bluuebunny/crossref_metadata_2025 huggingface dataset:
Early virologic relapse predicts alanine aminotransferase flares after nucleos(t)ide analogue withdrawal in patients with chronic hepatitis B
Authors: Liem Kin Seng , Chi Heng , Fung Scott , Wong David K. , Yim Colina , Noureldin Seham , Chen Jiayun , de Man Robert A. , Sarowar Arif , Feld Jordan J. , Hansen Bettina E. , Hou Jinlin , Peng Jie , Janssen Harry L. A.
Published: September 2022

When patients with chronic hepatitis B (CHB) stop nucleos(t)ide analogue (NA) therapy before achieving HBsAg loss, flares often ensue which are challenging to predict early. We determined the incidence, severity, outcome and predictors of flares after NA withdrawal. Forty‐five patients enrolled in an RCT were included; 107 patients from an external, prospective cohort were used for validation. Retreatment criteria were pre‐defined. Pre‐ and post‐treatment predictors of alanine aminotransferase (ALT) flare (>5× ULN) were evaluated by Cox proportional‐hazards regression. Seventy‐two weeks after NA withdrawal, 23/45 (51%) patients had developed >5× ULN and 14 (31%) >20× ULN. Median time to develop ALT >5× ULN was 12 weeks after NA withdrawal. Independent predictors of ALT >5× ULN were male sex (HR [95% CI] 3.2 [1.2–8.9]; p = 0.03) and serum HBV DNA (1.2 [1.0–1.8]; p = 0.03) at Week 6 off‐therapy. Specifically, week 6 HBV DNA >10,000 IU/ml predicted ALT >5× ULN (3.4 [1.4–8.4]; p = 0.01), which was externally validated. In conclusion, this study on post‐treatment flares revealed a high cumulative incidence in CHB. Week 6 HBV DNA >10,000 IU/ml independently predicted flares. The proposed threshold enables prediction of imminent flares in patients who may benefit from closer monitoring and earlier retreatment.
Outcomes of de novo belatacept‐based immunosuppression regimen and avoidance of calcineurin inhibitors in recipients of kidney allografts at higher risk for underutilization
Authors: Patel Ankita , Shertel Tara , Wynd Michael , Wadhera Vikram , Serur David , Schleich Benjamin , Yushkov Yuriy , Goldstein Michael
Published: September 2022

To describe an experience using a protocol using de novo belatacept (DNB) based maintenance immunosuppression in the setting of lymphocyte depletion. A retrospective, observational study was performed on 37 kidney transplant recipients treated with the DNB protocol, which was defined as belatacept initiated within 7 days after a kidney transplant with steroids and mycophenolate with anti‐thymocyte globulin (ATG) induction without concomitant calcineurin inhibitors (CNIs). Patients who received a deceased donor kidney meeting one or more of the following criteria: anticipated cold ischemia time (CIT) greater than 24 h, donation after cardiac death, donor acute kidney injury, and a Kidney Donor Profile Index (KDPI) >85% during the study period were included. Patient survival at 1 year was 97.3% and graft survival was 94.6%. Delayed graft function (DGF) occurred in 40.54% of the patients. Two patients experienced a Banff 1B acute cellular rejection. BK viremia was detected in 32.4% of patients. The mean estimated glomerular filtration rate (eGFR) calculated with the use of modification of diet in renal disease (MDRD) equation at 1 year in the study group was 54.7 ml/min/1.73 m2. We believe that utilization of the DNB protocol, which allows early CNI avoidance, may decrease organ discard rates.
On competitive balance in the group stage of the UEFA Champions League*
Authors: Triguero‐Ruiz Francisco , Avila‐Cano Antonio
Published: September 2022

This article examines competitive balance in the group stage of the UEFA Champions League over the last two decades (1999/2000–2017/2018). Competitive balance is considered both before and after a competition. Have the groups been designed in such a way as to ensure similar levels of competitive balance ex ante? Have the demonstrated strengths (ex post competitive balance) of the different groups been similar over each season? What is the relationship between the competitive balance in the designed groups and that achieved in the same groups after the competition? Are the performance achieved in terms of ex post competitive balance similar to ex ante competitive balance levels? We found that, despite expectations, the groups' ex ante competitive balance was not homogeneous. Although ex ante competitive balance serves as a good predictor, on average, of ex post competitive balance, we observed significant differences at the levels of group and seasons. Therefore, it is possible to improve the design mechanism of the groups that make up the group stage of the champions so that they are composed homogeneously in terms of ex ante competitive balance.
Political opportunity, democracy, and 40 years of protest, 1981–2020: A cross‐national analysis
Authors: Jami Waleed A. , Peoples Clayton
Published: September 2022

Objectives

: Political opportunity is considered an important factor in any kind of activism, as it represents the context or norms in which a movement operates. Much of the extant literature has focused on political opportunity on a case‐by‐case basis with little consistency in its operationalization. Our goal in this study is to build toward a generalizable measure of political opportunity. To do so, we measured opportunities as democracy and used data from 90+ countries over a 40‐year period, testing the long‐theorized inverse‐U relationship between opportunity and protest.

