bluuebunny/crossref_metadata_2025 huggingface dataset:
Flying with nut and other food allergies: unravelling fact from fiction
Authors: Turner Paul , Dowdall Nigel
Published: October 2024

There is a common perception that peanut/tree nut particles can be transmitted through aircraft ventilation systems and pose a significant risk to passengers with food allergies. In fact, food-induced allergic reactions are around 10–100 times less common during flights than ‘on the ground’, perhaps because of the multiple precautions food-allergic passengers take when flying. We review the evidence for strategies to help prevent accidental allergic reactions while travelling on commercial flights (review registered at PROSPERO, ref CRD42022384341). Research studies (including aircraft simulations) show no evidence to support airborne transmission of nut allergens as a likely phenomenon. Announcements requesting ‘nut bans’ are not therefore supported, and may instal a false sense of security. The most effective measure is for passengers to wipe down their seat area (including tray table and seat-back entertainment system). Food proteins are often ‘sticky’ and adhere to these surfaces, from where they are easily transferred to a person’s hands and onto food that might be consumed. Airline companies can help to facilitate this through pre-boarding. Passengers at risk of anaphylaxis should be prescribed two adrenaline [epinephrine] autoinjector devices, to carry on their person at all times—including when flying. Airlines should consider including a separate supply of ‘general use’ adrenaline autoinjectors in the onboard medical kit for use in an emergency. All airlines should have clear policies relating to food allergies which are easily available from their websites or on request. These policies should be applied consistently by both ground staff and cabin crew, in order to provide reassurance to food-allergic passengers and their caregivers.
Management of superior vena cava syndrome during lung transplantation for a patient with cystic fibrosis
Authors: Upadhyay Binayak , Anstead Michael I , Keshavamurthy Suresh , Gurley John
Published: October 2024

Central venous catheters including totally implantable venous access devices (TIVADs) have revolutionised the management of pulmonary infections and exacerbations in patients with cystic fibrosis (CF). While being better tolerated by the patient, these have allowed aggressive intravenous antibiotic therapies during recurrent hospitalisations. Given improvement in procedural strategies and operator experience, many patients with CF undergo lung transplants in the course of their disease nowadays. TIVADs can be associated with thrombosis leading to superior vena cava (SVC) obstruction and SVC syndrome which can pose a challenge, especially during the transplant surgery. We describe a case of successful management of SVC syndrome in a patient with CF undergoing a lung transplant, highlighting the strategies used to minimise risks associated with such a procedure.
Prioritising primary care patients with unexpected weight loss for cancer investigation: diagnostic accuracy study (update)
Authors: Nicholson Brian D , Virdee Pradeep , Aveyard Paul , Price Sarah J , Hobbs F D Richard , Koshiaris Constantinos , Hamilton Willie
Published: October 2024

Objective

To quantify the predictive value of unexpected weight loss for cancer according to patient’s age, sex, smoking status, and concurrent clinical features (symptoms, signs, and abnormal blood test results).

Design

Diagnostic accuracy study (update).

Setting

Data from Clinical Practice Research Datalink electronic health records linked to the National Cancer Registration and Analysis Service in primary care, England.

Participants

326 240 adults (≥18 years) with a code for unexpected weight loss from 1 January 2000 to 31 December 2019.

Main outcome measures

Cancer diagnosis in the six months after the earliest weight loss code (index date). Codes for additional clinical features were identified in the three months before to one month after the index date. Diagnostic accuracy measures included positive and negative likelihood ratios, positive predictive values, and diagnostic odds ratios.

Results

Of 326 240 adults with unexpected weight loss, 184 270 (56.5%) were women, 176 508 (54.1%) were aged ≥60 years, and 176 053 (54.0%) were ever smokers. 15 624 (4.8%) had a diagnosis of cancer within six months of the index date, of whom 15 051 (96.3%) were aged ≥50 years. The positive predictive value for cancer was above the 3% threshold recommended by the National Institute for Health and Care Excellence for urgent investigation in men aged ≥50 years and women aged ≥60 years. 17 additional clinical features were associated with cancer in younger men with unexpected weight loss, and eight in women. Positive likelihood ratios in men ranged from 1.43 (95% confidence interval 1.30 to 1.58) for fatigue to 21.00 (8.59 to 51.37) for rectal mass, and in women from 1.28 (1.16 to 1.41) for back pain to 19.46 (12.69 to 29.85) for pelvic mass. Abnormal blood test results associated with cancer included low albumin (positive likelihood ratio 3.24, 3.13 to 3.35) and raised platelets (3.48, 3.35 to 3.62), total white cell count (3.01, 2.89 to 3.14), and C reactive protein (3.13, 3.05 to 3.20). However, no normal blood test result in isolation ruled out cancer. Clinical features co-occurring with unexpected weight loss were associated with multiple cancer sites.

Conclusion

The risk of cancer in younger adults with unexpected weight loss presenting to primary care is <3% and does not merit investigation under current UK guidelines. However, in men aged ≥50 years, women aged ≥60 years, and younger patients with concurrent clinical features, the risk of cancer warrants referral for invasive investigation. Clinical features typically associated with specific cancer sites are markers of several cancer types when they occur with unexpected weight loss.

