bluuebunny/crossref_metadata_2025 huggingface dataset:
Signs of local adaptation by genetic selection and isolation promoted by extreme temperature and salinity in the Mediterranean seagrass Posidonia oceanica
Authors: Nguyen Hung Manh , Ruocco Miriam , Dattolo Emanuela , Cassetti Federica Paola , Calvo Sebastiano , Tomasello Agostino , Marín‐Guirao Lázaro , Pernice Mathieu , Procaccini Gabriele
Published: June 2023

Adaptation to local conditions is known to occur in seagrasses; however, knowledge of the genetic basis underlying this phenomenon remains scarce. Here, we analysed Posidonia oceanica from six sites within and around the Stagnone di Marsala, a semi‐enclosed coastal lagoon where salinity and temperature exceed the generally described tolerance thresholds of the species. Sea surface temperatures (SSTs) were measured and plant samples were collected for the assessment of morphology, flowering rate and for screening genome‐wide polymorphisms using double digest restriction‐site‐associated DNA sequencing. Results demonstrated more extreme SSTs and salinity levels inside the lagoon than the outer lagoon regions. Morphological results showed significantly fewer and shorter leaves and reduced rhizome growth of P. oceanica from the inner lagoon and past flowering events were recorded only for a meadow farthest away from the lagoon. Using an array of 51,329 single nucleotide polymorphisms, we revealed a clear genetic structure among the study sites and confirmed the genetic isolation and high clonality of the innermost site. In all, 14 outlier loci were identified and annotated with several proteins including those relate to plant stress response, protein transport and regulators of plant‐specific developmental events. Especially, five outlier loci showed maximum allele frequency at the innermost site, likely reflecting adaptation to the extreme temperature and salinity regimes, possibly due to the selection of more resistant genotypes and the progressive restriction of gene flow. Overall, this study helps us to disentangle the genetic basis of seagrass adaptation to local environmental conditions and may support future works on assisted evolution in seagrasses.
Scar‐related atrial macroreentries: Different arrhymogenic basis generates different reentry type
Authors: Zhai Lishang , Chen Hongwu , Chen Jianquan , Ju Weizhu , Zhang Fengxiang , Yang Gang , Gu Kai , Liu Hailei , Wang Zidun , Li Mingfang , Cao Kejiang , Wang Daowu , Chen Minglong
Published: June 2023

Background

Catheter ablation is an established therapeutic strategy to treat scar‐related macroreentry atrial tachycardia (MAT). However, the scar properties and arrhythmogenicity and the reentry type have not been clearly defined.

Methods and Results

A total of 122 patients with scar‐related MAT were enrolled in this study. The atrial scars were classified into two categories: spontaneous scars (Group A: n = 28) and iatrogenic scars (Group B: n = 94). According to the relationship between scar location and the reentry circuit, MAT was described as scar pro‐flutter MAT, scar‐dependent MAT, and scar‐mediated MAT. The reentry type of MAT was significantly different between Groups A and B: pro‐flutter (40.5% vs. 62.0%, p = 0.02), scar‐dependent AT (40.5% vs. 13.0%, p < 0.001), and scar‐mediated AT (19.0% vs. 25.0%, p = 0.42). After a median follow‐up of 25 months, 21 patients with AT recurrence were observed. Compared with the spontaneous group, there was a lower recurrence rate of MAT in the iatrogenic group (28.6% vs. 10.6%, p = 0.03).

Conclusion

Scar‐related MAT has three reentry types, and the proportion of each type varies with the scar properties and its arrhythmogenic basis. Optimization of the ablation strategy based on the scar properties to improve the long‐term outcome of catheter ablation of MAT is necessary.
A Theory of Rights Based on Autonomy
Authors: Maniaci Giorgio
Published: June 2023

This article takes a critical look at the classic couplet of theories on the justification of rights, namely, the choice theory and the interest or benefit theory, where the two are understood to be in conflict. The argument is made that this couplet is best replaced with a new one, namely, a sophisticated rendering of the benefit theory coupled with the autonomy theory, such that any conflict is resolved. The latter two theories take different cases in justifying the attribution of rights: The autonomy theory is concerned with justifying the attribution of rights to adult, rational, and competent subjects, arguing that this attribution requires a sufficiently autonomous claim by such subjects, while the benefit theory seeks to justify the attribution of rights to subjects who lack any of these three properties, meaning that they cannot be considered adult, rational, or competent.
Emotions in Action: The Role of Emotions in Refugee Solidarity Activism1,2
Authors: Milan Chiara
Published: June 2023

This article investigates the different types of emotions that result from participation in refugee solidarity activism, investigating how they change over time and to what extent they explain why individuals remain involved in action in spite of unfavorable circumstances. By bringing together scholarship on collective action with the literature on emotions, the article delves into the emotional response of sustained engagement in refugee solidarity activism. The study is based on the analysis of 40 in‐depth interviews with solidarity activists and volunteers involved in grassroots refugee solidarity initiatives along the Western Balkans route between 2015 and 2021, as well as on participant observation conducted between 2016 and 2021 in North Macedonia, Serbia, Croatia, Slovenia, Austria, and Bosnia and Herzegovina. The diachronic perspective presented in the article suggests that contrasting reactive emotions emerged during the initial stage of mobilization, while moral emotions were activated at a later stage. In the long run enduring affective bonds that had been formed with both solidarity peers and people on the move proved decisive for keeping individuals involved in action.
Applying propensity score matching to assess the impact of the pandemic on intimate relationships
Authors: Overall Nickola C. , Howard Chloe , Osborne Danny , Pietromonaco Paula R. , Satherley Nicole , Sibley Chris G.
Published: June 2023

