bluuebunny/crossref_metadata_2025 huggingface dataset:
How do world class top 5 Giro d'Italia finishers train? A qualitative multiple case study
Authors: Gallo Gabriele , Mateo‐March Manuel , Gotti Daniel , Faelli Emanuela , Ruggeri Piero , Codella Roberto , Filipas Luca
Published: June 2022

The aim of this study was to describe individual training strategies in preparation to Giro d'Italia of three world class road cyclists who achieved a top 5 in the general classification. Day‐to‐day power meter training and racing data of three road cyclists (age: 26, 27, 25 years; relative maximum oxygen consumption: 81, 82, 80 ml·min−1·kg−1; relative 20‐min record power output: 6.6, 6.6, 6.4 W kg−1) of the 22 weeks (December–May) leading up to the top 5 in Giro d'Italia general classification were retrospectively analyzed. Weekly volume and intensity distribution were considered. Cyclists completed 17, 22, 29 races, trained averagely for 19.7 (7.9), 16.2 (7.0), 14.7 (6.2) hours per week, with a training intensity distribution of 91.3–6.5‐2.2, 83.6–10.6‐5.8, 86.7–8.9‐4.4 in zone 1‐zone 2‐zone 3 before the Giro d'Italia. Two cyclists spent 55 and 39 days at altitude, one did not attend any altitude camp. Cyclists adopted an overall pyramidal intensity distribution with a relevant increase in high‐intensity volume and polarization index in races weeks. Tapering phases seem to be dictated by race schedule instead of literature prescription, with no strength training performed by the three cyclists throughout the entire periodization.
The virtual good farmer: Farmers’ use of social media and the (re)presentation of “good farming”
Authors: Riley Mark , Robertson Bethany
Published: June 2022

This paper advances the literature on the ‘good farmer’ by considering the role social media may play in the presentation, refinement and reworking of notions of good farming. In exploring these ideas, the paper brings current understandings of the good farmer into conversation with those literatures on online capital exchange and the extensions of Goffman's ideas of identity performance. The paper draws on analysis of 5,000 farming tweets and interviews with 22 farmers who utilize Twitter. The paper considers how social media offers a change to the geographies and temporalities of good farming as it allows connection to a broader, geographically unrestricted, audience, might open up the previously un(der)observed or inaccessible microspaces of the farm, and allow the multifarious and often ephemeral aspects of farming practices to be captured. In moving, conceptually, beyond the idea of identity performance toward one of curation, the paper introduces the idea of didactic text, which serves to contextualize what is seen as good (and bad) farming practice. The paper shows how social media's ability to offer this regular and contextual information allows us to move beyond abstracted and decontextualized symbols of good farming toward recognizing the context‐specific nature of the ‘rules of the game,’ and how a broader audience beyond the farming community may be beginning to play a role in (re)shaping the symbols and practices of good farming.
TMEM16A blockers T16Ainh‐A01 and benzbromarone do not modulate the regulation of sweating and cutaneous vasodilatation in humans in vivo
Authors: Fujii Naoto , Amano Tatsuro , Kenny Glen P. , Mündel Toby , Lei Tze‐Huan , Honda Yasushi , Kondo Narihiko , Nishiyasu Takeshi
Published: June 2022

New Findings

What is the central question of this study?

Do transmembrane member 16A (TMEM16A) blockers modulate the activation of heat loss responses of sweating and cutaneous vasodilatation?

What are the main finding and its importance?

Relative to the vehicle control site, TMEM16A blockers T16Ainh‐A01 and benzbromarone had no effect on sweat rate or cutaneous vascular conductance during whole‐body heating inducing a 1.1 ± 0.1°C increase in core temperature above baseline resting levels. These results suggest that TMEM16A blockers T16Ainh‐A01 and benzbromarone do not modulate the regulation of sweating and cutaneous vasodilatation during whole‐body heat stress.

Animal and in vitro studies suggest that transmembrane member 16A (TMEM16A), a Ca2+‐activated Cl− channel, contributes to regulating eccrine sweating. However, direct evidence supporting this possibility in humans is lacking. We assessed the hypothesis that TMEM16A blockers attenuate sweating during whole‐body heating in humans. Additionally, we assessed the associated changes in the heat loss response of cutaneous vasodilatation to determine if a functional role of TMEM16A may exist. Twelve young (24 ± 2 years) adults (six females) underwent whole‐body heating using a water‐perfused suit to raise core temperature 1.1 ± 0.1°C above baseline. Sweat rate and cutaneous vascular conductance (normalized to maximal conductance via administration of sodium nitroprusside) were evaluated continuously at four forearm skin sites treated continuously by intradermal microdialysis with (1) lactated Ringer's solution (control), (2) 5% dimethyl sulfoxide (DMSO) serving as a vehicle control, or (3) TMEM16A blockers 1 mM T16Ainh‐A01 or 2 mM benzbromarone dissolved in 5% DMSO solution. All drugs were administered continuously via intradermal microdialysis. Whole‐body heating increased core temperature progressively and this was paralleled by an increase in sweat rate and cutaneous vascular conductance at all skin sites. However, sweat rate (all P > 0.318) and cutaneous vascular conductance (all P ≥ 0.073) did not differ between the vehicle control site relative to the TMEM16A blocker‐treated sites. Collectively, our findings indicate that TMEM16A blockers T16Ainh‐A01 and benzbromarone do not modulate the regulation of sweating and cutaneous vasodilatation during whole‐body heating in young adults in vivo.
Abordaje práctico de la heterogeneidad en la lectura crítica de revisiones sistemáticas y metanálisis
Authors: Pineda Álvarez Mateo , Zapata Ospina Juan Pablo
Published: June 2022

