bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying Calcaneal Anatomical Regions of Interest (ROI) for Quantitative Ultrasound Application in Subadults
Authors: Blythe Connor S. , Reynolds Mikaela S. , Gregory Laura S.
Published: August 2022

Whilst quantitative ultrasound can be reliably used to assess bone health in adults, the fixed location of the transducers in current devices may result in inaccurate and unreliable measurements in bone assessment in children due to the variation in foot size during growth. To improve positioning for paediatric assessment, Jaworski et al. (1995) created an anatomical method to identify the region of interest (ROI), however, there have been no medical imaging studies to confirm that the Jaworski method results in consistent placement of the transducer on the centre of the calcaneal body to avoid edge artefacts. In this study, computed tomography scans of the tarsus were collected from 498 individuals (258 females; 240 males) aged 2 to 20 years and used to create three novel anatomical methods to identify ROI on the calcaneus using palpable landmarks. In addition, the established Jaworski method was applied to the same scans and compared to our novel methods. The maximum ROI significantly increased with age with males having significantly greater diameters, supporting the recommendation that ½ inch diameter transducers should be used on individuals younger than 7 years of age. We identified that 79% of the ‘Jaworski points’ lied anterosuperior to the ROI centre point identified in this study, with 10% of the points lying outside the ROI. Of the three novel methods, only the calcaneal insertion method demonstrated small measurement variance between individuals of the same age in each sex and is therefore the preferred method for ultrasound clinical application.
Symptoms in women with fibromyalgia after performing physical activity: the role of pain catastrophizing and disease impact
Authors: López-Gómez Irene , Velasco Lilian , Gutiérrez Lorena , Écija Carmen , Catalá Patricia , Peñacoba Cecilia
Published: August 2022

Introduction

Walking is an effective treatment for symptoms’ management in patients with fibromyalgia. However, despite its benefits, fibromyalgia patients face a variety of obstacles that result in reduced ability to sustain physical exercise. The main goal of the study was to analyze the role of pain catastrophizing and fibromyalgia impact in the relationship between regular walking behavior and pain and fatigue experienced after a laboratory walking test.

Method

The study has an observational analytical laboratory design. A total of 100 women were contacted by the research team. Seventy-six women diagnosed with fibromyalgia aged 18 years and older (mean age = 55.05, SD = 7.69) participated.

Results

Significant correlations were found among regular walking behavior, pain catastrophizing, impact of fibromyalgia, pain intensity after walking, and fatigue intensity after walking. The serial multiple mediation analyses confirmed that pain catastrophizing and impact of fibromyalgia mediated the relationship between regular walking behavior and the level of pain (beta B = 0.044, 95% CI = [0.01–0.012]) and fatigue (beta B = 0.028, 95% CI = [0.01–0.08]) after the laboratory walking test. Also, the participants that walked less regularly experienced more pain and fatigue after the 6-Minute Walk Test.

Conclusions

Considering cognitive variables alongside the impact of fibromyalgia will help understand the inhibitors of engaging in physical activity. Therapeutic walking programs must be tailored to patients with fibromyalgia to reduce pain and fatigue related to physical activity and to promote better functioning and quality of life.

Key Points• Regular walking behavior was associated with fibromyalgia impact, pain catastrophizing, and less pain and fatigue after physical activity.• When patients catastrophize pain, they usually interpret physical activity as threatening, which generates more pain and fatigue after doing exercise.• Therapeutic programs should be designed to reduce pain catastrophizing and fibromyalgia impact.
Observing the nature of relationships in male bottlenose dolphins
Authors: Fellner Wendi , Harley Heidi E. , Losch Barbara A.
Published: August 2022

As long-term studies reveal, bottlenose dolphin communities comprise a complex network of individual relationships. Individuals form strong bonds (e.g., mother-calf or male partnerships), transient relationships, and also compete against each other for resources. Evidence of bonded partnerships is typically revealed by the years-long study of associations with repeated sightings. However, quickly determining which individuals have close affiliations would benefit both field researchers working to describe individual behavior as they engage in cognitive activities such as cooperative foraging as well as caregivers in zoos who must decide which individuals should be housed together. Observations in aquariums are well-suited for collecting long-term, detailed information on how pairs interact because subjects can always be found and their behavior both above and below the water can be seen well. These are conditions that are rare for most (but not all) ocean-based studies. We used multiple measures to detect affiliated behavior across several dimensions of pairwise affiliation. Specifically, we used association indices to measure the frequency of affiliative behavior, the symmetry of the partnership, the tenor of interactions, and the stability of which partners were strongly affiliated from year to year. Synchronous behavior and reciprocity in proximity-seeking are two examples of potential markers of an affiliative relationship where individual choices–to join, to move together, and to leave–are visible to observers. We found that the combined measures were effective at identifying one pair that maintained a strong, stable relationship across years, one individual that formed a moderately strong trio relationship with both members of the most-affiliated pair, and one individual who was more variable in his relationships. These social markers provide a means of rapidly identifying bonded males in both aquarium and ocean settings, particularly when long-term knowledge of individual histories is not available.
Quantifying the contribution of fines production during refining to the resulting paper strength
Authors: Mandlez Daniel , Koller Sarah , Eckhart Rene , Kulachenko Artem , Bauer Wolfgang , Hirn Ulrich
Published: August 2022

