bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on ICD design method of airborne system
Authors: Gao Jiawei
Published: July 2023

Interface control file (ICD) is the intermediate link to undertake system architecture and software development during airborne system design process. Aiming at the design of the ICD of complex airborne systems, a set of design process based on systems engineering is proposed according to the engineering practice experience. The ICD management process is divided into two stages (data integration and change) according to NASA Systems Engineering Manual and practical engineering experience. In the face of a great number of ICD design changes and diversified design scenarios, an ICD design method based on a single data source is proposed, using the object-oriented idea to abstract the airborne system and bus data, and establish a business object data model, which greatly improves the productivity of the interface design and management process.
Effect of pulsed plasma on the scramjet combustor
Authors: Zhang Qian , Yan Zhe , Li Xiuqian , Zhang Tiantian , Che Xueke
Published: July 2023

To clarify the effect of pulsed plasma on the scramjet combustor and find the best area of pulsed plasma effect in the cavity, the effects of pulsed plasma on the pressure distribution, velocity distribution, transverse jet cross-sectional area, turbulent kinetic energy and total pressure loss in the combustor were analyzed at different position areas when the discharge frequency was 8 kHz under the condition of incoming flow Ma=1.7 and cold flow. The results show that the effect of pulsed plasma on the combustor is slightly stronger than that of constant plasma, causing a small fluctuation in the shear layer pressure and a further 12.20% increase in the degree of influence on the shear layer velocity. Among the position influence effects, the pulsed plasma has the greatest effect on enhancing the fuel mixing effect when it is located near the trailing edge of the cavity. Compared with the case without plasma, it can increase the shear layer longitudinal velocity by 81.62%; increase the transverse jet cross-sectional area by 2.14%, and increase the turbulent kinetic energy in the central region by 2.48%; reduce the intensity of the shock wave, and reduce the total pressure loss in the combustor by 0.25‰.
Isogeometric stiffness matrix formulations for buckling analysis of multi-layered shells based on lamination parameters for solid-shell elements
Authors: Fan Kuan , Hu Yuechen , Huang Zhengdong , Wu Hao
Published: July 2023

Multi-layered composite shells are extensively used in many industrial fields since they have superior performance in applications. As load-carrying components, buckling failure is one of the most common failure modes of multi-layered shells. Hence, the layup design of multi-layered shells based on optimal buckling factors is widely concerned, where lamination parameters are commonly used in the representation of stiffness. However, the common formulations of laminate stiffness are based on the Classical Laminate Plate Theory (CLT) or the First-order Shear Deformation Plate Theory (FSDT). This paper aims at developing stiffness formulations based on 3D continuum solid theory. The accuracy and efficiency of the stiffness formulations derived in this study are analysed and compared to those obtained by layer-by-layer integration and summation of stiffness calculations.
Intake pressure control based on improved super-twisting for altitude ground test facilities
Authors: Tao Li , Song Zhang , Bai Ke-qiang , Zhuang Yue , Dan Zhi-hong
Published: July 2023

This paper focuses on the problem of rapid tracking of engine transient pressure, an improved super twisting algorithm (STA) is adopted to control the intake pressure of the engine. The high altitude platform is analyzed systematically, the mathematical model is derived, and the system and control object model are established. It is improved on the basis of classical STA method and has better control effect than PID control methods and LADRC. Transient state tests of the engine under three different working conditions(acceleration/deceleration state of pushing/pulling accelerator lever, engine intake pressure changing from 50kPa to 60kPa, and engine intake pressure changing from 60kPa to 70kPa) are simulated and verified. The simulation results show that, compared with the traditional PID and active disturbance rejection control(LADRC)strategies, the method proposed in this paper can track the inlet pressure of the engine in transition state quickly, and can reach and stabilize the given set value accurately and quickly.
Parameter Adjustment of the Autothrust Control Law by Flight Tests
Authors: Zhang Zhen , Wu Yunpeng , Liu Huimin
Published: July 2023

Aiming at deriving precise automatic control of airspeed, a comprehensive flight test solution for autothrust control law parameter adjustment was proposed, providing a worthy reference for other aircraft types’ work, including the flight test points and methods, aircraft modification requirements for the test, the system performance analysis and evaluation methods, and the flight test risk analysis. A method invoking test scripts by a flight test interface unit and a control panel to configure parameters of autothrust control law and input excitation signals was proposed for the first time. The test scripts and the test devices cross-link can be fully verified in advance in both iron bird and real aircraft ground tests, which can greatly reduce unexpected risks of the test method based on the flight test engineers’ personal experience. According to the evaluation from three aspects of system response, robustness and throttle lever movement based on the test data, the optimal autothrust control law parameters configuration was given.
Effect of oxygen on trace impurities in extremely pure metal ingots used for realising ITS-90 fixed point temperatures
Authors: Chowdhury Y , Pearce J V
Published: July 2023

