bluuebunny/crossref_metadata_2025_split huggingface dataset:
A window of opportunity for ICU end‐of‐life care—A retrospective multicenter cohort study
Authors: Darfelt Iben Strøm , Nielsen Anne Højager , Klepstad Pål , Neergaard Mette Asbjoern 
Published: August 2024

AbstractBackgroundThe “window of opportunity” for intensive care staff to deliver end‐of‐life (EOL) care lies in the timeframe from “documenting the diagnosis of dying” to death. Diagnosing the dying can be a challenging task in the ICU. We aimed to describe the trajectories for dying patients in Danish intensive care units (ICUs) and to examine whether physicians document that patients are dying in time to perform EOL care and, if so, when a window of opportunity for EOL care exists.MethodsFrom the Danish Intensive Care Database, we identified patients ≥18 years old admitted to Danish ICUs between January and December 2020 with an ICU stay of >96 h (four days) and who died during the ICU stay or within 7 days after ICU discharge.A chart review was performed on 250 consecutive patients admitted from January 1, 2020, to ICUs in the Central Denmark Region.ResultsIn most charts (223 [89%]), it was documented that the patient was dying. Of those patients who received mechanical ventilation, 171 (68%) died after abrupt discontinuation of mechanical ventilation, and 63 (25%) died after gradual withdrawal. Patients whose mechanical ventilation was discontinued abruptly died after a median of 1 h (interquartile range [IQR]: 0–15) and 5 h (IQR: 2–15) after a diagnosis of dying was recorded. In contrast, patients with a gradual withdrawal died after a median of 108 h (IQR: 71–189) and 22 h (IQR: 5–67) after a diagnosis of dying was recorded.ConclusionsEOL care hinges on the ability to diagnose the dying. This study shows that there is a window of opportunity for EOL care, particularly for patients who are weaned from mechanical ventilation. This highlights the importance of intensifying efforts to address EOL care requirements for ICU patients and those discharged from ICUs who are not eligible for readmission.
Affirmative action and employment equity in the professions: Backlash fueled by individualism and meritocracy
Authors: Beagan Brenda L. , Sibbald Kaitlin R. , Goree Toni D. , Pride Tara M. 
Published: August 2024

AbstractIn the 40 years since federal employment equity initiatives were launched in Canada, they have faced persistent backlash. This backlash is grounded in and fueled by conceptualizations of justice and equality that are rooted in ideologies of individualism and meritocracy. Here we draw on 140 qualitative interviews with members of six professions from across Canada, who self‐identify as Indigenous, Black or racialized, ethnic minority, disabled, 2SLGBTQ+, and/or from working‐class origins, to explore tensions between concepts of justice grounded in group‐based oppressions and those grounded in individual egalitarianism. Though affirmative action and employment equity opened up opportunities, people were still left to fight for individual rights. This push to individualism was intensified by persistent hostile misperceptions that people are less qualified and in receipt of ‘unfair advantages.’ Through discursive misdirection, potential for transformative institutional change is undermined by liberal discourses of individualism and meritocracy.
Small vessel disease burden and prognosis of recent subcortical ischaemic stroke differ by parent artery atherosclerosis
Authors: Lin Qian‐Qian , Chen Hui‐Sheng , Yang Yi , Zhang Meng , Wu Shi‐Wen , Li Ming‐Li , Huang Yi‐Ning , Xu Wei‐Hai ,   Stroke Imaging Package Study (SIPS) study Group
Published: August 2024

