bluuebunny/crossref_metadata_2025 huggingface dataset:
Convective and Turbulent Motions in Nonprecipitating Cu. Part III: Characteristics of Turbulence Motions
Authors: Pinsky Mark , Khain Alexander
Published: January 2023

Velocity field in a nonprecipitating Cu under BOMEX conditions, simulated by SAM with 10-m resolution and spectral bin microphysics is separated into the convective part and the turbulent part, using a wavelet filtering. In Part II of the study properties of convective motions of this Cu were investigated. Here in Part III of the study, the parameters of cloud turbulence are calculated in the cloud updraft zone at different stages of cloud development. The main points of this study are (i) application of a fine-scale LES model of a single convective cloud allowed a direct estimation of turbulence parameters using the resolved flow in the cloud and (ii) the separation of the resolved flow into the turbulence flow and the nonturbulence flow allowed us to estimate different turbulent parameters with sufficient statistical accuracy. We calculated height and time dependences of the main turbulent parameters such as turbulence kinetic energy (TKE), spectra of TKE, dissipation rate, and the turbulent coefficient. It was found that the main source of turbulence in the cloud is buoyancy whose contribution is described by the buoyancy production term (BPT). The shear production term (SPT) increases with height and reaches its maximum near cloud top, and so does BPT. In agreement with the behavior of BPT and SPT, turbulence in the lower cloud part (below the inversion level) is weak and hardly affects the processes of mixing and entrainment. The fact that BPT is larger than SPT determines many properties of cloud turbulence. For instance, the turbulence is nonisotropic, so the vertical component of TKE is substantially larger than the horizontal components. Another consequence of the fact that BPT is larger than STP manifests itself in the finding that the turbulence spectrum largely obeys the −11/5 Bolgiano–Obukhov scaling. The classical Kolmogorov −5/3 scaling dominates for the low part of a cloud largely at the dissolving stage of cloud evolution. Using the spectra obtained we evaluated an “effective” dissipation rate which increases with height from nearly zero at cloud base up to 20 cm2 s−3 near cloud top. The coefficient of turbulent diffusion was found to increase with height and ranged from 5 m2 s−1 near cloud base to 25 m2 s−1 near cloud top. The possible role of turbulence in the process of lateral entrainment and mixing is discussed.

Significance Statement

1) This study investigates the turbulent structure of Cu using a 10-m-resolution LES model with spectral bin microphysics, 2) the main source of turbulence is buoyancy, 3) turbulence in cumulus clouds (Cu) is nonisotropic, 4) turbulence reaches maximum intensity near cloud top, 5) turbulence spectrum obeys largely the −11/5 Bolgiano–Obukhov scaling, and 6) the main turbulent parameters are evaluated.
Dynamic Characteristics and Possible Causes for the Propagation from Meteorological to Hydrological Drought over a Temperate Typical Steppe
Authors: Wang Yixuan , Duan Limin , Tong Xin , Shi Shuyue , Liu Tingxi , Ma Long
Published: January 2023

Knowledge gain in the characteristics and mechanisms of drought propagation is indispensable for timely drought early warning and risk reduction over the grassland eco-region. This study focused on the Xilin River basin, which is a typical inland river basin located in the Inner Mongolia temperate steppe, China. The characteristics of meteorological and hydrological drought were assessed by applying the standardized precipitation index and standardized streamflow index. The propagation relationship between meteorological and hydrological droughts was then investigated from both static and dynamic perspectives, and the possible reasons for its temporal dynamics were discussed by considering environmental factors. Our results showed that the Xilin River basin has suffered from more serious meteorological drought than hydrological drought during the past 60 years, with a stationary evolution of meteorological drought but an overall drying trend in hydrological drought. The propagation from meteorological to hydrological droughts exhibited obvious seasonality, characterized by stronger intensity and shorter response time in the wet season. Nonstationary behaviors were identified for the temporal patterns of drought propagation time, especially showing a significant trend in April, May, and August. The dynamic changes in propagation time affected by regional forces were principally ruled by the precipitation variation positively and strongly, and they were moderately controlled by temperature, vegetation cover, and deep-layer soil moisture, with season-dependent effects. The effects of low-frequency atmospheric anomalies on drought propagation will be further investigated in future studies, which are expected to provide a better understanding of the physical mechanism of the large-scale climate forcing on local drought condition.

