Primary Evidence Research Articles

Greenhouse gas concentrations and diffusive fluxes in the middle reach of the Lancang River before and after damming

With increasing concerns of greenhouse gas (GHG) emissions from reservoirs, the debate surrounding whether hydropower qualifies as green energy has become increasingly contentious. However, quantifying the impact of dam construction on river GHG emissions still poses challenging due to the absence of direct observational data on river GHG emissions pre- and post-damming. In the present study, the differences in GHG diffusive fluxes from pre- and post-dammed river channels in the middle reaches of the Lancang River were quantified through three field campaigns in 2016, 2018, and 2023. The results indicate that reservoir construction increases the diffusive fluxes of GHG from the natural river, the total GHG emissions (expressed as carbon dioxide equivalent: CO2eq) from post-dammed river ranged from 234.42 to 527.55 mg CO2eq m−2 d−1 and were 1.4–5.2 times higher than that from pre-dammed river. However, the GHG diffusive fluxes from the reservoirs in the Lancang River remain below the average of global reservoirs. Moreover, river damming enhances the methane (CH4) emissions, the average value of CH4/CO2 ratio (in mg m−2 d−1) was 0.003 post-dam and was 13 times higher than that of pre-dam. Our results revealed that alterations in sediment distribution following reservoir construction emerge as a pivotal factor contributing to the variations in spatial distributions of GHG diffusive fluxes in the studied river channel. Overall, the findings of the study provide a primary and direct evidence of river damming impact on GHG emissions and underscore the necessity of long-term continuous in-situ measurements of GHG fluxes in the rivers undergoing hydropower development.

Health Impact Assessment (HIA): a tool to drive health in all policies?

Abstract Health Impact Assessment (HIA) is often promoted as a tool to implement ‘health in all policies’ and sustainable development approaches to improve health and equity outcomes. However, is this truly the case? Currently global HIA practice is variable. This paper shares learning from the development and implementation of HIA in Wales to date to understand how HIA has been, and can be, used to inform policies and decisions and reduce health inequalities. The research investigated if, and how, HIA can be used as a tool to mobilise HiAP in reality. It followed a mixed methodological approach and investigated the contribution of HIA to practically advancing HiAP viewed through the lens of Wales and internationally. Primary and secondary evidence and statistics were collected and analysed. A literature review, stakeholder interviews, online statistical questionnaires and case studies were conducted. Thematic and content analysis techniques used. Findings include the importance of conceptual considerations i.e. the perspective on health - social determinant an equity or environmental determinant driven - taken by those carrying out or commissioning a HIA; the importance of centres of expertise to learn from; and practical considerations such as the political and regulatory environment, workforce and organisational knowledge and capacity. Wales has a dedicated expert HIA Unit, an enabling political environment and has led to HIA influencing policies and plans over 20 years. It has transferrable learning for other nations and the research including the online survey has been replicated by others, led to collaborations with nations such as Portugal and contributed to the reviewed literature by providing case studies on a topics like climate change which have influenced decision makers. Tangible ways forward for policy makers, researchers and academics include the need to develop more cross collaboration and fill gaps in the evidence i.e. on institutionalisation of HIA. Key messages • HIA is a excellent process to drive Health in all policies approaches. • HIA needs an enabling environment and workforce support such as that in Wales to thrive.

Indicators of the clinical utility of genetic or genomic testing: a scoping review

Abstract Background Genetic or genomic tests are the cornerstones of personalized prevention. Previous reviews primarily focused on theoretical frameworks rather than actual assessments and assessed dimensions rather than specific indicators within these dimensions. Our scoping review aimed to review the dimensions and the specific indicators measured in the published assessment reports of genetic or genomic tests. Methods We selected formal assessments of genetic and genomic test used for prevention through PubMed, Web of Science, Scopus, websites of 20 different organizations, Google, and Google Scholar. Also, through a separate analysis we identified ten comprehensive dimensions of clinical utility through an analysis of 30 theoretical frameworks for genetic and genomic tests. From the included assessments, we extracted all the indicators, clustering them based on the comprehensive dimensions. Results From 3054 unique references and 12000 grey literature search results, we collected 57 assessments, all from high income-countries (in Europe (53%) and North America (47%)). The assessment methods were HTA (42%), EGAPP (25%), ACCE (21%) and other (12%). 951 disease-specific indicators were extracted from the assessments. Analytic validity (60%), clinical validity (79%) clinical efficacy (79%), economic impact (58%) were the most common dimensions (had at least one indicator). However, only 12 assessments (21%) include indicators that compared health outcomes between tested and untested groups. Equity, acceptability, legitimacy, and personal value were evaluated in less than 15% of the documents. Conclusions Our study illustrate that, although dimensions such as equity and acceptability, are significantly emphasized in traditional evaluation frameworks, these are often not considered in the assessments. Additionally, our study has underscored a significant dearth of primary evidence concerning the clinical efficacy of these technologies. Key messages • Our study highlights the prevalence of evaluations lacking indicators for equity, acceptability, and legitimacy dimensions and a lack of direct evidence of clinical efficacy. • The catalog of indicators was openly provided as a resource for researchers and institutions working in evidence-based evaluations of personalized preventive healthcare.

