bluuebunny/crossref_metadata_2025 huggingface dataset:
Zooarchaeology through the lens of collagen fingerprinting at Denisova Cave
Authors: Brown Samantha , Wang Naihui , Oertle Annette , Kozlikin Maxim B. , Shunkov Michael V. , Derevianko Anatoly P. , Comeskey Daniel , Jope-Street Blair , Harvey Virginia L. , Chowdhury Manasij Pal , Buckley Michael , Higham Thomas , Douka Katerina
Published: July 2021

Denisova Cave, a Pleistocene site in the Altai Mountains of Russian Siberia, has yielded significant fossil and lithic evidence for the Pleistocene in Northern Asia. Abundant animal and human bones have been discovered at the site, however, these tend to be highly fragmented, necessitating new approaches to identifying important hominin and faunal fossils. Here we report the results for 8253 bone fragments using ZooMS. Through the integration of this new ZooMS-based data with the previously published macroscopically-identified fauna we aim to create a holistic picture of the zooarchaeological record of the site. We identify trends associated with climate variability throughout the Middle and Upper Pleistocene as well as patterns explaining the process of bone fragmentation. Where morphological analysis of bones from the site have identified a high proportion of carnivore bones (30.2%), we find that these account for only 7.6% of the ZooMS assemblage, with large mammals between 3 and 5 more abundant overall. Our analysis suggests a cyclical pattern in fragmentation of bones which sees initial fragmentation by hominins using percussive tools and secondary carnivore action, such as gnawing and digestion, likely furthering the initial human-induced fragmentation.
Pumping infusions with a syringe may cause contamination of the fluid in the syringe
Authors: Kawakami Yutaka , Tagami Takashi
Published: July 2021

Clinicians often perform pumping of infusions with a syringe (PIS) to quickly deliver fluid or blood transfusion to patients, especially during an emergency. Despite the efforts of the clinicians, critically ill patients are prone to acquire catheter-related bloodstream infections. Although clinicians have reported the possibility of PIS contamination, no group of researchers has studied nor confirmed this possibility. Here, we examined whether PIS can cause bacterial contamination of the fluid inside the syringes, using microbiological tests, including the analysis Escherichia coli DH-5 alpha growth by measuring the absorbance at OD600. We confirmed that contamination of fluid in the barrel was almost proportional to the applied volume of bacterial fluid. Aliquots of DH-5 alpha artificially applied on the surface of the gloved hand of an examiner, the plunger or the inner side of the barrel of a syringe could permeate inside the syringe. Furthermore, disinfection with ethanol before PIS almost successfully prevented bacterial multiplication. Our findings suggest that PIS can cause intraluminal contamination when performed with unsterilized hands, and that previous disinfection with ethanol can effectively prevent PIS-induced contamination. These results highlight the risk of PIS-induced contamination and the importance of disinfection in the daily clinical practice.
Intranasal insulin rescues repeated anesthesia-induced deficits in synaptic plasticity and memory and prevents apoptosis in neonatal mice via mTORC1
Authors: Roque Patricia Soriano , Hooshmandi Mehdi , Neagu-Lund Laura , Yin Shelly , Yousefpour Noosha , Sato Hiroaki , Sato Tamaki , Nakadate Yosuke , Kawakami Akiko , Tahmasebi Soroush , Ribeiro-da-Silva Alfredo , Gkogkas Christos G. , Prager-Khoutorsky Masha , Schricker Thomas , Wykes Linda , Khoutorsky Arkady
Published: July 2021

Long-lasting cognitive impairment in juveniles undergoing repeated general anesthesia has been observed in numerous preclinical and clinical studies, yet, the underlying mechanisms remain unknown and no preventive treatment is available. We found that daily intranasal insulin administration to juvenile mice for 7 days prior to repeated isoflurane anesthesia rescues deficits in hippocampus-dependent memory and synaptic plasticity in adulthood. Moreover, intranasal insulin prevented anesthesia-induced apoptosis of hippocampal cells, which is thought to underlie cognitive impairment. Inhibition of the mechanistic target of rapamycin complex 1 (mTORC1), a major intracellular effector of insulin receptor, blocked the beneficial effects of intranasal insulin on anesthesia-induced apoptosis. Consistent with this finding, mice lacking mTORC1 downstream translational repressor 4E-BP2 showed no induction of repeated anesthesia-induced apoptosis. Our study demonstrates that intranasal insulin prevents general anesthesia-induced apoptosis of hippocampal cells, and deficits in synaptic plasticity and memory, and suggests that the rescue effect is mediated via mTORC1/4E-BP2 signaling.
Author Correction: Ethnic variation of oral microbiota in children
Authors: Premaraj Thyagaseely S. , Vella Raven , Chung Jennifer , Lin Qingqi , Panier Hunter , Underwood Kori , Premaraj Sundaralingam , Zhou Yanjiao
Published: July 2021

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Configuration of flowsheet and reagent dosage for gilsonite flotation towards the ultra-low-ash concentrate
Authors: Bahrami Ataallah , Kazemi Fatemeh , Mirmohammadi Mirsaleh , Ghorbani Yousef , Farajzadeh Saghar
Published: July 2021

