bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for the development of Spitz neoplasms
Authors: Benton Sarah , Roth Andrew , Khan Ayesha U. , Zhao Jeffrey , Kim Daniel , Compres Elsy V. , Wagner Annette M. , Kruse Lacey L. , Zhang Bin , Gerami Pedram
Published: February 2022

Background/Objectives

The principal environmental risk factor for conventional nevi and melanomas is ultraviolet exposure. However, little is known about genetic or environmental risk factors for developing Spitz tumors. This study investigates risk factors associated with Spitz neoplasms.

Methods

Patients with Spitz tumors seen at Northwestern Memorial Hospital and Lurie Children's Hospital were surveyed with a 16‐item questionnaire about environmental and inherited factors. Spitz tumor patients were compared to a pediatric control cohort from a similar clinical setting. This was supplemented with a meta‐analysis of genetic and environmental causes of Spitz neoplasms.

Results

One hundred and six Spitz and 58 control surveys were obtained and no statistically significant differences in genetic or environmental risk factors were found between Spitz and control groups.

Conclusion

Our data and meta‐analysis suggest that typical risk factors associated with melanoma are not significantly associated with Spitz tumors. Identification of relevant genetic or environmental risk factors will likely require larger and population‐based studies.
Photobiomodulation Therapy Minimizes the DNA Damage in 5FU‐Treated Gingival Fibroblasts
Authors: Rosin Flávia Cristina Perillo , Novaes Cristina de Paula , dos Santos Anaeliza Figueiredo , Deboni Maria Cristina Zindel , Corrêa Luciana
Published: February 2022

5‐Fluoroufacil (5FU) is a chemotherapeutic agent indicated for solid tumors but causes oral mucositis, which can be prevented and treated using photobiomodulation therapy (PBMT). It is unknown whether PBMT modifies DNA damage induced by 5FU in oral cells. The aim of this study was to investigate the effect of PBMT on DNA damage and repair and on oxidative stress in gingival fibroblasts exposed to 5FU. Primary gingival fibroblasts were exposed to 5FU and then treated with a laser (660 nm, 100 mW, 1 W cm−2, 0.09 cm2 spot area) for three different irradiation times (6, 10 or 20 s). Six‐second irradiation decreased DNA damage and lipidic peroxidation. All irradiated groups showed low H2AX levels and increased p53 expression. Ten‐second irradiation showed a trend to induce high lipidic peroxidation levels and DNA damage than other irradiation groups. In conclusion, the PBMT effect on DNA damage and repair was dependent on the time irradiation: 6 s‐time irradiation (6.6 J cm−2) protect gingival fibroblasts from 5FU‐related genotoxicity and oxidative stress, whereas 10s‐ and 20s‐time irradiations (11.1 J cm−2 and 22.2 J cm−2, respectively) increased the risk of DNA damage after the 5FU exposure.
Dynamic analysis of a stochastic eco‐epidemiological model with disease in predators
Authors: Zhang Shengqiang , Yuan Sanling , Zhang Tonghua
Published: February 2022

It is widely accepted that epidemics in biological populations and stochasticity in the environments are two important components significantly influencing the real ecosystems. To more accurately reveal developmental changes of the population dynamics and explore effective control methods for infectious disease, in this paper, we first construct a stochastic eco‐epidemiological model with disease in predators, and mathematically analyze the fundamental properties of the model. Then, we establish sufficient criterion for the existence of a unique ergodic stationary distribution of the positive solution. Also, we derive sufficient conditions, respectively, for three different extinction scenarios of populations: (i) The predators go extinct, only the prey persists; (ii) both the predators and prey go extinct; and (iii) the disease is eradicated from the system, both the predators and prey persist. Finally, we perform some numerical simulations under different interferences of environment to illustrate the main theoretical results. Especially, we observe that once the disease is eradicated from the system, then the predators and prey will coexist in an oscillatory manner. Our research indicates that the environmental noises have significant impacts on the determination of the persistence and extinction of the disease and populations.
A comparison of perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students
Authors: Gaber Sophie Nadia , Klarare Anna , Mattsson Elisabet , Rosenblad Andreas Karlsson
Published: February 2022

Background

The population of women in homelessness in Europe is increasing and women in homelessness experience multiple healthcare needs. However, there is insufficient understanding about how perceptions of caring behaviours compare between women in homelessness as patients and nurses in their clinical practice.

Aim

This study aimed to investigate perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students.

Methods

A cross‐sectional design was used with convenience sampling to recruit groups of women in homelessness (n = 37), Registered Nurses (n = 92) and nursing students (n = 142) in Stockholm, Sweden. Between August 2019 and December 2020, data were collected through face‐to‐face interviews or online, using the Caring Behaviours Inventory‐24 instrument. Data were analysed using descriptive statistics and group‐comparing hypothesis tests.

Results

Overall, women in homelessness’ perceptions of caring behaviours were significantly lower than nursing students (p < 0.001), who in turn scored significantly lower than Registered Nurses (p < 0.001). The Knowledge and Skill domain had the highest score, and the Connectedness domain had the lowest score in all three groups. The ranking of the individual items according to score varied between the groups. However, all three groups had the highest score for the Knowing how to give shots, IVs, etc., item and the lowest score for the Helping the patient to grow item.

