bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer incidence and competing mortality risk following 15 presenting symptoms in primary care: a population-based cohort study using electronic healthcare records
Authors: Barclay Matthew E , Renzi Cristina , Harrison Hannah , Torralbo Ana , White Becky , Ip Samantha Hiu Yan , Usher-Smith Juliet , Lange Jane , Pashayan Nora , Denaxas Spiros , Wood Angela M , Antoniou Antonis , Lyratzopoulos Georgios
Published: November 2024

·

Objectives

Assessment of age, sex and smoking-specific risk of cancer diagnosis and non-cancer mortality following primary care consultation for 15 new-onset symptoms.

Methods and analysis

Data on patients aged 30–99 in 2007–2017 were extracted from a UK primary care database (CPRD Gold), comprising a randomly selected reference group and a symptomatic cohort of patients presenting with one of 15 new onset symptoms (abdominal pain, abdominal bloating, rectal bleed, change in bowel habit, dyspepsia, dysphagia, dyspnoea, haemoptysis, haematuria, fatigue, night sweats, weight loss, jaundice, breast lump and post-menopausal bleed).

Time-to-event models were used to estimate outcome-specific hazards for site-specific cancer diagnosis and non-cancer mortality and to estimate cumulative incidence up to 12 months following index consultation.

Results

Data included 1 622 419 patients, of whom 36 802 had a cancer diagnosis and 28 857 died without a cancer diagnosis within 12 months of the index.

The risk of specific cancers exceeded the UK urgent referral risk threshold of 3% from a relatively young age for patients with red flag symptoms. For non-organ-specific symptoms, the risk of cancer at individual sites either did not reach the threshold at any age or reached it only in older patients.

Conclusion

Patients with new-onset symptoms in primary care often have comparable risks of cancer diagnosis and non-cancer mortality. Non-organ-specific symptoms, in particular, are associated with elevated risk of cancer at multiple different sites. Management of symptomatic patients in primary care should be informed by the risk of different cancer types alongside mortality risk.
Social support network of Brazilian Amazonian women to subsidise the decision-making power of planned home birth: a qualitative study
Authors: Reis Laena Costa dos , Beviláqua Jannaina Campos , Alves Valdecyr Herdy , Penna Lucia Helena Garcia , Dias Da Silva Sílvio Éder , Parente Andressa Tavares , Vieira Bianca Dargam Gomes , Pereira Audrey Vidal , Carneiro Marcia Simão , da Conceição Natalia Tifanny , Calandrini Tatiana do Socorro dos Santos , Pereira Rafaela Chagas , Almeida Malena da Silva , Rodrigues Diego Pereira
Published: November 2024

Objective

To understand the social support network of Amazonian women when making decisions about planned home births.

Method

Descriptive, exploratory, qualitative research.

Setting

Planned home birth care, accompanied by obstetric nurses, in the state of Pará, Brazil.

Participants

20 women who had a planned home birth in the metropolitan region of the state of Pará, Brazil. These women were surveyed by a team of obstetric nurses working in home birth care. In-depth semistructured interviews were conducted at the women’s homes between August 2021 and February 2022, with the audio captured on an mp3 device. The data were analysed at the same time as the data collection. Each interview was transcribed and content analysis was used to process the data.

Results

The social support network shares experiences and knowledge between women in order to guarantee knowledge and not perpetuate traumatic episodes during childbirth. This network is a link to women’s power of choice in relation to their own birth, which culminates in successful experiences in the birth process.

Final considerations

Understanding the social support network for women’s decision-making during planned home births is central to guaranteeing rights and expectations regarding the place of birth. Social support networks need to be expanded by non-governmental groups and by the Unified Health System itself, especially in primary healthcare.

Descriptors

Women; home childbirth; social support; access to information and nursing.
Equity of financial protection for health in high-income countries: scoping review protocol
Authors: Xie Edward C , Ali Shehzad , Law Michael , Allin Sara , Proaño Diego , Sander Beate
Published: November 2024

Introduction

Financial protection (FP) is a central function of health systems to enhance access to essential care and improve health equity. We aim to characterise evidence on the distribution of FP in high-income countries as well as how equity of FP is conceptualised and measured in these settings. Findings from this review can advance methodological and conceptual knowledge about equity in FP, guide the evaluation of health systems and inform policy on eliminating inequitable barriers to care to achieve universal health coverage.

Methods and analysis

We will undertake a scoping review following guidance from Colquhounet aland the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We will search four academic databases covering health sciences and economic literature as well as four grey literature sources for relevant publications. Screening for eligibility will be performed independently by two reviewers after calibration of screening criteria. Data will be charted using a standardised form and summarised by thematic analysis.

Ethics and dissemination

Institutional research ethics review was not required; however, research ethics will be considered iteratively throughout the research process. Research findings will be disseminated to scientific and policy meetings, summarised for lay audiences and submitted for publication in a peer-reviewed journal.
Association between triglyceride-glucose index and risk of kidney stone: a Chinese population-based case–control study
Authors: Wang Dawei , Zhang Dingguo , Zhang Lin , Shi Feng , Zhu Yu
Published: November 2024

Objective

To investigate the association between the triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance and the risk of kidney stones (KSs) in a Chinese population.

