bluuebunny/crossref_metadata_2025 huggingface dataset:
A Retrospective, Long‐term Follow‐up of the Clinical Outcomes and Cost‐effectiveness of Single‐anesthetic Multiple Total Joint Procedures in Hemophilic Arthropathy
Authors: Peng Hui‐ming , Jiang Chao , Zheng Zhi‐bo , Chen Xin , Feng Bin , Zhai Ji‐liang , Bian Yan‐yan , Weng Xi‐sheng
Published: May 2023

Objective

Although total joint replacement (TJR) procedures are efficacious, perioperative high‐dose factors replacement therapy (FRT) to avoid catastrophic bleeding represents a significant hurdle, particularly for patients with multiple joint affection. Double simultaneous bilateral TJRs were reported as safe and cost‐effective. However, little is known about multiple TJRs. The feasibility and effects remain debatable. Surgeons need to weigh the high cost of FRT against safety. Accordingly, we aimed to evaluate the clinical outcomes and cost‐effectiveness of single‐anesthetic multiple‐joint procedures of lower limbs in end‐stage hemophilic arthropathy.

Methods

Our retrospective cohort study retrieved data from an inpatient database of patients with hemophilia who underwent total knee arthroplasty (TKA), total hip arthroplasty (THA), and/or ankle arthrodesis from January 2000 to April 2016. Complications, hospital stays, transfusion, doses of clotting factor, medical costs, range of motion (ROM), Harris hip scores (HHSs) and Hospital for special surgery knee scores (HSSs) were recorded. A P value < 0.05 was considered significant.

Results

A total number of 81 patients were included in this study, among which 89 TKAs and 52 THAs were performed. Compared to the single TJR group, the simultaneous multiple TJR group showed a significantly higher rate of blood transfusions (P < 0.05). But no significant differences were found in the length of hospital stays, factor consumption, hospitalization costs excluding prosthesis expenses, and total complication rates. Finally, similar postoperative ROM, HHS, and HSS were witnessed in two groups (P value > 0.05).

Conclusion

Our data indicated that simultaneous multiple TJRs are a safe and cost‐effective choice for treating hemophilic patients with multiple HA‐affected lower limb joints.
Physiotherapy management of nociplastic pain: A Delphi study of Italian specialists
Authors: Baroni Andrea , Margelli Michele , Saoncella Anna , Toigo Ilenia , Antonellini Giulia , Straudi Sofia
Published: May 2023

Background and Purpose

Nociplastic pain due to central sensitization (CS) is common in people suffering from chronic pain, but no clinical practice guideline is available in rehabilitative settings for patients' management. The aim of this study is to achieve expert consensus on physiotherapy competencies in the management of people with nociplastic pain and suspected CS mechanisms.

Methods

A web‐based Delphi process was employed. Experts in the rehabilitation field were recruited following pre‐defined eligibility criteria. Following completion of three Delphi rounds, the final list of competencies was generated.

Results

In all, 23 participants were recruited. They all completed Round 1 (23/23, 100%), twenty Round 2 and Round 3 (20/23, 87%). Following Round 1, seven areas were identified by the panel as crucial for CS physiotherapy management; 19 competencies out of 40 reached the consensus between experts, and nine additional competencies were added to Round 2 following literary review. Round 2 identified the agreement for all the 29 competencies. During Round 3, all the experts confirmed the final list generated through the consensus process.

Discussion

An agreement between experts was found for the final list of competencies that a physiotherapist should implement every time it approaches people with suspected CS mechanisms. Further research is needed to support the clinical utility of our findings and their applicability in daily practice.
Identification of stable restorer lines developed through inter‐sub‐specific hybridization in rice (Oryza sativa) using multi‐trait stability index
Authors: Sruthi Kanneboina , Eswari Kancherla Basaveswari , Damodhar Raju Chennamadhavuni , Sheshu Madhav Maganti , Dhandapani Appavoo , Senguttuvel Ponnuvel , Bala Satya Sree Muthireddy , Sri Krishna Latha Katuru , Beulah Pasumarthi , Nagaraju Pagidipala , Manasa Yekula , Koteswararao Potla , Sadath Ali Mohammad , Divya Balakrishnan , Revathi Ponnusamy , Kemparaju Kaliyur Balachandra , Jyothi Badri , Sundaram Raman Meenakshi , Hari Prasad Arremsetty Subramanyam
Published: May 2023