Pulp refining is an essential process step prior to paper production. The contribution of fines production during refining to the resulting paper strength so far has mostly been considered qualitatively. A quantitative and experimental evaluation regarding their effect has not yet been published. Unbleached softwood kraft pulp was refined using a PFI mill and a disc refiner at different refining intensities. Prior to handsheet forming, fines were removed in a lab scale pressure screen from one part of the refined and unrefined samples in order to investigate the difference in tensile strength between sheets with and without fines, which were furthermore produced with and without additional wet pressing. It was found, that fines formed in a disc refiner at 250 kWh/t are responsible for up to 25% of the breaking length increase, while the PFI mill at 10,000 revolutions fines only contribute to a maximum of 12%. In terms of fines efficiency, the disc refiner was able to achieve higher results compared to the PFI mill, which however might be attributed to the higher fibre flexibilization in the PFI mill. Thus fines formed in the refining process are of high importance for strength development especially for the disc refiner.
Simplicity conditions for binary orthogonal arrays
Authors: Carlet Claude , Kiss Rebeka , Nagy Gábor P.
Published: August 2022

It is known that correlation-immune (CI) Boolean functions used in the framework of side channel attacks need to have low Hamming weights. The supports of CI functions are (equivalently) simple orthogonal arrays, when their elements are written as rows of an array. The minimum Hamming weight of a CI function is then the same as the minimum number of rows in a simple orthogonal array. In this paper, we use Rao’s Bound to give a sufficient condition on the number of rows, for a binary orthogonal array (OA) to be simple. We apply this result for determining the minimum number of rows in all simple binary orthogonal arrays of strengths 2 and 3; we show that this minimum is the same in such case as for all OA, and we extend this observation to some OA of strengths 4 and 5. This allows us to reply positively, in the case of strengths 2 and 3, to a question raised by the first author and X. Chen on the monotonicity of the minimum Hamming weight of 2-CI Boolean functions, and to partially reply positively to the same question in the case of strengths 4 and 5.
Enabling Fairness in Healthcare Through Machine Learning
Authors: Grote Thomas , Keeling Geoff
Published: August 2022

The use of machine learning systems for decision-support in healthcare may exacerbate health inequalities. However, recent work suggests that algorithms trained on sufficiently diverse datasets could in principle combat health inequalities. One concern about these algorithms is that their performance for patients in traditionally disadvantaged groups exceeds their performance for patients in traditionally advantaged groups. This renders the algorithmic decisions unfair relative to the standard fairness metrics in machine learning. In this paper, we defend the permissible use of affirmative algorithms; that is, algorithms trained on diverse datasets that perform better for traditionally disadvantaged groups. Whilst such algorithmic decisions may be unfair, the fairness of algorithmic decisions is not the appropriate locus of moral evaluation. What matters is the fairness of final decisions, such as diagnoses, resulting from collaboration between clinicians and algorithms. We argue that affirmative algorithms can permissibly be deployed provided the resultant final decisions are fair.
Automated Design Error Debugging of Digital VLSI Circuits
Authors: Moness Mohammed , Gaber Lamya , Hussein Aziza I. , Ali Hanafy M.
Published: August 2022

As the complexity and scope of VLSI designs continue to grow, fault detection processes in the pre-silicon stage have become crucial to guaranteeing reliability in IC design. Most fault detection algorithms can be solved by transforming them into a satisfiability (SAT) problem decipherable by SAT solvers. However, SAT solvers consume significant computational time, as a result of the search space explosion problem. This ever- increasing amount of data can be handled via machine learning techniques known as deep learning algorithms. In this paper, we propose a new approach utilizing deep learning for fault detection (FD) of combinational and sequential circuits in a type of stuck-at-faults. The goal of the proposed semi-supervised FD model is to avoid the search space explosion problem by taking advantage of unsupervised and supervised learning processes. First, the unsupervised learning process attempts to extract underlying concepts of data using Deep sparse autoencoder. Then, the supervised process tends to describe rules of classification that are applied to the reduced features for detecting different stuck-at faults within circuits. The FD model proposes good performance in terms of running time about 187 × compared to other FD algorithm based on SAT solvers. In addition, it is compared to common classical machine learning models such as Decision Tree (DT), Random Forest (RF) and Gradient Boosting (GB) classifiers, in terms of validation accuracy. The results show a maximum validation accuracy of the feature extraction process at 99.93%, using Deep sparse autoencoder for combinational circuits. For sequential circuits, stacked sparse autoencoder presents 99.95% as average validation accuracy. The fault detection process delivers around 99.6% maximum validation accuracy for combinational circuits from ISCAS’85 and 99.8% for sequential circuits from ISCAS’89 benchmarks. Moreover, the proposed FD model has achieved a running time of about 1.7x, compared to DT classifier and around 1.6x, compared to RF classifier and GB machine learning classifiers, in terms of validation accuracy in detecting faults occurred in eight different digital circuits. Furthermore, the proposed model outperforms other FD models, based on Radial Basis Function Network (RBFN), achieving 97.8% maximum validation accuracy.
Inadequate Activation of γδT- and B-cells in Patient with Wiskott-Aldrich Syndrome (WAS) Portrayed by TRG and IGH Repertoire Analyses
Authors: Palevski Dahlia , Simon Amos , Lev Atar , Somech Raz , Lee Yu Nee
Published: August 2022

