bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospital Quality Mediates Impact of Care Fragmentation Following Elective Colectomy
Authors: Sakowitz Sara , Bakhtiyar Syed Shahyan , Mallick Saad , Cho Nam Yong , Kim Shineui , Le Nguyen K. , Lee Hanjoo , Benharash Peyman
Published: April 2024

Background

Readmission at a non-index hospital, or care fragmentation (CF), has been previously linked to greater morbidity and resource utilization. However, a contemporary evaluation of the impact of CF on readmission outcomes following elective colectomy is lacking. We additionally sought to evaluate the role of hospital quality in mediating the effect of CF.

Methods

All records for adults undergoing elective colectomy were tabulated from the 2016 to 2020 Nationwide Readmissions Database. Patients readmitted non-electively within 30 days to a non-index center comprised the CF cohort (others: Non-CF). Hierarchical mixed-effects models were constructed to ascertain risk-adjusted rates of major adverse events (MAEs, a composite of in-hospital mortality and any complication) attributable to center-level effects. Hospitals with risk-adjusted MAE rates ≥50th percentile were considered Low-Quality Hospitals (LQHs) (others: High-Quality Hospitals [HQHs]).

Results

Of 68,185 patients readmitted non-electively within 30 days, 8968 (13.2%) were categorized as CF. On average, CF was older, of greater comorbidity burden, and more often underwent colectomy for cancer, relative to Non-CF. Following risk adjustment, CF remained independently associated with greater likelihood of MAE (adjusted odds ratio [AOR] 1.16, 95% Confidence Interval [CI] 1.05-1.27) and per-patient expenditures (β+$2,280, CI +$1080-3490). Further, readmission to non-index LQH was linked with significantly increased odds of MAE, following initial care at HQH (AOR 1.43, CI 1.03-1.99) and LQH (AOR 1.72, CI 1.30-2.28; Reference: Non-CF).

Conclusions

Care fragmentation was associated with greater morbidity and resource utilization at readmission following elective colectomy. Further, rehospitalization at non-index LQH conferred significantly inferior outcomes. Novel efforts are needed to improve continuity of care.
Reconsidering Fresh Frozen Plasma Availability to Reduce Blood Product Waste During Massive Transfusion Events in Trauma
Authors: Shen Aricia , Di Meo Brent , Perez Ingrid A. , Hashim Yassar , Ko Ara , Margulies Daniel R. , Klapper Ellen B. , Barmparas Galinos
Published: April 2024

Background

Within component therapy of massive transfusion protocol (MTP) in trauma, thawed plasma is particularly susceptible to expiring without use given its short 5-day shelf life. Optimizing the number of thawed products without compromising safety is important for hospital resource management. The goal is to examine thawed plasma utilization rates in trauma MTP events and optimize the MTP cooler content at our Level I trauma center.

Methods

Trauma MTP activations from 01/2019 to 12/2022 were retrospectively reviewed. During the study period, blood products were distributed in a 12:12:1 ratio of packed red blood cells (pRBC): plasma: platelets per cooler, with up to 4 additional units of low-titer, group O whole blood (LTOWB) available. The primary measure was percent return of unused, thawed plasma.

Results

There were 367 trauma MTP activations with a median (IQR) activation call-to-first cooler delivery time of 8 (6-10) minutes. 73.0% of thawed plasma was returned to the blood bank unused. In one third of MTP activations, all dispensed plasma was returned. The majority (74.1%) of patients required 6 or fewer units of plasma. In 81.5% of activations, 10 or fewer units of plasma and 10 or fewer units of pRBC were used.

Discussion

The majority of trauma MTP requirements may be accommodated with a reduced cooler content of 6 units pRBC, 6 units plasma, and 1 pheresis platelets, buffered by up to 4 units LTOWB (approximates 4 units of pRBC/4 units plasma), in conjunction with a sub-10min cooler delivery time. Follow-up longitudinal studies are needed.
Problems of Citation in the Study of Religion: Who Do We Cite and Why?
Authors: Hovland Ingie , Halvorson Britt
Published: April 2024

This special issue introduction contributes to emerging discussions on citation in studies of religion. What particular issues of citation arise in cultural, historical, and textual research on religious traditions? What can the study of religion contribute to the study of citation? Weaving together references to the four articles of the special issue, we identify four citational themes that are particularly relevant to the study of religion: the continuing reverberations of colonization; relations to and in canonical traditions; the conjunction of morality and economy in neoliberal academic contexts; and the knowledge that comes from naming and interacting with a wider range of sources, such as ancestors. Finally, in the conclusion we argue for a relational ethics of citation in the study of religion.
Exploring the Potential of Chatbots in Extending Tourists’ Sustainable Travel Practices
Authors: Majid Gilang Maulana , Tussyadiah Iis , Kim Yoo Ri
Published: April 2024