Conclusion

Healthcare providers and nurse educators should consider incongruences and congruences in caring behaviours to better prepare Registered Nurses and nursing students to contribute to increased health equity, and more targeted clinical practice for women in homelessness.
Impact of antimicrobial stewardship intervention in clean and clean‐contaminated surgical procedures at a Vietnamese national hospital
Authors: Phan Quyen Thi Ngoc , Le Thanh Dinh , Do Que Kim , Pham Hien Thi Thu , Tran Mai Thi Phuong , Vo Thong Duy , Le Lam Van , Nguyen Thanh Minh , Tran Nhu Quynh , Nguyen Nhi Truc Y. , Nguyen Hai Thanh , Bui Quynh Thi Huong
Published: February 2022

Objectives

We investigated the characteristics of prophylactic antimicrobial use in clean and clean‐contaminated surgical procedures and assessed the efficacy of a prophylactic antimicrobial stewardship intervention at Thong Nhat Hospital, Ho Chi Minh City, Vietnam.

Methods

A cross‐sectional study was conducted on 354 patients who underwent either clean or clean‐contaminated surgical procedures at Thong Nhat Hospital. Eligible patients were classified with respect to three periods of intervention from 2017 to 2020. Data collection included surgical procedures, patient characteristics, and prophylactic antimicrobial usage. We determined the efficacy of antimicrobial stewardship intervention based on comparisons among the primary outcome (the appropriateness of prophylactic antimicrobials) and secondary outcomes (postoperative antimicrobial prophylaxis (AP) prolongation, length of postoperative hospital stay, and cost of antimicrobials).

Results

The mean age of patients in periods 1, 2, and 3 was 54.5 ± 16.6, 50.2 ± 16.5, and 52.8 ± 17.3 years, respectively, with an overall male/female ratio of 1.1/1. No significant differences were detected in basic patient characteristics during the three periods. Majority of the surgical procedures were clean (56%–59%) and scheduled (85%–86%). Prophylactic antimicrobial stewardship intervention enhanced AP appropriateness (by 12.7%, 12.7%, and 39.0% in periods 1, 2, and 3, respectively, p < 0.001), decreased postoperative prophylactic antimicrobial duration [3.0 (0–6), 1.5 (0–5), and 0.0 (0–1) days, respectively, p < 0.001], and reduced average antimicrobial expenses (p < 0.001).

Conclusions

The prophylactic antimicrobial stewardship interventions introduced at Thong Nhat Hospital had several positive impacts on the appropriateness of prophylactic antimicrobial use and treatment costs.
Most students have experience making radiographs prior to veterinary school but have limited radiation safety training
Authors: Jensen Monica , Hewson Joanne , Chalmers Heather , Jones‐Bitton Andria , Singh Ameet
Published: February 2022

The use of radiation for the diagnosis of various medical conditions is ubiquitous in veterinary medicine, and manual restraint of a patient during X‐ray exposure has become commonplace. Many prospective veterinary students have been involved with radiographs in general practice prior to veterinary school. Their experiences and level of safety training are largely unknown.   This prospective survey study involved two web‐based questionnaires that were used to evaluate the experiences, knowledge, and attitudes toward radiation and how these changed following a radiation safety lecture as part of their first‐year curriculum. The questionnaires were distributed to 122 first‐year veterinary students before and after this lecture. All participating students (100%) had worked in a veterinary hospital prior to admission to veterinary school and 79% were involved in making radiographs; however, only 28% reported receiving radiation safety training. The content of the safety training reported was variable. After the radiation safety lecture, students were more likely to report that the radiation safety training they had received was useful, but fewer students reported feelings of safety when using radiation. Despite most students being involved with radiation in practice, few had received radiation safety training, as hypothesized. Contrary to our second hypothesis, a single lecture did significantly improve knowledge and attitudes in several, but not all, instances. Importantly, once students gained knowledge regarding radiation, they placed more importance on its safe use. These results suggest that in‐clinic training of students in radiation safety is insufficient and that lecture‐based training is useful for certain concepts.
Associations between styloid process sheath CT sizes and age, body weight, and breed in horses
Authors: Whitty Justin A. , Miller Allison V. , Miller Andrew D. , Carney Patrick C. , Scrivani Peter V.
Published: February 2022

The styloid process sheath (SPS) is a part of the tympanic temporal bone and an incomplete bony sleeve surrounding the styloid process, tympanohyoid cartilage, and dorsal part of the stylohyoid bone. In horses undergoing head CT, we observed a range of SPS sizes and questioned whether differences were early features of temporohyoid osteoarthropathy (THO) or normal anatomic variations associated with age, body weight, sex, or breed. We hypothesized that SPS sizes were positively correlated with age and body weight, but not with sex or breed. Using a convenience population of horses that underwent head CT at our institution (2008–2017), regardless of THO status, we investigated these hypotheses in a retrospective cross‐sectional study. The sample comprised 102 horses. The median SPS height was larger medially (4.3 mm) than laterally (2.4 mm) and the median width was 11.1 mm: no difference was detected between sides. Geldings had a significantly larger median SPS width (11.6 mm) than stallions (8.7 mm; P < 0.05) and mares (10.0 mm; P < 0.05). No association was detected between SPS sizes and body weight and breed. Univariate and multivariate analyses initially found significant associations between SPS heights and age. Secondary analyses performed following removal of outliers and horses <2‐years old found similar but less pronounced results (annual increase in SPS heights decreased from 3.2‐3.8% to 0.9‐2.6%). Most associations were insignificant when investigated by age group, but the annual rate of increased size might be faster in older horses. Excessive SPS enlargement was theorized as an essential component of THO.
EVOLVING CREATION: AN ISMAILI MUSLIM INTERPRETATION OF EVOLUTION
Authors: Andani Khalil
Published: February 2022

