bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic Risk and Complex Networks in Modern Financial Systems
Authors: Pacelli Vincenzo
Published: October 2024

The crises of the last years have underlined how much the modern financial systems are today more exposed and vulnerable to systemic risk, defined as the risk of uncontrolled propagation of a crisis of a single player or area of an economic system to a wider system through contagion mechanisms. Systemic risk is more relevant today than in the past due to the increasing interconnection between the players in the economic system and the increasing speed of flows of goods, money and people. All this prompts us to reflect on the need to analyse, predict and manage systemic risk holistically and through the logical-conceptual schemes that can be borrowed from network science.
A Fiber Bundle Model of Systemic Risk in Financial Networks
Authors: Biswas Soumyajyoti , Chakrabarti Bikas K.
Published: October 2024

Failure statistics of banks in the US show that their sizes are highly unequal (ranging from a few tens of thousands to over a billion dollars) and also, they come in “waves” of intermittent activities. This motivates a self-organized critical picture for the interconnected banking network. For such dynamics, recent developments in studying the inequality of the events, measured through the well-known Gini index and the more recently introduced Kolkata index, have been proved to be fruitful in anticipating large catastrophic events. In this chapter we review such developments for catastrophic failures using a simple model called the fiber bundle model. We then analyse the failure data of banks in terms of the inequality indices and study a simple variant of the fiber bundle model to analyse the same. It appears, both from the data and the model, that coincidence of these two indices signal a systemic risk in the network.
Systemic Risk and the Insurance Sector: A Network Perspective
Authors: Labini Stefania Sylos , D’Apolito Elisabetta , Nyenno Iryna
Published: October 2024

Unlike the banking sector, whose impact on systemic risk has been amply proven, it remains unclear whether the insurance business constitutes a source of systemic risk. The aim of this chapter is to contribute to the debate and attempt to answer this question by examining the role of insurance companies in the financial system, the existing interconnections between insurance operators, and the vulnerability factors, i.e. the elements that increase the exposure of institutions to systemic risks. In recent years, attention to systemic risk has been focused on the insurance sector and the financial activity of insurance companies, which depends heavily on the performance of the financial markets as well as the phenomenon of bancassurance in the search for new investment methods, which inevitably increases the transmission channels of systemic risk. From this perspective, the insurance sector is significant in the network of financial relations and in the global economic system where a crisis can certainly cause systemic effects and repercussions due to the highly interconnected financial activities in place. The International Association of Insurance Supervisors (IAIS) in the Global Insurance Market Report (GIMAR) of 2022 highlights how systemic risk in the global insurance sector is still moderate overall, albeit with an upward trend in insurers’ scores due to increased illiquid exposures and assets, over-the-counter derivatives, short-term loans and intra-financial assets. The role of regulators and supervisory authorities is crucial in this context. Therefore, the chapter analyses both the main and most recent European regulatory and supervisory interventions in the field of systemic risk management in insurance and the possible macro- and micro-systemic supervisory tools envisaged for the insurance sector. Based on the data available on the Acharya Volatility Lab (V-Lab) website and the Bureau van Dijk Orbis database, the insurance sector is explored in terms of systemic risk management and in relation to the global economic and financial system.
Damping Systemic Risk. The Role of Cooperative Banks
Authors: Pacelli Vincenzo , Pampurini Francesca , Quaranta Anna Grazia
Published: October 2024

This chapter focuses on the countercyclical potentialities linked to the bank’s relational business model. We prove that cooperative banks are less involved in the mechanisms underlying systemic risk, thus verifying that their presence somehow contributes to mitigating this risk's spread in a financial system. Referring to a group of Italian banks, an innovative methodological approach is proposed, with relative empirical implementation, based on some variables—available for all banks—considered in the literature as proxies of the systemic risk propagation speed and capacity and the banks’ health managerial status.
The Dynamics of Crypto Markets and the Fear of Risk Contagion
Authors: Aliano Mauro , Ferrara Massimiliano , Ragni Stefania
Published: October 2024

Decentralized finance has gained significance in recent years, as have concerns about the financial system’s stability. Exchange mechanisms, such as those utilized on cryptocurrency platforms, enhance volatility, and transmit risk contagion to other financial actors globally, which may increase financial calamity. We propose a Susceptible-Infected-Recovered model with a time delay to examine the mechanism of risk contagion in the cryptocurrency markets during the last decade. The governance token prices of the main cryptocurrency exchange platforms, as well as their spillover effects, crash risks and indicators of people’s attention, are assessed, and the obtained parameters are used in the Susceptible-Infected-Recovered model to replicate the dynamics of risk contagion in the examined crypto markets. Findings suggest high interconnection among crypto markets in short-run and the fear spread among people play an important contribution to financial risks. Under the new decentralized finance paradigm, predictive modeling of the temporal distribution of risk among cryptocurrencies may provide useful insights for policy and financial system stability, as well as for contagion risk.
Financial Challenges and Threats of Circular Economy Logistics
Authors: Capozza Claudia , Mokiy Anatoliy , Zvarych Iryna , Ilyash Olha , Vankevych Ivan
Published: October 2024

