bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing teacher noticing on paper and pencil and technology tasks
Authors: Chandler Kayla
Published: October 2023

Work in teacher noticing has captured to what extent teachers notice students' thinking on paper and pencil tasks and technology tasks, yet no one study has considered how the same group of teachers notices across task types. This study used Jacobs et al.'s (Journal for Research in Mathematics Education, 2010, 41(2), pp: 169–202.) professional noticing of students' thinking framework to guide the design and analysis of prospective secondary mathematics teachers' (PSMTs) noticing of high school students' thinking on two geometry tasks: a paper and pencil task and a technology task. High school students' written work and a video clip were shared as the artifacts from which to notice for each task. PSMTs responded to a set of noticing prompts to capture how they were attending, interpreting, and deciding to respond to students' thinking for each task. Their written responses to these questions were then open coded for each noticing component and codes from each task were compared to reveal any differences in the content of PSMTs' noticing across task types. Results revealed differences between tasks for each component skill of noticing. Implications of these findings for mathematics teacher educators and future research are discussed.
The relationship between site history and human health risks: Lessons from 13 years of contaminated land risk assessments in Victoria, Australia
Authors: Kabay Victor Gabriel , Papaleo Clare Boni , Reichman Suzie M.
Published: October 2023

Site history is widely recognized as one of the key determinants of the nature and scale of contamination that is likely to be present at a location. While there is vast anecdotal and empirical evidence on the relationship between site history and risk of exposure to pollution, few attempts have been made to systematically collate data across sites to rigorously identify such trends. This study presents an analysis of human health risk metrics extracted from all 1732 contaminated land environmental audits published in Victoria, Australia between 2006 and 2018. The contaminating activities found to be most likely associated with elevated risks to human health were service stations, fuel depots, dry cleaners, gasworks, mechanical parts manufacturers, imported fill and unknown offsite sources generating regional groundwater pollution (usually polluted with trichloroethene). The ten chemical contaminants most frequently assessed in human health risk assessment reports included (in order): benzene, C>10–16 petroleum hydrocarbons, naphthalene, C6–10 petroleum hydrocarbons, xylenes, trichloroethene, toluene, ethylbenzene, benzo(a)pyrene, and tetrachloroethene. The findings of this report include recommendations to develop regulatory guideline values in Australia for trimethylbenzenes, heavy fraction petroleum hydrocarbons (C>16), and trans‐1,2‐dicholoethene, and to strengthen the evidence base informing risks associated with light fraction petroleum hydrocarbons (C6–16) and trichloroethene. To the author's knowledge, this study is the first to extract risk metrics from environmental audit reports and provides a strong evidence base to help regulators, academics and commercial practitioners rank and prioritize sites based on their site history and associated risks.
A rigidity result for holomorphic quadratic differentials of finite norm in the unit disk
Authors: Gao Qiang
Published: October 2023

Let be a holomorphic quadratic differential of finite norm in the unit disk . Let be equipped with the metric . In this paper, we prove that a geodesic‐preserving map of the unit disk into itself is affine. A map is called geodesic‐preserving if the image of each geodesic is a geodesic. We make no assumptions on the continuity of such a map.
Analysis of Shear Wave Propagation in Soft Biomaterials Using a Finite Element Model
Authors: Wang Jianing , Li Runze , Zhou Qifa , Gu Linxia , Dong Pengfei
Published: October 2023

The elastography method has been widely used to estimate the stiffness of biomaterials based on the shear wave speed. The wave propagation excited by a single indent on the surface of the biomaterials is not always an ideal shear wave. The distance from the interested region to the indent or different algorithms for elastography may affect the calculation of stiffness. This paper aims to analyze the shear wave propagation in soft biomaterials using a finite element model. A finite element model was constructed based on the setup of our previous in vitro experiments on the elastography of gelatin. Briefly, a shear wave propagation was induced by a single indent with a frequency of 1 kHz. Following simulation, the displacements along a path line, at three depths, were extracted for analyzing the shear wave propagation. The influence of the damping behavior and three different elastography algorithms were investigated. Results have shown that finite element simulation agreed well with the previous in vitro experiments. The estimated stiffness increased by more than 10% as the depth increased from 1 mm to 7 mm. This increase was even larger for the material with a larger damping behavior (viscoelasticity). The precise estimation was related to the distance between the interested region and the indent for the material with a larger damping behavior after the distance of 4 mm. The feasibility of three algorithms, i.e., wavefront slope, cross-correlation algorithm, and finite differencing method (FDM), were investigated. The FDM proposed in this work can determine the shear wave speed based on local spatial and temporal data, while it demands high-frequency data. The understanding from this work may provide valuable information for optimizing the performance of elastography.
An Integrated Kinematic Mapping and Fourier Method to Design Spherical Coupled Serial Chain Mechanisms for Single-Joint Rehabilitation
Authors: Li Xiangyun , Lv Hao , Yu Xi , Chen Peng , Li Kang
Published: October 2023