This article presents a constructive Shīʿī Ismaili Muslim engagement with Neo‐Darwinian evolution. By drawing on Ismaili metaphysics and hermeneutics, I argue that Ismailis can affirm evolution without exceptions due to four features of contemporary and historical Ismaili thought. First, Aga Khan III (d. 1957), the 48th hereditary Ismaili Imam, integrated Neo‐Darwinian evolution with his theological views. Likewise, the present Imam Aga Khan IV (b. 1936) teaches that there is no conflict between Islam and scientific truth because God's creative act is eternal and continuous. Second, Ismaili Neoplatonic metaphysics is compatible with evolution because it situates all natural processes as guided by the Universal Soul without a need for miracles. Third, the common descent of all life lends further support to the Ismaili belief in an unbroken lineage of hereditary Imams since the origins of life on earth. Fourth, the Quranic story of Adam's creation poses no hermeneutical issue because Ismaili scholars read the Adam story symbolically through esoteric exegesis (ta'wīl).
The Stress-Rupture Strength of Type 347 Stainless Steel Under Cyclic Temperature
Authors: Baldwin E. E.
Published: February 2022

Stress-rupture tests of Type 347 stainless steel were conducted in liquid sodium under constant and cyclic temperature conditions. Constant-temperature tests were conducted at temperatures between 1000 and 1200 deg F. Cyclic-test temperatures ranged from 416 to 1294 deg F, and cycle times ranged from 6 to 12 hr. It was concluded that the deviation of the test results from the rupture life calculated by the method of Robinson and Miller was due to transient creep of the steel under cyclic-temperature changes.
Thermal Properties of Titanium Alloys and Selected Tool Materials
Authors: Loewen E. G.
Published: February 2022

Thermal conductivity has been determined of five titanium alloys, four high-speed-steel alloys, and four types of tungsten-carbide tool materials, over a temperature range of 200 to 1000 F. In addition, the specific heat of two titanium alloys has been found between 70 and 1400 F.
The Relation Between Grinding Conditions and Thermal Damage in the Workpiece
Authors: Hahn R. S.
Published: February 2022

The tendency of heat checks and cracks to form in the workpiece is shown to be strongly dependent upon work speed. The durability of the cutting edges of tools is shown to be affected by the work speed during sharpening. Based on the rubbing-grain hypothesis, the “theory of heat conducton” is applied to the grinding process to show that lower surface temperatures occur when grinding is done at high work-surface speed.
On the Evaporation of a Drop of Volatile Liquid in High-Temperature Surroundings
Authors: Ranz W. E.
Published: February 2022

The evaporation of a drop of volatile liquid in high-temperature surroundings is analyzed in terms of the rate of heat transfer. Transfer of heat by mass transfer and by radiation as well as by conduction is taken into account for a pseudostationary and steady state without convection. The flow of cold vapor to the surroundings during evaporation requires that a considerable amount of heat conducted inward be used to warm vapor moving outward. This waylaying of heat energy results in a significant decrease in the apparent rate of heat transfer as measured by the rate of evaporation. Applications of the theoretical results to evaporation and combustion are discussed, and an empirical treatment for cases of free and forced convection is indicated.
Pulsation Errors in Manometer Gages
Authors: Williams T. J.
Published: February 2022

It is known that manometer gages of conventional design are subject to errors when the gas-pressure differential is pulsating. In this paper, various factors contributing to the production of such errors are analyzed and the requirements for their elimination established. A differential manometer capable of indicating the true time-mean of a pulsating head is described.
Analysis of the Effect of Blade Cooling on Gas-Turbine Performance
Authors: Burke J. C. , Buteau B. L. , Rohsenow W. M.
Published: February 2022

This paper is an analytical study of the effects on specific air consumption and thermal efficiency of three types of blade-cooling systems. The methods considered are: (a) Air forced-convection cooling; (b) air transpiration cooling; (c) liquid forced-convection cooling.

The analysis was applied to a simple gas-turbine power plant containing a cooled turbine and an uncooled turbine both of which were composed of an infinite number of infinitesimal stages. Certain general design parameters were chosen for each coolant system and the effect of variation of these parameters on power-plant performance was studied. The three cooling methods also were compared against one another for otherwise identical conditions in the basic power plant.

