bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical outcomes of sacrospinous ligament fixation at the time of vaginal hysterectomy for vaginal vault prolapse prevention: 10 years review
Authors: Bunyavejchevin Suvit , Songsiriphan Athiwat , Ruanphoo Purim , Chiengthong Keerati
Published: May 2023

Aims

To study the non‐recurrent prolapse rate after vaginal hysterectomy colpoperineorrhaphy and sacrospinous ligament fixation (SSLF) with or without anterior colporrhaphy, with or without posterior colpoperineorrhaphy.

Materials and Methods

A retrospective cohort study was carried out at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, during January 1, 2012—December 31, 2021. The inclusion criteria were Thai women diagnosed with uterovaginal prolapse and undergone vaginal hysterectomy, with or without anterior colporrhaphy, with or without posterior colpoperineorrhaphy, with SSLF and had the complete pelvic organ prolapse quantification (POP‐Q) information at the 12 months follow up. The recurrent case was defined as any compartment prolapse ≥ stage II by POP‐Q classification at 1, 3, 6, 12 months follow up.

Results

Of 71 cases included, 20 cases had recurrent prolapse at 12 months. The incidences of non‐recurrent prolapse rate at 1, 3, 6, and 12 months were 70/71 (98.59%), 65/70 (92.86%), 58/65 (89.23%), and 51/58 (87.93%). The overall PHVP prevalence at 12 months was 2/71 (2.81%). The anterior compartment prolapse were 18/71 (25.35%) at 12 months. The most common postoperative complications were the urinary tract infection (4.23%). There were one case of nerve entrapment and one case of stitches exposure that required stitches removal.

Conclusion

SSLF at the time of vaginal hysterectomy is safe and effective in post hysterectomy vaginal vault prolapse prevention. But there are high recurrence rate of anterior compartment prolapse at 12 months. Preoperative counseling and long‐term follow up after SSLF is advocated.
Exploring practices of multiliteracies pedagogy through digital technologies: a narrative inquiry
Authors: Yap Jia Rong , Gurney Laura
Published: May 2023

Digital technologies have fast become integral within literacy learning and teaching across contexts as students engage with a variety of digital and multimodal texts. While teachers in New Zealand schools have a high degree of autonomy in the design and planning of literacy programs, little is currently known about how they understand and enact multiliteracies pedagogy (MLP). Using data gathered via interviews and classroom observations in an intermediate school in New Zealand, this article adopts a narrative inquiry approach to explore one teacher's approaches to using digital technologies and texts within literacy instruction. We explore in particular the ways in which MLP may be enactedimplicitlyrather than explicitly, within the complex matrix of teachers' personal beliefs and learning experiences, the perceived learning needs of students, and the school curriculum. We conclude with a call for the conscious and purposeful teaching of MLP, focusing on synaesthesia and the semiotic functions of texts.
Characterization of iron meteorites by scanning electron microscopy, X‐ray diffraction, magnetization measurements, and Mössbauer spectroscopy: Gibeon IVA
Authors: Goryunov M. V. , Varga G. , Dankházi Z. , Felner I. , Chukin A. V. , Kuzmann E. , Homonnay Z. , Grokhovsky V. I. , Oshtrakh M. I.
Published: May 2023

Gibeon IVA iron meteorite fragment was characterized using optical microscopy, scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS), X‐ray diffraction (XRD), magnetization measurements, and Mössbauer spectroscopy. Optical microscopy and SEM made on the polished section of the meteorite, show the presence of α‐Fe(Ni, Co) and γ‐Fe(Ni, Co) phases and plessite structures. There are no troilite inclusions observed in the studied section. EDS studies indicate some variations in the Ni concentrations: (i) within the α‐Fe(Ni, Co) phase in the range ~5.0 ± 0.1 – ~7.5 ± 0.1 at% and (ii) within the γ‐Fe(Ni, Co) phase in the range ~26.0 ± 0.2 – ~36.1 ± 0.2 at%. The latter Ni concentration range indicates the presence of small amount of the paramagnetic γ‐phase in addition to the ferromagnetic γ‐phase. EDS also shows that Ni content in two plessite structures is varying in the range ~16–37 at%, which can indicate the presence of only the α2‐Fe(Ni, Co) and γ‐Fe(Ni, Co) phases in the duplex plessite structure. This may be a result of the γ‐phase decomposition with the incomplete martensitic transformation: γ → α2 + γ due to a faster cooling rate. XRD indicates the presence of ~1.3 wt% of the γ‐Fe(Ni, Co) phase in Gibeon VIA. The saturation magnetization moment of 185(2) emu g−1 obtained also confirms the presence of phases with low and high Ni concentrations. The most appropriate fit of the Gibeon IVA Mössbauer spectrum demonstrates the presence of five magnetic sextets and one paramagnetic singlet which are assigned to the ferromagnetic α2‐Fe(Ni, Co), α‐Fe(Ni, Co), γ‐Fe(Ni, Co), and paramagnetic γ‐Fe(Ni, Co) phases. The relative average Fe contents in these phases are: 13.4% in the α2‐Fe(Ni, Co) phase, 78.3% in the α‐Fe(Ni, Co) phase, and 8.3% in the ferromagnetic and paramagnetic γ‐Fe(Ni, Co) phases.
Enhanced neuron–glia network in the submucosa and increased neuron outgrowth into the mucosa are associated with distinctive expressions of neuronal factors in the colon of rat IBS model
Authors: Fujikawa Yoshiko , Tominaga Kazunari
Published: May 2023

Background

Neuronal attraction and repulsion factors regulate neuron network formation. In the colon of irritable bowel syndrome (IBS), neuron network and enteric glial cells (EGCs) in the submucosa, neuronal outgrowth in the mucosa, and expressions of neuronal factors remain unknown.