Robotic devices are capable of reducing the physical burden on rehabilitation therapists and providing training programs of good repeatability, high efficiency, and high precision. When designing the kinematic structure for rehabilitation robots, there has been a growing interest toward one-degree-of-freedom (DOF) end-effector mechanisms due to their simpler structure and less complicated control algorithms. Compared with current one-DOF mechanism designs that are mainly customized for multi-joint robotic training, spherical coupled serial chain (SCSC) mechanisms are proposed in this paper to specifically deliver the single-joint robotic training, which is of equal importance to the effective physical recovery. Using kinematic mapping theory, the end-effector motion of SCSC mechanisms can be naturally transformed to two trigonometric curves composed of finite Fourier series in two separate planes of the image space. This novel formulation helps to establish an analytical and direct relationship between the design parameters of the SCSC mechanism and the harmonic parameters of the image-space representation of the task rehabilitation motion. The result is a simple and effective method for kinematic synthesis of SCSC mechanisms for generation of single-joint motion with an arbitrary number of spherical poses. An example of designing SCSC mechanisms for shoulder-joint rehabilitation is presented at the end of this paper to illustrate the feasibility of the proposed method.
Correlating the Influence of the Purity of Hydrogen Produced by a Surplus Power on the Production of Green Ammonia
Authors: Kim Byungjun , Lee Young Duk
Published: October 2023

Carbon dioxide is the primary greenhouse gas contributing to climate change. Furthermore, due to the surplus power generated by renewable energy resources, various approaches have been developed to handle this overproduction. This study verifies via a correlation analysis the influence of the purity of hydrogen produced by a continuous surplus power on sustainable ammonia production. The influence of the temperature and pressure of the hydrogen treatment system on the purity of the hydrogen gas produced in the alkaline water electrolysis system was investigated, where the purity increased with a decrease in temperature and an increase in pressure. The purity of the produced ammonia was positively correlated with the purity of hydrogen. Furthermore, the energy consumption of the ammonia production process increased when the purity of hydrogen was low. In the case of storing the surplus power as ammonia, the effect of hydrogen purity was less affected by the hydrogen production system than by the ammonia production system, and it was thus concluded that it is more desirable to determine the hydrogen purity in the hydrogen production system prior to employing it in the ammonia production system.
High-mass metal ion irradiation enables growth of high-entropy sublattice nitride thin films from elemental targets
Authors: Rogoz Vladyslav , Pshyk Oleksandr , Wicher Bartosz , Palisaitis Justinas , Lu Jun , Primetzhofer Daniel , Petrov Ivan , Hultman Lars , Greczynski Grzegorz
Published: October 2023

Synthesis of high-entropy sublattice nitride (HESN) coatings by magnetron sputtering is typically done using custom-made alloyed targets with specific elemental compositions. This approach is expensive, requires long delivery times, and offers very limited flexibility to adjust the film composition. Here, we demonstrate a new method to grow HESN films, which relies on elemental targets arranged in the multicathode configuration with substrates rotating during deposition. TiVNbMoWN films are grown at a temperature of ∼520 °С using Ti, V, Nb, and Mo targets operating in the direct current magnetron sputtering mode, while the W target, operated by high power impulse magnetron sputtering (HiPIMS), provides a source of heavy ions. The energy of the metal ions EW+ is controlled in the range from 80 to 620 eV by varying the amplitude of the substrate bias pulses Vs, synchronized with the metal-ion-rich phase of HiPIMS pulses. We demonstrate that W+ irradiation provides dynamic recoil mixing of the film-forming components in the near-surface atomic layers. For EW+ ≥ 320 eV the multilayer formation phenomena, inherent for this deposition geometry, are suppressed and, hence, compositionally uniform HESN films are obtained, as confirmed by the microstructural and elemental analysis.
A broadly immunogenic polyvalent
Shigella
multiepitope fusion antigen protein protects against
Shigella sonnei
and
Shigella flexneri
lethal pulmonary challenges in mice
Authors: Li Siqi , Anvari Shaghayegh , Ptacek Galen , Upadhyay Ipshita , Kaminski Robert W. , Sack David A. , Zhang Weiping
Published: October 2023

There are no licensed vaccines for
Shigella
, a leading cause of children’s diarrhea and a common etiology of travelers’ diarrhea. To develop a cross-protective
Shigella
vaccine, in this study, we constructed a polyvalent protein immunogen to present conserved immunodominant epitopes of
Shigella
invasion plasmid antigens B (IpaB) and D (IpaD), VirG, GuaB, and Shiga toxins on backbone protein IpaD, by applying an epitope- and structure-based multiepitope-fusion-antigen (MEFA) vaccinology platform, examined protein (
Shigella
MEFA) broad immunogenicity, and evaluated antibody function against
Shigella
invasion and Shiga toxin cytotoxicity but also protection against
Shigella
lethal challenge. Mice intramuscularly immunized with
Shigella
MEFA protein developed IgG responses to IpaB, IpaD, VirG, GuaB, and Shiga toxins 1 and 2; mouse sera significantly reduced invasion of
Shigella sonnei
,
Shigella flexneri
serotype 2a, 3a, or 6,
Shigella boydii,
and
Shigella dysenteriae
type 1 and neutralized cytotoxicity of Shiga toxins of
Shigella
and Shiga toxin-producing
Escherichia coli in vitro
. Moreover, mice intranasally immunized with
Shigella
MEFA protein (adjuvanted with dmLT) developed antigen-specific serum IgG, lung IgG and IgA, and fecal IgA antibodies, and survived from lethal pulmonary challenge with
S. sonnei
or
S. flexneri
serotype 2a, 3a, or 6. In contrast, the control mice died, became unresponsive, or lost 20% of body weight in 48 h. These results indicated that this
Shigella
MEFA protein is broadly immunogenic, induces broadly functional antibodies, and cross-protects against lethal pulmonary challenges with
S. sonnei
or
S. flexneri
serotypes, suggesting a potential application of this polyvalent MEFA protein in
Shigella
vaccine development.
N-terminal domain of classical swine fever virus N
pro
induces proteasomal degradation of specificity protein 1 with reduced HDAC1 expression to evade from innate immune responses
Authors: Chen Rong , Han Xiao , Xu Hankun , Xu Jidong , Cao Tong , Shan Ying , He Fang , Fang Weihuan , Li Xiaoliang
Published: October 2023

