bluuebunny/crossref_metadata_2025 huggingface dataset:
P435 THE IMPORTANCE OF CORRELATION BETWEEN HEART FAILURE AND THYROID: A CASE REPORT
Authors: Falco O , Taras S , Maninchedda P , Cambule S , Atzori M
Published: May 2023

A 39–year–old African man was admitted to our department within a four days symptoms of short of breath, cough, tachycardia and lower limb edema. He also complained headache for about a month. He denied fever, chest pain and loss of consciousness. Clinical and family history were unremarkable. Blood tests showed moderate microcytic anemia ( Hb 9.6 g/dl, MCV 93.3 fL), hypoalbuminemia ( Albumin: 3.20 g/dl), elevated levels of LDH ( LDH: 246 U/L), mild C–reactive protein (CRP) and pro–Brain Natriuretic Peptide (pro–BNP) increase (CRP: 1.14 mg/dl); (PRO–BNP: 1133 pg/mL) and negative troponin. Given the clinical picture suggestive of heart failure, we immediately started diuretic therapy with benefit. Chest–x ray revealed a modest thickening of the pulmonary interstitium, electrocardiogram (ECG) a sinus rhythm and early repolarization changes. Chest CT highlighted a bilateral apical–basal pleural effusion, a bilateral hilar ectasia and interstitial markings due to stasis. He underwent an ultrasound of the abdomen that was normal. Thyroid function tests showed high levels of thyroid hormones with suppressed TSH and elevated levels of Ab anti–receptor TSH ( FT3: 8.73 pg/mL; FT4: 2.35 ng/dL; TSH<0.01 mUI/ml; TRAB: 3.62 UI/L). Thyroid ultrasound showed a multinodular goiter. The patient began therapy with Tapazole. Echocardiogram didn’t show any evidence of acute heart disease and systolic function was normal. After discharge he performed a heart MRI with evidence of no alteration of global systolic function, of regional left and right ventricular kinetics or of pathological areas of delayed enhancement in relation to myocardial edema/fibrosis/necrosis. Hyperthyroid patients can show signs and symptoms of heart failure that are due to the hyperdynamic circulatory state and/or to the frequent pulmonary arterial hypertension and our case report demonstrates that this clinical status tends to improve with the restoration of euthyroidism, but if left untreated, can worsen over the time leading to heart failure.
P439 INTERPRETING CARDIOVASCULAR TRIALS WITH NEUTRAL OR NEGATIVE RESULTS TRIALS: A MULTISTEP APPROACH
Authors: Aimo A , Rapezzi C , Fabiani I , Castiglione V , Emdin M , Ferrari R , Maggioni A , Tavazzi L
Published: May 2023

Despite great progress in randomized controlled trial (RCT) design, several methodological issues can still be encountered when reading superiority trials published in leading journals. We propose a 10–step approach to the interpretation of neutral or negative trials to exclude important methodological issues before concluding that the treatment does not work (Figure). 1. Premature interruption Except when there is evidence of superiority at interim analysis, all premature discontinuations make the RCT underpowered. 2. Insufficient power Insufficient power may derive from lower event rates than anticipated or a smaller effect size than expected. Two other possible reasons are a high cross–over rate or a number of events “hypertrophied” by minor events or medical decisions. 3. Logistical peculiarities Logistical issues, e.g., heterogeneous patient selection and management in different geographic areas, are sometimes crucial. 4. Errors or ambiguities in endpoint adjudication Cardiovascular death and HF hospitalization are often used as endpoints. In some cases, the discrepancy between investigator–reported and centrally adjudicated events is quite prominent. Furthermore, some endpoint definitions may be open to interpretation. 5. Suboptimal choice of composite endpoints A composite endpoint should have clinical relevance and should include only elements to be impacted by the intervention. This last requirement is often not met. 6. Nosographic trap The nosographic trap occurs when the study population is heterogeneous, and the importance of the treatment target is not the same across the whole population. 7. Lack of pathophysiological prerequisites for efficacy Some RCTs may prove neutral or negative because they enrolled patients where the treatment was unlikely to be effective. 8. Algebraic cancellation Algebraic cancellation occurs when results are positive in some patients and negative in others. 9. p trap A possible instance is that p value approaches the statistical significance value, leading to uncertainties as to whether borderline significance should be interpreted. 10. The treatment does not really work When a trial is adequately powered and without major methodological flaws, but the p value for the primary endpoint is far from significance (and therefore the p trap is not an issue), the reasonable conclusion is that the treatment is not more effective than its comparator in this specific setting.
P457 ISCHEMIC STROKE AS A FIRST PRESENTATION OF ATYPICAL ENDOCARDITIS AFTER SINGLE CORONARY ARTERY BYPASS GRAFTING (CABG) AND MITRAL VALVE REPLACEMENT
Authors: Speziali N , Benzoni G , Martano S , Ravaro S , Fratianni G , Seravalle G , Parati G , Gavazzoni M , Verde F , Castelletti S , Chianca R , Crotti L
Published: May 2023

