bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of virtual reality compared to video training on acetabular cup and femoral stem implantation accuracy in total hip arthroplasty among medical students: a randomised controlled trial
Authors: Kenanidis Eustathios , Boutos Panagiotis , Voulgaris Grigorios , Zgouridou Aikaterini , Gkoura Eleni , Gamie Zakareya , Papagiannakis George , Tsiridis Eleftherios 
Published: November 2023

Abstract
Purpose
Virtual reality (VR) training effectiveness in improving hip arthroplasty surgical skills requires further evaluation. We hypothesised VR training could improve accuracy and the time taken by medical students compared to a control group with only video teaching.

Methods
This single-centre randomized controlled clinical trial collected data from March to June 2023. Surgically naïve volunteer undergraduate medical students performed three sessions on a VR training platform, either cup (VR-Cup=Control-Stem) or stem (VR-Stem=Control-Cup) implantation. The primary outcome was the mean difference between predefined cup inclination (60°) and stem anteversion (20°) compared to the actual implanted values in sawbones between VR and control groups. Secondary outcomes were task completion time and mistake number between the groups.

Results
A total of 101 students participated (VR-Cup 47, VR-Stem 54). Groups did not significantly differ concerning age (p = 0.879), gender (p = 0.408), study year (p = 0.938), previous VR use (p = 0.269) and baseline medical and procedural knowledge. The VR-Cup implanted the cup closer to the intended target (p < 0.001) and faster than the Control-Cup group (p = 0.113). The VR-Stem implanted the stem closer to the intended target (p = 0.008) but not faster than the Control-Cup group (p = 0.661). Stem retroversion was commoner in the Control-Stem than in the VR-Stem group (p = 0.016).

Conclusions
VR training resulted in higher rates of accurate procedure completion, reduced time and fewer errors compared to video teaching. VR training is an effective method for improving skill acquisition in THA.

Trial registration
ClinicalTrials.gov Identifier: NCT05807828
Diurnal variations of summer rainfall response to large-scale circulations and low-level winds over the Sichuan Basin
Authors: Li Juan , Chen Haoming , Jiang Xingwen , Li Puxi 
Published: November 2023

AbstractThe evident nocturnal peak dominates the summer rainfall over the Sichuan Basin (SCB), which is closely related to the nocturnal intensification of low-level winds. Based on 21-year IMERG rainfall product and reanalysis data during summertime (June–August) from 2000 to 2020, the low-level winds are classified into four groups, with strong or weak daily mean wind accompanied by a large or small diurnal amplitude, to clarify their influences on rainfall over the SCB. The results show that under strong daily mean wind conditions, the westward extension of the Western Pacific Subtropical High (WPSH) determines the southwesterly monsoon airflow to be tuned to the southerly over the eastern Yunnan-Guizhou Plateau, which provides abundant warm and moist air resources for rainfall within the basin through the southeastern side of the SCB. Strong mean winds, coupled with a large diurnal amplitude due to the acceleration of easterly, strengthen the moisture convergence at night, and contribute to the rainfall increasing remarkable over the SCB with a peak at midnight. Meanwhile, there is an apparent anomalous low-level warming over the SCB, creating more unstable atmospheric conditions. In addition, the weak upward motion associated with the afternoon heating over the eastern slope of the Tibetan Plateau (TP) enhances the easterly and facilitates the development of upward motion over the western SCB in the early night, which is responsible for the larger diurnal amplitude of rainfall. On the contrary, rainfall is suppressed and the diurnal amplitude of rainfall is gentle under the condition of weak daily wind with small diurnal amplitude, due to the weak moisture transport and cooling planetary boundary layer related to the deepened midlatitude trough, as well as more active convection over the eastern slope of TP during the day. The results imply that atmospheric conditions associated with diurnal variation of low-level winds should be considered as a key component in regulating the rainfall and moisture budget over the SCB, the strength of low-level winds in the early evening may provide a predictive signal for the development of nocturnal rainfall over the SCB.
In the eye of the ophthalmologist: the corneal microbiome in microbial keratitis
Authors: Sagerfors Susanna , Edslev Sofie , Lindblad Birgitta Ejdervik , Lilje Berit , Stegger Marc , Söderquist Bo 
Published: November 2023

Abstract
Purpose
To describe the bacterial findings by a targeted sequencing approach from corneal samples of patients with microbial keratitis and factors influencing culture outcome of indirectly inoculated corneal specimen.