Gilsonite has a wide variety of applications in the industry, including the manufacture of electrodes, paints and resins, as well as the production of asphalt and roof-waterproofing material. Gilsonite ash is a determining parameter for its application in some industries (e.g., gilsonite with ash content < 5% used as an additive in drilling fluids, resins). Due to the shortage of high grade (low ash) gilsonite reserves, the aim of this study is to develop a processing flowsheet for the production of ultra-low-ash gilsonite (< 5%), based on process mineralogy studies and processing tests. For this purpose, mineralogical studies and flotation tests have been performed on a sample of gilsonite with an average ash content of 15%. According to mineralogical studies, carbonates and clay minerals are the main associated impurities (more than 90 vol.%). Furthermore, sulfur was observed in two forms of mineral (pyrite and marcasite) and organic in the structure of gilsonite. Most of these impurities are interlocked with gilsonite in size fractions smaller than 105 µm. The size fraction of + 105 − 420 µm has a higher pure gilsonite (approximately 90%) than other size fractions. By specifying the gangue minerals with gilsonite and the manner and extent of their interlocking with gilsonite, + 75 − 420 µm size fraction selected to perform flotation tests. Flotation tests were performed using different reagents including collector (Gas oil, Kerosene and Pine oil), frother (MIBC) and depressant (sodium silicate, tannic acid, sulfuric acid and sodium cyanide) in different dosages. Based on the results, the use of kerosene collector, MIBC frother and a mixture of sodium silicate, tannic acid, sulfuric acid and sodium cyanide depressant had the most favorable results in gilsonite flotation in the rougher stage. Cleaner and recleaner flotation stages for the rougher flotation concentrate resulted in a product with an ash content of 4.89%. Due to the interlocking of gilsonite with impurities in size fractions − 105 µm, it is better to re-grinding the concentrate of the rougher stage beforehand flotation in the cleaner and recleaner stages. Finally, based on the results of mineralogical studies and processing tests, a processing flowsheet including crushing and initial granulation of gilsonite, flotation in rougher, cleaner and recleaner stages has been proposed to produce gilsonite concentrate with < 5% ash content.
Author Correction: Sodium nitrite as a corrosion inhibitor of copper in simulated cooling water
Authors: Rizvi Marziya , Gerengi Husnu , Kaya Savas , Uygur Ilyas , Yıldız Mesut , Sarıoglu Ibrahim , Cingiz Zafer , Mielniczek Michal , Ibrahimi Brahim El
Published: July 2021

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Quantification of chromogranin A using a surface plasmon resonance-based biosensor
Authors: Xiao Yang , Tai Yang , Quan Xin , Zhao Chong , Liu Rui , Tong Huan , Huang Zhiyin , Tang Chengwei , Gao Jinhang
Published: July 2021

The SPR-based method quantifies CgA with detection range of 0.2–187 ng mL−1, covers the range of most diseases.
A fluorescent probe for rapid detection of low concentration mercury ions and its application in biological cells
Authors: Kan Chun , Wang Xing , Wu Linyun , Shao Xiaotao , Xing Haizhu , You Min , Zhu Jing
Published: July 2021

A new type of probe can be used for the detection of Hg3+ in biological cells.
Charge-transfer electronic states in organic solar cells: a TDDFT study
Authors: Marmolejo-Valencia Andres F. , Mata-Pinzón Zaahel , Amador-Bedolla Carlos
Published: July 2021

Prediction of new organic photovoltaic materials in solar cells must include a precise description of charge-transfer states that are involved in electron-transfer processes such as charge separation and charge recombination which govern efficiency.
Sol–gel preparation of crystalline Ni12P5/N-doped carbon and amorphous Ni–P–C catalysts and their high catalytic performances toward hydrogenation reduction reaction of 4-nitrophenol
Authors: Li Pingyun , Ni Haitao , Jiang Shengxiang , Wang Han
Published: July 2021

Sol–gel method was used to prepare Ni12P5/N-doped carbon and amorphous Ni–P–C materials where the dried gel precursors were heated under N2 atmosphere in a tube furnace.
The first PdO nanoparticle catalyzed one pot synthesis of propargylamine through A3-coupling of an aldehyde, alkyne and amine
Authors: Krishnaveni T. , Kaveri M. V. , Kadirvelu K.
Published: July 2021

Palladium(ii) oxide (PdO) nanoparticles (Nps) were prepared by an environmentally benign hydrothermal method with a new capping agent quercetin.
Correction: [(3-Nitro-1H-1,2,4-triazol-1-yl)-NNO-azoxy]furazans: energetic materials containing an N(O)N–N fragment
Authors: Gulyaev Dmitry A. , Klenov Michael S. , Churakov Aleksandr M. , Strelenko Yurii A. , Fedyanin Ivan V. , Lempert David B. , Kosareva Ekaterina K. , Kon’kova Tatiana S. , Matyushin Yurii N. , Tartakovsky Vladimir A.
Published: July 2021

Correction for ‘[(3-Nitro-1H-1,2,4-triazol-1-yl)-NNO-azoxy]furazans: energetic materials containing an N(O)N–N fragment’ by Dmitry A. Gulyaev et al., RSC Adv., 2021, 11, 24013–24021, DOI: 10.1039/D1RA03919A.
Ungewöhnliche Ursache einer PCT-Erhöhung
Authors: Vogelbacher Laura Clarissa , Thimme Robert
Published: July 2021

Zusammenfassung Procalcitonin (PCT) ist ein etablierter Marker für bakterielle Infektionen. Erhöhungen des PCT können jedoch aufgrund vielfältiger Ursachen auftreten und sind nicht spezifisch, wie wir in dem vorliegenden Fall kurz skizzieren möchten.