This chapter explores the economic aspects related to circular economy logistics and highlights the key financial challenges and threats that organizations may face when transitioning to a circular economy business model. We developed a methodological approach for researching financial challenges and threats, which consisted of 4 steps. In the 1st stage of the research, we identified the leader in the trade of processed raw materials—Germany and characterized the factors why this country is the leader. In the next stage, the authors reasonably identified possible financial threats that prevent the effective development of circular economy logistics. In the third stage, the relationship between the rate of reuse of materials and the exchange rate, interest rates, and inflation rates was investigated using the multiple regression method. Then, based on the results obtained in the first stage, we investigated which companies carry out their activities in the field of circular economy logistics. The hypothesis of the chapter is that the transition to circular economy logistics presents several financial problems and threats that must be carefully considered and resolved. By recognizing these challenges and adopting appropriate strategies, organizations can navigate financial challenges and unlock the economic benefits associated with the circular economy, promoting sustainability and resource efficiency.
Systemic Risks to Capital Investment Flows in the Post-crisis Economy of Ukraine
Authors: Rubino Alessandro , Mokiy Anatoliy , Fleychuk Mariya , Khaustova Viktoriia , Salashenko Tetiana
Published: October 2024

The study investigates systemic risks affecting capital investment flows in Ukraine’s post-crisis economy, employing VAR models and the Kalman filter. It analyzes the relationship between investment flows and key macroeconomic indicators. Utilizing neural network tools, the research identifies pivotal factors influencing investment processes amidst wartime. The study delineates primary strategies for risk mitigation, including the adoption of modern warfare economics principles, combating systemic dysfunctions such as corruption, and legitimizing property rights through targeted investments. Furthermore, in the financial sector, there is a notable emphasis on the imperative: to enhance commercialization in banking, align regulations with EU standards, develop money, bond, and securities markets, facilitate small business financing and financial inclusivity, and mobilize external financing to sustain financial stability.
A Holistic Journey into Systemic Risk: Theoretical Background, Transmission Channels and Policy Implications
Authors: Pacelli Vincenzo , Cananà Lucianna , Chakraborti Anirban , Di Tommaso Caterina , Foglia Matteo
Published: October 2024

Systemic risk represents a critical challenge in modern financial systems characterized by complex interconnections. This chapter comprehensively analyses systemic risk, exploring its measurement, models, determinants, interconnections, and the key variables influencing its dynamics. One of the central focuses of this chapter is to explore the transmission channels through which systemic risk propagates. By analyzing various channels, including contagion risk, credit risk, liquidity risk, market risk, operational risk, and macroeconomic risk, the chapter unveils the mechanisms through which disruptions can spread across financial institutions, markets, and economies. The interconnected nature of these channels is also emphasized to showcase the amplification of systemic risk. The interconnections between financial institutions and markets are crucial factors of systemic risk. We discuss the significance of network analysis and emphasize the importance of considering both visible and hidden (shadow) interconnections when assessing systemic risk. By identifying the vulnerabilities and interdependencies within the financial system, policymakers could then develop targeted measures to mitigate systemic risks. The chapter highlights the need for proactive monitoring, enhanced risk management practices, and coordinated regulatory efforts across jurisdictions. These policy implications could then strengthen the financial system’s resilience and reduce the likelihood of systemic crises.
Systemic Risks and Multilayer Financial Networks: From Contagion to Mitigation
Authors: Quirici Maria Cristina , Moro-Visconti Roberto
Published: October 2024

The global financial system’s interconnectedness has increased due to globalization, technological advancements and the integration of financial markets. Financial institutions and markets across different countries are more closely linked than ever before; while this interconnectedness facilitates global trade and investment, it also means that financial turmoil can quickly spread from one country to another. Systemic risk is the possibility that an event at the company level could trigger severe instability or collapse an entire industry or economy. The fall of Lehman Brothers in 2008 showed that the failure of a single entity could have far-reaching effects on the global financial system. This chapter innovatively interprets the financial system as a complex network formed by the relationships among various “nodes”: banks, financial institutions, markets, and consumers. These networks are intricate and opaque, making it challenging to understand and predict how risks and failures in one part of the system can affect the rest with a domino impact. In managing systemic risk, regulators and policymakers play a vital role, implementing stricter regulatory frameworks, overseeing financial institutions more closely, and developing mechanisms to identify and mitigate risks early. This chapter shows that effective strategies to mitigate systemic risk involve better risk assessment models, more robust regulatory frameworks, and international cooperation among regulatory bodies. Stress testing, capital adequacy requirements, and monitoring of “too big to fail” institutions, as well as of “too interconnected to fail” ones, are part of these strategies, that may usefully consider network theory to link economic agents to their edging patterns.
The Impact of Inflation and Financial Stability on the European Financial System: A Network Approach
Authors: Sánchez-García Javier , Cruz-Rambaud Salvador
Published: October 2024

Inflation and financial stability are pivotal elements in the fields of economics and finance, exerting a profound influence on economic performance and the overall stability of financial systems. The intricate interplay between these factors has garnered significant attention from researchers, policymakers, and market participants due to its far-reaching implications, especially since recent inflationary shocks have put many economies around the world under pressure. This chapter builds an econometric design to estimate a network of volatility connectedness, and an Exponential Random Graph Model (ERGM) is proposed to analyse the structure, capturing both endogenous and exogenous effects on the network. The results show no significant relationship between inflation and financial stress for this set of European countries, shedding light on potential macro-financial vulnerabilities and systemic risks within the European financial system.
Time Sensitive and Oversampling Learning for Systemic Crisis Forecasting
Authors: De Nicolò Francesco , La Rocca Marianna , Marrone Antonio , Monaco Alfonso , Tangaro Sabina , Amoroso Nicola , Bellotti Roberto
Published: October 2024