The results of this work make it possible to predict, in a semiquantitative manner, the effect of cooling-system design on power-plant performance. In particular, the results of this paper show that for well-designed cooling systems operating at design conditions, appreciable net gains in performance can be realized by increasing turbine-inlet temperature beyond the temperature which the uncooled blades can withstand.
The Patient Multiple. An Ethnography of Healthcare and Decision-Making in Buthan, de Jonathan Taee
Authors: Cuesta Ramunno Estibaliz
Published: February 2022

The Patient Multiple. An Ethnography of Healthcare and Decision-Making in Buthan, lejos de ser una etnografía más sobre un horizonte médico alejado de nuestro ámbito iberoamericano y ceñirse exclusivamente a la descripción de los aspectos folk, constituye un relato de la praxis de los pacientes de Bután («Tierra del Dragón Trueno», ubicada entre China e India, con Nepal en su oeste y una población total que no supera los 750.000 habitantes). La economía de Bután es considerada una de las más pequeñas del mundo y su transición de una monarquía milenaria a un régimen democrático es todavía reciente. Los butaneses se mueven entre diferentes modelos médicos y prácticas asociadas a ellos; subjetivamente, también lo hacen entre concepciones múltiples de salud y de cuerpos, con el fin de obtener atención de un sistema cuya particularidad está signada por la compleja convivencia del pluralismo asistencial. Convivencia que lejos de desaparecer en Bután bajo los rápidos cambios sociales que este país está experimentando, parece fortalecerse por un proceso de institucionalización promovido por las mismas políticas sanitarias del país.
Sociodemographic Factors Associated With Meeting the Canadian 24-Hour Movement Guidelines Among Adults: Findings From the Canadian Health Measures Survey
Authors: Rollo Scott , Roberts Karen C. , Bang Felix , Carson Valerie , Chaput Jean-Philippe , Colley Rachel C. , Janssen Ian , Tremblay Mark S.
Published: February 2022

Background: This study examined associations between sociodemographic factors and meeting versus not meeting the new Canadian 24-Hour Movement Guidelines recommendations. Methods: The study is based on 7651 respondents aged 18–79 years from the 2007 to 2013 Canadian Health Measures Survey, a nationally representative, cross-sectional survey. Sociodemographic factors included age, sex, household education, household income, race, having a chronic condition, smoking status, alcohol consumption, and body mass index. Participants were classified as meeting or not meeting each of the time-specific recommendations for moderate to vigorous physical activity, sedentary behavior, and sleep duration. Results: Being an adult aged 18–64 years, normal weight, nonsmoker, and not having a chronic condition were associated with meeting the integrated guidelines. Being aged 18–64 years, male, normal weight, nonsmoker, not having a chronic condition, having a higher household education, and higher household income were associated with meeting the moderate to vigorous physical activity recommendation; being aged 18–64 years was associated with meeting the sedentary behavior recommendation; and being white, not having a chronic condition, and having a higher household income were associated with meeting the sleep duration recommendation. Conclusions: Few Canadian adults met the 2020 Canadian 24-Hour Movement Guidelines, and disparities across sociodemographic factors exist. Implementation strategies and dissemination approaches to encourage uptake and adoption are necessary.
What is new in migraine management in children and young people?
Authors: Loh Ne Ron , Whitehouse William P , Howells Rachel
Published: February 2022

For this narrative review, we found recent publications on the use and effectiveness of old therapies including nutraceuticals, such as riboflavin, vitamin D, magnesium, melatonin and talking therapies. Recent large trials of established conventional pharmaceuticals such as propranolol, pizotifen, topiramate and amitriptyline for childhood migraine have failed, but the use of a quasi-placebo in future trials could help. We reviewed the evidence for angiotensin antagonists including candesartan in adults, but found a lack of evidence for their use in children. There have been new developments in pharmaceuticals recently, including a more selective 5-HT1F agonist, lasmiditan, an effective acute treatment with no vasoconstrictor activity in adults, currently being tested in children. Also, a number of new calcitonin gene-related peptide (CGRP) antibodies and antagonists, with proven efficacy in acute treatment and/or prevention of migraine in adults, are undergoing trials in children. Peripheral nerve blocks and botulinum toxin are gaining popularity in adult practice, but we really need more good quality evidence for their effectiveness in children. Finally, electroceuticals, that is, therapeutic electric devices, are now marketed for acute and or preventative treatment, including an external trigeminal nerve stimulator (e-TNS), a non-invasive vagal nerve stimulator (nVNS), a single-pulse transcranial magnetic stimulator (sTMS) and a remote electrical neuromodulation device (REN). At the moment, evidence for their effectiveness in children is still lacking. So, there has been much progress, but mostly for adults. We are in urgent need of more migraine trials in children.
Dexmedetomidine improves success of paediatric MRI sedation
Authors: Jackson Thomas J , Dawes Deborah , Ahmad Shaista , Martin Darren , Gyamtso Cassandra
Published: February 2022

Objective

To improve success rates of children requiring sedation for MRI.

Methods

Audits of sedation success for children attending planned MRI using three different approaches: (1) National Institute for Health and Care Excellence (NICE) guidance (chloral hydrate if <15 kg and oral midazolam if ≥15 kg), (2) Chloral hydrate for all patients, (3) Chloral hydrate±intranasal dexmedetomidine if <15 kg and intranasal dexmedetomidine alone if ≥15 kg.

