bluuebunny/crossref_metadata_2025 huggingface dataset:
Limiting Ship Motions for Small Ships in Heavy Seas
Authors: Rossignol Grant A. , Thomas William L.
Published: March 2022

This paper presents two independent methodologies for defining the seakeeping performance of vessels in various sea conditions. The results of a unique series of sea trials are compared to a new time domain computer program (FREDYN) that predicts ship performance and dangerous operating conditions in extreme seas. Both methods independently define the seakeeping performance during various ship operations such as transiting and weather deck operations.

Sea trials were conducted during various operations for two classes of small ships (less than 220 feet long) in a wide range of sea conditions. The use of improved trial procedures at specific geographical locations enabled these trials to establish operational limitations and provide challenging environmental conditions for this size ships.

The computer prediction (FREDYN) was developed by the Cooperative Research Navies (CRNAV) Dynamic Stability Working Group to provide a unique method of predicting seakeeping performance in extreme sea conditions. Dangerous events such as broaching and capsizing are able to be predicted, along with more accurate motion predictions than in the past. This method will be especially useful in the future for the designs of small ships.

The operational performance of ships A and B begins to decline in sea state 5 conditions as indicated by higher motion levels as well as coursekeeping and broaching problems. Capsizing events are predicted for ship A in sea state 6 and 7 conditions; and for ship B in sea state 7 conditions. The good agreement between the sea trial results and FREDYN predictions adds greatly to the credibility of the predictions of these events.
Nonlinear solitary waves in particle metamaterials with local resonators
Authors: Lu Qi , Wang Yi-Ze
Published: March 2022

In this work, solitary wave solutions of particle mechanical metamaterials are studied, in which the mass-in-mass structure with local resonators is considered. The Hertzian contact theory is used to describe adjacent particles in a precompressed granular chain. The governing wave equations are decoupled, and the expressions of bright, dark, and peaked solitary waves are derived, respectively. According to the results, both the wave velocity and prestress can affect the propagation of solitary waves. The amplitudes of bright and peaked solitary waves are smaller when a larger prestress is applied, which are different from the dark solitons. Furthermore, the wave widths become larger as the prestress increases.
The Protective Role of Physical Fitness on Cardiometabolic Risk During Pregnancy: The GESTAtion and FITness Project
Authors: Acosta-Manzano Pedro , Acosta Francisco M. , Flor-Alemany Marta , Gavilán-Carrera Blanca , Delgado-Fernández Manuel , Baena-García Laura , Segura-Jiménez Víctor , Aparicio Virginia A.
Published: March 2022

Physical fitness (PF) is a cornerstone of metabolic health. However, its role in maternal–fetal metabolism during pregnancy is poorly understood. The present work investigates: (i) the association of PF with maternal and fetal cardiometabolic markers, and with clustered cardiometabolic risk during pregnancy, and (ii) whether being fit counteracts cardiometabolic abnormalities associated with overweight/obesity. Several PF components (flexibility, lower and upper body strength, and cardiorespiratory fitness [CRF]) were objectively assessed in 151 pregnant women at gestational weeks 16 and 33, and an overall PF cluster score calculated. At the same times, maternal glycemic and lipid markers, cortisol, and C-reactive protein were assessed with standard biochemical methods, along with blood pressure and a proxy for insulin resistance, and a cardiometabolic risk cluster score determined. These analytes were also measured in maternal and umbilical cord arterial and venous blood collected at delivery. PF was found to be associated with several maternal and a small number of fetal cardiometabolic markers (p < .05). Lower and upper body muscle strength, CRF, overall PF (week 16), and CRF changes (weeks 16–33) were inversely associated with clustered cardiometabolic risk (p < .05). Normal weight fit women had lower values for insulin level, insulin resistance, triglycerides, low-density lipoprotein cholesterol, C-reactive protein, and diastolic blood pressure than did overweight/obese unfit women at week 16 (p < .05). In conclusion, greater PF, especially muscle strength and CRF in early–middle pregnancy, appears to be associated with a better metabolic phenotype, and may protect against maternal cardiometabolic risk. “Keep yourself fit and normal weight before and during early pregnancy” should be a key public health message.
Breakdown of topological protection by cavity vacuum fields in the integer quantum Hall effect
Authors: Appugliese Felice , Enkner Josefine , Paravicini-Bagliani Gian Lorenzo , Beck Mattias , Reichl Christian , Wegscheider Werner , Scalari Giacomo , Ciuti Cristiano , Faist Jérôme
Published: March 2022

The prospect of controlling the electronic properties of materials via the vacuum fields of cavity electromagnetic resonators is emerging as one of the frontiers of condensed matter physics. We found that the enhancement of vacuum field fluctuations in subwavelength split-ring resonators strongly affects one of the most paradigmatic quantum protectorates, the quantum Hall electron transport in high-mobility two-dimensional electron gases. The observed breakdown of the topological protection of the integer quantum Hall effect is interpreted in terms of a long-range cavity-mediated electron hopping where the anti-resonant terms of the light-matter coupling Hamiltonian develop into a finite resistivity induced by the vacuum fluctuations. Our experimental platform can be used for any two-dimensional material and provides a route to manipulate electron phases in matter by means of vacuum-field engineering.
Broad anti–SARS-CoV-2 antibody immunity induced by heterologous ChAdOx1/mRNA-1273 vaccination
Authors: Kaku Chengzi I. , Champney Elizabeth R. , Normark Johan , Garcia Marina , Johnson Carl E. , Ahlm Clas , Christ Wanda , Sakharkar Mrunal , Ackerman Margaret E. , Klingström Jonas , Forsell Mattias N. E. , Walker Laura M.
Published: March 2022

