bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceptions of Older People in Nursing Facilities About Advance Care Planning: A Systematic Review
Authors: Liang Ting , Feng Jia , Feng Xiao‐ning , Yang Tao
Published: September 2024

Background

With the ageing of the population intensifying, the implementation of advance care planning (ACP) in nursing facilities is especially crucial.

Objective

This study aimed to search and synthesise qualitative studies exploring the perspectives of older people in nursing facilities about ACP discussions.

Methods

The researchers conducted searches of PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP and CBM between the time of inception and October 2023. The PICo model was used to build the inclusion and exclusion criteria. Following the inclusion and exclusion criteria, two researchers screened the literature, extracted data and then integrated the literature using the integrative synthesis.

Results

A total of 12 articles were included, 47 themes were extracted, and three research integrations were summarised: (1) understanding of ACP; (2) attitude towards ACP; and (3) influencing factors of participation in ACP.

Conclusion

This study offers guidance for the future development of ACP on the participation of older people in nursing facilities.

Implications for Practice

It is necessary to strengthen the education of ACP‐related knowledge in conjunction with the cultural characteristics of different countries, to provide interdisciplinary support for older people through professional teamwork and to promote the development and improvement of ACP‐related practices.
Diversity in stomatal and hydraulic responses to post‐flowering drought in common (Phaseolus vulgaris) and tepary (P. acutifolius) beans
Authors: Buckley Thomas N. , Magney Troy S. , Berny Mier y Teran Jorge C. , Mills Colleen , Palkovic Antonia , Parker Travis A. , Pierce Marshall A. , Wadhwani Yasmin , Wong Christopher Y. S. , Gepts Paul , Gilbert Matthew E.
Published: September 2024

Plants differ widely in how soil drying affects stomatal conductance (gs) and leaf water potential (ψleaf), and in the underlying physiological controls. Efforts to breed crops for drought resilience would benefit from a better understanding of these mechanisms and their diversity. We grew 12 diverse genotypes of common bean (Phaseolus vulgaris L.) and four of tepary bean (P. acutifolius; a highly drought resilient species) in the field under irrigation and post‐flowering drought, and quantified responses of gs and ψleaf, and their controls (soil water potential [ψsoil], evaporative demand [Δw] and plant hydraulic conductance [K]). We hypothesised that (i) common beans would be more “isohydric” (i.e., exhibit strong stomatal closure in drought, minimising ψleaf decline) than tepary beans, and that genotypes with larger ψleaf decline (more “anisohydric”) would exhibit (ii) smaller increases in Δw, due to less suppression of evaporative cooling by stomatal closure and hence less canopy warming, but (iii) larger K declines due to ψleaf decline. Contrary to our hypotheses, we found that half of the common bean genotypes were similarly anisohydric to most tepary beans; canopy temperature was cooler in isohydric genotypes leading to smaller increases in Δw in drought; and that stomatal closure and K decline were similar in isohydric and anisohydric genotypes. gs and ψleaf were virtually insensitive to drought in one tepary genotype (G40068). Our results highlight the potential importance of non‐stomatal mechanisms for leaf cooling, and the variability in drought resilience traits among closely related crop legumes.
Composite hemangioendothelioma in a 2‐year‐old girl
Authors: Panizzardi Alejandra Anabel , Torres Natalia , Centeno del Valle María , Vigovich Félix , Besolari Verónica , Larralde Margarita
Published: September 2024

Composite hemangioendothelioma (CHE) is a rare locally aggressive vascular neoplasm of intermediate malignancy. We describe a 2‐year‐old patient diagnosed with this tumor. Careful documentation of patients with CHE is crucial to better define the prognosis and treatment of this entity.
The association between depressive trajectories and disability‐free survival among middle‐aged and older adults in China: a prospective cohort study
Authors: Ma Tao , Li Yu , Jiang Minglan , Ren Xiao , Han Longyang , Zheng Xiaowei
Published: September 2024

Background

This study aims to examine the association of depressive trajectories with disability‐free‐survival (DFS).

Methods

This prospective cohort study used data from the China Health and Retirement Longitudinal Study, 2011–2015. Depressive symptoms were assessed using the Centre for Epidemiology Studies Depression Scale‐10. Disability was assessed using activities of daily living (ADLs) and instrumental ADLs. Trajectories of depressive symptoms were identified and classified by latent mixture modelling. Logistic regression models were used to examine the association between depressive trajectories and DFS.

Results

A total of 8373 participants aged 45 years and older were included. We identified four distinct trajectories of depressive symptoms: ‘no depressive symptoms’, ‘decreasing depressive symptoms’, ‘increasing depressive symptoms’, and ‘persistent depressive symptoms’. Compared to participants in the no depressive symptom trajectory, those in the decreasing depressive symptoms, increasing depressive symptoms and persistent depressive symptoms trajectories had an increased risk of disability or mortality, with multiple‐adjusted hazard ratios (95% confidence intervals) of 1.75 (1.45–2.12), 2.05 (1.77–2.38) and 3.50 (2.77–4.42).

