bluuebunny/crossref_metadata_2025 huggingface dataset:
Judicilização de Tratamento Oncológico e a Responsabilização da União
Authors: Soares Sathler Lucas , Ferreira dos Santos Luana
Published: November 2023

O objeto de estudo é a judicialização de tratamento oncológico e a responsabilização da União. O objetivo do artigo é tratar dessa discussão a partir de julgados do Tribunal de Justiça de Minas Gerais (TJMG). A abordagem é qualitativa e o artigo baseia-se em dados secundários (75 processos), coletados por meio de pesquisa documental. O entendimento dominante no TJMG é de que a participação processual da União é prescindível, embora as regras do Sistema Único de Saúde (SUS) atribuam a ela a responsabilidade pelo financiamento dessa política pública. A ausência do ente nacional prejudica os demais entes e distorce estruturas consolidadas do SUS. O Poder Judiciário participa da elaboração de políticas públicas e a participação processual da União coaduna-se com normas e orientações vigentes, sendo importante e necessária. Sugere-se pesquisas empíricas que abordem a relação do Poder Judiciário com demais Poderes na implementação de políticas públicas e em processos de tratamentos oncológicos.
PALAVRAS-CHAVE: Judicialização da saúde; Sistema Único de Saúde (SUS); União; Oncologia; Tribunal de Justiça do Estado de Minas Gerais (TJMG).
A Noncontact Method for Estimating Thin Metal Film Adhesion Strength Through Current-Induced Void Growth
Authors: Prasanna Prasad Sudarshan , Kumar Vaitheeswaran Pavan , Singh Yuvraj , Chou Pei-En , Liao Huanyu , Subbarayan Ganesh
Published: November 2023

Studies have reported that the electromigration-induced void growth velocity in metal thin films is inversely related to the adhesion strength of the metal thin film with the base and passivation layers. It was also observed that the contribution of interface adhesion strength to electromigration resistance decreases with an increase in temperature. In this study, an expression is derived for the diffusive void growth velocity induced by electromigration from a generalized thermodynamically consistent continuum-based theory for reaction–diffusion driven solid-state interface evolution. This relation captures the effect of adhesion with the base and passivation layers on electromigration resistance of thin metal films. Electromigration experiments were carried out at elevated temperatures and high current density to induce voiding in thin Cu metal film deposited on a base layer of TiN and passivated with TiN or SiNx. The degradation of interface adhesion strength with temperature is modeled using an Andrade-type of relationship. The void growth rates characterized in these experiments are combined with the expression for void growth rate to estimate the interface adhesion strength for the Cu–TiN and Cu–SiNx interfaces. The methodology for estimating the adhesion strength of the metal-passivation layer interface is validated through comparison with interface adhesion strengths from mechanical de-adhesion tests reported in the literature.
Active control of sound transmission through a floor-level slit
Authors: Yang Ziyi , Wang Shuping , Tao Jiancheng , Qiu Xiaojun
Published: November 2023

The floor-level slit between the door and the floor is one weak point in building noise insulation. In this paper, an active noise control system is proposed to reduce the sound transmission through a floor-level slit with evenly distributed secondary sources on its top boundary. The system performance is first investigated based on the analytical and numerical models, and simulation results indicate a decrease in active control performance with increasing frequency. The upper limit frequency of 10 dB effective control increases with a higher number of secondary sources, and the corresponding wavelength of the upper limit frequency is approximately the interval between the secondary sources when a plane wave is incident normally. Although the upper limit frequency decreases with the slit height, it approaches a constant when the slit height becomes significantly smaller than the wavelength in the incident sound. The experimental results based on a typical floor-level door slit support the findings in the numerical simulations. For a slit with a width of 0.9 m and a height of 0.005 m, the upper limit frequency of 10 dB noise reduction can reach up to 2830 Hz when ten secondary sources are employed in the experiments.
Tidal modulation of very-low-frequency and ultra-low-frequency ambient noise levels
Authors: Eller Anthony I. , Heaney Kevin D. , Bradley David L.
Published: November 2023

Several years of continuous low-frequency underwater ambient noise data from 0.1 to 125 Hz have been made available for examination by the United Nations Comprehensive Nuclear Test Ban Treaty Organization. Narrow-band noise time records between 0.5 and 10 Hz were selected for study, chosen deliberately to address noise sources tied primarily to the environment. Power spectra of the variable narrow-band time records were found to display sharp spectral lines at fluctuation frequencies that match lunar and solar diurnal and semidiurnal ocean tides.
Solid-state NMR structure determination of a membrane protein in
E. coli
cellular inner membrane
Authors: Xie Huayong , Zhao Yongxiang , Zhao Weijing , Chen Yanke , Liu Maili , Yang Jun
Published: November 2023

