Small Rise Research Articles

Structure and spin of the low- and high-spin states of Fe2+(phen)3 studied by x-ray scattering and emission spectroscopy.

The structure and spin of photoexcited Fe2+(phen)3 in water are examined by x-ray scattering and x-ray emission spectroscopy with 100 ps time resolution. Excitation of the low-spin (LS) ground state (GS) to the charge transfer state 1MLCT* leads to the formation of a high-spin (HS) state that returns to the GS in 725 ps. Density functional theory (DFT) predicts a Fe-N bond elongation in HS by 0.19 Å in agreement with the scattering data. The angle between the ligands increases by 5.4° in HS, which allows the solvent to get 0.33 Å closer to Fe in spite of the expansion of the molecule. The rise in solvent temperature from the return of photoproducts to the GS is dominated by the formation dynamics of HS, 1MLCT* → HS, which is followed by a smaller rise from the HS → GS transition. The latter agrees with the 0.61 eV energy gap E(HS)-E(LS) calculated by DFT. However, the temperature rise from the 1MLCT → HS transition is greater than expected, by a factor of 2.1, which is explained by the re-excitation of nascent HS* by the 1.2 ps pump pulse. This hypothesis is supported by optical spectroscopy measurements showing that the 1.2 ps long pump pulse activates the HS* → 5MLCT* channel, which is followed by the ultrafast return to HS* via intersystem crossing. Finally, the spins of the photoproducts are monitored by the Kβ emission and the spectra confirm that the spins of LS and HS states are 0 and 2, respectively.

Divergent credit risk responses to local government debt among Chinese banks: a stress test analysis

ABSTRACT This study explores the heterogeneous impact of local government debt on credit risk across ‎state-owned and urban and rural commercial banks in China, through the analysis of stress test ‎methodology and quarter-based data in the period 2014–2021. It found that if the scale ‎of local government debt expands, the Non-Performing Loan (NPL) rates will reduce in state-owned commercial banks, ‎while the rural and urban commercial banks will increase. In the case of further decay in the scale of local government debt and macroeconomic indicators, there would be more credit risk in a heterogeneous manner among different-sized commercial banks. Medium-sized urban commercial banks have the smallest rise in non-performing loan rates due to the higher individual and corporate credit risks they face. Moreover, the study finds the resiliency of the risks weak and poor preparation for loan impairment in covering the potential loan losses in a pressured scenario compared to their counterpart urban and state-owned rural commercial banks. The findings suggest that rural commercial banks need to improve their risk ‎resilience to cope with extreme shocks.

Evaluation of physiological effects of examination stress on Quantitative red blood cells count and hemoglobin in female medical students at Peoples University of medical and health sciences for women, Nawabshah.

Objective: To assess the physiological effects of examination stress on red blood cells in female medical students at Peoples university of medical and health sciences for women, Nawabshah. Study Design: Comparative Cross Sectional study. Setting: Department of Physiology, Peoples University of Medical & Health Sciences for Women, Shaheed Benazir Abad. Period: 7th April 2019 to 6th October 2019. Methods: A total 110 healthy students of first & Second year MBBS were included for this, by the non-probability randomized sampling technique, divided into two equal (55-students in each) groups A and B first & second year MBBS. Blood samples were collected prior to and during the exam, and the findings were evaluated using statistical software. Results: The mean RBC count ± SD thru the examination of students including the first year was 4.98±0.26 c/cm3, which was considerably higher than the pre-exam mean RBC count ±SD of 4.65±0.27 c/cm3. There was a small rise in RBC count throughout the examination compared to before (n = 55, p-value = 0.031) among the first-year students. During the second year examination, students had a mean RBC count ± SD of 4.67±0.28 c/cm3, which was not substantially higher than the pre-exam mean of 4.66±0.33 c/cm3. There was no significant increase in RBC count throughout the examination compared to before it among 2nd year students (n = 55, p-value = 0.932). Conclusion: Findings of study concluded that examination stress significantly affects first-year medical students' red blood cell (RBC) count, increasing it during exams, but not second-year students. This suggests varying physiological responses to stress, possibly due to academic adaptation or stress levels.

Epidemiologic changes in thyroid disease.

