bluuebunny/crossref_metadata_2025 huggingface dataset:
Killer whale (Orcinus orca) occurrence in Icelandic waters revealed by passive acoustic monitoring
Authors: Bellon Giulia , Selbmann Anna , Wensveen Paul , Rasmussen Marianne , Laute Amelie , Mouy Xavier , Samarra Filipa I. P.
Published: November 2024

The distribution and occurrence of killer whales around Iceland are primarily studied in coastal herring grounds, with limited knowledge beyond these areas. This study employed opportunistic passive acoustic monitoring (PAM) data from four regions across Icelandic inshore and offshore waters to investigate killer whale distribution between 2018 and 2023. An automatic detector‐and‐classifier algorithm identified killer whale burst‐pulsed calls, manually confirmed by human observers. Killer whale calls were detected on a total of 59 of 3075 recording days over a broader geographic area than previously documented. Detections were spread throughout the years, and in some cases, potential feeding behavior could be inferred. In the south of Iceland, killer whales were detected throughout the winter period; their presence outside of the summer months was previously undocumented. In the west, daily occurrences differed between two locations, which may be linked to the distribution of herring. In the east and northeast, killer whales were detected in the summer months, aligning with the abundance of herring in these regions. This study highlights the importance of PAM for year‐round monitoring of killer whale occurrence in the North Atlantic and contributes to our understanding of how they may respond to potential changes in prey dynamics.
Chinese young adults' emotion regulation and conflict resolution response profiles, and their associations with perceived partner responsiveness and romantic relationship satisfaction
Authors: Zhang Lu Ran , Chen Wei‐Wen
Published: November 2024

Interpersonal conflicts are common in romantic relationships. How to respond and cope with conflicts impacts the romantic relationship process and outcomes. This study examined the heterogeneity of Chinese youth's cognitive emotion regulation (CER) strategies and conflict resolution responses, as well as their collective influence on individuals' perceived partner responsiveness (PPR) and relationship satisfaction. We recruited 300 Chinese youth who were currently involved in romantic relationships to complete self‐reported measures of CER (reappraisal and suppression), conflict resolution responses in romantic relationships (exit, voice, neglect, and loyalty), PPR, and relationship satisfaction. We used latent profile analysis (LPA) to classify the combined effects of CER and conflict resolution responses, identifying four profiles: releasing, gentle, proactive, and inhibiting. Proactive communicators have significantly higher levels of relationship satisfaction compared to the other three groups and significantly higher levels of PPR compared to individuals in releasing and inhibiting profiles. Individuals in releasing and gentle profiles have significantly higher relationship satisfaction and PPR than individuals in the inhibiting profile. This study uncovered the possible associations between Chinese young adults' emotion regulation and conflict response profiles and romantic relationship process and outcome by adopting the person‐centered approach. We further discussed the practical implications of the findings.
Modeling of Frictional Interbristle Contact in Brush Seals With Shaft Radial Movements
Authors: Phan H. M. , Pekris M. J. , Chew J. W. , Greenslade T. J.
Published: November 2024

Brush seals are utilized in turbines to minimize leakage flows and enhance thermal efficiency. Their widespread use faces challenges like pressure-stiffening and hysteresis, leading to unpredictable performance. This work introduces an advanced numerical model to simulate interbristle frictional contact, shaft and backing ring interaction, and three-dimensional (3D) bristle bending. The model is adopted to investigate multibristle brush seal's behavior under shaft radial movements and pressure loading. Backing ring friction emerges as a vital factor in hysteresis modeling, lessening the impact of shaft friction. When the shaft retracts, modeling the bristle tip clearance becomes important. The clearance greatly increases leakage flowrate and changes bristles' aerodynamic loading distribution. With clearance, the normal force on upstream bristles rises markedly, opposing bristle hang-up, while the axial force decreases in downstream bristles, alleviating the bristle pack compression. Considering these factors, an improved model for pressurized seals in the shaft retraction phase is developed and compared to experimental data in the literature. Frictional interbristle contact significantly modifies the distribution of local tip force through the pack. These effects would influence localized wear and heat generation across the brush seal pack, shedding light on the uneven wear patterns often observed in experiments. The present high-fidelity model can capture these complex interactions, offering a means to deepen our understanding of the physical mechanisms underpinning novel brush seal designs.
Review of Canadian Experience With the Fabrication of Thoria-Based Fuels for Advanced Reactors and Fuel Cycles for Long-Term Nuclear Energy Sustainability and Security
Authors: Cota-Sanchez Germán , Spencer Madalena S. , Leeder Kristin , Dimayuga Ike , Bromley Blair P.
Published: November 2024

