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We present a calibrated bulk mobility model for 4H-SiC. Hall measurements are performed on 4H-SiC samples to determine the bulk mobility/resistivity in the temperature range of 200-500K. We observe that temperature dependence of bulk resistivity cannot be predicted by popular mobility models available within TCAD tools. A careful investigation reveals that these popular mobility models need to be revised and replaced by a comprehensive model that can describe the impurity scattering effects dominant at low temperatures. We present a well calibrated bulk mobility model for 4H-SiC exhibiting excellent agreement with measured data, making it suitable for device simulation purposes using TCAD tools.

High-quality, low resistivity n-type (nitrogen-doped) single crystal 4H-SiC wafers are needed to grow high-quality epitaxial SiC layers used for the active blocking layers of high-voltage power devices. The resistance of the substrate constitutes a portion of the device resistance for vertical devices, and therefore the SiC substrate properties must be fully characterized. In this study we report the 4H-SiC substrate electrical properties as a function of temperature measured using van der Pauw structures to measure resistivity from 4-point measurements, and carrier concentration and mobility from Hall effect measurements. We find that the SiC substrate resistivity has a minimum around 425K for typical substrate doping levels, due to a competition between the decreasing mobility and increasing carrier concentration with increasing temperature. The measured energy levels of the N donor (hexagonal / cubic sites) are extracted for a 5.8×1018 cm-3 N-doped substrate, and found to be 15 meV and 105 meV, respectively.

Ninety-six percent of state legislative incumbents who appeared on the November 2022 ballot reclaimed their seats in the state legislature, the highest percentage since at least the 2010 elections. Such electoral success would suggest that these state legislators enjoyed a healthy incumbency advantage. However, prior work (e.g. Jacobson, G. C. 2015. “It’s Nothing Personal: The Decline of the Incumbency Advantage in US House Elections.” The Journal of Politics 77 (3): 861–73.) indicates that the incumbency advantage has diminished in recent elections, at least in the US House. I find similar – but smaller – declines in the magnitude of the incumbency advantage in state house elections in the last two decades. Instead of being attributable to the traditional incumbency advantage, state legislative incumbents’ success in the 2022 elections is more likely a consequence of the increasing number of partisan state house districts and the continued nationalization of state politics.

Background: Vein mapping using duplex ultrasound (DUS) is a routine in selecting optimal autologous bypass grafts (aBG) but is time consuming and operator-dependent. Tomographic three-dimensional (3D) ultrasound (tUS), using free-hand electromagnetic tracking, allows cardiac and vascular surgeons to view 3D images of the entire length of the potential bypass graft. This study compares tUS with DUS in the evaluation of potential autologous grafts for coronary and lower limb bypass. Methods: Both DUS and tUS imaging of 434 potential autologous grafts (364 long, 22 short saphenous veins, and 48 radial artery) immediately before bypass surgery were compared. The time in minutes to evaluate each aBG was recorded. Surgeons scored the quality of the aBG at operation. A score of 5 was in complete agreement with preoperative imaging with scores of 4 considered “good”. Results: Most operating surgeons (113, 57%) preferred interpreting the tUS images and felt that this technology could replace DUS completely. The choice of aBG would have been changed as a result of tUS images in 64 (32%) cases. DUS imaging took a mean (+/-sd) of 08:26 ± 04:44 minutes compared with only 01:00 ± 00:25 minutes for tUS (P < 0.001). However, processing the tUS images, which is currently done manually by the vascular scientist, took significantly longer at 19:31 ± 12:41 minutes compared with 09:03 ± 09:12 minutes for reporting DUS (P < 0.001). Conclusions: Surgeons preferred to see tUS images of the potential aBG themselves rather than relying on DUS reports. tUS images were significantly quicker than DUS to acquire but needed more processing time.

