bluuebunny/crossref_metadata_2025 huggingface dataset:
Elucidation of the needs for telecritical care services in Japan: a qualitative study
Authors: Morimoto Mizuki , Nawa Nobutoshi , Okada Eriko , Itsui Yasuhiro , Kashimada Ayako , Yamamoto Kouhei , Akaishi Yu , Yamawaki Masanaga
Published: November 2023

Objective

To clarify the reasons for consultation, advice sought by frontline physicians and relationship between the patient’s pathology and the type of advice provided to guide the future development of telecritical care services.

Design

Secondary analysis of transcripts of telephone calls originally recorded for quality control purposes was conducted using a thematic content analysis. The calls were conducted between December 2019 and April 2021 (total cases: 70; total time: ~15 hour).

Settings

Intensivists provided consultation services to frontline physicians at secondary care institutions in the Kansai and Chubu regions.

Participants

Non-intensive care frontline physicians working in five secondary care institutions in the Kansai and Chubu regions and intensivists providing a consultation service (n=26).

Interventions

Not applicable.

Primary and secondary outcome measures

The main outcome was the themes emerging from the language used during telephone and video consultations, indicating the gap filled by the telecritical care service.

Findings

We analysed 70 cases and approximately 15 hours of anonymised audio data. We identified the following reasons for consultation: ‘lack of competence in treatment and diagnostic testing’ and ‘lack of access to consultation in their own hospital’. Frontline physicians most often sought advice related to ‘treatment’, followed by ‘patient triage and transfer’, ‘diagnosis’ and ‘diagnostic testing and evaluation’. Regarding the relationship between the patient’s pathology and type of advice provided, the most commonly sought advice by frontline physicians varied based on the patient’s pathology.

Conclusion

This study explored the characteristics of 70 telecritical sessions and identified the reasons for and nature of the consultations. These findings can be used to guide the future provision and scale up of telecritical services.
Health-related quality of life and its changes of the Tibetan population in China: based on the 2013 and 2018 National Health Services Surveys
Authors: Dou Lei , Shi Zhao , Cuomu Zhaxi , Zhuoga Cidan , Li Chaofan , Dawa Zhaxi , Li Shunping
Published: November 2023

Objective

Health-related quality of life (HRQoL) was an important health outcome measure for evaluating an individual’s overall health status. However, there was limited in the literature on HRQoL and its long-term changes of the Tibetan population. This study aimed to assess HRQoL of Tibetan and its changes over time, and explore the differences in HRQoL for residents at different altitudes.

Design

Data for the cross-sectional study were extracted from the fifth and sixth waves of the National Health Services Surveys which were conducted in 2013 and 2018. A multistage stratified cluster random sampling strategy was used to select representative participants.

Setting

Tibet Autonomous Region in China.

Participants

This study recruited 14 752 participants in 2013 and 13 106 participants in 2018, and after excluding observations with missing values for key variables, 10 247 in 2013 and 6436 in 2018 were included in the study analysis.

Primary and secondary outcome measures

The EQ-5D-3L was used to measure participants’ HRQoL.

Results

The mean health state utility scores of the participants were 0.969±0.078 and 0.966±0.077 in 2013 and 2018, respectively. Pain/discomfort was the most frequently prevalent issue reported in 18.1% and 17.9% of the participants in 2013 and 2018, respectively. Tibetans living 3500–4000 m altitude had the best HRQoL. Age, sex, employment status, educational attainment, chronic disease and weekly physical exercise were influencing factors associated with HRQoL.

Conclusions

The HRQoL of the Tibetan population was lower than the general Chinese population, and decreased over time between 5 years. There were differences in HRQoL among Tibetan at different altitudes, with residents living at 3500–4000 m having the best quality of life. More attention should be paid to those Tibetans who are older, female, unemployed and without formal education.
Talking numbers: how women and providers use risk scores during and after risk counseling – a qualitative investigation from the NRG Oncology/NSABP DMP-1 study
Authors: Blakeslee Sarah B , Gunn Christine M , Parker Patricia A , Fagerlin Angela , Battaglia Tracy , Bevers Therese B , Bandos Hanna , McCaskill-Stevens Worta , Kennedy Jennifer W , Holmberg Christine
Published: November 2023

Objectives

Little research exists on how risk scores are used in counselling. We examined (a) how Breast Cancer Risk Assessment Tool (BCRAT) scores are presented during counselling; (b) how women react and (c) discuss them afterwards.

Design

Consultations were video-recorded and participants were interviewed after the consultation as part of the NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project 1 (NSABP DMP-1).

Setting

Two NSABP DMP-1 breast cancer care centres in the USA: one large comprehensive cancer centre serving a high-risk population and an academic safety-net medical centre in an urban setting.

Participants

Thirty women evaluated for breast cancer risk and their counselling providers were included.

Methods

Participants who were identified as at increased risk of breast cancer were recruited to participate in qualitative study with a video-recorded consultation and subsequent semi-structured interview that included giving feedback and input after viewing their own consultation. Consultation videos were summarised jointly and inductively as a team.tThe interview material was searched deductively for text segments that contained the inductively derived themes related to risk assessment. Subgroup analysis according to demographic variables such as age and Gail score were conducted, investigating reactions to risk scores and contrasting and comparing them with the pertinent video analysis data. From this, four descriptive categories of reactions to risk scores emerged. The descriptive categories were clearly defined after 19 interviews; all 30 interviews fit principally into one of the four descriptive categories.

