bluuebunny/crossref_metadata_2025 huggingface dataset:
Who Were the Mesolithic People
Authors: Simões Luciana G. , Günther Torsten
Published: February 2025

Ancient DNA (aDNA) research opened a direct window into the study of evolutionary history. This cross-disciplinary field, at the intersection of genetics and archaeology, has not only revealed genomic discontinuities and population transformations throughout human prehistory but also helped clarify or reformulate standing hypotheses, previously based solely on archaeological evidence. This chapter provides an overview of the basic genetic concepts underlying aDNA studies and summarizes the unique challenges and opportunities associated with the field of archaeogenomics. This is followed by a summary of the current state of the knowledge regarding the genetic makeup of Mesolithic peoples in Europe, highlighting the four main lines of ancestry found and their geographical distributions, with a special focus on the regional dynamics of the Scandinavian Mesolithic. The chapter also discusses how genomic data can be, and has been used, to study metabolic and physical appearance traits of Mesolithic hunter-gatherers. Expectedly, future studies incorporating abundant and more representative samples of Mesolithic Europeans, as well as new theoretical and technological approaches, will provide a more detailed picture of the genetic structure and sociocultural aspects of Mesolithic hunter-gatherers in Europe.
Sensory Experiences
Authors: Elliott Ben
Published: February 2025

Sensory experience has been an underexplored but persistent theme within European Mesolithic research, slowly building momentum within the broader discourse since the turn of the millennium. Critical considerations of inter-visibility (often advanced under the umbrella of phenomenological approaches to the experience of space), the manipulation of colour, and the role of emotion within Mesolithic archaeology have all, to varying extents, promoted an attention to sensory experience within the field. However, barring a few significant exceptions, more focused approaches to sensory experience have been somewhat lacking within Mesolithic archaeology. This is particularly noticeable in the past decade, at a time when ‘sensory archaeologies’ have blossomed more generally within the discipline and have been more extensively explored in relation to other places and periods. The concept of a ‘sensory horizon’ is revisited and developed here as a way to potentially address this. Two case studies are provided which investigate sensory experiences associated with mortuary practice at Skateholm (Sweden) and Hermitage (Ireland) respectively. These acknowledge the lack of familiarity afflicting most archaeological researchers when discussing the ways in which the living experience the dead, and draws on forensic experience and research to examine the specifics of distinct episodes of mortuary practice, whilst attempting to place these within the broader context of lived Mesolithic experience.
Food and Diet
Authors: Eriksson Gunilla , Lidén Kerstin
Published: February 2025

Food is at the core of cultural identity, fundamental for survival, yet intrinsically linked to culture. To study activities related to food is, therefore, in effect a way to study cultural practices and cultural differences. This chapter approaches Mesolithic food and diet through the concept of châine opératoire, which is a valuable tool to move beyond simple facts on what foodstuffs were eaten, or what resources were utilized, and instead consider the full spectrum of food practices during the Mesolithic. It is a structured way to describe the mental processes and actions involved in transforming environmental resources into foods, their consumption, and subsequent disposal. These activities require extensive knowledge, technology, and skills, all of which are culturally transmitted. Therefore, they are not only of great archaeological relevance, but they also potentially leave traces in the archaeological record, which can be studied by various approaches. Through a survey of the literature, this chapter provides examples of various Mesolithic food practices throughout Europe, and how these can be detected and interpreted. In addition, it presents a case study of the diverse Mesolithic diets in the Circum-Baltic area as evidenced by stable isotope analysis.
Flint Exchange
Authors: Johanson Kristiina , Werra Dagmara H. , Kriiska Aivar , Mangado Llach Javier
Published: February 2025

Using three case studies, this chapter attempts to summarize the essence and nature of flint exchange in Mesolithic Europe. It seeks to understand the possible ways of differentiating between the acts of direct procurement and exchange of flint in the archaeological material. For that, it considers the distances between raw material sources and sites (the model of effective distance), the changing value ascribed to specific raw materials, and the hybrid motivations for flint travel. Considering the procurement costs and distances as well as value of different flints, economic, social, and symbolic motivations for flint procurement are discussed. The conclusion is reached that flint procurement strategies are often multifaceted with economic, social, and symbolic motivations intertwined in single acts. Although a general regionalization is seen since the Early Mesolithic in Europe, long-distance networking still exists, with flint exchange being part of that, demonstrating the social nature of flint.
Exchange of Amber
Authors: Macāne Aija , Nordqvist Kerkko
Published: February 2025

This chapter focuses on the production, use, and exchange of amber by fisher-hunter-gatherer societies in the eastern Baltic Sea area and forested north of European Russia in the fourth–third millennia bc. Baltic amber, a fossil plant resin found primarily in the southern and southeastern Baltic Sea area, was distributed mostly as ready-made objects along aquatic contact networks up to 1,500 km from the assumed sources. Amber is often discussed as a prime example of the Stone Age exotica—non-local, easily transportable, and transformable, and with noticeable physical and haptic properties—but it is also a good indicator of the broader transformations of fisher-hunter-gatherer societies during this time period.