Las revisiones sistemáticas de la literatura (RSL) y metaanálisis (MA) son estudios que se encuentran en la cima de la pirámide de la medicina basada en evidencia por su alto poder y precisión al combinar los resultados provenientes de estudios primarios. Uno de los problemas más frecuentes es que los resultados de los estudios varíen de manera significativa entre sí lo que se conoce como heterogeneidad, que puede ser definida como la variabilidad que existe entre los resultados de estudios primarios sobre un desenlace, que puede deberse a las diferencias inherentes a cada estudio. Se puede identificar a través de métodos estadísticos y gráficos. Una vez identificada, se deben ahondar las causas que la expliquen para comprender cómo pueden aplicarse los resultados. También es posible incorporar la heterogeneidad en el MA y minimizarla a través de los modelos estadísticos para combinar los efectos.  En la presente revisión narrativa de la literatura se pretende definir la heterogeneidad en las RSL y MA y ofrecer un abordaje práctico para la lectura crítica de estos estudios secundarios.
Percepciones sobre una estrategia pedagógica en un currículo basado en competencias en Medicina
Authors: Mantilla Gilma Constanza , Santamaria Andrea , Moreno Luna Isabel del Socorro , Ariza Ruiz Liany Katerine
Published: June 2022

Introducción: La Facultad de Medicina de la Pontificia Universidad Javeriana ha venido implementando un plan curricular basado en competencias para garantizar la formación holística de los médicos generales a partir de una estrategia pedagógica denominada actividad integradora (AI), que busca incentivar conocimientos, habilidades y destrezas para el desarrollo de competencias de los médicos en formación. Objetivo: Explorar las percepciones y experiencias de estudiantes, docentes y directivos en el desarrollo de competencias a partir de la implementación de la AI. Método: Estudio cualitativo, descriptivo e interpretativo que se hizo a partir de entrevistas y grupos focales con estudiantes, docentes y personal directivo. Resultados: Se encontró que la AI se constituye como una estrategia de aprendizaje que permite el desarrollo de competencias a través de una didáctica específica que trasforma el escenario pedagógico en un espacio de construcción conjunta de saberes a partir del trabajo en grupo. Conclusiones: Los resultados muestran que, a pesar de que la definición de competencias no es unánime entre los actores, la implementación de la AI ha favorecido que los estudiantes desarrollen conocimientos, habilidades y destrezas desde los saberes propuestos por Miller en el marco de un currículo basado en competencias.
Design and Characterization of a Hollow and Duplex-Chambered Propulsion Module for Narrow Pipe Inspection
Authors: Yamamoto Tomonari , Kamimura Akiya
Published: June 2022

Conventional inspection procedures using industrial endoscope cameras find it challenging to inspect narrow pipes because the endoscope cannot be inserted in the pipes due to the increasing friction and complex pipe structure. Active propulsion techniques can help improve inspection efficiency; however, the locomotion mechanism in such a narrow space is challenging because of the pipe’s geometrical configuration. In this study, a novel flexible propulsion module is proposed for narrow pipe inspection. The module is designed based on a newly proposed hollow-type duplex-chambered inchworm mechanism, which achieves smooth inchworm locomotion using only two air supply lines. With a simple attachable module design, the inspection operator can easily add active propulsion capabilities onto the regular industrial endoscope camera with a maximum diameter of 7 mm. The concept of the system and the structure of the mechanism are presented herein. Various experiments and simulations were performed to reveal the characteristics of the mechanism, and the results are discussed in terms of operating pressure, generated force, and locomotion speed, among other parameters. A prototype demonstrated smooth locomotion through 31-mm pipes at 26.6, 22.1, and 51.1 mm/s for horizontal locomotion, vertical climbing, and vertical descent, respectively, and performed well through a bending pipe.
Kinematic Performance and Static Analysis of a Two-Degree-of-Freedom 3-RPS/US Parallel Manipulator With Two Passive Limbs
Authors: Li Xiao , Qu Haibo , Guo Sheng
Published: June 2022

In this paper, a new 3-RPS (the limb consisting of one revolute, one prismatic, and one spherical joint)/US (universal joint and spherical joint) parallel mechanism with two degrees-of-freedom (DOFs) is obtained by adding a US passive limb into the 3-RPS parallel mechanism with the aim of obtaining a high load-bearing capacity. The moving platform possesses two rotational motions, analyzed by the Grassmann line geometry and screw theory. Then, the kinematic performance of the mechanism is analyzed, including inverse kinematics, overall Jacobian matrix, workspace, and singularity. On this basis, the mapping between the driving force and the load on the moving platform is deduced and verified by simulation. Next, the static of the proposed parallel mechanism is compared with that of the 3-RPS mechanism. The results show that the load-bearing capacity of the mechanism is improved by introducing the US passive limb. Finally, a case study verifies the potential application of the mechanism as a dual-axis tracking photovoltaic bracket.
Analytical Study on Intricacies of Axial Conduction in Microchannel Heat Sinks
Authors: Mitra Indrasis , Ghosh Indranil
Published: June 2022

