bluuebunny/crossref_metadata_2025 huggingface dataset:
Advancements in the Control Strategy for Digital Hydraulically Driven Knee Exoskeleton
Authors: Rituraj Rituraj , Scheidl Rudolf
Published: November 2022

Compared to electromechanical drives, hydraulic drives can be a good actuation alternative for exoskeleton devices due to their advantages in terms of high force density and capabilities of energy recuperation, motion damping and locking. However, to promote a wider adoption of hydraulically driven exoskeleton devices, key challenges related to the compact lightweight design and energy efficient operation and control are needed to be addressed.

To tackle these challenges, the authors have recently developed a novel design of digital hydraulically driven knee exoskeleton. In this work, the authors address the control challenges during the operation of the knee exoskeleton over multiple gait cycles. Proper control methods for different phases of the gait cycle are adopted. Furthermore, these methods are augmented with strategies to accomplish knee motion repeatability across gait cycles. These strategies involve steps to ensure that at the beginning of every gait cycle: (a) the knee angle returns to the same position, and (b) the pressure in the hydraulic chambers return to the same levels.

These control strategies are investigated via a numerical model of the knee exoskeleton. The simulation results indicate that the device is able to repetitively track the motion of the knee over multiple gait cycles while delivering the required torque.
Improving Wheel Loader Energy Efficiency With a Series Electric Hybrid Powertrain
Authors: Lin Zichang , Wang Feng , Xu Bing
Published: November 2022

Engine-powered wheel loaders are widely used in the construction field. However, it suffers from poor engine operation and low efficiency, showing great potential in energy saving and emission reduction. To improve the overall energy efficiency, a series electric hybrid wheel loader powertrain with decoupled main functions is proposed. The system includes a downsized engine, an electric generator, battery pack and three electric motor for drivetrain and lift/tilt hydraulic circuits. The drivetrain is electric motor driven and the lift/tilt functions are powered by electric load sensing system based on variable-speed control. Simulation study are carried out to provide an efficiency comparison between conventional and the proposed powertrain. A battery power-based energy strategy is developed for the hybrid wheel loader to check its potential on fuel saving. Results show that the electric hybrid system saves 43.6% of fuel consumption compared to conventional wheel loader. Energy efficiency comparison of subsystems and components between conventional and proposed powertrain is also presented.
In-Situ Lubrication Film Thickness Measurements in a Radial Piston Motor Using Adaptive Ultrasound Reflectometry
Authors: Hansen Elias Vagn , Rendbæk Jens , Almind Jensen Lasse , Johansen Per
Published: November 2022

Lubrication film thickness monitoring between moving contact surfaces within industrial machinery is of great research interest because it is linked to the efficiency and rate of maintenance of the machine. Ultrasound reflectometry shows potential within this field of research, primarily because the ultrasound transducers can be conveniently implemented in operation-ready machinery. In this article, the lubrication film thickness inside an operational radial piston motor is estimated using two adaptive ultrasound reflectometry methods. A new Gaussian random walk based adaptive ultrasound reflectometry method is compared against the existing layer phase-lag method with adaptive Extended Kalman filter based calibration. It is found that the new method proposed gives less noisy and more accurate lubrication film thickness estimates, but it is more difficult to tune. It is found that both methods can detect the significant lubrication film thickness dynamics present in a radial piston motor, but they need further investigation regarding their robustness and reliability.
Saccade-related neural communication in the human medial temporal lobe is modulated by the social relevance of stimuli
Authors: Staudigl Tobias , Minxha Juri , Mamelak Adam N. , Gothard Katalin M. , Rutishauser Ueli
Published: November 2022

Humans predominantly explore their environment by moving their eyes. To optimally communicate and process visual information, neural activity needs to be coordinated with the execution of eye movements. We investigated the coordination between visual exploration and interareal neural communication by analyzing local field potentials and single neuron activity in patients with epilepsy. We demonstrated that during the free viewing of images, neural communication between the human amygdala and hippocampus is coordinated with the execution of eye movements. The strength and direction of neural communication and hippocampal saccade-related phase alignment were strongest for fixations that landed on human faces. Our results argue that the state of the human medial temporal lobe network is selectively coordinated with motor behavior. Interareal neural communication was facilitated for social stimuli as indexed by the category of the attended information.
Clustering of vomeronasal receptor genes is required for transcriptional stability but not for choice
Authors: Dietschi Quentin , Tuberosa Joël , Fodoulian Leon , Boillat Madlaina , Kan Chenda , Codourey Julien , Pauli Véronique , Feinstein Paul , Carleton Alan , Rodriguez Ivan
Published: November 2022

Rodents perceive pheromones via vomeronasal receptors encoded by highly evolutionarily dynamic Vr and Fpr gene superfamilies. We report here that high numbers of V1r pseudogenes are scattered in mammalian genomes, contrasting with the clustered organization of functional V1r and Fpr genes. We also found that V1r pseudogenes are more likely to be expressed when located in a functional V1r gene cluster than when isolated. To explore the potential regulatory role played by the association of functional vomeronasal receptor genes with their clusters, we dissociated the mouse
Fpr-rs3
from its native cluster via transgenesis. Singular and specific transgenic
Fpr-rs3
transcription was observed in young vomeronasal neurons but was only transient. Our study of natural and artificial dispersed gene duplications uncovers the existence of transcription-stabilizing elements not coupled to vomeronasal gene units but rather associated with vomeronasal gene clusters and thus explains the evolutionary conserved clustered organization of functional vomeronasal genes.
Astrocyte dysfunction drives abnormal resting-state functional connectivity in depression
Authors: Liu Jiaming , Mo Jia-Wen , Wang Xunda , An Ziqi , Zhang Shuangyang , Zhang Can-Yuan , Yi Peiwei , Leong Alex T. L. , Ren Jing , Chen Liang-Yu , Mo Ran , Xie Yuanyao , Feng Qianjin , Chen Wufan , Gao Tian-Ming , Wu Ed X. , Feng Yanqiu , Cao Xiong
Published: November 2022

