bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of the Gulf of California in the North American Monsoon
Authors: Johnson Benjamin O. , Delworth Thomas L.
Published: November 2022

The role of the Gulf of California (GoC) in the North American monsoon (NAM) is investigated using a global climate model with 50-km horizontal atmospheric resolution and prescribed SSTs. Specifically, two 135-yr simulations are compared to quantify the influence of the GoC on the NAM: in the first simulation a realistic representation of the GoC is incorporated, while in the second simulation the GoC is replaced with land surface. The results suggest that the GoC has a significant impact on circulation, with cooler surface air temperatures and lower surface friction allowing for south-southeasterly surface flow along the entire length of the GoC, in turn increasing low-level moisture fluxes into the NAM region. Cooler air over the GoC also leads to lower heights at 700–500 hPa, with a corresponding cyclonic moisture flux anomaly, further increasing moisture fluxes into the NAM region. Correspondingly, precipitation is substantially higher over the NAM region and even east of the Continental Divide in areas such as New Mexico and the U.S. Great Plains. July/August precipitation with a realistic GoC is generally 25%–50% greater in northwestern Mexico than the land-filled case, with precipitation 50% greater in much of the southwestern United States. Due to enhanced surface evaporation, areas with increased precipitation also tend to have lower surface temperatures, higher sea level pressure, and lower mid- to upper-tropospheric heights, thus altering the large-scale circulation. These results highlight the importance of the GoC in the NAM and demonstrate the necessity of resolving the GoC in climate simulations.

Significance Statement

This paper seeks to improve our understanding of the North American monsoon, an important moisture source in the relatively arid region of northwest Mexico and the Southwest United States. Specifically, we investigate the role of the Gulf of California: a long, narrow sea surrounded by elevated topography within the North American monsoon region, oriented roughly southeast–northwest. The results suggest the Gulf of California is an important component of the North American monsoon system. We find that the Gulf of California acts to enhance moisture transports into the North American monsoon, leading to substantially higher precipitation over a large region. Therefore, the Gulf of California should be carefully considered in climate simulations and future projections, especially given it is often not well resolved.
Embodying the Market: The Emergence of the Body Entrepreneur
Authors: Michel Alexandra
Published: November 2022

When organizations take radically new forms, employees’ minds and bodies can also take radically new forms, but prior organizational research has lacked the concepts and data to understand such qualitative changes in persons. For 17 years, I studied a profound societal change, the market turn, inside organizations at their center, investment banks on Wall Street. The banks took a new, market-like form that facilitated the emergence of a cultural–historical new form of personhood, the body entrepreneur. Unlike traditional organizations, which predictably reward employee effort, the banks gradually decoupled rewards from effort, paying bankers for winning first internal and then external competitions and increasingly exposing them to market risk. Bankers internalized this entrepreneurial positioning by transforming their minds and bodies into resources for competitive success regardless of health consequences. As rewards became more elusive, bankers invested more resources, first the mind and then the body, and controlled them in progressively more powerful ways, first through cognitive techniques, then through self-experimentation with drugs. Bankers thus intervened more radically in their minds and bodies than organizations legitimately can, resulting in two qualitative person changes. One, bankers constructed personhood in cultural–historical new ways, changing from the traditional psychological self, which locates processes such as emotions and motivation in the mind, toward a somatic self, the body entrepreneur, which locates them in the body as brain states that bankers could self-design. Two, the body functioned in new ways: not inside–out as a biological imperative but outside–in, fluidly adjusting to changing situations. Whereas prior organizational theories have assumed what the body is, I problematize it, empirically studying the self-technologies through which people construct the culturally situated biologies that compel them to unproblematically reproduce new, market-like organizations.
Association Between History of Polymerase Chain Reaction-verified COVID-19 Infection and Outcomes of Subsequent ST-Elevation Myocardial Infarction
Authors: Dogan Zeki , Erden Ismail , Bektasoglu Gokhan , Karabulut Ahmet
Published: November 2022

While the acute phase of coronavirus disease 2019 (COVID-19) is associated with worsening cardiac outcomes, it is unclear whether it affects the outcome of patients with ST-segment elevation myocardial infarction (STEMI) after the acute phase. In addition, while many studies compared the course of STEMI during the COVID-19 pandemic with the years before the outbreak, we evaluated the course of STEMI during the pandemic according to whether or not patients had history of COVID-19. Patients diagnosed with STEMI during the ongoing COVID-19 pandemic were included in the study. The Ministry of Health database was analyzed retrospectively, and patients with (n = 191) and without (n = 127) a history of polymerase chain reaction (PCR) confirmed COVID-19 infection were divided into groups. Clinical and angiographic characteristics were assessed. The rates of in-hospital major adverse cardiac events (MACE) were higher in those who had a history of PCR-verified COVID-19 infection. Angiographic and procedural findings indicating successful reperfusion were better in patients without a history of COVID-19. A history of COVID-19 infection (odds ratio 1.40, 95% confidence interval 1.25–1.60, P < .01) independently predicted MACE. A history of COVID-19 infection is a predictor of worse outcomes following coronary intervention and in-hospital MACE among patients with STEMI.
Electing Women in Ethnically Divided Societies: Candidates, Campaigns, and Intersectionality in Bihar, India
Authors: Hankla Charles , Banerjee Sayan , Thomas Anjali , Banerjee Arindam
Published: November 2022

