bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a Multiday, High-fidelity, Immersive Simulation on Military Medical Students’ Self-confidence
Authors: Cole Rebekah , Wightman John M 
Published: May 2023

ABSTRACT

Introduction
Decision-making is a critical competence that all medical students must develop before becoming independently licensed physicians. One aspect of the decision-making process is confidence, which has not been extensively studied in undergraduate medical education. Intermittent simulation has been found to improve medical students’ self-confidence across a wide range of clinical scenarios; however, no research to date has examined how a more extensive medical and operational simulation impacts miltary medical students’ confidence in their decision-making abilities.

Materials and Methods
This study was conducted online through the Uniformed Services University and in person at Operation Bushmaster, a multiday, out-of-hospital, high-fidelity, immersive simulation held at Fort Indiantown Gap, PA. This investigation focused on examining the impacts of asynchronous coursework and simulation-based learning on improving decision-making confidence for senior medical students 7 months before graduation. Thirty senior medical students volunteered. Each completed a 10-point confidence scale before and after either accomplishing asynchronous online coursework (control group) or attending a medical field practicum (experimental group). We conducted a repeated-measures analysis of variance to examine any change in students’ confidence scores before and after completing each educational modality.

Results
The results of the analysis of variance indicated a significant time effect for our students’ confidence in both the experimental and control groups as measured on our confidence scale, suggesting that Operation Bushmaster and asynchronous coursework both possessed the potential to increase students’ confidence in their decision-making.

Conclusions
Both simulation-based learning and asynchronous online learning can increase students’ decision-making confidence. Future larger-scale research is needed to calculate the impact of each modality on military medical students’ confidence.
The magnetohydrodynamic-particle-in-cell module in athena++: implementation and code tests
Authors: Sun Xiaochen , Bai Xue-Ning 
Published: May 2023

ABSTRACT
We present a new magnetohydrodynamic-particle-in-cell (MHD-PIC) code integrated into the athena++ framework. It treats energetic particles as in conventional PIC codes, while the rest of thermal plasmas are treated as background fluid described by MHD, thus primarily targeting at multiscale astrophysical problems involving the kinetic physics of the cosmic rays (CRs). The code is optimized towards efficient vectorization in interpolation and particle deposits, with excellent parallel scaling. The code is also compatible with static/adaptive mesh refinement, with dynamic load balancing to further enhance multiscale simulations. In addition, we have implemented a compressing/expanding box framework that allows adiabatic driving of CR pressure anisotropy, as well as the δf method that can dramatically reduce Poisson noise in problems where distribution function f is only expected to slightly deviate from the background. The code performance is demonstrated over a series of benchmark test problems, including particle acceleration in non-relativistic parallel shocks. In particular, we reproduce the linear growth of the CR gyro-resonant (streaming and pressure anisotropy) instabilities, under both the periodic and expanding/compressing box settings. We anticipate the code to open up the avenue for a wide range of astrophysical and plasma physics applications.
Sustained super-Eddington accretion around neutron stars & black holes
Authors: Ghodla Sohan , Eldridge J J 
Published: May 2023

ABSTRACT
Recently, it was shown that the formation of a photon-trapping surface might not be sufficient to ensure unimpeded super-Eddington (SE) accretion. In light of this finding, here we derive a condition such that sustained and unimpeded SE accretion could be achieved in optically thick slim accretion discs surrounding neutron stars (NSs) and black holes (BHs). For this, we calculate a semi-analytic approximation of the self-similar global radial velocity expression for an advection-dominated flow. Neglecting the influence of relativistic jets on the accretion flow, we find that for Eddington fraction $\dot{m} \gtrsim 1.5 (\epsilon /0.1)^{3/5}$ (ϵ being the accretion efficiency) sustained SE accretion might be possible in slim discs around BHs irrespective of their spin. The same condition holds for NSs when ϵ ≳ 0.03. The presence of a surface magnetic field might truncate the disc at the magnetosphere of the NS, resulting in lower efficiencies and consequently changing the condition to $\dot{m} \gt 0.013 \epsilon ^{-19/31}$. Our approach suggests that sustained SE accretion might almost always be possible around NSs and BHs hosting accretion discs.
The foreground transfer function for H i intensity mapping signal reconstruction: MeerKLASS and precision cosmology applications
Authors: Cunnington Steven , Wolz Laura , Bull Philip , Carucci Isabella P , Grainge Keith , Irfan Melis O , Li Yichao , Pourtsidou Alkistis , Santos Mario G , Spinelli Marta , Wang Jingying 
Published: May 2023