Results

Risk scores were individualised and given meaning by providers through: (a) presenting thresholds, (b) making comparisons and (c) emphasising or minimising the calculated risk. The risk score information elicited little reaction from participants during consultations, though some added to, agreed with or qualified the provider’s information. During interviews, participants reacted to the numbers in four primary ways: (a) engaging easily with numbers; (b) expressing greater anxiety after discussing the risk score; (c) accepting the risk score and (d) not talking about the risk score.

Conclusions

Our study highlights the necessity that patients’ experiences must be understood and put into relation to risk assessment information to become a meaningful treatment decision-making tool, for instance by categorising patients’ information engagement into types.

Trial registration number

NCT01399359.
Protocol for SNOTOB study: radical prostatectomy without prostate biopsy following18F-PSMA-1007 PET/CT based on a diagnostic model: a single-centre, single-arm, open-label study
Authors: Wang Changming , Dong Qifei , Liu Xuehan , Ni Ming , Xie Qiang , Xiao Jun , Tao Tao
Published: November 2023

Introduction

Nowadays, invasive prostate biopsy is the standard diagnostic test for patients with suspected prostate cancer (PCa). However, it has some shortcomings such as perioperative complications, economic and psychological burden on patients, and some patients may undergo repeated prostate biopsy. In this study protocol, our aim is to provide a non-invasive diagnostic strategy we call the ‘prostate-specific membrane antigen (PSMA) combined model’ for the diagnosis of PCa. If patients are diagnosed with PCa using PSMA combined model, we want to prove these patients can receive radical prostatectomy directly without prior prostate biopsies.

Methods

The SNOTOB trial adopts a prospective, single-centre, single-arm, open-label study design. The PSMA combined model consists of a diagnostic model based on what we previously reported and18F-PSMA-1007 positron emission tomography/CT (18F-PSMA-1007 PET/CT) examinations in series. First, patients use the diagnostic model (online address:https://ustcprostatecancerprediction.shinyapps.io/dynnomapp/) to calculate the risk probability of clinically significant PCa (csPCa). When the risk probability of csPCa is equal or greater than 0.60,18F-PSMA-1007 PET/CT will be applied for further diagnosis. If patients are still considered as csPCa after18F-PSMA-1007 PET/CT examinations, we define this condition as positive results of PSMA combined model. Subsequently, we will recommend these patients to accept radical prostatectomy without prostate biopsy directly. Finally, the diagnostic performance of PSMA combined model will be verified with the pathological results. Totally, 57 patients need to be enrolled in this clinical trial.

Ethics and dissemination

This study was approved by the ethics committee of The First Affiliated Hospital of USTC (No. 2022KY-142). The results of this study will be published in peer-reviewed journals and reported at academic conferences.

Trial registration number

NCT05587192.
Prognostic significance and clinical determinants of residual dyspnoea at discharge in acute heart failure: a single-centre, prospective observational study
Authors: Garus Mateusz , Jura Maksym , Guzik Mateusz , Zymliński Robert , Iwanek Gracjan , Ponikowski Piotr , Biegus Jan
Published: November 2023

Objective

This study aimed to assess the prognostic significance of residual (discharge) dyspnoea in acute heart failure (AHF) patients.

Design

Single-centre, prospective observational study.

Setting

Patients hospitalised for decompensated AHF in a single cardiology centre, in Poland.

Participants

All patients (n=202) who survived the hospitalisation with the primary diagnosis of AHF and were discharged from the hospital.

Primary and secondary outcome measures

1-year all-cause mortality; and the composite endpoint of 1-year all-cause mortality and rehospitalisation for the HF (whichever occurred first).

Results

On admission, 159 (78.7%) AHF patients presented dyspnoea at rest, while residual resting dyspnoea at discharge was present in 16 patients (7.9%). There were 48 (24%) patients with moderate/severe exertional dyspnoea at discharge. In the multivariable model, the resting dyspnoea at discharge was related to a higher risk of both 1-year mortality and composite outcome, with HR (95% CI) 8.0 (3.7 to 17.3) and 5.1 (2.6 to 10.2), respectively, both p<0.0001. Analogically, moderate or severe residual dyspnoea at discharge was related to the heightened risk of study both outcomes, with HR (95% CI) 3.1 (1.8 to 5.4) and 1.8 (1.1 to 2.9), respectively, p<0.01.

Conclusions

Among AHF patients the residual dyspnoea at discharge was unexpectedly common and was associated with an unfavourable outcome during 1-year follow-up.
Changes in alcohol consumption according to the duration of unemployment: prospective findings from the French CONSTANCES cohort
Authors: El Haddad Rita , Meneton Pierre , Melchior Maria , Wiernik Emmanuel , Zins Marie , Airagnes Guillaume
Published: November 2023

Objectives

To prospectively examine the association between the duration of unemployment among job seekers and changes in alcohol use in a year.

Design

A prospective study.

Setting

French population-based CONSTANCES cohort.

Participants

We selected 84 943 participants from the CONSTANCES cohort included between 2012 and 2019 who, at baseline and 1-year follow-up, were either employed or job-seeking.

