bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous coronary artery dissection in cardiac rehab: an exploration of lived experiences of patients and the knowledge, understanding, and perceptions of healthcare professionals
Authors: Plaza Godoy M , Midgley A , Levy A , Butler T
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic type of cardiovascular disease (CVD) that affects young and middle-aged women more than men. Many aspects of SCAD, however, remain unclear, including the outcomes of cardiac rehabilitation (CR) and the lived experiences of people with this condition in the programme. Furthermore, the awareness and knowledge of healthcare professionals (HCPs) regarding SCAD may be an important factor in determining patient engagement with rehabilitation services. A longitudinal study examining changes in physical and mental health outcomes of patients with SCAD is yet to be performed. Similarly, an in-depth exploration of HCPs' perspectives on SCAD is also needed.

Objectives

The objectives of this project are to understand the lived experiences of patients with SCAD, examine the knowledge of HCPs about the management of SCAD, and analyse the outcomes of CR on physical activity, diet, body mass index, waist circumference, stress, anxiety, depression and health-related quality of life upon completion of phase III and phase IV CR, and a year post-event.

Methods

A mixed-methods longitudinal observational study will be performed with four time points (pre-phase III CR, post-phase III CR, post-phase IV CR, and a year follow-up after SCAD event). Lived experiences of both male and female patients with SCAD, their pathways of care and barriers to engagement to CR will be explored through semi-structured interviews. Physical activity (short-form IPAQ questionnaire), dietary intake, anthropometric measures (waist circumference and body mass index), stress (PSS-10 questionnaire), anxiety (GAD-7 questionnaire), depression (PHQ-9 questionnaire) and health-related quality of life (EQ-5D-5L questionnaire) will be assessed at each timepoint. Patients with SCAD who are not engaged with CR will be used as a control group. Outcome measures will be compared between two groups using a mixed model ANOVA (time x intervention). A qualitative cross-sectional study using semi-structured interviews with HCPs will explore their understanding and management of SCAD.

Discussion: The findings of this project will indicate weather current CR needs are met in this patient group and what changes need to be made to existing CR services to improve uptake in patients with SCAD. This could lead to a larger clinical trial that examines the effectiveness of tailored CR for this group of patients. Additionally, the information received from HCPs will indicate if there is an unmet educational need regarding SCAD, which may ultimately lead to better recognition, medical and lifestyle management for this patient group.
Can AI-led remote ECG monitoring result in service improvement for cardiac investigations
Authors: Baker M , Rosengarten J , Hart E , Ojo M
Published: July 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): iRhytm

Background

Ambulatory ECG monitoring is needed to investigate intermittent heart rhythm symptoms. Traditional monitoring approaches are resource intensive, requiring multiple patient hospital visits and time-consuming analysis, using fixed capacity monitoring equipment.

Purpose

We carried out a 4000-patient pilot with an AI-led remote ECG monitoring service (Zio XT) to determine its impact on patients and the service. Single-use monitoring patches were sent directly to the patient to fit at home or fitted in outpatients. Patients wore the patch for 14 days of continuous monitoring and then returned it by Freepost for outsourced analysis and reporting.

Methods

We undertook a retrospective analysis of 200 consecutive patients attending for standard Holter monitoring, and compared this cohort with 200 consecutive patients who underwent monitoring with Zio. The Holter sample was taken from a time period prior to the introduction of the new remote service. Patients had been referred to cardiology for investigation of heart rhythm symptoms.

Results

The age ranges in the two groups were broadly comparable. In the Holter group, 100% of patients required a separate outpatient appointment to fit the monitor compared with 0% in the Zio group. Median time from monitor fitting to result was 18 days in the Zio group compared with 106 days in the Holter group (p<0.001). Test results were unavailable at follow-up in 16% of the Holter group compared with 2% of the Zio group (p<0.001). Arrhythmias were detected in more patients in the Zio group vs the Holter group (p<0.05), (SVT ≥ 30s 7.4% vs 0.5%; VT ≥ 8bts 10.5% vs 2.0%; Pause ≥ 3s 6.3% vs 2.5%; PAF 7.4% vs 2.5%). In the Holter group, 24 patients (12%) had no follow-up in cardiology outpatients. Of these, 9 were lost to follow-up and 3 deceased before completing the pathway. By comparison, 3 patients (1.6%) in the Zio group had no follow-up. In patients who had a follow-up appointment, 75% of patients in the Zio group had a non-face-to-face follow-up vs 48% in the Holter group (p<0.05). Repeat test was required in 11.5% of the Holter group compared with 4.7% of the Zio group (p<0.05). In the Holter group, 6 (3%) of the repeat tests were ILRs, compared with 2 (1.1%) in the Zio group.

Conclusions

Patients in the Zio group received their test results more quickly. Use of Zio XT resulted in fewer visits to hospital and a reduced need for repeat testing. Earlier detection of significant clinical arrhythmia, especially AF, facilitates rapid clinical decision making, and is expected to result in more patients receiving appropriate therapy.
Using co-design to develop INTERCEPT, a mobile health (mHealth) App, for the secondary prevention of cardiovascular disease
Authors: Gibson I , Neubeck L , Corcoran M , Morland C , Jones J , Costello C , Hynes L , Harris A , Atrey A , Savickas V , Ski C , Murphy A W , Byrne M , Wood D , Jennings C
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Health Research Board, Ireland

SOLVE CHD SYNERGY Grant, University of Sydney, Australia

Background

Co-design adopts a participatory, person-centred approach to the development of health interventions, which aims to maximise their acceptance and effectiveness. However, despite this many mobile applications are designed with little input from target end users, resulting in poor uptake and usage.