Major depressive disorder (MDD) is a devastating mental disorder that affects up to 17% of the population worldwide. Although brain-wide network-level abnormalities in MDD patients via resting-state functional magnetic resonance imaging (rsfMRI) exist, the mechanisms underlying these network changes are unknown, despite their immense potential for depression diagnosis and management. Here, we show that the astrocytic calcium-deficient mice, inositol 1,4,5-trisphosphate-type-2 receptor knockout mice (
Itpr2
−/−
mice), display abnormal rsfMRI functional connectivity (rsFC) in depression-related networks, especially decreased rsFC in medial prefrontal cortex (mPFC)–related pathways. We further uncover rsFC decreases in MDD patients highly consistent with those of
Itpr2
−/−
mice, especially in mPFC-related pathways. Optogenetic activation of mPFC astrocytes partially enhances rsFC in depression-related networks in both
Itpr2
−/−
and wild-type mice. Optogenetic activation of the mPFC neurons or mPFC-striatum pathway rescues disrupted rsFC and depressive-like behaviors in
Itpr2
−/−
mice. Our results identify the previously unknown role of astrocyte dysfunction in driving rsFC abnormalities in depression.
Chronic exposure to carbon black ultrafine particles reprograms macrophage metabolism and accelerates lung cancer
Authors: Chang Cheng-Yen , You Ran , Armstrong Dominique , Bandi Ashwini , Cheng Yi-Ting , Burkhardt Philip M. , Becerra-Dominguez Luis , Madison Matthew C. , Tung Hui-Ying , Zeng Zhimin , Wu Yifan , Song Lizhen , Phillips Patricia E. , Porter Paul , Knight John M. , Putluri Nagireddy , Yuan Xiaoyi , Marcano Daniela C. , McHugh Emily A. , Tour James M. , Catic Andre , Maneix Laure , Burt Bryan M. , Lee Hyun-Sung , Corry David B. , Kheradmand Farrah
Published: November 2022

Chronic exposure to airborne carbon black ultrafine (nCB) particles generated from incomplete combustion of organic matter drives IL-17A–dependent emphysema. However, whether and how they alter the immune responses to lung cancer remains unknown. Here, we show that exposure to nCB particles increased PD-L1
+
PD-L2
+
CD206
+
antigen-presenting cells (APCs), exhausted T cells, and T
reg
cells. Lung macrophages that harbored nCB particles showed selective mitochondrial structure damage and decreased oxidative respiration. Lung macrophages sustained the HIF1α axis that increased glycolysis and lactate production, culminating in an immunosuppressive microenvironment in multiple mouse models of non–small cell lung cancers. Adoptive transfer of lung APCs from nCB-exposed wild type to susceptible mice increased tumor incidence and caused early metastasis. Our findings show that nCB exposure metabolically rewires lung macrophages to promote immunosuppression and accelerates the development of lung cancer.
Carbonic anhydrase 4 disruption decreases synaptic and behavioral adaptations induced by cocaine withdrawal
Authors: Gupta Subhash C. , Ghobbeh Ali , Taugher-Hebl Rebecca J. , Fan Rong , Hardie Jason B. , LaLumiere Ryan T. , Wemmie John A.
Published: November 2022

Cocaine use followed by withdrawal induces synaptic changes in nucleus accumbens (NAc), which are thought to underlie subsequent drug-seeking behaviors and relapse. Previous studies suggest that cocaine-induced synaptic changes depend on acid-sensing ion channels (ASICs). Here, we investigated potential involvement of carbonic anhydrase 4 (CA4), an extracellular pH-buffering enzyme. We examined effects of CA4 in mice on ASIC-mediated synaptic transmission in medium spiny neurons (MSNs) in NAc, as well as on cocaine-induced synaptic changes and behavior. We found that CA4 is expressed in the NAc and present in synaptosomes. Disrupting CA4 either globally, or locally, increased ASIC-mediated synaptic currents in NAc MSNs and protected against cocaine withdrawal–induced changes in synapses and cocaine-seeking behavior. These findings raise the possibility that CA4 might be a previously unidentified therapeutic target for addiction and relapse.
Peripheral membrane proteins modulate stress tolerance by safeguarding cellulose synthases
Authors: Kesten Christopher , García-Moreno Álvaro , Amorim-Silva Vítor , Menna Alexandra , Castillo Araceli G. , Percio Francisco , Armengot Laia , Ruiz-Lopez Noemi , Jaillais Yvon , Sánchez-Rodríguez Clara , Botella Miguel A.
Published: November 2022

