bluuebunny/crossref_metadata_2025 huggingface dataset:
P42 An audit to assess prescribing of paediatric CD TTOs
Authors: Junaid Ebraheem , Agudetse Audrey
Published: April 2023

Aim

To establish the root cause leading to an increased amount of time spent for a pharmacist to triage a paediatric controlled drug (CD) to take out (TTO) prescription.

Method

Mixed methods were used to collect data. Initially, raw data was collected over a period of three weeks to identify any CD TTO’s that required intervention from the pharmacist. We recorded if the correct CD TTO prescription template was being used, number of CD TTO prescriptions, clinically and legally correct and how long it took to complete the triage by the pharmacist (ward or dispensary based). The amount of raw data collected was not sufficient to establish an accurate picture of the problem. For this reason, we also collected data from the paediatric prescribing tests. The open book prescribing tests are completed by all new doctors coming in to the paediatric rotation. This is a scenarios-based test and question 10 of the test asks them to write out a CD TTO prescription using the CD TTO template. The answers to question 10 of the test were then audited.

Results

The data that was collected shows that two thirds (67%) of prescribers failed to answer question 10 of the test (CD TTO question). This indicates an issue with CD TTO prescribing and the reasons why they failed to pass the question (i.e. legally and/or clinically incorrect). One of the reasons that may be a factor is the lack of CD TTO prescribing in paediatrics compared to adults (i.e. lack of practice/unfamiliarity). This may reduce their knowledge regarding CD TTO prescription requirements and thus confidence and competence in prescribing practice. It was also established that errors in relation to the dose and frequency were found to be the most frequent, which also suggests a lack of clinical knowledge and/or use of available resources. The causes of this can range from a lack of appropriate training to lack of self-checks and referring to the BNF and/or other prescribing guidelines. Furthermore, the live data (two CD TTOs audited) also showed that 50% of prescriptions written were not written on the CD TTO template, prompting the pharmacist to spend additional time triaging it. On average, it took 40 minutes to triage one CD TTO prescription.

Conclusions

Changes are needed to address the issues that were found in this audit. Recommended immediate actions include making prescribers aware of where CD TTO templates can be found and implementing teaching sessions to improve clinical and legal knowledge of prescription writing. In the long term, it is recommended to add the CD TTO template to the back of the Child Health medication chart (like we have for the adult charts at our Trust). We are also considering creating a pocket guide on the correct prescribing of CD TTOs in consultation with doctors, nurses and pharmacists.
Cystic lung disease lymphangioleiomyomatosis (LAM) in a male patient
Authors: Prakash Ashish Kumar , Chatterjee Siddharth , Datta Bornali , Jaiswal Anand
Published: April 2023

Lymphangioleiomyomatosis (LAM) is characterised by the proliferation of abnormal smooth muscle cells (LAM cells) in the lungs, lymph nodes and other organs. We report the case of a man in his 50s who had right-sided pleural effusion. On performing a diagnostic tap, the fluid was milky white in colour. An intercostal chest tube was inserted and after complete drainage of fluid, a high-resolution CT (HRCT) was done. HRCT revealed multiple cysts throughout both of the lungs. On subsequent bronchoscopy-guided transbronchial lung biopsy and histochemical staining, diagnosis of LAM was made. We started the patient on oral sirolimus. On subsequent follow-up, subjective and objective improvements were observed.
Neovascular glaucoma with combined retinal vascular occlusion in carotid cavernous fistula
Authors: Temkar Shreyas , Jayaseelan Jagadeeshwari , Deb Amit Kumar , Kaliaperumal Subashini
Published: April 2023

Carotid cavernous fistulas (CCFs) can present with varied ophthalmic manifestations. The most important vision-threatening complications of CCF include glaucoma and retinal vascular occlusions. We report a case of a man in his early 30s who developed a post-traumatic direct CCF. The patient denied undergoing embolisation therapy. This resulted in aggravation of his condition with onset of combined retinal venous and artery occlusion leading to neovascular glaucoma and severe vision loss. He was treated with medical management followed by diode laser photocoagulation to control intraocular pressure. Diagnostic cerebral angiography done 3 months later showed complete closure of the fistula; hence, no further intervention was advocated. Combined vascular occlusion is a rare vision-threatening occurrence in cases of CCF. Timely intervention with closure of the fistula can prevent the development of vision-threatening complications.
Large congenital facial teratoma
Authors: Solis-Pazmino Paola , Solano Vanessa , Pazmino-Chavez Camila , Garcia Cristhian
Published: April 2023

This case report discusses a presentation of a giant facial teratoma, a rare congenital neoplasm. Head and neck locations of the tumour uncommonly distort the face and may be associated with functional problems. We present a case of teratoma arising from the right parotid extending to the extracranial regions, successfully managed by surgical resection. Reviewing this case with the supporting body of literature anticipates further investigation to address patients’ needs more thoroughly.
Impacted foreign bodies in the faciomaxillary region: a multidisciplinary approach
Authors: Charlu Arun Paul , Sara Katti Blessi , Kumar Saurabh , Chandrasekhar Ajit
Published: April 2023

