bluuebunny/crossref_metadata_2025 huggingface dataset:
Secondary ion mass spectrometry for bone research
Authors: Kern Christine , Kern Stefanie , Henss Anja , Rohnke Marcus
Published: July 2023

The purpose of this Tutorial is to highlight the suitability of time-of-flight secondary ion mass spectrometry (ToF-SIMS) and OrbiTrap™ SIMS (Orbi-SIMS) in bone research by introducing fundamentals and best practices of bone analysis with these mass spectrometric imaging (MSI) techniques. The Tutorial includes sample preparation, determination of best-suited measurement settings, data acquisition, and data evaluation, as well as a brief overview of SIMS applications in bone research in the current literature. SIMS is a powerful analytical technique that allows simultaneous analysis and visualization of mineralized and nonmineralized bone tissue, bone marrow as well as implanted biomaterials, and interfaces between bone and implants. Compared to histological staining, which is the standard analytical procedure in bone research, SIMS provides chemical imaging of nonstained bone sections that offers insights beyond what is conventionally obtained. The Tutorial highlights the versatility of ToF- and Orbi-SIMS in addressing important questions in bone research. By illustrating the value of these MSI techniques, it demonstrates how they can contribute to advance progress in bone research.
Structure of the photoreceptor synaptic assembly of the extracellular matrix protein pikachurin with the orphan receptor GPR179
Authors: Patil Dipak N. , Pantalone Serena , Cao Yan , Laboute Thibaut , Novick Scott J. , Singh Shikha , Savino Simone , Faravelli Silvia , Magnani Francesca , Griffin Patrick R. , Singh Appu K. , Forneris Federico , Martemyanov Kirill A.
Published: July 2023

Precise synapse formation is essential for normal functioning of the nervous system. Retinal photoreceptors establish selective contacts with bipolar cells, aligning the neurotransmitter release apparatus with postsynaptic signaling cascades. This involves transsynaptic assembly between the dystroglycan-dystrophin complex on the photoreceptor and the orphan receptor GPR179 on the bipolar cell, which is mediated by the extracellular matrix protein pikachurin (also known as EGFLAM). This complex plays a critical role in the synaptic organization of photoreceptors and signal transmission, and mutations affecting its components cause blinding disorders in humans. Here, we investigated the structural organization and molecular mechanisms by which pikachurin orchestrates transsynaptic assembly and solved structures of the human pikachurin domains by x-ray crystallography and of the GPR179-pikachurin complex by single-particle, cryo–electron microscopy. The structures reveal molecular recognition principles of pikachurin by the Cache domains of GPR179 and show how the interaction is involved in the transsynaptic alignment of the signaling machinery. Together, these data provide a structural basis for understanding the synaptic organization of photoreceptors and ocular pathology.
Supplemental Material: Laramide bulldozing of lithosphere beneath the Arizona transition zone, southwestern United States
Authors: Kapp Paul , al. et
Published: July 2023

Analytical methods, data tables and figures, and thermal modeling information. 
Cost-effectiveness and willing-to-pay thresholds for vertebral augmentation of osteoporotic vertebral fractures, what are they based on: a systematic review
Authors: Pron Gaylene , Hwang Matthew , Nasralla Mehran , Smith Roger , Cheung Angela , Murphy Kieran
Published: July 2023

Objective

Although there is substantial clinical evidence on the safety and effectiveness of vertebral augmentation for osteoporotic vertebral fractures, cost-effectiveness is less well known. The objective of this study is to provide a systematic review of cost-effectiveness studies and policy-based willingness-to-pay (WTP) thresholds for different vertebral augmentation (VA) procedures, vertebroplasty (VP) and balloon kyphoplasty (BK), for osteoporotic vertebral fractures (OVFs).

Design

A systematic review targeting cost-effectiveness studies of VA procedures for OVFs.

Data sources

Six bibliographic databases were searched from inception up to May 2021.

Eligibility criteria for study selection

Studies were eligible if meeting all predefined criteria: (1) VP or BK intervention, (2) OVFs and (3) cost-effectiveness study. Articles not written in English, abstracts, editorials, reviews and those reporting only cost data were excluded.

Data extraction and synthesis

Information was extracted on study characteristics, cost-effective estimates, summary decisions and payer WTP thresholds. Incremental cost-effective ratio (ICER) was the main outcome measure. Studies were summarised by a structured narrative synthesis organised by comparisons with conservative management (CM). Two independent reviewers assessed the quality (risk of bias) of the systematic review and cost-effectiveness studies by peer-reviewed checklists.

Results

We identified 520 references through database searching and 501 were excluded as ineligible by titles and abstract. Ten reports were identified as eligible from 19 full-text reviews. ICER for VP versus CM evaluated as cost per quality-adjusted life-year (QALY) ranged from €22 685 (*US$33 395) in Netherlands to £−2240 (*US$−3273), a cost-saving in the UK. ICERs for BK versus CM ranged from £2706 (*US$3954) in UK to kr600 000 (*US$90 910) in Sweden. ICERs were within payer WTP thresholds for a QALY based on historical benchmarks.