Advanced fuels and fuel cycles are important for the current and next generation of advanced reactors, small modular reactors, and microreactors, in order to maximize the utilization of fissile and fertile nuclear fuel resources, and also to minimize the mass and volume of radioactive waste to be placed into long-term storage. Thorium-based fuels are a potentially attractive option for both advanced fuels and fuel cycles, since neutron irradiation will lead to the conversion of fertile 232Th to fissile 233U. Thus, thorium-based fuels can be used to augment and extend uranium resources. Through work done at Canadian Nuclear Laboratories (CNL), Canada has gained extensive experience over more than 50 years of how to fabricate thorium-based fuels. This paper provides an overview of Canada's experience in the fabrication of thorium-based fuels (mainly ThO2, (Th,U)O2, and (Th,Pu)O2) at CNL at its Chalk River Laboratories (CRL). Thoria (ThO2) fuel pellet fabrication uses processes and equipment similar to that of uranium dioxide (UO2) fuel pellet fabrication. However, since thorium lacks a fissile isotope, most ThO2 pellet fabrication processes must include a step to add a fissile component, such as enriched UO2, plutonium dioxide (PuO2), or U-233 in the form of 233UO2. Along with a review of the fuel fabrication effort that has taken place at CNL, the potential impact that CNL's extensive experience with thoria fabrication could have on the future Canadian nuclear energy landscape is also discussed.
Modeling and Control of Cable-Driven Exoskeleton for Arm Rehabilitation
Authors: Zhu Lihong , Cui Can , Zhang Dong , Tan Jiamin , Xu Changxing
Published: November 2024

Exoskeleton robotics is a key technology in the field of physical rehabilitation, and the main research direction is to precisely control the exoskeleton structure with improved dexterity. Bowden-cables are uniquely structured for power transmission in lightweight wearable exoskeletons, but precisely controlling the exoskeleton system is challenging when considering their inherent limitations such as friction and hysteresis. This paper proposes a compact wearable exoskeleton with Bowden-cable designed for the purpose of rehabilitating the elbow and forearm. First, we optimize the performance of the Bowden-cable transmission by incorporating redirection pulleys, while a mathematical model is developed to describe the Bowden-cable and pulley system (BCPS). Afterwards, guided by the principle of ergonomic concept, the mechanism design and size calculation of the exoskeleton are conducted. Moreover, an optimized sliding mode control strategy was implemented to control the exoskeleton, and the efficacy of the designed controller was assessed through trajectory tracking experiments simulating “eating” movements. Finally, the experimental results demonstrate that the root mean square errors (RMSEs) for elbow and forearm angle tracking are 0.84 deg and 1.13 deg, respectively, indicating that the designed exoskeleton is suitable for arm rehabilitation training.
Investigation of Fluidelastic Instability of Fuel Rod Bundles Subjected to Combined Axial Flow and Jet Crossflow
Authors: Chevalier Bastien , Mureithi Njuki , El-Hak Ibrahim Gad- , Karazis Kostas
Published: November 2024

Flow-induced vibration is a major concern in the nuclear industry. The combined axial flow and jet crossflow has been found to induce fluidelastic instabilities (FEI) within the rod bundle, thus increasing the risk for fretting wear of the fuel rods. This paper presents an experimental work aiming to improve our understanding of the dynamic behavior of two rod bundles subjected to combined axial flow and localized jet crossflow. Two different bundle geometries were experimentally investigated. The first was a 6 × 5 flexible single-span bundle and the second one was a 7 × 5 reduced scale nuclear fuel assembly mockup. Two working flow conditions, pure axial flow and jet in transverse flow (JITF) are studied. The experiments show that the bundle is stable under pure axial flow as expected. Then, for the single-span the response of the array under JITF in two eccentricity scenarios is tested for different axial velocities. The results show that the fluidelastic instability (FEI) threshold could occur whenever the velocity ratio (VR=Vjet/Vaxial) is above 1.25. The second part of the work is the design, fabrication and tests on the multispan array. Characterization tests are performed to identify the modal parameters of the rod bundle. Two working flow conditions, pure axial flow and JITF are studied. The experiments show that the rod bundle is stable under pure axial flow. The response of the array under JITF in three eccentricity scenarios is tested for two axial velocities. The results show that the rod bundle is stable under the jet velocity tested for all cases.
Road to Tokyo Paralympic Games: Impact of the COVID-19 Pandemic on the Mood States of Brazilian Para Athletes
Authors: Melo Geiziane Leite Rodrigues , Gomes Costa Rodrigo Rodrigues , Brandão Maria Regina Ferreira , de Campos Luis Felipe Castelli Correia , Winckler Ciro
Published: November 2024

Context: The COVID-19 pandemic had a significant impact on the world of sports due to the imposed quarantine and the postponement of regional, national, and international sporting events, which affected physical, socioeconomic, and psychological aspects of athletes. Thus, the present study aimed to evaluate changes in the mood state profile of Brazilian Para athletes at 2 different time points during the COVID-19 pandemic, specifically during their qualification for the Tokyo Paralympic Games. Design: This study used a longitudinal study design. Methods: The study included 83 Brazilian Para athletes from 14 sports, with a mean age of 34.64 (9.27) years, who were evaluated at 2 moments (March 2020 and April 2021) during the qualification period for the “Road to Tokyo Paralympic Games.” The online survey included questions about disability, sport, and experience; the 24-item Brunel Mood Scale questionnaire; and a question about the athlete’s perception of whether or not they had a chance of qualifying for the Tokyo Paralympics in April 2021. Results: Para athletes had significantly higher vigor scores in 2021 than in 2020, with a medium effect size (z = −3.454, P < .001). In addition, Para athletes who perceived themselves as nonqualified for the Tokyo 2021 Paralympics Games had higher scores for depression (U = 409,000, z = −2397, P = .017) and tension (U = 425,000, z = −2194, P = .017) in 2021 when compared with those who perceived that they had qualified. There were no differences between men and women. Conclusions: The COVID-19 pandemic significantly negatively impacted the mood of Brazilian Para athletes, especially those who perceived themselves as nonqualified for the Tokyo Paralympic Games. Para athletes in team sports exhibited higher potential symptoms of depression compared with those in individual sports.
Endothelial inflammation in COVID-19
Authors: Libby Peter
Published: November 2024

