bluuebunny/crossref_metadata_2025 huggingface dataset:
Green Public Procurement and the circularity of the built environment
Authors: Finamore M , Oltean-Dumbrava C
Published: December 2022

The case study presented in this paper is a demonstration of the success of a green public procurement (GPP) model that allows to build buildings in accordance with the principles of the circularity by ensuring sustainable consumption and production.

The relevance of green procurement has lately become a focus of research because of public institutions’ growing interest in circularity for built environment investment. The case study of a school gym presented in this paper is emphasising the role the public authorities are playing in promoting the transition to the circularity of the built environment through sustainable procurement. Despite being a voluntary instrument, GPP also plays a significant part in the global efforts to develop a more resource-efficient economy. It can help to develop a critical mass of demand for more sustainable buildings that would be difficult to bring to the market otherwise.

The challenge of convincing public-sector institutions to use GPP across nations, to become ‘normal practice’ continues and will drive the market for environmentally friendly buildings. The case study presented demonstrate that the GPP model is widely replicable and leads to positive outcomes. It has already been applied for the Brancati secondary and high school project built in Pesaro, Italy, that has been awarded by the International Jury of the Green Solutions Awards 2020-21, Construction 21, the Prize for the Energy for the Temperate Climate International Platform category.
IoT-based architecture for efficient energy monitoring in existing building structures
Authors: Redlein A , Thrainer L
Published: December 2022

Considering the definition of Environmental, Social and Governance (ESG) criteria, historical buildings in Europe need solutions to be able to be more energy efficient. One approach to identify high energy consumers is data analysis. To enable this approach, the following research questions have to be answered:

1. How can data be captured in a valid and efficient way?

2. How can data be standardized and merged within dashboards?

3. How can data be analysed within these common dashboards?

To answer these questions, results of a mixed-methods-research project [1] were used, to give a view on the impact and use of emerging technologies and to allow the definition of the best suited technology. Based on the results of this step and previous research [2], the relevant tools and the IT architecture was defined. Thirdly, a case study was enrolled, which is based on the previously defined IT architecture, using IoT measuring devices from European production, two different databases and two analytic tools. To cover the ESG-reporting demands, data structure and relevant building structures were defined. The paper also presents the final decision on the database and the analytics tool, both capable to analyse large amount of data and operated as open solutions (enables enlargement at any time and works without license cost).
Circular Economy Design towards Zero Waste: Laying the foundation for constructive stakeholder engagement on improving construction, renovation, and demolition (CRD) waste management
Authors: Keena Naomi , Rondinel-Oviedo Daniel R. , Demaël Hermine
Published: December 2022

The city of Montréal is one of many cities worldwide who strive to cut the amount of waste they generate and advance towards zero waste in an effort to meet the Paris Agreement goals. Construction, renovation, and demolition (CRD) waste is a major contributor to urban waste streams but also an area where waste diversion and innovative waste management approaches could deliver significant reductions in waste. One such promising approach is that of circular economy which envisions a future where CRD waste is designed-out of the built environment by keeping construction materials in use. This paper presents a series of methods used to collect and organize data towards advancing circular thinking within CRD material management decision-making in Montréal and mobilizing engagement with the relevant data. Methods includes a detailed literature review, semi-structured interviews with stakeholders from across the building sector value chain followed by a thematic analysis. Collected data is mapped to the internationally recognized United Nations Sustainable Development Goals (SDGs) framework in an aim to provide globally significant methodologies which cities worldwide can use to showcase contributions to the UN SDGs. Advancing towards zero CRD waste in Montréal will require the input of multiple stakeholders. The work presented in this paper is part of a larger research effort which works to deliver an initial but vital first step in the collection, integration, and dissemination of data towards a circular, more sustainable, built environment.
Process-specific digital recording of construction site LCA-inventory to identify decarbonisation pathways
Authors: Wagner A , Ott S
Published: December 2022

In building life cycle assessment, construction site processes are currently hardly accounted for in detail. If considered, the emission values are determined by globally capturing effort values and by allocating them to individual work steps, equipment, or materials. To identify improvement potential to decarbonize construction activities, detailed process data must be captured for specific processes to determine the carbon dioxide emissions of single processes. The results can then be aggregated to larger process units e.g. to components or trades. To fully implement this approach, a recording of process-specific data at construction site is necessary. Therefore, the basic framework to record specific processes at construction site is developed in this article and LCA methodology to systematically link them to emissions is explained. Further, the method of computer vision for automated recording of construction site activities is being presented.
Distributed cyber-physical systems that enhance local-based frugal innovation toward a sustainable built environment
Authors: Yashiro Tomonari
Published: December 2022