Structure determination of membrane proteins in native cellular membranes is critical to precisely reveal their structures in physiological conditions. However, it remains challenging for solid-state nuclear magnetic resonance (ssNMR) due to the low sensitivity and high complexity of ssNMR spectra of cellular membranes. Here, we present the structure determination of aquaporin Z (AqpZ) by ssNMR in
Escherichia coli
inner membranes. To enhance the signal sensitivity of AqpZ, we optimized protein overexpression and removed outer membrane components. To suppress the interference of background proteins, we used a “dual-media” expression approach and antibiotic treatment. Using 1017 distance restraints obtained from two-dimensional
13
C-
13
C spectra based on the complete chemical shift assignments, the 1.7-Å ssNMR structure of AqpZ is determined in
E. coli
inner membranes. This cellular ssNMR structure determination paves the way for analyzing the atomic structural details for membrane proteins in native cellular membranes.
LINE-1 retrotransposons drive human neuronal transcriptome complexity and functional diversification
Authors: Garza Raquel , Atacho Diahann A. M. , Adami Anita , Gerdes Patricia , Vinod Meghna , Hsieh PingHsun , Karlsson Ofelia , Horvath Vivien , Johansson Pia A. , Pandiloski Ninoslav , Matas-Fuentes Jon , Quaegebeur Annelies , Kouli Antonina , Sharma Yogita , Jönsson Marie E. , Monni Emanuela , Englund Elisabet , Eichler Evan E. , Gale Hammell Molly , Barker Roger A. , Kokaia Zaal , Douse Christopher H. , Jakobsson Johan
Published: November 2023

The genetic mechanisms underlying the expansion in size and complexity of the human brain remain poorly understood. Long interspersed nuclear element–1 (L1) retrotransposons are a source of divergent genetic information in hominoid genomes, but their importance in physiological functions and their contribution to human brain evolution are largely unknown. Using multiomics profiling, we here demonstrate that L1 promoters are dynamically active in the developing and the adult human brain. L1s generate hundreds of developmentally regulated and cell type–specific transcripts, many that are co-opted as chimeric transcripts or regulatory RNAs. One L1-derived long noncoding RNA,
LINC01876
, is a human-specific transcript expressed exclusively during brain development. CRISPR interference silencing of
LINC01876
results in reduced size of cerebral organoids and premature differentiation of neural progenitors, implicating L1s in human-specific developmental processes. In summary, our results demonstrate that L1-derived transcripts provide a previously undescribed layer of primate- and human-specific transcriptome complexity that contributes to the functional diversification of the human brain.
MicroRNAs in infectious diseases: potential diagnostic biomarkers and therapeutic targets
Authors: Kimura Muneyoshi , Kothari Sagar , Gohir Wajiha , Camargo Jose F. , Husain Shahid
Published: November 2023

MicroRNAs (miRNAs) are conserved, short, non-coding RNAs that play a crucial role in the post-transcriptional regulation of gene expression. They have been implicated in the pathogenesis of cancer and neurological, cardiovascular, and autoimmune diseases. Several recent studies have suggested that miRNAs are key players in regulating the differentiation, maturation, and activation of immune cells, thereby influencing the host immune response to infection. The resultant upregulation or downregulation of miRNAs from infection influences the protein expression of genes responsible for the immune response and can determine the risk of disease progression. Recently, miRNAs have been explored as diagnostic biomarkers and therapeutic targets in various infectious diseases. This review summarizes our current understanding of the role of miRNAs during viral, fungal, bacterial, and parasitic infections from a clinical perspective, including critical functional mechanisms and implications for their potential use as biomarkers and therapeutic targets.
Amplicon sequencing data profiling of rhizospheric microbiome associated with
Capsicum annuum
L. var.
Kulai
cultivated under organic farming
Authors: Tharek Munirah , Mat Amin Noriha
Published: November 2023

Data on the 16S rRNA and 18S rRNA amplicon sequencing from the rhizosphere of
Capsicum annuum
L. var.
Kulai
cultivated under organic farming are unveiled. The most dominant phyla for the 16S rRNA gene were
Actinobacteriota
and
Proteobacteria
. As for the 18S rRNA gene amplicon,
Charophyta
and
Fungi
were the major taxonomic groups.
Methanogen-mediated dolomite precipitation in an early Permian lake in northwestern China
Authors: Sun Funing , Hu Wenxuan , Wang Xiaolin , Hu Zhongya , Wu Haiguang , Guo Yangrui , Wei Gangjian
Published: November 2023

Microbes are known to mediate dolomite precipitation in laboratory experiments; however, the linkage of specific microbes to ancient dolomites remains poorly constrained due to scarce diagnostic biogeochemical signatures and mineralized microbial relics in the rock record. Here, we report the occurrence of methanogen-mediated dolomite in the Lower Permian lacustrine Lucaogou Formation in northwestern China. The clumped isotope (Δ47) temperature provides direct evidence of a low-temperature origin (typically <40 °C). The extremely positive δ26MgDSM3 (up to +0.44‰) and δ13CVPDB (up to +19‰) values in the dolomite indicate authigenic precipitation in methanogenic lake sediments. Micron-sized spheroidal bodies and filamentous and sheetlike structures are interpreted as mineralized coccoid methanogenic archaea and extracellular polymeric substances (EPSs), respectively. Dolomite nanoglobules (primarily 40–100 nm in diameter) are interpreted as mineralized viruses attached to the archaea and EPSs and between the cells. A combination of geochemical and microscale evidence confirms the microbial origin of the dolomite induced by methanogens and their associated bacteriophages. Furthermore, dolomite nanoglobules initially nucleated on the surfaces of methanogen cells, EPSs, and viruses and then merged into larger aggregates. The formation of microbial dolomite is characterized by a metabolic incubation, heterogeneous nucleation, and aggregative growth pathway. These findings provide valuable clues to decipher the biosignatures of these particular ancient dolomites.
Two phases of Cretaceous dextral shearing recorded in the plutonic rocks of NW Nevada (USA): A tectonic link between intra-arc shearing in the Sierra Nevada and Idaho batholiths
Authors: Trevino Sarah F. , Tikoff Basil
Published: November 2023