To analyze the evolving epidemiologic trends in thyroid disease, focusing on risk factors, underlying drivers of these changes, and their implications on clinical practice and research priorities. Thyroid disease remains one of the most prevalent groups of disorders globally, and the shift in its frequency and distribution is multifactorial. The prevalence of hypothyroidism increases with age, although normal thyrotropin ranges appear to be age-dependent, raising concern for potentially inappropriate levothyroxine use. Hyperthyroidism and Graves' disease continue to be predominant in reproductive-age women but exhibit a milder phenotype at diagnosis. Thyroid nodules are increasingly found in asymptomatic patients, likely from more widespread use of neck and chest imaging. Thyroid cancer incidence has risen exponentially over the years, mostly driven by overdiagnosis of low-risk tumors; however, a small rise in incidence of higher risk tumors has been noted. Obesity appears to be a risk factor for thyroid cancer occurrence and more aggressive forms of the disease. Understanding epidemiologic trends in thyroid disease is crucial for guiding clinical practice and research efforts, aiming to optimize patient outcomes while preventing unnecessary and potentially harmful interventions.

Effect of nonlinear terms in piston theory on characteristics of panel flutter

Currently, there is no systematic summary of the influence of the nonlinear terms in piston theory on the panel flutter. The two-dimensional nonlinear panel flutter equations under supersonic airflow based on the first, second, and third-order piston theories is established. The stability of the heated panel is analyzed by using the Lyapunov's indirect method, and the panel flutter equations are numerically solved based on the numerical analysis method to investigate the influence of the nonlinear terms in piston theory on the panel flutter. The results show that: ①Under a small temperature rise ratio, the panel response under the first-order piston theory only exhibits the convergent motion and single-period limit cycle flutter. While under higher-order piston theories, the panel response is more complex, exhibiting more complex nonlinear dynamic phenomena such as multi-period limit cycle flutter and chaotic motion in addition to the aforementioned characteristics. ②As the Mach number increases, the required dynamic pressure and temperature rise ratio decrease gradually when the dynamic response of the panel under the first-order piston theory and higher-order piston theories exhibit significant differences. ③The significant differences in the computational results of the second-order and third-order piston theory appear under the high Mach numbers and relatively high dynamic pressures, and the same phenomenon occurs underthe high temperature rise ratios. ④When the dynamic response characteristics of the panel are basically consistent, the displacement response peak calculated by using the higher-order piston theory is usually smaller than the result calculated by using the first-order piston theory, and the maximum error can reach about 16.66%. The present results have certain reference value for selecting the appropriate analysis method for the panel flutter under different conditions in practical applications.

#2617 Impact of CKD screening in high‑risk populations and guideline-directed therapy on RRT, CV events, and mortality in Europe: an IMPACT CKD analysis