The paper debates the comparison between centralized cyber-physical systems and distributed cyber-physical systems (CPS). Centralized CPS implies a system where a single player standardizes data format and protocol together with core services. Distributed CPS implies a system where varieties of digitalization systems by multiple vendors are interconnected to adapt to specific local contexts. Then the paper identifies that distributed CPS has practical advantages over centralized CPS. However, distributed CPS has potential disadvantages that threaten interconnectivity among digitalization systems by multiple vendors. The paper illustrates how such fragmentation could be avoided; it presents how interoperable linkage among multiple systems is realized. IoT-Hub, a sort of data conversion system, is an enabler of interoperability. The paper illustrates the framework of distributed CPS. That comprises several layers that could be managed autonomously by independent players regardless of activities in other layers. The paper exemplifies local-based frugal innovation by such distributed CPS. One example is IoT-based proactive energy demand control system. The system is composed of sensing systems, component systems and application software. The distributed CSP that deploys IoT-Hub enables adaptable coordination of building elements and digitalized systems respecting local specific contexts. In such a way, distributed CPS provides a comfortable indoor climate with optimized energy use. The other example is IoT-based inventory system for building materials. The system is composed of manufacturing process monitoring systems and logistics monitoring systems. The integrated system could provide reportable and verifiable inventory data of building materials. The system can facilitate responsible use of building materials by providing inventory data that is a piece of essential information for environmental declaration. Exemplified cases suggest how distributed CPS strategy has the potential to encourage a broad range of entrepreneurs to commit to frugal innovation toward a sustainable built environment.
0D to 2D carbon-based materials in flexible strain sensors: recent advances and perspectives
Authors: Liu Guodong , Zhang Zhuoqing , Li Zhijian , Guo Linghua , Ning Lulu
Published: December 2022

In the past decade, flexible strain sensors have attracted much attention in the fields of health care, soft robots and other flexible electronics due to their unique flexibility, high stability, and strong mechanical properties. To further meet the requirements of the excellent performance for electronic equipment, carbon-based conductive sensitive materials have become one of the first choice for the preparation of flexible strain sensors due to their excellent electrical conductivity, mechanical properties, and high compatibility. Herein, based on different strain behaviors, this paper analyzes the working mechanism of tensile and compressive strain sensors, focusing on the latest research progress of carbon-based conductive materials in strain sensors with different dimensions. The applications of carbon-based sensitive materials with multifunctional strain sensing in the areas of physiological information detection, human motion, human–machine interaction, and visual display have also been summarized. Furthermore, it has been attempted to discuss the current challenges of carbon-based strain sensors as well as the prospect of flexible strain sensors. This review is aimed to provide appropriate references for further exploitation of multi-functional flexible carbon-based strain sensors.
A sharp Poincaré inequality for functions in 𝐖^{1,∞}(Ω;ℝ)
Authors: Bevan Jonathan , Deane Jonathan , Zelik Sergey
Published: December 2022

For each natural number

n
n

and any bounded, convex domain

Ω
⊂

R

n

\Omega \subset \mathbb {R}^n

we characterize the sharp constant

C
(
n
,
Ω
)

C(n,\Omega )

in the Poincaré inequality
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="double-vertical-bar f minus f overbar Subscript normal upper Omega Baseline double-vertical-bar Subscript upper L Sub Superscript normal infinity Subscript left-parenthesis normal upper Omega semicolon double-struck upper R right-parenthesis Baseline less-than-or-equal-to upper C left-parenthesis n comma normal upper Omega right-parenthesis double-vertical-bar nabla f double-vertical-bar Subscript upper L Sub Superscript normal infinity Subscript left-parenthesis normal upper Omega semicolon double-struck upper R right-parenthesis">

‖
f
−

f
¯

Ω

‖

L

∞

(
Ω
;

R

)

≤
C
(
n
,
Ω
)
‖
∇
f

‖

L

∞

(
Ω
;

R

)

\| f - \bar {f}_{\Omega }\|_{L^{\infty }(\Omega ;\mathbb {R})} \leq C(n,\Omega ) \|\nabla f\|_{L^{\infty }(\Omega ;\mathbb {R})}

. Here,

f
¯

Ω

\bar {f}_{\Omega }

denotes the mean value of

f
f

over

Ω
\Omega

. In the case that

Ω
\Omega

is a ball

B
r

B_r

of radius

r
r

in

R

n

\mathbb {R}^n

, we calculate

C
(
n
,

B
r

)
=
C
(
n
)
r

C(n,B_r)=C(n)r

explicitly in terms of

n
n

and a ratio of the volumes of the unit balls in

R

2
n
−
1

\mathbb {R}^{2n-1}

and

R

n

\mathbb {R}^n

. More generally, we prove that
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="upper C left-parenthesis n comma upper B Subscript r left-parenthesis normal upper Omega right-parenthesis Baseline right-parenthesis less-than-or-equal-to upper C left-parenthesis n comma normal upper Omega right-parenthesis less-than-or-equal-to StartFraction n Over n plus 1 EndFraction normal d normal i normal a normal m left-parenthesis normal upper Omega right-parenthesis">

C
(
n
,

B

r
(
Ω
)

)
≤
C
(
n
,
Ω
)
≤

n

n
+
1

d
i
a
m

(
Ω
)

C(n,B_{r(\Omega )}) \leq C(n,\Omega ) \leq \frac {n}{n+1}\mathrm {diam}(\Omega )

, where

B

r
(
Ω
)

B_{r(\Omega )}

is a ball in

R

n

\mathbb {R}^n

with the same

n
−

n-

dimensional Lebesgue measure as

Ω
\Omega

. Both bounds are sharp, and the lower bound can be interpreted as saying that, among convex domains of equal measure, balls have the best, i.e. smallest, Poincaré constant.
Language Fluency Deficits in Post-treatment Lyme Disease Syndrome
Authors: Gorlyn Marianne , Keilp John G , Fallon Brian A
Published: December 2022

Objective

Recent neurocognitive studies of patients with post-treatment Lyme disease syndrome (PTLDS) find consistent deficits in memory and processing speed. Language fluency deficits are observed as well but may be secondary to poor memory and slowing rather than an independent deficit.