Molecular Fractionation of Ancient Organic Compounds in Deeply Buried Halite Crystals.

The molecular fractionation of organic compounds through adsorption in minerals has wide implications, including tracing the origins of life, carbon sequestration, and climate change. Here we present the first in situ examination of molecular fractionation within individual crystals via optical-photothermal infrared (O-PTIR) spectroscopy. Our study focuses on a unique inclusion trail within deeply buried halite crystals, characterized by a distinctive orange-to-blue fluorescence gradient, providing primary evidence of molecular variation in ancient carbon-based fluids within the inclusion trail. The findings reveal a trend in the CH2/C=O and CH3/C=O ratios, conforming with a consistent decrease from the blue fluorescence region to the orange fluorescence region. The chemically influenced fluorescent behavior of these ancient liquid carbon-based compounds is attributed to the fractionation of fluids in the inclusions as a result of microfractures within the crystal acting as chromatography capillaries. These capillaries facilitated interactions between specific organic compounds, serving as adsorbates, and the halite mineral, representing the adsorbent. Our study provides insights into the fluid-solid physicochemical interactions within extreme environments and extends our understanding of molecular processes in such settings.

Survey of Knowledge, Attitudes, and Levels of Confidence Regarding Age-Related Hyperkyphosis and Its Management among Thai Physiotherapists.

Thorough knowledge of the management of age-related hyperkyphosis is crucial to physiotherapists' effective handling of complex spinal deformities. This cross-sectional study investigated the knowledge, attitudes, and confidence of Thai physiotherapists regarding age-related hyperkyphosis. An online questionnaire with demographic, work-related, knowledge, attitude, and confidence questions was employed. The data analysis involved descriptive statistics, chi-square tests, and independent t-tests. Complete responses were obtained from 314 physiotherapists. The correct responses amounted to 68.79% for the definition, 90.00% for causes, 14.97% for age of onset, 22.38% for prevalence, and 64.65% for the gold-standard diagnosis of hyperkyphosis. Most of the diagnostic methods involved visual examination. The respondents reported that hyperkyphosis disrupts respiratory function. The aim of treatment, according to 88.85%, was to increase spine mobility. Corrective posture exercises were the most common treatment strategy, but the range of treatments was diverse. Many cited undergraduate education as their primary evidence source. Respondents had conflicting attitudes towards "age-related hyperkyphosis is a normal aging process" but mostly positive attitudes towards the need for physiotherapy treatment. Approximately 22% reported fair confidence in treating hyperkyphosis. This study highlights the importance of raising awareness and enhancing knowledge, attitudes, and confidence among physiotherapists to improve care for older adults with hyperkyphosis.

Sentimental Porcelain. Meissen Porcelain and Enlightenment Sensibility in Late Eighteenth-Century Saxony

Meissen porcelain objects representing sentimental subjects – such as scenes of familial and romantic love, and the joys of childhood – are documents of fundamental importance for understanding the penetration of Enlightenment ideas into late eighteenth-century Saxony. They speak to the reception of key Enlightenment literary works in social contexts characterised by a new elite made up of wealthy members of the bourgeoisie and liberal aristocrats united in their embrace of progressive ideas about the relationship between reason and sentiment. Embedded as they were in very specific social practices – the sociable rituals of hot beverage consumption, and cultures of viewing and conversation in the domestic interior – these porcelain objects are primary evidence for identifying and reconstructing emotional communities founded on a shared embrace of Enlightenment sensibility amongst the upper echelons of Saxon society in the last decades of the eighteenth century.

