bluuebunny/crossref_metadata_2025 huggingface dataset:
High CD4‐to‐CD8 ratio identifies an at‐risk population susceptible to lethal COVID‐19
Authors: De Zuani Marco , Lazničková Petra , Tomašková Veronika , Dvončová Martina , Forte Giancarlo , Stokin Gorazd Bernard , Šrámek Vladimir , Helán Martin , Frič Jan
Published: December 2021

Around half of people with severe COVID‐19 requiring intensive care unit (ICU) treatment will survive, but it is unclear how the immune response to SARS‐CoV‐2 differs between ICU patients that recover and those that do not. We conducted whole‐blood immunophenotyping of COVID‐19 patients upon admission to ICU and during their treatment and uncovered marked differences in their circulating immune cell subsets. At admission, patients who later succumbed to COVID‐19 had significantly lower frequencies of all memory CD8+ T cell subsets, resulting in increased CD4‐to‐CD8 T cell and neutrophil‐to‐CD8 T cell ratios. ROC and Kaplan‐Meier analyses demonstrated that both CD4‐to‐CD8 and neutrophil‐to‐CD8 ratios at admission were strong predictors of in‐ICU mortality. Therefore, we propose the use of the CD4‐to‐CD8 T cell ratio as a marker for the early identification of those individuals likely to require enhanced monitoring and/or pro‐active intervention in ICU.
Effects of caffeine on rate of force development: A meta‐analysis
Authors: Grgic Jozo , Mikulic Pavle
Published: December 2021

This review aimed to conduct a meta‐analysis of studies examining the effects of caffeine on rate of force development (RFD). Ten databases were searched to find relevant studies. Risk of bias (RoB) of the included studies was evaluated. Data were analyzed in a random‐effects meta‐analysis. Eleven studies with “some concerns” regarding RoB were included. In the main meta‐analysis, there was a significant ergogenic effect of caffeine ingestion on RFD (Hedges’ g = 0.37; 95% confidence interval [CI]: 0.21, 0.52; p < 0.0001). An ergogenic effect of caffeine was also found on RFD during resistance exercises (Hedges’ g = 0.49; 95% CI: 0.30, 0.67; p < 0.0001), but not during the countermovement jump test (Hedges’ g = 0.18; 95% CI: –0.02, 0.39; p = 0.08), with a significant difference between the subgroups (p = 0.03). Small‐to‐moderate (3–5 mg/kg; Hedges’ g = 0.25; 95% CI: 0.09, 0.41; p = 0.002) and moderate‐to‐high caffeine doses (6–10 mg/kg) enhanced RFD (Hedges’ g = 0.57; 95% CI: 0.30, 0.85; p < 0.0001), even though the effects were larger with higher caffeine doses (p = 0.04). Overall, caffeine ingestion increases RFD, which is relevant given that RFD is commonly associated with sport‐specific tasks. From a practical perspective: (1) individuals interested in the acute enhancement of RFD in resistance exercise may consider supplementing with caffeine; and (2) given that evaluation of RFD is most commonly used for testing purposes, caffeine ingestion (3–10 mg/kg 60 min before exercise) should be standardized before RFD assessments.
In sickness and in health: The politics of public health and their implications during the COVID‐19 pandemic
Authors: Daher‐Nashif Suhad
Published: December 2021

Politics is a major player in health, sickness, and death affairs. This article reviews the role of politics in public health and its impact on health outcomes, mortality ratios, and death scenarios amongst the most vulnerable populations. Furthermore, the article explains the reasons behind the absence of politics from health and public health discourses; and examines the role of politics during the mis/management of COVID‐19 pandemic. Drawing on Foucault's biopower, Mebmbe's necropolitics, and Butler's precarity, the article illuminates how public health policies are highly political insofar as they offer some individuals access to life but create possibilities of death for others. During COVID‐19, politics enabled governors to put at risk the most vulnerable groups, the precariat, namely refugees, asylum seekers, stateless, and immigrants, the majority of whom were impoverished. The article presents COVID‐19 as an example of a crisis that unmasks these politics, claiming that these politics are not new but rather a continuum of previous invisible policies that COVID‐19 unmasked and intensified. The article describes how the politics of health entail privileging individuals with capital value who can benefit the state's interests and maintains its power.
Thinking Disagreement
Authors: Verdejo Víctor M. , de Donato‐Rodríguez Xavier
Published: December 2021

In this paper, we bring into focus the level of thought or content in the elucidation of disagreement. We set out the view that disagreement at this level involves a specific form of noncotenability, namely, noncotenability as captured by sense or intension as opposed to reference. We present the challenge that nourishes the alternative referential view and suggest, through examples, that (i) only intensional disagreement is apt to adequately accommodate basic rationality constraints on disagreement, and (ii) it can meet the aforementioned challenge insofar as we discriminate between noncotenability affecting one's concepts, intensionally conceived, and noncotenability affecting merely one's particular understanding of those concepts. We conclude that intensional disagreement is our best choice for an account of disagreement at the level of thought.
UK national survey of anticoagulation in extra‐corporeal photopheresis—Is it time for a UK consensus statement?
Authors: Wolf Julia , Alfred Arun , Gennery Andrew R. , New Helen V. , Scarisbrick Julia , Griffin James
Published: December 2021

Background

Extra‐corporeal photopheresis (ECP) requires anticoagulation to prevent circuit clotting. Unfractionated heparin (UFH) is currently the only anticoagulant licensed for the ECP system in use in the United Kingdom (UK). Acid citrate dextrose‐A (ACD‐A) is the preferred anticoagulant for most other apheresis procedures. Anecdotal evidence suggested variability in ECP practice across the UK with some providers using off‐label ACD‐A.