The COVID‐19 pandemic produced multiple stressors that risk relationship conflict and dissatisfaction. We extended prior studies that yielded inconsistent effects of the pandemic on relationships by using propensity score matching to (1) compare levels of relationship conflict and satisfaction during the pandemic (pandemic group; N = 7268) to similar people immediately before the pandemic (matched control group; N = 7268), and (2) compare pandemic groups facing different types of restrictions, beginning with lockdowns involving household isolation to returning to normal life. Results reveal that relationship conflict increased and relationship satisfaction decreased in response to the pandemic, but these effects were very small and primarily occurred in the initial stages of the pandemic when lockdown involved household isolation. The results add to evidence of resilience in personal and relationship well‐being in 2020, but also indicate the importance of understanding the effects of varying pandemic‐related conditions across the years of the pandemic.
Associations between COVID‐19‐related disruptions and psychological adjustment in a sample of young adults
Authors: Hoyle Rick H. , Davisson Erin K.
Published: June 2023

We examined the relations between disruptions experienced by young adults in the US during the COVID‐19 pandemic and their psychological adjustment. An online sample (N = 180, Mage = 24.8) reported on the impact of the pandemic on their living arrangements, work status, and finances; their psychological adjustment overall and with specific reference to the pandemic; and whether they lived alone and, if living with others, there were children in the home. Results indicated a moderate association between financial strain and poor overall adjustment and a small association between job‐related problems and sleep disruption. Women experienced negative effects of pandemic‐related disruptions on their adjustment. Men were particularly vulnerable to the negative effects of financial strain. The results show the negative psychological effects of disruptions brought about by the COVID‐19 pandemic on young adults' mental health.
The psychological benefit of future vividness in goal persistence: An illustrative case of the class of 2020 before & during COVID‐19
Authors: McMichael Samantha L. , Kwan Virginia S. Y.
Published: June 2023

Graduating during COVID‐19, the Class of 2020 had difficulty pursuing their future goals. This research examined the likelihood of academic and career goal change early in the pandemic, disparities in persistence by socioeconomic status (SES), and how psychological resources mitigated goal change during the early stages of the pandemic. This 4‐year study surveyed students in the Class of 2020 eight times from their first week in college (Fall 2016) to their last semester before graduation (Spring 2020; N = 115; 20% below middle SES, 80% middle SES or above). Even in the first weeks of COVID‐19, a quarter of students changed goals. Lower SES students were less likely to persist in their post‐graduation plans. Nevertheless, students who entered college with a vivid image of their future were more likely to have secured a graduate school or job prospect prior to COVID‐19, and, in turn, were less likely to change goals.
Psychological impact of coronavirus‐related social isolation in Colombia after a year of lockdown
Authors: Gómez‐Díaz Javier Andrés , Barón‐Birchenall Leonardo Francisco
Published: June 2023

Several repercussions of the COVID‐19 pandemic and its subsequent isolation period have been reported worldwide. In this paper, we analyze the behavioral and emotional effects of 1 year of coronavirus‐related lockdown in Colombia. A cross‐sectional correlational design was used on a sample of 1853 participants from different regions, and with different levels of education, income, and employment situations. We applied the fear of coronavirus scale, the use of preventive behaviors scale, and a scale to measure pleasant and unpleasant emotions based on the circumplex model of affect. Our data shows that women, participants who were unemployed during the lockdown, and participants that study or work in legal, computational, or related fields, have been more affected in terms of unpleasant emotions. In addition, we observed a trend towards a relation between higher income and educational levels with lower degrees of fear, higher degrees of pleasant emotions, and a greater use of preventive behaviors related to the pandemic.
Does remote work erode trust in organizations? A within‐person investigation in the COVID‐19 context
Authors: Stavrova Olga , Spiridonova Teodora , van de Calseyde Philippe , Meyers Christina , Evans Antony M.
Published: June 2023

The global COVID‐19 pandemic led to a widespread increase in remote work arrangements. This trend raised concerns regarding the potential negative ramifications it might have for organizational trust and cooperation. We explored the initial effect of COVID‐19 induced remote work on trust in organizations: trust in co‐workers, trust in the supervisor and in the organization at large. In a four‐wave longitudinal survey of remote workers (N ∼ 1000) in the UK conducted between May 2020 and August 2020 (first COVID wave), we examined the association between the share of remote work (out of total working hours) and different forms of trust at work. The results showed that, for the same individual, increasing the share of working hours spent remotely was associated with more trust in the organization at large (but not in the supervisor and co‐workers). Further, during the months where individuals spent more time working remotely, they experienced lower turnover intentions (but not less burnout or more work engagement, productivity, and satisfaction) compared to the months where they spent less time working remotely. The results contribute to the literature on flexible work arrangements, organizational trust, and other work outcomes.
Replication of “Do state‐customized TANF work policies actually reduce unemployment?”
Authors: Nicholson Jack
Published: June 2023

Background

In Na Yeon Kim and Frances Stokes Berry's paper “Do State‐Customized TANF Work Policies Actually Reduce Unemployment?,” the researchers attempt to determine if the implementation of Worker Supplement Programs (WSPs) caused the unemployment rate of low‐income females to decrease. They found that states that enacted WSPs attained about 18 percent fewer unemployed low‐income females when compared with states that did not implement WSPs.