Methods
Prospective inclusion of patients fulfilling predefined criteria of microbial keratitis. Samples from the corneal lesion were collected and dispensed in liquid transport medium, from which both culture and targeted amplification and sequencing of the V3-V4 region of the 16S rRNA gene were carried out. Additional standard corneal culture from the corneal lesions was also performed. Factors influencing culture outcome of indirectly inoculated corneal samples were identified by a multivariate regression model incorporating quantitative data from sequencing.

Results
Among the 94 included patients with microbial keratitis, contact lens wear (n = 69; 73%) was the most common risk factor. Contact lens wearers displayed significant differences in the bacterial community composition of the corneal lesion compared to no lens wearers, with higher abundance of Staphylococcus spp., Corynebacterium spp., and Stenotrophomonas maltophilia. Targeted sequencing detected a potential corneal pathogen in the highest proportional abundance among 9 of the 24 (38%) culture-negative patients with microbial keratitis. Age, bacterial density in the sample, and prior antibiotic treatment significantly influenced culture outcome of indirectly inoculated corneal samples.

Conclusion
Targeted sequencing may provide insights on pathogens in both culture negative episodes of microbial keratitis and among subgroups of patients with microbial keratitis as well as factors influencing culture outcome of indirectly inoculated corneal samples.
Jagged1 contained in MSC-derived small extracellular vesicles promotes squamous differentiation of cervical cancer by activating NOTCH pathway
Authors: Li Weizhao , Zhang Xunzhi , Gao Tianshun , Liu Lixiang , Zhang Chi , Yang Huan , Xie Jiayuan , Pan Wei , Deng David Y. B. , Zhang Changlin , Li Tian 
Published: November 2023

Abstract
Purpose
Cervical cancer is the fourth most common cancer in women and poses a major threat to women's health, urgently requiring new treatment methods.

Methods
This study first successfully extracted and identified small extracellular vesicles secreted by human umbilical cord-derived mesenchymal stem cells. We studied the effects of MSC-sEV on the squamous differentiation levels of cervical cancer CaSki cells in vitro, and explored the effects of MSC-sEV on the NOTCH pathway, the growth, proliferation, migration abilities and squamous differentiation levels of cervical cancer cells. The roles of MSC-sEV were also verified in human keratinocyte HaCaT cells.

Results
The results showed that Jagged1 protein on MSC-sEV can bind to NOTCH1 on cervical cancer cells, activate NOTCH signaling, and promote squamous differentiation levels in CaSki cells, thus inhibiting the growth, proliferation and migration abilities of CaSki cells. MSC-sEV can also activate the NOTCH pathway in HaCaT cells, but promote the viability of HaCaT cells.

Conclusion
MSC-sEV can activate the NOTCH pathway to promote squamous differentiation of CaSki cells and inhibit the growth proliferation and migration abilities of CaSki cells which may be a new mechanism for cervical cancer treatment.
Innovative supraleitende Energiekabel für die Umsetzung der Energiewende
Authors: Bach Robert , Prusseit Werner 
Published: November 2023