Results

74 patients had 85 MRI scan attempts. Overall success rates were significantly higher when using intranasal dexmedetomidine compared with following NICE guidance (81% vs 52% p=0.017). Dexmedetomidine performed better than oral midazolam for the same indication (76% vs 33% p=0.026). The side effect profile for dexmedetomidine was as reported in larger studies.

Conclusions

Intranasal dexmedetomidine is an effective alternative to oral midazolam for sedation for MRI and as a rescue medication where chloral hydrate has been ineffective.
Uveal lymphoid hyperplasia: treatment with combination antibiotics and steroids
Authors: Francis Jasmine H , Winebrake James P , Abramson David H
Published: February 2022

Background/aims

Uveal lymphoid hyperplasia (formerly benign reactive hyperplasia of the choroid) spans histopatholological characteristics ranging from reactive hyperplasia to low-grade lymphoid neoplasm. There is strong evidence that other low-grade lymphoid neoplasms, particularly of gastric derivations, respond to oral antibiotics. Here, we explore that response of uveal lymphoid hyperplasia to treatment with only oral antibiotics and steroids.

Methods

Four eyes of three patients with clinically diagnosed uveal lymphoid hyperplasia were treated with a course of oral antibiotics and steroids. The main outcome was clinical response of choroidal infiltrate by optical coherence tomography (OCT) measurements of choroidal thickness and visual acuity. Secondary outcome measure included local and systemic recurrence. Clinical response was evaluated by clinical exam, fundus photography, ultrasound and OCT.

Results

All 4 eyes displayed a clinical response at a median 2 weeks after starting oral antibiotics and steroid course. The choroidal infiltration regressed as evidenced by: decrease of choroidal thickness by a median of 421 nm, myopic shift in refractive error by a median of 0.50 Diopters, and improved vision by a median of 1.5 Snellen lines. At a median of 51-month follow-up, all four eyes had a sustained complete response and no patient has developed systemic disease to date.

Conclusions

In this small cohort of patients with uveal lymphoid hyperplasia, measurable and sustained clinical responses were observed with antibiotics/steroids, without systemic recurrence. This suggests combination antibiotic/steroid therapy is a reasonable treatment for select cases of uveal lymphoid hyperplasia, and may avoid the need for systemic chemotherapy/monoclonal antibody and/or external beam irradiation.
Clinical research on COVID-19: perceptions and barriers to participation in The Gambia
Authors: Diallo Brahima Amara , Usuf Effua , Ceesay Omar , D'Alessandro Umberto , Roca Anna , Martinez-Alvarez Melisa
Published: February 2022

Introduction

The need to rapidly identify safe and efficacious drug therapies for COVID-19 has resulted in the implementation of multiple clinical trials investigating potential treatment options. These are being undertaken in an unprecedented research environment and at a higher speed than ever before. It is unclear how West African communities perceive such activities and how such perceptions influence participation in COVID-19 clinical trials. This qualitative study was conducted to assess the level of acceptability of a clinical trial on the prevention and treatment of COVID-19 in The Gambia and identify strategies to better engage communities in participating in such a trial.

Methods

Data were collected using digitally recorded semistructured interviews (SSIs) and focus group discussions (FGDs) in Brikama and Kanifing local government areas. These are two of the most densely populated administrative subdivisions in The Gambia, where the clinical trial was to be implemented by the MRC Unit The Gambia. 26 men and 22 women aged between 19 and 70 years, with diverse socioeconomic profiles, participated in 8 FGDs (n=36) and 12 SSIs (n=12). Thematic analysis was used to analyse the data.

Results

Fear of stigmatisation of patients with COVID-19 was a recurring theme in most FGDs and SSIs, with detrimental effects on willingness to accept COVID-19 testing and home visits to follow up patients with COVID-19 and their household contacts. Preserving the privacy of individuals enrolled in the study was key to potentially increase trial participation. Trust in the implementing institution and its acknowledged expertise were facilitators to accepting the administration of investigational products to sick individuals and their close contacts.

Conclusion

COVID-19 is a stigmatising disease. Developing a research–participant collaboration through an ongoing engagement with community members is crucial to a successful enrolment in COVID-19 clinical trials. Trust and acknowledged expertise of the implementing institution are key facilitators to foster such collaboration.
Deep recurrent reinforced learning model to compare the efficacy of targeted local versus national measures on the spread of COVID-19 in the UK
Authors: Dong Tim , Benedetto Umberto , Sinha Shubhra , Fudulu Daniel , Dimagli Arnaldo , Chan Jeremy , Caputo Massimo , Angelini Gianni
Published: February 2022

Objectives

To prevent the emergence of new waves of COVID-19 caseload and associated mortalities, it is imperative to understand better the efficacy of various control measures on the national and local development of this pandemic in space–time, characterise hotspot regions of high risk, quantify the impact of under-reported measures such as international travel and project the likely effect of control measures in the coming weeks.

Methods

We applied a deep recurrent reinforced learning based model to evaluate and predict the spatiotemporal effect of a combination of control measures on COVID-19 cases and mortality at the local authority (LA) and national scale in England, using data from week 5 to 46 of 2020, including an expert curated control measure matrix, official statistics/government data and a secure web dashboard to vary magnitude of control measures.

