bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary evaluation of reference intervals for a point‐of‐care viscoelastic coagulation monitor (VCM Vet) in healthy adult horses
Authors: Bishop Rebecca C. , Kemper Ann M. , Burges Julie W. , Jandrey Karl E. , Wilkins Pamela A.
Published: August 2023

Objective

To evaluate a point‐of‐care viscoelastic coagulation monitor (VCM Vet) for use in horses by assessing variability between devices and establish reference intervals (RIs) for healthy adult horses.

Design

Prospective observational study.

Setting

Two university teaching hospitals.

Animals

Healthy adult horses (n = 68).

Interventions

None.

Measurements and Main Results

Blood collected by direct jugular venipuncture was applied directly from the syringe into 2 VCM Vet cassettes to establish coefficients of variation (CVs) and RIs for reported parameters of clotting time (CT), clot formation time (CFT), alpha angle, amplitude at 10 and 20 minutes, maximum clot firmness, and lysis index at 30 and 45 minutes. CVs for each parameter were within clinical tolerance. There was a significant difference in CT between institutions (P < 0.001). Differences in CV were found between institutions for CT (P = 0.003) and CFT (P = 0.01). Healthy horse RIs were calculated for the overall data set and each individual institution. Calculated RIs were as follows: CT, 255.6–1233.9 seconds; CFT, 89.4–581 seconds; alpha angle, 11.4–53.6°; maximum clot firmness, 18–37.7; lysis index at 30 minutes, 97.3%–102.1%; lysis index at 45 minutes, 80.8%–103.3%; amplitude at 10 minutes, 8.7–28.3; and amplitude at 20 minutes, 17.4–35.7.

Conclusions

VCM Vet is a repeatable and practical option for rapid point‐of‐care assessment of hemostasis in horses but has a wide RI and is susceptible to variability. Establishment of institution‐specific RIs is recommended.
Retrospective evaluation of factors associated with emergency frequency and survival in equids presenting for emergency care (2019–2020): 3071 cases
Authors: Bouton Jessica , Fielding Langdon , Major Dustin , Deane Emma , Mayer Jennifer , Rhodes Diane
Published: August 2023

Objective

To determine factors associated with frequency and outcome of equid emergencies in private practice.

Design

Retrospective study from February 2019 to January 2020.

Setting

Private practice large animal hospital.

Animals

A total of 3071 equids of various breeds and ages presenting for emergency care.

Interventions

None.

Measurements and Main Results

Variables included for analysis of daily emergency frequency included day of the week, month, and daily climate data. A Poisson regression model found the maximum temperature (P = 0.05), average barometric pressure (P = 0.005), and decreases in barometric pressure (P = 0.05) were associated with an increasing daily number of emergencies. Overall survival for all emergencies was 89% (2748/3071). Variables included for analysis of nonsurvival for emergencies included signalment, body system, clinical examination findings, laboratory data, and experience of the veterinarian. A logistic regression model for primary emergencies (nonreferral) found that increasing age, increasing heart rate, and decreased gastrointestinal sounds were associated with an increase in nonsurvival. Body system and experience of the veterinarian affected nonsurvival. A logistic regression model for all emergencies (primary and referral) found that absent gastrointestinal sounds and an increasing PCV were associated with increased nonsurvival.

Conclusions

The number of daily emergencies in this practice was affected by the month of the year and day of the week. Additionally, hotter days, increased barometric pressure, or drops in barometric pressure are likely to be associated with a higher emergency caseload. Nonsurvival of primary equid emergencies in private practice increases with age, higher heart rates, and decreased gastrointestinal sounds.
Cardiomyocytes from female compared to male mice have larger ryanodine receptor clusters and higher calcium spark frequency
Authors: Laasmaa Martin , Branovets Jelena , Stolova Jekaterina , Shen Xin , Rätsepso Triinu , Balodis Mihkel Jaan , Grahv Cärolin , Hendrikson Eliise , Louch William Edward , Birkedal Rikke , Vendelin Marko
Published: August 2023

Sex differences in cardiac physiology are receiving increased attention as it has become clear that men and women have different aetiologies of cardiac disease and require different treatments. There are experimental data suggesting that male cardiomyocytes exhibit larger Ca2+ transients due to larger Ca2+ sparks and a higher excitation–contraction coupling gain; in addition, they exhibit a larger response to adrenergic stimulation with isoprenaline (ISO). Here, we studied whether there are sex differences relating to structural organization of the transverse tubular network and ryanodine receptors (RyRs). Surprisingly, we found that female cardiomyocytes exhibited a higher spark frequency in a range of spark magnitudes. While overall RyR expression and phosphorylation were the same, female cardiomyocytes had larger but fewer RyR clusters. The density of transverse t‐tubules was the same, but male cardiomyocytes had more longitudinal t‐tubules. The Ca2+ transients were similar in male and female cardiomyocytes under control conditions and in the presence of ISO. The synchrony of the Ca2+ transients was similar between sexes as well. Overall, our data suggest subtle sex differences in the Ca2+ influx and efflux pathways and their response to ISO, but these differences are balanced, resulting in similar Ca2+ transients in field‐stimulated male and female cardiomyocytes. The higher spark frequency in female cardiomyocytes is related to the organization of RyRs into larger, but fewer clusters.

image

Key points

During a heartbeat, the force of contraction depends on the amplitude of the calcium transient, which in turn depends on the amount of calcium released as calcium sparks through ryanodine receptors in the sarcoplasmic reticulum.