Patients with Wiskott-Aldrich syndrome (WAS) harbor mutations in the WAS gene and suffer from immunodeficiency, microthrombocytopenia, and eczema. T-cells play an important role in immune response in the skin and the γδT-cells have an important role in skin homeostasis. Since WAS patients often present with eczema, we wanted to examine whether the T-cell receptor gamma (TRG) repertoire of the γδT-cells is affected in these patients. In addition, the immunoglobulin heavy chain (IGH) repertoire from genomic DNA of WAS patients was not yet studied. Thus, we sought to determine the effects that specific WAS mutations from our patients have in shaping the TRG and IGH immune repertoires. We collected clinical and genetic data on four WAS patients, each harboring a different mutation in the WAS gene. Using next-generation sequencing (NGS), we analyzed their TRG and IGH repertoires using genomic DNA isolated from their peripheral blood. We analyzed the TRG and IGH repertoire sequences to show repertoire restriction, clonal expansions, preferential utilization of specific V genes, and unique characteristics of the antigen binding region in WAS patients with eczema compared to healthy controls. Both the TRG and IGH repertoire showed diverse repertoire comparable to healthy controls on one the hand, and on the other hand, the IGH repertoire showed increased diversity, more evenly distributed repertoire and immaturity of the antigen binding region. Thus, we demonstrate by analyzing the repertoire based on genomic DNA, the various effect that WAS mutations have in shaping the TRG and IGH adaptive immune repertoires.
Wavelet-packets for deepfake image analysis and detection
Authors: Wolter Moritz , Blanke Felix , Heese Raoul , Garcke Jochen
Published: August 2022

As neural networks become able to generate realistic artificial images, they have the potential to improve movies, music, video games and make the internet an even more creative and inspiring place. Yet, the latest technology potentially enables new digital ways to lie. In response, the need for a diverse and reliable method toolbox arises to identify artificial images and other content. Previous work primarily relies on pixel-space convolutional neural networks or the Fourier transform. To the best of our knowledge, synthesized fake image analysis and detection methods based on a multi-scale wavelet-packet representation, localized in both space and frequency, have been absent thus far. The wavelet transform conserves spatial information to a degree, allowing us to present a new analysis. Comparing the wavelet coefficients of real and fake images allows interpretation. Significant differences are identified. Additionally, this paper proposes to learn a model for the detection of synthetic images based on the wavelet-packet representation of natural and generated images. Our forensic classifiers exhibit competitive or improved performance at small network sizes, as we demonstrate on the Flickr Faces High Quality, Large-scale Celeb Faces Attributes and Large-scale Scene UNderstanding source identification problems. Furthermore, we study the binary Face Forensics++ (ff++) fake-detection problem.
Moralization and Mismoralization in Public Health
Authors: Kraaijeveld Steven R. , Jamrozik Euzebiusz
Published: August 2022

Moralization is a social-psychological process through which morally neutral issues take on moral significance. Often linked to health and disease, moralization may sometimes lead to good outcomes; yet moralization is often detrimental to individuals and to society as a whole. It is therefore important to be able to identify when moralization is inappropriate. In this paper, we offer a systematic normative approach to the evaluation of moralization. We introduce and develop the concept of ‘mismoralization’, which is when moralization is metaethically unjustified. In order to identify mismoralization, we argue that one must engage in metaethical analysis of moralization processes while paying close attention to the relevant facts. We briefly discuss one historical example (tuberculosis) and two contemporary cases related to COVID-19 (infection and vaccination status) that we contend to have been mismoralized in public health. We propose a remedy of de-moralization that begins by identifying mismoralization and that proceeds by neutralizing inapt moral content. De-moralization calls for epistemic and moral humility. It should lead us to pull away from our tendency to moralize—as individuals and as social groups—whenever and wherever moralization is unjustified.
Epistemic solidarity in medicine and healthcare
Authors: Pot Mirjam
Published: August 2022

In this article, I apply the concept of solidarity to collective knowledge practices in healthcare. Generally, solidarity acknowledges that people are dependent on each other in many respects, and it captures those support practices that people engage in out of concern for others in whom they recognise a relevant similarity. Drawing on the rich literature on solidarity in bioethics and beyond, this article specifically discusses the role that epistemic solidarity can play in healthcare. It thus focuses, in particular, on solidarity’s relationship with justice and injustice. In this regard, it is argued (1) that justice and solidarity are two equally important and complementary values that should both be considered in healthcare practices and institutions and (2) that solidarity often arises in unjust situations and can be a means to bring about justice. I transfer these ‘general’ insights about solidarity to knowledge practices in healthcare and link them to the discussion about epistemic injustices in healthcare and how to overcome them. I argue that epistemic solidarity can play an important role in overcoming epistemic injustices as well as—and independently from its contribution to justice—in knowledge production in medicine more generally. To demonstrate how epistemic solidarity can add to our understanding of collective knowledge practices, I discuss two examples: patients sharing their medical data for research purposes and healthcare professionals’ engagement with patients to better understand their afflictions.
A Lanczos-type procedure for tensors
Authors: Cipolla Stefano , Pozza Stefano , Redivo-Zaglia Michela , Van Buggenhout Niel
Published: August 2022

