bluuebunny/crossref_metadata_2025 huggingface dataset:
From “Local Control” to “Dependency”: Transitions to Single-Vendor Integrated Electronic Health Record Systems and Their Implications for the EHR Workforce
Authors: Brunner Julian , Anderson Ekaterina , Mohr David C. , Cohen-Bearak Adena , Rinne Seppo T.
Published: October 2023

Background

Healthcare systems that previously used either a single legacy electronic health record (EHR) system or a “best-of-breed” combination of products from multiple vendors are increasingly adopting integrated, single-vendor EHR systems. Though healthcare leaders are beginning to recognize the dramatic collateral consequences of these transitions, their impact on the EHR workforce — internal actors most closely involved in governing and supporting the EHR — is poorly understood.

Objective

Identify perceived impacts of adopting single-vendor, integrated EHR systems on the institutional EHR workforce.

Design

In this qualitative study, we conducted semi-structured phone interviews in four healthcare systems in the USA that had adopted an integrated EHR within the previous five years.

Participants

Forty-two staff members of four geographically and organizationally diverse healthcare systems, including 22 individuals with formal informatics roles.

Approach

Transcribed interviews were coded and analyzed using qualitative content analysis methods.

Key Results

Across organizations, participants described a loss of autonomy by the EHR workforce at the individual and institutional level following the adoption of an integrated EHR. We also identified references to transformations in four key professional functions of the EHR workforce: communication, governance, optimization, and education.

Conclusions

Transitions to integrated EHR systems can have important implications for the autonomy and professional functions of the EHR workforce. These findings may help institutions embarking on similar transitions better anticipate and prepare for these changes through such practices as revising job descriptions, strengthening EHR governance structures, and reinforcing pathways to engage frontline clinicians in supporting the EHR. Findings may also help institutions structure vendor contracts in a way that anticipates and mitigates loss of autonomy.
“Like One Long Battle:” Employee Perspectives of the Simultaneous Impact of COVID-19 and an Electronic Health Record Transition
Authors: Rucci Justin M. , Ball Sherry , Brunner Julian , Moldestad Megan , Cutrona Sarah L. , Sayre George , Rinne Seppo
Published: October 2023

Background

Healthcare organizations regularly manage external stressors that threaten patient care, but experiences handling concurrent stressors are not well characterized.

Objective

To evaluate the experience of Veterans Affairs (VA) clinicians and staff navigating simultaneous organizational stressors—an electronic health record (EHR) transition and the COVID-19 pandemic—and identify potential strategies to optimize management of co-occurring stressors.

Design

Qualitative case study describing employee experiences at VA’s initial EHR transition site.

Participants

Clinicians, nurses, allied health professionals, and local leaders at VA’s initial EHR transition site.

Approach

We collected longitudinal qualitative interview data between July 2020 and November 2021 once before and 2–4 times after the date on which the health system transitioned; this timing corresponded with local surges of COVID-19 cases. Interviewers conducted coding and analysis of interview transcripts. For this study, we focused on quotes related to COVID-19 and performed content analysis to describe recurring themes describing the simultaneous impact of COVID-19 and an EHR transition.

Key Results

We identified five themes related to participants’ experiences: (1) efforts to mitigate COVID-19 transmission led to insufficient access to EHR training and support, (2) clinical practice changes in response to the pandemic impacted EHR workflows in unexpected ways, (3) lack of clear communication and inconsistent enforcement of COVID-19 policies intensified pre-existing frustrations with the EHR, (4) managing concurrent organizational stressors increased work dissatisfaction and feelings of burnout, and (5) participants had limited bandwidth to manage competing demands that arose from concurrent organizational stressors.

Conclusion

The expected challenges of an EHR transition were compounded by co-occurrence of the COVID-19 pandemic, which had negative impacts on clinician experience and patient care. During simultaneous organizational stressors, health care facilities should be prepared to address the complex interplay of two stressors on employee experience.
Assessing Electronic Health Record (EHR) Use during a Major EHR Transition: An Innovative Mixed Methods Approach
Authors: Molloy-Paolillo Brianne , Mohr David , Levy Deborah R. , Cutrona Sarah L. , Anderson Ekaterina , Rucci Justin , Helfrich Christian , Sayre George , Rinne Seppo T.
Published: October 2023

Background

Electronic health record (EHR) transitions are inherently disruptive to healthcare workers who must rapidly learn a new EHR and adapt to altered clinical workflows. Healthcare workers’ perceptions of EHR usability and their EHR use patterns following transitions are poorly understood. The Department of Veterans Affairs (VA) is currently replacing its homegrown EHR with a commercial Cerner EHR, presenting a unique opportunity to examine EHR use trends and usability perceptions.

Objective

To assess EHR usability and uptake up to 1-year post-transition at the first VA EHR transition site using a novel longitudinal, mixed methods approach.

Design

A concurrent mixed methods strategy using EHR use metrics and qualitative interview data.

Participants

141 clinicians with data from select EHR use metrics in Cerner Lights On Network®. Interviews with 25 healthcare workers in various clinical and administrative roles.