Previous studies suggest that cardiomyocytes from male compared to female mice exhibit larger calcium sparks, larger sarcoplasmic reticulum calcium release and greater response to adrenergic stimulation triggering a fight‐or‐flight response.

In contrast, we show that cardiomyocytes from female mice have a higher spark frequency during adrenergic stimulation and similar spark morphology.

The higher spark frequency is related to the organization of ryanodine receptors into fewer, but larger clusters in female compared to male mouse cardiomyocytes.

Despite subtle sex differences in cardiomyocyte structure and calcium fluxes, the differences are balanced, leading to similar calcium transients in cardiomyocytes from male and female mice.
The Effect of Laser Cutting Heuristic Presentation Modality on Design Learning
Authors: Schauer Anastasia M. K. , Bhatt Ritesh J. , Saldaña Christopher , Fu Katherine
Published: August 2023

The goal of this work is to study the way student designers use heuristics to effectively design for laser-cut manufacturing methods. With the recent advent of academic makerspaces, digital fabrication tools like laser cutters are relatively new additions to the classroom. Therefore, there is a gap in formal education or training on these tools, and students can find it challenging to design effectively for them. A study was performed to investigate the way students apply heuristics to redesign laser-cut assemblies when received in different modalities. All participants were given an identical lecture on laser cutting heuristics. Then, a redesign problem was presented to students, and three different experimental groups were given the heuristics in different modalities: Text-Only, text with Visual aids, and text with Tactile aids. The novelty and quality of each of the resulting redesigns were evaluated. It was hypothesized that participants would have more difficulty interpreting and applying the Text-Only heuristics, lowering the quality of their redesigned solutions relative to the other two conditions. It was also hypothesized that participants would experience fixation caused by interacting with the tactile aids, leading to the lower novelty of their redesigned solutions relative to the other two conditions. Results showed that modality played a significant role in participants’ feelings of self-efficacy after the intervention, as well as in their understanding of laser cutter design skills when responding to quiz-style questions. However, analysis of novelty and quality showed little significant impact of the intervention and varying modalities on participants’ designs.
A Thickness-Accommodating Method for Void-Free Design in Uniformly Thick Origami
Authors: Kim Tae-Hyun , Jang Keon-Ik , Lee Dae-Young , Han Jae-Hung
Published: August 2023

This article proposes a novel thickness-accommodating method to design a void-free for flat-foldable origami pattern without self-intersection. Unlike existing methods, it enables uniform thickness distribution without any holes or voids at any location and maximizes the effective area of the unfolded state. The proposed method is applicable not only to 2D folding but also to a generic flat-foldable degree-4-vertex (D4V) pattern. The pattern's thickness-accommodated configuration to avoid self-intersection is determined through kinematic analysis, and a pattern design flow is provided for the generic D4V systematically. Prototypes of the D4V pattern and a more complex Miura-ori-based tessellation model are fabricated to demonstrate the effectiveness of the proposed method. This method can be employed in the design of more complete and diverse foldable structures, such as a foldable space shield with thick materials.
Six-Bar Linkages With Compliant Mechanisms for Programmable Mechanical Structures
Authors: Pieber Michael , Gerstmayr Johannes
Published: August 2023

Programmable mechanical structures are formed by autonomous and adaptive cells and can reproduce meshes known from the finite element method. Furthermore, they can change their structure not only through morphing, but also by self-reconfiguration of the cells. A crucial component of the cells, which can preserve the underlying geometry of a triangular mesh, are six-bar linkages. The main part of the present contribution concerns the six-bar linkages as a fully 3D-printable compliant mechanism where each revolute joint of the six-bar linkage is replaced with a notch flexure hinge with the circular contour. The utilization of notch flexure hinges presents two significant drawbacks. First, notch flexure hinges do not maintain the center of rotation. Second, although compliance is an inherent and desirable characteristic of flexural hinges, it gives rise to secondary or parasitic motion. The compliance subsequently lead to alterations in the underlying geometry of a triangular mesh. For self-reconfiguration of the cells, an efficient model is needed to predict the positioning errors. Therefore, the flexure hinge is represented by three distinct models, namely a finite element model, a beam model, and a simplified linearized model based on translational and rotational spring elements. These models are compared and evaluated in succession first to identify the parameters of the simplified model and later on, the simplified model is used to show the deviations of a medium-scaled programmable structure with respect to the idealized behavior. The current work brings us closer to both the development of programmable mechanical structures and the prediction of positioning errors during self-reconfiguration.
ManQala: Game-inspired strategies for quantum state engineering
Authors: Danaci Onur , Zhang Wenlei , Coleman Robert , Djakam William , Amoo Michaela , Glasser Ryan T. , Kirby Brian T. , N'Gom Moussa , Searles Thomas A.
Published: August 2023