The foundations of a discipline shape the way in which knowledge is created, by whom, for what, and dictates who is allowed to generate knowledge. The historical roots of modern Earth Science lie in early colonial principles, when geological exploration for resource extraction was a powerful tool in colonial expansion. The legacy is that dominance of western institutions in Earth Science disciplines reinforces imperial and colonial power relations, where ‘powerful knowledge’ continues to ignore, belittle and erase other systems of knowledge. The founding and growth of these institutions during colonialism dictated who was allowed to practise geology. Those whose class, gender, race, or disability did not fit were excluded. There is a documented diversity crisis in UK Higher Education Earth Science. However, Earth scientists of various underrepresented and intersecting identities have always existed; their histories have just been hidden. Marín-Spiotta et al., (2020) argue that any action to “increase diversity, equity, and inclusion needs to start with an examination of the historical roots of contemporary experiences of exclusion”. Dowey et al., (2021) argue that “fundamental lack of acknowledgement that geoscience is deeply rooted in, and built on, colonialism, white power, violence, exploitation and slavery pervades relationships in the present” and is a barrier to participation in the geosciences. However, at present, Earth Science curricula in the UK typically do not confront the subject’s colonial past, and are taught through a Western-centric lens. The UK ‘Fathers of Geology’ feature almost exclusively in historical accounts of the subject while non-western and indigenous scholars and ways of knowing are largely excluded. Geology in Society courses are often framed as how geoscience can help society, without due regard for ethics. Thus, the legacy of colonialism is perpetuated through current UK Earth Science practise and education. Decolonising the Curriculum is a philosophical and pedagogical initiative exploring the origin, development and use of knowledge that calls for academics to create “spaces and resources for a dialogue among all members of the university on how to imagine and envision all cultures and knowledge systems in the curriculum, and with respect to what is being taught and how it frames the world” (Keele University’s Decolonising the Curriculum Manifesto, 2018). Rogers et al., (2021) argue that Earth Scientists may lack the academic training, knowledge and interdisciplinary approaches needed to decolonise the Earth Science curriculum. In this project we have identified three needs in UK HE Earth Science: (1) to make explicit the exclusionary and unethical practices that were common in geological education and practice and how they manifest today; (2) to reveal the hidden histories of other historically excluded and minoritised Earth Scientists, making their contributions explicitly visible and (3) to train Earth Science professionals and researchers to be more aware of geology’s imperial/colonial past and ongoing extension of colonial practices to halt the perpetuation of this legacy. We present a package of open access pedagogical tools and resources we hope will enable sector-wide recognition, learning, and conversations around the historical legacy of Earth Science and modern inequities.

Geography, Earth and Environmental Science (GEES) research will play a vital role in addressing the grand challenges of the 21st century, contributing to many of the UN sustainable development goals and the global energy transition. However, geoscience knowledge can only be successfully applied to global problems that impact people from all walks of life if the discipline itself is equitable.There is a well-documented racial and ethnic diversity crisis in GEES subjects in the Global North1 that leads to inequities in who does environmental research. The Equator project2 set out to increase participation and retention of UK-domiciled Black, Asian and minority ethnic postgraduate research (PGR) students in GEES topics. Our goal was to improve equity and diversity in a research area critical to a more sustainable future; not because of a business case, or for diversity as a resource- but for social justice.Equator was a six-month project, funded by the Natural Environment Research Council (NERC), that developed three evidence-based interventions targeting different barriers to racial and ethnic diversity in GEES research. To remove barriers to access, a doctoral training working group was formed to share best practices and develop recommendations to make PhD recruitment more equitable. To improve access and participation, a ring-fenced research school for ethnic minority undergraduate, masters and doctoral students was delivered. To increase retention and improve student experience, a targeted mentoring network pairing students with mentors from both industry and academia was created.Evaluation of interventions took the form of action research with a Theory of Change approach, with surveys used to capture feedback and reflections in each of the three work packages. This occurred alongside collaborative, self-reflective inquiry within the project team and steering committee. The steering committee included grassroots organisations, higher education institutions, professional bodies and an equity, diversity and inclusion (EDI) consultant.The Equator doctoral training working group developed recommendations to remove barriers to ethnic minority students applying for and being accepted on to PhD programs. These transferable and practical suggestions are designed to be implemented by academics and professional service staff working in doctoral training recruitment, and are broken down into student-facing, procedural and interview/evaluation categories. Themes covered include pre-application support, data collection and reporting, website materials, and standardisation of recruitment materials.Evaluation of the Equator Research School and Mentoring Network led to the development of recommendations for successful interventions to improve participation and retention in research. Participants in the Equator Research School and Mentoring Network provided very positive feedback both during and following the interventions. The majority of those involved felt a stronger sense of belonging and inclusion in GEES research and were more likely to consider a research career after participating. The evaluation process showed unequivocally that the ring-fenced, discipline-specific, fully-funded nature of the interventions was a critical factor in participants applying to be involved. 1Dowey et al. 2021 Nature Geoscience https://doi.org/10.1038/s41561-021-00737-w2Dowey et al. 2022 The Equator Project https://doi.org/10.31223/X5793T

