bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical use and combination drug therapy among US adult users of central nervous system stimulants: a cross-sectional analysis
Authors: Moore Thomas J , Wirtz Phillip W , Curran Jill N , Alexander G Caleb
Published: April 2023

Objective

Examine patterns of adult medical use of amphetamine and methylphenidate stimulant drugs, classified in the USA as Schedule II controlled substances with a high potential for psychological or physical dependence.

Design

Cross-sectional study.

Setting and participants

Prescription drug claims for US adults, age 19–64 years, included in a commercial insurance claims database with 9.1 million continuously enrolled adults from 1 October 2019, through 31 December 2020. Stimulant use was defined as adults filling one or more stimulant prescriptions during calendar 2020.

Outcome measures

The primary outcome was an outpatient prescription claim, service date and days’ supply for central nervous system (CNS)-active drugs. Combination-2 was defined as 60 days or more of combination treatment with a Schedule II stimulant and one or more additional CNS-active drugs. Combination-3 therapy was defined as the addition of 2 or more additional CNS-active drugs. Using service date and days’ supply, we examined the number of stimulant and other CNS-active drugs for each of the 366 days of 2020.

Results

Among 9 141 877 continuously enrolled adults, the study identified 276 223 individuals (3.0%) using Schedule II stimulants during 2020. They filled a median of 8 (IQR, 4–11) prescriptions for these stimulant drugs that provided 227 (IQR, 110–322) treatment days of exposure. Among this group, 125 781 (45.5%) combined use of one or more additional CNS active drugs for a median of 213 (IQR, 126–301) treatment days. Also, 66 996 (24.3%) stimulant users used two or more additional CNS-active drugs for a median of 182 (IQR, 108–276) days. Among stimulants users, 131 485 (47.6%) were exposed to an antidepressant, 85 166 (30.8%) filled prescriptions for anxiety/sedative/hypnotic medications and 54 035 (19.6%) received opioid prescriptions.

Conclusion

A large proportion of adults using Schedule II stimulants are simultaneously exposed to one or more other CNS-active drugs, many with tolerance, withdrawal effects or potential for non-medical use. There are no approved indications and limited clinical trial testing of these multi-drug combinations, and discontinuation may be challenging.
Exploring the views of low-acuity emergency department consulters on an educational intervention and general practitioner appointment service: a qualitative study in Berlin, Germany
Authors: Kümpel Lisa , Oslislo Sarah , Resendiz Cantu Rebecca , Möckel Martin , Heintze Christoph , Holzinger Felix
Published: April 2023

Objectives

Low-acuity patients presenting to emergency departments (EDs) frequently have unmet ambulatory care needs. This qualitative study explores the patients’ views of an intervention aimed at education about care options and promoting primary care (PC) attachment.

Design

Qualitative telephone interviews were conducted with a subsample of participants of an interventional pilot study, based on a semi-structured interview guide. The data were analysed through qualitative content analysis.

Setting

The study was carried out in three EDs in the city centre of Berlin, Germany.

Participants

Thirty-two low-acuity ED consulters with no connection to a general practitioner (GP) who had participated in the pilot study were interviewed; (f/m: 15/17; mean age: 32.9 years).

Intervention

In the pilot intervention, ED patients with low-acuity complaints were provided with an information leaflet on appropriate ED usage and alternative care paths and they were offered an optional GP appointment scheduling service. Qualitative interviews explored the views of a subsample of the participants on the intervention.

Results

Interviewees perceived both parts of the intervention as valuable. Receiving a leaflet about appropriate ED use and alternatives to the ED was viewed as helpful, with participants expressing the desire for additional online information and a wider distribution of the content. The GP appointment service was positively assessed by the participants who had made use of this offer and seen as potentially helpful in establishing a long-term connection to GP care. The majority of patients declining a scheduled GP appointment expected no personal need for further medical care in the near future or preferred to choose a GP independently.

Conclusions

Low-acuity ED patients seem receptive to information on alternative acute care options and prevailingly appreciate measures to encourage and facilitate attachment to a GP. Promoting PC integration could contribute to a change in future usage behaviour.

Trial registration number

DRKS00023480.
Reducing the carbon footprint of research: experience from the NightLife study
Authors: Quann Niamh , Burns Steph , Hull Katherine L , Cluley Victoria , Richardson Carla , MacConaill Kateryna , Conefrey Carmel , Rooshenas Leila , Eborall Helen , Burton James O
Published: April 2023

Background

As set out in the Climate Change Act (2008), the UK National Health Service (NHS) has made a commitment to halve greenhouse gas emissions by 2025 and reach net zero by 2050. Research forms a core part of NHS activity and reducing the carbon footprint of clinical trials is a core element of the National Institute for Health and Care Research Carbon Reduction Strategy (2019).

Key arguments

However, support from funding organisations on how to achieve these targets is lacking. This brief communication article reports the reduction in the carbon footprint of the NightLife study, an ongoing multicentre randomised controlled trial assessing the impact of in-centre nocturnal haemodialysis on quality of life.

