bluuebunny/crossref_metadata_2025 huggingface dataset:
Supplemental Material: Geochronology, petrogenesis, and magmatic oxidation state of the Mangling intrusive complex, Northern Qinling Belt, Central China: Implications for magma fertility and tectonic setting
Authors: Zhao Liandang , Jiao Jiangang , al. et
Published: March 2023

Supplemental Text: Analytical Methods. Figure S1: Cathodoluminescence images of representative zircons for U-Pb dating and Lu-Hf isotope analyses for the Mangling intrusive complex. Figure S2: Chondrite-normalized REE patterns of analyzed zircons for the Mangling intrusive complex. Figure S3: Field photographs showing relationships of the granitic rocks of the Mangling intrusive complex. Figure S4: Harker diagrams of selected major and trace elements against SiO2 for the Mangling intrusive complex. Table S1: Zircon U-Pb dating results for the dioritic and granitic rocks of the Mangling intrusive complex. Table S2: Whole-rock major- (wt%), trace- (ppm), and rare earth (ppm) element compositions for the dioritic and granitic rocks of the Mangling intrusive complex. Table S3: Zircon trace element compositions (ppm) for the dioritic and granitic rocks of the Mangling intrusive complex. Table S4: Zircon Lu-Hf isotopic data for the dioritic and granitic rocks of the Mangling intrusive complex. Table S5: Summary of geochronological data for the Mangling intrusive complex. Table S6: Zircon trace element compositions (ppm) for the mineralized granitic rocks of porphyry molybdenum deposits in Central and NE China.
Characteristics and predictors of persistent symptoms post-COVID-19 in children and young people: a large community cross-sectional study in England
Authors: Atchison Christina J , Whitaker Matthew , Donnelly Christl A , Chadeau-Hyam Marc , Riley Steven , Darzi Ara , Ashby Deborah , Barclay Wendy , Cooke Graham S , Elliott Paul , Ward Helen
Published: March 2023

Objective

To estimate the prevalence of, and associated risk factors for, persistent symptoms post-COVID-19 among children aged 5–17 years in England.

Design

Serial cross-sectional study.

Setting

Rounds 10–19 (March 2021 to March 2022) of the REal-time Assessment of Community Transmission-1 study (monthly cross-sectional surveys of random samples of the population in England).

Study population

Children aged 5–17 years in the community.

Predictors

Age, sex, ethnicity, presence of a pre-existing health condition, index of multiple deprivation, COVID-19 vaccination status and dominant UK circulating SARS-CoV-2 variant at time of symptom onset.

Main outcome measures

Prevalence of persistent symptoms, reported as those lasting ≥3 months post-COVID-19.

Results

Overall, 4.4% (95% CI 3.7 to 5.1) of 3173 5–11 year-olds and 13.3% (95% CI 12.5 to 14.1) of 6886 12–17 year-olds with prior symptomatic infection reported at least one symptom lasting ≥3 months post-COVID-19, of whom 13.5% (95% CI 8.4 to 20.9) and 10.9% (95% CI 9.0 to 13.2), respectively, reported their ability to carry out day-to-day activities was reduced ‘a lot’ due to their symptoms. The most common symptoms among participants with persistent symptoms were persistent coughing (27.4%) and headaches (25.4%) in children aged 5–11 years and loss or change of sense of smell (52.2%) and taste (40.7%) in participants aged 12–17 years. Higher age and having a pre-existing health condition were associated with higher odds of reporting persistent symptoms.

Conclusions

One in 23 5–11 year-olds and one in eight 12–17 year-olds post-COVID-19 report persistent symptoms lasting ≥3 months, of which one in nine report a large impact on performing day-to-day activities.
Substernal multinodular goiter resulting in superior vena cava syndrome and tracheal compression
Authors: Gorniak Adrianna , Carlson-Dexter Philip , Ochoa Joana , Carmichael Annette
Published: March 2023

A woman in her early 70s presented to the family medicine clinic with shortness of breath and an inability to lie flat for several months. When lying flat or on lifting her arms above her head, her face would turn bright red and she felt lightheaded. The patient also had hair loss and skin colour changes of the upper extremities. On examination, the thyroid was palpated and felt normal without enlargement or nodularity. Considering the patient’s 70–90 pack-year smoking history, a malignant process of the lung causing superior vena cava syndrome was suspected. CT chest with intravenous contrast revealed a markedly enlarged thyroid with substernal extension of a multinodular goitre producing a mass effect in the upper mediastinum. Thyroid-stimulating hormone was normal. The patient had a total thyroidectomy performed by endocrine surgery. Pathology revealed multinodular hyperplasia and chronic lymphocytic thyroiditis. The patient recovered well postoperatively and her compressive symptoms resolved.
Bloody nipple discharge due to intraductal papilloma in an adolescent girl
Authors: Ostertag-Hill Claire Alexandra , Wang Yihong , Nickolich Stana , Wiggins Doreen L
Published: March 2023