ZusammenfassungDie bevorstehende Energiewende erfordert im Vergleich zur heutigen Situation den Transport einer viel größeren Menge elektrischer Energie in die Städte, die die fossil erzeugte Energie ersetzt. Damit werden die bestehenden Energiekabelsysteme in Zukunft noch nie dagewesenen Herausforderungen ausgesetzt sein. Problematisch könnte dabei insbesondere werden, dass die meisten der bestehenden 110-kV-Kabelsysteme in den Städten in den 70er- und 80er-Jahren des letzten Jahrhunderts gelegt wurden bzw. in dieser Zeit in Betrieb gingen. Damals wurden sie für die Bewältigung einer solchen Belastung, oder Belastungszyklen, wie wir sie in Zukunft erwarten, nicht ausgelegt.Da der Platz unter der Straßenoberfläche von Großstädten immer ein Thema ist, wirbt der Artikel für eine weitere innovative Kabeltechnologie, die viele Vorteile für die kommenden Herausforderungen mit sich bringt. Supraleitende Kabel, sogenannte HTS-Kabel, können bei sehr kleinem Querschnitt eine sehr große Menge elektrischer Energie transportieren. Das Münchner Projekt namens Superlink zielt darauf ab, ein 110-kV-HTS-Kabel mit 500 MVA zu verlegen, wobei der Querschnitt des gesamten Drehstromkabels etwa 200 mm betragen wird. Darüber hinaus gibt es keine thermischen oder magnetischen Feldemissionen, was diesen Kabeltyp in Zukunft zu einer echten Alternative zu Standard-VPE-Kabeln macht. Da es im Vergleich zu Kabeln mit Aluminium- oder Kupferleiter keine Strom-Wärme-Verluste gibt, verringert das HTS-Kabel die Belastung der bestehenden alten Kabelleitungen und verschafft somit Zeit für den Austausch der gealterten Kabelanlagen. Schließlich zeigen erste Berechnungen, dass der Nettobarwert des HTS-Kabels deutlich niedriger ist als der eines vergleichbaren VPE-Kabelsystems. Viele Vorteile, die HTS-Kabel in naher Zukunft immer mehr in den Fokus von Verteilnetzbetreibern rücken lassen könnten, um diese Technologie einzusetzen.
Cefepime versus carbapenems for treatment of AmpC beta-lactamase-producing Enterobacterales bloodstream infections
Authors: Herrmann Julia , Burgener-Gasser Anne-Valérie , Goldenberger Daniel , Roth Jan , Weisser Maja , Tamma Pranita D. , Tschudin-Sutter Sarah 
Published: November 2023

Abstract
Purpose
Cefepime is recommended for treating infections caused by AmpC beta-lactamase-producing Enterobacterales (AmpC-PE), though supporting evidence is limited. Therefore, this study compared outcomes associated with cefepime versus carbapenem therapy for bloodstream infections (BSIs) caused by AmpC-PE after phenotypic exclusion of ESBL-co-producing isolates.

Methods
This retrospective cohort study compared definite cefepime versus carbapenem treatment for AmpC-PE BSI in hospitalized patients of the University Hospital Basel, Switzerland, between 01/2015 and 07/2020. Primary outcomes included in-hospital death, renal impairment and neurologic adverse events; secondary outcomes included length of hospital stay and recurrent infection.

Results
Two hundred and seventy episodes of AmpC-PE BSI were included, 162, 77 and 31 were treated with a carbapenem, cefepime and other antibiotics, respectively. Patients treated with carbapenems were more likely to be transferred to the ICU on admission and more frequently had central venous catheter as a source of infection. In uni- and multivariable analyses, primary and secondary outcomes did not differ between the two treatment groups, except for more frequent occurrence of neurological adverse events among patients treated with carbapenems and shorter length of hospital stay among survivors treated with cefepime.

Conclusion
After excluding isolates with phenotypic ESBL-co-production, cefepime was not associated with adverse outcomes compared to carbapenems when used to treat BSIs caused by AmpC-PE. Our study provides evidence to support the use of cefepime as a safe treatment strategy for AmpC-PE BSI, particularly in clinically stable patients without initial renal impairment or increased susceptibility to neurological adverse events.
Clinical impact of diarrhea during enteral feeding after esophagectomy
Authors: Haneda Ryoma , Hiramatsu Yoshihiro , Kawata Sanshiro , Soneda Wataru , Booka Eisuke , Murakami Tomohiro , Matsumoto Tomohiro , Morita Yoshifumi , Kikuchi Hirotoshi , Takeuchi Hiroya 
Published: November 2023

Abstract
Background
Enteral feeding (EF) is recommended to enhance nutritional status after esophagectomy; however, diarrhea is a common complication of EF. We investigated the clinical and prognostic impact of diarrhea during EF after esophagectomy.

Methods
One hundred and fifty-two patients who underwent transthoracic esophagectomy were enrolled. The King's stool chart was used for stool characterization. The short- and long-term outcomes were compared between a non-diarrhea (Group N) and diarrhea group (Group D).

