bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of time‐matched aerobic, resistance or combined exercise training in women living with obesity: The EXOFFIT study
Authors: Davis Mary E. , Blake Catherine , O’Donoghue Gráinne
Published: April 2024

Background

Improvements in cardiorespiratory fitness (CRF) have been shown to largely attenuate the negative health risks associated with obesity. To date, literature on women with obesity has focused upon the evaluation of aerobic‐based exercise interventions. Hence, there is a need to evaluate resistance and combined interventions with this cohort.

Objective

This study aimed to evaluate the feasibility and efficacy of three exercise modalities in women with obesity for improving CRF, strength, body composition and other health outcomes.

Methods

Sixty‐seven women with obesity were randomly assigned to the control (CON) or one of three exercise groups (aerobic [AE], resistance [RE], COM). Exercise groups were trained x3 times/week for 12 weeks (up to 150‐min/week). Feasibility outcomes included adherence, attendance, recruitment and retention rates and adverse events. Secondary outcomes were CRF (predicted VO2 max), body composition (body weight [BW], waist circumference [WC], body fat percentage [%BF], fat mass [FM] and lean mass) and strength (5RM bench press, leg dynamometry, grip strength) and self‐reported measures of physical activity, mood, sleep, pain and quality of life.

Results

Findings support the feasibility of all three exercise modalities in terms of adherence, attendance, and retention. Interventions with a resistance component (COM and RE) were associated with the greatest improvements across the broad range of health outcomes measured. Combined was the most promising for body composition outcomes including body mass index (Effect size [ES] = 0.79, p = 0.04), BW (ES = 0.75, p = 0.05), %BF (ES = 0.77, p = 0.04), FM (ES = 0.83, p = 0.03) and WC (ES = 0.90, p = 0.02), physical activity (i.e., moderate physical activity [ES = 0.69, p = 0.07), mood (ES = 0.83, p = 0.03) and sleep (ES = 0.78, p = 0.04). Resistance was most promising for CRF (ES = 1.47, p = 0.002), strength (i.e., bench press [ES = 2.88, p=<0.001]) and pain (i.e., pain severity [ES = 0.40, p = 0.31]).

Conclusions

For health outcomes, these results indicate the importance of including a resistance component when prescribing exercise for women with obesity to achieve meaningful improvements.

CLINICAL TRIAL REGISTRATION

ISRCTN13517067
A novel micromechanical model for predicting the shear properties of multilayer Ti3C2TxMXene/carbon fiber fabric/epoxy composite
Authors: Duan Ningmin , Li Yong , Shi Zhenyu , Wang Jilai , Zhang Chengpeng , Tang Xuefeng , Wang Guilong
Published: April 2024

Nowadays, it is still a huge challenge to predict the interlaminar shear strength (ILSS) of three‐phase carbon fiber reinforced polymer (CFRP). Herein, the three‐phase micromechanical model is innovatively constructed to predict the ILSS of CFRP, and the conception of new matrix is proposed by establishing a connection between the third phase and the matrix, which effectively solves the problem of uneven distribution of the third phase. To verify the accuracy of the micromechanical model, the Ti3C2Tx MXene/CFf/epoxy composites were fabricated by the co‐blending, layer‐by‐layer assembly and hot‐pressing technology, and the finite element simulation analysis was also performed based on the micromechanical model. The results show that the micromechanical model possesses high accuracy. Specifically, the experimental value of ILSS of the composite with 1 wt% Ti3C2Tx MXene content is 52.12 MPa, and the errors of simulation value (56.64 MPa) and theoretical prediction value (58.69 MPa) are 8.67% and 12.61% MPa, respectively. Besides, the detailed fracture mechanism of the composite is presented based on the fracture morphology and simulation results. It is believed that this work will provide more possibilities for the prediction of the interlaminar shear performance of three‐phase composites.

Highlights

A novel micromechanical model is used to predict the ILSS of three‐phase composite.

The accuracy of the micromechanical model is verified by simulation and experiment.

The main failure form of the Ti3C2Tx MXene/CFf/epoxy composite is matrix broken.

The micromechanical model of the three‐phase composites has high accuracy.
Accelerating into production
Authors: Gutierrez Desi , Duggan Shane , Smyth Frank , Murphy Caolán , Jain Gaurav
Published: April 2024

The JePPIX InPulse pilot line projects, rooted in the objectives of accelerating InP PIC manufacturing and innovation, present Pilot Photonics with an excellent opportunity to enable a cost‐effective transition from multiproject wafers (MPWs) to dedicated wafers with its two partners Smart Photonics and Fraunhofer HHI, two leading European PIC foundries. The chip quantities produced bolster design optimization and preproduction efforts for the company's flagship tunable and comb laser products.
High speed wafer grooving with UV‐USP lasers
Authors: Biesheuvel Kees , Huberts Patrick
Published: April 2024

This article explores the application of ultraviolet ultrashort‐pulse (UV‐USP) laser grooving in tandem with other process steps such as plasma dicing as a practical approach to enable advanced microelectronic packaging. The non‐contact nature of UV‐USP laser grooving, along with its ability to ablate material with minimal lateral thermal damage, results in clean and precise grooving lines.
Registration of ‘TifJumbo’ peanut
Authors: Holbrook C. Corley , Clevenger Josh , Ozias‐Akins Peggy , Chu Ye , Brenneman Tim B.
Published: April 2024