Conclusions

Both VP and BK were judged cost-effective alternatives to CM for OVFs in economic studies and were within WTP thresholds in multiple healthcare settings.
What are the treatment remission, response and extent of improvement rates after up to four trials of antidepressant therapies in real-world depressed patients? A reanalysis of the STAR*D study’s patient-level data with fidelity to the original research protocol
Authors: Pigott H Edmund , Kim Thomas , Xu Colin , Kirsch Irving , Amsterdam Jay
Published: July 2023

Objective

Reanalyse the patient-level data set of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study with fidelity to the original research protocol and related publications.

Design

The study was open label and semirandomised examining the effectiveness of up to four optimised and increasingly aggressive, antidepressant therapies in depressed adults. Patients who failed to gain adequate relief from their level 1 trial on the SSRI citalopram could receive up to three additional treatment trials in levels 2–4.

Setting

41 North American psychiatry and primary care treatment centres.

Participants

4041 adults screened positive for major depressive disorder. In contrast to most clinical trials, STAR*D enrolled patients seeking care (vs recruited) and included patients with a wide range of common comorbid medical and psychiatric conditions to enhance the generalisability of findings to real-world clinical practice.

Interventions

STAR*D evaluated the relative effectiveness of 13 antidepressants therapies in treatment levels 2–4 for depressed patients who failed to gain adequate benefit from their level 1 medication trial.

Main outcome measures

According to the STAR*D protocol, the primary outcome was remission, defined as a score <8 on the blinded Hamilton Rating Scale for Depression (HRSD). Response was a secondary outcome defined as ≥50% reduction in HRSD scores. STAR*D’s protocol specifically excluded all non-blinded clinic-administered assessments from use as research outcome measures.

Results

STAR*D investigators did not use the protocol-stipulated HRSD to report cumulative remission and response rates in their summary article and instead used a non-blinded clinic-administered assessment. This inflated their report of outcomes, as did their inclusion of 99 patients who scored as remitted on the HRSD at study outset as well as 125 who scored as remitted when initiating their next-level treatment. These patients should have been excluded from data analysis. In contrast to the STAR*D-reported 67% cumulative remission rate after up to four antidepressant treatment trials, the rate was 35.0% when using the protocol-stipulated HRSD and inclusion in data analysis criteria.

Conclusion

STAR*D’s cumulative remission rate was approximately half of that reported.
Associations of three thermogenic adipokines with metabolic syndrome in obese and non-obese populations from the China plateau: the China Multi-Ethnic Cohort
Authors: Zhao Zhimin , Huang Juan , Zhong Dubo , Wang Yanjiao , Che Zhuohang , Xu Yahui , Hong Rudan , Qian Ying , Meng Qiong , Yin Jianzhong
Published: July 2023

Objectives

High altitude exposure decreases the incidence of obesity and metabolic syndrome, but increases the expression of the thermogenic adipokines (leptin, fat cell fatty acid-binding protein (A-FABP) and visfatin). This study investigated the correlation of these adipokines with obesity and metabolic syndrome (MetS) in populations residing in a plateau-specific environment.

Design

Case–control study.

Setting

We cross-sectionally analysed data from the China Multi-Ethnic Cohort.

Participants

A total of 475 obese (OB, body mass index (BMI)≥28.0 kg/m2) plateau Han people and 475 age, sex and region-matched non-obese (NO, 18.5≤BMI<24.0 kg/m2) subjects were recruited. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines.

Primary and secondary outcome measures

Data with normal distributions were expressed as the mean (Stanard Deviation, SD), and data with skewed distributions were expressed as the median (Interquartile Range, IQR). The participants were grouped and the rank-sum test, χ2test or t-tests was used for comparing groups. Spearman correlation coefficients were estimated to assess the relationships among leptin, A-FABP, visfatin and the components of MetS in each group.

Results

A-FABP was an independent predictor of OB (OR, 1.207; 95% CI, 1.170 to 1.245; p<0.05), ABSI (OR, 1.035; 95%CI, 1.019 to 1.052; p<0.05) and MetS (OR, 1.035; 95% CI, 1.013 to 1.057; p<0.05). Leptin was an independent predictor of MetS in the NO group. Visfatin was an independent predictor of increased ABSI, but not for OB or MetS.

Conclusion

An abnormally elevated plasma A-FABP level, but not leptin or visfatin is a potential risk factor for MetS in high-altitude populations.
Preoperative versus postoperative survival in patients with univentricular heart: a nationwide, retrospective study of patients born in 1990–2015
Authors: Erikssen Gunnar , Liestøl Knut , Aboulhosn Jamil , Wik Gunnar , Holmstrøm Henrik , Døhlen Gaute , Gjesdal Ola , Birkeland Sigurd , Hoel Tom Nilsen , Saatvedt Kjell Johan , Seem Egil , Thaulow Erik , Estensen Mette E , Lindberg Harald Lauritz
Published: July 2023

Objectives

Few data exist on mortality among patients with univentricular heart (UVH) before surgery. Our aim was to explore the results of intention to perform surgery by estimating preoperative vs postoperative survival in different UVH subgroups.

Design

Retrospective.

Setting

Tertiary centre for congenital cardiology and congenital heart surgery.