Outcome measures

Multinomial logistic regression models computed the odds of reporting continuous no alcohol use, at-risk alcohol use, increased or decreased alcohol use compared with being continuously at low risk and according to employment status. The duration of unemployment was self-reported at baseline; thus, the employment status at 1-year follow-up was categorised as follows: (1) employed, (2) return to employment since less than a year, (3) unemployed for less than 1 year, (4) unemployed for 1 to 3 years and (5) unemployed for 3 years or more. Analyses were adjusted for age, gender, education, household monthly income, marital status, self-rated health, smoking status and depressive state.

Results

Compared with being continuously at low risk (ie, ≤10 drinks per week), the unemployment categories were associated in a dose-dependent manner with an increased likelihood of reporting continuous no alcohol use (OR: 1.74–2.50), being continuously at-risk (OR: 1.21–1.83), experiencing an increase in alcohol use (OR: 1.21–1.51) and a decrease in alcohol use (OR: 1.17–1.84).

Conclusion

Although our results suggested an association between the duration of unemployment and a decrease in alcohol use, they also revealed associations between at-risk and increased alcohol use. Thus, screening for alcohol use among unemployed job seekers must be reinforced, especially among those with long-term unemployment.
Medication prescription profile and hospital admission related to medication administration errors in England and Wales: an ecological study
Authors: Al Shoaraa Oudai Amjad , Qadus Sami , Naser Abdallah Y
Published: November 2023

Objective

To explore the correlation between prescribing rate of medications and hospital admissions related to medications administration errors in England and Wales during the time from 1999 to 2020.

Design

An ecological study.

Setting

A population-based study using hospital admission data that are publicly available in the UK. Data in this study were extracted from the Hospital Episode Statistics database in England and the Patient Episode Database in Wales from Wales. The Prescription Cost Analysis database was used to extract the prescription data.

Participants

Patients who were hospitalised all National Health Service (NHS) trusts and any independent sector funded by NHS trusts.

Primary outcome measure

Hospitalisation rates related to medication administration errors and its associated prescriptions.

Results

The annual rate of hospital admissions related to medication administration errors increased by 32.0% (from 184.21 (95% CI 183.0 to 185.4) in 1999 to 243.18 (95% CI 241.9 to 244.4) in 2020 per 100 000 persons. The most common three indications of hospital admissions were T39 (non-opioid analgesics, antipyretics and antirheumatics), T43 (psychotropic drugs), T42 (antiepileptic, sedative-hypnotic and antiparkinsonism drugs). The age group 15–59 years had the highest number of hospital admissions (83.4%). Women contributed to 59.1% of the total number of hospital admissions. Admission rate among men increased by 16.7%. Among women, the admission rate increased by 44.6%.

Conclusion

Admission rates due to medication administration errors increased markedly in the past decade. This increase was correlated with an increase in the prescription rate of several therapeutic classes. Patients taking non-opioid analgesics, antipyretics and antirheumatics, psychiatric medications, antiepileptic, sedative-hypnotic and antiparkinsonism drugs should have their recommended (and administered) doses closely monitored. They should be followed up on a regular basis to ensure that they are taking their medications as prescribed.
Recognition of COVID-19 with occupational origin: a comparison between European countries
Authors: Nys Evelien , Pauwels Sara , Ádám Balázs , Amaro João , Athanasiou Athanasios , Bashkin Osnat , Bric Tatjana Kofol , Bulat Petar , Caglayan Cigdem , Guseva Canu Irina , Cebanu Serghei , Charbotel Barbara , Cirule Jolanta , Curti Stefania , Davidovitch Nadav , Dopelt Keren , Fikfak Metoda Dodic , Frilander Heikki , Gustavsson Per , Höper Anje Christina , Kiran Sibel , Kogevinas Manolis , Kudász Ferenc , Kolstad Henrik A , Lazarevic Sanja Brekalo , Macan Jelena , Majery Nicole , Marinaccio Alessandro , Mates Dana , Mattioli Stefano , McElvenny Damien Martin , Mediouni Zakia , Mehlum Ingrid Sivesind , Merisalu Eda , Mijakoski Dragan , Nena Evangelia , Noone Peter , Otelea Marina Ruxandra , Pelclova Daniela , Pranjic Nurka , Rosso Mark , Serra Consol , Rushton Lesley , Sandal Abdulsamet , Schernhammer Eva S , Stoleski Sasho , Turner Michelle C , van der Molen Henk F , Varga Marek , Walusiak-Skorupa Jolanta , Straif Kurt , Godderis Lode
Published: November 2023

Objectives

This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe.

Methods

A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022.

Results

The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries.

Conclusions

COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems.
Inconsistencies in, and short pathlength correction to, $$R_{AA}(p_T)$$ in $$\textrm{A}+\textrm{A}$$ and $$\textrm{p} + \textrm{A}$$ collisions
Authors: Faraday Coleridge , Grindrod Antonia , Horowitz W. A.
Published: November 2023

We present the first leading hadron suppression predictions in $$\textrm{Pb}+\textrm{Pb}$$

Pb
+
Pb

and $$\textrm{p}+\textrm{Pb}$$

p
+
Pb

collisions from a convolved radiative and collisional energy loss model in which partons propagate through a realistic background and in which the radiative energy loss receives a short pathlength correction. We find that the short pathlength correction is small for D and B meson $$R_{AA}(p_T)$$