The ability to prepare systems in specific target states through quantum engineering is essential for realizing the new technologies promised by a second quantum revolution. Here, we recast the fundamental problem of state preparation in high-dimensional Hilbert spaces as ManQala, a quantum game inspired by the West African sowing game mancala. Motivated by optimal gameplay in solitaire mancala, where nested nearest-neighbor permutations and actions evolve the state of the game board to its target configuration, ManQala acts as a pre-processing approach for deterministically arranging particles in a quantum control problem. Once pre-processing with ManQala is complete, existing quantum control methods are applied, but now with a reduced search space. We find that ManQala-type strategies match, or outperform, competing approaches in terms of final state variance even in small-scale quantum state engineering problems where we expect the slightest advantage, since the relative reduction in search space is the least. These results suggest that ManQala provides a rich platform for designing control protocols relevant to quantum technologies.
Platinum thin film by Ag Lα, hard x-ray photoelectron spectroscopy
Authors: Rincón-Ortiz Sergio A. , Quintero-Orozco Jorge H. , Ospina Rogelio
Published: August 2023

Pt thin film was characterized by hard x-ray photoelectron spectroscopy (HAXPES) with an Ag Lα (2984.3 eV) excitation source. Sample was fixed to a stainless-steel sample holder with a copper double-sided adhesive tape. The survey spectrum, Pt 3d, Pt 4f, Pt 4d, C 1s, and valence band core levels spectra were acquired.
Effects of spectral degradation on gated word recognition
Authors: Patro Chhayakanta , Bennaim Ariana , Shephard Ellen
Published: August 2023

Although much is known about how normal-hearing listeners process spoken words under ideal listening conditions, little is known about how a degraded signal, such as speech transmitted via cochlear implants, affects the word recognition process. In this study, gated word recognition performance was measured with the goal of describing the time course of word identification by using a noise-band vocoder simulation. The results of this study demonstrate that spectral degradations can impact the temporal aspects of speech processing. These results also provide insights into the potential advantages of enhancing spectral resolution in the processing of spoken words.
Esports Minus Sport?
Authors: Fried Gil
Published: August 2023

Is esports a sport? That question has been answered by one court in the negative. However, is that court decision correct? What specific arguments can be raised in the future to deal with the argument that at the collegiate-level esports is not considered a real sport?
Physical Activity During Adolescence and Mental Health in Early Adulthood: Findings From the 1993 Pelotas Birth Cohort Study
Authors: da Silva Bruna Gonçalves Cordeiro , Menezes Ana Maria Baptista , Gonçalves Helen , Alves Charles Phillipe de Lucena , Delpino Felipe Mendes , Martins Rafaela Costa , Wehrmeister Fernando César
Published: August 2023

Background: Low prevalence of physical activity (PA) and a high prevalence of mental health problems are common among youth. The aim of this study was to evaluate the association between PA during adolescence and depression and anxiety disorders in young adulthood. Methods: Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed. Leisure-time PA and total PA (leisure plus commuting) were evaluated at 11, 15, and 18 years using self-reported data. PA was evaluated at each age separately and during adolescence, considering the number of times participants reached PA recommendations. Depression and anxiety were assessed through Mini International Neuropsychiatric Interview at 22 years. Crude and adjusted association analyses were performed using Poisson regression with robust error variance, providing prevalence ratios and 95% confidence intervals. Results: Three thousand two hundred and forty-seven participants were included in the study. In the adjusted analyses, active participants in leisure-time PA (≥300 min/wk) and total PA at 11 years were less likely to be depressed at age 22 (prevalence ratios: 0.54; 95% confidence interval, 0.33–0.89; prevalence ratios: 0.63; 95% confidence interval, 0.41–0.97). For leisure-time PA, the more PA recommendations were met during adolescence, the lower the prevalence of depression. There was no association when PA variables were evaluated separately at 15 and 18 years and between PA and anxiety after controlling for potential confounders. Conclusions: Early adolescence appears to be a sensitive period for PA benefits on depression in early adulthood. The more timepoints reaching PA recommendations during adolescence, the lower the risk of depression. On the other hand, PA during adolescence was not associated with anxiety in young adults.
Cultural water and Indigenous water science
Authors: O’Donnell Erin , Kennedy Melissa , Garrick Dustin , Horne Avril , Woods Rene
Published: August 2023

Australia shows the need for more sustainable and just water management
Management approaches to conserve Australia’s marine ecosystem under climate change
Authors: Bay Line K. , Gilmour James , Muir Bob , Hardisty Paul E.
Published: August 2023

Australia’s coastal marine ecosystems have a deep cultural significance to Indigenous Australians, include multiple World Heritage sites, and support the nation’s rapidly growing blue economy. Yet, increasing local pressures and global climate change are expected to undermine the biological, social, cultural, and economic value of these ecosystems within a human generation. Mitigating the causes of climate change is the most urgent action to secure their future; however, conventional and new management actions will play roles in preserving ecosystem function and value until that is achieved. This includes strategies codeveloped with Indigenous Australians that are guided by traditional ecological knowledge and a modeling and decision support framework. We provide examples of developments at one of Australia’s most iconic ecosystems, the Great Barrier Reef, where recent, large block funding supports research, governance, and engagement to accelerate the development of tools for management under climate change.
The forgotten future of the phage
The Good Virus
Tom Ireland
Norton, 2023. 400 pp.
Authors: Woolfson Adrian
Published: August 2023

