bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk justice: Boosting the contribution of risk management to sustainable development
Authors: de Goër de Herve Mathilde , Schinko Thomas , Handmer John
Published: May 2023

Comprehensively addressing different aspects of justice is essential to enable risk management to contribute to sustainable development. This article offers a new conceptual framework called risk justice that comprises procedural, distributive, and corrective justice in four dimensions related to sustainable development: social, ecological, spatial, and temporal issues. Risk justice is defined as the quality of being fair and reasonable while governing and managing a possible negative event. After explaining the conceptual framework, a detailed content analysis of two international guidelines for disaster risk management (the Sendai Framework for Disaster Risk Reduction 2015–2030 and the European Floods Directive) illustrates the analytical potential of the risk justice framework. Findings show strong emphasis on social and spatial aspects of distributive and procedural justice in the two documents, whereas considerations of corrective justice and temporal and ecological issues are scarce or indirect. This may result in conflicting impacts of disaster risk management on sustainable development. Therefore, discussing risk management with a risk justice viewpoint while elaborating guidelines or choosing risk management strategies provides new avenues for sustainable development and facilitates transparent trade‐offs. Our risk justice framework enables risk practitioners and researchers to reflect systemically about justice in risk management in different risk contexts and can be used both as a proactive and as a retrospective tool.
The lived experiences of endometriosis in adolescence—A critical hermeneutic perspective
Authors: Nielsen Liv Juul , Poulsen Katja , Funch Anders Lundme , Petersen Kirsten Schultz
Published: May 2023

Background

Endometriosis is a condition that worldwide affects 10% of all women of childbearing age. Despite the large prevalence, it takes 4–11 years from the first onset of symptoms until the time of diagnosis, and the majority experience symptoms debut in adolescence. Endometriosis affects women's lives both physically, psychologically, socially and a lack of recognition from society causes the pain the women experience to be neglected, hidden and normalised. Preventative measures targeting endometriosis in adolescence are limited and there is a need to change the way these symptoms are viewed and affected by society at large.

Aim

The aim of this qualitative study was to explore the lived experiences of endometriosis in adolescence and the social reactions impact on the illness experience and quality of life.

Method

With a critical hermeneutic approach, individual interviews were conducted with women diagnosed with endometriosis. The analysis and interpretation were conducted inspired by Pedersen and Dreyer's (2018) method which is based on Ricoeur's critical theory.

Results

The structural analysis shows that women experience a struggle for recognition of symptoms from their immediate surroundings including family, friends, schools and health professionals, as symptoms considered linked to menstruation are deemed to be normal for women to experience. The women's narratives are characterised into a before and after diagnosis. Therefore, the diagnosis is found to be important for the meaning that the women attach to their experiences in adolescence.

Conclusion

Social experiences have a substantial impact on women's illness experience and quality of life and affect how women perceive themselves and their symptoms. Through interventions at the social level, it might be possible to change the existing societal discourses surrounding women's menstruation pain to raise the awareness of endometriosis.
Effect of the FIFA 11+ injury prevention program in collegiate female football players over three consecutive seasons
Authors: Magoshi Hirohisa , Hoshiba Takuma , Tohyama Miwako , Hirose Norikazu , Fukubayashi Toru
Published: May 2023

This study aimed to investigate the preventive effects of the FIFA 11+ for one‐season and over three consecutive seasons on the injury incidence rates in collegiate female football players in terms of duration of intervention. A total of 763 collegiate female football players from seven teams belonging to Kanto University Women Football Association Division 1 in 2013–2015 seasons were included in the study. At the start of the study, 235 players were assigned to a FIFA 11+ intervention group (four teams, 115 players) and a control group (three teams, 120 players). The intervention period was set to three seasons, and the players were followed up during this period. The one‐season effect of the FIFA 11+ was investigated after each season. The effect of continuous intervention was verified in 66 and 62 players from the intervention and control groups who continued the study for all three seasons, respectively. The one‐season intervention showed significantly lower total, ankle, knee, sprain, ligament injury, noncontact, moderate and severe injury incidence rates in the intervention group in each season. Regarding the continuous intervention, compared with the first season, the injury incidence rates in lower extremity, ankle, and sprain, decreased in the intervention group by 66.0%, 79.8%, and 82.2%, respectively, in the second season, and by 82.6%, 94.6%, and 93.4%, respectively, in the third season, indicating the persistent effect of the FIFA 11+. In conclusion, the FIFA 11+ is an effective program for lower extremity injury prevention in collegiate female football players, and preventive effects persist with continuation of the program.
Hofer's geometry and topological entropy
Authors: Chor Arnon , Meiwes Matthias
Published: May 2023

In this paper we study persistence features of topological entropy and periodic orbit growth of Hamiltonian diffeomorphisms on surfaces with respect to Hofer's metric. We exhibit stability of these dynamical quantities in a rather strong sense for a specific family of maps studied by Polterovich and Shelukhin. A crucial ingredient comes from enhancement of lower bounds for the topological entropy and orbit growth forced by a periodic point, formulated in terms of the geometric self-intersection number and a variant of Turaev's cobracket of the free homotopy class that it induces. Those bounds are obtained within the framework of Le Calvez and Tal's forcing theory.
The Influence of Fiber Orientation of the Conus Elasticus in Vocal Fold Modeling
Authors: Wang Xiaojian , Zheng Xudong , Xue Qian
Published: May 2023