Methods

IBS models were prepared by intracolonic injections of acetic acid to Wistar Kyoto (WKY) rats. Using whole‐mount submucosal plexus tissue stripped from the distal colon, we examined neuron network, EGC morphology, and localization of both attraction factor (nerve growth factor: NGF) and repulsion factor (semaphorin3A: Sema3A). We evaluated mRNA expressions of NGF and Sema3A in the mucosa and submucosa and neuron outgrowth into the mucosa.

Key Results

In IBS models, nerve fibers were thickened and densely increased in the submucosa remarkably from the outer toward the inner plexus. Submucosal EGCs exhibited process hyperplasia and bulbous swelling of terminals. NGF was predominantly expressed in EGCs than neurons in the submucosa. NGF mRNA expressions were increased in the submucosa in WKY, and their expressions were increased in the mucosa after the injection. Sema3A mRNA expressions were increased in both layers of WKY but tended to be decreased in the mucosa alone after the injection. Neuron outgrowth was increased into the mucosa. NGF was localized at EGCs in the lamina propria mucosae but not mucosal mast cells.

Conclusions & Inferences

Neuron network enhancement in the submucosa and neuron outgrowth into the mucosa may be associated with axon guidance factors expressed in hyperplastic EGCs in the colonic submucosa of IBS models.
The AP2/ERF transcription factor TOE4b regulates photoperiodic flowering and grain yield per plant in soybean
Authors: Li Haiyang , Du Haiping , Huang Zerong , He Milan , Kong Lingping , Fang Chao , Chen Liyu , Yang Hui , Zhang Yuhang , Liu Baohui , Kong Fanjiang , Zhao Xiaohui
Published: May 2023

Photoperiod‐mediated flowering determines the phenological adaptability of crops including soybean (Glycine max). A genome‐wide association study (GWAS) identified a new flowering time locus, Time of flowering 13 (Tof13), which defined a gene encoding an AP2/ERF transcription factor. This new transcription factor, which we named TOE4b, is localized in the nucleus. TOE4b has been selected for soybean latitude adaptability. The existing natural variant TOE4bH4 was rare in wild soybean accessions but occurred more frequently in landraces and cultivars. Notably, TOE4bH4 improved high‐latitude adaptation of soybean to some extent. The gene‐edited TOE4b knockout mutant exhibited earlier flowering, conversely, TOE4b overexpression delayed flowering time. TOE4b is directly bound to the promoters and gene bodies of the key flowering integration factor genes FT2a and FT5a to inhibit their transcription. Importantly, TOE4b overexpression lines in field trials not only showed late flowering but also altered plant architecture, including shorter internode length, more internodes, more branches and pod number per plant, and finally boosted grain yield per plant by 60% in Guangzhou and 87% in Shijiazhuang. Our findings therefore identified TOE4b as a pleiotropic gene to increase yield potential per plant in soybean, and these results provide a promising option for breeding a soybean variety with an idealized plant architecture that promotes high yields.
Metabolomic and transcriptomic analyses reveal the biosynthetic mechanisms of pigments and main taste compounds in an albino tea cultivar
Authors: Liu Sheng‐Chuan , Xu Ying‐Fen , Liu Ya‐Bing , Zhao Xiong , Wei Jie , Lin Kai‐Qin , Liu Yan , Yan Dong‐Hai
Published: May 2023

Significant variations in leaf colours, pigment contents, and main taste compounds in young shoots from albino tea plants (Camellia sinensis) influence tea flavour. However, the seasonal metabolic pattern and molecular regulatory mechanism of these metabolites remain largely elusive. Herein, we conducted morphological, biochemical, metabolomic and transcriptomic analyses between an albino tea cultivar ‘Zhonghuang 3’ (‘ZH3’) and a green strain ‘Tai cha 15’ (‘TC15’) at four‐time points (April 12, May 31, July 14, and August 17) to elucidate dynamic changes in these compounds and predict the relationships among transcription factors (TFs), target genes (TGs), and metabolite abundance. Generally, leaf colours and pigment contents were significantly lighter and lower, respectively, in ‘ZH3’ than in ‘TC15’ from spring to summer, but were subsequently similar. Compared to ‘TC15’, ‘ZH3’ had a lower and broader phenol/ammonia ratio as well as stable caffeine content and showed more significantly different metabolites and differentially expressed genes. The relationship between pigments, main taste compounds, and their biosynthetic genes, as well as TFs and their TGs, had genetic specificity. These results suggested that the biosynthesis of these compounds was probably both season‐ and variety‐dependent. In total, 12 models of the TF‐TG‐metabolite regulatory network were proposed to uncover the biosynthetic and regulatory mechanisms of these metabolites in tea plants. A high correlation was observed between some structural genes and TFs with the accumulation of these metabolites. These findings provide novel insights into the regulatory mechanisms underlying accumulation of pigments and main taste compounds in tea plants.
Validation of the g.tec Unicorn Hybrid Black wireless EEG system
Authors: Pontifex Matthew B. , Coffman Colt A.
Published: May 2023

