bluuebunny/crossref_metadata_2025 huggingface dataset:
Does global warming worsen poverty and inequality? An updated review
Authors: Dang Hai‐Anh H. , Hallegatte Stephane , Trinh Trong‐Anh
Published: June 2024

We offer an updated and comprehensive review of recent studies on the impacts of climate change, particularly global warming, on poverty and inequality, paying special attention to data sources as well as empirical methods. While studies consistently find negative impacts of higher temperatures on poverty across different geographical regions, with higher vulnerability especially in poorer Sub‐Saharan Africa, there is inconclusive evidence on climate change impacts on inequality. Further analyzing a recently constructed global database at the subnational unit level derived from official national household income and consumption surveys, we find that temperature change has larger impacts in the short term and more impacts on chronic poverty than transient poverty. The results are robust to different model specifications and measures of chronic poverty and are more pronounced for poorer countries. Our findings offer relevant inputs into current efforts to fight climate change.
Oral cancer detection and progression prediction using noninvasive cytology‐based DNA ploidy approach
Authors: Liu Kelly Y. P. , Ng Samson , Taleghani Maryam , Zhu Sarah Y. , Carraro Anita , Chen Zhaoyang , Palcic Branko , Poh Catherine F. , Guillaud Martial
Published: June 2024

Background

Despite the oral cavity being readily accessible, oral cancer (OC) remains a significant burden. The objective of this study is to develop a DNA ploidy‐based cytology test for early detection of high‐risk oral lesions.

Methods

This retrospective study was conducted using 569 oral brushing samples collected from 95 normal and 474 clinically abnormal mucosa with biopsy diagnosis of reactive, low‐grade or high‐grade precancer or cancers. Brushing cells were processed to characterize DNA ploidy. A two‐step DNA ploidy‐based algorithm, the DNA ploidy oral cytology (DOC) test, was developed using a training set, and verified in test and validation sets to differentiate high‐grade lesions (HGLs) from normal. The prognostic value of the test was evaluated by an independent outcome cohort, including progressed and non‐progressing normal, reactive and low‐grade lesions. Classification performance was assessed by accuracy, sensitivity, and specificity, while the prognostic value was evaluated by using the Cox proportional hazards analysis on 3‐year progression‐free survival (PFS).

Results

The developed DOC test exhibited high accuracy for detecting HGLs in the test and validation sets, with a sensitivity of 0.97 and 0.96, respectively. Its application to the Outcome cohort demonstrated significant prognostic value for 3‐year PFS (log rank, p < 0.001). Multivariate analysis showed that high‐grade pathology was the only variable explaining positive DOC test, not age, smoking, or lesional site.

Conclusion

Clinical implementation of the DOC test could provide an effective screening method for detecting HGLs for biopsy and lesions at risk of progression.
More Snakes Than Ladders: Mass Schooling, Social Closure, and the Pursuit of Taraqqi (Social Mobility) in Rural Pakistan☆
Authors: Naveed Arif
Published: June 2024

The international educational agenda that drives the educational expansion in the Global South makes universalist assumptions about the role of education in reducing poverty and promoting social mobility. Challenging these assumptions, this paper asks whether educational expansion in such contexts reduces social inequality across generations by offering individuals, from whatever background, educational opportunities and access to higher status livelihoods. By using Weberian and Bourdieusian theoretical frameworks, and drawing upon the perspectives of the families in rural Punjab, the paper contributes to the literature by revealing how local rural power relations in landownership, caste systems, religious identity, and political patronage, and their manifestation in the cultural realm, enact a form of social closure that closes off resources and opportunities for the disadvantaged to pursue social mobility through schooling. These power relations not only place limits on the assumed equalizing role of education in rural Punjab, but they also tend to perpetuate inequality in and through education. The paper argues that a sociological understanding of the role that education plays in the everyday rural life is crucial for designing a nuanced educational agenda capable of engaging with, rather than assuming away social and economic inequality in hierarchal societies.
TAPERED ANGLE MICROFLUIDIC DEVICE FOR CELL SEPARATION USING HYDRODYNAMIC PRINCIPLE
Authors: Jamrus Muhammad Asyraf , Ahmad Mohd. Ridzuan
Published: June 2024

Cell sorting is an essential technique used in a wide range of research, diagnostic, and therapeutic sectors. Fluorescence-activated cell sorting (FACS), magnetic-activated cell sorting (MACS), and CellSearch, which are conventional techniques, possess inherent limitations. For instance, the utilization of EpCam was ineffective in identifying specific malignancies. Cell sorting techniques have undergone significant advancements, with microfluidics being one of them. Regrettably, the current devices suffer from issues such as clogging and necessitate a lengthy main channel. Therefore, the goal of this work is to build and improve a microfluidic device with a tapered angle. There are three designs presented, each with one inlet, at least two exits, one focusing zone, and one tapering region. Using the finite element simulation software COMSOL Multiphysics, two studies are undertaken, the first examining the effect of taper angle on particle separation, and the second analyzing the effect of flow rate on particle separation. Based on the hydrodynamic theory and sedimentation process, this design allows particles to separate. When the taper angle approached 20 degrees, a mixture of 3 μm and 10 μm polystyrene microbeads were successfully separated, and separation continued until the taper angle approached 89 degrees. This technology offers simple, label-free, and continuous separation of many particles in a self-contained device without the use of bulky gear.
NUMERICAL STUDY OF THE RESISTANCE REDUCTION IN HYBRID MINI-SUBMARINE
Authors: Rayhan F. A. , Nugraha T. A. , Akhira H. R. , Pratiwi Y. , Hatuwe R.
Published: June 2024

