bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes over time in POLST use and content by race and ethnicity among California nursing home residents
Authors: Zingmond David S. , Powell David , Jennings Lee A. , Liang Li‐Jung , Escarce Jose J. , Parikh Punam , Wenger Neil S. 
Published: April 2023

AbstractBackgroundPhysician Orders for Life‐Sustaining Treatment (POLST) are commonly used for nursing home (NH) residents. Treatment orders differ across race and ethnicity, presumably related to cultural and socioeconomic variation and levels of access to care and trust. Because national efforts focus on addressing the underpinnings of racial and ethnic differences in treatment (i.e., access to care and trust), we describe POLST use and content by race and ethnicity.MethodsCalifornia requires NHs to document POLST completion and content in the Minimum Data Set. We describe POLST completion and content for all California NH residents from 2011 to 2016 (N = 1,120,376). Adjusting for resident characteristics, we compared changes in completion rate and differences by race and ethnicity in POLST content—orders for cardiopulmonary resuscitation (CPR), do not resuscitate (DNR), CPR with full treatment, DNR with selective treatment or comfort orders, and if unsigned.ResultsPOLST completion increased across all racial and ethnic groups from 2011 to 2016; by 2016, NH residents had a POLST two‐thirds or more of the time. In 2011, Black residents had a POLST with a CPR order 30.4% of the time, Hispanic residents 25.6%, and White residents 19.7%. By 2016, this grew to 42.5%, 38.2%, and 28.1%, respectively, with Black and Hispanic residents demonstrating larger increases than White residents (p < 0.001). Increases over time in POLST with CPR and full treatment were greater for Black and Hispanic residents compared to White residents. The increase in POLST with DNR and DNR with Selective treatment and Comfort orders was greater for White compared to Black patients (p < 0.001). Unsigned POLST with CPR and DNR orders decreased across all racial and ethnic groups.ConclusionsRacial and ethnic differences in POLST intensity of care orders increased between 2011 and 2016 suggesting that efforts to mitigate factors underlying differences were ineffective. Studies of newer POLST data are imperative.
Scheme for generating upscaling scenarios of emerging functional materials based energy technologies in prospective LCA (UpFunMatLCA)
Authors: Weyand Steffi , Kawajiri Kotaro , Mortan Claudiu , Schebek Liselotte 
Published: April 2023

AbstractUpscaling scenarios are indispensable elements of prospective life cycle assessment (LCA). However, current studies reveal confusing terminology and a wide range of approaches in this area. Therefore, we first defined the term upscaling scenario as the description of a possible future target stage of emerging technology, including the development pathway from a current stage within the course of research and development to this future stage. Second, we developed the novel systematic scheme UpFunMatLCA for generating explorative scenarios based on possible development pathways of the specific group of emerging functional material (FunMat)‐based energy technologies, including status quo developments. UpFunMatLCA represents a three‐step extension of conventional LCAs to upscale the life cycle inventory of emerging FunMats. UpFunMatLCA is based on a clear definition of a current status quo (conceptual, lab, or pilot stage) and a target matured (fab) development stage. A core part of UpFunMatLCA is the so‐called upscaling module, providing specific modeling methods and data for the upscaling of FunMats. Using perovskite solar cells, photovoltaic devices based on several FunMats and attached with great expectations regarding the future efficient provision of solar energy, we demonstrate the application of UpFunMatLCA, focusing on the upstream greenhouse gas (GHG) emissions of the prospective manufacturing. In the discussion, we point out the application area of UpFunMatLCA and the possible extension to depict further environmental impacts beyond GHG to contribute to the sustainability assessment of emerging technologies in the early stages of development.
Extending effectiveness to efficiency: Comparing energy and environmental assessment methods for a wet cooling tower
Authors: Wenzel Paula M. , Radgen Peter 
Published: April 2023

AbstractImproving the environmental performance and energy efficiency of cooling towers requires systematic evaluation. However, methodological challenges emerge when applying typical environmental assessment methods to cooling towers. Hence, this paper compares the methods, analyzes their strengths and weaknesses, and proposes adaptions for evaluating cooling towers. As a case study, we applied five methods for assessing the wet cooling system of the high‐performance data center in Stuttgart. These are material flow analysis (MFA), life cycle inventory, life cycle assessment (LCA), exergy analysis, and life cycle exergy analysis (LCEA). The comparison highlights that the LCA provides the most comprehensive environmental evaluation of cooling systems by considering several environmental impact dimensions. In the case of the wet cooling tower, however, electricity and water consumption cause more than 97% of the environmental impacts in all considered impact categories. Therefore, MFA containing energy flows suffices in many cases. Using exergy efficiency is controversially debated because exergy destruction is part of the technical principle applied in cooling towers and, therefore, difficult to interpret. The LCEA appears inappropriate because construction and disposal barely affect the exergy balance and are associated with transiting exergy. The method comparison demonstrates the need for further methodological development, such as dynamic extensions or the efficiency definition of cooling towers. The paper highlights that the methodological needs depend on the specific application.
Smartphone repairability indexes in practice: Linking repair scores to industrial design features
Authors: Barros Mário , Dimla Eric 
Published: April 2023