What factors influence women’s political success in ethnically divided societies? Using an original survey experiment in the Indian state of Bihar, supplemented with qualitative interviews, we explore the impact of two factors—intersecting gender and caste identity, and the interaction of campaign appeal with voter experiences of caste discrimination—on women candidates’ success in state-level elections. We find, first, that women voters prefer women candidates, and that Scheduled Caste and Muslim voters also prefer candidates from their in-groups. At the same time, we identify evidence of intersectional effects, namely, that Muslim women candidates suffer from a disadvantage vis-a-vis women candidates from other backgrounds. We also show that women voters prefer candidates who offer security, especially when the candidates are women. Finally, we demonstrate that personal experience with caste discrimination increases support for women candidates. These results indicate that voters see women leaders as well-placed to ameliorate their security vulnerabilities.
‘You are Still a Guest in This Country!’: Understanding Racism through the Concepts of Hospitality and Hostility in Healthcare Encounters in Sweden
Authors: Bradby Hannah , Thapar-Björkert Suruchi , Hamed Sarah , Ahlberg Beth Maina
Published: November 2022

While regularly applied to globalized migration, conceptualizations of hospitality have rarely been used to understand healthcare settings. Drawing on interviews with healthcare staff in Sweden, our article contributes to the current conceptualization of hospitality accounting for: the internal contradictions of hospitality that racialized staff experience in their everyday interactions with patients and other staff; the shifting boundaries between host and guest in everyday healthcare practices, especially when examined through the lens of racialization and finally; the subtle though troubled coexistence of hostility and un(conditional) hospitality that weakens resistance against racism. The analysis maps the complex contingencies of professional, ethnic and national relations between staff and patients, in light of their racialized and gendered nature, to suggest that the ambivalences theorized as part of the concept of hospitality show how the hurts of racism are so hard to pinpoint.
Social Quarantining in the Construction and Maintenance of White Australia
Authors: Staines Zoe
Published: November 2022

While medical quarantining has (again) received widespread attention during the COVID-19 pandemic, comparatively little consideration has been given to how medical quarantining is entangled with socio-political life. Further, there are no known studies that consider how quarantine might also be employed as a socio-political practice. This article explores the concept of social quarantine by tracing the creation of white Australia via the social construction, excise and discipline of Indigenous peoples as a potentially contagious Other. It shows how social quarantine integrates largely disparate sociological concepts/literatures (e.g. bordering, (im)mobility, confinement, enclave society, discipline, eugenics, assimilation), demonstrating how they unite under settler colonialism as a powerful assemblage of disciplinary technologies. Social quarantine also makes visible how the threat of contamination has been central to constructing and protecting Australia’s (white) imagined nationhood from the perceived disease of Otherness.
Choosing the Right Educational Technology Tool for Your Teaching: A Data-Privacy Review and Pedagogical Perspective into Teaching with Technology
Authors: Schlosser Lexi , Hood Christine E. , Hogan Ellen , Baca Bobby , Gentile-Mathew Amelia
Published: November 2022

Recently, there has been a demand for increased educational technology usage in the university classroom, despite expanded access and implementation there has been little attention paid to student data privacy concerns. Our work is one institution's response to addressing the data privacy gap by creating a comprehensive review process for educational technology discernment and adoption. Our review process provides a critical degree of reliability and validity for informed decision-making surrounding educational technology selection. We prioritize the frames of safety, pedagogy, consistency, and accessibility throughout the review. With the creation of this review process educational technology stakeholders can make empirically based decisions regarding educational technologies. While this work is only one institution's response, we believe that this process and approach can empower a broad set of stakeholders to consider their method behind adopting educational technologies.
Patrolling and Controlling the Streets: The Origin of School Safety Patrols in New York City
Authors: Smilie Kipton D.
Published: November 2022

The rise of automobile use in New York City in the 1920s placed pedestrians, particularly children and adolescents, in a new danger. Fatalities and injuries among youth involving automobile accidents created a public health crisis, especially as children navigated streets to and from school each day. The New York Automobile Club and the New York Police Department partnered with the school district to sponsor school safety patrols to educate children and protect them from this newfound danger. The motives of both sponsors, along with the increased expansion of police presence of school grounds, provide complexities, though, to this origin story. As scholars today intensify their explorations and investigations of police and carceral history in the United States, particularly involving black youth in urban centers, the origin story of school safety patrols in New York City has much to say about controlling and patrolling the nation’s streets and beyond.
Association of cognitive function and hypoperfusion in Moyamoya disease patients without stroke
Authors: Shen Xu-Xuan , Zhang Hou-Di , Fu He-Guan , Xu Jia-Li , Zhang Hong-Tao , Hou Lei , Zou Zheng-Xing , Li Bin , Hao Fang-Bin , Duan Lian , Han Cong
Published: November 2022

