bluuebunny/crossref_metadata_2025 huggingface dataset:
A quantitative microscopic view on the gas‐phase‐dependent phase transformation from tetragonal to monoclinic ZrO2
Authors: Bekheet Maged F. , Schlicker Lukas , Popescu Radian , Riedel Wiebke , Grünbacher Matthias , Penner Simon , Gurlo Aleksander
Published: February 2024

ZrO2 is a versatile material with diverse applications, including structural ceramics, sensors, and catalysts. The properties of ZrO2 are largely determined by its crystal structure, which is temperature‐ and atmosphere dependent. Thus, this work focuses on a quantitative analysis of the temperature‐ and gas atmosphere‐dependent phase transformation of tetragonal t‐ZrO2 into monoclinic m‐ZrO2 during heating–cooling cycles from room temperature to 1273 K. Synchrotron‐based in situ X‐ray diffraction (XRD) studies in gas atmospheres of different reduction strengths, namely, 5 vol% H2/Ar, He, CO2, and air, revealed a stabilizing effect of inert and reductive environments, directly yielding different temperature onsets in the phase transformation during cooling (i.e., 435, 510, 710, and 793 K for 5 vol% H2/Ar, He, CO2, and air, respectively). Rietveld refinement shows a direct influence of the atmosphere on grain size, unit cell, and weight fraction of both polymorphs in the product composite matrix. The tetragonal‐to‐monoclinic (t–m) phase transformation is suppressed in the sample heated only up to ∼850 K, independent of the gas atmosphere. The results of ex situ XRD, transmission electron microscopic, electron paramagnetic resonance, and oxygen titration experiments confirmed that the phase transformation is accompanied by a change in the crystallite/particle size and the amount of lattice defects (i.e., oxygen vacancy). Due to the different onset temperatures, a complex interplay between kinetic limitations of phase transformation and grain sintering yields different pathways of the phase transformation and, eventually, very different final crystallite sizes of both t‐ZrO2 and m‐ZrO2.
Sanitizing of stainless steel surfaces in the food industry: Effect of gaseous ozone against pathogens and filamentous fungi
Authors: Berni Elettra , Belloli Matteo , Cigarini Massimo , Brindani Demetrio , Cardoso Claudia Catelani , Mutti Paola , Imperiale Davide
Published: February 2024

The aim of this work was to evaluate the resistance of two pathogenic bacteria (Listeria monocytogenes and Salmonella enterica subsp. enterica serotype Senftenberg), and three airborne food‐spoiling filamentous fungi (Hyphopichia burtonii, Penicillium nordicum, and Aspergillus brasiliensis ATCC 16404) to gaseous ozone on stainless steel. Tests were carried out by exposing inoculated tiles to gaseous ozone in a laboratorial chamber at concentrations up to 50 mg/L and at times up to 180 min (bacteria) or 300 min (filamentous fungi). For bacteria, the resistance to gaseous ozone of L. monocytogenes proved markedly higher than that of S. enterica. Their D‐values increased by seven times (from 27.3 to 200.7 min for the strain of L. monocytogenes studied; from 7.3 to 48.0 min for the Salmonella species studied) when the ozone concentration were reduced from 12 to 4 mg/L. For filamentous fungi, a substantial effect was observed only at 50 mg/L on single‐layered inocula: at these conditions, A. brasiliensis ATCC 16404 proved the most resistant strain to gaseous ozone, its D‐value (134.4 min) being higher than those registered for the tested strains of H. burtonii (9.9 min) and P. nordicum (17.1 min). The results demonstrated that the use of gaseous ozone as a sanitizing agent for environments and working surfaces seems to be a potential alternative to chemical sanitizers against the two pathogens studied, whereas it seemed effective against the three filamentous fungi studied only in limited circumstances.
The status of drug evaluation in older adults in the United Kingdom: Bridging the representation gap
Authors: Walker Lauren E. , Pirmohamed Munir
Published: February 2024

Older adults are persistently underrepresented in clinical drug trials worldwide, despite increasing multiple long‐term conditions and significant prescribing in this demographic. We discuss systemic challenges such as the exclusion of people with comorbid conditions and the lack of assessment for comorbidities as modifiers of treatment effects and highlight the rising trend of polypharmacy, especially among the oldest age groups, which is linked to a significant percentage of unplanned hospitalizations and medication errors. The consequences of these trends prompted the United Kingdom National Overprescribing review, culminating in a set of recommendations for drug development tailored to older adults. Building on this, two critical reports released in April 2023 by the International Longevity Centre (ILC) and the Nuffield Council on Bioethics (NCOB) are discussed. These reports emphasize the importance of diversity and inclusion in clinical trials, advocating for ethical frameworks and methodologies that cater to the complex needs of older adults. The development of inclusive criteria, innovative statistical methodologies, and the integration of patient‐reported outcomes are needed to address the persistent barriers to older adult participation in research, suggesting that pragmatic trials, exemplified by the UK's RECOVERY trial during the COVID‐19 pandemic, could pave the way for more inclusive research practices.
Law & Economics at sixty: Mapping the field with bibliometric and machine learning tools
Authors: Kantorowicz‐Reznichenko Elena , Kantorowicz Jaroslaw
Published: February 2024