Classical swine fever virus (CSFV) poses a major threat to the pig industry. The mechanisms that CSFV uses to evade host innate immunity are not fully understood. Acetylation of histones and non-histone proteins is involved in modulating innate immune responses. Histone deacetylase 1 (HDAC1) could be proviral or antiviral by modulating the acetylation status of histones, viral proteins or non-histone host proteins, depending on the type of viruses involved. First, we found that CSFV infection in IPEC-J2 cells resulted in reduced expression of HDAC1. By chemical inhibition, gene silencing, and overexpression, we revealed that HDAC1 acts as a negative regulator of CSFV replication in IPEC-J2 cells probably through activation of poly(I:C) and IFN-λ3-induced IFN-I/III innate immunity. Mechanistically, CSFV N
pro
downregulated HDAC1 and its transcriptional regulator specificity protein 1 (Sp1). N
pro
interacted with Sp1 to facilitate its degradation through the ubiquitin-proteasome pathway via its N-terminal domain, a region that does not have significant effect on IRF3 stability. Thus, it is clear that CSFV deploys the two domains of its N
pro
to counteract the innate immune responses, the C-terminal one targeting the IRF3 pathway as previously reported, and the N-terminal one targeting the Sp1-HDAC1 axis.

IMPORTANCE

Of the flaviviruses, only CSFV and bovine viral diarrhea virus express N
pro
as the non-structural protein which is not essential for viral replication but functions to dampen host innate immunity. We have deciphered a novel mechanism with which CSFV uses to evade the host antiviral immunity by the N-terminal domain of its N
pro
to facilitate proteasomal degradation of Sp1 with subsequent reduction of HDAC1 and ISG15 expression. This is distinct from earlier findings involving N
pro
-mediated IRF3 degradation via the C-terminal domain. This study provides insights for further studies on how HDAC1 plays its role in antiviral immunity, and if and how other viral proteins, such as the core protein of CSFV, the nucleocapsid protein of porcine epidemic diarrhea virus, or even other coronaviruses, exert antiviral immune responses via the Sp1-HDAC1 axis. Such research may lead to a deeper understanding of viral immune evasion strategies as part of their pathogenetic mechanisms.
The SET and ankyrin domains of the secreted
Legionella pneumophila
histone methyltransferase work together to modify host chromatin
Authors: Rolando Monica , Wah Chung Ivy Yeuk , Xu Caishuang , Gomez-Valero Laura , England Patrick , Cygler Miroslaw , Buchrieser Carmen
Published: October 2023

Legionella pneumophila
is a bacterial pathogen ubiquitous in natural and man-made aquatic environments, where it replicates in protozoa. Its intracellular life cycle depends on the establishment of a
Legionella
-containing vacuole (LCV) where the bacteria replicate. To form the LCV,
L. pneumophila
depends on a type-4 secretion system that secretes more than 300 proteins in the host cell. Among these is RomA that encodes an N-terminal catalytic methyltransferase domain with a SET fold and a C-terminal domain containing six ankyrin repeats. We have reported that the SET domain has histone methyltransferase activity and specifically methylates lysine 14 of histone H3 during infection; however, the role of the ankyrin repeats is unknown. Here, we report the structure of RomA co-crystallized with a 15-mer peptide corresponding to the N-terminal tail of histone H3 at 2.2 Å. This structure revealed that the N-terminal arm of the peptide from Thr3-Ala7 binds to the ankyrin repeat domain and the C-terminal arm from Gly13-Arg17 and interacts with the SET domain, inserting Lys14 into the active site for methylation. Importantly, the interactions of the five N-terminal residues of the H3-peptide with the ankyrin domains account for ~50% of the peptide-RomA contacts, predicting that the ankyrin domains of RomA are essential for histone H3 binding and subsequent lysine methylation.
In vitro
enzymatic activity and binding assays confirmed these predictions. Thus, the six ankyrin domains are essential for chromatin binding, thereby allowing the SET domain to fulfill its histone transferase activity and to modify the host chromatin to the advantage of the pathogen.