Readers’ note

This article is an updated version of a previously published BMJ paper that has since been retracted.
Complex trauma and the unseen: who gets to be a victim?
Authors: Watts Jay
Published: October 2024

The inclusion of complex post-traumatic stress disorder (cPTSD) in the International Classification of Diseases 11th Revision in January 2022 marks a significant advancement in trauma recognition. However, while cPTSD offers a more inclusive framework, it risks perpetuating trauma hierarchies by reinforcing a division where some trauma responses are attributed to personality disorders (such as borderline personality disorder) and others to external factors (cPTSD). This division echoes one of the oldest themes in victimology—the separation of ‘deserving’ and ‘undeserving’ victims—raising broader questions about what is recognised as complex trauma. Survivors often face the danger of being ‘unvictimed’, where their experiences are dismissed or invalidated either internally or by families, society and institutions. Unvictiming results from trauma ideals that establish an elusive standard of what trauma should look like. While cPTSD broadens psychiatry’s role in shaping these ideals, it merely moves the goalposts rather than changing the rules of the game. To prevent the reproduction of a two-tier system, we should adopt transdiagnostic and transmodality approaches, ensuring that complex trauma recognition is accessible to all who find it validating. While systemic changes are essential, we can immediately focus on small acts of trauma recognition within clinical settings, which validate survivors and help expand our collective understanding of trauma.
Paroxysmal sympathetic hyperactivity caused by neurosyphilis
Authors: Fujiki Shuko , Fujino Masaki , Machida Akira
Published: October 2024

Background

Paroxysmal sympathetic hyperactivity (PSH) is a condition characterised by dysregulation of the autonomic nervous system commonly associated with severe traumatic brain injury. Recently, non-traumatic causes, such as infections and autoimmune conditions, have also been reported as potential triggers.

Case presentation

A 30-year-old man presented with convulsions following 5 days of soliloquy, insomnia and agitation. Neurosyphilis was diagnosed based on elevated non-treponemal and treponemal test findings in the serum and cerebrospinal fluid. Intravenous penicillin administration improved his alertness; however, by day 9, he experienced recurrent episodes of tachycardia, tachypnoea, hyperthermia, hypertension, limb stiffness and diaphoresis. The exclusion of sepsis, pulmonary embolism and malignant syndrome, combined with unremarkable interictal electroencephalogram findings and a high PSH Assessment Measure Score, led to a PSH diagnosis on day 40. Treatment with propranolol, gabapentin and clonidine resolved the episodes, and the patient regained independent ambulation.

Conclusions

This is the first reported case of neurosyphilis accompanied by PSH. Although PSH is rare in central nervous system infections compared with traumatic brain injury, early recognition is crucial, as untreated cases can persist and result in severe complications.
Association of regular plasmapheresis donation with serum protein and electrolyte levels: a multicentre cross-sectional study in China
Authors: Xiao Guanglin , Li Changqing , Chen Yongjun , Song Wenfu , Yang Hui , Yang Yating , Zhang Yu , Pu Zhongping , Wang Xiufang , Xie Shina , Yang Shouqiang , Zeng Jun , Li Wan , Wang Ya
Published: October 2024

Background

China’s plasmapheresis donation policy differs from that of Western countries. The association between regular plasmapheresis donation and donor health in China is still unknown.

Objectives

To investigate the association of regular plasmapheresis donation with serum protein and electrolyte levels and provide scientific evidence for policy improvement.

Design

Multicentre cross-sectional study.

Setting and participants

A total of 767 regular and 726 new donors from the provinces of Sichuan, Hunan, Henan and Yunnan were recruited from September 2021 to October 2022.

Primary and secondary outcome measures

Our primary outcome focused on measuring the levels of serum protein and electrolyte levels, including total serum protein (TSP), IgG, albumin (Alb), haemoglobin (Hb), calcium, potassium (K+) and magnesium (Mg2+). The secondary outcome assessed their abnormal rates.

Results

Male and female donors in the high donation frequency group (>16 donations per year) exhibited lower IgG levels compared with new donors (p=0.008 for male donors and p=0.007 for female donors). Additionally, female donors with high donation frequency and a high total number of lifetime donations (>100 donations) had significantly lower Hb concentrations than new donors. However, no significant changes were observed in TSP, Alb, calcium, K+and Mg2+levels. There were also no statistically significant differences in the rates of abnormal protein and electrolyte values below the respective threshold levels between new and regular donors.

Conclusions

Plasmapheresis donation is not associated with an increased risk of abnormalities in the analysed parameters. However, the results provide preliminary evidence supporting the routine inclusion of IgG screening for donors, as plasmapheresis donation is associated with a decrease in IgG levels. Particular attention should be paid to the Hb levels of female donors, especially those who donate frequently. Testing of TSP at each donation may not be necessary.
Piloting a PREMs and PROMs longitudinal survey on the integration of healthcare services for patients living with hepatitis C in Tuscany region: study protocol
Authors: Corazza Ilaria , Moretti Giaele , Ceccarelli Luca , Tavoschi Lara , Vainieri Milena
Published: October 2024

Introduction

Patient-reported measures are an invaluable resource for health systems to improve the quality of healthcare services. Patients with hepatitis C virus (HCV) are an under-represented group within the stream of literature on collecting and using the experiences and outcomes reported by patients to improve healthcare performance. This protocol outlines the methodology to implement a longitudinal survey in Tuscany, Italy, to systematically gather patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) for patients with HCV, with a focus on the integration of primary and hospital care.