Hybrid mini-submarine is a single innovative ship combining the concepts of conventional fast ships, hydrofoils, and submarine with the specific mission of safeguarding national sovereignty. This study was conducted to analyze the reduction of resistance in this mini-submarine by examining the positioning and shape of NACA hydrofoils. The process involved adjusting the positions of NACA hydrofoils and incorporating different configurations. This was indicated by the inclusion of nine speed configuration in the hydrofoil mode, eight in the conventional mode, and five in the submarine mode. Moreover, Computational Fluid Dynamics (CFD) simulation was applied for analysis using the Ansys CFX software. The results showed that the positioning of the NACA hydrofoils at close proximity reduced the resistance. The selection of symmetrical and slender configuration was also observed to optimize the reduction of resistance. Moreover, the combination of position and NACA hydrofoil 0012 produced an average resistance reduction of up to 12.52%. The configured model successfully reduced the total ship resistance and also identified the optimal position and shape configuration for the NACA hydrofoils. These findings provided valuable insights into the components and characteristics of total ship resistance and served as a valuable reference for further research on the development of maritime security technology.
INFLUENCE OF CRUSHED BRICK COLUMNS ON GEOTECHNICAL PROPERTIES OF EXPANSIVE SOIL
Authors: Jun Shen Ng , Hasan Muzamir , Yong Ler Low
Published: June 2024

Utilization of crushed brick which is a common industrial material that is potentially wasted during the construction process in ground improvement can relieve its detrimental effects on the environment thereby reducing the waste disposal challenges. Hence, this study proposes its utilization as reinforcement to the soft clay soil. The tests mainly focused on the particle size distribution (PSD), specific gravity, Atterberg limit, proctor analysis as well as the shear strength parameters from Unconfined Compression Test (UCT). Coherently, the vibro-replacement method was deployed within a small-scale laboratory approach as a prediction model for the construction of a group of crushed brick columns. The column design was mainly classified into partially penetrated columns which have 60 mm and 80 mm height, and fully penetrated columns with 100 mm height. The mass of crushed brick used was approximately 1.07% - 4.56% of its total mass of specimen which produces the shear strength improvement rate from 11.00% - 18.55%. From the obtained results, the use of fully penetrated 100 mm diameter columns enhanced the undrained shear strength of kaolin clay to the maximum value, 26.20kPa or 18.55% as compared to the control sample with no reinforcement, which reduced the soil settlement and promoted the use of sustainable material in ground improvement.
ADAPTIVE CONTROL OF A SUBMARINE FOR VARIOUS DIVING DEPTHS USING AN EXPONENTIAL FUNCTION
Authors: F. Al-Bakri Fawaz , H. Ali Hasan , Waheed Khafaji Salwan Obaid
Published: June 2024

Due to the progress of deep submergence capabilities, a submarine is extensively employed on many sides of marine science. For that reason, it has become necessary to design an effective submarine position controller while achieving a fast and stable mission. An adaptive analytical scheme for the underwater submarine was developed. The main purpose of the adaptive analytical scheme is to provide a powerful analytical controller that can successfully steer the submarine from the current state under the water to the surface of water in a short time. To achieve that, a seventh-term exponential function was proposed to reshape the reference diving depth while maintaining the control variable limitation and satisfying initial and final boundary conditions. The direct search method with two cascade loops was employed to achieve a minimum cost function by determining an appropriate constant of the function and minimum final time. However, using the direct search method can be time-consuming since a number of algebraic operations are executed inside these two loops. Therefore, the curve fitting method was used to fit the set of direct search method data using power functions. Then, at a certain diving depth, the function coefficients were computed based on the final settling time and function constant using the Gaussian elimination method. A nominal numerical simulation of the submarine’s model was implemented using both adaptive analytical and linear controllers.
EVALUATION OF GEOMETRIC MORPHOMETRIC APPROACH FOR ETHNICITIES DISCRIMINATION USING HANDWRITTEN NUMERAL CHARACTERS
Authors: Wan Mohd Taufek Wan Nurul Syafawani , Mohd Hadi Pritam Helmi , Mat Desa Wan Nur Syuhaila , Ismail Dzulkiflee
Published: June 2024

Handwriting evidence is a valuable source for authorship identification, an important aspect in investigating crimes such as murder, suicide, illegal drug trafficking, kidnapping, and document forgery. It relies heavily on the examination of written characters that make the document. However, specific studies on the handwritten numeral characters are scarce despite being crucial in assisting investigators in solving crimes. Hence, this study is aimed to gauge the possibility to discriminate authors according to their ethnicities by means of their handwritten numeral characters using a novel Geometric Morphometric (GMM) technique. Handwritten numeral characters collected from 30 individuals from three main different ethnic groups in Malaysia; Malay, Chinese and Indian were first digitised and landmarked using GMM software. Cluster patterns can be observed in the Principal Component Analysis (PCA) score plots, belonging exclusively to the three different ethnic groups. Significant differences (p<0.0001) were discovered in handwritten numerals characters 3, 4, 5, 7 and 9 amongst the three ethnicities when tested using Procrustes ANOVA, which signifying that it is possible to discriminate authors according to their ethnicities using their handwritten numeral characters. However, more sophisticated meta-analyses are needed in order to find the most effective technique for determining and discriminating the author's ethnicity.
EXPERIMENTAL STUDY ON THE EFFICACY OF ULTRASOUND IN IN-SITU DETECTION OF CORROSION IN PALM OIL REFINING EQUIPMENT
Authors: Tai Jan Lean , Hameed Sultan Mohamed Thariq , Shahar Farah Syazwani
Published: June 2024