The solution of linear non-autonomous ordinary differential equation systems (also known as the time-ordered exponential) is a computationally challenging problem arising in a variety of applications. In this work, we present and study a new framework for the computation of bilinear forms involving the time-ordered exponential. Such a framework is based on an extension of the non-Hermitian Lanczos algorithm to 4-mode tensors. Detailed results concerning its theoretical properties are presented. Moreover, computational results performed on real-world problems confirm the effectiveness of our approach.
Do green bonds offer a diversification opportunity during COVID-19?—an empirical evidence from energy, crypto, and carbon markets
Authors: Yadav Miklesh Prasad , Kumar Satish , Mukherjee Deepraj , Rao Purnima
Published: August 2022

The present study is a novel attempt to unravel the connectedness of the green bond with energy, crypto, and carbon markets using the S&P green bond index (RSPGB). We consider MAC global solar energy index (RMGS) and ISE global wind energy index (RIGW) as proxies of the energy market and use bitcoin and the European energy exchange carbon index (REEX) for the cryptocurrency and carbon market. Employing the Diebold and Yilmaz (2012), Baruník and Krehlík (2018), and wavelet coherence econometric techniques, we find that the energy market (RMGS) has the highest connectedness derived from other asset classes, and bitcoin (RBTC) has the least connectedness. Concurrently, we find that the risk transmission is heterogeneous in different scales as the short period has less connectedness than the medium and long run. We conclude that the overall diversification opportunity among green bonds, energy stock, bitcoin, and the carbon market is more in the short-run than in the medium and long-run. In summary, our findings on the green bond market will provide investors, portfolio managers, and policymakers with critical insight into ensuring a sustainable financial market.
Retaining Providers with Women’s Health Expertise: Decreased Provider Loss Among VHA Women’s Health Faculty Development Program Attendees
Authors: Farkas Amy H. , Merriam Sarah , Frayne Susan , Hardman Lisa , Schwartz Rachel , Kolehmainen Christine
Published: August 2022

Background

The Veterans Health Administration (VHA) provides care for over 500,000 women. In 2010 VHA instituted a policy requiring each facility to identify a designated women’s health provider (WH-PCP) who could offer comprehensive gender-specific primary care. Access to WH-PCPs remains a challenge at some sites with high turnover among WH-PCPs. Faculty development programs have been demonstrated to foster professional development, networks, and mentorship; these can enhance job satisfaction and provide one potential solution to address WH-PCP turnover. One such program, the VHA’s Women’s Health Mini-Residency (WH-MR), was developed in 2011 to train WH-PCPs through case-based hands-on training.

Objective

The objective of this program evaluation was to determine the association of WH-MR participation with WH-PCP retention.

Design

Using the Women’s Health Assessment of Workforce Capacity-Primary Care survey, we assessed the relationship between WH-MR participation and retention of WH-PCP status between fiscal year 2018 and 2019.

Participants

All WH-PCPs (N = 2664) at the end of fiscal year 2018 were included.

Main Measures

We assessed retention of WH-PCP status the following year by WH-MR participation. For our adjusted analysis, we controlled for provider gender, provider degree (MD, DO, NP, PA), women’s health leadership position, number of clinical sessions per week, and clinical setting (general primary care clinic, designated women’s health clinic, or a combination).

Key Results

WH-MR participants were more likely to remain WH-PCPs in FY2019 in both unadjusted analyses (OR 1.91, 95%CI 1.54–2.36) and adjusted analyses (OR 1.96, 95%CI 1.58–2.44).

Conclusions

WH-PCPs who participate in WH-MRs are more likely to remain WH-PCPs in the VHA system. Given the negative impact of provider turnover on patient care and the significant financial cost of onboarding a new WH-PCP, the VHA should continue to encourage all WH-PCPs to participate in the WH-MR.
Perceived Contraceptive Counseling Quality Among Veterans Using VA Primary Care: Data from the ECUUN Study
Authors: Callegari Lisa S. , Mahorter Siobhan S. , Benson Sam K. , Zhao Xinhua , Schwarz Eleanor Bimla , Borrero Sonya
Published: August 2022

Background

High-quality contraceptive counseling is critical to support Veterans’ reproductive autonomy and promote healthy outcomes.

Objective

To describe perceived quality of contraceptive counseling in Veterans Health Administration (VA) primary care and assess factors associated with perceived high- and low-quality contraceptive counseling.

Design

Cross-sectional study using data from the Examining Contraceptive Use and Unmet Need in women Veterans (ECUUN) national telephone survey.

Participants

Veterans aged 18–44 who received contraceptive services from a VA primary care clinic in the past year (N=506).

Main Measures

Perceived quality of contraceptive counseling was captured by assessing Veterans’ agreement with 6 statements regarding provider counseling adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. High-quality counseling was defined as a top score of strongly agreeing on all 6 items; low-quality counseling was defined as not agreeing (neutral, disagreeing, or strongly disagreeing) with >3 items. We constructed two multivariable models to assess associations between patient-, provider-, and system-level factors and perceived high-quality (Model 1) and perceived low-quality counseling (Model 2).