The Cretaceous intrusive units of the Sahwave and Nightingale ranges in northwestern Nevada, USA, located between the Sierra Nevada and Idaho batholiths, represent a critical segment of Cretaceous arc magmatism. U-Pb zircon age dating shows that the older, 104 Ma Power Line intrusive complex is dominantly granodioritic in composition, while the younger 94–88 Ma Sahwave Range intrusive suite (the Juniper Pass, Bob Springs, and Sahwave plutons) is similar in composition (tonalite to granodiorite) and age to the plutons of the Tuolumne intrusive suite of the east-central Sierra Nevada batholith. We present new field measurements, microstructural observations, and anisotropy of magnetic susceptibility analyses of the Power Line intrusive complex and Sahwave Range intrusive suite. The Power Line intrusive complex is characterized by a vertical, N–S-striking, solid-state foliation and down-dip lineation. Evidence of dextral shearing is observed on subhorizontal planes that are perpendicular to the lineation, which is consistent with pure shear-dominated transpression. This fabric is similar in style and timing to both the western Idaho shear zone of the Idaho batholith and mid-Cretaceous shear zones of the central Sierra Nevada. The plutons of the Sahwave Range intrusive suite are not affected by the pure shear-dominated transpressional fabric observed in the Power Line intrusive complex, which indicates that this deformation ceased by ca. 94 Ma. Rather, the Juniper Pass pluton contains an E–W-striking magmatic foliation fabric that rotates to a steep NW–SE-striking, solid-state foliation in the younger Sahwave pluton. These fabrics are strikingly similar to fabrics in the Tuolumne intrusive suite, Sierra Nevada, California, USA. Recent work in the western Idaho shear zone also indicates that late-stage deformation occurred there until ca. 85 Ma. Therefore, the intrusions of northwestern Nevada provide a tectonic link between the Sierra Nevada and Idaho batholiths, which suggests that two distinct phases of mid-Cretaceous, transpressional deformation occurred in at least three magmatic arc segments of the western U.S. margin.
Isolated pulmonary valve endocarditis in a patient without structural heart disease or a history of intravenous drug use
Authors: Whitehead Thomas , Moore Amber , Agarwal Ashima , Appleby Jennifer
Published: November 2023

We present a case of a febrile patient in his 70s who was found to have isolated native pulmonary valve vegetations on echocardiography, andEnterococcus faecalison blood cultures. Of note, our patient had none of the typical risk factors associated with this rare form of endocarditis previously described in only a handful of case reports.
Rapid progression of probable Creutzfeldt-Jakob disease with concomitant COVID-19 infection
Authors: McGrath Adrian , Pai Hari , Clack Aidan
Published: November 2023

A previously healthy man in his 80s was admitted to a district general hospital with rapidly progressing dementia, gait abnormalities and myoclonus alongside COVID-19 infection. Investigations showed mild elevation of C-reactive protein and neutrophils, unremarkable CT head and mildly raised protein in cerebrospinal spinal fluid (CSF). Brain MRI revealed bilateral cortical and striatal diffusion restriction and electroencephalogram (EEG) findings showed diffuse activity slowing with high amplitude sharp/slow-wave complexes. He was diagnosed with probable sporadic Creutzfeldt-Jakob disease (CJD) and management prioritised comfort and care. He passed away two weeks following admission and a mere 8 weeks after the first onset of symptoms.

We present the first documented case of probable CJD with concomitant COVID-19 infection in the UK. We identified six other cases worldwide identified in our literature review. These cases suggest a role of COVID-19 in the rapid progression of CJD and add to the growing evidence of its neuroinflammatory role in other forms of neurodegenerative diseases.
Segmental testicular infarction secondary to protein C deficiency
Authors: Gibson Damien , Zhong Wenjie , Bajaj Mohit , Ranasinghe Anu
Published: November 2023

Protein C deficiency is a rare blood disorder that increases the risk of thromboembolism, resulting in deep vein thrombosis, pulmonary embolisms and strokes. Segmental testicular infarction is also a rare condition with unclear aetiology. This case presents a man in his 50s with protein C deficiency who developed a segmental testicular infarction. The patient was managed conservatively, without surgical intervention. He was monitored with serial ultrasound, which demonstrated progression from normal testis to segmental infarction and eventually resolution. The case highlights that protein C deficiency can cause testicular infarction, and a multidisciplinary approach can help avoid unnecessary surgery with excellent outcomes. Segmental infarction should be considered in patients with pre-existing thrombophilias after excluding malignancy and infection. Conservative management with repeat ultrasonography and follow-up can be appropriate in such cases.
Follow-up ICD generator explantation in tuberculous myocarditis induced ventricular tachycardia patient
Authors: Saxena Anil , Karim Azmat , Saini Himanshu , Alam Mohammad Shadab
Published: November 2023

