bluuebunny/crossref_metadata_2025 huggingface dataset:
Hamartomatous polyp of the palatine tonsil: histological considerations and review of the literature
Authors: Goulioumis Anastasios , Gkorpa Magioula , Kekempanou Kyriaki , Kourelis Konstantinos
Published: May 2023

The hamartomatous polyp is a rare benign hamartoma of the palatine tonsil, usually encountered during the second decade of life. It may be reported under various terms in the literature, like lymphangioma of the tonsil, angiofibrolipoma, lymphangiomatous tonsillar polyp and lymphangiectatic fibrous polyp. Macroscopically, it appears as a large, pale, pedunculated mass. Typically, a hamartomatous polyp is asymptomatic or manifests mild symptoms, like foreign body sensation. It is not related to a generalised lymphatic malformation process. Despite its typical appearance, an excisional biopsy is necessary to rule out a malignancy. Histological findings are consistent with a squamous epithelial covering, a core of loose fibrous and adipose tissue with sparse lymphoid aggregations and dilated lymphatic channels filled with lymph and lymphocytes. Several embryologically based theories suggested its pathogenesis; however, recurrent tonsillitis does not play an established role. A typical tonsillectomy is suggested as a sufficient therapeutical approach with no tendency for recurrence.
Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ)
Authors: Duncan Polly , Murphy Mairead , Man Mei-See , Chaplin Katherine , Gaunt Daisy , Salisbury Chris
Published: May 2023

Objective

To develop and validate a new scale to assess treatment burden (the effort of looking after one’s health) for patients with multimorbidity.

Design

Mixed-methods.

Setting

UK primary care.

Participants

Content of the Multimorbidity Treatment Burden Questionnaire (MTBQ) was based on a literature review and views from a patient and public involvement group. Face validity was assessed through cognitive interviews. The scale was piloted and the final version was tested in 1546 adults with multimorbidity (mean age 71 years) who took part in the 3D Study, a cluster randomised controlled trial. For each question, we examined the proportion of missing data and the distribution of responses. Factor analysis, Cronbach’s alpha, Spearman’s rank correlations and longitudinal regression assessed dimensional structure, internal consistency reliability, construct validity and responsiveness, respectively. We assessed interpretability by grouping the global MTBQ scores into zero and tertiles (>0) and comparing participant characteristics across these categories.

Results

Cognitive interviews found good acceptability and content validity. Factor analysis supported a one-factor solution. Cronbach’s alpha was 0.83, indicating internal consistency reliability. The MTBQ score had a positive association with a comparator treatment burden scale (rs0.58, P<0.0001) and with self-reported disease burden (rs0.43, P<0.0001), and a negative association with quality of life (rs−0.36, P<0.0001) and self-rated health (rs−0.36, P<0.0001). Female participants, younger participants and participants with mental health conditions were more likely to have high treatment burden scores. Changes in MTBQ score over 9-month follow-up were associated, as expected, with changes in measures of quality of life (EuroQol five dimensions, five level questionnaire) and patient-centred care (Patient Assessment of Chronic Illness Care).

Conclusion

The MTBQ is a 10-item measure of treatment burden for patients with multimorbidity that has demonstrated good content validity, construct validity, reliability and responsiveness. It is a useful research tool for assessing the impact of interventions on treatment burden.

Trial registration number

NCT06180958.
Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics
Authors: Blæhr Emely Ek , Væggemose Ulla , Søgaard Rikke
Published: May 2023

Objectives

Fines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics.

Design, participants and setting

1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked.

Intervention

A fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system.

Main outcome measures

The main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance.

Results

All of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI –9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses.

Conclusions

At a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement.

Trial registration number

NCT61925912
Effectiveness of policy and risk targeting for opioid-related risk mitigation: a randomised programme evaluation with stepped-wedge design
Authors: Minegishi Taeko , Garrido Melissa M , Pizer Steven D , Frakt Austin B
Published: May 2023

Introduction

There is an epidemic of opioid use related to adverse events and deaths in the USA. The rates of chronic pain, mental illness and substance use disorder are higher at the Veterans Health Administration (VHA) compared with the general US population. The 2016 Comprehensive Addiction and Recovery Act requires the VHA to improve opioid therapy strategies in treating patients and to ensure responsible prescribing practices. The Stratification Tool for Opioid Risk Mitigation (STORM) is a web-based dashboard that prioritises review of VHA patients receiving opioids based on their risk. The VHA Partnered Evidence-based Policy Resource Center is coordinating a multiyear evaluation of STORM and aspects of the VHA policy that mandate case review of patients identified by STORM as very high risk.

Methods and analysis

This stepped-wedge cluster randomised controlled trial will test two hypotheses: (1) VHA medical centres randomised to facilitation for not meeting the targeted case review rate will achieve lower opioid-related serious adverse events (SAEs), relative to facilities not randomised to facilitation and (2) Patients whose cases are required to be reviewed will have a lower rate of opioid-related SAEs compared with comparable risk patients whose cases are not required to be reviewed. Patients who receive an opioid prescription at VHA medical centres will be followed for a minimum of 3 months after their first opioid prescription. Follow-up will continue until the last day of the project or death. The data will be analysed using an intention-to-treat approach with patient-month-level Cox proportional hazards models for both interventions.