Anamnese Wir berichten über eine 29-jährige Patientin, die bei unklaren abdominellen Schmerzen sowie seit 2 Tagen bestehender Übelkeit und Erbrechen von der psychiatrischen Klinik vorgestellt wurde. Die Anamnese war zunächst nicht zielführend.

Untersuchung und Diagnose Klinisch ergaben sich keine wegweisenden Befunde. Die Patientin war afebril. Laborchemisch zeigten sich deutlich erhöhte Transaminasen sowie ein massiv erhöhtes PCT. Sonografisch stellten sich keine Auffälligkeiten dar, die Hepatitis-Serologie fiel negativ aus. Entnommene Blutkulturen blieben steril, die weitere Infektfokussuche war blande.

Therapie und Verlauf Im Verlauf des stationären Aufenthalts berichtete die Patientin, 2 Tage zuvor kumulativ ca. 40 g Paracetamol in suizidaler Absicht eingenommen zu haben. Eine Therapie mit N-Acetylcystein (NAC) wurde eingeleitet. Die Transaminasen und das PCT zeigten sich in den Folgetagen fallend. Auf eine antibiotische Therapie wurde verzichtet.

Folgerung Der Fall zeigt, dass eine PCT-Erhöhung keinesfalls spezifisch für bakterielle Infektionen ist und der Laborwert immer in Korrelation mit der Anamnese und Klinik betrachtet werden muss.
68Ga-PSMA-11-PET/mpMRT zur Lokaldetektion des primären Prostatakarzinoms bei Männern mit negativer Vorbiopsie
Authors: Maurer Tobias , Gesterkamp Hannah , Nguyen Noemi , Westenfelder Kay , Gschwend Jürgen E. , Budäus Lars , Rauscher Isabel , Vag Tibor , Weber Wolfgang , Eiber Matthias
Published: July 2021

Hintergrund Die multiparametrische MRT (mpMRT) stellt den Goldstandard der bildgebenden Diagnostik zur Detektion eines primären Prostatakarzinoms (PC) nach negativer Biopsie dar. Die PSMA-PET weist eine hohe Genauigkeit auf, wird aber derzeit vor allem in der Rezidivsituation eingesetzt. Das Ziel der vorliegenden Arbeit war nun, die Effektivität einer kombinierten 68Ga-PSMA-11-PET/mpMRT-Bildgebung zur Detektion eines PC nach vorheriger negativer Prostatabiopsie zu untersuchen.

Material und Methoden Es wurden 57 Patienten in die retrospektive Analyse eingeschlossen, bei denen zuvor mindestens eine negative Prostatabiopsie erfolgt war. Alle Patienten erhielten eine 68Ga-PSMA-11-PET/mpMRT-Bildgebung der Prostata. Die mpMRT wurde anhand der PI-RADS-Klassifikation, die 68Ga-PSMA-11-PET durch eine 5-stufige Likert-Skala ausgewertet (1: PC sehr unwahrscheinlich; 2: PC unwahrscheinlich; 3: unklarer Befund; 4: PC wahrscheinlich; 5: PC sehr wahrscheinlich). Alle Patienten erhielten sowohl eine systematische randomisierte als auch eine gezielte transrektale Biopsie auffälliger Läsionen in der Bildgebung. Ergebnisse der Bildgebung und der histologischen Untersuchung der Prostatabiopsate wurden auf Patientenebene korreliert.

Ergebnisse In der histologischen Untersuchung zeigten sich bei 35/57 (61,4 %) der Patienten Prostatakarzinominfiltrate. Bei Patienten mit histologisch gesichertem PC zeigte sich bei 21/35 (60,0 %) eine PI-RADS-4- oder -5-Läsion im mpMRT bzw. bei 28/35 (80,0 %) ein PET-Rating von 4 oder 5. Die kombinierte 68Ga-PSMA-11-PET/mpMRT übersah nur einen Patienten mit PC-Gleason-Score (GS) 7a (Beurteilung mit 1 oder 2 in sowohl PET als auch mpMRT). Als Limitationen sind sowohl die retrospektive Analyse als auch negative Resultate trotz gezielter Biopsieentnahme anzuführen.

Schlussfolgerung In dieser ersten Analyse zeigte sich die kombinierte 68Ga-PSMA-11-PET/mpMRT als zuverlässige bildgebende Diagnostik für die Prostatabiopsie zur Detektion eines PC bei Patienten nach vorheriger negativer Biopsie. Dabei lieferten die 68Ga-PSMA-11-PET und die mpMRT teilweise komplementäre Ergebnisse, die die Detektion eines PC erhöhten.
Plasma accelerators produce X-rays with tunable parameters
Authors: Green Leigh Ann
Published: July 2021

Plasma accelerators act as coherent X-ray drivers and advance the study of electron motion in atomic and molecular systems.
Photopolymerization effects on the external quantum efficiency of fullerene/zinc phthalocyanine heterojunction solar cells
Authors: Kato Masahiro , Nakaya Masato , Watanabe Shinta , Okamoto Koichi , Onoe Jun
Published: July 2021

We have demonstrated that the external quantum efficiency (EQE) of organic photovoltaic cells with a heterojunction of zinc phthalocyanine (ZnPc) and fullerene (C60) bilayer films, which are used as a donor and an acceptor, respectively, is improved by photopolymerization (photon energy: 2–4 eV and light fluence: 0.4 W cm−2) between adjacent C60 molecules via a [2 + 2] cycloadditional four-membered ring. Comparison of the structural and physical properties of ZnPc, C60, and ZnPc/C60 bilayer films between before and after photoirradiation indicated that an increase in the number of photogenerated intra- and inter-molecular excitons in photopolymerized C60 film mainly contributes toward improvement of the EQE in a wavelength range of 400–600 nm.
Effect of dual aircraft formation spacing on target position tracking on measurement conversion by monopulse radar
Authors: Liu Mingjie , Wang Chunyang , Zeng Huiyong , Zhou Changlin
Published: July 2021