‘TifJumbo’ (Reg. no. CV‐157, PI 701814) is a virginia‐type peanut (Arachis hypogaea L. subsp. hypogaea var. hypogaea) cultivar released by the USDA–ARS and the Georgia Agricultural Experiment Station in 2021. TifJumbo was developed at the University of Georgia Coastal Plain Experiment Station, Tifton, GA. Our research objective was to develop a high oleic acid, virginia market‐type cultivar that also has resistance to the peanut root‐knot nematode [Meloidogyne arenaria (Neal) Chitwood race 1] and resistance to spotted wilt caused by Tomato spotted wilt tospovirus (TSWV). Breeding populations were developed by hybridizing C1805‐2‐9‐16 × N08082olJCT. C1805‐2‐9‐16 is a breeding line selected from the cross of Tifguard × ‘Florida‐07’. N08082olJCT is a ‘Bailey’‐derived, high‐oleic breeding line. Marker assisted selection was used in the development of TifJumbo to select for nematode resistance and the high oleic to linoleic (O/L) characteristic. TifJumbo has a high level of resistance to both the peanut root‐knot nematode and TSWV and has a high O/L ratio. When tested in fields without nematode pressure, TifJumbo exhibited yields that were at least similar to other currently grown peanut cultivars. When tested in fields with nematode pressure, TifJumbo exhibited significantly higher yields in comparison to Bailey, a widely grown, nematode‐susceptible, virginia‐type cultivar. Grade variables for TifJumbo were similar to other common virginia‐type peanut cultivars. Seed size and size distribution were similar to other virginia‐type cultivars.
Attitudes of clients of Dutch pest controllers towards integrated pest management (IPM) and preventive measures in relation to rodent nuisance
Authors: van Gerwen Maite AAM , Rodenburg T Bas , Arndt Saskia S , Meerburg Bastiaan G , Meijboom Franck LB
Published: April 2024

BACKGROUND

Rodent management with lethal methods (e.g., rodenticides) comes with downsides for rodent welfare, the environment and non‐target species. To reduce chemical use and prevent rodent nuisance, pest controllers in the Netherlands must work according to the principles of integrated pest management (IPM). A condition for the success of IPM is that there is sufficient engagement of all parties involved, including clients of pest controllers. The aim of this study was to gain insight into the attitudes of clients regarding rodent control, IPM and the application of preventive measures. Insight into their attitudes may contribute to a better implementation of IPM and with that to a more sustainable rodent management based on more effective prevention. An online survey among 248 clients of Dutch pest controllers from both the agricultural and other sectors was carried out.

RESULTS

Respondents from the agricultural sector had a relatively negative attitude towards IPM, the new IPM regulations in the Netherlands and had little confidence in prevention. In other sectors, respondents were more positive about IPM and had more confidence in prevention. The respondents from the latter subgroup had a similar attitude compared to Dutch pest controllers who participated in a previous survey.

CONCLUSION

The findings of the study provide information for the further development and practical implementation of IPM and preventive measures and with that a more sustainable and animal friendly rodent management. They can also be helpful for a better communication and cooperation between pest controllers and their clients. © 2024 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
Consistent, conservative, and efficient advection updatesfor iterative‐implicit atmospheric solvers
Authors: Thuburn John
Published: April 2024

Atmospheric model dynamical cores that iterate towards a Crank–Nicolson‐like implicit time‐stepping scheme are attractive for operational prediction because their excellent stability properties permit the use of long time steps. However, the long‐time‐step advection schemes used in such models are relatively expensive, and that expense is compounded by the need to compute the advection terms multiple times in the iterative solver. Moreover, unless care is taken in the design of the solver, desirable properties of an advection scheme, such as conservation, consistency, and boundedness, might only be achieved in the unaffordable limit of solver convergence. Here, a modification to such iterative solvers is proposed, similar to the previously published SLIC scheme, in which full advection calculations are made only once per time step, with cheap advection updates made at each solver iteration. This modification significantly reduces the cost of such iterative solvers. It is shown here that the cheap advection updates and the solver back‐substitution calculations can be formulated in such a way that the advection remains conservative, consistent, and bounded no matter how many solver iterations are taken, and not only at solver convergence. The proposed approach is demonstrated in shallow‐water model simulations.
A novel optimization method for attenuating multi‐interferences in satellite communication earth station
Authors: Luo Kang , Wang Qing , Yang Kai , Li Bin
Published: April 2024

The study of multi‐interferences plays a pivotal role in advancing the development of next‐generation, high‐performance communication devices. In this paper, we propose a design approach for auxiliary antennas aimed at mitigating multi‐interference challenges within satellite communication earth stations. We introduce an eight‐element auxiliary antenna with an elliptical beam comprising dual radiation patches and a T‐shaped power divider, to attenuate interferences originating from three distinct directions. To enhance the azimuthal beamwidth, we adjust the dimensions of the ground plane and extend the substrate. At a frequency of 12.5 GHz, the antenna exhibits a 3‐dB beam spacing of 38° and an azimuthal width of 162°, with a maximum gain of 7.9 dBi. We employ a sidelobe canceller to optimize the antenna's performance, and both simulations and measurements affirm that the auxiliary antenna achieves an extinction interference cancelation ratio exceeding 27 dB under all circumstances.
Promoting entrepreneurship for sustainable development: Are education capital and ICT diffusion important?
Authors: Altwaijri Ahmad , Omri Anis , Alfehaid Faisal
Published: April 2024