Ethics and dissemination

Evaluation of the randomised roll-out was approved by the VA Boston Healthcare System Institutional Review Board (IRB) and Research & Development Committees (Protocol # 3069). Findings will be published in peer-reviewed journals and presentations at national conference meetings.

Trial registration number

NCT16012111
What is usual care for teenagers expecting their first child in England? A process evaluation using key informant mapping and participant survey as part of the Building Blocks randomised controlled trial of specialist home visiting
Authors: Robling Michael , Cannings-John Rebecca , Channon Sue , Hood Kerenza , Moody Gwen , Poole Ria , Sanders Julia
Published: May 2023

Objectives

We compared the US-derived Family Nurse Partnership (FNP) home visiting programme when added to usually provided health and social care for first-time teenage mothers, to usual care alone. We aimed to: establish the nature of usual care, measure service usage and assess performance bias in core usual care services.

Design

Within trial process evaluation. Local professionals completed a survey mapping local health and social care services in seven domains. This focused on services available to young women, especially those relevant to pregnant teenagers. Descriptive data were assessed thematically to establish the range of services. Quantitative data collection with FNP supervisors enumerated service provision by site. Services identified were included in main participant trial follow-up interviews at four time points to quantify usage. Usage was described descriptively by domain. We explored predictors of health visitor visits.

Setting

18 partnerships of local authority and healthcare organisations in England.

Outcomes

Descriptive framework of services. Rates of service usage reported by trial participants.

Results

161 separate services were identified, with multiple service models in each domain, broadly categorised as universal or specialist (eg, for teenage mothers). FNP supervisors identified 30–63 universal services per site and 22–67 specialist services. Use of core maternity care services was similar across trial arms and with only small differences in use of health visiting services. Participants accessed a wide range of services. Women who had ever been homeless, who had a higher subjectively defined social status, and poorer mental health received more visits from a health visitor.

Conclusions

The large number of services available to teenage mothers in England may limit the incremental benefit achievable through enhanced home visiting. There was little evidence of compensatory practice, such as additional care for women in the usual care arm. Measuring usual care when trialling complex interventions is challenging and essential.

Trial registration number

NCT23019866.
Acupuncture as prophylaxis for chronic migraine: a protocol for a single-blinded, double-dummy randomised controlled trial
Authors: Liu Lu , Zhao Luo-peng , Zhang Claire Shuiqing , Zeng Lin , Wang Kelun , Zhao Jingxia , Wang Linpeng , Jing Xianghong , Li Bin
Published: May 2023

Introduction

Approximately 1.4%–2.2% of the global population suffers from chronic migraine. Acupuncture may serve as an alternative management for chronic migraine, where pharmacological prophylaxis is not suitable. However, the effects of acupuncture as migraine prophylaxis have not been confirmed. This study is designed as a single-blinded, double-dummy randomised controlled trial to evaluate the efficacy and safety of acupuncture compared with topiramate in patients with chronic migraine.

Methods and analysis

A total of 60 participants will be randomly assigned to two different groups. Participants will receive verum acupuncture and placebo medicine in the treatment group, while participants in the control group will be treated with sham acupuncture and real medicine (topiramate). All participants will receive a 12-week treatment and then be followed up for another 12 weeks. The primary outcome is the reduction of monthly headache days, and the secondary outcomes include the reduction of the number of days with acute headache medications, and changes of Migraine Disability Assessment, Migraine-Specific Quality of Life Questionnaire, Headache Impact Test, State-Trait Anxiety Inventory-trait, and Beck Depression Inventory-II scores from baseline to endpoints.

Ethics and dissemination

Ethical approval of this study was granted by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University (2017BL-045-01). Written informed consent will be obtained from all participants. Outcomes of the trial will be disseminated through peer-reviewed publications.

Trial registration number

NCT13563102.
Antiplatelet therapy in the primary prevention of cardiovascular disease in patients with chronic obstructive pulmonary disease: protocol of a randomised controlled proof-of-concept trial (APPLE COPD-ICON 2)
Authors: Kunadian Vijay , Chan Danny , Ali Hani , Wilkinson Nina , Howe Nicola , McColl Elaine , Thornton Jared , von Wilamowitz-Moellendorff Alexander , Holstein Eva-Maria , Burns Graham , Fisher Andrew , Stocken Deborah , De Soyza Anthony
Published: May 2023

Introduction

The antiplatelet therapy in the primary prevention of cardiovascular disease in patients with chronic obstructive pulmonary disease (APPLE COPD-ICON2) trial is a prospective 2×2 factorial, double-blinded proof-of-concept randomised controlled trial targeting patients with chronic obstructive pulmonary disease (COPD) at high risk of cardiovascular disease. The primary goal of this trial is to investigate if treatment with antiplatelet therapy will produce the required response in platelet function measured using the Multiplate test in patients with COPD.