Microchannel heat sinks are potential devices that remove heat flux from high power density miniaturized electronic components. While the large surface-area-to-volume ratio and high heat transfer coefficient are the key features rendering benefits, the small flow rate and short channel lengths alongside high solid cross section to fluid free flow area make them susceptible to intense axial conduction loss. The conventional models for macrodevices based on the one-dimensional energy equation are often inappropriate in the microdomain. A novel multidimensional analytical model (capable of capturing axial heat transfer in microchannel heat sinks) has been used to study the thermal performance over a varied range of geometric and flow parameters. The effect of axial conduction has been seen in the solid–fluid temperature profiles, interfacial flux distribution and the average amount of heat transferred axially. The results indicate a skewed flux distribution at the fluid–solid interface leading to nonlinear temperature variation when axial conduction is dominant. Moreover, it has been shown that nonlinearity in the fluid temperature introduces significant errors in experimental data reduction, leading to apparently very low Nusselt number estimation. Moreover, this erroneous data interpretation is also linked to the prediction of a strong Reynolds number dependency of the average Nusselt number in the laminar flow regime.
Deformation and Stresses During Alkali Metal Alloying/Dealloying of Sn-Based Electrodes
Authors: Gandharapu Pranay , Mukhopadhyay Amartya
Published: June 2022

Enhancement of energy density and safety aspects of Li-ion cells necessitate the usage of “alloying reaction”-based anode materials in lieu of the presently used intercalation-based graphitic carbon. This becomes even more important for the upcoming Na-ion battery system since graphitic carbon does not intercalate sufficient Na-ions to qualify as an anode material. Among the potential “alloying reaction” based anode materials for Li-ion batteries and beyond (viz., Na-ion, K-ion battery systems), Si and Sn have received the major focus; with the inherently ductile nature of Sn (as against the brittleness of Si) and the considerably better stability in the context of electrochemical Na-/K-storage, of late, tilting the balance somewhat in favor of Sn. Nevertheless, similar to Si and most other “alloying reaction”-based anode materials, Sn also undergoes volume expansion/contraction and phase transformations during alkali metal-ion insertion/removal. These cause stress-induced cracking, pulverization, delamination from current collector, accrued polarization and, thus, fairly rapid capacity fade upon electrochemical cycling. Unlike Si, the aforementioned loss in mechanical integrity is believed to be primarily caused by some of the deleterious first-order phase transformations and concomitant formation of brittle intermetallic phases during the alloying/de-alloying process. Against this backdrop, this review article focuses on aspects related to deformation, stress development and associated failure mechanisms of Sn-based electrodes for alkali-metal ion batteries; eventually establishing correlations between phase assemblage/transformation, stress development, mechanical integrity, electrode composition/architecture and electrochemical behavior.
Dominant hydrophobic interactions with β-glucan in nanoarchitectonics with mixed Langmuir monolayers of cholesterol/dipalmitoyl phosphatidyl choline
Authors: Souza Adriano L. , Oliveira Osvaldo N.
Published: June 2022

The polysaccharide β-glucan, found in the cell wall of cereals such as wheat, oats, and barley, is believed to lower the concentration of bad cholesterol in humans, but the molecular-level mechanisms responsible for such an action are unknown. In this study, we use Langmuir monolayers of cholesterol and dipalmitoyl phosphatidyl choline (DPPC) as cell membrane models that are made to interact with β-glucan. Neat cholesterol and mixed cholesterol/DPPC monolayers were expanded upon incorporating β-glucan from the aqueous subphase. This incorporation was found to induce ordering in mixed monolayers and dehydration of the carbonyl group at higher cholesterol concentrations. These effects are attributed to hydrophobic interactions as identified with polarization-modulated infrared reflection–absorption spectroscopy. They correlate well with the hypothesis that cholesterol levels can be lowered by the formation of soluble fibers with β-glucan through hydrophobic interactions, blocking cholesterol absorption by the organism.
An actin mechanostat ensures hyphal tip sharpness in
Phytophthora infestans
to achieve host penetration
Authors: Bronkhorst Jochem , Kots Kiki , de Jong Djanick , Kasteel Michiel , van Boxmeer Thomas , Joemmanbaks Tanweer , Govers Francine , van der Gucht Jasper , Ketelaar Tijs , Sprakel Joris
Published: June 2022