Conclusion

Our study shows that among middle‐aged and older Chinese adults, individuals with a trajectory of depressive symptoms are at increased risk of disability or mortality. Our findings underscore the importance of early prevention, identification and intervention of depression in clinical care to promote healthy ageing.
Tidal Versus Intermittent Peritoneal Dialysis in Chronic Peritoneal Dialysis Patients: Randomized, Open‐Label, Prospective Control Study
Authors: Lai Jia‐Wen , Wang Charles C. N. , Chang Pao‐Hsia , Chou Che‐Yi
Published: September 2024

Background

Tidal peritoneal dialysis (TPD) provides better fluid flow mechanics and is more comfortable for the patient, owing to fewer alarms and less pain during inflow and outflow. The long‐term characteristics of patients with TPD were not evident. In this randomized controlled follow‐up study, we aimed to explore the characteristics of patients with TPD, compared to IPD.

Methods

A total of 85 patients were randomized to either IPD or 70% TPD between January 2019 and December 2020, and all patients were followed up on December 2021. The characteristics of patients between the two groups were analyzed using a t‐test or chi‐square as appropriate. The overall survival and technical survival were analyzed using Kaplan–Meier analysis.

Results

Forty‐two patients were assigned to IPD, and 43 patients were assigned to TPD. The basal characteristics of patients were not different between the two groups. In an average of 16 months of follow‐up, 19 patients died, and 25 patients dropped out of peritoneal dialysis. The two groups had no difference in overall survival and technical survival. TPD was associated with high urine volume (p = 0.001), lower blood urea nitrogen (p = 0.002), lower phosphorus (p = 0.004), and fewer cycler alarms (p < 0.001). The chance of patients reporting abdominal fullness was higher in patients with TPD (p = 0.001).

Conclusion

In the randomized, controlled, follow‐up study, TPD may preserve residual renal function and is associated with lower urea nitrogen and phosphorus in chronic peritoneal dialysis patients. TPD is associated with fewer cycler alarms but may increase the chance of patients reporting abdominal distension.
Paternal activation parenting and growth in children's inhibitory control across early childhood
Authors: Feldman Julia S. , Wilson Melvin N. , Shaw Daniel S.
Published: September 2024

Activation parenting (AP) is a parenting construct derived from research and theory on paternal caregiving that includes behaviors that challenge children to approach novel situations, explore their environments, and take physical and socioemotional risks through a balance of encouragement and limit‐setting. Although components of AP have been linked to different domains of children's self‐regulation skills, comprehensive measures of AP and longitudinal research on families from low socioeconomic backgrounds are lacking. These limitations greatly constrain our understanding of the potential benefits of paternal AP for children's self‐regulation development, including the maturation of inhibitory control (IC) in early childhood. Thus, the present study tested associations between paternal AP at age 3 and growth in parent‐reported IC across ages 3–5 in a sample of low‐income, ethnically diverse fathers. Participating fathers (N = 171; 9% Black, 47% White, 8% Latinx, 61% not Latinx; mean household income = $25,145) and their children (51% female) were drawn from the Early Steps Multisite Study. AP during a clean‐up task at child age 3 years, but not a teaching task, was associated with greater growth in IC across ages 3–5 years. Implications of the current findings are presented for understanding associations between paternal AP and children's IC and broader self‐regulation skills with diverse samples of caregivers.
Judgements of identity claims vary for monoracial and biracial people
Authors: Quinn‐Jensen Elizabeth A. , Liberman Zoe
Published: September 2024

Despite increasing racial diversity in the United States, and the particular growth of multiracial populations, questions about how children perceive others’ (bi)racial identities remain poorly understood. In two preregistered studies, we asked White and racially minoritized American children (N = 157; 4–11‐years old) and White and multiracial adults (N = 226) how acceptable it was for monoracial people (Black or White; Study 1) and/or biracial people (Black–White; Studies 1 and 2) to claim either a monoracial or biracial identity. Consistent with past research with adults, children said that monoracial people should claim (only) the monoracial identity which matched their ancestry. Judgements about biracial identity were more variable. White and multiracial adults (Study 2) reported that biracial targets could claim a racial identity that matched either or both of their parents, with biracial claims being evaluated most positively. Exploratory analyses on children's judgements about biracial people's identity claims (Study 1) revealed different patterns of development for White children and children from minoritized backgrounds. Whereas White children became more likely with age to report that all identity claims were acceptable, children from racially minoritized groups became more likely with age to endorse biracial targets who claimed a biracial identity. These findings suggest that children's own racial background and age may have a larger impact on their perceptions of biracial people's identities, compared to their perceptions of monoracial people's identities.
Intraocular osseous metaplasia in an older red‐tailed hawk (Buteo jamaicensis) 24 years following traumatic injury to the globe
Authors: Wells Taylr , Sadar Miranda , Jost Haley , Teixeira Leandro , de Linde Henriksen Michala
Published: September 2024

