bluuebunny/crossref_metadata_2025 huggingface dataset:
Genome-wide DNA methylation risk scores for schizophrenia derived from blood and brain tissues further explain the genetic risk in patients stratified by polygenic risk scores for schizophrenia and bipolar disorder
Authors: Ohi Kazutaka , Shimada Mihoko , Soda Midori , Nishizawa Daisuke , Fujikane Daisuke , Takai Kentaro , Kuramitsu Ayumi , Muto Yukimasa , Sugiyama Shunsuke , Hasegawa Junko , Kitaichi Kiyoyuki , Ikeda Kazutaka , Shioiri Toshiki
Published: January 2024

Background

Genetic and environmental factors contribute to the pathogenesis of schizophrenia (SZ) and bipolar disorder (BD). Among genetic risk groups stratified by combinations of Polygenic Risk Score (PRS) deciles for SZ, BD and SZ versus BD, genetic SZ risk groups had high SZ risk and prominent cognitive impairments. Furthermore, epigenetic alterations are implicated in these disorders. However, it was unclear whether DNA Methylation Risk Scores (MRSs) for SZ risk derived from blood and brain tissues were associated with SZ risk, particularly the PRS-stratified genetic SZ risk group.

Methods

Epigenome-wide association studies (EWASs) of SZ risk in whole blood were preliminarily conducted between 66 SZ patients and 30 healthy controls (HCs) and among genetic risk groups (individuals with low genetic risk for SZ and BD in HCs (n=30) and in SZ patients (n=11), genetic BD risk in SZ patients (n=25) and genetic SZ risk in SZ patients (n=30)) stratified by combinations of PRSs for SZ, BD and SZ versus BD. Next, differences in MRSs based on independent EWASs of SZ risk in whole blood, postmortem frontal cortex (FC) and superior temporal gyrus (STG) were investigated among our case‒control and PRS-stratified genetic risk status groups.

Results

Among case‒control and genetic risk status groups, 33 and 351 genome-wide significant differentially methylated positions (DMPs) associated with SZ were identified, respectively, many of which were hypermethylated. Compared with the low genetic risk in HCs group, the genetic SZ risk in SZ group had 39 genome-wide significant DMPs, while the genetic BD risk in SZ group had only six genome-wide significant DMPs. The MRSs for SZ risk derived from whole blood, FC and STG were higher in our SZ patients than in HCs in whole blood and were particularly higher in the genetic SZ risk in SZ group than in the low genetic risk in HCs and genetic BD risk in SZ groups. Conversely, the MRSs for SZ risk based on our whole-blood EWASs among genetic risk groups were also associated with SZ in the FC and STG. There were no correlations between the MRSs and PRSs.

Conclusions

These findings suggest that the MRS is a potential genetic marker in understanding SZ, particularly in patients with a genetic SZ risk.
Poor haemorrhagic stroke outcomes during the COVID-19 pandemic are driven by socioeconomic disparities: analysis of nationally representative data
Authors: Bako Abdulaziz T , Potter Thomas , Pan Alan P , Borei Karim A , Prince Taya , Britz Gavin W , Vahidy Farhaan S
Published: January 2024

Background

Nationally representative studies evaluating the impact of the COVID-19 pandemic on haemorrhagic stroke outcomes are lacking.

Methods

In this pooled cross-sectional analysis, we identified adults (≥18 years) with primary intracerebral haemorrhage (ICH) or subarachnoid haemorrhage (SAH) from the National Inpatient Sample (2016–2020). We evaluated differences in rates of in-hospital outcomes between the prepandemic (January 2016–February 2020) and pandemic (March–December 2020) periods using segmented logistic regression models. We used multivariable logistic regression to evaluate differences in mortality between patients admitted from April to December 2020, with and without COVID-19, and those admitted from April to December 2019. Stratified analyses were conducted among patients residing in low-income and high-income zip codes, as well as among patients with extreme loss of function (E-LoF) and those with minor to major loss of function (MM-LoF).

Results

Overall, 309 965 patients with ICH (47% female, 56% low income) and 112 210 patients with SAH (62% female, 55% low income) were analysed. Prepandemic, ICH mortality decreased by ~1% per month (adjusted OR, 95% CI: 0.99 (0.99 to 1.00); p<0.001). However, during the pandemic, the overall ICH mortality rate increased, relative to prepandemic, by ~2% per month (1.02 (1.00 to 1.04), p<0.05) and ~4% per month (1.04 (1.01 to 1.07), p<0.001) among low-income patients. There was no significant change in trend among high-income patients with ICH (1.00 (0.97 to 1.03)). Patients with comorbid COVID-19 in 2020 had higher odds of mortality (versus 2019 cohort) only among patients with MM-LoF (ICH, 2.15 (1.12 to 4.16), and SAH, 5.77 (1.57 to 21.17)), but not among patients with E-LoF.

Conclusion

Sustained efforts are needed to address socioeconomic disparities in healthcare access, quality and outcomes during public health emergencies.
Attitude toward career development in Japanese medical students: a questionnaire survey
Authors: Komasawa Nobuyasu , Yokohira Masanao
Published: January 2024

Objectives

The study aimed to evaluate attitudes of Japanese medical students toward career development, including the acquisition of medical specialty and doctorate degree qualifications.

Design

This involved a web-based questionnaire survey.

