bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of turnover and stability of health staff on quality of care in remote communities of the Northern Territory, Australia: a retrospective cohort study
Authors: Jones Michael P , Zhao Yuejen , Guthridge Steven , Russell Deborah J , Ramjan Mark , Humphreys John S , Wakerman John
Published: October 2021

Objectives

To evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors which may counter hypothesised reduced quality of care associated with lower stability, higher turnover or higher use of short-term staff.

Design

Retrospective cohort study (Northern Territory (NT) Department of Health Primary Care Information Systems).

Setting

All 48 government primary healthcare clinics in remote communities in NT, Australia (2011–2015).

Participants

25 413 patients drawn from participating clinics during the study period.

Outcome measures

Associations between independent variables (resident remote area nurse and Aboriginal Health Practitioner turnover rates, stability rates and the proportional use of agency nurses) and indicators of health service quality in child and maternal health, chronic disease management and preventive health activity were tested using linear regression, adjusting for community and clinic size. Latent class modelling was used to investigate between-clinic heterogeneity.

Results

The proportion of resident Aboriginal clients receiving high-quality care as measured by various quality indicators varied considerably across indicators and clinics. Higher quality care was more likely to be received for management of chronic diseases such as diabetes and least likely to be received for general/preventive adult health checks. Many indicators had target goals of 0.80 which were mostly not achieved. The evidence for associations between decreased stability measures or increased use of agency nurses and reduced achievement of quality indicators was not supported as hypothesised. For the majority of associations, the overall effect sizes were small (close to zero) and failed to reach statistical significance. Where statistically significant associations were found, they were generally in the hypothesised direction.

Conclusions

Overall, minimal evidence of the hypothesised negative effects of increased turnover, decreased stability and increased reliance on temporary staff on quality of care was found. Substantial variations in clinic-specific estimates of association were evident, suggesting that clinic-specific factors may counter any potential negative effects of decreased staff employment stability. Investigation of clinic-specific factors using latent class analysis failed to yield clinic characteristics that adequately explain between-clinic variation in associations. Understanding the reasons for this variation would significantly aid the provision of clinical care in remote Australia.
Preparticipation medical evaluation for elite athletes: EFSMA recommendations on standardised preparticipation evaluation form in European countries
Authors: Ionescu Anca Mirela , Pitsiladis Yannis P , Rozenstoka Sandra , Bigard Xavier , Löllgen Herbert , Bachl Norbert , Debruyne Andre , Pigozzi Fabio , Casasco Maurizio , Jegier Anna , Smaranda Alina Maria , Caramoci Adela , Papadopoulou Theodora
Published: October 2021

Sports medicine is a medical specialty that supports the performance of professional and amateur athletes while maintaining their health. Sports medicine professionals need to ensure the safe participation of athletes in sports activities achieved through a periodical preparticipation evaluation (PPE) and a regular medical monitoring of the athletes’ health in accordance with the latest recommendations regarding health condition and medical history, physical working capacity, training period and programme, recovery, nutrition, use of supplements, injuries prevention and safe return to play.

In order to harmonise these national variations in the content and application of the PPE, the EFSMA Scientific and Educational Commission proposes a ‘gold standard’ for elite athletes across Europe.

Important objectives of PPE are early detection and prevention of severe complications during sports activities both in leisure time and competitive sports. The PPE should entail the following diagnostic components: health status, anthropometry, functional and exercise capacity.

It is of utmost importance to develop and implement preventive strategies such as the PPE. Besides monitoring the health status of athletes, the PPE plays an important role in the selection process, bringing valuable information for coaches and supporting a personalised treatment approach. Screening of athletes through a standardised digital PPE could be beneficial for a better understanding of the impact of long-term physical activity. Furthermore, PPE leads the scientific community to a way of working closer together in the interest of the athletes.
Assessment of the training program for Versius, a new innovative robotic system for use in minimal access surgery
Authors: Butterworth Jessica , Sadry Margaux , Julian Danielle , Haig Fiona
Published: October 2021

Objectives

The Versius surgical system has been developed for use in robot-assisted minimal access surgery (MAS). This study aimed to evaluate the effectiveness of the Versius training program.

Design

A 3.5-day program following 10 hours of online didactic training. Participants were assessed during the technical training using the Global Evaluative Assessment of Robotic Skills (GEARS).

Setting

Dry box exercises were conducted in classrooms, and wet lab sessions simulated an operating room environment using cadaveric specimens.

Participants

Seventeen surgical teams participated; surgeons represented general, colorectal, obstetrics/gynecology, and urology specialties. All surgeons had previous laparoscopic MAS experience, while experience with robotics varied.

Main outcomes measures

Participants were scored on a five-point Likert Scale for each of six validated GEARS domains (depth perception, bimanual dexterity, efficiency, force sensitivity, autonomy, and robotic control). Additional metrics used to chart surgeon performance included: combined instrument path length; combined instrument angular path; and time taken to complete each task.

Results

Participants demonstrated an overall improvement in performance during the study, with a mean GEARS Score of 21.0 (SD: 1.9) in Assessment 1 increasing to 23.4 (SD: 2.9) in Validation. Greatest improvements were observed in the depth perception and robotic control domains. Greatest differences were observed when stratifying by robotic experience; those with extensive experience consistently scored higher than those with some or no experience.