A rare case of ventricular tachycardia caused by extrapulmonary tuberculosis has been followed up. Automatic implantable cardioverter defibrillator implantation was done at the time of presentation. Following this, the patient is clinically well without any episodes of ventricular tachycardia and is considered for an implantable cardioverter defibrillator explantation.
Tertiary prevention and treatment of rheumatic heart disease: a National Heart, Lung, and Blood Institute working group summary
Authors: Vervoort Dominique , Yilgwan Christopher Sabo , Ansong Annette , Baumgartner Jennifer N , Bansal Geetha , Bukhman Gene , Cannon Jeffrey W , Cardarelli Marcelo , Cunningham Madeleine W , Fenton Kathleen , Green-Parker Melissa , Karthikeyan Ganesan , Masterson Mary , Maswime Salome , Mensah George A , Mocumbi Ana , Kpodonu Jacques , Okello Emmy , Remenyi B , Williams Makeda , Zühlke Liesl J , Sable Craig
Published: November 2023

Although entirely preventable, rheumatic heart disease (RHD), a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low-income and middle-income countries (LMICs) and rural, remote, marginalised and disenfranchised populations within high-income countries. In late 2021, the National Heart, Lung, and Blood Institute convened a workshop to explore the current state of science, to identify basic science and clinical research priorities to support RHD eradication efforts worldwide. This was done through the inclusion of multidisciplinary global experts, including cardiovascular and non-cardiovascular specialists as well as health policy and health economics experts, many of whom also represented or closely worked with patient-family organisations and local governments. This report summarises findings from one of the four working groups, the Tertiary Prevention Working Group, that was charged with assessing the management of late complications of RHD, including surgical interventions for patients with RHD. Due to the high prevalence of RHD in LMICs, particular emphasis was made on gaining a better understanding of needs in the field from the perspectives of the patient, community, provider, health system and policy-maker. We outline priorities to support the development, and implementation of accessible, affordable and sustainable interventions in low-resource settings to manage RHD and related complications. These priorities and other interventions need to be adapted to and driven by local contexts and integrated into health systems to best meet the needs of local communities.
Research priorities for the secondary prevention and management of acute rheumatic fever and rheumatic heart disease: a National Heart, Lung, and Blood Institute workshop report
Authors: Karthikeyan Ganesan , Watkins David , Bukhman Gene , Cunningham Madeleine W , Haller John , Masterson Mary , Mensah George A , Mocumbi Ana , Muhamed Babu , Okello Emmy , Sotoodehnia Nona , Machipisa Tafadzwa , Ralph Anna , Wyber Rosemary , Beaton Andrea
Published: November 2023

Secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) involves continuous antimicrobial prophylaxis among affected individuals and is recognised as a cornerstone of public health programmes that address these conditions. However, several important scientific issues around the secondary prevention paradigm remain unresolved. This report details research priorities for secondary prevention that were developed as part of a workshop convened by the US National Heart, Lung, and Blood Institute in November 2021. These span basic, translational, clinical and population science research disciplines and are built on four pillars. First, we need a better understanding of RHD epidemiology to guide programmes, policies, and clinical and public health practice. Second, we need better strategies to find and diagnose people affected by ARF and RHD. Third, we urgently need better tools to manage acute RF and slow the progression of RHD. Fourth, new and existing technologies for these conditions need to be better integrated into healthcare systems. We intend for this document to be a reference point for research organisations and research sponsors interested in contributing to the growing scientific community focused on RHD prevention and control.
Association between educational level and self-reported musculoskeletal pain and physical functioning in Danes 60–70 years old from 2010 to 2017: a longitudinal analysis of trends over time on data from the Danish Health and Morbidity Survey
Authors: Hansen Jeanette , Hansen Henrik , Nilsson Charlotte , Ekholm Ola , Molsted Stig
Published: November 2023

Objectives

The aims of this study were to investigate the association between educational level and musculoskeletal pain and physical function, respectively, in persons 60–70 years old, and to investigate if the association changed from 2010 to 2017.

Design and participants

This is a sex-stratified, cross-sectional study based on data from the Danish Health and Morbidity Survey in 2010 (n=15 165) and in 2017 (n=14 022).

Self-reported data from respondents who were 60–70 years old and reported data for pain or physical function, sociodemographic, education and behavioural factors were included.

Primary outcome measures

Prevalence of pain and physical limitations.

Results

Among men, a high educational level was associated with reduced odds of pain compared with low educational level (OR 0.56 (95% CI 0.41; 0.74)). Medium and high educational levels were associated with reduced odds of pain in women (0.74 (0.59; 0.92) and 0.64 (0.41; 1.00), respectively). High educational level was associated with reduced odds of physical limitations in men (0.35 (0.19; 0.65)) and women (0.33 (0.14; 0.78)). The interaction terms between time and education were not associated with pain and physical function, respectively.

