bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Focusing Performance in Phased Array Probe Using COMSOL
Authors: Yan Rui , Zhou Chilou
Published: October 2023

To improve the detection ability of ultrasonic phased array detection for hydrogen storage vessel, COMSOL was used to simulate the main parameters of phased array probes. The influence of the number of array elements, array element spacing and excitation frequency on the sound propagation characteristics was analysed. The results showed that the number of array elements has a significant effect on the focused sound field. When the number of array elements is 8, effective focus cannot be formed at the pre-set focus position, and the maximum sound pressure value does not change significantly at the three pre-set focus depths. At a focus depth of 30mm, the maximum sound pressure in the 32-element mode is more than twice that in the 8-element mode. The relationship between excitation frequency and focal sound pressure is non-linear. In addition, as the array element spacing increases, the length of the focal column decreases. And the smaller the array element spacing, the higher the sound pressure at a deeper depth.
Study on Purification of Emulsified Waste Liquid by Non-thermal Plasma
Authors: Rong Junfeng , Chen Minggong , Zhang Chengyuan , Han Jialin , Zhang Ye , Li Fuhu
Published: October 2023

This paper uses the Non-thermal Plasma produced by dielectric barrier discharge to treat the emulsion waste liquid. The effects of discharge time, peak voltage, and initial concentration of waste liquid and inorganic salt on Chemical Oxygen Demand COD degradation and turbidity removal rate were studied. The primary and secondary order of influencing factors of the COD degradation rate of emulsion cutting waste liquid is discharge time > peak voltage > initial concentration of emulsion cutting waste liquid > inorganic salt type. That is to say, when 0.3000 g of anhydrous calcium chloride is added to the emulsion waste liquid prepared according to the ratio of 1:200, the peak discharge voltage is 30 kV, the discharge time is 4 hours, and the COD degradation rate is the best. The experimental results show that the COD degradation rate is 87.48%. The primary and secondary order of factors affecting the turbidity removal rate of emulsion-cutting waste liquid is peak voltage > inorganic salt type > initial concentration of emulsion-cutting waste liquid > discharge time. The experimental results show that the turbidity removal rate of emulsion waste liquid is 93.21%.
Hydrophilic/oleophobic Copper Mesh for Oil-water Separation
Authors: Zhao Meiyun , Shang Yuanyuan , Li Yangyang , Kang Meng , Xiong Yufan
Published: October 2023

Functional materials based on the special wettability of the surface have always been the focus of scientific research, which are of great significance in the treatment of oily sewage and oil spill cleaning. The easily achievable hydrophobic/oleophilic and hydrophilic/underwater oleophobic surfaces cannot fully meet the needs of oil-water separation, while the ideal hydrophilic/oleophobic separation nets are less studied due to their “abnormal” wetting properties. In this study, a kind of hydrophilic/oleophobic copper mesh was prepared, which has hydrophobic-hydrophilic switching/oleophobic wetting properties, can separate immiscible oil and water, and has good recycling, water resistance, Frictional stability.
Theoretical and Experimental Study of CO2 Absorption by N-2-ethylhexylethylenediaminium-TFS Type Protic Ionic Liquid
Authors: Gao Jun , Li Chenguang , Hua Er
Published: October 2023

The CO2 absorption using the mixture of ethylenediaminium type protic ionic liquid [HEtHexen][TFS] and H2O with different molar ratio was investigated by the measurement of pH, density, viscosity and conductivity at 30°C. Meanwhile, we studied the hydrogen bonding between [HEtHexen][TFS] and CO2 using DFT calculation, the result of the interaction energy, vibration frequency and second-order perturbation energy, etc. shows that a weak or medium strength N-H···O type hydrogen bonding occurred between [HEtHexen][TFS] and nCO2 (n=1−4). The result of experimental and theoretical study indicates that one [HEtHexen][TFS] molecule absorbed a maximum of three molecules of CO2.
Deep Removal of Arsenic from Arsenic-Iron Slag by Carbothermal Reduction Method (CTR Method)
Authors: Li Xuepeng , Wang Juan
Published: October 2023

In order to remove arsenic from arsenic-iron slag, CTR method was used. CaO in arsenic-iron slag reacted with As2O3to form CaAsO4, which hindered the removal of arsenic, adding SiO2to arsenic-iron slag can generate CaSiO3, it can effectively avoid the production of CaAsO4. The CTR method can effectively remove arsenic from arsenic-iron slag, arsenic can be used in the form of As2O3and iron can be used in the form of Fe3O4. The removal rate of arsenic was 99.56%, and the arsenic remained in the slag was only 0.08%, under the conditions of temperature of 600 °C, reductant addition of 20%, and time of 150 minutes.
Synthesis and Fluorescent Sensing Properties for Ce3+ Ions of Di-Schiff Base Amine Containing Amaide Bridge Probe
Authors: Xu Wenguang , Ye Yajuan , Yan Kang , Hu Zhiyong , zhao Junjie , Zheng Tianhong , Cai Lihua
Published: October 2023