At the height of colonial Europe, during the late 18th century, many of the principles, theories, laws and practices that shape the (Western) academic discipline of Earth Science were established. However, during this imperial production of knowledge, there was little reference to or acknowledgement of any pre-existing geological knowledge. The legacy of colonialism is perpetuated through many modern Earth Science practices and education activities, and the influence of this legacy adds to the perception of Earth Science as a white, western-dominated subject and the erasure and dismissal of other geological knowledge. This project explores the unacknowledged local geological knowledge and labour upon which the foundational institutions of Earth Science are built and how this legacy creates modern-day exploitation, unethical behaviour and inequity in our discipline. We uncover some of the hidden histories of colonial mineral exploitation, including the role of British geologists and geological institutions in expanding colonial rule in Africa and how local geological knowledge and local guides underpinned the activities of the colonial geological surveys. British mineral exploitation in Africa started in the seventeenth century with a series of expeditions by pioneer British geologists and prospectors into South Africa's interior to make preliminary observations and geological surveys for minerals. More expeditions to other parts of Africa followed in the eighteenth century. During the late eighteenth century, many of the principles, theories, laws and practices that shaped the academic discipline of Earth Science were established in parallel to colonial expansion. The British Empire sustained a programme of exploratory geological surveys and activities directly linked with mapping the geological features to locate and discover economic mineral resources to fuel the British economy and industrialise the British Empire. Exploitable deposits of coal, copper, iron and limestone's essential smelting flux were vital for the long-term development of steamship lines, railways, and industry. At the end of the First World War, the British government promoted and intensified geological surveys in several British Empire territories – Uganda, Sierra Leone and Nigeria in 1918, Tanzania in 1925 and Kenya in 1933. Some pioneer British geologists were heralded for their pioneering work and credited with the discovery of economically significant minerals in Africa. Our archival investigation reveals many of these mineral resources were already used and mined locally and that local knowledge underpinned these resource 'discoveries' and local people were used as field assistants, guides, carriers, labourers, and camp guides. These pioneer geologists relied on the colonial structure to obtain information from natives central to fieldwork, mineral investigation, and discoveries. Still, history has omitted the contributions of the natives involved in these mineral discoveries and the acknowledgement of any local geological knowledge. Perhaps it is time to change the narrative from one of discovery to one of exploitation. As a discipline, by reckoning with the colonial legacy of our past, we can seek to normalise working with local knowledge and knowledge outside the boundaries of (western) Earth Science, leading to ethical, equitable, interdisciplinary work, better preparing the discipline for current global challenges.

Cardiac catheter ablations are an established treatment for supraventricular tachycardia (SVT) involving prolonged cannulation of the common femoral vein with multiple catheters. This study aimed to identify the risk of deep vein thrombosis (DVT) by studying the frequency of this complication after catheter ablation.This was a prospective multi-centre cohort study of patients undergoing cardiac ablation for atrioventricular nodal re-entry tachycardia or right-sided accessory atrioventricular connection. Those taking anticoagulation or antiplatelet therapy prior to the procedure were excluded. Following the procedure, bilateral venous duplex ultrasonography from the popliteal vein to the inferior vena cava for DVT was undertaken at 24 hours and between 10 to 14 days.Eighty (80) patients (mean age 47.6 yrs [SD 13.4] with 67% female) underwent cardiac ablation (median duration 70 mins). Seven (7) patients developed acute DVT in either the femoral or external iliac vein of the intervention leg, giving a frequency of 8.8% (95% CI 3.6-17.2%). No thrombus was seen in the contralateral leg (p=0.023). An elevated D-dimer prior to the procedure was significantly more frequent in patients developing DVT (42.9% vs 4.1%, p=0.0081; OR 17.0). No other patient or procedural characteristics significantly influenced the risk of DVT.In patients without peri-procedural anticoagulation catheter ablation precipitated DVT in the catheterised femoral or iliac veins in 8.8% of patients. Peri-procedure prophylactic anticoagulation may be considered for all patients undergoing catheter ablation for SVT.https://clinicaltrials.gov/ct2/show/NCT03877770.