An approximately 26‐year‐old, suspected female, red‐tailed hawk (Buteo jamaicensis) was presented with a history of chronic ocular changes of the left eye likely secondary to blunt trauma resulting in blindness and phthisis bulbi. Ophthalmic evaluation of OS revealed a large intraocular mass, 3+ aqueous flare indicating anterior uveitis, and severely decreased intraocular pressure measuring 5 mmHg. Ocular ultrasound revealed an abnormal, spherical shaped and hyperechoic lens, as well as hyperechoic material or a mass lesion in the posterior segment. An enucleation procedure was performed, and histopathology of the eye revealed no signs of neoplasia but instead intraocular osseous metaplasia with bone marrow and adipose tissue replacing the lens. Similar mass lesions were found in the retina and choroid. Multiple fractures in the scleral ossicle and cartilage correlated the intraocular lesions with a blunt traumatic event. A bioresorbable disk of porcine small intestine submucosa (BioSIS Vetrix®) was incorporated to relieve tension during closure. The graft sloughed during healing process, revealing a healed wound underneath. The BioSIS was not incorporated into the wound as designed but may have facilitated healing. This is the first report of intraocular osseous metaplasia in a raptor and the use of BioSIS Vetrix® with enucleation in an avian species.
Fourier–Mukai transforms commuting with Frobenius
Authors: Bragg Daniel
Published: September 2024

We show that a Fourier–Mukai equivalence between smooth projective varieties of characteristic that commutes with either pushforward or pullback along Frobenius is a composition of shifts, isomorphisms, and tensor products with invertible sheaves whose th tensor power is trivial.
The feasibility of carotid evaluation by resident radiologists to expand access to ultrasound services
Authors: Liu Jia , Liao Mei , Zhang Hui , Ren Jie
Published: September 2024

Aims: The purpose of our study was to determine resident radiologists’ accuracy in diagnosing carotid atherosclerotic plaque and to assess any factors leading to incorrect findings.Materials and methods: The results of preliminary carotid scanning performed by radiology residents from December 1, 2021, to August 1, 2022, were retrospectively reviewed. These scans received an instant review by experts. The discrepancy rates of the resident radiologists were evaluated using expert diagnoses. Then, the plaque detection rate of the resident radiologists was investigated for different plaque characteristics. The causes of incorrect stenosis diagnoses were analyzed.Results: In the investigation of carotid plaque detection, a total of 274 carotid scans from 137 patients were evaluated in our hospital. The overall agreement rate of plaque detection was 90.9%. Echolucent plaques, plaques in the lateral or near wall, and plaques in the carotid bulbs were more likely to be misdiagnosed by resident radiologists. A total of 325 plaques were included in the investigation of carotid artery stenosis classification. The overall agreement rate of stenosis evaluation was 67.7%. The misclassification of moderate stenosis was greater than that of mild and severe stenosis (p=0.0003). The sensitivity was as low as 55.56%. Nonstandard sonographic techniques and incorrect application of interpretive criteria were two main causes.Conclusions: Resident radiologists could accurately and efficiently detect carotid plaques. Scanning by resident radiologists can expand access to ultrasound services. Only the diagnosis of moderate stenosis by resident radiologists was not satisfactory and may require a specialized review from experienced radiologists.
Response to “Comment on ‘Anomalous reflection from a two-layered marine sediment’ ” [J. Acoust. Soc. Am. 156, 1524–1527 (2024)]
Authors: Buckingham Michael J.
Published: September 2024

In their Comment, the authors conclude that acoustic glint is not present in the reflection coefficient of a two-layer sediment in which the top layer is an Airy medium. They conclude, not that the original, inverse-square analysis of the glint is incorrect, but rather that the presence of glint is very sensitive to the detailed shape of the sound speed profile in the top layer.
APAQ at Forty: Publication Trends
Authors: Martin Jeffrey J.
Published: September 2024

The purpose of the present study was to analyze Adapted Physical Activity Quarterly (APAQ) publications over the journal’s fourth decade (2014–2023) and compare them with previous documentary analyses of the first 3 decades. Consistent with prior documentary analyses, publications were coded and analyzed based on the use of theory, research participants, topic, whether the study was an intervention, first-author country affiliation, and research method. The total number of published research papers increased substantially (n = 61) from the third to the fourth decade. Similar to prior documentary analyses, most of the research was quantitative (n = 140; 57.5%), followed by qualitative research (n = 96; 39.5%). There were far more qualitative-research publications in the fourth decade compared with the third decade (n = 34). This may reflect the continued acceptance and growth of qualitative research compared with 10–20 years ago. It may also reflect the value of rich in-depth exploratory research using small samples. Additional trends included more review papers and meta-analyses, possibly reflecting the increased knowledge base in particular areas requiring synthesis. The diversity of topics also increased, with papers on dignity, classification, coaching, and the Paralympics playing more prominent roles. The number of international publications also grew substantially. In brief, the current paper outlines both similarities and differences in APAQ’s published research over the 4 decades of its existence.
The Effect of Water Dousing on Heat Strain and Performance During Endurance Running in the Heat
Authors: Anderson Mitchell , Bellenger Clint , Chaseling Georgia K. , Chalmers Samuel
Published: September 2024

