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IntroductionThe patient journey for residents of New South Wales (NSW) Australia with ST-elevation myocardial infarction (STEMI) often involves transfer between hospitals and these can include stays in hospitals in other jurisdictions. ObjectiveTo estimate the change in enumeration of STEMI hospitalisations and time to subsequent cardiac procedures for NSW residents using cross-jurisdictional linkage of administrative health data. MethodsRecords for NSW residents aged 20 years and over admitted to hospitals in NSW and four adjacent jurisdictions (Australian Capital Territory, Queensland, South Australia, and Victoria) between 1 July 2013 and 30 June 2018 with a principal diagnosis of STEMI were linked with records of the Australian Government Medicare Benefits Schedule (MBS). The number of STEMI hospitalisations, and rates of angiography, percutaneous coronary intervention and coronary artery bypass graft were compared for residents of different local health districts within NSW with and without inclusion of cross-jurisdictional data. ResultsInclusion of cross-jurisdictional hospital and MBS data increased the enumeration of STEMI hospitalisations for NSW residents by 8% (from 15,420 to 16,659) and procedure rates from 85.6% to 88.2%. For NSW residents who lived adjacent to a jurisdictional border, hospitalisation counts increased by up to 210% and procedure rates by up to 70 percentage points. ConclusionsCross-jurisdictional linked hospital data is essential to understand patient journeys of NSW residents who live in border areas and to evaluate adherence to treatment guidelines for STEMI. MBS data are useful where hospital data are not available and for procedures that may be conducted in out-patient settings.

The ability of birds to fly through cluttered environments has inspired biologists interested in understanding its underlying mechanisms, and engineers interested in applying its underpinning principles. To analyse this problem empirically, we break it down into two distinct, but related, questions: How do birds select which gaps to aim for? And how do they steer through them? We answered these questions by using a combined experimental and modelling approach, in which we released pigeons (Columbia livia domestica) inside a large hall whose open exit was separated from the release point by a curtain creating two vertical gaps—one of which was obstructed by an obstacle. We tracked the birds using a high-speed motion capture system, and found that their gap choice seemed to be biased by their intrinsic handedness, rather than determined by extrinsic cues such as the size of the gap or its alignment with the destination. We modelled the pigeons’ steering behaviour algorithmically by simulating their flight trajectories under a set of six candidate guidance laws, including those used previously to model targeted flight behaviours in birds. We found that their flights were best modelled by delayed proportional navigation commanding turning in proportion to the angular rate of the line-of-sight from the pigeon to the midpoint of the gap. Our results are consistent with this being a two-phase behaviour, in which the pigeon first heads forward from the release point before steering towards the midpoint of whichever gap it chooses to aim for under closed-loop guidance. Our findings have implications for the sensorimotor mechanisms that underlie clutter negotiation in birds, uniting this with other kinds of target-oriented behaviours including aerial pursuit.

This paper is part of large effort within the J-PAS collaboration that aims to classify point-like sources in miniJPAS, which were observed in 60 optical bands over ~1 deg2 in the AEGIS field. We developed two algorithms based on artificial neural networks (ANN) to classify objects into four categories: stars, galaxies, quasars at low redshift (z < 2.1), and quasars at high redshift (z ≥ 2.1). As inputs, we used miniJPAS fluxes for one of the classifiers (ANN1) and colours for the other (ANN2). The ANNs were trained and tested using mock data in the first place. We studied the effect of augmenting the training set by creating hybrid objects, which combines fluxes from stars, galaxies, and quasars. Nevertheless, the augmentation processing did not improve the score of the ANN. We also evaluated the performance of the classifiers in a small subset of the SDSS DR12Q superset observed by miniJPAS. In the mock test set, the f1-score for quasars at high redshift with the ANN1 (ANN2) are 0.99 (0.99), 0.93 (0.92), and 0.63 (0.57) for 17 < r ≤ 20, 20 < r ≤ 22.5, and 22.5 < r ≤ 23.6, respectively, where r is the J-PAS rSDSS band. In the case of low-redshift quasars, galaxies, and stars, we reached 0.97 (0.97), 0.82 (0.79), and 0.61 (0.58); 0.94 (0.94), 0.90 (0.89), and 0.81 (0.80); and 1.0 (1.0), 0.96 (0.94), and 0.70 (0.52) in the same r bins. In the SDSS DR12Q superset miniJPAS sample, the weighted f1-score reaches 0.87 (0.88) for objects that are mostly within 20 < r ≤ 22.5. We find that the most common confusion occurs between quasars at low redshift and galaxies in mocks and miniJPAS data. We discuss the origin of this confusion, and we show examples in which these objects present features that are shared by both classes. Finally, we estimate the number of point-like sources that are quasars, galaxies, and stars in miniJPAS.