Recent advancement in Generative Conversational Artificial Intelligence (AI) has opened the possibility of promoting chatbots for nudging. Tourists returning home from destinations that enforce sustainable transport regulations might be nudged to continue traveling sustainably. Through exploratory qualitative research, this study conceptualizes a chatbot to facilitate pro-environmental behavior spillover among domestic tourists in the Gili Islands, Indonesia. The Service Design approach and Grounded Theory were applied throughout the data collection process involving semi-structured in-depth interviews, focus group discussions and field observations. Insights obtained from stakeholders from multidisciplinary backgrounds were used to provide an overview of how the chatbot can be developed and the potential impact it could bring. A theoretical model predicting factors that play important roles in adopting the proposed chatbot and its respective nudges was developed. It informs policymakers and practitioners about the potential use of AI to help transform tourist experiences and shape lasting responsible behaviors.
Practicing Safe Sects: Apostasy and Apotropaism in the Damascus Document and Paul
Authors: Greene Merrill G.
Published: April 2024

Previous scholarship on 1 Corinthians 5.1–5 has primarily used parallels from the Greek Magical Papyri (PGM) and curse formulae (defixiones) to understand Paul’s instructions about delivering a sexually immoral man over to Satan. This paper diverges from such an approach, instead looking at apotropaism in Second Temple Jewish literature and a parallel found in the Damascus Document that concerns a man excommunicated from the community due to sin done while in a state of spirit-possession. Obedience is often viewed in Second Temple Judaism as a method for repelling evil spirits and Paul seems to adopt a similar view. Additionally, the author(s) of the Damascus Document differentiate(s) between states of disobedience and apostasy. While apostasy incurs the death penalty, disobedience to Sabbath observance results in excommunication with the hope of remediation back into the community. Paul too seems to accept this dichotomy between apostasy and disobedience, but remediation is not possible for the sexually immoral man. Rather, his death serves to protect the spirit of the community from moral degradation and the ongoing threat of hostile spiritual forces.
Target Happiness Attenuates Perceivers’ Moral Condemnation of Prejudiced People
Authors: Rose Hope , Sanders Christopher A. , Willett Chloe , King Laura A.
Published: April 2024

Five experiments (combined N = 4,915) tested the prediction that the moral boost of happiness would persist for social targets with moral failings. In Studies 1 and 2, White and Black participants, respectively, judged happy (versus unhappy) racist targets more morally good. In Study 3, happy (versus unhappy) racist targets were judged more morally good and less (more) likely to engage in racist (good) behavior. Behavioral expectations explained the link between happiness and moral evaluations. Study 4 replicated Studies 1 to 3 in the context of sexism. In Study 5, happy (versus unhappy) targets who engaged in racially biased behavior were evaluated as more morally good, and this effect was explained by behavioral forecasts. Happiness boosts attributions of moral goodness for prejudiced people and does so via expectations for future behavior. Future directions are discussed.
Toxicologic Pathology Forum: Apoptosis/Single Cell Necrosis as a Possible Procedural Effect in Primate Brain Following Ice-Cold Saline Perfusion
Authors: Bolon Brad , Gary Joy M.
Published: April 2024

Nonclinical studies of test articles (TAs) in nonhuman primates are often designed to assess both biodistribution and toxicity. For this purpose, studies commonly use intravenous perfusion of ice-cold (2°C-8°C) saline to facilitate measurements of TA-associated nucleic acids and proteins, after which tissues undergo later fixation by immersion for histological processing and microscopic evaluation. Intriguingly, minimal apoptosis/single cell necrosis (A/SCN) of randomly distributed neural cells is evident in the cerebral cortex and less often the hippocampus in animals from all groups, including vehicle-treated controls. Affected cells exhibit end-stage features such as cytoplasmic hypereosinophilia, nuclear condensation or fragmentation, and shape distortions, so their lineage(s) generally cannot be defined; classical apoptotic bodies are exceedingly rare. In addition, A/SCN is not accompanied by glial reactions, leukocyte infiltration/inflammation, or other parenchymal changes. The severity is minimal in controls but may be slightly exacerbated (to mild) by TA that accumulate in neural cells. One plausible hypothesis explaining this A/SCN exacerbation is that cold shock (perhaps complicated by concurrent tissue acidity and hypoxia) drives still-viable but TA-stressed cells to launch a self-directed death program. Taken together, these observations indicate that A/SCN in brain processed by cold saline perfusion with delayed immersion fixation represents a procedural artifact and not a TA-related lesion.
“You cannot really live (or die) here” – Ongoing struggles over Muslim cemeteries in Tel Aviv-Jaffa, 1957–2020
Authors: Huss Michal , Margalit Talia
Published: April 2024

The article examines the Muslim community’s struggle to maintain their cemeteries in Tel Aviv-Jaffa, and highlights a broader geo-temporal interpretation of the indigenous right-to-the-city. We analyse a succession of mobilizations against sales and demolitions of Muslim cemeteries across the city since the 1950s and investigate how activists recently gained tangible achievements by framing their protest as an urban citizenship mobilization. We show that by utilizing creative spatial performances, applying to municipal governance and stressing their right to use and produce urban space, to participate, and to have their local heritage acknowledged and commemorated, they invoked and reinterpreted right-to-the-city ideas. Their struggle also expanded this agenda, as they did not focus on their living area, but rather advanced claims related to the full city space and its history, and to the customary view of their spaces as 'terra nullius'. In analysing their struggle, we thus contribute to the right-to-the-city literature and agenda, highlight the right for commemoration as part of right to live in the city as equal citizens, and address the promise this case presents for minority ethnic politics.
A novel gaze-based visual search task for children with CVI: A twin study
Authors: Hokken Marinke J , Stein Niklas , Kooiker Marlou JG , Pel Johan J
Published: April 2024