Controlled primary cell wall remodeling allows plant growth under stressful conditions, but how these changes are conveyed to adjust cellulose synthesis is not understood. Here, we identify the TETRATRICOPEPTIDE THIOREDOXIN-LIKE (TTL) proteins as new members of the cellulose synthase complex (CSC) and describe their unique and hitherto unknown dynamic association with the CSC under cellulose-deficient conditions. We find that TTLs are essential for maintaining cellulose synthesis under high-salinity conditions, establishing a stress-resilient cortical microtubule array, and stabilizing CSCs at the plasma membrane. To fulfill these functions, TTLs interact with CELLULOSE SYNTHASE 1 (CESA1) and engage with cortical microtubules to promote their polymerization. We propose that TTLs function as bridges connecting stress perception with dynamic regulation of cellulose biosynthesis at the plasma membrane.
CTR9 drives osteochondral lineage differentiation of human mesenchymal stem cells via epigenetic regulation of BMP-2 signaling
Authors: Chan Ngai Ting , Lee Ming-Song , Wang Yidan , Galipeau Jacques , Li Wan-Ju , Xu Wei
Published: November 2022

Cell fate determination of human mesenchymal stem/stromal cells (hMSCs) is precisely regulated by lineage-specific transcription factors and epigenetic enzymes. We found that CTR9, a key scaffold subunit of polymerase-associated factor complex (PAFc), selectively regulates hMSC differentiation to osteoblasts and chondrocytes, but not to adipocytes. An in vivo ectopic osteogenesis assay confirmed the essentiality of CTR9 in hMSC-derived bone formation. CTR9 counteracts the activity of Enhancer Of Zeste 2 (EZH2), the epigenetic enzyme that deposits H3K27me3, in hMSCs. Accordingly, CTR9 knockdown (KD) hMSCs gain H3K27me3 mark, and the osteogenic differentiation defects of CTR9 KD hMSCs can be partially rescued by treatment with EZH2 inhibitors. Transcriptome analyses identified bone morphology protein–2 (BMP-2) as a downstream effector of CTR9. BMP-2 secretion, membrane anchorage, and the BMP-SMAD pathway were impaired in CTR9 KD MSCs, and the effects were rescued by BMP-2 supplementation. This study uncovers an epigenetic mechanism engaging the CTR9–H3K27me3–BMP-2 axis to regulate the osteochondral lineage differentiation of hMSCs.
Presence or absence of stabilizing Earth system feedbacks on different time scales
Authors: Arnscheidt Constantin W. , Rothman Daniel H.
Published: November 2022

The question of how Earth’s climate is stabilized on geologic time scales is important for understanding Earth’s history, long-term consequences of anthropogenic climate change, and planetary habitability. Here, we quantify the typical amplitude of past global temperature fluctuations on time scales from hundreds to tens of millions of years and use it to assess the presence or absence of long-term stabilizing feedbacks in the climate system. On time scales between 4 and 400 ka, fluctuations fail to grow with time scale, suggesting that stabilizing mechanisms like the hypothesized “weathering feedback” have exerted dominant control in this regime. Fluctuations grow on longer time scales, potentially due to tectonically or biologically driven changes that make weathering act as a climate forcing and a feedback. These slower fluctuations show no evidence of being damped, implying that chance may still have played a nonnegligible role in maintaining the long-term habitability of Earth.
Pulsed transistor operation enables miniaturization of electrochemical aptamer-based sensors
Authors: Bidinger Sophia L. , Keene Scott T. , Han Sanggil , Plaxco Kevin W. , Malliaras George G. , Hasan Tawfique
Published: November 2022

By simultaneously transducing and amplifying, transistors offer advantages over simpler, electrode-based transducers in electrochemical biosensors. However, transistor-based biosensors typically use static (i.e., DC) operation modes that are poorly suited for sensor architectures relying on the modulation of charge transfer kinetics to signal analyte binding. Thus motivated, here, we translate the AC “pulsed potential” approach typically used with electrochemical aptamer-based (EAB) sensors to an organic electrochemical transistor (OECT). Specifically, by applying a linearly sweeping square-wave potential to an aptamer-functionalized gate electrode, we produce current modulation across the transistor channel two orders of magnitude larger than seen for the equivalent, electrode-based biosensor. Unlike traditional EAB sensors, our aptamer-based OECT (AB-OECT) sensors critically maintain output current even with miniaturization. The pulsed transistor operation demonstrated here could be applied generally to sensors relying on kinetics-based signaling, expanding opportunities for noninvasive and high spatial resolution biosensing.
Human genetics uncovers
MAP3K15
as an obesity-independent therapeutic target for diabetes
Authors: Nag Abhishek , Dhindsa Ryan S. , Mitchell Jonathan , Vasavda Chirag , Harper Andrew R. , Vitsios Dimitrios , Ahnmark Andrea , Bilican Bilada , Madeyski-Bengtson Katja , Zarrouki Bader , Zoghbi Anthony W. , Wang Quanli , Smith Katherine R. , Alegre-Díaz Jesus , Kuri-Morales Pablo , Berumen Jaime , Tapia-Conyer Roberto , Emberson Jonathan , Torres Jason M. , Collins Rory , Smith David M. , Challis Benjamin , Paul Dirk S. , Bohlooly-Y Mohammad , Snowden Mike , Baker David , Fritsche-Danielson Regina , Pangalos Menelas N. , Petrovski Slavé
Published: November 2022