Aimed at the current problem of insufficient analysis of the influence of the diversified formation of dual aircraft on monopulse radar position tracking, the dual aircraft echo equivalent two point source jamming model is built. We designed the dual aircraft formation penetration movement scenario and three different formation spacings of 150, 250, and 350 m and extracted the dynamic radar cross section sequences of dual aircraft under different formation spacings. We established the dual aircraft formation equivalent scenario and calculated the dynamic signal-to-noise ratio and distance measurement accuracy of the radar received echo signals with different formation spacings. We fully considered the randomness characteristics of the phase difference of the actual dual aircraft echo and built the random angle error model of dual aircraft echo equivalent jamming. The distribution and random numerical characteristics of the random angular error are simulated and analyzed, and we combined the radar measurement conversion target position tracking algorithm to analyze the influence of different formation spacings on the monopulse radar tracking target position and position tracking accuracy. The simulation results show that a formation spacing of 350 m produces a greater randomness of angular error for dual targets, resulting in a greater dispersion of radar measurement traces, and the final average position mean square error is 132.8 m, which improves the position error by 15.6% compared with 150 m spacing.
Spray patterns of multi-element swirl coaxial injector of interacting spray under different injection conditions
Authors: Song Wooseok , Koo Jaye
Published: July 2021

Multi-element injectors have been used in liquid rocket engines to obtain high thrust, and the gas-centered swirl coaxial injector is a representative injection system because it provides high mixing performance. Investigations of the spray characteristics of injection systems have focused on the characteristics of single-element injectors, including the spray angle, breakup, and atomization mechanism of the liquid sheet formation. However, the spray characteristics of multi-element injectors need to be studied because of their usage in real rocket engine systems. In this paper, spray patterns and interacting spray under different injection conditions are analyzed using the backlight imaging technique, and the dominant flow fields are observed using the dynamic mode decomposition method. The spray angle in the case of the gaseous nitrogen with a high Reynolds number is calculated to be lower than the case with a low Reynolds number. From the averaged images, it is found that there are two dominant flow fields: one is located in the vicinity of the injector head and the other is in the interacting spray zone, which is related to a secondary breakup via an adjacent injector. As a result of the dynamic mode decomposition analysis, however, the spray zone near the injector is confirmed to be a more dominant flow field than the interacting spray zone.
Analytical gradients for core-excited states in the algebraic diagrammatic construction (ADC) framework
Authors: Brumboiu Iulia Emilia , Rehn Dirk R. , Dreuw Andreas , Rhee Young Min , Norman Patrick
Published: July 2021

Expressions for analytical molecular gradients of core-excited states have been derived and implemented for the hierarchy of algebraic diagrammatic construction (ADC) methods up to extended second-order within the core–valence separation (CVS) approximation. We illustrate the use of CVS-ADC gradients by determining relaxed core-excited state potential energy surfaces and optimized geometries for water, formic acid, and benzene. For water, our results show that in the dissociative lowest core-excited state, a linear configuration is preferred. For formic acid, we find that the O K-edge lowest core-excited state is non-planar, a fact that is not captured by the equivalent core approximation where the core-excited atom with its hole is replaced by the “Z + 1” neighboring atom in the periodic table. For benzene, the core-excited state gradients are presented along the Jahn–Teller distorted geometry of the 1s → π* excited state. Our development may pave a new path to studying the dynamics of molecules in their core-excited states.
Australian landscapes from Eocene to Anthropocene
Authors: Bridgewater Peter
Published: July 2021

The 65-million-year journey from the demise of the dinosaurs to the present day is characterised by changing climes, periods of species extinctions and, finally, the appearance of Homo sapiens. As an island from the start of this period, Australia’s landscapes were isolated from the rest of the world and to this day are characterised by a unique biodiversity. Since their arrival, First Nations peoples have somehow understood this special landscape, living in conformity with it, changing along the way as the climate and landscape changed. That all changed with the arrival of people from Europe, who were more familiar with a weedy landscape recovering from deep glaciation. Over the last 250 years, a lack of understanding of the uniqueness of the Australian landscape, and of First Nations connections with that landscape, has wrought both biological and cultural disruptions. Looking ahead, more conversations between all Australians on how to manage this country into an uncertain future, respecting the range of world views that exist, and rebuilding a viable biocultural diversity, remains a significant but achievable challenge.
Incorporating Indigenous knowledge in mine closure: Ranger Uranium Mine
Authors: Brady Christopher , Christophersen Peter , O'Brien Justin
Published: July 2021