Methods and analysis

Patients with COPD are screened for eligibility using inclusion and exclusion criteria. Eligible patients are randomised and allocated into one of four groups to receive aspirin plus placebo, ticagrelor plus placebo, aspirin plus ticagrelor or placebo only. Markers of systemic inflammation, platelet reactivity, arterial stiffness, carotid intima-media thickness (CIMT), lung function and quality of life questionnaires are assessed. The primary outcome consists of inhibition (binary response) of aspirin and ADP-induced platelet function at 6 months. Secondary outcomes include changes in inflammatory markers, CIMT, non-invasive measures of vascular stiffness, quality of life using questionnaires (EuroQol–five dimensions–five levels of perceived problems (EQ5D-5L), St. George’s COPD questionnaire) and to record occurrence of repeat hospitalisation, angina, myocardial infarction or death from baseline to 6 months. Safety outcomes will be rates of major and minor bleeding, forced expiratory volume in 1 s, forced vital capacity and Medical Research Council dyspnoea scale.

Ethics and dissemination

The study was approved by the North East-Tyne and Wear South Research Ethics Committee (15/NE/0155). Findings of the study will be presented in scientific sessions and published in peer-reviewed journals.

Trial registration number

NCT43245574.
Endoscopic sphincterotoMy for delayIng choLecystectomy in mild acute biliarY pancreatitis (EMILY study): protocol of a multicentre randomised clinical trial
Authors: Kucserik Levente Pál , Márta Katalin , Vincze Áron , Lázár György , Czakó László , Szentkereszty Zsolt , Papp Mária , Palatka Károly , Izbéki Ferenc , Altorjay Áron , Török Imola , Barbu Sorin , Tantau Marcel , Vereczkei András , Bogár Lajos , Dénes Márton , Németh Imola , Szentesi Andrea , Zádori Noémi , Antal Judit , Lerch Markus M , Neoptolemos John , Sahin-Tóth Miklós , Petersen Ole H , Kelemen Dezső , Hegyi Péter
Published: May 2023

Introduction

According to the literature, early cholecystectomy is necessary to avoid complications related to gallstones after an initial episode of acute biliary pancreatitis (ABP). A randomised, controlled multicentre trial (the PONCHO trial) revealed that in the case of gallstone-induced pancreatitis, early cholecystectomy was safe in patients with mild gallstone pancreatitis and reduced the risk of recurrent gallstone-related complications, as compared with interval cholecystectomy. We hypothesise that carrying out a sphincterotomy (ES) allows us to delay cholecystectomy, thus making it logistically easier to perform and potentially increasing the efficacy and safety of the procedure.

Methods/Design

EMILY is a prospective, randomised, controlled multicentre trial. All patients with mild ABP, who underwent ES during the index admission or in the medical history will be informed to take part in EMILY study. The patients will be randomised into two groups: (1) early cholecystectomy (within 6 days after discharge) and (2) patients with delayed (interval) cholecystectomy (between 45 and 60 days after discharge). During a 12-month period, 93 patients will be enrolled from participating clinics. The primary endpoint is a composite endpoint of mortality and recurrent acute biliary events (that is, recurrent ABP, acute cholecystitis, uncomplicated biliary colic and cholangitis). The secondary endpoints are organ failure, biliary leakage, technical difficulty of the cholecystectomy, surgical and other complications.

Ethics and dissemination

The trial has been registered internationallyNCT10667869, and approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (EKU/2018/12176–5).

Trial registration number

NCT10667869; Pre-results.
Patient acceptability of three different central venous access devices for the delivery of systemic anticancer therapy: a qualitative study
Authors: Ryan Caoimhe , Hesselgreaves Hannah , Wu Olivia , Moss Jonathan , Paul James , Dixon-Hughes Judith , Germeni Evi
Published: May 2023

Objective

Three types of central venous access devices (CVADs) are routinely used in the delivery of intravenous systemic anticancer therapy (SACT): peripherally inserted central catheters (PICCs), subcutaneously tunnelled central catheters (Hickman-type devices) and totally implantable chest wall ports (Ports). This qualitative study, nested within a multicentre, randomised controlled trial, sought to explore patient acceptability and experiences of the three devices.

Design

Eight focus groups were audio-recorded, transcribed and thematically analysed.

Setting

Six outpatient cancer treatment centres in the UK.

Participants

Forty-two patients (20 female, mean age 61.7 years) who had taken part or were taking part in the broader trial.

Intervention

As part of the larger, randomised controlled trial, participants had been randomly assigned one of three CVADs for the administration of SACT.

Results

Attitudes towards all three devices were positive, with patients viewing their CVAD as part of their treatment and recovery. Participants with PICCs and Hickmans tended to compare their device favourably with peripheral cannulation. By comparison, participants with Ports consistently compared their device with PICCs and Hickmans, emphasising the perceived superiority of Ports. Ports were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships.

Conclusions

Patient experiences and preferences have not been systematically used to inform policy and practice regarding CVAD availability and selection. Our research identified patterns of patient device preferences that favoured Ports, although this was not universal. Results of this study could improve support for patients and offer greater scope for incorporating patient perspectives into decision-making processes.