Although dry and hybrid‐style electrode technology has been well validated, systems utilizing these electrodes have not been widely adopted. One reason for this may be that the systems incorporating such technology present limitations that are fundamental to the EEG approach. The g.tec Unicorn Hybrid Black system, a low density Bluetooth EEG amplifier, however, attempts to address many of these limitations to allow greater flexibility to replicate methods used with traditional EEG amplifiers and extend them to more novel applications. The aim of the present investigation was to validate the g.tec Unicorn Hybrid Black amplifier to determine if it provides comparable data to a traditional laboratory‐based system when no electrode preparation is utilized or if a saline‐based solution is necessary to obtain sufficient signal quality. Stimulus‐locked ERPs and EEG power spectrum data were concurrently recorded using both the Unicorn Hybrid Black amplifier and a traditional high‐end laboratory‐based low‐impedance wired system. Findings suggest that the Unicorn Hybrid Black provides valid measures for investigations of frequency spectra even with no conductive solution applied. However, to obtain valid assessments of event‐related brain potentials, it appears necessary to use a conductive solution for electrode preparation. This system appears well suited to allow for high‐quality and flexible EEG measures available outside of traditional laboratory environments.
Proof of concept for detection of staphylococcal enterotoxins in platelet concentrates as a novel safety mitigation strategy
Authors: Chi Sylvia Ighem , Yousuf Basit , Paredes Carina , Bearne Jennifer , McDonald Carl , Ramirez‐Arcos Sandra
Published: May 2023

Background and Objectives

Staphylococcus aureus is a predominant contaminant of platelet concentrates (PCs) that can evade detection during screening with culture methods. Importantly, S. aureus produces staphylococcal enterotoxins (SEs) during PC storage, which are linked to slow growth and enhanced biofilm formation. This study investigated timing of SE production during PC storage and feasibility of SE detection as a PC safety strategy.

Materials and Methods

Genomic and transcriptomic data of transfusion‐relevant S. aureus PS/BAC/169/17/W, PS/BAC/317/16/W, CI/BAC/25/13/W and CBS2016‐05 were used to determine the presence and differential expression of exotoxin genes in PCs. Trypticase soy broth (TSB) and PCs were inoculated with 1.0E+06 cfu/mL of S. aureus PS/BAC/169/17/W and CBS2016‐05. Expression of SEs at different growth phases was confirmed with Western blotting. PCs were inoculated with 30 cfu/unit of the same strains, and SE detection during PC storage was optimized with a sandwich dot‐ELISA assay.

Results

S. aureus genomes contain multiple exotoxin genes including those encoding for SEs. Transcriptome data revealed significant upregulation (0.5–6.7‐fold, p < 0.05) of SE genes in PCs versus TSB. Western blots demonstrated SE production at all growth phases. Notably, dot‐ELISA detected clinically relevant concentrations of SEs (~0.2 μg/mL) at 32 h of PC storage when S. aureus PS/BAC/169/17/W and CBS2016‐05 counts were 1.8E+04 and 1.4E+04 cfu/mL, respectively.

Conclusion

Genomic analyses revealed that staphylococcal exotoxins are widely distributed and highly conserved among transfusion‐relevant S. aureus isolates. Furthermore, SEs are significantly upregulated in PCs and detected at 30 h of PC storage. Therefore, bacterial toxin detection could supplement mitigation strategies to enhance PC safety.
Coaching Elementary Teachers in Literacy: Does Feedback Type Matter for Low Implementers?
Authors: Cutrer-Párraga Elizabeth A. , Miller Erica Ellsworth , Gjini Erjola , Garrett Melia Fonoimoana
Published: May 2023

For literacy coaches and teachers, feedback is an integral component of effective coaching. Yet, little is understood about the interaction between feedback and high/low implementing teachers within coaching sessions. This multiple case study explored the types of feedback literacy coaches provided both high and low implementing teachers over a two-year period. In the first year, the literacy coaches provided at least twice as much instructional feedback as emotional feedback to low-implementing teachers. Those teachers not only received more feedback in general, but the feedback they received was primarily what they needed to do to improve. In contrast, during the same period literacy coaches provided high-implementing teachers more emotional feedback than instructional feedback. Low implementation, or resistance, observed in this study may have been tied to the overwhelming amount and type of feedback the low implementing teachers received.  Coaches seeking to enhance instructional practices could benefit from attending to the amount and type of feedback they provide their learners.
Physical Inactivity, Inequalities, and Disparities Across Districts of Iran: A STEPs Survey-Based Analysis
Authors: Hajebi Amirali , Nasserinejad Maryam , Azadnajafabad Sina , Ghasemi Erfan , Rezaei Negar , Yoosefi Moein , Ghamari Azin , Keykhaei Mohammad , Ghanbari Ali , Mohammadi Esmaeil , Rashidi Mohammad-Mahdi , Gorgani Fateme , Moghimi Mana , Namazi Shabestari Alireza , Farzadfar Farshad
Published: May 2023

Background: We aimed to estimate the prevalence of physical inactivity in all districts of Iran and the disparities between subgroups defined by various measures. Methods: Small area estimation method was employed to estimate the prevalence of physical inactivity in districts based on the remaining districts in which data on the level of physical inactivity were available. Various comparisons on the estimations were done based on socioeconomic, sex, and geographical stratifications to determine the disparities of physical inactivity among districts of Iran. Results: All districts of Iran had a higher prevalence of physical inactivity compared with the world average. The estimated prevalence of physical inactivity among all men in all districts was 46.8% (95% uncertainty interval, 45.9%–47.7%). The highest and lowest estimated disparity ratio of physical inactivity were 1.95 and 1.14 in males, and 2.25 and 1.09 in females, respectively. Females significantly had a higher prevalence of 63.5% (62.7%–64.3%). Among both sexes, the poor population and urban residents significantly had higher prevalence of physical inactivity than rich population and rural residents, respectively. Conclusions: The high prevalence of physical inactivity among Iranian adult population suggests the urgent need to adopt population-wide action plans and policies to handle this major public health problem and avert the probable burden.
Micrometeoroid infall onto Saturn’s rings constrains their age to no more than a few hundred million years
Authors: Kempf Sascha , Altobelli Nicolas , Schmidt Jürgen , Cuzzi Jeffrey N. , Estrada Paul R. , Srama Ralf
Published: May 2023