The Ranger Project Area, located on the lands of the Mirarr clan, is surrounded by Kakadu National Park. After 40 years of uranium production at Ranger Mine, rehabilitation has begun, with a commitment that the land will be restored to a standard such that it could be incorporated into Kakadu National Park. Historically, mine closure has not been done well in the Northern Territory, and little if any consideration has been given to the views of Aboriginal landowners. An Aboriginal perspective of country recognises the interrelationship, via local kinship and moiety systems, of all things – the rocks, plants, animals, people, stories, weather, ceremonies and tradition. There is an opportunity for this worldview to be incorporated into the rehabilitation of Ranger Mine. The mine’s operator ERA (a subsidiary of Rio Tinto) has agreed to Cultural Closure Criteria that reflect a desire of Bininj (Aboriginal people from the region) to again use the land for hunting and gathering, recreation and cultural practice. Allowing Aboriginal people to have input to rehabilitation planning demonstrates a respect for people’s knowledge and connection to country. At Ranger, where the mine was imposed against the wishes of the traditional owners, this is an important step in a return to stewardship of this land and reconnecting people to place.
The business of biodiversity: the role of Odonata
Authors: Sharp Nigel
Published: July 2021

As one of the most biologically distinctive countries in the world, much of Australia’s flora and fauna are endemic to the continent; however, the issue of decline is immediate and ever present in many ecological communities. Odonata, as a not-for-profit business, believes that nature-focused business solutions are the key to properly supporting Australia’s biodiversity. By driving sustainable business solutions, supporting nature-focused projects and establishing predator-proof sanctuaries, Odonata looks to the role of stewardship as a means to promote healthy diversity and regenerate landscapes.
‘A talented young German’: exploration of the early career of Jacob Braché
Authors: McMullen Gabrielle L.
Published: July 2021

Jacob Braché (1827–1905) arrived in Melbourne in 1853, two years into the Victorian gold rush, and soon became a significant figure in local mining circles. For almost fifty years, he contributed actively to mining endeavours – during periods as a civil servant, in numerous mining enterprises, and as a consulting mining engineer. Following a summary of Braché’s contributions in Victoria, this paper focuses on his education and experience prior to emigrating to the Colony, looking at the expertise that he brought to his colonial roles. It concludes with insights into why this ‘talented young German’ was a controversial figure over his half century of professional life in Australia.
Alleged obligatorily controlled inflected infinitives
Authors: Barbosa Pilar
Published: July 2021

This paper examines the arguments presented in
Modesto (2009, 2018) and Sheehan (2013, 2018) in favor of the idea that inflected
infinitival complements of desideratives, commissives, and object
control verbs such as persuadir ‘persuade’ in
Portuguese can be obligatorily controlled. It argues that the
relevant complements are not instances of obligatory control (OC);
they rather contain pro, interpreted by the same
operations that govern its interpretation in finite clauses. This
conclusion reinforces Landau’s
(2015) claim that the presence of agreement inflection
blocks control in attitude complements. Focusing on European
Portuguese, the paper argues that this conclusion allows for a
precise characterization of the distribution of the inflected
infinitive in verbal complement position: the inflected infinitive
is barred in the complement position of restructuring verbs and in
interrogative complements. The paper offers an account of this
distribution that is based on the idea that inflected infinitives
are bare TP projections. Evidence in favor of this claim comes from
an examination of the distribution of pre-verbal subjects. The
restrictions on subject reference found in inflected infinitival
complements of different OC attitude verbs in European Portuguese
stem from the particular status of Actional complements in OC
contexts (Farkas 1992;
Jackendoff & Culicover
2003).
Changes in Hospital Discharges with Alcohol-Related Liver Disease in a Gastroenterology and General Medical Unit Following the Introduction of Minimum Unit Pricing of Alcohol: The GRI Q4 Study
Authors: Chaudhary Sardar , MacKey William , Duncan Katherine , Forrest Ewan H
Published: July 2021

Aims

Minimum unit price (MUP) of 50 pence per unit of alcohol was introduced in Scotland on the 1 May 2018. We assessed alcohol-related liver disease (ArLD) discharges from Glasgow Royal Infirmary (GRI) before and after the introduction of MUP.

Methods

Medical records of all patients discharged from Gastroenterology wards at GRI in the fourth quarter (Q4) of the years 2015–2019 were reviewed. All patients with ArLD were identified, and detailed hospitalization data were collected retrospectively. Active drinking, severity scores, presence of alcoholic hepatitis (AH) and 90-day mortality and readmission rates were assessed.

Results

There were fewer ArLD discharges per quarter after MUP than before (mean 80.3 pre-MUP; mean 68 post-MUP), and the proportion of active drinkers was lower post-MUP (64.7 vs. 70.5%). There was a significant fall in the mean number of weekly discharges of individual patients who were actively drinking (4.0 ± 2.0 pre-MUP, 2.8 ± 1.5 post-MUP, P = 0.01). There were no differences in the proportion of patients presenting with ascites, encephalopathy or AH; however, there was a reduction in presentations with acute upper gastrointestinal bleeding from 15.8% pre-MUP to 7.4% post-MUP (P = 0.02; odds ratio 0.42). Severity of liver disease remained unchanged. The 90-day mortality and readmission rates were not significantly different.