Method

This study performed a secondary analysis of data presented previously, including individuals with PTLDS and comparison samples of healthy volunteers (HC) and patients with major depressive disorder (MDD), to determine if language fluency deficits could be accounted for by poor performance in these other neurocognitive domains.

Results

Basic verbal abilities, memory, and processing speed were all significantly associated with fluency performance. MDD patients’ fluency deficits relative to HC were accounted for by these covariates. However, PTLDS patients’ poorer fluency performance relative to both other groups was not.

Conclusions

Language fluency appears to be an independent area of neurocognitive deficit within the constellation of PTLDS symptoms.
SCIBER: a simple method for removing batch effects from single-cell RNA-sequencing data
Authors: Gan Dailin , Li Jun
Published: December 2022

Motivation

Integrative analysis of multiple single-cell RNA-sequencing datasets allows for more comprehensive characterizations of cell types, but systematic technical differences between datasets, known as ‘batch effects’, need to be removed before integration to avoid misleading interpretation of the data. Although many batch-effect-removal methods have been developed, there is still a large room for improvement: most existing methods only give dimension-reduced data instead of expression data of individual genes, are based on computationally demanding models and are black-box models and thus difficult to interpret or tune.

Results

Here, we present a new batch-effect-removal method called SCIBER (Single-Cell Integrator and Batch Effect Remover) and study its performance on real datasets. SCIBER matches cell clusters across batches according to the overlap of their differentially expressed genes. As a simple algorithm that has better scalability to data with a large number of cells and is easy to tune, SCIBER shows comparable and sometimes better accuracy in removing batch effects on real datasets compared to the state-of-the-art methods, which are much more complicated. Moreover, SCIBER outputs expression data in the original space, that is, the expression of individual genes, which can be used directly for downstream analyses. Additionally, SCIBER is a reference-based method, which assigns one of the batches as the reference batch and keeps it untouched during the process, making it especially suitable for integrating user-generated datasets with standard reference data such as the Human Cell Atlas.

Availability and implementation

SCIBER is publicly available as an R package on CRAN: https://cran.r-project.org/web/packages/SCIBER/. A vignette is included in the CRAN R package.

Supplementary information

Supplementary data are available at Bioinformatics online.
Antigen-specific immunotherapy to restore antigen-specific tolerance in Type 1 diabetes and Graves’ disease
Authors: Zala Aakansha , Thomas Ranjeny
Published: December 2022

Type 1 diabetes and Graves’ disease are chronic autoimmune conditions, characterized by a dysregulated immune response. In Type 1 diabetes, there is beta cell destruction and subsequent insulin deficiency whereas in Graves’ disease, there is unregulated excessive thyroid hormone production. Both diseases result in significant psychosocial, physiological, and emotional burden. There are associated risks of diabetic ketoacidosis and hypoglycaemia in Type 1 diabetes and risks of thyrotoxicosis and orbitopathy in Graves’ disease. Advances in the understanding of the immunopathogenesis and response to immunotherapy in Type 1 diabetes and Graves’ disease have facilitated the introduction of targeted therapies to induce self-tolerance, and subsequently, the potential to induce long-term remission if effective. We explore current research surrounding the use of antigen-specific immunotherapies, with a focus on human studies, in Type 1 diabetes and Graves’ disease including protein-based, peptide-based, dendritic-cell-based, and nanoparticle-based immunotherapies, including discussion of factors to be considered when translating immunotherapies to clinical practice.
Is Mpox a Sexually Transmitted Infection? Why Narrowing the Scope of This Disease May Be Harmful
Authors: Hazra Aniruddha , Cherabie Joseph N
Published: December 2022

The 2022 multinational mpox outbreak has been characterized by unprecedented spread among men who have sex with men outside of sub-Saharan Africa. Close contact during sex and intimacy has been well established as a key pathway for human-to-human transmission in the current outbreak. Discussions on whether to assign this illness as a sexually transmitted infection (STI) have been ongoing since the initiation of the outbreak. While sexual contact certainly appears to be a primary means of spread, classifying mpox as an STI is inaccurate based on its known transmission dynamics, yields potential unintended consequences, and ignores the historical impact of the disease in Central and West Africa. Rather than focusing our energy on disease categorization, more effort should be placed on destigmatizing this illness and empowering communities at risk to protect themselves from mpox.
Two-Dimensional Block Trees
Authors: Brisaboa Nieves R , Gagie Travis , Gómez-Brandón Adrián , Navarro Gonzalo
Published: December 2022

The Block Tree is a data structure for representing repetitive sequences in compressed space, which reaches space comparable with that of Lempel–Ziv compression while retaining fast direct access to any position in the sequence. In this paper, we generalize Block Trees to two dimensions, in order to exploit repetitive patterns in the representation of images, matrices and other kinds of bidimensional data. We demonstrate the practicality of the two-dimensional Block Trees (2D-BTs) in representing the adjacency matrices of Web graphs, and raster images in GIS applications. For this purpose, we integrate our 2D-BT with the $k^2$-tree—an efficient structure that exploits clustering and sparseness to compress adjacency matrices—so that it also exploits repetitive patterns. Our experiments show that this structure uses 60–80% of the space of the original $k^2$-tree, while being 30% faster to three times slower when accessing cells.
Invasive Plants Have Higher Resistance to Native Generalist Herbivores Than Exotic Noninvasive Congeners
Authors: Wu Shan , Chen Li , Zhou Yue , Xiao Feng , Liu Danfeng , Wang Yi
Published: December 2022