Conclusion

High education was associated with reduced musculoskeletal pain and reduced limitations of physical function. The association between education and musculoskeletal pain and physical function did not change significantly over time. Musculoskeletal pain during the past 14 days and chronic pain among old men and women 60–70 years and their level of physical function contribute to important knowledge of a group near the retirement age. The future perspectives illustrate trends and importance of focusing on adapting job accommodations for senior workers.
Magnitude of occupational exposure to sharp injuries among nurses working in South Gondar zone public hospitals, Northcentral Ethiopia: institution-based cross-sectional study
Authors: Aytenew Tigabu Munye , Kassie Yohannes Tesfahun , Kebede Solomon Demis
Published: November 2023

Objective

This study aimed to determine the magnitude of occupational exposure to sharp injuries and identify its associated factors among nurses.

Design

Institution-based cross-sectional study design was conducted from 1 to 30 November 2022.

Analysis

The collected data were entered into EpiData V.4.2; then, exported to Stata V.14 for analysis. Variables with a p value of <0.05 at 95% CI were considered significantly associated with occupational exposure to sharp injuries.

Setting

The study was conducted in South Gondar zone public hospitals.

Participants

Nurses working in South Gondar zone public hospitals.

Results

Of the total respondents, 213 (56.65%) were between the ages of 25 and 34 with the mean±SD of age 30.22±6.63 years. Similarly, 202 (53.72%) of the respondents were women. This study finding showed that the magnitude of occupational exposure to sharp injuries among nurses was 52.39% (95% CI: 47.92% to 56.37%). Moreover, this study finding showed that year of service >10 years (adjusted OR (AOR)=2.35, 95% CI: 1.21 to 4.57), lack of infection prevention training (AOR=1.85, 95% CI: 1.09 to 3.45), job-related stress (AOR=2.24, 95% CI: 1.27 to 3.89) and presence of contaminated sharps at the workplace (AOR=2.76, 95% CI: 1.67 to 4.72) were significantly associated with occupational exposure to sharp injuries among nurses.

Conclusions

Generally, this study finding reported that the magnitude of occupational exposure to sharp injuries among nurses was high. This study finding also showed that years of service >10 years, lack of infection prevention training, job-related stress and the presence of contaminated sharps at the workplace were independent predictors of occupational exposure to sharp injuries among nurses. Hence, all the concerned bodies should strengthen regular provision of infection prevention training to nurses at all levels. Nurses should practice proper use of safety box more than ever in order to avoid the presence of contaminated needles and other sharp materials at the workplace.
Sex differences among children, adolescents and young adults for mental health service use within inpatient and outpatient settings, before and during the COVID-19 pandemic: a population-based study in Ontario, Canada
Authors: Moin John S , Vigod Simone N , Plumptre Lesley , Troke Natalie , Asaria Miqdad , Papanicolas Irene , Wodchis Walter P , Brail Shauna , Anderson Geoff
Published: November 2023

Objectives

The pandemic and public health response to contain the virus had impacts on many aspects of young people’s lives including disruptions to daily routines, opportunities for social, academic, recreational engagement and early employment. Consequently, children, adolescents and young adults may have experienced mental health challenges that required use of mental health services. This study compared rates of use for inpatient and outpatient mental health services during the pandemic to pre-pandemic rates.

Design

Population-based repeated cross-sectional study.

Setting

Publicly delivered mental healthcare in primary and secondary settings within the province of Ontario, Canada.

Participants

All children 6–12 years of age (n=2 043 977), adolescents 13–17 years (n=1 708 754) and young adults 18–24 years (n=2 286 544), living in Ontario and eligible for provincial health insurance between March 2016 and November 2021.

Primary outcome measures

Outpatient mental health visitsto family physicians and psychiatrists for: mood and anxiety disorders, alcohol and substance abuse disorders, other non-psychotic mental health disorders and social problems.Inpatient mental health visitsto emergency departments and hospitalisations for: substance-related and addictive disorders, anxiety disorders, assault-related injuries, deliberate self-harm and eating disorders. All outcomes were analysed by cohort and sex.

Results

During the pandemic, observed outpatient visit rates were higher among young adults by 19.01% (95% CI: 15.56% to 22.37%; 209 vs 175 per 1000) and adolescent women 24.17% (95% CI: 18.93% to 29.15%; 131 vs 105 per 1000) for mood and anxiety disorders and remained higher than expected. Female adolescents had higher than expected usage of inpatient care for deliberate self-harm, eating disorders and assault-related injuries.

Conclusions

Study results raise concerns over prolonged high rates of mental health use during the pandemic, particularly in female adolescents and young women, and highlights the need to better monitor and identify mental health outcomes associated with COVID-19 containment measures and to develop policies to address these concerns.
Asthma-related emergency admissions and associated healthcare resource use in Alberta, Canada
Authors: Mayers Irvin , Randhawa Arsh , Qian Christina , Talukdar Manisha , Soliman Mena , Jayasingh Pramoda , Johnston Karissa , Bhutani Mohit
Published: November 2023

Background

There is a lack of real-world research assessing asthma management following asthma-related emergency department (ED) discharges. The objective of this study was to characterise follow-up care, healthcare resource use (HCRU) and medical costs following ED admissions in Alberta, Canada.