Purpose

The aim of our study was to optimize the evolution of the INTERCEPT (I-App) mHealth app by integrating target users’ (patients and healthcare professionals) perspectives into its design and development.

Methods

A core project team of health care professionals (nurse specialists, physicians, physiotherapists, dietitians, psychologists and a pharmacist), software developers and patients was established. A four phase iterative anrticipatory approach to the design process for I-App was adopted using online workshops conducted over a 12-month period. Phase one involved identification of the guiding principles, content and design features. In phase two, a working prototype of the I-App was developed and in phase three a beta version of this prototype was pilot tested among the project team and reviewed for clarity of language, ease of navigation and functionality. Phase four involved user acceptance testing of the I-App with patients who had a recent cardiac event (<2 years). Improvements in the usability of the app were assessed using the System Usability Scale (SUS), which was administered pre and post user acceptance testing.

Results

From target user insights and scientific literature five key design principles were identified: simplicity and ease of use; behavioural change through goal setting; self-monitoring and use of rewards; provision of credible information and data privacy. Medication adherence, psychosocial support and tracking physiologic parameters like blood pressure were considered important components. Usability testing of I-App resulted in 64 recommendations for the app and of these 51 were implemented. Significant improvements in SUS scores were observed from 61 to 82 (p<0.001) demonstrating the effectiveness of adopting a co-design apporach.

Conclusion

Using co-design methodology resulted in the INTERCEPT mHealth app responding to the end users’ needs and preferences including desired content and features. The next step in the development process is to trial the feasibility and usage of the I-App in the real-world clinical setting.
Cardiac rehabilitation patient data management and quality improvement in Australia: A national survey
Authors: Gallagher R , Cartledge S , Zwack C , Hollings M , Zhang L , Gauci S , Gordon N , Zecchin R , O'neil A , Tiramacco R , Phillips S , Candelaria D , Astley C , Briffa T , Redfern J
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council Synergy Grant

Background

Receipt of guideline-indicated comprehensive cardiac rehabilitation improves patient outcomes. Optimum service delivery and meeting quality standards necessitates accurate standardised data collection and reporting. The methods, processes and systems used for data capture and reporting in cardiac rehabilitation are under-documented, limiting identification of areas needing change and creation of a platform for quality improvement (QI) at national levels.

Purpose

To describe data capture, management, and reporting and the awareness and use of quality indicators in contemporary Australian CR programs.

Methods

CR programs (n=396) were identified through professional and national directories, jurisdictional networks, webinars, and direct provider contact. Program coordinators completed an online survey on individual service characteristics, data capture and management systems (paper, electronic, database, integrated platform) including awareness, use and usefulness of the published National Cardiac Rehabilitation Quality toolkit components.

Results

Respondents totalled 319 (80.5%), from all eight states and territories. Coverage of Metropolitan, rural and remote towns, and regional centres was 46.3%, 45.9% and 7.8%, respectively. Indicative annual patient enrolments were >200 (31.0%), 51-200 (46.4%) and ≤50 (22.6%). Most programs used ≥2 data management systems: paper and electronic 62.6% or multiple e-systems 19.1%, or one system, either paper 20.9% or electronic 16.3%. Use of multiple systems and combinations of systems did not differ by number of patients enrolled. QI systems were infrequently used: QI Platforms 17.2%, QI Databases 10.0%.

Supplementary to patient care, data gained was used for reports for management (57.0%), QI (56.1%), funding support (43.2%), required jurisdictional reporting (41.1%) and research (30.7%). Higher volume programs were more likely to be using the data capture for multiple purposes. Independent covariates of services using data for QI were enrolments of >200 (OR 3.83 95% CI 1.76, 8.34) and the state/territory location, such that use of QI was less likely in the states of Victoria (OR 0.24 95% CI 0.08, 0.77), New South Wales (OR 0.25 95% CI 0.08, 0.76) and Western Australia (OR 0.16 95% CI 0.05, 0.57).

Conclusions

Management of cardiac rehabilitation patient data is highly variable across Australian programs and jurisdictions, often including multiple different systems, with limited use of the data for QI. A national user-friendly, low burden approach to CR data collection incorporated into daily work-flow that is capable of benchmarking and informs QI is essential.
Fatigue, shortness of breath and well-being in patients with heart failure: A daily trend analysis over 12 weeks
Authors: Deka P , Pathak D , Van Der Wal M H L , Stromberg A , Jaarsma T , Klompstra L
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work is supported by the Swedish National Science Council (2020-01109); The Swedish Heart and Lung Foundation (20200190); the Kamprad Foundation (20210074) and the Research Council in South East Sweden (FORSS-940933)

Introduction

Patients with heart failure (HF) experience symptoms of fatigue and shortness of breath (SoB) that may worsen over time and negatively impacts their well-being. Repeated admissions are partly related to delays in responding to HF symptoms.