Aims

We developed a survey together with the UK Photopheresis Society to establish current practice.

Materials & Methods

This was distributed to all 17 ECP providers covering 34 UK sites.

Results

Significant variability in practice was demonstrated with only 36% of responding providers (5/14) using UFH exclusively and 29% (4/14) using ACD‐A as standard.

Conclusion

This survey highlights the need for a UK consensus.
Evaluation of Sysmex XT‐2000iV analyzer performance across a network of five veterinary laboratories using a commercially available quality control material
Authors: Daly Susan , Freeman Kathleen P. , Graham Peter A.
Published: December 2021

Background

Laboratory and instrument harmonization is seldom reported in the veterinary literature despite its advantages to clinical interpretation, including the use of interchangeable results and common reference intervals within a system of laboratories.

Objectives

A three‐step process was employed to evaluate and optimize performance and then assess the appropriateness of common reference intervals across a network of six Sysmex XT‐2000iV hematology analyzers at 5 commercial veterinary laboratory sites. The aims were to discover if harmonization was feasible in veterinary hematology and which quality parameters would best identify performance deviations to ensure a harmonized status could be maintained.

Methods

The performance of 10 measurands of a commercially available quality control material (Level 2—Normal e‐CHECK (XE)‐Hematology Control) was evaluated during three 1‐month time periods. Precision and bias were assessed with Six Sigma, American Society of Veterinary Clinical Pathology (ASVCP) total error quality goals and biologic variation (BV)‐based quality goal approaches to performance measurement.

Results

Instrument adjustments were made to 1 analyzer twice and 3 analyzers once between evaluations to improve performance and achieve harmonization. Sigma metrics improved from 37/50 > 6 to 58/60 > 6 and to all >5 over the course of the harmonization project. BV‐based quality goals for desirable bias and for laboratory systems of 0.33 × CVI (within‐subject biologic variation) were more sensitive and useful for assessing performance than the ASVCP total error goals.

Conclusions

Optimization and harmonization were achieved, and because BV‐derived bias goals were achieved, common reference intervals could be implemented across the network of analyzers.
Monocular retinopathy of prematurity‐like retinal vasculopathy in a dog
Authors: Sato Yu , Gray Alexa , Takahashi Kei , Dufour Valerie , Lutty Gerard , Miyadera Keiko , Aguirre Gustavo
Published: December 2021

Purpose

To describe a case of monocular retinopathy of prematurity (ROP)‐like vasculopathy without oxygen supplementation in the dog.

Methods

Fundus photographs (RetCam), spectral‐domain optical coherence tomography (sdOCT), confocal scanning laser ophthalmoscopy (cSLO), and fluorescein angiography (FA), as well as postmortem histology and immunohistochemistry (Collagen IV and anti‐vWF antibodies), were carried out to characterize the vascular abnormalities.

Results

Ophthalmic examination showed peripheral and mid‐temporal avascular areas in the tapetal region, neovascularization and abnormally dilated and tortuous retinal vessels in the left eye. sdOCT demonstrated not only cross‐sectional views of preretinal fibrovascular proliferation but also extensive proliferation extraretinally into the vitreous. FA emphasized demarcation of vascular and avascular zones with neovascular tufts “popcorns.” Histology and immunohistochemistry confirmed presence of abnormally dilated vessels and the intravitreal blood vessels.

Conclusions

ROP is a disease of abnormally developed retinal vascularization associated with oxygen supplementation therapy, potentially causing blindness in premature infants. Although the mechanism of ROP‐like vasculopathy in our case is unclear, it is important to appreciate that the abnormal vascular pattern seen in ROP in premature infants can occur in canines without oxygen administration.
Short-Term Prediction of Remaining Life for Lithium-Ion Battery Based on Adaptive Hybrid Model With Long Short-Term Memory Neural Network and Optimized Particle Filter
Authors: He Ning , Qian Cheng , He Lile
Published: December 2021

As an important energy storage device, lithium-ion batteries have vast applications in daily production and life. Therefore, the remaining useful life (RUL) prediction of such batteries is of great significance, which can maintain the efficacy and reliability of the system powered by lithium-ion batteries. For predicting remaining useful life of lithium-ion batteries accurately, an adaptive hybrid battery model and an improved particle filter (PF) are developed. First, the adaptive hybrid model is constructed, which is a combination of empirical model and long short-term memory (LSTM) neural network model such that it could characterize battery capacity degradation trend more effectively. In addition, the adaptive adjustment of the parameters for hybrid model is realized via optimization technique. Then, the beetle antennae search (BAS) based particle filter is applied to update the battery states offline constructed by the proposed adaptive hybrid model, which can improve the estimation accuracy. Finally, remaining useful life short-term prediction is realized online based on long short-term memory neural network rolling prediction combined historical capacity with online measurements and latest offline states and model parameters. The battery data set published by NASA is used to verify the effectiveness of proposed strategy. The experimental results indicate that the proposed adaptive hybrid model can well represent the battery degradation characteristics and have a higher accuracy compared with other models. The short-term remaining useful life prediction results have good performance with the errors of 1 cycle, 3 cycles, and 1 cycle, above results indicate proposed scheme has a good performance on short-term remaining useful life prediction.
Visualizing Standardized Model-Based Design and Inspection Data in Augmented Reality
Authors: Vernica Teodor , Lipman Robert , Kramer Thomas , Kwon Soonjo , Bernstein William Z.
Published: December 2021

