bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delirium
Authors: Evans Bonnie D. , Hickey Erica J. 
Published: May 2023

Abstract
In the palliative care population, delirium is a common syndrome, and the incidence increases at the end of life. It is a complex phenomenon, and multiple theories are postulated to explain the underlying pathophysiology that causes acute changes primarily in attention and awareness. Factors contributing to the development of delirium are categorized as predisposing or unmodifiable factors such as older age and precipitating or potentially modifiable factors such as medications or infection. Delirium can cause significant caregiver distress, poses an immediate risk to patient safety, and can also be life-threatening. It is associated with an increase in inpatient mortality that can continue post-discharge, and some studies support persistent cognitive and functional impairment. Assessment requires information regarding the patient’s baseline cognitive status, familiarity with delirium risk factors, and validated delirium assessment tools. The hallmark for diagnosis is the presence of one or more underlying medical conditions, in palliative care, typically multifactorial. Primary prevention that targets known delirium risk factors with multicomponent, nonpharmacological interventions is preferable. Early recognition of symptoms and addressing any precipitating factors can limit the severity and duration of evolving delirium. The extent of any diagnostic workup and intervention must be based on the goals of care, particularly in the palliative care population. There is no consensus to guide current pharmacological management of delirium. In severe, refractory, or terminal delirium, the risk and benefit of any medication being considered must be carefully evaluated.
Palliative Sedation
Authors: Collett David , Baxter Kelly 
Published: May 2023

Abstract
This chapter examines palliative sedation, a therapy used for patients with intractable symptoms, and the advance practice registered nurse’s role in caring for the patient as well as the family and the interdisciplinary team. It discusses definitions of palliative sedation, indications, and settings, and reviews medication management and administration. An overview of identification and evaluation of intractable suffering is provided. There is a review of medications appropriate for palliative sedation, as well as guidelines and best practices for delivering team-based and patient-centered palliative care when palliative sedation is used. Ethical and legal aspects and national position statements from nursing and medical professional societies are reviewed. A case study is included to illustrate the nurse’s and the interdisciplinary team’s responsibilities to the patient, the family, and each other during the provision of palliative sedation.
Anxiety, Post-Traumatic Stress Disorder, and Other Trauma-Related Disorders
Authors: McDowell Anna K. , Simpson Scott A. 
Published: May 2023

Abstract
Anxiety is a universal experience, and impairing anxiety-related disorders are the most common psychiatric illnesses. Presentations of anxiety are common in emergency settings. Although anxiety may portend serious medical illness, it is more common that anxiety is a symptom that complicates the assessment and management of other illnesses. A brief history identifying the key sources of a patient’s anxiety is invaluable for developing a quick psychiatric differential, assessing suicide risk, and ascertaining the need for further treatment. This chapter reviews common anxiety syndromes, including generalized anxiety disorder, panic disorder, and adjustment disorders related to medical illness. The effects of trauma, including acute stress disorder and post-traumatic stress disorder, are also reviewed for their complex impacts on patients’ care.
Perinatal Patients and Related Illnesses, Symptoms, and Complications Related to Pregnancy
Authors: Slocum Sarah 
Published: May 2023

Abstract
Emergency psychiatrists and trainees often encounter women who are pregnant, postpartum, or of reproductive age. As physicians, emergency psychiatrists must improve counseling for patients who are or may become pregnant. Psychotropic medication management in pregnancy is underemphasized in training programs and clinical work. With 50% of pregnancies in the United States being unplanned, it is imperative that all clinicians gain a basic comfort level with this population. This chapter discusses the use of medication for acute agitation, psychotic and affective disorders, anxiety, substance use, and trauma-related disorders, in addition to special topics such as pregnancy loss, personality disorders, suicidality, gender identity and sexual orientation, and considerations for lactation.
Tool, Constraint, Liability, Context
Authors: Rozel John S. , Soliman Layla 
Published: May 2023

