bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonverbal Communication in Immersive Virtual Reality through the Lens of Presence: A Critical Review
Authors: Xenakis Ioannis , Gavalas Damianos , Kasapakis Vlasios , Dzardanova Elena , Vosinakis Spyros 
Published: June 2023

AbstractThe emergence of metaverse signifies the transformation of virtual reality (VR) from an isolated digital experience into a social medium, which facilitates new contexts of information exchange and communication. In fact, VR comprises the first-ever computer-mediated communication paradigm that enables the transfer of a broad range of nonverbal cues, including some unique cues which are not even known from face-to-face social encounters. This highlights the urgency to theoretically and experimentally investigate aspects of nonverbal communication (NVC) in immersive virtual environments (IVEs). We provide a critical outlook on empirical studies aiming at widening the discussion on how presence, as a core social factor, is affected by the perception of nonverbal signals and how NVC may be effectively utilized to facilitate social interactions in immersive environments. Our review proposes a classification of the most fundamental cues and modalities of NVC, which we associate with conceptualizations of presence that are more relevant to interpersonal communication. We also investigate the NVC-related aspects that are essential to construct an “active” virtual self-concept and highlight associations among NVC-related aspects through forming a complex web of research topics coming from the field of IVEs. We establish that the key research challenge is to go beyond simply studying nonverbal cues and technological settings in isolation.
Reasoning One’s Way Back into Skepticism
Authors: Satta Mark 
Published: June 2023

Abstract
Susanna Rinard aims to show that it is possible to rationally persuade an external world skeptic to reject external world skepticism. She offers an argument meant to convince a skeptic who accepts her views on “several orthogonal issues in epistemology” to give up their external world skepticism. While I agree with Rinard that it is possible to reason with a skeptic, I argue that Rinard overlooks a variety of good epistemic grounds a skeptic could appeal to in rejecting her argument and its conclusion. More specifically, I argue that the external world skeptic can resist Rinard’s conclusion by (1) distinguishing between skepticism about knowledge and skepticism about justification, (2) by prioritizing obtaining accurate beliefs (maximizing true beliefs and minimizing false beliefs) over being rational, or (3) by treating suspension of judgment as the default rational doxastic attitude.
Floral nectar reabsorption and a sugar concentration gradient in two long-spurred Habenaria species (Orchidaceae)
Authors: Zhang Hai-Ping , Wen Shi-Jia , Wang Hong , Ren Zong-Xin 
Published: June 2023

AbstractBackgroundFloral nectar is the most common reward flowers offered to pollinators. The quality and quantity of nectar produced by a plant species provide a key to understanding its interactions with pollinators and predicting rates of reproductive success. However, nectar secretion is a dynamic process with a production period accompanied or followed by reabsorption and reabsorption remains an understudied topic. In this study, we compared nectar volume and sugar concentration in the flowers of two long-spurred orchid species,Habenaria limprichtiiandH. davidii(Orchidaceae). We also compared sugar concentration gradients within their spurs and rates of reabsorption of water and sugars.ResultsBoth species produced diluted nectar with sugar concentrations from 17 to 24%. Analyses of nectar production dynamics showed that as flowers of both species wilted almost all sugar was reabsorbed while the original water was retained in their spurs. We established a nectar sugar concentration gradient for both species, with differences in sugar concentrations at their spur’s terminus and at their spur’s entrance (sinus). Sugar concentration gradient levels were 1.1% inH. limprichtiiand 2.8% inH. davidii, both decreasing as flowers aged.ConclusionWe provided evidence for the reabsorption of sugars but not water occurred in wilted flowers of bothHabenariaspecies. Their sugar concentration gradients vanished as flowers aged suggesting a slow process of sugar diffusion from the nectary at the spur’s terminus where the nectar gland is located. The processes of nectar secretion/reabsorption in conjunction with the dilution and hydration of sugar rewards for moth pollinators warrant further study.
Morphological, physio-biochemical and nutritional status as potential markers for grafting compatibility in Kalamata olive cultivar
Authors: Rashedy Ahmed AbdelHady , Hamed Hamed Hosni 
Published: June 2023

Abstract
Background
Choosing the most compatible and desirable rootstock for Kalamata olive cultivar is an important decision due to the longevity of the orchard and the difficulty rooting of Kalamata cuttings. Therefore, the goal of this study was to examine the morphological, physio-biochemical, and nutritional status as ppotential markers for grafting compatibility between Kalamata olive cultivar and three olive rootstocks (Coratina, Picual, Manzanillo) during two seasons (2020–2021) as well as follow up physio-bichemical and nutritional status of one-year-old Kalamata plants (2022).