Conclusions

The Versius training program is effective; participants were able to successfully operate the system by program completion, and more surgeons achieved intermediate-level and expert-level GEARS scores in Validation compared with Assessment 1.
Interleukin-30 feeds breast cancer stem cells via CXCL10 and IL23 autocrine loops and shapes immune contexture and host outcome
Authors: Sorrentino Carlo , Ciummo Stefania Livia , D'Antonio Luigi , Fieni Cristiano , Lanuti Paola , Turdo Alice , Todaro Matilde , Di Carlo Emma
Published: October 2021

Background

Breast cancer (BC) progression to metastatic disease is the leading cause of death in women worldwide. Metastasis is driven by cancer stem cells (CSCs) and signals from their microenvironment. Interleukin (IL) 30 promotes BC progression, and its expression correlates with disease recurrence and mortality. Whether it acts by regulating BCSCs is unknown and could have significant therapeutic implications.

Methods

Human (h) and murine (m) BCSCs were tested for their production of and response to IL30 by using flow cytometry, confocal microscopy, proliferation and sphere-formation assays, and PCR array. Immunocompetent mice were used to investigate the role of BCSC-derived IL30 on tumor development and host outcome. TCGA PanCancer and Oncomine databases provided gene expression data from 1084 and 75 hBC samples, respectively, and immunostaining unveiled the BCSC microenvironment.

Results

hBCSCs constitutively expressed IL30 as a membrane-anchored glycoprotein. Blocking IL30 hindered their proliferation and self-renewal efficiency, which were boosted by IL30 overexpression. IL30 regulation of immunity gene expression in human and murine BCSCs shared a significant induction ofIL23andCXCL10. Both immunoregulatory mediators stimulated BCSC proliferation and self-renewal, while their selective blockade dramatically hindered IL30-dependent BCSC proliferation and mammosphere formation. Orthotopic implantation of IL30-overexpressing mBCSCs, in syngeneic mice, gave rise to poorly differentiated and highly proliferating MYC+KLF4+LAG3+tumors, which expressed CXCL10 and IL23, and were infiltrated by myeloid-derived cells, Foxp3+T regulatory cells and NKp46+RORγt+type 3 innate lymphoid cells, resulting in increased metastasis and reduced survival. In tumor tissues from patients with BC, expression ofIL30overlapped with that ofCXCL10andIL23,and ranked beyond the 95th percentile in a Triple-Negative enriched BC collection from the Oncomine Platform. CIBERSORTx highlighted a defective dendritic cell, CD4+T and γδ T lymphocyte content and a prominent LAG3 expression in IL30highversusIL30lowhuman BC samples from the TCGA PanCancer collection.

Conclusions

Constitutive expression of membrane-bound IL30 regulates BCSC viability by juxtacrine signals andviasecond-level mediators, mainly CXCL10 and IL23. Their autocrine loops mediate much of the CSC growth factor activity of IL30, while their paracrine effect contributes to IL30 shaping of immune contexture. IL30-related immune subversion, which also emerged from computational analyses, strongly suggests that targeting IL30 can restrain the BCSC compartment and counteract BC progression.
Immunosuppressive metabolites in tumoral immune evasion: redundancies, clinical efforts, and pathways forward
Authors: Jennings Maria Rain , Munn David , Blazeck John
Published: October 2021

Tumors accumulate metabolites that deactivate infiltrating immune cells and polarize them toward anti-inflammatory phenotypes. We provide a comprehensive review of the complex networks orchestrated by several of the most potent immunosuppressive metabolites, highlighting the impact of adenosine, kynurenines, prostaglandin E2, and norepinephrine and epinephrine, while discussing completed and ongoing clinical efforts to curtail their impact. Retrospective analyses of clinical data have elucidated that their activity is negatively associated with prognosis in diverse cancer indications, though there is a current paucity of approved therapies that disrupt their synthesis or downstream signaling axes. We hypothesize that prior lukewarm results may be attributed to redundancies in each metabolites’ synthesis or signaling pathway and highlight routes for how therapeutic development and patient stratification might proceed in the future.
Targeting human leukocyte antigen G with chimeric antigen receptors of natural killer cells convert immunosuppression to ablate solid tumors
Authors: Jan Chia-Ing , Huang Shi-Wei , Canoll Peter , Bruce Jeffrey N , Lin Yu-Chuan , Pan Chih-Ming , Lu Hsin-Man , Chiu Shao-Chih , Cho Der-Yang
Published: October 2021

Background

Immunotherapy against solid tumors has long been hampered by the development of immunosuppressive tumor microenvironment, and the lack of a specific tumor-associated antigen that could be targeted in different kinds of solid tumors. Human leukocyte antigen G (HLA-G) is an immune checkpoint protein (ICP) that is neoexpressed in most tumor cells as a way to evade immune attack and has been recently demonstrated as a useful target for chimeric antigen receptor (CAR)-T therapy of leukemia by in vitro studies. Here, we design and test for targeting HLA-G in solid tumors using a CAR strategy.

Methods

We developed a novel CAR strategy using natural killer (NK) cell as effector cells, featuring enhanced cytolytic effect via DAP12-based intracellular signal amplification. A single-chain variable fragment (scFv) against HLA-G is designed as the targeting moiety, and the construct is tested both in vitro and in vivo on four different solid tumor models. We also evaluated the synergy of this anti-HLA-G CAR-NK strategy with low-dose chemotherapy as combination therapy.