Visual search is often impaired in children with cerebral visual impairment (CVI), but the current assessment of visual search performance is limited. This study aimed to investigate underlying visual search processes in detail by including gaze-based measurements. Twin brothers (age 11.8 years), one diagnosed with CVI and one with neurotypical development, underwent a newly developed conjunction visual search task while simultaneously their gaze was recorded. In addition to speed and accuracy, we analyzed additional timing and spatial parameters of the search process before and after their initial fixation in the target area. The twin with CVI had good visual sensory functions, but impaired search performance indicated by longer search time and larger search areas. Also, it was observed that in more difficult task conditions, he tended to miss the target, even when fixating on it. These results point towards higher-order visual deficits. This study gives insight into the visual search challenges of a child with CVI. Mapping the search process in detail provided new and distinctive information that can shape more tailored support. Coupling verbal and nonverbal gaze-based outcomes is a promising first step towards a more inclusive nonverbal and nonmotor assessment.
Unravelling pituitary tumours in medically treated patients with acromegaly: the impact of systematic MRI reassessment
Authors: Atai Shahriar , Knudtzon Andersen Martin , Wiedmann Markus , Dahlberg Daniel , Øystese Kristin Astrid B , Bollerslev Jens , Ringstad Geir , Heck Ansgar
Published: April 2024

Background

In acromegaly, the primary tumor is usually found during magnetic resonance imaging (MRI) of the pituitary gland. A remnant tumor after surgery is, however, harder to depict. When a tumor is missed, the remaining option is usually lifelong pharmacological treatment.

Purpose

To identify tumors by reassessment of all available MRI scans in pharmacologically treated patients, operated or not, and to compare our results with the routine MRI reports.

Material and Methods

Adult patients diagnosed with acromegaly and managed at a tertiary care center between 2005 and 2021 and currently on pharmacological treatment were included. MRI scans were evaluated in a standardized manner and classified independently by a radiologist and an endocrinologist into “certain,” “suspected,” or “no tumor.” In case of disagreement, consensus was achieved with a senior neuroradiologist. The results were compared using the clinical radiologists’ routine MRI reports.

Results

We identified certain and suspected tumors in 29/74 and 36/74 patients, respectively. No tumor was identified in nine patients. In five of these, no MRI contrast agent was given. Discrepancy between our results and the routine MRI reports was found in 31/74 patients ( P = 0.01). In 22 patients, the routine reports described no tumor while we identified certain tumors in 2/22 patients and suspected tumors in 13/22 patients.

Conclusion

In most patients with pharmacologically treated acromegaly, we identified a certain or suspected pituitary tumor. These findings were more frequent compared to the routine MRI reports. Based on our results, patients will be considered for a change in long-term treatment modality.
Combination of secukinumab and acitretin for generalized pustular psoriasis: A case report and review of literature
Authors: Li Ji , Wang Shiyu , Li Xiao-Dong , Han Yang
Published: April 2024

Generalized pustular psoriasis (GPP) is characterized by painful and occasionally disfiguring cutaneous manifestations with sepsis-like systemic symptoms, and is a rare severe variant of psoriasis. Currently, there is no standard treatment for GPP. Here, we report a case of a female patient with ankylosing spondylitis (AS) and mild scalp psoriasis, who developed GPP and alopecia following three courses of adalimumab therapy. The patient’s condition gradually improved following cessation of adalimumab and treatment with secukinumab and acitretin. After eight weeks of treatment, the patient achieved almost complete clearance of her psoriasis, her alopecia improved, and her AS was relieved. Therefore, we believe that a combination of secukinumab with acitretin may be a rational approach for the treatment of severe GPP.
The ecological value of Neotropical forest landscapes through a multicriteria approach employing spatial models
Authors: Amador-Cruz F , Figueroa-Rangel BL , Jiménez-García D , Mora-Ramírez MA , Olvera-Vargas M , Mendoza ME
Published: April 2024