The influence of hypoperfusion on cognition in patients with Moyamoya disease (MMD) is unclear. This study investigated cognitive function changes in MMD patients without stroke and illustrated the relationship between cognitive impairment and hypoperfusion. We prospectively performed a structured battery of seven neurocognitive tests on 115 adult MMD patients without stroke and 82 healthy controls. Hemodynamic assessment was performed using dynamic susceptibility contrast-enhanced MRI. The best subset regression (BSR) strategy was used to identify risk factors. Global cognition (MoCA), speed of information processing (TMT-A), executive function (TMT-B), visuospatial function (CDT), and verbal memory (CAVLT) were significantly poorer in MMD patients without stroke than in healthy controls. The TMT-B score significantly correlated with cerebral blood flow (CBF) in the bilateral lateral frontal lobes, centrum semiovale, and temporal lobes. The TMT-A and CAVLT scores significantly correlated with CBF in the left centrum semiovale (L-CSO) and temporal lobes. According to the BSR results, age, education, white matter lesions, and hypoperfusion of the L-CSO were risk factors for cognitive impairment. Hypoperfusion leads to multiple cognitive impairments in MMD patients without stroke. The perfusion of particular areas may help evaluate the cognitive function of MMD patients and guide therapeutic strategies.
Healthy adults with Streptococcus pneumoniae meningitis and Streptococcus pneumoniae subdural abscess: two case reports and a literature review
Authors: Kong Fanxin , Li Liling , Zhang Daxue , Lian Baorong , Liu Xudong , Ren Shuqun , Zhang Yu , Cao Liming
Published: November 2022

We present the cases of two otherwise healthy adults, one with meningitis and another with a subdural abscess, with both conditions attributable to Streptococcus pneumoniae. A 31-year-old man was admitted with a 3-day history of fever, headache, and vomiting. Physical examination revealed intermittent confusion, irritability, and neck stiffness. Cerebrospinal fluid (CSF) culture was positive for S. pneumoniae. Contrast-enhanced magnetic resonance imaging (C-MRI) revealed multiple small lesions on the bilateral frontal lobes. Intravenous ceftriaxone and vancomycin were administered, followed by intravenous moxifloxacin. His symptoms resolved within 3 months. Additionally, a 66-year-old man was admitted for acute fever with confusion, abnormal behavior, and a recent history of acute respiratory infection. Physical examination revealed confusion, neck stiffness, and a positive right Babinski sign. CSF metagenomic analysis detected S. pneumoniae. C-MRI disclosed left occipitotemporal meningoencephalitis with subdural abscesses. Intravenous ceftriaxone was administered for 3 weeks. His condition gradually improved, with resorbed lesions detected on repeat MRI. This study expanded the clinical and imaging spectra of S. pneumoniae meningitis. In healthy adults, S. pneumoniae can invade the brain, but subdural abscess is a rare neuroimaging manifestation. Early diagnosis of S. pneumoniae meningitis by high-throughput sequencing and flexible treatment strategies are necessary for satisfactory outcomes.
Biopolitics and speculative objects in Chilean health projects
Authors: Castillo-Sepúlveda Jorge , Tirado Francisco , Gálvez Ana
Published: November 2022

‘Biopolitics’ is a much-used concept in recent academic literature. One of its main fields of application is in the analysis of public health projects. This article analyses the national Explicit Health Guarantees project in Chile from that perspective. However, we criticize the standard invocation of ‘biopolitics’ by observing that such public health projects require technoscientific operations that establish truths and regimes of obligation for the groups involved -understanding regime both as a set of imposed orders and a set of regulated processes. Specifically, the Explicit Health Guarantees project defines what we call ‘speculative objects’. These have two characteristics: (a) They relate highly diverse entities into integrated wholes that are and involve objects of knowledge and uncertainty, and (b) this integration creates regimes of obligation considered as scientific truths on many different groups. We conclude by proposing new questions about the notion of biopolitics and its relationship with uncertainty and speculation.
Preparation of hexene-functionalized graphitic nanoplatelets for effective interaction with Nylon 6
Authors: Lee Se Jung , Yoon Seo Jeong , Baek Jong-Beom , Jeon In-Yup
Published: November 2022

Hexene-functionalized graphitic nanoplatelets (He- f-GN) were easily prepared using a mechanochemical reaction between solid graphite and liquid 1-hexene. The He- f-GN exhibited outstanding properties (e.g., high specific surface area, high crystallinity and so on) and could be well distributed in various solvents including formic acid. The He- f-GN/Nylon 6_X nanocomposites were simply prepared using the solution method, and showed excellent mechanical properties and thermal stability compared with the neat Nylon 6. Specifically, the tensile strength and Young’s modulus of the He- f-GN/Nylon 6_1 nanocomposites increased by approximately 32.5% and 33.7%, respectively, compared to the neat Nylon 6 due to the special properties of the He- f-GN and its excellent compatibility with Nylon 6 chains. The He- f-GN also acts as nucleation sites, increasing the crystallinity of Nylon 6, and generated hydrogen bonds with the amide groups of the Nylon 6. The new filler, He- f-GN, provides an effective way to increase the performance of polymer, demonstrating good application prospects.
Oxidative damage induced by combined exposure of titanium dioxide nanoparticles and cypermethrin in rats for 90 days
Authors: Zhong Mingqing , Zhang Ruoyu , He Xianzhi , Fu Yu , Cao Yuqing , Li Yuanyuan , Zhai Qingfeng
Published: November 2022

