bluuebunny/crossref_metadata_2025 huggingface dataset:
Gap distance dependence on field emission at the nanogap between silicon cleavage surfaces
Authors: Akura Yuki , Shimofuri Masaki , Banerjee Amit , Hirotani Jun , Tsuchiya Toshiyuki
Published: March 2023

In this study, we developed a model of field emission at a vacuum nanogap composed of semiconductor electrodes and conducted numerical calculations to evaluate its field emission characteristics. The current at the silicon nanogap was also measured, and the results were compared with the calculated results. Large-area vacuum nanogaps are expected to be used for highly efficient room-temperature thermionic power generation owing to their good thermal insulation, and their electrical conduction of tunneling current is sufficient for practical use. Because vacuum nanogaps should be parallel and smooth with a large area, we proposed and examined the use of cleavage to fabricate nanogaps in single-crystal materials. A nanogap with a nominal area of 26.5 μm2 was fabricated in a microelectromechanical device to evaluate its properties, and the model was used for the analysis. The calculated current–voltage characteristics of the semiconductor nanogap of both n-type and p-type silicon were affected by the bandgap and the presence of carriers, i.e., electrons and holes. Moreover, the Fowler–Nordheim plot was confirmed to be valid for semiconductor nanogaps based on the calculated results. We proposed an effective work function that compensates for the discrepancy between semiconductor nanogaps and the Fowler–Nordheim theory and enables a more accurate analysis. Field-emission currents flowing through a 1.1 nm nanogap were measured and matched with the calculated results by adjusting the field enhancement factor and emission area. The model developed and confirmed experimentally in this work will be helpful in examining field emissions at semiconductor nanogaps.
Layered piezoelectric structures with arbitrary acoustic termination impedances
Authors: Braun Stefan , Nowotny Helmut , Benes Ewald , Gröschl Martin
Published: March 2023

Multilayer piezoelectric transducers and resonators are widely used for generating propagating and standing acoustic waves as well as for sensor devices. More recently, layered piezoelectric structures based on thin film technology became increasingly important for electromechanical filters used in mobile phones. As a consequence, analytical mathematical modeling of such structures is of high interest. In this paper, a general rigorous transfer matrix description for one-dimensional (1D) layered structures consisting of piezoelectric, visco-elastic, and dielectric layers of arbitrary number is introduced to characterize the electrical and mechanical behavior of a general piezoelectric transducer or resonator with two electrodes and arbitrary acoustic termination impedances (Rig-1D-model). This model is the most general 1D analytical description of layered piezoelectric structures available and can be used for the characterization of various composite transducer and resonant sensor applications. Considered in detail are layered structures with the technically important cases of only one electromechanically coupled mode, and the structure at one or both outer surfaces is in contact with semi-infinite media. For such devices, it is shown how the frequency dependence of the total electrical admittance and spatial dependence of the displacements can be calculated.
Development and Validation of Single Items for Fatigue and Recovery in Dancers
Authors: Jeffries Annie C. , Novak Andrew R. , Coutts Aaron J. , McCall Alan , McLaren Shaun J. , Impellizzeri Franco M.
Published: March 2023

Purpose: To examine the construct validity and reliability of 2 single items for fatigue and recovery in dancers. The construct validity was assessed using reference instruments: the fatigue items of the Brunel Mood Scale (BRUMS) and the Short Recovery and Stress Scale (SRSS). A secondary aim was to explore the respondent interpretation of these 2 items using a concept identification approach. Methods: Two hundred forty-three (N = 243) dancers completed single-item fatigue and recovery (unipolar and bipolar), BRUMS, and SRSS once for construct validity. For reliability,  49 dancers completed the questionnaires twice, 1 week apart. Using a concept identification approach, 49 dancers were also asked comprehension and interpretation of fatigue and recovery. Results: The fatigue item correlated with SRSS stress items (rs = .37–.51) and BRUMs fatigue items (rs = .63–.66). The recovery item was only partially confirmed in terms of construct validity, when using the SRSS recovery items as reference (rs = .39–.43). Reliability was confirmed for the single items of fatigue (κ = .77–.78) and recovery (κ = .71–.78). Main responses for the concept of fatigue were tiredness (34.7%), muscle soreness (17.3%), and energy (13.0%). Main responses for the concept of recovery were muscle soreness (43.0%), tiredness (27.9%), and fatigue (24.0%). Conclusion: We provide preliminary confirmation of the validity and reliability of the single item fatigue in dancers. The recovery item was only partially confirmed in terms of construct validity, when using the SRSS recovery items as reference, but did display acceptable reliability and agreement. Further research is warranted further exploring other measurement properties.
Perception of Bar Velocity Loss in Resistance Exercises: Accuracy Across Loads and Velocity Loss Thresholds in the Bench Press
Authors: Dello Iacono Antonio , Watson Kevin , Marinkovic Milan , Halperin Israel
Published: March 2023