Significance Statement

A new research approach was proposed to assess the propagation relationship between meteorological and hydrological drought from both static and dynamic perspectives, and the possible reasons for the temporal dynamics were discussed by considering environmental factors. Focusing on an inland river basin over the Inner Mongolia typical steppe, the propagation from meteorological to hydrological droughts showed obvious seasonality. Nonstationary behaviors were identified for the temporal patterns of drought propagation time, which could be explained by the regional hydrometeorological conditions. The advanced understanding of drought propagation provides a scientific base for water resources planning and drought management within a grassland region.
Performance of a Convective-Scale Ensemble Prediction System on 2017 Warm-Season Afternoon Thunderstorms over Taiwan
Authors: Chen I-Han , Su Yi-Jui , Lai Hsiao-Wei , Hong Jing-Shan , Li Chih-Hsin , Chang Pao-Liang , Wu Ying-Jhang
Published: January 2023

A 16-member convective-scale ensemble prediction system (CEPS) developed at the Central Weather Bureau (CWB) of Taiwan is evaluated for probability forecasts of convective precipitation. To address the issues of limited predictability of convective systems, the CEPS provides short-range forecasts using initial conditions from a rapid-updated ensemble data assimilation system. This study aims to identify the behavior of the CEPS forecasts, especially the impact of different ensemble configurations and forecast lead times. Warm-season afternoon thunderstorms (ATs) from 30 June to 4 July 2017 are selected. Since ATs usually occur between 1300 and 2000 LST, this study compares deterministic and probabilistic quantitative precipitation forecasts (QPFs) launched at 0500, 0800, and 1100 LST. This study demonstrates that initial and boundary perturbations (IBP) are crucial to ensure good spread–skill consistency over the 18-h forecasts. On top of IBP, additional model perturbations have insignificant impacts on upper-air and precipitation forecasts. The deterministic QPFs launched at 1100 LST outperform those launched at 0500 and 0800 LST, likely because the most-recent data assimilation analyses enhance the practical predictability. However, it cannot improve the probabilistic QPFs launched at 1100 LST due to inadequate ensemble spreads resulting from limited error growth time. This study points out the importance of sufficient initial condition uncertainty on short-range probabilistic forecasts to exploit the benefits of rapid-update data assimilation analyses.

Significance Statement

This study aims to understand the behavior of convective-scale short-range probabilistic forecasts in Taiwan and the surrounding area. Taiwan is influenced by diverse weather systems, including typhoons, mei-yu fronts, and local thunderstorms. During the past decade, there has been promising improvement in predicting mesoscale weather systems (e.g., typhoons and mei-yu fronts). However, it is still challenging to provide timely and accurate forecasts for rapid-evolving high-impact convection. This study provides a reference for the designation of convective-scale ensemble prediction systems; in particular, those with a goal to provide short-range probabilistic forecasts. While the findings cannot be extrapolated to all ensemble prediction systems, this study demonstrates that initial and boundary perturbations are the most important factors, while the model perturbation has an insignificant effect. This study suggests that in-depth studies are required to improve the convective-scale initial condition accuracy and uncertainty to provide reliable probabilistic forecasts within short lead times.
Barriers to mental health care access in Nepal
Authors: Atreya Alok , Upreti Manish , Nepal Samata
Published: January 2023

Mental disorders are stigmatised in Nepal. There are many instances where mentally ill people are tormented by their family members and society and where patients with mental illness are shackled and kept under house arrest. Physical illness attracts early medical care, but not mental illness. There are no asylums for patients suffering from mental illness. The Nepalese government must prioritise it as a serious health issue and allocate more money and take steps to tackle the stigma and deficiencies associated with it.
Racial Biofutures: COVID-19 and Black Futurity Otherwise
Authors: Ehlers Nadine
Published: January 2023

Through a consideration of COVID-19, this article offers a series of provocations in thinking about racial biofutures. First, it suggests that looking backwards through a lens of recursivity only allows us to see the same anti-black futures mapped out again and again, the repeated production of predictable futures – always – already precarious. Second, along with many others, I argue that we know this story of recursivity and that naming these repetitions is analytically reductive and politically deficient: this is a recursive trap. Third, the article argues that sociology must instead address productions or remakings of life that are embedded within (but move out of) these recursive logics: it must prioritise and elevate those practices and voices that labour to actualise living alternative futurity now.
Towards variegated ‘Peripheral Municipalisms’: The experience of Valparaíso and Recoleta, Chile
Authors: Toro Fernando , Orozco Hernán
Published: January 2023

In the context of a renewed interest in new forms of municipalism, this paper seeks to contribute by critically analysing two cases of the municipal experience in Chile: Valparaíso and Recoleta. By coining the notion of ‘Peripheral Municipalisms’, our aim is to give voice to a diversity of municipal endeavours in the Global South marked by highly precarious forms of local government. In both case studies, municipalist strategies are used as tools to challenge deep-rooted neoliberal structures. Through a qualitative methodology, based mainly on document analysis and semi-structured interviews, we analyse particular forms of municipalism based on the remunicipalisation of public services and broad-based citizen platforms. These institutional reforms and participatory practices have enabled more just futures by challenging dependency on central government and building a more egalitarian urban process. The article calls for more situated studies on municipalist forces in the Global South in order to continue building this translocal movement from comparative experiences, going beyond ‘model cases’.
Effects of electroacupuncture on the ventral tegmental area- nucleus accumbens dopamine pathway in rats with chronic sleep deprivation
Authors: Xi Hanqing , Wu Wenzhong , Qin Shan , Wang Xiaoqiu , Liu Chengyong
Published: January 2023

Background:

Insomnia is a well-recognized clinical sleep disorder in the adult population. It has been established that acupuncture has a clinical effects in the treatment of insomnia; however, research on the underlying neural circuits involved in these effects is limited.