Disrupted endothelial function underlies the multiorgan complications of COVID-19
Identification of a factor that accelerates substrate release from the signal recognition particle
Authors: Wang Huping , Hegde Ramanujan S.
Published: November 2024

The eukaryotic signal recognition particle (SRP) cotranslationally recognizes the first hydrophobic segment of nascent secretory and membrane proteins and delivers them to a receptor at the endoplasmic reticulum (ER). How substrates are released from SRP at the ER to subsequently access translocation factors is not well understood. We found that TMEM208 can engage the substrate binding domain of SRP to accelerate release of its bound cargo. Without TMEM208, slow cargo release resulted in excessive synthesis of downstream polypeptide before engaging translocation factors. Delayed access to translocation machinery caused progressive loss of insertion competence, particularly for multipass membrane proteins, resulting in their impaired biogenesis. Thus, TMEM208 facilitates prompt cargo handover from the targeting to translocation machinery to minimize biogenesis errors and maintain protein homeostasis.
Suppression of neurons in circumventricular organs enables months-long survival without water in thirteen-lined ground squirrels
Authors: Junkins Madeleine S. , Feng Ni Y. , Merriman Dana K. , Bagriantsev Sviatoslav N. , Gracheva Elena O.
Published: November 2024

Water deprivation is a life-threatening condition that engages a protective physiological response to couple osmolyte retention with potentiation of thirst. This response, typical for most mammals, safeguards against short-term water deprivation but fails in the long term. Thirteen-lined ground squirrels (
Ictidomys tridecemlineatus
) use the short-term response during summer, whereas during winter, they lack thirst and survive without water for months. In this work, we show that long-term thirst suppression occurs despite hormonal and behavioral signs of a substantial fluid deficit and originates from hypoactivity of neurons in the circumventricular organs, which exhibit marked functional suppression during winter that blunts their sensitivity to thirst cues. Our work reveals a notable capacity of the evolutionarily conserved brain regions that control fluid homeostasis in mammals to enable long-term survival without water.
Mining lithium from brines goes electric
Authors: Service Robert F.
Published: November 2024

Critical battery metal could be extracted more quickly than in evaporation ponds
Representation of racialised and ethnically diverse populations in multicentre randomised controlled trials of GLP-1 medicines for obesity: a systematic review and meta-analysis of gaps
Authors: Jeyakumar Yaanu , Richardson Lisa , Sarma Shohinee , Retnakaran Ravi , Kramer Caroline K
Published: November 2024

Introduction

Trials of GLP-1 (glucagon-like peptide-1) medicines have changed the paradigm of obesity treatment. Diversity in trial participation is imperative considering that obesity disproportionately impacts marginalised populations worldwide. We performed a systematic review and meta-analyses to evaluate the representation of racialised and ethnically diverse populations in randomised controlled trials (RCTs) of GLP-1 medicines for obesity.

Methods

We searched PubMed/Embase/ClinicalTrials.gov. Prevalence of each racial/ethnic group was compared in relation to the USA, Canada, the UK, Brazil and South Africa. The geographical locations of the trial sites were extracted.

Results

27 RCTs were identified (n=21 547 participants). Meta-analyses of prevalence demonstrated the vast predominance of white/Caucasians (79%) with smaller proportion of blacks (9%), Asians (13%), Indigenous (2%) and Hispanics (22%). The gaps in representation were evidenced by the significantly under-represented proportion of non-white individuals in these RCTs as compared with the prevalence of non-white individuals in the general population of the USA (−23%, p=0.002) and Canada (−34%, p<0.0001), reaching an alarming gap of −58% in relation to Brazil and striking under-representation of −68% as compared with South Africa. Similar discrepancies in proportions of blacks, Asians and Indigenous peoples as compared with reference nations were found. Moreover, the trial sites (n=1859) were predominately located in high-income countries (84.2%), in sharp contrast to the global prevalence of obesity that is predominantly in low-income and middle-income countries.

Conclusion

There are discrepancies in representation of racialised and ethnically diverse populations in obesity trials as compared with multiethnic populations worldwide. These data highlight the need for broader reform in the research process in order to ultimately address health inequities.
Conceptual framework for data harmonisation in mental health using the International Classification of Functioning, Disability and Health: an example with the R2D2-MH consortium
Authors: Black Melissa H , Buitelaar Jan , Charman Tony , Ecker Christine , Gallagher Louise , Hens Kristien , Jones Emily , Murphy Declan , Sadaka Yair , Schaer Marie , St Pourcain Beate , Wolke Dieter , Bonnot-Briey Stef , Bourgeron Thomas , Bölte Sven
Published: November 2024

Introduction

Advancing research and support for neurologically diverse populations requires novel data harmonisation methods that are capable of aligning with contemporary approaches to understanding health and disability.

Objectives

We present the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework to support harmonisation of mental health data and present a proof of principle within the Risk and Resilience in Developmental Diversity and Mental Health (R2D2-MH) consortium.

Method

138 measures from various mental health datasets were linked to the ICF following the WHO’s established linking rules.