In the last few decades, Geology courses, particularly in the Global North have seen a decline in student enrolment. Geologists have linked this downturn to a lack of exposure to the subject at school and college level. This work seeks to understand the public’s relationship with Geology and draws on over 5000 open-ended question responses to a survey disseminated in 2021. The survey asked both those who had, and had not, studied geology as a subject a series of questions in order to explore their perceptions of the discipline. Our findings indicate that individuals ‘outside’ of geology see the subject as old fashioned, boring, and environmentally damaging; simply the study of rock samples with nothing new to be discovered from; and with poor job prospects outside of the oil and gas industry. Geologists who responded to the survey paint a picture of a broad, interdisciplinary subject, with vibrant employability opportunities – yet struggle to coherently and collectively describe this when asked, ‘what is geology?’. In addition to the identified perception of geology as boring, and notions of poor employability being a barrier to prospective students, diversity and inclusivity issues are highlighted as significant barriers by those who study geology. Our findings indicate that both geologists and the geology curriculum need to coherently describe what geology is more effectively. We need to develop and better communicate the subject's interdisciplinary nature and links to critical societal issues, such as the role of responsible mineral extraction in the energy transition and the importance of geology in vital areas such as climate change science, water resource management, environmental conservation, and sustainable urban/built development. Finding new ways to show that, far from being boring, geology is a subject that can fundamentally change the way you see and interact with the world around you is of central importance to achieving this. Efforts to make the subject more equitable are also highlighted as being critical in creating a more inclusive and accessible discipline.

Doctoral study is a crucial part of the academic pipeline, but discriminatory admissions procedures disproportionately impact students from ethnic minority backgrounds. We examine how doctoral recruitment policies contribute to inequity in the geosciences and propose improvements for change.

Geography, Earth and Environmental Science (GEES) research will play a vital role in addressing the grand challenges of the 21st century, contributing to many of the UN sustainable development goals and the global energy transition. However, geoscience knowledge cannot be successfully applied to global problems that impact people from all walks of life unless the discipline itself is equitable. There is a well-documented racial and ethnic diversity crisis in GEES subjects in the Global North1 that leads to inequities in who does environmental research. The Equator project set out to increase participation and retention of UK-domiciled Black, Asian and minority ethnic postgraduate research (PGR) students in GEES topics. Our goal was to improve equity and diversity in a research area critical to a more sustainable future; not because of a business case, or for diversity as resource- but for social justice.Equator was a six-month project, funded by the Natural Environment Research Council (NERC), that developed three evidence-based interventions targeting different barriers to racial and ethnic diversity in GEES research. To remove barriers to access, a doctoral training working group was formed to share best practice and develop recommendations to make PhD recruitment more equitable. To improve access and participation, a ring-fenced research school for ethnic minority undergraduate, masters and doctoral students was delivered. To increase retention and improve student experience, a targeted mentoring network pairing students with mentors from both industry and academia was created.Evaluation of interventions took the form of action research with a Theory of Change approach, with surveys used to capture thoughts and reflections in each of the three work packages. This occurred alongside collaborative, self-reflective inquiry within the project team and steering committee. The steering committee included grassroots organisations, higher education institutions, professional bodies and an equity, diversity and inclusion (EDI) consultant.The Equator doctoral training working group developed recommendations to remove barriers to ethnic minority students applying for and being accepted onto PhD programs. The practical suggestions are designed to be implemented by academics and professional service staff working in doctoral training recruitment, and are broken down into student-facing, procedural and interview/evaluation categories. Themes covered include pre-application support, data collection and reporting, website materials, and standardisation of application and interview materials. The Equator Research School and Mentoring Network led to development of a “how to” guide of recommendations for creating successful interventions for improving participation and retention in research. Participants in the Equator Research School and Mentoring Network provided very positive feedback both during and following the interventions. The majority of those involved felt a stronger sense of belonging and inclusion in GEES research and were more likely to consider a research career after taking part. The evaluation process showed unequivocally that the ring-fenced, discipline-specific, fully-funded nature of the interventions was a critical factor in participants applying to be involved. Equator project recommendations are provided as a graphic guide for educators and university leaders at the end of this report (Appendix 1, to be added Autumn 2022).

Ovummuridae are calcareous, egg-shaped microfossils with an unknown taxonomic affinity. Their limited observation is due to their occurrence only within exceptionally preserved carbonate rocks that have undergone little to no diagenesis or aggrading neomorphism. The Much Wenlock Limestone Formation (Homerian) is famous for its exceptionally preserved and diverse fossil biota, but Ovummuridae have not been previously observed and reported from the formation. This paper introduces the population of Ovummuridae from the off-reef tract limestones of The Much Wenlock Limestone Formation, Shropshire, UK. The authors analysed 124 polished and etched thin sections using reflected light microscopy to detect the presence of Ovummuridae. A total of 6591 ovummurids were identified, including observations of several previously undescribed morphotypes of Ovummuridae. Three new genera, Munneckella, Natantesprifmata and Hartonella, and subsequently four new species, Minourella wenlockiensis, Munneckella tribuscamera, Natantesprifmata rogersi and Hartonella oblonga, are introduced. The implications of this study suggest that reflected light microscopy is an effective and efficient method for observing calcareous microfossils. Ovummuridae may be more abundant than previously reported, their stratigraphic and palaeogeographic range is further extended, and it is highlighted that the off-reef tract may have been the microfossils’ preferred environment.