Design

Case–control study.

Setting

Three Physical Examination Centers in Shanghai, China, between January 2020 and December 2022.

Participants

A total of 117 757 Chinese adults underwent health check-ups during the study period.

Primary and secondary outcome measures

The association between the TyG index and the risk of KS was assessed using multivariable logistic regression analysis. The dose–response relationship between the TyG index and KS risk was evaluated with a restricted cubic spline (RCS) analysis. Stratified analyses were conducted to explore whether factors such as age, sex, obesity, hypertension and diabetes modify the association between the TyG index and KS risk.

Results

Out Of the 117 757 participants, 11 645 (9.9%) were diagnosed with KS using ultrasound. Individuals with KS had significantly higher TyG values than controls (p<0.001). The multivariable-adjusted ORs for KS increased across TyG quartiles, with the highest quartile showing an OR of 1.28 (95% CI 1.20 to 1.36) compared with the lowest quartile. Each SD increase in the TyG index was associated with a 10% higher risk of KS (OR: 1.10, 95% CI 1.08 to 1.13). RCS analysis revealed a significant positive and linear association between TyG index and KS (p overall<0.001, p non-linear=0.136). The positive association persisted across the subgroup and sensitivity analyses.

Conclusions

The TyG index was positively associated with the risk of prevalent KS, suggesting that insulin resistance may be a risk factor for KS in the Chinese population.
Mediating role of gut microbiota on Baduanjin for cognitive function in community-dwelling older adults with mild cognitive impairment: a study protocol for a cluster randomised controlled trial
Authors: Sun Liwei , Geng Qian , Zheng Guohua
Published: November 2024

Introduction

The gut microbiome plays an important role in maintaining both cognitive and physical functions in older adults, and gut dysbiosis is an important pathophysiological mechanism of mild cognitive impairment (MCI) in older adults. As a typical traditional Chinese mind-body exercise, regular Baduanjin training has been shown to improve cognitive function and modulate the gut microbiome in community-dwelling older adults. However, the potential role of the gut microbiome in the benefits of Baduanjin on cognitive function remains unclear. The aim of this study is to investigate the mediating effect of gut microbiome between regular Baduanjin training and improvement in cognitive function in community-dwelling older adults with MCI.

Methods and analysis

This is a two-arm, randomised, parallel-controlled, single-blinded trial. Four residential communities (clusters) with a total of 64 eligible participants (16 participants in each residential community) will be randomised 1:1 to either the 24-week Baduanjin exercise intervention group (60 min per session, four sessions per week) or the no specific exercise intervention control group. Global cognitive function and the subdimensions of cognition including executive function, visuospatial function, language function and memory function will be assessed using the Montreal Cognitive Assessment Scale, Trail Making Test, Auditory Verbal Learning Test, Boston Naming Test-30 and Clock-Drawing Test, while the gut microbiome and its metabolomics will be detected using 16S rRNA and ultra-high-performance liquid chromatography–tandem mass spectrometry at baseline and at the end of 24-week intervention. The intervention effect of Baduanjin exercise and mediating role of gut microbiota will be analysed using linear mixed models and the bootstrapping method in the Hayes process.

Ethics and dissemination

This study conforms to Declaration of Helsinki principles and relevant ethical guidelines. Ethical approval has been obtained from the Ethics Committee of the Shanghai University of Medicine and Health Sciences (approval number: 2023-GZR-011). Written informed consent will be obtained from all participants. Results will be disseminated to relevant groups in peer-reviewed journal(s), and at relevant international or national scientific conferences. Key findings will also be shared with social media, healthcare providers, participants or community-dwelling older adults to support access for non-research audiences.

Trial registration number

ChiCTR2300078147.
Association between physician burnout and patient safety: study protocol for an overview of systematic reviews and meta-analyses
Authors: Vaquero-Cepeda Pablo , Pujol-de Castro Antonio , Catalá-López Ferrán
Published: November 2024

Introduction

Burnout, a disorder caused by chronic stress at work, involves emotional exhaustion, depersonalisation and reduced professional efficacy. The prevalence of burnout appears to be high among physicians worldwide. Burnout may affect different dimensions of healthcare, such as patient safety. Several systematic reviews and meta-analyses have examined the relationship between physician burnout and quality of care, although with some controversial results. To our knowledge, no overview of systematic reviews and meta-analyses has been conducted, specifically evaluating physician burnout, patient safety and other relevant aspects of quality of care. The main objective of this study will be to evaluate the available evidence of the association between physician burnout and patient safety.

Methods and analysis

An overview of systematic reviews and meta-analyses will be carried out. Systematic reviews with or without meta-analyses assessing the relationship between burnout in physicians and quality of care will be included. The primary outcome will be patient safety (ie, the occurrence of any adverse event related to healthcare which could have resulted, or did result, in unnecessary harm to patients). Secondary outcomes will be patient satisfaction and professionalism. Literature searches will be conducted (from their inception onwards) in PubMed/MEDLINE, EMBASE and Cochrane Database of Systematic Reviews. Two researchers will select studies that meet the predefined eligibility criteria and proceed to extract information from each included study. The methodological characteristics, measures of association and qualitative conclusions of the reviews will be assessed. The methodological quality of each review will also be analysed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) tool. A descriptive synthesis will be carried out using evidence tables and graphs.