ABSTRACT
Blind cleaning methods are currently the preferred strategy for handling foreground contamination in single-dish H i intensity mapping surveys. Despite the increasing sophistication of blind techniques, some signal loss will be inevitable across all scales. Constructing a corrective transfer function using mock signal injection into the contaminated data has been a practice relied on for H i intensity mapping experiments. However, assessing whether this approach is viable for future intensity mapping surveys, where precision cosmology is the aim, remains unexplored. In this work, using simulations, we validate for the first time the use of a foreground transfer function to reconstruct power spectra of foreground-cleaned low-redshift intensity maps and look to expose any limitations. We reveal that even when aggressive foreground cleaning is required, which causes ${\gt }\, 50~{{\ \rm per\ cent}}$ negative bias on the largest scales, the power spectrum can be reconstructed using a transfer function to within sub-per cent accuracy. We specifically outline the recipe for constructing an unbiased transfer function, highlighting the pitfalls if one deviates from this recipe, and also correctly identify how a transfer function should be applied in an autocorrelation power spectrum. We validate a method that utilizes the transfer function variance for error estimation in foreground-cleaned power spectra. Finally, we demonstrate how incorrect fiducial parameter assumptions (up to ${\pm }100~{{\ \rm per\ cent}}$ bias) in the generation of mocks, used in the construction of the transfer function, do not significantly bias signal reconstruction or parameter inference (inducing ${\lt }\, 5~{{\ \rm per\ cent}}$ bias in recovered values).
3D stellar evolution: hydrodynamic simulations of a complete burning phase in a massive star
Authors: Rizzuti F , Hirschi R , Arnett W D , Georgy C , Meakin C , Murphy A StJ , Rauscher T , Varma V 
Published: May 2023

ABSTRACT
Our knowledge of stellar evolution is driven by one-dimensional (1D) simulations. 1D models, however, are severely limited by uncertainties on the exact behaviour of many multidimensional phenomena occurring inside stars, affecting their structure and evolution. Recent advances in computing resources have allowed small sections of a star to be reproduced with multi-D hydrodynamic models, with an unprecedented degree of detail and realism. In this work, we present a set of 3D simulations of a convective neon-burning shell in a 20 M⊙ star run for the first time continuously from its early development through to complete fuel exhaustion, using unaltered input conditions from a 321D-guided 1D stellar model. These simulations help answer some open questions in stellar physics. In particular, they show that convective regions do not grow indefinitely due to entrainment of fresh material, but fuel consumption prevails over entrainment, so when fuel is exhausted convection also starts decaying. Our results show convergence between the multi-D simulations and the new 321D-guided 1D model, concerning the amount of convective boundary mixing to include in stellar models. The size of the convective zones in a star strongly affects its structure and evolution; thus, revising their modelling in 1D will have important implications for the life and fate of stars. This will thus affect theoretical predictions related to nucleosynthesis, supernova explosions, and compact remnants.
Successful treatment of PR3-ANCA-positive interstitial pneumonia with a moderate dose of glucocorticoid and rituximab
Authors: Higashida-Konishi Misako , Akiyama Mitsuhiro , Hama Satoshi , Oshige Tatsuhiro , Izumi Keisuke , Oshima Hisaji , Okano Yutaka 
Published: May 2023