Approach

We assessed changes in total EHR time, documentation time, and order time per patient post-transition. Interview transcripts (n = 90) were coded and analyzed for content specific to EHR usability.

Key Results

Total EHR time, documentation time, and order time all decreased precipitously within the first four months after go-live and demonstrated gradual improvements over 12 months. Interview participants expressed ongoing concerns with the EHR’s usability and functionality up to a year after go-live such as tasks taking longer than the old system and inefficiencies related to inadequate training and inherent features of the new system. These sentiments did not seem to reflect the observed improvements in EHR use metrics.

Conclusions

The integration of quantitative and qualitative data yielded a complex picture of EHR usability. Participants described persistent challenges with EHR usability 1 year after go-live contrasting with observed improvements in EHR use metrics. Combining findings across methods can provide a clearer, contextualized understanding of EHR adoption and use patterns during EHR transitions.
The Differential Effect of Metformin on Osteocytes, Osteoblasts, and Osteoclasts
Authors: de Vries Teun J. , Kleemann Antonella S. , Jin Jianfeng , Schoenmaker Ton
Published: October 2023

Purpose of Review

Metformin is an anti-glycemic agent, which is widely prescribed to diabetes patients. Although its alleged role on bone strength has been reported for some time, this review focuses primarily on the recent mechanistical insights of metformin on osteocytes, osteoblasts, and osteoclasts.

Recent Findings

Overall, metformin contributed to steering anabolic activity in osteocytes. It caused lower expression in osteocytes of the negative regulators of bone formation sclerostin and DKK1. Likewise, the osteoclastogenesis function of osteoblasts was also skewed towards lower RANKL and higher OPG expressions. Osteoblast lineage cells generally responded to metformin by activating bone formation parameters, such as alkaline phosphatase activity, higher expression of anabolic members of the Wnt pathway, transcription factor Runx2, bone matrix protein proteins, and subsequent mineralization. Metformin affected osteoclast formation and activity in a negative way, reducing the number of multinucleated cells in association with lower expression of typical osteoclast markers and with inhibited resorption. A common denominator studied in all three cell types is its beneficial effect on activating phosphorylated AMP kinase (AMPK) which is associated with the coordination of energy metabolism.

Metformin differentially affects bone cells, shifting the balance to more bone formation. Although metformin is a drug prescribed for diabetic patients, the overall bone anabolic effects on osteocytes and osteoblasts and the anti-catabolic effect on osteoclast suggest that metformin could be seen as a promising drug in the bone field.
The Colourant Mapping Project: approaching the evidence of colourant production in the Aegean during the Hellenistic and Roman Period through Kea, Kos and Rhodes
Authors: Kostomitsoupoulou-Marketou Ariadne , Rodler-Rørbo Alexandra
Published: October 2023

Over the last decades, polychromy research has provided insight into the rich variety of materials that composed the ancient Mediterranean palette, including minerals, rocks, earths, metal oxides, lakes and pyrotechnological products. Even though polychromy is considered an important aspect of ancient Greek and Roman art, the organisation of colourant production and trade remains rather underexplored. This is possibly due to the inherent complexity of pigments and dyes as archaeological materials and the variability of possible sources. Recent methodological advances have demonstrated the potential to trace the provenance of raw materials and to identify colourant productionloci. This paper introduces the Colourant Mapping Project (CMP), which we are currently developing as a novel bibliographic and dissemination tool for researching colourant production and trade. The Aegean islands of Kea, Kos and Rhodes are three case studies included in the CMP that provide varied evidence of colourant production through a combined methodology using literary sources, archaeological and geological information for evaluating potential colourant production sites. Kea is mentioned in ancient texts as an excellent source of red earth, controlled by Athenian exportation legislation. The geology of Kea supports this; however, no earth pigment production sites are currently known and archaeometric evidence connecting to local raw materials is lacking. Kos, on the other hand, lacks historical evidence for local colourant production while a recently well-described multicrafting workshop and abundant archaeological finds substantiate colourant production on this island. The geological evidence also supports a local provenance for some of the materials processed on Kos (earth pigments), yet raw materials such as copper (for Egyptian blue) still required importation from elsewhere. Lastly, Rhodes was praised for its lead white and murex purple production by ancient writers and archaeological evidence might verify both, although not as clearly as is the case of Koan colourant production. The geological information for Rhodes also hints at raw material importation as no local lead ore deposits are known. The aim of the CMP is therefore twofold: on the one hand to evaluate the contribution of varied pieces of evidence to colourant provenancing and production, and on the other to situate the evidence of local colourant production within the context of Mediterranean networks of economic and cultural exchange. An ever-increasing and openly accessible bibliographic reference tool such as the CMP enables the investigation of the provenance of raw materials and colourants and can contribute to the reconstruction of ancient exchange networks.
Training and learning ultrasound: survey on a sample of Italian students, impact and role inside the core curriculum of degree courses in medicine and surgery
Authors: Boccatonda Andrea , Ursitti Antonio , Frisone Alessio , D’Alessandro Patrizio , Guagnano Maria Teresa , Iannetti Giovanni , Schiavone Cosima
Published: October 2023

Purpose

Ultrasound is essential in the clinical practice of many medical specialties due to non-invasiveness, rapidity of examination, low costs and simplicity. Many specialized companies and universities pointed out its potential as a teaching tool for medical students. The aim of our study is to evaluate the impact of an ultrasound course on a sample of students attending the fourth, fifth and sixth year of the degree course in Medicine, highlighting changing in satisfaction and preparation. Another target is to verify the capability of a course on ultrasound to positively impact on participants knowledge and competences.