As the year 2020 marks the 60th anniversary of the landmark paper in the Law & Economics (L&E) field by Ronald Coase—The Problem of Social Cost—we provide a systematic bibliometric analysis of the development of this field over the years. We look at the output and input side of knowledge production in the field of L&E. The former consists of the volume of production and thematic coverage of the field. The latter—input—looks at the producers of knowledge, the institutional and country affiliations of authors, and the intellectual structure of the field. Thus, the “who”, the “where” knowledge is produced as is also that of on “whose” shoulders the field stands. We demonstrate that Law & Economics shifted from more theory driven work to empirical and evidence‐based contributions. Likewise, we show that the Law & Economics field tends to be dominated by authors affiliated with economics departments, and crucially; however, more impactful research seems to be produced by inter‐disciplinary cooperation. The L&E field further resembles the economics domain in terms of co‐authorship patterns, number of citations and lengths of papers. Finally, we look at diversity in the field of L&E and show, for instance, that the share of female scholars has been steadily growing for the last two decades.
Examining attitudes toward public participation across sectors: An experimental study of food assistance
Authors: Amirkhanyan Anna , Roberts Fei , Meier Kenneth J. , Song Miyeon
Published: February 2024

Public views of government are linked to trust, coproduction, regulatory compliance, and political participation. This study focuses on factors shaping public attitudes toward government programs by exploring whether direct participation in governance matters for how the public evaluates the performance of government programs. With an experiment involving governmentally funded food assistance, we randomize the presence of public participation, service providers' sector, and third‐party performance ratings and explore their influence on respondents' assessments of the program. We find that respondents have more confidence in the efficiency, equity, and other aspects of performance when ordinary people play a role in designing and implementing the program. We observe no sector bias among respondents. Individual assessments depend on objective performance information from a credible source. These findings have critical implications for the value people place on engagement in governance and point to the role of publicly available data in shaping public views of government.
LaSap vaccine: Immunotherapy and immunochemotherapy associated with allopurinol in dogs naturally infected with Leishmania infantum
Authors: Clasta Ricardo B. , Rivas Açucena Veleh , Souza Adrieli Barboza , dos Santos Angelo G. V. , Le Quesne Andrés Hernán Mojoli , Gonçalves Ana Alice Maia , Cangussu Alex Sander R. , Giunchetti Rodolfo C. , Viana Kelvinson F.
Published: February 2024

Canine visceral leishmaniasis is a parasitic zoonosis that has a profound impact on public health in countries where it is endemic. Chemotherapeutic treatments cannot keep dogs stable for long periods, and the risk of generating parasitic resistance must be considered. Forty‐four symptomatic and naturally infected dogs with Leishmania infantum were tested with two treatment protocols (i) immunotherapy with LaSap vaccine and (ii) immunochemotherapy with LaSap vaccine plus allopurinol. At 90 days after the end of the treatment, it was verified that, although both protocols had generated significant clinical improvements with a greater production of IFN‐γ/IL‐10, in relation to the parasite load, mainly in the skin, the dogs treated only with immunotherapy maintained the same profile. These results indicate that LaSap is a good strategy to control dog parasitism.
‘You don't want to be seen to be struggling’; identifying sociocultural barriers and facilitators for Irish farmers’ mental health help‐seeking
Authors: Firnhaber Joseph , Malone Sandra M. , O'Hagan Anna Donnla , O'Keefe Sinead , McNamara John , O'Connor Siobhan
Published: February 2024

Farmers face significant mental health issues, including depression, anxiety and suicidal ideation. Additionally, rural populations widely endorse stoic values which can be a barrier to farmers’ help‐seeking. In this study, we identified sociocultural barriers and facilitators to Irish farmers’ mental health help‐seeking. We conducted 17 semi‐structured interviews with Irish farmers and three focus groups and one interview with farming stakeholders in Ireland online. Interviews and focus groups followed a conversational, semi‐structured schedule concerning Irish farmers’ help‐seeking beliefs and behaviours, and were analysed using reflexive thematic analysis. We identified three central barriers to farmers’ help‐seeking: resilience, pride in being a ‘good farmer’ and help‐seeking stigma. We also identified one central barrier/facilitator: slowly increasing mental health awareness. Across all themes, participants described Irish farmers of all genders, particularly older men, as suffering from a self‐reliant cycle of masculine stoicism. Our findings add to the growing ‘good farmer’ literature by illustrating how farmers’ health practices can be both a source of social capital and a detriment to their own health and help‐seeking.
Skin ultrasonography and magnetic resonance; new clinical applications and instrumentation
Authors: Zemtsov Alexander
Published: February 2024

Background

Technological advances in skin ultrasonography and magnetic resonance are discussed.

Methods

Literature review.

Results

40 publications cited.