The International Temperature Scale of 1990 (ITS-90) provides a scheme for calibrating thermometers which is largely based on the freezing points of pure metals such as indium, tin, zinc, aluminium and silver. The existence of trace impurities in pure metals results in uncertainties in the realization of these freezing points. Several methods such as the sum of individual estimates (SIE) and overall maximum estimate (OME) are used to assess the uncertainties due to the presence of impurities. However, it is becoming evident that the oxidation of impurities results in their precipitation, which means that these insoluble oxides no longer play a significant role in the elevation or depression of the freezing temperature. Hence the conventional correction techniques may overestimate the magnitude of the effect. In this study, the thermodynamic modelling software MTDATA was used to evaluate the effect of oxygen on selected impurities in In, Sn, Zn, Al and Ag by calculating the binary impurity-metal phase diagram in the presence of specific amounts of oxygen. It was found that oxygen has a significant effect on many of the systems studied. The most significant effect was observed in the Ag system, and then, in decreasing order of significance, In, Sn, Zn and Al.
The negative beam source with single driver for CRAFT NNBI: design and conditioning results
Authors: Xie Y.H. , Wei J.L. , Gu Y.M. , Xu Y.J. , Liang L.Z. , Cui Q.L. , liu W. , Pan J.J. , Yang Y.W. , Xie J.W. , Zhao Y.Z. , Jiang C.C. , Liu S. , Xie Y.L. , Hu C.D.
Published: July 2023

The Comprehensive Research Facility for Fusion Technology (CRAFT) is a large scientific
facility that is preferentially deployed for the construction of major national science and
technology infrastructures. A negative beam source based neutral beam injector (NNBI) with beam
energy of 200–400 keV, beam power of 2 MW and beam duration of 100 s is one of the devices. A
giant radio frequency (RF) based negative beam source was designed for the CRAFT NNBI system. In
order to understand the physics and pre-study the engineering problems for RF negative beams
source, several beam sources with different scales will be designed and tested. According to the
R&D schedule, a negative beam source with a single driver was designed, developed and tested
first. The single driver beam source is a quarter of the size of the full size negative beam
source. It contains an RF driver, an expansion chamber and a negative ion accelerator with three
electrodes, which are a plasma grid (PG), extraction grid (EG) and ground grid (GG). To enhance
the negative ion production, Cesium is injected into the plasma chamber and a magnetic filter
filed is produced by current flow through the PG to decrease the electron temperature. The
negative beam source was tested on the test facility after assembly, including RF plasma
generation, negative ion production, extraction and acceleration. The characteristic of plasma
discharge, beam extraction and acceleration was studied without and with Cs injection. The long
pulse of 105 seconds negative ion beam was achieved successfully. The extracted negative ion
current is 4 A and the ratio of electron and negative ion is around 0.8. It lays a good foundation
for the R&D of negative ion source with a multi-driver for the CRAFT NNBI system. The details of
the design and experimental results of beam source was shown in this paper.
Simultaneous imaging of prompt gamma photons and prompt X-rays during irradiation of proton beams to human torso phantom at clinical dose level
Authors: Yamamoto Seiichi , Yamashita Tomohiro , Kobashi Yusuke , Yabe Takuya , Akagi Takashi , Yamaguchi Mitsutaka , Kawachi Naoki , Kamada Kei , Yoshikawa Akira , Yokokawa Hiromu , Sagisaka Mayu , Kataoka Jun
Published: July 2023

Although both prompt gamma photon and prompt X-ray imaging
are promising methods for observing a beam shape and estimating the
range of the beam from outside a subject, the images using these two
methods have not been compared under realistic conditions such as in
a human torso phantom. To clarify the imaging capability of prompt
gamma photon and prompt X-ray imaging, simultaneous imaging with
these methods was conducted during irradiation by proton beams to a
human torso phantom at clinical dose level. After a human torso
phantom was set on the bed of a proton therapy system, proton pencil
beams of three different energies at clinical dose level and a
patient planning beam for prostate cancer were used to irradiate the
phantom. Prompt gamma photons and prompt X-rays emitted from the
phantom were simultaneously imaged by a developed gamma camera and
an X-ray camera during irradiation with proton beams to the human
torso phantom. For all of the tested beams, we could obtain the beam
shapes of prompt gamma photons and prompt X-rays images. The ranges
could be estimated within a difference of 11 mm and 14 mm from the
calculated dose for prompt gamma photon and prompt X-ray images,
respectively. For both types of images, time sequential images and
time count rate curves could be derived. We could clarify the
imaging capabilities of prompt gamma photons and prompt X-rays were
different by the simultaneous imaging during proton irradiation to a
human torso phantom. Although both methods had advantages and
disadvantages, we confirmed that both methods are promising for beam
imaging in a torso phantom and also for future clinical use in
proton therapy.
Preliminary characterisation of the HEXITECMHz spectroscopic X-ray imaging detector
Authors: Veale M.C. , Bell S. , Cline B.D. , Church I. , Cross S. , Day C. , French M. , Gardiner T. , Ghorbanian N. , Hart M.D. , Jones L.L. , Lipp J. , Nicholls T. , Nobes J. , Prydderch M. , Schneider A. , Seller P. , Sole D. , Wilson M.D. , Dhamgaye V. , Fox O. , Sawhney K.
Published: July 2023