A man in his 20s came for maxillofacial consultation with a pus discharge from the left preauricular region for the last 1 year. He had met with a road traffic accident 2 years earlier and had received surgical treatment for injuries associated with the same. Investigations revealed multiple impacted foreign bodies deep within his facial structures. Successful surgical removal of the objects required a multidisciplinary effort between maxillofacial surgeons and otorhinolaryngologists. Complete removal of all the impacted wooden pieces was done through a combined endoscopic and open preauricular approach. The patient made a rapid recovery postoperatively with minimal complications.
Rapid Reviews Methods Series: Involving patient and public partners, healthcare providers and policymakers as knowledge users
Authors: Garritty Chantelle , Tricco Andrea C , Smith Maureen , Pollock Danielle , Kamel Chris , King Valerie J
Published: April 2023

Rapid reviews (RRs) are a helpful evidence synthesis tool to support urgent and emergent decision-making in healthcare. RRs involve abbreviating systematic review methods and are conducted in a condensed timeline to meet the decision-making needs of organisations or groups that commission them. Knowledge users (KUs) are those individuals, typically patient and public partners, healthcare providers, and policy-makers, who are likely to use evidence from research, including RRs, to make informed decisions about health policies, programmes or practices. However, research suggests that KU involvement in RRs is often limited or overlooked, and few RRs include patients as KUs. Existing RR methods guidance advocates involving KUs but lacks detailed steps on how and when to do so. This paper discusses the importance of involving KUs in RRs, including patient and public involvement to ensure RRs are fit for purpose and relevant for decision-making. Opportunities to involve KUs in planning, conduct and knowledge translation of RRs are outlined. Further, this paper describes various modes of engaging KUs during the review lifecycle; key considerations researchers should be mindful of when involving distinct KU groups; and an exemplar case study demonstrating substantive involvement of patient partners and the public in developing RRs. Although involving KUs requires time, resources and expertise, researchers should strive to balance ‘rapid’ with meaningful KU involvement in RRs. This paper is the first in a series led by the Cochrane Rapid Reviews Methods Group to further guide general RR methods.
Improving coverage of antenatal iron and folic acid supplementation and malaria prophylaxis through targeted information and home deliveries in Côte d’Ivoire: a cluster randomised controlled trial
Authors: Koné Siaka , Probst-Hensch Nicole , Dao Daouda , Utzinger Jürg , Fink Günther
Published: April 2023

Introduction

Coverage of antenatal iron and folic acid (IFA) supplementation and malaria chemoprophylaxis remains low in many low-income and middle-income settings. We assessed the effectiveness of personal information (INFO) sessions and personal information session plus home deliveries (INFO+DELIV) to increase coverage of IFA supplementation and intermittent preventive treatment in pregnancy (IPTp), and their effectiveness on postpartum anaemia and malaria infection.

Methods

We included 118 clusters randomised to a control (39), INFO (39) and INFO+DELIV (40) arm, in a trial conducted between 2020 and 2021 with pregnant women (age ≥15 years) in their first or second trimester of pregnancy in Taabo, Côte d’Ivoire. We used generalised linear regression models to assess intervention impact in postpartum anaemia and malaria parasitaemia, and displayed resulting estimates as prevalence ratios.

Results

Overall, 767 pregnant women were enrolled and 716 (93.3%) were followed up after delivery. Neither intervention had an impact on postpartum anaemia, with estimated adjusted prevalence ratios (aPRs) of 0.97 (95% CI 0.79 to 1.19, p=0.770) for INFO and 0.87 (95% CI 0.70 to 1.09, p=0.235) for INFO+DELIV. While INFO had no effect on malaria parasitaemia (aPR=0.95, 95% CI 0.39 to 2.31, p=0.915), INFO+DELIV reduced malaria parasitaemia by 83% (aPR=0.17, 95% CI 0.04 to 0.75, p=0.019). No improvements in antenatal care (ANC) coverage (aPR=1.05, 95% CI 0.81 to 1.36, p=0.692), IFA (aPR=2.00, 95% CI 0.89 to 4.46, p=0.093) and IPTp (aPR=1.03, 95% CI 0.87 to 1.21, p=0.728) compliance were found for INFO. INFO+DELIV increased ANC attendance (aPR=1.35, 95% CI 1.02 to 1.78, p=0.037) and compliance with IPTp (aPR=1.60, 95% CI 1.41 to 1.80, p<0.001) and IFA recommendations (aPR=7.06, 95% CI 3.68 to 13.51, p<0.001).

Conclusions

INFO+DELIV can substantially increase compliance with IFA supplementation and improve malaria prevention. However, the increases in IFA supplementation are likely insufficient to address the prevalence of often severe anaemia in this population.

Trial registration number

NCT04250428.
What is the role of primary care in the COVID-19 vaccine roll-out and the barriers and facilitators to an equitable vaccine roll-out? A rapid scoping review of nine jurisdictions
Authors: Aggarwal Monica , Kokorelias Kristina Marie , Glazier Richard H , Katz Alan , Shiers-Hanley Jessica E , Upshur Ross E G
Published: April 2023

Objectives

This study aimed to: (1) examine the experience of nine global jurisdictions that engaged primary care providers (PCPs) to administer COVID-19 vaccines during the pandemic; (2) describe how vaccine hesitancy and principles of equity were incorporated in the COVID-19 vaccine roll-out strategies and (3) identify the barriers and facilitators to the vaccine roll-out.

Design

Rapid scoping review.

Data sources

Searches took place in MEDLINE, CINAHL, Embase, the Cochrane Library, SCOPUS and PsycINFO, Google, and the websites of national health departments. Searches and analyses took place from May 2021 to July 2021.