Conclusion

By using remote conferencing software and innovative data collection methods, we demonstrated a total saving of 136 tonnes of carbon dioxide equivalent over three workstreams during the first 18 months of the study, following grant activation on 1 January 2020. In addition to the environmental impact, there were additional benefits seen to cost as well as increased participant diversity and inclusion. This work highlights ways in which trials could be made less carbon intensive, more environmentally sustainable and better value for money.
Social inequalities in aggravating factors of somatic symptom persistence (SOMA.SOC): study protocol for a mixed-method observational study focusing on irritable bowel syndrome and fatigue
Authors: von dem Knesebeck Olaf , Barbek Rieke , Makowski Anna Christin
Published: April 2023

Introduction

Some studies indicate that persistent somatic symptoms (PSS) are more prevalent among individuals with a low socioeconomic status (SES) and a migration background. However, factors explaining social inequalities in PSS are largely unknown. It is expected that aggravating factors of PSS like illness perception, illness beliefs (health literacy, stigma), illness behaviour and health anxiety may play an important role for this explanation. The SOMA.SOC study will examine social inequalities (according to SES and migration) in factors contributing to symptom persistence in irritable bowel syndrome (IBS) and fatigue.

Methods and analysis

The project will collect both quantitative and qualitative data. Quantitative data will be gathered via a representative telephone survey in Germany (N=2400). A vignette design will be used depicting patients varying in sex, condition (IBS/fatigue), occupational status (low/high) and migration (yes/no). In the survey, we will assess public knowledge and beliefs (eg, health literacy), attitudes (stigma) and personal experiences with the condition (eg, somatic symptom burden). Complementary, longitudinal qualitative interviews will be conducted with patients (n=32 at three time points, resulting in N=96 interviews) who will also vary according to sex, condition, occupational status and migration. Patients will be recruited from primary care practices in Hamburg. The interviews will cover origin and development of the condition, coping and help-seeking as well as social interactions and perception of the disease by others (eg, perceived stigma). SOMA.SOC is part of the interdisciplinary SOMACROSS (Persistent SOMAtic Symptoms ACROSS Diseases) research unit.

Ethics and dissemination

The study protocol was approved by the Ethics Committee of the Hamburg Medical Association on 25 January 2021 (reference number: 2020–10194- BO-ff). Informed consent will be obtained from all participants. The main findings will be submitted for publication in peer-reviewed journals within 12 months of study completion.
Multidrug chemotherapy, whole-brain radiation and cytarabine therapy for primary central nervous system lymphoma in elderly patients with dose modification based on geriatric assessment: study protocol for a phase II, multicentre, non-randomised study
Authors: Yamasaki Fumiyuki , Fudaba Hirotaka , Asano Kenichiro , Sasayama Takashi , Natsumeda Manabu , Shimabukuro Taichi , Taguchi Kotaro , Koizumi Shinichiro , Nakayama Noriyuki , Fujii Kentaro , Nishibuchi Ikuno , Sugiyama Kazuhiko , Yoshida Kenji , Yonezawa Ushio , Yasutomo Momii , Kawasaki Yukari , Kakuta Kiyohide , Katayama Kosuke , Tanaka Kazuhiro , Nagashima Hiroaki , Tsukamoto Yoshihiro , Ideguchi Makoto , Nishizaki Takafumi , Kurozumi Kazuhiko , Hosoya Tomohiro , Akita Tomoyuki , Kambe Atsushi
Published: April 2023

Introduction

Multidrug chemoimmunotherapy with rituximab, high-dose methotrexate, procarbazine and vincristine (R-MPV) is a standard therapy for younger patients with primary central nervous system lymphoma (PCNSL); however, prospective data regarding its use in elderly patients are lacking. This multi-institutional, non-randomised, phase II trial will assess the efficacy and safety of R-MPV and high-dose cytarabine (HD-AraC) for geriatric patients with newly diagnosed PCNSL.

Methods and analysis

Forty-five elderly patients will be included. If R-MPV does not achieve complete response, the patients will undergo reduced-dose, whole-brain radiotherapy comprising 23.4 Gy/13 fractions, followed by local boost radiotherapy comprising 21.6 Gy/12 fractions. After achieving complete response using R-MPV with or without radiotherapy, the patients will undergo two courses of HD-AraC. All patients will undergo baseline geriatric 8 (G8) assessment before HD-AraC and after three, five and seven R-MPV courses. Patients with screening scores of ≥14 points that decrease to <14 points during subsequent treatment, or those with screening scores <14 points that decrease from the baseline during subsequent treatment are considered unfit for R-MPV/HD-AraC. The primary endpoint is overall survival, and the secondary endpoints are progression-free survival, treatment failure-free survival and frequency of adverse events. The results will guide a later phase III trial and provide information about the utility of a geriatric assessment for defining chemotherapy ineligibility.

Ethics and dissemination

This study complies with the latest Declaration of Helsinki. Written informed consent will be obtained. All participants can quit the study without penalty or impact on treatment. The protocol for the study, statistical analysis plan and informed consent form have been approved by the Certified Review Board at Hiroshima University (CRB6180006) (approval number: CRB2018-0011). The study is ongoing within nine tertiary and two secondary hospitals in Japan. The findings of this trial will be disseminated through national and international presentations and peer-reviewed publications.

Trial registration

jRCTs061180093.
Population-based user-perceived experience ofRheumatic?: a novel digital symptom-checker in rheumatology
Authors: Lundberg Karin , Qin Ling , Aulin Cecilia , van Spil Willem Evert , Maurits Marc P , Knevel Rachel
Published: April 2023

Objective

Digital symptom-checkers (SCs) have potential to improve rheumatology triage and reduce diagnostic delays. In addition to being accurate, SCs should be user friendly and meet patient’s needs. Here, we examined usability and acceptance ofRheumatic?—a new and freely available online SC (currently with >44 000 users)—in a real-world setting.

Methods

Study participants were recruited from an ongoing prospective study, and included people ≥18 years with musculoskeletal complaints completingRheumatic?online. The user experience survey comprised five usability and acceptability questions (11-point rating scale), and an open-ended question regarding improvement ofRheumatic?Data were analysed in R using t-test or Wilcoxon rank test (group comparisons), or linear regression (continuous variables).