Setting

We asked medical students about attitudes toward career development after graduation. We also asked them about their intentions to acquire a medical specialty and a doctorate degree using a 5-point Likert scale.

Participants

All 699 medical students (from first to sixth grade) in our medical school.

Results

The overall questionnaire response rate was 66.5% (465 of 699). Over 90.3% (420 of 465) of respondents desired the clinical discipline, while only 10 of 465 respondents (2.2%) did for basic research. Awareness of career development for ≥8 years after graduation was significantly lower compared with that for 1–2 years after graduation among fourth–sixth year students (fourth p=0.0023, fifth p<0.001, sixth p<0.001). Awareness of career development for 3–7 years after graduation was significantly lower compared with that for 1–2 years after graduation among third–sixth year students (third p<0.001, fourth p=0.003, fifth p<0.001, sixth p<0.001). In the sixth year medical students, only 10.3% showed strong awareness of career development for ≥8 years after graduation, while 39.7% of them did for 1–2 years after graduation. Intentions to acquire a doctorate degree were significantly weaker than those for a medical specialty in all years (p<0.001 in all grades).

Conclusion

Most Japanese medical students concentrated on the 2-year initial training period immediately after graduation, with vague plans for the subsequent years. Intentions to acquire a doctoral degree were significantly lower than those for a medical specialty. Our findings underscore the necessity for a comprehensive, longitudinal and systematic career development programme.
Caregivers with limited language proficiency and their satisfaction with paediatric emergency care related to the use of professional interpreters: a mixed methods study
Authors: Gmünder Myriam , Gessler Noemi , Buser Sina , Feuz Ursula , Fayyaz Jabeen , Jachmann Anne , Keitel Kristina , Brandenberger Julia
Published: January 2024

Objectives

Communication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy.

Design

A mixed-methods study.

Setting

Paediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland.

Participants and methods

Caregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted.

Results

The study included 181 caregivers, 14 of whom received professional language interpretation. Caregivers who were assisted by professional interpretation services were more satisfied than those without (5.5 (SD)±1.4 vs 4.8 (SD)±1.6). Satisfaction was influenced by five main factors (relationship with health workers, patient management, alignment of health concepts, personal expectations, health outcome of the patient) which were modulated by communication. Of all LLP-caregivers without professional interpretation, 44.9% were satisfied with communication due to low expectations regarding the quality of communication, unawareness of the availability of professional interpretation and overestimation of own language skills, resulting in low self-advocacy.

Conclusion

The use of professional interpreters had a positive impact on the overall satisfaction of LLP-caregivers with emergency care. LLP-caregivers were not well—positioned to advocate for language interpretation. Healthcare providers must be aware of their responsibility to guarantee good-quality communication to ensure equitable quality of care and patient safety.
Adherence Monitoring Package (AMoPac) in patients suspected of non-response to antihypertensive treatment: perceived usefulness by general practitioners
Authors: Dietrich Fine , Zeller Andreas , Hersberger Kurt E , Arnet Isabelle
Published: January 2024

Background

Non-adherence to antihypertensive agents is common, mainly because of the low perceived burden of high blood pressure. General practitioners (GPs) are unable to predict whether patients are adhering to a recommended treatment. Knowledge about adherence might be of clinical interest in patients non-responding to antihypertensive treatment.

Aim

To assess the usefulness of an Adherence Monitoring Package (AMoPac) to identify non-adherence in patients non-responding to antihypertensive treatment.

Methods

AMoPac consists of (1) 4 weeks of electronic adherence monitoring, (2) pharmacist’s feedback on patient’s intake behaviour and (3) adherence metrics including clinical-pharmaceutical recommendations to the GP. AMoPac-HYP (‘AdherenceMonitoringPackage to identify non-adherence in ambulatoryHYPertensive patients’) is an observational study among GPs and ambulatory patients with hypertension in a real-world setting. The primary outcome was GPs’ perceived usefulness of AMoPac. Secondary outcomes were (1) frequency of medication problems and prescribing errors; (2) types of pharmacist’s’ recommendations; (3) acceptance of the recommendations by GPs; (4) medication adherence and (5) patients’ satisfaction. Outcomes are reported descriptively. Data were collected with questionnaires and electronic monitoring of medicine intake.

Results

Fifteen GPs and 15 patients with hypertension participated in the AMoPac-HYP Study. Patients were on average 62 years old, and mean blood pressure was 137/83 mmHg. All GPs rated AMoPac as useful. The most frequently mentioned use was excluding non-adherence in patients with hypertension (93%). Medication problems and prescribing errors were observed in 80% of the patients. The study pharmacist recommended adherence support (N=9 patients) and treatment optimisation (N=8 patients). The recommendations were accepted and implemented in 10 of 17 cases by the GP. Patients’ mean taking and timing adherence were 90% and 86%, respectively. Satisfaction with the study procedures among patients was high.