The chapter explores three aspects that concretely illustrate these changes: the specialized production (workshops, incipient socioeconomical inequalities), the contexts of use (burial and settlement, materiality and social communication), and the exchange networks (sociopolitical alliances and reproduction). It is concluded that amber was among the new material cultures and practices that sustained and mediated the new sociocultural realities, a meaningful technology embedded in the lifeways and worldview of northern Stone Age forager societies.
The Baltic Basin
Authors: Groß Daniel , Rimkus Tomas
Published: February 2025

The Baltic Sea basin represents the southern and eastern Baltic shores and hinterlands of the countries Germany, Poland, Lithuania, Latvia, and Estonia. The Mesolithic in this area begins roughly at the Pleistocene–Holocene transition and ends with the appearance of pottery in Latvia and Lithuania or the establishment of agrarian Neolithic cultures in the other countries under consideration. It comprises several archaeological entities that are differentiated by artefact spectra and were present in different timespans. During the Preboreal and Boreal, the pan-European Maglemosian was present in the western parts and the last Swiderian and Pulli complex in the east. The area is characterized during the middle Mesolithic by the Kongemose and Chojnice-Pieńki cultures, while the Kunda culture appears at the beginning of the Boreal in the eastern Baltic area. During the Late Mesolithic, the Ertebølle culture establishes itself in Germany and western Poland, while the Janisławice (Neman) culture is distributed in eastern Poland and Lithuania. Further north, the Narva culture is present in Latvia and Estonia. While most of the cultural entities in the area were originally defined from a national perspective, modern research has shown that several of these belong to superregional technocomplexes.
Rock Art
Authors: Lahelma Antti , Gjerde Jan Magne
Published: February 2025

This chapter presents a review of the main bodies of Mesolithic rock art in Europe, from the earliest signs of post-Palaeolithic art to the lively scenes of Spanish Levantine art and the Late Mesolithic ‘rock art explosion’ in northern Europe. Outside the two main concentrations of Mesolithic rock art in the Iberian Peninsula and Fennoscandia, individual occurrences of rock art possibly dating to the Mesolithic can be found in the Alpine Region, central France, Italy, and the Urals. The precise dating of much of this art still presents challenges, but recent advances in dating methods have helped to anchor rock art more securely in general archaeological sequences. This is particularly true in northern Europe, where post-glacial isostatic land uplift has enabled the accurate geological dating of shore-bound rock art sites. The datings offer some credence to the old notion of gradual stylistic shift from depictions of large, naturalistic prey animals in the Early Mesolithic towards smaller, dynamic scenes of schematic human and animal figures in the Mesolithic/Neolithic transition. This shift may conceivably reflect changes in how the relationship between humans and animals was conceived. Later Mesolithic rock art in both southern and northern Europe also features images of communal hunting, large rituals, armed conflict, and other scenes that suggest increased sedentism and social complexity.
Hoarding
Authors: Bjørnevad-Ahlqvist Mathias
Published: February 2025

Mesolithic hoarding is a relatively little-known practice, even though hundreds of hoards that stretch from the very beginnings to the latest phases of the Mesolithic have been identified across Europe. This chapter aims to briefly draw out regional and macro-regional patterns whilst acknowledging the important variability in this hoarding practice, including within the types and biographies of the objects deposited, the careful geometric arrangement, wrapping and marking of some hoards, and the nature of their depositional contexts. The depositions have been interpreted as temporary storage, ritual sacrifices, or labelled simply as deposits or concentrations. However, rather than forcing a strictly ritual or profane interpretation onto these multifaceted practices, this chapter draws upon some central tendencies within hunter-gatherer lifeways, and rather suggests these hoards to be part of a complex gifting practice. Identifying and interpreting these Mesolithic hoards and the practices that lie behind them is fraught with difficulties, but they represent a relatively untapped potential to elucidate insights into Mesolithic practices, society, and ontologies.
Birch, Pine, and Other Adhesive Technologies
Authors: Langley Andrew , Little Aimée
Published: February 2025

The ability to adhere or glue two objects together is fundamental in the creation of composite tools. A number of different adhesives have been discovered across the European Mesolithic, mostly derived from plants. Of these, the dominant compound is birch tar. Evidence suggests that tar and resin were being used to haft microliths for arrowheads and slotted points, for sealing and repairing ceramics, and likely as an oral medicine. A number of pieces of birch tar have been discovered with teeth marks, several of which have preserved the DNA of the individuals who chewed on them. Despite this, there are many questions which remain unanswered, particularly around how and to what scale tar was distilled, why were certain adhesives favoured over others, how do adhesives fit into our wider understandings of Mesolithic lifeways, and to what extent did the transformative and sensory aspects of adhesives factor into Mesolithic belief systems?
Southern Scandinavia
Authors: Price T. Douglas
Published: February 2025

This chapter attempts a synthesis of the Mesolithic (9700–4000 bc) in southern Scandinavia, which includes northern Germany, Denmark, southern and mid-Sweden, and southern Norway. The core area for this chapter is Denmark which seems to be the role model for this region. Discussion centres on the major chronological periods and a few important sites. Major periods include Maglemose, Kongemose, Ertebølle, Hemsbacka, Sandarna, and Lilult. Sites include Tybrind Vig, Lundby Mose, Syltholm Fjord, Tågerup, Nivå, Huseby Klev, and Motala. Recent archaeogenetic information is also included in documenting the replacement of Mesolithic hunter-gatherers by Neolithic farmers whose ancestors were from Anatolia. Southern Scandinavia has often been seen as an area where foragers became farmers.
Orwell, Joseph Conrad, and Rudyard Kipling
Authors: Hampson Robert
Published: February 2025