This article makes a valuable contribution to the existing literature on sustainable entrepreneurship by investigating the impact of entrepreneurship (both opportunity‐driven and necessity‐driven) on the achievement of sustainable development (SD) across its three dimensions. Additionally, it explores the underlying mechanisms through which this relationship is influenced. Specifically, the study examines the role of education capital (including education levels and government spending on education) and information and communication technology (ICT) diffusion (access, usage, and skills) in facilitating this relationship. The analysis focuses on data from Saudi Arabia and utilizes the Dynamic Ordinary Least Squares (DOLS) estimator. The findings indicate that only opportunity entrepreneurship exhibits a positive influence on SD. Furthermore, the study reveals that the positive impact of opportunity entrepreneurship is amplified through its interaction with government spending on education and tertiary education, leading to favorable indirect net effects on SD at both aggregated and disaggregated levels. Similarly, the interaction between opportunity entrepreneurship and ICT usage, as well as access, generates positive indirect net effects on SD across aggregated and disaggregated levels. Therefore, education capital and ICT diffusion are indeed key mechanisms that foster opportunity‐driven entrepreneurship for achieving SD. Education equips individuals with the necessary skills and mindset, whereas ICTs provide access to information, markets, and tools for business efficiency and innovation. By investing in education and promoting the widespread adoption and accessibility of ICTs, governments can empower individuals to become successful entrepreneurs while driving sustainable economic, environmental, and social progress.
“Smile even if your burdens are heavy”: Smallholder challenges and the Sabah sustainable palm oil initiative
Authors: Hou Tham Mun , Tamunaidu Pramila , Padfield Rory , Huzir Nurhamieza Md
Published: April 2024

Sabah, Malaysia's biggest palm oil‐producing state, has made Roundtable Sustainable Palm Oil (RSPO) certification mandatory under Sabah's Jurisdictional Certified Sustainable Palm Oil (JCSPO) initiative. Few studies have examined the independent native smallholders' challenges in adopting the JCSPO initiative. To address this knowledge gap, we engaged with oil palm smallholders via various qualitative methodological approaches over a 14 month period. We identified a range of challenges currently faced by the smallholder; these include RSPO compliance, land tenure issue, low financial and knowledge capacities, increasing food insecurity, and unstable market price of certified crude palm oil. In our article, we argue that the statewide certification policy is consolidating the inequalities in resource access and capacity for growth amongst smallholder groups in different districts. Fair resource allocation to different geographical areas is needed to provide new empowerment mechanisms and remedies for marginalized groups.
Suppression of Thermally Induced Surface Traps in Colloidal Quantum Dot Solids via Ultrafast Pulsed Light
Authors: Lee Eon Ji , Lee Wonjong , Yun Tae Ho , You Hyung Ryul , Kim Hae Jeong , Yu Han Na , Kim Soo‐Kwan , Kim Younghoon , Ahn Hyungju , Lim Jongchul , Yim Changyong , Choi Jongmin
Published: April 2024

Thermal annealing (TA) of colloidal quantum dot (CQD) films is considered an important process for recent high‐performing CQD solar cells (SCs) due to its beneficial effects on CQD solids, including enhanced electrical conductivity, denser packing of CQD films, and the removal of organic residues and solvents. However, the conventional TA for CQDs, which requires several  minutes, leads to hydroxylation and oxidation on the CQD surface, resulting in the formation of trap states and a subsequent decline in SC performance. To address these challenges, this study introduces a flashlight annealing (FLA) technique that significantly reduces the annealing time to the millisecond scale. Through the FLA approach, it successfully suppressed hydroxylation and oxidation, resulting in decreased trap states within the CQD solids while simultaneously preserving their charge transport properties. As a result, CQD SCs treated with FLA exhibited a notable improvement, achieving an open‐circuit voltage of 0.66 V compared to 0.63 V in TA‐treated devices, leading to an increase in power conversion efficiency from 12.71% to 13.50%.
H‐Glass Supported Hybrid Gold Nano‐Islands for Visible‐Light‐Driven Hydrogen Evolution
Authors: Mandal Indrajeet , Gangareddy Jagannath , Sethurajaperumal Abimannan , NK Murugasenapathi , Majji Manikanta , Bera Susmita , Rudra Pratyasha , Ravichandran Vanmathi , Bysakh Sandip , Jacob Noah , Rao K. D. M. , Singh Rajiv K. , Krishnan N. M. Anoop , Chirumamilla Manohar , Palanisamy Tamilarasan , Motapothula M. , Varrla Eswaraiah , Ghosh Srabanti , Allu Amarnath R.
Published: April 2024