Filamentous plant pathogens apply mechanical forces to pierce their hosts surface and penetrate its tissues. Devastating
Phytophthora
pathogens harness a specialized form of invasive tip growth to slice through the plant surface, wielding their hypha as a microscopic knife. Slicing requires a sharp hyphal tip that is not blunted at the site of the mechanical interaction. How tip shape is controlled, however, is unknown. We uncover an actin-based mechanostat in
Phytophthora infestans
that controls tip sharpness during penetration. Mechanical stimulation of the hypha leads to the emergence of an aster-like actin configuration, which shows fast, local, and quantitative feedback to the local stress. We evidence that this functions as an adaptive mechanical scaffold that sharpens the invasive weapon and prevents it from blunting. The hyphal tip mechanostat enables the efficient conversion of turgor into localized invasive pressures that are required to achieve host penetration.
Predator control of marine communities increases with temperature across 115 degrees of latitude
Authors: Ashton Gail V. , Freestone Amy L. , Duffy J. Emmett , Torchin Mark E. , Sewall Brent J. , Tracy Brianna , Albano Mariano , Altieri Andrew H. , Altvater Luciana , Bastida-Zavala Rolando , Bortolus Alejandro , Brante Antonio , Bravo Viviana , Brown Norah , Buschmann Alejandro H. , Buskey Edward , Barrera Rosita Calderón , Cheng Brian , Collin Rachel , Coutinho Ricardo , De Gracia Luis , Dias Gustavo M. , DiBacco Claudio , Flores Augusto A. V. , Haddad Maria Angélica , Hoffman Zvi , Erquiaga Bruno Ibañez , Janiak Dean , Campeán Analí Jiménez , Keith Inti , Leclerc Jean-Charles , Lecompte-Pérez Orlando Pedro , Longo Guilherme Ortigara , Matthews-Cascon Helena , McKenzie Cynthia H. , Miller Jessica , Munizaga Martín , Naval-Xavier Lais P. D. , Navarrete Sergio A. , Otálora Carlos , Palomino-Alvarez Lilian A. , Palomo Maria Gabriela , Patrick Chris , Pegau Cormack , Pereda Sandra V. , Rocha Rosana M. , Rumbold Carlos , Sánchez Carlos , Sanjuan-Muñoz Adolfo , Schlöder Carmen , Schwindt Evangelina , Seemann Janina , Shanks Alan , Simoes Nuno , Skinner Luis , Suárez-Mozo Nancy Yolimar , Thiel Martin , Valdivia Nelson , Velez-Zuazo Ximena , Vieira Edson A. , Vildoso Bruno , Wehrtmann Ingo S. , Whalen Matt , Wilbur Lynn , Ruiz Gregory M.
Published: June 2022

Early naturalists suggested that predation intensity increases toward the tropics, affecting fundamental ecological and evolutionary processes by latitude, but empirical support is still limited. Several studies have measured consumption rates across latitude at large scales, with variable results. Moreover, how predation affects prey community composition at such geographic scales remains unknown. Using standardized experiments that spanned 115° of latitude, at 36 nearshore sites along both coasts of the Americas, we found that marine predators have both higher consumption rates and consistently stronger impacts on biomass and species composition of marine invertebrate communities in warmer tropical waters, likely owing to fish predators. Our results provide robust support for a temperature-dependent gradient in interaction strength and have potential implications for how marine ecosystems will respond to ocean warming.
Amplified emission and lasing in photonic time crystals
Authors: Lyubarov Mark , Lumer Yaakov , Dikopoltsev Alex , Lustig Eran , Sharabi Yonatan , Segev Mordechai
Published: June 2022

Photonic time crystals (PTCs), materials with a dielectric permittivity that is modulated periodically in time, offer new concepts in light manipulation. We study theoretically the emission of light from a radiation source placed inside a PTC and find that radiation corresponding to the momentum bandgap is exponentially amplified, whether initiated by a macroscopic source, an atom, or vacuum fluctuations, drawing the amplification energy from the modulation. The radiation linewidth becomes narrower with time, eventually becoming monochromatic in the middle of the bandgap, which enables us to propose the concept of nonresonant tunable PTC laser. Finally, we find that the spontaneous decay rate of an atom embedded in a PTC vanishes at the band edge because of the low density of photonic states.
Observation of a continuous time crystal
Authors: Kongkhambut Phatthamon , Skulte Jim , Mathey Ludwig , Cosme Jayson G. , Hemmerich Andreas , Keßler Hans
Published: June 2022

Time crystals are classified as discrete or continuous depending on whether they spontaneously break discrete or continuous time translation symmetry. Although discrete time crystals have been extensively studied in periodically driven systems, the experimental realization of a continuous time crystal is still pending. We report the observation of a limit cycle phase in a continuously pumped dissipative atom-cavity system that is characterized by emergent oscillations in the intracavity photon number. The phase of the oscillation was found to be random for different realizations, and hence, this dynamical many-body state breaks continuous time translation symmetry spontaneously. Furthermore, the observed limit cycles are robust against temporal perturbations and therefore demonstrate the realization of a continuous time crystal.
Solving the nuclear pore puzzle
Authors: Schwartz Thomas U.
Published: June 2022

