we performed transcriptomics of MtrBTN2 cells. Differential expression, enrichment, protein–protein interaction network, and targeted analyses were used. Overall, our results suggest the accumulation of multiple cancerous traits that may be linked to the long-term evolution of MtrBTN2. We also highlight that vertebrate and lophotrochozoan cancers could share a large panel of common drivers, which supports the hypothesis of an ancient origin of oncogenic processes in bilaterians.
On the study of slow–fast dynamics, when the fast process has multiple invariant measures
Authors: Goddard B. D. , Ottobre M. , Painter K. J. , Souttar I.
Published: October 2023

Motivated by applications to mathematical biology, we study the averaging problem for slow–fast systems,in the case in which the fast dynamics is a stochastic process with multiple invariant measures. We consider both the case in which the fast process is decoupled from the slow process and the case in which the two components are fully coupled. We work in the setting in which the slow process evolves according to an ordinary differential equation (ODE) and the fast process is a continuous time Markov process with finite state space and show that, in this setting, the limiting (averaged) dynamics can be described as a random ODE (i.e. an ODE with random coefficients).
A radiocarbon spike at 14 300 cal yr BP in subfossil trees provides the impulse response function of the global carbon cycle during the Late Glacial
Authors: Bard Edouard , Miramont Cécile , Capano Manuela , Guibal Frédéric , Marschal Christian , Rostek Frauke , Tuna Thibaut , Fagault Yoann , Heaton Timothy J.
Published: October 2023

We present new
14
C results measured on subfossil Scots Pines recovered in the eroded banks of the Drouzet watercourse in the Southern French Alps. About 400 new
14
C ages have been analysed on 15 trees sampled at annual resolution. The resulting Δ
14
C record exhibits an abrupt spike occurring in a single year at 14 300–14 299 cal yr BP and a century-long event between 14 and 13.9 cal kyr BP. In order to identify the causes of these events, we compare the Drouzet Δ
14
C record with simulations of Δ
14
C based on the
10
Be record in Greenland ice used as an input of a carbon cycle model. The correspondence with
10
Be anomalies allows us to propose the 14.3 cal kyr BP event as a solar energetic particle event. By contrast, the 14 cal kyr BP event lasted about a century and is most probably a common Maunder-type solar minimum linked to the modulation of galactic cosmic particles by the heliomagnetic field. We also discuss and speculate about the synchroneity and the possible causes of the 14 cal kyr BP event with the brief cold phase called Older Dryas, which separates the Bølling and Allerød millennium-long warm phases of the Late Glacial period.

This article is part of the Theo Murphy meeting issue 'Radiocarbon in the Anthropocene'.
Radiocarbon signatures of carbon phases exported by Swiss rivers in the Anthropocene
Authors: Rhyner Timo M. Y. , Bröder Lisa , White Margot E. , Mittelbach Benedict V. A. , Brunmayr Alexander , Hagedorn Frank , Storck Florian R. , Passera Lucas , Haghipour Negar , Zobrist Juerg , Eglinton Timothy I.
Published: October 2023

Lateral carbon transport through the land-to-ocean-aquatic-continuum (LOAC) represents a key component of the global carbon cycle. This LOAC involves complex processes, many of which are prone to anthropogenic perturbation, yet the influence of natural and human-induced drivers remains poorly constrained. This study examines the radiocarbon (
14
C) signatures of particulate and dissolved organic carbon (POC, DOC) and dissolved inorganic carbon (DIC) transported by Swiss rivers to assess controls on sources and cycling of carbon within their watersheds. Twenty-one rivers were selected and sampled during high-flow conditions in summer 2021, a year of exceptionally high rainfall. Δ
14
C values of POC range from −446‰ to −158‰, while corresponding ranges of Δ
14
C values for DOC and DIC are −377‰ to −43‰ and −301‰ to −40‰, respectively, indicating the prevalence of pre-aged carbon. Region-specific agricultural practices seem to have an influential effect on all three carbon phases in rivers draining the Swiss Plateau. Based on Multivariate Regression Analysis, mean basin elevation correlated negatively with Δ
14
C values of all three carbon phases. These contrasts between alpine terrain and the lowlands reflect the importance of overriding ecoregional controls on riverine carbon dynamics within Switzerland, despite high spatial variability in catchment properties.

This article is part of the Theo Murphy meeting issue 'Radiocarbon in the Anthropocene'.