Objectives

The original purpose of this project was to expand on Kim and Berry's research regarding TANF policies.

Methods

I created a dataset that closely matched Kim and Berry's original dataset. I then applied the same difference‐in‐differences model they reported using and two supplementary difference‐in‐differences models. Additionally, I used synthetic control methods for four states to further investigate the causal claim.

Results

I closely matched Kim and Berry's summary statistics, but the ambiguity of their data collection methods hindered my ability to exactly match the data. When excluding fixed effects and trend variables, I found that states with WSPs had about 20 percent fewer unemployed low‐income females. The inclusion of fixed effects and trend variables, which Kim and Berry reported using in their model, caused the WSP variable to become about 0 percent and insignificant. The results of the synthetic control methods provided additional evidence that questions the validity of the original findings.

Conclusions

Kim and Berry's research seemingly contains significant flaws, including incorrect results. This replication project offers evidence that the significant decrease in unemployment among low‐income females is likely not present, highlighting the importance of documentation and replication.
Changes in soil organic carbon and nutrient pools in aggregate‐sized fractions along a chronosequence of wolfberry (Lycium barbarum L.) plantations in arid areas of Northwest China
Authors: Wu Rongjie , Liu Bingqing , Xue Bin , Gao Ruili , Ndzana George M. , Liu Rentao , Huang Juying , An Hui , Du Lingtong , Kamran Muhammad
Published: June 2023

Different land use and management actions can affect soil aggregates (SAs) and nutrient stocks, which are crucial for sustainable agriculture. The impacts of various chrono‐sequences on the soil aggregate structure, soil organic carbon (SOC) and nutrients associated with aggregate fractions in wolfberry (Lycium barbarum L.) plantations are still not fully understood. This study examined the composition and stability of SAs, SOC, total nitrogen (TN), available phosphorus (AP) and exchangeable cations (K+, Na+, Ca2+ and Mg2+) in bulk soil and various aggregate‐size fractions from five wolfberry plantations with varying ages (1, 4, 6, 10 and 13 years) and a corn field (0 years) in the arid region of northwest Ningxia in China. The results indicated that silt–clay (<53 μm) fractions were dominant in the soil, accounting for 51%–66%, under different plantation ages. The proportion of the macro‐aggregates (>250 μm) increased significantly, by 40%–47%, over the 4 years of wolfberry plantation. Likewise, the soil aggregate stability was improved, and total exchangeable bases (TEB) along with numerous cations concentrations (K+, Na+, Ca2+ and Mg2+) in SAs were significantly reduced as the wolfberry plantings became older. Both concentrations of SOC and TN in the soil aggregates peaked in the 13th year. The silt–clay fractions stored a considerable amount of SOC and nutrients. However, short‐term (under 6 years) cultivation of wolfberry reduced the stocks of SOC, TN and AP in the soil, while long‐term (over 10 years) cultivation increased them, particularly in macro‐aggregates. These findings indicated that long‐term wolfberry farming had several advantages, such as enhancing soil structure, accumulating SOC and nutrients and ameliorating alkaline soils, especially after 10 years, in the arid northwest of China.
Using a computer‐aided personalized system of instruction to enhance the mastery of statistics in online learning
Authors: Butler Robert C. , Blair Christopher D. , Newman Rae Ette , Batchelor Leah L
Published: June 2023

This study compared the effectiveness of teaching a distance education statistics course using a computer‐aided personalized system of instruction (CAPSI) in comparison to a distance education course that used video lectures. Data were collected between 2017 and 2022. Two‐hundred and sixty‐eight students were included in the sample. Results supported that students enrolled in the CAPSI statistics course were less likely to drop out of the course and mastered significantly more material than students enrolled in the lecture‐based distance education course. It is recommended that instructors teaching statistics in distance education settings consider using CAPSI to improve student outcomes.
Effects of problem‐based learning on delivering medical and nursing education: A systematic review and meta‐analysis of randomized controlled trials
Authors: Ren Song , Li Yi , Pu Lei , Feng Yunlin
Published: June 2023

Background

There is still a lack of high‐level evidence on the effects of problem‐based learning (PBL) in general medical and nursing education.

Aims

We aimed to summarize current evidence on the effects of PBL in delivering medical and nursing education from randomized controlled trials (RCTs).

Methods

A systematic search was performed in MEDLINE, EMBASE, Cochrane Central Library, and CINAHL Complete. RCTs that assessed the effects of a PBL module in delivering medical education were eligible. Outcomes included knowledge, performance, and satisfaction. The risk of bias was assessed according to Cochrane handbook guidelines. Standardized mean differences with 95% confidence intervals of each outcome between PBL and control groups were pooled using a random‐effects model.

