bluuebunny/crossref_metadata_2025_split huggingface dataset:
Information sharing to mitigate delays in port: the case of the Port of Rotterdam
Authors: Nikghadam Shahrzad , Molkenboer Kim F. , Tavasszy Lori , Rezaei Jafar 
Published: November 2021

AbstractReliability of service times has long been a concern of many ports around the world. This paper presents an approach to mitigate delays in service times through improved information sharing in ports. The approach is based on a mapping of information sharing links and their association to the root causes of frequently occurring delays. We identify the kind of information which is critical in mitigating delays. Critical information links are then re-ordered to create an information sharing arrangement between the actors, which further condenses and simplifies the required information sharing actions. We apply the proposed approach to the Port of Rotterdam. Quantitative data of 28,000 port calls is complemented by qualitative data collected through direct observations and expert interviews with port actors, including the pilot organization, a tugboat company, the boatmen organization, the harbour master, a terminal and a vessel agent. Besides the suggested arrangement for information sharing, the case reveals the critical position of pilots, a vulnerable position of tugboat companies and the minimal contribution made by the terminal towards information sharing. The increased pressure on ports by ever larger vessels seems to bear its fair share for delays and bottlenecks in the smooth execution of port operations.
Synthesis and anisotropic magnetism in quantum spin liquid candidates AYbSe2 (A = K and Rb)
Authors: Xing Jie , Sanjeewa Liurukara D. , May Andrew F. , Sefat Athena S. 
Published: November 2021

The quantum spin liquid (QSL) state in rare-earth triangular lattices has attracted much attention recently due to its potential application in quantum computing and communication. Here, we report the single-crystal growth synthesis, crystal structure characterizations, and magnetic properties of AYbSe2 (A = K and Rb) compounds. The x-ray diffraction analysis shows that AYbSe2 (A = K and Rb) crystallizes in a trigonal space group, R-3m (No. 166) with Z = 3. AYbSe2 possesses a two-dimensional (2D) Yb–Se–Yb layered structure formed by edged-shared YbSe6 octahedra. The magnetic properties are highly anisotropic for both title compounds, and no long-range order is found down to 0.4 K, revealing the possible QSL ground state in these compounds. The isothermal magnetization exhibits a one-third magnetization plateau when the magnetic fields are applied in the ab-plane. Heat capacity is performed along both ab-plane and c axis and features the characteristic dome for triangular magnetic lattice compounds as a function of magnetic fields. Due to the change in the interlayer and intralayer distance of Yb3+, the dome shifts to low fields from KYbSe2 to RbYbSe2. All these results indicate that the AYbSe2 family presents unique frustrated magnetism close to the possible QSL and noncollinear spin states.
A multifaceted approach in leveraging electronic health record tools for safe inpatient use of concentrated U-500 insulin
Authors: Willner Marc A , Ketz Jeffrey , Davis Ramona A , Yaniv Angela W , Bulgar-Grozav Alina , Wang Weishi , Shah Sneha , Pang Bob , Hesketh Alexandria 
Published: November 2021

Abstract

Purpose
The Institute for Safe Medication Practices classifies subcutaneous insulin as a high-risk medication. Concentrated U-500 insulin carries additional risks in comparison to conventional U-100 insulin, as the 5-fold more concentrated nature of this product, limitations to insulin pen dosing, and various devices for dose measurement may lead to miscommunication of patient-reported doses, resulting in downstream errors in ordering, verification, or administration. We describe a multifaceted approach to leveraging technical tools within the electronic health record (EHR) for U-500 insulin use.

Summary
At Cleveland Clinic, the U-500 insulin use process evolved in a number of phases using EHR tools. Phase 1 included new clinical decision support and documentation tools during order entry, including a customized alert that fired during order entry recommending that the prescriber order a consult with endocrinology and requiring the prescriber to provide the patient’s home insulin measuring device and the source of the patient’s reported home dose. In order verification, a customized alert fired directing the pharmacist to contact the patient or patient’s nurse and validate the information provided by the prescriber. Phase 2 involved transitioning dispensing of patient-specific doses from tuberculin syringes to U-500 insulin syringes. Phase 3 transitioned to use of U-500 insulin pens and included automatic dose rounding of ordered doses down to the nearest 5 units, and an additional customized pharmacist alert intended for cost conservation was added to fire if the patient had a recent administration of U-500 insulin documented, directing the pharmacist to determine whether the nurse needed a new pen dispensed.