A 71–year–old patient with a history of prostatic cancer, recently underwent CABG and mitral valve replacement and during cardiac rehabilitation (CR) was diagnosed with a cryptogenic stroke while on treatment with oral anticoagulant and antiaggregants. It is worth mentioning that during hospitalization he suffered several feverish episodes without major organ involvement with the only exception of the one related to the chest scar infection. He was admitted to CR department with high fever (38.5 C) and hemocultures were positive for Staphylococcus epidermidis which was also isolated from the chest scar. The transthoracic echocardiogram executed at the admission did not show any pathological alteration. After 5 days of antibiotic therapy and optimized medical therapy, he had an ischemic stroke. NIHSS score was initially 10. Acute presentation of ischemic stroke was peculiar: he had left hemiparesis with Babinski sign, but a concomitant Broca‘s aphasia, thus suggesting multiple areas of cerebral ischemia. He was evaluated with a basal computerized tomography (CT) scan which didn’t show any sign of ischemic stroke and NIHSS score completely reversed after 30 minutes to 0: this was more suggestive for a transient ischemic attack rather than ischemic stroke but despite the negative CT scan, the subsequent cerebral magnetic resonance imaging showed ischemic signs localized in different vascular territories. Supra–aortic vessels were normal. Therefore, we performed a transesophageal echocardiography (TEE) which showed a peculiar vegetation over the mitral valve, presenting more as a filament rather than typical vegetation. Despite the absence of fever, negative PCR, negative procalcitonine and white blood cells within the normal limits, we performed hemocultures and Staphylococcus haemolyticus was isolated. Antibiotic therapy was immediately started; however, after three weeks of appropriate therapy the TEE exam showed an evolution of the valve’s lesion which required surgical revision.

Conclusion

This case highlights how ischemic stroke related to multiple ischemic foci may be the only sign of an underlying endocarditis that caused septic embolization. Indeed, the patient was completely asymptomatic, did not have fever, inflammatory markers were negative and only clinical investigations to understand the nature of his stroke allowed us to make the diagnosis of endocarditis.
P462 ATRIAL FIBRILLATION CIED DETECTED; WHEN TO SCOAGULATE? OUR EXPERIENCE ON A STILL VERY CONTROVERSIAL TOPIC
Authors: Scapinelli M , Guerra A , Bagni E
Published: May 2023

Introduction

Atrial fibrillation (AF), which is constantly increasing in the population, is associated with an important care burden linked, in particular, to its consequences (stroke, heart failure, etc.). In patients with an implantable cardiac device (CIED) it is frequent the detection of high atrial frequency episodes (AHRE), often asymptomatic, for which an increased thromboembolic risk has been described (about 2.5 times) but lower than the clinical AF for which there is still no unanimous consensus regarding the initiation of oral anticoagulant therapy (OAT). We report below our experience in patients undergoing CIED implantation in whom AHRE was detected and OAT started, evaluating the characteristics of thromboembolic risk and the follow–up of complications.

Methods

From 01 January 2020 to 31 December 2021, 242 patients (mean age 74.8 years) underwent CIED implant. Among these, 41 patients (16.9% mean age 78.6 years – 30 males and 11 females) presented episodes of AHRE, detected by remote monitoring, lasting between a few seconds and more than 24 hours. The mean CHADsVasc score of these patients was 3.8. Seven patients were not anticoagulated due to arrhythmic episodes lasting a few minutes and CHADsVasc score equal to 1–2, while the other 34 started OAT with DOAC.

Results

No thromboembolic events or major bleeding events have been recorded to date; only minor bleedings (11 epistaxis, 4 haematuria and 5 SOF positivity) were easily treated.

Conclusions

The current guidelines indicate to prolong monitoring until the detection of clinical AF or an arrhythmic burden > 24 hours before considering OAT; however, there are studies that recommend carefully correlating the duration of arrhythmic events with the determination of the thromboembolic risk. In our experience, the high thromboembolic risk of patients, sometimes not adequately represented by the CHADsVasc score, led us to start OAT even when the duration of the episodes was not particularly long and at the moment no major complications have been observed. The two ongoing trials (ARTESia and NOAH) dedicated to the evaluation of these situations will provide valuable indications on the treatment of these patients in whom the thromboembolic risk is certainly lower than that of patients with clinical AF but still not negligible.
P479 PATIENT WITH REGRESSION MULTIPLE MYELOMA AND INFILTRATIVE HYPERTROPHIC CARDIOMYOPATHY OF NDD UNDERGO CARDIAC TRANSPLANT
Authors: Savino L , Giovannico L , Parigino D , D‘errico Ramirez A , Fischetti G , Santeramo V , Silva A , Milano A , Bottio T
Published: May 2023

Introduction

We report the case of a 52–year–old patient with a history of multiple myeloma undergoing chemotherapy treatment according to the DaraRD scheme and currently in remission. Associated with haematological pathology, infiltrative hypertrophic cardiomyopathy of ndd is highlighted. Following haematological and instrumental screening tests, the patient underwent a heart transplant for frequent exacerbations of heart failure.