A fluorescent probe (L) of di-Schiff base amine ligand was designed and synthesized from 2,6-pyridine-dicarboxylic acid, ethylenediamine and p-hydroxybenzaldehyde by condensation reaction and reduction reaction. The structure was confirmed by means of IR, UV, 1H NMR and MS. The research of fluorescence spectroscopy indicated that the probe L exhibited high selectivity for Ce3+. The spectroscopic titration indicated that A good linear work curve with R2 = 0.99607, the stoichiometry of the Ce3+ complex was 1:1, the minimum detection limits for Ce3+was 3.8382×10-6 mol/L and the binding constant of L to Ce3+ was estimated as 6.3734×107 (mol/L)-1. It was expected to be applied to the detection of trace Ce3+.
Solution of hydrodynamic problems by complex modeling methods
Authors: Lagunov Alexey
Published: October 2023

Pollution of the environment, especially the marine environment, is currently a rather serious problem. The impact of noise on the fragile biota of the Arctic with an increase in shipping in this region is quite strong. The manufacture of new low-noise devices at an enterprise engaged in the creation of surface and underwater vessels is a very costly process. Computer simulation systems can reduce enterprise costs. The author proposes a system for complex modeling of low-noise devices that could predict the approximate behaviour of a viscous incompressible fluid (gas) in the form of vorticity per single object, described by Navier-Stokes differential equations for the case of fluid motion in a limited space. The system includes: a computer model in the well-established FlowSimulation system and a machine learning model. According to the results of the experimental study, the author found that the model from FlowSimulation has a clearer picture, but for FlowSimulation this is the limit of possibilities, and for the machine learning system there is the possibility of further development to improve the image. In the future, the author intends to continue experiments on training the model in order to obtain a better image.
3D ice-based fixturing system for thin-walled parts machining
Authors: Liu Haibo , Wang Chengxin , Xiong Wentao , Zhu Zhixiang , Li Xu , Wang Yongqing
Published: October 2023

Fixtures have an important influence on the machining process of thin-walled parts (TWP) and directly determine their final quality. Aiming at the problem of machining deformation caused by weak rigidity of TWP, an ice-based fixturing (IBF) is designed by taking advantage of the rigidity and viscosity of ice. The feasibility of IBF is then demonstrated based on the published papers of the authors of this paper. Afterwards, the structure and refrigeration process of IBF are described in detail, and the refrigeration capacity of the IBF system is analyzed, and the experimental results show that the IBF can achieve uniform and reliable icing. Finally, the process steps are formulated. This paper can provide a valuable reference for the development of advanced fixtures.
Magnetocaloric effect over a temperature span in (Gd
x
Tb1-x
)3Al2 compounds
Authors: Lei Gao , Xiang Jin , Pengyu Wang , Zhaojie Li , Cuilan Liu , Jing Zhao , Yaru Guo , Mohan Dai , Hao Pei , Juan Cheng
Published: October 2023

As an environmentally friendly, more efficient and operation-reliable technology, magnetic refrigeration is promised to replace traditional gas compression refrigeration. In our study, we studied the influence on magnetism and magnetocaloric effect of (Gd
x
Tb1-x
)3Al2 (x=0, 0.2, 0.4, 0.6, 0.8, 1) systematically. These results indicated that the increase of Gd concentration increased the lattice constants due to larger atomic radius of Gd atom. Simultaneously, the Curie temperature is dependent on magnetic interaction between Gd atom and Tb atom, and reduced from 279 K to 190 K for x=1 to x=0. Arrott plots indicated that (Gd
x
Tb1-x
)3Al2 compounds showed the characteristics of second-order magnetic phase transition. Under a magnetic field of 0-2 T, the maximum isothermal magnetic entropy (-ΔSM)max of (Gd
x
Tb1-x
)3Al2 (x=0, 0.2, 0.4, 0.6, 0.8, 1) compounds are 4.13, 3.79, 3.91, 4.08, 3.96 and 3.98 J/(kg K), respectively. Moreover, refrigeration capacity RC of (Gd
x
Tb1-x
)3Al2 are 59.7, 69.0, 77.6, 65.0, 76.1 and 75.6 J/kg, respective. Adjustable Curie temperature, lower magnetic and thermal hysteresis, (-ΔSM) and RC suggested that, (Gd
x
Tb1-x
)3Al2 compounds can be used as candidates for magnetic refrigeration.
Multi-channel electrical discharge machining of titanium alloy Ti-6Al-4V with semiconductor electrodes
Authors: Zhu Xuyang , Li Guangxian , Mo John , Ding Songlin
Published: October 2023

Titanium alloys are extensively used in aerospace and medical engineering owing to their exceptional mechanical properties and biocompatibility. For a long time, the low thermal conductivity of titanium alloys has made them difficult to machine with conventional approaches. Electrical discharge machining (EDM) is a nonconventional method for machining difficult-to-cut materials. However, it is not possible to achieve high-quality surface finish while simultaneously maintain high machining efficiency. This paper introduced a new EDM approach to obtain high surface quality in machining titanium alloy Ti-6Al-4V with discrete semiconductor electrodes by utilising a new multi-channel discharge principle to disperse the discharge energy. To explore the dissimilarities in discharge characteristics between semiconductor electrodes and traditional copper electrodes, continuous discharge waveforms of both electrodes were compared. Through modelling the discharge equivalent circuit and analysing workpiece surface using scanning electron microscopy (SEM), it was discovered that, due to the unique electrical properties of the semiconductor, it is possible for semiconductor electrodes to form multiple discharge channels. The outcomes reveal that the utilization of semiconductor electrodes can disperse discharge energy and enhance surface quality without sacrificing material removal rate compared to the use of conventional copper electrodes.
In situ TEM dark-field observation on ferroelectric/ferroelastic domain evolution in ferroelectrics sub-micrometer pillar under stress
Authors: Ren Yifeng , Li Jiayi , Yang Haixing , Pang Zhentao , Wu Jie , Liu Zhiyu , Fu Shaojie , Wang Meiyu , Deng Yu
Published: October 2023