Findings

Findings support the notion that the ICF can assist in the harmonisation of mental health data. The high level of shared ICF codes provides indications of where items may be readily harmonised to develop datasets that may align more readily with contemporary approaches to understanding health and disability. Although the linking process necessarily entails an element of subjectivity, the application of established rules can increase rigour and transparency of the harmonisation process.

Conclusions

We present the first steps towards data harmonisation in mental health that is compatible with contemporary approaches in psychiatry, being more capable of capturing diversity and aligning with more transdiagnostic and neurodiversity-affirmative ways of understanding data.

Clinical implications

Our findings show promise, but future work is needed to address quantitative harmonisation. Similarly, issues related to the traditionally ‘pathophysiological’ frameworks that existing datasets are often embedded in can hinder the full potential of harmonisation based on the ICF.
Incidence, prevalence and risk factors for comorbid mental illness among people with hypertension and type 2 diabetes in West Africa: protocol for a systematic review and meta-analysis
Authors: Ayiku Roberta Naa Barkey , Jahan Yasmin , Adjei-Banuah Nhyira Yaw , Antwi Edward , Awini Elizabeth , Ohene Sammy , Agyepong Irene Akua , Mirzoev Tolib , Amoakoh-Coleman Mary
Published: November 2024

Introduction

Mental illness remains a significant global health concern that affects diverse populations, including individuals living with hypertension and/or type 2 diabetes, predominantly in lower-income to middle-income countries. The association between non-communicable diseases (NCDs) and mental illness is firmly established globally, however, this connection has yet to be comprehensively explored in West Africa. Our systematic review and meta-analysis aim to synthesise existing evidence on the prevalence, incidence, and risk factors for comorbid mental illness with hypertension and/or type 2 diabetes in West Africa. This effort seeks to contribute to bridging the knowledge gap and facilitating the implementation of interventions tailored to this context.

Methods and analysis

A comprehensive search will be conducted across multiple databases (PubMed, Google Scholar, PsycINFO, Carin Info and CINAHL), supplemented by searches on the websites of the WHO and various countries’ ministries of health, and references cited in relevant papers. Inclusion criteria specify studies conducted in countries from the Economic Community of West African States, reported from January 2000 until date of search, focusing on adults with hypertension and/or type 2 diabetes and mental illness. Exclusion criteria encompass studies outside the specified time frame, involving pregnant women, or lacking relevant outcomes. There will be no language restrictions for inclusion. Study selection, data extraction and risk of bias assessment will be carried out independently by at least two reviewers. We will employ pooled proportions of OR, risk ratio and mean differences to assess prevalence, and incidence of mental illness and heterogeneity will be assessed.

Ethics and dissemination

This protocol does not require ethical approval; however, it is a part of a larger study on NCDs, which has received ethical clearance from the Ghana Health Service (ID NO: GHS-ERC 013/02/23). The results will be presented to stakeholders (policymakers and practitioners) and disseminated through conferences and peer-reviewed publications.

PROSPERO registration number

CRD42023450732.
Combined prediagnostic lifestyle factors and survival of breast, colorectal and lung cancer in the Norwegian Women and Cancer (NOWAC) study: a prospective cohort study
Authors: Chen Sairah Lai Fa , Borch Kristin Benjaminsen , Sandanger Torkjel Manning , Tinmouth Jill , Braaten Tonje , Nøst Therese Haugdahl
Published: November 2024

Background

With improvements in cancer treatment and early detection, the number of people living with cancer is increasing.

Objective

This study aimed to investigate the association between combined prediagnostic lifestyle factors, assessed by a Healthy Lifestyle Index (HLI) score, and mortality among women diagnosed with breast cancer (BC), colorectal cancer (CRC) and lung cancer (LC).

Design

Prospective cohort.

Setting

Women residing in Norway, general population.

Participants

Our analysis included 5032, 2468 and 1594 women from the Norwegian Women and Cancer study diagnosed with BC, CRC and LC, respectively, who responded to a questionnaire between 1996 and 2014.

Exposure measures

HLI score measured prior to cancer diagnosis. The HLI combines physical activity level, body mass index, smoking behaviour, alcohol consumption and dietary habits.

Outcome measures

We estimated HRs and 95% CIs using Cox proportional hazard models for all-cause and site-specific cancer mortality.

Results

After median follow-up times of 9.8, 7.1 and 5.9 years for BC, CRC and LC cases, respectively, there were 912, 902 and 1094 all-cause deaths; and 509 BC deaths, 679 CRC deaths and 961 LC deaths. For women diagnosed with BC, a 1-point HLI score increment was associated with a 6% lower all-cause mortality rate (HR: 0.94, 95% CI: 0.92 to 0.97). The data were compatible with no association for the estimated 3% lower BC mortality rate (HR: 0.97, 95% CI: 0.94 to 1.00) among women diagnosed with BC, and for the estimated 3% lower all-cause (HR: 0.97, 95% CI: 0.95 to 1.00) and 2% lower CRC mortality rates (HR: 0.98, 95% CI: 0.95 to 1.01) among women diagnosed with CRC. For women diagnosed with LC, prediagnostic HLI score was not associated with all-cause (HR: 1.00, 95% CI: 0.98 to 1.02) or LC mortality rates (HR: 1.00, 95% CI: 0.98 to 1.03).