An early adolescent girl was referred to our breast surgery clinic with multiple right-sided breast masses and several months of unilateral bloody nipple discharge. MRI demonstrated multiple enhancing masses in the right breast with intrinsic hypertensive T1 signal of the ducts extending to the nipple. A biopsy showed partially sclerosed intraductal papillomas without atypia or malignancy. Following extensive counselling with the patient and her family, two palpable breast masses and a single central breast duct responsible for bloody nipple discharge were fully excised. Histopathological analysis showed unique overlapping features of resembling intraductal papilloma, nipple adenoma and fibroadenomas. The patient has had resolution of her bloody nipple discharge and excellent cosmetic outcomes post-surgery. Intraductal papilloma is rare in the adolescent population and the risk of concurrent and future malignancy is not well established. Thus, a tailored approach to the work-up and management of paediatric breast masses is essential.
Saksenaeamucormycosis: a rare and dangerous cause of necrotising fasciitis
Authors: Sykes Blake Anthony , Krause Hans , Lamparelli Michael , Austin David
Published: March 2023

Necrotising fasciitis is a rapidly progressing soft tissue infection requiring early and adequate surgical debridement and appropriate antibiotic cover. The present case highlights bacterial fasciitis associated with fungal (Mucor) infection with insidious angioinvasive nature (Saksenaea vasiformis) which required amputation, negative-pressure vacuum dressings and amphotericin B for definitive treatment. This demonstrates a relatively rare case of the group IV classification of necrotising fasciitis, which we must consider when there is slowly progressing tissue death despite seemingly adequate treatment.
Association between physical activity and the time course of cancer recurrence in stage III colon cancer
Authors: Brown Justin C , Ma Chao , Shi Qian , Niedzwiecki Donna , Zemla Tyler , Couture Felix , Kuebler Philip , Kumar Pankaj , Hopkins Judith O , Tan Benjamin , Krishnamurthi Smitha , O'Reilly Eileen M , Shields Anthony F , Meyerhardt Jeffrey A
Published: March 2023

Objective

We determined if postoperative physical activity prevents or delays cancer recurrence in patients with stage III colon cancer.

Methods

This cohort study nested within a randomised trial enrolled 1696 patients with surgically resected stage III colon cancer. Physical activity was calculated based on self-reporting during and after chemotherapy. Patients were classified as physically active (≥9 MET-h/wk, comparable with the energy expenditure of 150 min/wk of brisk walking, consistent with the current physical activity guidelines for cancer survivors) or physically inactive (<9 MET-h/wk). The confounder-adjusted hazard rate (risk of recurrence or death) and HR by physical activity category were estimated with continuous time to allow non-proportionality of hazards.

Results

During a median 5.9 years follow-up, 457 patients experienced disease recurrence or death. For physically active and physically inactive patients, the risk of disease recurrence peaked between 1 and 2 years postoperatively and declined gradually to year 5. The risk of recurrence in physically active patients never exceeded that of physically inactive patients during follow-up, suggesting that physical activity prevents—as opposed to delays—cancer recurrence in some patients. A statistically significant disease-free survival benefit associated with physical activity was observed during the first postoperative year (HR 0.68, 95% CI 0.51 to 0.92). A statistically significant overall survival benefit associated with physical activity was observed during the first three postoperative years (HR 0.32, 95% CI 0.19 to 0.51).

Conclusions

In this observational study of patients with stage III colon cancer, postoperative physical activity is associated with improved disease-free survival by lowering the recurrence rate within the first year of treatment, which translates into an overall survival benefit.
Antiracism in leading public health universities, journals and funders: commitments, accountability and the decision-makers
Authors: Rahman-Shepherd Afifah , Erondu Ngozi A , Anwar Bakht , Boro Ezekiel , Chau Thuy Duyen , Guinto Renzo R , Hollmann Lara , Mejarito Jerome Alan , Rasheed Muneera A , Khan Mishal
Published: March 2023

Introduction

Two years since the murder of George Floyd, there has been unprecedented attention to racial justice by global public health organisations. Still, there is scepticism that attention alone will lead to real change.

Methods

We identified the highest-ranked 15 public health universities, academic journals and funding agencies, and used a standardised data extraction template to analyse the organisation’s governance structures, leadership dynamics and public statements on antiracism since 1 May 2020.

Results

We found that the majority of organisations (26/45) have not made any public statements in response to calls for antiracism actions, and that decision-making bodies are still lacking diversity and representation from the majority of the world’s population. Of those organisations that have made public statements (19/45), we identified seven types of commitments including policy change, financial resources, education and training. Most commitments were not accompanied by accountability measures, such as setting goals or developing metrics of progress, which raises concerns about how antiracism commitments are being tracked, as well as how they can be translated into tangible action.