Abstract
The everyday practice of emergency psychiatry involves a blend of clinical skills and legal knowledge. Perhaps more than any other clinical specialty, emergency psychiatry is beholden to the use of legal processes as a fundamental tool for ensuring that people in need of care are helped and that their civil rights are protected. Significant variation in rules and standards across jurisdictions complicates an already perilous balance between autonomy and beneficence. In addition to primary tools such as voluntary and involuntary commitment, emergency psychiatrists routinely work with important standards relating to confidentiality and duties to third parties. Furthermore, although psychiatry and emergency medicine are not frequently sued specialties per se, the psychiatric emergency service poses special risks for malpractice liability.
Quality Improvement in Psychiatric Emergency Settings
Authors: Balfour Margaret E. , Rhoads Richard 
Published: May 2023

Abstract
This chapter provides an overview of basic quality improvement concepts for those interested in improving clinical care in emergency psychiatric settings. Quality improvement is anything that improves the delivery, consistency, or outcome of care, ranging from large, multistep projects (e.g., changing the entire process for suicide assessment and triage) to small, seemingly minor improvements (e.g., updating a form or streamlining a process to make it more efficient). Frontline staff—including residents—are critical to successful quality improvement efforts because they are often the first to notice processes that need improvement and can help develop practical solutions based on their real-world experience. The chapter begins with an overview of the history of quality improvement in health care and some of the frameworks commonly applied in health care settings. Next, it discusses the importance of quality measurement and provides practical guidance on choosing what to measure and how to measure it. Then, the chapter presents a real-world example to illustrate how quality improvement concepts can be applied to improve care in an emergency psychiatric setting using the FOCUS-PDSA framework.
Models of Well-Being
Authors: Thomas Larissa R. 
Published: May 2023

Abstract
A shared mental model for how to conceptualize well-being is foundational to approaching and addressing well-being challenges. Such a framework helps to guide priorities and ensure that the entire organization is speaking the same language when discussing well-being. As with other major thought discourses, conceptual models of clinician well-being have evolved as studies on drivers and interventions have emerged. Today’s models incorporate an understanding of well-being as a complex problem that requires interventions to address systems and the culture of medicine while supporting individuals. This chapter includes a summary of the evolution of thought on models for well-being, describes several common models used for understanding drivers and intervention frameworks, and addresses the value of commitments to aspirational states.
What’s Causing the Problem?
Authors: Orrange Susan M. , Adragna Michael S. , Jeanlus Ashley 
Published: May 2023

Abstract
Numerous drivers of burnout have been explored in students and GME trainees; some at the individual level and others at the broader institutional level. Institutional supports for students shown to promote well-being include pass–fail curricula, decreased class hours, greater flexibility, supportive relationships with faculty and staff, and support for diversity. At the individual level, medical student well-being is influenced by self-care, social cohesion, stress perception, educational debt, and help-seeking behaviors. Meanwhile, among residents and fellows, well-being is influenced by both demands placed on individuals by institutions and programs and resources provided to them. Resident well-being is also driven by personal factors such as self-care, social support, and stress coping, empathy, emotional intelligence, and personality. This chapter concludes by contextualizing these findings within existing driver models of burnout and engagement. Exploring these drivers can guide educators and leaders to create changes that positively impact future physician well-being.
Making the Case for Institutional Commitment to Well-Being
Authors: Harry Elizabeth , Morrison Katherine , Lawrence Elizabeth 
Published: May 2023

Abstract
In this chapter, the authors describe five major reasons why health care institutions must embrace the need to improve and support the well-being of their physicians. These five reasons include the moral imperative to reduce distress, mental illness, and suicide in physicians; the need to avert tragedies; regulatory requirements; the quality and safety of patient care; and the economic cost associated with physician burnout. The authors explore each of these reasons in detail, providing the evidence behind their contentions. The chapter includes two practice boxes that help the reader identify what data and strategies are needed to make and present the case for institutional leadership to prioritize physician well-being.
Genotoxicity by rapeseed methyl ester and hydrogenated vegetable oil combustion exhaust products in lung epithelial (A549) cells
Authors: Rothmann Monika Hezareh , Møller Peter , Essig Yona J , Gren Louise , Malmborg Vilhelm B , Tunér Martin , Pagels Joakim , Krais Annette M , Roursgaard Martin 
Published: May 2023