As antibiotic resistance soars, a journalist revisits an often overlooked antimicrobial strategy
In Science Journals
Authors: Smith H. Jesse , Nusinovich Yevgeniya , Osborne Ian S. , Vignieri Sacha , Jiang Di , Shilatifard Ali , Olingy Claire , Simonti Corinne , Lavine Marc S. , Yeston Jake S. , Stajic Jelena , Wong Wei , Ali Mazhar N.
Published: August 2023

Highlights from the
Science
family of journals
On the Afghanistan-Iran border, a fight over water
Authors: Ruchi Kumar
Published: August 2023

Researchers fear a warming climate is intensifying a sometimes violent conflict
Disease alert system in trouble
Authors: Reardon Sara
Published: August 2023

Money woes and staff strike threaten ProMED dispatches
Preclinical safety and efficacy characterization of an LpxC inhibitor against Gram-negative pathogens
Authors: Zhao Jinshi , Cochrane C. Skyler , Najeeb Javaria , Gooden David , Sciandra Carly , Fan Ping , Lemaitre Nadine , Newns Kate , Nicholas Robert A. , Guan Ziqiang , Thaden Joshua T. , Fowler Vance G. , Spasojevic Ivan , Sebbane Florent , Toone Eric J. , Duncan Clayton , Gammans Richard , Zhou Pei
Published: August 2023

The UDP-3-
O
-(
R
-3-hydroxyacyl)-
N
-acetylglucosamine deacetylase LpxC is an essential enzyme in the biosynthesis of lipid A, the outer membrane anchor of lipopolysaccharide and lipooligosaccharide in Gram-negative bacteria. The development of LpxC-targeting antibiotics toward clinical therapeutics has been hindered by the limited antibiotic profile of reported non-hydroxamate inhibitors and unexpected cardiovascular toxicity observed in certain hydroxamate and non–hydroxamate-based inhibitors. Here, we report the preclinical characterization of a slow, tight-binding LpxC inhibitor, LPC-233, with low picomolar affinity. The compound is a rapid bactericidal antibiotic, unaffected by established resistance mechanisms to commercial antibiotics, and displays outstanding activity against a wide range of Gram-negative clinical isolates in vitro. It is orally bioavailable and efficiently eliminates infections caused by susceptible and multidrug-resistant Gram-negative bacterial pathogens in murine soft tissue, sepsis, and urinary tract infection models. It displays exceptional in vitro and in vivo safety profiles, with no detectable adverse cardiovascular toxicity in dogs at 100 milligrams per kilogram. These results establish the feasibility of developing oral LpxC-targeting antibiotics for clinical applications.
Supplemental Material: Late Cretaceous exhumation of the Little Belt Mountains and regional development of the Helena salient, west-central Montana, USA
Authors: Howlett Caden J. , et al.
Published: August 2023

Apatite fission-track and zircon (U-Th/He) data sets.
Plasma Excitations in SiGe/Si Quantum Wells
Authors: Khisameeva A. R. , Shchepetilnikov A. V. , Nikolaev G. A. , Lopatina S. A. , Fedotova Ya. V. , Kukushkin I. V.
Published: August 2023

Plasma and magnetoplasma excitations in high-quality undoped two-dimensional electron systems based on SiGe/Si quantum wells are studied in detail. A two-dimensional electron system is formed by applying a vo-ltage to the top gate, which is partially transparent to subterahertz radiation in the frequency range of 20‒160 GHz. The results for SiGe/Si quantum wells with a Sb δ-doping layer are also presented for comparison. The transport and quantum scattering times for both structures are directly determined. It has been found that the effective electron mass is almost independent of the two-dimensional electron density in a wide density range.
Inferior scapula avulsion fracture: an unusual presentation of winged scapula
Authors: Chan Julia , Hourston George Joseph Michael , Robinson Paul
Published: August 2023

Inferior scapula avulsion fractures are rare injuries, with few cases reported and only a small number managed operatively discussed in the literature. We report the case of a man in his 40s who fell from a height and presented with right-sided scapular winging and point tenderness at the inferior pole of his right scapula with no neurological deficit. Radiographs and CT diagnosed avulsion fracture of the inferior scapula. The patient underwent surgical fixation and, following a course of physiotherapy, successfully recovered with no residual winging and full range of movement.
Cost-effectiveness analysis of antibiotic prophylaxis versus no antibiotic prophylaxis for acute cholecystectomy
Authors: Satheeskaran Maya , Hussan Aminah , Anto Ailin , de Preux Laure
Published: August 2023

Objective

For acute cholecystitis, the treatment of choice is laparoscopic cholecystectomy. In mild-to-moderate cases, the use of antibiotic prophylaxis for the prevention of postoperative infectious complications (POICs) lacks evidence regarding its cost-effectiveness when compared with no prophylaxis. In the context of rising antimicrobial resistance, there is a clear rationale for a cost-effectiveness analysis (CEA) to determine the most efficient use of National Health Service resources and antibiotic routine usage.

Design

16 of 226 patients (7.1%) in the single-dose prophylaxis group and 29 of 231 (12.6%) in the non-prophylaxis group developed POICs. A CEA was carried out using health outcome data from thePerioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II) multicentre, randomised, open-label, non-inferiority, clinical trial. Costs were measured in monetary units using pound sterling, and effectiveness expressed as POICs avoided within the first 30 days after cholecystectomy.