Results

Sixty-two documents met the inclusion criteria (35=grey literature; 56% and 27=peer reviewed; 44%). This review found that the vaccine distribution approach started at hospitals in almost all jurisdictions. In some jurisdictions, PCPs were engaged at the beginning, and the majority included PCPs over time. In many jurisdictions, equity was considered in the prioritisation policies for various marginalised communities. However, vaccine hesitancy was not explicitly considered in the design of vaccine distribution approaches. The barriers to the roll-out of vaccines included personal, organisational and contextual factors. The vaccine roll-out strategy was facilitated by establishing policies and processes for pandemic preparedness, well-established and coordinated information systems, primary care interventions, adequate supply of providers, education and training of providers, and effective communications strategy.

Conclusions

Empirical evidence is lacking on the impact of a primary care-led vaccine distribution approach on vaccine hesitancy, adoption and equity. Future vaccine distribution approaches need to be informed by further research evaluating vaccine distribution approaches and their impact on patient and population outcomes.
Primary care provider interventions for addressing cancer screening participation with marginalised patients: a scoping review protocol
Authors: Ruco Arlinda , Cernat Alexandra , Calleja Sabine , Tinmouth Jill , Lofters Aisha K
Published: April 2023

Introduction

Cancer screening is an integral component of primary care, and providers can play a key role in facilitating screening. While much work has focused on patient interventions, there has been less attention on primary care provider (PCP) interventions. In addition, marginalised patients experience disparities in cancer screening which are likely to worsen if not addressed. The objective of this scoping review is to report on the range, extent and nature of PCP interventions that maximise cancer screening participation among marginalised patients. Our review will target cancers where there is strong evidence to support screening, including lung, cervical, breast and colorectal cancers.

Methods and analysis

This is a scoping review conducted in accordance with the framework by Levacet al. Comprehensive searches will be conducted by a health sciences librarian using Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Complete and the Cochrane Central Register of Controlled Trials. We will include peer-reviewed English language literature published from 1 January 2000 to 31 March 2022 that describes PCP interventions to maximise cancer screening participation for breast, cervical, lung and colorectal cancers. Two independent reviewers will screen all articles and identify eligible studies for inclusion in two stages: title and abstract, then full text. A third reviewer will resolve any discrepancies. Charted data will be synthesised through a narrative synthesis using a piloted data extraction form informed by the Template for Intervention Description and Replication checklist.

Ethics and dissemination

Since this is a synthesis of digitally published literature, no ethics approval is needed for this work. We will target appropriate primary care or cancer screening journals and conference presentations to publish and disseminate the results of this scoping review. The results will also be used to inform an ongoing research study developing PCP interventions for addressing cancer screening with marginalised patients.
Exploring gender dysphoria and related outcomes in a prospective cohort study: protocol for the Swedish Gender Dysphoria Study (SKDS)
Authors: Özel Fatih , Indremo Malin , Karamanis Georgios , Elofsson Ulf , Beckman Ulrika , Fazekas Attila , Frisén Louise , Isaksson Magnus , Sandström Lotta , Thelin Nils , Tivesten Åsa , Wahlberg Jeanette , Skalkidou Alkistis , Bodlund Owe , Papadopoulos Fotios C
Published: April 2023

Introduction

There has been a drastic increase in the reported number of people seeking help for gender dysphoria in many countries over the last two decades. Yet, our knowledge of gender dysphoria and related outcomes is restricted due to the lack of high-quality studies employing comprehensive approaches. This longitudinal study aims to enhance our knowledge of gender dysphoria; different aspects will be scrutinised, focusing primarily on the psychosocial and mental health outcomes, prognostic markers and, secondarily, on the underlying mechanisms for its origin.

Methods and analysis

The Swedish Gender Dysphoria Study is an ongoing multicentre longitudinal cohort study with 501 registered participants with gender dysphoria who are 15 years old or older. Participants at different phases of their clinical evaluation process can enter the study, and the expected follow-up duration is three years. The study also includes a comparison group of 458 age- and county-matched individuals without gender dysphoria. Data on the core outcomes of the study, which are gender incongruence and experienced gender dysphoria, body satisfaction and satisfaction with gender-affirming treatments, as well as other relevant outcomes, including mental health, social functioning and life satisfaction, are collected via web surveys. Two different research visits, before and after starting on gender-affirming hormonal treatment (if applicable), are planned to collect respective biological and cognitive measures. Data analysis will be performed using appropriate biostatistical methods. A power analysis showed that the current sample size is big enough to analyse continuous and categorical outcomes, and participant recruitment will continue until December 2022.

Ethics and dissemination

The ethical permission for this study was obtained from the Local Ethical Review Board in Uppsala, Sweden. Results of the study will be presented at national and international conferences and published in peer-reviewed journals. Dissemination will also be implemented through the Swedish Gender Dysphoria Study network in Sweden.
Brain responses to food viewing in women during pregnancy and post partum and their relationship with metabolic health: study protocol for the FOODY Brain Study, a prospective observational study
Authors: Lesniara-Stachon Anna , Quansah Dan Yedu , Schenk Sybille , Retsa Chrysa , Halter Ryan J , Murray Micah M , Lacroix Alain , Horsch Antje , Toepel Ulrike , Puder Jardena J
Published: April 2023

Introduction

Food cravings are common in pregnancy and along with emotional eating and eating in the absence of hunger, they are associated with excessive weight gain and adverse effects on metabolic health including gestational diabetes mellitus (GDM). Women with GDM also show poorer mental health, which further can contribute to dysregulated eating behaviour. Food cravings can lead to greater activity in brain centres known to be involved in food ‘wanting’ and reward valuation as well as emotional eating. They are also related to gestational weight gain. Thus, there is a great need to link implicit brain responses to food with explicit measures of food intake behaviour, especially in the perinatal period. The aim of this study is to investigate the spatiotemporal brain dynamics to visual presentations of food in women during pregnancy and in the post partum, and link these brain responses to the eating behaviour and metabolic health outcomes in women with and without GDM.