Palm oil is an important agricultural product for many countries. Stainless steel refining equipment faces corrosion challenges due to the corrosive nature of palm oil, which gradually deteriorates the equipment over time. Ultrasonic testing (UT) can detect corrosion, usually performed during palm mill downtime due to temperature constrain. The study aims to optimize UT at temperatures up to 250°C. The experimental outcomes serve as a foundation for broadening the application of phased array corrosion mapping (PACM) into elevated temperatures. The results offer intricate insights into velocity fluctuations within specific materials, correlating with temperature elevation. In summary, the suite of UT methods demonstrates their aptitude for employment during palm oil refinery operations up to 250°C involving carbon steel as well as 304 and 316 stainless steels. It allows further UT application during the palm mill’s operation and achieves the study’s objective of allowing palm mill owners to detect and monitor corrosion growths without stopping production.
REVIEWS OF ACOUSTICAL PATENTS
Authors: Fulop Sean A.
Published: June 2024

The purpose of these acoustical patent reviews is to provide enough information for a Journal reader to decide whether to seek more information from the patent itself. Any opinions expressed here are those of the reviewers as individuals and are not legal opinions. Patents are available via the internet at the USPTO website.
“What Are You Eating?” Is the Influence of Fortnite Streamers Expanding Beyond the Game?
Authors: Micallef David , Schivinski Bruno , Brennan Linda , Parker Lukas , Jackson Michaela
Published: June 2024

Online game microcelebrities (streamers) attract a large audience of emerging adult gamers (age 18–25 years) and have become a target for food industry advertising. Extant research has identified links between gaming and negative impacts on diet. However, little is known about the influence of game-streaming communities on food consumption. This study aims to understand the type and context of discussions about food and drink in streaming communities that may be influencing the consumption behavior of emerging adults. Data were collected through observation of food and drink-related conversations within streaming communities for Fortnite, which is popular with emerging adult gamers. The study found that the sharing of food is commonplace in organic discussions within streaming communities, driven by both streamers and their followers. The sharing of energy-dense nutrient-poor foods is commonplace in these organic discussions. The study suggests that game-streaming channels have expanded beyond the scope of only a gaming channel and, for emerging adults, are potentially influencing their healthful behavior.
High variance in quantification of
Mycobacterium tuberculosis
at low bacterial loads and with differentially detectable mycobacteria
Authors: Walsh Kathleen F. , Lee Myung Hee , Zainabadi Kayvan , Vilbrun Stalz Charles , Jean Juste Marc Antoine , Joseph Yvetot , Royal Gertrude , Saito Kohta , McAulay Kathrine , Pape Jean W. , Fitzgerald Daniel
Published: June 2024

We examined the correlation between three different methods of
Mycobacterium tuberculosis
quantification: time to positivity (TTP), log
10
CFU, and an assay to detect differentially detectable
M. tuberculosis
(DD Mtb) from three different prospective studies. Participants with DD Mtb have significantly more variation in the CFU/TTP correlation than participants with no DD Mtb (
P
< 0.001). This may impact the design of early bactericidal activity studies that use TTP as the primary outcome.
The biosynthesis mechanism of bacterioruberin in halophilic archaea revealed by genome and transcriptome analysis
Authors: Ma Yingchao , Sun Zhongshi , Yang Huan , Xie Wei , Song Mengyu , Zhang Bo , Sui Liying
Published: June 2024

Halophilic archaea are promising microbial cell factories for bacterioruberin (BR) production. BR is a natural product with multi-bioactivities, allowing potential application in many fields. In the previous work, a haloarchaeon
Halorubrum
sp. HRM-150 with a high proportion of BR (about 85%) was isolated, but the low yield impeded its large-scale production. This work figured out BR synthesis characteristics and mechanisms, and proposed strategies for yield improvement. First, glucose (10 g/L) and tryptone (15 g/L) were tested to be better sources for BR production. Besides, the combination of glucose and starch achieved the diauxic growth, and the biomass and BR productivity increased by 85% and 54% than using glucose. Additionally, this work first proposed the BR synthesis pattern, which differs from that of other carotenoids. As a structural component of cell membranes, the BR synthesis is highly coupled with growth, which was most active in the logarithm phase. Meanwhile, the osmotic down shock at the logarithm phase could increase the BR productivity without sacrificing the biomass. Moreover, the
de-novo
pathway for BR synthesis with a key gene of
lyeJ
, and its competitive pathways (notably tetraether lipids and retinal) were revealed through genome, transcriptome, and osmotic down shock. Therefore, the BR yield is expected to be improved through mutant construction, such as the overexpression of key gene
lyeJ
and the knockout of competitive genes, which need to be further explored. The findings will contribute to a better understanding of the metabolism mechanism in haloarchaea and the development of haloarchaea as microbial cell factories.