Ecological value (EV) is a term used to characterize the biotic or abiotic elements of a landscape, excluding human influence. Significant criteria for EV estimation can be grouped into two categories: ecological properties (biodiversity and vulnerability) and functional/structural features (fragmentation, connectivity, and resilience). While various methodological frameworks exist for estimating these criteria, few studies integrate all five criteria, and even fewer compare their results with fieldwork data. The objective of this study was to devise a novel spatial modelling tool for EV estimation based on biodiversity, vulnerability, fragmentation, connectivity, and resilience, utilizing data from Neotropical montane forests in west-central Mexico. The model incorporated data on (i) biodiversity and vulnerability estimated through ecological niche models, (ii) fragmentation and connectivity using landscape spatial patterns, and (iii) resilience estimated through the inverse of the vegetation sensitivity index. The results were then compared with fieldwork data. Natural protected areas within the Neotropical montane forests of west-central Mexico exhibited high EVs; however, a substantial portion of these forests lack legal protection. In terms of vegetation types, cloud and semideciduous forests exhibited the highest EV, emphasizing the urgent need for legal protection of these vital ecosystems. The comparison process demonstrated a moderate to high correlation in some criteria between the spatial and fieldwork data, indicating that the spatial model robustly captured the landscape spatial patterns. The spatial modelling tool proposed in this study is not only practical but also reproducible and applicable globally. Its efficacy lies in combining ecological properties with the functional and structural features of the landscape, making it particularly suitable for delineating protected natural areas and contributing to landscape planning efforts.
Collaborative Optimization of Dynamic Lane Assignment and Signal Timing for Incident-Affected Intersections
Authors: Wang Jiawen , Chen Yuli , Feng Yang , Zhao Jing
Published: April 2024

Traffic accidents can lead to rapid changes in the traffic supply and demand at urban intersections, thus causing a severe traffic supply/demand imbalance during specific periods. Responding to accidents requires dynamic and accurate adjustments to optimize intersection resources collaboratively and enhance the real-time reliability and stability of traffic flows during such accidents. Currently, research on traffic incidents rarely considers real-time data-based collaborative optimization theories. Therefore, this study, supported by real-time incident detection technology and accident data, first considers the location and intensity of traffic incidents to update dynamically the changes in intersection traffic demand and supply. Subsequently, a dynamically collaborative optimization method is proposed based on lane assignment and signal timings to minimize the sum of variances of the degree of saturation of various approach lanes. Finally, various traffic demand scenarios are set, and the effectiveness of the proposed model is validated based on numerical and sensitivity analyses. The results demonstrate that compared with signal-only optimization and the highway capacity methods (HCM), the collaborative optimization method presented in this study reduces the average vehicular delay percentages by 8.54% and 16.47%, respectively. Sensitivity analysis indicates that, under various detour rates and detour modes, collaborative optimization methods have effectively mitigated the average vehicular delay at upstream intersections to varying degrees. In the context of real-time accident response, collaborative optimization methods demonstrate a capacity to promptly address the urgency of incidents occurring and maintain a sustained reduction in overall delay levels following detours.
Overview of Trends in Anemia and Iron Deficiency in the Mexican Population From 1999 to 2018-19
Authors: De la Cruz-Góngora Vanessa , Villalpando Salvador , Shamah-Levy Teresa
Published: April 2024

Background:

Despite the emergence of diverse programs in Mexico to address anemia and micronutrient deficiencies in disadvantaged groups, progress on reducing their prevalence has stagnated. In Mexico, anemia surveillance at the population level is conducted through the National Health and Nutrition Survey ENSANUT (for its acronym in Spanish).

Objective:

To overview the trends in anemia and iron deficiency (ID) from 1999 to 2018-19 in the Mexican population before COVID-19 pandemic.

Methods:

Data from five nationwide surveys in Mexico were used. Where available, data on anemia, ID, and ID anemia (IDA) were extracted from ENSANUTs 1999, 2006, 2012, 2016, and 2018-19 in participants from 1 to 99 years old. Blood sample collection methods were similar across surveys (1999-2018) where capillary drop blood was used to estimate Hb using a HemoCue and serum blood samples to measure ferritin and C-reactive protein concentration.

Results:

The trend in anemia prevalence shows a U-shape from 1999 to 2018-19 in <60 years old. In older adults (≥60 years), an increasing trend was observed. Anemia declined progressively from 1999 to 2012 but increased from 2016 to 2018-19 in comparison with 2012. In contrast, ID declined from 2006 to 2018-19, mainly in children, while IDA did not change over this period. In older adults, ID prevalence remained constant over time.

Conclusions:

The shifting trend in anemia prevalence across ENSANUTs 1999 through 2018-19 did not mimic the decreasing trend of ID over the same period of time. Other noncausal factors seem to play an important role in the variability of hemoglobin measurements.
Managing Student Behavior in Middle School Special Education Classrooms: A Single-Subject Study of CW-FIT
Authors: Johnson Kelsey A. , Caldarella Paul , Wills Howard P. , Hansen Blake D. , Richards Erika J.
Published: April 2024

Teachers have the responsibility of managing student classroom behavior. The positive effects of evidence-based classroom management methods, like Class-Wide Function-related Intervention Teams (CW-FIT), have been demonstrated in a variety of settings; however, research on the efficacy of CW-FIT in special education classrooms is scarce. The purpose of this study was to determine the effectiveness of CW-FIT in two middle school special education math classrooms. Teachers implemented CW-FIT by instructing students in classroom behavior expectations and using a group contingency involving the use of teams, a timer, praise, points, and group rewards. One teacher alternated between using an audible and inaudible timer, while the other used an audible timer. There was an increase in student on-task behavior and teacher praise when CW-FIT was implemented, with no significant difference in outcomes between conditions with an audible versus inaudible timer. Teachers and students indicated that they found the intervention to be socially valid.
Development of an Infantile GM2 Clinical Rating Scale: Remote Assessment of Clinically Meaningful Health-Related Function
Authors: Kiefer Michael , Simione Meg , Eichler Florian S. , Townsend Elise L.
Published: April 2024