Results

A total of 12 712 people completed the user experience survey. The study population had a normal age distribution, with a peak at 50–59 years, and 78% women. A majority foundRheumatic?useful (78%), thought the questionnaire gave them an opportunity to describe their complaints well (76%), and would recommendRheumatic?to friends and other patients (74%). Main shortcoming was that 36% thought there were too many questions. Still, 39% suggested more detailed questions, and only 2% suggested a reduction of questions.

Conclusion

Based on real-world data from the largest user evaluation study of a digital SC in rheumatology, we conclude thatRheumatic?is well accepted by women and men with rheumatic complaints, in all investigated age groups. Wide-scale adoption ofRheumatic?, therefore, seems feasible, with promising scientific and clinical implications on the horizon.
Methotrexate therapy associated with a reduced rate of new-onset uveitis in patients with biological-naïve juvenile idiopathic arthritis
Authors: van Straalen Joeri W , Akay Görkem , Kouwenberg Carlyn V , de Roock Sytze , Kalinina Ayuso Viera , Wulffraat Nico M , de Boer Joke , Swart Joost F
Published: April 2023

Objective

To study the effect of methotrexate (MTX) therapy on new-onset uveitis in patients with biological-naïve juvenile idiopathic arthritis (JIA).

Methods

In this matched case–control study, we compared MTX exposure between cases with JIA-associated chronic uveitis (JIA-U) and patients with JIA and without JIA-U at the time of matching (controls). Data were collected from electronic health records of the University Medical Centre Utrecht, the Netherlands. Cases with JIA-U were matched 1:1 to JIA control patients based on JIA diagnosis date, age at JIA diagnosis, JIA subtype, antinuclear antibodies status and disease duration. The effect of MTX on JIA-U onset was analysed using a multivariable time-varying Cox regression analysis.

Results

Ninety-two patients with JIA were included and characteristics were similar between cases with JIA-U (n=46) and controls (n=46). Both ever-use of MTX and exposure years were lower in cases with JIA-U than in controls. Cases with JIA-U significantly more often discontinued MTX treatment (p=0.03) and out of those who did, 50% afterwards developed uveitis within 1 year. On adjusted analysis, MTX was associated with a significantly reduced new-onset uveitis rate (HR: 0.35; 95% CI: 0.17 to 0.75). No different effect was observed between a low (<10 mg/m2/week) and standard MTX dose (≥10 mg/m2/week).

Conclusion

This study demonstrates an independent protective effect of MTX on new-onset uveitis in patients with biological-naïve JIA. Clinicians might consider early initiation of MTX in patients at high uveitis risk. We advocate more frequent ophthalmologic screening in the first 6–12 months after MTX discontinuation.
Passport: Improving Automated Formal Verification Using Identifiers
Authors: Sanchez-Stern Alex , First Emily , Zhou Timothy , Kaufman Zhanna , Brun Yuriy , Ringer Talia
Published: April 2023

Formally verifying system properties is one of the most effective ways of improving system quality, but its high manual effort requirements often render it prohibitively expensive. Tools that automate formal verification by learning from proof corpora to synthesize proofs have just begun to show their promise. These tools are effective because of the richness of the data the proof corpora contain. This richness comes from the stylistic conventions followed by communities of proof developers, together with the powerful logical systems beneath proof assistants. However, this richness remains underexploited, with most work thus far focusing on architecture rather than on how to make the most of the proof data. This article systematically explores how to most effectively exploit one aspect of that proof data: identifiers.

We develop the Passport approach, a method for enriching the predictive Coq model used by an existing proof-synthesis tool with three new encoding mechanisms for identifiers: category vocabulary indexing, subword sequence modeling, and path elaboration. We evaluate our approach’s enrichment effect on three existing base tools: ASTactic, Tac, and Tok. In head-to-head comparisons, Passport automatically proves 29% more theorems than the best-performing of these base tools. Combining the three tools enhanced by the Passport approach automatically proves 38% more theorems than combining the three base tools. Finally, together, these base tools and their enhanced versions prove 45% more theorems than the combined base tools. Overall, our findings suggest that modeling identifiers can play a significant role in improving proof synthesis, leading to higher-quality software.
Evaluating Learning Outcomes of Virtual Reality Applications in Education: A Proposal for Digital Cultural Heritage
Authors: Paolanti Marina , Puggioni Mariapaola , Frontoni Emanuele , Giannandrea Lorella , Pierdicca Roberto
Published: April 2023

The surge of Mobile
Virtual Reality (VR)
applications is getting growing attention among researchers and practitioners. The recent literature demonstrates its benefits when used for education purposes, since virtual immersion yields promising results for learning. Leveraging this trend, within the so called “digital didactics”, the need to gauge VR’s effectiveness in the didactic field has become paramount; so far, a method to connect traditional evaluation strategies to novel VR-based learning is still broadly missing. This paper investigates the problem of quantifying the learning outcomes and proposes a new didactic evaluation method for the
Digital Cultural Heritage (DCH)
learning. This research, conducted in a higher education institute, proposes three new Key Performance Indicators, referring to
Revised Bloom’s Taxonomy (RBT)
:
Mnemonic (M)
,
Transversal (T)
, and
Disciplinary (D)
. A questionnaire was administered by the same teacher who holds the course, to evaluate how well the application communicated information. The participants have been subdivided into two groups with the same knowledge base. The first group (1ACAT) that represents the “VR group” used the app at home to deepen their subject studies; while the second group (1AGR) that represents the “control group” consulted and studied the app only before the test. The results have demonstrated that the “control group” has a greater ability to support purely mnemonic topics (1ACAT 46.9%, 1AGR 53.1%), such as dates and simple definitions. The skills reached by the “VR group” attest to both transveral (1ACAT 52.9%, 1AGR 47.1%) and disciplinary (1ACAT 52.5%, 1AGR 47.5%) knowledge. These results validate the use of VR in teaching, demonstrating both experiential value and student involvement, but even confirming the compensatory function of VR if compared with the irreplaceable role of teachers in guiding learners to learn.
Ultrafast X-Ray Probes of Elementary Molecular Events
Authors: Keefer Daniel , Cavaletto Stefano M. , Rouxel Jérémy R. , Garavelli Marco , Yong Haiwang , Mukamel Shaul
Published: April 2023