The development of early warning systems for systemic crises has recently received growing interests. Recent studies have proposed possible solutions to address this challenging topic, in particular by means of cutting-edge artificial intelligence (AI) approaches. Financial data are fundamentally characterized by intrinsic temporal dynamics and the presence of both short-/long-term interactions. Hence, it is of paramount importance, when validating the proposed solutions to adopt validation strategies which consider this aspect. To this aim, we show here how Temporal Cross Validation (TCV) deeply affects the models’ learning. Moreover, to take into account the data imbalance often characterizing these models, we combine the TCV with a popular solution, which is the SMOTE (Synthetic Minority Oversampling TEchnique) algorithm.
Beyond Precarity? Towards a Fairer Future for Live Performers
Authors: Hancock Philip , Tyler Melissa
Published: October 2024

In this final chapter, we focus specifically on the type of support and practical changes that the performers we studied identified as necessary not only to maintaining a sustainable recovery from the ongoing effects of the pandemic, as well as Brexit and the recent cost of living crisis, but also to securing a more fair, equitable, and accessible future. The chapter draws on established research and secondary data, as well as the analysis of the research findings from our own study presented in earlier chapters throughout the book, to speak directly to funding and legislative bodies, professional and membership organisations, policymakers, employers, activists, trade unions, practitioners, and creative workers about how the UK’s live entertainment industries might move ‘beyond precarity’ and to examine what conditions might be necessary to enable this to happen.
Evaluating predictors of mortality in octogenarians undergoing urgent or emergent trauma laparotomy
Authors: Shin Jordan G. , Nahmias Jeffry , Silver Elliot , Painter Robert , Sedighim Shaina , Park Flora , Grigorian Areg
Published: October 2024

Purpose

This study aimed to identify associated risk factors for mortality in octogenarian trauma patients undergoing urgent or emergent laparotomy (UEL).

Methods

Trauma patients ages 80–89 years-old undergoing UEL within 6-hours of arrival were included. A multivariable logistic regression analysis was performed to determine associated risk of mortality.

Results

From 701 octogenarians undergoing UEL, 324 (46.2%) died. Compared to survivors, UEL octogenarians who died had higher rates of cirrhosis (3.5% vs. 1.1%, p = 0.028), injuries to the brain (17.3% vs. 5.6%, p < 0.001), heart (8.6% vs. 1.6%, p < 0.001), and lung (57.4% vs. 23.9%, p < 0.001) and lower rates of functional independence (6.4% vs. 12.6%, p = 0.007). The strongest independent associated patient-related risk factor for death was cirrhosis (OR 8.28, CI 2.25–30.46, p = 0.001). However, undergoing concurrent thoracotomy increased risk of death significantly (OR 16.59, CI 2.07-132.76, p = 0.008). Functional independence was not associated with mortality (p > 0.05).

Conclusion

This national analysis emphasizes the need to identify and manage pre-existing conditions like cirrhosis and not determine futility based on pre-trauma functional status alone. Concurrent thoracotomy for hemorrhage control increases risk of death over 16-fold.
Nano Spirulina platensis countered cisplatin-induced repro-toxicity by reversing the expression of altered steroid hormones and downregulation of the StAR gene
Authors: Khalil Eman M. , Rady Mohamed I. , Darwish Samah F. , Abd-Allah Entsar R.
Published: October 2024

Cisplatin is a commonly utilized chemotherapy medication for treating different sarcomas and carcinomas. Its ability interferes with cancer cells’ DNA repair pathways and postpones unfavorable outcomes in cancer patients. The current investigation’s goal was to ascertain if nano Spirulina platensis (NSP) might shield rat testicles from cisplatin damage by assessing the expression of the StAR and SOD genes, sex hormones, 17ß-hydroxysteroid dehydrogenase(17ß-HSD), sperm profile picture, oxidative condition of testes, testicular histology, and DNA damage. Four equal and random groups of 28 adult male Wistar rats were created; the control group was given saline for 8 weeks. An extraction of NSP at a concentration of 2500 mg/kg body weight was administered orally for 8 weeks to the NSP group. For the first 4 weeks, the cisplatin group was intraperitoneally injected with 2 mg/kg/body weight of cisplatin, and for the next 4 weeks, they were given a dosage of 4 mg/kg/body weight. The cisplatin + NSP group was given both NSP and cisplatin. The results of the experiment showed that intake of NSP and cisplatin improved sperm profile; re-established the balance of oxidizing agents and antioxidant state; enhanced testicular histology; promoted the histometric parameters of seminiferous tubules including epithelial height, their diameter, and Johnsen’s score, decreasing DNA breakage in testicular tissue; increased testosterone level; decreased 17ß-HSD concentration; and upregulated both the StAR and SOD gene expression in testicles compared to rats exposed to cisplatin alone. These results demonstrate that NSP is a promising agent for improving cisplatin-induced testicular injury and infertility.
Supra-pectineal quadrilateral buttress plating versus infra-pectineal plating in the management of quadrilateral plate fractures: A randomized controlled trial
Authors: Moussa Islam Sayed , Nagy Amr Mohammed
Published: October 2024

Purpose

Management of quadrilateral plate fractures is technically demanding and requires specific fixation techniques. Infra-pectineal plating is the gold standard method of fixation. However, we recorded a high incidence of medial wall displacement and reoperations. Therefore, the aim of our study was to identify whether supra-pectineal quadrilateral buttress plating provides much more rigid fixation with a better functional and radiological outcome or not.