Heterologous prime-boost immunization strategies have the potential to augment COVID-19 vaccine efficacy. We longitudinally profiled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S)–specific serological and memory B cell (MBC) responses in individuals who received either homologous (ChAdOx1:ChAdOx1) or heterologous (ChAdOx1:mRNA-1273) prime-boost vaccination. Heterologous messenger RNA (mRNA) booster immunization induced higher serum neutralizing antibody and MBC responses against SARS-CoV-2 variants of concern (VOCs) compared with that of homologous ChAdOx1 boosting. Specificity mapping of circulating B cells revealed that mRNA-1273 boost immunofocused ChAdOx1-primed responses onto epitopes expressed on prefusion-stabilized S. Monoclonal antibodies isolated from mRNA-1273–boosted participants displayed overall higher binding affinities and increased breadth of reactivity against VOCs relative to those isolated from ChAdOx1-boosted individuals. Overall, the results provide molecular insight into the enhanced quality of the B cell response induced after heterologous mRNA booster vaccination.
The lasting legacy of John von Neumann
The Man from the Future: The Visionary Life of John von Neumann
Ananyo Bhattacharya
Norton, 2022. 368 pp.
Authors: Greenbaum Dov , Gerstein Mark
Published: March 2022

A new biography seeks to reacquaint readers with the once widely celebrated scientist
Forming roots from shoot
Authors: Shaar-Moshe Lidor , Brady Siobhan M.
Published: March 2022

Uncovering the genes responsible for different types of roots will transform aspects of plant agriculture
Can U.S. physics overcome its record of exclusion?
Authors: Mervis Jeffrey
Published: March 2022

Data show white institutions falling short and Black colleges leading the way
Fix the system, not the students
Authors: Mervis Jeffrey
Published: March 2022

Change requires building bridges, removing barriers
In Other Journals
Authors: Lopez Bianca , Yiu Yuen , Ash Caroline , Nusinovich Yevgeniya , Kelly Priscilla N. , Suleymanov Yury , Wible Brad
Published: March 2022

Editors’ selections from the current scientific literature
War in Ukraine poses stark choices for scientists
Authors: Stone Richard
Published: March 2022

As Ukrainian researchers hunker down or flee, backlash against Russian science builds
Studies bolster pandemic origin in Wuhan animal market
Authors: Cohen Jon
Published: March 2022

Close scrutiny of earliest cases and samples from market suggests virus crossed over from animals sold there
Limited Mechanistic Link Between the Monod Equation and Methanogen Growth: a Perspective from Metabolic Modeling
Authors: Jin Qusheng , Wu Qiong , Shapiro Benjamin M. , McKernan Shannon E.
Published: March 2022

The Monod equation has been widely applied to predict the rate of microbial growth, but its application is not always successful. Using a novel metabolic modeling approach, we simulated the growth of a methanogen and uncovered a limited mechanistic link between the Monod equation and the methanogen’s metabolic network.
The contribution of Walter Alvarez to the investigation of the Capitoline Hill in Rome
Authors: Ammerman Albert J.
Published: March 2022

The chapter consists of five sections. The first one provides an introduction to the collaboration between Walter Alvarez and the author in the interdisciplinary study of the Capitoline Hill in the early 1990s. The second section turns to how we first met in Rome in 1970 and our parallel pathways over the next two decades that saw each of us take the lead in developing a big new idea based on innovative interdisciplinary research. The third section gives the earth scientist essential background on the study of early Rome: such things as the seven kings of Rome, the original topography of the early city, and the syndrome of the eternal Rome. The fourth section develops an overview on the work that we conducted on the Capitoline Hill and the new results obtained. In the fifth section, we step back and consider the contribution of Walter Alvarez to our subsequent research and publications on early Rome and the emergence of the field of geoarchaeology in the study of ancient Rome.
Dinosaurs could not help it, can we? Big history and planetary health
Authors: García-Moreno* Olga , Oranje Maarten P.
Published: March 2022

One of the most recent intellectual enterprises of the scientist honored in this book, Walter Alvarez, is the dive into big history. Alvarez’s research and worldview contributed directly to the foundations of this transdisciplinary field. In this paper, the relevance of big history to the emergent idea of planetary health is demonstrated. Since big history studies both natural and human-made systems over long periods of time, it is uniquely positioned to help address the three categories of challenges identified within planetary health: imagination, knowledge, and governance. Most extensively, this paper focuses on governance challenges. A case study on the Ethiopian health system illustrates that governance frameworks can be reimagined in such a way that incentives and efforts of actors within the system are aligned, producing better human health outcomes. For Homo sapiens to have a better chance of survival than dinosaurs did 66 million years ago, these lessons will need to be applied more broadly in the planetary health domain.
The contrasting geologic record of inferred “hot” intraoceanic and “cold” continental margin subduction initiation
Authors: Wakabayashi* John , Shimabukuro* David H.
Published: March 2022