Purpose: Velocity-based training is used to prescribe and monitor resistance training based on velocity outputs measured with tracking devices. When tracking devices are unavailable or impractical to use, perceived velocity loss (PVL) can be used as a substitute, assuming sufficient accuracy. Here, we investigated the accuracy of PVL equal to 20% and 40% relative to the first repetition in the bench-press exercise. Methods: Following a familiarization session, 26 resistance-trained men performed 4 sets of the bench-press exercise using 4 different loads based on their individual load–velocity relationships (∼40%–90% of 1-repetition maximum [1RM]), completed in a randomized order. Participants verbally reported their PVL at 20% and 40% velocity loss during the sets. PVL accuracy was calculated as the absolute difference between the timing of reporting PVL and the actual repetition number corresponding to 20% and 40% velocity loss measured with a linear encoder. Results: Linear mixed-effects model analysis revealed 4 main findings. First, across all conditions, the absolute average PVL error was 1 repetition. Second, the PVL accuracy was not significantly different between the PVL thresholds (β = 0.16, P = .267). Third, greater accuracy was observed in loads corresponding to the midportion of the individual load–velocity relationships (∼50%–60% 1RM) compared with lighter (<50% 1RM, β = 0.89, P < .001) and heavier loads (>60% 1RM, 0.63 ≤ β ≤ 0.84, all P values < .001). Fourth, PVL accuracy decreased with consecutive repetitions (β = 0.05, P = .017). Conclusions: PVL can be implemented as a monitoring and prescription method when velocity-tracking devices are impractical or absent.
Changes in Sprint Force–Velocity Profile in International Para Footballers
Authors: Peña-González Iván , Javaloyes Alejandro , Sarabia Jose Manuel , Moya-Ramón Manuel
Published: March 2023

Purpose: Force production is crucial in football, and it is the main limitation of people with cerebral palsy (CP). This study aimed to describe the changes in sprint force–velocity (Fv) profile after a period of 25 weeks of regular training in international football players with CP. Methods: The sprint Fv profile and other physical performance variables (ie, linear sprint, vertical jump, change of direction, and intermittent endurance) of 14 international players from the Spanish national team were assessed during 2 consecutive training camps. Pretesting and posttesting sessions were carried out 1 week before and after the 25-week intervention period. The intervention consisted of 2 strength sessions per week added to the usual football training. Results: The repeated-measures analysis of variance showed changes in players’ physical performance (linear sprint: F = 18.05, P < .01; change of direction: F = 16.71, P < .01; and endurance: F = 31.45, P < .01) and in some variables of the sprint Fv profile (maximal horizontal force, maximal power, slope, maximal ratio of force, and decrease of ratio of force; F = 14.28–37.81; P < .01), whereas players’ maximal velocity (theoretical and actual) did not change (F = 0.13 and 0.01; P = .72 and .98, respectively). Conclusions: This study showed that the implementation of 2 strength-training sessions per week, for 25 weeks, is effective to improve CP football players’ physical performance. The main finding of this study is the improvement of force application in the acceleration phase (sprint Fv profile), which is the main attribute in many physical performance tests and is the main limitation of the CP population.
Association Between Domain-Specific Physical Activity and Chronic Low Back Pain in Community-Dwelling Older Adults: A Cross-Sectional Study
Authors: Martins Michael Douglas da Silva , Lemes Ítalo Ribeiro , Esposito Eleonora , Morelhão Priscila Kalil , Narciso Pedro Henrique , Franco Márcia Rodrigues , Pinto Rafael Zambelli
Published: March 2023

To investigate the association between physical activity (PA) domains and chronic low back pain (LBP) in older adults. A cross-sectional study where sociodemographic, behavioral, and health variables; PA; and presence of chronic LBP were collected. Higher scores of PA defined the “more active” participants. Binary logistic regression was used to test the association between PA domains and chronic LBP. A total of 516 participants were included. The mean age was 71.8 (95% confidence interval, CI, [71.1, 72.5]) years, and 29%, 27%, 25%, and 31% were identified as “more active” in the household, sports, leisure-time, and total PA domains, respectively. “More active” participants in sports (odds ratio = 0.62, 95% CI [0.40, 0.97]), leisure-time (odds ratio = 0.54, 95% CI [0.35, 0.85]) and total (odds ratio = 0.60, 95% CI [0.39, 0.92]) PA domains were less likely to report chronic LBP. High levels of sports, leisure-time, and total PA were inversely associated with chronic LBP.
Geometric deep optical sensing
Authors: Yuan Shaofan , Ma Chao , Fetaya Ethan , Mueller Thomas , Naveh Doron , Zhang Fan , Xia Fengnian
Published: March 2023

Geometry, an ancient yet vibrant branch of mathematics, has important and far-reaching impacts on various disciplines such as art, science, and engineering. Here, we introduce an emerging concept dubbed “geometric deep optical sensing” that is based on a number of recent demonstrations in advanced optical sensing and imaging, in which a reconfigurable sensor (or an array thereof) can directly decipher the rich information of an unknown incident light beam, including its intensity, spectrum, polarization, spatial features, and possibly angular momentum. We present the physical, mathematical, and engineering foundations of this concept, with particular emphases on the roles of classical and quantum geometry and deep neural networks. Furthermore, we discuss the new opportunities that this emerging scheme can enable and the challenges associated with future developments.
Phosphorus in all its forms
The Devil’s Element: Phosphorus and a World Out of Balance
Dan Egan
Norton, 2023. 256 pp.
Authors: Howarth Robert W.
Published: March 2023