While the conus elasticus is generally considered a part of continuation of the vocal ligament, histological studies have revealed different fiber orientations that fibers are primarily aligned in the superior-inferior direction in the conus elasticus and in the anterior-posterior direction in the vocal ligament. In this work, two continuum vocal fold models are constructed with two different fiber orientations in the conus elasticus: the superior-inferior direction and the anterior-posterior direction. Flow-structure interaction simulations are conducted at different subglottal pressures to investigate the effects of fiber orientation in the conus elasticus on vocal fold vibrations, aerodynamic and acoustic measures of voice production. The results reveal that including the realistic fiber orientation (superior-inferior) in the conus elasticus yields smaller stiffness and larger deflection in the coronal plane at the junction of the conus elasticus and ligament and subsequently leads to a greater vibration amplitude and larger mucosal wave amplitude of the vocal fold. The smaller coronal-plane stiffness also causes a larger peak flow rate and higher skewing quotient. Furthermore, the voice generated by the vocal fold model with a realistic conus elasticus has a lower fundamental frequency, smaller first harmonic amplitude, and smaller spectral slope.
Axial Crushing Behaviors of Metal Density Gradient Foam-Filled Square Taper Tubes: Analytical Model and Numerical Calculation
Authors: Wu Xiwei , Zhang Jianxun
Published: May 2023

Metal tube is a traditional energy-absorbing structure, and metal foam is a lightweight material with advantages, i.e., high energy absorption and high specific strength. The foam-filled square tube can improve crashworthiness and has better energy absorption, which is higher than the sum of the energy absorption of the tube and foam. Axial crushing behaviors of metal density gradient foam (DGF) filled square taper tubes are studied analytically and numerically in this paper. An analytical model is presented to study the crushing behavior of DGF-filled square taper metal tube under axial loading, in which the interaction between square taper tube and DGF is considered. The numerical calculation is conducted, and the deformation mode is obtained. The analytical predictions are well consistent with the experimental and numerical results. The influences of taper angle, foam strength, maximum relative density, and minimum relative density of gradient foam on the compressive behavior of metal DGF-filled square taper tubes under axial loading are considered. It is demonstrated that when the taper angle is less than 85 deg, the average crushing force increases as the minimum density of the DGF increases. However, when the taper angle is greater than 85 deg, the average crushing force decreases with the increase of the minimum density of the gradient. This proposed analytical model can effectively predict the axial crushing behaviors of metal DGF-filled square taper tubes.
Process-Structure-Property Relationships of Laser Powder Bed Fusion Lattice Structures
Authors: Jost Elliott W. , Pegues Jonathan , Moore David , Saldaña Christopher
Published: May 2023

Lattice structure metamaterials offer a variety of unique and tailorable properties, yet industrial adoption is slowed by manufacturability and inspection-related difficulties. Despite recent advances in laser powder bed fusion additive manufacturing, the sub-millimeter features of lattices are at the edge of process capabilities and suffer from low geometric quality. To better understand their complex process-structure-property (PSP) relationships, octahedron structures were manufactured across a power spectrum, inspected, and mechanically tested. X-ray computed tomography was used to characterize lattice geometry, and demonstrated that lattice strut geometry measures, increased significantly as a function of laser power. Furthermore, lattices are shown to exhibit a direct correlation between laser power and mechanical performance metrics. Performance variations up to 60% are shown as a function of process parameters despite nominally identical geometry. Significant geometry variations are found to be the cause of performance variation, while material properties as measured by microindentation hardness are constant across the studied parameter range. PSP relationships are modeled, and the limitations of these models are explored. It was found that resulting models can predict mechanical performance based on geometric characteristics with R2 values of up to 0.86. Finally, mechanistic causes of observed performance changes are discussed.
An Efficient Reliability Analysis Method Based on the Improved Radial Basis Function Neural Network
Authors: Zhang Dequan , Zhao Zida , Ouyang Heng , Wu Zeping , Han Xu
Published: May 2023

This paper develops an efficient reliability analysis method based on the improved radial basis function neural network (RBFNN) to increase the accuracy and efficiency of structural reliability analysis. To solve the problems of low computational accuracy and efficiency of the RBFNN, an improved RBFNN method is developed by transferring the sampling center of Latin hypercube sampling (LHS) from the mean values of random variables to the most probable point (MPP) in the sampling step. Then, the particle swarm optimization algorithm is adopted to optimize the shape parameters of RBFNN, and the RBFNN model is assessed by the cross-validation method for subsequent reliability analysis using Monte Carlo simulation (MCS). Four numerical examples are investigated to demonstrate the correctness and effectiveness of the proposed method. To compare the computational accuracy and efficiency of the proposed method, the traditional radial basis function method, hybrid radial basis neural network method, first-order reliability method (FORM), second-order reliability method (SORM), and MCS method are applied to solve each example. All the results demonstrate that the proposed method has higher accuracy and efficiency for structural reliability analysis. Importantly, one practical example of an industrial robot is provided here, which demonstrates that the developed method also has good applicability and effectiveness for complex engineering problems.
An acoustic study of Cantonese alaryngeal speech in different speaking conditions
Authors: Cox Steven R. , Huang Ting , Chen Wei-Rong , Ng Manwa L.
Published: May 2023