Conclusion

AMoPac was rated as useful for identifying and excluding non-adherence in patients with hypertension and was highly accepted among patients. Including adherence data in clinical decision-making could contribute to optimising patient care.
Standardised training for endoscopic mucosal resection of large non-pedunculated colorectal polyps to reduce recurrence (*STAR-LNPCP study): a multicentre cluster randomised trial
Authors: Meulen Lonne W T , Bogie Roel M M , Siersema Peter D , Winkens Bjorn , Vlug Marije S , Wolfhagen Frank H J , Baven-Pronk Martine , van der Voorn Michael , Schwartz Matthijs P , Vogelaar Lauran , de Vos tot Nederveen Cappel Wouter H , Seerden Tom C J , Hazen Wouter L , Schrauwen Ruud W M , Alvarez Herrero Lorenza , Schreuder Ramon-Michel M , van Nunen Annick B , Stoop Esther , de Bruin Gijs J , Bos Philip , Marsman Willem A , Kuiper Edith , de Bièvre Marc , Alderlieste Yasser A , Roomer Robert , Groen John , Bargeman Marloes , van Leerdam Monique E , Roberts-Bos Linda , Boersma Femke , Thurnau Karsten , de Vries Roland S , Ramaker Jos M , Vleggaar Frank P , de Ridder Rogier J , Pellisé María , Bourke Michael J , Masclee Ad A M , Moons Leon M G
Published: January 2024

Objective

Endoscopic mucosal resection (EMR) is the preferred treatment for non-invasive large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) but is associated with an early recurrence rate of up to 30%. We evaluated whether standardised EMR training could reduce recurrence rates in Dutch community hospitals.

Design

In this multicentre cluster randomised trial, 59 endoscopists from 30 hospitals were randomly assigned to the intervention group (e-learning and 2-day training including hands-on session) or control group. From April 2019 to August 2021, all consecutive EMR-treated LNPCPs were included. Primary endpoint was recurrence rate after 6 months.

Results

A total of 1412 LNPCPs were included; 699 in the intervention group and 713 in the control group (median size 30 mm vs 30 mm, 45% vs 52% size, morphology, site and access (SMSA) score IV, 64% vs 64% proximal location). Recurrence rates were lower in the intervention group compared with controls (13% vs 25%, OR 0.43; 95% CI 0.23 to 0.78; p=0.005) with similar complication rates (8% vs 9%, OR 0.93; 95% CI 0.64 to 1.36; p=0.720). Recurrences were more often unifocal in the intervention group (92% vs 76%; p=0.006). In sensitivity analysis, the benefit of the intervention on recurrence rate was only observed in the 20–40 mm LNPCPs (5% vs 20% in 20–29 mm, p=0.001; 10% vs 21% in 30–39 mm, p=0.013) but less evident in ≥40 mm LNPCPs (24% vs 31%; p=0.151). In a post hoc analysis, the training effect was maintained in the study group, while in the control group the recurrence rate remained high.

Conclusion

A compact standardised EMR training for LNPCPs significantly reduced recurrences in community hospitals. This strongly argues for a national dedicated training programme for endoscopists performing EMR of ≥20 mm LNPCPs. Interestingly, in sensitivity analysis, this benefit was limited for LNPCPs ≥40 mm.

Trial registration number

NTR7477.
TCCIA: a comprehensive resource for exploring CircRNA in cancer immunotherapy
Authors: Wang Shixiang , Xiong Yi , Zhang Yihao , Wang Haitao , Chen Minjun , Li Jianfeng , Luo Peng , Luo Yung-Hung , Hecht Markus , Frey Benjamin , Gaipl Udo , Li Xuejun , Zhao Qi , Ma Hu , Zhou Jian-Guo
Published: January 2024

Background

Immunotherapies targeting immune checkpoints have gained increasing attention in cancer treatment, emphasizing the need for predictive biomarkers. Circular RNAs (circRNAs) have emerged as critical regulators of tumor immunity, particularly in the PD-1/PD-L1 pathway, and have shown potential in predicting immunotherapy efficacy. Yet, the detailed roles of circRNAs in cancer immunotherapy are not fully understood. While existing databases focus on either circRNA profiles or immunotherapy cohorts, there is currently no platform that enables the exploration of the intricate interplay between circRNAs and anti-tumor immunotherapy. A comprehensive resource combining circRNA profiles, immunotherapy responses, and clinical outcomes is essential to advance our understanding of circRNA-mediated tumor-immune interactions and to develop effective biomarkers.

Methods

To address these gaps, we constructed The Cancer CircRNA Immunome Atlas (TCCIA), the first database that combines circRNA profiles, immunotherapy response data, and clinical outcomes across multicancer types. The construction of TCCIA involved applying standardized preprocessing to the raw sequencing FASTQ files, characterizing circRNA profiles using an ensemble approach based on four established circRNA detection tools, analyzing tumor immunophenotypes, and compiling immunotherapy response data from diverse cohorts treated with immune checkpoint blockades (ICBs).

Results

TCCIA encompasses over 4,000 clinical samples obtained from 25 cohorts treated with ICBs along with other treatment modalities. The database provides researchers and clinicians with a cloud-based platform that enables interactive exploration of circRNA data in the context of ICB. The platform offers a range of analytical tools, including browse of identified circRNAs, visualization of circRNA abundance and correlation, association analysis between circRNAs and clinical variables, assessment of the tumor immune microenvironment, exploration of tumor molecular signatures, evaluation of treatment response or prognosis, and identification of altered circRNAs in immunotherapy-sensitive and resistant tumors. To illustrate the utility of TCCIA, we showcase two examples, including circTMTC3 and circMGA, by employing analysis of large-scale melanoma and bladder cancer cohorts, which unveil distinct impacts and clinical implications of different circRNA expression in cancer immunotherapy.