Results

Model predictions of the number of cases and mortality of COVID-19 in the upcoming 5 weeks closely matched the actual values (cases: root mean squared error (RMSE): 700.88, mean absolute error (MAE): 453.05, mean absolute percentage error (MAPE): 0.46, correlation coefficient 0.42; mortality: RMSE 14.91, MAE 10.05, MAPE 0.39, correlation coefficient 0.68). Local lockdown with social distancing (LD_SD) (overall rank 3) was found to be ineffective in preventing outbreak rebound following lockdown easing compared with national lockdown (overall rank 2), based on prediction using simulated control measures. The ranking of the effectiveness of adjunctive measures for LD_SD were found to be consistent across hotspot and non-hotspot regions. Adjunctive measures found to be most effective were international travel and quarantine restrictions.

Conclusions

This study highlights the importance of using adjunctive measures in addition to LD_SD following lockdown easing and suggests the potential importance of controlling international travel and applying travel quarantines. Further work is required to assess the effect of variant strains and vaccination measures.
Web-based intervention to reduce psychological barriers to insulin therapy among adults with non-insulin-treated type 2 diabetes: study protocol for a two-armed randomised controlled trial of ‘Is insulin right for me?’
Authors: Holmes-Truscott Elizabeth , Holloway Edith E , Husin Hanafi M , Furler John , Hagger Virginia , Skinner Timothy C , Speight Jane
Published: February 2022

Introduction

Psychological barriers to insulin therapy are associated with the delay of clinically indicated treatment intensification for people with type 2 diabetes (T2D), yet few evidence-based interventions exist to address these barriers. We describe the protocol for a randomised controlled trial (RCT) examining the efficacy of a novel, theoretically grounded, psychoeducational, web-based resource designed to reduce psychological barriers to insulin among adults with non-insulin treated T2D: ‘Is insulin right for me?’.

Methods and analysis

Double-blind, parallel group RCT. A target sample of N=392 participants (n=196/arm) will be randomised (1:1) to ‘Is insulin right for me?’ (intervention) or widely available online resources (control). Eligible participants include adults (18–75 years), residing in Australia, currently taking oral hypoglycaemic agents to manage T2D. They will be primarily recruited via invitations and reminders from the national diabetes registry (from a purposefully selected sample of N≥12 000). Exclusion criteria: experience of self-administered injectable; previously enrolled in pilot RCT; ‘very willing’ to start insulin as baseline. Outcomes will be assessed via online survey at 2 weeks and 6 months. Primary outcome between-group: difference in mean negative Insulin Treatment Appraisal Scores (ITAS negative) at 2-week and 6-month follow-up. Secondary outcomes: between-group differences in mean positive insulin appraisals (ITAS positive) and percentage difference in intention to commence insulin at follow-up time points. All data analyses will be conducted according to the intention-to-treat principle.

Ethics and dissemination

Deakin University Human Research Ethics Committee (2020–073). Dissemination via peer-reviewed journals, conferences and a plain-language summary.

Trial registration number

ACTRN12621000191897; Australian and New Zealand Clinical Trials Registry.
Existing predictive methods applied to gait analysis of patients with diabetes: study protocol for a systematic review
Authors: Moura da Silva Patrícia Mayara , Oliveira Bezerra Ana Beatriz , Araújo Farias Luanna Barbara , Ribeiro Tatiana Souza , Morya Edgard , Cavalcanti Fabrícia Azevêdo da Costa
Published: February 2022

Introduction

Type 2 diabetes can lead to gait abnormalities, including a longer stance phase, shorter steps and improper foot pressure distribution. Quantitative data from objective methods for evaluating gait patterns are accurate and cost-effective. In addition, it can also help predictive methods to forecast complications and develop early strategies to guide treatments. To date, no research has systematically summarised the predictive methods used to assess type 2 diabetic gait. Therefore, this protocol aims to identify which predictive methods have been employed to assess the diabetic gait.

Methods and analysis

This protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) statement. Electronic searches of articles from inception to January 2022 will be performed, from May 2021 to 31 January 2022, in the Web of Science, MEDLINE, Embase, IEEE Xplore Digital Library, Scopus, CINAHL, Google Scholar, APA PsycInfo, the Cochrane Library and in references of key articles and grey literature without language restrictions. We will include studies that examined the development and/or validation of predictive methods to assess type 2 diabetic gait in adults aged >18 years without amputations, use of assistive devices, ulcers or neuropathic pain. Two independent reviewers will screen the included studies and extract the data using a customised charting form. A third reviewer will resolve any disagreements. A narrative synthesis will be performed for the included studies. Risk of bias and quality of evidence will be assessed using the Prediction Model Risk of Bias Assessment Tool and the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis.

Ethics and dissemination

Ethical approval is not required because only available secondary published data will be analysed. The findings will be disseminated through peer-reviewed journals and/or presentations at relevant conferences and other media platforms.

PROSPERO registration number

CDR42020199495.
Distribution of care expenditures for men and women with type 2 diabetes treated in primary care in the Netherlands: a case–control study (ZODIAC-59)
Authors: Mevissen M R J , Geurten Rose Julie , Hendriks S H , Elissen Arianne , van Dijk Peter Ruben , Bilo Henk J G
Published: February 2022

Objective

This study aims to provide insight into the distribution of care expenditures for patients with type 2 diabetes mellitus (T2DM)— across multiple healthcare service categories and medical specialties—who receive diabetes care in the primary care setting.