Conclusion

The absence of any kind of public statement paired with the greater lack of commitments and accountability measures calls into question whether leading public health organisations are concretely committed to racial justice and antiracism reform.
Adherence to physical rehabilitation delivered via tele-rehabilitation for people with multiple sclerosis: a scoping review protocol
Authors: Goldsmith Geraldine , Bollen Jessica C , Salmon Victoria E , Freeman Jennifer A , Dean Sarah G
Published: March 2023

Introduction

Using tele-rehabilitation methods to deliver exercise, physical activity (PA) and behaviour change interventions for people with multiple sclerosis (pwMS) has increased in recent years, especially since the SARS-CoV-2 pandemic. This scoping review aims to provide an overview of the literature regarding adherence to therapeutic exercise and PA delivered via tele-rehabilitation for pwMS.

Methods and analysis

Frameworks described by Arksey and O’Malley and Levacet alunderpin the methods. The following databases will be searched from 1998 to the present: Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Health Management Information Consortium Database, ProQuest Dissertations and Theses Global, Pedro, Cochrane Central Register of Controlled Trials, US National Library of Medicine Registry of Clinical Trials, WHO International Clinical Trials Registry Platform portal and The Cochrane Database of Systematic Reviews. To identify papers not included in databases, relevant websites will be searched. Searches are planned for 2023. With the exception of study protocols, papers on any study design will be included. Papers reporting information regarding adherence in the context of prescribed therapeutic exercise and PA delivered via tele-rehabilitation for pwMS will be included. Information relating to adherence may comprise; methods of reporting adherence, adherence levels (eg, exercise diaries, pedometers), investigation of pwMS’ and therapists’ experiences of adherence or a discussion of adherence. Eligibility criteria and a custom data extraction form will be piloted on a sample of papers. Quality assessment of included studies will use Critical Appraisal Skills Programme checklists. Data analysis will involve categorisation, enabling findings relating to study characteristics and research questions to be presented in narrative and tabular format.

Ethics and dissemination

Ethical approval was not required for this protocol. Findings will be submitted to a peer-reviewed journal and presented at conferences. Consultation with pwMS and clinicians will help to identify other dissemination methods.
What do we know about the psychosocial issues associated with cancer during pregnancy? A scoping review and gap analysis
Authors: Harris Jenny , Ream Emma , Armes Jo , Gibson Faith , Marcu Afrodita , Parsons Catherine Treena , Robinson Ann , Varghese Sherin , Poole Karen
Published: March 2023

Objectives

There is a global increase in the number of women diagnosed with cancer during their pregnancy and a nascent evidence base to guide their supportive care. The purposes of this study were to (1) map research on the psychosocial issues affecting women and their partners on diagnosis and treatment for cancer during pregnancy; (2) determine available supportive care or educational interventions; and (3) identify knowledge gaps for future research and development.

Design

Scoping review.

Search strategy

Six databases were searched (Scopus, CINAHL, PsycINFO, Medline, Intermid, Maternal and Infant Health) to retrieve primary research (January 1995 to November 2021) investigating women and/or their partner’s decision-making and their psychosocial outcomes during and after pregnancy.

Data extraction and synthesis

Sociodemographic, gestational and disease characteristics of participants and psychosocial issues identified were extracted. Leventhal’s self-regulatory model of illness provided a framework for mapping study findings enabling evidence synthesis and gap analysis.

Results

Twelve studies were included, conducted in eight countries in six continents. Most women (70% of 217) were diagnosed with breast cancer during pregnancy. Reporting of sociodemographic, psychiatric, obstetric and oncological characteristics that are important in assessing psychosocial outcomes was inconsistent. None of the studies had a longitudinal design and no supportive care or educational interventions were identified. The gap analysis highlighted the lack of evidence about pathways to diagnosis, impact of late effects and how internal/social resources may affect outcomes.

Conclusions

Research has focused on women with gestational breast cancer. Little is known about those diagnosed with other cancers. We encourage future study designs to capture data on sociodemographic, obstetric, oncological and psychiatric characteristics and adopt a longitudinal approach to explore the longer term psychosocial impact on women and their families. Future research should include outcomes that are meaningful for women (and their partners) and draw on international collaboration to accelerate progress in this field.
Qualitative study exploring the feasibility of using medication monitors and a differentiated care approach to support adherence among people receiving TB treatment in South Africa
Authors: Mukora Rachel , Maraba Noriah , Orrell Catherine , Jennings Lauren , Naidoo Pren , Mbatha M Thulani , Velen Kavindhran , Fielding Katherine , Charalambous Salome , Chetty-Makkan Candice Maylene
Published: March 2023

Objectives

The tuberculosis (TB) MATE study evaluated whether a differentiated care approach (DCA) based on tablet-taking data from Wisepill evriMED digital adherence technology could improve TB treatment adherence. The DCA entailed a stepwise increase in adherence support starting from short message service (SMS) to phone calls, followed by home visits and motivational counselling. We explored feasibility of this approach with providers in implementing clinics.

Design

Between June 2020 and February 2021, in-depth interviews were conducted in the provider’s preferred language, audiorecorded, transcribed verbatim and translated. The interview guide included three categories: feasibility, system-level challenges and sustainability of the intervention. We assessed saturation and used thematic analysis.

Setting

Primary healthcare clinics in three provinces of South Africa.

Participants

We conducted 25 interviews with 18 staff and 7 stakeholders.