Purpose

This study aimed to investigate the trend of fatigue, SoB and well-being over 12 weeks in patients with HF.

Methods

Diary data were collected as part of the HF-Wii study. From the 605 patients included in this study, 234 patients completed a 12-week diary. Patients rated their fatigue and SoB daily on a Likert scale (0 = no symptom, 10 = worst possible symptom). Patients also rated their daily well-being with the Cartrils Ladder of Life with 0 representing the worst possible life and 10 for the best possible life. The weekly differences in symptoms and well-being were assessed over 12 weeks. Also, the overall correlation over 12 weeks between symptoms and well-being was calculated.

Results

In total, 234 patients with HF were included in this analysis, mean age: 68±11 years, 31% female, 11% NYHA-class I, 65% NYHA-class II and 24% NYHA-class III. Over 12 weeks, patients had mild symptom experience. The minimum and maximum mean SoB score was 3.3(±2.1) and 3.8 (±2.5). The minimum mean fatigue score was 3.4 (±2.1) and the maximum was 3.9 (±2.4). The mean well-being minimum score was 5.8(±.9) and the maximum was 6.8 (±1.8). The trend analysis showed that when patients experience more symptom burden over time, this negatively impacted their well-being (Figure 1). A significant negative overall correlation between fatigue and well-being (r = -0.43) and between shortness of breath and well-being (r = -0.42) was noted.

Conclusions

Symptom experience has a significant influence on patient-reported daily well-being in patients with HF. Close monitoring of symptoms to improve well-being in this population is essential.
Sensitivity to clinical change in patients with syncope measured by the specific scale impact of syncope on quality of life
Authors: Alves S , Oliveira M , Ferreira R
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): CHULC (Centro Hospitalar Universitário de Lisboa Central), Hospital de Santa Marta.

Recurrent syncope has a significant impact on the quality of life (QL). Patients (P) identify better with specific scales to report their perception of their QL. We believe that sensitivity to changes in the clinical condition is an asset of this type of scale.

Objective

To assess the sensitivity of the specific scale "Impact of Syncope on Quality of Life" (ISQL) for measuring QL in P with syncope who have undergone changes in their clinical condition. Population and methodology: 57 P, 21 men and 36 women, mean age 54.4±17.3 (19 to 83 years), most married (65%) working (36.2%) or retired (46, 6%) whose answers to the ISQL were used to analyze the psychometric properties of this instrument (18 more individuals than in the preliminary validation) and 22 P who performed a tilt training program (TTr), 9 men and 11 women, with a mean age of 50.3±18,1 (18 to 78 years), mostly married (55%) working (50%) or retired (35%) who reported perception of their QL before TTr and 6 months after, responding to the ISQL.

Results

Regarding fidelity, convergent validity and divergent validity, the statistically significant results measured in the validation of the scale for the Portuguese population that had 39 P are maintained, which strengthens this measure in relation to psychometric properties and its use in clinical context. The stability in time was tested in the preliminary validation by the test-retest method of the instrument at six months after tilt test with 22 P (from the initial sample of 39 P) not submitted to clinical intervention, which did not show statistically significant changes in QL. Sensitivity to clinical change was tested in a group of 20 P who integrated and completed a TTr, with statistically significant changes in QL reported using this specific measure referring worry, fear, doing less than they wanted and avoiding certain locations.

Conclusions

The results obtained reinforce the use of the ISQL in the evaluation of QL in the P with syncope and indicate that the ISQL identifies the alteration of the clinical condition, being a fundamental measure for the evaluation of the results of clinical interventions in these patients, as well as in others.
Lay and general practitioner attitudes towards endometrial cancer prevention: a cross-sectional study
Authors: Kitson Sarah J , Khan Urwaa , Crosbie Emma J
Published: July 2023

Background

Effective and targeted endometrial cancer prevention strategies could reduce diagnoses by 60%. Whether this approach is acceptable to individuals and general practitioners (GPs) is currently unknown. This study sought to determine attitudes towards the provision of personalised endometrial cancer risk assessments and the acceptability of potential prevention strategies.

Methods

Specific online questionnaires were developed for individuals aged 45–60 years with a uterus and UK-practising GPs, with social media, charity websites, and email used to advertise the study. Individuals completed the questionnaires between February and April 2022.

Results

Of 660 lay questionnaire respondents, 90.3% (n = 596) thought that undergoing an endometrial cancer risk assessment was a good or very good idea and 95.6% (n = 631) would be willing to undergo such an assessment. The commonest reasons for wanting to participate were “to try and reduce my risk” (n = 442, 67.0%), “to be informed” (n = 354, 53.6%), and “it could save my life’ (n = 315, 47.7%). Over 80% of respondents would make lifestyle changes to reduce their endometrial cancer risk (n = 550), with half accepting a pill, Mirena, or hysterectomy for primary prevention. GPs were similarly engaged, with 93.0% (n = 106) willing to offer an endometrial cancer risk assessment if a tool were available, potentially during a Well Woman screen.