Elementary events that determine photochemical outcomes and molecular functionalities happen on the femtosecond and subfemtosecond timescales. Among the most ubiquitous events are the nonadiabatic dynamics taking place at conical intersections. These facilitate ultrafast, nonradiative transitions between electronic states in molecules that can outcompete slower relaxation mechanisms such as fluorescence. The rise of ultrafast X-ray sources, which provide intense light pulses with ever-shorter durations and larger observation bandwidths, has fundamentally revolutionized our spectroscopic capabilities to detect conical intersections. Recent theoretical studies have demonstrated an entirely new signature emerging once a molecule traverses a conical intersection, giving detailed insights into the coupled nuclear and electronic motions that underlie, facilitate, and ultimately determine the ultrafast molecular dynamics. Following a summary of current sources and experiments, we survey these techniques and provide a unified overview of their capabilities. We discuss their potential to dramatically increase our understanding of ultrafast photochemistry.
Effects of the Spacer Obstacles on the Capacitive Deionization Performance
Authors: Hadidi Hooman , Khorasgani Behnam Ghasaban , Ahmadi Javad
Published: April 2023

The capacitive deionization (CDI) process uses porous electrodes to adsorb electrostatic ions, offering the possibility of efficient desalination of salty water. The purpose of this study is to investigate the effects of obstacles in CDI spacers on charge transfer and adsorption. The results reveal that the adsorption rate of the CDI cells increases remarkably for the obstacle height ratios of h = 0.8 and 0.9 in comparison with the original channel. In contrast, the performance deteriorates for the cells with height ratios of h = 0.3 and 0.6. For desalination operations that end at half the equilibrium salt adsorption capacity (SAC), the CDI channel containing rectangular obstacles covering 80% of the channel, improves the ASAR (0.13 mg g−1 min−1) by 8% compared to the same situation with the original spacer (0.12 mg g−1 min−1). This gain increases to 25% for the barriers covering 90% of the channel height. The results show that as the barrier height is modest, it prevents salt from entering the electrodes, allowing a low concentration zone to be identified adjacent to the barrier inside the electrode. Interestingly, if the barrier height ratio is as high as h = 0.8 and 0.9, the strong vortices facilitate the ions transfer towards the electrode and consequently, more adsorption occurs.
Toward Tungsten Electrodeposition at Moderate Temperatures Below 100 °C Using Chloroaluminate Ionic Liquids
Authors: Higashino Shota , Takeuchi Yoshikazu , Miyake Masao , Sakai Takuma , Ikenoue Takumi , Tane Masakazu , Hirato Tetsuji
Published: April 2023

The electrodeposition of tungsten at moderate temperatures (<100 °C) has been of significant interest for the fabrication of thin films and microelectromechanical system components to decrease energy consumption and increase process safety. In this study, we investigated the electrochemical reduction of WCl4 and WCl5 in 1-ethyl-3-methylimidazolium chloride (EMIC) and EMIC–AlCl3 ionic liquids at 80 °C–120 °C. W-rich films with a thickness of approximately 1 μm were obtained from the Lewis acidic EMIC–AlCl3–WCl5 bath, whereas the other baths did not yield any deposits. The films obtained from the EMIC–AlCl3–WCl5 bath at 80 °C had higher W contents of 54 at.% than those obtained at 120 °C. X-ray absorption near-edge structure spectra of the W-rich films indicated that W existed in an oxidized state. The findings of this study can be used as a guide to explore optimal electrolytes and electrolytic conditions for the electrodeposition of metallic W at moderate temperatures.
TCAD Simulation Models, Parameters, and Methodologies for β-Ga2O3 Power Devices
Authors: Wong Hiu Yung
Published: April 2023

β-Ga2O3 is an emerging material and has the potential to revolutionize power electronics due to its ultra-wide-bandgap (UWBG) and lower native substrate cost compared to Silicon Carbide and Gallium Nitride. Since β-Ga2O3 technology is still not mature, experimental study of β-Ga2O3 is difficult and expensive. Technology-Computer-Aided Design (TCAD) is thus a cost-effective way to study the potentials and limitations of β-Ga2O3 devices. In this paper, TCAD parameters calibrated to experiments are presented. They are used to perform the simulations in heterojunction p-NiO/n-Ga2O3 diode, Schottky diode, and normally-off Ga2O3 vertical FinFET. Besides the current-voltage (I-V) simulations, breakdown, capacitance-voltage (C-V), and short-circuit ruggedness simulations with robust setups are discussed. TCAD Sentaurus is used in the simulations but the methodologies can be applied in other simulators easily. This paves the road to performing a holistic study of β-Ga2O3 devices using TCAD.
p38 MAPK activation and STIM1-Orai3 association mediate TRPC6 externalization
Authors: Chaudhuri Pinaki , Putta Priya , Rosenbaum Michael A. , Graham Linda M.
Published: April 2023