The HEXITECMHz ASIC is the next generation of the STFC's High Energy X-ray Imaging Technology (HEXITEC). With a ×100 increase in the camera frame rate to 1 MHz, the new ASIC is capable of delivering fully spectroscopic X-ray imaging at photon fluxes of 2×106 photons s-1 mm-2. The improved flux capability ensures the relevance of the technology at a new generation of difraction-limited storage ring (DLSR) synchrotrons as well as enabeling dynamic spectroscopic imaging with sub-keV energy resolution to be carried out on millisecond timescales. In this paper preliminary results from X-ray testing of a 0.3 mm thick p-type Si sensor and 2.0 mm thick HF-CdZnTe sensor at the Diamond Light Source Synchrotron are presented for the first time. Each module consists of 80 × 80 pixels on a 250 μm pixel pitch operated at a temperature of 20°C and a frame rate of 1 MHz. For these preliminary measurements, testing was completed using a prototype test system which limited readout to a portion of the 1 MHz output sampled over an SPI test interface at ∼50 Hz. Despite this limitation these measurements allow the spectroscopic performance of the ASIC to be characterised ahead of the full DAQ system. The prototype detectors were characterised using monochromatic X-rays with energies 12–35 keV at fluxes of (0.6 – 2.5) × 106 photons s-1 mm-2. At an X-ray energy of 12 keV, the energy resolution of the p-type Si and HF-CdZnTe detectors were measured to be 1.0 keV and 1.1 keV respectively. At the higher energies of 20 keV and 35 keV the energy resolution in the HF-CdZnTe was measured to be 1.2 keV and 1.4 keV respectively.
Dose distributions of the INTRABEAM electronic brachytherapy system measured with traceable detectors
Authors: Garcia Yip F. , Šolc J. , Behrens R. , Schneider T. , Grote F. , Kasper A.
Published: July 2023

In this work, a methodology to determine the absorbed dose rate to water distribution from electronic brachytherapy (eBT) units is suggested. It involves measuring directly in a full scatter water tank with small active detectors whose energy response at low X-ray photon energies have been previously characterized. Dose distributions of an INTRABEAM PRS 500 system in two configurations — bare needle and with the spherical applicator of 40 mm diameter — were measured in water using the Exradin A26 ionization chamber and the PTW 60019 microDiamond detector. The continuous energy response of these two detectors in terms of air kerma from 5 keV to 70 keV (eBT energy range) was available from a previous calibration at several X-ray radiation qualities. Here, it is converted to the response in absorbed dose to water using correction factors obtained with Monte Carlo (MC) particle transport simulations. The detectors were modelled using the MCNP code. The air kerma calibration factors were simulated and compared with measurements to refine and validate the models. A series of simulations of the experimental arrangement of the INTRABEAM and the detector were carried out for determining the system specific detector correction factors. These values are distance-dependent due to the steep dose gradient and the remarkable spectral changes around the eBT source in water. The dose rate with distance from the source, the radial and the polar distributions of the INTRABEAM are reported and compared with the manufacturers supplied data. This work is an effort to provide traceability for detectors and measurement procedures for the determination of 3D dose distributions as part of the European joint research project “Primary standards and traceable measurement methods for X-ray emitting electronic brachytherapy devices” (18NRM02 PRISM-eBT).
Google and Microsoft find new quasiparticle
Authors: Ball Philip
Published: July 2023

The existence of so-called non-Abelian anyons has been reported by four independent teams, but plenty of challenges remain before they can transform quantum computing. Philip Ball explains.
US releases framework for space diplomacy
Authors: Gwynne Peter
Published: July 2023

The US has released its first strategic framework for space diplomacy, which calls for the creation of a “rules-based international order” for outer space.
AI questions
Authors: Durrani Matin
Published: July 2023

Developments in AI are moving fast but is top-down regulation the best approach?
Isolation and substrate dependence on extracellular vesicle characterisation using atomic force microscopy
Authors: Dobhal Garima , Cottam Sophie , Jankowski Helen , Weidenhofer Jude , Goreham Renee V
Published: July 2023