Conclusion

Personalised endometrial cancer risk assessments are acceptable to potentially eligible individuals and GPs and could be accommodated within routine practice. Clinical trials to determine the effectiveness of lifestyle modification and Mirena for endometrial protection are urgently required and should be targeted at those at greatest disease risk.
Health and health system impacts of China’s comprehensive primary healthcare reforms: a systematic review
Authors: Cai Chang , Xiong Shangzhi , Millett Christopher , Xu Jin , Tian Maoyi , Hone Thomas
Published: July 2023

China’s comprehensive primary healthcare (PHC) reforms since 2009 aimed to deliver accessible, efficient, equitable and high-quality healthcare services. However, knowledge on the system-wide effectiveness of these reforms is limited. This systematic review synthesizes evidence on the reforms’ health and health system impacts. In 13 August 2022, international databases and three Chinese databases were searched for randomized controlled trials, quasi-experimental studies and controlled before-after studies. Included studies assessed large-scale PHC policies since 2009; had a temporal comparator and a control group and assessed impacts on expenditures, utilization, care quality and health outcomes. Study quality was assessed using Risk of Bias In Non-randomized Studies of Interventions, and results were synthesized narratively. From 49 174 identified records, 42 studies were included—all with quasi-experimental designs, except for one randomized control trial. Nine studies were assessed as at low risk of bias. Only five low- to moderate-quality studies assessed the comprehensive reforms as a whole and found associated increases in health service utilization, whilst the other 37 studies examined single-component policies. The National Essential Medicine Policy (N = 15) and financing reforms (N = 11) were the most studied policies, whilst policies on primary care provision (i.e. family physician policy and the National Essential Public Health Services) were poorly evaluated. The PHC reforms were associated with increased primary care utilization (N = 17) and improved health outcomes in people with non-communicable diseases (N = 8). Evidence on healthcare costs was unclear, and impacts on patients’ financial burden and care quality were understudied. Some studies showed disadvantaged regions and groups that accrued greater benefits (N = 8). China’s comprehensive PHC reforms have made some progress in achieving their policy objectives including increasing primary care utilization, improving some health outcomes and reducing health inequalities. However, China’s health system remains largely hospital-centric and further PHC strengthening is needed to advance universal health coverage.
Assessing the impact of anaesthetic and surgical task-shifting globally: a systematic literature review
Authors: Bognini Maeve S , Oko Christian I , Kebede Meskerem A , Ifeanyichi Martilord I , Singh Darshita , Hargest Rachel , Friebel Rocco
Published: July 2023

The global shortage of skilled anaesthesiologists, surgeons and obstetricians is a leading cause of high unmet surgical need. Although anaesthetic and surgical task-shifting are widely practised to mitigate this barrier, little is known about their safety and efficacy. This systematic review seeks to highlight the existing evidence on the clinical outcomes of patients operated on by non-physicians or non-specialist physicians globally. Relevant articles were identified by searching four databases (MEDLINE, EMBASE, CINAHL and Global Health) in all languages between January 2008 and February 2022. Retrieved documents were screened against pre-specified inclusion and exclusion criteria, and their qualities were appraised critically. Data were extracted by two independent reviewers and findings were synthesized narratively. In total, 40 studies have been included. Thirty-five focus on task-shifting for surgical and obstetric procedures, whereas four studies address anaesthetic task-shifting; one study covers both interventions. The majority are located in sub-Saharan Africa and the USA. Seventy-five per cent present perioperative mortality outcomes and 85% analyse morbidity measures. Evidence from low- and middle-income countries, which primarily concentrates on caesarean sections, hernia repairs and surgical male circumcisions, points to the overall safety of non-surgeons. On the other hand, the literature on surgical task-shifting in high-income countries (HICs) is limited to nine studies analysing tube thoracostomies, neurosurgical procedures, caesarean sections, male circumcisions and basal cell carcinoma excisions. Finally, only five studies pertaining to anaesthetic task-shifting across all country settings answer the research question with conflicting results, making it difficult to draw conclusions on the quality of non-physician anaesthetic care. Overall, it appears that non-specialists can safely perform high-volume, low-complexity operations. Further research is needed to understand the implications of surgical task-shifting in HICs and to better assess the performance of non-specialist anaesthesia providers. Future studies must adopt randomized study designs and include long-term outcome measures to generate high-quality evidence.
Drug Resistance Assessed in a Phase 3 Clinical Trial of Maribavir Therapy for Refractory or Resistant Cytomegalovirus Infection in Transplant Recipients
Authors: Chou Sunwen , Alain Sophie , Cervera Carlos , Chemaly Roy F , Kotton Camille N , Lundgren Jens , Papanicolaou Genovefa A , Pereira Marcus R , Wu Jingyang J , Murray Rose Ann , Buss Neil E , Fournier Martha
Published: July 2023

Background

This drug resistance analysis of a randomized trial includes 234 patients receiving maribavir and 116 receiving investigator-assigned standard therapy (IAT), where 56% and 24%, respectively, cleared cytomegalovirus DNA at week 8 (treatment responders).

Methods

Baseline and posttreatment plasma samples were tested for mutations conferring drug resistance in viral genes UL97, UL54, and UL27.