Results

HLA-G CAR-transduced NK cells present effective cytolysis of breast, brain, pancreatic, and ovarian cancer cells in vitro, as well as reduced xenograft tumor growth with extended median survival in orthotopic mouse models. In tumor coculture assays, the anti-HLA-G scFv moiety promotes Syk/Zap70 activation of NK cells, suggesting reversal of the HLA-G-mediated immunosuppression and hence restoration of native NK cytolytic functions. Tumor expression of HLA-G can be further induced using low-dose chemotherapy, which when combined with anti-HLA-G CAR-NK results in extensive tumor ablation both in vitro and in vivo. This upregulation of tumor HLA-G involves inhibition of DNMT1 and demethylation of transporter associated with antigen processing 1 promoter.

Conclusions

Our novel CAR-NK strategy exploits the dual nature of HLA-G as both a tumor-associated neoantigen and an ICP to counteract tumor spread. Further ablation of tumors can be boosted when combined with administration of chemotherapeutic agents in clinical use. The readiness of this novel strategy envisions a wide applicability in treating solid tumors.
Influenza B, Q Fever and the consequences of febrile illness occurring during Jungle Warfare Training: a clinical and serological study
Authors: Wale M. C. J.
Published: October 2021

Seventy-one Royal Marines undergoing jungle warfare training were studied clinically and serologically to determine the incidence and consequences of febrile illness. During acclimatisation and the early part of the deployment the incidence of illness having an impact on training was low; during the latter part an outbreak of influenza B occurred, with 25 cases diagnosed clinically. Only 12 of these were confirmed serogically, probably because the outbreak was still in progress when the second samples were taken. A further four subclinical cases were uncovered by the serological study.

Five cases of heat exhaustion occurred, one Marine suffering two episodes. Four patients required casevac from the jungle. Three Marines were found to have serological evidence of previous acute Q fever, including the patient who had two episodes of heat exhaustion. This incidence is higher than expected, and warrants further investigation.
Von Recklinghausen’s disease of nerves: A modern day social response
Authors: Hett D. A. , Mather S. , Dewar E. P.
Published: October 2021

We describe a patient with von Recklinghausen’s Disease of Nerves whose appearance provoked an emotive reaction in the close community of an RN ship akin to that reported in the case of Sir Frederick Treves’ “Elephant Man”. The RN divisional system provided a valuable contribution to the resolution of the problems created.
Meningioma as an incidental finding in an intensive care unit
Authors: Tighe S. Q. M. , Turner G. A.
Published: October 2021

A report on two hypotensive episodes secondary to post-operative haemorrhage is presented. Recovery was complicated by prolonged coma and a frontal meningioma was eventually discovered. The possible aetiology of this coma is discussed. Intracranial pathology should be suspected when coma persists on the intensive care unit.
Changing trends in dental restorative treatment needs of Naval Recruits 1987–1989—Disease or Diagnosis?
Authors: Alexander D. C. C. , Pethybridge R. J.
Published: October 2021

The restorative treatment needs of 9960 young men and women who entered the Naval Service at HMS Raleigh between January 1987 and April 1989 are summarised. A marked increase in the numbers of fillings required and a decrease in the proportion considered to be dentally fit occurred in May 1988 and has continued as a trend thereafter. Weighted non-orthogonal analysis of variances have been conducted to assess the significance of clinical and period variables upon the changes.
The diary of Assistant Surgeon Henry Piers, HMS Investigator, 1850–54
Authors: Savours Ann M.
Published: October 2021

From the 16th to the mid 19th century, many voyages were made from England to discover a North West Passage between the Atlantic and the Pacific oceans. The Investigator was one of some 40 vessels that searched for the lost North West Passage expedition of 1845–48 under the command of Sir John Franklin in HM Ships Erebus and Terror, which became beset among what are now known as the Canadian Arctic Islands. The “Investigators” found no trace of Franklin, but were the first to traverse the North West Passage, although their ship had to be abandoned in Mercy Bay on Banks Island after two winters there. The diary of Assistant Surgeon Henry Piers, from the manuscript collection of the National Maritime Museum, Greenwich, is here examined. Reference is also made to the narrative and report published by the senior surgeon of the Investigator, Dr Alexander Armstrong.
Operating at Sea in an Aircraft Carrier
Authors: Hett D. A. , Dewar E. P.
Published: October 2021

The policy of the Medical Officers serving in HMS Ark Royal between January 1988 and June 1989 with regard to surgery and anaesthesia at sea is described.

The skills and equipment available, techniques used, operations performed and complications that resulted are outlined.

The advantages and disadvantages of an active operating policy are discussed and the postulate ventured that in order to achieve maximum efficiency within the medical department of an aircraft carrier such a policy is justified.