Abstract Background and Aims Despite the rising and substantial burden of chronic kidney disease (CKD), there is a lack of recognition of CKD as a health priority in Europe. This contributes to underdiagnosis of CKD despite the potential for early detection and effective intervention to delay progression to late-stages (associated with costly and resource-intensive renal replacement therapy [RRT; i.e., dialysis and transplantation]). Further, diagnosed patients are undertreated when compared to current and upcoming CKD guidelines, leading to increased risk for progression to RRT and cardiovascular (CV) or other events. Early detection and intervention in high-risk populations, such as those with diabetes mellitus (DM) and hypertension (HTN) have shown cost-effectiveness; however, the broader implications of these strategies on CKD progression and clinical outcomes in a European context remains underexplored. Our study aims to illustrate the clinical benefit of targeted screening followed by an optimal compliance to guideline-directed treatment use to provide insight into potential CKD policies across Europe. Method Four country populations (Germany, Netherlands, Spain, United Kingdom [UK]) were simulated for 10-years (baseline: 2022; simulated years: 2023-2032) using the validated IMPACT CKD model to compare two scenarios: targeted screening for people with DM and/or HTN followed by 90% compliance to guideline-directed therapy versus current practice (i.e., underdiagnosis without screening and low treatment rates). Annual targeted screening was modelled using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing. Initiation of therapies for people with diagnosed CKD was based on Kidney Disease Improving Global Outcomes guidelines. A 90% compliance to guideline-directed therapies was assumed to approximate maximum clinical benefit. Current practice was modelled based on the observed diagnosed rate without screening and the observed treatment rate in each country. The incremental population initiated on recommended therapies were modelled to experience a multiplicative treatment effect on GFR decline, CV events, and acute kidney injury (AKI) events. The model projected CKD and RRT prevalence, incidence of CV and AKI events with results shown for year 10 (2032), as well as cumulative all-cause mortality over the simulated 10-years. Results Results compare the high-risk population screening followed by guideline-directed treatment scenario to continuation of current practices for the four countries (Fig. 1). The identification of undiagnosed CKD, as well as lower rates of progression due to guideline-directed treatment was associated with a small rise in the number of total CKD patients, with increases in stage 1-2 by 3.5% to 5.0%, and stage 3-5 by 0.2% to 1.2%. There was a reduction in the number of undiagnosed CKD stage 1-2 patients by 49.2% to 71.6%, and stage 3-5 by 60.2% to 69.8%. The largest reductions were predicted for CV events (44.6% to 49.1%) followed by dialysis (22.6% to 41.9%). The strategy resulted in a decrease in cumulative 10-year all-cause mortality between 4.5% to 9.1% in CKD patients. Conclusion The study predicted significant clinical benefits from targeted CKD screening followed by guideline-directed interventions across all four European countries. Notably, this approach was forecasted to reduce undiagnosed CKD cases, dialysis, CV events, and mortality. These findings underscore the potential of acting earlier on CKD to mitigate the future CKD burden.

Thermal and cardiovascular heat adaptations in active adolescents following summer

ABSTRACT This study aimed to investigate seasonal heat acclimatization in active adolescents following summer. Fifteen (5 females) active adolescents (14.6 ± 1.0 y) completed a 45-min heat response test (HRT) walking at 60% V ˙ O2peak in 40°C and 30% relative humidity before and after summer (i.e. November 2022 and March 2023). During the HRT, gastro-intestinal temperature (Tgi), skin temperature (Tsk), heart rate, local sweat rate (LSR) and whole-body sweat loss (WBSL) were recorded. Carbon monoxide rebreathing and dual-energy X-ray absorptiometry scans determined resting hematological measures and body composition. Participants completed physical activity (PA) diaries and wore an accelerometer for two one-week periods (pre- and post-summer). Daytime wet-bulb globe temperature (WBGT) was calculated for each summer day. Data are presented as posterior mean and 90% credible intervals. Participants reported 7 ± 4 h·wk−1 of outdoor PA, and daytime WBGT was 21.2 ± 4.6°C. Following summer, resting Tgi and heart rate were reduced by 0.2°C [−0.3, −0.1; probability of direction = 99%] and 7 beats·min−1 [−10, −3; 100%], respectively. During the HRT, there was an earlier onset of sweating (−0.2°C [−0.3, −0.0; 98%]), an attenuated rise of Tgi (0.2°C [−0.5, 0.0; 92%]) and mean Tsk changed by −0.2°C [−0.5, 0.1; 86%]. There was minimal evidence for heat adaptations in LSR or WBSL, hematological parameters or perceptual measures. This is the first study to demonstrate seasonal heat adaptations in active adolescents. Reductions in resting Tgi and exercising Tsk and a lower Tgi at the onset of sweating were associated with a smaller rise in Tgi during the HRT following summer.

Strategic trade policy in general oligopolistic equilibrium: The case of import tariffs

In a two-country model of general oligopolistic equilibrium with technologically heterogeneous sectors, I study how, in a home-market scenario, a unilateral rise in uniform cross-sector import tariffs affects wages, countrywide profits, and welfare. Firms face resource constraints and wages are simultaneously determined. Economy-wide protectionism reduces the foreign wage without affecting the domestic one. Domestic countrywide profits benefit from a small rise in uniform tariffs, whereas the foreign counterpart is damaged. Domestic welfare is unambiguously hindered. Hence, the general-equilibrium cross-sector perspective goes against the textbook version theory of the optimal tariff in partial equilibrium. Rationalization of these effects suggests a political-economy view on tariff formation in general equilibrium. Then I extend the model to segmented markets, considering uniform specific and ad valorem tariffs for bilateral and unilateral trade policies.