Participants

All 595 Norwegian children with UVH born alive from 1990 to 2015, followed until 31 December 2020.

Results

One quarter (151/595; 25.4%) were not operated. Among these, only two survived, and 125/149 (83.9%) died within 1 month. Reasons for not operating were that surgery was not feasible in 31.1%, preoperative complications in 25.2%, general health issues in 23.2% and parental decision in 20.5%. In total, 327/595 (55.0%) died; 283/327 (86.5%) already died during the first 2 years of life. Preoperative survival varied widely among the UVH subgroups, ranging from 40/65 (61.5%) among patients with unbalanced atrioventricular septal defect to 39/42 (92.9%) among patients with double inlet left ventricle. Postoperative survival followed a similar pattern. Postoperative survival among patients with hypoplastic left heart syndrome (HLHS) improved significantly (5-year survival, 42.5% vs 75.3% among patients born in 1990–2002 vs 2003–2015; p<0.0001), but not among non-HLHS patients (65.7% vs 72.6%; p=0.22)—among whom several subgroups had a poor prognosis similar to HLHS. A total of 291/595 patients (48.9%) had Fontan surgery

Conclusions

Surgery was refrained in one quarter of the patients, among whom almost all died shortly after birth. Long-term prognosis was largely determined during the first 2 years. There was a strong concordance between preoperative and postoperative survival. HLHS survival was improved, but non-HLHS survival did not change significantly. This study demonstrates the complications and outcomes encountering newborns with UVH at all major stages of preoperative and operative treatment.
Does adherence to antiretroviral therapy differ by place of residence in Nigeria? A systematic review and meta-analysis protocol
Authors: Badru Oluwaseun Abdulganiyu , Bain Luchuo Engelbert , Adeagbo Oluwafemi Atanda
Published: July 2023

Introduction

Retention in care is still a significant challenge in the HIV treatment cascade and varies extensively across regions, leading to poor adherence to antiretroviral therapy (ART). Several factors across different socioecological levels, such as health and community-level factors, inhibit ART adherence among people living with HIV (PLWH) in Nigeria. This review seeks to ask whether adherence to ART differs by place of residence in Nigeria.

Method and analysis

This systematic review and meta-analysis will follow the updated Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search PubMed, SCOPUS, CINAHL, Web of Science, MEDLINE (Ovid) and Google Scholar from onset to 30 April 2023. We will include only quantitative observational studies or mixed-method studies that measured the association between place of residence (urban and rural) and adherence to ART among PLWH aged ≥15 years. Title and abstract screening, full-text screening, data extraction and quality assessment will be done by two reviewers independently. A third reviewer will resolve disagreements. We will extract the author’s name and year of publication, study aim(s), participant’s characteristics, sample size, sampling method, region and state, adherence definition and adherence level in urban and rural areas. Data will be analysed with Review Manager V.5.4. The Q statistical test will be used to assess between-study heterogeneity, while Higgins and Thompson’s I2will be used to quantify the heterogeneity level. Several subgroups and sensitivity analyses will be conducted.

Ethics and dissemination

Ethical approval is not warranted for this study since primary published data will be utilised. The findings of this review will be published in a high-impact peer-reviewed journal and presented at a conference.

PROSPERO registration number

CRD42022371965.
Quantifying the available capacity and resource needs for provision of CAR-T therapies in the National Health Service in Spain: a survey-based study
Authors: Solano Carlos , Castro-Rebollo Pedro , Pérez-Martínez Antonio , López-Corral Lucia , Barba-Suñol Pere , Kwon Mi , Ortiz Valentín , Sanz-Caballer Jaime , Caballero Ana Carolina , Martínez Joaquín , Cedillo Ángel , Sureda Anna
Published: July 2023

Objectives

To estimate the readiness of Spanish National Health Service (NHS) hospitals to provide chimeric antigen receptor T cell (CAR-T), and to identify and quantify the different resources needed to provide CAR-T considering three scenarios defined by 10, 25 and 50 patients per centre per year.

Design

Targeted literature review and quantitative study using a questionnaire and telephone interviews. An algorithm was created to determine hospitals’ readiness based on their capacity and capability. All the requirements for quantification were assessed and validated by the steering committee, formed by members of the Spanish Group of Haematopoietic Transplantation and Cell Therapy. A weighting system (from 0 to 1) was established for capability quantification. For resources quantification, a scoring system was established, with 0 points representing the minimum and 3 points the maximum of additional resources that a hospital indicated necessary.

Setting

40 Spanish hospital centres that perform allogeneic haematopoietic stem cell transplantation were invited to complete the questionnaire for capacity quantification, 28 of which provided valid responses. Nine hospitals participated in the interviews for resource quantification, eight of which had previously been designated by the Ministry of Health (MoH) to provide CAR-T.

Outcome measure

Current capacity of NHS Spanish sites to administer CAR-T under different theoretical scenarios with varying numbers of procedures, and the potential healthcare resources that would be needed to realise the theoretical capacity requirements.

Results

Four hospitals were optimally ready, 17 were somewhat ready and 7 were not ready. The actual extrapolated capacity of the currently designated MoH CAR-T sites would allow treatment of approximately 250 patients per year. Regarding healthcare resource needs, the numbers of haematologists, nurses and beds were the most important limiting factors, and those requiring further growth as patient numbers increased.