The evolution of ferroelectric/ferroelastic domains in ferroelectric materials (FMs) under stress fields is a significant yet complex process. This process involves the interaction of hierarchical domain structures across scales, as well as the coupling of elastic and electrical potentials. To understand the critical local microstructure evolution, here we used in situ transmission electron microscopy (TEM) to directly observe the hierarchical domain evolution induced by stress in BaTiO3 and Pb(Mg1/3Nb2/3)O3-PbTiO3 (PMN-PT) sub-micrometer pillars. The results indicate that domain evolution is sensitive to the loading methods, including loading/unloading speed, stress maintenance duration, and stress amplitude. Assisted by phase-field simulations, we have proved that mobile point defect pinning effect also influence the domain evolution greatly. Based on above understanding, we successfully achieved a large recoverable deformation in PMN-PT pillar with 10% strain. Our findings provide a novel avenue to develop super-flexibility in FMs.
Research and deployment of a Python-based software framework for large-scale physical experiment control
Authors: Xia Shouteng , Zhang Yinhong , Qian Sen , Song Ruiqiang , Yang Jie
Published: October 2023

This paper presents a python-based, open-source framework
for slow control systems used in particle physics experiments. The
framework includes several functions such as display, data query,
alarm, log and remote monitoring, etc. The data communication
utilizes the MQTT (Message Queuing Telemetry Transport) protocol,
ensuring real-time and reliable data transmission. The
object-oriented programming approach ensures each functional
module's independence and reusability, making them easily
interchangeable and extendable through configuration files in
various applications. Finally, two case deployment applications of
the framework are provided, where both of them are tested with
Docker.
The potential of digital convergence and sharing of consumer goods to improve living conditions and reduce emissions
Authors: Bento Nuno
Published: October 2023

Access to modern energy services (entertainment, food preparation, etc) provided by consumer goods remains unequal, while growing adoption due to rising incomes in Global South increases energy demand and greenhouse gas emissions. The current model through which these energy services is provided is unsustainable and needs to evolve—a goal that emerging social and technological innovations can help to achieve. Digital convergence and the sharing economy could make access to appliances more affordable and efficient. This article estimates the effect of innovations around digital convergence and sharing in a highly granular, bottom-up representation of appliances. We simulate changes in demand for materials and energy, assuming decent living standards for all and global warming limited to 1.5 °C. By 2050, these innovations could attenuate the increase in the number of appliances to 135% and reduce overall energy demand by 28%. The results contribute to understand under which conditions digital convergence and sharing can improve living standards and climate mitigation.
Sustainability pathways in European waste management for meeting circular economy goals
Authors: Foggia Giacomo Di , Beccarello Massimo
Published: October 2023

This study explores trends in recycling rates and municipal solid waste landfilling to construct a circularity index (CI) forecasted up to 2035. This projection is contrasted with the pathways that countries must adopt to attain set targets. We further estimate the impact of the CI on factors such as sustainability performance, innovation, commodity trade balance, and waste reduction. Moreover, we provide policy implications useful for designing industrial and environmental strategies, including accelerating permit approval times for waste treatment facilities, introducing more flexibility in state aid rules, empowering service users or waste generators, implementing tax credits, and leveraging specialized funds. These strategies are aimed at supporting the recycling industry to stimulate convergence and achieve circular economy objectives.
The Space of Spaces: Curvature Bounds and Gradient Flows on the Space of Metric Measure Spaces
Authors: Sturm Karl-Theodor
Published: October 2023

Equipped with the

L

2
,
q

L^{2,q}

-distortion distance

\DD _{2,q}, the space

\XX _{2q} of all metric measure spaces

(X,\d ,\m ) is proven to have nonnegative curvature in the sense of Alexandrov. Geodesics and tangent spaces are characterized in detail. Moreover, classes of semiconvex functionals and their gradient flows on

\ol \XX _{2q} are presented.
Modernism in Irish Women’s Contemporary Writing
Authors: Reynolds Paige
Published: October 2023