Methods and analysis

This prospective observational study will include 20 women with and 20 without GDM, that have valid data for the primary outcomes. Data will be assessed at 24–36 weeks gestational age and at 6 months post partum. The primary outcomes are brain responses to food pictures of varying carbohydrate and fat content during pregnancy and in the post partum using electroencephalography. Secondary outcomes including depressive symptoms, current mood and eating behaviours will be assessed with questionnaires, objective eating behaviours will be measured using Auracle and stress will be measured with heart rate and heart rate variability (Actiheart). Other secondary outcome measures include body composition and glycaemic control parameters.

Ethics and dissemination

The Human Research Ethics Committee of the Canton de Vaud approved the study protocol (2021-01976). Study results will be presented at public and scientific conferences and in peer-reviewed journals.
Primary healthcare needs and service utilisation of people with disability: a data linkage protocol
Authors: Douglas Jacinta , Winkler Di , McLeod Adam , Oliver Stacey , Gardner Karina , Supple Jamie , Pearce Christopher
Published: April 2023

Introduction

General practitioners (GPs) play a crucial role in the early management and treatment of the comorbidities and complications experienced by people with disability. However, GPs experience multiple constraints, including limited time and disability-related expertise. Knowledge gaps around the health needs of people with disability as well as the frequency and extent of their engagement with GPs mean evidence to inform practice is limited. Using a linked dataset, this project aims to enhance the knowledge of the GP workforce by describing the health needs of people with disability.

Methods and analysis

This project is a retrospective cohort study using general practice health records from the eastern Melbourne region in Victoria, Australia. The research uses Eastern Melbourne Primary Health Network (EMPHN)-owned de-identified primary care data from Outcome Health’s POpulation Level Analysis and Reporting Tool (POLAR). The EMPHN POLAR GP health records have been linked with National Disability Insurance Scheme (NDIS) data. Data analysis will involve comparisons across disability groups and the rest of the population to explore utilisation (eg, frequency of visits), clinical and preventative care (eg, cancer screening, blood pressure readings) and health needs (eg, health conditions, medications). Initial analyses will focus on NDIS participants as a whole and NDIS participants whose condition is either an acquired brain injury, stroke, spinal cord injury, multiple sclerosis or cerebral palsy, as classified by the NDIS.

Ethics and dissemination

Ethics approval was obtained from the Eastern Health Human Research Ethics Committee (E20/001/58261), and approval for the general collection, storage and transfer of data was from the Royal Australian College of General Practitioners National Research Ethics and Evaluation Committee (protocol ID: 17-088). Dissemination mechanisms will include the engagement of stakeholders through reference groups and steering committees, as well as the production of research translation resources in parallel with peer-reviewed publications and conference presentations.
COVID-19 vaccine effectiveness and variants in Nepal: study protocol for a test-negative case–control study with SARS-CoV-2 genetic sequencing
Authors: Bijukchhe Sanjeev M , O'Reilly Peter J , Theiss-Nyland Katherine , Gurung Meeru , Pokhrel Bhishma , Kelly Sarah , Acharya Samita , Maharjan Shreekrishna , Shrestha Ashis , Pandey Bimal , Lama Mipsang , Shrestha Ira , Voysey Merryn , Eordogh Agnes , Shrestha Sonu , Feng Elaine Shuo , Li Grace , Shah Ganesh , Pollard Andrew J , Shrestha Shrijana
Published: April 2023

Introduction

Inactivated, viral vector and mRNA vaccines have been used in the Nepali COVID-19 vaccination programme but there is little evidence on the effectiveness of these vaccines in this setting. The aim of this study is to describe COVID-19 vaccine effectiveness in Nepal and provide information on infections with SARS-CoV-2 variants.

Methods and analysis

This is a hospital-based, prospective test-negative case–control study conducted at Patan Hospital, Kathmandu. All patients >18 years of age presenting to Patan Hospital with COVID-19-like symptoms who have received a COVID-19 antigen/PCR test are eligible for inclusion. The primary outcome is vaccine effectiveness of licensed COVID-19 vaccines against laboratory-confirmed COVID-19 disease.

After enrolment, information will be collected on vaccine status, date of vaccination, type of vaccine, demographics and other medical comorbidities. The primary outcome of interest is laboratory-confirmed SARS-CoV-2 infection. Cases (positive for SARS-CoV-2) and controls (negative for SARS-CoV-2) will be enrolled in a 1:4 ratio. Vaccine effectiveness against COVID-19 disease will be analysed by comparing vaccination status with SARS-CoV-2 test results.

Positive SARS-CoV-2 samples will be sequenced to identify circulating variants and estimate vaccine effectiveness against common variants.