Design

Observational, matched case–control study.

Setting

In the Netherlands, T2DM-specific care is mainly provided in the primary care setting. However, many patients with T2DM also use secondary care for complications and comorbidities, either related or unrelated to their diabetes.

Participants

Patients with T2DM receiving diabetes care in primary care and participating in the Dutch Zwolle Outpatient Diabetes project Integrating Available Care cohort in the year 2011 were matched to persons without T2DM. Matching (1:2 ratio) was performed based on age, gender and socioeconomic status. Clinical data were combined with an all-payer claims database from 2011.

Results

In total, 43 775 patients with T2DM were identified of whom 37 240 could be matched with 74 480 controls. Total secondary care expenditures were €94 705 814, with a total annual median expenditure per patient of €2133 (1161 to 3340) for men and €2,535 (1374 to 5105) for women. The largest share of expenditures was on medication (26%), followed by secondary care (23%) and primary care services related (23%) to T2DM. The five most expensive specialties were: cardiology, surgery, internal medicine, orthopaedics and ophthalmology. Care expenditures for T2DM patients were twofold higher than those for persons without T2DM. Healthcare expenditures showed a skewed distribution, indicating that a small part of the studied population is responsible for a considerable part of the costs.

Conclusions

Expenditures among primary care treated T2DM patients are higher than non-diabetic matched controls. Medication is the largest share of T2DM care expenditures. The present study provides insights into healthcare expenditures for T2DM; this may enable more efficient healthcare planning and reimbursement.
Evaluations of training and education interventions for improved infectious disease management in low-income and middle-income countries: a systematic literature review
Authors: van Dorst Pim Wilhelmus Maria , van der Pol Simon , Salami Olawale , Dittrich Sabine , Olliaro Piero , Postma Maarten , Boersma Cornelis , van Asselt Antoinette Dorothea Isabelle
Published: February 2022

Objectives

To identify most vital input and outcome parameters required for evaluations of training and education interventions aimed at addressing infectious diseases in low-income and middle-income countries.

Design

Systematic review.

Data sources

PubMed/Medline, Web of Science and Scopus were searched for eligible studies between January 2000 and November 2021.

Study selection

Health economic and health-outcome studies on infectious diseases covering an education or training intervention in low-income and middle-income countries were included.

Results

A total of 59 eligible studies covering training or education interventions for infectious diseases were found; infectious diseases were categorised as acute febrile infections (AFI), non-AFI and other non-acute infections. With regard to input parameters, the costs (direct and indirect) were most often reported. As outcome parameters, five categories were most often reported including final health outcomes, intermediate health outcomes, cost outcomes, prescription outcomes and health economic outcomes. Studies showed a wide range of per category variables included and a general lack of uniformity across studies.

Conclusions

Further standardisation is needed on the relevant input and outcome parameters in this field. A more standardised approach would improve generalisability and comparability of results and allow policy-makers to make better informed decisions on the most effective and cost-effective interventions.
Energy conservation education intervention for people with end-stage kidney disease receiving haemodialysis (EVEREST): protocol for a cluster randomised control trial
Authors: Sharma Sita , Alexander Kimberly E , Green Theresa , Wu Min-Lin (Winnie) , Bonner Ann
Published: February 2022

Introduction

Multiple symptoms occur in people with kidney failure receiving haemodialysis (HD) and these symptoms have a negative impact on health-related quality of life (HRQoL). Fatigue, the most common symptom, is debilitating and difficult to manage. Educational interventions involving energy conservation strategies are helpful in reducing fatigue, however the effectiveness of energy conservation has not been previously studied in those receiving HD. The aim of this study is to evaluate the effectiveness of an energy conservation education intervention for people with end-stage kidney disease receiving HD (EVEREST trial).

Methods and analysis

A pragmatic cluster randomised control trial with repeated measure will be used. One hundred and twenty-six participants from tertiary level dialysis centre will be cluster randomised to the intervention and control group according to HD treatment day. The intervention group will receive usual care along with a structured energy conservation education programme over 12 weeks comprising three individual face-to-face educational intervention sessions, one booster session and a booklet. The control group will receive usual care from their healthcare providers and a booklet at the end of the study. The primary outcome is fatigue, and the secondary outcomes are other Chronic Kidney Disease (CKD) symptoms, occupational performance and HRQoL. Intention-to-treat analysis will occur and will include a change in primary and secondary outcomes.

Ethics and dissemination

Ethical approval has been obtained from the Human Research Committee of the Griffith University and Nepal Health Research Council. The results of this research will be published and presented in a variety of forums.