Patients and Methods

The authors conducted this prospective, randomized control, single-blinded study at a level 1 single trauma centre. Between March 2022 and June 2023, 34 patients with quadrilateral plate fractures had anterior fixation, either via the anatomical QLP (17 cases) or infra-pectineal plating (17 cases) (Groups A and B, respectively). The radiological and clinical outcomes, as well as residual medial wall displacement, were the primary outcomes.

Results

The mean follow-up was 14.47 months in group A and 15.24 months in group B. In group A, the mean operative time (p = 0.02) was shorter, and the mean blood loss (p < 0.001) was significantly lower. However last follow-up showed no statistically significant differences as regards residual medial wall displacement (p = 1.0), final radiological (p = 0.86), and clinical outcomes (p = 1.0).

Conclusion

Authors concluded that the anatomical QLP made it easier to reduce and fix acetabular fractures with a displaced medial wall. This was done by using multidirectional screws in the posterior column through its infra-pectineal extension and a strong screw purchase aimed at the posterior column through its supra-pectineal part. The two groups were similar in terms of final radiological and clinical outcomes, as well as residual medial wall displacement rates. However, the QLP had less morbidity than the classic infra-pectineal plating (shorter operation time and less blood loss).
Enhancing clinical reasoning skills for medical students: a qualitative comparison of LLM-powered social robotic versus computer-based virtual patients within rheumatology
Authors: Borg Alexander , Jobs Benjamin , Huss Viking , Gentline Cidem , Espinosa Fabricio , Ruiz Mini , Edelbring Samuel , Georg Carina , Skantze Gabriel , Parodis Ioannis
Published: October 2024

Virtual patients (VPs) are increasingly used in medical education to train clinical reasoning (CR) skills. However, optimal VP design for enhancing interactivity and authenticity remains unclear. Novel interactive modalities, such as large language model (LLM)-enhanced social robotic VPs might increase interactivity and authenticity in CR skill practice. To evaluate medical students’ perceptions of CR training using an LLM-enhanced social robotic VP platform compared with a conventional computer-based VP platform. A qualitative study involved 23 third-year medical students from Karolinska Institutet, who completed VP cases on an LLM-enhanced social robotic platform and a computer-based semi-linear platform. In-depth interviews assessed students’ self-perceived acquirement of CR skills using the two platforms. Thematic analysis was employed to identify themes and sub-themes. Three main themes were identified: authenticity, VP application, and strengths and limitations. Students found the social robotic platform more authentic and engaging. It enabled highly interactive communication and expressed emotions, collectively offering a realistic experience. It facilitated active learning, hypothesis generation, and adaptive thinking. Limitations included lack of physical examination options and, occasionally, mechanical dialogue. The LLM-enhanced social robotic VP platform offers a more authentic and interactive learning experience compared to the conventional computer-based platform. Despite some limitations, it shows promise in training CR skills, communication, and adaptive thinking. Social robotic VPs may prove useful and safe learning environments for exposing medical students to diverse, highly interactive patient simulations.
Reference formulas for chest CT-derived lobar volumes in the lung-healthy general population
Authors: Bakker Jens T. , Dudurych Ivan , Roodenburg Sharyn A. , Vonk Judith M. , Klooster Karin , de Bruijne Marleen , van den Berge Maarten , Slebos Dirk-Jan , Vliegenthart Rozemarijn
Published: October 2024

Introduction

Lung hyperinflation, a key contributor to dyspnea in chronic obstructive pulmonary disease (COPD), can be quantified via chest computed tomography (CT). Establishing reference equations for lobar volumes and total lung volume (TLV) can aid in evaluating lobar hyperinflation, especially for targeted lung volume reduction therapies.

Methods

The Imaging in Lifelines study (ImaLife) comprises 11,729 participants aged 45 and above with analyzed inspiratory low-dose thoracic CT scans. Lung and lobar volumes were measured using an automatic AI-based segmentation algorithm (LungSeg). For the main analysis, participants were excluded if they had self-reported COPD/asthma, lung disease on CT, airflow obstruction on lung function testing, were currently smoking, aged over 80 years, or had height outside the 99% confidence interval. Reference equations for TLV and lobar volumes were determined using linear regression considering age and height, stratified by sex. For the subanalysis, participants who were currently smoking or experiencing airflow obstruction were compared to the group of the main analysis.

Results

The study included 7306 lung-healthy participants, 97.5% Caucasian, 43.6% men, with mean age of 60.3 ± 9.5 years. Lung and lobar volumes generally increased with age and height. Men consistently had higher volumes than women when adjusted for height. R2 values ranged from 7.8 to 19.9%. In smokers and those with airway obstruction, volumes were larger than in lung-healthy groups, with the largest increases measured in the upper lobes.