Titanium dioxide nanoparticles (TiO2NPs) and cypermethrin (CPM) are widely used in various fields, and they can enter the environment in different ways. Combined exposure of TiO2NPs and CPM may increase the accumulation of pollutants in organisms and affect human health. This study was undertaken to evaluate the oxidative and inflammatory parameters associated with the combined exposure of TiO2NPs and CPM in rats. Twenty-four healthy male adult SD rats were randomly divided into four groups. The first group served as the control, while groups 2, 3, and 4 were treated with TiO2NPs (450 mg/m3); CPM (6.67 mg/m3) or combined exposure of TiO2NPs and CPM by inhalation for 90 days. We investigated the oxidative damage induced through combined exposure of TiO2NPs and CPM in rats by evaluating hematology of the rats and determining the blood biochemical index. Our results demonstrated that inhalation of TiO2NPs and CPM increased the levels of oxidative stress markers such as malondialdehyde and alkaline phosphatase in the serum of rats. These were accompanied by a decreased glutathione peroxidase and total superoxide dismutase levels. Furthermore, the level of glutathione peroxidase was further decreased while malondialdehyde was increased in the combined exposure of TiO2NPs and CPM. Interestingly, pathological sections showed that different degrees of tissue injury could be seen in the liver and lung tissues of each exposure group. In summary, the combined exposure of TiO2NPs and CPM can cause increased oxidative damage in rats and damage the tissue structure of the liver and lung.
Beyond entrepreneurship, raising broad academic professionals: Work-based learning in science from the employer’s perspective
Authors: Grooters Saskia , Zaal Emma , Gerkema Menno
Published: November 2022

The need for employees in the exact and natural sciences sector with both work experience and academic qualifications, especially combined with an entrepreneurial mindset, is rising. The University of Groningen offers an alternative Master’s program entitled Science, Business and Policy (SBP). SBP combines entrepreneurship education with the integration of a disciplinary science domain and thereby prepares students in science advising. This includes a work placement of 6 months, provided by companies, policy organisations and NGOs. To examine the impact of work placements from the perspective of the employer, this article analyses 20 semi-structured interviews with providers of placements. The results show that employers judge students who have undertaken a work placement as attractive future employees, and the quality of science advice given by students is seen as high. From a work floor perspective, work placements are a strong component in the optimal education of future employees. Integrating academic theory and experience in practice contributes to the employability of science students. The impact of work placements goes further than employability, since employers also indicate a direct effect on work dynamics and see the direct impact of advice reports in their organisation. The work-based learning approach chosen to achieve this specific entrepreneurship education fits the need of industry and other non-academic employers.
The evaluation of an inorganic-organic poly(carborane-siloxane-arylacetylene) hybrid resin system
Authors: Monzel William Jacob , Berglund Kyle , Kolel-Veetil Manoj , Simone Davide , Gibson Thao
Published: November 2022

The realization of aerospace vehicle technologies demanding extreme service conditions is facilitated by the development of materials with greater oxidative stability at high temperatures. Thermal performance of polymer composites can be increased by incorporating a hybrid (organic-inorganic) resin as a thermal barrier coating. One such resin system, meta-poly (carborane-siloxane-arylacetylene) ( m-PCSAA), developed by the U.S. Naval Research Laboratory, shows potential for such application and is further investigated in this work. The resin has a low viscosity (0.1 Pa s) with large processing window (2.5 h) from 100°C to 230°C. These processing characteristics are advantageous for infusion processes or the inclusion of fillers for coating applications. Curing was accomplished in two stages, corresponding to two exothermic reactions. After the first curing stage, the resin exhibits elastomeric behavior, and after the second curing stage is rigid with a high glass transition temperature (∼330°C). The materials exhibited high char yields (89%) in air at 1000°C and may be useful in space or for attritable technology. No cracks were observed during long-term service at 288°C, but significant degradation and cracking were observed after aging at 316°C. The materials exhibited high coefficients of thermal expansion; 186.9 and 168.6 μm/(m∙°C) after first and second curing stage respectively. Similar to epoxies and polyimides, the resin acquired up to 3% moisture at 70°C and 85% relative humidity.
Enhanced energy absorption and microstructural studies on hollow glass microsphere filled closed cell aluminum matrix syntactic foam
Authors: Thiyagarajan Raja , Senthil Kumar M
Published: November 2022