Conclusion

This article illustrates crucial contributions made by the Editors, the Editorial Board and this Journal to these fields.
The Malagasy phrasal comparative
Authors: Potsdam Eric
Published: February 2024

There is no consensus in the literature on the analysis of phrasal comparatives. Both reduced clause analyses, in which the standard phrase contains elided clausal structure, and direct analyses, in which the standard of comparison is a direct complement to the standard marker, have been proposed. This paper argues for a direct analysis of the phrasal comparative in Malagasy, an Austronesian language spoken on the island of Madagascar. Evidence for the direct analysis comes from the lack of overt clausal comparatives, Binding Theory, scope, and Malagasy‐specific characteristics of the standard. The conclusion contributes to the rapidly expanding picture of cross‐linguistic variation in comparative syntax.
Reinforcement Learning Building Control: An Online Approach With Guided Exploration Using Surrogate Models
Authors: Dey Sourav , Henze Gregor P.
Published: February 2024

The incorporation of emerging technologies, including solar photovoltaics, electric vehicles, battery energy storage, smart devices, Internet-of-Things devices, and sensors in buildings, desirable control objectives are becoming increasingly complex, calling for advanced controls approaches. Reinforcement learning (RL) is a powerful method for this. RL can adapt and learn from environmental interaction, but it can take a long time to learn and can be unstable initially due to limited environmental knowledge. In our research, we propose an online RL approach for buildings that uses data-driven surrogate models to guide the RL agent during its early training. This helps the controller learn faster and more stably than the traditional direct plug-and-learn online learning approach. In this research, we propose an online approach in buildings with RL where, with the help of data-driven surrogate models, the RL agent is guided during its early exploratory training stage, aiding the controller to learn a near-optimal policy faster and exhibiting more stable training progress than a traditional direct plug-and-learn online learning RL approach. The agents are assisted in their learning and action with information gained from the surrogate models generating multiple artificial trajectories starting from the current state. The research presented an exploration of various surrogate model-assisted training methods and revealed that models focusing on artificial trajectories around rule-based controls yielded the most stable performance. In contrast, models employing random exploration with a one-step look-ahead approach demonstrated superior overall performance.
Inter-subunit energy transfer processes in a minimal plant photosystem II supercomplex
Authors: Nguyen Hoang Long , Do Thanh Nhut , Zhong Kai , Akhtar Parveen , Jansen Thomas L. C. , Knoester Jasper , Caffarri Stefano , Lambrev Petar , Tan Howe-Siang
Published: February 2024

Photosystem II (PSII) is an integral part of the photosynthesis machinery, in which several light-harvesting complexes rely on inter-complex excitonic energy transfer (EET) processes to channel energy to the reaction center. In this paper, we report on a direct observation of the inter-complex EET in a minimal PSII supercomplex from plants, containing the trimeric light-harvesting complex II (LHCII), the monomeric light-harvesting complex CP26, and the monomeric PSII core complex. Using two-dimensional (2D) electronic spectroscopy, we measure an inter-complex EET timescale of 50 picoseconds for excitations from the LHCII-CP26 peripheral antenna to the PSII core. The 2D electronic spectra also reveal that the transfer timescale is nearly constant over the pump spectrum of 600 to 700 nanometers. Structure-based calculations reveal the contribution of each antenna complex to the measured inter-complex EET time. These results provide a step in elucidating the full inter-complex energy transfer network of the PSII machinery.
Undergraduate-level biology students’ application of central dogma to understand COVID mRNA vaccines
Authors: Shahoy Saya , Du Michelle , Mostafa Ola , Parker Aliyah , Martirano Dylan , Owens Melinda T.
Published: February 2024

The coronavirus disease 2019 (COVID-19) pandemic has underscored the importance of mRNA vaccines. The mechanism for how such vaccines work is related to the core biology topic of the central dogma, which students often misunderstand despite its importance. Therefore, we wanted to know whether students can apply their biology knowledge of central dogma to the real-world issue of how mRNA COVID vaccines work. Accordingly, we asked college biology students of different expertise levels how the COVID vaccine worked. Later, we cued them by telling them the vaccine contains mRNA and asked them what the mRNA does. We used thematic analysis to find common ideas in their responses. In the uncued condition, fewer than half of the students used central dogma-related ideas to explain what was in the vaccine or how the vaccine worked. Inaccurate ideas were present among all groups of biology students, particularly entering biology majors and non-biology majors, including the idea that the COVID vaccines contain a weakened, dead, or variant form of the COVID virus. After students were cued, many more students in all expertise groups expressed central dogma-related themes, showing that students could apply the knowledge of central dogma if prompted. Advanced biology majors were much more likely to state that the vaccines code for a viral protein, indicating their advanced application of central dogma concepts. These results highlight inaccurate ideas common among students and show changes in the ability to apply knowledge with student expertise level, which could inform future interventions to support student learning about vaccines and central dogma.
Within-species variability of antibiotic interactions in Gram-negative bacteria
Authors: Tang Po-Cheng , Sánchez-Hevia Dione L. , Westhoff Sanne , Fatsis-Kavalopoulos Nikolaos , Andersson Dan I.
Published: February 2024