IMPORTANCE

Recent studies have revealed that halophilic microorganism is a promising microbial factory for the next-generation industrialization. Among them, halophilic archaea are advantageous as microbial factories due to their low contamination risk and low freshwater consumption. The halophilic archaea usually accumulate long chain C
50
carotenoids, which are barely found in other organisms. Bacterioruberin (BR), the major C
50
carotenoid, has multi-bioactivities, allowing potential application in food, cosmetic, and biomedical industries. However, the low yield impedes its large-scale application. This work figured out the BR synthesis characteristics and mechanism, and proposed several strategies for BR yield improvement, encouraging halophilic archaea to function as microbial factories for BR production. Meanwhile, the archaea have special evolutionary status and unique characteristics in taxonomy, the revelation of BR biosynthesis mechanism is beneficial for a better understanding of archaea.
Macrophage fate: to kill or not to kill?
Authors: Marrufo Armando M. , Flores-Mireles Ana Lidia
Published: June 2024

Macrophages are dynamic innate immune cells that either reside in tissue, serving as sentinels, or recruited as monocytes from bone marrow into inflamed and infected tissue. In response to cues in the tissue microenvironment (TME), macrophages polarize on a continuum toward M1 or M2 with diverse roles in progression and resolution of disease. M1-like macrophages exhibit proinflammatory functions with antimicrobial and anti-tumorigenic activities, while M2-like macrophages have anti-inflammatory functions that generally resolve inflammatory responses and orchestrate a tissue healing process. Given these opposite phenotypes, proper spatiotemporal coordination of macrophage polarization in response to cues within the TME is critical to effectively resolve infectious disease and regulate wound healing. However, if this spatiotemporal coordination becomes disrupted due to persistent infection or dysregulated coagulation, macrophages’ inappropriate response to these cues will result in the development of diseases with clinically unfavorable outcomes. Since plasticity and heterogeneity are hallmarks of macrophages, they are attractive targets for therapies to reprogram toward specific phenotypes that could resolve disease and favor clinical prognosis. In this review, we discuss how basic science studies have elucidated macrophage polarization mechanisms in TMEs during infections and inflammation, particularly coagulation. Therefore, understanding the dynamics of macrophage polarization within TMEs in diseases is important in further development of targeted therapies.
New discovery of 3.84–3.64 Ga diverse granitoids in eastern Hebei, North China Craton: Petrogenesis and significance
Authors: Dong Chunyan , Liu Shoujie , Nutman Allen P. , Li Pengchuan , Xie Hangqiang , Li Yuan , Liu Dunyi , Wan Yusheng
Published: June 2024

Eoarchean rocks are scarce worldwide, limiting our understanding of Earth’s early history. This contribution presents the field geology, sensitive high-resolution ion microprobe (SHRIMP) U-Pb zircon dating, Nd-Hf-O isotopic analysis, and whole-rock geochemical study of Eoarchean granitoids newly discovered in the Labashan area, eastern Hebei, North China Craton. Eoarchean rocks, including 3838–3754 Ma trondhjemitic gneisses (4 samples), 3786–3773 Ma granodioritic gneisses (4 samples), 3775 Ma quartz monzonite gneiss (1 sample), and 3786–3640 Ma potassic granite gneisses (3 samples), are identified in a tract 1 km long. They are in tectonic contact with 3.4–3.1 Ga supracrustal rocks, with both occurring as enclaves in 2.5 Ga potassic granite. The trondhjemitic gneisses show low (La/Yb)N values (23.4–56.8) and insignificant Eu anomalies (Eu/Eu* = 0.86–1.24). Compared with the trondhjemitic gneisses, the granodioritic gneisses and quartz monzonite gneiss have lower (La/Yb)N ratios (9.2–11.3) and lower Eu/Eu* values (0.62–0.79). The potassic granites have (La/Yb)N ratios of 20.7–55.2 and Eu/Eu* values of 0.75–1.84. Zircon saturation temperatures of the granitoids range from 667 °C to 878 °C. They have whole-rock εNd(t) of −4.6 to 1.0 and tCHUR(Nd) of 4.3–3.6 Ga, and zircon εHf(t) values of −6.9 to 0.4 and tCHUR(Hf) ages of 4.1–3.5 Ga (mainly 4.1–3.8 Ga) and δ18O of 4.6‰–7.5‰ (CHUR—chondritic uniform reservoir). It is speculated that different amounts of low-K mafic rocks and tonalite-trondhjemite-granodiorite rocks with prior crustal residence times were the source of the spectrum of trondhjemitic to granitic compositions at Labashan. Two possible models, magma underplating and convergent plate boundary processes, are explored for the tectonic regime forming these Eoarchean granitoids.
Advances in diagnosis and management of cancer of the esophagus
Authors: Deboever Nathaniel , Jones Christopher M , Yamashita Kohei , Ajani Jaffer A , Hofstetter Wayne L
Published: June 2024

