bluuebunny/crossref_metadata_2025 huggingface dataset:
Studies on the effects of cryogenic cooling on microstructure and mechanical properties of plasma arc welded SS 316
Authors: Hussain Malik Ijaz , Khushnood Shahab
Published: February 2023

The stainless steel of grade 316 has significant use in nuclear engineering, aerospace industry and submarines and has become a material of choice due to its diversified properties. While welding this material, the heat input supplied weakens the fusion zone by grain growth, widening the heat-affected zone (HAZ), reducing yield and tensile strengths, and introducing distortion. Therefore, to address these issues, this study investigated the effect of cryogenic cooling during the welding process of thin sheets of SS 316 to improve the microstructure, mechanical properties, and reducing the distortion of the welded material. The keyhole mode plasma arc welding process was used to weld in a single pass without using filler with three different cooling methods. The microstructures, microhardness, and tensile properties of cryogenically and conventionally cooled weld samples were investigated at room temperature. The microstructural behavior of samples was characterized by metallurgical microscopy and scanning electron microscopy. The SEM Analysis reveals γ austenite and δ ferrite phases in conventionally welded test samples. M23C6 is formed in small amounts from δ ferrite, surrounding the δ ferrite on grain boundaries. In cryogenic cooled samples, delta ferrite is detected on grain boundaries of the austenitic matrix. Additionally, traces of (Cr, Fe)2 N are also revealed in specific cryogenic cooled samples due to liquid nitrogen impingement. In gel cooled samples, M23C6 is shown due to comparatively prolonged duration of cooling, and the results reveal that the liquid nitrogen and thermo gel improved average grain size up to 83.53% and 66.84%, respectively, as compared to an average grain size of conventional plasma weld. The reduction in HAZ is observed to be about 43.38% and 7.92% for liquid nitrogen cooled and thermo-gel samples, respectively, compared to conventional weld. Moreover, the tensile and yield strength of liquid nitrogen-cooled weldments increased up to 22.28% and 28.96%, respectively, while for gel-cooled welded sample, a 10.50% improvement in tensile strength and 3.10% in yield strength was observed. Furthermore, a reduction of 75% in distortion is achieved for welded samples with liquid nitrogen cooling.
Water, Soap, Technology…
Authors: Runciman Brian
Published: February 2023

Criticism of health IT is easy to find. However, healthcare is reliant upon and much improved by IT in its many guises. BCS is very involved with this area. Philip Scott CITP FBCS, the BCS Health and Care Executive Chair, spoke to Brian Runciman MBCS about why he takes an optimistic approach.
How a Hidden GPS Tracker is Saving Lives
Authors: Duncan Andrew
Published: February 2023

Andrew Duncan, Director at MetAlert Inc, talks to Johanna Hamilton MBCS about how a simple GPS tracking device slipped into an insole of a vulnerable person is not only changing care requirements, it’s also preserving lives.
Climate Change: Good COP, Bad COP
Authors: Bardell Alex
Published: February 2023

COP27 has drawn to a close with the epic last minute deal making going on late into the night, writes Alex Bardell MBCS and Chair of the BCS Green Specialist Group.
Mentoring
Authors: Yetim Adem
Published: February 2023

Adem Yetim IntPE FIET FBCS, discusses AI, healthcare and transformation
Practical Security
Authors: Clark Timothy
Published: February 2023

Think before you open an attachment, says Timothy Clark MBCS as he examines macros and their risks.
Is Cyber Security Being Taught Correctly?
Authors: Houlden Nigel , Jackson Victoria , Youssef Moustafa Haj
Published: February 2023

Students, academia and businesses all want different things from security. Dr Nigel Houlden, Dr Victoria Jackson and Dr Moustafa Haj Youssef ask whether trying to meet all of these demands is the right approach.
AI Health Projects Win BCS Prizes
Authors: Temple Victoria
Published: February 2023

Two innovative technology projects have been honoured with awards from the BCS Primary Healthcare Specialist Group. Victoria Temple, BCS’ Senior Press Officer, explores how each uses AI to improve patient outcomes and save GPs’ time.
Managing Change During Turbulent Times
Authors: Taylor Paul
Published: February 2023

Organisations need excellent change management skills to determine how external environmental events could impact them, so they can either mitigate against them or exploit them to their advantage, writes Paul Taylor MBCS, author and consultant.
We All Need to Cut Back on the Cookies
Authors: Houlden Nigel
Published: February 2023

On 10 September 2021 the UK government launched its consultation, ‘Data: a new direction’, writes Dr Nigel Houlden. This consultation was to gather opinion about government proposals to change UK law relating to the General Data Protection Regulation. We all know this better as the UK GDPR.
Artificial Intelligence
Authors: Smith Adam Leon
Published: February 2023

Within healthcare, technology can be a cure – but not in isolation, says Adam Leon Smith FBCS.
Combatting thalassemia in the United Arab Emirates
Authors: Al-Oraimi Suaad Zayed , Davey Gareth
Published: February 2023