Finally, in the light of present day litigious trends, the question of the propriety of the policy is posed.
NBCI—Another threat to Operational Effectiveness?
Authors: Dewar E. P. , Taylor R. B. , Jones J. , Hett D. A.
Published: October 2021

Battle casualties are well recognised as a threat to Operational Effectiveness (OE) at times of conflict. Less well appreciated is that naturally occurring illnesses and injuries—Non-Battle Casualties and Injuries (NBCI)—continue to present at such times and will add to the problems of fighting the ship. This prospective study showed that NBCI resulted in a total of 1369 man days of lost personnel effectiveness among some 1738 RN servicemen during a 180 day deployment. That is just 0.42% of the possible man working days. This represents a loss of 4.3 man days per 1000 at risk per day in terms of fitness for Full Duties or 2.74/1000/day excluding those able to perform Light Duties. It is unlikely that such rates would affect the OE of the fighting units but they do represent a significant challenge to the Royal Naval Medical Service to continue to maintain the rates at such low levels, so that when aggregated to the numbers of battle casualties, OE is maintained as far as possible.
Haematological and biochemical screening of potential Royal Naval aircrew
Authors: Sheard S. C.
Published: October 2021

The objective of this study was to determine which, if any, of a small range of haematological and biological tests would be of value in detecting disease risk factors as an addition to the Initial Flying Medical when screening potential Royal Naval aircrew. A retrospective review of results of haematological and biochemical profiles of 200 candidates screened at the Central Air Medical Board was used. Ninety nine candidates (49.5%) were found to have profiles outside the normal range on initial testing. Many of these were found to be normal on repeat testing or further investigation. One candidate was made permanently unfit to fly and three others had certain conditions put on their training or careers. It is concluded that most of the screening carried out serves only a limited function. It is recommended that screening should be stopped; however, should screening still be considered necessary only four tests are required, ie, fasting blood glucose, fasting total cholesterol and triglycerides, liver function test and full blood count.
Ice skating injuries: a survey of cases seen in an Accident and Emergency department
Authors: Newton A. P.
Published: October 2021

Participating in sporting activities has its risks as well as its benefits. A simple study is described which documents the patients presenting at a casualty department after injury at an ice rink. Epidemiological data, risk factors and patterns of injury are discussed.
The retrograde tunnel: a method for the fixation of central venous catheters in the military environment
Authors: Wheeler R. A. , Spalding T. J. W. , Thomas J. A. , Carss G. A.
Published: October 2021

Central venous catheters (CVCs) are prone to accidental removal during patient transportation. Of the casualties who require transfer between medical facilities, those with CVC in situ require additional vigilance to prevent loss of the CVC, which continues to occur despite various methods of fixation. The fashioning of a subcutaneous tunnel has become an integral part of the placement of central venous catheters. Several methods have been described, but the long-term CVCs in paediatric practice pose special problems, particularly that of the patients continually testing the CVCs fixation. Using a new polyurethane CVC, a retrograde tunnelling technique has been developed which affords immediate and secure fixation. We propose that this CVC, together with the technique of retrograde tunnelling, is the solution to inadvertent central venous line removal during patient transfer.
Changes in selected parameters of health and physical fitness following a sixteen-week deployment at sea
Authors: King-Lewis P. W. , Allsopp A. J.
Published: October 2021

The effects of 16 weeks at sea upon selected parameters of health and physical fitness were investigated in 30 male volunteers (from a total crew of 48 men) prior to, and immediately following deployment.

The 30 subjects were assigned to either an exercise group, ‘Ex’ (n=12), or a non-exercising group, ‘Nilex’ (n=18), according to their reported participation in vigorous training or sports.

Body mass index (BMI), calculated from height and weight, revealed that prior to deployment 13 of the 30 subjects (two in the Ex group) had a BMI over 25 kg.m−2 (i.e. overweight), and a further three subjects (all ‘non-exercisers’) had values of 30 kg.m−2 or more (obese). In addition, the diastolic blood pressure of two subjects was in excess of 95 mmHg and five subjects had resting heart rates above 89 beats per minute. Retrospective comparisons between the Ex and Nilex groups revealed a significantly lower percentage body fat (P<0.01) and a faster rate of cardiac recovery (P<0.05) following a standardised bout of exercise in the Ex group, albeit that these individuals were significantly younger (mean age of 24 years) than those in the Nilex group (32 years).

Following deployment, in the Nilex group, comparison of pre- and post values showed that resting heart rate was elevated (P<0.01) on return from sea. Similarly, in the Nilex group heart rate while performing the standardised exercise about was also elevated (P<0.05) on the second test occasion. In the Ex group, heart rate measures during and following exercise indicated a significantly slower rate of recovery (P<0.05) on the second test occasion.

It is concluded that: firstly, these rudimentary measures suggest a poor level of physical fitness among some members of the crew who reported not to take regular physical exercise; secondly, changes in cardiac responses to exercise consistent with a reduction in cardiovascular fitness were observed following the 16 week deployment.
Medicine and the Master′s Degree Business Administration
Authors: James C. M.
Published: October 2021

This article provides a personal view of the Masters Degree in Business Administration (MBA) and its utility for a clinician. It outlines the principles behind the course and describes the details of one MBA provider, the Open Business School. Four examples are used to illustrate the value of the qualification and some conclusions are drawn as to its usefulness in modern healthcare.
Non-union of ankle fractures in patients with ipsilateral foot drop
Authors: Howell G. E. D. , Evans P. E. L.
Published: October 2021

We report two cases of non-union of closed ankle fractures in patients with neurologically compromised ipsilateral lower limbs, which we believe to be the first description of this association in the English language.
Tuberculous epididymitis presenting as acute hydrocele
Authors: Guy R. J.
Published: October 2021