Using a battery of tools, the architecture of the nuclear pore complex is revealed
The anti–SARS-CoV-2 monoclonal antibody bamlanivimab minimally affects the endogenous immune response to COVID-19 vaccination
Authors: Benschop Robert J. , Tuttle Jay L. , Zhang Lin , Poorbaugh Josh , Kallewaard Nicole L. , Vaillancourt Peter , Crisp Melissa , Trinh Thi Ngoc Vy , Freitas Joshua J. , Beasley Stephanie , Daniels Montanea , Haustrup Natalie , Higgs Richard E. , Nirula Ajay , Cohen Myron S. , Marovich Mary
Published: June 2022

As the coronavirus disease 2019 (COVID-19) pandemic evolves and vaccine rollout progresses, the availability and demand for monoclonal antibodies for the prevention and treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also accelerating. This longitudinal serological study evaluated the magnitude and potency of the endogenous antibody response to COVID-19 vaccination in participants who first received a COVID-19 monoclonal antibody in a prevention study. Over the course of 6 months, serum samples were collected from a population of nursing home residents and staff enrolled in a clinical trial who were randomized to either bamlanivimab treatment or placebo. In an unplanned component of this trial, a subset of these participants was subsequently fully vaccinated with two doses of either SpikeVax (Moderna) or Comirnaty (BioNTech/Pfizer) COVID-19 mRNA vaccines. This post hoc analysis assessed the immune response to vaccination for 135 participants without prior SARS-CoV-2 infection. Antibody titers and potency were assessed using three assays against SARS-CoV-2 proteins that bamlanivimab does not efficiently bind to, thereby reflecting the endogenous antibody response. All bamlanivimab and placebo recipients mounted a robust immune response to full COVID-19 vaccination, irrespective of age, risk category, and vaccine type with any observed differences of uncertain clinical importance. These findings are pertinent for informing public health policy with results that suggest that the benefit of receiving COVID-19 vaccination at the earliest opportunity outweighs the minimal effect on the endogenous immune response due to prior prophylactic COVID-19 monoclonal antibody infusion.
Closed, Circular Genome Sequence of Aureococcus anophagefferens Virus, a Lytic Virus of a Brown Tide-Forming Alga
Authors: Truchon Alexander R. , Gann Eric R. , Wilhelm Steven W.
Published: June 2022

Here, we report the genomic sequence ofAureococcus anophagefferensvirus, assembled into one circular contig from both Nanopore and Illumina reads. The genome is 381,717 bp long with a GC content of 29.1%, which includes an additional 5-kb region between the previously predicted polar ends of the reference genome.
Rifampicin Resistance Associated with
rpoB
Mutations in Neisseria gonorrhoeae Clinical Strains Isolated in Austria, 2016 to 2020
Authors: Schaeffer Justine , Lippert Kathrin , Pleininger Sonja , Stöger Anna , Hasenberger Petra , Stadlbauer Silke , Heger Florian , Eigentler Angelika , Geusau Alexandra , Indra Alexander , Allerberger Franz , Ruppitsch Werner
Published: June 2022

Gonorrhea, caused by
Neisseria gonorrhoeae
, is one of the most common bacterial sexually transmitted infections. It is treated with antibiotics, but an increasing number of
N. gonorrhoeae
strains are resistant to currently used treatments.
U-Pb and fission-track data from zircon and apatite resolve latest- and post-Alleghanian thermal histories along the Fall Line of the Atlantic margin of the southeastern United States
Authors: Craddock William H. , O'Sullivan Paul B. , McAleer Ryan J.
Published: June 2022

Although the Atlantic continental margin of the eastern United States is an archetypal passive margin, episodes of rejuvenation following continental breakup are increasingly well documented. To better constrain this history of rejuvenation along the southern portion of this continental margin, we present zircon U-Pb (ZUPb) age, zircon fission-track (ZFT) age, apatite U-Pb (AUPb) age, and apatite fission-track (AFT) age and length data from six bedrock samples. The samples were collected along the boundary between the exposed Appalachian hinterland (Piedmont province) and the updip limit of passive margin strata (Coastal Plain province). The samples were collected from central Virginia southward to the South Carolina–Georgia border. ZUPb age distributions are generally consistent with geologic mapping in each of the sample areas. The AUPb data are highly discordant owing to high common-Pb abundances, but for two plutons at the northern and southern ends of the sample area, they define a discordia regression line that indicates substantial Permo-Triassic exhumation-driven cooling. ZFT age distributions are highly dispersed but define central values ranging from Permian to Jurassic. AFT data mostly appear to define a singular underlying cooling age, generally approximately Jurassic or Early Cretaceous. Apatite fission tracks are moderately long (mean lengths in the range of ~13.5 µm), however track lengths for one sample in central North Carolina are shorter (~12.5 µm). To interpret the post-breakup thermal history, we present inverse models of time-temperature history for the five plutonic samples. The models show a history of (1) rapid cooling (>10 °C/m.y.) from deep-crustal to near-surface temperatures by the Triassic, (2) hundreds of degrees of Triassic reheating, (3) Jurassic–Early Cretaceous cooling (at rates of 1–10 °C/m.y.), and (4) slow Late Cretaceous–Cenozoic cooling (~1 °C/m.y.). An additional suite of forward models is presented to further evaluate the magnitude of maximum Triassic reheating at one sample site that is particularly well constrained by thermal maturity data. The model results and geologic reasoning suggest that the inverse models may overestimate Triassic paleotemperatures but that other aspects of the inverse modeling are robust. Overall, this thermal history can be reconciled with several aspects of the lithostratigraphy of distal parts of the continental margin, including the lack of Jurassic–earliest Cretaceous strata beneath the southern Atlantic coastal plain and Cretaceous–Cenozoic grain-size trends.
Goal-based measurement in paediatric settings: implications for practice
Authors: Jacob Jenna , Edbrooke-Childs Julian , Flannery Halina , Segal Terry Y , Law Duncan
Published: June 2022