Objectives: Assess the effect of water dousing on heat strain and performance during self- and fixed-paced exercise in the heat. Design: Crossover, block-randomized controlled trial. Methods: Thirteen trained runners completed a 10-km time trial (TT) and 60-minute fixed-pace run (60% velocity of ) in a 30.4 °C, 47.4% relative humidity environment using either water dousing (DOUSE) or no dousing (CON). Results: Ten-kilometer TT performance was faster in DOUSE compared to CON (44:11 [40:48, 47:34] vs 44:38 [41:21, 47:56] min:s; P = .033). Change in core temperature (Tc) was not different between groups during the TT (+0.02 [−0.04, 0.07] °C in DOUSE; P = .853) or fixed-pace run (+0.02 [−0.15, 0.18] °C; P = .848). Change in mean skin temperature was lower in DOUSE during the TT (−1.80 [−2.15, −1.46] °C; P < .001) and fixed-pace run (−1.38 [−1.81, −0.96] °C; P < .001). Heart rate was lower for DOUSE during the fixed-pace run (−3.5 [−6.8, −0.2] beats/min; P = .041) but not during the TT (−0.2 [−2.5, 2.1] beats/min; P = .853). Thermal sensation was lower for DOUSE during the TT (−49.3 [−72.1, −26.1] mm; P < .001) and fixed-pace run (−44.7 [−59.7, −29.6] mm; P < .001). Rating of perceived exertion was not different between groups for the TT (−0.2 [−0.7, 0.3]; P = .390) or fixed-pace run (−0.2 [−0.8, 0.4]; P = .480). Sweat rate was lower for DOUSE for the TT (−0.37 [−0.53, −0.22] L/h; P < .001) and fixed-pace run (−0.37 [−0.48, −0.26] L/h; P < .001). Conclusion: Water dousing improves 10-km TT performance in the heat but does not affect Tc. The positive change in thermal perception (via lower skin temperature) during the TT likely drives this benefit.
Effector memory–type regulatory T cells display phenotypic and functional instability
Authors: Wendering Désirée Jacqueline , Amini Leila , Schlickeiser Stephan , Farrera-Sal Martí , Schulenberg Sarah , Peter Lena , Mai Marco , Vollmer Tino , Du Weijie , Stein Maik , Hamm Frederik , Malard Alisier , Castro Carla , Yang Mingxing , Ranka Ramon , Rückert Timo , Durek Pawel , Heinrich Frederik , Gasparoni Gilles , Salhab Abdulrahman , Walter Jörn , Wagner Dimitrios Laurin , Mashreghi Mir-Farzin , Landwehr-Kenzel Sybille , Polansky Julia K. , Reinke Petra , Volk Hans-Dieter , Schmueck-Henneresse Michael
Published: September 2024

Regulatory T cells (T
reg
cells) hold promise for sustainable therapy of immune disorders. Recent advancements in chimeric antigen receptor development and genome editing aim to enhance the specificity and function of T
reg
cells. However, impurities and functional instability pose challenges for the development of safe gene-edited T
reg
cell products. Here, we examined different T
reg
cell subsets regarding their fate, epigenomic stability, transcriptomes, T cell receptor repertoires, and function ex vivo and after manufacturing. Each T
reg
cell subset displayed distinct features, including lineage stability, epigenomics, surface markers, T cell receptor diversity, and transcriptomics. Earlier-differentiated memory T
reg
cell populations, including a hitherto unidentified naïve-like memory T
reg
cell subset, outperformed late-differentiated effector memory–like T
reg
cells in regulatory function, proliferative capacity, and epigenomic stability. High yields of stable, functional T
reg
cell products could be achieved by depleting the small effector memory–like T
reg
cell subset before manufacturing. Considering T
reg
cell subset composition appears critical to maintain lineage stability in the final cell product.
A
Vibrio cholerae
Type IV restriction system targets glucosylated 5-hydroxymethylcytosine to protect against phage infection
Authors: Gomez Jasper B. , Waters Christopher M.
Published: September 2024

A major challenge faced by
Vibrio cholerae
is constant predation by bacteriophage (phage) in aquatic reservoirs and during infection of human hosts. To overcome phage predation,
V. cholerae
has acquired and/or evolved a myriad of phage defense systems. Although several novel defense systems have been discovered, we hypothesized that more were encoded in
V. cholerae
given the low diversity of phages that have been isolated, which infect this species. Using a
V. cholerae
genomic library, we identified a Type IV restriction system consisting of two genes within a 16-kB region of the
Vibrio
pathogenicity island-2, which we name TgvA and TgvB (

T

ype I-embedded

g

mrSD
-like system of

V

PI-2). We show that both TgvA and TgvB are required for defense against T2, T4, and T6 by targeting glucosylated 5-hydroxymethylcytosine (5hmC). T2 or T4 phages that lose the glucose modifications are resistant to TgvAB defense but exhibit a significant evolutionary tradeoff, becoming susceptible to other Type IV restriction systems that target unglucosylated 5hmC. We also show that the Type I restriction–modification system that embeds the
tgvAB
genes protects against phage T3, secΦ18, secΦ27, and λ, suggesting that this region is a phage defense island. Our study uncovers a novel Type IV restriction system in
V. cholerae
, increasing our understanding of the evolution and ecology of
V. cholerae,
while highlighting the evolutionary interplay between restriction systems and phage genome modification.