Methods:

The modified multiple platform method (MMPM) was used to establish a rat model of chronic sleep deprivation (CSD). Forty rats were randomly divided into a control (Con) group, (untreated) CSD group, electroacupuncture-treated CSD group (CSD + EA) and estazolam-treated CSD group (CSD + Estazolam group) with n = 10 per group. In the CSD + EA group, EA was delivered at Yintang and unilateral HT7 (left and right treated every other day) with continuous waves (2 Hz frequency) for 30 min/day over 7 consecutive days. In the CSD + Estazolam groups, estazolam was administered by oral gavage (0.1 mg/kg) for 7 consecutive days. The open field test (OFT) was used to observe behavioral changes. Immunofluorescence assays and enzyme-linked immunosorbent assay (ELISA) were used to observe the effects of EA on the ventral tegmental area (VTA)-nucleus accumbens (NAc) dopamine (DA) pathway. We also assessed the effects of EA on the expression of dopamine D1 receptor (D1R) and dopamine D2 receptor (D2R) in the NAc, which are the downstream targets of the VTA-NAc DA pathway.

Results:

After CSD was established by MMPM, rats exhibited increased autonomous activity and increased excitability of the VTA-NAc DA pathway, with increased VTA and NAc DA content, increased D1R expression and decreased D2R expression in the NAc. EA appeared to reduce the autonomous ability of CSD rats, leading to lower DA content in the VTA and NAc, reduced expression of D1R in the NAc and increased expression of D2R. Most importantly, EA produced effects similar to estazolam with respect to the general condition of rats with CSD and regulation of the VTA-NAc DA pathway.

Conclusions:

The therapeutic effect of EA in chronic insomnia may be mediated by reduced excitability of the VTA-NAc DA pathway, with lower DA content in the VTA and NAc, downregulated expression of D1R in the NAc and increased expression of D2R.
A Tale of Childhood Loss, Conditional Acceptance and a Fear of Abandonment: A Qualitative Study Taking a Narrative Approach to Eating Disorders
Authors: Watterson Roma L. , Crowe Marie , Jordan Jennifer , Lovell Sarah , Carter Janet D.
Published: January 2023

Eating disorders (EDs) are serious mental health illnesses, yet there is a need to better understand the illness experience to improve treatment outcomes. Qualitative research, and narrative approaches in particular, can elicit life stories that allow for the whole illness journey to be explored. This study aimed to explore the experiences of women with a history of an ED, identifying the life events they perceived were relevant to the onset of their ED through to recovery. Interviews were conducted with 18 women with lived experience of an ED. Through structural narrative analysis, an overarching storyline of childhood loss contributing to a belief of conditional acceptance, fear of abandonment and struggle to seek emotional support due to the fear of being a burden was identified. Negative experiences with the health sector were common. These findings have implications for the way medical professionals respond to help seeking and deliver treatment.
Orthotic Helmet Therapy for Deformational Plagiocephaly: Stratifying Outcomes by Insurance
Authors: Hauc Sacha C. , Junn Adam H. , Long Aaron S. , Rivera Jean Carlo , Littlefield Timothy R. , Ihnat Jacqueline M. , Shah Hemali P. , Pondugula Nishita , Almeida Mariana N. , Alper David P. , Persing John A. , Alperovich Michael
Published: January 2023

Objective

Deformational Plagiocephaly (DP) is commonly treated with cranial orthosis, or helmet therapy. A large, national study on the impact of insurance status on helmet outcomes is lacking. We assessed treatment outcomes for helmet therapy based on insurance status.

Design

This was a retrospective data analysis of patients referred to Cranial Technologies, Inc for helmet therapy between 2014–2020 across 21 states.

Patients, Participants

There were a total of 211,417 patients referred for helmeting, of whom 141,513 received helmet therapy.

Main Outcomes Measures

Multivariate regression was used to assess the relationship of insurance status with post-treatment residual flattening, measured by cephalic index (CI) and cranial vault asymmetry index (CVAI), and treating provider rating of success.

Results

Patients with Medicaid were more likely to complete treatment with residual flattening measured by CI and CVAI when compared to patients with private insurance (OR: 1.58, CI: 1.51–1.65, p < 0.001 and OR: 1.21, CI: 1.15–1.28, p < 0.001, respectively). Providers of patients with Medicaid were more likely to give a low rating of success following treatment (OR: 3.25, CI: 2.70–3.92, p < 0.001).