There is ongoing debate as to whether Saturn’s main rings are relatively young or ancient— having been formed shortly after Saturn or during the Late Heavy Bombardment. The rings are mostly water-ice but are polluted by non-icy material with a volume fraction ranging from ∼0.1 to 2%. Continuous bombardment by micrometeoroids exogenic to the Saturnian system is a source of this non-icy material. Knowledge of the incoming mass flux of these pollutants allows estimation of the rings’ exposure time, providing a limit on their age. Here we report the final measurements by Cassini’s Cosmic Dust Analyzer of the micrometeoroid flux into the Saturnian system. Several populations are present, but the flux is dominated by low-relative velocity objects such as from the Kuiper belt. We find a mass flux between 6.9 · 10
−17
and 2.7 · 10
−16
kg m
−2
s
−1
from which we infer a ring exposure time ≲100 to 400 million years in support of recent ring formation scenarios.
Swarming self-adhesive microgels enabled aneurysm on-demand embolization in physiological blood flow
Authors: Jin Dongdong , Wang Qinglong , Chan Kai Fung , Xia Neng , Yang Haojin , Wang Qianqian , Yu Simon Chun Ho , Zhang Li
Published: May 2023

The recent rise of swarming microrobotics offers great promise in the revolution of minimally invasive embolization procedure for treating aneurysm. However, targeted embolization treatment of aneurysm using microrobots has significant challenges in the delivery capability and filling controllability. Here, we develop an interventional catheterization-integrated swarming microrobotic platform for aneurysm on-demand embolization in physiological blood flow. A pH-responsive self-healing hydrogel doped with magnetic and imaging agents is developed as the embolic microgels, which enables long-term self-adhesion under biological condition in a controllable manner. The embolization strategy is initiated by catheter-assisted deployment of swarming microgels, followed by the application of external magnetic field for targeted aggregation of microrobots into aneurysm sac under the real-time guidance of ultrasound and fluoroscopy imaging. Mild acidic stimulus is applied to trigger the welding of microgels with satisfactory bio-/hemocompatibility and physical stability and realize complete embolization. Our work presents a promising connection between the design and control of microrobotic swarms toward practical applications in dynamic environments.
Toward perturbation theory methods on a quantum computer
Authors: Li Junxu , Jones Barbara A. , Kais Sabre
Published: May 2023

Perturbation theory, used in a wide range of fields, is a powerful tool for approximate solutions to complex problems, starting from the exact solution of a related, simpler problem. Advances in quantum computing, especially over the past several years, provide opportunities for alternatives to classical methods. Here, we present a general quantum circuit estimating both the energy and eigenstates corrections that is far superior to the classical version when estimating second-order energy corrections. We demonstrate our approach as applied to the two-site extended Hubbard model. In addition to numerical simulations based on qiskit, results on IBM’s quantum hardware are also presented. Our work offers a general approach to studying complex systems with quantum devices, with no training or optimization process needed to obtain the perturbative terms, which can be generalized to other Hamiltonian systems both in chemistry and physics.
LXR signaling controls homeostatic dendritic cell maturation
Authors: Bosteels Victor , Maréchal Sandra , De Nolf Clint , Rennen Sofie , Maelfait Jonathan , Tavernier Simon J. , Vetters Jessica , Van De Velde Evelien , Fayazpour Farzaneh , Deswarte Kim , Lamoot Alexander , Van Duyse Julie , Martens Liesbet , Bosteels Cédric , Roelandt Ria , Emmaneel Annelies , Van Gassen Sofie , Boon Louis , Van Isterdael Gert , Guillas Isabelle , Vandamme Niels , Höglinger Doris , De Geest Bruno G. , Le Goff Wilfried , Saeys Yvan , Ravichandran Kodi S. , Lambrecht Bart N. , Janssens Sophie
Published: May 2023

Dendritic cells (DCs) mature in an immunogenic or tolerogenic manner depending on the context in which an antigen is perceived, preserving the balance between immunity and tolerance. Whereas the pathways driving immunogenic maturation in response to infectious insults are well-characterized, the signals that drive tolerogenic maturation during homeostasis are still poorly understood. We found that the engulfment of apoptotic cells triggered homeostatic maturation of type 1 conventional DCs (cDC1s) within the spleen. This maturation process could be mimicked by engulfment of empty, nonadjuvanted lipid nanoparticles (LNPs), was marked by intracellular accumulation of cholesterol, and was highly specific to cDC1s. Engulfment of either apoptotic cells or cholesterol-rich LNPs led to the activation of the liver X receptor (LXR) pathway, which promotes the efflux of cellular cholesterol, and repressed genes associated with immunogenic maturation. In contrast, simultaneous engagement of TLR3 to mimic viral infection via administration of poly(I:C)-adjuvanted LNPs repressed the LXR pathway, thus delaying cellular cholesterol efflux and inducing genes that promote T cell–mediated immunity. These data demonstrate that conserved cellular cholesterol efflux pathways are differentially regulated in tolerogenic versus immunogenic cDC1s and suggest that administration of nonadjuvanted cholesterol-rich LNPs may be an approach for inducing tolerogenic DC maturation.
Made to order tuft cells by an OCA-T1 isoform switch
Authors: Wu Xiaoli S. , Vakoc Christopher R.
Published: May 2023

A genetic mechanism accounts for the variation in tuft cell abundance seen among inbred mouse strains: alternative isoforms of OCA-T1 (Oct coactivator from tuft cells 1), a recently discovered transcriptional coactivator that specifies the tuft cell lineage (see related Research Article by

Nadjsombati
et al.