We performed collapsing analyses on 454,796 UK Biobank (UKB) exomes to detect gene-level associations with diabetes. Recessive carriers of nonsynonymous variants in
MAP3K15
were 30% less likely to develop diabetes (
P
= 5.7 × 10
−10
) and had lower glycosylated hemoglobin (β = −0.14 SD units,
P
= 1.1 × 10
−24
). These associations were independent of body mass index, suggesting protection against insulin resistance even in the setting of obesity. We replicated these findings in 96,811 Admixed Americans in the Mexico City Prospective Study (
P
< 0.05). Moreover, the protective effect of
MAP3K15
variants was stronger in individuals who did not carry the Latino-enriched
SLC16A11
risk haplotype (
P
= 6.0 × 10
−4
). Separately, we identified a Finnish-enriched
MAP3K15
protein-truncating variant associated with decreased odds of both type 1 and type 2 diabetes (
P
< 0.05) in FinnGen. No adverse phenotypes were associated with protein-truncating
MAP3K15
variants in the UKB, supporting this gene as a therapeutic target for diabetes.
The missing link between zeolites and polyoxometalates
Authors: Wang Guangmei , Dorn Katharina V. , Siebeneichler Stefanie , Valldor Martin , Smetana Volodymyr , Mudring Anja-Verena
Published: November 2022

Open framework materials such as zeolites and metalorganic frameworks are garnering tremendous interest because of their intriguing architecture and attractive functionalities. Thus, new types of open framework materials are highly sought after. Here, we present the discovery of completely new inorganic framework materials, where, in contrast to conventional inorganic open frameworks, the scaffold is not based on tetrahedral EO
4
(E = main group element) but octahedral MO
6
(M = transition metal) building blocks. These structural features place them closer to polyoxometalates than zeolites. The first representatives of this class of materials are [(R)
24
(NH
4
)
14
(PO(OH)
2
)
6
]·[M
134
(PO
3
(OH,F))
96
F
120
] (M = Co, R = C
2
Py = 1-ethylpyridinium and M = Ni, R = C
4
C
1
Py = 1-butyl-3-methylpyridinium) featuring interlinked fullerene-like nanosphere cavities. Having a transition metal building up the framework brings about interesting properties, for example, spin-glass behavior, and, with this particular topology, a hedgehog-like spin orientation.
Visualization of exhaled breath metabolites reveals distinct diagnostic signatures for acute cardiorespiratory breathlessness
Authors: Ibrahim Wadah , Wilde Michael J. , Cordell Rebecca L. , Richardson Matthew , Salman Dahlia , Free Robert C. , Zhao Bo , Singapuri Amisha , Hargadon Beverley , Gaillard Erol A. , Suzuki Toru , Ng Leong L. , Coats Tim , Thomas Paul , Monks Paul S. , Brightling Christopher E. , Greening Neil J. , Siddiqui Salman ,   On behalf of the EMBER Consortium, Munton Rachel , Le Quesne John , Goodall Alison H. , Pandya Hitesh C. , Reynolds James C. , Clokie Martha R. J. , Samani Nilesh J. , Barer Michael R. , Shaw Jacqueline A.
Published: November 2022

Acute cardiorespiratory breathlessness accounts for one in eight of all emergency hospitalizations. Early, noninvasive diagnostic testing is a clinical priority that allows rapid triage and treatment. Here, we sought to find and replicate diagnostic breath volatile organic compound (VOC) biomarkers of acute cardiorespiratory disease and understand breath metabolite network enrichment in acute disease, with a view to gaining mechanistic insight of breath biochemical derangements. We collected and analyzed exhaled breath samples from 277 participants presenting acute cardiorespiratory exacerbations and aged-matched healthy volunteers. Topological data analysis phenotypes differentiated acute disease from health and acute cardiorespiratory exacerbation subtypes (acute heart failure, acute asthma, acute chronic obstructive pulmonary disease, and community-acquired pneumonia). A multibiomarker score (101 breath biomarkers) demonstrated good diagnostic sensitivity and specificity (≥80%) in both discovery and replication sets and was associated with all-cause mortality at 2 years. In addition, VOC biomarker scores differentiated metabolic subgroups of cardiorespiratory exacerbation. Louvain clustering of VOCs coupled with metabolite enrichment and similarity assessment revealed highly specific enrichment patterns in all acute disease subgroups, for example, selective enrichment of correlated C5-7 hydrocarbons and C3-5 carbonyls in heart failure and selective depletion of correlated aldehydes in acute asthma. This study identified breath VOCs that differentiate acute cardiorespiratory exacerbations and associated subtypes and metabolic clusters of disease-associated VOCs.
APOE ε4 genotype, amyloid-β, and sex interact to predict tau in regions of high APOE mRNA expression
Authors: Dincer Aylin , Chen Charles D. , McKay Nicole S. , Koenig Lauren N. , McCullough Austin , Flores Shaney , Keefe Sarah J. , Schultz Stephanie A. , Feldman Rebecca L. , Joseph-Mathurin Nelly , Hornbeck Russ C. , Cruchaga Carlos , Schindler Suzanne E. , Holtzman David M. , Morris John C. , Fagan Anne M. , Benzinger Tammie L.S. , Gordon Brian A.
Published: November 2022