Conclusions

Our study investigating the impact of insurance status on helmet therapy across 21 states found that patients with Medicaid were more likely to experience residual flattening and have lower provider-rated outcomes compared to those with commercial insurance. Given significant caregiver burden posed by helmet therapy, which requires frequent visits and consistent helmet use, caregivers of patients with Medicaid may require greater support to reduce outcome disparities observed here.
Retrospective Analysis of a Modern Cohort of Dermatofibrosarcoma Protuberans From 2000 to 2018
Authors: Baig Imran T. , Lauck Kyle , Nguyen Quoc-Bao D.
Published: January 2023

Background

There is limited data on how demographics, tumor characteristics, and treatment methods affect overall survival in patients with dermatofibrosarcoma protuberans (DFSP).

Objective

To summarize characteristics of patients with DFSP, assess prognostic factors, and evaluate the impact of treatment modality on their overall survival.

Methods

We investigated DFSP using data for 4451 patients with histologically confirmed cases of DFSP diagnosed between 2000 and 2018 from the 18 US regional registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program.

Results

Older age ( P < .001) and large tumor size ( P = .006) were significantly associated with worse overall survival in controlled analysis. Older age ( P < .050), males ( P < .001), non-white race ( P < .001), and lower median household income ( P < .010) were more likely to present with larger tumor size. Different treatments were associated with patient characteristics. Older age ( P < .001), non-white race ( P < .032), larger tumor size ( P < .001), and head/neck location ( P < .001) were associated with patients receiving surgery and radiation instead of surgery only. Additionally, men ( P < .021), non-whites ( P < .001), lower median household income ( P < .001), and larger tumor size ( P = .003) were less likely to have Mohs micrographic surgery performed over excision.

Conclusions

Age at presentation and tumor size appeared to be notable prognostic factors. Although treatment modality did not significantly influence patient survival, certain patient characteristics are associated with different treatment modalities.
Effectiveness of carotid council in the treatment of carotid artery disease: Early-term outcomes of the multidisciplinary approach
Authors: Ozbek Ismail C , Durmaz Aysegul , Ozen Yucel , Demir Serkan , Celik Didem , Yalcinkaya Emre , Cunurlu Merve , Ugur Murat
Published: January 2023

Objectives

Carotid arterial stenosis could be treated by surgical or percutaneous stenting. In this study, we aimed to investigate the effectiveness of the carotid council on the outcomes of patients with carotid artery disease.

Methods

In this retrospective study, we analyzed the patients who had undergone carotid arterial revascularization from April 2014 to July 2022 in our hospital. All patients were evaluated in carotid council, which is constituted by neurologist, cardiologist and cardiovascular surgeon. Patient-specific treatment procedure was decided in the council. Demographics and early-term follow-up results of the patients were evaluated.

Results

Totally 95 procedures in 85 patients were analyzed during the study period. 27.4 % of the patients had significant contralateral carotid arterial stenosis. In 88 (92.6%) procedures, patients were treated by carotid endarterectomy, and 5 procedures were performed under regional anesthesia. Shunt usage was 6.0% during the surgery, and arteriotomy was repaired with primary sutures in 87.3%. Stent implantation was performed in 7 patients. There were 5 neurological adverse events after the carotid endarterectomy and 2 neurological events were after carotid arterial stenting. In each treatment group, one patient died after the procedure. In the follow-up period, restenosis was observed just in a patient who was treated with carotid endarterectomy and primary repair.

Conclusion

Although carotid artery disease could be treated in accordance with the guidelines, treatment procedures should be patient-specific. Carotid councils might be helpful in giving patient-specific decisions, thereby providing the patient-based treatment procedure and improving the outcomes of the patients with carotid artery disease.
Reliving the Good Old Days: Nostalgia Increases Psychological Wellbeing Through Collective Effervescence
Authors: Naidu Esha , Gabriel Shira , Wildschut Tim , Sedikides Constantine
Published: January 2023

Nostalgia, a sentimental longing for one’s past, is associated with, or confers, psychological wellbeing (PWB). We identified a mechanism for this link: collective effervescence, a potent sense of connection to those present in an assembly and a sensation of transcendence (i.e., feeling that an experience is special or sacred). In six studies, involving measurement-of-mediation and experimental-causal-chain designs, nostalgia was associated with, and led to, higher PWB via collective effervescence. In Study 1, nostalgia was related to PWB through collective effervescence at the dispositional level. In Study 2, induced collective effervescence increased PWB. In Studies 3a–3c, induced nostalgia led to greater PWB due to collective effervescence. In Study 4, induced nostalgia increased PWB due to collective effervescence even when controlling for authenticity, an alternate mediator.
What do we want from a concept?
Authors: Bosworth Kai
Published: January 2023

The article ‘What is “affective infrastructure”?’ sought to historicize and rework a concept in geographical and philosophical thought. In doing so, it aimed to understand how scholars use the notion of ‘affective infrastructure’ to clarify the specific (but also rather diverse) relationships among spaces or worlds or ideas to which it was applied. The article also offered my own wagers: that in grasping at infrastructure today, scholars are sometimes implicitly missing – or explicitly disavowing – some of the historical-materialist and partisan origins and potential uses of the concept in continental theory, but also revolutionary movement analysis. Five reviews by six readers disaggregate my attempts to clarify and synthesize the stakes of this concept. This commentary responds to each of these generous accounts and reflects on the mediating work and stakes of conceptual genealogies, inventions, and rehabilitations.
Distribution of rare earth elements of Tunisian margin clays
Authors: Jamoussi Fakher , Lopez Galindo Alberto
Published: January 2023