Results

This CEA produced an incremental cost-effectiveness ratio of −£792.70. This suggests a modest cost-effectiveness of antibiotic prophylaxis being marginally less costly and more effective than no prophylaxis. Three sensitivity analyses were executed considering full adherence to the antibiotic, POICs with increased complexity and break-point analysis suggesting caution in the recommendation of systematic use of antibiotic prophylaxis for the prevention of POICs.

Conclusion

The results of this CEA point to greater consensus in UK-based guidelines surrounding the provision of antibiotic prophylaxis for mild-to-moderate cases of acute cholecystitis.
Medical device regulation and oversight in African countries: a scoping review of literature and development of a conceptual framework
Authors: Nasir Naima , Molyneux Sassy , Were Fred , Aderoba Adeniyi , Fuller Sebastian S
Published: August 2023

Regulatory and other governance arrangements influence the introduction of medical devices into health systems and are essential for ensuring their effective and safe use. Challenges with medical device safety, quality and use are documented globally, with evidence suggesting these are linked to poor governance. Yet, medical device regulation and oversight remain inadequately defined and described, particularly in low-income and middle-income settings. Through this review, we sought to examine the literature available on regulatory and oversight processes for medical devices in African countries.

Following a systematic approach, we searched academic databases including PubMed, Embase (Ovid) and MEDLINE (Ovid), supplemented by search for grey literature and relevant organisational websites, for documents describing medical device regulation and oversight in African countries. We summarised the data to present key actors, areas for regulation and oversight and challenges.

A total of 39 documents reporting regulation and oversight of medical devices were included for analysis. Regulatory and oversight guidelines and processes were reported as inadequate, including limited pre-market testing, reliance on international certifications and limited processes for post-market monitoring and reporting of adverse events. Challenges for regulation and oversight reported included inadequate funding, personnel and technical expertise to perform regulatory functions. The literature highlighted gaps in guidelines for donated medical devices and in information on governance processes at the national level.

The current literature provides a general overview of medical device regulatory guidelines and limited evidence on the implementation of regulatory/oversight processes at national and especially subnational levels. We recommend further research to elucidate existing governance arrangements for medical devices within African countries and propose a conceptual framework to inform future studies. The framework provides entry points for careful examination of governance and oversight in policy and practice, the exploration of governance realities across the health system and the influence of wider system dynamics.
‘Maze’ not pathway: focus group exploration of patients’ and public experiences of the UK NHS elective total joint arthroplasty pathway
Authors: Jasim Sarah , Aspinal Fiona , Mehta Raj , Ledger Jean , Raine Rosalind , Fulop Naomi J , Barratt Helen
Published: August 2023

Objective

To explore patient and public perceptions of planned improvements to the National Health Service (NHS) total joint arthroplasty (TJA) pathway.

Design

Three qualitative focus groups undertaken March–May 2018, as part of a mixed-methods evaluation of Getting It Right First Time. Transcripts were subject to framework analysis to identify thematic content between October 2018 and October 2021.

Setting

Elective TJA surgery in the English NHS.

Participants

Two focus groups including patients who had undergone TJA in the previous 2 years (group 1: n=5; group 2: n=4) and the other individuals who had not but were aged 60+ (group 3: n=5). Participants were recruited via community groups and patient panels.

Results

Fourteen individuals took part in the focus groups; all were aged over 60; seven (50%) were female and nine (64%) had undergone TJA surgery. Participants’ perspectives were categorised into themes and mapped onto stages of the TJA pathway. Although perioperative care is often the focus of improvement efforts, participants argued that the patient journey begins before individuals present to primary care. Participants had concerns about other aspects of the pathway, such as obtaining a surgical referral, with prereferral interventions aimed at potentially avoiding the need for surgery (ie, physiotherapy) being perceived as a mechanism to restrict access to secondary care. Patient experience was also conceptualised as a ‘maze’, rather than the logical, sequential process set out in clinical guidelines; exacerbated by a lack of information, knowledge and power imbalances.

Conclusion

The linear conceptualisation of the TJA pathway is at odds with patient experience. Improvement programmes focused on perioperative care fail to consider patient concerns and priorities. Patients should be directly involved in improvement programmes, to ensure that patient experience is optimised, as well as informing related processes and important outcomes of care.
Long-term comparative effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events: a population-based retrospective inception cohort study in the Netherlands
Authors: Li Xuechun , Bijlsma Maarten J , Bos Jens H J , Schuiling-Veninga Catharina C M , Hak Eelko
Published: August 2023

Objective

To determine the long-term effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events.

Design

Retrospective inception cohort study covering a 25-year study period.

Setting

University Groningen IADB.nl pharmacy prescription database with data from 1996 to 2020.

Participants

Patients aged 18 years or older, free of any cardiovascular disease (CVD) drug therapies prior to initiation of a preventive antihypertensive monotherapy (ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs) and thiazides).

Outcome measures

Primary outcome was the time to first prescription of acute cardiac drug therapy (CDT) measured by valid drug proxies to identify a first major CVD event in patients without a history of CVD.