Conclusions

We observed that a higher HLI score measured before cancer diagnosis was associated with lower all-cause and, possibly, lower BC mortality among Norwegian women diagnosed with BC; and a possible lower all-cause and CRC mortality among those diagnosed with CRC. Smoking was likely responsible for the observed associations.
Mapping context of sedentary behaviour in older adults who are prefrail and frail: an analysis of secondary outcomes from a longitudinal study (MAPS-B)
Authors: Rodrigues Isabel B , Kalra Mayank , Zheng Rong , Rabinovich Alexander , Ioannidis George , Kobsar Dylan , Bray Steven R , Adachi Jonathan D , Fang Qiyin , Papaioannou Alexandra
Published: November 2024

Objectives

To map the context of sedentary behaviour in older adults who are prefrail and frail during the winter and spring over 3 days (2 weekdays and 1 weekend) and to determine if certain types of sedentary behaviours are associated with health outcomes.

Design

Mixed methods, prospective longitudinal cohort study.

Setting

Community-dwelling older adults living in southern Ontario, Canada.

Participants

We recruited 21 older adults (72±7.3 years, 13 females, 13 frail) and experienced two dropouts.

Results

Participants accumulated a total of 18.4±2.6 hours/day of sedentary time in winter and 17.7±3.1 hours/day in spring. When considering daily indoor sedentary time (excluding sleep), participants accumulated 7.6±4.0 hours/day in winter and 6.3±2.7 hours/day in spring. In the spring, 68% of participants accumulated <8 hours/day of ≥15 min bouts of indoor sedentary time compared with 63% in the winter. Although there were no differences in sedentary time between seasons, we found a significant decrease in step count in winter (1190 fewer steps, 95% CI −2228 to −153 steps). There were no differences in sedentary time or step count between the weekday and weekend or between individuals who were prefrail and frail. There were no seasonal variations in participants’ sedentary activities; the most common activities were watching television (TV), eating, napping, browsing the internet and socialising. We also found there may be gender differences in time and activities. Individuals who identified as female were more sedentary than individuals who were male. Almost all indoor behaviours occurred in the living/family room. Sedentary time was evenly spread throughout the day; however, prolonged sedentary behaviours ≥60 min mainly occurred in the evening regardless of the season. Step count in both winter and spring was positively associated with the Nottingham Activity of Daily Living assessment. There was an inverse association between sedentary behaviours ≥60 min (not including sleeping) and the 5×sit-to-stand and grip strength.

Conclusion

The current definition of sedentary behaviour requires modification to capture total sedentary time, continuous bouts >60 min, the types of behaviours, time of day and season.

Trial registration number

NCT05661058.
Parent carer and disabled young people’s perspectives on the impacts of changes to service provision for children and young people in England during the COVID-19 pandemic: a qualitative study
Authors: Merrick Hannah , Driver Helen , Potts Lily , Exley Catherine , Allard Amanda , Morris Christopher , Parr Jeremy R , Pennington Lindsay
Published: November 2024

Objectives

In England, the delivery of health, education and social care services changed substantially during COVID-19. Some services closed, some had reduced capacity and there was a shift to the use of telehealth. This study aimed to understand how families of children and young people with neurodisability experienced these service changes, what did or did not work well for them and what impact the service changes had on them.

Design

Qualitative study with parent carers of children (aged 0–19 years) with neurodisability accessing children’s health, social care and education-based services during the COVID-19 pandemic.

Setting

Participants were recruited from five local authority areas in England and interviewed via telephone and/or video call.

Participants

48 parent carers (45 mothers, three fathers) were interviewed and nine young people (aged 8–16 years). Across the parent carers there were 55 children with neurodisability (43 males, 12 females), ranging from 3 to 19 years. Children had a range of diagnoses, including autism, attention deficit hyperactivity disorder, cerebral palsy, genetic conditions and epilepsy. Nine young people (aged 8–16 years; eight males, one female) were interviewed; two individually, three in a focus group and four with their parent carer.

Results

Four themes were identified: (1) communication of service changes, (2) access to services during the pandemic, (3) impacts of service changes and (4) learning for future emergencies and resetting services. Communication of service changes was reported as poor and confusing. Access to services during the pandemic varied. Medical services continued with least disruption; therapeutic, education-based and social care services were severely disrupted. Service changes had a detrimental impact on families coping with high levels of medical care and physical and behavioural support. Young people experienced negative impacts of service change on their physical, mental and behavioural health.

Conclusions

Services for children with neurodisability require a person-led, family centred approach with strong multidisciplinary team working. Findings indicated the need for improved communication within and between services, and between services and families and young people. Planning for future emergencies needs to factor in the specific health and care needs of children with neurodisability and maintain access to services, in particular, those accessed through schools.
Incidence of avoidant/restrictive food intake disorder in children and adolescents across the UK and Ireland: a BPSU and CAPSS surveillance study
Authors: Sanchez-Cerezo Javier , Neale Josephine , Julius Nikita , Lynn Richard M , Hudson Lee , Nicholls Dasha
Published: November 2024

Objective

We aimed to estimate the incidence of avoidant/restrictive food intake disorder (ARFID) in children and adolescents (CA) presenting to secondary care in the UK and Republic of Ireland (ROI).

Design

This observational surveillance study used the British Paediatric Surveillance Unit and the Child and Adolescent Psychiatry Surveillance System. Monthly electronic reports were submitted by consultant paediatricians and child and adolescent psychiatrists from 1 March 2021 to 31 March 2022, with outcomes assessed at a 1-year follow-up.