Methods

: We used all seven waves of the World Value Survey, which represents much of the world's countries, to examine the link between political opportunity and political behaviors (signing a petition, joining boycotts, and attending peaceful protests).

Results

: Results confirmed the inverse‐U effect on all three protest behaviors; that is, middle‐of‐the‐road democracies had the highest levels of protest participation, whereas the most representative and most repressive societies had the lowest levels of protest participation.

Conclusion

: Democracy can be used to represent important dimensions of political opportunity, as it was consistent with the long‐theorized inverse‐U. Moreover, our approach to using democracy, a cross‐national index, may serve as a stepping stone toward a unified and generalizable measure of political opportunity.
Neurodynamic Exercises in College Athletes With Musculoskeletal Pain: A Critically Appraised Topic
Authors: Hattrup Nicholas , Ohlemeyer Kacey , Schmidt Zachary , Gibb Emily , Pfeifer Nicholas
Published: September 2022

Clinical Scenario: Pain is a common complaint following an orthopedic injury; however, the exact cause of nociception can be complex. Multiple tissues can generate a patient’s complaint of pain, such as the skin, muscle, ligaments, tendon, nerves, and bones. Regarding the somatosensory system, inflammation around the nerve can create pain and alter movement coordination; this information has resulted in increased awareness of neurodynamic assessments and exercises. Neurodynamic assessments and exercises provide a unique paradigm to effectively assess and treat neural tissue, which may not commonly be considered within the traditional orthopedic examination. Clinical Question: In college athletes with musculoskeletal pain and activity impairments, does the use of neurodynamic exercises improve pain or function? Summary of Key Findings: Of the 5 studies, all consisted of chronic injuries with 3 involving upper-extremity pathologies and 2 focusing on lower-extremity pathologies. All 5 studies noted short- and long-term improvement following the incorporation of neurodynamic sliders or tensioners into the treatment plan. Four of the studies had follow-up periods greater than 30 days with sustained improvement on patient outcomes. Only 2 studies described a progression of neurodynamic exercises through sliders and tensioners. Three studies utilized a set/repetition format for exercise prescription, whereas a fourth used a time-based format, and a fifth article utilized both. Finally, 4 studies utilized neurodynamic assessments to identify whether there was a neural component to the patient’s presentation (eg, peripheral nerve mechanosensitivity). Clinical Bottom Line: In individuals with musculoskeletal impairments, evidence exists to support the use of neurodynamic exercises, such as sliders and tensioners, to improve pain and pain-related disability when neural sensitivity exists. Strength of Recommendation: Grade C evidence exists to support the use of neurodynamic exercises in college athletes with a musculoskeletal impairment.
The Impact of Sport Education on Physical Education Majors’ Basketball Content Knowledge and Performance
Authors: Liu Hairui , Shen Wei , Hu Anyi , Wang Wei , Li Wei , Hastie Peter A.
Published: September 2022

Purpose: To examine the consistency of findings between two studies examining the impact of sport education on Chinese physical education preservice teachers’ content knowledge and performance of volleyball and basketball. Methods: One hundred and six preservice teachers’ from a university in central China participated in six semester-long courses of basketball taught using either a Multi-Activity or Sport Education model of instruction. Pre- and postcourse measures of game performance were recorded for common content knowledge and specialized content knowledge. Results: After controlling for preintervention scores, statistically significant differences favoring Sport Education were found for common content knowledge as well as specialized content knowledge. Students in Sport Education had 62 times higher odds of reaching the specialized content knowledge benchmark depth for acceptable content development. Conclusion: These findings provide support for the idea that the accountability mechanisms specific to Sport Education, together with the tasks related to designing team training plans, serve to promote students’ ability to design and sequence tasks based on their team’s needs.
Insulin signaling in the long-lived reproductive caste of ants
Authors: Yan Hua , Opachaloemphan Comzit , Carmona-Aldana Francisco , Mancini Giacomo , Mlejnek Jakub , Descostes Nicolas , Sieriebriennikov Bogdan , Leibholz Alexandra , Zhou Xiaofan , Ding Long , Traficante Maria , Desplan Claude , Reinberg Danny
Published: September 2022

In most organisms, reproduction is correlated with shorter life span. However, the reproductive queen in eusocial insects exhibits a much longer life span than that of workers. In
Harpegnathos
ants, when the queen dies, workers can undergo an adult caste switch to reproductive pseudo-queens (gamergates), exhibiting a five-times prolonged life span. To explore the relation between reproduction and longevity, we compared gene expression during caste switching. Insulin expression is increased in the gamergate brain that correlates with increased lipid synthesis and production of vitellogenin in the fat body, both transported to the egg. This results from activation of the mitogen-activated protein kinase (MAPK) branch of the insulin signaling pathway. By contrast, the production in the gamergate developing ovary of anti-insulin Imp-L2 leads to decreased signaling of the AKT/forkhead box O (FOXO) branch in the fat body, which is consistent with their extended longevity.
Single-cell analyses of axolotl telencephalon organization, neurogenesis, and regeneration
Authors: Lust Katharina , Maynard Ashley , Gomes Tomás , Fleck Jonas Simon , Camp J. Gray , Tanaka Elly M. , Treutlein Barbara
Published: September 2022

