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Wavelength dispersive analysis of tephra grains and melt inclusions by EPMA has been carried out using a focused beam of 3 µm diameter without detected loss of sodium or potassium in standard glasses, including anhydrous basalts, a slightly hydrated rhyolite and a sodium-rich intermediate composition. The ability to make analyses without chemical modification is strongly dependent upon current density at the analysis site. Analysis with narrow beams requires extremely low beam currents that are normally associated with energy dispersive analysis. Experiments indicate that a value of 0.1 nA/µm2 must not be exceeded, at least for moderately hydrated samples, if sodium loss is to be avoided. High resolution analysis without beam-induced analytical artefacts enables fully quantitative analysis of very distal and/or highly vesicular tephras and very small melt inclusions without the need to use post-analysis corrections. This development has enabled high quality analyses from crypto-tephra layers that were previously impossible to analyse, and has removed the potential for sampling bias within mixed tephra layers by making (in most cases) tephra grains accessible for analysis. The use of focused beams also increases the level of automation, and hence the cost-effectiveness of data collection. The current data suggest limits to the applicability of the beam conditions reported, and that they may lead to alkali loss in compositions most prone to beam-induced modification such as significantly hydrated and/or sodic tephras.

The occurrence of a range of health outcomes following myocardial infarction (MI) is unknown. Therefore, this study aimed to determine the long-term risk of major health outcomes following MI and generate sociodemographic stratified risk charts in order to inform care recommendations in the post-MI period and underpin shared decision making. This nationwide cohort study includes all individuals aged ≥18 years admitted to one of 229 National Health Service (NHS) Trusts in England between 1 January 2008 and 31 January 2017 (final follow-up 27 March 2017). We analysed 11 non-fatal health outcomes (subsequent MI and first hospitalisation for heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes mellitus, dementia, depression, and cancer) and all-cause mortality. Of the 55,619,430 population of England, 34,116,257 individuals contributing to 145,912,852 hospitalisations were included (mean age 41.7 years (standard deviation [SD 26.1]); n = 14,747,198 (44.2%) male). There were 433,361 individuals with MI (mean age 67.4 years [SD 14.4)]; n = 283,742 (65.5%) male). Following MI, all-cause mortality was the most frequent event (adjusted cumulative incidence at 9 years 37.8% (95% confidence interval [CI] [37.6,37.9]), followed by heart failure (29.6%; 95% CI [29.4,29.7]), renal failure (27.2%; 95% CI [27.0,27.4]), atrial fibrillation (22.3%; 95% CI [22.2,22.5]), severe bleeding (19.0%; 95% CI [18.8,19.1]), diabetes (17.0%; 95% CI [16.9,17.1]), cancer (13.5%; 95% CI [13.3,13.6]), cerebrovascular disease (12.5%; 95% CI [12.4,12.7]), depression (8.9%; 95% CI [8.7,9.0]), dementia (7.8%; 95% CI [7.7,7.9]), subsequent MI (7.1%; 95% CI [7.0,7.2]), and peripheral arterial disease (6.5%; 95% CI [6.4,6.6]). Compared with a risk-set matched population of 2,001,310 individuals, first hospitalisation of all non-fatal health outcomes were increased after MI, except for dementia (adjusted hazard ratio [aHR] 1.01; 95% CI [0.99,1.02];p = 0.468) and cancer (aHR 0.56; 95% CI [0.56,0.57];p < 0.001). The study includes data from secondary care only-as such diagnoses made outside of secondary care may have been missed leading to the potential underestimation of the total burden of disease following MI. In this study, up to a third of patients with MI developed heart failure or renal failure, 7% had another MI, and 38% died within 9 years (compared with 35% deaths among matched individuals). The incidence of all health outcomes, except dementia and cancer, was higher than expected during the normal life course without MI following adjustment for age, sex, year, and socioeconomic deprivation. Efforts targeted to prevent or limit the accrual of chronic, multisystem disease states following MI are needed and should be guided by the demographic-specific risk charts derived in this study.

The 39-day long eruption at the summit of Eyjafjallajökull volcano in April–May 2010 was of modest size but ash was widely dispersed. By combining data from ground surveys and remote sensing we show that the erupted material was 4.8±1.2·1011 kg (benmoreite and trachyte, dense rock equivalent volume 0.18±0.05 km3). About 20% was lava and water-transported tephra, 80% was airborne tephra (bulk volume 0.27 km3) transported by 3–10 km high plumes. The airborne tephra was mostly fine ash (diameter <1000 µm). At least 7·1010 kg (70 Tg) was very fine ash (<28 µm), several times more than previously estimated via satellite retrievals. About 50% of the tephra fell in Iceland with the remainder carried towards south and east, detected over ~7 million km2 in Europe and the North Atlantic. Of order 1010 kg (2%) are considered to have been transported longer than 600–700 km with <108 kg (<0.02%) reaching mainland Europe.