Extracellular vesicles are nano- to micro-sized structures that carry biomolecules between cells to coordinate cellular activity and communication. Isolation and characterisation must be standardised to better understand the role of extracellular vesicles and how they can be used for disease diagnosis. Here we use atomic force microscopy to determine the physical differences between extracellular vesicles isolated using two different methods. Extracellular vesicles were isolated using two standardised methods, vacuum filtration and syringe filtration. In addition, extracellular vesicles were immobilised to plain mica and amino-functionalised mica to observe differences in adhesion onto substrates with different hydrophobicity. The application of atomic force microscopy enabled the study of vesicle adhesion, size distribution and morphology on the two different surfaces. It was found that both the isolation method and the substrate had a considerable effect on the physical properties of the extracellular vesicles, such as root mean square roughness values and size distribution. This demonstrates the ability to use atomic force microscopy to gain a more detailed understanding of the physical features of extracellular vesicles and the influence of different isolation methods on their morphology.
Alcohol consumption and oral microbiome composition in a sample of healthy young adults
Authors: Ward Gyles , Wurster Jenna I , Lamb Philip S , DeCost Grace , Belenky Peter , Monnig Mollie A
Published: July 2023

The oral microbiomes of 24 healthy adults (50% female; mean age = 24.3) were examined using 16 s ribosomal RNA sequencing and compared between light and heavy drinkers. Beta diversity was related at the trend level to drinking group, and light drinkers had significantly higher abundances of key oral taxa such as Lactobacillales. These preliminary results may offer insight into early effects of heavy drinking on the composition of the oral microbiome.
Transient ischaemic dilation ratio thresholds in patients with zero coronary calcium score undergoing exercise or dipyridamole stress SPECT myocardial perfusion imaging using a cadmium-zinc-telluride camera
Authors: Sim Eran Wen Jun , Yew Min Sen
Published: July 2023

Aims

Transient ischaemic dilation (TID) is a marker of underlying extensive coronary artery disease (CAD) during myocardial perfusion imaging (MPI). The cut-off for a normal TID ratio (TIDr) value is often derived from a cohort of individuals with no apparent CAD. Varying criteria have been used to define the absence of CAD. We aim to derive TIDr cut-offs using patients with normal MPI and coronary artery calcium (CAC) score of zero, and compare the TIDr obtained from different software packages.

Methods and results

We studied 232 patients with zero CAC and normal MPI undergoing exercise or dipyridamole stress using either a 1- or 2-day protocol. All patients were scanned in the supine position with a cadmium-zinc-telluride camera. TIDr was automatically generated using quantitative perfusion SPECT (QPS) software initially, and subsequently using Myometrix for comparison. The TIDr cut-offs calculated using the mean + 2 standard deviation were 1.29 and 1.24 for the 1- and 2-day protocol groups, respectively. In patients undergoing a 2-day protocol, dipyridamole stress resulted in significantly higher mean TIDr when compared to exercise stress (1.07 ± 0.13 vs. 1.01 ± 0.12, P = 0.035). Myometrix-derived TIDr were also significantly lower compared to QPS-derived values for most protocols except for 2-day exercise stress.

Conclusion

This study is the first to derive TIDr threshold values using a normal population defined by zero CAC and normal MPI. TIDr was found to vary depending on stress modality, protocol as well as the software used.
Non-invasive estimation of mean pulmonary artery pressure by cardiovascular magnetic resonance in under 2 min scan time
Authors: Abdula Goran , Ramos Joao G , Marlevi David , Fyrdahl Alexander , Engblom Henrik , Sörensson Peder , Giese Daniel , Jin Ning , Sigfridsson Andreas , Ugander Martin
Published: July 2023

Aims

Non-invasive estimation of mean pulmonary artery pressure (mPAP) by cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis has shown excellent agreement with invasive right heart catheterization. However, clinical application is limited by relatively long scan times. Therefore, the aim of this study was to evaluate the accuracy and time reduction of compressed sensing (CS) accelerated acquisition for mPAP estimation.

Methods and results

Patients (n = 51) referred for clinical CMR at 1.5 T or 3 T underwent imaging with both a prototype CS-accelerated and a non-CS-accelerated flow sequence acquiring time-resolved multiple 2D slice phase-contrast three-directional velocity-encoded images covering the pulmonary artery. Prototype software was used for the blinded analysis of pulmonary artery (PA) vortex duration to estimate mPAP as previously validated. CS-accelerated and non-CS-accelerated acquisition showed increased mPAP in 22/51 (43%) and 24/51 (47%) patients, respectively. The mean bias for estimating mPAP between the two methods was 0.1 ± 1.9 mmHg and the intraclass correlation coefficient was 0.97 (95% confidence interval 0.94–0.98). Effective scan time was lower for the CS-accelerated acquisition (1 min 55 s ± 27 s vs. 9 min 6 s ± 2 min 20 s, P < 0.001, 79% reduction).

Conclusions

CS-accelerated CMR acquisition enables preserved accuracy for estimating mPAP compared to a non-CS-accelerated sequence, allowing for an average scan time of less than 2 min. CS-acceleration thereby increases the clinical utility of CMR 4D flow analysis to estimate mPAP.
Dietary Interventions in Heart Failure with Preserved Ejection Fraction (HFpEF): a systematic scoping review and meta-analysis
Authors: Forsyth F , Hartley P J , Mulrennan S , Deaton C
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Evelyn Trust.