Salamanders are tetrapod models to study brain organization and regeneration; however, the identity and evolutionary conservation of brain cell types are largely unknown. We delineated the cell populations in the axolotl telencephalon during homeostasis and regeneration using single-cell genomic profiling. We identified glutamatergic neurons with similarities to amniote neurons of hippocampus, dorsal and lateral cortex, and conserved γ-aminobutyric acid–releasing (GABAergic) neuron classes. We inferred transcriptional dynamics and gene regulatory relationships of postembryonic, region-specific neurogenesis and unraveled conserved differentiation signatures. After brain injury, ependymoglia activate an injury-specific state before reestablishing lost neuron populations and axonal connections. Together, our analyses yield insights into the organization, evolution, and regeneration of a tetrapod nervous system.
The “atmosphere” of the human body
Authors: Schoemaecker Coralie , Carslaw Nicola
Published: September 2022

A human-occupied indoor space shares many similarities with Earth and its atmosphere
Researchers tackle vexing side effects of potent cancer drugs
Authors: Couzin-Frankel Jennifer
Published: September 2022

Wider use of checkpoint inhibitor therapy spurs efforts to predict and treat immune complications
Development and Validation of a Nomogram for Prediction of QT Interval Prolongation in Patients Administered Bedaquiline-Containing Regimens in China: a Modeling Study
Authors: Liu Fangchao , Gao Jingtao , Gao Mengqiu , Liu Yuhong , Shu Wei , Xie Li , Sun Yuxian , Zhang Lijie , Li Liang , Pang Yu
Published: September 2022

Corrected QT duration (QTc) interval prolongation is the most frequent adverse event associated with bedaquiline (BDQ) use. It may affect the safety of antituberculosis therapy, which leads to the consequent demands of needing to monitor during therapy.
Draft Genome Sequences of the Kocuria subflava Type Strain KCTC 39547 and
Kocuria
sp. Strain JC486, a Newly Isolated Strain from a Wild Ass Sanctuary in Gujarat, India
Authors: Uppada Jagadeeshwari , Chintalapati Sasikala , K Karthika , Chintapati Venkata Ramana
Published: September 2022

Here, we report a 2.86-Mbp genome sequence of
Kocuria
sp. strain JC486, which was isolated from a salt marsh, and a 3.03-Mbp sequence of the type strain
Kocuria subflava
KCTC 39547. Prediction from their genomes indicates that both strains are nonpathogenic.
Joint association of food nutritional profile by Nutri-Score front-of-pack label and ultra-processed food intake with mortality: Moli-sani prospective cohort study
Authors: Bonaccio Marialaura , Di Castelnuovo Augusto , Ruggiero Emilia , Costanzo Simona , Grosso Giuseppe , De Curtis Amalia , Cerletti Chiara , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia
Published: September 2022

Objective

To jointly analyse two food dimensions, the Food Standards Agency Nutrient Profiling System (FSAm-NPS), used to derive the Nutri-Score front-of-pack label, and the NOVA classification in relation to mortality.

Design

Prospective cohort study.

Setting

Moli-sani Study, Italy 2005-10.

Participants

22 895 participants (mean age 55 (SD 12) years; 48% men).

Main outcomes measures

Associations between dietary exposures and mortality risk, assessed using multivariable cause specific Cox proportional hazard models controlled for known risk factors.

Results

A total of 2205 deaths occurred during 272 960 person years of follow-up. In the highest quarter of the FSAm-NPS index compared with the lowest quarter, multivariable adjusted hazard ratios for all cause and cardiovascular mortality were 1.19 (95% confidence interval 1.04 to 1.35; absolute risk difference 4.3%, 95% confidence interval 1.4% to 7.2%) and 1.32 (1.06 to 1.64; 2.6%, 0.3% to 4.9%), respectively. The hazard ratios were 1.19 (1.05 to 1.36; absolute risk difference 9.7%, 5.0% to 14.3%) and 1.27 (1.02 to 1.58; 5.0%, 1.2% to 8.8%), respectively, for all cause and cardiovascular mortality when the two extreme categories of ultra-processed food intake were compared. When these two indices were analysed jointly, the magnitude of the association of the FSAm-NPS dietary index with all cause and cardiovascular mortality was attenuated by 22.3% and 15.4%, respectively, whereas mortality risks associated with high ultra-processed food intake were not altered.

Conclusions

Adults with the lowest quality diet, as measured using the FSAm-NPS dietary index (underpinning the Nutri-Score), and the highest ultra-processed food consumption (NOVA classification) were at the highest risk for all cause and cardiovascular mortality. A significant proportion of the higher mortality risk associated with an elevated intake of nutrient poor foods was explained by a high degree of food processing. In contrast, the relation between a high ultra-processed food intake and mortality was not explained by the poor quality of these foods.
EMAeHealth, a digital tool for the self-management of women’s health needs during pregnancy, childbirth and the puerperium: protocol for a hybrid effectiveness-implementation study
Authors: Espinosa Cifuentes Maite , Artieta-Pinedo Isabel , Paz-Pascual Carmen , Bully-Garay Paola , García-Alvarez Arturo
Published: September 2022

Introduction

EHealth can help health service users take a more active role in decision-making and help health professionals guide the patient in this process. A digital tool has been designed to support maternal education (ME), and it is organised into four areas: (1) information, (2) communication, (3) health self-management and (4) clinical data. The main objective of the study is to evaluate the effectiveness of the EMAeHealth digital tool, and assess its usability and acceptability under routine conditions.