Conclusion

Since the introduction of MUP there has been a reduction in the absolute numbers of patients discharged with ArLD and the number of individual patients involved at GRI. The pattern of clinical presentation was largely unaffected with overall ArLD severity, readmission rates and 90-day mortality similar pre- and post-MUP.
Taxonomic inflation due to inadequate sampling: are girdled lizards (Cordylus minorspecies complex) from the Great Karoo one and the same?
Authors: Tolley Krystal A , Telford Nicolas S , Taft Jody M , Bates Michael F , Conradie Werner , Makhubo Buyisile G , Alexander Graham J
Published: July 2021

The Great Karoo and Namaqualand of South Africa are home to a species complex of morphologically conserved lizards that occur in allopatry (Karoo: Cordylus aridus, Cordylus cloetei, Cordylus minor; Namaqualand: Cordylus imkeae). However, there are negligible morphological differences and a lack of obvious physical or climatic barriers, particularly among the three Karoo species. We hypothesized that poor geographic coverage in previous studies and lack of an explicit species concept has caused taxonomic inflation. We therefore tested species boundaries by examining multiple criteria: multi-gene phylogenetics, niche distribution modelling and re-examination of diagnostic morphological features with a larger sample size. We found that C. aridus, C. cloetei and C. minor lack diagnosable differences for both genetics and morphology. Distribution modelling, ranging from present day to the last interglacial period, show connectivity has been maintained especially during cooler periods. Conversely, C. imkeae is morphologically diagnosable, genetically distinct and lacks connectivity with the other taxa. By evaluating multiple operational criteria, we conclude that the C. minor species complex comprises only two species, C. minor (with C. aridus and C. cloetei as junior synonyms) and C. imkeae, demonstrating that species defined from inadequate data and lack of an explicit species concept can lead to taxonomic inflation.
Human Cerebral Perfusion, Oxygen Consumption, and Lactate Production in Response to Hypoxic Exposure
Authors: Vestergaard Mark B , Ghanizada Hashmat , Lindberg Ulrich , Arngrim Nanna , Paulson Olaf B , Gjedde Albert , Ashina Messoud , Larsson Henrik B W
Published: July 2021

Exposure to moderate hypoxia in humans leads to cerebral lactate production, which occurs even when the cerebral metabolic rate of oxygen (CMRO2) is unaffected. We searched for the mechanism of this lactate production by testing the hypothesis of upregulation of cerebral glycolysis mediated by hypoxic sensing. Describing the pathways counteracting brain hypoxia could help us understand brain diseases associated with hypoxia.

A total of 65 subjects participated in this study: 30 subjects were exposed to poikilocapnic hypoxia, 14 were exposed to isocapnic hypoxia, and 21 were exposed to carbon monoxide (CO). Using this setup, we examined whether lactate production reacts to an overall reduction in arterial oxygen concentration or solely to reduced arterial oxygen partial pressure. We measured cerebral blood flow (CBF), CMRO2, and lactate concentrations by magnetic resonance imaging and spectroscopy.

CBF increased (P < 10−4), whereas the CMRO2 remained unaffected (P > 0.076) in all groups, as expected. Lactate increased in groups inhaling hypoxic air (poikilocapnic hypoxia: $0.0136\ \frac{\mathrm{mmol}/\mathrm{L}}{\Delta{\mathrm{S}}_{\mathrm{a}}{\mathrm{O}}_2}$, P < 10−6; isocapnic hypoxia: $0.0142\ \frac{\mathrm{mmol}/\mathrm{L}}{\Delta{\mathrm{S}}_{\mathrm{a}}{\mathrm{O}}_2}$, P = 0.003) but was unaffected by CO (P = 0.36).

Lactate production was not associated with reduced CMRO2. These results point toward a mechanism of lactate production by upregulation of glycolysis mediated by sensing a reduced arterial oxygen pressure. The released lactate may act as a signaling molecule engaged in vasodilation.
Influence of frailty syndrome on anxiety and depression of patients with atrial fibrillation
Authors: Jankowska-Polanska B , Swiatoniowska-Lonc N , Polanski J , Slawuta A , Gajek J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Atrial fibrillation (AF) is a chronic disease whose somatic symptoms cause patients to feel anxiety. Anxiety and depression are associated with recurrent episodes of AF and may exacerbate the symptoms of arrhythmia, increasing the risk of sudden complications and death. The evidence suggests that frailty leads to cognitive decline and increased prevalence of anxiety and depression. However, there is little information on what increases the risk of frailty syndrome in atrial fibrillation.

The aim of the study was to determine the impact of frailty syndrome on anxiety and depression in patients with AF.

Material and methods. The study was conducted on 158 patients with AF (including 78 women) aged 70.4 ± 7.6 years. Standardized tools were used: the Edmonton frailty scale (EFS) and the hospital anxiety and depression scale (HADS-M) to assess and compare anxiety, depression, and frail and non-frail patients with AF.

Results. The average ESF score was 8.555.0. 53.2% had frailty syndrome, 10.1% were vulnerable and 36.7% had no frailty syndrome. Mean level of anxiety was 10.253.0 and depression was 9.83.85. In comparative analysis patients with frailty syndrome had more often high level of anxiety (73.8% vs. 18.9%, p < 0.001) and high level of depression (72.6% vs. 2.7%; p < 0.001) in comparison to patients without frailty syndrome. In multivariate analysis the independent determinants of frailty syndrome were longer duration of AF (β=4.649, p = 0.001), anxiety (β=2.4727, p = 0.036) and depression (β=5.5712, p < 0.001).

Conclusions. Patients with AF have high level of FS and anxiety and depression, and FS exacerbates the symptoms of anxiety and depression. Independent determinants of frailty syndrome are longer duration of AF, anxiety and depression.
Development and validation of a questionnaire to assess knowledge in patients with Atrial Fibrillation
Authors: Gallagher C , Rowett D , Nyfort-Hansen K , Simmons S , Bulto L , Middeldorp ME , Lau DH , Sanders P , Hendriks JM
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Centre for Heart Rhythm Disorders

Background

Education is critical to empower individuals to self-monitor and manage their condition. Significant variability exists in the provision of education for atrial fibrillation (AF), whilst individual patient factors including health literacy and education level attainment may impact on knowledge levels. Objective assessment of knowledge  may help to target education to areas of need, and result in improved patient outcomes.

