bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-directed flourishing: a conceptual meta-framework for dealing with the challenges of 21st-century learning and education
Authors: Mountbatten-O’Malley Eri , Morris Thomas Howard 
Published: January 2025

Purpose
This paper aims to address the concern that humans are experiencing unprecedented, rapidly changing conditions, in part exacerbated by a recent pandemic, digitization and ongoing wartime.

Design/methodology/approach
A paper that seeks to address what the authors are calling the “Educational Malaise”. The authors achieve this through a conceptual and theoretical exploration of the social nature of human beings and learning in the context of readings of human nature, and moral and rational powers.

Findings
It is proposed that education should be designed to empower learners to meet the demands of rapidly changing conditions. The ability to adapt is of primary importance for meeting the demands of the changing world, and the “Self-Directed Flourishing” meta-framework can help educators to meet this challenge.

Originality/value
Using conceptual and theoretical lenses, in this paper, the authors identify some core problems with traditional pedagogies in formal education and advance a person-centred, humanistic approach to pedagogy. The authors advocate for a new meta-framework for educators: “Self-Directed Flourishing”. The authors propose placing co-creation, courage and conceptual insight at the heart of educational policies and practices, which the authors suggest will nurture a dynamic, adaptable and ethical microculture for human flourishing in 21st-century education and beyond.
Association of a State‐Wide Alternative Payment Model for Rural Hospitals With Bypass for Elective Surgeries
Authors: Bourne Donald S. , Sun Zhaojun , Jacobs Bruce L. , Drake Coleman , Kahn Jeremy M. , Roberts Eric T. , Sabik Lindsay M. 
Published: January 2025

ABSTRACTObjectiveThis study aimed to measure the changes in rural hospital bypass for 11 common elective surgeries following the implementation of the Pennsylvania Rural Health Model (PARHM), a global budget payment model.Study Setting and DesignWe leveraged a natural experiment arising from the phase‐in of PHARM in Pennsylvania. We conducted a comparative interrupted time series analysis to assess changes in rural hospital bypass, comparing trends in rural hospital bypass among patients in hospital service areas (HSAs) with PARHM‐participating hospitals to patients in control HSAs with hospitals eligible for but not participating in PARHM. Analyses accounted for staggered entry into PARHM and examined outcomes up to 4 years post‐entry.Data Sources and Analytic SampleWe used Pennsylvania all‐payer visit‐level inpatient discharge data (2016–2022) to measure rural hospital bypass, encompassing 175,138 surgeries.Principal FindingsThe average bypass rate for elective surgeries was 59.9%, with an increasing trend observed during the study period. Overall, differential changes in bypass rates between PARHM‐participating and control HSAs were not statistically significant, from a low of 0.53 percentage points (−8.17–9.22) among Cohort 2 HSAs and a high of 5.96 percentage points (−4.63–16.55) among Cohort 1 HSAs. However, among critical access hospitals, PARHM participation was associated with a significant relative increase in levels and trends in bypass rates compared to controls, from a low of 9.12 percentage points (2.45–15.79) among Cohort 1 HSAs and a high of 29.70 percentage points (12.54–46.86) among Cohort 2 HSAs. These relative increases were largely due to a stable rate in PARHM‐participating HSAs and a marked decrease in control HSAs.ConclusionsThis study fills a gap in the relationship between global budgets and hospital bypass. Although PARHM did not broadly alter rural bypass rates overall, the differential increase in bypass among HSAs with CAHs participating in PARHM suggests meaningful effect heterogeneity, warranting further research and analysis of impacts on patient outcomes.
PR Interval as a Valuable Predictor of Tilt Table Test Results in Patients With Neurally Mediated Syncope
Authors: Nikoo Mohammad Hossein , Narimani‐Javid Roozbeh , Kamrava Alireza , Shafiei Sasan , Nozhat Salma , Fatemian Hosein , Asadzadeh Ali , Motahari Moadab Mehdi , Ghanbari Fatemeh , Arzhangzadeh Alireza 
Published: January 2025