Methods and analysis

Hybrid implementation-effectiveness design: (1) A cluster randomised, prospective, longitudinal, multicentre clinical trial to evaluate the effectiveness of EMAeHealth in (A) improving health-related quality of life (primary outcome), (B) improving self-efficacy for labour and childbirth and self-efficacy in breast feeding and (C) reducing the number of visits to the obstetric emergency services and health centre in situations of ‘non-pathological pregnancy’, ‘false labour pains’ and ‘non-pathological puerperium’. The EMAeHealth intervention plus usual care will be compared with receiving only usual care, which includes traditional ME. N=1080 participants, 540 for each study arm. Two measurements will be made throughout the pregnancy and three in the first 16 weeks post partum. (2) A mixed-method study to evaluate the usability and acceptability of the tool, barriers and facilitators for its use, and implementation in our health system: focus groups (women, professionals and agents involved) and a quantitative analysis of implementation indicators. Analysis: It will be carried out by intention to treat, using mixed models taking into account the hierarchical structure of the data and per protocol to evaluate the effectiveness of the express use of the digital tool.

Ethics and dissemination

Clinical Research Ethics Committee of Euskadi, Spain, (Ref: PI2020044) approved this study. The results will be actively disseminated through manuscript publications and conference presentations.

Trial registration number

NCT04937049.
Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND): protocol and baseline outcomes for a stepped-wedge cluster-randomised prevention trial
Authors: Whelan Jillian , Hayward Joshua , Nichols Melanie , Brown Andrew D , Orellana Liliana , Brown Victoria , Becker Denise , Bell Colin , Swinburn Boyd , Peeters Anna , Moodie Marj , Geddes Sandy A , Chadwick Craig , Allender Steven , Strugnell Claudia
Published: September 2022

Introduction

Systems science methodologies have been used in attempts to address the complex and dynamic causes of childhood obesity with varied results. This paper presents a protocol for the Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND) trial. RESPOND represents a significant advance on previous approaches by identifying and operationalising a clear systems methodology and building skills and knowledge in the design and implementation of this approach among community stakeholders.

Methods and analysis

RESPOND is a 4-year cluster-randomised stepped-wedge trial in 10 local government areas in Victoria, Australia. The intervention comprises four stages: catalyse and set up, monitoring, community engagement and implementation. The trial will be evaluated for individuals, community settings and context, cost-effectiveness, and systems and implementation processes. Individual-level data including weight status, diet and activity behaviours will be collected every 2 years from school children in grades 2, 4 and 6 using an opt-out consent process. Community-level data will include knowledge and engagement, collaboration networks, economic costs and shifts in mental models aligned with systems training. Baseline prevalence data were collected between March and June 2019 among >3700 children from 91 primary schools.

Ethics and dissemination

Ethics approval: Deakin University Human Research Ethics Committee (HREC 2018-381) or Deakin University’s Faculty of Health Ethics Advisory Committee (HEAG-H_2019-1; HEAG-H 37_2019; HEAG-H 173_2018; HEAG-H 12_2019); Victorian Government Department of Education and Training (2019_003943); Catholic Archdiocese of Melbourne (Catholic Education Melbourne, 2019-0872) and Diocese of Sandhurst (24 May 2019). The results of RESPOND, including primary and secondary outcomes, and emerging studies developed throughout the intervention, will be published in the academic literature, presented at national and international conferences, community newsletters, newspapers, infographics and relevant social media.

Trial registration number

ACTRN12618001986268p.
Acupuncture versus massage for pain in patients living with advanced cancer: a protocol for the IMPACT randomised clinical trial
Authors: Romero Sally A D , Emard Nicholas , Baser Raymond E , Panageas Katherine , MacLeod Jodi , Walker Desiree , Barton-Burke Margaret , Liou Kevin , Deng Gary , Farrar John , Xiao Han , Mao Jun J , Epstein Andrew
Published: September 2022

Introduction

Pain, comorbid fatigue and sleep disturbances are common and distressing symptoms for patients with advanced cancer, negatively impacting their quality of life. Clinical guidelines recommend non-pharmacological interventions, including acupuncture and massage, for pain management in adult patients with cancer in adjunct to conventional care. However, high-quality evidence about the comparative effectiveness and long-term durability of these therapies for symptom management is limited.

Methods and analysis

We describe the design of a two-arm, parallel group, multicentre randomised controlled trial that investigates the use of acupuncture versus massage for musculoskeletal pain among 300 patients with diverse types of advanced cancer. The primary aim is to evaluate the long-term effectiveness (26 weeks from randomisation) of acupuncture vs massage for pain (primary outcome) and comorbid symptoms (fatigue, sleep disturbance and quality of life). The secondary aim is to identify patient-level demographic characteristics (eg, sex, race, age), clinical factors (eg, insomnia, pain severity) and psychological attributes that are associated with a greater reduction in pain for either acupuncture or massage. Patients will receive weekly acupuncture or massage treatments for 10 weeks, followed by monthly booster sessions up to 26 weeks. The primary endpoint will be the change in worst pain intensity score from baseline to 26 weeks. We will collect validated patient-reported outcomes at multiple time points over 26 weeks.