Case Report

A 52–year–old patient, suffering from multiple myeloma for about 1 year, for which he began chemotherapy treatment with DaraRD scheme and good response to therapy. The patient also presented dyspnoic symptoms and declining edema with echocardiographic finding of infiltrative hypertrophic heart disease for which he undergoes diagnostic investigations. He performs: • Serial echocardiograms which showed marked uniform hypertrophy with ground glass appearance of the left ventricle and severely reduced systolic function; • PET–CT with no hyperaccumulation of the radiopharmaceutical; • Cardiac MRI with evidence of severely hypocontractile left ventricle and wall changes which could be associated with amyloid infiltration; • myocardial scintigraphy that does not give evidence for the deposit of the amyloid substance of the ATTR type in the heart; • biopsy of umbilical fat and cardiac biopsy, both negative for deposition of substance AL with Congo Red staining; • Right cardiac catheterization with evidence of post–capillary pulmonary hypertension. The patient was subjected to several exacerbations of heart failure which required continuous infusion therapy with inotropes and, ultimately, heart transplantation. At the time of surgery, the heart appeared enlarged, extremely hypocontractile and with rigid walls, with poor compliance of the ventricular muscle wall. The patient responded well to the surgical procedure, in the absence of signs and symptoms of rejection, with improvement of general clinical condition.

Conclusions

At the end of the surgical procedure and the rehabilitation period, the patient was discharged home, without showing signs and symptoms of graft rejection or multiple myeloma exacerbations, in stable and satisfactory general clinical conditions.
P489 A VERY DIFFICULT PATIENT
Authors: Corleto A , Giolitto S , Varbella F
Published: May 2023

68–year–old woman, normal weight, dyslipidemic, with family history of ischemic heart disease. Hypothyroidism in treatment. Peripheral vascular disease: bilateral carotid artery disease. She reported adverse effects on muscle (pain with rise in CPK) and on liver (ALT elevation clinically relevant) during simvastatin/ezetimib 10/10 mg taking March 2020 hospitalized for myocardial infarction without ST–segment elevation. Coronary angiography revealed three–vessel disease with subocclusive stenosis of the medium tract of circumflex, medium tract of anterior descending and medium tract of right coronary artery, all treated with angioplasty and drug–eluting stents. Preserved left ventricular ejection fraction on echocardiograpy. Blood LDL 216 mg/dl so we started therapy with Evolocumab 140 mg every 15 days. After 6 months of therapy LDL was 137 mg/dl. Non–target LDL values so Evolocumab 140mg was stopped and Alirocumab 150 mg started. January 2021 hospitalized for suspected recurrence angina. Coronary angiography unchanged. LDL 194 mg/dl so ezetimib 10 mg was associated to alirocumab (statin intolerance). September 2022 cardiology visit for alirocumab PT renewal. LDL 92 mg/dl. Patient wanted to stop PCSK9 inhibitory monoclonal antibodies therapy due to intolerance to drug self–administration. For this reason, we suggested Inclisiran 300 mg administration in association with ezetimibe 10 mg. The administration took place in cardiology outpatient clinic with patient satisfaction. At one month, dosage LDL 78 mg/dl, at 3 months LDL 72 mg/dl.

Conclusions

The innovative mechanism of action, with only two administrations per year, and the healthcare professional administration, allow Inclisiran to obtain a rapid and sustained LDL reduction over time even in conditions of poorly adherent patients to lipid–lowering therapies. Inclisiran is the first siRNA that reduces LDL levels by silencing the mRNA of the PCSK9 protein, involved in the degradation of R–LDL receptors on hepatocytes. Inclisiran allows, in combination with statin and ezetimib, to reach the target levels of LDL–C with two administrations a year. We wait for LDL value in the coming months to confirm its effectiveness over time.
P495 POLYVASCULAR ATHEROSCLEROTIC DISEASE AND CARDIOLOGICAL REHABILITATION: FUNCTIONAL IMPROVEMENT AND RISK RECLASSIFICATION
Authors: Pezzoli S , Maloberti A , Ghidini S , Colombo V , Daus F , De Censi L , Morelli M , Alloni M , Giannattasio C Prof
Published: May 2023

Introduction

polyvascular atherosclerotic involvement is one of the definitions of extreme CV risk. For this reason, the search for carotid or lower limb asyntomatic atherosclerotic pathology can be useful to guarantee more intensive treatments for these individuals, who have already had a heart attack. Purpose: the aim was to understand how much the polyvascular patients can improve in functional terms after Cardiological Rehabilitation, comparing them with monovasculars. Besides, the study purpose was to evaluate how many patients are reclassified with an active research of asyntomatic atherosclerotic pathology with carotid ultrasound and Ankle Brachial Index (ABI).

Methods

The study sample was composed by 87 patients who underwent a cardiological rehabilitation cycle at the Niguarda hospital in Milan from March 2021 to April 2022. Of these, personal, medical, clinical, laboratory and instrumental data were collected. Functional improvement was assested as the difference in meters walked on the 6–minutes walking test (6MWT) on the start day (6MWT–1) and on the end day of rehabilitation (6MWT–2). All patients performed an ABI (to evaluate asyntomatic PAD) and a carotid ultrasound (to evaluate asyntomatic cerebrovascular disease).