There is an observed link between physical illness and mental health difficulties and an increased likelihood of mental health difficulties in young people with chronic health conditions. The main outcome focus in paediatric settings is on physical health outcomes and functioning. In terms of functioning, the focus is on quality of life, measures of emotional well-being and perceptions of personal change, which are likely to be multifaceted and vary between patients. To complement standardised and diagnostically based measures, goal-based outcome measurement may be considered. The aim of this paper is to build on previous research, to provide a reflective commentary based on the authors’ clinical and research experience in the use and interpretation of goal-based outcomes, to address what using goal-based measures for outcome purposes in these settings means practically. Examples are provided to demonstrate the importance of considering meaningful outcomes of importance to young people and how professionals may presume that physical ‘recovery’ is the goal of treatment, but what recovery means to that young person may be very nuanced. Further key considerations and suggested phrasing are given to introduce and work with young people’s goals.
Using novel PF4-dependent P-selectin expression assay to diagnose heparin-induced thrombocytopaenia postliver transplantation
Authors: Tchen Stephanie , Bhatt Rootvij , Rezazadeh Alexandra , Foy Patrick
Published: June 2022

Heparin-induced thrombocytopaenia (HIT) is a well-known adverse event associated with the use of heparin products. HIT may be difficult to diagnose in patients following liver transplantation as patients routinely require massive transfusion support and immunosuppression. As an alternative or adjunctive to the serotonin release assay, the PF4-dependent P-selectin expression assay (PEA) may be a useful diagnostic test in the determination of HIT in this patient population. In this case, we describe a 63-year-old man who had an orthotopic liver transplant that was complicated by HIT that was diagnosed using the PEA.
Thoracic venous malformation: a particular form of a visceral variant
Authors: Pessanha Inês , Triana Paloma , Martinez-Glez Victor , Lopez-Gutierrez Juan Carlos
Published: June 2022

A teenage boy was admitted due to a thoracic mass with previous respiratory infections. The CT scan showed phleboliths in a cystic lesion with large draining channels. He also presented a mild thrombocytosis, elevated fibrinogen and D-dimer. Arteriogram revealed no abnormal arterial supply but venography proved venous draining channels as the major components of the lesion. The most important venous pedicle was embolised. However, 6 months later, CT scan showed no reduction in lesion size. Surgical resection was performed. Anatomopathological study described a venous malformation (VM) with a lymphatic component, and genetic testing found a typical mutation inPIK3CAand genetic variant inMAP3K3. This case reports a very rare pattern of thoracic vascular tumour. The authors aim to highlight the importance of genetic studies of VM with atypical presentation in order to achieve a definitive diagnosis.
Approach for reporting master protocol study designs on ClinicalTrials.gov: qualitative analysis
Authors: Williams Rebecca J , Dobbins Heather D , Tse Tony , Chon Sandy D , Loose David , Sarosy Gisele A , Prindiville Sheila A , Rockhold Frank W , Zarin Deborah A
Published: June 2022

Objective

To describe an approach for reporting master protocol research programs (MPRPs) that is consistent with existing good reporting practices and that uses structured information to convey the overall master protocol and design of each substudy.

Design

Qualitative analysis.

Data sources

ClinicalTrials.gov trial registry.

Main outcome measures

Established goals and related practices of the trial reporting system were outlined, examples and key characteristics of MPRPs were reviewed, and specific challenges in registering and reporting summary results to databases designed for traditional clinical trial designs that rely on a model of one study per protocol were identified.

Results

A reporting approach is proposed that accommodates the complex study design of MPRPs and their results. This approach involves the use of separate registration records for each substudy within one MPRP protocol (with potential exceptions noted).

Conclusions

How the proposed approach allows for clear, descriptive, structured information about each substudy’s prespecified design and supports timely reporting of results after completion of each substudy is described and illustrated. Although the focus is on reporting to ClinicalTrials.gov, the approach supports broader application across trial registries and results databases. This paper is intended to stimulate further discussion of this approach among stakeholders, build awareness about the need to improve reporting of MPRPs, and encourage harmonization across trial registries globally.
Health literacy in medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway
Authors: Bengtsson Kajsa Rebecka , Rognan Stine Eidhammer , Kälvemark Sporrong Sofia , Lie Helene Berg , Andersson Yvonne , Mowe Morten , Mathiesen Liv
Published: June 2022

Objective

When discharged from hospital patients are often assumed to have sufficient health literacy (HL) to participate in their medical treatment and manage medical self-care after discharge. However, limited HL is a widespread concern and patient participation during discharge is lacking. In this study, we explore how HL influences medication communication during hospital discharge.