Background

Pharmacotherapies have improved outcomes for patients with Heart Failure with reduced Ejection Fraction (HFrEF), but less so for patients with HFpEF. Limited treatments results in substantial burden at personal, clinical and economic levels. Diet has been implicated in the pathogenesis and prognosis of HFpEF, as such, dietary manipulation has the potential to be a useful management strategy.

Purpose

The aim of the scoping review was to establish which nutritional interventions have so far been tested in patients with HFpEF and establish how the dietary manipulation was achieved. The aim of the meta-analysis was to quantify the effects of interventions tested to determine whether there is evidence to support specific dietary recommendations in patients with HFpEF.

Methods

Key word searches were performed in five bibliographic databases to identify randomised or controlled studies of dietary interventions conducted in HFpEF or mixed heart failure (HF) samples. Study characteristics were summarised according to PICO (population, intervention, comparator, outcome) categories and intervention complexity was assessed. Studies included in the meta-analysis were appraised for bias and the quality of the body of evidence was assessed via the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework.

Results

Twenty-five different interventions reported across 31 papers were identified. Only ten (40%) were conducted exclusively in HFpEF subjects. Studies employing highly tailored prescribed methods were most common (n=12, 48%). Dietary supplementation (n=10, 40%) and dietary pattern manipulations (n=3, 12%) were less represented. Seventeen studies were considered for meta-analysis; all but one were judged to be at high risk of bias. There was moderate quality evidence that caloric restriction led to clinically meaningful improvements in blood pressure and body weight. There was moderate quality evidence carbohydrate restriction resulted in meaningful reductions in blood pressure. There was very low quality evidence protein supplementation improved blood pressure and body weight and moderate quality evidence for clinically meaningful improvements in function.

Conclusions

Very few dietary interventions have been tested in HFpEF specifically. Most interventions tested were complex at the patient level, which may not be suitable for the older, multi-morbid patients who typify HFpEF. Results of meta-analyses performed were not of sufficient quality to make generalised conclusions. Some interventions delivered clinically meaningful changes that may be important to patients, therefore, clinicians could draw on these findings to inform personalised care plans and treatment goals.
Excluding items on salt and fluid restriction from the European Heart Failure Self-care Behaviour Scale - a confirmatory factor analysis
Authors: Safstrom E , Jaarsma T , Stromberg A
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Self-care is an important component in heart failure (HF) care, and worse, self-care is an independent predictor of mortality, HF hospitalization, and quality of life. The European Heart Failure Self-care Behaviour scale (EHFScB-9) is a validated scale with a nine-item scale and two subscales (autonomy-based adherence and consulting behavior). The items in the EHFScB-9 are based on evidence and consensus. However, in recent years two items regarding salt and fluid restriction have been questioned due to the lack of evidence on their effects.

Aim

The aim of the study was to evaluate the factor structure of the EHFScB-9 when items on fluid- (item 5) and salt restriction (item 7) were excluded.

Method

Confirmatory factor analysis (CFA) was used to evaluate the factor structure of the different models of EHFScB-9. Since the item responses of the EHFScB-9 are ordinal, the recommended estimation Weighted Least Squares with Means and Variances (WLSMV) was used. The WLSMV is based on polychoric correlations. The fit indices and recommended cut-off used to support model fit were: the root mean square error of approximation (RMSEA) (≤0.06), Comparative Fit Indices (≥0.95), and Tucker Lewis Index (>0.95). Reliability was evaluated by composite reliability.

Results

A total of 605 patients were included (mean age 66.9 years (SD=11.7), 71% (n=430) males). All response options were used, but a floor effect was evident for all items (i.e., extreme scores > 15%). The missing values for the items ranged from 2.0 to 2.6%. A total of 10 patients had missing values on all items of the EHFScB-9 and were not included in the CFA.

The original two-factor 9-item version (Model 1 in table 1) presented good model fit in all fit indices, including RMSEA: 0.058 (90% confidence interval 0.043-0.073) (Table 1) and reliability of 0.678 in factor 1 "Adherence to regimen" and 0.878 in factor 2 "Consulting behavior". The RMSEA only slightly increased to 0.62 when the items on fluid- (item 5) and salt restriction (item 7) were both excluded (Model 1.2). The model presenting the best model fit was the model where item 5 (fluid restriction) was excluded from the model (RMSEA 0.047, 90% confidence interval 0.029-0.066) (Model 1.3 in the table). As expected, the reliability decreased in factor 1 ("Adherence to regimen") as the number of items was reduced.