Ethics and dissemination

The Institutional Review Board at Memorial Sloan Kettering Cancer Center in New York approved this protocol. Results will be disseminated via peer-reviewed scientific journals and conference presentations. Our findings will help patients and healthcare providers make informed decisions about incorporating non-pharmacological treatments to manage pain for patients with advanced cancer.

Trial registration number

NCT04095234.
Implementation of a colorectal cancer screening intervention in Malaysia (CRC-SIM) in the context of a pandemic: study protocol
Authors: Schliemann Désirée , Ramanathan Kogila , Ibrahim Tamin Nor Saleha Binti , O'Neill Ciaran , Cardwell Christopher R , Ismail Roshidi , Nanu Prathibha , Mohd Ghazali Ahmad Nizal bin , Kee Frank , Su Tin Tin , Donnelly Michael
Published: September 2022

Introduction

Colorectal cancer (CRC) is the second most common cancer in Malaysia and cases are often detected late. Improving screening uptake is key in down-staging cancer and improving patient outcomes. The aim of this study is to develop, implement and evaluate an intervention to improve CRC screening uptake in Malaysia in the context of the COVID-19 pandemic. The evaluation will include ascertaining the budgetary impact of implementing and delivering the intervention.

Methods and analysis

The implementation research logic model guided the development of the study and implementation outcome measures were informed by the 'Reach, Effectiveness, Adoption, Implementation and Maintenance' (RE-AIM) framework. This CRC screening intervention for Malaysia uses home-testing and digital, small media, communication to improve CRC screening uptake. A sample of 780 people aged 50–75 years living in Segamat district, Malaysia, will be selected randomly from the South East Asia Community Observatory (SEACO) database. Participants will receive a screening pack as well as a WhatsApp video of a local doctor to undertake a stool test safely and to send a photo of the test result to a confidential mobile number. SEACO staff will inform participants of their result. Quantitative data about follow-up clinic attendance, subsequent hospital tests and outcomes will be collected. Logistic regression will be used to investigate variables that influence screening completion and we will conduct a budget impact-analysis of the intervention and its implementation. Qualitative data about intervention implementation from the perspective of participants and stakeholders will be analysed thematically.

Ethics and dissemination

Ethics approval has been granted by Monash University Human Research Ethics Committee (MUHREC ID: 29107) and the Medical Review and Ethics Committee (Reference: 21-02045-O7G(2)). Results will be disseminated through publications, conferences and community engagement activities.

Trial registration number

National Medical Research Register Malaysia: 21-02045-O7G(2).
Minimally invasive surgical techniques for oesophageal cancer and nutritional recovery: a prospective population-based cohort study
Authors: Kauppila Joonas H , Rosenlund Helen , Klevebro Fredrik , Johar Asif , Anandavadivelan Poorna , Mälberg Kalle , Lagergren Pernilla
Published: September 2022

Objectives

To explore whether the minimally invasive oesophagectomy (MIE) or hybrid minimally invasive oesophagectomy (HMIE) are associated with better nutritional status and less weight loss 1 year after surgery, compared with open oesophagectomy (OE).

Design

Prospective cohort study.

Setting

All patients undergoing oesophagectomy for cancer in Sweden during 2013–2018.

Participants

A total of 424 patients alive at 1 year after surgery were eligible, and 281 completed the 1-year assessment. Of these, 239 had complete clinical data and were included in the analysis.

Primary and secondary outcome measures

The primary outcome was nutritional status at 1 year after surgery, assessed using the abbreviated Patient-Generated Subjective Global Assessment questionnaire. The secondary outcomes included postoperative weight loss at 6 months and 1 year after surgery.

Results

Of the included patients, 78 underwent MIE, 74 HMIE while 87 patients underwent OE. The MIE group had the highest prevalence of malnutrition (42% vs 22% after HMIE vs 25% after OE), reduced food intake (63% vs 45% after HMIE vs 39% after OE), symptoms reducing food intake (60% vs 45% after HMIE vs 60% after OE) and abnormal activities/function (45% vs 32% after HMIE vs 43% after OE). After adjustment for confounders, MIE was associated with a statistically significant increased risk of reduced food intake 1 year after surgery (OR 2.87, 95% CI 1.47 to 5.61), compared with OE. Other outcomes were not statistically significantly different between the groups. No statistically significant associations were observed between surgical techniques and weight loss up to 1 year after surgery.

Conclusions

MIE was statistically significantly associated with reduced food intake 1 year after surgery. However, no differences were observed in weight loss between the surgical techniques. Further studies on nutritional impact of surgical techniques in oesophageal cancer are needed.
Development of a screening tool for the need of specialist palliative care in oncologic inpatients: study protocol for the ScreeningPALL Study
Authors: Müller Evelyn , Müller Michael Josef , Boehlke Christopher , Ramsenthaler Christina , Jäger Helga , Schäfer Henning , Ostgathe Christoph , Klein Carsten , Simon Steffen , Becker Gerhild
Published: September 2022

Introduction

A range of referral criteria and scores have been developed in recent years to help with screening for the need of specialist palliative care (SPC) in advanced, incurable cancer patients. However, referral criteria have not yet been widely implemented in oncology, as they usually need to be revised by physicians or nurses with limited time resources. To develop an easily applicable screening for the need for SPC in incurable cancer inpatients, we aim to (a) test inter-rater reliability of multiprofessional expert opinion as reference standard for SPC need (phase I) and (b) explore the diagnostic validity of selected patient-reported outcome measures (PROMs) and routine data for the need of SPC (phase II).