Examining Performance Loss Mechanisms in Lithium-Ion Batteries with the High-Voltage Mn-Rich Spinel Positive Electrodes

The high-voltage spinel, with the nominal composition of LiNi0.5-xMn1.5+xO4 (LNMO), could be a sustainable alternative to the layered-oxide positive electrodes used in lithium-ion batteries. However, commercial acceptance has been limited as LNMO cells display rapid performance loss during cycling. To examine reasons for this loss we prepared cells with LNMO-based positive and either graphite or lithium titanate (LTO) based negative electrodes. Our initial cells displayed high impedance and rapid impedance rise during cycling. Adding single walled carbon nanotubes in the positive lowered initial cell impedance but impedance increased during cycling because of coating delamination from the Al foil. Using a primed Al current collector solved the delamination problem: cells with this current collector showed only a small impedance rise. Regarding capacity, cells with the LTO negative showed higher initial capacities and smaller fade. Our data indicate that cell capacity retention is determined by reduction reactions at the negative electrode that lower capacity and oxidation reactions at the positive electrode that increase capacity: both types of reactions deplete the cell electrolyte during extended cycling. All things considered, species generated at high voltages, either in the electrolyte or at the LNMO electrode, drive cell capacity fade.

353 Eph/Ephrin Signaling Influences Innervation of Outer Hair Cells in Cochlea

OBJECTIVES/GOALS: 48,000,000 people in the U.S. have hearing loss, negatively impacting quality of life and work. Unveiling axon guidance for auditory type II spiral ganglia neurons (SGNs) will aid development of new therapies. I study the role of Eph/Ephrin and planar cell polarity (PCP) signaling during type II SGN turning and outer hair cell (OHC) innervation. METHODS/STUDY POPULATION: This quantitative study was conducted on Efna3 and Vangl2 null mice possessing Neurog1CreERT2 and R26RtdTomato mutations. Spontaneous Cre activity within the Neurogenin1CreERT2 line causes recombination and expression of fluorescent Rosa26 Reporter (R26R)tdTomatoin a restricted number of SGNs, including type IIs. Together, these lines permit SGN sparse labeling. Immunostaining and confocal imaging were used to analyze dsRed in Efna3 and Vangl2 mice and quantify type II SGN turning. In combination, Imaris 3D renderings were used to quantify type II SGN turning, branching, navigation features and temporal effects of EPHRIN-A3-Fc on type IIs via cochlear cultures (a gain-of-function manipulation). For both sexes, 5-6 cochleae per genotype were analyzed and compared by t-test to wildtype (WT) controls. RESULTS/ANTICIPATED RESULTS: Efna3 nulls showed a small rise in type II SGNs incorrectly turning toward the apex at an error rate of 16.0% compared to WTs (n=6; p=0.05). P0 Efna3 nulls had reduced branch number compared to WTs, 4.1 and 7.2, respectively (n=129; p=<0.0001), suggesting EPHRIN-A3 acts as a positive growth cue. In cochlear cultures, EPHRIN-A3-Fc led to type II SGN collapse at E15.5, indicating a repulsive function. However, at P0, EPHRIN-A3-Fc treatment led to type II SGNs with elevated branch numbers compared to Control-Fc treatment: 18.1 and 11.4, respectively (n=116; p=<0.0001). This indicates a positive growth function. At E16.5, EPHRIN-A3 protein immunoreactivity on Deiters’ and pillar cells appears reduced in Vangl2 nulls compared to WT cochleae, suggesting that EPHRIN-A3 acts downstream of PCP signaling. DISCUSSION/SIGNIFICANCE: Results suggest that Eph/Ephrin signaling acts downstream of PCP signaling to mediate type II SGN guidance and EPHRIN-A3 switches its mode of activation. The clinical implications of these findings are that therapeutics targeting EPHRIN-A3 and/or VANGL2 in their given pathways could stimulate new OHC innervation following auditory damage.