Inter‐sub‐specific hybridization between indica and tropical japonica rice germplasm is the most efficient approach for broadening the genetic base of hybrid rice parental lines and enhancing the heterotic potential of hybrids in a tropical country like India. In the present study, 106 indica/tropical–japonica derived lines were developed through inter‐sub‐specific hybridization and screened using functional markers with respect to the major fertility restorer genes, Rf3 and Rf4, and the wide compatibility gene, S5n. The fertility restoration ability of newly developed restorers was validated through test cross nursery performance. The functional markers were observed to accurately predict the trait of fertility restoration. From the present study, the decreasing order of efficiency of different gene combinations on fertility restoration ability are as follows: Rf4/S5n > Rf4/Rf3/S5n > Rf4 > Rf4/Rf3 > Rf3/S5n > Rf3. Based on multi‐trait stability index (MTSI) analysis, the four newly identified restorers, that is, RP6388‐90, RP6382‐49, RP6375‐81 and RP6368‐38, were selected as the top best performing genotypes with high stability for multiple traits, and these genotypes will be useful for the development of superior rice hybrids in India.
Trends in prenatal diagnosis of congenital anomalies in Western Australia between 1980 and 2020: A population‐based study
Authors: MacArthur Cassandra , Hansen Michele , Baynam Gareth , Bower Carol , Kelty Erin
Published: May 2023

Background

Advances in screening and diagnostics have changed the way in which we identify and diagnose congenital anomalies.

Objective

To examine changes in rates of prenatal diagnosis of congenital anomalies over time and by demographic characteristics.

Methods

We undertook a population‐based retrospective cohort study of all children born in Western Australia between 1980 and 2020 and diagnosed with a congenital anomaly. Age at diagnosis (prenatal, neonatal, infancy, early childhood or childhood) prevalence (all‐type and type‐specific), and prevalence ratios (PR) were calculated. We fit joinpoint regression models to describe the average annual percentage change (APC) in prenatal diagnosis over time, and log‐binomial regression models to estimate the association between prenatal diagnosis and demographic characteristics.

Results

Prenatal diagnosis prevalence between the first (1980–1989: 28.3 per 10,000 births) and last (2005–2014: 156.1 per 10,000 births) decades of the study increased 5.5‐fold (95% confidence interval [CI] 5.0, 5.9). Substantial increases were observed for cardiovascular (PR 10.7, 95% CI 8.0, 14.6), urogenital (PR 10.5, 95% CI: 8.7, 12.6) and chromosomal anomalies (PR 7.0, 95% CI 5.9, 8.3). Prenatal diagnosis was positively associated with the birth year (adjusted risk ratio [RR] 1.04, 95% CI 1.03, 1.04), advanced maternal age (RR 1.14, 95% CI 1.11, 1.18), multiple anomalies (RR 2.86, 95% CI 2.77, 2.96) and major anomalies (RR 3.75, 95% CI 3.36, 4.19), and inversely associated with remoteness (RR 0.89, 95% CI: 0.83, 0.95) and Aboriginality (RR 0.90, 95% CI 0.83, 0.97).

Conclusions

Increases in prenatal diagnosis of congenital anomalies were observed in Western Australia from 1980 to 2020, reflecting advances in screening. Prenatal diagnosis was less common in remote regions and in Aboriginal children, strengthening calls for increased provision of antenatal care services for these populations.
Considering management behaviours to identify vulnerable caregivers of persons with dementia
Authors: Wawrziczny Emilie , Nandrino Jean‐Louis
Published: May 2023

Background

Persons with dementia gradually disengage from daily activities, and therefore require increasing daily support. Caregivers face a dilemma as to whether they should encourage the persons with dementia in terms of initiative and autonomy, or supervise and take charge of tasks, which may cause distress for both parties. This study seeks to better understand how caregivers manage the disengagement of the persons with dementia and the repercussions on their caregiving experience.

Methods

A total of 217 caregivers participated. Their management behaviours and the characteristics of their caregiving experiences were assessed with questionnaires. A cluster analysis was first performed to identify possible profiles of management behaviours and comparison, which were then compared to identify the caregiving experience associated with each profile.

Results

The first cluster (25.8% of the sample) corresponds to caregivers with high negative control behaviour scores and high positive stimulation behaviour scores; the second cluster (43.8% of the sample) corresponds to caregivers with low positive stimulation behaviour scores and high negative control behaviour scores; and the third cluster (30.4% of the sample) corresponds to caregivers with low negative control behaviour scores and high positive stimulation behaviour scores. Caregivers in Clusters 2 and 3 differ in terms of anxiety, depression, burden, gratification, health and financial problems. Cluster 1 is an intermediate profile with similar characteristics to Cluster 3.

Conclusions

Our results support the idea of considering management behaviours to identify vulnerable caregivers and highlight the deleterious role of negative control behaviours, especially when they are not offset by positive protective stimulation behaviours.
Identification of the novel HLA‐B*58:138 allele in a Korean individual
Authors: Youk Hee‐Jeong , Kwon Oh‐Joong , Oh Heung‐Bum
Published: May 2023

HLA‐B*58:138 differs from HLA‐B*58:01:01:01 by one nucleotide substitution in exon 3 at codon 145.
Language Entails Linguistic Relativity
Authors: Enfield N. J.
Published: May 2023