Trial registration number

NCT04360408.
Immunostimulatory effects of radioimmunotherapy
Authors: Constanzo Julie , Galluzzi Lorenzo , Pouget Jean-Pierre
Published: February 2022

Radiation therapy (RT) is known for its ability to kill cancer cells in an immunogenic manner. Recent preclinical data demonstrate that targeted alpha-particle therapy shares with RT the capacity to elicit immunostimulatory effects, standing out as a promising strategy to circumvent immune checkpoint inhibitor resistance in immunologically ‘cold’ tumors.
Novel tech throws knock-out punch to ECG improving GP referral decisions to cardiology
Authors: Calcagno Simone , Biondi-Zoccai Giuseppe , Stankovic Tatjana , Szabo Erzsebet , Szabo Aniko Berta , Kecskes Istvan
Published: February 2022

Purpose

In a comparator study, designed with assistance from the Food and Drug Administration, a State-of-the-Art (SOTA) ECG device augmented with automated analysis, the comparator, was compared with a breakthrough technology, Cardio-HART (CHART).

Methods

The referral decision defined by physician reading biosignal-based ECG or CHART report were compared for 550 patients, where its performance is calculated against the ground truth referral decision. The ground truth was established by cardiologist consensus based on all the available measurements and findings including echocardiography (ECHO).

Results

The results confirmed that CHART analysis was far more effective than ECG only analysis: CHART reduced false negative rates 15.8% and false positive (FP) rates by 5%, when compared with SOTA ECG devices. General physicians (GP’s) using CHART saw their positive diagnosis rate significantly increased, from ~10% to ~26% (260% increase), and the uncertainty rate significantly decreased, from ~31% to ~1.9% (94% decrease). For cardiology, the study showed that in 98% of the cases, the CHART report was found to be a good indicator as to what kind of heart problems can be expected (the ‘start-point’) in the ECHO examination.

Conclusions

The study revealed that GP use of CHART resulted in more accurate referrals for cardiology, resulting in fewer true negative or FP—healthy or mildly abnormal patients not in need of ECHO confirmation. The indirect benefit is the reduction in wait-times and in unnecessary and costly testing in secondary care. Moreover, when used as a start-point, CHART can shorten the echocardiograph examination time.
Mobilities of a drop and an encapsulated squirmer
Authors: Kree R. , Zippelius A.
Published: February 2022

We have analyzed the dynamics of a spherical, uniaxial squirmer which is located inside a spherical liquid drop at general position $$\varvec{r}_s$$

r

s

. The squirmer is subject to an external force and torque in addition to the slip velocity on its surface. We have derived exact analytical expressions for the linear and rotational velocity of the squirmer as well as the linear velocity of the drop for general, non-axisymmetric configurations. The mobilities of both, squirmer and drop, are in general anisotropic, depending on the orientation of $$\varvec{r}_s$$

r

s

, relative to squirmer axis, external force or torque. We discuss their dependence on the size of the squirmer, its distance from the center of the drop and the viscosities. Our results provide a framework for the discussion of the trajectories of the composite system of drop and enclosed squirmer.

Graphical Abstract
On brane cosmological behaviors of Starobinsky inflationary model
Authors: Belhaj A. , Benali M. , Hassouni Y. , Oualaid M. , Sedra M. B.
Published: February 2022

In this paper, we first study the brane cosmological behaviors of Starobinsky inflationary model. In particular, we compute the associated parameters including the perturbation ones. Among others, we find that the spectral index and the tensor-to-scalar ratio are in a good agreement with Planck observational and BICEP/Keck data. Varying the five-dimensional Planck mass [Formula: see text] values, we investigate the thermal behaviors. Concretely, we calculate and examine the reheating cosmological parameters. For a specific value of the stringy parameter, we provide good predictions of the involved quantities. Taking [Formula: see text] TeV, we obtain acceptable reheating temperatures.
Lightweight Hardware Architecture for Object Detection in Driver Assistance Systems
Authors: Vaidya Bhaumik , Paunwala Chirag
Published: February 2022

Object detection on hardware platforms plays a very significant role in developing driver assistance systems (DASs) with limited computational resources. Object detection for DAS is a multiclass detection problem that involves detecting various objects like cars, auto, traffic lights, bicycles, pedestrians, etc. DAS also requires accuracy, speed, and sensitivity for detecting these objects in various challenging conditions. The lighting and weather conditions pose a serious challenge for accurate object detection for DAS. This paper proposes a speed-efficient and lightweight fully convolutional neural network (CNN) architecture for object detection in adverse rainy conditions. The proposed architecture uses a CNN-based deraining network with a custom SSIM loss function in the object detection pipeline, which can give an accurate performance using limited computational and memory resources. The object detection architecture contains some architectural modifications to the existing single shot multibox detector (SSD) architecture to make it more hardware efficient and improve accuracy on small objects. It uses a trainable color transformation module using [Formula: see text] convolutions for handling the adverse lighting conditions encountered in DAS. The architecture uses feature fusion and the dilated convolution approach to enhance the accuracy of the proposed architecture on small objects. The datasets available for object detection in DAS are very imbalanced with cars as a predominant object. The class weight penalization technique is used to improve the performance of the architecture on scarcely present objects. The performance of the architecture is evaluated on well-known datasets like Kitti, Udacity, Indian Driving Dataset (IDD), and DAWN. The architecture achieves satisfactory performance in terms of mean average precision (mAP) and detection time on all these datasets. It requires three times fewer hardware resources compared to existing architectures. The lightweight nature of the proposed architecture and modification of CNN architecture with TensorRT allow the efficient implementation on the jetson nanohardware platform for prototyping, which can be integrated with other intelligent transportation systems.