Results

In all, 22 RCTs with 1969 participants were included. Both pooled analyses of changes in scores compared with baseline and absolute post‐interventional scores favored PBL module in knowledge and performance. The satisfaction degree was also higher in participants receiving PBL methods. Publication bias might exist in satisfaction; however, not in knowledge and performance. Eleven of the 22 studies were assessed as having a high risk of bias.

Linking Evidence to Action

Compared with traditional lecture‐based modules, PBL delivered medical education in different medical science specialities more efficiently from both theoretical knowledge and practice skill perspectives. The feedback from participants receiving PBL methods was more positive than that from those receiving traditional methods. However, the high heterogeneity and low quality of the included studies prevented drawing definite conclusions.
Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review
Authors: Buur Louise Engelbrecht , Bekker Hilary Louise , Madsen Jens Kristian , Søndergaard Henning , Kannegaard Michell , Khatir Dinah Sherzad , Finderup Jeanette
Published: June 2023

Objective:

The objective of this review was to investigate and map empirical evidence of patient involvement interventions to support patients with kidney failure making end-of-life care decisions in kidney services.

Introduction:

Clinical guidance integrating end-of-life care within kidney failure management pathways varies. Advance care planning interventions aimed at involving patients with kidney failure in their end-of-life care planning are established in some countries. However, there is limited evidence of the other types of patient involvement interventions integrated within services to support patients with kidney failure in making decisions about their end-of-life care.

Inclusion criteria:

This scoping review included studies exploring patient involvement interventions evaluated for patients with kidney failure considering end-of-life care, their relatives, and/or health professionals in kidney services. Studies of children under the age of 18 years were excluded.

Methods:

The review was informed by JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. MEDLINE, Scopus, Embase, and CINAHL were searched for full-text studies in English, Danish, German, Norwegian, or Swedish. Two independent reviewers assessed the literature against the inclusion criteria. A relational analysis framework was used to synthesize the data extracted from the included studies, and to investigate and map different patient involvement interventions.

Results:

The search identified 1628 articles, of which 33 articles met the inclusion criteria. A total of 23 interventions were described. Interventions targeted patients (n=3); health professionals (n=8); patients and health professionals (n=5); and patients, relatives, and health professionals (n=7). Intervention components included patient resources (eg, information, patient decision aids), consultation resources (eg, advance care planning, shared decision-making), and practitioner resources (eg, communication training). Patient involvement interventions were delivered within hospital-based kidney services.

Conclusions:

The review identified several ways to support patients with kidney failure to be involved in end-of-life care decisions. Future interventions may benefit from adopting a complex intervention framework to engage multiple stakeholders in the research and design of an intervention for shared decision-making between patients with kidney failure, their relatives, and health professionals about integrating end-of-life care options into their kidney disease management pathway.
Ultrafast dynamic machine vision with spatiotemporal photonic computing
Authors: Zhou Tiankuang , Wu Wei , Zhang Jinzhi , Yu Shaoliang , Fang Lu
Published: June 2023

Ultrafast dynamic machine vision in the optical domain can provide unprecedented perspectives for high-performance computing. However, owing to the limited degrees of freedom, existing photonic computing approaches rely on the memory’s slow read/write operations to implement dynamic processing. Here, we propose a spatiotemporal photonic computing architecture to match the highly parallel spatial computing with high-speed temporal computing and achieve a three-dimensional spatiotemporal plane. A unified training framework is devised to optimize the physical system and the network model. The photonic processing speed of the benchmark video dataset is increased by 40-fold on a space-multiplexed system with 35-fold fewer parameters. A wavelength-multiplexed system realizes all-optical nonlinear computing of dynamic light field with a frame time of 3.57 nanoseconds. The proposed architecture paves the way for ultrafast advanced machine vision free from the limits of memory wall and will find applications in unmanned systems, autonomous driving, ultrafast science, etc.
A Streptomyces tendae Specialized Metabolite Inhibits Quorum Sensing in Group A Streptococcus
Authors: Nepomuceno Vanessa M. , Tylor Kaitlyn M. , Carlson Skylar , Federle Michael J. , Murphy Brian T. , Perez Morales Tiara
Published: June 2023

Streptococcus pyogenes
, a human pathogen known for causing infections such as pharyngitis and necrotizing fasciitis, uses quorum sensing (QS) to regulate social responses in its environment. Previous studies have focused on disrupting QS as a means to control specific bacterial signaling outcomes.
Incorporating resilience when assessing pandemic risk in the Arctic: a case study of Alaska
Authors: Tiwari Sweta , Petrov Andrey , Mateshvili Nino , Devlin Michele , Golosov Nikolay , Rozanova-Smith Marya , Welford Mark , DeGroote John , Degai Tatiana , Ksenofontov Stanislav
Published: June 2023