Conclusions

Increasing the number of CAR-T-qualified centres and/or increasing resources in the current designated sites are two potential strategies that should be considered to treat CAR-T-eligible patients in Spain.
Discharge prescription patterns for antiplatelet and statin therapy following carotid endarterectomy: an analysis of the vascular quality initiative
Authors: Eppler Michael , Singh Nikhil , Ding Li , Magee Gregory , Garg Parveen
Published: July 2023

Objectives

Despite guidelines endorsing statin and single antiplatelet therapy (SAPT) therapy post-carotid endarterectomy (CEA), these medications may be either under or inappropriately prescribed. We determined rates of new statin prescriptions as well as change in antiplatelet therapy (APT) regimen at discharge. We identified characteristics associated with these occurrences.

Design

We performed a retrospective Vascular Quality Initiative registry analysis of more than 125 000 patients who underwent CEA from 2013 to 2021.

Setting

The Vascular Quality Initiative is a multicentre registry database including academic and community-based hospitals throughout the USA.

Participants

Patients age≥18 years undergoing CEA with available statin and APT data (preprocedure and postprocedure) were included.

Primary and secondary outcome measures

We determined overall rates of statin and APT prescription at discharge. Multivariate logistic regression was used to determine clinical and demographic characteristics that were mostly associated with new statin prescription or changes in APT regimen at discharge.

Results

Study participants were predominantly male (61%) and White (90%), with a mean age of 70.6±9.1. 13.1% of participants were not on statin therapy pre-CEA, and 48% of these individuals were newly prescribed one. Statin rates steadily increased throughout the study period: 36.2% in 2013 to 62% in 2021. A higher likelihood of new statin prescription was associated with non-race, diabetes, coronary heart disease, stroke, TIA and a non-elective indication. Older age, female gender, chronic obstructive pulmonary disease and prior carotid revascularisation were associated with a lower likelihood of new statin prescription. Nearly all participants were discharged on APT (63% SAPT and 37% dual antiplatelet therapy, DAPT). Among these individuals, 16% were discharged on a regimen that was different from the one on admission (11 947 (10.7%) of patients were upgraded to DAPT and 5813 (5.2%) were downgraded to SAPT).

Conclusions

Although statin use has substantially improved following CEA, more than half of individuals not on a statin preprocedure remained this way at discharge. In addition, DAPT at discharge was frequent, a quarter of whom were on SAPT preprocedure. Further efforts are needed to improve rates of new statin prescriptions, ensure appropriate APT intensity at discharge and determine how different discharge APT regimens impact outcomes.
Understanding the chronic pain journey and coping strategies that patients use to manage their chronic pain: a qualitative, patient-led, Canadian study
Authors: Bruce Marcia , Lopatina Elena , Hodge Jamie , Moffat Karen , Khan Sophia , Pyle Pamela , Kashuba Sherri , Wasylak Tracy , Santana Maria-Jose
Published: July 2023

Objective

To gain an insight into coping strategies that people living with chronic pain use to self-manage their pain.

Design

This qualitative Patient-oriented Research study used the Patient and Community Engagement Research approach. It was conducted by people with chronic pain lived experience, ensuring that patient perspective and needs were considered and addressed throughout the research cycle. Purposeful sampling was used for recruiting individuals living with chronic pain. A focus group and one-on-one semi-structured interviews were conducted via videoconference. The data were analysed iteratively using inductive thematic analysis and narrative story analysis.

Setting

Calgary, Alberta, Canada.

Participants

Eleven adult participants, between the ages of 18 and 65, who self-identified as living with chronic pain for greater than 2 years.

Results

Three main themes emerged from the data: (1) the elements of chronic pain, (2) the chronic pain journey to acceptance and (3) daily coping strategies for chronic pain. Participants thought it was important to discuss these three themes because the daily coping strategies that they employed at any given time (theme 3) depended on the factors discussed in themes 1 and 2. Overlaying all of this is also a grieving process that people living with chronic pain may have to go through more than once. Participants also identified recommendations for healthcare professionals to support people living with chronic pain.

Conclusions

Dealing with chronic pain affects all aspects of a person’s life and involves a grieving process. When treating patients with chronic pain, it is important for healthcare professionals to understand the journey that people living with chronic pain go through, not just coping strategies. Diagnosis is critical for a patient’s acceptance and in helping them find their new normal where they can employ daily coping strategies to manage their pain.
Addition of daptomycin for the treatment of pneumococcal meningitis: protocol for the AddaMAP study
Authors: Chavanet Pascal , Fournel Isabelle , Bourredjem Abderrahmane , Piroth Lionel , Blot Mathieu , Sixt Thibault , Binquet Christine
Published: July 2023

Background

The leading cause of acute bacterial meningitis in adults isStreptococcus pneumoniae. This infection is associated with high rates of mortality and morbidity related, among other factors, to the excessive host response to the pneumococcal lysis. Experimental in vitro and in vivo data show that the combination of corticosteroids/third-generation cephalosporins and the non-lytic antibiotic, daptomycin, has synergistic effects with (1) a rapid cerebrospinal fluid sterilisation, (2) less brain damages and (3) less loss of cognitive performances. Despite these encouraging results, daptomycin has never been evaluated in adult patients with pneumococcal meningitis.