Research on the invasive plant Phytolacca americana (L.) mostly focuses on its medicinal value and enrichment of heavy metals. However, little is known regarding its impact on native herbivorous insects. In this study, we explored the effects of P. americana and the exotic noninvasive Phytolacca icosandra (L.) on the Spodoptera litura (Fabricius) (native tobacco cutworm) via bioassay, oviposition preference, detoxifying enzyme activity analysis, and phytochemical determination. We found that the oviposition preference index (OPI) of S. litura feeding on P. icosandra was higher than that of P. americana. The developmental duration of S. litura feeding on P. icosandra was shorter than that of P. americana. Additionally, the Acetylcholinesterase (AchE) and Glutathione-S-transferase (GST) activities of S. litura feeding on P. americana were higher than that of S. litura feeding on artificial diets or P. icosandra. The content of lignin and flavonoids in P. americana was relatively high, whereas starch content was relatively low. These findings suggest invasive plants have higher resistance to herbivores, thereby suffering less damage than exotic noninvasive plants.
Multi-category classification of left ventricle ejection fraction using a convolutional neural network
Authors: Carter R , Hardway H , Johnson P , Douglass E , Adedinsewo D
Published: December 2022

Background

Screening for left ventricular (LV) systolic dysfunction (defined as ejection fraction ≤35%) based on data from a standard 12-lead electrocardiogram (ECG) has become well established when standard digital ECGs are available–8 independent leads sampled at least 250 hertz for 10 seconds. As the algorithm has been incorporated into various clinical scenarios and ancillary research projects, a limitation of the binary classification at 35% has become apparent.

Purpose

The objective of this study was to develop and validate a deep learning-based algorithm that would classify LVEF into three categories based on only the digital ECG input.

Methods

After IRB approval, native digital resting ECGs acquired between 1/1/2010 and 12/31/2021 on patients seen in Mayo Clinic in Jacksonville were extracted from the institutional electronic ECG database management system (MUSE, GE Healthcare). These ECGs were matched with transthoracic echocardiograms obtained up to four days prior or 30 days after the ECGs acquisition. A convolutional neural network consisting of 8 layers of convolutions, batch normalization and pooling was trained using Keras and Tensorflow with hyper-parameter optimization for L1 and L2 regularization, learning rate adjustments, and class weights to predict three classes of LVEF: ≤35%, 36–51%, and ≥52% based on clinical relevance. The primary measure of overall performance was the detection of LVEF ≤35%; however, the triad of model predictions was also considered in translating the model output to human interpretable findings.

Results

A total of 30,153 patients (60,169 ECG pairings; mean age 63 years; 48% male) were randomly split at the patient level into training (24,172 patients), validation (2,973 patients) and testing (3,008 patients). The trained model provided robust discrimination in the withheld testing data – AUROC of 0.941 (95% CI: 0.931 to 0.950). Using the optimal model threshold based on Youden's index from the validation data (0.186), sensitivity and specificity were estimated to be 87.9% (95% CI: 83.8% to 91.2%) and 86.3% (95% CI: 85.4% to 87.2%) in the testing data. In instances where discordant predictions were observed, the posterior distribution of model probabilities provide additional insights into the possible underlying value of LVEF (Figure 1).

Conclusions

The utilization of a multi-category deep learning classification model for the detection of reduced ejection fraction adds new dimensions to the use of AI technologies on digital ECGs. This work shows high discrimination can still be obtained when using three classes of LVEF.

Funding Acknowledgement

Type of funding sources: None.
Activation of the HeartLogic algorithm on top of heart failure care: a multicenter propensity-matched cohort analysis
Authors: Feijen M , Beles M , Than Y Z , Cordon A , Dupont M , Treskes R W , Caputo M , Mullens W , Van Bokstal K , Auricchio A , Egorova A D , Maes E , Beeres S L M A , Heggermont W A
Published: December 2022

Background

Hospitalization for decompensated heart failure may be prevented by early detection of fluid retention. The multisensory HeartLogic™ algorithm, incorporated in a cardiac implantable electronic device (CIED) aims to detect impending fluid retention and thereby enables timely adjustment of medical therapy. However, it is to be investigated whether HeartLogic™ provides clinical benefit compared to heart failure care with conventional telemonitoring. This analysis investigates the effects of activating HeartLogic™ on top of heart failure care with telemonitoring on the number of episodes with fluid retention and heart failure related hospitalizations.

Methods

Heart failure patients with a CIED were recruited from the outpatient clinics of four European cardiology departments. All patients were included from January 2017 until December 2020, and followed-up for 365 days. Patients with a CIED and an activated HeartLogic™ algorithm were compared to a 1:1 propensity score-based matched control group consisting of patients with CIED on routine telemonitoring. Data of all episodes of (impending) fluid retention with ≥2 signs and symptoms of congestion were included for analyses.