The apolipoprotein E (
APOE
) ε4 allele is strongly linked with cerebral β-amyloidosis, but its relationship with tauopathy is less established. We investigated the relationship between
APOE
ε4 carrier status, regional amyloid-β (Aβ), magnetic resonance imaging (MRI) volumetrics, tau positron emission tomography (PET),
APOE
messenger RNA (mRNA) expression maps, and cerebrospinal fluid phosphorylated tau (CSF ptau
181
). Three hundred fifty participants underwent imaging, and 270 had ptau
181
. We used computational models to evaluate the main effect of
APOE
ε4 carrier status on regional neuroimaging values and then the interaction of ε4 status and global Aβ on regional tau PET and brain volumes as well as CSF ptau
181
. Separately, we also examined the additional interactive influence of sex. We found that, for the same degree of Aβ burden,
APOE
ε4 carriers showed greater tau PET signal relative to noncarriers in temporal regions, but no interaction was present for MRI volumes or CSF ptau
181
. This potentiation of tau aggregation irrespective of sex occurred in brain regions with high
APOE
mRNA expression, suggesting local vulnerabilities to tauopathy. There were greater effects of
APOE
genotype in females, although the interactive sex effects did not strongly mirror mRNA expression. Pathology is not homogeneously expressed throughout the brain but mirrors underlying biological patterns such as gene expression.
Answer to November 2022 Photo Quiz
Authors: Maldonado-Barrueco Alfredo , Subirats-Núñez Mercedes , Vázquez-Colomo Paola Cristina , Fernández-Gutiérrez Eva , Roca-Cabau Mireia
Published: November 2022

Read the full article for the answer.
Draft Genome Sequence of a Ketoprofen Degrader, Rhodococcus erythropolis IEGM 746
Authors: Ivshina Irina B. , Tyumina Elena A. , Bazhutin Grigory A. , Polygalov Maxim А. , Krivoruchko Anastasiia V.
Published: November 2022

We report a draft genome sequence of
Rhodococcus erythropolis
IEGM 746 isolated from oil-polluted soil from an oil-extracting enterprise, Udmurt Republic, Russia. This strain was able to degrade ketoprofen, a commonly used nonsteroidal anti-inflammatory drug. Using the obtained sequence, putative genes encoding enzymes for ketoprofen degradation were revealed.
Supplemental Material: Revised age and regional correlations of Cenozoic strata on Bat Mountain, Death Valley region, California, USA, from zircon U-Pb geochronology of sandstones and ash-fall tuffs
Authors: Schwartz T.M. , al. et
Published: November 2022

Table S1: New zircon U-Pb data for tuffs of the Amargosa Valley and Bat Mountain formations exposed on Bat Mountain in the southern Funeral Mountains, California. Table S2: New detrital zircon U-Pb data for sandstones of the Amargosa Valley and Bat Mountain formations exposed on Bat Mountain in the southern Funeral Mountains, California. 
Assessing autism spectrum disorder in children with a background of maltreatment: challenges and guidance
Authors: Wilkinson Simon , Evans Sacha , DeJong Margaret
Published: November 2022

There may be some similarities in the presentation of children who have autism spectrum disorder (ASD) and those exposed to maltreatment affecting assessment and diagnosis. Overlapping characteristics include difficulties understanding and maintaining relationships, sensitivity to routine and hyper-reactivity to sensory inputs. Children who have been maltreated are at increased risk of various developmental vulnerabilities with both environmental and genetic factors being relevant. The existing epidemiological evidence has found that looked-after children are more likely to screen positively for neurodevelopmental disorders and there are smaller scale studies in adoptive children finding higher rates of ASD than would be expected in the general population. Other research suggests a predominantly genetic basis for this increased risk in keeping with what is generally understood about the aetiology of autism. Children exposed to profound deprivation in Romanian orphanages were found to be at higher risk of a pattern of traits termed ‘quasi autistic’ which tended to reduce following adoption, but these findings have not been replicated in children experiencing maltreatment in birth families. Reactive attachment disorder (RAD) has some overlapping criteria with ASD, but its prevalence is unknown and children with RAD should be more socially reciprocal and not have the same repetitive and restricted behaviours and interests. We recommend experienced multidisciplinary assessment that considers both the possibility of maltreatment in children with ASD and neurodevelopmental vulnerabilities in children who have been maltreated and advise on assessment and management strategies.
Rates of choroidal loss and ganglion cell–inner plexiform layer thinning in type 2 diabetes mellitus and healthy individuals: a 2-year prospective study
Authors: Hui Ziwen , Guo Xiao , Bulloch Gabriella , Yuan Meng , Xiong Kun , Zhang Shiran , Chen Yifan , Li Yuting , Liao Huan , Huang Wenyong , Zhu Zhuoting , Wang Wei
Published: November 2022

Aims

To investigate longitudinal choroid and ganglion cell–inner plexiform layer (GCIPL) changes in type 2 diabetes mellitus (T2DM) patients and healthy populations across 2 years.

Methods

This prospective cohort study included T2DM patients and healthy controls. T2DM patients were divided into mild non-proliferative diabetic retinopathy (NPDR) or non-DR (NDR) groups. Macular choroidal and GCIPL thickness was measured using swept-source optical coherence tomography at baseline and follow-up after 2 years. A linear-mixed effect model compared rates of change in choroidal and GCIPL thicknesses between the three groups.