Key Results

Most participants strongly agreed that their providers listened carefully (74%), explained things clearly (77%), and spent enough time discussing things (71%). Lower proportions strongly agreed that their provider discussed more than one option (54%), discussed pros/cons of various methods (44%), or asked which choice they thought was best for them (62%). In Model 1, Veterans who received care in a Women’s Health Clinic (WHC) had twice the odds of perceiving high-quality counseling (aOR=1.99; 95%CI=1.24–3.22). In Model 2, Veterans who received care in a WHC (aOR=0.49; 95%CI=0.25–0.97) or from clinicians who provide cervical cancer screening (aOR=0.49; 95%CI=0.26–0.95) had half the odds of perceiving low-quality counseling.

Conclusions

Opportunities exist to improve the quality of contraceptive counseling within VA primary care settings, including more consistent efforts to seek patients’ perspectives with respect to contraceptive decisions.
Prevalence and Correlates of Firearm Access Among Post-9/11 US Women Veterans Using Reproductive Healthcare: a Cross-Sectional Survey
Authors: Monteith Lindsey L. , Holliday Ryan , Miller Christin N. , Schneider Alexandra L. , Brenner Lisa A. , Hoffmire Claire A.
Published: August 2022

Background

Suicide rates have increased among women Veterans, with increased use of firearms as the method. Addressing suicide risk in this population requires understanding the prevalence and correlates of firearm access in healthcare settings frequented by women Veterans.

Objectives

Characterize the prevalence and correlates of firearm ownership and storage practices among women Veterans using Department of Veterans Affairs (VA) reproductive healthcare (RHC) services.

Design

Cross-sectional national survey conducted in 2018–2019 (17.9% response rate).

Participants

Post-9/11 women Veterans using RHC (n=350).

Main Measures

VA Military Sexual Trauma Screen, PTSD Checklist for DSM-5, Hurt/Insult/Threaten/Scream, Columbia-Suicide Severity Rating Scale screener, self-reported firearm access.

Key Results

38.0% (95% confidence interval [95% CI]: 32.9, 43.3) of participants reported personally owning firearms, and 38.9% (95% CI: 33.7, 44.2) reported other household members owned firearms. Among those with firearms in or around their homes, 17.8% (95% CI: 12.3, 24.4) and 21.9% (95% CI: 15.9, 28.9) reported all were unsafely stored (loaded or unlocked, respectively). Women who experienced recent intimate partner violence were less likely to report personally owning firearms (adjusted prevalence ratio [APR]=0.75; 95% CI: 0.57, 0.996). Those who experienced military sexual harassment (APR=1.46; 95% CI=1.09, 1.96), were married (APR=1.74; 95% CI: 1.33, 2.27), or lived with other adult(s) (APR=6.26; 95% CI: 2.87, 13.63) were more likely to report having household firearms owned by someone else. Storing firearms loaded was more prevalent among women with lifetime (APR=1.47; 95% CI=1.03, 2.08) or past-month (APR=1.69; 95% CI=1.15, 2.48) suicidal ideation and less likely among those with other adult(s) in the home (unadjusted PR=0.62; 95% CI=0.43, 0.91). Those with parenting responsibilities (APR=0.61; 95% CI=0.38, 0.97) were less likely to store firearms unlocked.

Conclusions

Firearm access is prevalent among post-9/11 women Veterans using VA RHC. Interpersonal factors may be important determinants of firearm access in this population. Safe firearm storage initiatives are needed among women Veterans using RHC, particularly for those with suicidal ideation.
Examining Pregnant Veterans’ Acceptance and Beliefs Regarding the COVID-19 Vaccine
Authors: Mattocks Kristin M. , Kroll-Desrosiers Aimee , Moore Simas Tiffany A. , Bastian Lori A. , Marteeny Valerie , Walker Lorrie , Sheahan Kate , Elwy A. Rani
Published: August 2022

Background

Pregnant persons have received mixed messages regarding whether or not to receive COVID-19 vaccines as limited data are available regarding vaccine safety for pregnant and lactating persons and breastfeeding infants.

Objective

The aims of this study were to examine pregnant Veteran’s acceptance of COVID-19 vaccines, along with perceptions and beliefs regarding vaccine safety and vaccine conspiracy beliefs.

Design and Participants

We conducted a cross-sectional survey of pregnant Veterans enrolled in VA care who were taking part in an ongoing cohort study at 15 VA medical centers between January and May 2021.

Main Measures

Pregnant Veterans were asked whether they had been offered the COVID-19 vaccine during pregnancy, and whether they chose to accept or refuse it. Additional questions focused on perceptions of COVID-19 vaccine safety and endorsements of vaccine knowledge and conspiracy beliefs. Logistic regression was utilized to examine predictors of acceptance of a vaccine during pregnancy.

Key Results

Overall, 72 pregnant Veterans were offered a COVID-19 vaccine during pregnancy; over two-thirds (69%) opted not to receive a vaccine. Reasons for not receiving a vaccine included potential effects on the baby (64%), side effects for oneself (30%), and immunity from a past COVID-19 infection (12%). Those who received a vaccine had significantly greater vaccine knowledge and less belief in vaccine conspiracy theories. Greater knowledge of vaccines in general (aOR: 1.78; 95% CI: 1.2–2.6) and lower beliefs in vaccine conspiracies (aOR: 0.76; 95% CI: 0.6–0.9) were the strongest predictors of acceptance of a COVID-19 vaccine during pregnancy.