Results

Three major themes emerged: First, providers were supportive of the intervention being integrated into the TB programme and were eager to be trained on the device as it helped to monitor treatment adherence. Second, there were challenges in the adoption system such as shortage of human resources which could serve as a barrier to information provision once the intervention is scaled up. Healthcare workers reported that some patients received incorrect SMS’s due to delays in the system that contributed to distrust. Third, DCA was considered as a key aspect of the intervention by some staff and stakeholders since it allowed for support based on individual needs.

Conclusions

It was feasible to monitor TB treatment adherence using the evriMED device and DCA. To ensure successful scale-up of the adherence support system, emphasis will need to be placed on ensuring that the device and the network operate optimally and continued support on adhering to treatment which will enable people with TB to take ownership of their treatment journey and help overcome TB-related stigma.

Trial registration number

Pan African Trial Registry PACTR201902681157721.
Opioid prescriptions after knee replacement: a retrospective study of pathways and prognostic factors in the Swiss healthcare setting
Authors: Wirth Kevin , Bähler Caroline , Boes Stefan , Näpflin Markus , Huber Carola A , Blozik Eva
Published: March 2023

Objectives

The optimal use of opioids after knee replacement (KR) remains to be determined, given the growing evidence that opioids are no more effective than other analgesics and that their adverse effects can impair quality of life. Therefore, the objective is to examine opioid prescriptions after KR.

Design

In this retrospective study, we used descriptive statistics and estimated the association of prognostic factors using generalised negative binomial models.

Setting

The study is based on anonymised claims data of patients with mandatory health insurance at Helsana, a leading Swiss health insurance.

Participants

Overall, 9122 patients undergoing KR between 2015 and 2018 were identified.

Primary and secondary outcome measures

Based on reimbursed bills, we calculated the dosage (morphine equivalent dose, MED) and the episode length (acute: <90 days; subacute: ≥90 to <120 days or <10 claims; chronic: ≥90 days and ≥10 claims or ≥120 days). The incidence rate ratios (IRRs) for postoperative opioids were calculated.

Results

Of all patients, 3445 (37.8%) received opioids in the postoperative year. A large majority had acute episodes (3067, 89.0%), 2211 (65.0%) had peak MED levels above 100 mg/day and most patients received opioids in the first 10 postoperative weeks (2881, 31.6%). Increasing age (66–75 and >75 vs 18–65) was associated with decreased IRR (0.776 (95% CI 0.7 to 0.859); 0.723 (95% CI 0.649 to 0.805)), whereas preoperative non-opioid analgesics and opioids were associated with higher IRR (1.271 (95% CI 1.155 to 1.399); 3.977 (95% CI 4.409 to 3.591)).

Conclusion

The high opioid demand is unexpected given that current recommendations advise using opioids only when other pain therapies are ineffective. To ensure medication safety, it is important to consider alternative treatment options and ensure that benefits outweigh potential risks.
Health visiting in the UK in light of the COVID-19 pandemic experience (RReHOPE): a realist review protocol
Authors: King Emma , Gadsby Erica , Bell Madeline , Duddy Claire , Kendall Sally , Wong Geoff
Published: March 2023

Introduction

Health visiting services, providing support to under 5s and their families, are organised and delivered in very different ways in different parts of the UK. While there has been attention to the key components of health visiting practice and what works well and how, there is little research on how health visiting services are organised and delivered and how that affects their ability to meet their objectives. The COVID-19 pandemic rapidly disrupted service delivery from March 2020. This realist review aims to synthesise the evidence on changes during the pandemic to identify the potential for improving health visiting services and their delivery.

Methods and analysis

This review will follow the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) quality standards and Pawson’s five iterative stages to locate existing theories, search for evidence, select literature, extract data, synthesise evidence and draw conclusions. It will be guided by stakeholder engagement with practitioners, commissioners, policymakers, policy advocates and people with lived experience. This approach will consider the emerging strategies and evolving contexts in which the services are delivered, and the varied outcomes for different groups. A realist logic of analysis will be used to make sense of what was happening to health visiting services during and following the pandemic response through the identification and testing of programme theories. Our refined programme theory will then be used to develop recommendations for improving the organisation, delivery and ongoing postpandemic recovery of health visiting services.

Ethics and dissemination

General University Ethics Panel approval has been obtained from University of Stirling (reference 7662). Dissemination will build on links to policymakers, commissioners, providers, policy advocates and the public. A range of audiences will be targeted using outputs tailored to each. A final stakeholder event focused on knowledge mobilisation will aid development of recommendations.

PROSPERO registration number

CRD42022343117.
Patient-reported outcome and experience measures for quality improvement in pregnancy and childbirth care: a retrospective cohort study
Authors: Klootwijk Anouk , Bakx Pieter , Franx Arie , Bijma Hilmar , Ernst-Smelt Hiske , Lamain-de Ruiter Marije , Posthumus Anke , van Rijn Bas
Published: March 2023

Background

Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) can highlight issues that remain unnoticed when using standard clinical quality indicators. However, estimations of the potential power of measuring PROMs and PREMs to identify unrecognised areas suitable for quality improvement are often limited by a lack of reliable real-world data. Here, we report on how the indicator set for PROMs and PREMs that was recently developed by the International Consortium for Health Outcome Measures can change perspectives on quality assessment in women receiving care for pregnancy and childbirth.