Results

Among 33 427 initiators, 5770 (17.3%) patients experienced an acute CDT. The average follow-up time was 7.8±5.4 years. The 25-year incidence rate per 1000 person-years were 28.4, 25.2, 20.1, 28.4 and 25.2 for ACEI, ARB, BB, CCB and thiazide starters, respectively. Inverse probability weighted Cox regression showed that thiazide starters had lower hazards than the reference BB starters (HR: 0.88, 95%CI: 0.82 to 0.96). Among patients on diabetes drugs, risks were lower (HR: 0.58, 95%CI: 0.34 to 0.96). CCB starters had higher hazards than reference BB (HR: 1.26, 95% CI: 1.13 to 1.41). The overall estimated number needed to treat for thiazides compared with BBs to prevent one acute CDT in 25 years was 26, and five among patients on diabetes drugs.

Conclusions

After adjustments for confounders, patients starting on monotherapy with thiazides had a lower incidence of CDT compared with those starting on BBs, notably among patients on diabetes drugs. Conversely, patients who began CCB monotherapy had a higher incidence of CDT compared with those starting on BBs. Other monotherapies had comparable incidence of cardiovascular disease compared with BBs.
Effectiveness of oestrogen pretreatment in patients with expected poor ovarian response (POSEIDON groups 3 and 4) undergoing GnRH antagonist protocol: study protocol for a randomised controlled trial
Authors: Han Qiao-Song , Wu Zhi-Juan , Zhou Yue , Liang Jing-Nan , Jin Qing-Mei , Song Jing-Yan , Sun Zhen-Gao
Published: August 2023

Introduction

Women characterised by diminished ovarian reserve are considered to have poor ovarian response (POR) according to Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria. Patients in this population often have a poor prognosis for treatment with assisted reproductive technology. In previous studies, oestrogen pretreatment before ovarian stimulation has been shown to have a beneficial effect. However, recent studies presented conflicting conclusions. This study aims to evaluate the effectiveness of oestrogen pretreatment in patients with expected POR (POSEIDON groups 3 and 4) undergoing gonadotrophin releasing hormone antagonist (GnRH-ant) protocol.

Methods and analysis

A prospective superiority randomised parallel controlled trial will be conducted at a tertiary university-affiliated hospital. A total of 316 patients will be randomly divided into two groups at a ratio of 1:1. In the intervention group, oral oestrogen pretreatment will be administered from day 7 after ovulation until day 2 of the next menstrual cycle. Afterwards, a flexible GnRH-ant protocol will be initiated. The control group will receive no additional intervention beyond routine ovarian stimulation. The primary outcome is the number of oocytes retrieved. Secondary outcomes include the total number of retrieved metaphase II oocytes, average daily dose of gonadotropin, total gonadotropin dose and duration of ovarian stimulation, cycle cancellation rate, top quality embryos rate, blastocyst formation rate, embryo implantation rate, clinical pregnancy rate, early miscarriage rate and endometrial thickness on trigger day. All data will be analysed according to the intention-to-treat and per-protocol principles.

Ethics and dissemination

The ethical approval has been confirmed by the reproductive ethics committee of the affiliated hospital of Shandong University of Traditional Chinese Medicine (SDUTCM/2022.9.20). In addition, written informed consent will be obtained from all the participants before the study. The results will be disseminated via publications.

Trial registration number

ChiCTR2200064812.
Initial effect of high-volume mobilisation with movement on shoulder range of motion and pain in patients with rotator cuff-related shoulder pain: protocol for a randomised controlled trial (Evolution Trial)
Authors: Wang Sizhong , Zeng Jiaxu , Chapple Cathy M , Mani Ramakrishnan , Ribeiro Daniel C
Published: August 2023

Introduction

Mobilisation with movement (MWM) is commonly used for treating patients with rotator cuff-related shoulder pain (RCRSP). However, the evidence supporting MWM efficacy for improving shoulder range of motion (ROM) and pain in patients with RCRSP is limited. It is also unclear whether higher volume MWM leads to better clinical outcomes compared with lower volume MWM in patients with RCRSP. The primary aim of this study is to assess the effect of MWM on the angular onset of pain during shoulder abduction in patients with RCRSP.

Methods and analysis

Sixty participants with RCRSP will be randomised to receive either MWM or sham MWM intervention. The primary outcome is the angular onset of pain during shoulder abduction, and secondary outcomes are pain intensity at the angular onset of pain during shoulder abduction, maximum shoulder ROM, pain intensity during maximum shoulder abduction, pressure pain threshold, mechanical temporal summation, global rating of change scale (GROC) and Brief Pain Inventory-Short Form (BPI-SF). The angular onset of pain and the pain intensity at that range will be assessed at baseline, after 1 set and 3 sets of 10 repetitions of MWM or sham MWM. The GROC will be measured immediately after receiving 3 sets of interventions and on day 3 after interventions. The BPI-SF will be measured on days 1, 3, 5 and 7 after interventions. Other secondary outcomes will be assessed at baseline and after 3 sets of interventions. A linear mixed effects model with a random intercept will be used to compare changes in the outcome measures between MWM and sham MWM interventions.

Ethics and dissemination

This study has been approved by the University of Otago Ethics Committee (Ref. H21/117). Findings from this study will be disseminated through presentations at international and national conferences and will be submitted for publication in a peer-reviewed journal.