Results

Data of 127 patients with an activated HeartLogic™ algorithm were adequately matched with 127 heart failure patients with a CIED on routine telemonitoring. Median age was 68 [59–75], majority of patients were male (80%), 46% had an ischemic etiology of heart failure. Total follow-up consisted of 254 patient years. During follow up, 77 (61%) individual patients with HeartLogic™ experienced an episode of fluid retention, compared to 85 (67%) induvial patients on routine telemonitoring. Patients with an activated HeartLogic™ algorithm had 1.62±1.78 events of fluid retention per patient year (PPY) compared to 2.61±3.71 events PPY in patients on routine telemonitoring, p<0.01 (Figure 1). Hospitalization for fluid retention occurred in 7 (6%) HeartLogic™ patients (0.06±0.27 hospitalizations PPY) compared to 13 (10%) patients on routine telemonitoring (0.15±0.45 PPY), p=0.07 (Figure 2A). Mean length of hospitalization in days PPY was 0.29±1.46 in patients with HeartLogic™ and 1.59±6.30 in patients on routine telemonitoring, p=0.02 (Figure 2B).

Conclusion

In a real-world multicenter heart failure population, activation of the HeartLogic™ algorithm was associated with a lower number of episodes of fluid retention per patient and a shorter duration of hospitalization for congestive heart failure.

Funding Acknowledgement

Type of funding sources: None.
Clinical relevance of the single-lead ECG of the Apple Watch
Authors: Pepplinkhuizen S , Hoeksema W F , Van Der Stuijt W , Smeding L , Wilde A A M , Knops R E
Published: December 2022

Introduction

The Apple Watch (AW) is one of the first commercially available wearable with built-in electrocardiogram (ECG) electrodes to perform a single-lead ECG to detect atrial fibrillation (AF). The AW ECG application showed to have a high rate of unclassifiable notifications. The interpretation of the single-lead ECG by a physician can possibly reduce the total of unclassifiable notifications and contribute to the overall accuracy to detect AF.

Methods

This was a prospective, non-randomized, single center observational study to evaluate the accuracy and interrater agreement of the single-lead ECG of the AW. Patients scheduled for cardioversion for atrial fibrillation were asked for participation. The AW series 6 was used with WatchiOS 7.2 or 7.3 and ECG algorithm version 2.0. A single-lead ECG was obtained pre-conversion and, when cardioversion was successful, post-conversion. All single-lead ECGs and 12-lead ECGs were adjudicated by two physicians, agreement was reached by consensus. The AW single-lead ECG notification was compared to the physicians “gold-standard” interpretation of the 12-lead ECG. Sensitivity and specificity of the AW single-lead ECG and Kappa coefficient were calculated.

Results

In total, 74 patients were included. Mean age was 67.1±12.3 years and 20.3% were female. In total 65 AF and 64 sinus rhythm (SR) single-lead ECG measurements were obtained. Of these measurements, 27.9% (36/129) showed an unclassifiable notification. The AW ECG notification showed a sensitivity of 93.5% to detect AF and a specificity of 100% to detect SR (K= 0.94). After adjudication of the unclassifiable notifications by two independent physicians 1.6% (2/129) of the measurements remained unclassifiable. When including the by the physicians adjudicated unclassifiable recordings the sensitivity to diagnose AF was 89.2% and the specificity to detect SR was 93.8% (K=0.83). The adjudication of all single-lead ECGs by the two physicians showed a sensitivity of 90.6% to detect AF and specificity of 95.2% to detect SR (K= 0.83) (Table 1). All SR and AF notification by the AW were similarly adjudicated by the two physicians. The kappa coefficient for interrater agreement between both physicians was 0.69 for all single-lead ECGs and 0.58 for unclassifiable notifications specific.

Conclusion

Unclassifiable notifications of the AW can be reduced by physicians interpretation of the single-lead ECG, however the interrater agreement is only moderate. The physicians interpretation of the single-lead ECGs did not increase the accuracy to detect AF and the clinical relevance of the single-lead ECG, in addition to the AW notification, should therefore be questioned.

Funding Acknowledgement

Type of funding sources: None.
Do patients prefer face-to-face or telephone consultations in an outpatient cardiology department?
Authors: Goode C , Manorekang R , Durham N
Published: December 2022

Introduction

There has been a significant rise in the telephone clinic consultations in preference to face-to-face (FTF) clinics in the UK during the COVID 19 pandemic. The cardiology department in a district general hospital has also seen increased use of telephone clinics. We wanted a greater understanding of the impact of telephone consultations on patient satisfaction.

Methods

A patient satisfaction survey was designed based on the joint Royal College of Physicians training board (JRCPTB) patient satisfaction survey. The survey (Image 1) was sent via post to 300 patients reviewed by the cardiology outpatient department during November 2021. 150 who had telephone appointments and to 150 patients who had FTF appointments. Descriptive statistics and student T test were used to compare differences between the two groups with a p value of <0.05.

Results

There were 171 responses returned over a four-week period giving a 57% response rate. Of these, 75 respondents had a telephone appointment and 96 who had FTF appointments. 49% of the FTF patients were male compared to 55% of the telephone clinic respondents. The majority of patients were aged 70–89 in both groups and most patients were retired (79.2% for FTF and 65.3% on the telephone consultation group).

More patients felt the doctor was polite and considerate in FTF clinics compared to telephone consultation (97% compared to 92% positive responses, p value – 0.02). There was no significant difference in patients feeling listened too, being allowed time to ask questions, understanding their condition and being involved in decision making between the two groups (Table 1).