R

AA

(

p
T

)

in both $$\textrm{Pb}+\textrm{Pb}$$

Pb
+
Pb

and $$\textrm{p}+\textrm{Pb}$$

p
+
Pb

collisions. However the short pathlength correction leads to a surprisingly large reduction in suppression for $$\pi $$
π
mesons in $$\textrm{p}+\textrm{Pb}$$

p
+
Pb

and even $$\textrm{Pb}+\textrm{Pb}$$

Pb
+
Pb

collisions. We systematically check the consistency of the assumptions used in the radiative energy loss derivation-such as collinearity, softness, and large formation time-with the final numerical model. While collinearity and softness are self-consistently satisfied in the final numerics, we find that the large formation time approximation breaks down at modest to high momenta $$p_T \gtrsim 30~\textrm{GeV}$$

p
T

≳
30

GeV

. We find that both the size of the small pathlength correction to $$R_{AA}(p_T)$$

R

AA

(

p
T

)

and the $$p_T$$

p
T

at which the large formation time assumption breaks down are acutely sensitive to the chosen distribution of scattering centers in the plasma.
Twist decomposition of non-linear effects in Balitsky–Kovchegov evolution of proton structure functions
Authors: Motyka Leszek , Sadzikowski Mariusz
Published: November 2023

Effects of non-linear small-x evolution of the gluon distribution given by the Balitsky–Kovchegov equation are analyzed within the collinear approximation framework. We perform a twist decomposition of the proton structure functions $$F_2$$

F
2

and $$F_{\textrm{L}}$$

F
L

obtained from the Balitsky–Kovchegov equation using the Mellin representation of the scattering cross-sections at high energies. In both the structure functions we find strong corrections coming from the non-linear effects in the gluon evolution at twist 2, and strongly suppressed higher twist effects. This implies that unitarization effects of high energy scattering amplitudes are mostly the leading twist effect. Furthermore we consider the double logarithmic limit of the Balitsky–Kovchegov equation for the collinear gluon distribution, and compare the result to the Gribov–Levin–Ryskin equation. We find that these two equations differ by two powers of the hard scale logarithm for the large scales.
A Novel Efficient Hybrid Encryption Algorithm Based on Twofish and Key Generation Using Optimization for Ensuring Data Security in Cloud
Authors: Maddila Suresh Kumar , Vadlamani Nagalakshmi
Published: November 2023

Cloud computing is a rapidly advancing paradigm that enables users to access various services and resources anytime, anywhere. With this advancement, security has become a major concern for business organisations and individuals, and hence, it is essential to ensure that the services are provided with high data security. Numerous researches have focused on devising effective techniques to enhance data security. However, with the increasing connectivity, security still remains to be a major challenge. This paper devises a novel data protection scheme in the cloud by using the Twofish encryption algorithm and a key generation scheme with the Bald Eagle Pelican Optimization (BEPO) Algorithm. The proposed Twofish+BEPO_KeyGen is implemented in various phases, like initialization, registration, key generation, data encryption, authentication, validation and data sharing, and data decryption. Here, the Twofish algorithm is used to encrypt the data that has to be outsourced to the cloud, and for encryption, the security key required is generated by the BEPO algorithm. The efficacy of the Twofish+BEPO_KeyGen approach is examined by considering metrics, like memory usage, validation time, normalized variance, and conditional privacy, and is detected to have achieved values of 76.3 MB, 37.278 s, 1.665, and 0.926, correspondingly.
Indigenous knowledge of palaeontology in Africa
Authors: Benoit Julien , Penn-Clarke Cameron R. , Rust Renée , Groenewald David P. , Vickers-Rich Patricia , Helm Charles W.
Published: November 2023

Compared to other continents, the study of indigenous (non-western) knowledge of palaeontology in Africa is a relatively new field. The literature reviewed here nevertheless suggests a long-lasting string of traditions, geomyths and folklore related to fossilized items on the whole continent and encompassing many African cultures. It is often difficult to estimate the antiquity of these traditions, but the evidence gathered here suggests that they range from the 1800s to pre-colonial times, and up to many millennia. Palaeontological items were collected and used for a variety of reasons, but the African record seems unusual for its scarce use of fossils for traditional medicine. Also, despite substantial efforts, some famous localities with conspicuous fossils still remain without any documented indigenous knowledge. We stress that documenting fossil-related folklore and geomyths is not only a matter of preserving this knowledge or promoting diversity, but is also crucial for establishing strong bonds with local stakeholders to encourage preservation of geoheritage and discover new sites.
Early Cretaceous palaeogeography of the Russian Platform
Authors: Baraboshkin Evgenij
Published: November 2023

This paper summarizes the data on the Early Cretaceous palaeogeography of the Russian Platform (RP) in the context of the development of the Northeastern Peritethys. One of the main features of the region is the constant mutual influence of the Tethyan and Boreal water masses (WMs) through the system of straits. The latest Volgian–Barremian development of the RP basin was under major influence of the Boreal WM. It differs from the Aptian–Albian interval, which formed under major influence of Tethyan and Peritethyan WMs. Zonal biostratigraphy reflects the type of marine biota related to the type of WM. The WM movement was interrupted by several episodes of exposition of the southern margin of the RP, the Berriasian–Barremian interval, or almost the whole platform, in the late middle–late Aptian.
Early Cretaceous continental sedimentatary environments, palaeogeography and biota of southeastern Western Siberia
Authors: Ivantsov Stepan V. , Fayngerts Alexey V. , Feofanova Olga A. , Vladimirova Olga N. , Slobodin Dmitriy A.
Published: November 2023