Limited availability and unwanted effects render the mineral’s future uncertain, despite its agricultural importance
Straight from the heart
Authors: Leslie Mitch
Published: March 2023

Lipids called ceramides may be better predictors of cardiovascular problems than cholesterol. Doctors and pharma are waking up to their potential
Seawater splitting could help green hydrogen grow
Authors: Service Robert F.
Published: March 2023

Corrosion-proof electrolyzers could tap ample supplies of saltwater
Biden backs science in 2024 spending blueprint
Authors: Mervis Jeffrey
Published: March 2023

But Congress will have its own views on setting funding levels for research agencies
Connecting Ethical Reasoning to Global Challenges through Analysis of Argumentation
Authors: Sjogren Caroline A. , Comstock Gary , Goller Carlos C.
Published: March 2023

Scientific literacy is built on critical thinking. The postbaccalaureate workforce enhances our economies and societies by contributing a wealth of knowledge and skill sets to local communities, respective industries, and beyond as our world becomes increasingly interconnected.
Near-Complete Genome Sequence of Lötschberg Virus (
Mononegavirales
:
Filoviridae
) Identified in European Perch (Perca fluviatilis Linnaeus, 1758)
Authors: Seuberlich Torsten , Kuhn Jens H. , Schmidt-Posthaus Heike
Published: March 2023

We obtained the near-complete genome sequence of a novel virus, Lötschberg virus (LTBV), from a European perch metatranscriptome. Genome organization and pairwise sequence comparison indicated that LTBV represents a tentative new species and genus of the mononegaviral family
Filoviridae.
Exhumed fluvial landforms reveal evolution of late Eocene–Pliocene rivers on the Central and Northern Great Plains, USA
Authors: Korus Jesse T. , Joeckel R.M.
Published: March 2023

Cenozoic strata on the Great Plains are the products of a longlived, continental sediment routing system, and yet strikingly little is known about these ancient rivers. This article details the discovery of ~3100 fluvial ridges—erosionally inverted alluvial-fan, channel-fill, channel-belt, and valley-fill deposits—extending from the Rocky Mountain front to the eastern margin of the Great Plains. The direct detection of these channel bodies reveals new insights into late Eocene–Pliocene drainage evolution. Late Eocene–Oligocene streams were morphologically diverse. Alluvial fans adjacent to the Rocky Mountain front changed eastward to parallel or downstream-divergent, fixed, single-thread, straight to slightly sinuous (S = 1.0–1.5) streams <50 m in width. At ~100 km from the Rocky Mountain front, streams became sinuous and laterally mobile, forming amalgamated channel bodies as much as 3 km in width. Streamflow in all these systems was highly dispersed (southeast to northeast) and temporally variable. These characteristics reveal a nascent Great Plains alluvial apron hosting small, poorly integrated drainages undergoing abrupt changes. By the Miocene, more uniform streamflow generally trended east-northeast. Channel deposits are identifiable 500 km from the Rocky Mountain front. Middle Miocene valley fills gave way to fixed, multithread channels a few kilometers in width by the late Miocene. These patterns evince a mature alluvial apron hosting bigger rivers in well-integrated drainages. We interpret the systematic changes between fixed and mobile channel styles to record spatially and temporally variable aggradation rates. The widening of channels in the late Miocene likely reflects increased discharge relating to wetter climates upstream or the integration of once-isolated Rocky Mountain drainage basins into a continental-scale drainage system.
Navigating the unknown: understanding and managing parental anxiety when a child is ill
Authors: Simoens Elise , Michiels Lauren , Toelen Jaan , de Winter Peter
Published: March 2023

Background

Parents are often confronted with a difficult decision when their child falls ill: should they go to the general practitioner (GP) or not? This study aims to describe this process comprehensively in order to allow clinicians to assess the extent to which parents can recognise clinical warning signs and act accordingly. The purpose of this study is to describe parents’ decision-making processes when deciding whether or not to consult a GP for their sick child.

Methods

We used a qualitative study design based on semistructured interviews to investigate the decision-making process of 25 parents. Four case scenarios describing a developing illness in a child were presented.

Results

Parents’ reasons for seeking medical attention could be divided into two main categories. First, non-specific fears lead parents to consult a doctor. Parents were alarmed by the persistence and progression of symptoms, the combination of symptoms or changes in their child’s behaviour or they needed reassurance. Second, several specific fears were identified. Sometimes, parents fear a specific disease, while at other times, they are concerned about warning signs. Some parents, however, would not seek medical attention at any decision point even though their child could be in a potentially life-threatening situation.

Conclusions

Although parents make carefully considered decisions on whether or not to consult a doctor, many appear to miss red flags, including more experienced parents. Conversely, some become overly concerned with certain specific symptoms such as fever, and few parents are familiar with self-management strategies.
Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed-methods pilot study
Authors: Humphries Brittany , León-García Montserrat , Bates Shannon M , Guyatt Gordon , Eckman M H , D'Souza Rohan , Shehata Nadine , Jack Susan M , Alonso-Coello Pablo , Xie Feng
Published: March 2023

Objectives

To gain insight into formal methods of integrating patient preferences and clinical evidence to inform treatment decisions, we explored patients’ experience with a personalised decision analysis intervention, for prophylactic low-molecular-weight heparin (LMWH) in the antenatal period.