Ethics and dissemination

The proposed research mainly involves the analysis of existing studies, approval from a research ethics committee is not required. This overview of systematic reviews will help to gain a better understanding of the association between physician burnout and patient safety. Our findings could support future research, recommendations and policies in this area. We plan to publish the full study in a peer-reviewed journal.

Registration of the protocol

Open Science Framework:https://osf.io/wr73u/
Pulmonary complications and mortality among COVID-19 patients undergoing a surgery: a multicentre cohort study
Authors: Amzallag Eva , Panchadsaram Thanushka , Girard Martin , Lecluyse Vincent , Couture Etienne , D'Aragon Frederick , Kandelman Stanislas , Turgeon Alexis F , Jodoin Caroline , Beaulieu Pierre , Richebé Philippe , Carrier Francois Martin
Published: November 2024

Objectives

Our primary objective was to assess the association between symptoms at the time of surgery and postoperative pulmonary complications and mortality in patients with COVID-19. Our secondary objective was to compare postoperative outcomes between patients who had recovered from COVID-19 and asymptomatic patients and explore the effect of the time elapsed between infection and surgery in the former. Our hypotheses were that symptomatic patients had a higher risk of pulmonary complications, whereas patients who had recovered from the infection would exhibit outcomes similar to those of asymptomatic patients.

Background

Managing COVID-19-positive patients requiring surgery is complex due to perceived heightened perioperative risks. However, Canadian data in this context remains scarce.

Design

To address this gap, we conducted a multicentre observational cohort study.

Setting

Across seven hospitals in the province of Québec, the Canadian province was most affected during the initial waves of the pandemic.

Participants

We included adult surgical patients with either active COVID-19 at the time of surgery or those who had recovered from the disease, from March 22, 2020 to April 30, 2021.

Outcomes

We evaluated the association between symptoms or recovery time and postoperative pulmonary complications and hospital mortality using multivariable logistic regression and Cox models. The primary outcome was a composite of any postoperative pulmonary complication (atelectasis, pneumonia, acute respiratory distress syndrome and pneumothorax). Our secondary outcome was hospital mortality, assessed from the date of surgery up to hospital discharge.

Results

We included 105 patients with an active infection (47 were symptomatic and 58 were asymptomatic) at the time of surgery and 206 who had recovered from COVID-19 prior to surgery in seven hospitals. Among patients with an active infection, those who were symptomatic had a higher risk of pulmonary complications (OR 3.19, 95% CI 1.12 to 9.68, p=0.03) and hospital mortality (HR 3.67, 95% CI 1.19 to 11.32, p=0.02). We did not observe any significant effect of the duration of recovery prior to surgery on patients who had recovered from their infection. Their postoperative outcomes were also similar to those observed in asymptomatic patients.

Interpretation

Symptomatic status should be considered in the decision to proceed with surgery in COVID-19-positive patients. Our results may help optimise surgical care in this patient population.

Study registration

ClinicalTrials.gov Identifier:NCT04458337registration date: 7 July 2020.
Association between gestational diabetes mellitus diagnostic criteria and adverse pregnancy outcomes—a systematic review and meta-analysis of adjusted effect sizes from studies using current diagnostic criteria
Authors: Mahmoud Elhassan , Elsayed Abdalla Moustafa , Elsayed Basant , Elsalakawi Yasmin , Gopinath Aswathy , Chivese Tawanda
Published: November 2024

Objectives

To quantify the association between Gestational Diabetes Mellitus (GDM) and adverse pregnancy outcomes and primarily compare the associations between diagnostic criteria following the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations and non-IADPSG criteria, which use higher blood glucose cut-offs.

Design

Systematic review and meta-analysis of observational studies using contemporary GDM diagnostic criteria.

Data sources

PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for articles published between 2010 and 2023. The search was carried out on 15 May 2023.

Eligibility criteria

Studies were included if they were observational studies that reported adjusted effect sizes for GDM-related adverse outcomes and compared outcomes between women with and without GDM, used contemporary diagnostic criteria and were conducted after 2010.

Data extraction and synthesis

Two reviewers independently extracted data and assessed study quality using the MethodologicAl STandards for Epidemiological Research (MASTER) scale. Bias-adjusted inverse variance heterogeneity meta-analysis models were used to synthesise adjusted effect sizes. The same meta-analytic models were used to synthesise the overall OR and their 95% CIs for comparisons of the criteria which followed the IADPSG recommendations to other criteria, mostly with higher blood glucose cut-offs (non-IADPSG).

Results

We included 30 studies involving 642 355 participants. GDM was associated with higher odds of maternal outcomes, namely; caesarean section (adjusted OR (aOR) 1.24, 95% CI 1.01 to 1.51) and pregnancy-induced hypertension (aOR 1.55, 95% CI 1.03 to 2.34). GDM was associated with higher odds of neonatal outcomes, specifically; macrosomia (aOR 1.38, 95% CI 1.13 to 1.69), large for gestational age (aOR 1.42, 95% CI 1.23 to 1.63), preterm birth (aOR 1.41, 95% CI 1.21 to 1.64), neonatal intensive care unit admission (aOR 1.42, 95% CI 1.12 to 1.78), neonatal hypoglycaemia (aOR 3.08, 95% CI 1.80 to 5.26) and jaundice (aOR 1.47, 95% CI 1.12 to 1.91). Further analyses showed no major differences in adverse pregnancy outcomes between IADPSG and non-IADPSG criteria.