Esophageal cancer is the seventh most common malignancy worldwide, with over 470 000 new cases diagnosed each year. Two distinct histological subtypes predominate, and should be considered biologically separate disease entities.1 These subtypes are esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). Outcomes remain poor regardless of subtype, with most patients presenting with late stage disease.2 Novel strategies to improve early detection of the respective precursor lesions, squamous dysplasia, and Barrett’s esophagus offer the potential to improve outcomes. The introduction of a limited number of biologic agents, as well as immune checkpoint inhibitors, is resulting in improvements in the systemic treatment of locally advanced and metastatic esophageal cancer. These developments, coupled with improvements in minimally invasive surgical and endoscopic treatment approaches, as well as adaptive and precision radiotherapy technologies, offer the potential to improve outcomes still further. This review summarizes the latest advances in the diagnosis and management of esophageal cancer, and the developments in understanding of the biology of this disease.
Restrictive use of Restraints and Delirium Duration in the Intensive Care Unit (R2D2-ICU): protocol for a French multicentre parallel-group open-label randomised controlled trial
Authors: Sonneville Romain , Couffignal Camille , Sigaud Florian , Godard Virginie , Audibert Juliette , Contou Damien , Celier Adam , Djibre Michel , Schmidt Julien , Jaquet Pierre , Mekontso Dessap Armand , Bourel Claire , Bellot Romane , Roy Carine , Lamara Fariza , Essardy Fatiha , Timsit Jean-François , Cornic Renaud , Bouadma Lila
Published: June 2024

Introduction

Physical restraint (PR) is prescribed in patients receiving invasive mechanical ventilation in the intensive care unit (ICU) to avoid unplanned removal of medical devices. However, it is associated with an increased risk of delirium. We hypothesise that a restrictive use of PR, as compared with a systematic use, could reduce the duration of delirium in ICU patients receiving invasive mechanical ventilation.

Methods and analysis

The Restrictive use of Restraints and Delirium Duration in ICU (R2D2-ICU) study is a national multicentric, parallel-group, randomised (1:1) open-label, controlled, superiority trial, which will be conducted in 10 ICUs. A total of 422 adult patients requiring invasive mechanical ventilation for an expected duration of at least 48 hours and eligible for prescription of PR will be randomly allocated within 6 hours from intubation to either the restrictive PR use group or the systematic PR use group, until day 14, ICU discharge or death, whichever comes first. In both groups, PR will consist of the use of wrist straps. The primary endpoint will be delirium or coma-free days, defined as the number of days spent alive in the ICU without coma or delirium within the first 14 days after randomisation. Delirium will be assessed using the Confusion Assessment Method-ICU twice daily. Key secondary endpoints will encompass agitation episodes, opioid, propofol, benzodiazepine and antipsychotic drug exposure during the 14-day intervention period, along with a core outcome set of measures evaluated 90 days postrandomisation.

Ethics and dissemination

The R2D2-ICU study has been approved by the Comité de Protection des Personnes (CPP) ILE DE FRANCE III—PARIS (CPP19.09.06.37521) on June 10th, 2019). Participant recruitment started on 25 January 2021. Results will be published in international peer-reviewed medical journals and presented at conferences.

Trial registration number

NCT04273360.
Hospital policy of tranexamic acid to reduce transfusion in major non-cardiac surgery (TRACTION): protocol for a phase IV randomised controlled trial
Authors: Houston Brett L , McIsaac Daniel I , Breau Rodney H , Andrews Meghan , Avramescu Sinziana , Bagry Hema , Balshaw Robert F , Daya Jayesh , Duncan Kaitlin , Harle Christopher , Jacobsohn Eric , Kerelska Tina , McIsaac Sarah , Ramsay Tim , Saha Tarit , Perelman Iris , Recio Angela , Solvason Dayna , Szoke Daniel , Tenenbein Marshall , Fergusson Dean A , Zarychanski Ryan
Published: June 2024

Introduction

Tranexamic acid (TXA) is an inexpensive and widely available medication that reduces blood loss and red blood cell (RBC) transfusion in cardiac and orthopaedic surgeries. While the use of TXA in these surgeries is routine, its efficacy and safety in other surgeries, including oncologic surgeries, with comparable rates of transfusion are uncertain. Our primary objective is to evaluate whether a hospital-level policy implementation of routine TXA use in patients undergoing major non-cardiac surgery reduces RBC transfusion without increasing thrombotic risk.

Methods and analysis

A pragmatic, registry-based, blinded, cluster-crossover randomised controlled trial at 10 Canadian sites, enrolling patients undergoing non-cardiac surgeries at high risk for RBC transfusion. Sites are randomised in 4-week intervals to a hospital policy of intraoperative TXA or matching placebo. TXA is administered as 1 g at skin incision, followed by an additional 1 g prior to skin closure. Coprimary outcomes are (1) effectiveness, evaluated as the proportion of patients transfused RBCs during hospital admission and (2) safety, evaluated as the proportion of patients diagnosed with venous thromboembolism within 90 days. Secondary outcomes include: (1) transfusion: number of RBC units transfused (both at a hospital and patient level); (2) safety: in-hospital diagnoses of myocardial infarction, stroke, deep vein thrombosis or pulmonary embolism; (3) clinical: hospital length of stay, intensive care unit admission, hospital survival, 90-day survival and the number of days alive and out of hospital to day 30; and (4) compliance: the proportion of enrolled patients who receive a minimum of one dose of the study intervention.

Ethics and dissemination

Institutional research ethics board approval has been obtained at all sites. At the completion of the trial, a plain language summary of the results will be posted on the trial website and distributed in the lay press. Our trial results will be published in a peer-reviewed scientific journal.