Flat panel reactors, coated with photocatalytic materials, offer a sustainable approach for the commercial production of hydrogen (H2) with zero carbon footprint. Despite this, achieving high solar‐to‐hydrogen (STH) conversion efficiency with these reactors is still a significant challenge due to the low utilization efficiency of solar light and rapid charge recombination. Herein, hybrid gold nano‐islands (HGNIs) are developed on transparent glass support to improve the STH efficiency. Plasmonic HGNIs are grown on an in‐house developed active glass sheet composed of sodium aluminum phosphosilicate oxide glass (H‐glass) using the thermal dewetting method at 550 °C under an ambient atmosphere. HGNIs with various oxidation states (Au0, Au+, and Au−) and multiple interfaces are obtained due to the diffusion of the elements from the glass structure, which also facilitates the lifetime of the hot electron to be ≈2.94 ps. H‐glass‐supported HGNIs demonstrate significant STH conversion efficiency of 0.6%, without any sacrificial agents, via water dissociation. This study unveils the specific role of H‐glass‐supported HGNIs in facilitating light‐driven chemical conversions, offering new avenues for the development of high‐performance photocatalysts in various chemical conversion reactions for large‐scale commercial applications.
The Social Logic of Invasion
Authors: Peña‐Alves Stephanie
Published: April 2024

In this article, I theorize invasion as a sociocognitive phenomenon grounded in conceptual relations between the social statuses of “in” and “out.” Pulling invasion out of its ordinary and historically physical context, I explore how people share similar ways of envisioning invasions across a wide variety of domains in social life. To demonstrate this, I employ the qualitative concept‐driven comparative method of trans‐level analysis, tracing common mental models of invasion in the cases of the body, the home, and the nation‐state. Drawing from a sample of 42 in‐depth interviews as well as discourse and policy materials, I find that people envision invasion to take four basic forms: entry and existence, contamination, theft, and domination. Offering the concept of invasion subversion, I explore the highly contestable nature of invasions and the semiotic strategies of marking and unmarking that people leverage to challenge and reinforce arrangements between “in” and “out.” Ultimately, I show that invasions foreground social order and make visible the tacit rules of inclusion and exclusion that shape it. This study advances and extends the study of inclusion and exclusion to cognitive sociological terrain.
A comparative analysis of Charlson's weighted index of comorbidity and perforated peptic ulcer scores in predicting postoperative mortality and high comprehensive complication index
Authors: Lim Raymond Zhun Ming , Tan Jih Huei , Raja Ram Novinth Kumar , Tan Henry Chor Lip , Ho Ivan Khor Ee , Chuah Jun Sen , Mahendran Hans Alexander
Published: April 2024

Background

Limited data exists on Charlson's weighted index of comorbidity (WIC) predictability for postoperative outcomes following perforated peptic ulcer (PPU) surgery. This study assesses the utility of WIC and other predictive scores in forecasting both postoperative mortality and morbidity in PPU.

Materials & Methods

Patients with PPUs operated between 2018 and 2021 in a Malaysian tertiary referral center were included. Clinical data were retrospectively analyzed for association with mortality and morbidity measured with the Comprehensive Complication Index (CCI). Predictability of WIC and other predictors were examined using area under receiver–operator characteristic (ROC) curve (AUC).

Results

Among 110 patients included, 18 died (16.4%) and 36 (32.7%) had significant morbidity postoperatively (High CCI, ≥26.2). Both mortality and high CCI were associated with age >65 years, female sex, comorbidities (diabetes mellitus, hypertension, and renal disease), and American Society of Anesthesiologist score >2. Most patients who died had renal dysfunction, metabolic acidosis, lactate >2 mmol/L upon presentation preoperatively. While surgery >24 h after presentation correlated with mortality and high CCI, the benefit of earlier surgery <6 h or <12 h was not demonstrated. WIC (AUC, 0.89; 95% CI, 0.81–0.99) showed similar predictability to Peptic Ulcer Perforation (PULP) (AUC, 0.97; 95% CI, 0.93–1.00) for mortality. PULP effectively predicted high CCI (AUC, 0.83; 95% CI, 0.73–0.93; p < 0.001).

Conclusion

WIC is valuable in predicting mortality, highlighting the importance of comorbidity in risk assessment. PULP score was effective in predicting both mortality and high CCI. Early identification of patients with high perioperative risk will facilitate patients' triage for escalated care, leading to a better outcome.
Celestial gluon and graviton OPE at loop level
Authors: Krishna Hare
Published: April 2024

Abstract

In this paper, we analyze the loop corrections to celestial OPE for gluons and gravitons. Even at the loop level, the soft gluons and gravitons have conformal dimensions ∆ = 1 −$${\mathbb{Z}}_{\ge 0}$$. The only novelty is the presence of higher poles. At one loop level, there are two types of conformal soft gluons with a single pole and a double pole in the ∆ plane. The celestial OPEs are obtained using the collinear splitting functions. In the case of gluons, the splitting functions receive loop corrections. After taking the holomorphic soft limit, we find the OPE of conformal soft gluons. We find a novel mixing of simple and double poles soft gluon operators in the OPE. In the case of gravitons, where splitting functions are known to be all loop exact, we still find a wedge algebra of w∞ which is in addition to the wedge algebra of w1+∞ already found by Strominger.
Spread complexity for measurement-induced non-unitary dynamics and Zeno effect
Authors: Bhattacharya Aranya , Das Rathindra Nath , Dey Bidyut , Erdmenger Johanna
Published: April 2024