IMPORTANCE

Legionella pneumophila
is an intracellular bacterium responsible of Legionnaires’ disease, a severe pneumonia that is often fatal when not treated promptly. The pathogen’s ability to efficiently colonize the host resides in its ability to replicate intracellularly. Essential for intracellular replication is translocation of many different protein effectors
via
a specialized secretion system. One of them, called RomA, binds and directly modifies the host chromatin at a unique site (tri-methylation of lysine 14 of histone H3 [H3K14me]). However, the molecular mechanisms of binding are not known. Here, we resolve this question through structural characterization of RomA together with the H3 peptide. We specifically reveal an active role of the ankyrin repeats located in its C-terminal in the interaction with the histone H3 tail. Indeed, without the ankyrin domains, RomA loses its ability to act as histone methyltransferase. These results discover the molecular mechanisms by which a bacterial histone methyltransferase that is conserved in
L. pneumophila
strains acts to modify chromatin.
Mycobacteriales
taxonomy using network analysis-aided, context-uniform phylogenomic approach for non-subjective genus demarcation
Authors: Val-Calvo Jorge , Vázquez-Boland José A.
Published: October 2023

Genomics allows accurately pinpointing microbial ancestry for taxonomic purposes, yet there is currently no consensus to genus definition based on genome data. Different metrics and criteria are used, with an increasing trend toward genera over-splitting. Here, we report a method for prokaryotic genus assignment that combines normalized tree clustering and network analysis of several genomic relatedness indices. Objectivity is maximized by linear application of the same partitioning thresholds across an entire middle/high taxonomic rank context (order level), with the classical (“pre-genomic”) genera as demarcation reference, ensuring continuity in taxonomy and nomenclature. We tested the method with the
Mycobacteriales
, where recent examples of genus fragmentation divided
Mycobacterium
into five genera, or made
Rhodococcus
paraphyletic by creating the genus
Prescottella
for the sublineage containing the animal and human pathogen,
Rhodococcus equi
. Our approach did not support the mycobacterial five-genus split or the
Prescottella
nested genus, but identified a basal branch in each of the mycobacterial and rhodococcal radiations warranting genus status (
Mycobacteroides
, and novel genus
Rhodococcoides
for the
Rhodococcus fascians
clade, respectively). The median average amino acid identity (AAI) between the demarcated genera was 56% to 59%, consistent with the <65% AAI genus boundary standard. Shifting the demarcation threshold to the
Prescottella
/mycobacterial five-genus level systematically elevated the intrageneric sublineages to genus rank, leading to taxonomic atomization (≈threefold increase in potential
Mycobacteriales
genera). The proposed approach provides a standardizable methodological framework for non-subjective prokaryotic genus delineation.

IMPORTANCE

A robust taxonomy is essential for the organized study of prokaryotes and the effective communication of microbial knowledge. The genus rank is the mainstay of biological classification as it brings together under a common name a group of closely related organisms sharing the same recent ancestry and similar characteristics. Despite the unprecedented resolution afforded by whole-genome sequencing in defining evolutionary relationships, a consensus approach for phylogenomics-based prokaryotic genus delineation remains elusive. Taxonomists use different demarcation criteria, sometimes leading to genus rank over-splitting and the creation of multiple new genera. This work reports a simple, reliable, and standardizable method that seeks to minimize subjectivity in genomics-based demarcation of prokaryotic genera, exemplified through application to the order
Mycobacteriales
. Formal descriptions of proposed taxonomic changes based on our study are included.
Deciphering the molecular components of the
quorum sensing
system in the fungus
Ophiostoma piceae
Authors: Santos-Pascual Rodrigo , Campoy Iván , Sanz Mata David , Martínez María Jesús , Prieto Alicia , Barriuso Jorge
Published: October 2023

Quorum sensing
(QS) is a complex cell-cell communication mechanism that coordinates population-level behaviors in microbes. In eukaryotes, this phenomenon has been extensively described in the dimorphic yeast
Candida albicans
as its main QS molecule, the sesquiterpene alcohol farnesol, is responsible for various phenotypic (i.e., inhibition of yeast-to-hyphae transition, biofilm formation, and, hence, pathogenesis) and metabolic (i.e., induction of oxidative stress and apoptosis) changes.
Ophiostoma piceae
CECT 20416 is a dimorphic saprotrophic ascomycete with biotechnological interest that also produces farnesol as QS molecule, but in this case, the alcohol promotes the morphological transition to the mycelial form, biofilm formation, enzyme secretion, and melanin production. Here, we characterized the physiological response of
Ophiostoma piceae
to farnesol, the molecular components of the QS system of this fungus have been investigated using a “multiomics” approach that involved genomic, transcriptomic, and proteomic analyses. Some genes identified in this work are proposed as key factors in farnesol transport and signaling. We have also cataloged the genes undergoing major transcriptional changes triggered by the presence of the autoinducer, such as cell-wall remodeling, reactive oxygen species (ROS) protection, and melanin biosynthesis, using self-organizing maps. This analysis could be useful for applications in the forestry industry, for enzymes production, and for the valorization of residues. Furthermore, it might as well help to investigate the QS mechanisms of clinically relevant fungi phylogenetically related to
Ophiostoma
.