Modernism in Irish Women’s Contemporary Writing: The Stubborn Mode examines the tangled relationship between Irish women writers and literary modernism. In the early decades of the twenty-first century, Irish women’s fiction has drawn widespread critical acclaim and commercial success, with a surprising number of works being commended for their innovative deployment of tactics drawn from early twentieth-century modernism. But this strategy is not a new one. Across nearly a century, writers from Kate O’Brien to Sally Rooney have restyled modernism to draw attention to the vexed nature of female privacy, exploring what unfolds when the amorphous nature of individual consciousness bumps up against external ordering structures in the public world. Living amid the tenacious imperatives of church and state in Ireland and Northern Ireland, their female characters are seen to embrace, reject, and rework the ritual of prayer, the fixity of material objects, the networks of the digital world, the ordered narrative of the book. Elizabeth Bowen, Edna O’Brien, Anne Enright, Anna Burns, Eimear McBride, and Claire-Louise Bennett are among those who employ the modernist mode to imagine ways around and through seemingly intransigent social problems, such as class inequity, gender bias, political violence, and sexual abuse. The lessons offered by modernism in such fiction, as assiduous close readings reveal, are often distressing. The stubborn problems depicted by the stubborn mode are often exhaustive (this problem is everywhere), exhausted (we’ve seen it a million times), and exhausting (and yet it continues).
An analysis of the implementation of a hybrid renewable-energy system in a building by considering the reduction in electricity price subsidies and the reliability of the grid
Authors: Al Hasibi Rahmat Adiprasetya , Haris Abdul
Published: October 2023

This article discusses the implementation of a hybrid renewable-energy system to satisfy the electricity requirements of a building. The analysis is based on optimization calculations performed using HOMER software. The components of the simulated hybrid renewable-energy system include photovoltaics, generators powered by biogas, converters and a grid. The input data utilized by the HOMER software are derived from measurements and surveys. The electric load curve is obtained through measurements at the location of the case study. Through surveys, parameters pertaining to the components of the hybrid renewable-energy system were gathered. The analysis was carried out using two sensitivity variables, namely electricity price and grid reliability. On the basis of these two sensitivity variables, optimal system configuration, net present cost, energy cost, return on investment, internal rate of return and payback period were analysed. The results of the analysis indicated that reducing subsidies, which results in higher electricity prices, provided opportunities for economically competitive hybrid renewable-energy systems. With electricity prices of US$0.094/kWh, the return of investment and the internal rate of return increased to 15% and 19%, respectively, and the payback period decreased to 5.3 years. When a hybrid renewable-energy system is implemented in regions with low grid reliability, the same phenomenon occurs.
Genotype–Phenotype Characterization of Serial Mycobacterium tuberculosis Isolates in Bedaquiline-Resistant Tuberculosis
Authors: Brown Tyler S , Tang Linrui , Omar Shaheed Vally , Joseph Lavania , Meintjes Graeme , Maartens Gary , Wasserman Sean , Shah N Sarita , Farhat Maha R , Gandhi Neel R , Ismail Nazir , Brust James C M , Mathema Barun
Published: October 2023

Background

Emerging resistance to bedaquiline (BDQ) threatens to undermine advances in the treatment of drug-resistant tuberculosis (DRTB). Characterizing serial Mycobacterium tuberculosis (Mtb) isolates collected during BDQ-based treatment can provide insights into the etiologies of BDQ resistance in this important group of DRTB patients.

Methods

We measured mycobacteria growth indicator tube (MGIT)–based BDQ minimum inhibitory concentrations (MICs) of Mtb isolates collected from 195 individuals with no prior BDQ exposure who were receiving BDQ-based treatment for DRTB. We conducted whole-genome sequencing on serial Mtb isolates from all participants who had any isolate with a BDQ MIC >1 collected before or after starting treatment (95 total Mtb isolates from 24 participants).

Results

Sixteen of 24 participants had BDQ-resistant TB (MGIT MIC ≥4 µg/mL) and 8 had BDQ-intermediate infections (MGIT MIC = 2 µg/mL). Participants with pre-existing resistance outnumbered those with resistance acquired during treatment, and 8 of 24 participants had polyclonal infections. BDQ resistance was observed across multiple Mtb strain types and involved a diverse catalog of mmpR5 (Rv0678) mutations, but no mutations in atpE or pepQ. Nine pairs of participants shared genetically similar isolates separated by <5 single nucleotide polymorphisms, concerning for potential transmitted BDQ resistance.

Conclusions

BDQ-resistant TB can arise via multiple, overlapping processes, including transmission of strains with pre-existing resistance. Capturing the within-host diversity of these infections could potentially improve clinical diagnosis, population-level surveillance, and molecular diagnostic test development.
The value of BAME health professional networks in tackling vaccine hesitancy
Authors: Latif S
Published: October 2023

This presentation discusses the findings from a Black, Asian and ethnic minority (BAME) Health Professional Leadership Engagement Session hosted by England's CMO between national health and care system leaders and the leadership of BAME health and care professional networks in England. The aim was to use an asset based approach, engage with the health professional networks both as citizens and as trusted sources of their communities, to acknowledge their contributions, to actively listen to concerns and issues, and develop sustainable solutions to address Covid vaccine hesitancy and improve uptake in the BAME communities in England.

Three questions were posed to selected professional representatives of BAME networks:

1. What are the underlying factors/ key concerns responsible for reduced uptake of the COVID-19 vaccine within your communities?