Conclusions

TCCIA represents a significant advancement over existing resources, providing a comprehensive platform to investigate the role of circRNAs in immuno-oncology.
Why the irremediability requirement is not sufficient to deny psychiatric euthanasia for patients with treatment-resistant depression
Authors: Teo Marcus T L
Published: January 2024

Treatment-resistant depression (TRD) holds centrality in many debates regarding psychiatric euthanasia. Among the strongest reasons cited by opponents of psychiatric euthanasia is the uncertainty behind the irremediability of psychiatric illnesses. According to this argument, conditions that cannot be considered irremediable imply that there are possible remedies that remain for the condition. If there are possible remedies that remain for the condition, then patients with that condition cannot be considered for access to euthanasia. I call this the irremediability requirement (IR). I argue that patients with TRD can, indeed, meet the operationalisation of irremediability in the IR. This is because the irremediability it asks for is not some global or absolute irremediability, but rather a present irremediability based on the current state of medical science. I show this by considering irremediability relating to (1) possible future treatments and (2) not trying presently available alternative treatments. I extend Schuklenk nd van de Vathorst’s argument from parity to terminal malignancies, to show that (1) is an unreasonable expectation for all cases of euthanasia. Taking (2) as a more serious opponent to psychiatric euthanasia, I show how the IR, based on how it is presently operationalised, can be realistically applied to cases of TRD. I do this by further developing Tully’s argument on broad-sense treatment resistance with the robust empirical data from the STAR*D trials. If my argument from Tully’s is valid, then we have reasons to, again, seek parity between the operationalisations of irremediability in terminal malignancies and TRD.
Nitroglycerin use and adverse clinical outcomes in elderly patients with acute coronary syndrome
Authors: Komaki Soichi , Matsuura Yunosuke , Tanaka Hiroki , Moribayashi Kohei , Yamamura Yoshimasa , Kurogi Kazumasa , Ideguchi Takeshi , Yamamoto Nobuyasu , Nakai Michikazu , Tsuruda Toshihiro , Kaikita Koichi
Published: January 2024

Objective

The primary care for acute coronary syndrome (ACS) includes the administration of nitroglycerin (GTN). This study aimed to investigate the association between the use of GTN before percutaneous coronary intervention (PCI) for ACS and clinical outcomes.

Methods

Nine-hundred and forty-seven patients who underwent PCI for ACS were examined and classified into two groups: those who were treated with GTN before PCI (GTN group) and those who were not (non-GTN group). The incidence of major adverse cardiovascular events (MACE), which consist of all-cause mortality, non-fatal myocardial infarction, stroke and rehospitalisation for heart failure at 1 year, was compared between the two groups.

Results

This study identified 289 patients with ACS who used GTN preceding PCI. Pre-PCI systolic blood pressure was significantly lower in the GTN group than in the non-GTN group (median (IQR); 132.0 (110.0–143.5) mm Hg vs 134.0 (112.0–157.0) mm Hg, respectively, p=0.03). Multivariate Cox regression analysis indicated that GTN use preceding PCI showed an independent association with the incidence of MACE (HR 1.57; 95% CI 1.09–2.28; p=0.016). Overall, the incidence of MACE 1 year after PCI for ACS was significantly higher in the GTN group than in the non-GTN group (log-rank test, p=0.024); however, this trend was consistently found in elderly patients aged ≥75 years (p=0.002) but not in non-elderly patients aged <75 years (p=0.773).

Conclusions

GTN use preceding PCI for ACS is associated with lower blood pressure and adverse clinical outcomes in elderly patients.
Fluoroquinolones do not provide added risk of out-of-hospital cardiac arrest: a nationwide study
Authors: Ellenardóttir Viktoría , Coronel Ruben , Folke Fredrik , Halili Andrim , Arulmurugananthavadivel Anojhaan , Parveen Saaima , Andersen Mikkel Porsborg , Schou Morten , Torp-Pedersen Christian , Gislason Gunnar , Eroglu Talip E
Published: January 2024

Aim

Conflicting results have been reported regarding the association between fluoroquinolones (FQs) and the risk of out-of-hospital cardiac arrest (OHCA). In particular, it has not become clear whether OHCA in FQ users is related to the inherent comorbidities or whether there is a direct pro-arrhythmic effect of FQs. Therefore, we studied the relation between FQs and OHCA in the general population.

Methods

Through Danish nationwide registries, we conducted a nested case–control study with OHCA cases of presumed cardiac causes and age/sex/OHCA date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the OR with 95% CI of OHCA comparing FQs with amoxicillin.

Results

The study population consisted of 46 578 OHCA cases (mean: 71 years (SD: 14.40), 68.8% men) and 232 890 matched controls. FQ was used by 276 cases and 328 controls and conferred no increase in the odds of OHCA compared with amoxicillin use after controlling for the relevant confounders (OR: 0.91 (95% CI: 0.71 to 1.16)). The OR of OHCA associated with FQ use did not vary significantly by age (OR≤65: 0.96 (95% CI: 0.53 to 1.74), OR>65: 0.88 (95% CI: 0.67 to 1.16), p value interaction=0.7818), sex (ORmen: 0.96 (95% CI: 0.70 to 1.31), ORwomen: 0.80 (95% CI: 0.53 to 1.20), p value interaction=0.9698) and pre-existing cardiovascular disease (ORabsent: 1.02 (95% CI: 0.57 to 1.82), ORpresent: 0.98 (95% CI: 0.75 to 1.28), p value interaction=0.3884), including heart failure (ORabsent: 0.93 (95% CI: 0.72 to 1.22), ORpresent: 1.11 (95% CI: 0.61 to 2.02), p value interaction=0.7083) and ischaemic heart disease (ORabsent: 0.85 (95% CI: 0.64 to 1.12), ORpresent: 1.38 (95% CI: 0.86 to 2.21), p value interaction=0.6230).