Methods

PROMs and PREMs were captured 6 months after childbirth via an online survey in a single academic maternity unit in the Netherlands between 2018 and 2019. Indicators of abnormality were scored using predefined cut-off values established by a national consensus group. We used regression analysis to identify associations between PROMs, PREMs and healthcare use, and further stratified data to explore the distribution of indicators among relevant patient subgroups.

Results

Of 2775 questionnaires, 645 were completed and linked to medical health records. Despite only 5% of women reporting overall dissatisfaction with care, suboptimal scores were often found; in birth experience for 32% of the population, and 42% who experienced painful sexual intercourse. Subgroup analysis further revealed associations with relevant indicators of quality of care; inadequate pain relief among women with preterm birth (OR 8.8), pain with sexual intercourse among women undergoing vaginal assisted delivery (OR 2.2) and women living in a deprived area had problematic birth experiences (coefficient −3.2).

Conclusion

Use of PROMs and PREMs in pregnancy and childbirth care provides new insights on quality of care, resulting in potentially actionable targets for improvement not normally identified with standard clinical quality indicators. Implementation strategies and follow-up are needed to act on these findings.
Interactive enhancer hubs (iHUBs) mediate transcriptional reprogramming and adaptive resistance in pancreatic cancer
Authors: Hamdan Feda H , Abdelrahman Amro M , Kutschat Ana Patricia , Wang Xin , Ekstrom Thomas L , Jalan-Sakrikar Nidhi , Wegner Wippel Catherine , Taheri Negar , Tamon Liezel , Kopp Waltraut , Aggrey-Fynn Joana , Bhagwate Aditya V , Alva-Ruiz Roberto , Lynch Isaac , Yonkus Jennifer , Kosinsky Robyn Laura , Gaedcke Jochen , Hahn Stephan A , Siveke Jens T , Graham Rondell , Najafova Zeynab , Hessmann Elisabeth , Truty Mark J , Johnsen Steven A
Published: March 2023

Objective

Pancreatic ductal adenocarcinoma (PDAC) displays a remarkable propensity towards therapy resistance. However, molecular epigenetic and transcriptional mechanisms enabling this are poorly understood. In this study, we aimed to identify novel mechanistic approaches to overcome or prevent resistance in PDAC.

Design

We used in vitro and in vivo models of resistant PDAC and integrated epigenomic, transcriptomic, nascent RNA and chromatin topology data. We identified a JunD-driven subgroup of enhancers, called interactive hubs (iHUBs), which mediate transcriptional reprogramming and chemoresistance in PDAC.

Results

iHUBs display characteristics typical for active enhancers (H3K27ac enrichment) in both therapy sensitive and resistant states but exhibit increased interactions and production of enhancer RNA (eRNA) in the resistant state. Notably, deletion of individual iHUBs was sufficient to decrease transcription of target genes and sensitise resistant cells to chemotherapy. Overlapping motif analysis and transcriptional profiling identified the activator protein 1 (AP1) transcription factor JunD as a master transcription factor of these enhancers. JunD depletion decreased iHUB interaction frequency and transcription of target genes. Moreover, targeting either eRNA production or signaling pathways upstream of iHUB activation using clinically tested small molecule inhibitors decreased eRNA production and interaction frequency, and restored chemotherapy responsiveness in vitro and in vivo. Representative iHUB target genes were found to be more expressed in patients with poor response to chemotherapy compared with responsive patients.

Conclusion

Our findings identify an important role for a subgroup of highly connected enhancers (iHUBs) in regulating chemotherapy response and demonstrate targetability in sensitisation to chemotherapy.
Evolution and triggers of defibrillator shocks in patients with arrhythmogenic right ventricular cardiomyopathy
Authors: Molitor Nadine , Hofer Daniel , Çimen Tolga , Gasperetti Alessio , Akdis Deniz , Costa Sarah , Jenni Rolf , Breitenstein Alexander , Wolber Thomas , Winnik Stephan , Fokstuen Siv , Fu Guan , Medeiros-Domingo Argelia , Ruschitzka Frank , Brunckhorst Corinna , Duru Firat , Saguner Ardan M
Published: March 2023

Introduction

Implantable cardioverter-defibrillators (ICDs) can prevent sudden cardiac death due to ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). The aim of our study was to assess the cumulative burden, evolution and potential triggers of appropriate ICD shocks during long-term follow-up, which may help to reduce and further refine individual arrhythmic risk in this challenging disease.

Methods

This retrospective cohort study included 53 patients with definite ARVC according to the 2010 Task Force Criteria from the multicentre Swiss ARVC Registry with an implanted ICD for primary or secondary prevention. Follow-up was conducted by assessing all available patient records from patient visits, hospitalisations, blood samples, genetic analysis, as well as device interrogation and tracings.