Conclusion

The established reference equations for CT-derived TLV and lobar volumes provide a standardized interpretation for individuals aged 45 to 80 of Northern European descent.

Key Points

QuestionLobar lung volumes can be derived from inspiratory CT scans, but healthy-lung reference values are lacking.

FindingsLung and lobar volumes generally increased with age and height. Reference equations for lung/lobar volumes were derived from a sizeable lung-healthy population.

Clinical relevanceThis study provides reference equations for inspiratory CT-derived lung and lobar volumes in a lung-healthy population, potentially useful for assessing candidates for lung volume reduction therapies, for lobe removal in lung cancer patients, and in case of restrictive pulmonary diseases.
Bladder Cancer detection by urinary methylation markers GHSR/MAL: a validation study
Authors: Beijert I. J. , van den Burgt Y. , Hentschel A. E. , Bosschieter J. , Kauer P. C. , Lissenberg-Witte B. I. , van Moorselaar R. J.A. , Nieuwenhuijzen J. A. , Steenbergen R. D.M.
Published: October 2024

Purpose

Although cystoscopy is a reliable tool for detecting bladder cancer, it poses a high burden on patients and entails high costs. This highlights the need for non-invasive and cost-effective alternatives. This study aimed to validate a previously developed urinary methylation marker panel containing GHSR and MAL.

Methods

We enrolled 134 patients who underwent cystoscopy because of hematuria, including 63 individuals with primary bladder cancer and 71 with non-malignant findings. Urine samples were self-collected at home and sent via regular mail. Subsequently, DNA was extracted and the hypermethylation of GHSR and MAL was evaluated using quantitative methylation-specific polymerase chain reaction. The performance of methylation markers was assessed using area-under-the-curve (AUC) analysis and sensitivity and specificity based on pre-established cut-off values.

Results

Validation of the marker panel GHSR/MAL resulted in an AUC of 0.87 at 79% sensitivity and 80% specificity. Sensitivity was comparable to the previous investigation (P > 0.9), though specificity was significantly lower (P = 0.026). Sensitivity was higher for high-grade tumors compared to low-grade tumors (94% vs. 60%, P = 0.002).

Conclusion

Validation of the GHSR/MAL methylation marker panel on at home collected urine samples confirms its robust performance for bladder cancer detection in a hematuria population, and underscores the diagnostic potential for future clinical application.
Proximal avulsion of the hamstring in young athlete patients: a case series and review of literature
Authors: Castelli Alberto , Parenti Matteo , Tirone Gianluca , Spera Marco , Azzola Flavio , Zanon Giacomo , Grassi Federico Alberto , Jannelli Eugenio
Published: October 2024

Hamstring injuries are a frequent occurrence of athletes, leading to a stop in practice and long-term alterations in sports performance. About 12% of these lesions involve avulsion at the level of the proximal insertion that can be complete (about 6%) or partial. Starting from an epidemiological and treatment evaluation of these lesions in literature, the aim of this study was to examine the functional outcomes and the rate of "return to play" in a population composed of athletes of various levels who have undergone surgery to reinsert the hamstring muscles at the ischial insertion, for a complete detachment of one or more tendon heads. Therefore, a retrospective study was carried out where 18 patients treated at the Orthopedics and Traumatology Unit of the I.R.C.C.S. San Matteo in Pavia (Italy) were identified in a time span ranging from March 2012 to August 2020. The sample was analysed taking into account age, sex and risk factors, as well as the pathophysiology and anatomy of the injury using the Wood classification, the time elapsed before surgery, the duration of the rehabilitation protocol and the possible return to sports activity, comparing the level of sports performance in the pre- and post-operative period using the Tegner Activity Score (TAS). Different post-operative outcome evaluation scores (Perth Hamstring Assessment Tool PHAT and Lower Extremity Functional Scale LEFS) were also compared with each other in order to find a correlation with the real level of return to sporting activity. The mean age at surgery was 26.4 11.6 years. The population is composed of 14 males (77.8%) and 4 females (22.2%). All 18 patients returned to sports following surgery (100%). Of these patients, 17 (94%) maintained a level of sports performance equal to that before the injury. 100% of patients rated the outcome of the surgery as satisfactory. This study has shown that Hamstring reinsertion surgery is a correct indication in all athletes, allowing them a satisfactory return to sports practice.
Mitigating overuse of antinuclear antibody (ANA) testing through educational intervention: a study in internal medicine and neurology departments
Authors: Pri-Paz Basson Yael , Neumark Eran , Kivity Shaye , Tayer-Shifman Oshrat E.
Published: October 2024

Introduction/objectives

Overuse of antinuclear antibody (ANA) tests leads to increased costs, false positives, and unnecessary treatments. This study evaluated ANA overuse in internal medicine and neurology departments and assessed the impact of an educational intervention.

Method

This quality improvement educational intervention study examined ANA test overuse in five internal medicine departments and one neurology department at a university-affiliated medical center. The educational intervention included a session focusing on ANA testing appropriateness. Outcome measures comprised the ANA/new patient ratio (APR) and the percentage of positive ANA test results. Outcomes were compared between the pre- and post-intervention periods (both 6 months).