Augmented reality (AR) has already helped manufacturers realize value across a variety of domains, including assistance in maintenance, process monitoring, and product assembly. However, coordinating traditional engineering data representations into AR systems without loss of context and information remains a challenge. A major barrier is the lack of interoperability between manufacturing-specific data models and AR-capable data representations. In response, we present a pipeline for porting standards-based design and inspection data into an AR scene. As a result, product manufacturing information with three-dimensional (3D) model data and corresponding inspection results are successfully overlaid onto a physical part. We demonstrate our pipeline by interacting with annotated parts while continuously tracking their pose and orientation. We then validate the pipeline by testing against six fully toleranced design models, accompanied by idealized inspection results. Our work (1) provides insight on how to address fundamental issues related to interoperability between domain-specific models and AR systems and (2) establishes an open software pipeline from which others can implement and further develop.
Binder Jetting and Infiltration of Metal Matrix Nanocomposites
Authors: Porter Quinton , Pei Zhijian , Ma Chao
Published: December 2021

The ability to produce a dense part of Al-based metal matrix nanocomposites using binder jetting followed by infiltration was investigated. A green density above 1.58 g/cm3 was determined to be necessary for spontaneous direct liquid infiltration to commence, and a press-compaction-assisted binder jetting process is needed to achieve this benchmark. A green density of 1.64 ± 0.02 g/cm3 only resulted in a density of 1.65 ± 0.03 g/cm3 by sintering at 1050 °C, which showed that densification is not possible with sintering alone. However, infiltration with Al-6061 produced specimens with a density of 2.74 ± 0.04 g/cm3, which corresponded to a density improvement of 65%. Moreover, the infiltrated specimens had a low open porosity of 2.71 ± 0.95% and a high hardness of 54 HRA. This study suggests that it is feasible to manufacture parts with complex shapes and superior mechanical properties using binder Jetting followed by infiltration.
Performing Energy-Efficient Pick-and-Place Motions for High-Speed Robots by Using Variable Stiffness Springs
Authors: Balderas Hill Rafael , Briot Sébastien , Chriette Abdelhamid , Martinet Philippe
Published: December 2021

Typically, for pick-and-place robots operating at high speeds, an enormous amount of energy is lost during the robot braking phase. This is due to the fact that, during such operational phase, most of the energy is dissipated as heat on the braking resistances of the motor drivers. To increase the energy efficiency during the high-speed pick-and-place cycles, this article investigates the use of variable stiffness springs (VSS) in parallel configuration with the motors. These springs store the energy during the braking phase, instead of dissipating it. The energy is then released to actuate the robot in a next displacement phase. This design approach is combined with a motion generator which seeks to optimize trajectories for input torques reduction (and thus of energy consumption), through solving a boundary value problem (BVP) based on the robot dynamics. Experimental results of the suggested approach on a five-bar mechanism show the drastic reduction of input torques and therefore of energetic losses.
Modulating the optoelectronic properties of hybrid Mo-thiolate thin films
Authors: Shi Jingwei , Zeng Li , Nikzad Shayla , Koshy David M. , Asundi Arun S. , MacIsaac Callisto , Bent Stacey F.
Published: December 2021

Hybrid MoS2-based molybdenum thiolate thin films with selected organic motifs are grown using molecular layer deposition (MLD), allowing for tunable optoelectronic film properties. The thin films are deposited at 170 °C using the metal precursor molybdenum hexacarbonyl and one of the three organic precursors: 1,2-ethanedithiol, 1,4-butanedithiol, and 1,4-benzenedithiol. The resulting Mo-ethanethiolate, Mo-butanethiolate, and Mo-benzenethiolate films show saturating growth with a growth per cycle of 1.2, 1.0, and 1.5 Å/cycle, respectively. Fourier transform infrared spectroscopy, x-ray photoelectron spectroscopy, Raman spectroscopy, x-ray absorption spectroscopy, and x-ray diffraction are used to characterize the as-deposited films. Results show that by changing the organic precursor, the film composition as well as the optical and electronic properties can be tuned. The Mo-thiolate films grown with benzenedithiol exhibit the lowest resistivity, which at 12 mΩ cm is ∼400 times more conductive than Mo-thiolates grown with aliphatic organic linkers. All three backbone chemistries of the Mo-thiolates show an optical bandgap between 2.3 and 2.4 eV and mild photoconductivity response. The MLD of these Mo-thiolate films demonstrates the synthesis of transition metal-organosulfur thin films with tunable properties.
Brazilian Gymnastics in a Crucible: A Media Data Case Study of Serial Sexual Victimization of the Brazilian Men’s Gymnastics Team
Authors: Seanor Michelle E. , Giffin Cole E. , Schinke Robert J. , Coholic Diana A.
Published: December 2021