IMPORTANCE

This manuscript presents a comprehensive study on the molecular mechanisms triggered by the
quorum sensing
(QS) molecule farnesol in the biotechnologically relevant fungus
Ophiostoma piceae
. We present for the first time, using a multiomics approach, an in-depth analysis of the QS response in a saprotroph fungus, detailing the molecular components involved in the response and their possible mechanisms of action. We think that these results are particularly relevant in the knowledge of the functioning of the QS in eukaryotes, as well as for the exploitation of these mechanisms.
Hamman’s syndrome – with audio file recording Hamman’s sign
Authors: Janardhan Nitish , Nair Nandu , Baikunje Nandakishore , Mandya Thimmaiah Chandramouli
Published: October 2023

A boy in his late adolescence, with no history of airway disease or medication use, presented with acute history of non-exertional chest pain increased on coughing and deep inspiration accompanied by dysphonia and odynophagia in the last 1 day. He had a notable history of viral fever with non-productive cough 2 weeks prior, which resolved spontaneously. Examination revealed stable haemodynamic parameters. Palpable non-tender crepitus was felt in left anterior chest wall, axilla and both sides of the neck. Auscultation revealed Hamman’s sign. ECG showed high voltage complexes and 2-dimensional echocardiogram (2D ECHO) showed normal biventricular function. CXR was evident of subcutaneous emphysema, pneumopericardium and Naclerio’s sign clinching the diagnosis of pneumomediastinum. CT findings were consistent with a diagnosis of Hamman’s syndrome. Patient was admitted for observation and treated with high-flow oxygen. He improved symptomatically and was discharged on the fourth day of admission.
Atypical case of acute posterior multifocal placoid pigment epitheliopathy with intraretinal fluid
Authors: Barbosa Renato Correia , Gonçalves Rita , Vieira Bruna
Published: October 2023

Acute posterior multifocal placoid pigment epitheliopathy is a rare inflammatory chorioretinopathy, classified as a white dot syndrome, in which ischaemia of the choriocapillaris leads to atrophy of the external retinal layers, including the retinal pigment epithelium.

A male patient in his 20s presented with sudden severe loss of vision in the left eye. Funduscopy revealed with yellow placoid lesions in the macula and near periphery. Spectral-domain optical coherence tomography and fluorescein angiography revealed the presence of central intraretinal fluid in the left eye and multiple areas of macular ischaemia bilaterally. Treatment with oral corticosteroids was initiated, and the anatomical changes, including the intraretinal fluid, improved steadily over the following weeks.

Although rare, the presence of subretinal or intraretinal fluid should not decrease the suspicion of acute posterior multifocal placoid pigment epitheliopathy. Reabsorption of the fluid is usually accompanied by the improvement of the remaining anatomical changes and the visual function.
Mortality risks associated with floods in 761 communities worldwide: time series study
Authors: Yang Zhengyu , Huang Wenzhong , McKenzie Joanne E , Xu Rongbin , Yu Pei , Ye Tingting , Wen Bo , Gasparrini Antonio , Armstrong Ben , Tong Shilu , Lavigne Eric , Madureira Joana , Kyselý Jan , Guo Yuming , Li Shanshan
Published: October 2023

Objective

To evaluate lag-response associations and effect modifications of exposure to floods with risks of all cause, cardiovascular, and respiratory mortality on a global scale.

Design

Time series study.

Setting

761 communities in 35 countries or territories with at least one flood event during the study period.

Participants

Multi-Country Multi-City Collaborative Research Network database, Australian Cause of Death Unit Record File, New Zealand Integrated Data Infrastructure, and the International Network for the Demographic Evaluation of Populations and their Health Network database.

Main outcome measures

The main outcome was daily counts of deaths. An estimation for the lag-response association between flood and daily mortality risk was modelled, and the relative risks over the lag period were cumulated to calculate overall effects. Attributable fractions of mortality due to floods were further calculated. A quasi-Poisson model with a distributed lag non-linear function was used to examine how daily death risk was associated with flooded days in each community, and then the community specific associations were pooled using random effects multivariate meta-analyses. Flooded days were defined as days from the start date to the end date of flood events.

Results

A total of 47.6 million all cause deaths, 11.1 million cardiovascular deaths, and 4.9 million respiratory deaths were analysed. Over the 761 communities, mortality risks increased and persisted for up to 60 days (50 days for cardiovascular mortality) after a flooded day. The cumulative relative risks for all cause, cardiovascular, and respiratory mortality were 1.021 (95% confidence interval 1.006 to 1.036), 1.026 (1.005 to 1.047), and 1.049 (1.008 to 1.092), respectively. The associations varied across countries or territories and regions. The flood-mortality associations appeared to be modified by climate type and were stronger in low income countries and in populations with a low human development index or high proportion of older people. In communities impacted by flood, up to 0.10% of all cause deaths, 0.18% of cardiovascular deaths, and 0.41% of respiratory deaths were attributed to floods.