The discourse on vulnerability to COVID-19 or any other pandemic is about the susceptibility to the effects of disease outbreaks. Over time, vulnerability has been assessed through various indices calculated using a confluence of societal factors. However, categorising Arctic communities, without considering their socioeconomic, cultural and demographic uniqueness, into the high and low continuum of vulnerability using universal indicators will undoubtedly result in the underestimation of the communities’ capacity to withstand and recover from pandemic exposure. By recognising vulnerability and resilience as two separate but interrelated dimensions, this study reviews the Arctic communities’ ability to cope with pandemic risks. In particular, we have developed a pandemic vulnerability–resilience framework for Alaska to examine the potential community-level risks of COVID-19 or future pandemics. Based on the combined assessment of the vulnerability and resilience indices, we found that not all highly vulnerable census areas and boroughs had experienced COVID-19 epidemiological outcomes with similar severity. The more resilient a census area or borough is, the lower the cumulative death per 100 000 and case fatality ratio in that area. The insight that pandemic risks are the result of the interaction between vulnerability and resilience could help public officials and concerned parties to accurately identify the populations and communities at most risk or with the greatest need, which, in turn, helps in the efficient allocation of resources and services before, during and after a pandemic. A resilience–vulnerability-focused approach described in this paper can be applied to assess the potential effect of COVID-19 and similar future health crises in remote regions or regions with large Indigenous populations in other parts of the world.
Monitoring of the regulatory ability and regulatory state of the autonomic nervous system and its application to the management of hypertensive patients: a study protocol for randomised controlled trials
Authors: Xiao Xiang , Deng Xinyi , Zhang Gaoyu , Liu Mengru , Fu Dongliang , Yang Peng , Li Xianlun , Jiang Hong
Published: June 2023

Introduction

Many causes lead to sympathetic-vagus imbalance, which promotes the development of hypertension and accelerates the process of target organ damage. Many studies have shown that exercise training and heart rate variability (HRV) biofeedback can improve diseases caused by autonomic nerve dysfunction, such as hypertension. Based on these theories and the Yin-Yang balance theory of traditional Chinese medicine and Cannon’s homeostasis theory, we have developed an assessment system of autonomic nerve regulation system and a harmony instrument. In this study, we aimed to find a new way to control blood pressure of hypertensive patients via cardiopulmonary resonance indices-based respiratory feedback training.

Methods and analysis

This is a prospective, randomised, parallel-controlled clinical trial, which aims to evaluate the effectiveness and safety of biofeedback therapy and exercise rehabilitation combined intervention in hypertension management. 176 healthy individuals will be recruited to get their autonomic nerve function parameters as normal control, while 352 hypertensive patients will be enrolled and randomly divided into a conventional treatment group and an experiment group in a ratio of 1:1. All patients will continue to receive standard hypertension blood pressure treatment, except that patients in the experiment group will have to complete additional daily respiratory training for 6 months. The primary outcome is the difference of clinical systolic blood pressure (SBP) between the two groups after 6 months of intervention. The secondary outcomes include the changes in the mean SBP and diastolic blood pressure (DBP) by 24-hour blood pressure monitoring, home SBP, clinical and home DBP, clinical and home heart rate, the standard-reaching rate of clinic and home SBP and the incidence of composite endpoint events at 6 months.

Ethics and dissemination

This study has been approved by the clinical research ethics committee of China-Japan Friendship Hospital (No. 2018-132 K98-2), the results of this study will be disseminated via peer-reviewed publications or conference presentations.

Trial registration number

Chinese Clinical Trial Registry, ChiCTR1800019457, registered on 12 August 2018.
Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a systematic review
Authors: Nieto-Gil Pilar , Marco-Lledó Javier , García-Campos Jonatan , Ruiz-Muñoz María , Gijon-Nogueron Gabriel , Ramos-Petersen Laura
Published: June 2023

Objectives

The aim of this review was to identify the potential intrinsic and extrinsic risk factors (RFs), associated factors (AFs) and consequences of developing calcaneal apophysitis (CA).

Design

Systematic review.

Data sources

Cochrane Library, Embase, Medline Ovid, PubMed, Web of Science and Evidence, searched from inception to April 2021.

Eligibility criteria

We included cohort, case–control and cross-sectional studies that were conducted in patients younger than 18 years who were exposed to RFs or who presented with factors associated with developing CA. Studies in languages other than English or Spanish were excluded.

Data extraction and synthesis

Two reviewers worked independently to evaluate the risk of bias of included studies. The Newcastle–Ottawa Scale (adapted version) was used.

Results

A total of 736 studies were identified and 11 observational studies fully met the inclusion criteria, including 1265 participants with a mean age of 10.72 years. Four studies identified extrinsic factors, 10 identified intrinsic factors and three identified both. The extrinsic and intrinsic RFs, AFs and consequences of CA include limitation of ankle dorsiflexion, foot alignment, stiffness and mobility of the midfoot, plantar pressures and ground reaction force, body mass index, age, gender, presence of other osteochondroses and practice of sport. The risk of bias varied, being either moderate or low.

Conclusions

Regarding the factors and consequences associated with CA (Sever’s disease), ankle dorsiflexion limitation is the most frequent intrinsic factor studied, followed by peak plantar pressures and foot malalignment. However, disagreements between the investigators of the included studies were found; in some cases, there is a lack of unanimity between different studies as to which factors are considered to be RFs, AFs and consequences.

PROSPERO registration number

CRD42021246366.
Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation
Authors: Huntington Susie , Puri Sudhir Krishnan , Schneider Verena , Sargent Alex , Turner Katy , Crosbie Emma J , Adams Elisabeth J
Published: June 2023

Objective

To compare the costs and effects of three sampling strategies for human papillomavirus (HPV) primary screening.