Esophageal (ES) speech, tracheoesophageal (TE) speech, and the electrolarynx (EL) are common methods of communication following the removal of the larynx. Our recent study demonstrated that intelligibility may increase for Cantonese alaryngeal speakers using clear speech (CS) compared to their everyday “habitual speech” (HS), but the reasoning is still unclear [Hui, Cox, Huang, Chen, and Ng (2022). Folia Phoniatr. Logop. 74, 103–111]. The purpose of this study was to assess the acoustic characteristics of vowels and tones produced by Cantonese alaryngeal speakers using HS and CS. Thirty-one alaryngeal speakers (9 EL, 10 ES, and 12 TE speakers) read The North Wind and the Sun passage in HS and CS. Vowel formants, vowel space area (VSA), speaking rate, pitch, and intensity were examined, and their relationship to intelligibility were evaluated. Statistical models suggest that larger VSAs significantly improved intelligibility, but slower speaking rate did not. Vowel and tonal contrasts did not differ between HS and CS for all three groups, but the amount of information encoded in fundamental frequency and intensity differences between high and low tones positively correlated with intelligibility for TE and ES groups, respectively. Continued research is needed to understand the effects of different speaking conditions toward improving acoustic and perceptual characteristics of Cantonese alaryngeal speech.
Efficient Production of Glucaric Acid by Engineered Saccharomyces cerevisiae
Authors: Zhao Yunying , Zuo Fangyu , Shu Quanxian , Yang Xiaoyan , Deng Yu
Published: May 2023

Glucaric acid is a value-added dicarboxylic acid that was synthesized mainly through the oxidation of glucose chemically. Due to the problems of the low selectivity, by-products, and highly polluting waste of this process, producing glucaric acid biologically has attracted great attention.
Presence of
Leptospira
spp. in a Mosaic of Wetlands Used for Livestock Raising under Differing Hydroclimatic Conditions
Authors: Chiani Yosena T. , Jacob Paulina , Mayora Gisela , Aquino Diego S. , Quintana Rubén D. , Mesa Leticia
Published: May 2023

Wetlands are environments that are often conducive to the survival and transmission of
Leptospira
because they provide a suitable habitat for the bacteria and are often home to many animal species that can act as reservoirs for leptospirosis. Bringing humans and animals into closer contact with contaminated water and soil and increased frequency and intensity of extreme weather events may further exacerbate the risk of leptospirosis outbreaks, which is mostly relevant in the context of climate change and a widespread intensification of productive activities, particularly in the Lower Delta of the Paraná River.
Global Transcriptomic Study of Circular-RNA Expression Profile in Osteoclasts Infected by Intracellular
Staphylococcus aureus
Authors: Chen Zhihao , Xie Zonggang , Han Mingxiao , Jin Qiyuan , Li Ziyuan , Zhai Yaxuan , Zhang Minxing , Hu Gangfeng , Zhang Haifang
Published: May 2023

Osteomyelitis is difficult to cure, and the rapidly rising morbidity is a thorny problem accompanied by a large number of joint replacement applications.
Staphylococcus aureus
is the main pathogen of osteomyelitis. Circular RNAs (circRNAs), as emerging noncoding RNAs, play important roles in multiple physiopathological processes which could provide novel insights into osteomyelitis.
Complete Genome Sequence of Bifidobacterium animalis subsp.
lactis
BLa80, a Strain Isolated from Human Breast Milk
Authors: Zhu Mingming , Zhu Jianguo , Fang Shuguang , Zhao Bin
Published: May 2023

We report the complete genome sequence of
Bifidobacterium animalis
subsp.
lactis
BLa80, a promising human probiotic strain isolated from breast milk of a healthy woman in Hongyuan, Sichuan Province, China. We have determined the complete genome sequence of strain BLa80, which consists of genes that are likely to provide useful information for its safe use as a probiotic in dietary supplements.
The Effect of Inoculum Size on Antimicrobial Susceptibility Testing of Mycobacterium tuberculosis
Authors: Yildirim Kubra , Atas Cemilenur , Simsek Ece , Coban Ahmet Yilmaz
Published: May 2023

During DST application, it can be challenging to evenly homogenize TB cell clumps with lipid-rich cell walls. These experiments must be carried out under Biosafety Level-3 (BSL-3) laboratory conditions with personal protective equipment and taking safety precautions because the procedures applied at this stage cause the formation of bacillus-laden aerosols and carry a serious risk of transmission.
PatA Regulates Isoniazid Resistance by Mediating Mycolic Acid Synthesis and Controls Biofilm Formation by Affecting Lipid Synthesis in Mycobacteria
Authors: Wang Kun , Deng Yimin , Cui Xujie , Chen Mengli , Ou Yanzhe , Li Danting , Guo Minhao , Li Weihui
Published: May 2023

Tuberculosis, caused by
Mycobacterium tuberculosis
, leads to a large number of human deaths every year. This is so serious, which is due mainly to the drug resistance of mycobacteria.
Variable Region Sequences Influence 16S rRNA Performance
Authors: Bose Nikhil , Moore Sean D.
Published: May 2023