The rare earth element (REE) content of the Tunisian Permian–Neogene shales have been studied to determine the origins of the clay minerals in these shales. The Permian–Neogene series overlies the Palaeozoic basement that has been studied via oil-drilling cores. This study of REEs was performed in various palaeogeographical domains of Tunisia, from the ‘Saharan Platform’ in the south to the ‘Nappes Zone’ in the north. In this work, those levels rich in illite (Palaeozoic, Triassic and Jurassic), smectite (Campanian–Maastrichtian) and palygorskite (continental Eocene) as well as some Miocene levels rich in halloysite are examined. The distribution of REEs in the Tunisian margin sediments is generally homogeneous, except for the Miocene levels containing halloysites. The normalization curves of REEs vs North American shale composite characterize the inherited clays regardless of the dominant minerals, except for a few cases of neoformation. The flat REE curves indicate a detrital origin of the studied clay levels.
Crystal chemistry of turkestanite, Dara-i-Pioz massif, Tajikistan
Authors: Kaneva Ekaterina , Radomskaya Tatiana , Belozerova Olga , Shendrik Roman
Published: January 2023

The results of combined single-crystal X-ray diffraction, electron probe microanalysis, Fourier microspectroscopy, and photoluminescence spectroscopy study of crystals of turkestanite from the Dara-i-Pioz deposit, Tien-Shan Mountains, Tajikistan are reported. It is a single-layer sheet silicate belonging to the ekanite group with a steacyite structural type. Averaged major-element analysis provided (wt.%): K2O 4.13(6), CaO 8.1(1), Na2O 2.3(1), ThO2 25.8(4), UO2 3.6(4) and SiO2 55.9(1). The averaged crystal-chemical formula for the studied turkestanite is (Th0.84U0.12)Σ0.96(Ca1.24Na0.65)Σ1.89(K0.75☐0.25)Σ1.00Si8O19.72(OH)0.28. Single-crystal structural refinement of turkestanite gave tetragonal, space group P4/mcc, a = 7.5708(3) Å, c = 14.7300(11) Å, V = 844.27(6) Å3 and Z = 2. Luminescence of the uranyl ion (UO2)2+ is observed in turkestanite. In the excitation spectrum, the bands corresponding to a charge transfer transition from the 2p states of the ligand to the 5f state of uranium were found.
HMGB1 mediates lipopolysaccharide-induced macrophage autophagy and pyroptosis
Authors: Shang Jiawei , Zhao Feng , Cao Yongmei , Ping Feng , Wang Wei , Li Yingchuan
Published: January 2023

Autophagy and pyroptosis of macrophages play important protective or detrimental roles in sepsis. However, the underlying mechanisms remain unclear. High mobility group box protein 1 (HMGB1) is associated with both pyroptosis and autophagy. lipopolysaccharide (LPS) is an important pathogenic factor involved in sepsis. Lentivirus-mediated HMGB1 shRNA was used to inhibit the expression of HMGB1. Macrophages were treated with acetylation inhibitor (AA) to suppress the translocation of HMGB1 from the nucleus to the cytosol. Autophagy and pyroptosis-related protein expressions were detected by Western blot. The levels of caspase-1 activity were detected and the rate of pyroptotic cells was detected by flow cytometry. LPS induced autophagy and pyroptosis of macrophages at different stages, and HMGB1 downregulation decreased LPS-induced autophagy and pyroptosis. Treatment with acetylation inhibitor (anacardic acid) significantly suppressed LPS-induced autophagy, an effect that was not reversed by exogenous HMGB1, suggesting that cytoplasmic HMGB1 mediates LPS-induced autophagy of macrophages. Anacardic acid or an anti-HMGB1 antibody inhibited LPS-induced pyroptosis of macrophages. HMGB1 alone induced pyroptosis of macrophages and this effect was inhibited by anti-HMGB1 antibody, suggesting that extracellular HMGB1 induces macrophage pyroptosis and mediates LPS-induced pyroptosis. In summary, HMGB1 plays different roles in mediating LPS-induced autophagy and triggering pyroptosis according to subcellular localization.
The journey to a learning health system in primary care: a qualitative case study utilising an embedded research approach
Authors: Dammery Genevieve , Ellis Louise A. , Churruca Kate , Mahadeva Janani , Lopez Francisco , Carrigan Ann , Halim Nicole , Willcock Simon , Braithwaite Jeffrey
Published: January 2023

Background

Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system.

Methods

Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine’s framework of learning health systems.

Results

In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice.