).
Nephrologists’ perspectives on the impact of COVID-19 on caring for patients undergoing dialysis in Latin America: a qualitative study
Authors: Matus Gonzalez Andrea , Lorca Eduardo , Cabrera Sebastian , Hernandez Alejandra , Zúñiga-SM Carlos , Sola Laura , Michea Luis , Ferreiro Fuentes Alejandro , Cervantes Lilia , Madero Magdalena , Teixeira-Pinto Armando , Wong Germaine , Craig Jonathan , Jaure Allison
Published: May 2023

Objective

To describe the experiences of nephrologists on caring for patients undergoing in-centre haemodialysis during the COVID-19 pandemic in Latin America.

Design

Twenty-five semistructured interviews were conducted by Zoom videoconference in English and Spanish languages during 2020 until data saturation. Using thematic analysis, we conducted line-by-line coding to inductively identify themes.

Setting

25 centres across nine countries in Latin America.

Participants

Nephrologists (17 male and 8 female) were purposively sampled to include diverse demographic characteristics and clinical experience.

Results

We identified five themes: shock and immediate mobilisation for preparedness (overwhelmed and distressed, expanding responsibilities to manage COVID-19 infection and united for workforce resilience); personal vulnerability (being infected with COVID-19 and fear of transmitting COVID-19 to family); infrastructural susceptibility of dialysis units (lacking resources and facilities for quarantine, struggling to prevent cross-contamination, and depletion of personal protective equipment and cleaning supplies); helplessness and moral distress (being forced to ration life-sustaining equipment and care, being concerned about delayed and shortened dialysis sessions, patient hesitancy to attend to dialysis sessions, being grieved by socioeconomic disparities, deterioration of patients with COVID-19, harms of isolation and inability to provide kidney replacement therapy); and fostering innovative delivery of care (expanding use of telehealth, increasing uptake of PD and shifting focus on preventing syndemics).

Conclusion

Nephrologists felt personally and professionally vulnerable and reported feeling helpless and morally distressed because they doubted their capacity to provide safe care for patients undergoing dialysis. Better availability and mobilisation of resources and capacities to adapt models of care, including telehealth and home-based dialysis, are urgently needed.
PANDORA dyadic project: hope, spiritual well-being and quality of life of dyads of patients with chronic obstructive pulmonary disease in Switzerland – a multicentre longitudinal mixed-methods protocol study
Authors: Baptista Peixoto Befecadu Filipa , Stirnemann Jerome , Guerreiro Ivan , Fusi-Schmidhauser Tanja , Jaksic Cyril , Larkin Philip J , da Rocha Rodrigues Gora , Pautex Sophie
Published: May 2023

Introduction

Chronic obstructive pulmonary disease (COPD) is responsible for 2.9 million deaths annually in Europe. Symptom burden and functional decline rise as patients reach advanced stages of the disease enhancing risk of vulnerability and dependency on informal caregivers (ICs).

Evidence shows that hope is an important psycho-social-spiritual construct that humans use to cope with symptom burden and adversity. Hope is associated with increased quality of life (QoL) comfort and well-being for patients and ICs. A better understanding of the meaning and experience of hope over time as patients transition through chronic illness may help healthcare professionals to plan and deliver care more appropriately.

Methods and analysis

This is a longitudinal multicentre mixed-methods study with a convergent design. Quantitative and qualitative data will be collected from dyads of advanced COPD patients and their ICs in two university hospitals at two points in time. The Herth Hope Index, WHO Quality of Life BREF, Functional Assessment of Chronic Illness Therapy-Spiritual Well-being and the French version of the Edmonton Symptom Assessment Scale will be used to collect data. Dyadic interviews will be conducted using a semi-structured interview guide with five questions about hope and their relationship with QoL.

Statistical analysis of data will be carried out using R V.4.1.0. To test whether our theoretical model as a whole is supported by the data, structural equation modelling will be used. The comparison between T1 and T2 for level of hope, symptom burden, QoL and spiritual well-being, will be carried out using paired t-tests. The association between symptom burden, QoL, spiritual well-being and hope will be tested using Pearson correlation.

Ethics and dissemination

This study protocol received ethical approval on 24 May 2022 from theCommission cantonale d'éthique de la recherche sur l'être humain—Canton of Vaud. The identification number is 2021-02477.
Effect of environmental enrichment on relapse rates in patients with severe alcohol use disorder: protocol for a randomised controlled trial
Authors: Barillot Lila , Chauvet Claudia , Besnier Marc , Jaafari Nematollah , Solinas Marcello , Chatard Armand
Published: May 2023

Introduction

Alcohol use disorder (AUD) ranks among the most prevalent psychiatric disorders worldwide. Despite current treatments, more than half of patients relapse within weeks after treatment. In animal models, exposure to environmental enrichment (EE) has been shown to be a promising approach to reduce relapse. However, controlled, multimodal EE is difficult to transpose to humans. To address this gap, this study aims at assessing the effectiveness of exposure to a newly designed EE protocol during AUD treatment in reducing relapse to alcohol use. Our EE will allow an enhancement of the standard intervention, and will combine several promising enrichment factors identified in the literature—physical activity, cognitive stimulation, mindfulness and virtual reality (VR).