This commentary addresses the challenge of linking an individual‐grounded theory of concepts to a phenomenon that assumes conceptual conventions at population level (linguistic relativity). We distinguish I‐concepts (individual, interior, imagistic) from L‐concepts (linguistic, labeled, local) and see that quite different causal processes are often conflated under the term “concepts.” I argue that the Grounded Cognition Model (GCM) entails linguistic relativity only to the extent that it imports L‐concepts into its scope, which it can hardly avoid doing given that practitioners require language to coordinate around their theory and findings. I conclude that what entails linguistic relativity is not the GCM but language itself.
Evaluation of Spray and Combustion Models for Simulating Dilute Combustion in a Direct-Injection Spark-Ignition Engine
Authors: Kim Joohan , Ameen Muhsin , Scarcelli Riccardo , Kim Namho , Singh Eshan , Sjöberg Magnus
Published: May 2023

Dilute combustion in spark-ignition engines has the potential to improve thermal efficiency by mitigating knock and by reducing throttling and wall heat losses. However, ignition and combustion processes can become unstable for dilute operation due to a lowered laminar flame speed, resulting in excessive cycle-to-cycle variability (CCV) of the combustion process. To compensate for the slower combustion in less reactive mixtures, a modified intake port geometry can be employed to generate a strong tumble flow in the cylinder and elevate turbulence levels around the spark plug, thereby promoting a faster transition to turbulent deflagration. Consequently, optimizing combustion chamber geometry and operating strategy is crucial to maximizing the benefits of using dilute combustion with enhanced in-cylinder turbulence across a wide range of operating conditions. Computational fluid dynamics (CFD) simulations can be utilized for virtual engine optimization tasks, but this would require the models to be truly predictive regarding the impact of changes to the engine design and operational parameters.

In this study, multicycle large-eddy simulations (LES) are performed for a direct-injection spark-ignition engine to investigate the model performance in predicting engine combustion characteristics with respect to changes in the intake configuration. A tumble plate that blocks the lower part of the intake port inlet is used to vary the tumble. A set of CFD models that have been recently developed are employed, which takes into account the drag of nonspherical droplets, flash-boiling behavior of liquid sprays, spray-wall interaction, surrogate formulation of a research-grade E10 gasoline, and fast chemical kinetic solvers. Simulation results are compared to experimental engine data in terms of cylinder pressure, apparent heat release rate, mass fraction burned timing, and flame images. It is found that LES employing the state-of-the-art CFD models are capable of properly predicting the spray processes and reproducing the measured mean cylinder pressure for the case with the tumble plate. On the other hand, the LES over-predicts the combustion rate during the early combustion stage and under-estimates the CCV, and these discrepancies become larger when the tumble plate is removed.
Shear Wave-Induced Friction at Periodic Interfaces for Programmable Mechanical Responses
Authors: Patil Ganesh U. , Fantetti Alfredo , Matlack Kathryn H.
Published: May 2023

Nonlinear phononic materials enable superior wave responses by combining nonlinearity with their inherent periodicity, creating opportunities for the development of novel acoustic devices. However, the field has largely focused on reversible nonlinearities, whereas the role of hysteretic nonlinearity remains unexplored. In this work, we investigate nonlinear shear wave responses arising from the hysteretic nonlinearity of frictional rough contacts, and harness these responses to enable programmable functions. By using a numerical approach, we solve the strongly nonlinear problem of shear wave propagation through a single contact and a periodic array of contacts, accounting for frictional effects. Specifically, the Jenkin friction model with experimentally obtained properties is used to capture the effects of stick–slip transition at the contacts. Results show that friction gives rise to shear-polarized eigenstrains, which are residual static deformations within the system. We then demonstrate how eigenstrain generation in multiple contacts can enable programmable functionalities such as an acoustically controlled mechanical switch, precision position control, and surface reconfigurability. Overall, our findings open new avenues for designing smart materials and devices with advanced functionalities via acoustic waves using the hysteretic nonlinearity of frictional contacts.
Challenges and Opportunities for Machine Learning in Multiscale Computational Modeling
Authors: Nguyen Phong C. H. , Choi Joseph B. , Udaykumar H. S. , Baek Stephen
Published: May 2023

Many mechanical engineering applications call for multiscale computational modeling and simulation. However, solving for complex multiscale systems remains computationally onerous due to the high dimensionality of the solution space. Recently, machine learning (ML) has emerged as a promising solution that can either serve as a surrogate for, accelerate or augment traditional numerical methods. Pioneering work has demonstrated that ML provides solutions to governing systems of equations with comparable accuracy to those obtained using direct numerical methods, but with significantly faster computational speed. These high-speed, high-fidelity estimations can facilitate the solving of complex multiscale systems by providing a better initial solution to traditional solvers. This paper provides a perspective on the opportunities and challenges of using ML for complex multiscale modeling and simulation. We first outline the current state-of-the-art ML approaches for simulating multiscale systems and highlight some of the landmark developments. Next, we discuss current challenges for ML in multiscale computational modeling, such as the data and discretization dependence, interpretability, and data sharing and collaborative platform development. Finally, we suggest several potential research directions for the future.
An Approach to Analyzing and Comparing the Cooling Performance of Two Indirect Evaporative Cooler Designs
Authors: Salman Braihan Abdulwadood
Published: May 2023