Trial registration number

NCT04803747.
Cardiovascular risk and physical activity in Syrians living in England compared with the population of North West England: a cross-sectional study
Authors: Abou Deb George , Hamdallah Hanady
Published: June 2024

Objective

This study aims to assess the 10-year cardiovascular risk and physical activity among Syrians residing in England and compare them with the North West England population.

Design

Cross-sectional study.

Setting

Bilingual online questionnaire distributed through social media platforms from 21 June to 23 July 2023.

Participants

Syrian individuals in England (aged 25–69, migrated post-2010) and residents of North West England within the same age bracket. All participants had no history of cardiovascular disease (CVD).

Primary and secondary outcome measures

Primary outcome measures included differences in QRISK3 score, 10-year relative risk (RR), metabolic equivalent of task (MET) and self-reported physical activity between the two groups. Secondary outcome measures included subgroup analyses based on sex and age.

Results

Of the 273 eligible participants (137 in the Syrian group and 136 in the Northwest England group), the QRISK3 score was twofold higher in the Syrian group (2.20, 5.50) than in the North West England group (1.20, 3.15) (p=0.042). The 10-year RR was approximately three times higher in the Syrian group (p<0.001), while MET was about twice as high in the Northwest England group (p<0.001).

Conclusions

Despite relocating to England, Syrians face substantially elevated cardiovascular risks attributed to an unhealthy lifestyle, including smoking, reduced physical activity, increased body mass index and diabetes, coupled with a strong family history of CVD in first-degree relatives under the age of 60. The study underscores the need for early assessment, risk factor identification and tailored interventions for this population. Raising awareness, particularly in the context of smoking, and promoting physical activity are crucial for mitigating cardiovascular risks. The findings emphasise the importance of culturally sensitive interventions to address the unique health challenges of Syrians in the UK.
Performance evaluation of ChatGPT in detecting diagnostic errors and their contributing factors: an analysis of 545 case reports of diagnostic errors
Authors: Harada Yukinori , Suzuki Tomoharu , Harada Taku , Sakamoto Tetsu , Ishizuka Kosuke , Miyagami Taiju , Kawamura Ren , Kunitomo Kotaro , Nagano Hiroyuki , Shimizu Taro , Watari Takashi
Published: June 2024

Background

Manual chart review using validated assessment tools is a standardised methodology for detecting diagnostic errors. However, this requires considerable human resources and time. ChatGPT, a recently developed artificial intelligence chatbot based on a large language model, can effectively classify text based on suitable prompts. Therefore, ChatGPT can assist manual chart reviews in detecting diagnostic errors.

Objective

This study aimed to clarify whether ChatGPT could correctly detect diagnostic errors and possible factors contributing to them based on case presentations.

Methods

We analysed 545 published case reports that included diagnostic errors. We imputed the texts of case presentations and the final diagnoses with some original prompts into ChatGPT (GPT-4) to generate responses, including the judgement of diagnostic errors and contributing factors of diagnostic errors. Factors contributing to diagnostic errors were coded according to the following three taxonomies: Diagnosis Error Evaluation and Research (DEER), Reliable Diagnosis Challenges (RDC) and Generic Diagnostic Pitfalls (GDP). The responses on the contributing factors from ChatGPT were compared with those from physicians.

Results

ChatGPT correctly detected diagnostic errors in 519/545 cases (95%) and coded statistically larger numbers of factors contributing to diagnostic errors per case than physicians: DEER (median 5 vs 1, p<0.001), RDC (median 4 vs 2, p<0.001) and GDP (median 4 vs 1, p<0.001). The most important contributing factors of diagnostic errors coded by ChatGPT were ‘failure/delay in considering the diagnosis’ (315, 57.8%) in DEER, ‘atypical presentation’ (365, 67.0%) in RDC, and ‘atypical presentation’ (264, 48.4%) in GDP.

Conclusion

ChatGPT accurately detects diagnostic errors from case presentations. ChatGPT may be more sensitive than manual reviewing in detecting factors contributing to diagnostic errors, especially for ‘atypical presentation’.
Does electronic data collection perform better than paper-based data collection in health research fieldwork? A participatory action research in Zanzibar
Authors: Othman Omar Juma , Mashayo Eden , Jones Jamison , Shah Kajal , Graham Christine , Yong Ai Chee , Graham Ronnie , Omar Fatma , Chan Ving Fai
Published: June 2024

Introduction

Technological advancement in low-resource settings is opening the gateway to implementation of electronic data collection methods that improve data quality. We examined the concerns to use electronic data collection tool in Zanzibar, codeveloped a tool that addressed the concerns and evaluated the process and limitations of incorporating an electronic data collection tool aside from paper-based during a community-based study in Zanzibar.

Methods

The science of improvement Plan-Do-Study-Act model guided this mixed-method participatory action research (PAR). From November 2022 to October 2023, 14 data collection team members participated in (1) a consultative workshop with a fishbone analysis to understand their hesitance to use electronic data collection tools for fieldwork (Plan); (2) developing implementation and evaluation plan for the paper-based method (Do); (3) assessing the proportion of errors and challenges faced using paper-based method (Study); and (4) codeveloping, implementing and assessing an electronic data collection tool (Act).

Results

Stakeholders were hesitant to use electronic data collection tools because of fear of lost data due to poor internet, insufficient competency with technology due to lack of training, unfamiliarity with technology in general and fear of lost wages. The study revealed that using a paper-based data collection tool during baseline was time-consuming, with 12.8% of responses being errors (2611 errors out of 20 398 responses). However, once implemented, the electronic data collection application was fast and simple, with minimal errors (0.02%). Overall, there is a need to improve devices’ storage capacity devices and provide more training.