Abstract

Using spread complexity and spread entropy, we study non-unitary quantum dynamics. For non-hermitian Hamiltonians, we extend the bi-Lanczos construction for the Krylov basis to the Schrödinger picture. Moreover, we implement an algorithm adapted to complex symmetric Hamiltonians. This reduces the computational memory requirements by half compared to the bi-Lanczos construction. We apply this construction to the one-dimensional tight-binding Hamiltonian subject to repeated measurements at fixed small time intervals, resulting in effective non-unitary dynamics. We find that the spread complexity initially grows with time, followed by an extended decay period and saturation. The choice of initial state determines the saturation value of complexity and entropy. In analogy to measurement-induced phase transitions, we consider a quench between hermitian and non-hermitian Hamiltonian evolution induced by turning on regular measurements at different frequencies. We find that as a function of the measurement frequency, the time at which the spread complexity starts growing increases. This time asymptotes to infinity when the time gap between measurements is taken to zero, indicating the onset of the quantum Zeno effect, according to which measurements impede time evolution.
Propagation of anisotropic Gabor singularities for Schrödinger type equations
Authors: Cappiello Marco , Rodino Luigi , Wahlberg Patrik
Published: April 2024

We show results on propagation of anisotropic Gabor wave front sets for solutions to a class of evolution equations of Schrödinger type. The Hamiltonian is assumed to have a real-valued principal symbol with the anisotropic homogeneity $$a(\lambda x, \lambda ^\sigma \xi ) = \lambda ^{1+\sigma } a(x,\xi )$$

a

(
λ
x
,

λ
σ

ξ
)

=

λ

1
+
σ

a

(
x
,
ξ
)

for $$\lambda > 0$$

λ
>
0

where $$\sigma > 0$$

σ
>
0

is a rational anisotropy parameter. We prove that the propagator is continuous on anisotropic Shubin–Sobolev spaces. The main result says that the propagation of the anisotropic Gabor wave front set follows the Hamilton flow of the principal symbol.
Accuracy between prehospital and hospital diagnosis in helicopter emergency medical services and its consequences for trauma care
Authors: Müller Martin , Hautz Wolf , Louma Yves , Knapp Jürgen , Schnüriger Beat , Simmen Hans-Peter , Pietsch Urs , Jakob Dominik A. ,   the Swiss Trauma Board
Published: April 2024

Purpose

For optimal prehospital trauma care, it is essential to adequately recognize potential life-threatening injuries in order to correctly triage patients and to initiate life-saving measures. The aim of the present study was to determine the accuracy of prehospital diagnoses suspected by helicopter emergency medical services (HEMS).

Methods

This retrospective multicenter study included patients from the Swiss Trauma Registry with ISS ≥ 16 or AIS head ≥ 3 transported by Switzerland’s largest HEMS and subsequently admitted to one of twelve Swiss trauma centers from 01/2020 to 12/2020. The primary outcome was the comparison of injuries suspected prehospital with the final diagnoses obtained at the hospital using the abbreviated injury scale (AIS) per body region. As secondary outcomes, prehospital interventions were compared to corresponding relevant diagnoses.

Results

Relevant head trauma was the most commonly injured body region and was identified in 96.3% (95% CI: 92.1%; 98.6%) of the cases prehospital. Relevant injuries to the chest, abdomen, and pelvis were also common but less often identified prehospital [62.7% (95% CI: 54.2%; 70.6%), 45.5% (95% CI: 30.4%; 61.2%), and 61.5% (95% CI: 44.6%; 76.6%)]. Overall, 7 of 95 (7.4%) patients with pneumothorax received a chest decompression and in 22 of 39 (56.4%) patients with an instable pelvic fracture a pelvic binder was applied prehospital.

Conclusion

Approximately half of severe chest, abdominal, and pelvic diagnoses made in hospital went undetected in the challenging prehospital environment. This underlines the difficult circumstances faced by the rescue teams. Potentially life-saving interventions such as prehospital chest decompression and increased use of a pelvic binder were identified as potential improvements to prehospital care.
Relative Impacts of Sea Ice Loss and Atmospheric Internal Variability on the Winter Arctic to East Asian Surface Air Temperature Based on Large-Ensemble Simulations with NorESM2
Authors: He Shengping , Drange Helge , Furevik Tore , Wang Huijun , Fan Ke , Graff Lise Seland , Orsolini Yvan J.
Published: April 2024