Elite gymnastics sport culture is presently under global scrutiny. Largely ignited by the highly publicized case of serial sexual abuses in USA Gymnastics, multiple national gymnastics teams have disclosed stories of athlete abuse. Our author team utilized media data to investigate the serial sexual abuses that occurred on the Brazilian Men’s Gymnastics Team. Using media data to conceptualize athlete maltreatment is novel and facilitated our holistic interpretation of athlete maltreatment across multiple levels of athletes’ developmental systems. The authors traced the media coverage temporally and identified four overarching themes: (a) uncovering the case (subthemes—the Brazilian sport context; the Brazilian men’s gymnastics context; the club context), (b) before abuse was identified (subthemes—the coach–athlete dyad: before disclosure; the athlete: a lost childhood; social connectivity: isolation; the gymnastics system: mechanisms of abuse), (c) when abuse was recognized (subthemes—the coach–athlete dyad: athlete resistance; the athlete: identifying the impact; social connectivity: building connections; the gymnastics system: consequences of abuse), and (d) the legacy of abuse (subthemes—the coach–athlete dyad: ongoing abuses; the athlete: cyclical victimization; social connectivity: expanding connections; the gymnastics system: after abuse). Utilizing media data facilitated our culturally contextualized interpretation of athlete abuse to present tailored recommendations for practitioners.
“All or Nothing”: The Road to the National Hockey League for Five Successful Danish Players Born in 1989
Authors: Bendorff Daniel K.S. , Aggerholm Anders W. , H. Dalsgaard Simon , M. Wrang Christian , Martin Luc J. , Rossing Niels N.
Published: December 2021

The purpose of this case study was to explore the conditions that contributed to the development of five Danish National Hockey League players born in 1989. Informed by the personal assets framework, we conducted nine semistructured interviews with six players, two parents, and a former head coach. The purpose of these interviews was to explore the conditions that surrounded the athlete’s development and facilitated their ascent to the National Hockey League. Generally, we found that the club coaches identified and targeted the National Hockey League players from an early age, were result oriented in their leadership approach, and provided exclusive training opportunities to identified players. During their specializing years, the players were encouraged to undertake an “all or nothing” approach, whereby they were largely expected to sacrifice opportunities to pursue dual careers. In addition, a relocation to the Swedish hockey gymnasium and club, Frölunda, provided an important developmental stepping-stone for nearly all of them. Furthermore, uncontrollable and fortuitous conditions (e.g., prosperous national sport environment, role models) inspired the players’ ambitions and perceptions of capability. The results of this study are discussed in relation to the literature and practical implications, and we highlight limitations and propose future directions.
Real-space imaging of nanoparticle transport and interaction dynamics by graphene liquid cell TEM
Authors: Kang Sungsu , Kim Ji-Hyun , Lee Minyoung , Yu Ji Woong , Kim Joodeok , Kang Dohun , Baek Hayeon , Bae Yuna , Kim Byung Hyo , Kang Seulki , Shim Sangdeok , Park So-Jung , Lee Won Bo , Hyeon Taeghwan , Sung Jaeyoung , Park Jungwon
Published: December 2021

Thermal motion and interactions of sub–4-nm particles are directly observed by graphene liquid cell electron microscopy.
Predicting speech from a cortical hierarchy of event-based time scales
Authors: Schmitt Lea-Maria , Erb Julia , Tune Sarah , Rysop Anna U. , Hartwigsen Gesa , Obleser Jonas
Published: December 2021

A temporoparietal pathway structures human speech into hierarchically organized events to make predictions on upcoming words.
Crystal graph attention networks for the prediction of stable materials
Authors: Schmidt Jonathan , Pettersson Love , Verdozzi Claudio , Botti Silvana , Marques Miguel A. L.
Published: December 2021

Crystal graph attention networks speed up the prediction of new thermodynamically stable materials in high-throughput searches.
Synaptic vesicle pools are a major hidden resting metabolic burden of nerve terminals
Authors: Pulido Camila , Ryan Timothy A.
Published: December 2021

The cost of not thinking: unused synapses are metabolically expensive due to persistent activity of a synaptic vesicle proton pump.
MON-2, a Golgi protein, mediates autophagy-dependent longevity in
Caenorhabditis elegans
Authors: Jung Yoonji , Artan Murat , Kim Nari , Yeom Jeonghun , Hwang Ara B. , Jeong Dae-Eun , Altintas Özlem , Seo Keunhee , Seo Mihwa , Lee Dongyeop , Hwang Wooseon , Lee Yujin , Sohn Jooyeon , Kim Eun Ji E. , Ju Sungeun , Han Seong Kyu , Nam Hyun-Jun , Adams Linnea , Ryu Youngjae , Moon Dong Jin , Kang Chanhee , Yoo Joo-Yeon , Park Sang Ki , Ha Chang Man , Hansen Malene , Kim Sanguk , Lee Cheolju , Park Seung-Yeol , Lee Seung-Jae V.
Published: December 2021