Methods and analysis

The AddaMAP trial is a phase II, open-label, Simon’s two-stage, multicentre trial that has been designed to assess the efficacy and safety of adding daptomycin (10 mg/kg/d for 8 days) to the recommended treatment (corticosteroids+third generation cephalosporin) in adults with confirmed pneumococcal meningitis. The main endpoint is the disability-free survival (defined as modified Rankin Scale mRS≤2) at day 30. Secondary outcomes are overall mortality, disability at D30 and D90 (mRS, Glasgow Coma Scale and Glasgow Outcome Scales, mini-mental score), hearing loss (Hearing Handicap Inventory Test at D30 and D90, routine audiometric test and Hearing-it test at D30), and quality of life (12-item Short Form Survey and WHO QOL BREF). Seventy-two analysable patients are required.

Ethics and dissemination

The study protocol was approved by the Institutional Review Board of the IDF 1 of the ethics committee on 16 January 2018, and authorisation was obtained from the Agence Nationale de Securité des Médicaments et des Produits de Santé on 22 September 2017. The results will be submitted for publication in a peer-reviewed journal.

Trial registration number

NCT03480191.
Efficacy of smartphone-based virtual reality relaxation in providing comfort to patients with cancer undergoing chemotherapy in oncology outpatient setting in Indonesia: protocol for a randomised controlled trial
Authors: Gautama Made Satya Nugraha , Haryani Haryani , Huang Tsai-Wei
Published: July 2023

Introduction

Patients with cancer undergoing chemotherapy experience various physical and psychological problems and discomfort. Virtual reality (VR) can be used in technology-based non-pharmacological therapy that can serve as a potential distractor in the symptom management of patients with cancer undergoing chemotherapy. We propose a smartphone-based virtual reality relaxation (S-VR) technique as a complementary modality to provide comfort to patients with cancer, and we will evaluate its effect on patients with cancer undergoing chemotherapy.

Methods and analysis

We will recruit 80 patients from the One Day Chemotherapy ‘Tulip’ Center of Dr. Sardjito General Hospital, Yogyakarta, Indonesia. This will be a two-arm parallel randomised controlled trial, with a 1:1 allocation and the primary outcome assessor blinded. This study will be divided into two groups: (1) an intervention group, with participants receiving 360° panoramic video content and music relaxation intervention through a VR device (head-mounted display) placed on their head during chemotherapy for ±10 min plus standard care and (2) a control group, with participants receiving guided imagery relaxation therapy in the form of a leaflet plus standard care. We will measure the outcomes after one chemotherapy cycle for each participant. The primary outcome is the effectiveness of the S-VR in improving the comfort of patients. The secondary outcome is the effect of the S-VR on the patients’ symptom management self-efficacy, pain, anxiety, blood pressure (systolic blood pressure and diastolic blood pressure) and pulse rate.

Ethics and dissemination

This study was approved by the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health and Nursing of Universitas Gadjah Mada—Dr. Sardjito General Hospital, Yogyakarta, Institutional Review Board (approval number: KE/FK/0301/EC/2023). Written informed consent will be obtained from all participants who enrol in the study. Dissemination will be conducted through peer-reviewed publications and conference presentations.

Trial registration number

NCT05756465.
High-performing primary care clinics across high-need, high-cost Medicare populations
Authors: Beckman Adam L , Tietschert Maike , Old Andrew , Orav E John , Singer Sara J , Figueroa Jose F
Published: July 2023

Background

To reduce spending and improve quality, some primary care clinics in the USA have focused on high-need, high-cost (HNHC) Medicare beneficiaries, which include clinically distinct subpopulations: older adults with frailty, adults under 65 years with disability and beneficiaries with major complex chronic conditions. Nationally, the extent to which primary care clinics are high-performing ‘Bright Spots’—clinics that achieve favourable outcomes at lower costs across HNHC beneficiary subpopulations—is not known.

Objective

To determine the prevalence of primary care clinics that perform highly on commonly used cost or quality measures for HNHC subpopulations.

Design and participants

Cross-sectional study using Medicare claims data from 2014 to 2015.

Main measures

Annual spending, avoidable hospitalisations for ambulatory care-sensitive conditions, treat-and-release emergency department visits, all-cause 30-day unplanned hospital readmission rates and healthy days at home. Clinics were high performing when they ranked in the top quartile of performance for ≥4 measures for an HNHC subpopulation. ‘Bright Spot’ clinics were in the top quartile of performance for ≥4 measures across all the HNHC subpopulations.

Key results

A total of 2770 primary care clinics cared for at least 10 beneficiaries from each of the three HNHC subpopulations (adults under 65 with disability, older adults with frailty and beneficiaries with major complex chronic conditions). Less than 4% of clinics were high performing for each HNHC subpopulation; <0.5% of clinics were in the top quartile for all five measures for a given subpopulation. No clinics met the definition of a primary care ‘Bright Spot’.