To quantify the relative contributions of Arctic sea ice and unforced atmospheric internal variability to the “warm Arctic, cold East Asia” (WACE) teleconnection, this study analyses three sets of large-ensemble simulations carried out by the Norwegian Earth System Model with a coupled atmosphere–land surface model, forced by seasonal sea ice conditions from preindustrial, present-day, and future periods. Each ensemble member within the same set uses the same forcing but with small perturbations to the atmospheric initial state. Hence, the difference between the present-day (or future) ensemble mean and the preindustrial ensemble mean provides the ice-loss-induced response, while the difference of the individual members within the present-day (or future) set is the effect of atmospheric internal variability. Results indicate that both present-day and future sea ice loss can force a negative phase of the Arctic Oscillation with a WACE pattern in winter. The magnitude of ice-induced Arctic warming is over four (ten) times larger than the ice-induced East Asian cooling in the present-day (future) experiment; the latter having a magnitude that is about 30% of the observed cooling. Sea ice loss contributes about 60% (80%) to the Arctic winter warming in the present-day (future) experiment. Atmospheric internal variability can also induce a WACE pattern with comparable magnitudes between the Arctic and East Asia. Ice-loss-induced East Asian cooling can easily be masked by atmospheric internal variability effects because random atmospheric internal variability may induce a larger magnitude warming. The observed WACE pattern occurs as a result of both Arctic sea ice loss and atmospheric internal variability, with the former dominating Arctic warming and the latter dominating East Asian cooling.
Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism
Authors: Mohr Katharina , Hobohm Lukas , Kaier Klaus , Farmakis Ioannis T. , Valerio Luca , Barco Stefano , Abele Christina , Münzel Thomas , Neusius Thomas , Konstantinides Stavros , Binder Harald , Keller Karsten
Published: April 2024

Background and aims

The socio-economic burden imposed by acute pulmonary embolism (PE) on European healthcare systems is largely unknown. We sought to determine temporal trends and identify cost drivers of hospitalisation for PE in Germany.

Methods and results

We analysed the totality of reimbursed hospitalisation costs in Germany (G-DRG system) in the years 2016–2020. Overall, 484 884 PE hospitalisations were coded in this period. Direct hospital costs amounted to a median of 3572 (IQR, 2804 to 5869) euros, resulting in average total reimbursements of 710 million euros annually. Age, PE severity, comorbidities and in-hospital (particularly bleeding) complications were identified by multivariable logistic regression as significant cost drivers. Use of catheter-directed therapy (CDT) constantly increased (annual change in the absolute proportion of hospitalisations with CDT + 0.40% [95% CI + 0.32% to + 0.47%]; P < 0.001), and it more than doubled in the group of patients with severe PE (28% of the entire population) over time. Although CDT use was overall associated with increased hospitalisation costs, this association was no longer present (adjusted OR 1.02 [0.80–1.31]) in patients with severe PE and shock; this was related, at least in part, to a reduction in the median length of hospital stay (for 14.0 to 8.0 days).

Conclusions

We identified current and emerging cost drivers of hospitalisation for PE, focusing on severe disease and intermediate/high risk of an adverse early outcome. The present study may inform reimbursement decisions by policymakers and help to guide future health economic analysis of advanced treatment options for patients with PE.

Graphical Abstract
The equivalence of Heegaard Floer homology and embedded contact homology via open book decompositions I
Authors: Colin Vincent , Ghiggini Paolo , Honda Ko
Published: April 2024

Given an open book decomposition $(S,\mathfrak{h} )$
(
S
,
h
)
adapted to a closed, oriented 3-manifold $M$
M
, we define a chain map $\Phi $
Φ
from a certain Heegaard Floer chain complex associated to $(S,\mathfrak{h} )$
(
S
,
h
)
to a certain embedded contact homology chain complex associated to $(S,\mathfrak{h} )$
(
S
,
h
)
, as defined in (Colin et al. in Geom. Topol., 2024), and prove that it induces an isomorphism on the level of homology. This implies the isomorphism between the hat version of Heegaard Floer homology of $-M$
−
M
and the hat version of embedded contact homology of $M$
M
.
Microglia in retinal angiogenesis and diabetic retinopathy
Authors: Hu Aiyan , Schmidt Mirko H. H. , Heinig Nora
Published: April 2024

Diabetic retinopathy has a high probability of causing visual impairment or blindness throughout the disease progression and is characterized by the growth of new blood vessels in the retina at an advanced, proliferative stage. Microglia are a resident immune population in the central nervous system, known to play a crucial role in regulating retinal angiogenesis in both physiological and pathological conditions, including diabetic retinopathy. Physiologically, they are located close to blood vessels and are essential for forming new blood vessels (neovascularization). In diabetic retinopathy, microglia become widely activated, showing a distinct polarization phenotype that leads to their accumulation around neovascular tufts. These activated microglia induce pathogenic angiogenesis through the secretion of various angiogenic factors and by regulating the status of endothelial cells. Interestingly, some subtypes of microglia simultaneously promote the regression of neovascularization tufts and normal angiogenesis in neovascularization lesions. Modulating the state of microglial activation to ameliorate neovascularization thus appears as a promising potential therapeutic approach for managing diabetic retinopathy.