MON-2, which mediates Golgi-endosome trafficking, mediates mitochondrial inhibition–induced longevity by enhancing autophagy.
Spatially uniform dynamics in equilibrium colloidal gels
Authors: Lattuada Enrico , Caprara Debora , Piazza Roberto , Sciortino Francesco
Published: December 2021

Equilibrium gels formed by the reversible association of limited-valence colloids display a remarkable spatially uniform dynamics.
Surplus sterols suppress
Salmonella
-specific IgA
Authors: Liu Elise G. , Eisenbarth Stephanie C.
Published: December 2021

Dietary cholesterol is metabolized into 25-hydroxycholesterol, which decreases intestinal IgA responses by reducing the expression of sterol-sensing transcription factor SREBP2, thereby preventing IgA plasma cell differentiation.
Exploring the emplacement of Cretaceous arc granites and dextral shear zones in northwestern Nevada, USA, using the StraboSpot data system
Authors: Trevino* S.F. , Tikoff B. , Van Buer N. , Wyld S.J. , McLachlan H.
Published: December 2021

This field trip traverses the Sahwave and Nightingale Ranges in central Nevada, USA, and northward to Gerlach, Nevada, to the Granite, northern Fox, and Selenite Ranges. Plutonic bodies in this area include the ca. 93–89 Ma Sahwave nested intrusive suite of the Sahwave and Nightingale Ranges, the ca. 106 Ma Power Line intrusive complex of the Nightingale Range, the ca. 96 Ma plutons in the Selenite Range, and the ca. 105–102 Ma plutons of the Granite and Fox Ranges. Collectively these plutons occupy nearly 1000 km2 of bedrock exposure. Plutons of the Sahwave, Nightingale, and Selenite Ranges intrude autochthonous rocks east of the western Nevada shear zone, while plutons of the Granite and Fox Ranges intrude displaced terranes west of the western Nevada shear zone. Integrated structural, geochemical, and geochronological studies are used to better understand magmatic and deformation processes during the Early Cretaceous, correlations with Cretaceous plutons in adjacent areas of Idaho and California, and regional implications.

Field-trip stops in the Sahwave and Nightingale Ranges will focus on: (1) microstructure and orientation of magmatic and solid-state fabrics of the incrementally emplaced granodiorites-granites of the Sahwave intrusive suite; and (2) newly identified dextral shear zones hosted within intrusions of both the Sahwave and Nightingale Ranges. The Sahwave intrusive suite exhibits moderate to weak magnetic fabrics determined using anisotropy of magnetic susceptibility, with magnetic foliations that strike NW-NE and magnetic lineations that plunge moderately to steeply. Microstructural analysis indicates that these fabrics formed during magmatic flow. The older Power Line intrusive complex in the Nightingale Range is cross-cut by the Sahwave suite and contains a N-S–trending solid-state foliation that reflects ductile dextral shearing. Field-trip stops in the plutons of the Gerlach region will focus on composition, texture, and emplacement ages, and key differences with the younger Sahwave suite, including lack of evidence for zoning and solid-state fabrics. The field trip will utilize StraboSpot, a digital data system for field-based geology that allows participants to investigate the relevant data projects in the study areas.
Moho carbonation at an ocean-continent transition
Authors: Coltat Rémi , Boulvais Philippe , Branquet Yannick , Richard Antonin , Tarantola Alexandre , Manatschal Gianreto
Published: December 2021

Carbonation of mantle rocks during mantle exhumation is reported in present-day oceanic settings, both at mid-ocean ridges and ocean-continent transitions (OCTs). However, the hydrothermal conditions of carbonation (i.e., fluid sources, thermal regimes) during mantle exhumation remain poorly constrained. We focus on an exceptionally well-preserved fossil OCT where mantle rocks have been exhumed and carbonated along a detachment fault from underneath the continent to the seafloor along a tectonic Moho. Stable isotope (oxygen and carbon) analyses on calcite indicate that carbonation resulted from the mixing between serpentinization-derived fluids at ~175°C and seawater. Strontium isotope compositions suggest interactions between seawater and the continental crust prior to carbonation. This shows that carbonation along the tectonic Moho occurs below the continental crust and prior to mantle exhumation at the seafloor during continental breakup.
Quantifying metasomatic high-field-strength and rare-earth element transport from alkaline magmas
Authors: Sokół Krzysztof , Finch Adrian A. , Hutchison William , Cloutier Jonathan , Borst Anouk M. , Humphreys Madeleine C.S.
Published: December 2021