Results
The results indicated that, Picual rootstock recorded the highest significant grafting success which was associated with increasing number of leaves, leaf area and SPAD value in Kalamata scions by 22.15%, 36.86% and 14.64% compared to Manzanillo rootstock as mean of both seasons, respectively. While, Manzanillo rootstock recorded the highest significant activity for peroxidase and catalase by 51.41% and 60.1% at grafting union compared to Picual rootstock. Moreover, Picual rootstock for Kalamata scions had the highest acid invertase and sucrose synthase activities by 67.23% and 57.94% compared to Manzanillo rootstock. Furthermore, Picual rootstock recorded the highest significant Gibberellic acid by 52.8% and 18.6% compared to Coratina and Manzanillo rootstocks. Meanwhile, Picual rootstock recorded the lowest significant Abscisic acid by 68.17% and 63.15% as well as the lowest total phenols by 14.36% and 23.47% compared to Coratina and Manzanillo rootstocks.

Conclusions
This study sheds light for the importance of choosing the suitable rootstock for Kalamata cultivar. Also, sucrose synthase and acid invertase may have a novel role in determining grafting compatibility in olives. Increasing growth promoters (Gibberellic, Nitrogen) and decreasing both growth inhibitors (Abscisic, phenols) and oxidative enzyme (catalase, peroxidase) required for better graft compatibility.
Epipericardial fat necrosis in chest CT and MRI: a case report of an unusual cause of chest pain associated with the initial diagnosis of undifferentiated connective tissue disease
Authors: Barreto Inês , Oliveira Francisca Godinho , Barreira Sofia Carvalho , Inácio João Rodrigues 
Published: June 2023

Abstract
Background
Epipericardial fat necrosis (EFN) is a benign and self-limited condition of unknown cause with a good prognosis, usually affecting otherwise healthy patients. Clinically, it presents with severe acute left pleuritic chest pain, often leading the patient to the Emergency Room (ER).

Case presentation
A 23-year-old male, smoker (5 pack-years), was evaluated in the ER due to left pleuritic chest pain, worsening with deep breathing and Valsalva maneuver. It was not associated with trauma and did not present other symptoms.
The physical examination was unremarkable. The arterial blood gases while breathing room air and the laboratory tests, including D-dimers and high-sensitivity cardiac Troponin T, were normal. The chest radiograph, electrocardiogram, and transthoracic echocardiogram showed no abnormalities.
A computed tomography (CT) pulmonary angiogram showed no signs of pulmonary embolism but depicted at the left cardiophrenic angle a focal 3 cm ovoid-shaped fat lesion with stranding and thin soft tissue margins, consistent with necrosis of the epicardial fat, which was confirmed by magnetic resonance (MRI) of the chest.
The patient was medicated with ibuprofen and pantoprazole, with clinical improvement in four weeks. At a two-month follow-up, he was asymptomatic and presented radiologic resolution of the inflammatory changes of the epicardial fat of the left cardiophrenic angle on chest CT. Laboratory tests revealed positive antinuclear antibodies, positive anti-RNP antibody, and positive lupus anticoagulant. The patient complained of biphasic Raynaud’s phenomenon initiated five years ago, and a diagnosis of undifferentiated connective tissue disease (UCTD) was made.