Measuring vaccine effectiveness and identifying SARS-CoV-2 variants in Nepal will help to inform public health efforts. Describing disease severity in relation to specific SARS-CoV-2 variants and vaccine status will also inform future prevention and care efforts.

Ethics and dissemination

Ethical approval was obtained from the University of Oxford Tropical Ethics Committee (OxTREC) (ref: 561-21) and the Patan Academy of Health Sciences Institutional Review Board (ref: drs2111121578). The protocol and supporting study documents were approved for use by the Nepal Health Research Council (NHRC 550-2021). Results will be disseminated in peer-reviewed journals and to the public health authorities in Nepal.
What is complexity of hospital-based physiotherapy from the perspective of physiotherapists themselves? A grounded theory study
Authors: de Zwart Lieven , Koenders Niek , Steenbruggen Rudi , Nijhuis-van der Sanden Ria , Hoogeboom Thomas J
Published: April 2023

Background

The concept of ‘complexity’ is widely used by healthcare professionals in patient care. However, it is not completely understood. The inappropriate use and incorrect understanding of complexity lead to ambiguity for hospital-based physiotherapists in dealing with complex patients and work situations.

Objectives

To develop an understanding of complexity for hospital-based physiotherapy from the perspective of physiotherapists themselves.

Design

A grounded theory study was conducted using data from face-to-face, semi-structured interviews with purposive sampled hospital-based physiotherapists. The sampling was used to incorporate variety in hospital work experience, field of expertise and gender. The interviews were conducted in three different types of Dutch hospitals. A conceptual model and grounded theory were constructed after open, axial and selective coding.

Results

Twenty-four hospital-based physiotherapists were interviewed. Two core themes emerged from the data: ‘puzzle-solving’ and ‘reflecting on decisions’. The third theme—‘relationship between learning, adapting and complexity’—describes how hospital-based physiotherapists’ perceptions of complexity change over time. Complexity as a construct was interpreted as the balance between context and patient-related factors on the one hand and therapist-related factors on the other.

Conclusions

Hospital-based physiotherapists encounter complexity during performing job-related activities and decision-making. Complexity depends on balancing context and patient-related factors and therapist-related factors. In hospital-based physiotherapy, it was perceived as challenging yet meaningful. Complexity contributes to becoming more competent and, as such, a balance between complex and non-complex activities should be sought for hospital-based physiotherapists.
Direct active rehabilitation after reverse total shoulder arthroplasty: an international multicentre prospective cohort safety study with 1-year follow up
Authors: Kornuijt Anke , de Vries Lieke , van der Weegen Walter , Hillen Robert Jan , Bogie Rob , Stokman Remco , van Kampen Derk
Published: April 2023

Objectives

To gain insight in the safety of direct active rehabilitation without immobilisation in patients undergoing reverse total shoulder arthroplasty without subscapularis reattachment, measured by the occurrence of complications until 1-year follow up. Next, to explore improvement in shoulder function and in patient-reported outcome measures.

Design

An international multicentre prospective cohort safety study.

Setting

Patients indicated for reverse total shoulder arthroplasty, visiting the orthopaedics outpatient clinic at two hospitals in the Netherlands and one hospital in Curaçao between January 2019 and July 2021, were selected.

Participants

100 patients (68% female, mean age 74±7.0 years) undergoing unilateral primary shoulder replacement were included if: ≥50 years, diagnosed with shoulder osteoarthritis, rotator cuff arthropathy or avascular necrosis, and selected for reverse total shoulder arthroplasty. A sling was used for only 1 day, followed by a progressive active rehabilitation for ≥12 weeks with no precautions.

Main outcome measures

Complications, range of motion and patient-reported outcome measures (Oxford Shoulder Score, Pain Numeric Rating Scale and EuroQol-5D for quality of life). Patients were evaluated preoperatively and 6 weeks, 3 months and 1 year postoperatively.

Results

In total, 17 complications were registered (17.0%) including five (5.0%) categorised as potentially related to the rehabilitation strategy: one dislocation, one acromion fracture and three cases with persistent pain. Anteflexion, abduction and external rotation, pain scores and the Oxford Shoulder Score all improved significantly (p<0.05) at all time points compared with preoperative. Quality of life improved significantly from 3 months onwards. These secondary outcomes improved further until 1 year postoperatively.

Conclusion

Direct active rehabilitation after reverse total shoulder arthroplasty seems to be safe and effective. Potentially, this approach will lead to less dependent patients and faster recovery. Larger studies, preferably including a control group, should corroborate our results.

Trial registration number

NL7656.
Dominant neoantigen verification in hepatocellular carcinoma by a single-plasmid system coexpressing patient HLA and antigen
Authors: Chen Pu , Chen Dongbo , Bu Dechao , Gao Jie , Qin Wanying , Deng Kangjian , Ren Liying , She Shaoping , Xu Wentao , Yang Yao , Xie Xingwang , Liao Weijia , Chen Hongsong
Published: April 2023

Background

Previous studies confirmed that most neoantigens predicted by algorithms do not work in clinical practice, and experimental validations remain indispensable for confirming immunogenic neoantigens. In this study, we identified the potential neoantigens with tetramer staining, and established the Co-HA system, a single-plasmid system coexpressing patient human leukocyte antigen (HLA) and antigen, to detect the immunogenicity of neoantigens and verify new dominant hepatocellular carcinoma (HCC) neoantigens.