Alkaline igneous rocks host many global high-field-strength element (HFSE) and rare-earth element (REE) deposits. While HFSEs are commonly assumed to be immobile in hydrothermal systems, transport by late-stage hydrothermal fluids associated with alkaline magmas is reported. However, the magnitude of the flux and the conditions are poorly constrained and yet essential to understanding the formation of REE-HFSE ores. We examined the alteration of country rocks (“fenitization”) accompanying the emplacement of a syenite magma at Illerfissalik in Greenland, through analysis of changes in rock chemistry, mineralogy, and texture. Our novel geochemical maps show a 400-m-wide intrusion aureole, within which we observed typically tenfold increases in the concentrations of many elements, including HFSEs. Textures suggest both pervasive and structurally hosted fluid flow, with initial reaction occurring with the protolith's quartz cement, leading to increased permeability and enhancing chemical interaction with a mixed Ca-K-Na fenitizing fluid. We estimated the HFSE masses transferred from the syenite to the fenite by this fluid and found ~43 Mt of REEs were mobilized (~12% of the syenite-fenite system total rare-earth-oxide [TREO] budget), a mass comparable to the tonnages of some of the world's largest HFSE resources. We argue that fenite can yield crucial information about the tipping points in magma evolution because retention and/or loss of volatile-bonded alkali and HFSEs are key factors in the development of magmatic zirconosilicate-hosted HFSE ores (e.g., Kringlerne, at Ilímaussaq), or the formation of the syenite-hosted Nb-Ta-REE (Motzfeldt-type) roof-zone deposits.
Synchronous association of hepatocellular carcinoma and cystic echinococcosis with unusual pathology: report on diagnostic and pathological variability
Authors: Suresh Sushrutha Chikkanayakanahalli , Swamy Nagesh N , Shah Pritik A , Babu Raghavendra
Published: December 2021

Cystic hydatid disease or cystic echinococcosis (CE) is a globally endemic zoonosis caused by the larval cyst stage of the tapewormEchinococcus granulosus. Concomitant presence of CE and hepatocellular carcinoma (HCC) is a rare clinical scenario. A 70-year-old male patient presented with acute abdominal pain to the surgical outpatient department. On evaluation, a cystic lesion with solid components and free fluid in the abdomen was observed, which led to multiple differentials in the working diagnosis. A CT showed the mass to have a delayed enhancement. Surgical exploration revealed a partially ruptured hydatid cyst with daughter cysts in the abdominal cavity and a solid-component mass lesion. We proceeded with a right partial hepatectomy. Pathological evaluation revealed a pale mass lesion with a large collapsed cyst. HCC with unusual dense fibrillar fibrosis and cystic interface with normal parenchyma was observed. This case connects the multimodal assessment of radiology, surgery and pathology.
Intervention targeted at physicians’ treatment of musculoskeletal disorders and sickness certification: an interrupted time series analysis
Authors: Kausto Johanna , Rosenström Tom Henrik , Ervasti Jenni , Pietiläinen Olli , Kaila-Kangas Leena , Rahkonen Ossi , Harkko Jaakko , Väänänen Ari , Kouvonen Anne , Lallukka Tea
Published: December 2021

Objective

An intervention was carried out at the occupational healthcare services (OHS) of the City of Helsinki beginning in 2016. We investigated the association between the intervention and employee sick leaves using interrupted time series analysis.

Design

Register-based cohort study with a quasi-experimental study design.

Setting

Employees of the City of Helsinki.

Participants

We analysed individual-level register-based data on all employees who were employed by the city for any length of time between 2013 and 2018 (a total 86 970 employees and 3 014 075 sick leave days). Sick leave days and periods that were OHS-based constituted the intervention time series and the rest of the sick leave days and periods contributed to the comparison time series.

Intervention

Recommendations provided to physicians on managing pain and prescribing sick leave for low back, shoulder and elbow pain.

Outcome measures

Number of sick leave days per month and sick leave periods per year.

Results

For all sick leave days prescribed at OHS, there was no immediate change in sick leave days, whereas a gradual change showing decreasing number of OHS-based sick leave days was detected. On average, the intervention was estimated to have saved 2.5 sick leave days per year per employee. For other sick leave days, there was an immediate increase in the level of sick leave days after the intervention and a subsequent gradual trend showing decreasing number of sick leave days.

Conclusions

The intervention may have reduced employee sick leaves and therefore it is possible that it had led to direct cost savings. However, further evidence for causal inferences is needed.
Acute subdural haematoma in the elderly: to operate or not to operate? A systematic review and meta-analysis of outcomes following surgery
Authors: Manivannan Susruta , Spencer Robert , Marei Omar , Mayo Isaac , Elalfy Omar , Martin John , Zaben Malik
Published: December 2021

Objectives

Acute subdural haematoma (ASDH) is a devastating pathology commonly found on CT brain scans of patients with traumatic brain injury. The role of surgical intervention in the elderly has been increasingly questioned due to its associated morbidity and mortality. Therefore, a systematic review and meta-analysis of the literature to quantify the mortality and functional outcomes associated with surgical management of ASDH in the elderly was performed.

Design/setting

A multidatabase literature search between January 1990 and May 2020, and meta-analysis of proportions was performed to quantify mortality and unfavourable outcome (Glasgow Outcome scale 1–3; death/ severe disability) rates.

Participants

Studies reporting patients aged 60 years or older.

Interventions

Craniotomy, decompressive craniectomy, conservative management.

Outcome measures

Mortality and functional outcomes (discharge, long-term follow-up (LTFU)).