With a unique set of 54 overlapping narrow-band and two broader filters covering the entire optical range, the incoming Javalambre-Physics of the Accelerating Universe Astrophysical Survey (J-PAS) will provide a great opportunity for stellar physics and near-field cosmology. In this work, we use the miniJPAS data in 56 J-PAS filters and 4 complementary SDSS-like filters to explore and prove the potential of the J-PAS filter system in characterizing stars and deriving their atmospheric parameters. We obtain estimates for the effective temperature with a good precision (, This work is supported by the National Natural Science Foundation of China through the projects NSFC 12222301, 12173007, 11603002, National Key Basic R & D Program of China via 2019YFA0405500, and Beijing Normal University grant no. 310232102. We acknowledge the science research grants from the China Manned Space Project with NO. CMS-CSST-2021-A08 and CMS-CSST-2021-A09. This research has made use of the Spanish Virtual Observatory (https://svo.cab.inta-csic.es) project funded by MCIN/AEI/10.13039/501100011033/ through grant PID2020-112949GB-I00. PC acknowledges financial support from the Government of Comunidad Autónoma de Madrid (Spain), via postdoctoral grant ‘Atracción de Talento Investigador’2019-T2/TIC-14760. The work of VMP is supported by NOIRLab, which is managed by the Association of Universities for Research in Astronomy (AURA) under a cooperative agreement with the National Science Foundation. FJE acknowledges financial support by the Spanish grant MDM-2017-0737 at Centro de Astrobiología (CSIC-INTA), Unidad de Excelencia María de Maeztu. CAG acknowledges financial support from the CAPES through scholarship for developing his PhD project and any related research. Part of this work was supported by institutional research funding IUT40-2, JPUT907, and PRG1006 of the Estonian Ministry of Education and Research. We acknowledge the support by the Centre of Excellence ‘Dark side of the Universe’ (TK133) financed by the European Union through the European Regional Development Fund., With funding from the Spanish government through the "Severo Ochoa Centre of Excellence" accreditation (CEX2021-001131-S).

Background Heart failure (HF) is a leading cause of hospital admission. However, prompt identification of worsening HF using implantable device data and proactive intervention may reduce hospitalizations. The validated TriageHF algorithm in enabled ICD/CRT devices uses sensor data to risk stratify patients for HF hospitalization in the next 30 days. TriageHF Plus is a novel device-based HF care pathway (DHFP) that uses “high” risk status as the trigger for remote intervention (see Figure 1 for pathway overview). Outcomes after DHFP implementation in a clinical setting have not been examined. Purpose To evaluate the impact of TriageHF Plus clinical pathway on hospitalisation rates. Methods A prospective, multi-center evaluation comparing monthly hospitalization rates for patients enrolled in a DHFP with a concurrent standard of care (SoC) cohort and characterizing staffing resources necessary to implement the DHFP. The DHFP cohort received telephonic assessment and guideline-directed clinical care upon transition to high-risk status. Propensity scores (PS) were applied to DHFP and SoC cohorts to allow unbiased comparison. A negative binomial model was fitted to the monthly number of all-cause hospitalizations with treatment group (DHFP vs. SoC) as a covariate, using PS as weights. Results Between 09/11/2019 and 06/24/2021, 758 patients were included in the study (443 DHFP, 315 SoC). Proportion CRT 76%/ 89% and LVEF 196 high risk transmissions prompted telephone assessment, with successful contact in 182; of which, 79 (43%) identified an explanatory acute medical issue. A secondary intervention was undertaken in 44/79 (56%). High risk transmissions took on average 19 minutes per clinical assessment (initial telephone triage and 30 day follow up). The rate of hospitalizations was 58% lower in the DHFP group, compared with SoC, after PS adjustment (IRR 0.42, 95% CI: 0.23, 0.76, p=0.004), see Figure 2. Sensitivity analyses showed Covid-19 had little effect on results. Conclusions This is the first prospective, real-world evaluation of a device-based HF care pathway to report a reduction in hospitalizations and does so with minimal staffing time. Integrated into existing HF services, device-based remote monitoring of HF patients can improve outcomes. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Medtronic