This study reevaluates the notion that 16S rRNA gene variable region sequences are uninformative for intra-genus classification and that single nucleotide variations within them have no consequence to strains that bear them. We demonstrated that the performance of 16S rRNAs in
Escherichia coli
can be negatively impacted by sequence changes in variable regions, even for single nucleotide changes that are native to closely related
Escherichia
and
Shigella
species; thus, biological performance is likely constraining the evolution of variable regions in bacteria.
Genomic Epidemiology and Characterization of Carbapenem-Resistant Klebsiella pneumoniae in ICU Inpatients in Henan Province, China: a Multicenter Cross-Sectional Study
Authors: Wang Shanmei , Wang Lei , Jin Jing , Li Gang , Shao Huanzhang , Song Yang , Sun Yuanzheng , Zhang Yan , Cheng Jianjian , Li Lifeng
Published: May 2023

In this study, we address the ongoing epidemic of carbapenem-resistant
Klebsiella pneumoniae
, a critical threat to public health. The alarming genotypic and phenotypic convergence of multidrug resistance and virulence highlights the increasingly aggravated threat posed by
K. pneumoniae
.
Culture-Independent Workflow for Nanopore MinION-Based Sequencing of Influenza A Virus
Authors: Miah Mojnu , Hossain Mohammad Enayet , Hasan Rashedul , Alam Md Shaheen , Puspo Joynob Akter , Hasan Md Mahmudul , Islam Ariful , Chowdhury Sukanta , Rahman Mohammed Ziaur
Published: May 2023

The Nanopore MinION-based influenza sequencing approach we are proposing makes it possible to sequence the influenza A virus, irrespective of its diverse serotypes, directly from clinical and environmental swab samples, so that we are not limited to virus culture. This third-generation, portable, multiplexing, and real-time sequencing strategy is highly convenient for local sequencing, particularly in low- and middle-income countries like Bangladesh.
Subspecies Distribution and Antimicrobial Susceptibility Testing of Mycobacterium abscessus Clinical Isolates in Madrid, Spain: a Retrospective Multicenter Study
Authors: Ruedas-López Alba , Tato Marta , Broncano-Lavado Antonio , Esteban Jaime , Ruiz-Serrano María Jesús , Sánchez-Cueto María , Toro Carlos , Domingo Diego , Cacho Juana , Barrado Laura , López-Roa Paula
Published: May 2023

Infections caused by
Mycobacterium abscessus
(MABS) are increasingly being reported worldwide. Identifying MABS subspecies and assessing their phenotypic resistance profiles are crucial for optimal management and better patient outcomes.
M. abscessus
subspecies differ in
erm
(41) gene functionality, which is a critical determinant of macrolide resistance.
Submandibular sialolith migration
Authors: Cannon Philip , Bhatti Dujanah , Arman Sam , Togo Athena
Published: May 2023

A middle-aged male Caucasian had rejected previous offers of surgery for submandibular gland removal in the past due to concerns about surgical complications. He presented with a month’s history of submandibular swelling and severe pain, which impeded his ability to eat. Prior to admission, he had been experiencing intermittent sialadenitis for several months. Cross-sectional imaging demonstrated a 16×12 mm migratory sialolith, located superficial to the right submandibular gland within a large loculated abscess. The patient underwent an incision and drainage of the abscess under general anaesthetic and the sialolith was expressed. He was discharged home with oral antibiotics and was followed up as an outpatient. This case serves to highlight a rare complication of chronic sialolithiasis.
Vestibular migraine: a manifestation of long COVID syndrome in children
Authors: Saniasiaya Jeyasakthy
Published: May 2023

Long COVID-19 syndrome has been reported among children and adolescents following COVID-19 recovery. Among them, notable symptoms include myalgia, insomnia, loss of smell and headache. Yet, novel manifestations are being discovered daily. Herein, we report two cases of vestibular migraine post-COVID-19 involving two children who presented with vestibular migraine symptoms following COVID-19 infection and their management. Children post-COVID-19 should be thoroughly evaluated for vestibular migraine symptoms so they can be managed promptly. This is the first article to report vestibular migraine as a manifestation of long COVID-19 syndrome.
Planning management for complex colorectal polyps: a qualitative assessment of factors influencing decision-making among colonoscopists
Authors: Parker Jody , Semedo Lenira , Shenbagaraj Lavanya , Torkington Jared , Dolwani Sunil
Published: May 2023

Objective

Endoscopic therapy is the recommended primary treatment for most complex colorectal polyps, but high colonic resection rates are reported. The aim of this qualitative study was to understand and compare between specialities, the clinical and non-clinical factors influencing decision making when planning management.

Design

Semi-structured interviews were performed among colonoscopists across the UK. Interviews were conducted virtually and transcribed verbatim. Complex polyps were defined as lesions requiring further management planning rather than those treatable at the time of endoscopy. A thematic analysis was performed. Findings were coded to identify themes and reported narratively.

Results

Twenty colonoscopists were interviewed. Four major themes were identified including gathering information regarding the patient and their polyp, aids to decision making, barriers in achieving optimal management and improving services. Participants advocated endoscopic management where possible. Factors such as younger age, suspicion of malignancy, right colon or difficult polyp location lead towards surgical intervention and were similar between surgical and medical specialties. Availability of expertise, timely endoscopy and challenges in referral pathways were reported barriers to optimal management. Experiences of team decision-making strategies were positive and advocated in improving complex polyp management. Recommendations based on these findings to improve complex polyp management are provided.