A Multiwavelength Approach to Constraining the Merger Properties of ACT-CL J0034.4+0225

ACT-CL J0034.4+0225 is a previously unrecognized merging galaxy cluster at z = 0.38588 ± 0.00068. Our primary evidence is provided by a 21 ks Chandra image that shows two surface brightness peaks separated by ∼49″ (259 kpc) surrounded by an extended cluster gas distribution. Each gas peak contains a brightest cluster galaxy, offset from the gas peak. We collect new South African Large Telescope optical spectra that, when augmented by archival data, yield redshifts for the two BGCs and 58 other cluster members. Archival Giant Metrewave Radio Telescope and MeerKAT data reveal a radio halo that encompasses the X-ray peaks. We provide and compare three X-ray-based mass estimates (5.0 × 1014 M ⊙, 6.4 × 1014 M ⊙, and 8.6 × 1014 M ⊙). The Planck and ACT Sunyaev–Zel’dovich masses are ≈5.8 × 1014 M ⊙. We constrain the merger state and properties by comparing them to an existing suite of N-body/hydrodynamical models using the measured gas peak separation (259 kpc, projected) and radial velocity difference (0–1000 km s−1). This constrains the epoch of the merger to be within ∼100 Myr of first pericenter passage. A strong lensing analysis constrains the mass ratio to be in the range 1:1–1:20, while the cluster morphology prefers values near the equal-mass range.

Retire or get retired: Stocks, memes, and desperation capitalism on r/WallStreetBets

There is growing discontent with the financial services industry. The roots of these feelings are old but have expanded during the 2008 financial crisis and were enhanced by the COVID-19 pandemic and its associated cost of living crisis. This has given rise to the concept of “desperation capitalism”, where individuals are resorting to high-risk measures to try to achieve economic security. This research paper presents new insights into desperation capitalism and its participants through an exploratory case study of the r/WallStreetBets community on Reddit. The case study asks: how does social media impact the behaviour of retail investors? Drawing on multiple sources of primary and secondary empirical evidence, the paper makes two core contributions. First, the paper offers an initial conceptualization and model for understanding the phenomenon of “desperation capitalism”. Second, the paper demonstrates how the decision-making processes of retail investors can be influenced by social media.

Scientometric analysis of global cyber security research output based on Web of Science

Objective. This study aims to analyze global cyber security research using various scientometric indicators for 25 years, from 1999 to 2023. Design/Methodology/Approach. The study used the Web of Science international citation database to retrieve a total of 5,640 records. The records were extracted in the CSV file format and further analyzed using an MS-Excel spreadsheet, VosViewer, and Biblioshiny software. Findings. The findings revealed that a 300% annual growth rate was recorded for the publications in 2002. The USA emerged as the top contributor (31.15%) among the countries. The authors affiliated with the State University System of Florida have more publications (107 contributions). Authors Lingfeng Wang of the University of Wisconsin-Milwaukee and Kim-Kwang Raymond Choo of the University of Texas at San Antonio have contributed the equal and highest number of (21) papers. Originality/Value. Cyber security research helps to guardian the individual or nation’s digital sovereignty, protecting it against sophisticated cyber threats and potential attacks. The discipline has become the subject of global research. This study helps cyber security experts, software or web developers, and researchers identify the primary research evidence and its impact on the research community and policymakers for evidence-based policymaking to combat invisible global threats.

Safety and efficacy of direct oral anticoagulants in chronic kidney disease: a meta-analysis