The major lysophospholipid component in oxidized LDL, lysophosphatidylcholine (lysoPC), can activate p38 MAP kinase, which in turn promotes externalization of Orai3 and STIM1-Orai3 association, suggesting involvement of arachidonic acid-regulated calcium (ARC) channels. The subsequent increase in intracellular calcium activates an Src kinase required for TRPC6 externalization. TRPC6 activation, which has been shown to inhibit endothelial cell migration, is blocked by p38 MAP kinase or Orai3 downregulation, and this partially preserves endothelial migration in lysoPC.
SH3BGRL Suppresses Liver Tumor Progression through Enhanced ATG5-Dependent Autophagy
Authors: Saleh Abdulmomen Ali Mohammed , Haider Farhan , Lv Haimei , Liu Bin , Xiao Jing , Zhang Mingming , Zheng Yuzhen , Yang Shulan , Wang Haihe
Published: April 2023

SH3BGRL, an adaptor protein, is upregulated in breast cancers and indicates its tumorigenic role. But the function of SH3BGRL in other types of cancers is largely unknown. Here, we modulate SH3BGRL expression level in two liver cancer cells and conduct both in vitro and in vivo analyses of SH3BGRL in cell proliferation and tumorigenesis. Results demonstrate that SH3BGRL notably inhibits cell proliferation and arrests the cell cycle in both LO2 and HepG2 cells. Molecularly, SH3BGRL upregulates the expression of ATG5 from proteasome degradation as well as the inhibitions of Src activation and its downstream ERK and AKT signaling pathways, which eventually enhance autophagic cell death. The xenograft mouse model reveals that SH3BGRL overexpression can efficiently suppress tumorigenesis in vivo, while the additional silencing ATG5 in SH3BGRL-overexpressing cells attenuates the inhibitory effect of SH3BGRL on both hepatic tumor cell proliferation and tumorigenicity in vivo. The relevance of SH3BGRL downregulation in liver cancers and their progression is validated based on the large-scale tumor data. Taken together, our results clarify the suppressive role of SH3BGRL in tumorigenesis of liver cancer, which would be of help to the diagnosis of liver cancer, while either promoting the autophagy of liver cancer cells or inhibiting the downstream signaling induced from SH3BGRL downregulation would be a promising therapy.
Research on Pure Modes I and II and Mixed-Mode (I/II) Fracture Toughness of Geopolymer Fiber-Reinforced Concrete
Authors: Karthik Sundaravadivelu , Saravana Raja Mohan Kaliyaperumal , Murali Gunasekaran , Ravindran Gobinath
Published: April 2023

The unsustainable use of resources and the rising demand for traditional concrete have disrupted ecological equilibrium, necessitating the adoption of a more appropriate and long-lasting alternative. One such substitute for cement in concrete production is geopolymer concrete, although this material is prone to cracking and fracturing due to its low tensile strength, leading to costly repairs or even structural collapse. Fiber-reinforced concrete has recently been widely adopted as a construction material to counteract these issues. This research examined the crack proliferation and fracture toughness of geopolymer concrete comprising different fibers using a cracked Brazilian disc. Four different fibers were used, such as polypropylene and steel fiber (short and long), at a dosage of 1.5% by volume. Fracture toughness was computed for various modes (I, II, and I/II) of fractures, and crack propagation from cracked specimens was studied. A different angle of inclination (0, 15, 28, 83, 60, 75, and 90 degrees) was used to conduct the Brazilian disc test on the specimens with respect to the preexisting crack direction. The findings indicate that the increasing loading angle increased the load-carrying capacity. The fracture toughness values of specimens under all three modes ranged from 0.26 to 1.75 MPa.m1/2. Additionally, long polypropylene and steel fibers exhibit higher fracture toughness than short fibers.
Kawasaki Disease: Unusual Presentation with Retropharyngeal Involvement
Authors: Zeroli Chiara , Gorica Armela , D’Aleo Canova Giulia Claire , Caruso Monica , Castelnuovo Paolo , De Bernardi Francesca
Published: April 2023

Background. Kawasaki disease is an acute febrile generalized vasculitic syndrome of childhood of unknown ethology. The most severe complication may involve the hearth and include acute myocarditis with hearth failure, arrythmia, and coronary artery aneurism. The typical clinical symptoms are fever, conjunctivitis, rash, cervical lymphadenopathy, and mucocutaneous changes, and the diagnosis is made by the clinical criteria. Early use of aspirin and immunoglobuline improves symptoms and prevent heart complications. Case Presentation. A 4-year-old male presented to our attention for multiple unilateral laterocervical lymphadenopathies, odynophagia, and neck stiffness, initially treated with IV antibiotic therapy with partial resolution of symptoms. After four months he made a new ER access for cervicalgia, tonsils asymmetry, trismus, stiff neck, lameness, and phalanx hyperaemia and increase in the size of cervical lymph nodes. Radiology showed increase of lymphnodes dimension and retropharyngeal space asymmetry. The same day heart murmur appeared, so the patient underwent cardiological evaluation that documented dilation of the coronary arteries. This sign made it possible to place the diagnostic suspicion of Kawasaki disease and to start IV immunoglobulins and acetylsalicylic acid administration with prompt response. Conclusions. Kawasaki disease presents with a range of symptoms which, taken individually, are very common in childhood. One of these symptoms is represented by the swollen of neck lymph nodes. It is only clinical reasoning that leads to the correct diagnosis, and therefore, to the correct setting of the therapy, reducing the risk of complications.
Combined Open-Slot and Monopole 8 × 8 High-Isolation Broadband MIMO Antenna System for Sub-6 GHz Terminals
Authors: Guo Jie , Zhang Shaoqing , Han Chong-Zhi , Zhang Liang
Published: April 2023