Methods and analysis

We designed and developed a longitudinal survey to collect HCV PREMs and PROMs. The survey, which lasts 1 year, consists of three questionnaires, starting with the first visit with a specialist/treatment initiation, with follow-ups at 6 and 12 months. It was implemented in six hospitals in Tuscany, Italy, of which three are University Hospitals. The survey was offered to all patients treated for HCV at these healthcare centres, deliberately not applying a specific criterion for patient selection, through both paper based and electronic modes of completion. The data from the three structured questionnaires will be analysed quantitatively.

Ethics and dissemination

The Ethics Committee for Clinical Experimentation of Area Vasta Nord Ovest approved the protocol (CEAVNO—CODE 18829). Participation in this study is voluntary. Study results will be disseminated through peer-reviewed publications and academic conferences.
Modified tai chi movement training based on sEMG and movement analysis on improving upper extremities motor function: a protocol for a clinical randomised controlled trial
Authors: Li Zhi , Li Xiaoyi , Fu Xueming , Zhou Ting , Wang Pei , Fang Leiwen , Sun Zihan , Wang Hongxing
Published: October 2024

Introduction

Stroke survivors often face motor dysfunction, increasing fall risk. Lower extremity muscle weakness is a key factor affecting walking ability. Tai chi (TC) has been shown to improve muscle strength and mobility in patients with stroke more effectively than traditional walking training. However, existing TC programmes for stroke rehabilitation are often too simplified and fail to fully use TC’s benefits. Additionally, subjective assessment scales are time-consuming and prone to bias. This study proposes integrating TC’s early movement features with neurodevelopmental therapy, using surface electromyography and inertial measurement unit (IMU) sensors to thoroughly analyse diverse TC movements. Tailored exercises, based on stroke-induced impairments, will be objectively assessed through biomechanical analysis.

Methods and analysis

The study unfolds in two phases. The initial phase employs the IMU sensor and electromyography to objectively analyse TC’s biomechanics, informing personalised rehabilitation plans aligned with distinct movement impairments. The second phase adopts a randomised, single-blind, parallel controlled trial design involving 60 patients with stroke randomly assigned to either the intervention or control group. The intervention group undergoes biomechanics-based TC training alongside routine rehabilitation for 12 weeks, practicing the 24-form TC three times weekly. The control group engages in routine rehabilitation thrice weekly for the same duration. Primary and secondary outcomes, including kinematic/dynamic data, surface electromyography, motion analysis, comprehensive the international classification of functioning, disability and health Core Set for Stroke, Modified Barthel Index and Fugl-Meyer Assessment, will be evaluated at baseline and post-intervention.

Ethics and dissemination

The study has received approval from the Ethics Committee of Zhongda Hospital Southeast University (2023ZDSYLL378-P01). All prospective participants will receive comprehensive information regarding the study protocol, and their informed consent will be obtained before their participation. Additionally, the trial will be registered with the Chinese Clinical Trial Registry to ensure transparency and compliance with research regulations. Results from this study will be disseminated through peer-reviewed journals, conference presentations and public databases to ensure wide accessibility and to contribute to the advancement of medical knowledge.

Protocol version

2.0 (14 June 2024).

Trial registration number

www.chictr.org.cn, identifier ChiCTR2400080158.
ABO blood types and head and neck cancer: a systematic review with meta-analysis of observational studies
Authors: Shi Hanbo , Yao Jingjing , Jiang Chenchen , Xu Wenying , Jiang Zhongliang , Chen Yan , Qian Yun
Published: October 2024

Objectives

This research aims to explore the correlation between ABO blood groups and neoplasms in the head and neck region, specifically investigating the susceptibility of different blood groups to tumours.

Design

Systematic review and meta-analysis.

Data sources

CNKI, WANFANG DATA, PubMed, Web of Science and Embase databases were systematically searched from inception to January 2024.

Eligibility criteria

All studies of ABO blood type and head and neck tumours will be included in this study.

Data extraction and synthesis

A systematic literature review was performed using digital platforms on CNKI, WANFANG DATA, PubMed, Web of Science and Embase databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for meta-analysis. Two authors independently extracted the data and assessed the quality of included studies. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. Comparisons were made between blood types A, B, AB and their combined group versus O, along with subgroup analyses. Systematic analysis was performed by using Review Manager V.5.4 and Stata V.18 statistical software.