Conclusion

Considering the clinical evidence and the model fit indices, both item 5 and item 7 can be excluded from the EHFScB. As expected, when reducing the number of items, the reliability decreases in factor 1 ("Adherence to regimen"). Nevertheless, the results open for an opportunity to exclude self-care items with less evidence from the EHFScB. The suggested version of the EHFScB needs to be further tested in other contexts, and adding items to factor 1 may be considered.
The importance of screening for depression and anxiety in ambulatory patients with chronic heart failure and the role of health care professionals
Authors: Georgieva M , Rushid M , Nankova M , Borisova S , Yotov Y
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Depression and anxiety are very common in patients with heart failure, both as risk factors and complications. The intensive follow-up by health care specialist is extremely important for screening of these conditions and for reducing their impact on the heart failure (HF) course.

Aim

to screen for depression and anxiety attitudes and to assess the effect of structured out-patient program for reducing the probability of their occurrence. Participants and methods: Overall, 71 patients were included in a structured follow-up program for ambulatory management of patients with HF, according to the OPTIMIZE-HF Care Program protocol. All participants answered standardized questionnaires PHQ-9 and GAD-7 for screening of depression and anxiety at discharge from hospital (baseline) and after 6 months. Score more than 8 points for GAD-7 and >10 points of PHQ-9 were considered clinically important. Paired samples t-test and Wilcoxon’s signed rank test were used to test statistical significance.

Results

the mean depression score decreased from mean 5.47±5,22 points to 3.65±6.05, with a mean difference between two visits 2.35±3.9, 95%CI 1.37-3.33, р<0.0001. At 6 months, the participants with PHQ-9>10 points decreased from 21% to 7.8% (Figure 1). There were 8 (14%) patients who were more prone to depression at baseline but who decreased their score to <10 points at the end (p = 0.04). Similar results were found for anxiety. The mean difference in GAD-7 score was -2.35±3.90 points, 95%CI -1.37—-3.33, p<0;0001. At the end of the study, the participants without anxious moods increased from 52.3% to 69.8%. (Figure 1) Only 3 patients worsened their anxiety results after 6 months while 27% of those with initial GAD-7>8 points successfully decreased their score to minimal or none.

Conclusions

Every 1 in 5 patients with HF have some depression attitudes at discharge and more than 1 in 3 were anxious. The structured ambulatory management program decreased these trends just after 6 months. The role of nurse in achieving the positive effects on the psychological well-being of the patients with HF is essential.Figure 1
Musculoskeletal disorders in men and women with heart transplantation. A cross- sectional study
Authors: Moreno Segura N , Almenar-Bonet L , Fuentes-Aparicio L , Atef H , Escudero P , Mesa-Rico R , Lopez-Vilella R , Pallares P , Sentandreu-Mano T , Berga-Congost G , Sillero-Sillero A , Marques-Sule E
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Scientific literature about musculoskeletal condition in heart transplantation patients is scarce, although musculoskeletal disorders seem to be common in more than a quarter of patients receiving cardiac rehabilitation. The aim of our study was to compare the musculoskeletal condition in men and women with heart transplantation.

Methods

Cross-sectional study. Sociodemographic data (age, sex, education and marital status) were collected. Musculoskeletal condition was assessed using two questionnaires: 1) the Musculoskeletal System Assessment Inventory (MSSAI) that evaluates 6-items related to musculoskeletal disorders rated in a yes/no variation scale, as well as the intensity and location of pain (from 1=mild pain to 5=unbearable pain); and 2) the Cornell Discomfort Questionnaire (CDQ), that evaluates the frequency of musculoskeletal pain in 5 different levels (from 0=never to 10 points=several times a day) for 20 different anatomic body regions.

Results

The sample consisted of 109 participants with heart transplantation (54 women and 64 men, mean ages=53.33±12.60 vs. 58.35±12.81 years old, respectively). 40% women and 29.7% men were diagnosed with musculoskeletal disorders by the physician (p = 0.263). With respect to pain sensation, significant differences were observed, with women reporting higher values of musculoskeletal pain than men (p = 0.049) (64.4% vs. 43.5% respectively). Moreover, differences by sex were observed in terms of pain location (p = 0.047), with the knee being the joint most frequently referred to by men (15.6%) and lumbar joints by women (26.7%). 51% of women reported higher levels of musculoskeletal pain than men after performing physical exercise (p = 0.015).

Conclusion

According to our results, women with heart transplantation reported more musculoskeletal pain than men, more commonly located in lumbar joints. In addition, women reported higher levels of musculoskeletal pain after performing physical exercise than men with heart transplantation.
Kinesiophobia in heart transplantation patients: a cross-sectional study with a special focus in sex differences
Authors: Moreno Segura N , Almenar-Bonet L , Fuentes-Aparicio L , Atef H , Escudero S , Escudero P , Lopez-Vilella R , Sentandreu-Mano T , Pallares P , Mesa-Rico R , Berga-Congost G , Sillero-Sillero A , Marques-Sule E
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with heart disease sometimes have a fear of moderate and vigorous physical activity, in addition to the possibility of kinesiophobia or fear of movement. There are scarce studies assessing kinesiophobia in men and women with heart transplantation. The aim of the study was to compare the levels of kinesiophobia in men and women with heart transplantation.