2. What examples of good practice regarding increasing uptake of COVID-19 vaccine would you like to highlight?

3. What can we, as leaders, collectively do to help address underlying factors/ key concerns?

Key insights included: a need to understand how the disproportionate impact of Covid on BAME communities is underpinned by different levels of acculturation and a variety of experiences; how conspiracy theories such as vaccine causing infertility can target important cultural expectations such as child bearing; the collective impact of years of historical injustices and health inequalities compounding what we see manifested as COVID-19 vaccine hesitancy.Some examples of good practice cited were around collective leadership, focusing on the younger BAME generations, role of social media, the role of the BAME health professional networks, leveraging the power of existing relationships and through representation in decision making and engagement. A set of recommendations were shared with health system leaders.
The impact of post COVID-19 condition on
health-related quality of life, fatigue and mental well-being
Authors: Brus I , Spronk I , Haagsma J A , de Groot A , Tieleman P , Biere-Rafi S , Polinder S
Published: October 2023

Background

This cross-sectional study aimed to compare symptoms, health-related quality of life (HRQoL), fatigue, mental well-being, and determinants of diminished HRQoL, between patients with post COVID-19 condition categorized by time since acute infection.

Methods

We performed an online survey and analyzed responses of 10,194 adult respondents with a confirmed or suspected COVID-19 infection, who experienced persisting symptoms ≥3 months after initial infection. The most debilitating symptoms and health outcomes were studied separately for respondents 3-6, 7-9, 10-12, 13-18, 19-24, and >24 months after acute infection.

Results

At each time period, fatigue, sensory-processing problems, and concentration problems were the most debilitating symptoms reported by respondents, although the proportion of respondents who reported these symptoms differed significantly between time periods. Respondents 3-6 months post-acute infection had the lowest HRQoL (median EQ-5D utility score: 0.59), the highest fatigue level (median score: 110.0) and the highest proportion with a likely depressive disorder (32.4%), whereas respondents 13-18 months post-infection had the highest HRQoL (0.65), the lowest fatigue level (106.0), and the second lowest proportion with a likely depressive disorder (25.0%) (p = 0.000-0.007). Younger age, female gender, lower level of education, not having paid work before COVID-19, comorbidity, and not being vaccinated, seemed to be determinants for worse HRQoL.

Conclusions

Regardless of time since infection, respondents considered fatigue, sensory processing problems and concentration problems the most debilitating symptoms. They experienced a low HRQoL and severe fatigue, even more than two years after acute COVID-19 infection. Respondents 3-6m post-infection had the worst health outcomes, whereas respondents 13-18m post-infection had the best outcomes, indicating that, at least for a subgroup of patients, health status may improve over time.
General practitioners’ knowledge, perception and experience on Long Covid: a cross-sectional study in Belgium and Malta
Authors: Moreels S , Bensemmane S , De Schreye R , Cuschieri S
Published: October 2023

Background

Over 10% of Covid-19 infected people experience persistent symptoms (Long Covid). As most Long Covid cases are in patients with a mild acute Covid-19 infection, primary health care and general practitioners (GPs) are at the forefront in their care. This study investigated GPs’ knowledge, perception and experience on Long Covid at cross-country level.

Methods

A cross-sectional study targeting GPs was conducted in Belgium and Malta during mid-2022. An online survey on Long Covid was disseminated. Descriptive and logistic regression analyses were performed.

Results

The survey was completed by 150 GPs (105 for Belgium, 45 for Malta). In both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Accessibility to educational material was limited and an awareness-rising campaign was seen as merited, especially by Maltese GPs (OR = 6.81, 95%CI [1.49;31.12]). For diagnosing Long Covid, 54.7% reported the requirement of a positive Covid-19 test, more among Belgian than Maltese GPs (64.3% vs 45.2%, p = 0.036). To assess Long Covid, GPs applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms. 76.0% GPs reported caring for Long Covid patients, irrespective of practice type and GPs’ country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%, p = 0.291) stated that Long Covid patients should follow multidisciplinary approach, only 29.8% of them reported to care for these patients by multidisciplinary cooperation and 48.3% by themselves/GP colleagues.

Conclusions

GPs frequently provide care to Long Covid patients and GPs’ care showed similarities at cross-country level. Although GPs perceived lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria were noted. Across Europe, uniform evidence-based guidelines, scientific support and training for GPs must be a priority to empower GPs in their Long Covid approach.
Impact of COVID-19 pandemic on care for chronic diseases in deprived and non-deprived neighbourhoods
Authors: Sana S , de Schepper EIT , van Pelt S , Magnee T , Bindels PJE , Denktas S , Kocken P L
Published: October 2023

Background

Due to stringent lock-down measures imposed during COVID-19 pandemic the access to the primary care dropped significantly. This study aims to investigate the impact on GP consultations for diabetes mellitus (DM) and COPD during the pandemic.

Methods

In an observational study from January 2018-June 2022, anonymized medical records of 379.567 patients in Rotterdam, were analyzed for the impact on DM and COPD consultations during the lockdown (March-May 2020) and after the lockdown (June 2020-June 2022) compared to pre-pandemic levels.