Heart failure with preserved ejection fraction (HFPEF) is a common, globally recognised, form of heart failure for which no treatment has yet been shown to improve symptoms or prognosis. The pathophysiology of HFPEF is complex but characterised by increased left atrial pressure, especially during exertion, which might be a key therapeutic target. The rationale for the present study was that a mechanical approach to reducing left atrial pressure might be effective in HFPEF. The REDUCe Elevated Left Atrial Pressure in Patients with Heart Failure (REDUCE LAP-HF) study was an open-label, single-arm, phase 1 study designed to assess the performance and safety of a transcatheter interatrial shunt device (IASD, Corvia Medical, Tewkesbury, MA, USA) in patients older than 40 years of age with symptoms of HFPEF despite pharmacological therapy, left ventricular ejection fraction higher than 40%, and a raised pulmonary capillary wedge pressure at rest (>15 mm Hg) or during exercise (>25 mm Hg). The study was done at 21 centres (all departments of cardiology in the UK, Netherlands, Belgium, France, Germany, Austria, Denmark, Australia, and New Zealand). The co-primary endpoints were the safety and performance of the IASD at 6 months, together with measures of clinical efficacy, including functional capacity and clinical status, analysed per protocol. This study is registered with ClinicalTrials.gov, number NCT01913613. Between Feb 8, 2014, and June 10, 2015, 68 eligible patients were entered into the study. IASD placement was successful in 64 patients and seemed to be safe and well tolerated; no patient had a peri-procedural or major adverse cardiac or cerebrovascular event or need for cardiac surgical intervention for device-related complications during 6 months of follow-up. At 6 months, 31 (52%) of 60 patients had a reduction in pulmonary capillary wedge pressure at rest, 34 (58%) of 59 had a lower pulmonary capillary wedge pressure during exertion, and 23 (39%) of 59 fulfilled both these criteria. Mean exercise pulmonary capillary wedge pressure was lower at 6 months than at baseline, both at 20 watts workload (mean 32 mm Hg [SD 8] at baseline vs 29 mm Hg [9] at 6 months, p=0·0124) and at peak exercise (34 mm Hg [8] vs 32 [8], p=0·0255), despite increased mean exercise duration (baseline vs 6 months: 7·3 min [SD 3·1] vs 8·2 min [3·4], p=0·03). Sustained device patency at 6 months was confirmed by left-to-right shunting (pulmonary/systemic flow ratio: 1·06 [SD 0·32] at baseline vs 1·27 [0·20] at 6 months, p=0·0004). Implantation of an interatrial shunt device is feasible, seems to be safe, reduces left atrial pressure during exercise, and could be a new strategy for the management of HFPEF. The effectiveness of IASD compared with existing treatment for patients with HFPEF requires validation in a randomised controlled trial. Corvia Medical Inc.

Recent geophysical studies have highlighted the potential utility of integrating both seismic and infrasound data to improve source characterization and event discrimination efforts. However, the influence of each of these data types within an integrated framework is not yet well‐understood by the geophysical community. To help elucidate the role of each data type within a merged structure, we develop a neural network which fuses seismic and infrasound array data via a gated multimodal unit for earthquake‐explosion discrimination within the Korean Peninsula. Model performance is compared before and after adding the infrasound branch. We find that the seismoacoustic model outperforms the seismic model, with the majority of the improvements stemming from the explosions class. The influence of infrasound is quantified by analyzing gated multimodal activations. Results indicate that the model relies comparatively more on the infrasound branch to correct seismic predictions. Plain Language Summary Earthquakes and explosions can produce energy that travel as waves through the ground, seismic, and the air, infrasound. As these waves travel to the station where they are detected, they can be changed so drastically by the medium that it makes it difficult to determine what caused them. In these instances, it has been shown that using both seismic and infrasound data works better to characterize an event than using them independent of one another. However, due to the differences in how the air and ground influence the movement of energy, it is not well‐known how these types of data work in unison to give us more information about an event. In this study, we use a machine learning model trained on both seismic and infrasound data to help us better understand how they can be used together to determine their source. Key Points Discrimination performance within the Korean Peninsula is improved after fusing seismoacoustic data within a deep learning architecture Neural network framework provides insight into how information in multimodal data combine to distinguish between different event types

IntroductionPeople identified as higher risk by a machine learning algorithm (Future Innovations in Novel Detection of Atrial Fibrillation [FIND-AF]) are at increased risk of cardio-renal-metabolic-pulmonary disease and cardiovascular death. The OPTIMISE-1 randomised controlled trial aims to test the effect of community-based specialist-led identification and management of cardio-renal-metabolic-pulmonary (CRMP) disease and risk factors compared with usual care on the use of therapeutic interventions over a follow-up of 6 months among high FIND-AF risk community-dwelling individuals.Methods and analysisOPTIMISE-1 is a multicentre, pragmatic, prospective, randomised, open-label, blinded-endpoint strategy trial that will recruit 138 participants aged 30 years or older, with a high FIND-AF risk score and previously enrolled in the FIND-AF pilot study (NCT05898165), to be randomised 1:1 to a specialist-led care intervention or usual care. The primary endpoint is a composite of initiation or increase of guideline-directed CRMP therapies. The secondary endpoints are the components of the primary endpoint, time to primary endpoint, diagnosis of new CRMP diseases or risk factors, time to diagnosis of new CRMP diseases or risk factors, initiation or increase of guideline-directed CRMP therapies for participants with recorded CRMP disease, initiation or increase of guideline-directed CRMP therapies for participants with newly diagnosed CRMP disease and change in participant-reported quality of life.Ethics and disseminationThe study has ethical approval (the North East & North Tyneside 2 Research Ethics Committee reference 24/NE/0188). Findings will be announced at relevant conferences and published in peer-reviewed journals in line with the Funder’s open access policy.Trial registration numberClinicaltrials.gov NCT06444711.