Conclusions

Our study provides important insights regarding pregnant Veterans’ decisions to accept the COVID-19 vaccine, and reasons why they may choose not to accept the vaccine. Given the high endorsement of vaccine conspiracy beliefs, trusted healthcare providers should have ongoing, open discussions about vaccine conspiracy beliefs and provide additional information to dispel these beliefs.
Long-term Psychoactive Medications, Polypharmacy, and Risk of Suicide and Unintended Overdose Death Among Midlife and Older Women Veterans
Authors: Gibson Carolyn J. , Li Yixia , Jasuja Guneet K. , Keyhani Salomeh , Byers Amy L.
Published: August 2022

Background

Rates of suicide and unintended overdose death are high among midlife and older women, yet there is paucity of data identifying women at greatest risk. Psychoactive medications, commonly prescribed and co-prescribed in this population, may serve as salient indicators of risk for these outcomes.

Objective

To determine whether long-term psychoactive medications and psychoactive polypharmacy predict risk of suicide and unintended overdose death among midlife and older women Veterans above and beyond other recognized factors.

Design

Longitudinal cohort study

Participants

Women Veterans aged ≥ 50 with at least one Veterans Health Administration (VHA) clinical encounter in FY2012–2013.

Main Measures

Long-term psychoactive medications (opioids, benzodiazepines, sedative-hypnotics, antidepressants, antipsychotics, and antiepileptics, prescribed for ≥ 90/180 days) and psychoactive polypharmacy (overlapping for ≥ 1 day) from VHA pharmacy records; suicide and unintended overdose death through December 31, 2018.

Key Results

In this national sample of 154,558 midlife and older women Veterans (mean age 63.4, SD 9.3 years), 130 died by suicide and 175 died from unintentional overdose over an average of 5.6 years. In fully adjusted models, long-term opioids (hazard ratio (HR) 2.01, 95% CI 1.21–3.35) and benzodiazepines (HR 2.99, 95% CI 1.82–4.91) were associated with death by suicide; opioids (HR 3.62, 95% CI 2.46–5.34), benzodiazepines (HR 2.77, 95% CI 1.73–4.42), sedative-hypnotics (HR 1.87, 95% CI 1.06–3.29), antidepressants (HR 1.47, 95% CI 1.03–2.12), antipsychotics (HR 1.81, 95% CI 1.02–3.22), and antiepileptics (HR 2.17, 95% CI 1.48–3.19) were associated with unintended overdose death. Women who were co-prescribed ≥ 3 psychoactive medications had over 2-fold increased risk of suicide (HR 2.83, 95% CI 1.65–4.84) and unintended overdose death (HR 2.60, 95% CI 1.72–3.94).

Conclusions

Long-term psychoactive medications and psychoactive medication polypharmacy were important indicators of risk for death by suicide and death by unintended overdose among midlife and older women Veterans, even after accounting for psychiatric and substance use disorders.
Gender Differences in Guideline-Directed Medical Therapy for Cardiovascular Disease Among Young Veterans
Authors: Dhruva Sanket S. , Dziura James , Bathulapalli Harini , Rosman Lindsey , Gaffey Allison E. , Davis Melinda B. , Brandt Cynthia A. , Haskell Sally G.
Published: August 2022

Background

There is an increasing burden of cardiovascular disease, including coronary artery disease (CAD) and heart failure (HF), among women Veterans. Clinical practice guidelines recommend multiple pharmacotherapies that can reduce risk of mortality and adverse cardiovascular outcomes.

Objective

To determine if there are disparities in the use of guideline-directed medical therapy by gender among Veterans with incident CAD and HF.

Design

Retrospective.

Participants

Veterans (934,504; 87.8% men and 129,469; 12.2% women) returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn.

Main Measures

Differences by gender in the prescription of Class 1, Level of Evidence A guideline-directed medical therapy among patients who developed incident CAD and HF at 30 days, 90 days, and 12 months after diagnosis. For CAD, medications included statins and antiplatelet therapy. For HF, medications included beta-blockers and renin-angiotensin-aldosterone system inhibitors.

Key Results

Overall, women developed CAD and HF at a younger average age than men (mean 45.8 vs. 47.7 years, p<0.001; and 43.7 vs. 45.4 years, p<0.02, respectively). In the 12 months following a diagnosis of incident CAD, the odds of a woman receiving a prescription for at least one CAD drug was 0.85 (95% confidence interval [CI], 0.68–1.08) compared to men. In the 12 months following a diagnosis of incident HF, the odds of a woman receiving at least one HF medication was 0.54 (95% CI, 0.37–0.79) compared to men.

Conclusions

Despite guideline recommendations, young women Veterans have approximately half the odds of being prescribed guideline-directed medical therapy within 1-year after a diagnosis of HF. These results highlight the need to develop targeted strategies to minimize gender disparities in CVD care to prevent adverse outcomes in this young and growing population.
Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study
Authors: Gawron Lori M. , He Tao , Lewis Lacey , Fudin Hannah , Callegari Lisa S. , Turok David K. , Stevens Vanessa
Published: August 2022

Background

In the USA, oral emergency contraception (EC) use to prevent unintended pregnancy is increasing. Oral EC methods include levonorgestrel (LNG) and ulipristal acetate (UPA), with increased UPA efficacy over LNG in high BMI users and those beyond 3 days post intercourse. The Veterans Health Administration (VHA) provides oral EC at low or no cost, yet prescription-level Veteran data are lacking.