Trial registration number

ACTRN 12621001723875.
Industry views of the UK Soft Drinks Industry Levy: a thematic analysis of elite interviews with food and drink industry professionals, 2018–2020
Authors: Jones Catrin P , Forde Hannah , Penney Tarra L , van Tulleken Dolly , Cummins Steven , Adams Jean , Law Cherry , Rutter Harry , Smith Richard , White Martin
Published: August 2023

Objectives

The UK Soft Drinks Industry Levy (SDIL), implemented in 2018, has been successful in reducing the sugar content and purchasing of soft drinks, with limited financial impact on industry. Understanding the views of food and drink industry professionals involved in reacting to the SDIL is important for policymaking. However, their perceptions of the challenges of implementation and strategic responses are unknown. The aim of this study, therefore, was to explore how senior food and drink industry professionals viewed the SDIL.

Design

We undertook a qualitative descriptive study using elite interviews. Data were analysed using Braun and Clarke’s thematic analysis, taking an inductive exploratory and descriptive approach not informed by prior theory or frameworks.

Setting and participants

Interviews were conducted via telephone with 14 senior professionals working in the food and drink industry.

Results

Five main themes were identified:(1) a level playing field…for some; industry accepted the SDIL as an attempt to create a level playing field but due to the exclusion of milk-based drinks, this was viewed as inadequate,(2) complex to implement, but no lasting negative effects; the SDIL was complex, expensive and time consuming to implement, with industry responses dependent on leadership buy-in,(3) why us?—the SDIL unfairly targets the drinks industry; soft drinks are an unfair target when other categories also contain high sugar,(4) the consumer is king; consumers were a key focus of the industry response to this policy and(5) the future of the SDIL; there appeared to be a wider ripple effect, which primed industry to prepare for future regulation in support of health and environmental sustainability.

Conclusions

Insights from senior food and drink industry professionals illustrate how sugar-sweetened beverage taxes might be successfully implemented and improve understanding of industry responses to taxes and other food and drink policies.

Trial registration number

ISRCTN18042742.
Use of a context-specific package to increase sputum smear monitoring among people with pulmonary tuberculosis in Uganda: a quality improvement study
Authors: Adrawa Norbert , Ongiro Simon , Lotee Kizito , Seret Jacob , Adeke Mary , Izudi Jonathan
Published: August 2023

Background

People with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) require sputum smear monitoring (SSM) to ascertain response to anti-TB treatment and cure from TB disease. We aimed to increase SSM at 2, 5 and 6 months among people with BC-PTB from the baseline (March to July 2021) of 68%, 37% and 39%, respectively, to 90% in February 2022 by implementing a context-specific improvement package at a rural health facility in northeastern Uganda.

Methods

We designed a continuous quality improvement (CQI) study for people with BC-PTB, developed and tested an improvement package that consisted of the following context-specific measures: (1) line listing of all eligible persons for SSM; (2) use of reminder stickers to identify eligible persons for SSM; (3) use of community health workers to conduct home visits for people with missed clinic visits; and (4) integration of SSM into community-based ART points for distant persons. We implemented the measures using the plan-do-study-act cycle and tracked the progress in SSM through monthly data reviews and analyses.

Results

SSM at 2 months improved from 68% (17/25) at the baseline to 74% (32/43) during phase I (p=0.818) and then to 94% (17/18) during phase II (p=0.562). SSM at 5 months improved from 37% (11/29) at the baseline to 82% (41/50) during phase I (p=0.094) and then to 100% (10/10) during phase II (p=0.688). SSM at 6 months improved from 39% (9/23) at the baseline to 59% (28/39) during phase I (p=0.189) and then to 100% (12/12) during phase II (p=0.487).

Conclusion

The use of a context-relevant CQI package was accompanied by improved SSM at 2, 5 and 6 months among people with BC-PTB. Trends are encouraging but this should be considered as preliminary report because of limited numbers. These data can inform the design of a fully powered randomised controlled trial.
Common contributing factors of diagnostic error: A retrospective analysis of 109 serious adverse event reports from Dutch hospitals
Authors: Hooftman Jacky , Dijkstra Aart Cornelis , Suurmeijer Ilse , van der Bij Akke , Paap Ellen , Zwaan Laura
Published: August 2023

Introduction

Although diagnostic errors have gained renewed focus within the patient safety domain, measuring them remains a challenge. They are often measured using methods that lack information on decision-making processes given by involved physicians (eg, record reviews). The current study analyses serious adverse event (SAE) reports from Dutch hospitals to identify common contributing factors of diagnostic errors in hospital medicine. These reports are the results of thorough investigations by highly trained, independent hospital committees into the causes of SAEs. The reports include information from involved healthcare professionals and patients or family obtained through interviews.

Methods

All 71 Dutch hospitals were invited to participate in this study. Participating hospitals were asked to send four diagnostic SAE reports of their hospital. Researchers applied the Safer Dx Instrument, a Generic Analysis Framework, the Diagnostic Error Evaluation and Research (DEER) taxonomy and the Eindhoven Classification Model (ECM) to analyse reports.