In this article, an 8 × 8 MIMO antenna system with multidecoupling structures is proposed for the fifth-generation (5G) terminal applications. First, an antenna element consisting of an L-shaped open slot with dimensions of 5.6 × 5 mm2 and two bent-L-shaped monopoles with dimensions of 12.7 × 6.1 mm2 is introduced. Due to coupling feed technology, the initial open slot owns a wide bandwidth from 3.62 GHz to 4.82 GHz. For broadening the bandwidth of the initial antenna element, two bent-L-shaped monopoles are added to the open slot to adjust the input impedance. By optimizing the parameters of monopoles, the proposed antenna element has been finally determined and the bandwidth of the antenna element has been broadened (2.82 GHz to 5.23 GHz). Second, a dual antenna pair is constructed by placing the two antenna elements with an edge-to-edge distance of 27 mm in a mirror image placement; the 8 × 8 MIMO antenna system is brought about by symmetrically disposing four such antenna pairs with an edge-to-edge distance of 47 mm. Moreover, the isolation of two closely placed antenna elements is achieved by the parasitic strip-loading technique and defective ground techniques. Due to the decoupling techniques used in the 8 × 8 MIMO antenna system, the average isolation has been optimized from 13.2 dB to 21.9 dB and the total efficiency of each antenna element has been improved from a worst 20% to over 45%. Besides, the calculated mean efficiency gain is less than 1 dB, and the calculated envelop correlation coefficient (ECC) is lower than 0.01 for desired frequency bands. Furthermore, the proposed 8 × 8 MIMO antenna system has the measured broadband bandwidth from 3.28 GHz to 5.05 GHz (covering N77, N78, and N79 bands) and a compatible dimension for ultra-thin mobile phones. The simulated results of this work are all obtained from EM software CST STUDIO SUITE 2019. In general, the proposed 8 × 8 MIMO antenna system with a high-isolation property provides a hopeful solution to 5G ultra-thin mobile phones.
A Feasibility Analysis of the Infrared Thermography Technique in Surface Crack Detection for High‐Speed Rail Slab Track
Authors: Ye Xuan-Yu , Luo Yan-Yun , Li Zai-Wei , Liu Xiao-Zhou
Published: April 2023

The surface crack on track slab is the main cause of the service reliability deterioration of the high‐speed rail (HSR) slab track. To realize the rapid and accurate detection of these cracks, infrared thermography (IRT) can be regarded as an effective way in HSR application. However, the performance of IRT can be significantly affected by the testing environment. This study aims to analyze the feasibility of IRT in crack detection for HSR slab track by investigating the key factors affecting the detection accuracy. Firstly, the principle of IRT in detecting surface crack of track slab is given, and the key factors influencing the detection performance are discussed. Considering the difficulty in conducting field tests for slab tracks, this study establishes a finite element (FE) model to simulate the temperature field of track slab with surface cracks. This model is verified by using the field measurement results of track slab temperature. With the FE model, the effects of detection time, ambient temperature, and sensitivity of the thermal imager on the detection accuracy are revealed. The results show that, during the window time for track maintenance (0:00 am–3:00 am), the difference of temperature between crack areas and noncrack areas gradually increases with time, so it is recommended to conduct detection during 2:00–3:00 am; under the condition of no auxiliary heat source, the crack detection is suggested to be arranged in summer with a high incidence of crack; the minimum limit of thermal sensitivity of thermal imager is below 108mk@25°C. The findings in this research can offer guidance for the implementation of IRT‐based crack detection for HSR slab crack.
A Bivalent Bacterium-like Particles-Based Vaccine Induced Potent Immune Responses against the Sudan Virus and Ebola Virus in Mice
Authors: Xu Shengnan , Li Wujian , Jiao Cuicui , Cao Zengguo , Wu Fangfang , Yan Feihu , Wang Hualei , Feng Na , Zhao Yongkun , Yang Songtao , Wang Jianzhong , Xia Xianzhu
Published: April 2023

Ebola virus disease (EVD) is an acute viral hemorrhagic fever disease causing thousands of deaths. The large Ebola outbreak in 2014–2016 posed significant threats to global public health, requiring the development of multiple medical measures for disease control. Sudan virus (SUDV) and Zaire virus (EBOV) are responsible for severe disease and occasional deadly outbreaks in West Africa and Middle Africa. This study shows that bivalent bacterium-like particles (BLPs)-based vaccine, SUDV-EBOV BLPs (S/ZBLP + 2 + P), generated by mixing SUDV-BLPs and EBOV-BLPs at a 1 : 1 ratio, is immunogenic in mice. The SUDV-EBOV BLPs induced potent immune responses against SUDV and EBOV and elicited both T-helper 1 (Th1) and T-helper 2 (Th2) immune responses. The results indicated that SUDV-EBOV BLPs-based vaccine has the potential to be a promising candidate against SUDV and EBOV infections and provide a strategy to develop universal vaccines for EVD.
Assessment of Perioperative Sleep Characteristics Using Subjective and Objective Methods: A Secondary Analysis of Prospective Cohort Study
Authors: In Junyong , Lim Eunjung , Kinjo Sakura
Published: April 2023