Background Allergy to iodinated contrast (IC) agent and advanced chronic kidney disease are major limitations to endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs). We describe our experience combining CO2-assisted EVAR with intraoperative contrast-enhanced ultrasound (CEUS) in an attempt to avoid contrast-induced allergy or nephropathy. Methods Observational cohort study using prospectively acquired data on patients undergoing CO2-assisted EVAR in single institution. EVAR planning was performed using computed tomographic angiography or magnetic resonance aortography in patients contraindicated for IC. Patients were considered if their estimated glomerular filtration rate was Results Fifteen patients (10 male) were treated across a 5-year period. Technical success was achieved in all cases. Completely IC-free EVAR was performed in 9 cases, whereas the remaining 6 required IC administration for adjunct procedures. CO2 completion angiography detected all type I endoleaks (2 Ia and 1 Ib) but was less sensitive to type II. Intraoperative CEUS confirmed all type I and 2 cases of type II endoleaks. Median hospital stay was 4 days. No significant deterioration in renal function was seen postoperatively. Conclusions In patients with abdominal aortic aneurysms and with contraindication for IC, a combined approach of using CO2 digital subtraction angiography and CEUS can be used safely and efficiently to minimize or obviate the need for IC agents with satisfactory mid-term results.

Objectives To identify the diverse services required by families of children with special health care needs (CSHCN) and identify the specific care coordination (CC) efforts associated with the most common types of observed diagnoses. Requested services were categorized into specific sectors, and CC efforts were quantified by observed diagnoses and defined sectors. Methods CC service data were extracted and analyzed from patient encounters over 4 years (2009-2013) in a department database. This included descriptive information about referrals and linkages to medical, dental, and behavioral health providers and to state, private, and community agencies. Diagnostic classifications and CC sectors were defined to enable categorization. Results A total of 2682 CSHCN records were reviewed. The majority (59%) required services/resources in 1 to 2 sectors, 24% required services/resources in 3 to 5 sectors, and 17% required services/resources in 6 or more sectors. Including informational service, the most frequently required sectors across the study population were education, financial, medical/dental, social connections, and advocacy. Children diagnosed with autism spectrum disorder had the highest needs across all sectors. Conclusion Most CSHCN and their families use a substantial amount of CC time and effort to secure services from diverse sectors. High-quality and efficient CC requires an understanding of the specific needs of these CSHCN and their families and how to link them to a diverse array of services and resources.

Abdominal aortic aneurysms (AAAs) are increasingly screen-detected and many small aneurysms enter surveillance. Computed tomography identifies characteristics that can predict subsequent AAA growth but ionizing radiation and nephrotoxic contrast disadvantage its use in surveillance. We investigated whether duplex and 3-dimensional tomographic ultrasound identified features associated with AAA growth in patients on AAA surveillance.Duplex and three-dimensional tomographic ultrasound imaging was performed independently by 2 vascular scientists in 128 AAA surveillance patients who all had AAA growth measured over at least 2 years. Diameter, cross-sectional area, length, volume, wall thickness/volume, and intraluminal thrombus were measured. Pulsatility using maximum systolic and minimum diastolic diameters corrected for diameter and distensibility (consisting of strain and stiffness) were also calculated.AAA growth rate correlated with AAA diameter (r 0.43), volume (r 0.46), and cross-sectional area (r 0.42) (P0.01). Measuring wall thickness was inaccurate, but wall volume (corrected for AAA volume) inversely related to growth rate (r -0.43, P0.01). On a multivariate analysis, diameter and wall volume (rAAA growth most strongly related to AAA volume and inversely to wall volume. AAA volume and wall volume may prove useful in the prediction of AAA growth rates.