Abstract>

A case of tuberculous epididymitis which presented as an acute hydrocele is reported and the relevant literature reviewed. The patient had undergone contralateral orchidectomy 20 years previously for the same condition associated with pulmonary tuberculosis. The most recent episode followed unrelated illness; the diagnosis was confirmed after surgical intervention and cure was achieved with adjuvant chemotherapy. Although rare, genital tuberculosis should still be considered in cases of scrotal swelling when there is a history of previous tuberculous disease or exposure.
Rationale and design of the preserved versus reduced ejection fraction biomarker registry and precision medicine database for ambulatory patients with heart failure (PREFER-HF) study
Authors: Abboud Andrew , Nguonly Austin , Bean Asher , Brown Kemar J , Chen Roy F , Dudzinski David , Fiseha Neyat , Joice Melvin , Kimaiyo Davis , Martin Mackenzie , Taylor Christy , Wei Kevin , Welch Megan , Zlotoff Daniel A , Januzzi James L , Gaggin Hanna K
Published: October 2021

Introduction

Patients with heart failure (HF) are classically categorised by left ventricular ejection fraction (LVEF). Efforts to predict outcomes and response to specific therapy among LVEF-based groups may be suboptimal, in part due to the underlying heterogeneity within clinical HF phenotypes. A multidimensional characterisation of ambulatory patients with and without HF across LVEF groups is needed to better understand and manage patients with HF in a more precise manner.

Methods and analysis

To date, the first cohort of 1313 out of total planned 3000 patients with and without HF has been enroled in this single-centre, longitudinal observational cohort study. Baseline and 1-year follow-up blood samples and clinical characteristics, the presence and duration of comorbidities, serial laboratory, echocardiographic data and images and therapy information will be obtained. HF diagnosis, aetiology of disease, symptom onset and clinical outcomes at 1 and 5 years will be adjudicated by a team of clinicians. Clinical outcomes of interest include all-cause mortality, cardiovascular mortality, all-cause hospitalisation, cardiovascular hospitalisation, HF hospitalisation, right-sided HF and acute kidney injury. Results from the Preserved versus Reduced Ejection Fraction Biomarker Registry and Precision Medicine Database for Ambulatory Patients with Heart Failure (PREFER-HF) trial will examine longitudinal clinical characteristics, proteomic, metabolomic, genomic and imaging data to better understand HF phenotypes, with the ultimate goal of improving precision medicine and clinical outcomes for patients with HF.

Ethics and dissemination

Information gathered in this research will be published in peer-reviewed journals. Written informed consent for PREFER-HF was obtained from all participants. All study procedures were approved by the Mass General Brigham Institutional Review Board in Boston, Massachusetts and performed in accordance with the Declaration of Helsinki (Protocol Number: 2016P000339).

Trial registration number

PREFER-HF ClinicalTrials.gov identifier:NCT03480633.
Long-term follow-up and sex differences in adults operated for tetralogy of Fallot
Authors: Quattrone Alessia , Lie Oyvind H , Nestaas Eirik , de Lange Charlotte , Try Kirsti , Lindberg Harald L , Skulstad Helge , Erikssen Gunnar , Edvardsen Thor , Haugaa Kristina , Estensen Mette E
Published: October 2021

Objective

Adults operated for tetralogy of Fallot (TOF) have high risk of ventricular arrhythmias (VA). QRS duration >180 ms is an established risk factor for VA. We aimed to investigate heart function, prevalence of arrhythmias and sex differences in patients with TOF at long-term follow-up.

Methods

We included TOF-operated patients≥18 years from our centre’s registry. We reviewed medical records and the most recent echocardiographic exam. VA was recorded on ECGs, 24-hour Holter registrations and from implantable cardioverter defibrillator.

Results

We included 148 patients (age 37±10 years). Left ventricular global longitudinal strain (LV GLS, −15.8±3.1% vs −18.8±3.2%, p=0.001) and right ventricular (RV) GLS (−15.8±3.9% vs −19.1±4.1%, p=0.001) were lower in men at all ages compared with women. Higher RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), lower ejection fraction (55%±8% vs 50%±9%, p=0.02), lower RV GLS (−18.1±4.0 ms vs −16.1±4.8 ms, p=0.04) and N-terminal pro-brain natriuretic peptide (NT-proBNP) over reference range (n=27 (23%) vs n=8 (77%), p<0.001) were associated with higher incidence of VA. QRS duration was longer in men (151±30 ms vs 128±25 ms, p<0.001). No patients had QRS duration >180 ms. QRS duration did not differ in those with and without VA (143±32 ms vs 137±28 ms, p=0.06).

Conclusions

Our results confirmed reduced RV function in adults operated for TOF. Male patients had impaired LV and RV function expressed by lower LV and RV GLS values at all ages. Reduced cardiac function and elevated NT-proBNP were associated with higher incidence of VA and may be important in risk assessment.
Effect of cigarette smoking on smoking biomarkers, blood pressure and blood lipid levels among Sri Lankan male smokers
Authors: Herath Prasanna , Wimalasekera Savithri , Amarasekara Thamara , Fernando Manoj , Turale Sue
Published: October 2021

Study purpose

The aim of this study was to determine the fractional exhaled nitric oxide (FeNO) levels, exhaled breath carbon monoxide (eCO) levels, blood pressure, blood lipid levels between smokers and non-smokers and to determine the association of smoking intensity with the above parameters.