Design

A qualitative case study, comprising unstructured observations of patient–healthcare personnel (HCP) encounters followed by semistructured interviews. Data were analysed using content analysis.

Setting

An internal medicines ward at a university hospital in Norway.

Participant

Fifteen patients aged 40–89 years were included close to the day of discharge.

Results

The following themes describing dimensions of HL emerged: (1) access, (2) understand, (3) appraise and (4) apply. Most patients sought access to medication information from HCP, while some felt dependent on HCP to provide it. However, their abilities to understand, evaluate and make informed decisions were challenged, partly because HCPs’ ability to adapt their communication to the patient’s knowledgebase varied.

Conclusion

The results give a broader understanding of how HL influences medication communication during hospital discharge. To consider central dimensions of HL is important to achieve optimal medication communication, as the communication only can be exercised within the frames of the patient’s HL. The findings in this study support that HL should be described as a shared responsibility between the patients and HCP. Attention should be focused to the HCP’s responsibility to adapt the communication to the patient’s knowledgebase.
Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme
Authors: Evans Subhadra , Olive Lisa , Dober Madeleine , Knowles Simon , Fuller-Tyszkiewicz Matthew , O Eric , Gibson Peter , Raven Leanne , Gearry Richard , McCombie Andrew , van Niekerk Leesa , Chesterman Susan , Romano Daniel , Mikocka-Walus Antonina
Published: June 2022

Introduction

Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD.

Methods and analysis

Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition.

Ethics and dissemination

This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences.

Trial registration number

ACTRN12621001316897.
Multilevel determinants of racial/ethnic disparities in severe maternal morbidity and mortality in the context of the COVID-19 pandemic in the USA: protocol for a concurrent triangulation, mixed-methods study
Authors: Liu Jihong , Hung Peiyin , Liang Chen , Zhang Jiajia , Qiao Shan , Campbell Berry A , Olatosi Bankole , Torres Myriam E , Hikmet Neset , Li Xiaoming
Published: June 2022

Introduction

The COVID-19 pandemic has affected communities of colour the hardest. Non-Hispanic black and Hispanic pregnant women appear to have disproportionate SARS-CoV-2 infection and death rates.

Methods and analysis

We will use the socioecological framework and employ a concurrent triangulation, mixed-methods study design to achieve three specific aims: (1) examine the impacts of the COVID-19 pandemic on racial/ethnic disparities in severe maternal morbidity and mortality (SMMM); (2) explore how social contexts (eg, racial/ethnic residential segregation) have contributed to the widening of racial/ethnic disparities in SMMM during the pandemic and identify distinct mediating pathways through maternity care and mental health; and (3) determine the role of social contextual factors on racial/ethnic disparities in pregnancy-related morbidities using machine learning algorithms. We will leverage an existing South Carolina COVID-19 Cohort by creating a pregnancy cohort that links COVID-19 testing data, electronic health records (EHRs), vital records data, healthcare utilisation data and billing data for all births in South Carolina (SC) between 2018 and 2021 (>200 000 births). We will also conduct similar analyses using EHR data from the National COVID-19 Cohort Collaborative including >270 000 women who had a childbirth between 2018 and 2021 in the USA. We will use a convergent parallel design which includes a quantitative analysis of data from the 2018–2021 SC Pregnancy Risk Assessment and Monitoring System (unweighted n>2000) and in-depth interviews of 40 postpartum women and 10 maternal care providers to identify distinct mediating pathways.

Ethics and dissemination

The study was approved by institutional review boards at the University of SC (Pro00115169) and the SC Department of Health and Environmental Control (DHEC IRB.21-030). Informed consent will be provided by the participants in the in-depth interviews. Study findings will be disseminated with key stakeholders including patients, presented at academic conferences and published in peer-reviewed journals.
Using stated-preferences methods to develop a summary metric to determine successful treatment of children with a surgical condition: a study protocol
Authors: Rivero-Arias Oliver , Buckell John , Allin Benjamin , Craig Benjamin M , Ayman Goher , Knight Marian
Published: June 2022

Introduction

Wide variation in the management of key paediatric surgical conditions in the UK has likely resulted in outcomes for some children being worse than they could be. Consequently, it is important to reduce unwarranted variation. However, major barriers to this are the inability to detect differences between observed and expected hospital outcomes based on the casemix of the children they have treated, and the inability to detect variation in significant outcomes between hospitals. A stated-preference study has been designed to estimate the value key stakeholders place on different elements of the outcomes for a child with a surgical condition. This study proposes to develop a summary metric to determine what represents successful treatment of children with surgical conditions.

Methods and analysis

Preferences from parents, individuals treated for surgical conditions as infants/children, healthcare professionals and members of the public will be elicited using paired comparisons and kaizen tasks. A descriptive framework consisting of seven attributes representing types of operations, infections treated in hospital, quality of life and survival was identified. An experimental design has been completed using a D-efficient design with overlap in three attributes and excluding implausible combinations. All participants will be presented with an additional choice task including a palliative scenario that will be used as an anchor. The survey will be administered online. Primary analysis will estimate a mixed multinomial logit model. A traffic light system to determine what combination of attributes and levels represent successful treatment will be created.