Conclusions

GDM is consistently associated with adverse pregnancy, maternal and foetal outcomes, regardless of the diagnostic criteria used. These findings suggest no significant difference in risk between lower and higher blood glucose cut-offs used in GDM diagnosis.
Results of a healthcare transition learning collaborative for emerging adults with sickle cell disease: the ST3P-UP study transition quality improvement collaborative
Authors: Osunkwo Ifeyinwa , Cornette Jennifer S , Noonan Laura , Courtlandt Cheryl , Mabus Sarah , White Patience H , McManus Margaret , Robinson Myra M , Wallander Michelle L , Eckman James R , Saah Elna , Alvarez Ofelia A , Goodwin Mark , Jerome Clay Leila , Desai Payal , Lawrence Raymona H
Published: November 2024

Background

Individuals with sickle cell disease (SCD) experience poor clinical outcomes while transitioning from paediatric to adult care. Standards for SCD transition are needed. We established a Quality Improvement (QI) Collaborative that aimed to improve the quality of care for all young adults with SCD by establishing a standardised SCD transition process. This study evaluates the implementation of the Six Core Elements (6CE) of Health Care Transition, which was a fundamental component of the cluster-randomised Sickle Cell Trevor Thompson Transition Project (ST3P-UP) study.

Methods

A central QI team trained 14 ST3P-UP study sites on QI methodologies, 6CE and Got Transition’s process measurement tool (PMT). Site-level QI teams included a transition coordinator, clinic physicians/staff, patients/parents with SCD and community representatives. Sites completed the PMT every 6 months for 54 months and monthly audits of 10 randomly-selected charts to verify readiness/self-care assessments and emergency care plans.

Results

Of a possible 100, the aggregate mean (±SD) PMT score for paediatric clinics was 23.9 (±13.8) at baseline, 95.9 (±6.0) at 24 months and 98.9 (±2.1) at 54 months. The aggregate mean PMT score for adult clinics was 15.0 (±13.5) at baseline, 88.4 (±11.8) at 24 months and 95.8 (±6.8) at 54 months. The overall QI Collaborative PMT score improved by 402%. At baseline, readiness/self-care assessments were current for 38% of paediatric and 20% of adult patients; emergency care plans were current for 20% of paediatric and 3% of adult patients. Paediatric clinics had one median readiness assessment shift (76%) and four median emergency care plan shifts (65%, 77%, 79%, 84%). Adult clinics experienced three median self-care assessment shifts (58%, 63%, 70%) and two median emergency care plan shifts (57%, 70%).

Conclusions

The ST3P-UP QI Collaborative successfully embedded the 6CE of Health Care Transition into routine care and increased administration of assessments and emergency care plans for transition-aged patients with SCD.
Chronic pouchitis: what every gastroenterologist needs to know
Authors: Kamal Shahed , Mingos Nicholas , Andrew Bridgette , Segal Jonathan
Published: November 2024

Background

Chronic pouchitis is a complication after restorative proctocolectomy with ileal pouch-anal anastomosis in ulcerative colitis (UC) and patients with familial adenomatous polyposis. Despite medical advances, many patients develop chronic inflammation in the ileal pouch, affecting their quality of life.

Objective

This narrative review provides an overview of chronic pouchitis, focusing on pathogenesis, clinical presentation, diagnostics and management, highlighting the need for a multidisciplinary approach.

Methods

A comprehensive literature review was conducted, analysing studies on chronic pouchitis incidence, pathogenesis, diagnosis and treatment, with an emphasis on emerging therapies and personalised medicine.

Results

The pathogenesis of chronic pouchitis involves genetic, immunological, microbial and environmental factors. Symptoms include increased stool frequency, urgency and abdominal pain. Diagnosis relies on clinical evaluation, endoscopy and histology. Management includes antibiotics, probiotics, immunomodulators, biologics and dietary interventions. Emerging therapies like anti-TNFα monoclonal antibodies, vedolizumab, ustekinumab and small molecules show promise for refractory cases.