Results

At baseline, genotypic testing revealed resistance to ganciclovir, foscarnet, or cidofovir in 56% of patients receiving maribavir and 68% receiving IAT, including 9 newly phenotyped mutations. Among them, 63% (maribavir) and 21% (IAT) were treatment responders. Detected baseline maribavir resistance mutations were UL27 L193F (n = 1) and UL97 F342Y (n = 3). Posttreatment, emergent maribavir resistance mutations were detected in 60 (26%) of those randomized to maribavir, including 49 (48%) of 103 nonresponders and 25 (86%) of the 29 nonresponders where viral DNA initially cleared then rebounded while on maribavir. The most common maribavir resistance mutations were UL97 T409M (n = 34), H411Y (n = 26), and C480F (n = 21), first detected 26 to 130 (median 56) days after starting maribavir.

Conclusions

Baseline maribavir resistance was rare. Drug resistance to standard cytomegalovirus antivirals did not preclude treatment response to maribavir. Rebound in plasma cytomegalovirus DNA while on maribavir strongly suggests emerging drug resistance.

Clinical Trials Registration

NCT02931539.
Impact of Metagenomic Next-Generation Sequencing of Bronchoalveolar Lavage Fluid on Antimicrobial Stewardship in Patients With Lower Respiratory Tract Infections: A Retrospective Cohort Study
Authors: Yan Mengwei , Zou Xiaohui , Wang Yeming , Wang Chenhui , Wang Yimin , Liu Zhibo , Shang Lianhan , Cui Xiaojing , Cao Bin
Published: July 2023

Background

The impact of metagenomic next-generation sequencing (mNGS) on antimicrobial stewardship in patients with lower respiratory tract infections (LRTIs) is still unknown.

Methods

This retrospective cohort study included patients who had LRTIs diagnosed and underwent bronchoalveolar lavage between September 2019 and December 2020. Patients who underwent both mNGS and conventional microbiologic tests were classified as the mNGS group, while those with conventional tests only were included as a control group. A 1:1 propensity score match for baseline variables was conducted, after which changes in antimicrobial stewardship between the 2 groups were assessed.

Results

A total of 681 patients who had an initial diagnosis of LRTIs and underwent bronchoalveolar lavage were evaluated; 306 patients were finally included, with 153 in each group. mNGS was associated with lower rates of antibiotic escalation than in the control group (adjusted odds ratio, 0.466 [95% confidence interval, .237–.919]; P = .02), but there was no association with antibiotic de-escalation. Compared with the control group, more patients discontinued the use of antivirals in the mNGS group.

Conclusions

The use of mNGS was associated with lower rates of antibiotic escalation and may facilitate the cessation of antivirals, but not contribute to antibiotic de-escalation in patients with LRTIs.
International Norms as Emergent Properties of Complex Adaptive Systems
Authors: Winston Carla
Published: July 2023

This theory note argues that international norms, as currently understood by scholars of international relations, can be seen as emergent properties of a complex adaptive system (the international political system). Arising from the microlevel interactions of agents within and across various levels of analysis, they have the potential to become system properties that (a) influence the constitution, relationships, and behavior of agents within that system and (b) are not analytically reducible to the sum of the interactions between those agents. They also exhibit evolutionary dynamics common to complex, rather than merely complicated, systems. Thinking of norms in this manner helps point norms scholars toward particular spaces and methodologies of research. After a brief resume of complexity theory in IR, the note proceeds with an introduction to complex systems theory. It then explores the conceptual nexus between norms theory and complexity. It finishes by suggesting the ways in which understanding norms as complex emergent phenomena might influence norms research more broadly.
Fate of microbial contamination in a South European Coastal Lagoon (Ria Formosa) under the influence of treated effluents dispersal
Authors: Caetano Sandra , Correia Cátia , Vidal Ana Flor Torres , Matos André , Ferreira Cristina , Cravo Alexandra
Published: July 2023

Aim

Assessment of the fate of microbial contamination driven from treated wastewater disposal at a highly productive zone on a South European coastal lagoon (Ria Formosa).

Methods and results

Microbial indicators of contamination (Total coliforms, Escherichia coli, and Enterococci) were evaluated monthly during September 2018–September 2020 at three study areas (Faro, Olhão, and Tavira) under different wastewater discharge flows and hydrodynamic conditions. Additional data on E. coli monitoring in bivalves, available from the national institution responsible for their surveillance was also considered. The maximum microbial contamination was found at Faro, the highest-load and less-flushed study area, contrasting the lowest contamination at Olhão, a lower-load and strongly flushed area. The wastewater impact decreased along the spatial dispersal gradients and during high water, particularly at Faro and Tavira study areas, due to a considerable dilution effect. Microbial contamination at Olhão increased during the summer, while at the other study areas seasonal evidence was not clear. Data also indicate that E. coli in bivalves from bivalve production zones next to the three study areas reflected the differentiated impact of the wastewater treatment plants effluents on the water quality of those areas.