Conclusion

Our findings do not support an association between FQ exposure and OHCA in the general population. This lack of association was consistent in men and women, in all age categories, and in the presence or absence of cardiovascular disease.
Determination of the factors associated with antigen-specific CD4+ T-cell responses to BNT162b2 in patients with rheumatoid arthritis
Authors: Sagawa Fumiaki , Yamada Hisakata , Ayano Masahiro , Kimoto Yasutaka , Mitoma Hiroki , Ono Nobuyuki , Arinobu Yojiro , Kondo Masakazu , Nakashima Yasuharu , Akashi Koichi , Horiuchi Takahiko , Niiro Hiroaki
Published: January 2024

Objectives

Understanding interpatient variation in CD4+T-cell responses is the bases for understanding the pathogenesis and management of rheumatoid arthritis (RA). We examined immune responses to SARS-CoV-2 vaccine in a cohort of patients with RA and determined factors associated with the responses.

Methods

Four hundred and thirty-one patients with RA having received two doses of BNT162b2, a messenger RNA-based vaccine for SARS-CoV-2, were included. Vaccine antigen-specific IgG was detected by ELISA, and antigen-specific CD4+T cells were detected by CD154 expression in response to antigenic stimulation. Expression of cytokines was concomitantly detected by intracellular staining. Associations among background variables, antigen-specific antibody production and the CD4+T-cell responses were analysed. Unsupervised hierarchical clustering was performed based on the profiles of antigen-specific cytokine production by CD4+T cells to stratify patients with RA.

Results

Multivariate analysis indicated that ageing negatively affects CD4+T-cell response as well as antibody production. No association was detected between the presence or the levels of rheumatoid factor/anti-cyclic citrullinated peptide antibody and anti-vaccine immune responses. Methotrexate and prednisolone reduced B cell but not T-cell responses. Conventional immunophenotyping by the expression of chemokine receptors was not associated with the actual CD4+T-cell response, except for T helper cells (Th1). Functional immunophenotyping based on the profiles of antigen-specific cytokine production of CD4+T cells stratified patients with RA into three clusters, among which Th1-dominant type less frequently underwent joint surgery.

Conclusions

Clinical and immunological variables that are associated with antigen-specific CD4 T-cell responses in patients with RA were determined by analysing immune responses against SARS-CoV-2 vaccine.
Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome
Authors: Wohlgemut Jared M , Pisirir Erhan , Stoner Rebecca S , Kyrimi Evangelia , Christian Michael , Hurst Thomas , Marsh William , Perkins Zane B , Tai Nigel R M
Published: January 2024

Background

Hemorrhage is the most common cause of potentially preventable death after injury. Early identification of patients with major hemorrhage (MH) is important as treatments are time-critical. However, diagnosis can be difficult, even for expert clinicians. This study aimed to determine how accurate clinicians are at identifying patients with MH in the prehospital setting. A second aim was to analyze factors associated with missed and overdiagnosis of MH, and the impact on mortality.

Methods

Retrospective evaluation of consecutive adult (≥16 years) patients injured in 2019–2020, assessed by expert trauma clinicians in a mature prehospital trauma system, and admitted to a major trauma center (MTC). Clinicians decided to activate the major hemorrhage protocol (MHPA) or not. This decision was compared with whether patients had MH in hospital, defined as the critical admission threshold (CAT+): administration of ≥3 U of red blood cells during any 60-minute period within 24 hours of injury. Multivariate logistical regression analyses were used to analyze factors associated with diagnostic accuracy and mortality.

Results

Of the 947 patients included in this study, 138 (14.6%) had MH. MH was correctly diagnosed in 97 of 138 patients (sensitivity 70%) and correctly excluded in 764 of 809 patients (specificity 94%). Factors associated with missed diagnosis were penetrating mechanism (OR 2.4, 95% CI 1.2 to 4.7) and major abdominal injury (OR 4.0; 95% CI 1.7 to 8.7). Factors associated with overdiagnosis were hypotension (OR 0.99; 95% CI 0.98 to 0.99), polytrauma (OR 1.3, 95% CI 1.1 to 1.6), and diagnostic uncertainty (OR 3.7, 95% CI 1.8 to 7.3). When MH was missed in the prehospital setting, the risk of mortality increased threefold, despite being admitted to an MTC.

Conclusion

Clinical assessment has only a moderate ability to identify MH in the prehospital setting. A missed diagnosis of MH increased the odds of mortality threefold. Understanding the limitations of clinical assessment and developing solutions to aid identification of MH are warranted.

Level of evidence

Level III—Retrospective study with up to two negative criteria.