Results

The intervention took place in December 2021. The APR decreased from 43% in the pre-educational intervention period to 27% in the post-intervention period in the neurology department (odds ratio [OR] 0.49, confidence interval [95% CI] 0.37–0.63, P < 0.0001) and from 2.6% to 2.2% in the internal medicine departments (OR 0.89, 95% CI 0.73–1.10, P = 0.28). The percentage of positive ANA tests increased from 43% pre-intervention to 53% in the post-intervention period (OR 1.49, 95% CI 0.90–2.46, P = 0.12) in the neurology department and from 48% to 59% (OR 1.56, 95% CI 0.99–2.44, P = 0.0543) in the internal medicine departments.

Conclusion

A simple educational intervention reduced unnecessary ANA testing in the neurology department but not in internal medicine departments, improving patient selection and potential cost savings. The results underscore the importance of targeted education to promote evidence-based behavior among healthcare professionals. Further research with longer follow-up is needed to assess the sustainability of these improvements.

Key Points• This study presents a quality improvement intervention to prevent the overuse of ANA testing in non-rheumatologist physicians.• A straightforward educational intervention effectively reduced unnecessary ANA testing and improved patient selection, following the Choosing Wisely campaign.• This educational intervention can be adapted and applied in various clinical settings to address the overuse of diagnostic tests, benefiting a wide range of healthcare professionals.
International spillovers of unconventional monetary policy: A meta-analysis
Authors: Araújo Tiago , Afonso Óscar , Neves Pedro Cunha , Sochirca Elena
Published: October 2024

The impacts of the unconventional monetary policy measures adopted by central banks after the 2007 financial crisis have been the focus of an increasing number of empirical studies. While some studies have focused on the impacts on the domestic economy, others have examined the international spillover effects of the policies adopted by the major central banks. The latter studies have, however, reported heterogeneous results. In this paper, we develop a meta-analysis of the empirical literature that examines the spillover effects of unconventional monetary policy on international capital flows. We find that, while the global average effect is not statistically different from zero, there are specific effects that vary significantly according to the development level of the destination country, the nature of the capital flow, the Central Bank that adopts the UMP, and the type and year of implementation of the UMP measure.
Impact of Elevated Atmospheric and Intercellular CO2 on Plant Defense Mechanisms
Authors: Hill Amber J. , Shlisel Meir
Published: October 2024

This review explores the complex relationship between carbon dioxide (CO2) levels and secondary metabolites in leaves, emphasizing their role in plant defense mechanisms. The synthesis of different research that has been done ranges from the influence of CO2 on photosynthesis, metabolic pathways, and the synthesis of secondary metabolites, crucial in protecting plants against environmental stressors, especially pathogens. The paper highlights the significance of various factors such as light intensity, water supply, and temperature in regulating stomatal conductance and subsequent CO2 assimilation. Additionally, it discusses the diverse secondary metabolites found in plants, including phenolic compounds, terpenoids, and tannins, and their antioxidant properties. The review suggests that elevated CO2 levels may enhance plant defense responses by influencing the production of secondary metabolites. The paper also explores the complex interplay between CO2 levels, metabolic activity, and defense mechanisms, providing valuable insights into how plants dynamically adjust their metabolism to cope with environmental challenges, highlighting the interaction of adaptation and physiology in plants, offering a holistic understanding of the biochemical and physiological processes involved in plant defense.
Vitamin D: A key player in COVID-19 immunity and lessons from the pandemic to combat immune-evasive variants
Authors: Sabit Hussein , Abdel-Ghany Shaimaa , Abdallah Mahmoud S. , Abul-Maaty Osama , Khoder Ahmed I. , Shoman Nabil A. , Farrag Mohamed Sameh , Martasek Pavel , Noreddin Ayman M. , Nazih Mahmoud
Published: October 2024

As of the 7th of July 2024, 775,754,322 confirmed cases of COVID-19, including 7,053,902 deaths worldwide, had been reported to the WHO (World Health Organization). Nevertheless, untill the 15th of July 2024, a total of 13,578,710,228 vaccine doses had been administered, with almost no country spared from COVID-19 attacks. The pathophysiology of this virus is complicated, and several symptoms require a deep understanding of the actual mechanisms. It is unclear why some patients develop severe symptoms while others do not, although literature suggests a role for vitamin D. Vitamin D plays a crucial role in the infection or in ameliorating the severity of symptoms. The mechanism of action of vitamin D and vitamin D deficiency (VDD) is well understood. VDD is associated with increased hospitalization of severely ill patients and increased levels of COVID-19-caused mortality. Recent studies suggest that vitamin D levels and genetic variations in the vitamin D receptor (VDR) gene significantly impact the severity and outcomes of COVID-19, especially in the infections caused by Delta and Omicron variants. Furthermore, VDD causes immune system dysregulation upon infection with SARS-CoV-2, indicating that vitamin D sufficiency is crucial in fighting against COVID-19 infection. The therapeutic effect of vitamin D raises interest in its potential role as a prophylactic and treatment adjunct. We evaluate the immunomodulatory effects of vitamin D and its ability to enhance the efficacy of new antiviral drugs like molnupiravir and paxlovid against SARS-CoV-2. This review discusses the role of vitamin D sufficiency and VDD in COVID-19 initiation and progression, emphasizing the molecular mechanisms by which vitamin D exerts its actions as a proactive step for the next pandemic. However, there is still no clear evidence of vitamin D’s impact on prevention and treatment, leading to contradictory findings. Therefore, large-scale randomized trials are required to reach a definitive conclusion. A bibliometric analysis of publications related to vitamin D, immunity, and COVID-19 revealed a significant increase in research activity in this area, particularly in 2020–2024, underscoring the growing recognition of vitamin D’s potential role in the context of the pandemic.
Single and combined effects of metal-based fungicides on Eisenia andrei in different scenarios of climatic change
Authors: Kaka Hussain , Opute Prosper , Maboeta Mark
Published: October 2024