Treatments with antibiotic combinations are becoming increasingly important even though the supposed clinical benefits of combinations are, in many cases, unclear. Here, we systematically examined how several clinically used antibiotics interact and affect the antimicrobial efficacy against five especially problematic Gram-negative pathogens. A total of 232 bacterial isolates were tested against different pairwise antibiotic combinations spanning five classes, and the ability of all combinations in inhibiting growth was quantified. Descriptive statistics, principal component analysis (PCA), and Spearman’s rank correlation matrix were used to determine the correlations between the different combinations on interaction outcome. Several important conclusions can be drawn from the 696 examined interactions. Firstly, within a species, the interactions are in general conserved but can be isolate-specific for a given antibiotic combination and can range from antagonistic to synergistic. Secondly, additive and antagonistic interactions are the most common observed across species and antibiotics, with 87.1% of isolate-antibiotic combinations being additive, 11.6% antagonistic, and only 0.3% showing synergy. These findings suggest that to achieve the highest precision and efficacy of combination therapy, not only isolate-specific interaction profiling ought to be routinely performed, in particular to avoid using drug combinations that show antagonistic interaction and an expected associated reduction in efficacy, but also discovering rare and potentially valuable synergistic interactions.

IMPORTANCE

Antibiotic combinations are often used to treat bacterial infections, which aim to increase treatment efficacy and reduce resistance evolution. Typically, it is assumed that one specific antibiotic combination has the same effect on different isolates of the same species, i.e., the interaction is conserved. Here, we tested this idea by examining how several clinically used antibiotics interact and affect the antimicrobial efficacy against several bacterial pathogens. Our results show that, even though within a species the interactions are often conserved, there are also isolate-specific differences for a given antibiotic combination that can range from antagonistic to synergistic. These findings suggest that isolate-specific interaction profiling ought to be performed in clinical microbiology routine to avoid using antagonistic drug combinations that might reduce treatment efficacy.
Whole genome sequence of denitrifying bacterium
Stutzerimonas stutzeri
strain NGHE31, collected from an eutrophic wetland in Sunamganj, Bangladesh, following the 2017 flash floods
Authors: Rahman Aura , Akter Sumaiya , Sadique Abdus , Alam Jahidul , Asrafie Shoheli , Tabassum Anika , Hossain Sakib Abrar , Rahman Mohammad Moshiur , Billah Md. Baki , Huq Tahrima Saiha , Uddin Kabir M. , Rahman Md. Mahbubur , Sharmin Ayesha , Hossain Md. Mainul , Alam Sayad Md. Didarul , Hossain Maqsud
Published: February 2024

Here, we report the whole genome sequence of
Stutzerimonas stutzeri
strain NGHE31, isolated from Dekhar Haor, following the 2017 flash flood that resulted in mass die-offs of local wildlife. The predicted genome size is 4,434,670 bp, with 63.97% GC content, 4,035 coding sequences, 3 rRNAs, and 50 tRNAs.
Polymyxin B nonapeptide potentiates the eradication of Gram-negative bacterial persisters
Authors: Kim Sun Ju , Jo Jeongwoo , Kim Jihyeon , Ko Kwan Soo , Lee Wonsik
Published: February 2024

Antibiotic-resistant Gram-negative bacteria remain a globally leading cause of bacterial infection-associated mortality, and it is imperative to identify novel therapeutic strategies. Recently, the advantage of using antibacterials selective against Gram-negative bacteria has been demonstrated with polymyxins that specifically target the lipopolysaccharides of Gram-negative bacteria. However, the severe cytotoxicity of polymyxins limits their clinical use. Here, we demonstrate that polymyxin B nonapeptide (PMBN), a polymyxin B derivative without the terminal amino acyl residue, can significantly enhance the effectiveness of commonly used antibiotics against only Gram-negative bacteria and their persister cells. We show that although PMBN itself does not exhibit antibacterial activity or cytotoxicity well above the 100-fold minimum inhibitory concentration of polymyxin B, PMBN can increase the potency of co-treated antibiotics. We also demonstrate that using PMBN in combination with other antibiotics significantly reduces the frequency of resistant mutant formation. Together, this work provides evidence of the utilities of PMBN as a novel potentiator for antibiotics against Gram-negative bacteria and insights for the eradication of bacterial persister cells during antibiotic treatment.

IMPORTANCE

The significance of our study lies in addressing the problem of antibiotic-resistant Gram-negative bacteria, which continue to be a global cause of mortality associated with bacterial infections. Therefore, identifying innovative therapeutic approaches is an urgent need. Recent research has highlighted the potential of selective antibacterials like polymyxins, which specifically target the lipopolysaccharides of Gram-negative bacteria. However, the clinical use of polymyxins is limited by their severe cytotoxicity. This study unveils the effectiveness of polymyxin B nonapeptide (PMBN) in significantly enhancing the eradication of persister cells in Gram-negative bacteria. Although PMBN itself does not exhibit antibacterial activity or cytotoxicity, it remarkably reduces persister cells during the treatment of antibiotics. Moreover, combining PMBN with other antibiotics reduces the emergence of resistant mutants. Our research emphasizes the utility of PMBN as a novel potentiator to decrease persister cells during antibiotic treatments for Gram-negative bacteria.
Link between glacial striation morphology and induced drag
Authors: Zoet Lucas K. , Smith Lillian , Mixtli Alex , Brooks Jeremy , Hansen Dougal D.
Published: February 2024