Methods

This descriptive study was conducted in selected periurban areas of the Colombo District, Sri Lanka. Adult male current tobacco smokers (n=360), aged between 21 and 60 years were studied and compared with anthropometrically matched male non-smokers (n=180). Data were collected by interviewer-administered questionnaire, clinical assessment and measurement of FeNO by FENO monitor and eCO by Smokerlyser.

Results

Smokers had significantly lower mean FeNO levels and higher mean eCO values compared with non-smokers. Presentation of palpitations was higher among the smokers and a significantly positive correlation was identified between palpitations and eCO levels. There was a significantly positive correlation between the systolic blood pressure of smokers with the duration of smoking (DS), Brinkman Index (BI), Body Mass Index (BMI) and there was a significantly negative correlation with FeNO levels. The mean arterial pressure was positively correlated with the DS, BI and BMI. There was a significantly negative correlation between FeNO and the number of cigarettes smoked per day, DS and BI of smokers. Significantly higher total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), very LDL-C, TC: HDL ratio and low high density lipoprotein cholesterol (HDL-C) level was observed among smokers compared with the non-smokers.

Conclusions

Tobacco smoking was found to impact blood pressure and serum lipid levels thus enhancing the cardiovascular risk among smokers. The levels of eCO and FeNO are useful biomarkers for determining the intensity of smoking. The results indicate the necessity for urgent measures to stop cigarette smoking in Sri Lanka.
Cardiovascular outcomes in systemic sclerosis with abnormal cardiovascular MRI and serum cardiac biomarkers
Authors: Dumitru Raluca B , Bissell Lesley-Anne , Erhayiem Bara , Kidambi Ananth , Dumitru Ana-Maria H , Fent Graham , Abignano Giuseppina , Donica Helena , Burska Agata , Greenwood John P , Biglands John , Schlosshan Dominik , del Galdo Francesco , Plein Sven , Buch Maya H
Published: October 2021

Objectives

To explore the prognostic value of subclinical cardiovascular (CV) imaging measures and serum cardiac biomarkers in systemic sclerosis (SSc) for the development of CV outcomes of primary heart involvement (pHI).

Methods

Patients with SSc with no clinical SSc-pHI and no history of heart disease underwent cardiovascular magnetic resonance (CMR) imaging, and measurement of serum high-sensitivity-troponin I (hs-TnI) and N-terminal-pro-brain natriuretic peptide (NT-proBNP). Follow-up clinical and CV outcome data were recorded. CV outcomes were defined as myocarditis, arrhythmia and/or echocardiographic functional impairment including systolic dysfunction and/or diastolic dysfunction.

Results

Seventy-four patients with a median (IQR) age of 57 (49, 63) years, 32% diffuse cutaneous SSc, 39% interstitial lung disease, 30% Scl70+ were followed up for median (IQR) 22 (15, 54) months. Ten patients developed CV outcomes, comprising one patient with myocarditis and systolic dysfunction and nine arrhythmias: three non-sustained ventricular tachycardia and six supraventricular arrhythmias. The probability of CV outcomes was considerably higher in those with NT-proBNP >125 pg/mL versus normal NT-proBNP (X2=4.47, p=0.035). Trend for poorer time-to-event was noted in those with higher extracellular volume (ECV; indicating diffuse fibrosis) and hs-TnI levels versus those with normal values (X2=2.659, p=0.103; X2=2.530, p=0.112, respectively). In a predictive model, NT-proBNP >125 pg/mL associated with CV outcomes (OR=5.335, p=0.040), with a trend observed for ECV >29% (OR=4.347, p=0.073).

Conclusion

These data indicate standard serum cardiac biomarkers (notably NT-proBNP) and CMR indices of myocardial fibrosis associate with adverse CV outcomes in SSc. This forms the basis to develop a prognostic model in larger, longitudinal studies.
Management of non-compressible torso hemorrhage of the abdomen in civilian and military austere/remote environments: protocol for a scoping review
Authors: Adams Donald , McDonald Paige L , Sullo Elaine , Merkle Alexander B , Nunez Timothy , Sarani Babak , Shackelford Stacy A , Bowyer Mark W , van der Wees Philip
Published: October 2021