Conclusion

Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework.
Risk thresholds for patients to switch between daily tablets and biweekly infusions in second-line treatment for advanced hepatocellular carcinoma: a patient preference study
Authors: Parikh Neehar D. , Girvan Allicia , Coulter Joshua , Gable Jonathon , Poon Jiat Ling , Kim Sangmi , Chatterjee Anindya , Boeri Marco
Published: January 2023

Background

Historically, high hepatocellular carcinoma (HCC)–related mortality has been, in part, due to lack of effective therapies; however, several systemic therapies have been recently approved for HCC treatment, including regorafenib and ramucirumab. These two treatments utilize different routes of administration (four daily tablets and biweekly intravenous infusions, respectively) and have different risks of adverse events (AEs). However, we lack data on patient preferences in balancing the route of administration and risk of AEs in patients with HCC. We aimed to determine patient preferences and trade-offs for second-line treatment in patients with HCC. 

Methods

Patients with advanced or metastatic HCC were recruited through their physicians for this study. Patient preferences were assessed by using a modified threshold technique (TT) design in which respondents were asked two direct-elicitation questions before (assuming same safety and efficacy and only varying mode of administration) and after (incorporating the safety profiles of ramucirumab and regorafenib) the TT series on seven risks of clinically relevant AEs.

Results

In total, of the 157 patients recruited by their physicians, 150 were eligible and consented to participate. In the first elicitation question (assuming risk and efficacy were equivalent), 61.3% of patients preferred daily tablets. However, 76.7% of patients preferred the biweekly infusion when the safety profiles of the two available second-line therapies were included. The TT analysis confirmed that preferences for oral administration were not strong enough to balance out the risk of AEs that differentiate the two therapies.

Discussion

We found that when patients were asked to choose between a daily, oral medication and a biweekly IV medication for HCC, they were more likely to choose a daily, oral medication if efficacy and safety profiles were the same. However, when risks of AEs representing the safety profiles of two currently available second-line treatments were introduced in a second direct-elicitation question, respondents often selected an IV administration with a safety profile similar to ramucirumab, rather than oral tablets with a safety profile similar to regorafenib. Our findings indicate that the risk profile of a second-line treatment for HCC may be more important than the mode of administration to patients.
Identification of immune associated potential molecular targets in proliferative diabetic retinopathy
Authors: Gao Ying , Xue Min , Dai Bing , Tang Yun , Liu Jingyu , Zhao Changlin , Meng Hu , Yan Feng , Zhu Xiaomin , Lu Yan , Ge Yirui
Published: January 2023

Background

Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes and causes of blindness in developed countries. Our study was designed to identify immune-related genes involved in the progression of proliferative diabetic retinopathy (PDR).

Methods

The “GSE102485” dataset of neovascular membrane samples (NVMs) from type 1 and 2 diabetes mellitus patients was downloaded from the Gene Expression Omnibus database. Functional enrichment analyses, protein–protein interaction network (PPI) construction, and module analysis of immune pathways in NVMs and controls were conducted via Gene Set Enrichment Analysis and Metascape.

Results

The significantly upregulated hallmark gene sets in DR2 and DR1 groups were involved in five immune pathways. Only CCR4, CXCR6, C3AR1, LPAR1, C5AR1, and P2RY14 were not previously reported in the context of PDR molecular pathophysiology. Except for P2RY14, all of the above were upregulated in retinal samples from experimental diabetes mouse models and human retina microvascular endothelial cells (HRMECs) treated with high glucose (HG) by quantitative Real Time Polymerase Chain Reaction (qRT-PCR).

Conclusion

The genes identified herein provide insight into immune-related differential gene expression during DR progression.
Sharing real-world data for public benefit: a qualitative exploration of stakeholder views and perceptions
Authors: Baxter Susan , Franklin Matthew , Haywood Annette , Stone Tony , Jones Monica , Mason Suzanne , Sterniczuk Kamil
Published: January 2023

Background

There has been an increasing interest in the use of “real-world” data to inform care decision making that could lead to public health benefit. Routinely collected service and activity data associated with the administration of care services and service-users (such as electronic health records or electronic social care records), hold potential to better inform effective and responsive decision-making about health and care services provided to national and local populations. This study sought to gain an in-depth understanding regarding the potential to unlock real world data that was held in individual organisations, to better inform public health decision-making. This included sharing data between and within health service providers and local governing authorities, but also with university researchers to inform the evidence base.

Methods

We used qualitative methods and carried out a series of online workshops and interviews with stakeholders (senior-level decision-makers and service leads, researchers, data analysts, those with a legal and governance role, and members of the public). We identified recurring themes in initial workshops, and explored these with participants in subsequent workshops. By this iterative process we further refined the themes identified, compared views and perceptions amongst different stakeholder groups, and developed recommendations for action.

Results

Our study identified key elements of context and timing, the need for a different approach, and obstacles including governmental and legal, organisational features, and process factors which adversely affect the sharing of real world data. The findings also highlighted a need for improved communication about data for secondary uses to members of the public.