Conclusion

The increasing recognition of complex colorectal polyps requires consistency in decision making and access to a full range of treatment options. Colonoscopists advocated the availability of clinical expertise, timely treatment and education in avoiding surgical intervention and providing good patient outcomes. Team decision-making strategies for complex polyps may provide an opportunity to coordinate and improve these issues.
A shared agenda for gender and COVID-19 research: priorities based on broadening engagement in science
Authors: George Asha S. , Lopes Claudia A. , Vijayasingham Lavanya , Mothupi Mamothena Carol , Musizvingoza Ronald , Mishra Gita , Stevenson Jacqui , Remme Michelle
Published: May 2023

While the acute and collective crisis from the pandemic is over, an estimated 2.5 million people died from COVID-19 in 2022, tens of millions suffer from long COVID and national economies still reel from multiple deprivations exacerbated by the pandemic. Sex and gender biases deeply mark these evolving experiences of COVID-19, impacting the quality of science and effectiveness of the responses deployed. To galvanise change by strengthening evidence-informed inclusion of sex and gender in COVID-19 practice, we led a virtual collaboration to articulate and prioritise gender and COVID-19 research needs. In addition to standard prioritisation surveys, feminist principles mindful of intersectional power dynamics underpinned how we reviewed research gaps, framed research questions and discussed emergent findings. The collaborative research agenda-setting exercise engaged over 900 participants primarily from low/middle-income countries in varied activities. The top 21 research questions included the importance of the needs of pregnant and lactating women and information systems that enable sex-disaggregated analysis. Gender and intersectional aspects to improving vaccine uptake, access to health services, measures against gender-based violence and integrating gender in health systems were also prioritised. These priorities are shaped by more inclusive ways of working, which are critical for global health as it faces further uncertainties in the aftermath of COVID-19. It remains imperative to address the basics in gender and health (sex-disaggregated data and sex-specific needs) and also advance transformational goals to advance gender justice across health and social policies, including those related to global research.
5 A new animal model for infected fracture non-union after external fixation of tibia with real-time in-vivo monitoring of infection
Authors: Robiati Louise , Hindle Paul , Stapley Sarah , Simpson Hamish
Published: May 2023

Background

Non-union is a well-recognised complication after open fractures. Fifty percent of open extremity trauma returning from military operations developed non-union. Aetiology of non-union is multi- factorial, with infection reported as major contributory factor. The aim of this study was to develop an in-vivo model of infected fracture non-union managed with external fixation which allowed real time in-vivo monitoring of infection to evaluate potential therapeutic strategies.

Method

Ten male Wistar rats underwent application of external fixator and midshaft tibia osteotomy. Osteotomy sites were inoculated with bioluminescent Staphylococcus aureus Xen36 (infected group; n=6); or phosphate buffer solution (control group; n=4). Animals were monitored for infection with invivo bioluminescent imaging and fracture healing with plain radiographs. Animals were sacrificed at eight weeks. Post-mortem micro-computed tomography (uCT) was used to assess fracture union; in-vivo bioluminescent imaging to assess persistence of Xen36 infection; tissue samples were processed for bacterial colony forming unit counts and histology to assess for fracture healing and infection.

Results

Eight animals reached experiment endpoint (infected=5, control=3). All five infected animals demonstrated radiographic non-union on x-ray and uCT. Bioluminescence, at fracture site in infected cohort, peaked at week two and reduced to chronic baseline of 105 photons per second for duration of experiment. At experiment endpoint bioluminescence was confirmed at fracture site and bioluminescent bacteria was cultured from fracture site tissue samples in all of the infected cohort. Two of three control animals demonstrated radiographic non-union, none luminesced, one grew bacteria from tissue samples but was not bioluminescent.

Conclusions

This study has developed an infected fracture non-union animal model. Use of bioluminescent bacteria allows for non-invasive and real-time monitoring of infection. This model is more representative of the military casualty than previously reported models and could be used to evaluate therapeutic strategies for prevention and management of infected fracture non-union.
6 Beyond the default male: exploring sex differences in the acute physiological response to trauma and associated clinical outcomes
Authors: Ross Jennifer , Bocchetta Natasha , Hickey Hayden , Lindsay Charlotte , Cole Elaine
Published: May 2023

Background

Female patients are consistently outnumbered by males in trauma studies. This bias towards male physiology may influence research outputs and result in females receiving less efficacious care. This study looks at male and female patients with comparable injury severities (as assessed by ISS), observing acute physiological responses to injury and subsequent clinical outcomes.

Method

Data from over 2000 patients enrolled in the Activation of Coagulation and Inflammation in Trauma (ACIT-II) prospective cohort study (REC: 07/Q0603/29) at the Royal London Hospital was sex disaggregated. Patients are eligible for inclusion into ACIT-II if they arrive in ED within 2 hours of injury and meet the local criteria for a trauma team activation. In order to look at males and females with comparable injury severities, Injury Severity Scores (ISS) were grouped into ‘control’ (ISS 0-3), ‘mild’ (ISS 4-8), ‘moderate’ (ISS 9-15), ‘severe’ (ISS 16-25), ‘critical’ (ISS ≥25).