The research on lightweight materials for advanced engineering applications attracted the development of metal matrix syntactic foams. The automobile sector has started using Al-based alloys in structural components such as crash-box, underride-guard, fenders, dampers, A, B, and C Pillars. The present study explores the energy absorption behavior; microstructural characterization such as SEM, EDS, and XRD analysis of hollow glass microsphere (HGM) filled aluminum matrix syntactic foam. A380 aluminum alloy reinforced with different volume fractions 10%, 20%, 30%, and 35% of hollow glass microspheres were used in the fabrication of syntactic foam using the stir casting technique. The quasi-static compression test conducted, evaluated the plateau strength, which improved from 284.14 to 341.69 MPa, and energy absorption capacity was observed in the range 139.25–187.92 MJ/m3. The plateau strength and energy absorption capacity were improved by 16.82% and 25.89% for the 35 vol.% HGM sample as compared with 10 vol.% HGM filled aluminum matrix syntactic foam. The addition of a calcium thickening agent in the casting process improved the bonding between aluminum and HGM particle and also the homogeneous distribution of HGM. The XRD analysis revealed the chemical reaction that occurred between aluminum and SiO2 that produced the AlSiO2 and Al2SiO5 interfacial compounds. This reaction tends to collapse the HGM cell wall and fills it with matrix material.
Investigation of the underwater clinching process for joining metal sheets
Authors: Zhang Xingang , Chen Chao
Published: November 2022

The underwater building of marine or offshore structures requires the application of underwater joining techniques. Compared to underwater welding and underwater adhesive bonding, clinching is energy efficient, clean, and simple to the tool. In particular, clinching is not susceptible to the effects of water as well as water depth. In the present study, the joinability of metal sheets by the underwater clinching process was investigated by experimental methods. Clinching tools with extensible die were used to join Al5052 sheets at different force levels. Material flow, shear strength, tensile strength, failure modes, and energy absorption were analyzed. The results showed that the application of clinching with an extensible die could be extended to underwater joining. In the study, three failure modes of the joints were obtained, including button separation, hybrid failure, and neck fracture. Increasing the forming force was effective in improving the strength of underwater clinched joints. 40 kN was considered to be the optimum forming force for joining double layers of Al5052 sheets using underwater clinching process.
Comparison of anterior and posterior wheeled walkers based on body weight support in improving gait function a subjects with spinal cord injury: A case study
Authors: Najafabadi Akbar Hojjati , Bani Monireh Ahmadi , Pourmoghadam Vahid
Published: November 2022

The majority of people with muscle weakness or paralysis lose their ability to walk and require various assistive devices like a walker to walk. Although various studies have examined the effect of different types of anterior and posterior walkers on different walking variables, so far no studies compare anterior versus posterior walker on forces and torques applied to the lower extremities. This paper presents a novel approach of using a passive saddle-assistive device (S-AD) to investigate the effect of this device on the torques of the joints. To measure the effectiveness of the device, a volunteer with spinal cord injury (SCI) participated to walk in four modes; including the use of a standard walker, anterior, and posterior mobility S-AD with and without body weight support, in the gait laboratory. The forces and torques applied to the lower and upper limbs were measured and examined. The result demonstrated a reduction in the vertical force on the lower limb in the anterior S-AD in supporting the patient’s weight compared to the standard walker up to 42.8% and to the posterior S-AD with weight support up to 12%. According to the results, the anterior S-AD has a greater effect compared to posterior S-AD and standard walkers on lower and upper limb torque and forces during walking of a SCI patient while using knee ankle-foot orthoses.
Classification of SSVEP-EEG signals using CNN and Red Fox Optimization for BCI applications
Authors: Bhuvaneshwari M , Grace Mary Kanaga E , George S Thomas
Published: November 2022

Classification of electroencephalography (EEG) signals associated with Steady-state visually evoked potential (SSVEP) is prominent because of its potential in restoring the communication and controlling capability of paralytic people. However, SSVEP signals classification is a challenging task for researchers because of its low signal-to-noise ratio, non-stationary and high dimensional properties. A proficient technique has to be evolved to classify the SSVEP-based EEG data. In recent times, convolutional neural network (CNN) has reached a quantum leap in EEG signal classification. Therefore, the proposed system employs CNN to classify the SSVEP-based EEG signals. Though CNN has proved its proficiency in handling EEG signal classification problems, the calibration of hyperparameters is required to enhance the performance of the model. The calibration of a hyperparameter is a time-consuming task, hence proposed an automated hyperparameter optimization technique using the Red Fox Optimization Algorithm (RFO). The effectiveness of the algorithm is evaluated by comparing it with the performance of Harris Hawk Optimization (HHO), Flower Pollination Algorithm (FPA), Grey Wolf Optimization Algorithm (GWO) and Whale Optimization Algorithm (WOA) based hyperparameter optimized CNN applied to the SSVEP based EEG signals multiclass dataset. The experimental results infer that the proposed algorithm can achieve a testing accuracy of 88.91% which is higher than other comparative algorithms like HHO, FPA, GWO and WOA. The above-mentioned values clearly show that the proposed algorithm achieved competitive performance when compared to the other reported algorithm.
Patterns of Unmet Needs With Assistance for Self-Care Activities at the End of Life by Place of Death Among Older Adults
Authors: Erçin Swearinger Hazal , Lapham Jessica
Published: November 2022