Conclusions

Effluent loads together with local hydrodynamics, water temperature, solar radiation, precipitation, and land runoff as well as seabirds populations and environmentally adapted faecal or renaturelized bacterial communities, contributed to microbial contamination of the study areas.
How to Recognize and Correct Artifacts on Contrast-Enhanced Mammography
Authors: Harper Laura K , Faulk Ellen A , Patel Bhavika , Collins Patricia , Rochman Carrie
Published: July 2023

Contrast-enhanced mammography (CEM) has emerged as an important new technology in breast imaging. It can demonstrate a number of imaging artifacts that have the potential to limit interpretation by either obscuring or potentially mimicking disease. Commonly encountered artifacts on CEM include patient motion artifacts (ripple and misregistration), pectoral highlighting artifact, breast implant artifact, halo artifact, corrugation artifact, cloudy fat artifact, contrast artifacts (retention and contamination), skin artifacts (skin line enhancement and skin overexposure), and skin lesions. Skin lesions may demonstrate a variety of imaging appearances and have both benign and malignant etiologies. It is important that the technologist, radiologist, and physicist be aware of potential artifacts and skin enhancement on CEM that may affect interpretation and understand their causes and potential solutions.
Too close for comfort: leveraging identity-based relevance through targeted health information backfires for Black Americans
Authors: Derricks Veronica , Earl Allison
Published: July 2023

Communicators frequently make adjustments to accommodate receivers’ characteristics. One strategy for accommodation is to enhance the relevance of communication for receivers. The current work uses information targeting—a communication strategy where information is disseminated to audiences believed to experience heightened risk for a health condition—to test whether and why targeting health information based on marginalized racial identities backfires. Online experimental findings from Black and White adults recruited via MTurk (Study 1) and Prolific Academic (Study 2) showed that Black Americans who received targeted (vs. nontargeted) health messages about HIV or flu reported decreased attention to the message and reduced trust in the message provider. White Americans did not differentially respond to targeting. Findings also demonstrated that (a) these negative consequences emerged for Black Americans due to social identity threat, and (b) these consequences predicted downstream cognitive and behavioral responses. Study 2 showed that these consequences replicated when the targeting manipulation signaled relevance directly via marginalized racial identities. Collectively, findings demonstrate that race-based targeting may lead to overaccommodation, thus precluding the expected benefits of relevance.
Salicylic acid regulates phenolic acid biosynthesis via SmNPR1–SmTGA2/SmNPR4 modules in Salvia miltiorrhiza
Authors: Ding Meiling , Xie Yongfeng , Zhang Yuhang , Cai Xiaona , Zhang Bin , Ma Pengda , Dong Juane
Published: July 2023

Phenolic acids are the main active ingredients in Salvia miltiorrhiza, which can be used for the treatment of many diseases, particularly cardiovascular diseases. It is known that salicylic acid (SA) can enhance phenolic acid content, but the molecular mechanism of its regulation is still unclear. Nonexpresser of PR genes 1 (NPR1) plays a positive role in the SA signaling pathway. In this study, we identified a SmNPR1 gene that responds to SA induction and systematically investigated its function. We found that SmNPR1 positively affected phenolic acid biosynthesis. Then, we identified a novel TGA transcription factor, SmTGA2, which interacts with SmNPR1. SmTGA2 positively regulates phenolic acid biosynthesis by directly up-regulating SmCYP98A14 expression. After double-gene transgenic analysis and other biochemical assays, it was found that SmNPR1 and SmTGA2 work synergistically to regulate phenolic acid biosynthesis. In addition, SmNPR4 forms a heterodimer with SmNPR1 to inhibit the function of SmNPR1, and SA can alleviate this effect. Collectively, these findings elucidate the molecular mechanism underlying the regulation of phenolic acid biosynthesis by SmNPR1–SmTGA2/SmNPR4 modules and provide novel insights into the SA signaling pathway regulating plant secondary metabolism.
The potential of microalgal sources as coating materials: A case study for the development of biocompatible surgical sutures
Authors: Tokgöz Merve , Yarkent Çağla , Köse Ayşe , Oncel Suphi S
Published: July 2023

Sutures are considered as surgical materials that form excellent surfaces to integrate the postoperative parts of the body. These materials present suitable platforms for potential bacterial penetrations. Therefore, coating these biomedical materials with biocompatible compounds is seen as a potential approach to improve their properties while avoiding adverse effects. The aim of this study was to evaluate Arthrospira platensis, Haematacoccus pluvialis, Chlorella minutissima, Botyrococcus braunii, and Nostoc muscorum as potential surgical suture coating materials. Their crude extracts were absorbed into two different sutures as poly glycolic (90%)-co-lactic acid (10%) (PGLA) and poly dioxanone (PDO); then, their cytotoxic effects and antibacterial activities were examined. Both N. muscorum-coated sutures (PGLA and PDO) and A. platensis-coated (PGLA and PDO) sutures did not induce any toxic effect on L929 mouse fibroblast cells (>70% cell viability). The highest antibacterial activity against Staphylococcus aureus was achieved with N. muscorum-coated PGLA and A. platensis-coated PGLA at 11.18 ± 0.54 mm and 9.52 ± 1.15 mm, respectively. These sutures were examined by mechanical analysis, and found suitable according to ISO 10993-5. In comparison with the commercial antibacterial agent (chlorohexidine), the results proved that N. muscorum extract can be considered as the most promising suture coating material for the human applications.
Simulation and experiment of gas diffusion in a granular bed
Authors: Güttler C , Rose M , Sierks H , Macher W , Zivithal S , Blum J , Laddha S , Gundlach B , Kargl G
Published: July 2023