Methods

Students attending 6 training courses of Medicine held between 2017 and 2019 were recruited. Five trainings held during an Italian society of ultrasound in medicine and biology (SIUMB) congress, in a session dedicated to students, and one during an elective didactic activity (ADE) held in Chieti University. A questionnaire was given to the students before and after the course, in order to assess the impact of the course on the motivation and knowledge. Moreover, a test was also administered at the end of the theoretical part, with questions relating to the notions learned.

Results

There was an 81% of correct response to the learning questionnaire by calculating the mean of 5 SIUMB courses performed. The students are strongly motivated to continue learning ultrasound already from the beginning of the course, and this result remains unchanged in the questionnaire administered at the end. The interest of students towards this method is high, and they would ultrasound courses within the Medicine degree, even before participating in the training. It was evident how students positively assessed the course in relation to the acquisition of skills and knowledge, albeit with a tendency to acquire more knowledge rather than skills.

Conclusions

Our data support the usefulness of including ultrasound into the curriculum of medical students and on its use as a teaching tool. Students are highly motivated and perceive a significant improvement in both skills and knowledge following the proposed courses. Hands-on part is necessary in the training course on ultrasonography.
Corticotropin-releasing hormone test predicts the outcome of unilateral adrenalectomy in primary bilateral macronodular adrenal hyperplasia
Authors: Tizianel I. , Detomas M. , Deutschbein T. , Fassnacht M. , Albiger N. , Iacobone M. , Scaroni C. , Ceccato F.
Published: October 2023

Purpose

Primary bilateral adrenal hyperplasia (PBMAH) is associated with hypercortisolism and a heterogeneous clinical expression in terms of cortisol secretion and related comorbidities. Historically, treatment of choice was bilateral adrenalectomy (B-Adx); however, recent data suggest that unilateral adrenalectomy (U-Adx) may be an effective alternative. For the latter, factors predicting the postsurgical outcome (e.g., biochemical control) have not been identified yet.

Methods

PBMAH patients undergoing U-Adx for overt Cushing’s syndrome (CS) in two tertiary care centers were retrospectively analysed. Remission was defined as a normalization of urinary free cortisol (UFC) without the need for medical treatment. The potential of hCRH test as a predictor of U-Adx outcome was evaluated in a subgroup.

Results

23 patients were evaluated (69% females, mean age 55 years). Remission rate after U-Adx was 74% at last follow up (median 115 months from UAdx). Before U-Adx, a positive ACTH response to hCRH (Δ%ACTH increase > 50% from baseline) was associated with higher remission rates.

Conclusions

Three of four patients with PBMAH are surgically cured with U-Adx. Pre-operative hCRH testing can be useful to predict long-term remission rates.
Urban Change Forecasting from Satellite Images
Authors: Metzger Nando , Türkoglu Mehmet Özgür , Daudt Rodrigo Caye , Wegner Jan Dirk , Schindler Konrad
Published: October 2023

Forecasting where and when new buildings will emerge is a rather unexplored topic, but one that is very useful in many disciplines such as urban planning, agriculture, resource management, and even autonomous flying. In the present work, we present a method that accomplishes this task with a deep neural network and a custom pretraining procedure. InStage 1, a U-Net backbone is pretrained within a Siamese network architecture that aims to solve a (building) change detection task. InStage 2, the backbone is repurposed to forecast the emergence of new buildings based solely on one image acquired before its construction. Furthermore, we also present a model that forecasts the time range within which the change will occur. We validate our approach using the SpaceNet7 dataset, which covers an area of 960 km$$^2$$2at 24 points in time across 2 years. In our experiments, we found that our proposed pretraining method consistently outperforms the traditional pretraining using the ImageNet dataset. We also show that it is to some degree possible to predict in advance when building changes will occur.
Threshold sensitivity of the production network topology
Authors: Molnár Eszter , Csala Dénes
Published: October 2023

Industries today are tightly interconnected, necessitating a systematic perspective in understanding the complexity of relations. Employing network science, the literature constructs dense production networks to address this challenge. However, handling this high density involves carefully choosing the level of pruning to retain as much information as possible. Yet, current research lacks comprehensive insight into the extent of distortion the data removal produces in the network structure. Our paper aims to examine how this widespread thresholding method changes the production network’s topology. We do this by studying the network topology and centrality metrics under various thresholds on inter-industry networks derived from the US input-output accounts. We find that altering even minor threshold values significantly reshapes the network’s structure. Core industries serving as hubs are also affected. Hence, research using the production network framework to explain the propagation of local shocks and disturbances should also take into account that even low-value monetary transactions contribute to the interrelatedness and complexity of production networks.
Conflict-aware workload co-execution on SX-aurora TSUBASA
Authors: Nunokawa Riku , Shimomura Yoichi , Agung Mulya , Egawa Ryusuke , Takizawa Hiroyuki
Published: October 2023