Results

895 T2DM patients (770 in the NDR group and 125 in the NPDR group) and 847 healthy controls were included. Following 2 years, choroidal thinning occurred at a rate of −7.7±9.2 µm/year, −8.1±8.7 µm/year and −5.2±8.1 µm/year in NDR, NPDR and control groups, respectively (p<0.001). GCIPL loss occurred quickest in NPDR patients (−0.97±0.97 µm/year), followed by NDR (−0.91±0.89 µm/year) and the control group (−0.04±0.55 µm/year) (p<0.001). Following multivariate adjustment, choroidal thinning was −2.04 µm/year (95% CI: −4.05 to –0.03; p=0.047) and −1.95 µm/year (95% CI: −3.14 to –0.75; p=0.001) faster in NPDR and NDR groups than in the control group, respectively, and GCIPL thinning was −1.02 µm/year (95% CI: −1.19 to –0.84; p<0.001) and −0.88 µm/year (95% CI: −0.98 to –0.78; p<0.001) faster in the NPDR and NDR groups than in the control group, respectively.

Conclusion

Progressive choroidal and GCIPL thinning occurs in healthy individuals and T2DM patients; however, T2DM undergoes accelerated choroidal and GCIPL loss in NPDR patients.
The impact of informal patient navigation initiatives on patient empowerment and National Health Insurance responsiveness in Indonesia
Authors: Raharja Dinna Prapto , Hanani Retna , Joyoadisumarta Fransiscus S , Jessani Nasreen S , Mathauer Inke
Published: November 2022

Background

Indonesia introduced a universal National Health Insurance (NHI) programmeJaminan Kesehatan Nasional(JKN) in 2014. However, challenges in timely consultation and access to health services resulted in the introduction of formal and informal patient navigation initiatives which facilitates access for patients. Informal patient navigation may emerge from the gaps in the services of the formal patient navigation. This study assesses how threeinformalnon-government patient navigation initiatives emerged, are organised, operate and interact with JKN authorities to enhance patient empowerment and JKN responsiveness.

Methods

This was a qualitative study comprising of document review, semi-structured interviews with key stakeholders and direct observations at JKN-contracted health facilities. Data was analysed deductively and inductively using Molyneuxet al’s accountability assessment framework to assess context, content, and process of the informal patient navigation initiatives.

Results

Our study found that informal patient navigation initiatives bridge a gap left by formal navigation initiatives. The navigators help spread awareness among patients of their benefits and entitlements and assist patients to communicate with health providers and authorities. However, we find limited effects on people’s ability to navigate the system themselves, on systemic change, or on JKN responsiveness.

Conclusion

We may know that when access to health services is challenged then formal or informal patient navigation initiatives to facilitate access for patients may emerge. What this study adds is how informal patient navigation bridge a gap left by formal navigation initiatives, from how they are organized, operate and interact with the NHI authorities. We demonstrate that in the absence of well-functioning formal navigation initiatives, the informal initiatives may fill a critical gap. However, their efforts are time intensive and do not translate across the population. What is implied here is that more is required from JKN authorities to enhance interaction with informal patient navigation to advance systemic change toward equitable access to NHI.
Protocol for scoping review study to map out the existing research in relation to post-traumatic stress symptoms among caregivers of individuals with neurodevelopmental, psychiatric and neurocognitive disorders
Authors: Lim Jan Mei , Barlas Joanna , Kaur Divjyot
Published: November 2022

Introduction

The challenges of providing caregiving that impacts the caregiver have been attributed to high levels of intensity and physical strain, burden and distress. This is likely to include emotional and psychological distress as manifested in post-traumatic stress symptoms (PTSS). As this is a new area of investigation among caregivers of individuals with neurodevelopmental, neurocognitive and psychiatric disorders, the extent of the literature for PTSS in these groups of caregivers is limited and unclear. This scoping review aims to map the existing research focusing on key concepts and identifying gaps in relation to PTSS among these caregivers.

Methods and analysis

The scoping review will be guided by Arksey and O’Malley’s proposed 5-stage framework. A search for published and unpublished grey literature between years 2005 to 2020 in the electronic databases of CINAHL, SCOPUS, PsychInfo, OVID PubMed and ProQuest Dissertation, and Thesis Global electronic databases was conducted using keywords to identify relevant studies. Articles will be limited to the English language. Endnote 20 software will be used to eliminate duplicates, and results will be exported into Abstrackr for the review screening process consisting of two stages: title and abstract reviews and full-text reviews. Selection process of eligible studies will follow the recommendations in the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. A data chart will be used to capture relevant information from all included studies, and results will be presented in tabular form and in a narrative report.

Ethics and dissemination

This scoping review consists of reviewing and collecting data from publicly available materials and hence does not require ethics approval. The scoping review results will be disseminated via publications in peer-reviewed journals and conference presentations. The results will also guide the design of a mixed method research study to examine the extent of trauma symptomatology and potentially traumatising experiences, and how they relate to the mental health of caregivers of adults with intellectual and developmental disability from different cultural backgrounds.
Geographic and socioeconomic differences in heat-related mortality among the Dutch population: a time series analysis
Authors: de Visser Mara , Kunst Anton E , Fleischmann Maria
Published: November 2022

Objectives

This study was conducted to examine modification in heat-related mortality in the Netherlands by sociodemographic and geographical factors including socioeconomic position and population density (PD).

Design

This observational study applied time series analysis on daily mortality counts according to mean daily temperature (°C).

Setting

Statistics Netherlands.

Participants

Death registrations in 2006, 2018 and 2019 from residents registered at the Dutch Personal Records Database, restricted to deaths in the period between April and October.