Abstract
Biofuel is an attractive substitute for petrodiesel because of its lower environmental footprint. For instance, the polycyclic aromatic hydrocarbons (PAH) emission per fuel energy content is lower for rapeseed methyl ester (RME) than for petrodiesel. This study assesses genotoxicity by extractable organic matter (EOM) of exhaust particles from the combustion of petrodiesel, RME, and hydrogenated vegetable oil (HVO) in lung epithelial (A549) cells. Genotoxicity was assessed as DNA strand breaks by the alkaline comet assay. EOM from the combustion of petrodiesel and RME generated the same level of DNA strand breaks based on the equal concentration of total PAH (i.e. net increases of 0.13 [95% confidence interval (CI): 0.002, 0.25, and 0.12 [95% CI: 0.01, 0.24] lesions per million base pairs, respectively). In comparison, the positive control (etoposide) generated a much higher level of DNA strand breaks (i.e. 0.84, 95% CI: 0.72, 0.97) lesions per million base pairs. Relatively low concentrations of EOM from RME and HVO combustion particles (&lt;116 ng/ml total PAH) did not cause DNA strand breaks in A549 cells, whereas benzo[a]pyrene and PAH-rich EOM from petrodiesel combusted using low oxygen inlet concentration were genotoxic. The genotoxicity was attributed to high molecular weight PAH isomers with 5–6 rings. In summary, the results show that EOM from the combustion of petrodiesel and RME generate the same level of DNA strand breaks on an equal total PAH basis. However, the genotoxic hazard of engine exhaust from on-road vehicles is lower for RME than petrodiesel because of lower PAH emission per fuel energy content.
Integration of dietary nutrition and TRIB3 action into diabetes mellitus
Authors: Lu Guangping , Li Jiahao , Gao Ting , Liu Qingbo , Chen Ou , Zhang Xiaohui , Xiao Mengjie , Guo Yuanfang , Wang Jie , Tang Yufeng , Gu Junlian 
Published: May 2023

Abstract
Despite intensive studies for decades, the common mechanistic correlations among the underlying pathology of diabetes mellitus (DM), its complications, and effective clinical treatments remain poorly characterized. High-quality diets and nutrition therapy have played an indispensable role in the management of DM. More importantly, tribbles homolog 3 (TRIB3), a nutrient-sensing and glucose-responsive regulator, might be an important stress-regulatory switch, linking glucose homeostasis and insulin resistance. Therefore, this review aimed to introduce the latest research progress on the crosstalk between dietary nutrition intervention and TRIB3 in the development and treatment of DM. This study also summarized the possible mechanisms involved in the signaling pathways of TRIB3 action in DM, in order to gain an in-depth understanding of dietary nutrition intervention and TRIB3 in the pathogenesis of DM at the organism level.
Three-Dimensional Morphological Analysis Revealed the Cell Patterning Bases for the Sexual Dimorphism Development in the Liverwort Marchantia polymorpha
Authors: Cui Yihui , Hisanaga Tetsuya , Kajiwara Tomoaki , Yamaoka Shohei , Kohchi Takayuki , Goh Tatsuaki , Nakajima Keiji 
Published: May 2023

Abstract
In land plants, sexual dimorphism can develop in both diploid sporophytes and haploid gametophytes. While developmental processes of sexual dimorphism have been extensively studied in the sporophytic reproductive organs of model flowering plants such as stamens and carpels of Arabidopsis thaliana, those occurring in gametophyte generation are less well characterized due to the lack of amenable model systems. In this study, we performed three-dimensional morphological analyses of gametophytic sexual branch differentiation in the liverwort Marchantia polymorpha, using high-depth confocal imaging and a computational cell segmentation technique. Our analysis revealed that the specification of germline precursors initiates in a very early stage of sexual branch development, where incipient branch primordia are barely recognizable in the apical notch region. Moreover, spatial distribution patterns of germline precursors differ between males and females from the initial stage of primordium development in a manner dependent on the master sexual differentiation regulator MpFGMYB. At later stages, distribution patterns of germline precursors predict the sex-specific gametangia arrangement and receptacle morphologies seen in mature sexual branches. Taken together, our data suggest a tightly coupled progression of germline segregation and sexual dimorphism development in M. polymorpha.
A Critique of Yablo’s If-thenism
Authors: Armour-Garb Bradley , Kroon Frederick 
Published: May 2023