NEC SX-Aurora TSUBASA (SX-AT) is the latest vector supercomputer, consisting of host processors called Vector Hosts (VHs) and vector processors called Vector Engines (VEs). The goal of this work is to simultaneously use both VHs and VEs to increase the resource utilization and improve the system throughput by co-executing more workloads. One difficulty is that performance interferences among VH and VE workloads could occur because they share some computing resources and potentially compete to use the same resource at the same time, so-called resource conflicts. To achieve efficient workload co-execution, first, this paper experimentally investigates the performance interference between a VH and a VE, when each of the two processors executes a different workload. It is empirically shown that the frequency of system calls from the VE workload could be a good indicator to predict if the co-execution could cause severe performance interference, even though monitoring system calls requires a huge runtime overhead and it is impractical to simply use it for decision making of co-execution. Then, this paper proposes a workload co-execution strategy based on a practical approach to identifying a pair of VE and VH workloads that could cause severe performance interferences. Our evaluation results clearly demonstrate that the system call frequency can be used to predict if the workload can affect the performance of another co-executing workload, and VH’s CPU load can be a good approximation of the system call frequency. The proposed approach based on the CPU loads could accurately identify a pair of workloads causing frequent resource conflicts, and thus reduce the risk of severe performance interferences between co-executing workloads on an SX-AT system, resulting in shorter makespan without significantly increasing the turn-around time.
Integrating biochar and bacteria for sustainable remediation of metal-contaminated soils
Authors: Ouyang Peng , Narayanan Mathiyazhagan , Shi Xiaojun , Chen Xinping , Li Zhenlun , Luo Yongming , Ma Ying
Published: October 2023

Due to anthropogenic activities, heavy metal (HM) pollution in soils has increased, resulting in severe ecological problems and posing a constant threat to human health. Among various remediation methods, bacterial remediation is a relatively clean, efficient, and minimally negative approach. However, bacterial agents face multiple environmental stresses, making them challenging to achieve long-lasting and stable restoration effects. To address this issue, supportive organic substances such as biochar can be added to the soil with bacteria. According to bibliometric studies, integrating biochar and bacteria is extensively researched and widely used for HM-contaminated soil remediation. By integrating biochar and bacteria, heavy metals in the soil can be remediated, and soil conditions can be improved over time. Bacteria can also better promote plant growth or contribute effectively to phytoremediation processes when assisted by biochar. However, the remediation agents integrating biochar and bacteria are still some distance away from large-scale use because of their high cost and possible environmental problems. Therefore, further discussion on the interaction between biochar and bacteria and the integration approach, along with their remediation efficiency and environmental friendliness, is needed to achieve sustainable remediation of HM-contaminated soils by integrating biochar and bacteria. This paper discusses the potential mechanisms of biochar-bacteria-metal interactions, current advancements in biochar-bacteria combinations for HM-contaminated soil treatment, and their application in sustainable remediation, analyzes the interaction between biochar and bacteria and compares the remediation effect of different ways and feedstocks to integrate biochar and bacteria. Finally, future directions of biochar-bacteria combinations are presented, along with evidence and strategies for improving their commercialization and implementation.

Graphical Abstract
Cytotoxic pathways activated by multifunctional thiosemicarbazones targeting sigma-2 receptors in breast and lung carcinoma cells
Authors: Kopecka Joanna , Barbanente Alessandra , Vitone Daniele , Arnesano Fabio , Margiotta Nicola , Berchialla Paola , Niso Mauro , Riganti Chiara , Abate Carmen
Published: October 2023

Background

Multifunctional thiosemicarbazones (TSCs) able to bind sigma receptors and chelate metals are considered as a promising avenue for the treatment of pancreatic cancer due to the encouraging results obtained on in vitro and in vivo models. Here, we assessed the biochemical mechanism of these TSCs also on lung (A549) and breast (MCF7) cancer cells.

Methods

The density of sigma-2 receptors in normal (BEAS-2B and MCF10A) and in lung and breast (A549 and MCF7) cancer cells was evaluated by flow cytometry. In these cells, cytotoxicity (MTT assay) and activation of ER- and mitochondria-dependent cell death pathways (by spectrofluorimetric assays to measure Caspases 3/7/9; qRT-PCR detection of GRP78, ATF6, IRE1, PERK; MitoSOX, DCFDA-AM and JC-1 staining), induced by the TSCs FA4, MLP44, PS3 and ACThio1, were evaluated.

Results

FA4 and PS3 exerted more potent cytotoxicity than MLP44 and ACThio1 in all cancer cell lines, where the density of sigma-2 receptors was higher than in normal cells. Remarkably, FA4 promoted ER- and mitochondria-dependent cell death pathways in both cell models, whereas the other TSCs had variable, cell-dependent effects on the activation of the two proapoptotic pathways.