Energy-efficient air cooling systems are always in demand. Direct evaporative coolers are energy-saving and have low cost, but in hot and humid areas, they produce an almost uncomfortable environment. Alternatively, modified indirect evaporative coolers with different technical configurations can produce better thermal output. This paper presents a simple thermodynamic approach developed to analyze, for comparison, the behavior of conventional and regenerative indirect evaporative coolers that comprise different process structures. The analysis is based on the energy balance of the coolers to consider which is more applicable for further modification. Similar performance cross-flow heat exchangers with separate air washers are adopted for both units. The two coolers are subjected to the same general summer operating conditions. The results showed that the conventional indirect evaporative cooler provided better cooling performance in terms of all thermal comparison parameters. The supply temperature trend in regenerative indirect evaporative cooler (RIEC) is higher by 23.4–34.1%, while its effectiveness is lower by 26–56% compared to that of the conventional indirect evaporative cooler (CIEC). The cooling capacity of CIEC is always higher at any air ratio value. At an equal secondary air flowrate where the primary air flowrate of RIEC is 25% more than that of CIEC, CIEC still generates lower air supply temperature and its effectiveness is higher. Thus, CIEC deserves priority attention for further development and additional improvement of performance.
Morphological ontogeny of Eubelba danubedeltaica sp. nov. (Acari, Oribatida, Damaeidae) and comments on Eubelba Miko
Authors: Seniczak Stanisław , Ivan Otilia , Kolesnikov Vasiliy B. , Kaczmarek Sławomir , Marquardt Tomasz , Seniczak Anna
Published: May 2023

The morphological ontogeny of Eubelba danubedeltaica sp. nov. is described and illustrated. The adult of E. danubedeltaica is most similar to E. sculpta (Mihelčič, 1957) which differs from E. danubedeltaica by the presence of tubercle E2p, slightly longer seta c1 and leg IV, and thicker and clearly barbed epimeral, genital, aggenital and anal setae whereas in E. danubedeltaica tubercle E2p is absent and these setae are thinner and most are smooth, except for finely barbed genital and anal setae that are clearly visible at a high SEM magnification. In the juveniles of E. danubedeltaica, most prodorsal setae are of medium size, except for short seta in in the nymphs and very long setiform bothridial seta which are strongly curved in the distal part. Most gastronotal setae of juveniles are long, or very long, except for medium-sized c3, la, lm and h2, and short h3 in the larva, and medium-sized c3 and p2 in nymphs. The nymphs are quadrideficient and eupheredermous, i.e. they have lost the d-series setae and carry the exuvial scalps of previous instars using a cornicle located between setal pair h3. In all juveniles, the famulus ɛ on tarsus I is sunken but is emergent in the adult. Seta d accompanies solenidion σ on genua I–III and φ on tibiae II–IV.
Applications of the eikonal approximation in quantum mechanical scattering
Authors: Holstein Barry R.
Published: May 2023

Scattering is an important component of any quantum mechanics course. However, the scattering amplitude in the case of a general potential is often calculated using the simple Born approximation, which does not embed general properties such as unitarity or analyticity. We show that a relatively simple extension, the eikonal approximation, offers a significant improvement and demonstrate this in the case of the electromagnetic and gravitational interactions.
The discovery of a supermassive black hole at the center of the Milky Way galaxy
Authors: McDonough Bryanne , Withers Paul
Published: May 2023

Black holes are fascinating astrophysical objects, yet they are rarely encountered in undergraduate-level physics courses. Here, we use concepts accessible to upper division physics majors to explain the discovery of a supermassive black hole at the center of the Milky Way galaxy, which was recognized by the award of the 2020 Nobel Prize in Physics. Infrared observations of the innermost region of the Milky Way galaxy show that many stars orbit around the galactic center at distances comparable to the size of the solar system with decadal-scale periods. We show how, given the sizes and periods of these stellar orbits, Newton's version of Kepler's third law can be used to determine the mass and maximum radius of the concentration of mass at the galactic center. We consider various possible physical interpretations consistent with this mass and maximum radius, rejecting flat disks due to dynamical instabilities, clouds of gas and/or dust due to gravitational instabilities, and clusters of compact objects due to collisional instabilities. This demonstrates that a supermassive black hole is the only possible explanation for the observed orbits of stars close to the galactic center.
Introducing quantum mechanics through its historical roots: The hydrogen Rydberg atom viewed through the lens of the old quantum theory
Authors: Littman M. G. , Gordis E. , Zhelnin P. , Arnold J.
Published: May 2023