Two contrasting field relationships may reflect different tectonic settings of subduction initiation preserved in orogenic belts. “Hot” subduction initiation assemblages include a large ophiolite unit (up to kms thick, extending tens to hundreds of km along strike) with supra subduction zone (SSZ) geochemical affinity that structurally overlies a thin (<500 m thick) sheet of high-pressure (HP), high-temperature (HT), primarily metamafic rocks called a metamorphic sole. The ophiolite generally lacks burial metamorphism and includes variably serpentinized peridotite at its base. The sole structurally overlies subduction complex rocks made up of oceanic materials (igneous part of oceanic crust and overlying pelagic sedimentary rocks, and clastic sedimentary rocks of trench fill affinity) and/or passive margin assemblages; some of the subduction complex may be metamorphosed under HP-low temperature (LT) conditions (such as blueschist facies). The field relationships suggest initiation of subduction within young (<15 My) and “hot” oceanic lithosphere and that the sole represents the first slice(s) of material transferred from the subducting to upper plate. Examples include the Neotethyan and northern Appalachian ophiolites and units beneath them, and the Coast Range ophiolite and subjacent Franciscan subduction complex of California.

“Cold” subduction initiation assemblages lack SSZ ophiolite and island arc components and a metamorphic sole. Instead, the upper plate above the subduction complex is made up of continental lithosphere that last experienced significant heating during a passive-margin forming rift event. The protoliths of the rocks subducted were >70 My in age at the time of subduction initiation. The HP-LT subduction complex is composed of slices of continental crust and oceanic crust representing parts of a hyperextended continental margin. These field relationships suggest initiation of subduction along a continental margin within old (“cold”) hyperextended continental lithosphere. Examples include the Apennine subduction zone, exposed in Calabria, Italy, and the Alpine orogenic belt, both remnants of the Alpine Tethys.
The Jurassic structural high of Sasso di Pale (Umbria-Marche Basin, Italy): How a small Apennine structure recorded Early to Middle Jurassic global perturbations
Authors: Baldanza* Angela , Bizzarri* Roberto , Bartolini* Annachiara , Bertinelli* Angela , Colacicchi* Roberto
Published: March 2022

The reduced Jurassic sedimentary sequences deposited on a structural high in the Umbria-Marche Apennines, as well their relationships with adjacent expanded basinal sequences, have been reconstructed through detailed, interdisciplinary study of the Sasso di Pale and Monte Serrone areas near Foligno, Italy. The physiographic features of the basin originated in the Early Jurassic (latest early Pliensbachian), when extensional tectonic activity broke up a shallow water platform where the Calcare Massiccio had been deposited, and the area evolved from an edge-stepped structural high to a distally steepened ramp. The biostratigraphic framework of this paper is mainly based on calcareous nannofossils, which are a useful tool for dating condensed Jurassic successions. Although the sections studied have limited thickness and much lateral facies variation, the sedimentary evolution can be traced and interpreted within a wider Jurassic environmental perspective. In the upper Pliensbachian–lower Bajocian interval, local sea-level variations are compatible with the global sea-level curve. Furthermore, some of the characteristic events—such as the Pliensbachian–Toarcian crisis, the Early Toarcian Jenkyns Event, and the Middle Jurassic carbonate crisis—can be recognized. The present study shows how the reconstruction of local paleogeography can fit into a more general framework and how regional and global signals can be recognized even in a small structural high such as the one we have investigated.
Impact-crater ages and micrometeorite paleofluxes compared: Evidence for the importance of ordinary chondrites in the flux of meteorites and asteroids to Earth over the past 500 million years
Authors: Schmitz* Birger , Schmieder Martin , Liao Shiyong , Martin Ellinor , Terfelt Fredrik
Published: March 2022