BackgroundDirect oral anticoagulants (DOACs) have emerged as the first-line therapy for venous thromboembolism and stroke prophylaxis in atrial fibrillation. As DOACs are partially excreted renally, their safety in patients with chronic kidney disease (CKD) is unclear. ObjectivesTo synthesize primary evidence on the safety profile of DOACs in patients with CKD. MethodsWe searched MEDLINE and Embase from inception to June 2023 for randomized and nonrandomized cohort studies comparing DOACs with vitamin K antagonists (VKAs) in CKD patients. Screening and data collection were conducted in duplicate. The primary safety outcome was major bleeding, defined by International Society on Thrombosis and Haemostasis criteria, stratified by CKD severity. Meta-analysis was done using the Mantel–Haenszel random-effects model, presented as odds ratios (ORs) with corresponding 95% CIs. ResultsOf the 2355 articles captured in the literature search, 25 nonrandomized studies (n = 6832) and 6 randomized studies (n = 66,898) were included. DOACs reduced major bleeding compared with VKAs in all subgroups (stage 4: OR, 0.73; 95% CI, 0.58, 0.93; stage 5/renal replacement therapy: OR, 0.70; 95% CI, 0.50, 0.98; stage unspecified: OR, 0.72; 95% CI, 0.63, 0.83). Apixaban and rivaroxaban both reduced major bleeding in stage 5/renal replacement therapy patients (apixaban: OR, 0.66; 95% CI, 0.52, 0.85; rivaroxaban: OR, 0.58; 95% CI, 0.35, 0.94). ConclusionIn this meta-analysis, DOACs reduced major bleeding compared with VKAs in stage 4, stage 5/renal replacement therapy, and CKD stage unspecified patients. Future analysis should evaluate the impact of specific DOACs and dosage on safety and efficacy in this population.

Contribution of bismuth melts to gold endowment in the Baolun gold deposit, Hainan Island, South China

Bismuth (Bi) melts and related polymetallic alloys can efficiently scavenge gold (Au) from Au-unsaturated aqueous solutions, contributing to the Au endowment in many hydrothermal deposits. However, original evidence for Au–Bi melts is often poorly preserved due to post-precipitation alteration. This complicates investigation of the liquid bismuth collector model in hydrothermal Au deposits. Here we present primary evidence for the occurrence of Au–Bi melt in hydrothermal systems through an examination of the Au–Bi phases and textures in the Baolun Au deposit (Hainan Island). This study found that maldonite, native bismuth, Au–Bi symplectite and Au–Bi melt blebs appeared successively following the precipitation of native gold. Notably, large Au–Bi melt blebs were well preserved in natural systems due to the rapid cooling of fluids. The mineral assemblages and their corresponding fluid physiochemical conditions suggest that the evolution of the ore fluids at Baolun was characterized by a continuous reduction in Au and Bi concentrations and Au/Bi ratios alongside decreasing fluid temperatures and sulfur fugacity (fS2). These observations offer direct evidence for Au scavenging by Bi melts in a mesothermal (275–450 °C), low-fS2 and reduced hydrothermal system, aligning well with the Au–Bi binary phase evolution established in metallurgy. As the fluid cooled further, the Au–Bi phases were subsequently overprinted by later Te–S-rich fluids, as evidenced by the formation of bismuthinite, jonassonite, and joséite-A around the Au–Bi phases. Importantly, our study reveals that the Baolun Au deposit ischaracterizedby a Au–Bi–Te hydrothermal system and that the metamorphic country rocks at Baolun are the major source of Au, Bi, and Te.

Potential Role of Indian Spices in the Management of Diabetic Complication: A Pre-Clinical and Clinical Review

Diabetic is a metabolic disorder that is concerning for people worldwide, caused by a lack of insulin or ineffective production of insulin in the pancreas. Diabetic retinopathy, nephropathy, and neuropathy are significant microvascular complications of diabetes mellitus, contributing to substantial morbidity and mortality worldwide. Several synthetic medications have been developed. However, none of the compounds provides complete recovery. Long-term use of some synthetic medications might have serious negative effects, thus, there is a need for safe, affordable, and effective medications. Throughout human history, traditional ailments have been much respected as a source of treatment. Their widespread usage across the globe suggests that herbs/ spices are becoming an increasingly important component of cutting-edge, contemporary medications. Therefore, the objective of this review is mainly based on the beneficial effect of Indian spices in managing diabetes. We review the current primary and clinical evidence about the potential of Indian spices, including curcumin, ginger, coriander, cumin seed, garlic, clove, cinnamon, curry leaves, and fenugreek seed with mainly their hypoglycemic and antioxidant properties, for treating diabetes mellitus, also managing diabetic-associated complications, such as neuropathy, retinopathy, and nephropathy. Here, we present the pre-clinical and clinical studies demonstrating how these spices can improve glucose metabolism, enhance insulin secretion, and mitigate oxidative stress, potentially alleviating diabetic complications.

Exploring the Experiences and Perceptions of the Utilisation of Structured Clinical Handover Frameworks by Nurses Working in Acute Care Settings: A Scoping Review.