Conclusion

Using the PAR approach, we understood the concerns with electronic data collection tools, allowed the team to experience the challenges faced with the paper-based collection method, codeveloped an appropriate solution and changed their attitude towards using technology that could increase accuracy and efficiency of their fieldwork.
Evaluating COVID-19 vaccine effectiveness during pre-Delta, Delta and Omicron dominant periods among pregnant people in the U.S.: Retrospective cohort analysis from a nationally sampled cohort in National COVID Collaborative Cohort (N3C)
Authors: Qin Qiuyuan , Wilkins Kenneth , Jones Sara E , Bradwell Katie Rebecca , Chan Lauren , Sun Jing , Anzalone Jerrod , Zheng Qulu , Liebman Michael , Mariona Federico , Groene Faherty Emily A , Challa Anup P , Hill Elaine , Patel Rena C
Published: June 2024

Objectives

To evaluate the effectiveness of COVID-19 vaccinations (initial and booster) during pre-Delta, Delta and Omicron dominant periods among pregnant people via (1) COVID-19 incident and severe infections among pregnant people who were vaccinated versus unvaccinated and (2) post-COVID-19 vaccination breakthrough infections and severe infections among vaccinated females who were pregnant versus non-pregnant.

Design

Retrospective cohort study using nationally sampled electronic health records data from the National COVID Cohort Collaborative, 10 December 2020 –7 June 2022.

Participants

Cohort 1 included pregnant people (15–55 years) and cohort 2 included vaccinated females of reproductive age (15–55 years).

Exposures

(1) COVID-19 vaccination and (2) pregnancy.

Main outcome measures

Adjusted HRs (aHRs) for COVID-19 incident or breakthrough infections and severe infections (ie, COVID-19 infections with related hospitalisations).

Results

In cohort 1, 301 107 pregnant people were included. Compared with unvaccinated pregnant people, the aHRs for pregnant people with initial vaccinations during pregnancy of incident COVID-19 were 0.77 (95% CI 0.62 to 0.96) and 0.88 (95% CI 0.73 to 1.07) and aHRs of severe COVID-19 infections were 0.65 (95% CI 0.47 to 0.90) and 0.79 (95% CI 0.51 to 1.21) during the Delta and Omicron periods, respectively. Compared with pregnant people with full initial vaccinations, the aHR of incident COVID-19 for pregnant people with booster vaccinations was 0.64 (95% CI 0.58 to 0.71) during the Omicron period. In cohort 2, 934 337 vaccinated people were included. Compared with vaccinated non-pregnant females, the aHRs of severe COVID-19 infections for people with initial vaccinations during pregnancy was 2.71 (95% CI 1.31 to 5.60) during the Omicron periods.

Conclusions

Pregnant people with initial and booster vaccinations during pregnancy had a lower risk of incident and severe COVID-19 infections compared with unvaccinated pregnant people across the pandemic stages. However, vaccinated pregnant people still had a higher risk of severe infections compared with non-pregnant females.
Implementation factors of non-communicable disease policies and programmes for children and youth in low-income and middle-income countries: a systematic review
Authors: Nguyen Gina T , Gauvreau Cindy , Mansuri Nabeel , Wight Lisa , Wong Bryan , Neposlan Josh , Petricca Kadia , Denburg Avram
Published: June 2024

Introduction

Despite declared life-course principles in non-communicable disease (NCD) prevention and management, worldwide focus has been on older rather than younger populations. However, the burden from childhood NCDs has mounted; particularly in low-income and middle-income countries (LMICs). There is limited knowledge regarding the implementation of paediatric NCD policies and programmes in LMICs, despite their disproportionate burden of morbidity and mortality. We aimed to understand the barriers to and facilitators of paediatric NCD policy and programme implementation in LMICs.

Methods

We systematically searched medical databases, Web of Science and WHOLIS for studies on paediatric NCD policy and programme implementation in LMICs. Screening and quality assessment were performed independently by researchers, using consensus to resolve differences. Data extraction was conducted within the WHO health system building-blocks framework. Narrative thematic synthesis was conducted.

Results

93 studies (1992–2020) were included, spanning 86 LMICs. Most were of moderate or high quality. 78% reported on paediatric NCDs outside the four major NCD categories contributing to the adult burden. Across the framework, more barriers than facilitators were identified. The most prevalently reported factors were related to health service delivery, with system fragmentation impeding the continuity of age-specific NCD care. A significant facilitator was intersectoral collaborations between health and education actors to deliver care in trusted community settings. Non-health factors were also important to paediatric NCD policies and programmes, such as community stakeholders, sociocultural support to caregivers and school disruptions.