Background The implementation of the Sustainable Development Goals (SDGs) requires much planning and the provision of resources, especially regarding the necessary investments, technologies and infrastructures needed. Yet, it is presently unclear how available these elements are, what gaps exist, what changes have taken place in terms of their availability since the adoption of the SDGs and what their requirements will be in the future. The knowledge gap has become even more concerning because of the impact of the COVID-19 pandemic. Using a bibliometric analysis, an assessment of the global progress of SDG implementation and requirements, identifying challenges through the development of a matrix, and a set of 11 case studies to triangulate the holistic analysis, an assessment of the global progress of the SDGs implementation and the impact of the COVID-19 pandemic on this process was carried out. Results The findings suggest that the scope and width of resources limitation are currently undermining the implementation of the SDGs. Apart from the fact that the pace of progress has been insufficient, the potential of the SDGs in pursuing sustainability and improving life quality is not fully realised. This trend suggests that a substantial acceleration of the efforts is needed, especially for the five SDGs whose progress since 2015 has not been optimal, namely SDG2, SDG11, SDG13, SDG15, and SDG16, while SDG3, SDG7, SDG9, SDG14, and SDG17 show signs of progress. The case studies showed that different industries have dissimilar effects on achieving the SDGs, with the food sector correlating with 15 SDGs, as opposed to the energy sector correlating with 6 SDGs. Accordingly, the priority level assessment in terms of achieving the SDGs, points to the need to further advance the above-mentioned five SDGs, i.e., 2, 11, 13, 15 and 16. Conclusions This study fills in a knowledge gap in respect of the current need for and availability of investments, new technologies, and infrastructures to allow countries to pursue the SDGs. It is suggested that this availability is rather limited in specific contexts. In respect of the needs to be addressed, these include resource-related constraints, limited technologies and infrastructures, affecting SDG2, SDG11, SDG13, SDG15, and SDG16, whose progress needs to be enhanced. Since the global progress in the process of implementation of the SDGs depends directly and indirectly on addressing the resource gaps, it is suggested that this topic be further investigated, so that the present imbalances in the three dimensions of sustainable development: the economic, social and environmental, be adequately addressed.

Introduction: Higher arterial stiffness independently predicts risk of future cardiovascular events. Although angiotensin converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARBs) reduce blood pressure, their impact on vascular function may vary. Hypothesis: We hypothesized differences in the impact of ACEi compared to ARBs on arterial stiffness, wave reflections and microvascular function in hypertension among older men and women. Methods: We measured vascular function at baseline and after 1 year in 176 (87 Candesartan, 89 Lisinopril therapy) hypertensive participants with mild cognitive impairment (age 65.9 +/-7.7 years, 57% female). Pulse-wave velocity (PWV), central pulse pressure (CPP) and central augmentation index (AIx) were measured using applanation tonometry and the reactive hyperemia index using digital pulse amplitude tonometry. Results: While Candesartan and Lisinopril lowered blood pressure equally, only Lisinopril therapy resulted in a lower PWV (-0.7 ± 0.4 m/s, p=0.03) and CPP (-7 ± 4 mmHg, p=0.01) after 1 year, while Candesartan produced no significant change. There was a significant interaction by sex whereby arterial stiffness was lowered only in women with Lisinopril. Candesartan lowered AIx more than Lisinopril (-4 ± 7% vs -1.5 ± 8%, p=0.05) in both sexes. After adjustment for sex and cardiovascular risk factors, Lisinopril remained a significant predictor of lower PWV and CPP after 1 year (all p Conclusions: In a cohort of older hypertensive patients, despite equipotent anti-hypertensive effects, Lisinopril was more effective than Candesartan at lowering arterial stiffness in women. Candesartan was effective in lowering wave reflections compared to Lisinopril.

Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.

Many technologies emerging from quantum information science heavily rely upon the generation and manipulation of entangled quantum states. Here, we propose and demonstrate a new class of quantum interference phenomena that arise when states are created in and coherently converted between the propagating modes of an optical microcavity. The modal coupling introduces several new creation pathways to a nonlinear optical process within the device, which quantum mechanically interfere to drive the system between states in the time domain. The coherent conversion entangles the generated biphotons between propagation pathways, leading to cyclically evolving path-entanglement and the manifestation of coherent oscillations in second-order temporal correlations. Furthermore, the rich device physics is harnessed to tune properties of the quantum states. In particular, we show that the strength of interference between pathways can be coherently controlled, allowing for manipulation of the degree of entanglement, which can even be entirely quenched. The states can likewise be made to flip-flop between exhibiting initially correlated or uncorrelated behavior. The phenomena presented here open a route to creating higher dimensional entanglement and exotic multi-photon states. In the quantum revolution era, parallel and complementary efforts are deployed in the manipulation of quantum states and their entanglement. The authors theoretically and experimentally present a method using quantum interference in circular propagating modes of silicon microdisks to control quantum states produced by optical resonators, affording the possibility to creating higher dimensional entanglement and exotic multi-photon states.