Results

30 articles were included, involving 737 506 subjects, among which 21 382 were patients with head and neck tumours. The overall analysis indicated a significant association between type AB blood (OR 0.762, 95% CI 0.637 to 0.910) and a reduced risk of head and neck tumours. In the Caucasoid race, type A blood is significantly linked to an elevated likelihood of head and neck tumours (OR 1.353, 95% CI 1.076 to 1.702), while in the Mongoloid race, type AB blood is significantly linked to a reduced likelihood of developing tumours in the head and neck area (OR= 0.732, 95% CI 0.588 to 0.910). No significant associations were found in the subgroup analysis by gender. Regarding different types of cancer, type A blood is significantly associated with an increased risk of salivary gland tumours (OR 1.338, 95% CI 1.075 to 1.665), and type AB blood is significantly linked to a lower likelihood of nasopharyngeal carcinoma (OR 0.590, 95% CI 0.429 to 0.812).

Conclusion

A correlation exists between ABO blood groups and tumours in the head and neck region. However, the link between blood type and head and neck tumours requires further confirmation through more prospective studies.

PROSPERO registration number

CRD42024510176.
Metabolic and bariatric surgery for obstructive sleep apnoea syndrome: bibliometric analysis and visualisation from 1999 to 2023
Authors: Jiang Tao , Zhang Xuan , Wang Hui , Yi Xianhao
Published: October 2024

Objectives

Metabolic and bariatric surgery (MBS) for obstructive sleep apnoea syndrome (OSAS) has garnered significant research interest. The main aim of this study was to analyse the unique characteristics of publications centred around MBS for OSAS. We aimed to provide valuable insights into the present status of the field and offer predictions regarding future trends.

Design

Bibliometric analysis through science mapping and performance analysis methods.

Data sources

Scientific articles.

Data extraction and synthesis

A comprehensive search was conducted in the Web of Science database to retrieve publications on MBS for OSAS within the time frame of 1999–2023. The search was performed using keywords such as “Obstructive Sleep Apnea syndrome”, “OSAS”, “metabolic surgery” and “bariatric surgery” to identify relevant papers. To analyse the bibliometric characteristics of these publications, VOSviewer and R software were used. This analysis encompassed various aspects, including the number of publications, contributions by different countries and institutions, the most cited author, journal publications, citation frequency and the identification of keywords related to popular scientific fields.

Results

1264 papers on MBS for OSAS were identified and are currently in a stage of rapid growth. The relevant study involved 1230 institutions from 53 different countries, with the USA topping the field with 465 publications contributed. Assistance Publique Hopitaux Paris proved to be the most productive institution, with De Vries N posting the highest number of papers (n=24). The most prolific journal wasObesity Surgery, with 241 publications. Keywords “Bariatric surgery”, “Obstructive sleep apnea”, “Obesity”, “Weight loss” and “Morbid obesity” have the highest frequency of occurrence.

Conclusions

The relationship between obesity and OSAS, various metabolic surgical techniques, and the mechanism of MBS for OSAS will continue to be related areas of frontiers. Furthermore, while there has been a gradual increase in basic research, the mechanisms involved and the long-term efficacy of bariatric MBS for OSAS still require further investigation. It is anticipated that these research areas may emerge as potential hot topics in the future.
Analysis and validation of clinical subgroups of Kawasaki disease in children in China: a retrospective study
Authors: Gong Chuxiong , Liu Kai , Li Bin , Li Yamin , Gao Huiqing , Wang Ziyu , Fu Yanan , Gao Lin , Hu Linzhen , Wang Yanchun , Wang Meifen , Zhao Bo , Liu Xiaomei
Published: October 2024

Objective

Although Kawasaki disease (KD) is commonly regarded as a single disease entity, clinical subgroups have recently been described. We aimed to validate previous research on clinical subgroups and establish a KD subgroup differentiation model specific to China.

Methods

We analysed clinical data of 1682 patients diagnosed with KD at the Kunming Children’s Hospital from December 2014 to December 2022. We performed principal component analysis and hierarchical clustering on 13 continuous variables. Then, we grouped the patients based on the optimal number of clusters and analysed the clinical characteristics of each subgroup.

Results

We ultimately identified three subgroups. In cluster 1, younger patients predominantly exhibited the highest risk of coronary artery aneurysm and the lowest rate of intravenous immunoglobulin resistance. Cluster 2 was characterised by high inflammatory markers and a lowered risk of coronary artery aneurysm. Cluster 3 was characterised by liver involvement, with significant elevations in liver enzymes, gamma-glutamyl transferase and total bilirubin. We found a positive correlation between the ratio of the rising trend and intravenous immunoglobulin resistance. Cluster 1 and cluster 3 shared similarities with the previously identified younger age subgroup and liver subgroup, respectively, whereas cluster 2 was unique to our study.

Conclusions

Our study preliminarily validated a previous KD subgroup study and established a KD subgroup model in China.
Through the patients’ eyes: psychometric evaluation of the 64-item version of the Experienced Patient-Centeredness Questionnaire (EPAT-64)
Authors: Christalle Eva , Zeh Stefan , Führes Hannah , Schellhorn Alica , Hahlweg Pola , Zill Jördis Maria , Härter Martin , Bokemeyer Carsten , Gallinat Jürgen , Gebhardt Christoffer , Magnussen Christina , Müller Volkmar , Schmalstieg-Bahr Katharina , Strahl André , Kriston Levente , Scholl Isabelle
Published: October 2024

Background

Patient-reported experience measures (PREMs) are valuable tools to evaluate patient-centredness (PC) from the patients’ perspective. Despite their utility, a comprehensive PREM addressing PC has been lacking. To bridge this gap, we developed the preliminary version of the Experienced Patient-Centeredness Questionnaire (EPAT), a disease-generic tool based on the integrative model of PC comprising 16 dimensions. It demonstrated content validity. This study aimed to test its psychometric properties and to develop a final 64-item version (EPAT-64).