The management of non-compressible torso hemorrhage in military austere/remote environments is a leading cause of potentially preventable death in the prehospital/battlefield environment that has not shown a decrease in mortality in 26 years. Numerous conceptual innovations to manage non-compressible torso hemorrhage have been developed without proven effectiveness in this setting. This scoping review aims to assess the current literature to define non-compressible torso hemorrhage in civilian and military austere/remote environments, assess current innovations and the effectiveness of these innovations, assess the current knowledge gaps and potential future innovations in the management of non-compressible torso hemorrhage in civilian and military austere/remote environments, and assess the translational health science perspective of the current literature and its potential effect on public health. The Joanna Briggs Institute for evidence synthesis will guide this scoping review to completion. A nine-step development process, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist, will be used to enhance the methodological and reporting quality of this scoping review. The Participant, Concept, Context framework will broaden this scoping review’s reach in developing a comprehensive search strategy. Thirty years will be explored to assess all relevant literature to ensure a thorough search. Two researchers will explore all the discovered literature and develop consensus on the selected literature included in this scoping review. The article will undergo review and data extraction for data analysis. The knowledge to action framework will guide the knowledge synthesis and creation of this scoping review. A narrative synthesis will systematically review and synthesize the collected literature to produce and explain a broad conclusion of the selected literature. Lastly, a consultation exercise in the form of qualitative interviews will be conducted to assess the thematic analysis results and validate the result of this scoping review. This scoping review will require Institutional Review Board approval for the expert consultation in the form of qualitative interviews. Consultants’ identifying information will remain confidential. The collected and analyzed data from this scoping review will identify gaps in the literature to create an evidence-informed protocol for the management of non-compressible torso hemorrhage of the abdomen in civilian and military austere/remote environments. The results of this scoping review will be distributed in peer-reviewed journals and educational, medical presentations. Scoping Review Protocol, Level IV.
Finding disease outbreak locations from human mobility data
Authors: Schlosser Frank , Brockmann Dirk
Published: October 2021

Finding the origin location of an infectious disease outbreak quickly is crucial in mitigating its further dissemination. Current methods to identify outbreak locations early on rely on interviewing affected individuals and correlating their movements, which is a manual, time-consuming, and error-prone process. Other methods such as contact tracing, genomic sequencing or theoretical models of epidemic spread offer help, but they are not applicable at the onset of an outbreak as they require highly processed information or established transmission chains. Digital data sources such as mobile phones offer new ways to find outbreak sources in an automated way. Here, we propose a novel method to determine outbreak origins from geolocated movement data of individuals affected by the outbreak. Our algorithm scans movement trajectories for shared locations and identifies the outbreak origin as the most dominant among them. We test the method using various empirical and synthetic datasets, and demonstrate that it is able to single out the true outbreak location with high accuracy, requiring only data of $N=4$
N
=
4
individuals. The method can be applied to scenarios with multiple outbreak locations, and is even able to estimate the number of outbreak sources if unknown, while being robust to noise. Our method is the first to offer a reliable, accurate out-of-the-box approach to identify outbreak locations in the initial phase of an outbreak. It can be easily and quickly applied in a crisis situation, improving on previous manual approaches. The method is not only applicable in the context of disease outbreaks, but can be used to find shared locations in movement data in other contexts as well.
Emotions in online rumor diffusion
Authors: Pröllochs Nicolas , Bär Dominik , Feuerriegel Stefan
Published: October 2021

Emotions are regarded as a dominant driver of human behavior, and yet their role in online rumor diffusion is largely unexplored. In this study, we empirically study the extent to which emotions explain the diffusion of online rumors. We analyze a large-scale sample of 107,014 online rumors from Twitter, as well as their cascades. For each rumor, the embedded emotions were measured based on eight so-called basic emotions from Plutchik’s wheel of emotions (i.e., anticipation–surprise, anger–fear, trust–disgust, joy–sadness). We then estimated using a generalized linear regression model how emotions are associated with the spread of online rumors in terms of (1) cascade size, (2) cascade lifetime, and (3) structural virality. Our results suggest that rumors conveying anticipation, anger, and trust generate more reshares, spread over longer time horizons, and become more viral. In contrast, a smaller size, lifetime, and virality is found for surprise, fear, and disgust. We further study how the presence of 24 dyadic emotional interactions (i.e., feelings composed of two emotions) is associated with diffusion dynamics. Here, we find that rumors cascades with high degrees of aggressiveness are larger in size, longer-lived, and more viral. Altogether, emotions embedded in online rumors are important determinants of the spreading dynamics.
Strong gravitational lensing by Kerr–Newman-NUT-Quintessence black hole
Authors: Molla Niyaz Uddin , Debnath Ujjal
Published: October 2021

We investigate the strong gravitational lensing on equatorial plane as well as quasi-equatorial plane by the Kerr–Newman-NUT-Quintessence (KNNQ) black hole (BH) with the equation of state (EoS) parameter of the quintessence [Formula: see text] and the quintessence density [Formula: see text]. Our results show that the strong gravitational lensing in the KNNQ black hole space–time has some distinct behaviors from those in the backgrounds of the four dimension Kerr black hole. Also, we investigate the strong gravitational lensing on equatorial plane as well as quasi-equatorial plane by the KNNQ BH with the effects of Nut charge, spin parameter and quintessence parameter. First, we calculate the null geodesic equations using the Hamilton–Jacobi separation method. Then we investigate the equatorial lensing by KNNQ black hole. We obtain the deflection angle and deflection coefficients in the equatorial plane, which is affected by EoS parameter of the quintessence [Formula: see text], quintessence density [Formula: see text], Nut parameter [Formula: see text], spin parameter [Formula: see text] and quintessence parameter [Formula: see text] [Formula: see text]. Next, we discuss the lens equation and the observables in the equatorial plane. Finally, we investigate gravitational lensing by the KNNQ black hole in the quasi-equatorial plane. In this work, the quintessence density [Formula: see text], the EoS parameter of the quintessence [Formula: see text], Nut parameter [Formula: see text], spin parameter [Formula: see text] and quintessence parameter [Formula: see text] [Formula: see text] have significant effects on the strong gravitational lensing both in equatorial plane as well as quasi-equatorial plane.
Preparedness for Innovation in Times of Crisis: Lessons From the Initial COVID-19 Pandemic Response
Authors: Durugbo Christopher M. , Almahamid Soud M. , Budalamah Lulwa H. , Al-Jayyousi Odeh R. , BendiMerad Batoul
Published: October 2021