Methods

First, we enrolled 14 patients with HCC for next-generation sequencing for variation calling and predicting potential neoantigens. Then, the Co-HA system was established. To test the feasibility of the system, we constructed target cells coexpressing HLA-A*11:01 and the reportedKRASG12D neoantigen as well as specific T-cell receptor (TCR)-T cells. The specific cytotoxicity generated by this neoantigen was shown using the Co-HA system. Moreover, potential HCC-dominant neoantigens were screened out by tetramer staining and validated by the Co-HA system using methods including flow cytometry, enzyme-linked immunospot assay and ELISA. Finally, antitumor test in mouse mode and TCR sequencing were performed to further evaluate the dominant neoantigen.

Results

First, 2875 somatic mutations in 14 patients with HCC were identified. The main base substitutions were C>T/G>A transitions, and the main mutational signatures were 4, 1 and 16. The high-frequency mutated genes includedHMCN1,TTNandTP53. Then, 541 potential neoantigens were predicted. Importantly, 19 of the 23 potential neoantigens in tumor tissues also existed in portal vein tumor thrombi. Moreover, 37 predicted neoantigens restricted by HLA-A*11:01, HLA-A*24:02 or HLA-A*02:01 were performed by tetramer staining to screen out potential HCC-dominant neoantigens. HLA-A*24:02-restricted epitope 5'-FYAFSCYYDL-3' and HLA-A*02:01-restricted epitope 5'-WVWCMSPTI-3' demonstrated strong immunogenicity in HCC, as verified by the Co-HA system. Finally, the antitumor efficacy of 5'-FYAFSCYYDL-3'-specific T cells was verified in the B-NDG-B2mtm1Fcrntm1(mB2m)mouse and their specific TCRs were successfully identified.

Conclusion

We found the dominant neoantigens with high immunogenicity in HCC, which were verified with the Co-HA system.
Barriers to immune cell infiltration in tumors
Authors: Melssen Marit M , Sheybani Natasha D , Leick Katie M , Slingluff Craig L
Published: April 2023

Increased immune cell infiltration into tumors is associated with improved patient survival and predicts response to immune therapies. Thus, identification of factors that determine the extent of immune infiltration is crucial, so that methods to intervene on these targets can be developed. T cells enter tumor tissues through the vasculature, and under control of interactions between homing receptors on the T cells and homing receptor ligands (HRLs) expressed by tumor vascular endothelium and tumor cell nests. HRLs are often deficient in tumors, and there also may be active barriers to infiltration. These remain understudied but may be crucial for enhancing immune-mediated cancer control. Multiple intratumoral and systemic therapeutic approaches show promise to enhance T cell infiltration, including both approved therapies and experimental therapies. This review highlights the intracellular and extracellular determinants of immune cell infiltration into tumors, barriers to infiltration, and approaches for intervention to enhance infiltration and response to immune therapies.
A randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of a bupivacaine hydrochloride implant in patients undergoing abdominoplasty
Authors: Beaton Alina C , Solanki Daneshvari , Salazar Hernan , Folkerth Steve , Singla Neil , Minkowitz Harold S , Leiman David , Vaughn Ben , Skuban Nina , Niebler Gwendolyn
Published: April 2023

Introduction

Surgical site infiltration with bupivacaine hydrochloride (HCl) is a standard element of postoperative analgesia for soft tissue surgeries, but results in short-lived analgesia. A novel bupivacaine implant, XARACOLL (bupivacaine HCl), is Food and Drug Administration approved for treatment of acute postsurgical pain following adult inguinal herniorrhaphy. This study examined the efficacy and safety of the bupivacaine implant (300 mg) compared with placebo for postsurgical pain after abdominoplasty.

Methods

In this double-blind, placebo-controlled study, patients undergoing abdominoplasty were randomized to three 100 mg bupivacaine implants or three placebo collagen implants, in a 1:1 ratio, implanted intraoperatively. No other analgesics were administered into the surgical site. Patients were allowed opioids and acetaminophen for postoperative pain. Patients were followed for up to 30 days after treatment. Primary outcome: the analgesic effect of the bupivacaine implants through 24 hours postsurgery, measured by the sum of time-weighted pain intensity (SPI24). Prespecified key secondary outcomes included SPI48 and SPI72, percentage of opioid-free patients through 24, 48, and 72 hours, and adverse events, which were tested sequentially to control for multiplicity (ie, if the first variable failed to reach significance, no subsequent variables were declared statistically significant).

Results

The bupivacaine implant patients (n=181) reported statistically significant lower SPI24 (mean (SD) SPI24=102 (43), 95% CI 95 to 109) compared with placebo patients (n=184; SPI24=117 (45), 95% CI 111 to 123, p=0.002). SPI48 was 190 (88, 95% CI 177 to 204) for INL-001 and 206 (96, 95% CI 192 to 219) for placebo, and not significantly different between groups. The subsequent secondary variables were therefore declared not statistically significant. SPI72 was 265 (131, 95% CI 244 to 285) for INL-001 and 281 (146, 95% CI 261 to 301) for placebo. The opioid-free percentage of patients at 24, 48, and 72 hours was 19%, 17%, and 17% for INL-001 and 6.5% for placebo patients (at all timepoints). The only adverse event occurring in ≥5% of patients and for which proportion INL-001 >placebo was back pain (7.7% vs 7.6%).

Conclusion

The study design was limited by not containing an active comparator. Compared with placebo, INL-001 provides postoperative analgesia that is temporally aligned with the period of maximal postsurgical pain in abdominoplasty and offers a favorable safety profile.