Results
A higher dysphagia score (≥ 1) was observed more frequently in Group D than in Group N (45.7% vs. 19.8%, p = 0.002). Deterioration of serum total protein, serum albumin, serum cholinesterase, and the prognostic nutritional index after esophagectomy was greater in Group D than in Group N (p = 0.003, 0.004, 0.014, and 0.001, respectively). Patients in Group D had significantly worse overall survival (OS) and recurrence-free survival (RFS) than those in Group N (median survival time (MST): OS, 21.9 vs. 30.6 months, p = 0.001; RFS, 12.4 vs. 27.7 months, p < 0.001). In stratified analysis due to age, although there was no difference in OS with or without diarrhea in young patients (MST: 24.1 months in a diarrhea group vs. 33.6 months in a non-diarrhea group, p = 0.218), patients in a diarrhea group had significantly worse OS than those in a non-diarrhea group in elderly patients (MST: 17.8 months vs. 27.9 months, p < 0.001).

Conclusions
Diarrhea during EF can put elderly patients at risk of postoperative malnutrition and a poor prognosis after esophagectomy.
The emergence of chaos in productivity distribution dynamics
Authors: Gomes Orlando 
Published: November 2023

AbstractThe distribution of productivity levels, and its evolution over time, is a research topic of utmost importance in empirical and theoretical economics. On the theory side, simple analytical models, involving intertemporal optimization, typically characterize agents’ investment decisions about ways to upgrade technology and enhance productivity. The prototypical model endogenously splits the productivity distribution in two: the right-hand side of the distribution is populated by innovators; the left-hand side is occupied by agents who follow a strategy of adoption or imitation. Given the assumptions of the model, the productivity of innovators grows at a constant rate (which directly depends on a constant probability of innovation). The evolution of the productivity of adopters may, in turn, implicate complex dynamics. Because the pace of productivity growth for adopters depends on the shape of the productivity distribution, different distributions might induce distinct growth paths, some of them potentially leading to the emergence of nonlinearities, such as limit cycles and chaos. This study investigates the presence of nonlinearities in technology adoption, for different configurations of the productivity distribution. Under reasonable parameterizations, endogenous fluctuations emerge as a plausible long-term equilibrium.
Potential impacts of 1.5 °C and 2 °C global warming levels on drought modes over Eastern Africa
Authors: Nguvava Mariam , Abiodun Babatunde J. 
Published: November 2023

AbstractThis study examines the impacts of 1.5 °C and 2.0 °C global warming levels (GWLs) on the characteristics of four major drought modes over Eastern Africa in the future under two climate forcing scenarios (RCP4.5 and RCP8.5). The droughts were quantified using two drought indices: the standardized precipitation evapotranspiration index (SPEI) and the standardized precipitation index (SPI) at 12-month scale. Four major drought modes were identified with the principal component analysis (PCA). Multi-model simulation datasets from the Coordinated Regional Climate Downscaling Experiment (CORDEX) were analysed for the study. The skill of the models to reproduce the spatial distribution and frequency of past drought modes over Eastern Africa was examined by comparing the simulated results with the Climate Research Unit (CRU) observation. The models give realistic simulations of the historical drought modes over the region. The correlation between the simulated and observed spatial pattern of the drought modes is high (r ≥ 0.7). Over the hotspot of the drought modes, the observed drought frequency is within the simulated values, and the simulations agree with the observation that the frequency of SPI-12 droughts is less than that of SPEI-12 droughts. For both RCP4.5 and RCP8.5 scenarios, the simulation ensemble projects no changes in the spatial structure of the drought modes but suggests an increase in SPEI-12 drought intensity and frequency over the hotspots of the drought modes. The magnitude of the increase, which varies over the drought mode hotspots, is generally higher at 2 °C than at 1.5 °C global warming levels. More than 75% of the simulations agree on these projections. The projections also show that the increase in drought intensity and frequency is more from increased potential evapotranspiration than from reduced precipitation. Hence, the study suggests that to reduce impacts of global warming on future drought, the adaptation activities should focus on reducing evaporative loss surface water.
Away from Home or Returned Home? What Iranian Participants with Dementia Experience while Living in a Culturally Profiled Nursing Home in Sweden
Authors: Kiwi Mahin 
Published: November 2023