GM2 gangliosidoses (GM2) are a group of rare lysosomal storage disorders in which accumulation of GM2 gangliosides results in progressive central nervous system damage. The infantile GM2 phenotype is characterized by delays in milestones by 6 months of age, followed by rapid loss of motor, cognitive, and visual function. Advancements in early diagnosis and pharmacotherapies provide promise for improved outcomes. However, the lack of feasible and clinically meaningful clinical outcome assessments for GM2 poses a challenge to characterizing GM2 natural history and selecting clinical trial endpoints. The purpose of this study was to develop a remotely administered infantile GM2 rating scale to measure health-related function in children with infantile GM2. A 2-phase mixed methods design was employed. In phase 1 of the study, 8 families of children with Infantile GM2 completed a natural history survey and a 1:1 semistructured interview to provide caregiver perspectives on the impacts of GM2 on health-related function. In phase 2 of the study, 8 expert clinicians provided feedback via surveys and participated in videoconference-hosted focus groups to refine scale administration and scoring procedures. These methods guided the development of 16 scale items to assess function in 5 health-related function domains: vision, hand and arm use, communication, gross motor, and feeding. This study used caregiver perspectives and expert clinician feedback to develop a remotely administered clinical outcome assessment of clinically meaningful health-related function in children with infantile GM2. Future studies will further evaluate the feasibility, reliability, and validity of the Infantile GM2 Clinical Rating Scale.
Preparing gelatin-containing polycaprolactone / polylactic acid nanofibrous membranes for periodontal tissue regeneration using side-by-side electrospinning technology
Authors: Zhang Zhuochen , Zhang Ying , Guo Yabin , Qian Cheng , Chen Kailun , Fang Sheng , Qiu Anna , Zhong Liangjun , Zhang Jian , He Rui
Published: April 2024

Electrospinning technology has recently attracted increased attention in the biomedical field, and preparing various cellulose nanofibril membranes for periodontal tissue regeneration has unique advantages. However, the characteristics of using a single material tend to make it challenging to satisfy the requirements for a periodontal barrier film, and the production of composite fibrous membranes frequently impacts the quality of the final fiber membrane due to the influence of miscibility between different materials. In this study, nanofibrous membranes composed of polylactic acid (PLA) and polycaprolactone (PCL) fibers were fabricated using side-by-side electrospinning. Different concentrations of gelatin were added to the fiber membranes to improve their hydrophilic properties. The morphological structure of the different films as well as their composition, wettability and mechanical characteristics were examined. The results show that PCL/PLA dual-fibrous composite membranes with an appropriate amount of gelatin ensures sufficient mechanical strength while obtaining improved hydrophilic properties. The viability of L929 fibroblasts was evaluated using CCK-8 assays, and cell adhesion on the scaffolds was confirmed by scanning electron microscopy and by immunofluorescence assays. The results demonstrated that none of the fibrous membranes were toxic to cells and the addition of gelatin improved cell adhesion to those membranes. Based on our findings, adding 30% gelatin to the membrane may be the most appropriate content for periodontal tissue regeneration, considering the scaffold’s mechanical qualities, hydrophilic properties and biocompatibility. In addition, the PCL-gelatin/PLA-gelatin dual-fibrous membranes prepared using side-by-side electrospinning technology have potential applications for tissue engineering.
Whether mismatch finds match in the digitalized era: A comparison of five types of graduates to align business education and banking jobs
Authors: Rahman Md Mahfuzur , Alam Gazi Mahabubul , Aziz Nor Azni Binti Abdul , Bashir Karima , Kader Romana
Published: April 2024

Reasons for the emerging mismatch between education and the labor market, its impact and the resolving mechanisms have been well studied. However, mismatch continues to be very problematic. Moreover, the new era of digitalization and artificial intelligence is accelerating this crisis. Acknowledging this tenet, we investigate further—whether a mismatch finds a match in the digitalized era. An individualist approach to answer each research question was considered so descriptive statistics, multinomial logistic regression and interviews are adopted under were implemented using the framework of both quantitative and qualitative methods. Findings suggest that the overall performance of the fully mismatched group (Science graduates) is comprehensively better compared to their counterpart (Business graduates). Digitalization has further generated a mismatch since business graduates are now increasingly irrelevant. This paper supplements the discourse on education and job market mismatch by using a distinct measurement strategy. We argue that digitalized skills are now the required competence to do jobs in any sector. Hence, all types of schools (business, science, social sciences) should equip their graduates with digitized skills in order to prevent them being replaced by science graduates.
Simulation and experimental research on longitudinal-torsional ultrasonic vibration drilling of CFRP/Ti laminates
Authors: Zhu He , Feng Yong , Zhou Zhiyuan , Lu Baofeng , Zheng Lei , Xu Weiwei
Published: April 2024