Thalassemia is a major health challenge in the United Arab Emirates (UAE), however previous studies have focused on genetics and molecular characterisation while neglecting culture and society. In this commentary, we discuss how tradition and religion in the UAE (e.g. consanguinity, endogamy, illegality of abortion and in vitro fertilisation, adoption restrictions), and limited academic research, affect the prevention and management of the blood disorder. It is suggested that changing attitudes towards traditional marriage practices, education and awareness campaigns targeting families and young people, and earlier genetic testing, are culturally acceptable solutions to curbing the high incidence of thalassemia in the UAE.
Complete resolution of rectal cancer with liver metastases after palliative chemoradiotherapy and unplanned surgical resection—a case report
Authors: Choong Zhi S , Wong King H , Yang Tze W W , Nguyen Margaret , Duieb Zeev
Published: February 2023

Metastatic colorectal cancer has poor prognosis for many patients at time of diagnosis with <20% 5-year survival rate. Recent advancements in palliative chemotherapy have improved patient outcomes as median survival has increased almost 2-fold. We report a 44-year-old gentleman who initially underwent palliative chemoradiotherapy and subsequently a Hartmann’s procedure for ypT3N1M1 upper rectal adenocarcinoma with multiple liver metastases. Fortuitously, he made a remarkable recovery with complete radiological resolution of liver metastasis post-operatively. The patient has remained in remission for the past 10 years.
An unexpected diagnosis of malignant supratentorial intraparenchymal cystic meningioma mimicking high-grade glioma: case report and literature review
Authors: Idowu Olufemi I , Oshola Hammed , Emiogun Edobor F
Published: February 2023

Meningiomas are generally dura-based extra axial tumours without cystic components, whereas high-grade gliomas are intra-axial with or without cystic component. This case describes an adult female who presented with clinical and radiological features suggestive of a high-grade astrocytoma; however, histology diagnosis was papillary meningioma (World Health Organization Grade III). A 58-year-old female presented with a 4-month history of recurrent generalized tonic–clonic seizures and a 1-week history of altered sensorium. Her Glasgow Coma Scale Score was 10. Magnetic resonance image revealed a large intra-axial heterogeneous solid mass with multiple cystic areas in the right parietal lobe. She subsequently had craniotomy and tumour excision and the histologic diagnosis was papillary meningioma (WHO Grade III). Rarely, meningioma can present as an intra-axial tumour and may mimic other lesions like high-grade astrocytoma.
Visible Cash, a Second Incentive, and Priority Mail? An Experimental Evaluation of Mailing Strategies for a Screening Questionnaire in a National Push-to-Web/Mail Survey
Authors: Zhang Shiyu , West Brady T , Wagner James , Couper Mick P , Gatward Rebecca , Axinn William G
Published: February 2023

In push-to-web surveys that use postal mail to contact sampled cases, participation is contingent on the mail being opened and the survey invitations being delivered. The design of the mailings is crucial to the success of the survey. We address the question of how to design invitation mailings that can grab potential respondents’ attention and sway them to be interested in the survey in a short window of time. In the household screening stage of a national survey, the American Family Health Study, we experimentally tested three mailing design techniques for recruiting respondents: (1) a visible cash incentive in the initial mailing, (2) a second incentive for initial nonrespondents, and (3) use of Priority Mail in the nonresponse follow-up mailing. We evaluated the three techniques’ overall effects on response rates as well as how they differentially attracted respondents with different characteristics. We found that all three techniques were useful in increasing the screening response rates, but there was little evidence that they had differential effects on sample subgroups that could help to reduce nonresponse biases.
Progression of Self-Directed Learning in Health Professions Education: Clarifying Terms and Processes
Authors: Papanagnou Dimitrios , Corliss Stephanie , Richards Jeremy B. , Artino Anthony R. , Schwartzstein Richard
Published: February 2023

As the complexity ofmedical knowledge and clinical practice continues to grow, physicians and physicians-intrainingmust learn to identify gaps in their knowledge and understand and engage in self-directed learning (SDL) in pursuit of academic goals and improved clinical performance. There is a lack of consensus, however, on the precise definition of SDL and how it relates to self-regulated learning (SRL) and co-regulated learning (CRL). We propose a conceptual framework for understanding the progression of a self-directed learner in the health professions and describe the interplay of SRL and CRL.
Alignment of RVU Targets With Operating Room Block Time
Authors: Rao Saieesh A. , Deshpande Nikita G. , Richardson Douglas W. , Brickman Jon , Posner Mitchell C. , Matthews Jeffrey B. , Turaga Kiran K.
Published: February 2023

Background:

Surgeon productivity is measured in relative value units (RVUs). The feasibility of attaining RVU productivity targets requires surgeons to have enough allocated block time to generate RVUs. However, it is unknown how much block time is required for surgeons to attain specific RVU targets. We aimed to estimate the effect of surgeon and practice environment characteristics (SPECs) on block time needed to attain fixed RVU targets.

Methods:

We computationally simulated individual surgeons’ annual caseloads under a variety of SPECs in the following way. First, empirical case data were sampled from ACS NSQIP in accordance with surgeon specialty, case-mix complexity, and RVU target. Surgeons’ operating schedules were then constructed according to the block length, turnover time, and scheduling flexibility of the practice environment. These 6 SPECs were concurrently varied over their ranges for a 6-way sensitivity analysis.