Objective

To describe the development and validation of a knowledge questionnaire for AF.

Methods

A multidisciplinary expert team of healthcare professionals developed the questionnaire, in conjunction with consumers, with question content based upon areas deemed most critical to AF and related self-management. The multiple choice questionnaire consists of 20 items, each worth 5 points, to give a total score out of 100. The questionnaire assesses five domains specific to AF: general knowledge, complications, medications, risk factors and action. The questionnaire was developed in English. The questionnaire was tested on 10 randomly selected patients with AF for face validity and 19 healthcare professionals for content validity. The final version was completed by 454 individuals with AF. Exploratory factor analysis was used to determine construct validity with factor loadings of 0.40 and above considered acceptable. Reliability was assessed using Cronbach’s alpha, with a value greater than 0.7 acceptable.

Results

Face and content validity were considered acceptable, after minor changes to wording. The cohort of 454 individuals with AF had a mean age of 66.9 ± 12 years and 43% were female. Mean (SD) total score was 57.7 ± 15.8. Exploratory factor analysis was undertaken using the principal components method. This resulted in a Kaiser–Meyer–Olkin Measure of Sampling Adequacy of .64 and a Bartlett"s Test of Sphericity being significant at 0.00. Seven factors were selected and analysed using principal component analysis with varimax rotation. All items loaded on one of the seven factors. Internal consistency demonstrated a Cronbach’s alpha of 0.65.

Conclusion

The Atrial Fibrillation Knowledge Questionnaire is a valid measure to assess knowledge in individuals with AF.
Heart Failure Patients with type II diabetes still require more focus
Authors: Caples N , Cronin E , Lehane M
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

A bidirectional relationship exists between heart failure and diabetes; heart failure is a risk factor for type II diabetes and type II diabetes is a risk factor for heart failure. The prevalence of both chronic conditions is on a continuous upward rise. Heart failure has a poorer prognosis than diabetes and therefore heart failure patients with diabetes should be also managed at a heart failure centre. It has been shown that heart failure medication is of benefit to patients with or without diabetes.

Purpose

With new advances in heart failure medication this retrospective and prospective analysis examines if patients with or without type II diabetes receiving similar care at a heart failure centre will have similar outcomes.

Methods

 A retrospective and prospective cohort analyses was performed on 50 patients attending a single centre heart failure clinic over a 12-month period. LVEF, NT Pro BNP and NYHA was examined pre- and post-receiving similar heart failure care.

Results

50 patients were recruited for this study. There were 25 patients in the type II diabetes cohort (10 female: 15 male. Average age 77 years old) and 25 patients in the non-diabetes cohort (7 female:18 male. Average age 79 years old). In the type II diabetes cohort average LVEF pre care 27%: post care 33% (difference 6%), average NT Pro BNP pre care 3558 pg/ml: post care 2564 pg/ml (difference 994 pg/ml), average NYHA pre care II: post care I-II (difference of 0.5).

In the non-diabetic cohort average LVEF pre care 26%: post care 37% (difference 11%), average NT Pro BNP pre care 1679 pg/ml: post care 1135 pg/ml (difference 544 pg/ml), average NYHA pre care II: post care I-II (difference 0.5).

Conclusion

Both cohorts of patients had similar NYHA functional class outcomes. The patients in the type II diabetes cohort had higher NT Pro BNP levels pre care and higher reduction in NT Pro BNP post care than the non-diabetic cohort. Both cohorts had similar LVEF pre care, but the non-diabetic cohort had better improvement post care, with possible avoidance of need for implantable cardiac devices compared to the type II diabetes cohort. This study shows that heart failure nurses should be aware that heart failure patients with type II diabetes carry a higher risk profile and should be actively identified as part of an individualised, person-centred care approach. Heart failure patients with type II diabetes need to have vigilant scrutiny of their care to optimise their outcomes.
Living with heart failure during the COVID-19 pandemic: an interpretative phenomenological analysis
Authors: Trenta AM , Ausili D , Caruso R , Moro M , Nania T , Vellone E , Dellafiore F
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The COVID-19 outbreak has presented significant challenges for healthcare systems worldwide, which are responsible for guaranteeing access to care for all patients and limiting the spread of the virus. The necessary changes in the healthcare systems have deeply impacted not only people affected by the novel coronavirus, but also those with chronic conditions, such as heart failure. Since the beginning of the pandemic, a reduction of routine visits and use of emergency services by patients with heart failure has been observed, and these patients have tended to visit the hospital only when their symptoms were severe. The consequences of the COVID-19 pandemic on heart failure patients’ lives have not yet been investigated.

Purpose

To explore the lived experiences of patients with heart failure during the COVID-19 pandemic.

Methods

A qualitative investigation based on interpretative phenomenological analysis was conducted. Fourteen patients with heart failure (12 males and 2 females with a median age of 68 years) completed in-depth, semi-structured interviews. Triangulation, journaling and member checking were used to improve the rigour of the study.

Results

Three themes describing the lived experience of patients were identified: "being vulnerable", "hanging in the balance", and "coping strategies". Patients reported feeling particularly vulnerable to the novel coronavirus due to their clinical conditions, and therefore they experienced fear and anxiety. Changes in the healthcare systems due to the COVID-19 pandemic created a sense of uncertainty that patients described as a feeling of hanging in the balance. However, despite these relevant difficulties, heart failure patients have managed to deal with the situation using various coping strategies, such as acceptance, recreational activities, family reorganization, and use of technology.