Methods and analysis

Inclusion criteria for patients are metastatic or locally advanced, incurable cancer, ≥18 years of age and informed consent by patient or proxy. (Exclusion criteria: malignant haematological disease as main diagnosis). In phase I, three palliative care consultation teams (PCTs) of three German university hospitals assess the SPC need of 20 patient cases. Fleiss’ Kappa will be calculated for inter-rater reliability. In phase II, 208 patients are consecutively recruited in four inpatient oncology wards of Freiburg University Hospital. The PCT will provide assessment of SPC need. As potential referral criteria, patients complete PROMs and a selection of routine data on person, disease and treatment is documented. Logistic regression models and ROC analyses are employed to test their utility in screening for SPC need.

Ethics and dissemination

Our findings will be published in peer-reviewed journals and presented at national and international scientific meetings and congresses. Ethical approval was granted by the Ethics Committee of Albert-Ludwigs—University Freiburg, Germany (approval no. 20-1103).

Trial registration number

German Clinical Trials Register, DRKS00021686, registered on 17 December 2020.
Retrospective study of medical student scholarship and career trajectory following a mentored preclinical cardiovascular summer research fellowship
Authors: Wahlberg Kramer , Mughal Amreen , Li Zhaojin , Cipolla Marilyn J , Cushman Mary , Flyer Jonathan N
Published: September 2022

Objectives

Developing a preclinical training infrastructure for cardiovascular clinician-scientists is an academic workforce priority. The Cardiovascular Research Institute of Vermont developed a cardiovascular summer research fellowship (SRF), wherein medical student awardees were selected by merit-based application and completed mentored research between the first and second years. We aimed to study the impact of the SRF on medical student scholarship and career planning.

Design

Retrospective survey study.

Setting

Single academic medical centre.

Participants

All SRF participants from 2015 to 2020.

Interventions

Not applicable.

Primary and secondary outcome measures

Prior SRF participants were surveyed to ascertain current position, research engagement and perspectives regarding SRF experience. Comparisons to American Association of Medical Colleges Graduation Questionnaire data from equivalent years were made using χ2 tests.

Results

Survey response rate was 87% (20/23), 55% were women. Median time from SRF completion was 2 years (IQR 0.75–2.25), with 75% still enrolled in medical school and 25% in residency. As a result of the first-year summer programme, 45% published a peer-reviewed abstract or manuscript, which was equivalent to the national rate for graduating students (53%, p=0.4). Most respondents (80%) were active in additional research projects during school separate from the SRF, 90% anticipated a career involving research (vs 53% nationally, p<0.001) and 75% planned to pursue a career in cardiovascular medicine.

Conclusion

Medical students completing a mentored cardiovascular SRF after their first year have a high rate of academic scholarship, with publication rate already equivalent to national peer graduates. Preclinical SRF students strongly anticipate cardiovascular medicine and research careers.
Needs of people with rare diseases that can be supported by electronic resources: a scoping review
Authors: Long Janet C , Best Stephanie , Nic Giolla Easpaig Bróna , Hatem Sarah , Fehlberg Zoe , Christodoulou John , Braithwaite Jeffrey
Published: September 2022

Objectives

Rare diseases are characterised by low incidence, often with little evidence for effective treatments. Isolated patients and specialist centres for rare diseases are increasingly connected, thanks to the internet. This scoping review aimed to identify issues facing people with a rare disease that authors report may be addressed by electronic resources (mobile applications, websites, social media platforms, telehealth and online portals).

Design

Scoping review guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.

Data sources

Medline, Embase and PsycInfo were searched, supplemented by hand searches of selected journals, in July 2021.

Eligibility criteria

Peer-reviewed literature in English was searched using terms for rare disease (incidence <1:2000), electronic modalities (eg, mobile phone) and patient support terms. No date limit was set. Conference abstracts were included.

Data extraction and synthesis

Data extracted: rare disease/group of diseases, name of the e-resource, need identified in the patient cohort, features of the e-resource, any other findings or observations of interest. From this, a framework was developed synthesising features across diseases and resources.

Results

Seventy-two papers were found (from 383). Fifty-six electronic resources were described in 64 papers, while 12 papers were exploratory studies. Cystic fibrosis (n=28) was the most frequently addressed, followed by haemophilia (n=16).

Four domains and 23 subdomains of needs were extracted from the papers. The domains of needs were: support for self-management, access to high-quality information, access to appropriate specialist services, and social support. Subdomains are sometimes related to needs of individual rare diseases (eg, social isolation due to infection risk in people with cystic fibrosis). Fifteen electronic resources were identified that supported parents of children with rare disorders.