Main outcome measures

Assuming a V-like relation between temperature and mortality, a segmented linear model was used to estimate the temperature effects on mortality. In order to estimate the effects of severe heat, a second model including a heat threshold of 22°C was included in the model. We stratified by sociodemographic groups, calendar year and the five main causes of death (cardiovascular, respiratory, neoplasm, psychological and nervous system, and other) and controlled for time trend and seasonality.

Results

The effect of 1°C increase in temperature whereby the mean daily temperature exceeded 16°C was a 1.57% (95% CI 1.51% to 1.63%) increase in mortality among the total population. In temperature segments whereby the mean daily temperature exceeded 22°C, this effect was 2.84% (95% CI 2.73% to 2.93%). Low-income groups were at higher risk of heat-related mortality, compared with high-income groups. Areas with a high PD show relatively weak effects within both the warm and heat segments.

Conclusion

Results of this study highlight the variation in terms of heat vulnerability among the Dutch population, whereby poor living conditions specifically may increase the effect on high temperature on mortality.
Vaccination practices, knowledge and attitudes regarding COVID-19 vaccines among Chinese university students: a cross-sectional study from a comprehensive university in Wuhan
Authors: Hu Xinyi , Yan Dan , Liao Mengfan , Wei Songyi , Wang Jun
Published: November 2022

Objective

In China, a free national COVID-19 vaccination programme has been launched in spring 2021 and is ongoing across the country. This study aimed to preliminarily understand the current COVID-19 vaccination practices and the associated knowledge/attitude factors among Chinese university students.

Design and setting

A single-centre cross-sectional questionnaire-based study was conducted between 1 and 20 May 2021 among a convenience sample of Chinese university students recruited from a comprehensive university in Wuhan. A total of 359 valid questionnaires were obtained.

Results

Just 1 month after the commencement of the university vaccination process, 75% of responding students had received the COVID-19 vaccination. Students without experience of COVID-19 infection were more likely to get vaccinated than those who had been infected. Most (57%) received information about COVID-19 vaccination through official announcements released by the university, and 67% were vaccinated at vaccination place arranged by the university. An interesting finding is that, although the overall vaccine uptake rate was 75%, nearly one-third of vaccinees did not know or incorrectly stated the type of COVID-19 vaccines that they had received. Mean knowledge test score was 3.05 out of 6, suggesting poor knowledge regarding COVID-19 vaccines. The vaccinated showed more positive attitudes towards the importance of establishing herd immunity through the COVID-19 vaccination programme for pandemic control than the non-vaccinated did. ‘Effectiveness in preventing COVID-19’ was perceived by 76% respondents as the most important factor contributing to COVID-19 vaccination. A total of 76% were worried about safety-related issues, including ‘unknown long-term safety’, ‘vaccine allergy’ and ‘vaccine-caused COVID-19 infection’.

Conclusions

Data suggested a rapid and effective progress of the national COVID-19 vaccination programme in China among university students. Taking effective official actions, as well as enhancing the belief in vaccines’ effectiveness, might be necessary for the good implementation of COVID-19 vaccination programmes.
Nurses’ clinical practices reducing the impact of HIV-related stigmatisation in non-HIV-specialised healthcare settings: a protocol for a realist synthesis
Authors: Pelletier Jérôme , Bergeron Dave , Rouleau Geneviève , Guillaumie Laurence
Published: November 2022

Introduction

Despite tremendous progress in care, people living with HIV (PLHIV) continue to experience HIV-related stigmatisation by nurses in non-HIV-specialised healthcare settings. This has consequences for the health of PLHIV and the spread of the virus. In the province of Quebec (Canada), only four interventions aimed at reducing the impact of HIV-related stigmatisation by nurses have been implemented since the beginning of the HIV pandemic. While mentoring and persuasion could be promising strategies, expression of fears of HIV could have deleterious effects on nurses’ attitudes towards PLHIV. In literature reviews on stigma reduction interventions, the contextual elements in which these interventions have been implemented is not considered. In order to develop new interventions, we need to understand how the mechanisms (M) by which interventions (I) interact with contexts (C) produce their outcomes (O).

Methods and analysis

Realist synthesis (RS) was selected to formulate a programme theory that will rely on CIMO configuration to describe (1) nursing practices that may influence stigmatisation experiences by PLHIV in non-HIV-specialised healthcare settings, and (2) interventions that may promote the adoption of such practices by nurses. The RS will draw on the steps recommended by Pawson: clarify the scope of the review; search for evidence; appraise primary studies and extract data; synthesise evidence and draw conclusions. To allow an acute interpretation of the disparities between HIV-related stigmatisation experiences depending on people’s serological status, an initial version of the programme theory will be formulated from data gathered from scientific and grey literature, and then consolidated through realist interviews with various stakeholders (PLHIV, nurses, community workers and researchers).

Ethics and dissemination

Ethical approval for realist interviews will be sought following the initial programme theory design. We intend to share the final programme theory with intervention developers via scientific publications and recommendations to community organisations that counter HIV-related stigmatisation.
Level of physical activity and its associated factors among adults in southeast Ethiopia: a community-based cross-sectional study
Authors: Tekalegn Yohannes , Solomon Damtew , Sahiledengle Biniyam , Beressa Girma , Desta Fikreab , Tolcha Fekata , Rogers Heather L , Petrucka Pammla P , Mwanri Lillian
Published: November 2022

Objective

Insufficient levels of physical activity are a well-known modifiable risk factor for a number of chronic conditions including obesity, type 2 diabetes, cardiovascular diseases and certain malignancies. Little is known about the status of physical activity and its associated factors among adults in low-income countries, including Ethiopia. Therefore, this study aimed to assess the level of physical activity and its associated factors among adults in southeast Ethiopia.