This chapter discusses Burmese Days as a late addition to the literature of empire through tracing links between Orwell’s work and specific works by Rudyard Kipling and Joseph Conrad. It begins with the public school education for empire (as depicted by Kipling and Orwell) as a training in lying, gaming the rules, and punitive violence. The second part of the essay uses Conrad’s Malay fiction to discuss the anti-colonial turn in the literature of empire and Maurice Collis’s memoir of his time in Burma to suggest the limitations of Orwell’s work through its emphasis on individualism and its neglect of indigenous political agency and collective action. The final section presents the same biases in The Road to Wigan Pier in relation to the contradictions of rebelliousness and privilege that are part of Orwell’s education and formation.
Orwell and Machines
Authors: Carver Beci
Published: February 2025

Orwell’s essay on Tolstoy ends with a cacophonous military attack on William Shakespeare. The Russian writer is at the helm of a battleship transferring all the fervour of his late-life disgruntlement at the bard into gunfire, and Shakespeare’s legacy crackles with bullets. Nevertheless, Orwell assures us, Shakespeare is safe and will remain so whatever his readers may say, for just as it is impossible to reproduce in paraphrase what makes his work beautiful and significant, it is impossible to destroy these qualities by denying their existence. Art, when genuine, is immune to interference: it cannot be recreated for the purposes of argument and cannot be arbitrarily put to death. It has the vitality and life lust, Orwell says, of a child ‘jumping up and down’ who never gets old or tired. This was March 1947, when Orwell’s own tubercular body was in rapid decline. My chapter for this volume reflects on the types of resistance that art and creative labour may oppose to the mechanical assaults of modern life.
Orwell and Stupidity
Authors: Wood Jamie
Published: February 2025

Orwell used the term ‘stupidity’, and closely associated concepts such as ‘foolishness’ and ‘ignorance’, throughout his essays and novels as an idiosyncratic shorthand for cultural, political, and social critique. But these ideas have a complex history, suggesting Orwell’s difficulties in fully realizing the term. Once this history is organized, we can better isolate ‘stupidity’s’ underpinnings, especially Orwell’s concern that individual action was increasingly mindless in modern societies. We find in Orwell three distinct sources for these mindless acts: the legacy of painful material conditions, the pressures of a technologized society of spectacle, and acts of self-hypnosis designed to protect the psyche from the state. This helps reveal ‘stupidity’ as a critique of both totalitarianism and colonialism. It also turns attention to Orwell’s many antidotes to ‘stupidity’, and especially to the need for carefulness, seriousness, and an awakened consciousness.
Orwell’s Words
Authors: Jakubowicz Karina
Published: February 2025

Orwell’s words are one of his greatest legacies. His influence can be found throughout the English language in the form of pithy quotations, stock phrases, and well-worn terms. This chapter examines this complex legacy, exploring the origins of phrases including ‘Newspeak’, ‘Big Brother’, and ‘2 + 2 = 5’. This overview demonstrates how the use and misuse of Orwell’s words (and of connected terms such as ‘Orwellian’) have played a major role in numerous cultural moments, influencing music, technology, advertising, and political discourse. Key to this chapter is the question of whether Orwell’s words are indeed his words any longer, or if they have been co-opted and adapted to the point where they bear little relation to his original intentions. This line of enquiry strikes at the heart of Orwell’s own concerns about the slipperiness of words, and animates his ideas concerning linguistic precision.
Orwell the Innovator
Authors: Rae Patricia
Published: February 2025

This chapter discusses the motives behind Orwell’s stylistic innovations. It proposes that many of these innovations were adaptations of modernist literary techniques, and that that they were fuelled by what Orwell called, in ‘Why I Write’, ‘political purpose’: the project of ‘push[ing] the world in a certain direction’. Examining techniques of ‘interiority’, ‘analogy’, and ‘fragmentation’, it argues that Orwell deployed each of these with the aim of encouraging readers to be self-aware, intellectually flexible, and curious, hence resistant to the reflex speech, rigid dichotomizing, and presentism he associated with political partisanship and totalitarianism. The goal is two-fold: to highlight the benefits of approaching Orwell as a ‘difficult’ writer rather than as a ‘transparent’ one, and to further discussion of his place in the reassessment of modernist techniques during the 1930s and 1940s.
Orwell the Literary Critic
Authors: Periyan Natasha
Published: February 2025

This chapter examines Orwell as a literary critic, focusing on his reviewing, broadcasting, and editing. Keep the Aspidistra Flying is read in the context of Orwell’s critique of book reviewers to argue that Orwell situates both the literary critic and the bookseller as compromised by commercial demands. In contrast to the hysterical, overblown rhetoric that Orwell found to be characteristic of the reviewer, Orwell’s candid book reviews deployed provisional language and a methodology of categorizing and ranking. As literary editor of Tribune, Orwell elevated the position of the literary critic by granting space and intellectual freedom to reviewers. This freedom was in dialogue with an orthodoxy of thought that he found to be characteristic of Marxist criticism. Orwell’s literary criticism negotiated questions of content and form, despite charges that he prioritized an interest in content. While a sensitive reader of literary form, Orwell did not ally himself with practical criticism.
Orwell the Broadcaster
Authors: Bloom Emily C.
Published: February 2025