More than 60 years ago, Angus Campbell offered an explanation for why the president’s party regularly loses congressional seats in midterm elections. He argued that peripheral voters “surge” to the polls in presidential elections and support the president’s congressional co-partisans but “decline” to turn out in the midterm. In his turnout-based explanation for midterm loss, Campbell speculated that “bad weather or an epidemic may affect the vote” but largely dismissed weather’s utility to test his theory (Campbell 1960, 399). I revisit Campbell’s speculation and employ a new identification strategy to investigate the “surge and decline” account of midterm loss. I show that as the costs of voting increase—due to above-average rainfall on Election Day—the strength of the relationship between presidential and congressional voting weakens.

OBJECTIVE: Clear imaging of below knee and foot arteries is essential to plan distal reconstructions. Contrast enhanced tomographic 3D ultrasound (CEtUS) is novel and entirely safe with no exposure to ionising radiation or nephrotoxic contrast. In the present study, inter- and intra-observer agreement of CEtUS was calculated, and compared with below knee angiography.METHODS: In the same week as computed tomography, magnetic resonance or catheter angiography, CEtUS was performed using intravenous 1.2 mL bolus injections of Sonovue with a maximum of 5 mL administered per patient. CEtUS was reported by a vascular scientist blinded to the angiograms reported by a consultant radiologist. Images were compared using a modified Society of Vascular Surgery (SVS) runoff score.RESULTS: Of the 181 patients recruited with peripheral arterial disease, 20 were excluded from analysis as they withdrew consent, could not be cannulated, or their images were non-diagnostic. In the remaining 161 patients, there were 175 comparative patient images split into two groups: 81 had calf imaging and 94 had pedal imaging representing 405 and 198 imaged arteries, respectively. Weighted quadratic kappa/ICC values for intra- and inter-observer agreement were excellent (κ/ICC = 0.83 to 0.95) and had narrow confidence intervals in both groups. When comparing angiography and CEtUS, weighted quadratic κ/ICC agreement was moderate with acceptable confidence intervals in both groups (Calf κ/ICC = 0.54; Pedal κ/ICC = 0.53). Agreement decreased from popliteal to pedal vessels as diameter decreased. Agreement between CEtUS and digital subtraction angiography was best, and computed tomography angiography the weakest.CONCLUSION: CEtUS is a novel imaging modality with strong observer agreement that achieves clear peripheral and foot images without ionising radiation exposure or nephrotoxic X-ray contrast media. CEtUS enhances visualisation of runoff vessels, which may play a role in planning of limb salvage or targeted assessment.

OBJECTIVES Mental health (MH) complaints are increasingly responsible for visits to pediatric emergency departments (PEDs). Bullying is associated with MH problems. Most adolescents use social media and many experience problems with cyberbullying (CB). This study determines prevalence of CB in MH and non-MH adolescents in a PED, describes technology use in these groups, and measures influence of CB on presentation to the PED and on thoughts/acts of self-harm. METHODS A prospective survey was administered to a convenience sample of 149 patients aged 11 to 17 years in a PED. Data were analyzed using descriptive and comparative statistical methods. RESULTS Cyberbullying was significantly more common in MH than in the non-MH patients (17% vs 3%, P = 0.007). More MH patients reported that bullying led to the current PED visit than that in the non-MH group (25% vs 10%, P = 0.02), and they were significantly more likely to report that CB led to self-harm (22% vs 4%, P = 0.003). Mental health participants who spent more than 3 hours on the Internet report higher levels of bullying than non-MH patients (38% vs 6%, P < 0.001). CONCLUSIONS Prevalence of bullying in MH patients presenting to a PED is significantly greater than controls, and CB caused more MH patients to have acts or thoughts of self-harm. Bullying is a risk factor for self-harm and suicide in patients with MH problems. Future studies should evaluate CB as part of suicide screening tools for emergency MH patients.