AbstractUsing ideas proposed in Aboutness and developed in ‘If-thenism’, Stephen Yablo has tried to improve on classical if-thenism in mathematics, a view initially put forward by Bertrand Russell in his Principles of Mathematics. Yablo’s stated goal is to provide a reading of a sentence like ‘The number of planets is eight’ with a sort of content on which it fails to imply ‘Numbers exist’. After presenting Yablo’s framework, our paper raises a problem with his view that has gone virtually unnoticed in the literature. If we are right, then Yablo’s version of if-thenism cannot succeed.
Peronophythora litchii RXLR effector P. litchii avirulence homolog 202 destabilizes a host ethylene biosynthesis enzyme
Authors: Li Peng , Li Wen , Zhou Xiaofan , Situ Junjian , Xie Lizhu , Xi Pinggen , Yang Bo , Kong Guanghui , Jiang Zide 
Published: May 2023

Abstract
Oomycete pathogens can secrete hundreds of effectors into plant cells to interfere with the plant immune system during infection. Here, we identified a Arg-X-Leu-Arg (RXLR) effector protein from the most destructive pathogen of litchi (Litchi chinensis Sonn.), Peronophythora litchii, and named it P. litchii avirulence homolog 202 (PlAvh202). PlAvh202 could suppress cell death triggered by infestin 1 or avirulence protein 3a/resistance protein 3a in Nicotiana benthamiana and was essential for P. litchii virulence. In addition, PlAvh202 suppressed plant immune responses and promoted the susceptibility of N. benthamiana to Phytophthora capsici. Further research revealed that PlAvh202 could suppress ethylene (ET) production by targeting and destabilizing plant S-adenosyl-L-methionine synthetase (SAMS), a key enzyme in the ET biosynthesis pathway, in a 26S proteasome-dependent manner without affecting its expression. Transient expression of LcSAMS3 induced ET production and enhanced plant resistance, whereas inhibition of ET biosynthesis promoted P. litchii infection, supporting that litchi SAMS (LcSAMS) and ET positively regulate litchi immunity toward P. litchii. Overall, these findings highlight that SAMS can be targeted by the oomycete RXLR effector to manipulate ET-mediated plant immunity.
A Fiscal Theory of Persistent Inflation
Authors: Bianchi Francesco , Faccini Renato , Melosi Leonardo 
Published: May 2023

Abstract
We develop a new class of general-equilibrium models with partially unfunded debt to propose a fiscal theory of persistent inflation. In response to business cycle shocks, the monetary authority controls inflation and the fiscal authority stabilizes debt. However, the central bank accommodates unfunded fiscal shocks, causing persistent movements in inflation, output, and real interest rates. In an estimated quantitative model, fiscal inflation accounts for the bulk of inflation dynamics. In the aftermath of the pandemic, unfunded fiscal shocks sustain the recovery but also cause a persistent increase in inflation. The model is able to predict the inflationary effects of the American Rescue Plan Act fiscal stimulus out of sample and with real-time data.
Prognostic and predictive markers of systemic sclerosis-associated interstitial lung disease in a clinical trial and long-term observational cohort
Authors: Ghuman Abeer , Khanna Dinesh , Lin Celia J F , Furst Daniel E , Raghu Ganesh , Martinez Fernando J , Zucchetto Mauro , Huang Suiyuan , Jennings Angus , Nihtyanova Svetlana I , Denton Christopher P 
Published: May 2023

Abstract

Objectives
To explore prognostic and predictive markers of SSc-associated interstitial lung disease (SSc-ILD) outcomes in a phase 3 trial (focuSSced) and prognostic markers in a real-world cohort (SMART).