There is increased interest in implementing structured clinical handover frameworks to improve clinical handover processes. Research postulates that structured clinical handover frameworks increase the quality of handovers; yet inconsistencies enacting these frameworks exist which has a potential to jeopardise the quality of communication during handovers thereby defeating the purpose of these frameworks. This scoping review aims to analyse and synthesise what is currently known of the nurses' experiences and perceptions in implementing structured clinical handover frameworks and identify knowledge gaps in relation to this topic area. A scoping review guided by the PRISMA-ScR checklist. A systematic search of five electronic databases was undertaken to identify peer-reviewed primary research studies which met the predetermined eligibility criteria. In total, 301 studies were imported into COVIDENCE, screened and assessed for eligibility resulting in 23 studies remaining. From the eligible studies, data was extracted, collated, appraised, summarised and interpreted. MEDLINE, CINHAL, ProQuest, EMCARE, Web of Science and Informit. Twenty three studies were included in this review which yielded the following major themes: (1) quality and completeness of information transfer; (2) interprofessional collaboration; (3) challenges impacting the experience of implementing the structured clinical handover frameworks and (4) perceived impacts on quality, patient safety and health outcomes. There are key benefits and issues experienced and perceived by nurses implementing structured clinical handover frameworks and this review identifies opportunities for further improvements. Future research should explore the perceived associations with patient outcomes. This review highlights the importance of structured clinical handover frameworks, the nurses' experiences in implementing these frameworks and strategies to improve the effectiveness of these frameworks. No Patient or Public Contributions as this study is a review of published primary evidence.

Electoral Management in Iran: The Ministry of Interior’s Role in Parliamentary Elections

Although Iran’s Guardian Council enjoys incomparable legal authority over every stage of the electoral process, Iranian laws and regulations also provide the Ministry of Interior with an important role to play in the management of parliamentary elections. Through analysis of primary source legal materials and original interview evidence, this article considers when and how Iran’s supreme leader delegates autonomy to the executive as related to management of parliamentary elections.

Developing films to support vaccine-hesitant, ethnically diverse parents’ decision-making about the human papillomavirus (HPV) vaccine: a codesign study

ObjectiveTo illustrate an evidence-, theory- and person-based approach to codesign the COMMUNICATE films that support parental decision-making about the human papillomavirus (HPV) vaccine for their teenagers.DesignCodesign study.SettingLocalities covered by two...

The Weight of Numbers: Counting Border Crossing Deaths and Policy Intent

Executive Summary This article explores how undocumented border crosser (UBC) deaths are counted as well as mis- and under-counted across the US southwest, and proposes a suite of policy remediations to standardize this process. An accurate count of UBC recovered remains is vital to understanding the scope of fatalities associated with border crossing, providing evidence accounting for the reciprocal relationship between US border enforcement and the incidence of migration-related death. To meaningfully intervene, it is insufficient to advocate only for more robust individual death investigations, though this is pivotal to forensically identify UBC decedents and unite them with their loved ones. Though identification and reunification of UBCs are the elements of forensic care most commonly attributed as humanitarian, the relationship between forensic investigation and international humanitarian principles is equally about accumulating primary evidence for policy intervention and justice claims on behalf of those who wrongfully die. Even if existing counting mechanisms do not provide the means for establishing this attribution between border-crossing deaths and border enforcement policy, this article lays out an argument for why they must do so and it makes recommendations for how this can take place. Necessarily, this article begins with a critique of existing mechanisms for counting UBC deaths, from the federal observation of such deaths by Customs and Border Protection, to the bureaucratic mechanisms for the collection of vital statistics authored at the local level. It then suggests means for improving accurate counting using the US Standard Certificate of Death. It particularly explores two aspects of the certificate, Manner of Death reporting and a section that asks death filers to describe how the death occurred, sections 37 and 43 respectively. Finally, it explores historical precedent for altering the standard death form at local and then national levels, positing that select amendments to the existing death certificate would be useful for standardizing how medicolegal death filers across the border and beyond can more accurately enumerate and characterize UBC deaths. Policy recommendations include the following, in order of immediacy: ● Jurisdictions across the US southwest must adopt standardized criteria for counting fatalities believed to be associated with undocumented border crossing. ● Despite some local formalization of UBC counting, current means of representing UBC status in vital records remains ad hoc across the US southwest and existing mechanisms for counting elude wider scale national recognition in vital statistics. The most straightforward and reliable method of standardization to ensure systematic representation of UBC deaths across the borderlands would be a UBC checkbox on the death certificate. This would require cooperation with state-level public health departments and legislatures. Precedent exists for changing the death form at the state level, facilitating, in some cases, for eventual inclusion of new components of the death certificate to be adopted on the US Standard Certificate of Death. This is recommended as a longer-term goal. ● Finally, there must be a means to characterize the deadly relationship between UBC fatalities and US border enforcement policy and practice in vital records where UBC Manners of Death are most often characterized as “Natural” or “Accidental.” Both are inaccurate. Unilaterally ensuring an accurate count leaves room for a trend already well underway in which agencies associated with border enforcement have cast UBC deaths as simply due to unfortunate heat-related accidents, resulting in legislation aimed to mitigate deaths that fails to address the role of border policy in causing deaths. This paper recommends that a new Manner of Death category could be useful beyond the border to represent non-capital crimes enforced by leveraging bodily harm.