Design

Cost-consequence analysis from a health system perspective using a deterministic decision tree model.

Setting

England.

Participants

A cohort of 10 000 women aged 25–65 years eligible for the National Health Service Cervical Screening Programme (NHSCSP).

Methods

The model was based on the NHSCSP HPV primary screening pathway and adapted for self-sampling. It used a 3-year cycle: routine screening (year 1) and recall screening (years 2/3). Parameter inputs were informed using published studies, NHSCSP reports and input from experts and manufacturers. Costs were from 2020/2021, British pound sterling (£).

Interventions

Three sampling strategies were implemented: (1) routine clinician-collected cervical sample, (2) self-collected first-void (FV) urine, (3) self-collected vaginal swab. The hypothetical self-sampling strategies involved mailing women a sampling kit.

Main outcome measures

Primary outcomes: overall costs (for all screening steps to colposcopy), number of complete screens and cost per complete screen. Secondary outcomes: number of women screened, number of women lost to follow-up, cost per colposcopy and total screening costs for a plausible range of uptake scenarios.

Results

In the base case, the average cost per complete screen was £56.81 for clinician-collected cervical sampling, £38.57 for FV urine self-sampling and £40.37 for vaginal self-sampling. In deterministic sensitivity analysis, the variables most affecting the average cost per screen were the cost of sample collection for clinician-collected sampling and the cost of laboratory HPV testing for the self-sampling strategies. Scaled to consider routine screening in England, if uptake in non-attenders increased by 15% and 50% of current screeners converted to self-sampling, the NHSCSP would save £19.2 million (FV urine) or £16.5 million (vaginal) per year.

Conclusion

Self-sampling could provide a less costly alternative to clinician-collected sampling for routine HPV primary screening and offers opportunities to expand the reach of cervical screening to under-screened women.
Comparative effects of off-pump and multiple cardiopulmonary bypass strategies in coronary artery bypass grafting surgery: protocol for a systematic review and network meta-analysis
Authors: Tan Jia , Gao Sizhe , Li Yongnan , Li Xuehan , Du Lei , Ji Bingyang
Published: June 2023

Introduction

Multiple revascularisation strategies with or without cardiac arrest have been developed to minimise the negative effects of cardiopulmonary bypass interventions during coronary artery bypass grafting (CABG) surgery. Several observational and randomised studies have evaluated the efficacy of these interventions. This study aims to compare the efficacy and safety of four prevalent revascularisation strategies with/without cardiopulmonary bypass interventions in CABG surgery.

Methods and analysis

We will search on PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov for randomised controlled trials and observational cohort studies comparing outcomes of CABG surgery under conventional on-pump, off-pump, on-pump beating heart and minimal extracorporeal circulation technology. All English articles published before 30 November 2022 will be considered. The primary outcome will be 30‐day mortality. The secondary outcomes will be various early and late adverse events after CABG surgery. The Revised Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale will be used to assess the quality of included articles. A random-effects pairwise meta-analysis will be performed to report the head-to-head comparison. Then, the network meta-analysis will be performed using a Bayesian framework with random-effects models.

Ethics and dissemination

This research does not require the approval of an ethics committee as it relies on reviewing literature and does not involve dealing with humans or animals. The findings of this review will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42023381279.
Sustainable pressure injury prevention
Authors: Singh Charleen , Shoqirat Noordeen , Thorpe Lee , Villaneuva Stephanie
Published: June 2023

The quality department used adaptive leadership and the plan-do-study-act cycle to decrease pressure injury (PI) rates. After identifying gaps, the pressure injury prevention bundle was developed and implemented to bring evidence-based nursing practice to frontline nurses. Organisational rates of PI was followed for 4 years (2019–2022) and a smaller subset of 88 patients were followed in the prospective arm. Using statistical analysis, the decrease in PI rates (90%) and severity is significant (p<0.5) and sustained compared with the year prior to interventions.
Tebentafusp in combination with durvalumab and/or tremelimumab in patients with metastatic cutaneous melanoma: a phase 1 study
Authors: Hamid Omid , Hassel Jessica C , Shoushtari Alexander N , Meier Friedegund , Bauer Todd M , Salama April K S , Kirkwood John M , Ascierto Paolo A , Lorigan Paul C , Mauch Cornelia , Orloff Marlana , Evans Thomas R Jeffry , Holland Chris , Edukulla Ramakrishna , Abedin Shaad E , Middleton Mark R
Published: June 2023

Background

Immune checkpoint inhibitors have significantly improved outcomes in first line cutaneous melanoma. However, there is a high unmet need for patients who progress on these therapies and combination therapies are being explored to improve outcomes. Tebentafusp is a first-in-class gp100×CD3 ImmTAC bispecific that demonstrated overall survival (OS) benefit (HR 0.51) in metastatic uveal melanoma despite a modest overall response rate of 9%. This phase 1b trial evaluated the safety and initial efficacy of tebentafusp in combination with durvalumab (anti-programmed death ligand 1 (PDL1)) and/or tremelimumab (anti-cytotoxic T lymphocyte-associated antigen 4) in patients with metastatic cutaneous melanoma (mCM), the majority of whom progressed on prior checkpoint inhibitors.