Methods
The focuSSced SSc-ILD subgroup included 68 of 106 placebo-treated and 68 of 104 tocilizumab-treated patients. The SMART cohort included 505 patients with SSc-ILD. Linear mixed-effect models were used to identify factors associated with change in forced vital capacity (FVC). Kaplan–Meier estimation and Cox regression were used for time-to-event analyses.

Results
In placebo-treated focuSSced patients, sex was a significant prognostic factor for FVC decline; males had increased risk for absolute decline ≥10% in percent-predicted FVC (ppFVC) and 0.22% faster weekly FVC decline than females (P = 0.0001). FVC was 9.8% lower in patients with CRP &gt;6 mg/ml vs those with CRP ≤6 mg/ml (P = 0.0059). Tocilizumab reduced the risk for ≥10% decline in ppFVC in patients who were male, had earlier disease (&lt;2 years duration), had IL-6 levels &lt;10 pg/ml, or had anti-topoisomerase antibodies (ATA). In the SMART cohort, prognostic factors for ppFVC &lt;70% were male sex, ATA, and low baseline FVC. Males had 3.3% lower FVC 1 year after disease onset (P &lt; 0.001) and 0.6% faster yearly decline (P = 0.03) than females.

Conclusion
Prognostic markers in SSc-ILD were similar between focuSSced and SMART. Male sex and inflammatory markers were associated with lower FVC but IL-6 ≥10 pg/ml was not predictive of response to tocilizumab.

Trial Registration
ClinicalTrials.gov: NCT02453256.
Citizen monitoring of ambient dose rate: the SAFECAST project
Authors: Kuča Petr , Helebrant Jan , Bossew Peter 
Published: May 2023

Abstract
Citizen Science (CS) is research performed by citizens who are not professional scientists in general. SAFECAST was founded in Japan after the Fukushima accident 2011, motivated by distrust in the perceived biassed information by authorities about radiation situation. Measurements of ambient dose rate (ADR) performed by citizens were intended to verify and complement official data using bGeigieNano designed for purpose, recording ADR, GPS coordinates and date/time allowing projection on digital maps. The project expanded internationally, by mid-2022 containing ⁓180 million measurements. CS generates large amount of data as valuable source for science; it has educational value and serves communication between citizens and professionals. Problems consist in quality assurance (QA): citizens who are no trained metrologists are usually little familiar with notions of representativeness, measurement protocols and uncertainty that are the central QA topics. We discuss variability of response of instruments of the same kind under same ambient conditions and isotropy of response under field conditions.
Assessment of absorbed power density in multilayer planar model of human tissue
Authors: Poljak Dragan , Šušnjara Anna , Kraljević Lucija 
Published: May 2023

Abstract
The paper deals with the determination of the absorbed power density (Sab) in a planar multilayer model of a tissue exposed to the radiation of a dipole antenna, based on the analytical/numerical approach. A derivation of Sab from the differential form of Poynting theorem is presented. The two-layer and three-layer tissue models are used. Illustrative analytical/numerical results for electric and magnetic fields and Sab induced at the tissue surface for various antenna lengths, operating frequencies and antenna-interface distances are presented in the paper. Exposure scenarios of interest pertain to frequencies above 6GHz pertaining to 5G mobile systems.
Twenty years of inspection interventions in Slovenia
Authors: Janžekovič Helena 
Published: May 2023

Abstract
After the Dijon Conference in 1998, Slovenia upgraded emergency response systems giving attention to orphan sources. It followed the European Union legislation, e.g. Council Directive 2013/59/EURATOM, and international experiences. The upgrading includes, among others, 24h on duty Slovenian Nuclear Safety Administration (SNSA) service, reporting of incidents and accidents and installation of radiation monitors. The SNSA established already in 2002, the SNSA Database of Interventions with records of all events requiring prompt inspector actions, i.e. interventions. Today, the SNSA Database contains records on about 300 cases. Despite the fact that each intervention is unique, several types of interventions might be identified, e.g. interventions related to handling sources or radioactive waste, transport and false alarms. About 20% of interventions are related to NORM, whereas about 30% are false alarms. The SNSA Database is a tool used to implement a graded approach as well as an optimization of radiation protection in SNSA response to interventions.