Conclusion
Cleveland Clinic successfully implemented customized tools and processes within the EHR pertaining to the prescribing, verification, dispensing, and administration of U-500 insulin.
A case of spontaneous idiopathic tension pneumoperitoneum successfully managed with bedside pig-tail catheter
Authors: Chang Wendy , Udo Mieko , Schulze Bettina 
Published: November 2021

Abstract
We present a 67-year-old gentleman with a high perioperative mortality and morbidity risk who presented with spontaneous idiopathic tension pneumoperitoneum that was successfully managed with bedside pig-tail catheter insertion. Here we also discuss other potential non-surgical aetiologies of pneumoperitoneum.
Incorporating Faith into Ethics Education
Authors: Smith Diane L. 
Published: November 2021

ABSTRACT:
Preparing students for ethical situations they will face in practice should be incorporated into nursing curricula, especially programs with a Christian focus. Linking ethical concepts with tenets from Scripture can increase students' confidence in their ability to respond through a biblical worldview to ethical dilemmas in nursing practice. Specific assignments can be geared to help students think critically about the Code of Ethics for Nurses with Interpretive Statements (Code) and biblical responses to ethical situations. Sample assignments are presented for the nine provisions of the Code.
Single-cell metabolomics reveals the metabolic heterogeneity among microbial cells
Authors: Meng Xuanlin , Tao Fei , Xu Ping 
Published: November 2021

AbstractIn microbial research, the heterogeneity phenomenon is closely associated with microbial physiology in multiple dimensions. For now, A few studies were proposed in transcriptome and proteome analysis to discover the heterogeneity among single cells. However, microbial single cell metabolomics has not been possible yet. Herein, we developed a method, RespectM, based on discontinuous mass spectrometry imaging, which can detect more than 700 metabolites at a rate of 500 cells per hour. While ensuring the high throughput of RespectM, it integrates matrix sublimation, QC-based peak filtering, and batch correction strategies to improve accuracy. The results show that RespectM can distinguish single microbial cells from the blank matrix with an accuracy of 98.4%, depending on classification algorithms. Furthermore, to verify the accuracy of RespectM for distinguishing different single cells, we performed a classification test on Chlamydomonas reinhardtii single cells among allelic strains. The results showed an accuracy of 93.1%, which provides RespectM with enough confidence to perform microbial single cell metabolomics analysis. As we expected, untreated microbial cells will spontaneously undergo metabolic grouping coherence with genetic and biochemical similarities. Interestingly, the pseudo-time analysis also provided intuitive evidence on the metabolic dimension, indicating the cell grouping is based on microbial population heterogeneity. We believe that the RespectM can offer a powerful tool in the microbial study. Researchers can now directly analyze the changes in microbial metabolism at a single-cell level with high efficiency.
Determinants of healthy diet choices during austerity in Greece
Authors: Koulierakis George , Dermatis Anastasia , Vassilakou Nair-Tonia , Pavi Elpida , Zavras Dimitris , Kyriopoulos John 
Published: November 2021