A PROMPT Update on Partial REBOA: Initial Clinical Data and Overview of the DoD-Funded Partial REBOA Outcomes Multicenter ProspecTive (PROMPT) Study.

Retrograde Endovascular Balloon Occlusion of the Aorta (REBOA) is an effective management for the transient responder, but the ischemic consequences of complete aortic occlusion currently limit its use. Multiple DoD-funded preclinical studies have clearly demonstrated that partial REBOA reduces distal ischemia to potentially extend safe occlusion times, while still providing effective temporization of noncompressible torso hemorrhage. Early versions of REBOA devices were designed to completely occlude the aorta and had little ability to provide partial occlusion. Recently, a new REBOA device (pREBOA-PRO) was designed specifically to allow for partial occlusion, with the hypothesis that this may reduce the complications of aortic occlusion and extend safe occlusion times while maintaining the benefits on cardiac and cerebrovascular circulation as well as reductions in resuscitation requirements. To ascertain the impact of a new purpose-built partial REBOA device on the extension of safe occlusion time, the Partial REBOA Outcomes Multicenter ProspecTive (PROMPT) trial compared available data from the pREBOA-PRO with existing data from 200 clinical uses of pREBOA-PRO and available data in the AAST AORTA Registry were reviewed to design primary endpoints and clinical evidence for a prospective multi-center trial, the PROMPT Study. Together with the endpoints identified in preclinical studies of partial REBOA, primary endpoints for the PROMPT study were identified and power analyses were conducted to determine the target patient enrollment goals. Results from the clinical implementation of partial REBOA at a single trauma center were used to conduct the initial power analysis for the primary endpoint of Acute Kidney Injury (AKI) after prolonged occlusion. The rate of AKI after complete REBOA was 55% (12/20) compared to 33% (4/12) after partial REBOA (Madurska etal., 2021). With an alpha of 0.05 and power (β) of 0.8, the projected sample size for comparison on a dichotomous outcome is 85 patients for the assessment of AKI. Initial power and endpoint analyses have been confirmed and extended with the ongoing analysis of partial and complete REBOA reported in the AORTA database. These analyses confirm preclinical findings which show that compared to complete REBOA, partial REBOA is associated with extended occlusion time in zone 1 (complete: 31 min vs. partial: 45 min, P = 0.003), lower rates of AKI after zone 1 occlusion (complete: 33% vs. partial: 19%, P = 0.05) and reduced resuscitation requirements (e.g., 25% reduction in pRBC administration: complete: 18 units vs. partial: 13 units, P = 0.02). The DoD-funded PROMPT study of partial REBOA will provide prospective observational clinical data on patients being treated with pREBOA-PRO. Outcomes will be stratified based on partial or complete occlusion to address whether partial REBOA has additional clinical benefits over complete REBOA, such as decreased distal ischemia, extension of safe occlusion time, improved hemodynamics during transition to and from occlusion, and reduced interoperative bleeding and blood product use. The results from this study are expected to confirm previous data demonstrating reduction of ischemic sequalae, improved transition to reperfusion, and reduced resuscitative requirements compared to complete REBOA.

Assessing the Accuracy of Reporting of Hypertension on Death Certificates in Australia.