In this paper, we explore preparedness strategies for the initial response to crisis-driven innovation, in the context of the Coronavirus Disease 2019 (COVID-19) pandemic. Using insights from semi-structured interviews with public health strategists, we apply analytic induction to investigate preparedness to innovate, and the main forms of crisis-driven innovation applied in the initial COVID-19 response. We thematically analyze measures of preparedness for the initial COVID-19 response and propose a framing aimed at boosting readiness for crisis-driven innovation. Our study finds themes on COVID-19 preparedness strategies involving combat-inspired public policies from assessed security, cyclic-oriented public projections of actionable safeguards, and continuity-driven public provisions for anticipated situations. The study also captures themes on crisis response as crisis-driven innovation in relation to digitalized, integrated, and tailored public services, initiatives, and systems. Our paper concludes with discussions on the implications of innovation intelligence for crisis preparedness, “ripple-inspired inside-out” view of crisis-driven innovation, “response as innovation” framings, and suggestions for further studies.
Numerical inversion method for the Laplace transform based on Boubaker polynomials operational matrix
Authors: Belgacem Rachid , Bokhari Ahmed , Djilali Salih , Kumar Sunil
Published: October 2021

We investigate through this research the numerical inversion technique for the Laplace transforms cooperated by the integration Boubaker polynomials operational matrix. The efficiency of the presented approach is demonstrated by solving some differential equations. Also, this technique is combined with the standard Laplace Homotopy Perturbation Method. The numerical results highlight that there is a very good agreement between the estimated solutions with exact solutions.
Sliding Mode Control-Based Autonomous Control of a Tri-rotor Unmanned Aerial Vehicle
Authors: Raza Abid , Malik Fahad Mumtaz , Khan Rameez , Mazhar Naveed , Ullah Hameed , Ahmed Nigar
Published: October 2021

A nonlinear control technique for autonomous control of a tri-rotor unmanned aerial vehicle is presented in this paper. First, a comprehensive mathematical model is developed using the Newton–Euler approach for a tri-rotor, which is found to be highly nonlinear and coupled. Then, the equivalent input affine model is extracted by applying a suitable transformation. Finally, the sliding mode control for trajectory tracking is chosen which is immune to matched external disturbances, parametric uncertainties, and modeling errors. The proposed controller performance has been verified for appropriate inputs under wind disturbances using MATLAB, and the simulation results are presented.
Autonomous Reconfiguration Strategy Based on Reconfigurability Evaluation
Authors: Xu Heyu , Li Wenbo , Zhang Kebei , Fu Fangzhou
Published: October 2021

This paper aims to improve the autonomous operational capabilities of spacecraft. For a complex system with physical coupling and flexible attachments, an autonomous reconfiguration strategy based on reconfigurability evaluation is proposed. First, a quantitative evaluation index for reconfigurability is given based on operator theory to fully exploit the potential of system reconfigurability under resource constraints. Then, specific requirements and evaluation methods for autonomous reconfiguration are proposed in accordance with the results, thereby providing a theoretical reference for the design of reconfiguration strategy methods. Thus, reconfigurability is maximized from the design point of view. Finally, the validity and correctness of the method are verified by simulation.
Struggling to Keep Tabs on Capstone Projects: A Chatbot to Tackle Student Procrastination
Authors: Pereira Juanan , Díaz Óscar
Published: October 2021

Capstone projects usually represent the most significant academic endeavor with which students have been involved. Time management tends to be one of the hurdles. On top, University students are prone to procrastinatory behavior. Inexperience and procrastination team up for students failing to meet deadlines. Supervisors strive to help. Yet heavy workloads frequently prevent tutors from continuous involvement. This article looks into the extent to which conversational agents (a.k.a. chatbots) can tackle procrastination in single-student capstone projects. Specifically, chatbot enablers put in play include (1) alerts, (2) advice, (3) automatic rescheduling, (4) motivational messages, and (5) reference to previous capstone projects. Informed by Cognitive Behavioural Theory, these enablers are framed within the three phases involved in self-regulation misalignment: pre-actional, actional, and post-actional. To motivate this research, we first analyzed 77 capstone-project reports. We found that students’ Gantt charts (1) fail to acknowledge review meetings (70%) and milestones (100%) and (2) suffer deviations from the initial planned effort (16.28%). On these grounds, we develop GanttBot, a Telegram chatbot that is configured from the student’s Gantt diagram. GanttBot reminds students about close landmarks, it informs tutors when intervention might be required, and it learns from previous projects about common pitfalls, advising students accordingly. For evaluation purposes, course 17/18 acts as the control group (N=28) while course 18/19 acts as the treatment group (N=25students). Using “overdue days” as the proxy for procrastination, results indicate that course 17/18 accounted for an average of 19 days of delay (SD = 5), whereas these days go down to 10 for the intervention group in course 18/19 (SD = 4). GanttBot is available for public usage as a Telegram chatbot.