Conclusions

Our data suggest that FA4 is a promising compound that deserves to be further studied for lung and breast cancer treatment. However, the other multifunctional TSCs also hold promise for the development of therapies towards a personalized medicine approach. Indeed, the presence of the sigma-2 receptor-targeting moiety would lead to a more specific tumor delivery embracing the characteristics of individual tumor types.
Multiphase Flow with Solid Particles
Authors: Kosinski Pawel
Published: October 2023

Multiphase flow is an area of fluid dynamics that describes interactions between two or more phases of matter and is relevant across a wide range of industrial processes and natural environmental systems, from the transport of natural resources to volcanic ash flow. This book covers the topic in detail, providing clear explanations of the underlying physics behind the complex behaviour of solid particles in fluids. The forces involved in particle-fluid interactions are first used to describe the interactions between the particles, and the fundamentals of contact mechanics are then outlined and applied to model interparticle collisions. The book is illustrated with frequent worked examples and algorithms, enabling the reader to develop the required tools for simulating the flow of fluids with solid particles. This self-contained text will appeal to physicists, applied mathematicians and mechanical engineers working in this important area of research.
Recent Approaches to the Study of Health, Healing, Illness, and Care in Africa
Authors: Cummiskey Julia Ross
Published: October 2023

So far, the twenty-first century has been a boom time for studies of health, illness, healing, and care work in Africa, and the COVID-19 pandemic has only increased attention to these issues. Yet again, current events remind us that history, politics, social relationships, and public health are inextricably linked. These five books encompass a range of approaches to the questions and sources that animate these studies from a variety of disciplinary perspectives, including anthropology, public health, gender studies, medicine, political science, and history. Each of these authors and editors is explicit about their commitment to reaching an interdisciplinary audience and, for most of them, interdisciplinary work is core to their professional identities. Paul Farmer, Luke Messac, and Simukai Chigudu all earned medical degrees as well as doctoral degrees in medical anthropology, history and sociology of science and medicine, and international development respectively; Nolwazi Mkhwanazi and Lenore Manderson describe themselves as working “at the intersections of medical anthropology, public health and gender studies” (vii). These five books reflect the wide range of authors and audiences engaging in questions about what constitutes health, how it is achieved or undermined, and how the past has contributed to present conditions on the continent.
Management strategies to improve forage accumulation and nutritive value in crabgrass hayfields
Authors: Pedreira B. C. , Yasuoka J. I. , Barros I. T. M. D. , Helwig D. , Farney J. K. , Sassenrath G. F.
Published: October 2023

Crabgrass (Digitaria spp.) is an annual summer grass capable of self-reseeding and can provide forage with high nutritive value. However, knowledge is still limited about crabgrass management. Our objective was to compare the forage accumulation (FA) and nutritive value of two crabgrass varieties (Mojo and Quick-N-Big) for 2 years under combinations of nitrogen rates and harvesting management. The experimental design was in randomized complete blocks with five treatments and three replications for each crabgrass variety, totalling 15 experimental units for Mojo and 15 for Quick-N-Big, in adjacent fields. Treatments were combinations of nitrogen rates (0, 112, and 224 kg N/ha) and harvest management (harvesting once or twice during the growing season). Nitrogen fertilization increased FA in Mojo and Quick-N-Big. The combination of two harvests and 224 kg N/ha (H2N224) resulted in a total forage accumulation (TFA) of 7840 kg DM/ha/yr for Mojo in 2020 and 8550 kg DM/ha/yr for Quick-N-Big in 2021. The H2N224 management also resulted in the highest crude protein (CP) accumulation. Nitrogen fertilization accelerates plant maturity, which can increase neutral detergent fibre (NDF). In this case, harvesting twice stimulates new tissue production, limits NDF and increases CP and total digestible nutrients (TDN). Therefore, increasing harvesting frequency (twice during the growing season) as N is input increases TFA, CP and TDN, and also enhances N recovery, which may contribute to reducing animal supplementation costs and improve the economic return of forage-based livestock systems.
Exploring sensory processing abilities in adults with acquired hearing loss
Authors: Tekin Dal Bilgehan , Çetin Binnur , Şimşek Eda Nur , Bumin Gonca
Published: October 2023

Objectives

This study aimed to evaluate the sensory processing abilities of adults with acquired hearing loss and determine whether their sensory processing patterns differ from those of the general population and adults with normal hearing.

Method

The study evaluated the sensory processing functions of 30 adults with acquired hearing loss using the Adolescent/Adult Sensory Profile and compared them with the sensory processing functions of 30 adults with normal hearing.

Results

The results showed that individuals with hearing loss have a significantly higher sensitivity to stimuli related to motion, vision, activity and touch, exhibiting a low-registration sensory pattern and a sensation-avoiding pattern that differed from those of most individuals.