Conclusion

The Covid-19 pandemic context and changes to organisational structures in the health service in England have provided opportunities to address data sharing challenges. Change at national and local level is required, within current job roles and generating new jobs roles focused on the use and sharing of real-world data. The study suggests that actions can be taken to unlock the potential of real-world data for public health benefit, and provides a series of recommendations at a national level, for organisational leaders, those in data roles and those in public engagement roles.
In vitro and in vivo anthelmintic and chemical studies of Cyperus rotundus L. extracts
Authors: El-Wakil Eman S. , Shaker Shimaa , Aboushousha Tarek , Abdel-Hameed El-Sayed S. , Osman Ezzat E. A.
Published: January 2023

Background

Trichinellosis, a zoonosis caused by the genus Trichinella, is a widespread foodborne disease. Albendazole, one of the benzimidazole derivatives, is used for treating human trichinellosis, but with limited efficacy in killing the encysted larvae and numerous adverse effects. Cyperus rotundus L. is a herbal plant with a wide range of medicinal uses, including antiparasitic, and is frequently used in traditional medicine to treat various illnesses.

Methods

LC-ESI-MS was used to identify the active phytoconstituents in the methanol extract (MeOH ext.) of the aerial parts of C. rotundus and its derivate fractions ethyl acetate (EtOAc fr.), petroleum ether (pet-ether fr.), and normal butanol (n-BuOH fr.). The in vivo therapeutic effects of C. rotundus fractions of the extracts were evaluated using the fraction that showed the most promising effect after detecting their in vitro anti-Trichinella spiralis potential.

Results

C. rotundus extracts are rich in different phytochemicals, and the LC-ESI-MS of the 90% methanol extract identified 26 phenolic compounds classified as phenolic acids, flavonoids, and organic acids. The in vitro studies showed that C. rotundus extracts had a lethal effect on T. spiralis adults, and the LC50 were 156.12 µg/ml, 294.67 µg/ml, 82.09 µg/ml, and 73.16 µg/ml in 90% MeOH ext., EtOAc fr., pet-ether fr. and n-BuOH fr., respectively. The n-BuOH fr. was shown to have the most promising effects in the in vitro studies, which was confirmed by scanning electron microscopy. The in vivo effects of n-BuOH fr. alone and in combination with albendazole using a mouse model were evaluated by counting adults in the small intestine and larvae in the muscles, in addition to the histopathological changes in the small intestine and the muscles. In the treated groups, there was a significant decrease in the number of adults and larvae compared to the control group. Histopathologically, treated groups showed a remarkable improvement in the small intestine and muscle changes. Remarkably, maximal therapeutic effects were detected in the combination therapy compared to each monotherapy.

Conclusion

Accordingly, C. rotundus extracts may have anti-T. spiralis potential, particularly when combined with albendazole, and they may be used as synergistic to anti-T. spiralis medication therapy.
Pandemic preparedness and management in European out-of-hours primary care services – a descriptive study
Authors: Rebnord Ingrid Keilegavlen , Rortveit Guri , Huibers Linda , Dale Jonas Nordvik , Smits Marleen , Morken Tone
Published: January 2023

Background

Primary care is the first point of contact for all acute health problems. As such, primary care was at the frontline in the COVID-19 pandemic, playing a significant role in clinical responses and information to the public. This study aimed to describe the variations in patient management strategies used in the out-of-hours services in different European countries during the first phase of the pandemic.

Method

We conducted a cross-sectional web-based survey in August 2020, selecting key informants from European countries using European networks. The questionnaire was developed in collaboration with researchers in the field of out-of-hours primary care. We performed descriptive analyses per region, structuring results into themes.

Results

Key informants from 38 regions in 20 European countries responded. Seven regions reported that their out-of-hours services had a pandemic preparedness plan, three had trained on the plan, and two had stockpiles of personal protection equipment before the outbreak. Extension of telephone triage lines and establishment of local infection-control teams and clinics were the main patient management strategies. Other strategies for patient contacts were also used in the regions, such as video-consultations (13 regions), electronic consultations (21 regions), patient’s car as alternative waiting room (19 regions), outside tents for testing (24 regions), “drive-through” testing (26 regions), and separate departments for infected patients (14 regions).

Conclusion

Few out-of-hours services were well prepared for a pandemic, but all expanded and reorganized rapidly, adopting new strategies for patient management and treatment. The results could be useful for planning of organization preparedness of out-of-hours primary care service for future pandemics.
Principal component analysis of flow-volume curves in COPDGene to link spirometry with phenotypes of COPD
Authors: Verstraete Kenneth , Das Nilakash , Gyselinck Iwein , Topalovic Marko , Troosters Thierry , Crapo James D. , Silverman Edwin K. , Make Barry J. , Regan Elizabeth A. , Jensen Robert , De Vos Maarten , Janssens Wim
Published: January 2023

Background

Parameters from maximal expiratory flow-volume curves (MEFVC) have been linked to CT-based parameters of COPD. However, the association between MEFVC shape and phenotypes like emphysema, small airways disease (SAD) and bronchial wall thickening (BWT) has not been investigated.