Methods

In this open-label, multicenter, phase 1b, dose-escalation trial, HLA-A*02:01-positive patients with mCM received weekly intravenous tebentafusp with increasing monthly doses of durvalumab and/or tremelimumab starting day 15 of each cycle. The primary objective was to identify the maximum tolerated dose (MTD) or recommended phase 2 dose for each combination. Efficacy analyses were performed in all tebentafusp with durvalumab±tremelimumab treated patients with a sensitivity analysis in those who progressed on prior anti-PD(L)1 therapy.

Results

85 patients were assigned to receive tebentafusp in combination with durvalumab (n=43), tremelimumab (n=13), or durvalumab and tremelimumab (n=29). Patients were heavily pretreated with a median of 3 prior lines of therapy, including 76 (89%) who received prior anti-PD(L)1. Maximum target doses of tebentafusp (68 mcg) alone or in combination with durvalumab (20 mg/kg) and tremelimumab (1 mg/kg) were tolerated; MTD was not formally identified for any arm. Adverse event profile was consistent with each individual therapy and there were no new safety signals nor treatment-related deaths. In the efficacy subset (n=72), the response rate was 14%, tumor shrinkage rate was 41% and 1-year OS rate was 76% (95% CI: 70% to 81%). The 1-year OS for triplet combination (79%; 95% CI: 71% to 86%) was similar to tebentafusp plus durvalumab (74%; 95% CI: 67% to 80%).

Conclusion

At maximum target doses, the safety of tebentafusp with checkpoint inhibitors was consistent with safety of each individual therapy. Tebentafusp with durvalumab demonstrated promising efficacy in heavily pretreated patients with mCM, including those who progressed on prior anti-PD(L)1.

Trial registration number

NCT02535078.
Staging model of PTSD: a strategy for the implementation of precision medicine in military settings
Authors: McFarlane Alexander
Published: June 2023

Biomarkers have been of considerable interest in military medicine as a strategy to identify objective measures of resilience in the context of the cumulative trauma exposure of combat as well defining the emerging neurobiological dysregulation associated with post-traumatic stress disorder (PTSD). This body of work has been driven by the imperative of developing strategies to optimally manage the long-term health outcomes of personnel and finding novel treatment approaches. However, the challenge of defining the relevant phenotypes of PTSD and in the context of the multiplicity of biological systems of interest has hampered the identification of biomarkers that have clinical utility. One key strategy to improve the utility of precision medicine in military settings is to use a staging approach to define the relevant phenotypes. A staging model of PTSD captures the progression of the disorder and the transitions from being at risk to subsyndromal disorder and the path to chronic disorder.

A staging approach addresses the longitudinal course of PTSD and the fluidity of the disorder across time. Staging describes how symptoms evolve into more stable diagnostic syndromes and the stepwise changes in clinical status which is key to the identification of phenotypes that can be tied to relevant biomarkers. When a population is exposed to a trauma, the individuals will be at different stages in the emergence of risk and the development of PTSD. The staging approach provides a method of capturing the matrix of phenotypes that need to be demarcated to study the role of multiple biomarkers. This paper forms part of the Special issue of
BMJ Military Health
dedicated to personalised digital technology for mental health in the armed forces.
Types of morbidity presenting in frontline-bordering regions of Ukraine: the experience of deploying additional mobile medical units
Authors: Semenov Viktor V , Kumar S , Zak M Y , Kuryata O , Murach A , Syrovatko I , Krupchak N , Cortellino C , Trombatore G
Published: June 2023

Introduction

On 24 February 2022, the full-scale military invasion of Russia into Ukraine has started, creating one of the largest humanitarian crises in Europe since the World War II. As of 27 July 2022 (by the time when the most of Russian advances have already occurred), more than 900 healthcare facilities in Ukraine were damaged and 127 hospitals were destroyed completely.

Methods

Mobile medical units (MMU) were deployed in the frontline-bordering areas. An MMU included a family doctor, a nurse, a social worker and a driver, and aimed to provide medical help in remote areas. 18 260 patients who received medical help in MMUs in Dnipro (Dnipro city) and Zaporizhia (Zaporizhia city and Shyroke village) oblasts from July until October 2022 were included in the study. The patients were subdivided by month of visit, area of residence and area of MMU operation. Patients’ sex, age, date of visit and diagnosis were analysed. Comparison between groups was performed using analysis of variance and Pearson’s χ2tests.

Results

Majority of patients were females (57.4%), people aged 60+ years (42.8%) and internally displaced persons (IDPs) (54.8%). The proportion of IDPs increased from 47.4% to 62.8% over the period of study (p<0.01). The most common cause of visit to doctors was cardiovascular diseases (17.9%). The frequency of non-respiratory infections remained stable over the period of study.