Trial registration number

NCT44504648
Testing a support programme for opioid reduction for people with chronic non-malignant pain: the I-WOTCH randomised controlled trial protocol
Authors: Sandhu Harbinder K , Abraham Charles , Alleyne Sharisse , Balasubramanian Shyam , Betteley Lauren , Booth Katie , Carnes Dawn , Furlan Andrea D , Haywood Kirstie , Iglesias Urrutia Cynthia Paola , Lall Ranjit , Manca Andrea , Mistry Dipesh , Nichols Vivien P , Noyes Jennifer , Rahman Anisur , Seers Kate , Shaw Jane , Tang Nicole K Y , Taylor Stephanie , Tysall Colin , Underwood Martin , Withers Emma J , Eldabe Sam
Published: May 2023

Introduction

Chronic non-malignant pain has a major impact on the well-being, mood and productivity of those affected. Opioids are increasingly prescribed to manage this type of pain, but with a risk of other disabling symptoms, when their effectiveness has been questioned. This trial is designed to implement and evaluate a patient-centred intervention targeting withdrawal of strong opioids in people with chronic pain.

Methods and analysis

A pragmatic, multicentre, randomised controlled trial will assess the clinical and cost-effectiveness of a group-based multicomponent intervention combined with individualised clinical facilitator led support for the management of chronic non-malignant pain against the control intervention (self-help booklet and relaxation compact disc). An embedded process evaluation will examine fidelity of delivery and investigate experiences of the intervention. The two primary outcomes are activities of daily living (measured by Patient-Reported Outcomes Measurement Information System Pain Interference Short Form (8A)) and opioid use. The secondary outcomes are pain severity, quality of life, sleep quality, self-efficacy, adverse events and National Health Service (NHS) healthcare resource use. Participants are followed up at 4, 8 and 12 months, with a primary endpoint of 12 months. Between-group differences will indicate effectiveness; we are looking for a difference of 3.5 points on our pain interference outcome (scale 40 to 77). We will undertake an NHS perspective cost-effectiveness analysis using quality adjusted life years.

Ethics and dissemination

Full approval was given by Yorkshire & The Humber - South Yorkshire Research Ethics Committee on 13 September, 2016 (16/YH/0325). Appropriate local approvals were sought for each area in which recruitment was undertaken. The current protocol version is 1.6 date 19 December 2018. Publication of results in peer- reviewed journals will inform the scientific and clinical community. We will disseminate results to patient participants and study facilitators in a study newsletter as well as a lay summary of results on the study website.

Trial registration number

ISRCTN49470934
; Pre-results.
Clinical and economic impact of a community-based, hybrid model of in-person and virtual care in a Canadian rural setting: a cross-sectional population-based comparative study
Authors: Fitzsimon Jonathan P , Belanger Christopher , Glazier Richard H , Green Michael , Peixoto Cayden , Mahdavi Roshanak , Plumptre Lesley , Bjerre Lise M
Published: May 2023

Objectives

To determine the clinical and economic impact of a community-based, hybrid model of in-person and virtual care by comparing health-system performance of the rural jurisdiction where this model was implemented with neighbouring jurisdictions without such a model and the broader regional health system.

Design

A cross-sectional comparative study.

Setting

Ontario, Canada, with a focus on three largely rural public health units from 1 April 2018 until 31 March 2021.

Participants

All residents of Ontario, Canada under the age of 105 eligible for the Ontario Health Insurance Plan during the study period.

Interventions

An innovative, community-based, hybrid model of in-person and virtual care, the Virtual Triage and Assessment Centre (VTAC), was implemented in Renfrew County, Ontario on 27 March 2020.

Main outcome measures

Primary outcome was a change in emergency department (ED) visits anywhere in Ontario, secondary outcomes included changes in hospitalisations and health-system costs, using per cent changes in mean monthly values of linked health-system administrative data for 2 years preimplementation and 1 year postimplementation.

Results

Renfrew County saw larger declines in ED visits (−34.4%, 95% CI −41.9% to −26.0%) and hospitalisations (−11.1%, 95% CI −19.7% to −1.5%) and slower growth in health-system costs than other rural regions studied. VTAC patients’ low-acuity ED visits decreased by −32.9%, high-acuity visits increased by 8.2%, and hospitalisations increased by 30.0%.