Trial registration number

NCT04785625.
Heart failure symptom burden in outpatient cardiology: observational cohort study
Authors: Walsh Maria , Bowen Elizabeth , Vaughan Carl , Kiely Fiona
Published: April 2023

Objectives

To assess the self-reported symptom burden in patients with a diagnosis of heart failure attending an outpatient cardiology clinic through the utilisation of validated patient-reported outcome measures.

Methods

Eligible patients were invited to partake in this observational cohort study. Participant demographics and comorbidities were recorded, followed by participants recording their symptoms using the Integrated Palliative care Outcome Scale (IPOS) and Brief Pain Inventory (BPI) outcome measure tools.

Results

A total of 22 patients were included in the study. The majority were male (n=15). The median age was 74.5 (range 55–94) years. Atrial fibrillation and hypertension were the most common comorbidities (n=10). Dyspnoea, weakness and poor mobility were the most prevalent symptoms, affecting 15 (68%) of the 22 patients. Dyspnoea was reported as being the most troublesome symptom. The BPI was completed by 68% (n=15) of the study participants. Median average pain score was 5/10; median worst pain score in the preceding 24 hours was 6/10 and median pain score at time of BPI completion was 3/10. The impact of pain on daily living during the preceding 24 hours ranged from impacting on all activities (n=7) to not impacting on activities (n=1).

Conclusions

Patients with heart failure experience a range of symptoms that vary in severity. Introduction of a symptom assessment tool in the cardiology outpatient setting could help identify patients with a high symptom burden and prompt timely referral to specialist palliative care services.
Reproductive biology of Caryocar brasiliense (Caryocaraceae) in preserved and degraded Cerrado areas in Brazil
Authors: Roque Stephanie Q. , Falcão Luiz A. D. , Rech André R. , Silva Jhonathan O. , Oliveira Priscila S. , Ferreira Kleiperry F. , do Espírito-Santo Mário M.
Published: April 2023

This study aimed to characterize the reproductive system and determine the importance of pollinators for fruit production of Caryocar brasiliense, an economically important tree, in preserved and degraded Cerrado areas in southeastern Brazil. For this purpose, we performed pollinator exclusion experiments to determine the frequency of self- and cross-pollination, and to determine fruit set. In general, fruit set was extremely low; only 2.92% and 2.71% of the flowers developed into fruits in the degraded and preserved areas, respectively. Fruit sets by manual cross-pollination and natural (open) pollination were higher than self-pollination in both areas. Pollen deposition was significantly higher at night and in the preserved area, although a relatively high amount of pollen grains is found in the stigmas during the day. The number of ripened and aborted seeds did not differ among areas, but fruits and seeds were heavier in the degraded area than in the preserved area. The abortion level was very high (64.5%), which may be related to low pollen quality due to selfing. Our study presents evidence that Cerrado degradation affects the reproductive biology of C. brasiliense, but whether such effect is a consequence of pollinator decline in degraded areas remains to be determined.
Illustration of Joule dissipation on the time-dependent stagnation point flow of nanofluid through a porous surface
Authors: Mishra S. R. , Sharma Ram Prakash , Swain Laxmipriya
Published: April 2023

The proposed flow problem is to analyze the behavior of dissipative heat on the time-dependent stagnation motion of nanofluids through a permeable surface. A novel approach to thermal buoyancy through the permeable medium enriches the flow properties. In the recent industrial applications for the cooling processes of the device, like the physiological application of the blood flow inside the capillary tube-like artery, drug delivery system, etc., the role of nanofluid is crucial. The proposed model equipped with various physical properties is used to design and subsequent transformation into a non-dimensional form is obtained for a set of similarity variables. Proposed models with different physical properties are designed and subsequent dimensionless transformations are obtained for a similar set of variables. In addition, shooting based Runge-Kutta fourth-order numerical technique is used to solve boundary value problems for nonlinear ordinary systems. The characteristics of the diversified quantities are presented graphically as well as numerically on the flow profile and other profiles. Furthermore, statistical approaches such as t-tests for simulated results of rate coefficients are also presented and validated with the obtained results. However, the important outcomes are presented as; the fluid velocity is controlled by the inclusion of the particle concentration as well as the magnetic parameter further the particle concentration and the dissipative heat encountered by the inclusion of Eckert number enhances the fluid temperature.
Spherical Heisenberg flux of magnetic Heisenberg optical ferromagnetic model
Authors: Körpinar Talat , Körpinar Zeliha
Published: April 2023

In this paper, we introduce optical normalized spherical Heisenberg total ferromagnetic recursional flux of Heisenberg spherical [Formula: see text]-particle with electromagnetic microscale in Heisenberg spherical space [Formula: see text]. Hence, we investigate the properties of spherical Heisenberg normalized electromagnetic microscale by ferromagnetic recursional model. Also, we study optical normalized spherical ferromagnetic Heisenberg recursional density with normalized ferromagnetic microscale for spherical Heisenberg [Formula: see text]-fiber in spherical Heisenberg space [Formula: see text]. Finally, we obtain spherical Heisenberg sonic crystal of spherical Heisenberg [Formula: see text]-fiber with spherical Heisenberg normalized microscale.
Rogue wave solutions over double-periodic wave background of a fifth-order nonlinear Schrödinger equation with quintic terms
Authors: Sinthuja N. , Senthilvelan M.
Published: April 2023