AbstractBackground and purposeParent artery atherosclerosis is an important aetiology of recent subcortical ischaemic stroke (RSIS). However, comparisons of RSIS with different degrees of parent artery atherosclerosis are lacking.MethodsProspectively collected data from our multicentre cohort (all were tertiary centres) of the Stroke Imaging Package Study between 2015 and 2017 were retrospectively reviewed. The patients with RSIS defined as a single clinically relevant diffusion‐weighted imaging positive lesion in the territory of lenticulostriate arteries were categorized into three subgroups: (1) normal middle cerebral artery (MCA) on magnetic resonance angiography and high‐resolution magnetic resonance imaging (HR‐MRI); (2) low‐grade MCA atherosclerosis (normal or <50% stenosis on magnetic resonance angiography and with MCA plaques on HR‐MRI); (3) steno‐occlusive MCA atherosclerosis (stenosis ≥50% or occlusion). The primary outcome was 90‐day functional dependence (modified Rankin Scale score >2). The clinical and imaging findings were compared between subgroups.ResultsA total of 239 patients (median age 60.0 [52.0–67.0] years, 72% male) were enrolled, including 140 with normal MCA, 64 with low‐grade MCA atherosclerosis and 35 with steno‐occlusive MCA atherosclerosis. Patients with steno‐occlusive MCA atherosclerosis had the largest infarct volume. Low‐grade MCA atherosclerosis was independently associated with cerebral microbleeding, more severe perivascular spaces in basal ganglia and higher total cerebral small vessel disease burden. Low‐grade MCA atherosclerosis was an independent determinant of 90‐day functional dependence (odds ratio 3.897; 95% confidence interval 1.309–11.604).ConclusionsOur study suggested RSIS with varying severity of parent artery atherosclerosis exhibits distinctive clinical and neuroimaging characteristics, with low‐grade MCA atherosclerosis associating with higher cerebral small vessel disease burden and worse prognosis.
The many dimensions of combination therapy: How to combine antibiotics to limit resistance evolution
Authors: Nyhoegen Christin , Bonhoeffer Sebastian , Uecker Hildegard 
Published: August 2024

AbstractIn combination therapy, bacteria are challenged with two or more antibiotics simultaneously. Ideally, separate mutations are required to adapt to each of them, which is a priori expected to hinder the evolution of full resistance. Yet, the success of this strategy ultimately depends on how well the combination controls the growth of bacteria with and without resistance mutations. To design a combination treatment, we need to choose drugs and their doses and decide how many drugs get mixed. Which combinations are good? To answer this question, we set up a stochastic pharmacodynamic model and determine the probability to successfully eradicate a bacterial population. We consider bacteriostatic and two types of bactericidal drugs—those that kill independent of replication and those that kill during replication. To establish results for a null model, we consider non‐interacting drugs and implement the two most common models for drug independence—Loewe additivity and Bliss independence. Our results show that combination therapy is almost always better in limiting the evolution of resistance than administering just one drug, even though we keep the total drug dose constant for a ‘fair’ comparison. Yet, exceptions exist for drugs with steep dose–response curves. Combining a bacteriostatic and a bactericidal drug which can kill non‐replicating cells is particularly beneficial. Our results suggest that a 50:50 drug ratio—even if not always optimal—is usually a good and safe choice. Applying three or four drugs is beneficial for treatment of strains with large mutation rates but adding more drugs otherwise only provides a marginal benefit or even a disadvantage. By systematically addressing key elements of treatment design, our study provides a basis for future models which take further factors into account. It also highlights conceptual challenges with translating the traditional concepts of drug independence to the single‐cell level.
Field survey assessment of flood loads and related building damage from the July 2021 event in the Ahr Valley (Germany)
Authors: Wüthrich Davide , Korswagen Paul A. , Selvam Harish , Oetjen Jan , Bricker Jeremy , Schüttrumpf Holger 
Published: August 2024

AbstractThe July 2021 flood heavily affected many inhabitants, buildings and critical infrastructure throughout Germany, Belgium and the Netherlands. Specifically, the Ahr Valley (Germany) showcased the destructive power associated with these extreme events. Hence, this region was the focus of a field survey, aiming at describing the flood‐induced damage to buildings and assessing the possible underlying processes that led to structural failures. The field assessment revealed a close connection between building failures and (1) local flow depths and velocities, (2) building location, (3) distance from the riverbank and (4) construction type. Although it is difficult to identify the exact causes that induced failures, the detailed assessment revealed that damages mainly originated from local scour and hydraulic loads, often unevenly distributed around buildings. Importantly, many buildings were significantly affected by (large) floating debris impacts and damming, both responsible for additional loads, highlighting their importance in flood‐resistant building design. Furthermore, data showed that buildings near the riverbanks and in the upstream part of villages were more severely damaged. Altogether, data provide a better understanding of the flood processes that lead to building failures, fostering future research towards the development of safer protection measures and more effective flood risk management strategies.
Clinical and preclinical evidence on the bioeffects and movement‐related implications of photobiomodulation in the orthodontic tooth movement: A systematic review
Authors: Gonçalves Aline , Monteiro Francisca , Brantuas Sara , Basset Priscilla , Estevez Alejandro , Silva Filipe S. , Pinho Teresa 
Published: August 2024