A numerical analysis on the thermal characteristics by filling parameters of high-pressure valve for hydrogen refueling station

Renewable hydrogen plays a critical role in the current energy transition, and can facilitate the decarbonization and de-fossilization of hard-to-abate sectors, such as the industrial, power, transportation and buildings sectors. High pressure hydrogen valve（HPHV）is an important energy storage element for the hydrogen fueling station. Given the problems of large internal pressure fluctuation and long adjustment time of the HPHV during the operation of the current hydrogen fueling system, it is necessary to study the thermal effects of the HPHV. In the study，the pressure、temperature and velocity changes of the HPHV are studied from the aspect of numerical calculation. The hydrogen pressure and temperature changes of the model were simulated and analyzed at the different filling parameters. The accuracy of the simulation model was demonstrated by practice. The influence of the internal taper of the spool on the temperature change of 40°, 50°, 60° and 70° was studied. The influence of outlet pressure of 5 MPa, 10 MPa, 15 MPa, 20 MPa, 25 MPa on the temperature of high-pressure hydrogen valve and the influence of mass flow rate of 0.1 g/s, 0.3 g/s, 0.5 g/s, 0.8 g/s on the velocity field of hydrogen high-pressure valve. The study shows that when the taper was 60°, the optimal decompression performance, small temperature rise, and the performance was stable. The highest speed and the lowest temperature appear near the gap outlet, up to 2500 m/s and 85 K, respectively. The temperature and speed change trends were basically opposite, and the temperature change range of the outlet was 280 K–370 K. The results of this study provide great support for the research and application of ultra-high pressure hydrogen storage and hydrogen refueling, which also provide a theoretical basis for the subsequent development of the hydrogen energy industry and the wide application of hydrogen fuel cell vehicles, and provide ideas for realizing the goal of “dual carbon".

Anterior cervical discectomy and fusion versus cervical disc arthroplasty: an epidemiological review of 433,660 surgical patients from 2011 to 2021

Background ContextAnterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are commonly performed operations to address cervical radiculopathy and myelopathy. Trends in utilization and revision surgery rates warrant investigation. PurposeTo explore the epidemiology, postoperative complications, and reoperation rates of ACDF and CDA. DESIGNRetrospective cohort study. Patient SampleA total of 433,660 patients who underwent ACDF or CDA between 2011 and 2021 were included in this study. Outcome MeasuresThe following data were observed for all cases: patient demographics, complications, and revisions. MethodsThe PearlDiver database was queried to identify patients who underwent ACDF and CDA between 2011 and 2021. Epidemiological analyses were performed to examine trends in cervical procedure utilization by age group and year. After matching by age, sex, Charlson Comorbidity Index (CCI), levels of operation, and reason for surgery, the early postoperative (2-week), short-term (2-year), and long-term (5-year) complications of both cervical procedures were examined. ResultsIn total, 404,195 ACDF and 29,465 CDA patients were included. ACDF utilization rose by 25.25% between 2011 and 2014 while CDA utilization rose by 654.24% between 2011-2019 followed by relative plateauing in both procedures. Mann-Kendall trend test confirmed a significant but small rise in ACDF and large rise in CDA procedures from 2011 to 2021 (p<.001). After matching, ACDF and CDA had an overall complication rate of 12.20% and 8.77%, respectively, with the most common complications being subsequent anterior revision (4.96% and 3.35%) and dysphagia (3.70% and 2.98%). The ACDF cohort, especially multilevel ACDF patients, generally had more complications and higher revision rates than the CDA cohort (p<.05). ConclusionsWhile ACDF utilization has plateaued since 2014, CDA rates have risen by a staggering 654.24% over the past decade. ACDF and CDA complication and revision rates were relatively low in comparison to previously published values, with significantly lower rates in CDA. Although a lack of radiographic data in this study limits its power to recommend either procedure for individual patients with cervical radiculopathy or myelopathy, CDA may be associated with minor improvement in the complication and revision profile.

Hypoxic pulmonary vasoconstriction does not limit maximal exercise capacity in healthy volunteers breathing 12% oxygen at sea level.