Study type

Original research; diagnostic accuracy study.
Assessment of inter-regional dietary differences in anadromous Arctic char (Salvelinus alpinus) in Nunavik, Canada, and links with flesh quality indicators
Authors: Bolduc Sara , Lemire Mélanie , Tremblay Jean-Éric , Falardeau Marianne , Dallaire Xavier , Brochu Mylène , Legros Justine , Moore Jean-Sébastien
Published: January 2024

Arctic char ( Salvelinus alpinus) is a salmonid fish that is the second-most consumed country food species by Nunavimmiut. Its nutritional quality is determined by omega-3 fatty acids and carotenoid pigments. Those molecules cannot be synthetized by fish and must be acquired through diet. We sampled Arctic char in 10 rivers from the three marine coastal regions of Nunavik (Hudson Bay, Hudson Strait, and Ungava Bay), described diet (stable isotopes δ13C and δ15N) and flesh quality (fatty acids and carotenoids, measured by chromatography) and assessed associations between both diet and flesh quality (including also bio-impedance and colorimetry). Our results suggested inter-regional differences in the diet and nutritional quality of Arctic char in Nunavik, where δ13C values indicated that the diet of Arctic char in Hudson Bay was more pelagic, while in Ungava Bay it was more coastal. We also observed inter-regional differences in omega-3 fatty acids and astaxanthin, the pigment responsible for the redness of the flesh color, where concentrations were highest in Ungava Bay Arctic char. In all sampling locations, Arctic char were an exceptional source of omega-3 fatty acids and astaxanthin, confirming its importance as a high-quality wild food. Our models suggest that astaxanthin, canthaxanthin, and water content influence flesh redness. Our data highlight inter-regional differences that could be taken in consideration to better predict the impact of climate change on fish quality and, ultimately, on Inuit diet and health.
A typology of Inuit youth engagement in environmental research
Authors: Sadowsky Hilary C. , Brunet Nicolas , Anaviapik Alex , Kublu Abraham , Longboat Sheri , Henri Dominique A.
Published: January 2024

The roles of Indigenous youth in environmental research remain largely unexplored with little practical guidance for achieving meaningful engagement in environmental research. This paper aims to characterize the varying types of Inuit youth engagement in environmental research conducted in Inuit Nunangat. Findings were derived from a community-engaged participatory research approach in Mittimatalik (Pond Inlet, Nunavut). Our typology of Inuit youth engagement in environmental research suggests three types of engagements: “participate”, “conduct”, and “control”. Results highlight that Inuit youth who are interested in undertaking their own environmental research projects expect to enhance their knowledge of natural and life sciences more than those who may seek short-term supportive research roles. Strategies employed by researchers seeking to enhance youth research capacity may also vary based on youth wants and expectations. Our findings suggest that there is no one-size-fits all solution. None of the engagement types identified were necessarily and inherently considered better than the others by project contributors, unlike what has been proposed in other, hierarchical, typologies. Our proposed typology contributes to a better understanding of the varying roles that Inuit youth can play in environmental research, as well as inform potential frameworks for enhancing Inuit youth engagement and leadership in research.
From macro-morphology to micro-mechanics: a deep dive into hydraulic fracturing of compacted bentonite
Authors: Li Kun-peng , Chen Yong-gui , Ye Wei-min , Wang Qiong
Published: January 2024

A series of injection tests with compacted Gaomiaozi bentonite of varying dry density were performed using an innovative testing apparatus for hydraulic fracturing visualization, with emphases placed on fracturing macro-morphological dynamics and micro-mechanical mechanisms. Results showed that fracturing dynamics mainly consisted of three stages, namely the hydrating stage, the cracking stage, and the fracturing stage. As dry density increased, the circular hydration zone expanded, the cracking network became more intricate, and the fracturing pattern transitioned from long and clear to short and fuzzy. Breakthrough time and breakthrough pressure increased exponentially with increasing dry density, while injection rate decreased exponentially and breakthrough water volume increased linearly. The fracturing mechanism in compacted bentonite was turning from tensile to shear mode with increasing dry density. By comparing the shear strength with the sum of swelling pressure and tensile strength, a simple criterion for determining the limit state between tensile and shear modes was established, which can be popularized in other soils without swelling potential but under different confining pressures. Finally, a novel calculation method for breakthrough pressure was proposed based on cavity expansion theory, taking into account swelling effects and fracturing failure modes.
Sedimentary characteristics, lithofacies, and paleogeography of the Middle–Lower Cambrian in the Tarim Basin, NW China
Authors: Ji Tianyu , Yang Wei , Wu Xueqiong , Li Dejiang , Liu Mancang , Song Chengpeng , Chen Xi
Published: January 2024

The Cambrian pre-salt dolomite sequence in the Tarim Basin is a target zone of great strategic significance for hydrocarbon exploration in the basin. Using the results of the interpretation of 3D seismic data from Lunnan and 2D seismic data covering the whole basin, and based on a synthesis of outcrop data, drilling data, well logs, core data, and thin-section data, and the findings from previous studies, this paper studies the characteristics of the facies of the Middle–Lower Cambrian in the platform area in the Tarim Basin, the formation and evolution of platform margins, and the sedimentary characteristics, lithofacies, and paleogeographic characteristics of the Middle–Lower Cambrian series. Based on the types of lithofacies and the seismic facies analysis, the sedimentary facies of the Middle–Lower Cambrian strata can be classified into the five types. From bottom to top, the Middle–Lower Cambrian have experienced several development stages, including the deposition of continental shelf sediments of the Yuertusi Formation, gently sloping non-rimmed platform margin sediments of the Xiaoerbulake Formation, weakly rimmed platform margin sediments of the Wusongger and Shayilike formations, and strongly rimmed platform margin sediments of the Awatage Formation. In each stage, the platform margin shifted further east relative to its location in the previous stage. Based on these results and previous studies, the lithofacies and paleogeography maps of the Middle–Lower Cambrian in the Tarim Basin are modified, and the implications for hydrocarbon exploration in this area are discussed.
Some curvature properties of spherically symmetric Finsler metrics
Authors: Tayebi Akbar , Eslami Faezeh
Published: January 2024