ABSTRACTBackgroundNeurally mediated syncope (NMS) is the primary cause of temporary and self‐limiting loss of consciousness. The tilt table test (TTT) has been consistently employed as a supplementary diagnostic tool for syncope evaluation. However, TTT requires specialized equipment, which is lacking in several emergency room and clinic environments. We hypothesized that patients susceptible to NMS may have higher parasympathetic tone. Thus, this study investigates the correlation between PR interval and Herat rate variability parameters as indicators of parasympathetic tone and TTT results.MethodsWe included 213 patients referred to our cardiology clinic with an impression of NMS in 2022 and 2023. Data was retrospectively collected from 24‐h ambulatory electrocardiographic monitoring recordings, TTT results, and patients' history and physical examination records.ResultsThe analysis of the PR interval revealed a mean duration of 155 ms (95% CI: 148.61, 161.39) in negative TTT patients and 164.21 ms (95% CI: 158.44, 169.97) in positive TTT patients, indicating a statistically significant difference between two groups (p = 0.035). We also found that patients with a PR interval duration exceeding 160 ms demonstrated a significantly higher prevalence of positive TTT compared to those with a PR interval duration of less than 160 ms (p < 0.001, OR: 3.911, 95% CI: 2.143, 7.140).ConclusionsOur study suggests a PR interval longer than 160 milliseconds as a valuable tool for predicting TTT results and identifying patients at higher risk of NMS.
Setting of initiation and factors associated with antidepressant use on entry to long‐term care facilities
Authors: Hughes Georgina A. , Inacio Maria C. , Rowett Debra , Lang Catherine , Jorissen Robert N. , Corlis Megan , Sluggett Janet K. 
Published: January 2025

AbstractAimsAntidepressant use increases around long‐term care facility (LTCF) entry, and initiation during hospitalizations may contribute to this. This study characterized the care setting (i.e., community‐based, hospital or LTCF) where antidepressants were initiated and determined associated resident characteristics.MethodsA cross‐sectional study including non‐Indigenous individuals aged 65–105 years who entered LTCFs in two Australian states during 2015–2019, and were dispensed an antidepressant within 2 months, was conducted. Care settings (community‐based, hospital or LTCF) were determined from linked LTCF records, and hospitalizations ≤30 days before LTCF entry. Pharmaceutical claims before and after LTCF entry were screened to determine antidepressant initiation. Multivariate multinomial logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for resident characteristics associated with care settings of antidepressant initiation.ResultsThis study included 34 525 residents from 1046 LTCFs. Overall, 27 160 (78.7%) commenced antidepressants prior to entry, 2552 (7.4%) in hospital and 4813 (13.9%) in LTCFs. Mirtazapine constituted 44.8% (n = 1143) of antidepressants initiated in hospitals and 39.5% (n = 1902) in LTCFs. Residents who were aged ≥90 years were more likely to start an antidepressant in the LTCF compared to community‐based settings (aOR = 1.97, 95% CI 1.74–2.23). Residents recently using a psychotropic were more likely to start an antidepressant in community‐based settings before LTCF entry, compared to a hospital or LTCF.ConclusionsIndividuals receiving antidepressants during transition to LTCFs are often already taking antidepressants prior to entry. Future interventions to optimize antidepressant use in LTCFs should consider setting, recency and indication for antidepressant initiation, and ongoing monitoring for safety.
Slow Codes are symptomatic of ethically and legally inappropriate CPR policies
Authors: McLennan Stuart , Bak Marieke , Knochel Kathrin 
Published: January 2025

AbstractAlthough cardiopulmonary resuscitation (CPR) was initially used very selectively at the discretion of clinicians, the use of CPR rapidly expanded to the point that it was required to be performed on all patients having in‐hospital cardiac arrests, regardless of the underlying condition. This created problems with CPR being clearly inadvisable for many patients. Do Not Resuscitate (DNR) orders emerged as a means of providing a transparent process for making decisions in advance regarding resuscitation, initially by patients and later also by clinicians. Under hospital policies in many countries, however, CPR remains the default position for all patients having cardiac arrest in the hospital if there is no DNR order in place, regardless of whether CPR is medically indicated or in the patient's best interests. “Slow Codes” are the delayed or token efforts to provide CPR when clinicians feel CPR is futile or inappropriate. After giving a historical overview of the development and the changing use of CPR, we argue that more attention needs to be given to the cause of slow codes, namely, policies requiring CPR to be performed as the default action while simultaneously lacking implementing interventions such as advance care planning as a routine policy. This is ethically and legally inappropriate, and hospital policies should be modified to allow clinicians to consider whether CPR is appropriate at the time of arrest. Such a change requires a stronger emphasis on early recognition of patients for whom CPR is not in their best interests and to improve hospital emergency planning.
Jointly modeling responses and omitted items by a competing risk model: A survival analysis approach
Authors: Guo Jinxin , Xu Xin , Fang Guanhua , Ying Zhiliang , Zhang Susu 
Published: January 2025