IMPORTANCE

Bacteria are constantly being predated by bacteriophage (phage). To counteract this predation, bacteria have evolved a myriad of defense systems. Some of these systems specifically digest infecting phage by recognizing unique base modifications present on the phage DNA. In this study, we discover a Type IV restriction system encoded in
V. cholerae,
which we name TgvAB, and demonstrate it recognizes and restricts phage that have 5-hydroxymethylcytosine glucosylated DNA. Moreover, the evolution of resistance to TgvAB render phage susceptible to other Type IV restriction systems, demonstrating a significant evolutionary tradeoff. These results enhance our understanding of the evolution of
V. cholerae
and more broadly how bacteria evade phage predation.
Improving viral annotation with artificial intelligence
Authors: Flamholz Zachary N. , Li Charlotte , Kelly Libusha
Published: September 2024

Viruses of bacteria, “phages,” are fundamental, poorly understood components of microbial community structure and function. Additionally, their dependence on hosts for replication positions phages as unique sensors of ecosystem features and environmental pressures. High-throughput sequencing approaches have begun to give us access to the diversity and range of phage populations in complex microbial community samples, and metagenomics is currently the primary tool with which we study phage populations. The study of phages by metagenomic sequencing, however, is fundamentally limited by viral diversity, which results in the vast majority of viral genomes and metagenome-annotated genomes lacking annotation. To harness bacteriophages for applications in human and environmental health and disease, we need new methods to organize and annotate viral sequence diversity. We recently demonstrated that methods that leverage self-supervised representation learning can supplement statistical sequence representations for remote viral protein homology detection in the ocean virome and propose that consideration of the functional content of viral sequences allows for the identification of similarity in otherwise sequence-diverse viruses and viral-like elements for biological discovery. In this review, we describe the potential and pitfalls of large language models for viral annotation. We describe the need for new approaches to annotate viral sequences in metagenomes, the fundamentals of what protein language models are and how one can use them for sequence annotation, the strengths and weaknesses of these models, and future directions toward developing better models for viral annotation more broadly.
Clues on the Australasian impact crater site inferred from detailed mineralogical study of a monazite inclusion in a Muong Nong tektite
Authors: Seydoux-Guillaume A.-M. , Rochette P. , Gardés E. , Zanetta P.-M. , Sao-Joao S. , de Parseval Ph. , Glass B.P.
Published: September 2024

Tektites are terrestrial impact-generated glasses distributed over regions of Earth's surface with ejection distances up to 10,000 km. The Australasian tektite strewn field is the largest and the youngest discovered so far (788 ka). However, the location of the source crater remains unsolved. The present work is the first to investigate the only monazite ever found as an inclusion in a Muong Nong tektite (MNT) from Indochina. In-depth observations down to the nanoscale revealed that the monazite experienced very high temperature, with silicate melt injection sometimes trapped within porosity at the grain boundaries, followed by a recovery mechanism responsible for dislocation migration and subgrain formation. The absence of radiation damage confirms that this recovery episode occurred recently, in line with the age of the tektite. The preservation of a primary zonation (Th component) and the absence of detectable diffusion profiles indicate that the monazite did not reach the melting point (∼2050 °C) before initial rapid cooling (∼1000 °C/s). The U-Th–total Pb dates of the monazite thus remained unchanged during the impact: 73 ± 6 Ma in a Th-rich domain and 156 ± 15 Ma in a Th-poor domain. This allows the source of the MNT to be constrained. Comparison with a detailed database of monazite ages and Th/U ratios in SE Asia indicates that the Australasian crater should be sought for in the triangle made up of the Philippines, coastal south China, and northern Vietnam, though the latter appears less probable.
Home-based EXercise and motivAtional programme before and after Liver Transplantation (EXALT): study protocol for phase II two-centre, randomised controlled trial
Authors:   EXALT Trial Team
Published: September 2024

Introduction

Physical frailty is associated with increased mortality and poor quality of life (QoL) before and after liver transplantation (LT). Evidence is lacking on how to tailor exercise and behavioural techniques in this patient population.

Methods and analysis

Home-based EXercise and motivAtional programme before and after Liver Transplantation (EXALT) is a phase 2b, open-label, two-centre randomised controlled clinical trial designed to investigate whether a remotely monitored ‘home-based exercise and theory-based motivation support programme (HBEP)’ before and after LT improves QoL in LT recipients. Adult patients awaiting a primary LT will be assessed for eligibility at two LT centres (Birmingham, Royal Free London). Participants will be randomly assigned (1:1) to receive either an HBEP while on the LT waiting list through to 24 weeks after LT (Intervention) or a patient exercise advice leaflet (Control). Using a standard method of difference in means (two-sided significance level 0.05; power 0.90) and accounting for a 35% attrition/withdrawal rate, a minimum of 133 patients will be randomised to each treatment group. The primary outcome measure will be assessed using intention-to-treat analysis of the difference in the Physical Component Score of Short form-36 version 2.0 health-related QoL questionnaire between the groups at 24 weeks post-LT.

Ethics and dissemination

The protocol was approved by the South Central-Hampshire A National Research Ethics Committee. Recruitment into the EXALT trial started in May 2022 and is due to end in June 2024, with 217/266 patients randomised to date. The intervention follow-up is due to finish in May 2026. The findings of this trial will be disseminated through peer-reviewed publications, conferences and social media.