In this paper, we study some important Remannian and non-Riemannian curvature properties of spherically symmetric Finsler metrics. Under a condition on the geodesic coefficient, we find the necessary and sufficient conditions under which spherically symmetric metrics are of scalar flag curvature, [Formula: see text]-quadratic or projectively Ricci-flat. For spherically symmetric metrics of relatively isotropic Landsberg curvature, we find the necessary and sufficient conditions under which these metrics are of constant flag curvature or Ricci-quadratic. Finally, we prove a rigidity result that every spherically symmetric metric of relatively isotropic Landsberg curvature is Ricci-quadratic if and only if it is a Berwald metric. Moreover, if the Finsler metric is negatively complete then it reduces to a Riemannian metric.
BOARD GENDER DIVERSITY AND FINANCIAL INCLUSION: EVIDENCE FROM THE GLOBAL MICROFINANCE INDUSTRY
Authors: SANGWAN SUNIL , KUMAR SANJEEV , MIA MD ASLAM , CHAUHAN SWATI , JIBIR ADAMU
Published: January 2024

This study examines the effect of board gender diversity within Microfinance Institutions (MFIs) on their ability to acquire new borrowers, a key indicator of progress toward achieving the financial inclusion agenda of the Sustainable Development Goals (SDGs). Utilizing an unbalanced panel dataset consisting of 1,450 unique MFIs operating in 106 countries over the period of 2010–2018, this study deployed various econometric models, including the Pooled Ordinary Least Squares (POLS), Random Effects Model (REM), and Fixed Effects Model (FEM). Rigorous measures, including endogeneity-corrected techniques, alternative proxies for board gender diversity such as the BLAU index and sub-sample analyses were applied to ensure the reliability and robustness of our results. The study’s findings indicated a positive association between board gender diversity and financial inclusion within MFIs. However, the statistical significance of these outcomes varied depending on the specific analytical techniques, sub-samples, and alternative proxies used during the research. Overall, this study offers implications for practitioners and policymakers, encouraging women’s participation in the boardrooms of MFIs to advance the financial inclusion agenda of the SDGs.
UTILITARIANISM: OVERCOMING THE DIFFICULTY OF INTERPERSONAL COMPARISON
Authors: NG YEW-KWANG
Published: January 2024

Argenziano and Gilboa ( 2019 ) obtain a very important result “that consumer choice data alone are sufficient … [to] provide a microfoundation for a weighted utilitarian social welfare function that reflects common moral intuitions about interpersonal comparisons of utilities”. This paper compares this result with my 1975 Review of Economic Studies paper and examines the sense in which consumer data alone are sufficient. A way to dispense with interpersonal comparisons of utility in specific issues by following efficiency supremacy is also discussed. The suspicion of interpersonal comparison and utilitarianism may be based on misunderstandings.
MACROPRUDENTIAL POLICIES AND BANK RISK: DOES LANGUAGE MATTER?
Authors: GHOSH SAIBAL
Published: January 2024

The role of macroprudential policies (MPPs) in influencing bank behavior has expanded significantly in recent years. However, the evidence regarding the impact of MPPs in influencing bank behavior across countries with different Future time reference (FTR) of languages has not been adequately examined. To inform this debate, utilizing bank-level data during 2010–2019, we examine how MPPs affect bank return and risk across countries with varying FTR of languages. The findings show that using MPPs lowers risk in countries with strong FTR. This is manifest in baseline regressions as well as in robustness tests that incorporate additional dimensions of a country’s economic and institutional environment. Over and above, the results show that although borrower- and lender-focused macroprudential measures are equally effective, their efficacy differs, with the former set of instruments being more useful in Emerging Market and Developing Economies (EMDEs). In contrast, the latter holds greater traction in advanced economies.
Strategic Technology Innovation of a Basic Product in an E-Commerce Platform Supply Chain with a Potential Entrant in a Complementary Goods Market
Authors: Shang Beibei , Nie Jiajia , Guo Qiang , Xu Xiaoxuan
Published: January 2024

This paper examines the impact of a potential entrant’s entry into the complementary goods market on the technology innovation of the basic product. We focus on an e-commerce platform supply chain comprising a manufacturer, an e-commerce platform, and a potential entrant. The manufacturer distributes a basic product and a complementary product through the e-commerce platform. The manufacturer has the option to improve the quality of the basic product through technology innovation. The determination of whether the potential entrant enters the market for complementary goods is contingent upon its observation of the manufacturer’s technology innovation strategy. Upon the potential entrant’s entry into this market, competition ensues between the potential entrant and the manufacturer in the realm of the complementary goods market. Our findings reveal a trade-off: on the one hand, the manufacturer’s decision to forgo technology innovation results in reduced profit, while, on the other hand, technology innovation attracts the potential competitor to enter the complementary goods market, which also leads to decreased profit. Under certain circumstances, the loss incurred by the former is less than that incurred by the latter. Consequently, the manufacturer may choose to forego technology innovation to prevent the entry of the potential entrant in the complementary goods market. Furthermore, our study demonstrates that the entry of the potential entrant can yield a mutually beneficial outcome for the manufacturer, the platform, and the potential entrant, creating a win–win–win scenario. In addition, our results suggest that as the production cost of innovative products rises, the manufacturer may have a stronger incentive to intensify its innovation efforts in response to the potential entrant’s exit from the market. Finally, we establish that our main results remain robust even when some of our initial assumptions are relaxed.
An Orthonormalization-Free and Inversion-Free Algorithm for Online Estimation of Principal Eigenspace
Authors: Zhou Siyun , Xu Liwei
Published: January 2024