AbstractItem response theory models are commonly adopted in educational assessment and psychological measurement. Such models need to be modified to accommodate practical situations when statistical sampling assumptions are violated. Omission is a common phenomenon in educational testing. In modern computer‐based testing, we have not only examinees' responses but also their response times. This paper utilizes response time and develops a joint model of responses and response times. The new approach is analogous to those developed in survival analysis for dealing with right‐censored data. In particular, a key ingredient is the introduction of the omission time (OT), which corresponds to the censoring time in survival analysis. By competing risk formulation, the proposed method provides an alternative narrative to how an item becomes answered versus omitted, depending on the competing relationship of response time and OT, so that the likelihood function can be constructed properly. The maximum likelihood estimator can be computed via the expectation‐maximization algorithm. Simulation studies were conducted to evaluate the performance of the proposed method and its robustness against various mis‐specifications. The method was applied to a dataset from the PISA 2015 Science Test.
α‐Adrenoreceptor blocker phentolamine inhibits voltage‐gated sodium channels via the local anaesthetic binding site
Authors: Toklucu Idil , Sudha Bhagavath Eswaran Vishal , Bott Raya Atlanta , Kesdoğan Aylin Bilge , Gaebler Arnim Johannes , Stingl Julia , Hausmann Ralf , Körner Jannis , Lampert Angelika 
Published: January 2025

AbstractBackground and PurposePhentolamine is a non‐selective α‐adrenoreceptor antagonist used to reverse local anaesthesia, for example, during dental procedures when a vasoconstrictor is co‐applied. Phentolamine‐mediated vasodilation leads to faster clearance of injected drugs. Previous electrophysiological studies hypothesized that phentolamine acts as a modulator of voltage‐gated sodium channels, which could conflict with its indication as local anaesthetic reversal agent.Experimental ApproachWe performed manual and high throughput patch‐clamp recordings on HEK and CHO cells expressing NaV1.7 and NaV1.5. We investigated the effects of phentolamine on sodium channel biophysics and the additive impact of phentolamine on cells preconditioned with the local anaesthetic mexiletine. We used site‐directed mutagenesis, homology modelling and drug docking to identify phentolamine's binding site. We compared the effect on sodium channels with other clinically established α‐adrenoreceptor antagonists.Key ResultsPhentolamine inhibits NaV1.7 in HEK and CHO cells with an IC50 value of 72 and 57 μM and NaV1.5 in CHO cells with an IC50 of 27 μM. Phentolamine enhances the tonic block induced by the local anaesthetic mexiletine. Phentolamine binds to sodium channels at the local anaesthetic receptor site. The α‐adrenoreceptor antagonists alfuzosin, urapidil and phenoxybenzamine show lower potency on NaV1.5 and NaV1.7 in patch‐clamp recordings.Conclusions and ImplicationsPhentolamine blocks voltage‐gated sodium channels via the local anaesthetic receptor site. This may conflict with its current indication as an antidote for local anaesthetics. We propose alternative α‐adrenoreceptor antagonists as possible candidates for local anaesthetic reversal because these are less potent inhibitors of both cardiac and neuronal voltage‐gated sodium channels.
No Association Found Between Uric Acid Levels and Peripheral Vertigo Disorders: Results From a Two‐Sample Mendelian Randomization Study
Authors: Liu Shihan , Lin Yiyi , Zhang Lingli , Luo Wenlong 
Published: January 2025