Methods

This was a cross-sectional study. Sociodemographic data (age, sex, education and marital status) were collected. Kinesiophobia was measured using the Tampa Scale for Kinesiophobia (TSK-11). Each item has a 4-point Likert scale ranging from ‘‘strongly disagree’’ to ‘‘strongly agree’’, and the total score ranges between 11 and 44 points, a high value indicating high levels of kinesiophobia.

Results

103 participants (40.78% women vs. 59.22% men, mean ages 53.38±12.59 vs. 57.80±12.60 years, respectively) were assessed. No differences by sex were found in the total score of the TSK-11 (women=24.02±6.38, men=23.49±5.71, p = 0.659). Women reported significantly higher scores than men in item 1 ("I’m afraid I might injure myself if I exercise", p = 0.007), item 2 ("If I were to try to overcome it, my pain would increase", p = 0.044) and item 5 ( "My accident/problem has put my body at risk for the rest of my life", p = 0.009). On the other hand, men reported significantly higher scores in item 11 ("No one should have to exercise when he/she is in pain", p = 0.008).

Conclusions

We found no differences by sex in overall kinesiophobia of heart transplantation patients. However, women were more afraid of getting injured during physical exercise and of injuring themselves accidentally, whilst men considered not recommendable to exercise when they were in pain.
See-saws: the delicate balance of burden of treatment in chronic heart failure
Authors: Austin R , Schoonhoven L , Kalra P R , May C , Richardson A
Published: July 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): This work was supported as a part of a fully funded Clinical Academic Doctoral Fellowship at the University of Southampton, Portsmouth Hospitals University NHS Trust, and the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex. This article is independent research supported in part by the NIHR ARC Wessex. Carl May’s contribution was supported by NIHR ARC North Thames and Alison Richardson’s by NIHR ARC Wessex. Rosalynn Austin is funded by an NIHR ARC Wessex Internship.

Background

Burden of Treatment (BoT) is often described as a delicate balance between a patient’s capacity (capabilities and resources) to do the work of illness management and the workload (self-care, treatment and illness burden). Chronic heart failure (CHF) is regarded as a burdensome disease for both patients and healthcare services with the burden expected to rise. While research in BoT in CHF is increasing, the factors influencing the balance between capacity and workload has yet to be fully elucidated.

Purpose

To identify factors which may influence BoT in CHF.

Methods

Secondary analysis of 32 semi-structured interviews of participants with CHF who participated in the SYMPACT trial. All participants were asked to describe the balance between capabilities and workload of manging CHF using the metaphor of a see-saw. Responses to that question were examined for factors patients reported as altering the balance between capacity and workload.

Results

Most participants (n=31) described the seesaw as dynamic, where capacity and workload were balanced or unbalanced. If capacity > workload this was viewed as positive, "I would stay down because the things that you mentioned are very easy" (T137). When instead the balance reversed and capacity < workload it was viewed as negative, "The heavier you know with the work and the abilities less, you kind of think […] I’m good for nothing" (B001). Factors reported by patients, to alter their capacity included: ability to self-care, support from social networks, symptoms, illness identity, and quality of life. Workload was reported to be altered by nature of healthcare interactions, effectiveness of treatments, comorbidities and the feeling of overwhelming treatment burden (Figure 1). One participant described overwhelming burden with a different metaphor: "A huge weight around my neck. Pulling me down into a pit of despair" (S110), was reported as more accurate than a seesaw when thinking about treatment burden.

Conclusions

BoT is an important factor to consider in the clinical management of CHF. Modifiable factors such as symptoms, quality of life, and the nature of healthcare interactions are reported as altering the balance between a patient’s capacity and the workload associated with self-care.Factors balancing burden of treatment
What happened? Perceptions of patients with hypertension on conflicting results between self-reported adherence of medication and chemical adherence testing
Authors: Westland H , Soldan S , Flint C , Jaarsma T
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Hypertension is one of the most prevalent causes of death worldwide. Despite the widespread availability and efficacy of pharmacological therapy for hypertension, few patients reach their blood pressure target values. Nonadherence to antihypertensive medication is common and can lead to adverse clinical effects, such as stroke, reduced quality of life and higher health care costs. Adherence to antihypertensive medication can objectively be measured with chemical adherence testing. In clinical practice, some patients state that they are taking the medication while the chemical adherence testing does not confirm this. Understanding of this discrepancy is needed to better support these patients in their treatment decisions.

Purpose

To explore the perceptions of outpatients with hypertension on conflicting results between self-reported adherence and chemical adherence testing.