George Orwell’s work as a radio producer on the BBC’s Eastern Service during the Second World War was intensely collaborative, drawing him into close contact with a dense network of fellow producers and administrators, as well as a creative pool of writers and public intellectuals from the UK, India, and across the globe. This chapter focuses on one such collaboration, his broadcast series, “Story by Five Authors,” which he characterized as an experiment in collective authorship, soliciting contributions from Inez Holden, L. A. G. Strong, Martin Armstrong, and E. M. Forster. This literary experiment on air showcases Orwell’s attempts to imagine a new space for literature in a mass media age and, necessarily, to redefine the role of the writer who would inhabit this space. In the end, Orwell deems this a “failed experiment,” one that echoes the larger failure of BBC broadcasting to India.
The parsley genome assembly and DNA methylome shed light on apigenin biosynthesis in the Apiaceae
Authors: Liu Hui , Zhang Jia-Qi , Chen Chen , Wang Ya-Hui , Xu Zhi-Sheng , Zhao Qin-Zheng , Zhang Jian , Xue Jia-Yu , Xiong Ai-Sheng
Published: February 2025

Parsley (Petroselinum crispum (Mill.)) is a medicinal and edible vegetable of the Apiaceae family that is rich in apigenin. The Apiaceae family is well known for its diverse secondary metabolites. As a high-quality reference genome is lacking for parsley, the evolution and apigenin biosynthesis in Apiaceae have remained unexplored. Here, we report the chromosome-level genome sequence of parsley, consisting of 1.85 Gb that mainly arose from the expansion of long terminal repeats. Whole-genome bisulfite sequencing (WGBS) revealed a significantly higher number of hypermethylated differentially expressed genes (hyper-DMGs) in leaf blades and petioles than in root tissues. Moreover, we identified and characterized ﻿chalcone isomerase (CHI) genes, encoding key enzymes involved in apigenin biosynthesis in parsley. We also established that the APETALA2 family transcription factor Pcrispum_6.2855 (PcAP2) binds to the (Pcrispum_11.4764) PcCHI promoter and promotes apigenin accumulation. In conclusion, our work presents a multi-omics data resource for understanding apigenin biosynthesis and its transcriptional regulation in parsley, in addition to shedding light on the evolution of parsley within the Apiaceae.
The influence of improved wheat and maize varieties on infant mortality in China
Authors: Wang Xiaobing , Liu Xinyu , Min Shi , Jin Songqing , Huang Jikun , Rozelle Scott , Feng Jieyuan , Prasanna Boddupalli M
Published: February 2025

The diffusion of high-yielding crop varieties has been a key driver for agricultural productivity. This study examines the relationship between the adoption of high-yielding crop varieties of two staple crops—wheat and maize—and infant mortality in rural China. Using data from 1954 to 1987, we find a significant reduction in infant mortality linked to high-yielding crop varieties diffusion, an association that remains robust even after excluding the Great Famine years. We investigate potential mechanisms driving this relationship, including increased grain production, improved infant nutrition, and changes in maternal characteristics. Additionally, our analysis unveils a spectrum of heterogeneous relationships between high-yielding crop varieties adoption and infant mortality across factors such as infant gender, maternal characteristics, and policy regulation. These findings reaffirm the positive and lasting benefits of dissemination of high-yielding crop varieties for human welfare and provide valuable policy insights for developing nations grappling with food and nutritional insecurity.
Correlation Functions Involving Dirac Fields from Homotopy Algebras I: The Free Theory
Authors: Konosu Keisuke , Okawa Yuji
Published: February 2025

We extend the formula for correlation functions of scalar field theories in terms of quantum A∞ algebras presented in arXiv:2203.05366 to incorporate Dirac fields. We use a description that is analogous to string field theory, and the formula for correlation functions takes the same form for both scalar fields and Dirac fields. We prove that correlation functions from our formula satisfy the Schwinger-Dyson equations in the free theory. The proof for interacting theories is presented in the companion paper arXiv:2305.13103 by one of the authors. We also explain the relation of our formula to the definition of correlation functions in the approach by Costello and Gwilliam based on factorization algebras.
Attribution of colorectal cancer symptoms to medications for pre-existing chronic conditions: a secondary analysis of a vignette study in England
Authors: Ricciardi Giovanni E , Pennisi Flavia , Von Wagner Christian , Smith Lauren , Kaushal Aradhna , Abel Gary A , Lyratzopoulos Georgios , Renzi Cristina
Published: February 2025

Objective

To investigate the likelihood of attributing colorectal cancer (CRC) symptoms to medications for chronic conditions.

Methods

The online vignette survey included 1287 participants aged ≥50 years, with quota sampling to recruit sufficient participants with type 2 diabetes. Participants self-reported chronic conditions and answered questions on symptom attribution and help-seeking, after reading vignettes describing new-onset rectal bleeding or change in bowel habit. Using multivariable logistic regression, we analyzed the association between specific conditions and attributing new-onset CRC symptoms to medications, controlling for demographics.