AbstractPhotobiomodulation (PBM) has been demonstrated as a non‐invasive and painless technique with great potential to accelerate orthodontic tooth movement (OTM). However, there is a great inconsistency among PBM protocols and reported outcomes, probably due to the poor translatability of preclinical knowledge into early clinical practice. Hence, this review aims to fill this gap by establishing the state‐of‐the‐art on both preclinical and clinical applications of PBM, and by comprehensively discussing the most suitable stimulation protocols described in the literature. This review was conducted according to PRISMA guidelines. A bibliographic search was carried out in the PubMed, Scopus and Cochrane databases using a combination of keywords. Only studies written in English were eligible and no time limit was applied. A total of 69 studies were selected for this review. The revised literature describes that PBM can effectively reduce orthodontic treatment time and produce analgesic and anti‐inflammatory effects. We found that PBM of 640 ± 25, 830 ± 20 and 960 ± 20 nm, delivered at a minimum energy density per irradiation point of 5 J/cm2 daily or every other day sessions is robustly associated with increased tooth movement rate. Pain relief seems to be achieved with lower irradiation doses compared to those required for OTM acceleration. For the first time, the bioeffects induced by PBM for the acceleration of OTM are comprehensively discussed from a translational point of view. Collectively, the evidence from preclinical and clinical trials supports the use of PBM as a coadjuvant in orthodontics for enhancing tooth movement and managing treatment‐associated discomfort. Overall, the revised studies indicate that optimal PBM parameters to stimulate tissue remodelling are wavelengths of 830 ± 20 nm and energy densities of 5–70 J/cm2 applied daily or every other day can maximize the OTM rate, while lower doses (up to 16 J/cm2 per session) delivered in non‐consecutive days seem to be optimal for inducing analgesic effects. Future research should focus on optimizing laser parameters and treatment protocols customized for tooth and movement type. By fine‐tuning laser parameters, clinicians can potentially reduce treatment times, improve patient comfort and achieve more predictable outcomes, making orthodontic care more efficient and patient‐friendly, thus consolidating PBM usage in orthodontics.
Effect of low‐level light therapy in individuals with dry eye disease
Authors: Antwi Antoinette , Schill Alexander W. , Redfern Rachel , Ritchey Eric R. 
Published: August 2024

AbstractIntroductionLow‐level light therapy (LLLT) or photobiomodulation, the application of red light to the eye, is used for the treatment of dry eye. Limited studies have investigated the efficacy of LLLT as a stand‐alone treatment. The investigation aimed to evaluate the effect of LLLT on signs and symptoms of dry eye.MethodsParticipants with mild to moderate dry eye were recruited for this three‐visit study. Visits were 7 (±3) days apart and all participants received 633 nm LLLT (eye‐light®) for 15 min at each visit. Clinical measures including first and average non‐invasive keratograph tear break‐up time (NIKBUT), tear meniscus height (TMH), meibomian gland (MG) loss for upper and lower eyelids, ocular surface disease index (OSDI) score, tear film lipid layer thickness, meibum quality score, Schirmer's test, corneal fluorescein staining and eyelid temperature for external upper (EUL) and external lower (ELL) eyelids were measured from the right eye of participants before and after treatment.ResultsThirty participants (mean [SD] age: 31.1 [9.5] years) completed the study. Treatment with LLLT resulted in significant differences in first and average NIKBUT, TMH, tear film lipid layer thickness, OSDI score, Schirmer's test, meibum quality score and eyelid temperature over time (all p < 0.05). Compared to baseline, TMH, tear film lipid layer thickness and eyelid temperature significantly increased by 0.06 mm (95% CI: 0.01–0.11), 12.9 nm (95% CI: 1.18–24.55), and 7.0°C, respectively, for both EUL (95% CI: 6.17–7.84) and ELL (95% CI: 6.17–7.73). The respective decrease in the OSDI score and Schirmer's test was 10.2 (95% CI: −15.15 to −5.26) and 4.4 mm (95% CI: −7.31 to −1.42; all p < 0.05). There was no significant difference in corneal fluorescein staining and MG loss after LLLT.ConclusionLow‐level light therapy treatment significantly improved signs and symptoms of dry eye in the early phases of treatment, suggesting its efficacy for dry eye management.
Pan‐genome analysis of 13 Spinacia accessions reveals structural variations associated with sex chromosome evolution and domestication traits in spinach
Authors: She Hongbing , Liu Zhiyuan , Xu Zhaosheng , Zhang Helong , Wu Jian , Cheng Feng , Wang Xiaowu , Qian Wei 
Published: August 2024