Trial registration number

ISRCTN13476586.
Caesarean sections, indications and outcomes: a cross-sectional study using the Robson classification in a tertiary hospital in Sierra Leone
Authors: Arata Matteo , Boyle Sonia , Sgorbissa Beatrice , Tognon Francesca , John-Cole Valerie , Orsi Michele , Caracciolo Claudia , Saccardi Carlo , Manenti Fabio , Putoto Giovanni , K Kamara Abibatu , Betran Ana Pilar
Published: September 2024

Objective

WHO recommends the use of the Robson’s ‘Ten Groups Classification’ for monitoring and assessing caesarean section (CS) rates. The aim of this study was to investigate the rates, indications and outcomes of CS using Robson classification in a tertiary hospital in Sierra Leone.

Design

Cross-sectional study.

Setting

Princess Christian Maternity Hospital (PCMH), Freetown, Sierra Leone.

Participants

All women who gave birth in PCMH from 1 October 2020 to 31 January 2021.

Primary and secondary outcome measures

Primary outcome: CS rate by Robson group. Secondary outcomes: indications for CS and the newborn outcomes for each Robson group.

Results

1998 women gave birth during the study period and 992 CS were performed, with a CS rate of 49.6%. Perinatal mortality was 7.8% and maternal mortality accounted for 0.5%. Two-thirds of the women entered labour spontaneously and were considered at low risk (groups 1 and 3). CS rates in these groups were very high (43% group 1 and 33% group 3) with adverse outcomes (perinatal mortality, respectively, 4.1% and 6%). Dystocia was the leading indication for CS accounting for about two-thirds of the CS in groups 1 and 3. Almost all women with a previous CS underwent CS again (95%). The group of women who give birth before term (group 10) represents 5% of the population with high CS rate (50%) mainly because of emergency conditions.

Conclusion

Our data reveals a notably high CS rate, particularly among low-risk groups according to the Robson classification. Interpretation must consider PCMH as a referral hospital within an extremely low-resourced healthcare system, centralising all the complicated deliveries from a vast catchment area. Further research is required to assess the impact of referred obstetrical complications on the CS rate and the feasibility of implementing measures to improve the management of women with dystocia and previous CS.
The changing shape of English general practice: a retrospective longitudinal study using national datasets describing trends in organisational structure, workforce and recorded appointments
Authors: Pettigrew Luisa M , Petersen Irene , Mays Nicholas , Cromwell David
Published: September 2024

Objective

To describe trends in the organisational structure, workforce and recorded appointments by role in English general practice.

Design

Retrospective longitudinal study.

Setting

English general practice.

Data sources and participants

NHS England, Office for Health Improvement and Disparities and Care Quality Commission national administrative datasets covering between 5 to 10 years from 2013 to 2023.

Results

Between 2013 and 2023, the number of general practices fell by 20% from 8044 to 6419; the average practice list size increase by 40% from 6967 to 9724 patients. The total population covered by providers with over 100 000 registered patients reached 2.3 million in 2023 compared to 0.5 million in 2017. The proportion of practices under individual ownership decreased from 13% to 11% between 2018 and 2023; there was little change in the proportion owned by partnerships, incorporated companies or NHS bodies, which respectively averaged around 80.3%, 6.9% and 0.7%. Between 2015 and 2022, there was a 20% rise in the total full-time equivalent (FTE) general practice workforce, including Primary Care Network staff, from 1.97 to 2.37 per 1000 patients because of an increase in multidisciplinary other 'Direct Patient Care' (DPC) and administrative roles. The number of nurses remained stable, and the number of qualified general practitioners (GPs) decreased by 15%. In September 2022, there were 0.45 FTE qualified GPs per 1000 patients; GPs and other DPC roles, excluding nurses, each represented 19% of the FTE per 1000 patients workforce; administrative roles represented 51%. The general practice workforce is predominantly female. A quarter of GPs qualified overseas. Between 2018 and 2023, there was no clear upward or downward trend in total appointments per 1000 patients with, on average, half provided by GPs.

Conclusions

Since 2013, there has been a shift in general practice towards larger practices with more multidisciplinary teams, alongside a reduction in the number of FTE qualified GPs per 1000 patients. We recommend that the impacts of these changes on access, quality and costs are closely monitored.
Quantitative sensory testing and chronic pain syndromes: a cross-sectional study from TwinsUK
Authors: Rhee Amber , Granville Smith Isabelle , Compte Roger , Vehof Jelle , Nessa Ayrun , Wadge Samuel , Freidin Maxim B , Bennett David L , Williams Frances M K
Published: September 2024

Objective

The chronic pain syndromes (CPS) include syndromes such as chronic widespread pain (CWP), dry eye disease (DED) and irritable bowel syndrome (IBS). Highly prevalent and lacking pathognomonic biomarkers, the CPS are known to cluster in individuals in part due to their genetic overlap, but patient diagnosis can be difficult. The success of quantitative sensory testing (QST) and inflammatory biomarkers as phenotyping tools in conditions such as painful neuropathies warrant their investigation in CPS. We aimed to examine whether individual QST modalities and candidate inflammatory markers were associated with CWP, DED or IBS in a large, highly phenotyped population sample.

Design

Cross-sectional study.

Setting

Community-dwelling cohort.

Participants

Twins from the TwinsUK cohort

Primary and secondary outcome measures

We compared 10 QST modalities, measured in participants with and without a CWP diagnosis between 2007 and 2012. We investigated whether inflammatory markers measured by Olink were associated with CWP, including interleukin-6 (IL-6), IL-8, IL-10, monocyte chemoattractant protein-1 and tumour necrosis factor. All analyses were repeated in DED and IBS with correction for multiple testing.