Design

Mixed-methods explanatory sequential pilot study.

Setting

Hospitals in Canada (n=1) and Spain (n=4 sites). Due to the COVID-19 pandemic, we conducted part of the study virtually.

Participants

15 individuals with a prior venous thromboembolism who were pregnant or planning pregnancy and had been referred for counselling regarding LMWH.

Intervention

A shared decision-making intervention that included three components: (1) direct choice exercise; (2) preference elicitation exercises and (3) personalised decision analysis.

Main outcome measures

Participants completed a self-administered questionnaire to evaluate decision quality (decisional conflict, self-efficacy and satisfaction). Semistructured interviews were then conducted to explore their experience and perceptions of the decision-making process.

Results

Participants in the study appreciated the opportunity to use an evidence-based decision support tool that considered their personal values and preferences and reported feeling more prepared for their consultation. However, there were mixed reactions to the standard gamble and personalised treatment recommendation. Some participants could not understand how to complete the standard gamble exercises, and others highlighted the need for more informative ways of presenting results of the decision analysis.

Conclusion

Our results highlight the challenges and opportunities for those who wish to incorporate decision analysis to support shared decision-making for clinical decisions.
Assessment of a primary care e-support package of automated case finding, simplified treatment algorithm and decision support to increase hepatitis B treatment uptake in primary care clinics in Australia (SIMPLY-B Study): protocol for a pilot evaluation
Authors: Moussa Dina , Wallace Jack , Manski-Nankervis Jo-Anne , Doyle Joseph S , Nguyen Long , Boyle Douglas , Stoové Mark A , Asselin Jason , Valaydon Zina , Ahad Marvad , Glasgow Susanne , New Kate , Hocking Jane S , Sanci Lena , Thompson Alexander , Hellard Margaret , Howell Jess
Published: March 2023

Introduction

Despite the availability of effective, subsidised hepatitis B treatment, linkage to care and treatment rates remain very low globally. In Australia, specially trained primary care physicians (general practitioner, GPs) can prescribe hepatitis B treatment, however, most hepatitis B care occurs in specialist clinics. Increasing hepatitis B management by GPs in primary care clinics is essential to achieve national hepatitis B linkage to care and treatment targets by 2030.

This pilot study determines the feasibility, acceptability and effectiveness of Simply B, a novel GP hepatitis B e-support package designed to increase hepatitis B management by GPs in primary care clinics.

Methods and analysis

This study will be conducted in three parts:

Part A: A prospective open-label pilot intervention study, comparing the proportion of people with hepatitis B who are managed by their GP in primary care clinics before, 12 months and 24 months after implementation of the Simply B electronic hepatitis B support package.

Part B: A nested qualitative health services feasibility study using semistructured interviews and thematic analysis

Part C: Cost-effectiveness analysis.

Ethics and dissemination

This study has received ethics approval by St Vincent’s Hospital. Data management and analysis will be centralised through the Department of Gastroenterology, St Vincent’s Hospital.

Trial registration number

NCT05614466.
Effect of oral pre-emptive analgesia on pain management after total knee arthroplasty: a protocol for systematic review and meta-analysis
Authors: Xiong Fan-jie , Zhao Wei , Jia Shi-jian , Huang Xiao-rong , Luo Xiang-fei , Pu Hong-jiang , Song Kai , Li Yan-ming
Published: March 2023

Introduction

Total knee arthroplasty (TKA) is currently regarded as an effective treatment for knee osteoarthritis, relieving patients’ pain and significantly enhancing their quality of life and activity levels, allowing them to return to work and daily life after surgery. However, some TKA patients suffer from varying degrees of postoperative residual pain and opioid abuse, which negatively impacts their recovery and quality of life. It has been reported that preoperative treatment with multimodal analgesics improves postoperative pain and reduces opioid consumption. However, there is no conclusive evidence that pre-emptive analgesia provides the same benefits in TKA. In order to inform future research, this protocol focuses on the efficacy and safety of oral analgesics used in TKA pre-emptive analgesia.

Methods and analysis

We will search the literature on the involvement of pre-emptive analgesia in the management of pain in TKA from the PubMed, EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, from their inception to 1 February 2023. Additionally, clinical registry platforms will be investigated to collect data for ongoing studies. Using the Cochrane Risk of Bias Tool, the quality assessment will be conducted. RevMan V.5.4 will be used for the meta-analysis. The statisticI2will be used to measure the percentage of total variability due to heterogeneity between studies. Where appropriate, subgroup and sensitivity analyses, assessment of evidence quality and publication bias will be conducted.

Ethics and dissemination

No ethical approval and consent is required for this systematic review. Moreover, the results of this systematic review will be disseminated through peer-reviewed publications and conference presentations.

PROSPERO registration number

CRD42022380782.
Emergency medical services and palliative care: a scoping review
Authors: Gage Caleb Hanson , Stander Charnelle , Gwyther Liz , Stassen Willem
Published: March 2023

Objectives

The aim of this study was to map existing emergency medical services (EMS) and palliative care literature by answering the question, what literature exists concerning EMS and palliative care? The sub-questions regarding this literature were, (1) what types of literature exist?, (2) what are the key findings? and (3) what knowledge gaps are present?