Older Americans experience adverse consequences linked to inadequate assistance with self-care activities. These unmet care needs increase risk of hospitalization, institutionalization, and morbidity. While a growing body of research has focused on disparities in unmet care needs and place of death outcomes among older adults separately, less is known about the intersection between the two: place of death and unmet care needs at the end of life. Therefore, this study utilized data from the National Health & Aging Trends Study (NHATS) to examine patterns of place of death and unmet care needs outcomes among older adults to identify disparities in care and inform policies and programs. We conducted weighted bivariate analyses and multivariate logistic regression models using appropriate survey weights. Findings suggest more than half of older adults experienced an unmet need at the end of their lives and increasing rates of unmet needs are experienced by older adults who died in hospitals. Older adults receiving hospice care were also found to have less unmet needs at the end of their lives. Given the well-documented consequences of unmet needs with self-care activities, ongoing research is needed to better inform policies and programs that provide assistance and support to older adults with their self-care activities during their end of lives.
How Safe Do Dying People Feel at Home? Patients’ Perception of Safety While Receiving Specialist Community Palliative Care
Authors: Pedrosa Carrasco Anna J , Bezmenov Alexandra , Sibelius Ulf , Berthold Daniel
Published: November 2022

Background

There is a research gap regarding safety concerns of patients at the end of life. The aim of this study was, therefore, to explore whether patients under specialist community palliative care feel safe at home and which factors affect the perceived safety. Furthermore, we investigated if perception of safety is associated with different aspects of subsequent care.

Methods

Using a standardized questionnaire, a cross-sectional survey was conducted among 100 specialist community palliative care patients. Logistic regression was used to examine the strength of the association between clinical and socio-demographic variables and the perception of safety. After a 6-month follow-up period, we analyzed differences in various care-related outcomes between patients with unaffected and impaired perceptions of safety.

Results

In our study, one in five patients receiving specialist community palliative care expressed safety concerns. Subdomains of safety that were reported most frequently were physical disability (60%), physical symptoms (30%), psychological symptoms (26%), and side effects/complications of drug therapy (19%). Of the participants surveyed after the initial COVID-19 lockdown, 35.1% reported that they felt their safety had been adversely affected by the pandemic. Compromised safety perception was associated with higher levels of palliative care-related problems, and proximity to death.

Conclusions

Our study uncovered relevant safety concerns of palliative care patients receiving specialist community palliative care. The insights gained into patient-reported problems may help healthcare professionals to identify situations where patients feel unsafe. Further research should address primary and secondary prevention measures to improve the quality of end-of-life care in the home environment.
Enjoyment of Physical Activity among Children and Adolescents: A Concept Analysis
Authors: Bajamal Eman , Abou Hashish Ebtsam Aly , Robbins Lorraine B.
Published: November 2022

Although enjoyment has been linked to participation in physical activity (PA), a thorough analysis of the concept is lacking. Health-related behavior research emphasizes the necessity of focusing on individual psychological requirements, such as enjoyment in PA, to boost children and adolescents’ motivation for PA. The current paper is a report on a conceptual analysis of the enjoyment of PA among children and adolescents. We adopted the concept analysis procedure by Walker and Avant. Several databases (PubMed, CINAHL, ERIC, PsychInfo, and Sport Discus) were searched and used to extract relevant articles about the enjoyment of PA. The review process yielded a final set of 72 papers. A refined definition of enjoyment in PA, attributes, cases, antecedents, and consequences of enjoyment in PA were presented. A conceptual understanding of enjoyment in PA can enable nurses to plan interventions that help children and adolescents get appropriate PA and improve their health habits.
Anti-Tumor Efficacy of Anti-PD-1/PD-L1 Antibodies in Combination With Other Anticancer Drugs in Solid Tumors: A Systematic Review and Meta-Analysis
Authors: Inoue Takashi , Narukawa Mamoru
Published: November 2022

Background

The clinical efficacy of immune checkpoint inhibitors (CPIs) has been proven; however, it is also known that their efficacy as monotherapy is limited, with a response rate of 20% or less in solid tumors. The combination of CPIs and anticancer agents has been actively attempted in solid tumors area. In this systematic review and meta-analysis, we aimed to find favorable combination therapies of programmed death 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors in terms of anti-tumor efficacy in clinical settings.

Methods

An electronic database search was performed using ClinicalTrials.gov , PubMed, and ASCO/ESMO annual meeting libraries. We included randomized or non-randomized trials designed to evaluate the efficacy and safety of combination therapies of PD-1/PD-L1 inhibitors and other anticancer drug-containing therapies. All clinical studies selected were solid tumors with objective response rate (ORR) data. The quality of the evidence was assessed with the Cochrane risk of bias tool or the Newcastle-Ottawa Scale. Meta-analysis used random effects models to pool results.