Maximal exercise capacity is reduced at altitude or during hypoxia at sea level. It has been suggested that this might reflect increased right ventricular afterload due to hypoxic pulmonary vasoconstriction. We have shown previously that the pulmonary vascular sensitivity to hypoxia is enhanced by sustained isocapnic hypoxia, and inhibited by intravenous iron. In this study, we tested the hypothesis that elevated pulmonary artery pressure contributes to exercise limitation during acute hypoxia. Twelve healthy volunteers performed incremental exercise tests to exhaustion breathing 12% oxygen, before and after sustained (8-h) isocapnic hypoxia at sea level. Intravenous iron sucrose (n = 6) or saline placebo (n = 6) was administered immediately before the sustained hypoxia. In the placebo group, there was a substantial (12.6 ± 1.5 mmHg) rise in systolic pulmonary artery pressure (SPAP) during sustained hypoxia, but no associated fall in maximal exercise capacity breathing 12% oxygen. In the iron group, the rise in SPAP during sustained hypoxia was markedly reduced (3.4 ± 1.0 mmHg). There was a small rise in maximal exercise capacity following sustained hypoxia within the iron group, but no overall effect of iron, compared with saline. These results do not support the hypothesis that elevated SPAP inhibits maximal exercise capacity during acute hypoxia in healthy volunteers.

Trends in female authorship in Acta Anaesthesiologica Belgica from 2005 to 2021

Purpose: This study aims to investigate the trend of female representation in publishing in the Acta Anaesthesiologica Belgica (AAB) from 2005 to 2021. In recent years, there has been an increased focus on gender equality and disparity. However, as far as we know, an evaluation of the Belgian literature in this regard has not been undertaken before. Methods: The study’s main objective is on determining the gender of the first author, with the gender of the second and last authorship position being secondary outcomes. Additionally, the study aimed to investigate whether other variables, such as the field in which the article was published, study type, the country of origin (of the first author), the first author’s academic degree, the number of authors, and coauthors’ gender, are related to these outcomes. Results: In total 475 manuscripts were included for data collection, of which 146 (30.7%) had a female first author, 94 (19.8%) had a female second author, and 61 (12.8%) had a female last authorship position. We demonstrated a trend towards greater gender equality in the AAB over time, with more women occupying first and second authorship positions. However, we observed a stagnation in female last authorship positions, with only a small increase of last female authorship of 1.16% reaching 7.41% in 2021. Further analysis showed that female last authorship affected first female authorship. As the number of authors increases, the representation of women (particularly for the last author) diminishes compared to their male colleagues. Lastly, the analysis of gender in relation to the number of coauthors showed that male authors are more likely to publish alone (as a single author) compared to their female colleagues. The AAB predominantly published case reports, observational studies, and narrative reviews, all of which had a higher number of male authors than female authors. The study also uncovered the absence of female first authors in the four systematic reviews published. Conclusion: From 2005 to 2021, the number of female first authors in the AAB has increased, and there has been a small but steady rise in female last authorship position. However, articles published in the AAB still exhibit a lower representation of female first authors. It is crucial to conduct further research and raise attention to gender disparity in anesthetic – and per extension in scientific - literature.

Učinkovitost obrade elektrokoagulacije kombinirane s različitim veličinama čestica prirodnog zeolita

In a previous study, the larger size of synthetic zeolite particles was highlighted as better choice for electrocoagulation combined with zeolite (ECZ). This choice resulted in a smaller rise in pH and temperature, a more significant decline in turbidity as well as chemical oxygen demand (COD), and lower electrode wastage, but with greater damage to the electrode surface. The focus of this study was to determine whether natural zeolite of three different particle sizes has the same effect on the ECZ process. The Taguchi method L9 was employed in planning the experiments, with particle sizes of natural zeolite ranging up to 600 μm, three different electrode materials (carbon steel, aluminium alloy, and sacrificial zinc anode), current density in the range of 0.003–0.018 A cm&amp;lt;sup&amp;gt;–2&amp;lt;/sup&amp;gt;, and contact time in the range 10–30 min. The Taguchi optimisation results revealed a more significant decrease in COD and turbidity with the smallest particle size of natural zeolite used (90 µm) and with Al electrodes. Evidently, the zeolite particle size, together with the zeolite composition, had a significant influence on the reduction in COD and turbidity. Anode consumption ranged from 0.0172 to 0.6469 g, with minor cathode consumption evident on all electrode materials. Optical microscopy analysis indicated significant corrosion of the anodes, particularly with the largest natural zeolite particle size of 160–600 µm, while minor corrosion damage was also observed on the cathodes.