Results

2572 articles were screened, yielding 21 studies for final inclusion and 15 for meta-analysis. Pooled estimates of mortality were 39.83% (95% CI 32.73% to 47.14%; 10 studies, 308/739 patients, I2=73%) at discharge and 49.30% (95% CI 42.01% to 56.61%; 10 studies, 277/555 patients, I2=63%) at LTFU. Mean duration of follow-up was 7.1 months (range 2–12 months). Pooled estimate of percentage of poor outcomes was 81.18% (95% CI 75.61% to 86.21%; 6 studies, 363/451 patients, I2=45%) at discharge, and 79.25% (95% CI 72.42% to 85.37%; 8 studies, 402/511 patients, I2=66%) at LTFU. Mean duration of follow-up was 6.4 months (range 2–12 months). Potential risk factors for poor outcome included age, baseline functional status, preoperative neurological status and imaging parameters.

Conclusions

Outcomes following surgical evacuation of ASDH in patients aged 60 years and above are poor. This constitutes the best level of evidence in the current literature that surgical intervention for ASDH in the elderly carries significant risks, which must be weighed against benefits.

PROSPERO registration number

CRD42020189508.
Positive impact of the COVID-19 pandemic? A longitudinal study on the impact of the COVID-19 pandemic on physicians’ work experiences and employability
Authors: Leeuwen Evelien H van , Taris Toon , van Rensen Elizabeth L J , Knies Eva , Lammers Jan-Willem
Published: December 2021

Objective

The COVID-19 pandemic places an enormous demand on physicians around the world. The aim of this study was to examine the impact of the COVID-19 pandemic on physicians’ work experiences and their ability and willingness to continue working in their profession until retirement (ie, their employability).

Design

A longitudinal comparative design was used. Survey data were collected on three moments: before (May 2019), in the early phase (May 2020) and in a later phase (November 2020) of the COVID-19 pandemic. Time effects were tested using repeated-measures analyses of variance and one-way analyses of variance.

Setting

This study took place among physicians of two hospitals in a large city in the Netherlands.

Participants

165 hospital physicians with surgical, medical and other specialties participated in this study.

Results

Physicians’ employability significantly increased from the time prior to the COVID-19 pandemic, compared with the period during this pandemic. Employability differs among physicians with surgical, medical and other specialties. Furthermore, physicians experienced a lower emotional, physical and quantitative workload during the first peak of the COVID-19 pandemic, compared with before the pandemic. Moreover, physicians experienced the most stress from the impact of COVID-19 on their work in general and from combining work and private life.

Conclusions

This study shows that physicians’ employability and work experiences are affected by the COVID-19 pandemic. Work experiences vary for physicians with different specialties. These varieties stress the importance of attention for physicians’ individual needs and challenges regarding working during the COVID-19 pandemic and the possibility of continuing work in the aftermath of this crisis. Based on this, physicians can be offered tailor-made solutions. This is important to maintain a healthy and employable workforce, which is essential for a sustainable healthcare system.
Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines
Authors: Gomez Gabriela Beatriz , Siapka Mariana , Conradie Francesca , Ndjeka Norbert , Garfin Anna Marie Celina , Lomtadze Nino , Avaliani Zaza , Kiria Nana , Malhotra Shelly , Cook-Scalise Sarah , Juneja Sandeep , Everitt Daniel , Spigelman Melvin , Vassall Anna
Published: December 2021

Objectives

Patients with highly resistant tuberculosis have few treatment options. Bedaquiline, pretomanid and linezolid regimen (BPaL) is a new regimen shown to have favourable outcomes after six months. We present an economic evaluation of introducing BPaL against the extensively drug-resistant tuberculosis (XDR-TB) standard of care in three epidemiological settings.

Design

Cost-effectiveness analysis using Markov cohort model.

Setting

South Africa, Georgia and the Philippines.

Participants

XDR-TB and multidrug-resistant tuberculosis (MDR-TB) failure and treatment intolerant patients.

Interventions

BPaL regimen.

Primary and secondary outcome measures

(1) Incremental cost per disability-adjusted life years averted by using BPaL against standard of care at the Global Drug Facility list price. (2) The potential maximum price at which the BPaL regimen could become cost neutral.

Results

BPaL for XDR-TB is likely to be cost saving in all study settings when pretomanid is priced at the Global Drug Facility list price. The magnitude of these savings depends on the prevalence of XDR-TB in the country and can amount, over 5 years, to approximately US$ 3 million in South Africa, US$ 200 000 and US$ 60 000 in Georgia and the Philippines, respectively. In South Africa, related future costs of antiretroviral treatment (ART) due to survival of more patients following treatment with BPaL reduced the magnitude of expected savings to approximately US$ 1 million. Overall, when BPaL is introduced to a wider population, including MDR-TB treatment failure and treatment intolerant, we observe increased savings and clinical benefits. The potential threshold price at which the probability of the introduction of BPaL becoming cost neutral begins to increase is higher in Georgia and the Philippines (US$ 3650 and US$ 3800, respectively) compared with South Africa (US$ 500) including ART costs.

Conclusions

Our results estimate that BPaL can be a cost-saving addition to the local TB programmes in varied programmatic settings.
Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy
Authors: Berney Alexandre , Carrard Valerie , Berney Sylvie , Schlegel Katja , Gaume Jacques , Gholam Mehdi , Bart Pierre-Alexandre , Preisig Martin , Wac Katarzyna , Schmid Mast Marianne , Bourquin Céline
Published: December 2021

Introduction

Physician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students’ interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients.

Methods and analysis

This project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1–6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills.