SummaryStructural variations (SVs) are major genetic variants that can be involved in the origin, adaptation and domestication of species. However, the identification and characterization of SVs in Spinacia species are rare due to the lack of a pan‐genome. Here, we report eight chromosome‐scale assemblies of cultivated spinach and its two wild species. After integration with five existing assemblies, we constructed a comprehensive Spinacia pan‐genome and identified 193 661 pan‐SVs, which were genotyped in 452 Spinacia accessions. Our pan‐SVs enabled genome‐wide association study identified signals associated with sex and clarified the evolutionary direction of spinach. Most sex‐linked SVs (86%) were biased to occur on the Y chromosome during the evolution of the sex‐linked region, resulting in reduced Y‐linked gene expression. The frequency of pan‐SVs among Spinacia accessions further illustrated the contribution of these SVs to domestication, such as bolting time and seed dormancy. Furthermore, compared with SNPs, pan‐SVs act as efficient variants in genomic selection (GS) because of their ability to capture missing heritability information and higher prediction accuracy. Overall, this study provides a valuable resource for spinach genomics and highlights the potential utility of pan‐SV in crop improvement and breeding programmes.
Examining the lateralization of electrophysiological correlates of auditory awareness
Authors: Gerdfeldter Billy , Andersson Annika , Wiens Stefan 
Published: August 2024

AbstractThe neurological basis for perceptual awareness remains unclear, and theories disagree as to whether sensory cortices per se generate awareness. Critically, neural activity in the sensory cortices is only a neural correlate of consciousness (NCC) if it closely matches the contents of perceptual awareness. Research in vision and touch suggest that contralateral activity in sensory cortices is an NCC. Similarly, research in hearing with two sound sources (left and right) presented over headphones also suggests that a candidate NCC called the auditory awareness negativity (AAN) matches perceived location of sound. The current study used 13 different sound sources presented over loudspeakers for natural localization cues and measured event‐related potentials to a threshold stimulus in a sound localization task. Preregistered Bayesian mixed models provided moderate evidence against an overall AAN and very strong evidence against its lateralization. Because of issues regarding data quantity and quality, exploratory analyses with aggregated data from multiple loudspeakers were conducted. Results provided moderate evidence for an overall AAN and strong evidence against its lateralization. Nonetheless, the interpretations of these results remain inconclusive. Therefore, future research should reduce the number of conditions and/or test over several sessions to procure a sufficient amount of data. Taken at face value, the results may suggest issues with AAN as an NCC of auditory awareness, as it does not laterally map onto experiences in a free‐field auditory environment, in contrast to the NCCs of vision and touch.
A holistic approach proposal for 3D underground land management (3D ULA) in Turkey: The case of utility network
Authors: Sürmeneli Hicret Gürsoy , Sun Jing , Alkan Mehmet 
Published: August 2024