Conclusions

High-performing primary care clinics that achieved favourable health outcomes or lower costs across subpopulations of HNHC beneficiaries in the Medicare programme in 2015 were rare. Efforts are needed to support primary care clinics in providing optimal care to HNHC subpopulations.
Using an electronic safety netting tool designed to improve safety with respect to cancer referral in primary care: a qualitative service evaluation using rapid appraisal methods
Authors: Black Georgia B , Machen Samantha , Parker-Deeks Saira , Cronin Andrea , Chung Donna
Published: July 2023

Background

This evaluation assesses the impact of an electronic safety netting software (E-SN) package, C the Signs, in primary care services across five boroughs in North East London (NEL).

Aim

This study evaluates the use of E-SN software in primary care, examining its benefits and barriers, safety implications, and overall impact on individual and practice usage.

Design and setting

The study is based on semi-structured interviews with 21 clinical and non-clinical members of staff from all primary care services using the software in NEL.

Method

Semi-structured interviews were conducted to gather data on individual use of the software, safety implications and practice use of features such as the monitoring dashboard. Data were analysed using a rapid qualitative methodology.

Results

Two approaches to E-SN software adoption were reported: whole practice adoption and self-directed use. Practices benefitted from shared responsibility for safety netting and using software to track patients’ progress in secondary care. Adoption was affected by information technology and administrative resources. Decision-support tools were used infrequently due to a lack of appreciation for their benefits. Selective adoption of different E-SN functions restricted its potential impact on early diagnosis.

Conclusion

The use of E-SN software in primary care services in NEL varied among participants. While some found it to be beneficial, others were sceptical of its impact on clinical decision-making. Nonetheless, the software was found to be effective in managing referral processes and tracking patients’ progress in other points of care.
Gut microbiota and immune alteration in cancer development: implication for immunotherapy
Authors: Lau Harry Cheuk Hay , Zhang Xiang , Yu Jun
Published: July 2023

Human gastrointestinal tract harbours trillions of microbes to form the gut microbiota. Through interacting with host cells, gut microbes play critical roles in host physiology and function. On the other hand, an altered or dysbiotic microbiota is now well acknowledged for contributing to cancer development and progression. Since the last decade, immunotherapy has risen as a promising and novel means to fight against cancer. Meanwhile, accumulating studies have clearly revealed the close association of gut microbiota with immunotherapy efficacy, suggesting the feasibility of modulating microbiota to improve treatment responsiveness. In this review, we present the current evidence elucidating the interplay between gut microbiota and immune system in the development of several cancers including colorectal cancer, hepatocellular carcinoma and melanoma. We also discuss how the gut microbiota impacts immune checkpoint inhibitors, one of the most common approaches of immunotherapy, and explore approaches that aim to harness the gut microbiota to improve treatment efficacy. Overall, investigations on the relationship between microbiota and cancer immunotherapy can have important clinical significance, potentially leading to the development of more potent and effective cancer therapeutics in the near future.
Medics as influencers: a historical analysis of British Army military medical exercises in Kenya over two decades
Authors: Falconer Hall Patricia , Falconer Hall T , Bailey Z , Horne S T
Published: July 2023

Introduction

Annual British Army medical training exercises have run in Kenya since the early 1990s, initially with a dual purpose—to deliver the Kenyan Extended Programme of Immunisation (in remote locations) and to undertake austere training. This provided a specific response to a capability gap request from the partner nation, but as this gap closed, the exercise changed in various ways. This study aimed to qualitatively explore the impact of these exercises on the Kenyan healthcare system and the influence and relationships between the nations.

Methods

Semistructured interviews were conducted for 10 former senior commanders and medical officers who had deployed in key command and clinical positions from 1993 to 2019. Three researchers conducted thematic content analysis on the key-informant interviews.

Results

Five domains with 18 subdomains formed the study’s analysis framework. 16 recurring themes were identified and placed into four categories that denote if they were of benefit to the engagement, enabled success, had the potential to cause harm or were a barrier to successful engagement. Three distinct phases of the exercise were identified: supporting Kenyan vaccinations, direct clinical care, training and education.

Conclusions

This is the first qualitative analysis of the impact of a British Defence Engagement (Health) on the partner nation and UK influence gained through it. It has identified factors which may improve outcomes, namely, ensuring sustainability and continuity between iterations; maintaining enduring stakeholder relationships; responding to a capability gap request; intelligence-led planning with incorporated assessment, monitoring and evaluation; adapting to changes in needs or contextual settings; while ensuring mutual benefit in objective setting. These may be used as the basis for a conceptual framework supporting the planning and execution of high-quality, mutually beneficial Defence Engagement (Health) activities in future. This framework and future research would also benefit from gaining perspectives from the partner nation.
Enhanced detection of severe aortic stenosis via artificial intelligence: a clinical cohort study
Authors: Strange Geoff , Stewart Simon , Watts Andrew , Playford David
Published: July 2023

Objective

We developed an artificial intelligence decision support algorithm (AI-DSA) that uses routine echocardiographic measurements to identify severe aortic stenosis (AS) phenotypes associated with high mortality.