Results

In the total study cohort, females were significantly more likely to be older, to have experienced blunt rather than penetrating injury, and to have a severe (AIS≥4) head injury. To mitigate the potential influence of these factors, a cohort of 757 patients aged <50 years with only blunt injury and without severe head injury was identified. In this group we showed that females were significantly more shocked and had different coagulation profiles at presentation to ED. There were minimal differences between males and females regarding blood product administration, time to first TXA or length of stay. Notably, however, females had a significantly worse survival rate at both 24hrs (p = 0.009 overall) and 28days (p = <0.001 overall).

Conclusions

Even when the confounding influences of age, mechanism and severe head injury are removed, females with comparable injury severities have different physiological responses and worse outcomes following trauma. Further work is needed to establish the underlying causes for this.
Validating the InterVA-5 cause of death analytical tool: using mortality data from the Comprehensive Health and Epidemiological Surveillance System in Papua New Guinea
Authors: Pham Bang Nguyen , Abori Norah , Maraga Seri , Jorry Ronny , Jaukae Gasowo S , Silas Vinson D , Aga Tess , Okely Tony , Pomat William
Published: May 2023

Objective

InterVA-5 is a new version of an analytical tool for cause of death (COD) analysis at the population level. This study validates the InterVA-5 against the medical review method, using mortality data in Papua New Guinea (PNG).

Design and setting

This study used mortality data collected from January 2018 to December 2020 in eight surveillance sites of the Comprehensive Health and Epidemiological Surveillance System (CHESS), established by the PNG Institute of Medical Research in six major provinces.

Methods

The CHESS demographic team conducted verbal autopsy (VA) interviews with close relatives of the deceased, who died in communities within the catchment areas of CHESS, using the WHO 2016 VA instrument. COD of the deceased was assigned by InterVA-5 tool, and independently certified by the medical team. Consistency, difference and agreement between the InterVA-5 model and medical review were assessed. Sensitivity and positive predictive value (PPV) of the InterVA-5 tool were calculated with reference to the medical review method.

Results

Specific COD of 926 deceased people was included in the validation. Agreement between the InterVA-5 tool and medical review was high (kappa test: 0.72; p<0.01). Sensitivity and PPV of the InterVA-5 were 93% and 72% for cardiovascular diseases, 84% and 86% for neoplasms, 65% and 100% for other chronic non-communicable diseases (NCDs), and 78% and 64% for maternal deaths, respectively. For infectious diseases and external CODs, sensitivity and PPV of the InterVA-5 were 94% and 90%, respectively, while the sensitivity and PPV of the medical review method were both 54% for classifying neonatal CODs.

Conclusion

The InterVA-5 tool works well in the PNG context to assign specific CODs of infectious diseases, cardiovascular diseases, neoplasms and injuries. Further improvements with respect to chronic NCDs, maternal deaths and neonatal deaths are needed.
Patient perceptions and experiences with medication-related activities in the emergency department: a qualitative study
Authors: Zahl-Holmstad Birgitte , Garcia Beate Hennie , Johnsgård Tine , Ofstad Eirik Hugaas , Lehnbom Elin Christina , Svendsen Kristian , Risør Torsten , Holis Renata Vesela , Elenjord Renate
Published: May 2023

Background

Emergency department (ED) pharmacists reduce medication errors and improve quality of medication use. Patient perceptions and experiences with ED pharmacists have not been studied. The aim of this study was to explore patients’ perceptions of and experiences with medication-related activities in the ED, with and without an ED pharmacist present.

Methods

We conducted 24 semistructured individual interviews with patients admitted to one ED in Norway, 12 before and 12 during an intervention, where pharmacists performed medication-related tasks close to patients and in collaboration with ED staff. Interviews were transcribed and analysed applying thematic analysis.

Results

From our five developed themes, we identified that: (1) Our informants had low awareness and few expectations of the ED pharmacist, both with and without the pharmacist present. However, they were positive to the ED pharmacist. (2) Our informants expressed a variation of trust in the healthcare system, healthcare professionals and electronic systems, though the majority expressed a high level of trust. They believed that their medication list was automatically updated and assumed to get the correct medication. (3) Some informants felt responsible to have an overview of their medication use, while others expressed low interest in taking responsibility regarding their medication. (4) Some informants did not want involvement from healthcare professionals in medication administration, while others expressed no problems with giving up control. (5) Medication information was important for all informants to feel confident in medication use, but the need for information differed.

Conclusion

Despite being positive to pharmacists, it did not seem important to our informants who performed the medication-related tasks, as long as they received the help they needed. The degree of trust, responsibility, control and information varied among ED patients. These dimensions can be applied by healthcare professionals to tailor medication-related activities to patients’ individual needs.
Baseline symptoms of depression and anxiety negatively impact the effectiveness of CBTi in treating acute insomnia among young adults
Authors: Zhang Chenxi , Zeng Shufei , Xu Yan , Liu Shuai , Du Shixu , Fang Leqin , Lv Zhihong , Zhang Lili , Zhang Bin
Published: May 2023

Background

Cognitive–behavioural therapy for insomnia (CBTi) is the first-line treatment for those with this sleep disorder. However, depressive and anxiety symptoms often co-occur with acute insomnia, which may affect the effectiveness of CBTi treatment.