Methods

In this cross-sectional study, we included adult patients treated for cardiovascular diseases, cancer, musculoskeletal diseases and mental disorders in inpatient or outpatient settings in Germany. For each dimension of PC, we selected four items based on item characteristics such as item difficulty and corrected item–total correlation. We tested structural validity using confirmatory factor analysis, examined reliability by McDonald’s Omega and tested construct validity by examining correlations with general health status and satisfaction with care.

Results

Analysis of data from 2.024 patients showed excellent acceptance and acceptable item–total correlations for all EPAT-64 items, with few items demonstrating ceiling effects. The confirmatory factor analysis indicated the best fit for a bifactor model, where each item loaded on both a general factor and a dimension-specific factor. Omega showed high reliability for the general factor, while varying for specific dimensions. Construct validity was confirmed by absence of strong correlations with general health status and a strong correlation of the general factor with satisfaction with care.

Conclusions

EPAT-64 demonstrated commendable psychometric properties. This tool allows comprehensive assessment of PC, offering flexibility to users who can measure each dimension with a four-item module or choose modules based on their needs. EPAT-64 serves multiple purposes, including quality improvement and evaluation of interventions aiming to enhance PC. Its versatility empowers users in diverse healthcare settings.
Rotator cuff-related shoulder pain (RCRSP): semistructured patient interviews to explore the barriers and enablers to rehabilitation exercises
Authors: Singh Vincent , Berry Alice , Cramp Fiona
Published: October 2024

This study aimed to explore the barriers and enablers to physiotherapist-prescribed rehabilitation exercises for people with rotator cuff-related shoulder pain (RCRSP) and to guide the development of a theoretically informed intervention for people with this condition. Eleven people receiving physiotherapy for RCRSP (M=69 ± 12 years) participated in semistructured interviews. Data were analysed using content analysis, the Theoretical Domains Framework (TDF). The following barriers and enablers were identified in line with the six themes and assigned relevant TDF domains. (1) The impact of previous knowledge and experience on beliefs, (2) therapeutic relationships, (3) expectations around diagnosis, (4) a long and slow pathway to treatment, (5) patients’ experience of doing the home exercise rehabilitation programme and (6) seeing positive outcomes. Patients’ beliefs that an investigation was necessary to make a diagnosis are incongruent with clinical guidelines. Several enablers identified that influence adherence to shoulder rehabilitation exercises will inform the development of interventions designed to improve adherence. Our findings highlight the importance of educating patients to alleviate identified barriers to self-management for RCRSP. Furthermore, it underscores the need to train healthcare professionals with the necessary skills to effectively educate patients, specifically about misconceptions and uncertainties about the condition and exercise.
Finding a way in and making it stick: an exploration of chiropractor experiences working in team-oriented elite sport practice settings
Authors: Myburgh Corrie , Lee Alexander D , Kazemi Mohsen , Howarth Samuel , Hill Jacob , Mior Silvano
Published: October 2024

Interprofessional healthcare teams have become the benchmark for optimising athlete health and performance in high-stakes sports. Despite a history of utility as provider partners, chiropractors are currently a relatively underutilised human resource in this rapidly developing and challenging field. Consequently, our study explored the global experiences and distinct perspectives of elite-level career sports chiropractors.

Through a qualitative explorative single case study, we purposively sampled and interviewed 15 chiropractors active in elite-level athletic contexts.

‘Professional characteristics and competencies’, ‘Running the gamut of professional career development’ and ‘Navigating team development in a small organisational structure’ emerged as the three key themes from the data.

Our data indicate that chiropractors gain provider as members of the elite athletic health and performance management team as multirole manual medicine practitioners. However, thriving in a team-oriented practice, this context appears to be reliant on their capacity for development as part of a small organisational group.
Nurse practitioner medication abortion providers in Canada: results from a national survey
Authors: Stirling-Cameron Emma , Carson Andrea , Abdulai Abdul-Fatawu , Martin-Misener Ruth , Renner Regina , Ennis Madeleine , Norman Wendy V
Published: October 2024

Background

In 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of NPs providing mifepristone/misoprostol MA in Canada and to identify context-specific barriers and enablers to NP provision of mifepristone/misoprostol MA in Canada among MA providers and non-providers.

Methods

From August 2020 to February 2021, we invited Canadian NPs to complete a national, web-based, bilingual (English/French) survey. The survey was distributed through national and provincial nursing associations and national abortion health professional organisations. We collected demographic and clinical care characteristics and present descriptive statistics and bivariate analyses to compare the experiences of NP providers and non-providers of MA.