PurposeThe purpose of this paper is to investigate the key determinants of dietary choices of the Greek population during a period of financial austerity.Design/methodology/approachData from the 2016 “Health and Welfare” Greek national cross-sectional survey, in a representative sample of 2,003 individuals, were examined. The survey was conducted via computer-assisted telephone interviews. Sociodemographic characteristics and diet knowledge were examined as potential determinants of four dietary behaviours (fruit, fish, red meat and fast food consumption).FindingsFindings showed significant gender differences against men (64.4% were overweight and obese; 57.6% and 18.4% reported red meat and fast food consumption more than twice a week, respectively). Age and financial affordability were the most significant determinants of fruit consumption. Fish consumption was determined by age, financial affordability, and family status (unmarried, living with the parents). Gender, age, family status (unmarried, living alone), employment status (unemployed) and social support affected red meat consumption. Finally, factors influencing fast food consumption were gender, age and employment status (unemployed).Originality/valueThis research incorporates unique and original insight in the determinants of healthy dietary choices during the austerity measures in Greece. Findings could contribute to a better understanding of the main factors that influence healthy eating and help develop policies to encourage healthy dietary lifestyles for the general public.
Real‐world, long‐term treatment patterns of commonly used biologics in Canadian patients with moderate‐to‐severe chronic plaque psoriasis
Authors: Gooderham Melinda J. , Lynde Charles , Turchin Irina , Avadisian Miriam , Labelle Melanie , Papp Kim A. 
Published: November 2021

AbstractReal‐world and long‐term data on biologic treatment changes – including switching, discontinuation, dose escalation, and interval change (both increasing and decreasing) – are required to understand treatment patterns for psoriasis (PsO) in Canada. The study objectives were to evaluate the time to first biologic treatment change and to document these changes in Canadian patients with moderate‐to‐severe chronic plaque PsO. Charts from 13 Canadian sites were queried retrospectively (2005–2019); a period covering all biologic classes commonly used for PsO in Canada. Included were patients diagnosed with, and currently using biologics for, moderate‐to‐severe chronic plaque PsO. Time to first treatment change, nature of treatment change, number of lines of treatment, proportion of patients on each drug, and drug survival were collected. Based on 1149 medical charts, adalimumab had the longest time to first treatment change (49.3 months; 95% confidence interval, 37.4–67.4). Approximately half of the patients had a treatment change, and nearly 75% of these changes were either an interval change or a biologic switch. Lack of efficacy was the most prevalent primary reason for biologic switch (67.3%), whereas 6.7% of patients switched due to adverse events. Drug survival for etanercept and infliximab was approximately twice as long for patients who had dose optimization (i.e., dose escalation or interval change) than patients without dose optimization. The survival curve of adalimumab was similar to the one of ustekinumab after 48 months of treatment, showing approximately 60% of patients remaining on treatment after 132 months, with or without dose optimization. Assessing treatment patterns of all commonly used biologics for moderate‐to‐severe chronic plaque PsO in Canada between 2005 and 2019 showed that approximately half of the patients required a treatment change (mainly interval change or biologic switch) while the other half remained on treatment.
A soil‐nesting invasive ant disrupts carbon dynamics in saplings of a foundational ant–plant
Authors: Milligan Patrick D. , Martin Timothy A. , Pringle Elizabeth G. , Riginos Corinna , Mizell Gabriella M. , Palmer Todd M. 
Published: November 2021

Abstract

Nearly every terrestrial ecosystem hosts invasive ant species, and many of those ant species construct underground nests near roots and/or tend phloem‐feeding hemipterans on plants. We have a limited understanding of how these invasive ant behaviours change photosynthesis, carbohydrate availability and growth of woody plants.

We measured photosynthesis, water relations, carbohydrate concentrations and growth for screenhouse‐reared Acacia drepanolobium saplings on which we had manipulated invasive Pheidole megacephala ants and native Ceroplastes sp. hemipterans to determine whether and how soil nesting and hemipteran tending by ants affect plant carbon dynamics. In a field study, we also compared leaf counts of vertebrate herbivore‐excluded and ‐exposed saplings in invaded and non‐invaded savannas to examine how ant invasion and vertebrate herbivory are associated with differences in sapling photosynthetic crown size.

Though hemipteran infestations are often linked to declines in plant performance, our screenhouse experiment did not find an association between hemipteran presence and differences in plant physiology. However, we did find that soil nesting by P. megacephala around screenhouse plants was associated with >58% lower whole‐crown photosynthesis, >31% lower pre‐dawn leaf water potential, >29% lower sucrose concentrations in woody tissues and >29% smaller leaf areas. In the field, sapling crowns were 29% smaller in invaded savannas than in non‐invaded savannas, mimicking screenhouse results.