Although the ~200 impact craters known on Earth represent only a small fraction of the craters originally formed, the available data suggest an excess of craters by one order of magnitude, in number, in the interval ca. 470–440 Ma during the Ordovician. Most of these “excess” craters may be related to the breakup of the L-chondrite parent body (LCPB) in the asteroid belt at 465.8 ± 0.3 Ma. This is the only obvious peak in the crater-age record that can currently be attributed to an asteroid breakup and shower event. Spatial crater densities in regions with high potential for crater preservation (e.g., Canada and Scandinavia) support a one order-of-magnitude increase in the flux of large (>0.1 km) impactors following the LCPB breakup. A similar pattern as seen in the cratering record is emerging in studies of the flux of micrometeoritic chrome spinel through the Phanerozoic, with so far only one major spike in the flux, and associated with the LCPB breakup. Similarly, the record of K-Ar and (U-Th)/He gas retention ages of recently fallen meteorites only locates one major breakup, the LCPB event, during the Phanerozoic. On the other hand, astronomical backtracking studies of the orbits of asteroid family members indicate ~70 major family-forming breakups within the past ~540 m.y., which apparently have not left any clear imprint in Earth’s geological record. The chrome-spinel grains recovered in our studies dominantly represent large micrometeorites (>300 µm) and as such are also representative of the flux of larger meteorites to Earth. An observed, nearly constant flux of ordinary chondritic chrome-spinel grains throughout the Phanerozoic, except after the LCPB event, indicates that the present situation—with a clear dominance of ordinary chondritic matter in the large (>500 µm) micrometeorite and macroscopic meteorite fractions—has prevailed at least for the last 500 m.y. This is also supported by generally high ratios in our samples of chrome-spinel grains from ordinary chondrites compared to other types of spinel-bearing meteorites. The chrome-spinel data together with the abundance of fossil meteorites (1–21 cm in diameter) on the Ordovician seafloor also sets an upper limit at one order of magnitude on the increase in flux of large (>0.1-km-diameter) L-chondritic projectiles to Earth following the LCPB. Such an increase would not stand out in the global cratering record if ordinary chondritic impactors had only represented a small fraction of all Phanerozoic impactors. We argue that the origin of impactors delivered to Earth during the past 500 m.y. has mirrored the flux of large micrometeorites and meteorites, with ordinary chondrites being an important or, most likely, the dominant (in numbers) component throughout.
Planetary defense: The communication challenge—Lessons from the COVID-19 pandemic
Authors: Nagel Lea K. , Albrecht Rudolf , Koeberl* Christian
Published: March 2022

As impact events are known to have had severe effects on the geological and biological evolution of the Earth, the need to detect potentially hazardous objects that might collide with the Earth, and to possibly protect our planet from asteroid impacts, has been recognized in recent years. Planetary defense covers human activities to address potential impacts of Near-Earth Objects on Earth. Once the immediate threat of such an impact is obvious, this fact, along with the intended countermeasures, will have to be communicated to the public. There is a parallel to the recent coronavirus (COVID-19) situation: an imminent threat and the required response are being communicated. Reactions between acceptance and cooperation all the way to denial, conspiracy theories, fake news, and active opposition can be observed. It is evident that these factors will have to be considered in the strategy for communicating the asteroid threat.
The Bottaccione Gorge and Gubbio: Hypotheses for a history of the city
Authors: Sannipoli* Ettore A. , Cencetti* Corrado
Published: March 2022

The Bottaccione Gorge at Gubbio, in central Italy, has been an important source of information about Cretaceous and Paleogene Earth history. At the much younger end of the historical continuum, it is also important for understanding the early history of Gubbio itself, for which the only written, although somewhat ambiguous, evidence comes from the Tavole eugubine, the unique bronze tablets which are a kind of Rosetta Stone for the Umbrian language. The role of the Bottaccione Gorge is debated in the history of Gubbio. The road through the gorge, crossing the Monti di Gubbio, is an important element for explaining the location of the city. One of the first settlements (late Bronze Age) is recognized from archaeological evidence at the top of a morphological fault scarp on the slope of Monte Ingino. In the Iron Age, the city described in the Tavole eugubine developed, in which Okri (fortress), Tota (city), and three sacred gates are mentioned. The locations of Okri, Tota, and the gates are still under study. According to the most likely hypothesis, Tota would have developed in the plain, on the right bank of the Torrente Camignano, while the initial settlement would have been transformed into Okri, to which the sacred gates would belong. Another gate may have been placed at the entrance to the Bottaccione Gorge. When the Eugubini (the people of Gubbio) built the new, post-Roman Gubbio in the twelfth century, they still identified, as the most suitable place for a fortified city, the location above the scarp on the slope of Monte Ingino, and they built two new gates at its lateral ends. The city was likely equipped with a third gate that faced the Bottaccione Gorge. In the thirteenth century, the Bottaccione Aqueduct was built to bring water to the highest point of Gubbio. Thus, two waterways—one natural (Torrente Camignano) and the other artificial—still branch off from Bottaccione to reach Gubbio at two different points that determine the lowest and highest levels of the city.
Latest Silurian syntectonic sedimentation and magmatism and Early Devonian orogenic gold mineralization, central Newfoundland Appalachians, Canada: Setting, structure, lithogeochemistry, and high-precision U-Pb geochronology
Authors: Honsberger I.W. , Bleeker W. , Kamo S.L. , Sandeman H.A.I. , Evans D.T.W. , Rogers N. , van Staal C.R. , Dunning G.R.
Published: March 2022

The eastern Dunnage Zone of the central Newfoundland Appalachians hosts Paleozoic orogenic gold mineralization along a northeast-trending, crustal-scale fault corridor that extends for more than 200 km. This orogenic gold system is characterized by polyphase, structurally controlled, quartz vein systems that cut Neoproterozoic granitoid rocks and unconformably overlying syntectonic, polymict conglomerate and associated transitional to calc-alkaline bimodal igneous rocks.