Methods

An explorative generic qualitative study design is used with face-to face semi-structured interviews. The study population consists of adult patients who are diagnosed with hypertension and are treated with antihypertensive medication. Patients have had negative blood levels for one or more antihypertensive drugs after chemical adherence testing, but report to adhere to the prescribed medication advice. To achieve data saturation, 12-15 adult patients are interviewed using a topic list with open ended questions. Interviews are audio-recorded and thematically analysed according to Braun & Clarke.

Results

At the time of this abstract submission, data collection is ongoing till the beginning of April 2023. At the time of the conference, we can present the results of our study addressing this very delicate and clinically relevant topic.

Conclusion

Data on the reasons for conflicting results between subjective and objective measures on medication adherence can help clinicians to optimize for patients with hypertension.
Assessing physical activity in heart failure with the CHAMPS physical activity questionnaire
Authors: Denfeld Q , Hiatt S O , Lee C S , Roberts Davis M , Camacho S A , Winters-Stone K
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Office of Research on Women’s Health and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health

Background

It is difficult to quantify physical activity among adults with heart failure (HF) in the context of many disease-driven limitations. The Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire, designed to measure physical activity among older adults, may be helpful in quantifying physical activity in HF.

Purpose

To quantify physical activity levels among adults with HF using the CHAMPS Physical Activity Questionnaire and to compare physical activity expenditure and frequency between adults ≥ 65 years vs. < 65 years, women and men, and those physically frail vs. non-physically frail.

Methods

This was an analysis of data collected from a cohort study of adults with New York Heart Association Functional Class I-IV HF. Using the CHAMPS Questionnaire, we calculated caloric expenditure (kcal) and frequency per week in all activities and moderate intensity activities. Physical frailty was measured with the Frailty Phenotype Criteria. Comparative statistics were used to compare physical activity between groups.

Results

The average age of the sample (n = 117) was 63.6±15.6 years, 48.7% were female, and most (76.9%) had non-ischemic HF etiology. Median caloric expenditure from all physical activities was 1827 kcal/week [Interquartile Range 735-3943] and moderate intensity activities was 397 kcal/week [Interquartile Range 0-1886]. For caloric expenditure from all physical activities, there was no significant difference between adults ≥ 65 years vs. < 65 years (p = 0.894), but women and those physically frail had significantly lower caloric expenditure (both p < 0.001). For caloric expenditure from moderate intensity physical activities, there was no significant difference between adults ≥ 65 years vs. < 65 years (p = 0.346), but women had significantly lower caloric expenditure (p < 0.001) as well as those physically frail (p < 0.001). Median frequency of all physical activities was 13 times per week [Interquartile Range 8-21] and of all moderate intensity activities was 3 times per week [Interquartile Range 0-8].

Conclusions

Many adults with HF, regardless of age, report low physical activity using the CHAMPS Physical Activity Questionnaire; however, women and those physically frail report considerably lower physical activity than men and those non-physically frail, respectively. Capturing physical activity levels across multiple activities is necessary for the design and implementation of physical activity interventions in HF, and the CHAMPS measure may be one tool to do this.
Perceptions of physical activity levels after a diagnosis of acute coronary syndrome and in the context of cardiac rehabilitation
Authors: Mchale S , Neubeck L , Dawkes S , Astin F , Hanson C L
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Physical activity [PA] is a core component of cardiac rehabilitation [CR] but those who consider themselves active are less likely to participate. It is unclear how CR services can better engage with this group and what support they should offer to encourage a return to PA at appropriate levels.

Purpose

We aimed to identify individuals from four UK CR services who considered themselves active prior to acute coronary syndrome [ACS] diagnosis and understand their PA support requirements.

Methods

A sequential mixed methods study, with data collected between October 2019 and April 2020. A quantitative survey examined self-reported PA levels, illness perceptions, and physical self-concept of ACS patients using validated questionniaires after their event but before the start of CR. Data were analysed via descriptive, correlational, and multiple regression analysis. Qualitative individual semi-structured telephone interviews were conducted with participants who self-reported to be at least moderately active. Data were thematically analysed. Data were integrated during study design and discussion stage.

Results

Sixty-seven participants (male n=53, 79.1%) with a median age of 63 (IQR = 56-71) completed the survey. Of these, 50 (74.6%) self-reported being at least moderately active before starting CR. During regression analysis, only physical self-concept for being physically active (F (9,56)=3.59, p<.005, adjusted R2 0.26) was significantly associated with PA level. Twenty-six participants completed qualitative interviews. Participants who perceived that they were active prior to their event based this on recollections of past PA, and step count monitoring. They made decisions about whether to engage with CR based on pre-CR information and comparison with peers. Despite considering themselves to be active, this group still required support to return to PA at appropriate intensity levels to gain secondary prevention benefits. This included information about how to self-monitor intensity effectively.

Conclusions

CR services should recognise that ACS survivors who consider themselves to be active prior to their event require support to return to PA at appropriate levels. Support should include exploring what patients mean when they say they are active so that CR professionals are better informed to provide indivualised advice.