This study evaluated the ecotoxicity of metal-based fungicides under the current scenarios of global climatic change (20 °C and 25 °C) and moisture content (30% and 50%) in single and binary mixtures of copper oxychloride (CuOx) [200, 500 and 1000 mg/kg] and mancozeb (MnZn) [44, 850 and 1250 mg/kg]. Endpoints assessed included mortality, changes in biomass, avoidance behaviour, and reproduction utilising standardised protocols (ISO and OECD). The changes in biomass and mortality tests lasted 28 days, followed by a 28-day reproduction test and a two-day avoidance test. In all temperature-moisture combinations, the mortality rate in the exposure groups exceeded 10% only in the CuOx1000 and CuOx1000 + MnZn1250 mg/kg groups. However, at 20 °C and 30% moisture, the mortality rate exceeded 10% only in the CuOx500 + MnZn850 mg/kg treatment. Relative growth rates in the CuOx and MnZn treatment groups decreased with increasing concentrations. In CuOx MnZn and the binary mixture treatments at 20 °C 30% and 25 °C 50% conditions, avoidance response behaviour was greater than 80% throughout the exposure, except in CuOx200 mg/kg, MnZn44 mg/kg and CuOx200 + MnZn44 mg/kg. The reproduction of exposed earthworms in all treatment groups was concentration-dependent and influenced by varying temperatures and soil moisture conditions. No juveniles or cocoons were produced in the CuOx1000 mg/kg treatment at 25 °C 30%, indicating that copper oxychloride may be more toxic than mancozeb, especially in drought conditions. This study found that different temperatures and soil moisture levels altered the ecotoxicity of CuOx and MnZn. It can be concluded that climate change is likely to significantly impact the outcomes of metals to earthworms and their ecological activities.
Let ‘Let n be such an x’ Be: A Reply to Meléndez Gutiérrez
Authors: Haze Tristan Grøtvedt
Published: October 2024

I defend Haze’s argument against the Breckenridge-Magidor theory of instantial reasoning from an objection by Meléndez Gutiérrez. According to Breckenridge and Magidor, in reasoning like ‘Some x is mortal. Let n be such an x…’, the ‘n’ refers to a particular object but we cannot know which. This surprisingly defensible view poses an obvious threat to widespread notions in the philosophy of language. Haze argues that the theory leads to absurdity in cases like ‘Some x is unreferred-to by any expression. Let n be such an x…’ and should therefore be rejected. Meléndez Gutiérrez counters that Haze’s argument is just a case of Berry-like paradox and thus fails to refute the Breckenridge-Magidor theory. I argue that the analogy breaks down: unlike the intuitively compelling and widely believed well-ordering principle about positive integers, the principle drawn from Breckenridge and Magidor that plays a supposedly analogous role enjoys no such status, and is instead simply shown to be false by Haze’s reductio. The possibility of such a response is obscured when Meléndez Gutiérrez portrays Haze’s argument as involving a stipulation that ‘n’ is to refer to an unreferred-to object. On the contrary, Haze’s argument does not assume that expressions like ‘n’ work by means of referring at all, and simply lets stipulations like ‘Let n be such an x’ be themselves, without imposing a theory on them. Once this is clarified, we can see that Haze’s argument is unaffected by Meléndez Gutiérrez’s objection.
Organisationale Gesundheitskompetenz und Qualitätsmanagement – Freund, Feind oder friedvolle Koexistenz? Ergebnisse eines Workshops mit Expert*innen für Qualitätsmanagement im Gesundheitswesen
Authors: Rathmann Katharina , Münch Inga , Fischbock Nadine , Häberle Nicola , László Emese , Soffried Jürgen , De Gani Saskia Maria , Dierks Marie-Luise , Bitzer Eva Maria
Published: October 2024

Hintergrund

Der Workshop „Organisationale Gesundheitskompetenz und Qualitätsmanagement im Gesundheitswesen – Freund, Feind oder friedvolle Koexistenz?“ diente als Forum zur Diskussion der Frage, ob und wie die Standards der organisationalen Gesundheitskompetenz (OGK) mit dem Qualitätsmanagement (QM) im Gesundheitswesen verknüpft werden können.