Results

Sixteen studies involving 3793 patients were included in the primary analysis. These studies have a monotherapy group with PD-1/PD-L1 inhibitors as the control group or the in-study arm/cohort (1863 patients in the combination group with PD-1/PD-L1 inhibitors and 1930 patients in PD-1/PD-L1 inhibitor monotherapy). The pooled results showed that the combination of PD-1/PD-L1 inhibitors and other anticancer drugs significantly improved the ORR (relative risk [RR] = 1.79, 95% confidence interval [CI] 1.46, 2.20). In the subgroup analysis, PD-1/PD-L1 inhibitor plus DNA-synthesis or microtubule inhibitor led to a statistically significant improvement in the ORR compared to PD-1/PD-L1 inhibitor alone.

Conclusions

It was suggested that combinations of PD-1/PD-L1 inhibitors and potential immunogenic cell death (ICD) inducers improve the clinical anti-tumor efficacy, although updated meta-analyses based on the results of ongoing clinical trials are further needed.
Vibroacoustic response of a high-speed train extruded profile under fluid-induced vibration
Authors: Li Ye , Zhang Yumei , Tang Zhao , Pan Aipeng
Published: November 2022

The wall pressure fluctuation caused by a turbulent boundary layer is an important source of noise and vibration in high-speed trains. Considering that railway vehicles are usually made of extruded profiles, a simple and reliable model is needed to predict the vibroacoustic characteristics of extruded profiles excited by a TBL in the early stages of design. A hybrid finite element and statistical energy analysis model is established for computing the vibroacoustic response of finite-sized panels excited by a TBL. In the hybrid model, the wall pressure fluctuation of the TBL is modelled in the wavenumber domain. The panels are modelled using FEs, and acoustic waves in the fluid space below the panels are modelled using SEA. The TBL wall pressure acting on the top surface of the panels is resolved into equivalent nodal forces with discretization of the structure using FEs, achieved by calculating the cross-spectrum matrix of the wall pressure in the spectral domain and using jinc functions with smooth boundary and symmetric properties as shape functions. The reciprocity between direct and reverberant fields couples the acoustic fields to the structure. Once the response of the hybrid model is determined, sound transmission through the panels can be calculated. By following the procedures outlined in this paper, the range of wall pressure model selection for TBL has extended and reduced computational time and provides a basis for the acoustic optimization design of extruded profiles.
Responsibility or Responsibilization in Medical Evidencing of Domestic Violence? The Belgian Case Analyzed Through a Care Ethical Lens
Authors: Vergaert Eva
Published: November 2022

The prosecution of domestic violence remains a complex process within criminal policy in Belgium. Evidence is often reliant on medical certificates or injury reports, necessary for victims who want to file official complaints. However, medical evidencing is a contentious issue. Based on qualitative research among public prosecutors, victims, and general practitioners in Belgium, this study analyses the challenges these groups face through an ethics of care lens. Despite their crucial importance in legal procedures, the use of certificates is surrounded by contradictions. The issues point to an unequal distribution of responsibilities, which masks institutional and political responsibilities and enhances the responsibilization of victims.
Letermovir and tacrolimus interaction effects in hematopoietic cell transplantation recipients receiving moderate cytochrome P450 3A4 inhibitors for antifungal prophylaxis
Authors: Malespini Jack , Lei Matthew , Tavares Erica , Hammond Sarah P , Chen Yi-Bin , Luk Samantha O , DeFilipp Zachariah
Published: November 2022

Introduction

Letermovir inhibits cytomegalovirus replication and is approved for the prevention of cytomegalovirus infection in cytomegalovirus seropositive hematopoietic cell transplantation recipients. Studies have found that letermovir coadministration has minimal effect on tacrolimus levels prior to the start of voriconazole, a strong cytochrome P450 (CYP) 3A4 inhibitor. However, data are lacking for hematopoietic cell transplantation recipients receiving letermovir and tacrolimus with moderate CYP 3A4 inhibitors as antifungal prophylaxis.

Methods

In this retrospective single-center analysis, we reviewed the charts of 92 consecutive adult allogeneic hematopoietic cell transplantation recipients receiving letermovir, tacrolimus, and moderate CYP3A4 inhibitors for antifungal prophylaxis.

Results

Tacrolimus concentration/dose (C/D) ratios were evaluated for the first 7 days pre-letermovir and for the first and second 7-day periods after letermovir. The tacrolimus mean C/D ratios [(ng/mL)/(mg/kg/day)] increased significantly with the addition of letermovir: 172.99 (95% confidence interval (CI): 158.2–187.78) pre-letermovir, 268.66 (95% CI: 244.34–292.98) first-week letermovir, and 312.19 (95% CI: 279.39–344.99) second-week letermovir ( P < 0.001). The average dosages (mg/kg) of tacrolimus also decreased significantly across the three-time intervals ( P < 0.001). Only four patients experienced clinically significant cytomegalovirus reactivation which required systemic treatment.