Results

Among participants, 25% reported type 2 diabetes, 31% being overweight, 25% hypertension and 22% arthritis. Participants with diabetes, versus those without, had a higher likelihood of attributing change in bowel habit to medications [7% vs 3%; adjusted Odds Ratio (aOR) 2.55, Confidence Interval (95% CI) 1.30–5.00]. This was also the case for participants reporting being overweight (7% vs 2%; aOR 2.36, 95% CI 1.25–4.44), arthritis (8% vs 3%; aOR 2.27, 95% CI 1.19–4.35), but not for hypertension. No significant association was found regarding attribution of rectal bleeding to medications.

Conclusions

Patients with common chronic conditions have a higher likelihood of attributing change in bowel habit to medications. Tailored information is needed for these patients, encouraging them to discuss any new symptom with their doctor.
Being Human: Envisioning the Future of Museum-Based Education for Health Professionals
Authors: Tackett Sean , Balhara Kamna S. , Ungaretti Toni , Yenawine Philip , Chisolm Margaret S.
Published: February 2025

The arts and humanities are fundamental to health professions education and can substantially enhance clinician empathy, tolerance for ambiguity, and openness to new perspectives. Museum-based education for health professionals (MBE-HP) has particular potential to achieve these aims but remains a nascent field of practice and study. To catalyze the growth of MBE-HP, a convening of 50 individuals from the United States and Canada, including museum educators and health professions educators, administrators, researchers, and learners, as well as patrons of the arts, was held for 3 days in December 2023 in Washington, DC. Activities included 7 distinct MBE-HP experiences at 5 national museums as well as facilitated discussions. This article describes the purpose and design of this unique gathering and summarizes its key outcomes. Through their shared experiences and discussions, participants developed a definition of MBE-HP as an approach that can occur in museums, other in-person settings, and/or online, which is informed by museum-based education adapted for health professional learners and involves exploring and/or creating visual and other forms of art, as well as individual and group reflection on these activities. Participants also developed strategies to advance MBE-HP and steps that can be taken by individuals, programs, and institutions involved in health professions education, as well as changes that may influence health professions education systems, such as professional organizations’ sponsorship, private and public funding, evidence generation through research, and changes to regulations and policymaking. Museum-based education for health professionals is reaching critical mass, backed by science and supported by an increasing collection of resources for health professions educators; the definitions and strategies outlined here may be of value to stakeholders seeking to move MBE-HP into the mainstream to realize its potential to benefit learners, educators, patients, and communities.
Association Between Buprenorphine Adherence Trajectories, Health Outcomes, and Health Care Costs Among Medicaid Enrollees
Authors: Olateju Olajumoke A. , Okeke Chijioke , Shrestha Mina , Thornton Douglas
Published: February 2025

Objectives:

To identify distinct buprenorphine adherence trajectories among patients with opioid use disorder (OUD) and evaluate their associations with health events and health care costs.

Methods:

A retrospective longitudinal cohort study was conducted using the Merative Multi-state Medicaid database. The study analyzed 12,244 Medicaid enrollees aged 18–64 years who were diagnosed with OUD and initiated buprenorphine treatment between July 1, 2017 and June 30, 2019. Group-based trajectory models were used to identify adherence patterns during the first 180 days of treatment. Cox proportional hazard models were used to evaluate the associations between adherence trajectories and time to opioid overdose, substance use disorder–related hospitalization, and all-cause hospitalization. Generalized linear models were used to compare health care costs across trajectories.

Results:

Four buprenorphine adherence trajectories were identified: completely adherent (50.8%), initially adherent with later decline (13.6%), increasing adherence with later decline (9.9%), and continuously declining nonadherence (25.8%). Compared to the completely adherent group, patients in other groups had a higher risk of opioid overdose, hospitalization and increased health care costs. The continuously declining nonadherent group demonstrated the highest risks, with an opioid overdose hazard ratio (HR) of 1.92 (95% CI, 1.46–2.39), all-cause hospitalization of HR of 1.71 (95% CI: 1.58–1.85), and substance use disorder (SUD)-related hospitalization HR of 2.01 (95% CI: 1.82–2.15). Additionally, healthcare costs were notably higher compared to the completely adherent group, with an increase of $1482.45 (95% CI: $745.45–$2756.01) in the increasing adherence with later decline group and $1698.46 (95% CI: $432.57–$3087.78) in the continuously declining nonadherence groups.

Conclusions:

Almost half of Medicaid beneficiaries with OUD exhibited varying degrees of nonadherence to buprenorphine within 180 days of treatment initiation. This nonadherence was associated with adverse clinical outcomes and increased health care costs. Health care providers should consider adherence challenges when designing therapeutic interventions with buprenorphine.
Analysis of industry payments among orthopedic fellowship program directors in the United States
Authors: Vallee Emily K. , Lucasti Christopher , Scott Maxwell M. , Tamweber Zachary , Graham Benjamin C. , Chipman Danielle E. , Ryan Thomas J. , Hawayek Bradley J. , Patel Dil V. , Binkley Matthew T. , Duquin Thomas R.
Published: February 2025

Background:

Orthopedic fellowship directors play a crucial role in shaping patient care approaches of fellowship trainees under their guidance. Given the influence fellowship directors have over surgeons-in-training practices, their financial conflicts of interest are of notable significance.