Research question

We analyzed if the shape of MEFVC can be linked to CT-determined emphysema, SAD and BWT in a large cohort of COPDGene participants.

Study design and methods

In the COPDGene cohort, we used principal component analysis (PCA) to extract patterns from MEFVC shape and performed multiple linear regression to assess the association of these patterns with CT parameters over the COPD spectrum, in mild and moderate-severe COPD.

Results

Over the entire spectrum, in mild and moderate-severe COPD, principal components of MEFVC were important predictors for the continuous CT parameters. Their contribution to the prediction of emphysema diminished when classical pulmonary function test parameters were added. For SAD, the components remained very strong predictors. The adjusted R2 was higher in moderate-severe COPD, while in mild COPD, the adjusted R2 for all CT outcomes was low; 0.28 for emphysema, 0.21 for SAD and 0.19 for BWT.

Interpretation

The shape of the maximal expiratory flow-volume curve as analyzed with PCA is not an appropriate screening tool for early disease phenotypes identified by CT scan. However, it contributes to assessing emphysema and SAD in moderate-severe COPD.
Implementing a novel capture and ligation probe-PCR method in mass screen and treatment to support malaria elimination efforts in the China-Myanmar border region
Authors: Sun Xiao-dong , Zhao Ya-ling , Lin Zu-rui , Zhao Ye , Zhou Yao-wu , Li Shi-gang , Guo Xiang-rui , Tian Peng , Duan Kai-xia , Ding Chun-li , Chen Qi-yan , Sui Yuan , Lu Shen-ning , Cotter Chris , Wang Duo-quan , Zheng Zhi
Published: January 2023

Background

Mass screening and treatment (MSAT) for malaria elimination lacks an ideal diagnostic tool to allow sensitive and affordable test of the target population in the field. This study evaluated whether Capture and Ligation Probe-PCR (CLIP-PCR) could be used in a field MSAT in Laiza City, Myanmar.

Methods

On day 0, two dried blood spots were collected from each participant. On day 1, all samples were screened for Plasmodium in a 20 m2 laboratory with workbench, a biosafety cabinet, a refrigerator, a benchtop shaking incubator and a qPCR machine, by four technicians using CLIP-PCR with sample pooling, at a health clinic of the Chinese bordering town of Nabang. On day 2, all positives were followed up and treated.

Results

Of 15,038 persons (65% of the total population) screened, 204 (1.36%) were CLIP-PCR positives. Among them, 188, 14, and 2 were infected with Plasmodium vivax, Plasmodium falciparum, and P. vivax/P. falciparum mix, respectively. The testing capacity was 538 persons/day, with a cost of US$0.92 /person. The proportion of submicroscopic infection was 64.7%. All positive individuals received treatment within 72 h after blood collection.

Conclusion

Using CLIP-PCR in MSAT in low transmission settings can support the malaria elimination efforts in the China-Myanmar border region.
The development of a home-based technology to improve gait in people with Parkinson's disease: a feasibility study
Authors: Yogev-Seligmann Galit , Josman Naomi , Bitterman Noemi , Rosenblum Sara , Naaman Sitar , Gilboa Yafit
Published: January 2023

Background

People with Parkinson’s disease (PwP) may experience gait impairment and freezing of gait (FOG), a major cause of falls. External cueing, including visual (e.g., spaced lines on the floor) and auditory (e.g., rhythmic metronome beats) stimuli, are considered effective in alleviating mobility deficits and FOG. Currently, there is a need for a technology that delivers automatic, individually adjusted cues in the homes of PwP. The aims of this feasibility study were to describe the first step toward the development of a home-based technology that delivers external cues, test its effect on gait, and assess user experience.

Methods

Iterative system development was performed by our multidisciplinary team. The system was designed to deliver visual and auditory cues: light stripes projected on the floor and metronome beats, separately. Initial testing was performed using the feedback of five healthy elderly individuals on the cues’ clarity (clear visibility of the light stripes and the sound of metronome beats) and discomfort experienced. A pilot study was subsequently conducted in the homes of 15 PwP with daily FOG. We measured participants' walking under three conditions: baseline (with no cues), walking with light stripes, and walking to metronome beats. Outcome measures included step length and step time. User experience was also captured in semi-structured interviews.

Results

Repeated-measures ANOVA of gait assessment in PwP revealed that light stripes significantly improved step length (p = 0.009) and step time (p = 0.019) of PwP. No significant changes were measured in the metronome condition. PwP reported that both cueing modalities improved their gait, confidence, and stability. Most PwP did not report any discomfort in either modality and expressed a desire to have such a technology in their homes. The metronome was preferred by the majority of participants.

Conclusions

This feasibility study demonstrated the usability and potential effect of a novel cueing technology on gait, and represents an important first step toward the development of a technology aimed to prevent FOG by delivering individually adjusted cues automatically. A further full-scale study is needed.

Trial registration This study was registered in ClinicalTrials.gov at 1/2/2022 NCT05211687.