Conclusion

After implementing VTAC, Renfrew County saw reduced ED visits and hospitalisations and slower health-system cost growth compared with neighbouring rural jurisdictions. VTAC patients experienced reduced unnecessary ED visits and increased appropriate care. Community-based, hybrid models of in-person and virtual care may reduce the burden on emergency and hospital services in rural, remote and underserved regions. Further study is required to evaluate potential for scale and spread.
Protocol for developing a personalised prediction model for viral suppression among under-represented populations in the context of the COVID-19 pandemic
Authors: Zhang Jiajia , Yang Xueying , Weissman Sharon , Li Xiaoming , Olatosi Bankole
Published: May 2023

Introduction

Sustained viral suppression, an indicator of long-term treatment success and mortality reduction, is one of four strategic areas of the ‘Ending the HIV Epidemic’ federal campaign launched in 2019. Under-represented populations, like racial or ethnic minority populations, sexual and gender minority groups, and socioeconomically disadvantaged populations, are disproportionately affected by HIV and experience a more striking virological failure. The COVID-19 pandemic might magnify the risk of incomplete viral suppression among under-represented people living with HIV (PLWH) due to interruptions in healthcare access and other worsened socioeconomic and environmental conditions. However, biomedical research rarely includes under-represented populations, resulting in biased algorithms. This proposal targets a broadly defined under-represented HIV population. It aims to develop a personalised viral suppression prediction model using machine learning (ML) techniques by incorporating multilevel factors using All of Us (AoU) data.

Methods and analysis

This cohort study will use data from the AoU research programme, which aims to recruit a broad, diverse group of US populations historically under-represented in biomedical research. The programme harmonises data from multiple sources on an ongoing basis. It has recruited ~4800 PLWH with a series of self-reported survey data (eg, Lifestyle, Healthcare Access, COVID-19 Participant Experience) and relevant longitudinal electronic health records data. We will examine the change in viral suppression and develop personalised viral suppression prediction due to the impact of the COVID-19 pandemic using ML techniques, such as tree-based classifiers (classification and regression trees, random forest, decision tree and eXtreme Gradient Boosting), support vector machine, naïve Bayes and long short-term memory.

Ethics and dissemination

The institutional review board approved the study at the University of South Carolina (Pro00124806) as a Non-Human Subject study. Findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media.
Effect of multicomponent interventions on tuberculosis notification in mining and pastoralist districts of Oromia region in Ethiopia: a longitudinal quasi-experimental study
Authors: de Groot Liza Marlette , Dememew Zewdu Gashu , Hiruy Nebiyu , Datiko Daniel Gemechu , Gebreyes Solomon Negash , Suarez Pedro G , Jerene Degu
Published: May 2023

Objective

To demonstrate the impact of interventions on tuberculosis (TB) case detection in mining and pastoralist districts in southeastern Ethiopia over a 10-year period.

Design

Longitudinal quasi-experimental study.

Setting

Health centres and hospitals in six mining districts implemented interventions and seven nearby districts functioned as controls.

Participants

Data from the national District Health Information System (DHIS-2) were used for this study; therefore, people did not participate in this study.

Interventions

Directed at training, active case finding and improving treatment outcomes.

Primary and secondary outcome measures

Primarily, trends in TB case notification and percentage of bacteriologically confirmed TB—as collected by DHIS-2—between pre-intervention (2012–2015) and post-intervention (2016–2021) were analysed. Secondarily, post-intervention was split into early post-intervention (2016–2018) and late post-intervention (2019–2021) to also study the long-term effects of the intervention.

Results

For all forms of TB, case notification significantly increased between pre-intervention and early post-intervention (incidence rate ratio (IRR): 1.21, 95% CI: 1.13, 1.31; p<0.001) and significantly decreased between pre-intervention/early post-intervention and late post-intervention (IRR: 0.82, 95% CI: 0.76, 0.89; p<0.001 and IRR: 0.67, 95% CI: 0.62, 0.73; p<0.001). For bacteriologically confirmed cases, we found a significant decrease between pre-intervention/early post-intervention and late post-intervention (IRR: 0.88, 95% CI: 0.81, 0.97; p<0.001 and IRR: 0.81, 95% CI: 0.74, 0.89; p<0.001). The percentage of bacteriologically confirmed cases was significantly lower in the intervention districts during pre-intervention (B: −14.24 percentage points, 95% CI: –19.27, –9.21) and early post-intervention (B: −7.78, 95% CI: –15.46, –0.010; p=0.047). From early post-intervention to late post-intervention, we found a significant increase (B: 9.12, 95% CI: 0.92 to 17.33; p=0.032).

Conclusions

The decrease in TB notifications in intervention districts during late post-intervention is possibly due to a decline in actual TB burden as a result of the interventions. The unabated increase in case notification in control districts may be due to continued TB transmission in the community.
Trends in psychological distress in Great Britain, 1991–2019: evidence from three representative surveys
Authors: Zhang Anwen , Gagné Thierry , Walsh David , Ciancio Alberto , Proto Eugenio , McCartney Gerry
Published: May 2023

Background

Previously improving UK mortality trends stalled around 2012, with evidence implicating economic policy as the cause. This paper examines whether trends in psychological distress across three population surveys show similar trends.

Methods

We report the percentages reporting psychological distress (4+ in the 12-item General Health Questionnaire) from Understanding Society (Great Britain, 1991–2019), Scottish Health Survey (SHeS, 1995–2019) and Health Survey for England (HSE, 2003–2018) for the population overall, and stratified by sex, age and area deprivation. Summary inequality indices were calculated and segmented regressions fitted to identify breakpoints after 2010.