Solutions of Schrödinger's equation for Rydberg states of hydrogen are shown to display patterns that can be understood semi-classically within the framework of Bohr-Sommerfeld planetary orbits and de Broglie's concept of matter waves. Using n = 10 and n = 100 quantum levels we show how de Broglie-wave-analyzed Kepler orbits can be matched to excited-state wavefunctions and charge distributions. Making the connection between the old and new quantum theories can help beginning students develop an intuition about quantum mechanics and allow them to develop an appreciation of how Schrödinger's wave mechanics was stimulated by the theories of his predecessors.
Flexible, low-cost phase-sensitive detection for the undergraduate laboratory with a Teensy microcontroller
Authors: Fung Jerome , Weil Christopher L.
Published: May 2023

We perform phase-sensitive detection with an inexpensive microcontroller, the Teensy 3.5. The programming and pricing of this microcontroller is similar to that of commonly used Arduino microcontrollers, but the Teensy 3.5 offers superior hardware performance. Our Teensy-based phase-sensitive detector can operate either with an external reference signal or by internally generating a reference signal. Additionally, we have developed an open-source graphical user interface for controlling the instrument. We demonstrate that our phase-sensitive detector exhibits good linearity in amplitude and phase, even with 25 mV signals dominated by larger-amplitude noise. We also use our phase-sensitive detector in a simple laboratory measurement: determining the distance dependence of the intensity of a light-emitting diode (LED) with the room lights on. Our instrument is a useful tool for teaching students about phase-sensitive detection and can be a viable low-cost alternative to commercial lock-in amplifiers.
Team Representation: Scale Development and Validation
Authors: Asada Akira , Reifurth Katherine R.N.
Published: May 2023

The purpose of the current study was to develop a valid and reliable measure of team representation, which refers to the extent to which the residents of a community perceive a local sports team to be representative of the community. Through our literature review, focus groups, and surveys, we identified four key dimensions that serve as formative indicators of team representation (i.e., normative, descriptive, symbolic, and substantive representation) and developed scale items measuring those dimensions. The results of exploratory factor analysis and partial least squares structural equation modeling confirmed the validity of our scale items and reflective–formative measurement model. As the first study to develop and validate scale items measuring specific dimensions of team representation, the current research provides significant contributions to the literature. Our scale items also enable sports teams to assess their representative status in their local communities and develop effective strategies to improve their representation.
Relationship Between Posterior Shoulder Tightness and Lower-Limb Flexibility in College Baseball Players
Authors: Ishigaki Tomonobu , Hirokawa Motoki , Ezawa Yuya , Yamanaka Masanori
Published: May 2023

Context: Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players. Design: Cross-sectional study. Setting: University laboratory. Participants: Twenty-two college baseball players (20 right-handed and 2 left-handed). Methods: To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs. Results: Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 = .250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P = .018) and horizontal adduction (R2 = .200, β [95% CI] = 0.447 [0.051 to 1.499], P = .019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 = .189, β [95% CI] = 0.435 [0.019 to 1.137], P = .022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 = .243, β [95% CI] = 0.493 [0.139 to 1.438], P = .010). Conclusion: College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players.
See no allergen, hear no allergen, speak no allergen!
Authors: Gay Aurore C. A. , Nawijn Martijn C.
Published: May 2023

Segmental allergen challenge in allergic patients with asthma reveals a previously unknown role for monocytes in the T helper 2 (T
H
2)–dependent inflammatory response, whereas in allergic controls without asthma, allergen unresponsiveness seems to be maintained through epithelial-myeloid cell cross-talk that prevents T
H
2 cell activation (see related Research Article by

Alladina
et al.

).
Cytokinopathy with aberrant cytotoxic lymphocytes and profibrotic myeloid response in SARS-CoV-2 mRNA vaccine–associated myocarditis
Authors: Barmada Anis , Klein Jon , Ramaswamy Anjali , Brodsky Nina N. , Jaycox Jillian R. , Sheikha Hassan , Jones Kate M. , Habet Victoria , Campbell Melissa , Sumida Tomokazu S. , Kontorovich Amy , Bogunovic Dusan , Oliveira Carlos R. , Steele Jeremy , Hall E. Kevin , Pena-Hernandez Mario , Monteiro Valter , Lucas Carolina , Ring Aaron M. , Omer Saad B. , Iwasaki Akiko , Yildirim Inci , Lucas Carrie L.
Published: May 2023