Birds of prey rely on vision to execute flight manoeuvres that are key to their survival, such as intercepting fast-moving targets or navigating through clutter. A better understanding of the role played by vision during these manoeuvres is not only relevant within the field of animal behaviour, but could also have applications for autonomous drones. In this paper, we present a novel method that uses computer vision tools to analyse the role of active vision in bird flight, and demonstrate its use to answer behavioural questions. Combining motion capture data from Harris’ hawks with a hybrid 3D model of the environment, we render RGB images, semantic maps, depth information and optic flow outputs that characterise the visual experience of the bird in flight. In contrast with previous approaches, our method allows us to consider different camera models and alternative gaze strategies for the purposes of hypothesis testing, allows us to consider visual input over the complete visual field of the bird, and is not limited by the technical specifications and performance of a head-mounted camera light enough to attach to a bird’s head in flight. We present pilot data from three sample flights: a pursuit flight, in which a hawk intercepts a moving target, and two obstacle avoidance flights. With this approach, we provide a reproducible method that facilitates the collection of large volumes of data across many individuals, opening up new avenues for data-driven models of animal behaviour.

Objective: To learn from primary health care experts’ experiences from the COVID-19 pandemic across countries. Methods: We applied qualitative thematic analysis to open-text responses from a multinational rapid response survey of primary health care experts assessing response to the initial wave of the COVID-19 pandemic. Results: Respondents’ comments focused on three main areas of primary health care response directly influenced by the pandemic: 1) impact on the primary care workforce, including task-shifting responsibilities outside clinician specialty and changes in scope of work, financial strains on practices, and the daily uncertainties and stress of a constantly evolving situation; 2) impact on patient care delivery, both essential care for COVID-19 cases and the non-essential care that was neglected or postponed; 3) and the shift to using new technologies. Conclusions: Primary health care experiences with the COVID-19 pandemic across the globe were similar in their levels of workforce stress, rapid technologic adaptation, and need to pivot delivery strategies, often at the expense of routine care.

ObjectiveTo characterise the transitional pulmonary physiology of infants with congenital diaphragmatic hernia (CDH) using measures of expiratory tidal volume (TV) and end-tidal carbon dioxide (ETCO2).DesignProspective single-centre observational study.SettingQuaternary neonatal intensive care unit.PatientsInfants with an antenatal diagnosis of CDH born at the Children’s Hospital of Philadelphia.InterventionsTV and ETCO2were simultaneously recorded using a respiratory function monitor (RFM) during invasive positive pressure ventilation immediately after birth.Main outcome measuresTV per birth weight and ETCO2values were summarised for each minute after birth. Subgroups of interest were defined by liver position (thoracic vs abdominal) and extracorporeal membrane oxygenation (ECMO) treatment.ResultsRFM data were available for 50 infants from intubation until a median (IQR) of 9 (7–14) min after birth. TV and ETCO2values increased for the first 10 min after birth, but intersubject values were heterogeneous. TVs were overall lower and ETCO2values higher in infants with an intrathoracic liver and infants who were ultimately treated with ECMO. On hospital discharge, survival was 88% (n=43) and 34% (n=17) of infants were treated with ECMO.ConclusionRespiratory function immediately after birth is heterogeneous for infants with CDH. Lung aeration, as evidenced by expired TV and ETCO2, appears to be ongoing throughout the first 10 min after birth during invasive positive pressure ventilation. Close attention to expired TV and ETCO2levels by 10 min after birth may provide an opportunity to optimise and individualise ventilatory support for this high-risk population.