Methods

A retrospective cohort study was conducted on adults with asthma using longitudinal population-based administrative data from Alberta Health Services. Adult patients with asthma and ≥1 ED admission from 1 April 2015 to 31 March 2020 were included. ED admissions, outpatient visits, hospitalisations and asthma-specific medication use were measured in the 30 days before and up to 90 days after each asthma-related ED admission. Mean medical costs attributable to each type of HCRU were summarised. All outcomes were stratified by patient baseline disease severity.

Results

Among 128 063 patients incurring a total of 20 142 asthma-related ED visits, a substantial rate of ED readmission was observed, with 10% resulting in readmissions within 7 days and 35% within 90 days. Rates increased with baseline asthma severity. Despite recommendations for patients to be followed up with an outpatient visit within 2−7 days of ED discharge, only 6% were followed up within 7 days. The mean total medical cost per patient was $C8143 in the 30 days prior to and $C5407 in the 30 days after an ED admission.

Conclusions

Despite recommendations regarding follow-up care for patients after asthma-related ED admissions, there are still low rates of outpatient follow-up visits and high ED readmission rates. New or improved multidimensional approaches must be integrated into follow-up care to optimise asthma control and prevent readmissions.
Cardiovascular risk and systemic inflammation in male professional rugby: a cross-sectional study
Authors: McHugh Clíodhna , Hind Karen , Kelly Aine , Fearon Ursula , Wasfy Meagan , Floudas Achilleas , Barad Zsuzsanna , Dane Kathryn , Farrell Gareth , Wilson Fiona
Published: November 2023

Objective

To investigate cardiovascular risk factors’ prevalence and association with systemic inflammation in professional male rugby players (RP).

Methods

A cross-sectional investigation of 46 professional male RP (26.1±4.1 years) cardiovascular risk factors were compared by position. Inflammatory markers were compared with healthy controls (n=13) and patients with rheumatoid arthritis (RA) (n=10).

Results

Twenty-six per cent of RP had no risk factors, 49% had 1–2 cardiovascular risk factors and 25% had 3–4 risk factors. Forwards had greater body fat (p<0.001), visceral fat (p<0.001), glucose (p=0.025), and C reactive protein (CRP) (p=0.023) compared with backs. RP demonstrated more favourable lipid and glucose profiles than reference values for the general population. Most RP (n=28, 61%) had elevated blood pressure (≥140/90 mm Hg). RP had higher vascular adhesion molecule-1 (VCAM-1) (p=0.004) and intracellular adhesion molecule-1 (ICAM-1) (p=0.002) than healthy controls. RP had lower CRP than patients with RA (p=0.009), while one-third (n=15) displayed equivalent ICAM-1 and VCAM-1 levels. Multivariate clustering and principal component analysis biplots revealed higher triglycerides, inflammatory markers, and worse body composition were associated with forwards.

Conclusions

Despite athletic status, most of this rugby cohort had at least one cardiovascular risk factor. Concomitantly, these RP demonstrated increased levels of inflammation, with one-third, primarily forwards, displaying equivalent levels to patients with inflammatory disease. Further studies are needed to unravel the prognostic implications of increased inflammation in RP because unchecked, chronic inflammation may lead to increased cardiovascular disease risk.
Social justice and medical leadership: what is preventing trainees in the East Midlands from accessing leadership training?
Authors: Clegg Rebecca , Bowen Jennifer
Published: November 2023

Introduction

Health inequality is a problem worldwide, with life expectancy decreasing in parts of the UK. Social justice requires effective leaders. Doctors can engage with their patients to understand how social determinants of health affect them and use their leadership skills to create meaningful change.

The East Midlands Leadership and Management Programme (LMP), run by NHS England (NHSE) East Midlands, teaches trainees the grounding principles for effective leadership and management. Many trainees struggle to access the course; therefore, we created a survey to determine the barriers for access.

Methods

The survey was sent to all applicable trainees in the East Midlands. 210 of 3000 trainees responded (7%). The questions were both qualitative, analysed using thematic analysis; and quantitative, which were descriptively analysed.

Results

90.5% of trainees said leadership training was somewhat or very important; however, only 52.4% had accessed training. The top barrier was not knowing what training was available (54.3%), followed by a lack of time or study leave (48.6%), and being unable to get a place on a course (46.7%). Concerningly, 3.8% thought leadership training to be of little or no importance.

Discussion

Despite most trainees acknowledging the importance of leadership training, barriers to access exist. Of concern, some thought leadership training to be unimportant.

Leadership is vital for social justice and to enact positive changes within our communities. The LMP provides tools for doctors to help them achieve this. Our work documents the perceived barriers our trainees have to accessing leadership training, alongside proposals for change and further research.
Clinical research in the NHS: a cross-sectional study of research engagement during the monkeypox pandemic
Authors: Wan Yize I , Smuk Melanie , Pearse Rupert M , Paparini Sara , Apea Vanessa J , Orkin Chloe M
Published: November 2023

Background

Recruitment and retention of clinical academics in the UK is under threat. Acute clinical crises can increase opportunities for clinical research. We aimed to examine research involvement among clinicians working in sexual health and HIV medicine during the monkeypox (mpox) pandemic and identify factors associated with differential research engagement.