Design

A scoping review of literature was performed with an a priori search strategy.

Data sources

MEDLINE via Pubmed, Web of Science, CINAHL, Embase via Scopus, PsycINFO, the University of Cape Town Thesis Repository and Google Scholar were searched.

Eligibility criteria for selecting studies

Empirical, English studies involving human populations published between 1 January 2000 and 24 November 2022 concerning EMS and palliative care were included.

Data extraction and synthesis

Two independent reviewers screened titles, abstracts and full texts for inclusion. Extracted data underwent descriptive content analysis and were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines.

Results

In total, 10 725 articles were identified. Following title and abstract screening, 10 634 studies were excluded. A further 35 studies were excluded on full-text screening. The remaining 56 articles were included for review. Four predominant domains arose from included studies: (1) EMS’ palliative care role, (2) challenges faced by EMS in palliative situations, (3) EMS and palliative care integration benefits and (4) proposed recommendations for EMS and palliative care integration.

Conclusion

EMS have a role to play in out-of-hospital palliative care, however, many challenges must be overcome. EMS provider education, collaboration between EMS and palliative systems, creation of EMS palliative care guidelines/protocols, creation of specialised out-of-hospital palliative care teams and further research have been recommended as solutions. Future research should focus on the prioritisation, implementation and effectiveness of these solutions in various contexts.
Time is tissue. Want to save millions in wound care? Start early: a QI project to expedite referral of high-risk wound care patients to specialised care
Authors: Hwang John Muen
Published: March 2023

Introduction

Wound care is a multibillion-dollar industry, and most research and treatment are geared towards late-stage or end-stage care. The longer a patient has a wound, the more likely it is that complications (like sepsis or vascular compromise) will occur that will both extend treatment and multiply costs. We postulated that much of the suffering and healthcare costs of chronic wounds could be avoided by early identification of high-risk patients and subsequent earlier intervention. In an established regional wound clinic, our aim was to decrease referral times by 50% within 1 year, and to demonstrate the beneficial outcomes on wound healing and total cost of care.

Methods

A prospective interventional quality improvement study was performed between June 2017 and June 2018. We determined baseline referral times to the clinic and then performed three interventions. The effects on referral time, healing time and number of home care visits to achieve wound healing were collected and displayed on annotated control charts. The cost of care and potential for cost avoidance was determined by an analysis of the medical encounters of twenty chronic wound patients.

Results

We achieved a 53.6% reduction in average referral times to the clinic, a 59.6% reduction in average healing times and a 66.0% reduction in the average number of home care visits required to achieve healing. Our cost analysis suggested the potential for significant cost avoidance (87.7%) compared with delayed treatment outside the clinic.

Conclusions

Early identification and treatment of patients at high risk for wound chronicity and complications, followed by early referral to and treatment at a specialised wound clinic, resulted in faster healing and reduced health system costs.
Role of percutaneous coronary intervention in the modern-day management of chronic coronary syndrome
Authors: Cartlidge Timothy , Kovacevic Mila , Navarese Eliano Pio , Werner Gerald , Kunadian Vijay
Published: March 2023

Contemporary randomised trials of percutaneous coronary intervention (PCI) in chronic coronary syndrome (CCS) demonstrate no difference between patients treated with a conservative or invasive strategy with respect to all-cause mortality or myocardial infarction, although trials lack power to test for individual endpoints and long-term follow-up data are needed. Open-label trials consistently show greater improvement in symptoms and quality of life among patients with stable angina treated with PCI. Further studies are awaited to clarify this finding. In patients with severe left ventricular (LV) systolic dysfunction and obstructive coronary artery disease in the Revascularization for Ischemic Ventricular Dysfunction trial, PCI has not been found to improve all-cause mortality, heart failure hospitalisation or recovery of LV function when compared with medical therapy. PCI was, however, performed without additional hazard and so remains a treatment option when there are favourable patient characteristics. The majority of patients reported no angina, and the low burden of angina in many of the randomised PCI trials is a widely cited limitation. Despite contentious evidence, elective PCI for CCS continues to play a significant role in UK clinical practice. While PCI for urgent indications has more than doubled since 2006, the rate of elective PCI remains unchanged. PCI remains an important strategy when symptoms are not well controlled, and we should maximise its value with appropriate patient selection. In this review, we provide a framework to assist in critical interpretation of findings from most recent trials and meta-analysis evidence.
Microvesicular hyperplastic polyp and sessile serrated lesion of the large intestine: a biological continuum or separate entities?
Authors: Bateman Adrian C , Booth Adam L , Gonzalez Raul S , Shepherd Neil A
Published: March 2023