AbstractThis study explores Iranian immigrants with dementia living in a culturally profiled Swedish nursing home and what it means to be at “home.” The meaning given to a place, in general, is understood to be generated and formed by experiences, expectations, hopes, and chains of events, and its significance can change over time. Life changes will mainly affect the understanding of what constitutes “home.” Such a concept can be challenging to define, especially amongst some immigrant populations and those with dementia, for whom parameters change and choice can be limited. This qualitative research study is based on ethnographic fieldwork following ten participants. The data was analyzed, and three main categories that contribute to understanding “home” as part of the delivery of care to elderly immigrants with dementia, namely “a place to escape to”, “a place to be”, and “a place to live”, were identified. The findings show that living in a culturally profiled nursing home in Sweden gave residents a feeling of self-rule, although the institution did have its codes and rules. Considering the feeling of home, none of the participants felt at home; instead, they stated that the culturally profiled nursing home was merely a place to live. Factors that strengthened their independence were the ability to speak the language they were familiar with and receiving medical help without relying on their children.
Enhancement of energy, exergy and soot characteristics with the utilization of MEK in diesel engine
Authors: Almanzalawy M. S. , Mori S. , Elkady M. F. , Elwardany A. E. 
Published: November 2023

AbstractThis study investigated the effects of methyl ethyl ketone (MEK) on a diesel engine’s energy, exergy and emissions. The evaporation of a bi-component droplet of MEK and heptane was modeled. Furthermore, the soot morphology and nanostructure were quantified. Different blends were examined at other engine conditions. Running the engine under idle conditions and optimum speed considerably reduced engine emissions. MEK noticeably decreased the maximum reachable load of the diesel engine. Both specific fuel consumption and thermal efficiency increased with MEK. The exergetic efficiency increased while the fuel exergy decreased at the same work exergy. The effects of MEK on combustion characteristics were insignificant. However, a stronger premixed combustion phase was obtained where MEK evaporated first and caused a slightly longer droplet lifetime. Low percentages of MEK reduced CO emissions, while NOx emissions increased consistently with the MEK addition. The engine conditions noticeably influenced the unburned hydrocarbon emissions with MEK. Both smoke opacity and primary particle diameter decreased. The fringe analysis emphasized that MEK decreased fringe length, soot intensity, and alignment, increasing fringe tortuosity and spacing. Clearly, methyl ethyl ketone suppressed soot formation in a diesel engine and decreased its reactivity.
Graphical abstract
An Improved Model to Help University Students Understand and Assess Results of Science in the Making
Authors: Goddiksen Mads Paludan 
Published: November 2023

AbstractDeveloping an adequate understanding of the nature of science includes developing an understanding of the uses and importance of models in science. General accounts of science aimed at university students, however, tend to neglect this aspect. A noticeable exception is the simple model of the key elements of a scientific result presented by Giere, Bickle, and Mauldin in their book Understanding Scientific Reasoning (2006, Ch. 2). The model—referred to here as the Giere model—is a valuable tool in nature of science teaching that aims to help university-level science students understand how scientists can claim that a result is justified and to evaluate whether this is in fact the case. However, students tend to have difficulty applying the model to real cases. This is partly due to ambiguities and (over)simplifications in the model. This paper therefore aims to improve the applicability of the Giere model under its original scope by clarifying and nuancing key concepts in the original model. Furthermore, the paper aims to adapt the Giere model to make it applicable to knowledge claims about the results of scientific design.
Wind farm layout optimization under uncertainty
Authors: Agra Agostinho , Cerveira Adelaide 
Published: November 2023

AbstractWind power is a major source of green energy production. However, the energy generation of wind power is highly affected by uncertainty. Here, we consider the problem of designing the cable network that interconnects the turbines to the substation in wind farms, aiming to minimize both the infrastructure cost and the cost of the energy losses during the wind farm’s lifetime. Nonetheless, the energy losses depend on wind direction and speed, which are rarely known with certainty in real situations. Hence, the design of the network should consider these losses as uncertain parameters. We assume that the exact probability distribution of these parameters is unknown but belongs to an ambiguity set and propose a distributionally robust two-stage mixed integer model. The model is solved using a decomposition algorithm. Three enhancements are proposed given the computational difficulty in solving real problem instances. Computational results are reported based on real data.