Results:

Annual operating schedules for 60,000,000 surgeons were simulated. The number of blocks required to attain RVU targets varied significantly with surgeon specialty and increased with increased case-mix complexity, increased turnover time, and decreased scheduling flexibility. Intraspecialty variation in block requirement with variation in environmental characteristics exceeded interspecialty variation with fixed environmental characteristics. Multivariate linear models predicted block utilization across surgical specialties with consideration for the stated factors. An online tool is shared with which to apply these results to one’s particular practice.

Conclusions:

Block time required to attain RVU targets varies widely with SPECs; intraspecialty variation exceeds interspecialty variation. The feasibility of attaining RVU targets requires alignment between targets and allocated operating time with consideration for surgical specialty and other practice conditions.
Targeting neuropilin-1 abolishes anti-PD-1-upregulated regulatory T cells and synergizes with 4-1BB agonist for liver cancer treatment
Authors: Wu Qinchuan , Pan Caixu , Zhou Yuan , Wang Shuai , Xie Liting , Zhou Wuhua , Ding Limin , Chen Tianchi , Qian Junjie , Su Rong , Gao Xingxing , Mei Zhibin , Qiao Yiting , Yin Shengyong , Wu Yi , Wang Jieyi , Zhou Lin , Zheng Shusen
Published: February 2023

Background & Aims:

Regulatory T cells (Tregs) are an obstacle to PD-1 blockade-mediated antitumor efficacy. However, the behaviors of Tregs response to anti-PD-1 in HCC and the characteristics of Tregs tissue adaptation from peripheral lymphoid tissues to the tumor are still unclear.

Approach & Results:

Here, we determine that PD-1 monotherapy potentially augments the accumulation of tumor CD4+ Tregs. Mechanistically, anti-PD-1 mediates Tregs proliferation in lymphoid tissues rather than in the tumor. Increased peripheral Tregs burden replenishes intratumoral Tregs, raising the ratio of intratumoral CD4+ Tregs to CD8+ T cells. Subsequently, single-cell transcriptomics revealed that neuropilin-1 (Nrp-1) supports Tregs migration behavior, and the genes of Crem and Tnfrsf9 regulate the behaviors of the terminal suppressive Tregs. Nrp-1+4-1BB- Tregs stepwise develop to the Nrp-1-4-1BB+ Tregs from lymphoid tissues into the tumor. Moreover, Treg-restricted Nrp1 depletion abolishes anti-PD-1-upregulated intratumoral Tregs burden and synergizes with the 4-1BB agonist to enhance the antitumor response. Finally, a combination of the Nrp-1 inhibitor and the 4-1BB agonist in humanized HCC models showed a favorable and safe outcome and evoked the antitumor effect of the PD-1 blockade.

Conclusion:

Our findings elucidate the potential mechanism of anti-PD-1–mediated intratumoral Tregs accumulation in HCC and uncover the tissue adaptation characteristics of Tregs and identify the therapeutic potential of targeting Nrp-1 and 4-1BB for reprogramming the HCC microenvironment.
Adherence to LI-RADS and EASL high-risk population criteria: A systematic review
Authors: Cannella Roberto , Dioguardi Burgio Marco , Sartoris Riccardo , Gregory Jules , Vilgrain Valérie , Ronot Maxime
Published: February 2023

Background and Aims:

The Liver Imaging Reporting and Data System (LI-RADS) and European Association for the Study of the Liver (EASL) diagnostic criteria for noninvasive diagnosis of HCC can only be applied to patients at a high risk of HCC. This systematic review assesses adherence to the LI-RADS and EASL high-risk population criteria in published studies.

Approach and Results:

PubMed was searched for original research, published between January 2012 and December 2021, reporting LI-RADS and EASL diagnostic criteria on contrast-enhanced ultrasound, CT, or MRI. The algorithm version, publication year, risk status, and etiologies of chronic liver disease were recorded for each study. Adherence to high-risk population criteria was evaluated as optimal (unequivocal adherence), suboptimal (equivocal), or inadequate (clear violation). A total of 219 original studies were included, with 215 that used the LI-RADS criteria, 4 EASL only, and 15 that evaluated both LI-RADS and EASL criteria. Optimal, suboptimal, or inadequate adherence to high-risk population criteria was observed in 111/215 (51.6%), 86/215 (40.0%), and 18/215 (8.4%) LI-RADS and 6/19 (31.6%), 5/19 (26.3%), and 8/19 (42.1%) EASL studies (p < 0.001) regardless of the imaging modality. Adherence to high-risk population criteria significantly improved according to the CT/MRI LI-RADS versions (optimal in v2018 in 64.5% of studies; v2017, 45.8%; v2014, 24.4%; v2013.1, 33.3%; p < 0.001) and the publication year (2020–2021, 62.5%; 2018–2019, 33.9%; 2014–2017, 39.3% of all LI-RADS studies; p = 0.002). No significant differences in adherence to high-risk population criteria were observed in the versions of contrast-enhanced ultrasound LI-RADS (p = 0.388) or EASL (p = 0.293).