High-precision chemical abrasion–isotope dilution–thermal ionization mass spectrometry (CA-ID-TIMS) U-Pb geochronology confirms a widespread, latest Silurian magmatic pulse (422–420 Ma) that is attributed to a transient phase of lithospheric extension resulting from asthenospheric and crustal melting related to slab break-off. Syntectonic conglomerate was deposited as a basal unit during extension-related uplift and erosion that lasted until ca. 418 Ma in north-central Newfoundland. Orogenic gold mineralization associated with syntectonic sedimentation and magmatism is hosted within third-order shear vein systems that form offshoots within a triangle zone–like structural corridor between southeast- and northwest-dipping, second-order fault splays and shear zones. The southeast-dipping fault system formed during northwest migration of the Acadian thrust front, whereas the northwest-dipping faults and shear zones are Salinic structures that were reactivated in the Early Devonian.

Primary hydrothermal rutile in the orogenic gold-mineralized quartz veins produced ages of ca. 410 Ma. These ages are consistent with quartz vein emplacement and orogenic gold mineralization as a result of hydrothermal fluid-pressure cycling related to far-field compression and thermal perturbations during the Early Devonian Acadian orogenic cycle. The setting and process evolution of the central Newfoundland gold district are remarkably similar to that of world-class orogenic gold systems of the Canadian Shield.
Injury modelling for strategic planning in protecting the national infrastructure from terrorist explosive events
Authors: Breeze Johno , Fryer R N , Nguyen T-T N , Ramasamy A , Pope D , Masouros S D
Published: March 2022

Terrorist events in the form of explosive devices have occurred and remain a threat currently to the population and the infrastructure of many nations worldwide. Injuries occur from a combination of a blast wave, energised fragments, blunt trauma and burns. The relative preponderance of each injury mechanism is dependent on the type of device, distance to targets, population density and the surrounding environment, such as an enclosed space, to name but a few. One method of primary prevention of such injuries is by modification of the environment in which the explosion occurs, such as modifying population density and the design of enclosed spaces. The Human Injury Predictor (HIP) tool is a computational model which was developed to predict the pattern of injuries following an explosion with the goal to inform national injury prevention strategies from terrorist attacks. HIP currently uses algorithms to predict the effects from primary and secondary blast and allows the geometry of buildings to be incorporated. It has been validated using clinical data from the‘7/7’terrorist attacks in London and the 2017 Manchester Arena terrorist event. Although the tool can be used readily, it will benefit from further development to refine injury representation, validate injury scoring and enable the prediction of triage states. The tool can assist both in the design of future buildings and methods of transport, as well as the situation of critical emergency services required in the response following a terrorist explosive event. The aim of this paper is to describe the HIP tool in its current version and provide a roadmap for optimising its utility in the future for the protection of national infrastructure and the population.
Stated preferences for family doctor contract services: a survey of the rural elderly in Anhui Province, China
Authors: Wang Cuilian , Gu Yuanyuan , Zhao Linhai , Zhang Youran , Zhou Rui , Gu Megan , Wang Lidan
Published: March 2022

Objective

A number of factors contribute to the utilisation of family doctor contract services (FDCS) in China. This study aims to measure the preferences of the elderly for the FDCS and identify the key factors (and their relative importance) that may guide policymakers in more accurately providing the FDCS.

Participants and methods

A discrete choice experiment was performed to elicit the preferences for FDCS among the rural elderly in China. Attributes and levels were established based on qualitative methods. Four attributes were included: service type, service package, physician’s reputation and annual contract costs. A D-efficient design was used to create a set of profiles that represented FDCS. The survey was conducted face to face using a sample of participants aged 60 and above in rural areas of Anhui Province. The data were analysed using a latent class logit (LCL) model.

Results

A total of 545 valid questionnaires were included in the analysis. The average age of the participants was 69.44 (SD 5.80). Two latent classes were identified with the LCL model. All four attributes proved statistically significant at the level of both the population mean and the two classes. The rural elderly showed a preference for FDCS with a relatively good reputation, lower annual contract costs, the basic service with the add-on of chronic disease service and home visit. Age, gender, education, self-reported health status and the number of chronic diseases were found to be associated with latent class membership.

Conclusion

In this study, the physician’s reputation had the largest impact on the rural elderly’s choice of FDCS. Policy recommendations included the need to strengthen family doctor team training, devote greater attention to improving the family doctor’s medical skills and service approaches, and increased FDCS efficiency for the care of the rural elderly.
Health status and healthcare services utilisation among unaccompanied asylum-seeking minors settled in Switzerland: a protocol for a retrospective cohort study from a hospital-based youth outpatient clinic
Authors: Patseadou Magdalini , Chamay Weber Catherine , Haller Dagmar M
Published: March 2022

Introduction

Unaccompanied asylum-seeking minors (UASMs) represent a population group with complex healthcare needs. Initial and ongoing healthcare is challenging for host countries but considered essential. This publication describes the protocol concerning a large cohort of UASMs settled in Switzerland in 2015–2016. Our aim is to assess their health status and examine their trajectories of healthcare services utilisation during the 3-year period after their initial health control.