Methods

We carried out a cross-sectional study between August and October 2022 using anonymised, self-reported data collected via an online survey disseminated worldwide across multiple specialties. We assessed demographic characteristics, research involvement and outputs, workplace setting, involvement with policy work and public health agencies and media. We examined differences by geographical location comparing the UK, European Union (EU) and the USA.

Results

Of 139 total respondents from the UK, none identified themselves as clinical researchers, compared with 23/210 (11.0%) from the EU and 5/58 (8.6%) from the USA. Overall research engagement was lowest in the UK (15.1% vs EU 36.7% and USA 37.9%). In the UK, research activity was greater among consultant physicians (19.5% vs 18.8% doctors-in-training and 4.9% nurses), those aged 35–50 years (19.7% vs 15.4% <35 and 8.5% >50 years), males (34.3% vs 7.1% females and 33.3% non-binary) and those who self-identified as White (15.6% vs 13.3% all other). In research-active individuals, measurable research achievements by journal publications or submissions and obtainment of grant funding were significantly higher in older, male, White, consultant physicians. Less disparity across demographic characteristic groups were seen in both the EU and the USA compared with the UK reflecting more diversity among research-active clinicians in overall research activity. Markers of research achievement were closer to parity in representation across gender and race and ethnicity, particularly for the EU.

Conclusions

Adherence to and evaluation of existing UK-based recommendations to improve the clinical academic pipeline are needed to increase research engagement and diversity to safeguard future UK clinical research.
Maternal folic acid supplementation does not impact skeletal muscle function and metabolism in male and female CD-1 mouse offspring
Authors: Saint Caitlin , Gittings William , Bunda Jordan , Giles Cameron , Sacco Sandra M. , Vandenboom Rene , Ward Wendy E. , LeBlanc Paul J.
Published: November 2023

Folic acid fortification of all white flour, enriched pasta, and cornmeal products became mandatory in Canada to reduce risk of neural tube defects at birth. Furthermore, Health Canada and the Society of Obstetricians and Gynaecologists of Canada recommend women take daily prenatal folic acid supplements in addition to folic acid fortified foods during pregnancy. However, the influence of maternal folic acid supplementation on offspring development, specifically the highly abundant and metabolically active skeletal muscle, is currently unknown. Thus, the purpose of this study was to determine the effect of supplemental folic acid (four times higher than normal dietary consumption), in utero and throughout suckling on muscle size, function, and metabolism in male and female CD-1 mouse offspring. The major findings were that maternal exposure to supplemental folic acid ( i) had no impact on postpartum growth rates or muscle mass in female and male offspring, ( ii) had no impact on skeletal muscle contractile kinetics in females and male offspring, and ( iii) increased maximal phosphofructokinase activity in extensor digitorum longus of female and male offspring. These findings suggest that exposure to folic acid supplementation in utero and throughout suckling at levels four times higher than recommended had minimal effect on skeletal muscle size, function, and metabolism regardless of sex. Future research is needed explore the underlying biological pathways and mechanisms affected by folic acid supplementation during pregnancy and lactation on offspring skeletal muscle tissue, specifically in humans.
Neuromechanical characterization of the abductor hallucis and its potential role in upright postural control
Authors: Sharma Tushar , Copeland Paige V. , Debenham Mathew I.B. , Bent Leah R. , Dalton Brian H.
Published: November 2023

There is growing evidence to support a role for the abductor hallucis (AH) in standing balance control; however, functional properties of the muscle that may provide more insight into AH's specific contribution to upright posture have yet to be characterized. This study was conducted to quantify functional neuromechanical properties of the AH and correlate the measures with standing balance variables. We quantified strength and voluntary activation during maximal voluntary isometric contractions of the great toe abductor in nine (3 females and 6 males) healthy, young participants. During electrically evoked twitch and tetanic contractions, we measured great toe abduction peak force and constructed a force–frequency curve. We also evaluated peak abduction force, contraction time (CT), half-relaxation time (HRT), rate of force development (RFD), and relaxation rate (RR) from twitch contractions evoked using doublet stimuli. Strength, VA, CT, HRT, RFD, and RR were correlated to centre of pressure standard deviation (COP SD) and velocity (COP VEL) variables of the traditional COP trace and its rambling and trembling components during single-legged stance. AH twitch properties (e.g., CT: 169.8 ± 32.3 ms; HRT: 124.1 ± 29.2 ms) and force–frequency curve were similar to other slow contractile muscles. Contractile speed related negatively with COP VEL, suggesting AH may be appropriate for slow, prolonged tasks such as ongoing postural balance control. Correlation coefficient outcomes for all variables were similar between rambling and trembling components. Our results provide further evidence for the importance of AH neuromechanical function for standing balance control, at least during a challenging single-legged posture.
Geometric background for the Teukolsky equation revisited
Authors: Millet Pascal
Published: November 2023

The aim of this review paper is to revisit the geometric framework of the Teukolsky equation in a form that is suitable for analysts working on this equation. We introduce spinor bundles, the Newman–Penrose formalism and the Geroch–Held–Penrose (GHP) formalism. In particular, we develop the case of Kerr spacetimes, for which we provide detailed computations.
Connections on Lie groupoids and Chern–Weil theory
Authors: Biswas Indranil , Chatterjee Saikat , Koushik Praphulla , Neumann Frank
Published: November 2023