Carbon fiber reinforced polymer (CFRP) and titanium alloy (Ti) laminated materials are extensively employed as primary load-bearing structures in aerospace engineering due to their exceptional characteristics. During the drilling process of CFRP/Ti laminates, issues like delamination and burr formation significantly impede the overall performance of these laminates. The finite element simulation was carried out to address above challenges using longitudinal-torsional ultrasonic vibration drilling (LT-UVD) of CFRP/Ti laminates. A three-dimensional solid model of CFRP/Ti laminates was developed using the ABAQUS custom VUMAT subroutine interface. A cohesive element was skillfully incorporated into the model to simulate delamination defects in the CFRP material effectively and to elucidate the material damage trends and stress distribution throughout the drilling process of laminated materials. The results obtained from the finite element simulation are meticulously compared with experimental data, revealing a consistent trend in the axial force curve. The simulated axial force’s peak value is 14.45% lower than the peak value obtained from experimental observations. The findings of this research substantiate the efficacy of the developed finite element model for LT-UVD of CFRP/Ti. The model successfully predicted the changing trend of axial force and layered defects during the drilling process. Moreover, it provides a visually intuitive instantaneous cutting state and stress distribution, imparting valuable insights into the intricate drilling mechanisms involved in CFRP/Ti laminates.
Seroprevalence of sexually transmitted infections over 44 years – A cross-sectional study in Sweden
Authors: Andersson Nirina , Waterboer Tim , Nylander Elisabet , Idahl Annika
Published: April 2024

Background

Sexually transmitted infections (STIs) may cause substantial individual suffering and a large economic burden for society. This study examined the seroprevalence of Chlamydia trachomatis, Mycoplasma genitalium, herpes simplex virus (HSV) types 1 and 2, and several human papillomaviruses (HPV) in the Swedish population over time.

Methods

The study population consisted of 30-year-old women attending maternity care, and 50 year-old men and women attending health check-ups, from 1975 to 2018. Antibody status was determined by multiplex serology and quantified using median reporter fluorescence intensity (MFI).

Results

A total of 891 samples were analysed (519 from 30-year-old women, 186 from 50 year-old women and 186 from 50 year-old men). Of these, 41.5% showed seropositivity for Chlamydia trachomatis, 16.7% for Mycoplasma genitalium, 70.5% for HSV-1, 14.9% for HSV-2, 13.2% for high-risk HPV, and 8.3% for low-risk HPV. Seropositivity for Mycoplasma genitalium, HSV-1 and especially Chlamydia trachomatis decreased over time.

Conclusions

There was a decrease over time in Chlamydia trachomatis seroprevalence, probably due to contact tracing, testing and early treatment; this might also have affected Mycoplasma genitalium seroprevalence. Despite the reduction, seroprevalences are still high, so continued and new efforts to reduce STI incidence are essential.
Robust vibration control for a flexible cable gantry crane system subject to boundary disturbance
Authors: Huang Xin , Wu Wei , Lou Xuyang , Görges Daniel
Published: April 2024

This paper addresses the robust vibration control problem for a gantry crane system which is governed by a partial differential equation. The control objectives are to transport the cargo from the initial position to the desired position and suppress the vibration of the cable and payload in the presence of boundary disturbance. To achieve the objectives, a sliding-mode controller is proposed by repressing the boundary disturbance. By using the operator semigroup theory, the well-posedness of the closed-loop system is guaranteed. The asymptotic stability of the closed-loop system is proven by using the extended LaSalle’s invariance principle. Both numerical simulations and experiments are provided to illustrate the effectiveness of the proposed boundary control method.
A novel adaptive super-twisting trajectory tracking control with back propagation algorithm for a quadrotor UAV
Authors: Huang Peike , Sun Jie , Qin Xinghao , Li Jixun
Published: April 2024

This paper presents a new method for controlling a quadrotor unmanned aerial vehicle (UAV) with neural network adaptive adjustment combined with a super-twisting algorithm, which utilizes back-propagation algorithm in neural networks to design an adaptive method that can adjust the coefficients of the sliding mode surface as well as the control gain adjustment adaptive problem in the super-twisting to improve the stability and accuracy of the position and attitude control of the quadrotor UAV under uncertainty and external disturbances. Specifically, the adaptive neural network learns to dynamically adjust the sliding surface parameters and control gain, effectively inhibiting the sensitivity to parameter uncertainty and external disturbances, while the super-twisting sliding mode control ensures that the sliding trajectory converges in finite time and reduces the chattering phenomenon. In addition, the quadrotor UAV system is divided into a fully-actuated subsystem and an under-actuated subsystem, each of which contains two control inputs and the appropriate control algorithms are designed respectively, and the stability of the algorithm is demonstrated by means of a Lyapunov function in finite time. The proposed control method for quadrotor UAVs is validated through numerical simulations conducted in the Matlab/Simulink environment.
Alpha-1 Antitrypsin Augmentation Therapy in Chronic Pancreatitis Patients Undergoing Total Pancreatectomy and Islet Autotransplantation: A Randomized, Controlled Study
Authors: Wang Hongjun , Gou Wenyu , Nietert Paul J. , Hirsch Jason , Wang Jingjing , Allawi Ahmed , Mortadha Abd S. , Cook Kelsey , Overstreet Morgan , Wei Hua , Adams David , Lancaster William P. , Morgan Katherine A. , Strange Charlie
Published: April 2024