Results

pre–riclassification, polyvascolar patients (13) compared to monovascular (74), in addition to being on average older (70 years vs 59 years, p=0.01), males (100% vs 73%, p<0.001) and having had more previous recurrent myocardial infarctions (46% vs 8%, p=0.002), are less performing in terms of 6MWT–1 (428m vs 514m, p=0.002) and 6MWT–2 (517m vs 597m, p=0.008). About absolute functional improvement from the beginning to the end of rehabilitation, there are no statistically significant differences (81m vs 82m, p=0.919). Following reclassification, 7 patients switched from monovascular (67) to polyvascular (20).

Conclusions

our data showed that polyvascular patients can improve as much as monovasculars after Cardiological Rehabilitation. Furthermore, following ABI and carotid ultrasound, 8% of patients were reclassified. Polyvascular patients may receive more targeted and intensive therapies if properly diagnosed.
P496 EXTREME CARDIOVASCULAR RISK IN CARDIOLOGICAL REHABILITATION: PREVALENCE AND IMPACT ON PATIENT’S FUNCTIONAL IMPROVEMENT
Authors: Maloberti A , Senini E , Fabbri S , Ciampi C , Regazzetti M , Monticelli M , Pirola R , Giannattasio C Prof
Published: May 2023

Background

Among patients at very high cardiovascular risk, some are more likely to experience recurrent cardiovascular events. In may 2022, an article was published in the European Heart Journal proposing different definitions of patients at extreme cardiovascular risk. However, the process of defining the patient at extreme cardiovascular risk is still ongoing and more data also on its prevalence are needed. Aims: To assess the prevalence of patients at extreme cardiovascular risk in cardiological rehabilitation, to evaluate the clinical features of these patients. Furthermore, we want to establish how the extreme cardiovascular risk condition correlates with the functional improvement obtained during cardiac rehabilitation.

Methods

The study included 938 patients suffering from atherosclerosis who attended the cardiological rehabilitation of Niguarda Hospital in Milan. Patients diagnosed with non–ischemic heart failure or congenital heart disease have been excluded. Patients classified as at extreme cardiovascular risk were compared with the remaining patients and a multivariate linear regression was performed with absolute functional improvement as the dependent variable.

Results

Among 938 patients, 26.9% belong to the category of extreme cardiovascular risk. Patients at extreme cardiovascular risk showed a higher average age (67.8 ± 10.4 vs 64.1 ± 11.1 years; p ≤ 0.001), a higher prevalence of significant comorbidities (peripheral arterial disease, cerebrovascular disease, chronic kidney disease, dyslipidemia, diabetes, hypertension) and a lower functional improvement during cardiac rehabilitation (102.9 ± 68.6 vs 138.1 ± 86.5 m; p ≤ 0.001). At multivariate analysis extreme cardiovascular risk remains a significant determinant of the absolute functional improvement at Six–Minute Walking Test obtained during cardiac rehabilitation with b = –0.137 and p = 0.035, together with female sex (b = –0.136; p = 0.035).

Conclusion

Extreme cardiovascular risk is a widespread condition among patients with chronic coronary syndrome and adversely affects the patient’s functional improvement during cardiac rehabilitation. The identification of patients at extreme cardiovascular risk is a goal to be pursued in order to intensify secondary prevention strategies.
Experimental evolution of metabolism under nutrient restriction: enhanced amino acid catabolism and a key role of branched-chain amino acids
Authors: Cavigliasso Fanny , Savary Loriane , Spangenberg Jorge E , Gallart-Ayala Hector , Ivanisevic Julijana , Kawecki Tadeusz J
Published: May 2023

Periodic food shortage is a common ecological stressor for animals, likely to drive physiological and metabolic adaptations to alleviate its consequences, particularly for juveniles that have no option but to continue to grow and develop despite undernutrition. Here we study changes in metabolism associated with adaptation to nutrient shortage, evolved by replicate Drosophila melanogaster populations maintained on a nutrient-poor larval diet for over 240 generations. In a factorial metabolomics experiment we showed that both phenotypic plasticity and genetically-based adaptation to the poor diet involved wide-ranging changes in metabolite abundance; however, the plastic response did not predict the evolutionary change. Compared to nonadapted larvae exposed to the poor diet for the first time, the adapted larvae showed lower levels of multiple free amino acids in their tissues—and yet they grew faster. By quantifying accumulation of the nitrogen stable isotope 15N we show that adaptation to the poor diet led to an increased use of amino acids for energy generation. This apparent “waste” of scarce amino acids likely results from the trade-off between acquisition of dietary amino acids and carbohydrates observed in these populations. The three branched-chain amino acids (leucine, isoleucine, and valine) showed a unique pattern of depletion in adapted larvae raised on the poor diet. A diet supplementation experiment demonstrated that these amino acids are limiting for growth on the poor diet, suggesting that their low levels resulted from their expeditious use for protein synthesis. These results demonstrate that selection driven by nutrient shortage not only promotes improved acquisition of limiting nutrients, but also has wide-ranging effects on how the nutrients are used. They also show that the abundance of free amino acids in the tissues does not, in general, reflect the nutritional condition and growth potential of an animal.
Variation in parasite infection between replicates of speciation in Lake Victoria cichlid fish
Authors: Gobbin Tiziana P , Vanhove Maarten P M , Veenstra Renée , Maan Martine E , Seehausen Ole
Published: May 2023