Methoden

Um ein vertieftes Verständnis für potenzielle Ansatzpunkte zwischen den Konzepten der OGK und dem QM zu entwickeln, wurde eine Fokusgruppendiskussion im Rahmen eines Workshops zum oben genannten Thema durchgeführt. Eingeladen waren sowohl QM-Beauftragte als auch ausgewählte OGK-Expert*innen. Insgesamtn = 30 Personen nahmen an dem Workshop teil und diskutierten in 6 Arbeitsgruppen die Schnittmengen zwischen Standards der OGK und dem QM in der Gesundheitsversorgung. Die zentralen Diskussionspunkte wurden mittels einer Inhaltsanalyse der Notizen, Audioaufnahmen und Transkripte ausgewertet.

Ergebnisse

Sowohl OGK als auch QM verfolgen das Ziel, die Patient*innenorientierung zu verbessern und durch gezieltere Information und Aufklärung die Qualität und Sicherheit der Gesundheitsversorgung zu erhöhen. Für die Praxis relevant ist die strategische Verzahnung beider Konzepte zum Wohl der Patient*innen und des Gesundheitswesens insgesamt. Die Diskussion zeigt, dass sowohl eine komplementäre Integration von OGK und QM im Gesamtsystem als auch eine fokussierte Verankerung einzelner OGK-Standards im QM vielversprechende Ansätze darstellen, die OGK im Gesundheitswesen voranzutreiben. Zugleich wird hervorgehoben, dass die Bekanntheit und das Verständnis von OGK in der Praxis noch gesteigert werden müssen. Um OGK erfolgreich zu implementieren, sind klare Rahmenbedingungen, ausreichende Ressourcen, die Unterstützung durch das Management und Forschung zu den Prozessen und Ergebnissen unerlässlich. Auch ist der systematische Einbezug der Patient*innen dabei zentral – von der Kokreation bis zur Diskussion finanzieller Aspekte.

Schlussfolgerung

Die Ergebnisse des Workshops legen eine Koexistenz und sogar eine synergetische Beziehung zwischen OGK und QM im Gesundheitswesen nahe. Die Verankerung von OGK in QM-Systemen bietet eine Chance, die Gesundheitskompetenz, die Patient*innensicherheit und auch die Versorgungsqualität wesentlich zu erhöhen.
Clinical scenarios of unusual FDG uptake in muscle
Authors: Minamimoto Ryogo , Kato Katsuhiko , Naganawa Shinji
Published: October 2024

Glucose is essential for muscle function and its uptake is influenced by aerobic conditions, hormonal regulations, and exercise. 18F-Fluorodeoxyglucose (FDG), a glucose analog used in PET/CT scans, can show incidental uptake in muscles, and thus careful interpretation is required to avoid misdiagnosis. Proper patient preparation and understanding of the clinical scenarios affecting FDG uptake are crucial for accurate PET/CT interpretation, thus ensuring precise diagnoses and avoiding unnecessary interventions. This review emphasizes the need to consider patient-specific factors in evaluating incidental FDG uptake in muscle.
Zweckänderung nach Einwilligung
Authors: Kneuper Ralf
Published: October 2024

Der Grundsatz der Zweckbindung gemäß DSGVO legt fest, dass personenbezogene Daten nur dann
für andere als die ursprünglichen Zwecke der Datenerhebung weiterverarbeitet werden dürfen,
wenn diese Zwecke nicht unvereinbar sind mit den ursprünglichen Zwecken. Dabei wird nicht ausdrücklich
nach der Rechtsgrundlage der ursprünglichen Verarbeitung unterschieden. Basiert die ursprüngliche
Verarbeitung allerdings auf der Rechtsgrundlage einer Einwilligung, dann sprechen sowohl Treu und Glauben
als auch der Sinn und Zweck der Zweckbindung dafür, dass eine Weiterverarbeitung nur auf Basis einer
neuen Einwilligung erlaubt ist. Einzige Ausnahme ist eine Weiterverarbeitung zum Schutz lebenswichtiger
Interessen.
Artificial intelligence for predicting arctic permafrost and active layer temperatures along the Alaskan North Slope
Authors: Chance Robert , Ahajjam Aymane , Putkonen Jaakko , Pasch Timothy
Published: October 2024

Climate change in Arctic regions poses a threat to permafrost stability, potentially leading to issues such as infrastructure damage, altered ecosystems, and increased greenhouse gas emissions. The challenge of monitoring permafrost temperatures and identifying critical environmental factors is accentuated by the scarcity of subsurface thermal data in remote Arctic locales. To alleviate this lack of soil thermal data we set out to combine in situ observed soil temperatures with MERRA-2 reanalysis data and Machine Learning (ML) to develop local and season-specific subsurface soil temperature predictions in Alaska. First, reanalysis features are selected based on surface energy budget physics. Coupled with Julian calendar dates, reanalysis features are preprocessed and then fed to the ML prediction model. We conducted a series of computational experiments and tested the results against performance benchmarks to determine the optimal prediction models, length of look-back period of model inputs, and the training set size. Six conventional ML models (e.g., GBDT, RF, SVR) and five statistical baselines (e.g. ARIMA) using in situ time series of soil temperature data ranging from 0 - 1 m depth are considered for the prediction task. The models are trained using in situ soil temperatures at depths between 0 and 1 m, spanning 16+ years, from field sites at Deadhorse and Toolik Lake, Alaska. All prediction performances are assessed using root mean squared error (RMSE) and mean absolute error (MAE). Results show that locally trained ML models can estimate shallow soil temperatures with an average error of $$RMSE=1.308^{\circ }$$

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