The Ilek Formation was distinguished by Ragozin in 1936 in the SE of Western Siberia, as a sequence of continental deposits accumulated in the alluvial and lacustrine environments, dating Barremian–Early Albian. At the end of the twentieth century a series of sites, comprising rich and diverse Early Cretaceous vertebrates, was discovered, which forced an intensive comprehensive research of the Ilek Formation. The stratotype section of the Bolshoi Ilek represents an abnormal section of the Ilek Formation, comprising the deposits of prodelta, delta front and mouth bars. Three regions within the area of the Ilek Formation reflect the evolution of the fluvial system. The eastern region represents the oldest part of the section, preliminarily dated to the Barremian based on spore and pollen analysis in addition to lithological characteristics. The western region was probably deposited during ocean anoxic event (OAE) 1a. The central region represents the final stage of the tectonic cycle, deposited within the environments of the calm plain river and fluvial delta. The vertebrate assemblages distinguished for the Kiya and Bolshoi Kemchug basins have specific features, which can support the heterochrony of the Ilekian deposits.
Resilient Intermediary-Based Key Exchange Protocol for IoT
Authors: Hu Zhangxiang , Li Jun , Wilson Christopher
Published: November 2023

Due to the limited resources of Internet of Things (IoT) devices, Symmetric Key Cryptography (SKC) is typically favored over resource-intensive Public Key Cryptography (PKC) to secure communication between IoT devices. To utilize SKC, devices need to execute a key exchange protocol to establish a session key before initiating communication. However, existing SKC-based key exchange protocols assume that communication devices have a pre-shared secret or there are trusted intermediaries between them; neither is always realistic in IoT.

We introduce a new SKC-based key exchange protocol for IoT devices. While also intermediary based, our protocol fundamentally departs from existing intermediary-based solutions in that intermediaries between two key exchange devices may be malicious, and moreover, our protocol can detect cheating behaviors and identify malicious intermediaries. We prove our protocol is secure under the universally composable model, and show that it can detect malicious intermediaries with probability 1.0. We implemented and evaluated our protocol on different IoT devices. We show that our protocol has significant improvements in computation time and energy cost. Compared to the PKC-based protocols ECDH, DH, and RSA, our protocol is 2.3 to 1,591 times faster on one of the two key exchange devices and 0.7 to 4.67 times faster on the other.
PEMFC-Performance of Unsupported Pt-Ni Aerogel Cathode Catalyst Layers under Automotive-Relevant Operative Conditions
Authors: Fikry Meriem , Herranz Juan , Leisibach Simon , Khavlyuk Pavel , Eychmüller Alexander , Schmidt Thomas J.
Published: November 2023

Unsupported, Pt-based electrocatalysts hold great potential for implementation in polymer electrolyte membrane fuel cell (PEMFC-) cathodes owing to their enhanced durability under startup/shutdown conditions entailing high potential excursions. Among such materials, the recently developed Pt-Ni aerogel consisting of tridimensional nanochains of interconnected nanoparticles has already been shown to feature an initial PEMFC–performance comparable to that of C-supported Pt-nanoparticles (Pt/C) along with a much better startup/shutdown durability. However, all PEMFC characterization of this materials has been carried out at 80 °C and using fully humidified gases, and its behavior under more demanding conditions concomitant to its potential implementation for automotive applications remains unexplored. Thus, in this work aerogel catalyst layers (CLs) are characterized under a wide range of temperatures and relative humidities, as well as submitted to fast current up-transients. These extensive tests showed that the performance of the aerogel CLs is comparable to that of a commercial Pt/C benchmark, except at high current densities and low temperatures at which the thin aerogel layers suffer from a low water storage capacity.
A Phase Ib First-In-Patient Study Assessing the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of Ponsegromab in Participants with Cancer and Cachexia
Authors: Crawford Jeffrey , Calle Roberto A. , Collins Susie M. , Weng Yan , Lubaczewski Shannon L. , Buckeridge Clare , Wang Ellen Q. , Harrington Magdalena A. , Tarachandani Anil , Rossulek Michelle I. , Revkin James H.
Published: November 2023

Purpose:

Cachexia is common in patients with advanced cancer and is associated with elevated serum growth differentiation factor 15 (GDF-15) concentrations. This first-in-patient (phase Ib), 24-week study assessed use of ponsegromab, a mAb against GDF-15, in adults with advanced cancer, cachexia, and elevated GDF-15 serum concentration.

Patients and Methods:

Participants (n = 10) received open-label ponsegromab subcutaneous 200 mg every 3 weeks for 12 weeks in addition to standard-of-care anticancer treatment. Ponsegromab safety, tolerability, and pharmacokinetics were assessed in addition to serum GDF-15 concentrations and exploratory measures of efficacy.

Results:

No treatment-related treatment-emergent adverse events, injection site reactions, or adverse trends in clinical laboratory tests, vital signs, or electrocardiogram parameters attributable to ponsegromab were identified. Median serum unbound GDF-15 concentration at baseline was 2.269 ng/mL. Following initiation of study treatment, median unbound GDF-15 concentrations were below the lower limit of quantification (0.0424 ng/mL) from day 1 (3 hours postdose) through week 15. Increases in body weight were observed at all time points during the treatment and follow-up periods. A least-squares mean (SE) increase of 4.63 (1.98) kg was observed at week 12, an increase of approximately 6.6% relative to baseline. Ponsegromab-mediated improvements in actigraphy-based assessments of physical activity and in quality of life, including appetite as assessed by Functional Assessment of Anorexia-Cachexia Therapy total and subscale scores, were also observed.