Because of potentially strong eco-evolutionary interactions with their hosts, parasites may initiate or enhance host diversification. The adaptive radiation of cichlid fish in Lake Victoria provides a good system to study the role of parasites at different stages of host speciation. We analyzed the macroparasite infection of four replicates of sympatric blue and red Pundamilia species pairs that vary in their age and extent of differentiation. Sympatric host species differed in parasite community composition and in the infection levels of some of these parasite taxa. Most infection differences were consistent between sampling years, indicating temporal consistency in parasite-mediated divergent selection between species. Infection differentiation increased linearly with genetic differentiation. However, significant infection differences between sympatric species were only found in the oldest, most strongly differentiated Pundamilia species pair. This is inconsistent with parasite-driven speciation. Next, we identified five distinct species of Cichlidogyrus, a genus of highly specific gill parasites that has radiated elsewhere in Africa. Infection profiles of species of Cichlidogyrus differed between sympatric cichlid species only in the oldest and most differentiated pair, again inconsistent with parasite-mediated speciation. To conclude, parasites may contribute to host differentiation after speciation, but do not initiate host speciation.
Experimental validation of membrane distillation unit coupled with direct contact membrane using solar energy
Authors: Zarzoum K , Alquraish M M , Zhani K , Bacha H Ben
Published: May 2023

This paper presents an experimental validation of membrane distillation unit using solar energy which is coupled with direct contact membrane, which is placed at Kairouan University, Tunisia (35 N, 10 E) and tested on several sunny days. This unit is located as part of a cooperation project research and development between German Institute for Solar Energy Systems and Tunisian Electromechanical Systems Laboratory named: Solar driven membrane distillation for resource efficient desalination in remote areas. A theoretical model investigation as well as experimental is carried out. A mathematical model based on heat and mass transfers of the membrane distillation unit has been presented in this paper. The obtained global model of the membrane distillation unit has been converted to a set of algebraic system of equations to render them ordinary. To compare the experimental and numerical data of the mathematical model of the membrane distillation unit an example of the validation process that has been presented to assess the credibility of the obtained numerical model of membrane distillation unit, a laptop simulation program based on the global model of the unit is simulated by C++ software to solve the model of solar irradiation and all temperature on the journal productivity of the membrane distillation unit. It was shown by this study that the global mathematical model of the unit is able to predict accurately the trends of the thermal characteristic of the membrane distillation unit.
Cypermethrin toxicity in the environment: analytical insight into detection methods and microbial degradation pathways
Authors: Kansal Ishita , Kapoor Arushi , Solanki Swati , Singh Rachana
Published: May 2023

The unrestricted utilization of xenobiotic compounds has sparked widespread concern by the world's growing population. A synthetic pyrethroid called cypermethrin (CP) is commonly utilized as an insecticide in horticulture, agriculture, and pest control. The high toxicity levels of accumulated CP have prompted environmental concerns; it damages soil fertility, and an ecosystem of essential bacteria, and causes allergic reactions and tremors in humans by affecting their nervous systems. The damage caused by CP to groundwater, food, and health makes it imperative that new effective and sustainable alternatives are investigated. Microbial degradation has been established as a reliable technique for mineralizing CP into less toxic chemicals. Among the many enzymes produced by bacteria, carboxylesterase enzymes are determined to be the most efficient in the CP breakdown process. High-performance liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS) have been reported as the best methods for determining CP and its metabolized products, with detection limits as low as ppb from diverse environmental samples. The current study describes the ecotoxicological impact of CP and innovative analytical techniques for their detection. The newly isolated CP-degrading bacterial strains have been evaluated in order to develop an efficient bioremediation strategy. The proposed pathways and the associated critical enzymes in the bacterial mineralization of CP have also been highlighted. Additionally, the strategic action to control CP toxicity has been discussed.
Estimating model parameters from SP anomaly of sheet-shaped sources using differential search and particle swarm optimization algorithms
Authors: Özyalın Şenol , Sındırgı Petek
Published: May 2023

In this study, the efficiency of estimating the model parameters of sheet-shaped single and multiple sources of the self-potential (SP) anomaly using the differential search algorithm (DSA) is investigated. First, noise-free and noisy synthetic anomalies are calculated for a single sheet-shaped source, and its model parameters estimated by DSA. The DSA inversion is also done for a model consisting of three inclined sheets. To test the effectiveness of the method, the same processes are repeated with a more conventional algorithm, particle swarm optimization (PSO), and the solutions of both methods are compared. The results of synthetic anomaly analyses show that DSA can predict the parameters as accurately as PSO. Then, both algorithms are also applied to two field SP anomalies (Surda and Beldih) that have been evaluated by different algorithms in the literature. The source of the Surda anomaly is modelled as one sheet, whereas the source model of the Beldih anomaly is assumed to consist of three sheets. The five model parameters for each model are estimated using both algorithms and it is determined that they are in good agreement with the findings of the previous studies. The contribution of the regional background anomaly to the synthetic and field anomalies are also included and regional coefficients are estimated. Finally, we conclude that DSA can solve the source parameters without the need for the initial values required in conventional iterative inversion methods and is an efficient and promising algorithm for determining the parameters of SP sources.
Breaking Down Grit: Persistency and Flexibility in the Career Plans of Military Medical Students
Authors: Landoll Ryan R , Highland Krista , Bell Kameha , Artino Anthony R , Moores Col Lisa K , Soh Michael , Uijtdehaage Sebastian , Durning Steven J , Grunberg Neil E , Dong Ting
Published: May 2023