Conclusion:

Adherence to high-risk population criteria was optimal or suboptimal in about 90% and 60% of LI-RADS and EASL studies, respectively.
Spatial metabolomics and its application in the liver
Authors: Santos André A. , Delgado Teresa C. , Marques Vanda , Ramirez-Moncayo Carmen , Alonso Cristina , Vidal-Puig Antonio , Hall Zoe , Martínez-Chantar María Luz , Rodrigues Cecilia M.P.
Published: February 2023

Hepatocytes work in highly structured, repetitive hepatic lobules. Blood flow across the radial axis of the lobule generates oxygen, nutrient, and hormone gradients, which result in zoned spatial variability and functional diversity. This large heterogeneity suggests that hepatocytes in different lobule zones may have distinct gene expression profiles, metabolic features, regenerative capacity, and susceptibility to damage. Here, we describe the principles of liver zonation, introduce metabolomic approaches to study the spatial heterogeneity of the liver, and highlight the possibility of exploring the spatial metabolic profile, leading to a deeper understanding of the tissue metabolic organization. Spatial metabolomics can also reveal intercellular heterogeneity and its contribution to liver disease. These approaches facilitate the global characterization of liver metabolic function with high spatial resolution along physiological and pathological time scales. This review summarizes the state of the art for spatially resolved metabolomic analysis and the challenges that hinder the achievement of metabolome coverage at the single-cell level. We also discuss several major contributions to the understanding of liver spatial metabolism and conclude with our opinion on the future developments and applications of these exciting new technologies.
Nursing Care of Children Post-Cardiac Surgery in Intensive Care Units: An Integrative Review
Authors: Vásquez Carlos Javier Avendaño , Vásquez Castellanos Luz Angela , Castellanos Arley David Forero , Pérez Jesús David Malagón
Published: February 2023

Introduction:

Congenital heart disease is one of the most common congenital disorders, affecting between 0.8% and 1.2% of live births worldwide. The treatment of children with congenital heart defects is highly specialized and includes, among others, surgical treatment as the first-choice approach and postoperative care in intensive care units. The aim of this review is to explore nursing care plans for post-cardiac surgery children during their stay in intensive care units.

Methods:

An integrative review was performed to obtain articles from the online databases SCOPUS, ScienceDirect, Scielo, PubMed, EMBASE, and Redalyc. The synthesis of information was performed based on diagnoses and interventions. In addition, complications and associated factors were identified.

Results:

Nursing diagnoses and interventions focus on problem-centered care to respond to cardiovascular and ventilatory needs, sedation and analgesia, infection control, and nutrition. The main complications identified were increased time on mechanical ventilation, postoperative infection, renal failure, and mortality. Complications were associated with intrinsic conditions such as age, gender, or type of malformation and clinical and procedural conditions such as extracorporeal circulation, mechanical ventilation, or higher postoperative risk index.

Discussion:

This review identified problem-focused nursing diagnoses and interventions with a strong focus on the physiological conditions of the child. Although the results of this study show the conceptual level of nurses for specialized care, it denotes the need to complement the nursing process through diagnoses and interventions that promote the transversality of care beyond the problem-centered approach based on the possibilities of the response of the child and the family.
Outcomes of Remote Patient Monitoring in Peritoneal Dialysis: A Meta-Analysis and Review of Practical Implications for COVID-19 Epidemics
Authors: Ali Hatem , Mohamed Mahmoud M. , Fülöp Tibor , Hamer Rizwan
Published: February 2023

The present study seeks to determine clinical outcomes associated with remote patient monitoring of peritoneal dialysis (RPM-PD), with potential implications during COVID-19 outbreaks. We performed a systematic review in the PubMed, Embase, and Cochrane databases. We combined all study-specific estimates using the inverse-variant weighted averages of logarithmic relative risk (RR) in the random-effects models. Confidence interval (CI) including the value of 1 was used as evidence to produce a statistically significant estimate. Twenty-two studies were included in our meta-analysis. Quantitative analysis demonstrated that RPM-PD patients had lower rates of technique failure (log RR = −0.32; 95% CI, −0.59 to −0.04), lower hospitalization rates (standardized mean difference = −0.84; 95% CI, −1.24 to −0.45), and lower mortality rates (log RR = −0.26; 95% CI, −0.44 to −0.08) compared with traditional PD monitoring. RPM-PD has better outcomes in multiple spheres of outcomes when compared with conventional monitoring and likely increases system resilience during disruptions of healthcare operations.
Adverse effects during treatment with renin–angiotensin–aldosterone system inhibitors; should we stay or should we stop?
Authors: Leon Silvia J. , Carrero Juan Jesus
Published: February 2023

Purpose of review

To discuss recent evidence on the benefits and harms of stopping therapy with renin–angiotensin–aldosterone system inhibitors (RAASi) after the occurrence of adverse events or in patients with advanced chronic kidney disease (CKD).

Recent findings

RAASi may result hyperkalemia or acute kidney injury (AKI), particularly in persons with CKD. Guidelines recommend to temporarily stop RAASi until the problem is resolved. However permanent discontinuation of RAASi is common in clinical practice with the potential to heighten subsequent cardiovascular disease (CVD) risk. A series of studies evaluating the consequences of stopping RAASi (vs. continuing) after an episode of hyperkalemia or AKI consistently report worse clinical outcomes, both higher risk of death and cardiovascular events. The STOP-angiotensin converting enzyme inhibitors (ACEi) trial and two large observational studies also favor the decision to continue ACEi/ angiotensin receptor blockers in advanced CKD, refuting old observations that use of these medications can accelerate the risk of kidney replacement therapy.