Conclusions

This study found that the risks of all cause, cardiovascular, and respiratory mortality increased for up to 60 days after exposure to flood and the associations could vary by local climate type, socioeconomic status, and older age.
Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors
Authors: Chow Erica , Clement Stephen , Garg Rajesh
Published: October 2023

Euglycemic diabetic ketoacidosis (EDKA) is an emerging complication of diabetes associated with an increasing use of sodium-glucose transporter type 2 (SGLT-2) inhibitor drugs. This review highlights the growing incidence of EDKA and its diagnostic challenges due to the absence of hallmark hyperglycemia seen in diabetic ketoacidosis (DKA). The paper presents a classification system for the severity of EDKA, categorizing it into mild, moderate, and severe based on serum pH and bicarbonate levels. Another classification system is proposed to define stages of EDKA based on anion gap and ketones at the time of diagnosis and during the treatment period. A treatment algorithm is proposed to guide clinicians in managing EDKA. This treatment algorithm includes monitoring anion gap and ketones to guide insulin and fluid management, and slower transition to subcutaneous insulin to prevent a relapse. Increased awareness of EDKA is essential for a timely diagnosis because an early diagnosis and treatment can improve clinical outcomes.
Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation
Authors: Palanikumar Logesh , Mahadevan Joshua , Kleinig Timothy
Published: October 2023

Introduction

Post-thrombectomy subarachnoid haemorrhage (SAH) can result in oculomotor palsy and drowsiness, which may falsely suggest transtentorial herniation.

Case presentation

We present a case of right oculomotor nerve palsy presenting after endovascular thrombectomy (EVT) for a right middle cerebral artery (MCA) stroke. The patient presented with a significant right MCA syndrome and a National Institutes of Health Stroke Scale (NIHSS) score of 10 with CT perfusion demonstrating a large penumbral lesion and a CT angiogram confirming a right MCA M1 occlusion. After thrombectomy, the patient developed a 9mm dilated non-reactive right pupil, and a new ipsilateral near-complete oculomotor nerve palsy. Repeat code stroke imaging demonstrated perimesencephalic SAH). The patient was managed expectantly and her conscious state and oculomotor palsy gradually resolved with an excellent neurological recovery.

Conclusion

This case underscores the potential for post-thrombectomy perimesencephalic SAH as a rare mimic of symptomatic intracranial haemorrhage with mass effect manifesting as sudden-onset oculomotor nerve palsy.
Cohort profile: TheSmartSleep Study, Denmark, combining evidence from survey, clinical and tracking data
Authors: Rod Naja Hulvej , Andersen Thea Otte , Severinsen Elin Rosenbek , Sejling Christoffer , Dissing Agnete , Pham Vi Thanh , Nygaard Mette , Schmidt Lise Kristine Højsgaard , Drews Henning Johannes , Varga Tibor , Freiesleben Nina La Cour , Nielsen Henriette Svarre , Jensen Andreas Kryger
Published: October 2023

Purpose

TheSmartSleep Studyis established to comprehensively assess the impact of night-time smartphone use on sleep patterns and health. An innovative combination of large-scale repeated survey information, high-resolution sensor-driven smartphone data, in-depth clinical examination and registry linkage allows for detailed investigations into multisystem physiological dysregulation and long-term health consequences associated with night-time smartphone use and sleep impairment.

Participants

TheSmartSleep Studyconsists of three interconnected data samples, which combined include 30 673 individuals with information on smartphone use, sleep and health. Subsamples of the study population also include high-resolution tracking data (n=5927) collected via a customised app and deep clinical phenotypical data (n=245). A total of 7208 participants are followed in nationwide health registries with full data coverage and long-term follow-up.

Findings to date

We highlight previous findings on the relation between smartphone use and sleep in theSmartSleep Study, and we evaluate the interventional potential of the citizen science approach used in one of the data samples. We also present new results from an analysis in which we use 803 000 data points from the high-resolution tracking data to identify clusters of temporal trajectories of night-time smartphone use that characterise distinct use patterns. Based on these objective tracking data, we characterise four clusters of night-time smartphone use.

Future plans

The unprecedented size and coverage of theSmartSleep Studyallow for a comprehensive documentation of smartphone activity during the entire sleep span. The study has been expanded by linkage to nationwide registers, which allow for further investigations into the long-term health and social consequences of night-time smartphone use. We also plan new rounds of data collection in the coming years.
Reflections of nurses in the fight against COVID-19 in Hubei: a qualitative study
Authors: Xiaoxu Zhi , Pu Yalou , Li Xiaoli , Zhao Yun , Zhu Shuqin , Niu Niu , Zuo Jingfang , Meng Aifeng , Chiang Lichi
Published: October 2023

Objectives

To explore the reflections and experiences of nurses who were deployed to the frontline to combat COVID-19 in Wuhan, China. In order to gain insights that can be useful in developing cultivating positive professional values and attitudes towards future public health emergencies.

Design

Qualitative study using semistructured interviews. Data were transcribed and analysed using the Colaizzi’s 7-step method. The study is reported in accordance with the consolidated Standards for Reporting Qualitative Research.

Setting

Telephonic interviews with nine participants who were deployed from Nanjing to Hubei Province for the fight against COVID-19.