Let [Formula: see text] be a Lie groupoid equipped with a connection, given by a smooth distribution [Formula: see text] transversal to the fibers of the source map. Under the assumption that the distribution [Formula: see text] is integrable, we define a version of de Rham cohomology for the pair [Formula: see text], and we study connections on principal [Formula: see text]-bundles over [Formula: see text] in terms of the associated Atiyah sequence of vector bundles. We also discuss associated constructions for differentiable stacks. Finally, we develop the corresponding Chern–Weil theory and describe characteristic classes of principal [Formula: see text]-bundles over a pair [Formula: see text].
Learning Multi-Modal Scale-Aware Attentions for Efficient and Robust Road Segmentation
Authors: Zhou Yunjiao , Yang Jianfei , Cao Haozhi , Zeng Zhaoyang , Zou Han , Xie Lihua
Published: November 2023

Road segmentation is essential to unmanned systems, contributing to road perception and navigation in the field of autonomous driving. While multi-modal road segmentation methods have shown promising results by leveraging the complementary data of RGB and Depth to provide robust 3D geometry information, existing methods suffer from severe efficiency problems that hinder their practical application in autonomous driving. Their direct concatenation of multi-modal features with a densely-connected network leads to increased semantic gaps among modalities and scales, causing high computational and time complexity. To address these issues, we propose a Multi-modal Scale-aware Attention Network (MSAN) to fuse RGB and Depth data effectively via a novel transformer-based cross-attention module, namely Multi-modal Scare-aware Transformer (MST), which fuses RGB-D features from a global perspective across multiple scales. To better consolidate different scales of features, we further propose a Scale-aware Attention Module (SAM) that captures channel-wise attention efficiently for cross-scale fusion. These two attention-based modules explore the complementarity of modalities and scales, narrowing the gaps and avoiding complex structures for road segmentation. Extensive experiments demonstrate MSAN achieves competitive performance at a low computational cost, suitable for real-time implementation on edge-devices in autonomous driving systems.
Sound Field Reconstruction Using Compressed Separable Projection-Based Equivalent Source Method
Authors: Shen Yang , Bi Chuan-Xing , Zhang Xiao-Zheng , Zhang Yong-Bin , Zhou Rong
Published: November 2023

The compressive-equivalent source method (C-ESM) has been developed for the sound field reconstruction by solving the [Formula: see text] minimization with the predetermined sparsity of the equivalent source strengths. However, the C-ESM would reconstruct the sound field with the error proportional to the measurement noise-related data fidelity constraint that increases with the decrease of the signal-to-noise ratio. Apart from that, the reconstruction stability of the C-ESM would not be guaranteed due to the existence of the measurement noise. To address such problem, the present paper proposes a compressed separable projection-based equivalent source method. In the method, the projections of the measured pressures in the predesigned basis that combines the priors of the sound radiation of the equivalent sources and the measurement noise are obtained by solving the [Formula: see text] minimization. This not only leads to the data fidelity constraint being small and unrelated to the measurement noise, but also separates the measurement noise from the measured sound field. Therefore, the proposed method can theoretically reconstruct the sound field more accurately and stably than the C-ESM. Numerical simulations and experiments are carried out to verify the effectiveness of the proposed method.
CADTrack: Instructions and Support for Orientation Disambiguation of Near-Symmetrical Objects
Authors: Evangelista Belo João Marcelo , Wissing Jon , Feuchtner Tiare , Grønbæk Kaj
Published: November 2023

Determining the correct orientation of objects can be critical to succeed in tasks like assembly and quality assurance. In particular, near-symmetrical objects may require careful inspection of small visual features to disambiguate their orientation. We propose CADTrack, a digital assistant for providing instructions and support for tasks where the object orientation matters but may be hard to disambiguate with the naked eye. Additionally, we present a deep learning pipeline for tracking the orientation of near-symmetrical objects. In contrast to existing approaches, which require labeled datasets involving laborious data acquisition and annotation processes, CADTrack uses a digital model of the object to generate synthetic data and train a convolutional neural network. Furthermore, we extend the architecture of Mask R-CNN with a confidence prediction branch to avoid errors caused by misleading orientation guidance. We evaluate CADTrack in a user study, comparing our tracking-based instructions to other methods to confirm the benefits of our approach in terms of preference and required effort.
Clarifying the Effect of Edge Targets in Touch Pointing through Crowdsourced Experiments
Authors: Usuba Hiroki , Yamanaka Shota , Sato Junichi
Published: November 2023

A prior work has recommended adding a 4-mm gap between a target and the edge of a screen, as tapping a target located at the screen edge takes longer than tapping non-edge targets. However, it is possible that this recommendation was created based on statistical errors, and unexplored situations existed in the prior work. In this study, we re-examine the recommendation by utilizing crowdsourced experiments to resolve the issues. If we observe the same results as the prior work through experiments including diversities, we can verify that the recommendation is suitable.
We found that increasing the gap between the target and the screen edge decreased the movement time, which was consistent with the prior work. In addition, we newly found that increasing the gap decreased the error rate as well. On the basis of these results, we discuss how the gap and the target should be designed.