Synthesis. We demonstrate that soil nesting near roots, a common behaviour by Pheidole megacephala and other invasive ants, can directly reduce carbon fixation and storage of Acacia drepanolobium saplings. This mechanism is distinct from the disruption of a native ant mutualism by P. megacephala, which causes similar large declines in carbon fixation for mature A. drepanolobium trees. Acacia drepanolobium already has extremely low natural rates of recruitment from the sapling to mature stage, and we infer that these negative effects of invasion on saplings potentially curtail recruitment and reduce population growth in invaded areas. Our results suggest that direct interactions between invasive ants and plant roots in other ecosystems may strongly influence plant carbon fixation and storage.
Trust, affect, and choice in parents’ vaccination decision‐making and health‐care provider selection in Switzerland
Authors: Deml Michael J. , Buhl Andrea , Huber Benedikt M. , Burton‐Jeangros Claudine , Tarr Philip E. 
Published: November 2021

AbstractThis article examines the relationships between biomedicine, complementary and alternative medicine (CAM) and parents’ vaccination decision‐making in Switzerland. Our empirical evidence sheds light on an understudied phenomenon—parents switching from one doctor to another provider (often one offering CAM services) around issues that arise during vaccination consultations. This is important to understand since CAM is used by 25%–50% of the Swiss population and is integrated into the Swiss health‐care system when offered by biomedically trained medical doctors with additional CAM training. Qualitative data gathered from in‐depth semi‐structured interviews with parents (N = 30) and ethnographic observations of vaccination consultations (N = 16 biomedical consultations, N = 18 CAM consultations) demonstrate how there was not always a clear‐cut, direct relationship between (non)vaccination and parents’ use of CAM and/or biomedicine. Borrowing from Hirschman (Exit, voice, and loyalty: Responses to decline in firms, organizations, and states, Harvard Univ. Press, 1970), we frame our analysis by using the concepts of exit, voice and loyalty to describe parents’ provider selection and vaccination decision‐making process, although only four families in the sample described switching solely because of vaccination‐related issues. Findings add to vaccine decision‐making literature by describing and analysing the underdiscussed provider‐switching phenomenon and by demonstrating the importance of parents’ experiences of trust, affect and choice in vaccination consultations as they pursue the best health outcomes for their children.
Changing landscape of nursing homes serving residents with dementia and mental illnesses
Authors: Xu Huiwen , Intrator Orna , Culakova Eva , Bowblis John R. 
Published: November 2021

AbstractObjectiveNursing homes (NHs) are serving an increasing proportion of residents with cognitive issues (e.g., dementia) and mental health conditions. This study aims to: (1) implement unsupervised machine learning to cluster NHs based on residents' dementia and mental health conditions; (2) examine NH staffing related to the clusters; and (3) investigate the association of staffing and NH quality (measured by the number of deficiencies and deficiency scores) in each cluster.Data sources2009–2017 Certification and Survey Provider Enhanced Reporting (CASPER) were merged with LTCFocUS.org data on NHs in the United States.Study designUnsupervised machine learning algorithm (K‐means) clustered NHs based on percent residents with dementia, depression, and serious mental illness (SMI, e.g., schizophrenia, anxiety). Panel fixed‐effects regressions on deficiency outcomes with staffing‐cluster interactions were conducted to examine the effects of staffing on deficiency outcomes in each cluster.Data extraction methodsWe identified 110,463 NH‐year observations from 14,671 unique NHs using CASPER data.Principal findingsThree clusters were identified: low dementia and mental illnesses (Postacute Cluster); high dementia and depression, but low SMI (Long‐stay Cluster); and high dementia and mental illnesses (Cognitive‐mental Cluster). From 2009 to 2017, the number of Postacute Cluster NHs increased from 3074 to 5719, while the number of Long‐stay Cluster NHs decreased from 6745 to 3058. NHs in Long‐stay/Cognitive‐mental Clusters reported slightly lower nursing staff hours in 2017. Regressions suggested the effect of increasing staffing on reducing deficiencies is statistically similar across NH clusters. For example, 1 hour increase in registered nurse hours per resident day was associated with −0.67 (standard error [SE] = 0.11), −0.88 (SE = 0.12), and −0.97 (SE = 0.15) deficiencies in Postacute Cluster, Long‐stay Cluster, and Cognitive‐mental Cluster, respectively.ConclusionsUnsupervised machine learning detected a changing landscape of NH serving residents with dementia and mental illnesses, which requires assuring staffing levels and trainings are suited to residents' needs.
Restrictive versus liberal transfusion in patients with diabetes undergoing cardiac surgery: An open‐label, randomized, blinded outcome evaluation trial
Authors: Mistry Nikhil , Shehata Nadine , Carmona Paula , Bolliger Daniel , Hu Raymond , Carrier François M. , Alphonsus Christella S. , Tseng Elaine E. , Royse Alistair G. , Royse Colin , Filipescu Daniela , Mehta Chirag , Saha Tarit , Villar Juan C. , Gregory Alexander J. , Wijeysundera Duminda N. , Thorpe Kevin E. , Jüni Peter , Hare Gregory M. T. , Ko Dennis T. , Verma Subodh , Mazer C. David ,   TRICS Investigators
Published: November 2021