A well functioning arteriovenous fistula (AVF) is essential for haemodialysis. Despite regular duplex ultrasound (DUS) a significant number of AVFs fail. Tomographic 3D ultrasound (tUS) creates a 3D image of the AVF that can be interpreted by the clinician. DUS, tUS, and fistulograms were compared for the identification and measurement of flow limiting stenosis.Patients with AVF dysfunction on routine Transonic surveillance, defined as (1)15% reduction in flow on two consecutive occasions, (2)30% reduction in flow on one occasion, (3) flow of600 mL/sec, (4) presence of recirculation, underwent DUS. AVF tUS imaging was performed prior to fistulography. All fistulograms were reported by the same consultant radiologist and tUS images by the same vascular scientist blinded to the fistulogram results. Maximum diameter reduction in all stenoses were measured using all three imaging techniques.In 97 patients with 101 stenoses, the mean (± standard deviation [SD]) severity of stenosis was 63.0 ± 13.9%, 65.0 ± 11.6%, and 64.8 ± 11.7% for the fistulograms, DUS, and tUS respectively. The mean (± SD) time between ultrasound and fistulography imaging was 15.0 ± 14.5 days. Assuming the fistulogram as the "gold standard", Bland-Altman agreement for DUS was -1.9 ± 15.5% (limit of agreement [LOA] -32.2 - 28.4) compared with -1.7 ± 15.4% (LOA -31.9 - 28.4) for tUS. Median (± interquartile range) time to complete the investigation was 09:00 ± 03:19 minutes for DUS and 03:13 ± 01:56 minutes for tUS (p.001).DUS and tUS were equally accurate at detecting AVF complications but tUS investigation requires less skill and was significantly quicker than DUS.

Background Violence is an increasingly common and significant problem for youth worldwide. Youth who rely on treatment at urban EDs are more likely to die as the result of violence than any other disease/condition for which they seek care. The first step in helping youth that are at risk, is identifying them. We developed a 7–item screening tool called VPET. The purpose of this study is to validate the VPET screening tool in identifying high-risk youth. Methods and findings We prospectively enrolled a convenience sample of children during the index ED visit who were called 3 months and 6 months after this visit. 269 youth (33%) completed 3-month follow up (44.2% male); 240 youth (29.4%) completed 6-month follow up (45% male); 84.0% reported some level of violence exposure after 3-months and 84.2% (n = 240) reported some level of violence exposure after 6-months. Predictive validity was assessed by Spearman's correlation between VPET score and follow-up score at 3-months and 6-months post-enrollment; logistic regression to calculate odds ratios between positive VPET item responses and positive follow-up score; ROC curve analysis. VPET score had internal consistency, as tested by Cronbach's alpha (α = 0.642). Children who were male, non-white, and had been hurt at home or school reported the highest VPET scores. Conclusion VPET has sufficiently strong psychometric function and performs well as a screening tool to predict future violence exposure for youth ages 8–17. Five questions on the VPET screening tool are independently predictive of violence reported at 6 months and four questions at 3 months.

Accurate prediction of suicide risk among children and adolescents within an actionable time frame is an important but challenging task. Very few studies have comprehensively considered the clinical risk factors available to produce quantifiable risk scores for estimation of short- and long-term suicide risk for pediatric population. In this paper, we built machine learning models for predicting suicidal behavior among children and adolescents based on their longitudinal clinical records, and determining short- and long-term risk factors. This retrospective study used deidentified structured electronic health records (EHR) from the Connecticut Children’s Medical Center covering the period from 1 October 2011 to 30 September 2016. Clinical records of 41,721 young patients (10–18 years old) were included for analysis. Candidate predictors included demographics, diagnosis, laboratory tests, and medications. Different prediction windows ranging from 0 to 365 days were adopted. For each prediction window, candidate predictors were first screened by univariate statistical tests, and then a predictive model was built via a sequential forward feature selection procedure. We grouped the selected predictors and estimated their contributions to risk prediction at different prediction window lengths. The developed predictive models predicted suicidal behavior across all prediction windows with AUCs varying from 0.81 to 0.86. For all prediction windows, the models detected 53–62% of suicide-positive subjects with 90% specificity. The models performed better with shorter prediction windows and predictor importance varied across prediction windows, illustrating short- and long-term risks. Our findings demonstrated that routinely collected EHRs can be used to create accurate predictive models for suicide risk among children and adolescents.

Allergy to iodinated contrast (IC) agent and advanced chronic kidney disease are major limitations to endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs). We describe our experience combining COObservational cohort study using prospectively acquired data on patients undergoing COFifteen patients (10 male) were treated across a 5-year period. Technical success was achieved in all cases. Completely IC-free EVAR was performed in 9 cases, whereas the remaining 6 required IC administration for adjunct procedures. COIn patients with abdominal aortic aneurysms and with contraindication for IC, a combined approach of using CO