Setting

The UK and ROI.

Participants

Clinician-reported data on children and young people aged 5–17 (inclusive) in contact with paediatric services or CA mental health services for a new diagnosis of ARFID.

Primary outcome measures

Annual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk.

Results

319 newly diagnosed cases of ARFID were reported over the 13-month surveillance period and assessed as eligible for inclusion. The mean age of the sample was 11.2 years (SD=3.8). The sample consisted of 145 females (45.5%). Most cases were of white British ethnicity (71.2%). The observed IR (IR0) in the UK was 2.79 per 100 000 CA (95% CI 2.48 to 3.13), with a higher IRo in males (2.98 per 100 000 CA (95% CI 2.55 to 3.49)) than in females (2.58 per 100 000 CA (95% CI 2.18 to 3.07)). Comorbidity was common in this sample with anxiety and autism spectrum disorder. At follow-up, 54.8% of cases had improved according to clinicians’ clinical impression.

Conclusions

We conducted the first study reporting estimates of incidence of ARFID in CA in the UK and ROI presenting to secondary care. Our finding that ARFID is a disorder of relatively low incidence in CA should help inform service planning and resource allocation, as well as the development of evidence-based interventions.
Impact of gastrointestinal symptoms and psychological distress on quality of life in systemic sclerosis: a cross-sectional study
Authors: Alcala-Gonzalez Luis Gerardo , Guillen-Del-Castillo Alfredo , Aguilar Ariadna , Barber Claudia , Codina Claudia , Marin Garcia Antonio , Malagelada Carolina , Simeon-Aznar Carmen P
Published: November 2024

Background

Systemic sclerosis (SSc) is a chronic autoimmune disease characterised by microvascular damage and fibrosis. Mortality in patients with SSc has significantly decreased. Consequently, patients with SSc have longer life expectancy, and health-related quality of life (HrQoL) has become more relevant in the comprehensive management of the disease.

Objective

To evaluate the impact between gastrointestinal (GI) symptom burden and psychological well-being on HrQoL in patients with SSc.

Design

Nested cross-sectional study conducted between January and July 2022.

Participants

A single-centre cohort of 166 patients with SSc, including 103 (55%) with limited cutaneous SSc, 43 (24%) with diffuse SSc and 37 (21%) with sine-sclerosis SSc.

Main measures

GI symptom burden was assessed using the University of California Los Angeles Scleroderma Clinical Trial Consortium gastrointestinal tract 2.0 (UCLA SCTC GIT 2.0) questionnaire, psychological well-being was measured with the Hospital Anxiety and Depression Scale (HADS), and HrQoL was evaluated using the Short Form 36 (SF-36) questionnaire. Demographic, clinical and immunological data were collected from a prospectively maintained database.

Key results

Patients with moderate to severe GI symptoms (UCLA SCTC GIT 2.0 score >0.5, n=95, 57%) reported decreased HrQoL in all subdomains except vitality by SF-36, and higher anxiety and depression scores by HADS (all p<0.05). The severity of GI symptom burden and depression were independently associated with a decline in the physical component of QoL (β=−0.273 and β=−0.411, respectively, p<0.01 for both). Only the severity of depression and anxiety (β=−0.482 and β=−0.213, respectively, p<0.05), but not GI symptom burden, were independently associated with a decline in the mental component of QoL.

Conclusions

Our data suggest that in patients with SSc, GI and psychological burden negatively influence quality of life independently, highlighting the need for a holistic approach to patient’s care.
Unravelling age-related gait decline in cerebral palsy: insights into physiological changes and functional implications through an observational study—a French study protocol in a laboratory setting
Authors: Gravholt Anders , Fernandez Bruno , Rimaud Diana , Zeghoudi Narimane , Bessaguet Hugo , Espeit Loic , FEASSON Léonard , Millet Guillaume Y , Buizer Annemieke I. , Lapole Thomas
Published: November 2024

Introduction

Cerebral palsy (CP) presents a complex neurodevelopmental disorder with a spectrum of motor impairments stemming from early brain injury. Whereas CP is traditionally viewed as a non-progressive condition, emerging evidence suggests a progressive decline in mobility and function, particularly in adulthood. Despite the prevalence of self-reported age-related gait decline in adults with CP, objective evidence supporting this phenomenon remains limited. Moreover, mechanistic insights into these functional alterations and their comparison with typically developing (TD) peers are lacking. To address this gap, our study aims to objectively assess age-related changes in gait performance among individuals with CP while examining physiological differences compared with TD peers.

Methods and analysis

This protocol will compare the mobility of individuals with and without CP within two age groups (18–25 and 35–50 years old). Participants at Gross Motor Function Classification System levels I–II at age 18 will be invited to partake in the study. Every participant will be invited to complete four visits investigating a wide range of mobility related measures: walking performance, muscle strength, cardiopulmonary performance, fatigability, cost of walking and quantitative gait analysis. Through this comprehensive analysis encompassing gait performance metrics, self-reported outcomes, muscle strength, biomechanics and metabolical cost of walking, and fatigability, we seek to elucidate the underlying mechanisms driving age-related gait decline in adults with CP and inform targeted interventions to maintain function and quality of life.

Ethics and dissemination

The study has been approved by the French ethics board (#2022-A02510-43) and will be communicated through conferences, articles and to participants through layman terms.