Available evidence suggests continuing with RAASi after the occurrence of adverse events or in patients with advanced CKD, primarily attributed to sustained cardioprotection. This is in line with current guideline recommendations.
Association of Interventions With Outcomes in Children At-Risk for Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study*
Authors: Hamill Grant S. , Remy Kenneth E. , Slain Katherine N. , Sallee Colin J. , Khemani Robinder , Smith Lincoln , Shein Steven L. ,   on behalf of the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: February 2023

Objectives:

Describe the frequency with which transfusion and medications that modulate lung injury are administered to children meeting at-risk for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria and evaluate for associations of transfusion, fluid balance, nutrition, and medications with unfavorable clinical outcomes.

Design:

Secondary analysis of the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study, a prospective point prevalence study. All enrolled ARF-PARDS patients were included unless they developed subsequent pediatric acute respiratory distress syndrome (PARDS) within 24 hours of PICU admission or PICU length of stay was less than 24 hours. Univariate and multivariable analyses were used to identify associations between therapies given during the first 2 calendar days after ARF-PARDS diagnosis and subsequent PARDS diagnosis (primary outcome), 28-day PICU-free days (PFDs), and 28-day ventilator-free days (VFDs).

Setting:

Thirty-seven international PICUs.

Patients:

Two hundred sixty-seven children meeting Pediatric Acute Lung Injury Consensus Conference ARF-PARDS criteria.

Interventions:

None.

Measurements and Main Results:

During the first 2 days after meeting ARF-PARDS criteria, 55% of subjects received beta-agonists, 42% received corticosteroids, 28% received diuretics, and 9% were transfused. Subsequent PARDS (15%) was associated with platelet transfusion (n = 11; adjusted odds ratio: 4.75 [95% CI 1.03–21.92]) and diuretics (n = 74; 2.55 [1.19–5.46]) in multivariable analyses that adjusted for comorbidities, PARDS risk factor, initial oxygen saturation by pulse oximetry:Fio
2 ratio, and initial type of ventilation. Beta-agonists were associated with lower adjusted odds of subsequent PARDS (0.43 [0.19–0.98]). Platelets and diuretics were also associated with fewer PFDs and fewer VFDs in the multivariable models, and TPN was associated with fewer PFDs. Corticosteroids, net fluid balance, and volume of enteral feeding were not associated with the primary or secondary outcomes.

Conclusions:

There is an independent association between platelet transfusion, diuretic administration, and unfavorable outcomes in children at risk for PARDS, although this may be related to treatment bias and unmeasured confounders. Nevertheless, prospective evaluation of the role of these management strategies on outcomes in children with ARF-PARDS is needed.
Botulinum Toxin Injection for the treatment of Compression of Lateral Plantar Nerve By Flexor Digitorum Accessorius Longus: A Case Report
Authors: Lee Jun Yeon , Kim Dong Hwee
Published: February 2023

The flexor digitorum accessorius longus (FDAL) is an anomalous muscle with a reported prevalence of 1.6–12.2% in cadaveric studies. FDAL courses through the tarsal tunnel and has been reported as an etiology of tarsal tunnel syndrome in prior case reports. The FDAL is intimately related to the neurovascular bundle and may impinge on the lateral plantar nerves. However, very few cases of lateral plantar nerve compression by the FDAL have been reported. Herein, we report a case of lateral plantar nerve compression caused by the FDAL muscle in a 51-year-old male who complained of insidious pain at the lateral sole and hypoesthesia at the left third–fifth toe and lateral sole, and the pain improved after treatment of botulinum toxin injection into the FDAL muscle.
Characteristics of wheelchair basketball falls during the Tokyo 2020 Paralympics by sex and physical impairment classification: A video-based observational study
Authors: Tsutsumi Shogo , Maeda Noriaki , Sasadai Junpei , Shimizu Reia , Suzuki Akira , Fukui Kazuki , Arima Satoshi , Tashiro Tsubasa , Kaneda Kazuki , Yoshimi Mitsuhiro , Mizuta Rami , Abekura Takeru , Esaki Hinata , Terada Tomoki , Komiya Makoto , Urabe Yukio
Published: February 2023

Objective

To evaluate the fall characteristics of wheelchair basketball players by sex and impairment classification using the official videos of the Tokyo 2020 Summer Paralympic Games.

Design

This was a video-based observational study. In total, 42 men’s and 31 women’s wheelchair basketball game videos were obtained from the official International Paralympic Committee. The videos were analyzed to assess the number of falls, playing time of the fall, playing phase, contact, foul judgment, fall location/direction, and the body part that first impacted the floor.

Results

A total of 1,269 falls (men, n = 944; and women, n = 325) occurred. The analysis of men demonstrated significant differences in rounds, playing phase, location of fall, and body part first impacted. Women demonstrated significant differences in all categories except in rounds. Comparisons by functional impairment showed different trends for men and women.