Abrasion acts to smooth glacial terrains and leaves behind linear scratch-like features (striations) on bedrock landscapes. Striations are often used as measures of glacier flow directions, but their morphology can also provide information about the subglacial stress conditions that produced the features. While striations are often abundant in the field, the processes that create them can be opaque and hard to examine in situ because they occur under thick layers of flowing ice. To alleviate that difficulty and provide information for interpretation of the populations of striations that are observed in the field, we conducted a set of laboratory experiments in which a ring of temperate debris-laden ice was slid atop a planar marble bed under various contact force conditions that led to the creation of hundreds of striations. During the experiment, numerous glaciological properties were continuously measured, including the resistive drag. Following the completion of the experiments, the marble beds were extracted, and the striations were measured for length and categorized by morphological type, and a subset was measured using a high-resolution white-light profilometer. These experiments showed that, similar to field observations, type 2 striations were initially the most abundant; however, we found that type 3 striations became the most abundant at large displacements. We found good correlation between the abundance of striations as a function of displacement and measured drag as a function of displacement. When taken together, these results suggest that, in natural settings, ice flow around small roughness elements in glacier beds can “reset” the basal debris field, causing striations to become more abundant in their wake. As roughness is linked to quarrying, abrasion rates may increase in areas of increased quarrying.
Diffuse Pneumonitis after Lutetium-177-PSMA-617 Treatment in a Patient with Metastatic Castration-Resistant Prostate Cancer
Authors: Wang John S , Wong Terence , Wu Kevin A , Mullikin Trey C , Armstrong Andrew
Published: February 2024

We present the case of a patient with heavily pretreated metastatic castration-resistant prostate cancer (mCRPC) who received lutetium Lu-177 vipivotide tetraxetan (also known as177Lu-PSMA-617) due to progressive disease despite chemotherapy, hormonal therapy and radiation, including palliative mediastinal and central nervous system radiation. He was subsequently hospitalised for worsening acute onset dyspnoea despite clinically responding to therapy. Interval imaging revealed progressive multifocal ground-glass opacities superimposed on a background of underlying peribronchovascular fibrosis. Further workup, including an extensive workup to identify a possible infectious aetiology, ruled out most aetiologies leaving radiation pneumonitis (RP), radiation recall pneumonitis (RRP) and drug-induced pneumonitis as possible diagnoses secondary to177Lu -PSMA-617. The associated imaging findings of ground-glass opacities and consolidation can be like other aetiologies such as acute infection and subsequently may be treated incorrectly. In the use of theragnostics like177Lu -PSMA-617, it is fundamental to apply the practices of radioprotection learnt from radiotherapy, as well as to consider prior radiotherapy treatments and their possible side effects when used in conjunction.
Prevalence and management of familial hypercholesterolaemia in patients with chest pain admitted to hospital: a retrospective observational study
Authors: Mülverstedt Stefan , Prescott Eva Irene Bossano , Jørgensen Henrik , Heitmann Merete
Published: February 2024

Objectives

Patients with familial hypercholesterolaemia (FH) are genetically burdened by a lifelong elevation of the low-density lipoprotein cholesterol (LDL-C) level, putting them at a very high risk of premature ischaemic heart disease (IHD). This study aims to assess the prevalence of FH among patients admitted for IHD and the preventive treatment status before admission.

Design

Observational, retrospective, register-based study.

Setting

Individuals discharged with a diagnosis of IHD were enrolled consecutively throughout 2012–2016 from the cardiac care units of two hospitals in Copenhagen.

Participants

4223 individuals were discharged during the period. Inclusion criteria for further investigation were the availability of one measurement of LDL-C at the time of admission. In total, 2797 individuals were included for further investigation. There were no exclusion criteria.

Primary and secondary outcome measures

The primary objective has been to determine the prevalence of FH in the population. The secondary objective has been to determine the use of lipid-lowering therapy and to which extend the individuals reach their treatment goal.

Results

Among the 2797 consecutive patients evaluated, the prevalence of potential FH was 7.7% (1: 13) and 6.8% (1:15) had probably or definite FH. The prevalence of FH was age-dependent: Among the 680 patients (24.3%) with premature IHD (men <55 years/women <60 years), 136 patients (20.0%) had potential FH and 21 (3.1%) had probable/definite FH. None were diagnosed and almost none attained their treatment goal.

Conclusions

There is still a massive lack of recognition of FH in patients admitted to a cardiac care unit with a diagnosis of IHD. Despite a measured high LDL-C, the diagnosis was not made for any patients not even in patients who were admitted at an early age or had a previous cardiovascular event.
Improving the emergency services using quality improvement project and Donabedian model in a quaternary teaching hospital in South India
Authors: Goenka Apoorva , Mundkur Suneel , Sujir Nayak Sachin , Shetty Avinash , Thomas Jibu , Mymbilly Balakrishnan Jayaraj , Chandra Sekaran Varalakshmi , Dsouza Brayal
Published: February 2024

Introduction

The primary goal of quality improvement is to enhance patient outcomes, particularly in the emergency department (ED). Timely and effective care is crucial in these situations. By comprehending the challenges, evaluating current performance and implementing quality improvement projects, areas in need of enhancement can be pinpointed and addressed, resulting in better outcomes.