Methods and analysis

We will retrospectively analyse data of all newly arrived UASMs aged 12–18 years who benefited from a first health assessment at the Youth Clinic of Geneva University Hospitals between 1 January 2015 and 31 December 2016. Source of data will be electronic medical records. Main outcomes include the determination of their health status (acute and chronic conditions) and the utilisation of different care sectors (ambulatory primary care and subspecialty clinics, emergency room and inpatient wards). A secondary outcome will be the identification of patients at risk for high use of services as well as those with limited access to care. We will extract the following data: demographic characteristics (age, gender and country of origin), social determinants (place of residence, the presence of family in Geneva, school performance and asylum status), clinical information (reason for attending service, anthropometric measurements and medical diagnosis at discharge) and laboratory parameters (complete blood count, ferritin level, 25-hydroxyvitamin D level, hepatitis B antigen and antibodies, tetanus antibodies, QuantiFERON and stool and serology tests for intestinal parasites). We will collect data from first health assessment and during a follow-up period of 3 years for each patient.

Ethics and dissemination

In accordance with the Swiss clinical research law, this protocol has been approved by the local ethics committee (project ID: 2021–01260). Our findings will provide important information for the development of quality healthcare services focusing to UASMs. We intend to disseminate our results through publication in peer-reviewed journals.
Dietary supplements to reduce symptom severity and duration in people with SARS-CoV-2: study protocol for a randomised, double-blind, placebo controlled clinical trial
Authors: Legacy Mark , Seely Dugald , Conte Ellen , Psihogios Athanasios , Ramsay Tim , Fergusson Dean A , Kanji Salmaan , Simmons John-Graydon , Wilson Kumanan
Published: March 2022

Introduction

COVID-19 has caused morbidity, hospitalisations and deaths worldwide. Despite four approved vaccines for COVID-19 in Canada, there is still a need for effective treatments, especially for people in the community. Vaccine efficacy is not 100% and long-term efficacy is still unknown. Furthermore, there are challenges to herd immunity including vaccine hesitancy and underlying conditions preventing vaccination. We aim to explore if the nutrients vitamin C, vitamin D, vitamin K2 and zinc are an effective treatment option for outpatients diagnosed with COVID-19. The primary outcome is the difference in participant-reported overall health; secondary outcomes include the effect on health status, symptom severity and duration, frequency and length of hospitalisations and mortality.

Methods and analysis

This study is a two-arm, parallel-group, double-blind, placebo-controlled, phase III randomised controlled trial. 200 patients will be recruited remotely from COVID-19 test centres in Ottawa, Canada associated with The Ottawa Hospital. Overall health will be measured using the EuroQol Visual Assessment Scale; health status will be measured using the EuroQol 5-dimension 5-level questionnaire; symptom severity and duration will be measured using an independently developed questionnaire; analyses will use an area under the curve approach and compare mean scores using unadjusted t tests. Study data will be recorded on electronic case report forms using the Research Electronic Data Capture platform. An independent data safety and monitoring board will perform ongoing review of the study for feasibility and safety.

Ethics and dissemination

This study has received ethical approval from the research ethics boards of the Canadian College of Naturopathic Medicine and the Ottawa Health Sciences Network, as well as regulatory approval from the Therapeutic Products Directorate and Natural and Non-Prescription Health Products Directorate of Health Canada. Results will be published in a peer-reviewed scientific journal with open access.

Trial registration number

NCT04780061.
Paediatric resident workflow observations in a community-based hospital
Authors: Di Rocco Jennifer R , Kimata Chieko , Barat Masihullah , Kodama Samantha
Published: March 2022

Objective

Residency graduates need to demonstrate competence in prioritising safe patient care through appropriate management of multiple competing tasks and workflow interruptions. This pilot study aimed to characterise and correlate interruptions in paediatric resident workflow at an academically affiliated, community-based hospital.

Methods

One of three trained observers followed a resident physician during a convenience sample of 1–2 hour increments, either in the emergency department or on the wards, and recorded all observed activities and interruptions using an established time-motion tool. All participants completed a baseline Multi-Tasking Ability Test (MTAT) and pre-observation and post-observation surveys. Statistical approach included descriptive statistics, logistic regression, mixed model and ORs.

Results

18 paediatric residents were observed for 57.5 total hours (an average of 3.2 hours/resident) which included 329 interruptions, defined as any external event drawing the resident’s attention away from a primary task. Interruptions occurred an average of 5.9 times per resident per hour. Interrupted primary tasks were not resumed during the observation period 11% of the time. A personal/social-related interruption yielded an OR of 0.29 that the resident will return to a primary task within 5 min (p=0.007) when compared with patient-related verbal interruptions by the medical team. The MTAT Score indicated decreased efficiency for interns versus postgraduate year 2 residents (p=0.029). Residents’ MTAT Scores did not correlate with their time to return to a primary task following an interruption (p=0.11).