Results

Fifty-three patients (male 71.7%, mean age 43±2.2 years, genotype positive 58.5%) were analysed during a median follow-up of 7.9 (IQR 10) years. In 29 (54.7%) patients, 177 appropriate ICD shocks associated with 71 shock episodes occurred. Median time to first appropriate ICD shock was 2.8 (IQR 3.6) years. Long-term risk of shocks remained high throughout long-term follow-up. Shock episodes occurred mainly during daytime (91.5%, n=65) and without seasonal preference. We identified potentially reversible triggers in 56 of 71 (78.9%) appropriate shock episodes, the main triggers representing physical activity, inflammation and hypokalaemia.

Conclusion

The long-term risk of appropriate ICD shocks in patients with ARVC remains high during long-term follow-up. Ventricular arrhythmias occur more often during daytime, without seasonal preference. Reversible triggers are frequent with the most common triggers for appropriate ICD shocks being physical activity, inflammation and hypokalaemia in this patient population.
Factors related to COVID-19 vaccine hesitancy among middle-income and low-income adults in the USA
Authors: Nguyen Vu-Thuy Thi , Huang Yuan , Huang Minda , Tsai Jack
Published: March 2023

Background

Vaccine hesitancy has been an ongoing challenge in campaigns, especially the rapid development and approval of the COVID-19 vaccines. The goal of this study was to understand the characteristics, perceptions and beliefs of COVID-19 vaccination prior to its widespread rollout among middle-income and low-income US adults.

Methods

Using a national sample of 2101 adults who completed an online assessment in 2021, this study examines the association of demographics, attitudes and behaviours related to COVID-19 vaccination intentions. Adaptive least absolute shrinkage and selection operator models were used to select these specific covariate and participant responses. Poststratification weights were generated using raking procedures and applied to improve generalisability.

Results and conclusion

Vaccine acceptance was high at 76% with 66.9% reporting intent to receive the COVID-19 vaccine when available. Only 8.8% of vaccine supporters screened positive for COVID-19-related stress compared with 9.3% among the vaccine hesitant. However, there were more people with vaccine hesitancy who screened positive for poor mental health and alcohol and substance misuse. The three main vaccine concerns were side effects (50.4%), safety (29.7%) and mistrust of vaccine distribution (14.8%).

Factors influencing vaccine acceptance included age, education, children, region, mental health and social support, threat perception, opinion of governmental response, risk exposure and prevention activities and rejecting COVID-19 vaccine concerns. The results indicated acceptance was more strongly associated with beliefs and attitudes about the vaccine than sociodemographics, which are noteworthy and may lead to targeted interventions to increase COVID-19 vaccine acceptance among subgroups who are vaccine hesitant.
What can clinical leaders contribute to the governance of integrated care systems?
Authors: Waring Justin , Bishop Simon , Black Georgia , Clarke Jenelle , Roe Bridget
Published: March 2023

Background

Integrated care systems present enduring governance challenges associated with fostering interorganisational collaboration.

Aim

To understand how clinical leaders can make a distinct contribution to the governance and system leadership of integrated care systems.

Methods

A qualitative interview study carried out between 2018 and 2019 with 24 clinical leaders, and a further 47 non-clinical leaders, involved in the governance of three Sustainability and Transformation Partnership in the English National Health Service.

Results

Clinical leaders were found to make four distinct contributions: (1) making analytical insights into integration strategies that ensured their relevance and quality to clinical communities; (2) representing the views of clinicians in system decision-making thereby enhancing the legitimacy of change; (3) translation and communication activities to articulate integration strategies in favourable ways and ensure clinical engagement; and (4) relational work in the form of brokering and building connections and mediating conflict between multiple stakeholders. These activities varied across the levels of system governance and at different stages in the processes of change.

Conclusions

Clinical leaders can make a distinct contribution to the governance and leadership of integrated care systems based on their clinical expertise, membership professional networks, reputation and formal authority.
Retinal microvascular signs and recurrent vascular events in patients with TIA or minor stroke
Authors: Klyscz Philipp , Ihl Thomas , Laumeier Inga , Steinicke Maureen , Endres Matthias , Michelson Georg , Audebert Heinrich J
Published: March 2023

Background and purpose

Retinal pathologies are an independent risk factor for ischaemic stroke, but research on the predictive value of retinal abnormalities for recurrent vascular events in patients with prior stroke is inconclusive. We investigated the association of retinal pathologies with subsequent vascular events.

Methods

In a substudy of the Intensified secondary prevention intending a reduction of recurrent events in TIA and minor stroke patients (INSPiRE-TMS) trial, we enrolled patients with recent transient ischaemic attack (TIA) or minor stroke with at least one modifiable risk factor. Primary outcome was the composite of subsequent vascular events. Retinal photographs were taken at baseline and categorised into three different fundus groups by a telemedically linked ophthalmologist.