Studies on rogue waves (RWs) over constant and periodic wave background are of contemporary interest in several areas of physics. These RWs arise not only on such backgrounds but also appear on double-periodic wave background. In this paper, we derive RW solutions over a double-periodic wave background of a fifth-order nonlinear Schrödinger equation. We create the double-periodic wave background with elliptic functions (in combinations of cn, sn and dn) as seed solutions in the first iteration of Darboux transformation. We then calculate the growth rate of instability for these double-periodic solutions under different values of elliptic modulus parameter. On the top of these background waves, we generate RWs with the help of second independent solution to the eigenvalue problem. Further, we analyze the differences that occur in the appearance of RWs with reference to the lower-order and higher-order dispersions terms. In addition to the above, we examine the derived solutions in detail for certain system and elliptic modulus parameter values and highlight some interesting features that we obtain from our studies.
On the higher-order Heisenberg spin system with quintic terms in self-consistent potential
Authors: Ge Jingjing , Li Chuanzhong
Published: April 2023

The integrable higher-order Heisenberg spin system with quintic terms in self-consistent potential (HHSQ) is an extension of Heisenberg ferromagnetic equations. In this paper, we calculate the Lax expression of the HHSQ system, then the motioning curves in [Formula: see text] dimension of Heisenberg ferromagnetic equations have been discussed. The Darboux transformation of the HHSQ system is constructed and a set of soliton solutions will be demonstrated by Darboux transformation.
Heat transport phenomenon of the MHD water-based hybrid nanofluid flow over a rotating disk with velocity slips
Authors: Algehyne Ebrahem A. , Haq Izharul , Raizah Zehba , Alduais Fuad S. , Saeed Anwar , Galal Ahmed M.
Published: April 2023

The present investigation computes the heat transport phenomenon of the magnetohydrodynamic (MHD) flow of CuO-Ag/H2O hybrid nanofluid over a spinning disc. The authors are confident that there is very less analysis covering the fluid flow containing silver and copper oxide nanoparticles over a rotating disk. Therefore, the authors are interested to consider the water-based nanoliquid flow over a spinning disk. Furthermore, the velocity slip and thermal convective conditions are taken into consideration. The formulation of the problem is made in the form of PDEs and is then converted into the nonlinear ODEs by employing suitable similarity transformations. The homotopic analysis approach is applied for the semi-analytical solution of these resulting equations. The convergence of homotopic approach has also revealed with the help of figure. The performance of the hybrid nanofluid flow velocities and temperature has been shown in a graphical form against distinct flow parameters. Also, the numerical results of skin friction coefficient and Nusselt number have been calculated in a tabular form. The outcomes of the current problem show that the increase in the skin friction of the water-based copper oxide nanofluid is greater than the water-based silver nanofluid at 4% of the nanoparticle volume fraction. Also, the skin friction of the hybrid nanofluid is increased by 8% compared to the silver nanofluid at 4% of the nanoparticle volume fraction. Furthermore, the heat transfer rate of the water-based copper oxide nanofluid is greater than the water-based silver nanofluid at 4% of the nanoparticle volume fraction. Also, the heat transfer rate of the hybrid nanofluid is 52% greater than that of silver nanofluid at 4% of the nanoparticle volume fraction. It is found that the Nusselt number of the hybrid nanofluid is highly affected by the embedded parameters as compared to nanofluids.
COMPLEXITY-BASED DECODING OF THE BRAIN REACTIONS TO VISUAL STIMULI WITH DIFFERENT FREQUENCIES
Authors: PARTHASARATHY SRIRAM , RAJAGOPAL KARTHIKEYAN , KREJCAR ONDREJ , FRISCHER ROBERT , NAMAZI HAMIDREZA
Published: April 2023

Analysis of the brain activity to external stimulation is an important area of research in biomedical engineering. In this paper, for the first time, we analyzed the brain reaction to visual stimuli with different frequencies using three complexity methods. For this purpose, we utilized fractal theory, sample entropy, and approximate entropy to study the variations of the complexity EEG signals while subjects received visual stimuli at 7, 9, 11, and 13 Hz. The results showed that, in general, by moving from 9 Hz to 13 Hz stimuli, the complexity of EEG signals increases, except in the case of 11 Hz stimulus. The statistical analysis also supported the results of the analysis. The conducted analysis in this research can be performed in the case of other types of external stimuli to study how the brain reacts in different conditions.
South Korea in 2022: Aspiring to Become a Global Pivotal State?
Authors: RYU Yongwook
Published: April 2023

South Korea aspires to become a global pivotal state and aims to play a greater role in the promotion of the existing liberal order. The central axis of this foreign policy is the ROK–US alliance, which will bring Seoul closer to Washington and Tokyo and will likely increase friction with Beijing and Pyongyang during the Yoon Suk-yeol administration.
North Korea’s Nuclear Armament: Assessment of 2022 and Outlook of 2023
Authors: KIM Sung Chull
Published: April 2023

North Korea’s missile firings aim at proving technological advancement before deploying the weapons in the field units, as well as demonstrating a show of force to the United States and its allies. These costly firings are financed by earnings from illegal cyberactivities and arms sales. North Korea’s nuclear threat has strengthened Seoul–Washington–Tokyo cooperation and has increasingly gained public support in South Korea towards the idea of possessing their own bombs.