Of the FTF group, 81% preferred FTF clinics with only 3% preferring telephone clinics and 16% with no preference. Of the telephone group 53% stated a preference for FTF clinics, with 11% having a preference for phone clinics and 36% having no preference.

Patients rated overall experience more positively with FTF appointments (95%) compared to telephone clinics (85%, p value 0.02).

Conclusion

Telephone consultations performed at a comparable level to FTF clinics although patients demonstrate an overall preference for FTF clinics.

Funding Acknowledgement

Type of funding sources: None.
Living Alone and Depressive Symptoms Among Older Japanese: Do Urbanization and Time Period Matter?
Authors: Kobayashi Erika , Harada Ken , Okamoto Shohei , Liang Jersey
Published: December 2022

Objectives

Previous research has suggested cross-national differences in the association between living alone and well-being among older adults. This study examined whether the association varied across social contexts within the country, Japan, in terms of varying degree of urbanization and differential time periods.

Methods

Data were obtained from a nine-wave nationwide longitudinal survey with a probability sample of Japanese adults aged 60 years and over. Respondents belonged to one of the three periods (around 1990, 2000, and 2015) according to the year they commenced participation. As many as 4,655 individuals from 575 municipalities provided 9,016 observation sets of two consecutive waves (t − 1 and t). Within a framework of the Hierarchical Generalized Linear Model, depressive symptoms at t were predicted based on changes in living arrangements from t − 1 to t and their cross-level interactions with gender, level of urbanization, and time period, controlling for various covariates at t − 1.

Results

In general, older adults living alone continuously as well as those who started living alone between the waves showed more depressive symptoms than those coresiding with someone continuously. However, this tendency was more prominent among rural residents than their urban counterparts, especially for men. Moreover, the effect of continuously living alone on depressive symptoms became smaller in Period 2015 than that in Period 1990, because of the increase in depressiveness in coresident older adults.

Discussion

Our findings indicate that living alone has a differential effect on older adults’ well-being depending on the social context where residents’ preferences for living arrangements and availability of formal services could vary.
Cardiorespiratory Fitness Moderates the Age-Related Association Between Executive Functioning and Mobility: Evidence From Remote Assessments
Authors: Dupuy Emma Gabrielle , Besnier Florent , Gagnon Christine , Breton Juliana , Vincent Thomas , Grégoire Catherine-Alexandra , Lecchino Catia , Payer Marie , Bérubé Béatrice , Olmand Miloudza , Levesque Marianne , Bouabdallaoui Nadia , Iglesies-Grau Josep , Juneau Martin , Vitali Paolo , Gayda Mathieu , Nigam Anil , Bherer Louis
Published: December 2022

Background and Objectives

In older adults, executive functions are important for daily-life function and mobility. Evidence suggests that the relationship between cognition and mobility is dynamic and could vary according to individual factors, but whether cardiorespiratory fitness reduces the age-related increase of interdependence between mobility and cognition remains unexplored.

Research Design and Methods

One hundred eighty-nine participants (aged 50–87) were divided into 3 groups according to their age: middle-aged (MA; <65), young older adults (YOA; 65–74), and old older adults (OOA; ≥75). Participants performed Timed Up and Go and executive functioning assessments (Oral Trail Making Test and Phonologic verbal fluency) remotely by videoconference. Participants completed the Matthews questionnaire to estimate their cardiorespiratory fitness (VO2 max in ml/min/kg). A 3-way moderation was used to address whether cardiorespiratory fitness interacts with age to moderate the relationship between cognition and mobility.

Results

Results showed that the cardiorespiratory fitness × age interaction moderated the association between executive functioning and mobility (β = −0.05; p = .048; R2 = 17.6; p < .001). At lower levels of physical fitness (<19.16 ml/min/kg), executive functioning significantly influenced YOA’s mobility (β = −0.48, p = .004) and to a greater extent OOA’s mobility (β = −0.96, p = .002).

Discussion and Implications

Our results support the idea of a dynamic relationship between mobility and executive functioning during aging and suggest that physical fitness could play a significant role in reducing their interdependency.
Moho depth variation and shear wave velocity structure in northern Algeria from joint inversion of P-wave receiver functions and Rayleigh wave dispersion data
Authors: Melouk Billel , Yelles-Chaouche Abdelkrim , Semmane Fethi , Galiana-Merino Juan Jose
Published: December 2022