AbstractPolicymaking mediates the relationships between manufacturers and consumers, thus defining the boundaries for the philosophies of production set forth by major companies. Research states that policymaking falls short in addressing the waste issues, natural resources consumption, greenhouse gas emissions, and other negative impacts posed by premature obsolescence; only recently have the “right‐to‐repair” guidelines demanded by environmental organizations and communities of citizens been included in policymaking. The introduction of the Index of Repairability in France as information at the point of sale aims to inform consumers and support their decision‐making in purchasing more repairable products. In this paper, we consider the two Indexes of Repairability publicly available to consumers—in the French legislation and iFixit—and assess their application to smartphones from three manufacturers. The study establishes links between the scores and the industrial design features that promote or hinder repairability, service factors and information for self‐repair, authorized repair, and independent repair. Data collection considers the available information for consumers and citizens by using netnography and secondary data from manufacturers, policymakers, and communities of users. Our findings suggest that higher scores that indicate easier repairability are not limited to product architectures that follow design for disassembly guidelines. Smartphones that are difficult to repair can still score high, and thus be perceived as easier to repair, if manufacturers provide high quality and affordable service. This paper discusses the results of the ongoing development of repairability scores for smartphones, thus suggesting paths for future research to improve methods and policies to support a longer lifetime of products.
Precision medicine in complex diseases—Molecular subgrouping for improved prediction and treatment stratification
Authors: Johansson Åsa , Andreassen Ole A. , Brunak Søren , Franks Paul W. , Hedman Harald , Loos Ruth J. F. , Meder Benjamin , Melén Erik , Wheelock Craig E. , Jacobsson Bo 
Published: April 2023

AbstractComplex diseases are caused by a combination of genetic, lifestyle, and environmental factors and comprise common noncommunicable diseases, including allergies, cardiovascular disease, and psychiatric and metabolic disorders. More than 25% of Europeans suffer from a complex disease, and together these diseases account for 70% of all deaths. The use of genomic, molecular, or imaging data to develop accurate diagnostic tools for treatment recommendations and preventive strategies, and for disease prognosis and prediction, is an important step toward precision medicine. However, for complex diseases, precision medicine is associated with several challenges. There is a significant heterogeneity between patients of a specific disease—both with regards to symptoms and underlying causal mechanisms—and the number of underlying genetic and nongenetic risk factors is often high. Here, we summarize precision medicine approaches for complex diseases and highlight the current breakthroughs as well as the challenges. We conclude that genomic‐based precision medicine has been used mainly for patients with highly penetrant monogenic disease forms, such as cardiomyopathies. However, for most complex diseases—including psychiatric disorders and allergies—available polygenic risk scores are more probabilistic than deterministic and have not yet been validated for clinical utility. However, subclassifying patients of a specific disease into discrete homogenous subtypes based on molecular or phenotypic data is a promising strategy for improving diagnosis, prediction, treatment, prevention, and prognosis. The availability of high‐throughput molecular technologies, together with large collections of health data and novel data‐driven approaches, offers promise toward improved individual health through precision medicine.
Effects of subsidies on growth and welfare in a quality‐ladder model with elastic labor
Authors: Hu Ruiyang , Yang Yibai , Zheng Zhijie 
Published: April 2023

AbstractThis paper develops a quality‐ladder growth model with elastic labor supply and distortionary taxes to analyze the effects of different subsidy instruments: subsidies to the production of final goods, subsidies to the purchase of intermediate goods, and subsidies to research and development (R&D). Moreover, the model is calibrated to the US data to compare the growth and welfare implications of these subsidies. The main results are as follows. First, we analytically show that an optimal coordination of all instruments attains the first‐best outcome. Second, in the calibrated economy, we numerically find that for the use of a single instrument, R&D subsidy is less growth‐enhancing and welfare‐improving than the other subsidies, whereas for the use of a mix of two instruments, subsidizing the production of final goods and the purchase of intermediate goods is most effective in promoting growth but least effective in raising welfare.
Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid
Authors: Charlesworth Christina J. , Nagy Dylan , Drake Coleman , Manibusan Brynna , Zhu Jane M. 
Published: April 2023