Conclusions

Multiple barriers prevent the optimal implementation of paediatric NCD policies and programmes in LMIC health systems. The low sociopolitical visibility of paediatric NCDs limits their prioritisation, resulting in fragmented service delivery and constraining the integration of programmes across key sectors impacting children, including health, education and social services. Implementation research is needed to understand specific contextual solutions to improve access to paediatric NCD services in diverse LMIC settings.
Sex differences in the intensity of statin prescriptions at initiation in a primary care setting
Authors: Kiss Pauline A J , Uijl Alicia , de Boer Annemarijn R , Duk Tessa C X , Grobbee Diederick E , Hollander Monika , Smits Elisabeth , Sturkenboom Miriam C J M , Peters Sanne A E
Published: June 2024

Background

Current guidelines for the prevention and management of cardiovascular diseases (CVD) provide similar recommendations for the use of statins in both women and men. In this study, we assessed sex differences in the intensity of statin prescriptions at initiation and in the achievement of treatment targets, among individuals without and with CVD, in a primary care setting.

Methods

Electronic health record data from statin users were extracted from the PHARMO Data Network. Poisson regressions were used to investigate sex differences in statin intensity and in the achievement of treatment targets. Analyses were stratified by age group, disease status and/or CVD risk category.

Results

We included 82 714 individuals (46% women) aged 40–99 years old. In both sexes, the proportion of individuals with a dispensed prescription for high-intensity statin at initiation increased between 2011 and 2020. Women were less likely to be prescribed high-intensity statins as compared with men, both in the subgroups without a history of CVD (risk ratio (RR) 0.69 (95% CI: 0.63 to 0.75)) and with CVD (RR 0.77 (95% CI: 0.74 to 0.81)). Women were less likely than men to achieve target levels of low-density lipoprotein cholesterol following statin initiation in the subgroup without CVD (RR 0.98 (95% CI: 0.97 to 1.00)) and with a history of CVD (RR 0.94 (95% CI: 0.89 to 0.98)).

Conclusion

Compared with men, women were less likely to be prescribed high-intensity statins at initiation and to achieve treatment targets, both in people without and with a history of CVD, and independent of differences in other individual and clinical characteristics.
Acute effect of an exogenous ketone monoester supplement on appetite and food intake in adults with type 2 diabetes
Authors: Oliveira Barbara , Falkenhain Kaja , Davy Brenda M. , Davy Kevin P. , Little Jonathan P.
Published: June 2024

The effects of exogenous ketones on appetite and food intake remain elusive, especially for people with type 2 diabetes (T2D). This study aimed to determine whether acute ingestion of an oral ketone monoester supplement (KME) affected appetite sensations, prospective food consumption and intake in T2D. Results showed that acute KME ingestion did not significantly alter appetite scores. However, there was a tendency for lower energy intake during an ad libitum meal 3 h following ketone ingestion compared to non-energetic placebo. Further research is warranted to understand the long-term effects of exogenous ketones for energy and macronutrient intake in T2D.
Characterizing prey fields in humpback whale foraging areas of southern British Columbia
Authors: Reidy Rhonda D. , Ens Nicholas , Gauthier Stéphane , Towers Jared R. , Cowen Laura L.E. , Juanes Francis
Published: June 2024

Humpback whales ( Megaptera novaeangliae) use southern British Columbia waters to feed, but the type and quantity of prey in many areas used for feeding is unknown. We conducted active acoustic prey mapping in 55 small grid-surveys in two regions off Vancouver Island. We quantitatively compared fish and zooplankton-dominated biomass in known feeding areas with and without foraging humpback whales, and qualitatively described the prey characteristics of the foraged areas. Surveys of the water column suggest that, on average, humpback whale foraging was associated more with increased zooplankton than fish biomass. Prey characteristics varied between the two regions (∼500 km apart), but there was no significant difference in mean backscatter strength in the actively foraged areas between the two regions. Frequency differencing discriminated between the dominant taxa in the water column, but potential epipelagic prey (<10 m) would have been omitted from analysis. However, average depth at the maximum acoustic prey detections was significantly deeper when whales were present (84 m) versus absent (60 m), suggesting predominantly subsurface foraging opportunities suitable to prey mapping.
On the Role of Nonlocal Strain Gradient Elasticity in Nonlinear Buckling of FG Porous Reinforced Curved Nanobeams Having Different Degrees of Curvature
Authors: Sahmani Saeid , Safaei Babak , Rabczuk Timon
Published: June 2024

Curved nanobeams are one of the essential components in manufacturing nano-electromechanical systems needing nonlinear stability design. In the current investigation, the nonlinear buckling characteristics of functionally graded porous reinforced curved (FGPRC) nanobeams having different degrees of curvature are analyzed by counting the higher-order gradients of the classical strain tensor as well as nonlocal-type interatomic interactions. In this regard, two independent length-scale constants within the framework of the nonlocal strain gradient theory (NSGT) of continuum elasticity are taken into account. Via employing the promising low computational cost and geometrically adaptable method of isogeometric collocation, various branches of NSGT-based equilibrium graphs of FGPRC nanobeams are plotted relevant to each considered degree of curvature. It is extrapolated that the quantity of graphene platelet (GPL) weight fraction has a negligible influence on the significance of nonlocal-type of interatomic size dependency as well as the strain gradient kind of small-scale effect in the value of the maximum deflections or lateral loads at the detected limit points, especially attributed to a higher degree of curvature. Besides, it can be remarked that, in the FGPRC nanobeam owning a small degree of curvature, lessening the quantity of porosity index results in an increment in the significance of the nonlocal-type of interatomic size dependency as well as the strain gradient kind of small-scale effect on the maximum deflection at both upper and lower limit points. However, in the FGPRC nanobeams owning medium and large degrees of curvature, it gets lesser at the upper limit point, but becomes higher at the lower limit one.