Multi-proxy evidence for woodland clearance in northeast Northumberland (England) during the Iron Age

Pollen diagrams covering the Bronze Age to Roman period from northeast Northumberland are scarce. We present a 14C-dated pollen record from a peat-filled forest hollow in Chillingham Wild Cattle Park, northeast Northumberland, that spans the Iron Age. For the first time for this part of Northumberland, fungal spores are also analysed to investigate whether clearances took place in the context of crop cultivation or pastoralism. The pollen diagram shows significant woodland cover during the Late Bronze Age, with small-scale landscape openness potentially representing crop cultivation and animal grazing under a tree canopy. A local clearance event, with arboreal pollen falling to 13.2%, is radiocarbon dated to the late Early to Middle Iron Age, likely coinciding with the construction and occupancy of the nearby Ros Castle hillfort. A significant rise in dung fungal spores and the presence of Plantago and other open vegetation taxa indicate animal husbandry played an important role in this clearance phase. A subsequent large decrease in dung fungi and a small rise in arboreal pollen may reflect a degree of abandonment of the area after the climate cooled. Peat formation ceased in the late Middle to Late Iron Age as the hollow filled up. Limited renewed peat growth occurred in the last century or so, after peat shrinkage due to drying and consequent oxidation provided the possibility for renewed peat formation within the hollow.

Sustainability of an intervention to reduce waiting for access to an epilepsy outpatient clinic

PurposeDelays in outpatient specialist neurologist care for people with epilepsy are common despite recommendations for prompt access. There is evidence to suggest that there are interventions that can minimise waitlists and waiting time. However, little is known about whether such interventions can result in sustained improvements in waiting. The aim of this study was to determine the extent to which an intervention to reduce waiting in an epilepsy specialist outpatient clinic demonstrated sustained outcomes two years after the intervention was implemented. MethodsThis observational study analysed routinely collected epilepsy clinic data over three study periods: pre-intervention, post-intervention and at two-year follow-up. The intervention, Specific Timely Assessment and Triage (STAT), combined a short-term backlog reduction strategy and creation of protected appointments for new referrals based on analysis of demand. After the initial intervention, there was no further active intervention in the following two years. The primary outcome was waiting measured by 1.) waiting time for access to a clinic appointment, defined as the number of days between referral and first appointment for all patients referred to the epilepsy clinic during the three study periods; and 2.) a snapshot of the number of patients on the waitlist at two time points for each of the three study periods. ResultsTwo years after implementing the STAT model in an epilepsy clinic, median waiting time from post-intervention to two-year follow-up was stable (52–51 days) and the interquartile range of days waited reduced from 37 to 77 days post-intervention to 45–57 days at two-year follow-up, with a reduction in the most lengthy wait times observed. After a dramatic reduction of the total number of patients on the waitlist immediately following the intervention, a small rise was seen at two years (n = 69) which remained well below the pre-intervention level (n = 582). ConclusionThe STAT model is a promising intervention for reducing waiting in an epilepsy clinic. While there was a small increase in the waitlist after two years, the median waiting time was sustained.

Impact of pulsed field ablation on intraluminal esophageal temperature.

Atrio-esophageal fistula after esophageal thermal injury (ETI) is one of the most devastating complications of available energy sources for atrial fibrillation (AF) ablation. Pulsed field ablation (PFA) uses electroporation as a new energy source for catheter ablation with promising periprocedural safety advantages over existing methods due to its unique myocardial tissue sensitivity. In preclinical animal studies, a dose-dependent esophageal temperature rise has been reported. In the TESO-PFA registry intraluminal esophageal temperature (TESO) changes in a clinical setting are evaluated. Consecutive symptomatic AF patients (62 years, 67% male, 61% paroxysmal AF, CHA2 DS2 Vasc Score 2) underwent first-time PFA and were prospectively enrolled into our registry. Eight pulse trains (2 kV/2.5 s, bipolar, biphasic, x4 basket/flower configuration each) were delivered to each pulmonary vein (PV). Two extra pulse trains per PV in flower configuration were added for wide antral circumferential ablation. Continuous intraluminal esophageal temperature (TESO) was monitored with a 12-pole temperature probe. Median TESO change was statistically significant and increased by 0.8 ± 0.6°C, p < .001. A TESO increase ≥ 1°C was observed in 10/43 (23%) patients. The highest TESO measured was 40.3°C. The largest TESO difference (∆TESO) was 3.7°C. All patients remained asymptomatic considering possible ETI. No atrio-esophageal fistula was reported on follow-up. A small but significant intraluminal esophageal temperature rise can be observed in most patients during PFA. TESO rise over 40°C is rare. The clinical implications of the observed findings need to be further evaluated.