Trial registration number

NCT06163950.
Codesign with citizens to prevent cardiometabolic diseases in disadvantaged neighbourhoods: an interview study on needs and priorities among stakeholders in Sweden
Authors: Ottesen Hedda , Alvesson Helle Mölsted , Idevall Hagren Jonas , Martinell Mats , Matta Laran , McAleenan Pia , Daivadanam Meena
Published: November 2024

Objectives

Cardiometabolic diseases are a global health concern, affecting socioeconomically disadvantaged groups more adversely. Effective public health interventions targeting preventable risk factors like physical inactivity and unhealthy diets are needed. Codesign with citizens presents a promising opportunity for developing context-relevant and population-relevant interventions, with high chances of adoption by the target population. This study aimed to understand the needs and priorities of key stakeholders to engage in codesign with citizens for the prevention of cardiometabolic diseases, focusing on socioeconomically disadvantaged groups in Uppsala, Sweden.

Design

A qualitative case study was conducted using semistructured interviews with stakeholders working with prevention and and promotion of healthy and active living in public, private and civil society sectors. The interviews were audio recorded, transcribed verbatim and analysed using reflexive thematic analysis.

Setting

Uppsala, Sweden.

Participants

A total of 24 participants were purposively sampled.

Results

While participants described the critical value of participatory processes to achieve goals in their work, they struggled to prioritise prevention efforts over time. This adversely affected the continuity of public health interventions and collaborations with other stakeholders. They also described resistance towards inclusive processes from within their organisations, as they were seen as time-consuming and generating unpredictable outcomes. Additionally, the persistence of a siloed system structure of organisations and the risks associated with accessing target populations through local intermediaries added to the challenges.

Conclusion

This study highlights the lack of integration of organisational values and functions within and across organisations, hindering cross-sector collaboration and citizen engagement in prevention and health promotion activities. Additionally, the low priority of prevention and ineffective use of codesign hampers continuity and long-term perspectives of prevention and health promotion. To create more conducive conditions for codesign, facilitating intersectoral activities and more inclusive processes is needed and may be enabled by explicit and systematic support.
Efficacy of acupuncture for pregnancy with early-onset ovarian hyperstimulation syndrome: study protocol for a randomised controlled clinical trial
Authors: Wen Kaoling , Sun Dejuan , Wang Dongying , Li Yu , Wang Jue , Wang Bo , Zhan Meiqi , Tan Hongyu , Su Ting , Lu Liming , Liang Xiaoyan , Lin Jinglin , Tang Chunzhi , Lai Xin
Published: November 2024

Introduction

Although ovarian hyperstimulation syndrome (OHSS) is a common complication primarily seen in patients undergoing in vitro fertilisation-embryo transfer, there is no recognised effective treatment to manage it, especially for pregnant patients. As an alternative non-pharmacological treatment, acupuncture presents itself as a promising, safe and effective intervention for those suffering from OHSS. Despite its potential, there is a noticeable absence of randomised controlled trials providing solid evidence on the efficacy of acupuncture in the management of pregnancy with OHSS. Therefore, the primary objective of this study is to conduct an initial investigation into the efficacy of acupuncture in pregnant patients with OHSS, hoping to contribute valuable insights from a medical-scientific perspective.

Methods and analysis

This is a three-arm, single-blind, parallel-design, randomised controlled clinical trial. A total of 384 patients will be enrolled and randomised in a ratio of 1:1:1 into acupuncture group (MA group), sham acupuncture group (SA group) and control group (C group) for a 20-day treatment period. The primary outcomes include 24-hour urine output, amount of ascites shown on ultrasound, abdominal circumference, degree of abdominal distension and chest tightness. The secondary outcomes are weight, ovarian size, rate of ascites drainage by tube placement and serum hCG. Besides, the study will consider changes in blood counts and hormonal levels as additional outcomes.

Ethics and dissemination

This study received authorisation from the Institutional Review Board of the Sixth Affiliated Hospital of Sun Yat-sen University on 4 February 2024 (Approval No. 2024ZSLYFEC-084). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.

Trial registration number

Chinese Clinical Trial Registry ChiCTR2400081751.
Impact of longitudinal changes in serum uric acid levels and weight gain on new-onset atrial fibrillation—The Nishimura Health Survey: a retrospective cohort study
Authors: Munakata Jun , Senoo Keitaro , Nakata Mitsuko , Teramukai Satoshi , Kumagai Muneaki , Yamaoka Miyoko , Nishimura Hiromi , Matoba Satoaki
Published: November 2024

Objective

Uric acid (UA) and obesity are significant risk factors for new-onset atrial fibrillation (AF). Based on the pathogenesis mechanisms of new-onset AF involving obesity and UA, it is possible that UA and weight gain may interact with each other. We investigated the impact of UA and weight gain on new-onset AF using a simple measure of weight change over time, ‘weight gain of ≥10 kg after age 20’.

Design

A retrospective cohort study.

Setting and participants

We retrospectively analysed 16 444 Japanese aged over 30 without AF from a cohort of employees undergoing annual health check-up from 2 April 2013 to 30 April 2022. We conducted a landmark survival analysis to assess the impact of longitudinal changes in UA and obesity on new-onset AF. Weight gain was defined as ‘weight gain of≥10 kg after age 20’ using a standardised self-administered questionnaire.

Primary outcome measure

Subjects were diagnosed with AF when AF was present in the electrocardiogram or when indicated in a patient interview.