Conclusions

The detailed observation of videos suggested that men are more likely to have dangerous falls. There is a necessity for discuss the prevention measures based on sex and impairment classification.
Effects of Physical Therapy on Joint Pain, Joint Range of Motion, Joint Health, Strength, and Mobility in Patients with Hemophilia: A Systematic Review and Meta-Analysis
Authors: Chen Chien-Min , Lin Chia-Hung , Kung Kuan-Yu
Published: February 2023

Objective

This study investigated the effects of physical therapy (PT), including exercise, manual therapy, and physical agent modality, on joints, muscle strength, and mobility of patients with hemophilia.

Methods

PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched from inception to September 10, 2022. Randomized controlled trials (RCTs) comparing pain, range of motion (ROM), and health of joints, as well as muscle strength and mobility (timed up and go test [TUG]) between PT and control groups were included.

Results

Fifteen RCTs with 595 male patients with hemophilia were included. In comparisons between PT and control groups, PT significantly reduced joint pain (standardized mean difference [SMD] = −0.87; 95% confidence interval [CI], −1.14 to −0.60), increased joint ROM (SMD = 0.24; 95% CI, 0.14–0.35), enhanced joint health (SMD = −1.08; 95% CI, −1.38 to −0.78), improved muscle strength (SMD = 1.42; 95% CI, 1.16–1.69) and TUG performance (SMD = −1.25; 95% CI, −1.89 to −0.60). The comparisons demonstrate moderate to high evidentiary quality grades.

Conclusions

PT is effective in reducing pain, increasing joint ROM, and enhancing joint health, as well as improving muscle strength and mobility in patients with hemophilia.
The SETPACE Trial: Stroke Survivors Impressions of the Education and Teaching Provided Regarding Physical Activity, and Patient Confidence Regarding Exercise
Authors: Wavell Christopher , Marrocco Stephanie , Lee Fiona Jih-Hsien , Momen Rozhan , Macaluso Steven
Published: February 2023

Objective

Investigate the association between patient self-efficacy, impression of exercise education and physical activity among stroke survivors. We hypothesized low self-efficacy and/or poor impressions of exercise education following stroke would be associated with reduced exercise participation.

Design

Cross-sectional investigation of patients’ post-stroke with physical activity as the primary outcome variable. Physical activity was measured with The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD). Self-efficacy was measured with the Self-Efficacy for Exercise questionnaire (SEE). Impression of exercise education measured by the Exercise Impression Questionnaire (EIQ).

Results

Low but significant correlation between SEE and PASIPD: r (66) = .272, p = .012. Insignificant correlation between EIQ and PASIPD: r (66) = .174, p = .078. Low but significant correlation between age and PASIPD: r (66) = -.269, p = .013. No correlation between sex and PASIPD: r (66) = .051, p = .339. Age, sex, EIQ and SEE predicts 17.1% of PASIPD variance (R2 = 0.171).

Conclusion

Self-efficacy was the strongest predictor of physical activity participation. There was a lack of association between the impressions of exercise education and physical activity. Addressing patient confidence to complete exercise has the potential to improve exercise participation in patients following stroke.
The ties that bind the sagebrush biome: integrating genetic connectivity into range-wide conservation of greater sage-grouse
Authors: Cross Todd B. , Tack Jason D. , Naugle David E. , Schwartz Michael K. , Doherty Kevin E. , Oyler-McCance Sara J. , Pritchert Ronald D. , Fedy Bradley C.
Published: February 2023

Conserving genetic connectivity is fundamental to species persistence, yet rarely is made actionable into spatial planning for imperilled species. Climate change and habitat degradation have added urgency to embrace connectivity into networks of protected areas. Our two-step process integrates a network model with a functional connectivity model, to identify population centres important to maintaining genetic connectivity then to delineate those pathways most likely to facilitate connectivity thereamong for the greater sage-grouse (
Centrocercus urophasianus
), a species of conservation concern ranging across eleven western US states and into two Canadian provinces. This replicable process yielded spatial action maps, able to be prioritized by importance to maintaining range-wide genetic connectivity. We used these maps to investigate the efficacy of 3.2 million ha designated as priority areas for conservation (PACs) to encompass functional connectivity. We discovered that PACs encompassed 41.1% of cumulative functional connectivity—twice the amount of connectivity as random—and disproportionately encompassed the highest-connectivity landscapes. Comparing spatial action maps to impedances to connectivity such as cultivation and woodland expansion allows both planning for future management and tracking outcomes from past efforts.
The end of the line: competitive exclusion and the extinction of historical entities
Authors: Strotz Luke C. , Lieberman Bruce S.
Published: February 2023

Identifying competitive exclusion at the macroevolutionary scale has typically relied on demonstrating a reciprocal, contradictory response by two co-occurring, functionally similar clades. Finding definitive examples of such a response in fossil time series has proven challenging, however, as has controlling for the effects of a changing physical environment. We take a novel approach to this issue by quantifying variation in trait values that capture almost the entirety of function for steam locomotives (SL), a known example of competitive exclusion from material culture, with the goal of identifying patterns suitable for assessing clade replacement in the fossil record. Our analyses find evidence of an immediate, directional response to the first appearance of a direct competitor, with subsequent competitors further reducing the realized niche of SLs, until extinction was the inevitable outcome. These results demonstrate when interspecific competition should lead to extinction and suggest that clade replacement may only occur when niche overlap between an incumbent and its competitors is near absolute and where the incumbent is incapable of transitioning to a new adaptive zone. Our findings provide the basis for a new approach to analyse putative examples of competitive exclusion that is largely free of
a priori
assumptions.
Adaptive Bayesian inference of Markov transition rates
Authors: Barendregt Nicholas W. , Webb Emily G. , Kilpatrick Zachary P.
Published: February 2023