Ethics and dissemination

The project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.
Quality of life and disease experience in patients with heart failure with reduced ejection fraction in Spain: a mixed-methods study
Authors: Rubio Raül , Palacios Beatriz , Varela Luis , Fernández Raquel , Camargo Correa Selene , Estupiñan María Fernanda , Calvo Elena , José Nuria , Ruiz Muñoz Marta , Yun Sergi , Jiménez-Marrero Santiago , Alcoberro Lidia , Garay Alberto , Moliner Pedro , Sánchez-Fernández Lydia , Soria Gómez María Teresa , Hidalgo Encarna , Enjuanes Cristina , Calero-Molina Esther , Rueda Yolanda , San Saturnino Maite , Garcimartín Paloma , López-Ibor Jorge V , Segovia-Cubero Javier , Comin-Colet Josep
Published: December 2021

Objectives

To gather insights on the disease experience of patients with heart failure (HF) with reduced ejection fraction (HFrEF), and assess how patients’ experiences and narratives related to the disease complement data collected through standardised patient-reported outcome measures (PROMs). Also, to explore new ways of evaluating the burden experienced by patients and caregivers.

Design

Observational, descriptive, multicentre, cross-sectional, mixed-methods study.

Setting

Secondary care, patient’s homes.

Participants

Twenty patients with HFrEF (New York Heart Association (NYHA) classification I–III) aged 38–85 years.

Measures

PROMs EuroQoL 5D-5L (EQ-5D-5L) and Kansas City Cardiomyopathy Questionnaire and patient interview and observation.

Results

A total of 20 patients with HFrEF participated in the study. The patients’ mean (SD) age was 72.5 (11.4) years, 65% were male and were classified in

NYHA functional classes I (n=4), II (n=7) and III (n=9). The study showed a strong impact of HF in the patients’ quality of life (QoL) and disease experience, as revealed by the standardised PROMs (EQ-5D-5L global index=0.64 (0.36); Kansas City Cardiomyopathy Questionnaire total symptom score=71.56 (20.55)) and the in-depth interviews. Patients and caregivers often disagreed describing and evaluating perceived QoL, as patients downplayed their limitations and caregivers overemphasised the poor QoL of the patients. Patients related current QoL to distant life experiences or to critical moments in their disease, such as hospitalisations. Anxiety over the disease progression is apparent in both patients and caregivers, suggesting that caregiver-specific tools should be developed.

Conclusions

PROMs are an effective way of assessing symptoms over the most recent time period. However, especially in chronic diseases such as HFrEF, PROM scores could be complemented with additional tools to gain a better understanding of the patient’s status. New PROMs designed to evaluate and compare specific points in the life of the patient could be clinically more useful to assess changes in health status.
TELEmedicine for EPIlepsy Care (TELE-EPIC): protocol of a randomised, open controlled non-inferiority clinical trial
Authors: Licchetta Laura , Trivisano Marina , Baldin Elisa , Mohamed Susan , Raschi Emanuel , Mostacci Barbara , Zenesini Corrado , Contin Manuela , Vigevano Federico , Bisulli Francesca , Tinuper Paolo , Vignatelli Luca
Published: December 2021

Introduction

Epilepsy is a chronic condition requiring consistent follow-up aimed at seizure control, and monitoring of anti-seizure medication (ASM) levels and side effects. Telemedicine (TM) offers invaluable support to patient follow-up, guaranteeing the prompt availability of a team of experts for persons with epilepsy (PWE) widely distributed across the country. Although many health institutions have endorsed the use of TM, robust data on effectiveness, safety and costs of TM applied to epilepsy are lacking. TELEmedicine for EPIlepsy Care (TELE-EPIC) will evaluate the effectiveness of video consultation (VC) via TM compared with usual care (UC) for the monitoring of PWE (TELE-EPIC_RCT). Moreover, TELE-EPIC will apply an innovative Volumetric Absorptive Microsampling (VAMS) device for quantitation of ASM through finger prick blood sampling as an alternative to venipuncture sampling (TELE-EPIC_VAMS).

Methods and analysis

TELE-EPIC_RCT is a multicentre, open, pragmatic two-arm randomised controlled trial prospectively including adult and paediatric outpatients with established diagnosis of epilepsy consecutively attending the Epilepsy Centres of Bologna and Rome, respectively. The primary outcome is the non-inferiority of VC on seizure control compared with UC after an 18-month follow-up. Secondary outcomes are adherence to treatment, ASM-related adverse events, quality of life, mood disorders, patient and caregiver satisfaction, safety and costs. TELE-EPIC_VAMS is a cross-validation study for blood ASM quantitation through a novel, VAMS-based device, comparing (1) VAMS versus plasma samples (reference standard method); and (2) nurse-collected versus self-collected blood by VAMS device.

Ethics and dissemination

The study has been approved by the local ethics committee (349-2019-SPER-AUSLBO). Complete information about the state of project, relevant events and results will be regularly updated on the project’s webpage on ClinicalTrials.gov. The project’s results and data on the potential impact of TM in epilepsy will be disseminated on social media. A closeout meeting will be convened for the communication and dissemination of the project, highlighting its main achievements and impacts.

Trial registration number

NCT04496310