AbstractPhysical and cadastral data management practices for underground facilities are insufficient to represent underground assets' Rights, Restrictions, and Responsibilities (RRRs) and their relationships with the cadastre. For this reason, developing a 3D integrated data (underground and above‐ground) model may be an approach to an effective land management system. This research aims to develop a creative data model by integrating Turkish National Geographic Information System (TUCBS‐AY in Turkish) with international standards (Land Administration Domain Model (LADM) and CityGML) as a holistic approach. The requirements determined for underground facilities using TUCBS‐AY were used. Since the data produced in Turkey were modeled according to the CityGML 2.0 version, the CityGML 2.0 UtilityNetwork version was used in the study to be compatible with the existing Turkish cadastral system. While some classes in the model are generalized, they are expanded using LADM's classes for legal rights and part information. In addition, the CityGML classes have been expanded within the model so that parcels, buildings, and independent sections are represented separately, thus providing the opportunity to represent the underground utilities associated with them, their RRRs, and ownership situations. Requirements for the proposed model were determined based on Turkey's cadastral system and underground data. The main purpose is to manage the legal and physical relations of underground and surface objects at the city scale, compatible with the current Turkish cadastral system, with a holistic approach. The proposed integrated conceptual data model shows how legal rights and ownership of underground structures can be logically represented with a 3D data model.
A health decision analytical model to evaluate the cost‐effectiveness of female genital schistosomiasis screening strategies: The female genital schistosomiasis SCREEN framework
Authors: Lamberti Olimpia , Terris‐Prestholt Fern , Bustinduy Amaya L. , Bozzani Fiammetta 
Published: August 2024

AbstractFemale genital schistosomiasis is a chronic gynaecological disease caused by the waterborne parasite Schistosoma (S.) haematobium. It affects an estimated 30–56 million girls and women globally, mostly in sub‐Saharan Africa where it is endemic, and negatively impacts their sexual and reproductive life. Recent studies found evidence of an association between female genital schistosomiasis and increased prevalence of HIV and cervical precancer lesions. Despite the large population at risk, the burden and impact of female genital schistosomiasis are scarcely documented, resulting in neglect and insufficient resource allocation. There is currently no standardised method for individual or population‐based female genital schistosomiasis screening and diagnosis which hinders accurate assessment of disease burden in endemic countries. To optimise financial allocations for female genital schistosomiasis screening, it is necessary to explore the cost‐effectiveness of different strategies by combining cost and impact estimates. Yet, no economic evaluation has explored the value for money of alternative screening methods. This paper describes a novel application of health decision analytical modelling to evaluate the cost‐effectiveness of different female genital schistosomiasis screening strategies across endemic settings. The model combines a decision tree for female genital schistosomiasis screening strategies, and a Markov model for the natural history of cervical cancer to estimate the cost per disability‐adjusted life‐years averted for different screening strategies, stratified by HIV status. It is a starting point for discussion and for supporting priority setting in a data‐sparse environment.
Molecular detection of extended‐spectrum β‐lactamase‐ and carbapenemase‐producing Klebsiella pneumoniae isolates in southwest Iran
Authors: Jomehzadeh Nabi , Rahimzadeh Mohammad , Ahmadi Bahare 
Published: August 2024

AbstractObjectiveThe global emergence of carbapenem‐resistant Klebsiella pneumoniae is considered a significant contemporary concern., as carbapenems are the last resort for treating infections caused by multidrug‐resistant Gram‐negative bacteria. This study aimed to investigate the carbapenem‐resistance genes in extended‐spectrum β‐lactamase producing K. pneumoniae isolates.MethodsSeventy‐five non‐duplicate clinical K. pneumoniae strains were isolated from urine, blood, sputum, and wound samples. Antimicrobial susceptibility tests for 12 different antibiotics were performed using the disk diffusion method, followed by determining minimum inhibitory concentrations of imipenem and meropenem. Phenotypic detection of extended‐spectrum β‐lactamase and carbapenemase enzymes was performed by double‐disc synergy test and modified Hodge test, respectively. PCR assay further investigated resistant isolates for extended‐spectrum β‐lactamase and carbapenemase‐encoding genes.ResultsThe highest and lowest resistance rates were observed against ampicillin (93.3%) and tigecycline (9.3%). According to phenotypic tests, 46.7% of isolates were positive for extended‐spectrum β‐lactamase enzymes and 52.8% for carbapenemase. A total of 11 isolates contained carbapenemase genes, with blaOXA‐48 (19.4%; 7/36) being the predominant gene, followed by blaNDM (8.3%; 3/36).ConclusionThe study's findings reveal the alarming prevalence of beta‐lactamase enzymes in K. pneumoniae strains. Early detection of carbapenem‐resistant isolates and effective infection control measures are necessary to minimise further spread, as carbapenem resistance has become a public health concern.