Methodology

This interventional study explores the implementation of quality improvement in the ED of a quaternary care teaching hospital in South India. It follows the Plan-Do-Check-Act (PDCA) cycle guided by the Donabedian model. Descriptive statistics were employed to measure changes in outcomes before and after implementation. To improve processes, Donabedian principles were applied, and a performance audit was conducted based on patient feedback and stakeholder input. Various ED indicators were measured. To address identified issues, formal root cause analysis was performed, leading to the generation of PDCA rapid change cycles. These cycles were implemented over 6 months, with two cycles executed, followed by postimplementation evaluation.

Results

Post implementation, improvements were observed in several aspects of ED operations. These included reduced ED average length of stay, decreased time to analgesia, shorter cross-consultation time, faster transfer time from ED and improved investigation turnaround time (TAT). Additionally, there was a reduction in revisits to ED within 72 hours and a decrease in patients who left without being seen. These positive changes demonstrate the effectiveness of the quality improvement intervention using the PDCA cycle.

Conclusion

A comprehensive understanding of patient profile in the ED and factors influencing care is essential for the hospital to ensure sufficient resources and skilled emergency medicine physicians are available 24/7. By enhancing services in the ED, reducing patient waiting times and improving TAT, the overall efficiency of services can be improved. This leads to provision of timely quality care to patients and ultimately improves their outcomes.
Increasing rates of screening and treatment of iron deficiency in ambulatory patients with heart failure with reduced ejection fraction: a quality improvement cohort study
Authors: Gewarges Mena , Mainland Roslyn , Wilkinson Katherine , Sklar Jaime , Gentilin Andrew , McLean Bianca , Hajjaj Omar I , Worme Mali , Lalonde Spencer , Patel Raumil , Lin Yulia , Callum Jeannie , Poon Stephanie
Published: February 2024

Introduction

Iron deficiency anaemia (IDA) is common in patients with heart failure (HF) and is associated with advanced HF and increased mortality. Intravenous iron supplementation increases exercise tolerance, improves quality of life, and decreases symptoms among patients with HF with reduced ejection fraction (HFrEF) and iron deficiency. Despite this, many patients are not screened or treated for IDA. We aimed to increase rates of screening and treatment of IDA among HF patients through the introduction of curated materials to aid HF clinicians with appropriate screening and treatment.

Methods

We conducted a retrospective chart review to identify the baseline number of HFrEF patients screened and treated for IDA at two ambulatory cardiology clinics in Toronto, Ontario. A quality improvement initiative was then introduced, which consisted of education and curated materials to aid clinicians in the screening and treatment of IDA among HFrEF patients. The proportion of patients screened and treated for IDA preintervention and postintervention were compared using χ2tests of Independence.

Results

In the preintervention cohort, 36.3% (n=45) of patients with anaemia were screened for IDA. Among those screened, 64.4% (n=29) had IDA. Only 17.2% (n=5) of these were treated with IV iron. After implementation of the quality improvement initiative, 90.9% (n=60) of patients with anaemia were screened for IDA (p<0.001) and 90.3% (n=28) of those with IDA were treated with IV iron (p<0.001).

Conclusion

The introduction of curated materials to aid clinicians was associated with increased rates of screening and treatment of IDA among ambulatory HFrEF patients. Further work is required to identify barriers and implement strategies to increase screening and treatment rates of IDA among HFrEF patients.
Between-hospital variation in indicators of quality of care: a systematic review
Authors: van der Linde Margrietha , Salet Nèwel , van Leeuwen Nikki , Lingsma Hester F , Eijkenaar Frank
Published: February 2024

Background

Efforts to mitigate unwarranted variation in the quality of care require insight into the ‘level’ (eg, patient, physician, ward, hospital) at which observed variation exists. This systematic literature review aims to synthesise the results of studies that quantify the extent to which hospitals contribute to variation in quality indicator scores.

Methods

Embase, Medline, Web of Science, Cochrane and Google Scholar were systematically searched from 2010 to November 2023. We included studies that reported a measure of between-hospital variation in quality indicator scores relative to total variation, typically expressed as a variance partition coefficient (VPC). The results were analysed by disease category and quality indicator type.

Results

In total, 8373 studies were reviewed, of which 44 met the inclusion criteria. Casemix adjusted variation was studied for multiple disease categories using 144 indicators, divided over 5 types: intermediate clinical outcomes (n=81), final clinical outcomes (n=35), processes (n=10), patient-reported experiences (n=15) and patient-reported outcomes (n=3). In addition to an analysis of between-hospital variation, eight studies also reported physician-level variation (n=54 estimates). In general, variation that could be attributed to hospitals was limited (median VPC=3%, IQR=1%–9%). Between-hospital variation was highest for process indicators (17.4%, 10.8%–33.5%) and lowest for final clinical outcomes (1.4%, 0.6%–4.2%) and patient-reported outcomes (1.0%, 0.9%–1.5%). No clear pattern could be identified in the degree of between-hospital variation by disease category. Furthermore, the studies exhibited limited attention to the reliability of observed differences in indicator scores.