Graphical abstract
Game design elements of serious games in the education of medical and healthcare professions: a mixed-methods systematic review of underlying theories and teaching effectiveness
Authors: Aster Alexandra , Laupichler Matthias Carl , Zimmer Saskia , Raupach Tobias
Published: April 2024

Serious games, as a learning resource, enhance their game character by embedding game design elements that are typically used in entertainment games. Serious games in its entirety have already proven their teaching effectiveness in different educational contexts including medical education. The embedded game design elements play an essential role for a game’s effectiveness and thus they should be selected based on evidence-based theories. For game design elements embedded in serious games used for the education of medical and healthcare professions, an overview of theories for the selection lacks. Additionally, it is still unclear whether and how single game design elements affect the learning effectiveness. Therefore, the main aim of this systematic review is threefold. Firstly, light will be shed on the single game design elements used in serious games in this area. Second, the game design elements’ underlying theories will be worked out, and third, the game design elements’ effectiveness on student learning outcome will be assessed. Two literature searches were conducted in November 2021 and May 2022 in six literature databases with keywords covering the fields of educational game design, serious game, and medical education. Out of 1006 initial records, 91 were included after applying predefined exclusion criteria. Data analysis revealed that the three most common game design elements were points, storyline, and feedback. Only four underlying theories were mentioned, and no study evaluated specific game design elements. Since game design elements should be based on theories to ensure meaningful evaluations, the conceptual GATE framework is introduced, which facilitates the selection of evidence-based game design elements for serious games.
Describing Non-Binary People’s Encounters with the Healthcare System: A Qualitative Study in Catalonia (Spain)
Authors: Gómez-Ibáñez Rebeca , Leyva-Moral Juan M. , Cruzado-Reyes Alexander , Platero Lucas R. , Granel Nina , Watson Carolina E.
Published: April 2024

Non-binary people face numerous stressors in their daily lives, including personal, interpersonal, and environmental. These stressors gain strength when such individuals access healthcare services, and discrimination and cisgenderism become the main barrier to obtaining gender-affirming healthcare. This study aimed to describe the experiences of non-binary people regarding the care and medical attention received in Catalonia (Spain). A qualitative phenomenological study was conducted with 21 non-binary people recruited using snowball sampling in 2022. Data were gathered through open-ended interviews and analyzed using thematic analysis. Two main themes were identified, which were further classified into two categories each: Theme 1—This is me composed of the categories, “My Name and My Pronouns” and “One’s Chosen Gender,” and Theme 2—I do not exist for the health system consisting of “Uneducated Health System in Sexual Health” and “Feeling Like an Outsider for Being Non-Binary.” Non-binary people face multiple stressors when accessing the healthcare services that makes them feel invisible, vulnerable, and marginalized. Further widespread implementation of person-centered care is essential to promote the relationship between non-binary people and the healthcare system. In addition, further sexual health training is required for all health professionals.
Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future
Authors: Jorgensen Sarah C. J. , Athéa Nicole , Masson Céline
Published: April 2024

In this essay, we consider the clinical and ethical implications of puberty blockers for pediatric gender dysphoria through the lens of “the child’s right to an open future,” which refers to rights that children do not have the capacity to exercise as minors, but that must be protected, so they can exercise them in the future as autonomous adults. We contrast the open future principle with the beliefs underpinning the gender affirming care model and discuss implications for consent. We evaluate claims that puberty blockers are reversible, discuss the scientific uncertainty about long-term benefits and harms, summarize international developments, and examine how suicide has been used to frame puberty suppression as a medically necessary, lifesaving treatment. In discussing these issues, we include relevant empirical evidence and raise questions for clinicians and researchers. We conclude that treatment pathways that delay decisions about medical transition until the child has had the chance to grow and mature into an autonomous adulthood would be most consistent with the open future principle.
Early detection of rare and elusive endangered species using environmental DNA: a case study for the Eurasian otter and the white-clawed crayfish in northwestern Italy
Authors: Ballini Lorenzo , Ottonello Dario , Repetto Valentina , Natali Chiara , Chini Giacomo , Tolve Livia , Ciofi Claudio , Fratini Sara , Iannucci Alessio
Published: April 2024

Monitoring, management and conservation of rare and elusive species often requires early detection of individuals, especially for re-introduced and endangered taxa. Environmental DNA (eDNA) approaches can enhance the detection power of traditional biomonitoring methods for low-density, newly-established populations. In this study, we used species-specific Real Time PCR TaqMan assays to assess the presence of two endangered freshwater species, the white-clawed crayfish Austropotamobius pallipes and the Eurasian otter Lutra lutra at eight sites in four river catchments in Liguria (northwestern Italy). The Eurasian otter was considered extinct in the study area since the 1980s. However, recent, although scattered sightings indicated a recolonisation by a few individuals. The white-clawed crayfish populations declined drastically and became increasingly dispersed in the western part of Liguria. Our eDNA analysis confirmed the presence of both species in some of the selected rivers and detected Eurasian otter DNA where the species was not recorded through traditional monitoring methods. This study confirms eDNA-based monitoring approaches as valuable tools to assess the presence of rare and elusive species and help implement protection plans at a local scale.
Cyanobacterial Harmful Algal Mats (CyanoHAMs) in tropical rivers of central Mexico and their potential risks through toxin production
Authors: Caro-Borrero Angela , Márquez-Santamaria Kenia , Carmona-Jiménez Javier , Becerra-Absalón Itzel , Perona Elvira
Published: April 2024