ABSTRACT
Antineutrophil cytoplasmic antibody (ANCA)–positive interstitial pneumonia (IP) is reported as IP that is ANCA-positive and does not involve organ damage associated with vasculitis other than the lungs. While the combination of glucocorticoid and rituximab is effective in ANCA-associated vasculitis, the treatment strategy for ANCA-positive IP has not been established. Here, we report the first case of successful treatment of proteinase 3 (PR3)-ANCA-positive IP with a moderate dose of glucocorticoid and rituximab. The patient was an 80-year-old male who presented with subacute dry cough and dyspnoea. Blood tests revealed elevated levels of C-reactive protein, Krebs von den Lungen 6 (KL-6), and PR3-ANCA. Chest computed tomography (CT) showed interstitial shadows and infiltrates around honeycomb cysts. 18F-fluorodeoxyglucose (FDG) positron emission tomography CT revealed an uptake of FDG in the IP area. After starting treatment with a moderate dose of prednisolone and rituximab, the patient’s clinical symptoms disappeared, C-reactive protein and KL-6 turned to be normal, and infiltrates around the cysts of honeycomb lungs disappeared. Prednisolone was gradually decreased to 2 mg, and no relapse or adverse events were observed during the course of treatment. Our case suggests that early treatment with a moderate dose of glucocorticoid and rituximab is effective for PR3-ANCA-positive IP.
Leitmotivic Strategies in Nobuo Uematsu’sFinal FantasySoundtracks
Authors: Anatone Richard 
Published: May 2023

AbstractThis article discusses Nobuo Uematsu’s leitmotivic soundtracks to the 16-bit Final Fantasy role-playing games. I identify five distinct techniques within these soundtracks whereby a game’s main theme is musically connected to a single character theme: eponymous omission, motivic networking, thematic hybridization, associative troping, and the double main theme. I argue that these different techniques demonstrate how a character’s individual journey reflects the story’s underlying literary theme, which is itself represented by the musical main theme. I conduct topical, motivic, formal, and semiotic analyses of the soundtracks to FFIV–VI and discuss how their character themes, though mostly non-transformative, engage in a larger leitmotivic network of inter-related thematic families that interact with their main themes in dramatically meaningful ways. This analysis demonstrates subtle ways in which leitmotivic scoring can heighten one’s narratological understanding of a story, and may be useful for those seeking to arrange video game soundtracks into programmatic music that tells or retells a game’s story.
Inter-laboratory variation in measurement of DNA damage by the alkaline comet assay in the hCOMET ring trial
Authors: Møller Peter , Azqueta Amaya , Collia Miguel , Bakuradze Tamara , Richling Elke , Bankoglu Ezgi Eyluel , Stopper Helga , Bastos Victoria Claudino , Langie Sabine A S , Jensen Annie , Ristori Sara , Scavone Francesca , Giovannelli Lisa , Wojewódzka Maria , Kruszewski Marcin , Valdiglesias Vanessa , Laffon Blanca , Costa Carla , Costa Solange , Teixeira João Paulo , Marino Mirko , Del Bo Cristian , Riso Patrizia , Zheng Congying , Shaposhnikov Sergey , Collins Andrew 
Published: May 2023

Abstract
The comet assay is a simple and versatile method for measurement of DNA damage in eukaryotic cells. More specifically, the assay detects DNA migration from agarose gel-embedded nucleoids, which depends on assay conditions and the level of DNA damage. Certain steps in the comet assay procedure have substantial impact on the magnitude of DNA migration (e.g. electric potential and time of electrophoresis). Inter-laboratory variation in DNA migration levels occurs because there is no agreement on optimal assay conditions or suitable assay controls. The purpose of the hCOMET ring trial was to test potassium bromate (KBrO3) as a positive control for the formamidopyrimidine DNA glycosylase (Fpg)-modified comet assay. To this end, participating laboratories used semi-standardized protocols for cell culture (i.e. cell culture, KBrO3 exposure, and cryopreservation of cells) and comet assay procedures, whereas the data acquisition was not standardized (i.e. staining of comets and image analysis). Segregation of the total variation into partial standard deviation (SD) in % Tail DNA units indicates the importance of cell culture procedures (SD = 10.9), comet assay procedures (SD = 12.3), staining (SD = 7.9) and image analysis (SD = 0.5) on the overall inter-laboratory variation of DNA migration (SD = 18.2). Future studies should assess sources of variation in each of these steps. On the positive side, the hCOMET ring trial demonstrates that KBrO3 is a robust positive control for the Fpg-modified comet assay. In conclusion, the hCOMET ring trial has demonstrated a high reproducibility of detecting genotoxic effects by the comet assay, but inter-laboratory variation of DNA migration levels is a concern.
Urinary albumin excretion and cancer risk: the PREVEND cohort study
Authors: Luo Li , Kieneker Lyanne M , van der Vegt Bert , Bakker Stephan J L , Gruppen Eke G , Casteleijn Niek F , de Boer Rudolf A , Suthahar Navin , de Bock Geertruida H , Aboumsallem Joseph Pierre , Vart Priya , Gansevoort Ron T 
Published: May 2023