Conclusion

Effective chronic pouchitis management requires a personalised approach. Treatment aims to alleviate symptoms and prevent recurrence. Chronic pouchitis can severely impact on a patient’s quality of life, and therefore surgical options remain a valuable alternative for those not responding to medical therapy. Ongoing research and interdisciplinary collaboration are essential to improve patient outcomes.
‘Golden day’ is a myth: rethinking medical timelines and risk in large scale combat operations
Authors: Dilday Joshua , Webster S , Holcomb J , Barnard E , Hodgetts T
Published: November 2024

The evolving landscape of battlefield medicine forces medical planners to prepare for large-scale combat operations (LSCO) against peer adversaries, requiring reassessment of recent medical strategies. Despite lacking medical backing, the term ‘golden day’ has been used by senior military leaders to link the resuscitative benefits of the ‘golden hour’ to prolonged medical care through similar nomenclature. Pseudomedical terminology can easily enter the lexicon of commanders as attractive soundbites. However, articulating the evidence-based factors influencing mortality on the battlefield is critical to effectively articulate risk to commanders. The challenges of LSCO will be significant with increased casualty numbers and treatment constraints. Realistic medical and operational planning is critical to maximising survival, with a clear understanding of what can and cannot be achieved. Recent improvements in trauma care, such as early haemorrhage control, advanced prehospital care and rapid evacuation to surgical care, have significantly reduced mortality rates. Given the predictability of when casualties die from significant injuries, the absence of timely clinical interventions will increase avoidable battlefield deaths. If evacuation to surgical care is extended to 24 hours, many more casualties will die from potentially survivable injuries. Medical planners must recognise the potential challenges associated with LSCO including contested, delayed evacuation which predicts a tripling of mortality rates from 10% to 30%. Leaders must appreciate the unchanging human physiologic response to injury and historical combat casualty statistics when preparing commanders and politicians for the excess in mortality during LSCO. Without candour, plans will be unrealistic, causing non-medical leaders and the public to be unprepared.
Better end-of-life care in surgical patients: Veterans Affairs Bereaved Family Survey – a qualitative analysis
Authors: Shabet Christina , Vitous C Ann , Evans Emily , Edwards Sydney , Bradley Sarah E , Duby Ashley , Suwanabol Pasithorn A
Published: November 2024

Background

End-of-life care among surgical patients is largely understudied and far fewer studies examine such care from the family perspective. To identify potential opportunities for improvement, we explored responses of family members of veterans who died following surgery using the Veterans Affairs (VAs) Bereaved Family Survey (BFS).

Methods

We examined data from the BFS open-text responses to explore insights into surgical patient’s end-of-life care. Data were analysed iteratively using qualitative content analysis and clustered into domains based on content.

Results

We evaluated 936 open-text responses to the BFS for all decedents who underwent any high-risk surgical procedure across 124 VA medical centres from 2010 to 2019. This report focused on the following domains: patient needs, family/caregiver needs, clinical teams/personnel characteristics and facility/organisational characteristics. Key themes within patient needs included concerns about pain management, preservation of patient dignity and spiritual support. Within the family/caregiver domain, key themes included enhanced communication needs, assistance with logistics and displays of gratitude for the patient’s military service. The clinical team’s domain included the key themes of professionalism concerns and understaffing. Finally, key themes identified within the facility/organisation domain were the need for more robust support services and discomfort with the physical space.

Conclusions

Narratives from the family perspective provide valuable insight into end-of-life care among surgical patients. Our data demonstrate the critical need for preserving patient dignity and improved communication, which emphasises family involvement and shared decision-making. In addition, hospital systems can optimise nurse-to-patient ratios and intentionally design physical spaces to help improve end-of-life care for surgical patients.
Optimising bronchoalveolar lavage: lessons from alpha-1 antitrypsin deficiency
Authors: Herron Malcolm , Roche Suzanne , Fraughen Daniel D , Heeney Ronan C , Kanchi Lasya , Leacy Emma J , Casey Michelle , Gunaratnam Cedric , Carroll Tomás P , Murphy Mark P , McElvaney Noel G
Published: November 2024

Background

Bronchoalveolar lavage (BAL) is essential in determining the efficacy of novel therapies in alpha-1 antitrypsin deficiency (AATD). These require initial proof-of-concept demonstration that treatment administration increases alpha-1 antitrypsin (AAT) levels and/or anti-neutrophil elastase inhibitory capacity (ANEC) in the lung. Early-phase studies often encounter high interindividual variability of BAL results, primarily stemming from the inherent dilution characteristics of returned BAL fluid. A BAL protocol that minimises this variability is needed for reliable comparison of biochemical endpoints in the lung.

Methods

The study population included 21 severe AATD (ZZ), 22 moderate AATD (MZ) and 23 non-AATD (MM) individuals, further categorised as healthy, unobstructed current smokers or patients with chronic obstructive pulmonary disease (COPD). An additional six ZZ individuals were receiving intravenous alpha-1 augmentation therapy. We compared common BAL correction methods—albumin, total protein and epithelial lining fluid (ELF) volume measured by urea—when reporting early-phase biochemical endpoints, AAT and ANEC.

Results

BAL performed with a paediatric bronchoscope (PB) improved alveolar sampling compared with a traditional adult bronchoscope. Both uncorrected and ELF-corrected BAL demonstrated high interindividual variability regardless of lung health status. BAL total protein correction minimised interindividual variability, producing significant differences in AAT and ANEC between all genotypes, the strongest relationship with plasma AAT levels (r
2
=0.83), greatest inter-lobar concordance in AAT levels (r
2
=0.76) and strong correlation between BAL AAT and ANEC (r
2
=0.88).