Cyanobacteria inhabiting lotic environments have been poorly studied and characterized in Mexico, despite their potential risks from cyanotoxin production. This article aims to fill this knowledge gap by assessing the importance of benthic cyanobacteria as potential cyanotoxin producers in central Mexican rivers through: (i) the taxonomic identification of cyanobacteria found in these rivers, (ii) the environmental characterization of their habitats, and (iii) testing for the presence of toxin producing genes in the encountered taxa. Additionally, we introduce and discuss the use of the term “CyanoHAMs” for lotic water environments. Populations of cyanobacteria were collected from ten mountain rivers and identified using molecular techniques. Subsequently, these taxa were evaluated for genes producing anatoxins and microcystins via PCR. Through RDA analyses, the collected cyanobacteria were grouped into one of three categories based on their environmental preferences for the following: (1) waters with high ionic concentrations, (2) cold-temperate waters, or (3) waters with high nutrient enrichment. Populations from six locations were identified to genus level: Ancylothrix sp., Cyanoplacoma sp., and Oxynema sp. The latter was found to contain the gene that produces anatoxins and microcystins in siliceous rivers, while Oxynema tested positive for the gene that produces microcystins in calcareous rivers. Our results suggest that eutrophic environments are not necessarily required for toxin-producing cyanobacteria. Our records of Compactonostoc, Oxynema, and Ancylothrix represent the first for Mexico. Four taxa were identified to species level: Wilmottia aff. murrayi, Nostoc tlalocii, Nostoc montejanii, and Dichothrix aff. willei, with only the first testing positive using PCR for anatoxin and microcystin-producing genes in siliceous rivers. Due to the differences between benthic growths with respect to planktonic ones, we propose the adoption of the term Cyanobacterial Harmful Algal Mats (CyanoHAMs) as a more precise descriptor for future studies.
Individualistic Versus Relational Ethics – A Contestable Concept for (African) Philosophy
Authors: Andanda Pamela , Düwell Marcus
Published: April 2024

Thaddeus Metz, in his book “A Relational Moral Theory” compares the relational African view to Western theories of right action with a focus on Kant (respective contemporary Kantianism) and Utilitarianism. In focussing on the opposition between a relational and an individualistic view, Metz questions the interpretation of basic normative assumptions that are guiding central Western moral and political institutions. He particularly focusses on Kantian and Utilitarian approaches to which he ascribes substantive moral assumptions in terms of utility respective autonomy. In this paper, we reconstruct Metz’s position on the opposition between a relational and an individualistic view on ethics. We then investigate whether his relational conceptualisation is a convincing reconstruction of African views and question his take on Western positions, focussing in particular on views around individual rights and communality as presented in the Kantian tradition. We highlight the value of ubuntu in intercultural discourse to foster ethical and moral reasoning in a holistic way and conclude that any reflection on ethics necessarily involves an understanding of our common human nature, which is at the core of philosophical anthropology.
Caregivers of Children with Special Healthcare Needs: A Quantitative Examination of Work-Family Culture, Caregiver Burden, and Work-Life Balance
Authors: Stevens Emily K. , Aziz Shahnaz , Wuensch Karl L. , Walcott Christy
Published: April 2024

The purpose of the current study was to examine the relationships between organizational work-family culture, caregiver burden, and work-life balance among employed caregivers of children with special healthcare needs. The potential moderating role of organizational work-family culture in the relationship between caregiver burden and work-life balance was also investigated. Using convenience sampling, data were collected from 150 primary caregivers who work or recently worked in the past three months and have at least one child with a special healthcare need. Participants completed an online survey. Findings revealed increasing caregiver burden was related to lower work-life balance, while organizational work-family culture was positively related to it. Organizational work-family culture, and two of its three facets (i.e., managerial support and time demands), were significant moderators, but only before COVID-19. Future researchers could focus on underrepresented groups and communities, examine organizational work-family culture in various industries, and improve work-life balance during social and economic downturns. With increases in dual earner and single parent households, employers should consider how their culture supports employees with households with a child with special healthcare needs. This is the first study to apply organizational work-family culture to employed caregivers with a child with special healthcare needs and test it as a moderator of the relationship between caregiver burden and work-life balance.
Counterpart Theory and Actuality
Authors: Milford James
Published: April 2024

Lewis (The Journal of Philosophy, 65(5), 113–126, 1968) attempts to provide an account of modal talk in terms of the resources of counterpart theory, a first-order theory that eschews transworld identity. First, a regimentation of natural language modal claims into sentences of a formal first-order modal language L is assumed. Second, a translation scheme from L-sentences to sentences of the language of the theory is provided. According to Hazen (The Journal of Philosophy, 76(6), 319–338, 1979) and Fara & Williamson (Mind, 114(453), 1–30, 2005), the account cannot handle certain natural language modal claims involving a notion of actuality. The challenge has two parts. First, in order to handle such claims, the initial formal modal language that natural language modal claims are regimented into must extend L with something like an actuality operator. Second, certain ways that Lewis’ translation scheme for L might be extended to accommodate an actuality operator are unacceptable. Meyer (Mind, 122(485), 27–42, 2013) attempts to defend Lewis’ approach. First, Meyer holds that in order to handle such claims, the formal modal language L$$^*$$

∗

that we initially regiment our natural language claims into need not contain an actuality operator. Instead, we can make do with other resources. Next, Meyer provides an alternative translation scheme from L$$^*$$

∗

-sentences to sentences of an enriched language of counterpart theory. Unfortunately, Meyer’s approach fails to provide an appropriate counterpart theoretic account of natural language modal claims. In this paper, I demonstrate that failure.