Methods and analysis

A randomised controlled trial involving 135 participants receiving treatment for severe AUD will be conducted. Patients will be randomised to an intervention enhancement group or a control group. The enhanced intervention will consist of six 40-min sessions of EE spread over 9 days. During the first 20 min of these sessions, patients will practise mindfulness in multisensory VR, in virtual environments designed to practise mindfulness and use it to regulate craving induced by virtual cues or stress. Then, participants will practise indoor cycling combined with cognitive training exercises. The control group will undergo standard management for AUD. The primary outcome is relapse assessed at 2 weeks after treatment, using a questionnaire and biological indicators. Relapse will be defined as drinking at least five drinks per occasion or drinking at least five times a week. It is predicted that the group receiving the EE intervention will have a lower relapse rate than the control group. The secondary outcomes are relapse at 1 month and 3 months after treatment, craving and drug-seeking behaviour, mindfulness skills acquisition and the effect of the intervention enhancement on the perceived richness of the daily environment, assessed by questionnaires and neuropsychological tasks.

Ethics and dissemination

All participants have to give written informed consent to the investigator. This study is approved by the Ethics Committee Nord Ouest IV of Lille (reference number 2022-A01156-37). Results will be disseminated through presentations, peer-reviewed journals and seminar conferences. All information on ethical considerations and open science practices can be accessed athttps://osf.io/b57uj/

Trial registration number

NCT05577741.
Effect of dementia on all-cause mortality in hip fracture surgery: a retrospective study on a nationwide Korean cohort
Authors: Jeong Sung Hoon , Lee Hyeon Ji , Kim Seung Hoon , Park Eun-Cheol , Jang Suk-Yong
Published: May 2023

Objectives

We aimed to evaluate the effect of dementia on the 1-year all-cause mortality in elderly patients who underwent hip fracture surgery, using a nationwide cohort in Korea.

Design, setting, and participants

This was a nationwide, retrospective study. Elderly patients (≥60 years) with and without dementia who underwent hip fracture surgery between January 2005 and December 2012 were distinguished using the data from the Korean National Health Insurance Service-Senior cohort.

Interventions

None.

Primary and secondary outcome measures

The mortality rates with 95% CIs and the impact of dementia on all-cause mortality were calculated using a generalised linear model with Poisson distribution and a multivariable-adjusted Cox proportional hazards model, respectively.

Results

Among the 10 833 patients who underwent hip fracture surgery, 13.4% were diagnosed with dementia. During the 1-year follow-up period, 1586 patients with hip fracture without dementia died in 8356.5 person-years (incidence rate (IR)=189.2 per 1000 person-years, 95% CI 179.91 to 198.99), while 340 deaths were confirmed in patients with hip fracture with dementia in 1240.8 person-years (IR, 273.1 per 1000 person-years, 95% CI 244.94 to 304.58). Patients with hip fracture and dementia were 1.23 times more likely to die than those in the control group in the same period (HR=1.23, 95% CI 1.09 to 1.39).

Conclusion

Dementia is a risk factor for 1-year all-cause mortality after hip fracture surgery. To improve the postoperative outcomes of patients with dementia who have undergone hip fracture surgery, effective treatment models such as multidisciplinary diagnosis and strategic rehabilitation should be established.
Rationale and Design of the Rivaroxaban Post-Transradial Access for the Prevention of Radial Artery Occlusion Trial (CAPITAL-RAPTOR)
Authors: Di Santo Pietro , Abdel-Razek Omar , Jung Richard , Parlow Simon , Poulin Anthony , Bernick Jordan , Morgan Baylie , Robinson Lisa , Feagan Hannah , Wade Jilliane , Goh Cheng Yee , Singh Kuljit , Froeschl Michael , Labinaz Marino , Fergusson Dean A , Coyle Doug , Kyeremanteng Kwadwo , Abunassar Joseph , Wells George A , Simard Trevor , Hibbert Benjamin
Published: May 2023

Introduction

Transradial access (TRA) has rapidly emerged as the preferred vascular access site for coronary angiography and percutaneous coronary intervention. Radial artery occlusion (RAO) remains as an important complication of TRA as it precludes future ipsilateral transradial procedures. While intraprocedural anticoagulation has been studied extensively, the definitive role of postprocedural anticoagulation has not yet been established.

Methods and analysis

The Rivaroxaban Post-Transradial Access for the Prevention of Radial Artery Occlusion trial is a multicentre, prospective, randomised, open-label, blinded-endpoint design study investigating the efficacy and safety of rivaroxaban to reduce the incidence of RAO. Eligible patients will undergo randomisation to receive either rivaroxaban 15 mg once daily for 7 days or to no additional postprocedural anticoagulation. Doppler ultrasound to assess radial artery patency will be performed at 30 days.

Ethics and dissemination

The study protocol has been approved by the Ottawa Health Science Network Research Ethics Board (approval number 20180319-01H). The study results will be disseminated via conference presentations and peer-reviewed publications.

Trial registration number

NCT03630055.
Utilisation and time to performance of diagnostic imaging in patients admitted to Danish emergency departments: a nationwide register-based study from 2007 to 2017
Authors: Christiansen Nanna Marie , Brabrand Mikkel , Fløjstrup Marianne , Bech Mickael , Lassen Annmarie Touborg , Mogensen Christian Backer , Bogh Søren Bie
Published: May 2023

Objectives

To describe the development of diagnostic imaging utilisation in Denmark from 2007 to 2017, coinciding with a major national reform of the emergency healthcare system.