The diffusion of gas through porous material is important to understand the physical processes underlying cometary activity. We study the diffusion of a rarefied gas (Knudsen regime) through a packed bed of monodisperse spheres via experiments and numerical modelling, providing an absolute value of the diffusion coefficient and compare it to published analytical models. The experiments are designed to be directly comparable to numerical simulations, by using precision steel beads, simple geometries, and a trade-off of the sample size between small boundary effects and efficient computation. For direct comparison, the diffusion coefficient is determined in Direct Simulation Monte Carlo (DSMC) simulations, yielding a good match with experiments. This model is further-on used on a microscopic scale, which cannot be studied in experiments, to determine the mean path of gas molecules and its distribution, and compare it against an analytical model. Scaling with sample properties (particle size and porosity) and gas properties (molecular mass and temperature) is consistent with analytical models. As predicted by these, results are very sensitive on sample porosity and we find that a tortuosity q(ε) depending linearly on the porosity ε can well reconcile the analytical model with experiments and simulations. Mean paths of molecules are close to those described in the literature, but their distribution deviates from the expectation for small path lengths. The provided diffusion coefficients and scaling laws are directly applicable to thermophysical models of idealized cometary material.
The carbonaceous dust at sub-parsec scales in the nucleus of NGC 1068
Authors: Gámez Rosas Violeta , Tielens Alexander G G M , van der Werf Paul , Jaffe Walter , Leftley James H , Burtscher Leonard , Petrov Romain , Isbell Jacob W , López Bruno , Millour Florentin , Meilland Anthony , Matter Alexis , Waters Laurens B F M , Meisenheimer Klaus
Published: July 2023

Single dish observations of NGC 1068 have shown the presence of a 3.4 μm aliphatic hydrocarbon absorption feature similar to diffuse lines of sight towards the Galactic Centre. Both, the single dish spectra and the correlated fluxes obtained by MATISSE, present a broad absorption profile in the L band as well, that vary from baseline to baseline. A new CRIRES spectrum with a slit width comparable to the MATISSE aperture also reveals a wide feature around 3.4 μm. We aim to analyse these features to learn about their origin and the distribution of the carriers across the source. We argue that all these features are caused by absorption of aliphatic hydrocarbons. The 3.4 μm absorption features in the interferometric MATISSE correlated fluxes vary in optical depth over scales of 0.2-1.4 parsec in the plane of the sky, although probably placed at a larger distance from the AGN along the line of sight. The absorption in the extended areas seems to peak in the direction of the inner jet, close to the center of the ionization cone. These results support the theory of a clumpy torus. In comparing our results to the N-band surface density previously reported, we have discovered a mass ratio of carbonaceous to silicate olivine dust at ∼2 - 3.6 per cent, which is similar to those found in several lines of sight in the diffuse interstellar medium of our Galaxy.
Cosmic-ray driven galactic winds from the warm interstellar medium
Authors: Modak Shaunak , Quataert Eliot , Jiang Yan-Fei , Thompson Todd A
Published: July 2023

We study the properties of cosmic-ray (CR) driven galactic winds from the warm interstellar medium using idealized spherically symmetric time-dependent simulations. The key ingredients in the model are radiative cooling and CR-streaming-mediated heating of the gas. Cooling and CR heating balance near the base of the wind, but this equilibrium is thermally unstable, leading to a multiphase wind with large fluctuations in density and temperature. In most of our simulations, the heating eventually overwhelms cooling, leading to a rapid increase in temperature and a thermally driven wind; the exception to this is in galaxies with the shallowest potentials, which produce nearly isothermal $T \approx 10^4\,$ K winds driven by CR pressure. Many of the time-averaged wind solutions found here have a remarkable critical point structure, with two critical points. Scaled to real galaxies, we find mass outflow rates $\dot{M}$ somewhat larger than the observed star-formation rate in low-mass galaxies, and an approximately ‘energy-like’ scaling $\dot{M} \propto v_{\rm esc}^{-2}$. The winds accelerate slowly and reach asymptotic wind speeds of only ∼0.4vesc. The total wind power is $\sim 1~{{\ \rm per\ cent}}$ of the power from supernovae, suggesting inefficient preventive CR feedback for the physical conditions modelled here. We predict significant spatially extended emission and absorption lines from 104–105.5 K gas; this may correspond to extraplanar diffuse ionized gas seen in star-forming galaxies.
Relation between photometric and parameter errors of star clusters
Authors: Li Zhongmu , Liu Xuejie
Published: July 2023