Conclusions:

Ponsegromab was well tolerated, suppressed serum GDF-15 concentrations, and demonstrated preliminary evidence of efficacy. These findings support the continued development of ponsegromab for the treatment of cachexia.
Temporary Knockdown of p53 During Focal Limb Irradiation Increases the Development of Sarcomas
Authors: Daniel Andrea R. , Su Chang , Williams Nerissa T. , Li Zhiguo , Huang Jianguo , Lopez Omar , Luo Lixia , Ma Yan , Campos Lorraine da Silva , Selitsky Sara R. , Modliszewski Jennifer L. , Liu Siyao , Hernansaiz-Ballesteros Rosa , Mowery Yvonne M. , Cardona Diana M. , Lee Chang-Lung , Kirsch David G.
Published: November 2023

Approximately half of patients with cancer receive radiotherapy and, as cancer survivorship increases, the low rate of radiation-associated sarcomas is rising. Pharmacologic inhibition of p53 has been proposed as an approach to ameliorate acute injury of normal tissues from genotoxic therapies, but how this might impact the risk of therapy-induced cancer and normal tissue injuries remains unclear. We utilized mice that express a doxycycline (dox)-inducible p53 short hairpin RNA to reduce Trp53 expression temporarily during irradiation. Mice were placed on a dox diet 10 days prior to receiving 30 or 40 Gy hind limb irradiation in a single fraction and then returned to normal chow. Mice were examined weekly for sarcoma development and scored for radiation-induced normal tissue injuries. Radiation-induced sarcomas were subjected to RNA sequencing. Following single high-dose irradiation, 21% of animals with temporary p53 knockdown during irradiation developed a sarcoma in the radiation field compared with 2% of control animals. Following high-dose irradiation, p53 knockdown preserves muscle stem cells, and increases sarcoma development. Mice with severe acute radiation-induced injuries exhibit an increased risk of developing late persistent wounds, which were associated with sarcomagenesis. RNA sequencing revealed radiation-induced sarcomas upregulate genes related to translation, epithelial–mesenchymal transition (EMT), inflammation, and the cell cycle. Comparison of the transcriptomes of human and mouse sarcomas that arose in irradiated tissues revealed regulation of common gene programs, including elevated EMT pathway gene expression. These results suggest that blocking p53 during radiotherapy could minimize acute toxicity while exacerbating late effects including second cancers.

Significance:

Strategies to prevent or mitigate acute radiation toxicities include pharmacologic inhibition of p53 and other cell death pathways. Our data show that temporarily reducing p53 during irradiation increases late effects including sarcomagenesis.
Ivabradine in the Prevention, and Reduction in Size, of Perioperative Myocardial Injury in Patients Undergoing Orthopedic Surgery for Acute Fracture
Authors: Rafiudeen Rifly , Barlis Peter , Hau Raphael , Vasanthakumar Sheran , Ng Reginald , Wu Philip , Tacey Mark , Banning Adrian , van Gaal William
Published: November 2023

Background

Perioperative myocardial injury is common after major noncardiac surgery and is associated with adverse outcomes. This study investigated the use of ivabradine in patients undergoing urgent surgery for fracture.

Methods and Results

This was a prospective, double‐blind, placebo‐controlled, randomized clinical trial. Participants were enrolled 1:1 into ivabradine or placebo arm, and study drug was commenced before operation and continued for 7 days or until discharge. High‐sensitivity troponin I was measured daily using Abbott Alinity analyzer and assay, and heart rate data were obtained using continuous Holter monitoring. A total of 199 patients underwent acute orthopedic surgery, 98 in the ivabradine group and 101 in the placebo group. The mean age was 78.7 years (range, 77.5–79.9 years), with 68% women. The average heart rate was 5 to 11 beats per minute lower in the ivabradine group compared with the placebo group at all time points (
P
<0.001 for all). There was no statistically significant difference between the ivabradine and placebo groups in the number of patients who had perioperative myocardial injury: 28.6% versus 31.6% (
P
=0.71). In patients with perioperative myocardial injury, average peak troponin was 168.8 ng/L (±431.2 ng/L) in the ivabradine group and 2094.5 ng/L (±7201.9 ng/L) in the placebo group (
P
=0.16). There was no statistically significant difference between groups in 30‐day mortality, blood pressure, stroke, or major adverse cardiovascular event.

Conclusions

Starting ivabradine preoperatively in elderly patients requiring acute surgery for fracture did not result in a statistically significant difference in the incidence of perioperative myocardial injury. There was no statistically significant difference in morbidity, mortality, or adverse events between treatment groups.

Registration

URL:
https://www.anzctr.org.au/
; Unique identifier: ACTRN12616001634460p.
Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry
Authors: Gordon Perue Gillian , Ying Hao , Bustillo Antonio , Zhou Lili , Gutierrez Carolina M. , Gardener Hannah E. , Krigman Judith , Jameson Angus , Dong Chuanhui , Rundek Tatjana , Rose David Z. , Romano Jose G. , Alkhachroum Ayham , Sacco Ralph L. , Asdaghi Negar , Koch Sebastian
Published: November 2023

Background

Guideline‐based hypertension management is integral to the prevention of stroke. We examine trends in antihypertensive medications prescribed after stroke and assess how well a prescriber's blood pressure (BP) medication choice adheres to clinical practice guidelines (BP‐guideline adherence).