Conclusions
This case report highlights the diagnosis of EFN as a rare and frequently unknown clinical condition, which should be considered in the differential diagnosis of acute chest pain. It can mimic emergent conditions such as pulmonary embolism, acute coronary syndrome, or acute pericarditis. The diagnosis is confirmed by CT of the thorax or MRI. The treatment is supportive and usually includes non-steroidal anti-inflammatory drugs. The association of EFN with UCTD has not been previously described in the medical literature.
Surveillance of diphtheria in the Netherlands between 2000–2021: cutaneous diphtheria supersedes the respiratory form
Authors: Elsinga Jelte , van Meijeren Dimphey , Reubsaet Frans 
Published: June 2023

Abstract
Background
Diphtheria is a severe respiratory or cutaneous infectious disease, caused by exotoxin producing Corynebacterium diphtheriae, C. ulcerans and C. pseudotuberculosis. Diphtheria is once again prevalent due to breakdown of immunisation programmes, social disruption and unrest.

Aim
This study describes the notified diphtheria cases in the Netherlands between 2000–2021 and isolates that were sent to the National Institute for Public Health and the Environment (RIVM).

Methods
File investigation was performed including all notified cases and isolates of C. diphtheriae, C. ulcerans and C. pseudotuberculosis that were tested for toxin production using a toxin-PCR and Elek test. An exploratory review was performed to understand transmission in populations with a high vaccination uptake.

Results
Eighteen diphtheria notifications were made with confirmed toxigenic C. diphtheriae (n = 9) or ulcerans (n = 9) between 2000 and 2021. Seventeen (94.4%) presented with a cutaneous infection. All cases with a suspected source abroad (n = 8) concerned infection with C. diphtheriae. In contrast, 9/10 cases infected in the Netherlands were caused by C. ulcerans, a zoonosis. Secondary transmission was not reported. Isolates of C. ulcerans sent to the RIVM produced more often the diphtheria exotoxin (11/31; 35%) than C. diphtheriae (7/89; 7.9%).

Conclusion
Both human-to-human transmission of C. diphtheriae and animal-to-human transmission of C. ulcerans rarely occurs in the Netherlands. Cases mainly present with a cutaneous infection. Travel-related cases remain a risk for transmission to populations with low vaccination coverage, highlighting the importance of immunization and diphtheria control measures.
Characterization and evaluation of gene fusions as a measure of genetic instability and disease prognosis in prostate cancer
Authors: Schimmelpfennig Carolin , Rade Michael , Füssel Susanne , Löffler Dennis , Blumert Conny , Bertram Catharina , Borkowetz Angelika , Otto Dominik J. , Puppel Sven-Holger , Hönscheid Pia , Sommer Ulrich , Baretton Gustavo B. , Köhl Ulrike , Wirth Manfred , Thomas Christian , Horn Friedemann , Kreuz Markus , Reiche Kristin 
Published: June 2023

Abstract
Background
Prostate cancer (PCa) is one of the most prevalent cancers worldwide. The clinical manifestations and molecular characteristics of PCa are highly variable. Aggressive types require radical treatment, whereas indolent ones may be suitable for active surveillance or organ-preserving focal therapies. Patient stratification by clinical or pathological risk categories still lacks sufficient precision. Incorporating molecular biomarkers, such as transcriptome-wide expression signatures, improves patient stratification but so far excludes chromosomal rearrangements. In this study, we investigated gene fusions in PCa, characterized potential novel candidates, and explored their role as prognostic markers for PCa progression.

Methods
We analyzed 630 patients in four cohorts with varying traits regarding sequencing protocols, sample conservation, and PCa risk group. The datasets included transcriptome-wide expression and matched clinical follow-up data to detect and characterize gene fusions in PCa. With the fusion calling software Arriba, we computationally predicted gene fusions. Following detection, we annotated the gene fusions using published databases for gene fusions in cancer. To relate the occurrence of gene fusions to Gleason Grading Groups and disease prognosis, we performed survival analyses using the Kaplan–Meier estimator, log-rank test, and Cox regression.

Results
Our analyses identified two potential novel gene fusions, MBTTPS2,L0XNC01::SMS and AMACR::AMACR. These fusions were detected in all four studied cohorts, providing compelling evidence for the validity of these fusions and their relevance in PCa. We also found that the number of gene fusions detected in a patient sample was significantly associated with the time to biochemical recurrence in two of the four cohorts (log-rank test, p-value < 0.05 for both cohorts). This was also confirmed after adjusting the prognostic model for Gleason Grading Groups (Cox regression, p-values < 0.05).