AbstractObjectiveMedicaid enrollees in rural and frontier areas face inadequate access to mental health services, but the extent to which access varies for different provider types is unknown. We assessed access to Medicaid‐participating prescribing and nonprescribing mental health clinicians, focusing on Oregon, which has a substantial rural population.MethodsUsing 2018 Medicaid claims data, we identified enrollees aged 18‐64 with psychiatric diagnoses and specialty mental health providers who billed Medicaid at least once during the study period. We measured both 30‐ and 60‐minute drive time to a mental health provider, and a spatial access score derived from the enhanced 2‐step floating catchment area (E2SFCA) approach at the level of Zip Code Tabulation Areas (ZCTAs). Results were stratified for prescribers and nonprescribers, across urban, rural, and frontier areas.ResultsOverall, a majority of ZCTAs (68.6%) had at least 1 mental health prescriber and nonprescriber within a 30‐minute drive. E2SFCA measures demonstrated that while frontier ZCTAs had the lowest access to prescribers (84.3% in the lowest quintile of access) compared to other regions, some frontier ZCTAs had relatively high access to nonprescribers (34.3% in the third and fourth quartiles of access).ConclusionsSome frontier areas with relatively poor access to Medicaid‐participating mental health prescribers demonstrated relatively high access to nonprescribers, suggesting reliance on nonprescribing clinicians for mental health care delivery amid rural workforce constraints. Efforts to monitor network adequacy should consider differential access to different provider types, and incorporate methods, such as E2SFCA, to better account for service demand and supply.
Development of a reliable clinical assessment tool for meningoencephalitis in dogs: The neurodisability scale
Authors: Gonçalves Rita , Maddox Thomas W. , Phillipps Stephanie , Nagendran Aran , Cooper Camilla , Orlandi Rocio , Fentem Rory , Walmsley Gemma L. 
Published: April 2023

AbstractBackgroundMeningoencephalitis of unknown origin (MUO) comprises a group of debilitating inflammatory diseases affecting the central nervous system of dogs. Currently, no validated clinical scale is available for the objective assessment of MUO severity.ObjectivesDesign a neurodisability scale (NDS) to grade clinical severity and determine its reliability and whether or not the score at presentation correlates with outcome.AnimalsOne hundred dogs with MUO were included for retrospective review and 31 dogs were subsequently enrolled for prospective evaluation.MethodsMedical records were retrospectively reviewed for 100 dogs diagnosed with MUO to identify the most frequent neurological examination findings. The NDS was designed based on these results and evaluated for prospective and retrospective use in a new population of MUO patients (n = 31) by different groups of independent blinded assessors, including calculation of interobserver agreement and association with outcome.ResultsThe most common clinical signs in MUO patients were used to inform categories for scoring in the NDS: seizure activity, ambulatory status, posture and cerebral, cerebellar, brainstem, and visual functions. The intraclass correlation coefficient (ICC) for prospective use of the NDS was 0.83 (95% confidence interval [CI], 0.68‐0.91) indicating good agreement, and moderate agreement was found between prospective and retrospective assessors (ICC, 0.71; 95% CI, 0.56‐0.83). No association was found between NDS score and long‐term outcome.Conclusions and Clinical ImportanceThe NDS is a novel clinical measure for objective assessment of neurological dysfunction and showed good reliability when used prospectively in MUO patients but, in this small population, no association with outcome could be identified.
Empowering English as an Additional Language students through digital multimodal composing
Authors: Barnes Melissa , Tour Ekaterina 
Published: April 2023

AbstractWhile digital multimodal composing, underpinned by a critical literacies approach, provides opportunities for students to make informed semiotic choices and voice concerns about social issues, there is limited research exploring how digital multimodal composing is employed to interrogate and challenge the entanglements of language, immigration status and power. This article explores how 23 primary‐aged English as an Additional Language (EAL) students (Years 3–6) engaged in digital multimodal composing, in the context of an after‐school multiliteracies programme in one Australian school. Conceptualising critical literacies as a bridge to access and transform codes of power, the article explores how the participating students selected and used different semiotic resources for their digital texts while challenging and redefining dominant discourses based on their lived experiences and interests. The study found that both students and pre‐service teachers found value in students having access to digital technologies and experimenting with a range of multimodal and multilingual resources to create digital texts, which reflected cultural and linguistic identities. The findings illustrate how the creation of digital multimodal and multilingual texts allows for opportunities for students to reposition themselves as knowledgeable and active meaning‐makers with strategic support from teachers and peers.
Non‐tuberculous mycobacteriosis of the liver responsive to empiric therapy
Authors: Siciliani Luisa , Vanoli Alessandro , Berton Francesca , Mondelli Mario U. 
Published: April 2023