Methods

631 824 individuals with 1.08 million echocardiograms were randomly spilt into two groups. Data from 442 276 individuals (70%) entered a Mixture Density Network (MDN) model to train an AI-DSA to predict an aortic valve area <1 cm2, excluding all left ventricular outflow tract velocity or dimension measurements and then using the remainder of echocardiographic measurement data. The optimal probability threshold for severe AS detection was identified at the f1 score probability of 0.235. An automated feature also ensured detection of guideline-defined severe AS. The AI-DSA’s performance was independently evaluated in 184 301 (30%) individuals.

Results

The area under receiver operating characteristic curve for the AI-DSA to detect severe AS was 0.986 (95% CI 0.985 to 0.987) with 4622/88 199 (5.2%) individuals (79.0±11.9 years, 52.4% women) categorised as ‘high-probability’ severe AS. Of these, 3566 (77.2%) met guideline-defined severe AS. Compared with the AI-derived low-probability AS group (19.2% mortality), the age-adjusted and sex-adjusted OR for actual 5-year mortality was 2.41 (95% CI 2.13 to 2.73) in the high probability AS group (67.9% mortality)—5-year mortality being slightly higher in those with guideline-defined severe AS (69.1% vs 64.4%; age-adjusted and sex-adjusted OR 1.26 (95% CI 1.04 to 1.53), p=0.021).

Conclusions

An AI-DSA can identify the echocardiographic measurement characteristics of AS associated with poor survival (with not all cases guideline defined). Deployment of this tool in routine clinical practice could improve expedited identification of severe AS cases and more timely referral for therapy.
Psychological factors and prognostic communication preferences in advanced cancer: multicentre study
Authors: Ramchandani Avinash , Mihic-Góngora Luka , Hernández Raquel , Zafra-Poves Marta , Muñoz María M , Ferreira Estrella , Cruz-Castellanos Patricia , Fernández-Montes Ana , Pacheco-Barcia Vilma , Jiménez-Fonseca Paula , Calderon Caterina
Published: July 2023

Objectives

Communication regarding prognosis to patients with advanced cancer is fundamental for informed medical decision making. Our objective was to analyse (1) the proportion of subjects with advanced cancer who prefer to know their prognosis, (2) the characteristics associated with patients’ preference for prognostic information, (3) the psychological factors that impact the preference to know prognosis and 4) the concordance between preference for prognostic information perceived among physicians and patients.

Methods

A prospective, cross-sectional design was adopted. Data were collected from 748 participants with advanced cancer at 15 tertiary hospitals in Spain. Participants completed the following questionnaires: Mental Adjustment to Cancer; Trust in the Physician; Uncertainty in Illness Scale Patient’s Prognostic Preferences.

Results

Fifty-two per cent of advanced cancer sufferers preferred to know the prognosis of their disease. Compared with participants who preferred not to know, those who did reported more uncertainty, greater satisfaction with their physician and higher scores on positive attitude (all p=0.001). Thirty-seven per cent of the physicians believed that patients want to know their prognosis, indicating that they underestimate the number of such patients. No significant differences were found regarding preference to know prognosis as a function of sociodemographic and clinical variables.

Conclusions

A substantial proportion of individuals with advanced cancer prefer to know the prognosis of their disease. It appears that knowing their prognosis was mainly motivated by a need to maintain a positive attitude, lessen uncertainty and by satisfaction with the physician. It is important to explore patients’ preferences for information to offer more personalised communication.
Effective nonlinear Ehrenfest hybrid quantum-classical dynamics
Authors: Alonso José Luis , Bouthelier-Madre Carlos , Clemente-Gallardo Jesús , Martínez-Crespo David , Pomar Javier
Published: July 2023

The definition of a consistent evolution equation for statistical hybrid quantum-classical systems is still an open problem. In this paper, we analyze the case of Ehrenfest dynamics on systems defined by a probability density and identify the relations of the nonlinearity of the dynamics with the obstructions to define a consistent dynamics for the first quantum moment of the distribution. This first quantum moment represents the physical states as a family of classically-parametrized density matrices $${\hat{\rho }}(\xi )$$

ρ
^

(
ξ
)

, for $$\xi$$
ξ
a classical point; and it is the most common representation of hybrid systems in the literature. Due to this obstruction, we consider higher order quantum moments, and argue that only a finite number of them are physically measurable. Because of this, we propose an effective solution for the hybrid dynamics problem based on approximating the distribution by those moments and representing the states by them.
Thermoconvective instability in a ferrofluid saturated porous layer
Authors: Sureshkumar S. , Chavaraddi Krishna B. , Gouder Priya M. , Ramesh G. K. , Chandaragi Praveen I.
Published: July 2023

The Forchheimer-extended Brinkman’s Darcy-flow model was used to investigate the initiation of ferroconvection in a flat porous layer while accounting for effective viscosity. The rigid ferromagnetic, rigid paramagnetic and stress-free isothermal boundary conditions are the three categories. The eigenvalue issue can be properly addressed for stress-free boundaries; the Galerkin approach is utilized to find the critical stability constraints quantitatively for other barriers. It was discovered that the boundary types had a strong influence on the system’s stabilization. Ferromagnetic boundaries are less preferred than paramagnetic boundaries in control of convection. The dependence of many physical limitations on the linear stability of the system is intentionally given, and it is demonstrated that increasing the value of the viscosity ratio delays the beginning of convection.
Remote Sensing Pansharpening with TV-H−1 Decomposition and PSO-Based Adaptive Weighting Method
Authors: Sangani Dhara J. , Thakker Rajesh A. , Panchal S. D. , Gogineni Rajesh
Published: July 2023