Results

Psychological distress was higher in Understanding Society than in SHeS or HSE. There was slight improvement between 1992 and 2015 in Understanding Society (with prevalence declining from 20.6% to 18.6%) with some fluctuations. After 2015 there is some evidence of a worsening in psychological distress across surveys. Prevalence worsened notably among those aged 16–34 years after 2010 (all three surveys), and aged 35–64 years in Understanding Society and SHeS after 2015. In contrast, the prevalence declined in those aged 65+ years in Understanding Society after around 2008, with less clear trends in the other surveys. The prevalence was around twice as high in the most deprived compared with the least deprived areas, and higher in women, with trends by deprivation and sex similar to the populations overall.

Conclusion

Psychological distress worsened among working-age adults after around 2015 across British population surveys, mirroring the mortality trends. This indicates a widespread mental health crisis that predates the COVID-19 pandemic.
Revisiting the comparison between healthcare strikes and just war
Authors: Brunning Luke
Published: May 2023

In the UK, healthcare workers are again considering whether to strike, and the moral status of strike action is being publicly debated. Mpho Selemogo argued that we can think productively about the ethical status of healthcare strikes by using the ethical framework often applied to armed conflict (2014). On this view, strikes need to be just, proportionate, likely to succeed, a last resort, pursued by a legitimate organisation and publicly communicated. In this article, I argue for a different approach to the just war comparison. Selemogo adopts a traditional, collectivist conception of just war reasoning but this is not the only view. So-called ‘individualist’ approaches to the morality of war can also be applied to strike action. Taking an individualist perspective complicates the traditional picture of a dispute arising between three well-defined groups of healthcare workers, employers and the innocent subjects of collateral damage: patients and the public. We arrive instead at a more complicated moral picture: some people might be more morally liable to be harmed than others during a strike, or can justly bear increased risks, and some are more obliged to strike than others. I describe this shift of framework before critically examining some of the traditionaljus ad bellumconditions as applied to strikes.
Hydrological and nutrient regulation per occupation unit differ between structurally contrasting native and planted forests in the Northern Andes
Authors: León-Peláez Juan Diego , Villegas Juan Camilo , Amador-Pérez Jorge Alejandro , Suescún Diego
Published: May 2023

Understanding ecohydrological dynamics that result from land-use conversions is fundamental in managing ecosystem services. One common forest transformation in the tropics is the establishment of monospecific plantations with exotic species for timber exploitation, replacing highly diverse natural forests. The impacts of establishing forest plantations in hydrological processes and biogeochemical dynamics have been highly controversial, with functions from structurally homogeneous plantations being sometimes assumed to be comparable to natural forests. To assess the effects of planting exotic conifer species versus natural forests on hydrological and biogeochemical functions, we measured incoming precipitation, throughfall, and stemflow. To compare between forest types, we propose the use of basal area for standardization of hydrochemical fluxes. While net precipitation was similar among forest types, the transmission of water to the forest floor per basal area unit was significantly higher in native forests. Yet, nutrient concentrations were similar among them. However, greater nutrient enrichment per unit basal area was observed for the native species. This more efficient nutrient cycling could be related to native forests being better adapted to oligotrophic soils. The re-establishment of native species rather than with exotic species can result in more efficient hydrochemical regulation, improving the capacity of these ecosystems to produce services.
Dark matter and neutrino masses in a Portalino-like model
Authors: Hepburn Dugald , West Stephen M.
Published: May 2023

We explore a Portalino-like model of dark matter and neutrino masses in which right-handed neutrino fields connect gauge neutral operators from the Standard Model and Hidden Sector. Neutrino masses are generated via a seesaw-like mechanism that can explain the light active neutrino masses. The model includes a “Portalino” state that connects the two sectors via the neutrino portal. Dark Matter in this model consists of a hidden sector Dirac fermion that dominantly freezes-out via resonant annihilations into other hidden sector states, which ultimately results in a population of Portalinos. Due to small mixing in the extended neutrino sector these Portalinos tend to be cosmologically long lived, decaying into Standard Model particles leading to constraints on the model from Big Bang Nucleosynthesis and measurements of the Cosmic Microwave Background radiation. Combining these limits with direct constraints on the size of the Portalino–neutrino mixing and the assumptions of the model the viable mass ranges for the Portalino states are found to be $${0.02}~\hbox {eV}\lesssim m_n \lesssim {6.4}~\hbox {eV}$$

0.02

eV
≲

m
n

≲

6.4

eV

or $${489}~{\hbox {MeV}} \lesssim m_n \lesssim $$

489

MeV
≲

m
n

≲

 TeV. Indirect dark matter signals in the form of highly boosted, mono-energetic Portalinos produced in Dark Matter annihilations provide a target for neutrino telescopes.
Dirty black hole supported by a uniform electric field in Einstein-nonlinear electrodynamics-Dilaton theory
Authors: Mazharimousavi S. Habib
Published: May 2023