Conclusions
Our gene fusion characterization workflow revealed two potential novel fusions specific for PCa. We found evidence that the number of gene fusions was associated with the prognosis of PCa. However, as the quantitative correlations were only moderately strong, further validation and assessment of clinical value is required before potential application.
Prognostic models for upper urinary tract urothelial carcinoma patients after radical nephroureterectomy based on a novel systemic immune-inflammation score with machine learning
Authors: Liu Jianyong , Wu Pengjie , Lai Shicong , Wang Jianye , Hou Huimin , Zhang Yaoguang 
Published: June 2023

Abstract
Purpose
This study aimed to evaluate the clinical significance of a novel systemic immune-inflammation score (SIIS) to predict oncological outcomes in upper urinary tract urothelial carcinoma(UTUC) after radical nephroureterectomy(RNU).

Method
The clinical data of 483 patients with nonmetastatic UTUC underwent surgery in our center were analyzed. Five inflammation-related biomarkers were screened in the Lasso-Cox model and then aggregated to generate the SIIS based on the regression coefficients. Overall survival (OS) was assessed using Kaplan-Meier analyses. The Cox proportional hazards regression and random survival forest model were adopted to build the prognostic model. Then we established an effective nomogram for UTUC after RNU based on SIIS. The discrimination and calibration of the nomogram were evaluated using the concordance index (C-index), area under the time-dependent receiver operating characteristic curve (time-dependent AUC), and calibration curves. Decision curve analysis (DCA) was used to assess the net benefits of the nomogram at different threshold probabilities.

Result
According to the median value SIIS computed by the lasso Cox model, the high-risk group had worse OS (p<0.0001) than low risk-group. Variables with a minimum depth greater than the depth threshold or negative variable importance were excluded, and the remaining six variables were included in the model. The area under the ROC curve (AUROC) of the Cox and random survival forest models were 0.801 and 0.872 for OS at five years, respectively. Multivariate Cox analysis showed that elevated SIIS was significantly associated with poorer OS (p<0.001). In terms of predicting overall survival, a nomogram that considered the SIIS and clinical prognostic factors performed better than the AJCC staging.

Conclusion
The pretreatment levels of SIIS were an independent predictor of prognosis in upper urinary tract urothelial carcinoma after RNU. Therefore, incorporating SIIS into currently available clinical parameters helps predict the long-term survival of UTUC.
Impact of an immersive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change
Authors: Singh Rishi P. , Welch Lauren , Longo Nicole L. , Frese Matt 
Published: June 2023

Abstract
Background
Retinal diseases, including wet or dry age-related macular degeneration, diabetic macular edema, and diabetic retinopathy (DR), are underdiagnosed and undertreated in the United States. Clinical trials support the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) therapies for several retinal conditions, but real-world data suggest underuse by clinicians, resulting in patients experiencing poorer visual outcomes over time. Continuing education (CE) has demonstrated effectiveness at changing practice behaviors, but more research is needed to understand whether CE can help address diagnostic and treatment gaps.

Methods
This test and control matched pair analysis examined pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners (i.e., retina specialists, ophthalmologists, optometrists, primary care providers, diabetes educators, pharmacists/managed care specialists, and other healthcare providers, such as registered nurses, nurse practitioners, and physician assistants) who participated in a modular, interactive CE initiative. An additional medical claims analysis provided data on practice change, evaluating use of VEGF-A inhibitors among retina specialist and ophthalmologist learners (n = 7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis.

Results
Learners significantly improved knowledge/competence scores on early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P-values = 0.003 to 0.004). Compared with matched controls, learners’ incremental total injections for anti-VEGF agents for retinal conditions increased more after the CE intervention (P < 0.001); specifically, there were 18,513 more (new) anti-VEGF injections prescribed versus non-learners (P < 0.001).