Methods:

A list of 566 orthopedic fellowship program directors in the United States was compiled. Program directors from the following subspecialties were included: adult hip and knee, sports medicine, hand, spine, trauma, foot and ankle, pediatric orthopedics, shoulder and elbow, and musculoskeletal oncology. Demographic information was obtained from public physician profiles. General payments, research payments, associated research funding, and ownership interest data were collected using Open Payments. Descriptive statistics and independent samples t-tests were employed in the investigation.

Results:

The 566 directors collected a total of 57,610,923.47 USD in general payments in 2021 with a median of 7,180.56 USD. Fellowship directors specializing in shoulder and elbow earned significantly greater than sports medicine (75,580.42 USD v. 8,006.10 USD, P=0.031), hand (1,200.00 USD, P=0.012), spine (22,296.72 USD, P=0.048), trauma (6,104.73 USD, P=0.046), foot and ankle (38,584.57 USD, P=0.046), pediatric orthopaedics (1,480.46 USD, P=0.016), and musculoskeletal oncology (348.09 USD, P=0.011) directors. The top 5% of earners (n=28/566) accounted for 61.5% of the total value. Royalties accounted for 74.6% (43,004,029.50 USD) of the total value exchanged, followed by consulting at 13.7% (7,894,319.64 USD).

Conclusions:

Orthopedic fellowship directors receive considerable payments from the medical industry. We strongly encourage transparent conversations about these associations with trainees, aiming to offer positive models of physician-industry collaborations.
Novel Minimally Invasive Approach for Arthrodesis in Distal Interphalangeal Joint Using Microscope
Authors: Hachisuka Hiroki , Okuhara Atsushi , Munemori Masaru , Ishibashi Shigeki , Adachi Nobuo
Published: February 2025

Arthrodesis is a definitive treatment for osteoarthritis of the distal interphalangeal (DIP) joint. The surgical approach is generally performed from the dorsal side of the DIP joint using a Y- or H-shaped incision. However, this approach can lead to relatively noticeable scarring and dorsal tissue complications. We introduced a microsurgery technique to address patients’ desire for cosmetic improvement in addition to pain relief. In our modified approach, a small 1.5-cm skin incision was made along the mid-lateral line of the finger. This approach allows for a safer and faster synovectomy, osteophyte resection, and osteotomy in a limited surgical field. The joint was fixed by using a headless screw. In this article, we describe the application of this method for DIP arthrodesis. Our study included 12 women with a mean age of 63 years (51–83 y) and a mean follow-up period of 6 months (3–12 mo). All patients expressed satisfaction with the results. Bone union was successfully achieved in all fingers, leading to the resolution of pain without complications. The average postoperative score on the short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire was 0. These findings suggest that the microsurgical approach is a minimally invasive and effective method for treating DIP arthrodesis.
Exploring performance profiles of home health care agencies: A two-stage analytical approach
Authors: Kilinc Mehmet Serdar , Kirac Emre
Published: February 2025

Background

Public reporting of home health care agencies' performance metrics, including patient satisfaction, care processes, and health outcomes, aims to inform customer decisions and encourage agencies to improve the quality of services. However, there is limited research that examines the heterogeneous performance of home health care agencies.

Purposes

The aim of this study was to analyze the performance of home health care agencies by identifying distinct subgroups of agencies with similar performance profiles and describing the relationships between agency characteristics and such subgroups.

Methodology/Approach

We propose a two-stage analytical approach employing unsupervised machine learning methods. First, clustering analysis is applied to performance measures, allowing the partitioning of agencies into homogeneous subgroups based on similarities in performance. Then, association rule mining is used to uncover the relationships between cluster assignments and agency characteristics.

Results

The two-stage analytical approach identified four clusters with significantly different performance profiles and agency characteristics: cost-efficient agencies with high patient satisfaction (Cluster 1), high-cost agencies with high-quality care (Cluster 2), urban agencies with low patient satisfaction (Cluster 3), and small agencies with low-quality care (Cluster 4).

Conclusion

This study contributes to understanding agency performance in the U.S. home health care industry. By identifying distinct subgroups of agencies and understanding the factors influencing their performance, we can enhance home health care services' overall quality and effectiveness.

Practice Implications

Our study uncovered diverse performance profiles and associated characteristics among home health care agencies, highlighting the need for tailored strategies and targeted interventions to improve the quality of care across clusters. Health care administrators and policymakers should consider cluster-specific recommendations.
Anonymity and employee engagement in creativity: A field experiment with nurses and patient care services staff
Authors: Jung Olivia S. , McCree Paula , Nadel Hiyam M.
Published: February 2025

Background

Nurses and patient care services staff are promising sources of creative ideas for improving care delivery, but hierarchical barriers can hinder engagement in creativity.

Purpose

We examined engagement in creativity among nurses and patient care services staff, particularly the support staff (e.g., medical assistants, unit coordinators) who sit low in the professional hierarchy. We tested whether the opportunity to give creative input anonymously increased engagement.