Conclusion

Assessing sensory processing profiles can help identify specific sensory difficulties and inform individualised treatment plans. The study highlights the importance of considering sensory processing patterns in the management of hearing loss to improve overall well-being and quality of life for adults with hearing loss.
Conceptual politics and resilience-at-work in the European Union
Authors: Joseph Jonathan , Juncos Ana E.
Published: October 2023

International crises, most recently the Covid-19 pandemic and Russia’s invasion of Ukraine, often radically change our view of the world and our place within it. The European Union (EU) has been particularly impacted by these developments because these crises have accentuated some of its ontological and epistemological uncertainties and insecurities. While the EU’s resilience turn initiated by the EU Global Strategy of 2016 aimed at strengthening the EU’s ability to prepare and recover from external shocks and crises, since then, the concept of resilience has undergone a transformation. In recent years, we have seen the EU turning back in on itself and abandoning the radical aspects of resilience. Hence a paradox has emerged – the more complex the problems faced by the EU, the more it turns away from the logics of complexity present in the idea of resilience. In this article, we examine this conceptual shift through the lenses of concepts in action and the way these have reflected changes in the external context, but also power coalitions and institutional path dependencies. This argument will be explored by examining the recently adopted Strategic Compass and the EU’s Recovery and Resilience Facility (RRF).
A problem of Erdős–Graham–Granville–Selfridge on integral points on hyperelliptic curves
Authors: BUI HUNG M. , PRATT KYLE , ZAHARESCU ALEXANDRU
Published: October 2023

Erdős, Graham and Selfridge considered, for each positive integer n, the least value of
$t_n$
so that the integers
$n+1, n+2, \dots, n+t_n $
contain a subset the product of whose members with n is a square. An open problem posed by Granville concerns the size of
$t_n$
, under the assumption of the ABC conjecture. We establish some results on the distribution of
$t_n$
, and in the process solve Granville’s problem unconditionally.
Impact of Smart Glasses on Patient Care Time in Emergency Medical Services Ambulance
Authors: Apiratwarakul Korakot , Cheung Lap Woon , Ienghong Kamonwon
Published: October 2023

Introduction:

The smart glasses were implemented as an innovative communication tool to enhance effectiveness in the field. The traditional mode of communication for Emergency Medical Services (EMS) was radio, which had significant restrictions, primarily that they were unable to transmit any visual data. To enhance efficiency, the smart glasses were used for a more accurate assessment of the condition of patients during transportation. At this time, however, no prior study has shown significant benefits of employing smart glasses into EMS.

Study Objective:

The primary objective of this study is to compare the duration of patient care in an ambulance between the use and non-use of smart glasses. The secondary objective is to identify the characteristics of data communication between the ambulance and the hospital.

Methods:

This retrospective study utilized data gathered from closed-circuit television (CCTV) in ambulances at Srinagarind Hospital, Thailand. The data were collected over a six-month period, specifically from July through December 2021. The study included two groups: the smart glasses group and no smart glasses groups, both used during EMS operations. The primary data collected focused on the duration of patient care in the ambulance. Additionally, the type and characteristics of data transfers via smart glasses during EMS operations were also recorded.

Results:

Out of the 256 EMS operations included in this study, 53.1% (N = 68) of the participants in the smart glasses group were male. The majority of operations were performed during the afternoon shift in both groups. The average patient care time in the smart glasses group was 10.07 minutes, while it was 5.10 minutes in the no smart glasses group (P <.001), indicating a significant difference. Visual data communication between the ambulance and the hospital via smart glasses predominantly involved vital signs (100.0%), physical examination (56.3%), and neurological examination (42.2%). The use of audio data from the hospital to the ambulance primarily included taking additional patient history (26.6%) and performing physical examinations (19.5%).

Conclusion:

The implementation of smart glasses in EMS operations resulted in an increase in patient care time in the ambulance. Furthermore, the use of smart glasses facilitated an effective channel of real-time two-way communication between the ambulance and the hospital.
A compact bent microstrip-based wideband millimeter wave MIMO antenna for 5G applications
Authors: Ali Ayyaz , Rasool Maryam , Zahid Zeeshan , Rashid Imran , Siddique Adil Masood , Maqsood Moazam , Bhatti Farooq Ahmed
Published: October 2023

This paper proposes a wideband four-element multiple-input multiple-output (MIMO) antenna operating in the millimeter-wave frequency band for 5G communications from 24.37–39.44 and 45.09–50.62 GHz. The antenna design has been realized using Rogers 5880 substrate and consists of a T-shaped strip that is attached to the top of a 50 Ω feeding line. Two microstrip lines are affixed at the terminal points of T-shaped strip and bent toward the feeding structure. These bent strip lines are then extended by joining two additional L-shaped microstrip lines. On the back, there is a partial defective ground plane featuring a rectangular slot and a thin strip line located at its center. The dimensions of the proposed single element and MIMO antenna are 0.933λ × 0.933λ × 0.024λ and 1.865λ × 1.865λ × 0.024λ, respectively (at 28 GHz), while the edge-to-edge distance between the radiation elements of the MIMO antenna is 4.0 mm. The design incorporates an efficient passive fan-shaped decoupling structure to decrease coupling between antenna elements. Simulations and experimental results show good agreement with each other. For all resonant frequencies the measured peak gain is greater than 4.85 dBi, radiation efficiency is over 90%, diversity gain is greater than 9.5, ECC is less than 0.025, TARC is less than -10 dB and CCL is below 0.4 bits/s/Hz. The proposed MIMO antenna, with its wide bandwidth, high gain, high inter-port isolation, and high efficiency characteristics, can be used for 5G wireless communication applications.
Adaptation of Family-Based Healthy Weight Program for Children Who Survived Leukemia
Authors: Jakubiak Jessica , Guan Megan , Khan Sabir , Fowler Lauren A. , Bates Carolyn R. , King Allison A. , Hayashi Robert J. , Fitzsimmons-Craft Ellen , Wilfley Denise E.
Published: October 2023