Design

Analytical cross-sectional study.

Setting

Community setting in southeast Ethiopia.

Participants

641 adults aged 18–64 years.

Primary outcome

Level of physical activity assessed via the Global Physical Activity Questionnaire (GPAQ).

Results

The overall prevalence of insufficient physical activity in this study was 29.48% (95% CI: 25.78 to 33.18). Women were more likely to report insufficient physical activity compared with men (39.0% for women and 12.3% for men, p<0.001). Being: a women (adjusted OR (AOR)=3.99, 95% CI: 2.15 to 7.40)), overweight/obese (AOR=1.95, 95% CI: 1.23 to 3.09), ever-married (AOR=2.13, 95% CI: 1.01 to 4.47), a person with no formal education (AOR=1.94, 95% CI: 1.05 to 3.56), a housewife (AOR=3.04, 95% CI: 1.75 to 5.29) and unemployed (AOR=3.30, 95% CI: 1.55 to 7.02) were significantly associated with insufficient physical activity.

Conclusion

The study revealed that three in 10 adults did not achieve the recommended level of physical activity. For chronic disease prevention in Ethiopia, the Ethiopian Ministry of Health and other stakeholders should pay special attention to strategies to improve the population’s physical activity especially among women, housewives, people with no formal education, and married, unemployed and overweight/obese adults.
New device multisegment Mechanical Thrombectomy System for endovascular treatment in acute ischaemic stroke: study protocol for a prospective, multicentre, randomised controlled trial
Authors: Zhong Hailong , Li Zhaoshuo , Zhou Tengfei , Li Tianxiao , He Yingkun
Published: November 2022

Introduction

Endovascular treatment is the standard of care for acute large vessel occlusion (LVO) in the anterior circulation. However, successful complete recanalisation is considerably difficult when the vessels are severely tortuous. At the bend, the stent retriever can distort, collapse and lose its ability to capture the clot due to structural change. The aim of the present study is to evaluate the safety and efficacy of the new thrombectomy device multisegment Mechanical Thrombectomy (MT) System for endovascular treatment of acute ischaemic stroke (AIS).

Methods and analysis

The present study is a prospective, multicentre, randomised controlled trial conducted in 11 stroke centres in China. The safety and efficacy of vascular recanalisation in patients with AIS who will be treated with a new thrombectomy device-multi-segment MT System or with Solitare FR within 8 hours of symptom onset will be compared. A total of 238 subjects who met the inclusion and exclusion criteria will be randomised into either a treatment group or a control group by an internet-based Central Random System in a 1:1 manner, and 30 subjects will be recruited into the small sample study. SAS V.9.4 statistical software will be used for statistical analysis of the primary endpoint indicators and other indicators.

Ethics and dissemination

The study involving human participants was reviewed and approved by the Ethics Committee of Drugs (devices) Clinical Experiment in Henan Provincial People’s Hospital (reference number: AF/SC-07/04.0) and other research centres participating in the clinical trial. The results yielded from this study will be presented at international conferences and sent to a peer-review journal to be considered for publication. The Standard Protocol Items: Recommendations for Interventional Trials checklist was utilised when drafting the study protocol.

Trial registration number

Registry on 10 September 2021 with Chinese clinical trial registry: ChiCTR2100051048.
Autonomy-supportive decision-making in maternity care during prenatal consultations: a qualitative interaction analysis
Authors: Kors Joyce , de la Croix Anne , Martin Linda , Verhoeven Corine J M , Bakker Petra , Peerdeman Saskia M , Kusurkar Rashmi A
Published: November 2022

Objectives

The aim of this study was to identify mechanisms of autonomy-supportive consultation (ASC) that maternity care professionals use during decision-making in prenatal consultations.

Design

This study was a descriptive, qualitative analysis of professional–patient interactions in maternity care, using concepts and analytic procedures of conversation analysis.

Setting

The prenatal consultations took place in hospitals and midwifery practices in the Netherlands. This study was part of a larger project. For the current study, we selected prenatal consultations concerning three topics in which patients make their own choices.

Participants

The first author invited the patient who was waiting in the waiting room. Participants were not selected a priori.

Main outcome measures

The main outcome measures were mechanisms of ASC.

Results

We selected 20 consultations which were conducted by 20 different professionals. We found eight mechanisms in the professional–patient interaction which were categorised into three overarching themes. The first theme, ‘Lightheartedness’, comprises the interactional mechanisms ‘minimising language’ and ‘humour’. The theme ‘Orientation to agreement’ describes how professionals and patients seem to be oriented towards demonstrating agreement and mutual understanding. The last theme, ‘Offering information and options’, describes the professional formally giving factual information almost completely without verbal interaction between the professional and the patient.

Conclusion

The results of this study show that the model of ASC can be enriched by adding minimising language and humour to the mechanisms that can be used to fulfil the psychological need ‘relatedness’. Second, our results show that professionals use only few mechanisms to meet the patients’ psychological needs ‘competence’ and ‘autonomy’. They mainly use information giving to meet patients’ need competence. To meet patients’ need for autonomy, the professionals keep all options open. This suggests that professionals could pay more attention to other mechanisms to meet patients’ needs for ‘competence’ and ‘autonomy’.