AbstractThis case demonstrates that clinical and pathological suspicion of NTM could be sufficient to start an empiric treatment even when microbiological isolation is unavailable. Moreover, disseminated mycobacteriosis may underlie an occult aggressive neoplasm.
Early sedation with dexmedetomidine in post‐operative adult intensive care unit patients
Authors: Yiewong Tenzin , Corry Margarita , Mooney Mary 
Published: April 2023

AbstractBackgroundDelirium is a leading healthcare concern in adult Intensive Care Units (ICU) and has a reported prevalence of up to 80%. Although individual studies report that early sedation with dexmedetomidine in post‐operative patients including its nocturnal administration can improve sleep quality and reduction in ICU delirium, these have not been synthesized in a systematic review.AimThe aim of this systematic review was to evaluate the effectiveness of early administration of dexmedetomidine infusion in the prevention of delirium, reduction in agitation, and improved sleep quality among post‐operative adults in ICU.Study DesignA systematic search was conducted across PubMed, CINAHL, MEDLINE, and EMBASE, together with a search for grey literature. Two authors independently screened the search results, extracted data, and assessed risk of bias (ROB). Data were meta‐analysed using RevMan 5.4 software. A simplified Cochrane approach was used in this review.ResultsFive randomized controlled trials with 2173 participants were included. ROB was assessed with the five studies included in this review. Of the five included studies, two were identified as having components with a high ROB; one study reporting high ROB in the domain of other biases, and the other study in the domains of allocation concealment as well as in the domains of blinding of participants and personnel. All other studies and domains were either low or unclear ROB. The result indicated that the incidence of delirium was reduced among the dexmedetomidine group (RR: 0.08, 95% CI −0.15 to −0.01, 3 studies, 1045 patients) when compared with those who received other medications. There was no difference in agitation (RR: 0.85, 95% CI 0.51 to 1.44, 2 studies, 779 patients), and although better sleep was associated with the dexmedetomidine group, no data focusing on the sleep quality was reported.ConclusionThe pooled result of this systematic review indicated a reduction in the incidence of delirium among ventilated patients who received early administration of dexmedetomidine post‐operatively. Although pooled sample sizes are relatively high, each outcome is based on one or two studies of primarily low or unclear ROB. Further research is warranted to determine the potential benefit of dexmedetomidine on agitation and sleep quality.Relevance to clinical practiceThe findings from this study support the use of light sedation, such as dexmedetomidine as recommended in the Society of Critical Care Medicine's guidelines.
The microbiome in adolescents with irritable bowel syndrome and changes with percutaneous electrical nerve field stimulation
Authors: Castillo Daniel F. , Denson Lee A. , Haslam David B. , Hommel Kevin A. , Ollberding Nicholas J. , Sahay Rashmi , Santucci Neha R. 
Published: April 2023

AbstractBackgroundIrritable bowel syndrome (IBS), a disorder of the gut–brain axis, is affected by the microbiome. Microbial studies in pediatric IBS, especially for centrally mediated treatments, are lacking. We compared the microbiome between pediatric IBS patients and healthy controls (HC), in relation to symptom severity, and with percutaneous electrical nerve field stimulation (PENFS), a non‐invasive treatment targeting central pain pathways.MethodsWe collected a stool sample, questionnaires and a 1–2 week stool and pain diary from 11 to 18 years patients with IBS. A patient subset completed 4 weeks of PENFS and repeated data collection immediately after and/or 3 months after treatment. Stool samples were collected from HC. Samples underwent metagenomic sequencing to evaluate diversity, composition, and abundance of species and MetaCyc pathways.Key ResultsWe included 27 cases (15.4 ± 2.5 year) and 34 HC (14.2 ± 2.9 year). Twelve species including Firmicutes spp., and carbohydrate degradation/long‐chain fatty acid (LCFA) synthesis pathways, were increased in IBS but not statistically significantly associated with symptom severity. Seventeen participants (female) who completed PENFS showed improvements in pain (p = 0.012), disability (p = 0.007), and catastrophizing (p = 0.003). Carbohydrate degradation and LCFA synthesis pathways decreased post‐treatment and at follow‐up (FDR p‐value <0.1).Conclusions and InferencesFirmicutes, including Clostridiaceae spp., and LCFA synthesis pathways were increased in IBS patients suggesting pain‐potentiating effects. PENFS led to marked improvements in abdominal pain, functioning, and catastrophizing, while Clostridial species and LCFA microbial pathways decreased with treatment, suggesting these as potential targets for IBS centrally mediated treatments.