AbstractAimTo characterize the association between diabetes and transfusion and clinical outcomes in cardiac surgery, and to evaluate whether restrictive transfusion thresholds are harmful in these patients.Materials and MethodsThe multinational, open‐label, randomized controlled TRICS‐III trial assessed a restrictive transfusion strategy (haemoglobin [Hb] transfusion threshold <75 g/L) compared with a liberal strategy (Hb <95 g/L for operating room or intensive care unit; or <85 g/L for ward) in patients undergoing cardiac surgery on cardiopulmonary bypass with a moderate‐to‐high risk of death (EuroSCORE ≥6). Diabetes status was collected preoperatively. The primary composite outcome was all‐cause death, stroke, myocardial infarction, and new‐onset renal failure requiring dialysis at 6 months. Secondary outcomes included components of the composite outcome at 6 months, and transfusion and clinical outcomes at 28 days.ResultsOf the 5092 patients analysed, 1396 (27.4%) had diabetes (restrictive, n = 679; liberal, n = 717). Patients with diabetes had more cardiovascular disease than patients without diabetes. Neither the presence of diabetes (OR [95% CI] 1.10 [0.93‐1.31]) nor the restrictive strategy increased the risk for the primary composite outcome (diabetes OR [95% CI] 1.04 [0.68‐1.59] vs. no diabetes OR 1.02 [0.85‐1.22]; Pinteraction = .92). In patients with versus without diabetes, a restrictive transfusion strategy was more effective at reducing red blood cell transfusion (diabetes OR [95% CI] 0.28 [0.21‐0.36]; no diabetes OR [95% CI] 0.40 [0.35‐0.47]; Pinteraction = .04).ConclusionsThe presence of diabetes did not modify the effect of a restrictive transfusion strategy on the primary composite outcome, but improved its efficacy on red cell transfusion. Restrictive transfusion triggers are safe and effective in patients with diabetes undergoing cardiac surgery.
The impact of knowledge base on technological innovation of emerging industries from the perspective of related variety: A case study of China’s fuel cell industry
Authors: Mi Zefeng , Shang Yongmin , Zeng Gang 
Published: November 2021

AbstractThe location of emerging industries has been hotly debated in the field of economic geography. While the concept of Windows of Locational Opportunity proposes that new industries emerge with relative freedom in space, the literature on Regional Branching has been underlining the importance of existing knowledge base. The concept of related variety provides us with a new way to handle this ongoing debate. By dividing technological knowledge base of a region into related and unrelated knowledge bases, this study empirically examines the impact of knowledge base on technological innovation of emerging industries by utilizing patent data of China’s fuel cell industry from 2000 to 2016. The empirical findings clearly confirm the stable and positive impact of related technological knowledge base on the emergence and development of emerging industries. However, the direction of the impact of unrelated technological knowledge base changes from negative to positive with the maturity of the industry. To an increasing extent, emerging industries tend to be less free in space and prefer to locate in developed regions with related and unrelated knowledge.