Results

In N=3022 twins (95.8% women), no association was identified between individual QST modalities and CPS diagnoses (CWP, DED and IBS). Analyses of candidate inflammatory marker levels and CPS diagnoses in n=1368 twins also failed to meet statistical significance.

Conclusion

Our findings in a large population cohort suggest a lack of true association between singular QST modalities or candidate inflammatory markers and CPS.
Enhancing the efficacy of healthcare information websites: a case for the development of a best practice framework
Authors: Tieman Jennifer , Nicholls Seth
Published: September 2024

Online healthcare information has the potential to improve health outcomes via the widespread, cost-effective translation of research evidence into practice by healthcare professionals and use by consumers. However, comparatively little is known about how healthcare professionals and consumers engage with healthcare websites, or whether the knowledge that is made available through digital platforms is translated into better health outcomes. To realise the potential of such resources, we argue that an evidence-based framework—grounded in a nuanced understanding of how audiences engage with and use information provided by healthcare websites—is needed. The goal of this paper is to outline a case for the development of a best-practice framework that can guide the development of websites that provide healthcare information to clinicians and consumers. In addition to supporting the design of more effective online resources, a common framework for understanding how better health outcomes can be achieved via digital knowledge translation has the potential to significantly improve patient outcomes in the face of a complex, rapidly changing and resource-constrained healthcare landscape.
Genetics Navigator: protocol for a mixed methods randomized controlled trial evaluating a digital platform to deliver genomic services in Canadian pediatric and adult populations
Authors: D'Amours Guylaine , Clausen Marc , Luca Stephanie , Reble Emma , Kodida Rita , Assamad Daniel , Bernier Francois , Chad Lauren , Costain Gregory , Dhalla Irfan , Faghfoury Hanna , Friedman Jan M , Hewson Stacy , Jamieson Trevor , Silver Josh , Shuman Cheryl , Osmond Matthew , Carroll June C , Jobling Rebekah , Laberge Anne-Marie , Aronson Melyssa , Liston Eriskay , Lerner-Ellis Jordan , Marshall Christian , Brudno Michael , Pham Quynh , Rudzicz Frank , Cohn Ronald , Mamdani Muhammad , Smith Maureen , Shastri-Estrada Serena , Seto Emily , Thorpe Kevin , Ungar Wendy , Hayeems Robin Z , Bombard Yvonne
Published: September 2024

Introduction

Genetic testing is used across medical disciplines leading to unprecedented demand for genetic services. This has resulted in excessive waitlists and unsustainable pressure on the standard model of genetic healthcare. Alternative models are needed; e-health tools represent scalable and evidence-based solution. We aim to evaluate the effectiveness of the Genetics Navigator, an interactive patient-centred digital platform that supports the collection of medical and family history, provision of pregenetic and postgenetic counselling and return of genetic testing results across paediatric and adult settings.

Methods and analysis

We will evaluate the effectiveness of the Genetics Navigator combined with usual care by a genetics clinician (physician or counsellor) to usual care alone in a randomised controlled trial. One hundred and thirty participants (adults patients or parents of paediatric patients) eligible for genetic testing through standard of care will be recruited across Ontario genetics clinics. Participants randomised into the intervention arm will use the Genetics Navigator for pretest and post-test genetic counselling and results disclosure in conjunction with their clinician. Participants randomised into the control arm will receive usual care, that is, clinician-delivered pretest and post-test genetic counselling, and results disclosure. The primary outcome is participant distress 2 weeks after test results disclosure. Secondary outcomes include knowledge, decisional conflict, anxiety, empowerment, quality of life, satisfaction, acceptability, digital health literacy and health resource use. Quantitative data will be analysed using statistical hypothesis tests and regression models. A subset of participants will be interviewed to explore user experience; data will be analysed using interpretive description. A cost-effectiveness analysis will examine the incremental cost of the Navigator compared with usual care per unit reduction in distress or unit improvement in quality of life from public payer and societal perspectives.

Ethics and dissemination

This study was approved by Clinical Trials Ontario. Results will be shared through stakeholder workshops, national and international conferences and peer-reviewed journals.

Trial registration number

NCT06455384.
Targeting IL-33 reprograms the tumor microenvironment and potentiates antitumor response to anti-PD-L1 immunotherapy
Authors: Nan Yanyang , Bai Yu , Hu Xiaozhi , Zhou Kaicheng , Wu Tao , Zhu An , Li Mengyang , Dou Zihan , Cao Zhonglian , Zhang Xumeng , Xu Shuwen , Zhang Yuanzhen , Lin Jun , Zeng Xian , Fan Jiajun , Zhang Xuyao , Wang Xuebin , Ju Dianwen
Published: September 2024

Background

The main challenge against patients with cancer to derive benefits from immune checkpoint inhibitors targeting PD-1/PD-L1 appears to be the immunosuppressive tumor microenvironment (TME), in which IL-33/ST2 signal fulfills critical functions. However, whether IL-33 limits the therapeutic efficacy of anti-PD-L1 remains uncertain.