In this study, we present an exact dirty/hairy black hole solution in the context of gravity coupled minimally to a nonlinear electrodynamic (NED) and a Dilaton field. The NED model is known in the literature as the square-root (SR) model i.e.,$${\mathcal {L}}\sim \sqrt{-{\mathcal {F}}}.$$L∼-F.The black hole solution which is supported by a uniform radial electric field and a singular Dilaton scalar field is non-asymptotically flat and singular with the singularity located at its center. An appropriate transformation results in an interesting line element$$ds^{2}=-\left( 1-\frac{2\,M}{\rho ^{\eta ^{2}}} \right) \rho ^{2\left( \eta ^{2}-1\right) }d\tau ^{2}+\left( 1-\frac{2\,M}{ \rho ^{\eta ^{2}}}\right) ^{-1}d\rho ^{2}+\varkappa ^{2}\rho ^{2}d\Omega ^{2} $$ds2=-1-2Mρη2ρ2η2-1dτ2+1-2Mρη2-1dρ2+ϰ2ρ2dΩ2with two parameters – namely the massMand the Dilaton parameter$$\eta ^{2}>1$$η2>1($$\varkappa ^{2}=\frac{1}{\eta ^{2}}$$ϰ2=1η2) – which may be simply considered as the dirty Schwarzschild black hole. This is because with$$\eta ^{2}\rightarrow 1$$η2→1the spacetime reduces to the Schwarzschild black hole. We show that although the causal structure of the above spacetime is similar to the Schwarzschild black hole, it is thermally stable for$$\eta ^{2}>2$$η2>2. Furthermore, the tidal force of this black hole behaves the same as a Schwarzschild black hole, however, its magnitude depends on$$\eta ^{2}$$η2such that its minimum is not corresponding to$$\eta ^{2}=1$$η2=1(Schwarzschild limit).
Thermal fluctuations, quasi-normal modes and phase transition of the charged AdS black hole with perfect fluid dark matter
Authors: Abbas G. , Ali R. H.
Published: May 2023

In this paper, we study thermodynamics, thermal fluctuations, phase transitions and the charged anti-de Sitter black hole surrounded by perfect fluid dark matter. Large black holes are shown to be stable when subject to thermal fluctuations, and we begin by exploring how these fluctuations affect the uncorrected thermodynamic quantities of entropy, Helmholtz free energy, Gibbs free energy, enthalpy specific heat, and phase transition stability. We also discuss null geodesics and the radius of the photon sphere for the charged AdS BH and use the radius of a photon sphere to calculate the Lyapunov exponent and angular velocity. Exceptionally, we test the effects of various parameters of a black hole graphically by observing the existence of the correction parameter and the coupling parameter, which reveal the behavior of corrected thermodynamic quantities. Lastly, we see how the system is stable (under the effects of the dark matter parameter) by figuring out the specific heat and Hawking temperature, which are both related to entropy.
Open string pair production from the interacting dressed-angled D-strings
Authors: Daniali Hamidreza , Kamani Davoud
Published: May 2023

We calculate the rate of the open string pair production from the interaction of two non-intersecting D-strings at angle. The D-strings have been equipped with the U(1) gauge potentials in the presence of the Kalb–Ramond field. This rate will be discussed when the D-strings intersect each other. Our computations is in the framework of the bosonic string theory.
Digital traces of brain drain: developers during the Russian invasion of Ukraine
Authors: Wachs Johannes
Published: May 2023

The Russian invasion of Ukraine has caused large scale destruction, significant loss of life, and the displacement of millions of people. Besides those fleeing direct conflict in Ukraine, many individuals in Russia are also thought to have moved to third countries. In particular the exodus of skilled human capital, sometimes called brain drain, out of Russia may have a significant effect on the course of the war and the Russian economy in the long run. Yet quantifying brain drain, especially during crisis situations is generally difficult. This hinders our ability to understand its drivers and to anticipate its consequences. To address this gap, I draw on and extend a large scale dataset of the locations of highly active software developers collected in February 2021, one year before the invasion. Revisiting those developers that had been located in Russia in 2021, I confirm an ongoing exodus of developers from Russia in snapshots taken in June and November 2022. By November 11.1% of Russian developers list a new country, compared with 2.8% of developers from comparable countries in the region but not directly involved in the conflict. 13.2% of Russian developers have obscured their location (vs. 2.4% in the comparison set). Developers leaving Russia were significantly more active and central in the collaboration network than those who remain. This suggests that many of the most important developers have already left Russia. In some receiving countries the number of arrivals is significant: I estimate an increase in the number of local software developers of 42% in Armenia, 60% in Cyprus and 94% in Georgia.
A cellular automata model for car–truck heterogeneous traffic flow considering drivers’ risky driving behaviors
Authors: Baikejuli Muladilijiang , Shi Jing
Published: May 2023