Perioperative sleep disturbances may impact healing and negatively affect the patient’s perception of well-being. Therefore, accurately assessing postoperative sleep characteristics is necessary to treat sleep disturbances. This study is a secondary data analysis of research investigating the association between sleep and cognition in a perioperative setting. This study compares sleep characteristics between the St. Mary’s Hospital Sleep Questionnaire and WatchPAT, a portable sleep apnea testing device. The goal of this study is to compare an objective measurement of sleep quality (WatchPAT) with a traditional questionnaire. One hundred and one patients who underwent elective, noncardiac surgical procedures wore a WatchPAT and completed the St. Mary’s Hospital Sleep Questionnaire for three nights: two preoperative and one postoperative night. In the preoperative period, a Bland-Altman analysis showed an agreement Watch PAT and the St Mary’s hospital sleep questionnaire except for sleep fragmentation. A good to fair correlation during the preoperative period was observed with both sleep latency and total sleep time. In the postoperative period, no correlation was observed between the St. Mary’s Hospital Sleep Questionnaire data and WatchPAT data. Our study indicates that some potential factors affecting sleep and cognition such as admission type, depression, anesthesia type, and sleep apnea may limit patients’ ability to report their sleep characteristics after surgery. Therefore, relying solely on one sleep assessment method is not advisable.
Rapid Methods for the Resolution of Contact Problems in Static Linear Elasticity
Authors: Tchoualag Laurent , Ouya Ndjansi Lionel , Woukeng Jean Louis
Published: April 2023

In this paper, the two‐dimensional Signorini static contact problem in linear elasticity is presented. We present the weak formulation of the frictional contact problems, and the boundary integral operators are used to propose a boundary variational formulation whose resolution by the generalized Newton method is presented. Moreover, a particular formulation by the fixed point method associated with the augmented Lagrangian is proposed for efficient analysis of contact problems with Coulomb friction, and powerful algorithms are constructed. The discretization is carried over by using the Galerkin method. The resulting linear system is solved by using a preconditioned conjugate gradient (CG) iterative solver.
Rapid Identification of Seven Common ABO Alleles by Two-Dimensional Polymerase Chain Reaction Technology
Authors: Chen Jin , Zhan Yuxia , Zhang Jun , Yu Yang , Yao Shuang , Luo Guanghua
Published: April 2023

Introduction: The molecular biology detection technology of the human ABO blood group system makes up for the limitations in many aspects compared with conventional serological typing technology. This study aimed to establish a new method to identify seven common ABO alleles (ABO*A1.01, ABO*A1.02, ABO*A2.01, ABO*B.01, ABO*O.01.01, ABO*O.01.02, and ABO*O.02.01) by two-dimensional polymerase chain reaction (2D PCR). 2D PCR can identify multiple target genes in a closed test tube by labeling specific primers with tags homologous to the sequence of fluorescently labeled probes, and melting curve analysis is performed after the fluorescent probes are hybridized with tag complementary sequences in PCR-specific products. In this study, 2D PCR and PCR sequence-specific primer (PCR-SSP) were combined to discriminate different alleles in a single reaction, which has the characteristics of high throughput, and compared with other typing techniques; the typing results can be obtained without additional operations. Methods: The ABO*A1.01 allele genetic sequence was used as the reference sequence. The specific sense and antisense primers for seven common ABO alleles were designed on exons 6 and 7 according to the principle of 2D PCR and PCR-SSP. Single nucleotide polymorphism sites for identifying seven alleles were detected in FAM and HEX channels, respectively. Two hundred sixty DNA samples were enrolled for rapid ABO genotyping by 2D PCR, and 95 of them were selected for Sanger sequencing. The Kappa test was used to analyze the agreement of the methodologies. Results: These 7 alleles each had four characteristic melting valleys at different single nucleotide polymorphism loci. A total of 15 genotypes were detected, including ABO*A1.01/A1.02, ABO*A1.01/O.01.01, ABO*A1.01/O.01.02, ABO*A1.02/A1.02, ABO*A1.02/O.01.01, ABO*A1.02/O.01.02, ABO*B.01/B.01, ABO*B.01/O.01.01, ABO*B.01/O.01.02, ABO*O.01.01/O.01.01, ABO*O.01.01/O.01.02, ABO*O.01.02/O.01.02, ABO*A1.01/B.01, ABO*A1.02/B.01, and ABO*B.01/O.01. v (containing a rare ABO*O allele, based on the sequencing results). The Kappa test showed completely consistent results for 2D PCR and Sanger sequencing (Kappa = 1). Conclusion: The 2D PCR technique could be used for molecular typing of the ABO blood group, which was efficient, rapid, accurate, and economical.
Safety and Efficacy of Ticagrelor versus Clopidogrel in East Asian Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Treated with Dual Antiplatelet Therapy: A Meta-Analysis of Randomized Controlled Trials
Authors: Li Jingyuan , Wang Qian , Wu Chunliu , Qu Xiaoyu , Zhang Lei , He Xiaofeng , Ma Sicong , Qiu Miaohan , Wang Xiaozeng
Published: April 2023