Conclusions
This modular, interactive, immersive CE initiative resulted in significant knowledge/competence gains among retinal disease care providers and changes in practice-related treatment behaviors (i.e., appropriate consideration and greater incorporation of guideline-recommended anti-VEGF therapies) among participating ophthalmologists and retina specialists compared to matched controls. Future studies will utilize medical claims data to show longitudinal impact of this CE initiative on treatment behavior among specialists and impact on diagnosis and referral rates among optometrists and primary care providers who participate in future programming.
Can protection motivation theory predict protective behavior against ticks?
Authors: Hansen Mette Frimodt , Sørensen Pelle Korsbaek , Sørensen Anja Elaine , Krogfelt Karen Angeliki 
Published: June 2023

Abstract
Background
Cases of reported tick-borne diseases in humans have increased over the past decades. Strategies informing the public about ticks, their associated diseases, and preventive measures are often highlighted as important in limiting pathogen transfer and disease. However, knowledge about the motivation for people to apply preventative measures is sparse.

Methods
The aim was to examine if Protection Motivation Theory, a model of disease prevention and health promotion, can predict the use of protective measures against ticks. Ordinal logistic regression and Chi-square tests were used on data from a cross-sectional survey with respondents from Denmark, Norway, and Sweden (n = 2658). We examined the effect of (1) the perceived seriousness of tick bites, Lyme borreliosis (LB), and tick-borne encephalitis (TBE), and (2) the perceived probability of getting a tick bite, Lyme borreliosis, and tick-borne encephalitis on protection against ticks. Finally, we examined if there was an association between the use of a protective measure and the perceived efficacy of that measure.

Results
The perceived seriousness of a tick bite and LB significantly predict who is more likely to apply protective measures for all three countries combined. The perceived seriousness of TBE did not significantly predict the level of adoption of protective measures applied by respondents. The perceived likelihood of getting a tick bite within the next 12 months and the perceived likelihood of getting LB if bitten by a tick significantly predicted the application of protective measures. However, the increases in the likelihood of protection were very small. The application of a certain type of protection was always correlated with the perceived efficacy of the same protective measure.

Conclusion
Some variables of PMT may be used to predict the level of adoption of protection applied against ticks and tick-borne diseases. We found that the perceived seriousness of a tick bite and LB significantly predict the level of adoption protection. The perceived likelihood of getting a tick bite or LB also significantly predicted the level of adoption of protection, although the change was very small. The results regarding TBE were less clear. Lastly, there was an association between applying a protective measure and the perceived efficacy of the same measure.
A 20-gene mutation signature predicts the efficacy of immune checkpoint inhibitor therapy in advanced non-small cell lung cancer patients
Authors: Hu Xilin , Guo Jing , Shi Jianguang , Li Da , Li Xinjian , Zhao Weijun 
Published: June 2023

Abstract
Background
There is an unmet need to identify novel predictive biomarkers that enable more accurate identification of individuals who can benefit from immune checkpoint inhibitor (ICI) therapy. The US FDA recently approved tumor mutational burden (TMB) score of ≥ 10 mut/Mb as a threshold for pembrolizumab treatment of solid tumors. Our study aimed to test the hypothesis that specific gene mutation signature may predict the efficacy of ICI therapy more precisely than high TMB (≥ 10).

Methods
We selected 20 candidate genes that may predict for the efficacy of ICI therapy by the analysis of data from a published cohort of 350 advanced non-small cell lung cancer (NSCLC) patients. Then, we compared the influences of various gene mutation signatures on the efficacy of ICI treatment. They were also compared with PD-L1 and TMB. The Kaplan-Meier method was utilized to evaluate the prognosis univariates, while selected univariates were adopted to develop a systematic nomogram.

Results
A high mutation signature, where three or more of the 20 selected genes were mutated, was associated with the significant benefits of ICI therapy. Specifically, patients with high mutation signature were confirmed to have better prognosis for ICI treatment, compared with those with wild type (the median PFS: 7.17 vs. 2.90 months, p = 0.0004, HR = 0.47 (95% [CI]:0.32–0.68); the median OS: unreached vs. 9 months, p = 1.8E-8, HR = 0.17 (95% [CI]:0.11–0.25)). Moreover, those patients with the high mutation signature achieved significant ICI treatment benefits, while there was no difference of OS and PFS between patients without the signature but TMB-H (≥ 10) and those without the signature and low TMB(< 10). Finally, we constructed a novel nomogram to evaluate the efficacy of ICI therapy.

Conclusion
A high mutational signature with 3 or more of the 20-gene panel could provide more accurate predictions for the outcomes of ICI therapy than TMB ≥ 10 in NSCLC patients.