Results

The study included 34.270 DM and 11.570 COPD patients. Until the COVID-19 pandemic, the patients living in deprived neighborhoods had comparisonly on average a higher number of consultations for DM (RR = 1.81, 95%CI=1.76-1.86) and COPD (RR = 1.48 95%CI=1.39-1.58). During the stringent lock-down there was almost same significant drop in both neighbourhoods in consultations for DM (RR = 0.85, 95%CI=0.79-0.92) and COPD (RR = 0.72, 95%CI=0.61-0.86). After the lockdown, the consultations for DM were higher and the HbA1c measurements were normalized compared to pre-pandemic levels in both neighbourhoods, (RR = 1.11, 95%CI=1.05-1.17) and (RR = 0.96, 95%CI=0.91-1.01) respectively. Conversely, the consultations for COPD and spirometry measurements remained significantly lower after the lockdown compared to pre-pandemic levels, (RR = 0.72, 95%CI=0.65-0.80) and (RR = 0.26, 95%CI=0.20-0.34) respectively. Surprisingly, the mean HbA1c value in the study population was significantly lower in the months after the lock-down (RR = 0.96, 95%CI=0.94-0.98) turning back to higher normal value at the end of 2021.

Conclusions

The recovery of primary care for chronic diseases after the lockdown phase was much faster for DM than for the COPD patients. The positive effect of lockdown on HbA1c was unfortunately temporary. More research is needed to know whether the decrease in chronic care has led to extra morbidity or mortality after 2 years of pandemic.

Key messages

• Diabetes mellitus’ care recovered soon for both deprived and non-deprived neighbourhoods after a significant drop during the lockdown. Lockdown seems to have a positive effect on disease management.

• The significant delay in chronic care for COPD patients in both deprived and non-deprived neighbourhoods for almost two years, raises questions about the adverse health effects due to this delay.
The Robert Koch Institute's cross-sectoral efforts to address climate change and health
Authors: Taylor A , Kümpfel R
Published: October 2023

The Robert Koch Institute (RKI) is Germany's national public health institute (NPHI). It recognises that climate change poses a significant threat to the health and wellbeing of people and that as an NPHI it has an important role to play. To reflect this, we have been strengthening our work on climate change and health in the institute, particularly in the last 18 months, guided by the “IANPHI Roadmap for Action on Health and Climate Change” amongst other resources. At the RKI, we see that our contribution on climate change and health is part of efforts together with an extensive landscape of actors, each with their own disciplinary and sector-specific expertise and resources. We have therefore been exploring our possible sector-specific contribution and further developing our cross-sectoral working in line with the institute's strategy for climate change and health. The RKI is also already underway with specific cross-sectoral exchange and projects on climate change and health. This includes taking part in the cross-sectoral German national agencies’ network on climate adaptation, carrying out a comprehensive and ambitious situation report on the evidence base on climate change and health in Germany, as well as through a cross-sectoral programme to develop new measurable climate adaptation goals as part of the German Adaptation strategy for Climate Change. This presentation will share how the RKI is developing and implementing its cross-sectoral contribution on climate change and health, and will include some lessons learnt and suggestions for how other health actors might be able to apply this learning for their own work.

The presentation aims to:

• illustrate how cross-sectoral work can be implemented and how use of the “health argument” can help with this;

• stimulate thinking on how other health actors, including in the audience, might be able to engage in cross-sectoral working in their own fields and organisations.
Foresight in public health: application and challenges
Authors: Berghuis-Mutubuki E , Moye Holz D , Hilderink H
Published: October 2023

Background

Foresight studies in the field of public health are limited. However, in the context of increasing uncertainty and complexity, such as with the COVID-19 pandemic, there is growing need to anticipate future trends and to plan for them. Foresight provides the tools to explore possible futures and develop policy strategies. Despite its value, foresight is an underused methodology. Hence, the aim of this study is to illustrate how foresight can be applied in public health, and how to deal with the associated challenges.

Methods

We describe the six-steps that are part of foresight methodology. In step 1 we discuss how to formulate study objectives. We illustrate in step 2, the application of the conceptual model and the DESTEP tool to identify and rank driving forces. We then discuss time horizon and spatial distribution, in step 3. In step 4, we discuss scenario logics. Finally in steps 5 and 6, we discuss the types of scenarios and tools for analyses. Possible challenges encountered when applying foresight methodology are drawn from the experiences and lessons learnt from the PHIRI project.

Results

Challenges during application of the foresight six-steps approach included difficulties in formulating research objectives, developing a conceptual model, identifying most important future trends, developing systematic, consistent and plausible scenarios with clear messages for policy makers. Understanding the concept of uncertainty was especially difficult, both in formulating scenarios and policy messages.

Conclusions

Understanding of foresight concepts and their relation to each other is difficult. Support from foresight experts, conducting foresight exercises and publication of tutorial papers on foresight can enhance understanding.

Key messages

• Foresight methodology is a valuable tool to explore possible futures with a diverse group of stakeholders.

• Foresight promotes the development of policies that are appropriate and robust in their implementation in changing times.
Professionals’ views on interventions to reduce and prevent problematic alcohol use in older adults
Authors: van den Bulck FAE , Knijff R , Crutzen R , van de Mheen D , Bovens RHLM , van de Goor LAM , Stutterheim S E , Rozema A D
Published: October 2023

Background

Interventions to address problematic alcohol use in older adults are needed as alcohol use is highly prevalent among those over 55 years of age. For interventions to be most effective, their working elements should be leveraged. However, understanding of working elements specifically in interventions for older adults is limited. The aim of this study was to understand how (i.e., which elements), in which context, and why (which mechanisms) interventions are successful in preventing or reducing (problematic) alcohol use among older adults, from the perspective of professionals providing these interventions.