The range of lesions with a serrated appearance within the large intestine has expanded and become more complex over the last 30 years. The majority of these were previously known as metaplastic polyps but are today called hyperplastic polyps (HPs). HPs show two main growth patterns: microvesicular and goblet cell-rich. The former type shows morphological and molecular similarities (eg,BRAFmutations) to the more recently described sessile serrated lesion (SSL). In this review, we debate whether these lesions represent a biological spectrum or separate entities. Whichever view is held, microvesicular HPs and SSLs are distinct from the goblet cell-rich HP and the traditional serrated adenoma (TSA), which may themselves share molecular changes (eg,KRASmutations), with the goblet cell-rich HP representing a precursor to the TSA. Both SSLs and the goblet cell-rich HP-TSA pathway are routes to colorectal cancer within the serrated pathway and overlaps between them can occur, for example, a (BRAF-mutated) TSA may arise from an SSL.
Impact of alcohol taxes on violence in Hong Kong: a population-based interrupted time series analysis
Authors: Ng Carmen S , Au Minnie , Tian Linwei , Quan Jianchao
Published: March 2023

Background

Interpersonal violence is a major public health concern with alcohol use a known risk factor. Despite alcohol taxation being an effective policy to reduce consumption; Hong Kong, contrary to most developed economies, embarked on an alcohol tax reduction and elimination policy.

Methods

To assess the impact of the alcohol tax reductions, we analysed population-based hospitalisation data for assault from the Hong Kong Hospital Authority, and violent and sexual crimes recorded by the Hong Kong Police Force (2004–2018). We conducted an interrupted time series using seasonal autoregressive integrated moving average models on monthly rates. Breakpoints in March 2007 and March 2008 were applied separately.

Results

The 2007 tax cut was associated with sustained increases in violence-related hospitalisation rates for 35–49 age group (female: 0.19%, p=0.007; male: 0.22%, p<0.001; overall: 0.16%, p=0.007); and an immediate increase of 51.3% (p=0.005) in the rate of sexual crimes reported. Results for the 35–49 age group after the 2008 tax cut were similar with sustained increases in hospitalisation rates (female: 0.21%, p=0.010; male: 0.23%, p<0.001; overall: 0.17%, p<0.001). The 2008 tax cut was also associated with immediate increases in hospitalisation rates in children (female: 33.1%, p=0.011; male: 49.2%, p<0.001, overall: 31.5%, p=0.007). For both tax cuts, results were insignificant in males and females for other age groups (15–34 and 50+ years).

Conclusions

Both alcohol tax reductions in 2007 and 2008 were in some age groups associated with increases in violence-related hospitalisations and reports of sexual assault even in an environment of low crime.
Poor adherence to dust, noise and safety regulations predict injury rates in underground coal mines
Authors: Friedman Lee S , Shannon Brett , Go Leonard H T , Shao Yuan , Almberg Kirsten S , Cohen Robert A
Published: March 2023

Background

While safety in US coal mining has improved over the past two decades, general occupational health research shows that risk of injury varies across individual worksites and is influenced by worksite safety cultures and practices.

Methods

In this longitudinal study, we evaluated whether mine-level characteristics reflecting poor adherence to health and safety regulations in underground coal mines are associated with higher acute injury rates. We aggregated Mine Safety and Health Administration (MSHA) data by year for each underground coal mine for the period 2000–2019. Data included part-50 injuries, mine characteristics, employment and production, dust sampling, noise sampling, and violations. Multivariable hierarchical generalised estimating equations (GEE) models were developed.

Results

Based on the final GEE model, despite an average annual decline in injury rates by 5.5%, the following indicators of inadequate adherence to health and safety regulations were associated with increased average annual injury rates: +2.9% for each 10% increase in dust samples exceeding the permissible exposure limit; +0.6% for each 10% increase of permitted 90 dBA 8-hour noise exposure dose; +2.0% for every 10 substantial-significant MSHA violations in a year; +1.8% for each rescue/recovery procedure violation; +2.6% for each safeguard violation. If a fatality occurred in a mine, injury rates increased by 11.9% in the same year, but declined by 10.4% in the following year. The presence of safety committees was associated with a 14.5% decline in injury rates.

Discussion

In US underground coal mines, injury rates are associated with poor adherence to dust, noise and safety regulations.
Late-onset and classic phenotypes of Fabry disease in males with theGLA-Thr410Ala mutation
Authors: Valtola Kati , Hedman Marja , Kantola Ilkka , Walls Susanne , Helisalmi Seppo , Maria Maleeha , Raivo Joose , Auray-Blais Christiane , Kuusisto Johanna
Published: March 2023

Objective

To present phenotypic characteristics and biomarkers of a family with the rare mutation Thr410Ala of theα-galactosidase Agene (T410A/GLA) causing Fabry disease (FD).

Methods and results

In a woman in her 60s with hypertrophic cardiomyopathy, T410A/GLAwas found in screening for variants in 59 cardiomyopathy-related genes. Her son in his 40s, two granddaughters and two great grandsons carried T410A/GLA. The son had a history of hypertension and paroxysmal AF but no microalbuminuria or classic symptoms or signs of FD. Baseline α-galactosidase A enzyme (α-Gal A) activity varied from 0% to 26.5%. Cardiac MRI showed mild Fabry cardiomyopathy (FC). During 11 years of enzyme replacement therapy (ERT), FC progressed and he suffered sudden cardiac death in his 50s. The great grandsons with T410A/GLAhad no active α-Gal A, high lyso-Gb3levels and normal cardiac imaging. They suffered from neuropathic pain and gastrointestinal symptoms and were started with ERT at the age under 10. Granddaughters with T410A/GLAhad α-Gal A activities of 8–18 and 10% of normal. The older granddaughter in her 30s was diagnosed with incipient FC. Plasma lyso-Gb3analogues were elevated, markedly in the elder male with FC and moderately in the elder granddaughter. In young males with classic phenotype, plasma lyso-Gb3analogues were only slightly elevated.