Reinfection rates, change in antibody titers and adverse events after COVID-19 vaccination among patients previously infected with COVID-19 in Metro Manila, Philippines: a secondary analysis of a completed cohort study

BackgroundVariation in immune response to COVID-19 vaccines is observed among different ethnicities. We aimed to describe the reinfection rates, change in antibody titers, and adverse events among Filipinos.MethodsThis is a secondary analysis of a cohort study of 307 participants within one year of having COVID-19 infection. We measured COVID-19 antibody levels at pre-determined timepoints (Days 21, 90, 180, 270, and 360 from initial infection). We monitored for COVID-19 symptoms and obtained details on COVID-19 vaccination. An adjudication committee classified the participants as probable, possible, or unlikely COVID-19 reinfection. We determined the probable reinfection rate, adverse events, and the geometric mean titer (GMT) ratio of pre- and post-vaccination antibody levels according to type and brand of COVID-19 vaccine.ResultsAt the end of the follow-up period, 287 (93.5%) out of 307 study participants were fully vaccinated, 1 was partially vaccinated (0.3%), and 19 were unvaccinated (6.2%). Among the fully vaccinated participants, those given mRNA vaccines had the lowest reinfection rate (19.2 cases/100 person-years, 95% CI 9.6, 38.4), followed by viral vector vaccines (29.8 cases/100 person-years, 95% CI 16.9, 52.4). We observed the highest reinfection rate among those given inactivated virus vaccines (32.7 cases/100 person-years, 95% CI 23.6, 45.3). The reinfection rate was 8.6 cases/100 person-years (95% CI 4.1, 17.9) for unvaccinated participants and 3.6 cases/100 person-years (95% CI 0.5, 25.3) for partially vaccinated participants. We observed the largest rise in antibody titers among those given mRNA vaccines (GMT ratio 288.5), and the smallest rise among those given inactivated virus vaccines (GMT ratio 16.7). We observed the highest percentage of adverse events following immunization with viral vector vaccines (63.8%), followed by mRNA vaccines (62.7%), and the lowest for inactivated virus vaccines (34.7%). No serious adverse events were reported.ConclusionVaccinees given the mRNA vaccines had the lowest reinfection rate and the highest rise in antibody titers. Vaccinees given inactivated virus vaccines had the highest reinfection rate, smallest rise in antibody titers, and lowest percentage of adverse events. The small sample size and imbalanced distribution of the type of vaccines received limits the external generalizability of our results.Study RegistrationThe cohort study was registered at the Philippine Health Research Registry on December 14, 2020 (PHRR201214-003199).

Effects of film thickness on crystal structure, surface topography, optical, and photoelectric properties of Ga2O3 thin film based solar blind photodetectors

β-Ga2O3 epitaxial thin films with different thicknesses were grown on Al2O3 (0001) substrates by the pulse laser deposition technology. The full width at half maximum of XRD rocking curve, grain size, surface roughness, and optical absorbance (200–300 nm) of the β-Ga2O3 films increase with increasing film thickness. In addition, with increasing film thickness, the adsorption edge presents a red-shift phenomenon, which is accompanied by a slight decrease in the optical band gap (). The metal-semiconductor-metal type photodetector made with the 401-nm β-Ga2O3 film shows the maximal photocurrent (1.06 μA @ 10 V), photo-to-dark current ratio (6.96 × 104), responsivity (90 mA W−1), and detectivity (0.5 × 1011 Jones) under 254-nm UV light illumination with a light intensity of 98.4 μW/cm2. Moreover, the 401-nm photodetector displays a small rise time of 0.111/0.561 s and a decay time of 0.046/0.047 s as well as a good stability and repeatability. These findings provide useful reference for the fabrication of β-Ga2O3 film based solar blind ultraviolet photodetectors.