Conclusions

Paediatric resident workflow interruptions in the hospital were observed to occur frequently and should be expected. Personal/social interruptions were most likely to delay prompt return to a primary task. The MTAT Score, although improved between the first 2 years of residency training, did not correlate with efficient return to a primary task. Interruption management and mitigation strategies should be developed as part of a standardised residency task management curriculum.
Building artificial intelligence and machine learning models : a primer for emergency physicians
Authors: Ramlakhan Shammi L , Saatchi Reza , Sabir Lisa , Ventour Dale , Shobayo Olamilekan , Hughes Ruby , Singh Yardesh
Published: March 2022

There has been a rise in the number of studies relating to the role of artificial intelligence (AI) in healthcare. Its potential in Emergency Medicine (EM) has been explored in recent years with operational, predictive, diagnostic and prognostic emergency department (ED) implementations being developed. For EM researchers building models de novo, collaborative working with data scientists is invaluable throughout the process. Synergism and understanding between domain (EM) and data experts increases the likelihood of realising a successful real-world model. Our linked manuscript provided a conceptual framework (including a glossary of AI terms) to support clinicians in interpreting AI research. The aim of this paper is to supplement that framework by exploring the key issues for clinicians and researchers to consider in the process of developing an AI model.
Plasma Aβ as a biomarker for predicting Aβ-PET status in Alzheimer’s disease：a systematic review with meta-analysis
Authors: Cheng Lizhen , Li Wei , Chen Yixin , Lin Yijia , Wang Beiyun , Guo Qihao , Miao Ya
Published: March 2022

Objective

Amyloid-β positron emission tomography (Aβ-PET) scan has been proposed to detect amyloid-β (Aβ) deposition in the brain. However, this approach is costly and not ideal for the early diagnosis of Alzheimer’s disease. Blood-based Aβ measurement offers a scalable alternative to the costly or invasive biomarkers. The aim of this study was to statistically validate whether plasma Aβ could predict Aβ-PET status via meta-analysis.

Methods

We systematically searched for eligible studies from PubMed, Embase and Cochrane Library, which reported plasma Aβ levels of amyloid-β positron emission tomography-positive (PET (+)) and amyloid-β positron emission tomography-negative (PET (−)) subjects. We generated pooled estimates using random effects meta-analyses. For any study that has significant heterogeneity, metaregression and subgroup analysis were further conducted. Publication bias was appraised by funnel plots and Egger’s test.

Results

16 studies with 3047 participants were included in the meta-analysis. Among all the enrolled studies, 10 studies reported plasma Aβ40 values, while 9 studies reported plasma Aβ42 values and 13 studies reported Aβ42/Aβ40 ratio. The pooled standardised mean difference (SMD) was 0.76 (95% CI −0.61 to 2.14, p=0.28) in the plasma Aβ40 values group. Plasma Aβ42 values group has a pooled SMD of −0.60 (95% CI −0.80 to −0.41, p<0.0001). In the plasma Aβ42/Aβ40 ratio group, the pooled SMD was −1.44 (95% CI −2.17 to −0.72, p<0.0001).

Conclusion

Plasma Aβ40 values might not distinguish between PET (+) and PET (−) people. However, plasma Aβ42 values and plasma Aβ42/Aβ40 ratio could be served as independent biomarkers for predicting Aβ-PET status.
Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action
Authors: Dai Xiaochen , Gakidou Emmanuela , Lopez Alan D
Published: March 2022

Background

Despite compelling evidence on the health hazards of tobacco products accumulated over the past 70 years, smoking remains a leading cause of death worldwide. Policy action to control smoking requires timely, comprehensive, and comparable evidence on smoking levels within and across countries. This study provides a recent assessment of that evidence based on the methods used in the Global Burden of Disease (GBD) Study.

Methods

We estimated annual prevalence of, and mortality attributable to smoking any form of tobacco from 1970 to 2020 and 1990–2020, respectively, using the methods and data sources (including 3431 surveys and studies) from the GBD collaboration. We modelled annual prevalence of current and former smoking, distributions of cigarette-equivalents per smoker per day, pack-years for current smoking, years since cessation for former smokers and estimated population-attributable fractions due to smoking.

Results

Globally, adult smoking prevalence in 2020 was 32.6% (32.2% to 33.1%) and 6.5% (6.3% to 6.7%) among men and women, respectively. 1.18 (0.94 to 1.47) billion people regularly smoke tobacco, causing 7.0 (2.0 to 11.2) million deaths in 2020. Smoking prevalence has declined by 27.2% (26.0% to 28.3%) for men since 1990, and by 37.9% (35.3% to 40.1%) for women. Declines have been largest in the higher sociodemographic countries, falling by more than 40% in some high-income countries, and also in several Latin American countries, notably Brazil, where prevalence has fallen by 70% since 1990. Smoking prevalence for women has declined substantially in some countries, including Nepal, the Netherlands and Denmark, and remains low throughout Asia and Africa. Conversely, there has been little decline in smoking in most low- and middle-income countries (LMICs) with over half of all men continuing to smoke in large populations in Asia (China, Indonesia), as well as the Pacific Islands.

Implications

While global smoking prevalence has fallen, smoking is still common and causes a significant health burden worldwide. The unequal pace of declines across the globe is shifting the epidemic progressively to LMICs. Smoking is likely to remain a leading cause of preventable death throughout this century unless smoking cessation efforts can significantly and rapidly reduce the number of smokers, particularly in Asia.