Aims

This study aimed to determine the impact of depressive and anxiety symptoms on the efficacy of CBTi in treating acute insomnia.

Methods

A single-arm clinical trial was conducted among individuals who have acute insomnia. Participants underwent self-guided CBTi for 1-week. Their insomnia, depressive symptoms and anxiety symptoms were evaluated using the Insomnia Severity Index and the Hospital Anxiety and Depression Scale at baseline, post-treatment and 3-month follow-up. Repeated measures analysis of variance was used to assess the effectiveness of CBTi in treating insomnia, depressive symptoms and anxiety symptoms. A multivariate Cox regression model was used to determine the impact of depressive and anxiety symptoms on insomnia.

Results

The study found significant reductions in insomnia, depressive symptoms and anxiety symptoms at both post-treatment and 3-month follow-up (F=17.45, p<0.001; F=36.37, p=0.001; and F=81.51, p<0.001, respectively). The duration of CBTi treatment had a positive impact on insomnia recovery (hazard ratio (HR)=0.94, p=0.018). However, baseline depressive symptoms (HR=1.83, p=0.004) and baseline anxiety symptoms (HR=1.99, p=0.001) had significant negative effects on insomnia recovery.

Conclusions

The study showed that a 1-week self-guided CBTi treatment is effective in treating acute insomnia and comorbid depressive and anxiety symptoms. However, baseline depressive and anxiety symptoms negatively impact treatment effectiveness. Therefore, clinicians should assess for depressive and anxiety symptoms before treating acute insomnia with monotherapy CBTi.
Quasi-experimental evaluation of municipal ice cleat distribution programmes for older adults in Sweden
Authors: Eklund Elin , Holmberg Robin , Svensson Mikael , Gustavsson Johanna , Bonander Carl
Published: May 2023

Introduction

Fall injuries caused by icy road conditions are a prevalent public health problem during winters in Sweden, especially in older populations. To combat this problem, many Swedish municipalities have distributed ice cleats to older adults. While previous research has shown promising results, there is a lack of comprehensive empirical data on the effectiveness of ice cleat distribution. We address this gap by investigating the impact of these distribution programmes on ice-related fall injuries among older adults.

Methods

We combined survey data on ice cleat distribution in Swedish municipalities with injury data from the Swedish National Patient Register (NPR). The survey was used to identify municipalities that have distributed ice cleats to older adults at some point between 2001 and 2019. Data from NPR were used to identify municipality-level data on patients who have been treated for injuries related to snow and ice. We used a triple differences design—a generalisation of difference in differences—that compared ice-related fall injury rates before and after intervention in 73 treatment and 200 control municipalities, with unexposed age groups serving as within-municipality controls.

Results

We estimate that the average ice cleat distribution programmes reduced ice-related fall injury rates by −0.24 (95% CI −0.49 to 0.02) per 1000 person-winters. The impact estimate was larger in municipalities that distributed more ice cleats (−0.38 (95% CI −0.76 to –0.09)). No similar patterns were found for fall injuries unrelated to snow and ice.

Conclusion

Our results suggest that ice cleat distribution can decrease the incidence of ice-related injuries among older adults.
Negative intracellular regulators of T-cell receptor (TCR) signaling as potential antitumor immunotherapy targets
Authors: Laletin Vladimir , Bernard Pierre-Louis , Costa da Silva Cathy , Guittard Geoffrey , Nunes Jacques A
Published: May 2023

Immunotherapy strategies aim to mobilize immune defenses against tumor cells by targeting mainly T cells. Co‐inhibitory receptors or immune checkpoints (ICPs) (such as PD-1 and CTLA4) can limit T cell receptor (TCR) signal propagation in T cells. Antibody-based blocking of immune checkpoints (immune checkpoint inhibitors, ICIs) enable escape from ICP inhibition of TCR signaling. ICI therapies have significantly impacted the prognosis and survival of patients with cancer. However, many patients remain refractory to these treatments. Thus, alternative approaches for cancer immunotherapy are needed. In addition to membrane‐associated inhibitory molecules, a growing number of intracellular molecules may also serve to downregulate signaling cascades triggered by TCR engagement. These molecules are known as intracellular immune checkpoints (iICPs). Blocking the expression or the activity of these intracellular negative signaling molecules is a novel field of action to boost T cell-mediated antitumor responses. This area is rapidly expanding. Indeed, more than 30 different potential iICPs have been identified. Over the past 5 years, several phase I/II clinical trials targeting iICPs in T cells have been registered. In this study, we summarize recent preclinical and clinical data demonstrating that immunotherapies targeting T cell iICPs can mediate regression of solid tumors including (membrane associated) immune‐checkpoint inhibitor refractory cancers. Finally, we discuss how these iICPs are targeted and controlled. Thereby, iICP inhibition is a promising strategy opening new avenues for future cancer immunotherapy treatments.
Long-term follow-up of anti-PD-1 naïve patients with metastatic melanoma treated with IDO/PD-L1 targeting peptide vaccine and nivolumab
Authors: Lorentzen Cathrine Lund , Kjeldsen Julie Westerlin , Ehrnrooth Eva , Andersen Mads Hald , Marie Svane Inge
Published: May 2023

Background

We have previously published initial efficacy of the indoleamine 2,3-dioxygenase (IDO)/anti-programmed death ligand 1 (PD-L1) vaccine in combination with nivolumab in 30 anti-PD-1 therapy naïve patients with metastatic melanoma (cohort A). We now report long-term follow-up of patients in cohort A. Further, we report results from cohort B, where the peptide vaccine was added to anti-PD-1 therapy for patients with progressive disease during anti-PD-1 treatment.