Optimal designs minimize the number of experimental runs (samples) needed to accurately estimate model parameters, resulting in algorithms that, for instance, efficiently minimize parameter estimate variance. Governed by knowledge of past observations, adaptive approaches adjust sampling constraints online as model parameter estimates are refined, continually maximizing expected information gained or variance reduced. We apply adaptive Bayesian inference to estimate transition rates of Markov chains, a common class of models for stochastic processes in nature. Unlike most previous studies, our sequential Bayesian optimal design is updated with each observation and can be simply extended beyond two-state models to birth–death processes and multistate models. By iteratively finding the best time to obtain each sample, our adaptive algorithm maximally reduces variance, resulting in lower overall error in ground truth parameter estimates across a wide range of Markov chain parameterizations and conformations.
Experimental evidence that cuckoos choose host nests following an egg matching strategy
Authors: Zhang Jinggang , Santema Peter , Lin Zixuan , Yang Lixing , Liu Meijun , Li Jianqiang , Deng Wenhong , Kempenaers Bart
Published: February 2023

The arms race between brood parasites and their hosts provides a classic model to study coevolution. Hosts often reject the parasitic egg, and brood parasites should therefore select host nests in which the colour of the eggs best matches that of their own. Although this hypothesis has received some support, direct experimental evidence is still lacking. Here, we report on a study of Daurian redstarts, which show a distinct egg-colour dimorphism, with females laying either blue or pink eggs. Redstarts are often parasitized by common cuckoos, which lay light blue eggs. First, we showed that cuckoo eggs were more similar in spectral reflectance to the blue than to the pink redstart egg morph. Second, we report that the natural parasitism rate was higher in blue than in pink host clutches. Third, we performed a field experiment in which we presented a dummy clutch of each colour morph adjacent to active redstart nests. In this set-up, cuckoos almost always chose to parasitize a blue clutch. Our results demonstrate that cuckoos actively choose redstart nests in which the egg colour matches the colour of their own eggs. Our study thus provides direct experimental evidence in support of the egg matching hypothesis.
Temporal change in functional rarity in marine fish assemblages
Authors: Moyes Faye , Trindade-Santos Isaac , Magurran Anne E.
Published: February 2023

Recent research has uncovered rapid compositional and structural reorganization of ecological assemblages, with these changes particularly evident in marine ecosystems. However, the extent to which these ongoing changes in taxonomic diversity are a proxy for change in functional diversity is not well understood. Here we focus on trends in rarity to ask how taxonomic rarity and functional rarity covary over time. Our analysis, drawing on 30 years of scientific trawl data, reveals that the direction of temporal shifts in taxonomic rarity in two Scottish marine ecosystems is consistent with a null model of change in assemblage size (i.e. change in numbers of species and/or individuals). In both cases, however, functional rarity increases, as assemblages become larger, rather than showing the expected decrease. These results underline the importance of measuring both taxonomic and functional dimensions of diversity when assessing and interpreting biodiversity change.
Determinants of male involvement in antenatal care at Palabek Refugee Settlement, Lamwo district, Northern Uganda
Authors: Irene Auma , Dinah Nabaweesi , Sam Orech , Alege John Bosco , Komakech Allan
Published: February 2023

Background

In 2014, Uganda launched the National Male Involvement Strategy in Maternal and Child Health. In 2020, the District Health Management Information System report for Lamwo district, where Palabek Refugee Settlement is located, indicated a 10% male involvement in antenatal care (ANC). We investigated determinants of male involvement in ANC in Palabek Refugee Settlement to inform programs on improvement of male involvement in ANC in a refugee setting.

Methodology

We conducted a community-based cross-sectional analytical study among a proportionate sample of mothers in Palabek Refugee Settlement from October-December 2021. Using a standardized questionnaire, we collected information on demographics and the constructs of the socio-ecological model where consent was given. We summarized data in tables and figures. We used Pearson chi-square test to determine significance of independent variables at bivariate level. A multivariable logistic regression model was run for all variables found significant at bivariate analysis to determine association between the different independent variables and male involvement in ANC.

Results

We interviewed 423 mothers. The mean age of their male partners was 31 years, SD 7. Eighty-one percent (343/423) of male partners had formal education, with 13% (55/423) having a source of income and 61% (257/423) having access to ANC information during their pregnancy. The level of male involvement in ANC in Palabek Refugee Settlement was 39% (164/423). Male involvement in ANC was positively associated with access to information on ANC (AOR 3.0; 95%Cl: 1.7-5.4) and frequent couple discussion on ANC (AOR 10.1; 95%Cl: 5.6-18.0). However, it was negatively associated with distance ≥3km to the health facility (AOR 0.6 ;95%Cl: 0.4-1.0).