Conclusions

In the frontline-bordering areas of Ukraine, females, people older than 60 years and IDPs more frequently sought medical help in MMUs. Causes of morbidity in the studied population were similar to the causes of morbidity before the beginning of full-scale military invasion. Maintaining continuous access to healthcare services may be beneficial for the patient outcomes, especially in terms of cardiovascular disease.
Comparison of remimazolam and dexmedetomidine for intraoperative sedation in patients undergoing lower extremity surgery under spinal anesthesia: a randomized clinical trial
Authors: Kim Hansol , Kim Youngwon , Bae Jinyoung , Yoo Seokha , Lim Young-Jin , Kim Jin-Tae
Published: June 2023

Background

Dexmedetomidine sedation has advantages, such as low incidence of respiratory depression and prolonged block duration, but also significant disadvantages, such as slow onset, high rate of sedation failure, and a long context-sensitive half-life. Remimazolam provides rapid sedation and recovery, high sedation efficacy and has minimal hemodynamic effects. We hypothesized that patients who received remimazolam would require less rescue midazolam than dexmedetomidine.

Methods

Patients (n=103) scheduled for surgery under spinal anesthesia were randomized to receive dexmedetomidine (DEX group) or remimazolam (RMZ group) targeting a Modified Observer’s Assessment of Alertness/Sedation score of 3 or 4. Rescue midazolam was administered if the patient failed to be sedated after the initial loading dose or despite infusion rate adjustment.

Results

Rescue midazolam administration was significantly higher in the DEX group (0% vs 39.2%; p<0.001). Patients in the RMZ group reached the target sedation level more rapidly. The incidences of bradycardia (0% vs 25.5%; p<0.001) and hypertension (0% vs 21.6%; p<0.001) were higher in the DEX group. Respiratory depression occurred at a higher rate in the RMZ group (21.2% vs 2.0%; p=0.002), but no patients required manual ventilation. Patients in the RMZ group recovered faster, had a shorter PACU stay and higher satisfaction scores. Hypotensive episodes in the PACU were more frequent in the DEX group (1.9% vs 29.4%; p<0.001).

Conclusions

Remimazolam showed excellent sedation efficacy, minimal hemodynamic effects, and fewer adverse events in the PACU than dexmedetomidine. However, it is important to note that respiratory depression was more frequent with the use of remimazolam.

Trial registration number

NCT05447507.
Are Bacteria Leaky? Mechanisms of Metabolite Externalization in Bacterial Cross-Feeding
Authors: McKinlay James B.
Published: June 2023

The metabolism of a bacterial cell stretches beyond its boundaries, often connecting with the metabolism of other cells to form extended metabolic networks that stretch across communities, and even the globe. Among the least intuitive metabolic connections are those involving cross-feeding of canonically intracellular metabolites. How and why are these intracellular metabolites externalized? Are bacteria simply leaky? Here I consider what it means for a bacterium to be leaky, and I review mechanisms of metabolite externalization from the context of cross-feeding. Despite common claims, diffusion of most intracellular metabolites across a membrane is unlikely. Instead, passive and active transporters are likely involved, possibly purging excess metabolites as part of homeostasis. Re-acquisition of metabolites by a producer limits the opportunities for cross-feeding. However, a competitive recipient can stimulate metabolite externalization and initiate a positive-feedback loop of reciprocal cross-feeding.
Bi-Cu Electrolytes with Aminocarboxylate Chelators for Reversible Metal Electrodeposition at High pH for Dynamic Windows
Authors: Li Judy Y. , Leahy Madeline J. , Bhoumik Nikhil C. , Miller Darren D. , Madu Desmond C. , Barile Christopher J.
Published: June 2023

Dynamic windows, which possess electronically tunable light transmission, increase both the energy efficiency and aesthetics of spaces such as buildings and automobiles. Although reversible metal electrodeposition affords a promising approach to constructing high-performing dynamic windows, the acidic nature of the aqueous electrolytes frequently used in these windows has prevented their commercialization due to tin-doped indium oxide (ITO) etching. In this manuscript, we design neutral and alkaline electrolytes that support the reversible electrodeposition of Bi and Cu at rates comparable to existing acidic electrolytes. In these electrolytes, Bi3+ and Cu2+ are solubilized by using aminocarboxylate chelating ligands. By evaluating a series of ligands with varying denticities, we demonstrate that N-(2-hydroxyethyl)ethylenedianmine-N,N’,N’-triacetic acid (ED3A-OH) provides the optimal metal ion binding strength that enhances solubility while simultaneously supporting rapid metal electrodeposition. These results allow us to design alkaline ED3A-OH electrolytes that are compatible with ITO even after four weeks of immersion at 85 °C. This manuscript thus demonstrates that chelating ligands can be utilized to design alkaline reversible metal electrodeposition electrolytes that support dynamic windows with robust shelf lives.
Inhibition of suplatast tosilate on EPSC in the single paratracheal ganglion neurons attached with presynaptic boutons
Authors: Zhou Jian-Rong , Shirasaki Tetsuya , Soeda Fumio , Takahama Kazuo
Published: June 2023

In this study, using single neurons of rat paratracheal ganglia (PTG) attached with presynaptic boutons, the effects of suplatast tosilate on excitatory postsynaptic currents (EPSCs) were investigated with patch-clamp recording technique. We found that suplatast concentration dependently inhibited the EPSC amplitude and its frequency in single PTG neurons attached with presynaptic boutons. Thus suplatast inhibited the function of PTG neurons at both of presynaptic and postsynaptic sites.