Results

722 patients participated in the current study and 109 major vascular events occurred. After multivariable adjustments, we did not find a significant association between fundus categories and risk for subsequent vascular events (HRs for moderate vascular retinopathy and vascular retinopathy with vessel rarefaction in comparison to no vascular retinopathy 1.03 (95% CI 0.64 to 1.67), p=0.905 and 1.17 (95% CI 0.62 to 2.20), p=0.626). In a selective post hoc analysis in patients with diabetes mellitus and hypertension, patients with vascular retinopathy with vessel rarefaction had a higher risk for recurrent stroke (HR 24.14 (95% CI 2.74 to 212.50), p=0.004).

Conclusions

Retinal changes did not predict major subsequent vascular events in patients with recent TIA or minor stroke. Further studies are needed to examine the utility of fundus photography in assessing the risk of stroke recurrence in patients with diabetes mellitus and hypertension.
Comparison of the empirical formula and the “CFD”-based semi-empirical method in the prediction of the critical speed of flutter
Authors: Abdulsattar Essam , Abdelnaby Mohamed , Elnaggar Mohamed
Published: March 2023

In this paper, the critical wind speed of flutter has been predicted by using two-dimensional computational fluid dynamics (CFD) model side by side with the empirical formula (Selberg's formula, 1961). The deck section of the Great Belt Bridge's main span has been used herein as a reference among other sectional varieties. For each case of the examined sections, the width was changed case by case, while its depth maintained unchanged. Both of the two methods, the semi-empirical using the “CFD” simulation and the empirical formula have been employed to predict the critical wind speed of flutter for a variety of the (width/depth) ratio and the natural frequency ratio (torsional/vertical). The results were obtained from the semi-empirical method and validated by comparison with wind tunnel test for typical section model of the Great Belt Bridge presented in the literature, and also compared with the empirical method. The results were represented graphically for each method and they have indicated the variation of the critical speed in terms of the section dimension and its natural frequencies, and furthermore, the change of the difference between the two methods was represented too.
U–Pb geochronology: its development and importance in Canada
Authors: Davis Donald W.
Published: March 2023

This article presents a history of the development of U–Pb geochronology with emphasis on the role of Canadian researchers and some of its applications to Canadian geology. Modern U–Pb dating is the result of work by many individuals over the past 60 years, but the most important was Tom Krogh, who established methods that allowed determination of precise ages (<0.1% errors) on zircon using isotope dilution thermal ionization mass spectrometry. This was followed by the introduction of new analytical approaches by others, notably secondary ion mass spectrometry and laser ablation inductively coupled plasma mass spectrometry that allow intracrystal domains to be dated. U–Pb geochronology is now an indispensable tool for understanding the Earth. In collaboration with field mapping, it has vastly improved our understanding of the geological history of Canada as well as important geological events such as mass extinctions, secular changes in geological processes, and the birth of the solar system.
Characterization of bluefish baits (keeled mullet, leaping mullet, and sardine) in regard to biochemical and physical properties: bait preference of bluefish
Authors: Ozyurt Caner Enver , Tabakoglu Sefik Surhan , Kiyaga Volkan Barıs , Ozyurt Gulsun
Published: March 2023

The fishing industry needs alternative baits that are not based on resources available for human consumption. In order to develop artificial baits, first the preferred baits should be determined, and then their biochemical and physiological composition should be identified. The aim of this study was to determine bluefish bait preferences and reveal the biochemical composition and physical characteristics of the preferred baits. In this study, keeled mullet, leaping mullet, and sardine species were found to have the highest catch, respectively. The highest texture hardness and whiteness colour values were found in keeled mullet, which had the highest catch efficiency for bluefish fishing. The highest palmitoleic acid content was found in keeled mullet at 25.86% (16.93% in leaping mullet and 17.05% in sardine). However, the highest PUFA content was found in sardine (15.56%), followed by leaping mullet (13.97%), and then keeled mullet (11.32%). As for the amino acid compositions, it was determined that glutamic acid and serine content, which are known to have positive effects on feed intake, were higher in keeled mullet. In regard to volatile components, mullet species were especially rich in total alcohol, aldehyde, ketone, and amines, while sardines were rich in hydrocarbons and furans. Hexanal and heptanal compounds, known as fish aroma, were determined at high rates in keeled mullet. It can be concluded that these components may be attractive to bluefish. The data presented in this study may be useful for the production of artificial bait.
Iveron Icon of the Mother of God: reconstruction based on physical–chemical tests as an element of conservation
Authors: Stępień Danuta , Nowicka Anna
Published: March 2023