Certain animal species use the earth's magnetic field (i.e., magnetoreception) in conjunction with other sensory modalities to navigate long distances. It is hypothesized that several animals use combinations of magnetic inclination and intensity as unique signatures for localization, potentially enabling migration without a pre-surveyed map. However, it is unknown how animals use magnetic signatures to generate guidance commands. While animal experiments have been invaluable in advancing this area, it is a difficult phenomenon to study in vivo or in situ. Modeling and simulation present a powerful complementary tool that can be used to investigate whether and how animals use magnetic signatures to navigate. This perspective article summarizes work we have conducted that systematically and mechanistically uses modeling and simulation to study the use of magnetic signatures. We have studied this phenomenon from simulated agents that navigate in simple and abstract environments, to physical devices that navigate in realistic environments. The results have consistently demonstrated that this is a plausible way in which animals might navigate, and provided early insights into the environmental and animal-specific factors that are most important to this navigation strategy.

BACKGROUND: Chronic Kidney Disease of unknown origin (CKDu) excludes known primary renal conditions or systemic disease (such as diabetes mellitus or hypertension). Prominence of CKDu has been noted for some decades in Sri Lanka, especially among men in particular rural areas, prompting many studies directed towards environmental causation. This article critically reviews relevant primary studies. METHODS: Articles for this literature review (n = 86) were found by searching Medline, Embase, Global Health and ProQuest databases over 2000-2020 utilizing a standard algorithm. Articles were critiqued according to criteria for diagnosis of CKDu, aetiological agents investigated, analytic methods employed and findings. RESULTS: Criteria for diagnosis of CKDu varied significantly, including pre-selection by proteinuria, eGFR and biopsy proven interstitial nephritis. Prevalence studies have been largely conducted in the North Central Province, with recent studies demonstrating the presence of CKDu in other regions. Aetiological factors investigated in primary studies included water source, use of agrochemicals, agricultural work, heavy metals, snake bites, ayurvedic medication, heat stress, infectious diseases and usage of tobacco and betel leaf. There is no conclusive evidence for any one aetiological agent despite consistent evidence of distal factors such as male sex, rural residence and farming. CONCLUSIONS: The current body of evidence for any aetiological agent as the cause of CKDu in Sri Lanka is limited. Further research with stronger study designs is necessary to increase knowledge of aetiology of CKDu in Sri Lanka to identify and eliminate exposure to possible causative agent(s) prior to concluding that the disease is multifactorial.

Effective management of freshwater fish habitat is essential to supporting healthy aquatic ecosystems and sustainable fisheries. In Canada, recent changes to the Fisheries Act enhanced the protection of fish habitat, but application of those provisions relies on sound scientific evidence. We employed collaborative research prioritization methods to identify scientific research questions that, if addressed, would significantly advance the management of freshwater fish habitat in Canada. This list was generated by a diverse group of freshwater fish experts, including substantial contributions from practitioners who administer provisions of the Fisheries Act. The research questions generated in this study identify priority topics for future research, while highlighting issues that could be addressed with different funding models. As a result, this study should support evidence-based management of Canada’s aquatic resources by identifying scientific knowledge gaps faced by practitioners, and suggesting mechanisms to address them. Given the important contribution of Canadian freshwater systems to global ecosystem values, and the similar scientific challenges facing fish habitat managers in other jurisdictions, this study is likely to have broad applicability.

Objective The aim of this study was to determine the unique and combined associations of various military stress exposures with positive and negative mental health symptoms in active duty service members. Materials and Methods We investigated 87 male U.S. Navy Explosive Ordnance Disposal (EOD) technicians (age M ± SE, range 33.7 ± 0.6, 22-47 years). Those who endorsed a positive traumatic brain injury diagnosis were excluded to eliminate the confounding effects on mental health symptoms. Using a survey platform on a computer tablet, EOD technicians self-reported combat exposure, deployment frequency (total number of deployments), blast exposure (vehicle crash/blast or 50-m blast involvement), depression, anxiety, posttraumatic stress, perceived stress, and life satisfaction during an in-person laboratory session. Results When controlling for other military stressors, EOD technicians with previous involvement in a vehicle crash/blast endorsed worse mental health than their nonexposed counterparts. The interactions of vehicle crash/blast with deployment frequency and combat exposure had moderate effect sizes, and combat and deployment exposures demonstrated protective, rather than catalytic, effects on negative mental health scores. Conclusions Military stressors may adversely influence self-reported symptoms of negative mental health, but deployment experience and combat exposure may confer stress inoculation.