Methods

All patients were treated with a therapeutic peptide vaccine in Montanide targeting IDO and PD-L1 combined with nivolumab (NCT03047928). A long-term follow-up of safety, response rates, and survival rates were performed in cohort A including patient subgroup analyses. Safety and clinical responses were analyzed for cohort B.

Results

Cohort A: At data cut-off, January 5, 2023, the overall response rate (ORR) was 80%, and 50% of the 30 patients obtained a complete response (CR). The median progression-free survival (mPFS) was 25.5 months (95% CI 8.8 to 39), and median overall survival (mOS) was not reached (NR) (95% CI 36.4 to NR). The minimum follow-up time was 29.8 months, and the median follow-up was 45.3 months (IQR 34.8–59.2). A subgroup evaluation further revealed that cohort A patients with unfavorable baseline characteristics, including either PD-L1 negative tumors (n=13), elevated lactate dehydrogenase (LDH) levels (n=11), or M1c (n=17) obtained both favorable response rates and durable responses. The ORR was 61.5%, 79%, and 88% for patients with PD-L1−tumors, elevated LDH, and M1c, respectively. The mPFS was 7.1 months for patients with PD-L1−tumors, 30.9 months for patients with elevated LDH, and 27.9 months for M1c patients. Cohort B: At data cut-off, the best overall response was stable disease for 2 of the 10 evaluable patients. The mPFS was 2.4 months (95% CI 1.38 to 2.52), and the mOS was 16.7 months (95% CI 4.13 to NR).

Conclusion

This long-term follow-up confirms the promising and durable responses in cohort A. Subgroup analyses of patients with unfavorable baseline characteristics revealed that high response rates and survival rates were also found in patients with either PD-L1 negative tumors, elevated LDH levels, or M1c. No meaningful clinical effect was demonstrated in cohort B patients.

Trial registration number

NCT03047928.
3 Management of a major medical incident – a multi national challenge
Authors:   Lt Col Jon Walker
Published: May 2023

Major Medical Incidents on deployed operations are increasingly likely with the utilisation of small DHC facilities with limited clinical personnel and resources. In June 2021 a Suicide Vehicle Borne IED was detonated against a DEU callsign resulting in 13 casualties. A multinational response working from the DEU Role 1+ facility was undertaken and personnel from the DEU, UK and SWE formed ‘Flash’ teams and utilised senior clinical SMEs to deliver care to all 13 patients, 9 directly from the incident and 4 after initial treatment at FRA and CHN facilities. 6 surgical cases were performed over 15 hours along with 2 critical care transfers being undertaken. There were no fatalities and all casualties were repatriated in a stable condition to allow immediate reconstruction.

The success of this undertaking was due to the acceptance from all of ‘Right Person, Right Role’ regardless of service or nationality. Recognising operational and clinical experience, combined with a shared approach to casualty management requires an adaptable mindset in order to find the best ways to deliver casualty care.

From this incident a number of key learning points were recognised:

Have a plan, but be prepared to adapt it as the situation changes.

Early meetings and understanding of other nations capabilities is key to being able to create multi–national flash teams with the right skill compositions.

Have equipment, medications and blood stored together and ready to deploy at short notice.

Be able to adapt and utilise other nations equipment and medications.

Always re–review the patients and re–prioritise as required.

It is not over until all the patients have been evacuated and the equipment and personnel are reconditioned.
4 The challenges of managing a COVID outbreak during a long-range desert patrol
Authors:   Lt Col Natasha Chatham-Zvelebil
Published: May 2023

The challenges of managing an infectious disease outbreak in a deployed military setting are well documented. During Op NEWCOMBE the outbreak of COVID in camp was predicted with Force Health Protection strategies and a medical response plan in place. Roto 3, December 2021 – June 2022, had a triple vaccinated task group, and models suggested any outbreak would be clinically and operationally insignificant.

These models did not consider the specific challenges of an outbreak during a long range environmentally challenging desert patrol. The consequences of this COVID outbreak were clinically and operationally significant. The clinical effects were disproportionately severe, with features of heat illness a likely contributor. The management of patients was challenged by heat and lack of climate controlled and isolation facilities. The medical group itself suffered with cases of COVID, resulting in the requirement of the Ground Manoeuvre Surgical Group to assume the deployed Role 1 clinical role, provide a partially climate-controlled environment and manage the logistics of maintaining the testing capability and PPE equipment. The outbreak resulted in 3 cancelled patrols, 8 aeromedical evacuations, 9 strategic evacuations and a total of 106 cases, of which 42 were confirmed or suspected whilst on patrol.

The clinical and operational impact of this COVID outbreak should have been predicted. The challenging environment combined with a physically degraded population towards the end of a 6-month deployment, demonstrated that using disease modelling based upon healthy UK-based populations is ineffective. Future deployments must take this into consideration.