Introduction

The field of medicine is experiencing a crisis as high levels of physician and trainee burnout threaten the pipeline of future physicians. Grit, or passion and perseverance for long-term goals, has been studied in high-performing and elite military units and found to be predictive of successful completion of training in adverse conditions. The Uniformed Services University of the Health Sciences (USU) graduates military medical leaders who make up a significant portion of the Military Health System physician workforce. Taken together, an improved understanding of the relationships between burnout, well-being, grit, and retention among USU graduates is critical to the success of the Military Health System.

Materials and Methods

The current study was approved by the Institutional Review Board at USU and explored these relations among 519 medical students across three graduating classes. These students participated in two surveys approximately one year apart from October 2018 until November 2019. Participants completed measures on grit, burnout, and likelihood of leaving the military. These data were then merged with demographic and academic data (e.g., Medical College Admission Test scores) from the USU Long Term Career Outcome Study. These variables were then analyzed simultaneously using structural equation modeling to examine the relationships among variables in a single model.

Results

Results reaffirmed the 2-factor model of grit as both passion and perseverance (or interest consistency). No significant relationships emerged between burnout and other study variables. Sustained and focused interest was predictive of less likelihood of staying in the military.

Conclusion

This study offers important insights into the relationship among well-being factors, grit, and long-term career planning in the military. The limitations of using a single-item measure of burnout and measuring behavioral intentions in a short time frame during undergraduate medical education highlight the importance of future longitudinal studies that can examine actual behaviors across a career lifespan. However, this study offers some key insights into potential impacts on the retention of military physicians. The findings suggest that military physicians who are most likely to stay in the military tend to embrace a more fluid and flexible medical specialty path. This is critical in expectation setting for the military to train and retain military physicians across a wide range of critical wartime specialties.
Evaluating a Competency-Based Blended Health Professions Education Program: A Programmatic Approach
Authors: Samuel Anita , King Beth , Cervero Ronald M , Durning Steven J , Melton John
Published: May 2023

Introduction

Competency-based education (CBE) programs usually evaluate student learning outcomes at a course level. However, a more comprehensive evaluation of student achievement of competencies requires evaluation at a programmatic level across all courses. There is currently insufficient literature on accomplishing this type of evaluation. In this article, we present an evaluation strategy adopted by the competency-based master’s degree program at the Center for Health Professions Education at the Uniformed Services University of Health Sciences to assess student achievement of competencies. We hypothesized that (1) learners would grow in the competencies through their time in the program and (2) learners would exhibit a behavioristic change as a result of their participation in the program.

Materials and Methods

The degree program at the Center for Health Professions Education conducts an annual student self-assessment of competencies using a competency survey. The competency survey data from graduated master’s students were collected, providing data from three time points: initial (pre-program survey), middle, and final (end-of-program survey). Open-ended responses from these three surveys were also analyzed. A general linear model for repeated measures was conducted. Significant effects were followed by post hoc tests across time. We also conducted post hoc analysis across domains to better understand the comparative levels of the domains at each time point. The responses to the open-ended prompt were thematically analyzed.

Results

Analysis of the quantitative data revealed that (1) learners reported significant growth across time, (2) learners had different perceptions of their competencies in each of the domains, and (3) not all domains experienced similar changes over time. Analysis of the free responses highlighted the impact of coursework on competency attainment and the behavioristic change in learners.

Conclusions

This study presents a strategic evaluation tool for course-based CBE programs that follow a traditional credit hour model. Programmatic evaluation of CBE programs should enable the inclusion of the learner’s voice and provide evaluation data that go beyond individual course evaluations.
Operation Bushmaster’s Impact on Military Medical Student Deployment Readiness
Authors: Cole Rebekah , Shumaker Jonathan T , Melo Estefania , Matthews Kevin J , Schwartz James , Vojta Leslie , Rudinsky Sherri L
Published: May 2023

Introduction

Operation Bushmaster is a high-fidelity simulation held for fourth-year medical students at the Uniformed Services University. No past research has examined this multi-day simulation’s ability to prepare military medical students for the complexities of their first deployment. This qualitative study, therefore, explored Operation Bushmaster’s impact on military medical student deployment readiness.

Methods

We interviewed 19 senior military medical personnel serving as faculty members at Operation Bushmaster during October 2022 in order to explore how Operation Bushmaster prepares students for their first deployment. These interviews were recorded and transcribed. Each research team member then coded the transcripts and came to a consensus on the themes and patterns that emerged from the data.

Results

The following themes described the ways in which Operation Bushmaster prepares military medical students for their first deployment: (1) primes them for the stress of the operational environment; (2) teaches them to navigate austere conditions; (3) facilitates their leadership development; and (4) provides them with a deeper understanding of the military’s medical mission.