Result

During a median follow-up period of 3.91 years, 69 new-onset AF occurred (incidence; 1.12/1000 person-years). UA levels were 5.76 (±1.37) in the weight gain group and 4.87 (±1.31) in the no weight gain group, both within normal limits. A multivariable landmark survival analysis including interaction term showed that new-onset AF was significantly associated with age, sex, baseline systolic blood pressure, baseline UA and the interaction term between UA change and weight gain. The interaction term between weight gain and UA change indicates that HR for every UA 1 mg/dL increase was 1.96 (95% CI 1.38 to 2.77) in subjects with weight gain and 0.95 (95% CI 0.61 to 1.48) in those without.

Conclusion

Even if UA levels are within the normal range, subsequent UA change and weight gain in adulthood have an interactive effect on new-onset AF.
Sintilimab plus HPV vaccine for recurrent or metastatic cervical cancer
Authors: Wang Buhai , Liang Yichen , Wu Yuechao , Li Qiuxian , Zeng Yichun , Liu Liqin , Cao Wenmiao , Geng Xiaoru , Huang Yuxiang , Wu Yinxia , Pan Jiulin , Zhang Xian , Gu J Juan
Published: November 2024

Purpose

Recurrent or metastatic cervical cancer (r/m CC) presents limited treatment options for patients failed or progressed quickly following first-line therapy. This study investigated the potential of sintilimab with a prophylactic human papillomavirus (HPV) quadrivalent vaccine as a second-line treatment for r/m CC.

Methods

In this phase 2 clinical trial, patients with r/m CC previously unresponsive or intolerant to standard treatments for metastatic or recurrent lesions were enrolled. Participants received sintilimab (3 mg/kg for body weight <60 kg; 200 mg for ≥60 kg) every 3 weeks until 24 months or 35 cycles and 3 doses of the HPV quadrivalent vaccine (initial dose prior to sintilimab initiation, with subsequent doses at 2 and 6 months). The primary endpoint was the objective response rate (ORR). A Simon two-stage optimal design was used.

Results

From October 2019 to October 2022, 13 patients with r/m CC were enrolled. ORR achieved 53.8% (95% CI 25.1% to 80.8%), and the disease control rate was 76.9% (95% CI 46.2% to 95.0%). Median follow-up duration was 16.07 months (range: 3.64–48.2 months), and median progressive free survival was 7.16 months (95% CI 1.91 –not applicable (NA)). The median overall survival (OS) was not reached (95% CI 9.89 –NA). Hypothyroidism (15.6%) was the most common treatment-related adverse event (AE). No grade 3 or above AEs were observed.

Conclusions

This study suggests the combination of sintilimab plus prophylactic HPV vaccine offers a potentially promising therapeutic strategy for patients with r/m CC unresponsive or intolerant to standard therapies.

Trial registration number

NCT04096911.
Renal response status to predict long-term renal survival in patients with lupus nephritis: results from the Toronto Lupus Cohort
Authors: Urowitz Murray , Georgiou Mary E , Touma Zahi , Su Jiandong , Diaz-Martinez Juan Pablo , Fu Qinggong , Levy Roger A , Gairy Kerry , MacKinnon Anne , Anderson Nicole , Juliao Patricia C
Published: November 2024

Objective

To evaluate modified versions of the Belimumab International Study in Lupus Nephritis (BLISS-LN) belimumab study primary efficacy renal response (mPERR) and complete renal response (mCRR) criteria (excluding mandatory corticosteroid tapering) as predictors of real-world, long-term renal outcomes among patients with lupus nephritis (LN).

Methods

This retrospective, observational study (GSK Study 212866) used deidentified data between 1970 and 2015 from the University of Toronto Lupus Cohort from adults diagnosed with systemic lupus erythematosus and biopsy-proven Class III±V, IV±V or V LN. At 24 months postbiopsy, patients were retrospectively indexed as responders/non-responders based on mPERR (estimated glomerular filtration rate (eGFR) ≤20% below biopsy value/≥60 mL/min/1.73 m2and urine protein:creatinine ratio (uPCR) ≤0.7 g/day) or mCRR (eGFR ≤10% below biopsy value/≥90 mL/min/1.73 m2and uPCR ≤0.5 g/day) criteria. The association between index mPERR (primary outcome) or mCRR (secondary outcome) status and long-term (up to 25 years, until censoring or death) renal survival (no progression to end-stage kidney disease (eGFR <30 mL/min/1.73 m2, dialysis or transplant) or death) was assessed.

Results

Overall, 179 patients were included in the analysis (mPERR responders, n=128; non-mPERR responders, n=51). Most patients were female (87.2%); the mean (SD) age was 34.1 (11.3) years.

Long-term renal survival was attained for 78.9% of mPERR responders and 60.8% of non-mPERR responders; achieving mPERR was associated with an increased likelihood of long-term renal survival versus not achieving mPERR (log-rank p=0.0119). Overall, 102 patients were mCRR responders, and 77 were non-mCRR responders. Long-term renal survival was attained for 80.4% of mCRR responders and 64.9% of non-mCRR responders; achieving mCRR was associated with an increased likelihood of long-term renal survival than not achieving mCRR (log-rank p=0.0259).

Conclusions

Achieving mPERR or mCRR was associated with improved long-term renal survival, highlighting that these statuses are suitable predictors of long-term renal outcomes in patients with LN.