Conclusions

The COVID-19 outbreak deeply affected the lives of patients with heart failure, and our results highlight the relevant difficulties they have faced. We point out that there is a great need for targeted interventions, and these could be developed taking into consideration the coping strategies described in the study.
Bleeding from the upper gastrointestinal tract in patients with acute coronary pathology receiving dual antiplatelet therapy
Authors: Sapozhnikov A , Razin V , Mazurova O , Mikaelyan A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): own funds

Routine administration of dual antiplatelet therapy reduces the incidence of thrombotic complications and deaths in patients with acute coronary syndrome. However, the widespread use of antithrombotic therapy in these patients is associated with a significant risk of bleeding from the upper gastrointestinal tract. Their frequency in patients with AMI according to various data ranges from 1.1% to 2.3%.

Purpose of the study. To determine the risk factors for upper gastrointestinal bleeding and its outcome in patients with acute coronary pathology receiving dual antiplatelet therapy.

Methods. Analyzed 2632 patients with acute myocardial infarction and 2114 patients with unstable angina who were admitted for a 10-year period (2011-2020) and underwent emergency coronary angiography. The average age of patients is 57 ± 9 years, women – 1649 (35%), men – 3097 (65%).

All patients received dual antiplatelet therapy (acetylsalicylic acid and P2Y12 inhibitor). Studies of the state of the gastric mucosa and duodenum were carried out by endoscopic method, which revealed 31 cases of bleeding. Various baseline characteristics and risk factors for upper gastrointestinal bleeding were evaluated.

Results. The source of bleeding was: gastric ulcer - 8 cases (26%), duodenal ulcer - 6 (20%), simultaneously 2 or more ulcers - 4 (14%), multiple acute erosions - 8 (26%), single acute erosions of the antral part of the stomach - 2 (7%), Mallory-Weiss syndrome - 2 (7%) and bleeding from varicose veins of the esophagus - 1 (3%). Clinically, patients noted pronounced weakness, dizziness, coffee ground vomitus was observed in 8 (26%) patients, melena in 14 (45 %) patients. Bleeding from the upper gastrointestinal tract was detected in 20 patients with AMI (1% of all AMI) and is characterized by a high frequency of deaths (9; 45%). Fatal cases are mainly associated with the appearance of several ulcers of different localization (multiple acute erosions of the stomach and duodenum). In patients with unstable angina, the frequency of bleeding from the upper GIT is about 0.5%, while the duration of hospitalization is extended by an average of 8 days.

Predictors of bleeding from the GIT in patients with acute coronary pathology include

the presence of peptic ulcer disease in the anamnesis, elderly (senile) age, previous long-term use of antiplatelet agents (anticoagulants).

Conclusion

Bleedings from the upper GIT are a serious clinical problem in patients with acute coronary pathology. They are characterized by a long stay in the hospital and a high mortality rate.
May the brief physical activity assessment tool accurately measure physical activity in patients with resistant hypertension?
Authors: Lopes S , Mesquita-Bastos J , Garcia C , Figueiredo D , Carvalho P , Oliveira J , Polonia J , Alves AJ , Ribeiro F
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): FEDER Funds through the Operational Competitiveness Factors Program—COMPETE National Funds through the Portuguese Foundation for Science and Technology (FCT) “PTDC/DTP-DES/1725/2014”. SL is a PhD fellow supported by the FCT (Grant Ref: SFRH/BD/129454/2017).

Introduction

Resistant hypertension is a major health problem due to the increased risk of cardiovascular events and mortality. Physical activity and exercise reduces blood pressure in resistant hypertension and is associated with lower cardiovascular risk and mortality. It is presently recommended that physical activity assessment should be a priority in all visits to health settings

Purpose

This study aims to determine if the Brief Physical Activity Assessment Tool (BPAAT), a 2-question tool to assess physical activity, is a valid instrument to detect inactive patients with resistant hypertension. 

Methods

Sixty patients with a diagnosis of resistant hypertension were recruited. Outcome measures included clinical data, blood pressure and daily physical activity. Physical activity was objectively measured over a 7-day period with an accelerometer and subjectively assessed (self-assessment) by the BPAAT. The association between the BPAAT and accelerometry, according to the BPAAT scoring categories, was assessed bythe percentage of agreement, Cohen’s Kappa and sensitivity and specificity.

Results

Patients (33 were male) had a mean age of 59.4 ± 9.1years, were on average overweight (BMI 29.5 ± 4.5 kg/m2) and on an average of 4.5 ± 0.7 antihypertensive medications. Forty-two patients (70%) were classified as insufficiently active by the BPAAT compared to the 38 (63.3%) insufficiently active patients identified by the accelerometry data. Regarding the questionnaire’s specificity and sensitivity, the BPAAT correctly identified 32 [84.2 (73.1 – 95.3) %] of the 38 ‘insufficiently active’ patients and 12 [54.5 (34.3 – 74.7) %] of the 22 ‘sufficiently active’ patients identified by accelerometry. The agreement between BPAAT and accelerometry to identify sufficiently/insufficiently active patients, according to the BPAAT’s cut-off values was fair to moderate (Kappa = 0.403 (0.162 – 0.674), with a percentage of agreement of 73.3%.

Conclusion

The BPAAT, a 2-question tool to assess physical activity, seems to be a valid and fast solution to identify insufficiently active adults with resistant hypertension during routine clinical visits.