Objective:

Understand the perspectives of children who survived acute lymphoblastic leukemia (ALL) and their parents to adapt a guideline-based, family-based, intensive health behavior and lifestyle intervention treatment for this population.

Method:

Nine children 8–17 years of age ( Mdn = 12 years [interquartile range, 10–16], median years off treatment = 5 [2–7]) who survived ALL and 11 parents participated in focus groups to assess perceptions of weight, weight-related behaviors, and perceived barriers to family-based behavioral weight loss treatment (FBT). Responses were analyzed thematically, and resultant adaptations were guided by the Framework for Reporting Adaptations and Modifications-Enhanced.

Results:

Topics and themes identified included mental and physical health concerns (e.g., treatment-related medical complications, body esteem), a perception of excess weight as protective, the continuing influence of eating habits established during cancer treatment (e.g., instrumental feeding practices, snacking), and potential barriers to activity (i.e., physical limitations, lack of sport experience). Resultant adaptations to FBT were contextual (e.g., virtual delivery) and related to the content, including an emphasis on weight management in the context of survivorship; education about late effects, overweight and obesity; increased emphasis on structured eating patterns and instrumental eating; provider recommended physical activity; and tailored emotion-focused and body esteem content.

Conclusions:

Focus groups for children who survived pediatric ALL provided insights that aided the adaptation of FBT for this population. A pilot trial of FBT for children who survived ALL and their parents is underway to evaluate acceptability, feasibility, and preliminary efficacy.

Implications for Impact Statement

This study elicited perspectives of children who survived acute lymphoblastic leukemia and their parents to inform the adaptation of an intensive health behavior and lifestyle treatment for this population. The adaptation, which is delivered entirely virtually and includes an increased emphasis on emotion-focused content and structured and instrumental eating patterns, may offer a promising approach to decrease the risk for chronic, treatment-related medical complications within this population.
An “off-the-shelf” CD2 universal CAR-T therapy for T-cell malignancies
Authors: Xiang Jingyu , Devenport Jessica M. , Carter Alun J. , Staser Karl W. , Kim Miriam Y. , O’ Neal Julie , Ritchey Julie K. , Rettig Michael P. , Gao Feng , Rettig Garrett , Turk Rolf , Lee Byung Ha , Cooper Matthew L. , DiPersio John F.
Published: October 2023

T-cell malignancies are associated with frequent relapse and high morbidity, which is partly due to the lack of effective or targeted treatment options. To broaden the use of CAR-T cells in pan T-cell malignancies, we developed an allogeneic “universal” CD2-targeting CAR-T cell (UCART2), in which the CD2 antigen is deleted to prevent fratricide, and the T-cell receptor is removed to prevent GvHD. UCART2 demonstrated efficacy against T-ALL and CTCL and prolonged the survival of tumor-engrafted NSG mice in vivo. To evaluate the impact of CD2 on CAR-T function, we generated CD19 CAR-T cells (UCART19) with or without CD2 deletion, single-cell secretome analysis revealed that CD2 deletion in UCART19 reduced frequencies of the effector cytokines (Granzyme-B and IFN-γ). We also observed that UCART19ΔCD2 had reduced anti-tumor efficacy compared to UCART19 in a CD19+NALM6 xenograft model. Of note is that the reduced efficacy resulting from CD2 deletion was reversed when combined with rhIL-7-hyFc, a long-acting recombinant human interleukin-7. Treatment with rhIL-7-hyFc prolonged UCART2 persistence and increased survival in both the tumor re-challenge model and primary patient T-ALL model in vivo. Together, these data suggest that allogeneic fratricide-resistant UCART2, in combination with rhIL-7-hyFc, could be a suitable approach for treating T-cell malignancies.
ACAA2 is a novel molecular indicator for cancers with neuroendocrine phenotype
Authors: Shen Michelle , Liu Shiqin , Toland Angus , Hsu En-Chi , Hartono Alifiani B. , Alabi Busola R. , Aslan Merve , Nguyen Holly M. , Sessions Conner J. , Nolley Rosalie , Shi Chanjuan , Huang Jiaoti , Brooks James D. , Corey Eva , Stoyanova Tanya
Published: October 2023

Background

Neuroendocrine phenotype is commonly associated with therapy resistance and poor prognoses in small-cell neuroendocrine cancers (SCNCs), such as neuroendocrine prostate cancer (NEPC) and small-cell lung cancer (SCLC). Expression levels of current neuroendocrine markers exhibit high case-by-case variability, so multiple markers are used in combination to identify SCNCs. Here, we report that ACAA2 is elevated in SCNCs and is a potential molecular indicator for SCNCs.