Objective

To describe oral EC provision in VHA, including method type and Veteran user and prescriber characteristics.

Design

A retrospective cohort study using VHA administrative data.

Participants

All VHA oral EC prescriptions from January 1, 2016, to December 31, 2020.

Main Measures

We linked Veteran-level sociodemographic and military characteristics and provider-level data with each prescription to identify variables associated with oral EC method.

Key Results

A total of 4280 EC prescriptions (85% LNG) occurred for 3120 unique Veterans over 5 years. While prescriptions remained low annually, the proportion of UPA prescriptions increased from 12 to 19%. Compared to LNG users, UPA users were older (34% vs 25% over age 35 years, p <0.001); more likely to identify as white (57% vs 46%) and non-Hispanic (84% vs 79%) (p <0.001); and more likely to have a BMI ≥ 25 (76% vs 67%, p <0.001). UPA prescriptions originated most frequently from VA Medical Centers (87%) and women’s health clinics (76%) compared to community-based or other clinic types. In multivariable regression models, race, ethnicity, BMI ≥30, and prescriber facility type of a VA Medical Center or a women’s clinic location were predictive of UPA prescription.

Conclusions

Oral EC provision in VHA remains low, but UPA use is increasing. LNG prescription occurs frequently in high BMI Veterans who would benefit from increased efficacy of UPA. Interventions to expand oral EC access in VHA are essential to ensure Veterans’ ability to avert unwanted pregnancies.
Influence of Titanium Additions to Aluminum on the Microhardness Value and Electrochemical Behavior of Synthesized Aluminum-Titanium Alloy in Solutions of HCl and H3PO4
Authors: El-Sayed Abdel-Rahman , Mohamed Adila E. , Hassan Fatma S. M. , El-Mahdy Mohamed Sarwat
Published: August 2022

The effect of Ti content in various concentrations as an alloying element with Al on both microhardness and crystallization structure of aluminum–titanium alloys was studied, utilizing x-ray diffraction (XRD) and a scanning electron microscope (SEM). To study the electrochemical and corrosion performance of Al and its investigated alloys in 0.5 M solutions of HCl and H3PO4,two different techniques were used: extrapolation of Tafel plot and electrochemical impedance spectroscopy (EIS). Tafel plots and EIS revealed a similar trend. Generally, the rate of corrosion of the alloys was higher than that of Al. This investigation exhibited that the corrosion of Al alloying with Ti increased with an increase in both Ti content and temperature, which is due to reducing the growth of oxide film on the surface. Changes in the standard values of both entropy (ΔS) and enthalpy (ΔH), in addition to apparent activation energy (Ea) of corrosion processes of Al and its alloys in HCl and H3PO4,were evaluated. The evaluated data indicated negative values of ΔS,while the values of ΔHwere positive. Besides, the decrease in ΔHvalue with the increase of Ti content in the alloy revealed that the dissolution of the studied alloys was fast. The positive values of ΔHwere accompanied by an endothermic process. On the other hand, the activation energy (Ea) was decreased as a result of Al alloying with Ti in the two mentioned acids. Those results were supported by the corrosion current density (icorr.) and impedance parameters. By comparing the data obtained for both HCl and H3PO4in all investigated electrodes, the corrosion current density (icorr.) in H3PO4was lower than that in HCl. Such behavior can be ascribed to the aggressive attack of Cl¯ ions on the surfaces of the investigated electrodes, leading to pits formation.
Approach to Localized Squamous Cell Cancer of the Esophagus
Authors: Weidenbaum Chloe , Gibson Michael K.
Published: August 2022

Opinion statement

Esophageal cancer is a leading cause of cancer deaths worldwide, with an increasing incidence in recent decades. The majority of esophageal cancers are squamous cell carcinoma. The 5-year survival rate of esophageal squamous cell carcinoma (ESCC) is poor, and there remains globally a pressing need for novel treatments that improve patient outcomes and quality of life. In this review, we discuss management of localized ESCC with an update on relevant newly published literature, including targeted therapy and novel biomarkers. The standard treatment approach for locally advanced, resectable ESCC is currently chemoradiation with or without surgery. Here we discuss different approaches to endoscopic resection, surgery, and radiation therapy. Although the typical chemotherapy regimen is a combination of a platinum with a fluoropyrimidine or paclitaxel, different regimens are being evaluated. With the landscape of immunotherapy rapidly evolving, at the forefront of new treatments for ESCC is immunotherapy and other targeted agents. Ultimately, the treatment approach should be individualized to each patient.
How Can a Complex Geosite Be Enhanced? A Landscape-Scale Approach to the Deep-Seated Gravitational Slope Deformation of Pointe Leysser (Aosta Valley, NW Italy)
Authors: Forno M. Gabriella , Gianotti Franco , Gattiglio Marco , Pelfini Manuela , Sartori Gaia , Bollati Irene Maria
Published: August 2022