Conclusion

Operation Bushmaster immerses students in a realistic, stressful operational environment, challenging them to develop an adaptive mindset and efficacious leadership skills that they will utilize during future deployments.
Optimizing Care for Military Women: The Value of the Dual-Certified Family and Women’s Health Nurse Practitioner
Authors: Johnson Heather L , Best Natasha I , Johnson Christopher A , Seibert Diane C
Published: May 2023

The number of women in the military has more than tripled over the past 50 years, increasing from 5% in the 1970s to 17% in 2023, making them essential for global health engagement and military operations. Provider competence and confidence are barriers to the consistent availability of preventive, gynecologic, and reproductive services for women across service locations and duty platforms. The Defense Health Board recommends standardizing services and improving the availability and scope of services for women at every point of care. In direct conflict with these recommendations, however, is a congressional call for a drawdown of medical forces, which creates a need for operationally trained clinicians with a broad skill set including comprehensive care for women. Advanced practice registered nurses, such as family and women’s health nurse practitioners, are key assets to fill this gap on military medical health-care teams. At the request of the U.S. Air Force, the Graduate School of Nursing at the Uniformed Services University began offering a Women’s Health Nurse Practitioner (WHNP) program in 2014. The WHNP curriculum was layered onto the existing Family Nurse Practitioner program so that Family Nurse Practitioner students receive enhanced education in women’s health and WHNP students are prepared to meet the holistic, primary care needs of patients across the lifespan in addition to caring for women with obstetric and urogenital health concerns. This article highlights the value of dual-certified Family Nurse Practitioners and WHNPs in the military health-care system. These Uniformed Services University alumni are uniquely prepared to provide comprehensive primary and specialty care for female warfighters across the lifecycle from stable, well-resourced duty stations to austere, operational settings or deployment platforms.
How do supernova remnants cool? – I. Morphology, optical emission lines, and shocks
Authors: Makarenko Ekaterina I , Walch Stefanie , Clarke Seamus D , Seifried Daniel , Naab Thorsten , Nürnberger Pierre C , Rathjen Tim-Eric
Published: May 2023

Supernovae (SNe) inject ∼1051 erg in the interstellar medium, thereby shocking and heating the gas. A substantial fraction of this energy is later lost via radiative cooling. We present a post-processing module for the flash code to calculate the cooling radiation from shock-heated gas using collisional excitation data from mappings v. When applying this tool to a simulated SN remnant (SNR), we find that most energy is emitted in the EUV. However, optical emission lines ([O iii], [N ii], [S ii], H α, H β) are usually best observable. Our shock detection scheme shows that [S ii] and [N ii] emissions arise from the thin shell surrounding the SNR, while [O iii], H $\rm \alpha$, and H $\rm \beta$ originate from the volume-filling hot gas inside the SNR bubble. We find that the optical emission lines are affected by the SNR’s complex structure and its projection on to the plane of the sky because the escaping line luminosity can be reduced by 10–80 per cent due to absorption along the line of sight. Additionally, the subtraction of contaminating background radiation is required for the correct classification of an SNR on the oxygen or sulphur BPT diagrams. The electron temperature and density obtained from our synthetic observations match well with the simulation but are very sensitive to the assumed metallicity.
First emergence of cold accretion and supermassive star formation in the early universe
Authors: Kiyuna Masaki , Hosokawa Takashi , Chon Sunmyon
Published: May 2023

We investigate the first emergence of the so-called cold accretion, the accretion flows deeply penetrating a halo, in the early universe with cosmological N-body/SPH simulations. We study the structure of the accretion flow and its evolution within small haloes with ≲108 M⊙ with sufficiently high spatial resolutions down to ∼1 pc scale. While previous studies only follow the evolution for a short period after the primordial cloud collapse, we follow the long-term evolution until the cold accretion first appears, employing the sink particle method. We show that the cold accretion emerges when the halo mass exceeds ∼2.2 × 107 M⊙{(1 + z)/15}−3/2, the minimum halo masses above which the accretion flow penetrates haloes. We further continue simulations to study whether the cold accretion provides the dense shock waves, which have been proposed to give birth to supermassive stars (SMSs). We find that the accretion flow eventually hits a compact disc near the halo centre, creating dense shocks over a wide area of the disc surface. The resulting post-shock gas becomes dense and hot enough with its mass comparable to the Jeans mass MJ ∼ 104–5 M⊙, a sufficient amount to induce the gravitational collapse, leading to the SMS formation.
A geometric calibration of the tip of the red giant branch in the Milky Way using Gaia DR3
Authors: Dixon M , Mould J , Flynn C , Taylor E N , Lidman C , Duffy A R
Published: May 2023