Methods

Molecular mechanisms of IL-33/ST2 signal on anti-PD-L1 treatment lewis lung carcinoma tumor model were assessed by RNA-seq, ELISA, WB and immunofluorescence (IF). A sST2-Fc fusion protein was constructed for targeting IL-33 and combined with anti-PD-L1 antibody for immunotherapy in colon and lung tumor models. On this basis, bifunctional fusion proteins were generated for PD-L1-targeted blocking of IL-33 in tumors. The underlying mechanisms of dual targeting of IL-33 and PD-L1 revealed by RNA-seq, scRNA-seq, FACS, IF and WB.

Results

After anti-PD-L1 administration, tumor-infiltrating ST2+regulatory T cells (Tregs) were elevated. Blocking IL-33/ST2 signal with sST2-Fc fusion protein potentiated antitumor efficacy of PD-L1 antibody by enhancing T cell responses in tumor models. Bifunctional fusion protein anti-PD-L1-sST2 exhibited enhanced antitumor efficacy compared with combination therapy, not only inhibited tumor progression and extended the survival, but also provided long-term protective antitumor immunity. Mechanistically, the superior antitumor activity of targeting IL-33 and PD-L1 originated from reducing immunosuppressive factors, such as Tregs and exhausted CD8+T cells while increasing tumor-infiltrating cytotoxic T lymphocyte cells.

Conclusions

In this study, we demonstrated that IL-33/ST2 was involved in the immunosuppression mechanism of PD-L1 antibody therapy, and blockade by sST2-Fc or anti-PD-L1-sST2 could remodel the inflammatory TME and induce potent antitumor effect, highlighting the potential therapeutic strategies for the tumor treatment by simultaneously targeting IL-33 and PD-L1.
Cyclic response of pre-failed and reinstalled single-helix piles in sand
Authors: Schiavon José Antonio , Neme Gamarra Mariano , Tsuha Cristina de Hollanda Cavalcanti , Thorel Luc
Published: September 2024

Helical piles can be rescrewed at greater depths after failure and put back into service again as long as their integrity is preserved. However, reports on the lifetime performance after reinstallation are completely missing in the literature. This work compares the tensile cyclic response of single helix piles in dry and saturated sand after experiencing failure due to monotonic uplift and after reinstallation, using centrifuge model testing. Tensile cyclic tests were conducted on three model piles with different helix-to-shaft diameter ratios, under two different conditions: (1) cyclic loading after monotonic pile failure, and (2) cyclic loading on a pile that has been reinstalled deeper into the soil after experiencing a monotonic failure. The experiments revealed that the preceding monotonic failure causes significant influence on the post-failure cyclic performance, in which few tens of cycles are enough to lead to a critical accumulated displacement. The cyclic tests on the reinstalled helical pile at a depth of 2 D ( D = helix diameter) below the initial helix depth showed that the cyclic performance can be partially to fully recovered depending on the loading amplitude.
A figment of our imagination: What is (and isn’t) imaginary after applying notional lateral loads?
Authors: Steele Taylor C.
Published: September 2024

Notional lateral loads are commonly used to capture the effects of initial out-of-plumbness in structures. Because these loads are imaginary, some assume the shear forces in the lateral force resisting system and horizontal reactions at the base can be ignored. However, for most structures, this is incorrect. This paper reviews two models for rationalizing notional loads. The first is a cantilever beam analogy that reinforces the imaginary nature of the horizontal force at the base. The second is a rigid link stabilized by a cantilever beam, which highlights that part of the notional load appears during a direct analysis. An example building is used to reinforce that, while the effect of Canadian notional loads may be artificially large, the portion of the notional load contributed by the gravity framing should not be ignored in the shear design of the lateral force resisting system, foundations, or even piers supporting gravity columns.
Quantum metrology of Schwinger effect
Authors: Fan Tingting , Liu Qianqian , Jing Jiliang , Wang Jieci
Published: September 2024

We propose a scheme for the quantum metrology of the Schwinger effect and the dynamics of Gaussian interference power (GIP). The ongoing reliability of the estimation strategy for the probe state prepared in particle–particle modes is demonstrated. Although the GIP sensitively depends on the strength of the external electric field and the transverse momentum, the advantage of quantum parameter estimation is still maintained even in the limit of an infinite electric field and zero transverse momentum. It is shown that the entanglement between the particle–particle modes provides a guarantee for obtaining higher precision for the black-box estimation. In contrast, for the probe state prepared in particle–antiparticle modes, the advantage of quantum parameter estimation can also be ensured even though there is no entanglement in the probe state. Put differently, some non-entanglement quantum correlations play the role of quantum resources in the estimation for particle–antiparticle modes.
Hard diffraction in SHERPA
Authors: Krauss Frank , Meinzinger Peter
Published: September 2024

We present the first complete simulation framework for the simulation of jet production in diffractive events at next-to leading order in QCD, matched to the parton shower. We validate the implementation in the SHERPA event generator with data from the H1 and ZEUS experiments for diffractive DIS and diffractive photoproduction. For the latter, we review different models aiming to explain the observed factorisation breaking and we argue that at NLO the direct component must also be suppressed. We provide predictions for diffractive jet production both in DIS and in photoproduction events for the upcoming EIC.