Methods and Results

The FSR (Florida Stroke Registry) uses statewide data prospectively collected for all acute stroke admissions. Based on established guidelines, we defined optimal BP‐guideline adherence using the following hierarchy of rules: (1) use of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker as first‐line antihypertensive among diabetics; (2) use of thiazide‐type diuretics or calcium channel blockers among Black patients; (3) use of beta blockers among patients with compelling cardiac indication; (4) use of thiazide, angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, or calcium channel blocker class as first line in all others; (5) beta blockers should be avoided as first line unless there is a compelling cardiac indication. A total of 372 254 cases from January 2010 to March 2020 are in the FSR with a diagnosis of acute ischemic stroke, hemorrhagic stroke, transient ischemic attack, or subarachnoid hemorrhage; 265 409 with complete data were included in the final analysis. Mean age was 70±14 years; 50% were women; and index stroke subtypes were 74% acute ischemic stroke, 11% intracerebral hemorrhage, 11% transient ischemic attack, and 4% subarachnoid hemorrhage. BP‐guideline adherence to each specific rule ranged from 48% to 74%, which is below quality standards of 80%, and was lower among Black patients (odds ratio, 0.7 [95% CI, 0.7–0.83];
P
<0.001) and those with atrial fibrillation (odds ratio, 0.53 [95% CI, 0.50–0.56];
P
<0.001) and diabetes (odds ratio, 0.65 [95% CI, 0.61–0.68];
P
<0.001).

Conclusions

This large data set demonstrates consistently low rates of BP‐guideline adherence over 10 years. There is an opportunity for monitoring hypertensive management after stroke.
Heart Failure, Female Sex, and Atrial Fibrillation Are the Main Drivers of Human Atrial Cardiomyopathy: Results From the CATCH ME Consortium
Authors: Winters Joris , Isaacs Aaron , Zeemering Stef , Kawczynski Michal , Maesen Bart , Maessen Jos , Bidar Elham , Boukens Bas , Hermans Ben , van Hunnik Arne , Casadei Barbara , Fabritz Larissa , Chua Winnie , Sommerfeld Laura , Guasch Eduard , Mont Luis , Batlle Montserrat , Hatem Stephane , Kirchhof Paulus , Wakili Reza , Sinner Mortiz , Stoll Monica , Goette Andreas , Verheule Sander , Schotten Ulrich
Published: November 2023

Background

Atrial cardiomyopathy (atCM) is an emerging prognostic factor in cardiovascular disease. Fibrotic remodeling, cardiomyocyte hypertrophy, and capillary density are hallmarks of atCM. The contribution of etiological factors and atrial fibrillation (AF) to the development of differential atCM phenotypes has not been quantified. This study aimed to evaluate the association between histological features of atCM and the clinical phenotype.

Methods and Results

We examined left atrial (LA, n=95) and right atrial (RA, n=76) appendages from a European cohort of patients undergoing cardiac surgery. Quantification of histological atCM features was performed following wheat germ agglutinin/CD31/vimentin staining. The contributions of AF, heart failure, sex, and age to histological characteristics were determined with multiple linear regression models. Persistent AF was associated with increased endomysial fibrosis (LA: +1.13±0.47 μm,
P
=0.038; RA: +0.94±0.38 μm,
P
=0.041), whereas total extracellular matrix content was not. Men had larger cardiomyocytes (LA: +1.92±0.72 μm,
P
<0.001), while women had more endomysial fibrosis (LA: +0.99±0.56 μm,
P
=0.003). Patients with heart failure showed more endomysial fibrosis (LA: +1.85±0.48 μm,
P
<0.001) and extracellular matrix content (LA: +3.07±1.29%,
P
=0.016), and a higher capillary density (LA: +0.13±0.06,
P
=0.007) and size (LA: +0.46±0.22 μm,
P
=0.044). Fuzzy k‐means clustering of histological features identified 2 subtypes of atCM: 1 characterized by enhanced endomysial fibrosis (LA: +3.17 μm,
P
<0.001; RA: +2.86 μm,
P
<0.001), extracellular matrix content (LA: +3.53%,
P
<0.001; RA: +6.40%,
P
<0.001) and fibroblast density (LA: +4.38%,
P
<0.001), and 1 characterized by cardiomyocyte hypertrophy (LA: +1.16 μm,
P
=0.008; RA: +2.58 μm,
P
<0.001). Patients with fibrotic atCM were more frequently female (LA: odds ratio [OR], 1.33,
P
=0.002; RA: OR, 1.54,
P
=0.004), with persistent AF (LA: OR, 1.22,
P
=0.036) or heart failure (LA: OR, 1.62,
P
<0.001). Hypertrophic features were more common in men (LA: OR=1.33,
P
=0.002; RA: OR, 1.54,
P
=0.004).