Ethics and dissemination

Ethics approval to conduct this study has been obtained from the Medical Sciences Inter-Divisional Research Ethics Committee (IDREC) at the University of Oxford (R59631/RE001-05). We will disseminate all of our results in peer-review publications and scientific presentations. Findings will be additionally disseminated through relevant charities and support groups and professional organisations.
Green endoscopy: practical implementation
Authors: Donnelly Leigh
Published: June 2022

There is a necessity for endoscopy services as a speciality to lead the way in creating more sustainable departments. It is important we seek to explore and implement practical measures to ensure endoscopy services are working to meet our sustainability goals. The following article explores the practical implementation of measures which can be taken to make endoscopy greener.
Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: a consensus document
Authors: Macken Lucia , Corrigan Margaret , Prentice Wendy , Finlay Fiona , McDonagh Joanne , Rajoriya Neil , Salmon Claire , Donnelly Mhairi , Evans Catherine , Ganai Bhaskar , Bedlington Joan , Steer Shani , Wright Mark , Hudson Ben , Verma Sumita
Published: June 2022

Palliative care remains suboptimal in advanced cirrhosis, in part relating to a lack of evidence-based interventions. Ascites remains the most common cirrhosis complication resulting in hospitalisation. Many patients with refractory ascites are not candidates for liver transplantation or transjugular intrahepatic portosystemic shunt, and therefore, require recurrent palliative large volume paracentesis in hospital. We review the available evidence on use of palliative long-term abdominal drains in cirrhosis. Pending results of a national trial (REDUCe 2) and consistent with recently published national and American guidance, long-term abdominal drains cannot be regarded as standard of care in advanced cirrhosis. They should instead be considered only on a case-by-case basis, pending definitive evidence. This manuscript provides consensus to help standardise use of long-term abdominal drains in cirrhosis including patient selection and community management. Our ultimate aim remains to improve palliative care for this under researched and vulnerable cohort.
Histopathologist and clinician interface in diagnosis and management of autoimmune hepatitis
Authors: Flatley Sarah , Dube Asha K , Gleeson Dermot
Published: June 2022

Diagnosis of AIH is based on a combination of clinical, laboratory and histological information. It has been formalised by diagnostic scoring systems, to which liver biopsy contributes substantially. Diagnostic biopsy is thus, desirable in nearly all patients. An adequate biopsy size, provision by clinicians of adequate information to histopathologists and active discussion at regular meetings are all important for accurate histological diagnosis. Recently, the specificity of some features previously thought to suggest AIH has been questioned, and new recommendations for histological diagnosis have been proposed, although not yet validated. The histology of acutely presenting AIH and that of severe or fulminant AIH include some characteristic features. Primary biliary cholangitis, primary sclerosing cholangitis and non-alcoholic fatty liver disease may co-exist with AIH on biopsy. Liver biopsy also enables grading of severity of inflammation and staging of fibrosis. Presence of cirrhosis is a poor prognostic marker. Repeat liver biopsy after achieving biochemical remission, although not performed routinely, enables assessment of (a) histological remission, a favourable prognostic indicator and (b) fibrosis progression. It can thus help determine further management.
Association of intermittent versus continuous hemodialysis modalities with mortality in the setting of acute stroke among patients with end-stage renal disease
Authors: Morgan Michael C , Waller Jennifer L , Bollag Wendy B , Baer Stephanie L , Tran Sarah , Kheda Mufaddal F , Young Lufei , Padala Sandeep , Siddiqui Budder , Mohammed Azeem
Published: June 2022

Patients with end-stage renal disease (ESRD) are 8–10 times more likely to suffer from a stroke compared with the general public. Despite this risk, there are minimal data elucidating which hemodialysis modality is best for patients with ESRD following a stroke, and guidelines for their management are lacking. We retrospectively queried the US Renal Data System administrative database for all-cause mortality in ESRD stroke patients who received either intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT). Acute ischemic stroke and hemorrhagic stroke were identified using the International Classification of Diseases 9th Revision (ICD-9)/ICD-10 codes, and hemodialysis modality was determined using Healthcare Common Procedure Coding System (HCPCS) codes. Time to death from the first stroke diagnosis was the outcome of interest. Cox proportional hazards modeling was used, and associations were expressed as adjusted HRs. From the inclusion cohort of 87,910 patients, 92.9% of patients received IHD while 7.1% of patients received CRRT. After controlling for age, race, sex, ethnicity, and common stroke risk factors such as hypertension, diabetes, tobacco use, atrial fibrillation, and hyperlipidemia, those who were placed on CRRT within 7 days of a stroke had an increased risk of death compared with those placed on IHD (HR=1.28, 95% CI 1.25 to 1.32). It is possible that ESRD stroke patients who received CRRT are more critically ill. However, even when the cohort was limited to only those patients in the intensive care unit and additional risk factors for mortality were controlled for, CRRT was still associated with an increased risk of death (HR=1.32, 95% CI 1.27 to 1.37). Therefore, further prospective clinical trials are warranted to address these findings.