Complex
geosites represent important georesources as components of the geoheritage of a region. Regardless, their management in terms of promotion and geoconservation may be challenging. Among others, gravity-related landforms can be considered complex geomorphological features and are often neglected in the geosite inventories, even if their dynamic and related educational exemplarity, multiscalarity and aesthetic value are relevant and make them potentially complex geosites. The aim of this research is to discuss the possible approaches to a potential complex geosite in the Western Italian Alps. The area is characterised by an articulated and geodiverse set of landforms that concur to define a multifaceted geological and geomorphological setting due to the presence of one of the most significant gravity-related geofeatures of the Italian Alps: the Pointe Leysser deep-seated gravitational slope deformation. The entire context, as well as each single geological/geomorphological feature, will be presented and described enhancing and quantifying their geoheritage values (i.e. scientific value, additional value, the potential for use). Finally, proposals for virtual or field approaches will be discussed, considering the limitations and advantages of dealing with a complex geosite. The suggested strategies assume an important role with respect to both the promotion and geoconservation of complex geosites.
Shock temporality: international students coping with disrupted lives and suspended futures
Authors: Gomes Catherine
Published: August 2022

During the COVID-19 pandemic, people around the word experienced periods of local, state and international immobility due to lockdowns, border closers and travel restrictions. For transient migrants such as international students, these kinds of immobility have resulted in disrupted lives with professional and personal futures suspended as careers and relationships become stuck in limbo. Moreover, such sudden and extended periods of immobility have not been sufficiently covered in temporality literature due to the novelty of the pandemic crisis in the international education, migration and mobility studies spaces. By conducting a pilot project investigating current and recently graduated higher degree by research (HDR) international students (PhD, Masters and Honours) from public institutions in the Australian city of Melbourne, this paper, thus, introduces the concept of ‘shock temporality’ caused by the global COVID-19 pandemic. Shock temporality takes place when the expected and finite temporary/transitory experience becomes forcefully broken and appears to be ongoing outside of the individual’s control. While shock temporality has left HDR international students’ professional and personal agendas and aspirations in suspension, students interviewed use the time to plan and prepare for truncated futures. The findings of this paper, thus, become relevant in assisting higher education student support services in creating potential approaches and strategies for a post-pandemic future.
Bioinspired PcBN/hBN fibrous monolithic ceramic: High-temperature crack resistance responses and self-lubricating performances
Authors: Chen Shu-na , Fan Hengzhong , Su Yunfeng , Li Jicheng , Song Junjie , Hu Litian , Zhang Yongsheng
Published: August 2022

The high strength and toughness of natural materials are mainly determined by a combination of mechanisms operating at different length scales, which can be used as a strategy to reduce the intrinsic brittleness of ceramics. Inspired by the architectures of bamboo, the polycrystalline cubic boron nitride/hexagonal boron nitride (PcBN/hBN) fibrous monolithic ceramics with a long fiber arrangement structure was constructed with PcBN fiber cells and hBN cell boundaries, and its crack resistance responses and tribological performances were investigated. The composite ceramic failed in a non-brittle manner with the rising resistance curve (R-curve) behavior, which was attributed to multiscale crack effects in the hierarchical architecture. The maximum crack growth toughness was extremely high (approximately 21 MPa·m1/2), corresponding to a 270% increase over the crack initiation toughness. Excellent fracture resistance could be retained even above 1000 °C. Moreover, the composite ceramic exhibited low and stable friction coefficients (approximately 0.33) when paired with a Si3N4 pin at high temperature (1000 °C), owing to the lubrication function of hBN cell boundaries with weak van der Waals forces and a small amount of liquid B2O3 produced. As a result, a synergistic improvement of mechanical and tribological properties at high temperature (1000 °C) was realized by combining bionic structure and tribological design. It provides important theoretical and technical support for expanding the application of self-lubricating composite ceramics in harsh environments.
What does gender have to do with the price of tuna? Social-ecological systems view of women, gender, and governance in Fiji’s tuna fishery
Authors: Syddall Victoria Margaret , Fisher Karen , Thrush Simon
Published: August 2022

Western and Central Pacific (WCP) tuna fisheries form part of a broad and complex social and ecological system (SES). This consists of interconnected elements including people (social, cultural, economic) and the biophysical environment in which they live. One area that has received little attention by policy makers is gender. Gender is important because it deepens understandings of behaviours, roles, power relations, policies, programs, and services that may differentially impact on social, ecological, economic, cultural, and political realities of people. This paper contributes a “first step” to examining gender issues in WCP tuna SES. Women’s roles in WCP tuna SES in Fiji are explored and an evaluation of the impact fisheries development policy has on gender equality over the past two decades is revealed. Three key findings emerged from interviews, focus group discussions, and observations: 1) traditional gendered roles remain where women are marginalised in either invisible or low-paid and unskilled roles, and violence is sanctioned; 2) gender mainstreaming of policy and practice remain simplistic and narrow, but are transitioning towards more equitable outcomes for women; and 3) failure to consider gender within the context of WCP tuna SES leads to unintended outcomes that undermine potential benefits of the fishery to broader society, especially to women. A multifaceted approach is recommended to integrate substantive gender equality into SES-based approaches. This research argues educating and getting women opportunities to work on boats falls short of redressing inequality and injustice that is embedded in the social, political, and economic status quo.