We present Atacama Large Millimeter/submillimeter Array observations of the [C I] 492 and 806 GHz fine-structure lines in 25 dusty star-forming galaxies (DSFGs) at z = 4.3 in the core of the SPT2349–56 protocluster. The protocluster galaxies exhibit a median L[CI](2−1)′/L[CI](1−0)′ ratio of 0.94, with an interquartile range of 0.81–1.24. These ratios are markedly different to those observed in DSFGs in the field (across a comparable redshift and 850 μm flux density range), where the median is 0.55, with an interquartile range of 0.50–0.76, and we show that this difference is driven by an excess of [C i](2–1) in the protocluster galaxies for a given 850 μm flux density. Assuming local thermal equilibrium, we estimate gas excitation temperatures of Tex=59.1−6.8+8.1 K for our protocluster sample and Tex=33.9−2.2+2.4 K for the field sample. Our main interpretation of this result is that the protocluster galaxies have had their cold gas driven to their cores via close-by interactions within the dense environment, leading to an overall increase in the average gas density and excitation temperature, as well as an elevated [C i](2–1) luminosity-to-far-infrared-luminosity ratio.

Background Postpartum pelvic girdle pain (PGP), experienced by approximately 10% of women, is typically refractory to conservative management. Customised dynamic elastomeric fabric orthoses (DEFOs) are one novel option to address this. We assessed the feasibility and acceptability of a randomised controlled trial comparing a DEFO plus standardised advice/exercises (intervention) versus standardised advice/exercise alone (control). Methods A multicentre randomised controlled feasibility trial with embedded qualitative study and economic evaluation. Participants were randomised to either intervention or control group. All received two remote physiotherapy sessions via videoconferencing separated by 14 days. Primary feasibility outcomes were related to the feasibility and acceptability of methods and interventions, recruitment, intervention fidelity, outcome measure performance and completion. The proposed primary outcome measure for the definitive trial was the Numerical Pain Rating Scale (NPRS) which assessed pain intensity fortnightly over 24 weeks. Secondary outcome measures assessed kinesiophobia, continence, function, health-related quality of life, depression and health/care resource use at baseline, 12 and 24 weeks. Adverse events were recorded. Pre-defined progression criteria were set to decide whether, and how, to proceed with a future definitive trial: (1) Target sample size (60 from 3 centres over a 7-month recruitment period), (2) outcome measure completion (> 60% at 24 weeks), (3) orthosis wear-time compliance (> 70% for 6 h/day) as measured by the Orthotimer, and (4) evidence suggesting efficacy. Results Of 180 participants sent information sheets, 40 were screened and 24 randomised. At 24 weeks, 95% completed NPRS and 89–95% the secondary outcome measures. Wear-time adherence appeared below the set target of 42 h per week. Outcomes were broadly comparable between groups. Recruitment was insufficient to estimate a signal of efficacy with confidence. Two intervention participants experienced Candida infections, considered possibly due to the DEFO. Conclusions Trial procedures and interventions were acceptable to participants. Technical Orthotimer issues are resolvable through modification of recording parameters. Recruitment of participants was a major challenge. Work to understand how best to engage women in this research is needed before moving to a definitive trial. Trial registration ISCRTN, ISRCTN67232113. Registered 08/05/2021, https://www.isrctn.com/ISRCTN67232113 . Key messages • What uncertainties existed regarding the feasibility? ➣ There is uncertainty regarding the feasibility of recruiting participants at a rate conducive to a definitive trial. • What are the key feasibility findings? ➣ Twenty-four participants were recruited over 7 months. Retention and complete NPRS data were available for analysis at final follow-up for 18 participants (75%). ➣ Overall, the trial procedures and interventions were perceived as acceptable by participants and clinicians. ➣ Overall recruitment was insufficient to estimate a signal of efficacy with confidence. ➣ Technical issues with the Orthotimer significantly impacted on adherence data collection. ➣ Progression criteria indicate that progression to a definitive trial in its current format is not recommended. • What are the implications of the feasibility findings for the design of the main study? ➣ Further research is required to best understand how to recruit women to a future study. ➣ A hybrid approach to intervention delivery may be preferable. ➣ Orthotimer reading intervals for capturing orthosis wear-time adherence require careful consideration. ➣ An internal pilot within a future definitive multicentre randomised controlled trial would add value.

Background Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m 2 ). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity. Methods This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m 2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted. Discussion This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients. Trial registration ISRCTN number 22088800.