Lithium ion batteries represent an emerging field. The development of battery materials could benefit from quick techniques that enable atomic-level diagnostics. High performance cathodes, such as high-voltage spinel, often require coatings to protect against the destructive electrochemical environments at the particle-to-electrolyte interface. The preparations of these coating are still in the early phases of development, and their analytical inspection by high resolution scanning and transmission electron microscopy (HR-S/TEM) techniques presents a significant challenge due to the microscale dimensions of cathode particles. In this work, a high throughput ultramicrotome technique was assessed for the characterization of the particle to coating interface. The ultramicrotome technique enabled the rapid preparation of cross-sections with a thickness of 126 ± 66 nm as determined by electron energy loss spectroscopy (EELS) measurements. Cathode particles composed of high-voltage spinel, LiNi0.5Mn1.5O4 (LNMO), coated with lithium niobate (LiNbO3) were synthesized and cross-sections were inspected using HR-S/TEM techniques. These ultra-thin cross-sections enabled the ability to obtain nanoscale information regarding the composition and crystallinity of the particle-to-coating interface over lateral areas of >1 µm. Accessible correlations between the electrochemical performance of the LiNbO3 coated LNMO particles and the HR-S/TEM results were enabled by the high-throughput method. Discharge capacity measurements were acquired over a series of 100 electrochemical cycles for both the LiNbO3 coated and the as-prepared LNMO particles. The limitations of the ultramicrotome technique are also discussed herein with respect to the coating morphology and the procedure for guidance toward technique optimization. The rapid preparation of ultra-thin cross-sections can assist the advancement of protective coatings on the surfaces of cathode particles for an efficient characterization of bulk-to-surface interfaces.

Highlights • One-in-five adolescents reported suicidality or pain. • Pain was associated with an increased risk of suicidality and vice versa (OR=4.00). • Network analysis supported the pain-suicidality association (aOR=1.39). • This cross-sectional association was not moderated by depression. • Pain should be considered as a key risk correlate of suicidality in adolescents., Background Whilst growing research suggests that pain is associated with suicidality in adolescence, it remains unclear whether this relationship is moderated by co-morbid depressive symptoms. The present study aimed to investigate whether the pain-suicidality association is moderated by depressive symptoms. Methods We performed secondary analyses on cross-sectional, pre-intervention data from the ‘My Resilience in Adolescence’ [MYRIAD] trial (ISRCTN ref: 86619085; N=8072, 11-15 years). Using odds ratio tests and (moderated) network analyses, we investigated the relationship between pain and suicidality, after controlling for depression, anxiety, inhibitory control deficits and peer problems. We investigated whether depression moderates this relationship and explored gender differences. Results Overall, 20% of adolescents reported suicidality and 22% reported pain, whilst nine percent of adolescents reported both. The experience of pain was associated with a four-fold increased risk of suicidality and vice versa (OR=4.00, 95%-CI=[3.54;4.51]), with no gender differences. This cross-sectional association remained significant after accounting for depression, anxiety, inhibitory control deficits and peer problems (aOR=1.39). Depression did not moderate the pain-suicidality association. Limitations The item-based, cross-sectional assessment of pain and suicidality precludes any conclusions about the direction of the effects and which aspects of suicidality and pain may drive this association. Conclusions Our findings underscore the need to consider pain as an independent risk correlate of suicidality in adolescents. Longitudinal research should examine how this relationship develops during adolescence. Clinically, our findings emphasise the need to assess and address suicidality in adolescents with pain, even in the absence of depressive symptoms.