Results

The 181 respondents represented all Canadian provinces and territories. Sixty-five NPs (36%) had provided MA at the time of the survey and 116 (64%) had not. Nearly half (47%) of respondents worked in rural or remote communities and 81% in primary care clinics. Significant barriers impacting non-providers’ abilities to provide MA included limited proximity to a pharmacy that dispensed mifepristone/misoprostol, few experienced abortion providers in their community of practice, poor access to procedural abortion services, policy restrictions in NPs’ places of employment, and no access to clinical mentorship. Some 98% of NPs providing MA services had never encountered anti-choice protest activity.

Conclusions

NPs appear prepared and able to provide MA, yet barriers remain, particularly for NPs in smaller, lower-resourced communities. Our findings inform the development of supports for NPs in this new practice to improve abortion access in Canada.
Physiological monitoring of movement and manoeuvrability during a military skiing exercise
Authors: Chatterjee Tirthankar , Bhattacharyya D
Published: October 2024

Introduction

Military forces receive training in various high-altitude warfare techniques to safeguard border regions and lives. Skiing is one of such practices where research evidences are limited. Therefore, a study was conducted to continuously monitor the physiological status of soldiers during military skiing practice to quantify the actual demands.

Methods

11 Indian soldiers skied a distance of 8 km while carrying 18 kg of military equipment. Physiological status and heart rate variability (HRV) were continuously recorded throughout the exercise. The participants completed the event in about 3 hours. The icy track consisted of about 50% upward slopes, 40% downward slopes and only 10% of flat surface. The full data set was divided into four phases (45 min each), to understand the degree of changes in physiological, and autonomic responses with progress in time and intensity. Repeated measures analysis of variance was used to examine the degree of significance between the phases.

Results

Physiological factors including HR rose consistently from the first to the fourth phase, increasing from 116 to 150 beats/min. The peak acceleration was maintained within 0.4–0.6 g and ground speed varied from 0 to 14.8 km/hour, respectively. The time domain parameters decreased steadily from pre-exercise to the first half of the event, then slightly increased at the beginning of the second half before decreasing again during the final part. The low frequency increased during the first half and remained low until the end of the second half, while the high frequency exhibited an exactly opposite pattern.

Conclusion

The HRV data indicated parasympathetic withdrawal and sympathetic activation in first half, primarily due to the uphill climb. The third phase featured with the flatter surface, which increased the speed and led to partial parasympathetic activation. The final incline caused a rise in physiological responses and sympathetic dominance. Persistent cold, exposure to hypoxia and job requirements ensured that the physiological variables remained at a ‘moderately’ high level.
Particle morphology and principal stress direction dependent strength anisotropy through torsional shear testing
Authors: He Shao-Heng , Yin Zhen-Yu , Ding Zhi , Li Rui-Dong
Published: October 2024

The major principal stress direction angle ( ασ) experienced by granular soils varies widely in engineering, causing different strengths. However, how particle morphology affects the strength anisotropy behavior under different ασ remains unclear. To address this gap, this study performed drained hollow cylinder torsional shear tests under different ασ on six granular materials with distinct morphologies. Results highlight the significant dependence of peak strengths of granular materials on both particle morphology and ασ. Increasing particle shape irregularity and surface roughness leads to a considerable enhancement in peak strength, while this peak strength significantly degrades with increasing ασ. Materials with more irregular shapes were found to have a more pronounced strength anisotropy. Furthermore, the initial fabric of particle packings, derived from three-dimensional X-ray microtomography, was used to interpret microscopic mechanisms behind the morphology-dependent strength anisotropy. Irregular-shaped materials display broader preferred particle orientations and higher initial fabric anisotropy compared to relatively regular-shaped materials. This higher morphology-induced fabric anisotropy contributes to strength anisotropy, and a correlation was established for describing this trend. Additionally, an anisotropic failure criterion incorporating fabric anisotropy was developed to characterize the strength envelope for granular materials with diverse shapes.
Modelling the evolving critical state of crushable soils and parameter optimization with an improved genetic algorithm (AIS–RCGA)
Authors: Zhang Sheng , Xiong Hai-Bin , Tong Chen-Xi , He Xuzhen , Sheng Daichao
Published: October 2024

The critical state line (CSL) plays an essential role in the constitutive modelling of granular soils. It serves as a reference line for the measurement of the state parameter. The critical state of crushable soils cannot accurately be determined from experimental data because of the ever-changing soil properties due to particle breakage. In this study, two new parameters eB and eb are introduced, which account for the final position and the evolution of CSL of crushable soils during shearing, respectively. To identify the optimal CSL-related parameters from experimental data, a hybrid genetic algorithm combining artificial immune system (AIS) and real-coded genetic algorithm (RCGA), namely AIS–RCGA is adopted. The fitness is defined to minimize the prediction error of both void ratio (or pore water pressure) and deviatoric stress. We have refined the tuning methods for several hyperparameters of AIS–RCGA and proposed a novel method to assess the similarity of individuals within AIS–RCGA. Results show that the new method is more efficient in finding the global optimal for our problem. With optimized model parameters, the new constitutive model can accurately predict the response of crushable soil, outperforming other constitutive model reported in the literature.
Stability of kangaroo rat burrows in the Sonoran Desert: evidence of biocementation
Authors: Tirkes Sera , Aydin Duygu , Thompson Madison , Collins Clint E. , Beyenal Haluk , Akin Idil Deniz
Published: October 2024