Rare immune-mediated cardiac tissue inflammation can occur after vaccination, including after SARS-CoV-2 mRNA vaccines. However, the underlying immune cellular and molecular mechanisms driving this pathology remain poorly understood. Here, we investigated a cohort of patients who developed myocarditis and/or pericarditis with elevated troponin, B-type natriuretic peptide, and C-reactive protein levels as well as cardiac imaging abnormalities shortly after SARS-CoV-2 mRNA vaccination. Contrary to early hypotheses, patients did not demonstrate features of hypersensitivity myocarditis, nor did they have exaggerated SARS-CoV-2–specific or neutralizing antibody responses consistent with a hyperimmune humoral mechanism. We additionally found no evidence of cardiac-targeted autoantibodies. Instead, unbiased systematic immune serum profiling revealed elevations in circulating interleukins (IL-1β, IL-1RA, and IL-15), chemokines (CCL4, CXCL1, and CXCL10), and matrix metalloproteases (MMP1, MMP8, MMP9, and TIMP1). Subsequent deep immune profiling using single-cell RNA and repertoire sequencing of peripheral blood mononuclear cells during acute disease revealed expansion of activated CXCR3
+
cytotoxic T cells and NK cells, both phenotypically resembling cytokine-driven killer cells. In addition, patients displayed signatures of inflammatory and profibrotic CCR2
+
CD163
+
monocytes, coupled with elevated serum-soluble CD163, that may be linked to the late gadolinium enhancement on cardiac MRI, which can persist for months after vaccination. Together, our results demonstrate up-regulation in inflammatory cytokines and corresponding lymphocytes with tissue-damaging capabilities, suggesting a cytokine-dependent pathology, which may further be accompanied by myeloid cell–associated cardiac fibrosis. These findings likely rule out some previously proposed mechanisms of mRNA vaccine–-associated myopericarditis and point to new ones with relevance to vaccine development and clinical care.
Supplemental Material: Thermal architecture of the Salmon River suture zone, Idaho, USA: Implications for the structural evolution of a ductile accretionary complex during arc-continent collision
Authors: Long Sean P. , al. et
Published: May 2023

Figure 2. Geologic map (1:48,000 scale) of the Salmon River transect (top) and accompanying geologic cross section A–A' (bottom). Geologic map compiled from Aliberti (1988), Gray (2013a, 2013b), Mann (2018), DeYoung (2019), and our mapping. The location of the map area is shown on Figure 1B. Timing constraints for rock units are from Gray (2013a, 2013b) and Gray et al. (2020) unless otherwise specified. The subsurface geometry beneath the Rapid River thrust is queried in the eastern part of the cross section.

Figure 3. Geologic map (1:48,000 scale) that includes the Whitebird Ridge transect (B–B' cross-section line) and Pollock Mountain transect (C–C' cross-section line) and accompanying geologic cross sections. Map is compiled from Aliberti (1988), Mann (2018), Nandi et al. (2018), and DeYoung, 2019. The location of the map area is shown on Figure 1B. Timing constraints for rock units are from Gray (2013a, 2013b) and Gray et al. (2020) unless otherwise specified. 
Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies
Authors: Simões Cunha Mafalda , Amaral Rita , Pereira Ana Margarida , Almeida Rute , Alves-Correia Magna , Loureiro Cláudia Chaves , Lopes Cristina , Carvalho Joana , Ribeiro Carmelita , Vidal Carmen , Antolín-Amérigo Dario , Pinto Diana , Ferreira-Magalhães Manuel , Vasconcelos Maria João , Lozoya Carlos , Santos Natacha , Cardia Francisca , Taborda-Barata Luís , Ferreira Rosário , Morais Silva Pedro , Ferreira Tania Monteiro , Câmara Raquel , Silva Eurico , Bordalo Diana , Guimarães Cristina , Calix Maria José , da Silva Sofia , Marques Maria Luís , Morete Ana , Nunes Carlos , Vieira Cláudia , Páscoa Rosália , Alves Adelaide , Marques José Varanda , Reis Bruno , Monteiro Luís , Monteiro Rosário , Cepa Margarida , Valentim Bruno , Coelho Daniela Sousa , Fernandes Sara , Meireles Patrícia , Aguiar Margarida Abreu , Mourão Ana Rita , Fonseca Joao A , Jácome Cristina
Published: May 2023

Objectives

Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.

Methods

This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen’s kappa. Two multivariable logistic regressions were built.

Results

According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.

Conclusion

At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.
’Where are youreallyfrom?’: a qualitative study of racial microaggressions and the impact on medical students in the UK
Authors: Morrison Nariell , Zaman Tabbasum , Webster George , Sorinola Olanrewaju , Blackburn Clare
Published: May 2023

Objective

To explore graduate-entry medical students’ experiences of racial microaggressions, the impact of these on learning, performance and attainment, and their views on how these can be reduced.

Design

Qualitative study using semistructured focus groups and group interviews.

Setting

UK.

Participants

20 graduate-entry medical students were recruited using volunteer and snowball sampling; all students self-identified as being from racially minoritised (RM) backgrounds.

Results

Participants reported experiencing numerous types of racial microaggressions during their time at medical school. Students’ accounts highlighted how these impacted directly and indirectly on their learning, performance and well-being. Students frequently reported feeling uncomfortable and out of place in teaching sessions and clinical placements. Students also reported feeling invisible and ignored in placements and not being offered the same learning opportunities as their white counterparts. This led to lack of access to learning experiences or disengagement from learning. Many participants described how being from an RM background was associated with feelings of apprehension and having their ‘guards up’, particularly at the start of new clinical placements. This was perceived to be an additional burden that was not experienced by their white counterparts. Students suggested that future interventions should focus on institutional changes to diversify student and staff populations; shifting the culture to build and maintain inclusive environments; encouraging open, transparent conversations around racism and promptly managing any student-reported racial experiences.