ABSTRACTBackgroundThe association between serum uric acid levels and peripheral vertigo diseases, namely Benign Paroxysmal Positional Vertigo (BPPV), Meniere's Disease (MD), and Vestibular Neuritis (VN), remains a subject of controversy. This study utilises the Mendelian Randomization (MR) approach to investigate the potential link between uric acid levels and these peripheral vertigo diseases, with the goal of informing preventative measures and early intervention strategies.MethodsDatasets pertaining to uric acid levels (sample size = 343 836) and BPPV (ncase = 3834, ncontrol = 209 582), MD (ncase = 1511, ncontrol = 209 582), and VN (ncase = 1224, ncontrol = 209 582) were selected from Genome‐Wide Association Studies (GWAS). Two‐sample MR was employed to analyse the correlation between the exposure (uric acid levels) and outcomes (BPPV, MD, VN). The MR analysis methods encompassed Inverse Variance Weighting (IVW), MR‐Egger, Simple Mode, Weighted Mode, and Weighted Median methods. The results derived from the IVW analysis were considered as the primary analytical outcomes.ResultThe findings indicated no significant correlation between uric acid levels and BPPV (IVW: OR = 1.152, 95% CI: 0.971–1.367, p = 0.103), MD (IVW: OR = 1.010, 95% CI: 0.757–1.348, p = 0.943), and VN (IVW: OR = 1.005, 95% CI: 0.744–1.358, p = 0.969).ConclusionThis study employed a two‐sample Mendelian randomization approach to conduct an in‐depth analysis of the relationship between serum uric acid levels and peripheral vestibular diseases (BPPV, MD, and VN). Our findings indicate that no significant association was found between serum uric acid levels and these diseases. The results of the study do not support the hypothesis that uric acid is an independent risk factor for these conditions.
When Do Optimistic CEOs Enhance Firm Value?
Authors: Deshmukh Sanjay , Goel Anand 
Published: January 2025

ABSTRACTWe predict how the effect of CEO optimism on firm value varies across firms and model how industry competition impacts the relation between CEO optimism and firm value. Estimating optimism from option‐exercise behaviour, we find that CEO optimism increases firm value by about 17% on average. Consistent with theoretical predictions, CEO optimism is more value‐enhancing in firms that are riskier, engage in greater innovation and investment, have more internal resources and operate in industries that are more competitive or have a larger fraction of optimistic CEOs. Various endogeneity checks support a causal impact of CEO optimism on firm value.
Hidradenitis Suppurativa Treatment During Pregnancy and Lactation: Navigating Challenges
Authors: Özbek Laşin , Güldan Mustafa , Alpsoy Erkan , Vural Seçil 
Published: January 2025

ABSTRACTHidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory skin condition primarily affecting skin folds such as the axilla, groins, and the inframammary, perineal, and perianal regions. It is characterized by painful abscesses, sinus tracts, and scarring. Predominantly affecting young adults, particularly females, HS often emerges during reproductive age, and flares are widely reported during pregnancy and postpartum, underscoring the need to consider management strategies tailored to pregnant or lactating individuals. Moreover, the chronic and relapsing nature of HS, along with challenges related to the safety and compliance of medication use during pregnancy and lactation, as well as various comorbidities and psychological distress, significantly complicate its management in pregnant or lactating women. Treatment options, including topical clindamycin, oral clindamycin‐rifampicin, adalimumab, metformin, antiseptic washes, and certolizumab pegol, have accumulated evidence supporting their relative safety in pregnant and lactating women. While certolizumab pegol has shown promising safety data among biologics, it requires more efficacy data in HS. Conversely, while newly approved HS medications such as secukinumab and bimekizumab show promise for the general population, further research is necessary to evaluate their safety profiles in pregnant and breastfeeding individuals. The scant research available on HS in pregnant and lactating women, also shown by our systematic literature review, highlights the need for a comprehensive investigation into the safety, efficacy, and suitability of management strategies.
The Modified Coronally Advanced Tunnel Technique for Coverage of Mucosal Recessions at Dental Implants
Authors: Sculean Anton , Nikou Georgios , Deppe Herbert , Allen Edward P. , Cosgarea Raluca 
Published: January 2025