Kangaroo rats ( Dipodomys deserti) construct complex burrow systems in loose desert sand that survive temperature and relative humidity fluctuations and storms. Animals that burrow in desert sand typically burrow in compacted sand, near plant roots, or when the soil is unsaturated. However, these processes are insufficient to explain tunnel stability of kangaroo rats. Our goal is to understand how kangaroo rat burrows remain stable in loose desert sand, intending to translate this knowledge to geotechnical engineering. A kangaroo rat habitat in the dunes of the Sonoran Desert, AZ, was selected for the study. Dynamic cone penetrometer tests performed at active, abandoned, and no-burrow sites demonstrated that the animals prefer loose sand for burrow construction. Soil samples collected from the burrows’ ceilings, subsurface, and surface were characterized. Brazilian tensile strength test results showed that burrow soil has approximately three times greater tensile strength than the rest at dry state, which indicates increased interparticle attractive stress in burrow ceilings due to biocementation. Laboratory experiments, scanning electron microscopy, and confocal microscopy images showed that fungal and microbial biofilms provided 17 kPa increase in interparticle attractive stress at less than 1% biomass concentration, indicating potential to be used in soil improvement applications.
Neutron spectrometry of a 241Americium-Boron neutron source using the NCT-WES single-moderator neutron spectrometer
Authors: Bedogni R. , Russo L. , Castro Campoy A. I. , Caballero-Pacheco M. A. , Dashdondog D. , Napolitano T. , Del Franco M. , Calamida A. , Loreti S. , Moro F. , Pietropaolo Antonino
Published: October 2024

241Americium-boron (α,n) neutron sources have been produced for various application from nuclear industry to well logging or radiation protection. Compared to 241Americium–beryllium sources their specific emission rate is lower, but their spectrum is narrower, and their production cycle uses boron, which is less toxic than beryllium. Very few data are available in literature about the energy distribution of this neutron source: the 2001 version of Standard ISO 8529-1 reported a reference spectrum derived from 1970s data, exhibiting a single peak from about 1 to 6 MeV. Other spectra are available in recent works from PTB and NPL, based on high-resolution spectrometers and Bonner spheres. ENEA Frascati owns a 241Am-B neutron source with nominal emission rate 3.5 × 106 s−1. Knowing its spectrum is important, as this source is used to feed the HOTNES (Homogeneous Thermal Neutron Source) facility. A spectrometry experiment was organized relying on the recently developed NCT-WES neutron spectrometer. Belonging to the family of the Single Moderator Neutron Spectrometers, NCT-WES is a convenient alternative to Bonner spheres as it derives the whole spectrum from a single exposure. The experimental data were elaborated in comparison with the existing literature spectra. As a main results of the study, the spectrum of the ENEA 241Am-B neutron source nearly perfectly agrees with that derived at NPL.
Truck Platooning Merging Control Method in Merge Areas Based on the IDM Model and V2X Communication
Authors: Zhan Haobai , Huang Yangchuan , Wang Mingyang , Han Jiaxuan , Quan Huinan , Su Guozhi
Published: October 2024

Truck platooning technology has been widely studied for its advantages in traffic efficiency and energy savings. Although recent studies have made significant progress in specific scenarios, research on merging ramp trucks into the main road truck platoons remains insufficient. This paper proposes an innovative cooperative control method for merging ramp trucks and main road truck platoons based on vehicle-to-everything (V2X) technology. The method integrates the intelligent driver model (IDM), acceleration control logic for merging trucks before merging, lane-changing decision logic, steering control methods, and on-board unit (OBU) and roadside unit (RSU) communication technologies. This ensures that autonomous merging trucks can smoothly join the main road truck platoon under various insertion positions and acceleration lane lengths. After successfully joining the platoon, the merging trucks can maintain appropriate spacing and high speed, thereby improving overall traffic efficiency. Further analysis on different insertion positions and acceleration lane lengths reveals that when using the proposed method, merging trucks have the least impact on the overall platoon when they join at the head or tail of the main road truck platoon. Although the proposed method performs better with longer acceleration lanes, these lanes are costly to construct. The proposed method can also enable successful platoon joining with shorter acceleration lanes, optimizing the use of acceleration lanes to some extent.
An Evolutionary Perspective on Dog Behavioral Genetics
Authors: Lord Kathryn A. , Chen Frances L. , Karlsson Elinor K.
Published: October 2024

Dogs have played an outsized role in the field of behavioral genetics since its earliest days. Their unique evolutionary history and ubiquity in the modern world make them a potentially powerful model system for discovering how genetic changes lead to changes in behavior. Genomic technology has supercharged this potential by enabling scientists to sequence the DNA of thousands of dogs and test for correlations with behavioral traits. However, fractures in the early history of animal behavior between biological and psychological subfields may be impeding progress. In addition, canine behavioral genetics has included almost exclusively dogs from modern breeds, who represent just a small fraction of all dog diversity. By expanding the scope of dog behavior studies, and incorporating an evolutionary perspective on canine behavioral genetics, we can move beyond associations to understanding the complex interactions between genes and environment that lead to dog behavior.
Allophonic Variation in Romance Languages: Categorical and Gradient Processes
Authors: Hualde José Ignacio
Published: October 2024