We use the latest parallaxes measurements from Gaia DR3 to obtain a geometric calibration of the tip of the red giant branch (TRGB) in Cousins I magnitudes as a standard candle for cosmology. We utilize the following surveys: SkyMapper DR3, APASS DR9, ATLAS Refcat2, and Gaia DR3 synthetic photometry to obtain multiple zero-point calibrations of the TRGB magnitude, $M_{I}^{TRGB}$. Our sample contains Milky Way halo stars at high galactic latitudes (|b| > 36) where the impact of metallicity, dust, and crowding are minimized. The magnitude of the TRGB is identified using Sobel edge detection, but this approach introduced a systematic offset. To address this issue, we utilized simulations with parsec isochrones and showed how to calibrate and remove this bias. Applying our method within the colour range where the slope of the TRGB is relatively flat for metal-poor halo stars (1.55 < (BP − RP) < 2.25), we find a weighted average $M_{I}^{TRGB} = -4.042 \pm 0.041$ (stat) ±0.031 (sys) mag. A geometric calibration of the Milky Way TRGB has the benefit of being independent of other distance indicators and will help probe systematics in the local distance ladder, leading to improved measurements of the Hubble constant.
Observability of photoevaporation signatures in the dust continuum emission of transition discs
Authors: Picogna Giovanni , Schäfer Carolina , Ercolano Barbara , Rab Christian , Franz Rafael , Gárate Matías
Published: May 2023

Photoevaporative disc winds play a key role in our understanding of circumstellar disc evolution, especially in the final stages, and they might affect the planet formation process and the final location of planets. The study of transition discs (i.e. discs with a central dust cavity) is central for our understanding of the photoevaporation process and disc dispersal. However, we need to distinguish cavities created by photoevaporation from those created by giant planets. Theoretical models are necessary to identify possible observational signatures of the two different processes, and models to find the differences between the two processes are still lacking. In this paper, we study a sample of transition discs obtained from radiation–hydrodynamic simulations of internally photoevaporated discs, and focus on the dust dynamics relevant for current Atacama Large Millimetre Array observations. We then compared our results with gaps opened by a super-Earth/giant planets, finding that the photoevaporated cavity steepness depends mildly on gap size, and it is similar to that of a ${1}\, {\rm M_J}$ planet. However, the dust density drops less rapidly inside the photoevaporated cavity compared to the planetary case due to the less efficient dust filtering. This effect is visible in the resulting spectral index, which shows a larger spectral index at the cavity edge and a shallower increase inside it with respect to the planetary case. The combination of cavity steepness and spectral index might reveal the true nature of transition discs.
Spatial eigenvalue problems for stars in hydrostatic equilibrium: Generalized Lane–Emden equations as boundary value problems
Authors: Van Gorder Robert A , Fisher Petra A
Published: May 2023

We derive a generic spatial eigenvalue problem governing stars in hydrostatic equilibrium. Our approach generalizes the various Lane–Emden equations finding use over the past century, allowing for more general equations of state (EoS) while ensuring a stellar structure with finite size (without the need for artificial truncation of the radius). We show that the resulting stellar structure is encoded into two quantities: the eigenvalue, which determines the total size or mass of the star, and the density distribution, which encodes the internal structure. While our formalism recovers known results for polytrope and white dwarf EoS, we also study additional EoS, such as those incorporating excluded volumes or those calibrated through viral expansions. We obtain numerical values for the stellar structure under a variety of frameworks, comparing and contrasting stellar structure under different EoS. Interestingly, we show how different EoS can be calibrated to give solutions with the same stellar structure, highlighting the arbitrariness of a particular EoS for replicating observations. This leads us to comment on general properties EoS should obey to describe physically realistic stars. We also consider hydrostatic gas clouds immersed in larger regions having non-zero ambient density. We compare three analytical methods for finding solutions of these eigenvalue problems, including Taylor series solutions, the variational approximation, and the non-perturbative delta-expansion method. Although each method has benefits and drawbacks, we show that the delta-expansion method provides the most accuracy in replicating stellar structure.
Collisional excitation of methyl (iso)cyanide by He atoms: rate coefficients and isomerism effects
Authors: Ben Khalifa M , Dagdigian P J , Loreau J
Published: May 2023

Among all closed-shell species observed in molecular clouds, molecules with C3v symmetry play a crucial role, as their rotational spectroscopy allows them to behave as a gas thermometer. In the interstellar medium, methyl cyanide (CH3CN) is the second most abundant of those (after ammonia, NH3). Its isomer, methyl isocyanide (CH3NC), is less abundant but has been detected in many astrophysical sources. In order to assess their absolute and relative abundances, it is essential to understand their collisional excitation properties. This paper reports the calculation of rate coefficients for rotational excitation of CH3CN and CH3NC molecules with He atoms, from low (5 K) to moderate (100 K) temperatures. We include the first 74 and 66 rotational states of both para and ortho symmetries of CH3CN and CH3NC, respectively. A propensity for Δj = 2 transitions is observed in the case of CH3CN-He collisions, whereas in the case of CH3NC-He a propensity for Δj = 1 is observed for transitions involving low values of j and at low temperatures, a propensity for Δj = 2 is observed for higher values of j and at high temperatures. A comparison of rate coefficients shows differences up to a factor of 3, depending on temperature and on the ortho/para symmetries for dominant transitions. This confirms the importance of having specific collisional data for each isomer. We also examined the effect of these new rates on the CH3CN and CH3NC excitation in molecular clouds by performing radiative transfer calculations of the excitation and brightness temperatures for several detected lines.