Conclusions

By capitalising on the marked consistency in AAT levels between AAT genotypes, and the close relationship between plasma and lung AAT levels, we demonstrate reliable alveolar sampling that aligns closely with plasma.
Integrating the effects of climate change into long-term strategic forest management planning using a process-based stand model
Authors: Albert Cédric , Taylor Anthony R. , D'Orangeville Loïc
Published: November 2024

Integrating climate change into strategic forest management is critical for predicting forest dynamics and maintaining resource availability. However, there is currently no scientific consensus on the best approach for integrating climate change effects into strategic-level forest management planning. In this study, we propose a novel approach to incorporate climate change into a strategic forest planning model, Woodstock, using a parsimonious set of climate-sensitive stand yield tables and transition rules derived from the PICUS stand simulation model, calibrated for the Acadian forest region. Climate-sensitive yield tables were generated for a baseline and two climate forcing scenarios to dynamically capture climate effects on forest growth and composition. Initial forest conditions were grouped into four age classes for each stand type, with future conditions determined by three transition periods. Stand simulations predicted a significant shift toward warm-adapted species, with red maple, white pine, and yellow birch becoming more dominant, while cold-adapted species like balsam fir and spruce declined by 2120. Under high climate forcing, the merchantable wood volume is projected to decrease by 50%, indicating potential shortages and economic risks. The incorporation of climate change uncertainty into strategic forest planning is essential to reduce the risk of overutilization of forest resources. This research offers a novel and practical approach to integrating climate change into forest planning models.
Color flavor locked strange stars in de Rham–Gabadadze–Tolley like massive gravity
Authors: Das Krishna Pada , Karmakar Akashdip , Debnath Ujjal
Published: November 2024

We investigate Color Flavor Locked (CFL) Strange Stars using the most basic de Rham–Gabadadze–Tolley massive gravity model, which explains the massive graviton in the absence of a ghost propagating mode. In the current study, the compact star model has been achieved by solving the field equations for a static, uncharged sphere (Li et al., in Phys Dark Universe 42: 101308, 2023). Here, we provide some analytical and numerical findings and examine the effects of the massive gravity and anisotropy characteristics on the structure of this stellar object. The modified Tolman–Oppenheimer–Volkoff equation is obtained by taking into account the hydrostatic equilibrium. In order to verify stability of the stellar object, we have taken into account the redshift function and adibatic index. Furthermore, it is observed that the model parameters have a substantial impact on the mass, radius, and compactness of the star object. Finally, our findings provide a possible structure of hypothetical super massive CFL strange stars, which may be placed in the lower “mass-gap” region $$2~M_{\odot }-5~M_{\odot }$$

2

M
⊙

-
5

M
⊙

and remains stable without collapsing into a black hole corresponding to our considered model parameters.
Scattering effects of bumblebee gravity in metric-affine formalism
Authors: Heidari N. , Macedo Caio F. B. , Filho A. A. Araújo , Hassanabadi H.
Published: November 2024

In this work, we explore a Schwarzschild-like black hole within the framework of metric-affine bumblebee gravity. First, we investigate the behavior of the Kretschmann scalar and singularities in this modified gravity approach. Next, we introduce a newly defined time coordinate related to a stationary asymptotically flat spacetime. We also analyze the scattering effects and numerically calculate and comprehensively examine the partial and total absorption cross sections. At the high-frequency approximation, we find that the absorption cross section tends to the geodesic capture cross section. The continued fraction method is applied to investigate the quasinormal modes, and we explore the deviations of both the real and imaginary terms of the quasinormal modes from the Schwarzschild case in detail. We verify the relation between the shadow radius and the real part of the quasinormal frequencies at the eikonal limit within this modified gravity framework. Finally, we examine the energy emission rate.
Isotropization by shock waves generation in anisotropic hydrodynamics
Authors: Kovalenko Aleksandr
Published: November 2024

Anisotropic hydrodynamics (aHydro) has proven successful in modeling the evolution of quark-gluon matter created in heavy-ion collisions. The hydrodynamic description of quark-gluon plasma has also been widely used to study sound phenomena, such as shock waves. It has recently been shown that initial fluctuations in energy density and supersonic partons can generate fairly strong shock waves. However, significant anisotropic properties of the system due to the rapid longitudinal expansion of matter have not been taken into account in such studies. Moreover, the process of isotropization and its characteristic time-scales were not considered along with the question of the shock waves formation. Previous studies on shock discontinuous solutions in anisotropic hydrodynamics assumed constant anisotropy, leading to flow refraction towards the anisotropy axis and flow acceleration, characteristics of rarefaction waves, indicating limitations in this approach. This paper investigates discontinuous solutions for normal shock waves without flow refraction, introducing two compression parameters for longitudinal and transverse pressures. The resulting analytical solutions, as well as numerical computations, provide an isotropization mechanism of the system.
Superconducting CCT quadrupole test at Budker INP
Authors: Shkaruba V. , Bragin A. , Gusev Ye. , Kanonik P. , Kazantsev F. , Khrushchev S. , Kremnev A. , Mezentsev N. , Pilipenko D. , Safronov A. , Sedov A. , Syrovatin V. , Tarasenko O. , Tsukanov V. , Volkov A. , Zorin A.
Published: November 2024