Methods

ACAA2 expressions in tumour xenografts, tissue microarrays (TMAs), and patient tissues from prostate and lung cancers were analysed via immunohistochemistry. ACAA2 mRNA levels in lung and prostate cancer (PC) patients were assessed in published datasets.

Results

ACAA2 protein and mRNA levels were elevated in SCNCs relative to non-SCNCs. Medium/high ACAA2 intensity was observed in 78% of NEPC PDXs samples (N = 27) relative to 33% of adeno-CRPC (N = 86), 2% of localised PC (N = 50), and 0% of benign prostate specimens (N = 101). ACAA2 was also elevated in lung cancer patient tissues with neuroendocrine phenotype. 83% of lung carcinoid tissues (N = 12) and 90% of SCLC tissues (N = 10) exhibited medium/high intensity relative to 40% of lung adenocarcinoma (N = 15).

Conclusion

ACAA2 expression is elevated in aggressive SCNCs such as NEPC and SCLC, suggesting it is a potential molecular indicator for SCNCs.
Statistical laws of stick-slip friction at mesoscale
Authors: Yan Caishan , Chen Hsuan-Yi , Lai Pik-Yin , Tong Penger
Published: October 2023

Friction between two rough solid surfaces often involves local stick-slip events occurring at different locations of the contact interface. If the apparent contact area is large, multiple local slips may take place simultaneously and the total frictional force is a sum of the pinning forces imposed by many asperities on the interface. Here, we report a systematic study of stick-slip friction over a mesoscale contact area using a hanging-beam lateral atomic-force-microscope, which is capable of resolving frictional force fluctuations generated by individual slip events and measuring their statistical properties at the single-slip resolution. The measured probability density functions (PDFs) of the slip length δxs, the maximal force Fc needed to trigger the local slips, and the local force gradient $${k}^{{\prime} }$$

k

′

of the asperity-induced pinning force field provide a comprehensive statistical description of stick-slip friction that is often associated with the avalanche dynamics at a critical state. In particular, the measured PDF of δxs obeys a power law distribution and the power-law exponent is explained by a new theoretical model for the under-damped spring-block motion under a Brownian-correlated pinning force field. This model provides a long-sought physical mechanism for the avalanche dynamics in stick-slip friction at mesoscale.
Fluorescent sensors for imaging of interstitial calcium
Authors: Valiente-Gabioud Ariel A. , Garteizgogeascoa Suñer Inés , Idziak Agata , Fabritius Arne , Basquin Jérome , Angibaud Julie , Nägerl U. Valentin , Singh Sumeet Pal , Griesbeck Oliver
Published: October 2023

Calcium in interstitial fluids is central to systemic physiology and a crucial ion pool for entry into cells through numerous plasma membrane channels. Its study has been limited by the scarcity of methods that allow monitoring in tight inter-cell spaces of living tissues. Here we present high performance ultra-low affinity genetically encoded calcium biosensors named GreenT-ECs. GreenT-ECs combine large fluorescence changes upon calcium binding and binding affinities (Kds) ranging from 0.8 mM to 2.9 mM, making them tuned to calcium concentrations in extracellular organismal fluids. We validated GreenT-ECs in rodent hippocampal neurons and transgenic zebrafish in vivo, where the sensors enabled monitoring homeostatic regulation of tissue interstitial calcium. GreenT-ECs may become useful for recording very large calcium transients and for imaging calcium homeostasis in inter-cell structures in live tissues and organisms.
Closed-loop superconducting materials discovery
Authors: Pogue Elizabeth A. , New Alexander , McElroy Kyle , Le Nam Q. , Pekala Michael J. , McCue Ian , Gienger Eddie , Domenico Janna , Hedrick Elizabeth , McQueen Tyrel M. , Wilfong Brandon , Piatko Christine D. , Ratto Christopher R. , Lennon Andrew , Chung Christine , Montalbano Timothy , Bassen Gregory , Stiles Christopher D.
Published: October 2023

Discovery of novel materials is slow but necessary for societal progress. Here, we demonstrate a closed-loop machine learning (ML) approach to rapidly explore a large materials search space, accelerating the intentional discovery of superconducting compounds. By experimentally validating the results of the ML-generated superconductivity predictions and feeding those data back into the ML model to refine, we demonstrate that success rates for superconductor discovery can be more than doubled. Through four closed-loop cycles, we report discovery of a superconductor in the Zr-In-Ni system, re-discovery of five superconductors unknown in the training datasets, and identification of two additional phase diagrams of interest for new superconducting materials. Our work demonstrates the critical role experimental feedback provides in ML-driven discovery, and provides a blueprint for how to accelerate materials progress.