Stress-induced islet graft loss during the peri-transplantation period reduces the efficacy of islet transplantation. In this prospective, randomized, double-blind clinical trial, we evaluated the safety and efficacy of 60 mg/kg human alpha-1 antitrypsin (AAT) or placebo infusion weekly for four doses beginning before surgery in chronic pancreatitis (CP) patients undergoing total pancreatectomy and islet autotransplantation (TP-IAT). Subjects were followed for 12 months post-TP-IAT. The dose of AAT was safe, as there was no difference in the types and severity of adverse events in participants from both groups. There were some biochemical signals of treatment effect with a higher oxygen consumption rate in AAT islets before transplantation and a lower serum C-peptide (an indicator of islet death) in the AAT group at 15 min after islet infusion. Findings per the statistical analysis plan using a modified intention to treat analysis showed no difference in the C-peptide area under the curve (AUC) following a mixed meal tolerance test at 12 months post-TP-IAT. There was no difference in the secondary and exploratory outcomes. Although AAT therapy did not show improvement in C-peptide AUC in this study, AAT therapy is safe in CP patients and there are experiences gained on optimal clinical trial design in this challenging disease.
Intraindividual Conflicts Reduce the Polarization of Attitudes
Authors: Sassenberg Kai , Winter Kevin
Published: April 2024

Societies are increasingly divided about political issues such as migration or counteracting climate change. This attitudinal polarization is the basis for intergroup conflict and prevents societal progress in addressing pressing challenges. Research on attitude change should provide an answer regarding how people might be persuaded to move away from the extremes to take a moderate stance. However, persuasive communication often most strongly affects those who hold a moderate attitude or are undecided. More importantly, barely any research has explicitly aimed at mitigating extreme attitudes and behavioral tendencies. Addressing this gap, this article summarizes research demonstrating that (different types of) intraindividual conflicts might be a means to mitigate polarized attitudes. Goal conflicts, cognitive conflicts, counterfactual thinking, and paradoxical thinking facilitate cognitive flexibility. This, in turn, seems to initiate the consideration of alternative stances and mitigate the polarization of attitudes. We discuss the limitations of the existing research and the potential of this approach for interventions.
An Empirical Study on Customer Perception Towards Digital  Marketing in the Banking Sector
Authors: Pruthi Nishita , Bansal Rohit
Published: April 2024

For marketers, the digital world offers a plethora of novel opportunities. Marketing in the modern day is all about relationships, involvement and relevancy. Digital marketing is the practice of marketers promoting goods and services through electronic media. The main objective of this study is to study the perception of customers towards digital marketing strategies implemented in the banking sector. Data were gathered from 535 banking customers by transmitting the questionnaire via Google Forms and handing out printed copies of the questionnaire. Results suggested that customers perceive digital marketing strategies as informative, interactive, entertaining and trustworthy but not offensive and personalised. Further, it was found that there is no significant difference among customers of different educational levels and occupations regarding customer perception towards digital marketing while a significant difference was found among customers based on age and income level. This analysis adds a great deal to the body of knowledge on marketing and has useful implications for marketing professionals as comprehending the perception of customers towards digital marketing may assist them in anticipating the usage of digital marketing.
What is the Cost of Logistics Activities in Healthcare Businesses? A Case Study of a Medical Centre in Türkiye
Authors: Cavmak Dogancan , Aksoylu Semra
Published: April 2024

Logistics holds an important role in healthcare provision. One of the significant dimensions of logistics is the cost incurred for these activities. However, the cost of logistics is an overlooked issue in most healthcare organisations. The purpose of this study is to provide an insight into the cost of logistic activities in healthcare businesses. A case study was conducted in a medical centre in Istanbul. Historical data (second half of 2021) were used for the analysis. Activity-based costing method was adopted for cost calculation. In line with this approach, logistic activities of the medical centre were examined, and logistic activity centres were determined. Resource consumption of each centre was determined based on interviews with staff and records of the accounting department. Consequently, the costs of all logistic activities of the medical centre were calculated, and their share in the total cost of service production was determined. The total logistical cost of the healthcare centre was calculated to be ₺689,983. The cost of patient services and transporting activity centres accounted for 49% of total logistical costs. The costs of logistic activities accounted for 15.42% of the total cost of service. The results of the study show that logistic activities have a significant share of the total cost of service production in the medical centre. Activity-based costing is an effective way of calculating costs of logistic activities in healthcare services. Managers can use cost data to improve logistic processes.
Tumours of the foot: A 10 years retrospective analysis
Authors: Ajit Singh Vivek , Sandhu Vinesh , Tze Yong Choo , Yasin Nor Faissal
Published: April 2024

Introduction

The foot is a complex structure composed of several tissues, each of which can be the origin of the proliferation and development of the tumour. Most lesions about the foot are reactive or inflammatory, but some are true neoplasms.