Methods

Guided by a Realist Evaluation approach, an existing Initial Program Theory (IPT) on working elements in alcohol interventions, was tested by conducting semi-structured interviews with professionals (N = 20). These professionals provide interventions targeting alcohol use across several contexts: with or without practitioner involvement; in-person or not; and in an individual or in a group setting. Data were coded and links between contexts, elements, mechanisms and outcomes were sought for in order to confirm, refute or refine the IPT.

Results

Several general working elements were found: 1) pointing out the risks and consequences of drinking behavior, 2) paying attention to abstinence, 3) contact with peers, 4) personalized content and 5) providing support. We also found context-specific working elements:1) personalized content and conversations in interventions with practitioners, 2) safety, trust and feeling connected in in-person interventions and 3) sharing experiences and tips in group interventions.

Conclusions

Findings are in general in line with the IPT. Our findings emphasize the need for social contacts and support for older adults. The mechanisms awareness and accessibility were important contributors to positive interventions outcomes. Further research should study the perspective of older adults and their relatives on interventions.

Key messages

• Social contacts and support are needed in interventions to reduce and prevent problematic alcohol use in older adults.

• Awareness and accessibility are important contributors to positive interventions outcomes in interventions to reduce and prevent problematic alcohol use in older adults.
Complementing traditional care with digital therapeutics for chronic non-communicable disease management
Authors: Buttigieg S
Published: October 2023

We will examine the role of digital therapeutics in diabetes care, where we will discuss how Digital Therapeutics can supplement face-to-face consultations by facilitating data exchange between patients and healthcare professionals, improving disease monitoring, and promoting patient empowerment. In the context of mental health, we will present evidence supporting the effectiveness of computer-assisted cognitive behaviour therapy (CCBT) as a valuable adjunct to treatment as usual (TAU) in primary care settings. Throughout the presentation, we will highlight the importance of integrating digital therapeutics into existing healthcare systems and addressing barriers to their adoption, such as socio-demographic disparities and healthcare professional attitudes through tools such as regulatory frameworks and reimbursement pathways. By exploring the complementary role of digital therapeutics in chronic NCD management, we aim to encourage dialogue on the potential synergies between traditional care and digital interventions to improve patient outcomes and inform public health policy.
Cost-effectiveness analysis of Next generation sequencing tests in critically ill pediatric patients
Authors: Nurchis M C , Heidar Alizadeh A , Raspolini G M , Altamura G , Santoli G , Pascucci D , Damiani G
Published: October 2023

Rare genetic diseases in the pediatric population constitute an urgent global public health issue; overall, more than 300 million people are affected worldwide. Next Generation Sequencing techniques, as Whole genome sequencing (WGS) and Whole exome sequencing (WES), have proven to be significantly supportive in diagnosing these complex conditions. The aim is to evaluate the cost-effectiveness of WGS versus WES in pediatric patients with suspected genetic disorders. A Bayesian Markov model was calibrated among this target population, comparing WGS to WES. Model parameters were retrieved from the scientific literature. Costs and benefits were discounted at a rate of 3%. A lifetime time horizon and the National Health Service perspective was chosen. The Eurozone threshold, ranging from €30,000 to €50,000, was adopted. Markov Chain Monte Carlo was used as the simulation method for Bayesian inference. Uncertainty was explored through a probabilistic sensitivity analysis (PSA) and a value of information analysis (VOI), illustrated through Cost-Effectiveness Acceptability Curve (CEAC) and Expected Value of Perfect Information (EVPI). Results were reported as Incremental Cost-Effectiveness Ratio (ICER), expressed as euros per additional diagnosis. The base case findings highlighted that WGS was cost-effective with an ICER of €31,973. The CEAC showed that for all thresholds over the ICER, WGS had the highest probability of being cost-effective. The EVPI per patient was estimated to be €6,535 on a threshold of €50,000/diagnosis. In addition to being cost-effective, WGS could allow early genetic diagnosis shortening the diagnostic odyssey. The use of WGS in the diagnostic workup has the potential to revolutionise personalised medicine and to play a significant role in achieving SDG 3 by providing personalised healthcare, identifying genetic risk factors for diseases, and informing public health policies for a target population that represents the human capital of the future.

Key messages

• This analysis informs that WGS is cost-effective and possibly cost-saving in the long term.

• WGS could be implemented in the diagnostic workup of children with suspected rare disorders.
Older family caregivers’ inadequate diet and social and health inequalities
Authors: Savela R M , Nykänen I , Koponen S , Suominen A L , Schwab U , Välimäki T
Published: October 2023

Background

Family caregivers may experience financial vulnerabilities due to their caregiving role, affecting their ability to afford appropriate food and ensure optimal nutrient intake. Therefore, this cross-sectional study aimed to assess the extent to which there are diet-related disparities among older family caregivers.

Methods

We included 125 family caregivers from Eastern Finland (mean age 74 y). Data on family caregivers’ health, nutritional status, and sociodemographic factors were collected at their households between June 2019 and December 2019. First, we assessed the sociodemographic factors associated with family caregivers’ inadequate diet. Then, we evaluated diet-related health disparities. The associations and predictors of diet-related disparities were assessed using the independent samples t-test, χ2-test, and binary logistic regression.