Participants

Of 11 volunteer nurses deployed to Hubei Province for the fight against COVID-19, two nurses did not finish the interview because of their working hours. The remaining nine were recruited through purposive sampling using the following criteria: nurses who were deployed at the first stage and those who verbally agreed and signed an informed consent form to participate in the study.

Results

Three thematic categories and subthemes that were identified from the analysis were as follows: (1) ‘Assertive attitude to fight against the pandemic’, included three subthemes: ‘Inner calling towards professional accountability for saving lives’, ‘Extrinsic support that facilitates the commitment to the nursing profession’ and ‘Holistic value ascribed to the nursing profession’. (2) ‘Challenges associated with the anti-pandemic mission’, included ‘overcoming challenges around the strict requirements for personal protection’ and ‘Fear and uncertainty over the rapid progression of the disease’. (3) ‘Unbearable heaviness and lightness of being a nurse’, with two subthemes: ‘the heavy crown of the anti-pandemic hero’ and ‘eternal reverence without regrets’.

Conclusions

As reflected by the nurses on frontline combating COVID-19, it was necessary to inculcate professional nursing values in them, as only their dedication and selflessness could improve humanity’s chances against the disease.
Swedish multimodal cohort of patients with anxiety or depression treated with internet-delivered psychotherapy (MULTI-PSYCH)
Authors: Boberg Julia , Kaldo Viktor , Mataix-Cols David , Crowley James J , Roelstraete Bjorn , Halvorsen Matthew , Forsell Erik , Isacsson Nils H , Sullivan Patrick F , Svanborg Cecilia , Andersson Evelyn H , Lindefors Nils , Kravchenko Olly , Mattheisen Manuel , Danielsdottir Hilda B , Ivanova Ekaterina , Boman Magnus , Fernández de la Cruz Lorena , Wallert John , Rück Christian
Published: October 2023

Purpose

Depression and anxiety afflict millions worldwide causing considerable disability. MULTI-PSYCH is a longitudinal cohort of genotyped and phenotyped individuals with depression or anxiety disorders who have undergone highly structured internet-based cognitive-behaviour therapy (ICBT). The overarching purpose of MULTI-PSYCH is to improve risk stratification, outcome prediction and secondary preventive interventions. MULTI-PSYCH is a precision medicine initiative that combines clinical, genetic and nationwide register data.

Participants

MULTI-PSYCH includes 2668 clinically well-characterised adults with major depressive disorder (MDD) (n=1300), social anxiety disorder (n=640) or panic disorder (n=728) assessed before, during and after 12 weeks of ICBT at the internet psychiatry clinic in Stockholm, Sweden. All patients have been blood sampled and genotyped. Clinical and genetic data have been linked to several Swedish registers containing a wide range of variables from patient birth up to 10 years after the end of ICBT. These variable types include perinatal complications, school grades, psychiatric and somatic comorbidity, dispensed medications, medical interventions and diagnoses, healthcare and social benefits, demographics, income and more. Long-term follow-up data will be collected through 2029.

Findings to date

Initial uses of MULTI-PSYCH include the discovery of an association between PRS for autism spectrum disorder and response to ICBT, the development of a machine learning model for baseline prediction of remission status after ICBT in MDD and data contributions to genome wide association studies for ICBT outcome. Other projects have been launched or are in the planning phase.

Future plans

The MULTI-PSYCH cohort provides a unique infrastructure to study not only predictors or short-term treatment outcomes, but also longer term medical and socioeconomic outcomes in patients treated with ICBT for depression or anxiety. MULTI-PSYCH is well positioned for research collaboration.
Navigating data governance associated with real-world data for public benefit: an overview in the UK and future considerations
Authors: Jones Monica Catherine , Stone Tony , Mason Suzanne M , Eames Andy , Franklin Matthew
Published: October 2023

Real-world data encompass data primarily captured for the provision or operation of services, for example, electronic health records for direct care purposes, but which may have secondary uses for informing research or commissioning. Public benefit is potentially forfeited by the underutilisation of real-world data for secondary uses, in part due to risk aversion when faced with the prospect of navigating necessary and important data governance processes. Such processes can be perceived as complex, daunting, time-consuming and exposing organisations to risk. By providing an overview description and discussion around the role of six key legal and information governance frameworks and their role regarding responsible data access, linkage and sharing, our intention is to make data governance a less daunting prospect and reduce the perception that it is a barrier to secondary uses, thus enabling public benefit.
Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia
Authors: Sakas Zoe , Hester Kyra A , Ellis Anna , Ogutu Emily A , Rodriguez Katie , Bednarczyk Robert , Dixit Sameer , Kilembe William , Sarr Moussa , Freeman Matthew C
Published: October 2023

Objectives

Vaccination averts an estimated 2–3 million deaths annually. Although vaccine coverage improvements across Africa and South Asia have remained below global targets, several countries have outperformed their peers with significant increases in coverage. The objective of this study was to examine these countries’ vaccination programmes and to identify and describe critical success factors that may have supported these improvements.

Design

Multiple case study design using qualitative research methods.