There is insufficient evidence of how accurately hypertension is reported on death certificates, which are the primary evidence of causes of death. This study assesses the accuracy of reporting of hypertension on death certificates of decedents in Australia who previously had their blood pressure measured. Blood pressure data from the 2014-2015 and 2017-2018 National Health Surveys were linked to death registration data from July 2015 to December 2021 (average 3.3 years from survey to death). The percentage of decedents with hypertension reported on the death certificate was calculated according to blood pressure level and previous diagnosis of hypertension. Hypertension was reported on the death certificate of 20.2% (95% confidence interval 12.1%-28.3%) of decedents who had very high to severe blood pressure (160/100 mm Hg and above), 14.5% (10.3%-18.8%) who had high blood pressure (140 to <160 / 90 to <100 mm Hg), 14.1% (10.8%-17.4%) who had normal to high blood pressure (<140/90 mm Hg) and who took hypertension medication, and 17.8% (13.6%-22.0%) who had been diagnosed with hypertension. Where the decedent had very high to severe blood pressure, hypertension was reported for 27.9% (14.1%-41.8%) of deaths if they had been diagnosed with hypertension, and 21.7% (9.6%-33.7%) where another cardiovascular disease was reported on the death certificate. Hypertension mortality in Australia is only reported for a minority of deaths of people with high or very high to severe blood pressure; this is also found for those with a prior diagnosis of hypertension.

When socialization fails: breaking the habit of engagement with China

Abstract Why do states sustain failing policy? The literature on path dependency and cognitive habits shows how foreign policy logics become axiomatic. Yet these explanations focus too much on people and not enough on policies. We argue that the content of policies matters for the degree and depth of their entrenchment. Policies with long-term time horizons, immeasurable objectives and diffuse effects are especially vulnerable to stasis. Engagement policies toward China are a paradigmatic example. We focus on Canada's engagement policy, which exhibits both stasis and change, and refer to similar policies of other countries. Drawing on primary evidence including interviews with high-level diplomats and decision-makers, we find that engagement aimed at socializing China was sustained despite growing evidence of its failure—including through a multi-year diplomatic crisis. Change only became possible through ‘institutionalized debate’, meaning the purposeful creation of formal channels for debate. The article makes three contributions. First, we identify a novel explanation of stasis, showing that the content of policies matters. Second, we introduce a practical pathway—institutionalized debate—that can disrupt stasis once a policy logic is habituated. Finally, we identify an aspect of socialization ignored in the literature: when operationalized as policy, it becomes resistant to reversal.

Screening and identification of reactive metabolic compounds of Cortex Periplocae based on glutathione capture-mass spectrometry.

As a traditional Chinese medicine (TCM), Cortex Periplocae (CP) has a wide range of pharmacological effects, as well as toxic side effects. The main toxic components of it are cardiac glycosides, which tend to cause cardiotoxicity. Currently, it has also been reported in studies to cause hepatotoxicity, but it is not clear whether the hepatotoxicity is related to the toxicity caused by the reactive metabolites. This study aims to investigate the target components of CP that generate reactive metabolic toxicity. The fluorescent probe method was used to detect glutathione (GSH)-trapped reactive metabolites in a co-incubation system of CP extract with rat liver microsomes. Identification of GSH conjugates was performed by LC-MS/MS and that of the possible precursor components that produce reactive metabolites was conducted by UPLC-Q-TOF/MS. Cell viability assays were performed onHepG2 and L02 cells to determine the cytotoxicity of the target components. The findings of our study demonstrate that the extract derived from CP has the ability to generate metabolites that exhaust the intracellular GSH levels, resulting in the formation of GSH conjugates and subsequent cytotoxic effects. Through the utilization of the UPLC-Q-TOF/MS technique, we were able to accurately determine the molecular weight of the precursor compound in CP to be 355.1023. The primary evidence to determining the GSH conjugetes relies on the appearance of characteristic product ions resulting from central neutral loss (CNL) scanning of 129Da and product scanning of m/z 660 in the positive MS/MS spectrum. Through analysis, it was ultimately ascertained that the presence of chlorogenic acid (CGA) and its isomers, namely neochlorogenic acid (NCGA) and cryptochlorogenic acid (CCGA), could lead to the production of GSH conjugates, resulting in cytotoxicity at elevated levels. Taking these findings into consideration, the underlying cause for the potential hepatotoxicity of CP was initially determined.