Conclusions

Approximately one in three male partners in Palabek Refugee Settlement were involved in ANC. Male partners who had access to information during ANC and those who had frequent discussions were more likely to get involved in ANC. Men who lived ≥3 kilometers from the health facility were less likely to be involved in ANC. We recommend intensified awareness creation on importance of male involvement in ANC and implementation of integrated community outreaches to reduce distance to the health facility.
Racial Differences and Contributory Cardiovascular and Non-cardiovascular Risk Factors Towards Chronic Kidney Disease Progression In Young To Middle-Aged Black And White American Adults
Authors: Choi Yuni , Jacobs David R , Kramer Holly J. , Shroff Gautam R. , Chang Alexander R. , Duprez Daniel A
Published: February 2023

Background

The progression of chronic kidney disease (CKD) is higher in Black than in White Americans but studies have mainly focused on racial differences within advanced CKD. We evaluated CKD progression in Black and White participants over 20 years and the contribution of conventional cardiovascular and non-traditional risk factors to racial disparities in CKD progression.

Methods

This study was based on 2,175 Black and 2,207 White adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Both estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were measured at study year 10 (age 27-41y) and every five years for 20 years. The outcome was CKD progression through No CKD into Low, Moderate, High, or Very High Risk that was based on categories of eGFR and UACR in combination. The association between race and CKD progression as well as the contribution of risk factors to racial differences were assessed in multivariable-adjusted Cox proportional hazards models.

Results

Black participants had higher CKD transition probabilities than White participants and more prevalent risk factors during the 20-year period studied. Hazard ratios for CKD transition for Black (vs White participants) were 1.38 from No CKD into ≥ Low Risk, 2.25 from ≤ Low Risk into ≥ Moderate Risk, and 4.49 for from ≤ Moderate Risk into ≥ High Risk. Racial differences in CKD progression from No CKD into ≥ Low Risk were primarily explained by forced vital capacity (54.8%), hypertension (30.9%), and obesity (20.8%). Similar findings were observed for the race difference in transition from ≤ Low Risk into ≥ Moderate Risk, but little of the race difference in transition ≤ Moderate Risk into ≥ High Risk was explained.

Conclusions

In this longitudinal study, Black compared to White participants had a higher risk of CKD progression, and this discrepancy may be partly explained by conventional cardiovascular and non-traditional risk factors.

Clinical Perspective

What Is New?

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In 20 years of follow-up, young Black American adults had higher risk of chronic kidney disease (CKD) progression than their White counterparts, and the differences were larger in transitions to more advanced categories.

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Additionally, Black individuals had more conventional cardiovascular and non-traditional characteristics known to increase risk of CKD.

What Are the Clinical Implications?

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Periodic screening for elevated albuminuria and eGFR would be helpful, particularly among young Black individuals.

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Future studies should evaluate if regular monitoring of eGFR and albuminuria in young Black individuals is helpful in preventing progression in CKD.
Biomonitoring of perfluoroalkyl and polyfluoroalkyl substances (PFAS) from the Survey of the Health of Wisconsin (SHOW) 2014-2016 and comparison with the National Health and Nutrition Examination Survey (NHANES)
Authors: Schultz Amy , Stanton Noel , Pomazal Rachel , Lange Meshel , Irving Roy , Meiman Jonathan , Shelton Brandon , Malecki Kristen CM
Published: February 2023

Background

Per- and polyfluoroalkyl substances (PFAS) are a growing class of manufactured chemical compounds found in a variety of consumer products. PFAS have become ubiquitous in the environment and were found in many humans sampled in the United States (U.S.). Yet, significant gaps in understanding statewide level exposures to PFAS remain.

Objective

The goals of this study are to establish a baseline of exposure at the state level by measuring PFAS serum levels among a representative sample of Wisconsin residents and compare to United States National Health and Nutrition Examination Survey (NHANES).

Methods

The study sample included 605 adults (18+ years of age) selected from the 2014-2016 sample of the Survey of the Health of Wisconsin (SHOW). Thirty-eight PFAS serum concentrations were measured using high-pressure liquid chromatography coupled with tandem mass spectrometric detection (HPLC-MS/MS) and geometric means presented. Weighted geometric mean serum values of eight PFAS analytes from SHOW were compared to U.S. national levels from the NHANES 2015-2016 sample (PFOS, PFOA, PFNA, PFHxS, PFHpS, PFDA, PFUnDA), and the 2017-2018 sample for Me-PFOSA, PFHPS using the Wilcoxon rank-sum test.

Results

Over 96% of SHOW participants had positive results for PFOS, PFHxS, PFHpS, PFDA, PFNA, and PFOA. In general, SHOW participants had lower serum levels across all PFAS when compared to NHANES. Serum levels increased with age and were higher among males and whites. These trends were seen in NHANES, except non-whites had higher PFAS levels at higher percentiles.

Significance

Wisconsin residents may have a lower overall body burden of some PFAS compounds compared to those seen by a nationally representative sample. Additional testing and characterization may be needed in Wisconsin, particularly among non-whites and low socioeconomic status, for which the SHOW sample had less representation compared to NHANES.

Impact Statement

The present study conducts biomonitoring of 38 PFAS in the state of Wisconsin and suggests that while most residents of Wisconsin have detectable levels of PFAS in their blood serum, they may have a lower body burden of some PFAS compared to a nationally representative sample. Older adults, males, and whites may have a higher body burden of PFAS relative to other groups both in Wisconsin and the wider United States.