Conclusion

These results demonstrate a reduction in tacrolimus dosing requirements for patients receiving tacrolimus and letermovir with concomitant moderate CYP3A4 inhibitors. The results of this interaction suggest that frequent monitoring of tacrolimus trough levels is warranted when starting letermovir and that empiric reduction of tacrolimus dosing upon letermovir initiation should be considered.
Firm- and Country-Specific Advantages: Towards a Better Understanding of MNEs’ Environmental Performance in the International Arena
Authors: Ahmadova Gozal , Bueno García Manuel , Delgado-Márquez Blanca , Pedauga Luis
Published: November 2022

International diversification is predominantly assumed to have a mixed (either positive or negative) linear relationship with environmental performance in multinational enterprises (MNEs). Departing from this assumption, we use firm-specific advantages (FSA) and institutional theory to hypothesise that international diversification, due to recombination barriers, has a curvilinear U-shaped relationship with MNEs’ environmental performance. Because of their key roles as boosters of country-specific advantages (CSA), we also examine whether home country competitiveness and environmental levels moderate the proposed curvilinear relationship. Results from panel data of 298 MNEs between 2006 and 2017 from 21 different countries in 11 sectors provide support for the main curvilinear relationship and the moderating influence of home country competitiveness. Our study contributes to the international business literature by casting doubt on the widely held assumption that international diversification always carries either positive or negative effects on environmental records.
Combined Use of ECMO, Prone Positioning, and APRV in the Management of Severe COVID-19 Patients
Authors: Ong Stephanie L , Tantawy Hossam , Assi Roland , Chichra Astha , Treggiari Miriam M
Published: November 2022

Background

Severe COVID-19-associated Acute Respiratory Distress Syndrome (ARDS) may warrant extracorporeal membrane oxygenation (ECMO). We evaluated the safety and physiologic changes in oxygenation and hemodynamic profile during ECMO, prone positioning, and the two modalities combined in patients receiving veno-venous (VV) ECMO.

Methods

Cohort study of consecutive adult patients with COVID-19-associated ARDS requiring VV-ECMO, classified into three groups: ECMO support only; Prone positioning only; and Prone positioning during ECMO. We collected hemodynamic, respiratory and ventilation variables as follows: pre-treatment, 1, 6, and 24 h post-treatment, and documented treatment-related complications. On-treatment variables were compared with pre-treatment using one-sample paired t-test with Bonferroni correction.

Results

Fourteen patients (mean age 48.1 [SD 9.3] years, male [100%]) received VV-ECMO. Of those, 10 patients had data during prone positioning alone and seven had data while proned on ECMO. While on ECMO, patients had improvement in oxygen saturation, PaO2/FiO2 ratio, and minute ventilation up to 24 h post-treatment. Vasopressor requirements increased with ECMO at 1 h and 24 h post-treatment. Prone positioning was not associated with clinically significant hemodynamic or respiratory changes, either alone or during ECMO support. All patients sustained deep tissue injuries, but only those on the face or chest were related to prone positioning. Three patients required cannula replacement. In-hospital mortality was 43%.

Conclusions

VV-ECMO and prone positioning in patients with COVID-19 ARDS was overall well-tolerated; however, physiologic improvements were marginal, and patients sustained deep tissue injuries. Although this was a selected population with high mortality, our data call into question the benefits of these management modalities in this severe COVID-19 population.
Security and digital nationalism: speaking the brand of Australia on social media
Authors: Li Xiufang (Leah) , Feng Juan
Published: November 2022

This article investigates the ways a nation brand is constructed by elite and non-elite actors on social media using the case of Australia in China through the lens of security. The mixed-method analysis unveils the collaborative process in the security realm driven by digital technologies does not enable vernacular discussions to produce an alternative understanding of the national brand of the Other crafted by the pro-state actors. The narratives centering around societal security to citizens strategically served to prompt the population's interactions and nationalistic support for the state's agendas. Uncovering the contribution of digital nationalism to the mean-making of securitization in the participatory media space, this article advances the engagement between security and nation branding from a critical vantage point. It enriches the strategies of harnessing the dynamics between people, digital media, and identity politics to create a unified response from the community to a security threat.
Pandemic, power and paradox: Improvising as the New Normal during the COVID-19 crisis
Authors: Simpson Ace Volkmann , Panayiotou Alexia , Berti Marco , e Cunha Miguel Pina , Kanji Shireen , Clegg Stewart
Published: November 2022

The global COVID-19 pandemic made salient various paradoxical tensions, such as the trade-offs between individual freedom and collective safety, between short term and long-term consequences of adaptation to the new conditions, the power implications of sameness (COVID-19 was non-discriminatory in that all were affected in one way or another) and difference (yet not all were affected equally due to social differences), whereas most businesses became poorer under lockdown, others flourished; while significant numbers of workers were confined to home, some could not return home; some thrived while working from home as others were challenged by the erosion of barriers between their private and working lives. Rapid improvisational responding and learning at all levels of society presented itself as a naturally occurring research opportunity for improvisation scholars. This improvisation saw the arrival of a ‘New Normal’, eventually defined as ‘learning to live with COVID-19’. The five articles in this special issue capture critical aspects of improvisation, paradoxes and power made salient by the COVID-19 pandemic in contexts ranging from higher-education, to leadership, to medical care and virtue ethics. In their own ways, each breaks new ground by contributing novel insights into improvisation scholarship.