Conclusions

The T410A/GLAmutation caused late-onset FD with progressive cardiomyopathy in elder male, and classic FD in young males of the same family. Varying levels of α-Gal A and lyso-Gb3analogues reflected variable phenotype of FD in the family.
Serum B-type natriuretic peptide levels (BNP) can be used as a predictor of complications in patients undergoing non-cardiac surgery: a prospective observational study
Authors: Singh Abhishek , Kumar Anil , Hai Ahmed Abdul , Masihullah Masihullah , Tripathy Nishant , Singh Pintu Kumar
Published: March 2023

Objectives

Worldwide, an estimated 10 million adults annually experience significant myocardial injury after non-cardiac surgery. Our aim is to assess whether preoperative and postoperative serum B-type natriuretic peptides levels (BNP) could be used as a predictor of postoperative complications in hypertensive and diabetic patients post non-cardiac surgery.

Design

Prospective observational study.

Setting

Single tertiary-care centre in northern India.

Participants

This study included 260 adult participants with known hypertension and diabetes who were planned for elective non-cardiac surgery.

Interventions

A preoperative BNP level (baseline BNP) was measured within 24 hours of surgery and another postoperative BNP level was measured within 24 hours of surgery.

Main outcome measures

The primary outcome was the change in BNP levels (delta BNP) between the postoperative and the preoperative BNP levels (baseline BNP) with respect to the baseline BNP and the development of postoperative complications within 30 days of surgery.

Results

The study established a correlation between delta BNP and baseline BNP (Pearson’s correlation coefficient=0.60; p=0.01). Our study found an increased serum BNP both in the preoperative period and the postoperative period in the patient group that developed complications, respectively (152.02 pg/mL±106.56 vs 44.90 pg/mL±44.22; t=4.120; p≤0.001); (313.99 pg/mL±121.29 vs 83.95 pg/mL±70.19; t=7.73; p≤0.001).

Conclusions

We found that an increased serum baseline and postoperative BNP is potentially important predictor for the development of postoperative complications. Serum BNP has the potential to emerge as a cost-effective test for risk-stratification for postoperative complications in patients undergoing non-cardiac surgery. It has promising prognostic advantages including modification of surgical procedures, deferral of surgery and the ability to tailor therapy postoperatively.
Crystallization of short-acting and intermediate-acting local anesthetics when mixed with adjuvants: a semiquantitative light microscopy analysis
Authors: Hoerner Elisabeth , Stundner Ottokar , Fiegl Heidi , Gasteiger Lukas
Published: March 2023

Introduction

The addition of adjuvants to short-acting local anesthetics (LA) is common practice in clinical routine to speed up block onset and decrease pain on injection. In a previous study, we observed the development of microscopic crystal precipitations after bupivacaine or ropivacaine were mixed with adjuvants; this follow-up study is intended to clarify whether crystallization (A) also occurs in short-acting or intermediate-acting LA-adjuvant mixtures, (B) changes over time, and (C) is associated with the solutions’ pH.

Methods

Lidocaine 2%, prilocaine 2%, mepivacaine 2%, procaine 2% and chloroprocaine 2% were individually mixed with clonidine, dexamethasone, dexmedetomidine, epinephrine, fentanyl, morphine or sodium bicarbonate 8.4% in clinically established ratios. For each mixture, we measured initial pH and recorded crystallization patterns at 0, 15, 30 and 60 min using a standardized, semiquantitative light microscopy approach.

Results

Lidocaine 2% and mepivacaine 2% plus sodium bicarbonate 8.4%, and mepivacaine 2% plus dexamethasone developed delayed grade 5 crystallization over 1 hour. Prilocaine-based, procaine-based and chloroprocaine-based mixtures showed much less pronounced crystallization, with a maximum of grade 2. Initial pH and grade of crystallization showed weak monotonic relationships at time points t0, t15and t30(ρ=−0.17, 0.31 and 0.32, (all p>0.05)) and a moderate relationship time point t60(ρ=0.57 (p=0.0003))

Conclusions

Our study revealed high grades of crystallization in lidocaine/mepivacaine-bicarbonate and mepivacaine-dexamethasone mixtures, although these were previously considered safe for local, perineural or neuraxial use. Our findings cast particular doubt on the safety of preparing these formulations for later use.
Work participation in patients with axial spondyloarthritis: high prevalence of negative workplace experiences and long-term work impairment
Authors: Kiltz Uta , Hoeper Kirsten , Hammel Ludwig , Lieb Sebastian , Hähle Andreas , Meyer-Olson Dirk
Published: March 2023

Introduction

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that typically affects people in their second and third decades of life, which are important years for establishing a professional career. We aim to study outcomes of work participation (WP) and their associations with demographic and clinical confounders, in addition to prevalence of negative workplace experiences in axSpA.