Method

This is a retrospective analysis of 4997 patient records treated in the Orthopaedic Oncology Unit of University Malaya Medical Centre, Malaysia, between 1 January 2010 to 31 December 2020. Demographic data of 195 patients with foot tumours were analysed out of 4997 neoplasm patients.

Results

There were 195 cases of foot tumours: 148 were benign, and 47 were malignant. 47 were bone tumours, 4 were metastases, and 144 were soft tissue tumours. Six patients succumbed to the disease, two cases of giant cell tumour (GCT) and one patient with synovial sarcoma had a recurrence. Treatment of foot tumours was wide resection in general. However, in metastasis cases, amputation was done. The majority of tumours were in the toes and dorsum of the foot. Soft tissue tumours of the foot occur in the elderly population in contrast to bone tumours, mainly in the second decade of life. The gender distribution was almost equal for foot tumours. Ganglion and Giant Cell Tumour of the bone are the commonest benign soft tissue and bone tumours. The most common malignant soft tissue and bone tumours are malignant melanoma and chondrosarcoma. The amputation rate is 5.64% the recurrence rate is 1.54%. Mortality rate is 3.08%. The MSTS score is 79%, and the TESS score is 76.23%.

Conclusion

Foot tumours are relatively rare, mostly originating from soft tissue and exhibiting a benign nature. Nonetheless, a noteworthy proportion—approximately a quarter of these tumours—demonstrate malignancy. The surgical interventions undertaken in managing these tumours and associated functional outcomes generally yield acceptable results.
DPA independence and ‘indirect’ access—illusory in Belgium, France and Germany?
Authors: Dimitrova Diana , De Hert Paul
Published: April 2024

Directive 2016/680 provides for two procedures for the exercise of the rights of access to one's data: a direct one (that is, directly against the law enforcement authority) and an ‘indirect’ one, in which the responsible Data Protection Authority (DPA) exercises the right of access of the data subject against the law enforcement authority which refused the direct access, including by carrying out a legality check on the data processing of the personal data of the individual requesting access. The recent judgment in Ligue des droits humains ASBL treated the question of the powers of DPAs in the framework of this procedure, amongst others, as a matter of DPA independence. Existing literature has observed that the implementing laws of three Member States – Belgium, France and Germany – severely restrict the powers of the DPAs when these perform the ‘indirect’ right of access, for example to carry out the legality check and inform the individuals of the results of the check. In the this article we will argue that these national restrictions constitute an unjustified interference with the requirement on DPA independence in EU data protection law, including in Article 8(3) of the EU Charter of Fundamental Rights.
Chilling effect: Turning the poison into an antidote for fundamental rights in Europe
Authors: Fajdiga Mohor
Published: April 2024

In the famous case of Baka v. Hungary, Judge Sicilianos proposed that the European Court of Human Rights should recognize a subjective right for judges to have their individual independence safeguarded and respected by the State. Such a reading of Article 6 of the Convention would enable national judges to claim a violation of that provision each time their individual independence is interfered with. It would also allow the Court to address one of the critical blind spots in the Convention system. However, the Court left the proposal dormant until recently. It is now put before the parties in three pending cases. This article argues that the Court should seize the opportunity to enhance the protection of judicial independence, but not by employing the proposed subjective right approach. Instead, it should rely on the better alternative: the chilling effect. Such an approach would enable the Court to fill the gaps in the Convention while remaining faithful to the text and avoiding the impression that judicial independence is a privilege of judges.
Analysis of the Complexity of Palliative Care for Cancer Patients
Authors: Mocha Campillo Fátima , Comín Orce Ana María , Monreal Cepero María Luna , Trincado Cobos Pablo , Gómez Mugarza Pablo , Barriendos Sanz Susana , Pascual de la Fuente Natalia , Ruffini Egea Sofia , Martínez Trufero Javier
Published: April 2024

Introduction

The Spanish National Health System has defined complexity as a set of factors of increased difficulty that require the intervention of a palliative care team. Palliative care aims to improve the quality of life of patients with chronic terminal illnesses. This study aims to describe the degree of complexity of cancer patients in palliative care, to determine which elements of complexity are most prevalent and to determine which other hospital clinical factors are associated with the level of complexity.

Methods

This study is a descriptive, observational, and cross-sectional analysis that included patients diagnosed with advanced oncological pathology undergoing palliative treatment who were admitted to the Medical Oncology ward of the Miguel Servet University Hospital between March and April 2023.

Result

A total of 100 patients were selected for the study. According to the IDC-Pal, 68% of patients were classified as highly complex, 26% of patients were complex and only 6% of patients were classified as non-complex. The presence of pain ( P < .001), nausea and vomiting ( P = .027), depression ( P = .033) and functional status ( P = .011) were statistically independent predictors of high complexity.

Discussion

This study has shown that a high proportion of hospitalized palliative care cancer patients have high complexity, suggesting a good matching of healthcare resources to patient complexity. Four factors related to complexity have been identified, namely pain, nausea and vomiting, depression and a bedridden functional state. The presence of any of the 4 factors could help healthcare professionals to identify patients for early specialized palliative care.