In this work, the Moho depth and the velocity structure of the crust and upper mantle beneath broad-band seismic stations of the Algerian broad-band seismic network are investigated. Teleseismic P-wave receiver functions jointly inverted with Rayleigh wave dispersion curves obtained from local earthquakes have been used. The seismic stations are located in different geological settings including the Tell Atlas, High Plateaus and the Saharan Atlas. The crustal thickness and the Vp/Vs ratio are first derived by the H–κ stacking method of receiver functions. The inversion results show the variation in Moho depth in the different geological contexts. The shallowest depths of the Moho (∼20–30 km) are estimated along the Algerian continental margin and Tell Atlas. In the High Plateaus region, the Moho depths vary from 30–36 km, whereas the deepest Moho depths are found in the Saharan Atlas (36–44 km). Two-layer crust is observed in the whole study area. In the upper crust, ∼8–14 km thick, the average shear wave velocity is ∼3.0 km s−1. The lower crust of about 12–30 km thick has an average shear wave velocity that ranges between 3.4 and 3.8 km s−1. The lower crust is thicker than the upper crust particularly in the Saharan Atlas. The upper mantle shear wave velocity varies from 4.1 to 4.5 km s−1 maximum and is stable, generally, below ∼60 km depth. Two low-velocity zones are clearly observed particularly in the eastern part of the Tell Atlas and the High Plateaus. The first one about 10 km thick is in the lower part of the lower crust and the other one is in the upper mantle between 40 and 60 km depth. The obtained results are in accordance with the previous results found in the region, particularly those using land gravity and seismic data. As the first estimate of the Moho depth from earthquake data in northern Algeria, using the receiver function method, this study sheds new light on the crustal structure and the Moho depth in this region of the world.
Night shift work and risk of aggressive prostate cancer in the Norwegian Offshore Petroleum Workers (NOPW) cohort
Authors: Berge Leon A M , Liu Fei-Chih , Grimsrud Tom K , Babigumira Ronnie , Støer Nathalie C , Kjærheim Kristina , Robsahm Trude E , Ghiasvand Reza , Hosgood H Dean , Samuelsen Sven Ove , Silverman Debra T , Friesen Melissa C , Shala Nita K , Veierød Marit B , Stenehjem Jo S
Published: December 2022

Background

Night shift work may acutely disrupt the circadian rhythm, with possible carcinogenic effects. Prostate cancer has few established risk factors though night shift work, a probable human carcinogen, may increase the risk. We aimed to study the association between night shift work and chlorinated degreasing agents (CDAs) as possible endocrine disrupters in relation to aggressive prostate cancer as verified malignancies.

Methods

We conducted a case-cohort study on 299 aggressive prostate cancer cases and 2056 randomly drawn non-cases in the Norwegian Offshore Petroleum Workers cohort (1965–98) with linkage to the Cancer Registry of Norway (1953–2019). Work history was recorded as years with day, night, and rollover (rotating) shift work, and CDA exposure was assessed with expert-made job-exposure matrices. Weighted Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for aggressive prostate cancer, adjusted for education and year of first employment, stratified by 10-year birth cohorts, and with 10, 15, and 20 years of exposure lag periods.

Results

Compared with day work only, an increased hazard of aggressive prostate cancer (HR = 1.86, 95% CI 1.18–2.91; P-trend = 0.046) was found in workers exposed to ≥19.5 years of rollover shift work. This persisted with longer lag periods (HR = 1.90, 95% CI 0.92–3.95; P-trend = 0.007). The exposure-hazard curve for a non-linear model increased linearly (HRs ≥1.00) for 18–26 years of rollover shift work. No association was found with CDA exposure.

Conclusions

Long-term exposure to rollover shift work may increase the hazard of aggressive prostate cancer in offshore petroleum workers.
Harm, Relationality and More-than-Human Worlds: Developing the Field of Transitional Justice in New Posthumanist Directions
Authors: Clark Janine Natalya
Published: December 2022

ABSTRACT∞

Consistent with its liberal origins, the field of transitional justice is overwhelmingly concerned with harms done to human victims. Posthumanism, however, challenges the framing of humans as bounded and autonomous individuals, emphasizing that all of us are entangled within wider relational assemblages that reflect the deep interconnections between human and more-than-human worlds. The core aim of this interdisciplinary article is to demonstrate what posthumanism can potentially contribute to transitional justice in the sense of pluralizing how we think, ontologically and epistemologically, about it – and in particular about the concepts of harm and, relatedly, agency. In discussing how posthumanist ideas and concerns might be practically incorporated into the field, the article explores the utility of two key concepts – social-ecological systems and visceral geography.
Population-Level Relative Effectiveness of the COVID-19 Vaccines and the Contribution of Naturally Acquired Immunity
Authors: Shioda Kayoko , Chen Yangping , Collins Matthew H , Lopman Benjamin A
Published: December 2022

Background

Immune protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be induced by natural infection or vaccination or both. Interaction between vaccine-induced immunity and naturally acquired immunity at the population level has been understudied.

Methods

We used regression models to evaluate whether the impact of coronavirus disease 2019 (COVID-19) vaccines differed across states with different levels of naturally acquired immunity from March 2021 to April 2022 in the United States. Analysis was conducted for 3 evaluation periods separately (Alpha, Delta, and Omicron waves). As a proxy for the proportion of the population with naturally acquired immunity, we used either the reported seroprevalence or the estimated proportion of the population ever infected in each state.

Results

COVID-19 mortality decreased as coverage of ≥1 dose increased among people ≥65 years of age, and this effect did not vary by seroprevalence or proportion of the total population ever infected. Seroprevalence and proportion ever infected were not associated with COVID-19 mortality, after controlling for vaccine coverage. These findings were consistent in all evaluation periods.