ABSTRACT

Background
Chronic kidney disease (CKD) is believed to be associated with an increased risk for cancer, especially urinary tract cancer. However, previous studies predominantly focused on the association of decreased estimated glomerular filtration rate (eGFR) with cancer. In this study, we investigated the association of albuminuria with cancer incidence, adjusted for eGFR.

Methods
We included 8490 subjects in the Prevention of Renal and Vascular End-stage Disease (PREVEND) observational study. Urinary albumin excretion (UAE) was measured in two 24-hour urine specimens at baseline. Primary outcomes were the incidence of overall and urinary tract cancer. Secondary outcomes were the incidence of other site-specific cancers, and mortality due to overall, urinary tract, and other site-specific cancers.

Results
Median baseline UAE was 9.4 (IQR, 6.3–17.8) mg/24 h. During a median follow-up of 17.7 years, 1341 subjects developed cancer (of which 177 were urinary tract cancers). After multivariable adjustment including eGFR, every doubling of UAE was associated with a 6% (hazard ratios (HR), 1.06, 95% confidence intervals (CI), 1.02–1.10), and 14% (HR, 1.14, 95% CI, 1.04–1.24) higher risk of overall and urinary tract cancer incidence, respectively. Except for lung and hematological cancer, no associations were found between UAE and the incidence of other site-specific cancer. Doubling of UAE was also associated with a higher risk of mortality due to overall and lung cancer.

Conclusions
Higher albuminuria is associated with a higher incidence of overall, urinary tract, lung, and hematological cancer, and with a higher risk of mortality due to overall and lung cancers, independent of baseline eGFR.
A single administration of FGF2 after renal ischemia–reperfusion injury alleviates post-injury interstitial fibrosis
Authors: Tan Xiaohua , Tao Qianyu , Yin Shulan , Fu Guangming , Wang Chengqin , Xiang Fenggang , Hu Haiqi , Zhang Sudan , Wang Zheng , Li Dequan 
Published: May 2023

ABSTRACT

Background
Despite lack of clinical therapy in acute kidney injury (AKI) or its progression to chronic kidney disease (CKD), administration of growth factors shows great potential in the treatment of renal repair and further fibrosis. At an early phase of AKI, administration of exogenous fibroblast growth factor 2 (FGF2) protects against renal injury by inhibition of mitochondrial damage and inflammatory response. Here, we investigated whether this treatment attenuates the long-term renal interstitial fibrosis induced by ischemia–reperfusion (I/R) injury.

Methods
Unilateral renal I/R with contralateral nephrectomy was utilized as an in vivo model for AKI and subsequent CKD. Rats were randomly divided into four groups: Sham-operation group, I/R group, I/R-FGF2 group and FGF2-3D group. These groups were monitored for up to 2 months. Serum creatinine, inflammatory response and renal histopathology changes were detected to evaluate the role of FGF2 in AKI and followed renal interstitial fibrosis. Moreover, the expression of vimentin, α-SMA, CD31 and CD34 were examined.

Results
Two months after I/R injury, the severity of renal interstitial fibrosis was significantly attenuated in both of I/R-FGF2 group and FGF2-3D group, compared with the I/R group. The protective effects of FGF2 administration were associated with the reduction of high-mobility group box 1 (HMGB1)-mediated inflammatory response, the inhibition of transforming growth factor beta (TGF-β1)/Smads signaling–induced epithelial–mesenchymal transition and the maintenance of peritubular capillary structure.