Conclusion

Hospital-level variation in quality indicator scores is generally small relative to residual variation. However, meaningful variation between hospitals does exist for multiple indicators, especially for care processes which can be directly influenced by hospital policy. Quality improvement strategies are likely to generate more impact if preceded by level-specific and indicator-specific analyses of variation, and when absolute variation is also considered.

PROSPERO registration number

CRD42022315850.
Association between pulmonary function and rapid kidney function decline: a longitudinal cohort study from CHARLS
Authors: Han Shisheng , Xu Yanqiu , Wang Yi
Published: February 2024

Background

Pulmonary function has been reported to be associated with chronic kidney disease. However, the relationship between lung function and rapid kidney function decline remains unclear.

Methods

Participants aged ≥45 years with complete data from the 2011 and 2015 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. Lung function, assessed by peak expiratory flow (PEF), and kidney function, assessed by estimated glomerular filtration rate (eGFR), were tested at the baseline and endpoint surveys. Rapid kidney function decline was defined as a decrease in eGFR ≥3 mL/min/1.73 m²/year, and ΔeGFR represented the difference between baseline and endpoint eGFR. Multivariate logistic regression models and linear regression models were employed to evaluate the association between PEF and the risk of rapid eGFR decline, as well as the correlation between PEF and ΔeGFR.

Results

A total of 6159 participants were included, with 1157 (18.78%) individuals experiencing a rapid decline in eGFR. After adjusting for potential covariates, higher baseline PEF (Quartile 4 vs Quartile 1, OR=0.95, 95% CI 0.92 to 0.98) and elevated PEF % predicted (OR=0.96, 95% CI 0.94 to 0.99) were found to be associated with a lower risk of rapid eGFR decline. ΔeGFR decreased by 0.217 and 0.124 mL/min/1.73 m² for every 1 L/s increase in baseline PEF (β (95% CI): −0.217 (−0.393 to –0.042)) and 10% increase in PEF % predicted (β (95% CI): −0.124 (−0.237 to –0.011)), respectively. During the follow-up period, ΔeGFR decreased as PEF increased over time among participants in Quartile 1 (β per 1 L/s increase in ΔPEF=−0.581, 95% CI −1.003 to –0.158; β per 10% increase in ΔPEF % predicted=−0.279, 95% CI −0.515 to –0.043).

Conclusions

Higher PEF was associated with a slower longitudinal eGFR decline in middle-aged and older adults.
Run, walk, cheer or volunteer: a patient and public involvement survey
Authors: Ross Alexandra , Gunasekera Roshan , Rowley Deborah
Published: February 2024

Background

Children with chronic diseases have been reported to participate in less regular physical activity (PA) than peers without chronic diseases; and less than recommended in guidelines. Sheffield Children’s Foundation Trust (SCFT) is an Active Hospitals pilot site, exploring options to facilitate PA for all children. One option is collaboration with Junior Parkrun: a free, weekly 2 km running event for children. The team investigated whether Junior Parkrun was of interest to guardians of children attending SCFT to increase PA.

Aims

This patient and public involvement survey assessed perceptions of PA for children attending SCFT according to their accompanying guardians. This will inform a possible collaboration between SCFT and Junior Parkrun.

Methods

A three-part, 14-question survey was developed, including demographics (age, ethnicity, postcode); perceptions of PA (barriers and facilitators); PA behaviours self-reported on Likert scales; and perceptions of Junior Parkrun. Guardians were asked whether they and their child would be interested in attending Junior Parkrun with SCFT staff support. This was distributed to guardians of children attending outpatient appointments.

Results

126 guardians responded. The average age of child was 10 years 10 months. 29.1% of guardians supported daily PA for their child. Almost half of respondents reported their child would be interested in attending Junior Parkrun. Of those not interested, the most common reason was travel.

Conclusion

The findings highlighted PA barriers perceived by guardians, and identified that almost half of respondents would be interested in attending Junior Parkrun. A collaboration between Junior Parkrun and SCFT could be explored.
Should environmental sustainability be a priority for the gastroenterology community?
Authors: Leddin Desmond
Published: February 2024

Sustainable practice means living within our means and not compromising the health of the planet for future generations. We are not meeting this goal at present as evidenced by the breaking of several indicators of planetary health and ever-increasing global mean temperatures. The arguments in favour of environmental sustainability include our ethical obligations as healthcare providers not to harm patients. We know that the emissions from healthcare are damaging health, so it follows that we have an obligation to minimise them. There is also the issue of intergenerational justice, that is not living beyond our means and leaving the problems for the next generation to deal with. We have professional obligations of leadership and advocacy on this issue, and it makes good economic and management sense to reduce environmental damage. Finally, there is the question of self-interest. If we do not change the trajectory of global warming, we face an existential threat in the not-too-distant future. We currently lack data on how to most effectively reduce the environmental impact of digestive health practice and we even lack a clear vision of what sustainable care might look like. However, that is being remedied and in the meantime it should not stop us beginning to take action, which is urgently needed as the climate crisis continues to gather momentum.
Assisted deaths in Switzerland for UK residents: diagnoses and their implications for palliative medicine and assisted dying legislation
Authors: Brewer Colin , Hopwood Marie-Claire , Winyard Graham
Published: February 2024

Objective

UK campaigners for a law permitting assisted dying (AD) restricted to those with a maximum life expectancy of 6 months claim that this would largely remove the need for UK residents to seek AD in Switzerland. We wanted to discover whether this prediction was correct.