Funding

XD and EG received funding through grant projects from Bloomberg Philanthropies (funding no. 66-9468) and the Bill & Melinda Gates Foundation (funding no. 63-3452).
Evolution of tobacco products: recent history and future directions
Authors: O'Connor Richard , Schneller Liane M , Felicione Nicholas J , Talhout Reinskje , Goniewicz Maciej Lukasz , Ashley David L
Published: March 2022

Declines in cigarette smoking prevalence in many countries and the consolidation of the tobacco industry have prompted the introduction of other forms of nicotine delivery. These include electronic nicotine delivery systems (ENDS), heated tobacco products (HTPs) and oral nicotine products (ONPs). Evolving over time, some of these products now deliver nicotine at levels comparable to cigarettes and may serve as effective substitutes for smokers. However, certain products, especially ENDS like JUUL, have also appealed to youth and non-smokers, prompting concerns about expanding nicotine use (and potentially nicotine addiction). The tobacco industry could shift away from primarily promoting cigarettes to promoting ENDS, HTPs and/or ONPs, though at this time it continues to heavily promote cigarettes in low and middle-income countries. Differing regulatory regimes may place upward and downward pressures on both cigarettes and these newer products in terms of population use, and may ultimately drive the extent to which cigarettes are or are not displaced by ENDS, HTPs and/or ONPs in the coming decade.
European Tobacco Products Directive (TPD): current impact and future steps
Authors: Vardavas Constantine I
Published: March 2022

Efforts to reduce the toll of tobacco-related morbidity and mortality in the European Union are spearheaded by the Tobacco Products Directive (TPD), a legal act implemented during 2016–2021, with the overall aim to reduce tobacco consumption by 2% in Europe. Within this time frame, several core tobacco control measures were implemented, the impact of which is outlined within this manuscript. Key successful legislative actions implemented in this time frame led to greater availability of information and further regulation of additives, the banning of mentholated cigarettes, enhanced pictorial package warnings and a regulatory framework for e-cigarettes. While repeated cross-sectional data indicated a 12.5% relative reduction in smoking prevalence after implementation of the TPD, the differential regulation of cigarettes and roll-your-own tobacco compared with other products, such as cigarillos, e-cigarettes and heated tobacco products, may have also led to product displacement. Moreover, as the TPD could not keep up with the ever-changing nicotine product landscape, further adaptations may be needed.
Waterpipe tobacco smoking (WTS) control policies: global analysis of available legislation and equity considerations
Authors: Alaouie Hala , Krishnamurthy Reddiar Sumithra , Tleis Malak , El Kadi Lama , A Afifi Rima , Nakkash Rima
Published: March 2022

Introduction

The Framework Convention on Tobacco Control (FCTC) offers guidance on evidence-based policies to reduce tobacco consumption and its burden of disease. Recently, it has provided guidance for alternative tobacco products, such as the waterpipe. Waterpipe tobacco smoking (WTS) is prevalent worldwide and policies to address it need to take into consideration its specificities as a mode of smoking. In parallel, a growing body of literature points to the potential of evidence-based tobacco control policies to increase health inequities. This paper updates a previous global review of waterpipe tobacco policies and adds an equity lens to assess their impact on health inequities.

Methods

We reviewed policies that address WTS in 90 countries, including 10 with state-owned tobacco companies; 47 were included in our final analysis. We relied primarily on the Tobacco-Free Kids organisation’s Tobacco Control Laws website, providing access to tobacco control laws globally. We categorised country tobacco policies by the clarity with which they defined and addressed waterpipe tobacco in relation to nine FCTC articles. We used the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status and Social capital) framework for the equity analysis, by reviewing equity considerations referenced in the policies of each country and including prevalence data disaggregated by equity axis and country where available.

Results

Our results revealed very limited attention to waterpipe policies overall, and to equity in such policies, and highlight the complexity of regulating WTS. We recommend that WTS policies and surveillance centre equity as a goal.

Conclusions

Our recommendations can inform global policies to reduce WTS and its health consequences equitably across population groups.
Tobacco farming: overcoming an understated impediment to comprehensive tobacco control
Authors: Lencucha Raphael , Drope Jeffrey , Magati Peter , Sahadewo Gumilang Aryo
Published: March 2022

Tobacco farming has emerged as an important concern for tobacco control advocates. Tobacco-growing countries face unique and important challenges to comprehensive, intersectoral tobacco control. These challenges stem from narratives that position tobacco as an important driver of economic growth and development, perpetuated by tobacco interests with close ties to government decision-making. While the global tobacco control movement has enshrined a commitment to alternatives to tobacco growing, there remain numerous obstacles. Tobacco growing is often situated in contexts with limited markets for other agricultural products, limited knowledge and economic resources to pursue alternatives, and/or a structure that favours industry control over the supply chain, all constraining the decision space of farmers. An evidence-informed approach is necessary to address tobacco supply, including growing, processing, manufacturing and trade, in this complex context. This paper reviews the economic, environmental and policy context of tobacco growing with an emphasis on the past decade of empirical work on the political economy of tobacco supply and introduces strategies to pursue alternatives. This analysis debunks many of the arguments used to perpetuate the narrative of tobacco’s prosperity and provides critical insights into the institutional constraints faced by government sectors in pursuing a policy of alternatives.