Methods

In total, 770 patients with axSpA participated in the multicentre, observational ATTENTUS–axSpA survey in Germany. Demographic information, clinical parameters and patient-related outcomes (including disease activity and function) with a focus on WP were prospectively recorded.

Results

A high prevalence of negative workplace experiences was reported among the 770 patients analysed. Overall, 23.4% of patients were not employed and 6.5% received disability pensions. Current work cessation was prevalent in 120 patients, and 28 of those were out of work for 10 years or longer. Of the 590 currently employed patients, 31.9% reported absenteeism and 35.9% reported presenteeism for >1 month within the past year. Multivariate logistic regression identified low disease activity (Bath Ankylosing Spondylitis Disease Activity Index), better physical function (Bath Ankylosing Spondylitis Functional Index) and better global functioning (Assessment of SpondylAarthritis International Society–Health Index) as the main predictors for unimpaired WP (n=242). Importantly, biological treatment, disease duration, age, sex, education level and body mass index were not reliable predictors.

Discussion

Despite improvements in pharmacological treatment options, we still observed substantially impaired WP in patients with axSpA. These data emphasise the high unmet need for targeted strategies to provide improved medical and social care.
Impact of patient ancestry on heterogeneity of Sjögren’s disease
Authors: Beydon Maxime , Seror Raphaele , Le Guern Véronique , Chretien Pascale , Mariette Xavier , Nocturne Gaetane
Published: March 2023

Objectives

We aimed to compare disease characteristics between primary Sjögren’s syndrome (pSS) patients of African ancestry (AA) and Caucasian ancestry.

Methods

We conducted a retrospective, case–control study in a French national and European referral centre for pSS. All patients with pSS of AA were matched with two Caucasians patients having similar follow-up duration. We explored clinical and biological parameters associated with a cumulative EULAR Sjögren’s Syndrome Disease Activity Index (cumESSDAI ≥5) (consisting of individual clinESSDAI domain maximum throughout follow-up).

Results

We identified 74 patients of AA matched with 148 Caucasian. Median age at pSS diagnosis was younger in AA patients (43 years (IQR 33–51) vs 56 years (44.8–59.2), p<0.001). AA patients presented higher median titre of gammaglobulins (18.5 g/L (IQR 15–22.8) vs 13.4 g/L (9.9–16.9), p<0.001), more frequently positive for anti-SSA (88% vs 72%, p=0.007) and anti-RNP (11% vs 2.7%, p=0.023) antibodies. During the follow-up (median: 6 years (IQR 2–11)), AA patients presented more systemic complications: arthritis, myositis, interstitial lung disease, lymphadenopathy, central nervous system involvement. Median cumESSDAI score was higher in AA patients (7.5 (IQR 3.2–16.0) vs 4.0 (IQR 2.0–9.0), p=0.002). Interestingly, in multivariate analyses, factors associated with disease activity were sub-Saharan AA (OR 2.65 (95% CI 1.06 to 6.94)), rheumatoid factor (OR 2.50 (95% CI 1.28 to 4.96)) and anti-RNP positivity (OR 11.1 (95% CI 1.88 to 212)).

Conclusion

Patients of AA display higher disease activity with a hallmark of higher B-cell activation. Studies to investigate biological drivers behind such differences are needed.
Measuring quality STI care among adolescent female primary care patients in Philadelphia
Authors: Teixeira da Silva Daniel , Makeneni Spandana , Wall Hannah , Bauermeister José A. , Wood Sarah
Published: March 2023

Objectives

Engagement in guideline-recommended sexually transmitted infection (STI) care is fundamental to ending the STI epidemic in the USA. However, the US 2021–2025 STI National Strategic Plan and STI surveillance reports do not include a framework to measure quality STI care delivery. This study developed and applied an STI Care Continuum that can be used across settings to improve STI care quality, assess adherence to guideline-recommended care and standardise the measurement of progress towards National Strategic goals.

Methods

Review of the Centers for Disease Control and Prevention STI Treatment guidelines identified seven distinct steps of STI care for gonorrhoea, chlamydia and syphilis: (1) STI testing indication, (2) STI test completion, (3) HIV testing, (4) STI diagnosis, (5) partner services, (6) STI treatment and (7) STI retesting. Steps 1–4, 6 and 7 for gonorrhoea and/or chlamydia (GC/CT) were measured among females aged 16–17 years with a clinic visit at an academic paediatric primary care network in 2019. We used Youth Risk Behavior Surveillance Survey data to estimate step 1, and electronic health record data for steps 2, 3, 4, 6 and 7.

Results

Among 5484 female patients aged 16–17 years, an estimated 44% had an STI testing indication. Among those patients, 17% were tested for HIV, of whom none tested positive, and 43% were tested for GC/CT, 19% of whom were diagnosed with GC/CT. Of these patients, 91% received treatment within 2 weeks and 67% were retested within 6 weeks to 1 year after diagnosis. On retesting, 40% were diagnosed with recurrent GC/CT.

Conclusions

Local application of an STI Care Continuum identified STI testing, retesting and HIV testing as areas for improvement. The development of an STI Care Continuum identified novel measures for monitoring progress towards National Strategic indicators. Similar methods can be applied across jurisdictions to target resources, standardise data collection and reporting and improve STI care quality.