Conclusion

RM students in this study reported that their medical school experiences were regularly affected by racial microaggressions. Students believed these microaggressions impeded their learning, performance and well-being. It is imperative that institutions increase their awareness of the difficulties faced by RM students and provide appropriate support in challenging times. Fostering inclusion as well as embedding antiracist pedagogy into medical curricula is likely to be beneficial.
How do people perceive different advice for rotator cuff disease? A content analysis of qualitative data collected in a randomised experiment
Authors: Zadro Joshua R , Michaleff Zoe A , O'Keeffe Mary , Ferreira Giovanni E , Traeger Adrian C , Gamble Andrew R , Afeaki Frederick , Li Yaozhuo , Wen Erya , Yao Jiawen , Zhu Kejie , Page Richard , Harris Ian A , Maher Christopher G
Published: May 2023

Objectives

To explore how people perceive different advice for rotator cuff disease in terms of words/feelings evoked by the advice and treatment needs.

Setting

We performed a content analysis of qualitative data collected in a randomised experiment.

Participants

2028 people with shoulder pain read a vignette describing someone with rotator cuff disease and were randomised to:bursitis labelplusguideline-based advice, bursitis labelplustreatment recommendation, rotator cuff tear labelplusguideline-based adviceandrotator cuff tear labelplustreatment recommendation. Guideline-based adviceincluded encouragement to stay active and positive prognostic information.Treatment recommendationemphasised that treatment is needed for recovery.

Primary and secondary outcomes

Participants answered questions about: (1) words/feelings evoked by the advice; (2) treatments they feel are needed. Two researchers developed coding frameworks to analyse responses.

Results

1981 (97% of 2039 randomised) responses for each question were analysed.Guideline-based advice(vstreatment recommendation) more often elicited words/feelings of reassurance, having a minor issue, trust in expertise and feeling dismissed, and treatment needs of rest, activity modification, medication, wait and see, exercise and normal movements.Treatment recommendation(vsguideline-based advice) more often elicited words/feelings of needing treatment/investigation, psychological distress and having a serious issue, and treatment needs of injections, surgery, investigations, and to see a doctor.

Conclusions

Words/feelings evoked by advice for rotator cuff disease and perceived treatment needs may explain whyguideline-based advicereduces perceived need for unnecessary care compared to atreatment recommendation.
Metformin improves cancer immunotherapy by directly rescuing tumor-infiltrating CD8 T lymphocytes from hypoxia-induced immunosuppression
Authors: Finisguerra Veronica , Dvorakova Tereza , Formenti Matteo , Van Meerbeeck Pierre , Mignion Lionel , Gallez Bernard , Van den Eynde Benoit J
Published: May 2023

Background

Despite their revolutionary success in cancer treatment over the last decades, immunotherapies encounter limitations in certain tumor types and patients. The efficacy of immunotherapies depends on tumor antigen-specific CD8 T-cell viability and functionality within the immunosuppressive tumor microenvironment, where oxygen levels are often low. Hypoxia can reduce CD8 T-cell fitness in several ways and CD8 T cells are mostly excluded from hypoxic tumor regions. Given the challenges to achieve durable reduction of hypoxia in the clinic, ameliorating CD8 T-cell survival and effector function in hypoxic condition could improve tumor response to immunotherapies.

Methods

Activated CD8 T cells were exposed to hypoxia and metformin and analyzed by fluorescence-activated cell sorting for cell proliferation, apoptosis and phenotype. In vivo, metformin was administered to mice bearing hypoxic tumors and receiving either adoptive cell therapy with tumor-specific CD8 T cells, or immune checkpoint inhibitors; tumor growth was followed over time and CD8 T-cell infiltration, survival and localization in normoxic or hypoxic tumor regions were assessed by flow cytometry and immunofluorescence. Tumor oxygenation and hypoxia were measured by electron paramagnetic resonance and pimonidazole staining, respectively.

Results

We found that the antidiabetic drug metformin directly improved CD8 T-cell fitness in hypoxia, both in vitro and in vivo. Metformin rescued murine and human CD8 T cells from hypoxia-induced apoptosis and increased their proliferation and cytokine production, while blunting the upregulation of programmed cell death protein 1 and lymphocyte-activation gene 3. This appeared to result from a reduced production of reactive oxygen species, due to the inhibition of mitochondrial complex I. Differently from what others reported, metformin did not reduce tumor hypoxia, but rather increased CD8 T-cell infiltration and survival in hypoxic tumor areas, and synergized with cyclophosphamide to enhance tumor response to adoptive cell therapy or immune checkpoint blockade in different tumor models.