Results

Thirty-one hospitals submitted 109 eligible reports. Diagnostic errors most often occurred in the diagnostic testing, assessment and follow-up phases according to the DEER taxonomy. The ECM showed human errors as the most common contributing factor, especially relating to communication of results, task planning and execution, and knowledge. Combining the most common DEER subcategories and the most common ECM classes showed that clinical reasoning errors resulted from failures in knowledge, and task planning and execution. Follow-up errors and errors with communication of test results resulted from failures in coordination and monitoring, often accompanied by usability issues in electronic health record design and missing protocols.

Discussion

Diagnostic errors occurred in every hospital type, in different specialties and with different care teams. While clinical reasoning errors remain a common problem, often caused by knowledge and skill gaps, other frequent errors in communication of test results and follow-up require different improvement measures (eg, improving technological systems).
High levels of high-sensitivity C reactive protein to albumin ratio can increase the risk of cardiovascular disease
Authors: Yang Xuemei , Yang Xiaoli , Yang Jingtao , Wen Xinran , Wu Shouling , Cui Liufu
Published: August 2023

Background

The high levels of C reactive protein (CRP) to albumin ratio (CAR) is thought to increase the risk of poor outcomes for cancer and cardiovascular disease (CVD). However, the association between CAR and CVD in the Chinese community population has not been investigated.

Objective

The aim of this study was to investigate the association between CAR and CVD in the Chinese community population.

Methods

A total of 62 067 participants without a history of CVD or cancer were included in this study. Kaplan-Meier survival curves were used to calculate the cumulative incidence of endpoint events in CAR quartile groups, and the results were tested by log-rank test. Fine-Gray model was used to analyse the competing risk of death. C-index, Net Reclassification Index (NRI) and Integrated Discrimination Improvement Index (IDI) of different indicators were calculated to distinguish the predictive performance of different indicators.

Results

During an average follow-up period of 10.3±2.1 years, 4025 participants developed CVD. In multivariable Cox regression analysis, compared with Q1 group, model 3 showed that the hazard ratio (HR) (95% confidence interval (95%CI)) of CVD in Q4 group was 1.26 (1.15 to 1.38) (p<0.01), and the HR (95% CI) per 1 SD increase was 1.06 (1.03 to 1.08) (p<0.01). The C-index, continuous NRI and IDI for predicting 10-year CVD were 73.48%, 0.1366 (0.1049 to 0.1684) (p<0.01) and 0.0002 (0.0001 to 0.0004) (p<0.01), respectively, which were higher than those of hs-CRP (C-index:0.7344, NRI:0.0711, IDI: 0.0001) and albumin (C-index:0.7339, NRI: −0.0090, IDI: 0.0000).

Conclusion

High levels of CAR can increase the risk of CVD and the predictive performance of CAR for CVD is better than that of hs-CRP or albumin alone.
Consultant-led UK paediatric palliative care services: professional configuration, services, funding
Authors: Bedendo Andre , Hinde Sebastian , Beresford Bryony , Papworth Andrew , Phillips Bob , Vasudevan Chakrapani , McLorie Emma , Walker Gabriella , Peat George , Weatherly Helen , Feltbower Richard , Hewitt Catherine , Haynes Andrew , Murtagh Fliss , Noyes Jane , Hackett Julia , Hain Richard , Oddie Sam , Subramanian Gayathri , Fraser Lorna
Published: August 2023

Objectives

To systematically gather information on the professional team members, services provided, funding sources and population served for all consultant-led specialised paediatric palliative care (SPPC) teams in the UK.

Methods

Two-part online survey.

Results

Survey 1: All 17 medical leads from hospital-based or hospice-based SPPC teams responded to the survey (100% response rate).

Only six services met the NICE guidance for minimum SPPC team.

All services reported providing symptom management, specialist nursing care, end-of-life planning and care, and supporting discharges and transfers to home or hospice for the child’s final days-hours. Most services also provided care coordination (n=14), bereavement support (n=13), clinical psychology (n=10) and social work-welfare support (n=9). Thirteen had one or more posts partially or fully funded by a charity.

Survey 2: Nine finance leads provided detailed resource/funding information, finding a range of statutory and charity funding sources. Only one of the National Health Service (NHS)-based services fully funded by the NHS.

Conclusions

One-third of services met the minimum criteria of professional team as defined by NICE. Most services relied on charity funding to fund part or all of one professional post and only one NHS-based service received all its funding directly from the NHS.
Unified inflation and dark energy with accelerated particle holographic model
Authors: Fazlollahi H. R.
Published: August 2023

In this paper and in the follows of the holographic approach to describe the primary acceleration and the late-time acceleration eras, we have considered and unified inflation and dark energy while accelerated particle holographic (APHM) density is used (Fazlollahi in Chin Phys C 47:035101, 2023). As discussed, establishing holographic model for constant roll inflation during the very early Universe leads one to explicit form of Hubble parameter which satisfies inflationary era. The validity of such holographic constant roll inflation with respect to the Planck data puts a certain bound on the infrared cut-off at the time of horizon crossing. Beside the mere inflation, the Hubble parameter gives explicit form for density of accelerated particle holographic model. It is shown such density due to inflationary bound condition on infrared cut-off could present late-time acceleration epoch. Consequently, inflation and late time expansion era unified in unique infrared cut-off model. Moreover, such corresponding fractional density gives more matter regimes during matter era. Nevertheless, studying matter structure formation during matter era reveals the model is not in conflict with$${\Lambda }$$ΛCDM model.