Results

The preliminary results show that family caregivers experiencing subjective poverty were less likely to consume two or more portions of fruit and vegetables per day (odds ratio = 0.11; 95% confidence interval 0.02-0.72; p = 0.021) and were more likely to be overweight. Furthermore, family caregivers’ inadequate diet (i.e., lack of daily fruit and vegetables and risk of malnutrition) was further associated with several health conditions, including comorbidity, depression, diabetes (type I and II), and osteoporosis.

Conclusions

Family caregivers have diet-related disparities, which may further lead to health inequalities. Family caregivers’ diet-related disparities require increasing attention in healthcare. Thus, addressing family caregivers’ food insecurity risk could enhance their health equity.

Key messages

• Older family caregivers’ inadequate diet is associated with social and health inequalities.

• We must assess the root causes of diet-related disparities among older family caregivers and the broad consequences to find solutions to narrow the inequalities.
Saxitoxin hazard! Detection of toxic algae in molluscs breeding areas in North-Western Adriatic Sea
Authors: Ragni L , Arnaboldi S , Cangini M , Guerrini F , Pistocchi R , Pezzolesi L , Penna A , Rubini S , Losio M N , Bertasi B
Published: October 2023

Background

Saxitoxin (SXT) can cause the paralytic shellfish poisoning (PSP) with severe impacts on both human health and marine ecosystems. Dinoflagellates are the major marine producers of STX and other variety of secondary toxic metabolites that can gather in molluscs becoming a risk for consumers’ poisoning. The aim of this work was to investigate the presence of the main algal species producing SXT in an area intended for molluscs breeding.

Methods

During 2020-2023, 40 seawater samples were collected from two macro-areas in the Adriatic Sea (North-Western) at different distances from the coast. After water filtration, DNA was extracted (DNeasy PLANT Mini Kit) and analysed with Real Time PCR for Alexandrium minutum and Gymnodinium catenatum detection. The possible ability to produce SXT was confirmed by sxt4A gene detection. Molecular results were compared with the microscopy gold-standard method.

Results

A. minutum was detected in 62.5% (CI 95% 0.47-0.75) of the samples, with 84% (CI 95% 0.65-0.94) of them possibly producing SXT. G. catenatum was found in 95% (CI 95% 0.83-0.99) of samples, with 73.7% (CI 95% 0.58-0.85) of them presenting STX gene. By microscopy, only Alexandrium spp. were identified without successful species identification. No other saxitoxin-producing genera or species were observed.

Conclusions

Our results underlined that A. minutum and G. catenatum can play an important role in the production of SXT, confirming their harmful presence in the areas intended for molluscs breeding. Microscopic identification can lead to an underestimation of the presence of potentially toxic algal species, stressing the relevance of improving molecular tools also in this field. These findings highlighted the importance of reporting and monitoring toxic algae presence, given the saxitoxin impact for food safety, and its significance for public health.

Key messages

• Saxitoxin-producing algae detection through molecular methods in molluscs breeding areas may represent an early warning useful to improve food safety and human health.

• Harmful algal monitoring can improve water management in a One Health perspective.
Risk assessment of exposure to multiple mycotoxins in the Icelandic population
Authors: Durão J , Eiríksdóttir A V , Halldórsson ÞI , Ólafsdóttir K , Twarużek M , Kosicki R , Viegas C , Assunção R , Viegas S , Martins C
Published: October 2023

Background

The proliferation of mycotoxin-producing fungi in agricultural settings poses a challenge for human health and nutrition around the world. Mycotoxins contaminate food sources and their negative health outcomes include carcinogenic, nephrotoxic and teratogenic effects. Potential risks are still poorly characterized and few studies assess exposure at an individual level. Thus, the goal of this study was to assess and characterize exposure risk to multiple mycotoxins in the Icelandic population.

Methods

Urine samples and data on urinary mycotoxins’ biomarkers (deoxynivalenol, zearalenone and ochratoxin A) from a pool of 171 individuals living in Iceland between 2020 and 2021 were used to estimate external doses through reverse dosimetry. For risk characterization, Hazard Quotient (HQ) and Margin of Exposure (MoE) approaches were applied for deoxynivalenol and zearalenone, and ochratoxin A, respectively.

Results

The Icelandic population was revealed to be exposed to multiple mycotoxins. Mean levels of deoxynivalenol and ochratoxin A were comparable to what have been reported in other European studies, while levels of zearalenone were considerably lower. Nevertheless, risk assessment revealed safe levels of exposure to deoxynivalenol and zearalenone (HQ < 1) but MoE based on a neoplastic endpoint to ochratoxin A indicated a possible health concern for all participants (MoE < 10000).

Conclusions

Although there are some uncertainties associated with a human biomonitoring approach, the results of this study confirm that mycotoxins are a growing threat to public health in the European continent. Since countries with different latitudes already present comparable levels of exposure, this is especially concerning in a climate change scenario. Further studies both on exposure assessment and specific effects on human health are required to accurately assess risk and introduce preventive measures.

Key messages

• The human exposome of the Icelandic population includes a mixture of mycotoxins.

• Risk assessment shows that mycotoxins pose a growing public health challenge in the European continent.