In remote sensing, owing to existing sensors’ limitations and the tradeoff between signal-to-noise ratio (SNR) and instantaneous field of view (IFOV), it is difficult to obtain a single image with good spectral and spatial resolution. Pansharpening (PS) is the technique for sharpening multispectral (MS) images by extracting structural and edge information of panchromatic (PAN) image. Multiscale decomposition methods are used for decomposing image in sub-bands but are affected by ringing artifacts, therefore the resultant image seems to be blurred and misregistered. The proposed method overcomes this drawback by decomposing PAN and four band MS image into cartoon and texture components with total variation (TV) Hilbert[Formula: see text] model. The particle swarm optimization (PSO) algorithm is used for finding the optimum weight for fusing texture and cartoon details of PAN and MS images. The proposed method is practically validated on both full-scale and reduced-scale. Robustness of our proposed approach is tested on different geographical areas such as hilly, urban, and vegetation areas. From the visual analysis and qualitative parameters, the proposed method is proved effective compared with other traditional approaches.
DOES INNOVATION EXPERIENCE AFFECT ENTERPRISE PERFORMANCE FROM INTER-FIRM COLLABORATION AND R&D INVESTMENTS?
Authors: AARSTAD JARLE , VAI FARAIMO JAY , KVITASTEIN OLAV ANDREAS
Published: July 2023

Purpose: Previous research shows that inter-firm collaboration and R&D investments have positive effects on enterprises’ product innovation performance. This study aims to assess if the performance effects are moderated by enterprises’ innovation experience. i.e., does the experience increase or decrease the innovation performance from inter-firm collaboration and R&D investments? Methods: Norwegian enterprise panel regressions between 2004 and 2016 were done on data provided by Statistics Norway. Results and implications: Consistent with the previous research, inter-firm collaboration increases enterprises’ product innovation performance. Also, R&D investments increase product innovation performance but at an exponentially decreasing rate that eventually turns negative. A novel contribution is that the results are consistent, independent of innovation experience. It implies that inexperienced and experienced enterprises have an equal absorptive capacity to innovate from inter-firm collaboration and R&D investments. Independent of innovation experience, enterprise revenues furthermore increase from new products as a function of R&D investments at an exponentially increasing rate.
ICON: A Linguistically-Motivated Large-Scale Benchmark Indonesian Constituency Treebank
Authors: Lim Ee Suan , Leong Wei Qi , Nguyen Thanh Ngan , Kng Wei Ming , Tjhi William Chandra , Adhista Dea , Purwarianti Ayu
Published: July 2023

Constituency parsing is an important task of informing how words are combined to form sentences. While constituency parsing in English has seen significant progress in the last few years, tools for constituency parsing in Indonesian remain few and far between. In this work, we publish ICON (Indonesian CONstituency treebank), the hitherto largest publicly available manually-annotated benchmark Indonesian constituency treebank with a size of 10,000 sentences and approximately 124,000 constituents and 182,000 tokens, which can support the training of state-of-the-art transformer-based models. As part of the process of building the treebank, we review and revamp the constituent and POS tagsets in use in existing treebanks to ensure that the labels are relevant and suitable for the grammatical features of Indonesian. We establish strong baselines on the ICON dataset using the Berkeley Neural Parser with transformer-based pre-trained embeddings, with the best performance of 88.85% F1 score coming from our own version of SpanBERT (IndoSpanBERT). We further analyze the predictions made by our best-performing model to reveal certain idiosyncrasies in Indonesian that pose challenges for constituency parsing.
Moving From Narrative to Interactive Multi-Modal Sentiment Analysis: A Survey
Authors: Ma Junxia , Rong Lu , Zhang Yazhou , Tiwari Prayag
Published: July 2023

A growing number of individuals are expressing their opinions and engaging in interactive communication with others through various modalities, including natural language (text), facial gestures (vision), acoustic behaviors (audio), and more. Within the realms of natural language processing (NLP) and artificial intelligence (AI), multi-modal sentiment analysis has consistently remained a fundamental research area. Building upon recent advancements, this survey aims to provide researchers with a comprehensive overview of the state-of-the-art techniques in multi-modal sentiment analysis, specifically focusing on various sentiment interaction tasks. It is worth noting that the existing literature on multi-modal sentiment analysis has rarely delved into the realm of sentiment interaction. This survey presents a novel perspective by outlining the progression of multi-modal sentiment analysis from narrative sentiment to interactive sentiment. Furthermore, it discusses the research background, problem definition, and various approaches in multi-modal sentiment analysis. Additionally, this survey provides insights into the development of multi-modal sarcasm recognition, emphasizing the shift from narrativity to interactivity. Lastly, we summarize the current scientific challenges related to interaction modeling and highlight future development trends in the field.