Conclusions

COVID-19 vaccination was associated with a sustained reduction in mortality at state level during the Alpha, Delta, and Omicron periods. The effect did not vary by naturally acquired immunity.
Antibody Avidity Maturation Following Recovery From Infection or the Booster Vaccination Grants Breadth of SARS-CoV-2 Neutralizing Capacity
Authors: Nakagama Yu , Candray Katherine , Kaku Natsuko , Komase Yuko , Rodriguez-Funes Maria-Virginia , Dominguez Rhina , Tsuchida Tomoya , Kunishima Hiroyuki , Nagai Etsuko , Adachi Eisuke , Ngoyi Dieudonné Mumba , Yamasue Mari , Komiya Kosaku , Hiramatsu Kazufumi , Uemura Naoto , Sugiura Yuki , Yasugi Mayo , Yamagishi Yuka , Mikamo Hiroshige , Shiraishi Satoshi , Izumo Takehiro , Nakagama Sachie , Watanabe Chihiro , Nitahara Yuko , Tshibangu-Kabamba Evariste , Kakeya Hiroshi , Kido Yasutoshi
Published: December 2022

Background

Cross-neutralizing capacity of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants is important in mitigating (re-)exposures. Role of antibody maturation, the process whereby selection of higher affinity antibodies augments host immunity, to determine SARS-CoV-2 neutralizing capacity was investigated.

Methods

Sera from SARS-CoV-2 convalescents at 2, 6, or 10 months postrecovery, and BNT162b2 vaccine recipients at 3 or 25 weeks postvaccination, were analyzed. Anti-spike IgG avidity was measured in urea-treated ELISAs. Neutralizing capacity was assessed by surrogate neutralization assays. Fold change between variant and wild-type neutralization inferred the breadth of neutralizing capacity.

Results

Compared with early-convalescent, avidity indices of late-convalescent sera were significantly higher (median, 37.7 [interquartile range 28.4–45.1] vs 64.9 [57.5–71.5], P < .0001). Urea-resistant, high-avidity IgG best predicted neutralizing capacity (Spearman r = 0.49 vs 0.67 [wild-type]; 0.18–0.52 vs 0.48–0.83 [variants]). Higher-avidity convalescent sera better cross-neutralized SARS-CoV-2 variants (P < .001 [Alpha]; P < .01 [Delta and Omicron]). Vaccinees only experienced meaningful avidity maturation following the booster dose, exhibiting rather limited cross-neutralizing capacity at week 25.

Conclusions

Avidity maturation was progressive beyond acute recovery from infection, or became apparent after the booster vaccine dose, granting broader anti-SARS-CoV-2 neutralizing capacity. Understanding the maturation kinetics of the 2 building blocks of anti-SARS-CoV-2 humoral immunity is crucial.
OpenSep: a generalizable open source pipeline for SOFA score calculation and Sepsis-3 classification
Authors: Hofford Mackenzie R , Yu Sean C , Johnson Alistair E W , Lai Albert M , Payne Philip R O , Michelson Andrew P
Published: December 2022

EHR-based sepsis research often uses heterogeneous definitions of sepsis leading to poor generalizability and difficulty in comparing studies to each other. We have developed OpenSep, an open-source pipeline for sepsis phenotyping according to the Sepsis-3 definition, as well as determination of time of sepsis onset and SOFA scores. The Minimal Sepsis Data Model was developed alongside the pipeline to enable the execution of the pipeline to diverse sources of electronic health record data. The pipeline’s accuracy was validated by applying it to the MIMIC-IV version 1.0 data and comparing sepsis onset and SOFA scores to those produced by the pipeline developed by the curators of MIMIC. We demonstrated high reliability between both the sepsis onsets and SOFA scores, however the use of the Minimal Sepsis Data model developed for this work allows our pipeline to be applied to more broadly to data sources beyond MIMIC.
Lower Limb Necrosis Secondary to Purpura Fulminans: A Case Report
Authors: Lin Chuangqiang , Li Dongxin , Hu Bei
Published: December 2022

Purpura fulminans is a rare and rapidly progressive septic process characterized by the development of hemorrhagic and ecchymotic lesions and skin necrosis. In this work, we report a case of a 52-year-old woman admitted to the Department of Emergency due to progressive purpura. The physical examination demonstrated a decreased skin temperature, unpalpable dorsalis pedis arteries, and ecchymoses covering both lower extremities. Laboratory tests indicated disseminated intravascular coagulation with prolonged activated partial thromboplastin time (APTT), low prothrombin time (PT), elevated d-dimer levels, and a low platelet count. A diagnosis of purpura fulminans was made, and steroids, therapeutic plasma exchange and empiric therapy, including antibiotic and anticoagulation therapy, were initiated immediately. Our treatment resulted in a good and sustained clinical response, as evidenced by the receding of blood blisters and the normalization of the patient’s coagulation factors, but bilateral below-knee amputation was inevitable. Finally, the patient recovered well and was discharged home without any complications other than amputation.
Medicine and History: a Surgical Model for National Integration
Authors: Barr Justin , Pappas Theodore N , Kennedy Meghan , Nakayama Don K
Published: December 2022

Historians and physicians have struggled to incorporate history into American medical education for over a century. Most efforts focus on local initiatives targeting a narrow audience. We describe a novel method involving the American College of Surgeons, a national organization with tens of thousands of members. Capitalizing on its infrastructure and influence over the field, we have implemented a variety of ventures that include panel sessions at meetings, poster competitions, travel grants, themed breakfasts, online communities, and other such projects. This programming has reached thousands of participants, ranging from pre-medical students to retired physicians, and it has increased both the exposure to and production of surgical history. Our article describes the process of establishing this nationally coordinated enterprise in the hopes that other medical specialties can emulate it and further the study of and appreciation for medical history.