Conclusions

While it can be argued that rare diseases, per se, may be no less distressing or onerous to care for than a high prevalence disease, rare diseases have unique features: the lengthy odyssey to find a diagnosis, then appropriate specialists, the lack of evidence around effective treatments, guidelines or access to knowledgeable general health service providers. Designers of electronic resources are urged to consult key stakeholders to enhance the effectiveness and usability of resources for people with a rare disease.
Measuring professional stigma towards patients with a forensic mental health status: protocol for a Delphi consensus study on the design of a questionnaire
Authors: Vorstenbosch Ellen , Masoliver-Gallach Ruth , Escuder-Romeva Gemma
Published: September 2022

Introduction

Negative attitudes towards individuals with a mental illness and/or criminal background are widely studied, but empirical interest in the attitudes towards patients with a forensic mental health status is lacking. Negative attitudes among mental healthcare (MHC) professionals can have a significant impact on treatment outcomes and hence, affect patients’ rehabilitation. This study will elaborate an instrument to assess stigmatising attitudes among community MHC professionals towards patients with a forensic mental health status.

Methods and analysis

The instrument will be developed by means of a Delphi study and depart from pre-existing instruments that assess public and professional stigma towards individuals with a mental illness and/or criminal background. Relevant instruments were identified through a targeted literature review. A longlist of items has been selected for the Delphi survey. Five expert panels (ie, academic experience in stigma or forensic MHC, clinical experience in community or forensic MHC or patient experience in forensic and community MHC) will be asked to score the relevance of each item on a 7-point Likert scale and to agree on the wording (yes/no). Participants will be provided with the option to suggest additional items or alternative wording. Adapted Delphi methodology will be applied with an expectation of at least three rounds to achieve consensus: ≥60% of the participants of at least four of five expert panels rank the item in the top three (inclusion) or bottom three (exclusion). Items will be reworded for a consecutive round based on a ‘yes minus no’ score and participants’ suggestions.

Ethics and dissemination

This study has been approved by the ethics committee of Fundación Sant Joan de Déu. Dissemination of results will be through peer-reviewed publications, presentations and (inter-)national academic conferences. A summary of the results will be shared with the participants and key persons in community and forensic MHC.
Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study
Authors: Honda Yuki , Nakamura Mieko , Aoki Takuya , Ojima Toshiyuki
Published: September 2022

Objectives

Classifying individuals into multimorbidity patterns can be useful to identify the target population with poorer clinical outcomes. Self-rated health (SRH) is one of the core outcomes in multimorbidity patients. Although studies have reported that multimorbidity is associated with poor SRH, whether certain patterns have stronger associations remains unknown. Therefore, this study aimed to identify the prevalence and patterns of multimorbidity and investigate the association between multimorbidity patterns and SRH in an older Japanese population.

Design

Cross-sectional study.

Setting

Data were obtained from the 2013 Comprehensive Survey of Living Conditions, a nationally representative survey of the general Japanese population.

Participants

This study mainly examined 23 730 participants aged ≥65 years who were not hospitalised or institutionalised.

Primary outcome measure

Poor SRH was defined as choosing ‘not very good’ or ‘bad’ from five options: ‘excellent’, ‘fairly good’, ‘average’, ‘not very good’ and ‘bad’.

Results

The prevalence of multimorbidity was 40.9% and that of poor SRH was 23.8%. Three multimorbidity patterns were identified by exploratory factor analysis: (1) degenerative/mental health, (3) malignant/digestive/urological/haematological and (3) cardiovascular/metabolic. Multivariable modified Poisson regression analysis revealed that high malignant/digestive/urological/haematological, degenerative/mental health and cardiovascular/metabolic pattern scores, corresponding to the number of affected body systems in each pattern, were significantly associated with poor SRH (adjusted risk ratio (aRR)=1.68, 95% CI: 1.60 to 1.76; aRR=1.63, 95% CI: 1.58 to 1.69; and aRR=1.31, 95% CI: 1.26 to 1.36, respectively). When including the Kessler 6 score, a screening scale for psychological distress, in the analysis, the association between each multimorbidity pattern score and poor SRH decreased.

Conclusions

Malignant/digestive/urological/haematological and degenerative/mental health patterns may be associated with a high risk for poor SRH. Further research should focus on interventions to improve SRH in multimorbidity patients.
Detailed analysis of the curvature bounce: background dynamics and imprints in the CMB
Authors: Renevey Cyril , Barrau Aurélien , Martineau Killian
Published: September 2022

If the spatial sections of the Universe are positively curved, extrapolating the inflationary stage backward in time inevitably leads to a classical bounce. This simple scenario, non-singular and free of exotic physics, deserves to be investigated in details. The background dynamics exhibits interesting features and is shown to be mostly insensitive to initial conditions as long as observational consequences are considered. The primordial scalar power spectrum is explicitly computed, for different inflaton potentials, and the subsequent CMB temperature anisotropies are calculated. The results are compatible with current measurements. Some deviations with respect to the standard paradigm can however appear at large scales and we carefully disentangle what is associated with the vacuum choice with what is more fundamentally due to the bounce itself.
Design of Multisensor Mobile Robot Vision Based on the RBPF-SLAM Algorithm
Authors: Cai Yiyi , Qin Tuanfa
Published: September 2022