Introduction: The treatment strategy for dual antiplatelet therapy (DAPT) with ticagrelor has been controversial in East Asian patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Our meta-analysis aimed to demonstrate whether intensified antithrombotic regimens with ticagrelor plus aspirin have more beneficial effects and fewer adverse events compared to those of clopidogrel plus aspirin in East Asian patients with ACS undergoing PCI. Methods: We searched PubMed, Embase, Web of Science, ScienceDirect, Clinical Trials, Cochrane Library, and Chinese Clinical Trial Registry for randomized controlled trials (RCTs) comparing the efficacy of DAPT with ticagrelor or clopidogrel plus aspirin for secondary prevention of ACS in East Asian patients undergoing PCI. Risk ratios (RRs) and 95% confidence intervals (CIs) were used as the metrics of choice for assessing treatment effects. The primary endpoint was bleeding events, and the secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs, including cardiovascular death, nonfatal myocardial infarction [MI], and stroke), all-cause death, and definite/probable/possible stent thrombosis. The I2 index was used to assess heterogeneity. Results: Six RCTs involving a total of 2,725 patients met the inclusion criteria. The incidence of all bleeding events with ticagrelor was higher than that with clopidogrel (RR, 1.65; 95% CI, 1.31–2.07), but the incidence of MACCE was not significantly different between the two groups (RR, 1.08; 95% CI, 0.54–2.16). All-cause death (RR, 1.10; 95% CI, 0.67–1.79), cardiovascular death (RR, 1.42; 95% CI, 0.68–2.98), nonfatal MI (RR, 0.92; 95% CI, 0.48–1.78), stroke (RR, 1.00; 95% CI, 0.40–2.50), and stent thrombosis (RR, 0.76; 95% CI, 0.19–2.98) were not statistically different between the two groups. Conclusion: Ticagrelor increased the risk of bleeding and did not increase treatment efficacy compared to that of clopidogrel in the East Asian population who have ACS treated with PCI.
Lipoprotein(a) Is Associated With the Progression and Vulnerability of New-Onset Carotid Atherosclerotic Plaque
Authors: Duan Youling , Zhao Dong , Sun Jiayi , Liu Jun , Wang Miao , Hao Yongchen , Li Jiangtao , Liu Tianxiao , Xiao Luoxi , Hao Yiming , Wang Haimei , Qi Yue , Liu Jing
Published: April 2023

Background:

Although important progress has been made in understanding Lp(a) (lipoprotein[a])-mediated stroke risk, the contribution of Lp(a) to the progression of vulnerable plaque features associated with stroke risk remains unclear. This study aims to evaluate whether Lp(a) is associated with carotid plaque progression, new-onset plaque features, and plaque vulnerability in a prospective community-based cohort study.

Methods:

Baseline Lp(a) levels were measured using latex-enhanced turbidimetric immunoassay among 804 participants aged 45 to 74 years and free of cardiovascular disease in the Chinese Multi-provincial Cohort Study—Beijing project. Carotid atherosclerosis was measured twice by B-mode ultrasonography over a 10-year interval during the 2002 and 2012 surveys to assess the progression of total, vulnerable and stable plaques, and plaque vulnerability. The total plaque area and plaque vulnerability score were calculated.

Results:

The median baseline Lp(a) level was 10.20 mg/dL (interquartile range, 6.20 to 17.18 mg/dL). Modified Poisson regression analysis showed that Lp(a) ≥50 mg/dL was significantly associated with 10-year progression of total carotid plaque (relative risk [RR], 1.41 [95% CI, 1.21–1.64];
E
-value=2.17), vulnerable plaque (RR, 1.93 [95% CI, 1.54–2.41]), and stable plaque (RR, 1.51 [95% CI, 1.11–2.07]) compared with Lp(a) <50 mg/dL. Moreover, among participants without plaque at baseline, Lp(a) ≥50 mg/dL was related to an increased total plaque area (β=0.36 [95% CI, 0.06–0.65];
P
=0.018) and increased plaque vulnerability score (β=0.30 [95% CI, 0.01–0.60];
P
=0.045) in multivariable linear regression.

Conclusions:

Elevated Lp(a) levels were associated with 10-year carotid plaque progression and plaque vulnerability, providing a basis for Lp(a) as a treatment target for stroke prevention.
Price Discrimination in Selection Markets
Authors: Veiga Andre
Published: April 2023

Should insurance prices vary with age? I consider competitive markets for lemons where a signal (e.g., age) partitions consumers (e.g., young and old). I study the continuum of policies from zero price-discrimination (zero- PD, equal prices) to full-PD (no restrictions). Restricting PD can increases welfare if high-cost markets exhibit greater adverse selection, or when the high-cost market “unravels.” I characterize optimal PD, and show how it is affected by changes in cost. In a calibration, optimal PD increases welfare by about $30/person-year. I extend the model to arbitrary signal structures, behavioral consumers, a monopolized industry, and multi-product firms.
Spontaneous Pneumomediastinum is Not Associated With Esophageal Perforation: Results From a Retrospective, Case-Control Study in a Pediatric Population
Authors: Roby Kevin , Barkach Catherine , Studzinski Diane , Novotny Nathan , Akay Begum , Brahmamdam Pavan
Published: April 2023

What is the optimal management of spontaneous pneumomediastinum (SPM) and is there a risk of esophageal perforation in patients with SPM? We performed a retrospective case-control study of children through age 21, diagnosed with SPM in one hospital system over 10 years with the primary aim of describing the diagnostic workup, treatment patterns, and clinical outcomes. We hypothesized that SPM is a self-limited disease and is not associated with esophageal injury. Cases were identified using International Classification of Disease codes and excluded for trauma or severe infections. Median age was 16 years, 66% were male ( n = 179). Chest radiography was performed in 97%, chest computed tomography (CT) in 33%, and esophagrams in 26%. Follow-up imaging showed resolution in 83% (mean = 17.2 days). SPM was not associated with esophageal perforation. We recommend avoiding CT scans and esophagrams unless there is discrete esophageal concern. Management of SPM should be guided by symptomatology.