ABSTRACTObjectivesTo clinically evaluate the outcomes following surgical coverage of single peri‐implant mucosal recessions in the aesthetic maxillary area by means of the modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG).Materials and MethodsEleven systemically healthy non‐smoking patients (8 females) each presenting a single peri‐implant mucosal recession in the anterior maxillary region were consecutively treated with MCAT in conjunction with SCTG. In all cases, the facial recession was associated with an impaired aesthetic appearance. Before reconstructive surgery and at 12 months postoperatively, clinical and aesthetic parameters were assessed. The primary outcome variable was the mean mucosal recession coverage (MRC).ResultsHealing was uneventful in all cases. At 12 months, statistically significant (p < 0.05) recession coverage (MRC 94.71%) and improvement of aesthetics (pink aesthetic score) was obtained at all implants. Complete RC was obtained in 10 out of the 11 patients (90.9%). The treatment was associated with a statistically significant gain of keratinized and attached mucosa (p < 0.05).ConclusionThe present results demonstrate that single peri‐implant mucosal recessions in the maxillary aesthetic area can be successfully treated with MCAT and SCTG.
A new circular economy conception for sustainable product design
Authors: Klose Svenja Anja , Fröhling Magnus 
Published: January 2025

AbstractThe design phase has a significant impact on a product's environmental footprint. To design sustainable products effectively, designers can make use of concepts from circular economy (CE) research. A plethora of conceptions of the CE (CECs) with links to sustainable product design can be found in the literature; however, we argue that they are incomplete and thereby miss effectiveness in enabling circular and sustainable product design. The aim of this paper is threefold: (i) We analyze the strengths and weaknesses of existing CE conceptions (CECs) and derive criteria for a reconception. (ii) Based on this, we propose a novel design approach with the newly developed conceptual CE design diagram (CEDD) in the center. (iii) The link between the CEDD to sustainable product design is established via four areas of decision (AoDs), which encompass CE strategies. One AoD has an overarching position, while the remaining AoDs are located along the three life cycle stages, production, use phase, and end of life, and should be considered jointly during design. Applied together, the CEDD with our design approach supports the structured generation and selection of sustainable design alternatives. Workshops were carried out to perform an initial validation of the conception. The proposition of CEDD and AoDs is targeted at a more effective product design for sustainability, thereby supporting a timely sustainability transition of the economy.
Native state structural and chemical characterisation of Pickering emulsions: A cryo‐electron microscopy study
Authors: Fernandez Ainaga Dario Luis , Roncal‐Herrero Teresa , Ilett Martha , Aslam Zabeada , Cheng Cheng , Hitchcock James P. , Cayre Olivier J. , Hondow Nicole 
Published: January 2025

SummaryTransmission electron microscopy can be used for the characterisation of a wide range of thin specimens, but soft matter and aqueous samples such as gels, nanoparticle dispersions, and emulsions will dry out and collapse under the microscope vacuum, therefore losing information on their native state and ultimately limiting the understanding of the sample.This study examines commonly used techniques in transmission electron microscopy when applied to the characterisation of cryogenically frozen Pickering emulsion samples. Oil‐in‐water Pickering emulsions stabilised by 3 to 5 nm platinum nanoparticles were cryogenically frozen by plunge‐freezing into liquid ethane to retain the native structure of the system without inducing crystallisation of the droplet oil cores.A comparison between the droplet morphology following different sample preparation methods has confirmed the effectiveness of using plunge‐freezing to prepare these samples. Scanning transmission electron microscopy imaging showed that dry droplets collapse under the microscope vacuum, changing their shape and size (average apparent diameter: ∼342 nm) compared to frozen samples (average diameter: ∼183 nm). Cryogenic electron tomography was used to collect additional information of the 3D shape and size of the emulsion droplets, and the position of the stabilising nanoparticles relative to the droplet surface. Cryogenic energy dispersive X‐ray and electron energy loss spectroscopy were used to successfully obtain elemental data and generate elemental maps to identify the stabilising nanoparticles and the oil phase. Elemental maps generated from spectral data were used in conjunction with electron tomography to obtain 3D information of the oil phase in the emulsion droplets.Beam‐induced damage to the ice was the largest limiting factor to the sample characterisation, limiting the effective imaging resolution and signal‐to‐noise ratio, though careful consideration of the imaging parameters used allowed for the characterisation of the samples presented in this study. Ultimately this study shows that cryo‐methods are effective for the representative characterisation of Pickering emulsions.