This paper first presents the results of the development, design and testing of a quadrupole lens with a gradient of 40[Formula: see text]T/m created at Budker INP with Canted–Cosine–Theta (CCT) technology. The quadrupole lens is intended to be used for the final focus of electron–positron collider Super Charm Tau factory which is planned to be built in the National Center for Physics and Mathematics (NCPM), Sarov.
RN-STLSTM-GAN: Spatiotemporal-Guided Generative Adversarial Network for Time-Evolving Precipitation Downscaling
Authors: Li Meng , Xu Ziting , Li Zhengjie , Qi Yajie
Published: November 2024

Generative adversarial networks (GANs) have been widely applied in the field of meteorological research, particularly in the downscaling of images due to their ability to generate super-resolution images. In recent years, numerous researchers have combined GANs with recurrent neural networks (RNNs) to address the issue of meteorological super-resolution. However, these models do not take into account the spatial variations of meteorological sequences. In this paper, we propose a super-resolution method named RN-STLSTM-GAN, which combines GANs with RN-STLSTM and ESA networks to learn the spatiotemporal features of meteorological sequences. Specifically, we first apply the RN-STLSTM at the initialization of the generator and discriminator to learn the spatiotemporal relationships between sequential images. Second, an ESA network is combined with the RN-STLSTM structure to enhance the learning of spatial features. Thirdly, LeakyReLU is used as the activation function for both the generator and discriminator to minimize the loss of image data during model training. Experiments conducted on the NJU-CPOL datasets demonstrate that our proposed method outperforms other existing methods and can generate realistic and temporally consistent super-resolution sequences for datasets at different heights.
Measuring DNS-over-HTTPS Downgrades: Prevalence, Techniques, and Bypass Strategies
Authors: Lee Jinseo , Mohaisen David , Kang Min Suk
Published: November 2024

DNS-over-HTTPS (DoH) is a privacy-enhancing protocol that encrypts plaintext query data in DNS resolution. However, DoH often faces accessibility challenges due to phenomena known as DoH downgrades, where DoH queries are reverted to plaintext DNS queries. Unlike downgrades in other security protocols, which are undoubtedly malicious, the act of downgrading DoH queries can be both desirable and undesirable depending on the context; e.g., enterprise networks are officially advised to avoid or downgrade DoH for security reasons. Recent research has drawn attention to the deeper examination of the phenomena of DoH downgrades, focusing on the prevalence, techniques, and potential bypass strategies. However, existing studies on DoH downgrades have several limitations, notably that they severely overestimate the severity of DoH downgrades across the globe as they lack any distinction between desirable and undesirable downgrades of DoH. In this work, we conduct a large-scale measurement study to provide a more accurate depiction of the DoH downgrade landscape. By minimizing the influence of desirable downgrades of DoH in our measurement probes, we show a skewed long-tail distribution of DoH downgrades across the globe. Our stateful probing techniques also reveal hidden DoH filtering mechanisms that were previously undetected. Furthermore, we design near perfect bypass strategies against existing DoH downgrades. Our study expands our limited understanding of DoH downgrades, offering a more accurate, fine-grained, and comprehensive view of the phenomena.
WaveFlex: A Smart Surface for Private 5G CBRS Networks
Authors: Yi Fan , Cho Kun Woo , Xie Yaxiong , Jamieson Kyle
Published: November 2024

We present the design and implementation of
WaveFlex,
the first smart surface that enhances Private 5G networks operating under the shared-license framework in the Citizens Broadband Radio Service frequency band. WaveFlex works in the presence of frequency diversity: multiple nearby base stations operating on different frequencies, as dictated by a Spectrum Access System coordinator. It also handles time dynamism: due to the dynamic sharing rules of the CBRS band, base stations occasionally switch channels, especially when priority users enter the network. Finally, WaveFlex operates independently of the network itself, not requiring access to nor modification of the gNB or UEs, yet it remains compliant with and effective on prevailing cellular protocols. We have designed and fabricated WaveFlex on a custom multi-layer PCB, software defined radio based network monitor, and supporting control software and hardware. Our experimental evaluation benchmarks operational Private 5G and LTE networks running at full line rate. In a realistic indoor office scenario, 5G experimental results demonstrate an 8.58~dB average SNR gain, and an average throughput gain of 10.77 Mbps under a single gNB, and 12.84 Mbps under three gNBs, corresponding to throughput improvements of 18.4% and 19.5%, respectively.
NetGSR: Towards Efficient and Reliable Network Monitoring with Generative Super Resolution
Authors: Sun Chuanhao , Xu Kai , Antichi Gianni , Marina Mahesh K.
Published: November 2024

Network monitoring systems are a key building block in today's networks. They all follow a common framework where measurement data from network elements is aggregated at a central collector for network-wide visibility. When designing network monitoring systems, two key properties have to be taken into account: (1) efficiency, to minimize the communication overhead from network elements to the collector; (2) high-fidelity, to faithfully represent the network status. However, in presence of network dynamics, tracking the right operating point to ensure both high fidelity and efficiency is hard and we observe that prior monitoring approaches trade off one for the other.