Recently art conservators tend to wonder which of the possible intervention paths to undertake while planning a conservation project and how deep their interference with the original substance should be. Limiting intervention to ceasing the ongoing degradation process and securing the object for the future without restoring any missing parts of the composition is just one of the many available approaches. Making a brand new copy of the painting where all the missing parts could be fully reconstructed and exposing it along with the original is a good alternative to traditional restoration practice. This method has been used by Danuta Stępień during conservation of a Russian icon entitled “Our Lady of Iver” (Moscow, 1908–1917, egg tempera on a wooden panel partially covered by a silver oklad, 10.8 × 13.2 × 0.8 cm). The silver oklad was executed by the workshop of Smirnow. Technology and materials have been identified via different analytical techniques: VIS, UV, IR and X-ray photography, microscopic photography, SEM–EDS analysis and FTIR. Specific medical radiological instruments have also been used as non-invasive analytical tools. The following materials have been identified: yellow ochre, cinnabar, cadmium red, red iron oxides, silver, gold and copper. The oklad is made of an Ag-rich silver–copper alloy. Its whole surfaces are richly engraved with traces of gold detected inside the engravings. Based on this fact, an assumption has been made that originally the upper part of the oklad might have been entirely covered with a layer of gold. The information gathered during research allowed to execute a fine copy of the icon using similar materials and techniques. An alternative to classic restoration approach is to create a faithful but fully reconstructed copy that could be exposed along with the original painting. This solution not only assures maximum respect for the original substance but also allows the recipients to better understand its history and technique.
Rational-type soft fuzzy contraction in soft fuzzy metric space and solution of nonlinear integral equation
Authors: Gupta Vishal , Gondhi Aanchal , Saini R. K.
Published: March 2023

This paper is devoted to the explication of the introduction of rational-type soft fuzzy contraction in soft fuzzy metric space. New fixed point results for these new contractions along with relevant and valid examples have been presented and generalized. We have also presented an application to our new formed results in finding the solution of a nonlinear integral equation.
Stability and Hopf Bifurcation Analysis of an HIV Infection Model in the Evolution of Drug Resistance
Authors: Xu Rui , Yang Yan
Published: March 2023

In the course of reverse transcription, drug-sensitive strain can mutate to a drug-resistant one. Cell-to-cell transmission is proved to be more efficient than virus-to-cell infection. The population of Cytotoxic T Lymphocytes (CTLs) can be divided into CTL precursors and CTL effectors. Naive CTL precursors are those that never have contacted antigen, circulating around the body. Once the host is infected, CTL precursors (CTLp) begin to proliferate and differentiate into CTL effectors (CTLe), which have antiviral activity. In this paper, we study an HIV model with drug-sensitive and drug-resistant mixed strains, CTLp and CTLe, both viral and cellular infections. The basic reproduction ratios for each strain are derived and the stability of each feasible equilibrium is analyzed by using Routh–Hurwitz criteria. The periodic solutions may occur near the equilibrium with CTL immune response via Hopf bifurcation. By using normal form theory, we find more information about the limit cycles, such as the amplitude, phase and stability.
Extended Inverse Weibull Distribution with Application in Reliability Sciences
Authors: Abbas Salman , Cakmakyapan Selen , Mustafa Fakhar , Ozel Gamze , Shahbaz Muhammad Qaiser
Published: March 2023

This paper presents a new four-parameter lifetime model by generalizing the Inverse Weibull (IW) distribution using Transmuted Kumaraswamy family of distributions. The proposed model explains the high probability at the tail effectively. The induction of additional parameters enhance the potentiality of the IW distribution and make it a pliant model that provides a vast range of existing distributions as special cases. Several probabilistic properties of the proposed model including moments, probability weighted moments, moment generating function, quantile function, reliability measures, and order statistics are discussed. The maximum likelihood (ML) procedure is adopted for the estimation of model parameters. The efficiency of ML estimates is to testify through simulation study. Four datasets from the field of reliability science are used to expound the competence of the proposed model.
A single image super resolution method based on cross residual network and wavelet transform
Authors: Ri Kwang-Chol , Kim Chol-Jin
Published: March 2023

In this paper, we propose a method to realize single image super resolution using a network composed of residual blocks with a cross architecture and wavelet transform. For the high quality of the reconstructed high resolution image, the brightness change must be sharp at the edge and gentle at the flat region. In single image super resolution, it is important to accurately predict the high-frequency components of the image. Hence, we propose a method to realize single image super resolution by estimating the high-frequency component in the wavelet domain using neural network composed of residual blocks with two crossing skip connections.
Energy absorption and vibration mitigation performances of novel 2D auxetic metamaterials
Authors: Sebaq M. H. , Liu Zishun
Published: March 2023

This paper proposes novel unit cells that can be arranged periodically constructing disparate auxetic metamaterials with negative Poisson’s ratio for engineering applications. The two-dimensional auxetic unit cells are designed utilizing the mathematical model of the modified Solid Isotropic Material with Penalization (SIMP) topological optimization method with the objective of maximizing the magnitude of the negative Poisson’s ratio. The deformation mechanisms of the auxetic structures are controlled effectively by straight and oblique struts attached at rotation joints since the optimum designs are a combination of chiral and re-entrant unit cells. Three structures with optimum auxetic designs are chosen to verify the modified SIMP method using numerical simulation. Additionally, the energy absorption and vibration mitigation of auxetic metamaterials have been extensively studied. The results showed a significant impact of negative Poisson’s ratio on the considered dynamic properties of the auxetic structures.