In this paper, we study the problem of estimating the principal eigenspace over an online data stream. First-order optimization methods are appealing choices for this problem thanks to their high efficiency and easy implementation. The existing first-order solvers, however, require either per-step orthonormalization or matrix inversion, which empirically puts pressure to the parameter tuning, and also incurs extra costs of rank augmentation. To get around these limitations, we introduce a penalty-like term controlling the distance from the Stiefel manifold into matrix Krasulina’s method, and propose the first orthonormalization- and inversion-free incremental PCA scheme (Domino). The Domino is shown to achieve the computational speed-up, and own the ability of automatic correction on the numerical rank. It also maintains the advantage of Krasulina’s method, e.g., variance reduction on low-rank data. Moreover, both of the asymptotic and non-asymptotic convergence guarantees are established for the proposed algorithm.
A novel quantum ring signature based on secret sharing
Authors: Wei Xing-Jia , Lu Dian-Jun , Luo Shuang-Shuang , Li Zhi-Hui
Published: January 2024

Quantum signature has become a hot topic in the current research of digital signature schemes due to its unconditional security. As a special kind of digital signature, ring signatures are frequently employed in practical situations because of their superior anonymity. In this work, we propose a quantum ring signature scheme based on secret sharing that does not use entanglement states. To guarantee the complete security of the participants’ secret keys, the idea of secret sharing is incorporated into the quantum key distribution process during the key distribution stage. Each ring member contributes his private key share to the final verification formula through a recursive relationship throughout the signing and verification phases, and the verifier can utilize his private key share along with the user’s public key to confirm the ring members’ authenticity; The [Formula: see text]-AS2U hash function is used to encrypt the ring signer’s identity during the entire signature process, which assures the signer’s identity’s complete anonymity, effectively protects the signer’s privacy, and is more in line with practical requirements.
Mechanical and dynamical stability, electronic, magnetic, and thermoelectric properties of RbBaX (X=Si and Ge) half-Heusler compounds
Authors: Boudjeltia Mohammed Amine , Terkhi Mohamed Cherif , Aziz Zoubir , Bennani Mohammed Abderrahim , Bouadjemi Bouabdellah
Published: January 2024

This research paper explores the structural, electronic, magnetic, elastic, dynamic, and thermoelectric properties of sp-based half-Heusler (HH) RbBaX ([Formula: see text] and Ge) compounds using density functional theory (DFT) and the full-potential linearized augmented plane wave (FP-LAPW) method within the WIEN2k software package. We evaluate the exchange correlation potential using two different approaches: The generalized gradient approximation (GGA) and the modified Becke–Johnson approach. We observe that RbBaX ([Formula: see text] and Ge) adopts a ferromagnetic configuration based on the analysis of total energy against volume. We establish that these alloys possess a genuine half-metallic character because of the full spin polarization observed at the Fermi level in their electronic spectrum. Both compounds under investigation have a total magnetic moment of 1.00[Formula: see text][Formula: see text]B, in agreement with the Slater–Pauling principle. The Born stability criteria for cubic structures and phonon dispersion patterns confirm the mechanical and dynamic stability of RbBaX ([Formula: see text] and Ge) alloys. The thermoelectric properties reveal a p-type semiconductor nature, characterized by significant positive Seebeck values. The thermoelectric figure of merit (ZT) calculated for both alloys at 300[Formula: see text]K approaches unity, highlighting their remarkable thermoelectric efficiency.
A Deep Neural Network-Based Intelligent Forecasting Approach for Multi-Dimensional Economic Indexes in Smart Cities
Authors: Chen Zhuo , Peng Wei , Yao Xuesong
Published: January 2024

Intelligent forecasting of economic indexes has been an important demand for sustainable management of smart cities. Existing methods for this purpose were mostly established upon the basis of economic mechanism. Econometric models are the most general technical means in this area. However, in era of digital economy, increasing amount of big data has brought great change to traditional production. It is becoming more difficult for conventional technological forecasting methods to deal with multi-dimensional economic indexes. To deal with such challenge, this paper introduces the artificial intelligence algorithms to implement automatic information processing, and proposes a deep neural network-based intelligent forecasting method for multi-dimensional economic indexes in smart cities. Specifically, a deep neural network with three-layer structure is developed as the backbone methodology. For empirical analysis, the real-world data from “Chengdu–Chongqing Economic Circle” in China from 2012 to 2022 are selected as the main simulation scenario. Four major indexes are selected as the main research object: gross product (GDP), per capita GDP, GDP growth rate and the proportion of tertiary industry in GDP. The experimental results show that the proposal can well deal with such forecasting problem from a data-driven perspective, with a proper forecasting effect on historical data.