Methods

We analysed the diagnoses of UK residents who had such deaths including, for the first time, data from all three of the main Swiss providers of AD to non-residents, comparing them with figures from Oregon, which has a 6-month restriction.

Results

Only 22.7% of UK residents had cancer (Oregon 72.5%) while nearly half (49.6% and over half including dementias) had neurological conditions (Oregon 11.2%) and many with prognoses of much more than 6 months.

Conclusion

Overall, less than half would meet a 6-month prognosis criterion. This has significant implications for patients, palliative care clinicians and legislators.
New examples of twisted Brill–Noether loci I
Authors: Brambila-Paz L. , Newstead P. E.
Published: February 2024

Our purpose in this paper is to construct new examples of twisted Brill–Noether loci on curves of genus [Formula: see text]. Many of these examples have negative expected dimension. We deduce also the existence of a new region in the Brill–Noether map, whose points support non-empty standard Brill–Noether loci.
Multiplicity algebras for rank 2 bundles on curves of small genus
Authors: Hitchin Nigel
Published: February 2024

In [11], Hausel introduced a commutative algebra — the multiplicity algebra — associated to a fixed point of the [Formula: see text]-action on the Higgs bundle moduli space. Here we describe this algebra for a fixed point consisting of a very stable rank 2 vector bundle and zero Higgs field for a curve of low genus. Geometrically, the relations in the algebra are described by a family of quadrics and we focus on the discriminant of this family, providing a new viewpoint on the moduli space of stable bundles. The discriminant in our examples demonstrates that as the bundle varies, we obtain a continuous variation in the isomorphism class of the algebra.
An Imperfect Debugging Non-Homogeneous Poisson Process Software Reliability Model Based on a 3-Parameter S-Shaped Function
Authors: Hung-Cuong Nguyen , Quyet-Thang Huynh
Published: February 2024

Considering the testing process of the software system as a stochastic process is a primary approach to the software reliability modeling technique. Besides some popular distributions, the Poisson distribution has been considered the best based on its advantage when modeling the times at which arrivals enter a system. In the non-homogeneous Poisson process group of models, the S-shaped function is a value curve with many good results. This paper proposes a new imperfect debugging software reliability model based on (1) an Imperfect debugging assumption (the testing process could cause new faults); and (2) the Fault detection rate can be controlled more effectively by the appearance of a growth-rate-controller. The real data from industrial projects verify the application of this model based on good popular criteria values.
In-Plane Vibrations of Deep Sandwich Arches with Different End Conditions Based on a Logarithmic Shear Deformation Theory
Authors: Zhang Yingying , Peng Jishen
Published: February 2024

This paper deals with the vibrational frequencies of deep sandwich arches to enhance their application domain and possibly use them for energy harvesting. The circular arch with porous nanocomposite core and titanium alloy face sheets having different end conditions is numerically analyzed. The middle core of the sandwich arch is made of a six-layered porous aluminum reinforced with graphene nanoplatelets. The kinematic equations are formulated in this study based on the higher-order shear deformation theory using a logarithmic function of radius. The effective properties of the nanocomposite media are modeled by employing the Halpin–Tsai modified rule. The equations of motion are determined by applying the principle of virtual displacement. The partial differential equations are reduced using the generalized differential quadrature technique to solving an algebraic eigenvalue problem. Novel numerical results are given to show the effects of geometrical parameters, material properties, and boundary conditions on the vibrations of deep sandwich arch.
A Flexible Cross-Efficiency Model with Partial Preference for Efficiency Evaluation of Clean Transportation Energy
Authors: Li Meiling , Wang Ying-Ming , Lin Jian
Published: February 2024

The rapid development of the transportation industry benefits from the consumption of energy, but the excessive dependence on petroleum fuels makes it a major source of air pollution. In order to achieve green and high-quality development of the transportation industry, many countries are committed to scientifically evaluating the utilization efficiency of clean energy, which has attracted wide attention from the whole society. Significantly, without considering the diversity and complexity of pollutants, indicators used in previous studies were unable to cover all pollutants when establishing the evaluation index system. Meanwhile, as an efficient tool, data envelopment analysis (DEA) is extensively used when it comes to efficiency evaluation. However, the absolute preference of existing benevolent and aggressive cross-efficiency models limits its application scenarios. To address the challenges above, an improved flexible cross-efficiency DEA model is proposed considering both same and different benevolence coefficients of decision-making units (DMUs) on the basis of pointing out the inadequacy of the previous model. The concepts of consensus coefficient and group preference are introduced in the aggregation of cross-efficiency. Besides, based on the theory of undesirable output, the consumption of nonclean energy is taken into account as the input indicator to characterize the degree of pollution. The results show that the obtained cross-efficiency value and efficiency ranking of clean transportation energy change sensitively under various benevolent coefficients. There is an important practical significance to consider the independent preference information of DMUs for the evaluation and ranking of cross-efficiency.