Methodology/Approach

An innovation contest at a hospital invited over 8,500 nurses, health professionals, and support staff to share improvement-oriented ideas. We conducted a field experiment, where a randomly assigned group of employees was told that idea submission would be anonymous, whereas another group was told that name and role would be attached to ideas. Engagement in creativity meant viewing the contest platform and submitting an idea.

Results

Support staff were less likely to view the platform and submit an idea compared to other roles. With the promise of anonymity, support staff became more likely to view the platform, but not to submit ideas.

Conclusion

Although innovation contests offer a structured process for soliciting creative ideas, simply implementing them may not result in widespread engagement, particularly among low-level employees. The promise of anonymity did increase interest in creativity among these employees, but it was not enough to motivate idea submission.

Practice Implications

Managers will need to pay attention to employee' hierarchy-driven beliefs about engaging in creativity when implementing mechanisms that solicit employees' creative input. The promise of anonymity may not be an effective motivator for creativity.
Estimating the Association Between Outdoor Temperature and Acute Kidney Injury Using Alternative Case Definitions
Authors: Rabin Benjamin , D’Souza Rohan , Weil E. Jennifer , Chang Howard H. , Ebelt Stefanie , Scovronick Noah
Published: February 2025

Objective: To improve estimates of the association between acute kidney injury (AKI) and ambient heat exposure through better case ascertainment and by isolating community-acquired AKI.

Methods: We conducted a case-crossover study using data on AKI-related emergency department (ED) visits in Atlanta. Daymet meteorology was used to assess exposure. We compared effect estimates for seven approaches (definitions) for identifying AKI.

Results: There were between 5,868 and 64,269 AKI cases depending on the definition. Higher temperatures were associated with AKI for all case definitions. Associations were strongest for cases with an ICD-coded AKI as a primary diagnosis (OR 1.15, 95%CI 1.01 – 1.31). We also observed significant (p < 0.05) heat associations among cases identified using lab results but without an ICD-coded AKI diagnosis.

Conclusion: Many AKI cases are not diagnosed; these cases are associated with heat.
AI Job substitution risks, digital self-efficacy and mental health among employees
Authors: Zhao Hairong , Wu Peiguan
Published: February 2025

Objective

AI becomes increasingly integrated into the workplace, its associated job substitution risks for employees are more evident, resulting in significant repercussions for their well-being. This study tries to elucidate the effects of AI-driven job substitution risks on employees' mental health.

Methods

Data was collected through questionnaires and structural equation modeling was used to analyze the relationships between variables.

Results

The job substitution risk of AI and Digital self-efficacy can positively influence job insecurity, which in turn adversely affects mental health. And job substitution risks of AI can amplify the negative impact of digital self-efficacy on job insecurity.

Conclusions

it provides an in-depth exploration of the specific processes and mechanisms through which AI-driven job substitution impacts employees' mental health. Practically, it offers insights for the implementation of AI and strategies to safeguard employee mental health.
Effects of Social Networking Service-Based Exercise Therapy on Reducing Non-Specific Low Back Pain and Improving Productivity in Workers: a Randomized Controlled Trial
Authors: Mikayama Shirou , Tomonaga Ryo , Jiang Ying , Yamato Hiroshi
Published: February 2025

Objective

This study aimed to evaluate the efficacy of exercise therapy using social networking services (SNS) to reduce non-specific low back pain (NLBP) among healthcare and transportation workers.

Methods

A total of 40 participants, 20 in the control group and 20 in the intervention group were enrolled in the study. The intervention group received exercise therapy after answering questions regarding NLBP and classifying it into seven categories. The intervention group was asked to perform therapeutic 15-minute exercises suitable for each type of NLBP, as demonstrated by a physical therapist, the first author of this paper, through YouTube, three times a week for 8 weeks.

Results

The results revealed that the SNS-based exercise therapy was significantly effective in reducing NLBP (P < 0.05).

Conclusions

Exercise therapy utilizing SNS effectively improved NLBP among healthcare and transportation workers.
Near-Infrared Informed Huddle for Neonatal Peripheral Intravenous Catheterization
Authors: August Deanne , Marsh Nicole , Hall Stephanie , Royle Ruth , Cobbald Linda , Koorts Pieter , McLaughlin Linda , Lack Gillian , Iminof Danika , Foxcroft Katie , Ware Robert S. , Ullman Amanda
Published: February 2025