Driving behavior is the core of traffic simulation modeling. Despite the sizable efforts to investigate the influence of risky driving behavior on traffic flow, very little is known about its influence under car–truck heterogeneous traffic conditions. Therefore, this study aims to analyze the influence of several common risky driving behaviors on car–truck heterogeneous traffic flow. A two-lane cellular automata (CA) model for heterogeneous traffic flow consisting of cars and trucks was proposed, the conditions for the occurrence of dangerous situations (DSs) and traffic congestion were defined. Then the vehicle performance under the influence of risky driving behaviors prevalent in car–truck heterogeneous traffic was obtained and incorporated into the proposed CA model to measure their influence on crash probabilities and congestion rates. The simulation results indicate that risky driving behaviors have a significant negative influence on traffic safety and efficiency, increasing the frequencies of DSs, reducing the traffic flow and aggravating the traffic congestion. In addition, the combinations of risky driving behaviors in traffic flow further deteriorate the traffic safety and efficiency. For example, when two risky driving behaviors, such as distracted driving and aggressive lane-changing, affect the traffic flow simultaneously, the frequencies of DSs increase dramatically and in some density ranges, they are even higher than the sum of the frequencies caused by two single risky driving behaviors. These findings may have notable practical implications in developing policies and regulations that enable truck operations without compromising safety and efficiency.
Sutterby hybrid nanofluid flow and heat transfer over a nonlinearly expanding sheet with convective boundary condition and zero-mass flux concentration
Authors: Basha N. Z. , Rajashekhar C. , Mebarek-Oudina F. , Prasad K. V. , Vaidya H. , Guedri Kamel , Boudjemline Attia , Mansouri Rami , Taieb Ahmed
Published: May 2023

This paper examines the impacts of a nonlinearly expanding sheet on velocity, heat and mass transport for a Suttery hybrid nanoliquid (mixture of Sutterby fluid and [Formula: see text] and [Formula: see text]. The zero-mass flux concentration and convective boundary conditions are considered. Nondimensionalization of governing equations may be achieved through similarity conversions. The governing equations are solved utilizing the Optimal Homotopy Analysis Method. Graphs and tables were used to document the effects of different variables. The numerical values for skin friction, Sherwood number and Nusselt number are provided in a table for diverse relevant factors. Comparisons were made to a previous study’s findings. The results obtained are in agreement with the findings of the prior study. The outcome is that the occurrence of hybrid nanoparticles ([Formula: see text] and [Formula: see text] in ethylene glycol liquid enhances its thermal conductivity thereby increasing the thermal boundary layer thickness. The presence of hybrid nanoparticles ([Formula: see text] and [Formula: see text] in ethylene glycol liquid also increases the momentum boundary layer thickness.
ELECTROCHEMICAL ARC DRILLING OF NICKEL–TITANIUM SHAPE MEMORY ALLOY USING MOLYBDENUM ELECTRODE: INVESTIGATION, MODELING AND OPTIMIZATION
Authors: KUMAR NITISH , KUMAR AMARESH , DAS SUDHANSU RANJAN
Published: May 2023

In the present scenario, electrochemical arc machining (ECAM) (hybrid of electric discharge erosion and electrochemical dissolution) is an evolving procedure for difficulty in machining the materials due to constraints of existing processes. This research aims to investigate the machinability of Ni[Formula: see text]Ti alloy through electrochemical arc drilling using molybdenum electrode. Electrolyte concentration (ethanol with ethylene glycol and sodium chloride), supply voltage, and tool rotation are considered as the variable factors to evaluate the ECAM performance characteristics in drilling blind hole operation concerning overcut (OC), tool wear rate (TWR) and materials removal rate (MRR). Consequently, response surface methodology is implemented for predictive modeling of various performance characteristics. Finally, multi-objective optimization through desirability function approach (DFA) has produced a set of optimal parameters to improve the productivity along with the accuracy, which is the prime requirement for the industrial applicability of the ECAM process. Results demonstrated that supply voltage is the influential key factor for improvement of machining rate. Scanning electron microscope (SEM) photographs revealed the development of heat affected zone (HAZ), white layer, melted droplet, craters, re-solidified material, ridge-rich surface and voids as well as cavities around the end-boundary surfaces of a blind hole. Composition analysis through energy dispersive spectroscopy (EDS) indicated the oxygen content on the machined surface because electrolyte breakdown causes oxidation to take place at elevated temperatures across the machining zone. Moreover, carbide precipitation like TiC was found in the melting zone of the drilled hole, as revealed by X-ray diffraction (XRD) analyses, which has the affinity to reduce the SMA properties in HAZ.
Traffic Control: Subversion of Plant Membrane Trafficking by Pathogens
Authors: Yuen Enoch Lok Him , Shepherd Samuel , Bozkurt Tolga O.
Published: May 2023

Membrane trafficking pathways play a prominent role in plant immunity. The endomembrane transport system coordinates membrane-bound cellular organelles to ensure that immunological components are utilized effectively during pathogen resistance. Adapted pathogens and pests have evolved to interfere with aspects of membrane transport systems to subvert plant immunity. To do this, they secrete virulence factors known as effectors, many of which converge on host membrane trafficking routes. The emerging paradigm is that effectors redundantly target every step of membrane trafficking from vesicle budding to trafficking and membrane fusion. In this review, we focus on the mechanisms adopted by plant pathogens to reprogram host plant vesicle trafficking, providing examples of effector-targeted transport pathways and highlighting key questions for the field to answer moving forward.