In this paper, we show that it is possible to satisfy both these properties with
NetGSR,
a new deep learning based solution we introduce that reconstructs the fine-grained behavior of network status at the collector while requiring low resolution measurement data from network elements. This is achieved through a combination of a new custom-tailored conditional deep generative model
(DistilGAN),
and a new feedback mechanism
(Xaminer)
based on model uncertainty estimation and denoising that allows the collector to adjust the sampling rate for measurement data from network elements, at run-time. We extensively evaluate NetGSR using three different network scenarios with corresponding real-world network monitoring datasets as well as two downstream use cases. We show that
NetGSR
can faithfully reconstruct fine-grained network status with 25x greater measurement efficiency than prior approaches while requiring only few ms of inference time at the collector.
Accessibility Considerations for Mobile Applications
Authors: Spencer Juanami
Published: November 2024

Considering accessibility is essential when creating mobile applications to ensure they are usable and enjoyable for as broad an audience as possible. Mobile accessibility has unique considerations compared with desktop experiences, but it provides immense value to those users who rely on mobile devices in their day-to-day activities. By keeping these considerations in mind, mobile product development teams can better support and enhance the lives of all users. This article explores some of the key accessibility considerations for a mobile application and highlights a few ways the Bloomberg Connects app supports accessibility in both the product and process.
Driving Organizational Accessibility
Authors: Donati Vinnie
Published: November 2024

In this article we'll explore how Microsoft drives accessibility throughout its organization and we'll look closely at essential frameworks and practices that promote an inclusive culture. Through examining aspects like awareness building, strategic development, accessibility maturity modeling, and more, we aim to offer a guide for organizations starting their accessibility journey. The idea is to share what we've learned in the hope that you can take it, tweak it to fit your company's purpose, and nurture accessibility in a way that's not just a checkbox activity but genuinely integrated into your culture.
Safe Driving Adversarial Trajectory Can Mislead: Toward More Stealthy Adversarial Attack Against Autonomous Driving Prediction Module
Authors: Dong Yingkai , Wang Li , Li Zheng , Li Hao , Tang Peng , Hu Chengyu , Guo Shanqing
Published: November 2024

The prediction module, powered by deep learning models, constitutes a fundamental component of high-level Autonomous Vehicles (AVs). Given the direct influence of the module’s prediction accuracy on AV driving behavior, ensuring its security is paramount. However, limited studies have explored the adversarial robustness of the prediction modules. Furthermore, existing methods still generate adversarial trajectories that deviate significantly from human driving behavior. These deviations can be easily identified as hazardous by AVs’ anomaly detection models and thus cannot effectively evaluate and reflect the robustness of the prediction modules.

To bridge this gap, we propose a stealthy and more effective optimization-based attack method. Specifically, we reformulate the optimization problem using Lagrangian relaxation and design a Frenet-based objective function along with a distinct constraint space. We conduct extensive evaluations on 2 popular prediction models and 2 benchmark datasets. Our results show that our attack is highly effective, with over 87% attack success rates, outperforming all baseline attacks. Moreover, our attack method significantly improves the stealthiness of adversarial trajectories while guaranteeing adherence to physical constraints. Our attack is also found robust to noise from upstream modules, transferable across trajectory prediction models, and high realizability. Lastly, to verify its effectiveness in real-world applications, we conduct further simulation evaluations using a production-grade simulator. These simulations reveal that the adversarial trajectory we created could convincingly induce autonomous vehicles (AVs) to initiate hard braking.
Aqua Barrier: Polypropylene/Stearic Acid-Infused Zn-ZnO-Cu Multilayer Superhydrophobic Coatings on Steel for Enhancing Anti-Microbial and Anti-Corrosion Efficiency
Authors: Mamgain Himanshu Prasad , Pandey Jitendra Kumar , Brajpuriya Ranjeet
Published: November 2024

This study investigates the enhancement of anti-microbial efficiency, hydrophobicity, and corrosion resistance, by depositing a multilayer Cu and Zn/Zno superhydrophobic (SH) coating modified with polypropylene/stearic acid (PP/SA) on steel. The electrodeposition of Cu and Zn on steel results in a unique leaves and cotton-like structures, increasing the hydrophobicity with a contact angle(CA) of 157°, up from 24° for bare steel. Further modification with polypropylene and stearic acid (PP/SA) maximises the contact angle to 167° and minimises the Fsl value to 1.34%, resulting in improved surface energy reduction and increased hydrophobicity. The anti-microbial efficiency of the polypropylene-stearic acid-modified Zn-Cu SH coating demonstrates a remarkable zone of inhibition of 30 mm, which is 300 times more effective than bare steel against E.coli Bacteria. The micro- and nano-scale roughness of the SH surface creates a challenging environment for microbial adhesion, reducing the risk of contamination by minimising contact area and inhibiting attachment. Corrosion resistance, evaluated through electrochemical impedance spectroscopy (EIS) and open circuit voltage (OCV), revealed exceptional performance, a corrosion rate of 0.00153
mm year

−1
with a polarisation resistance of 12200 Ω.cm2, and a charge transfer resistance of 600000 Ω. cm2. The nanostructured coating traps air to minimise contact area, providing superior corrosion protection. This study demonstrates that the Cu-Zn SH coating modified by PP/SA significantly enhances anti-microbial, hydrophobic, and corrosion-resistant properties, providing a promising approach for steel surface protection.