Conclusions
A single dose of exogenous FGF2 administration 1 h or 3 days after reperfusion inhibited renal fibrogenesis and thus blocked the transition of AKI to CKD. Our findings provided novel insight into the role of FGF signaling in AKI-to-CKD progression and underscored the potential of FGF-based therapy for this devastating disease.
How has Expenditure on Nicotine Products Changed in a Fast-Evolving Marketplace? A Representative Population Survey in England, 2018–2022
Authors: Jackson Sarah E , Tattan-Birch Harry , Shahab Lion , Brown Jamie 
Published: May 2023

Abstract

Introduction
In the last 5 years, there has been a dramatic shift in the types of nicotine products being purchased. This study aimed to estimate how much users spend on types of cigarettes and alternative nicotine products (e-cigarettes, nicotine replacement therapy (NRT), heated tobacco, and nicotine pouches) and describe changes between 2018 and 2022.

Aims and Methods
Monthly representative cross-sectional survey in England. 10 323 adults who smoked cigarettes or used alternative nicotine reported their average weekly expenditure on these products, adjusted for inflation.

Results
Smokers spent £20.49 [95% CI = 20.09–20.91] on cigarettes each week (£27.66 [26.84–28.50] and £15.96 [15.49–16.28] among those who mainly smoked manufactured and hand-rolled cigarettes, respectively), e-cigarette users spent £6.30 [5.99–6.55] (£8.41 [7.17–9.78], £6.42 [5.58–7.39], and £5.93 [5.64–6.30] among those who mainly used disposable, pod, and refillable devices, respectively), NRT users £6.11 [5.53–6.69], and heated tobacco users £13.87 [9.58–20.09]. Expenditure on cigarettes grew by 10% from September 2018 to July 2020, then fell by 10% from July 2020 to June 2022. These changes coincided with a 13% reduction in cigarette consumption and a 14% increase in the proportion mainly smoking hand-rolled cigarettes. Expenditure on e-cigarettes was stable between 2018 and late 2020, then rose by 31% up to mid-2022. Expenditure on NRT increased slowly in 2018–2020 (+4%) and more quickly thereafter (+20%).

Conclusions
Inflation-adjusted expenditure on cigarettes has fallen since 2020, such that the average smoker in England currently spends the same on cigarettes each week as in 2018. This has been achieved by smoking fewer cigarettes and switching to cheaper hand-rolled cigarettes. Expenditure on alternative nicotine has increased above inflation; users spent around a third more on these products in 2022 than between 2018–2020.

Implications
People in England continue to spend substantially more on smoking cigarettes than using alternative nicotine products. The average smoker in England spends around £13 a week (~£670 a year) more than people using only e-cigarettes or NRT. The average expenditure on manufactured cigarettes is double that of hand-rolled cigarettes.
The Impact of Opioid Use Disorder on Families and Children
Authors: Winstanley Erin L. , Newhouse Amanda , Law Kari-Beth 
Published: May 2023

Abstract
The consequences of an opioid use disorder (OUD) and the overdose epidemic span beyond the individual suffering with the disease, as the effects of addiction ripple across the social context in which they live. Individuals with OUD have parents, siblings, children, and extended family members. This chapter summarizes existing research on how OUD and the overdose epidemic has impacted those families’ members and children, in terms of short- and long-term sequelae. There is specific focus on parent/caregiver use of opioids and its impact on children under 18 years old including medical, psychosocial, and behavioral consequences. The chapter will begin by reviewing the incidence of OUD in parents and focus broadly on how OUD impacts parenting style, parent–child bonding, child maltreatment, trauma, family dissolution and removal of children from the home. The next section will discuss prevention and treatment services for families, the added burden of stigma experienced by parents with OUD and how policies are desperately needed to encourage cross-system collaboration. The chapter will conclude with a case report that illustrates much of the content covered in this chapter and a summary of evidence-based clinical recommendations.