The distinction between categorical phonological alternations and gradual phonetic processes is an important one in the study of sound systems. However, the correct classification of specific phenomena as belonging to phonology or to phonetics is often difficult. In recent years some researchers have argued that many processes traditionally understood as phonological alternations actually belong to the realm of gradient phonetics. Here I focus on consonant lenition phenomena in Spanish and other Romance languages and examine the potential arguments for their traditional analysis as alternations between phonological categories.
Charting the Course of Aphasia Recovery: Factors, Trajectories, and Outcomes
Authors: Marte Manuel Jose , Russell-Meill Marissa , Carvalho Nicole , Kiran Swathi
Published: October 2024

Aphasia, a neurological condition primarily resulting from stroke, significantly impairs communication and quality of life. This review focuses on aphasia recovery and emphasizes the interplay of clinical impairment, neural adaptation, and therapeutic intervention. Natural recovery varies with factors such as lesion characteristics, white matter integrity, and demographics, and neuroplasticity and cognitive compensation play crucial roles. Treatment-induced recovery encompasses traditional language therapies and innovative strategies, including the integration of advanced neurological techniques like neuromodulation and neurofeedback. Emerging trends, such as self-managed digital therapeutics and precision medicine approaches, offer promising avenues for enhancing language recovery. By bridging the gap between neurological understanding and clinical application, this review highlights the multifaceted nature of aphasia recovery and the latest advancements in treatment strategies, paving the way for more targeted and effective rehabilitation approaches.
Word Order Universals and Their Relationship to Structure
Authors: Svenonius Peter
Published: October 2024

Word order provides important clues to underlying syntactic structure. Despite great crosslinguistic variation, some generalizations are robust enough to inform theory development. This article reviews patterns of major clause elements and their derivation and discusses a pair of generalizations relating syntactic hierarchy to surface order—namely, the Universal 20 generalization (U20) and the Final-over-Final Constraint (FOFC). U20 rules out basic orders in which a lower modifier precedes a higher modifier to the left of the head, as in *adjective-demonstrative-noun (*Adj-Dem-N). FOFC rules out basic orders in which a head-final projection contains a head-initial one, as in *verb-object-auxiliary (*V-O-Aux). In each case, there are two frequent orders (Aux-V-O and O-V-Aux, Dem-Adj-N and N-Adj-Dem) that reveal the underlying hierarchies transparently. The two constraints differ, however: In the order ruled out by U20, *Adj-Dem-N, the middle element is structurally the highest, while FOFC rules out an order, *V-O-Aux, in which the middle element is lowest.
Computational Architecture of Speech Comprehension in the Human Brain
Authors: Gwilliams Laura , Bhaya-Grossman Ilina , Zhang Yizhen , Scott Terri , Harper Sarah , Levy Deborah
Published: October 2024

Understanding the computational algorithm that gives rise to human language is a shared endeavor among neuroscience, linguistics, and machine learning. We propose a conceptual framework for making measurable progress toward this goal by studying the subcomponents of the processing system: its underlying representations, operations, and information flow. We review evidence from neurophysiology, neuropsychology, linguistic theory, and computational modeling and suggest future directions to push the field forward in developing a precise characterization of spoken language understanding. Overall, we claim that representations of speech properties, and the operations that generate and manipulate those representations, exist within a highly parallel, highly redundant spatiotemporal regime.
Boosting: Empowering Citizens with Behavioral Science
Authors: Herzog Stefan M. , Hertwig Ralph
Published: October 2024

Behavioral public policy came to the fore with the introduction of nudging, which aims to steer behavior while maintaining freedom of choice. Responding to critiques of nudging (e.g., that it does not promote agency and relies on benevolent choice architects), other behavioral policy approaches focus on empowering citizens. Here we review boosting, a behavioral policy approach that aims to foster people's agency, self-control, and ability to make informed decisions. It is grounded in evidence from behavioral science showing that human decision making is not as notoriously flawed as the nudging approach assumes. We argue that addressing the challenges of our time—such as climate change, pandemics, and the threats to liberal democracies and human autonomy posed by digital technologies and choice architectures—calls for fostering capable and engaged citizens as a first line of response to complement slower, systemic approaches.
Impact of sleep deprivation on aperiodic activity: a resting-state EEG study
Authors: Bai Duo , Hu Jingyi , Jülich Simon , Lei Xu
Published: October 2024

Aperiodic and periodic components were separated in a large open-access EEG dataset of sleep deprivation. Aperiodic offsets increase after deprivation, particularly in the occipital region, reflecting a decline in self-reported vigilance. Parameterized alpha bandwidth, which was ignored in previous studies, is found to be relevant to sleep deprivation. Increase in bandwidth of alpha was focused in the occipital and temporal lobes.