Conclusions

This study describes a novel mechanism of action of metformin and presents a promising strategy to achieve immune rejection in hypoxic and immunosuppressive tumors, which would otherwise be resistant to immunotherapy.
Single women’s access to egg freezing in mainland China: an ethicolegal analysis
Authors: Wang Hao
Published: May 2023

In the name of safeguarding public interests and ethical principles, China’s National Health Commission bans unmarried women from using assisted reproductive technology (ART), including egg freezing. Supported by local governments, the ban has restricted single women’s reproductive rights nationwide. Although some courts bypassed the ban to allow widowed single women to use ART, they have not adopted a position in favour of single women’s reproductive autonomy, but quite the contrary. Faced with calls to relax the ban and allow single women to freeze eggs electively, the National Health Commission refused to amend their policy, partly to protect women’s well-being paternalistically and partly to implement the central government’s policies to boost the birthrate and maintain traditional family structures. While the government’s concerns about elective egg freezing are not entirely unfounded, they have failed to demonstrate that banning single women’s egg freezing is a suitable, necessary and proportionate means to safeguard societal interests and ethical principles. The authority’s assumptions that women cannot make rational decisions for their health even with adequate informed consent procedures, that banning egg freezing by single women promotes a culture of having children ‘at a proper age’, and that egg freezing by single women offends China’s public moralities have not been substantiated.
Vision for tobacco endgame in Korea: suggestions for countries with endgame aspirations
Authors: Kang Heewon , Cheon Eunsil , Kim Hyun Kyung , Park Jung Mi , Hwang Jieun , Kim Jinyoung , Lee Sungkyu , Han Yuri , Lim Min Kyung , Park Susan , Cho Sung-il
Published: May 2023

Tobacco endgame is a focal point of discussion at both national and international levels. We aimed to describe efforts related to achieving the tobacco endgame in the Republic of Korea, an exemplar of a country with endgame aspirations, and compare them with the efforts of other nations. We reviewed the tobacco endgame efforts of three nations considered tobacco control leaders: New Zealand (NZ), Australia and Finland. The efforts/attempts of each country were described using an endgame strategy category. The tobacco control leaders had explicit goals to achieve a smoking prevalence of <5% before a target date and had legislation and research centres for tobacco control and/or endgame. NZ is implementing a mixture of conventional and innovative endgame interventions; the others use incremental conventional approaches. In Korea, there has been an attempt to ban the sale and manufacture of combustible cigarettes. The attempt led to the filing of a petition, and a survey of adults showed 70% supported the legislation banning tobacco. The Korean government mentioned a tobacco endgame in a 2019 plan, yet a target and an end date were absent. The 2019 plan in Korea included incremental FCTC strategies. Practices in the leading countries show that legislation and research are key to ending the tobacco epidemic. The MPOWER measures must be strengthened, endgame objectives must be set and bold strategies must be adopted. Key endgame policies include those with evidence of effectiveness, such as retailer reductions.
On black hole surface gravity
Authors: Pugliese Daniela , Quevedo Hernando
Published: May 2023

We analyze the properties of the black hole surface gravity by using an alternative approach based upon the use of light surfaces that are represented by certain characteristic frequencies. To this end, we rewrite the Kerr line element in terms of the characteristic frequencies, which allows us to obtain copies of the Kerr geometries (black hole–clusters) as the parameters vary. In particular, we replace the spin parameter $$a=J/M$$

a
=
J
/
M

with the corresponding characteristic frequencies so that the line element describes only black holes. This new representation is particularly adapted to analyze how the surface gravity behaves as the black hole passes from one state to another. It turns out that the spins $$a={\sqrt{3}}/{2} M$$

a
=

3

/
2
M

and $$a=1/\sqrt{2} M$$

a
=
1
/

2

M

for black holes and $$a/M=\sqrt{9/8}$$

a
/
M
=

9
/
8

for naked singularities are of particular relevance for the analysis of the surface gravity properties.
Influence of chemical reaction and thermal convective condition on the heat and mass transport in boundary layer flow over a magneto-radiated wedge with cross diffusion
Authors: Alharbi Khalid Abdulkhaliq M. , Adnan  , Ali Fateh , Eldin Sayed M.
Published: May 2023

The analysis of Boundary Layer Flows (BLFs) is of huge significance due to its large-scale applications most likely in aerodynamics, manufacturing of vehicles front faces and many other advanced research areas. Therefore, this study is organized by exercising significant important engineering parameters like surface convection, radiative flux, MHD and thermal and mass diffusion. The developed model embedded the concrete effects of velocity slip, diffusion convection, thermal radiations, magnetic field, chemical reaction and thermo-mass gradients. Later, the numerical treatment is made via RK scheme and the model efficaciously is tackled with desired accuracy. Then the results are decorated over the region (wedge and sheet) and deeply examined. It is observed that slippery surface of wedge and sheet [Formula: see text] enlarges the fluid movement rapidly. The directed magnetic field ([Formula: see text] controlled the fluid motion which can be beneficial from industrial view point. Further, temperature and concentration distributions upsurge by strengthening convective heat ([Formula: see text] and diffusion convection processes. Moreover, skin friction and Nusselt number improved against the parameters under consideration.