Purpose: Implement and evaluate near-infrared (NIR) huddles for neonatal peripheral intravenous catheter (PIVC) insertion. Methods: An implementation project investigated PIVC insertion attempts, site, inserter designation, dwell, and complications during 3 phases (baseline, education, and implementation). Implementation consisted of planning insertion site(s) and attempt frequency with an NIR device huddle. The primary effectiveness outcome was first-time insertion success. Secondary outcomes included: PIVC completion/failure, failure reason, complications. Implementation outcomes were compliance, utility, and acceptability. The association between study phase and primary outcome was assessed using logistic regression. Exploratory analyses investigated intrinsic and extrinsic risks for PIVC insertion failure. Results: Over 5 months, data from 248 (33%) neonates with 771 admissions was collected. Fifty-nine (24%) neonates required multiple PIVCs; resulting in 370 cannulations (n = 94 baseline, n = 55 education, and n = 221 intervention phases). Median birthweight was 2909 grams (IQR 2033-3499), gestation was 37.3 weeks (IQR 33.9-38.9). Length of stay, weight, gestation, and previous PIVC events were similar across phases. Insertion success was lower during education (n = 15, 39.5%) than baseline (n = 29, 56.9%), but differences were not significant. Acceptability of huddle process was higher (mean = 7.5/10, SD 2.2) than NIR device (mean = 5.0/10, SD 3.7). First time insertion failure was higher for forearm compared to hand/wrist (OR 5.94; 95% CI 1.22-28.87). Conclusion: The implementation of NIR-huddle failed to improve first-time insertion success, but PIVC dwell time and documentation were improved. Further research is needed to minimize harm and improve neonatal vascular access preservation.
Lower child opportunity index is associated with increased healthcare utilization following pediatric liver transplantation
Authors: Bennett Aaron D. , Morales Knashawn H. , Huang Yuan-Shung V. , Tam Vicky , Shah Amit , Loomes Kathleen M. , Serper Marina , Bittermann Therese
Published: February 2025

Social determinants of health (SDOH) are known to lead to adverse health outcomes, including high acute care utilization. The mechanisms underlying healthcare disparities among children who have undergone liver transplantation (LT) are poorly understood. To elucidate the relationship between SDOH and healthcare utilization among children (<18 y old at time of LT) who have undergone LT, we performed a retrospective study merging data from the Organ Procurement and Transplantation Network (OPTN) and the Pediatric Hospital Information System (PHIS) database. Children with lower Child Opportunity Index (COI) scores, a composite measure of SDOH, were admitted for 28% more days in the first year and 29% more days over the first two years post-LT, as compared to children with higher COI. We also observed that in the second year post-LT, children with a lower COI were more often admitted with a complication of LT (23%) than those with a higher COI (18%). COI may be a useful composite screening instrument for clinical teams to target resources and limit acute care use post-LT.
Concurrent hemophagocytic lymphohistiocytosis and thrombotic microangiopathy in a patient with Epstein-Barr virus infection and gastric adenocarcinoma: the puzzle started with microangiopathic hemolytic anemia
Authors: Zhou Kehua , Faraz Aniqa , Vallatharasu Yazhini
Published: February 2025

Malignancy-associated-hemophagocytic lymphohistiocytosis (HLH) is rare and often seen in high-grade lymphomas and acute leukemias; solid-tumor-associated HLH is extremely uncommon. The diagnosis of malignancy-associated-HLH remains challenging in clinical practices as it masquerades as and coexists with many other conditions. Here we presented a case with concurrent solid-tumor-associated HLH and thrombotic microangiopathy. The patient was an 80-year-old male with microangiopathic hemolytic anemia (MAHA), progressive bi-lineage cytopenia, and active Epstein-Barr virus (EBV) infection. Extensive lab works excluded all other alternative etiologies for MAHA but B12 deficiency, malignancy, and EBV infection. Concurrently, poorly differentiated gastric adenocarcinoma-associated HLH and thrombotic microangiopathy (TMA) were confirmed with extensive lab work. This patient passed away despite high-dose dexamethasone treatment. In the paper, we also discussed the possible pathophysiology of EBV infection in the development of MAHA and HLH and reviewed the treatment options for HLH and TMA.
Association of Dietary Inflammation Index with sarcopenia in adult women with nonalcoholic fatty liver disease: based on the National Health and Nutrition Examination Survey Database
Authors: Wang Xue , Zhang Rong , Yan Chunying , Jin Yan
Published: February 2025

Background

A higher Dietary Inflammatory Index (DII) is linked with an elevated risk of sarcopenia, but the relationship between the two in adult female patients with nonalcoholic fatty liver disease (NAFLD) remains uncertain.

Objective

The project was designed to probe into the relationship between DII and the risk of sarcopenia in adult female NAFLD patients.

Methods

As a cross-sectional study, this study used NAFLD data for adult women from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES) Database, with DII as the independent variable and sarcopenia as the dependent variable. The relationship between DII and sarcopenia was examined by utilizing weighted logistic regression. Restricted cubic splines (RCS) and threshold effect models were further employed to explore the nonlinear relationship between the two.

Results

We included 469 NAFLD patients, of whom 65 (10.2%) were sarcopenic. In adult female NAFLD patients, a great positive correlation of DII with the risk of sarcopenia was observed in the weighted logistics regression model [odds ratio (OR): 1.459, 95% confidence interval (CI): 1.013–2.103, P = 0.045]. The RCS curve manifested a linear correlation between the two (P
nonlinear = 0.751). The threshold analysis demonstrated that when DII > 0, DII was positively linked with an elevated risk of sarcopenia (OR: 1.328, 95% CI: 1.030–1.722, P = 0.030).

Conclusion

In adult female NAFLD patients, DII is positively linked with the risk of sarcopenia. Future research should further explore the mechanism of influence of DII on sarcopenia in NAFLD patients and evaluate whether improving eating habits can effectively reduce the occurrence of sarcopenia in women with NAFLD.