Conclusions

Fibrotic atCM is associated with female sex, persistent AF, and heart failure, while hypertrophic features are more common in men.
Cross-cultural differences in visual object and background processing in the infant brain
Authors: Köster Moritz , Bánki Anna , Yamasaki Daiki , Kato Masaharu , Itakura Shoji , Hoehl Stefanie
Published: November 2023

Human visual cognition differs profoundly between cultures. A key finding is that visual processing is tuned toward focal elements of a visual scene in Western cultures (US and Europe) and toward the background in Eastern cultures (Asia). Although some evidence for cultural differences exists for young children, to date, the ontogenetic origins of cultural differences in human visual cognition have not been unveiled. This study explores early cross-cultural differences in human visual processing, by tracking the neural signatures for object versus background elements of a visual scene in the electroencephalogram (EEG) of 12-month-old infants, in Vienna (Austria; a Western culture; n = 35) and Kyoto (Japan; an Eastern culture; n = 36). Specifically, we separated neural signatures by presenting object and background at different stimulation frequencies (5.67 and 8.5 Hz). Results show that human visual processing is different between cultures from early on. We found that infants from Vienna showed a higher object signal, in contrast to infants from Kyoto, who showed an accentuated background signal. This early emergence of cultural differences in human vision may be explained in part by early social experiences: In a separate interaction phase, mothers from Vienna pointed out object (versus background) elements more often than mothers from Kyoto. To conclude, with a cross-cultural developmental neuroscience approach, we reveal that cross-cultural differences in visual processing of object and background are already present in the first year after birth, which is much earlier than previously thought.
Warn-on-Forecast System: From Vision to Reality
Authors: Heinselman Pamela L. , Burke Patrick C. , Wicker Louis J. , Clark Adam J. , Kain John S. , Gao Jidong , Yussouf Nusrat , Jones Thomas A. , Skinner Patrick S. , Potvin Corey K. , Wilson Katie A. , Gallo Burkely T. , Flora Montgomery L. , Martin Joshua , Creager Gerry , Knopfmeier Kent H. , Wang Yunheng , Matilla Brian C. , Dowell David C. , Mansell Edward R. , Roberts Brett , Hoogewind Kimberly A. , Stratman Derek R. , Guerra Jorge , Reinhart Anthony E. , Kerr Christopher A. , Miller William
Published: November 2023

In 2009, advancements in NWP and computing power inspired a vision to advance hazardous weather warnings from a warn-on-detection to a warn-on-forecast paradigm. This vision would require not only the prediction of individual thunderstorms and their attributes but the likelihood of their occurrence in time and space. During the last decade, the warn-on-forecast research team at the NOAA National Severe Storms Laboratory met this challenge through the research and development of 1) an ensemble of high-resolution convection-allowing models; 2) ensemble- and variational-based assimilation of weather radar, satellite, and conventional observations; and 3) unique postprocessing and verification techniques, culminating in the experimental Warn-on-Forecast System (WoFS). Since 2017, we have directly engaged users in the testing, evaluation, and visualization of this system to ensure that WoFS guidance is usable and useful to operational forecasters at NOAA national centers and local offices responsible for forecasting severe weather, tornadoes, and flash floods across the watch-to-warning continuum. Although an experimental WoFS is now a reality, we close by discussing many of the exciting opportunities remaining, including folding this system into the Unified Forecast System, transitioning WoFS into NWS operations, and pursuing next-decade science goals for further advancing storm-scale prediction.

Significance Statement

The purpose of this research is to develop an experimental prediction system that forecasts the probability for severe weather hazards associated with individual thunderstorms up to 6 h in advance. This capability is important because some people and organizations, like those living in mobile homes, caring for patients in hospitals, or managing large outdoor events, require extended lead time to protect themselves and others from potential severe weather hazards. Our results demonstrate a prediction system that enables forecasters, for the first time, to message probabilistic hazard information associated with individual severe storms between the watch-to-warning time frame within the United States.
Adolescent Trauma Patients With Isolated Head Trauma and Glasgow Coma Scale 6-8: Routine Intubation?
Authors: Park Flora S. , Nahmias Jeffry , Schubl Sebastian , Swentek Lourdes , Guner Yigit , Goodman Laura F. , Emigh Brent , Grigorian Areg
Published: November 2023

Background

Recent evidence suggests that routine intubation upon arrival for adults with isolated head trauma and a depressed Glasgow Coma Scale (GCS) score is associated with increased risk of morbidity and mortality. Whether these outcomes are similar within an adolescent trauma population has not been previously investigated. We hypothesized intubation upon arrival for adolescent trauma patients with isolated head trauma to be associated with a higher risk of death and prolonged length of stay (LOS).

Methods

The 2017-2019 TQIP was queried for adolescents (age 12-16) presenting after isolated blunt head trauma (abbreviated injury scale [AIS] <1 spine/chest/abdomen/upper-extremity/lower-extremity) and GCS 6-8 on arrival. Transferred patients, dead-on-arrival, and those undergoing emergent operation from the emergency department were excluded. Patients intubated within one-hour were compared to patients not intubated within one-hour. A multivariable logistic regression analysis was performed adjusting for age, sex, GCS, and AIS-grade for the head.

Results

From 141 patients, 73 (51.8%) were intubated upon arrival. Intubated patients had a low complication rate (5.6%). Intubated and non-intubated patients had a similar rate and mortality risk (6.8% vs 1.5%, P = .11) (OR 1.84, CI .08-43.69, P = .71) and median length of stay (LOS) (2 days vs 2 days, P = .13).

Discussion

Unlike adult patients, adolescents with isolated head trauma and a depressed GCS have similar outcomes if they are intubated upon arrival. Utilizing initial GCS score to determine which adolescent trauma patients with isolated head trauma should be intubated appears to be a safe practice.