Design

Nationwide descriptive register-based study.

Setting

All public hospitals in Denmark.

Participants

All unplanned hospital contacts ≥18 years old at somatic hospitals in Denmark from 1 January 2007 to 31 December 2017.

Primary and secondary outcome measures

The primary outcome measure was the probability of having CT, X-ray, MRI or ultrasound performed during hospitalisation in 2017 compared with 2007. The secondary outcome measure was receiving diagnostic imaging within 4 hours of hospitalisation.

Results

The probability of having a radiological examination during unplanned hospital admission increased from 2007 to 2017 (CT: 3.5%–10.3%; MRI: 0.2%–0.8%; ultrasound: 2.3%–4.5%; X-ray: 23.8%–26.8%). For CT scan, the adjusted OR was 3.09 (95% CI: 2.73, 3.51); for MRI, the adjusted OR was 3.39 (95% CI: 1.87, 6.12) and for ultrasound, the adjusted OR was 1.93 (95% CI: 1.56, 2.38). The likelihood of having the examination within the first 4 hours in the hospital increased from 2007 to 2017. For X-ray, the adjusted OR was 1.39 (95% CI: 1.07, 1.56); for CT scan, the adjusted OR was 1.35 (95% CI: 1.16, 1.59); for MRI, the adjusted OR was 1.34 (95% CI: 1.09, 1.66) and for ultrasound, the adjusted OR was 1.38 (95% CI: 1.16, 1.64).

Conclusion

This nationwide study describes the development of diagnostic imaging utilisation in Denmark from 2007 to 2017. The probability of receiving radiological examinations during unplanned hospitalisation increased over this period, and the time from hospital contact to performance decreased. This supports the notion that enhancement in radiological equipment will also lead to more frequent and faster utilisation.
Biopsy of Canada’s family physician shortage
Authors: Li Kaiyang , Frumkin Anna , Bi Wei Guang , Magrill Jamie , Newton Christie
Published: May 2023

Family physicians provide comprehensive care for the community and are an integral part of the healthcare system. Canada is experiencing a shortage of family physicians, driven in part by overbearing expectations of family physicians, limited support and resources, antiquated physician compensation, and high clinic operating costs. An additional factor contributing to this scarcity is the shortage of medical school and family medicine residency spots, which have not kept pace with population demand. We analysed and compared data on provincial populations and numbers of physicians, residency spots and medical school seats across Canada. Family physician shortages are the highest in the territories (>55%), Quebec (21.5%) and British Columbia (17.7%). Among the provinces, Ontario, Manitoba, Saskatchewan and British Columbia have the fewest family physicians per 100 000 persons in the population. Among the provinces that offer medical education, British Columbia and Ontario have the fewest medical school seats per population, while Quebec has the most. British Columbia has the smallest medical class size and the least number of family medicine residency spots as a function of population, and one of the highest percentages of provincial residents without family doctors. Paradoxically, Quebec has a relatively large medical class size and a high number of family medicine residency spots as a function of population, but also one of the highest percentages of provincial residents without family doctors. Possible strategies to improve the current shortage include encouraging Canadian medical students and international medical graduates to consider family medicine, and reducing administrative burdens for current physicians. Other steps include creating a national data framework, understanding physician needs to guide effective policy changes, increasing seats in medical schools and family residency programmes, providing financial incentives and facilitating entry into family medicine for international medical graduates.
Risk prediction score for clinical outcome in atrial fibrillation and stable coronary artery disease
Authors: Ishii Masanobu , Kaikita Koichi , Yasuda Satoshi , Akao Masaharu , Ako Junya , Matoba Tetsuya , Nakamura Masato , Miyauchi Katsumi , Hagiwara Nobuhisa , Kimura Kazuo , Hirayama Atsushi , Nishihara Eiichiro , Nakamura Shinichiro , Matsui Kunihiko , Ogawa Hisao , Tsujita Kenichi
Published: May 2023

Objective

Antithrombotic therapy is essential for patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) because of the high risk of thrombosis, whereas a combination of antiplatelets and anticoagulants is associated with a high risk of bleeding. We sought to develop and validate a machine-learning-based model to predict future adverse events.

Methods

Data from 2215 patients with AF and stable CAD enrolled in the Atrial Fibrillation and Ischaemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease trial were randomly assigned to the development and validation cohorts. Using the random survival forest (RSF) and Cox regression models, risk scores were developed for net adverse clinical events (NACE) defined as all-cause death, myocardial infarction, stroke or major bleeding.

Results

Using variables selected by the Boruta algorithm, RSF and Cox models demonstrated acceptable discrimination and calibration in the validation cohort. Using the variables weighted by HR (age, sex, body mass index, systolic blood pressure, alcohol consumption, creatinine clearance, heart failure, diabetes, antiplatelet use and AF type), an integer-based risk score for NACE was developed and classified patients into three risk groups: low (0–4 points), intermediate (5–8) and high (≥9). In both cohorts, the integer-based risk score performed well, with acceptable discrimination (area under the curve 0.70 and 0.66, respectively) and calibration (p>0.40 for both). Decision curve analysis showed the superior net benefits of the risk score.

Conclusions

This risk score can predict the risk of NACE in patients with AF and stable CAD.