The existing algorithms are mainly based on the laser or visual inertial odometer, which has problems such as large particle recommendation distribution error, particle consumption, and long running time of the algorithm. An SLAM scheme based on multisensor fusion is proposed, which integrates multisource sensor data including lidar, camera, and IMU and constructs a set of real-time mapping and positioning system with better robustness and higher accuracy. The experimental results show that the proposed SLAM method uses less running time, and the accuracy of map construction is better.
Statistical Evaluation and Trend Analysis of ANN Based Satellite Products (PERSIANN) for the Kelani River Basin, Sri Lanka
Authors: Perera Helani , Gunathilake Miyuru B. , Panditharathne Ravindu , Al-mahbashi Najib , Rathnayake Upaka
Published: September 2022

Satellite-based precipitation products, (SbPPs) have piqued the interest of a number of researchers as a reliable replacement for observed rainfall data which often have limited time spans and missing days. The SbPPs possess certain uncertainties, thus, they cannot be directly used without comparing against observed rainfall data prior to use. The Kelani river basin is Sri Lanka’s fourth longest river and the main source of water for almost 5 million people. Therefore, this research study aims to identify the potential of using SbPPs as a different method to measure rain besides using a rain gauge. Furthermore, the aim of the work is to examine the trends in precipitation products in the Kelani river basin. Three SbPPs, precipitation estimation using remotely sensed information using artificial neural networks (PERSIANN), PERSIANN-cloud classification system (CCS), and PERSIANN-climate data record (CDR) and ground observed rain gauge daily rainfall data at nine locations were used for the analysis. Four continuous evaluation indices, namely, root mean square error (RMSE), (percent bias) PBias, correlation coefficient (CC), and Nash‒Sutcliffe efficiency (NSE) were used to determine the accuracy by comparing against observed rainfall data. Four categorical indices including probability of detection (POD), false alarm ratio (FAR), critical success index (CSI), and proportional constant (PC) were used to evaluate the rainfall detection capability of SbPPs. Mann‒Kendall test and Sen’s slope estimator were used to identifying whether a trend was present while the magnitudes of these were calculated by Sen’s slope. PERSIANN-CDR performed well by showing better performance in both POD and CSI. When compared to observed rainfall data, the PERSIANN product had the lowest RMSE value, while all products indicated underestimations. The CC and NSE of all three products with observed rainfall data were also low. Mixed results were obtained for the trend analysis as well. The overall results showed that all three products are not a better choice for the chosen study area.
Behavioural Risk for HIV, Hepatitis B, and Hepatitis C Infections among a Population of Drug Users and Injectors across Four Regions in Ghana
Authors: Guure Chris , Obiri-Yeboah Laryea Sharren Margaret , Dery Samuel , Baptista da Silva Carlota , Asamoah-Adu Comfort , Ayisi-Addo Stephen , Loglo Maria-Goretti , Mohammed Adamu , Torpey Kwasi
Published: September 2022

Background. Blood borne infections such as HIV, Hepatitis B (HBV), and Hepatitis C (HCV) are of great importance to governments and their implementing partners, especially among people who use drugs (PWUD) and people who inject drugs (PWID). Prevalence and determinants of HIV, HBV, and HCV among PWUD and PWID in Ghana are not well established, the significance of this study. Method. This assessment was a cross-sectional study implemented via the respondent driven sampling approach. A team of community advisory boards that comprised former users, current users, and civil society organizations were constituted to help in the implementation of the study. The study was conducted in four regions in Ghana. The assessment was based on a representation of populations of PWID and PWUD from the four regions. Efforts were made by the team to ensure adequate representation of women where feasible. A quantitative questionnaire was developed and used to obtain information on the respondents’ sociodemographics, sexual behavior, substance use, and biological characteristics. The prevalence of HIV, HBV, and HCV among PWID and PWUD was determined using blood samples. First response and oral quick test for confirmation of HIV positivity were carried out, while SD bioline was used to test for the presence of HBV and HBC. Data were analyzed using the Bayesian generalized linear model via the binomial family of distributions under the logit link function with weak Cauchy and Normal distribution as prior. Results. A total of 323 PWUD and PWID participants were interviewed across four regions of Ghana. The overall median age of the respondents was 36 (28, 43) years. The prevalence of HIV, HBV, and HCV infection in the study was 2.5%, 4.6%, and 5.9%, respectively. The prevalence of HIV, HBV, and HCV among drug users was 2.5% (95% CI: 0.7%–4.2%), 4.1% (95% CI: 1.8%–6.2%), and 6.7% (95% CI: 3.9%–9.4%), respectively. Most drug injectors and users started using and injecting drugs at ages less than 20 years and between 20 and 29 years, respectively. Drug users who identified themselves as part of the general population were 66% less likely to be tested HIV positive (POR = 0.34, CrI: 0.12–0.81) compared to sex workers. Part time employment respondents had fivefold odds (POR = 5.50, CrI: 1.20–16.16) of being HBV positive as against full-time employment. Conclusion. Most of the injectors and users started drugs at an early age. Drug users and injectors are at higher risk of these infections because of associated risky sexual behaviors and risky injection practices. Harm reduction programs to help addicts who are willing to quit the practice are recommended.