Setting

Three countries with high routine immunisation rates: Nepal, Senegal, and Zambia.

Participants

We conducted 207 key informant interviews and 71 focus group discussions with a total of 678 participants. Participants were recruited from all levels, including government officials, health facility staff, frontline workers, community health workers, and parents. Participants were recruited from both urban and rural districts in Nepal, Senegal, and Zambia.

Results

Our data revealed that the critical success factors for vaccination programmes relied on the cultural, historical, and statutory context in which the interventions were delivered. In Nepal, Senegal, and Zambia, high immunisation coverage was driven by (1) strong governance structures and healthy policy environments; (2) adjacent successes in health system strengthening; (3) government-led community engagement initiatives, and (4) adaptation considering contextual factors at all levels of the health system.

Conclusions

Throughout this project, our analysis returned to the importance of defining and understanding the context, governance, financing, and health systems within a country, rather than focusing on any one intervention. This paper augments findings from existing literature by highlighting how contextual factors impact implementation decisions that have led to improvements in childhood vaccine delivery. Findings from this research may help identify transferable lessons and support actionable recommendations to improve national immunisation coverage in other settings.
What is the existing evidence base for adult medical same day emergency care in UK NHS hospitals? A scoping review protocol
Authors: Dean Sue , Barratt Julian
Published: October 2023

Objectives

Same day emergency care (SDEC) is a new model of care, which has emerged over the past 5 years, building on prior ambulatory care services. The National Health Service (NHS) England National Strategy for SDEC suggests SDEC can meet local health needs by providing alternatives to emergency department attendance or hospital admission, for people with an urgent healthcare need, beyond the limited scope of an urgent treatment centre. This review focuses on acute medical SDEC, as medical patients represent a significant proportion of emergency admissions. The planned scoping review aims to map the existing evidence base.

Methods and analysis

This is a protocol for a scoping review to be conducted in accordance with the format of the Joanna Briggs Institute (JBI) methodology for scoping reviews. The databases to be searched will include EMBASE, MEDLINE and CINAHL, via EBSCOhost. Sources of unpublished studies, policies and grey literature will include Google Scholar, the Cochrane Library, TRIP database, ProQuest Dissertations and Theses Open, and the Health Management Information Consortium. Papers relating to acute medicine adult patients attending NHS SDEC services in the UK will be included. International papers will be excluded, as will those over 5 years old, and those where full text is not available. The results of the search and study inclusion/exclusion process will be reported and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram. Data will be extracted from papers included in the scoping review by two reviewers, using a JBI data extraction tool. Any differences of opinion will be discussed until consensus is reached. If needed, a third reviewer will be asked to join the review team to achieve consensus. Data and themes extracted will be summarised and presented in tables. A narrative thematic summary will accompany the presented results, describing how the results relate to the review objective. Literature gaps will be identified and recommendations for future research made.

Ethics and dissemination

There is no requirement for ethical approval for this scoping review. On completion, it will be published in a peer-reviewed academic journal and presented at a conference.
Associations of smoking and alcohol consumption with the development of open angle glaucoma: a retrospective cohort study
Authors: Mahmoudinezhad Golnoush , Nishida Takashi , Weinreb Robert N , Baxter Sally L , Chang Aimee C , Nikkhoy Nicki , Walker Evan , Liebmann Jeffrey M , Girkin Christopher A , Moghimi Sasan
Published: October 2023

Objectives

To investigate the associations of alcohol consumption and smoking with the development of perimetric glaucoma in patients with suspected glaucoma.

Design

A retrospective cohort study of patients suspected to have glaucoma enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES).

Setting

Three tertiary glaucoma centres in the USA.

Participants

825 eyes of 610 patients with glaucoma suspect eyes with normal visual fields (VF) at baseline were followed over an average of 9 years from the DIGS and ADAGES studies.

Outcome measures

Development of glaucoma was defined as occurrence of three consecutive abnormal VF tests during follow-up. Univariable and multivariable Cox regression models were used to investigate lifestyle-related factors associated with development of VF loss over time.

Results

VF tests were abnormal three times in a row in 235 (28.5%) eyes. Alcohol consumption was associated with a higher risk of developing glaucoma (HR 1.57, 95% CI 1.03 to 2.38, p=0.037). In men, the risk of developing glaucoma in alcohol drinkers (HR 1.92, 95% CI 1.00 to 3.68, p=0.048) was greater than non-alcohol drinkers. In individuals of African descent, the risk of developing glaucoma in alcohol drinkers (HR 1.79, 95% CI 1.02 to 3.15, p=0.043) was greater than non-alcohol drinkers. Age was a modifier of the relationship between smoking and glaucomatous VF defects (p=0.048). The risk of developing glaucoma in smokers (HR 1.73, 95% CI 1.10 to 2.72, p=0.019) was greater than never smokers after adjustment for confounding factors in older patients (age >61 years).

Conclusion

Alcohol consumption was associated with an increased risk of developing glaucoma, particularly in men and individuals of African descent. The risk of developing glaucoma among smokers suspected of having glaucoma was influenced by age, with older individuals having a higher risk than younger people.

Trial registration number

NCT00221897andNCT00221923.