Trial registration numbers

UMIN000016612,NCT02642419.
Impact of aortic valve replacement in symptomatic low-risk patients with less than severe aortic stenosis
Authors: Ito Saki , Laham Roger , Nkomo Vuyisile T , Forrest John K , Reardon Michael J , Little Stephen H , Mumtaz Mubashir , Gada Hemal , Bajwa Tanvir , Langholz David , Heiser John , Chawla Atul , Jenson Bart , Attizanni Guilherme , Markowitz Alan H , Huang Jian , Oh Jae K
Published: May 2023

Objective

To evaluate whether transcatheter or surgical aortic valve replacement (TAVR or SAVR) affects clinical and haemodynamic outcomes in symptomatic patients with moderately-severe aortic stenosis (AS).

Methods

Echocardiographic evidence of severe AS for enrolment in the Evolut Low Risk trial was based on site-reported measurements. For this post hoc analysis, core laboratory measurements identified patients with symptomatic moderately-severe AS (1.0<aortic valve area (AVA)<1.5 cm2, 3.0<peak velocity<4.0 m/s and 20≤mean gradient (MG) <40 mm Hg). Clinical outcomes were reported through 2 years.

Results

Moderately-severe AS was identified in 113 out of 1414 patients (8%). Baseline AVA was 1.1±0.1 cm2, peak velocity 3.7±0.2 m/s, MG 32.7±4.8 mm Hg and aortic valve calcium volume 588 (364, 815) mm3. Valve haemodynamics improved following TAVR (AVA 2.5±0.7 cm2, peak velocity 1.9±0.5 m/s and MG 8.4±4.8 mm Hg; p<0.001 for all) and SAVR (AVA 2.0±0.6 cm2, peak velocity 2.1±0.4 m/s and MG 10.0±3.4 mm Hg; p<0.001 for all). At 24 months, the rates of death or disabling stroke were similar (TAVR 7.7% vs SAVR 6.5%; p=0.82). Kansas City Cardiomyopathy Questionnaire overall summary score assessing quality of life improved from baseline to 30 days after TAVR (67.0±20.6 to 89.3±13.4; p<0.001) and SAVR (67.5±19.6 to 78.3±22.3; p=0.001).

Conclusions

In symptomatic patients with moderately-severe AS, AVR appears to be beneficial. Determination of the clinical and haemodynamic profile of patients who can benefit from earlier isolated AVR needs further investigation in randomised clinical trials.
DHOST gravity in ultra-diffuse galaxies—Part II: NGC 1052-DF4 and Dragonfly 44
Authors: Laudato Enrico , Salzano Vincenzo
Published: May 2023

Ultra-Diffuse galaxies are a family of gravitational systems with quite varied properties, counting both objects highly deficient in dark matter and others which are dark matter-dominated. Such a variety of behaviors might be a problem for both the standard dark matter paradigm and for alternative theories of gravity. Here we consider two systems, NGC1052-DF4 and Dragonfly 44, which are respectively dark matter deficient and dark matter dominated, in the context of Degenerate Higher-Order Scalar Tensor theories exhibiting a partial breaking of the Vaishtein screening mechanism for which they might have an influence not only on cosmological scales but also on astrophysical ones, thus mimicking dark matter. For NGC1052-DF4 the galaxy dynamics might be successfully described only by a stellar component and, at least at the scales which are probed, the content of dark matter is quite low. We also show that our alternative gravity model is consistent with data and is statistically equivalent to a standard General Relativity dark matter scenario, and it might even replace dark matter. On the contrary, Dragonfly 44 requires dark matter both in General Relativity and in our extended theory. When the latter is considered only as a cosmological dark energy fluid, it is statistically fully reliable and equivalent to General Relativity. But when we try to use it to substitute dark matter, although we get good fits to the data, the constraints on the theoretical parameters are in sharp contrast with those derived from more stringent probes from the stellar scales.
Adsorption of Heavy Metals on Bentonitic Soil for Use in Landfill Liners
Authors: da Silva Daniela Lima Machado , Boscov Maria Eugenia Gimenez , de Almeida Costa Marcela , dos Santos Laércio Leal , de Melo Márcio Camargo , Monteiro Veruschka Escarião Dessoles
Published: May 2023

Hazardous heavy metal ions such as copper, zinc, nickel, chromium, cadmium, and lead engender a potential risk to human health. Among the processes involved in the retention of these contaminants, adsorption is advantageous for removing toxic metals because of its environmentally friendly aspect, efficiency, and low-cost operation. Information on the adsorption of heavy metals in soils from the semiarid region of northeastern Brazil is still scarce. In this study, the adsorption of heavy metals (Cd, Cu, Zn, Ni, and Pb) by a semiarid Brazilian bentonitic soil is investigated. This soil has been used as a bottom liner in an experimental municipal solid waste (MSW) cell located in Campina Grande, State of Paraíba, Brazil. The experimental cell consists of a landfill unit on an experimental scale, with the same constructive elements of a sanitary landfill. Disturbed and undisturbed samples of the investigated soil were collected at a quarry in the rural zone of Boa Vista (state of Paraiba, Northeast Brazil). Sorption attributes were determined via batch tests with a soil-solution ratio of 1 : 12.5 (4 g of dry soil to 50 mL of solution). Linear, Freundlich, and Langmuir isotherms were fitted to the experimental data, using as fitting parameters Pearson correlation coefficient ([Formula: see text]) and [Formula: see text] value with a significance level [Formula: see text]. The ascending order of maximum adsorption capacity for heavy metals followed the series Ni < Cr < Zn < Cd < Cu < Pb. The maximum adsorbent capacities obtained were similar to those of other Brazilian soils and other adsorbents. Therefore, the studied soil has a high potential to be used in the retention of heavy metals.