Many observations supply only photometry data with large uncertainties. The study of star clusters based on such data is important for astrophysical studies, although photometric uncertainty affects the accuracy of results. In order to estimate the parameter uncertainties that are caused by photometric errors, this work quantifies the influence of photometric error on the uncertainties of some basic parameters when colour-magnitude diagram (CMD) fitting is used to determine these parameters. The observed data are derived from Hubble Space Telescope (HST) observations with the WFPC2 in four bands because of the large coverage of photometric error. The photometric errors that are estimated by Artificial Star Test (AST) are taken, and a binary star stellar population synthesis model and the Powerful CMD code are adopted to determine the parameters of star clusters. Two popular types of stellar population models, i.e. binary star simple stellar population (bsSSP) and single star simple stellar population (ssSSP), are used. The effects of photometric errors on the uncertainties of distance modulus (m − M), colour excess (E), metallicity (Z), and age (t), i.e. Δm − M, ΔE, ΔZ, and Δt, are studied via 19 globular clusters. The results show that Δm − M, ΔE, ΔZ, and Δt have positive correlations with photometric error. Some linear fitting formulae are given to make the results easy to use. The results can be used to estimate the errors of parameters that are caused by photometric error when determining the parameters by CMD fitting, for star clusters with relatively large photometric uncertainties (>∼0.01 mag).
Constraints on the Galactic centre environment from Gaia hypervelocity stars III: insights on a possible companion to Sgr A*
Authors: Evans F A , Rasskazov A , Remmelzwaal A , Marchetti T , Castro-Ginard A , Rossi E M , Bovy J
Published: July 2023

We consider a scenario in which Sgr A* is in a massive black hole binary (MBHB) with an as-of-yet undetected supermassive or intermediate-mass black hole companion. Dynamical encounters between this MBHB and single stars in its immediate vicinity would eject hypervelocity stars (HVSs) with velocities beyond the Galactic escape velocity of the Galaxy. In this work, we use existing HVS observations to constrain for the first time the existence of a companion to Sgr A*. We simulate the ejection of HVSs via the ‘MBHB slingshot’ scenario and show that the population of HVSs detectable today depends strongly on the companion mass and the separation of the MBHB. We demonstrate that the lack of uncontroversial HVS candidates in Gaia Data Release 3 places a firm upper limit on the mass of a possible Sgr A* companion. Within one milliparsec of Sgr A*, our results exclude a companion more massive than $2000 \, \mathrm{M_\odot }$. If Sgr A* recently merged with a companion black hole, our findings indicate that unless this companion was less massive than $500 \, \mathrm{M_\odot }$, this merger must have occurred at least 10 Myr ago. These results complement and improve upon existing independent constraints on a companion to Sgr A* and show that large regions of its parameter space can now be ruled out.
A variable corona during the transition from type-C to type-B quasi-periodic oscillations in the black hole X-ray binary MAXI J1820+070
Authors: Ma Ruican , Méndez Mariano , García Federico , Sai Na , Zhang Liang , Zhang Yuexin
Published: July 2023

We analyse a Neutron Star Interior Composition Explorer observation of the black hole X-ray binary MAXI J1820+070 during a transition from type-C to type-B quasi-periodic oscillations (QPOs). We find that below ∼2 keV, for the type-B QPOs the rms amplitude is lower and the magnitude of the phase lags is larger than for the type-C QPOs. Above that energy, the rms and phase-lag spectra of the type-B and type-C QPOs are consistent with being the same. We perform a joint fit of the time-averaged spectra of the source, and the rms and phase-lag spectra of the QPOs with the time-dependent Comptonization model vkompth to study the geometry of the corona during the transition. We find that the data can be well fitted with a model consisting of a small and a large corona that are physically connected. The sizes of the small and large coronae increase gradually during the type-C QPO phase whereas they decrease abruptly at the transition to type-B QPO. At the same time, the inner radius of the disc moves inward at the QPO transition. Combined with simultaneous radio observations showing that discrete jet ejections happen around the time of the QPO transition, we propose that a corona that expands horizontally during the type-C QPO phase, from ∼104 km ($\sim 800\, R_{\rm g}$) to 105 km ($\sim 8000\, R_{\rm g}$) overlying the accretion disc, transforms into a vertical jet-like corona extending over ∼104 km ($\sim 800\, R_{\rm g}$) during the type-B QPO phase.
Measuring tidal dissipation in giant planets from tidal circularization
Authors: Mahmud Mohammad M , Penev Kaloyan M , Schussler Joshua A
Published: July 2023

In this project, we determined the constraints on the modified tidal quality factor, $Q_{\rm pl}^{\prime }$, of gas-giant planets orbiting close to their host stars. We allowed $Q_{\rm pl}^{\prime }$ to depend on tidal frequency, accounting for the multiple tidal waves with time-dependent frequencies simultaneously present on the planet. We performed our analysis on 78 single-star and single-planet systems, with giant planets and host stars with radiative cores and convective outer shells. We extracted constraints on the frequency-dependent $Q_{\rm pl}^{\prime }$ for each system separately and combined them to find general constraints on $Q_{\rm pl}^{\prime }$ required to explain the observed eccentricity envelope while simultaneously allowing the observed eccentricities of all systems to survive to the present-day. Individual systems do not place tight constraints on $Q_{\rm pl}^{\prime }$. However, since similar planets must have similar tidal dissipation, we require that a consistent, possibly frequency-dependent, model must apply. Under that assumption, we find that the value of $\log _{10}Q_{\rm pl}^{\prime }$ for HJs is 5.0 ± 0.5 for the range of tidal period from 0.8 to 7 d. We did not see any clear sign of frequency dependence of $Q_{\rm pl}^{\prime }$.